Episode 67: How to Optimize Your Hormones for Health & Vitality| Huberman Lab

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Key Takeaways

  • Six pillars of hormone health: (1) diet (specifically caloric restriction); (2) exercise (specifically resistance training); (3) stress & stress optimization; (4) sleep optimization; (5) sunlight; (6) spirit – dial in the body, mind, and soul connection
  • Think of yourself as a Venn diagram: you have a body, mind, and soul – you can’t completely be well if you’re missing the health of one area
  • Tip to get your doctor to order more bloodwork than the basic panel: tell your doctor your (fill in the blank) – energy, sleep, endurance, etc. – is not as good as it used to be
  • High alcohol intake and smoking marijuana will ultimately decrease testosterone
  • Caffeine has a negligible effect on hormones
  • Vegans: you are possibly at risk of not getting enough of certain types of fats and nutrients to maintain a proper ratio of testosterone to estrogen – supplement with algae or other healthy fats
  • To naturally increase growth hormone output: don’t eat within 2 hours of sleep, get good deep sleep, resistance exercise early in the day, manage stress        
  • A word of caution about peptides: work with a physician! There are so many bad quality peptides with detrimental side effects       

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 break down how to improve and optimize hormones levels for better health in both men and women.

Host: Andrew Huberman (@hubermanlab)

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How To Approach Hormone Health

  • “Doing a little amount of lifestyle interventions over a long period of time is going to be far more helpful or efficacious than doing a lot than doing nothing, then doing a lot, then doing nothing.” – Dr. Kyle Gillett
  • Six pillars of hormone health: (1) diet (specifically caloric restriction); (2) exercise (specifically resistance training); (3) stress & stress optimization; (4) sleep optimization; (5) sunlight; (6) spirit – dial in the body, mind, and soul connection
  • Diet should be an individualized approach – your goals and genetics should dictate your diet, not fads or what others are doing
  • Ideally, get bloodwork every 3-6 months for preventive purposes – even better if you can get one while fasting and one while not fasting
  • “The more you’re doing zone 2 cardio, the slightly less important your caloric restriction is.” – Dr. Kyle Gillett
  • Men, how to know whether you should use caloric restriction: if you’re obese or have metabolic syndrome, the caloric restriction will increase testosterone in men
  • “There’s nothing special about intermittent fasting or caloric restriction or exercise when it pertains to body weight in general. When you lose weight about 33% of that is lean body mass and about 10% of fat cells are lean body mass.” – Dr. Kyle Gillett
  • The reason for exercise, caloric restriction, and intermittent fasting in general: it’s how you increase healthspan, not necessarily change the weight on the scale
  • Intermittent fasting & effects on hormones: more significant spike in growth hormone and IGF-1 levels which will help in older age groups than younger – the longer you fast, the bigger the spike
  • Major functions of IGF-1 and IGF-2: growth hormone acts on the liver to produce IGF-1 which is the active form of growth hormone with a much longer duration of action
  • Potential underlying hormonal causes of poor sleep: (1) growth hormone deficiency (very rare); (2) vasomotor symptoms of menopause or andropause (very common); (3) being on testosterone replacement therapy (TRT) increases the risk of sleep apnea

Testosterone In Women

  • For health optimization: it’s just as important to know testosterone levels as it is to know estrogen and progesterone levels
  • For pathology prevention (e.g., breast cancer): it’s more important to know estrogen and progesterone
  • Women think they have very low testosterone levels because tests generally look at free testosterone which is the smallest proportion of testosterone in the body
  • If you look at the total amount of DHEA (weak androgen) and testosterone in a woman, it’s more than estradiol but it’s in different measurements
  • Testosterone in pre-menopausal women comes from theca cells in ovaries
  • Women with endometriosis are candidates for tongkat ali

Testosterone In Men

  • “Testosterone is not going to cause prostate cancer, however, normal aging causes prostate cancer and testosterone will grow your prostate cancer.” – Dr. Kyle Gillett
  • The question is really, do you want to take something that will definitely grow prostate cancer once you have it?
  • Men, be sure to check prostate-specific antigen (PSA) levels – also be aware, overweight and obese men have higher rates of prostate cancer
  • 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 an 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
  • TRT’s goal is 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
  • Very few people need aromatase inhibitors – there are a lot of ways to control estrogen through lifestyle or other interventions without the potency of aromatase inhibitors
  • Non-traditional supplements which increase testosterone: creatine, tongkat ali, stinging nettles, boron, turkesterone, fadogia acrastis
  • Tongkat ali (from Indonesia) regimen: 11 months on, 1 month off because it does affect aromatase and is an estrogen receptor modifier
  • Fadogia acrastis (shrub from Nigeria): can increase testosterone by stimulating luteinizing hormone release and receptor sensitivity – but there’s not a lot of evidence supporting long term use
  • Tongkat ali + fadogia acrastis regimen: cycle 3 weeks on, 1 week off
  • Boron dosage: 3-6mg 1-2x per day

Dihydrotestosterone

  • Dihydrotestosterone (DHT): an androgenic hormone on the X chromosome (so its from the mother)
  • DHT is responsible for male pattern baldness so you can look to the males on your mother’s side – the better your androgen receptor works, the more likely you are to experience male pattern baldness
  • Role of DHT:
    • In central nervous system: activates androgen receptor gene and helps make effort feel good and motivating
    • In the cardiovascular system: androgen receptors are present in heart tissue
  • Impact of diet on DHT: a diet high in bioavailable plant polyphenols (such as curcuminoids, turmeric, black pepper) inhibits an enzyme that converts testosterone to DHT – but don’t worry, effects are nearly always reversible
  • Creatine can increase the 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

Diving Deeper Into Hair Loss

  • There are two types of hair loss: (1) male pattern baldness/androgenetic alopecia; (2) other types of alopecia  
  • For androgenetic alopecia: you want something to decrease the activity of androgen receptors – most promising treatment is dutasteride mesotherapy (localized injections in vulnerable areas)
  • Women can get male pattern baldness

Polycystic Ovarian Syndrome (PCOS)

  • “This is one of those diseases that is underdiagnosed. Its prevalence is much higher than we think.” – Dr. Kyle Gillett
  • Most women don’t know they have PCOS until they have infertility or subfertility
  • PCOS is usually diagnosed in the 30s
  • Symptoms of PCOS: androgen excess (symptom would be excessive hair growth, deepening of the voice, etc.), insulin resistance, oligomenorrhea (more than 35 days between periods or less than 9 per year), infertility
  • If living with PCOS: be vigilant about addressing insulin resistance and insulin sensitivity (talk to a doctor about inositol variation, metformin)

Female Contraception & Effects On Hormone Output

  • Perceptual effects of oral contraception: some studies have shown that there’s a shift in how men and women perceive attractiveness in each other among women who take oral contraceptive
  • Almost all contraceptives have a synthetic estrogen and progesterone
  • Ethanol estradiol (common synthetic estrogen): 100x more potent than endogenous estradiol in the liver so binds to estrogen receptor in the liver and increases sex hormone-binding globulin which decreases free-testosterone and DHT
  • Oral contraceptive blunts increase testosterone that occurs before ovulation and usually come with an increase in libido
  • Effects of contraception on fertility: if contraception is taken 6-12 months, fertility is likely equitable as baseline; beyond 12 months it’s still unlikely to have a long term effect on fertility unless you are experiencing side effects of the contraception such as insulin resistance   

Social Interactions & Relational Effects On Hormones

  • Feelings about a new partner or love interest are largely regulated by the dopamine system
  • There’s a lot of pheromonal and hormonal crosstalk that happens in relationships between men and women
  • Prolactin & estrogen are close cousins: prolactin inhibits the release of testosterone from the pituitary glands
  • Prolactin helps with nesting and breastfeeding
  • Building in “prolactin adjustments” can be helpful for your relationship: take some time away from each other so it’s exciting when you see each other – prolactin and dopamine are inversely related
  • Plan ahead to have good times if you know you are going to enter a tough period or crisis in your relationship
  • In long-distance relationships: the dopamine remains high until you are together for a longer period of time and the hormones adjust

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
  • Prostate, bladder & urinary health: phosphodiesterase and tadalafil (low dose is not arousing) can help will flow regularity and decrease nighttime urination trips
  • A daily low dose of tadalafil is becoming a more common regimen for men’s health

Other Notable Hormones

  • HCG is (1) a hormone produced during pregnancy; (2) fertility treatment; (3) can help maintain testicular function while on testosterone
  • HCG: when a woman is pregnant her HCG levels double every 48 hours, preventing hypothyroidism in pregnancy
  • L carnitine can support fertility and can increase the density of androgen receptors – and can be supplemented or found in food but isn’t very bioavailable; you can find injectable L carnitine – try 500mg-1g per day

Effects Of Marijuana And Alcohol On Testosterone

  • Cannabinoids will not reduce testosterone by themselves
  • Smoked marijuana promotes significant reductive activity in aromatase (which converts testosterone to estrogen)
    • Note, high-fat diets also promote aromatase activity
  • Pot smokers have a higher rate of development of gynecomastia (male development of breasts)
  • High alcohol intake will decrease testosterone (as will any gabba agonist, which you want to be cautious to not take gabba daily)
  • Interestingly, the American Heart Association recommends females consume 0-1 servings of alcohol per day and men consume 1-2 servings of alcohol per day
  • Alcohol recommendation: it’s better to have 2 drinks of alcohol 1-2 days per week than drink every day

Additional Lifestyle Factors That Can Affect Hormones

  • An ice bath will help overheated testes
  • “Temperature is the enemy of testes. They like to be 5-10 degrees cooler than the rest of the body.” – Dr. Kyle Gillett
  • Avoid saunas if you are experiencing infertility or have a low sperm count – but the real enemy is warm water (i.e., warm bath, jacuzzi) which raises the temperature of the testes faster than a sauna
  • Ice bath increases the activity of beta-adrenergic receptors

Peptides & Prescription Drugs

  • Most hormones we make have been synthesized and are available by prescription from a physician
  • Caution: anytime you inject something, you will shut down your own production of that hormone
  • 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 continued production of the hormone of interest
  • Peptides increase healing rates, weight loss, recovery, etc., and are used by actors, athletes, etc
  • Therapeutic peptides are prescribed by physicians
  • 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 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, protects organs, prevents stomach ulcers and heals skin burns
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