The Best Technologies and Practices for Male Hormone Optimization
Dr. Dan Stickler, cofounder of the Apeiron Center for Human Potential, shares his expertise in the field of male hormone optimization, peak performance, and well-being. Dr. Stickler has dedicated nearly 20 years to helping his patients regain vitality, balance hormones levels, and work toward youthful physiology as they age. For every patient, healthy hormone levels first require core lifestyle commitments to nutrition, healthy stress management, and abundant sleep. The effect of hormones in the body is profound, driving metabolism, influencing muscle mass, immunity, cognition, sex drive and much more. In this conversation Dr.
Stickler unpacks in great detail the specific roles and relationships of several major hormones, and how best to safely regulate, measure, and rebalance them. We discuss raising testosterone naturally, directed supplementation, as well as the risks and benefits associated with hormone replacement therapies, and how hormones can go wrong. For the many self-experimenters out there taking a sovereign approach to hormone regulation, it is important to gather accurate information from trustworthy sources and to understand the nature of these compounds in the body.
In This Episode We Discussed:
Ways to boost testosterone naturally
Testing growth hormone levels
IGFBP3, a protein that protects you from cancer
The important role of estrogen, and the downside of excess
Measuring and interpreting hormone labs for performance optimization
Risks in up-regulating or down-regulating hormone pathways
Strength, erectile function, prostate health
The trouble with sex hormone binding globulin (SHBG)
Deciding factors for beginning testosterone therapy
Available forms of testosterone
Long term use of androgens
Atrophy of the testis
Sex hormone feedback loops
Selective Androgen Receptor Modulators (SARMs) cycling and effects
Peptides that enhance growth hormone.
Related & Recommended Links:
3:40 The sovereign approach to self-experimentation and biohacking.
6:45 critical lifestyle work, a prerequisite before enhancement.
10:38 Cortisol, testosterone, and leadership.
14:39 Intermittent fasting and growth hormone levels.
18:25 A symphony of hormones and their roles and relationships.
20:40 Symptoms of hormones level changes.
33:10 Understanding total testosterone as distinct from free testosterone.
39:17 Adrenal hormones related to sex hormones.
46:20 Topical versus injected testosterone.
51:42 The negative effects of excessive testosterone.
54:33 Stimulating testis with HCG (human chorionic gonadotropin)
58:93 SARMs, selective androgen receptor modulators, why Dr Stickler likes them.
1:03:37 Other interesting compounds for optimizing peak performance.
1:11:01 Peptides and their interesting effects.
Full Episode Transcript:
Daniel Schmachtenberger:All right, welcome, everyone, to Collective Insights, Neurohacker Collective's podcast on health wellness, human well-being optimization. Really delighted to be here with Dan Stickler again. Some of you may have heard some of the podcast we've done with Dan in the past on cognitive chemistry and other topics. Today, we're doing a really interesting, really fun topic on male hormone optimization. Dan happens to be an expert in this topic. I'll share a little bit of his background and an overview of what we're going to talk about today so you can orient.
Daniel Schmachtenberger:This is not going to be the intro topic of how to just make sure that you have a lifestyle that is producing enough testosterone, et cetera, because that's done really well in the Internet, and lots of place. We'll spend the first five minutes just doing the basics to make sure that they're done because that's the practice. The rest of the time is going to be if you're sleeping well and exercising and eating well then what else do you do, so we're going to get into everything from testosterone replacement therapy to how to modulate estrogen to SARMs to maybe a little bit on fun things like myostatin inhibition. So, that's what to stay tuned in for.
Daniel Schmachtenberger:This is also not the right podcast for people who are seriously juicing and are looking for high level insights on that. So, this is more performance, and health, and wellbeing enhancement across the board. Ben is a surgeon who his work in bariatric surgery got him into lifestyle medicine. One of the real interesting things for trying to dive into this area was he was one of the doctors at Cenegenics for a long time. Which is male hormone longevity optimization clinic. Then went from there into deeper functional medicine, lifestyle medicine, then very deeply into genetic and epigenetics work.
Daniel Schmachtenberger:He's medical director of something called The Apeiron Academy and Apeiron Health Center, just a very, very top health medical center. And the Apeiron Academy, I know many of the people listening are just listing for their own wellbeing. But we all also have a lot of health practitioners listening. So if you're a health practitioner and you want to understand genetics better, and epigenetics and how to be able to look at someone's genome, see predispositions, know how to help genetic expression moving in the right direction in a personalized way, you might be really interested in checking out the Apeiron Academy .
Daniel Schmachtenberger:Dan joined as a advisor and medical director with Neurohacker sometime ago. And so, that's a little bit on his background. If you see him with his shirt off, you'll know that he understands things about male hormones. Right as we were just getting on before hitting record, we were talking about the most recent fun experiments that he was doing. So, that's one of the areas we always have fun with. So Dan, welcome and thanks for being here.
Dan Stickler:Happy to be here. Yeah. And you know, I think we should introduce this too, the fact that there's a lot of people out there experimenting in [inaudible 00:03:46] studies and everything like that, and I am all for the sovereign human approach to things. What we've run into is, a medical system that is somewhat judgemental about it. And there's a, I think an asymmetric risk that you're dealing with and going to a physician. I mean, it is not illegal to self-experiment.
Dan Stickler:It is if you're using illegal drugs, but there's a lot of self-experimentation that goes on. And there's really not much direction for people, we're a kind of reference for people. I mean, when I first started doing it, I was going to Reddit, and trying to figure out what the best thing is here, and talking to others that were doing it. But, I think the medical establishment needs to step up to this, and really own the fact that, it's about doing no harm. But it's also about allowing sovereign decisions for each human, and helping them by giving them some feedback on this without actually condoning what they're doing per se.
Daniel Schmachtenberger:Yeah. So this is interesting, right? Because when people are trying to figure out how to experiment for themselves, they have to talk to other people who are actually allowed to talk to them. Which means for the most part, companies and medical doctors just can't say a lot of things for legal reasons. So they go to Reddit, and they get a bunch of broscience, some of which is amazing. And some of which is terrible, and it's a little bit hard to parse which is which. So that's why we have this podcast, is to try and find people that actually have good knowledge in the field and share it.
Daniel Schmachtenberger:And I'll just say the disclaimer, which will already be at the front of this, and I'll say it again, which is we are not telling you how to treat medical conditions here, or how to diagnose, or prescribe or anything like that. If you have real medical conditions, go speak to your medical doctor, et Cetera, et cetera. This is educational purposes only.
Daniel Schmachtenberger:It's a bummer for people when they're experimenting on their own, to not have a good source of education to learn from other people's experimentation. It's also a bummer if people take on their sovereignty, and they're playing the things that actually have real side effect potential. So a goal here is, just some general education in the field. When we say go talk to your doctor, not all doctors have equal background and these topics. So if you were to go talk to a doctor like Dan, who happens to be a licensed medical doctor and medical director, you would get a very different experience than if you go talk to a doctor who says, "Oh, you have a total test of 300, that's fine." Or the most they would do is, give you a test injection and that's the end of the story. So, know that who you go talk to is going to determine your experience pretty deeply.
Daniel Schmachtenberger:Alright, so let's dive in. We don't need more than five minutes on this. But if people have not already done the basics of lifestyle, when we're talking about male hormone optimization, and just for those who are interested, we will do another podcast on the female hormone optimization. And there's some crossover of course, because we all have hormones of both types. This is particularly geared towards male hormone optimization for both performance enhancement, anabolics, exercise, recovery weights, etc. And health and wellbeing and extending quality of life into older age. Um, but if people don't Already have the basics down, just very quick, what are the basics?
Dan Stickler:Well, I mean it's all lifestyle basics. I mean, people come in all the time that they want that enhancement, but they're not willing to do the lifestyle work that's the core requirement. It's just like somebody coming in and wanting, wanting super focusing concentration, yet they're sleeping five hours a night, you it just doesn't work that way. You've got to really get the human system into a balanced state of homeostasis across all parameters, and that's sleep, stress, nutrition, supplementation, cognitive function and thought processing. The meditation [inaudible 00:07:52] the movement, [inaudible 00:07:53] and environment. So you've got to have all that really dialed in before you can even consider enhancement. I mean, enhancement, it's more of a treatment than it is enhancement, when you don't have this lifestyle factors dialed in.
Daniel Schmachtenberger:So in terms of lifestyle factors, you mentioned them, but just so people have a quick sentence. When we think of male hormone optimization, we're thinking about all the androgens, testosterone, the various testosterone's, and we're thinking about growth hormone and more stuff. But that's kinda where people's mind goes first. So what are the major things that people do that mess those hormones up? You mentioned sleep, you mentioned stress. How do those effective it?
Dan Stickler:Sleep is absolutely off the chart with it, and with its impact on the, on the whole HPA system. I mean, it's just a ubiquitous issue, when you're dealing with people who are lacking sleep or sleep structure qualities. So that's always the first thing you want to address, and it's probably the most. I bring that first because it's the thing that I see ... most of the clients are that are deficient in. Nutrition and fitness, I mean that's pretty basic. People don't generally come for optimization hormones, unless they've got that stuff already dialed in. That is something that you can fine tune. But most people have that down.
Dan Stickler:Now stress is the other piece, and I'm not talking about eliminating stress. Everybody thinks that the goal is to eliminate stress and that's not the case. The case is to really exercise control over the physiologic functions of stress, or the physiologic impacts of stress. So dialing that piece in, and understanding that stress is a good thing when it's expressed in the right way, versus the one that's kind of more of a chronic component of it. That can really impact the hormonal system.
Dan Stickler:I mean think of the hormone system is this big symphony, and cortisone is certainly a part of that symphony. Thyroid, the sex hormones, all of these are playing a role in this. When you have one section of a symphony that goes out of tune, it can throw the others off. So a lot of times you'll see symptoms of a thyroid issue that isn't really a thyroid issue per se, but it could be excess cortisol that's diminishing the conversion of T4 to T3. So you, you get into a state that that can mimic, or can look like from the outset, the thyroid is the primary problem.
Dan Stickler:Testosterone is the same way. I mean they've done plenty of studies on this, and I have a lot of executives that will come to me and they're like, "I've lost my edge. I think testosterone is the answer for me." and it's not. You can give them testosterone, and it's not going to correct that underlying issue when the stress is there. Because we do know that cortisol impairs the ability of testosterone to really provide that impact. They looked at the leaders in companies, and they looked at the people that are at the bottom of the chain, the middle of the chain, and the top of the chain.
Dan Stickler:And the ones that were at the top had the highest testosterone in the lowest cortisol. Those down below either had low testosterone or high cortisol, and there's no pill to fix that. You're not gonna fix cortisol with the pill. It's lifestyle factors. So, we really focus heavily on getting that stress response under control and minimize the cortisol expressions as much as we can, if we're going to provide testosterone therapy for sure.
Daniel Schmachtenberger:And so that's everything from making sure they get enough sleep, to meditation, to cycle therapy, to neurofeedback, to exercise can all help with that process.
Dan Stickler:Absolutely. Yep.
Daniel Schmachtenberger:Um, okay. So if, if people are interested, if we get a lot of questions coming in on the basics, we might come back and record another podcast. Otherwise, if you google how to raise test naturally, you'll get a lot of things, and help.[crosstalk 00:12:02]
Dan Stickler:Yeah, it's all out there.
Daniel Schmachtenberger:Just maybe taking a second and saying, there's a lot of different types of exercise that are good for the human physiology in different ways. They're not all good for male hormones equally. So jogging versus heavy squats- [crosstalk 00:12:19]
Dan Stickler:Yeah, I mean, intense resistance training is always going to be your better choice for boosting the testosterone. We actually see impairment of testosterone in more endurance runners, and things like that. It's not a huge impairment, but there's a big difference in the boost you get from resistance training, versus the depression you get with the endurance training. It's not to say don't do endurance, but you've got to mix it up. So, there's different pieces of that. The one thing I found interesting was, if you want to boost testosterone, lift heavy weights, and talk to attractive women. 30% boost in testosterone from talking to attractive women. So right there, go to a gym that has attractive women and you got it.
Daniel Schmachtenberger:And from an evolutionary perspective, that makes heaps of sense, right? Because the testosterone is going to be affecting sperm count and et cetera. Now our bicep curls and deadlifts equal as far as resistance training goes for testosterone.
Dan Stickler:They aren't because you've got to look at the amount of force that's generated with the exercise. So you're dealing with biceps that, a low muscle mass. The amount of weight you're lifting with the that is down, so you're not getting a lot of force generation with that. With the squads, especially, squats is probably the best one. Um, but deadlifts, anything using the legs tends to really boost that. I like more of a total body, like an overhead squat is really good for engaging a lot of muscle at one time. I think that is one of the best ones for really boosting those testosterone levels, again, that's anecdotal. But if you want to talk about activation of a lot of muscles at one time under resistance, then overhead squats probably one of the best exercises.
Daniel Schmachtenberger:So one thing I'll just say there is, when you're looking at compound exercises where a lot of muscle groups are involved in heavier weight, so you're getting near peak, it makes sense that you are anabolic hormones would have to upregulate to deal with something pretty hard. The harder it is, kind of the better. But also the easier it is to injure yourself. And so, getting your form down really matters.
Daniel Schmachtenberger:What about intermittent fasting for hormone optimization?
Dan Stickler:Well, the big issue there is, a lot of people talk about fasting and the boosting growth hormone levels. Yes it will boost growth hormone levels, but it doesn't do it quite the way people think. Some of the more recent research is indicating that, what happens is you have less utilization of the growth hormone being secreted. So it makes it look like there's a greater amount, especially the conversion growth hormone to IGF-1, it tends to diminish the conversion, So, it gives you that impression that it's actually boosting growth hormone.
Dan Stickler:There's a mix of studies on that, but nothing that really clearly defined that difference. And so, I just haven't seen really good results from ... and intermittent fast and you're not gonna get ... I just don't see a whole lot of growth hormone effect with intermittent fasting. Now the, the, the 24, 48, 72 hour fast, that's where they really started to show the growth hormone boost. But I think a lot of that was related to the fact that it wasn't converting to IGF-1.
Daniel Schmachtenberger:Okay. So now we're, we're moving topics and the understanding the hormones, but it's not very easy to test growth hormone directly. We have to test it indirectly. And the indirect then, has an interpretive issue. So for testing IGF-1 and its going up, that does not automatically mean growth hormones going up.
Dan Stickler:Correct. Um, growth hormone only exists in the circulation for like four to 12 minutes once it's secreted from the anterior pituitary. And so it makes no sense to measure growth hormone levels, unless you're getting injections of it through an alternative or replacement means. But as far as testing growth hormone itself, you get surges, especially at night. There's two peaks that occur at night, in the third cycle of REM, you get 50% of the growth hormone secretion for the day right then. And that is not a good way to measure, so blood levels of growth hormone are really useless in that regard. That's why they do provocation test, where they inject you with a drug to make you secrete growth hormone and they measure your response. So what we've relied on is what's called the IGF-1. And insulin like growth factor 1. So growth hormone, after it's four to 12 minutes of circulation gets converted into IGF-1 or, or IGFBP-3, it's binding protein 3. They have two different functions. So, IGF-1 is a very highly anabolic product, whereas the IGFBP-3, it's interesting because it's kind of a surveillance protein. It goes around and identifies cells that are abnormal in a sense, and induces apoptosis, self destruction of those cells.
Dan Stickler:That's why you don't see people with growth hormone. Tumors like Andre the Giant and Tony Robbins, those kind of guys that have had growth hormone tumors. You would think with all the growth hormone, that they would be eaten up with other cancers, and they aren't. They just tend not to get them, because of that balance of that IGFBP-3 really kind of protecting that in a sense. But that IGF-1 that we're measuring to determine levels, and you can make your IGFBP-3 as well, that exists and a half life of about five or six days, I believe. So you can get an idea of the average release of growth hormone based on that.
Daniel Schmachtenberger:So I think it's a good idea for people to just have an overview of, when we're thinking about performance enhancement, male hormone optimization, what are the primary hormones we're thinking about? So, we're talking about growth hormone and IGF, we're talking about total test, free test, DHT, estrogen, progesterone, the androgens. Maybe just kind of put it together so that people understand, what do each of those things do, and what kind of gets thrown off? What's the difference when someone 60 versus 20? What are the main targets that we're looking at?
Dan Stickler:Well, they're all involved in some way. I mean we talked about cortisol. Testosterone obviously is an anabolic and androgenic, but when it comes to performance, we're talking about the anabolic effect. Which means the growth effect of it. IGF-1, same thing. It is a growth hormone, so it induces cells to grow. Whether it's a muscle cell, or the lining of the gut or whatever it is. It's inducing growth of cells. Some cells get primed to utilize the growth hormone. Like when you exercise, the muscles are primed to take up that growth or better, and they're going to respond better to it. Now, estrogen is underestimated in how it's involved there, especially when it comes to performance because ... Testosterone gets converted to estrogen, and one of the factors that we do know is the testosterone is really good for cognitive performance. When the testosterone crosses the blood-brain barrier, a great deal of it is converted through aromatase into estrogen. Then estrogen is actually one of the primary factors that helps to create the optimized response to the brain, to testosterone therapy.
Dan Stickler:Estrogen's really good for the strengthening of the bones as well, which is essential. As you build muscle, you've got to have the bone scaffolding to support the greater strength. Same with progesterone in that regard. Thyroid, another one. You need the metabolic capacity feeding into these cells, that are now in a growth phase, to really bring in all of the factors and metabolic components to help build that structure for you. So they all interact in some way.
Daniel Schmachtenberger:So talk to us about the relationship between testosterone and estrogen. It's possible that someone is doing test therapy. They're converting too much to estrogen. We see estrogen getting too high, there's a problem. But have you also seen people doing too much aromatase inhibition, getting estrogen too low? Why would that matter? How does someone kind of access that, and what are the tools?
Dan Stickler:Yeah, there's a lot of ways to address that. We get individual responses quite a bit with it. I used to be very cautious anytime estrogen levels would get about 40, and somebody was on replacement therapy. I have since, in the last couple of years, really move that more towards 60 without symptoms. Over 60, I tend to see symptoms in the majority of males. That they get to that point, maybe a third of them between 40 and 60. But that estrogen can be detrimental in a number of ways. One is, estrogen effects the prostate. In fact, there's some evidence leading more towards the estrogen component creating the cancer risk associated with testosterone therapy. So you have to be cautious with that.
Dan Stickler:One of the other downsides is that, you can get gynecomastia, which is breast tissue growth in the males. A lot of pubertal males kind of go through that, because they have that breast tissue there. With their high testosterone, they have high conversion, they end up with that. Also, abdominal obesity. There's a tendency fo, we have to be careful with the estrogen. But we also don't want it to get too low. When we get below 20, I tend to see males, they get emotionally detached. So there is an emotional component associated with estrogen. We always say testosterone is the sex, and estrogens in the love. You got to have a little bit of both.
Dan Stickler:We're seeing, especially with the use of SARMs, which we'll talk about later, but SARMs have a real problem with causing estrogen to get a little bit on that low side, along with sex hormone binding globulin. It really dumped sex hormone binding globulin. So, you've got to have a little bit of that testosterone to convert into estrogen. So if you're low on testosterone, and you decided to go the route SARMs as your primary, you're gonna also be low on estrogen. So you gotta kinda pay attention to those aspects of things.
Dan Stickler:I also see a lot of people that take high doses of aromatase inhibitors, whether prescribed for them, or decisions they've made in talking with other guys in the gym, saying how bad estrogen is. And you can really dump that estrogen down with the aromatase inhibitors. And I see real cognitive impact from that, which they just don't pay attention to.
Daniel Schmachtenberger:So cognitive, emotional and joints, right?
Daniel Schmachtenberger:So if someone's doing too much Anastrozole, or some other aromatase inhibitor, those are the things that they'd want to be measuring. Ideally, they'd be actually doing blood labs, or saliva labs or something and seeing the levels they're at.
Dan Stickler:Yeah. I prefer not to do saliva labs. They have kind of a narrow spectrum. I mean, I would use them occasionally. But only if somebody brings them to me, to kind of look at. Saliva is interesting because the spectrum you're looking at is like this big, and you get to figure out where somebody is in that spectrum. Versus blood which is this big, and if they're here, you know they're there. If they're hear, you know they're there.
Dan Stickler:Now the urine metabolites is pretty good, with the dutch test. We've had some decent results with that. But sometimes it's hard to interpret from a optimized performance standpoint. I do like the DHT conversion map that they provide with that one, and the breakdown of the estrogen products. Because estrogen can break down into very highly toxic forms, especially in genetically prone individuals. So, we can actually see that, and form interventions with that. So first choice is always going to be blood tests. For me some of the followup work, I do like to use the dutch test to kinda confirm some things that we see in genetics and all.
Daniel Schmachtenberger:So Ideally if someone's really interested in they have the capacity, you'll do blood and urine, to get a bigger picture.
Daniel Schmachtenberger:And you mentioned something to me once about differential effects of DIM and Indole-3-carbinol, and some of the kind of supplement versions of how people deal with estrogen also affecting detox pathways, and things like that. I think a lot of people think of DIM as just a weaker anastrozole, and you think of them as pretty different things.
Dan Stickler:Yeah. DIM only has a pretty minor effect on CYP3A4. That has an impact on the amount of conversion testosterone, it's a downstream, but it still has an impact on it. And then you're talking about two other CYPs that convert estrone into 2-hydroxy and 4-hydroxyestrones. Dim will drive that pathway, so the body's decided ... think of it as a decision tree where you've got 2-hydroxy and 4-hydroxy. It's kind of a decision tree into which direction it's going to go. DIM tends to drive it in a direction that the breakdown product, the estrone that's formed in that pathway is beneficial for the body, especially in DNA repair and things like that.
Dan Stickler:Whereas there's a more toxic form, that some people are genetically prone to. So, DIM works really well with kind of pushing it down that other pathway a little bit better. You also had the 1-16, which is more of the CYP3A4 interacting with that one too. But, you don't want to just go on DIM thinking, "Okay, well I need DIM." Because when you inhibit or enhance the cytochrome P450, people are focused on the one the thing that they're trying to treat.
Dan Stickler:And if you downregulate or upregulate any one thing in the CYPs, it's going to have effects on other forms of metabolism because the cytochrome P450s are really important for detoxification. Not only of exogenous chemicals and toxins, but also in your own hormones. So you don't want to haphazardly just go in and start inhibiting or enhancing different forms of these CYPs.
Daniel Schmachtenberger:I have a very interesting question, I'll save for another time of, I've seen a number of women who told me that DIM made them feel much better as far as PMS, when they had to estrogen dominance. But then started noticing some decreased detox pathways on labs. So, I'm curious about that.
Dan Stickler:Yeah, and that's what typically happens. I mean, we don't pay attention to all the different pathways that these cytochrome O450s deal with, and they deal with a lot. Some drugs like St. John's wort, it has a different effect of low dose versus high dose, and they will upregulate some CYPs and downregulate other CYPs. But you have to be very specific about what you're trying to fix, and then pay attention to the consequences of upregulation and downregulation, with some other potential toxins that the body is going to deal with.
Daniel Schmachtenberger:Okay. So you're mentioning different kinds of estrones, which are in the estrogen family. We haven't talked about that estrogen isn't just one hormone. It's a whole family of hormones. If men are trying to test, to get a baseline, what should they test? If they're doing the Dutch test, they obviously get a lot of stuff, if they're doing blood tests, is estradiol enough?
Dan Stickler:Yeah. I, you know, I've found that, I will typically test estrone and estradiol, but I've found that the estradiol is probably 95% of the time pretty accurate, with determining how much of aromatization is occurring. Which is that conversion of testosterone into estrogen. And like I said, you want some, it's a natural body process, but some people have excessive amounts of that. We actually look at some genetic factors that can promote that, and it correlates well with the lab work that we see. But, I like to get total testosterone, free testosterone, estradiol as my core.
Dan Stickler:Sometimes we'll get DHT, just to see that conversion of testosterone into the Dht. Testosterone can be metabolized into estrogen or DHT typically. I have not seen much in ... we do a lot of work with women as well, and they always complain that they've got hair loss. And so they're convinced that as the testosterone causing it, even though we know it's the cortisol that's crossing it. But we can't convince them of that until we get the blood work, and we've always had normal levels of DHT for women on testosterone replacement therapy.
Dan Stickler:So, we at least get that to show them why it's not that big of a deal. And we use predominantly injectable testosterone, testosterone cypionate. Which really bypasses a lot of that DHt conversion by itself. Whereas topical testosterone's going to have a very high DHT conversion.
Daniel Schmachtenberger:You mentioned hair loss, which people think of with DHD. But if a guy's thinking about his strength, or he's thinking about erectile function or prostate, there's a bunch of reasons that people might want to look at DHT. So, where would you see a situation where you actually want to bring someone's DHT up versus down?
Dan Stickler:Well, muscle strike, of course. DHT is a really good anabolic. It's really strong for building muscle. I see quite a few guys that have really low levels of DHT. If I've got somebody on testosterone, and they're doing everything right and they're not building muscle, then DHT can and can sometimes be the culprit. Um, I rarely see DHT levels too high unless they're on topical. Now on topical, I see a lot of elevated DHT. DHT can definitely lead to issues with the prostate, as far as enlargement is concerned. It can lead to hair loss. Now the roid rage, the anger, it's been pretty much debunked with hormonal therapies.
Dan Stickler:Testosterone, here's the way I look at testosterone. Testosterone build self confidence. It's one of the things that we see routinely. If you're an asshole, and you become more confident about your thought processes, then you become more of one. If you're a nice guy, you tend to enhance those aspects of it. So it's really enhancing your self confidence in your decision making, in your thought processing and everything like that. We just are not seeing that. I mean, most of these people with roid rage, I mean they've got pathologies underlying already. It's not the testosterone causing it.
Daniel Schmachtenberger:It's interesting. I've heard many people who believed that it was actually excessive conversion of testosterone to estrogen that wasn't being controlled, that was the roid rage. You don't think so. Just enhancing- [crosstalk 00:32:48]
Dan Stickler:No, most of what I have understood over the years is, it's more of that DHT conversion that's leading to that. Most have these guys that were on testosterone. were taking aromatase inhibitors. So they weren't getting much estrogen any way.
Daniel Schmachtenberger:So we, we've talked about testing testosterone, estrogen, DHT. We haven't talked about the difference between total test and free test. And why if someone has a total testosterone of 350 and their doctor says they're fine, and they don't feel that good, talk to us about physiologic range a little bit.
Dan Stickler:Well, the difference between free and total testosterone is, total testosterone counts basically three categories. It counts free testosterone, testosterone bound to sex hormone binding globulin, and testosterone bound to albumin. Free testosterone eliminates the albumin in sex hormone binding globulin bounds. So I say the total testosterone, it's like the number of soldiers in your army, and free testosterone are the number that have weapons. So you've got to really look at those ones.
Dan Stickler:Because testosterone doesn't do anything circulating around in the blood, and when it's bound to the proteins it stays in the blood. Now binding to sex hormone binding globulin is pretty much your irreversible binding, so it grabs onto it and it does not let it go. So, it's not getting out of the blood. Albumin bound, which is a small quantity of it, can come off when needed. So it's kind of a reserve, but it's a very small quantity of that. Sometimes they'll call that bioavailable testosterone, but that's a calculated number based on the albumin level, and never really a direct measure. I see a lot of problems with elevated sex hormone binding globulin across the board. Women on oral estrogens, birth control pills, even bioidentical estrogens taken orally, or things like the Nuva ring for birth control. I see sex hormone binding globulins off the chart all the time. They can persist for up to five years after they stop taking those. What's the consequence of this? It will make your total testosterone look much higher than what it is.
Dan Stickler:Because, your sex hormone binding globulin, that's going to circulate with that testosterone attached to it for roughly five to seven days. It's just the turnover time of breaking down the sex hormone binding globulin. Whereas free testosterone circulates for about 20 minutes in the circulation before it exits the circulation, gets into a cell, activates receptors in the nucleus. So it's important to really understand, and you don't have to necessarily get free testosterone, but as long as you're getting sex hormone binding globulin, you can get a rough idea. Direct measures of free testosterone are the best way to go. And they always correlate well with the sex hormone binding globulin levels.
Dan Stickler:I had a 44 year old male, very thin, uh, no muscle. He worked outside, he was a laborer. He came in with a 2,500 testosterone. I looked and he had a sex hormone binding globulin of 160, which is off the chart. I mean a male should be somewhere between 20 and 40, preferably between 20 and 30. His free testosterone was six, which I've seen people with 200 total testosterone, that had free testosterone of six. So we put him on testosterone, and within three months we retested him, and his total testosterone and came down to 1200. So we put him on testosterone and testosterone came down. He has sex hormone binding globulin came down to 80, so it's still a little elevated.
Dan Stickler:But his free testosterone went from six up to 17. A big improvement there. But he also gained 20 pounds of muscle mass in three months. That was what we would have expected. So there's a big difference in understanding free and total testosterone.
Daniel Schmachtenberger:So when you put them on test, you actually bound up the sex hormone binding globulin, which is what allowed the conversion to start happening?
Dan Stickler:There's a feedback loop of exogenous testosterone reducing sex hormone binding globulin. I'm not quite as powerful as the SARMs. I mean the SARMs dump sex hormone binding globulin to less than 10 and we don't know the consequences of that right now. But, just putting somebody on testosterone tends to lower that. We do that when we have females that have really high, like over 200 on their sex hormone binding globulin. They have no measurable amount of free testosterone at all. I mean, it's just all gone. We put them on it, and the testosterone replacement actually causes the sex hormone binding globulin to come down much more quickly.
Daniel Schmachtenberger:So you mentioned that for women sex hormone binding globulin can go up as a result of hormone replacement. But for guys, what induces excessive sex hormone binding globulin, and other than a SARM or testosterone, is there anything someone can do for that?
Dan Stickler:Well, there is some evidence of stinging nettle root, which is what we typically put people on. It's the only thing I have seen in the literature that is really ... in the medical literature. I've researched how to lower sex hormone binding globulin, and the medical literature, actually recommends the stinging nettle root. Not the leaf, but the root. And we've had modest results with that. I mean, it hasn't been spectacular. Usually it's just the testosterone injection itself that really helps bring it down. But it'll come right back up when they go off testosterone too.
Dan Stickler:This one guy that came in to me that had the 2,500, he was on like 40 different supplements a day. I figured it was something he was taking that was doing it, but I couldn't identify which ones it was.
Daniel Schmachtenberger:Have you started to explore genetic predispositions there yet?
Dan Stickler:Yeah, yeah, we have about 20 genes that we look at, 20 variants that we look at, that specifically address sex hormone binding globulin. We've got some consistency with it, but I'm trying to narrow it down, which ones are the most impactful right now. We just don't have enough volume of people going through the testing quite yet. We're seeing propensities, but it's not as accurate as I would like to see it. And over time we're going to have enough to really identify that.
Daniel Schmachtenberger:Talk to me real quick about adrenal hormones related to sex hormones, DHEA, cortisol, pregnenolone .
Dan Stickler:Well DHEA, that's one of those hormones that I think people definitely are too low levels. The normal values they're associated with DHEA are substantially low in my opinion, from what I've seen from performance standpoints. I like to see it between 350 and 500, for sure. In both males and females. It's banned from sports competition, which I think is the most ridiculous thing ever. I mean, it's really anabolic effect is pretty minimal. It's great though for immune modulation. It's great for women that have PMS, women that have after menopause, and menopausal symptoms, DHEA is more effective than estrogen in most of the cases that I've seen with it.
Dan Stickler:So the DHEA is really a potent immune modulating hormone in my opinion. It's not much as far as performance is concerned. A little bit and brain performance. But as far as a physical performance, I don't find the DHEA to be hugely impactful in that realm. Especially relative into testosterone. So then, pregnenolone. I mean it's the mother hormone. It's what it's all kind of made from. And you do see deficiencies in that, especially in stress cases. You get a pregnenolone steal, which can really tank your other hormones. So you've got to make sure you've got enough of that pregnenolone circulating. People that go on low cholesterol diets, you've got to have cholesterol to make pregnenolone. They go on these low cholesterol diets or take statins, and their and their cholesterol really drops off. You see huge hormonal impacts with that.
Dan Stickler:You've got to look at that whole system. That's where medicine is just so off base right now, is it's so focused on these stove pipes of what they're treating. Rather than looking at the impact of this across the board.
Daniel Schmachtenberger:Okay. So we could talk for hours on understanding the hormone pathways and how they relate and it's actually kind of painful for me to just move on. But seeing the amount of time I want to get into what can people do about it. So that's kind of a little intro to some of the hormones that are interesting. I might ask you at the end if people wanted to learn more, what are some good sources? Actually, anything off the top of your head right now as a good source for people to learn more about the hormone pathways?
Dan Stickler:Uh, you can look them up online. You just look at hormone pathway and go to images on google and you can get some really detailed images of the hormone pathways to help you understand that. There's some basic trainings on there too that you can ... understanding hormone pathways and type that in. You can find a lot of educational material on that.
Daniel Schmachtenberger:Okay, so now basics of male hormone optimization. You started to talk about injecting tests. There's obvious testosterone, there's obviously different forms of tests to inject. We also talked about topicals. That's probably the right place to start. So if someone sees testosterone markers that are low, what would be the deciding factor to try using testosterone? And what forms would you recommend for what things?
Dan Stickler:Well, I've been doing this for close to 20 years now, so I am a big fan of it. I've seen the outcomes with it, and you can't go by that total number. I mean, you got to have the free. If the free is 12 or less, in the nanograms per deciliter ... this is the weird thing too. I have to mention this, depending on the lab you go to, it's going to be nanograms per deciliter, or what's the other form of it? Pica grams per ml.
Dan Stickler:To convert picograms to ml, to nanograms per deciliter, you have to divide by 10. And the scales don't ever match, they don't even come close. I mean, for nanograms per deciliter, it's like 2 to 25. And you really want to be 18 or higher, 18 to 35 is kind of that great zone of a response that I see. And so that should translate into 182 to 350 on the picograms per deciliter. I think the ranges are like 60 to 150. So it would be like six to 15 versus the other scale which is showing 2 to 25. So they don't even line up.
Dan Stickler:This is the problem, there are no guidelines for setting up what testosterone levels should be. Total even. Total doesn't have guidelines. I mean, you look at some lab, say 150 is the point of pathology, other say 250. Then the peak side of it, some labs are at 800 and other labs are at 1600. So, it just depends on the lab. I think there was a Harvard study done many years ago, that they analyzed 25 labs that ran testosterone levels, and they said what's the clinical relevance of these ranges? And 23 and 25 lab directors said, "There's no clinical relevance whatsoever."
Dan Stickler:What we do, is we measure lab techs each year. Or we take the tests that were brought in, in the last year, and we use those as our range. Well, who's getting tested for testosterone levels? It's typically people with low levels, that have symptoms. So you're going to have a nice range, of symptomatic people on their scale. So, you've got to go to somebody that really understands that.
Dan Stickler:Endocrinologists or not the people to go to. There are some really experienced endocrinologists. Urologists are another group, that are not the best people to go to for hormone replacement. It's because these people focus ... like the endocrinologists. They're overwhelmed with the amount of thyroid and diabetes if they're dealing with. For the urologists, they're after procedures, so they don't focus on replacement. Or they'll make it come in and get an injection, because they don't trust you with having a prescription for it.
Dan Stickler:So go to some, a physician that specializes specifically in the hormone replacement, that has a lot of experience in it. I would recommend not going to somebody who looked like a bodybuilder, as far as the physicians are concerned. They tend to be cowboys in that regard. You either want to go to somebody who kind of looks like you want to look, essentially. They're fit, but not excessively bulky or anything like that. Those are usually the physicians that have the best take on the testosterone replacement.
Dan Stickler:Now topical versus injection, hands down injections win, by far. There's a lot of argument that the topical is better regulated, as far as daily levels. But if you look at the pharmacology of it, testosterone typically, has about a seven day half life. So basic pharmacodynamics says that after three half lives, you should be pretty close to steady state levels. That's what I pretty much see. I mean, I see a little fluctuation between 48 hours after the injection, and the day of the next injection. There's a slight variation in the totals. But I don't see much of a dramatic difference in swing.
Dan Stickler:Some people psychologically feel a difference, and they'll inject twice a week instead of once a week. But I also see people that are injected once a month, once every two weeks, and that's just insane. They feel great for like the first three or four days, and they tank for the rest of the month. It's pretty sad to just see these people that ... and they're usually people that are required to come into the clinic for an injection, rather than doing their own.
Daniel Schmachtenberger:And specifically cypionate is your preferred form?
Dan Stickler:Pf the available forms that we have in the United States, yes cypionate. There are some mixes. There's a tri-mix which is cypionate and enanthate propionate, which they have kind of three different half lives. But I can tell you propionate burns like stink. I mean you've got to really have good pain tolerance for the propionate, because it's so acidic. But, it's only got like a two day half life, so it's really short. Enanthate is about five to seven days, and then cypionate is about seven days. So the tri-mix was available through compounding pharmacies for a while. I haven't seen it available in a while, and it was nice because it really hit all those half lives. But cypionate, by far. I like it better than the enanthate. It seems to have the best response.
Dan Stickler:I've been out of the country, and used Sustanon, and I can tell you a world of difference with Sustanon. Sustanon is a mix of quite a few different ones.
Daniel Schmachtenberger:And that's Russian, right?
Dan Stickler:Right. That's what the Russian bodybuilders were really ... they developed that one mean. You look at the number of anabolics that are on the market, there's hundreds of them. You can go to Wikipedia and just type in forms of androgens, and there's hundreds.
Daniel Schmachtenberger:Okay. So let's talk about when people think about steroids, and the downsides of steroids to positives. For the most part, the main thing we're talking about is actually testosterone and androgens, just in way higher than normal physiologic range. But then, also looking at some other anabolic kinds of hormone. So, what's the difference between optimization in the healthy range, and where people get into trouble?
Dan Stickler:Well, most testosterones are dose dependent, so the higher the dose, the better the response that you get. But I've found that pretty much when you're in an optimized range, you have that ability to really create an outcome that you want to see, without being into a bodybuilder range. To get to the bodybuilder range, you got to do about three times the dose of an optimizing range. Three to 10 times the dose. So using an optimized level, you're able to build muscle. I mean, you're typically not going to get over the 25 to 27 lean BMI. That's gonna be kind of that top range of that. That top range of it, would be like the top 10 male CrossFitters. Those are lean body mass index of 25 to 28.
Dan Stickler:A lot of studies have looked at it and to naturally build the body, you typically can't get over 25 without some form of exogenous steroid. 25 is kind of the max. They looked at all these bodybuilders prior to the age of hormones and, and that's what they essentially found was that they can cap out at about 25, with full effort of the human body. So, that enhanced range, you're going to get 25 to 28. Really the male body, the physique looks really good around 22 lean BMI, with a low body fat.
Dan Stickler:I used to joke with some of the guys in the gym, I said, "Who you getting those biceps for? Is it for the girls or the guys?" Because it's always the guys going, "Hey, yeah. Those are great guns." Girls typically prefer the more cut, muscular lean guys than that physique of too much.
Daniel Schmachtenberger:When we start looking at excessive levels of testosterone or growth hormone, we're usually looking at two things. Which is dropping endogenous production when you get off, even if you do a post-cycle. And we're also looking at some of the negative effects of that much anabolism, especially with things like growth hormone and growth of organs and things like that. [crosstalk 00:52:06]
Dan Stickler:You're gonna get some risks with that. Some risks with cardiomyopathy, some enlargement of the heart that can occur. Those are the main things. Over time you can get the roid belly where you get the really odd shaped abdominal cavity and chest cavity. Those are really long term users. But, in the males, typically they can sustain the higher doses for a much longer time than a female. A female really gets masculinized on the higher doses of testosterone, profoundly masculinized. I mean, you look at some of these women after 10 years of doing high dose androgens, and it's hard to really differentiate them from males at that point.
Dan Stickler:You were talking about the post-cycle therapy. I mean, the high dose really requires that. Natural dose, I've had guys on the performance dose of it ... keeps them in that physiologic range right at the top end. On it for five years without doing any post cycle therapy, or anything when they came off because they wanted to have kids. They were able to have kids within a couple months. So, nice rebound on that, just don't see as much suppression, when they're there in those lower ranges. I mean, when you get up to that three to six times what is really a performance range, you can get into significant testicular shrinkage, and probably longterm atrophy of the of the testes.
Daniel Schmachtenberger:So talk to me about HCG injections. Clomid, nolvadex for boosting endogenous testosterone production in the testes. Both as a post cycle therapy as an alternative maybe, especially for young guys or people who don't want to be on testosterone forever. And/or as a way of combating a testicular shrinkage while on testosterone.
Dan Stickler:Yeah. So human chorionic gonadotropin, and it's really good. It mimics luteinizing hormone, which is what the pituitary secretes into the blood, cause the testes to be stimulated to produce testosterone. So, the HCG works really well to do that. We've had some people that were young with healthy testicles, that giving them some HCG is because, the disconnect is they're not recruiting as much LH as they need to.
Dan Stickler:When you initially go in, you're going to get tests for luteinizing hormone and testosterone, so you can get an idea of how much stimulation is occurring. So naturally, as testosterone levels will decrease, luteinizing hormone levels should go up. Because the brain's going, "I'm not getting enough testosterone to stimulate this testes." If the testes aren't responding to the luteinizing hormone that's increasing, it's not going to do any good to put somebody on HCG. So you've gotta kind of look at that and decide which way to go. Now some of the younger clients that I work with, they tell me, "In a couple of years I want to have kids." I'll typically put them on HCG intermittently throughout the year. So, usually three cycles a year, of one month with the HCG on top of the testosterone. It's not going to boost their testosterone production to any degree, but at least it stimulates the testes periodically to keep them nice and healthy. So that when they do come off the testosterone, they can quickly get the testes back online.
Dan Stickler:Clomid tends to work well in a different route. It kind of blocks the feedback loop, the testosterone to the pituitary. So, the hypothalamus gets the impression that there's not enough testosterone. So, it secretes more LH and FSH to stimulate the testes. As long as that clomid's there, the brain's still not getting that feedback loop. I've seen clomid work in healthy younger males all by itself, as far as increasing testosterone.
Daniel Schmachtenberger:So if you've got someone who's on testosterone, and maybe using HCG now and again to just keep their endogenous production capacity up. When they get off, you also then would have them do an HCG or clomid round, to kind of speed up the rebound?
Dan Stickler:Yeah, because typically they're coming off, because they want to have kids. So I'll put them on either clomid and HCG, or just HCG by itself. And, typically see the testes rebound within a month of that end-post cycle therapy. It's just because the dose that they're on, they're not fully suppressing the testes, even though the CLH level's very low. They rebound very quickly. I've had many of guys that have had kids within two months of coming off therapy.
Daniel Schmachtenberger:In case it's not obvious for people, why do they need to get off of test if they want to have kids?
Dan Stickler:Well, typically it's because the testosterone circulating around is telling the brain that there's plenty of testosterone, that does not need to stimulate the testes to produce more. And when the tests these aren't stimulated, they tend to atrophy. So they'll shrink, and it's kind of a myth. The doses we use, we don't see the shrinkage in the testes as much as you see with the high dose users. Some high dose users are talking about testes being the size of peas. We don't experience that in our crowd.
Dan Stickler:There is definitely a reduction, usually about a 20% reduction in testicular volume after about a year on testosterone therapy. But, you do just a one month course of HCG, and it usually rebounds right back to normal. When you come off therapy, you've got to kick it back in. Because not only are the testes reduced in size, and not producing testosterone, but they're also not creating sperm. So getting the testes these re-stimulated gets them producing sperm again. But, being on testosterone doesn't make you infertile by itself.
Daniel Schmachtenberger:Talk to us about SARMs.
Dan Stickler:Love SARMs. They're not allowed for human consumption in the United States, but I work with a lot of clients that have elected to do this on their own, and they've asked me to help them with it. Tried it myself. Really, really like what I'm seeing with it. SARMs are selective androgen receptor modulators. What they've done is, they've chemically modified testosterone, essentially, to work specifically into areas. It works almost exclusively in muscle and bone. So you get an anabolic effect, but not an androgenic effect.
Dan Stickler:So androgenic is all of the male characteristics, whereas anabolic is growth aspects of the testosterone. A lot of really good ones on the market right now, that work really well, and used in males and females. The other advantage is that, it does not stimulate the prostate at all in males. In fact, it has been shown to reduce prostate enlargement, while still giving you the anabolic effect of testosterone. And the reason for that is, that when it gets into the cell and the cytoplasm, it all combined with heat shock protein. Then there's another co-factor combines with it, migrates into the nucleus and binds onto the DNA.
Dan Stickler:Well, in prostate cells, there's five alpha reductase, which we talked about, converts testosterone into the DHT. And that's required for activation of that complex, in the nucleus of the cells in the prostate. That's not required in the cells in the muscle and the bone. And that's why you get the positive effect on muscle and bone, and you don't get the negative effect in the prostate itself. So SARMs came about I think in the late '90s. People started really marketing them, and there's a bunch of them out there, and they all have little differences in what they do.
Dan Stickler:Probably the most used right now would be Ostarine LGD-4033, and a new one which looks pretty good, which is LGD-3033, and a little bit more potent. And S4 and RAD-140s, those are really a really good SARMs, that people have been using. There's a lot of research on Ostarine and LGD. Some of the drug companies were actually researching these, in order to find something to help with muscle loss and bone. Works really well for building bone density, for building lean body mass without the androgenic effects. Interesting thing though, it doesn't have the dose dependent response that testosterone does. So, by taking more, it doesn't have a greater effect, which is kind of cool. So it keeps you in that performance range, without getting into the overt enhancement range.
Daniel Schmachtenberger:Okay. So I'm curious about a couple of things. With regard to various SARMs, the topic of SARMs versus testosterone, versus SARMs with testosterone, and cycling of SARMs. Can somebody stay on Ostarine longterm? If they're cycling off of it, do they have a post cycle therapy they need to do? Is there anything else they need to be cognizant of? Yeah, talk to us about those things.
Dan Stickler:Yeah. The interesting thing is, most of the SARMs do not require a cycle therapy. Because they don't suppress the HPA access. So, they're not reducing that luteinizing hormone release that occurs. So, you can be on the SARMs, and not worry about it. Now there's a couple that do. You have to know which ones you're dealing with. I think S4 has a requirement for a post cycle therapy in most people. But the Ostarine and LGD, LGD has a minor one. Ostarine's probably the least impactful one, on the reduction in [inaudible 01:02:17] production. But you don't really require that.
Dan Stickler:Now you still have to cycle these, because they kind of peek out. You kind of build a tolerance to them over time, usually about 12 to 14 weeks on a cycle, and then come off. But the one thing that we are seeing that's happening, is this really profound drop in sex hormone binding globulin, and that's a new thing. So we don't really know the consequences of that longterm. It rebounds pretty quickly as soon as you stop.
Daniel Schmachtenberger:You see that from all the SARMs?
Dan Stickler:Pretty much. Yeah, all the ones that I have followed up clients on, I'm seeing that sex hormone binding globulin and really get below 10 and almost every one of them.
Daniel Schmachtenberger:So you can't cycle off of MK-2866 onto RAD-140. You have to cycle off all of them for a while, to let the bounce back occur.
Dan Stickler:That's what I suggest to clients that are doing it. I usually have them come off for about a month or two. But again, most of my clients are already on testosterone, so it's not a big deal for them. It's just a bit of a boost, especially for guys that had been on testosterone for awhile. It's a nice little boost for them that they've opted to do.
Daniel Schmachtenberger:And there's a few things that people cluster with SARMs, that aren't actually SARMs. Like the MK-677 and GW. But that are also in this kind of performance enhancement range. Can you just speak quickly to them?
Dan Stickler:Yeah. So the GW-501516 also called Cardarine, is not a SARM, but it's an interesting and really cool one, I really like it. It is a PPAR agonist, so peroxisomes proliferating activating, or activation receptor. I can't remember exactly what PPAR stands for. I see a lot of genetics of people that have low activity or low production of PPAR GC1-a, PPARD, and this actually goes in and stimulates the receptors, which is pretty amazing. You see a big boost in VO2 max, exercise performance.
Dan Stickler:I was actually taking it for three months leading up to a spartan race, and my VO2 max went up by like four points. And didn't even pay attention to it, but I noticed my running the other day was really not optimized. I started looking at my VO2 max and my biometrics and I've dropped three points in the last three months. So the only thing I can attribute it to is the GW, which I was taking. So, it's definitely impactful for me. And it helps with weight loss. I mean, you want to cut, I mean that, that, uh, that GW-501516 has been pretty effective in clients that have been taking it.
Daniel Schmachtenberger:Something I noticed when I took it was, my max on one rep didn't go up weight wise, but at a specific weight how many times I could do it went up a lot. So I would go from 10 reps to failure, to 15 reps to failure at the same weight, being on it.
Dan Stickler:Yeah. Because it doesn't have much in the way of strength or anabolic. It definitely does have an impact in performance. Which we've really seen that, and it's also a lot of health markers go up. It improves cholesterol, and in whole host of other things. The MK, or Ibutamoren, is a growth hormone releasing peptide that can be administered orally. All of these SARMs are oral, so they're modified in a way that actually absorbs, and best form is a tincture. I don't like the pills. I don't find the same effect with the pills in clients that are taking it. But the liquid tinctures, which tastes like crap, but they work.
Daniel Schmachtenberger:Peptide warehouse kind of places, or a SARMs warehouse.
Dan Stickler:Yeah, yeah, absolutely. But, that alcohol based tincture works really well. But, getting bact to Ibutamoren, it's a growth hormone releasing peptide. It's highly effective. The people I've seen take it sleep really well after they've taken it, but it tends to wear off pretty quickly, after being on it for a week or two. Then you don't get the full growth woman are an effect of it for months. It's just a very slow, slow process. You have to take it at night before bed to really boost that sleep pattern. But I've seen sleep patterns on wearable devices that improved dramatically with, with Ibutamoren. But, I prefer really peptides over Ibutamoren. As far as the injectable peptides, I think I'm seeing much better response with those.
Daniel Schmachtenberger:So we didn't talk about growth hormone much at all yet. Can you just say briefly-
Dan Stickler:I actually got about 10 more minutes.[crosstalk 01:07:33]
Daniel Schmachtenberger:All right then we'll do that.
Dan Stickler:I got a little reprieve. On growth hormone, I mean, I don't like replacing growth hormone by itself. I used to do it many years ago, and then there was some data coming out about people chronically using growth hormone and getting pituitary atrophy. And not just of the anterior pituitary, they were getting pan pituitary atrophy with growth hormone. It's a very unnatural way to do things. I mean, you're injecting a dose that peaks out and stays up all day. Whereas the normal growth hormone releasing, is these two spikes predominantly at night, with multiple tiny spikes during the day.
Dan Stickler:So, you want to mimic as much natural production as you possibly can. A lot of the growth hormone releasing peptides are wonderful, because they actually enhanced the peaks, rather than causing the ... it's strange because you would think, you know, growth hormone releasing peptide, you give it, it's going to go right to the pituitary and caused this surge. But it doesn't work that way. It just seems to enhance the peaks. Which is really impressive the way it does that. I've seen people that'll do it for a couple months, and then they'll come off it and their levels will stay up for three months. It's just like, it upregulates the pituitary in that regard. So you don't have to stay on it all the time, and it's a lot cheaper than growth hormone.
Daniel Schmachtenberger:So is this So it was this Sermorelin, GHRP-6, which ones?
Dan Stickler:The most effective one is Tesamorelin. Tesamorelin is available both by prescription, which is like a thousand dollars a month, or through some of the peptide warehouses where it's a lot cheaper. But, Tesamorelin is by far the most effective growth hormone releasing peptide that I've seen. Very fast acting. I mean within two to three weeks of being on it, you're seeing results. Most of the other ones are going to take months.
Dan Stickler:GHRP-6, you have to be careful because it will jack appetite through the roof. These people will eat voraciously. I had one guy that said he had to time it, so right when he was getting ready to go to sleep, he would inject himself. Because otherwise he would just, within 10 minutes of getting it, he was in the kitchen just chowing down on food. So I haven't had real good results with GHRP-6 by itself. GHRP-2 and Sermorelin combined, pretty effective. One that I have found some pretty impressive results with, his CJC 1295, with the drug affinity complex. It's a twice a week, which is, you know, that thrilled me to know it was only twice a week, as opposed to every day with tesamorelin, or the other growth hormone releasing peptides.
Dan Stickler:I really like what they're, what they're bringing on with the CJC 1295. But you have to do the DAC, if you want the every other week. And it's pretty reasonable. It takes a little longer to onset, usually three to six weeks. So it's not quite as good. Sermorelin now, is pretty much old school. So much better stuff than sermorelin right now. If a ipamorelan kind of fell by the wayside too, with the tesamorelin coming on board and the CJC.
Dan Stickler:So, you're getting better and better with this. The industry is really figuring this stuff out, in a pretty cool way.
Daniel Schmachtenberger:Maybe just last thing is, other peptides that are interesting for anabolic purposes. Obviously a lot of peptides are going to be specifically for regenerating damaged tissue, or for skin, or for immune function. I'm curious if you've ever played with the Russian oral peptides, like Testoluten, or any other injected peptides that have performance enhancing effect.
Dan Stickler:Well, we've talked about this, the Epitalon, which is pretty amazing. The clients that have chosen to do Epitalon, I mean, they rave about it. I've never seen a response of anything that was so consistent, as the people doing Epitalon. Follistatin, I have not seen good results with. Follistatin is a myostatin inhibitor, which is designed to build muscle. But, it's kind of disappointing right now. I'm not sure why, but even in the Reddit forums, people were downplaying the Follistatin pretty much right now.
Dan Stickler:The BPC-157 and TB-500, wonderful for soft tissue recovery, for injury prevention, for just recovery in general. I know a lot of crossfitters that are doing the TB-500 or the BPC-157. And the interesting thing about BPC-157 is, you can take it in an oral capsule, it's one of the few peptides you can do that with, and you absorb about 50% of it. It's amazing for recovering the gut, it's just huge for healing in the gut. Had a couple of clients that have used it for that, and works very quickly.
Daniel Schmachtenberger:That's were it comes from.
Daniel Schmachtenberger:Yeah, peptide. Since it's a short peptide, I do it sublingually, and you're going to get a little bit of an oral but a little bit of sublingual absorption. I think anything that's maybe less than about five amino acids, make sense that you'd get some sublingual absorption.
Dan Stickler:Yeah, yeah, absolutely. The other interesting one is melanotan. Melanotan 2, most people are taking it to tan their bodies, and it works. I mean rapid tan within three days. You've got a full summer tan with this stuff. You just have to make sure you mix it right. Because I had somebody that makes it in .3 cc's instead of 3 cc's for 10 milligrams. Not a good idea. The interesting thing about that it though, it stimulates the alpha MSH. It mimics alpha MSH. When you're talking about people that have, Chronic Inflammatory Response Syndrome, like from mold or from Lyme, they're problem is that their alpha MSH tanks.
Dan Stickler:Met a guy the other day, I looked at him and, and you can tell because most people with melanotan, and they get a little bit of dark circles under their eyes. I said, "You're taking melanotan." And he said, "I am." And I said, "Are you taking it for tanning purposes?" And he said, "No, I'm taking it because I have chronic mold." I kind of came to that on my own conclusion that it would work. And then I found somebody who was actually doing it, and he said it worked miracles for him. It was just amazing to hear that.
Daniel Schmachtenberger:Do you have any experience or insight on melanotan compared to intranasal MSH?
Dan Stickler:Have not.
Daniel Schmachtenberger:Okay. When I see MSH low, in people with biotoxin illnesses, this is obviously a different topic. It just controls so many things since it's interior, posterior pituitary communication. But it's a little bit hard to get up. And I haven't played with melanotan that much, with a few people. But I'm very curious in that differential, in those two.
Dan Stickler:Well, this guy raved about it. I mean, you look at the pathway of alpha MSH suppression in Chronic Inflammatory Response Syndrome, the cascade is scary.
Daniel Schmachtenberger:Okay, so closing thought, and I want to just let listeners know. If you have any questions that you're really interested in, send them into customer service on this. If we get enough questions of a certain type, we'll make a follow up on it. We've maybe discussed 15% of the topic that I hoped to discuss, and yet it's awesome. So again, thank you.
Daniel Schmachtenberger:There's a whole bunch of things that are promising, but we're not quite there yet. Like myostatin inhibitors, like the SR-9009, like oral peptides, like whatever interesting things. What is interesting to you on the edge, that you think will be developing into, in this space, the kind of anabolic space.
Dan Stickler:In the anabolic space? I think we're going to get better and better with the SARMs That's such an exciting area, just because they've been able to engineer these chemicals to be so site specific. Then even the peptides, peptides are amazing. They're inexpensive. I mean all you need is a peptide sequence, and somebody to do quality control with it. And you can manufacturer peptides anywhere. Uh, it's not an expensive process overall. I think with all the bio hackers out there experimenting with this stuff, I think they're going to be leading the way. And just in the same way that bodybuilders led the way for testosterone replacement, I think these bio hackers are going to be leading the way for human optimization across the board in these different categories.
Daniel Schmachtenberger:And if someone can't find a doctor who has a compounding pharmacy, that can get them peptides for instance, because there just aren't that many of them, then what do you think about places like peptide sciences for quality control?
Dan Stickler:I'll tell you, Reddit is a really good forum to find out which ones work. Because these are people that have been going to the different websites. Some of our favorite websites have closed down. They pop up and they close down. But, people are pretty good. I mean it's like yelp for peptides and SARMs, when you go into these Reddit sites. You can get ratings, and people who have had experience with really effective stuff. Then they get the stuff from somebody who's not producing quality stuff, they'll let you know. It's a nice kind of crowd based community, that polices itself.
Daniel Schmachtenberger:Yeah. I miss Ceretropic a lot.
Dan Stickler:Yeah, Ceretropic was wonderful.
Daniel Schmachtenberger:So, on Reddit, obviously not everyone is equally smart. You can find it takes a little while to pay attention to what the scores are and et cetera. One of the quick things I would say is, don't get overexcited and want to try every cool thing right away. Do one thing at a time, and typically spend three times as long studying as you think you need to, before you start, because you'll have a much better experience. Any other kind of words of caution, or words of wisdom for people who want to take what they learned here and go further?
Dan Stickler:Yeah, there's a tendency for people to want to jump in and stack all this stuff. "Oh, I want this because it causes weight loss. I want this for VO 2 max. I want this for muscle. I want this for sleep." So, you throw them all together and it just doesn't tend to work very well that way. I say pick one or two, kind of focus on that. See what kind of response, and always have something measurable. Say, what are you measuring? What are your testing, to see if this is truly working for you? Just get some guidance from somebody that really has been there, done that. Or, somebody that can at least make sure that they're monitoring what you're doing, a little bit more closely.
Daniel Schmachtenberger:Now on that, your clinic in Asheville is still running. Do you have a clinic in Austin yet?
Dan Stickler:Yeah, it opens this week.
Daniel Schmachtenberger:Very nice. [crosstalk 01:18:54] So if someone happens to be near Austin or near North Carolina, great. If they don't and they're interested, do you take remote clients?
Dan Stickler:I do. But we also have health coaches that we've trained, all over the United States. Most of them work remotely, but they're actually educated in the SARMs and peptides.
Daniel Schmachtenberger:All of them?
Dan Stickler:Pretty much, yeah, I mean, we provide them education in the area, because we do know that they're going to encounter people that are going to be doing these. So we do provide them with the education. And, they'll work with clients all over the world. Got about 140 coaches, now.
Daniel Schmachtenberger:So where does someone go to find one of those coaches, or to look at your clinic?
Dan Stickler:Yeah, if you go to AppearOnCenter.com or go to AppearOn.coach, either one of those. Fill out the contact form on there. We can line you up with coaches, or the center.
Daniel Schmachtenberger:Thank you the time. This was fun and valuable. I hope this was a good kind of introduction to the topic for everybody. [crosstalk 01:20:14] I do look forward to hearing questions that come in, and we'll see where we go next.
Dan Stickler:All right, sounds good.