Essentials: Tools for Hormone Optimization in Males | Dr. Kyle Gillett
Dr. Kyle Gillett:
凯尔·吉列博士：
Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science-based tools for mental health, physical health, and performance.
欢迎来到 Huberman Lab Essentials，在这里我们回顾过去的剧集，寻找针对心理健康、身体健康和表现的最有效、最可操作的基于科学的工具。
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
And now for my discussion with Dr. Kyle Gillett.
现在我与凯尔·吉列博士进行讨论。
Dr. Gillett, great to have you back.
吉列博士，很高兴您回来。
Andrew Huberman:
安德鲁·休伯曼：
Great to be back.
很高兴回来。
Thank you.
谢谢。
Dr. Kyle Gillett:
凯尔·吉列博士：
I'd like to begin with a question about what all males ought to do in order to optimize their hormones.
我想首先问一个问题：所有男性应该做什么来优化荷尔蒙。
What should they be doing and what should they avoid doing if the goal is to have a long arc of healthy hormone optimization throughout the lifespan?
如果目标是在整个生命周期中保持健康的激素优化，他们应该做什么以及应该避免做什么？
Andrew Huberman:
安德鲁·休伯曼：
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, and I think we should do the same thing with humans as well.
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，我认为我们也应该对人类做同样的事情。
During puberty, obviously you're a functioning human, but I would say there's still development, and I think that the human always develops.
在青春期，显然你是一个功能正常的人，但我想说仍然有发展，而且我认为人类总是在发展。
I don't think development ever ends.
我认为发展永远不会结束。
But you want to monitor that progress across a person's lifespan.
但您想要监控一个人一生中的进展。
Dr. Kyle Gillett:
凯尔·吉列博士：
What do you think are the key things to look for in blood work?
您认为血液检查中要寻找的关键内容是什么？
Testosterone is always the topic that comes up in the context of male hormone optimization, but certainly there are a lot of other hormones that are important as well.
睾丸激素始终是男性激素优化背景下出现的话题，但当然还有许多其他激素也很重要。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
And with testosterone, you want to get either testosterone and a 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。
Dr. Kyle Gillett:
凯尔·吉列博士：
Could you define SHBG for our listeners, please?
您能为我们的听众定义一下 SHBG 吗？
Andrew Huberman:
安德鲁·休伯曼：
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。
During puberty, strong androgens, especially DHT, which is the strongest bioidentical androgen, has a huge role, a prominent role in secondary sexual characteristics.
在青春期，强大的雄激素，尤其是DHT，它是最强的生物同质雄激素，在第二性征中发挥着巨大、突出的作用。
And if your SHBG is very high, then your DHT can run higher because it's not metabolized, but there's not quite as much free DHT.
如果你的性激素结合球蛋白（SHBG）非常高，那么你的双氢睾酮（DHT）就会更高，因为它没有被代谢，但游离的双氢睾酮（DHT）却没有那么多。
So you want a balance between a high enough free DHT and a high enough total DHT.
因此，您需要在足够高的游离 DHT 和足够高的总 DHT 之间取得平衡。
Dr. Kyle Gillett:
凯尔·吉列博士：
So assuming that there's no major intervention, how often do you recommend that people get their blood work done?
因此，假设没有重大干预，您建议人们多久进行一次血液检查？
Andrew Huberman:
安德鲁·休伯曼：
Using shared decision-making with their physician, usually a good follow-up is about six months.
通过与医生共同决策，通常良好的随访时间约为六个月。
Dr. Kyle Gillett:
凯尔·吉列博士：
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。
Andrew Huberman:
安德鲁·休伯曼：
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 two.
饮食和运动是前两者。
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。
Dr. Kyle Gillett:
凯尔·吉列博士：
And just again for our audience, maybe you just mention what having enough IGF-1 can do for us that's beneficial is.
再次对我们的观众来说，也许您只是提到拥有足够的 IGF-1 可以为我们带来哪些好处。
Andrew Huberman:
安德鲁·休伯曼：
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、长骨生长、皮肤生长、头发生长等等。
Dr. Kyle Gillett:
凯尔·吉列博士：
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？
Andrew Huberman:
安德鲁·休伯曼：
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.
维生素 D 有助于睾酮的产生。
It helps, again, with bone mineralization and stature.
它再次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, but you want to help basically stockpile bone to prevent a risk of osteoporosis or thin bones fractures when you're older.
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，但您希望帮助基本上储存骨骼，以防止老年时骨质疏松症或薄骨骨折的风险。
Dr. Kyle Gillett:
凯尔·吉列博士：
I realize that some of this relates to ethics and food allergies and things of that sort, but would you say that on balance that most people would benefit from eating a combination of quality proteins from animal sources and non-animal sources, fruits, vegetables, and starches?
我意识到其中一些与道德和食物过敏等相关，但您是否认为总的来说，大多数人会从动物源和非动物源、水果、蔬菜和淀粉的优质蛋白质组合中受益？
What do you think, for instance, about people following a pure carnivore or a very pure vegan diet in their 20s and 30s?
例如，对于 20 多岁和 30 多岁的人遵循纯粹的肉食动物或非常纯粹的素食饮食，你有何看法？
Andrew Huberman:
安德鲁·休伯曼：
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, so you will have less testosterone acting on receptors through the body.
在 20 岁出头，当然还有青少年，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，因此您体内作用于受体的睾酮会减少。
Dr. Kyle Gillett:
凯尔·吉列博士：
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？
Andrew Huberman:
安德鲁·休伯曼：
Fiber is going to be paramount in kind of like setting your set point of your gut microbiome the rest of your life.
纤维将变得至关重要，就像在你的余生中设定肠道微生物组的设定点一样。
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。
Any fiber or food that you're putting in your gut, it's going to skew your gut microbiome towards something that is more beneficial or more detrimental.
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。
Dr. Kyle Gillett:
凯尔·吉列博士：
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？
Andrew Huberman:
安德鲁·休伯曼：
Throughout the lifespan.
整个生命周期。
Particularly important in the teenage, 20s, 30s, because that helps with brain development.
对于青少年、20 多岁、30 多岁尤其重要，因为这有助于大脑发育。
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，但它确实在整个生命周期中持续发育，但当然也持续到 20 多岁和 30 多岁。
Dr. Kyle Gillett:
凯尔·吉列博士：
In a previous discussion of ours, I asked you about caloric restriction and testosterone, and if I recall correctly, the idea was that if somebody is overweight, they have 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.
在我们之前的讨论中，我问过你关于热量限制和睾丸激素的问题，如果我没记错的话，我们的想法是，如果有人超重，他们就会有多余的脂肪和脂肪组织，然后通过热量限制和运动去除一些脂肪组织，只要以健康的方式进行得不太快，从长远来看对睾丸激素是有益的。
But that for individuals who are not carrying an excess of body fat, caloric restriction is actually going to lower testosterone.
但对于体内脂肪不多的人来说，热量限制实际上会降低睾酮水平。
First of all, do I have that correct?
首先，我说的对吗？
And second, are there any addendums to that that you'd like to give us now?
其次，您现在想向我们提供任何补充吗？
Andrew Huberman:
安德鲁·休伯曼：
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。
Dr. Kyle Gillett:
凯尔·吉列博士：
Now, what are some of the other pillars of creating the proper environment for hormone optimization?
现在，为激素优化创造适当的环境还有哪些其他支柱？
Andrew Huberman:
安德鲁·休伯曼：
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 多岁期间，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, 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，就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。
Dr. Kyle Gillett:
凯尔·吉列博士：
What would be some of the additional things that everybody should do?
每个人都应该做哪些额外的事情？
Andrew Huberman:
安德鲁·休伯曼：
Another one is finding what your purpose is in life.
另一种是找到你的人生目标。
So I call this spirit, but it's really just the self-actualization component of Maslow's hierarchy of needs, which is basically your physical needs, your mental needs, and then your purpose in life, what you really like to do.
所以我称之为精神，但它实际上只是马斯洛需求层次中的自我实现组成部分，基本上是你的身体需求，你的精神需求，然后是你的人生目标，你真正喜欢做的事情。
Dr. Kyle Gillett:
凯尔·吉列博士：
The idea is not to pick the end goal, it's to pick a goal, and then once you reach that goal, to assess and then pick another goal and so on.
这个想法不是选择最终目标，而是选择一个目标，然后一旦达到该目标，进行评估，然后选择另一个目标，依此类推。
I think sometimes when people hear about picking a purpose, they're like, "Oh, my goodness, I have to define..." Sort of like naming oneself.
我想有时当人们听说要选择一个目标时，他们会说，“哦，天哪，我必须定义……”有点像给自己命名。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Kyle Gillett:
凯尔·吉列博士：
But you actually can change your goals and purpose over time.
但随着时间的推移，你实际上可以改变你的目标和目的。
I'd like to take a quick break and acknowledge one of our sponsors, LMNT.
我想稍微休息一下并感谢我们的赞助商之一 LMNT。
LMNT is an electrolyte drink that has everything you need and nothing you don't.
LMNT 是一种电解质饮料，拥有您需要的一切，没有您不需要的东西。
That means the electrolytes, sodium, magnesium, and potassium in the correct amounts, but no sugar.
这意味着电解质、钠、镁和钾的含量正确，但不含糖。
Proper hydration is critical for optimal brain and body function.
适当的水合作用对于大脑和身体的最佳功能至关重要。
Even a slight degree of dehydration can diminish cognitive and physical performance.
即使是轻微程度的脱水也会降低认知和身体表现。
It's also important that you get adequate electrolytes.
获得充足的电解质也很重要。
The electrolytes, sodium, magnesium, and potassium, are vital for functioning of all the cells in your body, especially your neurons or your nerve cells.
电解质（钠、镁和钾）对于体内所有细胞（尤其是神经元或神经细胞）的功能至关重要。
Drinking LMNT dissolved in water makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes.
饮用溶解在水中的 LMNT 可以很容易地确保您获得足够的水分和电解质。
To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of LMNT in about 16 to 32 ounces of water when I first wake up in the morning, and I drink that basically first thing in the morning.
为了确保我获得适量的水合作用和电解质，当我早上第一次醒来时，我将一包 LMNT 溶解在大约 16 至 32 盎司的水中，并且我基本上早上第一件事就是喝它。
I'll also drink LMNT dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes.
我还会在进行任何体育锻炼时饮用溶解在水中的 LMNT，尤其是在炎热的日子里，当我大量出汗并失去水和电解质时。
LMNT has a bunch of great-tasting flavors.
LMNT 有很多美味的口味。
I love the raspberry, I love the citrus flavor.
我喜欢覆盆子，我喜欢柑橘味。
Right now, LMNT has a limited edition lemonade flavor that is absolutely delicious.
现在LMNT推出了限量版柠檬水口味，绝对美味。
I hate to say that I love one more than all the others, but this lemonade flavor is right up there with my favorite other one, which is raspberry or watermelon.
我不想说我比其他所有口味都更喜欢其中一种，但这种柠檬水口味与我最喜欢的另一种口味（覆盆子或西瓜）不相上下。
Again, I can't pick just one flavor.
再说一次，我不能只选择一种口味。
I love them all.
我爱他们所有人。
If you'd like to try LMNT, you can go to drinklmnt.com/huberman, spelled drink L-M-N-T.com/huberman to claim a free LMNT sample pack with a purchase of any LMNT drink mix.
如果您想尝试 LMNT，可以访问 Drinklmnt.com/huberman（拼写为 Drink L-M-N-T.com/huberman），购买任何 LMNT 混合饮料即可领取免费 LMNT 样品包。
Again, that's drinklmnt.com/huberman to claim a free sample pack.
再次强调，请访问 Drinklmnt.com/huberman 索取免费样品包。
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，或者我应该说男人应该做的关键事情来优化他们的荷尔蒙。
What do you think is a healthy, sustainable exercise regimen that anyone can follow that will also support their hormone status?
您认为什么是任何人都可以遵循的健康、可持续的锻炼方案，同时也能支持他们的激素状态？
Andrew Huberman:
安德鲁·休伯曼：
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 three or four more instances of less vigorous exercise.
最重要的是，您可以再添加三到四次不太剧烈的运动。
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，研究的一个领域是持续超过一小时的剧烈运动。
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, it is not hormonally helpful to train, especially regularly train vigorously for longer than an hour.
但从根本上来说，训练对荷尔蒙没有帮助，尤其是定期进行超过一个小时的剧烈训练。
Dr. Kyle Gillett:
凯尔·吉列博士：
These days, for better or for worse, I think for worse, younger guys are asking about and using testosterone replacement therapy, so-called TRT.
如今，无论好坏，我认为更糟糕的是，年轻人正在询问并使用睾酮替代疗法，即所谓的 TRT。
Why in the world would any male in his teens or 20s or even 30s whose blood levels of testosterone and estrogen are at the appropriate levels, meaning within the normal reference range, why would they take exogenous testosterone given all the negative effects on fertility, some of the challenges that it can present if the dosages aren't quite right, et cetera?
为什么世界上任何十几岁、二十多岁甚至三十多岁的男性血液中睾酮和雌激素水平处于适当水平，即在正常参考范围内，为什么他们会服用外源性睾酮，因为它会对生育能力产生所有负面影响，如果剂量不正确可能会带来一些挑战，等等？
Why would they do that?
他们为什么要这么做？
Certainly, if they are not being paid for a particular endeavor, like they're not making money.
当然，如果他们没有因为某种特定的努力而得到报酬，就像他们没有赚钱一样。
If they are playing a sport, chances are they're not allowed to do that anyway.
如果他们正在参加一项运动，那么他们很可能不被允许这样做。
It's on the banned substances list.
它在禁用物质清单上。
So to me, it just seems like a crazy idea.
所以对我来说，这似乎是一个疯狂的想法。
But then again, I'm of a generation that really hasn't thought about doing that stuff until people were in their 40s and 50s, or even never.
但话又说回来，我这一代人直到 40 多岁和 50 多岁时才真正考虑过做这些事情，甚至从来没有想过。
So is there ever a case for somebody in their 20s or 30s to take testosterone, if their blood levels are within the 300 to 900 nanograms per deciliter reference range?
那么，如果 20 多岁或 30 多岁的人的血液水平在 300 至 900 纳克每分升参考范围内，是否有必要服用睾酮呢？
Andrew Huberman:
安德鲁·休伯曼：
Everyone has their different reason, as far as when does the benefit outweigh the detriment?
每个人都有不同的理由，至于什么时候利大于弊呢？
Not very often if you're in your 20s, and certainly almost hardly never.
如果你二十多岁，就不会经常这样，当然也几乎不会。
There's always rare cases like Kallmann syndrome and whatnot, but almost never if you're very young.
总是有像卡尔曼综合症之类的罕见病例，但如果你很年轻，几乎不会有这种情况。
Dr. Kyle Gillett:
凯尔·吉列博士：
Okay, so for people in their 20s, 30s, and beyond, 40s, et cetera, whose testosterone and estrogen levels are at the appropriate ratios and within the normal reference range libido, energy recovery, et cetera, are feeling at least workable for their lifestyle.
好吧，对于 20 多岁、30 多岁、40 多岁等年龄段的人来说，他们的睾酮和雌激素水平处于适当的比例，性欲、能量恢复等在正常参考范围内，至少感觉自己的生活方式是可行的。
For those people, what can they do besides get great sleep, train but not too hard or too often, 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之外，他们还能做什么呢？
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？
Andrew Huberman:
安德鲁·休伯曼：
Let's mention creatine as the first one.
让我们首先提到肌酸。
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。
It can also serve as the backup fuel tank for your mitochondria, so kind of holding backup ATP.
它还可以充当线粒体的备用燃料箱，从而保存备用 ATP。
And it does slightly increase total testosterone, and it also increases the conversion of testosterone to dihydrotestosterone.
它确实略微增加了总睾酮水平，并且还增加了睾酮向二氢睾酮的转化。
So potentially, it's especially useful in men in even their teenage years and their 20s.
因此，它对于十几岁和二十多岁的男性尤其有用。
Dr. Kyle Gillett:
凯尔·吉列博士：
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, and DHT is one of the primary hormones that can promote male pattern baldness.
你提到了睾酮向二氢睾酮的转化，有一种神话说肌酸会增加脱发，我猜是因为至少有一项研究表明肌酸可以增加双氢睾酮，二氢睾酮，而双氢睾酮是促进男性型秃发的主要激素之一。
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？
Andrew Huberman:
安德鲁·休伯曼：
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.
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，因为它不会让你达到超生理水平。
It's not going to increase your androgens to an unnormal level of binding.
它不会将您的雄激素增加到不正常的结合水平。
So I feel like if that was a reason to not take creatine for hair loss, then that's-
所以我觉得如果这是不服用肌酸治疗脱发的一个原因，那么那就是-
Dr. Kyle Gillett:
凯尔·吉列博士：
Sorry, you mean hair loss is not a reason to avoid taking creatine?
抱歉，您的意思是脱发不是避免服用肌酸的理由？
Andrew Huberman:
安德鲁·休伯曼：
Correct.
正确。
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。
It just kind of resets your balance between testosterone being aromatized to estrogen or being 5 alpha-reduced to DHT.
它只是重置睾酮芳香化为雌激素或 5 α 还原为 DHT 之间的平衡。
So it's not going to speed up hair loss more than just naturally being a male does.
因此，它不会比男性更自然地加速脱发。
So in some individuals, it will have no effect.
所以对某些人来说，它不会产生任何影响。
In some individuals, for whatever reason, they have almost no 5 alpha-reductase activity, it will return them to natural or normal.
在某些个体中，无论出于何种原因，他们几乎没有 5α-还原酶活性，这将使他们恢复自然或正常。
Dr. Kyle Gillett:
凯尔·吉列博士：
So what other supplement-based tools can people consider?
那么人们还可以考虑哪些其他基于补充剂的工具呢？
Andrew Huberman:
安德鲁·休伯曼：
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 non-responders 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，因此您可以将其增加到 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.
除此之外，我还会添加左旋肉碱。
Dr. Kyle Gillett:
凯尔·吉列博士：
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？
Andrew Huberman:
安德鲁·休伯曼：
One to three grams.
一到三克。
Dr. Kyle Gillett:
凯尔·吉列博士：
Per day?
每天？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Several versions of creatine have betaine mixed in because it helps with the processing of methionine and homocysteine.
几种肌酸中都混有甜菜碱，因为它有助于蛋氨酸和同型半胱氨酸的加工。
Dr. Kyle Gillett:
凯尔·吉列博士：
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，例如我自己，添加甜菜碱会有所帮助，还是肌酸是多余的？
Andrew Huberman:
安德鲁·休伯曼：
Only if their homocysteine is persistently elevated, and homocysteine is kind of like an inflammatory marker that can build up if you're not converting enough of it downstream.
只有当他们的同型半胱氨酸持续升高时，同型半胱氨酸有点像一种炎症标记物，如果你没有在下游转化足够的同型半胱氨酸，它就会积聚起来。
Dr. Kyle Gillett:
凯尔·吉列博士：
How would I know?
我怎么知道？
Andrew Huberman:
安德鲁·休伯曼：
Just a blood test.
只是验血。
Dr. Kyle Gillett:
凯尔·吉列博士：
So L-carnitine, what are the ways to take L-carnitine?
那么左旋肉碱，左旋肉碱的服用方法有哪些呢？
I know that there's an oral form, so capsules, and there's injectables.
我知道有口服剂型、胶囊剂和注射剂。
Injectables, I think you need a prescription.
注射剂，我想你需要处方。
Is that right?
是这样吗？
Andrew Huberman:
安德鲁·休伯曼：
Correct.
正确。
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。
When you inject it, of course, at the supervision of your doctor, it's usually done intramuscularly.
当然，当您注射时，是在医生的监督下进行的，通常是肌肉注射。
It's an aqueous solution, so it does not have an oil or a carrier oil in it like testosterone esters do.
它是一种水溶液，因此不像睾酮酯那样含有油或载体油。
However, if you inject it too superficially, it's not going to make or break anything.
然而，如果你注射得太浅，它不会产生或破坏任何东西。
Often, it just burns if you inject it subcutaneously, and it does not disseminate throughout the body as well.
通常，如果皮下注射，只会产生灼烧感，并且不会扩散到全身。
L-carnitine potentially has localized effects if you inject it.
如果注射左旋肉碱，可能会产生局部效应。
If you ingest it orally, then it has a very low bioavailability, maybe only 10%.
如果口服的话，它的生物利用度非常低，可能只有 10%。
Dr. Kyle Gillett:
凯尔·吉列博士：
So what are the dosages of L-carnitine that one needs to ingest then if they want to get a benefit?
那么，如果想要获得益处，需要摄入多少剂量的左旋肉碱呢？
Because if only 10% is being absorbed, that's probably a lot of L-carnitine.
因为如果只有 10% 被吸收，那可能就是大量的左旋肉碱。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Kyle Gillett:
凯尔·吉列博士：
How much should people take per day?
人们每天应该服用多少？
Andrew Huberman:
安德鲁·休伯曼：
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。
Dr. Kyle Gillett:
凯尔·吉列博士：
Okay, so one to four, maybe even five grams.
好的，一到四克，甚至五克。
Andrew Huberman:
安德鲁·休伯曼：
Correct.
正确。
Dr. Kyle Gillett:
凯尔·吉列博士：
Okay.
好的。
Andrew Huberman:
安德鲁·休伯曼：
Up to five grams a day.
每天最多五克。
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.
如果您摄入这么多，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。
Dr. Kyle Gillett:
凯尔·吉列博士：
Is it true that I can offset any negative effects of alpha-GPC choline, that is an L-carnitine that I take by ingesting garlic?
我真的可以通过摄入大蒜来抵消 α-GPC 胆碱（一种左旋肉碱）的负面影响吗？
Is that right?
是这样吗？
Andrew Huberman:
安德鲁·休伯曼：
There's a compound in garlic called allicin.
大蒜中有一种化合物，叫做大蒜素。
I believe it's A-L-L-I-C-I-N.
我相信是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。
And this can help decrease the conversion to TMAO.
这有助于减少 TMAO 的转化。
Berberine actually slightly decreases the conversion to TMAO as well, probably through alteration of the gut microbiome.
小檗碱实际上也会略微降低TMAO的转化，可能是通过改变肠道微生物组来实现的。
And then just optimizing your gut microbiome can decrease conversion.
然后，仅仅优化肠道微生物组就会降低转化率。
So not everyone needs allicin, but it's something that you should certainly consider if you are on a high dose.
因此，并不是每个人都需要大蒜素，但如果您服用高剂量的大蒜素，您当然应该考虑这一点。
Dr. Kyle Gillett:
凯尔·吉列博士：
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，但我将不服用黄连素，因为黄连素会让我剧烈头痛，而且它会降低我的血糖，使我渴望碳水化合物。
Andrew Huberman:
安德鲁·休伯曼：
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。
Dr. Kyle Gillett:
凯尔·吉列博士：
Okay, and what we did not talk about is what L-carnitine does.
好吧，我们没有讨论左旋肉碱的作用。
Andrew Huberman:
安德鲁·休伯曼：
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。
It also has a unique effect-- well, not too unique, because tadalafil actually has this effect as well, is that it increases the density of the androgen receptor in the cytoplasm of your cells.
它还有一个独特的作用——嗯，不是太独特，因为他达拉非实际上也有这种作用，就是它增加了细胞细胞质中雄激素受体的密度。
So even if your androgen receptor sensitivity doesn't change, and even if your testosterone does not change, you will have more testosterone binding to that increased number of receptors.
因此，即使您的雄激素受体敏感性没有变化，即使您的睾酮没有变化，您也会有更多的睾酮与数量增加的受体结合。
Dr. Kyle Gillett:
凯尔·吉列博士：
Does one need to cycle L-carnitine, creatine, betaine?
是否需要循环左旋肉碱、肌酸、甜菜碱？
Andrew Huberman:
安德鲁·休伯曼：
No reason to cycle any of those.
没有理由循环其中任何一个。
Dr. Kyle Gillett:
凯尔·吉列博士：
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水平时，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。
Do people feel like they are going to have more energy as a consequence of doing these things?
人们是否觉得做这些事情后他们会拥有更多的精力？
Are they going to have the more optimized libido?
他们的性欲会更加优化吗？
Are they going to have more optimized recovery from exercise, right?
他们会从运动中得到更优化的恢复吗？
Because it's not clear to me that taking one's testosterone from 600 to 800 is always going to be a good thing, especially if estrogen is increasing in parallel.
因为我不清楚将一个人的睾酮从 600 提高到 800 总是一件好事，特别是在雌激素平行增加的情况下。
That could cause issues.
这可能会导致问题。
It could certainly make things better.
它肯定能让事情变得更好。
It could certainly make things worse, right?
这肯定会让事情变得更糟，对吧？
Andrew Huberman:
安德鲁·休伯曼：
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 sterol hormone.
它实际上是一种甾醇激素。
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。
So if you have a very high SHBG, boron can acutely help lower it, usually in a dose of 5 to 12 milligrams per day.
因此，如果您的性激素结合球蛋白（SHBG）非常高，硼可以迅速帮助降低它，通常每天服用 5 至 12 毫克的剂量。
It's not really a sustained effect, but boron is depleted in soils in many countries.
这并不是真正的持续效应，但许多国家土壤中的硼都被耗尽了。
I believe it's very high in soils in Greece and Turkey, so eating dates or raisins that are from those areas potentially have more boron.
我相信希腊和土耳其的土壤中硼含量非常高，因此食用来自这些地区的枣子或葡萄干可能含有更多的硼。
Boron also might be one of the reasons why the reference range for testosterone is much higher in those countries than other countries.
硼也可能是这些国家睾酮参考范围远高于其他国家的原因之一。
Dr. Kyle Gillett:
凯尔·吉列博士：
And just to remind people, the 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.
只是提醒人们，性激素结合球蛋白（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。
Okay, so vitamin D3, I'm guessing you're talking about vitamin D3 specifically when you say vitamin D.
好的，维生素 D3，我猜当您说维生素 D 时，您指的是维生素 D3。
And then boron, 5 to 12 milligrams per day, right?
然后是硼，每天 5 到 12 毫克，对吧？
And then what are some of the other things to optimize testosterone that are in supplement form?
那么还有哪些补充品可以优化睾丸激素呢？
Andrew Huberman:
安德鲁·休伯曼：
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。
It's also known as-
它也被称为——
Dr. Kyle Gillett:
凯尔·吉列博士：
Yeah, but I'm guessing a number of people probably haven't heard that conversation
是的，但我猜很多人可能没有听过那次对话
Andrew Huberman:
安德鲁·休伯曼：
...
...
also known as long jack, and that upregulates several different enzymes in the steroidogenesis cascade.
也称为长杰克，它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.
你的意思是，如果——这对谷歌来说是另一件好事。
I think anybody interested in hormone optimization should understand where sterol hormones come from.
我认为任何对激素优化感兴趣的人都应该了解甾醇激素的来源。
They come usually from cholesterol, and they can be shunted off to vitamin D very easily.
它们通常来自胆固醇，并且可以很容易地转化为维生素 D。
They can be shunted off to testosterone or estrogens or progestogens quite easily as well.
它们也可以很容易地转化为睾酮、雌激素或孕激素。
But tongkat helps with the conversion of multiple key steps where you synthesize testosterone.
但东革有助于转化合成睾酮的多个关键步骤。
Another, if you think of it as like a coenzyme or a cofactor, an upregulator of these steps is insulin and IGF-1.
另外，如果您将其视为辅酶或辅因子，那么这些步骤的上调剂就是胰岛素和 IGF-1。
So a good rule of thumb is if you are not expecting as much growth hormone, insulin, and IGF-1, for example, lower carb diets, caloric deficits, you're trying to cut body fat or body weight, then tongkat is going to be theoretically especially powerful.
因此，一个好的经验法则是，如果您不期望摄入那么多的生长激素、胰岛素和 IGF-1，例如，低碳水化合物饮食、热量不足、您想减少体内脂肪或体重，那么理论上东革将会特别有效。
Dr. Kyle Gillett:
凯尔·吉列博士：
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？
Andrew Huberman:
安德鲁·休伯曼：
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, so that's the compound that's having the effect on the body.
对于东革，你需要小心标准化，因为如果你正在考虑一种通用的东革补充剂，这是迄今为止研究最充分的，那么你就会关注东革酮的含量，它是一种植物化合物，可能是主要的活性药理作用，所以它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。
Dr. Kyle Gillett:
凯尔·吉列博士：
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 blood work of your patients taking tongkat ali?
您在服用东革阿里的患者的血液检查中观察到对各种激素的其他影响有哪些？
Andrew Huberman:
安德鲁·休伯曼：
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.
如果你的性激素结合球蛋白（SHBG）非常高，那么它就是结合雄激素和雌激素的蛋白质，这是一种极其重要的蛋白质。
The higher your SHBG, the more it helps decrease it.
SHBG 越高，就越有助于降低它。
So they've studied tongkat in populations with very normal SHBG, and it does nothing for SHBG.
因此，他们在性激素结合球蛋白（SHBG）非常正常的人群中研究了东革，但它对性激素结合球蛋白（SHBG）没有任何作用。
Dr. Kyle Gillett:
凯尔·吉列博士：
Interesting.
有趣。
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 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？
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
It'll increase their total and free testosterone.
它将增加他们的总睾酮和游离睾酮。
Dr. Kyle Gillett:
凯尔·吉列博士：
I'd like to take a quick break and acknowledge our sponsor, AG1.
我想稍微休息一下并感谢我们的赞助商 AG1。
AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens.
AG1 是一种维生素矿物质益生菌饮料，还包含益生元和适应原。
I discovered AG1 way back in 2012, long before I ever had a podcast, and I've been taking it every day since.
我早在 2012 年就发现了 AG1，那时我还没有播客，从那时起我就每天都在服用它。
The reason I started taking AG1, and the reason I still take it every day, is because AG1 is, to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market.
我开始服用 AG1 的原因，以及我仍然每天服用的原因，是因为据我所知，AG1 是市场上质量最高、最全面的基础营养补充剂。
AG1 is designed to support things like gut health, immune health, and overall energy, and it does so by helping to fill any gaps that you might have in your daily nutrition.
AG1 旨在支持肠道健康、免疫健康和整体能量等方面，它通过帮助填补您日常营养中可能存在的任何缺口来实现这一目标。
I get asked pretty much all the time, "If I could only take one supplement, what should that supplement be?" And my answer is always AG1.
我经常被问到，“如果我只能服用一种补充剂，那么该补充剂应该是什么？”我的答案始终是AG1。
It has just been so helpful for supporting all aspects of physical health, mental health, and performance.
它对于支持身体健康、心理健康和表现的各个方面都非常有帮助。
If you would like to try AG1, you can go to drinkag1.com/huberman to get a special offer.
如果您想尝试 AG1，可以访问 Drinkag1.com/huberman 以获得特别优惠。
For a limited time, AG1 is giving away a free bottle of their new omega-3 coenzyme Q10 product.
AG1 限时免费赠送一瓶新的 omega-3 辅酶 Q10 产品。
Omega-3 and coenzyme Q10 are known to support cardiovascular health, cellular health and energy generally, brain health, and much more.
众所周知，Omega-3 和辅酶 Q10 可支持心血管健康、细胞健康和能量、大脑健康等。
I personally take them both every day.
我个人每天都会服用它们。
Again, go to drinkag1.com/huberman to get a free bottle of the new Omega-3 coenzyme Q10 with your first AG1 subscription.
同样，请访问 Drinkag1.com/huberman，首次订阅 AG1 即可免费获得一瓶新型 Omega-3 辅酶 Q10。
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？
Andrew Huberman:
安德鲁·休伯曼：
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。
That species is likely the most well-studied, and it will increase LH.
该物种可能是研究最深入的，它会增加 LH。
Dr. Kyle Gillett:
凯尔·吉列博士：
Luteinizing hormone.
黄体生成素。
Andrew Huberman:
安德鲁·休伯曼：
I would not consider it an LH mimetic, so it doesn't really mimic it, but it increases the release of luteinizing hormone from the pituitary.
我不认为它是 LH 模拟物，所以它并没有真正模仿它，但它增加了垂体中黄体生成素的释放。
That's a hormone that binds to the leydig cell, to the LH receptor, kind of like HCG does, and it will increase the release of testosterone.
这是一种与间质细胞、LH 受体结合的激素，有点像 HCG，它会增加睾酮的释放。
Dr. Kyle Gillett:
凯尔·吉列博士：
What dosages do you have patients take?
你们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。
Andrew Huberman:
安德鲁·休伯曼：
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 different pro-inflammatory markers.
他们没有给这些老鼠任何抗氧化剂，但它增加了几种不同的促炎标记物。
One is GGT or gamma-glutamyl transferase, comes from both the testes and the liver, and one is alkaline phosphatase, also known as ALK phos, again, coming from both areas.
一种是 GGT 或 γ-谷氨酰转移酶，来自睾丸和肝脏，另一种是碱性磷酸酶，也称为 ALK phos，来自这两个区域。
There are several different ways that you can attenuate this increase, and you can also just check to see if you have increased.
有几种不同的方法可以减弱这种增加，您也可以检查是否增加了。
In the rat dose that equates with humans that had no effect, so the safe dose, was an average of 300 milligrams a day.
大鼠的剂量与人类相同，没有效果，因此安全剂量是平均每天 300 毫克。
Dr. Kyle Gillett:
凯尔·吉列博士：
So that would be 300 milligrams a day in humans is the dosage that did not have toxicity, correct?
那么人体每天 300 毫克的剂量是没有毒性的，对吗？
Andrew Huberman:
安德鲁·休伯曼：
Correct.
正确。
And often, even if there is toxicity in rats, there is not toxicity in humans, so it's not directly equitable.
通常，即使对老鼠有毒性，对人类也没有毒性，所以这不是直接公平的。
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.
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、周三和周五。
Dr. Kyle Gillett:
凯尔·吉列博士：
My understanding is that nowadays a lot of people are using testosterone.
我的理解是，现在很多人都在使用睾酮。
Let's not even call it replacement therapy because some of these people have 600, 700, or even 800 nanogram per deciliter reads.
我们甚至不称其为替代疗法，因为其中一些人的读数为 600、700 甚至 800 纳克/分升。
So they're not replacing anything that is diminished, they're just trying to augment what's already there, increase what's already there.
因此，他们并没有取代任何减少的东西，他们只是试图增加已经存在的东西，增加已经存在的东西。
My understanding is that taking a low dose more frequently is going to be more beneficial than the kind of old school way of giving 100 or even 200 milligrams in a single injection once every two weeks.
我的理解是，更频繁地服用低剂量比每两周一次注射 100 甚至 200 毫克的老式方法更有益。
Is that right?
是这样吗？
And what do you do with your patients?
你对你的病人做了什么？
So let me give you a hypothetical.
那么让我给你一个假设。
Somebody comes into your office, they do their blood work, and they have blood levels of, let's say, 600 nanograms per deciliter testosterone.
有人来到你的办公室，进行血液检查，血液中的睾酮水平为，比方说，每分升 600 纳克。
Their estrogen is also in normal range.
他们的雌激素也处于正常范围。
Everything else checks out, but they're complaining of slightly diminished libido, slightly poor recovery from workouts, maybe reduced motivation and drive, although no major depression.
其他一切都检查了，但他们抱怨性欲略有下降，锻炼恢复稍差，动力和干劲可能下降，尽管没有严重的抑郁症。
And you come to the conclusion that testosterone therapy, not replacement, but testosterone therapy might be a good option to explore.
您得出的结论是，睾酮疗法（而不是替代疗法）可能是一个值得探索的不错选择。
What's a typical dosage range and frequency of administration range that you might consider exploring?
您可能考虑探索的典型剂量范围和给药频率范围是多少？
Andrew Huberman:
安德鲁·休伯曼：
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，性激素结合球蛋白又是结合睾酮、所有雄激素和雌激素的结合蛋白，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.
但一般正常剂量范围，特别是对于刚开始服用的人来说，每周服用 100 至 120 毫克左右，通常每隔一天或每周 3 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。
Dr. Kyle Gillett:
凯尔·吉列博士：
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。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, very common dosing.
是的，非常常见的剂量。
Dr. Kyle Gillett:
凯尔·吉列博士：
To hit that 120 milligrams per week as kind of the typical average.
达到每周 120 毫克的标准平均值。
Andrew Huberman:
安德鲁·休伯曼：
Correct.
正确。
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。
All of this is said with the caveat that testosterone is normally released in a pulsatile manner, so it's high in the morning, low in the evening.
所有这一切都需要注意的是，睾丸激素通常以脉动方式释放，因此早上含量高，晚上含量低。
Whereas if you're on testosterone therapy, then you're going to have a steady state, so your testosterone level is going to be pretty much the same even in the evening.
然而，如果您正在接受睾酮治疗，那么您将处于稳定状态，因此即使在晚上您的睾酮水平也会几乎相同。
Dr. Kyle Gillett:
凯尔·吉列博士：
In your experience when patients do that, I'm guessing they report the normal constellation of positive effects, improved mood, improved energy, improved 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 blood work 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？
Andrew Huberman:
安德鲁·休伯曼：
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 a very common change.
痤疮是一种非常常见的变化。
Lots of different skin pathologies or even bruising can be related to hormone replacement.
许多不同的皮肤病变甚至瘀伤都可能与激素替代有关。
Hair loss is very common to see as well.
脱发也很常见。
Mental status changes.
精神状态发生变化。
Occasionally, it even induces a manic or a bipolar episode because testosterone is also dopaminergic.
有时，它甚至会诱发躁狂或躁郁症发作，因为睾酮也是多巴胺能的。
And then cardiovascularly, not just in the heart, but also concerns for microvascular ischemic disease, ferritin buildup because the estrogen also increases, and then fertility concerns as well, and lipid concerns too.
然后是心血管方面，不仅仅是心脏，还包括微血管缺血性疾病、铁蛋白积聚（因为雌激素也会增加）、生育问题和血脂问题。
So you really have to be hematologist, dermatologist, cardiologist A lipidologist, the whole nine yards.
所以你真的必须是血液学家、皮肤科医生、心脏病学家、脂质学家，整个九码。
Dr. Kyle Gillett:
凯尔·吉列博士：
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，如果一个人正在考虑使用睾酮疗法，并与一位真正优秀的医生密切沟通来真正做到这一点，那么还有另一个或一组原因，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 blood work 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，这是另一回事，我听说这需要通过血液检查来完成。
Andrew Huberman:
安德鲁·休伯曼：
Correct.
正确。
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。
Dr. Kyle Gillett:
凯尔·吉列博士：
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.
有些男性想要增加睾酮和其他激素，可能是生长激素等，但他们选择不服用外源性睾酮。
So no cream, no pellet, no pill, no injectable cypionate, but decide to take clomiphene a couple times a week.
因此，没有乳膏，没有颗粒，没有药丸，没有注射环戊丙酸，但决定每周服用几次克罗米芬。
My understanding, I've never done this, I would say if I had.
我的理解是，我从来没有这样做过，如果我这样做过的话，我会说。
My understanding is that taking clomiphene, maybe two 50 milligram tablets a week is what I hear people are doing, will increase what?
我的理解是，服用克罗米芬，也许每周两片50毫克片剂是我听说人们正在做的，会增加什么？
Luteinizing hormone, the various estrogen receptor subunits.
黄体生成素，各种雌激素受体亚基。
Could you explain how clomiphene would benefit anyone and is this a good strategy?
您能否解释一下克罗米芬如何使任何人受益？这是一个好的策略吗？
I'm hearing that it's being done quite a lot now.
我听说现在已经做很多了。
Andrew Huberman:
安德鲁·休伯曼：
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，或者阻断雌激素的作用。
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。
Dr. Kyle Gillett:
凯尔·吉列博士：
Why would I want to take something that would increase the activity of an estrogen receptor?
为什么我要服用可以增加雌激素受体活性的药物？
I just can't find the rationale for that.
我只是找不到这样做的理由。
Andrew Huberman:
安德鲁·休伯曼：
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.
采取 SERM 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，大多数时候它在临床上没有用处，SERM 不应该经常使用，当然也不能作为大多数人的长期睾酮替代或睾酮优化。
There's always exceptions to everything, but there's five different estrogen and estrogen-related receptors.
凡事总有例外，但有五种不同的雌激素和雌激素相关受体。
There's two main estrogen receptors, and Clomid and every SERM has a very unique profile because they selectively inhibit some receptors in some tissues, but not other receptors in other tissues.
有两种主要的雌激素受体，克罗米芬和每种 SERM 都具有非常独特的特征，因为它们选择性抑制某些组织中的某些受体，但不抑制其他组织中的其他受体。
For example, Clomid can inhibit receptors that are in the eye, and it can cause visual changes, blurry vision, especially at higher doses, and it also acts in every other tissue of the body.
例如，克罗米芬可以抑制眼睛中的受体，并可能导致视力变化、视力模糊，尤其是在较高剂量下，并且它还作用于身体的所有其他组织。
So side effects from Clomid and other selective estrogen receptor modifiers are very common.
因此，克罗米芬和其他选择性雌激素受体调节剂的副作用非常常见。
Dr. Kyle Gillett:
凯尔·吉列博士：
I'd like to take a quick break to acknowledge one of our sponsors, David.
我想稍微休息一下，向我们的赞助商之一大卫表示感谢。
David makes protein bars unlike any other.
大卫制作的蛋白质棒与众不同。
Their newest bar, the Bronze Bar, has 20 grams of protein, only 150 calories, and zero grams of sugar.
他们最新的 Bronze Bar 含有 20 克蛋白质，仅 150 卡路里，零克糖。
I have to say, these are the best-tasting protein bars I've ever had, and I've tried a lot of protein bars over the years.
我不得不说，这些是我吃过的味道最好的蛋白质棒，这些年来我尝试过很多蛋白质棒。
These new David bars have a marshmallow base, and they're covered in chocolate coating, and they're absolutely incredible.
这些新的大卫巧克力棒有一个棉花糖底座，上面覆盖着巧克力涂层，它们绝对令人难以置信。
I, of course, eat regular whole foods.
当然，我经常吃天然食品。
I eat meat, chicken, fish, eggs, fruits, vegetables, et cetera, but I also make it a point to eat one or two David bars per day as a snack, which makes it easy to hit my protein goal of one gram of protein per pound of body weight.
我吃肉、鸡肉、鱼、鸡蛋、水果、蔬菜等，但我也强调每天吃一两块大卫棒作为零食，这样很容易达到我每磅体重一克蛋白质的蛋白质目标。
And that allows me to take in the protein I need without consuming excess calories.
这使我能够摄入所需的蛋白质，而不会消耗过多的热量。
I love all the David Bronze Bar flavors, including cookie dough, caramel chocolate, double chocolate, peanut butter chocolate.
我喜欢大卫青铜棒的所有口味，包括饼干面团、焦糖巧克力、双层巧克力、花生酱巧克力。
They all actually taste like candy bars.
它们实际上尝起来都像棒棒糖。
Again, they're amazing.
再说一次，他们太棒了。
But again, they have no sugar, and they have 20 grams of protein with just 150 calories.
但同样，它们不含糖，并且含有 20 克蛋白质，只有 150 卡路里热量。
If you'd like to try David, you can go to davidprotein.com/huberman.
如果您想尝试 David，可以访问 david Protein.com/huberman。
Right now, David is offering a deal where if you buy four cartons, you get the fifth carton for free.
现在，大卫正在提供一项优惠，如果您购买四箱，您可以免费获得第五箱。
You can also find David on Amazon or in stores such as Target, Walmart, and Kroger.
您还可以在亚马逊或 Target、沃尔玛和克罗格等商店找到 David。
Again, to get the fifth carton for free, go to davidprotein.com/huberman.
同样，要免费获得第五箱，请访问 david Protein.com/huberman。
Alcohol, does it increase aromatase, the enzyme that converts testosterone into estrogen, or not?
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？
Andrew Huberman:
安德鲁·休伯曼：
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 every two weeks.
每两周喝一大杯酒可能相当于五标准杯。
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 nine, 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, so that can also decrease testosterone, almost kind of similar to how opiates can decrease testosterone.
另一件要记住的关于酒精的事情是它含有大量的卡路里，每克有 7 卡路里，几乎和脂肪一样多，每克有 9 卡路里，而且它也具有很强的 GABA 能，所以它可以激活抑制性神经传递，这也会影响 LH 和 FSH 的释放量，这样也会减少睾酮，几乎类似于阿片类药物减少睾酮的方式。
Dr. Kyle Gillett:
凯尔·吉列博士：
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, so in dosage ranges of 2.5 milligrams to 5 milligrams per day, but not for erectile dysfunction, but rather for improving prostate health, and presumably they get sort of a boost in terms of blood flow to the genitalia as well.
我知道你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），因此剂量范围为每天 2.5 毫克到 5 毫克，但不是为了勃起功能障碍，而是为了改善前列腺健康，并且大概他们在流向前列腺的血液方面得到了某种促进。生殖器也是如此。
But again, not specifically a deal with erectile dysfunction, but to deal with prostate health and blood flow to the prostate.
但同样，这不是专门处理勃起功能障碍，而是处理前列腺健康和前列腺的血液流动。
Is that something that you sometimes often prescribe to your patients, and of what age?
这是您有时经常给患者开的药吗？患者的年龄是多少？
Andrew Huberman:
安德鲁·休伯曼：
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 So tadalafil is also a blood pressure medication.
年龄在某种程度上取决于适应症，因此他达拉非也是一种血压药物。
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。
A high dose would be 20 milligrams, not 2.5 milligrams.
高剂量是 20 毫克，而不是 2.5 毫克。
But consistently, it can somewhat affect the cones in the eye that have to do with red and green sight.
但始终如一的是，它会在一定程度上影响眼睛中与红色和绿色视觉有关的视锥细胞。
Although if you remove it, that effect is reversed.
但如果将其删除，效果就会相反。
So basically, if you don't need really, really good red-green discrimination, you can take higher doses.
所以基本上，如果你不需要非常非常好的红绿辨别能力，你可以服用更高的剂量。
But in general, I recommend no higher than 10 milligrams a day, usually just two or five milligrams.
但一般来说，我建议每天不要高于10毫克，通常是两到五毫克。
One other benefit or other use of tadalafil is that it increases the density of the androgen receptor similarly to L-carnitine.
他达拉非的另一个好处或其他用途是，它与左旋肉碱类似，可以增加雄激素受体的密度。
So that's an interesting benefit.
这是一个有趣的好处。
Another benefit is that if you give it to people with nocturia, which is urinating at night, in general, it will cut the episodes in half.
另一个好处是，如果你给患有夜尿症（即在夜间排尿）的人服用，一般来说，它会使发作次数减少一半。
So it could go from two to one, which can make a big difference for your sleep, which will secondarily make a big difference for your growth hormone and testosterone optimization.
因此，它可以从两种变为一种，这会对您的睡眠产生很大的影响，其次会对您的生长激素和睾丸激素的优化产生很大的影响。
Dr. Kyle Gillett:
凯尔·吉列博士：
Interesting.
有趣。
So you said 2.5 to five milligrams per day is kind of 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来说是典型的。
Andrew Huberman:
安德鲁·休伯曼：
Yes.
是的。
Dr. Kyle Gillett:
凯尔·吉列博士：
I get a lot of questions about drugs to offset hair loss.
我收到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, DHT receptors being on the scalp and causing beard growth on the face.
大多数这些药物将通过 DHT 系统（二氢睾酮系统）发挥作用，原因我们之前讨论过，DHT 受体位于头皮上，导致面部胡须生长。
Is it the case that a number of people taking things like Propecia and other things to block the DHT or disrupt the DHT pathway are going to experience diminished sex drive, diminished motivation and general vigor?
是否有许多人服用保法止（Propecia）和其他药物来阻断 DHT 或扰乱 DHT 途径，会出现性欲减退、动力和整体活力减退的情况？
And if so, are there alternatives like topical DHT antagonists that they might use if they want to keep their hair but not have those negative effects?
如果是这样，如果他们想保留头发但又不想产生这些负面影响，是否可以使用局部 DHT 拮抗剂等替代方案？
Andrew Huberman:
安德鲁·休伯曼：
Many people that have just a bit of predisposition, they can use things that are topical anti-androgens.
许多有一点倾向的人可以使用局部抗雄激素的药物。
Ketoconazole is one of them.
酮康唑就是其中之一。
Caffeine is actually another one.
咖啡因实际上是另一种。
Dr. Kyle Gillett:
凯尔·吉列博士：
Wait, you have to explain how this works.
等等，你必须解释一下这是如何工作的。
How do people get caffeine into the hair follicle?
人们如何让咖啡因进入毛囊？
Andrew Huberman:
安德鲁·休伯曼：
Topically, the caffeine enters the scalp and somewhat crowds out the androgen.
局部使用时，咖啡因会进入头皮并在一定程度上挤出雄激素。
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。
Of note, spironolactone can be prescribed topically, but it is absorbed systemically because of the size of the molecule.
值得注意的是，螺内酯可以局部使用，但由于分子的大小，它会被全身吸收。
So unless your doctor specifically prescribes that for you, especially as a male, do not use topical spironolactone.
因此，除非您的医生特别为您开具处方，尤其是作为男性，否则不要使用外用螺内酯。
Topical finasteride is also a smaller molecule, so it is also systemically absorbed, but it is not extremely well systemically absorbed.
外用非那雄胺也是一个较小的分子，因此它也被全身吸收，但它的全身吸收不是很好。
If you take topical finasteride, then usually your systemic DHT will decrease by about 30%.
如果您外用非那雄胺，那么通常您的全身 DHT 会降低约 30%。
Topical dutasteride is likely a tiny bit systemically absorbed, but it's unique because its half-life is much faster at a lower dose.
外用度他雄胺可能会被一点点全身吸收，但它的独特之处在于，在较低剂量下，其半衰期要快得多。
So topical dutasteride will not affect your systemic DHT at all, and I've seen this anecdotally on many people on topical dutasteride therapy.
因此，外用度他雄胺根本不会影响您的全身 DHT，而且我在许多接受外用度他雄胺治疗的人身上都看到过这种情况。
Dr. Kyle Gillett:
凯尔·吉列博士：
On behalf of the audience and just for myself, thank you so much.
我代表观众并代表我自己，非常感谢你们。
You have an immense amount of knowledge, and you're exquisitely good at sharing it with people in an actionable way.
您拥有丰富的知识，并且非常擅长以可行的方式与人们分享知识。
So thank you.
所以谢谢你。
Andrew Huberman:
安德鲁·休伯曼：
My pleasure.
我很高兴。
Speaker 3:
演讲者3：
"I don't think I can be your friend," Isabella said.
“我想我不能成为你的朋友，”伊莎贝拉说。
Rebecca's stomach flipped.
丽贝卡的胃翻腾起来。
This is the love story of real Hinge couple Isabella and Rebecca, written and read by me, Tembi Denton-Hurst.
这是真实的铰链夫妇伊莎贝拉和丽贝卡的爱情故事，由我 Tembi Denton-Hurst 撰写和阅读。
Listen to the free audiobook now.
立即收听免费有声读物。