back to indexDr. Kyle Gillett: How to Optimize Your Hormones for Health & Vitality | Huberman Lab Podcast #67
link |
Welcome to the Huberman Lab Podcast,
link |
where we discuss science and science-based tools
link |
for everyday life.
link |
I'm Andrew Huberman,
link |
and I'm a professor of neurobiology and ophthalmology
link |
at Stanford School of Medicine.
link |
Today, my guest is Dr. Kyle Gillette.
link |
Dr. Gillette is dual board certified in family medicine
link |
and obesity medicine and practices out of a clinic
link |
in Kansas and via telemedicine.
link |
He provides full spectrum medicine,
link |
including hormone health, preventative medicine,
link |
obstetrics, which is the branch of medicine and surgery
link |
concerned with childbirth
link |
and the care of women giving birth, and pediatrics.
link |
I first learned about Dr. Gillette from a podcast
link |
of all things, and was immediately struck
link |
by the breadth and depth of his knowledge
link |
on all things hormones and hormone optimization.
link |
As you'll see very soon today,
link |
Dr. Gillette can teach you how to optimize your hormones
link |
using behavioral tools, nutrition, exercise-based tools,
link |
supplementation, and hormone therapies
link |
if those are appropriate for you.
link |
There are many professionals out there,
link |
including many medical doctors, of course,
link |
talking about hormone health.
link |
What really sets Dr. Gillette apart from the pack
link |
is his ability to understand how the different factors
link |
that I described before, nutrition, supplementation,
link |
exercise, and hormone therapies,
link |
how those interact with one another,
link |
and the safest and most rational ways
link |
to approach hormone optimization.
link |
During today's episode,
link |
you will learn how to optimize your hormones,
link |
not just testosterone and estrogen,
link |
but also prolactin and other hormone pathways
link |
that impact your mood, mental health, and physical health.
link |
Dr. Gillette is also an avid educator
link |
about hormones and other aspects of health.
link |
He does this on zero-cost-to-consumer platforms,
link |
such as Instagram and other social media.
link |
On Instagram, he is KyleJilletteMD.
link |
That's K-Y-L-E-G-I-L-L-E-T-T, no E at the end, MD.
link |
So KyleJilletteMD on Instagram,
link |
and he is Gillette Health on all other platforms,
link |
including LinkedIn, Twitter, YouTube, TikTok, and Facebook.
link |
If you go to his Instagram or his other social media,
link |
you will learn a lot about hormone health,
link |
about the latest science impacting obesity
link |
and metabolic health.
link |
He is a wealth of knowledge.
link |
And again, he's providing all that information
link |
at zero cost to you, the consumer.
link |
What you are soon to hear is a conversation
link |
between me and Dr. Gillette about all things hormones
link |
and hormone health and hormone optimization.
link |
We dive deep into mechanisms,
link |
but we are clear to establish what each word
link |
or set of concepts mean.
link |
So if you have no background in biology, or even if you do,
link |
I'm sure that you'll come away
link |
with a wealth of valuable knowledge.
link |
We also talk about specific protocols related, again,
link |
to lifestyle factors, nutrition, supplementation,
link |
and where appropriate, hormone replacement therapy.
link |
I know there's a lot of interest about these topics.
link |
Dr. Gillette is very thorough
link |
about addressing both male and female issues
link |
and addressing hormone health
link |
for people at all stages of life.
link |
I'm sure that you will come away from this episode
link |
with the same impression that I did,
link |
which is that Dr. Gillette
link |
is an extraordinarily clear communicator
link |
and that he has tremendous compassion for his patients
link |
and that he has a deep love of understanding biology
link |
and medicine in ways that can benefit you.
link |
I'm pleased to announce that I'm hosting two live events
link |
The first live event will take place in Seattle, Washington
link |
The second live event will take place in Portland, Oregon
link |
Both are part of a lecture series
link |
entitled The Brain-Body Contract,
link |
during which I will talk about science
link |
and science-based tools,
link |
many of which overlap with the topics covered
link |
on the Huberman Lab podcast,
link |
but most of which will not
link |
and will be completely new topics and tools
link |
never discussed publicly before.
link |
Both live events will also include
link |
a question and answer period
link |
during which you, the audience,
link |
can ask me questions directly
link |
about any aspect of science or science-based tools,
link |
and I will attempt to answer them.
link |
Tickets for the two events,
link |
again, Seattle on May 17th and Portland on May 18th,
link |
are both available at HubermanLab.com slash tour.
link |
Before we begin with today's episode,
link |
I want to emphasize that this podcast
link |
is separate from my teaching and research roles at Stanford.
link |
It is, however, part of my desire and effort
link |
to bring zero cost to consumer information about science
link |
and science-related tools to the general public.
link |
In keeping with that theme,
link |
I'd like to thank the sponsors of today's podcast.
link |
Our first sponsor is Thesis.
link |
Thesis makes nootropics.
link |
In fact, they make custom nootropics.
link |
Now, what is a nootropic?
link |
Technically, nootropic means smart drug.
link |
Frankly, I'm not a big fan of the word nootropics
link |
because what is smart?
link |
I mean, there's creativity, there's focus,
link |
there's task switching,
link |
different aspects of our brain and body
link |
engage different aspects of cognition,
link |
many of which we can call smart.
link |
There's emotional intelligence,
link |
there's analytic intelligence,
link |
there's logic, there's creativity.
link |
Thesis understands this and has designed custom nootropics
link |
designed to bring your body and brain
link |
into the specific state that you want.
link |
they have specific nootropics for creativity,
link |
other nootropics for focus,
link |
other nootropics for motivation and so on and so forth.
link |
In addition to that,
link |
each nootropic is custom designed for you.
link |
They use only the highest quality ingredients,
link |
things like alpha-GPC and phosphatidylserine,
link |
which I've talked about on this podcast before.
link |
They also use ingredients like ginkgo biloba,
link |
which many people use, like and benefit from.
link |
However, there are also people like me
link |
who can't take ginkgo biloba
link |
because it gives me terrible headaches.
link |
I learned that a long time ago
link |
and so I simply can't take any nootropic
link |
or any supplement for that matter
link |
that includes ginkgo biloba.
link |
I'm sure I'm not alone in the fact
link |
that some ingredients work for me and others do not.
link |
Thesis has solved this problem of individual variation
link |
by creating a brief quiz.
link |
So if you go online to takethesis.com slash Huberman
link |
and take a three minute quiz,
link |
and then Thesis will send you to four different formulas
link |
that match your specific preferences.
link |
Again, that's takethesis.com slash Huberman.
link |
And if you use the code Huberman,
link |
you'll get 10% off your first box of custom nootropics.
link |
Today's episode is also brought to us by Inside Tracker.
link |
Inside Tracker is a personalized nutrition platform
link |
that analyzes data from your blood and DNA
link |
to help you better understand your body
link |
and help you reach your health goals.
link |
I've long been a believer in getting regular blood work done
link |
for the simple reason that many of the factors
link |
that impact your immediate and long-term health
link |
can only be analyzed from a quality blood test.
link |
There are a lot of blood and DNA tests out there,
link |
but a major issue with many of them
link |
is that you get numbers back about levels of hormones,
link |
metabolic factors, lipids, et cetera,
link |
but you don't know what to do with that information.
link |
Inside Tracker has solved that problem
link |
by creating a personalized dashboard.
link |
So you take your blood and or your DNA test,
link |
you get the results back
link |
and where certain values might be too high
link |
or too low for your preference, you can click on that
link |
and it will direct you immediately to lifestyle factors,
link |
nutrition and supplementation, et cetera,
link |
that can help you bring those numbers back
link |
into the ranges that are ideal for you.
link |
So it not only gives you information
link |
about where your health stands,
link |
it gives you directives as to how to improve your health.
link |
If you'd like to try Inside Tracker,
link |
go to insidetracker.com slash Huberman
link |
to get 20% off any of Inside Tracker's plans.
link |
That's insidetracker.com slash Huberman to get 20% off.
link |
Today's episode is also brought to us by Roka.
link |
Roka makes eyeglasses and sunglasses
link |
that are the absolute highest quality.
link |
I spent a lifetime studying the visual system.
link |
I can tell you that your visual system
link |
is incredibly sophisticated.
link |
It allows you to do things like move
link |
from a shady area outside to a sunny area outside
link |
and to adjust your visual system
link |
so you don't even notice that transition.
link |
A lot of sunglasses and eyeglasses are not designed
link |
with those sorts of biological transitions in mind.
link |
Roka sunglasses and eyeglasses are different.
link |
Every one of their glasses is designed
link |
with the biology of the visual system in mind.
link |
First of all, they're incredibly lightweight
link |
so you don't even notice that they're on your face.
link |
Second of all, they were designed to be worn
link |
during activities like running and cycling, et cetera,
link |
and they won't slip off your face,
link |
even if you get sweaty, and they have a terrific aesthetic.
link |
So even though they were originally designed
link |
as active eyewear, they look great.
link |
So you can wear them out to dinner,
link |
to school, at work, et cetera.
link |
If you'd like to try Roka sunglasses or eyeglasses,
link |
you can go to Roka, that's R-O-K-A dot com,
link |
and enter the code Huberman to save 20% on your first order.
link |
Again, that's Roka, R-O-K-A dot com,
link |
and enter the code Huberman at checkout.
link |
And now for my discussion about hormone health
link |
and optimization with Dr. Kyle Gillette.
link |
Dr. Gillette, welcome.
link |
Thank you for having me.
link |
Well, I'm super excited to talk to you
link |
because I found out about you on a podcast
link |
and it immediately became clear
link |
that you are an encyclopedia of knowledge
link |
about hormone health for men and for women
link |
across the lifespan.
link |
So I have many, many questions,
link |
but before we dive into those questions,
link |
I'd love to just get a little bit of your background
link |
in terms of your medical training
link |
and what your particular orientation is
link |
toward treating your patients.
link |
And how do you think about this whole landscape
link |
that we call hormone health?
link |
What is a hormone?
link |
How do you envision people managing their hormones?
link |
If you could just kind of fill in a few of those blanks
link |
for us, I think a lot of people would appreciate it.
link |
So I'm dual board certified in family medicine
link |
and obesity medicine.
link |
I've kind of tailored my training
link |
in order to provide what I call a balanced approach
link |
to total health, which includes body, mind, and soul.
link |
I recently saw a podcast with Joe Rogan and Mr. Beast,
link |
and Joe asks, Mr. Beast,
link |
how do you become such an amazing YouTuber
link |
and have all these great clickbait videos?
link |
And how did you become good at it?
link |
And it turns out he just became obsessed
link |
when he was a teenager.
link |
And that's essentially how I've tailored my education
link |
I've become obsessed with optimal human performance,
link |
their body, their mind, and even their spirit.
link |
So I attended med school at the University of Kansas,
link |
which is one of the few med schools
link |
that still emphasizes full spectrum care.
link |
They emphasize exercise as medicine.
link |
They emphasize food as medicine,
link |
of which I was active in both of those interest groups.
link |
In residency, I was active in a lot
link |
of mindfulness curriculum,
link |
and then also things like walk with a doc,
link |
where you emphasize preventative medicine.
link |
That's something that we've kind of got away from,
link |
and that niche led me to hormone health.
link |
It didn't really start as hormone health,
link |
but it's a very important component of health in general
link |
that many people don't emphasize.
link |
Well, this idea of preventative medicine,
link |
I think is starting to really take hold
link |
in the general population,
link |
especially given the events of the last few years.
link |
People realize that they are showing up to health challenges
link |
at a bunch of different levels,
link |
and with some people feeling very robust,
link |
other people feeling back on their heels.
link |
When someone comes to you as a patient,
link |
what are some of the first things
link |
that you want to know about them?
link |
I mean, obviously you want to know their blood pressure,
link |
you want to know something about their mental health
link |
and family history,
link |
but in terms of hormone health,
link |
what are the sorts of probe questions that you ask,
link |
and what are you looking for?
link |
And I ask this because I'd like people to be able
link |
to ask some of these very same questions for themselves.
link |
So when you do a physical exam and a history,
link |
you have a lot of different parts.
link |
You have your history of present illness,
link |
if they have a complaint.
link |
Maybe the patient doesn't have a complaint.
link |
In that case, things like their social history
link |
and their family history are extremely important
link |
because that gives you an insight into their genetics
link |
and an insight into their hormone health.
link |
So patients will tell me, oh, I'm doing okay,
link |
but it helps to ask them, well, how are you now?
link |
Let's say the patient is 50.
link |
How are you now versus when you were 20?
link |
And what has changed?
link |
So I've gotten the question a lot,
link |
how do you get your doctor to order a better lab workup
link |
or to even include your basic hormones?
link |
And there's no magic answer to that.
link |
But what really helps is you tell them,
link |
my energy is not as good as it used to be.
link |
My focus is not as good as it used to be.
link |
My athletic performance is not as good as it used to be.
link |
So you don't have to have a pathology
link |
in order for a lab to be indicated.
link |
You just need to have that pertinent symptom.
link |
I think that's gonna be really helpful
link |
because for many people, the idea of getting a blood test
link |
to look at their hormones just seems like
link |
such an enormous hurdle to get over.
link |
And many doctors won't prescribe them.
link |
And would you say that it's using the approach
link |
you just described that it's equally effective
link |
for men and women?
link |
Or do you find that for one reason or another,
link |
that men and women have different challenges
link |
and advantages in trying to access
link |
their deeper hormone data?
link |
Yeah, it's slightly different.
link |
With women, there's a lot more objective data.
link |
So if they're having menstrual irregularities
link |
or if they're not having a period,
link |
if they're having too heavy of periods,
link |
then those are things that they talk about
link |
very frequently with their doctor.
link |
Men are more hesitant.
link |
So men really wanna know what their testosterone is,
link |
but at the same time,
link |
they really don't wanna tell their doctor
link |
how their libido is or how their energy is
link |
because it's almost like they feel less masculine
link |
or they feel less like a guy when they say that,
link |
even if they're just talking to their doctor about it.
link |
Yeah, I think that that raises a really important point,
link |
which is that the whole discussion around hormone health
link |
is a bit of a barbed wire topic
link |
because in many ways, when we hear the word hormone,
link |
we think testosterone and estrogen,
link |
we think notions of masculinity and femininity.
link |
And of course, testosterone and estrogen
link |
are present in all sexes, right?
link |
All chromosomal backgrounds
link |
and just to varying degrees and ratios.
link |
But it also raises all these issues about sexual health
link |
that it's kind of interesting
link |
because I'm surrounded by medical doctors
link |
in my lab at Stanford.
link |
And the more physicians that I surround myself with,
link |
the more open is the discussion around sexual health
link |
and reproductive health.
link |
But in the general population,
link |
I think some of these topics are a little bit taboo
link |
or again, it's kind of barbed wire.
link |
And so I think that people are seeking
link |
a lot of this information on YouTube
link |
and through communities that may or may not be very educated
link |
about the actual biology.
link |
So along those lines,
link |
you know, we could probably assume
link |
that hormones are changing across the lifespan, right?
link |
Certainly from childhood and puberty and onward.
link |
If you would, I'd love to just kind of take a snapshot
link |
of what you think everybody should be thinking about
link |
or doing to optimize their hormone health,
link |
male or female, in the, let's say in their twenties.
link |
And then maybe we could migrate that to their thirties
link |
But before that, could you just tell us
link |
what everyone should be doing for their hormone health
link |
from puberty onward?
link |
The law of diminishing returns applies.
link |
So doing a little amount of what I call
link |
lifestyle interventions over a long period of time
link |
is gonna be far more helpful or efficacious
link |
than doing a lot and then doing nothing
link |
or doing a lot and then doing nothing.
link |
So I talk about the big six pillars.
link |
The two strongest ones are likely diet and exercise.
link |
For hormone health, specifically resistance training
link |
is particularly helpful.
link |
For diet, caloric restriction can be particularly helpful,
link |
especially with the epidemic of metabolic syndrome
link |
that is continuing to on-go in this country
link |
and in developed countries in general.
link |
So those are the two most powerful.
link |
So number one and number two are diet and exercise.
link |
For the last four, I have a little bit of alliteration.
link |
So there's stress and stress optimization
link |
that has to do with cortisol,
link |
that has to do with your mental health,
link |
that has to do with societal health
link |
and collective health of your family as well.
link |
When you're a member of a family
link |
or even a very close friend,
link |
trying to achieve optimal health together is very important.
link |
It's the same thing with nicotine cessation.
link |
It's the same thing with hormone optimization.
link |
If you do it as a household unit, it's far more helpful.
link |
So after stress, you have sleep optimization.
link |
Sleep is extremely important,
link |
especially for mitochondrial health as well.
link |
And then you have sunlight,
link |
which encompasses anything that's outdoors.
link |
So you move more, you have cold exposure,
link |
you have heat exposure, that's sunlight.
link |
And then the last one is spirit.
link |
So that's kind of the body, mind and soul.
link |
If you have all the other five and they're dialed in
link |
completely, but you don't have your spiritual health,
link |
whatever you believe,
link |
then that's going to profoundly impact your body
link |
and your mind as well.
link |
And we're definitely going to touch into this notion
link |
of spiritual health, because I think for some people
link |
that might draw connotations of certain things
link |
that may or may not be accurate,
link |
but I know a number of academic laboratories
link |
that are focused on this and a number of,
link |
not just functional medicine clinics,
link |
but research clinics and hospitals throughout the country
link |
that are achieving some really interesting data,
link |
not just in people that are quite sick,
link |
but in healthy people who are trying
link |
to further optimize health.
link |
So we will definitely touch back to that.
link |
If you would be so kind as to maybe give us
link |
a little bit more detail about some of these other areas.
link |
So when people hear diet, I immediately think, okay,
link |
now we get into the combat around vegan, plant-based,
link |
carnivore, et cetera.
link |
But I think that my general view of this is that
link |
most people should probably be eating
link |
as few highly processed foods,
link |
highly palatable foods as possible,
link |
which doesn't mean eating foods
link |
that don't taste good, of course.
link |
But what other sorts of things do you recommend
link |
in the realm of diet?
link |
And then I also want to know about caloric restriction,
link |
because my understanding is that a caloric surplus
link |
can actually support certain hormones like testosterone.
link |
So how does one combine caloric restriction
link |
and still optimize hormones?
link |
But what would you say is a really terrific way
link |
to think about and approach diet?
link |
Yeah, diet should be an individualized approach.
link |
So if you have a car, each car is made different
link |
and requires a different sort of fuel,
link |
whether it's a race car, whether it's a diesel truck,
link |
they have different fuels
link |
for different performance outcomes.
link |
So if you're trying to tow something
link |
or you're trying to go fast.
link |
So it's the same way with athletes.
link |
It's pretty well studied.
link |
The more intra-workout carbs
link |
ultra long distance athletes take,
link |
in general, they do better.
link |
I think they've studied this in cyclists quite often.
link |
It also depends on your genetics.
link |
So you can have a genetic polymorphism
link |
and you metabolize carbs and sugar better,
link |
even when they're unopposed by fiber.
link |
How does one determine whether or not
link |
they have such a polymorphism?
link |
I mean, I'm an omnivore,
link |
so I do eat some high quality meats, not in huge quantities,
link |
but I also eat vegetables and starches, I feel fine.
link |
I've never done an elimination diet.
link |
I think I did a very low carb diet once
link |
and all it gave me was a lot of psoriasis and poor sleep.
link |
So I backed off, I probably didn't do it correctly,
link |
but I know a lot of people that do quite well
link |
on a very low carb or zero carb diet.
link |
Yeah, particularly those who are at risk of cancer
link |
because you have less glucose
link |
that can be easily uptaken into cells.
link |
And then also people with autoimmune diseases.
link |
They tend to do well on-
link |
On lower carb diets, yeah.
link |
But yeah, as far as the, how do you know,
link |
basically you can use your biofeedback,
link |
how you're feeling to guess what you tolerate well,
link |
or you can just get genetic testing,
link |
which can be fairly expensive,
link |
but most of all, it requires a physician
link |
or someone who knows how to interpret the test accurately.
link |
And if someone had the means or would you say
link |
that getting regular blood testing is a good idea?
link |
And if so, what is regular blood testing?
link |
Is it every three months?
link |
Is it every six months?
link |
Of course, the backdrop of life is changing too,
link |
stress levels, et cetera.
link |
Yeah, every three to six months for preventative purposes.
link |
At times you need blood tests at faster frequencies
link |
And then you should also get a blood test
link |
when you're fasting and when you're not fasting.
link |
So if you're looking for damage to the beach,
link |
you want to, you don't just look at low tide,
link |
you look at high tide and you see what's happening
link |
at high tide as well.
link |
It's a great way to put it.
link |
And in terms of general recommendations around exercise,
link |
I mean, I'm of the mind based on the data that I've seen
link |
that almost everybody should,
link |
or everybody should be getting 150 to 180 minutes,
link |
minimum of zone two cardio per week.
link |
That kind of could continue while having a conversation,
link |
but with, if one were to exert any more effort,
link |
it would have a hard time getting the words out.
link |
At least that, right?
link |
For cardiovascular health and general brain health
link |
and musculoskeletal health plus resistance exercise.
link |
Is that more or less the contour of what you recommend?
link |
Yeah, that's more or less the contour.
link |
The more you're doing your zone two cardiovascular exercise,
link |
the slightly less important a long duration
link |
of caloric restriction is.
link |
And that brings us to caloric restriction.
link |
So it's very clear that caloric restriction
link |
can allow one to lose weight, right?
link |
This is the classic Kiko, C-I-C-O,
link |
calories in, calories out.
link |
We are not disputing calories in, calories out.
link |
Somehow that always has to be stated 50 times in any forum
link |
because of whatever follows.
link |
People I think will anchor to and assume
link |
that we don't mean that,
link |
but I know you and I both agree on calories in,
link |
calories out as a fundamental law of thermodynamics.
link |
But it's clear to me that based on what I've read,
link |
that when one is in a slight caloric surplus,
link |
that hormones like testosterone can be optimized,
link |
but is that true for somebody who's showing up
link |
with excessive body fat?
link |
How does this all work?
link |
Because body fat is manufacturing enzymes
link |
that convert testosterone to estrogen.
link |
So in other words, how does someone know
link |
if they should use caloric restriction
link |
or avoid caloric restriction?
link |
Yeah, here's how to parse that out.
link |
So before I delve into the details a bit more,
link |
I should say as a board certified
link |
obesity medicine physician,
link |
obviously the laws of thermodynamics apply.
link |
And then in addition to that,
link |
there is nothing special about intermittent fasting
link |
or caloric restriction or exercise
link |
when it pertains to losing body weight in general.
link |
When you do lose weight,
link |
about 33% of that is lean body mass
link |
and about 10% of fat cells,
link |
adipose cells are actually lean body mass as well,
link |
because it has proteins and water
link |
and things like that in it too.
link |
So the reason for exercise
link |
and the reason for caloric restriction in general,
link |
including intermittent fasting is health reasons.
link |
That's how you increase your health span.
link |
It's not necessarily gonna make the weight
link |
on the scale change, but that doesn't matter as much.
link |
It's been fairly well studied in both mice and humans.
link |
It's much easier to study in mice.
link |
So that's a precursor to our six types of people,
link |
the ones that care about mice studies
link |
and the ones that care about human studies.
link |
But if you calorically restrict mice by 40%,
link |
then they can have improved testosterone parameters,
link |
but only if they're obese to start.
link |
And it appears to be that same way in humans as well.
link |
So the easy way to think about it is if you're obese
link |
or you have metabolic syndrome,
link |
caloric restriction will improve your testosterone.
link |
There has been a study and they talk about all these studies
link |
in a systematic review from the Mayo Clinic proceedings
link |
in March of last year.
link |
And they note that there is a study in young healthy men
link |
and they calorically restrict them
link |
and their testosterone does decrease.
link |
So if you're young and healthy
link |
and you don't have metabolic syndrome,
link |
then caloric restriction
link |
will likely decrease your testosterone.
link |
That clarifies a lot for me.
link |
And I believe it will clarify a lot
link |
for other people as well.
link |
And I'm delighted that you pointed out this distinction
link |
about intermittent fasting not being the only way
link |
to achieve caloric restriction.
link |
There are a number of young healthy or older healthy people
link |
I know who like using intermittent fasting,
link |
even if they're not trying to lose weight.
link |
For a couple of reasons,
link |
some believe that it might extend lifespan.
link |
I think there's still,
link |
that's still a bit of an open question.
link |
It's a bit of a hard experiment to do
link |
because the control group is,
link |
no one wants to be in the control group, as I say.
link |
And the other feature of it that's a little bit tricky
link |
is that many people like intermittent fasting
link |
because of the mental effects,
link |
the clarity of mind that they feel during fasting,
link |
the increased pleasure in eating when they finally do eat.
link |
And here I'm referring to intermittent fasting of the sort
link |
where eating windows are anywhere
link |
from eight to 12 hours a day,
link |
not extended fast of 24 hours or more.
link |
So the question therefore is for the healthy,
link |
lean enough person, right?
link |
Is intermittent fasting a bad idea
link |
in terms of hormone health?
link |
Is oscillating between this period of kind of feast
link |
and famine within a 24 hours a problem
link |
if one is getting sufficient calories to maintain weight?
link |
Yeah, so if they're in a caloric maintenance,
link |
then it's not going to be,
link |
it's not going to be deleterious.
link |
It's not going to be bad for their hormone health.
link |
There's a couple of different hormones
link |
that we can talk about.
link |
We can talk about testosterone.
link |
We can talk about DHEA, which usually go hand in hand.
link |
And then we can also talk about growth hormone,
link |
which is not a steroid hormone, but it's a peptide hormone.
link |
So it's a chain of proteins,
link |
amino acids that are put together in sort of a sterile,
link |
think of sterile hormones as coming from cholesterol.
link |
So intermittent fasting,
link |
you do get a little spike in growth hormone after you eat,
link |
but you also get a huge spike in growth hormone,
link |
a more significant, less negligible spike overnight.
link |
And that is improved if you are intermittent fasting.
link |
So it's probably going to help your growth hormone
link |
and subsequently IGF-1 levels,
link |
which will help more in older age groups
link |
than younger age groups.
link |
And I like to eat dinner.
link |
So for me, that means sometime around six or seven o'clock,
link |
sometimes eight o'clock.
link |
I confessed last night because I was working late.
link |
I was basically my only meal of the day at 10 o'clock.
link |
That's a rare thing for me.
link |
Can I still achieve a high degree of growth hormone output
link |
if I, let's say I avoid food in the two to three hours
link |
before going to sleep?
link |
Or does one have to be very deep into a fast
link |
in order to achieve the increase in growth hormone?
link |
There's still pretty good growth hormone output,
link |
even if you eat two or three hours before you sleep.
link |
It's just the law of diminishing returns.
link |
The longer you go, you get slightly more and slightly more.
link |
And I know a number of people think of growth hormone
link |
in the context of the exogenous growth hormone
link |
and the fact that that can, in some cases,
link |
be associated with cancers.
link |
I've been asked many times before,
link |
can the increase in growth hormone from things like saunas
link |
or intermittent fasting cause levels of growth hormone
link |
that are so high that they cause cancers?
link |
My impulse is to say, no, that doesn't,
link |
that seems like it's not likely to happen,
link |
but I should probably verify that statement with you.
link |
Yeah, so quite unlikely.
link |
I think about growth hormone and especially IGF-1,
link |
and there's actually an IGF-1 and IGF-2,
link |
but I think about it in terms of endocrine IGF-1,
link |
mostly IGF-1 that's synthesized in the liver
link |
and released in the liver versus IGF-1 that's released.
link |
Classically, an example of this would be
link |
your IGF-1 levels increase after resistance training
link |
or exercise, and that's more of like paracrine or autocrine,
link |
and they have more local action.
link |
So that IGF-1, it's pretty well studied
link |
that if you just give people IGF-1,
link |
it's not going to, at physiologic levels,
link |
it's not going to improve their body composition.
link |
However, that IGF-1 that's autocrine and paracrine
link |
just working in those local tissues and muscles
link |
is likely part of the reason why you get
link |
a improved body composition response after exercise.
link |
And just to clarify for me and for others,
link |
what can we say are the major functions of IGF-1 and IGF-2
link |
that are distinct from just growth hormone?
link |
Are they just kind of the active form of growth hormone,
link |
the kind of the pickaxe end of the assembly line?
link |
So they have a much longer duration of action.
link |
I believe the half-life of IGF-1 is several days,
link |
almost a week, whereas growth hormone
link |
has an extremely fast half-life of only hours.
link |
So growth hormone acts significantly
link |
on the liver to produce IGF-1.
link |
So it's around in the serum, in the blood long enough
link |
to where it's producing an effect pretty much all the time.
link |
Well, and then your other pillars, stress,
link |
you know, we've talked a lot about stress
link |
on this podcast before and tools for managing stress.
link |
Sleep obviously is a big one.
link |
I think, you know, if nothing else,
link |
I will either put people to sleep with my podcasts.
link |
I'm certainly not this one, but my solo episodes
link |
or hopefully convince people that sleep
link |
is the foundation of mental and physical health
link |
Are there any aspects of hormone optimization
link |
that can improve sleep?
link |
I know sleep can improve hormone optimization,
link |
but are there any aspects of hormone optimization
link |
that can improve sleep?
link |
And for people that are suffering from this common syndrome
link |
of going to sleep and then waking up
link |
at three or four in the morning,
link |
we know that can be associated with depression,
link |
but are there any hormonal indications
link |
that might lead to that kind of situation?
link |
Yeah, there's three big ones.
link |
The first one is not super common,
link |
but it's a very direct correlation.
link |
If you have a growth hormone deficiency, a true deficiency,
link |
whether you're an adult or a child,
link |
then your sleep is likely going to be affected.
link |
And let's say you're a child with growth hormone deficiency.
link |
Once that is replaced with therapy,
link |
your sleep is gonna get significantly better.
link |
The second one that's a very common scenario
link |
is if you're having what's called vasomotor symptoms
link |
of menopause or vasomotor symptoms of andropause,
link |
which are also applicable.
link |
And that's where your progestogenic activity,
link |
so your main progestogens are progesterone
link |
and then pregnenolone,
link |
and then 5-alpha, 3-alpha progesterone,
link |
which is a slight-
link |
Where are those manufactured in the body?
link |
So they're manufactured in a few places.
link |
In men, they're manufactured some in the testes
link |
and the late egg cells.
link |
In women, they're manufactured in the ovaries
link |
and then they're also manufactured in the adrenal glands.
link |
So if you're preadrenopausal,
link |
where your adrenal glands are still working fairly well,
link |
usually still have a decent amount of progesterone around,
link |
and this can be measured too.
link |
So after menopause,
link |
women make progesterone from their ovaries,
link |
or sorry, from their adrenal glands.
link |
If that progesterone crosses the blood-brain barrier,
link |
especially if it's 5-alpha and 3-alpha reduced,
link |
so it's modified a little bit,
link |
then it is both a GABA agonist,
link |
which helps sleep just like GABA does,
link |
gamma-aminobutyric acid,
link |
the main inhibitory neurotransmitter
link |
of which lots of things work on.
link |
Alcohol works on GABA as well.
link |
GABA-Penten also works on GABA.
link |
Migraine medicines, many of them work on GABA.
link |
Benzodiazepines and also non-benzos.
link |
So an example of a benzo would be Xanax.
link |
An example of a non-benzo would be Ambien.
link |
So those all work on GABA.
link |
So GABA is also helped
link |
by the progestogenic activity as well.
link |
That's why a lot of women in menopause
link |
feel like their sleep is much worse,
link |
is because they have lower activity of those progestogens.
link |
And for men in so-called andropause,
link |
is that also one of the causes of poor sleep?
link |
Low testosterone can lead to poor sleep,
link |
but my third scenario is actually,
link |
if a man begins TRT,
link |
then they develop a poor sleep because of sleep apnea.
link |
It drastically raises the risk
link |
that somebody is going to have sleep apnea.
link |
And then a lot of people,
link |
especially when they first started
link |
in the first month or two,
link |
it puts them into this hyper sympathetic state
link |
because they have overactive androgen receptors,
link |
especially after a long time of being hypogonadal.
link |
Then they have a physiologic dose of TRT,
link |
and that causes the sleep issue itself.
link |
I have a lot of questions
link |
about TRT, testosterone replacement therapy.
link |
I should just mention
link |
that when you say it increases sympathetic activity,
link |
you don't mean that taking testosterone
link |
increases sympathy for others.
link |
It may in fact do the opposite,
link |
although it's very clear from my discussions
link |
with my colleagues in the endocrinology side
link |
and also with the great Dr. Robert Sapolsky
link |
that increasing testosterone
link |
merely exacerbates existing features of people.
link |
So the jerks become bigger jerks,
link |
kind people become even more kind in general.
link |
But I want to get into TRT in depth,
link |
but it's very interesting to me to hear
link |
that testosterone replacement therapy
link |
increases the risk of sleep apnea.
link |
And I want to make sure that I ask that,
link |
is that also the case in people that are using TRT
link |
who are not hypogonadal?
link |
Because in the classic situation,
link |
if somebody isn't making enough testosterone,
link |
they're below 300 nanograms per deciliter on the chart,
link |
they go in and take TRT.
link |
But many people nowadays, let's be honest,
link |
are taking doses of testosterone
link |
even though they are in the sort of standard range
link |
because the range is so large
link |
because of other symptomology, is that right?
link |
Yeah, I do love the analogy that Dr. Sapolsky had
link |
about monks taking testosterone and making them
link |
more and more generous.
link |
So that does appear to be what testosterone usually does
link |
is it exacerbates, if you will, what you're previously like.
link |
So it's not going to change you as a person.
link |
But if you're ugonadal before you start testosterone-
link |
Meaning you have normal testosterone
link |
and then you start TRT or self-administered TRT,
link |
steroids, however you want to look at it,
link |
then your risk of sleep apnea still goes up
link |
in a dose dependent fashion.
link |
So the higher the dose, the more risky.
link |
With the sympathetic and the parasympathetic nervous system,
link |
the sympathetic is the fight or flight nervous system.
link |
The parasympathetic is the rest and digest.
link |
So if you have too much fight or flight
link |
and stress can cause that too,
link |
then you're not going to rest as well at night.
link |
I want to touch on testosterone in women
link |
because there is testosterone in women.
link |
I'd like to know where that testosterone comes from,
link |
I'd like to know whether or not
link |
testosterone replacement therapy makes sense in women.
link |
I'm hearing more and more about women using testosterone.
link |
And I'd like to know whether or not
link |
knowing a woman's testosterone,
link |
for her to know her testosterone is of equal,
link |
less than, or more value than knowing,
link |
for instance, progesterone and estrogen levels.
link |
Because I think there are a lot of misconceptions
link |
about the roles of testosterone in women.
link |
For health optimization,
link |
testosterone is just as important to know.
link |
For pathology prevention,
link |
for example, breast cancer, osteoporosis,
link |
estrogen and progesterone are more important to know.
link |
So when you're thinking about women,
link |
women think that they have such a tiny amount of testosterone
link |
because you test it.
link |
Most people test a free testosterone.
link |
So testosterone that's unbound,
link |
which is by far the smallest proportion of testosterone.
link |
Any androgen is bound by lots of different
link |
steroid binding proteins,
link |
but the ones that are most pertinent are called SHBG,
link |
or sex hormone binding globulin.
link |
And that binds the androgenic steroid,
link |
for example, DHT or dihydrotestosterone.
link |
It's associated with prostate enlargement,
link |
associated with male pattern baldness.
link |
It binds that the most strongly,
link |
and then it binds testosterone next most strongly.
link |
And then it binds things like androstenedione
link |
or DHEA, dehydroepiandrosterone.
link |
And then it binds the estrogens, the weakest,
link |
So if you look at the total amount of testosterone,
link |
women actually have, almost all women, not all women,
link |
but almost all of them have significantly more testosterone
link |
but it's because it's in different measurements.
link |
So estradiol a lot of time is, you know,
link |
grams per mil as opposed to nanograms per deciliter.
link |
So women have more testosterone than estrogen
link |
and significantly more DHEA than either.
link |
Do women make dihydrotestosterone?
link |
And where does this testosterone come from?
link |
Because they don't have testes.
link |
So most testosterone in women that are premenopausal
link |
can come from theca cells, T-H-E-C-A.
link |
So theca cells are cells in the ovaries
link |
that can produce testosterone.
link |
And a lot of people have actually heard
link |
about hyperthecosis, not the term itself,
link |
but a lot of Olympians that are,
link |
their chromosomes are XY, they're females,
link |
and they're not taking any-
link |
Wait, they're XY, but they're females?
link |
Sorry, they're XX, yeah, thank you.
link |
So they're XX, they're not XY,
link |
and they have never transitioned
link |
or been on any sort of hormone replacement or testosterone,
link |
but they naturally produce a huge amount of testosterone,
link |
as much as many men.
link |
And some of these women,
link |
I believe they were from Botswana,
link |
were banned from competing in the Olympics
link |
in certain distances.
link |
I believe they were banned from the 400 meter and 800 meter
link |
because their natural testosterone
link |
was deemed to be too high.
link |
So they mistakenly thought that they were using steroids?
link |
They actually knew they were not using steroids.
link |
They knew it was their theca cells
link |
were just genetically gifted, I suppose,
link |
and they still made them change distances.
link |
So one or two of these athletes changed to,
link |
I believe it was a 3K or the 5K,
link |
and they still did quite well,
link |
but it was not their best event.
link |
Yeah, that's turning out to be a very interesting
link |
and controversial area of this notion of hormone therapies
link |
and natural variation in hormones
link |
on different chromosomal backgrounds.
link |
Fascinating, we should probably do a whole episode
link |
about that, because it's very much of the times.
link |
So men and women both make DHT.
link |
I'd like to ask about DHT in men.
link |
So often we hear about testosterone in men
link |
and free testosterone and being the unbound form, of course,
link |
but dihydrotestosterone, where does it come from in men?
link |
What is the cascade of events that takes testosterone
link |
to dihydrotestosterone?
link |
And what are some of the quote unquote positive
link |
and negative effects of,
link |
here I'm only referring to endogenous dihydrotestosterone.
link |
And in fact, I'll make it very clear whether or not
link |
I'm talking about taking something
link |
or one's own natural production.
link |
Here we're just, I think up until now,
link |
we've just been talking about natural production.
link |
So tell us about DHT in men.
link |
It's such a powerful hormone during development, obviously,
link |
but what is it doing?
link |
DHT is a very androgenic hormone.
link |
So whether you're talking about DHEA,
link |
which is a mild, a weak androgen,
link |
or testosterone, which is a relatively strong androgen,
link |
or DHT, which is a very strong androgen,
link |
they bind to the androgen receptor
link |
in both men and in women.
link |
So the effect of all three of those
link |
is mediated by the androgen receptor.
link |
There's a couple of different beta estradiol receptors
link |
and alpha estradiol receptors,
link |
but there's only one androgen receptor.
link |
Intriguingly, it is on the X chromosome.
link |
So men get their androgen receptor gene from their mother.
link |
Women get one androgen receptor gene from their father,
link |
one from their mother.
link |
Often the one that is more sensitive to androgens
link |
and people with PCOS, that's the one that's active.
link |
The other one is methylated and inactive.
link |
Can I just pause you one second?
link |
Sorry to interrupt, but I have to ask this question
link |
And I know a number of people are probably wondering,
link |
I've heard that whether or not
link |
one develops male pattern baldness,
link |
whether or not a male develops male pattern baldness,
link |
just to be very precise,
link |
you could get some information about that
link |
by looking at your mother's father.
link |
And that would be in keeping with what you just described
link |
that the X chromosome,
link |
which of course is handed off through the mother
link |
is carrying the genes that encode
link |
for the number and distribution
link |
of these androgen receptors that DHT will bind to.
link |
Because of course, I think as you'll probably tell us
link |
that DHT is responsible for male pattern baldness
link |
and beard growth, is that right?
link |
Should I look at my grandfather on my mother's side
link |
to determine what I'm likely to look like
link |
in terms of my DHT-ness, is that a word?
link |
Yeah, it's the best guess that you can make
link |
purely from phenotypes.
link |
And you can measure your genotype
link |
and get a better idea of that.
link |
Assuming that it's true male pattern baldness,
link |
it's related to the gene transcription
link |
of the androgen receptor.
link |
So I like to think of it as
link |
how much of this androgen receptor gene
link |
is activated by any androgen.
link |
So if you have an extremely sensitive gene,
link |
which usually means you have very few CAG repeats,
link |
which is basically just a certain CAG encodes
link |
for a certain amino acid.
link |
And if you have very few of the repeats,
link |
then your androgen receptor gene works better.
link |
Think of it as a corollary to Huntington's disease,
link |
where if you have very few called trinucleotide repeats,
link |
then it's not as severe of a disease.
link |
But after you get more and more CAG repeats,
link |
which by the way are in the population,
link |
you're getting more and more CAG repeats.
link |
So it's a natural selection of process
link |
that has been ongoing for a variety of number of reasons.
link |
But anyway, if you have more repeats,
link |
then that gene activates in the cytoplasm
link |
and moves to the nucleus
link |
and causes gene transcription more often
link |
and hair loss more often.
link |
So does that mean that we're seeing more hair loss now
link |
due to elevated levels of DHT than we were 50 years ago?
link |
The hair loss 50 years ago, well, not 50 years ago,
link |
but 500 years ago was probably more significant
link |
because on average 500 years ago,
link |
people were more sensitive to androgens.
link |
So there's a syndrome called androgen insensitivity syndrome,
link |
AIS, and that syndrome was related to when men
link |
who have the copy from their mother who is a carrier,
link |
their AR gene or androgen receptor gene
link |
is completely insensitive.
link |
So think of it, it's not related to the CAG repeats,
link |
but think of that receptor as just not working at all.
link |
So there's a continuum.
link |
So everybody's receptor works a little bit better
link |
or a little bit worse, and the better your receptor works,
link |
the more likely you are to have male pattern baldness.
link |
To zoom out from this, but still keeping an eye on DHT,
link |
what do you like to see all women and all men do
link |
And here I'm talking about regardless of age.
link |
So we're still in this from puberty onward phase.
link |
We haven't yet micro dissected out decade by decade,
link |
which we will do, but what do you like to see people do
link |
to keep DHT in check?
link |
But before you tell us that,
link |
could you tell us what positive things DHT does
link |
when it's in the proper range?
link |
Yeah, so DHT helps a lot for,
link |
it's the same reason why testosterone helps.
link |
It activates the androgen receptor gene.
link |
It helps effort feel good.
link |
So it can be motivating.
link |
So that's how it's active in the CNS.
link |
It also is active in cardiovascular tissue.
link |
So if you look at someone that has heart failure,
link |
or if someone has cardiac hypertrophy,
link |
the level of DHT can matter because it's also binding
link |
to the androgen receptor in the myocardium
link |
or in the heart itself.
link |
So you think of the classic bodybuilder heart,
link |
that's an easy example to make.
link |
They have very thickened muscle.
link |
Their muscle is very strong because they're pumping blood
link |
often with high blood pressure and that DHT
link |
and the testosterone and any DHT derivatives like masterone
link |
or oxandrolone, primaboulin also bind to the heart
link |
and they cause even more hypertrophy
link |
or enlargement of that muscle tissue.
link |
So then let's say the person stops and they're recovering
link |
and they're trying to have cardiac remodeling,
link |
which is where you take a very thick heart
link |
and cardiac remodeling is important
link |
in a lot of different cardiac pathologies.
link |
But if you give them finasteride or dutasteride,
link |
which inhibit the enzyme that converts testosterone to DHT,
link |
so making less activity at the androgen receptor gene,
link |
they have cardiac remodeling and their heart health improves.
link |
So for the non-bodybuilder, the typical woman or man
link |
or younger or older, what sorts of things support DHT
link |
and thereby heart health?
link |
Presumably DHT is involved in some of the other things
link |
that testosterone is famous for in both men and women,
link |
things like libido, as you mentioned,
link |
making effort feel good, so motivation drive and vitality,
link |
is I guess could be the general phrase.
link |
What sorts of things support DHT?
link |
What sorts of things create problems for DHT?
link |
There's lots of dietary changes and supplementation
link |
that you're probably doing right now
link |
that's affecting your DHT.
link |
You mean me personally?
link |
Well, everybody, all of the listeners,
link |
because let's say you have a diet high in plant polyphenols.
link |
Many of those inhibit the enzyme
link |
that converts testosterone to DHT.
link |
Could you give us an example of one of those,
link |
either in supplementation form or in food form?
link |
Curcumin, certain curcuminoids, depending on the structure,
link |
will inhibit the enzyme called 5-alpha reductase
link |
that converts testosterone to DHT.
link |
Yeah, turmeric, black pepper extract.
link |
So it's used often to increase bioavailability.
link |
It's also called biopurine.
link |
It's also a 5-alpha reductase inhibitor.
link |
And on top of that, people have different genetics too.
link |
So some people, there are 5-alpha reductase enzymes.
link |
There's three of them.
link |
They're on chromosome two, three, and four, I believe.
link |
But some of them are active in the prostate.
link |
Some of them are active in the brain.
link |
And so it depends on which tissue.
link |
They're tissue-specific enzymes
link |
that depend on how much DHT you convert.
link |
Do you recommend that people avoid curcumin
link |
and turmeric for that reason?
link |
And is there any specific recommendations
link |
for men versus women?
link |
If a man or a woman, by the way, in women,
link |
a lot of times if you just ask your doctor for a DHT check,
link |
it's the same unit as in men.
link |
So it's essentially undetectable.
link |
So you have to, you know,
link |
especially if they're on oral contraceptives,
link |
which is a different topic,
link |
their DHT is very likely undetectable,
link |
especially if it's free DHT.
link |
You can measure both a DHT and a free DHT.
link |
But if someone's DHT is already low
link |
or if they have somewhat insensitive androgen receptor
link |
via genetics or via lifestyle,
link |
then I recommend they avoid bioavailable curcuminoids
link |
like bioavailable turmeric, black pepper extract,
link |
and they might be a good candidate for creatine.
link |
Creatine, like creatine monohydrate,
link |
can significantly increase the conversion
link |
of testosterone to DHT.
link |
There's also a lot of really interesting data
link |
coming out now about the role of creatine as a brain fuel
link |
and maybe even as a cognitive enhancer over time.
link |
The data are still ongoing,
link |
but some of the studies in humans are pretty impressive,
link |
I'm glad you mentioned this thing
link |
about curcumin and black pepper.
link |
I wish we'd had this conversation six years ago
link |
because I had the experience
link |
of jumping on the bandwagon of the excitement around turmeric
link |
when I took a turmeric supplement.
link |
It was a couple of capsules of what I thought to be,
link |
and I think was high quality turmeric.
link |
And I've never felt as poor as I did
link |
in the subsequent few days.
link |
Flat line of, let's just say,
link |
everything that one would want to have in life,
link |
energy, vitality, just, it was a cliff.
link |
And a friend somehow knew
link |
that curcumin could inhibit 5-alpha reductase
link |
that converts testosterone to DHT, as you pointed out.
link |
I stopped taking it, it was the only new addition
link |
to my diet and supplementation,
link |
and things bounced back within about three, four days,
link |
but it was remarkable.
link |
I mean, I felt like garbage,
link |
and it was actually kind of frightening
link |
to experience the sharpness of that cliff.
link |
But I know that some people like turmeric
link |
for its anti-inflammatory properties, et cetera.
link |
Sounds like people either need to experiment or,
link |
and if they do, obviously to approach that with caution
link |
anytime you add or remove something,
link |
you need to talk to your doctor, you're a doctor,
link |
and I'm guessing that if one were to experiment,
link |
would you say that most of these effects
link |
of things like curcumin are reversible as they were in me,
link |
or is there any potential of permanent damage
link |
if people have been taking them for a long time?
link |
The effects are nearly always reversible.
link |
When you're talking about 5-alpha reductase inhibition,
link |
so what turmeric does, but stronger,
link |
the most common story that we hear
link |
is regarding a supplement known as saw palmetto,
link |
which a lot of older men take for their prostate health,
link |
or finasteride, which you can take for your prostate,
link |
or your heart, or your hair, or dutasteride.
link |
So if you're having side effects on these,
link |
then it's probably because of a couple different reasons.
link |
One can be your ratio of androgens to estrogens is off,
link |
and that needs addressed.
link |
Another one can be, it's inhibiting the conversion
link |
of your progesterone to that other type of progesterone,
link |
a 5-alpha, 3-alpha that we talked about earlier
link |
that's helping with your sleep,
link |
and your brain, and your calmness,
link |
and that's definitely an effect.
link |
Another one is depending on the type of supplement or med,
link |
they inhibit different isoenzymes
link |
of that 5-alpha reductase.
link |
So if they're just inhibiting one and two,
link |
then that's gonna be a different effect
link |
than if they're inhibiting two and three.
link |
So finasteride does two and three,
link |
saw palmetto does one and two,
link |
and then dutasteride does all three.
link |
The third one is active in the brain,
link |
and dutasteride inhibits that third one
link |
a little bit weaker in vivo, but strongly in vitro.
link |
So it's really hard to parse out.
link |
You can use biofeedback and experimentation.
link |
I do think with supplements, it's safe to experiment.
link |
The time that it takes to set in
link |
is usually about three months.
link |
So the risk of, and this is anecdotally,
link |
there's been lots of research published
link |
about if post-finasteride syndrome is real or fake,
link |
and it is real, but it's one of those things
link |
that's a combination of organic and inorganic disease,
link |
almost kind of like fibromyalgia,
link |
where it's definitely real,
link |
and there's lots of things that you can do to help with it,
link |
but it's very unlikely to occur
link |
if you stop taking your supplement or medication
link |
after you have side effects.
link |
Well, I certainly feel better when I'm taking five grams
link |
of creatine monohydrate per day.
link |
I know most people take it for muscle growth
link |
and tissue repair and things of that sort.
link |
Mainly, I think, brings water into the muscle tissue,
link |
et cetera, but I take it for the brain effects,
link |
and also because I like to think that it gives me
link |
a little bit of a DHT bump that I can actually see
link |
in my blood charts when I've done them.
link |
I know many people want to avoid the hair loss
link |
that can sometimes be associated
link |
with DHT levels going too high.
link |
And so I've been asked many times,
link |
does creatine monohydrate cause hair loss?
link |
It would make sense that if creatine increases DHT and DHT,
link |
binding to the endocrine receptor on the scalp
link |
can induce hair loss, that that would be the case.
link |
Is that true, or are people just overly concerned
link |
about something that's trivial or non-existent?
link |
Each male, so yes, it can potentially add it.
link |
I don't like to say it causes it,
link |
but it can be a little bit more fuel to the fire.
link |
So just like everybody has a different sensitivity
link |
of their androgen receptor,
link |
they have a different amount of gene transcription
link |
that is going to cause death of the follicle.
link |
That's an arbitrary threshold.
link |
So you don't really know until you start losing hair.
link |
And if somebody takes a little bit of creatine
link |
to increase their DHT,
link |
maybe for the cognitive enhancing effects
link |
or for whatever reason,
link |
and they notice a little bit more hair falling out
link |
in the sink and they stop taking it,
link |
you just said death of the follicle,
link |
which sounds very dramatic.
link |
Are those little stem cell niches
link |
that reside in the follicle, which hairs grow from,
link |
are those then abolished?
link |
Like there's no going back,
link |
or can you want to rescue the hair?
link |
If they're still there, the hair will come back.
link |
So the loss of the hair itself
link |
is a normal part of the hair cycle.
link |
So you have your androgen phase, your catagen phase,
link |
your telogen phase, and then your hair loss,
link |
and then a new follicle.
link |
Of the stem cell niche in the hair follicle.
link |
Think of it like sharks have teeth.
link |
So a shark loses a tooth
link |
and they have a new one that comes through,
link |
or losing your baby tooth and you have a new one,
link |
but your hair just always keeps coming through.
link |
So it's natural for it to die and lose.
link |
That's why when you start five alpha reductase inhibitors,
link |
often you have a big shed.
link |
So what happens during that big shed
link |
is all of these cells that are unhealthy,
link |
they immediately jettison that hair
link |
and they start making a much healthier new follicle.
link |
So all of the hairs that are at the end of their
link |
telogen phase, then they have what's called
link |
telogen effluvium, which also happens after pregnancy,
link |
also happens in thyroid pathologies.
link |
So you shed it, a new one comes in place,
link |
and you think that you're having a horrible hair loss
link |
caused by your finasteride or whatever you're doing,
link |
and minoxidil does this too,
link |
but you're really just having a new, healthier follicle.
link |
If you go a really long time, if you go a year,
link |
then those hairs might come back and they might not.
link |
So for simplicity sake, if somebody is concerned about
link |
or is experiencing hair loss, male or female,
link |
what are their options of ways to offset that hair loss
link |
that are not going to negatively impact
link |
other tissues sensitive to DHT?
link |
And what I'm basically saying here is
link |
I could imagine taking a DHT inhibitor,
link |
a pill of some sort or an injection of some sort,
link |
and offsetting hair loss,
link |
maybe even stimulating more hair growth.
link |
It's clear that I'm not doing that,
link |
but I know people that do,
link |
but then experience some of the other negative effects
link |
of blunting DHT, reduced affect, reduced libido,
link |
reduced drive, disruptions in prostate function,
link |
or even sexual function generally.
link |
So what can people do if they want to maintain
link |
or grow back hair,
link |
but they don't want all those other effects?
link |
What should they avoid?
link |
And what should they perhaps consider
link |
talking to their doctor about?
link |
There's a whole host of options.
link |
I try to separate alopecia or hair loss
link |
into two different categories,
link |
male pattern baldness or androgenic alopecia,
link |
also known as androgenetic alopecia,
link |
versus other types of alopecia, usually telogen effluviums.
link |
And if it's androgenetic alopecia or male pattern baldness,
link |
even if they're female, perhaps say a PCOS,
link |
something like that,
link |
then you want some sort of strategy
link |
to decrease the activity of that androgen receptor.
link |
So women can get male pattern baldness?
link |
Okay, I'm gonna have to wrap my head around that one,
link |
So there's a lot of different things
link |
that you can do that are topical.
link |
The most promising is called dutasteride mesotherapy.
link |
Essentially what it is is it's very localized injections
link |
in areas that are prone to male pattern baldness,
link |
whether they're female or male.
link |
And it acts locally only,
link |
and you repeat these injections from time to time.
link |
It decreases the conversion of testosterone to DHT
link |
just in the scalp.
link |
So that can avoid prostate effects.
link |
And what are some of the negative effects
link |
of blocking DHT in females in the periphery,
link |
meaning not on the scalp or in the brain,
link |
but where is DHT doing its stuff?
link |
Yeah, so it's both DHT
link |
and then also that 5-alpha, 3-alpha progesterone,
link |
which is called THP or dihydroprogesterone
link |
or tetrahydro, trihydroprogesterone.
link |
So they're active in the central nervous system,
link |
but it's also just active, again,
link |
binding to the androgen receptor in a female as well,
link |
causing them to have that effort, feel good motivation.
link |
A lot of women that are sensitive to DHT,
link |
because women can be sensitive to DHT as well,
link |
feel very different when they start an oral contraceptive,
link |
not because it alters their DHT to a huge amount.
link |
It does to some degree,
link |
because the negative feedback inhibition in the pituitary
link |
and less produced in the ovaries,
link |
but it increases SHBG really high.
link |
So because their SHBGs are significantly higher,
link |
their free DHT is way lower.
link |
How does a woman know if she has PCOS,
link |
polycystic ovarian syndrome?
link |
What are the issues with polycystic ovarian syndrome?
link |
What can be done about PCOS?
link |
I confess I was naive to PCOS.
link |
That wasn't supposed to rhyme, but since it does,
link |
I do confess I was completely naive to it.
link |
And I started getting a lot of questions about it
link |
in various forums.
link |
And I think that's actually the reason
link |
why I initially approached you.
link |
I know you have treated a lot of PCOS.
link |
What age women should be thinking about PCOS?
link |
Teach us about PCOS, please.
link |
So PCOS is polycystic ovarian syndrome.
link |
And this is one of those conditions
link |
which is underdiagnosed.
link |
So its prevalence is much higher than we think it is.
link |
There's been a lot of studies,
link |
and some studies say prevalence of 10%, some say 20%.
link |
It's not completely clinically penetrant.
link |
So most people don't know they have PCOS
link |
until they have infertility or subfertility.
link |
And is PCOS happening at this frequency
link |
in 20-year-old women and 30-year-old women
link |
and 40 and onward?
link |
Most women find out they have PCOS in their 30s,
link |
especially because it's on a spectrum or a continuum
link |
like a lot of things where you can have a weaker version
link |
or a very severe version.
link |
What are the symptoms?
link |
There's a criteria called the Rotterdam criteria.
link |
And in the Rotterdam criteria,
link |
there's a couple of different ways that you can diagnose it.
link |
You're looking for androgen excess, insulin resistance,
link |
and you can also look for polycystic ovaries.
link |
You don't actually have to have polycystic ovaries
link |
or to get an ultrasound of your ovaries to be diagnosed.
link |
If you have androgen excess, for example,
link |
androgenic acne or hormonal acne,
link |
if you have hair growth, like a hair growth on the chin,
link |
it's called a hirsutism,
link |
or if you have deepening of the voice,
link |
any symptom of too much male pattern baldness,
link |
if you're a female, that's a symptom of PCOS as well.
link |
Then you can also have insulin resistance.
link |
So this is obesity, it's pre-diabetes,
link |
a high fasting insulin, a HOMA-IR over two,
link |
a fasting insulin of over six.
link |
So if you have significant insulin resistance
link |
and also androgen dominance, that's a sign of it.
link |
Androgen dominance often leads
link |
to what's called oligominorrhea.
link |
So if you're having more than 35 day intervals
link |
in between a period,
link |
or if you have less than nine per year,
link |
then that can be a sign that you have oligo,
link |
which means too little, menorrhea, which means menses.
link |
So that's a very common sign of PCOS.
link |
If you have infertility, so if you're under the age of 35
link |
and you've been trying for more than a year,
link |
or if you're over the age of 35
link |
and you've been trying for more than six months,
link |
then that can also be,
link |
it's a very common presenting complaint
link |
when somebody presents with PCOS.
link |
And assuming that a woman is doing all these other things,
link |
is paying attention to the six pillars
link |
that you talked about earlier,
link |
diet, exercise, caloric restriction, in some cases, right?
link |
Not everyone needs to be caloric restricted,
link |
stress, sleep, and sunlight, spirit.
link |
Assuming that they're doing all those things,
link |
what other things in the realm of diet or supplementation
link |
can help them avoid PCOS if they have subclinical PCOS
link |
or they have not developed it but don't want to develop it?
link |
Because it doesn't sound like a good thing.
link |
Yeah, so depending on where they are,
link |
if they're very strong on the insulin resistance spectrum,
link |
then optimizing their body composition,
link |
decreasing their body fat,
link |
and treating that metabolic syndrome can help.
link |
So a lot of people ask, well, does everybody that's on,
link |
like does everybody need to be on metformin that has PCOS?
link |
Not necessarily, but metformin is one of the tools
link |
that can help with insulin sensitization.
link |
Other tools that can help are inositol.
link |
So myoinositol is an insulin sensitizer.
link |
Its cousin, d-chiroinositol, is a weak anti-androgen.
link |
A lot of types of inositol have both of those in it.
link |
So depending on if you're a female or a male
link |
and you're on inositol, the type of inositol does matter.
link |
Yeah, this is a very important point.
link |
Just today I said I'm trying this new supplement, inositol,
link |
for its role in perhaps enhancing sleep even further.
link |
My sleep's generally pretty good.
link |
Lately it's been a little bit off for a number of reasons.
link |
So I took it for the first time last night
link |
and I said I thought it helped and just subjectively.
link |
And you said, what kind of inositol is it?
link |
Because inositol is a very potent androgen inhibitor.
link |
It turns out I was taking myoinositol,
link |
which is not an androgen inhibitor.
link |
The type, the other type that you mentioned,
link |
which is an androgen inhibitor is?
link |
It's usually in a ratio of one to 25 or one to 40
link |
in a much lower amount compared to myoinositol.
link |
In a supplement or in the body?
link |
In a supplement to help induce ovulation.
link |
But for women who have PCOS who might want to try
link |
and reduce androgen, then they would perhaps want
link |
to take a form of inositol
link |
that reduce the androgen receptor activity, correct?
link |
So if you're a woman and you've ever talked to your doctor
link |
about getting it on the oral contraceptive
link |
or spironolactone, which is also an anti-androgen,
link |
but it happens to be a potassium sparing diuretic
link |
blood pressure medicine as well.
link |
D-chiroinositol might be a better option.
link |
DIM or diindomethane is another kind of a weak
link |
anti-estrogen, anti-androgen that a lot of women
link |
should consider as well.
link |
You mentioned oral contraception.
link |
I've done a few posts on these, let's just call them,
link |
they really are perceptual effects whereby
link |
it's been demonstrated in humans several times now
link |
in what appeared to me to be very solid studies
link |
where women that take oral contraceptives,
link |
there is both a shift in their perception of men,
link |
because these studies only looked at heterosexual,
link |
the sort of arrangements here,
link |
where women who are on oral contraception,
link |
because it blunts some of the peaks and valleys
link |
of hormone output, no longer experience the same peaks
link |
and valleys in their assessment of other men's
link |
attractiveness, so it sort of flattens their perception,
link |
They still find certain men attractive
link |
and certain men unattractive, but the degree of difference
link |
is kind of mellowed out.
link |
And likewise, these data say that men
link |
perceiving women's attractiveness,
link |
they still see women on oral contraceptives as attractive,
link |
but a woman taking oral contraception eliminates
link |
this kind of peak in her attractiveness
link |
that men would otherwise perceive.
link |
In other words, oral contraceptives are changing the way
link |
that we perceive each other, at least in terms
link |
of these male-female experiments.
link |
What is going on with that?
link |
Is that because oral contraceptives blunt the increase
link |
in testosterone that occurs just before ovulation,
link |
or is it because of a complex cascade?
link |
I find this fascinating.
link |
Yeah, so there's differences in how your,
link |
and I wouldn't use the word change necessarily,
link |
but alter the severity or alter the peak, as you said.
link |
So it's just like TRT is not going to change you
link |
as a person, an oral contraceptive will not change you
link |
It will just change your day-to-day peaks and troughs
link |
in libido and attractiveness.
link |
So one of the main effects of oral contraceptives,
link |
almost all of them have a synthetic estrogen
link |
and a synthetic progestogen in them.
link |
One common type of synthetic estrogen is ethyl estradiol.
link |
There is another new synthetic estrogen
link |
that's out there as well, but anecdotally,
link |
that seems to have even more side effects.
link |
So this ethyl estradiol is 100 times more potent
link |
than endogenous or bio-identical estradiol in the liver.
link |
So it binds to the estrogen receptor in the liver,
link |
and it's going to increase sex hormone binding globulin,
link |
which secondarily, as you mentioned,
link |
decreases your free testosterone
link |
and especially your free DHT.
link |
So that little testosterone hump that you get
link |
when you're a female that's ovulating,
link |
that's really flatlined.
link |
And it's already, it's a pretty insignificant difference.
link |
It's not negligible, but it's a little bit of a hump,
link |
and you have significantly less of that
link |
when you're on an oral contraceptive.
link |
And does that blunt the associated increase in libido
link |
that normally would occur from that increase in androgen?
link |
What about other forms of contraception, right?
link |
Because there are, there's copper IUD,
link |
there's various implants, there's rings,
link |
there's a huge number of different forms of these.
link |
So what we're talking about is, as I understand it,
link |
is only the effect of oral contraception
link |
that impacts hormone output, is that correct?
link |
Yeah, there's a lot of other effects as well.
link |
For example, your choice of synthetic progestin
link |
will alter how high your platelets and SHBG go.
link |
It appears to be the higher your platelets
link |
and the higher your SHBG, the higher risk of a blood clot.
link |
So a lot of women know that
link |
if they're on an oral contraceptive
link |
and they're already predisposed to a blood clot
link |
or a venous thromboembolism in their vein,
link |
they have a blood clot in either their leg or their lung,
link |
then it can increase that chance.
link |
So you can choose a synthetic progestin
link |
that is not going to have as high of a response.
link |
But there's various pros and cons.
link |
Some synthetic progestins are weak anti-androgens as well.
link |
For example, there's one known as Slind,
link |
which is made from spironolactone.
link |
So some women are on spironolactone and that as well,
link |
which is made from spironolactone,
link |
which probably isn't particularly necessary
link |
unless they need it for a diuretic or hypertensive effect.
link |
I'm just going to intentionally interrupt and I apologize,
link |
but specifically because I wanted to ask about,
link |
there is this notion that, you know,
link |
that oral contraception taken over long periods of time
link |
can disrupt fertility in ways that are independent
link |
of just the age-related decrease in fertility.
link |
It depends on what you mean by a long time.
link |
Six to 12 months, it's possible.
link |
Past that, it seems very unlikely.
link |
However, the persistently elevated SHBG
link |
can be present for quite some time.
link |
Wait, so if a woman takes oral contraception
link |
for six to 12 months and then stops,
link |
will she essentially be where she would have been anyway
link |
in terms of her fertility at that age?
link |
Or are you saying that it can cause permanent damage?
link |
Her fertility would be equitable
link |
as if she had never taken it,
link |
if she's certainly 12 months, but probably six months off.
link |
I know of women that have taken an oral contraception
link |
in addition to the age-related decline in fertility
link |
that occurs, that's inevitable.
link |
Of course, the slope is going to be different
link |
depending on the individual,
link |
but are they quickening the transition to infertility?
link |
You could make a case that
link |
because they've been an oral contraceptive,
link |
they may have been slightly more predisposed
link |
to insulin resistance and or lower lean body mass.
link |
But that's probably going to be a negligible difference
link |
compared to their resistance training
link |
and also their caloric restriction or caloric maintenance.
link |
Of course, there are also effects of having children.
link |
I mean, on all these parameters, right?
link |
Because it's a major lifestyle shift, right?
link |
That obviously people contend with
link |
and have since the beginning of human time anyway.
link |
I want to ask some questions about male hormone therapy
link |
and male hormones generally.
link |
But before I do that,
link |
I have a couple of burning questions that I get very often
link |
that I'm just going to insert now.
link |
I've heard that it can decrease testosterone
link |
I've heard that it can increase testosterone.
link |
I think there's general consensus that
link |
high alcohol intake, high barbiturate intake
link |
does in fact reduce testosterone.
link |
What about modest increase of alcohol?
link |
I'm not a drinker.
link |
So I'm not asking these questions for me.
link |
I don't smoke pot quite open.
link |
I just never really liked marijuana or alcohol.
link |
They're not my thing.
link |
But many people want to know the answers to these.
link |
And the data that I've seen are very confused
link |
So what about marijuana?
link |
Does it reduce testosterone to a significant degree or not?
link |
Cannabinoids itself, whether it's THC or CBD
link |
are not going to reduce testosterone by themselves.
link |
If it's smoked marijuana,
link |
then it's very likely to increase your aromatase,
link |
which increases your estrogen.
link |
And that's going to, it's aromatizing from testosterone.
link |
So that is going to decrease testosterone.
link |
When you have an increased estrogen, like estradiol,
link |
that's going to work on your pituitary
link |
to make less hormones that cause the release of testosterone.
link |
So you're going to have less LH and less FSH.
link |
So it's almost kind of like,
link |
opiates are well known to opiate agonists.
link |
They're going to decrease LH and FSH
link |
and subsequently testosterone.
link |
Smoked marijuana will as well.
link |
As far as alcohol,
link |
high alcohol will decrease testosterone
link |
as will any very potent GABA agonist,
link |
whether it's a barbiturate or a benzodiazepine
link |
or a non-benzo or alcohol, they're definitely going to.
link |
Moderate alcohol, I guess it depends
link |
on what your definition of that is.
link |
I mean, like some people I know
link |
that don't seem to be alcoholics,
link |
at least by my assessment,
link |
will have a glass or two of wine four nights a week,
link |
which to me seems like a tremendous amount
link |
only because I don't like alcohol.
link |
I don't have a problem with other people liking alcohol,
link |
but I think for many people,
link |
that would be considered low or moderate intake.
link |
Yeah, I would consider that low intake.
link |
The American Heart Association for Men
link |
recommends between one and two drinks a day on average.
link |
They recommend it?
link |
Yeah, so around one per week.
link |
Wait, so I'm making my heart less healthy
link |
by not drinking alcohol?
link |
Yeah, they recommend a very low amount
link |
of alcohol intake for men.
link |
For women, they recommend zero to one.
link |
So that's kind of hard to interpret, zero to one.
link |
But the protective effect of alcohol,
link |
especially if it's a red wine with polyphenols in it,
link |
outweighs the deleterious effect.
link |
Interesting, because I've seen some studies
link |
that point to the idea that even low intake of alcohol
link |
over a prolonged period of time
link |
might actually decrease brain volume,
link |
or at least volume of particular brain areas.
link |
But of course, we don't know the consequence
link |
of decreasing the volume of a given brain area either.
link |
I mean, one can imagine it's decreasing the size
link |
of one's amygdala and making them less stressed,
link |
although there's no evidence to support that.
link |
I've been told that I need a drink many, many times,
link |
but I always reply that I don't need to drink anything
link |
in order to speak my mind.
link |
So again, individual differences.
link |
Very interesting, so it sounds like smoked marijuana
link |
may in fact reduce testosterone,
link |
or at least increase the conversion
link |
of testosterone to estrogen, correct?
link |
And with alcohol and gaba agonist,
link |
it's important to remember that it shouldn't be daily.
link |
So one drink of alcohol a day
link |
is actually very mildly immunosuppressive.
link |
So it's better to have two drinks of alcohol
link |
one day of the week, and then two more drinks of alcohol
link |
another day of the week,
link |
and then no alcohol the rest of the time.
link |
The same could be said even for supplements
link |
that have gaba in them.
link |
A lot of sleep supplements have immunobutyric acid,
link |
I occasionally take, oh, sorry to interrupt.
link |
I occasionally take 100 to 200 milligrams of gaba
link |
in order to enhance sleep,
link |
but I do it maybe every third or four nights,
link |
no more than three or four nights a week.
link |
Yeah, that's perfect.
link |
So there's a lot of sleep supplements
link |
that should not be taken daily.
link |
And gaba is one of them.
link |
Another one of them is trazodone.
link |
And melatonin is kind of arguable,
link |
and it depends on the situation.
link |
But in general, if you're taking a sleep supplement,
link |
it should not be taken every night.
link |
The sleep supplements that I understand are okay
link |
to take every night or nearly every night
link |
are things like magnesium threonate, apigenin.
link |
If that's not true, correct me.
link |
I certainly take them every night
link |
unless I forget them back home when I'm traveling.
link |
Magnesium is one of the exceptions.
link |
L-theanine is also another exception.
link |
Great, well then at least I haven't put anything
link |
into the world that's wrong in that category yet.
link |
And hopefully I won't.
link |
But if I do, I'll correct myself.
link |
So let's talk about testosterone in males.
link |
You see these headlines all the times now
link |
that testosterone levels are dropping,
link |
sperm counts are dropping,
link |
phenotypes of men are changing over time.
link |
And I can't quite follow the literature on that
link |
because obviously those are hard controlled experiments to do
link |
because techniques change over time
link |
and sensitivity of techniques change over time.
link |
But regardless, I'm aware that a lot of people
link |
are considering increasing their testosterone
link |
by taking testosterone.
link |
A few years ago, that was considered steroid use
link |
and it was really extreme kind of stance.
link |
Nowadays, it seems like there's more discussion about it.
link |
First off, I'd like to know,
link |
does testosterone supplementation,
link |
and here I'm talking about prescription from a doctor,
link |
does it make one more prone to prostate cancer?
link |
That seems to always be the first question that comes out.
link |
Yeah, and there is a huge amount
link |
of misinformation about this too.
link |
So testosterone is not going to cause a prostate cancer.
link |
However, normal aging causes prostate cancer
link |
and testosterone will grow your prostate cancer.
link |
So if you're a 80 year old male and you have an autopsy
link |
and there's at least a 50% chance
link |
that you have a prostate cancer,
link |
if you're 90 or a hundred years old,
link |
there's at least a 90% chance.
link |
So for humans with a prostate,
link |
it's only a matter of time until you get a prostate cancer.
link |
So that begs the question,
link |
do you want to take something that's going to grow it
link |
for sure once you have it?
link |
So it's an individual assessment
link |
and it's important to follow things like PSAs as well.
link |
So a PSA of four or less,
link |
I mean, ideally you wouldn't be at four
link |
because that's kind of the upper threshold,
link |
is the simplest readout of whether or not
link |
there's excessive prostate growth.
link |
There's benign prostate hyperplasia
link |
where the prostate is growing,
link |
but it's non-cancerous, correct?
link |
And then of course there are the symptomologies,
link |
like people have challenges of urination,
link |
they have sexual difficulties, et cetera.
link |
I'm always struck by the correlation
link |
that people draw between testosterone and prostate health
link |
and the fact that, or I should say the claim
link |
that testosterone makes prostate health worse,
link |
because if you think about it,
link |
young males have high testosterone often,
link |
if not always, certainly often,
link |
and you don't see a lot of prostate overgrowth
link |
and cancer in young males.
link |
So something's going on here.
link |
How should we conceptualize this?
link |
So if you have a PSA of 3.9
link |
and you're a 25-year-old male
link |
versus a 75-year-old male,
link |
and you have a PSA of 5.9,
link |
the 3.9 PSA is significantly more concerning.
link |
So think of your prostate as taking cumulative damage
link |
from not only testosterone,
link |
but also estrogen and also growth hormone.
link |
So that's why obese individuals
link |
have higher incidences of prostate cancer as well,
link |
is because they don't have those cell checkpoints
link |
where your immune system takes a second
link |
and says, all right, stop replicating
link |
as fast prostate cells.
link |
Let's see if there's any atypical ones,
link |
and then it finds those
link |
and it prevents them from reproducing.
link |
That's why immunotherapy and cancer is so promising,
link |
is because they can target these certain things.
link |
So the older male is going to have
link |
that cumulative damage happen already,
link |
and arguably prostate cancer is a normal,
link |
with aging, fast aging is abnormal,
link |
very slow aging is normal.
link |
There's a fine line to walk between those two,
link |
but there's a lot of things that can be done
link |
to decrease the turnover, decrease the inflammation,
link |
and decrease the congestion of the prostate over time.
link |
There's also a lot more than just PSAs that can be done.
link |
There's prostate MRIs and things like that.
link |
They can look at the structure
link |
and the function of the prostate.
link |
So what should every male do
link |
to maintain the health of their prostate?
link |
And I realized that younger males
link |
probably aren't thinking about it at all,
link |
although it seems like nowadays,
link |
I get these kind of what I call cryptic questions.
link |
I think women are more comfortable talking
link |
about their hormone and sexual health
link |
because of menstrual cycles.
link |
They're used to fluctuations that sort of give them
link |
the experience of what it's like to have different levels
link |
of progesterone, estrogen, testosterone, et cetera.
link |
I get these kind of cryptic questions
link |
often in my direct messages,
link |
where what I think people are asking is,
link |
is there something wrong with my prostate?
link |
What should I do for my prostate?
link |
These are often indirect questions
link |
for other aspects of their life where they're suffering.
link |
And I don't say that in jest.
link |
I think more direct discussion would be great.
link |
So what should all males do to maintain prostate health
link |
throughout the lifespan?
link |
Maintaining prostate health can be looked at
link |
similarly how you can maintain
link |
a good natural optimal testosterone.
link |
So you look for things that can hurt it.
link |
You don't necessarily look for one thing
link |
that can improve it or boost it.
link |
So for young males, those are prostatitis.
link |
So it goes hand in hand with epididymitis.
link |
So different infections of the prostate.
link |
The younger the male is, the more likely it is
link |
related to something that could be
link |
sexually transmitted.
link |
But another very common cause is what we call
link |
gram-negative and anaerobic bacteria.
link |
The prostate is right by the end of the colon.
link |
So if you have chronic constipation,
link |
or if you have colitis,
link |
or if you have, you know,
link |
even just an E. coli overgrowth in the colon
link |
is very likely to cause an infection
link |
of the prostate as well.
link |
What should males do to prevent that?
link |
Have a diet that has good healthy prebiotic fiber,
link |
probiotics as well.
link |
Make sure that they're having regular bowel movements,
link |
that they don't have chronic constipation.
link |
Have good sources of dietary fiber,
link |
which is also known as soluble fiber,
link |
and enough insoluble fiber.
link |
Most people get enough insoluble or non-dietary fiber.
link |
So that can help prevent the chance of diverticulitis,
link |
which is another type of infection.
link |
It can also decrease the chance of colitis
link |
and decrease the chance of prostate infections as well.
link |
Are there any foods and or supplements
link |
that men should take or avoid?
link |
What about, you hear about salt palmetto.
link |
Yeah, supplements for,
link |
supplements that support or cause issues for the prostate.
link |
If there's a strong genetic predisposition
link |
to enlarged prostates,
link |
or even just really early prostate cancers that grow fast,
link |
then they could consider taking salt palmetto
link |
or even curcumin as an anti-androgen,
link |
as long as they're able to tolerate it.
link |
It's an individualized basis and depends on their history.
link |
As far as making sure that their prostate is not congested,
link |
there's an interesting correlation
link |
between having girls and having prostate cancer.
link |
Having girls offspring.
link |
So if your offspring are females,
link |
then you're slightly more likely to have prostate cancer.
link |
There is some, there's hypotheses that link estrogen
link |
to prostate cancer rather than testosterone.
link |
So if you have hyper estrogenism,
link |
your prostate has more atypical cells.
link |
In general, the higher your C-reactive protein,
link |
which is a general marker of inflammation in your body,
link |
and the test order is HS-CRP or high sensitivity CRP.
link |
If your CRP raises up very high,
link |
if you have an autoimmune disease,
link |
like if you have a Crohn's flare,
link |
or if you have a lupus or an infection
link |
or a sexually transmitted infection
link |
or even a colitis or even the flu,
link |
your CRP is going to raise significantly.
link |
That you would detect in a blood test, of course.
link |
So you want to get a baseline CRP
link |
when you haven't had any of those things recently.
link |
And if your CRP is higher,
link |
you also have more female offspring.
link |
If your CRP is higher, then your reactive oxygen species,
link |
which are causing mutations
link |
and atypical cell turnover in the prostate,
link |
are also likely higher.
link |
So you want to keep a very low CRP.
link |
And what about blood flow and pelvic floor in general?
link |
We should probably do a whole episode on pelvic floor.
link |
You know, there's so much interesting data coming out
link |
of the fields of clinical and research urology.
link |
I realize it's kind of the Netherlands
link |
of biology and medicine.
link |
People probably aren't thinking so much about this,
link |
but pelvic floor is obviously a confluence
link |
of a ton of vasculature, of nerves.
link |
And of course the prostate resides there.
link |
And of course the genitals reside there as well.
link |
So I would imagine that one of the six pillars,
link |
you know, exercise,
link |
being able to maintain adequate blood flow
link |
to those regions is key.
link |
What about just postural things?
link |
People sitting too much, not hydrating well enough.
link |
You mentioned avoiding constipation.
link |
But what are some other things,
link |
including medications that can serve
link |
to support the prostate over time
link |
and maybe even support pelvic floor in general,
link |
both in males and females over time?
link |
And this is something that's rightfully getting
link |
more and more attention.
link |
The way I explain the pelvic floor is your abdominal cavity,
link |
which includes your peritoneum
link |
or where most of your organs are,
link |
your retroperitoneum, your pelvic space.
link |
Think of it as a box and your abs are the front of the box.
link |
Your back muscles are the back.
link |
Your diaphragm is the top of the box.
link |
And your pelvic floor,
link |
that's where your port is to the outside world.
link |
Especially important, it has muscles as well.
link |
And you can do exercises.
link |
Pelvic floor physical therapists
link |
are becoming more and more utilized,
link |
especially after childbirth,
link |
but in other situations as well,
link |
including by men getting care from urologists.
link |
So you want to both strengthen that pelvic floor
link |
and make sure that the tubes that are docked
link |
to the outside world are working well enough,
link |
but they're not too loose.
link |
They're not working too well.
link |
So there's a lot of medications that can be positives
link |
or negatives for your pelvic floor.
link |
We kind of talked about your gut
link |
and colon health in general.
link |
As far as your prostate health,
link |
and as far as your bladder and urinary system health,
link |
you think about a couple of different classes.
link |
So you have your phosphodiesterases.
link |
You have your tadalafil.
link |
Basically, this is going to help decrease congestion
link |
A lot of people take it for ED,
link |
but it can actually help you decrease your-
link |
Do you define that?
link |
A lot of men take tadalafil, it's generic as Cialis,
link |
has a much longer half-life than Viagra or Levitra.
link |
It's half-life is almost a day.
link |
So you can take a very low dose of it.
link |
Instead of taking 20 milligrams,
link |
you take two or two and a half milligrams.
link |
So they're taking, you're saying that a lot of men
link |
take it for erectile dysfunction,
link |
but that at lower doses, it may have served purposes
link |
for prostate health, independent of erection.
link |
The most common scenario is if a male is waking up twice
link |
at night to pee, on average, it'll cut that down to once.
link |
So if they're waking up four times at night,
link |
then it can cut that down to twice at night,
link |
just because you have easier blood flow.
link |
We used to use other medications like Flomax,
link |
which is Tamsulosin.
link |
That's an alpha antagonist.
link |
So it basically binds to a receptor in smooth muscle,
link |
and it helps relax that.
link |
There's several other alpha antagonists.
link |
And then you also have your medications that are hormonal,
link |
like finasteride, that a lot of people take
link |
for prostate health to decrease the enlargement
link |
The periurethral area or periurethral lobe,
link |
there are several lobes of the prostate,
link |
that tends to be especially enlarged in cases of BPH.
link |
Prostate hyperplasia or an enlarged prostate.
link |
And if you are able to shrink that area,
link |
then at that point it's just a plumbing problem,
link |
and the urine is able to get by easier.
link |
Yeah, my understanding is that now there's a growing,
link |
I don't want to say a movement,
link |
but the idea of taking very low dose,
link |
like 2.5 milligram or five milligram to Dallafil,
link |
even daily, is becoming pretty common.
link |
For many men who do not have erectile dysfunction,
link |
simply to either maintain or enhance prostate health.
link |
Yeah, that's correct.
link |
do you see any negative effects of doing that?
link |
There can be negative effects.
link |
It can lower blood pressure.
link |
So theoretically it can increase your chance
link |
of vasovagal syncope.
link |
A lot of people take it as a alternative to pump
link |
because it kind of works similarly to citrulline
link |
or different pump products in pre-workout.
link |
And it can certainly help with that.
link |
But if you're about to go do a deadlift
link |
where you might pass that anyway,
link |
it can certainly increase the chance that that happens
link |
because you don't have
link |
that compensatory exercise hypertension response.
link |
Could someone just take it away from exercise?
link |
If you took to Dallafil,
link |
then that's going to be,
link |
has a long half-life.
link |
Whereas Viagra and Levitra is just a few hours.
link |
Dallafil is almost today.
link |
Some interesting studies on Viagra have been done as well.
link |
It can potentially alter your rays and cones in your eye.
link |
So the usual recommendation for pilots
link |
that need to have red-green discrimination
link |
from very long distances with very small indicator lights
link |
is to not take Viagra.
link |
So I usually say if you're a pilot
link |
and that's your profession,
link |
perhaps hold off from that for a while.
link |
There's also studies with Viagra that significantly,
link |
which is also known as sildenafil as the generic now,
link |
it can increase eyebrow hair growth.
link |
So potentially what it does is it helps vasodilate
link |
and relax the veins, especially in older men.
link |
And when those veins are relaxed,
link |
you have better blood flow.
link |
That's one of the proposals or theories
link |
behind why older men get the androgenetic alopecia more.
link |
You're having less blood flow in the scalp.
link |
So theoretically it can also help prevent that.
link |
So in theory increasing blood,
link |
oh, because it increases blood flow systemically
link |
throughout the body, not just in specific tissues.
link |
Well, I find it incredibly interesting that, yeah,
link |
there are these online forums building up now
link |
around low dose to dalafil,
link |
daily use of low dose to dalafil, again,
link |
not for sexual or erectile dysfunction,
link |
but for sake of long-term prostate health.
link |
Is there any reason why women
link |
might want to take low dose to dalafil?
link |
To dalafil is also a weak androgen receptor sensitizer,
link |
kind of like L-carnitine,
link |
where the density of the available androgen receptors
link |
to bind increases slightly.
link |
So there could potentially be a benefit from that,
link |
but most of the time it's used in men.
link |
We haven't really talked about testosterone
link |
and optimizing testosterone in males.
link |
Assuming someone is paying attention to the six pillars,
link |
there's a kind of a gap as I see it
link |
between doing all those things
link |
and TRT, hormone replacement therapy.
link |
And again, the R, the replacement in TRT
link |
is a little bit of a, in quotes nowadays,
link |
because a lot of people who have testosterone
link |
in that 300 to 900 nanogram per deciliter range
link |
opt to take low dose testosterone anyway.
link |
My understanding is that there've been some new kind
link |
of movements in this area toward, for instance,
link |
not doing big, large doses injected infrequently,
link |
but rather low doses quite frequently.
link |
Obviously prescribed by a doctor,
link |
monitored by a doctor, et cetera.
link |
Is that generally what you like to see in your patients
link |
if they're going to take this route?
link |
If they're a hypogonadal patient whose benefits outweigh
link |
risks of TRT, then you want to have a nice,
link |
even steady state.
link |
It's not going to be exactly the same as producing
link |
pulsatile testosterone release endogenously
link |
from your own body.
link |
When you have a steady state,
link |
you don't have a peak or a trough.
link |
And when you have a peak,
link |
that's when the androgen receptor gene is overactive.
link |
That's when you get more erythropoietin or EPO release.
link |
And that leads to a lot of the side effects of thick blood.
link |
So higher hemoglobins and hematocrits.
link |
And then when you have a crash, you don't feel good.
link |
So it's definitely not optimal.
link |
There's a lot of ways to get around this.
link |
So when you're doing testosterone replacement,
link |
if you're someone that needs it,
link |
you can have different types of esters,
link |
or you could do topical testosterone.
link |
So the ester is basically something that's attached
link |
to increase the biological half-life.
link |
The most common ones are cipunate and anthate.
link |
There's also a very short-acting propionate,
link |
which has almost no clinical relevance.
link |
And there's also very long-acting ones,
link |
decanoate and undecanoate,
link |
and different mixtures of all those.
link |
So if you're someone who has a very, very low SHBG,
link |
you're going to have trouble of regulating
link |
your serum testosterone in the long run.
link |
If you do it topically, then the testosterone is absorbed,
link |
hopefully bound to SHBG.
link |
And then a lot of times you reapply twice daily
link |
or once daily, but you have lots of variations.
link |
So for most people,
link |
especially for people who can absorb it well,
link |
that's not going to be a great option.
link |
So injections would be preferred.
link |
Most people end up injecting
link |
because they have either side effects from too high,
link |
too low, or just too much of a varied dose
link |
when they do topical.
link |
There's also a capsule with a special lymphatic absorption.
link |
So it's not being absorbed through the liver.
link |
It's not hepatically metabolized,
link |
but it's absorbed through the lymph.
link |
And it's essentially the testosterone undecanoate
link |
and then put into a capsule.
link |
So, and that's taken twice daily.
link |
It has fairly steady half-lives,
link |
but you have to take it at specific times of the day.
link |
So that being said, and it's new enough
link |
to where there isn't a huge amount of data on it,
link |
but it is FTA approved.
link |
So it is brand name now.
link |
It's called Jatenzo, but the injectables in general,
link |
the lower your SHBG, the longer of an ester you want,
link |
because when you inject it,
link |
whether it's intramuscular or subcutaneous,
link |
just talk to your doctor about the risks
link |
and the benefits of those.
link |
Subcutaneous has slightly longer active half-life
link |
because the ester races take longer to reach
link |
that cipunate or an ester to cleave it.
link |
So most men, a lot of people ask me about
link |
what a usual dose is.
link |
For most people, it would be a total of about 100 to 120
link |
per week for an actual replacement dose.
link |
Milligrams, 120 to 100 milligrams per week
link |
administered two to three times per week.
link |
And you're not, so you're saying dividing that
link |
into two or three, right?
link |
Because I'm sure there's a bunch of people out there
link |
thinking, oh yeah, 100 three times a week,
link |
which is actually quite high dose.
link |
Yeah, there really does seem to be a shift
link |
toward spreading these dosages out into,
link |
dividing them into two or three smaller doses.
link |
And then along those lines, five, 10 years ago,
link |
it was common to hear about inhibiting estrogen
link |
through aromatase inhibitors.
link |
Nowadays you hear, and I think it's true,
link |
at least by my read of the literature,
link |
that that inhibiting estrogen can disrupt brain function,
link |
can cause connective tissue issues,
link |
and even can cause reductions in libido.
link |
So a lot of people think that estrogen,
link |
if you crash estrogen, that basically libido goes up,
link |
but actually the opposite is often true.
link |
You don't want estrogen too high or too low.
link |
And for that reason, do you shy away
link |
from people taking aromatase inhibitors?
link |
Yeah, very few people truly need an aromatase inhibitor.
link |
There's almost always lifestyle interventions.
link |
It can just depend on which gene,
link |
how active your aromatase gene is.
link |
Some people's aromatase gene is very active.
link |
A lot of times these individuals have
link |
pubertal gynecomastia, which is breast tissue growth
link |
in males, even despite no other risk factor.
link |
Even if they're lean?
link |
Some people get it if they're lean.
link |
I remember growing up, there were a few kids
link |
that got mild cases of gynecomastia that were transient.
link |
Like it's sort of like they developed gynecomastia
link |
and then it went away.
link |
Often it's unilateral on one side too.
link |
So growth hormone a lot of times is the fuel to that fire.
link |
Yeah, there were a couple of kids.
link |
I mean, they took some teasing,
link |
because back then there wasn't online discussions
link |
about hormones and things like that,
link |
but then it would seem transient.
link |
And they were, the people I'm thinking of
link |
were actually lean individuals.
link |
So they weren't overweight,
link |
which of course can cause gynecomastia
link |
because adipose fat tissue can convert testosterone
link |
So it sounds like, except in special cases,
link |
that avoiding aromatase inhibitors
link |
is probably going to be a good idea.
link |
There's several other ways
link |
that you can control your estrogen
link |
and keep it at a healthy level,
link |
which you do have to check.
link |
There's a lot of patients who assure me
link |
that their estrogen is going to be sky high
link |
and it's actually very low and vice versa.
link |
But calcium D-glucarate is a supplement
link |
that can help with estrogen control.
link |
What's a typical dosage of calcium D-glucarate?
link |
500 to 1000 milligrams.
link |
But is there the risk that if someone's estrogen
link |
is in normal range and they take the supplement
link |
that their estrogen will go too low,
link |
is it that potent?
link |
It's not that potent.
link |
It's not near as potent as an aromatase inhibitor.
link |
So it helps with excretion
link |
and also the sensitivity of the estrogen receptor itself.
link |
It kind of like helps out-compete it.
link |
Some people will also take DIM
link |
or different cruciferous vegetable.
link |
They get them from cruciferous vegetables like kale
link |
And that is both an anti-estrogen and an anti-androgen.
link |
So if you're on TRT and you're on that,
link |
then you're probably just on too much TRT.
link |
Yeah, I remember a few years ago I had a friend
link |
and it truly is, it's not like I have a friend's thing.
link |
Because I'm very cautious about which supplements I take.
link |
I think people might get the impression
link |
that I'm very cavalier about this, but I'm not.
link |
I always alter one thing at a time.
link |
I talk to physicians.
link |
What I suggest other people do,
link |
I actually do and have done for a long period of time.
link |
And I recall wanting to take DIM
link |
because I thought, well, back then you hear,
link |
okay, reduce estrogen.
link |
My estrogen levels weren't out of range, so they were fine.
link |
But I thought, well,
link |
what would the experience be of bringing those down?
link |
But someone I know is quite informed in this area,
link |
said, yeah, exactly what you said,
link |
which is that DIM can reduce estrogen, but also testosterone.
link |
So I just never opted to try and take it.
link |
I do want, we're sort of erring in this direction,
link |
but we went straight from the six pillars to TRT
link |
or to what some people now call sports TRT,
link |
which is basically code language for saying,
link |
taking exogenous testosterone,
link |
even though one doesn't need it to get into a semi
link |
super physiological range or a high end,
link |
like 900 to a thousand nanogram per deciliter range.
link |
And people always point out, I should mention that,
link |
oh, well in certain countries,
link |
the high end range is 1200 nanograms per deciliter.
link |
In the US it's 900.
link |
And so if you're 1200, are you really super physiological?
link |
I neglected to ask about that gap in between
link |
where individuals could think about supplementation,
link |
meaning non-prescription approaches
link |
to increasing testosterone.
link |
And here we should probably also talk about things like,
link |
is it true that ice baths increase testosterone or not?
link |
Lifestyle factors that go beyond the six pillars
link |
for increasing testosterone.
link |
If you could comment on those, that would be terrific.
link |
Supplements that are useful.
link |
And it'd be wonderful if you can mention
link |
where some of these same practices and supplements
link |
might be useful for women as well as men
link |
to increase testosterone
link |
for all the reasons we talked about earlier.
link |
Yeah, so this is where a true individualized approach
link |
When you're talking about what dose of TRT you should be on,
link |
one thing to keep in mind
link |
is the law of diminishing returns.
link |
Quality of life is a subjective thing
link |
and it's different for each person.
link |
So some people are more willing to give up
link |
a little bit of athleticism or body composition.
link |
Some people are more willing to give up
link |
or not willing to give up libido or sexual health.
link |
And as we mentioned earlier,
link |
everybody's androgen receptor is less or more sensitive.
link |
So you can make a case that if somebody's androgen receptor
link |
is half as sensitive as somebody else,
link |
the person with the less sensitive receptor
link |
does need a level of 1000 or 1200.
link |
There's no great way to know that.
link |
And you can alter the sensitivity of your androgen receptor
link |
with things like L-carnitine and tadalafil as mentioned.
link |
And we'll definitely come back to L-carnitine
link |
because I'm really intrigued by the data on L-carnitine,
link |
both for women and men in terms of egg quality,
link |
sperm quality, fertility,
link |
and a bunch of other interesting effects.
link |
So we'll come back to L-carnitine.
link |
But a lot of how you feel, the biofeedback or subjective,
link |
I feel like this comes from the ratio of your androgens
link |
to your estrogens.
link |
And a lot of that is lifestyle.
link |
So if someone's also an HCG,
link |
that could upregulate aromatase as well.
link |
HCG, you might want to just, human chorionic gonadotropin,
link |
found, used to be found in pregnant,
link |
is still found in pregnant women's urine.
link |
But used to be, believe it or not,
link |
there was a black market for pregnant women's urine
link |
before this stuff was developed synthetically.
link |
So in other words, what we're saying is,
link |
men typically would buy pregnant women's urine
link |
through black markets in order to get the HCG,
link |
in order to get the testosterone enhancing effects of HCG.
link |
So in other words,
link |
men were using pregnant women's urine for HCG.
link |
I do not want to know how they got it into their body.
link |
Let's just skip to what you were going to say next instead.
link |
Yeah, so that's HCG.
link |
There's a lot of other things that upregulate estrogen.
link |
Alcohol significantly increases aromatase.
link |
So if you're very sensitive to estrogen,
link |
then you probably shouldn't even consume the two glasses
link |
three times a week.
link |
High fat meals also upregulate aromatase.
link |
So if you're on a ketogenic diet,
link |
but you have hyper-estrogenism,
link |
then you should take care with that as well.
link |
All kinds of fats or just saturated fats?
link |
I'm not sure if it's just saturated fats,
link |
but fat definitely increases both fat in your body
link |
and consumption of a high amount of calories
link |
increases aromatase.
link |
So it's the ratio of testosterone to estrogen.
link |
I don't want to break your flow,
link |
but since we're talking about fat,
link |
I have to ask since estrogen and testosterone
link |
are both synthesized from the cholesterol molecule,
link |
I've heard that ingesting some amount of saturated fat
link |
can be useful because of the way that cholesterol
link |
can serve as a precursor to these molecules.
link |
Now, I once said on a podcast that I like butter so much
link |
that I occasionally eat pats of butter.
link |
Somehow that got misinterpreted to mean
link |
that I eat entire many pats of butter.
link |
I'm talking like one or two pats of butter here and there,
link |
and I have no guilt or shame about it.
link |
My blood lipids are in great shape also,
link |
But is it possible that people who are ingesting
link |
too little of saturated fats could directly or indirectly
link |
reduce or somehow disrupt the proper ratio
link |
of testosterone to estrogen in men and women?
link |
It's theoretically possible,
link |
but it probably doesn't happen in developed countries,
link |
just like it's theoretically possible
link |
to have not enough omega-6 fatty acids,
link |
but that probably does not happen in developed countries.
link |
So I don't need the butter pats,
link |
but I'm going to do it anyway.
link |
Grass-fed butter has good omega-3 content as well.
link |
So grass-fed foods in general,
link |
you know, it's not the end all be all,
link |
and everybody doesn't need grass-fed foods,
link |
but they are one of the only sources of healthy trans fat.
link |
So a naturally occurring trans fat comes from ruminants.
link |
So ruminants that I think of like cows
link |
and the rumination in the different stomachs
link |
can change your omega-3 and omega-6
link |
to trans linolenic and trans linoleic fatty acids.
link |
Which are healthy for us.
link |
Yeah, so it's actually omega-3s and omega-6s
link |
that just happened to have a trans instead of a cis isomer.
link |
So, and these healthy trans fats would be found
link |
in ruminant cheese and milk and butter from ruminants
link |
So, and for people who are following
link |
a purely plant-based diet or mostly plant-based diet,
link |
are they at risk of not getting enough
link |
of certain types of fats or other nutrients
link |
to maintain that healthy ratio of testosterone to estrogen
link |
If they're a vegetarian, they're probably not at risk.
link |
If they're a vegan, they very well could be at risk.
link |
Most vegans are aware of this very acutely
link |
and they'll supplement with, you know, algae
link |
or they'll supplement with other sources of healthy fats.
link |
So, the takeaway that I'm drawing from this
link |
is that less so than getting saturated fat,
link |
it's key to get these healthy trans fats from ruminants
link |
or the food products of those ruminants
link |
as well as to get proper amounts of omega-3s.
link |
And to be clear, you don't need any trans fats.
link |
It just happens that those omega-3s and omega-6s
link |
are in a trans isomer.
link |
Okay, so that's nutrition.
link |
What other supplements can support
link |
healthy testosterone to estrogen ratios?
link |
Anything that alters aromatase
link |
can support healthy testosterone to estrogen.
link |
And your testosterone to estrogen ratio,
link |
think about it as how much estrogen activity
link |
do you have at the beta estradiol receptor
link |
and your alpha estradiol receptor.
link |
How would I know that?
link |
So, it's hard to tell, but depending on what you're eating,
link |
if you have a lot of plant-based diets or polyphenols,
link |
many of these are beta estradiol receptors.
link |
People know about turkestrone and also beta-ectisterone,
link |
which are two ectisteroids
link |
that are beta estradiol receptor agonists.
link |
So, they activate the beta estradiol receptor.
link |
So, if you have a very low amount of estrogen naturally,
link |
you're probably a better candidate for it.
link |
For taking to turkestrone or ectisterone.
link |
I've never tried them, but I know my understanding
link |
is that they work tremendously well for some people
link |
and not at all for others.
link |
And so, one just simply has to try.
link |
But in promoting the activity of this estrogen receptor,
link |
is there a risk that turkestrone or ectisterone
link |
could cause some of the quote-unquote problems
link |
associated with increasing estrogen activity,
link |
like reduced libido, water retention?
link |
Water retention, yes. Reduced libido, probably not.
link |
Closing growth plates in the bone, no,
link |
because that's the alpha estradiol receptor.
link |
I've talked before on a couple of podcasts
link |
about tonga ali, which is this Indonesian herb.
link |
I guess it's also made and found in Malaysia,
link |
but it seems to be the Indonesian variety of tonga ali
link |
that's most effective for potentially
link |
for reducing sex hormone and binding globulin
link |
and thereby freeing up testosterone.
link |
Whether or not the effects are through that pathway,
link |
through another pathway,
link |
a lot of people report improvements in things like libido
link |
and maybe androgen-like phenotypes, right?
link |
Feeling more vital, et cetera.
link |
And of course, some of that could be placebo, correct?
link |
But what are your thoughts on tonga ali?
link |
And please challenge my statements about tonga ali
link |
if they're incorrect.
link |
I'm not looking for validation here.
link |
I just really want to know what your thoughts are on it.
link |
Do you ever recommend it to patients?
link |
When men, women, one or the other?
link |
Yeah, so tongkat ali or long jack,
link |
it has multiple mechanisms of action
link |
and there have been several placebo-controlled studies on it.
link |
Some of them show decrease in SHBG.
link |
At least one of them did not show any change in SHBG.
link |
However it is, it does act on aromatase very weakly,
link |
probably not so strongly that you would have to be concerned
link |
with hypoestrogenism.
link |
So it reduces aromatase and thereby can reduce estrogen?
link |
It's also a weak, it's not a CIRM,
link |
so it's not a selective estrogen receptor modifier,
link |
but it's probably a weak, it's probably an ERM as well,
link |
or a non-selective estrogen receptor modifier.
link |
And that should help with decreasing negative feedback
link |
inhibition of estradiol in various locations
link |
and also increasing testosterone.
link |
Interesting. Yeah, the dosage that I've been using
link |
for years now is, I think it's 400 milligrams
link |
taken once a day, typically early in the day,
link |
cause it can kind of have a mild stimulant effect,
link |
And I know that some of the products out there
link |
recommend dosages that are much higher.
link |
Anytime I've taken more than 400, I don't feel very good.
link |
I don't know how to describe it other than it's just
link |
a little over stimulatory in terms of,
link |
makes me kind of, it's like drinking too much coffee.
link |
Yeah. So that's interesting.
link |
And so would women ever want to take Tonga Ali
link |
So there's a lot of women that have hyper-estrogenism
link |
and unlike adrenal fatigue or andropods,
link |
there's actually ICD-10 codes for hyper-estrogenism.
link |
Yeah. That's doctor speak, right?
link |
So there's codes to where your doctor
link |
can actually diagnose you with something.
link |
So if you go to your doctor and you say,
link |
I have adrenal fatigue,
link |
they can't diagnose you with that.
link |
Or if you say, I have andropods,
link |
they also can't diagnose you with that.
link |
But if you say you have hyper-estrogenism,
link |
the most common complaint that comes with it
link |
is endometriosis, which is overgrowth
link |
of the lining of the uterus.
link |
And those people could potentially,
link |
I think that's one area where we might see
link |
Tongkat supplementation more and more,
link |
because not only does it decrease aromatase,
link |
like we mentioned, testosterone in females is higher
link |
than estrogen in females.
link |
So a lot of females get estrogen from aromatization as well.
link |
Peripheral estrogen is sometimes what we call it,
link |
because it's not directly produced in the ovaries,
link |
but they could be good candidates for Tongkat
link |
if that's the case.
link |
And my understanding is that people should be looking
link |
for sources of Indonesian Tongkat, Ali, in particular.
link |
Another interesting application is essentially a,
link |
I'll call it a PCT, but essentially what that means is,
link |
PCT means how defined it is, post-cycle therapy.
link |
Physicians love acronyms, scientists love acronyms,
link |
military love acronyms, but yeah, PCT, post-cycle therapy.
link |
So this would be people coming off hormone therapy
link |
This would actually be for women that are coming off
link |
of their birth control pill,
link |
because perhaps it can help lower that SHBG back to normal,
link |
which is sometimes persistently elevated,
link |
and then it can help prevent
link |
the subsequent hyper-estrogenism that happens.
link |
Does Tongkat, Ali, need to be cycled?
link |
When I first started taking it, I would cycle it.
link |
I would do a few, three, four months,
link |
and I would take some time off.
link |
Now I've just been taking it continuously for years.
link |
And I should say, I do blood work to check my liver enzymes
link |
and everything else.
link |
And I don't see any reason for me to cease taking it.
link |
Yeah, probably not.
link |
There's been human studies on both Tongkat and Fidosia.
link |
And full disclosure, I did help design
link |
Derek's new testosterone optimization supplement,
link |
which has both Fidosia arrestris
link |
and also Tongkat, Ali, in it.
link |
Yeah, let's talk about Fidosia separately in a moment.
link |
But let's say someone is only taking Tongkat, Ali
link |
for whatever reason, but do they need to cycle off?
link |
Likely not, but I would just to be safe
link |
because it does both affect your aromatase
link |
and it's an estrogen receptor modifier.
link |
And what would be a reasonable cycle off?
link |
So how long to take and how long to stop
link |
before taking again?
link |
Yeah, there's a couple different protocols
link |
that you can do, but 11 months on,
link |
one month off for Tongkat is pretty reasonable.
link |
Now, I guess this is, we'll talk about this later too,
link |
but if it's combined with Fidosia,
link |
the protocol that I would do is three weeks on,
link |
So that's Tongkat, Ali.
link |
But I'm curious what your thoughts are
link |
on Fidosia aggressis, this Nigerian shrub,
link |
or this extract from Nigerian shrubs,
link |
that at least in my experience,
link |
in my read of the literature,
link |
has the potential to increase testosterone
link |
and probably other hormones as well
link |
by way of increasing luteinizing hormone,
link |
something that we haven't really talked about
link |
much up until now.
link |
What are your thoughts about Fidosia aggressis?
link |
What are your ideas about the proposed mechanism
link |
or mechanisms and where might this be useful
link |
for people on or off hormone replacement therapy?
link |
Yeah, Fidosia aggressis has just reached a point
link |
where we have enough evidence to we know
link |
it probably helps both with luteinizing hormone release,
link |
which stimulates latex cells in the testes
link |
to produce more testosterone,
link |
and probably with LH receptor sensitivity as well,
link |
which is a good combination of the two.
link |
It does come from the Nigerian shrub,
link |
but there is not quite enough evidence
link |
for me to be able to say,
link |
it's safe for somebody to take this all the time,
link |
which again, full disclosure,
link |
that's why I recommended that we,
link |
recommended for people to cycle this supplement.
link |
So three weeks on, one week off, that's likely safe.
link |
The only toxicity studies in general are in rats
link |
and in humans, it looks quite safe.
link |
My understanding is that the toxicity studies in rats
link |
showed toxicity to the testicular cells.
link |
So that's certainly concerning,
link |
but that the dosages that were used
link |
or translating the dosages used to humans
link |
would lead to a situation where the dosages
link |
that humans would have to take would be very, very large.
link |
So the amount of, I no longer take Fidosia,
link |
but I took it at 600 milligrams per day for a long time.
link |
And I ceased taking it because I was experimenting
link |
with other things and I didn't want to confound those things,
link |
not because I had any negative side effects.
link |
In fact, I was monitoring blood work
link |
and other biological parameters
link |
that would have told me if there was testicular toxicity
link |
and there wasn't, let's put it that way.
link |
Yeah, I think it's extremely safe.
link |
And I'm just not convinced
link |
that there's enough overwhelming evidence
link |
for long-term consistent administration.
link |
So do you recommend this to people who are not taking TRT?
link |
And do you recommend to men and women?
link |
Yeah, so if you have a really high LH,
link |
then there's probably a gonadal issue,
link |
whether it's heat damage to the testes, a varicocele,
link |
a history of testicular cancer,
link |
where your LH is going to be higher.
link |
So if your LH is already very high,
link |
increasing it even more is probably not going to help.
link |
However, if your LH is low,
link |
then obviously try to find out if it is low.
link |
Is it deficient or is it just a little bit low?
link |
If it's low and you don't have an issue with prolactin,
link |
you don't have an issue with opioid receptor antagonism,
link |
then naltrexone can actually potentially help antagonize
link |
that to increase LH as well,
link |
especially in people recovering from opiates
link |
or likely even alcohol.
link |
So you're looking for a subclinical secondary hypogonadism,
link |
which is essentially, just think of that as low LH.
link |
So in people with that lower LH and their estrogen is fine
link |
and their prolactin is fine,
link |
then Fidogia is a particularly good option.
link |
Interesting, so three weeks on, one week off
link |
for 600 milligrams Fidogia, 400 milligrams Tonga Ali,
link |
Indonesian Tonga Ali could potentially be good.
link |
And of course, everyone should always check
link |
with their physician, clear this, do blood work, et cetera.
link |
I would say, we don't just say that to protect us.
link |
We say that to protect you,
link |
meaning that the consumer is very, very important.
link |
You don't want to get,
link |
you don't want to fly blind with any of this stuff.
link |
You want to do blood work, right?
link |
That's the catch-22 with supplements,
link |
is most of them are safer than medications,
link |
but the only difference between them and a medication
link |
is one's prescribed and one's not.
link |
And oftentimes with supplements,
link |
it's unclear whether or not what's listed on the bottle
link |
is actually what's in the bottle,
link |
but I think there are a number of reputable brands now.
link |
The other supplement I want to talk about
link |
in terms of testosterone augmentation is Boron.
link |
What is Boron thought to do?
link |
Does it actually do that?
link |
And do you ever recommend Boron?
link |
Yeah, so Boron is actually an element
link |
and you can find it on the periodic table.
link |
It's more plentiful in rich soils.
link |
So frequent farming can deplete the soils of Boron.
link |
It's very plentiful in the Mediterranean area,
link |
like Greece and Turkey.
link |
So a lot of people will just eat dates or raisins
link |
that are grown there.
link |
I thought you were going to tell me people eat dirt,
link |
but there are people who eat dirt.
link |
And there's a phenomenon called pica, right?
link |
Where people in a, and that's not a good thing.
link |
Often a sign of iron deficiency.
link |
Okay, but they're eating grapes and dates
link |
that were grown in soil that has high amounts of Boron?
link |
So Boron can help regulate SHBG,
link |
but its effect is mostly acute.
link |
So it's unlikely to have a bad effect.
link |
So a lot of people take Boron
link |
because it's probably not going to hurt
link |
and it will lower SHBG,
link |
even if it is for a short period of time.
link |
So I guess you can make a case
link |
that maybe cycling Boron can help too.
link |
What sorts of dosages are useful for Boron supplementation?
link |
Three to six milligrams, once to twice a day.
link |
So that's higher than the amounts that I've been taking.
link |
I've long been doing this cocktail of Tonga Ali.
link |
Again, I stopped taking Fidogia,
link |
but for a long time with Fidogia and Boron,
link |
I think it was two to four milligrams per day,
link |
but maybe I could afford to go higher.
link |
Although my blood work is where I want it, thankfully.
link |
Sort of circling back to Fidogia,
link |
Fidogia was attractive to me as a supplement
link |
because I saw increases in LH,
link |
testosterone and free testosterone.
link |
My estrogen stayed in check,
link |
but I also did not see a down regulation of LH
link |
when I would cycle off.
link |
Whereas with HCG, human cortionic gonadotropin,
link |
which does now arrive in forms
link |
not from pregnant women's urine only,
link |
but the synthetic forms that people inject,
link |
that as I understand it can actually suppress hormone,
link |
endogenous hormone output
link |
if one takes it for a long period of time.
link |
So why would a man or woman want to take HCG
link |
and what are the potential risks and benefits of taking HCG?
link |
Yeah, so HCG or human cortionic gonadotropin
link |
is actually very similar to TSH.
link |
So if you- Thyroid stimulating hormone.
link |
So when a woman is pregnant, she produces more HCG,
link |
especially in the first trimester.
link |
When you take a pregnancy test,
link |
whether it's qualitative or quantitative,
link |
you see the HCG rise and it actually doubles every 48 hours.
link |
So if you're five weeks pregnant, you can get an HCG level.
link |
And then two days later, five weeks and two days,
link |
you can see your HCG and maybe it went from 500 to 1,000.
link |
So it precipitously increases.
link |
It does a few things.
link |
One thing is it prevents hypothyroidism
link |
or hypothyroxinemia of pregnancy,
link |
which is one of the most common causes of miscarriage.
link |
It's also why if you have hypothyroidism
link |
and you get pregnant in the first trimester,
link |
you want to increase your dose from 25 to 40%
link |
to keep your free T4 high as much as possible.
link |
And the reason why you have to do that
link |
as opposed to somebody who does not have hypothyroidism
link |
is if you have hypothyroidism,
link |
then likely your thyroid will not respond
link |
to either TSH or HCG.
link |
So the increased HCG does not compensate for that.
link |
So if you take HCG,
link |
then it can potentially improve your thyroid function.
link |
So that along with selenium are likely the two best things
link |
that you can do for thyroid health.
link |
Well, I definitely make sure I get enough selenium
link |
by eating three to five Brazil nuts per day,
link |
which I very much enjoy the taste of also.
link |
Who should take HCG and can HCG suppress
link |
one's normal luteinizing hormone output?
link |
Yeah, it suppresses LH in a dose dependent manner.
link |
So the higher the dose of HCG you take,
link |
the more it suppresses LH.
link |
A common dose for fertility,
link |
fertility is usually why HCG is prescribed.
link |
In both, is 10,000 IUs all at one time,
link |
which is quite a bit.
link |
That's a tremendous dose.
link |
Yeah, in fact, some formulations,
link |
some brand names of HCG come in auto injector pins
link |
to where you cannot even dose
link |
lower than 5,000 units at a time.
link |
Wow, but I know a number of people
link |
who take HCG to maintain testicular function
link |
while on testosterone therapy or augmentation of some sort.
link |
Does it work to do that?
link |
Yeah, some people are on HCG model therapy.
link |
It can be slightly better on your lipids than being on TRT.
link |
Oh, so people are using HCG alone
link |
as a kind of a sort of a hormone augment,
link |
indirect hormone augmentation.
link |
Some clinics advertise it
link |
as a non-suppressive alternative to TRT,
link |
but it is suppressive of LH.
link |
But it could also increase estrogen pretty potently.
link |
And is it true that increasing LH
link |
and or HCG can improve sensitivity of the genitals?
link |
And is that true for men and women?
link |
I've heard this anecdotally.
link |
People say HCG makes sexual activity
link |
more pleasurable for people because of some,
link |
is it a direct effect on some of the nerve cells
link |
Yeah, so LH is also an agonist in the prostate
link |
and in genital tissue in general.
link |
So it's a very common treatment
link |
for post finasteride syndrome or post 5-alpha reductase.
link |
When you've blocked the conversion of DHT for a long time,
link |
it helps re-upregulate DHT.
link |
So someone who's been taking finasteride
link |
to prevent hair loss comes off,
link |
it feels maybe because they felt lousy,
link |
but then feels even lousier
link |
for reasons that you talked about earlier.
link |
And then they might use HCG as a transition treatment
link |
to transition back to normal hormone health.
link |
It's extremely helpful in many cases.
link |
Now, when you come off the HCG,
link |
then you need to have a strategy
link |
of how to return to your normal
link |
as fast as possible as well,
link |
but it will upregulate those 5-alpha reductase enzymes.
link |
You have in your genital skin,
link |
both scretal skin and penile skin and perineum in general,
link |
you have, I believe it's called stratum lucidum.
link |
It's a skin layer that is very, very thin,
link |
but it has the highest concentration of 5-alpha reductase.
link |
So you have a lot of activity
link |
and after you've been on something
link |
that inhibits the enzyme, the 5-AR enzyme in those tissues,
link |
then you do something else to upregulate those enzymes.
link |
Whether it's waiting and taking time,
link |
whether it's trying Tidalafil,
link |
whether it's trying creatine even,
link |
or whether it's trying HCG,
link |
a lot of times those are the go-tos
link |
for post-finasteride syndrome.
link |
Any risks for women taking HCG
link |
on their ability to get pregnant or risk generally?
link |
Yeah, obviously it'll make any pregnancy test positive.
link |
So that's a risk that some women don't know.
link |
So one could in theory fake a pregnancy test
link |
I have no motivation to do that.
link |
I was just curious.
link |
What about prolactin?
link |
The simple version of this that I was taught,
link |
because I was taught mainly
link |
from the neuroendocrine perspective,
link |
was dopamine is a kind of close cousin of testosterone
link |
and also estrogen, for that matter,
link |
drives repetitive behaviors,
link |
including pursuit of sexual partners, sex itself,
link |
motivated behaviors generally.
link |
Then post-copulatory, post-orgasmic states
link |
are accompanied by a prolactin increase,
link |
sets the refractory period for mating in males
link |
and maybe even in females as well,
link |
involved in milk letdown, et cetera.
link |
What are sort of the general contours of syndromes
link |
or things that people could be on the lookout for
link |
of having too much prolactin or too little prolactin?
link |
And I'm aware of a number of people
link |
who take dopamine agonists, L-tyrosine, cabergoline,
link |
things like that, to really boost their dopamine levels.
link |
And that isn't always a good thing, as it turns out.
link |
Oftentimes people will become kind of hyper dopaminergic.
link |
And so they have the drive to do all these repetitive things,
link |
you know, fill in the blanks,
link |
but they don't always have the ability
link |
because it seems just as testosterone and estrogen
link |
need to be in the proper ratios,
link |
dopamine and prolactin need to be
link |
in the appropriate ratios.
link |
So how should we think about
link |
and perhaps act on our prolactin systems?
link |
The way I describe it is the dopamine wave pool.
link |
So if you're increasing your dopamine too much,
link |
you're going to overflow,
link |
and then you're going to have that wave crash too much.
link |
So you want to have nice, even waves
link |
that are not going too far above the pool of dopamine
link |
and prolactin will follow.
link |
So prolactin and estrogen are quite close cousins.
link |
Estrogen upregulates a gene called the PRL gene
link |
that directly increases prolactin synthesis.
link |
So prolactin is going to also inhibit
link |
the release of testosterone from the pituitary.
link |
So if you're using a dopamine agonist,
link |
then you're going to help decrease
link |
the prolactin producing cells,
link |
including if you have a prolactin producing
link |
micro adenoma in the pituitary.
link |
How common are those?
link |
Because I mean, I hear a lot about these,
link |
you know, hypogonadism or,
link |
and of course that can be due to an issue at the testicles
link |
or hypogonadism could also be of course
link |
in like ovarian syndromes.
link |
And then there's of course the brain side of it,
link |
where the signals aren't coming from the brain.
link |
You're not enough gonadotropin,
link |
not enough luteinizing hormone.
link |
And there are ways of teasing this apart
link |
through with an endocrinologist
link |
that are quite elegant in fact, right?
link |
Using stimulating hormones, too much to dive into here,
link |
but how often does one actually have
link |
one of these pituitary tumors?
link |
I have heard that people
link |
that play a lot of high contact sports,
link |
so boxing, football,
link |
people that headed the soccer ball quite a lot,
link |
sadly people whose jobs forced them to take head blows
link |
for, you know, it could be military.
link |
And so they were firing, you know, 50 caliber guns
link |
and the kind of woodpeckering of the brain
link |
inside of the skull and construction workers,
link |
or just a concussion can cause the pituitary
link |
to go malfunctional.
link |
Is that really common or is this something that,
link |
you know, is a rare, like 1%?
link |
Yeah, it's extremely common.
link |
It's another one of those conditions
link |
where a lot of people never know they have it.
link |
They just feel a little bit more fatigued.
link |
They have that high prolactin feeling all the time.
link |
Pituitary micro adenomas can be non-producing as well.
link |
So your prolactin can be totally normal.
link |
Your growth hormone and IGF-1 can be totally normal.
link |
That's the second most common producing micro adenoma
link |
is growth hormone,
link |
causing either acromegaly,
link |
which is growth of cartilage or gigantism.
link |
This is the big brow, yeah.
link |
So those are fairly common causes of adenomas,
link |
but a lot of people that have a very small adenoma,
link |
you know, much less than one centimeter,
link |
it's hard to see on imaging,
link |
even if you have a contrast
link |
that specifically looks at the pituitary,
link |
and many people aren't symptomatic.
link |
So it's one of those things along with PCOS and prediabetes
link |
that are much more frequent when it comes to prevalence,
link |
which is the amount, the percentage of people
link |
that have it in the general population.
link |
I'm glad you mentioned the dopamine wave pool.
link |
I know nowadays there's a lot of interest
link |
in augmenting dopamine.
link |
I know a number of people that do this
link |
through prescription drugs, Adderall, Ritalin, Modafinil,
link |
and those drugs, of course, hit many transmitter systems,
link |
but dopamine is certainly involved.
link |
People taking antidepressants like wellbutrin
link |
tap into that system.
link |
And of course, people are trying to inhibit prolactin
link |
and promote serotonin or reduce serotonin.
link |
To me, it all seems like a very delicate dance, right?
link |
I mean, to just imagine the arousal arc
link |
for mating behavior, for sexual reproduction,
link |
is such an elaborate dance between sympathetic drive
link |
and parasympathetic drive,
link |
even with across the span of minutes, right?
link |
I mean, I've talked about this before on the podcast
link |
that the arousal is kind of more parasympathetic.
link |
Orgasm in itself is a sympathetic response,
link |
a completely different set of neurons.
link |
And so where do you see people getting into trouble
link |
just trying to hit the gas pedal on dopamine?
link |
And where do you think there is a place for people
link |
who perhaps are experiencing low drive and motivation,
link |
not just sexual, but in general,
link |
to increase the amount of dopamine circulating
link |
in their brain and body?
link |
How do you think about that given this wave pool analogy?
link |
Yeah, so it's important to parse it out
link |
and start with the least powerful interventions.
link |
So if someone's concerned about dopamine,
link |
or maybe they have a slightly higher prolactin,
link |
then they eliminate things
link |
that could be increasing that prolactin.
link |
So casein or gluten,
link |
which are mu opioid receptor agonists,
link |
or any mu opioid receptor agonist in the gut.
link |
So casein, so milk protein?
link |
Can increase prolactin?
link |
In addition to that, they should,
link |
if they need a pituitary MRI,
link |
then they should get a pituitary MRI.
link |
If they don't have an adenoma,
link |
or if they don't have a high enough prolactin level
link |
to where they need an MRI,
link |
if they're having visual symptoms,
link |
or if they're having olfactory symptoms with the nose,
link |
then it's more likely that they do.
link |
But if they don't,
link |
a lot of times a prolactin under about 40
link |
is not too big of a deal.
link |
They can take dopamine agonists
link |
that agonize that D2 receptor,
link |
like P5P, which is essentially vitamin B6.
link |
It's pyridoxine 5-pyrophosphate,
link |
and pyridoxine is vitamin B6.
link |
So that can help 50 milligrams once to twice a day.
link |
Vitamin E can also help,
link |
especially if it's mixed to co-forals.
link |
A lot of people have the high levels of vitamin E,
link |
but low levels of the gamma form of vitamin E.
link |
So that can also help.
link |
I'm so glad you mentioned vitamin B6 and P5P.
link |
I have heard that one can shorten the refractory period
link |
essentially to be able to have sex again,
link |
to be quite direct about it,
link |
by way of vitamin B6 blunting of the prolactin response,
link |
which turns out to be quite potent.
link |
But I've also heard that vitamin B6 can be neurotoxic,
link |
especially in the periphery,
link |
that it can cause peripheral neuropathies
link |
if it's taken at high doses,
link |
but that P5P is the safer form.
link |
It's pre-activated, so it does not build up.
link |
Think of it as a allegory to how folate can build up.
link |
It's not methyl folate,
link |
but it builds up and it can increase levels of homocysteine.
link |
Or if you have too much vitamin B12,
link |
another water-soluble B vitamin,
link |
you can have too much methylmalonic acid or MMA.
link |
So depending on what your enzymatic conversion is
link |
to the active form of the enzyme,
link |
often it's just safer to take the active form of the enzyme.
link |
Yeah, very interesting.
link |
Okay, well, at risk of going down every hormonal pathway
link |
and talking about supplementation lifestyle factors,
link |
I think touching on,
link |
as we have testosterone and estrogen and now prolactin,
link |
I'd love to chat a little bit about L-carnitine.
link |
We talked about this earlier,
link |
but I want to raise this discussion about L-carnitine,
link |
not in the context of L-carnitine itself,
link |
but in the context of fertility,
link |
because my read of the literature is that L-carnitine
link |
can be very beneficial for enhancing sperm quality
link |
and egg quality and even rates of conception.
link |
What forms does L-carnitine come in
link |
that people can reasonably consider?
link |
Again, talk to your doctor, folks.
link |
What is it doing and do we know how it's doing it?
link |
And do you often use this in your patients?
link |
Yeah, so the way I think about L-carnitine,
link |
and I'll try to tie this in with creatine
link |
and other things as well,
link |
is if your cell is an energy factory or a car,
link |
then L-carnitine is the shuttle that helps get the fuel
link |
into the motor to use the motor.
link |
The motor is mostly due to lifestyle factors,
link |
so like your diet and your exercise.
link |
And the type of fuel itself is NAD+.
link |
We don't need to get into NAD precursors
link |
or NMN or NR or anything.
link |
And then the accessory fuel tank is your creatine phosphate.
link |
So creatine is your accessory fuel tank.
link |
Your NAD status, which is largely determined
link |
by your REM sleep and quality sleep and exercise,
link |
along with supplementation, is the fuel.
link |
The carnitine shuttle is carnitine palmitoyl coenzyme A,
link |
and that takes medium-chain fatty acids.
link |
It takes different molecules of fat.
link |
You have two main energy sources other than ketones.
link |
You have your glucose or carbs.
link |
You have your fat or fatty acids.
link |
And that takes it across the layer of the mitochondria
link |
so that it can be utilized.
link |
So it upregulates that.
link |
That's why things that have flagella in general,
link |
the flagella are gonna work better, like sperm.
link |
Flagella being sort of the wavy little tendrils
link |
on cell types, of which they're everywhere, right?
link |
In the gut too, right?
link |
So those are going to work significantly better.
link |
And in general, your mitochondria are going to work better.
link |
So the worse your mitochondria are off the bat,
link |
the better they're going to be helped by the shuttle
link |
that shuttles them across.
link |
It also slightly increases the density
link |
of the androgen receptor as well.
link |
Is that a local effect?
link |
So if alkaline is injected into a particular muscle,
link |
will it increase the density of androgen receptors
link |
So how are people taking L-carnitine,
link |
their capsule forms and their injectable forms?
link |
Most people are going to be taking the capsule forms
link |
because that's all they're going to have access to.
link |
And then we should also ask,
link |
can you get L-carnitine from food?
link |
So L-carnitine is just a combination of,
link |
it's actually a very small peptide.
link |
So glutathione is just three amino acids.
link |
L-carnitine is the smallest peptide, two.
link |
So peptide is just a protein that has amino acids
link |
between two and about 200.
link |
And L-carnitine is just two amino acids.
link |
So it's like a micro peptide.
link |
Yeah, so your body synthesizes enough.
link |
It likes to absorb the amino acids by themselves.
link |
And then if it puts them together,
link |
there it makes L-carnitine.
link |
It's not very bioavailable if you take it.
link |
A lot of people will take L-carnitine L-tartrate
link |
or acyl L-carnitine, and that's about 10% bioavailable.
link |
So if you want one gram or a thousand milligrams
link |
of L-carnitine, you can take 10 grams of oral L-carnitine.
link |
Is the one gram, the typical dose you recommend,
link |
For fertility and androgen receptor upregulation.
link |
So that means taking 10 grams of the capsule form.
link |
Yeah, so it's about 15 to 20 capsules, which is a lot.
link |
It can also potentially increase TMAO.
link |
Yeah, I wanted to ask about that because TMAO
link |
on your blood chart is, when that's elevated,
link |
that's going to cause some concern.
link |
You taught me a trick, however, that one can take
link |
600 milligrams of garlic capsule for the allicin.
link |
Is that what it's called?
link |
Allicin is in it, yeah.
link |
It's like the name allicin, but with two Ls?
link |
And that had a remarkable effect in reducing TMAO.
link |
So that's quite potent.
link |
And also, was it just coincidence
link |
that it really brought my LDL down as well?
link |
I'm not sure if the LDL is a coincidence,
link |
but depending on your gut microbiome or your microbiota,
link |
some microbiome beneficial bacteria
link |
will convert carnitine and also choline.
link |
So any choline precursor like alpha GPC
link |
or phosphatidylserine, it will convert them
link |
more or less to TMAO.
link |
So TMAO is something that you can get measured
link |
in a blood test and see if it's high or low.
link |
Some people might not even need allicin.
link |
Some people do benefit from it.
link |
So I think it was you that also told me
link |
that allicin and garlic can have positive effects
link |
on cardiovascular tone and blood flow generally.
link |
Okay, so maybe, so it's 600 milligrams garlic
link |
in excessive amount, or can I just eat garlic?
link |
You can just eat garlic.
link |
I mean, I like eating garlic.
link |
Yeah, so, okay, so one could also just eat garlic.
link |
If one were going to take L-carnitine in injectable form,
link |
how much of that is bioavailable?
link |
100% if you inject it.
link |
It is in an aqueous solution.
link |
So it's a bacteriostatic water essentially.
link |
So it's not in a carrier oil.
link |
So it really, it's going to burn a lot
link |
if you inject it subcutaneously.
link |
So it's going to be absorbed faster and more evenly
link |
and also just hurt a lot less
link |
if you inject it into a muscle.
link |
But one could then just take one gram per day injected
link |
or divide it up into a couple of doses.
link |
The minimally efficacious dose for injectables
link |
is probably around 200 when it comes to sperm motility
link |
and androgen receptor upregulation.
link |
So it really depends on why you're taking it.
link |
In terms of fertility and in terms of blood tests generally,
link |
you know, I always say that if possible,
link |
either by way of insurance or by way of some other way
link |
affording it, it would be great for people
link |
to have blood tests to know what their hormone levels
link |
and other levels of other things like metabolic markers
link |
and lipids were in their 20s,
link |
also in their 30s, also in their 40s.
link |
I think there's this idea that you only take a blood test
link |
when you have a problem,
link |
but then of course one can't actually do the comparison
link |
that you mentioned earlier or state the comparison
link |
to one's physician that things are changing over time.
link |
And it seems to me that basically everyone should get
link |
at least a once a year blood test.
link |
Is there the hope that insurance will someday
link |
just cover it for everybody?
link |
This will be standard care.
link |
I would think that everybody should know what sorts
link |
of things are floating around in their bloodstream
link |
and what they need more of and less of in life.
link |
I doubt it will ever be covered by insurance.
link |
In many cases, you could make an argument
link |
that it's indicated.
link |
As insurance begins to cover more of the population
link |
for pathologies, the things like FSAs or HSAs
link |
or care credit will likely cover this advanced testing,
link |
which it continues to come down and down in price.
link |
So it'll be affordable, but it won't be free.
link |
I'd like to shift gears slightly and talk about
link |
social interactions and relational effects on hormones.
link |
Something that I just find fascinating.
link |
We touched on this a little bit earlier
link |
with in terms of oral contraception,
link |
but now that we have the backdrop
link |
of what these various hormones do,
link |
some involvement in neurotransmitter systems like dopamine
link |
and prolactin and associated pathways,
link |
prolactin of course being a hormone,
link |
not a neurotransmitter.
link |
But there's a phenomenon in human beings
link |
where people get very excited about a new partner
link |
and that excitement no doubt is related
link |
to the dopamine system among other systems.
link |
And that excitement can be maintained
link |
or can wane over time.
link |
And here I'm talking about attraction,
link |
but I'm also talking about just general excitement
link |
in the sense of novelty,
link |
because that's what dopamine is associated with.
link |
Given that you work with human beings
link |
and they have lives and relationships and lifestyles
link |
and they have hormones and all these things interact,
link |
what are some of the ways that we could think about
link |
adjusting our relationships in order to optimize hormones,
link |
as opposed to just thinking about how to optimize hormones
link |
for sake of our relationship?
link |
Because it's bi-directional, of course.
link |
And this assumes, I should say,
link |
that one is already paying attention
link |
to the six pillars talked about earlier,
link |
that people are doing most things right.
link |
How should we think about relationships and hormones?
link |
Friendships, romantic relationships, new partners,
link |
long-term partners.
link |
How do you think about this kind of stuff?
link |
Yeah, so if you have a new partner,
link |
then it is largely regulated by the dopaminergic system,
link |
which changes over time.
link |
So people may have heard the saying
link |
that you have to go through a full calendar year
link |
with someone that you're in a relationship so that you-
link |
Very good advice, by the way.
link |
So that you really know what to do and what not to do.
link |
But because you experience both of your families
link |
and the holidays and all the different situations,
link |
but I would argue until you have moved in together,
link |
had a baby, and then raised that baby,
link |
preferably breastfeeding,
link |
because that's when you get the prolactin spikes,
link |
you aren't really gone through every stage in life yet.
link |
Now, you can't really do that
link |
with every person that you're considering.
link |
Well, some people do, but it can be quite costly
link |
in terms of time and finances and emotionally costly.
link |
And then here, I'm definitely not referring
link |
to any personal experience
link |
of having done all that many times over,
link |
but what would you suggest people do or think about
link |
as they enter relationship
link |
or for people that are in long-term relationships
link |
where they feel like something has shifted,
link |
and indeed, those shifts may reflect the output
link |
of different hormone systems and neurotransmitter systems.
link |
It almost certainly has to be the case, right?
link |
So just like women who spend a lot of time together,
link |
whether they're coworkers or whatever,
link |
a lot of times their menstrual cycles will align.
link |
There is a lot of pheromoneal and hormonal crosstalk,
link |
including prolactin, between men and women.
link |
So spending 100% of the time together,
link |
this is why people think it's so hard to work together
link |
and live together, they're around each other 24-7.
link |
You don't have the reprieve
link |
where you let that dopamine settle down
link |
and then you're excited when you see them again.
link |
A lot of guys know that if they've gone on a hunting trip
link |
or if they've gone on a trip for a long time,
link |
they come back and they see their partner
link |
and it's like a new, not quite like a new relationship,
link |
but almost like a new relationship,
link |
and they have that excitement again.
link |
And purposely building that into every relationship
link |
can help significantly,
link |
especially if you choose to have a child
link |
or get pregnant or be breastfeeding,
link |
because you just plan ahead
link |
for both of your prolactins to be high
link |
and both of your dopamines to be low
link |
and both of your testosterone to be low.
link |
So there's a lot of planning that you can do.
link |
Essentially every relationship goes through a crisis
link |
and that crisis is personal between the two of you
link |
and you can plan ahead and figure out a way,
link |
maybe it's not supplementation,
link |
maybe it's not even the amount of time
link |
you spend away from each other,
link |
but plan ahead to have good times
link |
if you know you're about to go into a crisis.
link |
And so it sounds like time apart and time together,
link |
which is actually built into a number of cultures
link |
where men and women will purposefully avoid each other
link |
for some period of time,
link |
avoid physical touch and maybe in proximity,
link |
and then we'll reconvene.
link |
And yet those are very stable relationships over time often.
link |
Is the inverse also true?
link |
For instance, for people
link |
that are in long distance relationships
link |
where they're only seeing each other
link |
three or four days a week or two days a week,
link |
does this explain the fact that some of those relationships
link |
can go on for a very long period of time
link |
without ever actually entering the,
link |
let's call it the hyperprolactin phase
link |
of actually moving in together and et cetera, et cetera.
link |
Like in other words,
link |
is that a way in which people are spiking
link |
and troughing dopamine that keeps them attached?
link |
This kind of elusive, this sort of, what is it called?
link |
I think it's called like a cat string.
link |
Like if you play with a cat and you move the string away,
link |
they'll keep reaching,
link |
but you throw the string on the ground,
link |
they're like, they're totally uninterested in it.
link |
Is that what's going on?
link |
Cause that's a dopaminergic phenomenon,
link |
the cat string example.
link |
We know this experimentally.
link |
In those cases, the relationship hasn't really progressed
link |
in many of those cases past the dopamine spike,
link |
the fun initial stage, honeymoon stage,
link |
whatever you want to call it.
link |
So it's almost kind of like a roommate.
link |
If you're looking for a roommate,
link |
if it was for college or after college or whatever,
link |
you can fill out forms and look for common interests,
link |
but until you're actually together
link |
a significant proportion of the time,
link |
you're not really going to know
link |
if you're going to be compatible or not.
link |
And is there evidence that the appearance of an infant
link |
changes, obviously there are going to be hormonal shifts.
link |
We know actually that for, in both women and in men,
link |
there's a prolactin increase when couples
link |
are expecting a child.
link |
This is the, it's almost like a brooding phenomenon.
link |
You see this in birds where it's actually called brooding
link |
and it's caused by prolactin increase,
link |
but it turns out this also occurs in humans.
link |
And some people would argue this causes
link |
the dad bod phenomenon,
link |
cause it actually prolactin is involved
link |
in laying down a body fat, preparing for sleepless nights.
link |
And presumably that spike in prolactin
link |
is there also to suppress sexual activity
link |
because there are periods of time immediately
link |
near childbirth where sexual activity is not advantageous.
link |
Yeah, you see a prolactin spike right after breastfeeding.
link |
So if you think about it, often when you have an infant,
link |
you'll breastfeed, put the infant to bed
link |
and then immediately go to bed with your partner,
link |
which is not particularly conducive.
link |
It's almost like trying to have intercourse back to back.
link |
And it's very difficult.
link |
Because of the, in the prolactin sense.
link |
Yeah, low dopamine, high prolactin.
link |
Oxytocin is also increased significantly
link |
to help with milk let down as well.
link |
So yeah, as far as brooding,
link |
there's definitely a human equivalent of brooding.
link |
Some humans call it nesting instinct, which is both helpful,
link |
but it's not necessarily a bad change in relationship.
link |
It's just a change.
link |
And as long as you know that it's coming,
link |
you're gonna do better with it.
link |
Just like any medication,
link |
if you are aware of the side effect
link |
and then it might happen, then when it happens,
link |
it's not only less severe,
link |
it also happens less often.
link |
You tell the patient.
link |
Well, as a neuroscientist,
link |
I come from the framework that,
link |
of course hormones impact perception and behavior,
link |
but perception and behavior also impact hormones.
link |
I found this fascinating.
link |
I also really liked the example you gave
link |
of people taking time apart,
link |
but also these affiliative bonds that are non-romantic bonds
link |
can serve as kind of a reservoir to replenish dopamine
link |
that is then released upon experience
link |
going back to one's partner
link |
or some sort of regular feature of home.
link |
And of course this should exist on both sides.
link |
I'm guessing that from both the male side and female side,
link |
there's an interest in kind of separation and reunion
link |
And I guess the frequency will vary for different couples
link |
in different situations.
link |
And I don't wanna make it seem like prolactin is all bad.
link |
So prolactin does help with the nesting instinct.
link |
It helps with breastfeeding as well.
link |
A lot of women are diagnosed with luteal phase defects,
link |
which is basically the phase after ovulation,
link |
but before a period or giving birth.
link |
The pregnancy is kind of a prolonged luteal phase.
link |
And a lot of them will go on progesterone for this.
link |
Progesterone can also decrease prolactin.
link |
And prolactin is also helpful
link |
for the maturity of the lungs and infants.
link |
So it helps the sphingomyelin to lechithin ratio.
link |
So it can decrease,
link |
if your prolactin is too low through pregnancy,
link |
it spikes up very high during pregnancy,
link |
then it can lead to increased risk
link |
of respiratory distress of the newborn.
link |
Really interesting.
link |
Yeah, so we certainly don't wanna paint a picture
link |
where prolactin is the bad, bad hormone to avoid.
link |
Without prolactin, none of us would be here, of course.
link |
I realized that earlier I raised the question
link |
about whether or not cold exposure
link |
could modify hormone output.
link |
In particular, whether or not ice baths
link |
or ice applied to specific tissues of the body,
link |
as people are doing one way or the other,
link |
can change testosterone levels, estrogen levels.
link |
In other words, taking ice baths in cold showers
link |
increase testosterone and or estrogen.
link |
Yeah, so taking an ice bath or a cold shower
link |
or a cold exposure in general,
link |
it's not gonna correct a vitamin D deficiency
link |
or a metabolic syndrome.
link |
So there's a lot of things that it will not correct
link |
that are causes of hypogonadism or low testosterone,
link |
but it will help acutely,
link |
specifically the application of cold
link |
to testes that are too warm.
link |
So if you have a varicocele
link |
or if you have a little bit of a primary hypogonadism,
link |
which is where testosterone is not released by the testes,
link |
but your LH and FSH signals are sufficiently high,
link |
then you'll likely respond to cold exposure better.
link |
And there's actually undergarments
link |
that are designed specifically to help with fertility.
link |
And there's probably gonna be more
link |
and more of that in the future.
link |
You just need to be careful not to get frostbite
link |
because it's a particularly bad spot to get frostbite.
link |
Could you define varicocele?
link |
You mentioned it a few times.
link |
That's a varicose vein?
link |
Yeah, so it's essentially a varicose vein.
link |
It brings warm blood and the venous flow
link |
or the flow back to the heart is not as good.
link |
Just like in the legs, it can happen in the scrotum.
link |
Usually about 20 to 25% of people
link |
have one grade of varicocele.
link |
There's grades one through four, one through five.
link |
And most people just have a very mild one,
link |
usually on the left side,
link |
because the blood has to go through further
link |
to get back to the heart.
link |
And it raises the temperature of the testes.
link |
Temperature is the enemy of testes.
link |
So they like to be five to 10 degrees cooler
link |
than the rest of the body.
link |
So are saunas particularly bad for sperm production?
link |
They can be, yeah.
link |
When you say can be,
link |
how long could one safely be in the sauna?
link |
Would you want to go back and forth
link |
between the cold and sauna?
link |
Are there any data?
link |
If someone is having infertility,
link |
then I tell them to avoid all saunas empirically.
link |
If someone has, if they're not infertile,
link |
but they have a low sperm count,
link |
I also tell them to avoid.
link |
However, it's mostly warmed water
link |
that can raise the temperature of the testes
link |
faster than the sauna.
link |
So hot tubs and things of that sort.
link |
Yeah, so hot tub and a jacuzzi,
link |
those are enemies number one and number two of sperm.
link |
What about ice baths and cold showers for women?
link |
Any evidence that it can shift hormone output in women?
link |
It increases the activity of the beta adrenergic receptors,
link |
even in the central nervous system
link |
and the astrocytes as well.
link |
So it can do a few things.
link |
It can slightly decrease the drive for food,
link |
which astrocytes and beta adrenergic receptors
link |
have some medications that are weight loss medicines
link |
also do similar things.
link |
But it can be beneficial in women too.
link |
But no evidence that it changes
link |
estrogen output in women, correct?
link |
Not that I know of.
link |
Peptides, lot of discussion these days about peptides.
link |
Peptides, of course, just being strings of amino acids,
link |
as you mentioned, very small ones,
link |
like two amino acids like L-carnitine
link |
all the way up to polypeptides,
link |
which just mean many, many, many amino acids.
link |
There are so many peptides that there's,
link |
we should probably just do an entire episode about peptides.
link |
But I think one of the reasons I'm hearing so much
link |
about peptides these days
link |
is that they are not called steroids.
link |
You know, the name steroids, I think has been,
link |
has come to be associated with anabolic steroids
link |
in the context of acne, testosterone rage, et cetera.
link |
But of course, testosterone, excuse me,
link |
estrogen is a steroid hormone, right?
link |
There are other steroid hormones, as we both know.
link |
But peptides are gaining increasing popularity.
link |
I am willing to go on record saying that you can be sure
link |
that many of the incredible transformations
link |
that you see in Hollywood
link |
are the consequence of peptide use.
link |
And I'd put my name behind that
link |
because I'm well aware of people
link |
that use these to prepare for roles, but athletes use them.
link |
And then everyday people are using them too.
link |
For instance, sermorelin, tesemorelin, ipomorlin
link |
to stimulate the release of growth hormone
link |
rather than taking growth hormone.
link |
BPC-157, which is essentially a synthetic gastric juice
link |
that normally repairs the gut,
link |
that is being used to treat injuries.
link |
And there are other ones as well.
link |
What can we say generally about peptides?
link |
Are they safe? Are they not safe?
link |
What about sourcing?
link |
And are there any peptides that you think
link |
could be of particular use for people?
link |
And we should probably also touch on peptides
link |
that people shouldn't go anywhere near with a 10-foot pole.
link |
So peptides are very heterogeneous.
link |
There's very dangerous ones and very safe ones.
link |
My favorite peptide is the original peptide,
link |
So insulin is a peptide.
link |
And less than a hundred years ago,
link |
there was a scientist studying insulin.
link |
And at some point they saw that an animal
link |
had its diabetes cured by insulin injection.
link |
Less than a year later, they were injecting insulin
link |
into every type 1 diabetic
link |
because it was saving their lives.
link |
And yet insulin can kill you
link |
if you take it at the incorrect dose.
link |
So just like insulin should be prescribed by a doctor,
link |
there is over-the-counter insulin rely on, or NPH,
link |
but ideally your insulin is prescribed by your doctor
link |
for your diabetes as it's life-saving.
link |
Peptides should be prescribed by doctors as well.
link |
And there are several that are FDA approved.
link |
So you mentioned a lot of different ones.
link |
Let's start with tesamorylin.
link |
So tesamorylin was recently FDA approved
link |
for something called lipodystrophy.
link |
It happens where body fat is displaced into abnormal areas,
link |
often as part of AIDS or severe burns, things like that.
link |
And it helps redistribute this body fat
link |
and give people their quality of life back.
link |
Tesamorylin is a GHRH,
link |
which I kind of loop into the category of GHRPs,
link |
so growth hormone releasing peptides.
link |
So it's only a couple amino acids different
link |
from endogenously produced growth hormone releasing hormone.
link |
So growth hormone itself is also a peptide.
link |
It's a peptide hormone, not a steroid hormone.
link |
So you have different somatotrophs,
link |
which are very similar to growth hormone.
link |
Another fun fact is that HPL,
link |
which is human placental lactogen,
link |
we love acronyms, right?
link |
Human placental lactogen is nearly identical
link |
to growth hormone.
link |
The growth hormone in pregnancy is not what causes
link |
the sugar spike and gestational diabetes.
link |
It's the human placental lactogen.
link |
So if you look at twin pregnancies,
link |
if they have two placentas or more placental tissue
link |
making more human placental lactogen,
link |
the risk of gestational diabetes is exponentially higher.
link |
So this HPL is only a couple molecules
link |
different from growth hormone.
link |
It is interesting that these different GHRHs and GHRPs
link |
actually have pretty different mechanisms of action.
link |
Grelin is also a hormone that's released
link |
when you're hungry.
link |
This is probably one of the reasons
link |
why you have more growth hormone release overnight.
link |
And there's a lot of peptides
link |
that are very similar to ghrelin.
link |
So these peptides are not bio-identical peptides,
link |
but they just have a couple different amino acids change.
link |
So they're almost identical.
link |
And they're probably going to be used in the future
link |
for growth hormone deficiencies,
link |
including in kids they've been studied.
link |
So if somebody wants to increase their growth hormone output
link |
in addition to not eating within two hours of sleep,
link |
getting good, deep sleep,
link |
doing all the other things in the six pillars
link |
that you mentioned earlier,
link |
especially resistance exercise
link |
at some point earlier in the day,
link |
what are the risks and benefits
link |
of taking a growth hormone releasing hormone peptide
link |
like sirloin, prescribed by a doctor, of course?
link |
What should one be concerned about?
link |
How long could one take these?
link |
I've even heard that they can modify gene expression
link |
so that they really are changing your hypothalamus
link |
in very long lasting ways.
link |
Yeah, there's definitely a lot of risk.
link |
Tumor growth and cancer.
link |
So you look at a type one diabetic,
link |
they have very high incidences of various types of cancer.
link |
They have very high growth hormone,
link |
but low IGF-1 paradoxically.
link |
So they would likely give you a similar cancer risk
link |
to a type one diabetic that has very high growth hormone.
link |
However, there are the benefits of it.
link |
You think of lipolysis, decreased body fat,
link |
increased lean body mass.
link |
A lot of those, you can use other things
link |
to get those benefits.
link |
So then you don't need growth hormone for those benefits.
link |
It just leaves cosmetic benefit
link |
to which you can usually use topicals
link |
to get your hair and your skin and your nails.
link |
There's a lot of other things that you can do
link |
other than growth hormone.
link |
So a lot of people just don't need these GHRPs
link |
if they don't have lipodystrophy
link |
or if they don't have growth hormone deficiency.
link |
There is other uses of them, specifically in injuries.
link |
So I know that they've been studied.
link |
I'm not sure if it's in the military.
link |
We mentioned the woodpecker or the coup, contrecoup injury.
link |
So that can obviously-
link |
Head resulting back and forth,
link |
then the brain basically slamming up
link |
against the front of the skull.
link |
Yeah, football, heading the ball in soccer.
link |
Definitely people who use the 50 caliber in military,
link |
although that's a fairly small population.
link |
And I think anyone that's hit their head hard
link |
We can talk about BPC157 for a bit,
link |
GHK copper peptide for a bit,
link |
TB500 or thymosin beta-4 analog.
link |
And then we can also talk about brim melanotide,
link |
which is melanotan three.
link |
They have melanotan one and two,
link |
and then they also have melanotan three and four.
link |
Yeah, let's talk about BPC157 and melanotan.
link |
Cause I think those are the ones that most people are eyeing,
link |
So BPC157 is body protective compound, 157.
link |
It's identical or bio-identical
link |
to gastric protective compound, 157,
link |
that's produced in the stomach.
link |
So as you age, you get atrophic gastritis very often.
link |
That's why you have less intrinsic factor,
link |
which is kind of another peptide that binds to vitamin B12.
link |
That's why you can get age-related B12 deficiencies.
link |
So that's one reason why you have more colitis,
link |
more diverticulitis as you age.
link |
You don't have that gastric protective compound.
link |
It increases VEGF, vascular endothelial growth factor,
link |
which basically makes your blood vessels grow more.
link |
So that's what causes your body to form a blood vessel.
link |
So another medication known as Avastin,
link |
it's on the WHO's list of essential medications for cancer.
link |
So many different types of cancer, including colon cancer,
link |
you treat it with Avastin, which is a VEGF inhibitor.
link |
So if you have cancer or a high cancer risk,
link |
you probably don't want to be taking a medication
link |
that's the exact opposite mechanism of action
link |
as your essential anti-cancer med.
link |
In other words, if you have cancer,
link |
you're at risk of cancer, avoid BPC157.
link |
A lot of people prescribe it for six weeks.
link |
And BPC157, so bremelanotide, that is FDA approved
link |
for a hypoactive sexual disorder.
link |
Tessamoralin, that's also approved for lipodystrophy.
link |
Interestingly, another one of the melanotans
link |
is also approved for lipodystrophy
link |
and also deficiency in the melanocorticoid receptor.
link |
So the receptor that receives
link |
the alpha melanocyte stimulating hormone,
link |
it's a very rare condition.
link |
It's also approved for that
link |
because if you don't take it, then you get obesity.
link |
But BPC157 is not FDA approved,
link |
but it is essentially standard of care at this point.
link |
I would say if you're not counting insulin
link |
or growth hormone as peptides,
link |
it's one of the most commonly used peptides
link |
and anecdotally and in some clinical literature,
link |
it's fairly well tolerated for short periods of time.
link |
I'm not in the camp that everybody needs to do it
link |
two to three times a week or even daily
link |
for six weeks, no matter what.
link |
The major benefit is when you're gonna take it early on,
link |
because it's gonna allow your body
link |
to increase blood flow to the injured area
link |
and the less blood flow it has,
link |
for example, cartilage ligaments have horrible blood flow,
link |
especially as people age,
link |
it's gonna make a significant difference.
link |
So I would wager that that Russian gymnast
link |
that Achilles healed in one month
link |
and completely from a full rupture
link |
was likely taking BPC157 or something very similar.
link |
I'm willing to wager on that as well, a remarkable recovery.
link |
And so, because it is prescription,
link |
there are non-prescription forms.
link |
My understanding of the non-prescription forms
link |
and the danger of going after non-prescription forms
link |
is that oftentimes they will contain
link |
what they claim they contain, BPC157 in this case,
link |
but they are not adequately cleaning out the LPS,
link |
the lipopolysaccharide, which can cause inflammation.
link |
In fact, in the laboratory,
link |
we use LPS to deliberately induce fever and inflammation
link |
to study systemic inflammation.
link |
So this is a warning to people,
link |
if you're interested in peptides,
link |
you absolutely need to work with a physician, in my opinion,
link |
get it from a really good compounding pharmacy
link |
who will clean out, that cleans out the LPS.
link |
Because if you're buying it through a source that,
link |
you know, a lot of people, I don't wanna name sources,
link |
but there are these common sources on the internet
link |
that everyone knows about, they're buying these sources,
link |
they'll ship it to anyone essentially,
link |
but then the LPS is really causing inflammation
link |
and many people experience a kind of mild fever,
link |
tingling from that when they inject it
link |
and they're like, oh, I can feel it working.
link |
That's probably LPS action,
link |
which is not good for the brain.
link |
I don't know about the, on other peripheral tissues.
link |
I haven't heard of people dropping dead
link |
from this stuff yet,
link |
but I certainly wouldn't wanna be
link |
ingesting any LPS unnecessarily.
link |
So would you agree that you should work with a doctor?
link |
After all, you are a doctor.
link |
Yeah, definitely talk to your doctor about this
link |
and talk to them about the dosing regimen as well.
link |
So if they have you doing it for six weeks,
link |
ask them why am I doing it for six weeks, why not?
link |
Two weeks or why not?
link |
As soon as I feel better, can I just stop it?
link |
Yeah, there's a lot of good questions like that
link |
that you should ask your doctor.
link |
And if somebody is trying to prescribe you
link |
a bunch of different things,
link |
then see is this what they prescribe everybody
link |
or is this individualized for me?
link |
There are peptides like GHK copper peptide,
link |
which is produced endogenously in the liver
link |
more at younger ages.
link |
That's why the liver can regenerate fully
link |
is this a GHK copper peptide helps.
link |
And if you're copper deficient,
link |
which not a whole lot of people are,
link |
but a lot of people that have had bariatric surgery
link |
are copper deficient.
link |
GHK copper peptide can help significantly
link |
with your nervous system.
link |
And it's also synergistic.
link |
So any growth agonists like thymus and beta-4
link |
made in kids in the thymus, which shrinks,
link |
that's another reason why kids heal really well.
link |
That and GHK is somewhat synergistic with BPC,
link |
but if you don't need all three, you don't want them.
link |
And if you don't need it for more than a week,
link |
you don't want it for more than a week.
link |
I really appreciate you saying that.
link |
I often say that sometimes the best dose
link |
of something to take is zero.
link |
It's often the case that the best dosage is zero.
link |
You mentioned melanotan.
link |
There are several kinds of melanotan.
link |
I find it a little bit of a funny conversation
link |
because I first learned about melanotan
link |
from reading about peptides and discovering
link |
that people were taking, injecting melanotan to get tan
link |
because it's in the melanin synthesis pathway.
link |
They also discovered, this isn't an individual,
link |
this is reading about this in various manuscripts
link |
and peer-reviewed papers, that it could cause things
link |
like pre-epism, like sustained erection,
link |
that might be the last one that anyone would ever have
link |
because of damage to the vasculature.
link |
Also women taking melanotan as a way to get tan
link |
and lose body fat.
link |
So this sounds all very recreational.
link |
Are there any clinical usage of melanotan?
link |
So separate from the kind of extreme biohacking
link |
cosmetic world, which is really not the main focus
link |
of this podcast ever, more in terms
link |
of pursuing health optimization.
link |
Yeah, there's actually three FDA-approved indications,
link |
believe it or not.
link |
Not many people know about this,
link |
but there's three well-accepted indications.
link |
One of them is the hypoactive sexual disorder
link |
and more in women.
link |
That's for brimelanotide.
link |
So those are women that have essentially
link |
no libido whatsoever, but other hormones are in check.
link |
Classically, it's before menopause.
link |
So those hormonal issues are not contributing.
link |
And when you give them this peptide,
link |
it's also known as PT-141, it helps significantly.
link |
A lot of times you use it in a nasal spray.
link |
It goes straight into the central nervous system
link |
and acts centrally.
link |
You can also inject it and you can also take it via trochee.
link |
Men and women take it?
link |
It's approved for women, but it can also help men.
link |
And it's relatively safe.
link |
The only relative contraindication that I tell people,
link |
and a lot of people say,
link |
oh, there's no side effects that I know of,
link |
but if you have a family history of melanoma
link |
or potentially have a melanoma and don't know about it,
link |
that's why I'm a big advocate of germoscopy as well
link |
and regular skin checks,
link |
then theoretically it's gonna increase
link |
that alpha melanocyte stimulating hormone
link |
and it can grow that.
link |
So that's definitely not a good thing.
link |
So be very careful about long-term administration of it.
link |
It's also approved for lipodystrophy,
link |
which is the same exact thing as tesamorylin,
link |
which I believe is also known as Evista or Agrifta.
link |
And then it's also approved for the rare genetic condition
link |
where your receptors or your melanocytes
link |
don't proliferate as well.
link |
So you usually have hypopigmentation.
link |
It's not true albinism,
link |
but it's associated with morbid morbid obesity
link |
and very poor outcomes from that in childhood.
link |
So it's used in kids actually.
link |
Well, peptides are a fascinating landscape,
link |
but thank you for that deep dive into several of them.
link |
We will probably return to you
link |
to talk about peptides again in the near future,
link |
because I know there's a lot more there
link |
and a lot of interest.
link |
I want to talk about the sixth pillar, all right?
link |
So just to remind people, you said diet, exercise,
link |
wear appropriate caloric restriction, managing stress,
link |
sleep and sunlight are critical for everyone
link |
at all ages to manage and optimize hormone health.
link |
Then you have the sixth category,
link |
which is a really intriguing one, which is spirit,
link |
which is a kind of unusual thing to hear
link |
coming from a medical doctor,
link |
except that I have many colleagues
link |
and indeed our former director
link |
of the National Institutes of Health, Francis Collins,
link |
has talked about this notion of spirit.
link |
We've talked about belief effects on this podcast before
link |
with Ali Krum, how one's understanding of the things
link |
that they do and their world in general
link |
really creates an important effect on everything
link |
at the level of physiology, not just psychology.
link |
So as a physician,
link |
how do you conceptualize the spiritual aspect
link |
and how do you talk to patients about this
link |
given that people walking into your clinic
link |
presumably have a bunch of different religious
link |
and not a religious backgrounds?
link |
I'm sure some are atheists,
link |
some are probably strong believers.
link |
How do you deal with that
link |
and how should people think about this?
link |
Yeah, I believe it is surprisingly well-received.
link |
You wouldn't think at first glance
link |
that a patient really wants to talk about
link |
their spiritual health with their doctor.
link |
But the way I think about it and the way that it really is,
link |
is it's like a Venn diagram
link |
and you have a body and a mind and a soul
link |
and you can't have one healthy without the other healthy.
link |
Even if your mental health is phenomenal
link |
and even if your physical health is phenomenal,
link |
the mental aspect of spirituality,
link |
if that piece is not there,
link |
then that's gonna affect your body physiologically as well.
link |
And Ali Crum's done some excellent work.
link |
There's also been a lot of other studies regarding prayer.
link |
And I'm a Christian, I believe in God,
link |
and that gives me a lot of that resilience and motivation.
link |
It gives me the cornerstone or the groundwork,
link |
how I can interact with life.
link |
And regardless if someone's an atheist
link |
or regardless of what someone believes
link |
as far as religion or the origin of the species,
link |
they can know that their spirituality
link |
is going to have a profound effect
link |
on their mental and physical health as well.
link |
People like to compartmentalize it.
link |
So they like to talk to their doctor
link |
only about the physical health
link |
because it's comfortable to do that.
link |
They only talk to their pastor or a mom
link |
or a reiki healer for their spiritual health.
link |
And they just talk to their therapist or psychiatrist
link |
about their mental health.
link |
But you need to bring all three of those things together.
link |
It's well known that interdisciplinary clinics
link |
lead to improved patient outcomes.
link |
And that's just disciplines within medicine.
link |
So that's just doctors that are specializing
link |
So this takes a step back in the upper part of that tree
link |
before you've reached those dichotomies or the split offs.
link |
You have your body and your mind and your soul.
link |
So your spiritual health and your mental health
link |
and your physical health.
link |
So if you're in line in all three of those things,
link |
that builds the cornerstone for the rest of your health
link |
and the rest of your life.
link |
So if someone comes into your clinic and they say,
link |
they're feeling one way in their body,
link |
they're feeling one way in their emotional life,
link |
you run their charts, you get their blood work,
link |
and they're an atheist or they're agnostic.
link |
What are some of the six pillar practices
link |
that they can consider that are in keeping
link |
with their atheism or agnosticism?
link |
Because I have to assume that people who participate
link |
or feel that they belong to a particular religious sect
link |
will have particular prescriptives
link |
from those religious sects that will direct them
link |
towards particular types of prayer.
link |
But how would somebody who doesn't have a prescriptive
link |
coming to them from some other source,
link |
what could they do or would they do?
link |
Yeah, so I certainly don't force prayer on anybody
link |
or anything like that.
link |
But it's my belief that being, especially being an agnostic,
link |
it's almost the hardest thing because if you're an atheist,
link |
then you have some groundwork and you have some spirituality
link |
even if it has to do with the human spirit's interaction
link |
with the environment,
link |
things that can't be physically explained well,
link |
phenomenon like the work that Ali Krum does.
link |
But if you're agnostic, you're still trying to find that.
link |
So I hope that everybody does find
link |
what they truly believe in as far as their own spirituality.
link |
But yeah, that's a personal journey
link |
from a physician standpoint.
link |
And even if I'm friends with him as well,
link |
from a friend standpoint,
link |
I don't like to push anybody in any specific direction.
link |
So I don't think that everybody
link |
should believe what I believe.
link |
And I don't feel like there should be any pressure
link |
for them to believe something different.
link |
So I think that there can be excellent physician-patient
link |
rapport regardless of what we believe
link |
and what our backgrounds are.
link |
That's wonderful to hear.
link |
I can say without revealing any names
link |
that I have close colleagues that in every bin
link |
of this spectrum, like hardcore atheists,
link |
hardcore religious in different domains, different religions.
link |
I don't know if I know many,
link |
I'm agnostic as to whether or not I know any agnostics,
link |
I should say, it's not something
link |
that people commonly discuss,
link |
but in the context of science and medicine,
link |
but it's starting to happen more and more.
link |
And certainly this issue of spirituality
link |
is one of the areas in which neuroscience
link |
is asking a lot of questions,
link |
like what spiritual experiences really are
link |
in terms of how they're grounded in the brain
link |
or not grounded in the brain.
link |
I think it's a really interesting area for discovery.
link |
And I appreciate that you bring it up
link |
and you bring it up in the non-pressured way that you do.
link |
I think that it will stimulate a lot of thinking,
link |
which is ultimately the goal of this podcast.
link |
Well, I have one final question
link |
that a listener insisted I ask,
link |
and it's a very straightforward one.
link |
It's not at all a curve ball
link |
and not at all related to what we were just talking about,
link |
but it was the most common question
link |
when I told people that I was going to be talking to you,
link |
which is, is caffeine problematic for hormones?
link |
I've received hundreds of the same question about caffeine.
link |
And since it's probably the most commonly used drug
link |
on the planet, I know it's taking us back
link |
into the very practical, but in closing,
link |
we're not quite there yet,
link |
but in closing, is caffeine having an effect
link |
one way or the other on testosterone, estrogen,
link |
or other hormones that is positive, negative, or neutral?
link |
Only if it affects your sleep.
link |
So it works on adenosine,
link |
and it can actually slightly improve allergies as well,
link |
but negligible effect otherwise.
link |
Well, sorry to end on such a practical brass tacks
link |
type of question, but I did promise to the listeners
link |
that I would ask that question.
link |
Listen, I want to sincerely thank you.
link |
We covered basically an endocrinology textbook,
link |
a neuroendocrinology textbook's worth of information,
link |
a ton of practical tips in there.
link |
Where can people find out more about you?
link |
We will certainly provide links.
link |
And I guess the other question is, are you taking patients?
link |
I'm sure you'll hear that in the various venues
link |
where people can contact you,
link |
but where are you active in terms of public facing work?
link |
I'm active on Instagram, Kyle Gillette, MD.
link |
I'm also active on the social medias of my brand new clinic,
link |
which is Gillette Health.
link |
That's at Gillette Health on Instagram or GilletteHealth.com.
link |
We'll provide links to those.
link |
And I should say that the content you've been putting out
link |
on Instagram is terrific
link |
because you actually point to specific studies
link |
and you put things into actionable context,
link |
which is very meaningful for me.
link |
Kyle, Dr. Gillette, I should say,
link |
thanks so much for your time.
link |
I really appreciate it.
link |
I know the listeners will too.
link |
Thank you for joining me for my discussion
link |
about hormone health and optimization with Dr. Kyle Gillette.
link |
As you just heard,
link |
he is a treasure trove of actionable, clear information.
link |
And again, you can find him teaching more about hormones
link |
and other aspects of health on Instagram at Kyle Gillette.
link |
That's Gillette with two T's and two L's, but no E.
link |
Kyle Gillette, MD on Instagram
link |
and Gillette Health on all other platforms.
link |
And if you would like more information about his practice,
link |
you can find that at GilletteHealth.com.
link |
If you're learning from and or enjoying this podcast,
link |
please subscribe to us on YouTube.
link |
That's a terrific zero cost way to support the podcast.
link |
In addition, please subscribe to the podcast
link |
on Spotify and Apple.
link |
And on Apple, you have the opportunity
link |
to leave us up to a five-star review.
link |
If you have questions or comments about this
link |
or any episode of the Huberman Lab Podcast,
link |
or if you'd like to suggest topics
link |
that you'd like us to cover
link |
or guests that you would like me to talk to,
link |
please put that in the comment section on YouTube.
link |
In addition, please check out the sponsors
link |
mentioned at the beginning of today's episode.
link |
That is the best way to support the podcast.
link |
We also have a Patreon.
link |
It's patreon.com slash Andrew Huberman.
link |
And there you can support the podcast
link |
at any level that you like.
link |
During today's episode and on many previous episodes
link |
of the Huberman Lab Podcast, we discuss supplements.
link |
While supplements certainly aren't necessary for everybody,
link |
many people derive tremendous benefit from them
link |
for things like optimizing sleep and focus
link |
and indeed hormone health.
link |
Anytime you're considering taking a supplement,
link |
you want to make sure that the supplements
link |
are of the very highest quality.
link |
For that reason, we've partnered with Thorne, T-H-O-R-N-E,
link |
because Thorne supplements are known
link |
to have the highest levels of stringency
link |
in terms of the quality of their ingredients
link |
and precision about the amounts of the ingredients
link |
that they put in each bottle.
link |
Meaning what is listed on the packaging
link |
is actually what's contained in those supplements,
link |
which is not true for many supplement companies out there.
link |
If you'd like to see the Thorne supplements that I take,
link |
you can go to Thorne, that thorne.com
link |
slash the letter U slash Huberman,
link |
and you can get 20% off any of those supplements.
link |
Also, if you navigate deeper into the Thorne site,
link |
so go to thorne.com slash U slash Huberman,
link |
but then pass into thorne.com,
link |
you can also get 20% off any of the other supplements
link |
in the Thorne catalog.
link |
If you're not already following us
link |
on Instagram and Twitter, please do so.
link |
It's Huberman Lab on both Instagram and Twitter.
link |
And there I cover science and science-based tools,
link |
some of which overlap with the contents
link |
of the Huberman Lab podcast,
link |
but much of which is distinct
link |
from the contents of the Huberman Lab podcast.
link |
And again, we are hosting two live events,
link |
one in Seattle on May 17th,
link |
another in Portland on May 18th.
link |
That series is called the Brain Body Contract,
link |
where I'll talk about science and science-based tools,
link |
some of which I have never talked about
link |
in a public forum before.
link |
And there'll be an open question and answer format
link |
for you to ask me your questions,
link |
and I will do my best to answer them in real time.
link |
Thank you once again for joining me
link |
for today's discussion with Dr. Kyle Gillette.
link |
And as always, thank you for your interest in science.
link |
I'm Dr. Kyle Gillette, and I'll see you next time.