Episode 102: Dr. Kyle Gillett – Tools For Hormone Optimization In Males | Huberman Lab

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Key Takeaways

  • The timing and length of puberty have long-term effects on height, stature, and body composition; early and short puberty can lead to a shorter height
  • If money isn’t an issue, get blood work for hormones and lipids done around age 18 – measure testosterone sex hormone binding globulin or free testosterone
  • Porn and masturbation can limit libido in the real world, even once per day is detrimental to hormones (not to mention the dopamine system)
  • Topical DHT receptor antagonists may be a better choice for men who want to maintain or grow their hair with fewer side effects
    • You can also try topical caffeine, topical spironolactone (if prescribed), or topical finasteride
  • Lifestyle changes to improve fertility in males: no tight-fitting clothing, cold shower or cold plunge, no sauna use                
  • You may want to avoid drinking from cans or plastics with BPA – there is evidence it negatively impacts sperm count and fertility     
  • What to avoid for hormone optimization: smoking cannabis or tobacco, alcohol in excess of 3-4 drinks every two weeks, too much-seated cycling
  • There are tons of ways to improve testosterone through lifestyle! Try exercise, a well-rounded diet (not a carnivore, not vegan – especially in teens), adequate sleep, ample vitamin D, avoiding porn, managing stress

Introduction

Dr. Kyle Gillett, MD, (@kylegillettmd) is a dual board-certified physician in family medicine and obesity medicine and an expert in optimizing hormone levels to improve overall health and well-being in both men and women. He is a firm believer in practicing medicine and focusing on prevention by approaching the body, mind, and soul.

Andrew Huberman and Kyle Gillett discuss how to optimize male hormones using a range of nutritional and behavioral tools, exercise, and supplementation.

Host: Andrew Huberman (@hubermanlab)

What We Learn From Length & Age Of Puberty

  • Puberty affects height, stature, and body composition
  • Puberty is a good time to reset bad habits or childhood obesity to set the right tone for the future
  • Early puberty can lead to shorter height – you only grow a few more inches after puberty
  • “Dirty bulking” can stunt growth
    • Dirty bulking = lifting heavy weights and eating excessive calories to acquire muscle and fat
    • Avoid deliberately or rapidly gaining weight
  • Both males and females are experiencing early puberty nowadays
  • First puberty: first three months of life; second puberty: preteen or teen development of secondary sex characteristics

Bloodwork & Lifestyle Tips To Optimize Hormone Status

  • Ideally, have bloodwork checked around age 18 specifically looking at testosterone sex hormone binding globulin (SHBG) or free testosterone
  • Monitoring: follow up every six months
  • Lifestyle: diet, exercise, sleep, adequate vitamin D, optimized bone density, and fiber is paramount to set gut microbiome health, manage stress, maintaining healthy relationships and connections, avoiding porn
    • Don’t eliminate dairy from your diet, it’s helpful for development
    • Lifestyle changes are particularly helpful in teens but beneficial throughout life
  • It’s a bad idea to be pure vegan or pure carnivore in your early teens – it will likely decrease free androgens so you will have less testosterone acting on receptors
  • You probably don’t need to load up on supplements unless you have a dietary restriction or limitation (e.g., celiac disease)
  • Caveat to caloric restriction: unless you are overweight or obese, caloric restriction will reduce building blocks for hormones, leave the body in the catabolic state more frequently, less signaling from growth hormones, reduced free androgens
  • Managing stress: diet and exercise can help, mindfulness, therapy, sunlight

Leveraging Exercise For Hormone Health

  • Dose: vigorous exercise 3-4x per week, less vigorous exercise a few times per week
  • Weight training tips: weight train heavy sometimes for lean body mass growth benefits and lighter other times since those can be done more consistently with less fatigue
  • “It is not hormonally helpful to vigorously train longer than an hour.” – Dr. Kyle Gillett
  • After a vigorous workout, you feel the strain from the heavy load on the sympathetic system which can affect how you feel the rest of the day

Understanding What’s “Normal”

  • Some people are better at understanding how they feel on a daily basis – for some guidance, check out the ADAM questionnaire
  • There’s a big difference between subjective and situational – labs may tell a different story than a discussion with the doctor
  • Erectile dysfunction: in rare cases, a test will be done overnight to see if the patient is getting a normal erection during sleep, 90% of the time it’s normal so indicative of something else
  • Porn and masturbation can limit libido in the real world
    • At any age, more than once per day is detrimental to hormones, not to mention neurological component
    • Porn is particularly bad for the dopamine system – dopamine will be further depleted
    • Dopamine wave pool: natural variations of ups and downs in dopamine levels; if the peak is too high, the low will be lower

Testosterone Replacement Therapy (TRT) & Exogenous Hormones

  • Testosterone and estrogen are both steroid hormones
  • Males in teens, 20s, and even 30s whose levels are within normal range should not have TRT
  • TRT goal is a steady state with minimal peaks and troughs
  • General TRT doses: 100-120mg/week divided over 2-3x per week – but there is a law of diminishing returns here, TRT has its trade-offs so you have to find the right level for you
  • Testosterone is normally higher in the morning and lower in the evening
  • Monitoring systems on TRT: watch for acne, hair loss, mental status changes, cardiovascular system, infertility – only do TRT in close relation with a physician
  • Human chorionic growth factor (HCG): made during the first trimester of pregnancy; binds to luteinizing hormone and thyroid stimulating hormone
    • May help with spermatogenesis and fertility
  • Clomid: will increase luteinizing hormone and testosterone but has wider effects with may block out estrogen, can blur vision; not usually clinically useful for testosterone optimization

Optimizing Other Hormones

  • Usually don’t need to optimize IGF-1 or growth hormone unless you are diabetic
    • Check out the episode with Duncan French for ways to use exercise to enhance growth hormone
  • Fasting potently increases growth hormone release – but genes downstream will not be significantly higher; general rule of thumb: avoid eating two hours before bed
  • Make sure you have balance and a good source of iodine to ensure proper thyroid hormone levels especially is eating goitrogen-rich foods (like cruciferous vegetables)

Maintaining & Improving Prostate Health

  • Men, be sure to check prostate-specific antigen (PSA) levels – also be aware, overweight and obese men have higher rates of prostate cancer
    • Healthy levels of PSA by age
      • 20 years old: around 1
      • 40 years old: between 1-3
      • 80 years old: not unusual to be around 5
  • Cialis (usually 2-5mg per day) is sometimes prescribed for prostate health – it can increase the density of androgen receptors and can decrease the need to urinate at night
  • Non-prescription tips to maintain prostate health: prostate is right by the colon so make sure you have regular bowel movements, be aware of any genetic predisposition to enlarged prostate, there’s an interesting correlation between having female offspring and prostate cancer, check estrogen levels (there’s a link to high estrogen and prostate cancer), make sure CRP levels are low

What Not To Do

  • Cannabis: smoked cannabis will increase prolactin and decrease testosterone; edible CBD and cannabis do not increase prolactin (but all cannabis may increase gynecomastia)
  • Smoked nicotine is bad for testosterone and estrogen; even chewed nicotine is a vasoconstrictor
    • An extremely low dose of chewed nicotine won’t overload nicotinic receptors but there is a dose-dependent response
  • Cycling (seated) can damage the prostrate if putting a lot of pressure on the perineum and lead to incontinence or impotence
  • Don’t forget about the pelvic floor!
    • If you don’t know where the pelvic floor is – think of your body as a box: your abs are the front of the box, your back is the back of the box, your diaphragm is the top of the box, your pelvic floor is the bottom and serves as your port to the outside world
    • Try Kegels for improved blood flow and sexual performance
  • Alcohol significantly increases aromatase (an enzyme that converts testosterone into estrogen) – avoid more than 3-4 standard drinks every two weeks
  • Saturated fat tends to be nutrient dense but not in large amounts – of course avoid trans fats and find healthy sources

Medication & Supplements To Improve Hormone Profiles

  • Medications and supplements are closely related but medication may have more side effects and a stronger therapeutic target
  • Medications and supplements are both a means to an end if you desire specific goals – but don’t forget that food is also medicine and you can achieve a lot through diet
  • Creatine: helps with amino acid synthesis, oxidative stress, backup fuel tank for mitochondria, slightly increases total testosterone, increases conversion of testosterone to DHT
    • If you’re worried about hair loss, creatine can potentially add fuel to the fire – but if the follicle is still there the hair will come back after a few months
    • Males get hair loss gene from their mother
  • Betaine: supplement with 1-3g if you don’t respond to creatine
  • L carnitine: shuttle for mitochondrial nutrients and increases the density of androgen receptor in cytoplasm of cells; supplement with capsule or injectable (by prescription)
    • Dose 1000mg-5000mg for oral and 500mg-2000mg for injectable
    • TMAO will increase with chronic use and have adverse effects on the heart (offset with 600mg of garlic or berberine)
  • If you have deficient vitamin D and replace it, you will optimize testosterone – ideal level of free testosterone in males is about 2% of total testosterone
  • Use boron (5-12mg per day) if you have high SHBG (found in dates and raisins from Turkey)
  • Tongkat Ali (from Indonesia) regimen: upregulates enzymes in sterol hormone cascade (300-1200mg per day)
    • Especially powerful if you are on a low carb diet
    • Can increase DHEA and can decrease high SHBG
  • Fadogia acrastis (shrub from Nigeria): stimulates luteinizing hormone and can increase testosterone by stimulating luteinizing hormone release and receptor sensitivity – but there’s not a lot of evidence supporting long-term use; dose 300mg per day, 600mg every other day, or cycle 600mg daily for one month then take 1-2 weeks off
    • Be vigilant about dosing to avoid toxicity if not monitoring bloodwork
  • Turmeric: most of the beneficial action is through action on the microbiome but formula with black pepper fruit extract may cause negative side effects

Peptides

  • A word of caution about peptides: work with a physician! There are so many bad-quality peptides with detrimental side effects       
  • Peptides: short sequences of amino acids that resemble hormones enough, they mimic the effect of hormones in the body – some peptides change gene expression and set pathways for the continued production of hormones of interest
  • Peptides increase healing rates, weight loss, recovery, etc., and are used by actors, athletes, etc
  • Therapeutic peptides are prescribed by physicians
  • “Part of the problem with the effect of peptides is many people take them in levels far above the physiologic range.” – Dr. Kyle Gillett
  • Growth hormone-releasing peptide (GHRP): two main types – (1) ghrelin agonist and (2) GHRH-like peptide
    • GHRPs increase growth hormone but may make you anxious, and hungry, and increase blood glucose
  • Body protective compound (BPC-157): identical to the protein found in the stomach used to treat disorders in intestine
  • BPC-157 is tolerated for short periods of time and is the most prescribed peptide
  • Benefits of BP-157: the healing of many different types of tissue from tendon, muscle, and the nervous system, increases blood flow back to injured sites, protection organs, prevention stomach ulcers and heals skin burns
  • Lipopolysaccharide (LPS): a common additive that makes peptides “dirty” and contaminates them
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