Essentials: Tools for Hormone Optimization in Males | Dr. Kyle Gillett

Dr. Gillett compares hormone monitoring to a full diagnostic workup on a new car. He stresses that just knowing total testosterone is insufficient; SHBG (sex hormone binding globulin) binds androgens and estrogens, so free testosterone is what acts on tissues. For example, high SHBG can make a normal total testosterone behave like a low-free state. He recommends baseline testing during puberty and regular follow-ups every 6 months to track changes, adjust lifestyle, and catch deviations early. This is not just for those considering TRT—it’s a proactive health practice.

Beyond erectile dysfunction, daily tadalafil at low doses offers underappreciated benefits for prostate health. Dr. Gillett explains that it halves nighttime urination frequency, which improves sleep quality, cascading into better growth hormone and testosterone regulation. The drug also upregulates androgen receptors (similar to L-carnitine), meaning more binding sites for testosterone without raising levels. He prescribes it as a long-term wellness agent rather than a reactive ED medication. Patients should get a prescription and discuss cardiovascular status, but the safety profile at 2.5–5 mg is excellent.

Dr. Gillett walks through the hierarchy of DHT-blocking hair loss treatments. Oral finasteride and dutasteride carry well-known risks of decreased libido and mood disturbances. Topical finasteride, though localized, still gets absorbed enough to cut systemic DHT by ~30%. Topical dutasteride, due to its larger size and rapid local metabolism at low doses, affects only scalp DHT. He backs this with clinical anecdotes of zero systemic change. He also mentions weaker topical anti-androgens like ketoconazole and caffeine that can be used in combination. This protocol targets hair loss without sacrificing overall androgen tone, which is crucial for men seeking to maintain libido and muscle mass.

Dr. Gillett explains that L-carnitine acts as a shuttle for long-chain fatty acids into mitochondria and, importantly, increases cytoplasmic androgen receptor density—so even if testosterone doesn’t rise, more receptors amplify the signal. Oral absorption is poor, necessitating gram-range dosing. But high doses risk elevating TMAO, a gut-microbiota-dependent metabolite linked to cardiovascular risk. Garlic, via allicin, alters the microbiome to reduce TMAO formation; berberine has a similar effect but can crash blood sugar. Huberman shares his personal protocol of 600 mg garlic with every L-carnitine dose. The injection form is prescription-only and avoids GI/TMAO issues but is less convenient.

Dr. Gillett describes Tongkat Ali as a plant that acts like a co-enzyme for steroidogenic enzymes, increasing the conversion of cholesterol into testosterone. It is particularly effective in states of low insulin/IGF-1, such as during caloric restriction or low-carb diets, where steroidogenic drive is naturally downregulated. He notes that blood work in his patients shows increases in free testosterone and luteinizing hormone, and sometimes DHEA. The effect on SHBG is conditional: it only lowers it when SHBG is high. The standardization of eurycomanone is critical because it’s the main active compound. Unlike some testosterone boosters, Tongkat has reasonable clinical evidence and blood work correlates.

Fadogia agrestis is a plant that stimulates pituitary release of LH, which in turn drives testicular Leydig cells to produce testosterone. Dr. Gillett bases dosing on rat toxicity data: at high doses, the plant raised GGT and alkaline phosphatase, markers of testicular and liver stress. However, those rats lacked antioxidant co-supplementation. The safe human equivalent is 300 mg/day. He sometimes prescribes 600 mg every other day or three times a week to reduce exposure. He emphasizes that one should monitor liver and testicular enzymes and consider antioxidants to be safe. This protocol is for men not on TRT who want an LH-mediated boost.

Dr. Gillett directly tackles the pervasive internet myth that creatine causes hair loss. The fear stems from a study showing a small increase in DHT, but he clarifies that this increase simply brings a person’s DHT to their genetically predetermined level—if 5-alpha reductase activity was low, creatine may normalize it; if already high, creatine doesn’t further raise it. Thus, it won’t speed up male pattern baldness beyond what genetics dictate. For those who don’t respond to standard doses, he suggests either 10 g or adding betaine (1–3 g) if homocysteine is high. This debunks a major barrier to creatine use.

Boron is a trace mineral that features heavily in the diets of countries like Greece and Turkey, where soils are rich in it and reference ranges for testosterone are higher. Dr. Gillett posits that boron’s SHBG-lowering action may contribute to those population-level differences. While the effect is acute, consistent intake can maintain lower SHBG. He recommends 5–12 mg daily, easily obtained from supplements or boron-rich foods like raisins and dates from those regions. This is a simple, inexpensive addition for men with high SHBG.

Dr. Gillett describes tadalafil as a 'very underrated medication' that can slash nighttime urination episodes, which secondarily improves sleep and growth hormone/testosterone optimization. He notes that at 2.5–5 mg daily, there is little risk of the red-green color vision changes seen at higher doses (20 mg). The drug also slightly lowers blood pressure. By increasing androgen receptor density—similar to L-carnitine—it may amplify the effects of endogenous testosterone without raising hormone levels. This makes it a multi-purpose tool for middle-aged men with prostate symptoms and mild androgen concerns, though it requires a prescription and monitoring.

According to Dr. Gillett, topical finasteride is a small molecule that gets partially absorbed and drops systemic DHT by 30%, carrying risk. Topical dutasteride, however, is larger and likely much less absorbed; its half-life at the low doses used on the scalp is short enough that it doesn’t affect systemic DHT. He has seen this anecdotally in many patients on topical dutasteride therapy. Weak topical anti-androgens like ketoconazole and caffeine can also be used. He warns against topical spironolactone in males because it absorbs systemically. This shift toward non-systemic DHT management is attractive for young men wanting to preserve hair without compromising androgen signaling elsewhere.

Dr. Gillett states that, aside from rare cases like Kallmann syndrome, the benefit rarely outweighs the detriment in the 20s and even 30s—testosterone is on the banned list in sports, supraphysiologic levels pose cardiovascular, dermatologic, and psychiatric risks, and fertility suppression is a major concern. The episode frames this as a cautionary stance: optimize lifestyle, sleep, diet, and supplements before even considering TRT, and even then, only with close medical surveillance and clear indications of hypogonadism.