Ben Greenfield [00:00:00]: My name is Ben Greenfield, and on this episode of the Ben Greenfield Life podcast.

Dr. Amie Hornaman [00:00:03]: DHT is the most potent testosterone. It's what we want in our body to actually have the anabolic effect instead of the androgenic effect. So androgenic is the male characteristic. And for women taking testosterone, we want to mitigate that, obviously, but we want the anabolic, we want the muscle growth, we want the strength. So you don't really want to shut down the DHT pathway in either sex. You just want to mitigate and address each individual if they have that genetic tendency toward the androgenic side effects.

Ben Greenfield [00:00:42]: Fitness, nutrition, biohacking, longevity, life optimization, spirituality, and.

Ben Greenfield [00:00:50]: A whole lot more.

Ben Greenfield [00:00:51]: Welcome to the Ben Greenfield Live show. Are you ready to hack your life? Let's do this.

Ben Greenfield [00:01:06]: My guest on today's show blew my mind, and I know many of you really loved my last show with her. It's Dr. Amie Hornaman. We did an episode about all the things your doctor won't tell you about the thyroid and little-known hacks to improve your thyroid function, the best thyroid supplements, and a whole lot more in our last episode. And Amie kind of hinted during that episode about the importance of testosterone, especially when it comes to women's hormone management. And I'm so intrigued by this topic that I want to get into that. Guys, if you're listening in, we're also going to talk a little bit about steroids, about things you may want to tell your wife or your mother or your sister or your girlfriend or someone else who you think might benefit from hormone management. And Amie's just a wealth of advice. If you didn't hear our last podcast, I would link to it in the show notes for this podcast, the show notes you can find at BenGreenfieldlife.com./theFixxr.

Ben Greenfield [00:02:06]: F-I-X-X-R because Amie's known as the Thyroid Fixer, but also just the hormone fixer in general. I'm assuming Hormone Fixer was already trademarked. Amie. But anyway, she's a nutritionist, dietitian, and functional medicine practitioner in Erie, Pennsylvania. She's been practicing privately since the late 90s and is a real expert in thyroid and hormone optimization, so works with people from all over the world. I'll link to her website as well as the last podcast that I did with her in the show notes again at BenGreenfieldlife.com./thefixxr F-I-X-X-R. How are you doing, Amie?

Dr. Amie Hornaman [00:02:47]: I'm great, Ben. I am so excited you brought me back on because you know that testosterone is my second love. Next to the thyroid. And like you said, it's important for men and women. So guys listening, you can still listen to, we're going to talk about testosterone for you, but it's so important to talk about it in the context of women. It really is.

Ben Greenfield [00:03:06]: Well, I think that a lot of women, I mean, just, just besides lab tests, which we can get into, but before even jumping into lab tests, how would a woman even know? Like, what would the clues be if testosterone is off, or if a woman could benefit from some kind of testosterone optimization?

Dr. Amie Hornaman [00:03:24]: So, first of all, age. So we know that number one, testosterone is the most abundant hormone in a woman's body. So we have ten times more testosterone than we do estradiol. And everyone thinks of testosterone as a dude hormone, right? So I'll say to a woman, "Hey, let's check your testosterone. It might be low, we might have to replace it. " And she'll say, "Well, wait a minute, isn't that a male hormone? Am I going to get all big and masculine and bulky and grow a beard?"

Ben Greenfield [00:03:53]: Lose the hair on the top of my head, and grow a beard?

Dr. Amie Hornaman [00:03:56]: Right. And voice deep and all that. And, yeah, okay, that happens in the bodybuilding world, as you and I know, when you use and abuse. And we can get into all those nuances when we talk about treatment, but the bottom line is, that women need testosterone. And as we age, just like guys, we start to notice a decline in all of our hormones. And really, testosterone is one of the first to go. So we'll see low testosterone levels in a woman's 30s, 40s, and definitely, as she enters perimenopause and menopause, that hormone just tanks. Now, the typical signs and symptoms, yes, you might have low libido, but that's, again, that's kind of like a closed-minded thought with testosterone.

Dr. Amie Hornaman [00:04:36]: Oh, testosterone equals sex. No, testosterone is important for thinking and for your brain function. So when you start to get that brain fog and you start to lose motivation, and you are forgetting where you put your keys, and you're thinking that you have early Alzheimer's, that can be low testosterone, loss of muscle mass, loss of strength, just that general motivation to get stuff done. That's why I call it the GSD hormone because you need it to just get through your day and check the boxes off of your list. To get everything done in a day, whether you're a mom or an entrepreneur, you need that drive and motivation to get through your day. So that's another symptom that someone might notice. And then fat deposition, fat gain, loss of muscle, increased fat that's going to be directly related to low testosterone.

Ben Greenfield [00:05:24]: So do you see any of that happen through perimenopause or menopause with other hormones that could kind of make the situation a little more confusing? Like progesterone drops but testosterone stays up, or estrogen drops, but testosterone stays up, or something like that?

Dr. Amie Hornaman [00:05:43]: Oh, yeah, yeah, definitely. So really the biggest one that crosses over with testosterone is thyroid. So when you have low thyroid function, it'll mimic low testosterone symptoms. Now with estrogen and progesterone, really when we're looking at women, progesterone will decline in, again, 30s, 40s as well. So that progesterone and testosterone kind of share the race to the finish line of being the first hormone to go, to drop. Estrogen really comes later. I mean, unless it's a case of genetically predisposed early menopause onset, you're not really going to see estradiol or estrogen levels drop before testosterone and progesterone. It's usually those two hormones that drop first.

Dr. Amie Hornaman [00:06:29]: And they do share a lot of the same characteristics, and a lot of the same benefits, like even bone loss, and bone protection, that's imperative for estrogen, progesterone, and testosterone. They all benefit from the reduction of osteoporosis and osteopenia as we age. So there's some crossover there. But I would say the closest hormone is going to be thyroid hormone.

Ben Greenfield [00:06:51]: When you hear people talk about estrogen dominance, could that be a case of, or is that defined as something like progesterone and now arguably testosterone lowering relative to estrogen? Or does that have to indicate that estrogen is going up from like estrogens in the environment or the food supply or something like that?

Dr. Amie Hornaman [00:07:14]: So with men and women, it can be either. So you can have that estrogen-dominant state where estrogen is so high, it will block testosterone's effect, on the cells. So specifically the brain, we'll see a lot of brain fog and low brain function when estrogen is high. And testosterone could be normal or even optimal. But in that estrogen-dominant state, it's gonna block the action of testosterone at the cell level. Now in men especially, we also see elevated estrogen push down testosterone. So we'll see an elevated prolactin level, we'll see some wonky LH levels in guys, and then ultimately we'll look at their total and free testosterone and it will be decreased in relation to estradiol. But you can also have a situation of totally normal estradiol.

Dr. Amie Hornaman [00:08:06]: Again, men and women, you could have a low estradiol in a woman. A woman could be in full-blown menopause and still have low testosterone. So it's not. It can be correlated, but it's not always correlated. It's not. Okay, you have low T, so you must have E dominance. That's not the case.

Ben Greenfield [00:08:24]: That's what I was kind of wondering, like, if estrogen dominance is more of a measurement of estrogen or a measurement of the ratio of estrogen to progesterone or estrogen to testosterone, does that make sense?

Dr. Amie Hornaman [00:08:35]: Yeah. So estrogen, progesterone ratio, definitely. And this is where, you know, a lot of women get confused, too, with this whole estrogen-dominant scenario. They'll think that they have to have that little flag next to their estrogen level, that little eight, or it has to be red, and then they'll say, oh, my gosh, I have too much estrogen. I'm estrogen-dominant. Well, you could be estrogen-dominant just in, like you said, a low progesterone state. I like that ratio to be a 1 to 20 ratio. So if estradiol specifically.

Dr. Amie Hornaman [00:09:07]: So there are three estrogens. There's estradiol, estrogen, and estriol. We like testing estradiol in both men and women because that's your most potent estrogen. So if estradiol is 20 times higher than your progesterone level, then your estrogen is dominant, and it's not that we necessarily have to lower estrogen, but we might have to raise your progesterone.

Ben Greenfield [00:09:29]: Yeah. And that's not going to necessarily be something that'll leap out. A lab test. You would have to dig in and look at that ratio. Similar to how, like, if a guy measures testosterone, sometimes total T might be a little bit low, but often free testosterone is just fine or in optimal ranges. And that's kind of a situation where there's a little less concern, right?

Dr. Amie Hornaman [00:09:49]: Oh, yeah, definitely. Definitely. And I like looking at free testosterone more than total. We'll still look at the total, because obviously, if a. A male or female comes in with a low total, does it really matter what the free is? No, but once we get that total into the optimal range, then we definitely want to drop down. Look at the free testosterone.

Ben Greenfield [00:10:08]: Okay, total aside, a little Easter egg for the guys out there listening in. Do you look at any kind of ratio for total to free testosterone?

Dr. Amie Hornaman [00:10:16]: I don't. I just look at numbers. So for men, I like their total to be above a 20, easily above a 20. I mean, close to even, like, 30, 40 is really amazing for a dude. And then for women, I just want you to be in that upper half of the range. So the free testosterone for women can vary. I've seen it change from lab to lab, whether you're looking at Labcorp or Quest. And then I'll get some people overseas and they have this wonky lab.

Dr. Amie Hornaman [00:10:46]: So the easiest way for women when they're looking at their free testosterone is to look at that, that free range and then cut it in half. And you want to be in that upper half of the range.

Ben Greenfield [00:10:58]: When you said for guys 20, what values were you talking about? Or were you talking about percentile?

Dr. Amie Hornaman [00:11:03]: No, 20 nanograms per deciliter of the free testosterone.

Ben Greenfield [00:11:07]: Oh, free. Okay. I think maybe you. You said total. I think you meant free.

Dr. Amie Hornaman [00:11:11]: Oh, gosh.

Ben Greenfield [00:11:12]: Cause I was thinking 20 is kind of low.

Dr. Amie Hornaman [00:11:14]: No, no, no. Total. Oh, my gosh. Total. You know, I talk about this a lot. I don't care what age you are, as we'll start with men, then I'll go to the female range. I don't care if you're 75. I don't want your total testosterone to be below an 800.

Dr. Amie Hornaman [00:11:32]: Now, it gets a little age-dependent. Like, if you're in your thirties and you have a testosterone level of 500 or 800, that's not good. We want that more. 1200, maybe even 1500 if you have a high sex hormone binding globulin. But for females and for males, too, we want to keep it in that 1000 to 1500 range. Really? I mean, my 75-year-old dad can hit 800 and still be okay, but I wouldn't let him fall below that. Women, here's the kicker for us, that range, most standard lab value ranges for testosterone, you get cut off on the total before you even hit optimal. So I really like my women to be at 50 or above for the total.

Dr. Amie Hornaman [00:12:19]: And then, like I said, in that upper half of the range for the free, most labs cut women off at a 48. So how is anyone supposed to get diagnosed if they're being told, oh, yeah, you're normal, your testosterone level's a 10. That's totally fine because they're in that standard lab value range.

Ben Greenfield [00:12:38]: Okay, so let's say I'm a woman and I'm listening in and I actually want to get this tested. Obviously, there's blood, there's urine, there's saliva. What do you like to use?

Dr. Amie Hornaman [00:12:47]: I like blood. I just. I'm a serum girl. I mean, I know there's all these other ways to test out there, but, I mean, when it. Especially when it comes to testosterone. Let's just pull a blood lab. It doesn't even matter what time of the month you are in your cycle, like with estrogen and progesterone, a cycling woman should test on days 19th to 22th of her cycle. Testosterone doesn't matter.

Dr. Amie Hornaman [00:13:11]: Just go. It remains pretty constant at a constant level throughout the month. It doesn't fluctuate like the other hormones. So go. At any time of the month. Let's test blood. Let's look at that. Now, when we're starting to get into treatment, we can use the urine metabolites like a Dutch test, because that shows us if that individual is going to push down the 5-alpha reductase pathway.

Dr. Amie Hornaman [00:13:34]: And the 5-alpha reductase pathway is when it's strong, let's say when someone is a strong pusher down the 5a pathway, he or she might experience the side effects that are unwanted from testosterone. So the more androgenic side effects of elevated DHT levels, hair loss, acne, facial hair growth, hair loss where you don't want it, hair loss where you don't want it, hair growth where you don't want it, on your face. And that will tell us when we're actually supplementing with testosterone replacement. Maybe we go a little bit slower, maybe we use a DHT blocker in the beginning, before we even start therapy, to try to mitigate the side effects, because she's going to push down that 5-alpha reductase pathway. So in that instance, maybe we'll use a Dutch test. But it's really expensive to just look at that one little dial marker of 5a-reductase. So, yeah, I say let's just use blood.

Ben Greenfield [00:14:41]: Okay. And you couldn't use a blood to look at 5-alpha reductase pathways?

Dr. Amie Hornaman [00:14:45]: No, you can look at DHT and I will measure that. But I have to tell you, I mean, it's so individualized. I mean, this is really where personalized medicine comes into play again. I have many women with elevated DHT, myself included. And on the Dutch test, that dial will be all the way to the 5-alpha reductase side. It's like, oh, yeah, she's going to push down that pathway and she's going to be miserable with side effects. And then no side effects. Like, I do not get DHT elevation side effects.

Dr. Amie Hornaman [00:15:17]: I'm not losing my hair, I'm not growing a beard, I don't get acne. But then I'll have a woman that has a low DHT, and that dial might be at the other end of the spectrum saying, oh, no, she'll be, she'll do fine on testosterone. She won't push down that pathway. And sure enough, two weeks and I'm getting messages. I'm breaking out in cystic acne. Seriously, like I'm losing hair on my head. What's going on? And there's no indication on any of the labs, urine or blood that she would respond that way. So it's very individualized.

Dr. Amie Hornaman [00:15:49]: There's markers that we can look at to get an idea, but nothing is definitive until we start.

Ben Greenfield [00:15:55]: Okay, so serum test, start treatment. If you do get Paul Bunyan Lumberjack syndrome, then consider a Dutch test to see what the 5- alpha reductase pathway is doing.

Dr. Amie Hornaman [00:16:06]: Right. Right. And then we might use the DHT blocker. So this is where a lot of controversy comes in. So for men, you know, DHT is, it's the most potent testosterone. Right. It's what, we want in our body to actually have the anabolic effect instead of the androgenic effect.

Dr. Amie Hornaman [00:16:27]: So androgenic is, is the male characteristics. And for women taking testosterone, we want to mitigate that, obviously, but we want the anabolic, we want the muscle growth, we want the strength. So you don't really want to shut down the DHT pathway in either sex. You just want to mitigate and address each individual if they have that tendency, that genetic tendency toward the androgenic side effects, the hair loss, and the lumberjack syndrome. So sometimes we will start someone on something like saw palmetto.

Ben Greenfield [00:17:02]: And again, male or female, that's a DHT blocker.

Dr. Amie Hornaman [00:17:06]: It is. It's a very mild DHT blocker for men. Like, you'll see it in prostate supplements because it helps to. In lowering DHT in men that have BHP or their PSA is elevated, we can add in saw palmetto to help bring that down without totally blocking their DHT, like a finasteride or dudasteride would. So that's a really nice natural way for guys to lower their PSA, to slightly lower their DHT without plumbing it into the ground and experiencing no benefits from testosterone at all. For women, we can use the same thing. So it's basically like using a prostate support formula in women to again try to block some of that DHT, which will then help them experience the anabolic effects of testosterone without the androgenic effects.

Ben Greenfield [00:18:00]: Do you ever see the saw palmetto in men? Or women can help with the hair loss that might accompany hormone replacement.

Dr. Amie Hornaman [00:18:06]: Yep, exactly. Exactly. So someone's coming in and they're already experiencing hair loss. And I mean, hair loss can be a totally other episode. There's so many different factors. There's your protein intake and amino acids and thyroid and estrogen levels and ferritin levels, all the things. But yes, if someone is already experiencing thinning of hair, or they're. They're losing their hair.

Dr. Amie Hornaman [00:18:27]: And for women, especially the top of the head, the crown is where they'll notice that elevated DHT hair loss from testosterone. We can start them on saw palmetto first. Just get that into their system. We did this, actually with my assistant, because we would give her a drop of testosterone. She would break out cystic acne everywhere. We would try Tribulus Terrestris. We would try Tongkat Ali natural forms to raise her testosterone. Boom, breaking out.

Dr. Amie Hornaman [00:18:55]: So we said, okay, let's stop the testosterone completely. Let's add in saw palmetto and nettles, stinging nettles because that will also lower DHT. Let's do that. And then maybe three weeks from now, we'll start you on the testosterone. And that worked to keep her from breaking up.

Ben Greenfield [00:19:14]: Interesting. By the way, I did do a huge two parter on hair loss and hair graying with Dr. Cameron Chestnuts. That might be a good one for folks to listen to if they want to take a dive into that. Maybe I'll have to do a three parter with you, too, Amie, to hear about some of your strategies on that front. But you mentioned tribulus, and what was the other one you said? Was it trachesterone?

Dr. Amie Hornaman [00:19:36]: Tonkat Ali.

Ben Greenfield [00:19:38]: Tonkat Ali, that's right. The other ticket. So that kind of segues into what I wanted to ask you about what you do if it's low, as far as your replacement method of choice, whether herbal or natural, Hormone Replacement Therapy.

Dr. Amie Hornaman [00:19:53]: So I prefer. If I'm working with someone, I prefer to use testosterone. Testosterone cypionate, to be more precise. Now, we can use propionate in guys if we're micro-dosing. And if they do have an enlarged prostate and elevated DHT, the propionate sometimes works better to better regulate that and not spike their DHT. But for women, once a week, injection of testosterone cypionate at a lower dose, and I'm talking anywhere between 5 milligrams and 20 milligrams is all we'll use in a woman. And that will so beautifully raise her testosterone levels. So I prefer that method.

Dr. Amie Hornaman [00:20:32]: Now, I will use cream as well. I don't use pellets. I can get into that as to why, but I will use cream. However, cream has a greater propensity to push down that DHT pathway. So, you know, a lot of women think that, oh, injectable. That's so. That's so harsh. I'm injecting something.

Dr. Amie Hornaman [00:20:50]: And isn't that what the bodybuilders do who look like guys? Okay, yeah, but they're injecting probably a male dose of 200 megs a week, and they're using everything else under the sun as well. So we're talking about 5 to 20 milligrams a week of injectables. It just works better than the cream. Now, the. The pellets. The pellets I have never used. But I will get patients coming to me who have been on pellets. And the biggest complaint there is hair loss, because pellets, once they're in, they're in.

Ben Greenfield [00:21:22]: And some women and men listening in might not know that when you say pellets, some people might think this is an oral, swallowable pellet, but it's an actual inserted device, right?

Dr. Amie Hornaman [00:21:29]: Yeah. They put it in your butt. They put it in your butt, under the skin, and it dissolves over time. So it's this little pellet of hormones. And, you know, there are so many TRT clinics popping up everywhere that offer the pellets. They get. They make money off of them. They get a kickback from them.

Dr. Amie Hornaman [00:21:47]: And the issue is, they're not treating people as individuals like they should be. They're giving everybody the same dose. It's like a cookie cutter pellet therapy. And what's happening to some women is they will spike their total testosterone to a 900.

Ben Greenfield [00:22:06]: 900. Geez.

Dr. Amie Hornaman [00:22:07]: I have seen 900. Yes. In a woman from a pellet, and she has to ride that out. I mean, you want to talk about hair loss and acne, she has to ride that out until that pellet is dissolved. So not my most favorite delivery method of testosterone, but that's what I really like to use. The Tongkat Ali, the tribulus. They are fantastic herbals. And we have to remember that testosterone, according to the DEA, is in a class the same as opioids.

Dr. Amie Hornaman [00:22:39]: You have to have your DEA license to prescribe someone testosterone. So in many instances, it's very hard to get the general population. They're listening to this. They're going, well, wait a minute. I know I need it. I'm looking at my labs. I'm super low. So what do I do in the case of women? Honestly, Tonkat and tribulus are phenomenal at raising natural testosterone levels for guys you had mentioned earlier, the Trichesterone.

Dr. Amie Hornaman [00:23:10]: Yeah. Trachesterone, Fidoja. That's what I would use on my male patients if they. Well, on my male listeners or audience, if their patients were going to use straight-up testosterone.

Ben Greenfield [00:23:21]: So the injection for women, that's once a week?

Dr. Amie Hornaman [00:23:25]: Yep, once a week.

Ben Greenfield [00:23:26]: Do you see any issues? Because I've heard about this before. For example, Jay Campbell, who I interviewed, he's a big fan of morning, evening, small doses of testosterone cream, scrotally for men. And of course, you'd still want to be tracking with that approach, DHT, particularly because of the conversion pathways that you talked about, the increased propensity for the 5-alpha reductase pathway if you're using a cream. But that's because he was concerned about the large bolus of testosterone given all at once with an injection, producing some side effects like irritability, mood swings, etcetera. His hypothesis is to more closely mimic the natural diurnal variation of testosterone with a cream applied, a small amount applied morning and evening. Do you see any issues with the large bolus of testosterone given once a week via an injection?

Dr. Amie Hornaman [00:24:19]: First of all, love Jay. He is freaking brilliant when it comes to testosterone. So, yes, I agree with him for guys. So for guys, we'll use the injectable, but we'll micro-dose it. So we'll take that 200 milligram once a week or once every ten-day dose and we'll break that up. And it could be broken up every day. It could be broken up every other day. It depends on, really, the compliance of the patient.

Dr. Amie Hornaman [00:24:46]: I mean, to get my husband to do it every day, it's not happening. So we'll do an every. He'll, he'll work with me on a three times a-week dosing schedule for his testosterone. So that's what we can do. And then when you stack that. See, I would stack that with the scrotal cream.

Ben Greenfield [00:25:03]: Oh, you do both?

Dr. Amie Hornaman [00:25:05]: You could do both because we're using such a low dose of the testosterone cream on a guy that's just helping him stay at that daily nice level. And then when you take that, that 200-milligram injectable dose and space it out, and you can even space out 200 over the course of two weeks, I mean, that's even going to be closer to mimicking the body's natural T level. But again, it all depends on where the guy is starting. If he's starting at a 300 for his test level, like, let's do that once a week, shall we? Or break up that 200 milligrams over the course of a week and then stack it with the cream. If you're. If you're rolling in at like a 600 and we just really want to get you up to a thousand or 1100, then we could probably stretch that 200 milligrams out over the course of like 10 to 14 days.

Ben Greenfield [00:25:54]: Okay. When you say. When you say stack with the cream, would you still use the screen, the cream on the same day that you inject?

Dr. Amie Hornaman [00:26:00]: Yeah. Yeah. Because that's just coming in daily. That's kind of almost, for lack of a better description, keeping your levels afloat. We want to just keep them afloat so that when, even when you're doing the injection and you get that, even with the micro-dosing, you're going to get a little bit of a bump. Right. You're not going to coast at a streamlined thin line. You're going to bump up and you might get a little bit of a drop and you might get a little bump up the next time it's time for an injection.

Dr. Amie Hornaman [00:26:29]: And the next day you drop down a little bit so the cream can come in and keep it nice and steady on the daily. But then the injection is really working to increase the levels. I have not seen a man respond well to just cream. I've had many guys come into the practice that were on it, or they were doing the Androgel. They just, the numbers just don't move. They go from like a 300 to a 450 and that's it.

Ben Greenfield [00:26:58]: Yeah. I'll tell you my approach because I use the cream morning and evening. He's a pretty small amount. I use actually about a third of whatever. I forget the actual dosage, but it's a very small amount compared to what the doctor prescribed to me, and then I take the botanobolic formulation from Level Up Health, which is a blend of trokesterone, Tribulus, Tongkat Ali, and a few different choice ingredients he has in there. I interviewed him about it and it might have come out by the time this podcast gets released, was my interview with Kyle from Level Up Health in Australia. And I feel pretty good.

Ben Greenfield [00:27:33]: My levels stay consistently between about 700 and 800. My DHT is low. My DHEA is a little bit higher than what I'd like to see. I think that might be because the morning dose of the cream actually has a little bit of DHEA in it. So I'm doing cream, but then I am combining that with herbal oral support, and that feels pretty good. Maybe I'm getting close to what I get if I combine it with cream. With an injection.

Dr. Amie Hornaman [00:27:59]: Well, you're young, and you take care of yourself. I mean, most people are not biohacking the hell out of their bodies like you are. So when you take that typical 50-year-old guy who's been drinking beer and playing golf, and, you know, we still want to protect his heart, we still want to give him the quality of life, obviously, we want to intervene and have him clean up some stuff in his life and maybe, you know, cut back on the beer because that's very estrogenic and clean his body up. But for somebody like that, they're probably not going to respond as well. But, I mean, I love your stack for anybody that is actually taking care of themselves.

Ben Greenfield [00:28:40]: Yeah, and you make a good point. I do red light therapy, naked for 20 minutes a day, I do cold plunges, I do deadlifts, and squats. So I'm hitting a lot of the androgen receptors in the leg, I get sunlight, I de-stress, I have sex regularly.

Ben Greenfield [00:28:53]: I sleep well. So I think there's a cluster of factors here when we're talking about healthy lifestyle combined with biohacking.

Dr. Amie Hornaman [00:29:00]: And you just literally nailed all the lifestyle things that men and women need to do for their own testosterone support, natural testosterone support. You have to be lifting heavy. You have to be sleeping. You have to be having sex. Like you said, that's going to kick up testosterone levels. You have to do all of the things in order to support your own levels. You can't just throw hormone replacement on. I don't care whether it's Thyroid Hormone Replacement, testosterone, estrogen, progesterone, or whatever it is, it can only do so much if it's butting up against a bad lifestyle.

Dr. Amie Hornaman [00:29:35]: So, yeah, it has to be done in conjunction.

Ben Greenfield [00:29:37]: Yeah. Now, what about steroids? I mean, you briefly mentioned steroids. There's, like, Anavar Oxandrolone. Do you ever see a time and a place for something like that, or is that total bad news bears?

Dr. Amie Hornaman [00:29:47]: No. This is what's super fascinating. So you and I were in the whole bodybuilding scene, and back in the day, Anavar, also known as Oxandrolone, because, actually, Anavar is not in play anymore. They lost their trademark name, and now I think there's a supplement called Anavar because you can't even use it. The drug name, but the drug name is Oxandrolone, and back in the days when we were competing, well, I'm sure even still now, it was called the girly steroid because it would produce more of that anabolic effect of strength and hardened muscle and that lean, tight look. And actually, it doesn't even work as a fat burner.

Dr. Amie Hornaman [00:30:32]: It's just increasing your muscle mass, thus decreasing your. Your fat mass and it's making you stronger, and you better lift at the gym, more energy, all of that. But it's also raising your DHT, but not in a bad way. So this was called the girly steroid because we saw more anabolic than androgenic effects from it. And women just loved it because they wouldn't get the beard, they wouldn't get the acne, they wouldn't get the deepening of the voice unless they used really super high doses, which you normally didn't see. So it kind of went out of circulation as a medication in the eighties and nineties when bodybuilders were abusing it. It actually came out in 1964, and it was used for muscle wasting, it was used for different states of cachexia, and it was very beneficial because it would hold onto muscle tissue and help people.

Dr. Amie Hornaman [00:31:31]: Even as we moved into the nineties and two thousand, it was being used for HIV and AIDS treatment to prevent muscle wasting that occurred with that disease. So it's a very, very effective drug. It was just brought into the bodybuilding scene and kind of used and abused, and that's where it got pulled. But it's fascinating when we're looking at the mechanism of action of oxandrolone and where we can effectively use it in therapy. So when it is prescribed, it will have that little bit of a testosterone-boosting effect, and it can have that negative feedback loop to shut down your own testosterone, just like testosterone does. Where we'll use it in perimenopause and menopausal women to hold on to muscle and actually help protect their bone and protect them from bone loss, because it's beautiful for that. And we'll use it in cases where someone just cannot tolerate testosterone of any kind. So I mentioned my assistant earlier.

Dr. Amie Hornaman [00:32:35]: Okay. We got her to a place where she can take a little bit of testosterone, and she's not one big pimple. I have another patient right now. I just had this conversation with her abouT2 weeks ago. I said, we're going to start you on Oxandrolone, then we cannot, I mean, at the smallest level, we've tried cream, we've tried trochees, we've tried injectable, we've tried the DHT blockers, we've done Tribulus, we've done Tongkat. She cannot tolerate anything. She loves the effects of the testosterone. She loves how she feels, but she can't tolerate it.

Dr. Amie Hornaman [00:33:07]: She's grown a beard. She's like, I'm going to have to get, like, some kind of laser on my face done to get rid of the hair. I got cystic acne everywhere. I look like I'm 14. Not happening. It's just not happening. So we're using Oxandrolone with her so she can get the strength and the stamina the motivation and the libido without the side effects of testosterone.

Ben Greenfield [00:33:30]: And what is the delivery mechanism for Oxandrolone?

Dr. Amie Hornaman [00:33:33]: So it is a pill form. It is best taken when it's prescribed by a compounding pharmacy. So that's where we prescribe ours when we're working with patients that need it through a compounding pharmacy. So it's compounded, it'll come in a harder tablet form, but it's actually best delivered sublingually. So if you can let that just sit under your tongue and dissolve. That way you're absorbing that medication sublingually, mucosally. It doesn't have to pass through and do that double pass of the liver, because we will see liver enzymes rise when on this medication. And that's really why it became kind of a no-no for guys to take back in the body, you know, in our, in our competition days, because they would have to take such a large dose, it would just pound their liver.

Dr. Amie Hornaman [00:34:21]: So guys were like, well, I'll. I'll just take injectable everything instead of pounding my liver with this oral, that's super expensive at a high dose, but for women, it's such a low dose that we're using. I mean, we're literally using 5 to 10 milligrams a week or 5 to 10milligrams a day, and then we'll cycle that about six weeks on, six weeks off, and it works beautifully. Guys, they have to use 50 milligrams, and that just becomes really expensive.

Ben Greenfield [00:34:48]: Got it. So 5 to 10 milligrams of Oxandrolone, six on. And with the testosterone, what's kind of a dosage range that you'd be using for those injectables? For women?

Dr. Amie Hornaman [00:34:58]: For women, that's 5 to 20 milligrams once a week. Now, you asked earlier, can we break that up? Okay, I mean, 5 milligrams, you're not going to break up more than once a week because it's hard enough getting that out of the vial. I mean, that's. It's. It's like a little, tiny little droplet in the needle but if someone, if a woman's using 20 milligrams a week, or I have a couple of patients using 30 a week, then, yes, we can break that up and go 10-10 and 10 or 10 twice a week just to space it out a little bit more to avoid that bolus dose reaction, so to speak.

Ben Greenfield [00:35:34]: And for people not familiar with the differences in testosterone dosage between men and women, how would that compare to the amount that a man would normally take in a week?

Dr. Amie Hornaman [00:35:42]: A man is gonna take 200, like 200, once a week.

Ben Greenfield [00:35:46]: 200 milligrams, and you said a woman is going to be around 30 a week.

Dr. Amie Hornaman [00:35:50]: Five to 30. 30 would be the high end. I had the occasional woman that comes in, and she's like, listen, I want to keep my total testosterone level at 200. That's where I feel my best. I take 30 milligrams of test sip a week. I'm like, okay, okay. I would be one big pimple.

Dr. Amie Hornaman [00:36:12]: But we'll keep you there. I got you. And that's really where, again, that personalized, nuanced medicine comes in, is you have to look at each person individually and say, okay, she can tolerate 30 mgs a week. She's not androgenic at all. Okay, let's leave her there. But you have another woman that's super scared, doesn't want the side effects, but wants the benefits. We'll keep her at 5 to 10.

Ben Greenfield [00:36:39]: So man's are like 20 to 40 times what a woman would be taking.

Dr. Amie Hornaman [00:36:42]: Yeah, yeah, yeah.

Ben Greenfield [00:36:44]: Now, I think it was Dave Asprey who I heard talking about how it can significantly enhance the quality and intensity of a woman's orgasm if she applies a little bit of testosterone cream clitorally prior to sex. Is there anything to that?

Dr. Amie Hornaman [00:37:01]: There is a little bit to that. So that can be. I mean, you could even apply. Well, first of all, testosterone applied vaginally is going to increase circulation to the area, to the genitals. So. But you want to be careful because testosterone is a growth hormone, so to speak. It's like, you know, it's not going to, let's say, directly cause you to grow clitenis, but it could, if you apply it every day. Because let's say you're having sex every day, you could grow a clitenis, and.

Ben Greenfield [00:37:35]: A clitenis is an enlarged clitoris. Like clitoris, penis combined.

Dr. Amie Hornaman [00:37:40]: Exactly. Yeah. And we see that in the bodybuilding community, and there's no going back once it happens.

Ben Greenfield [00:37:46]: Oh, wow.

Dr. Amie Hornaman [00:37:47]: So we really want to be careful with that. And there are so many other ways. I mean, you can apply a compounded DHEA cream vaginally, that helps with lubrication and helps to just increase the circulation for enlargement, for engorgement, for better satisfaction. You can definitely do that. But the thing with testosterone, whether you're applying it topically to your arms via a cream or injectable like we're talking about, that alone is going to increase orgasm.

Ben Greenfield [00:38:21]: Right. So if you're already on TRT replacement and you're not, just say like borrowing your, your significant other's testosterone cream and putting a dab of that on prior to sex, like you're, you're going to already be enhancing orgasm quality and libido just if you're under the type of systemic administration we've been talking about.

Dr. Amie Hornaman [00:38:40]: Exactly, exactly. So you're going to notice that. So you most likely will not need a topical because testosterone has the same effect as estrogen in that it helps with vaginal lubrication. So just having that vaginal lubrication present without even having to apply it topically, that's going to help with arousal, that's going to help with desire. A lot of women want to avoid sex because of the pain, because of the vaginal atrophy that occurs in perimenopause and menopause through the loss of estrogen and the loss of vaginal lubrication that occurs from the loss of testosterone and the loss of estrogen.

Ben Greenfield [00:39:16]: Okay, got it. Now, peptides, obviously they've been under increasing scrutiny and are a little bit more difficult to get. But are you still incorporating any type of peptide therapy in conjunction with some of these other therapies?

Dr. Amie Hornaman [00:39:29]: Oh, definitely. So I still love, I know, BPC-157, TB-500, very hard to get. But obviously those are just so beautiful for post surgery recovery, post injury recovery.

Ben Greenfield [00:39:42]: Right. But they're not that hormone specific, are they?

Dr. Amie Hornaman [00:39:45]: No, no, those are just more those general peptides, hormone specific. GHRP, CJC, and EPA are still fantastic for increasing your growth hormone naturally, and I've seen some clinics using kisspeptin and a couple of other derivatives, peptide derivatives, to increase testosterone, but they never work. They never work. So, you know, when I see that happening, I go, why don't you just use testosterone instead of using a just as expensive peptide that you're, you're throwing a dart and hoping that it sticks. I mean, you know, that woman may or may not get relief from that. Just use testosterone because she's low anyway and it's not coming back.

Ben Greenfield [00:40:31]: Yeah, because peptin's interesting is it's something that would be a kind of precursor stimuli for LH and FSH, which is something that may assist with fertility or something like that if I'm not mistaken. But that kind of makes me wonder with women, particularly with men, one of the concerns is exogenous testosterone could decrease fertility. Do you see the same thing in women?

Dr. Amie Hornaman [00:40:56]: Oh, definitely. But at the time in a woman's life where we start to use TRT, she's past childbearing years anyways.

Ben Greenfield [00:41:06]: Okay. But it's still good to know if you're a woman and you're listening in, right?

Dr. Amie Hornaman [00:41:09]: No, definitely. Definitely. And with, let's say, hypothetically, we'll have a woman come into the practice. She's 35, and pretty sure that she's done having kids, but she's not 100% positive. So for her, I will use things like tribulus or Tongkat Ali, maybe we use a really low dose cream, like 2 milligrams of testosterone cream daily just to see how she responds with that so that we're not affecting her fertility and that we're not androgenizing the baby should she get pregnant. Now, if a woman is actively in fertile years and planning on having a baby, we will not use testosterone. Not at all.

Ben Greenfield [00:41:53]: And if you were kind of wondering if it was going to impact fertility, are there specific markers you would look at on a blood or urinary panel to see if even that low dose could be having an impact on certain hormones related to fertility?

Dr. Amie Hornaman [00:42:06]: Yeah, I mean, we look at AMH, FSH, LH, prolactin levels, kind of the.

Ben Greenfield [00:42:12]: Same things you look at in a man, basically.

Dr. Amie Hornaman [00:42:14]: Yeah, exactly. Exactly. Progesterone, obviously, is the most important hormone for female fertility, and thyroid balance. We'll look at that and make sure. Really, testosterone can improve thyroid function because we know that testosterone will lower thyroid antibodies. So it's actually very protective from that Hashimoto switch turning on. So we normally don't see testosterone affect the thyroid, but it could affect the fertility markers.

Ben Greenfield [00:42:40]: Yeah. I actually want to ask you a question about thyroid here in a second. But before we pivot from the endocrine or the testosterone piece, if a woman is listening and she wants to get on testosterone, can she do that through you? Like, do you do any type of consults or telemedicine or anything like that?

Dr. Amie Hornaman [00:42:57]: We do. We can prescribe to all 50 states, so. And parts of Canada. And that was, that was always my goal after being misdiagnosed. We talked about that on the last podcast, it was my goal to be able to help women and men everywhere in every state. You don't have to suffer because it's so hard going through that conventional medicine system and getting with a doctor who actually understands the endocrine system and understands the importance of Bioidentical Hormone Replacement. So these days, we're seeing a little bit, I mean, and I mean, within the last couple of months, we're seeing a little bit more come out where the authors of the Women's Health Initiative Study are coming out and saying, hey, you know that whole thing that we said years ago about hormones causing cancer? Turns out it's not true. We were wrong in that study.

Dr. Amie Hornaman [00:43:52]: And go ahead and take your hormones now. So a lot of doctors are coming around to the concept of prescribing Bioidentical Hormone Replacement, but they're still kind of in the estrogen-progesterone prescribing realm. They haven't quite stretched their brain out into testosterone because just like we talked about at the beginning of the show, doctors think that testosterone is just a dude hormone and why in the world would I give it to a female? So it's just really, really difficult. So, yes, we can prescribe to all 50 states, the right thyroid dosing medication, the right hormones, Bioidentical Hormone Replacement, and then peptides, too. I mean, we will prescribe the growth hormone-releasing peptides, and the growth hormone-stimulating peptides, and we'll do the weight loss peptides when applicable. But we won't do that first line, you know, right out of the gate. I always say, let's get your testosterone, let's get your hormones optimized, let's get your thyroid optimized, and then if you're still struggling with weight loss, we can add in the GLPs, but not until.

Ben Greenfield [00:44:57]: Yeah, I don't know if you know Karen Becker, but I had like an hour-long conversation with her about hormone confusion, especially when it comes to breast cancer studies. So that podcast will likely have been released when this one comes out. So if you go to BenGreenfieldlife.com/thefixxr, the F-I-X-X-R, I'll link to that episode in the show notes. So the T2 piece, we talked that we were blue in the face last time about T2, the active ingredient in your supplement, which I've actually been taking since our podcast, the Thyroid Fixture. It's fantastic. As far as metabolic rate, I think there's a little bit of, I believe we discussed brown adipose tissue conversion. A lot of cool effects, metabolically but I found a paper, and it's about T2. And I'll just tell you this line from the paper, and I want to run it by you to hear your take on this.

Ben Greenfield [00:45:48]: It says, that 30 years of research using mammalian and nonmammalian in vivo and in vitro models has generated substantial data on the biological effects of T2. However, a debate is open concerning the side effects, an issue that needs to be investigated by performing more comprehensive studies in humans and animal models to fully evaluate any potential risks. So I just wanted to ask you, what is this debate? Because I've seen other papers, including those you cited in our last podcast, saying it increases metabolic rate and reduces body weight without negative side effects. So what's the debate on this?

Dr. Amie Hornaman [00:46:29]: You know, I have combed through, I swear, every single paper on T2 or 3, five DIY to l thyroidine, and I did see that one that you were referring to. I've seen maybe one or two papers that state that, well, you know, there might be some thyromimetic effect of it, meaning it's going to actually start affecting your thyroid lab values like TSH, Free T3, Free T4. But I'm only seeing it in that. Hey, there might be. There was some. There was some thyromimetic effect. There were some cardiovascular effect, meaning an increased heart rate, which we obviously see when we're using any kind of stimulant, or we'll even see it if we're using T3 thyroid hormone. But the majority of the papers say, say no.

Dr. Amie Hornaman [00:47:17]: So now I have to go to Anecdotally. Anecdotally, I've been using T2 with my patients now for about 15 years, easily. And I maybe have one out of a hundred that say, you know what? I feel a little bit jittery. Like, I feel like maybe my heart rate's increasing a little bit. Maybe it feels like I drank too much coffee. And they'll get that slight stimulant effect from it, but it's very, very rare that I'll have that happen.

Ben Greenfield [00:47:47]: Rare and possibly also relative to a hypothyroid condition and sluggish metabolism they may have had before. So what they could be feeling is normal metabolism, potentially.

Dr. Amie Hornaman [00:47:57]: Yeah, exactly. I say that to people, too. I'm like, okay, you're experiencing an elevated heart rate. What is it? They'll go, it's like 70. I'm like, right, because you were 50 before because you were hypo-low and slow. So now you're in the normal range, and it feels high to you. So that's possible. There's also, there was one paper that showed that it is possible for T2 to grab an iodine atom and become T3.

Dr. Amie Hornaman [00:48:23]: So now we know that if there is sufficient thyroid hormone in the body, what's going to happen in TSH? It's going to go down. So you're going to get that slight lowering of TSH, a slight increasing of Free T3, not to the point where someone would all of a sudden appear like they're hyperthyroid, but, but you might get that little bit of a shift. So perhaps that will come with it, a side effect. But honestly, I, I've not seen it. I'm not just saying this because I have thyroid fixer. It's, I really haven't seen negative side effects from T2. I really haven't. And I can't find enough literature that states it, but I do agree with that paper and that we need more human studies because there was only like two or three done.

Ben Greenfield [00:49:12]: Yeah, well, I mean, I alluded to this in our last podcast when my thyroid was super disordered. After I finished and hung up the hat on the Ironman Triathlon, I talked with you like seven years after that in our last podcast, and I still had elevated TSH and dysregulated, particularly Free T3. I started using one capsule, and I don't want this to turn into a giant commercial or anything, but a thyroid fixture after our show. And my thyroid values are better than they've ever been. TSH is normalized. Feel great. Total T3 and t four, good. Free T3 and t four, good.

Ben Greenfield [00:49:46]: So it is working for me anecdotally.

Dr. Amie Hornaman [00:49:50]: Yeah. And that's what I see. That's what I see with people, too, is like, there might be that little bit of a shift in their thyroid lab values, but then you have to say, okay, what else are you doing? Are you taking magnesium and selenium and iodine? And that's helping, too. So I think it's just the conjunction, but I'm with you, I don't really. And you don't have any negative side effects, right?

Ben Greenfield [00:50:10]: No, I feel great. I'm just doing one capsule. I'm not even cycling. I just take it for seven days a week.

Dr. Amie Hornaman [00:50:14]: Yeah, yeah, exactly. Yeah. But I would like, I would love to see more human studies done on it. I think that'd be great.

Ben Greenfield [00:50:22]: Yeah, exactly. Well, I'll link to that first podcast so that you have no clue what we're talking about with Amie's thyroid fixer supplement and this 3,5-T2. But in the meantime, Amie, this is fantastic. I think it tackles a topic I've been wanting to address for a long time, that of women and testosterone. And I couldn't think of anything or anyone better to talk to you about. So I'm super grateful for you coming on the show again. If folks are listening in, it's at BenGreenfieldlife.com/thefixxr.

Ben Greenfield [00:50:52]: Amie, anything else you want to throw in here?

Dr. Amie Hornaman [00:50:55]: You know, I'm just super happy that you're bringing this to the public, to your audience, because, and I know, you know, a lot of guys are listening, but I've been an avid listener, your podcast forever. Forever. And I'm a chick. I think women need to hear this and they need to take control of their, their life, their health, and their hormones, and know that there are so many options. They're not locked into a box. There's no one-size-fits-all treatment. It's very, very nuanced, and you can absolutely feel and live like the badass human you're supposed to be. And that's really the message that I want to get out there.

Dr. Amie Hornaman [00:51:35]: So that's what I'm excited about. I'm excited that you're getting the message out. And hey, super pumped about what's coming up for you.

Ben Greenfield [00:51:43]: That's right.

Dr. Amie Hornaman [00:51:44]: Well, I know.

Ben Greenfield [00:51:45]: Little teaser.

Dr. Amie Hornaman [00:51:45]: Excited.

Ben Greenfield [00:51:46]: Stay tuned. Amie's going to be part of a super cool thing I'm launching soon, so stay tuned for more on that, mysterious. So anyway, BenGreenfieldlife.com/thefixxr is where the show notes are. Definitely listen to the first episode with Amie on thyroid. And Amie, I know I'm going to see you at the time we're recording at Hack Your Health and I think the Health Optimisation Summit and all over the place over the next few weeks. So I'll see you soon.

Dr. Amie Hornaman [00:52:10]: I know you're gonna get sick of me, but it'll be good.

Ben Greenfield [00:52:12]: I won't get sick of you.

Dr. Amie Hornaman [00:52:14]: Thanks, Ben.

Ben Greenfield [00:52:15]: All right, talk to you later.

Ben Greenfield [00:52:16]: Do you want free access to comprehensive show notes, my weekly roundup newsletter, cutting-edge research and articles, top recommendations from me for everything that you need to hack your life, and a whole lot more, check out BenGreenfieldlife.com.

Ben Greenfield [00:52:33]: It's all there.

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