Holistic Lifestyle Interventions Optimize Hormone Health Across Lifespan

Key Quotes

"When someone comes to you as a patient in terms of hormone health what are the sorts of probe questions that you ask and what are you looking for and i ask this because i'd like people to be able to ask some of these very same questions for themselves so when you do a physical exam and a history you have a lot of different parts you have your history of present illness if they have a complaint maybe the patient doesn't have a complaint and in that case things like their social history and their family history are extremely important because that gives you an insight into their genetics and insight into their hormone health so patients will tell me oh i'm doing okay but it helps to ask them well how are you now let's say the patient is 50 how are you now versus when you were 20 and what has changed"

Dr. Gillett explains that understanding a patient's hormone health involves more than just addressing current complaints. He emphasizes the importance of social and family history to gain insight into genetics and past health status. Dr. Gillett suggests that patients can prompt their doctors for better lab work by describing changes in energy, focus, or athletic performance compared to their younger selves.

"The law of diminishing returns applies so doing a little amount of what i call lifestyle interventions over a long period of time is going to be far more helpful or efficacious than doing a lot and then doing nothing so i talk about the big six pillars the two strongest ones are likely diet and exercise for hormone health specifically resistance training is particularly helpful for um diet caloric restriction can be particularly helpful especially with the epidemic of metabolic syndrome that is continuing to go on in this country and in developed countries in general those are the two most powerful for the last four i have a little bit of alliteration so there's stress and stress optimization that has to do with cortisol that has to do with your mental health that has to do with societal health and collective health of your family as well"

Dr. Gillett advocates for a consistent, long-term approach to lifestyle interventions for hormone optimization, rather than intense, short-term efforts. He outlines six key pillars, highlighting diet and exercise, particularly resistance training and caloric restriction, as the most impactful. Dr. Gillett also includes stress optimization, sleep, sunlight exposure, and spiritual health as crucial components for overall well-being.

"The reason for exercise and the reason for caloric restriction in general including intermittent fasting is health reasons that's how you increase your health span it's not necessarily going to make the weight on the scale change but that doesn't matter as much so the easy way to think about it is if you're obese or you have metabolic syndrome caloric restriction will improve your testosterone there has been a study and they talk about all these studies in a systematic review from the mayo clinic proceedings they note that there is a study in young healthy men and they calorically restrict them and their testosterone does decrease so if you're young and healthy and you don't have metabolic syndrome then caloric restriction will likely decrease your testosterone"

Dr. Gillett clarifies that the primary benefit of caloric restriction and intermittent fasting is increasing healthspan, not necessarily weight loss. He notes that for individuals who are obese or have metabolic syndrome, caloric restriction can improve testosterone levels. However, Dr. Gillett cautions that in young, healthy men without metabolic syndrome, caloric restriction may lead to a decrease in testosterone.

"The first one is not super common but it's a very direct correlation if you have a growth hormone deficiency a true deficiency whether you're an adult or a child then your sleep is likely going to be affected and let's say you're a child with growth hormone deficiency once that is replaced with therapy your sleep is going to get significantly better the second one that's a very common scenario is if you're having what's called vasomotor symptoms of menopause or vasomotor symptoms of andropause which are also applicable that's why a lot of women in menopause feel like their sleep is much worse is because they have lower activity of those progestogens and for men in so called andropause um low testosterone is that also one of the causes of poor sleep"

Dr. Gillett identifies three primary hormonal factors that can negatively impact sleep. He explains that a growth hormone deficiency directly affects sleep quality, with therapy improving it. Dr. Gillett also points to vasomotor symptoms associated with menopause and andropause, often linked to lower progestogen activity in women and low testosterone in men, as common causes of disrupted sleep.

"Dht is a very androgenic hormone so whether you're talking about dhea which is a mild a weak androgen or testosterone which is a relatively strong androgen or dht which is a very strong androgen they bind to the androgen receptor in both men and women so the uh effect of all three of those is mediated by the androgen receptor intriguingly it is on the x chromosome so men get their androgen receptor gene from their mother so dht helps a lot for uh the same reason why testosterone helps it helps effort feel good so it can be motivating there's lots of dietary changes and supplementation that you're probably doing right now that's affecting your dht"

Dr. Gillett describes dihydrotestosterone (DHT) as a potent androgen whose effects are mediated by the androgen receptor, which is located on the X chromosome. He notes that DHT, like testosterone, contributes to motivation and a sense of well-being. Dr. Gillett also points out that various dietary changes and supplements can influence DHT levels.

"So Pcos is polycystic ovarian syndrome and this is one of those conditions which is underdiagnosed so its prevalence is much higher than we think it is there's been a lot of studies and some some studies say prevalence of 10 some say 20 it's not completely clinically penetrant so most people don't know they have pcos until they have infertility or subfertility and is this is pcos happening at this frequency in 20 year old women and 30 year old women and 40 and onward most women find out they have pcos in their 30s especially because it's on a spectrum or a continuum like a lot of things where you can have a weaker version or a very severe version"

Dr. Gillett explains that Polycystic Ovarian Syndrome (PCOS) is frequently underdiagnosed and more prevalent than commonly believed, with studies suggesting rates between 10-20%. He notes that PCOS is not always clinically apparent, and many women discover they have it in their 30s, often due to infertility or subfertility. Dr. Gillett emphasizes that PCOS exists on a spectrum, ranging from mild to severe presentations.