Latest / NO FILTER / Essentials_ Tools for Hormone Optimization in Males _ Dr. Kyle Gillett(MP3_160K)

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Essentials_ Tools for Hormone Optimization in Males _ Dr. Kyle Gillett(MP3_160K) · NO FILTER

0:00
Speaker 1: Welcome to Huberman Lab Essentials, where we revisit past episodes
0:04
Speaker 1: for the most potent and actionable science based tools for
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Speaker 1: mental health, physical health, and performance. I'm Andrew Huberman, and
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Speaker 1: I'm a professor of neurobiology and ophthalmology at Stanford School
0:16
Speaker 1: of Medicine, and now for my discussion with doctor Kyle Gillette.
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Speaker 1: Doctor Gillette, great to have you back, Great to be back.
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Speaker 1: Thank you. I'd like to begin with a question about
0:26
Speaker 1: what all males ought to do in order to optimize
0:29
Speaker 1: their hormones. What should they be doing, what should they
0:32
Speaker 1: avoid doing? If the goal is to have a long
0:35
Speaker 1: arc of healthy hormone optimization throughout the lifespan.
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Speaker 2: There's many things that you should do. An analogy that
0:42
Speaker 2: I often make is when there's a brand new car
0:44
Speaker 2: that comes off the assembly line, you do a full
0:47
Speaker 2: scope of diagnostic workup, hook it up to the computer.
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Speaker 2: And I think we should do the same thing with
0:51
Speaker 2: humans as well. Dear, in puberty, you know, obviously you're
0:55
Speaker 2: a functioning human, but I would say there's still development,
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Speaker 2: and I think the human always develops. I don't think
1:02
Speaker 2: development ever ends, but you want to monitor that progress
1:05
Speaker 2: across a person's lifespan.
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Speaker 1: What do you think are the key things to look
1:11
Speaker 1: for in blood work? I mean, testosterone is always the
1:14
Speaker 1: topic that comes up in the context of male hormone optimization,
1:16
Speaker 1: but certainly there are a lot of other hormones that
1:18
Speaker 1: are important as well.
1:19
Speaker 2: And with testosterone, you want to get either testosterone in
1:22
Speaker 2: an SHBG or a free testosterone.
1:25
Speaker 1: Could you define SHBG for our listeners please.
1:27
Speaker 2: It is sex hormone binding globulin. It is the protein
1:30
Speaker 2: that binds up all androgens and estrogen to the body.
1:34
Speaker 2: So the stronger the androgen, the stronger it binds. During puberty,
1:39
Speaker 2: strong androgens, especially DHT, which is the strongest bioidentical androgen,
1:44
Speaker 2: has a huge role a prominent role in secondary sexual characteristics.
1:50
Speaker 2: And if your SHBG is very high, then your DHT
1:53
Speaker 2: can run higher because it's not metabolized, but there's not
1:56
Speaker 2: quite as much free DHD, So you want to balance
1:59
Speaker 2: between a high enough free DHD and a high enough TOTALDHD.
2:04
Speaker 1: So, assuming that there's no major intervention, how often do
2:08
Speaker 1: you recommend that people get their blood work done.
2:11
Speaker 2: Using shared decision making with their physician. Usually a good
2:15
Speaker 2: followup is about six months.
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Speaker 1: So on a daily basis, maybe you could just take
2:19
Speaker 1: us through the arc of a day and push out
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Speaker 1: some of the protocols that you use or the things
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Speaker 1: that you like to see your male patients use in
2:26
Speaker 1: order to try and optimize their hormones.
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Speaker 2: Goddess, I'll briefly touch on some of the lifestyle pillars
2:31
Speaker 2: to start. Diet and exercise are the first two. In puberty.
2:35
Speaker 2: Sleep is particularly important, of course, but with diet and
2:40
Speaker 2: exercise throughout a lifespan, you want to not exclude things
2:47
Speaker 2: that are helping you. For example, daring puberty, if you're
2:50
Speaker 2: consuming dairy and then all of a sudden you cut
2:52
Speaker 2: out all dairy. Dairy can help increase IGF one and
2:55
Speaker 2: free IGF one.
2:56
Speaker 1: And just for our audience, maybe you just mentioned what
2:59
Speaker 1: I What having enough IGF one can do for us
3:02
Speaker 1: that's beneficial is.
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Speaker 2: It helps you grow. It helps with genital development, secondary
3:08
Speaker 2: sexual characteristics and long bone growth, skin growth, hair growth,
3:13
Speaker 2: a host of things.
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Speaker 1: So getting an array of nutrients that include dairy. What
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Speaker 1: other sorts of nutrients are important during development?
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Speaker 2: You want to have adequate vitamin D. Vitamin D helps
3:23
Speaker 2: with testosterone production. It helps again with bone mineralization and stature.
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Speaker 2: After an age of about twenty five, and there's not
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Speaker 2: a strict cutoff, but up to about an age of
3:35
Speaker 2: twenty five. Optimizing your growth hormone and IGF one helps
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Speaker 2: with bone density and bone growth. So from the dietary standpoint,
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Speaker 2: you want to have enough free estrogen, not too much
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Speaker 2: when you're growing, but you want to help basically stockpile
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Speaker 2: bone to prevent a risk of osteoporosis or thin bones
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Speaker 2: fractures when you're older.
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Speaker 1: I realize that some of this relates to ethics and
4:00
Speaker 1: fod allergies and things of that sort, But would you
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Speaker 1: say that, on balance, that most people would benefit from
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Speaker 1: eating a combination of quality proteins from animal sources and
4:11
Speaker 1: non animal sources fruits, vegetables, and starches. I mean, what
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Speaker 1: do you think, for instance, about people following a pure
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Speaker 1: carnivore or a very pure vegan diet in their twenties
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Speaker 1: and thirties.
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Speaker 2: In their late twenties, it might be a reasonable option.
4:26
Speaker 2: In early twenties and certainly teens, it is a horrible
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Speaker 2: idea because it is likely to significantly decrease your free androgens,
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Speaker 2: so you will have less testosterone actin on receptors through
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Speaker 2: the body.
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Speaker 1: Are there any other micronutrients or macronutrients that people in
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Speaker 1: their twenties and thirties should emphasize.
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Speaker 2: Fiber is going to be paramount in kind of like
4:45
Speaker 2: setting your set point of your gut microbiome the rest
4:48
Speaker 2: of your life. There is prebiotic fiber, which you could
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Speaker 2: think of as fish food for your good gut microbiome.
4:55
Speaker 2: Your gut microbiomes kind of like an aquarium or a
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Speaker 2: fish tank. Any fiber or food that you're putting in
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Speaker 2: your gut, it's either going to it's going to skew
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Speaker 2: your gut microbiome towards something that is more beneficial or
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Speaker 2: more detrimental.
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Speaker 1: And would you say that the prebiotic fiber and getting
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Speaker 1: essential fatty acids that would be important to do throughout
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Speaker 1: the lifespan or just for the people in their twenties and.
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Speaker 2: Thirties throughout the lifespan, particularly important in the teenage, twenties
5:22
Speaker 2: thirties because it helps with brain development. You're certainly more
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Speaker 2: of an expert than me when it comes to brain development,
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Speaker 2: but it does continue to develop really throughout the lifespan,
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Speaker 2: but certainly through the twenties and thirties as well.
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Speaker 1: In a previous discussion of ours, I asked you about
5:39
Speaker 1: caloric restriction and testosterone, and if I recall correctly, the
5:42
Speaker 1: idea was that if somebody is overweight they have an
5:45
Speaker 1: excess fat at a post tissue, then getting rid of
5:48
Speaker 1: some of that at a post tissue but throughchloric restriction
5:51
Speaker 1: and exercise, provided it's done not too fast in a
5:53
Speaker 1: healthy way, is going to be beneficial for testosterone in
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Speaker 1: the long run. But that for individual who are not
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Speaker 1: carrying an excess of body fat, caloric restriction is actually
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Speaker 1: going to lower testosterone. First of all, do I have
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Speaker 1: that correct? And second are there any addendums to that
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Speaker 1: that you'd like to give us?
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Speaker 2: Now that's correct. If you look at an individual in
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Speaker 2: a caloric deficit, several changes will happen. One is that
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Speaker 2: they'll have less building blocks for hormones. Another is that
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Speaker 2: they will be in a catabolic state more often, so
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Speaker 2: that balance of anabolism and catabolism will be different. They'll
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Speaker 2: likely have less signaling from growth hormone and IGF one,
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Speaker 2: and they'll also have the high SHBG that we defined
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Speaker 2: earlier as the binding protein. So there are free androgens
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Speaker 2: and free estrogens will go down.
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Speaker 1: Now, what are some of the other pillars of creating
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Speaker 1: the proper environment for hormone optimization? Stress is probably the
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Speaker 1: next one.
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Speaker 2: During both puberty but also the twenties and thirties, individuals
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Speaker 2: are figuring out how they want to cope with stress
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Speaker 2: and also figuring out what they want to choose to
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Speaker 2: put their effort into. So if someone is overstressed, then
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Speaker 2: they can have it, can put all the other lifestyle pillars,
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Speaker 2: and then they stop dieting, well, they stop exercising, and
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Speaker 2: everything else can go askew.
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Speaker 1: What would it be some of the additional things that
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Speaker 1: everybody should do.
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Speaker 2: Another one is finding what your purpose is in life.
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Speaker 2: So I call this spirit, but it's really just a
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Speaker 2: self actualization component of Maslow's hierarchy of needs, which is
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Speaker 2: basically your physical needs, your mental needs, and then your
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Speaker 2: purpose in life, what you really like to do.
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Speaker 1: The idea is not to pick the end goal, is
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Speaker 1: to pick a goal and then once you reach that goal,
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Speaker 1: to assess and then pick another goal and so on.
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Speaker 1: I think sometimes when people hear about picking up purpose
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Speaker 1: of like, oh goodness, I have to define sort of
7:49
Speaker 1: like naming oneself, that you actually can change your goals
7:54
Speaker 1: and purpose over time, I'd like to return to the
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Speaker 1: key things that people should do, or i should say,
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Speaker 1: the key things that men should do to optimize their hormones.
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Speaker 1: What do you think is a healthy, sustainable exercise regimen
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Speaker 1: that anyone can follow that will also support their hormone status.
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Speaker 2: For really vigorous exercise around three to four times a
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Speaker 2: week is very sustainable over a long period of time.
8:20
Speaker 2: On top of that, you could add in three or
8:22
Speaker 2: four more instances of less vigorous exercise. When they study
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Speaker 2: the effect of exercise, specifically vigorous exercise, one area that's
8:32
Speaker 2: been studied is vigorous exercise episodes lasting longer than an hour,
8:37
Speaker 2: and they usually track it by a rating of perceived exertion,
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Speaker 2: which isn't perfect and it's not extremely actionable, but it's
8:44
Speaker 2: helpful for clinical science. But the takeaway from that is basically,
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Speaker 2: do it is not hormonally helpful to train, especially regularly
8:55
Speaker 2: train vigorously for longer than an hour.
8:59
Speaker 1: These days, for better or for worse, I think for worse,
9:03
Speaker 1: younger guys are asking about and using testosterone replacement therapy
9:09
Speaker 1: so called TRT. Why in the world would any male
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Speaker 1: in his teens or twenties or even thirties, whose blood
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Speaker 1: levels of testosterone and estrogen are at the appropriate levels,
9:23
Speaker 1: I mean, within the normal reference range. Why would they
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Speaker 1: take exogenous testosterone? Given all the negative effects on fertility,
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Speaker 1: some of the challenges that it can present, if the
9:34
Speaker 1: dosages aren't quite right, et cetera, why would they do that?
9:37
Speaker 1: Certainly if they are not being paid for a particular endeavor,
9:42
Speaker 1: like they're not making money, if they are playing a sports,
9:44
Speaker 1: chances are they're not allowed to do that anyway. It's
9:47
Speaker 1: on the pan substances list. So to me, it just
9:49
Speaker 1: seems like a crazy idea. But then again, I'm of
9:53
Speaker 1: a generation that really hasn't thought about doing that stuff
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Speaker 1: until people were in their forties and fifties or even never.
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Speaker 1: So is there ever a case for somebody in their
10:03
Speaker 1: twenties or thirties to take testosterone? But if their blood
10:06
Speaker 1: levels are within the three hundred to nine hundred nanograms
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Speaker 1: per desolator reference range?
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Speaker 2: You know, everyone has their different reason as far as
10:15
Speaker 2: like when does the benefit outweigh the detriment? Not very
10:20
Speaker 2: often if you're in your twenties, and certainly probably almost hardly. Never,
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Speaker 2: there's always you know, rare cases like Coleman syndrome and whatnot,
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Speaker 2: but almost never if you're very young.
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Speaker 1: Okay, So for people in their twenties, thirties, and beyond forties,
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Speaker 1: et cetera, whose testosterone and estrogen levels are at the
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Speaker 1: appropriate ratios and in within the normal reference range libido,
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Speaker 1: energy recovery, et cetera, are feeling, you know, least workable
10:49
Speaker 1: for their lifestyle. For those people, what can they do
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Speaker 1: besides get great sleep, train but not too hard or
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Speaker 1: too often, et cetera, et cetera. What are some of
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Speaker 1: the things in the realm of supplementation that can help
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Speaker 1: them optimize their testosterone and estrogen without suppressing their own
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Speaker 1: endogenous production of testosterone and estrogen.
11:10
Speaker 2: Let's mention. Creatine is the first one. Creatine is interesting
11:14
Speaker 2: because it has multiple different effects. That helps with amino
11:17
Speaker 2: acid synthesis. It also helps with oxidative stress. It can
11:21
Speaker 2: also serve as the backup fuel tank for your mitochondria,
11:24
Speaker 2: so kind of holding backup atp and it does slightly
11:28
Speaker 2: increase total testosterone and it also increases the conversion of
11:31
Speaker 2: testosterone to dihydro testosterone, So potentially it's especially useful in
11:38
Speaker 2: men in their even their teenage years and their twenties.
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Speaker 1: You mentioned the conversion of testosterone to dihydrag testosterone, and
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Speaker 1: there is mythology out there that creatine can increase hair loss.
11:48
Speaker 1: I'm guessing because there's at least one study showing that
11:50
Speaker 1: creatine can increase DHD dihydrag testosterone, and DHD is one
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Speaker 1: of the primary hormones that can promote mail pattern baldness.
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Speaker 1: The question therefore, is does create creatine supplementation increase the
12:05
Speaker 1: rate of hair.
12:06
Speaker 2: Loss in each individual. Preventing hair loss is a very
12:12
Speaker 2: poor reason to take creatine because it's not going to
12:14
Speaker 2: take you to a supra physiologic level. It's not going to,
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Speaker 2: you know, increase your androgens to an unnormal level of binding.
12:26
Speaker 2: So I feel like this, if that was a reason
12:29
Speaker 2: to not take creatine for hair loss, then that.
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Speaker 1: Means sorry, you mean hair loss is not a reason
12:34
Speaker 1: to avoid taking creatine.
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Speaker 2: Correct hair loss is not a reason to avoid taking creatine.
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Speaker 2: Think of it as just bringing you to what you
12:44
Speaker 2: are naturally inclined to have. If your conversion of testosterone
12:48
Speaker 2: to DHD is already high, then often creatine does not
12:52
Speaker 2: affect this. It just kind of resets your balance between
12:56
Speaker 2: testosterone being aromatized to estrogen or being five alpha reduced DHT.
13:02
Speaker 2: So it's not going to speed up hair loss more
13:04
Speaker 2: than just naturally being a mail does. So in some individuals,
13:08
Speaker 2: it will have no effect. In some individuals for whatever reason,
13:12
Speaker 2: they have almost no five alpha reductase activity. It will
13:15
Speaker 2: return them to natural or normal.
13:17
Speaker 1: So what other supplement based tools can people consider?
13:21
Speaker 2: Another one we can loop in with creating is beta en.
13:24
Speaker 2: Some people are non responders to creatines. You can increase
13:27
Speaker 2: that to ten grams, or you can use its cousin
13:30
Speaker 2: beta en to help with amino acid synthesis and shunting
13:34
Speaker 2: of energy. Along with that, I would put l carnatine
13:37
Speaker 2: beta en.
13:39
Speaker 1: Do you recall what dosage people typically would take if
13:43
Speaker 1: they're creating non responder.
13:45
Speaker 2: One to three grams. In fact, yeah, several versions of
13:49
Speaker 2: creating have beta en mixed in because it helps with
13:52
Speaker 2: the processing of mathianine and homocysteine.
13:55
Speaker 1: So if somebody is already taking creatine and likes it
13:57
Speaker 1: and responds to it, will raise my hand, is myself
14:00
Speaker 1: would adding beta ene help or is it redundant? With creatine?
14:05
Speaker 2: Only if their homocystine is persistently elevated, and homocysteine is
14:08
Speaker 2: kind of like an inflammatory marker that can build up
14:11
Speaker 2: if you're not converting enough of it down the stream.
14:14
Speaker 1: How would I know just a blood test? So L carnatine,
14:18
Speaker 1: What are the ways to take L carnatine? I know
14:20
Speaker 1: that there's an oral form of capsules, and there's injectibles
14:23
Speaker 1: the injectibles. I think you need a prescription, Is that
14:26
Speaker 1: right correct?
14:26
Speaker 2: You need a prescription for the injectibles or you should
14:29
Speaker 2: really get a prescription for the injectibles. When you inject it,
14:34
Speaker 2: of course at the supervision of your doctor. It's usually
14:37
Speaker 2: done intramuscularly. It's an aqueous solution, so it does not
14:40
Speaker 2: have like an oil or a carrier oil in it
14:42
Speaker 2: like tr like testosterone esters do. However, if you inject
14:47
Speaker 2: it to superficially, it's not going to make it break anything.
14:50
Speaker 2: Often it just burns if you inject it subcutaneously, and
14:54
Speaker 2: it does not disseminate throughout the body as well. L
14:58
Speaker 2: carnatine potentially has localized effects if you inject it, if
15:03
Speaker 2: you ingest it orally, then it has a very low bioavailability,
15:07
Speaker 2: maybe only ten percent, So.
15:09
Speaker 1: What are the dosages of lcarantine that one needs to
15:11
Speaker 1: ingest then if they want to get a benefit. Because
15:14
Speaker 1: I find only ten percent is being absorbed, it's probably
15:18
Speaker 1: a lot of L carnantine. How much should people take
15:20
Speaker 1: per day?
15:20
Speaker 2: Usually I recommend for oral L carnatine between one thousand
15:24
Speaker 2: milligrams and up to four or five thousand milligrams, so.
15:28
Speaker 1: One to four, maybe even five grams.
15:31
Speaker 2: Correct, up to five grams a day. If you're on
15:34
Speaker 2: that much, especially if you have a dysregulated gut microbiome,
15:38
Speaker 2: you should be concerned with tmao, which is a potential
15:41
Speaker 2: carcinogen that both carnatine and coline can convert into, and
15:46
Speaker 2: your gut microbiota determine how much that happens.
15:49
Speaker 1: Is it true that I can offset any negative effects
15:52
Speaker 1: of alpha gpc coline, that is NL carnatine that I
15:56
Speaker 1: take by ingesting garlic? Is that right?
15:59
Speaker 2: There's a common in garlic called alison. I believe it's
16:02
Speaker 2: a L I ci in. It's also part of the
16:05
Speaker 2: scientific name the genus of types of garlic, and this
16:09
Speaker 2: can help decrease the conversion to tmao. Berberine actually slightly
16:13
Speaker 2: decreases the conversion to TMAO as well, probably through alteration
16:17
Speaker 2: of the gut microbiome, and then just optimizing your gut
16:20
Speaker 2: microbiome can decrease conversion. So not everyone needs Allison, but
16:24
Speaker 2: it's something that you should certainly consider if you were
16:27
Speaker 2: on a high dose.
16:28
Speaker 1: I'm going to continue to take the six hunderd milligrams
16:31
Speaker 1: of garlic every time I take my L carnatine, but
16:34
Speaker 1: I'm going to skip the berberene because berbering gives me
16:36
Speaker 1: brutal headaches, and it makes me create carbohydrates because it
16:39
Speaker 1: drops my blood sugar.
16:40
Speaker 2: It has many other effects, including the dawn phenomenon where
16:43
Speaker 2: it drops your blood sugar when you're sleeping and you
16:45
Speaker 2: can't even realize it.
16:46
Speaker 1: Okay, And what we did not talk about is what
16:48
Speaker 1: L carnatine does.
16:50
Speaker 2: It's a shuttle, so I think it's named carnatine palmetel
16:54
Speaker 2: coenzyme A. Basically, it's it just takes nutrients from outside
16:59
Speaker 2: your mitochondria and puts them in. It also has a
17:02
Speaker 2: unique effect, well not too unique, because tadalafil actually has
17:05
Speaker 2: this effect as well, is that it increases the density
17:08
Speaker 2: of the androgen receptor and the cytoplasm of your cells.
17:12
Speaker 2: So even if your androgen receptor sensitivity doesn't change, and
17:16
Speaker 2: even if you doesn't testosterone does not change, you will
17:19
Speaker 2: have more testosterone binding to that increased number of receptors.
17:23
Speaker 1: Does one need to cycle el carnacine, creatine, beta en.
17:27
Speaker 2: No reason to cycle any of those.
17:29
Speaker 1: What other supplements can one use to try and improve
17:32
Speaker 1: hormone profiles? And here I realize we're using a very
17:36
Speaker 1: broad brush because when we say improve hormone profiles, what
17:38
Speaker 1: are we really talking about? And for me, at least,
17:41
Speaker 1: I think about the subjective stuff. You know, do people
17:46
Speaker 1: feel like they are going to have more energy as
17:48
Speaker 1: a consequence of doing these things? Are they going to
17:50
Speaker 1: have the more optimized libido? Are they going to have
17:53
Speaker 1: more optimized recovery from exercise? Right? Because I mean, it's
17:57
Speaker 1: not clear to me that taking one's testosterone from six
18:00
Speaker 1: hundred to eight hundred is always going to be a
18:01
Speaker 1: good thing, especially if estrogen is increasing in parallel. That
18:04
Speaker 1: could cause issues. It could certainly make things better, it
18:07
Speaker 1: could certainly make things worse.
18:09
Speaker 2: Right, Let's briefly mention vitamin D, which is also a
18:11
Speaker 2: hormone it's actually a sterile hormone, and if you have
18:15
Speaker 2: deficient vitamin D and you replace it, then you will
18:18
Speaker 2: optimize your testosterone. It's also mentioned boron, so if you
18:22
Speaker 2: have a very high SHBG, boron can acutely help lower it,
18:26
Speaker 2: usually in a dose of five to twelve milligrams per day.
18:29
Speaker 2: It's not really a sustained effect, but boron is depleted
18:33
Speaker 2: in soils in many countries. I believe it's very high
18:36
Speaker 2: in soils in grease and Turkey, so eating dates or
18:39
Speaker 2: raisins that are from those areas potentially have more boron.
18:42
Speaker 2: Boron also might be one of the reasons why the
18:45
Speaker 2: reference range for testosterone is much higher in those countries
18:50
Speaker 2: than other countries.
18:51
Speaker 1: And just to remind people that SHBG sex hormone mining
18:54
Speaker 1: globulin is attaching to the disosterone molecule and limiting the
18:57
Speaker 1: amount of so called free testosterone that's available tab its
19:00
Speaker 1: impact on cells. Okay, so, vitamin D three, I'm guessing
19:03
Speaker 1: you're talking about vitamin D three specifically when you say
19:05
Speaker 1: vitamin D and then boron five to twelve milligrams per day, right,
19:10
Speaker 1: and then what are some of the other things to
19:12
Speaker 1: optimize testosterone? That are in supplement form, we.
19:15
Speaker 2: Can talk about things that affect the steroidgenesis cascades. So
19:18
Speaker 2: we could touch on tong cat ali. I know we've
19:20
Speaker 2: talked about that a little bit before it, and.
19:22
Speaker 1: I'm guessing a number of people probably haven't heard that conversation, also.
19:25
Speaker 2: Known as long jack, and that upregulates several different enzymes
19:30
Speaker 2: in this steroid genesis cascade. And by that what you
19:34
Speaker 2: mean if and this is another good thing to google.
19:36
Speaker 2: I think anybody interested in hormone optimization should understand where sterole.
19:41
Speaker 1: Hormones come from.
19:42
Speaker 2: They come usually from cholesterol, and they can be shunted
19:45
Speaker 2: off to vitamin D very easily. They can be shunted
19:48
Speaker 2: off to testosterone or estrogens or progestogens quite easily as well.
19:54
Speaker 2: But tonkat helps with the conversion of multiple key steps
19:59
Speaker 2: where you sit the size testosterone another. I think of
20:04
Speaker 2: it as like a coenzyme or a cofactor. An upregulator
20:07
Speaker 2: of these steps is insulin and IGF one. So a
20:11
Speaker 2: good rule of thumb is if you are not expecting
20:14
Speaker 2: as much growth hormone insulin and IGF one, for example,
20:18
Speaker 2: lower carb diets, caloric deficits. You're trying to cut body
20:22
Speaker 2: fat or body weight, then tonkat is going to be
20:26
Speaker 2: theoretically especially powerful.
20:29
Speaker 1: What sorts of dosages of tongu got do you recommend
20:32
Speaker 1: to your patients.
20:33
Speaker 2: Anywhere from three hundred to twelve hundred milligrams a day
20:37
Speaker 2: with tonkat? You need to be careful with the standardization
20:42
Speaker 2: because if you're thinking about a general tonkat supplement, which
20:45
Speaker 2: is by far the most well studied, then you're looking
20:50
Speaker 2: at the uryicominone content, which is a plant compound that
20:54
Speaker 2: is likely the main active pharmacologic effect. So that's the
20:59
Speaker 2: compound having the effect on the body. And if you
21:02
Speaker 2: standardize the uricominone very very high, then theoretically you're having
21:07
Speaker 2: more effect at a lower dose.
21:10
Speaker 1: My blood work tells me that it causes an increase
21:12
Speaker 1: in free testosterone for me and also a slight increase
21:15
Speaker 1: in lutinizing hormone for me. What are some of the
21:18
Speaker 1: other effects on various hormones that you've observed in the
21:21
Speaker 1: blood work of your patients taking tongua ali.
21:24
Speaker 2: Tongkat can also slightly increase DHA and if you have
21:28
Speaker 2: a very high SHBG. Again, that's the protein that binds
21:32
Speaker 2: up your androgens and Estrogen's an extremely important protein. The
21:37
Speaker 2: higher your SHBG, the more it helps decrease it. So
21:40
Speaker 2: they've studied tongkat in populations with very normal shbgs and
21:45
Speaker 2: it does nothing for SHBG.
21:47
Speaker 1: Interesting, does that mean it does nothing for somebody overall?
21:50
Speaker 1: So if somebody has SHBG that's in the normal range,
21:53
Speaker 1: will taking tonga benefit them in any other way?
21:57
Speaker 2: Yes, it'll increase their total and free to stosterone.
22:01
Speaker 1: What are some of the other hormones that you prescribe
22:04
Speaker 1: to your patients who do not want to go on
22:06
Speaker 1: testosterone replacement therapy or take exogens, DHA or anything like that.
22:12
Speaker 2: We could talk about Fidosian next. Fidosia's interesting because it's
22:15
Speaker 2: a genus of plants. Fidosia agrestis is.
22:18
Speaker 1: One of them.
22:18
Speaker 2: There's many others that are very interesting. That species is
22:23
Speaker 2: likely the most well studied. And it will increase LH,
22:26
Speaker 2: so I would not consider it an LH mimetic, so
22:30
Speaker 2: it doesn't really mimic it, but it increases the release
22:33
Speaker 2: of lutinizing a hormone from the pituitary that's a hormone
22:35
Speaker 2: that binds to the lated cell, to the LED receptor,
22:39
Speaker 2: kind of like HGG does and it will increase the
22:43
Speaker 2: release of testosterone.
22:44
Speaker 1: What dosages do you have patients, Steake, I've heard of
22:48
Speaker 1: some potential toxicity to the testicular cells.
22:52
Speaker 2: There is one study, and this is a rat study,
22:54
Speaker 2: but you can equate the dose of toxicity in rats
22:57
Speaker 2: in humans. They did not give these rats any antioxidants.
23:01
Speaker 2: But it increases a couple different like pro inflammatory markers.
23:06
Speaker 2: One is GGT or gamma glut tamil transfer race comes
23:09
Speaker 2: from both the testes and the liver, and one is
23:11
Speaker 2: alkaline phosphatase also known as alk foss, again coming from
23:15
Speaker 2: both areas. There are several different ways that you can
23:18
Speaker 2: attenuate this increase, and you can also just check to
23:21
Speaker 2: see if you have increased in the rat dose that
23:24
Speaker 2: equates with humans that had no effect. So the safe
23:27
Speaker 2: dose was an average of three hundred milligrams a day.
23:31
Speaker 1: So that would be three hundred milligrams a day in humans.
23:34
Speaker 1: Is the dosage that did not have toxicity. Correct.
23:37
Speaker 2: Correct, And often even if there is toxicity in rats,
23:42
Speaker 2: there is not toxicity humans, so it's not directly equitable,
23:45
Speaker 2: but to be safe, another regimen that I have people
23:49
Speaker 2: take is six hundred milligrams every other day, or six
23:52
Speaker 2: hundred milligrams three times a week, often Monday, Wednesday, Friday.
23:56
Speaker 1: My understanding is that nowadays a lot of people are
23:59
Speaker 1: using testosterone. Let's not even call it replacement therapy, because
24:02
Speaker 1: some of these people have six hundred and seven hundred
24:04
Speaker 1: or even you know, eight hundred and anagram per distlet
24:07
Speaker 1: or reads. So they're not replacing anything that is diminished.
24:10
Speaker 1: They're just trying to augment what's already there, increase what's
24:12
Speaker 1: already there. My understanding is that taking a low dose
24:16
Speaker 1: more frequently is going to be more beneficial than the
24:19
Speaker 1: kind of old school way of giving you know, one
24:21
Speaker 1: hundred or even two hundred milligrams in a single injection
24:24
Speaker 1: once every two weeks. Is that right? And what do
24:26
Speaker 1: you do with your patients? So let me give you
24:28
Speaker 1: a hypothetical. Somebody comes into your office. There their blood
24:32
Speaker 1: work and they have blood levels of let's say, six
24:36
Speaker 1: hundred anagrams per estosterone. Their estrogen is also in normal range.
24:41
Speaker 1: Everything else checks out, but they're complaining of you know,
24:44
Speaker 1: slightly diminished libido, slightly poor recovery from workouts, maybe you know,
24:50
Speaker 1: reduce motivation and drive. Although no major depression and you
24:53
Speaker 1: come to the conclusion that testosterone therapy not replacement, but
24:57
Speaker 1: testosterone therapy might be a good option to explore. What's
24:59
Speaker 1: a the typical dosage range and frequency of administration range
25:04
Speaker 1: that you might consider exploring.
25:07
Speaker 2: Some of this depends on the SHBG and free testosterone
25:10
Speaker 2: as well. So if that same individual had a very
25:12
Speaker 2: high SHBG, which again is the binding protein that binds
25:15
Speaker 2: up the testosterone and all androgens and estrogens, if it
25:18
Speaker 2: is extremely high and they have a free testosterone of two,
25:23
Speaker 2: then they might need a different dose because they need
25:25
Speaker 2: enough testosterone in order to have a normal YUGANADL free testosterone.
25:32
Speaker 2: But a general normal dosing range, especially for someone starting,
25:36
Speaker 2: is around one hundred to one hundred and twenty milligrams
25:39
Speaker 2: divided over the course of a week, usually either every
25:43
Speaker 2: other day or three times a week, occasionally twice a week.
25:47
Speaker 2: Many people with SHBG a bit higher can get away
25:50
Speaker 2: pretty easily with twice a week. This is assuming that
25:53
Speaker 2: the ester is sipienate or a nanthate, so.
25:55
Speaker 1: Two sixty milligram injections of tesosconcipientate per week very common
26:00
Speaker 1: dosing to hit that one hundred and twenty milligrams per
26:02
Speaker 1: week as kind of the typical average.
26:04
Speaker 2: Erect and I would consider this like a physiologic yugen
26:08
Speaker 2: adut dose. For many people, even two hundred milligrams a
26:11
Speaker 2: week is far above the reference range. All of this
26:15
Speaker 2: is said with the caveat that testosterone is normally released
26:18
Speaker 2: in a pulsatile manner, so it's high in the morning,
26:21
Speaker 2: low in the evening, Whereas if you're on testosterone therapy,
26:26
Speaker 2: then you're going to have a steady state, so your
26:29
Speaker 2: testosterone level is going to be pretty much the same
26:32
Speaker 2: even in the evening.
26:33
Speaker 1: In your experience. When patients do that, I'm guessing they
26:36
Speaker 1: report the normal constellation of positive effects, you know, improved mood,
26:40
Speaker 1: improved energy, improved sleep, recovery, et cetera. But what are
26:43
Speaker 1: some of the hazards or things that can crop up
26:46
Speaker 1: in blood work or just subjectively that can be warning
26:50
Speaker 1: signs that even a dosage of one hundred and twenty
26:52
Speaker 1: milligrams divided into these two or three dosages per week
26:55
Speaker 1: is too high.
26:56
Speaker 2: So this is when you really have to be at
26:59
Speaker 2: least well versed in every organ system, not just the
27:04
Speaker 2: ganadal like you know, genital system. You need to have
27:09
Speaker 2: you know dermatology, prowess acne is very common change lots
27:14
Speaker 2: of different skin pathologies or even bruising can be related
27:18
Speaker 2: to hormone replacement. Hair loss is very common to see
27:21
Speaker 2: as well mental status changes. It could occasionally it even
27:26
Speaker 2: induces a manic or a bipolar episode because dostosterone is
27:29
Speaker 2: also dopaminergic, and then cardiovascularly, not just in the heart,
27:34
Speaker 2: but also concerns for like microvascular a schemic disease, ferretin
27:38
Speaker 2: build up because the estrogen also increases, and then fertility
27:43
Speaker 2: concerns as well, and lipid concerns too, So you really
27:46
Speaker 2: have to be you know, hematologist, dermatologist, cardiologists, lipidologists, the
27:52
Speaker 2: whole nine yards.
27:53
Speaker 1: So another reason or set of reasons rather too, if
27:59
Speaker 1: one is concer using testosterone therapy, to really do this
28:02
Speaker 1: in close communication with a really good physician, because that's
28:06
Speaker 1: a lot to monitor. Knowing whether or not you have
28:07
Speaker 1: acting or not is one thing, But knowing whether or
28:10
Speaker 1: not your LDL is going up, your ApoB is going up,
28:12
Speaker 1: that's a whole other biz. And that needs to be
28:14
Speaker 1: done through blood work, is what I'm hearing.
28:16
Speaker 2: Correct And if your physician that is managing or prescribing
28:20
Speaker 2: your testosterone therapy or your HRT is not well versed
28:25
Speaker 2: in these systems. You would want him or her to
28:27
Speaker 2: be part of an interdisciplinary team where they have other
28:30
Speaker 2: experts that can monitor those systems.
28:32
Speaker 1: There are males out there who want to increase their
28:35
Speaker 1: testosterone and other hormones, maybe growth hormone, et cetera, who
28:40
Speaker 1: opt to not take exogenous testosterones, no cream, no pellet,
28:44
Speaker 1: no no pill, no injectable scipion eate, but decide to
28:48
Speaker 1: take chlomophin a couple times a week. My understanding, I've
28:52
Speaker 1: never done this, I would say if I had. My
28:54
Speaker 1: understanding is that taking chlomophin maybe two fifty milligramble it's
29:00
Speaker 1: a week, is what I hear people are doing, will
29:02
Speaker 1: increase what lutinizing hormone, the various estrogen receptor subunits. Could
29:08
Speaker 1: you explain how chomophin would benefit anyone and is this
29:11
Speaker 1: a good strategy. I'm hearing that it's been done quite
29:13
Speaker 1: a lot now.
29:14
Speaker 2: It will increase testosterone in a dose to pendent manner,
29:18
Speaker 2: but it has many other pharmacodynamic effects, which is the
29:21
Speaker 2: effect of the drug on the body other than its
29:24
Speaker 2: effect on the hypothalamus in the pituitary. So in the
29:27
Speaker 2: hypothalamus and the pituitary it does what's called negative feedback inhibition,
29:34
Speaker 2: or it blocks the axgen of estrogen, so it crowds
29:38
Speaker 2: out estrogen from the estrogen receptor on the hypothalamus and
29:42
Speaker 2: the pituitary.
29:43
Speaker 1: Why would I want to take something that would increase
29:46
Speaker 1: the activity of an estrogen receptor. I just can't find
29:50
Speaker 1: the rationale for that.
29:51
Speaker 2: The main rationale behind taking a serm is as a
29:55
Speaker 2: very temporary measure that is not going to suppress pituitary
30:00
Speaker 2: or hypothalamic function. If your testosterone is just so drastically
30:05
Speaker 2: low that it is unlikely to recover anyone anyway. So
30:09
Speaker 2: most of the time it is not clinically useful and
30:14
Speaker 2: SERMs should not be prescribed very often, certainly not as
30:17
Speaker 2: long term testosterone replacement or testosterone optimization in most individuals.
30:23
Speaker 2: There's always exceptions to everything. But there's five different estrogen
30:28
Speaker 2: and estrogen related receptors. There's two main estrogen receptors and chlomid,
30:34
Speaker 2: and every serm has a very unique profile because they
30:38
Speaker 2: selectively inhibit some receptors in some tissues but not other
30:42
Speaker 2: receptors and other tissues. For example, chlomid can inhibit receptors
30:47
Speaker 2: that are in the eye and it can cause visual
30:51
Speaker 2: changes blurry vision, especially at higher doses. And it also
30:57
Speaker 2: acts in every other tissue with the body. So side
31:00
Speaker 2: effects from chlomate and other selective estrogen receptor modifiers are
31:05
Speaker 2: very common.
31:06
Speaker 1: Alcohol. Does it increase a romatase the ens on the
31:09
Speaker 1: converse testosterone into estrogen or not? And is there a
31:13
Speaker 1: dose dependence there?
31:14
Speaker 2: It significantly does there is a dose dependence In general,
31:18
Speaker 2: I would not recommend more than three to four, you know,
31:23
Speaker 2: standard drinks. One huge glass of wine is probably five
31:27
Speaker 2: standard drinks every two weeks. The other thing to keep
31:30
Speaker 2: in mind with alcohol is as a lot of calories
31:33
Speaker 2: seven kilo calories program almost as much as fat, which
31:36
Speaker 2: is nine. And then it's also very gaba urgic, so
31:40
Speaker 2: it can activate inhibitory neurotransmission, and that can also affect
31:46
Speaker 2: how many how much LH and FSH is released, so
31:50
Speaker 2: that can also decrease testosterone, almost kind of similar to
31:55
Speaker 2: how opiates can decrease testosterone.
31:58
Speaker 1: Want to go back to the and talk to you
32:01
Speaker 1: about something that's kind of a newer emerging trend. I
32:04
Speaker 1: know that you've talked to a little bit about this
32:06
Speaker 1: in previous podcasts that a number of men, I should say,
32:10
Speaker 1: a number of physicians are prescribing low dose to dalophil
32:14
Speaker 1: also known as cialis, to their male patients. So in
32:18
Speaker 1: dosage ranges of like two point five milligrams to five
32:20
Speaker 1: milligrams per day, but not for a rectile dysfunction, but
32:23
Speaker 1: rather for improving prostate health, and presumably they get sort
32:27
Speaker 1: of a boost in terms of blood flow to the
32:29
Speaker 1: genitalia as well, but again not specifically a deal with
32:33
Speaker 1: a rectile dysfunction, but to deal with prostate health and
32:37
Speaker 1: blood flow to the prostate. Is that something that you
32:40
Speaker 1: sometimes often prescribe to your patients, And of what age?
32:43
Speaker 2: Tod Alaphil is a very underrated medication. The age would
32:47
Speaker 2: kind of depend on the indication. So tod aalaphil is
32:51
Speaker 2: also a blood pressure medication. It can very slightly decrease
32:55
Speaker 2: blood pressure, especially at higher doses. At higher doses at
32:58
Speaker 2: theorem high dose would be twenty miligrams, not two point
33:02
Speaker 2: five miligrams, but consistently it can somewhat affect with the
33:07
Speaker 2: cones in the eye that have to do with red
33:08
Speaker 2: and green sight, although if you remove it, that effect
33:11
Speaker 2: is reversed. So basically, if you don't need really really
33:14
Speaker 2: good red green discrimination, you can take higher doses, but
33:17
Speaker 2: in general I recommend no higher than ten miligrams a day,
33:21
Speaker 2: usually just two or five miligrams. One other benefit or
33:27
Speaker 2: other use of to dalafil is that it increases the
33:30
Speaker 2: density of the androgen receptor, similarly to L carnotine, so
33:35
Speaker 2: that's an interesting benefit. Another benefit is that if you
33:38
Speaker 2: give it to people with nolturia, which is urinating at night,
33:41
Speaker 2: in general, it will cut the episodes in half, so
33:44
Speaker 2: it could go from two to one, which can make
33:46
Speaker 2: a big difference for your sleep, which will secondarily make
33:49
Speaker 2: a big difference for your growth hormone and cystosterone optimization.
33:52
Speaker 1: Interesting, so you said two point five to five milligrams
33:55
Speaker 1: per day is goin typical for these prostate enhancing effects. Yes,
33:59
Speaker 1: I get a lot of questions about drugs to offset
34:03
Speaker 1: hair loss. Most of those drugs are going to operate
34:05
Speaker 1: through the DHD system, the dehydras oftosterone system. For the
34:08
Speaker 1: reasons we talked about before, DHG receptors being on the
34:10
Speaker 1: scalp and causing beard growth on the face. Is it
34:13
Speaker 1: the case that a number of people taking things like
34:16
Speaker 1: propecia and other things to block the DHT or disrupt
34:20
Speaker 1: the DHD pathway are going to experience diminished sex drive,
34:25
Speaker 1: diminished you know, kind of motivation and general vigor. And
34:30
Speaker 1: if so, are there alternatives, like topical DHD antagonists that
34:33
Speaker 1: they might use if they want to keep their hair
34:37
Speaker 1: but not have those negative effects.
34:39
Speaker 2: Many people that have just a bit of predisposition, they
34:42
Speaker 2: can use things that are topical anti androgens. Ketoconazol is
34:48
Speaker 2: one of them. Caffeine is actually another one.
34:50
Speaker 1: Wait, you have to explain how this works. How do
34:52
Speaker 1: people get caffeine into the hair ollicle?
34:55
Speaker 2: Topically, the caffeine enters the scalp and crowds out, like
35:00
Speaker 2: somewhat crowds out the androgen. It is a weak effect.
35:03
Speaker 2: It's likely just strong enough to be clinically significant. Usually
35:07
Speaker 2: caffeine is put into formulations with other things like ketoconazol
35:11
Speaker 2: that are also weak anti androgens. Of notes, spernalactone can
35:16
Speaker 2: be prescribed topically, but it is absorbed systemically because the
35:20
Speaker 2: size of the molecule. So unless your doctor specifically prescribes
35:23
Speaker 2: that for you, especially as a male, do not use
35:26
Speaker 2: topical spronalactone. Topical finasteride is also a smaller molecule, so
35:32
Speaker 2: it is also systemically absorbed, but it is not extremely
35:36
Speaker 2: well systemically absorbed. If you take topical phinasteride, then usually
35:40
Speaker 2: your systemic DHT will decrease by about thirty percent. Topical
35:44
Speaker 2: detastoride is likely a tiny bit systemically absorbed, but it's
35:49
Speaker 2: unique because it's half life is much faster at a
35:51
Speaker 2: lower dose, so topical detastoride will not affect your systemic
35:56
Speaker 2: DHT at all, and I've seen this anecdotally on many
35:59
Speaker 2: people on topical cold a test ride.
36:00
Speaker 1: Therapy on behalf of the audience, and just for myself,
36:04
Speaker 1: thank you so much. You have an immense amount of
36:06
Speaker 1: knowledge and you're exquisitely good at sharing it with people
36:09
Speaker 1: in an actual way, So thank you. My pleasure,