Dr. Kyle Gillett: Tools for Hormone Optimization in Males

Dr. Kyle Gillette on Male Hormone Optimization

• Dual board certified physician in family medicine and obesity medicine
• Expert in hormone optimization
• Treats patients with various backgrounds, ages, and goals

Puberty and Hormones

• Puberty affects adult height, stature, and body composition
• Wide variation in how quickly puberty progresses
• Entering puberty early can decrease adult height
• Tanner stages: stages of puberty development
• Bone scans can determine if growth plates are closed

Resistance Training and Growth

• Lifting heavy weights does not stunt growth
• Dirty bulking: eating excess calories to acquire muscle and fat
• Dirty bulking can stunt growth through two mechanisms: 
  1. Excess body fat can lead to early puberty, which can limit adult height
  2. Excess body fat can lead to insulin resistance, which can negatively affect growth hormone levels

Hormone Optimization Across Ages

• Discussion covers all ages for male hormone optimization
• Explores adolescent puberty, teen and late teens, early adulthood, adulthood, and late geriatric ages
• Upcoming episode will focus on female hormone optimization

Psychology and Life Events Impact on Hormones

• How psychology and life events impact hormones
• How hormones impact psychology and response to life events
• Broad overview with fine details about male hormone optimization
• Understanding the endocrine (hormone) system and its interaction with the brain and other tissues
• Actionable tools for hormone optimization regardless of stage of life
  Early Puberty and Childhood Obesity
• Fat can become leptin resistant and produce more leptin in very young children 
  • Leptin activates the hypothalamus, pituitary, and increases testosterone and estrogen
  • Childhood obesity causes early puberty
• Leptin secretion triggers the onset of puberty when enough body fat accumulates 
  • Increase in childhood obesity leads to earlier onset of puberty in both males and females
  • Leptin directly binds to a G protein-​​coupled receptor on the hypothalamus

Weight Training and Height Growth

• Young males who bulk up and overeat may limit their total height 
  • Growth of long bones is related to the estrodiol alpha receptor
  • Estrogen receptor can be secondary to early puberty and body fat conversion of testosterone to estrogen
• Young males should avoid “dirty bulking” and focus on bodyweight exercises and weight training 
  • Avoid rapid weight gain to reach maximum height and avoid laying down excess body fat cells

Blood Work and Hormone Optimization

• Blood work should be done as early as possible to monitor hormone levels and overall health 
  • For healthy children, blood work can be done during later tanner stages (4 and 5)
  • If concerned with stature or height, get blood work done earlier
• Key things to look for in blood work: 
  • Testosterone and sex hormone binding globulin (SHBG) or free testosterone
  • Balance between high enough free DHT and high enough total DHT
• Blood work should be done twice a year for optimal monitoring and evaluation by a physician

Lifestyle Pillars for Hormone Optimization

• Diet and exercise are crucial during puberty 
  • Proper nutrition and physical activity can help regulate hormone levels and promote healthy growth
• Other daily habits for hormone optimization: 
  • Getting adequate sleep
  • Managing stress levels
  • Avoiding excessive alcohol consumption and smoking
  • Regular check-​​ups with a physician to monitor hormone levels and overall health Sleep, Diet, and Hormone Optimization in Lifespan

Sleep and Hormone Optimization

• Sleep is critical throughout the lifespan
• Aim for quality sleep at least 80% of the time
• Occasional sleep loss is normal due to stress, external factors, or enjoyable experiences

Diet and Hormone Optimization

• Consume a variety of nutrients, including dairy, for IGF‑1 benefits during puberty
• Adequate vitamin D intake is important for testosterone production, bone mineralization, and stature
• Optimize growth hormone and IGF‑1 up to age 25 for bone density and growth
• Balance of animal and plant-​​based proteins, fruits, vegetables, and starches is beneficial for most people
• Consider individual ethics, food allergies, and dietary preferences
• Prebiotic fiber and essential fatty acids are important throughout the lifespan, especially during teenage years and early adulthood for brain development
• Multivitamins may not be necessary for everyone, but can be safe and useful for those with exclusionary diets or planning for fertility

Caloric Restriction and Testosterone

• Overweight individuals can benefit from caloric restriction and exercise to reduce adipose tissue and improve testosterone levels
• For individuals without excess body fat, caloric restriction may lower testosterone levels

Pillars of Hormone Optimization

1. Sleep
2. Nutrition
3. Stress management (mindfulness, relaxation techniques, outdoor activities, dietary changes, exercise, prayer, meditation, counseling, therapy, or open communication with loved ones)
4. Social connections (family, friends, work relationships)
5. Outdoor activities and movement (sunlight exposure, heat and cold exposure)
6. Purpose and goal-​​setting (self-​​actualization, Maslow’s hierarchy of needs)
7. Supplementation (behaviors first, then nutrition, supplementation, and prescription drugs if necessary)

Supplementation and Medication

• Supplements and medications are tools to reach an end goal
• Athletes and those seeking high cognitive performance may consider supplementation
• Food can also provide many benefits found in supplements
• Financial constraints may influence supplementation choices

Hormone Optimization Recommendations

• Optimize testosterone, estrogen, thyroid, and growth hormone levels through sleep, diet, stress management, social connections, outdoor activities, and goal-setting
• Consider supplementation and medication as tools to reach specific goals, but prioritize behaviors and nutrition first Male Hormone Optimization and Libido
• Subjective nature of libido, recovery, energy, and confidence
• Differences between males and females in hormonal changes 
  • Females have monthly cycles with dramatic hormonal changes
  • Males lack language to discuss subtle hormonal aspects
• Motivational interviewing to understand patient’s hormone optimization needs 
  • Open-​​ended questions
  • Listening carefully to patient’s responses
• Atom questionnaire for men’s health and hormone-​​related health 
  • Not a clinically validated tool, but useful for gathering information
• Examples of questions in Atom questionnaire 
  • Libido, athletic performance, motivation
  • Listening for discrepancies between questionnaire answers and patient’s subjective experience
• Erectile dysfunction as a “canary in the coal mine” 
  • Can indicate plaque buildup in arteries and veins
  • May be situational or related to habits (e.g., porn and masturbation)
• Porn and masturbation’s effects on hormones 
  • Debate on whether masturbation increases or decreases testosterone
  • Prolactin increase after ejaculation inhibits release of LH and FSH, which can increase testosterone
  • Frequent porn and masturbation (daily or multiple times per day) can be detrimental to hormone profile
  • Intense visual stimulus of porn can affect dopamine sensitivity
• Dopamine wave pool analogy 
  • Natural variation of dopamine levels
  • High peaks can lead to deeper troughs and depleted dopamine levels
  • Balancing dopamine levels for optimal motivation and well-being
    Dr. Analemki on Addiction and Pleasure-​​Pain Seesaw
• Intense experiences (e.g., pornography, masturbation, high adrenaline activities) can lead to depressive episodes and low libido
• Similar to withdrawal from stimulants like amphetamines
• Sex with a partner can be different, but still may lead to a “crash” if dopamine levels are too high for too long

Optimizing Hormones for Men

• Get movement, sunlight, and quality social connections
• Avoid excessively frequent masturbation and viewing pornography
• Balance between intense experiences and recovery is crucial

Sustainable Exercise Regimen for Hormone Support

• Vigorous exercise 3–4 times a week
• Less vigorous exercise 3–4 times a week
• Limit training sessions to around an hour to avoid hormonal issues

Overtraining and Hormonal Imbalance

• Overtraining and large caloric deficits can lead to low free testosterone levels
• Consistency is key for maintaining hormonal balance
• Aim for 80–90% of optimal hormone levels consistently rather than 100% half the time

Balancing Exercise Intensity and Recovery

• Finish workouts with energy left to avoid exhaustion
• Save vigor from training for other aspects of life (e.g., work, socializing)
• Focus on long-​​term consistency and overall well-​​being rather than short-​​term cosmetic changes
  Balance Between Sympathetic and Parasympathetic Nervous Systems
• Sympathetic: fight or flight
• Parasympathetic: rest and digest
• Elite bodybuilders often very parasympathetic except during workouts
• Vigorous workouts can affect cognitive performance throughout the day

Testosterone Replacement Therapy (TRT) and Performance Enhancing Drugs

• No strict cutoff for TRT
• Some people use TRT for cosmetic reasons or performance enhancement
• TRT can limit fertility and have other negative effects
• Rarely beneficial for people in their 20s or 30s with normal testosterone levels

Supplements for Optimizing Testosterone and Estrogen

• Creatine
  • Helps with amino acid synthesis, oxidative stress, and serves as backup fuel for mitochondria
  • Increases total testosterone and conversion to dihydrotestosterone (DHT)
  • Hair loss not a reason to avoid Creatine
• Betaine
  • Helps with amino acid synthesis and energy shunting
  • Useful for Creatine non-responders
  • Dosage: 1–3 grams
• L‑carnitine
  • Smallest peptide hormone
  • Available in oral and injectable forms (prescription needed for injectables)
  • Low bioavailability when taken orally (around 10%)

Other Supplements and Factors

• Omega‑3 fatty acids
• Prebiotic fiber for gut microbiome support
• Vitamin D
• Regular blood tests to monitor hormone levels and inflammatory markers
• Genetic testing for predispositions to hair loss or hormone imbalances
  L‑Carnitine Dosage and Benefits
• Oral L‑Carnitine recommended dosage: 1000–5000 milligrams (1–5 grams) per day 
  • Only 10% is absorbed, so higher dosages may be necessary
  • Concerns with TMAO, a potential carcinogen, when taking high doses
• Garlic (specifically, allicin) can help decrease conversion to TMAO 
  • Berberine also slightly decreases conversion to TMAO, but may cause side effects like headaches and carbohydrate cravings
• Injectable L‑Carnitine has higher absorption 
  • Recommended dosage: 500‑2000 milligrams
• L‑Carnitine benefits:
  • Shuttles nutrients into mitochondria
  • Increases density of androgen receptors in cells, leading to more testosterone binding

Other Supplements for Hormone Optimization

• Vitamin D (specifically, Vitamin D3) 
  • A steroid hormone that, when optimized, can improve testosterone levels
• Boron (5–12 milligrams per day) 
  • Can help lower SHBG (Sex Hormone Binding Globulin) levels, which bind to testosterone and limit free testosterone
• Tongkat Ali (Longjack) (300‑1200 milligrams per day) 
  • Upregulates enzymes in the steroidogenesis cascade, helping synthesize testosterone
  • Can increase free testosterone, luteinizing hormone, and DHEA levels
  • Can decrease SHBG levels in individuals with high SHBG

Understanding Steroid Hormones and SHBG

• Steroid hormones come from cholesterol and can be converted into testosterone, estrogens, or progestogens
• SHBG (Sex Hormone Binding Globulin) attaches to testosterone molecules, limiting free testosterone available to impact cells 
  • Ideal level of free testosterone in males is about 2% of total testosterone
  • Levels can vary due to genetic polymorphisms or conditions like varicose veins in testes (varicoceles) “Human3 Attia Style” Notetaking:

Effects of Hormone Alteration on Thyroid Hormone

• No direct effect on thyroid hormone pathways
• Altering free androgen or free estrogen affects thyroxine binding globulin (TBG)
  • Binds active thyroid hormones
• Starting hormone replacement therapy can affect TBG and thyroid hormone levels 
  • Can lead to tachycardia or increased fight or flight response

Fidoja Agrestis and Hormone Optimization

• Fidoja Agrestis: genus of plants, increases luteinizing hormone (LH) release 
  • LH stimulates testosterone production
• Dosage recommendations:
  • Safe dose: 300 mg/​​day (based on rat study)
  • More aggressive regimen: 600 mg/​​day for a month, then 1–2 weeks off
  • Alternative regimen: 600 mg every other day or three times a week

Growth Hormone and IGF‑1 Optimization

• Growth hormone: peptide hormone released by the pituitary 
  • Stimulated by growth hormone-​​releasing hormone and agrellin
• IGF‑1: released in response to growth hormone, important for tissue repair and metabolism
• Amino acids before bed can help with growth hormone release
• High volume training exercises can transiently increase growth hormone and IGF‑1
• Fasting increases growth hormone release, but receptor sensitivity decreases 
  • Avoiding food 2 hours before bed can optimize growth hormone release during sleep

Thyroid Hormone Optimization

• Balance iodine intake for optimal thyroid hormone levels 
  • Controversy over high-​​dose vs. low-​​dose iodine
• Be aware of goitrogens or compounds that interfere with iodine uptake 
  • Found in certain foods like cruciferous vegetables, soy, and millet
  • Cooking or fermenting these foods can reduce goitrogenic effects
    Goitrogens and Iodine
• Goitrogens: substances that interfere with iodine uptake in the thyroid gland 
  • Examples: cruciferous vegetables, boron
  • Higher goitrogens require higher iodine intake
• Iodine-​​containing salt can prevent goiter, but not the ideal form of iodine 
  • Good forms of iodine often come from the ocean
  • Hypothyroidism more common inland

Supplements for Thyroid Health

• Creatine
• Betaine
• L‑carnitine
• Allicin (from garlic) to offset TMAO
• Vitamin D3
• Boron
• Tongkat Ali
• Fadogia

Peptides

• Peptides: chains of amino acids between 2 and a couple hundred in length
• Growth hormone-​​releasing peptides (GHRPs)
  • Ghrelin agonists: Ipomarelin, Ibutamoren (MK-​​677)
  • GHRH-​​like peptides: Tesamorelin, Sermorelin, CJC
• Peptides like BPC-​​157 for tissue healing and recovery
• Safety and sourcing concerns: contaminants, lipopolysaccharides (LPS)

Exogenous Hormones

• Testosterone therapy for those with normal levels but experiencing symptoms 
  • Low dose, more frequent injections better than high dose, less frequent
  • Typical dosage range: 100–120 mg per week, divided into 2–3 injections
  • Depends on SHBG (sex hormone-​​binding globulin) and free testosterone levels
  • Ester options: cypionate or enanthate
    Testosterone Therapy and Hormone Optimization
• Testosterone therapy can have positive effects on mood, energy, sleep, and recovery
• Potential hazards and side effects include: 
  • Acne and skin issues
  • Hair loss
  • Mental status changes (e.g., manic or bipolar episodes)
  • Cardiovascular concerns
  • Fertility concerns
  • Lipid concerns
• Monitoring blood work and working with a knowledgeable physician is crucial

Prescription Drugs for Hormone Optimization

• HCG (human chorionic gonadotropin) can increase testosterone and estrogen
• Clomiphene (found in Clomid) can increase testosterone in a dose-​​dependent manner 
  • Has many other pharmacodynamic effects
  • Can cause side effects and is not recommended for long-​​term use

Maintaining Fertility While on Testosterone Therapy

• Taking HCG several times per week can help maintain sperm production and fertility
• Avoiding heat damage to the testes (e.g., avoiding saunas and hot tubs, wearing loose clothing) can improve fertility

Effects of Cannabis, THC, and Nicotine on Hormones

• Smoked cannabis can diminish testosterone levels and increase prolactin
• Edible cannabis and THC do not significantly disrupt hormones
• Smoked THC is associated with gynecomastia (growth of male breast tissue)
• Nicotine, especially when smoked or used in high doses, can negatively affect hormone profiles and cardiovascular health
  PSA Levels and Age
• PSA levels can vary depending on age 
  • 20-​​year-​​olds: between 0 and 1
  • 40-​​year-​​olds: between 1 and 3
  • 80-​​year-​​olds: up to 5 (within the reference range)
• 5‑alpha reductase inhibitors (e.g., Finasteride, Dutasteride) can cut PSA levels in half

Hair Loss Prevention and Treatment

• Hair loss can be addressed through growth agonists (fertilizers) and antiandrogens (systemic or topical)
• Topical antiandrogens include: 
  • Ketoconazole
  • Caffeine (topical, not oral)
  • Spironolactone (prescription required, can be systemically absorbed)
  • Topical Finasteride (systemically absorbed, reduces systemic DHT by 30%)
  • Topical Dutasteride (minimal systemic absorption)

Turmeric, Curcuminoids, and DHT

• Turmeric can lower DHT levels, potentially causing negative effects on vitality
• Most beneficial actions of turmeric act on the gut microbiome, not necessarily requiring absorption
• Black pepper fruit extract (Bioperine) is a 5‑alpha reductase inhibitor and can affect liver cytochromes

Phthalates and BPA Exposure

• Phthalates are most enriched in pesticides, leading to drops in sperm and testosterone levels in rural areas
• BPA (Bisphenol A) is a xenoestrogen, binding to the estrogen-​​related receptor gamma
• Avoiding BPA and phthalates: 
  • Avoid drinking from cans or plastics containing BPA
  • Test tap water for microplastics and contaminants
  • Avoid processed foods with high phthalate content (e.g., mac and cheese)