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Tools for Hormone Optimization in Males | Dr. Kyle Gillett

Episode 102 Dec 12, 2022 2h 20m 48 insights
My guest is Kyle Gillett, MD, a dual board-certified physician in family medicine and obesity medicine and an expert in optimizing hormone levels to improve overall health. We discuss how to optimize male hormones using a range of nutritional and behavioral tools, exercise, and supplementation (including discussions on tongkat ali, fadogia agrestis, creatine, peptides and more). We explain how puberty and aging affect hormone levels, how to use bloodwork to monitor hormone levels, how hormone health impacts fertility, libido, hair loss, and prostate health, and describe behaviors that negatively impact testosterone levels. We also discuss how to approach prescription hormone therapies, including which biomarkers to monitor when using these approaches and how to optimize synergistic hormones (e.g., growth hormone and thyroid hormone) to support complete hormone health safely and rationally. Dr. Gillett offers numerous actionable tools that can be tailored to specific goals and age ranges to attain and maintain optimal levels of male hormones for overall health, well-being and longevity.  For the full show notes, visit hubermanlab.com.
Actionable Insights

1. Prioritize Quality Sleep

Aim for enough quality sleep at least 80% of the nights of your life, as it is critical for overall hormone optimization and well-being.

2. Manage Stress Effectively

Learn to manage stress through mindfulness, relaxation techniques, spending time outdoors, dietary changes, exercise, or talking with friends/family, as excessive stress negatively impacts all other lifestyle pillars for hormone health.

3. Foundational Diet & Exercise

Prioritize diet and exercise as the foundational lifestyle pillars for hormone optimization throughout your entire life.

4. Get Regular Blood Work

Get comprehensive blood work done for hormones (testosterone, SHBG, free testosterone) and other markers starting at age 18, or as soon as possible if older, and monitor these markers with a physician every six months.

5. Engage in Sustainable Exercise

Engage in vigorous exercise 3-4 times per week, ensuring sessions do not regularly exceed one hour, and supplement with 3-4 instances of less vigorous exercise (e.g., Zone 2 cardio) per week for sustainable hormone optimization.

6. Avoid Dirty Bulking

Limit the amount of abnormal body fat accumulation or ‘dirty bulking’ (purposely acquiring body fat by overeating) indefinitely throughout your entire life, especially during puberty, as it can stunt height, accelerate early puberty, and limit long bone growth.

7. Limit Porn & Masturbation

Avoid daily or multiple-times-a-day masturbation and pornography use, as this frequency can be detrimental to hormonal profiles (e.g., increased prolactin, blunted libido) and decrease motivation for real-world sexual interactions.

8. Limit Alcohol Consumption

Limit alcohol consumption to no more than two standard drinks (20g alcohol) per week, as higher intake significantly increases aromatase activity (converting testosterone to estrogen), can decrease LH/FSH release, and negatively impacts overall health and hormone profiles.

9. Optimize Hydration & Electrolytes

Ensure proper hydration and adequate electrolytes (sodium, magnesium, potassium) without sugar for optimal brain and body function. Drink one packet of Element in 16-32 oz water first thing in the morning and during physical exercise.

10. Cultivate Social Connections & Purpose

Cultivate strong social connections with family and friends, and find a purpose in life (a goal or target that can change over time) to support overall well-being, which indirectly aids hormone optimization.

11. Get Outside & Move

Get outside regularly to engage in a lifelong movement pastime, which provides sunlight, heat/cold exposure, and promotes overall physical activity, counteracting the negative effects of artificial environments.

12. Include Dairy in Diet

Include dairy in your diet, especially during puberty and up to age 25, as it can help increase IGF-1, which is beneficial for growth, genital development, secondary sexual characteristics, and bone density.

13. Ensure Adequate Vitamin D

Ensure adequate vitamin D intake, as it supports testosterone production, bone mineralization, and stature.

14. Consume Prebiotic Fiber

Consume adequate prebiotic fiber throughout your lifespan, especially during teenage years, 20s, and 30s, to establish a healthy gut microbiome and support brain development.

15. Avoid Caloric Restriction if Lean

If not overweight, avoid caloric restriction as it can lower testosterone by reducing hormone building blocks, increasing catabolism, and raising SHBG.

16. Finish Workouts with Energy

Finish workouts with energy, avoiding exhaustion, to maintain vigor throughout the day and prevent negative impacts on mood and cognitive function.

17. Exercise Early Morning

Exercise early in the morning (before 9 a.m.) to experience sustained energy throughout the day and avoid an afternoon crash.

18. Include Weekly Jog

Include at least one 45-minute jog per week to support healthy blood profiles, including testosterone and estrogen levels.

19. Take Creatine Monohydrate

Take 5 grams per day of creatine monohydrate for benefits in amino acid synthesis, oxidative stress, mitochondrial function, slight increases in total testosterone and DHT, tissue voluminizing, and cognitive effects; it is not a significant cause of hair loss.

20. Consider Beta-Alanine

If you are a creatine non-responder, consider taking 1-3 grams of beta-alanine daily to aid amino acid synthesis and energy shunting.

21. Take L-Carnitine

Take 1-5 grams of oral L-carnitine daily to increase the density of androgen receptors in cells, which can enhance testosterone binding and its effects, despite its low bioavailability.

22. Ingest Garlic with L-Carnitine

If taking high doses of L-carnitine or choline, consider ingesting garlic (specifically allicin) to help decrease the conversion to TMAO, a potential carcinogen.

23. Consider Boron Supplementation

If you have high SHBG (sex hormone binding globulin), consider taking 5-12 milligrams of boron daily, as it can acutely help lower SHBG and increase free testosterone.

24. Take Tongkat Ali (Longjack)

Take 300-1200 milligrams of standardized Tongkat Ali (Longjack) daily, preferably in the morning due to its stimulant effect, to upregulate steroidogenesis enzymes, increase total and free testosterone, DHEA, and potentially lower high SHBG.

25. Take Fadogia Agrestis

To increase luteinizing hormone (LH) and testosterone, consider taking Fadogia Agrestis; a safe regimen is 300 mg daily, or 600 mg every other day/three times a week, with a more aggressive regimen of 600 mg daily for a month followed by 1-2 weeks off.

26. Avoid Eating Before Sleep

Avoid eating for at least two hours before bedtime to help optimize the pulsatile release of growth hormone during sleep.

27. Optimize Iodine for Thyroid

Ensure a balanced intake of iodine (around 200 micrograms per day), ideally from ocean sources, to support thyroid hormone levels, adjusting intake if consuming more goitrogens.

28. Exercise Caution with Peptides

Exercise extreme caution with peptides (e.g., GHRPs, GHRHs) purchased online, as sources can be unclean, contain contaminants, and dosages often exceed physiologic ranges, making their use precarious and potentially dangerous.

29. Avoid Young TRT

Avoid exogenous testosterone therapy if you are young (teens, 20s, 30s) and have normal testosterone levels, as benefits rarely outweigh detriments.

30. Monitor TRT Closely with Doctor

If considering testosterone therapy (typical starting doses 100-120 mg/week, divided 2-3 injections), work closely with a physician to monitor all organ systems for potential side effects like acne, hair loss, mood changes, cardiovascular issues, ferritin buildup, fertility, and lipid concerns.

31. Avoid Clomiphene Monotherapy

Avoid using clomiphene (Clomid) or HCG monotherapy for long-term testosterone optimization, as they are not clinically useful for most individuals, have many pharmacodynamic effects, and can cause significant side effects like visual changes.

32. Protect Fertility on TRT

If on testosterone therapy and concerned about fertility, consider taking HCG (human chorionic gonadotropin) several times per week, as it can help maintain spermatogenesis, though individual responses vary.

33. Avoid Testicular Heat Exposure

To protect fertility and sperm viability, avoid excessive heat exposure to the testes (e.g., daily hot tubs, saunas, heated car seats, prolonged sitting) and consider cold therapy like ice baths or cold packs.

34. Avoid Smoked Nicotine

Avoid smoked nicotine and high doses of chewed nicotine, as it can negatively impact testosterone, estrogen, and increase risk for cardiovascular and neurodegenerative diseases due to its vasoconstrictive effects.

35. Limit Prolonged Cycling

Limit prolonged cycling, especially when seated and putting pressure on the perineum, as it can damage the prostate and weaken the pelvic floor, potentially leading to incontinence and impotence.

36. Strengthen Pelvic Floor

Strengthen your pelvic floor through exercises like Kegels and proper form during Valsalva maneuvers, especially if you have a history of inguinal hernia, but avoid excessive contraction to prevent limiting blood flow.

37. Include Healthy Fats

Include healthy fats like omega-3s and olive oils in your diet. While saturated fat correlates with hormone optimization due to nutrient density, it’s not vital; focus on eliminating unhealthy trans fats.

38. Consider Low-Dose Tadalafil

Consider discussing low-dose tadalafil (2.5-5 mg daily) with your physician to improve prostate health, increase androgen receptor density, and reduce nocturia, which can secondarily enhance sleep, growth hormone, and testosterone optimization.

39. Monitor PSA Levels

Monitor Prostate Specific Antigen (PSA) levels, noting that healthy ranges vary by age (e.g., 0-1 for 20-year-olds, 1-3 for 40-year-olds), and consult a physician for interpretation.

40. Consider Topical DHT Blockers

If concerned about hair loss, consider topical anti-androgens like ketoconazole or caffeine, as they are less likely to cause systemic side effects (e.g., diminished sex drive, motivation) compared to systemic 5-alpha reductase inhibitors.

41. Avoid Turmeric/Bioperine if Sensitive

Be aware that turmeric and curcuminoids, especially when combined with black pepper fruit extract (Bioperine), can act as 5-alpha reductase inhibitors, potentially crushing DHT levels and negatively impacting vitality for some individuals.

42. Avoid BPA & Phthalates

Avoid drinking from plastic bottles and cans containing BPA (bisphenol A), as it acts as a xenoestrogen. Test your tap water for microplastics and other contaminants to ensure water quality.

43. Use ADAM Questionnaire

Use the ADAM (Androgen Deficiency in Aging Males) questionnaire as a self-assessment tool to gauge men’s health and hormone-related well-being, but do not use it for self-diagnosis.

44. Recognize ED as Warning Sign

Recognize erectile dysfunction (ED) as a potential early warning sign for underlying cardiovascular issues like plaque buildup, as symptoms may appear in the genitals before the coronaries.

45. Practice Yoga Nidra/NSDR

Practice yoga nidra or non-sleep deep rest (NSDR) for 10-minute sessions to restore cognitive and physical energy. This involves lying still with an active mind.

46. Dieting for Childhood Obesity

If a young person (around puberty or younger) is overweight, it is safe and wise to diet and actively try to lose body fat under the supervision of a physician to change body composition.

47. Avoid Vegan/Carnivore in Teens

Avoid strict vegan or carnivore diets during teenage years and early 20s, as they can significantly decrease free androgens and testosterone.

48. Multivitamin for Exclusionary Diets

A multivitamin is generally safe but not always necessary; consider taking one if your diet is exclusionary (e.g., celiac disease) or if planning for fertility.