Dr. Kyle Gillett: How to Optimize Your Hormones for Health & Vitality

00:00:00.000 | Welcome to the Huberman Lab Podcast,

00:00:02.260 | where we discuss science and science-based tools

00:00:04.900 | for everyday life.

00:00:05.900 | I'm Andrew Huberman,

00:00:10.160 | and I'm a professor of neurobiology and ophthalmology

00:00:13.060 | at Stanford School of Medicine.

00:00:14.860 | Today, my guest is Dr. Kyle Gillette.

00:00:17.380 | Dr. Gillette is dual board certified in family medicine

00:00:20.580 | and obesity medicine,

00:00:21.980 | and practices out of a clinic in Kansas

00:00:24.540 | and via telemedicine.

00:00:26.460 | He provides full spectrum medicine,

00:00:28.460 | including hormone health, preventative medicine,

00:00:31.220 | obstetrics, which is the branch of medicine and surgery

00:00:33.700 | concerned with childbirth

00:00:35.020 | and the care of women giving birth, and pediatrics.

00:00:38.300 | I first learned about Dr. Gillette from a podcast

00:00:40.580 | of all things, and was immediately struck

00:00:42.220 | by the breadth and depth of his knowledge

00:00:43.860 | on all things hormones and hormone optimization.

00:00:47.660 | As you'll see very soon today,

00:00:49.540 | Dr. Gillette can teach you how to optimize your hormones

00:00:52.100 | using behavioral tools, nutrition, exercise-based tools,

00:00:56.300 | supplementation, and hormone therapies

00:00:58.980 | if those are appropriate for you.

00:01:00.820 | There are many professionals out there,

00:01:02.100 | including many medical doctors, of course,

00:01:04.060 | talking about hormone health.

00:01:06.100 | What really sets Dr. Gillette apart from the pack

00:01:08.980 | is his ability to understand how the different factors

00:01:11.720 | that I described before, nutrition, supplementation,

00:01:14.100 | exercise, and hormone therapies,

00:01:15.740 | how those interact with one another,

00:01:17.920 | and the safest and most rational ways

00:01:20.300 | to approach hormone optimization.

00:01:22.580 | During today's episode,

00:01:23.540 | you will learn how to optimize your hormones,

00:01:25.840 | not just testosterone and estrogen,

00:01:27.640 | but also prolactin and other hormone pathways

00:01:30.220 | that impact your mood, mental health, and physical health.

00:01:33.300 | Dr. Gillette is also an avid educator

00:01:35.480 | about hormones and other aspects of health.

00:01:37.660 | He does this on zero-cost-to-consumer platforms,

00:01:40.700 | such as Instagram and other social media.

00:01:42.800 | On Instagram, he is @KyleJilletteMD.

00:01:45.860 | That's K-Y-L-E-G-I-L-L-E-T-T, no E at the end, MD.

00:01:50.860 | So @KyleJilletteMD on Instagram,

00:01:52.860 | and he is @JilletteHealth on all other platforms,

00:01:55.820 | including LinkedIn, Twitter, YouTube, TikTok, and Facebook.

00:01:58.600 | If you go to his Instagram or his other social media,

00:02:01.400 | you will learn a lot about hormone health,

00:02:03.600 | about the latest science impacting obesity

00:02:06.300 | and metabolic health.

00:02:07.520 | He is a wealth of knowledge.

00:02:08.880 | And again, he's providing all that information

00:02:11.120 | at zero cost to you, the consumer.

00:02:13.280 | What you are soon to hear is a conversation

00:02:15.200 | between me and Dr. Gillette about all things hormones

00:02:19.440 | and hormone health and hormone optimization.

00:02:22.020 | We dive deep into mechanisms,

00:02:24.080 | but we are clear to establish what each word

00:02:27.360 | or set of concepts mean.

00:02:29.420 | So if you have no background in biology,

00:02:31.240 | or even if you do, I'm sure that you'll come away

00:02:33.700 | with a wealth of valuable knowledge.

00:02:35.400 | We also talk about specific protocols related, again,

00:02:38.640 | to lifestyle factors, nutrition, supplementation,

00:02:41.320 | and where appropriate, hormone replacement therapy.

00:02:43.960 | I know there's a lot of interest about these topics.

00:02:46.320 | Dr. Gillette is very thorough about addressing

00:02:48.680 | both male and female issues

00:02:50.760 | and addressing hormone health

00:02:52.700 | for people at all stages of life.

00:02:55.100 | I'm sure that you will come away from this episode

00:02:56.720 | with the same impression that I did,

00:02:58.500 | which is that Dr. Gillette

00:02:59.700 | is an extraordinarily clear communicator

00:03:02.120 | and that he has tremendous compassion for his patients

00:03:04.900 | and that he has a deep love of understanding biology

00:03:08.160 | and medicine in ways that can benefit you.

00:03:10.800 | I'm pleased to announce that I'm hosting two live events

00:03:13.200 | in May, 2022.

00:03:15.020 | The first live event will take place in Seattle, Washington

00:03:17.880 | on May 17th.

00:03:19.300 | The second live event will take place in Portland, Oregon

00:03:22.060 | on May 18th.

00:03:23.380 | Both are part of a lecture series

00:03:24.760 | entitled The Brain-Body Contract,

00:03:26.740 | during which I will talk about science

00:03:28.180 | and science-based tools,

00:03:29.560 | many of which overlap with the topics covered

00:03:31.720 | on the Huberman Lab podcast,

00:03:33.320 | but most of which will not

00:03:35.240 | and will be completely new topics and tools

00:03:37.500 | never discussed publicly before.

00:03:39.280 | Both live events will also include

00:03:40.960 | a question and answer period

00:03:42.720 | during which you, the audience,

00:03:44.120 | can ask me questions directly

00:03:45.880 | about any aspect of science or science-based tools,

00:03:48.720 | and I will attempt to answer them.

00:03:50.720 | Tickets for the two events,

00:03:52.020 | again, Seattle on May 17th and Portland on May 18th,

00:03:56.160 | are both available at HubermanLab.com/tour.

00:04:00.100 | Before we begin with today's episode,

00:04:01.680 | I want to emphasize that this podcast

00:04:03.400 | is separate from my teaching and research roles at Stanford.

00:04:06.340 | It is, however, part of my desire and effort

00:04:08.600 | to bring zero cost to consumer information about science

00:04:11.280 | and science-related tools to the general public.

00:04:13.940 | In keeping with that theme,

00:04:15.040 | I'd like to thank the sponsors of today's podcast.

00:04:17.800 | Our first sponsor is Thesis.

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00:05:57.900 | Today's episode is also brought to us by InsideTracker.

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00:06:06.060 | to help you better understand your body

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00:06:09.660 | I've long been a believer in getting regular blood work done

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00:06:20.040 | There are a lot of blood and DNA tests out there,

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00:08:19.320 | And now for my discussion about hormone health

00:08:21.280 | and optimization with Dr. Kyle Gillette.

00:08:24.340 | Dr. Gillette, welcome.

00:08:26.340 | - Thank you for having me.

00:08:27.760 | - Well, I'm super excited to talk to you

00:08:29.860 | because I found out about you on a podcast,

00:08:34.100 | and it immediately became clear

00:08:37.780 | that you are an encyclopedia of knowledge

00:08:40.300 | about hormone health for men and for women

00:08:43.460 | across the lifespan.

00:08:44.580 | So I have many, many questions,

00:08:46.860 | but before we dive into those questions,

00:08:49.180 | I'd love to just get a little bit of your background

00:08:51.780 | in terms of your medical training

00:08:53.740 | and what your particular orientation is

00:08:56.340 | toward treating your patients.

00:08:57.840 | And how do you think about this whole landscape

00:09:01.180 | that we call hormone health?

00:09:02.300 | What is a hormone?

00:09:03.780 | How do you envision people managing their hormones?

00:09:07.860 | If you could just kind of fill in a few of those blanks

00:09:09.880 | for us, I think a lot of people would appreciate it.

00:09:12.300 | - Absolutely.

00:09:13.180 | So I'm dual board certified in family medicine

00:09:16.000 | and obesity medicine.

00:09:17.300 | I've kind of tailored my training

00:09:20.220 | in order to provide what I call a balanced approach

00:09:23.740 | to total health, which includes body, mind, and soul.

00:09:28.240 | I recently saw a podcast with Joe Rogan and Mr. Beast,

00:09:32.620 | and Joe asks, Mr. Beast,

00:09:35.160 | how do you become such an amazing YouTuber

00:09:38.180 | and have all these great clickbait videos?

00:09:41.320 | And how did you become good at it?

00:09:42.940 | And it turns out he just became obsessed

00:09:44.820 | when he was a teenager.

00:09:46.380 | And that's essentially how I've tailored my education

00:09:49.100 | as well.

00:09:49.940 | I've become obsessed with optimal human performance,

00:09:53.060 | their body, their mind, and even their spirit.

00:09:56.220 | So I attended med school at the University of Kansas,

00:09:59.620 | which is one of the few med schools

00:10:02.220 | that still emphasizes full spectrum care.

00:10:04.860 | They emphasize exercise as medicine.

00:10:06.620 | They emphasize food as medicine,

00:10:08.660 | of which I was active in both of those interest groups.

00:10:11.360 | In residency, I was active

00:10:12.500 | in a lot of mindfulness curriculum,

00:10:14.740 | and then also things like walk with a doc,

00:10:17.160 | where you emphasize preventative medicine.

00:10:20.340 | That's something that we've kind of got away from,

00:10:22.260 | and that niche led me to hormone health.

00:10:25.660 | It didn't really start as hormone health,

00:10:27.660 | but it's a very important component of health in general

00:10:30.680 | that many people don't emphasize.

00:10:32.780 | - Great.

00:10:34.520 | Well, this idea of preventative medicine, I think,

00:10:36.640 | is starting to really take hold in the general population,

00:10:40.020 | especially given the events of the last few years.

00:10:42.260 | People realize that they are showing up to health challenges

00:10:45.660 | at a bunch of different levels,

00:10:46.880 | and with some people feeling very robust,

00:10:48.960 | other people feeling back on their heels.

00:10:51.060 | When someone comes to you as a patient,

00:10:53.600 | what are some of the first things

00:10:55.100 | that you want to know about them?

00:10:56.680 | I mean, obviously you want to know their blood pressure,

00:10:58.940 | you want to know something about their mental health

00:11:01.500 | and family history, but in terms of hormone health,

00:11:04.160 | what are the sorts of probe questions that you ask,

00:11:06.580 | and what are you looking for?

00:11:07.960 | And I ask this because I'd like people to be able to ask

00:11:10.940 | some of these very same questions for themselves.

00:11:13.040 | - Yeah.

00:11:14.580 | So when you do a physical exam and a history,

00:11:19.020 | you have a lot of different parts.

00:11:20.500 | You have your history of present illness,

00:11:22.100 | if they have a complaint.

00:11:23.140 | Maybe the patient doesn't have a complaint.

00:11:25.580 | In that case, things like their social history

00:11:27.780 | and their family history are extremely important

00:11:30.780 | because that gives you an insight into their genetics

00:11:33.820 | and an insight into their hormone health.

00:11:36.400 | So patients will tell me, "Oh, I'm doing okay,"

00:11:39.200 | but it helps to ask them, "Well, how are you now?"

00:11:42.220 | Let's say the patient is 50.

00:11:43.340 | "How are you now versus when you were 20,

00:11:45.900 | "and what has changed?"

00:11:47.920 | So I've gotten the question a lot,

00:11:49.420 | how do you get your doctor to order a better lab workup

00:11:52.580 | or to even include your basic hormones?

00:11:55.700 | And there's no magic answer to that.

00:11:58.540 | But what really helps is you tell them,

00:12:01.180 | my energy is not as good as it used to be.

00:12:03.100 | My focus is not as good as it used to be.

00:12:05.020 | My athletic performance is not as good as it used to be.

00:12:08.160 | So you don't have to have a pathology

00:12:10.200 | in order for a lab to be indicated.

00:12:12.020 | You just need to have that pertinent symptom.

00:12:14.540 | - I think that's gonna be really helpful

00:12:15.760 | because for many people,

00:12:17.180 | the idea of getting a blood test to look at their hormones

00:12:20.180 | just seems like such an enormous hurdle to get over.

00:12:22.620 | And many doctors won't prescribe them.

00:12:25.920 | And would you say that it's using the approach

00:12:29.560 | you just described that it's equally effective

00:12:33.360 | for men and women,

00:12:34.480 | or do you find that for one reason or another,

00:12:36.940 | that men and women have different challenges

00:12:39.400 | and advantages in trying to access

00:12:41.460 | their deeper hormone data?

00:12:43.240 | - Yeah, it's slightly different.

00:12:45.760 | With women, there's a lot more objective data.

00:12:48.660 | So if they're having menstrual irregularities,

00:12:51.360 | or if they're not having a period,

00:12:55.600 | if they're having too heavy of periods,

00:12:57.560 | then those are things that they talk about

00:12:58.960 | very frequently with their doctor.

00:13:01.920 | Men are more hesitant.

00:13:03.480 | So men really wanna know what their testosterone is,

00:13:06.880 | but at the same time,

00:13:08.420 | they really don't wanna tell their doctor

00:13:09.960 | how their libido is or how their energy is,

00:13:13.100 | because it's almost like they feel less masculine

00:13:16.560 | or they feel less like a guy when they say that,

00:13:19.240 | even if they're just talking to their doctor about it.

00:13:21.740 | - Yeah, I think that that raises a really important point,

00:13:23.840 | which is that the whole discussion around hormone health

00:13:26.600 | is a bit of a barbed wire topic,

00:13:28.920 | because in many ways, when we hear the word hormone,

00:13:32.200 | we think testosterone and estrogen,

00:13:34.860 | we think notions of masculinity and femininity,

00:13:37.920 | and of course, testosterone and estrogen

00:13:39.440 | are present in all sexes, right?

00:13:42.300 | All chromosomal backgrounds,

00:13:44.120 | and just to varying degrees and ratios.

00:13:46.560 | But it also raises all these issues about sexual health

00:13:49.000 | that it's kind of interesting

00:13:50.560 | 'cause I'm surrounded by medical doctors

00:13:52.480 | in my lab at Stanford.

00:13:54.000 | And the more physicians that I surround myself with,

00:13:56.840 | the more open is the discussion around sexual health

00:14:00.320 | and reproductive health.

00:14:01.620 | But in the general population,

00:14:02.860 | I think some of these topics are a little bit taboo

00:14:06.320 | or again, it's kind of barbed wire.

00:14:07.740 | And so I think that people are seeking

00:14:08.960 | a lot of this information on YouTube

00:14:10.640 | and through communities that may or may not be very educated

00:14:13.480 | about the actual biology.

00:14:15.280 | So along those lines,

00:14:18.360 | we could probably assume that hormones

00:14:20.200 | are changing across the lifespan, I think, right?

00:14:22.560 | Certainly from childhood and puberty and onward.

00:14:26.000 | If you would, I'd love to just kind of take a snapshot

00:14:29.760 | of what you think everybody should be thinking about

00:14:33.680 | or doing to optimize their hormone health,

00:14:37.280 | male or female, in the, let's say in their 20s.

00:14:41.640 | And then maybe we could migrate that

00:14:43.120 | to their 30s and 40s.

00:14:44.480 | But before that, could you just tell us

00:14:46.640 | what everyone should be doing for their hormone health

00:14:49.520 | from puberty onward?

00:14:51.280 | - Yeah, the law of diminishing returns applies.

00:14:55.260 | So doing a little amount of what I call

00:14:58.800 | lifestyle interventions over a long period of time

00:15:01.880 | is gonna be far more helpful or efficacious

00:15:05.400 | than doing a lot and then doing nothing

00:15:07.640 | or doing a lot and then doing nothing.

00:15:09.880 | So I talk about the big six pillars.

00:15:12.800 | The two strongest ones are likely diet and exercise.

00:15:16.640 | For hormone health, specifically resistance training

00:15:19.560 | is particularly helpful.

00:15:21.900 | For diet, caloric restriction can be particularly helpful,

00:15:26.900 | especially with the epidemic of metabolic syndrome

00:15:30.280 | that is continuing to on go in this country

00:15:33.280 | and in developed countries in general.

00:15:36.000 | So those are the two most powerful.

00:15:38.020 | So number one and number two are diet and exercise.

00:15:41.760 | For the last four, I have a little bit of alliteration.

00:15:44.280 | So there's stress and stress optimization

00:15:47.160 | that has to do with cortisol,

00:15:48.580 | that has to do with your mental health,

00:15:50.320 | that has to do with societal health

00:15:52.120 | and collective health of your family as well.

00:15:54.940 | When you're a member of a family

00:15:56.880 | or even a very close friend,

00:15:58.380 | trying to achieve optimal health together is very important.

00:16:03.340 | It's the same thing with nicotine cessation,

00:16:05.080 | same thing with hormone optimization.

00:16:06.920 | If you do it as a household unit, it's far more helpful.

00:16:10.760 | So after stress, you have sleep optimization.

00:16:14.080 | Sleep is extremely important,

00:16:16.200 | especially for mitochondrial health as well.

00:16:18.960 | And then you have sunlight,

00:16:20.360 | which encompasses anything that's outdoors.

00:16:22.600 | So you move more, you have cold exposure,

00:16:25.420 | you have heat exposure, that's sunlight.

00:16:27.760 | And then the last one is spirit.

00:16:29.680 | So that's kind of the body, mind and soul.

00:16:33.520 | If you have all the other five and they're dialed in

00:16:37.460 | completely, but you don't have your spiritual health,

00:16:40.000 | whatever you believe,

00:16:41.200 | then that's going to profoundly impact your body

00:16:43.840 | and your mind as well.

00:16:44.920 | - And we're definitely gonna touch into this notion

00:16:46.680 | of spiritual health, because I think for some people

00:16:48.780 | that might draw connotations of certain things

00:16:53.160 | that may or may not be accurate,

00:16:54.480 | but I know a number of academic laboratories

00:16:57.080 | that are focused on this and a number of,

00:16:59.440 | not just functional medicine clinics,

00:17:01.200 | but research clinics and hospitals throughout the country

00:17:04.560 | that are achieving some really interesting data,

00:17:06.920 | not just in people that are quite sick,

00:17:09.460 | but in healthy people who are trying

00:17:11.140 | to further optimize health.

00:17:12.280 | So we will definitely touch back to that.

00:17:14.160 | If you would be so kind as to maybe give us

00:17:17.580 | a little bit more detail about some of these other areas.

00:17:19.800 | So when people hear diet, I immediately think, okay,

00:17:22.960 | now we get into the combat around vegan,

00:17:27.080 | plant-based, carnivore, et cetera.

00:17:29.000 | But I think that my general view of this

00:17:33.040 | is that most people should probably be eating

00:17:35.160 | as few highly processed foods,

00:17:37.080 | highly palatable foods as possible,

00:17:38.600 | which doesn't mean eating foods

00:17:39.740 | that don't taste good, of course.

00:17:40.820 | But what other sorts of things do you recommend

00:17:44.120 | in the realm of diet?

00:17:45.240 | And then I also want to know about caloric restriction,

00:17:49.400 | because my understanding is that a caloric surplus

00:17:51.900 | can actually support certain hormones like testosterone.

00:17:55.220 | So how does one combine caloric restriction

00:17:57.400 | and still optimize hormones?

00:17:59.420 | But what would you say is a really terrific way

00:18:02.720 | to think about and approach diet?

00:18:04.800 | - Yeah, diet should be an individualized approach.

00:18:07.040 | So if you have a car, each car is made different

00:18:10.560 | and requires a different sort of fuel,

00:18:12.360 | whether it's a race car, whether it's a diesel truck,

00:18:16.000 | they have different fuels

00:18:17.220 | for different performance outcomes.

00:18:19.840 | So if you're trying to tow something

00:18:21.160 | or you're trying to go fast.

00:18:22.920 | So it's the same way with athletes.

00:18:24.580 | It's pretty well studied.

00:18:26.620 | The more intra-workout carbs

00:18:29.080 | ultra long distance athletes take,

00:18:30.920 | in general, they do better.

00:18:31.920 | I think they've studied this in cyclists quite often.

00:18:35.080 | It also depends on your genetics.

00:18:37.020 | So you can have a genetic polymorphism

00:18:39.240 | and you metabolize carbs and sugar better,

00:18:42.500 | even when they're unopposed by fiber.

00:18:44.280 | - How does one determine whether or not

00:18:46.680 | they have such a polymorphism?

00:18:48.700 | I mean, I'm an omnivore,

00:18:50.140 | so I do eat some high quality meats, not in huge quantities,

00:18:53.580 | but I also eat vegetables and starches, I feel fine.

00:18:55.960 | I've never done an elimination diet.

00:18:58.400 | I think I did a very low carb diet once

00:19:00.700 | and all it gave me was a lot of psoriasis and poor sleep.

00:19:03.400 | So I backed off, I probably didn't do it correctly,

00:19:06.000 | but I know a lot of people that do quite well

00:19:07.920 | on a very low carb or zero carb diet.

00:19:10.560 | - Yeah, particularly those who are at risk of cancer

00:19:15.200 | because you have less glucose

00:19:16.920 | that can be easily uptaken into cells.

00:19:19.240 | And then also people with autoimmune diseases.

00:19:22.160 | - They tend to do well on-

00:19:23.360 | - On lower carb diets, yeah.

00:19:25.560 | But yeah, as far as the, how do you know?

00:19:28.420 | Basically you can use your biofeedback,

00:19:30.680 | how you're feeling to guess what you tolerate well,

00:19:33.320 | or you can just get genetic testing,

00:19:35.400 | which can be fairly expensive,

00:19:36.880 | but most of all, it requires a physician

00:19:40.000 | or someone who knows how to interpret the test accurately.

00:19:43.040 | - And if someone had the means,

00:19:45.080 | would you say that getting regular blood testing

00:19:47.920 | is a good idea?

00:19:48.740 | And if so, what is regular blood testing?

00:19:50.600 | Is it every three months?

00:19:51.500 | Is it every six months?

00:19:52.800 | Of course, the backdrop of life is changing too,

00:19:55.320 | stress levels, et cetera.

00:19:56.920 | - Yeah, every three to six months for preventative purposes.

00:20:01.240 | At times, you need blood tests at faster frequencies

00:20:04.580 | than that.

00:20:05.920 | And then you should also get a blood test

00:20:08.080 | when you're fasting and when you're not fasting.

00:20:10.560 | So if you're looking for damage to the beach,

00:20:12.620 | you wanna, you don't just look at low tide,

00:20:14.640 | you look at high tide

00:20:15.520 | and you see what's happening at high tide as well.

00:20:17.720 | - That's a great way to put it.

00:20:18.960 | And in terms of general recommendations around exercise,

00:20:23.380 | I mean, I'm of the mind based on the data that I've seen

00:20:26.320 | that almost everybody should,

00:20:28.480 | or everybody should be getting 150 to 180 minutes,

00:20:32.800 | minimum of zone two cardio per week.

00:20:35.220 | That kind of could continue while having a conversation,

00:20:39.160 | but if one were to exert any more effort,

00:20:42.160 | it would have a hard time getting the words out.

00:20:43.600 | At least that, right?

00:20:44.920 | For cardiovascular health and general brain health

00:20:46.980 | and musculoskeletal health plus resistance exercise.

00:20:50.080 | Is that more or less the contour of what you recommend?

00:20:52.780 | - Yeah, that's more or less the contour.

00:20:54.840 | The more you're doing your zone two cardiovascular exercise,

00:20:59.840 | the slightly less important a long duration

00:21:03.840 | of caloric restriction is.

00:21:05.740 | - Interesting.

00:21:06.580 | And that brings us to caloric restriction.

00:21:08.240 | So it's very clear that caloric restriction

00:21:12.320 | can allow one to lose weight, right?

00:21:14.920 | This is the classic Kiko, C-I-C-O,

00:21:17.220 | calories in, calories out.

00:21:18.440 | We are not disputing calories in, calories out.

00:21:20.680 | Somehow that always has to be stated 50 times in any forum

00:21:24.040 | because of whatever follows.

00:21:25.920 | People I think will anchor to and assume

00:21:28.120 | that we don't mean that,

00:21:28.940 | but I know you and I both agree on calories in,

00:21:31.180 | calories out as a fundamental law of thermodynamics.

00:21:33.920 | But it's clear to me that based on what I've read,

00:21:38.660 | that when one is in a slight caloric surplus,

00:21:42.060 | that hormones like testosterone can be optimized,

00:21:44.840 | but is that true for somebody who's showing up

00:21:47.120 | with excessive body fat?

00:21:48.840 | How does this all work?

00:21:49.680 | Because body fat is manufacturing enzymes

00:21:52.340 | that convert testosterone to estrogen.

00:21:54.040 | So in other words, how does someone know

00:21:55.480 | if they should use caloric restriction

00:21:57.420 | or avoid caloric restriction?

00:21:58.960 | - Yeah, here's how to parse that out.

00:22:01.000 | So before I delve into the details a bit more,

00:22:04.260 | I should say as a board certified

00:22:06.080 | obesity medicine physician,

00:22:07.820 | obviously the laws of thermodynamics apply.

00:22:10.860 | And then in addition to that,

00:22:12.880 | there is nothing special about intermittent fasting

00:22:16.340 | or caloric restriction or exercise

00:22:19.760 | when it pertains to losing body weight in general.

00:22:24.200 | When you do lose weight,

00:22:25.240 | about 33% of that is lean body mass

00:22:27.960 | and about 10% of fat cells, adipose cells

00:22:31.820 | are actually lean body mass as well,

00:22:34.100 | because it has proteins and water

00:22:35.440 | and things like that in it too.

00:22:37.220 | So the reason for exercise

00:22:41.360 | and the reason for caloric restriction in general,

00:22:44.420 | including intermittent fasting is health reasons.

00:22:47.260 | That's how you increase your health span.

00:22:49.260 | It's not necessarily gonna make the weight

00:22:50.880 | on the scale change, but that doesn't matter as much.

00:22:53.820 | It's been fairly well studied in both mice and humans.

00:22:56.180 | It's much easier to study in mice.

00:22:57.980 | So that's a precursor to our six types of people,

00:23:01.540 | the ones that care about mice studies

00:23:02.940 | and the ones that care about human studies.

00:23:05.060 | But if you calorically restrict mice by 40%,

00:23:08.620 | then they can have improved testosterone parameters,

00:23:13.620 | but only if they're obese to start.

00:23:17.140 | And it appears to be that same way in humans as well.

00:23:19.680 | So the easy way to think about it is if you're obese

00:23:22.920 | or you have metabolic syndrome,

00:23:24.760 | caloric restriction will improve your testosterone.

00:23:27.900 | There has been a study and they talk about all these studies

00:23:30.500 | in a systematic review from the Mayo Clinic proceedings

00:23:33.420 | in March of last year.

00:23:35.580 | And they note that there is a study in young healthy men

00:23:40.580 | and they calorically restrict them

00:23:42.740 | and their testosterone does decrease.

00:23:44.620 | So if you're young and healthy

00:23:46.040 | and you don't have metabolic syndrome,

00:23:47.680 | then caloric restriction

00:23:48.680 | will likely decrease your testosterone.

00:23:51.440 | - That clarifies a lot for me.

00:23:53.420 | And I believe it will clarify a lot

00:23:55.480 | for other people as well.

00:23:56.780 | And I'm delighted that you pointed out this distinction

00:24:00.000 | about intermittent fasting not being the only way

00:24:02.720 | to achieve caloric restriction.

00:24:04.420 | There are a number of young healthy or older healthy people

00:24:09.420 | I know who like using intermittent fasting,

00:24:12.980 | even if they're not trying to lose weight.

00:24:15.380 | For a couple of reasons,

00:24:16.500 | some believe that it might extend lifespan.

00:24:18.900 | I think that's still a bit of an open question.

00:24:21.380 | It's a bit of a hard experiment to do

00:24:22.780 | because the control group is,

00:24:24.460 | no one wants to be in the control group, as I say.

00:24:26.500 | - It does in mice.

00:24:27.820 | - Right, exactly. - Captain audience.

00:24:29.420 | - Exactly.

00:24:30.320 | And the other feature of it that's a little bit tricky

00:24:33.080 | is that many people like intermittent fasting

00:24:35.780 | because of the mental effects,

00:24:37.240 | the clarity of mind that they feel during fasting,

00:24:39.400 | the increased pleasure in eating when they finally do eat.

00:24:44.460 | And here I'm referring to intermittent fasting of the sort

00:24:47.540 | where eating windows are anywhere

00:24:48.820 | from eight to 12 hours a day,

00:24:50.300 | not extended fast of 24 hours or more.

00:24:52.800 | So the question therefore is for the healthy,

00:24:57.500 | lean enough person, right, non-obese person,

00:25:01.620 | is intermittent fasting a bad idea

00:25:03.700 | in terms of hormone health?

00:25:05.400 | Is oscillating between this period of kind of feast

00:25:08.320 | and famine within a 24 hours a problem

00:25:10.940 | if one is getting sufficient calories to maintain weight?

00:25:14.220 | - Yeah, so if they're in a caloric maintenance,

00:25:16.580 | then it's not going to be deleterious.

00:25:21.580 | It's not gonna be bad for their hormone health.

00:25:24.100 | There's a couple of different hormones

00:25:25.300 | that we can talk about.

00:25:26.120 | We can talk about testosterone.

00:25:27.660 | We can talk about DHEA, which usually go hand in hand.

00:25:31.460 | And then we can also talk about growth hormone,

00:25:33.420 | which is not a steroid hormone, but it's a peptide hormone.

00:25:36.900 | So it's a chain of proteins, amino acids

00:25:40.540 | that are put together instead of a sterile.

00:25:43.100 | Think of sterile hormones as coming from cholesterol.

00:25:46.580 | So intermittent fasting, you do get a little spike

00:25:50.020 | in growth hormone after you eat,

00:25:52.320 | but you also get a huge spike in growth hormone,

00:25:56.220 | a more significant, less negligible spike overnight.

00:26:00.880 | And that is improved if you are intermittent fasting.

00:26:05.160 | So it's probably gonna help your growth hormone

00:26:08.180 | and subsequently IGF-1 levels,

00:26:11.100 | which will help more in older age groups

00:26:14.300 | than younger age groups.

00:26:15.720 | - And I like to eat dinner.

00:26:17.540 | So for me, that means sometime around six or seven o'clock,

00:26:19.840 | sometimes eight o'clock, I confessed last night,

00:26:21.900 | 'cause I was working late, I ate pretty big.

00:26:24.480 | It's basically my only meal of the day.

00:26:26.540 | At 10 o'clock, that's a rare thing for me.

00:26:28.640 | Can I still achieve a high degree of growth hormone output

00:26:33.660 | if let's say I avoid food in the two to three hours

00:26:36.780 | before going to sleep?

00:26:38.160 | Or does one have to be very deep into a fast

00:26:40.640 | in order to achieve the increase in growth hormone?

00:26:44.280 | - There's still pretty good growth hormone output,

00:26:46.760 | even if you eat two or three hours before you sleep.

00:26:49.900 | It's just the law of diminishing returns.

00:26:51.640 | The longer you go, you get slightly more and slightly more.

00:26:55.400 | - Great.

00:26:56.720 | And I know a number of people think of growth hormone

00:26:59.560 | in the context of the exogenous growth hormone

00:27:03.200 | and the fact that that can, in some cases,

00:27:05.540 | be associated with cancers.

00:27:08.720 | I've been asked many times before,

00:27:10.240 | can the increase in growth hormone from things like saunas

00:27:13.040 | or intermittent fasting cause levels of growth hormone

00:27:15.600 | that are so high that they cause cancers?

00:27:18.600 | My impulse is to say, no,

00:27:20.560 | that seems like it's not likely to happen,

00:27:23.740 | but I should probably verify that statement with you.

00:27:27.080 | - Yeah, so quite unlikely.

00:27:28.800 | I think about growth hormone and especially IGF-1,

00:27:32.080 | and there's actually an IGF-1 and IGF-2,

00:27:34.080 | but I think about it in terms of endocrine IGF-1,

00:27:37.800 | mostly IGF-1 that's synthesized in the liver

00:27:41.160 | and released in the liver versus IGF-1 that's released.

00:27:45.760 | Classically, an example of this would be

00:27:47.880 | your IGF-1 levels increase after resistance training

00:27:51.360 | or exercise, and that's more of like paracrine or autocrine,

00:27:55.040 | and they have more local action.

00:27:57.600 | So that IGF-1, it's pretty well studied

00:28:00.740 | that if you just give people IGF-1,

00:28:02.620 | it's not going to, at physiologic levels,

00:28:05.520 | it's not going to improve their body composition.

00:28:08.400 | However, that IGF-1 that's autocrine and paracrine

00:28:11.760 | just working in those local tissues and muscles

00:28:14.940 | is likely part of the reason why you get

00:28:17.260 | a improved body composition response after exercise.

00:28:21.720 | - I see.

00:28:22.540 | And just to clarify for me and for others,

00:28:25.680 | what can we say are the major functions of IGF-1 and IGF-2

00:28:30.500 | that are distinct from just growth hormone?

00:28:32.520 | Are they just kind of the active form of growth hormone,

00:28:34.880 | or kind of the pickaxe end of the assembly line?

00:28:39.880 | - So they have a much longer duration of action.

00:28:42.860 | I believe the half-life of IGF-1 is several days,

00:28:46.060 | almost a week, whereas growth hormone

00:28:48.060 | has an extremely fast half-life of only hours.

00:28:51.680 | So growth hormone acts significantly on the liver

00:28:55.800 | to produce IGF-1.

00:28:58.440 | So it's around in the serum in the blood long enough

00:29:04.440 | to where it's producing an effect pretty much all the time.

00:29:08.840 | - Very interesting.

00:29:10.080 | Well, and then your other pillars, stress.

00:29:12.760 | We've talked a lot about stress on this podcast before

00:29:15.260 | and tools for managing stress.

00:29:17.060 | Sleep obviously is a big one.

00:29:20.040 | I think if nothing else,

00:29:22.580 | I will either put people to sleep with my podcasts,

00:29:25.520 | certainly not this one, but my solo episodes,

00:29:27.820 | or hopefully convince people that sleep is the foundation

00:29:30.960 | of mental and physical health and performance.

00:29:33.040 | Are there any aspects of hormone optimization

00:29:36.000 | that can improve sleep?

00:29:37.460 | I know sleep can improve hormone optimization,

00:29:40.120 | but are there any aspects of hormone optimization

00:29:42.720 | that can improve sleep?

00:29:44.160 | And for people that are suffering from this common syndrome

00:29:47.140 | of going to sleep and then waking up

00:29:48.560 | at three or four in the morning,

00:29:49.920 | we know that can be associated with depression,

00:29:51.600 | but are there any hormonal indications

00:29:54.180 | that might lead to that kind of situation?

00:29:57.640 | - Yeah, there's three big ones.

00:29:59.880 | The first one is not super common,

00:30:02.660 | but it's a very direct correlation.

00:30:04.800 | If you have a growth hormone deficiency, a true deficiency,

00:30:08.760 | whether you're an adult or a child,

00:30:10.340 | then your sleep is likely going to be affected.

00:30:12.920 | And let's say you're a child with growth hormone deficiency.

00:30:16.320 | Once that is replaced with therapy,

00:30:19.040 | your sleep is gonna get significantly better.

00:30:21.740 | The second one that's a very common scenario

00:30:25.100 | is if you're having what's called vasomotor symptoms

00:30:28.400 | of menopause or vasomotor symptoms of andropause,

00:30:31.320 | which are also applicable.

00:30:33.780 | And that's where your progestogenic activity,

00:30:37.400 | so your main progestogens are progesterone

00:30:41.340 | and then pregnenolone,

00:30:42.640 | and then 5-alpha, 3-alpha progesterone,

00:30:45.780 | which is a slight-

00:30:46.620 | - Where are those manufactured in the body?

00:30:48.240 | - So they're manufactured in a few places.

00:30:51.480 | In men, they're manufactured some in the testes

00:30:54.720 | and the late egg cells.

00:30:56.080 | In women, they're manufactured in the ovaries

00:30:58.120 | until menopause.

00:30:59.620 | And then they're also manufactured in the adrenal glands.

00:31:02.740 | So if you're in, if you're pre-adrenopausal,

00:31:07.660 | where your adrenal glands are still working fairly well,

00:31:10.620 | you usually still have a decent amount of progesterone around

00:31:13.500 | and this can be measured too.

00:31:15.500 | So after menopause, women make progesterone

00:31:19.900 | from their ovaries, or sorry, from their adrenal glands.

00:31:24.620 | If that progesterone crosses the blood-brain barrier,

00:31:27.900 | especially if it's 5-alpha and 3-alpha reduced,

00:31:30.300 | so it's modified a little bit,

00:31:32.180 | then it is both a GABA agonist, which helps sleep,

00:31:36.060 | just like GABA does, gamma-amino-butyric acid,

00:31:38.820 | the main inhibitory neurotransmitter

00:31:41.580 | of which lots of things work on.

00:31:42.940 | Alcohol works on GABA as well.

00:31:44.740 | GABA, Penten also works on GABA.

00:31:46.980 | Migraine medicines, many of them work on GABA.

00:31:50.100 | Benzodiazepines and also non-benzos.

00:31:53.780 | So an example of a benzo would be Xanax,

00:31:55.820 | an example of a non-benzo would be Ambien.

00:32:00.620 | So those all work on GABA.

00:32:02.340 | So GABA is also helped

00:32:04.740 | by the progestogenic activity as well.

00:32:07.820 | That's why a lot of women in menopause

00:32:09.460 | feel like their sleep is much worse,

00:32:11.860 | is because they have lower activity of those progestogens.

00:32:15.620 | - And for men in so-called andropause,

00:32:18.460 | low testosterone, is that also one of the causes

00:32:22.660 | of poor sleep?

00:32:24.220 | - Low testosterone can lead to poor sleep,

00:32:26.500 | but my third scenario is actually,

00:32:30.020 | if a man begins TRT,

00:32:32.180 | then they develop a poor sleep because of sleep apnea.

00:32:35.140 | It drastically raises the risk

00:32:37.900 | that somebody is going to have sleep apnea.

00:32:39.980 | And then a lot of people,

00:32:40.860 | especially when they first started

00:32:42.100 | in the first month or two,

00:32:43.540 | it puts them into this hyper sympathetic state

00:32:45.900 | because they have overactive androgen receptors,

00:32:49.540 | especially after a long time of being hypogonadal.

00:32:52.980 | Then they have a physiologic dose of TRT

00:32:56.900 | and that causes the sleep issue itself.

00:33:00.100 | - Interesting.

00:33:01.580 | I have a lot of questions

00:33:02.420 | about TRT, testosterone replacement therapy.

00:33:05.340 | I should just mention that when you say

00:33:07.620 | it increases sympathetic activity,

00:33:09.740 | you don't mean that taking testosterone

00:33:14.220 | increases sympathy for others.

00:33:15.780 | It may in fact do the opposite,

00:33:16.980 | although it's very clear from my discussions

00:33:18.900 | with my colleagues in the endocrinology side

00:33:22.300 | and also with the great Dr. Robert Sapolsky

00:33:24.860 | that increasing testosterone merely exacerbates

00:33:27.740 | existing features of people.

00:33:30.140 | So the jerks become bigger jerks,

00:33:31.620 | kind people become even more kind in general.

00:33:35.180 | But I want to get into TRT in depth,

00:33:37.740 | but it's very interesting to me to hear

00:33:39.340 | that testosterone replacement therapy

00:33:41.700 | increases the risk of sleep apnea.

00:33:44.200 | And I want to make sure that I ask that,

00:33:47.420 | is that also the case in people that are using TRT

00:33:50.540 | who are not hypogonadal?

00:33:52.140 | Because in the classic situation,

00:33:54.300 | if somebody isn't making enough testosterone,

00:33:55.980 | they're below 300 nanograms per deciliter on the chart,

00:33:58.340 | they go in and take TRT.

00:33:59.180 | But many people nowadays, let's be honest,

00:34:01.620 | are taking doses of testosterone

00:34:04.980 | even though they are in the sort of standard range

00:34:07.140 | because the range is so large

00:34:08.620 | because of other symptomology.

00:34:10.220 | Is that right?

00:34:11.200 | - Yeah.

00:34:12.160 | I do love the analogy that Dr. Sapolsky had

00:34:15.000 | about monks taking testosterone

00:34:17.220 | and making them more and more generous.

00:34:19.500 | So that does appear to be what testosterone usually does

00:34:23.340 | is it exacerbates, if you will, what you're previously like.

00:34:26.860 | So it's not going to change you as a person.

00:34:29.520 | But if you're ugonadal before you start testosterone-

00:34:33.860 | - Meaning?

00:34:34.940 | - Meaning you have normal testosterone

00:34:37.020 | and then you start TRT or self-administered TRT,

00:34:41.540 | steroids, however you want to look at it,

00:34:44.100 | then your risk of sleep apnea still goes up

00:34:46.540 | in a dose dependent fashion.

00:34:48.140 | So the higher the dose, the more risky.

00:34:50.780 | With the sympathetic and the parasympathetic nervous system,

00:34:53.500 | the sympathetic is the fight or flight nervous system.

00:34:56.180 | The parasympathetic is the rest and digest.

00:34:58.940 | So if you have too much fight or flight

00:35:00.740 | and stress can cause that too,

00:35:02.260 | then you're not going to rest as well at night.

00:35:04.300 | - I want to touch on testosterone in women

00:35:07.540 | because there is testosterone in women.

00:35:11.100 | I'd like to know where that testosterone comes from,

00:35:13.500 | which tissues.

00:35:14.940 | I'd like to know whether or not

00:35:16.680 | testosterone replacement therapy makes sense in women.

00:35:19.520 | I'm hearing more and more about women using testosterone.

00:35:22.300 | And I'd like to know whether or not

00:35:25.080 | knowing a woman's testosterone,

00:35:26.560 | for her to know her testosterone is of equal,

00:35:30.860 | less than or more value than knowing, for instance,

00:35:33.860 | progesterone and estrogen levels,

00:35:35.280 | because I think there are a lot of misconceptions

00:35:36.840 | about the roles of testosterone in women.

00:35:38.780 | - For health optimization,

00:35:40.220 | testosterone is just as important to know.

00:35:43.260 | For pathology prevention, for example,

00:35:46.540 | breast cancer, osteoporosis, estrogen and progesterone

00:35:50.600 | are more important to know.

00:35:52.380 | So when you're thinking about women,

00:35:53.820 | women think that they have

00:35:54.680 | such a tiny amount of testosterone because you test it.

00:35:57.860 | Most people test a free testosterone.

00:35:59.940 | So testosterone that's unbound,

00:36:02.280 | which is by far the smallest proportion of testosterone.

00:36:06.880 | Any androgen is bound by lots of different

00:36:10.340 | steroid binding proteins,

00:36:12.520 | but the ones that are most pertinent are called SHBG

00:36:15.560 | or sex hormone binding globulin.

00:36:17.780 | And that binds the androgenic steroid,

00:36:20.740 | for example, DHT or dihydrotestosterone.

00:36:23.580 | It's associated with prostate enlargement,

00:36:25.660 | associated with male pattern baldness.

00:36:27.600 | It binds that the most strongly,

00:36:29.780 | and then it binds testosterone next most strongly.

00:36:32.660 | And then it binds things like androstenedione

00:36:35.540 | or DHEA, dehydroepiandrosterone.

00:36:39.740 | And then it binds the estrogens, the weakest, like estradiol.

00:36:44.360 | So if you look at the total amount of testosterone,

00:36:47.340 | women actually have, almost all women, not all women,

00:36:50.940 | but almost all of them have significantly more testosterone

00:36:55.940 | than estradiol,

00:36:57.620 | but it's because it's in different measurements.

00:37:00.780 | So estradiol a lot of time is, you know,

00:37:02.700 | P grams per mil as opposed to nanograms per deciliter.

00:37:06.300 | So women have more testosterone than estrogen

00:37:09.760 | and significantly more DHEA than either.

00:37:14.100 | - Interesting.

00:37:14.940 | Do women make dihydrotestosterone?

00:37:16.860 | - Yeah.

00:37:18.080 | - And where does this testosterone come from?

00:37:20.500 | Because they don't have testes.

00:37:22.140 | - Yeah, so most testosterone in women that are premenopausal

00:37:25.660 | can come from theca cells, T-H-E-C-A.

00:37:29.400 | So theca cells are cells in the ovaries

00:37:31.480 | that can produce testosterone.

00:37:33.380 | And a lot of people have actually heard about hyperthecosis,

00:37:37.060 | not the term itself,

00:37:38.700 | but a lot of Olympians that are,

00:37:41.660 | their chromosomes are XY, they're females,

00:37:44.960 | and they're not taking any-

00:37:47.220 | - Wait, they're XY, but they're females?

00:37:48.780 | - Oh, sorry, they're XX, yeah, thank you.

00:37:51.340 | So they're XX, they're not XY,

00:37:54.300 | and they have never transitioned

00:37:55.860 | or been on any sort of hormone replacement or testosterone,

00:37:59.580 | but they naturally produce a huge amount of testosterone

00:38:03.260 | as much as many men.

00:38:05.100 | And some of these women, I believe they were from Botswana,

00:38:08.140 | were banned from competing in the Olympics

00:38:10.640 | in certain distances.

00:38:12.440 | I believe they were banned from the 400 meter and 800 meter

00:38:15.880 | because their natural testosterone was deemed to be too high.

00:38:19.300 | - So they mistakenly thought that they were using steroids?

00:38:22.140 | - They actually knew they were not using steroids.

00:38:24.820 | They knew it was their theca cells

00:38:26.380 | were just genetically gifted, I suppose,

00:38:28.900 | and they still made them change distances.

00:38:31.520 | So one or two of these athletes changed to,

00:38:33.880 | I believe it was a 3K or the 5K,

00:38:37.240 | and they still did quite well,

00:38:38.860 | but it was not their best event.

00:38:40.580 | - Interesting, yeah,

00:38:41.500 | that's turning out to be a very interesting

00:38:43.120 | and controversial area of this notion of hormone therapies

00:38:46.140 | and natural variation in hormones

00:38:48.220 | on different chromosomal backgrounds.

00:38:49.880 | Fascinating, we should probably do a whole episode

00:38:51.860 | about that 'cause it's very much of the times.

00:38:54.360 | So men and women both make DHT.

00:38:59.240 | I'd like to ask about DHT in men.

00:39:02.260 | So often we hear about testosterone in men

00:39:04.600 | and free testosterone being the unbound form, of course,

00:39:08.740 | but dihydrotestosterone, where does it come from in men?

00:39:13.600 | What is the cascade of events that takes testosterone

00:39:17.400 | to dihydrotestosterone?

00:39:18.900 | And what are some of the quote unquote

00:39:21.180 | positive and negative effects of,

00:39:23.860 | here I'm only referring to endogenous dihydrotestosterone.

00:39:28.180 | And in fact, I'll make it very clear whether or not

00:39:31.300 | I'm talking about taking something

00:39:33.220 | or one's own natural production.

00:39:34.620 | Here we're just, I think up until now

00:39:35.940 | we've just been talking about natural production.

00:39:37.940 | So tell us about DHT in men,

00:39:40.440 | such a powerful hormone during development, obviously,

00:39:43.700 | but what is it doing?

00:39:45.100 | - DHT is a very androgenic hormone.

00:39:48.700 | So whether you're talking about DHEA,

00:39:51.380 | which is a mild, a weak androgen,

00:39:54.940 | or testosterone, which is a relatively strong androgen,

00:39:58.420 | or DHT, which is a very strong androgen,

00:40:01.300 | they bind to the androgen receptor

00:40:03.280 | in both men and in women.

00:40:05.340 | So the effect of all three of those

00:40:08.540 | is mediated by the androgen receptor.

00:40:11.160 | There's a couple of different beta estradiol receptors

00:40:13.900 | and alpha estradiol receptors,

00:40:15.820 | but there's only one androgen receptor.

00:40:18.300 | Intriguingly, it is on the X chromosome.

00:40:21.020 | So men get their androgen receptor gene from their mother.

00:40:25.180 | Women get one androgen receptor gene from their father,

00:40:29.720 | one from their mother.

00:40:31.000 | Often the one that is more sensitive to androgens

00:40:33.660 | in people with PCOS, that's the one that's active.

00:40:36.540 | The other one is methylated and inactive.

00:40:38.940 | - Can I just pause you one second?

00:40:40.060 | Sorry to interrupt, but I have to ask this question

00:40:42.580 | before I forget.

00:40:43.780 | And I know a number of people are probably wondering.

00:40:45.260 | I've heard that whether or not

00:40:47.340 | one develops male pattern baldness,

00:40:50.420 | whether or not a male develops male pattern baldness,

00:40:53.700 | just to be very precise,

00:40:55.200 | you could get some information about that

00:40:58.520 | by looking at your mother's father.

00:41:00.780 | And that would be in keeping with what you just described,

00:41:03.180 | but the X chromosome,

00:41:04.060 | which of course is handed off through the mother,

00:41:06.620 | is carrying the genes that encode

00:41:09.300 | for the number and distribution

00:41:11.060 | of these androgen receptors that DHT will bind to.

00:41:14.060 | 'Cause of course, I think as you'll probably tell us,

00:41:15.940 | that DHT is responsible for male pattern baldness

00:41:18.260 | and beard growth.

00:41:19.080 | Is that right?

00:41:19.920 | Should I look at my grandfather on my mother's side

00:41:21.980 | to determine what I'm likely to look like

00:41:23.740 | in terms of my DHT-ness?

00:41:26.000 | Is that a word?

00:41:26.840 | - Yeah.

00:41:27.660 | It's the best guess that you can make

00:41:29.380 | purely from phenotypes.

00:41:31.020 | And you can measure your genotype.

00:41:33.020 | And get a better idea of that.

00:41:35.940 | Assuming that it's true male pattern baldness,

00:41:38.140 | it's related to the gene transcription

00:41:40.420 | of the androgen receptor.

00:41:42.220 | So I like to think of it as

00:41:44.260 | how much of this androgen receptor gene

00:41:48.100 | is activated by any androgen.

00:41:50.780 | So if you have an extremely sensitive gene,

00:41:53.020 | which usually means you have very few CAG repeats,

00:41:55.960 | which is basically just a certain CAG encodes

00:41:59.420 | for a certain amino acid.

00:42:02.180 | And if you have very few of the repeats,

00:42:04.740 | then your androgen receptor gene works better.

00:42:07.460 | Think of it as a corollary to Huntington's disease,

00:42:10.300 | where if you have very few called trinucleotide repeats,

00:42:14.260 | then it's not as severe of a disease.

00:42:17.200 | But after you get more and more CAG repeats,

00:42:20.140 | which by the way are in the population,

00:42:22.540 | you're getting more and more CAG repeats.

00:42:24.800 | So it's a natural selection of process

00:42:27.960 | that has been ongoing for a variety of number of reasons.

00:42:32.680 | But anyway, if you have more repeats,

00:42:34.360 | then that gene activates in the cytoplasm

00:42:37.040 | and moves to the nucleus

00:42:38.360 | and causes gene transcription more often

00:42:40.880 | and hair loss more often.

00:42:42.640 | - Does that mean that we're seeing more hair loss now

00:42:45.360 | due to elevated levels of DHT than we were 50 years ago?

00:42:48.980 | - Probably not.

00:42:51.520 | The hair loss 50 years ago,

00:42:55.640 | well, not 50 years ago, but 500 years ago

00:42:57.960 | was probably more significant

00:43:00.160 | because on average 500 years ago,

00:43:02.760 | people were more sensitive to androgens.

00:43:05.520 | So there's a syndrome called androgen insensitivity syndrome,

00:43:09.360 | AIS, and that syndrome was related to when men

00:43:13.420 | who have the copy from their mother who is a carrier,

00:43:16.640 | their AR gene or androgen receptor gene

00:43:19.840 | is completely insensitive.

00:43:21.800 | So think of it, it doesn't have it,

00:43:23.400 | it's not related to the CAG repeats,

00:43:25.280 | but think of that receptor as just not working at all.

00:43:30.280 | So there's a continuum.

00:43:31.940 | So everybody's receptor works a little bit better

00:43:34.480 | or a little bit worse.

00:43:35.880 | And the better your receptor works,

00:43:38.080 | the more likely you are to have male pattern baldness.

00:43:40.920 | - To zoom out from this,

00:43:42.080 | but still keeping an eye on DHT,

00:43:46.980 | what do you like to see all women and all men do

00:43:51.980 | to optimize DHT?

00:43:54.360 | And here I'm talking about regardless of age.

00:43:56.280 | So we're still in this from puberty onward phase.

00:43:59.200 | We haven't yet micro dissected out decade by decade,

00:44:01.880 | which we will do.

00:44:02.720 | But what do you like to see people do to keep DHT in check?

00:44:05.940 | But before you tell us that,

00:44:07.600 | could you tell us what positive things DHT does

00:44:11.920 | when it's in the proper range?

00:44:13.720 | - Yeah, so DHT helps a lot for,

00:44:16.440 | it's the same reason why testosterone helps.

00:44:18.280 | It activates the androgen receptor gene.

00:44:20.560 | It helps effort feel good.

00:44:22.500 | So it can be motivating.

00:44:24.620 | So that's how it's active in the CNS.

00:44:27.220 | It also is active in cardiovascular tissue.

00:44:30.420 | So if you look at someone that has heart failure,

00:44:34.640 | or if someone has cardiac hypertrophy,

00:44:37.400 | the level of DHT can matter

00:44:39.280 | because it's also binding to the androgen receptor

00:44:42.200 | in the myocardium or in the heart itself.

00:44:45.240 | So you think of the classic bodybuilder heart.

00:44:48.640 | That's an easy example to make.

00:44:50.520 | They have very thickened muscle.

00:44:52.360 | Their muscle is very strong because they're pumping blood,

00:44:55.620 | often with high blood pressure.

00:44:57.760 | And that DHT and the testosterone

00:45:00.660 | and any DHT derivatives like masterone

00:45:03.560 | or oxandrolone, primaboulin, also bind to the heart.

00:45:08.120 | And they cause even more hypertrophy

00:45:10.620 | or enlargement of that muscle tissue.

00:45:13.180 | So then let's say the person stops and they're recovering

00:45:16.040 | and they're trying to have cardiac remodeling,

00:45:18.800 | which is where you take a very thick heart.

00:45:21.640 | And cardiac remodeling is important

00:45:23.240 | in a lot of different cardiac pathologies.

00:45:27.040 | But if you give them finasteride or dutasteride,

00:45:29.600 | which inhibit the enzyme that converts testosterone to DHT,

00:45:33.560 | so making less activity at the androgen receptor gene,

00:45:37.240 | they have cardiac remodeling and their heart health improves.

00:45:40.240 | - I see.

00:45:41.080 | So for the non-bodybuilder,

00:45:42.280 | the typical woman or man or younger or older,

00:45:46.520 | what sorts of things support DHT and thereby heart health,

00:45:51.320 | presumably DHT is involved in some of the other things

00:45:53.520 | that testosterone is famous for in both men and women,

00:45:56.280 | things like libido, as you mentioned,

00:45:58.360 | making effort feel good.

00:45:59.320 | So motivation drive and vitality is, I guess,

00:46:03.600 | could be the general phrase.

00:46:05.760 | What sorts of things support DHT?

00:46:07.960 | What sorts of things create problems for DHT?

00:46:11.560 | - There's lots of dietary changes and supplementation

00:46:14.380 | that you're probably doing right now

00:46:16.000 | that's affecting your DHT.

00:46:17.560 | - You mean me personally?

00:46:18.400 | Well, everybody, all of the listeners,

00:46:21.200 | because let's say you have a diet high in plant polyphenols.

00:46:26.640 | Many of those inhibit the enzyme

00:46:28.960 | that converts testosterone to DHT.

00:46:31.000 | - Could you give us an example of one of those,

00:46:36.380 | either in supplementation form or in food form?

00:46:39.360 | - Curcumin, certain curcuminoids,

00:46:41.760 | depending on the structure,

00:46:43.460 | will inhibit the enzyme called 5-alpha reductase

00:46:46.480 | that converts testosterone to DHT.

00:46:48.400 | - Turmeric.

00:46:49.240 | - Yeah, turmeric, black pepper extract.

00:46:51.440 | So it's used often to increase bioavailability.

00:46:55.360 | It's also called biopurine.

00:46:57.500 | It's also a 5-alpha reductase inhibitor.

00:46:59.780 | And on top of that, people have different genetics too.

00:47:04.800 | So some people, there are 5-alpha reductase enzymes.

00:47:07.720 | There's three of them.

00:47:08.800 | They're on chromosome two, three, and four, I believe.

00:47:12.940 | But some of them are active in the prostate.

00:47:15.380 | Some of them are active in the brain.

00:47:17.380 | And so it depends on which tissue.

00:47:19.620 | They're tissue-specific enzymes

00:47:22.460 | that depend on how much DHT you convert.

00:47:26.160 | - Do you recommend that people avoid curcumin and turmeric

00:47:28.580 | for that reason?

00:47:29.940 | And is there any specific recommendations

00:47:32.060 | for men versus women?

00:47:33.300 | - If a man or a woman, by the way, in women,

00:47:36.780 | a lot of times if you just ask your doctor for a DHT check,

00:47:39.920 | it's the same unit as in men.

00:47:41.380 | So it's essentially undetectable.

00:47:43.420 | So you have to, you know,

00:47:46.340 | especially if they're on oral contraceptives,

00:47:48.140 | which is a different topic,

00:47:49.100 | their DHT is very likely undetectable,

00:47:51.700 | especially if it's free DHT.

00:47:53.700 | You can measure both a DHT and a free DHT.

00:47:57.180 | But if someone's DHT is already low,

00:47:59.480 | or if they have somewhat insensitive androgen receptor

00:48:04.220 | via genetics or via lifestyle,

00:48:07.400 | then I recommend they avoid bioavailable curcuminoids,

00:48:11.140 | like bioavailable turmeric, black pepper extract,

00:48:14.500 | and they might be a good candidate for creatine.

00:48:16.620 | Creatine, like creatine monohydrate,

00:48:19.580 | can significantly increase

00:48:21.140 | the conversion of testosterone to DHT.

00:48:23.140 | - Interesting.

00:48:23.980 | There's also a lot of really interesting data coming out now

00:48:25.860 | about the role of creatine as a brain fuel

00:48:30.000 | and maybe even as a cognitive enhancer over time.

00:48:32.180 | The data are still ongoing,

00:48:34.160 | but some of the studies in humans are pretty impressive,

00:48:36.500 | at least to me.

00:48:37.620 | I'm glad you mentioned this thing

00:48:39.020 | about curcumin and black pepper.

00:48:40.360 | I wish we'd had this conversation six years ago

00:48:42.640 | because I had the experience of jumping on the bandwagon

00:48:46.660 | of the excitement around turmeric,

00:48:48.040 | and I took a turmeric supplement.

00:48:49.620 | It was a couple of capsules of what I thought to be,

00:48:52.760 | and I think was high quality turmeric.

00:48:54.900 | And I've never felt as poor as I did

00:48:57.960 | in the subsequent few days.

00:48:59.580 | Flat line of, let's just say,

00:49:01.300 | everything that one would want to have in life,

00:49:04.020 | energy, vitality, just, it was a cliff.

00:49:07.500 | And a friend somehow knew

00:49:11.120 | that curcumin could inhibit 5-alpha reductase

00:49:13.880 | that converts testosterone to DHT, as you pointed out.

00:49:17.040 | I stopped taking it.

00:49:18.020 | It was the only new addition to my diet and supplementation,

00:49:21.200 | and things bounced back within about three, four days,

00:49:23.600 | but it was remarkable.

00:49:25.880 | I mean, I felt like garbage,

00:49:27.380 | and it was actually kind of frightening

00:49:28.720 | to experience the sharpness of that cliff.

00:49:32.540 | But I know that some people like turmeric

00:49:35.500 | for its anti-inflammatory properties, et cetera.

00:49:39.440 | Sounds like people either need to experiment or,

00:49:43.520 | and if they do, obviously to approach that with caution.

00:49:45.960 | Anytime you add or remove something,

00:49:47.460 | you need to talk to your doctor.

00:49:49.180 | You're a doctor, and I'm guessing that

00:49:51.840 | if one were to experiment,

00:49:53.320 | would you say that most of these effects

00:49:56.380 | of things like curcumin are reversible as they were in me,

00:49:59.240 | or is there any potential of permanent damage

00:50:01.840 | if people have been taking them for a long time?

00:50:04.080 | - The effects are nearly always reversible.

00:50:06.880 | When you're talking about five alpha reductase inhibition,

00:50:09.700 | so what turmeric does, but stronger,

00:50:11.660 | the most common story that we hear

00:50:14.280 | is regarding a supplement known as saw palmetto,

00:50:17.500 | which a lot of older men take for their prostate health,

00:50:20.420 | or finasteride, which you can take for your prostate,

00:50:23.120 | or your heart, or your hair, or dutasteride.

00:50:26.240 | So if you're having side effects on these,

00:50:28.760 | then it's probably because of a couple different reasons.

00:50:31.560 | One can be your ratio of androgens to estrogens is off,

00:50:36.280 | and that needs addressed.

00:50:37.720 | Another one can be,

00:50:39.400 | it's inhibiting the conversion of your progesterone

00:50:42.040 | to that other type of progesterone,

00:50:44.200 | the five alpha, three alpha that we talked about earlier

00:50:46.280 | that's helping with your sleep,

00:50:47.720 | and your brain, and your calmness.

00:50:50.060 | And that's definitely an effect.

00:50:53.960 | Another one is depending on the type of supplement or med,

00:50:57.880 | they inhibit different isoenzymes

00:51:00.320 | of that five alpha reductase.

00:51:01.840 | So if they're just inhibiting one and two,

00:51:05.660 | then that's gonna be a different effect

00:51:07.280 | than if they're inhibiting two and three.

00:51:09.220 | So finasteride does two and three,

00:51:11.360 | saw palmetto does one and two,

00:51:13.040 | and then dutasteride does all three.

00:51:15.900 | The third one is active in the brain,

00:51:17.960 | and dutasteride inhibits that third one

00:51:19.800 | a little bit weaker in vivo, but strongly in vitro.

00:51:23.820 | So it's really hard to parse out.

00:51:26.200 | You can use biofeedback and experimentation.

00:51:28.800 | I do think with supplements, it's safe to experiment.

00:51:32.400 | The time that it takes to set in

00:51:34.300 | is usually about three months.

00:51:36.280 | So the risk of, and this is anecdotally,

00:51:39.380 | there's been lots of research published about

00:51:42.160 | if post finasteride syndrome is real or fake,

00:51:46.560 | and it is real, but it's one of those things

00:51:49.720 | that's a combination of organic and inorganic disease,

00:51:53.120 | almost kind of like fibromyalgia,

00:51:54.960 | where it's definitely real,

00:51:56.400 | and there's lots of things that you can do to help with it,

00:51:58.840 | but it's very unlikely to occur

00:52:01.340 | if you stop taking your supplement or medication

00:52:04.360 | after you have side effects.

00:52:05.640 | - Interesting.

00:52:06.460 | Well, I certainly feel better when I'm taking five grams

00:52:08.800 | of creatine monohydrate per day.

00:52:10.480 | I know most people take it for muscle growth

00:52:12.600 | and tissue repair and things of that sort.

00:52:15.020 | Mainly, I think, brings water

00:52:16.360 | into the muscle tissue, et cetera,

00:52:18.200 | but I take it for the brain effects,

00:52:20.000 | and also because I like to think

00:52:21.440 | that it gives me a little bit of a DHT bump

00:52:25.440 | that I can actually see in my blood charts

00:52:27.360 | when I've done them.

00:52:29.200 | I know many people want to avoid the hair loss

00:52:33.240 | that can sometimes be associated

00:52:34.520 | with DHT levels going too high,

00:52:36.520 | and so I've been asked many times,

00:52:38.160 | does creatine monohydrate cause hair loss?

00:52:40.780 | It would make sense that if creatine increases DHT and DHT,

00:52:44.980 | binding to the endocrine receptor on the scalp

00:52:46.840 | can induce hair loss, that that would be the case.

00:52:49.280 | Is that true, or are people just overly concerned

00:52:53.280 | about something that's trivial or nonexistent?

00:52:55.900 | - Each male, so yes, it can potentially add it.

00:53:01.180 | I don't like to say it causes it,

00:53:02.920 | but it can be a little bit more fuel to the fire.

00:53:06.200 | So just like everybody has a different sensitivity

00:53:08.840 | of their androgen receptor,

00:53:10.180 | they have a different amount of gene transcription

00:53:13.280 | that is going to cause death of the follicle.

00:53:16.240 | That's an arbitrary threshold,

00:53:17.760 | so you don't really know until you start losing hair.

00:53:20.440 | - And if somebody takes a little bit of creatine

00:53:22.480 | to increase their DHT,

00:53:24.280 | maybe for the cognitive enhancing effects

00:53:25.840 | or for whatever reason,

00:53:26.840 | and they notice a little bit more hair

00:53:28.320 | falling out in the sink and they stop taking it,

00:53:32.040 | you said death of the follicle, which sounds very dramatic.

00:53:35.200 | Are those little stem cell niches

00:53:37.520 | that reside in the follicle, which hairs grow from,

00:53:40.320 | are those then abolished, like there's no going back,

00:53:42.920 | or can one rescue the hair?

00:53:45.380 | - It takes months.

00:53:46.560 | If they're still there, the hair will come back.

00:53:48.940 | So the loss of the hair itself is a normal part

00:53:53.100 | of the hair cycle.

00:53:54.460 | So you have your androgen phase, your catagen phase,

00:53:57.380 | your telogen phase, and then your hair loss,

00:54:00.060 | and then a new follicle.

00:54:00.900 | - Of the stem cell niche in the hair follicle.

00:54:03.360 | - Think of it like sharks have teeth.

00:54:05.220 | So a shark loses a tooth

00:54:06.660 | and they have a new one that comes through,

00:54:08.340 | or losing your baby tooth and you have a new one,

00:54:10.160 | but your hair just always keeps coming through.

00:54:12.000 | So it's natural for it to die and lose.

00:54:15.180 | That's why when you start five alpha reductase inhibitors,

00:54:18.740 | often you have a big shed.

00:54:20.420 | So what happens during that big shed

00:54:22.520 | is all of these cells that are unhealthy,

00:54:26.180 | they immediately jettison that hair

00:54:27.680 | and they start making a much healthier new follicle.

00:54:30.820 | So all of the hairs that are at the end

00:54:33.200 | of their telogen phase,

00:54:36.540 | then they have what's called telogen effluvium,

00:54:39.580 | which also happens after pregnancy,

00:54:41.780 | also happens in thyroid pathologies.

00:54:44.740 | So you shed it, a new one comes in place,

00:54:46.740 | and you think that you're having a horrible hair loss

00:54:49.220 | caused by your finasteride or whatever you're doing,

00:54:52.980 | and minoxidil does this too,

00:54:54.740 | but you're really just having a new, healthier follicle.

00:54:57.580 | If you go a really long time, if you go a year,

00:55:00.280 | then those hairs might come back and they might not.

00:55:03.100 | - So for simplicity's sake,

00:55:05.180 | if somebody is concerned about

00:55:07.020 | or is experiencing hair loss, male or female,

00:55:09.440 | what are their options of ways to offset that hair loss

00:55:15.300 | that are not going to negatively impact

00:55:18.340 | other tissues sensitive to DHT?

00:55:20.140 | And what I'm basically saying here is

00:55:22.500 | I could imagine taking a DHT inhibitor,

00:55:26.460 | a pill of some sort or an injection of some sort,

00:55:29.420 | and offsetting hair loss,

00:55:31.980 | maybe even stimulating more hair growth.

00:55:34.100 | It's clear that I'm not doing that,

00:55:35.540 | but I know people that do,

00:55:36.800 | but then experience some of the other negative effects

00:55:39.300 | of blunting DHT, reduced affect, reduced libido,

00:55:41.880 | reduced drive, disruptions in prostate function

00:55:45.840 | or even sexual function generally.

00:55:48.640 | So what can people do if they want to maintain

00:55:51.320 | or grow back hair,

00:55:52.160 | but they don't want all those other effects?

00:55:54.320 | What should they avoid?

00:55:56.040 | And what should they perhaps consider

00:55:58.080 | talking to their doctor about?

00:55:59.680 | - Yeah, there's a whole host of options.

00:56:01.800 | I try to separate alopecia or hair loss

00:56:06.080 | into two different categories, male pattern baldness

00:56:08.640 | or androgenic alopecia, also known as androgenetic alopecia

00:56:13.440 | versus other types of alopecia, usually telogen effluviums.

00:56:17.720 | And if it's androgenetic alopecia

00:56:20.560 | or male pattern baldness, even if they're female,

00:56:23.760 | perhaps say a PCOS, something like that,

00:56:26.020 | then you want some sort of strategy

00:56:28.560 | to decrease the activity of that androgen receptor.

00:56:31.680 | - So women can get male pattern baldness?

00:56:33.840 | - Absolutely.

00:56:34.680 | - Okay, I'm going to have to wrap my head around that one,

00:56:36.520 | but okay.

00:56:37.760 | So there's a lot of different things that you can do

00:56:40.920 | that are topical.

00:56:41.760 | The most promising is called dutasteride mesotherapy.

00:56:45.080 | Essentially what it is is it's very localized injections

00:56:48.960 | in areas that are prone to male pattern baldness,

00:56:52.040 | whether they're female or male, and it acts locally only,

00:56:57.040 | and you repeat these injections from time to time.

00:56:59.960 | It decreases the conversion of testosterone to DHT

00:57:03.020 | just in the scalp.

00:57:04.920 | - So that can avoid prostate effects.

00:57:06.880 | And what are some of the negative effects

00:57:08.480 | of blocking DHT in females in the periphery,

00:57:12.720 | meaning not on the scalp or in the brain,

00:57:15.080 | but where is DHT doing its stuff?

00:57:18.720 | - Yeah, so it's both DHT

00:57:20.260 | and then also that 5-alpha, 3-alpha progesterone,

00:57:23.560 | which is called THP or dihydroprogesterone

00:57:27.520 | or tetrahydro, trihydroprogesterone.

00:57:30.780 | So they're active in the central nervous system,

00:57:33.560 | but it's also just active, again,

00:57:36.240 | binding to the androgen receptor in a female as well,

00:57:39.280 | causing them to have that effort feel good motivation.

00:57:42.560 | A lot of women that are sensitive to DHT,

00:57:45.680 | 'cause women can be sensitive to DHT as well,

00:57:48.360 | feel very different when they start an oral contraceptive,

00:57:52.480 | not because it alters their DHT to a huge amount.

00:57:55.840 | It does to some degree,

00:57:57.640 | because of the negative feedback inhibition

00:57:59.700 | in the pituitary and less produced in the ovaries,

00:58:02.340 | but it increases SHBG really high.

00:58:06.600 | So because their SHBGs are significantly higher,

00:58:09.660 | their free DHT is way lower.

00:58:12.500 | - How does a woman know if she has PCOS,

00:58:16.260 | polycystic ovarian syndrome?

00:58:18.140 | What are the issues with polycystic ovarian syndrome?

00:58:20.860 | What can be done about PCOS?

00:58:22.620 | I confess I was naive to PCOS.

00:58:25.140 | That wasn't supposed to rhyme, but since it does,

00:58:28.860 | I do confess I was completely naive to it.

00:58:31.500 | And I started getting a lot of questions about it

00:58:33.900 | in various forums.

00:58:35.340 | And I think that's actually the reason

00:58:37.820 | why I initially approached you.

00:58:39.340 | I know you have treated a lot of PCOS.

00:58:42.300 | What age women should be thinking about PCOS?

00:58:46.600 | What's PCOS?

00:58:48.140 | Teach us about PCOS, please.

00:58:50.060 | - So PCOS is polycystic ovarian syndrome.

00:58:54.140 | And this is one of those conditions which is underdiagnosed.

00:58:58.640 | So its prevalence is much higher than we think it is.

00:59:02.580 | There's been a lot of studies and some studies

00:59:04.820 | say prevalence of 10%, some say 20%.

00:59:08.480 | It's not completely clinically penetrant.

00:59:10.840 | So most people don't know they have PCOS

00:59:13.120 | until they have infertility or subfertility.

00:59:16.220 | - And is PCOS happening at this frequency

00:59:18.480 | in 20-year-old women and 30-year-old women

00:59:20.860 | and 40 and onward?

00:59:22.100 | - Most women find out they have PCOS in their 30s,

00:59:25.500 | especially because it's on a spectrum or a continuum

00:59:28.260 | like a lot of things where you can have a weaker version

00:59:30.680 | or a very severe version.

00:59:32.060 | - What are the symptoms?

00:59:33.900 | - There's a criteria called the Rotterdam criteria.

00:59:37.520 | And in the Rotterdam criteria,

00:59:39.060 | there's a couple of different ways that you can diagnose it.

00:59:41.400 | You're looking for androgen excess, insulin resistance,

00:59:45.940 | and you can also look for polycystic ovaries.

00:59:47.900 | You don't actually have to have polycystic ovaries

00:59:50.240 | or to get an ultrasound of your ovaries to be diagnosed.

00:59:53.260 | If you have androgen excess, for example,

00:59:55.780 | androgenic acne or hormonal acne.

00:59:58.500 | If you have hair growth, like a hair growth on the chin,

01:00:00.660 | it's called a hirsutism.

01:00:02.820 | Or if you have, you know, like deepening of the voice,

01:00:06.540 | any symptom of too much male pattern baldness,

01:00:11.540 | if you're a female, that's a symptom of PCOS as well.

01:00:14.500 | Then you can also have insulin resistance.

01:00:17.220 | So this is obesity, it's prediabetes,

01:00:20.700 | a high fasting insulin, a HOMA IR over two,

01:00:24.660 | a fasting insulin of over six.

01:00:27.260 | So if you have significant insulin resistance

01:00:30.520 | and also androgen dominance, that's a sign of it.

01:00:34.780 | Androgen dominance often leads

01:00:36.380 | to what's called oligominorrhea.

01:00:38.700 | So if you're having more than 35 day intervals

01:00:42.120 | in between a period,

01:00:44.060 | or if you have less than nine per year,

01:00:47.740 | then that can be a sign that you have oligo,

01:00:49.980 | which means too little, minorrhea, which means menses.

01:00:54.380 | So that's a very common sign of PCOS.

01:00:58.020 | If you have infertility, so if you're under the age of 35

01:01:01.460 | and you've been trying for more than a year,

01:01:04.080 | or if you're over the age of 35

01:01:05.540 | and you've been trying for more than six months,

01:01:07.800 | then that can also be,

01:01:08.820 | it's a very common presenting complaint

01:01:10.720 | when somebody presents with PCOS.

01:01:12.840 | - And assuming that a woman is doing all these other things,

01:01:16.540 | is paying attention to the six pillars

01:01:18.180 | that you talked about earlier, diet, exercise,

01:01:20.140 | caloric restriction, in some cases, right?

01:01:21.980 | Not everyone needs to be caloric restricted,

01:01:24.460 | stress, sleep and sunlight, spirit.

01:01:27.540 | Assuming that they're doing all those things,

01:01:30.100 | what other things in the realm of diet or supplementation

01:01:33.340 | can help them avoid PCOS if they have subclinical PCOS

01:01:37.460 | or they have not developed it, but don't want to develop it?

01:01:40.540 | 'Cause it doesn't sound like a good thing.

01:01:42.800 | - Yeah, so depending on where they are,

01:01:45.540 | if they're very strong on the insulin resistance spectrum,

01:01:49.340 | then optimizing their body composition,

01:01:52.380 | decreasing their body fat

01:01:53.820 | and treating that metabolic syndrome can help.

01:01:56.680 | So a lot of people ask, well, does everybody that's on,

01:02:00.600 | like does everybody need to be on metformin that has PCOS?

01:02:04.160 | Not necessarily, but metformin is one of the tools

01:02:06.900 | that can help with insulin sensitization.

01:02:10.080 | Other tools that can help are inositol.

01:02:12.860 | So myoinositol is an insulin sensitizer.

01:02:16.220 | Its cousin, D-chiroinositol is a weak anti-androgen.

01:02:21.220 | A lot of types of inositol have both of those in it.

01:02:26.800 | So depending on if you're a female or a male

01:02:29.920 | and you're on inositol, the type of inositol does matter.

01:02:33.460 | - Yeah, this is a very important point.

01:02:35.620 | Just today I said, I'm trying this new supplement inositol

01:02:40.620 | for its role in perhaps enhancing sleep even further.

01:02:45.460 | My sleep's generally pretty good.

01:02:46.760 | Lately it's been a little bit off for a number of reasons.

01:02:48.620 | So I took it for the first time last night

01:02:50.620 | and I said, I thought it helped and just subjectively.

01:02:54.480 | And you said, what kind of inositol is it?

01:02:56.980 | Because inositol is a very potent androgen inhibitor.

01:03:00.180 | It turns out I was taking myoinositol,

01:03:02.600 | which is not an androgen inhibitor.

01:03:05.160 | The other type that you mentioned,

01:03:07.000 | which is an androgen inhibitor is?

01:03:09.300 | - D-chiroinositol.

01:03:11.180 | It's usually in a ratio of one to 25 or one to 40.

01:03:15.380 | In a much lower amount compared to myoinositol.

01:03:18.500 | - In a supplement or in the body?

01:03:20.100 | - In a supplement to help induce ovulation.

01:03:23.340 | - But for women who have PCOS,

01:03:25.740 | who might want to try and reduce androgen,

01:03:28.520 | then they would perhaps want to take a form of inositol

01:03:32.580 | that reduce the androgen receptor activity, correct?

01:03:35.060 | - They want both.

01:03:35.940 | So if you're a woman and you've ever talked to your doctor

01:03:38.300 | about getting it on the oral contraceptive

01:03:40.780 | or spironolactone, which is also an anti-androgen,

01:03:43.640 | but it happens to be a potassium sparing

01:03:46.120 | diuretic blood pressure medicine as well.

01:03:48.160 | D-chiroinositol might be a better option.

01:03:51.780 | DIM or diindomethane is other,

01:03:54.720 | another kind of weak anti-estrogen, anti-androgen

01:03:57.960 | that a lot of women should consider as well.

01:04:00.220 | - You mentioned oral contraception.

01:04:02.660 | I've done a few posts on these, let's just call them,

01:04:07.080 | they really are perceptual effects whereby

01:04:09.760 | it's been demonstrated in humans several times now

01:04:12.080 | in what appeared to me to be very solid studies

01:04:14.780 | where women that take oral contraceptives,

01:04:19.240 | there is both a shift in their perception of men,

01:04:23.320 | 'cause these studies only looked at heterosexual,

01:04:25.920 | the sort of arrangements here,

01:04:28.780 | where women who are on oral contraception,

01:04:32.740 | because it blunts some of the peaks and valleys

01:04:35.220 | of hormone output,

01:04:39.060 | no longer experience the same peaks and valleys

01:04:42.500 | in their assessment of other men's attractiveness.

01:04:44.680 | So it sort of flattens their perception, so to speak.

01:04:47.800 | They still find certain men attractive

01:04:49.520 | and certain men unattractive,

01:04:50.540 | but the degree of difference is kind of mellowed out.

01:04:55.540 | And likewise, these data say that

01:05:00.220 | men perceiving women's attractiveness,

01:05:04.740 | they still see women on oral contraceptives as attractive,

01:05:07.900 | but a woman taking oral contraception

01:05:11.340 | eliminates this kind of peak in her attractiveness

01:05:14.500 | that men would otherwise perceive.

01:05:16.180 | In other words, oral contraceptives are changing

01:05:17.980 | the way that we perceive each other,

01:05:19.460 | at least in terms of these male-female experiments.

01:05:23.460 | What is going on with that?

01:05:25.520 | Is that because oral contraceptives blunt

01:05:29.220 | the increase in testosterone that occurs

01:05:31.080 | just before ovulation?

01:05:33.020 | Or is it because of a complex cascade?

01:05:35.020 | What is going on?

01:05:35.900 | I find this fascinating.

01:05:37.240 | - Yeah, so there's differences in how your,

01:05:41.140 | and I wouldn't use the word change necessarily,

01:05:43.760 | but alter the severity or alter the peak, as you said.

01:05:48.760 | So it's just like TRT is not gonna change you as a person.

01:05:53.580 | An oral contraceptive will not change you as a person.

01:05:56.500 | It will just change your day-to-day peaks and troughs

01:06:01.140 | in libido and attractiveness.

01:06:06.420 | So one of the main effects of oral contraceptives,

01:06:09.240 | almost all of them have a synthetic estrogen

01:06:11.620 | and a synthetic progestogen in them.

01:06:14.220 | One common type of synthetic estrogen is ethyl estradiol.

01:06:18.120 | There is another new synthetic estrogen

01:06:20.440 | that's out there as well, but anecdotally,

01:06:22.580 | that seems to have even more side effects.

01:06:24.840 | So this ethyl estradiol is 100 times more potent

01:06:29.240 | than endogenous or bioidentical estradiol in the liver.

01:06:33.320 | So it binds to the estrogen receptor in the liver

01:06:36.560 | and it's going to increase sex hormone binding globulin,

01:06:39.720 | which secondarily, as you mentioned,

01:06:41.680 | decreases your free testosterone

01:06:43.760 | and especially your free DHT.

01:06:46.380 | So that little testosterone hump that you get

01:06:49.260 | when you're a female that's ovulating,

01:06:51.280 | that's really flatlined and it's already,

01:06:53.920 | it's a pretty insignificant difference.

01:06:56.920 | It's not negligible, but it's a little bit of a hump

01:06:59.800 | and you have significantly less of that

01:07:02.180 | when you're on oral contraceptive.

01:07:03.800 | - And does that blunt the associated increase in libido

01:07:06.320 | that normally would occur from that increase in androgen?

01:07:10.040 | - Yes. - Interesting.

01:07:11.480 | And what about other forms of contraception, right?

01:07:13.820 | 'Cause there are, there's copper IUD,

01:07:16.160 | there's various implants, there's rings,

01:07:19.800 | there's a huge number of different forms of these.

01:07:23.420 | So what we're talking about is, as I understand it,

01:07:26.240 | is only the effect of oral contraception

01:07:30.480 | that impacts hormone output, is that correct?

01:07:33.960 | - Yeah, there's a lot of other effects as well.

01:07:35.820 | For example, your choice of synthetic progestin

01:07:39.360 | will alter how high your platelets and SHBG go.

01:07:43.020 | It appears to be the higher your platelets

01:07:46.520 | and the higher your SHBG, the higher risk of a blood clot.

01:07:50.180 | So a lot of women know that

01:07:51.900 | if they're on an oral contraceptive

01:07:53.460 | and they're already predisposed to a blood clot

01:07:56.100 | or a venous thromboembolism in their vein,

01:07:58.940 | they have a blood clot in either their leg or their lung,

01:08:01.580 | then it can increase that chance.

01:08:03.900 | So you can choose a synthetic progestin

01:08:06.980 | that is not going to have as high of a response.

01:08:10.320 | But there's various pros and cons.

01:08:13.060 | Some synthetic progestins are weak anti-androgens as well.

01:08:16.900 | For example, there's one known as Slind,

01:08:19.280 | which is made from spironolactone.

01:08:21.700 | So some women are on spironolactone and that as well,

01:08:26.160 | which is made from spironolactone,

01:08:27.380 | which probably isn't particularly necessary

01:08:29.660 | unless they need it for a diuretic or hypertensive effect.

01:08:32.340 | - I see.

01:08:33.180 | I'm just going to intentionally interrupt and I apologize,

01:08:36.080 | but specifically because I wanted to ask about,

01:08:39.460 | there is this notion that, you know,

01:08:44.020 | that oral contraception taken over long periods of time

01:08:46.860 | can disrupt fertility in ways that are independent

01:08:50.060 | of just the age-related decrease in fertility.

01:08:54.580 | Is that true?

01:08:56.140 | - It depends on what you mean by a long time.

01:08:58.100 | Six to 12 months, it's possible.

01:09:00.460 | Past that, it seems very unlikely.

01:09:03.580 | However, the persistently elevated SHBG

01:09:06.980 | can be present for quite some time.

01:09:08.780 | - Wait, so if a woman takes oral contraception

01:09:11.300 | for six to 12 months and then stops,

01:09:13.780 | will she essentially be where she would have been anyway

01:09:17.440 | in terms of her fertility at that age?

01:09:19.820 | Or are you saying that it can cause permanent damage?

01:09:22.920 | - Her fertility would be equitable

01:09:25.360 | as if she had never taken it,

01:09:26.880 | if she's certainly 12 months, but probably six months off.

01:09:29.920 | - And what if she,

01:09:30.960 | I know of women that have taken an oral contraception

01:09:32.840 | for many years.

01:09:34.720 | In addition to the age-related decline in fertility

01:09:37.040 | that occurs, that's inevitable.

01:09:39.320 | Of course, the slope is going to be different

01:09:40.800 | depending on the individual,

01:09:42.640 | but are they quickening the transition to infertility?

01:09:47.640 | - Probably not.

01:09:52.820 | You could make a case that because they've been an oral

01:09:55.580 | contraceptive, they may have been slightly more predisposed

01:09:59.820 | to insulin resistance and/or lower lean body mass,

01:10:04.820 | but that's probably going to be a negligible difference

01:10:08.860 | compared to their resistance training

01:10:10.500 | and also their caloric restriction or caloric maintenance.

01:10:13.780 | - So of course, there are also effects of having children.

01:10:16.080 | - Yeah. - Yeah.

01:10:17.240 | I mean, on all these parameters, right?

01:10:18.920 | 'Cause it's a major lifestyle shift, right?

01:10:22.300 | That obviously people contend with and have first

01:10:26.020 | since the beginning of human time anyway.

01:10:29.120 | I want to ask some questions about male hormone therapy

01:10:34.180 | and male hormones generally.

01:10:35.340 | But before I do that,

01:10:36.340 | I have a couple of burning questions that I get very often

01:10:39.840 | that I'm just going to insert now.

01:10:41.540 | Marijuana.

01:10:43.940 | I've heard that it can decrease testosterone

01:10:47.660 | in men and women.

01:10:48.820 | I've heard that it can increase testosterone.

01:10:51.940 | Alcohol.

01:10:53.340 | I think there's general consensus that high alcohol intake,

01:10:57.980 | high barbiturate intake does in fact reduce testosterone.

01:11:01.740 | What about modest increase of alcohol?

01:11:03.700 | I'm not a drinker,

01:11:04.520 | so I'm not asking these questions for me.

01:11:05.980 | I don't smoke pot and quite over.

01:11:07.420 | I just never really liked marijuana or alcohol.

01:11:10.020 | They're not my thing.

01:11:11.140 | But many people want to know the answers to these.

01:11:14.140 | And the data that I've seen are very confused

01:11:17.100 | and conflicting.

01:11:18.320 | So what about marijuana?

01:11:19.260 | Does it reduce testosterone to a significant degree or not?

01:11:23.420 | - Cannabinoids itself, whether it's THC or CBD,

01:11:27.220 | are not going to reduce testosterone by themselves.

01:11:30.700 | If it's smoked marijuana,

01:11:32.940 | then it's very likely to increase your aromatase,

01:11:36.620 | which increases your estrogen.

01:11:39.300 | And it's aromatizing from testosterone.

01:11:43.340 | So that is going to decrease testosterone.

01:11:45.740 | When you have an increased estrogen, like estradiol,

01:11:49.260 | that's going to work on your pituitary

01:11:51.060 | to make less hormones that cause the release of testosterone.

01:11:55.260 | So you're going to have less LH and less FSH.

01:11:58.900 | So it's almost kind of like, you know,

01:12:00.940 | opiates are well known to opiate agonists.

01:12:04.960 | They're going to decrease LH and FSH

01:12:08.380 | and subsequently testosterone.

01:12:09.900 | Smoked marijuana will as well.

01:12:12.580 | As far as alcohol, high alcohol will decrease testosterone

01:12:15.860 | as will any very potent GABA agonist,

01:12:19.200 | whether it's a barbiturate or benzodiazepine

01:12:21.380 | or a non-benzo or alcohol, they're definitely going to.

01:12:24.440 | Moderate alcohol, I guess it depends

01:12:26.980 | on what your definition of that is.

01:12:28.700 | The American- - I guess I'm thinking like,

01:12:31.340 | some people I know that don't seem to be alcoholics,

01:12:33.980 | at least by my, you know, assessment,

01:12:36.700 | will have a glass or two of wine four nights a week,

01:12:40.900 | which to me seems like a tremendous amount

01:12:43.620 | only because I don't like alcohol.

01:12:46.060 | I don't have a problem with other people liking alcohol,

01:12:48.100 | but I think for many people,

01:12:50.320 | that would be considered low or moderate intake.

01:12:52.780 | - Yeah, I would consider that low intake.

01:12:55.580 | The American Heart Association for men recommends

01:12:59.400 | between one and two drinks a day on average.

01:13:02.220 | - They recommend it?

01:13:03.300 | - Yeah, so around one per week.

01:13:04.740 | - Wait, so I'm making my heart less healthy

01:13:06.380 | by not drinking alcohol?

01:13:07.740 | - Yeah, they recommend a very low amount of alcohol intake

01:13:11.540 | for men.

01:13:12.360 | For women, they recommend zero to one.

01:13:14.760 | So that's kind of hard to interpret, zero to one.

01:13:17.220 | But the protective effect of alcohol,

01:13:20.460 | especially if it's a red wine with polyphenols in it,

01:13:25.360 | outweighs the deleterious effect.

01:13:28.460 | - Interesting, 'cause I've seen some studies

01:13:29.820 | that point to the idea that even low intake of alcohol

01:13:34.540 | over a prolonged period of time

01:13:35.660 | might actually decrease brain volume

01:13:37.940 | or at least volume of particular brain areas.

01:13:39.860 | But of course, we don't know the consequence

01:13:41.160 | of decreasing the volume of a given brain area either.

01:13:44.460 | I mean, one could imagine it's decreasing

01:13:45.860 | the size of one's amygdala and making them less stressed,

01:13:47.900 | although there's no evidence to support that.

01:13:49.660 | I've been told that I need a drink many, many times,

01:13:52.160 | but I always reply to I don't need to drink anything

01:13:54.620 | in order to speak my mind.

01:13:55.820 | So again, individual differences.

01:13:59.020 | Very interesting, so it sounds like smoked marijuana

01:14:01.720 | may in fact reduce testosterone

01:14:04.260 | or at least increase the conversion

01:14:06.020 | of testosterone to estrogen, correct?

01:14:07.420 | - Yeah. - Okay.

01:14:08.260 | - And with alcohol and GABA agonist,

01:14:10.060 | it's important to remember that it shouldn't be daily.

01:14:12.780 | So one drink of alcohol a day

01:14:14.820 | is actually very mildly immunosuppressive.

01:14:17.540 | So it's better to have two drinks of alcohol

01:14:20.820 | one day of the week,

01:14:21.680 | and then two more drinks of alcohol another day of the week,

01:14:24.700 | and then no alcohol the rest of the time.

01:14:26.920 | The same could be said even for supplements

01:14:29.060 | that have GABA in them.

01:14:30.340 | A lot of sleep supplements have immunobutyric acid,

01:14:33.460 | which is GABA, so. - I occasionally take,

01:14:34.700 | oh, sorry to interrupt.

01:14:35.540 | I occasionally take 100 to 200 milligrams of GABA

01:14:39.100 | in order to enhance sleep,

01:14:40.100 | but I do it maybe every third or four nights,

01:14:42.740 | no more than three or four nights a week.

01:14:44.900 | - Yeah. - Yeah.

01:14:45.820 | - That's perfect. - Okay.

01:14:46.940 | - So there's a lot of sleep supplements

01:14:48.780 | that should not be taken daily, and GABA is one of them.

01:14:52.640 | Another one of them is trazodone,

01:14:55.520 | and melatonin is kind of arguable,

01:14:58.620 | and it depends on the situation.

01:15:00.600 | But in general, if you're taking a sleep supplement,

01:15:02.860 | it should not be taken every night.

01:15:05.020 | - The sleep supplements that I understand are okay

01:15:07.520 | to take every night or nearly every night

01:15:10.080 | are things like magnesium threonate, apigenin.

01:15:13.400 | If that's not true, correct me.

01:15:15.680 | I certainly take them every night

01:15:16.940 | unless I forget them back home when I'm traveling.

01:15:20.140 | - Magnesium is one of the exceptions.

01:15:21.900 | L-theanine is also another exception.

01:15:24.680 | - Great, well then at least I haven't put anything

01:15:26.420 | into the world that's wrong in that category yet,

01:15:31.220 | and hopefully I won't.

01:15:32.140 | But if I do, I'll correct myself.

01:15:34.340 | So let's talk about testosterone in males.

01:15:37.220 | You see these headlines all the times

01:15:40.540 | now that testosterone levels are dropping,

01:15:43.980 | sperm counts are dropping,

01:15:45.460 | phenotypes of men are changing over time,

01:15:48.980 | and I can't quite follow the literature on that

01:15:51.700 | because obviously those are hard controlled experiments

01:15:54.740 | to do because techniques change over time

01:15:58.660 | and sensitivity of techniques change over time.

01:16:01.120 | But regardless, I'm aware that a lot of people

01:16:05.020 | are considering increasing their testosterone

01:16:08.180 | by taking testosterone.

01:16:09.780 | A few years ago, that was considered steroid use

01:16:12.260 | and it was really extreme kind of stance.

01:16:14.740 | Nowadays, it seems like there's more discussion about it.

01:16:17.480 | First off, I'd like to know,

01:16:18.880 | does testosterone supplementation,

01:16:22.740 | and here I'm talking about prescription from a doctor,

01:16:25.540 | does it make one more prone to prostate cancer?

01:16:28.700 | That seems to always be the first question that comes out.

01:16:31.780 | - Yeah, and there is a huge amount of misinformation

01:16:34.480 | about this too.

01:16:35.840 | So testosterone is not going to cause a prostate cancer.

01:16:40.160 | However, normal aging causes prostate cancer

01:16:43.820 | and testosterone will grow your prostate cancer.

01:16:47.380 | So if you're a 80 year old male and you have an autopsy

01:16:52.840 | and there's at least a 50% chance

01:16:54.820 | that you have a prostate cancer,

01:16:56.480 | if you're 90 or a hundred years old,

01:16:58.180 | there's at least a 90% chance.

01:17:00.580 | So for humans with a prostate,

01:17:04.140 | it's only a matter of time until you get a prostate cancer.

01:17:07.660 | So that begs the question,

01:17:08.860 | do you want to take something that's going to grow it

01:17:11.140 | for sure once you have it?

01:17:13.840 | So it's an individual assessment

01:17:15.980 | and it's important to follow things like PSAs as well.

01:17:18.840 | - So a PSA of four or less,

01:17:21.820 | I mean, ideally you wouldn't be at four

01:17:23.160 | 'cause that's kind of the upper threshold,

01:17:24.740 | is the simplest readout of whether or not

01:17:27.200 | there's excessive prostate growth.

01:17:29.800 | There's benign prostate hyperplasia

01:17:31.500 | where the prostate is growing,

01:17:33.320 | but it's non-cancerous, correct?

01:17:35.720 | And then of course there are the symptomologies,

01:17:37.640 | like people have challenges of urination,

01:17:39.640 | they have sexual difficulties, et cetera.

01:17:42.080 | I'm always struck by the correlation

01:17:45.180 | that people draw between testosterone and prostate health.

01:17:48.440 | And the fact that, or I should say the claim

01:17:50.760 | that testosterone makes prostate health worse,

01:17:52.640 | because if you think about it,

01:17:53.920 | young males have high testosterone often,

01:17:57.320 | if not always, certainly often,

01:18:00.120 | and you don't see a lot of prostate overgrowth

01:18:04.100 | and cancer in young males.

01:18:05.840 | So something's going on here.

01:18:07.600 | How should we conceptualize this?

01:18:10.000 | - So if you have a PSA of 3.9

01:18:12.800 | and you're a 25 year old male versus a 75 year old male,

01:18:17.800 | and you have a PSA of 5.9,

01:18:21.480 | the 3.9 PSA is significantly more concerning.

01:18:25.260 | So think of your prostate as taking cumulative damage

01:18:29.400 | from not only testosterone,

01:18:31.380 | but also estrogen and also growth hormone.

01:18:34.920 | So that's why obese individuals

01:18:37.160 | have higher incidences of prostate cancer as well.

01:18:39.880 | It's because they don't have those cell checkpoints

01:18:42.920 | where your immune system takes a second and says,

01:18:46.560 | "All right, stop replicating as fast prostate cells.

01:18:50.480 | Let's see if there's any atypical ones."

01:18:52.080 | And then it finds those

01:18:53.600 | and it prevents them from reproducing.

01:18:56.080 | That's why immunotherapy and cancer is so promising

01:18:58.480 | is because they can target these certain things.

01:19:01.600 | So the older male is going to have

01:19:05.000 | that cumulative damage happen already.

01:19:07.840 | And arguably prostate cancer is a normal,

01:19:11.980 | with aging, fast aging is abnormal,

01:19:18.880 | very slow aging is normal.

01:19:21.760 | There's a fine line to walk between those two,

01:19:25.200 | but there's a lot of things that can be done

01:19:27.260 | to decrease the turnover, decrease the inflammation,

01:19:30.160 | and decrease the congestion of the prostate over time.

01:19:33.880 | There's also a lot more than just PSAs that can be done.

01:19:36.240 | There's prostate MRIs and things like that

01:19:38.400 | that can look at the structure

01:19:40.000 | and the function of the prostate.

01:19:41.260 | - So what should every male do

01:19:42.560 | to maintain the health of their prostate?

01:19:44.260 | And I realized that younger males

01:19:45.440 | probably aren't thinking about it at all.

01:19:46.640 | Although it seems like nowadays,

01:19:48.880 | I get these kind of what I call cryptic questions.

01:19:52.480 | I think women are more comfortable

01:19:53.760 | talking about their hormone and sexual health

01:19:55.580 | because of menstrual cycles.

01:19:59.040 | They're used to fluctuations that sort of give them

01:20:02.160 | the experience of what it's like to have different levels

01:20:04.160 | of progesterone, estrogen, testosterone, et cetera.

01:20:06.600 | But I get these kind of cryptic questions

01:20:08.480 | often in my direct messages

01:20:10.040 | where what I think people are asking is,

01:20:12.680 | is there something wrong with my prostate?

01:20:16.160 | What should I do for my prostate?

01:20:17.560 | These are often indirect questions

01:20:18.720 | for other aspects of their life where they're suffering.

01:20:21.560 | And I don't say that in jest.

01:20:23.280 | I think more direct discussion would be great.

01:20:26.760 | So what should all males do to maintain prostate health

01:20:31.760 | throughout the lifespan?

01:20:34.240 | - Maintaining prostate health can be looked at similarly

01:20:37.120 | how you can maintain a good, natural, optimal testosterone.

01:20:40.960 | So you look for things that can hurt it.

01:20:42.720 | You don't necessarily look for one thing

01:20:45.000 | that can improve it or boost it.

01:20:47.320 | So for young males, those are prostatitis.

01:20:51.000 | So it goes hand in hand with epididymitis.

01:20:54.120 | So different infections of the prostate.

01:20:56.920 | The younger the male is, the more likely it is related

01:20:59.640 | to something that could be sexually transmitted.

01:21:02.940 | But another very common cause is what we call

01:21:05.960 | gram-negative and anaerobic bacteria.

01:21:08.920 | The prostate is right by the end of the colon.

01:21:14.340 | So if you have chronic constipation or if you have colitis,

01:21:18.880 | or if you have, you know, even just an E. coli overgrowth

01:21:22.480 | in the colon is very likely to cause an infection

01:21:25.920 | of the prostate as well.

01:21:27.580 | - What should males do to prevent that?

01:21:30.140 | - Have a diet that has good, healthy prebiotic fiber,

01:21:34.460 | probiotics as well.

01:21:35.940 | Make sure that they're having regular bowel movements,

01:21:39.260 | that they don't have chronic constipation.

01:21:41.580 | Have good sources of dietary fiber,

01:21:43.500 | which is also known as soluble fiber

01:21:45.320 | and enough insoluble fiber.

01:21:47.000 | Most people get enough insoluble or non-dietary fiber.

01:21:50.600 | So that can help prevent the chance of diverticulitis,

01:21:54.880 | which is another type of infection.

01:21:57.360 | It can also decrease the chance of colitis

01:21:59.800 | and decrease the chance of prostate infections as well.

01:22:02.840 | - Are there any foods and/or supplements

01:22:06.260 | that men should take or avoid?

01:22:08.400 | What about, you hear about salt palmetto.

01:22:12.280 | Yeah, supplements for, or supplements that support

01:22:16.160 | or cause issues for the prostate.

01:22:18.520 | - Yeah, if there's a strong genetic predisposition

01:22:21.340 | to enlarged prostates,

01:22:23.560 | or even just really early prostate cancers that grow fast,

01:22:27.320 | then they could consider taking salt palmetto

01:22:29.920 | or even curcumin as an anti-androgen,

01:22:32.160 | as long as they're able to tolerate it.

01:22:33.920 | It's an individualized basis and depends on their history.

01:22:37.260 | As far as making sure that their prostate

01:22:41.880 | is not congested, there's an interesting correlation

01:22:44.700 | between having girls and having prostate cancer.

01:22:49.120 | - Having girls offspring.

01:22:50.360 | - So if your offspring are females,

01:22:53.240 | then you're slightly more likely to have prostate cancer.

01:22:56.880 | There is some, there's hypotheses that link estrogen

01:23:01.320 | to prostate cancer rather than testosterone.

01:23:04.440 | So if you have hyper-estrogenism,

01:23:06.840 | your prostate has more atypical cells.

01:23:10.760 | In general, the higher your C-reactive protein,

01:23:13.720 | which is the general marker of inflammation in your body,

01:23:16.060 | we call it CRP, and the test order is HS-CRP,

01:23:20.480 | or high sensitivity CRP.

01:23:22.920 | If your CRP raises up very high,

01:23:26.300 | if you have an autoimmune disease,

01:23:27.960 | like if you have a Crohn's flare,

01:23:29.840 | or if you have a lupus or an infection

01:23:33.040 | or a sexually transmitted infection,

01:23:35.580 | or even a colitis or even the flu,

01:23:38.180 | your CRP is gonna raise significantly.

01:23:40.480 | - That you would detect in a blood test, of course.

01:23:42.160 | - Correct, yeah.

01:23:43.000 | So you wanna get a baseline CRP

01:23:44.640 | when you haven't had any of those things recently.

01:23:47.980 | And if your CRP is higher,

01:23:49.980 | you also have more female offspring.

01:23:52.720 | If your CRP is higher, then your reactive oxygen species,

01:23:56.820 | which are causing mutations and atypical cell turnover

01:24:00.200 | in the prostate, are also likely higher.

01:24:02.760 | So you wanna keep a very low CRP.

01:24:05.440 | - Interesting.

01:24:06.280 | And what about blood flow and pelvic floor in general?

01:24:09.360 | - We should probably do a whole episode on pelvic floor.

01:24:11.540 | There's so much interesting data

01:24:14.160 | coming out of the fields of clinical and research urology.

01:24:17.640 | I realize it's kind of the Netherlands

01:24:19.140 | of biology and medicine.

01:24:20.780 | People probably aren't thinking so much about this,

01:24:22.460 | but pelvic floor is obviously a confluence

01:24:26.280 | of a ton of vasculature, of nerves,

01:24:29.360 | and of course the prostate resides there,

01:24:31.100 | and of course the genitals reside there as well.

01:24:33.820 | So I would imagine that one of the six pillars,

01:24:38.120 | you know, exercise,

01:24:39.400 | being able to maintain adequate blood flow

01:24:42.320 | to those regions is key.

01:24:43.960 | What about just postural things?

01:24:45.220 | People sitting too much, not hydrating well enough.

01:24:49.380 | You mentioned avoiding constipation.

01:24:51.580 | What are some other things,

01:24:52.720 | including medications that can serve

01:24:54.640 | to support the prostate over time,

01:24:56.780 | and maybe even support pelvic floor in general,

01:24:59.360 | both in males and females over time?

01:25:01.640 | - Absolutely.

01:25:02.480 | And this is something that's rightfully

01:25:03.920 | getting more and more attention.

01:25:05.460 | The way I explain the pelvic floor is your abdominal cavity,

01:25:09.520 | which includes your peritoneum,

01:25:11.080 | or where most of your organs are,

01:25:12.760 | your retroperitoneum, your pelvic space.

01:25:15.460 | Think of it as a box,

01:25:16.660 | and your abs are the front of the box.

01:25:18.760 | Your back muscles are the back.

01:25:20.320 | Your diaphragm is the top of the box,

01:25:22.600 | and your pelvic floor,

01:25:24.080 | that's where your port is to the outside world.

01:25:26.760 | Especially important, it has muscles as well,

01:25:29.680 | and you can do exercises.

01:25:31.040 | Pelvic floor physical therapists are becoming more

01:25:33.620 | and more utilized, especially after childbirth,

01:25:35.800 | but in other situations as well,

01:25:37.560 | including by men getting care from urologists.

01:25:41.480 | So you want to both strengthen that pelvic floor,

01:25:44.720 | and make sure that the tubes that are docked

01:25:48.480 | to the outside world are working well enough,

01:25:51.780 | but they're not too loose, they're not working too well.

01:25:54.680 | So there's a lot of medications that can be positives

01:25:59.420 | or negatives for your pelvic floor.

01:26:01.820 | We kind of talked about your gut and colon health in general.

01:26:05.080 | As far as your prostate health,

01:26:07.040 | and as far as your bladder and urinary system health,

01:26:11.380 | you think about a couple of different classes.

01:26:13.160 | So you have your phosphodiesterases,

01:26:14.940 | you have your Tidalofil.

01:26:16.340 | Basically, this is going to help decrease congestion

01:26:20.860 | in the prostate.

01:26:22.620 | A lot of people take it for ED,

01:26:25.020 | but it can actually help you decrease your-

01:26:26.760 | - Do you define that?

01:26:27.680 | - A lot of men take Tidalofil, it's generic as Cialis,

01:26:31.600 | as a much longer half-life than Viagra or Levitra.

01:26:34.160 | It's half-life is almost a day.

01:26:36.120 | So you can take a very low dose of it.

01:26:37.640 | Instead of taking 20 milligrams,

01:26:39.080 | you take two or two and a half milligrams.

01:26:41.040 | - So they're taking, you're saying that a lot of men

01:26:42.960 | take it for erectile dysfunction,

01:26:45.600 | but that at lower doses, it may have served purposes

01:26:49.640 | for prostate health independent of erection.

01:26:53.300 | - Correct.

01:26:54.140 | The most common scenario is if a male is waking up twice

01:26:57.960 | at night to pee, on average, it'll cut that down to once.

01:27:01.420 | So if they're waking up at four times at night,

01:27:03.600 | then it can cut that down to twice at night,

01:27:05.800 | just because you have easier blood flow.

01:27:07.480 | We used to use other medications like Flomax,

01:27:09.820 | which is Tamsulosin.

01:27:11.520 | That's an alpha antagonist.

01:27:13.000 | So it basically binds to a receptor in smooth muscle

01:27:16.400 | and it helps relax that.

01:27:18.920 | There's several other alpha antagonists.

01:27:21.720 | And then you also have your medications that are hormonal,

01:27:24.000 | like finasteride, that a lot of people take

01:27:26.340 | for prostate health to decrease the enlargement

01:27:28.620 | of the prostate.

01:27:29.840 | The periurethral area or periurethral lobe,

01:27:33.360 | there are several lobes of the prostate,

01:27:35.960 | that tends to be especially enlarged in cases of BPH.

01:27:39.820 | - And BPH?

01:27:41.540 | - Prostate hyperplasia or an enlarged prostate.

01:27:45.060 | And if you are able to shrink that area,

01:27:48.060 | then at that point it's just a plumbing problem

01:27:51.240 | and the urine is able to get by easier.

01:27:53.700 | - Yeah, my understanding is that now there's a growing,

01:27:57.240 | I don't want to say a movement, but take,

01:28:00.640 | the idea of taking very low dose,

01:28:03.160 | like 2.5 milligram or five milligram to Dallafil,

01:28:06.560 | even daily is becoming pretty common for many men

01:28:10.440 | who do not have erectile dysfunction,

01:28:12.620 | simply to either maintain or enhance prostate health.

01:28:16.040 | Is that correct?

01:28:17.240 | - Yeah, that's correct.

01:28:18.080 | - And are there,

01:28:18.920 | do you see any negative effects of doing that?

01:28:21.880 | - There can be negative effects.

01:28:23.320 | It can lower blood pressure.

01:28:24.760 | So theoretically it can increase your chance

01:28:27.320 | of vasovagal syncope.

01:28:29.400 | A lot of people take it as a alternative to pump

01:28:32.300 | because it kind of works similarly to citrulline

01:28:35.180 | or a different pump products in pre-workout.

01:28:38.760 | And it can certainly help with that.

01:28:40.220 | But if you're about to go do a deadlift

01:28:42.400 | where you might pass that anyway,

01:28:44.000 | it can certainly increase the chance that that happens

01:28:46.660 | because you don't have that compensatory

01:28:48.640 | exercise hypertension response.

01:28:51.400 | - Could someone just take it away from exercise?

01:28:54.560 | - They could.

01:28:55.760 | If you took to Dallafil then that's gonna be,

01:28:59.120 | has a long half-life.

01:29:00.960 | Whereas Viagra and Levitra is just a few hours.

01:29:03.760 | Dallafil is almost a day.

01:29:05.480 | Some interesting studies on Viagra have been done as well.

01:29:09.520 | It can potentially alter your rays and cones in your eye.

01:29:13.600 | So the usual recommendation for pilots

01:29:17.400 | that need to have red-green discrimination

01:29:19.920 | from very long distances with very small indicator lights

01:29:23.600 | is to not take Viagra.

01:29:26.400 | So I usually say, if you're a pilot

01:29:28.640 | and that's your profession,

01:29:29.800 | perhaps hold off from that for a while.

01:29:31.940 | There's also studies with Viagra that significantly,

01:29:34.960 | which is also known as sildenafil as the generic now,

01:29:38.560 | it can increase eyebrow hair growth.

01:29:41.080 | So potentially what it does is it helps vasodilate

01:29:45.380 | and relax the veins, especially in older men.

01:29:48.320 | And when those veins are relaxed,

01:29:50.080 | you have better blood flow.

01:29:51.960 | That's one of the proposals or theories

01:29:54.660 | behind why older men get the androgenetic alopecia more.

01:29:59.280 | You're having less blood flow in the scalp.

01:30:01.440 | So theoretically it can also help prevent that.

01:30:04.200 | - So in theory increasing blood,

01:30:06.180 | oh, because it increases blood flow

01:30:08.000 | systemically throughout the body,

01:30:09.600 | not just in specific tissues.

01:30:12.560 | Well, I find it incredibly interesting that, yeah,

01:30:14.960 | there are these online forums building up now

01:30:16.760 | around low dose to Dallafil,

01:30:20.840 | daily use of low dose to Dallafil.

01:30:22.640 | Again, not for sexual or erectile dysfunction,

01:30:26.000 | but for sake of long-term prostate health.

01:30:29.220 | Is there any reason why women might want

01:30:31.280 | to take low dose to Dallafil?

01:30:33.300 | - To Dallafil is also a weak androgen receptor sensitizer,

01:30:39.920 | kind of like L-carnitine where the density

01:30:43.040 | of the available androgen receptors to bind

01:30:46.140 | increases slightly.

01:30:48.120 | So there could potentially be a benefit from that,

01:30:52.520 | but most of the time it's used in men.

01:30:55.080 | - Very interesting.

01:30:55.980 | We haven't really talked about testosterone

01:30:59.600 | and optimizing testosterone in males.

01:31:01.760 | Assuming someone is paying attention to the six pillars,

01:31:05.760 | there's a kind of a gap as I see it between

01:31:10.880 | doing all those things and TRT, hormone replacement therapy.

01:31:15.800 | And again, the R, the replacement in TRT

01:31:18.960 | is a little bit of a, in quotes nowadays,

01:31:21.980 | because a lot of people who have testosterone

01:31:24.980 | in that 300 to 900 nanogram per deciliter range

01:31:28.700 | opt to take low dose testosterone anyway.

01:31:30.920 | My understanding is that there've been

01:31:34.600 | new kind of movements in this area toward, for instance,

01:31:38.080 | not doing big, large doses injected infrequently,

01:31:43.720 | but rather low doses quite frequently,

01:31:46.380 | obviously prescribed by a doctor,

01:31:47.640 | monitored by a doctor, et cetera.

01:31:49.960 | Is that generally what you like to see in your patients

01:31:53.240 | if they're going to take this route?

01:31:55.360 | - If they're a hypogonadal patient

01:31:57.120 | whose benefits outweigh risks of TRT,

01:32:01.800 | then you want to have a nice, even steady state.

01:32:05.100 | It's not going to be exactly the same as producing

01:32:07.720 | pulsatile testosterone release endogenously

01:32:11.480 | from your own body.

01:32:12.840 | When you have a steady state,

01:32:14.740 | you don't have a peak or a trough.

01:32:16.320 | And when you have a peak,

01:32:17.720 | that's when the androgen receptor gene is overactive.

01:32:20.840 | That's when you get more erythropoietin or EPO release.

01:32:24.200 | And that leads to a lot of the side effects of thick blood,

01:32:27.560 | so higher hemoglobins and hematocrits.

01:32:30.000 | And then when you have a crash, you don't feel good.

01:32:33.920 | So it's definitely not optimal.

01:32:37.040 | There's a lot of ways to get around this.

01:32:38.960 | So when you're doing testosterone replacement,

01:32:41.560 | if you're someone that needs it,

01:32:43.440 | you can have different types of esters

01:32:46.000 | or you could do topical testosterone.

01:32:48.560 | So the ester is basically something that's attached

01:32:52.160 | to increase the biological half-life.

01:32:54.760 | The most common ones are cipunate and anthate.

01:32:57.300 | There's also a very short-acting propionate,

01:32:59.320 | which has almost no clinical relevance.

01:33:01.720 | And there's also very long-acting ones,

01:33:03.780 | decanoate and undecanoate,

01:33:05.980 | and different mixtures of all those.

01:33:08.660 | So if you're someone who has a very, very low SHBG,

01:33:12.580 | you're going to have trouble

01:33:14.180 | of regulating your serum testosterone in the long run.

01:33:17.540 | If you do it topically, then the testosterone is absorbed,

01:33:20.180 | hopefully bound to SHBG.

01:33:22.260 | And then a lot of times you reapply twice daily

01:33:24.140 | or once daily, but you have lots of variations.

01:33:26.940 | So for most people,

01:33:28.540 | especially for people who can absorb it well,

01:33:31.580 | that's not going to be a great option.

01:33:33.060 | - So injections would be preferred.

01:33:34.740 | - Most people end up injecting

01:33:36.660 | because they have either side effects from too high, too low,

01:33:39.980 | or just too much of a varied dose when they do topical.

01:33:43.300 | There's also a capsule with a special lymphatic absorption.

01:33:47.620 | So it's not being absorbed through the liver.

01:33:49.540 | It's not hepatically metabolized,

01:33:51.000 | but it's absorbed through the lymph.

01:33:52.960 | And it's essentially testosterone undecanoate

01:33:56.260 | and then put into a capsule.

01:33:58.380 | So, and that's taken twice daily.

01:34:01.260 | It has fairly steady half-lives,

01:34:03.100 | but you have to take it at specific times of the day.

01:34:05.780 | So that being said,

01:34:07.420 | and it's new enough to where there isn't a huge amount

01:34:09.780 | of data on it, but it is FTA approved.

01:34:12.500 | So it is brand name now.

01:34:14.920 | It's called Jotenzo, but the injectables in general,

01:34:19.520 | the lower your SHBG, the longer of an ester you want,

01:34:23.260 | because when you inject it,

01:34:24.900 | whether it's intramuscular or subcutaneous,

01:34:26.940 | just talk to your doctor about the risks

01:34:28.620 | and the benefits of those.

01:34:29.540 | Subcutaneous has slightly longer active half-life

01:34:32.100 | because the esterases take longer to reach

01:34:34.340 | that cipunate or an ester to cleave it.

01:34:37.780 | So most men, a lot of people ask me about

01:34:40.940 | like what a usual dose is.

01:34:42.520 | For most people, it would be a total of about 100 to 120

01:34:47.100 | per week for an actual replacement dose.

01:34:49.560 | - Milligrams. - Milligrams.

01:34:51.020 | 120 to 100 milligrams per week,

01:34:53.940 | administered two to three times per week.

01:34:56.180 | - And you're not, so you're saying dividing that

01:34:58.280 | into two or three, right?

01:34:59.620 | 'Cause I'm sure there are a bunch of people

01:35:00.540 | out there thinking, oh yeah, 100 three times a week,

01:35:02.640 | which is actually quite, quite high dose.

01:35:04.720 | Yeah, there really does seem to be a shift

01:35:07.220 | toward spreading these dosages out into,

01:35:10.800 | dividing them into two or three smaller doses.

01:35:13.560 | And then along those lines, five, 10 years ago,

01:35:18.440 | it was common to hear about inhibiting estrogen

01:35:21.020 | through aromatase inhibitors.

01:35:22.460 | Nowadays you hear, and I think it's true,

01:35:25.180 | at least by my read of the literature,

01:35:27.120 | that that inhibiting estrogen can disrupt brain function,

01:35:30.280 | can cause connective tissue issues,

01:35:32.160 | and even can cause reductions in libido.

01:35:35.160 | So a lot of people think that estrogen,

01:35:38.560 | if you crash estrogen, that basically libido goes up,

01:35:42.040 | but actually the opposite is often true.

01:35:43.680 | You don't want estrogen too high or too low.

01:35:45.720 | Is that correct?

01:35:46.560 | And for that reason,

01:35:47.420 | do you shy away from people taking aromatase inhibitors?

01:35:53.640 | - Yeah, very few people truly need an aromatase inhibitor.

01:35:58.800 | There's almost always lifestyle interventions.

01:36:01.800 | It can just depend on which gene,

01:36:04.160 | how active your aromatase gene is.

01:36:06.280 | Some people's aromatase gene is very active.

01:36:09.200 | A lot of times these individuals

01:36:10.920 | have pubertal gynecomastia,

01:36:13.760 | which is breast tissue growth in males,

01:36:16.240 | even despite no other risk factor.

01:36:18.360 | - Even if they're lean?

01:36:19.600 | - Some people get it if they're lean.

01:36:22.320 | - I remember growing up, there were a few kids

01:36:24.120 | that got mild cases of gynecomastia that were transient.

01:36:27.800 | Like it's sort of like they developed gynecomastia

01:36:29.960 | and then it went away.

01:36:31.320 | Often it's unilateral on one side too.

01:36:33.880 | So growth hormone a lot of times is the fuel to that fire.

01:36:38.080 | - Oh, interesting.

01:36:39.240 | Yeah, there were a couple of kids.

01:36:40.360 | I mean, they took some teasing 'cause back then

01:36:42.640 | there wasn't online discussions about hormones

01:36:45.680 | and things like that, but then it would seem transient.

01:36:48.060 | And they were, the people I'm thinking of

01:36:49.760 | were actually lean individuals.

01:36:51.520 | So they weren't overweight,

01:36:52.640 | which of course can cause gynecomastia

01:36:54.880 | because adipose fat tissue

01:36:57.440 | can convert testosterone into estrogen.

01:37:00.240 | - So it sounds like, except in special cases,

01:37:02.440 | that avoiding aromatase inhibitors

01:37:05.200 | is probably gonna be a good idea.

01:37:07.240 | - There's several other ways

01:37:08.120 | that you can control your estrogen

01:37:09.640 | and keep it at a healthy level,

01:37:11.120 | which you do have to check.

01:37:12.200 | There's a lot of patients who assure me

01:37:14.980 | that their estrogen is going to be sky high

01:37:16.920 | and it's actually very low and vice versa.

01:37:20.020 | But calcium D-glucarate is a supplement

01:37:22.600 | that can help with estrogen control.

01:37:24.480 | - What's a typical dosage of calcium D-glucarate?

01:37:26.920 | - 500 to 1000 milligrams.

01:37:28.960 | - But is there the risk that if someone's estrogen

01:37:31.160 | is in normal range and they take the supplement

01:37:33.920 | that their estrogen will go too low?

01:37:35.600 | Is it that potent?

01:37:37.460 | - It's not that potent.

01:37:38.360 | It's not near as potent as an aromatase inhibitor.

01:37:40.640 | So it helps with excretion

01:37:42.440 | and also the sensitivity of the estrogen receptor itself.

01:37:46.100 | It kind of like helps out-compete it.

01:37:48.760 | Some people will also take DIM

01:37:50.720 | or different cruciferous vegetable.

01:37:53.900 | They get them from cruciferous vegetables like kale,

01:37:57.960 | but, or broccoli.

01:37:59.840 | And that is both an anti-estrogen and an anti-androgen.

01:38:04.680 | So if you're on TRT and you're on that,

01:38:07.000 | then you're probably just on too much TRT.

01:38:09.240 | - Yeah, I remember a few years ago I had a friend

01:38:10.840 | and it truly is, it's not like I have a friend's thing.

01:38:13.800 | 'Cause I'm very cautious about which supplements I take.

01:38:15.840 | I think people might get the impression

01:38:17.520 | that I'm very cavalier about this, but I'm not.

01:38:19.640 | I always alter one thing at a time.

01:38:21.240 | I talk to physicians.

01:38:22.360 | What I suggest other people do,

01:38:24.400 | I actually do and have done for a long period of time.

01:38:26.760 | And I recall wanting to take DIM

01:38:30.160 | 'cause I thought, well, back then you hear,

01:38:31.820 | okay, reduce estrogen.

01:38:34.120 | My estrogen levels weren't out of range, so they were fine.

01:38:36.560 | But I thought, well, what would the experience be

01:38:38.160 | of bringing those down?

01:38:39.000 | But someone I know is quite informed in this area said,

01:38:41.640 | yeah, exactly what you said,

01:38:42.880 | which is that DIM can reduce estrogen,

01:38:44.520 | but also testosterone.

01:38:45.560 | So I just never opted to try and take it.

01:38:48.140 | I do want, we're sort of erring in this direction,

01:38:50.400 | but we went straight from the six pillars to TRT

01:38:54.240 | or to what some people now call sports TRT,

01:38:56.820 | which is basically code language for saying,

01:38:59.960 | taking exogenous testosterone,

01:39:02.440 | even though one doesn't need it

01:39:03.680 | to get into a semi-super physiological range

01:39:07.080 | or a high-end like 900 to 1000 nanogram per deciliter range.

01:39:12.080 | And people always point out, I should mention that,

01:39:14.780 | oh, well, in certain countries,

01:39:16.000 | the high-end range is 1200 nanograms per deciliter.

01:39:18.680 | In the US, it's 900.

01:39:19.840 | And so if you're 1200, are you really super physiological?

01:39:22.680 | All that aside, I neglected to ask about that gap in between

01:39:27.480 | where individuals could think about supplementation,

01:39:30.920 | meaning non-prescription approaches

01:39:32.480 | to increasing testosterone.

01:39:33.880 | And here, we should probably also talk about things like,

01:39:36.600 | is it true that ice baths increase testosterone or not?

01:39:40.520 | Lifestyle factors that go beyond the six pillars

01:39:43.160 | for increasing testosterone.

01:39:44.560 | If you could comment on those, that would be terrific,

01:39:46.520 | supplements that are useful.

01:39:47.920 | And it'd be wonderful if you could mention

01:39:50.320 | where some of these same practices and supplements

01:39:52.600 | might be useful for women as well as men

01:39:55.100 | to increase testosterone

01:39:56.340 | for all the reasons we talked about earlier.

01:39:58.160 | - Yeah.

01:39:59.000 | So this is where a true individualized approach comes in.

01:40:02.660 | When you're talking about what dose of TRT you should be on,

01:40:06.480 | one thing to keep in mind

01:40:07.520 | is the law of diminishing returns.

01:40:09.280 | Quality of life is a subjective thing

01:40:13.880 | and it's different for each person.

01:40:15.480 | So some people are more willing to give up

01:40:17.520 | a little bit of athleticism or body composition.

01:40:21.160 | Some people are more willing to give up

01:40:22.960 | or not willing to give up libido or sexual health.

01:40:26.600 | And as we mentioned earlier,

01:40:28.520 | everybody's androgen receptor is less or more sensitive.

01:40:32.560 | So you can make a case that if somebody's androgen receptor

01:40:36.120 | is half as sensitive as somebody else,

01:40:40.480 | the person with the less sensitive receptor

01:40:42.680 | does need a level of 1000 or 1200.

01:40:46.620 | There's no great way to know that.

01:40:47.980 | And you can alter the sensitivity of your androgen receptor

01:40:50.240 | with things like L-carnitine and Tidalofil as mentioned.

01:40:53.080 | - And we'll definitely come back to L-carnitine

01:40:54.720 | because I'm really intrigued by the data on L-carnitine,

01:40:58.240 | both for women and men in terms of egg quality,

01:41:01.000 | sperm quality, fertility,

01:41:02.200 | and a bunch of other interesting effects.

01:41:03.840 | So we'll come back to L-carnitine.

01:41:05.440 | - But a lot of how you feel the biofeedback or subjective,

01:41:09.960 | I feel like this comes from the ratio of your androgens

01:41:13.400 | to your estrogens.

01:41:14.920 | And a lot of that is lifestyle.

01:41:16.640 | So if someone's also an HCG,

01:41:18.280 | that could upregulate aromatase as well.

01:41:20.720 | - HCG, you might want to just,

01:41:23.200 | human chorionic gonadotropin used to be found in pregnant,

01:41:27.040 | is still found in pregnant women's urine.

01:41:28.560 | - Still found in pregnant women's.

01:41:29.400 | - But used to be, believe it or not,

01:41:31.280 | there was a black market for pregnant women's urine

01:41:34.540 | before this stuff was developed synthetically.

01:41:36.920 | So in other words,

01:41:37.760 | what we're saying is men typically

01:41:40.080 | would buy pregnant women's urine through black markets

01:41:44.400 | in order to get the HCG,

01:41:46.280 | in order to get the testosterone enhancing effects of HCG.

01:41:49.960 | So in other words,

01:41:50.800 | men were using pregnant women's urine for HCG.

01:41:52.720 | I do not want to know how they got it into their body.

01:41:55.200 | Let's just skip to what you were going to say next instead.

01:41:57.760 | - Yeah, so that's HCG.

01:41:59.940 | There's a lot of other things that upregulate estrogen.

01:42:03.200 | Alcohol significantly increases aromatase.

01:42:06.680 | So if you're very sensitive to estrogen,

01:42:08.260 | then you probably shouldn't even consume the two glasses

01:42:11.520 | three times a week.

01:42:13.600 | High fat meals also upregulate aromatase.

01:42:16.880 | So if you're on a ketogenic diet,

01:42:18.960 | but you have hyper estrogenism,

01:42:21.160 | then you should take care with that as well.

01:42:23.280 | - All kinds of fats or just saturated fats?

01:42:25.720 | - I'm not sure if it's just saturated fats,

01:42:27.600 | but fat definitely increases both fat in your body

01:42:31.240 | and consumption of a high amount of calories

01:42:34.200 | increases aromatase.

01:42:35.240 | - So it's the ratio of testosterone to estrogen.

01:42:37.120 | I don't want to break your flow,

01:42:38.040 | but since we're talking about fat,

01:42:39.520 | I have to ask since estrogen and testosterone

01:42:41.640 | are both synthesized from the cholesterol molecule,

01:42:44.200 | I've heard that ingesting some amount of saturated fat

01:42:49.580 | can be useful because of the way that cholesterol

01:42:51.840 | can serve as a precursor to these molecules.

01:42:55.240 | Now, I once said on a podcast that I like butter so much

01:42:58.360 | that I occasionally eat pats of butter.

01:43:00.080 | Somehow that got misinterpreted to mean that I eat entire,

01:43:03.960 | the many pats of butter.

01:43:05.120 | I'm talking like one or two pats of butter here and there,

01:43:07.460 | and I have no guilt or shame about it.

01:43:08.780 | My blood lipids are in great shape also, so I feel good.

01:43:11.560 | But is it possible that people who are ingesting too little

01:43:16.560 | of saturated fats could directly or indirectly reduce

01:43:21.800 | or somehow disrupt the proper ratio

01:43:24.640 | of testosterone to estrogen in men and women?

01:43:27.080 | - It's theoretically possible,

01:43:28.560 | but it probably doesn't happen in developed countries,

01:43:31.920 | just like it's theoretically possible

01:43:33.600 | to have not enough omega-6 fatty acids,

01:43:36.320 | but that probably does not happen in developed countries.

01:43:38.560 | - So I don't need the butter pats,

01:43:40.040 | but I'm going to do it anyway.

01:43:41.660 | I'm just curious.

01:43:42.500 | - Yeah. - Okay.

01:43:43.340 | - Grass-fed butter has good omega-3 content as well.

01:43:46.500 | So grass-fed foods in general,

01:43:49.800 | it's not the end all be all,

01:43:51.080 | and everybody doesn't need grass-fed foods,

01:43:53.580 | but they are one of the only sources of healthy trans fat.

01:43:57.360 | So a naturally occurring trans fat comes from ruminants.

01:44:01.300 | So ruminants that I think of like cows

01:44:04.440 | and the rumination in the different stomachs

01:44:09.440 | can change your omega-3 and omega-6

01:44:12.480 | to trans linolenic and trans linoleic fatty acids.

01:44:16.840 | - Which are healthy for us.

01:44:17.680 | - Yeah, so it's actually omega-3s and omega-6s

01:44:20.720 | that just happened to have a trans instead of a cis isomer.

01:44:24.440 | - So, and these healthy trans fats would be found

01:44:28.240 | in ruminant cheese and milk and butter from ruminants

01:44:32.320 | and the meats? - And the meats, yes.

01:44:35.460 | - So, and for people who are following

01:44:36.800 | a purely plant-based diet or mostly plant-based diet,

01:44:40.960 | are they at risk of not getting enough

01:44:43.540 | of certain types of fats or other nutrients

01:44:45.340 | to maintain that healthy ratio

01:44:46.800 | of testosterone to estrogen or not?

01:44:49.320 | - If they're a vegetarian, they're probably not at risk.

01:44:51.580 | If they're a vegan, they very well could be at risk.

01:44:54.760 | Most vegans are aware of this very acutely,

01:44:59.040 | and they'll supplement with, you know, algae,

01:45:03.520 | or they'll supplement with other sources of healthy fats.

01:45:07.700 | - I see.

01:45:08.540 | So the takeaway that I'm drawing from this

01:45:10.960 | is that less so than getting saturated fat,

01:45:14.860 | it's key to get these healthy trans fats from ruminants

01:45:18.360 | or the food products of those ruminants,

01:45:21.040 | as well as to get proper amounts of omega-3s.

01:45:26.000 | - And to be clear, you don't need any trans fats.

01:45:28.240 | It just happens that those omega-3s and omega-6s

01:45:31.560 | are in a trans isomer.

01:45:33.560 | - I see.

01:45:34.400 | Okay, so that's nutrition.

01:45:35.320 | What other supplements can support healthy testosterone

01:45:38.100 | to estrogen ratios?

01:45:39.680 | - Anything that alters aromatase

01:45:42.540 | can support healthy testosterone to estrogen.

01:45:45.340 | And your testosterone to estrogen ratio,

01:45:50.340 | think about it as how much estrogen activity

01:45:53.800 | do you have at the beta estradiol receptor

01:45:55.880 | and your alpha estradiol receptor.

01:45:57.720 | - How would I know that?

01:45:58.560 | - So it's hard to tell,

01:46:01.800 | but depending on what you're eating,

01:46:03.480 | if you have a lot of plant-based diets or polyphenols,

01:46:06.400 | many of these are beta estradiol receptors.

01:46:09.540 | People know about turkestrone and also beta-ectisterone,

01:46:13.320 | which are two ectisteroids

01:46:14.880 | that are beta estradiol receptor agonists.

01:46:17.680 | So they activate the beta estradiol receptor.

01:46:20.600 | So if you have a very low amount of estrogen naturally,

01:46:23.160 | you're probably a better candidate for it.

01:46:24.800 | - For taking to turkestrone or ectisterone.

01:46:27.720 | - I've never tried them, but I know my understanding

01:46:30.800 | is that they work tremendously well for some people

01:46:34.000 | and not at all for others.

01:46:35.280 | And so one just simply has to try.

01:46:37.040 | But in promoting the activity of this estrogen receptor,

01:46:41.400 | is there a risk that turkestrone or ectisterone

01:46:43.800 | could cause some of the quote-unquote problems

01:46:46.840 | associated with increasing estrogen activity,

01:46:49.800 | like reduced libido, water retention?

01:46:52.840 | - Water retention?

01:46:54.440 | Yes. Reduced libido, probably not.

01:46:58.360 | Closing growth plates in the bone?

01:46:59.880 | No, because that's the alpha estradiol receptor.

01:47:03.140 | - I've talked before on a couple of podcasts

01:47:05.600 | about tonga ali, which is this Indonesian herb.

01:47:09.920 | I guess it's also made and found in Malaysia,

01:47:13.220 | but it seems to be the Indonesian variety of tonga ali

01:47:16.480 | that's most effective for potentially for reducing

01:47:20.200 | sex hormone and binding globulin

01:47:21.740 | and thereby freeing up testosterone.

01:47:24.240 | Whether or not the effects are through that pathway,

01:47:26.400 | through another pathway,

01:47:27.760 | a lot of people report improvements in things like libido

01:47:31.560 | and maybe androgen-like phenotypes, right?

01:47:36.160 | Feeling more vital, et cetera.

01:47:37.680 | And of course, some of that could be placebo, correct?

01:47:40.560 | But what are your thoughts on tonga ali?

01:47:42.600 | And please challenge my statements about tonga ali

01:47:45.120 | if they're incorrect.

01:47:45.940 | I'm not looking for validation here.

01:47:48.160 | I just really want to know what your thoughts are on it.

01:47:50.480 | Do you ever recommend it to patients?

01:47:53.000 | When men, women, one or the other?

01:47:56.560 | - Yeah, so tongkat ali or long jack,

01:48:00.360 | it has multiple mechanisms of action

01:48:02.440 | and there have been several placebo-controlled studies on it.

01:48:06.840 | Some of them show decrease in SHBG.

01:48:09.080 | At least one of them did not show any change in SHBG.

01:48:12.360 | However it is, it does act on aromatase very weakly,

01:48:16.380 | probably not so strongly

01:48:17.760 | that you would have to be concerned of hypoestrogenism.

01:48:20.720 | - So it reduces aromatase and thereby can reduce estrogen?

01:48:24.800 | - Correct. - Okay.

01:48:25.640 | - It's also a weak, it's not a CIRM,

01:48:28.560 | so it's not a selective estrogen receptor modifier,

01:48:31.640 | but it's probably a weak, it's probably an ERM as well,

01:48:34.960 | or a non-selective estrogen receptor modifier.

01:48:38.360 | And that should help with decreasing

01:48:41.360 | negative feedback inhibition of estradiol

01:48:44.280 | in various locations and also increasing testosterone.

01:48:47.820 | - Interesting.

01:48:48.660 | Yeah, the dosage that I've been using for years now

01:48:50.520 | is, I think it's 400 milligrams taken once a day,

01:48:54.080 | typically early in the day,

01:48:56.180 | 'cause it can kind of have a mild stimulant effect,

01:48:58.740 | very mild.

01:48:59.580 | And I know that some of the products out there

01:49:02.560 | recommend dosages that are much higher.

01:49:04.360 | Anytime I've taken more than 400, I don't feel very good.

01:49:07.960 | I don't know how to describe it

01:49:09.440 | other than it's just a little over stimulatory

01:49:11.760 | in terms of makes me kind of,

01:49:13.920 | it's like drinking too much coffee.

01:49:16.360 | So that's interesting.

01:49:18.480 | And so would women ever want to take Tonga Ali

01:49:22.800 | for any reason?

01:49:23.680 | - Yeah, absolutely.

01:49:25.040 | So there's a lot of women that have hyper-estrogenism

01:49:28.760 | and unlike adrenal fatigue or andropause,

01:49:31.600 | there's actually ICD-10 codes for hyper-estrogenism.

01:49:35.040 | - ICD-10 codes?

01:49:36.160 | - Yeah.

01:49:37.000 | - That's doctor speak, right?

01:49:37.820 | - Yeah, so there's codes to where your doctor

01:49:40.080 | can actually diagnose you with something.

01:49:41.480 | So if you go to your doctor and you say,

01:49:43.080 | I have adrenal fatigue, they can't diagnose you with that.

01:49:45.860 | Or if you say, I have andropause,

01:49:47.240 | they also can't diagnose you with that.

01:49:49.280 | But if you say you have hyper-estrogenism,

01:49:52.860 | the most common complaint that comes with it

01:49:55.040 | is endometriosis,

01:49:56.240 | which is overgrowth of the lining of the uterus.

01:50:00.340 | And those people could potentially,

01:50:03.360 | I think that's one area where we might see

01:50:06.440 | Tongkat supplementation more and more

01:50:09.560 | because not only does it decrease aromatase,

01:50:11.960 | like we mentioned, testosterone in females

01:50:13.660 | is higher than estrogen in females.

01:50:15.800 | So a lot of females get estrogen from aromatization as well.

01:50:19.580 | Peripheral estrogen is sometimes what we call it

01:50:21.920 | because it's not directly produced in the ovaries,

01:50:25.000 | but they could be good candidates for Tongkat

01:50:26.740 | if that's the case.

01:50:27.800 | - Very interesting.

01:50:28.640 | And my understanding is that people should be looking

01:50:30.440 | for sources of Indonesian Tongkat in particular.

01:50:33.460 | - Correct.

01:50:34.300 | Another interesting application is essentially a,

01:50:38.120 | I'll call it a PCT, but essentially what that means is,

01:50:41.080 | PCT means how defined it is, post-cycle therapy.

01:50:44.400 | - Physicians love acronyms, scientists love acronyms,

01:50:46.460 | military love acronyms, but yeah, PCT, post-cycle therapy.

01:50:49.640 | So this would be people coming off hormone therapy

01:50:51.640 | or steroids.

01:50:52.480 | - This would actually be for women that are coming off

01:50:54.780 | of their birth control pill,

01:50:56.240 | because perhaps it can help lower that SHBG back to normal,

01:50:59.200 | which is sometimes persistently elevated,

01:51:01.160 | and then it can help prevent

01:51:02.800 | the subsequent hyper-estrogenism that happens.

01:51:05.820 | - Does Tongkat Ali need to be cycled?

01:51:07.640 | When I first started taking it, I would cycle it.

01:51:09.620 | I would do a few, three, four months,

01:51:11.220 | and I would take some time off.

01:51:12.180 | Now I've just been taking it continuously for years.

01:51:14.960 | And I should say, I do blood work to check my liver enzymes

01:51:18.100 | and everything else.

01:51:18.940 | And I don't see any reason for me to cease taking it.

01:51:23.660 | - Yeah, probably not.

01:51:25.820 | There's been human studies on both Tongkat and Fidoja,

01:51:28.620 | and full disclosure, I did help design Derek's new

01:51:32.220 | testosterone optimization supplement,

01:51:34.180 | which has both Fidoja arrestris and also Tongkat Ali in it.

01:51:38.140 | - Yeah, let's talk about Fidoja separately in a moment,

01:51:40.400 | but let's say someone is only taking Tongkat Ali

01:51:44.700 | for whatever reason, but do they need to cycle off?

01:51:48.260 | - Likely not, but I would just to be safe

01:51:51.000 | because it does both affect your aromatase

01:51:54.100 | and it's an estrogen receptor modifier.

01:51:57.860 | - And what would be a reasonable cycle off?

01:52:00.980 | So how long to take and how long to stop

01:52:03.820 | before taking again?

01:52:04.960 | - Yeah, there's a couple different protocols

01:52:07.860 | that you can do, but 11 months on,

01:52:10.420 | one month off for Tongkat is pretty reasonable.

01:52:13.180 | Now, I guess this is, we'll talk about this later too,

01:52:15.880 | but if it's combined with Fidoja,

01:52:17.980 | the protocol that I would do is three weeks on,

01:52:21.300 | one week off.

01:52:23.060 | - So that's Tongkat Ali, but I'm curious

01:52:25.840 | what your thoughts are on Fidoja aggressis,

01:52:28.360 | this Nigerian shrub or this extract from Nigerian shrubs

01:52:32.740 | that at least in my experience,

01:52:34.340 | in my read of the literature has the potential

01:52:36.980 | to increase testosterone and probably other hormones as well

01:52:40.680 | by way of increasing luteinizing hormone,

01:52:42.860 | something that we haven't really talked about much

01:52:44.780 | up until now.

01:52:45.880 | What are your thoughts about Fidoja aggressis?

01:52:48.380 | What are your ideas about the proposed mechanism

01:52:51.240 | or mechanisms and where might this be useful

01:52:55.060 | for people on or off hormone replacement therapy?

01:53:00.060 | - Yeah, Fidoja aggressis has just reached a point

01:53:04.460 | where we have enough evidence to we know

01:53:06.660 | it probably helps both with luteinizing hormone release,

01:53:10.340 | which stimulates latex cells in the testes

01:53:12.340 | to produce more testosterone

01:53:14.140 | and probably with LH receptor sensitivity as well,

01:53:18.900 | which is a good combination of the two.

01:53:20.860 | It does come from the Nigerian shrub,

01:53:24.480 | but there is not quite enough evidence

01:53:27.860 | for me to be able to say,

01:53:30.620 | it's safe for somebody to take this all the time,

01:53:33.340 | which again, full disclosure,

01:53:35.040 | that's why I recommended that we,

01:53:37.020 | recommended for people to cycle this supplement.

01:53:41.700 | So three weeks on, one week off, that's likely safe.

01:53:46.480 | The only toxicity studies in general are in rats

01:53:49.640 | and in humans, it looks quite safe.

01:53:51.620 | - My understanding is that the toxicity studies in rats

01:53:55.340 | showed toxicity to the testicular cells.

01:53:59.780 | So that's certainly concerning,

01:54:01.180 | but that the dosages that were used

01:54:04.140 | or translating the dosages used to humans

01:54:07.500 | would lead to a situation where the dosages

01:54:09.900 | that humans would have to take would be very, very large.

01:54:12.460 | So the amount of, I no longer take Fidogia,

01:54:15.780 | but I took it at 600 milligrams per day for a long time.

01:54:19.080 | And I ceased taking it because I was experimenting

01:54:22.300 | with other things and I didn't want to confound those things,

01:54:25.500 | not because I had any negative side effects.

01:54:27.800 | In fact, I was monitoring blood work

01:54:29.360 | and other biological parameters that would have told me

01:54:33.180 | if there was testicular toxicity and there wasn't,

01:54:35.820 | let's put it that way.

01:54:36.900 | - Yeah, I think it's extremely safe.

01:54:38.440 | And I'm just not convinced

01:54:41.820 | that there's enough overwhelming evidence

01:54:44.220 | for long-term consistent administration.

01:54:48.780 | - So do you recommend this to people

01:54:50.940 | who are not taking TRT?

01:54:53.380 | And do you recommend to men and women?

01:54:55.540 | - Yeah, so if you have a really high LH,

01:54:58.660 | then there's probably a gonadal issue,

01:55:01.300 | whether it's heat damage to the testes, a varicocele,

01:55:05.240 | a history of testicular cancer,

01:55:06.740 | where your LH is gonna be higher.

01:55:09.200 | So if your LH is already very high,

01:55:11.260 | increasing it even more is probably not gonna help.

01:55:14.020 | However, if your LH is low,

01:55:16.100 | then obviously try to find out if it is low.

01:55:18.300 | Is it deficient or is it just a little bit low?

01:55:20.940 | If it's low and you don't have an issue with prolactin,

01:55:23.340 | you don't have an issue with opioid receptor antagonism,

01:55:26.880 | then naltrexone can actually potentially help antagonize

01:55:29.660 | that to increase LH as well,

01:55:31.260 | especially in people recovering from opiates

01:55:34.380 | or likely even alcohol.

01:55:36.380 | So you're looking for a subclinical secondary hypogonadism,

01:55:39.540 | which is essentially, just think of that as low LH.

01:55:41.960 | So in people with that lower LH and their estrogen is fine

01:55:45.820 | and their prolactin is fine,

01:55:48.120 | then Fidogia is a particularly good option.

01:55:51.660 | - Interesting, so three weeks on, one week off,

01:55:54.500 | for 600 milligrams Fidogia,

01:55:57.860 | 400 milligrams Tonga Ali, Indonesian Tonga Ali,

01:56:00.900 | could potentially be good.

01:56:03.220 | And of course, everyone should always check

01:56:04.400 | with their physician, clear this, do blood work, et cetera.

01:56:07.120 | I would say, we don't just say that to protect us.

01:56:09.120 | We say that to protect you,

01:56:11.100 | meaning that the consumer is very, very important.

01:56:15.460 | You don't want to get,

01:56:16.740 | you don't want to fly blind with any of this stuff.

01:56:18.860 | You want to do blood work, right?

01:56:20.300 | - That's the catch-22 with supplements

01:56:21.980 | is most of them are safer than medications,

01:56:24.160 | but the only difference between them and a medication

01:56:26.500 | is one's prescribed and one's not.

01:56:28.700 | - And oftentimes with supplements,

01:56:30.100 | it's unclear whether or not what's listed on the bottle

01:56:32.420 | is actually what's in the bottle.

01:56:33.700 | But I think there are a number of reputable brands now.

01:56:37.140 | The other supplement I want to talk about

01:56:41.360 | in terms of testosterone augmentation is Boron.

01:56:44.620 | What is Boron thought to do?

01:56:46.580 | Does it actually do that?

01:56:47.920 | And do you ever recommend Boron?

01:56:50.400 | - Yeah, so Boron is actually an element

01:56:53.300 | and you can find it on the periodic table.

01:56:55.880 | It's more plentiful in rich soils.

01:56:59.100 | So frequent farming can deplete the soils of Boron.

01:57:03.120 | It's very plentiful in the Mediterranean area,

01:57:04.960 | like Greece and Turkey.

01:57:06.440 | So a lot of people will just eat dates or raisins

01:57:09.420 | that are grown there.

01:57:10.260 | - I thought you were going to tell me people eat dirt,

01:57:11.460 | but there are people who eat dirt.

01:57:12.580 | - There are people who eat dirt.

01:57:13.420 | - There's a phenomenon called pica, right?

01:57:15.880 | Where people in a, and that's not a good thing.

01:57:19.240 | - Often a sign of iron deficiency.

01:57:21.100 | - Okay, but they're eating grapes and dates

01:57:23.340 | that were grown in soil that has high amounts of Boron.

01:57:26.360 | - Yeah, so Boron can help regulate SHBG,

01:57:30.300 | but its effect is mostly acute.

01:57:32.680 | So it's unlikely to have a bad effect.

01:57:36.040 | So a lot of people take Boron

01:57:37.320 | because it's probably not going to hurt

01:57:39.520 | and it will lower SHBG,

01:57:42.120 | even if it is for a short period of time.

01:57:45.400 | So I guess you can make a case

01:57:46.440 | that maybe cycling Boron can help too.

01:57:48.800 | - What sorts of dosages are useful

01:57:51.280 | for Boron supplementation?

01:57:52.860 | - Three to six milligrams, once to twice a day.

01:57:55.140 | - Oh, interesting.

01:57:55.980 | So that's higher than the amounts that I've been taking.

01:57:58.600 | I've long been doing this cocktail of Tonga Ali.

01:58:02.040 | Again, I stopped taking Fidogia,

01:58:03.560 | but for a long time with Fidogia and Boron,

01:58:07.120 | I think it was two to four milligrams per day,

01:58:08.880 | but maybe I could afford to go higher.

01:58:10.440 | Although my blood work is where I want it, thankfully.

01:58:13.500 | Sort of circling back to Fidogia.

01:58:15.920 | Fidogia was attractive to me as a supplement

01:58:19.140 | because I saw increases in LH,

01:58:21.420 | testosterone and free testosterone.

01:58:23.520 | My estrogen stayed in check,

01:58:25.360 | but I also did not see a downregulation of LH

01:58:29.600 | when I would cycle off.

01:58:31.640 | Whereas with HCG, human cortionic gonadotropin,

01:58:35.600 | which does now arrive in forms

01:58:39.880 | not from pregnant women's urine only,

01:58:41.740 | but the synthetic forms that people inject,

01:58:43.980 | that, as I understand it,

01:58:45.040 | can actually suppress endogenous hormone output

01:58:49.100 | if one takes it for a long period of time.

01:58:50.580 | So why would a man or woman want to take HCG

01:58:54.080 | and what are the potential risks and benefits of taking HCG?

01:58:58.280 | - Yeah, so HCG or human cortionic gonadotropin

01:59:01.800 | is actually very similar to TSH.

01:59:04.660 | - Thyroid-stimulating hormone.

01:59:06.100 | - Correct.

01:59:07.100 | So when a woman is pregnant, she produces more HCG,

01:59:11.980 | especially in the first trimester.

01:59:14.120 | When you take a pregnancy test,

01:59:15.440 | whether it's qualitative or quantitative,

01:59:17.860 | you see the HCG rise

01:59:19.880 | and it actually doubles every 48 hours.

01:59:22.720 | So if you're five weeks pregnant, you can get an HCG level.

01:59:26.260 | And then two days later, five weeks and two days,

01:59:29.040 | you can see your HCG

01:59:30.200 | and maybe it went from 500 to 1,000.

01:59:33.220 | So it precipitously increases.

01:59:36.020 | It does a few things.

01:59:39.060 | One thing is it prevents hypothyroidism

01:59:42.040 | or hypothyroxemia of pregnancy,

01:59:44.820 | which is one of the most common causes of miscarriage.

01:59:48.260 | It's also why if you have hypothyroidism

01:59:52.740 | and you get pregnant in the first trimester,

01:59:54.920 | you wanna increase your dose from 25 to 40%

01:59:58.840 | to keep your free T4 high as much as possible.

02:00:02.200 | And the reason why you have to do that

02:00:04.060 | as opposed to somebody who does not have hypothyroidism

02:00:07.360 | is if you have hypothyroidism,

02:00:08.860 | then likely your thyroid will not respond

02:00:11.780 | to either TSH or HCG.

02:00:15.480 | So the increased HCG does not compensate for that.

02:00:18.780 | So if you take HCG,

02:00:20.820 | then it can potentially improve your thyroid function.

02:00:23.580 | So that along with selenium are likely the two best things

02:00:26.920 | that you can do for thyroid health.

02:00:28.500 | - HCG and selenium?

02:00:30.200 | Well, I definitely make sure I get enough selenium

02:00:33.020 | by eating three to five Brazil nuts per day,

02:00:36.980 | which I very much enjoy the taste of also.

02:00:39.160 | Who should take HCG

02:00:42.380 | and can HCG suppress one's normal luteinizing hormone output?

02:00:47.020 | - Yeah, it suppresses LH in a dose dependent manner.

02:00:51.060 | So the higher the dose of HCG you take,

02:00:53.940 | the more it suppresses LH.

02:00:55.500 | A common dose for fertility,

02:00:57.500 | fertility is usually why HCG is prescribed.

02:01:00.100 | - In men or women?

02:01:01.060 | - In both, is 10,000 IUs all at one time,

02:01:06.060 | which is quite a bit.

02:01:07.580 | - That's a tremendous dose.

02:01:10.040 | - Yeah, in fact, some formulation,

02:01:11.860 | some brand names of HCG come in auto-injector pins

02:01:15.820 | to where you cannot even dose

02:01:17.320 | lower than 5,000 units at a time.

02:01:19.660 | - Wow, but I know a number of people who take HCG

02:01:22.740 | to maintain testicular function while on testosterone therapy

02:01:26.700 | or augmentation of some sort.

02:01:28.340 | Does it work to do that?

02:01:30.580 | - Yeah, some people are on HCG monotherapy.

02:01:34.460 | It can be slightly better on your lipids than being on TRT.

02:01:40.140 | - So people are using HCG alone as a kind of neither,

02:01:44.980 | sort of a hormone augment, indirect hormone augmentation.

02:01:48.260 | - Some clinics advertise it as a non-suppressive

02:01:53.260 | alternative to TRT, but it is suppressive of LH.

02:01:56.500 | - But it could also increase estrogen pretty potently.

02:01:58.940 | - Yeah.

02:01:59.780 | - And is it true that increasing LH and or HCG

02:02:04.500 | can improve sensitivity of the genitals?

02:02:08.340 | And is that true for men and women?

02:02:09.900 | I've heard this anecdotally.

02:02:11.060 | People say HCG makes sexual activity

02:02:14.200 | more pleasurable for people because of some,

02:02:17.060 | is it a direct effect on some of the nerve cells

02:02:20.300 | in the genitals?

02:02:21.860 | - Yeah, so LH is also an agonist in the prostate

02:02:26.380 | and in genital tissue in general.

02:02:29.140 | So it's a very common treatment

02:02:32.400 | for post-phenasteride syndrome or post-5-alpha reductase.

02:02:36.220 | When you've blocked the conversion of DHT for a long time,

02:02:39.660 | it helps re-upregulate DHT.

02:02:42.580 | - So someone who's been taking phenasteride

02:02:44.420 | to prevent hair loss comes off,

02:02:46.420 | it feels maybe because they felt lousy,

02:02:49.100 | but then feels even lousier

02:02:50.540 | for reasons that you talked about earlier.

02:02:52.060 | And then they might use HCG as a transition treatment

02:02:55.560 | to transition back to normal hormone health.

02:02:58.980 | Is that right?

02:02:59.820 | - It's extremely helpful in many cases.

02:03:02.240 | Now, when you come off the HCG,

02:03:03.580 | then you need to have a strategy of how to return

02:03:06.160 | to your normal as fast as possible as well,

02:03:08.600 | but it will upregulate those 5-alpha reductase enzymes.

02:03:11.540 | You have in your genital skin,

02:03:13.120 | both scretal skin and penile skin and perineum in general,

02:03:17.180 | you have, I believe what's called stratum lucidum.

02:03:20.260 | It's a skin layer that is very, very thin,

02:03:24.020 | but it has the highest concentration of 5-alpha reductase.

02:03:28.420 | So you have a lot of activity

02:03:30.820 | and after you've been on something that inhibits the enzyme,

02:03:35.800 | the 5-AR enzyme in those tissues,

02:03:38.220 | then you do something else to upregulate those enzymes,

02:03:41.460 | whether it's waiting and taking time,

02:03:43.620 | whether it's trying Tidalafil,

02:03:45.420 | whether it's trying creatine even,

02:03:47.960 | or whether it's trying HCG,

02:03:50.300 | a lot of times those are the go-tos

02:03:51.700 | for post-fenasteride syndrome.

02:03:53.400 | - Any risks for women taking HCG

02:03:56.080 | on their ability to get pregnant or risk generally?

02:04:01.980 | - Yeah, obviously it'll make any pregnancy test positive.

02:04:05.240 | So that's a risk that some women don't know.

02:04:07.720 | - So one could in theory fake a pregnancy test

02:04:09.900 | by injecting HCG?

02:04:10.980 | - Absolutely.

02:04:11.860 | - Interesting.

02:04:12.700 | - Yeah.

02:04:13.520 | - I have no motivation to do that.

02:04:15.660 | I was just curious.

02:04:16.700 | - Yeah.

02:04:19.300 | - What about prolactin?

02:04:21.540 | You know, the simple version of this that I was taught

02:04:24.660 | because I was taught mainly

02:04:26.020 | from the neuroendocrine perspective was, you know,

02:04:28.820 | dopamine is a kind of close cousin of testosterone

02:04:31.140 | and also estrogen for that matter drives a repetitive

02:04:34.260 | behaviors, including pursuit of sexual partner sex itself,

02:04:38.400 | motivated behaviors generally.

02:04:40.160 | Then post-copulatory, post-orgasmic states are accompanied

02:04:45.160 | by a prolactin increase.

02:04:46.960 | That's the refractory period for mating in males

02:04:48.920 | and maybe even in females as well,

02:04:51.520 | involved in milk letdown, et cetera.

02:04:54.000 | What are sort of the general contours of syndromes

02:04:57.280 | or things that people could be on the lookout for

02:04:59.360 | of having too much prolactin or too little prolactin?

02:05:03.280 | And I'm aware of a number of people who take

02:05:06.460 | a dopamine agonist, L-tyrosine, cabergoline,

02:05:10.120 | things like that to really boost their dopamine levels.

02:05:13.060 | And that isn't always a good thing as it turns out.

02:05:15.540 | Oftentimes people will become kind of hyper dopaminergic.

02:05:18.260 | And so they have the drive to do all these

02:05:20.280 | repetitive things, you know, fill in the blanks,

02:05:23.020 | but they don't always have the ability because it seems

02:05:26.180 | just as testosterone and estrogen need to be

02:05:27.960 | in the proper ratios, dopamine and prolactin

02:05:30.320 | need to be in the appropriate ratios.

02:05:32.320 | How should we think about and perhaps act

02:05:35.440 | on our prolactin systems?

02:05:37.520 | - Absolutely.

02:05:38.760 | The way I describe it is the dopamine wave pool.

02:05:41.480 | So if you're increasing your dopamine too much,

02:05:44.200 | you're going to overflow and then you're going to have

02:05:46.260 | that wave crash too much.

02:05:47.960 | So you want to have nice even waves that are not going

02:05:50.920 | too far above the pool of dopamine

02:05:53.200 | and prolactin will follow.

02:05:55.040 | So prolactin and estrogen are quite close cousins.

02:05:58.180 | Estrogen upregulates a gene called the PRL gene

02:06:01.560 | or prolactin gene that directly increases

02:06:04.760 | prolactin synthesis.

02:06:06.840 | So prolactin is going to also inhibit the release

02:06:11.840 | of testosterone from the pituitary.

02:06:14.880 | So if you're using a dopamine agonist,

02:06:17.480 | then you're going to help decrease the prolactin producing

02:06:21.660 | cells, including if you have a prolactin producing

02:06:23.960 | micro adenoma in the pituitary.

02:06:26.200 | - How common are those?

02:06:27.100 | Because I mean, I hear a lot about these, you know,

02:06:29.720 | hypogonadism or, and of course that can be due to an issue

02:06:32.880 | at the testicles or hypogonadism could also be of course,

02:06:37.880 | in like ovarian syndromes.

02:06:40.560 | And then there's of course the brain side of it,

02:06:42.200 | where the signals aren't coming from the brain.

02:06:43.720 | You're not enough gonadotropin,

02:06:45.720 | not enough luteinizing hormone.

02:06:47.160 | And there are ways of teasing this apart through with an

02:06:49.300 | endocrinologist that are quite elegant in fact, right?

02:06:51.360 | Using stimulating hormones, too much to dive into here,

02:06:54.000 | but how often does one actually have one of these pituitary

02:06:58.160 | tumors?

02:06:59.240 | I have heard that people that play a lot of high contact

02:07:03.180 | sports, so boxing, football,

02:07:05.680 | people that head headed the soccer ball quite a lot.

02:07:08.240 | Sadly, people whose jobs forced them to take head blows for,

02:07:13.960 | you know, it could be military.

02:07:15.260 | And so they were firing, you know,

02:07:16.460 | 50 caliber guns and the kind of woodpeckering of the brain

02:07:19.200 | inside of the skull and construction workers,

02:07:22.760 | or just a concussion can cause the pituitary to go

02:07:26.020 | malfunctional, is that really common or is this something

02:07:30.100 | that, you know, is, is a rare, like 1%?

02:07:33.340 | - Yeah, it's extremely common.

02:07:34.920 | It's another one of those conditions where a lot of people

02:07:37.580 | never know they have it.

02:07:39.020 | They just feel a little bit more fatigued.

02:07:40.940 | They have that high prolactin feeling all the time,

02:07:44.660 | but pituitary micro adenomas can be non-producing as well.

02:07:47.880 | So your prolactin can be totally normal.

02:07:49.960 | Your growth hormone and IGF-1 can be totally normal.

02:07:52.180 | That's the second most common producing micro adenomas

02:07:54.920 | growth hormone, causing either acromegaly,

02:07:57.440 | which is growth of cartilage or gigantism.

02:07:59.840 | - This is the big brow, yeah.

02:08:02.880 | - So those are fairly common causes of adenomas,

02:08:05.720 | but a lot of people that have a very small adenoma,

02:08:09.600 | you know, much less than one centimeter,

02:08:11.960 | it's hard to see on imaging,

02:08:13.520 | even if you have a contrast that specifically looks

02:08:16.960 | at the pituitary and many people aren't symptomatic.

02:08:20.720 | So it's one of those things along with PCOS and prediabetes

02:08:25.720 | that are much more frequent when it comes to prevalence,

02:08:29.960 | which is the amount, the percentage of people

02:08:32.720 | that have it in the general population.

02:08:35.120 | - I'm glad you mentioned the dopamine wave pool.

02:08:37.020 | I know nowadays there's a lot of interest

02:08:39.240 | in augmenting dopamine.

02:08:40.720 | I know a number of people that do this

02:08:42.880 | through prescription drugs, Adderall, Ritalin, Modafinil,

02:08:46.160 | and those drugs of course hit many transmitter systems,

02:08:48.300 | but dopamine is certainly involved.

02:08:49.840 | People taking antidepressants like wellbutrin,

02:08:53.040 | tap into that system.

02:08:55.000 | And of course, people are trying to inhibit prolactin

02:08:58.440 | and promote serotonin or reduce serotonin.

02:09:01.140 | To me, it all seems like a very delicate dance, right?

02:09:04.460 | I mean, to just imagine the arousal arc

02:09:07.560 | for mating behavior, for sexual reproduction

02:09:10.600 | is such an elaborate dance between sympathetic drive

02:09:14.000 | and parasympathetic drive,

02:09:15.120 | even with across the span of minutes, right?

02:09:17.660 | I mean, I've talked about this before in the podcast

02:09:19.320 | that the arousal is kind of more parasympathetic.

02:09:23.100 | Orgasm in itself is a sympathetic response,

02:09:26.240 | a completely different set of neurons.

02:09:28.080 | And so where do you see people getting into trouble

02:09:31.520 | just trying to hit the gas pedal on dopamine?

02:09:34.600 | And where do you think there is a place for people

02:09:37.040 | who perhaps are experiencing low drive and motivation,

02:09:39.840 | not just sexual, but in general,

02:09:42.360 | to increase the amount of dopamine circulating

02:09:44.760 | in their brain and body?

02:09:45.960 | How do you think about that given this wave pool analogy?

02:09:49.440 | - Yeah, so it's important to parse it out

02:09:51.420 | and start with the least powerful interventions.

02:09:55.220 | So if someone's concerned about dopamine,

02:09:57.340 | or maybe they have a slightly higher prolactin,

02:09:59.960 | then they eliminate things

02:10:01.000 | that could be increasing that prolactin.

02:10:03.540 | So casein or gluten,

02:10:06.640 | which are mu opioid receptor agonists,

02:10:09.360 | or any mu opioid receptor agonist in the gut.

02:10:12.480 | - So casein, so milk protein?

02:10:14.360 | - Correct. - Can increase prolactin?

02:10:16.100 | - Correct.

02:10:17.200 | - Interesting.

02:10:18.040 | - In addition to that, they should,

02:10:20.000 | if they need a pituitary MRI,

02:10:22.200 | then they should get a pituitary MRI.

02:10:23.840 | If they don't have an adenoma,

02:10:25.200 | or if they don't have a high enough prolactin level

02:10:27.480 | to where they need an MRI,

02:10:29.640 | if they're having visual symptoms,

02:10:31.060 | or if they're having olfactory symptoms with the nose,

02:10:33.920 | then it's more likely that they do.

02:10:36.800 | But if they don't, a lot of times a prolactin

02:10:39.680 | under about 40 is not too big of a deal.

02:10:42.720 | They can take dopamine agonists

02:10:44.760 | that agonize that D2 receptor, like P5P,

02:10:47.840 | which is essentially vitamin B6.

02:10:51.020 | It's pyridoxine, five pyrophosphate,

02:10:53.400 | and pyridoxine is vitamin B6.

02:10:55.720 | So that can help, 50 milligrams once to twice a day.

02:10:59.480 | Vitamin E can also help,

02:11:01.460 | especially if it's mixed to Cofarols.

02:11:03.660 | A lot of people have the high levels of vitamin E,

02:11:07.540 | but low levels of the gamma form of vitamin E.

02:11:11.060 | So that can also help.

02:11:12.200 | - Fascinating.

02:11:13.040 | I'm so glad you mentioned vitamin B6 and P5P.

02:11:16.020 | I have heard that one can shorten the refractory period

02:11:21.580 | after orgasm, essentially to be able to have sex again,

02:11:26.580 | to be quite direct about it,

02:11:27.960 | by way of vitamin B6 blunting of the prolactin response,

02:11:32.880 | which turns out to be quite potent.

02:11:35.440 | But I've also heard that vitamin B6 can be neurotoxic,

02:11:38.320 | especially in the periphery,

02:11:39.600 | that it can cause peripheral neuropathies

02:11:41.160 | if it's taken at high doses,

02:11:42.760 | but that P5P is the safer form.

02:11:45.600 | Is that true?

02:11:47.000 | - It's pre-activated, so it does not build up.

02:11:50.960 | Think of it as a allegory to how folate can build up.

02:11:55.320 | It's not a methyl folate, but it builds up

02:11:59.320 | and it can increase levels of homocysteine.

02:12:01.700 | Or if you have too much vitamin B12,

02:12:03.600 | another water-soluble B vitamin,

02:12:05.600 | you can have too much methylmalonic acid or MMA.

02:12:08.820 | So depending on what your enzymatic conversion is

02:12:11.520 | to the active form of the enzyme,

02:12:13.460 | often it's just safer to take the active form of the enzyme.

02:12:17.200 | - Very interesting.

02:12:18.240 | Okay, well, at risk of going down every hormonal pathway

02:12:22.180 | and talking about supplementation lifestyle factors,

02:12:24.800 | I think touching on, as we have,

02:12:26.620 | testosterone and estrogen and now prolactin,

02:12:29.300 | I'd love to chat a little bit about L-carnitine.

02:12:32.120 | We talked about this earlier,

02:12:33.860 | but I want to raise this discussion about L-carnitine,

02:12:37.040 | not in the context of L-carnitine itself,

02:12:39.340 | but in the context of fertility.

02:12:42.060 | Because my read of the literature is that L-carnitine

02:12:45.300 | can be very beneficial for enhancing sperm quality

02:12:48.680 | and egg quality and even rates of conception.

02:12:51.700 | What forms does L-carnitine come in

02:12:55.220 | that people can reasonably consider?

02:12:57.900 | Again, talk to your doctor folks.

02:13:00.580 | What is it doing and do we know how it's doing it?

02:13:03.580 | And do you often use this in your patients?

02:13:07.200 | - Yeah, so the way I think about L-carnitine,

02:13:10.340 | and I'll try to tie this in with creatine

02:13:12.380 | and other things as well,

02:13:14.000 | is if your cell is an energy factory or a car,

02:13:17.400 | then L-carnitine is the shuttle that helps get the fuel

02:13:22.400 | into the motor to use the motor.

02:13:24.260 | The motor is mostly due to lifestyle factors,

02:13:27.240 | so like your diet and your exercise.

02:13:30.600 | And the type of fuel itself is NAD+.

02:13:34.600 | We don't need to get into NAD precursors or NMN

02:13:36.860 | or NR or anything.

02:13:38.480 | And then the accessory fuel tank is your creatine phosphate.

02:13:42.020 | So creatine is your accessory fuel tank.

02:13:44.560 | Your NAD status, which is largely determined

02:13:47.080 | by your REM sleep and quality sleep and exercise,

02:13:50.000 | along with supplementation is the fuel.

02:13:52.320 | The carnitine shuttle is carnitine palmitoyl coenzyme A,

02:13:57.320 | and that takes medium chain fatty acids.

02:13:59.760 | It takes different molecules of fat.

02:14:01.840 | You have two main energy sources other than ketones.

02:14:04.520 | You have your glucose or carbs.

02:14:06.120 | You have your fat or fatty acids.

02:14:08.360 | And that takes it across the layer of the mitochondria

02:14:12.380 | so that it can be utilized.

02:14:13.960 | So upregulates that.

02:14:15.700 | That's why things that have flagella in general,

02:14:18.880 | the flagella are going to work better, like sperm.

02:14:21.240 | - Flagella being anything,

02:14:22.320 | sort of the wavy little tendrils on cell types,

02:14:24.960 | of which they're everywhere, right, in the gut too, right?

02:14:27.120 | - Yeah. - Yeah.

02:14:27.960 | - So those are going to work significantly better.

02:14:30.240 | And in general, your mitochondria are going to work better.

02:14:32.880 | So the worse your mitochondria are off the bat,

02:14:35.440 | the better they're going to be helped by the shuttle

02:14:38.500 | that shuttles them across.

02:14:40.320 | It also slightly increases the density

02:14:42.700 | of the androgen receptor as well.

02:14:45.000 | - Is that a local effect?

02:14:46.020 | So if L-carnitine is injected into a particular muscle,

02:14:48.540 | will it increase the density of androgen receptors

02:14:50.360 | in that muscle?

02:14:51.480 | - Likely so.

02:14:52.480 | - So how are people taking L-carnitine?

02:14:54.160 | Their capsule forms and their injectable forms?

02:14:56.600 | Most people are going to be taking the capsule forms

02:14:59.020 | because that's all they're going to have access to.

02:15:01.000 | And then we should also ask, can you get L-carnitine

02:15:02.960 | from food?

02:15:04.020 | - Yeah.

02:15:04.860 | So L-carnitine is just a combination of,

02:15:08.600 | it's actually a very small peptide.

02:15:10.380 | So glutathione is just three amino acids.

02:15:13.960 | L-carnitine is the smallest peptide, two.

02:15:16.840 | So peptide is just a protein that has amino acids

02:15:19.460 | between two and about 200.

02:15:21.680 | And L-carnitine is just two amino acids.

02:15:24.560 | - Amazing.

02:15:25.400 | So it's like a micropeptide.

02:15:27.240 | - Yeah, so your body synthesizes enough.

02:15:29.480 | It likes to absorb the amino acids by themselves.

02:15:32.120 | And then if it puts them together, there it makes L-carnitine.

02:15:35.800 | It's not very bioavailable if you take it.

02:15:38.480 | A lot of people will take L-carnitine L-tartrate

02:15:40.620 | or acyl L-carnitine, and that's about 10% bioavailable.

02:15:45.220 | So if you want one gram or a thousand milligrams

02:15:48.040 | of L-carnitine, you can take 10 grams of oral L-carnitine.

02:15:51.640 | - Is the one gram, the typical dose you recommend,

02:15:54.580 | one gram per day?

02:15:56.000 | - For fertility and androgen receptor upregulation.

02:15:58.720 | So that means taking 10 grams of the capsule form.

02:16:01.480 | - Yeah, so that's about 15 to 20 capsules, which is a lot.

02:16:05.760 | - That is a lot.

02:16:06.600 | - It can also potentially increase TMAO.

02:16:08.500 | - Yeah, I wanted to ask about that

02:16:09.600 | because TMAO on your blood chart, when that's elevated,

02:16:14.360 | that's going to cause some concern.

02:16:16.280 | You taught me a trick, however,

02:16:17.880 | that one can take 600 milligrams of garlic capsule

02:16:22.880 | for the allicin, is that what it's called?

02:16:24.600 | - Allicin is in it, yeah.

02:16:25.440 | - It's like the name allicin, but with two Ls?

02:16:27.280 | - Yeah. - Okay.

02:16:29.120 | And that had a remarkable effect in reducing TMAO.

02:16:33.360 | So that's quite potent.

02:16:34.680 | And also, was it just coincidence

02:16:38.440 | that it really brought my LDL down as well?

02:16:41.940 | - I'm not sure if the LDL is a coincidence,

02:16:45.240 | but depending on your gut microbiome or your microbiota,

02:16:49.880 | some microbiome beneficial bacteria

02:16:54.160 | will convert carnitine and also choline.

02:16:57.620 | So any choline precursor like alpha GPC

02:17:00.000 | or phosphatidylserine,

02:17:01.580 | it will convert them more or less to TMAO.

02:17:04.500 | So TMAO is something that you can get measured

02:17:06.280 | in a blood test and see if it's high or low.

02:17:08.600 | Some people might not even need allicin.

02:17:11.100 | - Interesting. - Some people

02:17:11.940 | do benefit from it.

02:17:12.840 | - Interesting.

02:17:13.680 | Although I think it was you that also told me

02:17:16.800 | that allicin and garlic can have positive effects

02:17:19.220 | on cardiovascular tone and blood flow generally.

02:17:22.400 | Is that right? - Yeah.

02:17:23.600 | - Okay, so maybe, so it's 600 milligrams garlic

02:17:26.500 | in excessive amount, or can I just eat garlic?

02:17:29.640 | - You can just eat. - I mean,

02:17:30.480 | I like eating garlic. - Yeah.

02:17:31.760 | - Yeah, so, okay, so one could also just eat garlic.

02:17:34.600 | If one were going to take allicin in injectable form,

02:17:37.640 | how much of that is bioavailable?

02:17:39.920 | - 100% if you inject it.

02:17:41.960 | It is in an aqueous solution.

02:17:44.040 | So it's a bacteriostatic water essentially.

02:17:47.040 | So it's not in a carrier oil.

02:17:49.400 | So it really, it's going to burn a lot

02:17:51.400 | if you inject it subcutaneously.

02:17:53.480 | So it's going to be absorbed faster and more evenly

02:17:57.460 | and also just hurt a lot less

02:17:59.360 | if you inject it into a muscle.

02:18:01.360 | - But one could then just take one gram per day injected

02:18:05.420 | or divide it up into a couple of doses.

02:18:07.060 | - Yeah, or 500.

02:18:07.980 | The minimally efficacious dose for injectables,

02:18:10.700 | probably around 200 when it comes to sperm motility

02:18:14.700 | and the androgen receptor upregulation.

02:18:16.940 | So it really depends on why you're taking it.

02:18:19.580 | - In terms of fertility and in terms of blood tests,

02:18:21.620 | generally, you know, I always say that if possible,

02:18:26.620 | either by way of insurance or by way of some other way,

02:18:32.260 | affording it, it would be great for people

02:18:34.580 | to have blood tests to know what their hormone levels

02:18:37.360 | and other levels of other things like metabolic markers

02:18:39.820 | and lipids were in their 20s, also in their 30s,

02:18:43.120 | also in their 40s.

02:18:43.960 | I think there's this idea that you only take a blood test

02:18:46.220 | when you have a problem.

02:18:47.420 | But then of course, one can't actually do the comparison

02:18:51.700 | that you mentioned earlier or state the comparison

02:18:53.700 | to one's physician that things are changing over time.

02:18:57.580 | And it seems to me that basically everyone should get

02:19:00.620 | at least a once a year blood test.

02:19:02.540 | Is there the hope that insurance will someday just cover it

02:19:05.620 | for everybody, this will be standard care?

02:19:07.280 | I would think that everybody should know what sorts

02:19:10.500 | of things are floating around in their bloodstream

02:19:12.140 | and what they need more of and less of in life.

02:19:14.740 | I doubt it will ever be covered by insurance.

02:19:17.940 | In many cases, you could make an argument that it's indicated

02:19:21.300 | as insurance begins to cover more of the population

02:19:24.640 | for pathologies, the things like FSAs or HSAs,

02:19:29.640 | your care credit will likely cover this advanced testing,

02:19:34.420 | which it continues to come down and down in price.

02:19:37.500 | So it'll be affordable, but it won't be free.

02:19:40.020 | - Got it. - Yeah.

02:19:41.400 | - I'd like to shift gears slightly

02:19:42.640 | and talk about social interactions

02:19:46.220 | and relational effects on hormones.

02:19:48.900 | Something that I just find fascinating.

02:19:50.660 | We touched on this a little bit earlier

02:19:52.040 | with in terms of oral contraception,

02:19:53.480 | but now that we have the backdrop

02:19:55.360 | of what these various hormones do,

02:19:57.280 | some involvement in neurotransmitter systems

02:19:59.320 | like dopamine and prolactin and associated pathways,

02:20:02.640 | prolactin of course being a hormone, not a neurotransmitter,

02:20:04.840 | but there's a phenomenon in human beings

02:20:09.800 | where people get very excited about a new partner

02:20:13.260 | and that excitement no doubt is related

02:20:16.700 | to the dopamine system among other systems.

02:20:18.980 | And that excitement can be maintained

02:20:21.100 | or can wane over time.

02:20:22.340 | And here I'm talking about attraction,

02:20:23.620 | but I'm also talking about just general excitement

02:20:25.460 | in the sense of novelty,

02:20:26.440 | because that's what dopamine is associated with.

02:20:29.380 | Given that you work with human beings

02:20:33.500 | and they have lives and relationships and lifestyles,

02:20:36.560 | and they have hormones and all these things interact,

02:20:39.260 | what are some of the ways that we could think

02:20:41.040 | about adjusting our relationships

02:20:45.920 | in order to optimize hormones,

02:20:48.100 | as opposed to just thinking about how to optimize hormones

02:20:51.500 | for sake of our relationship?

02:20:52.620 | Because it's bi-directional, of course.

02:20:55.080 | And this assumes, I should say,

02:20:57.900 | that one is already paying attention

02:20:59.900 | to the six pillars talked about earlier

02:21:02.340 | that people are doing most things right.

02:21:04.460 | How should we think about relationships and hormones?

02:21:07.140 | Friendships, romantic relationships,

02:21:08.740 | new partners, long-term partners.

02:21:11.100 | How do you think about this kind of stuff?

02:21:15.100 | - Yeah, so if you have a new partner,

02:21:18.460 | then it is largely regulated by the dopaminergic system,

02:21:22.180 | which changes over time.

02:21:23.500 | So people may have heard the saying

02:21:25.380 | that you have to go through a full calendar year

02:21:28.200 | with someone that you're in a relationship so that you-

02:21:29.900 | - Very good advice, by the way.

02:21:30.740 | - So that you really know what to do and what not to do.

02:21:34.780 | But because you experience both of your families

02:21:37.940 | and the holidays and all the different situations,

02:21:40.220 | but I would argue until you have moved in together,

02:21:44.460 | had a baby, and then raised that baby,

02:21:46.780 | preferably breastfeeding,

02:21:48.740 | because that's when you get the prolactin spikes,

02:21:50.780 | you aren't really gone through every stage in life yet.

02:21:54.100 | Now, you can't really do that

02:21:55.020 | with every person that you're considering.

02:21:56.560 | - Well, some people do,

02:21:57.460 | but it can be quite costly in terms of time and finances

02:22:01.500 | and emotionally costly.

02:22:02.880 | And then here, I'm definitely not referring

02:22:05.360 | to any personal experience of having done all that

02:22:07.960 | many times over,

02:22:08.800 | but what would you suggest people do or think about

02:22:13.800 | as they enter relationship,

02:22:16.220 | or for people that are in long-term relationships

02:22:18.500 | where they feel like something has shifted,

02:22:21.200 | and indeed, those shifts may reflect the output

02:22:24.840 | of different hormone systems and neurotransmitter systems.

02:22:27.120 | It almost certainly has to be the case, right?

02:22:28.960 | - Yeah.

02:22:29.860 | So just like women who spend a lot of time together,

02:22:33.580 | whether they're coworkers or whatever,

02:22:35.040 | a lot of times their menstrual cycles will align.

02:22:38.440 | There is a lot of pheromoneal and hormonal crosstalk,

02:22:42.040 | including prolactin between men and women.

02:22:44.800 | So spending 100% of the time together,

02:22:48.280 | this is why people think it's so hard to work together

02:22:51.080 | and live together.

02:22:51.960 | They're around each other 24/7.

02:22:54.240 | You don't have the reprieve

02:22:55.600 | where you let that dopamine settle down,

02:22:58.300 | and then you're excited when you see them again.

02:23:00.760 | A lot of guys know that if they've gone on a hunting trip

02:23:03.720 | or if they've gone on a trip for a long time,

02:23:05.140 | they come back and they see their partner,

02:23:07.860 | and it's like a new, not quite like a new relationship,

02:23:10.120 | but almost like a new relationship,

02:23:11.960 | and they have that excitement again.

02:23:13.660 | And purposely building that into every relationship

02:23:16.440 | can help significantly,

02:23:18.180 | especially if you choose to have a child or get pregnant

02:23:21.760 | or be breastfeeding,

02:23:23.080 | because you just plan ahead

02:23:24.760 | for both of your prolactins to be high

02:23:26.720 | and both of your dopamines to be low

02:23:28.840 | and both of your testosterone to be low.

02:23:31.800 | So there's a lot of planning that you can do.

02:23:36.680 | Essentially, every relationship goes through a crisis,

02:23:41.680 | and that crisis is personal between the two of you,

02:23:46.600 | and you can plan ahead and figure out a way,

02:23:51.160 | maybe it's not supplementation,

02:23:52.660 | maybe it's not even the amount of time

02:23:55.080 | you spend away from each other,

02:23:56.880 | but plan ahead to have good times

02:24:00.400 | if you know you're about to go into a crisis.

02:24:02.600 | - Got it.

02:24:03.440 | And so it sounds like time apart and time together,

02:24:05.280 | which is actually built into a number of cultures

02:24:07.480 | where men and women will purposefully avoid each other

02:24:10.360 | for some period of time,

02:24:11.400 | avoid physical touch and maybe in proximity,

02:24:13.640 | and then we'll reconvene,

02:24:14.660 | and yet those are very stable relationships

02:24:16.360 | over time often.

02:24:17.480 | Is the inverse also true?

02:24:21.020 | For instance, for people

02:24:21.860 | that are in long distance relationships,

02:24:24.160 | where they're only seeing each other

02:24:25.440 | three or four days a week or two days a week,

02:24:28.880 | does this explain the fact that some of those relationships

02:24:32.080 | can go on for a very long period of time

02:24:33.640 | without ever actually entering the,

02:24:36.240 | let's call it the hyperprolactin phase

02:24:38.040 | of actually moving in together and et cetera, et cetera?

02:24:40.960 | Like in other words,

02:24:42.120 | is that a way in which people are spiking

02:24:46.000 | and troughing dopamine that keeps them attached?

02:24:48.340 | This kind of elusive, this sort of, what is it called?

02:24:52.520 | I think it's called like a cat string.

02:24:54.320 | Like if you play with a cat and you move the string away,

02:24:56.580 | they'll keep reaching,

02:24:57.420 | but you throw the string on the ground,

02:24:58.440 | and they're like, they're totally uninterested in it.

02:24:59.880 | Is that what's going on?

02:25:01.240 | 'Cause that's a dopaminergic phenomenon,

02:25:02.960 | the cat string example.

02:25:04.480 | We know this experimentally.

02:25:06.140 | - In those cases, the relationship hasn't really progressed,

02:25:09.440 | in many of those cases, past the dopamine spike,

02:25:13.440 | the fun initial stage, honeymoon stage,

02:25:15.840 | whatever you want to call it.

02:25:17.080 | So it's almost kind of like a roommate.

02:25:19.360 | If you're looking for a roommate,

02:25:20.600 | if it was for college or after college or whatever,

02:25:23.360 | you can fill out forms and look for common interests,

02:25:26.320 | but until you're actually together

02:25:28.900 | a significant proportion of the time,

02:25:31.320 | you're not really going to know

02:25:32.160 | if you're going to be compatible or not.

02:25:34.480 | - And is there evidence that the appearance of an infant

02:25:39.480 | changes, obviously there are going to be hormonal shifts.

02:25:43.400 | We know actually that for, in both women and in men,

02:25:47.460 | there's a prolactin increase

02:25:49.360 | when couples are expecting a child.

02:25:53.020 | This is the, it's almost like a brooding phenomenon.

02:25:55.260 | You see this in birds where it's actually called brooding

02:25:58.400 | and it's caused by prolactin increase,

02:26:00.360 | but it turns out this also occurs in humans.

02:26:03.180 | And some people would argue this causes

02:26:05.020 | the dad bod phenomenon because it actually,

02:26:06.960 | prolactin's involved in laying down a body fat,

02:26:08.720 | preparing for sleepless nights.

02:26:10.460 | And presumably that spike in prolactin

02:26:12.420 | is there also to suppress sexual activity

02:26:15.100 | because there are periods of time immediately

02:26:17.460 | near childbirth where sexual activity is not advantageous.

02:26:22.200 | - Yeah, you see a prolactin spike right after breastfeeding.

02:26:25.860 | So if you think about it, often when you have an infant,

02:26:28.660 | you'll breastfeed, put the infant to bed

02:26:33.120 | and then immediately go to bed with your partner,

02:26:35.040 | which is not particularly conducive.

02:26:36.780 | It's almost like trying to have intercourse back to back.

02:26:40.000 | And it's very difficult.

02:26:41.320 | - Because of the, in the prolactin sense.

02:26:43.240 | - Yeah, low dopamine, high prolactin.

02:26:46.220 | Oxytocin is also increased significantly

02:26:48.880 | to help with milk let down as well.

02:26:51.380 | So yeah, as far as brooding,

02:26:54.380 | there's definitely a human equivalent of brooding.

02:26:58.740 | Some humans call it nesting instinct, which is both helpful,

02:27:03.280 | but it's not necessarily a bad change in relationship.

02:27:07.440 | It's just a change.

02:27:09.020 | And as long as you know that it's coming,

02:27:11.240 | you're gonna do better with it, just like any medication.

02:27:14.240 | If you are aware of the side effect

02:27:16.280 | and then it might happen, then when it happens,

02:27:19.300 | it's not only less severe, it also happens less often.

02:27:24.300 | - Very interesting. - You tell the patient.

02:27:26.800 | - Well, as a neuroscientist,

02:27:28.320 | I come from the framework that,

02:27:30.360 | of course hormones impact perception and behavior,

02:27:32.720 | but perception and behavior also impact hormones.

02:27:35.080 | I find this fascinating.

02:27:36.000 | I also really liked the example you gave

02:27:37.920 | of people taking time apart,

02:27:40.000 | but also these affiliative bonds that are non-romantic bonds

02:27:43.800 | can serve as kind of a reservoir to replenish dopamine

02:27:48.760 | that is then released upon experience,

02:27:51.560 | going back to one's partner

02:27:52.880 | or some sort of regular feature of home.

02:27:54.840 | Very interesting.

02:27:57.260 | And of course this should exist on both sides.

02:27:59.020 | I'm guessing that from both the male side and female side,

02:28:02.560 | there's an interest in kind of separation and reunion

02:28:05.240 | as the theme.

02:28:06.240 | And I guess the frequency will vary for different couples

02:28:09.000 | in different situations.

02:28:10.400 | - Yeah, and I don't want to make it seem

02:28:12.320 | like prolactin is all bad.

02:28:13.600 | So prolactin does help with the nesting instinct.

02:28:16.520 | It helps with breastfeeding as well.

02:28:19.120 | A lot of women are diagnosed with luteal phase defects,

02:28:22.540 | which is basically the phase after ovulation,

02:28:25.120 | but before a period or giving birth.

02:28:26.960 | The pregnancy is kind of a prolonged luteal phase.

02:28:29.840 | And a lot of them will go on progesterone for this.

02:28:33.040 | Progesterone can also decrease prolactin.

02:28:35.920 | And prolactin is also helpful

02:28:38.040 | for the maturity of the lungs and infants.

02:28:40.320 | So it helps the sphingomyelin to lechithin ratio.

02:28:43.360 | So it can decrease,

02:28:44.320 | if your prolactin is too low through pregnancy,

02:28:46.700 | it spikes up very high during pregnancy,

02:28:49.360 | then it can lead to increased risk

02:28:51.400 | of respiratory distress of the newborn.

02:28:54.120 | - Really interesting.

02:28:54.960 | Yeah, so we certainly don't want to paint a picture

02:28:56.680 | where prolactin is the bad, bad hormone to avoid.

02:28:59.840 | It's without prolactin, none of us would be here, of course.

02:29:04.680 | It's so vital.

02:29:05.940 | I realized that earlier I raised the question

02:29:07.680 | about whether or not cold exposure

02:29:09.940 | could modify hormone output.

02:29:11.900 | In particular, whether or not ice baths

02:29:13.800 | or ice applied to specific tissues of the body,

02:29:16.280 | as people are doing one way or the other,

02:29:19.520 | can change testosterone levels, estrogen levels.

02:29:24.040 | In other words, does taking ice baths in cold showers

02:29:26.360 | increase testosterone and/or estrogen?

02:29:28.800 | - Yeah, so taking an ice bath or a cold shower

02:29:32.560 | or cold exposure in general,

02:29:34.440 | it's not going to correct a vitamin D deficiency

02:29:36.800 | or a metabolic syndrome.

02:29:38.440 | So there's a lot of things that it will not correct

02:29:40.760 | that are causes of hypogonadism or low testosterone,

02:29:44.720 | but it will help acutely,

02:29:47.120 | specifically the application of cold

02:29:50.160 | to testes that are too warm.

02:29:52.560 | So if you have a varicocele

02:29:55.040 | or if you have a little bit of a primary hypogonadism,

02:29:58.720 | which is where testosterone is not released by the testes,

02:30:02.780 | but your LH and FSH signals are sufficiently high,

02:30:06.720 | then you'll likely respond to cold exposure better.

02:30:11.080 | And there's actually undergarments

02:30:12.380 | that are designed specifically to help with fertility.

02:30:15.840 | And there's probably going to be more and more

02:30:17.080 | of that in the future.

02:30:18.120 | You just need to be careful not to get frostbite

02:30:20.280 | because it's a particularly bad spot to get frostbite.

02:30:23.680 | - Noted.

02:30:24.520 | Could you define varicocele?

02:30:26.840 | You mentioned it a few times.

02:30:28.320 | That's a varicose vein?

02:30:30.440 | - Yeah, so it's essentially a varicose vein.

02:30:33.120 | It brings warm blood and the venous flow

02:30:36.920 | or the flow back to the heart is not as good.

02:30:39.420 | Just like in the legs, it can happen in the scrotum.

02:30:42.080 | Usually about 20 to 25% of people

02:30:44.360 | have one grade of varicocele.

02:30:46.480 | There's grades one through four, one through five.

02:30:49.160 | And most people just have a very mild one,

02:30:51.460 | usually on the left side,

02:30:53.000 | because the blood has to go through further

02:30:55.060 | to get back to the heart.

02:30:56.680 | And it raises the temperature of the testes.

02:31:00.120 | Temperature is the enemy of testes.

02:31:01.980 | So they like to be five to 10 degrees cooler

02:31:04.640 | than the rest of the body.

02:31:06.000 | - So are saunas particularly bad for sperm production?

02:31:09.180 | - They can be, yeah.

02:31:10.800 | - When you say can be,

02:31:11.820 | how long could one safely be in the sauna?

02:31:13.920 | Would you want to go back and forth

02:31:16.100 | between the cold and sauna?

02:31:18.620 | Are there any data?

02:31:22.000 | - If someone is having infertility,

02:31:24.720 | then I tell them to avoid all saunas empirically.

02:31:28.140 | If someone has, if they're not infertile,

02:31:32.040 | but they have a low sperm count,

02:31:33.320 | I also tell them to avoid.

02:31:35.480 | However, it's mostly warmed water

02:31:38.920 | that can raise the temperature of the testes

02:31:42.100 | faster than the sauna.

02:31:43.600 | - So hot tubs and things of that sort.

02:31:45.000 | - Yeah, so hot tub and a jacuzzi,

02:31:47.040 | those are enemies number one and number two of sperm.

02:31:50.000 | - What about ice baths and cold showers for women?

02:31:54.220 | Any evidence that it can shift hormone output in women?

02:31:57.560 | - Yeah, it can.

02:31:58.720 | It increases the activity of the beta adrenergic receptors,

02:32:03.720 | even in the central nervous system

02:32:06.700 | and the astrocytes as well.

02:32:08.620 | So it can do a few things.

02:32:10.020 | It can slightly decrease the drive for food,

02:32:15.020 | which astrocytes and beta adrenergic receptors

02:32:17.420 | have some medications that are weight loss medicines

02:32:20.000 | also do similar things.

02:32:21.540 | But it can be beneficial in women too.

02:32:26.900 | - But no evidence that it changes

02:32:28.360 | estrogen output in women, correct?

02:32:30.980 | - Not that I know of.

02:32:33.300 | - Me either.

02:32:34.140 | Peptides, lot of discussion these days about peptides.

02:32:38.960 | Peptides, of course, just being strings of amino acids,

02:32:41.020 | as you mentioned, very small ones,

02:32:42.940 | like two amino acids, like L-carnitine,

02:32:45.060 | all the way up to polypeptides,

02:32:46.660 | which just mean many, many, many amino acids.

02:32:49.720 | There are so many peptides that there's,

02:32:52.800 | we should probably just do an entire episode about peptides.

02:32:54.940 | But I think one of the reasons I'm hearing so much

02:32:57.140 | about peptides these days

02:32:58.480 | is that they are not called steroids.

02:33:00.860 | You know, the name steroids, I think,

02:33:03.480 | has come to be associated with anabolic steroids

02:33:07.580 | in the context of acne, testosterone rage, et cetera.

02:33:12.120 | But of course, estrogen is a steroid hormone, right?

02:33:16.420 | There are other steroid hormones, as we both know.

02:33:19.540 | But peptides are gaining increasing popularity.

02:33:23.440 | I am willing to go on record saying that you can be sure

02:33:25.940 | that many of the incredible transformations

02:33:28.180 | that you see in Hollywood

02:33:29.340 | are the consequence of peptide use.

02:33:32.380 | And I put my name behind that

02:33:35.940 | because I'm well aware of people

02:33:37.540 | that use these to prepare for roles, but athletes use them.

02:33:40.660 | And then everyday people are using them too.

02:33:42.460 | For instance, sermorelin, tesemorelin, ipomorlin,

02:33:46.780 | to stimulate the release of growth hormone

02:33:50.260 | rather than taking growth hormone.

02:33:52.260 | PPC 157, which is essentially a synthetic gastric juice

02:33:56.460 | that normally repairs the gut.

02:33:58.840 | They're being used to treat injuries.

02:34:01.100 | And there are other ones as well.

02:34:03.520 | What can we say generally about peptides?

02:34:05.300 | Are they safe? Are they not safe?

02:34:06.640 | What about sourcing?

02:34:08.020 | And are there any peptides

02:34:09.220 | that you think could be of particular use for people?

02:34:12.820 | And we should probably also touch on peptides

02:34:14.420 | that people shouldn't go anywhere near with a 10-foot pole.

02:34:17.380 | - Yeah, definitely.

02:34:18.420 | So peptides are very heterogeneous.

02:34:20.560 | There's very dangerous ones and very safe ones.

02:34:24.120 | My favorite peptide is the original peptide,

02:34:27.440 | which is insulin.

02:34:28.800 | So insulin is a peptide.

02:34:31.360 | And less than a hundred years ago,

02:34:34.960 | there was a scientist studying insulin.

02:34:38.360 | And at some point,

02:34:39.360 | they saw that an animal had its diabetes cured

02:34:43.280 | by insulin injection.

02:34:46.440 | Less than a year later,

02:34:47.680 | they were injecting insulin into every type one diabetic

02:34:50.920 | because it was saving their lives.

02:34:52.240 | - And yet insulin can kill you

02:34:54.640 | if you take it at the incorrect dose.

02:34:57.040 | - Yeah, so just like insulin

02:34:59.400 | should be prescribed by a doctor,

02:35:01.200 | there is over-the-counter insulin rely on or NPH,

02:35:04.160 | but ideally your insulin is prescribed by your doctor

02:35:08.000 | for your diabetes as it's life-saving.

02:35:11.680 | Peptides should be prescribed by doctors as well.

02:35:14.080 | And there are several that are FDA approved.

02:35:16.580 | So you mentioned a lot of different ones.

02:35:19.220 | Let's start with tesamorylin.

02:35:21.300 | So tesamorylin was recently FDA approved

02:35:24.300 | for something called lipodystrophy.

02:35:26.800 | It happens where body fat is displaced into abnormal areas,

02:35:31.160 | often as part of AIDS or severe burns, things like that.

02:35:34.740 | And it helps redistribute this body fat

02:35:36.840 | and give people their quality of life back.

02:35:39.120 | Tesamorylin is a GHRH,

02:35:41.880 | which I kind of loop into the category of GHRPs,

02:35:44.600 | so growth hormone releasing peptides.

02:35:47.640 | So it's only a couple amino acids different

02:35:49.660 | from endogenously produced growth hormone releasing hormone.

02:35:53.800 | So growth hormone itself is also a peptide.

02:35:57.460 | It's a peptide hormone, not a steroid hormone.

02:36:01.160 | So you have different somatotrophs,

02:36:05.620 | which are very similar to growth hormone.

02:36:09.040 | Another fun fact is that HPL,

02:36:11.780 | which is human placental lactogen,

02:36:13.860 | we love acronyms, right?

02:36:15.460 | Human placental lactogen is nearly identical

02:36:18.560 | to growth hormone.

02:36:19.640 | The growth hormone in pregnancy is not what causes

02:36:24.260 | the sugar spike and gestational diabetes.

02:36:26.600 | It's the human placental lactogen.

02:36:29.100 | So if you look at twin pregnancies,

02:36:31.220 | if they have two placentas or more placental tissue

02:36:35.100 | making more human placental lactogen,

02:36:37.520 | the risk of gestational diabetes is exponentially higher.

02:36:42.320 | So this HPL is only a couple molecules different

02:36:46.920 | from growth hormone.

02:36:48.520 | It is interesting that these different GHRHs and GHRPs

02:36:52.680 | actually have pretty different mechanisms of action.

02:36:55.360 | Grelin is also a hormone that's released

02:36:58.420 | when you're hungry.

02:36:59.780 | This is probably one of the reasons

02:37:01.400 | why you have more growth hormone release overnight.

02:37:04.360 | And there's a lot of peptides

02:37:05.560 | that are very similar to ghrelin.

02:37:07.620 | So these peptides are not bio-identical peptides,

02:37:11.480 | but they just have a couple different amino acids changed.

02:37:14.480 | So they're almost identical.

02:37:16.880 | And they're probably going to be used in the future

02:37:19.220 | for growth hormone deficiencies,

02:37:21.000 | including in kids they've been studied.

02:37:23.020 | - So if somebody wants to increase

02:37:24.400 | their growth hormone output,

02:37:25.600 | in addition to not eating within two hours of sleep,

02:37:29.600 | getting good, deep sleep,

02:37:31.080 | doing all the other things in the six pillars

02:37:34.480 | that you mentioned earlier,

02:37:35.400 | especially resistance exercise at some point

02:37:39.120 | earlier in the day,

02:37:41.340 | what are the risks and benefits

02:37:43.280 | of taking a growth hormone releasing hormone peptide

02:37:46.400 | like sirloin, prescribed by a doctor, of course?

02:37:50.100 | What should one be concerned about?

02:37:53.420 | How long could one take these?

02:37:54.780 | I've even heard that they can modify gene expression

02:37:57.280 | so that they really are changing your hypothalamus

02:38:00.380 | in very long lasting ways.

02:38:02.800 | - Yeah, there's definitely a lot of risk,

02:38:05.340 | tumor growth and cancer.

02:38:07.600 | So you look at a type one diabetic,

02:38:10.360 | they have very high incidences of various types of cancer.

02:38:14.540 | They have very high growth hormone,

02:38:16.060 | but low IGF-1 paradoxically.

02:38:18.960 | So they would likely give you a similar cancer risk

02:38:21.760 | to a type one diabetic that has very high growth hormone.

02:38:26.620 | However, there are the benefits of it.

02:38:29.480 | You think of lipolysis, decreased body fat,

02:38:33.260 | increased lean body mass.

02:38:34.940 | A lot of those you can use other things

02:38:38.460 | to get those benefits.

02:38:40.300 | So then you don't need growth hormone for those benefits.

02:38:45.300 | It just leaves cosmetic benefit

02:38:48.260 | to which you can usually use topicals

02:38:49.900 | to get your hair and your skin and your nails.

02:38:52.820 | There's a lot of other things that you can do

02:38:55.180 | other than growth hormone.

02:38:57.020 | So a lot of people just don't need these GHRPs

02:39:00.860 | if they don't have lipodystrophy

02:39:02.860 | or if they don't have growth hormone deficiency.

02:39:05.080 | There is other uses of them specifically in injuries.

02:39:09.040 | So I know that they've been studied.

02:39:11.280 | I'm not sure if it's in the military.

02:39:12.620 | We mentioned the woodpecker or the coup contrecoup injury.

02:39:16.060 | So that can obviously-

02:39:17.020 | - Head resulting back and forth.

02:39:17.860 | Then the brain basically slamming up

02:39:19.120 | against the front of the skull.

02:39:20.340 | Yeah, football, heading the ball in soccer.

02:39:24.020 | Definitely people who use the 50 caliber in military,

02:39:26.980 | although that's a fairly small population.

02:39:29.800 | And I think anyone that's hit their head hard

02:39:33.340 | more than once.

02:39:34.240 | - Yeah.

02:39:35.080 | We can talk about BPC-157 for a bit.

02:39:38.340 | GHK copper peptide for a bit.

02:39:40.260 | TB-500 or a thymosin beta-4 analog.

02:39:44.520 | And then we can also talk about bromelanotide,

02:39:48.060 | which is melanotan-3.

02:39:49.760 | They have melanotan-1 and 2.

02:39:51.960 | And then they also have melanotan-3 and 4.

02:39:54.040 | - Yeah, let's talk about BPC-157 and melanotan.

02:39:56.980 | 'Cause I think those are the ones

02:39:57.940 | that most people are eyeing, so to speak.

02:40:01.860 | - So BPC-157 is body protective compound, 157.

02:40:06.300 | It's identical or bio-identical

02:40:09.860 | to gastric protective compound, 157,

02:40:13.080 | that's produced in the stomach.

02:40:14.860 | So as you age, you get atrophic gastritis very often.

02:40:19.860 | That's why you have less intrinsic factor,

02:40:22.620 | which is kind of another peptide that binds to vitamin B12.

02:40:25.740 | That's why you can get age-related B12 deficiencies.

02:40:28.980 | So that's one reason why you have more colitis,

02:40:32.420 | more diverticulitis as you age.

02:40:34.040 | You don't have that gastric protective compound.

02:40:36.640 | It increases VEGF, vascular endothelial growth factor,

02:40:41.600 | which basically makes your blood vessels grow more.

02:40:45.360 | So that's what causes your body to form a blood vessel.

02:40:49.520 | So another medication known as Avastin,

02:40:53.020 | it's on the WHO's list of essential medications for cancer.

02:40:57.660 | So many different types of cancer, including colon cancer,

02:41:00.980 | you treat it with Avastin, which is a VEGF inhibitor.

02:41:04.240 | So if you have cancer or a high cancer risk,

02:41:06.380 | you probably don't want to be taking a medication

02:41:08.680 | that's the exact opposite mechanism of action

02:41:11.300 | as your essential anti-cancer med.

02:41:14.200 | - In other words, if you have cancer,

02:41:15.940 | you're at risk of cancer, avoid BPC-157.

02:41:18.440 | - Correct.

02:41:19.380 | A lot of people prescribe it for six weeks.

02:41:21.900 | And BPC-157, so bremelanotide, that is FDA approved

02:41:25.980 | for a hypoactive sexual disorder.

02:41:29.380 | Tessamoralin, that's also approved for lipodystrophy.

02:41:32.440 | Interestingly, another one of the melanotans

02:41:35.600 | is also approved for lipodystrophy

02:41:38.160 | and also deficiency in the melanocorticoid receptor.

02:41:41.840 | So the receptor that receives

02:41:43.760 | the alpha melanocyte stimulating hormone,

02:41:47.280 | it's a very rare condition.

02:41:48.700 | It's also approved for that because if you don't take it,

02:41:52.560 | then you get obesity.

02:41:54.480 | But BPC-157 is not FDA approved,

02:41:58.080 | but it is essentially standard of care at this point.

02:42:01.080 | I would say if you're not counting insulin

02:42:04.860 | or growth hormone as peptides,

02:42:06.880 | it's one of the most commonly used peptides.

02:42:09.440 | And anecdotally and in some clinical literature,

02:42:12.360 | it's fairly well tolerated for short periods of time.

02:42:15.680 | I'm not in the camp that everybody needs to do it

02:42:17.720 | two to three times a week or even daily

02:42:20.360 | for six weeks no matter what.

02:42:22.760 | The major benefit is when you're gonna take it early on

02:42:26.900 | because it's gonna allow your body to increase blood flow

02:42:31.000 | to the injured area and the less blood flow it has,

02:42:34.080 | for example, cartilage ligaments have horrible blood flow,

02:42:36.800 | especially as people age.

02:42:38.460 | It's gonna make a significant difference.

02:42:40.040 | So I would wager that that Russian gymnast

02:42:42.120 | that Achilles healed in one month

02:42:44.020 | and completely from a full rupture

02:42:46.120 | was likely taking BPC-157 or something very similar.

02:42:49.280 | - Yeah, I'm willing to wager on that as well.

02:42:51.240 | A remarkable recovery.

02:42:52.760 | And so because it is prescription,

02:42:55.760 | there are non-prescription forms.

02:42:57.180 | My understanding of the non-prescription forms

02:42:59.120 | and the danger of going after non-prescription forms

02:43:02.180 | is that oftentimes they will contain

02:43:04.780 | what they claim they contain, BPC-157 in this case,

02:43:08.000 | but they are not adequately cleaning out the LPS,

02:43:11.280 | the lipopolysaccharide, which can cause inflammation.

02:43:14.040 | In fact, in the laboratory,

02:43:14.960 | we use LPS to deliberately induce fever and inflammation

02:43:18.480 | to study systemic inflammation.

02:43:20.680 | So this is a warning to people

02:43:22.280 | if you're interested in peptides,

02:43:23.380 | you absolutely need to work with a physician, in my opinion.

02:43:26.340 | Get it from a really good compounding pharmacy

02:43:28.340 | who will clean out, that cleans out the LPS.

02:43:31.660 | Because if you're buying it through a source that,

02:43:34.340 | you know, a lot of people, I don't want to name sources,

02:43:36.080 | but there are these common sources on the internet

02:43:37.700 | that everyone knows about.

02:43:38.540 | They're buying these sources.

02:43:39.540 | They'll ship it to anyone essentially.

02:43:41.340 | But then the LPS is really causing inflammation.

02:43:45.680 | And many people experience a kind of mild fever

02:43:48.140 | or tingling from that when they inject it.

02:43:50.260 | And they're like, "Oh, I can feel it working."

02:43:51.540 | That's probably LPS action, which is not good for the brain.

02:43:55.940 | I don't know about the, on other peripheral tissues.

02:43:58.940 | I haven't heard of people dropping dead from this stuff yet,

02:44:01.020 | but I certainly wouldn't want to be ingesting

02:44:03.020 | any LPS unnecessarily.

02:44:04.620 | So would you agree that you should work with a doctor?

02:44:07.340 | After all, you are a doctor.

02:44:08.180 | - Yeah, definitely talk to your doctor about this

02:44:10.800 | and talk to them about the dosing regimen as well.

02:44:12.940 | So if they have you doing it for six weeks,

02:44:15.100 | ask them, "Why am I doing it for six weeks?

02:44:17.260 | Why not two weeks or why not as soon as I feel better,

02:44:19.940 | can I just stop it?"

02:44:21.360 | - Yeah, there's a lot of good questions like that

02:44:22.960 | that you should ask your doctor.

02:44:24.300 | And if somebody is trying to prescribe you

02:44:25.760 | a bunch of different things, then see,

02:44:28.940 | is this what they prescribe everybody

02:44:30.580 | or is this individualized for me?

02:44:32.620 | There are peptides like GHK copper peptide,

02:44:35.020 | which is produced endogenously in the liver

02:44:37.060 | more at younger ages.

02:44:38.700 | That's why the liver can regenerate fully

02:44:40.440 | is this a GHK copper peptide helps.

02:44:43.180 | And if you're copper deficient,

02:44:44.460 | which not a whole lot of people are,

02:44:45.720 | but a lot of people that have had bariatric surgery

02:44:47.600 | are copper deficient.

02:44:49.260 | GHK copper peptide can help significantly

02:44:51.740 | with your nervous system.

02:44:53.280 | And it's also synergistic.

02:44:54.580 | So any growth agonists like thymus and beta-4

02:44:57.400 | made in kids in the thymus, which shrinks,

02:45:00.120 | that's another reason why kids heal really well.

02:45:03.080 | That and GHK is somewhat synergistic with BPC,

02:45:06.580 | but if you don't need all three, you don't want them.

02:45:08.840 | And if you don't need it for more than a week,

02:45:10.420 | you don't want it for more than a week.

02:45:13.000 | - I really appreciate you saying that.

02:45:14.440 | I often say that sometimes the best dose

02:45:16.580 | of something to take is zero.

02:45:18.580 | That's often the case that the best dosage is zero.

02:45:21.580 | You mentioned melanotan.

02:45:22.640 | There are several kinds of melanotan.

02:45:24.700 | I find it a little bit of a funny conversation

02:45:26.760 | because I first learned about melanotan

02:45:29.120 | from reading about peptides and discovering

02:45:31.780 | that people were taking, injecting melanotan to get tan

02:45:35.320 | because it's in the melanin synthesis pathway.

02:45:38.580 | They also discovered, this isn't an individual,

02:45:41.380 | this is reading about this in various manuscripts

02:45:44.120 | and peer-reviewed papers that it could cause things

02:45:47.100 | like pre-opism, like sustained erection

02:45:49.620 | that might be the last one that anyone would ever have

02:45:52.340 | because of damage to the vasculature.

02:45:55.060 | Also women taking melanotan as a way to get tan

02:45:59.260 | and lose body fat.

02:46:00.820 | So this sounds all very recreational.

02:46:02.540 | Are there any clinical usage of melanotan?

02:46:07.020 | So separate from the kind of extreme biohacking

02:46:09.520 | cosmetic world, which is really not the main focus

02:46:12.140 | of this podcast ever, but more in terms of, you know,

02:46:15.620 | pursuing health optimization.

02:46:18.060 | - Yeah, there's actually three FDA approved indications,

02:46:21.480 | believe it or not.

02:46:22.320 | Not many people know about this,

02:46:23.320 | but there's three well-accepted indications.

02:46:26.820 | One of them is the hypoactive sexual disorder

02:46:29.500 | and more in women.

02:46:30.400 | That's for brimelanotide.

02:46:31.960 | - So those are women that have essentially

02:46:33.900 | no libido whatsoever, but other hormones are in check.

02:46:38.380 | - Classically, it's before menopause.

02:46:42.360 | So those hormonal issues are not contributing.

02:46:45.700 | And when you give them this peptide,

02:46:48.420 | it's also known as PT-141, it helps significantly.

02:46:51.860 | A lot of times you use it in a nasal spray.

02:46:53.940 | It goes straight into the central nervous system

02:46:55.520 | and acts centrally.

02:46:56.360 | You can also inject it and you can also take it via trochee.

02:46:59.320 | - Men and women take it?

02:47:00.600 | - Correct.

02:47:01.460 | It's approved for women, but it can also help men.

02:47:05.340 | And it's relatively safe.

02:47:07.380 | The only relative contraindication that I tell people,

02:47:10.020 | and a lot of people say, oh, there's no side effects

02:47:11.640 | that I know of, but if you have a family history of melanoma

02:47:15.560 | or potentially have a melanoma and don't know about it,

02:47:18.380 | that's why I'm a big advocate of germoscopy as well

02:47:20.700 | and regular skin checks, then theoretically,

02:47:23.120 | it's gonna increase that alpha melanocyte stimulating hormone

02:47:27.120 | and it can grow that.

02:47:28.420 | So that's definitely not a good thing.

02:47:31.340 | So be very careful about long-term administration of it.

02:47:33.680 | It's also approved for lipodystrophy,

02:47:35.880 | which is the same exact thing as tesamoralin,

02:47:39.300 | which I believe is also known as Evista or Agrifta.

02:47:44.300 | And then it's also approved for the rare genetic condition

02:47:47.740 | where your receptors or your melanocytes

02:47:50.980 | don't proliferate as well.

02:47:52.200 | So you usually have hypopigmentation.

02:47:53.900 | It's not true albinism,

02:47:55.540 | but it's associated with morbid morbid obesity

02:47:59.740 | and very poor outcomes from that in childhood.

02:48:02.420 | So it's used in kids actually.

02:48:04.180 | - Interesting.

02:48:05.620 | - Well, peptides are a fascinating landscape,

02:48:08.140 | but thank you for that deep dive into several of them.

02:48:12.700 | We will probably return to you

02:48:15.200 | to talk about peptides again in the near future,

02:48:17.540 | because I know there's a lot more there

02:48:19.040 | and a lot of interest.

02:48:20.140 | I want to talk about the sixth pillar, all right?

02:48:23.460 | So just to remind people, you said diet, exercise,

02:48:27.820 | where appropriate caloric restriction, managing stress,

02:48:31.500 | sleep and sunlight are critical for everyone at all ages

02:48:35.580 | to manage and optimize hormone health.

02:48:38.160 | Then you have the sixth category,

02:48:39.360 | which is a really intriguing one, which is spirit,

02:48:42.600 | which is a kind of unusual thing to hear coming

02:48:44.900 | from a medical doctor, except that I have many colleagues

02:48:48.260 | and indeed our former director

02:48:51.740 | of the National Institutes of Health, Francis Collins,

02:48:53.840 | has talked about this notion of spirit.

02:48:55.780 | We've talked about belief effects on this podcast

02:48:58.040 | before with Ali Krum.

02:48:59.540 | How one's understanding of the things that they do

02:49:02.600 | and their world in general really creates an important effect

02:49:06.840 | on everything at the level of physiology,

02:49:09.720 | not just psychology.

02:49:11.000 | So as a physician, how do you conceptualize

02:49:14.360 | the spiritual aspect and how do you talk to patients

02:49:16.780 | about this given that people walking into your clinic

02:49:19.360 | presumably have a bunch of different religious

02:49:21.360 | and not a religious backgrounds?

02:49:22.720 | I'm sure some are atheists,

02:49:23.840 | some are probably strong believers.

02:49:25.960 | How do you deal with that

02:49:28.080 | and how should people think about this?

02:49:30.520 | - Yeah, I believe it is surprisingly well-received.

02:49:34.820 | You wouldn't think at first glance

02:49:36.820 | that a patient really wants to talk

02:49:38.200 | about their spiritual health with their doctor.

02:49:41.040 | But the way I think about it and the way that it really is,

02:49:43.260 | is it's like a Venn diagram

02:49:44.680 | and you have a body and a mind and a soul

02:49:47.040 | and you can't have one healthy without the other healthy.

02:49:49.440 | Even if your mental health is phenomenal

02:49:52.480 | and even if your physical health is phenomenal,

02:49:54.740 | the mental aspect of spirituality,

02:49:57.240 | if that piece is not there,

02:49:59.420 | then that's gonna affect your body physiologically as well.

02:50:03.920 | And Ali Crum's done some excellent work.

02:50:06.400 | There's also been a lot of other studies regarding prayer.

02:50:09.680 | And I'm a Christian, I believe in God,

02:50:11.540 | and that gives me a lot of that resilience and motivation.

02:50:15.300 | It gives me the cornerstone or the groundwork,

02:50:18.140 | how I can interact with life.

02:50:20.560 | And regardless if someone's an atheist

02:50:22.420 | or regardless of what someone believes

02:50:25.440 | as far as religion or the origin of the species,

02:50:29.560 | they can know that their spirituality

02:50:32.620 | is going to have a profound effect

02:50:34.340 | on their mental and physical health as well.

02:50:37.600 | People like to compartmentalize it.

02:50:39.280 | So they like to talk to their doctor

02:50:41.640 | only about the physical health

02:50:42.960 | 'cause it's comfortable to do that.

02:50:44.280 | They only talk to their pastor or a mom

02:50:46.760 | or a reiki healer for their spiritual health.

02:50:50.160 | And they just talk to their therapist or psychiatrist

02:50:52.860 | about their mental health.

02:50:55.080 | But you need to bring all three of those things together.

02:50:58.280 | It's well known that interdisciplinary clinics

02:51:00.560 | lead to improved patient outcomes,

02:51:02.860 | and that's just disciplines within medicine.

02:51:04.700 | So that's just doctors that are specializing in this or this.

02:51:08.900 | So this takes a step back in the upper part of that tree

02:51:13.320 | before you've reached those dichotomies or the split offs.

02:51:16.160 | You have your body and your mind and your soul,

02:51:18.840 | so your spiritual health and your mental health

02:51:20.680 | and your physical health.

02:51:22.800 | So if you're in line in all three of those things,

02:51:26.840 | that builds the cornerstone for the rest of your health

02:51:29.160 | and the rest of your life.

02:51:30.620 | - So if someone comes into your clinic and they say,

02:51:33.200 | they're feeling one way in their body,

02:51:35.160 | they're feeling one way in their emotional life,

02:51:37.300 | you run their charts, you get their blood work,

02:51:39.600 | and they're an atheist or they're agnostic,

02:51:44.520 | what are some of the six pillar practices

02:51:48.780 | that they can consider that are in keeping

02:51:51.520 | with their atheism or agnosticism?

02:51:54.800 | Because I have to assume that people who participate

02:51:58.680 | or feel that they belong to a particular religious sect

02:52:02.000 | will have particular prescriptives

02:52:03.960 | from those religious sects that will direct them

02:52:07.500 | towards particular types of prayer.

02:52:08.880 | But how would somebody who doesn't have a prescriptive

02:52:13.160 | coming to them from some other source,

02:52:15.000 | what could they do or would they do?

02:52:17.680 | - Yeah, so I certainly don't force prayer on anybody

02:52:19.900 | or anything like that.

02:52:21.300 | But it's my belief that especially being an agnostic,

02:52:25.780 | it's almost the hardest thing because if you're an atheist,

02:52:29.540 | then you have some groundwork and you have some spirituality

02:52:32.460 | even if it has to do with the human spirit's interaction

02:52:36.780 | with the environment,

02:52:38.000 | things that can't be physically explained well,

02:52:40.220 | phenomenon like the work that Ali Krum does.

02:52:42.640 | But if you're agnostic, you're still trying to find that.

02:52:45.760 | So I hope that everybody does find what they truly believe in

02:52:50.080 | as far as their own spirituality.

02:52:52.760 | But yeah, that's a personal journey

02:52:55.880 | from a physician standpoint.

02:52:58.440 | And even if I'm friends with him as well

02:52:59.900 | from a friend standpoint,

02:53:01.020 | I don't like to push anybody in any specific direction.

02:53:04.720 | So I don't think that everybody should believe

02:53:07.160 | what I believe.

02:53:08.380 | And I don't feel like there should be any pressure

02:53:11.640 | for them to believe something different.

02:53:14.380 | So I think that there can be excellent physician,

02:53:17.160 | patient rapport, regardless of what we believe

02:53:20.600 | and what our backgrounds are.

02:53:22.280 | - Yeah.

02:53:23.120 | That's wonderful to hear.

02:53:24.960 | I can say without revealing any names

02:53:27.300 | that I have close colleagues that in every bin

02:53:30.760 | of this spectrum, like hardcore atheists,

02:53:34.000 | hardcore religious in different domains, different religions.

02:53:38.280 | I don't know if I know many,

02:53:40.840 | I'm agnostic as to whether or not I know any agnostics,

02:53:43.080 | I should say.

02:53:44.360 | It's not something that people commonly discuss,

02:53:46.300 | but in the context of science and medicine,

02:53:48.620 | but it's starting to happen more and more.

02:53:50.780 | And certainly this issue of spirituality

02:53:52.740 | is one of the areas in which neuroscience

02:53:54.680 | is asking a lot of questions,

02:53:55.840 | like what spiritual experiences really are

02:53:59.080 | in terms of how they're grounded in the brain

02:54:00.760 | or not grounded in the brain.

02:54:02.040 | I think it's a really interesting area for discovery.

02:54:04.520 | And I appreciate that you bring it up

02:54:06.940 | and you bring it up in the non-pressured way that you do.

02:54:09.680 | I think that it will stimulate a lot of thinking,

02:54:11.840 | which is ultimately the goal of this podcast.

02:54:16.160 | - Well, I have one final question

02:54:19.360 | that a listener insisted I ask,

02:54:23.000 | and it's a very straightforward one.

02:54:25.880 | It's not at all a curve ball and not at all related

02:54:28.720 | to what we were just talking about,

02:54:30.340 | but it was the most common question

02:54:32.000 | when I told people that I was going to be talking to you,

02:54:34.340 | which is, is caffeine problematic for hormones?

02:54:38.880 | It's amazing.

02:54:39.720 | I received hundreds of the same question about caffeine.

02:54:43.360 | And since it's probably the most commonly used drug

02:54:45.860 | on the planet, I know it's taking us back

02:54:48.900 | into the very practical, but in closing,

02:54:52.920 | we're not quite there yet,

02:54:53.760 | but in closing, is caffeine having an effect one way

02:54:57.620 | or the other on testosterone, estrogen,

02:54:59.800 | or other hormones that is positive, negative, or neutral?

02:55:04.520 | - Only if it affects your sleep.

02:55:05.800 | So it works on adenosine,

02:55:07.080 | and it can actually slightly improve allergies as well,

02:55:10.200 | but negligible effect otherwise.

02:55:13.060 | - Great.

02:55:13.900 | Well, sorry to end on such a practical brass tacks

02:55:16.280 | type of question, but I did promise to the listeners

02:55:19.640 | that I would ask that question.

02:55:21.560 | Listen, I want to sincerely thank you.

02:55:24.080 | We covered basically an endocrinology textbook,

02:55:27.140 | a neuroendocrinology textbook's worth of information,

02:55:29.680 | a ton of practical tips in there.

02:55:32.160 | Where can people find out more about you?

02:55:33.600 | We will certainly provide links.

02:55:35.440 | And I guess the other question is, are you taking patients?

02:55:38.520 | I'm sure you'll hear that in the various venues

02:55:40.560 | where people can contact you,

02:55:41.600 | but where are you active in terms of public facing work?

02:55:45.240 | - I'm active on Instagram, KyleJilletteMD.

02:55:48.120 | I'm also active on the social medias of my brand new clinic,

02:55:52.020 | which is Gillette Health.

02:55:53.580 | That's @JilletteHealth on Instagram or jillettehealth.com.

02:55:57.040 | - Great. We'll provide links to those.

02:55:58.540 | And I should say that the content you've been putting out

02:56:01.380 | on Instagram is terrific

02:56:02.480 | because you actually point to specific studies

02:56:04.680 | and you put things into actionable context,

02:56:06.820 | which is very meaningful for me.

02:56:10.760 | Kyle, Dr. Gillette, I should say,

02:56:13.120 | thanks so much for your time.

02:56:14.420 | I really appreciate it.

02:56:15.260 | I know the listeners will too.

02:56:16.680 | - Thank you. My pleasure.

02:56:18.440 | - Thank you for joining me for my discussion

02:56:20.120 | about hormone health and optimization with Dr. Kyle Gillette.

02:56:24.080 | As you just heard,

02:56:25.240 | he is a treasure trove of actionable, clear information.

02:56:29.920 | And again, you can find him teaching more about hormones

02:56:32.680 | and other aspects of health on Instagram @KyleJillette.

02:56:35.960 | That's Gillette with two T's and two L's, but no E.

02:56:39.520 | Kyle Gillette MD on Instagram

02:56:42.080 | and Gillette Health on all other platforms.

02:56:44.900 | And if you would like more information about his practice,

02:56:47.480 | you can find that at jillettehealth.com.

02:56:50.240 | If you're learning from and or enjoying this podcast,

02:56:52.920 | please subscribe to us on YouTube.

02:56:54.640 | That's a terrific zero cost way to support the podcast.

02:56:57.640 | In addition,

02:56:58.480 | please subscribe to the podcast on Spotify and Apple.

02:57:01.800 | And on Apple, you have the opportunity

02:57:03.440 | to leave us up to a five-star review.

02:57:05.520 | If you have questions or comments about this

02:57:07.520 | or any episode of the Huberman Lab Podcast,

02:57:09.840 | or if you'd like to suggest topics

02:57:11.680 | that you'd like us to cover,

02:57:12.720 | or guests that you would like me to talk to,

02:57:15.520 | please put that in the comment section on YouTube.

02:57:18.000 | In addition, please check out the sponsors mentioned

02:57:20.200 | at the beginning of today's episode.

02:57:21.920 | That is the best way to support the podcast.

02:57:24.440 | We also have a Patreon.

02:57:25.760 | It's patreon.com/andrewhuberman.

02:57:28.760 | And there you can support the podcast

02:57:30.400 | at any level that you like.

02:57:31.760 | During today's episode and on many previous episodes

02:57:34.040 | of the Huberman Lab Podcast, we discuss supplements.

02:57:36.860 | While supplements certainly aren't necessary for everybody,

02:57:39.440 | many people derive tremendous benefit from them

02:57:41.760 | for things like optimizing sleep and focus

02:57:44.240 | and indeed hormone health.

02:57:45.840 | Anytime you're considering taking a supplement,

02:57:47.920 | you want to make sure that the supplements

02:57:49.680 | are of the very highest quality.

02:57:51.420 | For that reason, we've partnered with Thorne, T-H-O-R-N-E,

02:57:55.380 | because Thorne supplements are known

02:57:56.800 | to have the highest levels of stringency

02:57:58.480 | in terms of the quality of their ingredients

02:58:00.480 | and precision about the amounts of the ingredients

02:58:02.920 | that they put in each bottle.

02:58:03.920 | Meaning what is listed on the packaging

02:58:05.900 | is actually what's contained in those supplements,

02:58:07.800 | which is not true for many supplement companies out there.

02:58:11.220 | If you'd like to see the Thorne supplements that I take,

02:58:13.160 | you can go to Thorne, that's T-H-O-R-N-E dot com

02:58:16.160 | slash the letter U slash Huberman,

02:58:18.800 | and you can get 20% off any of those supplements.

02:58:21.600 | Also, if you navigate deeper into the Thorne site,

02:58:24.240 | so go to thorne.com/u/huberman,

02:58:27.000 | but then pass into thorne.com.

02:58:29.200 | You can also get 20% off any of the other supplements

02:58:31.820 | in the Thorne catalog.

02:58:33.160 | If you're not already following us on Instagram and Twitter,

02:58:36.260 | please do so.

02:58:37.100 | It's Huberman Lab on both Instagram and Twitter.

02:58:39.340 | And there I cover science and science-based tools,

02:58:41.800 | some of which overlap with the contents

02:58:43.420 | of the Huberman Lab podcast,

02:58:44.600 | but much of which is distinct

02:58:46.380 | from the contents of the Huberman Lab podcast.

02:58:48.740 | And again, we are hosting two live events,

02:58:50.520 | one in Seattle on May 17th,

02:58:53.080 | another in Portland on May 18th.

02:58:55.640 | That series is called the Brain Body Contract,

02:58:57.860 | where I'll talk about science and science-based tools,

02:59:00.240 | some of which I have never talked about

02:59:01.920 | in a public forum before.

02:59:03.280 | And there'll be an open question and answer format

02:59:05.880 | for you to ask me your questions,

02:59:07.640 | and I will do my best to answer them in real time.

02:59:10.340 | Thank you once again for joining me

02:59:11.800 | for today's discussion with Dr. Kyle Gillette.

02:59:14.240 | And as always, thank you for your interest in science.

02:59:17.380 | [upbeat music]

02:59:19.960 | (upbeat music)

Dr. Kyle Gillett: How to Optimize Your Hormones for Health & Vitality | Huberman Lab Podcast #67

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