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Dr. Kyle Gillett: How to Optimize Your Hormones for Health & Vitality | Huberman Lab Podcast #67



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Welcome to the Huberman Lab Podcast,
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where we discuss science and science-based tools
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for everyday life.
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I'm Andrew Huberman,
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and I'm a professor of neurobiology and ophthalmology
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at Stanford School of Medicine.
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Today, my guest is Dr. Kyle Gillette.
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Dr. Gillette is dual board certified in family medicine
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and obesity medicine and practices out of a clinic
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in Kansas and via telemedicine.
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He provides full spectrum medicine,
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including hormone health, preventative medicine,
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obstetrics, which is the branch of medicine and surgery
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concerned with childbirth
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and the care of women giving birth, and pediatrics.
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I first learned about Dr. Gillette from a podcast
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of all things, and was immediately struck
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by the breadth and depth of his knowledge
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on all things hormones and hormone optimization.
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As you'll see very soon today,
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Dr. Gillette can teach you how to optimize your hormones
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using behavioral tools, nutrition, exercise-based tools,
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supplementation, and hormone therapies
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if those are appropriate for you.
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There are many professionals out there,
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including many medical doctors, of course,
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talking about hormone health.
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What really sets Dr. Gillette apart from the pack
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is his ability to understand how the different factors
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that I described before, nutrition, supplementation,
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exercise, and hormone therapies,
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how those interact with one another,
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and the safest and most rational ways
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to approach hormone optimization.
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During today's episode,
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you will learn how to optimize your hormones,
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not just testosterone and estrogen,
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but also prolactin and other hormone pathways
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that impact your mood, mental health, and physical health.
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Dr. Gillette is also an avid educator
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about hormones and other aspects of health.
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He does this on zero-cost-to-consumer platforms,
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such as Instagram and other social media.
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On Instagram, he is KyleJilletteMD.
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That's K-Y-L-E-G-I-L-L-E-T-T, no E at the end, MD.
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So KyleJilletteMD on Instagram,
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and he is Gillette Health on all other platforms,
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including LinkedIn, Twitter, YouTube, TikTok, and Facebook.
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If you go to his Instagram or his other social media,
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you will learn a lot about hormone health,
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about the latest science impacting obesity
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and metabolic health.
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He is a wealth of knowledge.
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And again, he's providing all that information
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at zero cost to you, the consumer.
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What you are soon to hear is a conversation
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between me and Dr. Gillette about all things hormones
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and hormone health and hormone optimization.
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We dive deep into mechanisms,
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but we are clear to establish what each word
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or set of concepts mean.
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So if you have no background in biology, or even if you do,
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I'm sure that you'll come away
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with a wealth of valuable knowledge.
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We also talk about specific protocols related, again,
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to lifestyle factors, nutrition, supplementation,
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and where appropriate, hormone replacement therapy.
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I know there's a lot of interest about these topics.
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Dr. Gillette is very thorough
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about addressing both male and female issues
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and addressing hormone health
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for people at all stages of life.
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I'm sure that you will come away from this episode
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with the same impression that I did,
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which is that Dr. Gillette
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is an extraordinarily clear communicator
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and that he has tremendous compassion for his patients
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and that he has a deep love of understanding biology
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and medicine in ways that can benefit you.
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I'm pleased to announce that I'm hosting two live events
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in May, 2022.
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The first live event will take place in Seattle, Washington
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on May 17th.
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The second live event will take place in Portland, Oregon
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on May 18th.
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Both are part of a lecture series
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entitled The Brain-Body Contract,
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during which I will talk about science
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and science-based tools,
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many of which overlap with the topics covered
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on the Huberman Lab podcast,
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but most of which will not
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and will be completely new topics and tools
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never discussed publicly before.
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Both live events will also include
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a question and answer period
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during which you, the audience,
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can ask me questions directly
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about any aspect of science or science-based tools,
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and I will attempt to answer them.
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Tickets for the two events,
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again, Seattle on May 17th and Portland on May 18th,
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are both available at HubermanLab.com slash tour.
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Before we begin with today's episode,
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I want to emphasize that this podcast
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is separate from my teaching and research roles at Stanford.
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It is, however, part of my desire and effort
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to bring zero cost to consumer information about science
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and science-related tools to the general public.
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In keeping with that theme,
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I'd like to thank the sponsors of today's podcast.
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Our first sponsor is Thesis.
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00:04:19.860
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Technically, nootropic means smart drug.
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Frankly, I'm not a big fan of the word nootropics
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because what is smart?
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I mean, there's creativity, there's focus,
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there's task switching,
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different aspects of our brain and body
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engage different aspects of cognition,
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many of which we can call smart.
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They also use ingredients like ginkgo biloba,
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who can't take ginkgo biloba
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I learned that a long time ago
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and so I simply can't take any nootropic
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or any supplement for that matter
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that includes ginkgo biloba.
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I'm sure I'm not alone in the fact
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Thesis has solved this problem of individual variation
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So if you go online to takethesis.com slash Huberman
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Today's episode is also brought to us by Inside Tracker.
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Inside Tracker is a personalized nutrition platform
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that analyzes data from your blood and DNA
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to help you better understand your body
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and help you reach your health goals.
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I've long been a believer in getting regular blood work done
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for the simple reason that many of the factors
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that impact your immediate and long-term health
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can only be analyzed from a quality blood test.
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There are a lot of blood and DNA tests out there,
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but a major issue with many of them
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is that you get numbers back about levels of hormones,
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metabolic factors, lipids, et cetera,
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but you don't know what to do with that information.
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you get the results back
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and where certain values might be too high
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or too low for your preference, you can click on that
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and it will direct you immediately to lifestyle factors,
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nutrition and supplementation, et cetera,
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that can help you bring those numbers back
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into the ranges that are ideal for you.
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So it not only gives you information
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about where your health stands,
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it gives you directives as to how to improve your health.
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If you'd like to try Inside Tracker,
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go to insidetracker.com slash Huberman
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Today's episode is also brought to us by Roka.
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Roka makes eyeglasses and sunglasses
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that are the absolute highest quality.
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I spent a lifetime studying the visual system.
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I can tell you that your visual system
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is incredibly sophisticated.
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It allows you to do things like move
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from a shady area outside to a sunny area outside
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And now for my discussion about hormone health
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and optimization with Dr. Kyle Gillette.
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Dr. Gillette, welcome.
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Thank you for having me.
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Well, I'm super excited to talk to you
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because I found out about you on a podcast
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and it immediately became clear
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that you are an encyclopedia of knowledge
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about hormone health for men and for women
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across the lifespan.
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So I have many, many questions,
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but before we dive into those questions,
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I'd love to just get a little bit of your background
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in terms of your medical training
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and what your particular orientation is
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toward treating your patients.
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And how do you think about this whole landscape
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that we call hormone health?
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What is a hormone?
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How do you envision people managing their hormones?
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If you could just kind of fill in a few of those blanks
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for us, I think a lot of people would appreciate it.
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Absolutely.
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So I'm dual board certified in family medicine
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and obesity medicine.
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I've kind of tailored my training
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in order to provide what I call a balanced approach
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to total health, which includes body, mind, and soul.
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I recently saw a podcast with Joe Rogan and Mr. Beast,
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and Joe asks, Mr. Beast,
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how do you become such an amazing YouTuber
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and have all these great clickbait videos?
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And how did you become good at it?
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And it turns out he just became obsessed
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when he was a teenager.
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And that's essentially how I've tailored my education
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as well.
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I've become obsessed with optimal human performance,
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their body, their mind, and even their spirit.
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So I attended med school at the University of Kansas,
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which is one of the few med schools
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that still emphasizes full spectrum care.
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They emphasize exercise as medicine.
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They emphasize food as medicine,
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of which I was active in both of those interest groups.
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In residency, I was active in a lot
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of mindfulness curriculum,
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and then also things like walk with a doc,
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where you emphasize preventative medicine.
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That's something that we've kind of got away from,
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and that niche led me to hormone health.
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It didn't really start as hormone health,
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but it's a very important component of health in general
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that many people don't emphasize.
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Great.
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Well, this idea of preventative medicine,
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I think is starting to really take hold
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in the general population,
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especially given the events of the last few years.
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People realize that they are showing up to health challenges
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at a bunch of different levels,
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and with some people feeling very robust,
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other people feeling back on their heels.
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When someone comes to you as a patient,
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what are some of the first things
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that you want to know about them?
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I mean, obviously you want to know their blood pressure,
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you want to know something about their mental health
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and family history,
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but in terms of hormone health,
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what are the sorts of probe questions that you ask,
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and what are you looking for?
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And I ask this because I'd like people to be able
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to ask some of these very same questions for themselves.
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Yeah.
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So when you do a physical exam and a history,
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you have a lot of different parts.
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You have your history of present illness,
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if they have a complaint.
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Maybe the patient doesn't have a complaint.
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In that case, things like their social history
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and their family history are extremely important
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because that gives you an insight into their genetics
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and an insight into their hormone health.
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So patients will tell me, oh, I'm doing okay,
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but it helps to ask them, well, how are you now?
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Let's say the patient is 50.
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How are you now versus when you were 20?
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And what has changed?
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So I've gotten the question a lot,
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how do you get your doctor to order a better lab workup
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or to even include your basic hormones?
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And there's no magic answer to that.
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But what really helps is you tell them,
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my energy is not as good as it used to be.
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My focus is not as good as it used to be.
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My athletic performance is not as good as it used to be.
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So you don't have to have a pathology
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in order for a lab to be indicated.
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You just need to have that pertinent symptom.
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I think that's gonna be really helpful
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because for many people, the idea of getting a blood test
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to look at their hormones just seems like
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such an enormous hurdle to get over.
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And many doctors won't prescribe them.
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And would you say that it's using the approach
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you just described that it's equally effective
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for men and women?
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Or do you find that for one reason or another,
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that men and women have different challenges
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and advantages in trying to access
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their deeper hormone data?
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Yeah, it's slightly different.
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With women, there's a lot more objective data.
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So if they're having menstrual irregularities
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or if they're not having a period,
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if they're having too heavy of periods,
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then those are things that they talk about
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very frequently with their doctor.
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Men are more hesitant.
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So men really wanna know what their testosterone is,
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but at the same time,
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they really don't wanna tell their doctor
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how their libido is or how their energy is
link |
00:13:13.060
because it's almost like they feel less masculine
link |
00:13:16.540
or they feel less like a guy when they say that,
link |
00:13:19.220
even if they're just talking to their doctor about it.
link |
00:13:21.740
Yeah, I think that that raises a really important point,
link |
00:13:23.840
which is that the whole discussion around hormone health
link |
00:13:26.580
is a bit of a barbed wire topic
link |
00:13:28.940
because in many ways, when we hear the word hormone,
link |
00:13:32.200
we think testosterone and estrogen,
link |
00:13:34.860
we think notions of masculinity and femininity.
link |
00:13:37.900
And of course, testosterone and estrogen
link |
00:13:39.460
are present in all sexes, right?
link |
00:13:42.300
All chromosomal backgrounds
link |
00:13:44.100
and just to varying degrees and ratios.
link |
00:13:46.540
But it also raises all these issues about sexual health
link |
00:13:48.980
that it's kind of interesting
link |
00:13:50.540
because I'm surrounded by medical doctors
link |
00:13:52.460
in my lab at Stanford.
link |
00:13:53.980
And the more physicians that I surround myself with,
link |
00:13:56.800
the more open is the discussion around sexual health
link |
00:14:00.300
and reproductive health.
link |
00:14:01.580
But in the general population,
link |
00:14:02.820
I think some of these topics are a little bit taboo
link |
00:14:06.300
or again, it's kind of barbed wire.
link |
00:14:07.700
And so I think that people are seeking
link |
00:14:08.940
a lot of this information on YouTube
link |
00:14:10.620
and through communities that may or may not be very educated
link |
00:14:13.460
about the actual biology.
link |
00:14:15.260
So along those lines,
link |
00:14:16.840
you know, we could probably assume
link |
00:14:19.600
that hormones are changing across the lifespan, right?
link |
00:14:22.520
Certainly from childhood and puberty and onward.
link |
00:14:25.960
If you would, I'd love to just kind of take a snapshot
link |
00:14:29.720
of what you think everybody should be thinking about
link |
00:14:33.660
or doing to optimize their hormone health,
link |
00:14:37.240
male or female, in the, let's say in their twenties.
link |
00:14:41.600
And then maybe we could migrate that to their thirties
link |
00:14:43.920
and forties.
link |
00:14:44.760
But before that, could you just tell us
link |
00:14:46.600
what everyone should be doing for their hormone health
link |
00:14:49.480
from puberty onward?
link |
00:14:51.240
Yeah.
link |
00:14:52.840
The law of diminishing returns applies.
link |
00:14:55.220
So doing a little amount of what I call
link |
00:14:58.760
lifestyle interventions over a long period of time
link |
00:15:01.840
is gonna be far more helpful or efficacious
link |
00:15:05.360
than doing a lot and then doing nothing
link |
00:15:07.600
or doing a lot and then doing nothing.
link |
00:15:09.840
So I talk about the big six pillars.
link |
00:15:12.760
The two strongest ones are likely diet and exercise.
link |
00:15:16.600
For hormone health, specifically resistance training
link |
00:15:19.520
is particularly helpful.
link |
00:15:21.860
For diet, caloric restriction can be particularly helpful,
link |
00:15:27.480
especially with the epidemic of metabolic syndrome
link |
00:15:30.240
that is continuing to on-go in this country
link |
00:15:33.240
and in developed countries in general.
link |
00:15:35.960
So those are the two most powerful.
link |
00:15:37.980
So number one and number two are diet and exercise.
link |
00:15:41.720
For the last four, I have a little bit of alliteration.
link |
00:15:44.240
So there's stress and stress optimization
link |
00:15:47.120
that has to do with cortisol,
link |
00:15:48.540
that has to do with your mental health,
link |
00:15:50.300
that has to do with societal health
link |
00:15:52.080
and collective health of your family as well.
link |
00:15:54.900
When you're a member of a family
link |
00:15:56.840
or even a very close friend,
link |
00:15:59.840
trying to achieve optimal health together is very important.
link |
00:16:03.320
It's the same thing with nicotine cessation.
link |
00:16:05.040
It's the same thing with hormone optimization.
link |
00:16:06.880
If you do it as a household unit, it's far more helpful.
link |
00:16:10.720
So after stress, you have sleep optimization.
link |
00:16:14.040
Sleep is extremely important,
link |
00:16:16.160
especially for mitochondrial health as well.
link |
00:16:18.920
And then you have sunlight,
link |
00:16:20.320
which encompasses anything that's outdoors.
link |
00:16:22.560
So you move more, you have cold exposure,
link |
00:16:25.380
you have heat exposure, that's sunlight.
link |
00:16:27.720
And then the last one is spirit.
link |
00:16:29.640
So that's kind of the body, mind and soul.
link |
00:16:33.480
If you have all the other five and they're dialed in
link |
00:16:37.420
completely, but you don't have your spiritual health,
link |
00:16:39.960
whatever you believe,
link |
00:16:41.160
then that's going to profoundly impact your body
link |
00:16:43.820
and your mind as well.
link |
00:16:44.880
And we're definitely going to touch into this notion
link |
00:16:46.660
of spiritual health, because I think for some people
link |
00:16:48.740
that might draw connotations of certain things
link |
00:16:53.120
that may or may not be accurate,
link |
00:16:54.440
but I know a number of academic laboratories
link |
00:16:57.040
that are focused on this and a number of,
link |
00:16:59.400
not just functional medicine clinics,
link |
00:17:01.160
but research clinics and hospitals throughout the country
link |
00:17:04.520
that are achieving some really interesting data,
link |
00:17:06.900
not just in people that are quite sick,
link |
00:17:09.420
but in healthy people who are trying
link |
00:17:11.120
to further optimize health.
link |
00:17:12.280
So we will definitely touch back to that.
link |
00:17:14.160
If you would be so kind as to maybe give us
link |
00:17:17.600
a little bit more detail about some of these other areas.
link |
00:17:19.800
So when people hear diet, I immediately think, okay,
link |
00:17:22.840
now we get into the combat around vegan, plant-based,
link |
00:17:28.020
carnivore, et cetera.
link |
00:17:29.000
But I think that my general view of this is that
link |
00:17:33.760
most people should probably be eating
link |
00:17:35.160
as few highly processed foods,
link |
00:17:37.080
highly palatable foods as possible,
link |
00:17:38.600
which doesn't mean eating foods
link |
00:17:39.760
that don't taste good, of course.
link |
00:17:40.820
But what other sorts of things do you recommend
link |
00:17:44.120
in the realm of diet?
link |
00:17:46.480
And then I also want to know about caloric restriction,
link |
00:17:49.400
because my understanding is that a caloric surplus
link |
00:17:51.880
can actually support certain hormones like testosterone.
link |
00:17:55.200
So how does one combine caloric restriction
link |
00:17:57.400
and still optimize hormones?
link |
00:17:59.440
But what would you say is a really terrific way
link |
00:18:02.720
to think about and approach diet?
link |
00:18:04.800
Yeah, diet should be an individualized approach.
link |
00:18:07.040
So if you have a car, each car is made different
link |
00:18:10.560
and requires a different sort of fuel,
link |
00:18:12.360
whether it's a race car, whether it's a diesel truck,
link |
00:18:16.000
they have different fuels
link |
00:18:17.220
for different performance outcomes.
link |
00:18:19.880
So if you're trying to tow something
link |
00:18:21.160
or you're trying to go fast.
link |
00:18:22.900
So it's the same way with athletes.
link |
00:18:24.580
It's pretty well studied.
link |
00:18:26.620
The more intra-workout carbs
link |
00:18:29.080
ultra long distance athletes take,
link |
00:18:30.920
in general, they do better.
link |
00:18:31.920
I think they've studied this in cyclists quite often.
link |
00:18:35.080
It also depends on your genetics.
link |
00:18:37.040
So you can have a genetic polymorphism
link |
00:18:39.280
and you metabolize carbs and sugar better,
link |
00:18:42.520
even when they're unopposed by fiber.
link |
00:18:44.320
How does one determine whether or not
link |
00:18:46.720
they have such a polymorphism?
link |
00:18:48.720
I mean, I'm an omnivore,
link |
00:18:50.160
so I do eat some high quality meats, not in huge quantities,
link |
00:18:53.600
but I also eat vegetables and starches, I feel fine.
link |
00:18:56.000
I've never done an elimination diet.
link |
00:18:58.440
I think I did a very low carb diet once
link |
00:19:00.720
and all it gave me was a lot of psoriasis and poor sleep.
link |
00:19:03.440
So I backed off, I probably didn't do it correctly,
link |
00:19:06.000
but I know a lot of people that do quite well
link |
00:19:07.920
on a very low carb or zero carb diet.
link |
00:19:10.560
Yeah, particularly those who are at risk of cancer
link |
00:19:15.200
because you have less glucose
link |
00:19:16.920
that can be easily uptaken into cells.
link |
00:19:19.240
And then also people with autoimmune diseases.
link |
00:19:22.160
They tend to do well on-
link |
00:19:23.400
On lower carb diets, yeah.
link |
00:19:25.560
But yeah, as far as the, how do you know,
link |
00:19:28.420
basically you can use your biofeedback,
link |
00:19:30.680
how you're feeling to guess what you tolerate well,
link |
00:19:33.320
or you can just get genetic testing,
link |
00:19:35.400
which can be fairly expensive,
link |
00:19:36.880
but most of all, it requires a physician
link |
00:19:40.000
or someone who knows how to interpret the test accurately.
link |
00:19:43.040
And if someone had the means or would you say
link |
00:19:45.640
that getting regular blood testing is a good idea?
link |
00:19:48.520
And if so, what is regular blood testing?
link |
00:19:50.600
Is it every three months?
link |
00:19:51.520
Is it every six months?
link |
00:19:52.800
Of course, the backdrop of life is changing too,
link |
00:19:55.320
stress levels, et cetera.
link |
00:19:56.920
Yeah, every three to six months for preventative purposes.
link |
00:20:01.240
At times you need blood tests at faster frequencies
link |
00:20:04.580
than that.
link |
00:20:05.920
And then you should also get a blood test
link |
00:20:08.080
when you're fasting and when you're not fasting.
link |
00:20:10.560
So if you're looking for damage to the beach,
link |
00:20:12.620
you want to, you don't just look at low tide,
link |
00:20:14.640
you look at high tide and you see what's happening
link |
00:20:16.400
at high tide as well.
link |
00:20:17.720
It's a great way to put it.
link |
00:20:18.960
And in terms of general recommendations around exercise,
link |
00:20:23.380
I mean, I'm of the mind based on the data that I've seen
link |
00:20:26.320
that almost everybody should,
link |
00:20:28.480
or everybody should be getting 150 to 180 minutes,
link |
00:20:32.800
minimum of zone two cardio per week.
link |
00:20:35.200
That kind of could continue while having a conversation,
link |
00:20:39.160
but with, if one were to exert any more effort,
link |
00:20:42.160
it would have a hard time getting the words out.
link |
00:20:43.600
At least that, right?
link |
00:20:44.920
For cardiovascular health and general brain health
link |
00:20:46.980
and musculoskeletal health plus resistance exercise.
link |
00:20:50.080
Is that more or less the contour of what you recommend?
link |
00:20:52.780
Yeah, that's more or less the contour.
link |
00:20:54.840
The more you're doing your zone two cardiovascular exercise,
link |
00:21:00.380
the slightly less important a long duration
link |
00:21:03.840
of caloric restriction is.
link |
00:21:05.740
Interesting.
link |
00:21:06.580
And that brings us to caloric restriction.
link |
00:21:08.240
So it's very clear that caloric restriction
link |
00:21:12.320
can allow one to lose weight, right?
link |
00:21:14.920
This is the classic Kiko, C-I-C-O,
link |
00:21:17.220
calories in, calories out.
link |
00:21:18.440
We are not disputing calories in, calories out.
link |
00:21:20.680
Somehow that always has to be stated 50 times in any forum
link |
00:21:24.040
because of whatever follows.
link |
00:21:25.920
People I think will anchor to and assume
link |
00:21:28.120
that we don't mean that,
link |
00:21:28.940
but I know you and I both agree on calories in,
link |
00:21:31.180
calories out as a fundamental law of thermodynamics.
link |
00:21:33.920
But it's clear to me that based on what I've read,
link |
00:21:38.660
that when one is in a slight caloric surplus,
link |
00:21:42.060
that hormones like testosterone can be optimized,
link |
00:21:44.840
but is that true for somebody who's showing up
link |
00:21:47.120
with excessive body fat?
link |
00:21:48.840
How does this all work?
link |
00:21:49.680
Because body fat is manufacturing enzymes
link |
00:21:52.340
that convert testosterone to estrogen.
link |
00:21:54.040
So in other words, how does someone know
link |
00:21:55.480
if they should use caloric restriction
link |
00:21:57.400
or avoid caloric restriction?
link |
00:21:58.960
Yeah, here's how to parse that out.
link |
00:22:01.000
So before I delve into the details a bit more,
link |
00:22:04.260
I should say as a board certified
link |
00:22:06.080
obesity medicine physician,
link |
00:22:07.820
obviously the laws of thermodynamics apply.
link |
00:22:10.840
And then in addition to that,
link |
00:22:12.880
there is nothing special about intermittent fasting
link |
00:22:16.340
or caloric restriction or exercise
link |
00:22:19.760
when it pertains to losing body weight in general.
link |
00:22:24.200
When you do lose weight,
link |
00:22:25.240
about 33% of that is lean body mass
link |
00:22:27.960
and about 10% of fat cells,
link |
00:22:31.080
adipose cells are actually lean body mass as well,
link |
00:22:34.100
because it has proteins and water
link |
00:22:35.440
and things like that in it too.
link |
00:22:37.240
So the reason for exercise
link |
00:22:41.360
and the reason for caloric restriction in general,
link |
00:22:44.420
including intermittent fasting is health reasons.
link |
00:22:47.260
That's how you increase your health span.
link |
00:22:49.240
It's not necessarily gonna make the weight
link |
00:22:50.880
on the scale change, but that doesn't matter as much.
link |
00:22:53.820
It's been fairly well studied in both mice and humans.
link |
00:22:56.200
It's much easier to study in mice.
link |
00:22:57.980
So that's a precursor to our six types of people,
link |
00:23:01.520
the ones that care about mice studies
link |
00:23:02.960
and the ones that care about human studies.
link |
00:23:05.060
But if you calorically restrict mice by 40%,
link |
00:23:08.620
then they can have improved testosterone parameters,
link |
00:23:15.040
but only if they're obese to start.
link |
00:23:17.120
And it appears to be that same way in humans as well.
link |
00:23:19.680
So the easy way to think about it is if you're obese
link |
00:23:22.920
or you have metabolic syndrome,
link |
00:23:24.760
caloric restriction will improve your testosterone.
link |
00:23:27.900
There has been a study and they talk about all these studies
link |
00:23:30.480
in a systematic review from the Mayo Clinic proceedings
link |
00:23:33.440
in March of last year.
link |
00:23:35.600
And they note that there is a study in young healthy men
link |
00:23:41.120
and they calorically restrict them
link |
00:23:42.720
and their testosterone does decrease.
link |
00:23:44.600
So if you're young and healthy
link |
00:23:46.040
and you don't have metabolic syndrome,
link |
00:23:47.680
then caloric restriction
link |
00:23:48.680
will likely decrease your testosterone.
link |
00:23:51.440
That clarifies a lot for me.
link |
00:23:53.400
And I believe it will clarify a lot
link |
00:23:55.480
for other people as well.
link |
00:23:56.760
And I'm delighted that you pointed out this distinction
link |
00:24:00.000
about intermittent fasting not being the only way
link |
00:24:02.720
to achieve caloric restriction.
link |
00:24:04.400
There are a number of young healthy or older healthy people
link |
00:24:10.320
I know who like using intermittent fasting,
link |
00:24:12.980
even if they're not trying to lose weight.
link |
00:24:15.400
For a couple of reasons,
link |
00:24:16.520
some believe that it might extend lifespan.
link |
00:24:18.920
I think there's still,
link |
00:24:20.000
that's still a bit of an open question.
link |
00:24:21.400
It's a bit of a hard experiment to do
link |
00:24:22.820
because the control group is,
link |
00:24:24.480
no one wants to be in the control group, as I say.
link |
00:24:26.560
It does in mice.
link |
00:24:27.860
Right, exactly.
link |
00:24:28.700
Captain audience.
link |
00:24:29.520
Exactly.
link |
00:24:30.360
And the other feature of it that's a little bit tricky
link |
00:24:33.120
is that many people like intermittent fasting
link |
00:24:35.800
because of the mental effects,
link |
00:24:37.280
the clarity of mind that they feel during fasting,
link |
00:24:39.440
the increased pleasure in eating when they finally do eat.
link |
00:24:43.380
And here I'm referring to intermittent fasting of the sort
link |
00:24:47.540
where eating windows are anywhere
link |
00:24:48.820
from eight to 12 hours a day,
link |
00:24:50.300
not extended fast of 24 hours or more.
link |
00:24:52.800
So the question therefore is for the healthy,
link |
00:24:57.520
lean enough person, right?
link |
00:24:59.340
Non-obese person.
link |
00:25:01.620
Is intermittent fasting a bad idea
link |
00:25:03.700
in terms of hormone health?
link |
00:25:05.400
Is oscillating between this period of kind of feast
link |
00:25:08.320
and famine within a 24 hours a problem
link |
00:25:10.940
if one is getting sufficient calories to maintain weight?
link |
00:25:14.220
Yeah, so if they're in a caloric maintenance,
link |
00:25:16.540
then it's not going to be,
link |
00:25:20.340
it's not going to be deleterious.
link |
00:25:21.620
It's not going to be bad for their hormone health.
link |
00:25:24.060
There's a couple of different hormones
link |
00:25:25.260
that we can talk about.
link |
00:25:26.100
We can talk about testosterone.
link |
00:25:27.620
We can talk about DHEA, which usually go hand in hand.
link |
00:25:31.420
And then we can also talk about growth hormone,
link |
00:25:33.380
which is not a steroid hormone, but it's a peptide hormone.
link |
00:25:36.860
So it's a chain of proteins,
link |
00:25:39.820
amino acids that are put together in sort of a sterile,
link |
00:25:43.060
think of sterile hormones as coming from cholesterol.
link |
00:25:46.540
So intermittent fasting,
link |
00:25:48.740
you do get a little spike in growth hormone after you eat,
link |
00:25:52.300
but you also get a huge spike in growth hormone,
link |
00:25:56.180
a more significant, less negligible spike overnight.
link |
00:26:00.840
And that is improved if you are intermittent fasting.
link |
00:26:05.120
So it's probably going to help your growth hormone
link |
00:26:08.140
and subsequently IGF-1 levels,
link |
00:26:11.060
which will help more in older age groups
link |
00:26:14.260
than younger age groups.
link |
00:26:15.700
And I like to eat dinner.
link |
00:26:17.500
So for me, that means sometime around six or seven o'clock,
link |
00:26:19.800
sometimes eight o'clock.
link |
00:26:20.700
I confessed last night because I was working late.
link |
00:26:22.700
I ate pretty big.
link |
00:26:24.460
I was basically my only meal of the day at 10 o'clock.
link |
00:26:27.140
That's a rare thing for me.
link |
00:26:29.980
Can I still achieve a high degree of growth hormone output
link |
00:26:33.620
if I, let's say I avoid food in the two to three hours
link |
00:26:36.740
before going to sleep?
link |
00:26:38.100
Or does one have to be very deep into a fast
link |
00:26:40.620
in order to achieve the increase in growth hormone?
link |
00:26:44.260
There's still pretty good growth hormone output,
link |
00:26:46.720
even if you eat two or three hours before you sleep.
link |
00:26:49.860
It's just the law of diminishing returns.
link |
00:26:51.620
The longer you go, you get slightly more and slightly more.
link |
00:26:55.340
Great.
link |
00:26:56.660
And I know a number of people think of growth hormone
link |
00:26:59.520
in the context of the exogenous growth hormone
link |
00:27:03.160
and the fact that that can, in some cases,
link |
00:27:05.500
be associated with cancers.
link |
00:27:08.700
I've been asked many times before,
link |
00:27:10.200
can the increase in growth hormone from things like saunas
link |
00:27:13.020
or intermittent fasting cause levels of growth hormone
link |
00:27:15.560
that are so high that they cause cancers?
link |
00:27:18.540
My impulse is to say, no, that doesn't,
link |
00:27:20.940
that seems like it's not likely to happen,
link |
00:27:23.700
but I should probably verify that statement with you.
link |
00:27:27.060
Yeah, so quite unlikely.
link |
00:27:28.740
I think about growth hormone and especially IGF-1,
link |
00:27:32.020
and there's actually an IGF-1 and IGF-2,
link |
00:27:34.060
but I think about it in terms of endocrine IGF-1,
link |
00:27:37.780
mostly IGF-1 that's synthesized in the liver
link |
00:27:41.120
and released in the liver versus IGF-1 that's released.
link |
00:27:45.700
Classically, an example of this would be
link |
00:27:47.860
your IGF-1 levels increase after resistance training
link |
00:27:51.320
or exercise, and that's more of like paracrine or autocrine,
link |
00:27:55.020
and they have more local action.
link |
00:27:57.560
So that IGF-1, it's pretty well studied
link |
00:28:00.700
that if you just give people IGF-1,
link |
00:28:02.580
it's not going to, at physiologic levels,
link |
00:28:05.500
it's not going to improve their body composition.
link |
00:28:08.380
However, that IGF-1 that's autocrine and paracrine
link |
00:28:11.720
just working in those local tissues and muscles
link |
00:28:14.900
is likely part of the reason why you get
link |
00:28:17.220
a improved body composition response after exercise.
link |
00:28:21.660
I see.
link |
00:28:22.500
And just to clarify for me and for others,
link |
00:28:26.620
what can we say are the major functions of IGF-1 and IGF-2
link |
00:28:30.460
that are distinct from just growth hormone?
link |
00:28:32.500
Are they just kind of the active form of growth hormone,
link |
00:28:34.840
the kind of the pickaxe end of the assembly line?
link |
00:28:40.620
So they have a much longer duration of action.
link |
00:28:42.820
I believe the half-life of IGF-1 is several days,
link |
00:28:46.020
almost a week, whereas growth hormone
link |
00:28:48.020
has an extremely fast half-life of only hours.
link |
00:28:51.660
So growth hormone acts significantly
link |
00:28:54.620
on the liver to produce IGF-1.
link |
00:28:58.380
So it's around in the serum, in the blood long enough
link |
00:29:04.400
to where it's producing an effect pretty much all the time.
link |
00:29:08.780
Very interesting.
link |
00:29:10.060
Well, and then your other pillars, stress,
link |
00:29:12.540
you know, we've talked a lot about stress
link |
00:29:13.860
on this podcast before and tools for managing stress.
link |
00:29:18.220
Sleep obviously is a big one.
link |
00:29:20.000
I think, you know, if nothing else,
link |
00:29:22.540
I will either put people to sleep with my podcasts.
link |
00:29:25.340
I'm certainly not this one, but my solo episodes
link |
00:29:27.780
or hopefully convince people that sleep
link |
00:29:30.300
is the foundation of mental and physical health
link |
00:29:32.200
and performance.
link |
00:29:33.060
Are there any aspects of hormone optimization
link |
00:29:36.000
that can improve sleep?
link |
00:29:37.460
I know sleep can improve hormone optimization,
link |
00:29:40.100
but are there any aspects of hormone optimization
link |
00:29:42.720
that can improve sleep?
link |
00:29:44.180
And for people that are suffering from this common syndrome
link |
00:29:47.140
of going to sleep and then waking up
link |
00:29:48.580
at three or four in the morning,
link |
00:29:49.920
we know that can be associated with depression,
link |
00:29:51.580
but are there any hormonal indications
link |
00:29:54.180
that might lead to that kind of situation?
link |
00:29:57.620
Yeah, there's three big ones.
link |
00:29:59.860
The first one is not super common,
link |
00:30:02.620
but it's a very direct correlation.
link |
00:30:04.780
If you have a growth hormone deficiency, a true deficiency,
link |
00:30:08.700
whether you're an adult or a child,
link |
00:30:10.300
then your sleep is likely going to be affected.
link |
00:30:12.900
And let's say you're a child with growth hormone deficiency.
link |
00:30:16.260
Once that is replaced with therapy,
link |
00:30:18.980
your sleep is gonna get significantly better.
link |
00:30:21.700
The second one that's a very common scenario
link |
00:30:25.060
is if you're having what's called vasomotor symptoms
link |
00:30:28.380
of menopause or vasomotor symptoms of andropause,
link |
00:30:31.300
which are also applicable.
link |
00:30:33.740
And that's where your progestogenic activity,
link |
00:30:37.360
so your main progestogens are progesterone
link |
00:30:41.300
and then pregnenolone,
link |
00:30:42.580
and then 5-alpha, 3-alpha progesterone,
link |
00:30:45.740
which is a slight-
link |
00:30:46.580
Where are those manufactured in the body?
link |
00:30:48.220
So they're manufactured in a few places.
link |
00:30:51.440
In men, they're manufactured some in the testes
link |
00:30:54.660
and the late egg cells.
link |
00:30:56.060
In women, they're manufactured in the ovaries
link |
00:30:58.100
until menopause,
link |
00:30:59.580
and then they're also manufactured in the adrenal glands.
link |
00:31:02.700
So if you're preadrenopausal,
link |
00:31:07.620
where your adrenal glands are still working fairly well,
link |
00:31:10.580
usually still have a decent amount of progesterone around,
link |
00:31:13.460
and this can be measured too.
link |
00:31:15.460
So after menopause,
link |
00:31:18.620
women make progesterone from their ovaries,
link |
00:31:22.460
or sorry, from their adrenal glands.
link |
00:31:24.580
If that progesterone crosses the blood-brain barrier,
link |
00:31:27.860
especially if it's 5-alpha and 3-alpha reduced,
link |
00:31:30.260
so it's modified a little bit,
link |
00:31:32.140
then it is both a GABA agonist,
link |
00:31:34.980
which helps sleep just like GABA does,
link |
00:31:37.180
gamma-aminobutyric acid,
link |
00:31:38.780
the main inhibitory neurotransmitter
link |
00:31:41.540
of which lots of things work on.
link |
00:31:42.900
Alcohol works on GABA as well.
link |
00:31:44.720
GABA-Penten also works on GABA.
link |
00:31:46.940
Migraine medicines, many of them work on GABA.
link |
00:31:50.060
Benzodiazepines and also non-benzos.
link |
00:31:53.740
So an example of a benzo would be Xanax.
link |
00:31:55.800
An example of a non-benzo would be Ambien.
link |
00:32:00.580
So those all work on GABA.
link |
00:32:02.300
So GABA is also helped
link |
00:32:04.700
by the progestogenic activity as well.
link |
00:32:07.760
That's why a lot of women in menopause
link |
00:32:09.420
feel like their sleep is much worse,
link |
00:32:11.800
is because they have lower activity of those progestogens.
link |
00:32:15.580
And for men in so-called andropause,
link |
00:32:19.420
low testosterone,
link |
00:32:20.540
is that also one of the causes of poor sleep?
link |
00:32:24.180
Low testosterone can lead to poor sleep,
link |
00:32:26.460
but my third scenario is actually,
link |
00:32:29.980
if a man begins TRT,
link |
00:32:32.140
then they develop a poor sleep because of sleep apnea.
link |
00:32:35.120
It drastically raises the risk
link |
00:32:37.860
that somebody is going to have sleep apnea.
link |
00:32:39.940
And then a lot of people,
link |
00:32:40.820
especially when they first started
link |
00:32:42.100
in the first month or two,
link |
00:32:43.500
it puts them into this hyper sympathetic state
link |
00:32:45.860
because they have overactive androgen receptors,
link |
00:32:49.500
especially after a long time of being hypogonadal.
link |
00:32:52.940
Then they have a physiologic dose of TRT,
link |
00:32:56.920
and that causes the sleep issue itself.
link |
00:33:00.100
Interesting.
link |
00:33:01.580
I have a lot of questions
link |
00:33:02.420
about TRT, testosterone replacement therapy.
link |
00:33:05.320
I should just mention
link |
00:33:06.160
that when you say it increases sympathetic activity,
link |
00:33:10.700
you don't mean that taking testosterone
link |
00:33:14.220
increases sympathy for others.
link |
00:33:15.760
It may in fact do the opposite,
link |
00:33:16.980
although it's very clear from my discussions
link |
00:33:18.900
with my colleagues in the endocrinology side
link |
00:33:22.300
and also with the great Dr. Robert Sapolsky
link |
00:33:24.860
that increasing testosterone
link |
00:33:26.680
merely exacerbates existing features of people.
link |
00:33:30.120
So the jerks become bigger jerks,
link |
00:33:31.620
kind people become even more kind in general.
link |
00:33:35.180
But I want to get into TRT in depth,
link |
00:33:37.720
but it's very interesting to me to hear
link |
00:33:39.320
that testosterone replacement therapy
link |
00:33:41.700
increases the risk of sleep apnea.
link |
00:33:44.200
And I want to make sure that I ask that,
link |
00:33:47.420
is that also the case in people that are using TRT
link |
00:33:50.540
who are not hypogonadal?
link |
00:33:52.140
Because in the classic situation,
link |
00:33:54.300
if somebody isn't making enough testosterone,
link |
00:33:55.980
they're below 300 nanograms per deciliter on the chart,
link |
00:33:58.340
they go in and take TRT.
link |
00:33:59.180
But many people nowadays, let's be honest,
link |
00:34:01.940
are taking doses of testosterone
link |
00:34:04.980
even though they are in the sort of standard range
link |
00:34:07.140
because the range is so large
link |
00:34:08.620
because of other symptomology, is that right?
link |
00:34:11.220
Yeah, I do love the analogy that Dr. Sapolsky had
link |
00:34:14.980
about monks taking testosterone and making them
link |
00:34:17.960
more and more generous.
link |
00:34:19.500
So that does appear to be what testosterone usually does
link |
00:34:23.340
is it exacerbates, if you will, what you're previously like.
link |
00:34:26.860
So it's not going to change you as a person.
link |
00:34:29.520
But if you're ugonadal before you start testosterone-
link |
00:34:33.860
Meaning?
link |
00:34:34.940
Meaning you have normal testosterone
link |
00:34:37.020
and then you start TRT or self-administered TRT,
link |
00:34:41.560
steroids, however you want to look at it,
link |
00:34:44.100
then your risk of sleep apnea still goes up
link |
00:34:46.540
in a dose dependent fashion.
link |
00:34:48.140
So the higher the dose, the more risky.
link |
00:34:50.740
With the sympathetic and the parasympathetic nervous system,
link |
00:34:53.460
the sympathetic is the fight or flight nervous system.
link |
00:34:56.140
The parasympathetic is the rest and digest.
link |
00:34:58.900
So if you have too much fight or flight
link |
00:35:00.700
and stress can cause that too,
link |
00:35:02.220
then you're not going to rest as well at night.
link |
00:35:04.260
I want to touch on testosterone in women
link |
00:35:07.500
because there is testosterone in women.
link |
00:35:11.060
I'd like to know where that testosterone comes from,
link |
00:35:13.460
which tissues.
link |
00:35:14.900
I'd like to know whether or not
link |
00:35:16.640
testosterone replacement therapy makes sense in women.
link |
00:35:19.480
I'm hearing more and more about women using testosterone.
link |
00:35:22.260
And I'd like to know whether or not
link |
00:35:25.060
knowing a woman's testosterone,
link |
00:35:26.540
for her to know her testosterone is of equal,
link |
00:35:30.820
less than, or more value than knowing,
link |
00:35:33.400
for instance, progesterone and estrogen levels.
link |
00:35:35.240
Because I think there are a lot of misconceptions
link |
00:35:36.820
about the roles of testosterone in women.
link |
00:35:38.740
For health optimization,
link |
00:35:40.180
testosterone is just as important to know.
link |
00:35:43.220
For pathology prevention,
link |
00:35:45.700
for example, breast cancer, osteoporosis,
link |
00:35:48.820
estrogen and progesterone are more important to know.
link |
00:35:52.340
So when you're thinking about women,
link |
00:35:53.780
women think that they have such a tiny amount of testosterone
link |
00:35:56.220
because you test it.
link |
00:35:57.820
Most people test a free testosterone.
link |
00:35:59.900
So testosterone that's unbound,
link |
00:36:02.240
which is by far the smallest proportion of testosterone.
link |
00:36:06.840
Any androgen is bound by lots of different
link |
00:36:10.300
steroid binding proteins,
link |
00:36:12.480
but the ones that are most pertinent are called SHBG,
link |
00:36:15.520
or sex hormone binding globulin.
link |
00:36:17.740
And that binds the androgenic steroid,
link |
00:36:20.700
for example, DHT or dihydrotestosterone.
link |
00:36:23.540
It's associated with prostate enlargement,
link |
00:36:25.620
associated with male pattern baldness.
link |
00:36:27.580
It binds that the most strongly,
link |
00:36:29.740
and then it binds testosterone next most strongly.
link |
00:36:32.620
And then it binds things like androstenedione
link |
00:36:35.500
or DHEA, dehydroepiandrosterone.
link |
00:36:39.700
And then it binds the estrogens, the weakest,
link |
00:36:42.580
like estradiol.
link |
00:36:44.320
So if you look at the total amount of testosterone,
link |
00:36:47.300
women actually have, almost all women, not all women,
link |
00:36:50.900
but almost all of them have significantly more testosterone
link |
00:36:56.060
than estradiol,
link |
00:36:57.580
but it's because it's in different measurements.
link |
00:37:00.740
So estradiol a lot of time is, you know,
link |
00:37:02.900
grams per mil as opposed to nanograms per deciliter.
link |
00:37:06.260
So women have more testosterone than estrogen
link |
00:37:09.720
and significantly more DHEA than either.
link |
00:37:14.060
Interesting.
link |
00:37:14.900
Do women make dihydrotestosterone?
link |
00:37:16.820
Yeah.
link |
00:37:18.060
And where does this testosterone come from?
link |
00:37:20.460
Because they don't have testes.
link |
00:37:22.120
Yeah.
link |
00:37:22.960
So most testosterone in women that are premenopausal
link |
00:37:25.620
can come from theca cells, T-H-E-C-A.
link |
00:37:29.360
So theca cells are cells in the ovaries
link |
00:37:31.440
that can produce testosterone.
link |
00:37:33.340
And a lot of people have actually heard
link |
00:37:35.580
about hyperthecosis, not the term itself,
link |
00:37:38.700
but a lot of Olympians that are,
link |
00:37:41.660
their chromosomes are XY, they're females,
link |
00:37:44.960
and they're not taking any-
link |
00:37:47.220
Wait, they're XY, but they're females?
link |
00:37:48.820
Sorry, they're XX, yeah, thank you.
link |
00:37:51.340
So they're XX, they're not XY,
link |
00:37:54.300
and they have never transitioned
link |
00:37:55.860
or been on any sort of hormone replacement or testosterone,
link |
00:37:59.580
but they naturally produce a huge amount of testosterone,
link |
00:38:03.260
as much as many men.
link |
00:38:05.100
And some of these women,
link |
00:38:06.480
I believe they were from Botswana,
link |
00:38:08.140
were banned from competing in the Olympics
link |
00:38:10.640
in certain distances.
link |
00:38:12.440
I believe they were banned from the 400 meter and 800 meter
link |
00:38:15.900
because their natural testosterone
link |
00:38:17.780
was deemed to be too high.
link |
00:38:19.300
So they mistakenly thought that they were using steroids?
link |
00:38:22.140
They actually knew they were not using steroids.
link |
00:38:24.840
They knew it was their theca cells
link |
00:38:26.380
were just genetically gifted, I suppose,
link |
00:38:28.900
and they still made them change distances.
link |
00:38:31.520
So one or two of these athletes changed to,
link |
00:38:33.860
I believe it was a 3K or the 5K,
link |
00:38:37.240
and they still did quite well,
link |
00:38:38.860
but it was not their best event.
link |
00:38:40.580
Interesting.
link |
00:38:41.420
Yeah, that's turning out to be a very interesting
link |
00:38:43.140
and controversial area of this notion of hormone therapies
link |
00:38:46.140
and natural variation in hormones
link |
00:38:48.220
on different chromosomal backgrounds.
link |
00:38:49.900
Fascinating, we should probably do a whole episode
link |
00:38:51.860
about that, because it's very much of the times.
link |
00:38:55.780
So men and women both make DHT.
link |
00:38:59.240
I'd like to ask about DHT in men.
link |
00:39:02.260
So often we hear about testosterone in men
link |
00:39:04.620
and free testosterone and being the unbound form, of course,
link |
00:39:08.740
but dihydrotestosterone, where does it come from in men?
link |
00:39:13.580
What is the cascade of events that takes testosterone
link |
00:39:17.380
to dihydrotestosterone?
link |
00:39:18.900
And what are some of the quote unquote positive
link |
00:39:21.780
and negative effects of,
link |
00:39:23.860
here I'm only referring to endogenous dihydrotestosterone.
link |
00:39:28.180
And in fact, I'll make it very clear whether or not
link |
00:39:31.300
I'm talking about taking something
link |
00:39:33.220
or one's own natural production.
link |
00:39:34.620
Here we're just, I think up until now,
link |
00:39:35.940
we've just been talking about natural production.
link |
00:39:37.940
So tell us about DHT in men.
link |
00:39:40.420
It's such a powerful hormone during development, obviously,
link |
00:39:43.700
but what is it doing?
link |
00:39:45.940
DHT is a very androgenic hormone.
link |
00:39:48.700
So whether you're talking about DHEA,
link |
00:39:51.380
which is a mild, a weak androgen,
link |
00:39:54.940
or testosterone, which is a relatively strong androgen,
link |
00:39:58.420
or DHT, which is a very strong androgen,
link |
00:40:01.340
they bind to the androgen receptor
link |
00:40:03.300
in both men and in women.
link |
00:40:05.340
So the effect of all three of those
link |
00:40:08.540
is mediated by the androgen receptor.
link |
00:40:11.180
There's a couple of different beta estradiol receptors
link |
00:40:13.940
and alpha estradiol receptors,
link |
00:40:15.820
but there's only one androgen receptor.
link |
00:40:18.340
Intriguingly, it is on the X chromosome.
link |
00:40:21.020
So men get their androgen receptor gene from their mother.
link |
00:40:25.220
Women get one androgen receptor gene from their father,
link |
00:40:29.700
one from their mother.
link |
00:40:30.980
Often the one that is more sensitive to androgens
link |
00:40:33.620
and people with PCOS, that's the one that's active.
link |
00:40:36.500
The other one is methylated and inactive.
link |
00:40:38.900
Can I just pause you one second?
link |
00:40:40.060
Sorry to interrupt, but I have to ask this question
link |
00:40:42.540
before I forget.
link |
00:40:43.740
And I know a number of people are probably wondering,
link |
00:40:45.220
I've heard that whether or not
link |
00:40:47.300
one develops male pattern baldness,
link |
00:40:50.380
whether or not a male develops male pattern baldness,
link |
00:40:53.660
just to be very precise,
link |
00:40:56.580
you could get some information about that
link |
00:40:58.500
by looking at your mother's father.
link |
00:41:00.740
And that would be in keeping with what you just described
link |
00:41:03.140
that the X chromosome,
link |
00:41:04.020
which of course is handed off through the mother
link |
00:41:06.580
is carrying the genes that encode
link |
00:41:09.260
for the number and distribution
link |
00:41:11.020
of these androgen receptors that DHT will bind to.
link |
00:41:14.060
Because of course, I think as you'll probably tell us
link |
00:41:15.900
that DHT is responsible for male pattern baldness
link |
00:41:18.220
and beard growth, is that right?
link |
00:41:19.580
Should I look at my grandfather on my mother's side
link |
00:41:21.940
to determine what I'm likely to look like
link |
00:41:23.740
in terms of my DHT-ness, is that a word?
link |
00:41:26.780
Yeah, it's the best guess that you can make
link |
00:41:29.380
purely from phenotypes.
link |
00:41:31.020
And you can measure your genotype
link |
00:41:33.020
and get a better idea of that.
link |
00:41:35.940
Assuming that it's true male pattern baldness,
link |
00:41:38.140
it's related to the gene transcription
link |
00:41:40.420
of the androgen receptor.
link |
00:41:42.220
So I like to think of it as
link |
00:41:44.260
how much of this androgen receptor gene
link |
00:41:48.100
is activated by any androgen.
link |
00:41:50.780
So if you have an extremely sensitive gene,
link |
00:41:53.020
which usually means you have very few CAG repeats,
link |
00:41:55.940
which is basically just a certain CAG encodes
link |
00:41:59.420
for a certain amino acid.
link |
00:42:02.180
And if you have very few of the repeats,
link |
00:42:04.740
then your androgen receptor gene works better.
link |
00:42:07.460
Think of it as a corollary to Huntington's disease,
link |
00:42:10.300
where if you have very few called trinucleotide repeats,
link |
00:42:14.260
then it's not as severe of a disease.
link |
00:42:17.200
But after you get more and more CAG repeats,
link |
00:42:20.140
which by the way are in the population,
link |
00:42:22.540
you're getting more and more CAG repeats.
link |
00:42:25.700
So it's a natural selection of process
link |
00:42:27.960
that has been ongoing for a variety of number of reasons.
link |
00:42:32.700
But anyway, if you have more repeats,
link |
00:42:34.340
then that gene activates in the cytoplasm
link |
00:42:37.060
and moves to the nucleus
link |
00:42:38.340
and causes gene transcription more often
link |
00:42:40.900
and hair loss more often.
link |
00:42:42.620
So does that mean that we're seeing more hair loss now
link |
00:42:45.380
due to elevated levels of DHT than we were 50 years ago?
link |
00:42:50.300
Probably not.
link |
00:42:52.380
The hair loss 50 years ago, well, not 50 years ago,
link |
00:42:56.660
but 500 years ago was probably more significant
link |
00:43:00.140
because on average 500 years ago,
link |
00:43:02.760
people were more sensitive to androgens.
link |
00:43:05.500
So there's a syndrome called androgen insensitivity syndrome,
link |
00:43:09.340
AIS, and that syndrome was related to when men
link |
00:43:13.420
who have the copy from their mother who is a carrier,
link |
00:43:16.620
their AR gene or androgen receptor gene
link |
00:43:19.840
is completely insensitive.
link |
00:43:21.800
So think of it, it's not related to the CAG repeats,
link |
00:43:25.280
but think of that receptor as just not working at all.
link |
00:43:30.620
So there's a continuum.
link |
00:43:31.940
So everybody's receptor works a little bit better
link |
00:43:34.460
or a little bit worse, and the better your receptor works,
link |
00:43:38.100
the more likely you are to have male pattern baldness.
link |
00:43:40.920
To zoom out from this, but still keeping an eye on DHT,
link |
00:43:46.980
what do you like to see all women and all men do
link |
00:43:52.100
to optimize DHT?
link |
00:43:54.340
And here I'm talking about regardless of age.
link |
00:43:56.300
So we're still in this from puberty onward phase.
link |
00:43:59.200
We haven't yet micro dissected out decade by decade,
link |
00:44:01.880
which we will do, but what do you like to see people do
link |
00:44:04.500
to keep DHT in check?
link |
00:44:05.940
But before you tell us that,
link |
00:44:07.600
could you tell us what positive things DHT does
link |
00:44:11.920
when it's in the proper range?
link |
00:44:13.700
Yeah, so DHT helps a lot for,
link |
00:44:16.620
it's the same reason why testosterone helps.
link |
00:44:18.300
It activates the androgen receptor gene.
link |
00:44:20.560
It helps effort feel good.
link |
00:44:22.500
So it can be motivating.
link |
00:44:24.620
So that's how it's active in the CNS.
link |
00:44:27.220
It also is active in cardiovascular tissue.
link |
00:44:30.420
So if you look at someone that has heart failure,
link |
00:44:34.620
or if someone has cardiac hypertrophy,
link |
00:44:37.400
the level of DHT can matter because it's also binding
link |
00:44:40.980
to the androgen receptor in the myocardium
link |
00:44:43.020
or in the heart itself.
link |
00:44:45.200
So you think of the classic bodybuilder heart,
link |
00:44:48.620
that's an easy example to make.
link |
00:44:50.500
They have very thickened muscle.
link |
00:44:52.340
Their muscle is very strong because they're pumping blood
link |
00:44:55.600
often with high blood pressure and that DHT
link |
00:44:59.460
and the testosterone and any DHT derivatives like masterone
link |
00:45:03.540
or oxandrolone, primaboulin also bind to the heart
link |
00:45:08.100
and they cause even more hypertrophy
link |
00:45:10.580
or enlargement of that muscle tissue.
link |
00:45:13.140
So then let's say the person stops and they're recovering
link |
00:45:15.980
and they're trying to have cardiac remodeling,
link |
00:45:18.780
which is where you take a very thick heart
link |
00:45:21.600
and cardiac remodeling is important
link |
00:45:23.180
in a lot of different cardiac pathologies.
link |
00:45:27.000
But if you give them finasteride or dutasteride,
link |
00:45:29.580
which inhibit the enzyme that converts testosterone to DHT,
link |
00:45:33.580
so making less activity at the androgen receptor gene,
link |
00:45:37.260
they have cardiac remodeling and their heart health improves.
link |
00:45:40.260
I see.
link |
00:45:41.100
So for the non-bodybuilder, the typical woman or man
link |
00:45:43.660
or younger or older, what sorts of things support DHT
link |
00:45:49.140
and thereby heart health?
link |
00:45:51.300
Presumably DHT is involved in some of the other things
link |
00:45:53.520
that testosterone is famous for in both men and women,
link |
00:45:56.260
things like libido, as you mentioned,
link |
00:45:58.340
making effort feel good, so motivation drive and vitality,
link |
00:46:02.500
is I guess could be the general phrase.
link |
00:46:05.760
What sorts of things support DHT?
link |
00:46:07.980
What sorts of things create problems for DHT?
link |
00:46:11.540
There's lots of dietary changes and supplementation
link |
00:46:14.380
that you're probably doing right now
link |
00:46:16.020
that's affecting your DHT.
link |
00:46:17.540
You mean me personally?
link |
00:46:18.380
Well, everybody, all of the listeners,
link |
00:46:22.220
because let's say you have a diet high in plant polyphenols.
link |
00:46:26.620
Many of those inhibit the enzyme
link |
00:46:28.940
that converts testosterone to DHT.
link |
00:46:32.660
Could you give us an example of one of those,
link |
00:46:36.380
either in supplementation form or in food form?
link |
00:46:39.380
Curcumin, certain curcuminoids, depending on the structure,
link |
00:46:43.460
will inhibit the enzyme called 5-alpha reductase
link |
00:46:46.500
that converts testosterone to DHT.
link |
00:46:48.380
Turmeric.
link |
00:46:49.220
Yeah, turmeric, black pepper extract.
link |
00:46:51.460
So it's used often to increase bioavailability.
link |
00:46:55.380
It's also called biopurine.
link |
00:46:57.500
It's also a 5-alpha reductase inhibitor.
link |
00:47:01.900
And on top of that, people have different genetics too.
link |
00:47:04.820
So some people, there are 5-alpha reductase enzymes.
link |
00:47:07.700
There's three of them.
link |
00:47:09.840
They're on chromosome two, three, and four, I believe.
link |
00:47:12.940
But some of them are active in the prostate.
link |
00:47:15.380
Some of them are active in the brain.
link |
00:47:17.420
And so it depends on which tissue.
link |
00:47:19.660
They're tissue-specific enzymes
link |
00:47:22.500
that depend on how much DHT you convert.
link |
00:47:26.200
Do you recommend that people avoid curcumin
link |
00:47:28.060
and turmeric for that reason?
link |
00:47:29.980
And is there any specific recommendations
link |
00:47:32.100
for men versus women?
link |
00:47:34.440
If a man or a woman, by the way, in women,
link |
00:47:36.820
a lot of times if you just ask your doctor for a DHT check,
link |
00:47:39.960
it's the same unit as in men.
link |
00:47:41.420
So it's essentially undetectable.
link |
00:47:43.460
So you have to, you know,
link |
00:47:46.380
especially if they're on oral contraceptives,
link |
00:47:48.180
which is a different topic,
link |
00:47:49.140
their DHT is very likely undetectable,
link |
00:47:51.740
especially if it's free DHT.
link |
00:47:53.740
You can measure both a DHT and a free DHT.
link |
00:47:57.200
But if someone's DHT is already low
link |
00:47:59.500
or if they have somewhat insensitive androgen receptor
link |
00:48:04.260
via genetics or via lifestyle,
link |
00:48:07.420
then I recommend they avoid bioavailable curcuminoids
link |
00:48:11.180
like bioavailable turmeric, black pepper extract,
link |
00:48:14.500
and they might be a good candidate for creatine.
link |
00:48:16.660
Creatine, like creatine monohydrate,
link |
00:48:19.620
can significantly increase the conversion
link |
00:48:21.700
of testosterone to DHT.
link |
00:48:23.200
Interesting.
link |
00:48:24.040
There's also a lot of really interesting data
link |
00:48:25.340
coming out now about the role of creatine as a brain fuel
link |
00:48:30.060
and maybe even as a cognitive enhancer over time.
link |
00:48:32.220
The data are still ongoing,
link |
00:48:34.220
but some of the studies in humans are pretty impressive,
link |
00:48:36.560
at least to me.
link |
00:48:38.180
I'm glad you mentioned this thing
link |
00:48:39.100
about curcumin and black pepper.
link |
00:48:40.420
I wish we'd had this conversation six years ago
link |
00:48:42.700
because I had the experience
link |
00:48:43.980
of jumping on the bandwagon of the excitement around turmeric
link |
00:48:48.100
when I took a turmeric supplement.
link |
00:48:49.660
It was a couple of capsules of what I thought to be,
link |
00:48:52.800
and I think was high quality turmeric.
link |
00:48:54.940
And I've never felt as poor as I did
link |
00:48:58.000
in the subsequent few days.
link |
00:48:59.620
Flat line of, let's just say,
link |
00:49:01.340
everything that one would want to have in life,
link |
00:49:04.060
energy, vitality, just, it was a cliff.
link |
00:49:07.540
And a friend somehow knew
link |
00:49:11.140
that curcumin could inhibit 5-alpha reductase
link |
00:49:13.940
that converts testosterone to DHT, as you pointed out.
link |
00:49:17.020
I stopped taking it, it was the only new addition
link |
00:49:19.540
to my diet and supplementation,
link |
00:49:21.200
and things bounced back within about three, four days,
link |
00:49:23.600
but it was remarkable.
link |
00:49:25.860
I mean, I felt like garbage,
link |
00:49:27.380
and it was actually kind of frightening
link |
00:49:29.060
to experience the sharpness of that cliff.
link |
00:49:32.540
But I know that some people like turmeric
link |
00:49:35.500
for its anti-inflammatory properties, et cetera.
link |
00:49:39.440
Sounds like people either need to experiment or,
link |
00:49:43.500
and if they do, obviously to approach that with caution
link |
00:49:45.940
anytime you add or remove something,
link |
00:49:47.460
you need to talk to your doctor, you're a doctor,
link |
00:49:50.140
and I'm guessing that if one were to experiment,
link |
00:49:54.580
would you say that most of these effects
link |
00:49:56.380
of things like curcumin are reversible as they were in me,
link |
00:49:59.240
or is there any potential of permanent damage
link |
00:50:01.820
if people have been taking them for a long time?
link |
00:50:04.080
The effects are nearly always reversible.
link |
00:50:06.860
When you're talking about 5-alpha reductase inhibition,
link |
00:50:09.700
so what turmeric does, but stronger,
link |
00:50:12.780
the most common story that we hear
link |
00:50:14.260
is regarding a supplement known as saw palmetto,
link |
00:50:17.500
which a lot of older men take for their prostate health,
link |
00:50:20.420
or finasteride, which you can take for your prostate,
link |
00:50:23.120
or your heart, or your hair, or dutasteride.
link |
00:50:26.240
So if you're having side effects on these,
link |
00:50:28.780
then it's probably because of a couple different reasons.
link |
00:50:31.560
One can be your ratio of androgens to estrogens is off,
link |
00:50:36.300
and that needs addressed.
link |
00:50:37.740
Another one can be, it's inhibiting the conversion
link |
00:50:40.780
of your progesterone to that other type of progesterone,
link |
00:50:44.220
a 5-alpha, 3-alpha that we talked about earlier
link |
00:50:46.300
that's helping with your sleep,
link |
00:50:47.780
and your brain, and your calmness,
link |
00:50:50.100
and that's definitely an effect.
link |
00:50:54.020
Another one is depending on the type of supplement or med,
link |
00:50:57.940
they inhibit different isoenzymes
link |
00:51:00.380
of that 5-alpha reductase.
link |
00:51:01.880
So if they're just inhibiting one and two,
link |
00:51:05.700
then that's gonna be a different effect
link |
00:51:07.300
than if they're inhibiting two and three.
link |
00:51:09.260
So finasteride does two and three,
link |
00:51:11.420
saw palmetto does one and two,
link |
00:51:13.060
and then dutasteride does all three.
link |
00:51:15.940
The third one is active in the brain,
link |
00:51:18.020
and dutasteride inhibits that third one
link |
00:51:19.860
a little bit weaker in vivo, but strongly in vitro.
link |
00:51:23.860
So it's really hard to parse out.
link |
00:51:26.240
You can use biofeedback and experimentation.
link |
00:51:28.840
I do think with supplements, it's safe to experiment.
link |
00:51:32.400
The time that it takes to set in
link |
00:51:34.300
is usually about three months.
link |
00:51:36.300
So the risk of, and this is anecdotally,
link |
00:51:39.380
there's been lots of research published
link |
00:51:41.180
about if post-finasteride syndrome is real or fake,
link |
00:51:46.580
and it is real, but it's one of those things
link |
00:51:49.740
that's a combination of organic and inorganic disease,
link |
00:51:53.120
almost kind of like fibromyalgia,
link |
00:51:54.960
where it's definitely real,
link |
00:51:56.380
and there's lots of things that you can do to help with it,
link |
00:51:58.840
but it's very unlikely to occur
link |
00:52:01.340
if you stop taking your supplement or medication
link |
00:52:04.360
after you have side effects.
link |
00:52:05.620
Interesting.
link |
00:52:06.460
Well, I certainly feel better when I'm taking five grams
link |
00:52:08.800
of creatine monohydrate per day.
link |
00:52:10.480
I know most people take it for muscle growth
link |
00:52:12.580
and tissue repair and things of that sort.
link |
00:52:15.020
Mainly, I think, brings water into the muscle tissue,
link |
00:52:17.460
et cetera, but I take it for the brain effects,
link |
00:52:20.020
and also because I like to think that it gives me
link |
00:52:22.080
a little bit of a DHT bump that I can actually see
link |
00:52:26.300
in my blood charts when I've done them.
link |
00:52:29.180
I know many people want to avoid the hair loss
link |
00:52:33.240
that can sometimes be associated
link |
00:52:34.500
with DHT levels going too high.
link |
00:52:36.540
And so I've been asked many times,
link |
00:52:38.160
does creatine monohydrate cause hair loss?
link |
00:52:40.780
It would make sense that if creatine increases DHT and DHT,
link |
00:52:44.980
binding to the endocrine receptor on the scalp
link |
00:52:46.860
can induce hair loss, that that would be the case.
link |
00:52:49.280
Is that true, or are people just overly concerned
link |
00:52:53.260
about something that's trivial or non-existent?
link |
00:52:57.060
Each male, so yes, it can potentially add it.
link |
00:53:01.180
I don't like to say it causes it,
link |
00:53:02.920
but it can be a little bit more fuel to the fire.
link |
00:53:06.200
So just like everybody has a different sensitivity
link |
00:53:08.820
of their androgen receptor,
link |
00:53:10.180
they have a different amount of gene transcription
link |
00:53:13.300
that is going to cause death of the follicle.
link |
00:53:16.260
That's an arbitrary threshold.
link |
00:53:17.780
So you don't really know until you start losing hair.
link |
00:53:20.460
And if somebody takes a little bit of creatine
link |
00:53:23.220
to increase their DHT,
link |
00:53:24.300
maybe for the cognitive enhancing effects
link |
00:53:25.840
or for whatever reason,
link |
00:53:26.860
and they notice a little bit more hair falling out
link |
00:53:29.140
in the sink and they stop taking it,
link |
00:53:32.020
you just said death of the follicle,
link |
00:53:33.620
which sounds very dramatic.
link |
00:53:35.200
Are those little stem cell niches
link |
00:53:37.540
that reside in the follicle, which hairs grow from,
link |
00:53:40.320
are those then abolished?
link |
00:53:41.380
Like there's no going back,
link |
00:53:42.900
or can you want to rescue the hair?
link |
00:53:45.380
It takes months.
link |
00:53:46.580
If they're still there, the hair will come back.
link |
00:53:48.940
So the loss of the hair itself
link |
00:53:52.260
is a normal part of the hair cycle.
link |
00:53:54.460
So you have your androgen phase, your catagen phase,
link |
00:53:57.380
your telogen phase, and then your hair loss,
link |
00:54:00.060
and then a new follicle.
link |
00:54:00.900
Of the stem cell niche in the hair follicle.
link |
00:54:03.380
Think of it like sharks have teeth.
link |
00:54:05.220
So a shark loses a tooth
link |
00:54:06.660
and they have a new one that comes through,
link |
00:54:08.340
or losing your baby tooth and you have a new one,
link |
00:54:10.160
but your hair just always keeps coming through.
link |
00:54:12.000
So it's natural for it to die and lose.
link |
00:54:15.180
That's why when you start five alpha reductase inhibitors,
link |
00:54:18.740
often you have a big shed.
link |
00:54:20.420
So what happens during that big shed
link |
00:54:22.500
is all of these cells that are unhealthy,
link |
00:54:26.180
they immediately jettison that hair
link |
00:54:27.680
and they start making a much healthier new follicle.
link |
00:54:30.820
So all of the hairs that are at the end of their
link |
00:54:34.340
telogen phase, then they have what's called
link |
00:54:38.580
telogen effluvium, which also happens after pregnancy,
link |
00:54:41.780
also happens in thyroid pathologies.
link |
00:54:44.740
So you shed it, a new one comes in place,
link |
00:54:46.740
and you think that you're having a horrible hair loss
link |
00:54:49.220
caused by your finasteride or whatever you're doing,
link |
00:54:52.980
and minoxidil does this too,
link |
00:54:54.740
but you're really just having a new, healthier follicle.
link |
00:54:57.580
If you go a really long time, if you go a year,
link |
00:55:00.280
then those hairs might come back and they might not.
link |
00:55:03.100
So for simplicity sake, if somebody is concerned about
link |
00:55:07.020
or is experiencing hair loss, male or female,
link |
00:55:09.440
what are their options of ways to offset that hair loss
link |
00:55:15.320
that are not going to negatively impact
link |
00:55:18.360
other tissues sensitive to DHT?
link |
00:55:20.140
And what I'm basically saying here is
link |
00:55:22.500
I could imagine taking a DHT inhibitor,
link |
00:55:26.460
a pill of some sort or an injection of some sort,
link |
00:55:29.420
and offsetting hair loss,
link |
00:55:31.980
maybe even stimulating more hair growth.
link |
00:55:34.100
It's clear that I'm not doing that,
link |
00:55:35.540
but I know people that do,
link |
00:55:36.820
but then experience some of the other negative effects
link |
00:55:39.300
of blunting DHT, reduced affect, reduced libido,
link |
00:55:41.860
reduced drive, disruptions in prostate function,
link |
00:55:45.820
or even sexual function generally.
link |
00:55:48.660
So what can people do if they want to maintain
link |
00:55:51.340
or grow back hair,
link |
00:55:52.160
but they don't want all those other effects?
link |
00:55:54.300
What should they avoid?
link |
00:55:56.020
And what should they perhaps consider
link |
00:55:58.060
talking to their doctor about?
link |
00:56:00.020
There's a whole host of options.
link |
00:56:02.820
I try to separate alopecia or hair loss
link |
00:56:06.080
into two different categories,
link |
00:56:07.500
male pattern baldness or androgenic alopecia,
link |
00:56:10.500
also known as androgenetic alopecia,
link |
00:56:13.460
versus other types of alopecia, usually telogen effluviums.
link |
00:56:17.700
And if it's androgenetic alopecia or male pattern baldness,
link |
00:56:22.240
even if they're female, perhaps say a PCOS,
link |
00:56:24.700
something like that,
link |
00:56:26.020
then you want some sort of strategy
link |
00:56:28.580
to decrease the activity of that androgen receptor.
link |
00:56:31.700
So women can get male pattern baldness?
link |
00:56:33.820
Absolutely.
link |
00:56:34.660
Okay, I'm gonna have to wrap my head around that one,
link |
00:56:36.520
but okay.
link |
00:56:37.740
So there's a lot of different things
link |
00:56:40.140
that you can do that are topical.
link |
00:56:41.780
The most promising is called dutasteride mesotherapy.
link |
00:56:45.100
Essentially what it is is it's very localized injections
link |
00:56:48.940
in areas that are prone to male pattern baldness,
link |
00:56:52.020
whether they're female or male.
link |
00:56:54.340
And it acts locally only,
link |
00:56:57.340
and you repeat these injections from time to time.
link |
00:56:59.960
It decreases the conversion of testosterone to DHT
link |
00:57:03.020
just in the scalp.
link |
00:57:04.920
So that can avoid prostate effects.
link |
00:57:06.880
And what are some of the negative effects
link |
00:57:08.500
of blocking DHT in females in the periphery,
link |
00:57:12.720
meaning not on the scalp or in the brain,
link |
00:57:15.100
but where is DHT doing its stuff?
link |
00:57:18.740
Yeah, so it's both DHT
link |
00:57:20.260
and then also that 5-alpha, 3-alpha progesterone,
link |
00:57:23.540
which is called THP or dihydroprogesterone
link |
00:57:27.540
or tetrahydro, trihydroprogesterone.
link |
00:57:30.780
So they're active in the central nervous system,
link |
00:57:33.560
but it's also just active, again,
link |
00:57:36.240
binding to the androgen receptor in a female as well,
link |
00:57:39.280
causing them to have that effort, feel good motivation.
link |
00:57:42.560
A lot of women that are sensitive to DHT,
link |
00:57:45.660
because women can be sensitive to DHT as well,
link |
00:57:48.360
feel very different when they start an oral contraceptive,
link |
00:57:52.480
not because it alters their DHT to a huge amount.
link |
00:57:55.860
It does to some degree,
link |
00:57:57.660
because the negative feedback inhibition in the pituitary
link |
00:58:00.540
and less produced in the ovaries,
link |
00:58:02.340
but it increases SHBG really high.
link |
00:58:06.620
So because their SHBGs are significantly higher,
link |
00:58:09.660
their free DHT is way lower.
link |
00:58:12.560
I see.
link |
00:58:13.700
How does a woman know if she has PCOS,
link |
00:58:16.260
polycystic ovarian syndrome?
link |
00:58:18.160
What are the issues with polycystic ovarian syndrome?
link |
00:58:20.860
What can be done about PCOS?
link |
00:58:22.620
I confess I was naive to PCOS.
link |
00:58:26.420
That wasn't supposed to rhyme, but since it does,
link |
00:58:28.860
I do confess I was completely naive to it.
link |
00:58:31.500
And I started getting a lot of questions about it
link |
00:58:33.900
in various forums.
link |
00:58:35.340
And I think that's actually the reason
link |
00:58:37.820
why I initially approached you.
link |
00:58:39.340
I know you have treated a lot of PCOS.
link |
00:58:43.300
What age women should be thinking about PCOS?
link |
00:58:46.600
What's PCOS?
link |
00:58:48.140
Teach us about PCOS, please.
link |
00:58:50.060
So PCOS is polycystic ovarian syndrome.
link |
00:58:54.140
And this is one of those conditions
link |
00:58:56.260
which is underdiagnosed.
link |
00:58:58.640
So its prevalence is much higher than we think it is.
link |
00:59:02.580
There's been a lot of studies,
link |
00:59:03.580
and some studies say prevalence of 10%, some say 20%.
link |
00:59:08.460
It's not completely clinically penetrant.
link |
00:59:10.840
So most people don't know they have PCOS
link |
00:59:13.100
until they have infertility or subfertility.
link |
00:59:16.220
And is PCOS happening at this frequency
link |
00:59:18.460
in 20-year-old women and 30-year-old women
link |
00:59:20.860
and 40 and onward?
link |
00:59:22.100
Most women find out they have PCOS in their 30s,
link |
00:59:25.500
especially because it's on a spectrum or a continuum
link |
00:59:28.260
like a lot of things where you can have a weaker version
link |
00:59:30.700
or a very severe version.
link |
00:59:32.060
What are the symptoms?
link |
00:59:33.900
There's a criteria called the Rotterdam criteria.
link |
00:59:37.540
And in the Rotterdam criteria,
link |
00:59:39.060
there's a couple of different ways that you can diagnose it.
link |
00:59:41.400
You're looking for androgen excess, insulin resistance,
link |
00:59:45.940
and you can also look for polycystic ovaries.
link |
00:59:47.900
You don't actually have to have polycystic ovaries
link |
00:59:50.220
or to get an ultrasound of your ovaries to be diagnosed.
link |
00:59:53.260
If you have androgen excess, for example,
link |
00:59:55.780
androgenic acne or hormonal acne,
link |
00:59:58.500
if you have hair growth, like a hair growth on the chin,
link |
01:00:00.660
it's called a hirsutism,
link |
01:00:02.820
or if you have deepening of the voice,
link |
01:00:08.000
any symptom of too much male pattern baldness,
link |
01:00:11.540
if you're a female, that's a symptom of PCOS as well.
link |
01:00:15.560
Then you can also have insulin resistance.
link |
01:00:17.220
So this is obesity, it's pre-diabetes,
link |
01:00:20.660
a high fasting insulin, a HOMA-IR over two,
link |
01:00:24.620
a fasting insulin of over six.
link |
01:00:27.260
So if you have significant insulin resistance
link |
01:00:30.520
and also androgen dominance, that's a sign of it.
link |
01:00:34.780
Androgen dominance often leads
link |
01:00:36.380
to what's called oligominorrhea.
link |
01:00:38.700
So if you're having more than 35 day intervals
link |
01:00:42.120
in between a period,
link |
01:00:44.060
or if you have less than nine per year,
link |
01:00:47.740
then that can be a sign that you have oligo,
link |
01:00:49.980
which means too little, menorrhea, which means menses.
link |
01:00:54.380
So that's a very common sign of PCOS.
link |
01:00:58.020
If you have infertility, so if you're under the age of 35
link |
01:01:01.460
and you've been trying for more than a year,
link |
01:01:04.080
or if you're over the age of 35
link |
01:01:05.540
and you've been trying for more than six months,
link |
01:01:07.800
then that can also be,
link |
01:01:08.820
it's a very common presenting complaint
link |
01:01:10.720
when somebody presents with PCOS.
link |
01:01:12.820
And assuming that a woman is doing all these other things,
link |
01:01:16.540
is paying attention to the six pillars
link |
01:01:18.180
that you talked about earlier,
link |
01:01:19.400
diet, exercise, caloric restriction, in some cases, right?
link |
01:01:21.980
Not everyone needs to be caloric restricted,
link |
01:01:24.420
stress, sleep, and sunlight, spirit.
link |
01:01:27.500
Assuming that they're doing all those things,
link |
01:01:30.060
what other things in the realm of diet or supplementation
link |
01:01:33.300
can help them avoid PCOS if they have subclinical PCOS
link |
01:01:37.420
or they have not developed it but don't want to develop it?
link |
01:01:40.500
Because it doesn't sound like a good thing.
link |
01:01:42.780
Yeah, so depending on where they are,
link |
01:01:45.540
if they're very strong on the insulin resistance spectrum,
link |
01:01:49.340
then optimizing their body composition,
link |
01:01:52.340
decreasing their body fat,
link |
01:01:53.820
and treating that metabolic syndrome can help.
link |
01:01:56.680
So a lot of people ask, well, does everybody that's on,
link |
01:02:01.600
like does everybody need to be on metformin that has PCOS?
link |
01:02:04.160
Not necessarily, but metformin is one of the tools
link |
01:02:06.880
that can help with insulin sensitization.
link |
01:02:10.080
Other tools that can help are inositol.
link |
01:02:12.860
So myoinositol is an insulin sensitizer.
link |
01:02:16.220
Its cousin, d-chiroinositol, is a weak anti-androgen.
link |
01:02:22.740
A lot of types of inositol have both of those in it.
link |
01:02:26.800
So depending on if you're a female or a male
link |
01:02:29.920
and you're on inositol, the type of inositol does matter.
link |
01:02:33.460
Yeah, this is a very important point.
link |
01:02:35.620
Just today I said I'm trying this new supplement, inositol,
link |
01:02:41.580
for its role in perhaps enhancing sleep even further.
link |
01:02:45.460
My sleep's generally pretty good.
link |
01:02:46.780
Lately it's been a little bit off for a number of reasons.
link |
01:02:48.620
So I took it for the first time last night
link |
01:02:50.620
and I said I thought it helped and just subjectively.
link |
01:02:54.500
And you said, what kind of inositol is it?
link |
01:02:56.980
Because inositol is a very potent androgen inhibitor.
link |
01:03:00.180
It turns out I was taking myoinositol,
link |
01:03:02.600
which is not an androgen inhibitor.
link |
01:03:05.140
The type, the other type that you mentioned,
link |
01:03:06.980
which is an androgen inhibitor is?
link |
01:03:09.260
D-chiroinositol.
link |
01:03:11.140
It's usually in a ratio of one to 25 or one to 40
link |
01:03:15.340
in a much lower amount compared to myoinositol.
link |
01:03:18.500
In a supplement or in the body?
link |
01:03:20.100
In a supplement to help induce ovulation.
link |
01:03:23.340
But for women who have PCOS who might want to try
link |
01:03:26.660
and reduce androgen, then they would perhaps want
link |
01:03:31.300
to take a form of inositol
link |
01:03:32.600
that reduce the androgen receptor activity, correct?
link |
01:03:35.060
They want both.
link |
01:03:35.980
So if you're a woman and you've ever talked to your doctor
link |
01:03:38.340
about getting it on the oral contraceptive
link |
01:03:40.820
or spironolactone, which is also an anti-androgen,
link |
01:03:43.680
but it happens to be a potassium sparing diuretic
link |
01:03:46.660
blood pressure medicine as well.
link |
01:03:49.180
D-chiroinositol might be a better option.
link |
01:03:51.820
DIM or diindomethane is another kind of a weak
link |
01:03:55.980
anti-estrogen, anti-androgen that a lot of women
link |
01:03:58.660
should consider as well.
link |
01:04:00.260
You mentioned oral contraception.
link |
01:04:02.700
I've done a few posts on these, let's just call them,
link |
01:04:07.100
they really are perceptual effects whereby
link |
01:04:09.780
it's been demonstrated in humans several times now
link |
01:04:12.100
in what appeared to me to be very solid studies
link |
01:04:14.780
where women that take oral contraceptives,
link |
01:04:19.220
there is both a shift in their perception of men,
link |
01:04:23.300
because these studies only looked at heterosexual,
link |
01:04:27.020
the sort of arrangements here,
link |
01:04:28.760
where women who are on oral contraception,
link |
01:04:32.700
because it blunts some of the peaks and valleys
link |
01:04:35.200
of hormone output, no longer experience the same peaks
link |
01:04:41.820
and valleys in their assessment of other men's
link |
01:04:43.980
attractiveness, so it sort of flattens their perception,
link |
01:04:47.240
so to speak.
link |
01:04:48.080
They still find certain men attractive
link |
01:04:49.480
and certain men unattractive, but the degree of difference
link |
01:04:54.000
is kind of mellowed out.
link |
01:04:56.100
And likewise, these data say that men
link |
01:05:02.160
perceiving women's attractiveness,
link |
01:05:04.720
they still see women on oral contraceptives as attractive,
link |
01:05:07.840
but a woman taking oral contraception eliminates
link |
01:05:12.240
this kind of peak in her attractiveness
link |
01:05:14.460
that men would otherwise perceive.
link |
01:05:16.160
In other words, oral contraceptives are changing the way
link |
01:05:18.200
that we perceive each other, at least in terms
link |
01:05:20.000
of these male-female experiments.
link |
01:05:23.420
What is going on with that?
link |
01:05:25.480
Is that because oral contraceptives blunt the increase
link |
01:05:29.800
in testosterone that occurs just before ovulation,
link |
01:05:32.980
or is it because of a complex cascade?
link |
01:05:35.000
What is going on?
link |
01:05:35.880
I find this fascinating.
link |
01:05:37.200
Yeah, so there's differences in how your,
link |
01:05:41.120
and I wouldn't use the word change necessarily,
link |
01:05:43.720
but alter the severity or alter the peak, as you said.
link |
01:05:50.220
So it's just like TRT is not going to change you
link |
01:05:52.940
as a person, an oral contraceptive will not change you
link |
01:05:55.440
as a person.
link |
01:05:56.520
It will just change your day-to-day peaks and troughs
link |
01:06:01.160
in libido and attractiveness.
link |
01:06:06.400
So one of the main effects of oral contraceptives,
link |
01:06:09.240
almost all of them have a synthetic estrogen
link |
01:06:11.640
and a synthetic progestogen in them.
link |
01:06:14.220
One common type of synthetic estrogen is ethyl estradiol.
link |
01:06:18.120
There is another new synthetic estrogen
link |
01:06:20.440
that's out there as well, but anecdotally,
link |
01:06:22.580
that seems to have even more side effects.
link |
01:06:24.840
So this ethyl estradiol is 100 times more potent
link |
01:06:29.240
than endogenous or bio-identical estradiol in the liver.
link |
01:06:33.320
So it binds to the estrogen receptor in the liver,
link |
01:06:36.560
and it's going to increase sex hormone binding globulin,
link |
01:06:39.720
which secondarily, as you mentioned,
link |
01:06:41.680
decreases your free testosterone
link |
01:06:43.760
and especially your free DHT.
link |
01:06:46.380
So that little testosterone hump that you get
link |
01:06:49.240
when you're a female that's ovulating,
link |
01:06:51.280
that's really flatlined.
link |
01:06:53.000
And it's already, it's a pretty insignificant difference.
link |
01:06:56.920
It's not negligible, but it's a little bit of a hump,
link |
01:06:59.800
and you have significantly less of that
link |
01:07:02.180
when you're on an oral contraceptive.
link |
01:07:03.800
And does that blunt the associated increase in libido
link |
01:07:06.320
that normally would occur from that increase in androgen?
link |
01:07:10.040
Yes.
link |
01:07:10.880
Interesting.
link |
01:07:11.800
What about other forms of contraception, right?
link |
01:07:13.820
Because there are, there's copper IUD,
link |
01:07:16.160
there's various implants, there's rings,
link |
01:07:19.800
there's a huge number of different forms of these.
link |
01:07:23.400
So what we're talking about is, as I understand it,
link |
01:07:26.240
is only the effect of oral contraception
link |
01:07:30.480
that impacts hormone output, is that correct?
link |
01:07:33.960
Yeah, there's a lot of other effects as well.
link |
01:07:35.820
For example, your choice of synthetic progestin
link |
01:07:39.360
will alter how high your platelets and SHBG go.
link |
01:07:43.020
It appears to be the higher your platelets
link |
01:07:46.520
and the higher your SHBG, the higher risk of a blood clot.
link |
01:07:50.160
So a lot of women know that
link |
01:07:51.880
if they're on an oral contraceptive
link |
01:07:53.480
and they're already predisposed to a blood clot
link |
01:07:56.120
or a venous thromboembolism in their vein,
link |
01:07:58.940
they have a blood clot in either their leg or their lung,
link |
01:08:01.580
then it can increase that chance.
link |
01:08:03.880
So you can choose a synthetic progestin
link |
01:08:06.980
that is not going to have as high of a response.
link |
01:08:11.440
But there's various pros and cons.
link |
01:08:13.040
Some synthetic progestins are weak anti-androgens as well.
link |
01:08:16.900
For example, there's one known as Slind,
link |
01:08:19.280
which is made from spironolactone.
link |
01:08:21.680
So some women are on spironolactone and that as well,
link |
01:08:26.160
which is made from spironolactone,
link |
01:08:27.360
which probably isn't particularly necessary
link |
01:08:29.680
unless they need it for a diuretic or hypertensive effect.
link |
01:08:32.340
I see.
link |
01:08:33.180
I'm just going to intentionally interrupt and I apologize,
link |
01:08:36.080
but specifically because I wanted to ask about,
link |
01:08:39.460
there is this notion that, you know,
link |
01:08:43.980
that oral contraception taken over long periods of time
link |
01:08:46.820
can disrupt fertility in ways that are independent
link |
01:08:50.040
of just the age-related decrease in fertility.
link |
01:08:54.540
Is that true?
link |
01:08:56.100
It depends on what you mean by a long time.
link |
01:08:58.060
Six to 12 months, it's possible.
link |
01:09:00.420
Past that, it seems very unlikely.
link |
01:09:03.540
However, the persistently elevated SHBG
link |
01:09:06.940
can be present for quite some time.
link |
01:09:08.740
Wait, so if a woman takes oral contraception
link |
01:09:11.260
for six to 12 months and then stops,
link |
01:09:13.740
will she essentially be where she would have been anyway
link |
01:09:17.420
in terms of her fertility at that age?
link |
01:09:19.780
Or are you saying that it can cause permanent damage?
link |
01:09:22.880
Her fertility would be equitable
link |
01:09:25.320
as if she had never taken it,
link |
01:09:26.860
if she's certainly 12 months, but probably six months off.
link |
01:09:29.780
And what if she,
link |
01:09:30.920
I know of women that have taken an oral contraception
link |
01:09:32.800
for many years,
link |
01:09:34.700
in addition to the age-related decline in fertility
link |
01:09:37.000
that occurs, that's inevitable.
link |
01:09:39.280
Of course, the slope is going to be different
link |
01:09:40.740
depending on the individual,
link |
01:09:42.600
but are they quickening the transition to infertility?
link |
01:09:50.560
Probably not.
link |
01:09:52.780
You could make a case that
link |
01:09:54.300
because they've been an oral contraceptive,
link |
01:09:56.940
they may have been slightly more predisposed
link |
01:09:59.780
to insulin resistance and or lower lean body mass.
link |
01:10:04.780
But that's probably going to be a negligible difference
link |
01:10:08.820
compared to their resistance training
link |
01:10:10.460
and also their caloric restriction or caloric maintenance.
link |
01:10:13.740
So-
link |
01:10:14.580
Of course, there are also effects of having children.
link |
01:10:16.040
Yeah.
link |
01:10:16.880
Yeah, right.
link |
01:10:17.700
I mean, on all these parameters, right?
link |
01:10:18.880
Because it's a major lifestyle shift, right?
link |
01:10:23.140
That obviously people contend with
link |
01:10:25.340
and have since the beginning of human time anyway.
link |
01:10:30.960
I want to ask some questions about male hormone therapy
link |
01:10:34.140
and male hormones generally.
link |
01:10:35.300
But before I do that,
link |
01:10:36.300
I have a couple of burning questions that I get very often
link |
01:10:39.800
that I'm just going to insert now.
link |
01:10:43.060
Marijuana.
link |
01:10:44.820
I've heard that it can decrease testosterone
link |
01:10:47.620
in men and women.
link |
01:10:48.780
I've heard that it can increase testosterone.
link |
01:10:51.940
Alcohol.
link |
01:10:53.360
I think there's general consensus that
link |
01:10:55.900
high alcohol intake, high barbiturate intake
link |
01:10:59.820
does in fact reduce testosterone.
link |
01:11:01.740
What about modest increase of alcohol?
link |
01:11:03.700
I'm not a drinker.
link |
01:11:04.540
So I'm not asking these questions for me.
link |
01:11:06.020
I don't smoke pot quite open.
link |
01:11:07.460
I just never really liked marijuana or alcohol.
link |
01:11:10.060
They're not my thing.
link |
01:11:11.180
But many people want to know the answers to these.
link |
01:11:14.180
And the data that I've seen are very confused
link |
01:11:17.140
and conflicting.
link |
01:11:18.360
So what about marijuana?
link |
01:11:19.300
Does it reduce testosterone to a significant degree or not?
link |
01:11:23.440
Cannabinoids itself, whether it's THC or CBD
link |
01:11:27.260
are not going to reduce testosterone by themselves.
link |
01:11:30.720
If it's smoked marijuana,
link |
01:11:32.940
then it's very likely to increase your aromatase,
link |
01:11:36.620
which increases your estrogen.
link |
01:11:39.300
And that's going to, it's aromatizing from testosterone.
link |
01:11:43.340
So that is going to decrease testosterone.
link |
01:11:45.740
When you have an increased estrogen, like estradiol,
link |
01:11:49.260
that's going to work on your pituitary
link |
01:11:51.060
to make less hormones that cause the release of testosterone.
link |
01:11:55.260
So you're going to have less LH and less FSH.
link |
01:11:58.900
So it's almost kind of like,
link |
01:12:00.940
opiates are well known to opiate agonists.
link |
01:12:06.200
They're going to decrease LH and FSH
link |
01:12:08.380
and subsequently testosterone.
link |
01:12:09.900
Smoked marijuana will as well.
link |
01:12:12.560
As far as alcohol,
link |
01:12:13.880
high alcohol will decrease testosterone
link |
01:12:15.860
as will any very potent GABA agonist,
link |
01:12:19.180
whether it's a barbiturate or a benzodiazepine
link |
01:12:21.380
or a non-benzo or alcohol, they're definitely going to.
link |
01:12:25.380
Moderate alcohol, I guess it depends
link |
01:12:26.980
on what your definition of that is.
link |
01:12:28.700
The American-
link |
01:12:29.540
I mean, like some people I know
link |
01:12:32.340
that don't seem to be alcoholics,
link |
01:12:33.980
at least by my assessment,
link |
01:12:36.700
will have a glass or two of wine four nights a week,
link |
01:12:40.900
which to me seems like a tremendous amount
link |
01:12:43.620
only because I don't like alcohol.
link |
01:12:46.060
I don't have a problem with other people liking alcohol,
link |
01:12:48.100
but I think for many people,
link |
01:12:50.300
that would be considered low or moderate intake.
link |
01:12:52.780
Yeah, I would consider that low intake.
link |
01:12:55.580
The American Heart Association for Men
link |
01:12:57.980
recommends between one and two drinks a day on average.
link |
01:13:02.220
They recommend it?
link |
01:13:03.300
Yeah, so around one per week.
link |
01:13:04.700
Wait, so I'm making my heart less healthy
link |
01:13:06.380
by not drinking alcohol?
link |
01:13:07.740
Yeah, they recommend a very low amount
link |
01:13:10.500
of alcohol intake for men.
link |
01:13:12.260
For women, they recommend zero to one.
link |
01:13:14.760
So that's kind of hard to interpret, zero to one.
link |
01:13:18.220
But the protective effect of alcohol,
link |
01:13:20.460
especially if it's a red wine with polyphenols in it,
link |
01:13:25.360
outweighs the deleterious effect.
link |
01:13:28.460
Interesting, because I've seen some studies
link |
01:13:29.820
that point to the idea that even low intake of alcohol
link |
01:13:34.540
over a prolonged period of time
link |
01:13:35.660
might actually decrease brain volume,
link |
01:13:37.940
or at least volume of particular brain areas.
link |
01:13:39.860
But of course, we don't know the consequence
link |
01:13:41.160
of decreasing the volume of a given brain area either.
link |
01:13:44.460
I mean, one can imagine it's decreasing the size
link |
01:13:46.180
of one's amygdala and making them less stressed,
link |
01:13:47.900
although there's no evidence to support that.
link |
01:13:49.660
I've been told that I need a drink many, many times,
link |
01:13:52.160
but I always reply that I don't need to drink anything
link |
01:13:54.620
in order to speak my mind.
link |
01:13:55.800
So again, individual differences.
link |
01:13:59.020
Very interesting, so it sounds like smoked marijuana
link |
01:14:01.720
may in fact reduce testosterone,
link |
01:14:04.260
or at least increase the conversion
link |
01:14:06.020
of testosterone to estrogen, correct?
link |
01:14:07.820
Okay.
link |
01:14:08.660
And with alcohol and gaba agonist,
link |
01:14:10.060
it's important to remember that it shouldn't be daily.
link |
01:14:12.800
So one drink of alcohol a day
link |
01:14:14.820
is actually very mildly immunosuppressive.
link |
01:14:17.540
So it's better to have two drinks of alcohol
link |
01:14:20.820
one day of the week, and then two more drinks of alcohol
link |
01:14:23.740
another day of the week,
link |
01:14:24.700
and then no alcohol the rest of the time.
link |
01:14:26.940
The same could be said even for supplements
link |
01:14:29.060
that have gaba in them.
link |
01:14:30.340
A lot of sleep supplements have immunobutyric acid,
link |
01:14:33.460
which is gaba.
link |
01:14:34.300
I occasionally take, oh, sorry to interrupt.
link |
01:14:35.540
I occasionally take 100 to 200 milligrams of gaba
link |
01:14:39.100
in order to enhance sleep,
link |
01:14:40.120
but I do it maybe every third or four nights,
link |
01:14:42.760
no more than three or four nights a week.
link |
01:14:45.260
Yeah, that's perfect.
link |
01:14:46.940
So there's a lot of sleep supplements
link |
01:14:48.780
that should not be taken daily.
link |
01:14:51.100
And gaba is one of them.
link |
01:14:52.660
Another one of them is trazodone.
link |
01:14:55.520
And melatonin is kind of arguable,
link |
01:14:58.620
and it depends on the situation.
link |
01:15:00.600
But in general, if you're taking a sleep supplement,
link |
01:15:02.860
it should not be taken every night.
link |
01:15:05.020
The sleep supplements that I understand are okay
link |
01:15:07.520
to take every night or nearly every night
link |
01:15:10.080
are things like magnesium threonate, apigenin.
link |
01:15:13.400
If that's not true, correct me.
link |
01:15:15.700
I certainly take them every night
link |
01:15:16.940
unless I forget them back home when I'm traveling.
link |
01:15:20.140
Magnesium is one of the exceptions.
link |
01:15:21.900
L-theanine is also another exception.
link |
01:15:24.680
Great, well then at least I haven't put anything
link |
01:15:26.420
into the world that's wrong in that category yet.
link |
01:15:31.220
And hopefully I won't.
link |
01:15:32.140
But if I do, I'll correct myself.
link |
01:15:34.340
So let's talk about testosterone in males.
link |
01:15:37.220
You see these headlines all the times now
link |
01:15:40.900
that testosterone levels are dropping,
link |
01:15:43.960
sperm counts are dropping,
link |
01:15:46.660
phenotypes of men are changing over time.
link |
01:15:49.180
And I can't quite follow the literature on that
link |
01:15:51.700
because obviously those are hard controlled experiments to do
link |
01:15:55.860
because techniques change over time
link |
01:15:58.660
and sensitivity of techniques change over time.
link |
01:16:01.140
But regardless, I'm aware that a lot of people
link |
01:16:05.020
are considering increasing their testosterone
link |
01:16:08.180
by taking testosterone.
link |
01:16:09.780
A few years ago, that was considered steroid use
link |
01:16:12.260
and it was really extreme kind of stance.
link |
01:16:14.760
Nowadays, it seems like there's more discussion about it.
link |
01:16:17.500
First off, I'd like to know,
link |
01:16:18.900
does testosterone supplementation,
link |
01:16:22.740
and here I'm talking about prescription from a doctor,
link |
01:16:25.540
does it make one more prone to prostate cancer?
link |
01:16:28.700
That seems to always be the first question that comes out.
link |
01:16:31.780
Yeah, and there is a huge amount
link |
01:16:33.700
of misinformation about this too.
link |
01:16:35.820
So testosterone is not going to cause a prostate cancer.
link |
01:16:40.140
However, normal aging causes prostate cancer
link |
01:16:43.820
and testosterone will grow your prostate cancer.
link |
01:16:47.380
So if you're a 80 year old male and you have an autopsy
link |
01:16:52.820
and there's at least a 50% chance
link |
01:16:54.820
that you have a prostate cancer,
link |
01:16:56.480
if you're 90 or a hundred years old,
link |
01:16:58.180
there's at least a 90% chance.
link |
01:17:00.580
So for humans with a prostate,
link |
01:17:04.140
it's only a matter of time until you get a prostate cancer.
link |
01:17:07.660
So that begs the question,
link |
01:17:08.860
do you want to take something that's going to grow it
link |
01:17:11.140
for sure once you have it?
link |
01:17:13.820
So it's an individual assessment
link |
01:17:15.980
and it's important to follow things like PSAs as well.
link |
01:17:18.840
So a PSA of four or less,
link |
01:17:21.820
I mean, ideally you wouldn't be at four
link |
01:17:23.160
because that's kind of the upper threshold,
link |
01:17:24.740
is the simplest readout of whether or not
link |
01:17:27.200
there's excessive prostate growth.
link |
01:17:29.800
There's benign prostate hyperplasia
link |
01:17:31.500
where the prostate is growing,
link |
01:17:33.340
but it's non-cancerous, correct?
link |
01:17:35.740
And then of course there are the symptomologies,
link |
01:17:37.660
like people have challenges of urination,
link |
01:17:39.620
they have sexual difficulties, et cetera.
link |
01:17:42.060
I'm always struck by the correlation
link |
01:17:45.180
that people draw between testosterone and prostate health
link |
01:17:48.460
and the fact that, or I should say the claim
link |
01:17:50.780
that testosterone makes prostate health worse,
link |
01:17:52.660
because if you think about it,
link |
01:17:53.940
young males have high testosterone often,
link |
01:17:57.340
if not always, certainly often,
link |
01:18:01.680
and you don't see a lot of prostate overgrowth
link |
01:18:04.140
and cancer in young males.
link |
01:18:05.860
So something's going on here.
link |
01:18:07.640
How should we conceptualize this?
link |
01:18:10.020
So if you have a PSA of 3.9
link |
01:18:12.820
and you're a 25-year-old male
link |
01:18:16.540
versus a 75-year-old male,
link |
01:18:19.500
and you have a PSA of 5.9,
link |
01:18:21.500
the 3.9 PSA is significantly more concerning.
link |
01:18:25.260
So think of your prostate as taking cumulative damage
link |
01:18:29.380
from not only testosterone,
link |
01:18:31.380
but also estrogen and also growth hormone.
link |
01:18:34.920
So that's why obese individuals
link |
01:18:37.180
have higher incidences of prostate cancer as well,
link |
01:18:39.900
is because they don't have those cell checkpoints
link |
01:18:42.900
where your immune system takes a second
link |
01:18:46.340
and says, all right, stop replicating
link |
01:18:48.660
as fast prostate cells.
link |
01:18:50.500
Let's see if there's any atypical ones,
link |
01:18:52.080
and then it finds those
link |
01:18:53.620
and it prevents them from reproducing.
link |
01:18:56.100
That's why immunotherapy and cancer is so promising,
link |
01:18:58.480
is because they can target these certain things.
link |
01:19:01.600
So the older male is going to have
link |
01:19:05.020
that cumulative damage happen already,
link |
01:19:07.820
and arguably prostate cancer is a normal,
link |
01:19:15.060
with aging, fast aging is abnormal,
link |
01:19:18.860
very slow aging is normal.
link |
01:19:21.780
There's a fine line to walk between those two,
link |
01:19:25.220
but there's a lot of things that can be done
link |
01:19:27.300
to decrease the turnover, decrease the inflammation,
link |
01:19:30.220
and decrease the congestion of the prostate over time.
link |
01:19:33.900
There's also a lot more than just PSAs that can be done.
link |
01:19:36.300
There's prostate MRIs and things like that.
link |
01:19:38.420
They can look at the structure
link |
01:19:40.060
and the function of the prostate.
link |
01:19:41.300
So what should every male do
link |
01:19:42.580
to maintain the health of their prostate?
link |
01:19:44.300
And I realized that younger males
link |
01:19:45.460
probably aren't thinking about it at all,
link |
01:19:46.700
although it seems like nowadays,
link |
01:19:48.900
I get these kind of what I call cryptic questions.
link |
01:19:52.500
I think women are more comfortable talking
link |
01:19:54.060
about their hormone and sexual health
link |
01:19:55.580
because of menstrual cycles.
link |
01:19:59.020
They're used to fluctuations that sort of give them
link |
01:20:02.160
the experience of what it's like to have different levels
link |
01:20:04.140
of progesterone, estrogen, testosterone, et cetera.
link |
01:20:06.620
I get these kind of cryptic questions
link |
01:20:08.460
often in my direct messages,
link |
01:20:10.040
where what I think people are asking is,
link |
01:20:14.660
is there something wrong with my prostate?
link |
01:20:16.180
What should I do for my prostate?
link |
01:20:17.540
These are often indirect questions
link |
01:20:18.720
for other aspects of their life where they're suffering.
link |
01:20:21.580
And I don't say that in jest.
link |
01:20:23.300
I think more direct discussion would be great.
link |
01:20:26.740
So what should all males do to maintain prostate health
link |
01:20:31.740
throughout the lifespan?
link |
01:20:34.220
Maintaining prostate health can be looked at
link |
01:20:36.300
similarly how you can maintain
link |
01:20:38.020
a good natural optimal testosterone.
link |
01:20:40.920
So you look for things that can hurt it.
link |
01:20:42.660
You don't necessarily look for one thing
link |
01:20:44.980
that can improve it or boost it.
link |
01:20:47.300
So for young males, those are prostatitis.
link |
01:20:50.980
So it goes hand in hand with epididymitis.
link |
01:20:54.120
So different infections of the prostate.
link |
01:20:56.920
The younger the male is, the more likely it is
link |
01:20:59.220
related to something that could be
link |
01:21:00.740
sexually transmitted.
link |
01:21:02.940
But another very common cause is what we call
link |
01:21:05.940
gram-negative and anaerobic bacteria.
link |
01:21:08.920
The prostate is right by the end of the colon.
link |
01:21:14.340
So if you have chronic constipation,
link |
01:21:16.840
or if you have colitis,
link |
01:21:18.880
or if you have, you know,
link |
01:21:20.660
even just an E. coli overgrowth in the colon
link |
01:21:23.140
is very likely to cause an infection
link |
01:21:25.940
of the prostate as well.
link |
01:21:27.580
What should males do to prevent that?
link |
01:21:30.140
Have a diet that has good healthy prebiotic fiber,
link |
01:21:34.460
probiotics as well.
link |
01:21:37.180
Make sure that they're having regular bowel movements,
link |
01:21:39.260
that they don't have chronic constipation.
link |
01:21:41.580
Have good sources of dietary fiber,
link |
01:21:43.500
which is also known as soluble fiber,
link |
01:21:45.300
and enough insoluble fiber.
link |
01:21:47.000
Most people get enough insoluble or non-dietary fiber.
link |
01:21:50.600
So that can help prevent the chance of diverticulitis,
link |
01:21:54.900
which is another type of infection.
link |
01:21:57.360
It can also decrease the chance of colitis
link |
01:21:59.800
and decrease the chance of prostate infections as well.
link |
01:22:02.860
Are there any foods and or supplements
link |
01:22:06.260
that men should take or avoid?
link |
01:22:08.420
What about, you hear about salt palmetto.
link |
01:22:12.260
Yeah, supplements for,
link |
01:22:14.980
supplements that support or cause issues for the prostate.
link |
01:22:18.500
Yeah.
link |
01:22:19.340
If there's a strong genetic predisposition
link |
01:22:21.340
to enlarged prostates,
link |
01:22:23.580
or even just really early prostate cancers that grow fast,
link |
01:22:27.320
then they could consider taking salt palmetto
link |
01:22:29.940
or even curcumin as an anti-androgen,
link |
01:22:32.180
as long as they're able to tolerate it.
link |
01:22:33.940
It's an individualized basis and depends on their history.
link |
01:22:38.320
As far as making sure that their prostate is not congested,
link |
01:22:42.820
there's an interesting correlation
link |
01:22:44.660
between having girls and having prostate cancer.
link |
01:22:49.020
Having girls offspring.
link |
01:22:50.320
So if your offspring are females,
link |
01:22:53.220
then you're slightly more likely to have prostate cancer.
link |
01:22:56.840
There is some, there's hypotheses that link estrogen
link |
01:23:01.300
to prostate cancer rather than testosterone.
link |
01:23:04.380
So if you have hyper estrogenism,
link |
01:23:06.800
your prostate has more atypical cells.
link |
01:23:10.700
In general, the higher your C-reactive protein,
link |
01:23:13.660
which is a general marker of inflammation in your body,
link |
01:23:16.020
we call it CRP,
link |
01:23:17.980
and the test order is HS-CRP or high sensitivity CRP.
link |
01:23:22.900
If your CRP raises up very high,
link |
01:23:26.260
if you have an autoimmune disease,
link |
01:23:27.940
like if you have a Crohn's flare,
link |
01:23:29.820
or if you have a lupus or an infection
link |
01:23:33.020
or a sexually transmitted infection
link |
01:23:35.580
or even a colitis or even the flu,
link |
01:23:38.180
your CRP is going to raise significantly.
link |
01:23:40.500
That you would detect in a blood test, of course.
link |
01:23:42.140
Correct, yeah.
link |
01:23:42.980
So you want to get a baseline CRP
link |
01:23:44.660
when you haven't had any of those things recently.
link |
01:23:47.980
And if your CRP is higher,
link |
01:23:49.980
you also have more female offspring.
link |
01:23:52.720
If your CRP is higher, then your reactive oxygen species,
link |
01:23:56.820
which are causing mutations
link |
01:23:58.580
and atypical cell turnover in the prostate,
link |
01:24:01.140
are also likely higher.
link |
01:24:02.740
So you want to keep a very low CRP.
link |
01:24:05.460
Interesting.
link |
01:24:06.280
And what about blood flow and pelvic floor in general?
link |
01:24:09.340
We should probably do a whole episode on pelvic floor.
link |
01:24:11.380
You know, there's so much interesting data coming out
link |
01:24:14.620
of the fields of clinical and research urology.
link |
01:24:17.640
I realize it's kind of the Netherlands
link |
01:24:19.140
of biology and medicine.
link |
01:24:20.780
People probably aren't thinking so much about this,
link |
01:24:22.460
but pelvic floor is obviously a confluence
link |
01:24:26.260
of a ton of vasculature, of nerves.
link |
01:24:29.380
And of course the prostate resides there.
link |
01:24:31.100
And of course the genitals reside there as well.
link |
01:24:35.380
So I would imagine that one of the six pillars,
link |
01:24:38.140
you know, exercise,
link |
01:24:39.400
being able to maintain adequate blood flow
link |
01:24:42.300
to those regions is key.
link |
01:24:43.940
What about just postural things?
link |
01:24:45.220
People sitting too much, not hydrating well enough.
link |
01:24:49.380
You mentioned avoiding constipation.
link |
01:24:51.580
But what are some other things,
link |
01:24:52.720
including medications that can serve
link |
01:24:54.620
to support the prostate over time
link |
01:24:56.780
and maybe even support pelvic floor in general,
link |
01:24:59.340
both in males and females over time?
link |
01:25:01.660
Absolutely.
link |
01:25:02.480
And this is something that's rightfully getting
link |
01:25:04.140
more and more attention.
link |
01:25:05.460
The way I explain the pelvic floor is your abdominal cavity,
link |
01:25:09.540
which includes your peritoneum
link |
01:25:11.100
or where most of your organs are,
link |
01:25:12.760
your retroperitoneum, your pelvic space.
link |
01:25:15.460
Think of it as a box and your abs are the front of the box.
link |
01:25:18.740
Your back muscles are the back.
link |
01:25:20.340
Your diaphragm is the top of the box.
link |
01:25:22.540
And your pelvic floor,
link |
01:25:24.040
that's where your port is to the outside world.
link |
01:25:26.720
Especially important, it has muscles as well.
link |
01:25:29.660
And you can do exercises.
link |
01:25:31.020
Pelvic floor physical therapists
link |
01:25:32.420
are becoming more and more utilized,
link |
01:25:34.380
especially after childbirth,
link |
01:25:35.760
but in other situations as well,
link |
01:25:37.520
including by men getting care from urologists.
link |
01:25:41.420
So you want to both strengthen that pelvic floor
link |
01:25:44.700
and make sure that the tubes that are docked
link |
01:25:48.460
to the outside world are working well enough,
link |
01:25:51.780
but they're not too loose.
link |
01:25:52.740
They're not working too well.
link |
01:25:54.700
So there's a lot of medications that can be positives
link |
01:25:59.420
or negatives for your pelvic floor.
link |
01:26:01.820
We kind of talked about your gut
link |
01:26:03.100
and colon health in general.
link |
01:26:05.100
As far as your prostate health,
link |
01:26:07.020
and as far as your bladder and urinary system health,
link |
01:26:11.380
you think about a couple of different classes.
link |
01:26:13.160
So you have your phosphodiesterases.
link |
01:26:14.940
You have your tadalafil.
link |
01:26:16.340
Basically, this is going to help decrease congestion
link |
01:26:20.860
in the prostate.
link |
01:26:22.620
A lot of people take it for ED,
link |
01:26:25.020
but it can actually help you decrease your-
link |
01:26:26.820
Do you define that?
link |
01:26:27.660
A lot of men take tadalafil, it's generic as Cialis,
link |
01:26:31.580
has a much longer half-life than Viagra or Levitra.
link |
01:26:34.180
It's half-life is almost a day.
link |
01:26:36.120
So you can take a very low dose of it.
link |
01:26:37.620
Instead of taking 20 milligrams,
link |
01:26:39.080
you take two or two and a half milligrams.
link |
01:26:41.060
So they're taking, you're saying that a lot of men
link |
01:26:42.960
take it for erectile dysfunction,
link |
01:26:45.620
but that at lower doses, it may have served purposes
link |
01:26:49.620
for prostate health, independent of erection.
link |
01:26:53.300
Correct.
link |
01:26:54.140
The most common scenario is if a male is waking up twice
link |
01:26:57.940
at night to pee, on average, it'll cut that down to once.
link |
01:27:01.420
So if they're waking up four times at night,
link |
01:27:03.580
then it can cut that down to twice at night,
link |
01:27:05.800
just because you have easier blood flow.
link |
01:27:07.460
We used to use other medications like Flomax,
link |
01:27:09.820
which is Tamsulosin.
link |
01:27:11.540
That's an alpha antagonist.
link |
01:27:13.020
So it basically binds to a receptor in smooth muscle,
link |
01:27:16.400
and it helps relax that.
link |
01:27:18.920
There's several other alpha antagonists.
link |
01:27:21.740
And then you also have your medications that are hormonal,
link |
01:27:23.980
like finasteride, that a lot of people take
link |
01:27:26.340
for prostate health to decrease the enlargement
link |
01:27:28.620
of the prostate.
link |
01:27:29.840
The periurethral area or periurethral lobe,
link |
01:27:33.360
there are several lobes of the prostate,
link |
01:27:35.960
that tends to be especially enlarged in cases of BPH.
link |
01:27:39.820
And BPH?
link |
01:27:41.540
Prostate hyperplasia or an enlarged prostate.
link |
01:27:45.060
And if you are able to shrink that area,
link |
01:27:48.060
then at that point it's just a plumbing problem,
link |
01:27:51.260
and the urine is able to get by easier.
link |
01:27:53.700
Yeah, my understanding is that now there's a growing,
link |
01:27:57.260
I don't want to say a movement,
link |
01:27:59.060
but the idea of taking very low dose,
link |
01:28:03.180
like 2.5 milligram or five milligram to Dallafil,
link |
01:28:06.580
even daily, is becoming pretty common.
link |
01:28:09.800
For many men who do not have erectile dysfunction,
link |
01:28:12.660
simply to either maintain or enhance prostate health.
link |
01:28:16.100
Is that correct?
link |
01:28:17.300
Yeah, that's correct.
link |
01:28:18.120
And are there,
link |
01:28:18.960
do you see any negative effects of doing that?
link |
01:28:21.900
There can be negative effects.
link |
01:28:23.360
It can lower blood pressure.
link |
01:28:24.820
So theoretically it can increase your chance
link |
01:28:27.340
of vasovagal syncope.
link |
01:28:29.460
A lot of people take it as a alternative to pump
link |
01:28:32.340
because it kind of works similarly to citrulline
link |
01:28:36.220
or different pump products in pre-workout.
link |
01:28:38.800
And it can certainly help with that.
link |
01:28:40.260
But if you're about to go do a deadlift
link |
01:28:42.460
where you might pass that anyway,
link |
01:28:44.020
it can certainly increase the chance that that happens
link |
01:28:46.700
because you don't have
link |
01:28:47.540
that compensatory exercise hypertension response.
link |
01:28:51.460
Could someone just take it away from exercise?
link |
01:28:54.580
They could.
link |
01:28:55.780
If you took to Dallafil,
link |
01:28:57.140
then that's going to be,
link |
01:28:59.140
has a long half-life.
link |
01:29:00.980
Whereas Viagra and Levitra is just a few hours.
link |
01:29:03.780
Dallafil is almost today.
link |
01:29:05.500
Some interesting studies on Viagra have been done as well.
link |
01:29:09.540
It can potentially alter your rays and cones in your eye.
link |
01:29:13.620
So the usual recommendation for pilots
link |
01:29:17.420
that need to have red-green discrimination
link |
01:29:19.940
from very long distances with very small indicator lights
link |
01:29:23.640
is to not take Viagra.
link |
01:29:26.420
So I usually say if you're a pilot
link |
01:29:28.660
and that's your profession,
link |
01:29:29.840
perhaps hold off from that for a while.
link |
01:29:31.980
There's also studies with Viagra that significantly,
link |
01:29:34.980
which is also known as sildenafil as the generic now,
link |
01:29:38.620
it can increase eyebrow hair growth.
link |
01:29:41.140
So potentially what it does is it helps vasodilate
link |
01:29:45.420
and relax the veins, especially in older men.
link |
01:29:48.380
And when those veins are relaxed,
link |
01:29:50.100
you have better blood flow.
link |
01:29:52.020
That's one of the proposals or theories
link |
01:29:54.700
behind why older men get the androgenetic alopecia more.
link |
01:29:59.340
You're having less blood flow in the scalp.
link |
01:30:01.500
So theoretically it can also help prevent that.
link |
01:30:04.260
So in theory increasing blood,
link |
01:30:06.220
oh, because it increases blood flow systemically
link |
01:30:08.580
throughout the body, not just in specific tissues.
link |
01:30:12.600
Well, I find it incredibly interesting that, yeah,
link |
01:30:15.000
there are these online forums building up now
link |
01:30:16.780
around low dose to dalafil,
link |
01:30:20.860
daily use of low dose to dalafil, again,
link |
01:30:22.960
not for sexual or erectile dysfunction,
link |
01:30:26.000
but for sake of long-term prostate health.
link |
01:30:29.220
Is there any reason why women
link |
01:30:30.820
might want to take low dose to dalafil?
link |
01:30:34.900
To dalafil is also a weak androgen receptor sensitizer,
link |
01:30:40.140
kind of like L-carnitine,
link |
01:30:42.060
where the density of the available androgen receptors
link |
01:30:45.140
to bind increases slightly.
link |
01:30:48.100
So there could potentially be a benefit from that,
link |
01:30:52.540
but most of the time it's used in men.
link |
01:30:55.060
Very interesting.
link |
01:30:57.300
We haven't really talked about testosterone
link |
01:30:59.620
and optimizing testosterone in males.
link |
01:31:02.920
Assuming someone is paying attention to the six pillars,
link |
01:31:07.620
there's a kind of a gap as I see it
link |
01:31:10.260
between doing all those things
link |
01:31:12.120
and TRT, hormone replacement therapy.
link |
01:31:15.820
And again, the R, the replacement in TRT
link |
01:31:18.940
is a little bit of a, in quotes nowadays,
link |
01:31:21.980
because a lot of people who have testosterone
link |
01:31:24.980
in that 300 to 900 nanogram per deciliter range
link |
01:31:28.700
opt to take low dose testosterone anyway.
link |
01:31:30.940
My understanding is that there've been some new kind
link |
01:31:35.260
of movements in this area toward, for instance,
link |
01:31:38.120
not doing big, large doses injected infrequently,
link |
01:31:43.760
but rather low doses quite frequently.
link |
01:31:46.420
Obviously prescribed by a doctor,
link |
01:31:47.660
monitored by a doctor, et cetera.
link |
01:31:50.000
Is that generally what you like to see in your patients
link |
01:31:53.280
if they're going to take this route?
link |
01:31:55.400
If they're a hypogonadal patient whose benefits outweigh
link |
01:31:58.940
risks of TRT, then you want to have a nice,
link |
01:32:03.240
even steady state.
link |
01:32:05.100
It's not going to be exactly the same as producing
link |
01:32:07.740
pulsatile testosterone release endogenously
link |
01:32:11.500
from your own body.
link |
01:32:12.860
When you have a steady state,
link |
01:32:14.740
you don't have a peak or a trough.
link |
01:32:16.340
And when you have a peak,
link |
01:32:17.700
that's when the androgen receptor gene is overactive.
link |
01:32:20.860
That's when you get more erythropoietin or EPO release.
link |
01:32:24.220
And that leads to a lot of the side effects of thick blood.
link |
01:32:27.540
So higher hemoglobins and hematocrits.
link |
01:32:29.980
And then when you have a crash, you don't feel good.
link |
01:32:33.900
So it's definitely not optimal.
link |
01:32:37.020
There's a lot of ways to get around this.
link |
01:32:38.940
So when you're doing testosterone replacement,
link |
01:32:41.540
if you're someone that needs it,
link |
01:32:43.420
you can have different types of esters,
link |
01:32:45.980
or you could do topical testosterone.
link |
01:32:48.540
So the ester is basically something that's attached
link |
01:32:52.140
to increase the biological half-life.
link |
01:32:54.760
The most common ones are cipunate and anthate.
link |
01:32:57.300
There's also a very short-acting propionate,
link |
01:32:59.300
which has almost no clinical relevance.
link |
01:33:01.740
And there's also very long-acting ones,
link |
01:33:03.780
decanoate and undecanoate,
link |
01:33:05.980
and different mixtures of all those.
link |
01:33:08.660
So if you're someone who has a very, very low SHBG,
link |
01:33:12.580
you're going to have trouble of regulating
link |
01:33:14.900
your serum testosterone in the long run.
link |
01:33:17.540
If you do it topically, then the testosterone is absorbed,
link |
01:33:20.200
hopefully bound to SHBG.
link |
01:33:22.260
And then a lot of times you reapply twice daily
link |
01:33:24.140
or once daily, but you have lots of variations.
link |
01:33:26.940
So for most people,
link |
01:33:28.540
especially for people who can absorb it well,
link |
01:33:31.580
that's not going to be a great option.
link |
01:33:33.060
So injections would be preferred.
link |
01:33:34.720
Most people end up injecting
link |
01:33:36.660
because they have either side effects from too high,
link |
01:33:39.020
too low, or just too much of a varied dose
link |
01:33:42.060
when they do topical.
link |
01:33:43.300
There's also a capsule with a special lymphatic absorption.
link |
01:33:47.620
So it's not being absorbed through the liver.
link |
01:33:49.540
It's not hepatically metabolized,
link |
01:33:51.000
but it's absorbed through the lymph.
link |
01:33:52.960
And it's essentially the testosterone undecanoate
link |
01:33:56.260
and then put into a capsule.
link |
01:33:58.380
So, and that's taken twice daily.
link |
01:34:01.260
It has fairly steady half-lives,
link |
01:34:03.100
but you have to take it at specific times of the day.
link |
01:34:05.780
So that being said, and it's new enough
link |
01:34:08.620
to where there isn't a huge amount of data on it,
link |
01:34:10.540
but it is FTA approved.
link |
01:34:12.500
So it is brand name now.
link |
01:34:14.900
It's called Jatenzo, but the injectables in general,
link |
01:34:19.500
the lower your SHBG, the longer of an ester you want,
link |
01:34:23.260
because when you inject it,
link |
01:34:24.900
whether it's intramuscular or subcutaneous,
link |
01:34:26.940
just talk to your doctor about the risks
link |
01:34:28.620
and the benefits of those.
link |
01:34:29.560
Subcutaneous has slightly longer active half-life
link |
01:34:32.100
because the ester races take longer to reach
link |
01:34:34.340
that cipunate or an ester to cleave it.
link |
01:34:37.780
So most men, a lot of people ask me about
link |
01:34:41.140
what a usual dose is.
link |
01:34:43.400
For most people, it would be a total of about 100 to 120
link |
01:34:47.100
per week for an actual replacement dose.
link |
01:34:49.580
Milligrams.
link |
01:34:50.420
Milligrams, 120 to 100 milligrams per week
link |
01:34:53.940
administered two to three times per week.
link |
01:34:56.180
And you're not, so you're saying dividing that
link |
01:34:58.280
into two or three, right?
link |
01:34:59.620
Because I'm sure there's a bunch of people out there
link |
01:35:00.860
thinking, oh yeah, 100 three times a week,
link |
01:35:02.620
which is actually quite high dose.
link |
01:35:04.720
Yeah, there really does seem to be a shift
link |
01:35:07.220
toward spreading these dosages out into,
link |
01:35:10.800
dividing them into two or three smaller doses.
link |
01:35:13.540
And then along those lines, five, 10 years ago,
link |
01:35:18.460
it was common to hear about inhibiting estrogen
link |
01:35:21.020
through aromatase inhibitors.
link |
01:35:22.460
Nowadays you hear, and I think it's true,
link |
01:35:25.180
at least by my read of the literature,
link |
01:35:27.140
that that inhibiting estrogen can disrupt brain function,
link |
01:35:30.260
can cause connective tissue issues,
link |
01:35:32.180
and even can cause reductions in libido.
link |
01:35:35.180
So a lot of people think that estrogen,
link |
01:35:38.560
if you crash estrogen, that basically libido goes up,
link |
01:35:42.020
but actually the opposite is often true.
link |
01:35:43.660
You don't want estrogen too high or too low.
link |
01:35:45.700
Is that correct?
link |
01:35:46.540
And for that reason, do you shy away
link |
01:35:50.940
from people taking aromatase inhibitors?
link |
01:35:53.780
Yeah, very few people truly need an aromatase inhibitor.
link |
01:35:59.140
There's almost always lifestyle interventions.
link |
01:36:01.780
It can just depend on which gene,
link |
01:36:04.160
how active your aromatase gene is.
link |
01:36:06.300
Some people's aromatase gene is very active.
link |
01:36:09.180
A lot of times these individuals have
link |
01:36:12.380
pubertal gynecomastia, which is breast tissue growth
link |
01:36:15.780
in males, even despite no other risk factor.
link |
01:36:18.580
Even if they're lean?
link |
01:36:20.660
Some people get it if they're lean.
link |
01:36:22.300
I remember growing up, there were a few kids
link |
01:36:24.120
that got mild cases of gynecomastia that were transient.
link |
01:36:27.820
Like it's sort of like they developed gynecomastia
link |
01:36:29.940
and then it went away.
link |
01:36:31.340
Often it's unilateral on one side too.
link |
01:36:33.880
So growth hormone a lot of times is the fuel to that fire.
link |
01:36:38.100
Oh, interesting.
link |
01:36:39.220
Yeah, there were a couple of kids.
link |
01:36:40.360
I mean, they took some teasing,
link |
01:36:41.780
because back then there wasn't online discussions
link |
01:36:45.060
about hormones and things like that,
link |
01:36:46.260
but then it would seem transient.
link |
01:36:48.060
And they were, the people I'm thinking of
link |
01:36:49.740
were actually lean individuals.
link |
01:36:51.500
So they weren't overweight,
link |
01:36:52.620
which of course can cause gynecomastia
link |
01:36:54.880
because adipose fat tissue can convert testosterone
link |
01:36:58.500
into estrogen.
link |
01:37:00.240
So it sounds like, except in special cases,
link |
01:37:02.460
that avoiding aromatase inhibitors
link |
01:37:05.200
is probably going to be a good idea.
link |
01:37:07.240
There's several other ways
link |
01:37:08.120
that you can control your estrogen
link |
01:37:09.620
and keep it at a healthy level,
link |
01:37:11.100
which you do have to check.
link |
01:37:12.220
There's a lot of patients who assure me
link |
01:37:14.980
that their estrogen is going to be sky high
link |
01:37:16.940
and it's actually very low and vice versa.
link |
01:37:20.020
But calcium D-glucarate is a supplement
link |
01:37:22.600
that can help with estrogen control.
link |
01:37:24.500
What's a typical dosage of calcium D-glucarate?
link |
01:37:26.900
500 to 1000 milligrams.
link |
01:37:28.940
But is there the risk that if someone's estrogen
link |
01:37:31.180
is in normal range and they take the supplement
link |
01:37:33.920
that their estrogen will go too low,
link |
01:37:35.580
is it that potent?
link |
01:37:37.460
It's not that potent.
link |
01:37:38.340
It's not near as potent as an aromatase inhibitor.
link |
01:37:40.660
So it helps with excretion
link |
01:37:42.440
and also the sensitivity of the estrogen receptor itself.
link |
01:37:46.100
It kind of like helps out-compete it.
link |
01:37:48.740
Some people will also take DIM
link |
01:37:50.700
or different cruciferous vegetable.
link |
01:37:54.940
They get them from cruciferous vegetables like kale
link |
01:37:58.820
or broccoli.
link |
01:37:59.820
And that is both an anti-estrogen and an anti-androgen.
link |
01:38:04.660
So if you're on TRT and you're on that,
link |
01:38:06.980
then you're probably just on too much TRT.
link |
01:38:09.180
Yeah, I remember a few years ago I had a friend
link |
01:38:10.780
and it truly is, it's not like I have a friend's thing.
link |
01:38:13.780
Because I'm very cautious about which supplements I take.
link |
01:38:15.820
I think people might get the impression
link |
01:38:17.500
that I'm very cavalier about this, but I'm not.
link |
01:38:19.620
I always alter one thing at a time.
link |
01:38:21.200
I talk to physicians.
link |
01:38:23.260
What I suggest other people do,
link |
01:38:24.340
I actually do and have done for a long period of time.
link |
01:38:26.700
And I recall wanting to take DIM
link |
01:38:30.120
because I thought, well, back then you hear,
link |
01:38:31.780
okay, reduce estrogen.
link |
01:38:34.080
My estrogen levels weren't out of range, so they were fine.
link |
01:38:36.540
But I thought, well,
link |
01:38:37.380
what would the experience be of bringing those down?
link |
01:38:38.900
But someone I know is quite informed in this area,
link |
01:38:41.500
said, yeah, exactly what you said,
link |
01:38:42.860
which is that DIM can reduce estrogen, but also testosterone.
link |
01:38:45.540
So I just never opted to try and take it.
link |
01:38:48.140
I do want, we're sort of erring in this direction,
link |
01:38:50.420
but we went straight from the six pillars to TRT
link |
01:38:54.240
or to what some people now call sports TRT,
link |
01:38:56.820
which is basically code language for saying,
link |
01:38:59.960
taking exogenous testosterone,
link |
01:39:02.440
even though one doesn't need it to get into a semi
link |
01:39:05.420
super physiological range or a high end,
link |
01:39:09.860
like 900 to a thousand nanogram per deciliter range.
link |
01:39:12.460
And people always point out, I should mention that,
link |
01:39:14.780
oh, well in certain countries,
link |
01:39:15.980
the high end range is 1200 nanograms per deciliter.
link |
01:39:18.700
In the US it's 900.
link |
01:39:19.820
And so if you're 1200, are you really super physiological?
link |
01:39:22.680
All that aside,
link |
01:39:24.420
I neglected to ask about that gap in between
link |
01:39:27.460
where individuals could think about supplementation,
link |
01:39:30.900
meaning non-prescription approaches
link |
01:39:32.480
to increasing testosterone.
link |
01:39:33.880
And here we should probably also talk about things like,
link |
01:39:36.580
is it true that ice baths increase testosterone or not?
link |
01:39:40.520
Lifestyle factors that go beyond the six pillars
link |
01:39:43.160
for increasing testosterone.
link |
01:39:44.560
If you could comment on those, that would be terrific.
link |
01:39:46.520
Supplements that are useful.
link |
01:39:47.900
And it'd be wonderful if you can mention
link |
01:39:50.320
where some of these same practices and supplements
link |
01:39:52.620
might be useful for women as well as men
link |
01:39:55.100
to increase testosterone
link |
01:39:56.340
for all the reasons we talked about earlier.
link |
01:39:58.180
Yeah, so this is where a true individualized approach
link |
01:40:01.460
comes in.
link |
01:40:02.660
When you're talking about what dose of TRT you should be on,
link |
01:40:06.480
one thing to keep in mind
link |
01:40:07.520
is the law of diminishing returns.
link |
01:40:10.680
Quality of life is a subjective thing
link |
01:40:13.880
and it's different for each person.
link |
01:40:15.480
So some people are more willing to give up
link |
01:40:17.860
a little bit of athleticism or body composition.
link |
01:40:21.180
Some people are more willing to give up
link |
01:40:22.980
or not willing to give up libido or sexual health.
link |
01:40:26.640
And as we mentioned earlier,
link |
01:40:28.520
everybody's androgen receptor is less or more sensitive.
link |
01:40:32.560
So you can make a case that if somebody's androgen receptor
link |
01:40:36.120
is half as sensitive as somebody else,
link |
01:40:40.060
the person with the less sensitive receptor
link |
01:40:42.680
does need a level of 1000 or 1200.
link |
01:40:46.620
There's no great way to know that.
link |
01:40:47.980
And you can alter the sensitivity of your androgen receptor
link |
01:40:50.220
with things like L-carnitine and tadalafil as mentioned.
link |
01:40:53.040
And we'll definitely come back to L-carnitine
link |
01:40:54.680
because I'm really intrigued by the data on L-carnitine,
link |
01:40:58.220
both for women and men in terms of egg quality,
link |
01:41:00.960
sperm quality, fertility,
link |
01:41:02.160
and a bunch of other interesting effects.
link |
01:41:03.800
So we'll come back to L-carnitine.
link |
01:41:05.400
But a lot of how you feel, the biofeedback or subjective,
link |
01:41:09.920
I feel like this comes from the ratio of your androgens
link |
01:41:13.360
to your estrogens.
link |
01:41:14.880
And a lot of that is lifestyle.
link |
01:41:16.600
So if someone's also an HCG,
link |
01:41:18.240
that could upregulate aromatase as well.
link |
01:41:20.640
HCG, you might want to just, human chorionic gonadotropin,
link |
01:41:25.600
found, used to be found in pregnant,
link |
01:41:27.040
is still found in pregnant women's urine.
link |
01:41:28.440
But used to be, believe it or not,
link |
01:41:31.280
there was a black market for pregnant women's urine
link |
01:41:34.540
before this stuff was developed synthetically.
link |
01:41:36.920
So in other words, what we're saying is,
link |
01:41:38.880
men typically would buy pregnant women's urine
link |
01:41:42.640
through black markets in order to get the HCG,
link |
01:41:46.280
in order to get the testosterone enhancing effects of HCG.
link |
01:41:49.960
So in other words,
link |
01:41:50.800
men were using pregnant women's urine for HCG.
link |
01:41:52.720
I do not want to know how they got it into their body.
link |
01:41:55.200
Let's just skip to what you were going to say next instead.
link |
01:41:57.760
Yeah, so that's HCG.
link |
01:42:00.800
There's a lot of other things that upregulate estrogen.
link |
01:42:03.200
Alcohol significantly increases aromatase.
link |
01:42:06.680
So if you're very sensitive to estrogen,
link |
01:42:08.240
then you probably shouldn't even consume the two glasses
link |
01:42:11.520
three times a week.
link |
01:42:13.600
High fat meals also upregulate aromatase.
link |
01:42:16.880
So if you're on a ketogenic diet,
link |
01:42:18.960
but you have hyper-estrogenism,
link |
01:42:21.160
then you should take care with that as well.
link |
01:42:23.280
All kinds of fats or just saturated fats?
link |
01:42:25.720
I'm not sure if it's just saturated fats,
link |
01:42:27.600
but fat definitely increases both fat in your body
link |
01:42:31.240
and consumption of a high amount of calories
link |
01:42:34.200
increases aromatase.
link |
01:42:35.240
So it's the ratio of testosterone to estrogen.
link |
01:42:37.120
I don't want to break your flow,
link |
01:42:38.040
but since we're talking about fat,
link |
01:42:39.520
I have to ask since estrogen and testosterone
link |
01:42:41.640
are both synthesized from the cholesterol molecule,
link |
01:42:44.200
I've heard that ingesting some amount of saturated fat
link |
01:42:49.560
can be useful because of the way that cholesterol
link |
01:42:51.800
can serve as a precursor to these molecules.
link |
01:42:55.200
Now, I once said on a podcast that I like butter so much
link |
01:42:58.320
that I occasionally eat pats of butter.
link |
01:43:00.080
Somehow that got misinterpreted to mean
link |
01:43:02.880
that I eat entire many pats of butter.
link |
01:43:05.080
I'm talking like one or two pats of butter here and there,
link |
01:43:07.400
and I have no guilt or shame about it.
link |
01:43:08.760
My blood lipids are in great shape also,
link |
01:43:10.480
so I feel good.
link |
01:43:11.520
But is it possible that people who are ingesting
link |
01:43:15.200
too little of saturated fats could directly or indirectly
link |
01:43:21.880
reduce or somehow disrupt the proper ratio
link |
01:43:24.600
of testosterone to estrogen in men and women?
link |
01:43:27.040
It's theoretically possible,
link |
01:43:28.520
but it probably doesn't happen in developed countries,
link |
01:43:31.880
just like it's theoretically possible
link |
01:43:33.560
to have not enough omega-6 fatty acids,
link |
01:43:36.280
but that probably does not happen in developed countries.
link |
01:43:38.520
So I don't need the butter pats,
link |
01:43:40.000
but I'm going to do it anyway.
link |
01:43:41.600
I'm just curious.
link |
01:43:42.440
Yeah. Okay.
link |
01:43:43.280
Grass-fed butter has good omega-3 content as well.
link |
01:43:46.440
So grass-fed foods in general,
link |
01:43:49.440
you know, it's not the end all be all,
link |
01:43:51.040
and everybody doesn't need grass-fed foods,
link |
01:43:53.520
but they are one of the only sources of healthy trans fat.
link |
01:43:57.320
So a naturally occurring trans fat comes from ruminants.
link |
01:44:01.240
So ruminants that I think of like cows
link |
01:44:04.400
and the rumination in the different stomachs
link |
01:44:09.400
can change your omega-3 and omega-6
link |
01:44:12.440
to trans linolenic and trans linoleic fatty acids.
link |
01:44:16.800
Which are healthy for us.
link |
01:44:17.640
Yeah, so it's actually omega-3s and omega-6s
link |
01:44:20.680
that just happened to have a trans instead of a cis isomer.
link |
01:44:24.400
So, and these healthy trans fats would be found
link |
01:44:28.200
in ruminant cheese and milk and butter from ruminants
link |
01:44:32.280
and the meats?
link |
01:44:34.440
Yes.
link |
01:44:35.440
So, and for people who are following
link |
01:44:36.760
a purely plant-based diet or mostly plant-based diet,
link |
01:44:40.920
are they at risk of not getting enough
link |
01:44:43.480
of certain types of fats or other nutrients
link |
01:44:45.280
to maintain that healthy ratio of testosterone to estrogen
link |
01:44:48.680
or not?
link |
01:44:49.520
If they're a vegetarian, they're probably not at risk.
link |
01:44:51.520
If they're a vegan, they very well could be at risk.
link |
01:44:54.720
Most vegans are aware of this very acutely
link |
01:44:59.000
and they'll supplement with, you know, algae
link |
01:45:03.480
or they'll supplement with other sources of healthy fats.
link |
01:45:07.680
I see.
link |
01:45:08.520
So, the takeaway that I'm drawing from this
link |
01:45:10.920
is that less so than getting saturated fat,
link |
01:45:14.800
it's key to get these healthy trans fats from ruminants
link |
01:45:19.200
or the food products of those ruminants
link |
01:45:21.000
as well as to get proper amounts of omega-3s.
link |
01:45:25.960
And to be clear, you don't need any trans fats.
link |
01:45:28.200
It just happens that those omega-3s and omega-6s
link |
01:45:31.520
are in a trans isomer.
link |
01:45:33.560
I see.
link |
01:45:34.400
Okay, so that's nutrition.
link |
01:45:35.280
What other supplements can support
link |
01:45:37.120
healthy testosterone to estrogen ratios?
link |
01:45:39.640
Anything that alters aromatase
link |
01:45:42.520
can support healthy testosterone to estrogen.
link |
01:45:45.320
And your testosterone to estrogen ratio,
link |
01:45:50.560
think about it as how much estrogen activity
link |
01:45:53.760
do you have at the beta estradiol receptor
link |
01:45:55.840
and your alpha estradiol receptor.
link |
01:45:57.720
How would I know that?
link |
01:45:58.560
So, it's hard to tell, but depending on what you're eating,
link |
01:46:03.480
if you have a lot of plant-based diets or polyphenols,
link |
01:46:06.400
many of these are beta estradiol receptors.
link |
01:46:09.540
People know about turkestrone and also beta-ectisterone,
link |
01:46:13.320
which are two ectisteroids
link |
01:46:14.880
that are beta estradiol receptor agonists.
link |
01:46:17.680
So, they activate the beta estradiol receptor.
link |
01:46:20.600
So, if you have a very low amount of estrogen naturally,
link |
01:46:23.160
you're probably a better candidate for it.
link |
01:46:24.800
For taking to turkestrone or ectisterone.
link |
01:46:27.720
I've never tried them, but I know my understanding
link |
01:46:30.800
is that they work tremendously well for some people
link |
01:46:34.000
and not at all for others.
link |
01:46:35.280
And so, one just simply has to try.
link |
01:46:37.040
But in promoting the activity of this estrogen receptor,
link |
01:46:41.400
is there a risk that turkestrone or ectisterone
link |
01:46:43.800
could cause some of the quote-unquote problems
link |
01:46:46.860
associated with increasing estrogen activity,
link |
01:46:49.800
like reduced libido, water retention?
link |
01:46:52.880
Water retention, yes. Reduced libido, probably not.
link |
01:46:58.360
Closing growth plates in the bone, no,
link |
01:47:00.220
because that's the alpha estradiol receptor.
link |
01:47:03.140
I've talked before on a couple of podcasts
link |
01:47:05.600
about tonga ali, which is this Indonesian herb.
link |
01:47:09.920
I guess it's also made and found in Malaysia,
link |
01:47:13.220
but it seems to be the Indonesian variety of tonga ali
link |
01:47:16.480
that's most effective for potentially
link |
01:47:19.180
for reducing sex hormone and binding globulin
link |
01:47:21.740
and thereby freeing up testosterone.
link |
01:47:24.220
Whether or not the effects are through that pathway,
link |
01:47:26.380
through another pathway,
link |
01:47:27.740
a lot of people report improvements in things like libido
link |
01:47:31.540
and maybe androgen-like phenotypes, right?
link |
01:47:36.120
Feeling more vital, et cetera.
link |
01:47:37.660
And of course, some of that could be placebo, correct?
link |
01:47:40.520
But what are your thoughts on tonga ali?
link |
01:47:42.580
And please challenge my statements about tonga ali
link |
01:47:45.080
if they're incorrect.
link |
01:47:45.920
I'm not looking for validation here.
link |
01:47:48.120
I just really want to know what your thoughts are on it.
link |
01:47:50.480
Do you ever recommend it to patients?
link |
01:47:52.980
When men, women, one or the other?
link |
01:47:56.580
Yeah, so tongkat ali or long jack,
link |
01:48:00.380
it has multiple mechanisms of action
link |
01:48:02.420
and there have been several placebo-controlled studies on it.
link |
01:48:06.840
Some of them show decrease in SHBG.
link |
01:48:09.060
At least one of them did not show any change in SHBG.
link |
01:48:12.380
However it is, it does act on aromatase very weakly,
link |
01:48:16.380
probably not so strongly that you would have to be concerned
link |
01:48:18.900
with hypoestrogenism.
link |
01:48:20.700
So it reduces aromatase and thereby can reduce estrogen?
link |
01:48:24.820
Correct. Okay.
link |
01:48:25.640
It's also a weak, it's not a CIRM,
link |
01:48:28.540
so it's not a selective estrogen receptor modifier,
link |
01:48:31.620
but it's probably a weak, it's probably an ERM as well,
link |
01:48:34.960
or a non-selective estrogen receptor modifier.
link |
01:48:38.340
And that should help with decreasing negative feedback
link |
01:48:42.100
inhibition of estradiol in various locations
link |
01:48:45.820
and also increasing testosterone.
link |
01:48:47.820
Interesting. Yeah, the dosage that I've been using
link |
01:48:49.740
for years now is, I think it's 400 milligrams
link |
01:48:52.940
taken once a day, typically early in the day,
link |
01:48:56.180
cause it can kind of have a mild stimulant effect,
link |
01:48:58.740
very mild.
link |
01:49:00.580
And I know that some of the products out there
link |
01:49:02.540
recommend dosages that are much higher.
link |
01:49:04.380
Anytime I've taken more than 400, I don't feel very good.
link |
01:49:07.940
I don't know how to describe it other than it's just
link |
01:49:09.980
a little over stimulatory in terms of,
link |
01:49:12.420
makes me kind of, it's like drinking too much coffee.
link |
01:49:15.320
Yeah. So that's interesting.
link |
01:49:18.460
And so would women ever want to take Tonga Ali
link |
01:49:22.800
for any reason?
link |
01:49:23.680
Yeah, absolutely.
link |
01:49:25.040
So there's a lot of women that have hyper-estrogenism
link |
01:49:28.760
and unlike adrenal fatigue or andropods,
link |
01:49:31.600
there's actually ICD-10 codes for hyper-estrogenism.
link |
01:49:35.040
ICD-10 codes?
link |
01:49:36.160
Yeah. That's doctor speak, right?
link |
01:49:37.520
So there's codes to where your doctor
link |
01:49:40.080
can actually diagnose you with something.
link |
01:49:41.480
So if you go to your doctor and you say,
link |
01:49:43.080
I have adrenal fatigue,
link |
01:49:44.020
they can't diagnose you with that.
link |
01:49:45.840
Or if you say, I have andropods,
link |
01:49:47.240
they also can't diagnose you with that.
link |
01:49:50.400
But if you say you have hyper-estrogenism,
link |
01:49:52.840
the most common complaint that comes with it
link |
01:49:55.000
is endometriosis, which is overgrowth
link |
01:49:57.720
of the lining of the uterus.
link |
01:50:00.300
And those people could potentially,
link |
01:50:03.320
I think that's one area where we might see
link |
01:50:06.400
Tongkat supplementation more and more,
link |
01:50:09.520
because not only does it decrease aromatase,
link |
01:50:11.920
like we mentioned, testosterone in females is higher
link |
01:50:14.120
than estrogen in females.
link |
01:50:15.800
So a lot of females get estrogen from aromatization as well.
link |
01:50:19.580
Peripheral estrogen is sometimes what we call it,
link |
01:50:21.920
because it's not directly produced in the ovaries,
link |
01:50:25.000
but they could be good candidates for Tongkat
link |
01:50:26.760
if that's the case.
link |
01:50:27.820
Very interesting.
link |
01:50:28.660
And my understanding is that people should be looking
link |
01:50:30.440
for sources of Indonesian Tongkat, Ali, in particular.
link |
01:50:33.480
Correct.
link |
01:50:34.300
Another interesting application is essentially a,
link |
01:50:38.120
I'll call it a PCT, but essentially what that means is,
link |
01:50:41.080
PCT means how defined it is, post-cycle therapy.
link |
01:50:44.440
Physicians love acronyms, scientists love acronyms,
link |
01:50:46.480
military love acronyms, but yeah, PCT, post-cycle therapy.
link |
01:50:49.620
So this would be people coming off hormone therapy
link |
01:50:51.640
or steroids.
link |
01:50:52.480
This would actually be for women that are coming off
link |
01:50:54.780
of their birth control pill,
link |
01:50:56.240
because perhaps it can help lower that SHBG back to normal,
link |
01:50:59.200
which is sometimes persistently elevated,
link |
01:51:01.200
and then it can help prevent
link |
01:51:02.800
the subsequent hyper-estrogenism that happens.
link |
01:51:05.840
Does Tongkat, Ali, need to be cycled?
link |
01:51:07.640
When I first started taking it, I would cycle it.
link |
01:51:09.620
I would do a few, three, four months,
link |
01:51:11.220
and I would take some time off.
link |
01:51:12.180
Now I've just been taking it continuously for years.
link |
01:51:14.960
And I should say, I do blood work to check my liver enzymes
link |
01:51:18.100
and everything else.
link |
01:51:18.940
And I don't see any reason for me to cease taking it.
link |
01:51:23.680
Yeah, probably not.
link |
01:51:25.820
There's been human studies on both Tongkat and Fidosia.
link |
01:51:28.640
And full disclosure, I did help design
link |
01:51:30.980
Derek's new testosterone optimization supplement,
link |
01:51:34.180
which has both Fidosia arrestris
link |
01:51:36.440
and also Tongkat, Ali, in it.
link |
01:51:38.160
Yeah, let's talk about Fidosia separately in a moment.
link |
01:51:40.400
But let's say someone is only taking Tongkat, Ali
link |
01:51:44.680
for whatever reason, but do they need to cycle off?
link |
01:51:48.280
Likely not, but I would just to be safe
link |
01:51:51.000
because it does both affect your aromatase
link |
01:51:54.100
and it's an estrogen receptor modifier.
link |
01:51:57.860
And what would be a reasonable cycle off?
link |
01:52:00.980
So how long to take and how long to stop
link |
01:52:03.840
before taking again?
link |
01:52:04.960
Yeah, there's a couple different protocols
link |
01:52:07.840
that you can do, but 11 months on,
link |
01:52:10.420
one month off for Tongkat is pretty reasonable.
link |
01:52:13.200
Now, I guess this is, we'll talk about this later too,
link |
01:52:15.880
but if it's combined with Fidosia,
link |
01:52:17.980
the protocol that I would do is three weeks on,
link |
01:52:21.280
one week off.
link |
01:52:23.080
So that's Tongkat, Ali.
link |
01:52:24.680
But I'm curious what your thoughts are
link |
01:52:26.740
on Fidosia aggressis, this Nigerian shrub,
link |
01:52:30.340
or this extract from Nigerian shrubs,
link |
01:52:32.720
that at least in my experience,
link |
01:52:34.340
in my read of the literature,
link |
01:52:35.680
has the potential to increase testosterone
link |
01:52:38.280
and probably other hormones as well
link |
01:52:40.680
by way of increasing luteinizing hormone,
link |
01:52:42.880
something that we haven't really talked about
link |
01:52:44.540
much up until now.
link |
01:52:45.880
What are your thoughts about Fidosia aggressis?
link |
01:52:48.360
What are your ideas about the proposed mechanism
link |
01:52:51.240
or mechanisms and where might this be useful
link |
01:52:55.080
for people on or off hormone replacement therapy?
link |
01:53:00.320
Yeah, Fidosia aggressis has just reached a point
link |
01:53:04.480
where we have enough evidence to we know
link |
01:53:06.640
it probably helps both with luteinizing hormone release,
link |
01:53:10.360
which stimulates latex cells in the testes
link |
01:53:12.360
to produce more testosterone,
link |
01:53:14.160
and probably with LH receptor sensitivity as well,
link |
01:53:18.940
which is a good combination of the two.
link |
01:53:22.080
It does come from the Nigerian shrub,
link |
01:53:24.520
but there is not quite enough evidence
link |
01:53:27.880
for me to be able to say,
link |
01:53:30.660
it's safe for somebody to take this all the time,
link |
01:53:33.360
which again, full disclosure,
link |
01:53:35.080
that's why I recommended that we,
link |
01:53:38.080
recommended for people to cycle this supplement.
link |
01:53:41.700
So three weeks on, one week off, that's likely safe.
link |
01:53:46.480
The only toxicity studies in general are in rats
link |
01:53:49.640
and in humans, it looks quite safe.
link |
01:53:51.620
My understanding is that the toxicity studies in rats
link |
01:53:55.320
showed toxicity to the testicular cells.
link |
01:53:59.800
So that's certainly concerning,
link |
01:54:01.180
but that the dosages that were used
link |
01:54:04.160
or translating the dosages used to humans
link |
01:54:07.500
would lead to a situation where the dosages
link |
01:54:09.900
that humans would have to take would be very, very large.
link |
01:54:12.440
So the amount of, I no longer take Fidosia,
link |
01:54:15.780
but I took it at 600 milligrams per day for a long time.
link |
01:54:19.080
And I ceased taking it because I was experimenting
link |
01:54:22.320
with other things and I didn't want to confound those things,
link |
01:54:25.480
not because I had any negative side effects.
link |
01:54:27.800
In fact, I was monitoring blood work
link |
01:54:29.360
and other biological parameters
link |
01:54:31.920
that would have told me if there was testicular toxicity
link |
01:54:35.040
and there wasn't, let's put it that way.
link |
01:54:36.860
Yeah, I think it's extremely safe.
link |
01:54:38.400
And I'm just not convinced
link |
01:54:41.800
that there's enough overwhelming evidence
link |
01:54:44.160
for long-term consistent administration.
link |
01:54:48.760
So do you recommend this to people who are not taking TRT?
link |
01:54:53.360
And do you recommend to men and women?
link |
01:54:55.520
Yeah, so if you have a really high LH,
link |
01:54:58.620
then there's probably a gonadal issue,
link |
01:55:01.280
whether it's heat damage to the testes, a varicocele,
link |
01:55:05.240
a history of testicular cancer,
link |
01:55:06.720
where your LH is going to be higher.
link |
01:55:09.160
So if your LH is already very high,
link |
01:55:11.220
increasing it even more is probably not going to help.
link |
01:55:14.000
However, if your LH is low,
link |
01:55:16.080
then obviously try to find out if it is low.
link |
01:55:18.260
Is it deficient or is it just a little bit low?
link |
01:55:20.880
If it's low and you don't have an issue with prolactin,
link |
01:55:23.320
you don't have an issue with opioid receptor antagonism,
link |
01:55:26.840
then naltrexone can actually potentially help antagonize
link |
01:55:29.640
that to increase LH as well,
link |
01:55:31.280
especially in people recovering from opiates
link |
01:55:34.380
or likely even alcohol.
link |
01:55:36.380
So you're looking for a subclinical secondary hypogonadism,
link |
01:55:39.560
which is essentially, just think of that as low LH.
link |
01:55:41.960
So in people with that lower LH and their estrogen is fine
link |
01:55:45.820
and their prolactin is fine,
link |
01:55:48.120
then Fidogia is a particularly good option.
link |
01:55:51.640
Interesting, so three weeks on, one week off
link |
01:55:54.520
for 600 milligrams Fidogia, 400 milligrams Tonga Ali,
link |
01:55:59.400
Indonesian Tonga Ali could potentially be good.
link |
01:56:03.240
And of course, everyone should always check
link |
01:56:04.400
with their physician, clear this, do blood work, et cetera.
link |
01:56:07.120
I would say, we don't just say that to protect us.
link |
01:56:09.120
We say that to protect you,
link |
01:56:11.100
meaning that the consumer is very, very important.
link |
01:56:15.460
You don't want to get,
link |
01:56:16.740
you don't want to fly blind with any of this stuff.
link |
01:56:18.860
You want to do blood work, right?
link |
01:56:20.320
That's the catch-22 with supplements,
link |
01:56:21.960
is most of them are safer than medications,
link |
01:56:24.160
but the only difference between them and a medication
link |
01:56:26.520
is one's prescribed and one's not.
link |
01:56:28.680
And oftentimes with supplements,
link |
01:56:30.100
it's unclear whether or not what's listed on the bottle
link |
01:56:32.400
is actually what's in the bottle,
link |
01:56:33.680
but I think there are a number of reputable brands now.
link |
01:56:38.080
The other supplement I want to talk about
link |
01:56:41.360
in terms of testosterone augmentation is Boron.
link |
01:56:44.620
What is Boron thought to do?
link |
01:56:46.560
Does it actually do that?
link |
01:56:47.920
And do you ever recommend Boron?
link |
01:56:50.400
Yeah, so Boron is actually an element
link |
01:56:53.320
and you can find it on the periodic table.
link |
01:56:55.880
It's more plentiful in rich soils.
link |
01:56:59.120
So frequent farming can deplete the soils of Boron.
link |
01:57:03.120
It's very plentiful in the Mediterranean area,
link |
01:57:04.960
like Greece and Turkey.
link |
01:57:06.440
So a lot of people will just eat dates or raisins
link |
01:57:09.420
that are grown there.
link |
01:57:10.260
I thought you were going to tell me people eat dirt,
link |
01:57:11.440
but there are people who eat dirt.
link |
01:57:13.280
And there's a phenomenon called pica, right?
link |
01:57:15.880
Where people in a, and that's not a good thing.
link |
01:57:19.240
Often a sign of iron deficiency.
link |
01:57:21.100
Okay, but they're eating grapes and dates
link |
01:57:23.320
that were grown in soil that has high amounts of Boron?
link |
01:57:26.120
Is that right?
link |
01:57:26.960
Yeah, yeah.
link |
01:57:27.780
So Boron can help regulate SHBG,
link |
01:57:30.280
but its effect is mostly acute.
link |
01:57:32.680
So it's unlikely to have a bad effect.
link |
01:57:36.040
So a lot of people take Boron
link |
01:57:37.320
because it's probably not going to hurt
link |
01:57:39.520
and it will lower SHBG,
link |
01:57:42.120
even if it is for a short period of time.
link |
01:57:45.400
So I guess you can make a case
link |
01:57:46.440
that maybe cycling Boron can help too.
link |
01:57:48.800
What sorts of dosages are useful for Boron supplementation?
link |
01:57:52.880
Three to six milligrams, once to twice a day.
link |
01:57:55.160
Oh, interesting.
link |
01:57:55.980
So that's higher than the amounts that I've been taking.
link |
01:57:58.600
I've long been doing this cocktail of Tonga Ali.
link |
01:58:02.040
Again, I stopped taking Fidogia,
link |
01:58:03.560
but for a long time with Fidogia and Boron,
link |
01:58:07.120
I think it was two to four milligrams per day,
link |
01:58:08.880
but maybe I could afford to go higher.
link |
01:58:10.440
Although my blood work is where I want it, thankfully.
link |
01:58:13.500
Sort of circling back to Fidogia,
link |
01:58:15.920
Fidogia was attractive to me as a supplement
link |
01:58:19.140
because I saw increases in LH,
link |
01:58:21.440
testosterone and free testosterone.
link |
01:58:23.520
My estrogen stayed in check,
link |
01:58:25.360
but I also did not see a down regulation of LH
link |
01:58:29.600
when I would cycle off.
link |
01:58:31.640
Whereas with HCG, human cortionic gonadotropin,
link |
01:58:35.600
which does now arrive in forms
link |
01:58:39.880
not from pregnant women's urine only,
link |
01:58:41.760
but the synthetic forms that people inject,
link |
01:58:43.960
that as I understand it can actually suppress hormone,
link |
01:58:47.880
endogenous hormone output
link |
01:58:49.120
if one takes it for a long period of time.
link |
01:58:50.580
So why would a man or woman want to take HCG
link |
01:58:54.080
and what are the potential risks and benefits of taking HCG?
link |
01:58:58.280
Yeah, so HCG or human cortionic gonadotropin
link |
01:59:01.800
is actually very similar to TSH.
link |
01:59:04.640
So if you- Thyroid stimulating hormone.
link |
01:59:06.120
Correct.
link |
01:59:07.080
So when a woman is pregnant, she produces more HCG,
link |
01:59:11.960
especially in the first trimester.
link |
01:59:14.120
When you take a pregnancy test,
link |
01:59:15.440
whether it's qualitative or quantitative,
link |
01:59:17.860
you see the HCG rise and it actually doubles every 48 hours.
link |
01:59:22.720
So if you're five weeks pregnant, you can get an HCG level.
link |
01:59:26.240
And then two days later, five weeks and two days,
link |
01:59:29.040
you can see your HCG and maybe it went from 500 to 1,000.
link |
01:59:33.220
So it precipitously increases.
link |
01:59:37.420
It does a few things.
link |
01:59:39.060
One thing is it prevents hypothyroidism
link |
01:59:42.040
or hypothyroxinemia of pregnancy,
link |
01:59:44.820
which is one of the most common causes of miscarriage.
link |
01:59:48.260
It's also why if you have hypothyroidism
link |
01:59:52.740
and you get pregnant in the first trimester,
link |
01:59:54.920
you want to increase your dose from 25 to 40%
link |
01:59:58.840
to keep your free T4 high as much as possible.
link |
02:00:02.200
And the reason why you have to do that
link |
02:00:04.060
as opposed to somebody who does not have hypothyroidism
link |
02:00:07.360
is if you have hypothyroidism,
link |
02:00:08.860
then likely your thyroid will not respond
link |
02:00:11.760
to either TSH or HCG.
link |
02:00:15.480
So the increased HCG does not compensate for that.
link |
02:00:18.800
So if you take HCG,
link |
02:00:20.840
then it can potentially improve your thyroid function.
link |
02:00:23.600
So that along with selenium are likely the two best things
link |
02:00:26.960
that you can do for thyroid health.
link |
02:00:28.520
HCG and selenium?
link |
02:00:30.240
Well, I definitely make sure I get enough selenium
link |
02:00:33.060
by eating three to five Brazil nuts per day,
link |
02:00:37.000
which I very much enjoy the taste of also.
link |
02:00:40.880
Who should take HCG and can HCG suppress
link |
02:00:44.460
one's normal luteinizing hormone output?
link |
02:00:47.040
Yeah, it suppresses LH in a dose dependent manner.
link |
02:00:51.080
So the higher the dose of HCG you take,
link |
02:00:53.960
the more it suppresses LH.
link |
02:00:55.560
A common dose for fertility,
link |
02:00:57.520
fertility is usually why HCG is prescribed.
link |
02:01:00.120
In men or women?
link |
02:01:01.080
In both, is 10,000 IUs all at one time,
link |
02:01:06.080
which is quite a bit.
link |
02:01:07.600
That's a tremendous dose.
link |
02:01:10.080
Yeah, in fact, some formulations,
link |
02:01:11.920
some brand names of HCG come in auto injector pins
link |
02:01:15.840
to where you cannot even dose
link |
02:01:17.320
lower than 5,000 units at a time.
link |
02:01:19.640
Wow, but I know a number of people
link |
02:01:21.720
who take HCG to maintain testicular function
link |
02:01:24.220
while on testosterone therapy or augmentation of some sort.
link |
02:01:28.360
Does it work to do that?
link |
02:01:30.600
Yeah, some people are on HCG model therapy.
link |
02:01:34.460
It can be slightly better on your lipids than being on TRT.
link |
02:01:40.120
Oh, so people are using HCG alone
link |
02:01:42.440
as a kind of a sort of a hormone augment,
link |
02:01:46.280
indirect hormone augmentation.
link |
02:01:48.240
Some clinics advertise it
link |
02:01:49.640
as a non-suppressive alternative to TRT,
link |
02:01:54.720
but it is suppressive of LH.
link |
02:01:56.460
But it could also increase estrogen pretty potently.
link |
02:01:58.900
Yeah.
link |
02:01:59.740
And is it true that increasing LH
link |
02:02:01.760
and or HCG can improve sensitivity of the genitals?
link |
02:02:08.340
And is that true for men and women?
link |
02:02:09.900
I've heard this anecdotally.
link |
02:02:11.060
People say HCG makes sexual activity
link |
02:02:14.200
more pleasurable for people because of some,
link |
02:02:17.060
is it a direct effect on some of the nerve cells
link |
02:02:20.300
in the genitals?
link |
02:02:21.860
Yeah, so LH is also an agonist in the prostate
link |
02:02:26.380
and in genital tissue in general.
link |
02:02:29.140
So it's a very common treatment
link |
02:02:32.380
for post finasteride syndrome or post 5-alpha reductase.
link |
02:02:36.220
When you've blocked the conversion of DHT for a long time,
link |
02:02:39.660
it helps re-upregulate DHT.
link |
02:02:42.580
So someone who's been taking finasteride
link |
02:02:44.420
to prevent hair loss comes off,
link |
02:02:46.440
it feels maybe because they felt lousy,
link |
02:02:49.120
but then feels even lousier
link |
02:02:50.540
for reasons that you talked about earlier.
link |
02:02:52.060
And then they might use HCG as a transition treatment
link |
02:02:55.560
to transition back to normal hormone health.
link |
02:02:58.980
Is that right?
link |
02:02:59.820
It's extremely helpful in many cases.
link |
02:03:02.240
Now, when you come off the HCG,
link |
02:03:03.580
then you need to have a strategy
link |
02:03:04.660
of how to return to your normal
link |
02:03:06.700
as fast as possible as well,
link |
02:03:08.600
but it will upregulate those 5-alpha reductase enzymes.
link |
02:03:11.540
You have in your genital skin,
link |
02:03:13.120
both scretal skin and penile skin and perineum in general,
link |
02:03:17.180
you have, I believe it's called stratum lucidum.
link |
02:03:20.260
It's a skin layer that is very, very thin,
link |
02:03:24.020
but it has the highest concentration of 5-alpha reductase.
link |
02:03:28.420
So you have a lot of activity
link |
02:03:30.820
and after you've been on something
link |
02:03:32.700
that inhibits the enzyme, the 5-AR enzyme in those tissues,
link |
02:03:38.220
then you do something else to upregulate those enzymes.
link |
02:03:41.460
Whether it's waiting and taking time,
link |
02:03:43.620
whether it's trying Tidalafil,
link |
02:03:45.420
whether it's trying creatine even,
link |
02:03:47.940
or whether it's trying HCG,
link |
02:03:50.300
a lot of times those are the go-tos
link |
02:03:51.700
for post-finasteride syndrome.
link |
02:03:53.420
Any risks for women taking HCG
link |
02:03:56.060
on their ability to get pregnant or risk generally?
link |
02:04:02.180
Yeah, obviously it'll make any pregnancy test positive.
link |
02:04:05.240
So that's a risk that some women don't know.
link |
02:04:07.720
So one could in theory fake a pregnancy test
link |
02:04:09.880
by injecting HCG?
link |
02:04:10.980
Absolutely.
link |
02:04:11.860
Interesting.
link |
02:04:13.500
I have no motivation to do that.
link |
02:04:15.660
I was just curious.
link |
02:04:19.040
What about prolactin?
link |
02:04:22.480
The simple version of this that I was taught,
link |
02:04:24.660
because I was taught mainly
link |
02:04:26.020
from the neuroendocrine perspective,
link |
02:04:27.660
was dopamine is a kind of close cousin of testosterone
link |
02:04:31.140
and also estrogen, for that matter,
link |
02:04:33.420
drives repetitive behaviors,
link |
02:04:34.800
including pursuit of sexual partners, sex itself,
link |
02:04:38.400
motivated behaviors generally.
link |
02:04:40.180
Then post-copulatory, post-orgasmic states
link |
02:04:45.020
are accompanied by a prolactin increase,
link |
02:04:46.940
sets the refractory period for mating in males
link |
02:04:48.900
and maybe even in females as well,
link |
02:04:51.520
involved in milk letdown, et cetera.
link |
02:04:53.980
What are sort of the general contours of syndromes
link |
02:04:57.260
or things that people could be on the lookout for
link |
02:04:59.380
of having too much prolactin or too little prolactin?
link |
02:05:03.260
And I'm aware of a number of people
link |
02:05:05.460
who take dopamine agonists, L-tyrosine, cabergoline,
link |
02:05:10.120
things like that, to really boost their dopamine levels.
link |
02:05:13.020
And that isn't always a good thing, as it turns out.
link |
02:05:15.540
Oftentimes people will become kind of hyper dopaminergic.
link |
02:05:18.220
And so they have the drive to do all these repetitive things,
link |
02:05:21.220
you know, fill in the blanks,
link |
02:05:23.020
but they don't always have the ability
link |
02:05:25.260
because it seems just as testosterone and estrogen
link |
02:05:27.660
need to be in the proper ratios,
link |
02:05:29.240
dopamine and prolactin need to be
link |
02:05:30.680
in the appropriate ratios.
link |
02:05:32.340
So how should we think about
link |
02:05:34.540
and perhaps act on our prolactin systems?
link |
02:05:37.520
Absolutely.
link |
02:05:38.740
The way I describe it is the dopamine wave pool.
link |
02:05:41.500
So if you're increasing your dopamine too much,
link |
02:05:44.180
you're going to overflow,
link |
02:05:45.660
and then you're going to have that wave crash too much.
link |
02:05:47.960
So you want to have nice, even waves
link |
02:05:50.100
that are not going too far above the pool of dopamine
link |
02:05:53.180
and prolactin will follow.
link |
02:05:55.040
So prolactin and estrogen are quite close cousins.
link |
02:05:58.180
Estrogen upregulates a gene called the PRL gene
link |
02:06:01.540
or prolactin gene
link |
02:06:03.100
that directly increases prolactin synthesis.
link |
02:06:06.860
So prolactin is going to also inhibit
link |
02:06:11.280
the release of testosterone from the pituitary.
link |
02:06:14.880
So if you're using a dopamine agonist,
link |
02:06:17.500
then you're going to help decrease
link |
02:06:20.300
the prolactin producing cells,
link |
02:06:22.180
including if you have a prolactin producing
link |
02:06:23.980
micro adenoma in the pituitary.
link |
02:06:26.180
How common are those?
link |
02:06:27.100
Because I mean, I hear a lot about these,
link |
02:06:28.960
you know, hypogonadism or,
link |
02:06:31.300
and of course that can be due to an issue at the testicles
link |
02:06:34.320
or hypogonadism could also be of course
link |
02:06:37.940
in like ovarian syndromes.
link |
02:06:40.540
And then there's of course the brain side of it,
link |
02:06:42.180
where the signals aren't coming from the brain.
link |
02:06:43.700
You're not enough gonadotropin,
link |
02:06:45.740
not enough luteinizing hormone.
link |
02:06:47.140
And there are ways of teasing this apart
link |
02:06:48.700
through with an endocrinologist
link |
02:06:49.980
that are quite elegant in fact, right?
link |
02:06:51.380
Using stimulating hormones, too much to dive into here,
link |
02:06:54.020
but how often does one actually have
link |
02:06:57.040
one of these pituitary tumors?
link |
02:06:59.220
I have heard that people
link |
02:07:01.780
that play a lot of high contact sports,
link |
02:07:03.540
so boxing, football,
link |
02:07:05.700
people that headed the soccer ball quite a lot,
link |
02:07:09.460
sadly people whose jobs forced them to take head blows
link |
02:07:13.500
for, you know, it could be military.
link |
02:07:15.260
And so they were firing, you know, 50 caliber guns
link |
02:07:17.500
and the kind of woodpeckering of the brain
link |
02:07:19.200
inside of the skull and construction workers,
link |
02:07:22.740
or just a concussion can cause the pituitary
link |
02:07:25.660
to go malfunctional.
link |
02:07:27.220
Is that really common or is this something that,
link |
02:07:30.340
you know, is a rare, like 1%?
link |
02:07:33.340
Yeah, it's extremely common.
link |
02:07:34.940
It's another one of those conditions
link |
02:07:36.260
where a lot of people never know they have it.
link |
02:07:39.020
They just feel a little bit more fatigued.
link |
02:07:40.940
They have that high prolactin feeling all the time.
link |
02:07:44.660
Pituitary micro adenomas can be non-producing as well.
link |
02:07:47.880
So your prolactin can be totally normal.
link |
02:07:49.960
Your growth hormone and IGF-1 can be totally normal.
link |
02:07:52.180
That's the second most common producing micro adenoma
link |
02:07:54.820
is growth hormone,
link |
02:07:56.020
causing either acromegaly,
link |
02:07:57.460
which is growth of cartilage or gigantism.
link |
02:07:59.840
This is the big brow, yeah.
link |
02:08:02.900
So those are fairly common causes of adenomas,
link |
02:08:05.740
but a lot of people that have a very small adenoma,
link |
02:08:09.600
you know, much less than one centimeter,
link |
02:08:11.980
it's hard to see on imaging,
link |
02:08:13.500
even if you have a contrast
link |
02:08:15.900
that specifically looks at the pituitary,
link |
02:08:18.300
and many people aren't symptomatic.
link |
02:08:20.720
So it's one of those things along with PCOS and prediabetes
link |
02:08:25.960
that are much more frequent when it comes to prevalence,
link |
02:08:29.940
which is the amount, the percentage of people
link |
02:08:32.700
that have it in the general population.
link |
02:08:35.140
I'm glad you mentioned the dopamine wave pool.
link |
02:08:37.020
I know nowadays there's a lot of interest
link |
02:08:39.240
in augmenting dopamine.
link |
02:08:41.660
I know a number of people that do this
link |
02:08:42.880
through prescription drugs, Adderall, Ritalin, Modafinil,
link |
02:08:46.140
and those drugs, of course, hit many transmitter systems,
link |
02:08:48.300
but dopamine is certainly involved.
link |
02:08:49.820
People taking antidepressants like wellbutrin
link |
02:08:53.020
tap into that system.
link |
02:08:55.000
And of course, people are trying to inhibit prolactin
link |
02:08:58.420
and promote serotonin or reduce serotonin.
link |
02:09:01.140
To me, it all seems like a very delicate dance, right?
link |
02:09:04.460
I mean, to just imagine the arousal arc
link |
02:09:07.560
for mating behavior, for sexual reproduction,
link |
02:09:10.600
is such an elaborate dance between sympathetic drive
link |
02:09:13.980
and parasympathetic drive,
link |
02:09:15.100
even with across the span of minutes, right?
link |
02:09:17.660
I mean, I've talked about this before on the podcast
link |
02:09:19.340
that the arousal is kind of more parasympathetic.
link |
02:09:23.120
Orgasm in itself is a sympathetic response,
link |
02:09:26.260
a completely different set of neurons.
link |
02:09:28.100
And so where do you see people getting into trouble
link |
02:09:31.540
just trying to hit the gas pedal on dopamine?
link |
02:09:34.620
And where do you think there is a place for people
link |
02:09:37.060
who perhaps are experiencing low drive and motivation,
link |
02:09:39.840
not just sexual, but in general,
link |
02:09:42.360
to increase the amount of dopamine circulating
link |
02:09:44.780
in their brain and body?
link |
02:09:45.940
How do you think about that given this wave pool analogy?
link |
02:09:49.420
Yeah, so it's important to parse it out
link |
02:09:51.420
and start with the least powerful interventions.
link |
02:09:55.220
So if someone's concerned about dopamine,
link |
02:09:57.340
or maybe they have a slightly higher prolactin,
link |
02:09:59.960
then they eliminate things
link |
02:10:01.000
that could be increasing that prolactin.
link |
02:10:03.540
So casein or gluten,
link |
02:10:06.620
which are mu opioid receptor agonists,
link |
02:10:09.360
or any mu opioid receptor agonist in the gut.
link |
02:10:12.460
So casein, so milk protein?
link |
02:10:14.360
Correct.
link |
02:10:15.200
Can increase prolactin?
link |
02:10:16.100
Correct.
link |
02:10:17.180
Interesting.
link |
02:10:18.020
In addition to that, they should,
link |
02:10:20.820
if they need a pituitary MRI,
link |
02:10:22.220
then they should get a pituitary MRI.
link |
02:10:23.820
If they don't have an adenoma,
link |
02:10:25.180
or if they don't have a high enough prolactin level
link |
02:10:27.480
to where they need an MRI,
link |
02:10:29.620
if they're having visual symptoms,
link |
02:10:31.060
or if they're having olfactory symptoms with the nose,
link |
02:10:33.920
then it's more likely that they do.
link |
02:10:36.800
But if they don't,
link |
02:10:38.420
a lot of times a prolactin under about 40
link |
02:10:40.900
is not too big of a deal.
link |
02:10:42.740
They can take dopamine agonists
link |
02:10:44.780
that agonize that D2 receptor,
link |
02:10:46.700
like P5P, which is essentially vitamin B6.
link |
02:10:51.020
It's pyridoxine 5-pyrophosphate,
link |
02:10:53.380
and pyridoxine is vitamin B6.
link |
02:10:55.720
So that can help 50 milligrams once to twice a day.
link |
02:10:59.500
Vitamin E can also help,
link |
02:11:01.460
especially if it's mixed to co-forals.
link |
02:11:03.660
A lot of people have the high levels of vitamin E,
link |
02:11:07.540
but low levels of the gamma form of vitamin E.
link |
02:11:11.060
So that can also help.
link |
02:11:12.320
Fascinating.
link |
02:11:13.160
I'm so glad you mentioned vitamin B6 and P5P.
link |
02:11:17.180
I have heard that one can shorten the refractory period
link |
02:11:21.580
after orgasm,
link |
02:11:24.260
essentially to be able to have sex again,
link |
02:11:26.640
to be quite direct about it,
link |
02:11:27.980
by way of vitamin B6 blunting of the prolactin response,
link |
02:11:32.880
which turns out to be quite potent.
link |
02:11:35.420
But I've also heard that vitamin B6 can be neurotoxic,
link |
02:11:38.340
especially in the periphery,
link |
02:11:39.580
that it can cause peripheral neuropathies
link |
02:11:41.160
if it's taken at high doses,
link |
02:11:42.760
but that P5P is the safer form.
link |
02:11:45.580
Is that true?
link |
02:11:46.980
It's pre-activated, so it does not build up.
link |
02:11:50.960
Think of it as a allegory to how folate can build up.
link |
02:11:55.300
It's not methyl folate,
link |
02:11:57.940
but it builds up and it can increase levels of homocysteine.
link |
02:12:01.700
Or if you have too much vitamin B12,
link |
02:12:03.580
another water-soluble B vitamin,
link |
02:12:05.620
you can have too much methylmalonic acid or MMA.
link |
02:12:08.820
So depending on what your enzymatic conversion is
link |
02:12:11.520
to the active form of the enzyme,
link |
02:12:13.460
often it's just safer to take the active form of the enzyme.
link |
02:12:17.020
Yeah, very interesting.
link |
02:12:19.140
Okay, well, at risk of going down every hormonal pathway
link |
02:12:22.180
and talking about supplementation lifestyle factors,
link |
02:12:24.820
I think touching on,
link |
02:12:25.980
as we have testosterone and estrogen and now prolactin,
link |
02:12:29.300
I'd love to chat a little bit about L-carnitine.
link |
02:12:32.140
We talked about this earlier,
link |
02:12:33.260
but I want to raise this discussion about L-carnitine,
link |
02:12:37.020
not in the context of L-carnitine itself,
link |
02:12:39.300
but in the context of fertility,
link |
02:12:42.020
because my read of the literature is that L-carnitine
link |
02:12:45.260
can be very beneficial for enhancing sperm quality
link |
02:12:48.620
and egg quality and even rates of conception.
link |
02:12:53.280
What forms does L-carnitine come in
link |
02:12:55.180
that people can reasonably consider?
link |
02:12:57.860
Again, talk to your doctor, folks.
link |
02:13:00.540
What is it doing and do we know how it's doing it?
link |
02:13:03.580
And do you often use this in your patients?
link |
02:13:07.220
Yeah, so the way I think about L-carnitine,
link |
02:13:10.340
and I'll try to tie this in with creatine
link |
02:13:12.380
and other things as well,
link |
02:13:14.000
is if your cell is an energy factory or a car,
link |
02:13:17.400
then L-carnitine is the shuttle that helps get the fuel
link |
02:13:22.460
into the motor to use the motor.
link |
02:13:24.260
The motor is mostly due to lifestyle factors,
link |
02:13:27.240
so like your diet and your exercise.
link |
02:13:30.600
And the type of fuel itself is NAD+.
link |
02:13:34.620
We don't need to get into NAD precursors
link |
02:13:36.320
or NMN or NR or anything.
link |
02:13:38.480
And then the accessory fuel tank is your creatine phosphate.
link |
02:13:42.020
So creatine is your accessory fuel tank.
link |
02:13:44.540
Your NAD status, which is largely determined
link |
02:13:47.100
by your REM sleep and quality sleep and exercise,
link |
02:13:49.980
along with supplementation, is the fuel.
link |
02:13:52.320
The carnitine shuttle is carnitine palmitoyl coenzyme A,
link |
02:13:57.580
and that takes medium-chain fatty acids.
link |
02:13:59.760
It takes different molecules of fat.
link |
02:14:01.860
You have two main energy sources other than ketones.
link |
02:14:04.500
You have your glucose or carbs.
link |
02:14:06.120
You have your fat or fatty acids.
link |
02:14:08.340
And that takes it across the layer of the mitochondria
link |
02:14:12.380
so that it can be utilized.
link |
02:14:13.940
So it upregulates that.
link |
02:14:15.700
That's why things that have flagella in general,
link |
02:14:18.860
the flagella are gonna work better, like sperm.
link |
02:14:21.220
Flagella being sort of the wavy little tendrils
link |
02:14:24.060
on cell types, of which they're everywhere, right?
link |
02:14:26.100
In the gut too, right?
link |
02:14:27.260
Yeah.
link |
02:14:28.100
So those are going to work significantly better.
link |
02:14:30.240
And in general, your mitochondria are going to work better.
link |
02:14:32.860
So the worse your mitochondria are off the bat,
link |
02:14:35.440
the better they're going to be helped by the shuttle
link |
02:14:38.500
that shuttles them across.
link |
02:14:40.320
It also slightly increases the density
link |
02:14:42.700
of the androgen receptor as well.
link |
02:14:44.980
Is that a local effect?
link |
02:14:46.020
So if alkaline is injected into a particular muscle,
link |
02:14:48.540
will it increase the density of androgen receptors
link |
02:14:50.340
in that muscle?
link |
02:14:51.480
Likely so.
link |
02:14:52.500
So how are people taking L-carnitine,
link |
02:14:54.140
their capsule forms and their injectable forms?
link |
02:14:56.580
Most people are going to be taking the capsule forms
link |
02:14:59.020
because that's all they're going to have access to.
link |
02:15:00.980
And then we should also ask,
link |
02:15:02.020
can you get L-carnitine from food?
link |
02:15:04.020
Yeah.
link |
02:15:04.860
So L-carnitine is just a combination of,
link |
02:15:08.580
it's actually a very small peptide.
link |
02:15:10.380
So glutathione is just three amino acids.
link |
02:15:13.940
L-carnitine is the smallest peptide, two.
link |
02:15:16.820
So peptide is just a protein that has amino acids
link |
02:15:19.460
between two and about 200.
link |
02:15:21.660
And L-carnitine is just two amino acids.
link |
02:15:24.580
Amazing.
link |
02:15:25.420
So it's like a micro peptide.
link |
02:15:27.260
Yeah, so your body synthesizes enough.
link |
02:15:29.500
It likes to absorb the amino acids by themselves.
link |
02:15:32.140
And then if it puts them together,
link |
02:15:34.140
there it makes L-carnitine.
link |
02:15:35.840
It's not very bioavailable if you take it.
link |
02:15:38.540
A lot of people will take L-carnitine L-tartrate
link |
02:15:40.660
or acyl L-carnitine, and that's about 10% bioavailable.
link |
02:15:45.260
So if you want one gram or a thousand milligrams
link |
02:15:48.060
of L-carnitine, you can take 10 grams of oral L-carnitine.
link |
02:15:51.660
Is the one gram, the typical dose you recommend,
link |
02:15:54.580
one gram per day?
link |
02:15:56.020
For fertility and androgen receptor upregulation.
link |
02:15:58.700
So that means taking 10 grams of the capsule form.
link |
02:16:01.500
Yeah, so it's about 15 to 20 capsules, which is a lot.
link |
02:16:05.780
That is a lot.
link |
02:16:06.620
It can also potentially increase TMAO.
link |
02:16:08.500
Yeah, I wanted to ask about that because TMAO
link |
02:16:11.620
on your blood chart is, when that's elevated,
link |
02:16:14.380
that's going to cause some concern.
link |
02:16:16.300
You taught me a trick, however, that one can take
link |
02:16:19.140
600 milligrams of garlic capsule for the allicin.
link |
02:16:23.980
Is that what it's called?
link |
02:16:24.820
Allicin is in it, yeah.
link |
02:16:25.660
It's like the name allicin, but with two Ls?
link |
02:16:27.300
Yeah.
link |
02:16:28.140
Okay.
link |
02:16:29.100
And that had a remarkable effect in reducing TMAO.
link |
02:16:33.360
So that's quite potent.
link |
02:16:34.700
And also, was it just coincidence
link |
02:16:38.440
that it really brought my LDL down as well?
link |
02:16:42.940
I'm not sure if the LDL is a coincidence,
link |
02:16:45.220
but depending on your gut microbiome or your microbiota,
link |
02:16:49.900
some microbiome beneficial bacteria
link |
02:16:54.180
will convert carnitine and also choline.
link |
02:16:57.620
So any choline precursor like alpha GPC
link |
02:16:59.980
or phosphatidylserine, it will convert them
link |
02:17:02.300
more or less to TMAO.
link |
02:17:04.460
So TMAO is something that you can get measured
link |
02:17:06.220
in a blood test and see if it's high or low.
link |
02:17:08.580
Some people might not even need allicin.
link |
02:17:11.060
Interesting.
link |
02:17:11.900
Some people do benefit from it.
link |
02:17:12.800
Interesting.
link |
02:17:13.640
So I think it was you that also told me
link |
02:17:16.500
that allicin and garlic can have positive effects
link |
02:17:19.220
on cardiovascular tone and blood flow generally.
link |
02:17:22.420
Is that right?
link |
02:17:23.240
Yeah.
link |
02:17:24.080
Okay, so maybe, so it's 600 milligrams garlic
link |
02:17:26.500
in excessive amount, or can I just eat garlic?
link |
02:17:29.620
You can just eat garlic.
link |
02:17:30.460
I mean, I like eating garlic.
link |
02:17:31.300
Yeah.
link |
02:17:32.140
Yeah, so, okay, so one could also just eat garlic.
link |
02:17:34.620
If one were going to take L-carnitine in injectable form,
link |
02:17:37.620
how much of that is bioavailable?
link |
02:17:39.860
100% if you inject it.
link |
02:17:41.940
It is in an aqueous solution.
link |
02:17:44.020
So it's a bacteriostatic water essentially.
link |
02:17:47.020
So it's not in a carrier oil.
link |
02:17:49.360
So it really, it's going to burn a lot
link |
02:17:51.340
if you inject it subcutaneously.
link |
02:17:53.420
So it's going to be absorbed faster and more evenly
link |
02:17:57.420
and also just hurt a lot less
link |
02:17:59.320
if you inject it into a muscle.
link |
02:18:01.320
But one could then just take one gram per day injected
link |
02:18:05.380
or divide it up into a couple of doses.
link |
02:18:07.020
Yeah, or 500.
link |
02:18:07.940
The minimally efficacious dose for injectables
link |
02:18:10.660
is probably around 200 when it comes to sperm motility
link |
02:18:14.660
and androgen receptor upregulation.
link |
02:18:16.900
So it really depends on why you're taking it.
link |
02:18:19.540
In terms of fertility and in terms of blood tests generally,
link |
02:18:23.500
you know, I always say that if possible,
link |
02:18:28.020
either by way of insurance or by way of some other way
link |
02:18:32.220
affording it, it would be great for people
link |
02:18:34.540
to have blood tests to know what their hormone levels
link |
02:18:37.320
and other levels of other things like metabolic markers
link |
02:18:39.780
and lipids were in their 20s,
link |
02:18:42.100
also in their 30s, also in their 40s.
link |
02:18:43.780
I think there's this idea that you only take a blood test
link |
02:18:46.180
when you have a problem,
link |
02:18:47.380
but then of course one can't actually do the comparison
link |
02:18:51.660
that you mentioned earlier or state the comparison
link |
02:18:53.660
to one's physician that things are changing over time.
link |
02:18:57.540
And it seems to me that basically everyone should get
link |
02:19:00.580
at least a once a year blood test.
link |
02:19:02.500
Is there the hope that insurance will someday
link |
02:19:05.040
just cover it for everybody?
link |
02:19:06.060
This will be standard care.