Tools for Hormone Optimization in Males: Bloodwork, Lifestyle, Supplements, and Therapy

Hormone optimization is not simply a matter of increasing testosterone. The more useful questions are whether you have adequate energy, a healthy libido, good recovery from exercise, and a hormonal environment that supports health over time.

A higher laboratory value does not automatically mean a better outcome. Moving testosterone from 600 to 800 nanograms per deciliter, for example, may help one person, do very little for another, and create problems for someone else. Changes in estrogen, hormone-binding proteins, and tissue sensitivity all matter.

In my discussion with Dr. Kyle Gillett, we explored how to approach male hormone health across the lifespan, beginning with nutrition, sleep, exercise, and bloodwork, then moving into supplements and prescription treatments. The central principle is straightforward: understand your baseline, establish the fundamentals, and evaluate interventions by their overall effects, not just their effects on testosterone.

The medication and supplement doses discussed below describe clinical approaches raised in that conversation, not individualized treatment recommendations. Prescription hormone treatment, in particular, requires medical assessment and ongoing monitoring.

Table of Contents

• Start With Bloodwork, Not Assumptions
• Nutrition Should Support Your Stage of Life
• Sleep, Stress, Purpose, and Sustainable Exercise
• Supplements: Understand the Intended Effect and the Uncertainty
• Tongkat Ali and Fadogia Agrestis Require Different Levels of Caution
• Testosterone Therapy: Replacement Is Not the Same as Augmentation
• Clomiphene Is Not a Simple Workaround
• Alcohol Can Work Against Hormone Goals
• Tadalafil, Prostate Symptoms, and Nighttime Urination
• Hair Loss Treatments: Topical Does Not Necessarily Mean Local Only
• The Goal Is Better Function, Not the Highest Number

Start With Bloodwork, Not Assumptions

Gillett compares hormone assessment to running diagnostics on a new car. Rather than waiting for something to go wrong, establish a baseline and monitor changes over time. Human development does not abruptly stop after puberty, and hormone assessment should account for age, symptoms, and life circumstances.

For testosterone, a total testosterone measurement alone may not provide enough information. Gillett recommends assessing either:

• Total testosterone together with sex hormone-binding globulin, or SHBG.
• Free testosterone, interpreted in the context of the broader clinical picture.

SHBG is a protein that binds sex hormones, including testosterone and estrogen. Its concentration influences how much hormone remains unbound and available to act on tissues. Two people with similar total testosterone can therefore have different free testosterone levels.

Dihydrotestosterone, or DHT, is another part of this picture. It is a potent androgen involved in secondary sexual characteristics, particularly during puberty. Binding proteins affect its availability as well, which is another reason that a single total hormone measurement can be misleading.

In the absence of a major intervention, Gillett described approximately six months as a reasonable follow-up interval for many patients, determined through shared decision-making with their physician. That is not a universal testing schedule. Symptoms, treatment changes, and medical history can alter what needs to be measured and when.

Nutrition Should Support Your Stage of Life

Development Is Not the Time for Unnecessary Restriction

Diet and exercise are foundational, with sleep especially important during puberty. One concern Gillett emphasized is removing foods that are helping someone meet developmental needs without replacing their nutritional contribution.

Dairy was one example. It can support insulin-like growth factor 1, or IGF-1, which contributes to growth and development, including long bones and secondary sexual characteristics. That does not make dairy mandatory for everyone, particularly when allergies or other constraints apply. The broader point is to avoid restricting a useful food category without considering what is lost.

Gillett also emphasized adequate vitamin D for testosterone production, bone mineralization, and skeletal development. Growth hormone, IGF-1, and estrogen all contribute to building bone. Through adolescence and early adulthood, the goal is to establish a strong skeletal foundation rather than assume that lower estrogen is always better.

There is no precise birthday at which these considerations disappear. Gillett used roughly age 25 as a useful reference point for the importance of building bone, not a rigid biological cutoff.

He was particularly concerned about highly restrictive carnivore or vegan diets during the teenage years and early adulthood because of their potential to compromise nutritional adequacy and free androgen availability. That concern should not be reduced to a claim that every person following either diet will develop low testosterone. The practical issue is whether the diet supplies enough energy and a sufficiently broad range of nutrients during development.

Fiber and Essential Fatty Acids Matter Beyond Hormones

Prebiotic fiber helps feed the gut microbiome. Gillett used the analogy of an aquarium: what you feed the system influences which organisms thrive.

Fiber and essential fatty acids deserve attention throughout life, not merely during a short “optimization” phase. The discussion emphasized adolescence and the following decades because development, including brain development, continues well beyond childhood.

A useful nutritional starting point is variety: adequate protein, fruits, vegetables, appropriate starches, and sources of essential fats, adapted to individual needs and preferences.

Caloric Restriction Has Different Effects Depending on the Starting Point

For someone carrying excess body fat, gradual fat loss through an appropriate calorie deficit and exercise can benefit testosterone over the longer term. That does not mean that calorie restriction itself is a testosterone booster.

For someone already relatively lean, an energy deficit can lower testosterone. Gillett described several contributing factors:

• Less energy and fewer available building blocks for hormone production.
• More time spent in a catabolic state rather than supporting tissue growth and repair.
• Changes in growth hormone and IGF-1 signaling.
• Higher SHBG, which can reduce free androgen and estrogen availability.

Fat loss can be useful when excess body fat is part of the problem, while chronic under-fueling can create a different hormonal problem.

Sleep, Stress, Purpose, and Sustainable Exercise

Stress does not operate in isolation. When someone becomes chronically overwhelmed, nutrition may deteriorate, exercise may disappear or become excessive, and sleep can suffer. One disrupted pillar can pull the others down with it.

Gillett also includes a sense of purpose among his lifestyle pillars. He calls this “spirit,” meaning the self-actualization component of life: what you care about and where you want to direct your effort.

That need not mean identifying one permanent life mission. Pick a meaningful goal, work toward it, reassess, and choose another. Purpose can change as you change.

For exercise, Gillett proposed a sustainable structure of approximately:

• Three to four vigorous sessions per week.
• Three to four additional instances of less vigorous activity, as recovery and circumstances allow.

He cautioned against regularly extending very vigorous training beyond about an hour when the goal is hormone support. The underlying research he described often uses ratings of perceived exertion, which are useful but imperfect. Treat the hour as a practical caution about repeatedly combining high intensity with long duration, not a precise threshold after which all exercise becomes harmful.

The objective is to train consistently and recover adequately. More exercise is not automatically better if it comes at the expense of sleep, sufficient food, or normal functioning.

Supplements: Understand the Intended Effect and the Uncertainty

Supplements can influence performance, nutrient status, or hormone signaling, but those are not interchangeable outcomes. A supplement that helps training does not necessarily produce a meaningful testosterone increase, and a biochemical change does not necessarily improve how someone feels.

Creatine and the Hair Loss Question

Creatine supports rapid energy availability through the phosphocreatine system, functioning somewhat like a reserve fuel supply for ATP regeneration. Gillett also discussed possible effects on oxidative stress and androgen metabolism.

The hair loss concern largely comes from research reporting an increase in DHT with creatine supplementation. Because DHT contributes to male pattern hair loss, people sometimes assume that creatine must accelerate baldness.

Gillett did not consider that concern a compelling reason to avoid creatine. His interpretation was that any effect on androgen conversion is not equivalent to pushing hormones to supraphysiological levels. Still, a reported DHT change and a demonstrated increase in hair loss are different findings; one should not be substituted for the other.

For broader context on creatine and other exercise supplements, the NIH Office of Dietary Supplements review is a useful reference.

Betaine and Homocysteine

Gillett discussed betaine as a related option for people who do not respond well to creatine, citing a range of 1 to 3 grams daily. He also mentioned that some apparent creatine nonresponders may be evaluated for a higher creatine intake, such as 10 grams, rather than assuming the usual approach works equally well for everyone.

Betaine participates in pathways involving methionine and homocysteine. If someone already responds well to creatine, Gillett did not see a clear reason to add betaine unless there was another indication, such as persistently elevated homocysteine.

Homocysteine is assessed with a blood test. The useful distinction is between adding a supplement to address a measured issue and adding it simply because it appears in a hormone-related supplement stack.

L-Carnitine: Energy Transport, Receptors, and Gut Metabolism

L-carnitine helps transport fatty acids into mitochondria for energy metabolism. Gillett also discussed evidence suggesting effects on androgen receptor density: potentially changing the number of available receptors rather than increasing testosterone itself.

He described oral absorption as relatively low and discussed oral doses of 1 to 5 grams daily. Injectable L-carnitine is a separate medical intervention that should involve a prescription and physician supervision, not an at-home substitute for oral supplementation.

A concern with higher oral intakes is conversion, through gut microbial metabolism, into compounds that contribute to trimethylamine N-oxide, or TMAO. Carnitine and choline can both feed into that pathway, and the degree of conversion varies with the gut microbiome.

Gillett raised TMAO as a potential health concern. That warrants caution, but it should not be simplified into a definitive claim that L-carnitine causes cancer.

We also discussed allicin, a compound associated with garlic, as a possible way to reduce TMAO formation. I mentioned using 600 milligrams of a garlic supplement with L-carnitine. That personal practice does not establish that a particular garlic product or dose will reliably offset risk.

Berberine was another compound discussed in this context. I have experienced headaches and symptoms associated with lowered blood sugar when taking it. Adding another supplement to counter a theoretical downside can introduce its own problems.

Gillett did not identify a routine need to cycle creatine, betaine, or L-carnitine. That is different from saying everyone needs them or should take them indefinitely.

Vitamin D and Boron

Vitamin D is relevant when someone is deficient. Correcting that deficiency may support normal testosterone production, but that is not the same as expecting extra vitamin D to keep raising testosterone in someone whose status is already adequate. The NIH vitamin D overview provides additional context on intake and safety.

For boron, Gillett discussed 5 to 12 milligrams daily as a range that may acutely lower high SHBG. He emphasized that the effect is not necessarily sustained.

He also noted that soil composition can influence the boron content of foods, mentioning dates and raisins from regions such as Greece and Turkey. His suggestion that regional boron intake might help explain differences in testosterone reference ranges was speculative, not an established basis for treatment.

Tongkat Ali and Fadogia Agrestis Require Different Levels of Caution

Tongkat Ali: Product Standardization Matters

Tongkat ali, also called longjack, was discussed as a supplement that may influence several steps in steroid hormone synthesis. Steroid hormones arise through pathways involving cholesterol, and changing one part of that system can have effects beyond testosterone alone.

Gillett suggested that tongkat ali might be particularly relevant during calorie restriction or lower-carbohydrate intake, when insulin and IGF-1 signaling may differ. That was a mechanistic rationale, not proof that it reliably compensates for under-fueling.

He described doses of 300 to 1,200 milligrams daily, while stressing that extract standardization matters. Eurycomanone is one compound used to characterize these products, so the milligram weight of two extracts does not necessarily represent the same exposure.

In my own bloodwork, I observed increased free testosterone and a slight increase in luteinizing hormone while using tongkat ali. Those are personal observations, not a prediction of anyone else’s response.

Gillett also described possible increases in DHEA and reductions in SHBG when SHBG is unusually high. He noted that studies in people with normal SHBG do not necessarily show a reduction in that binding protein.

Fadogia Agrestis: Animal Findings Do Not Establish Human Safety

Fadogia agrestis was discussed as potentially increasing luteinizing hormone release. Luteinizing hormone comes from the pituitary and stimulates Leydig cells in the testes to produce testosterone. That proposed mechanism differs from directly supplying testosterone.

The major concern is safety. The discussion included animal findings suggesting possible testicular and liver-related toxicity, including changes in markers such as gamma-glutamyl transferase and alkaline phosphatase.

Gillett described regimens of 300 milligrams daily or 600 milligrams every other day or three times weekly, based partly on extrapolation from animal data. Those regimens should not be interpreted as established safe human doses. Converting an animal dose into a human-equivalent amount does not demonstrate human safety, and monitoring selected blood markers does not resolve every potential risk.

Fadogia belongs in a different risk category from addressing a documented nutrient deficiency. The uncertainty is part of the decision, not a minor detail to ignore.

Testosterone Therapy: Replacement Is Not the Same as Augmentation

Why would a young man with normal testosterone, adequate energy, workable recovery, and a healthy libido begin taking testosterone?

Gillett’s position was that the benefits rarely outweigh the drawbacks in otherwise healthy young men. Rare medical conditions are a separate matter, but the existence of legitimate indications does not justify routine use in people without them.

The conversation referenced a total testosterone range of roughly 300 to 900 nanograms per deciliter. A reference range alone does not establish who needs treatment. Symptoms, free testosterone, SHBG, fertility goals, and the broader medical assessment all matter. The Endocrine Society’s testosterone therapy guideline offers additional clinical context.

Dose and Frequency Must Be Individualized

For testosterone cypionate or enanthate, Gillett described a common starting clinical range of 100 to 120 milligrams total per week, divided into two or more administrations. One example was 60 milligrams twice weekly.

These were examples of supervised prescribing, not a universal protocol. SHBG and free testosterone can influence the response, and a dose that is physiological for one person may put another above the reference range. Gillett noted that even 200 milligrams weekly can be well above physiological replacement for many people.

Administered testosterone also does not reproduce the normal daily pattern perfectly. Natural testosterone generally rises and falls across the day; therapy can produce a different exposure pattern, even when a laboratory value appears acceptable.

Monitoring Must Extend Beyond Testosterone

Potential benefits may include changes in energy, mood, libido, and recovery. Potential adverse effects involve multiple organ systems:

• Acne, other skin changes, and accelerated hair loss.
• Mood or behavioral changes, including possible manic symptoms in susceptible individuals.
• Suppression of fertility.
• Changes in blood counts and cardiovascular risk markers.
• Changes in lipids, including LDL cholesterol and apoB.

You can notice acne yourself. You cannot reliably feel an increase in apoB. That is why treatment requires more than a prescription and a question about whether you feel better.

Gillett emphasized that a prescriber should either understand these systems well or work within an interdisciplinary team that can monitor them.

Clomiphene Is Not a Simple Workaround

Clomiphene is a selective estrogen receptor modulator, or SERM. By altering estrogen feedback at the hypothalamus and pituitary, it can increase signals that stimulate testosterone production.

That can sound attractive to someone who wants to avoid taking testosterone directly. But clomiphene does not act only in the brain, and selective does not mean free of systemic effects.

Estrogen receptors occur in many tissues, and SERMs have different patterns of action across those tissues. Gillett highlighted visual disturbances, including blurry vision, as an important concern with clomiphene, particularly at higher doses.

His view was that SERMs may have specific, sometimes temporary clinical uses, but generally should not be treated as routine long-term testosterone optimization tools. Raising endogenous testosterone does not automatically make an intervention safer or more appropriate.

Alcohol Can Work Against Hormone Goals

Gillett described alcohol as influencing male hormones through several routes, including increased aromatase activity, the enzyme pathway that converts testosterone to estrogen, and effects on signaling involved in luteinizing hormone and follicle-stimulating hormone release.

Alcohol also supplies approximately 7 calories per gram, compared with 9 calories per gram for fat. Its effects are therefore not limited to the hormone system.

His personal recommendation was conservative: no more than approximately three to four standard drinks over two weeks. That was his clinical guidance, not a universal threshold below which alcohol has no effects.

Serving size matters. A large or generously poured glass should not automatically be counted as one standard drink.

Tadalafil, Prostate Symptoms, and Nighttime Urination

Tadalafil, commonly known as Cialis, is often associated with erectile dysfunction, but we also discussed its use for urinary symptoms associated with prostate enlargement.

Gillett described 2.5 to 5 milligrams daily as a common low-dose approach when clinically indicated. The objective is symptom management, not a general promise of “prostate enhancement.”

One potentially meaningful benefit is reducing nighttime urination. Going from two awakenings to one can materially improve sleep, which may indirectly support the hormonal environment.

Other considerations included modest blood pressure reduction, possible effects on androgen receptor density, and visual effects at higher doses. These are reasons to treat tadalafil as a medication requiring an appropriate indication, not a casual addition to a supplement routine.

Hair Loss Treatments: Topical Does Not Necessarily Mean Local Only

DHT has different effects in different tissues. It contributes to beard growth while also contributing to scalp hair loss in susceptible individuals. Reducing DHT signaling can therefore create trade-offs.

Gillett discussed topical ketoconazole and caffeine as options with relatively weak proposed anti-androgen effects. He described caffeine as commonly combined with other ingredients rather than as a powerful standalone intervention.

The important distinction is systemic absorption:

• Topical spironolactone: Gillett cautioned against unsupervised use in men because topical application does not exclude systemic effects.
• Topical finasteride: It can lower circulating DHT. Gillett cited an approximate 30 percent reduction, although exposure depends on the formulation and use.
• Topical dutasteride: Gillett reported observing little systemic DHT change in his own patients. That clinical observation should not be treated as a guarantee that every preparation remains local.

For someone concerned about libido, sexual function, motivation, or other effects of DHT suppression, the formulation and the individual response deserve attention. “Topical” is a route of administration, not a promise of zero systemic exposure.

The Goal Is Better Function, Not the Highest Number

The most useful sequence is to establish a baseline, support sleep and nutrition, train sustainably, address stress, and investigate persistent symptoms with a qualified clinician.

Supplements and medications can then be considered for a specific purpose, with an understanding of what is known, what is uncertain, and what needs monitoring. A supplement stack cannot substitute for adequate food and recovery, and a normal-looking testosterone result cannot substitute for a complete medical assessment.

Successful hormone optimization should improve the overall picture: how you function now, the risks you accept, and the health you are building for later.