How to Optimize Your Hormones for Health & Vitality
Summary
Dr. Kyle Gillett, a dual board-certified physician in family medicine and obesity medicine, outlines a comprehensive framework for optimizing hormones across the lifespan using lifestyle, nutrition, supplementation, and medical therapies. The conversation covers the major hormonal systems in both men and women, including testosterone, estrogen, DHT, progesterone, and growth hormone. Key topics include the interplay between body composition and hormone levels, the effects of common supplements and substances on hormone pathways, and condition-specific guidance for issues like PCOS and hair loss.
Key Takeaways
- The “Big Six” pillars for hormone optimization are: diet, exercise, stress management, sleep, sunlight/outdoor activity, and spiritual health — with diet and resistance training being the most impactful.
- Caloric restriction improves testosterone in obese individuals with metabolic syndrome, but decreases testosterone in lean, healthy young men.
- Intermittent fasting at maintenance calories does not harm hormone health and may boost growth hormone and IGF-1, especially overnight.
- Creatine monohydrate increases the conversion of testosterone to DHT, which can benefit motivation and cognition but may accelerate hair loss in genetically predisposed individuals.
- Turmeric (curcumin) and black pepper extract (BioPerine) inhibit 5-alpha-reductase, reducing testosterone-to-DHT conversion — potentially impacting energy, libido, and drive.
- Smoked marijuana increases aromatase activity, raising estrogen and suppressing LH/FSH, thereby lowering testosterone.
- Oral contraceptives dramatically raise SHBG, lowering free testosterone and DHT, which flattens libido peaks and alters perception of attractiveness.
- PCOS (polycystic ovarian syndrome) affects an estimated 10–20% of women and is characterized by androgen excess, insulin resistance, and menstrual irregularity — often underdiagnosed.
- Testosterone replacement therapy (TRT) increases sleep apnea risk in a dose-dependent manner, even in eugonadal men.
- Testosterone does not cause prostate cancer, but it can accelerate the growth of an existing prostate cancer — making PSA monitoring essential.
Detailed Notes
The Six Pillars of Hormone Health
Dr. Gillett identifies six foundational lifestyle factors, ranked roughly by impact:
- Diet — individualized; caloric balance matters most
- Exercise — resistance training is especially important for hormone optimization; Zone 2 cardio (150–180 min/week minimum) supports overall health
- Stress optimization — affects cortisol, mental health, and social/family well-being
- Sleep — critical for mitochondrial health and hormone output
- Sunlight/outdoor exposure — includes cold exposure, heat exposure, and general movement
- Spiritual health — social, existential, and purpose-driven wellbeing; affects both body and mind
“Doing a little amount of lifestyle interventions over a long period of time is far more efficacious than doing a lot and then doing nothing.”
Diet and Caloric Restriction
- Diet should be individualized based on genetics, activity level, and health goals.
- Calories in, calories out is affirmed as a fundamental principle.
- When losing weight, approximately 33% of loss is lean body mass.
- Caloric restriction and intermittent fasting improve health span, independent of scale weight.
- In obese individuals: caloric restriction improves testosterone parameters (supported by a Mayo Clinic Proceedings systematic review).
- In lean, healthy young men: caloric restriction decreases testosterone.
- Intermittent fasting at caloric maintenance does not harm hormone health.
- Blood testing should be done both fasted and non-fasted to get a full picture (“don’t just look at low tide”).
Growth Hormone and IGF-1
- Growth hormone has a short half-life (hours); IGF-1 has a half-life of nearly a week.
- The largest GH spike occurs overnight during sleep, enhanced by fasting.
- Eating 2–3 hours before sleep still allows reasonable GH output.
- Endocrine IGF-1 (produced in the liver) differs from paracrine/autocrine IGF-1 (produced locally in muscles after exercise).
- Exogenous physiologic-level IGF-1 alone does not improve body composition; local IGF-1 from exercise likely contributes to muscle adaptation.
- GH spikes from sauna or fasting are very unlikely to be large enough to promote cancer.
DHT (Dihydrotestosterone)
- DHT is a potent androgen, stronger than testosterone, converted by the enzyme 5-alpha-reductase.
- Benefits of optimal DHT:
- Makes effort feel rewarding — motivating and energizing
- Active in cardiovascular tissue (myocardium)
- Supports libido and vitality in both men and women
- Androgen receptor gene is located on the X chromosome — men inherit it from their mother.
- Fewer CAG repeats = more sensitive androgen receptor = higher likelihood of male pattern baldness
- DHT plays a role in cardiac hypertrophy; finasteride/dutasteride can support cardiac remodeling in cases of excessive hypertrophy.
5-Alpha-Reductase Inhibitors (reduce DHT):
- Turmeric/curcumin
- Black pepper extract (BioPerine/piperine)
- Saw palmetto (inhibits isoenzymes 1 and 2)
- Finasteride (inhibits isoenzymes 2 and 3)
- Dutasteride (inhibits all three isoenzymes)
DHT Booster:
- Creatine monohydrate (~5g/day) increases testosterone-to-DHT conversion; also associated with cognitive benefits.
Hair Loss
- Androgenetic alopecia (male or female pattern baldness) is driven by DHT binding to androgen receptors in scalp follicles.
- Telogen effluvium is a separate type — caused by stress, pregnancy, or thyroid issues — involving a natural shedding cycle.
- Starting 5-alpha-reductase inhibitors often causes an initial large shed (telogen effluvium), after which healthier follicles grow back.
- Dutasteride mesotherapy — localized scalp injections — can reduce DHT conversion only at the scalp, avoiding systemic effects.
- Hair follicle stem cells can recover if treatment is stopped promptly; permanent loss is more likely after very prolonged neglect (approximately 1 year+).
- Women can develop androgenetic alopecia, often associated with PCOS.
Testosterone in Women
- Women produce testosterone primarily in theca cells of the ovaries (premenopausal).
- Women have more total testosterone than estradiol (measured in different units: ng/dL vs. pg/mL).
- Women also have significantly more DHEA than either testosterone or estradiol.
- DHT is detectable in women; free DHT may be near-undetectable, especially on oral contraceptives.
- Testosterone is equally important to measure for health optimization in women; estrogen and progesterone matter more for pathology prevention (e.g., breast cancer, osteoporosis).
- Some women naturally produce very high testosterone (via overactive theca cells = hyperthecosis).
PCOS (Polycystic Ovarian Syndrome)
- Prevalence estimated at 10–20%; widely underdiagnosed.
- Most women are diagnosed in their 30s, often presenting with infertility.
- Rotterdam Criteria for diagnosis (need 2 of 3):
- Androgen excess (acne, hirsutism, voice deepening, female-pattern hair loss)
- Insulin resistance (obesity, pre-diabetes, fasting insulin >6, HOMA-IR >2)
- Polycystic ovaries on ultrasound
- Menstrual irregularity (oligomenorrhea: cycles >35 days or