The Peter Attia Drive
#274 - Performance-enhancing drugs and hormones: risks, rewards, and broader implications for the public | Derek: More Plates, More Dates
Episode guests
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Quick takeaways
- Growth hormone is not essential in adulthood, but some claim it can optimize fat loss and vitality.
- Peptides like GHRP and GHRH can enhance growth hormone production and have various effects on hunger, sleep, and IGF-1 production.
- The hypothalamus-pituitary-gonadal axis regulates testosterone and estrogen production through negative feedback loops.
- Androgenic effects refer to the masculinizing properties of hormones, while anabolic effects are related to muscle growth.
- Bodybuilders often use high doses of anabolic steroids and other compounds to promote muscle growth, with careful management of estrogen levels.
- Monitoring hormone levels accurately is crucial for individuals using drugs like testosterone, requiring more sensitive testing methods.
Deep dives
Context and Importance of Growth Hormone
Growth hormone (GH) plays a crucial role in determining height during adolescence and is responsible for the growth of tissues. It declines significantly in adulthood and continues to drop as one gets older. While GH is not essential in adulthood, some proponents claim it can help optimize fat loss, vitality, and overall function. However, the evidence is lacking, and the benefits and risks can vary depending on individual factors such as baseline insulin-like growth factor 1 (IGF-1) levels and overall health. GH is used clinically for GH deficiency in adolescents but is not widely prescribed for other purposes and does not have FDA approval for anti-aging or longevity purposes.
Clinical Applications of Growth Hormone
GH has various clinical applications, such as aiding in the recovery of burn victims and potentially promoting the healing of orthopedic injuries. While the evidence is limited, anecdotal reports suggest that using GH and anabolic steroids during rehabilitation may lead to positive outcomes. GH has also been explored for its potential effects on osteopenia and osteoporosis, though the evidence in this area is inconclusive. Overall, the clinical use of GH in specific medical contexts requires further investigation and tailored approaches based on individual factors.
Peptides and Growth Hormone Enhancers
Peptides such as GHRP (Growth Hormone-Releasing Peptide) and GHRH (Growth Hormone-Releasing Hormone) are often used in combination to enhance GH production. For example, IPamorelin and MK677 are commonly prescribed. GHRP compounds primarily stimulate the ghrelin receptor, while GHRH compounds mimic the effects of GHRH. These peptides have various effects on hunger, sleep, and IGF-1 production. The FDA has approved some peptides for specific medical conditions, but many others are used off-label or prescribed in anti-aging clinics without official approval. Clinicians often combine GHRP and GHRH to maximize the body's endogenous GH production.
Overview of the hypothalamus-pituitary-gonadal axis
The hypothalamus releases gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to produce luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH acts on Leydig cells in the testes to stimulate testosterone production, while FSH acts on Sertoli cells to support sperm production. This axis is tightly regulated through negative feedback loops, with testosterone and estrogen levels influencing the production and release of GnRH and LH.
Conversion and Role of Testosterone, DHT, and Estrogen
Testosterone can be converted into dihydrotestosterone (DHT) or estrogen (estradiol). DHT is the most potent androgen, responsible for masculinizing effects and sexual differentiation during development. Testosterone and DHT bind to the androgen receptor, translocating to the nucleus and acting as transcription factors to regulate gene expression, including muscle protein synthesis. Estrogen, on the other hand, exerts feminizing effects and regulates a balance with androgens. The conversion and balance between these hormones depend on factors such as aromatase activity, adipose tissue, and genetic factors.
Role of Androgenic and Anabolic Effects
Androgenic effects refer to the masculinizing and masculinizing properties of hormones, while anabolic effects are related to muscle growth and protein synthesis. DHT is highly androgenic and promotes masculine characteristics, while testosterone, along with its metabolism into DHT, has both androgenic and anabolic effects. The balance between androgenic and anabolic properties varies between individuals and can be influenced by factors such as lifestyle, genetics, and hormone levels.
Concerns and Considerations for Testosterone and Androgens
The use of testosterone and other androgens comes with considerations and potential side effects. These may include cardiovascular effects, impact on fertility and hormone regulation, as well as concerns related to the misuse or abuse of these substances. It is important to approach the use of androgens with caution and under the guidance of a qualified healthcare professional.
The use of anabolic steroids in bodybuilding
Bodybuilders in the top 50 are typically on anabolic steroids for 90-100% of the year, with testosterone as the base. These bodybuilders are often on high doses of various compounds, including testosterone, to promote muscle growth. They may also use selective androgen receptor modulators (SARMs) for their anabolic effects. The dosages and compounds used vary depending on the individual's goals and preferences. A combination of testosterone and other anabolic agents, such as deca or primobolan, is common during the off-season, while preparing for a contest may involve higher doses and different compounds. The management of estrogen levels and the prevention of gynecomastia are also important considerations for bodybuilders.
Recovery of endogenous testosterone production
Recovery of natural testosterone production after prolonged use of anabolic steroids is possible but can be challenging. Some individuals have successfully restored endogenous production after being shut down for years, but the process requires a thoughtful approach to post-cycle therapy and bridging into recovery. Strategies may involve the use of human chorionic gonadotropin (HCG) to preserve testicular function and stimulate hormone production. The timing and duration of drug clearance, as well as individual responses to gonadotropins, play a role in achieving successful recovery. However, the long-term consequences and potential limitations of recovery following prolonged steroid use are not well understood.
Drug selection and health consequences
Bodybuilders often navigate complex drug regimens and risks in pursuit of their goals. The selection of drugs is based on individual responses, desired outcomes, and the management of side effects. Estrogen management is crucial, and some bodybuilders use aggressive aromatase inhibitors and SERMs (selective estrogen receptor modulators) to prevent gynecomastia. However, the use of high doses of androgens and the suppression of estrogen can have negative health consequences, including neurotoxicity. Gynecomastia surgery may be required for individuals who develop breast tissue growth. Overall, bodybuilders face the challenge of balancing muscle growth and contest preparation with minimizing side effects and maintaining health.
The nuance of drug-related side effects and the importance of monitoring hormone levels
The podcast episode discusses the importance of closely monitoring hormone levels in individuals using drugs such as testosterone or nandrolone. It highlights that standard immunoassay testing may not accurately reflect the actual dosage of these compounds, leading to misinterpretations of hormone levels. Additionally, certain supplements may interfere with hormone testing. The episode emphasizes the need for more accurate and sensitive testing methods, such as liquid chromatography with tandem mass spectrometry, to ensure proper monitoring of hormone levels and avoid potential health risks.
Understanding the roles of HCG and Clomid in fertility and hormone regulation
The podcast delves into the roles of HCG and Clomid in fertility and hormone regulation. It explains that HCG, a compound found in pregnant women's urine, can stimulate the luteinizing hormone receptor and help maintain testicular function, making it crucial for individuals on testosterone replacement therapy who wish to preserve fertility. On the other hand, Clomid, a selective estrogen receptor modulator, can stimulate the production of testosterone by tricking the brain into thinking it's estrogen deprived. While HCG is not FDA-approved for certain uses, it is commonly prescribed and used. The episode also mentions the potential benefits and risks of using nClomid, a specific stereoisomer of Clomid that may have more selective and antagonistic activity.
View the Show Notes Page for This Episode
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We discuss:
- Derek’s interest in weightlifting and experimentation with anabolic steroids at a young age [3:15];
- Derek’s experience acquiring steroids from underground labs and the potential long-term fertility concerns early in his bodybuilding career [12:00];
- The backstory on More Plates, More Dates and Derek’s unique ability to blend scientific knowledge with personal observation [17:00];
- Growth hormone – from extreme use-cases to the more typical – and the misconception that it’s the “elixir of life” [21:30];
- Growth hormone 101: definition, where it comes from, and the challenges of measuring it [28:45];
- Does exogenous growth hormone compromise one’s ability to make endogenous growth hormone? [40:00];
- The use of growth hormone in restoration of tissue during periods of healing [42:00];
- Growth hormone-releasing peptides to increase endogenous GH: various peptides, risks, benefits, and comparison to exogenous growth hormone [48:45];
- The role of growth hormone in building muscle and burning fat, as well as its effects on sleep and daytime lethargy [1:02:30];
- The evolution of drug use in the sport of bodybuilding [1:10:30];
- What explains the protruding abdomens on some bodybuilders and athletes? [1:20:30];
- Death of bodybuilders [1:26:00];
- The complex interplay of hormones, and the conversion of testosterone into metabolites like DHT and estrogen [1:33:45];
- Post-finasteride syndrome and how Derek successfully treated his hair loss [1:43:15];
- Testosterone replacement therapy: compelling use-cases, side effects, and optimal dosing schedules [1:57:15];
- Aromatase inhibitors to suppress estrogen, and the misconceptions around estrogen in men [2:16:00];
- Other hormones beyond testosterone for male sex hormone replacement [2:21:00];
- The history of anabolic compounds, and the differing effects of various anabolic testosterone derivatives and related drugs [2:24:30];
- Use of SARMs by bodybuilders [2:29:45];
- Anabolic steroid and testosterone regimens of professional bodybuilders and the downstream consequences [2:36:15];
- The challenge of accurate hormone testing in the presence of anabolic steroids and supplements [2:44:45];
- The use of Clomid, hCG, and enclomiphene [2:47:15];
- Concerns about fertility: comparing the use of testosterone and hCG [3:00:30];
- The use of BPC-157 peptide for healing injuries [3:12:00]; and
- More.
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