#196 The Blueprint for Male Vitality: A Deep Dive with Dr. Kyle Gillett on Men’s Hormonal Health, Optimizing Testosterone, Exploring the 7 Pillars of Health, Uncovering the Essential Biomarkers & Tackling the Biggest Threat to Men’s Wellness

Our guest this week is Dr. Kyle Gillett, a specialist in preventative medicine, sports medicine, hormone optimization, infertility and obstetrics, integrative medicine, and genomics. Our focus is all things male hormones. From navigating puberty to knowing when to consider testosterone replacement therapy, Dr. Gillett sets the record straight about testosterone and provides a comprehensive guide on how to manage men’s health and hormones.

We dive into important topics such as early hair shedding and the impact of the microbiome on hormones. We also explore the concept of male menopause and how to best approach hormone health at any age. So, grab your pen and paper and get ready to learn from Dr. Gillett’s expertise. Enjoy.

This episode is Part 2 of a two part series on hormonal health. Dr. Gillett has an expertise in men’s hormonal health. Part 1 is a discussion with Dr. Mary Claire Have who has a more specific expertise with women’s hormonal health through perimenopause and menopause.

Episode Buckets:

– Testosterone’s Impact on Men’s Hormonal Health

– Investigating the 7 Essential Pillars of Health for Optimal Aging

– A Comprehensive List of Biomarkers and Bloodwork to Get

– The Biggest Threat to Men’s Health

Listen to the episode here:

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Key Topics:

• Testosterone and Men’s Health [00:05:22]
• Male Puberty [00:14:20]
• Importance of Prenatal and Postpartum Care for Boys [00:16:32]
• Supporting the Process of Male Puberty [00:22:33]
• Parenting [00:36:51]
• Supplementation for Young Men [00:41:21]
• Present-Day Positive and Negative Approach to Health and Lifestyle [00:45:25]
• Getting the Right Tests Done [00:52:55]
• How Environment Affects Male’s Hormones [01:02:48]
• Young and Adolescent Male Lifestyle [01:04:47]
• Gut Health [01:15:31]
• On Alcohol and Marijuana [01:29:23]
• Recreating Your Gut Microbiome [01:35:18]
• Andropause [01:41:31]
• The Benefits of Regular Check-Ups [01:43:12]
• The Impact of Relationships to Men’s Health [01:48:04]
• Tongkat Ali and Its Benefits [01:50:32]

#196 The Blueprint for Male Vitality: A Deep Dive with Dr. Kyle Gillett on Men’s Hormonal Health, Optimizing Testosterone, Exploring the 7 Pillars of Health, Uncovering the Essential Biomarkers & Tackling the Biggest Threat to Men’s Wellness

Welcome to the Gabby Reece Show where we break down the complex worlds of health, fitness, family, business, and relationships with the world’s leading experts. I’m here to simplify these topics and give you practical takeaways that you can start using today. We all know that living a healthy balanced life isn’t always easy. Let’s try working on managing life a little better and have some fun along the way. After all, life is one big experiment and we’re all doing our best.

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“One of the first things we ask a patient is what their goals are. It is reasonable to have an accurate and honest assessment. Can you achieve this goal regardless of what you do? Can you achieve this goal with any therapy or medication if it might be indicated and can you achieve it without that? Depending on what the answers to those questions are and also depending on how important that goal is to the patient, that can make them a better or a worse candidate for something like hormone replacement.”

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“The phenomenon that you described of men not wanting to check or men not seeking help is partly because they are masculine and they don’t want to be perceived as needing help. That’s what I call the number one thing harming men’s health. You don’t know what you don’t know and at the very least, you need to take your machine, and we’re organic machines, take it in for preventive maintenance and at least get a comprehensive check of what’s going on. Fixing something now can prevent something catastrophic from happening in the future.”

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My guest is Dr. Kyle Gillett. This is 1 of 2 shows that we’re releasing. We are doing a show on women’s hormone health with Dr. Mary Claire Haver. This show is the one all on men’s hormone health with Dr. Kyle Gillett. I have visited with Dr. Kyle Gillett. I am giving you a warning, you’re probably reading this but, at some point, you might want a pen and paper.

Dr. Kyle is one of the smartest and most informative people in the shortest period of time that I’ve had the pleasure of interviewing him. I have interviewed him before and we get into it. We talk about male puberty, when is a good time to start checking your blood, what happens if you did a lot of the wrong things when you were younger, and what can you do now, what should you be looking for. Is testosterone all that?

We’re always culturally focusing on the king male hormone but is it really? We get in behind what somebody needs to do to make the whole system work together. Does alcohol impact your overall health, your hormone health? Does your gut impact it? What about baldness? Is there anything you can do about baldness? Libido.

We get into all of this. He is a wealth of knowledge. Like many of my guests, what I respect and appreciate beside his ability to solve problems and support people where they are is the constant reminder of the real pillars of health, nutrition, movement, sleep, connection, and on and on. Several shows like mine beat that to death because it’s the truth.

The other thing that is beautiful about Dr. Kyle Gillett is his desire to remind males that it’s okay to get help and to take a look under the hood. Many times, we don’t support men and their health quest as much as we do women. That’s not to say that women don’t bear different things. We have a whole other set of complications. One thing we know how to do is say, “What is that? I don’t feel my best.” With men, sometimes, they push it aside and maybe brave through it.

Maybe there are many little small things that they can do to not only have more high performance and enjoyable time while they’re here but also, go through the later parts of their life with higher performance, more muscle, more libido, and more energy and live a life that has a ton of vitality. Grab something to write some of this down. You may need to re-read some of it. I hope you enjoy our conversation with Dr. Kyle Gillett.

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Dr. Gillett, welcome. Thank you for coming to the house again. I thought we were doing this digitally and then I had the luxury that you’re here in person. Thank you. It means a lot.

My pleasure.

Let’s dive right in. We’re doing a male counterpart to a female show. What I always say to people though is even if you’re male, you should read the female show. If you have a daughter, a sister, a girlfriend, a partner, or a mom, you have a bigger understanding. I think the same thing for women, there’s a lot to learn on both sides.

Last time, I harassed you a little bit about women. Even though you have female patients, you talk about male hormones. The magic word always is testosterone. I feel like it’s been oversimplified. You were saying that more isn’t always better. Let’s start there. What is testosterone? How did it get such an important role in the language of hormone, men’s health, and men’s virility? We can go from there.

Testosterone is the main androgen. You have a couple of different classes of sterile hormones, these are cholesterol based. Vitamin D is a cholesterol-based hormone. On androgens, you have testosterone, DHT, DHEA sulfate, and others. Testosterone is not the most androgenic, DHT is. There’s nothing special about testosterone, it binds the same androgen receptor as DHT and DHEA It does not bind it as strongly as DHT but it binds it stronger than DHEA sulfate. Ironically enough, the androgen receptor is on the X chromosome so males only have one of them. Depending on how sensitive that androgen receptor is in that individual. For males, you can thank your mother or one of her ex-chromosomes for whatever androgen receptor sensitivity you inherited.

We’ll get into the lifestyle component of it. There are things we can do to dull that signal. You’re saying also on some genetic level, the signal is preset to be a certain type of sensitivity, and then our lifestyle either keeps it or starts to tarnish it.

Correct. The way to think about that is you have sensitivity and density.  The androgen receptor is active in the cytoplasm of a cell, whether it’s your muscle cell, your hair cell, your prostate cell, or even glandular breast tissue including in males. You have the density or the number of androgen receptors that are not put away by what’s called heat shock proteins, those are in the cytoplasm of the cell. If you have 200, this is an example, you are going to have more androgen receptor gene transcription even at the same level of testosterone and DHT as somebody that has 100.

[bctt tweet=”If you don’t have a good way to explain your self-actualization, then it can also cascade through the other aspects of your health and be very harmful.”]

You mentioned lifestyle, heat shock proteins, heat and cold exposure, stress, and winning an event. Also, things like tadalafil or L-carnitine can affect the density. The sensitivity of the endogen receptor, that’s something that you’re born with and that will never change. It’s something called CAG repeats or trinucleotide repeats. There are other pathologies that are similar. If you have complete androgen sensitivity, it’s a syndrome called AIS. You have an X and a Y chromosome but you present completely as a female because you lack any sensitivity to any androgen. You can have high testosterone levels but you’re not sensitive to them.

What does that look like? How does that show up then in the 3D world? What happens if somebody is going through that?

It can present a few ways. Occasionally, you find out during childhood. It is possible that a child that is born with complete androgen insensitivity, which is AIS, would present as female perhaps with a few phenotypic changes. This individual is not going to be fertile so they’re going to have what’s called undescended testes.

Without going too much into a rabbit trail, sometimes you can have such low sensitivity to androgens that it’s hard to tell. To bring that back into the normal spectrum of androgen insensitivity, it’s similar to a disease called Huntington’s disease, in which you also have CAG repeats. The more repeats, the more severe the disease because the protein doesn’t function because it can’t fold right.

Another similar disease is Fragile X syndrome, which is another X-linked. Technically, androgen sensitivity is X-linked. Normal repeats are about nineteen. There’s something called a reference genome, which is average. Depending on what country you’re born in, some countries have an average of 17 and some countries have an average of 28. There’s a pretty wide variation. Normal is considered between about 14 and 30 CAG repeats.

What do you mean it’s different in different countries?

The average can be different. Depending on the maternal heritage or your ancestry far back, there is a different amount of CAG repeats expected if you’re from that area.

That’s interesting.

For example, the average number of CAG repeats in Zambia is seventeen.

Where would it be high? Is it a place that maybe is more untouched by mixing with other races and it has a longer lineage straight back that they can find? I’ve never even heard that. That’s amazing.

Possibly, the country with the highest number of average CAG repeats, the least sensitive androgen receptor, is Romania.

You wouldn’t think that.

I’m not sure what it’s linked to other than ancestry of the maternal lineage happening to have more repeats. This is where it deviates from science a little bit. Why is the number of CAG repeats increasing? Why are males and females as well becoming less and less sensitive to androgens as time goes on? The prevailing theory, which I mostly agree with, is that if you’re more sensitive to androgens and you have a lower risk threshold, you’re more likely to volunteer to go to the front lines of a war, and more likely to pass away at an early age. For example, World War I and World War II. We know there was a lot of genetic bottlenecking with many different organisms but humans were likely one of those as well.

When you say it’s showing up for men and women that we have less of this, it’s because we haven’t been in these stressful environments where we’ve needed to have this and it’s an adaptation. Why do you think that is?

It’s likely natural selection. Individuals that are sensitive to androgens are probably more likely to volunteer or be chosen to go to the frontline in war and pass away before they’re able to reproduce.

That’s sad, isn’t it? My daughter has to get volunteer hours and she’s like, “I don’t want to.” That’s what we’re talking about.

A lot of this is theoretical but it would be interesting to see, at least in the modern day, you look at 18, 19, and 20-year-old recruits that are serving on the frontline in a war zone and see how sensitive to androgens they are compared to another cohort.

That’s interesting. Let’s start with puberty and young men and we’ll work our way through the hormonal story of what men have to go through. I even talked to somebody who is a practicing vegetarian. I found him to be incredibly informed and reasonable, Simon Hill. He did make this little window where there was information that maybe a male going through puberty was not maybe going to serve their long-term growth and benefits by being vegetarian or vegan.

I’m not here to get dogmatic about how people want to eat. I don’t care. I’m here to try to get the most scientific information and that’s how you communicate. Maybe we can explain a little bit about what happens, what hormones, and what changes are happening in a young man. There are sort of two puberties if I’m not mistaken. First, puberty is fascinating. Let’s talk about that.

As a lot of people know, one of the main reasons why I went into medicine is birth to death, being able to provide prenatal care, and giving optimal quality prenatal care when the human is in the uterus. I suppose that’s the beginning of the first puberty and then it continues the first three months of life. There are a lot of reasons for things like baby acne and a lot of people are familiar with around three months of age, the baby hair is lost and new hair comes in.

One of my theories is the changes that you can see during that three-month period often happen later on in life as well, which is interesting. You can see the recession of hair in male pattern baldness areas even at 2 to 3 months of age. That’s not a direct correlation but it’s certainly something that I do think it’s correlated. During the first three months, you have a surge of hormones including androgens. It is no different than puberty which happens in adolescent time where you do have things like acne develop and you do have swelling and growth of the genitals as well.

Of course, this happens in both males and females. It’s interesting in males because, as our mutual friend Andrew Huberman has pointed out, estrogen is what masculinizes the. In males, testosterone converts to estrogen, which then secondarily masculinizes the brain. The ratio of testosterone to DHT to estrogen is important and it’s not necessarily more of one way is better.

I don’t want to say it’s too late for my kids, plus they’re not boys. Let’s say someone is considering having a baby and then this child is a few months old. Besides some of the obvious, as far as getting rest, continuing to move, eating healthy foods, and then once the baby is born, if they have the opportunity to nurse the child and things like that. Is there anything that is particularly supportive beyond that for the health of the boy?

During prenatal care and postpartum care in the care of the infant, I consider that time the most important for watching for things like the quality of your water, the quality of the plastic in your water bottle, and looking for Xenoestrogens. Xenoestrogens are things that bind estrogen receptors. Estrogen receptors, for better or for worse, are much more complicated than androgen receptors. You have estradiol receptors alpha and beta, not to get too scientific.

You have three estrogen-related receptors, ERR-alpha, ERR-beta, and ERR-gamma. You also have a membrane estrogen receptor. You have more than that but you have at least six main estrogen and estrogen-related receptors. Xenoestrogens bind a combination of all of them. For example, bisphenol A and phthalates are both related to binding estrogen-related receptors. Cholesterol itself is a ligand for one of the estrogen-related receptors.

Having a normal amount of estrogen binding all three of those is particularly important in the developing male and female as well but, in this case, the developing male. Think about the predisposition or the incidents and prevalence of estrogen dominance in the mother, caring for a mother that has estrogen dominance. You are thinking about things to minimize estrogen receptor signaling.

For example, maybe calcium gluconate. If there’s some intrahepatic circulation of estrogen, that way you have less excess estrogen binding in utero. I’m a fan of breastfeeding, most people are when possible. It’s not always possible but also think about your probiotic and prebiotic regimen. Think about diet if you’re breastfeeding and incorporating dairy if you’re able to. Sometimes you’re not able to do colic or whatnot. This is when we can talk about meat. Incorporating meat because the iron in utero in the first six months is strongly correlated with the IQ of the infant.

In parts of this, is there a different and more complicated dynamic between a mother and a male baby because of the difference in the hormonal environment?

Yes. With the difference in chromosomes, you’re more likely to have a mild allergic reaction. That’s why the risk of things like pre-eclampsia is significantly higher if you have a male infant, especially if it’s your first male infant. If you think about it, you have what’s called cell-free fetal DNA. At 9 or 10 weeks, you can look to see what the gender is because you’re essentially looking for foreign Y chromosome material that your body can recognize as foreign. You’re more likely to recognize that foreign if there’s more of it. Twins have a higher risk of pre-eclampsia. Male pregnancies have a higher risk of pre-eclampsia. First pregnancies have a higher risk of pre-eclampsia. The definitive management for that is delivery because then you’re not having that allergen introduced.

I didn’t check on the genders of my children and it’s funny that you say that now because we always were saying, “It’s the last great surprise.” When you say that, that’s an argument for knowing a little bit. It’s an interesting thought. I’m always like, “Why does everybody want to know? Doesn’t anyone want to be surprised?” Did you find out what gender babies you were having?

Yeah. For the first one, we did. We were going to wait until the end in the first one and then right around ten weeks, my wife decided that she’ll do the test and she want to know.

Was that a concern for you or not really? You were going along because she’s the mom and you were like, “Do what you want.”

I would’ve got along regardless of what she would’ve wanted.

What about the next pregnancy?

For the second one, I was doing enough ultrasounds that, either way, I would’ve known. She decided she wanted to know but not until twenty weeks for that one.

That’s weird, you wait until 5 or 6 months in. That’s funny. Usually, it’s right away. It’s a lot of fun. First, puberty, it’s almost till three months old, which people don’t realize. There are some interesting and important things that you talk about about what’s happening as far as bone density stacking and things like that.

You have a young male going through puberty and there are all disruptive things happening besides hormones. The fact that they want to stay up later, sleep later, and things happening in the brain. I experienced this with my girls differently, it’s that freedom. I can control what they eat here. There’s a part of me, and I’ve been in this long enough, where I’m like, “Go ahead. If you want to eat that weird food out there when you’re out there, you’re going to learn and your skin is going to look a certain way.”

When you eat pretty well in your house, kids are smart and they will eat it and then be like, “Eww,” and get over it. Fighting it, at least for me, was not even worth it, especially for girls. A boy is going through puberty. As a parent, for parents, if they have the opportunity, if the kid is open to it, can they ramp up on certain things to support that process because it has such long-term impacts?

The first thing that you would want to think about doing when it comes to physical growth and development is you want to get good objective data about height, weight, and, ideally, and this is for everybody, not just going through puberty, the body composition. In a perfect world, we’d be assessing body composition and not height, weight, and BMI to track growth.

When you say body composition, break that down because I don’t know if people know what you mean.

Body fat and then what’s called fat-free mass, which encompasses bone mineral density, how the bones are developing, how dense they are, and also muscle mass. You want a body composition that is consistently progressing in equal proportion. The worst-case scenario is you could be malnourished. What’s a more common scenario is you have body fat accrual significantly faster than the accrual of bone mineral density and muscle mass. In that case, you’re likely to have over-aromatization, which is testosterone converts to estrogen.

Estrogen is interesting because estrogen primes the switch. The puberty switch is two different switches, you’re turning on your car with two keys at the same time. One of them is leptin, which comes from adipose. One of them is the melanocyte-stimulating hormone, AMSH. They both activate these kisspeptin neurons. Kisspeptin is also a peptide. They activate kisspeptin neurons, which are strongly tied in with the limbic system, the emotional system in the brain. When that happens, if you have the estrogen primer, then LH starts to work and LH starts to get released. LH is what goes to the Leydig cell to produce testosterone and the Theca cell to produce testosterone as well in females.

In males, the Leydig cell is in the testes and LH is going to bind it and causes the synthesis and release of testosterone. All of those things have to be present at the same time. You want a little bit of estrogen, otherwise, you’re not going to be able to prime the switch. If you have too much, this is common to see in childhood obesity, you have precocious puberty, which is early puberty, and the growth plates shut down and you have decreased stature of the individual.

In a perfect world, this symphony has to occur for the switches to go. If they blow it, especially if the kid is obese, they’ll do it too soon and maybe stop their growth or how big they can be. Does it impact bone density and things like that as well?

Yes, it certainly does. One of the standards of care treatments for early precocious puberty.

What’s that? Is that 9 or 10?

If it’s 9 or 10, commonly they give something that activates the pituitary so much that it shuts down. It’s called tachyphylaxis. It becomes desensitized to all the other signals. You don’t have the release of testosterone and estrogen so you don’t have an accrual of bone mass but it does keep the growth plates open. There’s a cost-benefit analysis to all of it. It’s a moving target because there’s not any such thing as a free lunch.

There are a lot of theories about how we can improve this because that is not root-cause medicine at all to shut down everything and impede growth and development. Yes, there is evidence and case studies to where this has impeded even a decade in the future. That’s also a secondary concern to that. When you’re considering the decision-making process for that, it’s often impossible to find the root cause because it’s a chicken or egg situation. You see what’s happening, you see they’re in early puberty, and at the end of the day, it’s already coming.

Let’s say I have a six-year-old and maybe I’m doing the best I can as a parent but our lifestyle combined with the kids’ activity level or access to an activity or it was COVID for that matter and they don’t live in a place that’s natural. You can see certain changes happening. If somebody goes to their pediatrician with the kid, we’re going to try to do better. We’re going to try to eat our vegetables and oversimplify it. Is there a way to pump the brakes on that so that the kid doesn’t have to go through this early puberty and that they have a chance to pull up the plane a little bit and push it off to 13, 14, or 15? Is it a death sentence?

It’s certainly possible. Even among individuals, there is a strong genetic predisposition when you go through puberty. For example, almost everyone on my mom’s side of the family, including myself, goes through puberty late compared to other individuals with the same body mass, the same body composition, and the same chronologic age. Sometimes you’re slowly going through puberty and you keep your growth plates open longer.

Is that why you’re big? Is that it?

Yeah.

You’re a big person.

That’s a lot of genetic predisposition. Probably, in your case, it’s relatively similar to that.

I wouldn’t say I went through puberty early or late. I was average. I probably got my cycle at 12 or 13.  I grew until 15. My mother is quite tall, 6’2”. Maybe I could have been bigger, I don’t know. I’m taller than my biological father, which is unusual for daughters to be taller than their dads. For example, my daughters are different. One went through early and the one you met went through later and she’s also the tallest one. Maybe one took it from one side of the family and one took it from the other, I don’t know.

In general, the earlier you go through puberty, the faster your growth velocity as well. You can grow quickly, 5 or 6 inches in one year.

I used to do that.

That can be difficult to deal with as well.

I was 6ft at 12 and 5ft at 7. I grew pretty quickly. I was a kid who could grow three inches in the summer with no problem. Let’s say you’re active and your family’s background looks normal or average. Are there environmental things that can kick kids that are not dealing with obesity, are active, and eat reasonably into this early puberty?

Yeah, there certainly is. They are rare. It’s rare to have a gonadotropin-producing tumor, which is extra LH and FSH. Rarely you do see them and there are case reports. Often, when you have some of those changes earlier, it’s not true puberty, it’s just that you have hyperactive adrenal glands producing a lot of DHEA sulfate. That’s dehydroepiandrosterone, it’s a weak androgen but it can convert to testosterone and estrogen, and there’s a huge variation in the amount of that as well.

[bctt tweet=”Hormones indirectly influence autoimmunity.”]

You were talking about these switches, this can also impact your brain, temperament, and personality. Is there some pattern seen in a kid who maybe goes through puberty a little bit earlier for these reasons like their behavior?

There certainly is. This is not all or nothing. It’s not a true dichotomy. On average, they’re interested in different things. You compare a male child that goes through puberty at 12 versus 15 and they will be interested in different things at different ages and they will be predisposed to getting in different trouble depending on what age they’re at.

Are you saying they will be getting girls pregnant earlier than other boys? I’m joking. What is it that they’re more interested in?

Theoretically, anything from that to higher-risk behaviors. Testosterone and androgens don’t change who you are as a person and how you’ve developed. That goes back to nature and nurture and it’s both at the same time. They do augment what you are already developing. If you augment those in an individual who’s younger, let’s say they have one of the things that they call oppositional defiant disorder, people who are stubborn, combative, likely to disagree with authority, more likely to get in trouble with the law, or trouble with any authority figure, that will be augmented at an earlier age.

It must be interesting for someone like you who sees patients and is equipped with a lot of information where these systems and patterns are all around us and we can start to identify a lot of things and how they’re linked together, you’re like, “It’s obvious.” I’m curious because you grew up in a more specific or unique way.

I was homeschooled.

I feel like your family are smart people. There’s something in your journey that I am curious about that informed you to want to be in medicine and get under the hood. I’m also curious now that you’re a parent, besides somebody who knows, how does it show up for you as a parent? Now we’re in real life and we’re trying to put it into play.

We can have all the lists of what we’re supposed to do. Let’s start with maybe what your parents did well that worked for you and your siblings that you’ve brought into your own personal practice as a parent and maybe some modifications you’ve made because you and your wife are a new family.

I like that I had a lot of ability to be creative and do a lot of critical thinking. I did not have to sit a lot. If I was in public school, I would’ve been diagnosed with ADHD. Unless I’m actively doing something, I don’t like sitting for a long period of time and doing nothing. I like that I spent a lot of time outdoors and I like that I learned how to do a lot of things, for example, tend to garden, tend animals, or a number of things like that, prepare food shop for myself, and be financially responsible.

As far as things that I have been doing differently, partly because my kids are different than me and it’s a different world as well, is being okay with not becoming medically orthorexic. By that, I mean, with food, if you’re hyper-focused on only eating the healthiest foods, another name for that is orthorexia. If you’re orthorexic and you eat something unhealthy, let’s say, french fries and chicken fingers, you feel bad about yourself for doing that. In my case, let’s say one of my kids is watching Blippi. The dose makes the poison but I have to be okay with not feeling guilty about that and being okay with the positives of that and not thinking about the negatives.

With my husband and I, technology is a battle. If it was up to him, everything would be in the driveway and he’d have his truck and he’d be going forwards and backward. Especially with technology, it starts with Blippi. and then before you know it, you’re in TikTok and Snapchat and you have other things. Do you guys already have a strategy in place? I’m fascinated by people who can pull it off. Are you going to send your children to 9:00 to 5:00 school or 8:00 to 3:00? I homeschool my kids for a bit until they request otherwise.

We’re not sure. Part of that will be up to how my kids develop.

If they’re naughty, you’re going to keep them home?

Probably not. Depending on what situation would be best for them. One thing that I do know is I cannot perfectly predict everything that will happen to them and how they will turn out. I already know their personalities by now. I can predict some things of how they will succeed and maybe how they won’t but that very well might change.

You’re just going to see, that’s the conversation, the pillow talk, we call it.

I would expect that we’d probably at least partly homeschool them. There’s not as much of a separation between going to school and being homeschooled. There are co-ops where you go a day or two a week or parents might teach or you can go to a university model school where it’s a couple of days a week. There are a lot of in-between options and a lot of people will be looking at one of those.

If you have that opportunity, it’s an incredible option. You’re an even pealed person. Are you surprised? Does parenting surprise you, the impact it’s had on you as a person?

There are a lot of surprises but it does not surprise me that there are. One of the reasons why I like medicine is that it can be hyper-analytical. You can see why something happened and then you can also delineate between, “This is certainly why and this is maybe why.” Being a parent, instead of predicting a lot of things, you do your best to predict but then you also are okay when a different outcome happens.

Do you have the 2 on 1 and both of them in the car and, all of a sudden, you’re like, “I can’t think my way out of this. I’m feeling the whole thing.” It’s not that I don’t know what to do but there’s a winging it or are you always being strategic about it?

I always try to have a plan but, at the end of the day, most of it is winging it. If you talked to me 3 or 4 years ago and told me exactly my situation now, I would’ve said, “Sure,” but I would’ve never predicted it.

Let’s say you have athletic teenage boys. You hear about growth plates when they’re open, they shouldn’t have tons of time under tension, or should they? Is there something that shows up as a universal truth? For example, girls, with the shapes of their hips and their hormones, they’re talking about why are we not having them do skill-oriented training versus sometimes resistance while they’re going through some of the changes. Why are all the soccer players blowing out their ACLs and things like that? If there are some ways that show up that it feels overall pretty good for an athletic male as far as the training outside of the sport.

Mobility and flexibility are certainly important. Coordination is important too, especially if there’s a high growth velocity, which is a lot of growth in a short period of time. The main thing to keep in mind is to not dirty bulk.

That’s what they’re all doing too, though. If guys play football, then they’re like, “I drink creatine. My mom is making me 75 shakes a day.” It’s trying to calorie load and get size.

I suppose you could make the case that after your growth plates are completely closed, maybe when you’re 17, it wouldn’t be extremely detrimental. If you’re 14 or 15 years old, you should not be dirty bulking, just a nice even weight gain, especially trying to dirty bulk o over the summer, that’s a terrible idea.

Let’s say we’re in Texas and football is religion, let’s say, and they hold guys back, some guys are graduating at 20 or whatever. I’m not picking on Texas but they’re a great example of it. The long-term dirty bulking, for anyone, can be tough on you.

My wife’s family, all the men in the family, they’re all football players, and they like to say there are only two ways that an athlete can go. They’re specifically talking about football and wrestling, which is what they do. One of the ways is that they become obese and get diabetes and metabolic syndrome. The other way is that they lean down even if they think that they’re losing muscle mass after college.

It’s a lot easier to manage. It’s funny how it is like that. The important thing is not to be broken so that you can’t move enough to try to manage the weight. I see that with a lot of athletes. People don’t realize pretty much if you play sports at any high level, even if it’s high school, you’re paying the piper something. If you go longer, college, and then pros, it’s trying to navigate that fine line between being beaten up or you’re over it. You’ve trained so much and you’re like, “I’m over it. You say that if people have the opportunity at around 18 or such, get that baseline blood work. Are there supplements that show up for young men even if their blood work shows up great that is supportive?

There certainly is but it’s individualized, especially so for the pediatric population. In the past, I’ve talked about various strategies to improve growth hormones, but those are only applicable in pediatric populations that are borderline insufficient or borderline efficient in growth hormones. If you have optimal levels of growth hormone, those will do nothing. There are also strategies to decrease levels of estrogen and those strategies are only applicable in pediatric populations. At 18 or 19 years old, the physiology is similar to a 16-year-old.

What’s interesting, is in the past, I’ve talked about creatine specifically. The AAP still has a statement that anybody up to the age of 18 specifically should not take creatine due to the potential risk of renal injury. The physiology of a 16-year-old and an 18-year-old is quite similar. Creatine has some interesting benefits, especially for the athlete given that it can help them retain more water weight and also improve testosterone and DHT while giving them more energy as well.

As a female that takes creatine, I don’t love it. 3 to 5 pounds of creatine, it’s the way it is. You have to know that my standing weight is 175 and now it’s 180. When you step on the scale, you’re like, “There’s the water weight.” What is the benefit to a young man to have water weight?

You have more sarcoplasm. Sarcoplasm is the cytoplasm or the water inside the cell in the muscle and that’s going to help with shunting energy. Think of creatine as the backup fuel tank for your mitochondria, the main powerhouse of the cell.

We love the mitochondria. Is that happening for me too?

Certainly.

You’re trying to make me feel better.

It’s also a potent nootropic, especially as age is increasing. There are studies and they take different ages of people and then have them do memory recall. The more increased their age, the more the creatine will help with improved speed and accuracy in recalling items.

Is a certain time of the day better than another time or does it matter?

Not necessarily. Most people take it in the morning. Some people that are non-responders can take more than five grams a day. You can load it but you don’t need to load it. Also, you can combine it with other things like betaine, which is the same thing as trimethylglycine. If you’re trying to decrease homocysteine as a methyl donor, which has to do with the homocysteine methionine cycle, that’s like oxidative damage and also amino acid synthesis. A good rule of thumb is five grams of creatine once a day in the morning.

You don’t have to cycle that off. You can just take it.

Years ago, we didn’t know that for sure. Some people would cycle off and take creatinine. Creatinine is a lab, it’s in a CMP. We used to estimate GFR, which is the filtration rate of the kidney using creatinine. If you’re on creatine, especially if you exercise, your creatinine is going to look high because you’ve been utilizing more fuel and you’re detecting the exhaust there. What I usually use for people that are on creatine, including pediatric populations, is Cystatin C. You can also estimate a filtration rate from that.

We can move into mature men. What is showing up or what are you seeing? Is something changing? Are you seeing a change? Your patients are coming to you, whether younger or older. Are there some new patterns that are either positive or negative that are showing up based on the world that we’re in right now?

It’s common to see pediatric obesity. It’s common to see pediatric sleep disorders, including sleep apnea even in 12 or 13 year old. I’m trying to think of positive patterns as well. There are a lot more of the pediatric population that is interested in health optimization perhaps due to podcasts or perhaps due to sports, it’s hard to say. My recommendation there is for every patient, pediatric or not, to find a movement pastime to last a lifetime. That is often easiest to do when you are still an adolescent or developing because you have more of that built-in neuroplasticity.

Especially for guys, guys are interested in performance-enhancing drugs, especially athletes. Think of your adolescence as your freebie performance-enhancing drug but it’s endogenously produced. When you go through puberty, you are sensitive to those hormones. You are noticing those hormone shifts in all systems. You go from low levels to hopefully high normal levels. That is one of the best times to stockpile and accrue and invest. Like you want to invest in your 401(k), you invest in your bone mass and your lean body mass during that time.

Let’s say someone is reading this and they’re like, “I blew that. I grew up in an uninformed household. I didn’t get that lifestyle note. I was sickly.” “I’m 30,” or, “I’m 40,” whatever it is. Let’s say they’ve made corrections, the lifestyle is on cue. They’re doing enough Zone-2. I’m joking with you. Everyone wants to talk to me about Zone-2. I know it’s correct but it’s funny. They’re eating well. Are you comfortable with one gram of protein of ideal body weight-ish for people, for men? Does that seem okay?

It’s a good rule of thumb and yes, it’s okay if a lot of that is a plant protein.

You need that fiber. Let’s go right there right now. We were talking about, with aging women, being mindful, especially if you’re a performance woman, that maybe fasting isn’t going to be great for you.  You need to probably eat more protein and spend some time under tension, lift something heavy, and move your body. When I say that, people think, “I need to go load up on the plates and get in the gym and squat.” No, you need to lift something. I don’t want women to be intimidated. For men, you’re saying that in certain things, it’s a flip of that, especially as they get older.

A lot of times, your optimal protocol for an aging female and an aging male is the opposite. The males need to eat more fruits and vegetables and need to do more cardio, Zone-1, Zone-2, and all the above. They need to get more steps and have more non-exercise. Thermogenesis or more calories burn outside of exercise.

They’re usually at lower risk of sarcopenia and osteopenia, which is low muscle mass and low bone mass but not necessarily. Regardless of the individual, if you are at risk of low bone mass, a specific type of exercise called axial loading is of particular benefit. They have different brand name protocols for this like OsteoStrong.

That is not a sexy name.

Axial loading is training against the weight that comes from the head down through your feet. A squat or deadlift would be an example of that. One of my favorite versions of that for someone who is not into lifting is using a trap bar or an open trap bar, especially the ones with the built-in, changing the weights off and on.

It’s smart. I got one from my friend, Chris Duffin. He’s out of control. He lifts 1,000 pounds and has multiple reps, deadlifts, and squats. He sent us a beautiful one.

Kabuki has a nice open trap bar.

If someone is now concerned, they’ve looked up, they’ve gotten through college, they’re in their life, and they now have a little bit of extra time to look up and they realize, “I may not be in the best setup place for this next chapter.” We have the idea of lifting and eating a certain way and burning calories outside of exercise per se. Is there anything as far as your bones are concerned to make up for lost time if you will or maybe they were obese when they were young? Is there something?

As far as accruing more bone mass after the mid-20s, it’s difficult. There have been interesting studies on growth hormone on IGF-1 and even TRT or androgen therapy. After the early to mid-20s, it is difficult to get ahead to stockpile more. However, you can prevent loss well. When you combine it with things like axial loading or resistance training, you can get some response, it’s just not as pronounced. It’s not a reason not to do that. Let’s take an individual who is in the pediatric population versus someone who’s 30 years old. There’s less benefit to something like growth hormone therapy if they are borderline efficient.

How did TRT, growth hormone, testosterone, and some of this hormone therapy, in certain ways, get a bad rap? There was a lot of like, “You’re going to get cancer.” It’s maybe based on a study, I don’t know if it’s true or not. Overall, if someone comes to you and they get their blood work done, let’s say it’s an appropriate age. What’s an appropriate age? Mid-40s?

It depends on what it’s appropriate for.

Let’s take a civilian. Let’s say maybe not a performance athlete and not somebody who’s still doing triathletes. Let’s say somebody who’s trying to stay healthy, longevity, but they do train, they’re moving their body. It is about mid-40s or 50-ish.

There are a lot of variabilities but often that’s the last chance to get your baseline panel.

You start to drop off a cliff.

There are a lot of studies that look at testosterone levels after the age of 30 with good lifestyle factors. A lot of that can be delayed slightly. With average lifestyle factors, for example, it would be average to have a decline of ten nanograms per deciliter every year. If your testosterone at age 30 is 700, ten years later, it would be 100 less, and then ten years later, 100 less.

It’s the idea of getting your blood work done. Would you be comfortable sharing what panels are reasonable that give you a nice snapshot?

They are on my website. The most important part of the panel would be the screening labs that your doctor will already likely order. Hopefully, for your A1C, maybe fasting insulin. I recommend fasting insulin because those are signs of metabolic syndrome, which is the most common pathology. You want to make sure you’re not pre-diabetic. You want to make sure you don’t have insulin resistance. You also want to get your lipids checked. Hopefully, Apo B in addition to LDL if you know your LDL is going to be high. You want to get your metabolic panel, which is your CMP and your C BBC to check for things like anemia.

Do men have anemia?

They do. It’s not as often iron deficiency anemia because they don’t have as much blood loss. Men can certainly be anemic. Estrogen helps you retain iron. Higher estrogen, you can have iron overload. You could also have things like B12 deficient anemia or even athlete’s anemia, anemia from exploding red blood cells. They can certainly become anemic. Even if they’re not anemic, they’re probably going to have a lot better performance if they have a hemoglobin of 16 instead of 13.2. That’s something to look at.

[bctt tweet=”It’s difficult to live in a time where the miracle of what the human brain is capable of is slowly being lost.”]

As far as hormones, TSHt, and at least a Free T4 and probably a Free T3 as well, those are your thyroid hormones. Your estradiol, for men, needs to be an LCMS or sensitive estradiol or also known as equilibrium ultrafiltration. Look for sensitive estradiol or free estradiol and then you want total and free testosterone or total testosterone. SHBG, that’s Sex Hormone Binding Globulin, binds up androgens and estrogens, that would be your bare minimum.

If you hear that, people go, “That’s so much stuff.” They get all this checked and they go, “You’re doing pretty good on the levers you can control. It wouldn’t hurt to get some ho hormone therapy.” This is more about people who don’t know. Is it showing up as a shot? Is it a pellet? Is it creams? Is it supplementation? Is it a mixture of all of the above? When is that appropriate?

When it comes to choosing whether or not to do HRT, regardless of which formulations and whatnot, it’s like any other medication. You have a scale and you have your benefit and you have your detriment. You want your benefit to outweigh your detriment. The difference between how heavy the benefit and the detriment are, that’s called the therapeutic window. Some people have a narrow therapeutic window.

The therapeutic window might be a lot of benefits and a lot of detriments for someone or it might be a little bit of benefit and a little bit of detriment. The pain and inconvenience of having to take the medication regardless if it’s injectable or a pill does weigh to the detriment and that can be different depending on the individual.

When you say pain, do you mean the hassle?

Sometimes literally the pain as well.

Getting a little shot? I have a good friend who’s a badass, do not give him a needle. Thank God for the little baby needles. You’re calling that part of the pain.

It’s bothersome. It’s not always pills but pill fatigue is another term that people have.

I’d be embarrassed. I could show you my cabinet over here. Sometimes I’m like, “Get it together.”

That’s something to take into account and that’s something that I encounter frequently because I work with an interdisciplinary team. There are dieticians, health coaches, DCs, PTs, and a whole bunch of other individuals who are often starting supplements. You start a supplement because you want to help someone. Someone has to be the bad guy that tries to weigh which ones are helping the most.

It’s important too. Is it the pellet? Is that seen sometimes to be the most reasonable because they get it in there and then is it in every 3 or 4 months or how does that work?

This is highly dependent on the individual. Most people end up preferring if it’s TRT an injectable subcutaneous regimen. It’s usually twice a week or maybe three times a week. Sometimes you can get it shallow subcutaneous, five-sixteenths of an inch. There are autoinjectors. If you have an SHBG of above about 40, you can get by once a week. It does depend on the individual. If you take another individual and they have an SHBG, that’s the protein that binds it up.

If you have lower SHBG, you’re going to have a lot faster metabolism. In that case, you’d probably need 2 or 3 times a week. The more superficial you inject, the longer it takes the enzyme called esterases to come and cleave off the esther. For example, cypionate or enanthate. That’s why using a shallower needle and often a much smaller needle as well is preferable.

Now they’ve got it where you hit a button and it goes in there. That’s amazing.

They have autoinjectors for almost everything. They have lymphatically absorbed testosterone. They have testosterone patches called Androderm.  They have testosterone cream and testosterone gel. There are three different brand name lymphatically absorbed testosterone capsules that you take twice a day with food. They go through your lymph system and not the liver. There are a lot of different formulations.

That’s amazing. You’re going to be young forever. You’re going to get to play around with all this stuff. The base of some of this stuff, do you have a preference?

Almost all hormones are based on oils or what’s called carrier oils. Even the lymphatically absorbed ones, you’re supposed to take with fat because fat and oil help it be absorbed. Each one is usually mixed in with oil. Like vitamin D, vitamin D is absorbed better if it’s in a gel cap that has oil in it rather than powder. If you are injecting it, there’s something called viscosity which means how thick or how thin the oil is.

There’s no perfect oil but a thin carrier oil that has a thin viscosity like MCT oil will go in and out of the needle easier so you can use a narrower gauge needle but it also has a faster half-life. There’s an interesting on testosterone undecanoate and they compared castor oil, which has thick viscosity, and tea tree oil. The tea tree oil does not have super thin viscosity. If they had used MCT oil, it would’ve been way different, or even GSO, which is grape seed. The half-life of the tea tree oil was almost twice as short as the half-life of the castor oil.

When you think of a tea tree, you think of something pretty strong.

Castor oil as well. Progesterone is usually in caster oil. That’s why often if you’re injecting progesterone, you have to use a pretty big needle. Otherwise, the castor oil will not flow through a nice narrow gauge needle.

This is a random question but let’s say someone is single. Can you take it in the thigh if you were by yourself versus in the glute? Where is it optimal?

There are a lot of different regions that you can take it. Some people do it in subcutaneous abdominal fat. A lot of people do it in what’s called the ventral glute, the gluteus medius area, which is halfway between the hip bones on the side of the buttocks. Some people do it in the deltoid area. Some people even do it in the peck, I don’t recommend that. Some people still do it in the vastus lateralis, which is the edge of the quad muscle. For most people, it’s either recommended to do it in the subcutaneous abdominal region or the gluteus medius, the buttocks.

We might have talked about the book Count Down and talking about the environmental disruptors to the endocrine system. Women are able to have children so there’s a different level of orchestration and complication and then we have our cycle every month. I could be wrong. It feels that, in certain ways, men are impacted by environmental things also maybe more than they even realize like their testosterone levels, sperm efficacy, sperm count, or whatever that is.

Do you have patients that come to you that it’s about the environmental impacts? I interviewed somebody who had bad psoriasis and eczema because he doesn’t methylate toxins well. He created an entire company based on this, which is fascinating. He doesn’t methylate things well. If someone comes to you and you think, “Maybe this person is impacted by the places they’ve lived.” What are the steps because that’s a hard onion to peel a little bit for people?

This is where individualized medicine comes in. If you’re thinking about the immune system, you have humoral, and you have cell-mediated. Humoral is antibody-mediated pathologies and cell-mediated is not due to antibodies, it’s your white blood cells, the rest of your immune system. Estrogen tends to skew you more toward humoral diseases.

You think about Hashimoto’s thyroiditis, that’s mediated by an antibody. Whereas androgens tend to skew you to other types of immunological pathology. Psoriasis is an example of cell-mediated. If you tend to be less estrogen dominant, that will skew what’s called the Th1 to Th2 immune system. Those are the two different types. You can make the case that if you have deficient estrogen, you might have something like psoriasis get worse. There are a lot of other factors that are at play, of course, but that is one of the ways that hormones indirectly influence autoimmunity.

Are you seeing younger men coming in and wanting to contemplate, maybe based on their lifestyle, getting some? Maybe people feel more tired, they feel overwhelmed. It’s constant information, news, blue light, sitting in cars, and sitting at desks. In certain ways, it feels like there’s a big load sitting on a lot of people that you have to consciously figure out how to break out of. Are you seeing more and more men that are younger going, “I don’t feel good. I feel tired. I’m not excited.” People aren’t having as much sex, they’ve got all these dating apps, and they’re having less sex. What’s your feeling on that?

There’s an interesting phenomenon. Chris Williamson talks about this a lot on his podcast.

He’s interested in women, men, and relationships. Maybe that’s also where he is in his life. You see him drilling down on this.

It’s interesting because you look at both adolescent males and males in their 20s. Compared to the rest of human, they have completely different motives. Think about their collective cultural psyche has not come to a conclusion of what they should be doing. Does an individual want to pursue a career? Maybe or maybe not. Does the individual want to pursue having a family? Maybe or maybe not. They’re trying to figure out what they can do because even if they wanted to, for example, get married and have a family in their early 20s, many are not able to. You have the Manosphere that tries to explain things like that.

People are explaining, “It’s this reason or it’s that reason.” At the end of the day, it’s multifactorial. A lot of times, when they seek out care with me, it’s because they have something that they are not happy with. For example, it could be something simple as hair loss prevention. They’re 28 and they don’t want to lose their hair early because they still want to get married and have a family and they know that can play a part in how attractive they’re perceived.

For these guys, maybe their hair is starting to thin a little so they come in to see you about this.

Yeah. The time to do it is as early as possible. Hair is scored on what’s called the Norwood Scale. Norwood 0 is perfect and then 1, 2, 3, 4, 5, and 6, you have progression. The earlier you intervene through a variety of different means, the better results you have in the long run.

I’m curious, how does one intervene? What does it look like in your 20s, 30s, 40s, and in your 50s? I would imagine it’s different.

It can be slightly different. You intervene to get the most benefit with the least detriment like anything else. The three different mechanisms are anti-androgen. Men are predisposed to what’s called male pattern baldness or androgenetic alopecia. You have growth agonists and then you also have blood flow or hypoxic tissue damage. You assess through both history and objective labs what’s the true cause of your hair loss.

Some people come in and have a thyroid disorder or they have an iron deficiency or they had a virus and that’s what’s caused a big hair shed. Usually, there’s an androgenic component. You look at how severe and how significant this is. Occasionally, there’s also an estrogen-deficient component. You pick an individualized regimen for that patient. People don’t necessarily have to have genetic tests. Occasionally, it’s useful. Often, you can tell by getting objective lab markers and getting a history.

What is it? Is it topical or do you take something? I’m curious because, as a woman, we worry about a lot of other things. We get that too.

Occasionally, it’s topical. Occasionally, it’s medication. The more predisposed you are or the later you’re intervening, the more likely you are to need to use a regimen that has better efficacy. Regimens with the best efficacy are oral anti-androgens or oral 5-alpha-reductase inhibitors. If you’re desiring future fertility within the next 12 to 24 months, that changes your options. Oral minoxidil is also particularly useful if you need more growth agonism or you want results faster.

If you’re trying to get results in 3 to 6 months, you’re going to likely want to incorporate some growth agonists like PRP, minoxidil, and GHRP peptides. Microneedling is another growth agonist. There’s a whole host of those. Your anti-androgens are things like Ketoconazole and 5-alpha-reductase inhibitors, both natural and prescribed. As far as blood flow and preventing hypoxic tissue damage, those are things like sildenafil and tadalafil, even immunomodulator, botulinum toxin. Theoretically, scalp massage.

I like how you say theoretically. You’re not buying it.

I’m sure there are some people that have such good adherence that they can massage their scalp in order to decrease hypoxic tissue damage. If you’re going to have adherence that much, why not use an immunomodulator that you’re not going to form auto-antibodies to?

If I’m an older guy and I’m not planning on having any kids, you can throw the kitchen sink at it, for the most part. It’s about also considering if you’re trying to have babies.

Even if you’re a younger guy and you don’t plan to attempt a conception or if you’re a finasteride candidate.

You can trick her, throw everything at it, land the babe, get off the stuff, have the baby, and worry about the hair later. Is that it?

I suppose so. There’s something called intratesticular testosterone. This could be a good time to get into testosterone in the gonads itself. Intratesticular testosterone is going to have what’s called a positive feedback mechanism on spermatogenesis. More testosterone in the sperm leads to better production of sperm. One of the ways it does that is what some people call increases androgen-binding globulin but it’s just SHBG. It’s the same thing. I call it SHBG. It happens to come from the testes and not from the liver. It’s usually synthesized in the liver. That doesn’t matter so much.

When you’re thinking about 5-alpha-reductase, that’s the enzyme that converts testosterone to DHT. You have three different buckets. I think of these as three different rooms. Each one is present in all cells but in some cells, it’s at much higher levels. What’s called pubic skin, the type-2 isoenzyme is at a high level. That’s mainly what finasteride inhibits. This is also in the nervous system tissue in the CNS. That’s one reason why individuals on finasteride tend to notice what’s called finasteride syndrome, which is a disproportionate symptom of low testosterone in the genitourinary system or nervous system.

Whereas you have type-3, which is in non-genital skin that is mainly inhabited by dutasteride. Type-1 is inhibited by both of them to some degree. There’s a different ratio of type-2 to type-3 and type-1 to type-2 in every tissue, including the hair follicle. Finasteride and dutasteride both work in the hair follicle but dutasteride is much more efficacious than finasteride in non-genital skin like the skin of the scalp. Theoretically, dutasteride is a much better pharmacodynamic, which is the drug effect on the body for hair loss prevention.

However, type-3 is also in a high concentration in the testicle. Finasteride is far superior to dutasteride when you desire optimal spermatogenesis. For that reason, plan to avoid dutasteride within 12 to 24 months of conception to have optimal spermatogenesis parameters and a positive feedback mechanism in the gonad. Other than that, finasteride is usually the second-best choice in either topical or oral dutasteride regimens.

You’ll see guys that are taking GH or some hormone but they say, “I lose my hair.” What’s happening there?

HGH can increase cell turnover. It can increase the quality of the skin and the hair that you do have. In fact, there wasn’t a big single point in time like the Women’s Health Initiative where GH, testosterone, or TRT were kicked out. There are several points. There was a study in the New England Journal of Medicine on HGH years ago. There was a famous episode of a dermatologist that went to a derm conference and said, “I’ve been prescribed high doses of HGH to optimize my HGH. Look how great my skin and hair are.” That was years ago.

Since then, the cancer risks have been rightfully equally weighted or perhaps even too much towards the risk and not the benefit. Years ago, a lot of people were on HGH therapy for that and it can induce hair shed. We see similar things with GHRPs like tesamorelin or sermorelin, which are usually indicated for growth hormone deficiency or lipodystrophy, which is too much fat inside the abdominal cavity. That will speed up hair shedding but also improve the quality of your hair. You see a similar phenomenon with HCG.

You have less of it but it’s good.

A fairly similar thing happens during pregnancy because there’s a hormone called HPL, Human Placental Lactogen. It’s similar to HGH when you compare it molecule to molecule. It’s also what happens that causes gestational diabetes. That’s one reason why a lot of men that are on something called MK-677 or ibutamoren or any GHRP also develop pre-diabetes or even diabetic-level blood markers.

What’s happening?

I call it GHRP diabetes. It’s the same pathologic process that happens during gestational diabetes, except instead of being due to human placental lactogen, it’s due to AGHRP like MK-677.

Should someone be concerned about that?

It’s equally reversible but equally as dangerous if it is not reversed.

Gut health. We did this the last time. You have six pillars but I feel like you’ve added an extra one.

I added social health. Talking with Rich Roll, he said, “You need a social health pillar that’s separate.”

He’s sensitive. It’s nice.

I agree so I added that one.

One thing I appreciate is you can get into the weeds like nobody’s business but you identify these pillars. I would like to figure out, from your point of view, what feels if certain things feel more important or if are they all equally as important as these pillars. Can we go over your pillars of health? We know that the seventh one is now social.

[bctt tweet=”The difference between how heavy the benefit and the detriment are is called the therapeutic window. Some people have a very narrow therapeutic window.”]

Diet and exercise are the first two. Dominoes is not a perfect analogy but you need to have those two dominoes knocked over before you knock over the other ones. You can remove a domino at any point and you’re not going to have the cascade work correctly. They’re the first two and they are the most important. When things go wrong in the other pillars, it’s usually because they affect diet and exercise.

Sleep is the next one. I would argue that sleep is the third most important. We mentioned zone 2 and now it’s a buzzword but it’s great. The best two things that you can do for the aging of your cell, and we can go into the anti-aging tangent later, are zone 2 cardio and getting good REM sleep. If you have sleep pathologies like sleep apnea, you’re not going to be getting good REM sleep.

Pass that. We used Ss for the rest of them so stress is one of them. You want stress to feel good. You don’t want zero stress. You don’t want a lot of stress. You want sunlight, cold exposure, and hot exposure, that’s included with that. We went into social health. We didn’t go into spiritual health this time.

We went into it last time but the importance of your spiritual health.

This is not necessarily being religious or not religious. This is Maslow’s Hierarchy of Needs. You have your physical needs down low and you have your mental needs. The top is self-actualization, that’s your metaphysical need. What your purpose is beyond your body being here as an organic machine.

What a lot of men are experiencing is like, “What should I be doing?” I appreciate some of the social corrections that we’re living in. There are some pendulum parts that are an overcorrection. In that overcorrection, we’ve said things associated with masculinity are all bad, which is not true. We’re killing God a bit in our social conversation. Maybe for people, it doesn’t have to be a guy with a white beard but it’s something greater than that. These are important to have because it does give us that meaning. Once we get it all, whatever all is, we realize, “That wasn’t the point. It’s something much bigger than me and I.”

I am a Christian but I also don’t believe that you have to be a Christian to have optimal spiritual health. You can still explain your self-actualization or why you’re here beyond your physical body in many ways that are not going to affect the other aspects of your health. I know that if you don’t have a good way to explain that, it can also cascade through the other aspects of your health and be harmful.

We can sit here and talk about hormones and such and drill down. The whole thing is a miracle. The fact that you’re sitting there and you’re you, if we don’t have those opportunities to notice these miracles. The body is extraordinary in what it’s able to do. I don’t mean, “Here’s my butt on Instagram.” I mean the body and what it can do. I hope I don’t ever lose what is perfect about it.

That’s one of the interesting things about living in modern times when the buzzwords are artificial intelligence and machine learning. I was thinking of my friend and colleague, Dr. Taylor Martin, a data scientist and a physician. He points out that intelligence and machine learning are only as good as the input that you put into them. As these things are developing, humans are losing the ability of a lot of areas of their brains.

For example, if you look at the average size of the hippocampus, that’s part of the emotional system but also helps with direction, we are losing a lot of the size and function of that area. We are likely to lose more and more of it as time goes on. Maybe Neurolink will save us all or maybe not, who knows? It’s difficult to live in a time where the miracle of what the human brain is capable of is slowly being lost.

I think about that. I’m a lot older than you. I joke with Laird because his sense of direction is good. He’s connected to the direction of the wind and the water. It’s all, “Where is east? The sun,” and such. When we go somewhere sometimes, we used to use the Thomas Guide, or you would stop, the joke about asking for directions. I don’t know how many columns of cartoons have been written about a guy not asking for directions and the wife is like, “Ask for directions.” We plug it in and we trust it and off we go.

Now that we’ve covered the pillars and we talked about nutrition and movement, I’m seeing over and over the health of your microbiome, your gut. It is one of the big players at the table. It’s certainly complicated. Are you, in your practice, seeing how this can impact young men’s hormones, the efficiency, or the health of them?

A lot of times, people ask me for direct examples. One direct example is estrogens are metabolized in three main ways, ubiquitination, adding a ubiquitin group, adding a sulfate group, and glucuronidation. Glucuronidation takes place mostly with estrogens but a little tiny bit with androgen. Almost half of the estrogens are metabolized this way. The microbiota in your gut affects the level of an enzyme called glucuronidase. This beta-glucuronidase enzyme will regulate how much glucuronidation is taking place.

There’s an analogy called the estrogen bathtub analogy. That’s where your estrogen goes down the estrogen sink. When it’s in your gut, it’s in the pipe. After it’s excreted, that’s when it’s excreted from the body. It can be reabsorbed. I would posit that you can draw another pipe that goes back into the bathtub and then there are 3 drains and not just 1 drain. It’s a little bit of a complicated bathtub. That is one way that your gut microbiome will directly affect your hormone balance because you can retain estrogen. This same intrahepatic recirculation is how you can reabsorb bilirubin or other molecules in the gut, potentially uric acid and bio acids as well.

When you say uric acid, reabsorb it, meaning mitigate its negative impact of it.

Uric acid and many other things. For example, bilirubin can be excreted both in the gut and renally, in urine and stool. A lot of things that are excreted for the first time through the liver are then reabsorbed later in the gut and then put back into the bathtub, estrogen included in that situation. They have to be excreted again.

What you’re saying is for the health of the gut, there are certain things you don’t want to reabsorb, you want to get rid of them. Is that not right?

Correct. Reabsorption is not always bad but often it is. Certain microbiota in the gut, for example, if you have an overgrowth of EHEC or ETEC, which are types of pathogenic E. coli, will certainly affect your level of glucuronidation through the body, which can make it difficult to excrete estrogen. GLP-1 also affects this. Metformin can also significantly affect your gut microbiome as well.

In a good or bad way? Everyone talks about how great metformin is in certain ways.

In both. Usually, in a good way unless it causes GI symptoms or diarrhea, which it often does.

It is like concrete.

The interesting thing about metformin is it has multiple different mechanisms of action. It’s going to somewhat affect your gut microbiome but it’s going to affect your insulin sensitivity. They used to call them GLUT2 and GLUT4 but they’ve renamed them so they’re different transporter enzymes. It affects your glucose uptake. It also affects your SHBG. It can slightly increase your SHPG if it’s low.

Some of that is related to the amount of insulin binding to the insulin receptor hepatically. It also affects both your IGF-1 and one of your IGF-binding peptides. It affects the free level of circulating IGF-1, which you think of that as the level of growth hormone through your body, which can be too high or too low. You’re affecting so many different things with one medication. It’s not an easy thing to manage, especially if you’re not also checking those things.

You take it and then you leave it at that. Let’s say someone goes, “I’m trying. I’m eating my fiber. I try to take a prebiotic or probiotic.” To get it, do you test people’s microbiomes? Do you have a way? It’s a complex zone and then people go, “I’m doing this stuff for my gut.” It’s like, “Are you? What are you doing?”

There’s no perfect way to check your gut microbiome because it’s contiguous with the rest of your microbiome. I did a podcast with Dr. Thomas Hitchcock who is a PhD in genetics. He is well-versed in the microbiome. He does mostly skin microbiome. Of course, you have microbiomes on the mucosa, for example, the eye or in the mouth, and there are ways to test that. You can get biopsies and some gastroenterologists do these biopsies.

For example, if you get an endoscopy, you can do a biopsy to look for H. pylori, which is not necessarily all bad. In fact, high levels are associated with less Crohn’s disease, asthma, and allergies. You can also get a biopsy that’s in your stomach. You can also get a biopsy in the small intestine. You can also get a biopsy in the large intestine.

You can also check the microbiome in your stool, which is the best we have right now. It’s highly variable but it can be useful in some individuals. The analogy I make is you have an aquarium or a terrarium and you drain your fish tank. Checking what’s in the silt or checking what’s drained in the fish tank can give you an idea but it varies quite a bit from day to day. That being said, the level of cholesterol in our blood or the level of lipoproteins also varies a lot from day to day.

What do you do? What tests would you do? Elimination would be how you would check it?

As far as looking to see what your microbiota is?

Yeah, how you’re doing.

Occasionally, I do stool tests. Occasionally, gastroenterologists that I work with will do a biopsy and look for it. Occasionally, I do H. pylori tests as well. You can do a breath test, stool test, or biopsy. The blood test for H. pylori is not clinically applicable. Occasionally, I do oral microbiome tests. There’s one called a Bristle that Chris Strandberg introduced me to.

If a guy has some real gut issues, can that throw his hormones out of whack? If you can get that house in order, can it help the downstream effect on that?

It can. One of the mechanisms is estrogen, as we mentioned.  One of the other mechanisms is it’s going to affect your micronutrient absorption. If you have Crohn’s or chronic diarrhea, it’s likely that you’re also iron deficient and you’re B12 deficient and you don’t have a good dopaminergic tone or serotonergic tone and that throws everything else off.

Let’s be Debbie Downers for a minute. Weed and alcohol. We won’t get into other recreational drugs. Let’s just stay there. I love asking questions I know the answer to. It does fascinate me. I have no judgment. If people want to yeehaw all they want, I’m like, “Knock yourself out.” If they’re concerned or interested in supporting their hormones and overall health, can we talk about the impact of regular use of things like alcohol and marijuana?

Regular alcohol use certainly upregulates aromatization, conversion of testosterone to estrogen, especially when you consume higher amounts of alcohol.

Is it like beer or is tequila better? Do we know or is it a no-go?

If it has more carbohydrates in it, it has more calories. The caloric content of alcohol is one of the main reasons why it is not optimal to regularly consume. Fats have 9-kilo calories per gram and alcohols have 7 and then carbs and proteins have 4. Let’s say you consume four drinks every evening and then you compare the calories of that, which is probably about 400 calories, how many grams of fat could you consume for that amount of calories? Quite a bit.

Let’s get to it because sometimes you got to talk the language. Could it mess up the size of your muscles if you drank alcohol?

At higher doses, it certainly does. You have increased muscle protein degradation, especially decreased muscle protein synthesis when you consume high amounts of alcohol. If you consume it once every two weeks, even if you drink 3 or 4 alcoholic beverages once every two weeks or once every month, that’s not going to have a significant effect. It’s going to have a clinically insignificant effect but a statistically significant effect. If you do that every day, it certainly is.

Do we know anything about weed? Less blood flow to the brain, I heard.

Cannabinoids are interesting. Smoked cannabis increases prolactin significantly more than non-smoked cannabis. It’s unknown how much of that is the smoke or how much of that is the culmination of the smoke and the cannabinoids. You have THC and CBD. There are also endocannabinoids. For example, PEA, poly ethanolamine, a naturally occurring fatty acid. Lots of it is in safflower oil. That is also a cannabinoid receptor agonist and that is not particularly hormonal hormonally active.

A lot of times, cannabinoids, any of the three, are going to have effects on your sleep. They can decrease the memory of dreams, which can be both good and bad. In general, if you have high prolactin, it’s the same effect that you can get from frequent masturbation, which can be another problem as well because that is like having a mini seizure. There’s a philosopher that said, “An orgasm is like a small seizure with a period of clarity afterward.” Prolactin is increased after both.

One of the ways that we differentiate seizure from pseudo seizure is you have a tonic-clonic seizure, you expect an increase in prolactin. Prolactin decreases LH release from the pituitary so that can affect your testosterone if it’s frequent. It also gives you that negative direction at a reward that is probably not what you want to do consistently.

I feel like a whole world is built on that though.

There’s a different stimulus when it comes to sex. For example, sex, especially for the purpose of procreation.

Are we calling sex making love then or are we saying baby-making sex? It’s like, “My temperature is up. Get home now,” or, “I’m in this relationship and we’re open to having babies.”

The latter. Sex with another individual for any purpose. If that was not a strong positive feedback stimulus, we would be extinct as a species. The fact of the matter is most pregnancies are not planned. A lot of unplanned pregnancies are wanted but most are not planned and they happen to be secondary to the strong positive feedback stimulus of sex. Especially compared to the past, orgasm without sex, for example, masturbation, especially masturbation with porn, is more heavily sought out compared to sex than it has been.

Everything is readily available. It’s interesting, isn’t it? These mechanisms that we have in place biologically, the way that they’ve turned against us. Eating everything that you can get your hands on when it’s available. We didn’t realize we were going to have giant grocery stores. Also, porn.

Effort and aggression are the same. There is a deleterious aspect to aggression that many young people can find themselves in. There’s also a way to use aggression and effort to achieve positive things.

That’s a good point. Now they make mean comments but they didn’t do anything with it. I want to go back to the gut. Let’s say, for whatever reason, you had to take a real round of antibiotics and you gassed out your microbiome a little bit. Do you do anything to support your gut health besides the pillars? If you felt like you got behind because of an unavoidable prescription, would you do anything to reboot?

Back to the aquarium analogy. You have prebiotics, that’s like your fish food. You have probiotics, that’s your fish. You have postbiotics, that’s what your fish produce that is often beneficial for the environment. When you take an antibiotic, depending on which antibiotic, it’s going to kill some good fish and some bad fish. Hopefully, your physician has chosen ones that will kill mostly bad fish and not too many good fish.

One of the best periods of time when it comes to clinical evidence for probiotic use is after an antibiotic course. I usually recommend people take probiotics. If they need it, prebiotics. They need it if they’re not getting it in their diet. Sometimes also postbiotics. Dr. Hitchcock said about 80% of over-the-counter probiotics don’t have any active culture in them. I would believe him because he’s the expert.

Where do p where do you get them? Where do you find them?

I don’t have any specific brand recommendations. Occasionally, I will use the seed probiotic, which is a prebiotic capsule. Occasionally, I’ll also use spore-based probiotics. MegaSpore is one variety of those.  Some of the Garden of Life raw probiotics seem reasonable to use.

Is that refrigerated?

Some of them are and some of them are not. Probiotics do not necessarily have to be refrigerated. All that being said, my favorite probiotics are food probiotics like kimchi, real sauerkraut, fermented peppers, kombucha, and kefir. There are a lot of varieties of good live probiotics in food.

What’s happened, which is great, is we brought attention around gut health, prebiotics, and probiotics, but then it sounds like noise. It’s like, “What do you mean?” One of my kids eats Natto.  Have you ever had nato?

I have not. I’ve heard it can be rough.

It is. She loves it because she was introduced to it early. Apparently, it’s incredible for your gut. Going back to hormones, I want to push along just a little bit to maybe someone a little older, 50s, 60s, or 70s, and they are looking into doing some type of hormone replacement. We’re talking about some of the risk-reward. Going through the process, they get their blood work done, and they look at it. What would be the way for them to decide, “This is a good idea.” Maybe their doctor doesn’t spell it out for them as well as you’re able to. What are the columns that you’d be looking at to make that decision if they had to figure it out for themselves?

[bctt tweet=”My recommendation is for every patient, pediatric or not, to find a movement pastime to last a lifetime.”]

One of the first things we ask a patient is what their goals are. It is reasonable to have an accurate and honest assessment. Can you achieve this goal regardless of what you do? Can you achieve this goal with any therapy or medication if it might be indicated and can you achieve it without that? Depending on what the answers to those questions are and also depending on how important that goal is to the patient, that can make them a better or a worse candidate for something like hormone replacement.

If they have a low level but it’s not deficient and they have no symptoms versus someone who has the same level, low, still not deficient. Let’s call it a total testosterone of 350. Different academic societies have different cutoffs, by the way. Some societies, regardless of the free testosterone or SHBG, want total testosterone to be less than 260 multiple times. Whereas some societies, the Urologist Society, have a much higher cutoff, even as a society recommendation. At the end of the day, it’s individualized medicine. In fact, I saw Mayo Clinic named one of their new clinics Individualized Medicine. That’s what Gillett Health Clinic is also named.

Did you notice it? You’re like, “That’s an interesting name.”

I thought, “Great name.” Where medicine is going is not by the cutoff. If you look at the pyramid of evidence-based medicine, the expert recommendation is at the bottom. It’s good to know what the expert recommendation is, both as a patient and a healthcare provider. The higher levels of evidence are things like systematic reviews or meta-analyses or randomized controlled trials, significantly above that. You’re thinking about the situation that the individual patient is in and then you take those two individuals that both have a total testosterone of 350. One of them is severely symptomatic and one of them has no symptoms. The individual with more symptoms is a much better candidate.

Male andropause. Because I’ve been married for a long time to a good person who happens to be a male, I’ve become even more, over time, an advocate of men because I’ve met many good ones that do represent the positive traits of even hyper-masculinity. We have a ton of military guys that come here and train and they’d be the first to help somebody or protect somebody, or, “Yes, ma’am,” or, “No, ma’am,” however you want to say it.

I feel like sometimes guys don’t get care the way women do because we talk about it more. Women have a different load in a different way that is uniquely challenging and wonderful to our walk in this world. Guys won’t say, “I’m tired.” I don’t mean just throw Viagra at it. The erection is changing or different. Men don’t realize that they too have menopause.

Andropause is slower so it has what I would call an insidious onset and it can be varied. Some men have late andropause and some men have early andropause. Sometimes people don’t have symptoms and they could be hypogonadal and they could have low estrogen, which is the most concerning combination and they wouldn’t even know it.

The phenomenon that you described of men not wanting to check or men not seeking help is partly because they are masculine and they don’t want to be perceived as needing help. That’s what I call the number one thing harming men’s health. You don’t know what you don’t know. We’re organic machines. At the very least, you need to take in your machine for preventive maintenance and at least get a comprehensive check of what’s going on. Fixing something now can prevent something catastrophic from happening in the future.

We said, “If you’re 18 and you’re able and you can get a baseline, awesome.” In a way some, that’s a notion of optimal. You haven’t wrecked your machine usually too much and not too much has happened. You’re getting a little snapshot. Is the invitation any different? Let’s put having children on the side plate. Let’s talk about their own isolated health. In their 20s, is there a different invitation, or is it, “Get your blood work done once a year.” In your 30s, is it to maybe ramp it up to twice a year if you can, and so forth? What is that invitation for you to do to stay on top of that?

This is an interesting question because the average individual in a developed country has a pathology. For example, metabolic syndrome or insulin resistance. The average individual likely does need labs more often and at least has several lifestyle interventions if not supplements and medications that they can temporarily use as tools to intervene. The average person probably needs labs twice a year, maybe even three times a year. By the way, some studies say that 6% of the population of the United States is truly metabolically healthy.

That means they’re not on the edge of every known thing.

They defined it as a fasting insulin, an elevated A1C, elevated fasting glucose, or dyslipidemia, which is a high LDL. It’s not a perfect definition of metabolic health but it’s pretty decent. It’s certainly concerning that only 6% of the population meets those criteria. If you happen to be in the 6%, getting basic labs every year is more than enough.

That being said, for some people that will affect their quality of life, there are four boxes you can be in. You can check things to see if they’re wrong. You can check yes or check no. Will you do something about it? Ideally, you will check to see if there’s something wrong and you’ll do something about it. If you know you’re not going to do anything about it. You might not want to check to see if anything’s wrong. If you are stubborn, you will not do anything about it.

There’s lots of case studies that have been reported. People that have prolactinomas or tumors that are producing prolactin and they’re recommending all these medications and they’re saying, “You’re going to need surgery and you’re going to start having visual changes if you don’t take the medicine.” They still don’t take the medicine and then they start to have visual changes.

Having that discussion is important. For your average individual, let’s say they have obesity, insulin resistance, and pre-diabetes, they don’t necessarily have to do something. They would be the owner of the car that’s willing to get the tires rotated and the oil changed but they will not do anything else for preventive maintenance.

As somebody who’s seeing people all the time whether it’s through telemedicine or in person, I’m always so intrigued about why we get in our own way. I can’t help but think sometimes, especially after having lots of conversations around this and being around a lot of people, it’s like that chicken and egg thing. Do we do things in our lifestyle that keeps us emotionally from being able to do something about our lifestyle? Did our lifestyle mess up our emotional capacity to even get to the place to make the change?

It can go both ways and sometimes both things can be dysregulated at once. What I do know is that, for men that are coming to see, often, it is their wife or a female in their life that has said, “You have to go to the doctor now.” That’s a positive social interaction. Maybe they’re looking for an excuse.

“She’s been bugging me.” They know they need to.

It’s like, “I’m going to be a man about this. I don’t care. I had to come in because she made me.”

I was talking to a friend of mine and I’m curious about what you see when you deal with men. Women talk about their feelings quite a bit. We talk about having it all. We get in there. I was talking to a friend of mine prior to speaking with you and she’s been in a long marriage and she was saying, “You should ask about libido besides stress and all these things.”

I said, “Yes.” Also, how about this as a thought, as a partner to somebody, you could be like, “Good morning. It’s nice to see you. I appreciate you. You look good.” We never think that has a reverse impact back on even things like the male libido. It’s finding a way to elevate them in that way besides they kill it at work and bringing home a paycheck. Do you see maybe that people that are in an upcycle dynamic with a partner, that does support them in a serious you-can-see-it-in-their-blood-work way?

I certainly think so. I was listening to Lex Fridman’s podcast and he was discussing the situation in a relationship or in a marriage that almost certainly leads to divorce. The takeaway was a complete lack of appreciation. I don’t remember the exact term that they used. If there is no appreciation left, that will likely lead to divorce. Whereas if there is an optimal level of understanding of whatever role those people have in their relationship, that will lead to improved libido. Maybe that leads to them being more likely to go to the doctor and being okay with it or being more likely to have an open discussion about emotions. It’s like a headway or a way into the male mind.

It gets explored as this testosterone equals aggression and all these things instead of there’s some nuance around it and complication and also the high level of sensitivity of men. How do you get in there and weirdly protect them at the same time? I’ll talk out of school for a second. If Laird was here sick on the couch and the phone rang and his buddy was like, “Is Laird there?” I’d be like, “No, he is not.” I’m not going to show his weakness. I’m there to fortify him. If they show you, it’s this weird thing.

I often think about sometimes we don’t know how to understand how it’s both happening simultaneously all the time with men. You must see a lot. We made some grounds this time and it was hopefully a little different than last time. We didn’t have to talk about women so much. First of all, I wanted to talk about Tongkat Ali because Laird was introduced to it by Huberman. Maybe we could talk about that as a supplement because it is an interesting supplement.

This is a common question as well. Tongkat Ali, also known as long jack, Is an herbal medication that’s from Southeast Asia, Indonesia, and Malaysia. It has an interesting mechanism of action. We used to think that it was an estrogen receptor modulator, which is not as much. We used to think it was an aromatase inhibitor, but there’s also not great evidence of an aromatase inhibitor. It certainly helps up-regulate certain enzymes in the astrogenesis cascade both in the gonads and in the adrenals.

Similar enzymes that insulin and IGF-1 help up-regulate. If you have lower DHEA sulfate, that’s another sign that these enzymes can be of low activity. The active ingredient is called eurycomanone and it probably also has active ingredients in its eurypeptides. It’s also a phytoandrogen. People are familiar with how soy can be a weak phytoestrogen, probably not clinically significant in low quantities by the way. Tongkat can be a phytoandrogen. Even independent of its activity, it likely binds to the androgen receptor or upregulates gene transcription of the androgen receptor to give more of that androgenic feeling.

For a lot of individuals that have low insulin and low IGF-1, for example, if you’re losing a lot of body weight, or you’re lean, Tongkat could be a great addition. Whereas for some other people, likely it’s only benefit is its phytoandrogen benefit. One of its ingredients is perhaps one of the other saponins. Eurycomonone is a type of eurypeptide, which is a type of saponin. It’s also a stimulant. I do recommend people take it in the morning when they first start taking it. That way, they don’t have insomnia.

Do you partner it with another supplement sometimes?

Occasionally, you do. Creatine is my second favorite testosterone optimization supplement.

You like creatine.

My next favorites are vitamin D, zinc, selenium, and magnesium. After that, specifically for people that have low LH receptor sensitivity or a low level of LH, Fadogia is occasionally a good add-on. I say occasionally because years ago, I’d say nobody knows about the supplement. It’s super underrated. Now, everybody knows about the supplement. It is popular now that it is slowly becoming overrated because there are no human data on this other than the anecdotal data of hundreds of years of use in herbal medicine, which counts for something.

One of the things I like about it is it has a well-defined mechanism of action. It is not uncommon to see someone’s LH go up significantly when they start Fadogia. For whatever reason your LH might be low, that could be a reasonable addition to add Fadogia even if it’s temporary. In rodent models, which is what we call preclinical data, it can increase Alk Phos and GGT, which is Gamma-glutamyltransferase, two enzymes that are present in the gonads and the liver.

In patients, especially if they’re on high doses of Fadogia, which is above 300 milligrams, I do check those two markers to make sure that they have not gone out of range. I’ve been doing that for over two years. I hardly ever see those two out of range in humans. Although when you look at the dose equivalency, there’s a rodent-to-human dose equivalency. Theoretically, it could start going out of range at 300 MGs. That’s why I say start at 300 per day unless you’re checking your laps.

Do you forget anything?

Yes.

It must be amazing to be able to remember all that.

It’s easy to remember something when you have an adrenaline spike or when you’re extremely excited about something. That’s one of the best ways to learn. People do this in a lot of different ways. I don’t recommend slapping your face or running a sprint after every time. I’m certainly studying things that you enjoy and not doing it continuously is helpful. Maybe you sit down and study something and read about something and then go for a walk outside or study something and then talk to a friend about it. I highly recommend it, especially if you’re excited about a certain study or you find new clinical data or a new systematic review has been launched. You’re likely to remember that because you’re excited.

Does your wife pretend to be excited about science and stuff like that?

For some of it, she is legitimately excited. For some of it, she says that I should stop talking about it because it is annoying.

It’s awesome. Dr. Kyle Gillett, I appreciate you. I have to talk to people like you, I get to, and I’m excited to. You’re always like, “How are we going to enter? I have to try to understand what they’re saying. I’m also interested selfishly.” It’s all of the things. Having you as a resource to make things clear is a gift and you’re willing to talk about it and share. Is there anything I forgot that feels especially important to you that I didn’t cover that occurs to you?

I don’t believe so. To reiterate a point, one of the number one things that’s harming men’s health is the hesitancy to talk about or seek a solution to have optimal health.

It’s not a weakness to go, “Let’s take a look,” or, “I’m not feeling my best.” Get a look. Even if they don’t live in your area, are they able to become patients of yours still? Is that off the table?

They are. It does depend on where they live and regardless of where they live. I do like to see everybody in person when possible. An aside to that is I wrote an article about telemedicine with my friend Alec McCarthy in MS Journal. There is certainly an emerging role of telemedicine in the care of the patient. It is almost always better to see them in person when possible. The alternative to telemedicine is often no medical care at all. The patient population that’s served by that is underserved regardless of where they live. Accommodation of in-person visits and telemedicine visits is always best.

We know the name of your clinic since it’s double-named.

I wanted to name it something else and then a few of my good friends said, “Name it after your last name.” That makes sense. It’s what people search for.

Dr. Kyle Gillett, thank you.

My pleasure.

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Thank you so much for reading this episode. Stay tuned for a bonus episode where I go deeper into one of the topics that resonated with me. If you have any questions for my guest or even myself, please send them to @GabbyReece on Instagram. If you feel inspired, please hit the follow button, and leave a rating and a comment. It not only helps me, it helps the show grow and reach new readers.

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Resources mentioned:

• Dr. Kyle Gillett
• Dr. Mary Claire Haver
• Count Down
• @GabbyReece

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About Dr. Kyle Gillett

Dr. Gillett enjoys providing holistic individualized care to his patients. His practice includes preventative medicine, aesthetics, sports medicine, hormone optimization, obstetrics and infertility, integrative medicine, and precision medicine including genomics. He believes that each human is a unique creation that requires attention to their body, mind, and soul to achieve optimal health. He enjoys caring for others using shared decision-making and an evidence-based, patient-centered approach. He is active in Obesity Medicine organizations and firmly believes “food is medicine” and “exercise is medicine”. Dr. Gillett describes the “6 pillars of health”: exercise, diet, sleep, stress, sunlight, and spirit. These are more powerful than any medication or supplement. He enjoys spending time outdoors on the farm with his wife, two sons, and two wolfhounds.