Dr. Kyle Gillett: Tools for Hormone Optimization in Males | Huberman Lab

Intro

In this episode of the Huberman Lab podcast, Dr. Andrew Huberman is joined by Dr. Kyle Gillett, an expert in hormone optimization, to discuss tools for hormone optimization in males. They delve into various behavioral, nutrition-based, supplement-based, and prescription drug-based tools that can optimize hormones such as testosterone, free testosterone, dihydrotestosterone, estrogen growth hormone, thyroid hormone, and more. These hormones have a significant impact on mood, libido, well-being, strength, cognition, and various psychological factors. Dr. Gillett provides specific recommendations for individuals of different ages and goals.

Main Takeaways

Tools for Hormone Optimization

• Behavioral, nutrition-based, supplement-based, and prescription drug-based tools are discussed for optimizing testosterone, free testosterone, dihydrotestosterone, estrogen growth hormone, thyroid hormone, and other hormones that impact mood, libido, well-being, strength, cognition, and various psychological factors.
• Specific recommendations are given for people of different ages and goals.

Calibrating Libido and Behavioral Foundations

• The importance of calibrating libido and gauging how good one should feel is discussed.
• The behavioral foundations of optimal hormone function are explored, and things to avoid are mentioned.

Electrolytes and Cognitive Performance

• Electrolytes (salt, magnesium, and potassium) are critical to the function of all cells in the body, particularly nerve cells.
• Slight reductions in electrolyte concentrations or dehydration can lead to deficits in cognitive and physical performance.
• Element has a science-backed electrolyte ratio of 1000mg sodium, 200mg potassium, and 60mg magnesium.

Restoring Energy with Mindfulness and Yoga Nidra

• Waking Up is a meditation app with hundreds of programs, mindfulness training, yoga nidra sessions, and NSDR protocols.
• Yoga nidra and NSDR can greatly restore levels of cognitive and physical energy.

Puberty and Growth

• Puberty affects adult height, stature, and body composition.
• Early puberty can decrease adult height or stature.
• Dirty bulking, purposely acquiring body fat while lifting weights, can stunt growth by increasing leptin and activating hormones that cause early puberty.
• Childhood obesity is linked to earlier onset of puberty in both males and females.
• Overeating and lifting weights can limit total height by shutting down long bone growth.
• Resistance training is okay for young males, but they should avoid dirty bulking until puberty is over to limit abnormal body fat accumulation.
• Limiting excess body fat is important not just for reaching maximum height, but also for overall health.
• Under the supervision of a physician, it is safe for young people to change their body composition and re-normalize their growth curve compared to peers.

Hormone Optimization for a Long and Healthy Lifespan

• All males should optimize their hormones for a long and healthy lifespan.
• Blood work is important for hormone optimization and should be done early on in life.
• Testosterone is important, but other hormones are also crucial to monitor.
• SHBG (sex hormone binding globulin) is a protein that binds up all androgens and estrogen in the body.
• Strong androgens, especially DHT, have a prominent role in secondary sexual characteristics during puberty.
• High SHBG levels can lead to higher DHT, but less free DHT.
• Regular blood work is important and should be evaluated by a qualified physician.
• Getting blood work done twice a year is reasonable for monitoring markers.

Nutrition and Supplements for Hormone Optimization

• Nutrients like dairy and vitamin D are important for growth hormone and IGF1 optimization, which helps with bone density and growth.
• Eating a combination of quality proteins from animal and non-animal sources, fruits, vegetables, and starches is beneficial for most people.
• Following a pure carnivore or vegan diet in the late 20s might be reasonable, but not in the early 20s.
• Fiber is paramount in setting the set point of your gut microbiome for the rest of your life.
• Prebiotic fiber is like fish food for your good gut microbiome, which is important throughout the lifespan.
• Multivitamins are generally safe to take, but not necessary for everyone. Exclusionary diets may require them.
• Caloric restriction can be beneficial for testosterone in overweight individuals, but not for those without excessive body fat.

Stress Management for Hormone Optimization

• Stress is a crucial factor in hormone optimization, especially during the 20s and 30s when individuals are figuring out how to cope with it.
• The health of the family unit is important for overall well-being.
• Social connections are important for individuals who are not starting families.
• Managing stress is crucial for hormone optimization.
• Mindfulness, exercise, dietary changes, therapy, and talking to friends or family can help with stress management.
• Finding purpose in life and engaging in movement activities are important for hormone optimization.

Supplements and Medications for Hormone Optimization

• Supplements and medications are tools to reach an end goal.
• Food is medicine and can provide similar benefits to supplements.
• Depending on the goal, supplementation can be beneficial for athletes or those seeking cognitive performance.
• Subjectivity makes it difficult to determine whether hormone optimization is necessary.
• Motivational interviewing and open-ended questions can help determine if hormone optimization is needed.
• Atom questionnaire and what patients say can differ.

Sexual Health and Hormone Optimization

• Erectile dysfunction can be a sign of plaque buildup in the coronaries.
• Labs are ordered to determine hormone levels, but subjective symptoms also matter.
• Nocturnal penile tumescence test can determine if ED is psychogenic or not.
• Masturbation can create a brainwiring situation where males teach their brain to be aroused by watching others have sex.
• Ejaculation and orgasm cause an increase in prolactin, which blunts libido for some time.
• Daily or frequent masturbation can be detrimental to the hormone profile of males.
• Pornography and screens are not the real world and can limit libido in the real world.
• Dopamine sensitivity is important to maintain a happy medium in the dopamine wave pool.
• Intense visual or auditory input can lead to dopamine depletion and depressive episodes.
• Intense experiences from pornography or high adrenaline activities can lead to low libido episodes.
• Sex with a partner can also lead to dopamine crashes, but the dose makes the poison.
• Optimizing hormones involves movement, sunlight, social connection, and avoiding excessive masturbation and pornography.
• Internet pornography addiction is a serious issue that affects males of all ages.

Exercise and Hormone Optimization

• Athletic greens are optimal for microbiotic health and contain adaptogens, vitamins, and minerals to meet foundational nutritional needs.
• Exercise is a double-edged sword, too much can lead to negative effects on sleep and recovery.
• A healthy and sustainable exercise regimen includes vigorous exercise 3-4 times a week and less vigorous exercise 3-4 more instances a week.
• Weight training at a low to moderate intensity can still help with hypertrophy and collagen growth.
• Limiting intensity can mean being lazy between sets and taking long rests, and finding a comfortable rep range that doesn’t lead to failure can lead to feeling fantastic in all other dimensions of life.
• Regularly training vigorously for longer than an hour is not hormonally helpful.
• An hour a day of exercise is a great program that most anyone can follow.
• Beyond an hour, you start running into challenges.
• Consistency is key to achieving optimal hormone levels.
• Finish the workout while still having energy to feel great throughout the day.
• Exercising early in the morning can give you more energy throughout the day.
• Lack of exercise can negatively affect blood profiles, including testosterone and estrogen.

Hormone Replacement Therapy and Performance Enhancing Drugs

• Testosterone replacement therapy (TRT) can have negative effects on fertility and should only be considered if blood levels are below normal range.
• There are various reasons why people use performance enhancing drugs, including cosmetic reasons, but the benefits rarely outweigh the detriments for those with normal testosterone and estrogen levels.
• Supplementation with creatine can help optimize testosterone and estrogen levels without suppressing endogenous production.
• Creatine serves as a back-up fuel tank for mitochondria and helps with oxidative stress.
• Creatine increases the conversion of testosterone to dihydrotestosterone.
• Hair loss is not a reason to avoid taking creatine.
• Betaene and L-carnitine are other supplements that can benefit amino acid synthesis and energy shunting.
• Betaene can help with the processing of methionine and homosistine.
• Elkharnatine has localized effects if injected and low bioavailability if ingested orally.
• Recommended dose for oral Elkharnatine is between 1000-5000mg per day.
• Garlic compound Alicin can help decrease conversion to potential carcinogen TMAO.
• Injectable L-carnitine is absorbed almost entirely and can be taken in doses up to 2000 milligrams.
• L-carnitine increases the density of the androgen receptor in the cytoplasm of cells, allowing for more testosterone to bind to the receptors.
• Vitamin D and boron can also help optimize testosterone levels.
• SHBG attaches to testosterone molecules and limits the amount of free testosterone available to have an impact on cells. The ideal level of free testosterone in males should be about 2% of one’s total testosterone.
• Free testosterone levels can be affected by high SHBG levels, but the ideal percentage of free testosterone to total testosterone should be around 2%.
• Varicose veins in the testicles can be diagnosed through a physical exam or valve salva technique.
• Supplements like vitamin D3, boron, and Tonkette Ali can help optimize testosterone levels by affecting the steroidogenesis cascade.
• Tonkette Ali is a co-factor in synthesizing testosterone and can be taken in doses of 300-1200 milligrams per day.
• Tonkette Ali should be standardized with urecommonone for maximum effects, and should be taken early in the day to avoid sleep disruption.
• Tongkat Ali can increase total and free testosterone and slightly increase DHEA.
• Tongkat Ali doesn’t affect SHBG in people with normal levels, but can help decrease it in those with high levels.
• Changes in free androgen or estrogen levels can alter the binding protein that binds thyroid hormones.
• Fodosia can increase LH and release of testosterone without mimicking LH.
• HCG is synthetic LH and is refined from the urine of pregnant women in their first trimester.
• Fodosia is a genus of plants that includes Fodosia Agrestis, which is the most well-studied species.
• Fodosia can be used to create non-synthetic HCG and menotropins.
• Safe dosage of Fodosia is 300 milligrams a day, but can be increased to 600 milligrams every other day or three times a week.
• Taking Fodosia can lead to increased pro-inflammatory markers, but can be attenuated with antioxidants or other supplements.
• Growth hormone is released by the pituitary and can be stimulated by growth hormone releasing hormone and ghrelin.
• Checking IGF-1 levels can help determine adequate levels of growth hormone and IGF-1.
• Diabetic individuals may have dysregulated levels of growth hormone and IGF-1.
• Taking amino acids before bed can potentially help with growth hormone release.
• Fasting can increase growth hormone release, but genes downstream to it will not be significantly higher.
• Avoid eating for two hours before bed to optimize growth hormone release during sleep.
• Iodine intake should be balanced, with more needed if consuming goitrogens like cruciferous vegetables and boron.
• Iodized salt prevents goiter but is not necessarily the ideal form of iodine.
• Hypothyroidism tends to be more prevalent inland, so consuming cruciferous vegetables and iodine-rich foods from the ocean is recommended.
• Peptides are chains of amino acids and can be categorized into different types.
• GHRP peptides like Tessa Morlin and Cermorlin release growth hormone, while GHRH-like peptides like Ipomorellen act similarly to growth hormone releasing hormone.
• Growth hormone mimics an endogenous hormone and may be a better option than some peptides for those looking to increase growth hormone levels.
• Peptides can have precarious effects and are highly individualized.
• Many people take peptides in doses far above the physiologic range, which can be concerning.
• Peptides may be helpful for individuals with imbalances between orexigenic and anorexigenic signaling in the hypothalamus, and may be theoretically helpful for anorexics.
• LPS is a common additive in many companies that are not pharmacies, and can cause an inflammatory response.
• Your gut microbiome actually makes a lot of LPS, which can affect your baseline body temperature.
• Taking a low dose of testosterone more frequently is more beneficial than a high dose once every two weeks.
• A typical dosage range for testosterone therapy is around 100 to 120 milligrams divided over the course of a week, usually every other day or three times a week.
• Testosterone is normally released in a pulsatile manner, so dosing should be considered with this in mind.
• Testosterone therapy provides a steady state of testosterone, which can lead to positive effects such as improved mood, energy, and sleep.
• Hazards of testosterone therapy include changes in every organ system, such as acne, skin pathologies, hair loss, mental status changes, and cardiovascular concerns.
• Monitoring blood work is necessary to detect changes in LDL and apobie levels.
• Physicians managing testosterone therapy should be well-versed in various systems or be part of an interdisciplinary team.
• HCG monotherapy involves taking HCG and Clomifen to ratchet up hormones, as HCG can also bind to the TSH receptor in the thyroid.
• Clomifen is a drug that can increase testosterone in a dose-dependent manner.
• It has many other pharmacodynamic effects other than its effect on the hypothalamus in the pituitary.
• Clomid can inhibit receptors in the eye and cause visual changes in blurry vision, especially at higher doses.
• Side effects from Clomid and other selective estrogen receptor modifiers are very common.
• Testosterone therapy should not be used as a replacement but rather building on what the body already has.
• Taking HCG can help maintain sperm production while on testosterone.
• Heat damage to the testes can decrease sperm count, cold therapy can help.
• Tight-fitting clothing can decrease fertility in men.
• Smoked THC can increase gynecomastia (growth of male breast tissue).
• Nicotine is concerning for both testosterone and estrogen levels, and can lead to cardiovascular and neurodegenerative diseases.
• Nicotine can lead to cardiovascular and neurodegenerative diseases, and it’s concerning for both testosterone and estrogen levels.
• Cycling for too long and putting pressure on the perineum can weaken the pelvic floor, leading to incontinence and impotence.
• Heavy leg work done correctly can augment and build up the strength of the pelvic floor, but done incorrectly can weaken it and lead to negative sexual effects.
• The pelvic floor is a constellation of muscles that can be targeted with exercises like the valve salve maneuver and kegels to help build it up.
• Excessive contraction of the pelvic floor can limit blood flow to the pelvic area, so it’s important to find a balance in strengthening it.
• Combination of weight training and casual exercise like walking and stretching is key to pelvic health.
• Kegels are just one aspect of pelvic floor health, not a cure-all solution.
• Alcohol consumption should be limited to 2-3 standard drinks per week to avoid negative effects on health and hormone production.
• Saturated fat is correlated with hormone optimization, but not vital to hormone production.
• Cholesterol is both a component of cell membranes and a hormone in itself.
• Low dose to dallophil (Tadalafil) can be prescribed for improving prostate health and blood flow to the prostate.
• It is an underrated medication that can increase the density of the androgen receptor and cut episodes of urinating at night in half.
• Recommended dosage ranges from 2.5 to 10 milligrams per day, depending on the indication.
• Higher doses can slightly affect red and green sight, but it is not clinically significant unless someone is a commercial pilot.
• PSA levels should be kept below 1-4 depending on age and taking a 5-alpha reductase inhibitor can cut PSA levels in half.
• PSA levels should be kept below 1-4 depending on age.
• Drugs to offset hair loss operate through the DHT system, which can cause negative side effects.
• Topical DHT antagonists can be used to maintain hair without negative side effects.
• Caffeine can be used topically to crowd out androgens in the scalp.
• Topical spironolactone and finasteride are absorbed systemically and should only be used under doctor’s prescription.
• “Most of those drugs are going to operate through the DHT system…and causing beard growth on the face.”
• “You have your fertilizers…and then you have your anti-indrigence.”
• “The higher your SHBG, things that increase SHBG are beneficial for hair loss prevention.”
• “Topical caffeine enters the scalp and crowds out, like, somewhat crowds out the enders.”
• “Topical finasteride is also a smaller molecule. So it is also systemically absorbed. But it is not extremely well systemically absorbed.”
• Topical finasteride decreases systemic DHT by 30%.
• Topical dutasteride does not affect systemic DHT at all.
• Turmeric can lower DHT levels, but it may not need to be bioavailable to have beneficial effects.
• Black pepper fruit extract (biopeurine) is a five alpha reductase inhibitor and is added to many supplements.
• DHT optimization is important for libido, motivation, and drive.
• Thallates exposure negatively impacts sperm counts, testosterone levels, and genitalia size in male fetuses.
• Thallates are most enriched in pesticides, causing drops in sperm and testosterone levels in rural areas.
• Bisphenol A (BPA) is a Zeno estrogen that binds to estrogen-related receptor gamma.
• Phytoestrogens from plants are not concerning, but Zenoestrogens are.
• Testing water for microplastics and avoiding plastic bottles and cans with BPA is recommended.
• Male hormone optimization can improve quality of life for men.
• Balancing testosterone and estrogen levels is key for hormone optimization.
• Supplements can be beneficial for sleep, hormone augmentation, and focus.
• The Huberman Lab podcast newsletter provides free toolkits for sleep, fitness, and deliberate cold exposure.

Summary

Tools for Hormone Optimization

Dr. Kyle Gillett joins the Hub