The Art of Manliness - Optimize Your Testosterone

00:00:00.000 Hey, this is Brett, we're taking a break from new episodes today, so we're rebroadcasting

00:00:02.840 episode number 893, Optimize Your Testosterone with Dr. Kyle Gillette.

00:00:07.180 Hope you enjoy it.

00:00:07.860 We'll see you on Monday with a brand new episode.

00:00:16.520 Brett McKay here, and welcome to another edition of the Art of Manliness podcast.

00:00:20.640 When men think about optimizing their hormones, they tend only to think about raising their 0.97

00:00:24.500 testosterone.

00:00:25.500 But while increasing T can be important, an ideal health profile also means having testosterone

00:00:29.980 that's in balance with your other hormones as well.

00:00:32.700 Today on the show, Dr. Kyle Gillette joins me to discuss both of those prongs of all-around

00:00:36.760 hormone optimization.

00:00:38.400 We start with a quick overview of the different hormones that affect male health.

00:00:42.000 We then get into what qualifies as low testosterone and how to accurately test yours.

00:00:46.480 We also discuss what causes low testosterone in individual men and how its decline in the

00:00:51.020 general male population may be linked to both birth control and the world wars.

00:00:55.520 In the second half of our conversation, we discuss how to both raise testosterone and get

00:00:59.380 rid of excess estrogen, including the use of some effective supplements you may never

00:01:03.460 heard of.

00:01:04.160 We then get into the risk and benefits of taking TRT, before ending our discussion with

00:01:08.520 what young men can do to prepare for a lifetime of optimal T and hormonal health.

00:01:13.100 After the show's over, check out our show notes at awim.is slash optimal T.

00:01:16.420 All right, Dr. Kyle Gillette, welcome to the show.

00:01:35.900 Thank you.

00:01:36.560 My pleasure.

00:01:37.280 So you are a medical doctor.

00:01:39.100 You do family practice.

00:01:40.580 You specialize in obesity, but also hormone optimization, helping people have healthy hormones.

00:01:45.880 So they live a flourishing life.

00:01:47.620 And today I like to talk about hormones, particularly male hormones.

00:01:51.840 I think when most people think about male hormone optimization, they think about testosterone,

00:01:57.420 which is obvious why you do that.

00:01:59.980 We're going to dig deep into testosterone today.

00:02:01.820 But are there other hormones that affect male health that people often overlook?

00:02:07.320 There certainly are.

00:02:08.800 So even testosterone in and of itself, there's nothing unique about it compared to other androgens.

00:02:15.040 There's just one androgen receptor.

00:02:17.160 Testosterone just happens to be the most well-known androgen.

00:02:20.680 So there's DHEA, which is a very weak androgen. 0.98

00:02:23.160 It's produced by the adrenal glands, which are small glands above the kidney.

00:02:26.520 There's DHT, which is dihydrotestosterone.

00:02:29.520 This is a very strong androgen.

00:02:31.380 You don't have as much of it as testosterone, but it's vitally important for what's called

00:02:36.040 secondary sexual characteristic development, like the deepening of the voice,

00:02:40.060 growing facial hair, those secondary sexual characteristics, which are vital.

00:02:45.720 And also, I think people often overlook estrogen plays a role in male health.

00:02:50.360 Certainly.

00:02:51.260 Testosterone aromatizes and directly converts to estrogen.

00:02:54.320 So the way to think about estrogen is the more estrogen, the better for your health,

00:02:59.960 because it prevents things like heart attacks at a correct ratio to where you feel good.

00:03:05.940 Okay.

00:03:06.080 So we got to have some estrogen in there at the right balance. 0.65

00:03:09.660 And then there's another hormone called SHBG.

00:03:13.620 What does that do?

00:03:14.340 So SHBG is also known as androgen binding globulin.

00:03:18.120 It's a protein.

00:03:19.000 It's made in many places.

00:03:20.460 The liver makes most of it, but the testes also make some of it.

00:03:25.060 And SHBG stands for sex hormone binding globulin.

00:03:28.300 It most strongly binds DHT, and then it binds testosterone relatively strongly.

00:03:33.800 DHEA weaker than that.

00:03:35.320 And then estradiol, which is your main estrogen, even weaker than that.

00:03:39.180 So think of this as regulating all of the hormones and keeping them more stable.

00:03:44.260 The higher the SHBG, the more stable the level will be.

00:03:48.100 Men produce a lot of testosterone during sleep.

00:03:50.780 So the level is generally much higher in the morning.

00:03:53.420 But if you have a very low SHBG, you'll crash.

00:03:56.620 And you can actually have deficient levels of testosterone in the evening routinely.

00:04:00.480 But normal levels in the morning, if you don't have enough SHBG,

00:04:03.940 the most common cause of an SHBG deficiency is insulin resistance,

00:04:07.940 which is often due to too many calories or too many carbohydrates and sugar.

00:04:12.720 So what's interesting about all those hormones is they interact with each other.

00:04:15.540 It's a complex system.

00:04:16.760 So if you raise the level on one, one might go down or up.

00:04:20.200 So I think a lot of guys, they get too focused on,

00:04:22.340 well, I got to increase this one thing or reduce this one thing.

00:04:25.040 Well, if you do that, you're going to have these cascading effects that might not be optimal.

00:04:29.660 Correct.

00:04:30.020 I actually heard an advertisement from a TRT clinic this morning, and it said,

00:04:34.740 new study shows that men with low testosterone are more prone to cardiovascular disease and early

00:04:42.040 death and diseases of aging.

00:04:44.100 And I thought to myself, this is odd because they're implying that you need testosterone

00:04:49.400 replacement to prevent this.

00:04:51.420 But of course, that is a logical fallacy because just replacing the testosterone without figuring

00:04:57.800 out what's actually causing it in the first place.

00:04:59.820 Not that TRT is wrong, but you need to figure out what the cause of it is and then address it.

00:05:05.280 Okay.

00:05:05.740 And I hope we can talk about TRT because I know a lot of guys are thinking about doing it,

00:05:09.640 or maybe they are doing it, and they might have questions about that.

00:05:12.140 Let's talk about testosterone.

00:05:13.680 So there's two ways to measure testosterone, or two measurements of testosterone that I read about.

00:05:18.320 One is total testosterone and free testosterone.

00:05:21.620 So first, what's the difference between the two?

00:05:23.220 And as a clinician, is there a particular number you focus on?

00:05:28.160 Yeah.

00:05:28.580 So total testosterone is a total amount of testosterone, whether it's bound or unbound.

00:05:33.940 When testosterone is bound, it in general does not bind the androgen receptor, which is on the

00:05:39.800 X chromosome.

00:05:40.700 And total testosterone includes a testosterone bound to albumin, which is the main protein in

00:05:45.900 the blood, and also SHBG, which we talked about earlier.

00:05:49.200 But free testosterone, or any free androgen, is what is going to be what is actually binding

00:05:56.080 to the receptor, and then it takes it into the nucleus of the cell, and then it binds

00:06:01.060 to DNA to cause what's called gene transcription.

00:06:04.100 So the androgen receptor gene that's on the X chromosome is then mostly activated by free

00:06:11.100 testosterone.

00:06:12.540 Oddly enough, sometimes I make the analogy of plumbing.

00:06:15.740 So you have a pipe, that's your bloodstream that takes testosterone everywhere, and then

00:06:19.860 you have different types of cells, for example, a muscle cell or a brain cell or a germ cell

00:06:26.340 in the testicle or a somatic cell in the testicle, which we don't have to get into.

00:06:30.960 But anyway, the free testosterone level can be very different in the bloodstream, which

00:06:35.300 is where we measure it on a blood test, versus inside the cell.

00:06:38.920 So it is possible to have symptoms of low testosterone because you don't have enough androgen

00:06:43.440 in the cell but have a normal level in the blood, it's rare, but it's possible, and the

00:06:48.100 opposite is possible, to have a low level in the blood but still have enough inside the

00:06:53.860 cell that's free to be causing normal gene transcription.

00:06:57.880 Okay, so just to recap there, total testosterone is made up of bound and unbound testosterone.

00:07:03.580 Bound testosterone can be bound to albumin or SHBG.

00:07:08.220 And then when it's bound to those things, it can't attach to the androgen receptor in

00:07:12.800 the cell.

00:07:13.640 And so it can't be, can't have those changes on the cell.

00:07:17.280 Free testosterone, unbound testosterone is free testosterone.

00:07:20.340 So as a clinician, when you do a blood test on a patient, like what number is more important

00:07:26.320 to you?

00:07:26.780 Like which one are you going to be focusing on more?

00:07:29.340 Is it the free or the total?

00:07:30.600 I think both are equally important for athletic purposes, for muscle building purposes.

00:07:38.120 Usually that's more correlated with free testosterone level.

00:07:42.080 However, symptoms and how you feel is usually correlated more with total.

00:07:46.300 Insurance companies and academic societies usually put more weight into total testosterone,

00:07:52.120 partly because free testosterone are often measured inaccurately.

00:07:55.260 So often it's more accurate to calculate your free testosterone using your total testosterone

00:08:01.500 and your SHBG.

00:08:03.620 And then you estimate what your free testosterone is.

00:08:06.500 Some societies say low testosterone is often best treated if you have one have symptoms and

00:08:13.480 then two also have a testosterone below about 400.

00:08:16.980 That's what the urologists say.

00:08:18.720 Most other societies go by 300.

00:08:21.160 And I tend to agree with the level of 400 with a caveat if you have significant symptoms

00:08:27.020 and with a second caveat if you cannot improve that naturally in any way after identifying

00:08:33.040 the root cause.

00:08:34.200 Okay.

00:08:34.280 I want to dig more into diagnosing low testosterone because there's lots of commercials out there.

00:08:38.840 You just mentioned one or these businesses popping up where you can just go in and get

00:08:43.060 a blood test and like, hey, you got low T.

00:08:45.200 Here's testosterone. 0.95

00:08:46.460 And maybe they don't.

00:08:47.860 So you mentioned two things you look at to diagnose low testosterone.

00:08:51.700 You're going to do blood work.

00:08:53.160 And if it's below 400, coupled with if the patient is reporting symptoms of low testosterone,

00:09:00.260 we'll talk about the symptoms of low testosterone here in a bit.

00:09:02.560 Let's talk about blood work.

00:09:03.540 I think a lot of guys out there, they think it's a panacea.

00:09:05.740 If you just take a test, you take the test and it says, oh, well, your T is at 400.

00:09:10.280 They're like, well, I got low T.

00:09:11.860 Why isn't one blood test alone sufficient to diagnose low testosterone?

00:09:16.300 In general, testosterone levels can have what's called outliers.

00:09:23.360 It's the statistical phenomenon, but it's especially true of testosterone where you

00:09:27.480 could check it one time and your testosterone that morning could be low because the last

00:09:32.320 two nights you've had poor sleep and poor diet and other lifestyle factors.

00:09:37.380 Males that are generally seeking a TRT prescription know this very well because there's various things

00:09:42.180 that you can do to artificially make your testosterone level look low that morning.

00:09:47.880 So in general, the recommendation is to recheck it two to three times after, you know, good

00:09:52.800 night of sleep and normal diet and whatever you're doing normally, not after you've dieted

00:09:57.940 down to 7% body fat to do an ultra marathon or bodybuilding show, then your testosterone is

00:10:03.300 certainly going to be low.

00:10:04.360 But when you're at a healthy body fat and there's not an artificial something else that

00:10:09.200 is going to make your testosterone look low, there's a runner. 0.99

00:10:13.200 His name is Nick Bear, and he also is doing a bodybuilding show.

00:10:16.880 And I saw that he got his total testosterone checked and he's a healthy guy.

00:10:20.200 I'm not sure what his baseline testosterone is.

00:10:22.280 And his total testosterone was right at 100 before his bodybuilding show.

00:10:27.500 So that was obviously secondary to the caloric deficit.

00:10:29.820 That wouldn't necessarily count as a testosterone reading that you could put stock in assessing

00:10:35.420 TRT or not.

00:10:36.980 But for most people, they probably won't be in a scenario like that.

00:10:41.100 But it is important to get at least two readings.

00:10:44.180 If you've been sick before, then maybe just postpone the blood test by a week.

00:10:48.080 That way you get an accurate reading.

00:10:50.460 Let's move on to the symptoms.

00:10:51.560 So you do the blood test.

00:10:53.420 What symptoms are you looking for to diagnose low testosterone?

00:10:57.880 Yeah, could be through any system.

00:10:59.320 So it could be anything from depression, anxiety to low libido is certainly classic.

00:11:05.620 Low muscle mass is not really one that we look for.

00:11:08.820 Testosterone levels that are naturally produced are not as correlated as people would think with

00:11:16.200 body composition and muscle mass and athletic performance.

00:11:19.760 So it's not uncommon to see a pretty high level athlete have a total testosterone of, you know,

00:11:24.860 let's say 450 and let's say someone that has very low muscle mass and maybe even 20, 22% body fat to have

00:11:33.740 a total testosterone of a thousand.

00:11:35.840 There's not as much correlation.

00:11:37.020 But other things that you would look for seriously is, for example, erectile dysfunction, sexual health in general, sperm production.

00:11:45.560 So if there's a patient that is having even subfertility, just a little bit of trouble getting pregnant,

00:11:50.320 that individual should certainly have a test of his testosterone as well.

00:11:54.880 So with low libido, how does a guy know if he has low libido?

00:11:59.540 Because that seems like it'd be pretty subjective.

00:12:02.220 Yeah.

00:12:02.480 Libido obviously has a lot of psychosocial factors as well.

00:12:06.680 It's usually taken at a patient's word.

00:12:10.740 And a lot of times when you're testing these patients, you've known the patients for a while.

00:12:14.320 Sometimes you haven't.

00:12:15.180 But if they're telling you that it's low relative to what it usually is and no other factors of change, for example,

00:12:23.880 you know, they've been married to the same person for five years.

00:12:26.860 They're not actively going through problems in the marriage.

00:12:29.780 There's not something else that would be affecting the libido.

00:12:32.540 So that would usually come up in the social history.

00:12:35.020 When you do a history and physical on a patient, it is important to dig into the social history to make sure

00:12:40.480 there's not something else that is affecting the libido.

00:12:43.520 So besides low libido, maybe lack of drive, what are the consequences of suboptimal male hormone levels, like chronically?

00:12:52.260 Is it going to affect your cardiovascular system?

00:12:54.240 Is it going to affect cancers?

00:12:56.320 Does it affect things like that?

00:12:58.080 It will.

00:12:58.940 If someone is significantly hypogonadal for a long time, they're at much higher risk of osteoporosis,

00:13:06.180 which leads to bone fractures and even mortality as well.

00:13:09.640 They're at higher risk of neurodegenerative disease, likely largely due to low estrogen.

00:13:15.280 If you don't have a lot of testosterone, you're probably not converting a lot of it to estrogen.

00:13:19.300 And if you're not doing that, then you're also at risk of cardiovascular disease.

00:13:23.500 Estrogen is very cardioprotective and helps with the production of good cholesterol to help take cholesterol out of the plaque.

00:13:30.020 So they've done studies and you look at one group of people that have true hypogonadism, which is generally two levels under 264 or so.

00:13:39.640 And then one group you give TRT and then one group you don't give TRT.

00:13:45.540 You would think that the group that you give TRT would have a shorter lifespan because androgens do cause excess production of quote unquote bad cholesterol.

00:13:55.500 They do increase a particle called ApoB, which is the most important one to watch for cardiovascular risk.

00:14:01.120 But the group that you give TRT actually has less heart attacks and strokes.

00:14:04.600 Right, because what you were saying before, the testosterone creates estrogen and then the estrogen protects the heart.

00:14:11.000 So let's talk about the causes of low testosterone.

00:14:13.660 What can be behind low T?

00:14:15.960 Most commonly metabolic syndrome.

00:14:18.620 So excess calories, excess carbs, insulin resistance, high fasting insulin leads to the liver not producing SHBG.

00:14:27.320 So you might be producing a decent amount of testosterone, but it's being metabolized so fast that it's difficult to use.

00:14:33.980 That's most common.

00:14:35.140 The second most common, I think, is sleep apnea or obstructive sleep apnea.

00:14:39.760 Obviously, that kind of goes hand in hand with metabolic syndrome, but often it goes hand in hand with PTSD.

00:14:45.540 I saw a study on young men that had just gotten out of the military and they had been diagnosed with PTSD and they tested them all for sleep apnea.

00:14:56.080 And something like 80% of them had sleep apnea and they were all under a BMI of 25.

00:15:02.360 So there's certainly a lot of stress component as well.

00:15:05.980 The limbic system includes places like the hypothalamus and the amygdala and downstream to that is the hippocampus and the amygdala.

00:15:13.320 Downstream of those is the hypothalamus.

00:15:16.120 And that's some of the places of the brain that are involved in sleep regulation and breathing.

00:15:22.060 So the theory is that apneic episodes don't just come from having a huge neck and excess body fat, but there are other factors like trauma at play.

00:15:32.040 And when you have a patient with severe sleep apnea, they have a score called an AHI score.

00:15:40.100 And if that score is very high, like 100 or 200, you almost always see deficient testosterone levels.

00:15:47.040 Okay, so having metabolic syndrome, being overweight, sleep apnea, any other causes of low testosterone?

00:15:52.920 Yeah, so theoretically, xenoestrogens could be a cause of low testosterone.

00:15:58.700 These are things like phthalates.

00:16:00.240 These are also things like bisphenol A, also known as BPA.

00:16:03.520 You might see BPA-free on water bottles from time to time.

00:16:07.180 These do bind various estrogen receptors and are likely suppressive.

00:16:12.260 By suppressive, I just mean they shut down the production of the hormones that lead to testosterone production to some degree.

00:16:19.160 Heat damage is also kind of an honorable mention.

00:16:22.840 Some people might be familiar with what varicose veins are.

00:16:25.760 Varicocele is where there's varicose veins in the scrotum.

00:16:28.200 And some people with varicocele can have venous cooling very well.

00:16:32.880 The testes want to be about 91 to 92 degrees, where the body is 98.6 degrees.

00:16:38.060 So if you can't keep your testes at 91 or 92, then you're going to have less testosterone production and less sperm production.

00:16:46.440 And in the more severe cases, you'll have atrophy, which is shrinking because, think about them as factories.

00:16:52.880 If you're not using the factory, they start to shut down.

00:16:56.600 And besides these lifestyle factors, environmental factors, you could also have just an issue with your pituitary system, right?

00:17:02.760 You might have a tumor or something in your pituitary gland that's dysregulating the release of hormones.

00:17:07.900 Correct.

00:17:09.360 I suppose that would be likely one of the more common, less modifiable risk factors.

00:17:15.040 There's not a lot that you can do about that.

00:17:16.640 You can take supplements like vitamin B6 or like vitamin E.

00:17:20.560 But a lot of times, pituitary microadenomas or even macroadenomas, basically, it's a small tumor in the brainstem.

00:17:29.180 The pituitary gland is where you make a lot of different hormones, like growth hormone and like LH and FSH.

00:17:34.900 But LH is the main hormone that's produced there that leads to testosterone release.

00:17:39.840 So there's two different types of hypogonadism.

00:17:43.400 There's primary and secondary.

00:17:45.080 So primary is where the testes are not functioning.

00:17:49.580 And then secondary, think about it, it's two steps instead of one step.

00:17:53.340 So the LH can be low in secondary hypogonadism.

00:17:57.040 And if your LH is very low and a hormone like prolactin or IGF-1 is very high,

00:18:03.020 then that might be a sign of a pituitary microadenoma, in which case you need an MRI.

00:18:08.980 And LH, that's luteinizing hormone, correct?

00:18:11.380 Correct.

00:18:11.680 LH is luteinizing hormone.

00:18:13.260 FSH is follicle-stimulated hormone.

00:18:15.780 They do cross-talk to some degree.

00:18:18.100 But LH mostly helps with testosterone production and mostly binds to the Leydig cell in the testicle.

00:18:24.700 And FSH mostly binds in the seminiferous tubules and helps with spermatogenesis. 0.87

00:18:31.200 So, I mean, listeners have probably heard reports that T levels in men have been declining in the past few decades.

00:18:36.320 Do we know what's causing this sort of general decline?

00:18:39.140 Is it just all these lifestyle, like people are getting fatter, they're not sleeping, they're stressed, and the stuff in the environment,

00:18:44.420 is that kind of what we've decided is the cause of the lower T levels?

00:18:48.800 The various causes that we've already discussed are likely the primary causes of what is causing declining testosterone levels.

00:18:55.560 But I think there is another factor, and a lot of that has to do with what I'd call epigenetic drift.

00:19:04.240 Some people might call it natural selection.

00:19:06.520 I might call it unnatural selection, where individuals with higher testosterone levels are no longer being selected for as early.

00:19:18.160 And also, a lot of individuals are having kids later on in life.

00:19:23.280 For example, in their 30s or even 40s, when you might have very different maternal and paternal hormone profiles.

00:19:30.760 That's one of the reasons why I recommend if men are taking medications like finasteride or dutasteride, 0.95

00:19:37.000 that they stop their finasteride 90 days before attempting conception.

00:19:41.260 And they stop dutasteride, depending on what dose they are, usually six months before conception.

00:19:45.740 By the way, spermatogenesis takes about 60 days or two months.

00:19:50.000 That way, they have enough time to wash out before they start producing the sperm in the germ cells, 0.98

00:19:55.520 so that they wouldn't pass down any epigenetic changes to potential offspring.

00:20:01.300 Okay, so maybe the idea is that, again, this is theoretical, right?

00:20:04.820 The testosterone increases aggression and risk-taking behaviors,

00:20:08.560 and that's not as adaptive in our safe, high-tech, modern landscape.

00:20:13.200 So men with lower testosterone might be more successful these days,

00:20:17.820 and women choose those men for their partners. 1.00

00:20:20.480 And then when they have children, the men pass down his genes,

00:20:24.560 and then his children have lower testosterone too.

00:20:27.840 And that just perpetuates just lower testosterone in the male population overall.

00:20:33.000 Also, this idea of selection.

00:20:36.140 I've heard that, I read this somewhere, correct me if I'm wrong on this,

00:20:40.520 that women on birth control, they're not attracted to higher testosterone men.

00:20:45.640 Is that true?

00:20:46.720 Yeah, that is one of the major players of what I would call unnatural selection.

00:20:52.740 Another interesting unnatural selection, I suppose,

00:20:56.700 if you look at, not very recently, but the World War,

00:20:59.500 certainly in World War I and World War II,

00:21:01.400 or in the Korean War or Vietnam War,

00:21:04.600 but especially wars that, even if a war has a draft,

00:21:09.420 the individual that has higher testosterone and also more sensitive androgen receptors,

00:21:15.580 so this is probably true throughout all of human history,

00:21:19.020 you would, and this obviously cannot be proven scientifically,

00:21:22.240 but theoretically, that individual would be more likely to volunteer

00:21:25.700 to go to the front line or to very risky positions.

00:21:30.000 And if that male passes away at age 18 or age 19,

00:21:34.740 then that is likely a fecundity rate of zero,

00:21:38.780 so no offspring from that individual,

00:21:40.580 and then you start to have genetic drift.

00:21:42.940 Okay, so again, this is theoretical.

00:21:44.580 What you're saying is that men with very high testosterone,

00:21:47.660 they're going to take more risk,

00:21:49.120 and in doing so, that may take them out of the gene pool

00:21:51.960 by taking those risks.

00:21:53.340 And there's more opportunity for that sort of risk-taking

00:21:55.940 during big global conflicts like the World Wars, right?

00:21:59.100 More high-T men die,

00:22:00.600 they lose the chance to reproduce and pass on their genes,

00:22:03.620 and then that just contributes to the declining testosterone in men in general,

00:22:07.900 and that's going to have echoes through the generations.

00:22:11.700 And on top of that,

00:22:13.180 we just have selection factors going on in the mating market as well. 0.94

00:22:18.300 Yes, and it's not like it's an be-all, end-all,

00:22:22.460 you know, all-or-nothing.

00:22:24.040 You select for high testosterone or you select for low testosterone.

00:22:27.020 There's a lot more psychosocial factors at play,

00:22:29.680 but we are certainly seeing that there's likely a decline in testosterone

00:22:35.240 even a bit more than could be accounted for

00:22:37.680 by just metabolic syndrome and sleep apnea.

00:22:41.460 Maybe things like heat damage to the testicle,

00:22:44.440 maybe things like xenoestrogens are playing some part in this,

00:22:49.620 but we'll probably never know,

00:22:51.800 but it's very fun to speculate about it. 0.88

00:22:53.600 Well, the heat damage to the testicle, 0.95

00:22:54.940 like what would cause, 0.95

00:22:56.060 is it like keeping your laptop on your lap sitting down a lot?

00:22:58.360 Is that, would that cause heat damage?

00:23:01.200 Probably not significantly enough,

00:23:03.140 but if you already had a varicocele

00:23:05.180 and you already spent an hour in the jacuzzi,

00:23:08.820 keeping your really hot laptop and phone 0.99

00:23:11.280 directly over your scrotum is certainly not going to help. 0.98

00:23:14.060 I suppose someone could prove this at some point. 0.97

00:23:16.000 They've actually done a lot of studies

00:23:17.880 where they look at the scrotal temperature

00:23:19.880 and they've randomized two groups of usually college students.

00:23:24.800 And one group they have where basically like a sock 0.98

00:23:28.720 around their scrotum that has something really warm in it. 0.85

00:23:32.100 So they warm up the scrotum artificially to 98 degrees 0.76

00:23:36.980 instead of 91 or 92 degrees.

00:23:39.780 And in the individuals that don't have varicocele,

00:23:42.720 they can still overcome that heat damage

00:23:45.520 because their venous pooling mechanism

00:23:48.080 is so good at buffering that heat damage.

00:23:50.940 So that did not affect their testosterone production

00:23:53.460 and it did not affect their spermatogenesis.

00:23:56.700 However, in individuals that already have impaired venous cooling,

00:24:00.340 for example, with varicocele or varicose veins,

00:24:03.140 then it did.

00:24:04.440 We're going to take a quick break

00:24:05.480 for a word from our sponsors.

00:24:06.580 And now back to the show.

00:24:12.920 Let's talk about optimal levels of testosterone.

00:24:15.320 So below 400,

00:24:16.860 and if you're experiencing low testosterone symptoms,

00:24:19.120 that's not good.

00:24:20.820 Is there an optimal level?

00:24:21.980 Is there a level that guys should reach for?

00:24:24.320 Or is it going to differ from man to man?

00:24:26.640 It certainly differs,

00:24:27.520 but that's kind of an easy answer.

00:24:29.240 So I'll get into it more than that.

00:24:31.120 A lot of times people have told me

00:24:33.120 that I say individualized.

00:24:34.580 I say that word a lot because health is individualized.

00:24:38.220 We are all unique.

00:24:39.640 We have different genetics.

00:24:41.140 We have different epigenetics

00:24:42.240 and we have different growth and development past that as well.

00:24:46.100 But for most men,

00:24:47.780 an optimal testosterone level is between about 500

00:24:50.360 and as high as you can go naturally.

00:24:53.420 So, you know, there is some individuals

00:24:54.860 with a total testosterone of 1500.

00:24:57.480 They almost always have really high SHBG.

00:25:00.920 So a lot of times their free testosterone is only 20 or 25.

00:25:04.640 Between about 550 and whatever you can produce

00:25:07.340 top-in endogenously naturally without medication.

00:25:11.000 But you all say it could be lower.

00:25:12.300 I mean, you mentioned there are athletes who are at 450

00:25:14.620 and they're healthy.

00:25:16.400 So if you get a blood test and it's below 500 a little bit,

00:25:19.460 you probably, I mean,

00:25:20.360 I guess you shouldn't worry too much about it

00:25:22.000 if you're not experiencing any symptoms.

00:25:24.520 Correct.

00:25:25.260 Okay.

00:25:25.880 That's good to know.

00:25:26.960 So let's say a patient comes to you

00:25:28.520 reporting symptoms of low T.

00:25:29.920 You do a series of blood tests that show,

00:25:32.260 yeah, that your T levels are low.

00:25:33.860 They're below 400.

00:25:35.320 What's your first line of attack

00:25:36.940 in helping this patient get his T levels up?

00:25:40.440 First thing to look at would be LH and FSH.

00:25:43.020 If those are really low,

00:25:44.040 then I'm worried about the pituitary or the brain.

00:25:46.280 If those are really high, 0.99

00:25:48.000 then I'm worried about the health of the testicles. 0.97

00:25:51.220 If they're in between, 0.96

00:25:52.840 then I look for another pathology,

00:25:54.900 like diabetes, metabolic syndrome,

00:25:56.880 insulin resistance, sleep apnea, et cetera.

00:25:59.600 I also look at prolactin and IGF-1.

00:26:02.240 Make sure you assess their tumor risk.

00:26:04.340 And then I also look at estradiol.

00:26:05.960 If it's a very high estradiol,

00:26:07.760 then estradiol is likely what is suppressing

00:26:10.000 the production of LH from the pituitary.

00:26:13.180 So you have estradiol, which is your main estrogen,

00:26:15.780 which is causing less testosterone production.

00:26:18.480 And in that case,

00:26:19.300 I look at things like alcohol consumption

00:26:21.000 that can upregulate aromatase

00:26:22.560 or consumption of excess calories or fat

00:26:25.060 that can upregulate aromatase,

00:26:27.260 which converts testosterone to estrogen, by the way.

00:26:30.340 So those are the first things.

00:26:32.460 Beyond that, what are you looking at?

00:26:34.700 Beyond that, I'd like to, if pertinent, do an exam.

00:26:38.420 Make sure, especially if this individual is,

00:26:41.360 you know, developing,

00:26:42.640 if they're an adolescent or whatnot,

00:26:44.440 you need to make sure that they're

00:26:45.380 through all the Tanner stages,

00:26:46.940 basically Tanner stages one to five,

00:26:49.300 five is done.

00:26:50.020 When you're essentially adult growth and development

00:26:52.980 to make sure that they don't have some

00:26:55.740 unusual or unlikely syndrome.

00:26:58.940 And then after that,

00:27:00.700 I'd like to look at their fasting insulin,

00:27:03.580 their A1C,

00:27:05.140 see if there's something that I can correct.

00:27:06.480 I look at their cortisol.

00:27:07.480 If their cortisol is high,

00:27:08.680 then there's a lot of lifestyle factors

00:27:10.760 and also supplements

00:27:11.720 that can help control cortisol

00:27:14.020 like ashwagandha or emodin.

00:27:15.800 I look at their prolactin.

00:27:17.500 So if their prolactin is just a little bit high,

00:27:19.360 then maybe I do start them on some vitamin B6

00:27:21.680 or some vitamin E.

00:27:23.760 If their estrogen is high,

00:27:25.320 maybe I start them on some calcium D-glucarate

00:27:27.180 that helps with estrogen,

00:27:28.740 glucuronidation and metabolism.

00:27:30.300 It basically helps you excrete it through your stool.

00:27:33.440 And then repeat labs in one, two,

00:27:36.700 maybe even three months

00:27:37.660 and see if we can improve those things

00:27:39.960 along with, as always, diet and exercise.

00:27:43.300 Okay.

00:27:43.440 So it sounds like the first line of attack,

00:27:45.220 if it's not a pituitary problem,

00:27:47.260 you're going to be primarily doing lifestyle changes, right?

00:27:50.200 Quitting drinking, getting better sleep,

00:27:52.820 diet, exercise to help get

00:27:54.520 that insulin sensitivity back online.

00:27:57.480 So yeah, lifestyle stuff would be

00:27:58.600 the first line of attack.

00:27:59.560 And then will it take maybe one to two months

00:28:02.300 before you start seeing results from that?

00:28:04.460 Yeah, often it does.

00:28:05.480 A lot of times you feel better the first week

00:28:07.580 and a lot of times your testosterone production

00:28:09.560 recovers very quickly.

00:28:11.880 But occasionally I use medications as well.

00:28:14.420 So some people utilize a short course of HCG,

00:28:18.020 which essentially binds the LH receptor,

00:28:20.220 takes the place of LH.

00:28:21.740 And occasionally I'll utilize very short courses.

00:28:24.600 By very short, I mean a week

00:28:25.960 or maybe two weeks of selective estrogen receptor modifiers,

00:28:29.640 or sometimes longer in the right patient,

00:28:32.700 especially very young patients

00:28:34.200 that you're trying to stimulate endogenous production.

00:28:37.420 These are often patients that desire fertility

00:28:39.700 within the near to mid near future.

00:28:42.920 Besides diet, exercise, sleep, managing stress,

00:28:47.020 you mentioned a few supplements

00:28:48.160 that you recommend men taking 0.66

00:28:49.380 to optimize male hormones. 0.79

00:28:50.820 Are there ones that you recommend for just any guy

00:28:53.280 who maybe they don't have any problems with their testosterone,

00:28:55.980 but they just want to feel good?

00:28:57.580 Are there ones that you like and that are safe?

00:29:00.520 Creatine, five to 10 grams a day would be a great start.

00:29:03.480 L-carnitine would be a consideration,

00:29:06.360 especially if they're interested

00:29:07.680 in athletic performance optimization

00:29:09.660 or body composition optimization.

00:29:12.760 L-carnitine would be reasonable.

00:29:14.040 Consider checking a TMAO

00:29:15.480 to make sure that it doesn't convert to that 0.93

00:29:17.500 and too high of a rate.

00:29:19.360 Another reasonable addition,

00:29:20.740 if someone has high estradiol,

00:29:23.160 would be calcium deglucarate

00:29:25.060 to make sure that they're binding up extra estrogen

00:29:27.320 and excreting it.

00:29:28.940 I've heard that boron can impact testosterone.

00:29:31.560 How does boron increase T levels?

00:29:33.900 Boron works okay for people

00:29:36.120 with really high SHBGs.

00:29:38.000 It increases free testosterone

00:29:40.480 by decreasing SHBG.

00:29:42.580 The effect wears off to some degree

00:29:44.420 if you take boron for a very long period of time.

00:29:46.840 If you have very low levels

00:29:48.940 or you're insufficient or deficient in boron,

00:29:51.040 it works extremely well.

00:29:52.640 And a lot of people consume dates or raisins

00:29:55.480 because they tend to be relatively high in boron.

00:29:59.020 There's another something I've been hearing about lately,

00:30:00.500 Tunggat Ali, I think that's how you pronounce it.

00:30:02.180 What's going on with that one?

00:30:03.300 Tunggat Ali is also known as Long Jack.

00:30:06.740 So Tunggat's active ingredients are Uri peptides,

00:30:10.560 one of which is Uri comanone.

00:30:12.880 And Tunggat is helpful

00:30:14.760 because it upregulates a couple different enzymes

00:30:17.060 in the stroitogenesis pathway.

00:30:19.240 There's been plenty of human study on it

00:30:21.400 with mixed results.

00:30:23.060 And it looks like the cause of the mixed results

00:30:25.580 is sometimes people have great activity of those enzymes.

00:30:29.000 So that's not the rate limiting step

00:30:30.800 in testosterone production.

00:30:31.940 So think of it as a signal. 0.99

00:30:34.480 Think of your testicles as a factory. 1.00

00:30:36.720 Tunggat is a signal to that factory 1.00

00:30:38.320 to ramp up production.

00:30:40.400 But if your factory is already operating

00:30:42.260 at maximum capacity

00:30:43.460 or it's limited by something else,

00:30:46.020 then that's not going to improve

00:30:48.160 your testosterone level.

00:30:49.720 Tunggat works on very similar enzymes

00:30:51.660 that are also upregulated by insulin and IGF-1.

00:30:55.860 So in general, if you're in a caloric deficit

00:30:57.920 or if you're trying to lose weight or body fat,

00:31:00.320 Tunggat will work better.

00:31:01.740 If you have a low fasting insulin

00:31:03.340 or a lower end IGF-1,

00:31:06.280 Tunggat will also likely work better.

00:31:08.140 And I've seen this anecdotally as well.

00:31:10.160 A couple of years ago,

00:31:10.700 I remember ZMA was a big supplement

00:31:12.660 that was pushed for increasing testosterone levels.

00:31:15.400 Anything to that?

00:31:17.200 ZMA is very reasonable to add

00:31:18.860 if you have a low ALKFOS.

00:31:20.520 So if you look at your CMP,

00:31:22.560 which is your metabolic panel,

00:31:24.300 there'll be an enzyme called alkaline phosphatase.

00:31:26.740 It's alkaline phosphatase along with GGT

00:31:29.460 or two intracellular enzymes.

00:31:31.720 And the lower these two are,

00:31:33.080 the more likely you are to have insufficient levels

00:31:35.560 of zinc and magnesium.

00:31:37.280 That's why when I have input to various companies

00:31:39.820 designing a supplement to optimize testosterone,

00:31:43.860 I almost always put in zinc,

00:31:45.600 magnesium, and vitamin D.

00:31:47.500 You just want to make sure

00:31:48.260 these aren't the right limiting stuff.

00:31:49.860 Think about trying to optimize your testosterone

00:31:51.660 as like trying to get into a fraternity.

00:31:53.360 You're not just making best friends

00:31:56.500 with one of the people

00:31:57.980 and then just hoping

00:31:58.840 that nobody else will blackball you.

00:32:00.860 You want to make sure

00:32:01.420 that you address each individual

00:32:03.020 because if you,

00:32:04.140 like let's say you forget your vitamin D

00:32:05.680 and forget your zinc,

00:32:06.640 you're deficient in zinc,

00:32:07.920 you're deficient in vitamin D.

00:32:09.580 Those two things will hold you back.

00:32:12.060 Once you start down this path

00:32:13.200 of increasing your testosterone

00:32:14.460 or getting them optimized,

00:32:17.060 is there any benefit to getting them higher?

00:32:19.260 So like let's say you started off at 400,

00:32:21.980 you had low T symptoms.

00:32:22.880 And then through lifestyle changes

00:32:24.840 and maybe taking some supplements,

00:32:26.160 you bump it up to like 700.

00:32:29.880 Are you going to get any more benefit

00:32:31.360 from testosterone

00:32:32.340 by getting it up to 800 or 900?

00:32:35.100 Past about 600,

00:32:36.500 there's little to no benefit

00:32:37.540 other than bragging rights.

00:32:39.140 At what point would you have a patient

00:32:41.120 go on testosterone replacement therapy?

00:32:44.140 At any point when the risks outweigh the benefits

00:32:46.800 and they understand both the risks

00:32:49.580 and the benefits in their own terms.

00:32:52.260 So what are the risks of TRT?

00:32:54.500 Yeah.

00:32:54.840 One of the risks is

00:32:56.100 it causes more fluid retention and swelling.

00:32:58.320 One of the risks is

00:32:59.260 if you hyperconvert to estrogen,

00:33:01.140 estrogen will then bind to the liver 0.69

00:33:02.660 and cause more SHBG and platelet production.

00:33:05.740 And if your platelets go very high

00:33:07.180 past a certain point,

00:33:08.160 we know that people on oral estrogen,

00:33:11.040 the blood clot risk is associated

00:33:12.440 with how high their platelets and SHBG go.

00:33:15.480 It's likely the same for TRT.

00:33:17.180 So if you go on TRT

00:33:19.560 and you go into a huge bulk

00:33:20.800 and you start consuming a bunch of alcohol

00:33:22.420 and your platelets skyrocket,

00:33:24.260 then it is going to increase

00:33:25.940 your blood clot risk.

00:33:27.880 So TRT is not in and of itself

00:33:30.000 going to improve health.

00:33:31.400 It's just going to be a tool

00:33:32.620 to help you achieve a lot of your goals.

00:33:36.120 Another risk of testosterone is

00:33:38.640 if people have heard of medications

00:33:40.280 called statins,

00:33:41.180 those work by decreasing the activity

00:33:43.860 of an enzyme called HMG C-way reductase,

00:33:46.940 any androgen including testosterone

00:33:48.880 increases the activity of this enzyme.

00:33:51.820 So often people's cholesterol,

00:33:53.860 and it's not actually cholesterol,

00:33:55.280 it's their lipoproteins,

00:33:56.620 but people's quote unquote

00:33:57.940 bad cholesterol gets worse.

00:33:59.520 That's why we watch that APOB number

00:34:01.240 very closely

00:34:02.080 because we know that APOB

00:34:03.800 is the particle that is going to

00:34:06.080 lead to plaque formation

00:34:07.740 in areas like the coronary artery.

00:34:10.120 And I guess the benefits of TRT

00:34:13.020 is that you'll mitigate those

00:34:14.600 symptoms of low testosterone.

00:34:17.180 Correct.

00:34:18.080 And there's of course other benefits as well,

00:34:19.880 like the benefits of estrogen

00:34:21.020 that we discussed earlier

00:34:22.700 being its cardioprotective benefit.

00:34:25.180 And one of the main benefits of testosterone

00:34:27.940 in a lot of individuals that I see start

00:34:29.700 is they might have it,

00:34:30.960 let's say they have an A1C of 5.7 or 5.8,

00:34:34.060 which is technically pre-diabetes.

00:34:36.200 You're very unlikely to get diabetes

00:34:39.320 on testosterone compared to

00:34:41.300 if you are not on TRT.

00:34:43.540 So a lot of individuals,

00:34:45.200 perhaps they're,

00:34:46.240 I wouldn't say doomed,

00:34:48.020 but very likely to get diabetes.

00:34:50.180 And TRT can make a huge difference,

00:34:52.300 especially when combined

00:34:53.540 with other insulin-sensitizing medications

00:34:55.940 to prevent that.

00:34:57.580 Do you keep people on TRT indefinitely?

00:34:59.420 Is it like once you start,

00:35:00.140 do you keep doing it?

00:35:00.800 Or are there periods where you're like,

00:35:02.160 well, we're going to take you off

00:35:03.140 and see what happens?

00:35:03.920 Or how does that work?

00:35:05.480 Most individuals are on indefinitely,

00:35:08.460 but not everyone.

00:35:09.900 Occasionally, there will be a patient

00:35:11.140 that is profoundly hypogonadal.

00:35:14.000 And the benefit of testosterone

00:35:15.900 at that time is just huge.

00:35:17.680 Let's say it's a patient

00:35:18.540 who has a BMI of 40

00:35:20.560 and they weigh 400 pounds.

00:35:22.980 And they also don't have

00:35:24.300 a huge amount of lean body mass

00:35:25.860 to lose in proportion.

00:35:27.400 Everybody who weighs 400 pounds 0.99

00:35:28.620 is going to have a lot of lean body mass,

00:35:30.180 but just less relative

00:35:31.220 to your average person.

00:35:32.160 And they want to maintain

00:35:33.900 as much of that as possible.

00:35:35.060 They need that tool

00:35:36.940 in order to exercise.

00:35:38.520 Even if it's somewhat of a placebo tool,

00:35:40.720 that still helps.

00:35:42.200 So if it gets them

00:35:43.040 having a very healthy lifestyle,

00:35:45.300 they go on that medication.

00:35:46.560 Perhaps they go on another medication

00:35:47.800 like a GLP-1

00:35:48.960 for a short period of time.

00:35:50.820 And then they don't really know

00:35:52.300 what their baseline testosterone is.

00:35:53.780 So maybe after two years,

00:35:55.000 they learn those lifestyle interventions.

00:35:57.500 They very slowly are ready

00:35:59.980 to come off of every medication.

00:36:02.160 And then you can use a medication

00:36:04.500 like HCG

00:36:05.540 to help restore natural production.

00:36:07.740 Perhaps one week of a medication

00:36:09.600 like Inclomiphene or Novodex

00:36:11.380 or even Riloxifene.

00:36:13.020 And then you see

00:36:14.140 what their natural production capability is.

00:36:16.600 You give them a few weeks

00:36:17.660 and perhaps they restore

00:36:19.780 to a total testosterone of 600s,

00:36:21.980 which is likely quite good

00:36:24.560 in that situation.

00:36:25.440 Or perhaps they go down

00:36:26.740 to 100s again.

00:36:28.240 But a lot of people

00:36:29.860 would want that chance

00:36:32.880 to go back to producing

00:36:34.600 their testosterone naturally.

00:36:36.500 And in some cases,

00:36:37.240 it does work.

00:36:38.360 I would say 90% of people

00:36:40.300 that start on testosterone

00:36:41.420 are going to remain on it indefinitely.

00:36:45.020 But I would also say that

00:36:46.560 90% of people

00:36:48.160 that go on testosterone

00:36:49.060 can very likely regain

00:36:51.440 at least their

00:36:53.340 previous level of testosterone

00:36:55.220 if they were to want to come off.

00:36:57.000 Well, here's a question.

00:36:58.600 With female hormone therapy, 1.00

00:37:00.540 you might start taking it

00:37:02.440 during menopause

00:37:03.800 to help with symptoms.

00:37:05.680 But at a certain point,

00:37:07.060 you know,

00:37:07.300 like once menopause is over,

00:37:08.960 I think you're supposed

00:37:09.840 to get off those hormones.

00:37:11.640 Does something like that happen

00:37:12.820 for men?

00:37:13.540 Like, I mean,

00:37:13.900 you might do TRT

00:37:15.020 throughout your 50s and 60s.

00:37:16.600 And then at a certain point,

00:37:17.620 you're in your 70s

00:37:18.880 and you're like,

00:37:19.340 well,

00:37:19.680 I don't need to do this anymore.

00:37:21.640 Or are there 80-year-old

00:37:23.020 or 90-year-old guys

00:37:24.120 taking TRT?

00:37:24.920 There are 80-year-old

00:37:26.460 or 90-year-old guys

00:37:27.200 taking TRT.

00:37:28.980 Occasionally,

00:37:29.500 you will do a dose adjustment.

00:37:31.540 It just kind of depends

00:37:32.380 on the situation.

00:37:33.640 But a lot of times

00:37:34.660 when males reach that age,

00:37:37.900 they are less likely

00:37:39.620 to have as much benefit

00:37:41.320 and they are more likely

00:37:42.680 to have slightly more harm.

00:37:44.720 So it's a moving target

00:37:46.440 over time

00:37:47.240 where you get out the scale

00:37:48.640 and you're weighing

00:37:49.260 the risks and the benefits.

00:37:50.940 And at that point,

00:37:51.820 when a patient's already on TRT,

00:37:53.240 you also weigh the risks

00:37:54.500 of how difficult

00:37:56.180 it would be to come off,

00:37:57.280 which is not extremely difficult.

00:37:59.040 But it is difficult

00:37:59.780 because there's medication regimens

00:38:01.320 that you have to go with.

00:38:02.720 And even with those medications,

00:38:04.480 often there is a short period of time

00:38:06.100 when you don't feel great.

00:38:08.160 So we've been talking about

00:38:08.660 optimizing male hormones

00:38:09.940 in grown men.

00:38:10.840 But let's say we got some dads

00:38:12.060 and moms out there listening 0.97

00:38:13.140 and they've got boys

00:38:14.040 who are about to start

00:38:15.840 or are in the middle of puberty.

00:38:17.680 What can they do for their sons?

00:38:19.760 What can young guys do 0.98

00:38:21.480 to make sure they set themselves up

00:38:23.040 for a lifetime

00:38:24.340 of male hormone optimization?

00:38:27.960 First and foremost,

00:38:29.380 no huge dirty bulk

00:38:30.920 in early adolescence.

00:38:32.300 What I mean by that is,

00:38:33.620 you know, like let's say

00:38:34.340 there's somebody

00:38:34.820 that's trying to put on weight

00:38:36.040 for football

00:38:36.720 or whatever other reason.

00:38:38.600 Can't think of many reasons

00:38:39.420 where it would be worth it.

00:38:40.640 But they're putting on weight

00:38:41.840 and also putting on fat.

00:38:43.880 Adipose tissue in fat,

00:38:46.420 adipose tissue is fat,

00:38:47.400 that is going to increase

00:38:48.760 the conversion to estrogen

00:38:49.860 and estrogen is going to close

00:38:51.600 the growth plates of the bone.

00:38:53.160 So that's going to prevent you

00:38:54.360 from reaching full stature,

00:38:55.660 both in height

00:38:56.960 and other areas

00:38:58.040 of your skeletal developments as well.

00:39:00.260 So that's a great initial recommendation.

00:39:03.480 Thinking about gut health

00:39:04.700 and fiber consumption

00:39:05.660 is also very important.

00:39:07.520 That's going to prevent,

00:39:08.760 again, from over,

00:39:10.120 it's called intrahepatic circulation

00:39:11.660 of estrogen.

00:39:12.920 Estrogen is not necessarily the enemy.

00:39:14.660 In fact, a little bit of estrogen

00:39:16.000 is needed to what's called

00:39:17.160 priming the pituitary

00:39:18.600 in order to fully kickstart adolescence.

00:39:22.320 And that's one of the reasons

00:39:23.060 why boys with very high body masses

00:39:25.880 have higher estrogens.

00:39:27.120 The pituitary gets primed too early

00:39:28.820 and something called

00:39:29.700 precocious puberty is happening,

00:39:31.340 which is too early of puberty.

00:39:33.700 So that's another thing to consider.

00:39:35.560 In addition to that,

00:39:37.280 you want to have a reasonable balance

00:39:39.680 between cardiovascular exercise

00:39:41.260 and resistance training.

00:39:42.580 You certainly want to do both

00:39:44.200 because adolescence can be thought of

00:39:47.040 as your free endogenous steroids.

00:39:51.060 I'll say cycle

00:39:51.840 just because people understand it,

00:39:53.300 but your free endogenous steroid boost

00:39:55.440 where you know you are going to be

00:39:57.000 one, super sensitive

00:39:58.840 to all the androgens that are released

00:40:01.120 that probably most people

00:40:02.540 remember puberty.

00:40:03.520 And you will also be

00:40:04.980 having a lot of androgen around,

00:40:08.320 regardless of what you do,

00:40:09.660 even if your health hasn't been great.

00:40:11.040 So when that endogenous steroid burst happens,

00:40:15.380 that is the perfect time

00:40:17.140 to take advantage of those lifestyle tools

00:40:19.080 to build up very high bone mineral density

00:40:22.260 and very high lean body mass

00:40:24.140 without putting on excess body fat.

00:40:27.240 I imagine young people getting plenty of sleep

00:40:29.320 is important too.

00:40:31.100 Yes, extremely important.

00:40:32.980 And that might be one of the most common causes

00:40:35.540 of suboptimal hormone profiles

00:40:38.620 in adolescence.

00:40:41.100 What about supplementation?

00:40:42.100 Is supplementation something you encourage

00:40:43.700 in young people

00:40:45.140 to optimize their hormones

00:40:46.080 or do you just focus on the diet and exercise?

00:40:49.540 With the oversight of a doctor,

00:40:51.500 I do encourage supplementation

00:40:53.160 if it makes sense.

00:40:54.480 For example,

00:40:55.040 let's say there's a young person

00:40:56.440 and they get a stool test

00:40:58.140 and the beta-glucuronidase enzyme

00:40:59.620 is very high.

00:41:00.660 We know that that individual

00:41:01.660 is just recycling their estrogen

00:41:03.340 over and over again.

00:41:04.540 That makes something like a calcium deglucrate.

00:41:06.620 Or with the oversight of the doctor,

00:41:09.020 maybe even a very low dose

00:41:10.280 of an aromatase inhibitor,

00:41:12.040 a very reasonable addition.

00:41:13.660 And then if you get blood tests,

00:41:14.800 you can actually check the hormones

00:41:15.980 to make sure that they're increasing

00:41:17.600 at the correct rates,

00:41:19.380 that your DHT is optimal,

00:41:21.200 your testosterone is optimal,

00:41:22.440 your estradiol is optimal,

00:41:23.600 your IGF-1 is optimal.

00:41:25.460 And then you can tweak a supplement.

00:41:27.020 Supplements are just like medications.

00:41:29.040 They have pharmacologic effects,

00:41:31.000 so they have an effect on the body

00:41:32.020 and the body metabolizes them.

00:41:34.220 So things like creatine

00:41:35.260 can be very reasonable.

00:41:36.440 Creatine does not affect

00:41:37.540 the development of the kidneys.

00:41:39.140 I did a podcast

00:41:39.800 with my good friend,

00:41:41.660 James O'Hara, recently.

00:41:43.080 We get a lot of questions

00:41:43.860 from pediatricians

00:41:44.860 because the AAP,

00:41:46.380 which is a society of pediatricians,

00:41:48.880 still recommends

00:41:49.740 no creatine supplementation whatsoever

00:41:52.380 up to the age of 18.

00:41:54.300 So not even a 17-year-old.

00:41:56.680 So I just kind of thought

00:41:57.340 that that was,

00:41:58.120 and it's been 15 years,

00:41:59.580 so they're going to update

00:42:00.180 their recommendation

00:42:00.880 within the next couple years

00:42:02.020 whenever they have a joint meeting.

00:42:04.080 But that's definitely a vestige

00:42:05.800 of times past

00:42:06.600 when we thought that creatine

00:42:07.740 was harmful to healthy kidneys.

00:42:10.520 You just check us a statin C

00:42:11.860 because creatine makes

00:42:12.940 your creatinine blood marker

00:42:14.900 look abnormally high,

00:42:17.160 falsely high.

00:42:18.860 So creatine can make sense

00:42:20.400 in a lot of kids as well.

00:42:21.940 And then if there is a kid

00:42:23.460 that has really low insulin

00:42:24.500 and IGF-1,

00:42:25.320 sometimes Tomcat makes sense

00:42:26.940 in that individual.

00:42:28.700 And then in some kids

00:42:29.940 that do have optimal hormone profiles,

00:42:32.160 let's say there's an athlete

00:42:33.100 and he's developing

00:42:34.000 or she's developing

00:42:35.180 and they have very high testosterone,

00:42:37.660 very high IGF-1,

00:42:38.680 that's great.

00:42:39.480 You know that myostatin levels

00:42:40.760 are going to be really high

00:42:42.220 after you have that burst

00:42:44.320 of androgen during adolescence.

00:42:47.160 Myostatin is going to stop

00:42:48.560 the muscle from developing

00:42:49.640 and cause you to start putting

00:42:51.400 more fat into the tissue.

00:42:53.400 I think that myostatin inhibitors,

00:42:55.520 weak ones like fortitropin,

00:42:56.980 which comes from fertilized egg yolks

00:42:59.400 or epicatechin.

00:43:01.700 Cocovia is a good source

00:43:03.020 of epicatechins.

00:43:04.440 Different cocoa powders

00:43:05.500 have a lot of epicatechins.

00:43:06.660 Green tea has EGCG,

00:43:08.500 which is another epicatechin.

00:43:10.280 Basically, those take down

00:43:11.380 the levels of myostatin.

00:43:12.700 Those are also very reasonable

00:43:13.840 to take for the right patient.

00:43:15.760 What about should parents

00:43:16.600 be sweating about xenestrogens

00:43:18.340 in their kids?

00:43:19.120 Like, you know,

00:43:19.640 make sure they get certain types

00:43:20.500 of deodorants

00:43:21.280 for cosmetic products

00:43:22.320 and avoiding plastics.

00:43:24.920 Bisphenol A and phthalates.

00:43:27.240 Yes.

00:43:28.440 That's kind of where

00:43:29.420 I personally draw the line,

00:43:31.040 where if you are worried

00:43:33.220 about every single thing,

00:43:34.460 we live in an unnatural environment,

00:43:36.740 more so than ever.

00:43:38.520 So those are usually the ones

00:43:39.600 that I say to avoid.

00:43:40.600 If you live in an area

00:43:41.580 that more likely has contaminants

00:43:43.400 and microplastics,

00:43:44.920 a lot of times I do recommend

00:43:46.380 testing your water.

00:43:47.680 There are a lot of services

00:43:48.440 that do this.

00:43:49.300 I personally used my tap score

00:43:51.540 to test both the water

00:43:52.820 from the tap and the water

00:43:54.760 through my Berkey filter.

00:43:56.140 If you have young children,

00:43:57.980 then that seems like

00:43:58.760 a very reasonable time

00:43:59.900 to use a water filter

00:44:02.420 if you don't know

00:44:04.120 what the contents

00:44:05.220 of your water is.

00:44:06.460 And then as far as foods,

00:44:07.780 of course,

00:44:08.080 avoiding ultra-processed foods.

00:44:10.400 I think it was like

00:44:11.180 ultra-processed mac and cheese

00:44:12.600 that got a bad name

00:44:13.760 for having high phthalates.

00:44:14.940 I assume they fixed that by now,

00:44:16.300 but I actually don't know.

00:44:17.880 So a lot of times

00:44:19.060 it's the same recommendations

00:44:20.100 as any other whole food diet.

00:44:22.120 And then know your sources.

00:44:24.280 Try to avoid contaminants

00:44:26.240 at very high levels

00:44:27.120 and use the Pareto principle.

00:44:29.080 You know,

00:44:29.560 try to do right most of the time

00:44:31.420 and you'll get most of the benefit

00:44:32.700 even if you're just doing it

00:44:34.060 some of the time.

00:44:35.520 Well, Kyle,

00:44:35.760 this has been a great conversation.

00:44:37.000 Where can people go

00:44:37.500 to learn more about your work?

00:44:39.180 My help is on Instagram,

00:44:40.620 KyleGilletteMD,

00:44:42.020 and it's Gillette Health

00:44:43.040 on all other platforms.

00:44:44.800 I do have a podcast

00:44:45.600 that we fairly recently

00:44:47.280 have, I guess,

00:44:49.400 gotten pretty good audio

00:44:50.400 and video of,

00:44:51.160 but that's on YouTube,

00:44:52.100 Spotify,

00:44:52.640 and Apple Podcasts.

00:44:53.920 We have a clinically,

00:44:56.040 I guess,

00:44:56.460 a clinical-grade podcast

00:44:57.520 and then we have

00:44:58.320 a layman's podcast

00:44:59.860 that we're going to call

00:45:00.760 After Hours,

00:45:01.780 which should provide

00:45:03.060 good entertainment.

00:45:04.500 Fantastic.

00:45:04.880 Well, Dr. Kyle Gillette,

00:45:05.800 thanks for your time.

00:45:06.280 It's been a pleasure.

00:45:07.680 Thank you.

00:45:08.900 My guest today

00:45:09.540 was Dr. Kyle Gillette.

00:45:10.580 You can find more information

00:45:11.380 about his work

00:45:11.840 at his website,

00:45:12.760 GilletteHealth.com.

00:45:14.360 Also check out his podcast,

00:45:15.340 GilletteHealthPodcast

00:45:16.540 and check out our show notes

00:45:18.180 at AOM.IS

00:45:19.000 slash OptimalT

00:45:19.840 where you can find links

00:45:20.500 to resources

00:45:21.120 and we can delve deeper

00:45:21.780 into this topic.

00:45:29.820 Well, that wraps up

00:45:30.820 another edition

00:45:31.520 of the AOM Podcast.

00:45:32.620 Make sure to check out

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00:45:36.040 as well as thousands

00:45:37.100 of articles

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The Art of Manliness - May 08, 2023

Optimize Your Testosterone

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