Dr. Kyle Gillett: Tools for Hormone Optimization in Males

Welcome to the Huberman Lab podcast where we discuss science and science-based tools for everyday life.

欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。

Great to be back.

很高兴回来。

Thank you.

谢谢。

I'd like to begin with a question about one of the most mysterious and important phases of life, which is puberty.

我想首先问一个关于生命中最神秘和最重要的阶段之一的问题，即青春期。

I've long wondered whether or not how quickly somebody goes into puberty-- so at what age-- and how long puberty takes-- so how brief or protracted that puberty is for them to acquire the so-called secondary sexual characteristics, things like hair growth on the face for males and changes in bone, and muscle density, and growth, et cetera.

长期以来，我一直想知道一个人进入青春期的速度有多快，即在什么年龄，以及青春期需要多长时间，那么青春期对他们来说是短暂还是漫长，才能获得所谓的第二性征，比如男性脸上的毛发生长、骨骼的变化、肌肉密度和生长等等。

When I was in middle school and high school, I noticed that some people transitioned into all that very fast and some people took a long time to acquire those characteristics.

当我在初中和高中时，我注意到有些人转变得非常快，而有些人则需要很长时间才能获得这些特征。

Can we learn anything about ourselves, our hormones, and maybe even how long we're going to live based on the time in which we enter puberty and how long it takes us to progress through puberty?

我们能否根据进入青春期的时间以及进入青春期需要多长时间来了解有关我们自己、荷尔蒙的信息，甚至我们的寿命？

And I guess that also raises the question, does puberty ever truly end?

我想这也提出了一个问题，青春期真的会结束吗？

There are many takeaways from puberty.

青春期有很多收获。

Some of the actionable items from it are, yes, it can and does affect your adult height and also stature and also body composition.

其中一些可操作的项目是，是的，它可以而且确实会影响您的成年身高、身材和身体成分。

So puberty is a time-- and if we're talking specifically about males, think of it as a time where, if you have obesity as a child, you could potentially use that time to change your lifestyle and habits and reset things, and it is a bit easier.

因此，青春期是一个时期，如果我们专门谈论男性，那么可以将其视为一个时期，如果您小时候患有肥胖症，您可能会利用这段时间来改变您的生活方式和习惯并重新设置事物，而且会更容易一些。

So for a given male that enters puberty at 13 versus a male that enters puberty at 15, can we say that the guy that entered puberty at 13 is going to be shorter than the guy that entered puberty at 15, or it's not quite that straightforward?

因此，对于 13 岁进入青春期的男性和 15 岁进入青春期的男性，我们是否可以说 13 岁进入青春期的男性会比 15 岁进入青春期的男性矮，或者情况不是那么简单？

If they are identical twins and the individual who entered puberty at age 13 also finished puberty, went all the way through the Tanner stages-- and if you do a bone scan, which I believe is usually done on the left wrist, and it says yes, your growth plates are mostly closed, you're not going to grow more than a couple inches of height after that.

如果他们是同卵双胞胎，并且 13 岁进入青春期的人也完成了青春期，一路经历了坦纳阶段——如果你进行骨扫描（我相信通常在左手腕上进行），结果显示是的，你的生长板大部分闭合，此后你的身高不会增长超过几英寸。

Just a related question.

只是一个相关的问题。

When I was growing up, it was thought, or at least people would say, that resistance training-- in particular, lifting heavy weights could stunt one's growth.

在我成长的过程中，人们认为，或者至少人们会说，阻力训练——尤其是举重可能会阻碍一个人的成长。

Is that true or false?

这是真的还是假的？

It is false when you're talking about just lifting heavy weights.

当你谈论只是举重时，这是错误的。

Dirty bulking certainly has the potential to stunt one's growth for two main mechanisms.

脏膨胀肯定有可能通过两种主要机制阻碍一个人的生长。

Could you define dirty bulking?

你能定义脏膨胀吗？

So dirty bulking is eating an excess of calories not just to acquire lean metabolically active body mass or get stronger, but purposely acquiring body fat.

因此，肮脏的增肌是指摄入过量的卡路里，不仅是为了获得瘦代谢活跃的体重或变得更强壮，而且是故意增加身体脂肪。

So purposely acquiring muscle and fat by overeating and lifting weights can stunt one's growth.

因此，通过暴饮暴食和举重来故意增加肌肉和脂肪会阻碍一个人的生长。

Do I have that correct?

我说的对吗？

Correct.

正确的。

So it does two things.

所以它做了两件事。

If you're doing it as a very young child, it can-- that fat can become leptin resistant and it can produce more leptin, and that leptin can activate the hypothalamus, which activates the pituitary, which releases gonadotropin, which basically just increase testosterone and estrogen earlier than it otherwise would have.

如果你在很小的时候就这样做，那么脂肪会变得对瘦素有抵抗力，并且会产生更多的瘦素，而瘦素可以激活下丘脑，从而激活垂体，释放促性腺激素，基本上只是比其他情况更早地增加睾酮和雌激素。

It's the same mechanism behind why childhood obesity causes early puberty.

这与儿童肥胖导致青春期提前的机制相同。

Interesting.

有趣的。

I do remember a paper published in Science Magazine-- I believe it was focused mainly on females, but showing that when enough body fat accumulates, the hormone leptin is secreted, and that triggers the onset of puberty.

我确实记得《科学》杂志上发表的一篇论文——我相信它主要针对女性，但表明当体内脂肪积累足够多时，就会分泌瘦素激素，从而引发青春期的开始。

Correct.

正确的。

Given the increase in childhood obesity that we're observing now, are we seeing an earlier onset of puberty in males and females?

鉴于我们现在观察到的儿童肥胖人数的增加，我们是否看到男性和女性的青春期开始较早？

Yes, in both males and females.

是的，无论男性还是女性。

Not to get too technical, but there's a G protein-coupled receptor on the hypothalamus and leptin directly binds it, so it does appear directly cause causatory and not just correlation.

不要太技术化，但下丘脑上有一个 G 蛋白偶联受体，瘦素直接与其结合，所以它确实看起来是直接因果关系，而不仅仅是相关性。

And if I understand correctly, what you're saying is for a young guy-- let's say, 13, 14-- who wants to really bulk up and deliberately-- deliberately, excuse me-- overeats, and is doing their squats, and deadlifts, and bench presses and really trying to get big, they will get big, but only in the lateral dimension.

如果我理解正确的话，你所说的是针对一个年轻人——比方说，13岁、14岁——他想要真正增肌，故意——故意，对不起——吃得过多，并且正在做深蹲、硬拉和卧推，并且真的想变大，他们会变大，但只是在横向维度上。

They're effectively limiting their total height and it can shut down the long bone growth of their limbs.

他们有效地限制了他们的总高度，并且可以阻止他们四肢的长骨生长。

Is that correct?

这是正确的吗？

Correct.

正确的。

The growth of the long bones is mostly related to the estradiol alpha receptor, so basically, one of the receptors for estrogen, which can be secondary to early puberty and also is related to body fat because you have that conversion of testosterone to estrogen.

长骨的生长主要与雌二醇α受体有关，所以基本上是雌激素受体之一，它可能继发于青春期早期，也与身体脂肪有关，因为睾酮会转化为雌激素。

So can we assume that if a young male wants to get into resistance training that bodyweight exercises are probably OK and maybe even some weight training, kettlebells, et cetera, but that they should avoid doing so-called dirty bulking-- trying to deliberately gain weight-- up until what age?

那么我们是否可以假设，如果一个年轻男性想要进行阻力训练，自重练习可能是可以的，甚至可能进行一些重量训练、壶铃等，但他们应该避免做所谓的“肮脏的增重”——试图故意增加体重——直到几岁？

Until puberty is over?

直到青春期结束？

I would say an individual should limit the amount of abnormal body fat accumulation, or dirty bulking, indefinitely throughout their entire life.

我想说，一个人应该在一生中无限期地限制身体异常脂肪积累或肮脏膨胀的数量。

So again, if I understand correctly, that recommendation to avoid deliberate weight gain or rapid weight gain is not just to allow an individual to reach their maximum height, but also to avoid laying down a lot of body fat cells.

所以，如果我理解正确的话，避免故意体重增加或快速体重增加的建议不仅仅是为了让一个人达到最大身高，也是为了避免放下大量的身体脂肪细胞。

Correct?

正确的？

Correct.

正确的。

The balance between that is, when you are going through puberty, you are able to add a lot of lean body mass-- not just muscle mass, but bone mass and other mass as well.

两者之间的平衡是，当你经历青春期时，你能够增加大量的瘦体重——不仅仅是肌肉质量，还有骨质量和其他质量。

I started lifting weights when I was 16, and I confess I trained pretty heavy at times.

我从 16 岁开始举重，我承认有时我的训练量很大。

I don't know whether or not I would have been taller than I am now, but when I started that training, I had already reached what was at least close to my predicted height.

我不知道我是否会比现在更高，但是当我开始训练时，我已经达到了至少接近我预测的高度。

I can't say that I deliberately waited until I had grown.

我不能说我是刻意等到我长大了。

Under the supervision of a physician, it is certainly safe to change your body composition.

在医生的监督下，改变身体成分当然是安全的。

In pediatric obesity medicine, you're often talking about a recomposition or a renormalization of the growth curve compared to peers.

在儿科肥胖医学中，您经常谈论与同龄人相比生长曲线的重组或重新正常化。

Great.

伟大的。

Thank you.

谢谢。

So as you may have sensed, we started chronologically with puberty, and I know that there's another puberty that even precedes the puberty that we're all familiar with.

正如您可能已经感觉到的，我们按时间顺序从青春期开始，我知道还有另一个青春期，甚至早于我们都熟悉的青春期。

Maybe-- if you want to just briefly mention that because I was talking with you about this before we started.

也许——如果你想简单地提一下这一点，因为在我们开始之前我正在和你谈论这个问题。

The first puberty of everyone's life is the first three months of their life.

每个人生命中的第一个青春期是生命的前三个月。

You may notice that your baby has more acne the first three months and that they also have, in general, just more changes related to androgens and estrogens, perhaps oilier skin, even more genitourinary-- genital growth during the first three months.

您可能会注意到，您的宝宝在前三个月有更多的痤疮，而且一般来说，他们在前三个月也有更多与雄激素和雌激素相关的变化，可能皮肤更油腻，甚至更多的泌尿生殖器官生长。

Is there a standard age or age range in which the testicles descend in males?

男性睾丸下降是否有一个标准年龄或年龄范围？

Usually before birth.

通常在出生前。

It is not uncommon to have one or even two undescended testes, but there is a risk of testicular cancer, especially if they are not fixed early and also heat damage to the teste.

有一个甚至两个睾丸未降的情况并不罕见，但存在患睾丸癌的风险，特别是如果不及早修复睾丸以及睾丸受热损伤。

Well, thank you for that coverage of the two puberties.

嗯，谢谢您对两个青春期的报道。

So early in life.

这么早的时候。

I imagine some of our listeners probably still in one or the-- well, one or the other puberty.

我想我们的一些听众可能仍处于一个或一个——嗯，一个或另一个青春期。

The ones that are in the first puberty, obviously, aren't aware that they're listening to this podcast, but maybe it'll be embedded in their subconscious.

显然，处于第一个青春期的人并没有意识到他们正在听这个播客，但也许它会嵌入他们的潜意识中。

But some listeners probably are still in puberty.

但有些听众可能仍处于青春期。

There's many things that you should do.

有很多事情你应该做。

An analogy that I often make is when there's a brand new car that comes off the assembly line, you do a full scope of diagnostic workup-- hook it up to the computer.

我经常做的一个类比是，当一辆全新的汽车下线时，你会进行全面的诊断检查——将其连接到计算机上。

And I think we should do the same thing with humans as well.

我认为我们也应该对人类做同样的事情。

Oh, sorry.

哦，抱歉。

So for bloodwork-- I mean, what would be the earliest-- let me put it this way.

所以对于血液检查——我的意思是，最早是什么——让我这样说。

If blood work didn't cost anything and everyone could get it, when would you want to see everybody get their bloodwork done for the first time?

如果血液检查不需要任何费用并且每个人都可以获得，那么您希望什么时候看到每个人第一次完成血液检查？

So if I could travel back in time, I would have gotten my bloodwork done for hormones, and lipids, and everything else at 18.

所以，如果我能回到过去，我会在 18 岁时就进行血液检查，检查激素、血脂和其他各项指标。

I, unfortunately, didn't know where and how to get that, and I didn't have any pressing clinical issues.

不幸的是，我不知道在哪里以及如何获得它，而且我没有任何紧迫的临床问题。

And with testosterone, you want to get either testosterone and an SHBG or a free testosterone.

对于睾酮，您想要获得睾酮和性激素结合球蛋白（SHBG）或游离睾酮。

Could you define SHBG for our listeners, please?

您能为我们的听众定义一下 SHBG 吗？

It is Sex Hormone Binding Globulin.

它是性激素结合球蛋白。

It is the protein that binds up all androgens and estrogen in the body.

它是结合体内所有雄激素和雌激素的蛋白质。

So the stronger the androgen, the stronger it binds.

因此，雄激素越强，它的结合力就越强。

And obviously, these blood tests are going to have to be read and interpreted by a qualified physician.

显然，这些血液测试必须由合格的医生阅读和解释。

Most people aren't going to be in a position to evaluate them properly, or at least not with the full depth that they could if they had an M.D like yourself looking at them.

大多数人无法正​​确地评估它们，或者至少无法像您这样的医学博士来观察它们而进行全面的深度评估。

Let's say-- let's take an individual who just turned 18, they just got their first set of bloodwork.

比方说，我们以一个刚满 18 岁的人为例，他们刚刚进行了第一次血液检查。

They'll probably find something in it that they may want to optimize using shared decision-making with their physician.

他们可能会在其中发现一些他们可能想要通过与医生共同决策来优化的内容。

Usually, a good follow-up is about six months.

通常，良好的随访时间约为六个月。

So twice a year, getting bloodwork done, and then having a physician evaluate it.

所以每年两次，进行血液检查，然后让医生进行评估。

That sounds reasonable to me.

这对我来说听起来很合理。

And for those that didn't initiate this at 18, such as myself, I guess the best time to start then would be as soon as possible.

对于那些在 18 岁时没有开始这样做的人，比如我自己，我想最好的开始时间是尽早开始。

Yeah.

是的。

In terms of the other things that all males should do, meaning all males of all ages-- puberty and beyond-- what are some of those things?

就所有男性应该做的其他事情而言，即所有年龄段的所有男性（青春期及以后），其中有哪些事情？

So on a daily basis, maybe you could just take us through the arc of a day and push out some of the protocols that you use or the things that you like to see your male patients use in order to try and optimize their hormone status.

因此，在日常工作中，也许您可​​以带我们了解一天中的情况，并推出一些您使用的方案或您希望看到男性患者使用的东西，以尝试优化他们的激素状态。

I'll briefly touch on some of the lifestyle pillars to start.

首先，我将简要介绍一些生活方式的支柱。

Diet and exercise are the first to.

饮食和运动是第一位的。

In puberty, sleep is particularly important, of course.

当然，在青春期，睡眠尤为重要。

But with diet and exercise, throughout a lifespan, you want to not exclude things that are helping you.

但在整个一生中，通过饮食和锻炼，您不希望排除对您有帮助的事物。

For example, during puberty if you're consuming dairy, and then all of a sudden you cut out all dairy, dairy can help increase IGF-1 and free IGF-1.

例如，在青春期，如果您正在食用乳制品，然后突然戒掉所有乳制品，乳制品可以帮助增加 IGF-1 和游离 IGF-1。

And just, again, for our audience, maybe just mention what having enough IGF-1 can do for us that's beneficial is?

再次，对于我们的观众来说，也许只是提到拥有足够的 IGF-1 可以为我们带来什么好处？

It helps you grow.

它可以帮助你成长。

It helps with genital development, secondary sexual characteristics, and long bone growth-- skin growth, hair growth, a host of things.

它有助于生殖器发育、第二性征和长骨生长——皮肤生长、毛发生长等等。

So getting an array of nutrients that include dairy.

因此，获取包括乳制品在内的一系列营养素。

What other sorts of nutrients are important during development?

在发育过程中还有哪些其他重要的营养素？

You want to have adequate vitamin D.

您想要摄入足够的维生素 D。

Vitamin D helps with testosterone production, it helps, again, with bone mineralization and stature.

维生素 D 有助于睾酮的产生，也有助于骨骼矿化和身材。

After an age of about 25-- and there's not a strict cutoff, but up to about an age of 25, optimizing your growth hormone and IGF-1 helps with bone density and bone growth.

大约 25 岁之后——没有严格的界限，但在 25 岁左右，优化生长激素和 IGF-1 有助于骨密度和骨骼生长。

So from the dietary standpoint, you want to have enough free estrogen-- not too much when you're growing.

因此，从饮食的角度来看，您需要有足够的游离雌激素——在生长过程中不要太多。

But you want to help basically stockpile bone to prevent a risk of osteoporosis or thin bone fractures when you're older.

但您希望从根本上帮助储存骨骼，以防止老年时患骨质疏松症或薄骨骨折的风险。

Well, as someone who broke his left foot 5 times while in high school, I can say that whatever young people can do to optimize their bone density would be great.

好吧，作为一个在高中时左脚骨折过 5 次的人，我可以说年轻人能做的任何事情来优化他们的骨密度都是很棒的。

That problem seems to have resolved itself over time, but I don't know.

随着时间的推移，这个问题似乎已经解决了，但我不知道。

In their late 20s, it might be a reasonable option.

对于二十多岁的人来说，这可能是一个合理的选择。

In early 20s and certainly teens, it is a horrible idea because it is likely to significantly decrease your free androgens.

对于 20 岁出头，尤其是青少年来说，这是一个可怕的想法，因为它可能会显着减少您的游离雄激素。

So you will have less testosterone acting on receptors through the body.

因此，体内作用于受体的睾酮激素会减少。

Are there any other micronutrients or macronutrients that people in their 20s and 30s should emphasize?

20 多岁和 30 多岁的人还应该强调其他微量营养素或常量营养素吗？

We haven't really touched on fatty acids or fiber too much.

我们还没有过多接触脂肪酸或纤维。

Fiber is going to be paramount in kind of setting your set point of your gut microbiome the rest of your life.

纤维对于设定您余生的肠道微生物组设定点至关重要。

There is prebiotic fiber, which you can think of as fish food for your good gut microbiome.

有益生元纤维，您可以将其视为有益于肠道微生物组的鱼食。

Your gut microbiome is kind of like an aquarium or a fish tank.

您的肠道微生物组有点像水族馆或鱼缸。

Now, I'm just thinking about goldfish swimming around in that-- the goldfish eating people.

现在，我只想着金鱼在那儿游来游去——金鱼吃人。

Don't eat goldfish, people--

别吃金鱼，人们——

--live or dead.

——生或死。

Yeah, but any fiber or food that you're putting in your gut, it's either going to skew your gut microbiome toward something that is more beneficial or more detrimental.

是的，但是您放入肠道的任何纤维或食物，都会使您的肠道微生物群向更有益或更有害的方向倾斜。

And would you say that the prebiotic fiber and getting essential fatty acids, that would be important to do throughout the lifespan or just for people in their 20s and 30s?

您认为益生元纤维和获取必需脂肪酸对于整个生命周期都很重要，还是仅对于 20 多岁和 30 多岁的人来说很重要？

Throughout the lifespan, particularly important in the teenage, '20s, '30s, because it helps with brain development.

在整个一生中，特别是在青少年、20多岁、30多岁的时候，它有助于大脑发育。

You're certainly more of an expert than me when it comes to brain development, but it does continue to develop, really, throughout the lifespan, but certainly through the 20s and 30s as well.

在大脑发育方面，你当然比我更专家，但实际上，在整个生命周期中，大脑确实在持续发育，但当然也持续到 20 多岁和 30 多岁。

What about taking a multivitamin while you're growing up?

在成长过程中服用多种维生素怎么样？

So many people do that.

很多人都这样做。

Is it necessary, is it useful?

有必要吗，有用吗？

And if it's not necessary, is it safe to do anyway?

如果没有必要，这样做安全吗？

It's generally safe to do anyway.

无论如何，通常都是安全的。

I do not think everybody needs a multivitamin.

我不认为每个人都需要复合维生素。

The more exclusionary your diet is-- for example, if you have celiac disease or if you're planning on fertility soon, then perhaps it's more reasonable to take a multivitamin.

您的饮食越具有排斥性——例如，如果您患有乳糜泻或您计划很快生育，那么服用复合维生素可能更合理。

In a previous discussion of ours, I asked you about caloric restriction and testosterone.

在我们之前的讨论中，我问过您有关热量限制和睾丸激素的问题。

And if I recall correctly, the idea was that if somebody is overweight-- they have an excess fat, adipose tissue-- then getting rid of some of that adipose tissue through caloric restriction and exercise, provided it's done not too fast in a healthy way, is going to be beneficial for testosterone in the long-run.

如果我没记错的话，这个想法是，如果一个人超重——他们有多余的脂肪，脂肪组织——那么通过热量限制和锻炼来消除一些脂肪组织，只要以健康的方式进行得不太快，从长远来看将对睾丸激素有益。

That's correct.

这是正确的。

If you look at an individual in a caloric deficit, several changes will happen.

如果你观察一个热量不足的人，就会发生一些变化。

One is that they'll have less building blocks for hormones.

一是它们的激素组成部分较少。

Another is that they will be in a catabolic state more often, so that balance of anabolism and catabolism will be different.

另一个是它们会更频繁地处于分解代谢状态，因此合成代谢和分解代谢的平衡会有所不同。

They'll likely have less signaling from growth hormone and IGF-1, and they'll also have the high SHBG that we defined earlier as the binding protein, so their free androgens and free estrogens will go down.

它们的生长激素和 IGF-1 信号可能会较少，而且它们的 SHBG 也较高（我们之前定义为结合蛋白），因此它们的游离雄激素和游离雌激素会下降。

Got it.

知道了。

So we touched on sleep being critical.

所以我们谈到了睡眠的重要性。

I would say throughout the lifespan, trying to get enough quality sleep at least 80% of the nights of your life, and the other 20% are just what happens when there's noise outside or you're stressed.

我想说，在人的一生中，至少 80% 的夜晚都在努力获得足够的优质睡眠，而另外 20% 的夜晚只是在外面有噪音或有压力时才会发生。

It just-- you have an exam or you're having a great time for whatever reason.

只是——你要参加考试，或者无论出于什么原因你都玩得很开心。

Stress is probably the next one.

压力可能是下一个。

During both puberty, but also the 20s and 30s, individuals are figuring out how they want to cope with stress and also figuring out what they want to choose to put their effort into.

在青春期，以及20多岁和30多岁，人们正在弄清楚他们想要如何应对压力，并弄清楚他们想要选择将精力投入到什么事情上。

So if someone is overstressed, then it can have-- it can put all the other lifestyle pillars-- and then they stop dieting well, they stop exercising, and everything else can go askew.

因此，如果一个人压力过大，那么它可能会影响所有其他生活方式的支柱，然后他们就会停止节食，停止锻炼，其他一切都会变得不正常。

And for people that are not starting their own families in their 20s and 30s, can that social connection be extended to friendships and work relationships as well?

对于 20 多岁和 30 多岁还没有组建自己家庭的人来说，这种社会联系是否也可以扩展到友谊和工作关系？

Absolutely.

绝对地。

In fact, if someone's not starting a family, it is just as concerning, but for other reasons.

事实上，如果有人没有组建家庭，这也同样令人担忧，但只是出于其他原因。

Each individual is going to have their close group of family and friends.

每个人都会有他们亲密的家人和朋友。

And if someone does not have one of those connections, that's when things can potentially get bad not just for them individually, but also society.

如果某人没有这些联系之一，那么事情可能会变得糟糕，不仅对他们个人，而且对整个社会。

So when you say stress, you mean learn to manage your stress.

所以当你说压力时，你的意思是学会管理你的压力。

What does that look like?

那看起来像什么？

I mean, if a patient has high blood pressure, or even if they don't, you just sense that they're stressed.

我的意思是，如果一个病人患有高血压，或者即使他们没有，你也会感觉到他们有压力。

They have a lot of pressured speech, or they're not feeling well, or communicating that they're not doing well.

他们有很多压力性的言论，或者他们感觉不舒服，或者表达他们做得不好。

What are some of the things that you recommend in order to try and ameliorate that stress?

为了尝试减轻这种压力，您建议采取哪些措施？

There's different mindfulness or relaxation techniques.

有不同的正念或放松技巧。

Going outside can often help with this as well.

走出去通常也能对此有所帮助。

Dietary changes and exercise can help with this too.

饮食改变和锻炼也能对此有所帮助。

Some people like prayer or meditation.

有些人喜欢祈祷或冥想。

And a lot of people like counseling or therapy, or even just talking openly with a family member or a friend.

很多人喜欢咨询或治疗，甚至只是与家人或朋友开诚布公地交谈。

What would it be some of the other pillars for hormone optimization?

激素优化的其他支柱是什么？

Here, I feel like we're not just talking about people in their 20s and 30s, but again, we're wrapping our arms around basically puberty onward.

在这里，我觉得我们不仅仅是在谈论 20 多岁和 30 多岁的人，而且我们基本上是在谈论青春期以后的人。

Everyone should get outside and find a movement pastime to last a lifetime.

每个人都应该走出去，找到一种可以持续一生的运动消遣。

You're going to get sunlight, you're going to get some degree of heat and cold exposure, and you're also just going to move more.

你会得到阳光，你会受到一定程度的冷热暴露，而且你也会更多地活动。

Being in an artificial environment, where there's artificial lights artificial air conditioning, is going to have many effects on your body.

处于人工环境中，有人造光、人造空调，会对您的身体产生很多影响。

Yeah, picking some goal or target.

是的，选择一些目标。

And I always say that you don't have to stick to the same goal over time.

我总是说，你不必随着时间的推移坚持同一个目标。

Certainly, I haven't although I got started early in the science game and I'm still in it.

当然，我还没有，尽管我很早就开始了科学游戏，而且我仍然参与其中。

I see supplements and medications as very similar-- one is prescribed and one is not.

我认为补充剂和药物非常相似——一种是处方药，另一种不是。

In general, medications have more side effects or potentially stronger therapeutic with more efficacy.

一般来说，药物具有更多的副作用或可能具有更强的治疗效果。

But they are just tools to reach an end goal.

但它们只是实现最终目标的工具。

I guess it depends on how much time and energy you're willing to spend and also finances.

我想这取决于您愿意花费多少时间和精力以及财务状况。

I know that when I was in college, I could afford just a few supplements, and they were basically whey protein and some fish oil-- I was fortunate that I was pointed in the direction of those things-- and some creatine.

我知道，当我上大学时，我只能买一些补充剂，它们基本上是乳清蛋白和一些鱼油——我很幸运，我被指出了这些东西的方向——还有一些肌酸。

You want to use a lot of open-ended questions.

你想要使用很多开放式问题。

This process is called motivational interviewing.

这个过程称为动机访谈。

And your goal is to listen to the patient and not plant an idea in their mind that they can follow because everybody is going to have a different goal.

你的目标是倾听患者的意见，而不是在他们的脑海中植入一个他们可以遵循的想法，因为每个人都会有不同的目标。

Some people are better at reading their biofeedback or telling how they feel on a daily basis.

有些人更擅长阅读他们的生物反馈或讲述他们每天的感受。

There is screening questionnaires designed-- for example, an ADAM questionnaire to look at men's men's health and hormone-related health.

有专门设计的筛查问卷——例如，ADAM 问卷，用于了解男性健康和激素相关健康。

It's called ADAM questionnaire?

这叫ADAM问卷吗？

ADAM questionnaire.

ADAM 问卷。

A-D-A-M?

A-D-A-M？

Correct.

正确的。

Is it available online that people could administer it to themselves.

是否可以在线提供，人们可以自行管理。

Although we don't want people making clinical diagnoses of themselves or anyone else, is it that sort of exam?

尽管我们不希望人们对自己或其他人进行临床诊断，但这就是那种检查吗？

It is.

这是。

Interesting.

有趣的。

I don't believe it is a clinically-validated tool like an ASCVD, which is like a risk of heart attack and stroke tool or many other tools.

我不相信它是像 ASCVD 那样经过临床验证的工具，ASCVD 就像心脏病发作和中风的风险工具或许多其他工具一样。

There's one for depression, there's one for anxiety.

一种是抑郁症，一种是焦虑症。

They're called PHQ9 and GAD7 respectively.

它们分别称为 PHQ9 和 GAD7。

But anyway, there is often an in-- the ADAM questionnaire-- and what you hear from the patient, if you are a very careful listener, is often different.

但无论如何，通常会有一个 ADAM 问卷，如果您是一个非常细心的倾听者，您从患者那里听到的内容通常会有所不同。

Can you give me an example of some of the questions on this ADAM questionnaire or the sorts of motivational interviewing that you might do?

您能否举例说明 ADAM 调查问卷中的一些问题或您可能会进行的动机性访谈类型？

So let's say I'm your patient.

假设我是你的病人。

I sit down.

我坐下。

What sorts of questions would you ask to probe these kinds of dimensions of hormones?

你会问什么样的问题来探究激素的这些维度？

Questions about libido, questions about athletic performance, questions about motivation.

关于性欲的问题，关于运动表现的问题，关于动机的问题。

And often, the patient will answer one thing, but what you hear from them subjectively is far different.

通常，患者会回答一件事，但你从他们那里听到的主观答案却大不相同。

Interesting.

有趣的。

Can you give me an example of a question?

你能给我一个问题的例子吗？

I'm happy to be the guinea pig here.

我很高兴成为这里的小白鼠。

A classic one is, a guy comes in-- and a lot of times, they say, oh, no, the wife made me go to the doctor.

一个典型的例子是，一个男人进来了——很多时候，他们说，哦，不，妻子让我去看医生。

I go once a year, that's it.

我一年去一次，就这样了。

I don't want anything, I don't want any medications.

我不想要任何东西，我不需要任何药物。

I see.

我懂了。

So right as you're leaving the room, a patient will tell you that they're having some sexual side effects-- or not side effects.

因此，当您离开房间时，患者会告诉您他们出现了一些性副作用——或者没有副作用。

They're having some sexual challenges, and then they'll mention chest pressure.

他们遇到了一些性方面的挑战，然后他们会提到胸部压力。

Is the chest pressure a general decoy for, it's got to be my heart, or is it related to the other things that they're reporting?

胸压是一个普遍的诱饵吗？它一定是我的心脏，还是与他们报告的其他事情有关？

It can be related.

它可以是相关的。

In fact, erectile dysfunction is known as the canary in the coal mine.

事实上，勃起功能障碍被称为煤矿里的金丝雀。

So coal miners would take the canary down, and it would-- the canary would die before the coal miners would of, I believe, carbon monoxide poisoning.

所以煤矿工人会把金丝雀拿下来，我相信金丝雀会在煤矿工人一氧化碳中毒之前死去。

And often, one of the causes of ED is plaque buildup, which can happen in the coronaries as well.

通常，ED 的原因之一是斑块积聚，这也可能发生在冠状动脉中。

But sometimes, they notice the symptom in the genitals before they do in the coronaries.

但有时，他们会先注意到生殖器的症状，然后再注意到冠状动脉的症状。

So for such a patient, let's say that patient was a young person where plaque buildup in the arteries and veins is not all that likely if they're, let's say, in their 20s or 30s, what would be your next step of the interview at that point, and what would you consider?

因此，对于这样的患者，假设该患者是一名年轻人，动脉和静脉中形成斑块的可能性不太可能，如果他们是 20 多岁或 30 多岁，那么您此时访谈的下一步是什么，您会考虑什么？

Would you immediately order labs for that person to try and rule out any kind of actual hormone level deficiency?

您会立即为那个人安排实验室来尝试排除任何实际的激素水平缺乏吗？

I certainly would order labs.

我当然会订购实验室。

There are some individuals that are very similar, and they come in, and they have the same symptoms, and one individual might have a very, very high testosterone, and one individual might be severely hypogonadal.

有些人非常相似，他们进来，有相同的症状，一个人可能有非常非常高的睾丸激素，一个人可能患有严重的性腺功能减退症。

So there's a big difference between the subjective and what the labs look like.

因此，主观感受和实验室的样子之间存在很大差异。

Now, is it true that there are periodic erections during sleep-- correct?

现在，睡眠期间确实会定期勃起吗？对吗？

Yes.

是的。

So you basically put a cuff to see if you were having a normal sized erection during sleep.

所以你基本上可以戴上袖带来看看你在睡眠时是否有正常大小的勃起。

And I believe about 90% of the time they do that test, they are indeed having erections.

我相信，大约 90% 的时间他们进行该测试时，他们确实会勃起。

Which would point to this psychogenic origin of whatever challenges they're having in terms of sexual interactions.

这表明他们在性互动方面遇到的任何挑战都是由心理根源造成的。

You mentioned porn and masturbation.

你提到了色情和手淫。

This topic has come up a bunch of times on this podcast and on other podcasts I've gone on because of the relationship between dopamine sexual motivation and sexual behavior.

由于多巴胺性动机和性行为之间的关系，这个话题在这个播客和我参加的其他播客上出现了很多次。

Yes.

是的。

And there are more and more data on this all the time.

并且一直以来都有越来越多的数据。

In terms of the effects of pornography and masturbation-- and here, I suppose we need to be somewhat specific and operationally define what we're talking about.

就色情和手淫的影响而言，在这里，我想我们需要具体一点并在操作上定义我们所讨论的内容。

We're talking about porn and masturbation to the point of ejaculation, because my understanding is that the ejaculation and orgasm associated with causes an increase in prolactin, which blunts libido for some period of time.

我们谈论的是色情和手淫到射精的程度，因为我的理解是，射精和性高潮会导致催乳素增加，从而在一段时间内削弱性欲。

That's an accurate statement, and prolactin does have a significant acute increase after ejaculation.

这是一个准确的说法，催乳素在射精后确实有显着的急剧增加。

It does to some degree after orgasm as well, but prolactin acts on the pituitary to inhibit the release of the hormones LH and FSH, of which LH can increase testosterone.

性高潮后也会有一定程度的影响，但催乳素作用于脑下垂体，抑制黄体生成素（LH）和卵泡刺激素（FSH）的释放，其中黄体生成素（LH）可以增加睾酮水平。

So this may be one of the cases where the dose makes the poison.

所以这可能是剂量产生毒物的情况之一。

And if it is a very frequent habit, certainly daily or more than once a day would be very detrimental from a hormonal component not even taking into account the neural wiring.

如果这是一个非常频繁的习惯，那么每天或每天超过一次肯定会对荷尔蒙成分非常有害，甚至不考虑神经线路。

Listen, I think it's terrific that you've actually defined frequency, because this is the problem on the internet or even in the doctor's office.

听着，我认为您实际上定义了频率真是太棒了，因为这是互联网甚至医生办公室的问题。

You'll see descriptions about pornography being dangerous for certain things or detrimental to hormones.

您会看到有关色情内容对某些事物有害或对荷尔蒙有害的描述。

People say frequent, but what's frequent?

人们说频繁，但什么是频繁呢？

So you're saying daily or multiple times per day would be potentially detrimental to the hormone profile of a male of essentially any age.

所以你是说每天或每天多次可能会对任何年龄段的男性的激素水平产生潜在的损害。

And that's just for masturbation.

那只是为了自慰。

With pornography-- with porn use as well, it would likely be worse.

对于色情内容——以及色情内容的使用，情况可能会更糟。

And why is that?

这是为什么呢？

Just the sort of dopaminergic drive of the stimulus-- just the really intense visual stimulus?

只是那种多巴胺能驱动的刺激——只是真正强烈的视觉刺激？

Dopamine sensitivity.

多巴胺敏感性。

I think that using the analogy of a dopamine wave pool, it would deepen the pool, but not increase your supply of dopamine.

我认为用多巴胺波池来类比，它会加深池，但不会增加多巴胺的供应。

Maybe you could describe the dopamine wave pool because I think it's such a powerful way of thinking about dopamine and what dopamine does.

也许你可以描述多巴胺波池，因为我认为这是思考多巴胺和多巴胺作用的一种强有力的方式。

In fact, I've always credited you when I've done it, but I've generally stolen your analogy of the dopamine wave pool because it's so astute.

事实上，当我做到这一点时，我总是相信你，但我通常偷用你对多巴胺波池的类比，因为它是如此精明。

The dopamine wave pool describes the natural variation of ups and downs in your dopamine or your motivation.

多巴胺波池描述了多巴胺或动机起伏的自然变化。

And in the wave pool, depending on how high the peak is, you often have a deeper trough.

在波浪池中，根据波峰的高度，通常会有更深的波谷。

So you do not want to high of a peak.

所以你不想太高。

So if I interpret that in the context of this discussion about libido, sex, porn, and masturbation, if somebody has a very intense sexual experience-- and here, we're not necessarily talking about an intense orgasm-- we're talking about just a lot of intense visual, so very-- a lot of intense imagery, or auditory input, or both-- that is going to lead to a situation where dopamine is going to be depleted afterwards.

因此，如果我在讨论性欲、性、色情和手淫的背景下解释这一点，如果某人有非常强烈的性体验——在这里，我们不一定谈论强烈的性高潮——我们谈论的只是大量强烈的视觉，非常——大量强烈的意象，或听觉输入，或两者兼而有之——这将导致多巴胺随后耗尽的情况。

A guest on this podcast before-- my colleague at Stanford, Dr. Anna Lembke, who's an expert in addiction, talked a bit about this-- the sort of seesawing.

之前这个播客的一位嘉宾——我在斯坦福大学的同事安娜·伦布克博士（Anna Lembke）是成瘾方面的专家，曾谈到过这一点——那种跷跷板。

Like, here, we're talking about a wave and a crashing out of the water from the wave pool.

就像，在这里，我们谈论的是波浪和从波浪池中冲出水面的声音。

Correct-- in a similar physiologic way to withdrawal from stimulants, like amphetamines.

正确——与戒除安非他明等兴奋剂的生理方式类似。

Now, is sex with a partner different?

现在，与伴侣的性行为有什么不同吗？

Because there are many people who are chasing more and more intense experiences with a partner as opposed to through pornography and masturbation.

因为有很多人追求与伴侣越来越强烈的体验，而不是通过色情和手淫。

Again, here, we're talking about all ages.

再说一遍，我们在这里讨论的是所有年龄段。

And I should always say, anytime we're talking about sex with a partner, we're talking-- the four conditions that I always lay out on the Huberman Lab podcast are that we're talking about consensual, age appropriate, context appropriate, species appropriate interactions.

我应该总是说，任何时候我们与伴侣谈论性行为时，我们都在谈论——我总是在休伯曼实验室播客上提出的四个条件是，我们谈论的是自愿的、适合年龄的、适合环境的、适合物种的互动。

Yeah, and this is also a case where the dose makes the poison.

是的，这也是剂量产生毒药的情况。

So if there's-- obviously, meeting all those criteria, if they have one preference that, for both of them, is a positive experience, then that is likely OK.

因此，如果——显然，满足所有这些标准，如果他们有一个偏好，对他们俩来说都是一种积极的体验，那么这可能是可以的。

You're not going to be able to maintain dopamine over a certain threshold for a long period of time, so there very well may be a crash from that experience as well.

你不可能在很长一段时间内将多巴胺维持在某个阈值以上，所以这种经历也很可能会导致崩溃。

And that crash may be different in one partner than the other.

而其中一方的崩溃可能与另一方的情况有所不同。

Interesting.

有趣的。

So I'll draw an analogy to food.

所以我会用食物来比喻。

It would be like you don't have to serve the banquet meal seven nights of the week, maybe just two.

这就好像你不必在一周的七个晚上提供宴会餐，也许只需两个晚上。

Is that right?

是这样吗？

And there are other delicious foods out there?

还有其他美味的食物吗？

Can--

可以——

Yes--

是的——

--we use that analogy?

——我们用这个比喻吗？

--that is very reasonable.

——说得非常有道理。

I'm not trying to be PG-13.

我并不是想成为 PG-13。

I'm just trying to parsimony Occam's razor the ability to describe a lot of things in a few words.

我只是想简化奥卡姆剃刀原理，即用几句话描述很多事情的能力。

I'd like to return to the key things that people should do-- or I should say, the key things that men should do to optimize their hormones.

我想回到人们应该做的关键事情上——或者我应该说，男性应​​该做的优化荷尔蒙的关键事情。

For most people.

对于大多数人来说。

--for most people.

——对于大多数人来说。

Interesting.

有趣的。

I feel so fortunate to have grown up prior to the availability of internet pornography.

我感到很幸运，我在网络色情出现之前就已经长大了。

I've never been a big consumer of pornography.

我从来都不是色情作品的大消费者。

It's just not been my thing, but I hear so often from males of all ages about their addiction to it, their affliction by it.

这不是我的事，但我经常从各个年龄段的男性那里听到他们对它的上瘾和痛苦。

It's really a serious issue, and that's one of the reasons why I'm grateful that you're willing to talk about this and your clinical experience with these patients.

这确实是一个严重的问题，这也是我很感激您愿意谈论这个问题以及您与这些患者的临床经验的原因之一。

For really vigorous exercise, around three to four times a week is very sustainable over a long period of time.

对于真正剧烈的运动，每周进行三到四次左右是非常可持续的，可以持续很长一段时间。

On top of that, you could add in 3 or four more instances of less vigorous exercise.

除此之外，您还可以再添加 3 到 4 次不太剧烈的运动。

So for less vigorous, would you mean zone two cardio where you can hold a conversation, but beyond which you can't?

那么，对于不太活跃的情况，您是否指的是有氧运动第二区，您可以在其中进行对话，但超出该区域就不能进行对话？

And for more vigorous you're thinking weight training or high intensity interval type training?

为了更有活力，您正在考虑重量训练还是高强度间歇式训练？

Is that right?

是这样吗？

Correct.

正确的。

You can also weight train and have some benefit even at a low to moderate intensity.

您还可以进行重量训练，即使是低到中等强度也能获得一些好处。

If you think about weight training where you have-- and it's not necessarily related to the incidence of DOMS, which is Delayed Onset Muscle soreness.

如果你考虑一下你所进行的重量训练，它并不一定与 DOMS（延迟性肌肉酸痛）的发生率相关。

But if you weight train lazy or easy from time to time-- obviously, you want to weight train very heavy from time to time as well because of more lean body mass growth.

但如果你时不时地进行懒惰或轻松的举重训练——显然，你也会时不时地进行非常大的举重训练，因为瘦体重会增加。

But if you weight train lighter, you're going to be able to do it more often, and it can still help with the hypertrophy of collagen-- for example, in tendons and ligaments.

但如果你训练的重量较轻，你就能更频繁地进行训练，而且它仍然有助于胶原蛋白的肥大——例如肌腱和韧带中的胶原蛋白。

So here, again, I'd like to perhaps drill into this notion of intensity and light weights because for me, some of the most brutal workouts I've ever done were in what I would consider a high repetition range-- 15 to 50.

因此，在这里，我想再次深入探讨强度和轻重量的概念，因为对我来说，我做过的一些最残酷的锻炼都在我认为的高重复范围内——15 到 50 次。

Actually, I went up to Oregon to watch the International Track and Field Championships.

事实上，我去俄勒冈州观看了国际田径锦标赛。

When they study the effect of exercise, specifically vigorous exercise, one area that's been studied is vigorous exercise-- episodes lasting longer than an hour.

当他们研究运动（特别是剧烈运动）的效果时，研究的一个领域是剧烈运动——持续时间超过一小时的运动。

And they usually track it by a rating of perceived exertion, which isn't perfect, and it's not extremely actionable, but it's helpful for clinical science.

他们通常通过感知用力的评级来跟踪它，这并不完美，也不是非常可行，但它对临床科学很有帮助。

But the takeaway from that is, basically, do not-- it is not hormonally helpful to train, especially regularly train, vigorously for longer than an hour.

但从中得出的结论是，基本上，训练时间超过一个小时，尤其是定期训练，对荷尔蒙没有帮助。

So I'm happy to hear that because it sounds like for most people, that hour of work is really the threshold.

所以我很高兴听到这个消息，因为对于大多数人来说，工作时间确实是门槛。

I think this is important for people to hear, especially males because I think with all of the incredible examples out there of people like Cam, like David Goggins, people who are training for very long periods of time-- and leaving aside all issues of what people are doing in order to optimize the recovery, I think an hour a day of exercise is just a great program that most anyone can follow.

我认为这对人们来说很重要，尤其是男性，因为我认为像卡姆、大卫·戈金斯这样的人有很多令人难以置信的例子，他们进行了很长一段时间的训练——并且抛开人们为了优化恢复而所做的所有问题，我认为每天一小时的锻炼是一个大多数人都可以遵循的伟大计划。

Yes.

是的。

When the blood work is particularly bad, they're often in a large caloric deficit as well.

当血液工作特别糟糕时，他们通常也会出现大量的热量赤字。

There's a synergistic effect between a caloric deficit.

热量不足之间存在协同效应。

Interesting.

有趣的。

I often hear, and I'm starting to wonder whether or not, some of the quicker-to-results nutrition tactics-- things like dropping all carbohydrates, or the quicker-to-results exercise habits, like starting to do six day a week really intense workouts-- whether or not, in the short run, they work because they cause the cosmetic changes that people are seeking, but that they really undermine the overall goal, which is, at least to me, to have your hormones Maybe.

我经常听到，并且我开始怀疑，一些快速见效的营养策略——比如戒掉所有碳水化合物，或者更快见效的锻炼习惯，比如开始每周进行六天的高强度锻炼——从短期来看，它们是否有效，因为它们会带来人们所寻求的外观变化，但它们确实破坏了总体目标，至少对我来说，也许是为了保持荷尔蒙。

not optimized to 100%, but to always be aiming for 100% and be close to it at every stage of life.

不是优化到100%，而是始终以100%为目标，并在人生的每个阶段都接近它。

Consistency is key here.

一致性是这里的关键。

If you are not consistent, then the law of diminishing returns certainly applies.

如果你不一致，那么收益递减法则肯定适用。

So 80% or 90% of the benefit over many, many months is far better than 100%, but only half the time.

因此，80% 或 90% 的效益在很多个月内远好于 100%，但只占一半的时间。

Yeah.

是的。

One thing that I found to be tremendously useful is to finish the workout while I still have energy, to not take myself to exhaustion.

我发现非常有用的一件事就是在我还有精力的时候完成锻炼，不要让自己筋疲力尽。

And then I'm able to talk about the dopamine wave pool.

然后我可以谈谈多巴胺波池。

Another component of that is the balance between your sympathetic, which is your fight or flight nervous system, and your parasympathetic, which is your rest or digest nervous system.

其中的另一个组成部分是交感神经（即战斗或逃跑神经系统）和副交感神经（即休息或消化神经系统）之间的平衡。

There is an anecdote, which is likely true, that many elite bodybuilders are very parasympathetic besides while they're lifting weights.

有一个轶事，这可能是真的，许多精英健美运动员在举重时副交感神经非常发达。

You mean they're lazy and they like to eat a lot.

你的意思是他们很懒而且喜欢吃很多东西。

Yeah.

是的。

The lazy bear in the gym kind of phenomenon.

健身房里的懒熊是一种现象。

Absolutely.

绝对地。

But that being said, after a very, very vigorous workout-- for example, one where you're trained to failure, which bodybuilders and power lifters do all the time-- you feel the tiredness-- or you feel the strain from that heavy sympathetic activity when you are lifting a heavy weight, and it can potentially affect how you feel the rest of the day.

但话虽这么说，在一次非常非常剧烈的锻炼之后——例如，健美运动员和力量举重运动员经常做的训练到力竭的锻炼——你会感到疲劳，或者当你举起重物时，你会感到交感神经活动的压力，这可能会影响你一天中剩下的时间的感觉。

So many people who have a job where that is highly cognitive do not like to have an extremely vigorous workout in the morning, which is when a lot of people are able to exercise.

许多从事高认知工作的人不喜欢在早上进行剧烈的锻炼，而早上正是很多人能够锻炼身体的时候。

When I exercise early in the morning-- that is, before 9:00 AM-- I have more energy all day long.

当我在清晨（即上午 9:00 之前）锻炼时，我一整天都会精力充沛。

If I do it mid-morning, I have experienced more of an afternoon crash.

如果我在上午进行，我会经历更多下午的崩溃。

There's probably some circadian biology in there.

那里可能有一些昼夜节律生物学。

Not many cases.

案例不多。

The reason for any performance enhancing drug, whether or not it is a steroid, synthetic, bioidentical, or otherwise, varies a lot.

任何性能增强药物的原因，无论是类固醇、合成药物、生物同质药物还是其他药物，都有很大差异。

Some individuals do it only for cosmetic reasons even if it can have deleterious effects on the cosmetic appearance, for example, of your skin in the long run.

有些人只是出于美容原因才这样做，即使从长远来看它会对美容外观（例如皮肤）产生有害影响。

So for people in their 20s, 30s, and beyond-- 40s, et cetera-- whose testosterone and estrogen levels are at the appropriate ratios, and then within the normal reference range, and they feel pretty good-- we talked about the ADAMs exam-- or this sort of like feel-pretty-good is code for libido, energy, recovery, et cetera, and are feeling at least workable for their lifestyle.

因此，对于 20 多岁、30 多岁以及 40 多岁等人来说，他们的睾酮和雌激素水平处于适当的比例，然后在正常参考范围内，他们感觉很好，我们谈到了 ADAM 考试，或者这种感觉很好是性欲、精力、恢复等的代号，并且感觉至少适合他们的生活方式。

For those people, what can they do besides get great sleep, train, but not too hard or too often, et cetera, et cetera?

对于这些人来说，除了保证良好的睡眠、训练，但不要太辛苦或太频繁等等，他们还能做什么？

What are some of the things in the realm of supplementation that can help them optimize their testosterone and estrogen without suppressing their own endogenous production of testosterone and estrogen?

补充领域中有哪些东西可以帮助他们优化睾酮和雌激素而不抑制自身内源性睾酮和雌激素的产生？

Let's mention creatine is the first one.

首先我们要提到的是肌酸。

Creatine is interesting because it has multiple different effects.

肌酸很有趣，因为它有多种不同的作用。

It helps with amino acid synthesis.

它有助于氨基酸的合成。

It also helps with oxidative stress.

它还有助于缓解氧化应激。

You mentioned the conversion of testosterone to dihydrotestosterone, and there is mythology out there that creatine can increase hair loss, I'm guessing because there's at least one study showing that creatine can increase DHT-- dihydrotestosterone.

你提到了睾酮转化为二氢睾酮，而且有传言说肌酸会增加脱发，我猜是因为至少有一项研究表明肌酸可以增加 DHT（二氢睾酮）。

And DHT is one of the primary hormones that can promote male pattern baldness.

而DHT是促进男性型脱发的主要激素之一。

So the question therefore is, does creatine supplementation increase the rate of hair loss?

那么问题来了，补充肌酸会增加脱发率吗？

Theoretically, it can, but in each individual, preventing hair loss is a very poor reason to take creatine, because it's not going to take you to a supraphysiologic level, it's not going to increase your androgens to a unnormal level of binding.

从理论上讲，它可以，但对于每个人来说，预防脱发并不是服用肌酸的一个非常糟糕的理由，因为它不会将你带到超生理水平，它不会将你的雄激素增加到不正常的结合水平。

So I feel like this-- if that was a reason to not take creatine for hair loss, then that's--

所以我的感觉是——如果这是不服用肌酸治疗脱发的一个原因，那么那就是——

You mean-- sorry-- hair loss is not a reason to avoid taking creatine?

您的意思是——抱歉——脱发不是避免服用肌酸的理由？

Correct.

正确的。

Hair loss is not a reason to avoid taking creatine.

脱发并不是避免服用肌酸的理由。

Think of it as just bringing you to what you are naturally inclined to have.

把它想象成只是把你带到你自然想要拥有的东西上。

If your conversion of testosterone to DHT is already high, then often, creatine does not affect this.

如果您的睾酮向 DHT 的转化率已经很高，那么肌酸通常不会对此产生影响。

I see.

我懂了。

Well, I take 5 grams a day of creatine monohydrate.

嗯，我每天服用 5 克一水肌酸。

I do it for the tissue volumizing effects, so for exercise benefits, but also for the cognitive effects.

我这样做是为了使组织丰盈，因此是为了锻炼的好处，也是为了认知的效果。

I don't know if it's increasing my hair loss.

不知道是不是会加剧我的脱发。

Yes

是的

What I learned-- but then again I haven't been into those literature in a long time-- is that because of differences in receptors, that DHT causes hair growth on the face and hair loss on the head.

我了解到——但话又说回来，我已经很长时间没有读过这些文献了——由于受体的差异，双氢睾酮会导致面部毛发生长和头部脱发。

Is that right?

是这样吗？

Yes, and the amount, and the sensitivity, and density of those receptors is genetically determined.

是的，这些受体的数量、敏感性和密度是由基因决定的。

And is it true that if your mother's father was bald that you will be bald in the same pattern, and if he wasn't, you won't?

如果你的父母是秃头，你也会以同样的方式秃头，如果他不是，你也不会，这是真的吗？

That is a decent correlation.

这是一个不错的相关性。

Part of the proposed mechanism of this-- well, there are several genes, and you can actually test your genes for hair loss.

所提出的机制的一部分——嗯，有几个基因，你实际上可以测试你的脱发基因。

You do get a decent amount of them from your mother.

你确实从你母亲那里得到了相当多的东西。

It's on their X chromosome, not on the Y chromosome.

它位于 X 染色体上，而不是 Y 染色体上。

Correct.

正确的。

Interesting.

有趣的。

Even though all of the, quote, unquote, male promoting genes are on the Y chromosome, like malaria, and inhibiting, et cetera.

尽管所有的男性促进基因（如疟疾）和抑制基因（等等）都位于 Y 染色体上。

Interesting.

有趣的。

So 5 grams a day of creatine for most people should be fine.

因此，对于大多数人来说，每天 5 克肌酸应该没问题。

Another one we can loop in with creatine is betaine.

另一种我们可以与肌酸循环的物质是甜菜碱。

Some people are nonresponders to creatine, so you can increase that to 10 grams, or you can use its cousin betaine to help with amino acid synthesis and shunting of energy.

有些人对肌酸没有反应，因此您可以将肌酸增加到 10 克，或者您可以使用其近亲甜菜碱来帮助氨基酸合成和能量分流。

Along with that, I would put l-carnitine which is actually the smallest peptide hormone.

除此之外，我还会添加左旋肉碱，它实际上是最小的肽激素。

It's just two amino acids that are put together, so it's a--

它只是两个氨基酸放在一起，所以它是--

It's a hormone?

这是激素吗？

Interesting.

有趣的。

I'm not challenging it.

我不是在挑战它。

Well, peptide.

嗯，肽。

I'm just-- I'm not challenging it.

我只是——我不是在挑战它。

I would call it a peptide more than a hormone.

我更愿意称其为肽而不是激素。

So I would not call l-carnitine a hormone, but I would call dopamine a hormone.

所以我不会称左旋肉碱为激素，但我会称多巴胺为激素。

Yeah, I could-- a neurohormone.

是的，我可以——一种神经激素。

It's so hard to define things as transmitters or hormones at some level.

在某种程度上，很难将事物定义为递质或激素。

I agree.

我同意。

So l-carnitine-- actually, I should backtrack.

所以左旋肉碱——实际上，我应该回想一下。

Betaine-- do you recall what dosage people typically would take if they're a creatine non-responder?

甜菜碱——您还记得如果人们对肌酸无反应者通常会服用什么剂量吗？

1 to 3 grams.

1至3克。

Per day?

每天？

In fact-- yeah-- several versions of creatine have betaine mixed in because it helps with the processing of methionine and homocysteine.

事实上，是的，几种肌酸都混合了甜菜碱，因为它有助于蛋氨酸和同型半胱氨酸的加工。

So if somebody is already taking creatine and likes it and responds to it-- I'll raise my hand-- such as myself, would adding betaine help or is it redundant with creatine?

因此，如果有人已经在服用肌酸并且喜欢它并对它做出反应——我会举手——比如我自己，添加甜菜碱会有帮助还是肌酸是多余的？

Only if their homocysteine is persistently elevated.

仅当他们的同型半胱氨酸持续升高时。

And homocysteine is kind of like an inflammatory marker that can build up if you're not converting enough of it down stream.

同型半胱氨酸有点像一种炎症标记物，如果您没有在下游转化足够的同型半胱氨酸，它就会积聚起来。

How would I know?

我怎么知道？

Just a blood test or if you knew your MTHFR polymorphism, which is basically how you add methyl groups to many things in the body.

只需进行一次血液测试，或者您是否知道自己的 MTHFR 多态性，这基本上就是向体内许多物质添加甲基的方式。

Great.

伟大的。

Any side effects of betaine that people should be aware of?

人们应该注意甜菜碱的副作用吗？

Not that I know of.

据我所知没有。

People can look it up on-- examine.com is a great site for that.

人们可以在该网站上查找——examine.com 是一个很棒的网站。

They'll surely list it.

他们肯定会把它列出来。

They just revamped their site by the way, and it was awesome before, and it's platinum now.

顺便说一句，他们刚刚改版了他们的网站，以前非常棒，现在是白金级了。

Correct.

正确的。

You need a prescription for the injectables, or you should really get a prescription for the injectables.

您需要注射剂处方，或者您确实应该获得注射剂处方。

For when you inject it-- of course, at the supervision of your doctor-- it's usually done intramuscularly.

因为当你注射时——当然是在医生的监督下——通常是肌肉注射。

Well, I think most people are going to be able to get l-carnitine only-- or in its capsule form.

嗯，我认为大多数人只能获得左旋肉碱，或者胶囊形式的左旋肉碱。

So what are the dosages of l-carnitine that one needs to ingest then if they want to get a benefit because if only 10% is being absorbed, it's probably a lot of l-carnitine.

那么，如果一个人想要获得益处，需要摄入多少剂量的左旋肉碱，因为如果只有 10% 被吸收，那么可能是大量的左旋肉碱。

How much should people take per day?

人们每天应该服用多少？

Usually, I recommend for oral l-carnitine between 1,000 milligrams and up to 4,000 or 5,000 milligrams.

通常，我建议口服左旋肉碱 1,000 毫克至 4,000 或 5,000 毫克。

So 1 to 4-- maybe even 5 grams.

所以 1 到 4 克——甚至可能是 5 克。

Correct.

正确的。

Up to 5 grams a day.

每天最多 5 克。

If you're on that much, especially if you have a dysregulated gut microbiome, you should be concerned with TMAO which is a potential carcinogen that both carnitine and choline can convert into.

如果您的摄入量如此之多，特别是如果您的肠道微生物组失调，您应该担心TMAO，它是一种潜在的致癌物质，肉碱和胆碱都可以转化为这种物质。

And your gut microbiota determine how much that happens.

你的肠道微生物群决定了这种情况发生的程度。

Is it true that I can offset any negative effects of alpha GPC-- choline that is-- and l-carnitine that I take by ingesting garlic?

我真的可以通过摄入大蒜来抵消 α GPC（即胆碱）和左旋肉碱的负面影响吗？

Is that right?

是这样吗？

There's a compound in garlic called allicin-- I believe it's A-L-L-I-C-I-N.

大蒜中有一种叫做大蒜素的化合物——我相信它是A-L-L-I-C-I-N。

It's also part of the scientific name-- the genus of types of garlic.

它也是大蒜属学名的一部分。

I'm going to continue to take the 600 milligrams of garlic every time I take my l-carnitine, but I'm going to skip the berberine because berberine gives me brutal headaches and it makes me crave carbohydrates because it drops my blood sugar.

每次服用左旋肉碱时，我将继续服用 600 毫克大蒜，但我将不服用小檗碱，因为小檗碱会让我剧烈头痛，而且它会让我渴望碳水化合物，因为它会降低我的血糖。

It has many other effects, including the dawn phenomenon where it drops your blood sugar when you're sleeping and you can't even realize it.

它还有许多其他影响，包括黎明现象，当你睡觉时，它会降低你的血糖，而你甚至没有意识到这一点。

I am not a fan of berberine, and I'm sorry for those of you that are.

我不喜欢小檗碱，我为那些喜欢小檗碱的人感到抱歉。

I'm not trying to offend anyone, although frankly, if you're being offended by my stance on berberine, then maybe we should have another discussion.

我并不是想冒犯任何人，但坦率地说，如果你因我对小檗碱的立场而感到冒犯，那么也许我们应该再进行一次讨论。

In any case injectable l-carnitine, if one can get that through a doctor, how much is absorbed and how much should one take?

无论如何，注射左旋肉碱，如果可以通过医生获得，那么吸收了多少以及应该服用多少？

Almost all of it's absorbed.

几乎全部被吸收了。

In general you're taking between 500 milligrams up to-- you can take a pretty high dose up to 2,000 milligrams.

一般来说，您服用的剂量在 500 毫克到 2,000 毫克之间。

And what we did not talk about is what l-carnitine does?

我们没有讨论左旋肉碱的作用是什么？

So why should why should someone go through all of this?

那么为什么有人要经历这一切呢？

Is it to optimize testosterone, is it working on the receptor side?

是为了优化睾丸激素，还是在受体方面起作用？

What's l-carnitine doing?

左旋肉碱有什么作用？

It's a shuttle.

这是班车。

So I think it's named carnitine palmitoyl coenzyme A.

所以我认为它被命名为肉碱棕榈酰辅酶A。

Basically, it just takes nutrients from outside your mitochondria and puts them in.

基本上，它只是从线粒体外部获取营养并将其放入体内。

Does one need to cycle l-carnitine, creatine, betaine?

是否需要循环左旋肉碱、肌酸、甜菜碱？

No reason to cycle any of those.

没有理由循环其中任何一个。

What other supplements can one use to try and improve hormone profiles?

还可以使用哪些其他补充剂来尝试改善荷尔蒙状况？

And here, I realize we're using a very broad brush because when we say improve hormone profiles, what are we really talking about?

在这里，我意识到我们使用的范围非常广泛，因为当我们说改善激素状况时，我们真正在谈论什么？

And for me, at least, I think about the subjective stuff.

至少对我来说，我会考虑主观的东西。

Let's briefly mention vitamin D, which is also a hormone.

我们简单提一下维生素D，它也是一种激素。

It's actually a sterile hormone.

它实际上是一种无菌激素。

And if you have deficient vitamin D and you replace it, then you will optimize your testosterone.

如果您缺乏维生素 D 并且补充它，那么您的睾酮激素就会得到优化。

Let's also mention boron.

我们还要提一下硼。

And just to remind people, that SHBG sex hormone binding globulin is attaching to the testosterone molecule and limiting the amount of so-called free testosterone that's available to have its impact on cells.

只是为了提醒人们，SHBG 性激素结合球蛋白附着在睾酮分子上，并限制了可对细胞产生影响的所谓游离睾酮的量。

When Dr. Peter Attia was on this podcast-- in fact, sitting in that very chair-- he said that the ideal level of free testosterone in males should be about 2% of one's total testosterone.

当彼得·阿提亚博士在这个播客上时——事实上，就坐在那把椅子上——他说，男性游离睾酮的理想水平应该是一个人总睾酮的 2% 左右。

Would you agree with that number or disagree?

您同意这个数字还是不同意？

I'm sure Peter would be fine if you said either.

我相信如果你说的话彼得也不会介意。

KYLE GILLETT: 2% is a good rule of thumb.

凯尔·吉列特：2% 是一个很好的经验法则。

Usually, the reference range is between about 1% and 4%.

通常，参考范围大约在1%到4%之间。

Some people do have genetic polymorphisms in SHBG, a specific gene mutation where they have very low SHBGs.

有些人的性激素结合球蛋白 (SHBG) 确实存在遗传多态性，这是一种特定的基因突变，导致他们的性激素结合球蛋白 (SHBG) 水平非常低。

Also men that have varicose veins in their testes, also known as varicoceles, tend to have very high SHBGs, so that percentage would likely be less than 2%.

此外，患有睾丸静脉曲张（也称为精索静脉曲张）的男性往往具有非常高的性激素结合球蛋白（SHBG），因此该百分比可能低于 2%。

So just because your percentage of free T to total T is a little bit above or below 2%, that's OK.

因此，仅仅因为您的免费 T 占总 T 的百分比略高于或低于 2%，就可以了。

We just need to figure out the reason why it is.

我们只需要弄清楚为什么会这样。

How would somebody know if they have varicose veins in their testicles, especially if their testicles are still in-- attached to their body?

人们如何知道他们的睾丸是否有静脉曲张，特别是如果他们的睾丸仍然附着在他们的身体上？

Sometimes, it's hard to tell.

有时，很难说清楚。

There are several grades.

有几个等级。

If you have a grade 3 or a grade 4 varicocele, it has what's called a bag of worms appearance.

如果您患有 3 级或 4 级精索静脉曲张，则会出现所谓的蠕虫袋外观。

That's a scary visual.

这是一个可怕的视觉效果。

--yeah, bag of worms.

——是的，一袋蠕虫。

Well, it was just that-- yeah, anyway.

嗯，就是这样——是的，无论如何。

I think parasites when I hear that, but that's not what you're referring to.

当我听到这个时，我认为是寄生虫，但这不是你指的。

You're talking about just the texture.

你说的只是质感。

The best way for most people to check is to valsalva for a long period of time.

对于大多数人来说，最好的检查方法是长时间进行瓦氏动作。

When you valsalva, venous return will decrease.

当您进行瓦尔萨尔瓦动作时，静脉回流会减少。

Can you explain valsalva for people?

你能为人们解释一下瓦尔萨尔瓦法吗？

It's bearing down like you're lifting a weight or having a bowel movement, where you swallow.

它的压力就像你举重或排便时吞咽一样。

And a lot of times, you can almost see build up of blood in you're jugular veins as well.

很多时候，您几乎可以看到颈静脉中也有血液积聚。

So you have decreased blood return to the heart and increased blood in the veins themselves.

因此，返回心脏的血液减少，静脉本身的血液增加。

I'd like to take a brief break and thank our sponsor InsideTracker.

我想短暂休息一下并感谢我们的赞助商 InsideTracker。

InsideTracker is a personalized nutrition platform that analyzes data from your blood and DNA to help you better understand your body and help you reach your health goals.

InsideTracker 是一个个性化营养平台，可分析您的血液和 DNA 数据，帮助您更好地了解您的身体并帮助您实现健康目标。

I've long been a believer in getting regular bloodwork done for the simple reason that many of the factors that impact your immediate and long-term health can only be analyzed from a quality blood test.

长期以来，我一直坚信定期进行血液检查，原因很简单，影响您当前和长期健康的许多因素只能通过高质量的血液测试来分析。

We can talk about things that affect the steroidogenesis cascade.

我们可以讨论影响类固醇生成级联的事情。

So we could touch on tongkat ali.

所以我们可以谈谈东革阿里。

I know we've talked about that a little bit before--

我知道我们之前已经讨论过这个问题了——

But I'm guessing a number of people probably haven't heard that conversation.

但我猜很多人可能没有听过那次谈话。

Also known as Long Jack.

也称为长杰克。

And that upregulates several different enzymes in the steroidogenesis cascade.

这会上调类固醇生成级联中的几种不同酶。

And by that, what you mean if-- and this is another good thing to Google-- I think anybody interested in hormone optimization should understand where sterile hormones come from.

你的意思是，如果——这对谷歌来说是另一件好事——我认为任何对激素优化感兴趣的人都应该了解无菌激素的来源。

What sorts of dosages of tongkat do you recommend to your patients?

您向患者推荐什么剂量的东革？

Anywhere from 300 to 1,200 milligrams a day.

每天 300 至 1,200 毫克不等。

With tongkat, you need to be careful with the standardization because-- and if you're thinking about a general tongkat supplement, which is by far the most well-studied-- then you're looking at the eurycomanone content, which is a plant compound that is likely the main active pharmacologic effect.

对于东革，您需要小心标准化，因为如果您正在考虑通用的东革补充剂，这是迄今为止研究最充分的，那么您会关注广藿酮含量，它是一种植物化合物，可能是主要的活性药理作用。

So that's the compound that's having the effect on the body.

这就是对身体产生影响的化合物。

And if you standardize the eurycomanone very, very high, then theoretically you're having more effect at a lower dose.

如果你将广果酮标准化得非常非常高，那么理论上你会以较低的剂量获得更多的效果。

I take 400 milligrams of tongkat ali per day.

我每天服用 400 毫克东革阿里。

I take it early in the day because it has a bit of a stimulant effect, and if I take it after 2:00 PM, it starts to inhibit my sleep.

我在当天早些时候服用，因为它有一点兴奋作用，如果我在下午 2:00 之后服用，它就会开始抑制我的睡眠。

I've been taking it for years.

我已经服用它很多年了。

And I rather like that the effects.

我更喜欢这种效果。

I don't see any reason to cycle it.

我看不出有什么理由循环它。

There is a reason to cycle some supplements, but no reason to cycle tongkat.

循环使用一些补充剂是有理由的，但没有理由循环使用东革。

My blood work tells me that it causes an increase in free testosterone for me and also a slight increase in luteinizing hormone for me.

我的血液检查告诉我，它会导致我的游离睾酮增加，并导致我的黄体生成素略有增加。

What are some of the other effects on various hormones that you've observed in the bloodwork of your patients taking tongkat ali?

您在服用东革阿里的患者的血液中观察到对各种激素的其他影响有哪些？

Tongkat can also slightly increase DHEA.

东革还可以稍微增加DHEA。

And if you have a very high SHBG-- again, that's the protein that binds up your androgens and estrogens-- an extremely important protein-- the higher your SHBG, the more it helps decrease it.

如果你的性激素结合球蛋白（SHBG）非常高——同样，这是一种结合雄激素和雌激素的蛋白质——一种极其重要的蛋白质——你的性激素结合球蛋白越高，就越有助于降低它。

So they've studied tongkat in populations with very normal SHBGs and it does nothing for SHBG.

因此，他们在性激素结合球蛋白非常正常的人群中研究了东革，但它对性激素结合球蛋白没有任何作用。

Interesting.

有趣的。

Does that mean it does nothing for somebody overall?

这是否意味着它对某人没有任何帮助？

So if somebody has an SHBG that's in the normal range, will taking tongkat benefit them in any other way?

那么，如果某人的性激素结合球蛋白（SHBG）在正常范围内，服用东革会对他们有其他好处吗？

Yes, it'll increase their total and free testosterone.

是的，它会增加他们的总睾酮和游离睾酮。

Got it.

知道了。

Does it-- is it known to have effects on anything else like thyroid hormone, growth hormone, or is it purely in these steroid synthesis pathways?

是否已知它对甲状腺激素、生长激素等其他物质有影响，或者它纯粹在这些类固醇合成途径中？

Or steroid-- I should say synthesis, and receptor, and modulation pathways.

或者类固醇——我应该说合成、受体和调节途径。

There's no direct effect on those pathways.

对这些途径没有直接影响。

However, any time you alter your free androgen or free estrogen, particularly one without altering the other, it will alter the binding protein that binds thyroid hormones.

然而，任何时候你改变游离雄激素或游离雌激素，尤其是其中一种而不改变另一种，它就会改变与甲状腺激素结合的结合蛋白。

So any change you make, whether it's natural optimization or hormone replacement, you're going to slightly skew your thyroid hormone profile.

因此，您所做的任何改变，无论是自然优化还是激素替代，都会稍微改变您的甲状腺激素状况。

One common actionable example of this that I see often clinically is someone starts, let's say, estrogen replacement or testosterone replacement-- maybe they're taking an AI with their testosterone replacement--

我在临床上经常看到的一个常见的可操作的例子是，有人开始，比方说，雌激素替代品或睾酮替代品——也许他们正在服用人工智能和睾酮替代品——

Aromatase inhibitor?

芳香酶抑制剂？

Correct, an aromatase inhibitor, which blocks the conversion to estrogen.

正确，一种芳香酶抑制剂，可以阻止转化为雌激素。

If they're taking testosterone and they have very little estrogen, then you're going to decrease the binding protein, also known as thyroxine binding globulin, which binds active thyroid hormones.

如果他们服用睾酮并且雌激素很少，那么你就会减少结合蛋白，也称为甲状腺素结合球蛋白，它与活性甲状腺激素结合。

Interesting.

有趣的。

So tongkat ali-- just a broad range-- 300 to 1,200 milligrams per day.

所以东革阿里——只是一个广泛的范围——每天 300 到 1,200 毫克。

And I realize that the source matters there.

我意识到来源很重要。

What are some of the other hormones that you prescribe to your patients who do not want to go on testosterone replacement therapy or take exogenous DHEA or anything like that?

对于不想接受睾酮替代疗法或服用外源性 DHEA 或类似药物的患者，您会开出哪些其他激素？

We can talk about fadogia next.

接下来我们可以谈谈 fadogia。

Fadogia is interesting because-- it's a genus of plants.

Fadogia 很有趣，因为它是植物的一个属。

Fadogia agrestis is one of them.

Fadogia agrestis 就是其中之一。

There's many others that are very interesting.

还有很多其他的非常有趣。

I see.

我懂了。

So I think for people who aren't familiar with hCG-- so human chorionic gonadotropin-- is basically synthetic luteinizing hormone and luteinizing hormone is the hormone released from the pituitary that is going to travel down to the testes to stimulate the production of sperm and testosterone, but mainly testosterone.

因此，我认为对于那些不熟悉 hCG（即人绒毛膜促性腺激素）的人来说，它基本上是合成的黄体生成素，而黄体生成素是从垂体释放的激素，会向下移动到睾丸以刺激精子和睾酮的产生，但主要是睾酮。

Is that correct?

这是正确的吗？

Mostly correct.

大部分是正确的。

Technically, synthetic LH is also known as little r LH, or recombinant LH.

从技术上讲，合成 LH 也称为小 r LH，或重组 LH。

And hCG can be synthetic, but often, it is just refined from the urine of pregnant ladies since the placenta makes it.

hCG 可以是合成的，但通常是从孕妇的尿液中提炼出来的，因为胎盘会产生它。

That's why it's called chorionic gonadotropin.

这就是为什么它被称为绒毛膜促性腺激素。

So where are they getting all this pregnant women's urine?

那么他们从哪里得到这些孕妇的尿液呢？

I mean, there a location?

我的意思是，有一个位置吗？

I mean, not that I want to go there, I just--

我的意思是，我并不是想去那里，我只是——

Donation?

捐赠？

--really-- so there are women that--

——真的——所以有些女人——

First trimester pregnant ladies.

怀孕初期的孕妇。

It's very high.

这是非常高的。

Donating their urine, and then they're purifying it, and then men are injecting it?

捐献尿液，然后净化，然后男人注射？

Yes.

是的。

Wow.

哇。

And that's actually the same for menopausal ladies.

对于更年期女性来说实际上也是如此。

So first trimester pregnant ladies, that's how you can make non-synthetic hCG.

因此，妊娠早期的孕妇可以通过这种方法制造非合成 hCG。

And then for menotropins which are also known-- there's a couple of different names for it, like menopur.

然后对于促性腺激素，它也是众所周知的——它有几个不同的名称，比如 menopur。

You have menopausal ladies that have very high LH and FSH, and then you refine the FSH and LH.

更年期女性的 LH 和 FSH 非常高，然后您可以改善 FSH 和 LH。

So moving away from the sources and from urine, Fadogia agrestis, what dosages do you have patients take?

那么，远离来源和尿液，Fadogia agrestis，您让患者服用什么剂量？

I've heard of some potential toxicity to the testicular cells.

我听说对睾丸细胞有一些潜在的毒性。

There is one study-- and this is a rat study, but you can equate the dose of toxicity in rats and humans.

有一项研究——这是一项大鼠研究，但你可以将大鼠和人类的毒性剂量等同起来。

They did not give these rats any antioxidants, but it increases a couple of different proinflammatory markers.

他们没有给这些老鼠提供任何抗氧化剂，但它增加了几种不同的促炎标记物。

So that would be 300 milligrams a day in humans is the dosage that did not have toxicity.

因此，人体每天 300 毫克的剂量是没有毒性的。

Correct?

正确的？

Correct.

正确的。

And often, even if there is toxicity in rats, there is not toxicity in humans.

通常，即使对老鼠有毒性，对人类也没有毒性。

So it's not directly equitable, but to be safe, another regimen that I have people take is 600 milligrams every other day or 600 milligrams three times a week-- often Monday, Wednesday, Friday.

所以这并不直接公平，但为了安全起见，我让人们服用的另一种方案是每隔一天服用 600 毫克，或者每周 3 次服用 600 毫克——通常是周一、周三、周五。

This is very interesting and relevant, because I've been taking fadogia for some period of time.

这非常有趣且相关，因为我已经服用 fadogia 一段时间了。

All my markers and tests indicate that there's no toxicity.

我所有的标记和测试都表明没有毒性。

But I've been taking 600 milligrams per day, but I've been cycling it for about 8 to 12 weeks on and then a few weeks off.

但我每天服用 600 毫克，但我已经连续服用 8 到 12 周，然后休息几周。

But based on what you're saying, I'm thinking maybe three times per week or every other day might be better.

但根据你所说的，我想也许每周三次或每隔一天可能会更好。

Is that right?

是这样吗？

If you weren't going to get any labs, that is certainly the regimen that you want.

如果您不打算进行任何实验室检查，那么这肯定是您想要的方案。

If you're going to check your GGT and ALK phos, or even take other things to prevent those from increasing, then you can certainly be more aggressive with your fadogia dosing.

如果您要检查您的 GGT 和 ALK 磷酸盐，或者甚至采取其他措施来防止它们增加，那么您当然可以更积极地服用 fadogia 剂量。

Great.

伟大的。

I think that's more or less what I've been doing.

我想这或多或少就是我一直在做的事情。

Terrific.

了不起。

In terms of other hormones, what are some of the supplements that can support growth hormone-- a hormone that's associated with tissue repair and, in some cases, metabolism and fat loss?

就其他激素而言，有哪些补充剂可以支持生长激素（一种与组织修复有关的激素，在某些情况下还与新陈代谢和减肥有关）？

What are some of the tools, nutritional and/or supplement-based, one can do to tap on the growth hormone pathway?

人们可以采取哪些基于营养和/或补充剂的工具来利用生长激素途径？

And let's lump IGF-1 in there too since they're essentially working along the same dimensions.

我们也将 IGF-1 也归入其中，因为它们本质上是沿着相同的维度发挥作用的。

A quick synopsis-- growth hormone is a peptide hormone, and it is released by the pituitary.

简要概述——生长激素是一种肽激素，由垂体释放。

There's growth hormone releasing hormone and ghrelin that stimulate the release.

有生长激素释放激素和生长素释放肽可以刺激释放。

So there's also peptides that are very analogous to these two things.

所以还有一些肽与这两种物质非常相似。

I've heard that fasting can increase growth hormone.

我听说禁食可以增加生长激素。

And I know there are certain patterns of weight training that can increase growth hormone.

我知道某些重量训练模式可以增加生长激素。

Some of those regimens in the weight room that increase growth hormone have been covered by Dr. Duncan French, who was a guest on this podcast, and so maybe we'll refer people to that episode for the specific protocols-- these high volume training.

邓肯·弗伦奇（Duncan French）博士是这个播客的嘉宾，他介绍了举重室中一些增加生长激素的治疗​​方案，因此也许我们会向人们推荐该节目以了解具体的方案——这些高容量训练。

During those training exercises, it usually does it transiently for a period of a few hours.

在这些训练练习中，它通常会短暂地进行几个小时。

And a lot of this IGF-1 is released by the muscle itself.

大部分 IGF-1 是由肌肉本身释放的。

So it's not necessarily released by the liver.

所以它不一定是由肝脏释放的。

IGF-1 that is released directly due to growth hormone signaling-- usually, the growth hormone comes from the pituitary and binds to the liver where usually, it has a half life of about a week, where the paracrine or autocrine-- think of it as like the peripherally acting or acting in the muscles itself, which is also helpful-- is released and is not as concerning because it's not related to insulin resistance, but it is related to the training itself.

由于生长激素信号传导而直接释放的 IGF-1（通常，生长激素来自垂体并与肝脏结合，通常它的半衰期约为一周），其中旁分泌或自分泌（将其视为外周作用或在肌肉本身中作用，这也有帮助）被释放，并且不那么令人担忧，因为它与胰岛素抵抗无关，但与训练本身有关。

So fasting and growth hormone-- is it true that fasting can increase growth hormone?

那么禁食和生长激素——禁食真的可以增加生长激素吗？

And maybe as a little related tangent, I've heard that limiting food intake for the two hours before going to sleep can increase the pulse of growth hormone that one experiences during sleep.

也许作为一个相关的切线，我听说限制睡前两小时的食物摄入量可以增加人们在睡眠期间经历的生长激素的脉冲。

Of course, everyone gets a pulse of growth hormone during sleep, but especially carbohydrate-laden meals can blunt that peak that occurs during sleep quite substantially.

当然，每个人在睡眠期间都会产生生长激素的脉冲，但特别是富含碳水化合物的食物可以大大削弱睡眠期间出现的生长激素峰值。

Fasting certainly potently increases growth hormone release.

禁食无疑会有效地增加生长激素的释放。

However, the IND binding to the receptor is less sensitive.

然而，IND 与受体的结合不太敏感。

So although fasting does increase growth hormone, the genes that are downstream to it-- both the growth hormone genes and IGF-1 related gene transcription activity-- will not be significantly higher.

因此，尽管禁食确实会增加生长激素，但其下游基因——生长激素基因和 IGF-1 相关基因转录活性——不会显着升高。

However, if you are optimizing the growth hormone that is released as a pulsatile secretion, it is helpful to avoid eating for two hours.

然而，如果您正在优化以脉动分泌物形式释放的生长激素，那么两小时内避免进食会有所帮助。

So the general rule of thumb is avoid eating about two hours before bed.

因此，一般的经验法则是睡前两小时左右避免进食。

I think that's clinically significant and helpful.

我认为这具有临床意义和帮助。

But fasting otherwise specifically for growth hormone optimization in someone who already has normal growth hormone signaling is not helpful.

但是，对于已经具有正常生长激素信号的人来说，专门为了优化生长激素而禁食是没有帮助的。

That's extremely useful to hear because one of the major reasons why people fast is to get that growth hormone increase.

这听起来非常有用，因为人们禁食的主要原因之一是为了增加生长激素。

But if they're adjusting things on the backend that negate that, well, then, no such luck.

但如果他们在后端调整一些东西来否定这一点，那么，就没有这样的运气了。

You want to have a balance of iodine and you want to have a good source of iodine.

您想要保持碘平衡，并且想要拥有良好的碘来源。

So there are some camps that say you should use a huge high dose of iodine and there's protocols for it.

因此，有些阵营说你应该使用大量高剂量的碘，并且有相应的方案。

And there are some that say you should use just barely enough iodine-- I believe it's like 200 micrograms per day.

有些人说你应该使用刚好足够的碘——我相信每天大约 200 微克。

So ingesting iodine containing salt is useful?

那么摄入含碘盐有用吗？

Yes or no?

是还是不是？

Iodized salt does prevent goiter, but it is not necessarily the ideal form of iodine.

碘盐确实可以预防甲状腺肿，但它不一定是碘的理想形式。

Good forms of iodine often come from the ocean.

优质的碘通常来自海洋。

If you look at a chart of hypothyroidism, there is a tendency to have more hypothyroidism the more inland you go.

如果你看一下甲状腺功能减退症的图表，你就会发现，越往内陆地区，甲状腺功能减退症就越多。

So trying to eat some cruciferous vegetables each day would be the best way to improve thyroid hormone.

因此，每天尝试吃一些十字花科蔬菜将是改善甲状腺激素的最佳方法。

Along with plenty of iodine.

同时补充大量的碘。

You don't want too much iodine signaling.

你不需要太多的碘信号。

Many people are familiar with radioactive iodine tablets, and that's basically an extremely high amount of iodine to block out the radioactive iodine that comes from after like a nuclear meltdown or whatnot.

许多人都熟悉放射性碘片，这基本上是极高量的碘，可以阻挡核熔毁或其他事故后产生的放射性碘。

So we've got creatine, betaine, l-carnitine, with allicin garlic to offset the TMAO.

所以我们有肌酸、甜菜碱、左旋肉碱和大蒜素来抵消TMAO。

Vitamin D3, boron, tongkat ali, fadogia, some fasting.

维生素 D3、硼、东革阿里、fadogia，一些禁食。

I'd love to talk to you about peptides.

我很想和你谈谈肽。

A peptide is just a chain of amino acids between two and a couple hundred in length.

肽只是一条长度在两个到几百个之间的氨基酸链。

So I think of peptides as several different categories.

所以我认为肽有几个不同的类别。

And the GHRPs that you mentioned, I would consider those-- and that stands for Growth Hormone Releasing Peptide.

你提到的 GHRP，我会考虑那些——它代表生长激素释放肽。

I think of ghrelin as making me hungry.

我认为胃饥饿素让我感到饥饿。

Hungry and angry.

又饿又生气。

Why would I want to take something that would increase ghrelin signaling?

我为什么要服用可以增强生长素释放肽信号传导的药物？

Some people are trying to gain weight.

有些人正在努力增加体重。

It also does increase your growth hormone.

它还确实会增加您的生长激素。

So if your growth hormone is very low, you can consider it.

所以如果你的生长激素很低的话，可以考虑一下。

Ibutamoren is a long-acting-- so it has a long half life, also known as MK-677.

Ibutamoren 是一种长效药物，因此半衰期很长，也称为 MK-677。

It was well-- it was studied mostly in growth hormone deficiency.

效果很好——主要研究的是生长激素缺乏症。

And do these people get angry also?

这些人也会生气吗？

They can.

他们可以。

Many people report a side effect of anxiety or significant hunger.

许多人报告有焦虑或严重饥饿的副作用。

Most people take it in the evening so they don't notice that hunger as much.

大多数人在晚上服用，这样他们就不会注意到饥饿感。

It can also greatly increase your blood glucose.

它还可以大大增加你的血糖。

So if you're insulin resistant or pre-diabetic, it gets especially concerning.

因此，如果您有胰岛素抵抗或糖尿病前期，那就尤其令人担忧。

This is one of those rare moments where I hear something and I think, even though there is this kit of compounds that can increase GH and IGF-1, based on everything you're telling me, maybe just taking GH is the better option for those people, because growth hormone, at least it's-- synthetic growth hormone is mimicking an endogenous hormone.

这是我听到一些消息的罕见时刻之一，我想，尽管有一套可以增加 GH 和 IGF-1 的化合物，但根据你告诉我的一切，也许服用 GH 对这些人来说是更好的选择，因为生长激素，至少是——合成生长激素正在模仿内源性激素。

I mean, certainly not taking anything might be the ideal.

我的意思是，不采取任何东西当然可能是理想的。

But for those that want to increase growth hormone and they want to use pharmacology to do that, it sounds like these peptides are pretty precarious.

但对于那些想要增加生长激素并且想要利用药理学来做到这一点的人来说，这些肽听起来相当不稳定。

Yeah, it kind of depends on the situation.

是的，这取决于具体情况。

If there's an individual that struggles with hunger and not eating enough-- for example, someone who has a very small stomach or they just have a very low hunger drive, sometimes you want more of that orexigenic signaling.

如果一个人与饥饿作斗争并且吃得不够——例如，一个人的胃很小，或者他们的饥饿感很低，有时你需要更多的食欲信号。

The hypothalamus, you have anorexia signaling, which is kind of like anorexia, and orexigenic signaling, which is-- I call it the hangry center of the hypothalamus or the hangry center.

下丘脑有厌食信号传导，有点像厌食症，还有食欲产生信号传导，我称之为下丘脑的饥饿中心或饥饿中心。

And if there's an imbalance between those two, then perhaps it'd be helpful.

如果这两者之间存在不平衡，那么也许会有帮助。

Potentially theoretically helpful in anorexics, of which, the incidence of anorexia in men is increasing significantly.

理论上对厌食症有潜在帮助，其中男性厌食症的发病率正在显着增加。

As you're telling me this, I'm remembering being 14 or 15 years old, and I would go into the kitchen sometimes, and I was so hungry I would just obliterate all the food.

正如你告诉我的那样，我记得14或15岁的时候，我有时会走进厨房，我太饿了，我会把所有的食物都吃掉。

And I do remember being-- I've always been a pretty high energy guy, but having an immense amount of energy.

我确实记得——我一直是一个精力充沛的人，而且精力充沛。

Part of the problem with the effect of peptides is many people take them and levels that are far above the physiologic range.

肽作用的部分问题在于许多人服用肽并且其水平远远高于生理范围。

Even individuals who are checking their IGF-1 while they take these different GHRPs, most of them do not check the binding peptides-- for example, IGF binding peptide 1, 2, or 3.

即使个体在服用这些不同的 GHRP 时检查 IGF-1，他们中的大多数人也不会检查结合肽，例如 IGF 结合肽 1、2 或 3。

And their free IGF-1 level might be significantly different.

他们的游离 IGF-1 水平可能显着不同。

So common doses that people will take these off-label for as a supplement are often much greater than the therapeutic or physiologic range.

因此，人们将这些超说明书服用的补充剂的常见剂量通常远远大于治疗或生理范围。

Which, for me, just underscores the fact that it's pretty precarious.

对我来说，这只是强调了一个事实：它非常不稳定。

I mean, I'm not coming in here as the referee of what anyone should or shouldn't do.

我的意思是，我来这里并不是作为任何人应该做什么或不应该做什么的裁判。

I'm just trying to gather and distribute information.

我只是想收集和分发信息。

LPS is a common additive in many companies that are not pharmacies, but they're selling things that people often use as human consumption.

LPS 是许多非药房公司的常见添加剂，但他们销售的是人们经常用作人类消费的东西。

One interesting note about lipopolysaccharide is your gut microbiome actually makes a lot of it as well, especially prevotella which is a specific species, that can have to do with your baseline body temperature.

关于脂多糖的一个有趣的说明是，您的肠道微生物组实际上也会产生很多脂多糖，尤其是普氏菌，它是一种特定的物种，可能与您的基线体温有关。

So your baseline body temperature might also change depending on if you're on a peptide that has LPS in it.

因此，您的基线体温也可能会发生变化，具体取决于您是否服用含有 LPS 的肽。

Yikes, yikes, and yikes.

哎呀，哎呀，哎呀。

But I tend to be pretty conservative when it comes to taking anything exogenous.

但当涉及到任何外源性的东西时，我往往相当保守。

But I do rely on many of the supplements that we talked about earlier and I do try and optimize the behavioral things and nutritional things for a long time.

但我确实依赖我们之前讨论过的许多补充剂，并且我确实长期尝试优化行为和营养。

And some of this depends on the SHBG and free testosterone as well.

其中一些还取决于性激素结合球蛋白 (SHBG) 和游离睾酮。

So if that same individual had a very high SHBG which, again, is the binding protein that binds up the testosterone and all androgens and estrogens, if it is extremely high and they have a free testosterone of two, then they might need a different dose because they need enough testosterone in order to have a normal eugonadal free testosterone.

因此，如果同一个人的性激素结合球蛋白（SHBG）非常高，性激素结合球蛋白（SHBG）是与睾酮、所有雄激素和雌激素结合的结合蛋白，如果它非常高并且他们的游离睾酮为二，那么他们可能需要不同的剂量，因为他们需要足够的睾酮才能获得正常的性腺游离睾酮。

But a general normal dosing range, especially for someone starting, is around 100 to 120 milligrams divided over the course of a week, usually either every other day or three times a week-- occasionally, twice a week.

但一般的正常剂量范围，特别是对于刚开始服用的人来说，是在一周内分次服用 100 至 120 毫克左右，通常是每隔一天或每周三次，偶尔每周两次。

Many people with SHBG a bit higher can get away pretty easily with twice a week.

许多性激素结合球蛋白（SHBG）稍高的人每周两次就可以轻松摆脱困境。

This is assuming that the ester is cypionate or enanthate.

这是假设该酯是环丙酸酯或庚酸酯。

So two 60 milligram injections of testosterone cypionate per week.

因此，每周注射两次 60 毫克的环戊丙酸睾酮。

Yeah, very common dosing.

是的，非常常见的剂量。

To hit that 120 milligrams per week is kind of the typical average.

每周达到 120 毫克是典型的平均值。

Correct.

正确的。

And I would consider this like a physiologic eugonadal dose.

我认为这就像生理性的性腺剂量一样。

For many people, even 200 milligrams a week is far above the reference range.

对于许多人来说，即使每周 200 毫克也远远超出了参考范围。

And in your experience, when patients do that, I'm guessing they report that normal constellation of positive effects-- improved mood, improved energy, improve sleep, recovery, et cetera.

根据您的经验，当患者这样做时，我猜他们会报告正常的一系列积极影响——改善情绪、改善精力、改善睡眠、恢复等等。

What are some of the hazards or things that can crop up in bloodwork or just subjectively that can be warning signs that even a dosage of 120 milligrams divided into these two or three dosages per week is too high?

血液检查中可能会出现哪些危险或情况，或者主观上可能是警告信号，表明即使每周 120 毫克的剂量分为两到三个剂量也太高了？

Every organ system in the body.

身体的每个器官系统。

So this is when you really have to be at least well-versed in every organ system, not just the gonadal genital system.

因此，此时您确实必须至少精通每个器官系统，而不仅仅是性腺生殖系统。

You need to have dermatology prowess.

您需要具备皮肤科实力。

Acne is very common change.

痤疮是很常见的变化。

So another reason-- or set of reasons rather to, if one is considering using testosterone therapy, to really do this in close communication with a really good physician because that's a lot to monitor.

因此，另一个原因——或者说一系列原因，如果一个人正在考虑使用睾酮疗法，那么要与一位真正优秀的医生密切沟通来真正做到这一点，因为需要监测的东西很多。

Knowing whether or not you have acne or not is one thing, but knowing whether or not your LDL is going up, your ApoB is going up, that's a whole other biz and that needs to be done through bloodwork is what I'm hearing.

知道你是否有痤疮是一回事，但知道你的 LDL 是否上升、ApoB 是否上升，这完全是另一回事，我听说这需要通过血液检查来完成。

Correct.

正确的。

And if your physician that is managing or prescribing your testosterone therapy or your HRT is not well-versed in these systems, you would want him or her to be part of an interdisciplinary team where they have other experts that can monitor those systems.

如果您的医生负责管理或开出睾酮治疗或激素替代疗法的处方，但对这些系统并不熟悉，您会希望他或她成为跨学科团队的一员，该团队还有其他专家可以监控这些系统。

I skipped over a sort of still intermediate set of things-- prescription drugs-- but maybe talking about testosterone first was a bit of a mistake on my part because I'm aware that there are-- actually, I think there are companies, but certainly groups out there that say, no, wait-- don't go straight from nothing to supplements to testosterone.

我跳过了一些仍然中间的东西——处方药——但也许首先谈论睾酮对我来说有点错误，因为我知道——实际上，我认为有一些公司，但肯定有团体说，不，等等——不会直接从无到有补充睾酮。

So a quick points on hCG-- human chorionic gonadotropin-- made during especially the first trimester of pregnancy, it has effects other than binding to the LH receptor.

因此，我们要快速了解一下 hCG（人绒毛膜促性腺激素），特别是在怀孕的前三个月，它除了与 LH 受体结合之外还有其他作用。

It also binds to the TSH receptor in the thyroid.

它还与甲状腺中的 TSH 受体结合。

So it's thyroid stimulating hormone?

那么它是促甲状腺激素吗？

Yes.

是的。

In fact, if you look at a molecule of hCG and thyroid stimulating hormone, they are extremely similar.

事实上，如果你观察 hCG 和促甲状腺激素的分子，就会发现它们非常相似。

However, you need a relatively high dose of hCG to bind to the TSH receptor.

然而，您需要相对高剂量的 hCG 才能与 TSH 受体结合。

So there's Clomid which contains clomiphene, but there are also-- because we're talking about male hormone optimization this episode-- there are males out there who want to increase their testosterone and other hormones-- maybe growth hormone, et cetera-- who opt to not take exogenous testosterone-- so no cream, no pellet, no pill, no injectable cypionate-- but decide to take clomiphene a couple of times a week.

因此，有含有克罗米芬的克罗米芬，但也有——因为我们这一集讨论的是男性荷尔蒙优化——有些男性想要增加睾酮和其他激素——可能是生长激素等——他们选择不服用外源性睾酮——所以没有乳膏、没有颗粒、没有药丸、没有注射环丙酸——但决定每周服用几次克罗米芬。

It will increase testosterone in a dose dependent manner, but it has many other pharmacodynamic effects, which is the effect of the drug on the body other than its effect on the hypothalamus and the pituitary.

它会以剂量依赖的方式增加睾酮，但它还有许多其他的药效作用，这是药物除了对下丘脑和垂体的作用之外对身体的作用。

So in the hypothalamus and the pituitary, it does what's called negative feedback inhibition or it blocks the action of estrogen.

因此，在下丘脑和垂体中，它会起到所谓的负反馈抑制作用，或者阻止雌激素的作用。

So it crowds out estrogen from the estrogen receptor on the hypothalamus and the pituitary.

因此，它将雌激素从下丘脑和垂体上的雌激素受体中挤出。

And what's this objective effect that would cause?

那么这个客观效果会造成什么？

So to my understanding and experience of estrogen is that if I ever took-- and I did take a very low dose of an aromatase inhibitor once and I felt terrible.

因此，根据我对雌激素的理解和经验，如果我曾经服用过——而且我确实服用过一次非常低剂量的芳香酶抑制剂，我会感觉很糟糕。

The main rationale behind taking a serm is as a very temporary measure that is not going to suppress pituitary or hypothalamic function if your testosterone is just so drastically low that it is unlikely to recover anyway.

服用血清的主要理由是，作为一种非常临时的措施，如果您的睾酮水平太低以至于不太可能恢复，则不会抑制垂体或下丘脑功能。

So most of the time it is not clinically useful, and serm should not be prescribed very often, certainly not as long term testosterone replacement or testosterone optimization in most individuals.

因此，大多数情况下，它在临床上没有用处，并且不应经常使用血清，当然也不适合大多数人进行长期睾酮替代或睾酮优化。

There's always exceptions to everything.

凡事总有例外。

So I'm at least-- by my mind, I'm going to pool them with peptides and say it sounds precarious and probably not ideal for most people.

所以我至少——根据我的想法，我会把它们与肽结合起来，并说这听起来很不稳定，对大多数人来说可能并不理想。

Going back to testosterone therapy then-- and notice, folks, I've deleted the replacement part because I think so many people are using testosterone therapy without the need to-- the sort of reference range need to replace anything, but rather are building on what they already have for purposes of increasing vitality, et cetera.

然后回到睾酮治疗——请注意，伙计们，我删除了替换部分，因为我认为很多人都在使用睾酮治疗，而不需要——这种参考范围需要替换任何东西，而是建立在他们已经拥有的东西的基础上，以增加活力等。

Correct.

正确的。

And there's many reasons for this.

这有很多原因。

Some of this has to do with heat damage to the testes, so potentially cold therapy could be helpful for that.

其中一些与睾丸的热损伤有关，因此潜在的冷疗法可能对此有所帮助。

And--

还有——

Ice baths, cold showers?

冰浴、冷水淋浴？

Mhm.

嗯。

Yeah, or just avoid-- and certainly avoiding--

是的，或者只是避免——当然是避免——

Mostly avoiding heat.

主要是避热。

--sauna and hot tub.

--桑拿和热水浴缸。

Yeah.

是的。

Stopping the daily hot tub can restore fertility in many people.

停止日常热水浴缸可以恢复许多人的生育能力。

I know a number of people that are trying to conceive children that go into the sauna, and they'll just put a cold pack in their shorts or between their legs depending on whether or not they're wearing shorts or not when they go in.

我知道很多想要怀孕的人会去桑拿房，他们只会在短裤里或两腿之间放一个冰袋，具体取决于他们进去时是否穿短裤。

Yeah, excellent data, and anecdotally, you see it as well.

是的，数据非常好，而且有趣的是，你也看到了。

I've had several patients come in for fertility consultations.

我接待过好几位患者来咨询生育问题。

And all we do is like, no medications, no supplements.

我们所做的就是，不吃药物，不吃补充剂。

We change their-- several lifestyle things.

我们改变了他们的一些生活方式。

Very tight fitting clothing is another one.

另一种是非常紧身的衣服。

And soon, they have fertility again and they're no longer-- they have sperm whereas before, they did not.

很快，他们又恢复了生育能力，但他们不再有精子，而以前却没有。

Interesting.

有趣的。

I'd like to talk about some of the do's and don'ts, but we have talked about a lot of do's-- things that one can do to optimize hormones.

我想谈谈一些该做和不该做的事情，但我们已经讨论了很多可以做的事情——可以优化荷尔蒙的事情。

Maybe we could just do sort of more rapid fire Q&A on some of the don'ts and maybe throw in some science where you feel it's appropriate.

也许我们可以对一些不该做的事情进行更快速的问答，也许在你认为合适的地方加入一些科学知识。

Cannabis, marijuana, THC-- yes or no-- it diminishes testosterone levels?

大麻、大麻、四氢大麻酚——是或否——它会降低睾酮水平吗？

Smoked cannabis, I would say, diminishes testosterone, increases prolactin.

我想说，吸食大麻会减少睾丸激素，增加催乳素。

That's a no. Other cannabinoids, not particularly harmful.

那是不。其他大麻素并不是特别有害。

So CBD?

那么CBD？

CBD, not particularly harmful.

CBD，并不是特别有害。

Smoked CBD, I'm not sure.

熏CBD，我不确定。

What about edible cannabis and THC?

食用大麻和四氢大麻酚怎么样？

As far as I know, edible cannabis and THC does not significantly increase prolactin to a point where it would be disruptive of hormones.

据我所知，食用大麻和四氢大麻酚不会显着增加催乳素到破坏激素的程度。

Can marijuana, THC, cannabis, whatever you want to call it, increase gynecomastia-- the growth of male breast tissue?

大麻、四氢大麻酚、大麻，不管你怎么称呼它，可以增加男性乳房发育——男性乳房组织的生长吗？

Yes, it certainly can, and there's a pretty good association between smoked THC and gynecomastia.

是的，它当然可以，而且吸烟的 THC 和男性乳房发育症之间有很好的关联。

What about nicotine and testosterone and estrogen and other hormones-- smoked nicotine?

尼古丁、睾酮、雌激素和其他激素（烟熏尼古丁）怎么样？

Nicotine is particularly concerning not only for testosterone, but also for estrogen.

尼古丁不仅对睾酮特别重要，而且对雌激素也特别重要。

Part of it is, if you're talking about nicotine from tobacco, there's many other carcinogens in it, especially if it's smoked.

部分原因是，如果你谈论的是烟草中的尼古丁，那么其中还含有许多其他致癌物质，尤其是吸烟时。

But nicotine, even if it is chewed in a dose dependent manner-- so if you can use an extremely small amount of nicotine, then it's not as concerning in the long run.

但尼古丁，即使以剂量依赖的方式咀嚼，所以如果你可以使用极少量的尼古丁，那么从长远来看，这并不那么令人担忧。

But it's a vasoconstrictor, and one of the main concerns with it would be cardiovascular disease or even microvascular ischemic disease that can lead to neurodegenerative disease, so like a type of dementia that can be partly due to nicotine.

但它是一种血管收缩剂，它的主要问题之一是心血管疾病，甚至可能导致神经退行性疾病的微血管缺血性疾病，就像一种部分由尼古丁引起的痴呆症一样。

If you use nicotine for a very long period of time, especially at a higher dose, it's a dose-dependent effect on your hormone profile.

如果您长时间使用尼古丁，尤其是较高剂量，则会对您的激素状况产生剂量依赖性影响。

Is that also true for Nicorette and other nicotine gums?

Nicorette 和其他尼古丁口香糖也是如此吗？

At high doses, if you can use an extremely low dose of a nicotine gum, then theoretically, that would be maintainable.

在高剂量时，如果您可以使用极低剂量的尼古丁口香糖，那么理论上，这是可以维持的。

It's not going to overload the nicotinic receptor.

它不会使烟碱受体超载。

You have acetylcholine and the cholinergic system is one of your main nervous systems, of course.

你有乙酰胆碱，胆碱能系统当然是你的主要神经系统之一。

Is it true that cycling for too long-- literally, bicycling-- sitting on a bike seat too long can damage the prostate?

骑自行车太久——字面意思是骑自行车——坐在自行车座椅上太久会损害前列腺吗？

Yes, it can be very concerning, especially if you're seated while cycling, especially if you're putting a lot of pressure on the perineum.

是的，这可能非常令人担忧，尤其是当您骑自行车时坐着时，尤其是当您对会阴施加很大压力时。

Your core is kind of like a box where your diaphragm sort of makes the top and your abs and serratus make the front and the sides.

你的核心有点像一个盒子，横膈膜构成顶部，腹肌和前锯肌构成前面和侧面。

Your back muscles make the back, and then your pelvic floor makes the bottom of the box, which is arguably the most important part of your core.

你的背部肌肉构成了背部，然后你的骨盆底构成了盒子的底部，这可以说是你的核心最重要的部分。

And that pressure can weaken and even lead to incontinence and impotence.

这种压力会减弱，甚至导致尿失禁和阳痿。

So we were talking earlier today in the gym about how heavy legwork, hack squats, deadlifts, those kinds of things a lot of guys are doing to increase their testosterone, done correctly, can actually augment and build up the strength of the pelvic floor.

所以今天早些时候我们在健身房里讨论了很多人为了增加睾丸激素而做的大重量腿部训练、哈克深蹲、硬拉等，如果做得正确，实际上可以增强和增强骨盆底的力量。

Done incorrectly, can actually weaken the pelvic floor and lead to all sorts of issues, including sexual effects-- negative sexual effects.

如果做得不正确，实际上会削弱盆底并导致各种问题，包括性影响——负面的性影响。

So how does one go about learning whether or not their movements are being done properly to support pelvic floor or to destruct pelvic floor?

那么，如何才能了解自己的动作是否正确地支撑骨盆底或破坏骨盆底呢？

The pelvic floor is a constellation of muscles just like any other kind of like system in the body.

盆底是一组肌肉，就像身体中任何其他类似的系统一样。

And form is important.

形式很重要。

If you're doing the valsalva maneuver, which again, is that bearing down or deep breath where you feel all of your abs are tight, you can also notice that your pelvic floor is tight as well.

如果你正在做瓦氏动作，即用力或深呼吸，让你感觉所有的腹肌都紧绷，你也会注意到你的骨盆底也紧绷。

My understanding is that while strengthening the pelvic floor is good, excessive contraction of the pelvic floor can actually limit blood flow to the pelvic area, the penis, and so forth.

我的理解是，虽然加强骨盆底有好处，但骨盆底的过度收缩实际上会限制流向骨盆区域、阴茎等的血液。

So this is, again, a double-edged sword.

所以这又是一把双刃剑。

Correct.

正确的。

So for the-- the reason I chuckle is that for-- because we're talking about things, we don't have visuals or charts, and certainly, it's hard to know whether or not a given exercise like kegels are going to be good or not good.

所以，我笑的原因是，因为我们正在谈论事情，我们没有视觉效果或图表，当然，很难知道像凯格尔这样的特定练习是否会好或不好。

If it's excessive, what-- how many sets and reps does it take before it goes from good to bad.

如果过度，需要多少组和重复次数才能从好变坏。

I think that's a good way to think about it.

我认为这是一个很好的思考方式。

I think the main point with kegels is they're just one of many different things.

我认为凯格尔运动的要点是它们只是许多不同的事情之一。

So if you're having some pelvic floor pathology certainly or even just concerned about your pelvic floor, don't just take the advice do kegels and you'll be OK.

因此，如果您确实患有盆底病变，或者只是担心自己的盆底，不要只听从凯格尔运动的建议，您就会没事的。

That is not near enough.

这还不够近。

It's just one of the many aspects.

这只是众多方面之一。

So going back to the rapid Q&A, and then we'll come back to this issue of blood flow because there's some interesting science and protocols there-- the question I have is, alcohol, does it increase aromatase, the enzyme that converts testosterone into estrogen or not?

因此，回到快速问答，然后我们将回到血流问题，因为那里有一些有趣的科学和协议 - 我的问题是，酒精是否会增加芳香酶（将睾酮转化为雌激素的酶）？

And is there a dose dependence there?

那里有剂量依赖性吗？

It significantly does.

确实如此。

There is a dose dependence.

存在剂量依赖性。

In general, I would not recommend more than three to four standard drinks.

一般来说，我不会推荐超过三到四标准的饮料。

One huge glass of wine is probably five standard drinks.

一大杯酒大概相当于五杯标准酒。

But I'd say every two weeks.

但我想说每两周一次。

Yeah, that's consistent with what I discovered researching alcohol in an episode we did on alcohol.

是的，这与我在关于酒精的一集中研究酒精时发现的一致。

That no alcohol is definitely better for all aspects of health than any alcohol.

对于健康的各个方面来说，没有任何酒精肯定比任何酒精都更好。

And anyone that says that, well, red wine contains these various things, well, it doesn't contain enough of those positive things to have a positive effect.

如果有人说，红酒含有这些不同的物质，那么，它所含有的积极物质还不足以产生积极的影响。

But that if people do opt to drink alcohol, that two drinks per week-- and meaning 20 grams of alcohol, so that's probably two 12 ounce beers or two 4 ounce glasses of wine-- is going to be the upper limit beyond which you're going to start seeing all sorts of negative effects.

但如果人们确实选择喝酒，那么每周喝两杯——也就是 20 克酒精，所以可能是两杯 12 盎司的啤酒或两杯 4 盎司的葡萄酒——将是上限，超过这个上限，你就会开始看到各种负面影响。

The other thing to keep in mind with alcohol is it has a lot of calories-- seven kilocalories per gram, almost as much as fat, which is 9.

关于酒精要记住的另一件事是它含有大量卡路里——每克 7 卡路里，几乎与脂肪一样多，即 9 卡路里。

And then it's also very GABAergic, so it can activate inhibitory neurotransmission, and that can also affect how much LH and FSH is released.

而且它也具有很强的 GABA 能，因此它可以激活抑制性神经传递，这也会影响 LH 和 FSH 的释放量。

So that can also decrease testosterone almost kind of similar to how opiates can decrease testosterone.

因此，这也可以降低睾丸激素，几乎类似于阿片类药物降低睾丸激素的方式。

And I feel very lucky that I don't enjoy alcohol-- never really did.

我感到很幸运，因为我不喜欢喝酒——从来没有真正喜欢过。

I can kind of take it or leave it.

我可以接受或离开。

I certainly don't like sedatives like Valium or anything like that, which, as you just mentioned, can suppress testosterone.

我当然不喜欢像安定这样的镇静剂或类似的东西，正如你刚才提到的，它们可以抑制睾丸激素。

You said the word fat, so I'm going to pick up on that and say, in order to optimize hormone production, is it important to have some saturated fat in one's diet?

你提到了“脂肪”这个词，所以我要继续说，为了优化激素的产生，饮食中含有一些饱和脂肪很重要吗？

And what happens on very low fat diets to testosterone, and estrogen, and other steroid hormones?

极低脂肪饮食对睾酮、雌激素和其他类固醇激素有何影响？

Fat is interesting because there are so many different beneficial fats.

脂肪很有趣，因为有很多不同的有益脂肪。

Omega 3s-- almost every American gets plenty of omega 6s-- in any developed country really.

欧米伽 3 脂肪酸——几乎每个美国人都摄入了大量的欧米伽 6 脂肪酸——实际上在任何发达国家都是如此。

When it comes to saturated fat, there is more of a correlation with hormone optimisation.

当谈到饱和脂肪时，与激素优化有更多的相关性。

But ingesting mostly olive oils, maybe nut butters in limited amounts because they're very calorie dense, but-- unless people are trying to increase their calories, in which case, they're a great source of calories, small amounts of butter, ghee, probably OK, but not excessive amounts?

但是摄入的主要是橄榄油，也许是限量的坚果酱，因为它们的热量非常密集，但是——除非人们试图增加热量，在这种情况下，它们是热量的重要来源，少量的黄油，酥油，可能可以，但不要过量？

Is that the idea?

是这个想法吗？

Yes.

是的。

Fat is perfectly fine.

脂肪完全没问题。

Cholesterol has an interesting-- so cholesterol and, in general, phospholipids make the bilayer that's around the cell.

胆固醇有一个有趣的作用——因此胆固醇和磷脂通常会形成细胞周围的双层。

But cholesterol is also a hormone in and of itself because it binds to the estrogen-related receptor alpha.

但胆固醇本身也是一种激素，因为它与雌激素相关受体α结合。

So I consider that like in the estrogen receptor category, and that can help with metabolism, but also potentially have concerns for cancer and tumor risk.

所以我认为，就像雌激素受体类别一样，它可以帮助新陈代谢，但也可能担心癌症和肿瘤风险。

I want to go back to the prostate and talk to you about something that's kind of a newer emerging trend.

我想回到前列腺并与您讨论一些新出现的趋势。

I know that you've talked a little bit about this in previous podcasts, that a number of men-- or I should say a number of physicians are prescribing low dose tadalafil, also known as Cialis, to their male patients.

我知道您在之前的播客中谈到过这一点，一些男性——或者我应该说一些医生正在给他们的男性患者开低剂量的他达拉非（也称为西力士）。

Tadalafil is a very underrated medication.

他达拉非是一种被严重低估的药物。

The age would kind of depend on the indication.

年龄在某种程度上取决于指示。

So tadalafil is also a blood pressure medication.

所以他达拉非也是一种降压药。

It can very slightly decrease blood pressure, especially at higher doses.

它可以非常轻微地降低血压，尤其是在较高剂量时。

Interesting.

有趣的。

So you said 2.5 to 5 milligrams per day is typical for these prostate enhancing effects.

所以你说每天 2.5 到 5 毫克对于这些前列腺增强作用是典型的。

Yes.

是的。

And you mentioned the potential side effects on adjusting visual perception.

您提到了调整视觉感知的潜在副作用。

As a vision scientist, that rings in my mind.

作为一名视觉科学家，这在我脑海中响起。

But in terms of red/green color discrimination, I'm guessing unless you're going to be a subject in one of the experiments in my lab or you want to be a fighter pilot, chances are you can probably get away with a little less red/green color discrimination.

但就红/绿颜色歧视而言，我猜除非你要成为我实验室的一个实验的对象，或者你想成为一名战斗机飞行员，否则你很可能可以少一点红/绿颜色歧视。

Correct.

正确的。

It's not considered clinically significant unless someone is a commercial pilot.

除非某人是商业飞行员，否则它不被认为具有临床意义。

Great.

伟大的。

So if someone's getting their pilot exam, that's one of the things we look for.

因此，如果有人正在参加飞行员考试，这就是我们寻找的事情之一。

So commercial pilots aside, you might want to ask your doctor about low dose tadalafil for sake of enhancing prostate health.

因此，除了商业飞行员之外，您可能想向您的医生询问低剂量他达拉非，以增强前列腺健康。

Certainly monitoring PSA prostate specific antigen is important.

当然，监测 PSA 前列腺特异性抗原很重要。

It depends on the age.

这取决于年龄。

If there's a 20-year-old, likely between 0 and 1.

如果有一个 20 岁的人，可能在 0 到 1 之间。

If there's a 40-year-old, likely between 1 and 3.

如果有一个 40 岁的人，可能在 1 到 3 之间。

And then if there's an 80-year-old, it would not be abnormal to have a PSA of 5 and have that be well within the reference range.

那么如果有一个80岁的老人，PSA为5并且完全在参考范围之内，那也不算异常。

Another thing we should mention about PSA is if you do take a 5-alpha reductase inhibitor like finasteride or dutasteride, often these will cut your PSA in half.

关于 PSA，我们应该提到的另一件事是，如果您确实服用非那雄胺或度他雄胺等 5-α 还原酶抑制剂，通常这些药物会使您的 PSA 减少一半。

So if you-- for example, if you have a PSA of 6 and you start finasteride or dutasteride, and then you recheck it in six months and it's 6.5, that is a huge concern, because that's actually doubled.

因此，如果你——例如，如果你的 PSA 为 6，你开始服用非那雄胺或度他雄胺，然后你在六个月后重新检查，结果是 6.5，那就是一个巨大的问题，因为实际上翻了一番。

I'm glad you brought this up because I almost overlooked the fact that I get a lot of questions about drugs to offset hair loss.

我很高兴你提出这个问题，因为我几乎忽略了这样一个事实：我收到了很多关于治疗脱发药物的问题。

Most of those drugs are going to operate through the DHT system-- the dihydrotestosterone system-- for the reasons we talked about before.

出于我们之前讨论过的原因，大多数药物将通过 DHT 系统（二氢睾酮系统）发挥作用。

DHT receptors being on the scalp and causing beard growth on the face.

DHT 受体位于头皮上，导致面部胡须生长。

The way that I think about hair loss is you have your fertilizers, also known as growth agonist, and then you have your anti-androgens.

我对脱发的看法是你有你的肥料，也称为生长激动剂，然后你有你的抗雄激素。

Whether they're systemic or topical, there is both, but that's the general laymen's way to think about hair loss.

无论是全身性的还是局部性的，两者都有，但这是一般外行人看待脱发的方式。

If you're only putting fertilizer in your hair but you have androgenic alopecia or male pattern baldness, then those hairs will still miniaturize, and eventually, you'll still have loss.

如果你只在头发上施肥，但你患有雄激素性脱发或男性型秃发，那么这些头发仍然会变小，最终你仍然会脱落。

Such a great word-- miniaturize.

这是一个多么伟大的词——小型化。

It's enough to send anybody off to find a therapeutic.

送任何人去寻找治疗方法就足够了。

And by the way, it's difficult to tell if miniaturization is happening unless you have a magnifying glass.

顺便说一句，除非你有放大镜，否则很难判断小型化是否正在发生。

And you can use--

你可以使用——

I almost didn't know-- for a second there, I didn't know whether or not you were making a joke.

我几乎不知道——有那么一瞬间，我不知道你是否在开玩笑。

You're talking about miniaturization of the hair follicle.

你说的是毛囊的小型化。

Correct.

正确的。

So what can reverse that miniaturization?

那么什么可以扭转这种小型化呢？

Gosh, it's just a fun word to say.

天哪，这只是一个有趣的词。

I'm going to just keep saying it.

我要继续说下去。

Each individual has-- again, we mentioned the androgen receptor.

每个人都有——我们再次提到了雄激素受体。

Males only have one androgen receptor gene that's on their X chromosome.

男性的 X 染色体上只有一个雄激素受体基因。

So depending on how sensitive that androgen receptor is and depending on the density of the receptors in the hair follicle, you can have an arbitrary threshold.

因此，根据雄激素受体的敏感程度以及毛囊中受体的密度，您可以设置任意阈值。

Got it.

知道了。

So are some of the topical DHT receptor antagonists going to be a better choice for people that want to maintain their hair or grow more hair if they want to avoid side effects?

那么，对于那些想要保持头发或生长更多头发以避免副作用的人来说，一些外用 DHT 受体拮抗剂是否会是更好的选择呢？

Likely so.

很可能是这样。

Some individuals benefit from systemic-- a systemic decrease in DHT for a couple of reasons.

由于多种原因，一些人受益于系统性 DHT 的系统性降低。

One could be prostate and then one could actually be hypertrophy of the myocardium.

一种可能是前列腺，另一种可能是心肌肥大。

So DHT also disproportionately thickens the ventricle.

因此，双氢睾酮也会使心室不成比例地增厚。

Wait-- drinking caffeine?

等等——喝咖啡因？

Topical caffeine.

外用咖啡因。

Oh, I was going to say my hair tends to grow pretty fast, so it might be-- but I drink a lot of caffeine.

哦，我想说我的头发长得很快，所以可能是——但我喝了很多咖啡因。

So topical caffeine?

那么外用咖啡因吗？

Really, rubbing coffee on their head--

真的，把咖啡擦在他们的头上——

Yes.

是的。

--or taking caffeine tablets-- and how does it-- wait, you have to explain how this works?

——或者服用咖啡因片——以及它是如何的——等等，你必须解释一下它是如何工作的？

How do people get caffeine into the hair follicle.

人们如何将咖啡因进入毛囊。

Topically, the caffeine enters the scalp and crowds out-- somewhat crowds out the androgen.

从局部来看，咖啡因进入头皮并挤出——在某种程度上挤出了雄激素。

It is a weak effect.

这是一种微弱的影响。

It's likely just strong enough to be clinically significant.

它的强度可能足以具有临床意义。

Usually, caffeine is put into formulations with other things like ketoconazole that are also weak anti-androgens.

通常，咖啡因与酮康唑等其他抗雄激素作用较弱的物质一起放入配方中。

We're going to have to get you back on here to do an episode all about DHT, and hair loss, and hair growth.

我们得让你回到这里来制作一集关于双氢睾酮、​​脱发和头发生长的剧集。

Again, not a topic that I focus on a lot for myself, but that I get a lot of questions about from men and women.

再说一遍，这不是我自己经常关注的话题，但我从男人和女人那里收到了很多问题。

One thing that we could mention-- I got a ton of questions about turmeric and curcuminoids after the last episode.

我们可以提到的一件事是——在上一集之后，我收到了很多关于姜黄和类姜黄素的问题。

Oh, yeah, I had reported my own anecdotal experience that taking turmeric really crushed my DHT levels and I did not feel good.

哦，是的，我报告了我自己的轶事经历，服用姜黄确实降低了我的 DHT 水平，而且我感觉不舒服。

I mean, it crushed all sorts of positive feelings of vitality.

我的意思是，它摧毁了各种积极的活力感觉。

The moment I stopped taking turmeric, felt great again.

当我停止服用姜黄的那一刻，感觉又很棒了。

Many people report this.

很多人都报告了这一点。

And the interesting thing about turmeric is most of it's beneficial action-- not all of it-- some people benefit from systemic turmeric.

姜黄的有趣之处在于它的大部分有益作用——不是全部——有些人从全身性姜黄中受益。

And some people that can tolerate it-- well, it's actually great for the prostate.

有些人可以忍受它——嗯，它实际上对前列腺很有好处。

Yeah, I avoid turmeric like the plague based on that one previous experience because it was clearly turmeric that caused the negative effect.

是的，根据之前的一次经验，我像躲避瘟疫一样避开姜黄，因为显然是姜黄造成了负面影响。

Coming off it, everything reversed rapidly.

摆脱它后，一切都迅速逆转。

Again, another reason to not disrupt 5-alpha reductase.

这又是不破坏 5-α 还原酶的另一个原因。

And we'll definitely get you back on here to talk about-- I think we should just do a whole episode about DHT, because so often when people are thinking about optimizing hormones, especially males trying to optimize their hormones, they're thinking testosterone, testosterone.

我们肯定会让你回到这里来谈论——我认为我们应该做一整集关于双氢睾酮的话题，因为通常当人们考虑优化荷尔蒙时，尤其是男性试图优化荷尔蒙时，他们会想到睾酮，睾酮。

Maybe nowadays, they think a little bit more about free testosterone and maybe they think about estrogen as also being important-- not to crush estrogen.

也许现在，他们更多地考虑游离睾酮，也许他们认为雌激素也很重要——而不是压垮雌激素。

Yeah.

是的。

So I do avoid drinking out of cans that-- or plastics that may have BPA or bisphenol A in them.

因此，我确实避免饮用可能含有 BPA 或双酚 A 的罐头或塑料制品。

Bisphenol A is known to bind to what I would consider the fifth estrogen receptor, estrogen-related receptor gamma.

众所周知，双酚 A 可以与第五种雌激素受体（雌激素相关受体 γ）结合。

Interesting.

有趣的。

Well, thank you for that.

嗯，谢谢你。

I'm going to extract your statement that you avoid drinking out of plastic bottles when possible.

我将摘录您关于尽可能避免使用塑料瓶饮用饮料的陈述。

I'm guessing you're not neurotically attached to that.

我猜你对此并不神经质。

If you were dying of thirst, you might crack a plastic bottle of water to survive.

如果你快渴死了，你可能会敲碎塑料瓶来求生。

My pleasure.

我的荣幸。

Thank you for joining me today for my discussion with Dr. Kyle Gillett all about male hormone optimization.

感谢您今天加入我与凯尔吉列博士讨论有关男性荷尔蒙优化的话题。

And I just want to remind everybody that we will soon have an episode all about female hormone optimization.

我只是想提醒大家，我们很快就会有一个关于女性荷尔蒙优化的剧集。

If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.

如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。

That's a terrific zero-cost way to support us.

这是支持我们的绝佳零成本方式。