Essentials: How to Optimize Your Hormones for Health & Vitality | Dr. Kyle Gillett

Welcome to Huberman Lab Essentials, [music] where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. And now for my discussion about hormone health and optimization with Dr. Kyle Gillette. Dr. Gillette, welcome. Thank you for having me. Well, I'm super excited to talk to you. You are an encyclopedia of knowledge about hormone health for men and for women across the lifespan. So, I have many, many questions. When someone comes to you as a patient in terms of hormone health, what are the sorts of probe questions that you ask? And what And what are you looking for? And I ask this because I'd like people to be able to ask some of these very same questions for themselves. So, when you do a physical exam and a history, you have a lot of different parts. You have your history of present illness if they have a complaint. Maybe the patient doesn't have a complaint. And that case, things like their social history and their family history are extremely important. Because that gives you a an insight into into their genetics and insight into their hormone health. So, patients will tell me, "Oh, I'm doing okay, but it helps to ask them, well, how are you now?" Let's say the patient is 50. How are you now versus when you were 20? And what has changed? So, I've got the question a lot, how do you get your doctor to order a better lab workup or to even include your basic hormones? And there's no magic answer to that. But what really helps is you tell them, you know, my energy is not as good as it used to be. My focus is not as good as it used to be. My athletic performance is not as good as it used to be. So, you don't have to have a pathology in order for a lab to be indicated. You just need to have that pertinent symptom. Would you say that using the approach you just described that it's um equally effective for men and women? Or do you find that um for one reason or another that men and women have different challenges in and advantages in trying to access their deeper hormone data. With women, there's a lot more objective data. So, if they're having menstrual irregularities or if they're not having a period, if they're having too heavy of periods, then those are things that they talk about very frequent frequently with their doctor. Men are more hesitant. Men really want to know what their testosterone is, but they at the same time they really don't want to tell their doctor how their libido is or how their energy is because it it's almost like they feel less masculine or they feel less like a guy when they say that even if they're just talking to their doctor about it. >> I'd love to just kind of take a snapshot of what you think everybody should be thinking about or doing to optimize their hormone health, male or female, from puberty onward? The law of diminishing returns applies. So, doing a little amount of what I call lifestyle interventions over a long period of time is going to be far more helpful or efficacious than doing a lot and then doing nothing. So, I talk about the big six pillars. The two strongest ones are likely diet and exercise. For hormone health, specifically resistance training is particularly helpful. For diet, caloric restriction can be particularly helpful, especially with the epidemic of metabolic syndrome that is continuing to ongoing in this country and in developed countries in general. Those are the two most powerful. For the last four, I have a little bit of alliteration. So, there's stress and stress optimization. That has to do with cortisol. That has to do with your mental health. That has to do with societal health and collective health of your family as well. Um when you're a member of a family or even a very close friend, um trying to achieve optimal health together is very important. It's the same thing with nicotine cessation. it's the same thing with hormone optimization. If you do it as a household unit, it's far more helpful. So, after stress, you have sleep optimization. Sleep is extremely important, uh especially for mitochondrial health as well. And then you have sunlight, which encompasses anything that's outdoors. So, you move more, you have cold exposure, you have heat exposure. Um that's sunlight. And then the last one is spirit. So, um that's kind of the body, mind, and soul. If you have all the other five in uh they're dialed in completely, but you don't have your spiritual health, whatever you believe, then that's going to profoundly impact your body and your mind as well. What would you say is a a really terrific way to think about and approach diet? Yeah, diet should be an individualized approach. So, if you have a a car, each car is made different and requires a different sort of fuel, whether it's a race car, whether it's a diesel truck. They have different fuels for different performance outcomes. So, if you're trying to tow something or you're trying to go fast. It also depends on your genetics. So, you can have a genetic polymorphism and you metabolize carbs and sugar better even when they're unopposed by fiber. Basically, you can use your biofeedback, how you're feeling to guess what you tolerate well, or you can just get genetic testing, which can be fairly expensive, but most of all it requires a physician or someone who knows how to interpret the test accurately. And if someone had the means or the uh would you say that getting regular blood testing is a good idea? And if so, what is regular blood testing? Is it every 3 months? Is it every 6 months? Every 3 to 6 months for preventative purposes. You should also get a blood test when you're fasting and when you're not fasting. And in terms of uh general recommendations around exercise, I'm of the mind, based on the data that I've seen, that almost everybody should or everybody should be getting 150 to 180 minutes minimum of zone two cardio per week. Yeah, that's more or less the contour. The more you're doing your zone two cardiovascular exercise, the slightly less important a long duration of caloric restriction is. And that brings us to caloric restriction. How does someone know if they should use caloric restriction or avoid caloric restriction? The reason for exercise and the reason for caloric restriction in general, including intermittent fasting, is health reasons. That's how you increase your health span. It's not necessarily going to make the weight on the scale change, but that doesn't matter as much. So, the easy way to think about it is if you're obese or you have metabolic syndrome, caloric restriction will improve your testosterone. There has been a study, and they talk about all these studies in a systematic review from the Mayo Clinic Proceedings. They note that there is a study in young healthy men, and they calorically restrict them, and their testosterone does decrease. So, if you're young and healthy, and you don't have metabolic syndrome, then caloric restriction will likely decrease your testosterone. For the healthy, um, lean enough person, right, non-obese, uh, person, is intermittent fasting a bad idea in terms of hormone health? Is oscillating between this period of of kind of feast and famine within a 24 hours a problem if one is getting sufficient calories to maintain weight? So, if they're in a caloric maintenance, then it's not going to be, uh, it's not going to be deleterious. It's not going to be bad for their hormone health. There's a couple different hormones that we can talk about. We can talk about testosterone. We can talk about DHEA, which usually go hand in hand. And then we can also talk about growth hormone, which is not a steroid hormone, but it's a peptide hormone. So, it's, um, a chain of proteins, amino acids that are put together instead of a sterol. Think of sterol hormones as coming from cholesterol. So, you do get a little spike in growth hormone after you eat. But, you also get a huge spike in growth hormone, a more significant, less negligible spike overnight. And that is improved if you are intermittent fasting. So, it's probably going to help your growth hormone and subsequently IGF-1 levels, which will help more in older age groups and younger age groups. Can I still achieve a high degree of growth hormone output if I let's say I avoid food in the 2 to 3 hours before going to sleep? Or does one have to be very deep into a fast in order to achieve this the increase in growth hormone? There's still pretty good growth hormone output even if you eat two or three hours before you sleep. It's just the law of diminishing returns. The longer you go, you get slightly more and slightly more. But, I think about it in terms of endocrine IGF-1, mostly IGF-1 that's uh synthesized in the liver and released in the in the liver versus IGF-1 that's released um classically an example of this would be your IGF-1 levels increase after resistance training or exercise. And that's more of like paracrine or autocrine, and they have more local action. So, that IGF-1, it's pretty well studied that if you just give people IGF-1, it's not going to at uh physiological levels, it's not going to improve their body composition. However, that IGF-1 that's autocrine and paracrine and just working in those local tissues and muscles is likely part of the reason why you get a improved body composition response after exercise. Are there any aspects of hormone optimization that can improve sleep? I know sleep can improve hormone optimization, but for people that are suffering from this common syndrome of going to sleep and then waking up at 3:00 or 4:00 in the morning. We know that can be associated with depression, but are there any hormone hormonal indications that might lead to that kind of situation? There's three big ones. The first one is not super common, but it's a very direct correlation. If you have a growth hormone deficiency, a true deficiency, whether you're an adult or a child, then your sleep is likely going to be affected. And uh let's say you're a child with growth hormone deficiency. Once that is replaced with therapy, your sleep is going to get significantly better. The second one that's a very common scenario is if you're having what's called vasomotor symptoms of menopause or vasomotor symptoms of andropause, which are also applicable. That's why a lot of women in menopause feel like their sleep is much worse is because they have lower activity of those progestogens. And for men in so-called andropause, um low testosterone, is that also one of the causes of poor sleep? Low testosterone can lead to poor sleep, but my third scenario uh is actually if a man begins TRT, then they develop poor sleep because of sleep apnea. It drastically raises the risk that somebody is going to have sleep apnea. And then a lot of people, especially when they first start it in the first month or two, it puts them into this hyper-sympathetic state because they have uh overactive androgen receptors, especially after a long time of being hypogonadal. Then they have uh a physiologic dose of TRT, and that causes the sleep issue itself. Is that also the case in people that are using TRT who are not hypogonadal? Many people nowadays, let's be honest, are are taking doses of of testosterone even though they are in the sort of standard range because the range is so large because of other symptomatology. Is that right? >> Uh if you're eugonadal before you start testosterone, you Meaning you're Meaning Meaning you have normal testosterone, and then you start TRT or um self-administered [clears throat] TRT, steroids, whatever you want to look at it, then your risk of sleep apnea still goes up in a dose-dependent fashion. So, the higher the dose, the more risky. I want to touch on testosterone in women. I'd like to know whether or not knowing a woman's testos- for her to know her testosterone is of equal, less than, or more value than knowing, uh, for instance, progesterone and estrogen levels because I think there are a lot of misconceptions about the roles of testosterone in women. For health optimization, testosterone is just as important to know. For pathology prevention, for example, breast cancer, osteoporosis, estrogen and progesterone are more important to know. So, when you're thinking about women, women think that they have such a tiny amount of testosterone because you could you test it. Most people test a free testosterone, so testosterone that's unbound, which is by far the the smallest proportion of testosterone. Any androgen is bound by lots of different steroid binding proteins, but the ones that are most pertinent are called SHBG or sex hormone binding globulin, and that binds the androgenic steroid, for example, DHT or dihydrotestosterone. It's associated with prostate enlargement, associated with male pattern baldness. It binds that the most strongly, and then it binds testosterone next most strongly, and then it binds things like androstenedione or DHEA, dehydroepiandrosterone, and then it binds the estrogens the weakest, like estradiol. So, if you look at the total amount of testosterone, women actually have, almost all women, not all women, but almost all of them have significantly more testosterone than estradiol, but it's because it's in different, uh, measurements. So, estradiol a lot of time is, you know, picograms per mil as opposed to nanograms per deciliter. So, women have more testosterone than estrogen. And significantly more DHEA than either. I'd like to ask about DHT in men. Uh so often we hear about testosterone in men and free testosterone and uh being the unbound form, of course, but dihydrotestosterone um but what's it What is it doing? DHT is a very androgenic hormone. So, whether you're talking about DHEA, which is a mild a weak androgen, or testosterone, which is a relatively strong androgen, or DHT, which is a very strong androgen, they bind to the androgen receptor in both men and in women. So, the uh effect of all three of those is mediated by the androgen receptor. Intriguingly, it is on the X chromosome. So, men get their androgen receptor gene from their mother. So, DHT helps a lot for uh the same reason why testosterone helps. It helps effort feel good. So, it can be motivating. There's lots of dietary changes and supplementation that you're probably doing right now that's affecting your DHT. You mean me personally? >> every everybody all all of the listeners. Um because, let's say you have a diet high in plant polyphenols. Many of those inhibit the enzyme that converts testosterone to DHT. Could you give us an example of of one of those um either in supplementation form or in food form? Yeah, turmeric, black pepper extract. >> Do you recommend that people avoid curcumin in turmeric for that reason? If someone's DHT is already low or if they have somewhat insensitive androgen receptor via genetics or via lifestyle, then I recommend they avoid bioavailable curcuminoids like bioavailable turmeric, black pepper extract. I know many people want to avoid the hair loss that can sometimes be associated with DHT levels going too high. If somebody is concerned about or is experiencing hair loss, male or female, what are their options of uh ways to offset that hair loss that are not going to negatively impact other tissues sensitive to DHT? And And what I'm What I'm basically saying here is I could imagine taking a a DHT inhibitor um a pill of some sort or an injection of some sort and offsetting hair loss, maybe even stimulating more hair growth. Um it's clear that I'm not doing that, but but I know people that do, but then experience some of the other negative effects of of blunting DHT, reduced affect, reduced libido, reduced drive, um disruptions in um prostate function or or even um sexual function generally. So, what could can people do if they want to maintain or grow back hair, but they don't want all those other effects? What should they avoid and what should they perhaps consider talking to their doctor about? >> You want some sort of strategy to decrease the activity of that androgen receptor. There's a lot of different things that you can do that are topical. The most promising is called dutasteride mesotherapy. Essentially, what it is is it's very localized injections in areas that are prone to male pattern baldness um whether they're female or male and it acts uh locally only and you repeat these injections from time to time. It decreases the conversion of testosterone to DHT just in the scalp. How does a woman know if she has PCOS, polycystic ovarian syndrome? I know you uh have treated a lot of PCOS. Uh what age women um should be thinking about PCOS? What's PCOS? Teach us about PCOS, please. Yeah. So, PCOS is polycystic ovarian syndrome. >> [snorts] >> And this is one of those conditions which is underdiagnosed. So, its prevalence is much higher than we think it is. There's been a lot of studies and some some studies say prevalence of 10%, some say 20%, it's not completely clinically penetrant. So, most people don't know they have PCOS until they have infertility or subfertility. And is this is PCOS happening this frequency in 20-year-old women and 30-year-old women and 40 and onward? >> Most women find out they have PCOS in their 30s. Especially because it's it's on a spectrum or a continuum like a lot of things where you can have a weaker version or a very severe version. What are the symptoms? There's uh criteria called the Rotterdam criteria. And in the Rotterdam criteria, there's a couple different ways that you can diagnose it. You're looking for androgen excess, insulin resistance, and you can also look for polycystic ovaries. You don't actually have to have polycystic ovaries or get an ultrasound of your ovaries to be diagnosed. If you have androgen excess, for example, androgenic acne or hormonal acne, if you have hair growth like a hair growth on the chin, it's called uh hirsutism, or if you have uh you know, like deepening of the voice, um at [clears throat] any symptom of too much and uh male pattern baldness if you're female, that's a a symptom of PCOS as well. Then you can also have insulin resistance. So, this is obesity, it's prediabetes, a high fasting insulin, a HOMA-IR over two, uh a fasting insulin of over six. So, if you have significant insulin resistance and also uh androgen dominance, that's a sign of it. Androgen dominance often leads to what's called oligomenorrhea. So, if you're having more than 35-day intervals in between a period, or if you have less than nine per year, then that can be a sign that you have oligo, which means too little, menorrhea, which means menses. So, that's a very common sign of PCOS. If you have infertility, so if you're under the age of 35 and you've been trying for more than a year, or if you're over the age of 35 and you've been trying for more than 6 months, then that can also be it's a very common presenting complaint when somebody presents with PCOS. If they're very strong on the insulin resistance spectrum, then uh optimizing their body composition, decreasing their body fat, and treating that metabolic syndrome can help. So, uh a lot of people ask, "Well, does everybody that's on uh like does everybody need to be on metformin that has PCOS?" Not necessarily, but metformin is one of the tools that can help with insulin sensitization. Other tools that can help are inositol. So, myo-inositol is an insulin sensitizer. It's uh cousin D-chiro-inositol is a a weak anti-androgen. A lot of types of inositol have both of those in it. So, depending on if you're a female or a male and you're on an inositol, the type of inositol does matter. Marijuana. I've heard that it can decrease testosterone in men and women. I've heard that it can increase testosterone. Alcohol. I think there's general consensus that high alcohol intake, high barbiturate intake does in fact reduce testosterone. I'm not a drinker, so that I'm not asking these questions for me. I don't smoke pot. I'm quite over I've just never really liked uh marijuana or alcohol. They're not my thing, but many people want to know the answers to these. So, what about marijuana? Does it reduce testosterone to significant degree or not? Cannabinoids itself, whether it's THC or CBD, are not going to reduce testosterone by themselves. If it's smoked marijuana, then it's very likely to increase your aromatase, which increases your estrogen. And uh you know, that's going to it's aromatizing from testosterone. So, that is going to decrease testosterone. When you have an increased estrogen like estradiol, that's going to work on your pituitary to make less hormones that cause the release of of testosterone. So, you're going to have less LH and less FSH. >> [snorts] >> So, it's almost kind of like you know, opiates are well known to um opiate agonists. Uh they're going to decrease LH and FSH and subsequently testosterone. Smoked marijuana will as well. As far as alcohol, high alcohol will decrease testosterone as will any very potent GABA agonist, whether it's a barbiturate or a benzodiazepine or a non-benzo or alcohol. They're definitely going to. So, let's talk about testosterone in in males. I'm aware that a lot of people are considering increasing their testosterone by taking testosterone. That a few years ago that was considered you know, steroid use and it was really extreme kind of stance. Nowadays, it seems like there's more discussion about it. Does testosterone supplementation, and here I'm talking about prescription from a doctor, does it make one more prone to prostate cancer? That seems to always be the first question that comes out. So, testosterone is not going to cause a prostate cancer. However, normal aging causes prostate cancer and testosterone will grow your prostate cancer. So, if you're a 80-year-old male and you have an autopsy, then there's at least a 50% chance that you have a prostate cancer. If you're 90 or 100 years old, there's at least a 90% chance. So, for humans with a prostate, it's only a matter of time until you get a prostate cancer. So, that begs the question, do you want to take something that's going to grow it for sure once you have it? So, it's an individual assessment with aging, you know, a fast aging is abnormal. Very slow aging is normal. There's a fine line to walk between those two. What about uh prolactin? Just as testosterone and estrogen need to be in the proper ratios, dopamine and prolactin need to be in the appropriate ratios. So, what what what how should we think about um and perhaps act on our prolactin systems? The way I describe it is the dopamine wave pool. So, if you're increasing your dopamine too much, you're going to overflow, and then you're going to have that wave crash too much. So, you want to have nice even waves that are not going too far above the pool of dopamine, and prolactin will follow. So, prolactin and estrogen are quite close cousins. Estrogen upregulates a gene called the PRL gene, or prolactin gene, that directly increases prolactin synthesis. So, prolactin is going to uh also inhibit the release of testosterone from the pituitary. So, if you're using a dopamine agonist, then you're going to help decrease the prolactin-producing cells. So, if someone's concerned about dopamine, or maybe they have a slightly higher prolactin, then they eliminate things that could be increasing that prolactin. Such as? Uh casein or gluten, which are mu opioid receptor agonists, or any mu opioid receptor agonist in the gut. Casein, so milk protein? Correct. >> Can increase prolactin? Correct. >> Interesting. I'd like to shift gears slightly and and talk about uh social interactions and relational effects on hormones. What would you suggest people uh do or think about as they enter relationship, or if for people that are in long-term relationships where they feel like something has shifted, and indeed it those shifts may reflect the output of different hormone systems and neurotransmitter systems. It almost certainly has to be the case, right? >> Yeah. So, just like uh women who spend a lot of time together, whether they're co-workers or whatever, a lot of times their men- menstrual cycles will align. There is a lot of pheromonal and hormonal cross-talk, including prolactin, between men and women. So, spending 100% of the time together, this is why people think it's so hard to work together and live together. They're around each other 24/7. >> [snorts] >> You don't have the reprieve where you let that dopamine settle down and then you're excited when you see them again. Uh a lot of guys know that they go on a trip for a long time, they come back and they see their partner and it's like a new not quite like a new relationship, but almost like a new relationship. They have that excitement again. And purposely building that into every relationship can help significantly, especially if you choose to have a child or get pregnant or be breastfeeding, because you just plan ahead for both of your prolactins to be high and both of your dopamines to be low and both of your testosterones to be low. So, um there's a there's a lot of planning that you can do. Essentially, every relationship goes through uh a crisis. Mhm. And that crisis is personal between uh the two of you and you can plan ahead and figure out a way, maybe it's not supplementation, maybe it's not even uh the amount of time you spend away from each other, but plan ahead to have good times if you know you're about to go into a crisis. Peptides. A lot of discussion these days about peptides. What can we say generally about peptides? Are they safe? Are they not safe? What about sourcing? And are there any peptides that you think could be of particular use for people? And we should probably also touch on peptides that people shouldn't go anywhere near with a 10-ft pole. Yeah, definitely. So, peptides are very heterogeneous. There's very dangerous ones and very safe ones. My favorite peptide is the original peptide, which is insulin. And yet insulin can kill you if you take it at the incorrect dose. Yeah. So, just like insulin should be prescribed by a doctor, there is over-the-counter insulin, rely on our NPH, but ideally your insulin is prescribed by your doctor for your diabetes as it's life-saving. Peptides should be prescribed by doctors as well, and there's several that are FDA-approved. Growth hormone itself is also a peptide. It's a peptide hormone, not a steroid hormone. So, if somebody wants to increase their growth hormone output, what are the risks and benefits of taking a growth hormone releasing hormone peptide prescribed by a doctor, of course? What should one be concerned about? There's definitely a lot of risk, tumor growth, and cancer. So, you look at a type 1 diabetic, they have very high incidences of various types of cancer. They have very high growth hormone, but low IGF-1 paradoxically. So, they would likely give you a similar cancer risk to a type 1 diabetic that has very high uh growth hormone. However, there are the benefits of it, you think of lipolysis, uh decreased body fat, increased lean body mass. A lot of those can you can use other things to get those benefits. So, then you know, you don't need growth hormone for those benefits, it just leaves cosmetic benefit. To which you can usually use topicals to get uh you know, your hair and your skin and your nails. There's a lot of other things that you can do other than growth hormone. So, a lot of people just don't need these GHRPs. Yeah, let's talk about BPC 157 and melanotan, cuz I think those are the ones that most people are um eyeing, so to speak. Yeah. So, BPC 157 is body protective compound 157. It's uh identical or bioidentical to gastric protective compound 157 that's produced in the stomach. So, as you age, you get atrophic gastritis very often. That's why you have less intrinsic factor, which is kind of another peptide that binds to vitamin B12. That's why you can get age-related B12 deficiencies. So, that's one reason why you have more colitis, more diverticulitis as you age. You don't have that gastric protective compound. It's uh it increases VEGF, vascular endothelial growth factor, which basically makes your blood vessels grow more. So, that's what uh causes your body to form a blood vessel. So, another medication known as Avastin, it's on the WHO's list of essential medications for cancer. So, many different types of cancer, including colon cancer, you treat it with Avastin, which is a VEGF inhibitor. So, if you have cancer or at high cancer risk, you probably don't want to be taking a medication that's the exact opposite mechanism of action as your essential anti-cancer med. In other words, if you have cancer or you're at risk of cancer, avoid BPC-157. >> Correct. BPC-157 is not FDA-approved, but it is essentially standard of care at this point. Uh I would say it's uh you know, if you're not counting insulin or growth hormone as peptides, it's one of the most commonly used peptides. And anecdotally and in some clinical literature, it's fairly well tolerated for short periods of time. I'm not in the camp that everybody needs to do it two to three times a week or even daily for 6 weeks, no matter what. The major benefit is when you're going to take it early on because it's going to allow your body to increase blood flow to the injured area. And the less blood flow it has, for example, cartilage, ligaments have horrible blood flow, especially as people age, it's going to make a significant difference. So, I would wager that that Russian gymnast that Achilles healed in 1 month and completely from a a full rupture, was likely taking BPC 157 or something very similar. Yeah, I'm willing to wager on that as well. That remarkable recovery. Uh and so, because it is prescription, there are non-prescription forms. My understanding of the non-prescription forms and the danger of going after non-prescription forms is that oftentimes they will contain what they claim they contain, BPC 157 in this case, but they are not adequately cleaning out the LPS, the lipopolysaccharide, which can cause inflammation. In fact, in the laboratory we use LPS to deliberately induce fever and inflammation to study systemic inflammation. So, this is a warning to people if you're interested in peptides, you absolutely need to work with a physician, in my opinion. Get it from a really good compounding pharmacy who will clean out who that cleans out the LPS. Because if you're buying it through a source that um you know, a lot of people I don't want to name sources, but there are these common sources on the internet that everyone knows about. They're buying these sources, they'll ship it to anyone essentially, but then the LPS is really causing inflammation, and many people experience a kind of mild fever or tingling from that when they inject it, and they're like, "Oh, I can feel it working." That's probably LPS action, which Yeah. is not good for the brain. I don't know about the on other peripheral tissues. Um I haven't heard of people dropping dead from this stuff yet, but I certainly wouldn't want to be ingesting any LPS unnecessarily. You mentioned Melanotan, there are several kinds of Melanotan. I first learned about Melanotan from um reading about peptides and discovering that people were taking injecting Melanotan to get tan, because it's in in the melanin um synthesis pathway. Are there any clinical usage of Melanotan? There's actually three FDA-approved indications, believe it or not. Not many people know about this, but there's three well-accepted indications. One of them is the hypoactive sexual disorder and more in women. That's for Bremelanotide, So, those are those are women that have essentially no libido whatsoever, but other hormones are seem are in check. >> Yeah. Classically, it's um before menopause. So, >> [clears throat] >> those hormonal issues are not contributing. And uh when you give them this peptide, it's also known as PT-141, it helps significantly. A lot of times you use it in nasal spray. It goes straight into the central nervous system and acts centrally. You can also inject it and you can also take it via troche. Men and women take it? Correct. It's approved for women, but it can also help men. And it's relatively safe. The only relative contraindication that I tell people, and a lot of people say, "Oh, there's no side effects that I know of." But if you have a family history of melanoma or potentially have a melanoma and don't know about it, that's why I'm a big advocate of dermoscopy as well and regular skin checks, then theoretically it's going to increase that alpha-melanocyte-stimulating hormone and it can grow that. So, that's definitely not a good thing. Um so, be very careful about long-term administration of it. It's also approved for lipodystrophy, which is the same exact thing as tesamorelin, which I believe is also known as uh uh Egrifta or Egrifta. And then it's also approved for the rare genetic condition where your uh receptors or your melanocytes don't proliferate as well. So, you usually have hypopigmentation. It's not true albinism. Um but it's associated with morbid morbid obesity and very poor outcomes from that in childhood. So, it's used in kids, actually. Interesting. I want to talk about the sixth pillar, spirit. How do you conceptualize the spiritual aspect and how do you talk to patients about this given that people walking into your clinic are presumably have a bunch of different religious and not a religious backgrounds. I'm sure some are atheists, some are probably strong believers. How do you deal with that and how should people think about this? Yeah, it is surprisingly well received. You wouldn't think at first glance that a patient really wants to talk about their spiritual health with their doctor. But, the way I think about it and the way that it really is is it's like a Venn diagram and you have a body and a mind and a soul. And you can't have one healthy without the other healthy. Even if your mental health is uh phenomenal and even if your physical health is phenomenal, the mental aspect of spirituality, if that piece is not there, then that's going to affect your body physiologically as well. And regardless of someone's an atheist or regardless of regardless of what someone believes as far as religion or the origin of the species, they can know that their spirituality is going to have a profound effect on their mental and physical health as well. People like to compartmentalize it. So, they like to talk to their doctor only about the physical health cuz it it's comfortable to do that. They only talk to their pastor or a mom or uh you know, Reiki healer for their spiritual health and they just talk to their therapist or psychiatrist about their mental health. But, you need to bring all three of those things together. Uh it's well known that interdisciplinary clinics lead to improved patient outcomes. And that's just disciplines within medicine. So, that's just uh doctors that are specializing in this or this. So, this takes a step back and upper uh in the upper part of that tree before you reach those dichotomies or the split-offs, you have your you have your body and your mind and your soul. So, your spiritual health and your mental health and your physical health. So, if you're uh in line in all three of those things, that builds the cornerstone for the rest of your health and the rest of your life. So, I hope that everybody does find what they truly believe in as far as their own spirituality. But, uh yeah, that that's a a personal journey. Uh from a physician standpoint and even if I'm friends with him as well, from a friend standpoint, I don't like to push anybody in any specific direction. So, I don't think that everybody should believe what I believe. And uh uh I don't feel like there should be any pressure for them to believe something different. So, I think that there can be excellent physician-patient rapport regardless of what we of what we believe and what our backgrounds are. I have one final question. Is caffeine having a an effect one way or the other on testosterone, estrogen, or other hormones that uh is positive, negative, or neutral? Only if it affects your sleep. So, it works on adenosine and it can actually slightly improve allergies as well. But uh negligible effect otherwise. Kyle, Dr. Gillette, I should say. Thanks so much for your time. I really appreciate it. I know the listeners will, too. Thank you. My pleasure.