Super Human

by Dave Asprey

  When I saw Wiley’s booth at the convention, I got in line right away to meet her. Directly in front of me was a gynecologist. When it was her turn to speak to Wiley, she raved about how good she felt on the Wiley Protocol, which is Wiley’s recommended dosing of bioidentical hormones to keep postmenopausal women young.

  Wiley smiled, looking younger than her years. “Oh, that’s great,” she said. “Do you use it with your patients?”

  The doctor paused. “Oh, no,” she said. “I can’t do that. It’s too complex, and the regulators wouldn’t understand.”

  This was the first time I saw firsthand a doctor who knew about and benefited from a treatment she wouldn’t share with her patients—and all because of federal regulations. Wiley was clearly frustrated, and so was I. To this day, it baffles me that it can be considered ethical to withhold useful and even life-changing information from your patients simply because it’s not the standard of care.

  That’s exactly why I find it so ironic that people criticize Wiley for being a researcher instead of a medical doctor. Her recommendations for bioidentical hormone replacement therapy come largely from a detailed understanding of how hormones work combined with self-experimentation. She clearly knows her stuff. Her books are incredibly well researched and backed up by citations from medical literature, and the fact that she is not beholden to a regulatory medical association means she can actually try things and see what works without fear of losing her license. And take it from me, one can learn a lot about the human body from self-experimentation.

  For some reason, though, the idea of hormone replacement is still somewhat controversial. People consider it unethical or dangerous to take hormones after your body has stopped producing them in ideal amounts. We buy into the myth that since our bodies naturally begin producing lower levels of some hormones as we reach middle age, the only option is to accept it and stoically face a swift decline. When our hormone levels go down, we don’t just become infertile—our bodies begin to age in numerous, devastating ways.

  Hormones are chemicals that serve as messengers in the body, relaying important information to various glands and organs. Specifically, hormones govern your thyroid, adrenal, and pituitary glands, as well as your ovaries or testicles and pancreas. In fact, hormones control much more than most people realize. When our hormones are out of balance, we feel it—and the list of symptoms is nearly endless.

  But unless you have a serious health condition, if you have your hormone levels tested by a conventional doctor, he or she will probably tell you that you are within the normal range for your age. But the “for your age” part should be a huge red flag for anyone who isn’t looking forward to the typical course of aging in our culture. I want my hormones to be within the normal range for someone who is the age I want to feel, not the age on the calendar. To be within the normal range of someone who is beyond his or her reproductive years means you are dying, albeit slowly. It may not be particularly comfortable to hear, but it’s true. You can accept your fate and start sliding downhill at around the age of forty, or you can work to keep your hormones at the levels of someone at his or her peak so you can keep kicking ass long term.

  In many ways, the natural reduction in hormone levels as you get older drives the aging process. In both sexes, as you age your body produces less and less pregnenolone and dehydroepiandrosterone (DHEA), two pre-hormones that your body converts into the other major sex hormones: testosterone, estrogen, and progesterone. With less DHEA, you also have less of these other hormones, and as a result you can expect more skin aging,1 more body fat, less muscle, lower bone density, crappy sleep, and often, sexual dysfunction.

  Today, after menopause women live about a third of their lives deficient in sex hormones. Even before that, two-thirds of women experience reduced sexual pleasure during the period of time directly preceding menopause, which is called perimenopause. Most women enter perimenopause in their early forties.2 It’s not just about sexual pleasure, though. Estrogen, which starts to dip during perimenopause, helps prevent cancer, bone loss, and heart disease. When estrogen levels decline, your risk of these killers rises. Men need estrogen, too, and they face the same risks when their levels decline in middle age.

  Testosterone also does a lot more than you may think in the bodies of both men and women. This hormone helps both men and women burn fat, build muscle,3 and maintain a healthy sex drive. Low testosterone is linked to osteoporosis in men, mild cognitive impairment, and even Alzheimer’s. Yikes! You can consider bioidentical testosterone replacement a potent nootropic, or smart drug, because it improves verbal, spatial, and working memory and executive function.4

  Testosterone is also lower in men who have heart attacks, suggesting that proper levels can help you avoid this major killer.5 A study of eighty-three thousand older men who underwent testosterone replacement therapy found it decreased their risk of mortality from all causes.6 Yet doctors routinely underdiagnose and undertreat the decrease in testosterone that men experience at around the same age that women enter menopause, called male andropause.7 Remember the movie Grumpy Old Men? That’s andropause. You can avoid it.

  For men, Wiley recommends cycling between testosterone, DHEA, and growth hormone in a natural rhythm to stay young and avoid this fate, and to start as young as twenty-nine, since your levels will drop off about ten years later. This will keep your immune system strong and your inflammation levels low, adding quality years to your life. For women, she recommends using bioidentical hormones to mirror the exact hormonal cycle of a woman in her peak reproductive years. She has female patients who still menstruate in their sixties, and Wiley says that these women have made the choice to keep menstruating and stop aging. That is powerful.

  END THE STIGMA OF HORMONE REPLACEMENT THERAPY

  Yet, hormone replacement has a bad reputation for no good reason. In 2002, the Women’s Health Initiative found that women who were treated with nonhuman estrogen from horse urine and a modified pharmaceutical form of progesterone had a higher risk of breast cancer, stroke, and cardiovascular disease.8 That was enough for people to associate “hormone replacement” with cancer. But the same study also found a reduction in hip and back fractures and no total increase in cancer. In other words, the increase in breast cancer was offset by a decrease in other types of cancers.

  Still, after the study came out, hormone replacement lost its luster. Within three months of the study, prescriptions dropped by about half. That may have been a good thing, however. It’s not a great idea to use synthetic hormones, especially since bioidentical hormones that are exactly the same as what your body makes are available. However, bioidentical hormones cannot be patented, so they don’t receive major research funding.

  Meanwhile, testosterone replacement has a similarly bad reputation because of 1970s body builders who used synthetic testosterone pharmaceuticals to get jacked. Unfortunately, their livers also got jacked. To this day, when many people hear about testosterone replacement for men, they think of body building instead of staying young, lean, and vibrant at any age. Using bioidentical testosterone instead of synthetics makes a huge difference, as does dosing it for aging instead of body building.

  There is also a myth that testosterone replacement will cause prostate issues, but this connection is based on old animal studies. Three recent studies failed to find any link between prostate issues and testosterone therapy, but two did find that low testosterone levels are associated with an increased risk of prostate cancer.9

  So let’s just get rid of preconceived notions about hormone replacement and think about what would happen if as you aged you maintained the hormone levels you had at twenty-five or thirty. Before trying any of this, though, it’s best to get a lab test to learn your current hormone levels. You can order these tests online to save money, but if you need help interpreting the results or getting a prescription for hormone replacement, it’s best to work with a functional medicine practitioner. Before prescribing any hormone replacement, a physi
cian will measure:

  Estradiol—the most potent estrogen

  Estrone or estriol—weaker estrogens (estrone turns into estriol in your body)

  Progesterone—balances estrogen

  Testosterone—necessary for muscles and sexual function

  Prostate-specific antigen (PSA)—for men who are on testosterone, discontinue if it climbs

  Hematocrit—for men who are on testosterone, discontinue if it climbs

  Sex hormone binding globulin (SHBG)—this sticks to hormones to make them unavailable

  DHEA—a pre-hormone

  Pregnenolone—a pre-hormone

  I’ve supplemented with many of these, including:

  TESTOSTERONE

  As you read earlier, I started hormone replacement therapy (HRT) when I was in my twenties and my hormones, particularly testosterone, were trashed. At first my physician prescribed a cream that I rubbed into my skin, which my body absorbed transdermally. This is the form of treatment that Wiley recommends, too. Personally, I found the cream to be inconvenient. I worried that if someone touched me, the testosterone would rub off on him or her. This can be dangerous with kids or pregnant women. If you’re sleeping next to someone, the cream can get on the sheets and transfer over that way, too.

  There is a dirty little secret about testosterone cream that almost no one knows, however, and I’m going to share it here. Please don’t abuse it. If you are a woman and you take a vanishingly small dose of testosterone cream and apply it to your labia and vulva (or ask your partner for help), you will experience a form of vasodilation (increased blood flow) rarely seen no matter how good your partner is in bed. It has a profound local effect and will produce a night you won’t soon forget. You don’t want to do this every night, but on an occasional basis it is unlikely to be harmful and very likely to blow your mind. Compounding pharmacists call it “scream cream” for a reason.

  And in fact, having better sex is also a great anti-aging strategy. There’s real data to back that up. A ten-year study of nine hundred men found that men who had sex only once a month died twice as often as those who had it twice a week.10 Given that this test started in 1979, as was the practice at the time, researchers didn’t bother to ask about the women.

  In the last few years, a lot of men and women have switched from a hormone cream to a pellet that goes under your skin. This is probably the best way to take testosterone now. The pellet is life-changing for both men and women. The regular dose for women is much lower than it is for men. Women, you won’t get bulky and grow a beard when you take testosterone to achieve ideal hormone levels, but you will probably lean out a little without losing your curves, and your energy and sex drive will be amazing. Female body builders who experience weird, scary side effects are taking anabolic steroids, not bioidentical testosterone. For the pellets, you visit a doctor’s office once every three to four months to get a new one.

  I started bioidentical testosterone at age twenty-six and have been on it for most of the last twenty years, except in 2013, when I was testing the Bulletproof Diet to see what it did to my testosterone. (It raised my testosterone, but not as much as I wanted.) In that time, my sex drive returned, my energy increased, my brain function improved, I lost weight, and I gained muscle. Yes, like a young person—which my body thought I was. Please don’t tell it the truth.

  DHEA

  The pre-hormone dehydroepiandrosterone (DHEA), which you read about earlier, has been getting a lot of attention lately for its longevity-enhancing effects. A major review of the available research on DHEA concluded: “During the past five decades, a myriad of animal experiments has suggested that DHEA is a multifunctional hormone with immune-enhancing, anti-diabetic, anti-obesity, anti-cancer, neurotropic, memory-enhancing, and anti-aging effects.”11 Boom.

  Sadly, DHEA levels plummet as you age, reaching a mere 10 to 20 percent of youthful levels by the time you hit seventy.12 These levels are even lower in postmenopausal women. When the ovaries stop producing hormones during menopause, the only source of sex hormones in a woman’s body is her adrenal glands, which produce hormones in much lower levels than ovaries. Low DHEA is linked to depression and a higher risk of heart attacks and death from all causes. Low DHEA is also related to sexual dysfunction.13

  You may read this and decide to just buy some DHEA supplements, but that is a bad idea. Without proper testing, you don’t know what your body is going to do with those hormones once it gets them. I first tried taking DHEA when I was only nineteen. My man boobs got even bigger, and my libido tanked. It turns out that the men in my family have a gene that preferentially turns androgenic hormones, including DHEA, into estrogen!

  As a side note, this genetic fluke causes a few other hormone therapies that work for some people to completely fail for me. For instance, men can take human chorionic gonadotropin (hCG), a pregnancy hormone in women, to stimulate the body to produce more testosterone. Some guys swear that it also causes penile growth,14 but this was certainly not my experience. When I tried injecting hCG, I grew a nice round bubble butt, developed soft thighs, and regained the man boobs I had fought so hard to lose. My body literally thought I was pregnant. Every body is different, so it’s incredibly important to find a doctor you trust, get the proper lab tests, and take any hormone supplements under supervision.

  OXYTOCIN

  Even oxytocin, a hormone best known for its role in making you feel good and bond with others, is easy to supplement with and has powerful anti-aging effects, specifically when it comes to tissue and muscle maintenance and regeneration. A 2015 study showed that inhibiting oxytocin reduced muscle regeneration, while supplementing with oxytocin caused rapid muscle regeneration via enhanced muscle stem cell activation.15 In other words, the additional oxytocin told the body that it was young and needed to build more muscle, so the body quickly recruited latent stem cells for the job. Oxytocin also works alongside your inflammatory stress hormones such as cortisol during times of stress so you maintain homeostasis and don’t become too inflamed.16 Since reducing inflammation is pretty much the most effective anti-aging strategy of all, you clearly want to make sure you have plenty of oxytocin in your body.

  Meanwhile, we know that our levels of circulating oxytocin typically decline with age. This is clearly one reason our stem cells become less activated as we get older and we become more inflamed. It also makes me wonder if it’s why having strong relationships and being a part of a close-knit community helps people live longer. Perhaps in addition to offering psychological benefits, those relationships cause oxytocin levels to rise, and that oxytocin helps these people stay young. Another great benefit of oxytocin is that it reduces your stress response and dramatically boosts feelings of happiness. And you already know that less stress equals less aging.

  As you read earlier, for most of my life I was more than a little bit socially awkward. So I was curious and hopeful when I learned about the benefits of oxytocin from Dr. Paul Zak, a neuroeconomist whose research on oxytocin has earned him the nickname Dr. Love. In his lab, Dr. Zak has conducted hundreds of experiments measuring oxytocin levels in participants’ tissues and blood and manipulating it using oxytocin injections or nasal spray. He says that an increase in oxytocin makes people more generous and trusting, less suspicious, and better able to read social cues.

  Learning this, I saw that it might be possible to hack my empathy and my aging at once. I had my oxytocin levels tested, and they were indeed far too low. The healthy range for men is 7 to 18 pg/ml, and I measured at a measly 4. So I got to work boosting my oxytocin levels using both natural and pharmaceutical means.

  Any type of human interaction will increase oxytocin, but some are more effective than others. Face-to-face communication stimulates the greatest release of oxytocin. So I make sure to regularly schedule time with my team at Bulletproof in person, even though most of the staff works remotely. On a personal level, getting a massage, sharing a bed with a partner, playing with a dog, and even giving someone an eight
-second (or longer) hug all boost oxytocin levels. I make sure to do all of these things on a regular basis.

  I’ve also experimented with oxytocin lozenges and nasal sprays, which are available from a compounding pharmacy with a prescription. There are some retailers selling oxytocin products online, but be careful if you choose to go this route. Some are simply labeled “oxytocin” and are filled with other junky ingredients. I highly recommend working with your doctor if you want to try supplementation.

  When I used the nose spray, I felt a bit happier and more at ease, but the change was very subtle—not dissimilar to how I feel after playing with my kids or my dog. Most of the time, I opt for the latter because it improves my performance while keeping me young and has the benefit of raising my kids’ (and dog’s) oxytocin levels, too. Of course, playing with my dog and kids has plenty of other mental, emotional, and even spiritual benefits for all of us. We do these things naturally because they feel good. But it’s nice to know that they can simultaneously help you age backward!

  HGH

  Finally, human growth hormone (HGH), the famous anti-aging compound, declines as you age. Unfortunately, it is frighteningly expensive and doesn’t have clear science backing its use as a supplement. If lab tests show you are deficient in growth hormone, you will most likely benefit from replacing it. If you want to just look young, you may still benefit, but if you want to actually live longer, the results are mixed.

  I was clinically diagnosed with deficient growth hormone about two years before I started writing this book. My levels were exceptionally low, which raised my risk of the Four Killers. I take a low dose of HGH on occasion, but given that it is expensive and hard to travel with, I do not take it every day. Unless your lab tests indicate that you really need it, this one may not be the best use of your money. However, if you are recovering from a major surgery, there’s a case for using HGH to recover.