Optimising hormones for health: the six pillars and key interventions

Executive overview

Hormonal health declines gradually and is often misread as normal ageing. Patients — especially men — underreport symptoms, leaving problems undetected until they're entrenched.

Dr. Kyle Gillett's framework centres on six lifestyle pillars that govern hormone output before any supplementation is considered. Diet and exercise are the most powerful levers; stress, sleep, sunlight, and spirit follow.

Consistent, moderate lifestyle inputs over time outperform intense short-term interventions for long-term hormone health.

The six pillars of hormone optimisation

• Diet — individualised to genetics and metabolic phenotype; no universal fuel type applies
• Exercise — 150–180 minutes of zone 2 cardio per week minimum; resistance training especially important for hormones
• Stress optimisation — cortisol dysregulation harms mental, social, and hormonal health; household-level change is more effective than individual change
• Sleep — critical for mitochondrial health and hormonal recovery; poor sleep is both a cause and consequence of hormone imbalance
• Sunlight — encompasses outdoor movement, cold exposure, and heat exposure
• Spirit — body, mind, and soul are interdependent; spiritual health has measurable physiological effects regardless of religious belief

Getting a useful lab workup

• Telling a doctor "my energy, focus, and performance are lower than they used to be" is enough to justify hormone testing — no pathology required
• Women more readily receive hormonal investigation due to menstrual data; men are more reluctant to discuss libido or energy with doctors
• Blood tests every 3–6 months for preventative monitoring; test both fasted and non-fasted states

Diet, caloric restriction, and fasting

• Caloric restriction improves testosterone in obese or metabolically unhealthy individuals
• In young, lean men, caloric restriction can decrease testosterone
• Intermittent fasting at caloric maintenance is not harmful to hormone health
• Fasting increases overnight growth hormone pulses; avoiding food 2–3 hours before sleep provides meaningful (if diminishing) benefit
• Growth hormone triggers IGF-1 synthesis in the liver; local (autocrine/paracrine) IGF-1 from exercise improves body composition independently of systemic IGF-1

Testosterone in men and women

• Women have significantly more total testosterone than estradiol — different units obscure this; DHEA levels exceed both
• SHBG (sex hormone-binding globulin) binds DHT most strongly, then testosterone, then DHEA, then estradiol — free (unbound) fractions are the smallest proportion
• For health optimisation, testosterone is as important to know in women as estrogen; for pathology prevention (breast cancer, osteoporosis), estrogen and progesterone take priority

DHT: effects, inhibitors, and hair loss

• DHT is a potent androgen bound by the same androgen receptor as testosterone and DHEA; the androgen receptor gene is X-linked (inherited from the mother)
• DHT supports motivation and makes effort feel rewarding
• Plant polyphenols — including bioavailable curcumin (turmeric + black pepper extract) — inhibit conversion of testosterone to DHT; avoid if DHT or androgen sensitivity is already low
• Systemic DHT inhibitors (e.g. finasteride, dutasteride) can reduce libido, affect, drive, and sexual function
• Dutasteride mesotherapy — localised scalp injections — reduces DHT conversion only in the scalp, preserving systemic androgenic effects; most promising targeted option for hair loss

TRT: risks and sleep effects

• Testosterone does not cause prostate cancer, but will accelerate growth of existing cancer — relevant given the very high autopsy prevalence in men over 80
• TRT raises sleep apnea risk in a dose-dependent fashion — applies to both hypogonadal and eugonadal men
• New TRT users may enter a hypersympathetic state in the first 1–2 months due to overactive androgen receptors, disrupting sleep

Prolactin, dopamine, and relationships

• Prolactin and dopamine operate in balance — excess dopamine stimulation leads to a rebound crash; stable, moderate dopamine is the target
• Estrogen up-regulates the PRL (prolactin) gene, directly increasing prolactin synthesis
• Casein (milk protein) and gluten act as mu-opioid receptor agonists in the gut and can elevate prolactin
• Smoked marijuana increases aromatase, converting testosterone to estradiol — elevated estradiol then suppresses LH and FSH, lowering testosterone; THC/CBD alone do not have this effect
• High alcohol, benzodiazepines, and barbiturates all reduce testosterone
• In relationships, deliberate time apart allows dopamine to reset, rekindling attraction; plan ahead for hormonal lows during pregnancy and breastfeeding

PCOS: diagnosis and management

• PCOS (polycystic ovarian syndrome) prevalence may be 10–20%; most women are diagnosed in their 30s, often first presenting with infertility
• Rotterdam criteria: two of three — androgen excess, insulin resistance, or polycystic ovaries (ultrasound not required)
• Symptoms of androgen excess: hormonal acne, hirsutism (chin hair), voice deepening, female pattern hair loss, oligomenorrhoea (cycles >35 days apart or <9/year)
• Insulin resistance markers: obesity, pre-diabetes, fasting insulin >6, HOMA-IR >2
• Metformin is one tool; myoinositol (insulin sensitiser) and D-chiro-inositol (weak antiandrogen) are useful adjuncts — the ratio matters depending on sex
• Improving body composition and reducing metabolic syndrome is primary treatment for insulin-dominant presentations

Peptides: risk stratification

• Peptides are highly heterogeneous — some safe, some dangerous; physician oversight is essential
• Growth hormone-releasing peptides (GHRPs): meaningful cancer risk (tumour growth via IGF-1); cosmetic benefits achievable through safer alternatives — most people do not need them
• BPC-157: not FDA approved but widely used; promotes angiogenesis via VEGF — contraindicated with active cancer or high cancer risk; most beneficial early in injury for tissues with poor blood supply (cartilage, ligaments)
  • Non-prescription sources often contain LPS (lipopolysaccharide) contamination, causing inflammation; perceived "tingling" is likely LPS reaction, not therapeutic effect
  • Use only from compounding pharmacies that verify LPS removal
• Melanotan / PT-141 (bremelanotide): FDA approved for hypoactive sexual desire disorder in women; also used in men; delivered nasally, orally, or by injection; contraindicated with personal or family history of melanoma
• Caffeine: negligible direct hormonal effect — only matters if it disrupts sleep