Protocols
Science-based tools and supplements that push the needle.
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Full Notes
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:
- Excess body fat can lead to early puberty, which can limit adult height
- 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
- Sleep
- Nutrition
- Stress management (mindfulness, relaxation techniques, outdoor activities, dietary changes, exercise, prayer, meditation, counseling, therapy, or open communication with loved ones)
- Social connections (family, friends, work relationships)
- Outdoor activities and movement (sunlight exposure, heat and cold exposure)
- Purpose and goal-setting (self-actualization, Maslow’s hierarchy of needs)
- 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)
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