Welcome to the huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew huberman, and I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine. Today. My guest is dr. Kyle Gillette. Dr. Gillette is duel board certified in family medicine and obesity medicine and practices out of a clinic in Kansas and Via telemedicine. He provides full spectrum medicine, including Hormone Health.
Then of medicine obstetrics, which is the branch of medicine and surgery concerned with childbirth, and the care of women giving birth and Pediatrics. I first learned about dr. Gillette from a podcast of all things and was immediately struck by the breadth and depth of his knowledge. On all things hormones and hormone optimization as you'll see very soon today. Dr. Gillette can teach you how to optimize your hormones using behavioral tools nutrition. Exercise, based tools, supplementation, and hormone therapies. If those are appropriate,
For you, there are many professionals out there, including many medical doctors, of course, talking about Hormone Health. What really sets doctor Gillette apart from the pack is his ability to understand how the different factors that I described before nutrition supplementation, exercise and hormone therapies how those interact with one another and the safest, and most rational ways to approach hormone optimization. During today's episode. You will learn how to optimize your hormones. Not just testosterone and estrogen, but also prolactin and other hormone pathways,
That impact your mood. Mental health, and physical health. Dr. Gillette is also an avid educator about hormones and other aspects of Health. He does this on zero cost to Consumer platforms such as Instagram and other social media on Instagram. He is, Kyle, Gillette MD. That's KY L. EG. I ll e TT no e at the end MD. So Kyle Gillette MD on Instagram and he has Gillette Health on all other platforms, including LinkedIn, Twitter Youtube, Tick-Tock and Facebook. If you go to his Instagram,
More his other social media. You will learn a lot about Hormone Health about the latest science, impacting obesity and metabolic Health. He has a wealth of knowledge. And again, he's providing all that information at zero cost. To you the consumer. What you are soon to here is a conversation between me and Doctor, Gillette about all things hormones and Hormone Health and hormone optimization. We dive deep into mechanisms, but we are clear to establish what each word or set of concepts mean. So if you have
Background in biology or even if you do, I'm sure that you'll come away with a wealth of valuable knowledge. We also talked about specific, protocols related again to Lifestyle factors nutrition supplementation, and, where appropriate hormone replacement therapy. I know there's a lot of interest about these topics. Doctors Gillette is very thorough about addressing both male and female issues and addressing Hormone Health. For people at all stages of life. I'm sure that you will come away from this episode with the same impression that I did, which is the doctor Gillette isn't.
Extraordinarily clear communicator and that he has tremendous compassion for his patience. And that he has a deep love of understanding biology and Medicine in ways that can benefit. You. I'm pleased to announce that I'm hosting to live events in May 20-22. The first live event will take place in Seattle, Washington on May 17th. The second live event will take place in Portland, Oregon on May 18th. Both are part of a lecture series entitled, The Brain body contract, during which I will talk about science and science based tools many.
Which overlap with the topics covered on the huberman Lab podcast, but most of which will not, and will be completely new topics, and tools, never discuss publicly before. Both Live Events will also include a question and answer period during which you the audience can ask me questions, directly about any aspect of science, or science based tools and I will attempt to answer them tickets for the two events again. Seattle on, May 17th. And Portland on May 18th are both available at huberman. Lab.com tour.
Before we begin with today's episode. I want to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however, part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our first sponsor is thesis thesis makes nootropics. In fact, they make custom nootropics. Now, what is a nootropic technically nootropic means smart drug. Frankly. I'm not a big fan of the word.
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welcome.
Thank you for having me.
Well, I'm super excited to talk to you because I found out about you on a podcast and it immediately became clear that you are an encyclopedia of knowledge about Hormone Health for men and for women Across the Life Span. So I have many, many questions. But before we dive into those questions, I'd love to just get a little bit of your background in terms of your medical training and what your particular orientation.
Is toward treating your patients and how do you think about this whole landscape that we call Hormone Health? What is a hormone? How do you envision people managing their hormones? You could just kind of fill in a few of those blanks for us. I think a lot of people would appreciate
it. Absolutely. So I'm duel board certified in family medicine and obesity medicine.
I've kind of tailored my training in order to provide, what I call a balanced approach to Total Health, which includes body mind, and soul. I recently saw a podcast with Joe Rogan and mr. Beast. And Joe asks, mr. Beast. How do you become such an amazing YouTuber, and have all these, you know, great clickbait videos, and how did you become good at it? And it turns out you just became obsessed when he was a teenager, and that's essentially how I've
Willard my education as well. I become obsessed with optimal Human Performance, their body, their mind and even their spirit. So I attended med school at the University of Kansas, which is one of the few Med schools that still emphasizes full-spectrum care. They emphasize exercise is medicine. They emphasize food is Medicine of which I was active in both of those interest groups and residency, I was active in a lot of mindfulness curriculum. And then also things like walk with the dock where you
Sighs preventative medicine, that's something that we've kind of got away from and that neech led me to Hormone Health didn't really start as Hormone Health, but it's a very important component of Health in general, that many people don't emphasize
great. Well, this idea of preventive medicine, I think is starting to really take hold in the general population, especially given the events of the last few years, people realize that they are showing up to health challenges at a bunch of different levels and with some
Feeling very robust other people feeling back on their heels when someone comes to you as a patient, what are some of the first things that you want to know about them? I mean, obviously you want to know their blood pressure, you want to know something about their mental health and family history, but in terms of Hormone Health, what are the sorts of probe questions that you ask? And what are you looking for? And I ask this because I'd like people to be able to ask some of these very same questions for
themselves. Yeah, so when you do a physical exam and
A history. You have a lot of different parts. You have your history of present illness. If they have a complaint, maybe the patient doesn't have a complaint. And that case things like their social history and their family, history are extremely important because that gives you an insight into their into their genetics and insight into their Hormone Health. So patients will tell me I'm doing okay, but it helps to ask them. Well, how are you now? Let's say the patient is 50. How are you now versus when you were 20 and what has changed?
So I've got the question a lot. How do you get your doctor to order a better lab workup or to even include your basic hormones? And there's no magic answer to that. But what really helps is you tell them, you know, my energy is not as good as it used to be. My focus is not as good as they used to be. My athletic performance is not as good as it used to be. So you don't have to have a pathology in order for a lab to be indicated. You just need to have that pertinent symptom. I
think it's gonna be really helpful because for many people, the idea.
Getting a blood test to look at their home hormones. Just seems like such an enormous hurdle to get over and many doctors won't prescribe them. And would you say that it's using the approach? You just described that it's equally effective for men and women? Or do you find that for one reason or another that men and women have different challenges in an advantages in trying to access their deeper hormone
data yet? Slightly different with women. There's a lot more.
Active data, so if they're having menstrual irregularities, or, you know, if they're going in, if they're not having a period, if they're having too heavy of periods, then those are things that they talk about, very frequent frequently with their doctor. Men are more hesitant. So men really want to know what their testosterone is, but they at the same time, they really don't want to tell their doctor, how their libido is or how their energy is because it's almost like they feel less masculine or they feel less like a god.
Why? When they say that, even if they're just talking to their doctor about it?
I think that that raises a really important point, which is that the whole discussion around Hormone Health is a bit of a barbed wire topic because in many ways, when we hear the word hormone, we think testosterone and estrogen, we think Notions of masculinity and femininity and of course, testosterone and estrogen are present in all Sexes, right? All chromosomal backgrounds and just to varying degrees in ratios, but it also raises all these
Is about sexual health that it's kind of interesting because I surrounded by medical doctors in my lab at Stanford. And the more Physicians that I surround myself with. The more open is the discussion around sexual health and reproductive Health, but in the general population, I think some of these topics are a little bit taboo or against kind of barbed wire. And so, I think that people are seeking a lot of this information on YouTube and through communities that may or may not be very educated about the actual biology. So, along those lines, you know,
No, we could probably assume that hormones are changing across the lifespan, right? Certainly from from childhood and puberty and onward. If if you would, I'd love to just kind of take a snapshot of what you think. Everybody should be thinking about or doing to optimize their Hormone Health male or female.
In the let's say in their 20s, and then maybe we could migrate that to their 30s and 40s. But before that could you just tell us what everyone should be doing for their Hormone Health from puberty onward?
Yeah, the law of diminishing returns applies. So, doing a little amount of what I call lifestyle interventions over a long period of time is going to be far more helpful or efficacious than doing a lot and then doing nothing or doing a lot and then doing nothing.
So I talked about the big six pillars, the two strongest ones are likely diet and exercise for Hormone Health. Specifically resistance training is particularly helpful for diet caloric. Restriction can be particularly helpful, especially with the epidemic of metabolic syndrome. That is continuing to on go in this country and in developed countries in general. So those are the two most powerful. So number one.
Number two, our diet, and exercise. For the last four. I have a little bit of alliteration. So there's stress and stress optimization that has to do with cortisol, that has to do with your mental health that has to do with societal health and Collective health of your family as well. When you're a member of a family or even a very close friend, trying to achieve Optimal Health together is very important. It's the same thing with nicotine. Cessation. Same thing with hormone optimization. If you do it as a household unit.
It's for more helpful. So after stress, you have sleep optimization, sleep is extremely important, especially for mitochondrial Health as well. And then you have sunlight, which encompasses anything that's Outdoors. So you move more, you have cold exposure, you have heat exposure. That's sunlight. And then, the last one is spirit. So that's kind of the body mind and soul. If you have all the other five in there, dialed in completely, but you don't have
Your spiritual health, whatever, you believe then, that's going to profoundly impact your body and your mind as well.
And we're definitely going to touch into this notion of spiritual health, because I think for some people that might draw connotations of certain things that may or may not be accurate, but, I know a number of academic Laboratories that are focused on this a number of, not just functional medicine clinics, but research, clinics and hospitals throughout the country that are achieving some really interesting data. Not just in people that are
Sick, but in healthy, people are trying to further optimize health. So we will definitely touch back to that if you would be so kind as to maybe give us a little bit more detail about some of these other areas. So, when people hear diet, I immediately think, okay, now we get into the, the combat around vegan plant-based carnivore, Etc. But I think, the, my general view of this is that most people should probably be eating. As few highly processed foods, highly palatable Foods as possible, which
I mean eating foods that don't taste good, of course, but what other sorts of things do you recommend in the realm of diet? And then I also want to know about caloric restriction, because my understanding is that a caloric Surplus can actually support certain hormones like testosterone. So how does one combine caloric restriction and still optimize hormones? But what would you say? Is it a really terrific way to think about an approach
diet? Yeah, diet should be an individualized approach. So if you have a car
Each car is made different and requires a different sort of fuel, whether it's a race car, whether it's a diesel truck. They have different fuels for different performance outcomes. So if you're trying to tow something or you're trying to go fast, so it's the same way with athletes. It's pretty well studied the more intra workout carbs, Ultra long distance, athletes take in general. They do better. I think they've studied this in cyclists quite often. It also depends on your genetics so you can have a genetic
Mm and you metabolize carbs and sugar butter, even when they're on a pose by
fiber. How does one determine whether or not? They have such a polymorphism. I mean, I've I'm an omnivore. So I do eat some high Quality Meats, not in huge quantities, but I also eat vegetables and starches. I feel fine. I've never done an Elimination Diet. May I think I did a very low carb diet, once and all it gave me was a lot of psoriasis and poor sleep. So, I backed off, I probably didn't do it correctly, but I know a lot of people that do quite well on on a very low.
Barber, zero carb
diet. Yeah, particularly those who are at risk of cancer because you have less glucose that can be easily up taken into cells. And then also people with autoimmune diseases,
they tend to do well on Auto, on
lower carb diets. Yeah, but yeah, as far as the, how do you know, basically, you can use your biofeedback, how you're feeling to guess, what your tolerate? Well, or you can just get genetic testing which can be fairly expensive, but most of all it requires a
A physician or someone who knows how to interpret the test accurately.
And if someone had the means, or would you say that getting regular blood? Testing is a good idea. And if so, what is regular blood testing? Is it every three months? Is it every six months? Of course, the backdrop of life, is changing to stress levels
etcetera. Yeah, every three to six months, for preventive purposes at times. You need blood test set faster, frequencies than that.
And then you should also get a blood test when you're fasting and when you're not fasting. So if you're looking for damage to the beach, you want to, you. Don't just look at low tide. You look at high tide. And you see what's happening at high tide as well.
It's a great way to put it. And in terms of General recommendations around exercise. I mean, I'm of the Mind based on the data that I've seen that almost everybody should or everybody should be getting 150 to 180 minutes minimum of Zone to cardio per week. The
I kind of could continue while having a conversation but with if one were to exert any more effort, it would have a hard time getting the words out at least that right for cardiovascular health in general brain health and musculoskeletal Health Plus resistance exercise. Is that more or less the Contour of what you
recommend? Yeah, that's more or less the Contour the more you're doing your Zone to cardiovascular exercise. The slightly less important, a long duration of caloric restriction is
Interesting and that brings us to caloric restriction. So it's very clear that caloric. Restriction can allow one to lose weight. Right? This is a the classic Kiko. Cic 0 calories in calories out. We are not disputing calories in calories out somehow that always has to be stated 50 times in any Forum because of whatever follows people I think we'll anchor to and assume that we don't mean that. But I know you and I both agree on calories in, calories out as a fundamental law of thermodynamics, but it's
It's clear to me that based on what I've read that when one is in a slight caloric Surplus that hormones like testosterone can be optimized. But is that true for somebody who's showing up with excessive body fat? How does this all work? Because body fat is manufacturing enzymes that convert testosterone to estrogen. So in other words, how does someone know if they should use caloric restriction or avoid caloric? Restriction?
Yeah, here's how to parse that out. So before I delve into the details a bit more, I should say as a boy.
Certified obesity medicine physician obviously the laws of thermodynamics apply and then in addition to that, there is nothing special about intermittent fasting or caloric, restriction, or exercise when it pertains to losing body weight in general, when you do lose weight, about 33 percent of that is lean body mass and about 10 percent of fat cells, you know, adipose cells are actually lean body mass as well, because as proteins and water.
And things like that at 2. So the reason for exercise and the reason for cleric restriction in general, including intermittent fasting is health reasons. That's how you increase your health span. It's not necessarily going to make the weight on the scale change, but that doesn't matter as much. It's been fairly. Well, studied in both mice, and humans is much easier to study in mice. So that's a precursor to are six types of people. The ones that care about my studies in the ones that care about human studies, but if
Lyrically, restrict, mice by 40%. Then they can have improved testosterone parameters. But only if they're obese to start and it appears to be that same way in humans as well. So the easy way to think about it is if you're obese, or you have metabolic syndrome, caloric restriction will improve your testosterone. There has been a study and they talk about all these studies in a systematic review from the Mayo Clinic proceedings in March of last year.
And they note that there is a study in young healthy men and they clerk literally struck them and their testosterone does decrease. So if you're young and healthy and you don't have metabolic syndrome, then caloric restriction will likely decrease your testosterone
that clarifies a lot for me and I believe it will clarify a lot for other people as well. And I'm delighted that you pointed out this distinction about intermittent fasting not being the only way to achieve caloric restriction. There are a number of
Of young healthy or older healthy people. I know who like using intermittent fasting. Even if they're not trying to lose weight for a couple of reasons, some believe that it might extend lifespan. I think there's still that still a bit of an open question. It's a bit of a hard experiment to do because the control group is it? No one wants to be in the control group, as I say, it doesn't mice. All right, right. Exactly audience. Exactly. And the other feature of it. That's a little bit tricky. Is that many people like in
And fasting because of the mental affects the clarity of mind that they feel during fasting The increased pleasure in eating, when they finally do eat. And here, I'm referring to intermittent fasting of the sort. We're eating windows are anywhere from 8 to 12 hours a day. Not extended fast of 24 hours or more. So the question therefore is for the healthy lean enough person, right? Non obese person is intermittent fasting. A bad idea in terms of Hormone Health,
Is oscillating between this period of kind of feast and famine within a 24 hours, a problem. If one is getting sufficient calories to maintain weight.
Yeah. So if they're in a caloric maintenance, then it's not going to be, it's not going to be deleterious. It's not going to be bad for their Hormone Health. There's a couple different hormones that we can talk about. We can talk about testosterone, we can talk about DHEA, which usually go hand in hand. And then we can also talk about growth hormone, which is not a steroid hormone, but
It's a peptide hormone. So it's a chain of proteins, amino acids that are put together instead of a sterile think of sterile hormones is coming from cholesterol. So, intermittent fasting, you do get a little spike in growth hormone after you eat, but you also get a huge spike in growth hormone. A more significant less negligible Spike overnight and that is improved if you are intermittent fasting.
Is probably going to help your growth hormone and subsequently igf-1 levels, which will help more in older age groups than younger age groups
and I like to eat dinner. So for me, that means sometime around 6:00 or 7:00. Sometimes 8:00. I confessed last night because I was working late. I ate a pretty big white. Basically, my only meal of the day at 10:00. That's a rare thing for me.
Can I still achieve a high degree of growth hormone output? If I let's say, I avoid food in the two to three hours before going to sleep or does one have to be very deep into a fast in order to achieve this, the increase in growth
hormone. They're still pretty good growth hormone output. Even if you eat two or three hours before you sleep, it's just the law of diminishing returns the longer you go. You get slightly more and slightly more.
And I know a number of people think of growth hormone.
The context of the exoticness growth hormone and the fact that that can in some cases be associated with Cancers. I've been asked many times before, can the increase in growth hormone from things like saunas or intermittent fasting cause levels of growth hormone that are so high that they cause cancers. I my impulse is to say no that doesn't. It seems like it's not likely to happen, but I should probably verify that statement with you.
Yeah, so quite unlikely I think about growth.
Hormone and especially igf-1 and there's actually an IG F1 and igf2, but I think about it in terms of endocrine igf-1 mostly igf-1 that's synthesized in the liver and released in the in the liver versus igf-1 that's released classically. An example of this would be your igf-1 levels increase after resistance training or exercise and that's more of like paracrine autocrine and they have more local action. So that igf-1
It's pretty well studied that if you just give people igf-1, it's not going to at physiological levels. It's not going to improve their body composition. However, that igf-1 that's autocrine and paracrine just working in those local tissues and muscles is likely part of the reason why you get a improved body composition response after exercise, I see
and just to clarify for me and for for others, what can we say are the major functions of igf-1?
And igf2 that are distinct from just growth hormone. Are they just kind of the active form of growth hormone? The kind of the pickaxe end of the of the assembly line.
So they have a much longer duration of action. I believe the half-life of igf-1 is several days almost a week. Whereas growth hormone has an extremely fast half-life of only H. So growth hormone acts significantly on the liver to produce igf-1. So it's
It's around in the serum in the blood, long enough to where it's producing an effect. Pretty much all the time. Very interesting.
Well, and then your other pillars stress, you know, we've talked a lot about stress on this podcast before and tools for managing stress. Sleep, obviously is a big one. I think, you know, if nothing else, I will either put people to sleep with my podcasts. Certainly not this one, but my my solo episodes or hopefully, convince people that
That sleep is the foundation of mental and physical, health and performance. Are there any aspects of hormone optimization that can improve sleep? I know sleep can improve hormone optimization, but are there any aspects of hormone optimization that can improve sleep? And for people that are suffering from this common syndrome of going to sleep? And then waking up at 3 or 4 in the morning, we know that can be associated with depression, but are there any hormonal indications that might lead to that kind of situation?
Yeah, there's three big ones.
It's the first one is not super common, but it's a very direct correlation. If you have a growth hormone deficiency, a true deficiency, whether you're an adult or a child, then your sleep is likely going to be affected and let's say you're a child with growth hormone deficiency. Once that is replaced with therapy. Your sleep is going to get significantly better. The second one. That's a very common scenario is if you're having what's called vasomotor symptoms of menopause or
Peso motor symptoms of andropause, which are also applicable and that's where your progestin genic activity. So your main progestogen Czar, progesterone, and then pregnant alone and then 5 Alpha 3 Alpha progesterone, which
is are those manufactured in the
body. So they're manufactured in a few places in men. They're manufactured some in the testes and the latex cells and women, they're manufactured in the ovaries until menopause.
And in there also manufactured in the adrenal glands. So if you're in, if your pre Adrena puzzle, where your adrenal, glands are still working fairly. Well, usually still have a decent amount of progesterone around and this can be measured to. So, after menopause women make progesterone from their ovaries, or sorry, from their adrenal glands, if that progesterone crosses the blood-brain barrier, especially if it's 5 Alpha and
Offer do. So. It's modified a little bit. Then it is both a Gaba Agonist which helps sleep. Just like Gaba does gamma-aminobutyric acid the main inhibitory, neurotransmitter of which lots of things work on, alcohol, works on Gaba as well. Gabapentin also works on Gaba migraine medicines. Many of them work on Gaba, benzodiazepines and also non benzos of. So, an example of a benzo would be Xanax, an example of a non benzo would be
Ambient. So those all work on Gaba. So Gaba is also helped by the progestogen activity as well. That's why a lot of women in menopause. Feel like their sleep is much worse is because they have lower activity of those progestogen. 'S
is that end for men in so called andropause low testosterone. Is that also one of the causes of poor sleep,
low testosterone can lead to poor sleep, but my third scenario is actually
If a man begins trt, then they develop a poor sleep because of sleep apnea. It drastically raises the risk that somebody is going to have sleep apnea. And then a lot of people especially when they first started in the first month or two, it puts them into this hyper sympathetic State because they have overactive antigen receptors, especially after a long time of being hypo gonadal, then they have a physiologic dose of trt. And that causes the Sleep issue itself.
Elf interesting. Have a lot of questions about trt testosterone, replacement therapy. I should just mention that when you say it increases sympathetic activity. You don't mean that taking testosterone increases sympathy for others. It may in fact do the opposite. Although it's very clear from my discussions with my colleagues in on the in the Endocrinology side. And also with the great. Dr. Robert sapolsky, that that increasing testosterone, merely exacerbates existing features.
Of people. So the jerks become bigger jerks kind of people become even more kind in general, but we will I want to get into trt in-depth but it's very interesting to me to hear that testosterone replacement therapy increases the risk of sleep apnea. And I want to make sure that I ask that is that also the case in people that are using trt who are not hypo gonadal because in the classic situation is somebody isn't making enough testosterone there below, 300 grams per deciliter on the chart. They go in and take trt. But many people.
People nowadays. Let's be honest are taking those his of testosterone even though they are in the sort of standard range. Because the range is so large because of other symptomatology that right.
Yeah. I do love the analogy that doctor sapolsky, had about monks, taking testosterone, and making them more and more generous. So that does appear to be what testosterone usually does. Is it exacerbates if you will what your previously like. So it's not going to change you as a person.
But if you're you gonadal before you start testosterone, you meaning, meaning, meaning you have normal testosterone and then you start T. RT, or self-administered trt. Steroids would have read want to look at it. Then your risk of sleep, apnea still goes up in a dose-dependent fashion. So the higher the dose, the more risky with the sympathetic and the parasympathetic nervous system. The sympathetic is the fight-or-flight nervous system. The parasympathetic is the rest and Digest.
So if you have too much fight or flight and stress, can cause that to then you're not going to rest as well at
night. I want to touch on testosterone in women because
There is just Austrian and women. I'd like to know where that testosterone comes from. Which tissues. I'd like to know whether or not testosterone replacement therapy, makes sense in women. I'm hearing more and more about women using testosterone, and I'd like to know whether or not knowing a woman's testosterone for her to know her testosterone is of equal less than or more value than knowing, for instance, progesterone and estrogen levels, because I think there are a lot of misconceptions about the roles of testosterone in women
for health.
Some ization testosterone is just as important to know, for pathology prevention, for example, breast cancer osteoporosis, estrogen and progesterone are more important to know. So when you're thinking about women, women think that they have such a tiny amount of testosterone, because you could you test it. Most people test a free testosterone so testosterone. That's Unbound, which is by far the, the smallest proportion of testosterone. Any Androgen is bound by
Lots of different steroid binding proteins, but the ones that are most pertinent are called shbg or sex hormone-binding globulin and that binds the androgenic steroid. For example, DHT or dihydrotestosterone, its associated with prostate enlargement associated with male pattern baldness. It binds that the most strongly, and then it binds testosterone next most strongly and then it binds things. Like Anderson, add. I own or DHEA dehydroepiandrosterone.
And then it binds the estrogens, the weakest, like estradiol. So if you look at the total amount of testosterone, women actually have almost all women, not all women, but almost all of them have significantly more testosterone than estradiol, but it's because it's in different measurements. So, estradiol a lot of time is, you know, Peak grams per mil as opposed to nanograms per deciliter. So women have more testosterone and estrogen.
And significantly more DHA than either.
Interesting. Do women make dihydrotestosterone. Yeah,
where does it, where does this
testosterone come from? Because they don't have testes.
Yeah, so most testosterone and women that are premenopausal can come from theca cells th e CA so theca cells are cells in the ovaries that can produce testosterone and a lot of people have actually heard about hyper theosis. Not the term itself, but a
Of Olympians that are their chromosomes are XY. Their females and they are not taking any weight. There is why but they're femur. Sorry there XX. Yeah. Thank you. So they're XX. They're not XY and they have never transitioned or been on any sort of hormone replacement or testosterone, but they naturally produce a huge amount of testosterone as much as many men. And some of these women I believe they were from Botswana where banned from competing.
P-ting in the Olympics and certain distances. I believe, there are banned from the 400 meter and 800 meter because their natural testosterone was deemed to be too
high. So they mistakenly thought that they were using
steroids. They actually knew they were not using steroids. They knew it was there. Theca cells were just genetically gifted, I suppose and they still made them change distances. So, one or two of these athletes change to, I believe it was a 3K over the 5K and they still did quite well, but it was
Their best event interesting.
Yeah, that's turning out to be a very interesting and controversial area of this notion of hormone therapies and natural variation and hormones on different chromosomal backgrounds fasting. We should probably do a whole episode about that because it's very much of the times. So men and women, both make DHT, I'd like to ask about DHT in men. So often we hear about testosterone in men and free testosterone, and being the Unbound form, of course, but
Dihydrotestosterone, where does it come from in men? What is the Cascade of events that takes testosterone to dihydrotestosterone? And what are some of the quote unquote positive and negative effects of a hero, I'm only referring to endogenous die Hydra testosterone. And in fact, I'll make it very clear whether or not I'm talking about taking something or one's own natural production here. We're just, I think up until now, we've just been talking about natural production. So tell us about
Htin men, such a powerful hormone during development obviously, but what is it? What is it doing?
DHT is a very androgenic hormones. So whether you're talking about DHEA, which is a mile of week, Androgen or testosterone, which is a relatively strong Androgen or DHT, which is a very strong Androgen. They bind to the antigen receptor in both men and women. So the effect of all three of those is mediated by
By the Androgen receptor, there's a couple different beta. Estradiol receptors and Alpha estradiol receptors. But there's only one Androgen receptor intriguingly. It is on the X chromosome. So men get their Androgen receptor Gene from their mother.
Women get 1 antigen receptor, Gene from their father, one from their mother often. The one that is more sensitive to androgens and people with PCOS. That's the one that's active. The other one is methylated and
inactive. Can I just pause? You would say, is sorry to interrupt, but I have to ask this question before I forget. And I know number of people are probably wondering. I've heard that whether or not one develops, male, pattern baldness, whether or not a male develops, male pattern baldness, just to be very precise.
You could get some information about that by looking at your mother's father. And that would be in keeping with what you just described that the X chromosome, which of course is handed off through. The mother is carrying the genes that encode for the number and distribution of these D of these Androgen receptors that D HD will bind to. Because, of course, I think, as you'll probably tell us the DHT is a responsible for male pattern baldness and beard growth. Is that right? Should I look at my grandfather on my mother's side to determine what I'm likely to look like in terms of my DHT - is
Word.
Yeah, it's the best guess that you could make purely from phenotypes. Now, you can measure your genotype and, you know, get a better idea of that. Assuming that it's true male pattern baldness. It's related to the gene transcription of the Androgen receptor. So, I like to think of it as how much of this Androgen receptor Gene is activated by any Androgen. So if you have an extremely sensitive Gene, which usually means you have very few CAG repeats, which
It is basically just a certain CAG encodes for a certain amino acid. And if you have very few of the repeats, then your Androgen receptor. Gene works better think of it as a corollary to Huntington's disease where if you have very few of called trinucleotide repeats, then it's not as severe the disease, but after you get more and more CAG repeats, which by the way, are in the population, you're getting more and more CAG repeats. So it's
Natural selection. The process that has been ongoing for a variety of number reasons. But anyway, if you have more repeats than that Gene activates in the cytoplasm and moves to the nucleus and causes Gene transcription more often and hair loss, more
often. Does that mean that we're seeing more hair loss? Now, due to elevated levels of DHT than we were 50 years ago.
Probably not the hair loss, 50 years ago. Well, not
50 years ago at 500 years ago, was probably more significant because on average 500 years ago, people were more sensitive to androgens. So there's a syndrome called Androgen insensitivity insensitivity syndrome. A is and that syndrome was related to when men who have the copy from their mother, who was a carrier there AR gene or Androgen receptor. Gene is completely insensitive. So think of it, it doesn't have, it's not related to the CAG repeats, but think of
That receptor as just not working at all. So there's a Continuum so everybody's receptor Works a little bit better or a little bit worse and the better your receptor works. The more likely you are to have male pattern baldness
to zoom out from this but still keeping a anion DHT. What do you like to see all women and all men do to optimize DHT and here I'm talking about regardless of age.
Age. So we're still in this from puberty onward phase. We haven't yet micro dissected out, decade by decade, which we will do. But what do you like to see? People do to keep DHT in check, but before you tell us, that could you tell us what positive things DHT does? When it's in the proper
range? Yeah. So DHT helps a lot for the same reason. Why testosterone helps it activates the Androgen receptor Gene and helps effort feel good. So it can be motivating. So that's how it's active in the
- it also is active in cardio, vascular tissue. So, if you look at someone that has heart failure, or someone has cardiac hypertrophy, the level of DHT can matter. Because it's also binding to the antigen receptor in The myocardium. We're in the heart itself. So you think of the classic bodybuilder heart, it's an easy example to make. They have very thick and muscle. Their muscle is very strong because they're pumping blood often.
With high blood pressure and that DHT and the testosterone and in a DHT derivatives, like Master own or oxandrolone Prima bowl and also bind to the heart and they caused even more hypertrophy or enlargement of that muscle tissue. So then let's say the person stops and they're recovering and they're trying to have cardiac remodeling, which is where you take a very thick heart. And cardiac remodeling is important in a lot of different cardiac pathology.
Ologies. But if you give them finasteride or doot, asteroid, which inhibit the enzyme that converts testosterone into DHT, so making less activity at the Androgen receptor gene, they have cardiac Remodeling and their heart health
improves. I see. So for the non bodybuilder, the typical woman or man, or young younger or older, what sorts of things? Support? DHT, and thereby heart health. Presumably DHT is involved in some of the other things that testosterone is famous for in both men and
Owen, things like libido. As you mentioned, making effort feel good. So, motivation drive and vitality is an odds of I guess, because be the general phrase. What, what sorts of things support? DHD what sorts of things create problems for
DHT, there's lots of dietary changes and supplementation that you're probably doing right now. That's affecting your DHT me so well, everybody all of the listeners because let's say you have a diet high in plant polyphenols.
Many of those inhibit, the enzyme that converts testosterone to DHT good.
Could you give us an example of one of those either in supplementation for more in food form,
Kirk humans certain curcuminoids depending on the structure will inhibit the enzyme called 5-alpha reductase that converts testosterone to DHT. Tumeric, tumeric, black pepper extract. So if you it's used often to increase bioavailability, it's also called
And bio purine. It's also a 5-alpha reductase inhibitor. So, and on top of that people have different genetics to. So some people there 5-alpha reductase enzyme. So there's three of them there on chromosome, 2, 3 and 4, I believe, but some of them are active in the prostate, some of them are active in the brain, and some of the. So it depends on which tissue their tissue specific. Enzymes that depend on how much DHT you convert.
Do you recommend that people avoid? Curcumin in. Turmeric for that reason and as there any specific recommendations for men versus
women?
If a man or a woman by the way and women a lot of times, if you just ask your doctor for a DHT check, it's the same unit dozen men. So it's essentially undetectable. So you have to, you know, especially if they're on oral contraceptives, which is a different topic. There. DHT is very likely undetectable. Especially if its free DHT, you can measure both a DHT and a free DHT, but if someone's DHT is already low or if they have somewhat insensitive, Androgen receptor.
Via genetics or via lifestyle. Then I recommend, they avoid bioavailable curcuminoids like bioavailable tumeric, black pepper extract and they might be a good candidate for creatine creatine, like creatine monohydrate and significantly increase the conversion of testosterone to DHD
interesting. There's also a lot of really interesting data coming out now about the role of creatine as a brain fuel and maybe even as a cognitive enhancer over time, the data are still ongoing.
NG, but some of the studies in humans are pretty impressive. At least to me, I, I'm glad you mentioned seeing about curcumin and black pepper. I wish we'd had this conversation and six years ago because I had the experience of jumping on the bandwagon or the excitement around turmeric and I took a tumeric supplement. It was a couple capsules of what I thought to be hot, and I think was high-quality turmeric. And I've never felt as poor as I did in the subsequent few days. Flatline of let's just say everything that one would want to have in life.
Energy Vitality just, it was a cliff. And a friend somehow knew that curcumin could inhibit 5-alpha reductase. It converts testosterone into DHT as you pointed out. I stopped taking it was the only new addition to my diet and supplementation and things bounce back within about three, four days, but, it was remarkable. I mean, I felt like garbage and it was actually kind of frightening to experience the the sharpness of that Cliff, but I know,
That some people like tumeric for its anti-inflammatory properties. Etc. Sounds like people either need to experiment or, and if they do obviously to approach that with caution anytime you add or remove, something you need to talk to your doctor, you're a doctor. And I'm guessing that if one were to experiment, would you say that most of these effects of things? Like curcumin are reversible as they were in me or is there any potential of permanent damage if people have been taking them for a long time?
The effects are nearly always reversible when you're talking about 5 Alpha reductase inhibitor. And so what turmeric does? But stronger the most common story that we hear is regarding a supplement known as saw palmetto, which a lot of older men take for their prostate health or finasteride which you can take for your prostate or your heart, or your hair or do tasks to ride. So if you're having side effects on these, then it's probably because of a couple different reasons. One can be your ratio of and
Origins to estrogens is off and that needs addressed. Another one can be. It's inhibiting. The conversion of your progesterone to that other type of progesterone, the 5 Alpha 3 Alpha, that we talked about earlier, that's helping with your sleep and your brain, and your calmness. And that's definitely an effect. Another one is depending on the type of supplement or Med. They inhibit different ISO enzymes of that 5-alpha reductase. So if it's if they're just inhibiting
And to then that's going to be a different effect than if they're inhibiting two and three. So finasteride does two and three saw palmetto does one and two and then do tasks to ride. Does all three? The third. One is active in the brain and do tasks. Dried inhibits that third one a little bit weaker in Vivo, but strongly in vitro. So it's really hard to parse out. You can use biofeedback and experimentation. I do think with supplements. It's safe to experiment the time that it takes to set.
Tin is usually about three months. So the risk of an is anecdotally, there's been lots of research published about if post finasteride post finasteride syndrome is real or fake and it is real but it's one of those things that's a combination of organic and inorganic disease almost kind of like fibromyalgia where it's definitely real and there's lots of things that you can do to help with it, but it's very unlikely to occur. If you stop taking your supplements or medications,
And after you have side effects,
interesting, well, I certainly feel better when I'm taking 5 grams of creatine monohydrate per day. I know most people take it for muscle growth and tissue repair and things of that sort. Mainly, I think brings water into the muscle tissue Etc. But I take it for the brain effects and also because I like to think that it gives me a little bit of a DHT bump that I can actually see in my blood charts when I've done them. I know many people want to avoid the hair loss, that can sometimes be.
A associated with DHT levels going too high. And so I've been asked many times does creatine monohydrate cause hair loss. It would make sense that if creatine increases DHT and DHT binding to the antigen receptor on the scalp can induce hair loss. That that would be the case is that true or is our people just overly concerned about something that's trivial or
non-existent.
Each male and so yes, it can potentially add it. I don't like to say it causes it, but it's a, it can be a little bit more fuel to the fire. So just like everybody has a different sensitivity of their Androgen receptor. They have a different amount of Gene transcription that is going to cause death of the follicle. That's an arbitrary threshold. So you don't really know until you start losing
hair, and if somebody takes a little bit of creatine for the to increase their DHT, maybe for the cognitive enhancing effects or for whatever reason,
And they noticed a little bit more hair falling out in the sink and they stop taking it with. You just said death of the follicle which sounds very dramatic are. Those follicle those little stem cell niches that reside in the follicle which hairs grow from are those then abolished? Like there's, there's no going back or can you run rescue the, the hair?
It takes months if they're still there, the hair will come back. So the loss of the hair itself is a normal part of the hair cycle. So your have your anagen phase. Your
Adage and phase your tillage and phase and then your hair loss. And then I
move the stem cell niche in the, in the hair
follicle think think of it like, sharks have teeth. So sharp loses, a tooth and they have a new one that comes through or losing your baby tooth and you have a new one but your hair just always keeps coming through. So it's natural for it to die and lose. That's way. That's why when you start 5-alpha reductase Inhibitors, often you have a big shed. So what happens during that Big Shed is all of the cells that are unhealthy.
The immediately jettison that hair and they start making a much healthier new follicle. So, out of the hairs that are at the end of their telogen phase, then they have what's called telogen effluvium, which also happens after pregnancy. Also happens in thyroid pathologies. So you shed it a new one comes in place and you think that you're having a horrible hair loss caused by your finasteride, or whatever your whatever you're doing and minoxidil does this too. But you're really just having a
A new healthier follicle. If you go a really long time, if you go a year, then those hairs might come back and they might not.
So for Simplicity sake. If somebody is concerned about or is experiencing hair loss, male or female what are their options of ways to offset that hair loss that are not going to negatively impact other tissues sensitive to DHD. And what I'm what I'm basically saying here is, I could imagine taking a DA DHT.
Our a pill of some sort of an injection of some sort and offsetting hair loss. Maybe even stimulate more hair growth. It's clear that I'm not doing that, but but I know people that do, but then experience some of the other negative effects of blunting DHT reduced effect reduced libido reduced Drive disruptions and prostate function or even sexual function in generally. So what could can people do if they want to maintain or grow back here, but they don't want all those other effects. What should they avoid?
Lloyd, and what should they perhaps consider talking to their doctor? About?
There's a whole host of options. I try to separate alopecia or hair loss into two different categories. Male pattern baldness or androgenic alopecia also known as androgenetic alopecia versus other types of alopecia, usually, telogen, effluvium, 's and if it's androgenetic alopecia or male pattern baldness, even if they're female, perhaps a PCOS, something like that.
Then you want some sort of strategy to decrease the activity of that Androgen receptor. So
women can get male pattern baldness. Absolutely. Okay, I'm gonna have to wrap my head around that one. But okay.
So there's a lot of different things that you can do that are topical. The most promising is called doot, asteroid mesotherapy. Essentially what it is is it's very localized injections in areas that are prone to male pattern baldness. Whether there are female or a male and it acts a little
Glee only and you repeat these injections from time to time. It decreases. The conversion of testosterone to DHT just in the
scalp so that can avoid prostate effects. And what are some of the negative effects of blocking DHT in females in the periphery meaning. Not in the, not on the scalp, or in the brain, but where is DHT doing its
stuff? Yeah, so it's both DHT and then also that 5 Alpha 3 Alpha progesterone, which is called thp.
Or die Hydro progesterone or Tetra Hydro try, Hydro progesterone. So, they're active in the central nervous system, but it's also just active again, binding to the antigen receptor and a female as well causing them to have that effort, feel good motivation. A lot of women that are sensitive to DHT because women can be sensitive to DHT as well, feel very different when they start an oral contraceptive, not because it Alters their DHT to a huge.
It does to some degree because the negative feedback inhibition and the pituitary and less produced in the ovaries, but it increases shbg really high. So because their shbg is are significantly higher their free. DHT is way lower.
How does a woman know if she has PCOS, polycystic ovarian syndrome? What are the issues with polycystic ovarian syndrome? What can be done about PCOS? I confess. I was naive to PCOS.
That wasn't supposed to rhyme, but since it does, I do confess. I was completely naive to it and I start getting a lot of questions about it in various forums. And I think that's, that's actually the reason why I initially approached to you. I know you have treated a lot of PCOS. What age women should be thinking about PCOS. What's PCOS? Teach us about PCOS, please? Yeah.
So PCOS is polycystic, ovarian syndrome, and this is one of those
Editions, which is under-diagnosed. So, it's prevalence is much higher than we think it is. There's been a lot of studies in some, some studies say, prevalence of 10%, some say, 20% It's not completely clinically penetrant. So most people don't know. They have PCOS until they have infertility or subfertility.
And is this as PCOS happening. This frequency in 20 year old women and 30 year, old women and 40 and
onward, most women find out they have PCOS in their 30s.
Especially because it's on a spectrum or a Continuum, like a lot of things where you can have a weaker version or a very severe version. What are the symptoms? There's criteria called the Rotterdam criteria and in the Rotterdam criteria, there's a couple different ways that you can diagnose it. You're looking for Androgen excess insulin resistance and you could also look for polycystic ovaries. You don't actually have to have polycystic ovaries or get an ultrasound of your ovaries to be diagnosed if you have Androgen access, for example,
Androgenic acne or hormonal acne. If you have hair growth like a hair growth on the chin, it's called hirsutism. Or if you have, you know, like deepening of the voice, any symptom of too much and male, pattern baldness. If you're female, that's a symptom of PCOS as well. Then you can also have insulin resistance. So this is obesity. It's pre-diabetes a high fasting insulin, a Homa, I are over to a fasting
Insulin of over 6. So if you have significant insulin resistance and also Androgen dominance, that's a sign of it. Energon dominance often leads to what's called a Lego mini area. So if you're having more than 35 day intervals in between a period, or if you have less than nine per year, then that can be a sign that you have oligo, which means to little mini area, which means Menses. So, that's a very common.
Sign of PCOS if you have infertility, so if you're under the age of 35, and you've been trying for more than a year or if you're over the age of 35, and you've been trying for more than six months, then that can also be. It's a very common presenting complaint when somebody presents with PCOS.
And assuming that a woman is doing the all these other things is paying attention. To the six pillars that we you talked about earlier diet, exercise, caloric restriction in some cases, right? Not everyone needs to be clerk restricted, stress sleep and suddenly
Light Spirit, assuming that they're doing all those things. What other things in the realm of diet or supplementation can help them avoid PCOS if they have subclinical PCOS or they have not developed it, but don't want to develop it because it doesn't sound like a good thing.
Yeah, so depending on where they are, if they're very strong on the insulin resistance Spectrum, then optimizing their body composition decreasing, their body fat and treating that metabolic syndrome.
Help. So a lot of people ask. Well does everybody that's on like, does everybody need to be on that form and as PCOS, not necessarily but metformin is one of the tools that can help with insulin sensitization other tools that can help our inositol. So myo-inositol is an insulin sensitizer. It's cousin. DiCarlo knows that all is a week anti-androgen, a lot of types of inositol have both
Both of those in it. So depending on if you're a female or a male and you're on an acetal, the type of inositol does
matter. Yeah. This is very important point. I just today, I said, I'm trying this new supplement inositol for its role in help. Perhaps enhancing sleep. Even further my sleeps generally. Pretty good lately. It's been a little bit off for a number of reasons. So I took it for the first time last night and I said, I thought it helped and just objectively and you said,
What kind of inositol is it? Because nostrils are very potent, Androgen inhibitor. It turns out I was taking myo-inositol, which is not an androgen inhibitor the type. The other type that you mentioned, which is an androgen. Inhibitor is
D, Cairo and office. That's all. It's usually in a ratio of 1 to 25 or 1240 in a much lower amount compared to
myo-inositol, you know, in a supplement or in the
body in a supplement to help induce
ovulation, but for women who have PCOS
OS who might want to try and reduce Androgen. Then they would perhaps want to take a form of inositol. That reduce the Androgen receptor activity.
Correct? They want both. So if you're a woman and you've ever talk to your doctor about getting on the oral contraceptive or spur on a locked own, which is also an anti-androgen, but it happens to be a potassium sparing diuretic, blood pressure medicine as well. Di Caro, inositol might be a better option dim or die in. Do methane is other. Another kind of
We can't I estrogen anti-androgen that a lot of women should consider as
well. You mention oral contraception. I've done a few posts on these. Let's just call them that they really are perceptual effects, whereby. It's been demonstrated in human several times now and what I would appear to me to be very solid studies where women that take oral contraceptives, there is both a shift in their perception of men because the these studies only looked at heterosexual.
Boil, the sort of Arrangements here where women who are on oral contraception. Because it blunts, some of the Peaks and valleys of hormone output, no longer experience the same Peaks and valleys in their assessment of other men's attractiveness. So, it sort of flattens, the their perception, so to speak. They still find certain men attractive and certain men unattractive, but the the degree of difference is kind of mellowed out.
And like, wise men, pursue these data's say that men perceiving, women's attractiveness. They still see women on oral contraceptives as attractive, but they're a woman, taking oral contraception eliminates. This kind of peak in her attractiveness that men would otherwise. Perceive in other words. Oral contraceptives are changing the way that we perceive each other. At least in terms of these male-female experiments. What is going on with that?
Is that because oral contraceptives?
Blunt the increase in testosterone that occurs just before ovulation, or is it because of a complex Cascade? What is going on? I find this
fascinating. Yeah, so there's differences in how your and I wouldn't use the word change necessarily but alter the severity or alter the peak as you said, so it's just like trt is not going to change you as a person. An oral contraceptive will not change you as a person, it will just change your
Your day today Peaks and troughs in libido and attractiveness. So one of the main effects of oral contraceptives, almost all of them have a synthetic estrogen and a synthetic progestogen. And them one, common type of synthetic estrogen is ethinyl. Estradiol. There's another new synthetic estrogen that's out there as well. But that anecdotally, that seems to have even more side effects. So this ethinyl estradiol is
Times more potent than endogenous or bioidentical estrogen. I'll in the liver. So it binds to the estrogen receptor in the liver, and it's going to increase sex hormone-binding globulin, which secondarily, as you mentioned decreases, your free testosterone and especially your free DHT, so that little testosterone hump that you get. When you're a female is ovulating. That's really flatlined and it's already. It's a pretty insignificant difference. It's not negligible.
Bowl. But it's a little bit of a hump and you have significantly less of that when you're on oral
contraceptive and does that blunt the associated increase in libido? That normally would occur from that increase in the Androgen. Yes, interesting. What about other forms of contraception, right? Because there are there's copper IUD. There's various implants. There's Rings. There's a huge number of different forms of these. So what we're talking about is as I understand, it is only the effect of
I'm or contraception that impacts hormone output side. Is that
correct? Yeah, there's a lot of other effects as well. For example, your choice substance, thetic progestin will alter, how high your platelets and shbg go. It appears to be the higher your platelets and the higher, your shbg, the higher risk of a blood clot. So a lot of women know that if they're on an oral contraceptive and they're already predisposed to a blood clot or a venous thromboembolism.
And their vain, they have a blood clot and either their leg or their lung, then it can increase that chance. So you can choose a synthetic progestin that is not going to have as high of a response, but there's various pros and cons some synthetic progestin Czar. We can tie and regions as well. For example, there's one known as slend, which is made from sprawl octone. So, some women are on sprung, a lactone and that as well, which is made from Spurlock, too much. Probably.
Isn't particularly necessary unless they need it for a diuretic or hypertensive effect.
I see I'm just going to intentionally interrupt and I apologize but specifically because I want to ask about there. Is this notion that, you know, that oral contraception taken over long periods of time can disrupt fertility in ways that are independent of just, the age-related decrease in fertility. Is that true?
It depends on what you mean by a long time.
Six to 12 months. It's possible past that it seems very unlikely. However, the persistently elevated shbg can be present for quite some
time. Wait. So if a woman takes oral contraception for 6 to 12 months and then stops, will she essentially be aware? She would have been. Anyway, in terms of her fertility at that age, where you saying that it can cause permanent damage, her
fertility would be Equitable as if she had never taken it. If she's
Certainly 12 months, but probably six
months. And what is she? I know of women have taken an oral contraception for many years are, in addition, to the age-related decline in fertility that occurs. That's inevitable. Of course, the slope is going to be different depending on the individual but it are they quickening? The the transition to
infertility. Probably not. You could make a case that because they've been an oral contraceptive. They may have
Slightly more predisposed to insulin resistance, and or lower lean body mass, but that's probably going to be a negligible difference compared to the resistance training and also their caloric restriction, or clerk maintenance. So first there are also
effects of having children. Yeah, right. I mean, on, all these parameters, right? Because it's a severe, it's a major lifestyle shift, right? That obviously people contend with and have for since the beginning of human.
Ian time. Anyway, I want to ask some questions about male hormone therapy and male hormones generally, but before I do that, I have a couple of burning questions that I get very often that I'm just going to insert now. Marijuana.
I've heard that it can decrease testosterone in men and women. I've heard that it can increase testosterone, alcohol. I think there's General consensus that high alcohol intake. Hi barbiturate intake can does. In fact, reduce testosterone. What about modest increase of alkyl? I'm not a drinker so that I'm not asking these questions for me. I don't smoke pot, I do but I'm just never really liked marijuana or alcohol. They're not my thing. But many people want to know the answers to these and
The data that I've seen are very confused and conflicting. So, what about marijuana? Does it reduce testosterone to significant degree or
not cannabinoids itself? Whether it's THC or CBD are not going to reduce testosterone by themself if it's smoked marijuana, then it's very likely to increase your aromatase, which increases your estrogen and, you know, that's going to its romanticizing from testosterone. So that is going to
decreased testosterone when you have an increased estrogen like estradiol that's going to work on your pituitary to make less hormones that cause the release of of testosterone. So you're going to have less LH and less FSH. So it's almost kind of like, you know, opiates are well known to opiate agonists. They're going to decrease LH and FSH and subsequently testosterone. Smoked marijuana will as well as far as alcohol. Hi Al
All will decrease testosterone as will any very potent Gaba Agonist, whether it's a barbiturate or a benzodiazepine, or a non bends or alcohol. They're definitely going to moderate alcohol. I guess. It depends on what your definition of that is the amount the amount
assembly in like a, like some people. I know that don't seem to be alcoholics, at least by my, you know, assessment will have a glass or two of wine, four nights a week, which to me seems like a tremendous amount only because
And I don't like alcohol. I don't have a problem with other people like an alcohol. But but I think many people for many people that would be considered low or moderate
intake. Yeah, I would consider that low intake, the American Heart Association for men recommends, believe between one and two, drinks a day on average. They recommend it. So round one per
week. So I'm making my heart less healthy by not drinking
alcohol. Yeah, they recommend a very low amount of alcohol intake. For men, for women. They recommend 0 to
So that's kind of hard to interpret the 0 to 1, but the protective effect of alcohol, especially if it's a red wine with polyphenols in it, outweighs the deleterious
effect interesting. Because I've seen some studies that point to the idea that even low intake of alcohol, over a prolonged period of time, might actually decrease brain volume or at least volume of particular, brain areas. But of course, we don't know the consequence of of decreasing. The volume would give of a given brain area either.
I mean, one can imagine, it's decreasing the size of one's amygdala and making them less stress. Although, there's no evidence to support that. I've been told that I need a drink many, many times, but I always reply to, I don't need to drink anything in order to speak my mind. So, again, individual differences, very interesting. So, it sounds like, smoked marijuana made, in fact, reduce testosterone, or at least increase the conversion of testosterone to estrogen. Yeah, okay,
and with alcohol and Gaba Agonist, it's important to remember that, it shouldn't be daily. So one drink of alcohol.
A is actually very mildly immunosuppressive. So it's better to have two drinks of alcohol. One day the week and then two more drinks of alcohol and other day of the week and then no alcohol. The rest of the time. The same could be said, even for supplements that have Gaba in them. A lot of sleep supplements, have gamma-aminobutyric acid, which
I occasionally take. Oh, sorry to interrupt. I occasionally take 100 to 200 milligrams of Gaba in order to enhance sleep, but I do it. Maybe every third or four night no more than three or four.
Nights a
week. Yeah, that's perfect. Okay. So there's a lot of sleep supplements. That should not be taken daily. And Gaba is one of them. Another one of them is trazodone and and melatonin is kind of arguable and it depends on the situation. But in general, if you're taking a sleep supplement, it should not be taken every night
the the Sleep supplements that I understand her. Okay? To take every night or nearly every night or things like magnesium, three and eight apigenin if that's not true.
Correct me. I, those are I certainly take them every night unless I forget them back home and I'm
traveling. Magnesium is one of the exceptions. L-theanine is also another
exception. Great. Well, then, at least I haven't put anything into the world, that's that's wrong in that category yet and hopefully, I won't. But if I do, I'll correct myself. So let's talk about testosterone in males there. You see these headlines all the times. Now that testosterone levels are dropping.
Encounter dropping phenotypes of men are changing over time and I can't quite follow the literature on that because obviously those are hard controlled experiments to do because techniques change over time and sensitivity of techniques change over time, but regardless, I'm aware that a lot of people are considering increasing their testosterone by taking testosterone that a few years ago that was considered, you know, steroid use. And it was really extreme kind of
Us nowadays, it seems like there's more discussion about it. First off. I'd like to know.
Does testosterone supplementation and here, I'm talking about prescription from a doctor. Does it make one more prone to prostate cancer? That seems to always be the first question that comes out.
Yeah, and there is a huge amount of misinformation about this to so testosterone is not going to cause a prostate cancer. However, normal aging causes prostate cancer and testosterone will grow your prostate cancer.
So if you are 80 year old male and you have an autopsy and there's at least a 50% chance that you have a prostate cancer if you're 90 or 100 years old, there's at least a 90% chance. So for humans with the prostate, it's only a matter of time until you get a prostate cancer. So that begs the question. Do you want to take something that's going to grow it for sure? Once you have it so it's an individual assessment and it's important to follow things like psh.
As well, so a PSA of four or less. I mean, ideally, you wouldn't be at four because that's kind of the upper threshold is the simplest readout of whether or not, there's excessive prostate growth. There's benign, prostate hyperplasia, where the prostate is growing, but it's non-cancerous, correct? And then, of course, there are the symptom ologies, like people have challenges of urination. They have sexual difficulties, Etc. I'm always struck by the correlation that people draw between testosterone and prostate health,
With and the fact that or the I should say, the claim that testosterone makes prostate health worse. Because if you think about it, young males have high testosterone often. If not always certainly often.
And you don't see a lot of prostate overgrowth in cancer in young males. So something's going on here. How should we conceptualize this?
So if you have a PSA of 3.9 and your 25 year old male versus a 75 year old male and have a PSA of 5.9. The 3.9. PSA is significantly more concerning. So think of your prostate is taking cumulative damage from not only testosterone.
It also estrogen and also growth hormone. So that's why obese individuals have higher incidences of prostate cancer as well. It's because they don't have those cell checkpoints where your immune system takes a second. And says, alright, stop replicating. This fast prostate cells. Let's see if there's any a typical ones and then it finds those and it prevents them from reproducing. That's why immunotherapy and cancer is so promising us because it can Target these certain things.
So the older male is going to have that cumulative damage happen already and arguably prostate cancer is a normal, you know it with aging, you know, a fast aging is abnormal very slow, aging is normal. There's a fine line to walk between those two but there's a lot of things that can be done to decrease the turnover. Decrease, the inflammation and decrease the
Section of the prostate overtime. There's also a lot more than just PSAs that can be done. There's prostate MRIs and things like that. They can look at the structure and the function of the prostate. So what
should every male do to maintain the health of their prostate? And I realized that younger males probably aren't thinking about it. Although it seems like nowadays. I get these kind of what I call cryptic questions, you know, I think women are more comfortable talking about their hormone and sexual health, because of, they cycle, you know, because of menstrual cycles, they're used to fluctuations that allow its
Give them the experience of what it's like to have different levels of progesterone. Estrogen testosterone, etcetera by get these kind of cryptic questions, often in my direct messages. Where, what I think people are asking is why, you know, what? Is there something wrong with my prostate? What should I do for my prostate? These are often indirect questions for other aspects of their life where they're suffering. But and I don't say that in jest. I think more direct discussion would be great. So what should it all males? Do to maintain to maintain.
Prostate health throughout the lifespan
maintaining prostate health can be looked at. Similarly, how you can maintain a good natural optimal testosterone. So you look for things that can hurt it. You don't necessarily look for one thing that can improve it or boost it. So for young males, those are prostatitis. So it goes hand-in-hand with epididymitis. So different infections of the prostate, the younger, the male is, the more likely it is related to something that could be sexually.
Lee transmitted. But another very common cause is what we call gram-negative and anaerobic, bacteria. The prostate is right by the end of the colon. So if you have chronic constipation or if you have Colitis or if you have, you know, even just an E coli overgrowth in the colon is very likely to cause an infection of the prostate as well.
What should males do to prevent that
have a diet that has
Good healthy, Prebiotic fiber, probiotics as well. Make sure that they're having regular bowel movements that they don't have. Chronic constipation have good sources of dietary fiber, which is also known as soluble fiber and enough insoluble fiber. Most people get enough insoluble or non dietary fiber so that can help prevent the chance of diverticulitis, which is another type of infection. It can also decrease the chance of colitis and decrease the chance of prostate.
Infections as
well, are there any foods and or supplements that men should take or avoid? What about you hear about? Saw palmetto? Yeah, supplements for or supplements, that support or cause issues for the prostate.
Yeah, if there's a strong genetic predisposition to enlarged prostates, or even just really early prostate cancers that grow fast, then they consider taking saw palmetto or even curcumin.
An anti-androgen. As long as they're able to tolerate it. It's an individualized basis and depends on their history. As far as making sure that their prostate is not congested. There's an interesting correlation between having girls and having prostate, Kevin's roloffs. Yeah. So if your, if your offspring are females, then you're slightly more likely to have prostate cancer. There is some, there's hypotheses that link.
Into prostate cancer rather than testosterone. So if you have hyper estrogen is MM, your prostate has more atypical cells. In general, the higher, your C-reactive protein, which is a general marker of inflammation in your body. We call it CRP and the test order is HS, C, RP, or high sensitivity. CRP, if your CRP raises up, very high, if you have an autoimmune disease, like if you over Crohn's flare or if you have
Lupus or infection, or a sexually transmitted infection or even colitis, or even the flu, your CRP is going to raise
significantly that you would detect in a blood test of
correct. Yeah. So you want to get a baseline CRP when you haven't had any of those things recently and if your CRP is higher, you also have more female Offspring. If your CRP is higher, then your reactive oxygen species which are causing mutations and a typical cell turnover in the prostate.
Are also likely higher so you want to keep it very low CRP, interesting.
And what about blood flow and pelvic floor? In general? We should, I do a whole episode on pelvic floor, you know, there's so much interesting data coming out of the fields of clinical and research Urology. I realize, it's kind of the Netherlands of biology and Medicine. People probably aren't thinking so much about this, but pelvic floor is, obviously a Confluence of a ton of vasculature of nerves and of course, the prostate resides there and
Course the genitals and reside there as well. So I would imagine that the one of the six pillars that, you know, exercise being able to maintain adequate blood flow to those regions is key. What about just postural things people sitting too much, not hydrating. Well enough, you mentioned avoiding constipation. What are some other things including medications that can serve to support the prostate over time and maybe even support pelvic floor in general. Both in males and females over time.
I'm
absolutely. And this is something that's rightfully, getting more and more attention. The way I explain the pelvic floor is your abdominal cavity, which includes your peritoneum or where most of your organs are your retroperitoneum your pelvic space. Think of it as a box and your abs are the front of the box your back. Muscles are the back. Your diaphragm is the top of the box and your pelvic floor. That's where your Port is to the outside world, especially important. It has muscles as well, and you can do exercises.
Floor. Physical therapists are becoming more and more utilized especially after childbirth, but in other situations as well, including by men getting care of from urologists, so you want to both strengthen that pelvic floor and make sure that the tubes that are docked to the outside world are working well enough, but they're not too loose or not working too. Well, so there's a lot of medications that can be positives or negatives for your pelvic floor.
Or we kind of talked about your gut and colon Health in general, as far as your prostate health. And as far as your bladder and urinary system Health, you think about a couple different classes? So you have your phosphodiesterase has you have your tadalafil? Basically, this is going to help decrease congestion in the prostate. A lot of people take it for Ed, but it can actually help you decrease your. You define that a lot of men take to dalla Phil, just generic is Cialis.
As a much longer, Half-Life, than Viagra or Levitra, its Half-Life is almost a day. So you can take a very low dose of it. Instead of taking 20 mg. You take two or two-and-a-half mg. So, they're
taking, you're saying that a lot of men take it for erectile dysfunction. Yes, but that it at lower doses. It may have served purposes for prostate health independent of Direction.
Correct. The most common scenario is if a male is waking up twice at night, to pee on average. It'll cut that down to once.
So if they're waking up at four times that night, then it can cut that down to twice at night just because you have easier, blood flow. We used to use other medications like Flomax, which is tamsulosin. That's an alpha antagonist. So it basically binds to a receptor in smooth muscle and it helps relax that there's several other Alpha antagonists. And then you also have your medications that are hormonal like finasteride that. A lot of people take for prostate health to decrease the enlargement of the prostate, the pair urethral.
Area or Parry urethral lobe. There are several lobes of the prostate that tends to be especially enlarged in cases of BPH, and BPH prostate hyperplasia or an enlarged prostate. And if you are able to shrink that area, then at that point, it's just a plumbing problem and the urine is able to get by
easier. My understanding is that now there's a growing I don't see a movement, but take the idea of
Looking very low dose like to point 5 mg or 5 mg. 2 Dolla Phil even daily is becoming pretty common for many men who do not have erectile dysfunction, simply to either maintain or enhance prostate health. Is that correct? Yeah, that's correct. And are there. Do you see any negative effects of doing, that?
There can be negative effects. It can lower blood pressure. So, theoretically it can increase your chance of vasovagal syncope. A lot of people take it as
Alternative to pump because it kind of works similarly to citrulline, or a different pump products in pre workout, and it can certainly help with that. But if you're about to go do a deadlift or you might pass out, only way it can certainly increase the transit that happens because you don't have that compensatory exercise. Hypertension response.
Could someone just take it away from exercise.
They could, if you took tadalafil, then it's that's going to be, has a long half-life.
Viagra and Levitra is just a few hours to dalla. Phil is almost today. Some interesting studies on Viagra have been done as well. It can potentially alter your raise and cones in your eye. So the usual recommendation for Pilots that need to have red green discrimination from very long distances, with very small indicator lights is to not take Viagra. So I usually say, if your, if your pilot that your profession, perhaps hold off from that for a while.
While there's also studies with Viagra that significantly, which is also known as sildenafil as the generic. Now, it can increase eyebrow hair growth. So potentially what it does is it helps vasodilate and relax the veins especially in older men and when those veins are relaxed you have better blood flow. That's one of the proposals or theories behind. Why older men get the androgenetic alopecia more. You're having less blood flow in the scalp.
So theoretically it can also help prevent that. So it's in theory,
increasing blood flow because it increases blood flow, systemically throughout the body, not just in specific tissues. Well, I find it incredibly interesting that there are these online forms building up. Now around low dose to dial, Phil daily use of low-dose tadalafil again, not for sexual erectile dysfunction, but for sake of long-term prostate health, is there any reason why women might
And to take low-dose to dalla Phil.
To Dallas, Phil is also weak Androgen receptor. Sensitizer kind of like L-Carnitine where the density of the available Androgen receptors to bind increases slightly. So there could potentially be a benefit from that. But most of the time it's used in Men, very interesting.
We haven't really talked about testosterone and optimizing testosterone in males.
Assuming someone is paying attention to the six pillars.
There's a kind of a gap as I see it between doing all those things and trt hormone replacement therapy. And again, the are the replacement in trt is a little bit of a in quotes nowadays, because a lot of people who have testosterone in that 300 to 900 nanogram per deciliter range opted to take low-dose testosterone. Anyway, my understanding is that there have been some new kind of movements in this area, too.
For instance, not doing big large doses in injected infrequently, but rather low doses. Quite frequently obviously prescribed by a doctor monitored by a doctor Etc. Is that generally what you like to see in your patients, if they're going to take this
route, if they're a hypo gonadal patient, whose benefits outweigh risks of trt. Then you want to have a nice even steady state. It's not going to be exactly the same as
Reducing pulsatile, testosterone release endogenous Lee from your own body. When you have a steady state, you don't have a puker, a trough. And when you have a peak, that's when the antigen receptor Gene is overactive. That's when you get more erythropoietin or EPO release and that leads to a lot of the side effects of thick blood. So higher hemoglobins, and hematocrit. It's and then when you have a crash you don't feel good. So it's definitely not optimal.
There's a lot of ways to get around this. So when you're doing testosterone replacement, if you're someone that needs it, you can have different types of Esters or you could do topical testosterone. So the Ester is basically something that's attached to increase the biological. Half-Life. The most common ones are sippy innate and nth a, there's also a very short acting appropriate 8, which has almost no clinical relevance. And there's also very long acting ones to can await and under can await and different mixtures of
Of all those. So if you're someone who has a very, very low shbg, you're going to have trouble, regulating your serum testosterone in the long run. If you do it. Topically and the testosterone is absorbed, hopefully bound to shbg. And then a lot of times you reapply twice daily or once daily, but you have lots of variations. So for most people, especially for people who can't absorb it. Well, that's not going to be a great option.
So injections would be
preferred most people end up injecting because
Have either side effects from too high to low or just too much of a very dose when they do topical. There's also a capsule with a special lymphatic absorption. So it's not being absorbed through the liver. It's not that Paddock we metabolized but it's absorbed through the lymph and it's essentially testosterone unda can await and then put into a capsule. So that's taken twice daily. It has fairly steady half-lives, but you have to take it at specific times of the day, so that
He said and it's knew enough to where there isn't a huge amount of data on it, but it is FDA approved. So it is, it is brand name. Now. It's called jit Enzo, but the injectables in general, the lower your shbg, the longer of an ester you want. Because when you inject it, whether it's intramuscular or subcutaneous, just talk to your doctor about the risks and the benefits of those subcutaneous has slightly longer active half life because the esterases take a longer to reach that sippy innate or an ant, they stirred cleave it.
So most men a lot of people ask me about like what a usual dose is for most people. It would be a total of about 100 to 120 per week for an actual replacement dose milligrams mg 120 to 100 milligrams per week administered two to three
times per week. And you're not. So you saying dividing that into two or three, right? Because I'm sure they're a bunch of people out there thinking. Oh, yeah. Hundred three times a week, which is actually quite quite high dose. Yeah. They're they're really does seem to be a shift in.
Word spreading these dosages out into, you know, dividing them into two or three smaller Doses, and then, along those lines. Five, ten years ago. It was common to hear about inhibiting, estrogen, through aromatase Inhibitors nowadays. You here. And I think it's true, at least by my reading of the literature that that inhibiting estrogen can disrupt brain function can cause connective tissue issues. N even can cause reductions in libido. So, a lot of people think that
At estrogen, if you crash estrogen, that basically Beetle goes up. But actually the opposite is often. True. You don't want estrogen too high or too low. Is that correct? And for that reason, do you shy away from people taking aromatase
Inhibitors? Yeah, very few people. Truly need aromatase inhibitor. There's almost always lifestyle interventions and can just depend on which Gene how active your Aroma taste. Gene is some people's aromatase.
Gina's very active. A lot of times these individuals have pubertal gynecomastia, which is breast tissue growth in males, even despite. No other risk
factor, even if they're lean,
some people get it. If they're lean. I remember growing up there were a few
kids that got mild cases of gynecomastia that we're transient like they had sort of like they developed gynecomastia and then it went away
often. It's unilateral on one side too. So growth hormone a lot of times is the fuel.
All to
that fire. Oh interesting too. Yeah, there were a couple of kids. I mean, they took some teasing because back then it was there was an online discussions about hormones and things like that, but then it would seem transient and they were the people. I'm thinking of, we're actually lean individuals. So they weren't overweight, which of course can cause gynecomastia because adipose fat tissue can convert testosterone into estrogen. So it sounds like except in special cases that avoiding aromatase Inhibitors is probably going to be a good
idea.
Several other ways that you can control your estrogen and keep it at a healthy level which you do have to check. There's a lot of patients who assured me that their estrogen is going to be sky-high and it's actually very low and vice versa. But calcium D glue, create is a supplement that can help with estrogen control.
What's a typical dosage of calcium? D-glucose
500 to 1000
mg. But is there the risk that if someone's estrogen is in normal range and they take this supplement that their estrogen will go to low. Is it that
potent?
It's not that potent. It's not near as potent as an aromatase inhibitor. So it helps with excretion and also the sensitivity of the estrogen receptor itself and it kind of like helps out-compete it. Some people also take dim or different cruciferous vegetable, the get them from cruciferous vegetables, like kale but or broccoli and that is both an anti estrogen and an anti-androgen. So if you're on trt and you're on that then,
Probably just on too much trt.
Yeah, I remember a few years ago. I had a friend and it truly is a not like I had if I have a friend thing because I'm very cautious about which supplements. I take, I think people might get the impression that I'm very Cavalier about this, but I'm not, I always alter one thing at a time. I talk to Physicians, I tell, you know, what, I suggest other people do. I actually do and have done for a long period of time, and I recall wanting to take dim because I thought, well, you know back, then you here. Okay. Reduce estrogen. My estrogen levels weren't out of range. So they were fine, but I thought well what
What would the experience be a bringing those down? But someone I know is quite informed in this area. So, the yet exactly what you said, which is that dim, can reduce estrogen, but also testosterone. So I just never opted to try and take it. Um, I do want, we're sort of airing in this direction, but we went straight from the six pillars to trt or to what some people now call Sports trt, which is basically code language for saying taking exhaustion has testosterone even though one doesn't need it to get into a semi super physiological range.
A high-end like 900 to 1000 nanograms per deciliter range and people always point out. I should mention that. Oh, well in certain countries, the high-end range is 1200 nanograms per deciliter in the u.s. It's 900. And so if your 12:00, are you really super physiological all that aside? I neglected to ask about that Gap in between where individuals could think about supplementation. Meaning non-prescription, approaches to increasing testosterone. And here, we should probably also talk about things like, is it true?
Ooh, that ice baths increase testosterone or not lifestyle factors that go beyond the six pillars for increasing testosterone. If you could comment on those, that would be terrific supplements that are useful and it be wonderful. If you can mention where some of these same practices and supplements might be useful for women, as well as men to increase testosterone for all the reasons. We talked about earlier.
Yeah. So this is where a true individualized approach comes in. When you're talking about what dose of trt. You should be on one thing to keep in.
Mine is the law of diminishing returns quality of life is a subjective thing and it's different for each person. So some people are more willing to give up a little bit of athleticism or body composition. Some people are more willing to give up or not willing to give up libido or sexual health. And as we mentioned earlier, everybody's Androgen receptor is less or more sensitive. So you can make a case that if somebody's Androgen receptor is
Half as sensitive as somebody else the one, the person with the less sensitive receptor, does need a level of 1,000 or 1,200. There's no great way to know that and you can alter the sensitivity for Androgen receptor or things like L-Carnitine and tadalafil. As
mentioned will definitely come back to L-Carnitine because I'm really intrigued by the data on L-Carnitine, both for women and men. In terms of egg quality, sperm quality fertility, and a bunch of other interesting effects. So, we will come back to L
carnitine, but a lot of how you feel.
The biofeedback or subjective. I feel like this comes from the ratio of your androgens to your estrogens. And a lot of that is lifestyle. So if someone's also on HCG that could upregulate Aroma taste as well and
HTV, you might want to just human chorionic. Gonadotropin found used to be found in pregnant is still found in pregnant. Women still found. It used to be consumed. Believe it or not. There was a black market for pregnant woman's urine before it with this stuff was developed synthetically, so
In other words, what we're saying is men typically would buy pregnant woman's urine. Yes, through black markets in order to get the HCG in order to get the testosterone enhancing effects of HCG. So in other words men were using pregnant woman's urine for HD. I do not want to know how they got into their body. Let's just skip to what you were going to say next
instead. Yeah. So that's HCG. There's a lot of other things that upregulate estrogen alcohol significantly increases the aromatase. So if you're very,
Sensitive to estrogen, then you probably shouldn't even consume the two glasses, three times a week, high fat meals, also operated in Roma tastes. So if you're on a ketogenic diet, but you have hyper estrogen has, mmm, then you should take care without as
well. All kinds of fats are just saturated fats. I'm not
sure if it's just that traded fats, but fat definitely increases both fat in your body, and consumption of a high amount of calories, increases of Roma
to so that it's the ratio of testosterone to estrogen.
I don't want to break your flow, but that, but since we're talking about fat, I have to ask since estrogen and testosterone are both synthesized from the cholesterol molecule.
I've heard that ingesting some amount of saturated fat can be useful because of the way that cholesterol can serve as a precursor to these molecules. Now, I once said on a podcast that I like butter, so much that occasionally eat Pat's of butter. Somehow that misinterpreted to mean that I eat entire, the many paths of Butters. I'm like one or two Pat's of butter here and there and I have no guilt or Shame. About my blood lipids are in great shape also, so I'm feel good. But is it possible that people
People who are ingesting too little of saturated fats could directly or indirectly, reduce, or somehow disrupt. The proper ratio of testosterone to estrogen in men and
women. It's theoretically possible, but it probably doesn't happen in developed countries. Just like it's theoretically possible to have not enough omega-6 fatty acids, but that probably does not happen in developed
countries, so I don't need the butter Pat's but I'm gonna do it. Anyway. I'm just curious.
Okay, grass-fed butter.
Good omega-3 content as well. So grass-fed Foods in general, you know, it's not the end-all be-all and everybody doesn't need grass-fed foods, but they are one of the only sources of healthy trans fat. So a naturally occurring trans fat comes from ruminants. So ruminants that I think of like cows and this the rumination and the different stomachs can change your omega-3 and omega-6 to trans linolenic acid.
And trans linoleic fatty acids, which are healthy for. Yeah, so it's actually Omega-3s and omega-6s that just happened to have a trans instead of a sis
isomer. So and these healthy trans fats would be found in ruminant cheese and milk and butter from ruminants and or the meat and the meats. Yes. So and for people who were following a purely plant-based diet or or mostly plant-based diet, are they at risk of not getting enough of certain types?
Fats are other nutrients to maintain that healthy ratio of testosterone to estrogen or not.
If they're a vegetarian, they're probably not at risk. If they're a vegan. They very well could be at risk. Most vegans are aware of this very acutely and they'll supplement with, you know, algae or they'll supplement with other sources of healthy
fats. I see. So the takeaway that I'm drawing from this is that less so than getting saturated.
Saturated fat. It's key to get these healthy trans fats from ruminants. Yes, or the food products of those ruminants, as well as to get proper amounts of
Omega-3s. And to be clear. You don't need any trans fats. It just happens that those Omega-3s and omega-6s are in a trans.
Isomer. I see. Okay. So that's nutrition. What other supplements can support healthy, testosterone to estrogen
ratios, anything that alters aromatase can support healthy testosterone to
Regina and your testosterone to estrogen ratio, think about it, as how much estrogen activity, do you have at the beta estradiol receptor and your Alpha estradiol receptor? How would I know that? So it's hard to tell but depending on what you're eating, if you have a lot of plant-based diets or polyphenols, many of these are beta estradiol receptors people know about Turkish Tyrone and also beta XT stair own which are 2X.
D steroids that are beta, estradiol receptor Agonist. So, they activate the beta estradiol receptor. So, if you have a very low amount of estrogen naturally, you're probably a better candidate for it for
taking to Turk Esther owner extract Easter. I've never tried them, but I know my understanding is that they work tremendously. Well for some people and not at all for others. And so one just simply has to try, but in in promoting the activity of this recessed region receptor. Is there a risk that Turkish Throne erectus their own could.
Cause some of the quote-unquote problems associated with increasing estrogen activity, like reduced libido. Water, retention
water, water retention. Yes, reduced libido. Probably not closing growth plates in the bone. No, because that's the alpha estradiol or scepter.
I've talked before, on a couple of podcasts about tone golly in, which is this Indonesian herb. I guess it's also man-made and found in Malaysia, but it seems to be the
Indonesian variety of Tonga Ali, that's most effective or potentially for reducing sex hormone-binding globulin and thereby freeing up testosterone whether or not the effects are through that pathway through another pathway. A lot of people report improvements and things like libido and maybe Androgen like phenotypes, right? Feeling more vital, Etc. And of course some of that could be Placebo, correct, but what are your thoughts on Tunga Ali? And please challenge by
It's about Tom golly. If they're incorrect. I'm not looking for validation here. I just really want to know what your thoughts are on it. Do you ever recommend it to patients when men women one or the other?
Yeah. So tongkat Ali or long Jack. It has multiple mechanisms of action and there have been several placebo-controlled studies on it. Some of them show, decrease in shbg. At least one of them. Did not show any change in shbg. However, it is, it does.
Act on aromatase very weakly, probably not so strongly that you would have to be concerned of hypo, estrogen is,
mm. So it reading it reduces Aroma taste and thereby can reduce estrogen,
correct. Okay. It's also a week. It's not a sermon, so it's not a selective estrogen receptor modifier, but it's probably a week. It's probably a term as well, or a non selective estrogen receptor modifier. And that should help with decreasing negative feedback inhibition of estradiol.
In various locations and also increasing testosterone,
saying yeah, the dosage that I've been using for years now is it's 400 mg taken once a day, typically, early in the day because it can kind of have a mild stimulant effect, very mild. And I know that some of the products out there. Recommend dosages that are much higher. Anytime. I've taken more than 400. I don't feel very good. I don't know how to describe it other than it's just a little overly stimulatory in terms of makes me kind of its
Drinking too much coffee. So that's, that's interesting. And so
Would women ever want to take Tonga Ali for any
reason? Yeah, absolutely. So there's a lot of women that have hyper estrogen is mmm. And unlike adrenal fatigue or andropause. There's actually ICD-10 codes for hyper estrogen is MM, ICD-10
codes. Yes. Dr. Speak. I saw the
okay, there's codes to where your doctor can actually diagnose, you with something. So if you go to your doctor and you say I have adrenal fatigue, they can't diagnose you with that. Or if you say, I have andropause, they also can't diagnose you with that.
But if you say, you have hyper estrogen is mmm. The most common complaint that comes with, it is endometriosis, which is overgrowth of the lining of the uterus. And those people could potentially, I think that's one area where we might see Tomcat, supplementation, more and more because not only does it decrease Aroma taste. Like we mentioned testosterone and females is higher than estrogen and females. So a lot of females get estrogen from aromatization as well.
Peripheral estrogen is sometimes what we call it because it's not directly produced in the ovaries, but they could be good candidates for Tomcat. If that's the
case. Very interesting and my understanding is that people should be looking for sources of Indonesian tongue. Golly in particular
correct? Another interesting application is essentially, a, I'll call it a PCT. But essentially what he sees is PCT means how the fine is post, Psychotherapy
Physicians, love acronyms scientist, live action's military, love acronyms. But we yeah, you see, Tipo
Psychotherapy, so there would be people coming off hormone therapy or
steroids. This would actually be for women that are coming off of their birth control pill because perhaps they can help lower that shbg back to normal which is sometimes persistently elevated and then it can help prevent the subsequent hyper estrogen ISM. That happens
does tonga Ali need to be cycled when I first started taking it I would cycle it. I would do a few 3-4 months and I would take some time off now. I've just been taking it continuously for years and my and I should say I do blood work to check my liver enzymes and everything else. And
you know, I don't see any reason to for me to cease taking it.
Yeah, probably not. There's been human studies on both tomcat and for Doja and full disclosure. I did help design Derek's new testosterone, optimization supplement which has both vadodara restless and also tongkat Ali
in it. Yeah. Let's talk about Fado just separately in a moment. But if let's say, someone is only taking Tonga Ali, for whatever reason, but do they need to cycle
off, likely not?
But I would just to be safe because it does both affect your Aroma taste, and it's an estrogen, estrogen receptor
modifier. And how, what, what would be a reasonable cycle off. So, how long to take and how long to to stop before taking again?
Yeah, there's a couple different protocols that you can do. But 11 months on one month off for Tomcat is pretty reasonable. This is, I guess this is. We'll talk about this later too. But if it's combined with the Doja, the protocol that
I would do is three weeks on one week off.
So that's Tonga Ali. What I'm curious. What your thoughts are on Fado G aggressiveness, this Nigerian shrub, or this extract from Nigeria and shrubs that, at least, in my experience in my reading of the literature, has the potential to increase testosterone and probably other hormones as well by way of increasing luteinizing hormone something that we haven't really talked about much up until. Now, what are your thoughts about Fidelity? Agreste is what are
Ideas about the proposed mechanism or mechanisms and where might this be useful for people on or off hormone replacement
therapy. Yeah, Fado jie aggressed. Us has just reached a point where we have enough evidence to. We know it probably helps both with luteinizing hormone release, which stimulates latex cells in the testes to produce more testosterone and probably with LH receptor sensitivity as well.
Which is a good combination of the two, it does come from the Nigerian shrub, but there is not quite enough evidence for me, to be able to say it's safe for somebody to take this all the time. Which again, fold a stroke disclosure. That's why I recommended that we recommended for people to cycle this supplement. So, three weeks on one week off, that's likely safe. The only toxicity studies in general.
Rats. And in humans, it looks quite
safe. My understanding is that the toxicity? Studies in rats, showed toxicity to the testicular cells so that certainly concerning. But that the dosage is that were used or translating, the dosages used to humans would lead to a situation where the dosages that humans would have to take would be very, very large. So the amount of I no longer take Fado Gia, but I took it at 600 milligrams per day for a long.
Time. And I see taking it because I was experimenting with other things and I didn't want to confound those things not because I had any negative side effects. In fact, I was monitoring blood work and another bite biological parameters. That would would have told me if there was just a killer to toxicity. And there wasn't, let's put it that
way. Yeah, I think it's extremely safe and I'm just not convinced that there's enough overwhelming evidence for a long-term consistent
Administration.
Do you recommend this to people who are not taking trt? And do you recommend to men and women?
Yeah, so if you have a really high LH, then they're probably a good model issue, whether it's he damaged the testes varicocele, history of testicular, cancer or your LH is going to be higher. So if your LH, is already very high increase in it even more as probably not going to help. However, if your LH is low, then obviously try to find out if it low, is it.
Agent or is it just a little bit low if it's low and you don't have an issue with prolactin. You don't have an issue with opioid receptor antagonist. Mm. And now tracks own can actually potentially help antagonize that to increase LH as well, especially in people recovering from opiates that are likely even alcohol. So you're looking for a subclinical secondary hypogonadism, which is essentially just think of that as low well H, so when people with that lower LH and their estrogen is fine, and they're prolactin is fun. Then Fado.
Is a particularly good option.
Interesting. So three weeks on one week off, for, for 600 milligrams, for do Gia, 400 mg. Tonga Ali, Indonesian Tonga. Ali could potentially be good. Of course, everyone should always check with their physician clear. This do blood work, etc. I would say we don't just say that to protect us. We said it protect you. Meaning that the the consumer is very, very important. You don't want to get you don't want to fly blind with any of this stuff.
You want to do blood work,
right? That's the Catch-22 is supplements is most of them are safer than medications, but the only difference between them and a medication is one's prescribed and one's
not and often times with supplements. It's unclear whether or not what's listed on the bottles. Actually what's in the bottle. But but the I think there are a number of reputable Brands. Now the the other supplement I want to talk about in terms of testosterone, augmentation is boron. What is boron thought to do? Does it actually do that. And do you ever
Recommend Boron. Yeah. So Boron is actually an element and you can find it on the periodic table. It's more plentiful and a rich soils. So frequent farming can deplete, the soils of boron. It's very plentiful in the Mediterranean area like Greece and Turkey. So a lot of people will just eat dates or raisins
that are grown there, but you can't tell me, people, eat dirt, but there are people who eat there. Are people who dare, there's a phenomenon called Pica, right? Where people in a and that's not a good thing.
They often assign an iron deficiency.
Okay, but they're they're eating grapes and dates that were grown in soil that has high amounts of boron
has. Yeah. Yeah. So Boron can help regulate shbg but its effect is mostly a cute. So it's unlikely to have a bad effect. So a lot of people take Boron because it's probably not going to hurt and it will lower shbg, even if it is for a short period of time, so, I guess you can make a case that may be cycling. Boron can help too.
Sorts of dosages, are, are useful for Boron,
supplementation. Three to six milligrams once to twice a
day. Oh, interesting. So that's higher than the amounts that I've taken. I've, I've long been doing this cocktail of Tonga Ali. Again. I stopped taking Fado Gia, but for a long time, with Fado Gia and and Boron, I think it was 2 to 4 milligrams per day, but maybe I could afford to go higher. Although my blood work is where I want it, thankfully circling back to Fado Gia, but do Gia was attractive to me as a
Element. Because I saw increases in LH testosterone and free testosterone. My estrogen stayed in check, but I also did not see a down-regulation of LH, when I would cycle off, whereas, with HCG human chorionic gonadotropin, which does now arrived in informs not from pregnant woman's urine only, but the synthetic forms that people inject that, as I understand, it can actually suppress hormone out endogenous hormonal.
But if one takes it for a long period of time, so, why would a man or woman want to take HCG and what are the potential risks and benefits of taking
HCG? Yeah. So HCG or human chorionic gonadotropin is actually very similar to TSH thyroid stimulating hormone, correct. So, when a woman is pregnant, she produces more HCG, especially in the first trimester when you take a pregnancy test, whether it's qualitative or quantitative, you see that.
HCG rise and it actually doubles every 48 hours. So if you're five weeks pregnant, you can get HCG level and then two days later five weeks in two days. You can see your HCG and maybe it went from 500 to 1000. So it precipitously increases.
It does a few things, one thing. Is it prevents hypothyroidism or hyperthyroidism idea of pregnancy, which is one of the most common causes of miscarriage. It's also why if you are, if you have hypothyroidism and you get pregnant in the first trimester, you want to increase your dose from 25 to 40 percent, to keep your free T4 high as much as possible. And the reason why you have to do that, as opposed to somebody, who does not have high,
Thyroidism, is if you have hypothyroidism, then likely your thyroid will not respond to either TSH or HCG. So the increased HCG does not compensate for that. So if you take HCG, then it can potentially improve your thyroid function. So that along with selenium are likely the two best things that you can do for thyroid
Health, HCG and selenium. Why? Definitely make sure I get enough selenium by eating three to five, Brazil nuts.
Day. Try very much. Enjoy the taste of also who should take a HCG and can HCG suppress ones. Normal luteinizing hormone
output. Yeah. It suppresses LH in a dose-dependent matter. So the higher the dose of HCG, you take the more it suppresses. LH a common dose for fertility, fertility is usually why HCG is prescribed in men or women in both is 10,000 IU's. All at one time.
Which is quite a
bit. That's a
tremendous dose. In fact, some formulation some brand names of HCG come in auto-injector, pins to where you cannot even do slower than 5,000 units at a time.
Wow, but I know a number of people who take HCG to maintain testicular function while on testosterone therapy or augmentation of some sort. Does, it does it work to do
that? Yeah. Some people are on HCG model therapy. It can be slightly.
Are on your lipids, then being on T,
RT. So people are using HCG alone as a kind of, neither, as sort of a hormone augment, indirect hormone augmentation.
Some clinics advertise it as a non suppressive alternative to trt, but it is suppressive
LH, but it could also increase estrogen pretty potent lie. Yeah, and is it true that increasing LH and or HCG can improve sensitivity?
Activity of the genitals and is that true for men and women? I've heard this anecdotally, people say HCG makes sexual activity more pleasurable for people because of some is it a direct effect on on some of the nerve cells? In the, in the
genitals. Yes. Olh is also an Agonist in the prostate and engine of the tissue in general. So it's a very common treatment for post finasteride syndrome or post 5-alpha reductase when
Blocked the conversion of DHT for a long time. It helps re-up regulate DHT.
So, someone who's been taking finasteride to prevent hair loss, comes off at feels maybe because they felt lousy, but then feels even lousier for reasons, you talked about earlier and then they might use HCG as a transition treatment to transition back to normal Hormone Health. Is that
right? It's extremely helpful in many cases. Now when you come off the HCG, then you need to have a strategy of how to return to your
Normal as fast as possible as well, but it will up regulate. Those 5-alpha reductase enzymes. You have in your genital skin. Both scrotal skin and penile skin and perineum. And general. You have. I believe it's called stratum lucidum. It's a skin layer that is very, very thin but it has the highest concentration of 5-alpha reductase. So you have a lot of activity and after you've been on something that inhibits the enzyme the 5A,
Enzyme in those tissues. Then you do something else to up, regulate those enzymes, whether it's waiting and taking time whether it's trying to dalla Phil, whether it's trying creatine, even or whether it's trying to HCG. A lot of times. Those are the go Twos for post finasteride zandro. Any risks for women
taking HCG on their ability to get pregnant or would risk generally.
Yeah, obviously, it'll make any pregnancy test positive. So that's a
ask that some women don't
know. So one could in theory, fake a pregnancy test by injecting,
HCG absolutely interested.
I have no motivation to do that. I was just curious. What about prolactin, you know, the simple version of this that I was taught because I was taught, mainly from the neuroendocrine perspective was, you know, dopamine is a kind of close cousin of testosterone and also estrogen for that matter. Drives appetitive behaviors including pursuit of
Your partner sex itself. Motivated behaviors. Generally, then post copulatory post orgasmic states are accompanied by a prolactin increase. That's the refractory period for mating in males and maybe even in females as well. Involved in milk letdown, etcetera. What are sort of the the general Contours of syndromes or things that people could be on the lookout for of having too much prolactin or too little prolactin. And I'm aware of a number of people who take
Dopamine agonists, l-tyrosine cabergoline, things like that, to really boost their dopamine levels and that isn't always a good thing. As it turns out, oftentimes people become kind of hyper dopaminergic. And so they have the drive to do all these appetitive things, you know, fill in the blanks, but they don't always have the ability because it seems just as testosterone and estrogen need to be in the proper ratios. Dopamine, and prolactin need to be in the appropriate ratios. What, what, what, how should we think about and perhaps act on our prolactin?
Systems.
Absolutely. The way I describe it is the dopamine wave pool. So, if you're increasing your dopamine too much, you're going to overflow and then you're going to have that wave crashed too much. So you want to have nice even waves that are not going too far above the pool of dopamine and prolactin will follow. So prolactin, an estrogen are quite close cousins, estrogen up, regulates a gene called the PRL gene or proact in gene that directly increases prolactin synthesis.
So prolactin is going to also inhibit the release of testosterone from the pituitary. So if you're using a dopamine Agonist, then you're going to help decrease the prolactin producing cells. Including if you have a prolactin producing micro adenoma in the pituitary,
how common are those? Because, I mean, I hear a lot about these, you know, hypogonadism or and of course that can be due to an issue at the testicles or I organized.
I could also be of course in like ovarian syndromes and then there's of course, the brain side of it where the signals aren't coming from the brain. You're not enough gonadotropin, not enough luteinizing hormone, and their ways of teasing this apart through with an endocrinologist that are quite elegant. In fact, write using stimulating hormones, too much to dive into here, but how often does one actually have one of these pituitary? Tumors. I have heard that people that play a lot of high contact Sports. So boxing football people that head
Headed. The soccer ball quite a lot. Sadly people whose jobs forced them to take head blows for you know, could be military. And so they were firing, you know, 50 caliber guns and the kind of woodpecker ring of the brain inside of the skull and construction workers or just a concussion can cause the pituitary to go Mal functional. Is that really common or is this something that, you know, is a rare like
1%? Yeah. It's extremely common. It's another one of those conditions.
A lot of people never know, they have it. They just feel a little bit more fatigued. They have that high prolactin feeling all the time. But to eteri, microadenomas can be non-producing as well. So your prolactin can be totally normal your growth hormone and igf-1 can be totally normal. That's the second most common producing microadenomas growth hormone causing either acromegaly, which is growth of cartilage or
gigantism. This is the the big brow. Yeah.
So those are fairly common causes of adenoma as but a
Of people that have a very small adenoma, you know, much less than one centimeter. It's hard to see on Imaging even if you have a contrast that specifically looks at the pituitary and many people aren't symptomatic. So it's one of those things along with PCOS and pre-diabetes that are much more frequent when it comes to prevalence, which is the amount that percentage of people that have it in the general
population. I'm glad you mentioned the dopamine.
Wave pool. I know nowadays. There's a lot of interest in augmenting. Dopamine. I know a number of people who do this through prescription drugs, Adderall Ritalin, modafinil, and those drugs, of course, hit many transmitter systems, but dopamine is certainly involved, people taking antidepressants like Wellbutrin tap into that system and of course, people trying to inhibit prolactin and promote serotonin or reduced serotonin to me. It all seems like a very delicate dance, right? I mean, to just imagine the
Arousal Ark of for mating behavior for sexual reproduction is such an in an elaborate dance between sympathetic drive and parasympathetic Drive, even with across the span of minutes. Right? I mean I've talked about this before in the podcast that the arousal is kind of more parasympathetic orgasm and itself is as a sympathetic response, a completely different set of neurons. And so where do you see people getting into trouble? Just trying to hit the gas pedal on dopamine and where do you think there is a place for?
People who perhaps are experiencing low drive and motivation. Not just sexual, but in general, to increase the amount of dopamine circulating in their brain and body. How do you how do you think about that? Given this wave? Pool analogy?
Yeah. So it's important to parse it out and start with the least powerful interventions. So someone's concerned about dopamine or maybe they have a slightly higher prolactin then they eliminate things that could be increasing that prolactin. So casein or glue.
Cotton, which arm you opioid receptor? Agonists or any mu opioid receptor Agonist in the
gut casein. So, milk protein correct can increase prolactin,
correct. Interesting. In addition to that. They should if they need a pituitary MRI and they should get up to a Terry MRI if they don't have an adenoma, or if they don't have a high enough prolactin level to where they need an MRI, if they're having visual symptoms, or if they're having olfactory symptoms with the nose, then it's more likely that they do that they do.
But if they don't a lot of times a prolactin under about 40 is not too big of a deal. They can take dopamine Agonist that. Agonize that D2 receptor like P 5 P, which is essentially vitamin B6. It's puradox seen, five, pyrophosphate and pyridoxamine is vitamin B6, so that can help 50 milligrams once to twice a day. Vitamin E, can also help especially if it's mixed tocopherols. A lot of people have the high levels of
Vitamin E but low levels of the gamma form of vitamin E so that can also
help fastening. I'm so glad you mentioned vitamin B6 and P 5 P. I have heard that one can shorten the refractory period after after orgasm to essentially, to be able to have sex again, to be quite direct About It. By by way, of vitamin B6, blunting of the prolactin response, with turns out to be quite potent, but I've also heard that
That vitamin B6 can be neurotoxic, especially in the, in the periphery that it can cause peripheral neuropathies if it's taken high doses. But that P 5 p is the safer form. Is that true?
It's pre-activated. So it does not build up think of it as an allegory, to how folate can build up, its not methylfolate, but it builds up and it can increase levels of homocysteine or if you have too much vitamin B12. Another water-soluble b-vitamin, you can have too much.
The malonic acid or MMA. So depending on what your enzymatic conversion is to the active form of the enzyme often. It's just safer to take the active form of the enzyme
are very interesting. Okay. Well, at risk of going down every hormonal pathway and talking about supplementation lifestyle factors. I think touching on test as we have testosterone and estrogen. And now prolactin. I'd love to chat a little bit about L-Carnitine. We talked about this earlier, and, but I want to raise this discussion about
L-Carnitine not in the context of while, carnitine itself, but in the context of fertility because my read of the literature is that L-Carnitine can be very beneficial for enhancing sperm quality, and egg quality. And even rates of conception. What forms does L-Carnitine come in? That people can reasonably consider again, talk to your doctor folks. What is it doing? And do we know how it's doing it? And do you often use this in your
patients?
Yeah, so the way I think about L-Carnitine and I'll try to tie this in with creatine and other things as well, is if your cell is an energy Factory or a car, then L carnitine is the shuttle that helps keep get the fuel into the motor to use the motor. The motor is mostly due to Lifestyle factors. So like, you know, your diet and your exercise and the type of fuel itself is NAD. Plus we don't need to get into NAD precursors or
Banner and are anything and then the accessory fuel tank, is your creatine phosphate? So creatine is your accessory fuel tank, your NAD status, which is largely determined by your REM sleep, and quality sleep and exercise. Along with supplementation is to fuel. The carnitine shuttle, is carnitine Palm until coenzyme, a, and that takes medium chain fatty acids. It takes different molecules of fat. You have two main energy sources, other than ketones, you have your glucose or carbs. If your
Fat or fatty acids, and that takes it across the layer of the mitochondria so that it can be utilized. So up regulates that. That's why things that have flagella in general. The flagella are going to work better
like sperm flagella, being anything, sort of the wavy little tendrils on cell types which way they're everywhere, right? In the gut to, right?
Yeah. So those are going to work significantly better and in general your Mata kondo are going to work better. So they'll wash your mitochondria are off the bat the better they're going.
You be helped by the shuttle that shuttles them across. They it also slightly increases the density of the Androgen receptor as
well as at a local effect. So, if the current is injected into a particular muscle, will it increase the density of Androgen receptors in that muscle likely? So so how are people taking L-Carnitine their capsule forms and their injectable forms. Most people are going to be taking the capsule forms because that's all they're going to have access to. And then we also asked, can you get L carnitine from food?
Yeah, so, L carnitine.
18 is just a combination of, it's actually a very small peptide. So glutathione is just three amino acids. L-Carnitine is the smallest peptide to. So peptide is just a protein that has amino acids between 2 and about 200 and L-Carnitine is just two amino acid, amazing. So,
it's like a micro
peptide. Yeah. So, your body synthesizes enough, it likes to absorb the amino acids by themselves. And then if it puts them together, they're makes L-Carnitine. It's not very
Available. If you take it, a lot of people take L-Carnitine L tartrate or a soul L carnitine and that's about 10% bioavailable. So if you want one gram or 1,000, milligrams of L-Carnitine, you can take 10 grams of oral
L-Carnitine is it is the one G. The typical dose you recommend one gram per day
for fertility and androgen receptor up
regulation. So that means taking 10 grams of the capsule
form. Yeah, so it's about 15 to 20
capsules and which is a lot that is a lot.
You could also potentially increase
tmao. Yeah, I want to ask about that because tmao on your blood chart is, you know, that's when that's elevated. That's going to cause some concern. You taught me a trick. However, that one can take 600 milligrams of garlic capsule for the Alison. Has always gone Alison, isn't it? It's like the name, Allison. But with two L's, yeah, okay, and that had a remarkable effect in reducing tmao. So that's quite potent. Also, rude. And they was
Um, just coincidence that it really brought my LDL down as
well. I'm not sure if the LDL is a coincidence, but depending on your gut microbiome or your micro biota some microbiome, beneficial bacteria will convert carnitine and also choline. So any choline precursor like Alpha GPC or phosphatidyl serine, they will convert them more or less the tmao. So tmao is something that you can get measured in.
A blood test and see if it's high or low. Some people might not even need Allison. And some people do benefit from it.
Interesting. Although I think it, I think it was you that also told me that that Allison and garlic can have positive effects on cardiovascular tone and blood flow generally. Is that right? Yeah. Okay, so maybe so is 600 mg garlic in excess of excessive amount of can I just eat? Garlic? You guys see? I mean, I like eating Garlic. Yeah, so, okay. So one could also just eat garlic if one were going to take L-Carnitine.
Injectable form. How much of that is
bioavailable 100%. If you inject it. It is in an aqueous solution. So it's a bacteriostatic water essentially. So it's not in a carrier oil. So it's really it's going to burn a lot if you injected subcutaneously, so, it's going to be absorbed faster and more evenly and also, just hurt a lot less if you inject it into a
muscle, but one could then just take 1 1 gram per day injected or divided up into
A couple
doses or 500, the minimally efficacious dose for, injectibles probably around 200 when it comes to sperm motility to Androgen receptor upregulation. So it really depends on why you're taking
it in terms of fertility and in terms of blood tests, generally, you know, I always say that if possible either by way of insurance, or by way of some other way, affording it it would be great for people to have blood tests to know what
Hormone levels and other levels of other things like metabolic markers and lipids were in their 20s. Also in their 30s, also in their 40s. I think there's this idea that you only take a blood test when you have a problem, but then, of course you one can't actually do the comparison that you mentioned earlier or state the comparison to one's position that things are changing over time and it it seems to me that basically everyone should get at least a once-a-year blood test. Is there, the hope that insurance will someday just cover it for everybody this will
Be standard care, I would think that everybody should know what sorts of things are floating around in the bloodstream, and what they need more of, unless of, in life.
I doubt it will ever be covered by Insurance in many cases. You can make an argument that it's indicated as insurance begins to cover more of the population for pathologies. The things like fsa's or hsas, or Care. Credit will likely cover this Advanced testing, which become it's continues to come down and
Down in price, so it'll be affordable, but it won't be free. Got it.
I'd like to shift gears slightly and and talk about social interactions and relational effects on hormones. Something. I just find fascinating, we touched on this a little bit earlier with in terms of oral contraception, but now that we have the backdrop of, what these various hormones, do some involvement of neurotransmitter systems, like dopamine and prolactin Associated Pathways prolactin course, being a hormone on it, neurotransmitter, but
You know, there's a phenomenon in human beings, where people get very excited about a new partner and that excitement. No doubt is related to the dopamine system among other systems and that excitement can be maintained or can Wayne overtime and here I'm talking about attraction, but I'm also talking about just general excitement in the sense of novelty because that's what dopamine's associated with given that you know, Europe you work with human beings and they have life's lives and relationships in life.
Cells and they have hormones and all these things interact. What are some of the ways that we could think about adjusting our relationships in order to optimize hormones as opposed to just thinking about how to optimize hormones for sake of our relationship? Because it's bi-directional of course. And this assumes, I should say that one is already paying attention to. The six pillars talked about earlier is doing that. People are doing most things, right. How should we think about?
And chips and hormones, friendships, romantic relationships, new partners, long-term Partners. You know, how do you think about this kind of stuff?
Yeah. So if you have a new partner, then it is largely regulated by the dopaminergic system, which changes over time. So people may have heard the saying that you have to go through a full calendar year with someone that you're in a relationship. So, that you very good advice. By the look at, you really know what to do and what not to do, but
As they, you know, you experienced both of your families in the holidays and all the different situations, but I would argue until you have moved in together. Had a baby and then a raise that baby. Preferably breastfeeding because that's when you get the prolactin spikes, you don't, you don't really gone through every stage in life yet. Now, you can't really do that with every person that you're considering. Well, some
people do, but it can be quite costly in terms of time and finances and emotionally costly. And then here, I'm definitely not referring to
Or any personal experience of having done all that many times over. But what would you suggest people do or think about as they enter relationship or if for people that are in long-term relationships where they feel like something has shifted? And indeed those shifts May reflect the output of different hormone systems and neurotransmitter systems. They almost certainly has to be the
case, right? Yeah. So, just like women who spend a lot of time together whether their co-workers, or whatever, A lot of times,
Bench, menstrual cycles will align. There is a lot of pheromonal and hormonal crosstalk, including prolactin, between men and women. So spending 100% of the time together. This is why people think it's so hard to work together and live together. They're around each other 24/7. You don't have the reprieve where you let that dopamine settle down and then you're excited. When you see them again, a lot of guys know that if they've gone on a hunting trip, or if they go on a trip for a long time, they come back.
Back and they see their partner and it's like a new roof, not quite like a new relationship, but almost like a new relationship. They have that excitement again and purposely building that into every relationship can help significantly, especially if you choose to have a child or get pregnant or breastfeeding because you just plan ahead for both of your parole octants to be high and both of your dopamines to be low and both of your testosterones to be low. So there's a there's a lot of planning that you can
Essentially every relationship goes through a crisis and that crisis is personal between the two of you and you can plan ahead and figure out a way, maybe it's not supplementation. Maybe it's not even. The amount of time you spend away from each other, but plan ahead to have good times. If you know, you're about to go into a crisis,
got it. And so it sounds like time apart and time together, which is a
Ashley built into a number of cultures where men and women will purposefully avoid each other for some period of time, avoid physical touch, and maybe in proximity, and then we'll reconvene. And yet those are very stable relationships over time. Often is the inverse also true. For instance, for people that are in long-distance relationships where they're only seeing each other three or four days a week or two days a week. Does this explain the fact that some of those relationships can go on for a very long period of time without ever actually entering the
Let's call it the hyper prolactin phase of actually moving in together and etc. Etc. Like, in other words, is that a way in which people are spiking and troughing dopamine that keeps them attached? This kind of elusive, this sort of what is it called? I think it's called like a cat string. Like if you play with a cat and you move the string away, they'll keep reaching but you throw the string on the ground there. Like they're totally uninterested in it. Is that is that what's going on? Because that's a dopaminergic phenomenon. The cat string example, we know this experimental
Really.
In those cases. The relationship hasn't really progressed in. Many of those cases past the dopamine Spike, the fun initial stage, honeymoon stage, whatever you want to call it. So it's almost kind of like a roommate. If you're looking for a roommate, if it was for college or after college or whatever, you know, you can fill out forms and look for common interest. But until you're actually together a significant proportion of the time, you're not really going to know if you're going to be compatible or
not and is there.
Evidence that the appearance of an infant changes, obviously they're going to be hormonal shifts. We know, actually it that for in both women and in men, there's a prolactin increase when one when couples are expecting a child. This is the it's almost like a brooding phenomenon. You see this in birds or it's called actually cause called brooding and it's caused by prolactin increase. But turns out this also occurs in humans. And some people would argue this causes the dad.
Bought phenomenon because it actually prolactin involved in laying down a body fat preparing for sleepless nights and presumably that spike in prolactin. Is there also to suppress sexual activity because there are periods of time immediately near childbirth where sexual activity is not
advantageous. Yeah, you see, a prolactin Spike right after breastfeeding. So, if you think about it often, when you have an infant, you'll breastfeed put the infant to bed, and then immediately go to bed with your partner, which is not
Particularly conducive, it's almost like trying to have intercourse back-to-back and it's very
difficult because of the, in the prolactin sense. Yeah. Low
dopamine, High prolactin. Oxytocin is also increased significantly to help with milk lied down as well. So yeah, as far as brooding there's definitely a human equivalent of brooding, Some Humans, call it nesting instinct, which is both helpful, but it's a it's not necessarily a bad.
Bad change in a relationship. It's just a change and as long as you know that it's coming, you're going to do better with it. Just like any medication. If you are aware of the side effect and then it might happen, then when it happens, it's not only less severe. It also happens less often very interesting tell the
patient. Well, as a neuroscientist, you know, I come from the framework that, you know, of course, hormones impact perception and behavior, but perception, and behavior also impact hormones. I find this fascinating
Saying, I also really like the example you gave of people taking time apart. But also these affiliative bonds that are non romantic bonds can serve, as kind of a reservoir to replenish dopamine. That is then released upon experience. Going back to one's partner or some sort of regular feature of home, very interesting. And of course, it should exist on both sides. I'm guessing that from both the male side and female side. There's an interest in kind of separation and reunions as
As the theme and I guess, the frequency will vary for different. Different couples in different situations.
Yeah, and I don't want to make it seem like prolactin is all bad. So prolactin does help with the nesting Instinct. It helps with breastfeeding as well. A lot of women are diagnosed with luteal phase defects, which is basically the phase after ovulation, but before a period or giving birth a pregnancy is kind of a prolonged luteal phase and a lot of them will go on progesterone for this progesterone. Can also decrease prolactin.
And prolactin is also helpful for them maturity of lungs and infant. So it helps the sphingomyelin to lecherous and ratio. So it can decrease, if your, if your prolactin is too low through pregnancy at spikes, a very high during pregnancy. Then it can lead to increased risk of respiratory distress of the newborn
really interesting. Yeah. So we did we certainly don't want to paint a picture where prolactin is the bad bad hormone to avoid its without prolactin. None of us would be here. Of course. It's so vital.
I realize that earlier, I raised the question about whether or not cold exposure could modify hormone output in particular, whether or not ice baths or ice applied to specific tissues of the body, as people are doing one way or the other can change testosterone levels estrogen levels. In other words, to taking ice bath, and cold, showers increase testosterone and, or estrogen.
Yeah. So take a nice bath or a cold shower or cold exposure. In general. It's not going to correct.
Then D deficiency or a metabolic syndrome. So there's a lot of things that it will not correct that are causes of hypogonadism or lothar low testosterone, but it will help acutely specifically the application of cold to testes that are too warm. So if you have a varicocele or if you have a little bit of a primary hypogonadism, which is where testosterone is not released by the testes, but your LH and FSH signals are sufficiently
Hi, then you'll likely respond to cold exposure better. And there's actually under garments that are designed specifically to help with fertility. And there's probably going to be more and more of that in the future. You just need to be careful. Not to get frostbite because it's a particularly bad spot to get frostbite noted.
Could you define varicocele? You mentioned a few times? Is that's a varicose vein.
Yeah, so it's essentially a varicose vein. It brings warm blood.
And the venous flow or the flow back to the heart is not as good. Just like in the legs it can happen in the scrotum. Usually about 20 to 25 percent of people have one greater varicocele. There's grades, 1 through 4 1, through 5, and most people just have a very mild one, usually, on the left side because the blood has to go through further to get back to the heart. And it raises the temperature of the testes. Temperature is the enemy of testy. So they like to be 5 to 10 degrees cooler than the rest of the body.
And
so our sauna is particularly bad for sperm production.
They can be.
When you say can be a man. How long could one safely be in the sauna? A would you want to go back and forth between the cold and sauna? Is there any, are there any data?
If someone is having infertility, then I tell them to avoid all saunas empirically if someone has if they're not infertile, but they have a low sperm count. I also tell them to avoid
However, it's mostly warmed water that can raise the temperature of the testes faster than the sauna. So hot sauces and things of that sort. Yeah, so hot tub and a Jacuzzi, those are enemies number one, and number two of sperm.
What about ice baths and cold showers for women, any evidence that it can shift hormone output in
women? Yeah, it can, it increases the activity of the beta adrenergic receptors.
Even in the central nervous system and the astrocytes as well. So it can do a few things. It can slightly decrease the drive for food which astrocytes and beta adrenergic receptors, have some medications that are weight loss. Medicines also do similar things, but it can be beneficial in women
do but no evidence that it changes estrogen output in women, correct. Now that I know of me either
Peptides lot of discussion these days about peptides peptides, of course, just being strings of amino acids. As you mentioned, very strong, small ones like to two amino acids, like L-Carnitine all the way up to polypeptides, which has been many, many, many amino acids. There are so many peptides that there's, we should probably just do an entire episode about peptides, but I think one of the reasons I'm hearing so much about peptides these days is that they are not called steroids, you know, the name steroids I think has been as
Come to be associated with anabolic steroids in the context of, you know, acne testosterone, rage Etc. But of course testosterone, excuse me, estrogen is a steroid hormone, right? There are other steroid hormones. As we both know, but peptides are gaining increasing popularity. I'm willing to go on record saying that. You can be sure that many of the incredible Transformations that you see in Hollywood are the consequence of peptide use. And I'd put my My Name Behind
And that because I'm well aware of people that use these to prepare for roles, but athletes use them and then everyday people are using them. To, for instance, sir. Moral intestine, Morlin type immoral and to stimulate the release of growth hormone rather than taking growth hormone bpc 157, which is a essentially a synthetic gastric juice that normally repairs, the gut, the being used to treat injuries and there are other ones as well. What can we say generally about peptides?
Are they safe? Are they not safe? What about sourcing? And are there any peptides that you think could be of particular use for people? And we should probably also touch on peptides that people shouldn't go anywhere near with a 10-foot pole.
Yeah, definitely. So peptides are very heterogenous. There's very dangerous ones and a very safe ones. My favorite peptide is the original peptide, which is insulin. So insulin is a peptide and you know, less than a hundred years ago.
There is a scientist studying insulin. And at some point they saw that an animal had its diabetes cured by insulin inject cured by insulin injection, less than a year later. They were injecting insulin into every type 1 diabetic because it was saving their
lives and yet insulin can kill you, if you take it at the end. Correct
dose. Yeah, so, just like insulin should be prescribed by a doctor. There is over-the-counter insulin rely on her NPH, but I do.
Your insulin is prescribed by your doctor for your diabetes, as its life-saving peptide, should be prescribed by doctors as well. And there are several that are FDA approved. So you mentioned a lot of different ones. Let's start with Tessa Morlin. So testimonial and was recently FDA-approved for something called lipodystrophy. It happens where body fat is displaced into abnormal areas. Often as part of AIDS or severe burns, things like that and
It helps redistribute this body fat and give people their quality of life. Back. Tessa Morlan is AG H RH, which I kind of loop into the category of GH R PS. So growth hormone releasing peptides. So it's only a couple amino acids, different from endogenous sleep, reduced growth hormone, releasing hormone. So, growth hormone itself is also a peptide. It's a peptide hormone, not a steroid hormone. So you have different
Oaths, which are very similar to growth hormone. Another fun fact, is that hpl? Which is human placental oxygen? We love acronyms. Right? Human placental. Acted. Jin is nearly identical to growth hormone.
The growth hormone in pregnancy is not what causes the sugar Spike and gestational diabetes. It's the human placental octogenarian. So if you look at Twin pregnancies, if they have to placentas or more placental tissue, making more human placental Activision, the risk of gestational diabetes is exponentially higher. So this hpl is only a couple molecules different from growth hormone. It is interesting that
He's different GH. R HS in ghr. Peas actually have pretty different mechanisms of action. Ghrelin is also a hormone that's released when you're hungry. This is probably one of the reasons why you have more growth hormone release overnight. And there's a lot of peptides that are very similar to ghrelin. So these peptides are not bio identical peptides, but they just have a couple different amino acids change. So they're almost identical and they're probably going to be used in the future for growth.
Mo deficiencies, including and kids, they've been
studied. So if somebody wants to increase their growth from worn-out, put in addition to not eating within two hours of sleep, getting good, deep sleep doing all the other things of in the six pillars that you mentioned earlier, especially resistance exercise at some point earlier in the day. What are the risks and benefits of taking a growth hormone releasing hormone peptide like, sir, Morlan? Prescribed by a doctor, of course.
What should one be concerned about how long could one take these? I've even heard that they can modify gene expression, so that they really are changing your hypothalamus in very long lasting
ways. Yeah, there's definitely a lot of risk tumor growth and cancer. So you look at a type 1 diabetic. They have very high incidences of various types of cancer. They have very high growth hormone, but low igf-1 paradoxically.
So they would likely give you a similar cancer risk to a type 1 diabetic that has very high growth hormone. However, there are the benefits of it. You think of lipolysis decreased body fat, increased lean body mass. A lot of those can you can use other things to get those benefits? So then, you know, you don't need growth hormone for those benefits that just leaves cosmetic benefit to which you
Usually use topicals to get, you know, your hair and your skin and your nails. There's a lot of other things that you can do other than growth hormone. So a lot of people just don't need these GH R PS, if they're they don't have lipodystrophy or if they don't have growth hormone deficiency. There is other uses of them specifically in injuries. So I know that they've been studied. I'm not sure if it's in the military, we mentioned the Woodpecker or the coup contrecoup injury, so that he'll
be sitting back and forth. The brain busy.
A slamming up against it on the skull. So they all football, heading the ball in soccer. Definitely people who use the 50 caliber and Military. Oh, that's a fairly small population. And I think anyone that's hit their head hard more than
once. Yeah, we can talk about bpc 1574 a bit ghk. Copper peptide for a bit TV, 500 or a thymus in beta for analog. And then, we can also talk about brim Alano tide, which is
Note and three. They have Planet n 1 and 2 and then they also have Lana 10, 3 and
4. Now, let's talk about bpc 157 and melanotan because I think those are the ones that most people are eyeing, so to speak.
So, bpc. 157 is body, protective, compound 157. It's identical or bioidentical to gastric protective, compound 157 that's produced in the stomach. So as you age, you get atrophic gastritis,
Itís very often. That's why you have less intrinsic factor, which is kind of another peptide that binds to vitamin B12. That's why you can get age-related B12 deficiencies. So that's one reason why you have more colitis more diverticulitis as you age. You don't have that gastric protective compound. It's it increases vegf vascular endothelial growth factor, which basically makes your blood vessels grow more. So that's what causes your body to form a blood vessel.
So another medication known as avastin, it's on the who s list of essential medications for cancer. So many different types of cancer including colon cancer, you treat it with avastin, which is a vegf inhibitor. So, if you have cancer or a high cancer risk, you probably don't want to be taking a medication. That's the exact opposite mechanism of action. As your essential anti-cancer
Med, in other words. If you have cancer, you're at risk of cancer. Avoid bpc 157,
correct?
A lot of people prescribed it for six weeks and bpc 157 sobre, Milano tide that is FDA approved for a hypoactive sexual disorder Tessa Morlin. That's also approved for lipodystrophy interestingly Melissa. Another one of the melanotan. This is also approved for lipodystrophy and also deficiency in the maletto quarter could receptor. So the receptor that receives the alpha melanocytes stimulating hormone. It's a very rare Condition. It's
Also approved for that because if you don't take it, then you get obesity. But bpc 157 is not FDA approved but it is essentially standard of care of this point. I would say it's, you know, if you're not counting insulin or growth hormone has peptides. It's one of the most commonly used peptides and anecdotally and in some clinical literature. It's fairly. Well, tolerated for short periods of time. I'm not in the camp that everybody needs to do it two to three times a week.
Or even daily for six weeks, no matter what the major benefit is, when you're going to take it early on because it's going to allow your body to increase, blood flow to the injured area, and the less blood flow has, for example, cartilage ligaments have horrible blood flow, especially as people age. It's going to make a significant difference. So I would wager that that Russian gymnast that Achilles heel than one month and completely from a full rupture was likely taking PPC 157 or something very similar.
Owner. I'm willing to wager on that as well, a remarkable recovery. And so because it is prescription. There are non prescription forms. My understanding of the non prescription forms, and the danger of going after. Non prescription forms. Is that often times, they will contain what they claim. They contain bpc 157 in this case, but they are not adequately cleaning out the LPS, the lipopolysaccharide, which can cause inflammation fact in the laboratory. We use LPS to deliberately induced fever and inflammation to
Systemic inflammation. So this is a warning to people if you're interested in peptides, you absolutely need to work with a physician. In my opinion, get it from a really good compounding pharmacy who will clean out that cleans out the LPS because if you're buying it through a source that you know, a lot of people I don't want to name sources, but they're these common sources on the internet that everyone knows about their buying these sources. They'll ship it to anyone essentially, but then the LPS is really causing inflammation and many people experience, a kind of mild fever or tingling from that.
That when they inject it and like, oh, I can feel it working. That's probably LPS action, which is not good for the brain. I don't know about the on other peripheral tissues, haven't heard of people dropping Dead from the stuff yet, but I certainly wouldn't want to be ingesting. Any LPS unnecessarily. So would you agree that you should work with a doctor after all? You are the
yeah, definitely talk to your doctor about this and talk to them about the dosing regimen as well. So if they have you doing it for six weeks, ask him. Why am I doing it for six weeks? Why not two weeks or why not?
As soon as I feel better, can I just stop it? Yeah, there's a lot of good questions like that that you should ask your doctor. And if somebody's trying to prescribe you a bunch of different things then see, is this what they prescribe, everybody, or is this individualized for me? There are peptides like ghk copper peptide, which is produced in dodging asleep, in the liver, more at younger ages. That's why the liver can regenerate Foley. Is this the ghk copper peptide helps and if your copper deficient, which not a whole lot of people are, but a lot of people that have had bariatric surgery are copper deficient.
Ghk copper peptide, can help significantly with your nervous system and it's also synergistic. So any growth agonists like thymosin beta for made and kids in the thymus which shrinks. That's another reason. Why kids heal really? Well that and ghk is somewhat synergistic with PPC, but if you don't need all three, you don't want them. And if you don't need it for more than a week, you don't want it for more than a
week. I really appreciate you saying that. I often say that it sometimes the best do something to take is 0. It's off.
The case that the best dosage is zero, you mentioned melanotan. There are several kinds of melanotan. I find it a little bit of a funny conversation because the I first learned about melanotan from reading about peptides and discovering that people were taking injecting Milan attempt to get tan because it's in the melanin synthesis pathway. They also discovered. This is an individual. This is reading about this, in various manuscripts and peer-reviewed papers that it could cause things like priapism. Like like
Action that might be the last one that anyone would ever have because of damage to the to the vasculature, to also women taking melanotan as a way to get tan and lose body fat. So this sounds all very recreational. Are there any clinical usage of melanotan? So separate from the kind of extreme biohacking cosmetic World, which is really not the main focus of this podcast ever more in terms of, you know, Health pursuing Health
optimization. Yeah, there's actually
33 FDA-approved indications, believe it or not, many people know about this, but there's three well-accepted indications. One of them is the hypoactive, sexual disorder, and More in women, that's for brim Alano tide. So those are
those are women that have essentially no libido whatsoever. But other hormones are seeing, are in
check classically, it's before menopause. So those hormonal issues are not contributing. And when you give them this peptide, it's also known as
He won 4-1 at help significantly. A lot of times you use it in nasal spray. It goes straight into the central nervous system and X Central. You can also inject it. And you can also take it via a
trochee men and women ticket,
correct. It's approved for women, but it can also help men and it's relatively safe. The only relative contraindication that I tell people. And a lot of people say, oh, there's no side effects that I know of, but if you have a family history of melanoma, or potentially, have a melanoma and don't know about it. That's why I'm a big
Advocate of damask appear as well and regular skin checks, then theoretically, it's going to increase that Alpha melanocytes stimulating hormone and it can grow that. So that's definitely not a good thing. So be very careful about long-term administration of it. It's also approved for lipodystrophy, which is the same exact thing as Tess immoral. And, which I believe is also known as Vista or a grifter. And then it's also approved for the rare genetic condition. Where your
Scepters or your melano sites, don't proliferate as well. So usually have hypopigmentation. It's not, true albinism, but it's associated with morbid morbid obesity. And very bet poor outcomes from that in childhood. So it's used in kids. Actually, interesting.
Well, peptides are a fascinating landscape. But thank you for that deep dive into. Several of them. We will probably return to you to talk about peptides again in the near future because I know there's a lot more there.
A lot of interest. I want to talk about the sixth pillar. All right, so just to remind people, you said diet exercise, where appropriate caloric restriction, managing stress, sleep and sunlight are critical for everyone at all, ages to manage and optimize Hormone Health. Then you have the six category, which is a really intriguing one, which is Spirit, which is it kind of unusual thing to hear coming from a medical doctor except that I have many colleagues and
Indeed. Our former director of the National Institutes of Health. Francis. Collins has talked about this notion of spirit. We talked about belief effects on this podcast. Before with Ali crumb, how one's understanding of the things that they do and their world. In general, really creates an important effect on everything at the level of physiology, not just psychology. So as a physician, how do you conceptualize the spiritual aspect? And how do you talk to patients about this given that people walking into your clinic?
Presumably have a bunch of different religious and not a religious backgrounds. I'm sure some are atheists, some are probably strong Believers. How do you deal with that? And how should people think about this?
Yeah, I believe it's it is surprisingly. Well received, you wouldn't think at first glance that a patient really wants to talk about their spiritual health with their doctor, but the way I think about it and the way that it really is is it's like a Venn diagram and you have a body and a mind and a soul and you can't have one healthy without the
Healthy. Even if your mental health is phenomenal. And even if your physical health is phenomenal, the mental aspect of spirituality, if that piece is not there, then that's going to affect your body physiologically as well. And Ali crumbs done some excellent work. There's also been a lot of other studies regarding prayer and I'm a Christian. I believe in God and that gives me a lot of that resilience and motivation. It gives me the Cornerstone or the groundwork how I can.
Interact with life and regardless of someone's an atheist or regardless of regardless of what someone believes as far as religion or the origin of the species. They can know that their spirituality is going to have a profound effect on their mental and physical health as well. People like to compartmentalize it. So they like to talk to their doctor only about the physical health because it's comfortable to do that. They only talked to their Pastor, or a mom or, you know, Reiki healer.
For their spiritual health and they just talk to their therapist or psychiatrist about their mental health, but you need to bring all three of those things together. It's well-known that interdisciplinary clinics lead to improved patient outcomes and that's just disciplines within medicine. So that's just doctors that are specializing in this or this. So this takes a step back and upper in the upper part of that tree before you reach those dichotomies or the split offs. You have your feet. You have your body and your mind and your soul. So
your spiritual health and your mental health and your physical health.
So if you're in line and all three of those things that builds the Cornerstone for the rest of your health and the rest of your life, so if
someone comes into your clinic, and they say they're feeling one way in their body. They're feeling one way. In their emotional life. You run their charts, you get their blood work and they're an atheist or agnostic. What are some of the sixth pillar practices that they can consider that are in keeping with their?
R atheism or agnosticism because I have to assume that people who are in participate or feel that they belong to you. No particular religious sect will have particulars prescriptives from those religious sects, that will direct them towards particular types of prayer. But how would somebody who doesn't have a prescriptive coming to them from some other source? What would they, what could they do or would they do?
Yeah, so I certainly don't for sprayer on anybody or anything like that, but it's my belief.
If that being especially being an agnostic, it's almost the hardest thing because if you're an atheist, then you have some groundwork and you have some spirituality, even if it has to do with the human Spirits, interaction with the environment, things, that can't be physically explained. Well, phenomenon. Like the work that Ali Chrome does, but if you're agnostic, you're still trying to find that. So, I hope that everybody does find what they truly believe in as far as their own spirituality.
Leti. But yeah, that that's a personal Journey from a physician standpoint. And even if I'm friends with him as well, from a friend standpoint, I don't like to push anybody in any specific Direction. So, I don't think that everybody should believe what I believe, and I don't feel like there should be any pressure for them to believe something different. So I think that there can be excellent. Physician-patient Rapport, regardless of what of what we believe and what our backgrounds
are.
Yeah, that's wonderful to hear. I can say, without revealing any names that I have close colleagues that in every bin of this spectrum, like hardcore atheists hardcore religious in different domains, a different religions. I don't know. I don't know if I know many I'm agnostic as to whether or not. I know any agnostics. I should say. I it's not something that people commonly discussed, but in the context of science and medicine, but it's starting to happen, more and more, and certainly this issue.
Of spirituality is one of the areas in which Neuroscience is asking a lot of questions, like what spiritual experiences really are in terms of how they're grounded in the brain or not grounded in the brain. I think it's a really interesting area for Discovery and I appreciate that you that you bring it up and you bring it up in the in the non pressured. Way that you do. I think that a lot it will stimulate a lot of thinking which is ultimately the goal of this podcast.
Well, I have one final question that I a listener insisted I ask and it's a very straightforward one. It's not at all a curveball and not at all related to what we were just talking about. But it was the most common question when I told people that I was gonna be talking to you, which is
Is caffeine problematic. For hormones is amazing. I received hundreds of the same question about caffeine. And since it's probably the most commonly used drug on the planet.
I know it's taking us back into the very practical. But in enclosing, we're not quite there yet. But in closing is caffeine having a, in effect, one way, or the other on testosterone estrogen or other hormones. That is positive negative or neutral.
Only, if it affects your sleep, so works on adenosine and it can actually slightly improve allergies as well, but negligible effects, otherwise,
great. Well, sorry to end on such a practical, brass tacks type of
Type of question but I did promise the listeners that I would I would ask that question. Listen, I want it sincerely. Thank you. We covered it. Basically an Endocrinology textbook and neuroendocrinology text books worth of information, a ton of practical tips in there. Where can people find out more about you. We will certainly provide links and I guess the other question is, are you taking patients? I'm sure you'll hear that in the various venues where people can contact you. But where are you active? In terms of public facing
work? I'm active on Instagram. Kyle, July.
At MD. I'm also active on the social medias of my brand new Clinic, which is Gillette Health. That's at Gillette Health on Instagram or Gillette. Health.com.
Great will provide links to those. And I should say that your the content you've been putting out on Instagram is terrific because you actually point to specific studies and you put things into actionable context, which is very meaningful for me. Kyle. Dr. Julie. I should say. Thanks so much for your time. I really appreciate it. I know the listeners will to thank you.
Pleasure. Thank you for joining me for my discussion about Hormone Health and optimization with dr. Kyle, Gillette as you just heard he is a treasure Trove of actionable. Clear information. And again, you can find him teaching more about hormones and other aspects of Health on Instagram at Kyle Gillette. That's Gillette with two T's and two L's, but no eat Kyle. Gillette MD on Instagram and Gillette Health on all other platforms and if you would like more information about his practice,
You can find that at Gillette health.com., If you're learning from, and, or enjoying this podcast, please subscribe to us on YouTube. That's a terrific, zero cost way to support the podcast. In addition, please subscribe to the podcast on Spotify and apple, and on Apple, you have the opportunity to leave us up to a five star review. If you have questions or comments about this, or any episode of The huberman Lab podcast, or if you'd like to suggest topics that you'd like us to cover, or guess that you would like me to talk to, please put that in the comment section on
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It's of the huberman Lab podcast. And again, we are hosting to Live Events. One in Seattle on, May 17th. Another, in Portland on May 18th that series is called the brain-body contract where I'll talk about science and science based tools. Some of which I have never talked about in a public forum before and there will be an open question and answer format for you to ask me your questions, and I will do my best to answer them in real time. Thank you. Once again for joining me for today's discussion with dr. Carl Gillette. And as always, thank you for your interest in science.
Yes.
