Welcome to the huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew huberman and I'm a professor of neurobiology and Ophthalmology at Stanford school of medicine. Today, my guest is dr. Kyle Gillette dr. Crowell Gillette is a duel board certified physician in family medicine and obesity medicine and an expert in hormone optimization. He is an MD that is a medical doctor and he treats patients with a variety of
Of backgrounds ages and goals. Today, we discuss male hormone optimization, we discuss behavioral tools nutrition based, tools supplement based tools prescription drug based tools and their interactions in determining overall levels of testosterone, free testosterone to dihydrotestosterone, estrogen growth hormone, thyroid hormone and many other hormones. The impact mood libido, well-being strength, cognition, and various
Logical factors. We covered hormone optimization in both men and women in previous episodes of The huberman Lab podcast. But today's discussion is different dr. Kyle Gillette offers very specific recommendations for people with different goals and of different ages and we get deep into the weeds of, for instance, how does one know whether or not their testosterone is optimized or not? How often to test for specific hormones. Such as testosterone and other hormones and really how to gauge how
good one should feel. This is something that's often overlooked in discussions about hormone optimization or health optimization of any kind for that matter. For instance, people will talk about reduced libido and discuss whether or not testosterone levels are to blame. But how does one calibrate their libido in the first place? That is, how does one know whether or not their libido is normal too low or too high. We also discussed for instance whether or not hormone optimization should be pursued continually throughout the year for instance, whether or not
Should cycle on and off supplements and or prescription drugs, geared towards hormone optimization and we discuss the behavioral foundations of optimal hormone function, these are things that every male should be doing and various things, they should actively avoid. If their goal is to have healthy hormones and to quote, unquote, optimize their levels of every hormone from growth hormone testosterone at any stage of life. And while today's discussion is about male hormone optimization, I want to emphasize that we discuss all the various
Ages for male hormone optimization. So for those of you that are parents for those of you that are young, those of you that are middle-aged or old or teenagers, we explore adolescent puberty teen, and late teens early, adulthood adulthood, and into the late geriatric ages. So, regardless of your age and whether or not you are male or female, today's episode ought to be of interest to you, I should also point out that we will soon also be hosting an expert guest on female hormone.
The one thing that I'm certain people of all ages and biological sex will enjoy about. Today's conversation is that we also get into descriptions of how psychology and life events, impact hormones, and hormones impact our psychology. And the way that we show up to various life events so today is really a broad overview. That goes all the way down to find details about male hormone optimization. And I'm certain that by the end of today's episode, you will have an immense amount of new information about how this endocrine that is hormone system.
Mm in your body works and how it interacts with your brain and other tissues. And many, many actionable tools that you can pursue regardless of stage of life. Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is however, part of my desire and effort to bring zero cost to Consumer information about science and science related tools to the general public in keeping with that theme. I'd like to thank the sponsors of today's podcast. Our first sponsor is thesis thesis makes custom neutral
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back, great to be back. Thank you.
I'd like to begin with a question about one of the most mysterious and important phases of life, which is puberty.
I've long wondered whether or not how quickly somebody goes into puberty. So at what age and how long puberty takes? So how brief or protracted that puberty is for them to acquire, the so-called secondary sexual characteristics. Things like hair growth on the face for males and changes in bone and muscle density and growth Etc. You know, when I was in Middle School and High School, I noticed that some people transitioned into all that very fast and some people took a long time to
Acquire those characteristics. Can we learn anything about ourselves our hormones? And maybe even how long were going to live based on the time in which we enter puberty and how long it takes us to progress through puberty I guess that also raises the question does puberty ever truly end?
There are many takeaways from puberty. Some of the actionable items from it is. Yes it can. And does affect your adult height and also
Stature and also body composition. So puberty is a time and if you're if we're talking specifically about males, think of it as a time where if you have obesity as a child, you could potentially use that time to change your lifestyle, and habits and reset things. And it is a bit easier. It's almost like a free injection of testosterone and metabolism and drive and effort into your life.
There is a wide variation in how quickly puberty goes through. So there's stages called Tanner stages, which we don't necessarily need to get into, but if you enter puberty very early then it can decrease your adult height or
stature. So for a given male that enters puberty at 13 versus a male that enters puberty at 15. Can we say that the guy that entered puberty at 13 is going to be shorter than the
Guy that entered puberty at 15 or it's not quite that straightforward. If they
are identical twins and the individual who enter puberty at age 13 also finished puberty when all the way through the Tanner stages and if you do a bone scan which I believe is usually done on the left to wrist and it says yes your growth plates are mostly closed. You're not going to grow more than a couple inches of height after that.
Okay, just a related question when I was growing up it was thought or at least people
I'd say that resistance training in particular, lifting heavy weights could stunt ones growth is that true or false?
It is false when you're talking about just lifting heavy weights, dirty bulking. Certainly has the potential to stunt ones grow through two main
mechanisms. Could you define dirty
bulking? So dirty, bulking is eating an excess of calories, not just to acquire lean metabolically active body mass or get stronger, but purposely acquiring body
fat,
So purposely acquiring muscle and fat by overeating. Yes. And lifting weights can stun ones growth? Do I have that? Correct.
Correct. So it does two things. If you're doing it as a very young child, it can that fat kanpur can become leptin resistant, and it can produce more leptin and that leptin can activate the hypothalamus which activates the pituitary, which releases get atropine's which basically just increase testosterone and estrogen.
Her than it, otherwise would have it's the same mechanism behind. Why childhood obesity causes early puberty
interesting? I do remember a paper published in Science magazine, I believe it was focused mainly on females, but showing that when enough body fat accumulates, the hormone leptin is secreted and that triggers the onset of puberty. Given the increase in childhood obesity. That we're observing now. Are we seeing an earlier onset of puberty in males and
females? Yes.
Both males and females not to get too technical but there's a g-protein coupled receptor on the hypothalamus and left and directly binds it. So, it does appear directly caused a Tory and not just correlation.
Okay? So if I understand correctly, what you're saying is for a young guy, let's say 13 14 who wants to really bulk up and deliberately deliberately scuse me overeats and is doing their squats and deadlifts and bench presses and really trying to get big. They will get big but
Only in the lateral Dimension. They are. They're effectively limiting their total height and it can shut down. The long bone growth of their limbs is that correct correct. The
the growth of the long bones is mostly related to the estradiol Alpha receptor. So basically one of the receptors for estrogen, which can be secondary to early puberty and also is related to body fat because you have that conversion of testosterone to estrogen
So can we assume that if a young male wants to get into resistance training, that bodyweight exercises are probably okay? And maybe even some weight training kettlebells Etc, but that they should avoid doing so called Dirty bulking trying to deliberately gain weight up until what age until puberty is over.
I would say an individual should limit the amount of body abnormal body, fat accumulation or dirty bulking and definitely throughout their entire
life. So, again, if I understand correctly, that recommendation to avoid deliberate weight gain or rapid weight gain, is not just to allow an individual to reach their maximum height, but also to avoid laying down a lot of body fat cells. Correct?
Correct. The balance between that is
When you are going through puberty, you are able to add a lot of lean body mass, not just muscle mass, but bone mass and other masses. Well,
I started lifting weights when I was 16 and I confess I trained. Pretty heavy at times. I don't know whether or not, I would have been taller than I am now, but when I started that training, I had already reached. What was at least close to my predicted height. I can't say that, I deliberately waited until I grow. And it just so happened that I stumbled into the
Roman found that I liked it at age 16, at which point, I was already died that I am now. So, in any case, what I'm hearing is that laying down a lot of excess bad body fat is not a good idea. What if somebody grows up chubby or fat, for whatever reason, reasons related to the eating patterns in their family, maybe even some genetic reasons, is it safe and or wise for a young person. So let's say somebody who's around the age of puberty or even younger.
Or in their late teens to be dieting and actively trying to lose body fat. Is that
safe.
Under the supervision of a physician, it is certainly safe to change your body, composition in pediatric, obesity medicine. You're often talking about it recomposition or a renormalization of the growth curve compared to
peers. Thank you. So as you may have sense, we started chronologically with puberty. And I know that there's another puberty that even precedes the puberty that we're all familiar with maybe if you want to just briefly mention that because I was talking with you about this before we started the
That I'm most familiar with and I think most people are most familiar with the acquisition of deepening of the voice growth of muscle and bone body, hair acquisition of libido and things like that. That's actually the second puberty that we all go through maybe just mention for us and educate us on the first puberty. I think most people will be hearing this for the very first time.
The first puberty of everyone's life, is the first three months of their life. You may notice that your baby has more
Arachne the first three months and that they also have, in general, just more changes related to androgens and estrogens. Perhaps oil, your skin even more genitourinary, like, genital growth during the first three months. And this is mostly due to DHEA, which is an adrenal hormone the second puberty or the puberty that most people know of actually starts that same way as well. It's called adjourn our key and it's when the adrenals kick in I guess for the
and
time is there a standard age or age range in which the testicles descend in males?
Usually before birth it is not uncommon to have one or even two undescended testes, but there is a risk of testicular cancer especially if they are not fixed early and also heat damage to the
testy well thank you for that coverage of the to puberty's so early in life. I imagine some of our listeners are probably still in one or the other one or the other people. The ones that are in the first puberty obviously aren't aware that they're listening to this podcast but maybe it'll be embedded in their subconscious but
some listeners probably are still in puberty but I think everyone can remember back to their puberty and roughly when they first entered puberty and how quickly they aggregated the secondary sex characteristics like to turn. Now to a general question about what all males ought to do in order to optimize their hormones. So if you could just list off the things that all males should do on a daily basis weekly basis, I mean, should guys in their teens and 20s be getting their blood work done, should they be taking supplements?
We already talked about weight training. What should they be doing? What should they avoid doing? If the goal is to have a long Arc of healthy hormone optimization throughout the lifespan,
there's many things that you should do an analogy that I often make is when there's a brand-new car that comes off the assembly line, you do a full scope of diagnostic workup, hook it up to the computer. And I think we should do the same thing with humans as well during puberty. You know, obviously you're a functioning human but I would say there's
Till development. And I think that the human always develops, I don't think development ever ends, but you want to monitor that progress across a person's life span. So under,
oh, sorry. So for blood work, I mean, what would be the earliest? Let me put it this way. If blood work didn't cost anything and then everyone could get it. When would you want to see everybody get their blood work done for the first
time?
Of obviously individuals under the age of 18 should talk with her parents about this and as long as that the parents and the child kind of agree and the parents are on board with this as well. You can start getting blood work often, child will come in with complaints of either precocious puberty or delayed puberty. And this individual might be nine or this individual might be 15 for a healthy child when they're going through kind of their later Tanner stages, which is 4
I've saved developed several secondary sexual characteristics. They might have hair growth or starting to notice more beard growth. That's a good time to do it. If you're concerned with stature or height or if you're not tracking along where most members of your family have not just their height and stature but also the timing of the puberty, then that's time to get
laps, right? So if I could travel back in time, I would have gotten my blood work.
Done for hormones and lipids and everything else at 18. I unfortunately didn't know where and how to get that. And I didn't have any pressing clinical issues. And so I think the first time that I got my blood work done, I was in my late twenties, maybe even my early 30s and I'm still dying to know what my blood work was when. For instance, I was 17 and I felt a certain way and and I, and I confessed that in many dimensions, I actually feel better now at, I'll be 47 soon at 47, then I did in my teens.
20s. And I think it was more on the psychological side, I think that but in terms of just understanding why we felt great or why we felt or feel terrible or not so great. I think blood work is extremely informative. What do you think? Are the key things to look for in blood work? I mean every testosterone is always the topic that comes up in the context of male hormone optimization. But certainly there are a lot of other hormones that are important as
well. And with testosterone you want to get either testosterone and shbg or a
free
testosterone. Could you define shbg for our listeners?
Please, it is sex hormone-binding globulin. It is the protein that binds up all androgens and estrogens in the body. So the stronger, the Androgen, the stronger. It binds during puberty, strong androgens, especially DHT, which is the strongest bioidentical Androgen has a huge role, a prominent role in secondary, sexual characteristics, and if your shbg is very high, then your DHT can
Higher because it's not metabolized, but there's not quite as much free tht. So you want to balance between a high enough, free DHT and a high enough total
tht. And obviously, these blood tests are going to have to be read and interpreted by a qualified physician. Most people aren't going to be in a position to evaluate them properly or least, not with the full depth that they could if they had an MD like yourself looking at them, okay? So everyone should get blood work as early as possible depending on their budget and
ability. What should everybody do in terms of monitoring those markers? So assuming that there's no major intervention, how often do you recommend that people get their blood work done?
Let's say with, let's take an individual who just turned 18, they just got their first set of blood work, they'll probably find something in it that they may want to optimize using shared decision making with their physician. Usually a good follow-up is about six months.
Okay, so twice a year, getting blood work done, then having a physician evaluate it. That sounds reasonable to me. And for those that didn't initiate this at 18, such as myself is the best time to start then would be as soon as possible. Yeah, in terms of the other things,
That all male should do. Meaning all males of, all ages puberty and Beyond should do what? What are some of those things? So on a daily basis, maybe you could just take us through the Arc of a day and and push out some of the protocols that you use or the things that you like to see your male patients, use in order to try and optimize their hormone
status. I'll briefly touch on some of the lifestyle pillars to start diet and exercise, or the first two in puberty sleep is particularly important of
Of course, but with diet and exercise throughout a life, span you want to not exclude things that are helping you, for example, during puberty, if you're consuming Dairy, and then all of a sudden, you cut out all dairy, dairy can help, increase igf-1, and free,
igf-1, and what? And just waiting for our audience, maybe you just mention what IG what having enough igf-1 can do for us? That's beneficial. Is
it helps you grow? It helps with genital
Secondary sexual characteristics and long bone growth skin of growth hair growth, host of
things. So getting an array of nutrients that include Dairy, what other sorts of nutrients are important during development,
you want to have adequate vitamin D, vitamin D helps, with testosterone production, at helps again with bone mineralization and stature after an age of about 25. And there's not a strict cut off, but up to about age of 25,
optimizing your growth hormone and igf-1 helps with bone density and bone growth. So from the dietary standpoint, you want to have enough free estrogen, not too much when you're growing. But you want to help basically stockpile bone to prevent a risk of osteoporosis or thin bones fractures. When you're older,
someone who broke his left foot five times. While in high school, I can say, in a, whatever young people can do to optimize their bone density.
He would be great that problem seems to have resolved itself over time, but I don't know back then I was I did a short run as a vegetarian but I've always been an omnivore. I realized that some of this relates to ethics and food allergies and things of that sort. But would you say that on balance that most people would benefit from eating a combination of, you know, quality proteins from animal sources and non-animal sources, fruits, vegetables, and starches mean, what do you think for instance, about people, following a pure
Carnivore or a very pure vegan diet in their 20s and 30s
in their late 20s and might be a reasonable option in early twenties and certainly teens, it is a horrible idea because it is likely to significantly, decrease your free androgens so you will have less testosterone acting on receptors through the
body.
Are there any other micronutrients and macronutrients that people in their 20s and 30s should
emphasize?
We haven't really touched on fatty acids or Fiber too much. Fiber is going to be Paramount in kind of like setting your set point of your gut microbiome. The rest of your life. There is Prebiotic fiber which you can think of as fish food for your good gut microbiome. Your gut microbiome is kind of like an aquarium or a fish tank. Now I'm just thinking about goldfish swimming around in that goldfish eating people don't eat goldfish, people. Help you live or dead. Yeah. But any fiber or
That you're putting in your gut, it's either going to it's going to skew your gut microbiome towards something that is more beneficial or or more
detrimental and would you say that the Prebiotic fiber and the getting essential fatty acids? That would be important to do throughout the lifespan or just for people in their 20s and
30s throughout the lifespan particularly important in the teenage 20s 30s because it helps with brain development. You're certainly more of an expert than me when it comes to
Brain development, but it does continue to develop through really throughout the lifespan but certainly through the 20s and 30s as
well about taking a multivitamin while you're growing up so many people do that? Is it necessary? Is it useful? And if it's not necessary as it's safe to do
anyway,
It's generally safe to do anyway, I do not think everybody needs a multivitamin. The more exclusionary your diet is. For example, if you have celiac disease or if you're planning on fertility soon, then perhaps it's more reasonable to take a multi
vitamin in a previous discussion of ours. I asked you about caloric restriction in testosterone and if I recall correctly, the idea was that if somebody is overweight, they have an excess fat adipose tissue, then getting rid of some of that adipose
You bite through caloric, restriction and exercise. Provided it's done, not too fast and healthy way is going to be beneficial for testosterone in the long run but that for individuals who are not carrying an excess of body fat caloric restriction is actually going to lower testosterone. First of all, do I have that correct? And second, are there any addendums to that? That you'd like to give us now?
That's correct. If you look at an individual in a caloric deficit, several changes will happen. One, is that they'll have less building blocks for hormones? Another is that they will be in a catabolic State more often. So that balance of anabolism and catabolism will be different, they'll likely have less signaling from growth hormone and igf-1 and they'll also have the high shbg that we defined earlier as The Binding protein. So they're free androgens and free Esther.
Engines will go
down. Okay, so we touched on sleep being critical. I would say throughout the lifespan trying to get enough quality sleep, at least 80% of the nights of your life and the other 20% in are just what happens when there's noise outside or your stress, it just you have an exam or you're having a great time for whatever reason that a lot of good reasons to lose some sleep now and again as well. But we have sleep. We've got nutrition and we touched on that. I will get back into supplementation.
What are some of the other pillars of creating a, the proper environment for hormone
optimization?
Stress is probably the next one during both puberty but also the 20s and 30s. Individuals are figuring out how they want to cope with stress and also figuring out what they want to choose to put their effort into. So if someone is overstressed, then it can have it can put all the other lifestyle pillars and then they stop dieting. Well, they stop exercising and everything else. Can go ask you.
There is also some degree of social component to this. Oh, perhaps, I need to add a seventh, pillar of social, you know, during your 20s and 30s. You may be forming a family as well. Perhaps you have children, and the health of the family unit is going to be vitally important. Not only not necessarily directly for hormone optimization, but it's going to throw everything else off if it's off.
And for people that are not starting their own families in their
And 30s, can that social connection be extended to friendships and work relationships as
well. Absolutely. In fact, if someone's not starting a family, it, it is just as concerning. But for other reasons, each individual is going to have their clothes group of family and friends. And if someone does not have one of those connections, that's when things can potentially get bad, not just for them individually but also Society. So,
when you say stress, you mean learn to manage your stress. What does that look like? I mean, when if a patient
You know, as high blood pressure, even if they don't, you just sense that their stress. They were a lot of pressured speech or they're not feeling well or communicating that they're not doing well. What are some of the things that you recommend in order to try and ameliorate that stress?
There's different mindfulness or relaxation techniques going outside can often help with this as well. Dietary changes and exercise can help with this to some people like prayer or meditation and a lot of people like counseling or therapy or
Or even just talking openly with a family member or a
friend.
What would be some of the other pillars for hormone optimization here? I feel like we're not just talking about people in their 20s and 30s. But again, we're wrapping our arms around, basically puberty onward. I mean, I mean, gosh, I looking back, I started meditating pretty early. I started weight training and running early. I gave some thought to my diet and high school, but really was in college that I started thinking more about what I was ingesting and why, and trying to do better there. But people are coming to the table at different stages of life and trying to optimize
As for hormones. So you know so what would be some of the additional things that everybody should do?
Everyone should get outside and find a movement Pastime to last a lifetime. You're going to get sunlight, you're going to get some degree of heat and cold exposure and you're also just going to move more being an artificial environment. Where there's artificial lights, artificial air conditioning is going to have many effects on your body. So that's vital. Another one is finding what your purpose is in life. So I call this
Hear it. But it's really just the self-actualization component of Maslow's hierarchy of needs, which is basically your physical needs, your mental needs, and then your purpose in life, what you really like to do picking some goal or
Target and I always say that you don't have to stick to the same goal over time. Certainly I haven't although I got started early in the science game and I'm still in it. The idea is not to pick the end goal is to pick a goal and then once you reach that goal to assess and then pick another goal and so on, I think sometimes when people hear about
Picking a purpose of like a winner. I have to Define sort of, like, naming oneself that you, you actually can change your your, your goals and purpose over time. This is terrific. Would you suggest that people actively use or avoid supplementation prior to doing all these other things? I'm somebody that likes to throw the kitchen sink at things, but I also like to do things pretty systematically. So I always say behaviors first, then nutrition, then supplementation, and then maybe and if, and only if there's a real need and
Working with the doctor prescription drugs. But you know, they're probably people in their 20s or 30s maybe even in their 50s that aren't feeling great. And they want to do something in order to be able to train more and or to feel more confident to seek out social connection, they try and go go about the whole business from the other, from the other side as well. What are your thoughts on that?
I see supplements and medications as very similar once prescribed and once not in general medications have more side effects or
Ali stronger therapeutic with more efficacy, but they are just tools to reach an end goal. So, depending on the goal, if there's an individual that's an athlete and certainly they should consider supplementation, or if someone desires optimal or very a very high level of cognitive performance, they should also consider supplementation at the same time, food is medicine, and a lot of the benefits you can get in supplements, you can get in food as well.
I guess it depends on how much time and energy you willing to spend and also
Says, you know, I know that when I was in college, I could afford just a few supplements and they were basically whey protein and some fish oil. I was fortunate that I was pointing the direction of those things and some creatine, I couldn't afford much else over time. Of course, I could afford more, but it really does often depend on finances before we get into some specific recommendations to optimize testosterone, estrogen thyroid, growth hormone, etcetera. When I ask you a question, I've been wondering about for a long time, you know. So often in the
Russian about male hormone optimization. People will say, well, you know, if your libido is suffering, you know, you might want to be concerned about testosterone or even estrogen, right? Because we know that estrogen can impact will be do as well. Sometimes, having estrogen, too low is detrimental for libido or people would say you're not recovering from workouts or you're just, you're feeling kind of depressed. The problem is, it's all subjective. So how does one know whether or not their recovery from workouts their energy, their
Confidence, their libido is within a healthy range. I mean, obviously for people in a relationship, they can know whether or not their libido matches, the sort of cadence of, of the relationship in their partner. But how should people think about this? And maybe even start to talk about it? Because one of the big differences I think between males and females is that because females have a monthly cycle they are familiar with the changes that occur in their hormones over time because every 28 days those hormones are changing dramatically in ways that impact their physiology.
G and psychology, but for males. I feel like they're sort of a dearth of language to get into the more subtle aspects of this also has to do with privacy issues and people feeling like they don't want to over share too much not knowing what's appropriate to share. But when you talk to a patient who's in their 30s, or maybe even their 70s or 60s, doesn't matter. A male patient, what are you listening for? And you know, I know you're not a psychiatrist but you know what are your ears tuned to in order to try and figure out whether or not this person?
Could really use some help with hormone optimization or whether or not something else or maybe they're just doing great and they don't realize it because they're placing demands on themselves that are excessive. You want to you want to
use a lot of open ended questions. This process is called motivational interviewing and your goal is to listen to the patient and not plant an idea in their mind that they can follow because everybody is going to have a different goal. Some people are better at reading their biofeedback or telling.
How they feel on a daily basis. There is screening questionnaires designed, for example, an atom questionnaire to look at men's men's health and hormone related Health,
it's called an atom question. Adam question ad am correct. Is it available online that people could be administer it to themselves? Although we don't want people making clinical diagnosis of themselves or anyone else? Is it that sort of
exam? It is interesting. I don't believe it is a clinically validated tool like an ASC VD which is like a risk of heart attack and stroke to.
Or many other tools. There's one for depression, there's one for anxiety, they're called phq-9 and Gad 7 respectively, but anyway, there's often an in the atom questionnaire and what you hear from the patient, if you are very careful. Listener is often different.
Can you give me an example of some of the questions on this item questionnaire or the sorts of motivational interviewing that you might do. So say I'm your patient, we sit down what sorts of questions would you ask to probe these
Kinds of dimensions of hormones,
questions about libido questions about athletic performance questions about motivation and often. The patient will answer one thing but what you hear from them subjectively is far different, interesting. Can you give me an example
of a question. I'm happy to be the guinea pig here,
a classic one, is a guy comes in and a lot of times they say, oh no, the wife made me go to the doctor. I go once a year. That's it. I don't want.
Thing, I don't want any medications their screening questionnaires might be zeros across the board, so nothing no issues there. Apparently, in perfect health. They talk to you for a while, they get some Rapport, they like you. And then, right, as you're finished of the visit and about to go out the room, they mention that their libido isn't quite there, and they're having a little bit of Ed as well. And perhaps are even having some chest pressure
tightness. I see. So right, as you're leaving the room, a patient will tell you that they're having
Some sexual side effects or not side effects are having some sexual challenges and then they'll mention chest. Pressure is the chest pressure. I'd sort of General Decoy for. It's got to be my heart. Or is it? Or is it related to the other things? They're
reporting, it can be related. In fact, erectile dysfunction is known as the canary in the coal mine. So, coal miners would take the canary down and it would the canary would die before the coal miners would have, I believe carbon monoxide poisoning and often one of the causes of eat
Is plaque buildup, which can happen in the coronaries as well, but sometimes they notice the symptom and the genitals before they do in the corners.
So, for such a patient, let's say that patient was a young person where plaque buildup in the arteries and veins is not all that likely. If their let's say in their 20s or 30s, what would you be your next step of the interview at that point? And what would you consider? Would you immediately order labs for that person to try and rule out any kind of actual hormone level?
See, I certainly would order Labs. There's some individuals that are very similar and they come in and they have the same symptoms and one individual might have a very, very high testosterone and one individual might be severely hypogonadism. So there is a big difference between the subjective and what the labs look like. So, I certainly order Labs. You also asked them about if it's situational or not, you ask them if they have Ed, if they're, you know, the asking about their habits, you even ask about porn and masturbation.
Probation and all these issues. And of course, it's between the doctor and the patient. And depending on what they tell you, you can often determine if there is a situational component. Some people call it psychogenic, Ed but I don't love the term psychogenic, Ed because it kind of puts some some blame on the patient's mind. But a lot of the time that is the case, there is even a test and this is very rarely ordered, but it's called a nocturnal penile tumescence now because is, is it?
It true that there are periodic erections during sleep, correct. Yeah.
So you basically put a cuff to see if you are having a normal size Direction during sleep and I believe about 90% of the time they do that test, they are indeed having erections,
which would point to this psychogenic origin of whatever challenges they're having in terms of sexual interactions, you mentioned porn and masturbation. This topic has come up a bunch of times on this podcast and on other
As I've gone on because of the relationship between dopamine sexual motivation and sexual behavior. And I've been of the pretty strong stance that while I'm not judging Corner masturbation, it can create a brain wiring situation where males in particular essentially, teach their brain to be aroused by watching other people have sex, as opposed to being the first person actor in sexual interactions. So in that sense,
You know, that's more about the brain wiring and neuroplasticity and dopamine. But what are your thoughts on porn and masturbation as they relate to hormones? I mean, this is a big debate on the internet. In fact, one of the most common debates is whether or not masturbation increases or decreases testosterone in males. Certainly it will decrease motivation to go find sexual partners. We know this and there are more and more data on this all the time in terms of the effects of pornography and masturbation and here I suppose we need to be
Somewhat specific and operationally defined. What we're talking about, we're talking about porn and masturbation to the point of ejaculation, right? Because my understanding is that the ejaculation and orgasm associated with it, cause an increase in prolactin, which blunts libido for some period of time. The duration of that will vary from person to person and Circumstance to circumstance. But basically, all of this points to the fact that
Porn and masturbation can really limit libido in the real world. And to me, pornography, and the screen is not the real world screens exist in the real world, the real world doesn't exist in the screen.
That's an accurate statement and prolactin does have a significant acute increase after ejaculation. It does to some degree after orgasm as well. But prolactin acts on the pituitary to inhibit
The release of the hormones, LH and FSH of which LH can increase testosterone. So this may be one of the cases where the dose makes the poison. And if it is a very frequent habit, certainly daily, or more than once a day, would be very detrimental from a hormonal component. Not even taking into account that the neural wiring.
Listen, I think is terrific. The, you've actually defined frequency because this is the problem on the Internet or even in the doctor's office, you'll see this
Options about pornography being dangerous for certain things or detrimental to hormones will say frequent. But what's frequent? So you're saying daily or multiple times per day would be potentially detrimental to the hormone profile of a male. Essentially, any
age, and that's just for masturbation with pornography, with porn use as well. It would likely be worse.
Why is that just as this the sort of dopaminergic Drive of the stimulus? Just a really intense visual stimulus.
Is dopamine, Sensitivity. I think that using the analogy of a dopamine wave pool. It would deepen the pool, but not increase your supply of
dopamine. Maybe you could describe the dopamine wave pool because I think it's such a powerful way of thinking about dopamine, what dopamine does. In fact, I've always credited you and when I've done it, but I've generally stolen your analogy of the dopamine wave pool because it's so astute.
The dopamine wave pool describes the natural variation.
Of ups and downs in your dopamine or your motivation and in the wave pool depending on how high the peak is, you often have a deeper trough. So you do not want too high of a peak. In addition, if your Peak is very, very high. For example, when you're using many substances like cocaine, or like amphetamines, your dopamine can go so high. You lose almost all the water from the wave pool.
Pool. And then when you crash from that, not only is the trough low, you have less dopamine in the pool to begin with the dopamine receptor, is extremely sensitive as is the Gaba receptor, which is an inhibitory receptor where as dopamine is technically a stimulant more related to Adrenaline and noradrenaline the depth of the pool can change very quick. So you want to have that happy medium, where you're fairly near the top but you're not so near the top that the depth of the pool is going to
go down.
So, if I interpret that in the context, of this discussion, about libido sex porn and masturbation it. If somebody has a very intense sexual experience and not not here, we're not necessarily talking about an intense orgasm, we're talking about Justin and, you know, a lot of intense visual. So very a lot of intense imagery or auditory input or both, that is going to lead to a situation where dopamine is going to be depleted afterwards. Correct. A guest on this
Podcast before my colleague at Stanford, dr. Anna lemke's expert Edition. Talked a bit about this. The sort of see-sawing you were taking about a wave in a crashing, out of the water from the wave pool. There was a see-sawing from Pleasure and Pain is going to be a longer and deeper period of lack of pleasure following that. And I think a lot of people think oh well, that's great, you know, they want the intense experience but if that intense experience is coming from pornography and masturbation or I suppose coming from, you know, High adrenaline activities like, you know, life
Life-risking parkour hanging off the side of a building. It inevitably is going to lead to depressive episodes. Low libido episodes that follow, is that right
correct in a similar physiologic way to withdrawal from stimulants. Like amphetamines
now is sex with a partner different because there are many people who are chasing more and more intense experiences with a partner as opposed to through pornography and masturbation. Again here, we're talking about all ages and I should always say anytime we're
About sex with a partner. We're talking why, you know, the four conditions that I was just lay out on the human lab podcasts are that we're talking about consensual age, appropriate context, appropriate species-appropriate interactions.
Yeah. And this is also a case where the dose makes the poison so if there's, you know, obviously meeting all those criteria, if they have one preference that for both of them is a positive experience.
Audience, then that is likely, okay, you're not going to be able to maintain dopamine over a certain threshold for a long period of time. So they're very well, maybe a crash from that experience as well. And the Crash may be different in one partner than the other interesting. Oh, I'll
draw an analogy to food and be like, you know, you don't have to serve the banquet meal seven, seven nights of the week, maybe just to, is that right? And there are other delicious foods out there.
And yes, use that analogy. That is
Very
reasonable. Okay. Not trying to be PG-13. Just trying to parsimony Occam's razor. The ability to describe a lot of things and in a few words, I'd like to return to the key things that people should do or I should say the key things that men should do to optimize their hormones. We talked about getting some movement, getting some sunlight getting Quality Social connection, one way, or the other avoid excessively frequent masturbation and viewing pornography. And for some people
Zero might be the optimal number and I keep coming back to this to people for most people, interesting. I feel so fortunate to have grown up prior to the availability of Internet. Pornography, I've never been a big consumer of pornography at just not been my thing at but I hear so often from males of all ages about their addiction to it, their Affliction by it. It's really a serious issue and that's one of the reasons why I'm grateful that you're willing to talk about this in your clinical experience with these patients. I'd like to take a quick break and acknowledge.
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That's sort of my general schedule. I'm also familiar with when I go out for runs that are excessively long to our runs or I spend 90 minutes in the gym too, frequently start to feel like garbage, everything suffers my sleep starts to suffer doesn't matter how much I eat. I don't seem to recover, I don't feel well. So I realized that recovery ability varies between individuals. But what do you think is a healthy sustainable exercise regimen that anyone can follow that will also support their hormones?
Thatís
for really vigorous exercise around three to four times a week is very sustainable over a long period of time on top of that you could add in three or four more instances of less vigorous exercise.
Okay so for Less vigorous we do you mean that you know Zone to cardio where you can hold a conversation but beyond which you can't and for more vigorous you're thinking weight training or high intensity interval type training. Is that right
correct? You can also wait train and have
Benefit even at a low to moderate intensity. If you think about weight training where you have and it's not necessarily lead to the incidents of Dom's which is delayed onset muscle soreness. But if you wait train, lazy or easy from time to time, obviously you want to weight train very heavy from time to time as well because of more lean body mass growth. But if you weight train the lighter, you're going to be able to do it more often, and it can still help with the
Rafi of collagen, for example in tendons and ligaments.
So here again like to perhaps drill into this notion of intensity and light weights because for me some of the most brutal workouts I've ever done where in what I would consider a high repetition range. 15 to 50, I went up to Oregon to watch the international track and field championships and we went by to Cameron haynes's place, right? The Cameron hands and he and his trainer put us through a workout. That was 20.
52 50 repetitions per set and it was done in circuit and it was brutal. So it was light. I mean, that's those weights were nothing in some cases. It was body weight but the number of repetitions was brutal. So when you say limiting intensity, are you talking about limiting the number of sets to failure? Are you talking about really being kind of lazy bear in the gym? I like to do that room to a long, long rest to that sort of thing. What are your thoughts on that as it relates to hormone optimization? So I'll just mention and then I'll let you
Answer, I feel best overall when I'm training for 10 minute warm-ups and about 45 or 50 minutes of weight training, where I'm pretty lazy between set, two to three minute, rest training, somewhere in the 6 to 10 rep range, going to failure every once in a while, but mostly getting that sort of last rep, before what I would think is failure, no, for straps, that kind of thing and then jogging on the other days, nice and easy. When I do that, I feel fantastic and all other dimensions of life when I train more, intensely than that, even with
Lightweight to faster, Cadence, and lower rest. I feel like garbage, I get ahead, a kind of ornery, I everything suffers. So what are your thoughts on? Kind of defining a optimal exercise strategy for hormones. I've never measured my hormones in those two different context, but I have to imagine that it's cortisol related
when they study the effect of exercise specifically, vigorous exercise, one area that's been studied as vigorous exercise episodes lasting
Longer than an hour and they usually track it by a rating of perceived exertion, which isn't perfect. And it's not extremely actionable, but it's helpful for clinical science. But the takeaway from, that is basically do not, it is not hormonal e helpful to drain especially regularly train vigorously for longer than an
hour. Okay, so I'm happy to hear that because it sounds like for most people that hours of work is really the
Old. I think this is important for people to hear especially males because I think with all of the incredible examples out there people like cam, like David Goggins, people who are training for very long periods of time, you know, and leaving aside all issues of what people are doing in order to optimize the recovery. I think an hour a day of exercise is just a great program that most, anyone can follow and Beyond an hour, you start running into challenges. And I, you know, the
Occasional 90 minute or two hour. Workout is no big deal but if you start doing that more than once, every two months, I think you're headed for trouble. Have you seen that in people's blood blood work and in their hormones? You ever see people that are just badly over train because they're just trying too hard and too often.
Yes when the blood work is particularly bad, they're often in a large caloric deficit as well. There's a synergistic effect between a caloric deficit even if you're
Inadequate, protein intake. You might not be maintaining adequate iron intake or adequate vitamin D. And you're also just literally in a caloric deficit. Perhaps low carbs as well. Very low, free testosterone and they are simultaneously doing a lot of vigorous exercise.
Just I often hear and I'm starting to wonder whether or not some of the quicker to results nutrition tactics things like
dropping all carbohydrates or the quicker to result exercise Habits Like starting to do six day a week. Really intense workouts, whether or not in the short run, they work because they cause the Cosmetic changes that people are seeking. But that they really undermined the overall goal, which is, at least to me to have your hormones, maybe not optimized to the, you know, 100%. But to always be aiming for 100% and be close to it at every stage of Life.
Consistency is key here.
If you are not consistent then the law of diminishing returns certainly applies, so 80 or 90% of the benefit over many, many months is far better than a hundred percent, but only half the time.
One thing that I found to be tremendously useful is to finish the workout while I still have energy to not take myself to exhaustion, and then I'm able to kind of talk about the dopamine wave pool. I'm able to sort of ride that into the rest of the day.
Feeling great, I serve save or Bank. Some of the Vigor from the training, to bring it into my work. But then again, I'm not an athlete. I do I get paid to think and to speak not to not to lift weights, or to run
another component of that is the balance between your sympathetic, which is your fight, or flight, nervous system and your parasympathetic, which is your rest, or digest nervous system. There is an anecdote, which is likely true. That many Elite bodybuilders are very parasympathetic, besides, while they're lifting
weights, you mean
Lazy and they like to eat a lot. Yeah. The lazy bear in the gym kind of phenomenon.
Absolutely but that being said, after a very, very vigorous workout. For example, one where you're trained to failure which bodybuilders and powerlifters do all the time, you feel the tiredness or you feel the strain from that heavy sympathetic activity when you are lifting a heavy weight and it can potentially affect how you feel the rest of the day. So many people who
have a job where that is highly cognitive. Do not like to have an extremely vigorous workout in the morning, which is when a lot of people are able to exercise.
When I exercise early in the morning that is before, 9 a.m. I have more energy all day long. If I do it. Mid-morning, I have experienced more of an afternoon crash. There's probably some circadian biology in there. I also noticed, and I've actually seen in my blood work that if I don't get out for a 45 minute jog, at least once a week, all of my blood profile suffer in the
Section that I don't want them to go in particular testosterone and estrogen move in directions. That are not conducive to my goals.
I'd like to talk about some of the approaches that people can use in order to optimize hormones and these days for better for worse. I think for Worse, younger guys are asking about and using testosterone replacement therapy, so called trt. And I just want to frame this up by saying there is no strict cut off for what is trt. There are plenty of people whose blood levels of testosterone and estrogen are in the, within the normal reference range and decide to start doing these things. Of course they can limit.
Leti, they're a bunch of issues. Even at non quote-unquote steroidal performance-enhancing dosages. I love to frame this out by first defining, our terms because one of the challenges on the internet as people talk about trt then they'll talk about performance. Enhancing drugs will talk about steroids they're all steroids right? I mean the testosterone estrogen are both steroid hormones. But what one considered replacement therapy versus what one considers performance-enhancing is going to depend, right? So here's my question.
Why in the world? Why in the world would any male in his teens or 20s, or even 30s, whose blood levels of testosterone and estrogen are at the appropriate levels meaning within the normal reference range? Why would they take exogenously testosterone, given all the negative effects on fertility? Some of the challenges that it can present if the dosage is aren't quite right etcetera. Why would they do that?
Certainly, if they are not being paid for a particular Endeavor, like they're not making money. If they are playing a sport, chances are, they're not allowed to do that anyway. It's on the banned substances list. So to me, it just seems like a crazy idea, but then again, I'm of a generation that really hasn't thought about doing that stuff until people were in their 40s and 50s or even never. So, is there ever a case for somebody in their twenties or thirties? To take testosterone suspect? If their blood levels are within
300 to 900 nanograms per deciliter, reference range,
not many cases. The reason for any performance-enhancing drug whether or not it is a steroid synthetic bioidentical or otherwise, it varies a lot, some individuals do it, only for cosmetic reasons, even if it can have deleterious effects on like, the Cosmetic appearance, for example, if your skin and a long run. But you
No, everyone has their different reason as far as like, when does the benefit outweighed? The detriment not very often. If you're in your 20s and certainly probably almost hardly never, there's always, you know, rare cases like Cullman syndrome and whatnot, but almost never if you're very young,
okay. So for people in their 20s 30s and Beyond 40s etcetera, who's testosterone and estrogen levels are at the appropriate ratios and in the within the normal range
Prince range and they feel pretty good. Right. We talked about the atoms exam where this sort of like, feel pretty good as her of code, for libido energy recovery, Etc. And are feeling, you know, at least workable for their lifestyle. For those people what can they do? Besides get great sleep train but not too hard or too often etcetera, Etc. What are some of the things in the realm of supplementation? That can help them optimize their testosterone and estrogen without
Suppressing their own endogenous production of testosterone. And estrogen,
let's mention creatine is the first one creatine is interesting because it has multiple different effects that helps with amino acid synthesis. It also helps with oxidative stress. It can also serve as the backup fuel tank for your mitochondria. So kind of holding back up ATP and it does slightly increase total testosterone, and it also increases the conversion of testosterone to dihydrotestosterone. So potentially it's especially useful
In Men in there, even their teenage years and their 20s,
you mentioned the conversion of testosterone to dihydrotestosterone, and there is mythology-- out there that creatine can increase hair loss. I'm guessing because there's at least one study showing that creatine can increase. DHT dihydrotestosterone, DHT is one of the primary hormones that can promote male pattern baldness. So, the question therefore, is does creamy creatine supplementation, increase the rate of
Of hair loss.
Theoretically, it can, but in in each individual preventing hair loss is a very poor reason to take creatine because it's not going to take you to a Supra physiologic level. It's not going to, you know, increase your androgens to a nun, normal level of binding. So I feel like this, if that was a reason to not take creatine for hair loss, then that is
for sorry.
I mean hair loss is not a reason to avoid taking creatine
correct. Hair loss is not a reason to avoid taking creatine it. Think of it as just bringing you to what you are naturally inclined to have. If your conversion of testosterone to DHT is already high. Then often creatine does not affect this, it just kind of resets your balance between testosterone, being aromatized to estrogen, or being five, Alfred deuced DHT. So it's not going to
Speed up hair loss more than just naturally, be a male does. So in some individuals, it will have no effect in some individuals for whatever reason, they have almost no 5-alpha reductase activity. It will return them to Natural or
normal. I see, well, I Take 5 grams a day of creatine monohydrate. I do it for the tissue volatilizing effects of for exercise benefits, but also for the cognitive effects, I don't know if it's increasing my hair loss. I mean, I've got a little bit of sort of widow's peak type hair loss. That's where,
As for me I suppose beard growth is associated with the HD2. Most. Is that right? My what I learned but then again, I haven't been into the literature a long time. Is that? Because of change differences in receptors that DHC causes hair growth on the face and hair loss on the head? Is that right?
Yes. And the amount and the sensitivity and density of those receptors is genetically
determined and is it true that if your mother's father was bald that you will be bald in the same pattern and if that he wasn't
You
won't, that is a decent correlation part of the proposed mechanism of this. Well, there are several genes and you can actually test your genes for hair loss. You do get a decent amount of them from your mother. The unique thing you get from your mother, that she may have gotten from her father that she got one of the copies from her father, is your X chromosome and the Androgen receptor Gene is on your X chromosome. So all men got their Androgen receptor Gene from their mother.
It's on their
I'm not on the Y chromosome. Correct. Interesting. Even though all of the sort of quote, unquote, male-male promoting genes are on the Y chromosome, like malaria and inhibiting etcetera. Interesting. Okay, so, 5 grams a day of creatine for most people should be fine. Beneficial for tissue Vulcanizing so strength, bring water into the muscles and for cognate the cognitive effects and the clinical support recruiting. I think it's quite strong at the five grams per day. Dosage. Now, what other sorts of stuff?
Elements can people benefit from? We already talked about the omegas and making sure that people are getting enough. Prebiotic fiber to support the gut microbiome and vitamin D. So what other supplement based tools? Can people
consider another one? We can Loop in with creatine as beta in some people are non responders to creatine. So you can increase that to 10 grams or you can use its cousin beta into help with amino acid synthesis and shunting of energy. Along with that. I would put a
Carnitine, which is actually the smallest peptide. Hormone is just two amino acids that are put together. So, it's a hormone interesting. Well, I'm not challenging at times. Yeah, I'm not challenging call it a peptide bond more than a hormone. So I would not call L-Carnitine hormone. Okay. But I would call dopamine, oh, a hormone. Yeah, I could,
neurohormone, it's so hard to to Define things as transmitters, or hormones at some level. I agree. So L-Carnitine actually I should backtrack
Betadine, do you recall what dosage people typically would take? If there is a creatine
non-responder, 123 grams insects? Yeah, several versions of creatine have beta n mixed in because it helps with the processing of methionine and
homocysteine. So if somebody is already taking creatine and likes it in response to it, raised my hand such as myself, would adding beta in help or is it redundant with creatine
only if their homocysteine is persistently elevated?
And homocysteine is kind of like an inflammatory marker that can build up if you're not converting enough of it down the stream, how would I know? Just a blood test? Okay? Or if you knew your MTHFR polymorphism, which is basically how you add methyl groups to many things in the body,
great, any side effects of beta in that people should be aware of.
Not that I know of. Ok Peewee. Look it up and on examine dot-coms. A great site for that they'll surely list it, they just revamped their site by the way, and it was awesome before and it's Platinum now, so L-Carnitine, what are the ways to take L-Carnitine? I know that there's an oral forms of capsules and there's injectables injectables. I think you need a prescription. Is that right,
correct? You need a prescription for the injectables or you should really get a prescription for the injectables for when you inject it.
Of course at the supervision of your doctor, it's usually done intramuscularly, it's an aqueous solution. So it does not have like an oil or a carrier oil in it. Like TR like testosterone Esters do however if you inject it to superficially it's not going to make a wreck anything. Often it just burns if you inject it subcutaneously and it is not disseminate throughout the body, as well. L-Carnitine potentially has localized effects. If you inject it, if you ingest,
It orally, then it has a very low bioavailability, maybe only
10% what most people are going to be able to get L-Carnitine only or, you know, in its capsule form. So what are the dosages of L-Carnitine that one needs to ingest? Then if they want to get a benefit because if only 10% is being absorbed it's probably a lot of L-Carnitine. How much should people take per day?
Usually I recommend for oral L-Carnitine between 1000 mg and up to 45 thousand milligrams.
S,
so 1 to 4 maybe even 5 G.
Correct, I got up to 5 grams a day. If you're on that much, especially if you have a dysregulated gut microbiome, you should be concerned with tmao, which is a potential carcinogen that both carnitine and choline can convert into and your gut microbiota, determine how much that happens.
Is it true that I can offset any negative effects of alpha GPC, choline that is n L-Carnitine that I take by in
Resting garlic. Is that
right? There's a compound in garlic called Allison, I believe it's a lli cin. It's also part of the scientific name, the genus of types of garlic and this can help decrease the conversion to tmao berberine, actually slightly decreases the conversion to tmao as well probably through alteration of the gut microbiome and then just optimizing your gut microbiome can decrease conversion. So not everyone needs Alison, but it's something that you should certainly consider if you were on a
High dose.
I'm going to continue to take the 600 milligrams of garlic. Every time I take my L-Carnitine but I'm going to skip the berberine because berberine gives me brutal headaches and it makes me crave carbohydrates, could because it drops, my blood sugar, it
has many other effects including the dawn phenomenon, where it drops, your blood sugar, when you're sleeping and you can't even realize
it. I am not a fan of berberine and I'm sorry. For those of you that are I'm not trying to offend anyone, although frankly, if you're being offended by my stance on berberine and maybe we should have another discussion.
And in any case injectable L-Carnitine, if one can get that through a doctor, how much is absorbed and how much should one take
almost all of its absorbed in general, you're taking between 500 mg up to. You can take a pretty high dose up to 2,000
milligrams, okay? And what we did not talk about is what L-Carnitine does. So why should why should someone go through all of this? Is it to optimize testosterone, is it working on the receptor side? What's L carnitine doing?
It's a shuttle. So I think it's named carnitine Paul material coenzyme, a basically it's it just takes nutrients from outside your mitochondria and puts them in. It also has a unique effect. Well, not too unique because tadalafil actually has this effect as well. Is that it increases the density of the Androgen receptor and the cytoplasm of your cells. So even if your Androgen receptor, sensitivity doesn't change, and even if your does testosterone does not change, you will have more.
Testosterone binding to that increased number of
receptors, does one need to cycle L-Carnitine creatine beta-alanine. No reason to cycle any of those okay, what other supplements can one use to try and improve hormone profiles. And, and here, I realize we're using a very broad brush because we say improve hormone profiles, what are we really talking about? And for me, at least I think about the subjective stuff, you know, do people feel like they are going to have more energy as a
And of doing these things. Are they going to have the more optimized Lippy do? Are they going to have more optimized recovery from exercise, right? Because I mean it's not clear to me that taking once testosterone from 600 to 800 is always going to be a good thing. Especially if estrogen is increasing in parallel that could cause issues it could certainly make things better, it could certainly make things worse. Alright. So with that backdrop, what are some of the other things people can take and then we'll go back to this issue of what really is
optimization. Let's briefly.
We mention vitamin D, which is also a hormone. It's actually a steroid hormone and have. If you have deficient vitamin D and you replace it, then you will optimize your testosterone. It's also mention Boron. So if you have a very high shbg Boron can acutely help lower it usually, in a dose of 5 to 12 milligrams per day. It's not really a sustained effect, but Boron is depleted in soils and many countries, I believe it's very high in soils, in Greece, and Turkey. So eating dates or raisins that are from
Areas potentially have more Boron. Boron also meet might be one of the reasons why the reference range for testosterone is much higher, in those countries than other countries and just
to remind people, the shbg sex hormone-binding globulin is attaching to the testosterone molecule and limiting the amount of so-called free testosterone that's available to have its impact on cells from dr. Peter attia was on this podcast, in fact sitting in that very chair. He said that the ideal level of free testosterone in males should be about
two percent of one's total testosterone. Do would you agree with that number or disagree? I'm sure. Peter will be fine. If you said either
2%, is a good rule of thumb, usually, the reference ranges between about 1 and 4 percent. Some people do have genetic polymorphisms in shbg. A specific gene mutation where they have very low shbg. He's also men that have varicose veins in their testes, also known as varicocele, 's tend to have very high sh Bee Gees. So
Percentage would likely be less than 2%. So just because your percentage of free to Total T is a little bit above or below 2%. That's okay. We just need to figure out the reason why it is,
how would somebody know if they have varicose veins in their testicles, especially if their testicles are still in attached to their body?
Sometimes it's hard to tell there is several grades, if you have a grade 3 or grade for test varicocele,
Seal it has what's called a bag of worms appearance. So think about if you've just resistance trained or it's a really hot day or rearrange, very tight fitting clothing. Then if you feel it and almost feels like there's worms in the scrotum the other way is to do the scary visual. Yeah, bag of
worms. Well, it's just that. Yeah, anyway, I think parasites when I hear that, but that's not what you're referring to. You're talking about. Just the the
texture, the best way for most people to check is to Val.
Salva, for a long period of time. When you valsalva venous return will decrease,
can you explain valsalva for
people? It's bearing down, like you're lifting a weight or having a bowel movement.
Where you swallow, and I'll a lot of times you can almost see build up of blood in your like, jugular veins as well. So you have increased decreased blood, return to the heart and increased blood in the veins
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Grams per day. All right. And then what are some of the other things to optimize testosterone that are in supplement
form?
We can talk about things that affect this dorota Genesis Cascade, so we could touch on tongkat Ali. I know we've talked about that a little bit
before it's all, but I'm guessing a number of people, probably haven't heard that conversation
also known as long Jack, and that up regulates several different enzymes in this dorota, Genesis Cascade. And by that, what you mean? If, and this is another good thing to Google. I think anybody interested in a hormone optimization should understand where Horst are all hormones. Come from, they come usually from cholesterol and they can be sure.
It off to vitamin D, very easily, they can be shunted off to testosterone or estrogen Zoar. Progestogen is quite easily as well, but tongkat helps with the conversion of multiple key steps where you synthesize testosterone. Another think of it as like a coenzyme or a cofactor up, regulator of these steps is insulin and igf-1. So A good rule of thumb is if you are not expecting as much growth.
Growth hormone insulin and igf-1 for example, lower carb diets. Caloric deficits you're trying to cut body fat, or body weight. Then Tomcat is going to be theoretically, especially
powerful, what sorts of dosages of Tonga. Do you recommend to your
patients anywhere from 300 to 1200 mg a day with tongkat? You need to be careful with the standardization because an if you're thinking about a general Tomcat
Which is by far the most, well studied. Then you're looking at the URI, Komen own content, which is a plant compound that is likely the main active pharmacologic effect. So that's the compound is having the effect on the body. And if you standardize, the yuriko manone, very, very high. Then theoretically, you're having more effect at a lower dose.
I take 400 mg of Tonga Ali per day. I take it early in the day because it has a bit of a
stimulant effect. And if I take it after 2 p.m. it starts to inhibit my sleep, I've been taking it for years and I rather like the the effects that it seems subtle but you know consistent, I've never cycled it. Do you recommend cycling
it? I don't see any reason to cycle it. There is there is a reason to cycle some supplements but no reason to cycle Tonka,
my blood work tells me that it causes an increase in free testosterone for me and also a
an increase in luteinizing hormone for me, what are some of the other effects on various hormones that you've is observed in the blood work of your patients, taking Tonga Ali,
Tomcat can also, slightly increase DHEA. And if you have a very high shbg, again, that's the protein that binds up your androgens and estrogens and extremely important protein. The higher, your shbg, the more it helps decrease it. So they've studied Tomcat in populations. With very normal. Sh Bee Gees and it does nothing for shbg.
Interesting. Does that mean it does nothing for somebody over. Also, if somebody has shbg, that's in the
Normal range will taking tongue. Got benefit them in any other way.
Yes it'll increase their total and free
testosterone got it. Okay, does it? Is it known to have effects on anything else? Like thyroid hormone growth hormone or is it purely in these steroid synthesis Pathways or steroid? I should say synthesis and receptor and modulation Pathways
there's no direct effect on those Pathways. However, anytime you alter your free Androgen or free estrogen.
Particularly one without altering the other, it will alter The Binding protein that binds thyroid hormones. So any change you make whether its natural optimization or a hormone replacement, you're going to slightly skew your thyroid hormone profile, one, common like actionable example of this that I see often. Clinically is someone starts, let's say estrogen replacement or testosterone replacement. Maybe they're taking an AI with their testosterone
replacement aromatase, inhibitor.
Correct, an aromatase inhibitor, which blocks the conversion to estrogen, if they're taking testosterone and they have very little estrogen. Then you're going to decrease The Binding protein, also known as thyroxine binding globulin, which binds active thyroid hormones. So if you start trt and you either have low aromatase activity or no Aroma taste activity, no conversion to estrogen, then you're free thyroid. Hormones will go up. Even just
Acutely it usually feedback inhibition which is how the body talks to itself. And says, you know, we need to make more of this or less of this. But acutely, there's not always enough time. You're going to have very high thyroid hormones and you can have tachycardia, which is a fast heart rate, or you can feel kind of like overly fight or flight due to increased thyroid hormone activity in the in tissue. Interesting.
Okay, so Tom, golly this, it's a broad range. 300 2.
Under mg per day. And I realized that the source matters there, what are some of the other hormones that you prescribe to your patients who do not want to go on testosterone? Replacement therapy or take exogenous DHEA or anything like that?
We can talk about for Dozier next 4. Doge is interesting because it's a genus of plants for Doja. Aggress, this is one of them. There's many others that are very interesting that species is likely the most, well studied and it will increase.
Reese LH. So I would not consider it an LH memetic, so it doesn't really mimic it, but it increases the release of luteinizing hormone from the pituitary. That's a hormone that binds to the latex sell to the LH receptor. Kind of like HCG does and it will increase the release of testosterone.
I see. So I think for people that aren't familiar with HCG. So human chorionic gonadotropin is basically synthetic luteinizing hormone and luteinizing hormone is the hormone released from the pituitary. That is going to
Travel down to the testes, to stimulate the production of sperm and testosterone. But mainly testosterone is that
correct, mostly correct. Technically synthetic LH is also known as little rlh or recombinant LH, and HCG can be synthetic, but often it is. Just refined from the urine of pregnant ladies since the since the placenta mix it, that's why it's called chorionic
gonadotropin. So where are they getting all this pregnant?
Woman's urine. I mean, is I mean, there's their location. I mean, not that I want to go to a nation, is it really? So there with
person? Right Master pregnant ladies.
It's very high donating, their urine and then they're purifying it. And then men are injecting
it. Yes, wow. And that's actually the same for menopausal ladies. So first, trimester pregnant ladies. That's how you can make, you know, non-synthetic, HCG, and then for miniature opens, which are also known.
There's a couple of different names for it like menopur. You have menopausal ladies that have very high LH and FSH and then you refine the FSH and LH.
Okay, so moving away from the sources and from urine, Fado G aggressed. This, what dosages do you have patients? Take, I've heard of some potential toxicity to the testicular cells.
There was one study and this is a rat study but you can equate the dose of toxicity in rats and humans.
Emmons, they did not give these rats any antioxidants, but it increases a couple different like Pro inflammatory markers one is ggt or gamma gluten will transfer race. Comes from both the testes and the liver and one is alkaline phosphatase also known as elk Foss. Again, coming from both areas. There are several different ways that you can attenuate, this increase. And you can also just check to see if you have increased in the rat dose that equates with humans, that had no effect. So, the safe dose,
Was an average of 300 milligrams a
day so that would be 300 milligrams a day in humans is the dosage that did not have toxicity.
Correct. And often, even if there is toxicity in rats, there is not toxicity in humans, so it's not directly Equitable. But to be safe, another regimen that I have people take is 600 milligrams every other day or 600 milligrams three times a week often Monday Wednesday Friday. This is
very interesting and
and relevant because i-i've been taking Fado Gia for some period of time all my markers and tests indicate that there's no toxicity. But I've been taking 600 milligrams per day but I've been cycling it for about 8 to 12 weeks on and then a few weeks off. But based on what you're saying, I'm thinking maybe three times per week or every other day might be better. Is that right?
If you aren't going to get any labs, that is certainly with the regimen that you want. If you're going to check your ggt and out Foss or
Take other things to prevent those from increasing, then you can certainly be more aggressive with the fruit. Your Fado shh dosing, you can increase it quite a bit and it has a dose-dependent response in. Both the activities associated with high testosterone and also just LH and testosterone. So the, uh, no more aggressive regimen would be 600 milligrams, daily for a month. And then take one to two weeks
off, great. I think that's more or less. What I've been doing, okay, terrific.
In terms of other hormones, what are some of the supplements that can support growth hormone? I don't hormone that's associated with tissue repair and in some cases metabolism and fat loss, what are some of the tools nutritional and, or supplement based one can do to tap on the growth hormone pathway? And, and let slump igf-1 in there, to since they're essentially working along the same
dimensions. A quick, synopsis growth hormone is a peptide hormone and it is released by the pituitary.
There's growth hormone releasing hormone and a ghrelin that stimulate the release. So there's also a peptides that are very analogous to these two things. You have that pulsatile secretion of growth hormone in a very fast half-life of just a minutes. And then it increases igf-1. There is both peripheral igf-1, and Central igf-1 and igf2, but no need to get into the specifics. There is a happy medium to where your growth hormone is at a adequate level and your igf-1 is an adequate
What level? Usually those two are congruent. So in most cases we just check and igf-1 and occasionally The Binding peptides for igf-1 kind of like shbg that we talked about earlier but you're estimating, a free igf-1. It's kind of confusing because all hormone almost all hormones, have binding proteins to help regulate them. But often you want to look at free testosterone, free estradiol, free igf-1 or at least estimate it, free cortisol, even and free.
Hormone. But when you're talking about growth hormone and igf-1, usually, you don't need to do anything to optimize it. If you are diabetic, then I depending on the type of Diabetes, your igf-1 and growth hormone can be too high specifically in type 1 diabetes, your growth hormone is extremely high but your igf-1 is low. So if you're in a dysregulated state or if pathology I would just talk to your
Doctor about igf-1 or growth hormone, taking thing taking amino acids before you go to bed could potentially help with growth hormone release. Just because most growth hormone is released while you sleep.
I've heard that fast and can increase growth hormone, and I know there are certain patterns of weight training, the that can increase growth hormone some of those regimens in the weight room that increase. Growth hormone have been covered by dr. Duncan French. Who is a guest on this podcast?
So maybe we'll refer people to that episode for the specific protocols, he's high volume training
during those training exercises. It usually does it transiently for a period of a few hours and at a lot of this igf-1 is released by the muscle itself. So it's not necessarily the reefs, by the liver igf-1 that is released directly due to growth hormone signaling usually, the growth hormone comes from the pituitary and binds to the liver. Where at
Usually has a half-life of About a Week where the paracrine or autocrine think of it as like the peripherally acting or acting in the muscles itself which is also helpful is released and is not as concerning because it's not related to insulin resistance but it is related to the training
itself so fasting and growth hormone, is it true that fasting can increase growth hormone and maybe as a little related tangent? I've
That limiting food intake for the two hours before going to sleep can increase the pulse of growth hormone. That one experiences during sleep course everyone gets a pulse of growth hormone during sleep but especially carbohydrate Laden meals can blunt that Peak that occurs during sleep quite substantially. So, two questions does avoiding food intake in the two hours prior to sleep help, increase growth hormone release, maybe it's being overly neurotic. Maybe people need to avoid food in the four hours before sleep, but
Guard less. What is the relationship between fasting and growth hormone release? I find this really
interesting fasting. Certainly potent. Lee increases growth hormone release, however, the end binding to, the receptor is less sensitive. So, although fasting does increase growth hormone. The genes that are Downstream to it. Both the growth hormone genes and igf-1 related Gene, transcription activity will not be significantly.
Fire. However, if you are optimizing the growth hormone that is released as pulsatile secretion, it is helpful to avoid eating for two hours. So the general rule of thumb is avoid eating about two hours before bed. I think that's clinically significant and helpful but fasting otherwise specifically for growth hormone optimization. And someone who already has normal growth hormone signaling is not helpful.
That's extremely useful to hear because they have one of the major
is why people fast as get that growth hormone increase. But if they're adjusting things on the back end, that negate, that well, then no, such luck. Not that. I have anything against fasting. I do a sudo intermittent fasting mostly because I prefer to eat it. Rip fairly regular times of day. Okay, so it doesn't sound like there's a lot that people can take in supplement form to improve growth hormone, what about thyroid hormone, what are the? Some of the things that people can take or do in order to make sure that their thyroid hormone levels are appropriate?
You want to have a balance of iodine and you won't have a good source of iodine. So there's some camps that say you should use a huge high dose of iodine and there's protocols for it. And there's some that say you should use just barely enough iodine. I believe it's like 200 micrograms per day, but you want to balance one of the things that I see that many people do not talk about when it comes to iodine and thyroid is, there's compounds known as glitter regions or go Trojans and these
Go, Trojans are neither good nor evil but they're actually kind of a nice check and balance, you need more iodine. If you consume more goitrogens and some examples of these are some of my favorite fruit Foods. Cruciferous vegetables. Boron is also a go Trojan. So higher go Trojans, higher
iodine, so adjusting iodine, containing salt is useful. Yes or no.
Iodized salt does prevent goiter but it is not necessarily the ideal form of iodine. Good forms of iodine often come from the ocean. If you look at a chart of hypothyroidism, there is a tendency to have more hypothyroidism, the more Inland you go. So trying to eat some cruciferous vegetables. Each day would be the best way to improve thyroid hormone along, with plenty of iodine, you don't want too much iodine, signaling. Many people are familiar with Radioactive,
Iodine, tablets. And that's basically an extremely high amount of iodine to block out the, like, the radioactive iodine that comes from after a, you know, like a nuclear meltdown or
whatnot. So we've got creatine bidding L-Carnitine with Alison garlic to offset the tmao. Vitamin D3 Boron, Tonga Ali, Fado Jia fasting. Love to talk to you about peptides so I can imagine a hierarchy
Hierarchy starts with Behaviors new and nutrition. Behaviors, of course, includes training and limiting stress. And all the things we talked about before Sunshine, Etc and optimize nutrition. Then we talked about supplements, all the things we just listed off to optimize testosterone and we can get into this but estrogen as well, which is important for libido and brain function, and tissue function and Joints feeling good at cetera. But then we get into the realm where one might or could
Exogenous hormones, get taking a small dose of testosterone or taking a small dose of GH even if you know, if that were appropriate and certainly only working with the doctor, but in between there's this step of so-called peptides. And of course, there are many peptides we've already talked about some of them, but when people talk about taking peptides, the ones that I hear most often about is a category that increases GH and igf-1 and those to my knowledge, go by the things like sir, more.
And I prefer, Ellen Tessa more Ellen, sort of Kit of things that taken separately, or in combination to increase, g, h, and igf-1. But then other people for instance, are taking peptides like bpc 157 to try and improve tissue healing and Recovery. There's a lot of interest in peptides. Please, if you would tell us about what, you know about the safety of peptides, in terms of their sourcing, and the utility of peptides, you know, is this something that people should consider before?
Think about hormone replacement should people be wary of these things? I am very wary of particular sources that are sold online that are not clean. They contain contaminants. And that could be dangerous. I really would love your thoughts on peptides. I'm just going to sit back and let you Riff on peptides, but if you could touch on some of the ones that I mentioned, I'd be most grateful
a peptide is just a chain of amino acids, between two and a couple hundred in length. So I think of peptides as several different categories.
And the GH RPS that you mentioned, I would consider those net stands for growth hormone releasing peptide. You have two main types, The ghrelin Agonist that, or they hit the ground receptor and though it helps release growth hormone because of that. And then also the g h RH like peptide. So they're very similar to growth hormone. Releasing hormone often, they just change a couple amino acids and it acts like that Tessa
Merlin is one of them. Sir, Morlin is another one and CJ C is another common one. I believe those are all in the class of g h RH like peptides whereas I Boomer Eleanor I Buda Morin which is also known as MK 6 7 7, those two are in the class of ghrelin Agonist so they're more like they hit the receptor that ghrelin does where's the other ones? Hit the g h RH receptor.
I think of ghrelin is making me hungry hungry and angry. Why would I want to take something that would increase?
Growling signaling.
Some people are trying to gain weight. It also does increase your growth hormone. So if your growth hormone is very low, you can consider it. A beaut. A Morin is a long-acting. So, as a long, Half-Life also known as MK. 677, it was, well, it was studied mostly in growth hormone
deficiency and do these people get angry.
Also, they can many people report a side effect of anxiety, or significant hunger. Most
Take it in the evening so they don't notice that hunger as much. It can also greatly increase your blood glucose so if your insulin resistant or pre-diabetic gets it especially
concerning
This is one of those rare moments where I hear something and I like that and I think okay, even though there's this kit of compounds that can increase, g h, and igf-1, based on everything you're telling me maybe just taking g. H is the better option for those people because growth hormone at least it's synthetic. Growth hormone is mimicking an endogenous hormone may not certainly not taking anything. It might be the ideal but for those that want to increase growth hormone and they want to use pharmacology to do that sounds like these peptides are pretty.
The precarious.
Yeah, it kind of depends on the situation. If there's a, an individual that struggles with hunger and not eating enough, for example, you know, someone who has a very small stomach or they just have a very low hunger Drive. Sometimes, you want more of that, Rex, agentic, signaling the hypothalamus. You have inner exogenic signaling, which is kind of like anorexia and 0r exogenic signaling which is I call it the hangry center of the hypothalamus or the
The hangry Center and if there's an imbalance between those two then perhaps it'd be helpful. Potentially theoretically helpful in anorexics of which the incidence of anorexia Atman is increasing significantly.
As you're telling me this I'm remembering being 14 or 15 years old and I would go into the kitchen sometimes and I was so hungry I would just obliterate all the food and I do remember being always been pretty high energy guy but having an immense amount of energy. I don't recall if it was a hangry feeling or not.
But I'm guessing that was growth hormone. I grew one foot in a single Academic Year so imagine that was at least in part due to growth hormone in any case summer Ellen is the peptide that I hear the most often about. I admittedly try to run of it. I was researching a book and decide to take it before sleep on an empty stomach. It gave me a tremendous depth of sleep but that sleep was really truncated, which is just nerd speak for saying deep but short sleep, I would wake.
Up after very intense dreams, I can't say that it helped me recover from exercise that much. I didn't notice any additional fat loss or anything sort of abandon it except for occasional use again, this was prescribed by a doctor, you know, I'm starting to get the sense that these these peptides and their effects are somewhat vague and distributed and highly individual is that a fair way to describe
them part of the problem, with the effect of peptides, is many people, take them and levels that are far above the
physiologic range even individuals who are checking their igf-1 while they take these different GH R. PS, most of them do not check the binding peptides for example, igf binding peptide, 1 2 or 3 and their Free igf-1 level might be significantly different. So the common doses that people will take these off label for as a supplement are often much greater than the
Therapeutic or physiologic
range which were me just underscores. The fact that it's pretty precarious. I mean, I'm not coming in here as the referee of what anyone should or shouldn't do just trying to gather and distribute information. But it I've heard for instance, that some companies where people can acquire these things without prescription, they those companies are not good at cleaning out the the Lippy polysaccharide, the LPS, which can cause an inflammatory response. In other words, these are dirty compounds and that just sounds risky.
It just sounds frankly. It just sounds really dangerous to
me. LPS is a common additive in many companies that are not pharmacies, but they're selling things that people often use as human consumption. One interesting note about lipopolysaccharide is your gut microbiome. Actually, makes a lot of it as well, especially prevalent Ella, which is a specific species that can have to do with your Baseline body temperature. So your Baseline body temperature might
So, change depending on if you're on a peptide that has LPS in
it. Yikes, yikes yikes. But I tend to be pretty conservative when it comes to taking anything exogenous. But I do rely on many of the supplements that we talked about earlier and I do try and optimize the behavioral things and nutritional things up for a long time. Okay. So then leaving peptides behind we are now I suppose in the territory of exodia's hormone. So let's say that somebody decides.
Odds are not concerned with fertility or they're going to bank sperm or they already have kids or they're going to defer on this issue of one and have kids. My understanding is that nowadays? A lot of people are using testosterone. Let's not even call it replacement therapy because some of these people have 600 700 or even you know, 800 mg per deciliter read. So they're not replacing anything that is diminished, they're just trying to augment what's already there. Increase, what's already there? My understanding is that taking a low-dose more frequently is going to be more
Beneficial than the kind of old-school way of giving you know, 100 or even 200 milligrams in a single injection. Once every two weeks is that right? And what do you do with your patients? So let me give you a hypothetical. Somebody comes into your office, there you their blood work, and they have blood levels of, let's say 600 and a grams per deciliter testosterone. Their estrogen is also in normal range, everything else checks out but they're complaining of, you know, slightly diminished libido slightly, poor recovery from work.
Shouts. Maybe, you know, reduce motivation and drive although no major depression and you come to the conclusion that testosterone therapy, not replacement, but testosterone therapy, might be a good option to explore. What's a typical dosage range and frequency of administration range that you might consider exploring?
And some of this depends on the shbg and free testosterone as well. So if that same individual had a very high shbg, which again is The Binding protein that binds up the testosterone and all androgens.
Estrogens, if it is extremely high and they have a free testosterone of to, then they might need a different dose because they need enough testosterone in order to have a normal, you gonadal free testosterone, but a general normal dosing range especially for someone starting is around 100 to 120 milligrams, divided over the course of a week. Usually either every other day or three times a week, occasionally twice a week.
Me people with shbg a bit higher. Can get away pretty easily with twice a week. This is assuming that the Ester is sippy innate or an ante.
So to 60 mg injections of testosterone subpoena per
week. Yeah, very common dosing to hit
that 120 milligrams per week as kind of the typical average
erect and I would consider this a, like, a physiologic you can add Altos for many people. Even 200 mg a week is far above the reference range. All of this is said with the caveat that testosterone.
It is not normally released in a pulsatile manner so it's high in the morning low in the evening, whereas if you're on testosterone therapy, then you're going to have a steady state. So your testosterone level is going to be pretty much the same even in the evening.
And in your experience, when patients do that, they I'm guessing they report that normal constellation of positive effects. You know, improved mood, improved energy, improve sleep recovery. Etc. What are some of the hazards?
Or things that I'm can crop up in blood work or just subjectively that can be warning. Signs that even a dosage of 120 mg divided into these two or three doses per week is too high,
every organ system in the body. So this is when you really have to be at least well versed in every organ system. Not just the gonadal like, you know, genital system. You need to have, you know, Dermatology prowess acne is
Recall and change lots of different skin, pathologies or even bruising. Can be related to hormone replacement hair loss is very common to see as well. Mental status changes. It could occasionally even induces a manticore, a bipolar episode because testosterone is also dopaminergic and then cardiovascularly not just in the heart but also concerns for like microvascular ischemic disease. Ferritin build up because the estrogen also increases and then
Leti concerns as well and lipid concerns to. So you really have to be, you know, hematologist dermatologist cardiologist, lipid ologist, the whole nine yards.
So another reason or set of reasons rather to if one is considering using testosterone therapy to really do this in close communication with a really good physician because that's a lot to monitor knowing whether or not you have acne or not is one thing but knowing whether or not your LDL is going up. Your apob is going up, that's all
All other Biz and that needs to be done through blood. Work is what I'm hearing.
Correct. And if your physician that is managing or prescribing, your testosterone therapy or HRT is not well versed in these systems, you would want him or her to be part of an interdisciplinary team where they have other experts that can monitor those systems.
I skipped over sort of still intermediate set of things prescription drugs. But maybe talking about testosterone first was a bit of a mistake on my part because I'm aware that they're actually. I think their companies but certainly groups out there that say, no, wait, don't go straight from nothing to supplements to testosterone once you're doing behaviors and optimizing nutrition supplements. Let's forget peptides instead of going straight to testosterone therapy, one idea that many people are pursuing.
Doing is to take the prescription drugs that trigger luteinizing hormone, so take Taking HCG human, chorionic gonadotropin. Which my understanding is will increase testosterone but also estrogen or they'll take things like clomiphene. In fact, I think there are a bunch of companies out there. Now, that are saying, don't take testosterone and shuts down, spermatogenesis shuts down to stop touring production. Clomiphene is the way to go. Maybe you could educate us about the age HCG monotherapy. I think it's called where you're just
At mono one, just taking HCG and clomiphene as a and or clomiphene as a tool to ratchet up hormones.
So quick points on HCG human chorionic gonadotropin made during, especially the first trimester of pregnancy. It has effects other than binding to the LH receptor. It also binds to the TSH receptor and the thyroid. It's a road stimulating hormone. Yes. In fact, if you look at a molecule of HCG and thyroid stimulating hormone, they are extremely similar. However, you need a relatively high dose of HCG to bind to the TSH receptor. This is the normal mechanism and pregnancy
See that accounts for the increased need of thyroid hormone, usually about 30 to 40 percent. So that's why if someone has hypothyroidism, you need to increase their dose of thyroid, because the HCG is not going to be doing it for you. The Clomid or clomiphene? There's two main. I believe it's die stereoisomers and one of them is in clomiphene. One of them is uclan withan, needs to work slightly differently in coma that I believe has a faster half-life.
And it is potentially slightly better tolerated. However, they were studying it, you know, Clomid is a very commonly prescribed drug and obviously, there is plenty of in clomiphene, in Clomid, however, the drug which was, and Rizal a and Dro. Exhale did not go all the way through the FDA approval process, despite Clomid been FDA approved,
okay? So there's Clomid which contains clomiphene but they're also because we're talking about men who are male hormone
Ization. This episode, there are nails out there who want to increase their testosterone and other hormones, maybe growth hormone and Cetera, who opted to not take exoticness testosterone. So no cream. No pellet. No, no. He'll know injectable sippy innate but decide to take clomiphene a couple times a week. My understanding I've never done this, I would say if I had my understanding is that taking clomiphene maybe 250 mg tablets a week is what I
Here people are doing will increase what luteinizing hormone?
The various estrogen receptor subunits. Could you explain how clomiphene would benefit anyone and is this a good strategy? I'm hearing that it's being done quite a lot. Now
it will increase testosterone in a dose-dependent manner but it has many other pharmacodynamic effects which is the effect of the drug on the body other than its effect on the hypothalamus and the pituitary. So in the hypothalamus and the pituitary it does, what's called negative feedback, inhibition, or it? It blocks
It's the action of estrogen. So it crowds out estrogen from the estrogen receptor on the hypothalamus and the pituitary. And
what's this objective effect that that would cause. So, my understanding and experience of estrogen is that if I ever took, and I did take a very low dose of an aromatase inhibitor once and I felt terrible actually reduced libido. Joints fell a key. That's when I discovered that. Wow, estrogen is actually really important for your brain function for joint function, and for libido and suppressing Esther
And for me, turned just turned out to be the wrong idea, but my levels indicate that it's within reference range. Okay. So, why would I want to take something that would increase the activity of an estrogen receptor. I just can't find the rationale for that.
The main rationale behind taking a serm is as a very temporary measure. That is not going to suppress pituitary or hypothalamic function if you were testosterone. It's just so drastically low. That
It is unlikely to recover anyway. Anyway, so most of the time it is not clinically useful. And serm should not be prescribed, very often, certainly not as long-term testosterone replacement or testosterone optimization in most individuals. There's always exceptions to everything. But there's five different estrogen and estrogen related receptors. There's two main estrogen receptors and Clomid and every serm has a
Very unique profile because they selectively inhibits um, receptors in some tissues, but not other receptors. In other tissues, for example, Clomid can inhibit receptors that are in the eye and it can cause visual changes blurry vision especially at higher Doses. And it also acts and every other tissue of the body. So, side effects from Clomid and other selective estrogen receptor, modifiers are very common.
So I'm at least by my mind I'm going to pull them with peptides and say, it sounds precarious and probably not ideal for most people going back to testosterone therapy. Then I get a notice folks, I've deleted the replacement part because I think so many people are using testosterone therapy without the need to the sort of reference range need to to replace anything. But rather a building on what they already have for purposes of increasing. Vitality Etc.
Going back to that. My understanding is that taking HCG several times per week, can help maintain spermatogenesis and fertility, even while people are on testosterone. But and you and I were talking about this earlier that there's tremendous variation, some people will take a small amount testosterone and just Crush their sperm count. They just won't make any viable sperm. Other people can maintain viable. Sperm production while on testosterone, especially if they're teaching taking HCG. Is that right?
Correct. And there's many reasons for this, some of this has to do with
Heat damage to the testes. So, potentially, cold therapy could be helpful for that. And
I spaz, cold showers. Mmm, you know, or just avoid and, and certainly avoiding most sought own hot
tub. Yeah, stopping the daily hot tub, can restore fertility, and many
people, I know a number of people that are trying to conceive children that go into the sauna, and they'll just put a cold pack in their shorts or between their legs, depending on whether or not, they're wearing shorts, are not really going or they'll alternate ice and heat in a
That maintains coolness of the, the milieu in, which the sperm live other words. They're cooling their scrotum deliberately in order to avoid killing the sperm. Actually, I saw an interesting paper that said that for every two degree increase in temperature of the scrotum, there's a 20%, decrease in, and spermatogenesis, and, and viability of sperm. And that actually, if you look at the difference between
Mean people, who stand a lot, sit a lot and drive a lot. What you see, is a progressive, decrease in sperm count that because when people are sitting, there's an increase in temperature and then when they're sitting on the hot seat of the car, there's an or using the heated seats actually, kills sperm. I think they're good data on that.
Yeah, excellent data and anecdotally is heat as well. I've had several patients come in for fertility consultations and all we do is like you know, no medications no supplements. We change their like several lifestyle things.
Um, another tight fit, it very tight. Fitting clothing is another one and soon, they have fertility and they're no longer. They, they have sperm whereas before they did not
interesting like to talk about some of the do's and don'ts, but we have talked about a lot of dues things that one can do to optimize hormones. Maybe we could just do sort of more rapid fire Q&A on some of the don'ts and maybe throw in some science where you feel it's appropriate.
Cannabis marijuana THC. Yes? Or no? It diminishes testosterone
levels.
Smoked cannabis, I would say diminishes testosterone increases prolactin. That's a no other cannabinoids not particularly harmful. So CBD! CBD, not particularly, harmful, smoked CBD. I'm not sure what about edible cannabis and THC as far as I know. Edible cannabis and THC does not significantly increase prolactin to a point where it would be disruptive of hormones can marijuana.
THC cannabis, whatever you want to call it, increased gynecomastia, the growth of male breast tissue. Yes, it certainly can. And there's a pretty good association between smoked THC and gynecomastia.
What about nicotine and testosterone and estrogen and other hormones? Smoking. Nicotine,
nicotine is particularly concerning not only for testosterone, but also for estrogen, part of it is, if you're talking about nicotine from tobacco, there's many other carcinogens in it, especially if it's smoked, but nicotine, even if it is chewed in a dose-dependent manner. So if you can use an extremely small amount of nicotine, then it's not as concerning in a long run, but it's a vasoconstrictor and
And one of the main concerns with it would be cardiovascular disease or even microvascular ischemic disease that can lead to neurodegenerative disease. So like a type of dementia that can be partly due to nicotine. If you use nicotine for a very long period of time especially at a higher dose it's a dose-dependent effect on your hormone profile
is that also true for Nicorette and nicotine other nicker nicotine gums
at hide.
Versus if you can use an extremely low dose of a nicotine gum, then theoretically, that would be, you know, maintainable. It's not going to overload. The nicotinic receptor. You have acetylcholine and the cholinergic system is one of your domain nervous systems, of course, and you have muscarinic receptors and nicotine receptors. And there's just better ways to optimize your nicotinic. Receptor activity. For example, acetylcholine precursors like Al
The GPC phosphatidyl serine phosphatidylcholine week, acetylcholinesterase Inhibitors especially natural ones potentially have a like a part, as well and then other alkaloids. So nicotine is an alkaloid from the tobacco plant. There is other plants like cytosine and the that genus of plants and that alkaloid is also a nicotine receptor
Agonist.
Is it true that cycling for too long, literally bicycling sitting on a bike seat too long? Can damage the
prostate? Yes it can be very concerning especially if you're seated while cycling especially if you're putting a lot of pressure on the perineum your chorus kind of like a box where your diaphragm sort of makes the top and your abs and serratus, make the front and the sides, your back muscles make the back and then your pelvic floor.
The bottom of the box which is arguably the most important part of your core and that pressure can weaken and even lead to incontinence and impotence.
So, we were talking earlier today in the gym, about how heavy leg, work hack, squats, deadlifts, those kinds of things. A lot of guys are doing to increase their testosterone. Done correctly, can actually augment and build up the strength of the pelvic floor done. Incorrectly can actually weaken the pelvic floor, and lead to all sorts of issues, including
actual effects - sexual effects. So how does one go about learning whether or not their movements are being done properly to support pelvic floor or to destruct pelvic floor.
The pelvic floor is a constellation of muscle just like any other kind of like system in the body and you know form is important. If you're doing the valsalva maneuver which again, is that kind of like bearing down or deep breath?
Refill, all of your abs are tight. You can also notice that your pelvic floor is tight as well. If you have a history of a an inguinal hernia which is a whole kind of like connecting the abdominal cavity down through the pelvic floor. Even the scrotum in some cases and that can be a sign that there is weakness in that area and you might have to concentrate it on it most or even have a physiotherapist or a physical therapist, specifically Target the pelvic floor, many exercises in which you value,
Salva or use your glutes or legs, you can learn to squeeze them and have that mind-muscle connection in order to help build up the pelvic floor. And there's other things. Many people are familiar with kegels that is just one of the many different exercises that can help your pelvic floor.
My understanding is that while strengthening the pelvic floor is good. Excessive contraction of the pelvic floor can actually limit blood flow to the pelvic area, the penis and so forth. So, this is again, it's a double-edged sword, right? I mean you don't want guys out there too.
Start doing endless number of key goals every day because they're actually going to constrict blood flow to that area. Right. There's a and in fact the the erection response is parasympathetic it's a relaxed induced response. Right? Correct. So you know for the the reason I chuckle is that, you know, for because we're talking about things, we don't have visuals or charts and and certainly it's hard to know whether or not a given exercise, like, kegels are going to be good or not good. If it's excessive what you know, how many sets and Reps be does does
It take before it goes from, from good to bad? Is there a kind of general rule of thumb for people? Think about this? I mean, clearly blood flow to that area is key. All right, for sexual performance. And yet, when one trains, the legs or even walks, you're getting blood flow. So, my understanding is this that a combination of weight training to stimulate the positive hormonal and muscular and connective tissue growth is key provides not over training but so is casual exercise like walking and
Stretching and the sorts of things that will then return blood flow to that area, is that it overly basic way to think about it or will that
suffice? I think that's a good way to think about it. I think the main point with key goals is there just one of many different things. So, if you're having some pelvic floor, pathology certainly or even just concerned about your pelvic floor, don't just, you know, take the advice do kegels and you'll be okay, that is not near enough. It's just one of the many
aspects
Okay, so going back to the rapid Q&A and then we'll come back to this issue of blood flow because there's some interesting science and protocols. Their question I have is alcohol, does it increase Aroma taste the enzyme that converts testosterone into estrogen or not? And is there a dose dependence
there? It's significantly. Does, there is a dose dependence in general. I would not recommend more than three to four. You know. Standard drinks of one. Huge glass of wine is probably five standards.
But I'd say every two weeks.
Yeah that's consistent with what I discovered researching alcohol and episode we did on alcohol. That no alcohol is definitely better for all aspects of Health than any alcohol. And anyone that says that, well, red wine contains these various things. Well, it doesn't contain enough of those positive things to have a positive effect. But that if people do opt to drink alcohol, that two drinks per week and meaning 20
grams of alcohol. So that's probably to 12 oz beers or to, you know, four ounce glasses of wine is going to be the upper limit Beyond which you're going to start seeing all sorts of negative effects. And
the other thing to keep in mind with alcohol as a lot of calories 7 kilocalories per gram, almost as much as fat which is 9. And then it's also very gabaergic so it can activate inhibitory, neurotransmitter ssion and that can also affect how many how much LH and FSH.
Is released. So that can also decrease testosterone almost kind of similar to how opiates can decrease
testosterone feel very lucky that I don't enjoy alcohol. Never really did, can kind of take it or leave? It certainly don't like sedatives like valium or anything like that which as you just mentioned can suppress testosterone you said the word fat. So I'm going to pick up on that and say in order to optimize hormone production is it important to have some saturated fat
In one's diet, and what happens on very, low fat diets to testosterone estrogen and other steroid hormones
fats. Interesting because there's so many different beneficial fats Omega-3s almost every American gets plenty of Omega sixes in any developed country. Really when it comes to saturated fat, there is more of a correlation with hormone optimization. If you're eating things with saturated fat, you tend to have, those are things with more, you know,
Fat soluble vitamins and things that are very nutrient-dense, otherwise, but it is not vital in general. You want to eliminate any trans fat, unless it's trans fat from the ruminants, there's always an exception to everything, right? So there is healthy trans omega-3 fats, which are formed in the stomach of, like, grass-fed and finished ruminants.
But ingesting, mostly olive oils maybe nut Butters in, in limited amounts because they're very calorie dense. But
unless people are trying to increase their calories in which case, they're a great source of calories, small amounts of butter ghee. Probably, okay, but not excessive amounts is right
idea? Yes, fat is perfectly fine. Cholesterol has an interest is a cholesterol and in general phospholipids make the bilayer that's around the cell. But cholesterol is also a hormone in and of itself because it binds to the estrogen related receptor Alpha. So, I consider that like in the estrogen receptor category.
And they can help with metabolism but also potentially have concerns for cancer and tumor
risk, when I go back to the prostate and talk to you about something that's kind of a newer emerging Trend. I know that you've talked a little bit about this in previous podcasts, that a number of men are just a number of Physicians, are prescribing low-dose. Tadalafil also known as Cialis to their male patients. So in doses ranges of like two point. Five milligrams, 25 milligrams per
Verde but not for erectile dysfunction, but rather for improving prostate health and presumably, they get sort of a boost in terms of blood flow to the genitalia as well. But again, not specifically a deal with erectile dysfunction, but to deal with prostate health and blood flow to the prostate. Is that something that you sometimes often prescribed to your patients and of what age?
Tudela fills a very underrated medication the age would kind of depend on the indication. So, tadalafil is also a blood pressure medication. It can vary, slightly decreased blood pressure, especially at higher doses at higher doses. It theorem high dose would be 20 mg. Not two point, five milligrams, but consistently, it can somewhat effect with the cones in the eye that have to do with red and green site. Although if you remove it, that effect is reverse. So basically, if you
Need really, really good. Red green discrimination. You can take higher doses, but in general, I recommend no higher than 10 milligrams a day. Usually just 2, or 5 milligrams, one other benefit, or other use of tadalafil, is that it increases the density of the Androgen receptor. Similarly, to L-Carnitine, so that's an interesting benefit. Another benefit is that, if you give it to people with nocturia, which is urinating at night in general, it will cut the episodes in
Half. So it could go from 2 to 1 which can make a big difference for your sleep which will secondarily make a big difference for your growth hormone and testosterone optimization.
Interesting, so you said 2.5 25 milligrams per day is going to typical for these prostate enhancing
effects. Yes,
and you mentioned the potential side effects on adjusting visual perception as a vision scientist that rings in my mind. But in terms of red green color discrimination, I'm guessing, unless you're going to be a subject in one of the experiments in my lab or
Want to be a fighter pilot. Chances are, you can probably get away with a little less red green color
discrimination correct. It's not considered clinically significant unless someone is a commercial pilot, right? So if someone's getting their like pilot exam that's one of the things we look for. Okay? So
commercial pilots aside, you might want to ask your doctor about low dose to dalla fill for sake of enhancing prostate health, certainly monitoring PSA prostate, specific antigen is important. I can give an anecdote there when I tried sir moral, and one of the
Surprising side effects, that was not welcomed, was a dramatic spike in my prostate specific antigen. No one could explain to me why that would happen but when I stopped taking some moral and it went back to normal. So that's one reason. I avoid some more land at least frequent use of us for Moreland. PSA should be kept what below levels of, you know, somewhere between one and four is considered healthy. Is that
right? It depends on the age. If there's a 20-year old likely between 0 and 1, if there's a forty-year-old,
Between 1 and 3. And then if there's an 80 year old, it would not be abnormal to have a PSA of five and have that be well within the reference range. Another thing we should mention about PSAs. If you do take a 5-alpha reductase inhibitor like finasteride or do tester, I'd often these will cut your PSA in half. So if you, for example, if you have a PSA of six and you start finasteride or do test a ride and then you recheck, it in six months and it's 6.5. That is a huge concern.
CERN, because that's actually doubled.
Glad you brought this up because I almost overlooked the fact that I get a lot of questions about drugs to offset hair loss. Most of those drugs are going to operate through the DHT system that I had George disaster. Own system for the reasons we talked about before. DHE receptors being on the scalp and causing beard growth on the face, is it the case that a number of people taking things like Propecia and other things to block DHT or disrupt the DHT pathway
Are going to experience, diminished sex, drive diminished, you know, kind of motivation and general Vigor and if so are there Alternatives like topical? DHT antagonist that they might use if they want to keep their hair but not have those negative effects.
The way that I think about hair loss is you have your fertilizers and also known as the growth Agonist, and then you have your anti androgens, whether there's a systemic or topical, there is both
But that's the general Layman's way to think about hair loss. If you're only putting fertilizer in your hair but you have androgenic alopecia or male pattern baldness and those hairs will still miniaturize. And eventually you'll still have
lost such a great word, miniaturize. Yeah. It's enough to send anybody off to find a therapeutic. Right
by the way, it's difficult to tell if miniaturization is happening unless you have a magnifying glass
You can use a shadow for a second there. I didn't know whether or not you're making a joke. You're saying about miniaturization of the hair, follicle correct? Yeah. So we're can reverse that miniaturization. That's just a fun word to say, I'm going to just keep saying it.
Each individual has, again, we mentioned the Androgen receptor. Males only have one Androgen receptor. Gene is on their X chromosome. So to paint on how sensitive that Androgen receptor is, and depending on the density of The receptors, in the hair, follicle.
You can have a arbitrary threshold and you don't know what the threshold is until you start to have miniaturization and loss of hair. But over the threshold, the follicle will die and eventually the stem cell will leave. But under the threshold, you're okay. Every Androgen binds to the same antigen receptor. So, there is nothing special about DHT. DHT is just a stronger Androgen. So the higher, your shbg things that increase shbg
Are beneficial for hair loss, prevention because you have less binding of that receptor. So if you think about hair loss specifically androgenic or male pattern baldness in the terms of that Androgen receptor and everything in general binding to it and not just DHT but also testosterone. It's helpful. It's just that DHT is a huge battering ram. Whereas the other antigens are just light presses on the door.
Got it. So are some of the topical? DHT receptor. Antagonist. Going to be a better choice for
That want to maintain or their hair grow more hair if they want to avoid side effects
likely, so some individuals benefit from systemic, a systemic decrease in DHT for a couple reasons. One could be prostate and then one could actually be hypertrophy of The myocardium. So DHT, also disproportionately thickens The ventricle. So for someone on trt that might be a benefit that is prone to thickening of the ventricular at Baseline.
However, many people that have just a bit of predisposition, they can use things that are topical anti androgens Ketoconazole. As one of them caffeine is actually another one. We drinking
caffeine topical caffeine. I was going to say my hair tends to grow pretty fast is so it may be that but I drink a lot of caffeine. So topical caffeine really rubbing coffee on their head or were taking caffeine tablets and how does it? Wait you have to explain how this works. How do people get caffeine into the hair follicle?
Topically the caffeine enters the scalp and crowds out like somewhat crowds out the Anderson. It is a weak effect, it's likely just strong enough to be clinically significant. Usually caffeine is put into formulations with other things. Like Ketoconazole that are also we can tie androgens of notes, piranhas lactone can be prescribed topically but is it is absorbed systemically because the size of the molecule so unless your doctor specifically prescribes that for you,
Especially as a male do not use topical. Sprung, a lactone. Topical finasteride is also a smaller molecule, so it is also systemically absorbed but it is not extremely well, systemically absorbed if you take topical, finasteride. And usually your systemic, DHT will decrease by about 30 percent. Topical do tasks to ride is likely a tiny bit stomach we absorbed, but it's Unique because it's Half-Life is much faster at a lower dose. So topical due to asteroid
Not affect your systemic DHT at all. And I've seen this anecdotally on many people on topical, do test ride therapy.
We're going to have to get you back on here. Do an episode all about DHT and hair loss and hair growth is, you know, again, not a topic that I focus on a lot for myself. But that I get a lot of questions about for men and women,
one thing that we could mention, I got a ton of questions about turmeric and curcumin noise after a last episode.
Oh yeah. But I had reported my own anecdotal experience that taking turmeric.
Really crushed my DHT levels and I did not feel good. I mean, crushed, all sorts of positive feelings of Vitality, the moment I stopped taking turmeric felt great. Again,
many people report this. And the interesting thing about tumeric is most of it's beneficial action. Not all of it. Some people benefit from systemic turmeric and some people that can tolerate it. Well, it's actually great for the prostate, but most of the action, it does not need to be bioavailable it acts on the gut microbiome.
So you can take turmeric and if it is not absorbed, some turmeric, says put in special formulations like my seller or liposomal or complexed but a lot of it is put with black pepper fruit extract, which is also known as bio purine which is actually also a 5-alpha reductase inhibitor, and it affects liver cytochromes, and so many. Supplement companies, put this black pepper fruit extract, bio purine and almost everything. So, some people are on really high doses and that could also be making
Most of the effect of people who do not tolerate
turmeric. Well, yeah, I avoid turmeric like the plague based on that one previous experience because it was clearly turmeric that cause the effect, the negative effect coming off, it everything, reversed rapidly and the bio pureeing. The black pepper extract. I also avoid that like the plague based on everything you just said, I want my 5-alpha reductase. I want my DHT to be optimized simply because my understanding is DHT is
The board powerful Androgen is the one that yes, it causes a little bit of hair loss. And I've got a few, you know, patches here and there. But I'm willing to live with that based on all the other wonderful things that DHT optimization does.
I'll quickly mention a few other things. One saw palmetto is also a 5-alpha reductase inhibitor, but only a couple of the iso enzymes. There's three main ISO, enzymes and a lot of the problem is that your inhibiting a couple of the iso enzymes, but not the other one. Finasteride.
It inhibits one and to do test ride actually inhibits all three and finasteride inhibits. The isoenzyme that is in genital skin but not in the skin throughout the rest of your body. So a lot of the side effects of finasteride, which is loss of sensation and loss of erectile function, have to do with the disc concordance between the sensitivity of the genital skin and the skin.
Again, another reason to not disrupt 5-alpha reductase,
Test and will definitely get you back on here to talk about D. I think we should just do a whole episode about DHT because so often when people are thinking about optimizing hormones, especially male males, trying to optimize their hormones, they're thinking testosterone testosterone, maybe nowadays, they think a little bit more about free testosterone and maybe they think about estrogen is also being important not to crush estrogen. But DHT is, you know, least to my mind, the linchpin of so many of the things that subjectively people are really focused on libido. Motivation Drive, Etc. I have one final
No question, it's just a brief one, but many of us have heard that the bpa's that are present in, you know, plastic bottles and even in a certain aluminum cans and phthalates a difficult word to pronounce, what a fun. One, nonetheless, phalates and work by dr. Shana swan has shown that with a latex exposure to the fetus to pregnant mothers and fetuses very likely ISM negatively, impacting sperm counts, testosterone levels, and even changing genitalia size for the worse in males, nowadays,
I saw beautiful lecture that dr. Shamness one did on this when I was in Copenhagen and it's very clear that it's negatively impacting, the male fetus, she was also in Joe Rogan's podcast. I hope to get her on this podcast. However, what she couldn't answer for me was whether or not phthalates and BPA. Seen these things present in Plastics and some people won't claim in tap. Water are bad for males after they're born and after puberty. What are your thoughts on where I should just ask you? Do you drink water out of plastic bottles. Do you owe
Avoid drinking out of cans that are not specifically, non BPA containing cans and do you actively avoid phthalates? My understanding is that phthalates are most enriched in pesticides and that's why you're seeing dramatic drops in sperm and testosterone levels. Mainly in rural areas where their dust cropping.
So, I do avoid drinking out of cans that are Plastics that may have BPA, or bisphenol a, and them bisphenol a is known to bind to
What I would consider the fifth estrogen receptor estrogen related receptor gamma. So it it I would I would consider it a xenoestrogen. So phytoestrogens are estrogens from plants and in general they're not concerning or clinically significant and xenoestrogens are just other estrogens. So I do avoid BPA. And I also test my water, I use a water testing service and I test it both after it's through my water filter and the tap water that might
Two boys, drink almost every day and it's very interesting. I only found one microplastic, just a bit over the reference range. So it wasn't a terrible tap score. But even in developed countries, these are widely variable, as far as Pathologists again, very difficult and interesting for to pronounce. But I remember learning about these because there is, I believe a lawsuit that had to do with mac and cheese and this is probably five years ago.
Go. And I was coming up with my list of each provider that does obstetrics has a list what to avoid for the pregnant lady, you know, sketchy deli meats or high, Mercury fish like swordfish and salmon and I actually added processed mac and cheese to that list. Interesting. Well,
thank you for that. I'm going to extract your statement that you avoid drinking out of plastic bottles when when possible. I'm guessing you're not neurotically attached to that. If you were dying of thirst, you might crack a plastic bottle of water to survive but
Listen Kyle, dr. Gillette, thank you so much. You gave us an enormous wealth of knowledge, everything from behaviors to psychology to supplementation to prescription drugs. We will make sure to point out where people can get a hold of you on Instagram and on Twitter and on, and on other websites in our show, note captions, but really just on behalf of the audience and just for myself. Thank you so much. You have an immense amount of knowledge and your experience.
Exquisitely, good, at sharing it with people in an action will way. So thank you. My pleasure. Thank you for joining me today for my discussion with dr. Carl Gillette, all about male hormone optimization. I just want to remind everybody that we will soon have an episode all about female hormone optimization. If you're learning from and are enjoying this podcast, please subscribe to our YouTube channel. That's a terrific. Zero cost way to support us. In addition, please subscribe to the podcast on both Spotify, and apple and on both Spotify and apple. You can leave us up to a five star review.
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