Essentials: Tools for Hormone Optimization in Males | Dr. Kyle Gillett
In a Nutshell
Dr. Kyle Gillett emphasizes foundational lifestyle pillars—diet with adequate protein, fiber, and calories, vigorous exercise 3-4x weekly, sleep, stress management, and purpose—for natural hormone optimization in males. Key supplements include creatine, tongkat ali, fadogia, L-carnitine, vitamin D, and boron to support testosterone, DHT balance, and androgen receptor density, with monitoring of SHBG and free testosterone. Exogenous testosterone or clomiphene is rarely recommended for young men with normal levels due to fertility risks and side effects, while low-dose tadalafil may aid prostate health and blood flow.
These notes were generated by AI and may contain inaccuracies.
Dr. Kyle Gillett recommends treating hormone optimization like a new car coming off the assembly line by performing a full scope of diagnostic workup and monitoring progress across a person's lifespan. Development continues throughout life, so ongoing monitoring is essential.
Testosterone should be measured either as total testosterone with SHBG or as free testosterone. SHBG (sex hormone binding globulin) is the protein that binds up all androgens and estrogens in the body. The stronger the androgen, the stronger it binds. During puberty, strong androgens like DHT (the strongest bioidentical androgen) play a prominent role in secondary sexual characteristics. High SHBG means DHT can run higher because it is not metabolized, but there is less free DHT. The goal is balancing enough free DHT and enough total DHT.
Blood work follow-up is recommended at approximately 6 months using shared decision-making with a physician.
Diet and exercise are the first two pillars. During puberty, sleep is particularly important. Throughout the lifespan, do not exclude things that are helping you. During puberty, consuming dairy can help increase IGF-1 and free IGF-1. IGF-1 helps with growth, genital development, secondary sexual characteristics, long bone growth, skin growth, and hair growth.
Adequate vitamin D is important because it helps with testosterone production, bone mineralization, and stature. Up to approximately age 25, optimizing growth hormone and IGF-1 helps with bone density and bone growth. From a dietary standpoint, having enough free estrogen (not too much) during growth helps stockpile bone to prevent osteoporosis risk later in life.
Most people benefit from eating a combination of quality proteins from animal and non-animal sources, fruits, vegetables, and starches. A pure carnivore or pure vegan diet in the early 20s and teens is a poor idea because it is likely to significantly decrease free androgens, resulting in less testosterone acting on receptors throughout the body. In late 20s, it might be a reasonable option.
Fiber is paramount for setting the set point of the gut microbiome for the rest of life. Prebiotic fiber acts as fish food for good gut microbiome. The gut microbiome is like an aquarium or fish tank where food either skews it toward beneficial or detrimental states.
Prebiotic fiber and essential fatty acids are important throughout the lifespan, but particularly in teenage years through 30s because they help with brain development.
If an individual is overweight with excess adipose tissue, caloric restriction and exercise done not too fast and in a healthy way is beneficial for testosterone in the long run. For individuals not carrying excess body fat, caloric restriction lowers testosterone. In a caloric deficit, there are less building blocks for hormones, a more catabolic state, less signaling from growth hormone and IGF-1, and higher SHBG, causing free androgens and free estrogens to decrease.
Stress is the next pillar. During puberty and 20s-30s, individuals are figuring out how to cope with stress and what to put their effort into. Overstress can disrupt all other lifestyle pillars.
Finding purpose in life is important, referred to as spirit or the self-actualization component of Maslow's hierarchy of needs. The idea is not to pick the end goal but to pick a goal, reach it, assess, then pick another goal. Goals and purpose can change over time.
A healthy sustainable exercise regimen is vigorous exercise around 3 to 4 times per week. On top of that, 3 or 4 more instances of less vigorous exercise can be added. Vigorous exercise episodes lasting longer than an hour are not hormonally helpful, especially when done regularly. Training vigorously for longer than an hour is not recommended.
For males in teens, 20s, or 30s with blood levels within the normal reference range (300-900 nanograms per deciliter), taking exogenous testosterone is almost never recommended. Rare cases like Kallmann syndrome may warrant consideration, but generally the detriment outweighs the benefit. Negative effects include impacts on fertility and challenges if dosages are not correct. TRT is on the banned list for sports.
Creatine helps with amino acid synthesis, oxidative stress, and serves as backup fuel for mitochondria. It slightly increases total testosterone and increases conversion of testosterone to dihydrotestosterone. It is especially useful in teenage years and 20s. Creatine does not increase hair loss beyond what naturally occurs as a male. If conversion of testosterone to DHT is already high, creatine often does not affect it further. It resets balance between testosterone being aromatized to estrogen or being 5-alpha reduced to DHT.
Betaine (1-3 grams) can be used for creatine non-responders to help with amino acid synthesis and shunting of energy. Several versions of creatine have betaine mixed in because it helps with processing of methionine and homocysteine.
L-Carnitine is a shuttle that takes nutrients from outside mitochondria and puts them inside. It increases density of androgen receptors in the cytoplasm of cells. Even if androgen receptor sensitivity and testosterone levels do not change, there are more receptors for testosterone to bind. Oral bioavailability is approximately 10%. Recommended oral dosage is 1,000 to 5,000 milligrams per day. No reason to cycle creatine, betaine, or L-Carnitine.
High doses of carnitine or choline can convert to TMAO, a potential carcinogen, depending on gut microbiota. Allicin (from garlic) and berberine can help decrease TMAO conversion. Berberine can cause brutal headaches, carbohydrate cravings, and drops blood sugar including during sleep (dawn phenomenon).
Vitamin D (specifically D3) is a steroid hormone. Replacing deficient vitamin D optimizes testosterone.
Boron (5-12 milligrams per day) can acutely help lower very high SHBG, though the effect is not sustained. Boron is depleted in soils in many countries but high in Greece and Turkey. Dates or raisins from those areas may contain more boron, potentially explaining higher testosterone reference ranges in those countries.
Tongkat Ali (also known as Longjack) upregulates several enzymes in the steroidogenesis cascade. It helps with conversion of multiple key steps where testosterone is synthesized. It is theoretically especially powerful on lower carb diets or caloric deficits when less growth hormone, insulin, and IGF-1 are expected. Recommended dosage is 300 to 1,200 milligrams per day. Standardization matters; look for eurycomanone content. Tongkat Ali can slightly increase DHEA and decrease very high SHBG. In populations with normal SHBG, it increases total and free testosterone but does nothing for SHBG.
Fadogia increases LH (luteinizing hormone) release from the pituitary, which binds to the LH receptor on Leydig cells and increases testosterone release. A safe dose is approximately 300 milligrams per day. One regimen is 600 milligrams every other day or three times a week (Monday, Wednesday, Friday). A rat study showed potential toxicity markers (GGT and alkaline phosphatase) at certain doses without antioxidants, but the 300 mg human-equivalent dose showed no effect.
Taking a low dose more frequently is more beneficial than older approaches of 100-200 milligrams in a single injection once every two weeks. For individuals with testosterone around 600 nanograms per deciliter complaining of slightly diminished libido, poor workout recovery, and reduced motivation, dosage range and frequency depend on SHBG and free testosterone levels.
If an individual has very high SHBG, which binds up testosterone and all androgens and estrogens, they may need a different dose to achieve a normal youthful free testosterone level even if their measured free testosterone appears adequate.
A general normal dosing range, especially for someone starting testosterone therapy, is around 100 to 120 milligrams divided over the course of a week. Injections are usually given either every other day or three times a week, occasionally twice a week. Many people with slightly higher SHBG can manage with twice-weekly dosing. This assumes the ester is cypionate or enanthate.
Two 60-milligram injections of testosterone cypionate per week is a very common dosing approach to reach 120 milligrams per week as the typical average. This is considered a physiologic youthful dose. For many people, even 200 milligrams a week is far above the reference range.
Testosterone is normally released in a pulsatile manner, high in the morning and low in the evening. On testosterone therapy, levels reach a steady state and remain relatively constant throughout the day and evening.
When patients begin testosterone therapy at 120 milligrams per week divided into two or three doses, they commonly report improved mood, energy, sleep, and recovery. However, even this dosage can be too high for some individuals, and careful monitoring across multiple organ systems is required.
Potential warning signs and side effects include:
- Dermatologic changes such as acne, various skin pathologies, and bruising
- Hair loss
- Mental status changes, including occasional induction of manic or bipolar episodes, since testosterone is also dopaminergic
- Cardiovascular concerns including microvascular ischemic disease
- Ferritin buildup related to increased estrogen
- Fertility concerns
- Lipid abnormalities
A physician managing testosterone therapy must be well-versed in dermatology, hematology, cardiology, lipidology, and other systems beyond just the gonadal system. Blood work is essential for tracking changes such as rising LDL and ApoB that cannot be assessed through symptoms alone.
If the prescribing physician is not well-versed in these systems, they should be part of an interdisciplinary team with other experts who can monitor the relevant parameters.
Some males choose not to use exogenous testosterone in any form (cream, pellet, pill, or injectable cypionate) and instead take clomiphene a couple of times per week. A commonly discussed regimen is two 50-milligram tablets per week.
Clomiphene increases testosterone in a dose-dependent manner by blocking estrogen at the estrogen receptor on the hypothalamus and pituitary, thereby reducing negative feedback inhibition. This leads to increased luteinizing hormone (LH) release.
However, clomiphene has many other pharmacodynamic effects beyond its action on the hypothalamus and pituitary. There are five different estrogen and estrogen-related receptors, and clomiphene, like other SERMs, selectively inhibits some receptors in some tissues but not others.
Clomiphene can inhibit receptors in the eye, causing visual changes and blurry vision, especially at higher doses. Side effects from clomiphene and other selective estrogen receptor modulators are very common.
Clomiphene is sometimes considered as a very temporary measure that will not suppress pituitary or hypothalamic function, particularly if testosterone is so drastically low that natural recovery is unlikely. It is generally not clinically useful for long-term testosterone replacement or optimization in most individuals.
Alcohol significantly increases aromatase activity, the enzyme that converts testosterone into estrogen, and this effect is dose-dependent. More than three to four standard drinks every two weeks is generally not recommended. One large glass of wine may equal approximately five standard drinks.
Alcohol also contains 7 kilocalories per gram, nearly as much as fat at 9 kilocalories per gram. Additionally, alcohol is GABAergic and activates inhibitory neurotransmission, which can reduce LH and FSH release and thereby decrease testosterone in a manner similar to opiates.
Some physicians prescribe low-dose tadalafil (Cialis) at 2.5 to 5 milligrams per day to male patients not for erectile dysfunction but to improve prostate health and blood flow to the prostate and genitalia.
Tadalafil is a very underrated medication. It can also function as a blood pressure medication, slightly decreasing blood pressure especially at higher doses. A high dose is considered 20 milligrams. Consistent use can affect cones in the eye responsible for red-green discrimination, though this effect reverses upon discontinuation.
Tadalafil increases the density of the androgen receptor similarly to L-carnitine. It is also beneficial for nocturia (urinating at night), generally cutting episodes in half, which can improve sleep and secondarily support growth hormone and testosterone optimization.
Recommended dosing for these effects is typically no higher than 10 milligrams per day, usually 2 or 5 milligrams.
Many drugs used to offset hair loss operate through the DHT (dihydrotestosterone) system because DHT receptors on the scalp contribute to hair loss while promoting beard growth on the face.
Some individuals taking medications such as Propecia (finasteride) to block the DHT pathway experience diminished sex drive, motivation, and general vigor.
Topical anti-androgens can be alternatives for those wishing to preserve hair without systemic effects. Ketoconazole is one option. Caffeine is another weak topical anti-androgen that enters the scalp and partially crowds out androgen at the receptor level. This effect is weak but likely clinically significant, and caffeine is often combined with other weak anti-androgens such as ketoconazole in formulations.
Spironolactone can be prescribed topically but is systemically absorbed due to molecular size; males should not use topical spironolactone unless specifically prescribed by a physician.
Topical finasteride is also systemically absorbed to some degree, typically decreasing systemic DHT by about 30 percent. Topical dutasteride has minimal systemic absorption and a faster half-life at lower doses, so it generally does not affect systemic DHT levels.
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