How to Optimize Testosterone & Estrogen

The episode opens a month-long focus on hormones, presented as chemicals that influence mood, behavior and feelings of optimism or pessimism. Its central framing is that the influence runs both ways: hormones affect how we feel, act and think, and those same feelings, actions and thoughts can also change our hormones. This instalment concentrates on estrogen, testosterone and their derivatives. It follows an earlier episode on sexual development and covers mostly what happens from puberty onward, mixing basic biology with practical tools.

Before getting to hormones, the discussion introduces salutogenesis, a concept credited to a Stanford Medicine colleague. The familiar pathogenic model frames health behaviors as ways to avoid diseases such as dementia, heart disease and stroke. Salutogenesis frames the same behaviors, including nutrition, exercise and supplementation, as ways to raise wellbeing above where it would otherwise be: to feel good, have more energy, and improve endocrine and metabolic function. The episode calls the two "two sides of the same coin" and argues that the strongest mindset combines them: moving away from sickness and toward health at the same time. It also observes that allopathic medicine contains both models, but the salutogenic one is discussed less often.

Mindset is offered as the reason this matters, with a pointer back to earlier material. The episode mentions studies from Alia Crum's group at Stanford and others. In those studies, hotel room cleaners who were told their work was good for them showed greater positive health effects than workers who did not have that information. From this, the episode argues that keeping in mind the positive effects of a behavior can have "an outsized effect on wellbeing right down to the level of our physiology." The study is described only briefly and is not re-examined here.

Estrogen, testosterone and their derivatives are grouped as sex steroids. The episode notes that the term tends to suggest anabolic steroids. It accepts that anabolic steroids are testosterone or its derivatives and are heavily used and abused in and outside sport, but says performance enhancement in sport is not the subject here. It still flags that exercise type, patterns of cold exposure and even breathing patterns will come up as influences on estrogen and testosterone, and it mentions a possible future episode, or month, on physical performance.

But I just want to emphasize that estrogen and testosterone are present in everybody. It's their ratios that determine their effects.

The ratio of estrogen to testosterone is said to strongly affect wellbeing, optimism, anxiety, reproduction, and sexual behavior apart from reproduction. The stated aim is to show how behavioral tools, supplements and prescription drugs can shift those ratios to fit particular life goals.

The episode lists several hormone-producing glands: the pineal gland, the hypothalamus, the gonads (ovaries or testes) and the thyroid. For the sex steroids, the main sources are the ovaries for estrogen and the testes for testosterone, and the adrenals can also make testosterone. The adrenals sit on top of the kidneys. The episode says their release of testosterone and related derivatives is "mainly activated by competition."

Enzymes, which change chemical composition, come next, with a focus on the aromatases. Aromatase converts testosterone into estrogen. In a male with very high testosterone, some of it will be converted to estrogen. Aromatase is made by body fat and also by the testes. The episode points out that the testes can make estrogen and aromatase, though at low levels, and says this matters later for optimizing male hormone levels.

The episode deliberately gives no reference ranges. Hormone levels differ greatly between individuals and within one person over a lifetime, and the units used in measurement (picograms, nanograms and so on) also vary. Anyone who wants their hormones examined is told to do so with a medical doctor, ideally an endocrinologist.

Lifespan patterns described in the episode: - Estrogen discussion centers on estradiol, called the most active form in both males and females. - Prepubescent females make very little estrogen. Levels "basically skyrocket" during puberty and then vary with the stage of the menstrual cycle. - Estrogen drops during menopause, which the episode says now typically happens somewhere between age 45 and 60. After menopause, estrogen is very low. - In males, testosterone is relatively low before puberty, skyrockets during puberty, and by current figures declines about 1% per year. - The 1% figure comes with a caveat: the episode cites many men in their 90s whose testosterone levels resemble pubertal levels. It treats this as evidence of large individual variation.

Competition is presented as both a driver and a result of sex steroids. The episode says most males of a given mammalian species never reproduce, and that testosterone strongly influences which ones gain access to females. It names elephant seals, antlered animals and rams as species in which higher testosterone correlates with mating access. It explicitly says this is not a claim about humans specifically.

Two explanations are compared. One is that females detect and choose males with high testosterone. The episode leans more toward the other: males with higher testosterone forage further and fight harder for females. It supports this with what it calls very good evidence that testosterone can reduce anxiety, encourage novelty seeking and promote competitive interactions.

The proposed mechanism runs through the amygdala, which the episode describes as more about threat detection than fear alone, since it sets thresholds for anxiety and for what feels scary or too much. Testosterone from the gonads and elsewhere binds to the amygdala and changes the stress threshold. This is how the episode reframes its earlier line that testosterone has "this incredible effect of making effort feel good": the underlying effect is reduced stress and anxiety, particularly in males of a given species. On this account, the job of testosterone in competition and mate choice is to lower the anxiety threshold, so individuals push further and tolerate more suffering. The episode adds that testosterone also reduces pain, "so maybe they also suffer less."

For humans, the episode says males and females with elevated testosterone both show more novelty seeking. It stresses that people without testes also have testosterone, and that peaks have similar effects whether a person has ovaries or testes. Rises in testosterone are linked to more foraging, more novelty seeking, higher libido and more desire to mate, in humans and in nonhuman mammals.

The opposite direction is then emphasized: competitive environments can themselves raise testosterone. The episode accepts that winning raises testosterone and losing lowers it, "to some extent." It says this is not a direct effect on the gonads. Instead it is mediated by dopamine, which acts in the brain so that the pituitary releases hormones that in turn promote more testosterone. Winning increases dopamine and, later, testosterone. In the short term, though, simply competing raises testosterone whether one wins or loses. The episode suggests this may be an ancient feedback loop that encourages more competition, since every species competes for mates or other resources.

The episode repeats that rising testosterone also increases reproductive behavior and libido in females. It describes a phase of the menstrual cycle when testosterone peaks just before ovulation. At that point, on average, women report seeking sex more than at other times in the cycle. It notes that this finding is self-reported, though collected alongside measurements of testosterone-to-estrogen ratios.

The episode then separates the roles of the two hormones. Across chromosomal and gonadal backgrounds, testosterone increases mate seeking and the willingness to compete, and lowers the threshold for stress and anxiety. In females, estrogen is what promotes receptivity to mating, which the episode calls "consensual receptivity." In males, testosterone drives the seeking of sex, but estrogen is also needed for libido. The episode states that if estrogen is pushed too low, men will completely lose their libido.

The episode says this point is often missed in discussions of testosterone therapy and performance-enhancing drugs. Hyperandrogenized individuals will have high libido only if estrogen is available in sufficient ratio to their testosterone. Its conclusion pushes back on the idea that high testosterone and low estrogen are good across the board.

you actually need both in both males and females. It's just that in females, the testosterone levels are always going to be lower than the estrogen levels. And in males, the estrogen levels are always going to be lower than testosterone levels.

The episode treats the question of whether sex raises testosterone as complicated, with a short answer of yes. It divides sex into stages: seeking, the physical act, and orgasm and ejaculation. Dopamine rises with sexual activity, and the episode says dopamine and testosterone tend to rise linearly together. After ejaculation, prolactin is released, and prolactin sets the male refractory period. The length of that period depends on how much prolactin is released and for how long.