核心要点：男性激素优化的工具 | 凯尔·吉莱特博士

欢迎来到休伯曼实验室精华版，这里我们会回顾过往节目，为你提炼出最有效、最实用的科学工具，帮助你改善心理健康、身体健康和表现水平。

Welcome to Huberman Lab Essentials, where we revisit past episodes for the most potent and actionable science based tools for mental health, physical health, and performance.

我是安德鲁·休伯曼，斯坦福大学医学院神经生物学和眼科学的教授。

I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.

接下来，让我开始与医生的对话。

And now for my discussion with Doctor.

凯尔·吉莱特。

Kyle Gillett.

医生。

Doctor.

吉莱特医生，很高兴你再次回来。

Gillett, great to have you back.

能回来我也很高兴，谢谢。

Great to be back, thank you.

我想先问一个问题：所有男性应该做些什么，才能最好地调节自己的激素水平？

I'd like to begin with a question about what all males ought to do in order to optimize their hormones.

他们应该

What should they

怎么做呢？

be doing?

如果目标是让激素水平在整个生命周期中保持长期健康优化，那他们应该避免做什么？

What should they avoid doing if the goal is to have a long arc of healthy hormone optimization throughout the lifespan?

有很多事情是该做的。

There's many things that you should do.

我常打个比方：一辆新车刚下生产线时，我们会做全套检测，连上电脑全面诊断。

An analogy that I often make is when there's a brand new car that comes off the assembly line, you do a full scope of diagnostic workup, hook it up to the computer.

我觉得对人也该这么处理。

And I think we should do the same thing with humans as well.

青春期时，你当然已经是正常人了，但身体还在继续发育。

During puberty, you know, obviously you're a functioning human, but I would say there's still development.

我认为人的成长从来不会真正停止，只是我们需要在整个生命历程中持续关注这种变化。

And I think that the human always develops, I don't think development ever ends, but you want to monitor that progress across a person's lifespan.

你觉得在血液检查中应该重点关注哪些指标？

What do you think are the key things to look for in blood work?

提到男性激素优化，睾酮总是第一个被讨论的，但其实还有很多其他激素也很重要。

Mean, testosterone is always the topic that comes up in the context of male hormone optimization, but certainly there are a lot of other hormones that are important as well.

关于睾酮，你需要检测总睾酮加上性激素结合球蛋白，或者直接测游离睾酮。

And with testosterone, you want to get either testosterone and SHBG or a free testosterone.

你能给听众解释一下什么是SHBG吗？

Could you define SHBG for our listeners, please?

SHBG就是性激素结合球蛋白。

It is sex hormone binding globulin.

它是一种能结合体内所有雄激素和雌激素的蛋白质。

It is the protein that binds up all androgens and estrogen of the body.

雄激素活性越强，和它结合得就越紧密。

So the stronger the androgen, the stronger it binds.

在青春期，强效雄激素，尤其是二氢睾酮——这是最强的生物同源雄激素，在第二性征发育中起着关键作用。

During puberty, strong androgens, especially DHT, which is the strongest bioidentical androgen, has a huge role, a prominent role in secondary sexual characteristics.

如果SHBG水平很高，DHT虽然代谢得慢，但游离的DHT反而不会太多。

And if your SHBG is very high, then your DHT can run higher because it's not metabolized, but there's not quite as much free DHT.

所以你需要在游离DHT和总DHT之间找到平衡。

So you want to balance between a high enough free DHT and a high

足够的总DHT。

enough total DHT.

如果没有重大干预，你一般建议人们多久做一次血液检查？

So assuming that there's no major intervention, how often do you recommend that people get their blood work done?

在和医生共同决策的前提下，通常建议每六个月复查一次。

Using shared decision making with their physician, usually a good follow-up is about six months.

能不能从日常生活的角度，给我们讲讲你平时用的那些方法，或者你希望男性患者坚持哪些习惯，来优化他们的激素水平？

So on a daily basis, maybe you could just take us through the arc of a day and push out some of the protocols that you use or the things that you like to see your male patients use in order to try and optimize their hormone status.

我先简单聊聊几个生活方式的关键点。

I'll briefly touch on some of the lifestyle pillars to start.

饮食和运动是最重要的两个方面。

Diet and exercise are the first two.

青春期的时候，睡眠特别重要，这点不用说。

In puberty, sleep is particularly important, of course.

但说到饮食和运动，整个人生阶段都别轻易放弃那些对你有帮助的东西。

But with diet and exercise, throughout a lifespan, you want to not exclude things that are helping you.

比如在青春期，如果你一直在喝奶，突然全戒了，其实奶制品能帮助提升IGF-1和游离IGF-1的水平。

For example, during puberty, if you're consuming dairy and then all of a sudden you cut out all dairy, dairy can help increase IGF-one and free IGF-one.

为了让听众更清楚，您刚才提到的，IGF-1足够对身体有哪些好处？

Just for our audience, maybe you just mentioned what having enough IGF-one can do for us that's beneficial is?

它能促进生长，帮助生殖器官发育，推动第二性征出现，还有长骨生长、皮肤和毛发的发育，很多方面都离不开它。

It helps you grow, it helps with genital development, secondary sexual characteristics, and long bone growth, skin growth, hair growth, a host of things.

那除了奶制品，发育阶段还有哪些营养素特别关键？

So getting an array of nutrients that include dairy, what other sorts of nutrients are important during development?

你得确保

You want to

维生素D摄入充足。

have adequate vitamin D.

维生素D有助于睾酮的生成，也能促进骨骼矿化和身高发育。

Vitamin D helps with testosterone production, it helps again with bone mineralization and stature.

大约25岁之后，虽然没有绝对的界限，但在25岁之前，优化生长激素和IGF-1水平对骨密度和骨骼生长很有帮助。

After an age of about 25, and there's not a strict cutoff, but up to about an age of 25, optimizing your growth hormone and IGF-one helps with bone density and bone growth.

从饮食角度看，生长期需要适量的游离雌激素，不能太多，但要帮助骨骼充分储备，以降低老年时骨质疏松或骨折的风险。

So from the dietary standpoint, you want to have enough free estrogen, not too much when you're growing, but you want to help basically stockpile bone to prevent a risk of osteoporosis or thin bones fractures when you're older.

我知道这些话题牵涉到伦理和食物过敏等问题，但总体来看，大多数人是否还是应该摄入优质动物蛋白和非动物蛋白，再加上水果、蔬菜和淀粉类食物？

I realize that some of this relates to ethics and food allergies and things of that sort, but would you say that on balance that most people would benefit from eating a combination of quality proteins from animal sources and non animal sources, fruits, vegetables, and starches?

比如，你怎么看那些在二三十岁坚持纯肉食或纯素食的人？

I mean, what do you think for instance about people following a pure carnivore or a very pure vegan diet in their 20s and 30s?

到了快30岁的时候，这种饮食方式或许还能接受。

In their late 20s, it might be a reasonable option.

但在二十岁出头，尤其是青春期，这绝对是个糟糕的选择，很可能大幅降低游离雄激素水平。

In early 20s and certainly teens, it is a horrible idea because it is likely to significantly decrease your free androgens.

这样一来，体内的睾酮就无法充分作用于各个组织的受体了。

So you will have less testosterone acting on receptors through the body.

除了这些，二十多岁和三十多岁的人还应该特别关注哪些微量或常量营养素？

Are there any other micronutrients or macronutrients that people in their twenties and thirties should emphasize?

膳食纤维对塑造你一生的肠道菌群平衡至关重要。

Fiber is going to be paramount in kind of like setting your set point of your gut microbiome the rest of your life.

有可溶性膳食纤维，你可以把它看作是滋养你体内有益菌群的‘鱼粮’。

There is prebiotic fiber, which you could think of as fish food for your good gut microbiome.

你的肠道菌群就像一个水族箱。

Your gut microbiome is kind of like an aquarium or a fish tank.

你吃进肚子里的任何纤维或食物，都会让肠道菌群朝更健康或更不健康的方向偏移。

Any fiber or food that you're putting in your gut, it's going to skew your gut microbiome towards something that is more beneficial or more detrimental.

那么，补充可溶性纤维和必需脂肪酸，是应该贯穿一生，还是只在二十多岁和三十多岁重要？

And would you say that the prebiotic fiber and getting essential fatty acids, that would be important to do throughout the lifespan or just for people in their 20s and 30s?

应该贯穿一生，尤其在青少年和二十到三十岁期间特别关键，因为这对大脑发育有帮助。

Throughout the lifespan, particularly important in the teenage 20s, 30s, because it helps with brain development.

说到大脑发育，你肯定比我更专业，但大脑其实是一直在发育的，只是在

You're certainly more of an expert than me when it comes to brain development, but it does continue to develop really throughout the lifespan, but certainly through

20多岁和30多岁也同样重要。

the 20s and 30s as well.

之前我们聊过热量限制和睾酮的问题。

In a previous discussion of ours, I asked you about caloric restriction and testosterone.

如果我没记错的话，你的意思是，如果一个人超重，体内脂肪过多，通过适度、健康的热量控制和运动减掉一些脂肪，长期来看对睾酮水平是有好处的。

And if I recall correctly, the idea was that if somebody is overweight, they have excess fat adipose tissue, then getting rid of some of that adipose tissue through caloric restriction and exercise, provided it's done not too fast in a healthy way, is going to be beneficial for testosterone in the long run.

但对于本身体脂并不超标的人，热量限制反而会导致睾酮水平下降。

But that for individuals who are not carrying an excess of body fat, caloric restriction is actually going to lower testosterone.

我理解得对吗？

First of all, do I have that correct?

另外，你还有什么要补充的吗？

And second, are there any addendums to that that you'd like to give us now?

没错。

That's correct.

如果你观察一个处于热量缺口状态的人，身体会发生好几项变化。

If you look at an individual in a caloric deficit, several changes will happen.

首先，身体用于合成激素的原料会减少。

One is that they'll have less building blocks for hormones.

其次，身体会更常处于分解状态，导致合成与分解之间的平衡被打破。

Another is that they will be in a catabolic state more often, so that balance of anabolism and catabolism will be different.

生长激素和IGF-1的信号也会减弱，同时我们之前提到的性激素结合球蛋白水平会升高。

They'll likely have less signaling from growth hormone and IGF-one, and they'll also have the high SHBG that we defined earlier as the binding protein.

因此，游离的雄激素和雌激素水平都会下降。

So they're free androgens and free estrogens will go down.

那么，除了饮食之外，还有哪些关键因素有助于优化激素水平呢？

Now, what are some of the other pillars of creating the proper environment for hormone optimization?

压力可能是下一个重要因素。

Stress is probably the next one.

无论是青春期，还是二十多岁到三十多岁这段时间，人们都在摸索如何应对压力，同时也决定把精力投入到哪些事情上。

During both puberty, but also the 20s and 30s, individuals are figuring out how they want to cope with stress and also figuring out what they want to choose to put their effort into.

如果一个人长期压力过大，就会影响其他所有健康习惯——饮食变得不规律，锻炼也荒废了，整体状态都会走偏。

So if someone is overstressed, then they can have, it can put all the other lifestyle pillars and then they stop dieting well, they stop exercising and everything else can go askew.

那除此之外，每个人还应该做些什么呢？

What would be some of the additional things that everybody should do?

另一个是找到自己人生的意义。

Another one is finding what your purpose is in life.

我把这叫做精神层面，其实也就是马斯洛需求层次里的自我实现，也就是先满足生理需求、心理需求，再找到人生的目标。

So I call this spirit, but it's really just the self actualization component of Maslow's hierarchy of needs, which is basically your physical needs, your mental needs, and then your purpose in life,

就是你真正喜欢做的事。

what you really like to do.

重点不是一下子定下最终目标，而是先定一个小目标。

The idea is not to pick the end goal, it's to pick a goal.

等你达成这个目标后，再评估一下，接着设定下一个目标，就这样一步步来。

And then once you reach that goal to assess and then pick another goal and so on.

有些人一听要设定人生目标，就觉得天啊，我得立刻给自己定个死规矩，其实目标和意义是会随时间变化的。

I think sometimes when people hear about picking a purpose, they're like, oh my goodness, I have to define, sort of like naming oneself that you actually can change your goals and purpose over time.

我们先插个广告，感谢我们的赞助商LMNT。

I'd like to take a quick break and acknowledge one of our sponsors, LMNT.

LMNT 是一种电解质饮料，该有的都有，不该有的全无。

LMNT is an electrolyte drink that has everything you need and nothing you don't.

也就是含有适量的电解质——钠、镁和钾，但完全不含糖。

That means the electrolytes, sodium, magnesium, and potassium in the correct amounts, but no sugar.

良好的水分补充对大脑和身体的正常运作至关重要。

Proper hydration is critical for optimal brain and body function.

哪怕只是轻微脱水，也会降低你的认知能力和体能表现。

Even a slight degree of dehydration can diminish cognitive and physical performance.

同时，确保摄入足够的电解质也很重要。

It's also important that you get adequate electrolytes.

钠、镁和钾这些电解质对体内所有细胞的功能都至关重要，尤其是神经细胞。

The electrolytes, sodium, magnesium, and potassium, are vital for functioning of all the cells in your body, especially your neurons or your nerve cells.

把 LMNT 溶解在水里喝，能轻松保证你摄入足够的水分和电解质。

Drinking LMNT dissolved in water makes it very easy to ensure that you're getting adequate hydration and adequate electrolytes.

为了确保自己每天摄入足量的水分和电解质，我一早醒来就会把一包 LMNT 溶在 500 到 1000 毫升水里，第一时间喝掉。

To make sure that I'm getting proper amounts of hydration and electrolytes, I dissolve one packet of LMNT in about 16 to 32 ounces of water when I first wake up in the morning, and I drink that basically first thing in the morning.

我还会在运动时把LMNT溶解在水里喝，尤其是大热天出汗多、流失水分和电解质的时候。

I'll also drink LMNT dissolved in water during any kind of physical exercise that I'm doing, especially on hot days when I'm sweating a lot and losing water and electrolytes.

LMNT有好几种味道都很棒。

LMNT has a bunch of great tasting flavors.

我特别喜欢覆盆子味，还有柑橘味。

I love the raspberry, I love the citrus flavor.

现在LMNT推出了一款限量版的柠檬水味，简直太好喝了。

Right now, LMNT has a limited edition lemonade flavor that is absolutely delicious.

我不太好意思说哪个口味最棒，但这款柠檬水味绝对和我最爱的覆盆子味或西瓜味不相上下。

I hate to say that I love one more than all the others, but this lemonade flavor is right up there with my favorite other one, which is raspberry or watermelon.

真的，我没法只挑一个最喜欢的。

Again, I can't pick just one flavor.

我每个口味都喜欢。

I love them all.

如果你想试试LMNT，可以去drinkelement.com/huberman，输入这个网址就能在购买任何Element饮品粉时免费获得一份试用装。

If you'd like to try LMNT, you can go to drinkelement.com/huberman, spelleddrinklmnt.com/huberman to claim a free Element sample pack with a purchase of any Element drink mix.

再次提醒，前往 drinkelement.com/huberman 可以免费领取一份试用装。

Again, that's drinkelement.com/huberman to claim a free sample pack.

我想回到之前提到的关键点，也就是男性应该如何做来优化自己的激素水平。

I'd like to return to the key things that people should do, or I should say the key things that men should do to optimize their hormones.

你觉得什么样的锻炼计划既健康又可持续，还能有效支持激素平衡？

What do you think is a healthy, sustainable exercise regimen that anyone can follow that will also support their hormone status?

每周进行三到四次高强度锻炼，长期坚持下来是完全可行的。

For really vigorous exercise around three to four times a week is very sustainable over a long period of time.

除此之外，还可以再安排三到四次强度较低的运动。

On top of that, you could add in three or four more instances of less vigorous exercise.

研究运动效果时，尤其是高强度运动，有一个被广泛研究的领域是单次超过一小时的高强度训练。

When they study the effect of exercise, specifically vigorous exercise, one area that's been studied is vigorous exercise episodes lasting longer than an hour.

通常他们会用主观疲劳评分来衡量，虽然不够精确，也不太便于日常操作，但在临床研究中很有参考价值。

And they usually track it by a rating of perceived exertion, which isn't perfect, and it's not extremely actionable, but it's helpful for clinical science.

关键结论是：长期频繁进行超过一小时的高强度训练，对激素水平并没有好处。

But the takeaway from that is basically, it is not hormonally helpful to train, especially regularly train vigorously for longer than an hour.

现在呢，

These days,

不管好坏，我觉得是更糟了，年轻男生们越来越关注甚至开始使用睾酮替代疗法，也就是所谓的TRT。

for better or for worse, I think for worse, younger guys are asking about and using testosterone replacement therapy, so called TRT.

既然他们的睾酮和雌激素水平都在正常范围内，为什么任何十几岁、二十几岁甚至三十几岁的男性要额外补充外源性睾酮呢？毕竟这会对生育能力造成负面影响，剂量没掌握好还会带来其他问题，这么做到底图什么？

Why in the world would any male in his teens or 20s or even 30s whose blood levels of testosterone and estrogen are at the appropriate levels, meaning within the normal reference range, why would they take exogenous testosterone given all the negative effects on fertility, some of the challenges that it can present if the dosages aren't quite right, etcetera, why would they do that?

当然，如果他们不是为了职业目的，比如不是在参加竞技体育，那本来就不被允许这么做。

Certainly if they are not being paid for a particular endeavor, like they're not making If they are playing a sport, chances are they're not allowed to do that anyway.

这可是禁用物质名单上的东西。

It's on the banned substances list.

对我来说，这简直太荒谬了。

So to me, it just seems like a crazy idea.

不过话说回来，我这一代人通常到四五十岁，甚至一辈子都没想过要干这种事。

But then again, I'm of a generation that really hasn't thought about doing that stuff until people were in their 40s and 50s, or even never.

那么，如果一个人二十多岁或三十多岁，血液中的睾酮水平已经在300到900纳克/分升的正常范围内，还有必要补充睾酮吗？

So is there ever a case for somebody in their 20s or 30s to take testosterone, if their blood levels are within the 300 to 900 nanograms per deciliter reference range?

每个人的情况都不一样，关键是要看好处是不是真能超过坏处。

You know, everyone has their different reason as far as like, when does the benefit outweigh the detriment?

二十多岁的人几乎没必要，说真的，几乎从来都不需要。

Not very often if you're in your 20s and certainly, probably almost hardly never.

当然，像库尔曼综合征这种罕见情况是例外，但年轻人基本用不着。

There's always rare cases like Cullman syndrome and whatnot, but almost never if you're very young.

对于二十多岁、三十多岁，甚至四十多岁的人来说，如果睾酮和雌激素水平正常， libido、精力、恢复状态也都还能应付日常生活，那他们还能做点什么？

Okay, so for people in their 20s, 30s, and beyond, 40s, etcetera, whose testosterone and estrogen levels are at the appropriate ratios and within the normal reference range, Libido, energy, recovery, etcetera are feeling at least workable for their lifestyle.

除了保证优质睡眠、适度锻炼别过度，还有别的办法吗？

For those people, what can they do besides get great sleep, train but not too hard or too often, etcetera, etcetera?

还有一些

What are some

在补充剂方面，有哪些方法能帮助他们提升睾酮和雌激素水平，同时又不抑制身体自身分泌？

of the things in the realm of supplementation that can help them optimize their testosterone and estrogen without suppressing their own endogenous production of testosterone and estrogen?

第一个要提的是肌酸。

Let's mention creatine is the first one.

肌酸挺有意思的，因为它有好几种作用。

Creatine is interesting because it has multiple different effects.

它能帮助氨基酸的合成。

It helps with amino acid synthesis.

还能减轻氧化应激。

It also helps with oxidative stress.

它还能当线粒体的备用能量库。

It can also serve as the backup fuel tank for your mitochondria.

相当于储存一些备用的ATP，同时会轻微提升总睾酮水平，也会促进睾酮转化为二氢睾酮。

So kind of holding backup ATP, and it does slightly increase total testosterone and it also increases the conversion of testosterone to dihydrotestosterone.

所以对青少年甚至二十多岁的男性来说，它可能特别有帮助。

So potentially it's especially useful in men in their, even their teenage years and their 20s.

你提到睾酮转成二氢睾酮，网上有种说法认为肌酸会导致脱发。

You mentioned the conversion of testosterone to dihydrotestosterone, and there is mythology out there that creatine can increase hair loss.

我猜是因为有研究显示

I'm guessing because there's at

至少有一项研究显示，肌酸会提高DHT（二氢睾酮）的水平，而DHT正是导致男性型脱发的主要激素之一。

least one study showing that creatine can increase DHT, dihydrotestosterone and DHT is one of the primary hormones that can promote male pattern baldness.

所以问题来了：补充肌酸会不会加快脱发的速度？

So the question therefore is, does creatine supplementation increase the rate of hair loss?

对每个人来说，防止脱发根本不是不服用肌酸的理由，因为它不会让你的激素水平超出正常生理范围，也不会导致雄激素过度结合。

In each individual, preventing hair loss is a very poor reason to take creatine, because it's not going to take you to a supra physiologic level, it's not going to increase your androgens to an unnormal level of binding.

所以我觉得，如果单凭担心脱发就不吃肌酸，那……

So I feel like if that was a reason to not take creatine for hair loss, then

你是说，脱发不该成为你拒绝吃肌酸的理由？

that's- Sorry, you mean hair loss is not a reason to avoid taking creatine?

没错，脱发完全不是拒绝服用肌酸的理由。

Correct, hair loss is not a reason to avoid taking creatine.

你应该把它看作是帮你恢复到身体本来应有的水平。

Think of it as just bringing you to what you are naturally inclined to have.

如果你体内睾酮转化成DHT的效率本来就高，那补充肌酸通常也不会再进一步影响这个过程。

If your conversion of testosterone to DHT is already high, then often creatine does not affect this.

它只是帮你重新平衡睾酮转化为雌激素还是转化为二氢睾酮的比例。

It just kind of resets your balance between testosterone being aromatized to estrogen or being five alpha reduced DHT.

所以它不会比男性天生的状况更快地导致脱发。

So it's not going to speed up hair loss more than just naturally being a male does.

对某些人来说，它根本不会有影响。

So in some individuals, it will have no effect.

对另一些人来说，由于某种原因，他们的5α还原酶活性很低，补充后反而能帮他们恢复到正常水平。

In some individuals, for whatever reason, they have almost no five alpha reductase activity, it will return them to natural or normal.

那还有哪些基于补充剂的方法可以考虑呢？

So what other supplement based tools can people consider?

另一个可以和肌酸一起讨论的是甜菜碱。

Another one we can loop in with creatine is Betaine.

有些人对肌酸没反应，你可以把剂量加到十克，或者用它的近亲甜菜碱来帮助氨基酸合成和能量分配。

Some people are non responders to creatine, so you can increase that to ten grams, or you can use its cousin Betaine to help with amino acid synthesis and shunting of energy.

此外，我还会推荐左旋肉碱。

Along with that, I would put L carnitine.

甜菜碱，你

Betaine, do you

知道一般作为肌酸非响应者的人会服用多少剂量吗？

recall what dosage people typically would take if they're a creatine non responder?

一到三克。

One to three grams.

是的，市面上好几种肌酸产品都添加了甜菜碱，因为它有助于甲硫氨酸和同型半胱氨酸的代谢。

Yeah, several versions of creatine have Betaine mixed in because it helps with the processing of methionine and homocysteine.

所以如果一个人已经在吃肌酸，而且效果不错，那我举手问一下，

So if somebody is already taking creatine and likes it and responds to it, I'll raise my

再额外补充甜菜碱会有帮助吗？还是说这和肌酸重复了？

hand, such as myself, would adding Betaine help or is it redundant with creatine?

只有当你的同型半胱氨酸水平持续偏高时才有必要。

Only if their homocysteine is persistently elevated.

同型半胱氨酸有点像炎症指标，如果你体内无法充分将其向下代谢，它就会积累。

And homocysteine is kind of like an inflammatory marker that can build up if you're not converting enough of it downstream.

我怎么知道呢？

How would I know?

做个血检就行了。

Just a blood test.

左旋肉碱，一般怎么服用呢？

So L carnitine, what are the ways to take L carnitine?

我知道有口服的，比如胶囊，还有注射剂。

I know that there's an oral form, so capsules and there's injectables.

注射剂好像需要处方，是这样吗？

The injectables, I think you need a prescription, is that right?

没错，注射剂必须凭处方使用，或者强烈建议凭处方使用。

Correct, you need a prescription for the injectables or you should really prescription for the injectables.

注射的时候，当然要在医生监督下进行，通常是肌肉注射。

When you inject it, of course, at the supervision of your doctor, it's usually done intramuscularly.

它是水溶性的，不像睾酮酯那样含有油类或载体油。

It's an aqueous solution, so it does not have like an oil or a carrier oil in it like testosterone esters do.

不过，如果你注射得太浅，效果就微乎其微，还经常会有灼烧感，尤其是皮下注射时，它很难在体内均匀分布。

However, if you inject it too superficially, it's not going to make or rake anything, often it just burns if you inject it subcutaneously and it does not disseminate throughout the body as well.

L-肉碱如果注射的话，可能会有局部作用。

L carnitine potentially has localized effects if you inject it.

如果口服的话，它的生物利用度非常低，大概只有10%左右。

If you ingest it orally, then it has a very low bioavailability, maybe only 10%.

那如果想获得效果，口服的话得吃多少呢？毕竟只有10%被吸收，估计得吃不少才行。

So what are the dosages of L carnitine that one needs to ingest then if they want to get a benefit because if only ten percent is being absorbed, it's probably a lot of L carnitine.

一般人每天该吃多少？

How much should people take per day?

我通常建议口服L-肉碱的剂量在1000毫克到4000甚至5000毫克之间。

Usually I recommend for oral L carnitine between one thousand milligrams and up to four thousand or five thousand milligrams.

所以是1到4克，甚至5克。

So one to four, maybe even five grams.

没错。

Correct,

每天最多五克。

up to five grams a day.

如果你每天摄入这么多，尤其是肠道菌群失衡的话，就得留意TMAO了，这是一种潜在的致癌物，由左旋肉碱和胆碱转化而来。

If you're on that much, especially if you have a dysregulated gut microbiome, you should be concerned with TMAO, which is a potential carcinogen that both carnitine and choline can convert into.

而你肠道菌群的构成，决定了这种转化会发生多少。

And your gut microbiota determine how much that happens.

我听说吃大蒜能抵消我服用的α-GPC胆碱或者左旋肉碱可能带来的负面影响，是这样吗？

Is it true that I can offset any negative effects of alpha GPC choline, that is NL carnitine that I take by ingesting garlic, is that right?

这有个

There's a

大蒜里有一种叫大蒜素的成分，我想应该是A-L-L-I-C-I-N。

compound in garlic called allicin, I believe it's A L L I C I N.

它也是大蒜所属植物属名的一部分。

It's also part of the scientific name, the genus of types of garlic.

这种成分有助于减少TMAO的生成。

And this can help decrease the conversion to TMAO.

小檗碱也能稍微降低TMAO的生成，可能是通过调节肠道菌群实现的，而优化肠道菌群本身就能减少这种转化。

Berberine actually slightly decreases the conversion to TMAO as well, probably through alteration of the gut microbiome, and then just optimizing your gut microbiome can decrease conversion.

所以不是每个人都需要大蒜素，但如果你在服用高剂量，确实值得考虑一下。

So not everyone needs allicin, but it's something that you should certainly consider if you were on a high dose.

我每次吃左旋肉碱的时候还是会继续吃六百毫克大蒜，但我会跳过小檗碱，因为它让我头疼得厉害，还会让我特别想吃碳水，因为它会让血糖骤降。

I'm going to continue to take the six hundred milligrams of garlic every time I take my L carnitine, but I'm going to skip the Berberine because Berberine gives me brutal headaches and it makes me crave carbohydrates because it drops my blood sugar.

它还有其他很多影响，比如黎明现象——睡觉时血糖会下降，而你根本察觉不到。

It has many other effects, including the dawn phenomenon where it drops your blood sugar when you're sleeping and you can't even realize it.

我们还没聊到左旋肉碱到底有什么作用。

Okay, and what we did not talk about is what L carnitine does.

它就像个运输车。

It's a shuttle.

我觉得它的全名是肉碱棕榈酰辅酶A。

So I think it's named carnitine palmitoyl coenzyme A.

简单说，就是把线粒体外的营养物质运送到里面去。

Basically it just takes nutrients from outside your mitochondria and puts them in.

它还有一个独特的作用，不过也不算特别独特，因为他达拉非也有类似效果，就是能增加细胞质中雄激素受体的数量。

It also has a unique effect, well not too unique because Tadalafil actually has this effect as well, is that it increases the density of the androgen receptor and the cytoplasm of your cells.

所以即使你的雄激素受体敏感度没变，睾酮水平也没变，但因为受体多了，能结合的睾酮也就更多了。

So even if your androgen receptor sensitivity doesn't change, and even if your testosterone does not change, you will have more testosterone biting to that increased number of receptors.

那L肉碱、肌酸和甜菜碱需要轮换着吃吗？

Does one need to cycle L carnitine, creatine, Betaine?

没必要轮换这些补充剂。

No reason to cycle any of those.

还有哪些补充剂可以帮助改善激素水平？

What other supplements can one use to try and improve hormone profiles?

这里我要说明一下，我们说的‘改善激素水平’其实是个很笼统的说法，具体到底指的是什么？

Here I realize we're using a very broad brush because when we say improve hormone profiles, what are we really talking about?

至少对我来说，我更关注那些主观的感受。

And for me, at least, I think about the subjective stuff.

比如，人们做完这些之后，会不会觉得精力更充沛了？

You know, do people feel like they are going to have more energy as a consequence of doing these things?

他们的性欲会变得更旺盛吗？

Are they going to have the more optimized libido?

他们的运动恢复会变得更高效吗？

Are they going to have more optimized recovery from exercise, right?

因为说实话，我不确定把睾酮从600提升到800就一定更好，尤其是如果雌激素也在同步上升，这可能会带来问题——当然也可能改善状况，但也可能让情况更糟，对吧？

Because, I mean, it's not clear to me that taking one's testosterone from 600 to 800 is always going to be a good thing, especially if estrogen is increasing in parallel, that could cause issues, it could certainly make things better, it could certainly make things worse, right?

我们简单说一下维生素D，它也是一种激素，实际上是一种类固醇激素。

Let's briefly mention vitamin D, which is also a hormone, it's actually a sterile hormone.

如果你的维生素D水平偏低，补充之后，睾酮水平就能得到优化。

And if you have deficient vitamin D and you replace it, then you will optimize your testosterone.

再来说说硼元素。

Let's also mention boron.

如果你的SHBG特别高，硼可以在短期内帮助降低它，通常每天摄入5到12毫克就行。

So if you have a very high SHBG, boron can acutely help lower it, usually in a dose of five to twelve milligrams per day.

这种效果不是长期持续的，但土壤中的硼含量普遍不足。

It's not really a sustained effect, but boron is depleted in soils.

在很多国家，我觉得希腊和土耳其的土壤里硼含量特别高。

In many countries, I believe it's very high in soils in Greece and Turkey.

所以吃来自这些地区的椰枣或葡萄干，可能摄入的硼会更多。

So eating dates or raisins that are from those areas potentially have more boron.

硼可能是这些国家男性睾酮参考值远高于其他国家的原因之一。

Boron also might be one of the reasons why the reference range for testosterone is much higher in those countries than other countries.

顺便提醒一下，性激素结合球蛋白（SHBG）会与睾酮分子结合，从而减少能自由发挥作用的游离睾酮量。

And just to remind people, the SHBG, sex hormone binding globulin, is attaching to the testosterone molecule and limiting the amount of so called free testosterone that's available to have its impact on cells.

好的，所以你提到的维生素D是指维生素D3吧？还有硼的剂量是每天五到十二毫克，对吗？

Okay, so vitamin D3, I'm guessing you're talking about vitamin D3 specifically when you say vitamin D, and then boron five to twelve milligrams per day, right?

那除了这些，还有哪些通过补充剂来提升睾酮水平的方法呢？

And then what are some of the other things to optimize testosterone that are in supplement form?

我们也可以聊聊影响睾酮生成通路的东西，比如 Tongkat Ali。

We could talk about things that affect the stewardogenesis cascade, so we could touch on Tongkat Ali.

之前我们已经简单提过这个了。

I know we've talked about that a little bit before.

是的

Yeah,

但我想

but I'm

很多人可能没听说过，它也叫长爪，能促进类固醇生成通路中的多种酶活性。

guessing a number of people probably haven't heard Also that known as Long Jack, and that upregulates several different enzymes in the steroidogenesis cascade.

换句话说，这也是个值得去搜索一下的知识点——任何对激素优化感兴趣的人都该了解类固醇激素的来源。

And by that, what you mean if, and this is another good thing to Google, I think anybody interested in hormone optimization should understand where sterile hormones come from.

它们通常来自胆固醇，很容易被转化成维生素D。

They come usually from cholesterol and they can be shunted off to vitamin D very easily.

也很容易被转向转化为睾酮、雌激素或孕激素。

They can be shunted off to testosterone or estrogens or progestogens quite easily as well.

而长爪能促进睾酮合成过程中的多个关键步骤。

But Tongkat helps with the conversion of multiple key steps where you synthesize testosterone.

另一个能提升这些步骤效率的物质，可以看作是辅酶或调控因子，那就是胰岛素和IGF-1。

Another, think of it as like a coenzyme or a co factor, an up regulator of these steps is insulin and IGF-one.

所以一个不错的经验法则是：如果你的生长激素、胰岛素和IGF-1水平本来就不高，比如你正在吃低碳饮食、处于热量缺口，或者想减脂减重，那么 Tongkat 的效果理论上会特别明显。

So a good rule of thumb is if you are not expecting as much growth hormone, insulin and IGF-one, for example, lower carb diets, caloric deficits, you're trying to cut body fat or body weight, then Tongkat is going to be theoretically especially powerful.

你一般会给患者推荐多大剂量的 Tongkat？

What sorts of dosages of Tongkat do you recommend to your patients?

每天三百到一千二百毫克之间都可以。

Anywhere from three hundred to twelve hundred milligrams a day.

使用 Tongkat 时要注意标准化问题，如果你考虑的是最常见的那种 Tongkat 补充剂——这也是研究最多的一种——那就要关注其中的尿囊素含量，这是一种植物化合物，很可能就是主要的活性成分。

With Tongkat, you need to be careful with the standardization because, and if you're thinking about a general Tongkat supplement, which is by far the most well studied, then you're looking at the uricomenon content, which is a plant compound that is likely the main active pharmacologic effect.

也就是说，真正对身体起作用的就是这个成分。

So that's the compound that's having the effect on the body.

如果把尿囊素的含量标准化得非常高，理论上你用更小的剂量就能达到更强的效果。

And if you standardize the uricomenon very, very high, then theoretically you're having more effect at a lower dose.

我的血液检测显示，它让我游离睾酮水平上升了，促黄体生成素也略有增加。

My blood work tells me that it causes an increase in free testosterone for me and also a slight increase in luteinizing hormone for me.

你观察过服用 Tongkat Ali 的患者在其他激素指标上还有哪些变化吗？

What are some of the other effects on various hormones that you've observed in the blood work of your patients taking Tongkat Ali?

Tongkat 也可能轻微提升 DHEA 水平。

Tongkat can also slightly increase DHEA.

如果你的 SHBG 非常高，也就是那种结合雄激素和雌激素的蛋白质——这可是个非常关键的蛋白。

And if you have a very high SHBG, again, that's the protein that binds up your androgens and estrogens, an extremely important protein.

SHBG 越高，Tongkat 对它的降低作用就越明显。

The higher your SHBG, the more it helps decrease it.

研究发现，在 SHBG 本来就很正常的人群中，Tongkat 对它几乎没有影响。

So they've studied Tongkat in populations with very normal SHBGs and it does nothing for SHBG.

有意思，那是不是说

Interesting, does

对普通人来说就完全没效果吗？

that mean it does nothing for somebody overall?

如果一个人的 SHBG 在正常范围内，吃 Tongkat 还能带来其他好处吗？

So if somebody has SHBG that's in the normal range, will taking Tongkat benefit them in any other way?

会的，它能提升他们的总睾酮和游离睾酮水平。

Yes, it'll increase their total and free testosterone.

我先稍微休息一下，感谢我们的赞助商AG1。

I'd like to take a quick break and acknowledge our sponsor AG1.

AG1是一种含有维生素、矿物质、益生菌，同时还添加了益生元和适应原的饮品。

AG1 is a vitamin mineral probiotic drink that also includes prebiotics and adaptogens.

我早在2012年就发现了AG1，那时候还没做播客，但从那以后我每天都喝。

I discovered AG1 way back in 2012, long before I ever had a podcast, and I've been taking it every day since.

我开始喝AG1，到现在还每天坚持，是因为在我看来，它是市面上质量最高、成分最全面的基础营养补充品。

The reason I started taking AG1 and the reason I still take it every day is because AG1 is to my knowledge, the highest quality and most comprehensive of the foundational nutritional supplements on the market.

AG1的设计旨在支持肠道健康、免疫系统健康以及整体精力水平。

AG1 is designed to support things like gut health, immune health, and overall energy.

它通过弥补你日常饮食中可能缺失的营养来发挥作用。

And it does so by helping to fill any gaps that you might have in your daily nutrition.

我经常被人问，如果只能选一种补充剂，你会选哪个？

I get asked pretty much all the time, if I could only take one supplement, what should that supplement be?

我的答案永远都是AG1。

And my answer is always AG1.

它对支持身体、心理和整体表现的帮助真的特别大。

It has just been so helpful for supporting all aspects of physical health, mental health, and performance.

如果你想试试AG1，可以去drinkag1.com/huberman获取专属优惠。

If you would like to try AG1, you can go to drinkag1.com/huberman to get a special offer.

目前限时赠送一盒他们新推出的Omega-3辅酶Q10产品。

For a limited time, AG1 is giving away a free bottle of their new omega-three coenzyme Q10 product.

Omega-3和辅酶Q10有助于支持心血管健康、细胞健康、整体能量、大脑健康等等。

Omega-three and Coenzyme Q10 are known to support cardiovascular health, cellular health and energy generally, brain health, and much more.

我自己每天都吃这两种。

I personally take them both every day.

还是那句话，去drinkag1.com/huberman，首次订阅AG1就免费送你一盒新出的Omega-3辅酶Q10。

Again, go to drinkag1.com/huberman to get a free bottle of the new omega-three coenzyme Q10 with your first AG1 subscription.

除了睾酮替代疗法或者外源性DHEA，你还会给那些不想用这些的患者开哪些其他激素？

What are some of the other hormones that you prescribe to your patients who do not want to go on testosterone replacement therapy or take exogenous DHEA or anything like that.

我们接下来可以聊聊法多吉亚。

We could talk about Fadogia next.

Fadogia 很有意思，它是一类植物，其中 Fadogia agrestis 是一种，还有其他几种也相当值得关注。

Fadogia is interesting because it's a genus of plants, Fadogia agrestis is one of them, there's many others that are very interesting.

这种植物可能是研究得最深入的，它能提升黄体生成素的水平。

That species is likely the most well studied and it will increase LH.

就是黄体生成素。

Luteinizing hormone.

我不把它看作黄体生成素的模拟物，它并不直接模仿这种激素，而是促进脑垂体释放更多的黄体生成素。

I would not consider it an LH mimetic, so it doesn't really mimic it, but it increases the release of luteinizing hormone from the pituitary.

这种激素会结合到莱迪希细胞上的受体，有点像 hCG 的作用，从而增加睾酮的分泌。

That's a hormone that binds to the Leydig cell, to the LH receptor, kind of like hCG does, and it will increase the release of testosterone.

你一般让患者服用多少剂量？

What dosages do you have patients take?

我听说过一些研究提到，它可能对睾丸细胞有潜在毒性。

I've heard of some potential toxicity to the testicular cells.

有一项研究，虽然是在大鼠身上做的，但可以大致推算出大鼠和人类之间的毒性剂量对应关系。

There was one study, and this is a rat study, but you can equate the dose of toxicity in rats and humans.

这些大鼠没有接受任何抗氧化剂，但它的使用会提升几种促炎标志物。

They did not give these rats any antioxidants, but it increases a couple different like pro inflammatory markers.

一个是GGT，也就是γ-谷氨酰转移酶，来自睾丸和肝脏；另一个是碱性磷酸酶，也叫ALP，同样来自这两个部位。

One is GGT or gamma glutamyl transferase, comes from both the testes and the liver, and one is alkaline phosphatase, also known as alk phos, again, coming from both areas.

有好几种方法可以减轻这种升高，你也可以直接检测一下指标有没有上升。

There are several different ways that you can attenuate this increase, and you can also just check to see if you have increased.

在大鼠身上等效于人类无副作用的剂量，平均每天是三百毫克。

In the rat dose that equates with humans that had no effect, so the safe dose was an average of three hundred milligrams a day.

所以，人类每天服用三百毫克就是没有毒性的剂量，对吧？

So that would be three hundred milligrams a day in humans is the dosage that did not have toxicity, correct?

没错，而且很多时候，即使大鼠出现毒性，人体也不会，所以不能直接等同。

Correct, and often even if there is toxicity in rats, there is not toxicity in humans, so it's not directly equitable.

但为了安全起见，我建议另一种用法：隔天六百毫克，或者每周三次，通常是周一、周三、周五。

But to be safe, another regimen that I have people take is six hundred milligrams every other day, or six hundred milligrams three times a week, often Monday, Wednesday, Friday.

我了解到，现在很多人在用睾酮，我们甚至不叫它替代疗法，因为有些人血液里的水平已经到了六百、七百，甚至八百纳克每分升。

My understanding is that nowadays a lot of people are using testosterone, let's not even call it replacement therapy, because some of these people have 600, 700, or even 800 nanogram per deciliter read.

他们并不是在补充体内减少的东西，而是在原有基础上进一步提升。

So they're not replacing anything that is diminished, they're just trying to augment what's already there, increase what's already there.

我了解到，比起过去那种每两周打一次一百或两百毫克的注射方式，少量多次的给药效果会更好。

My understanding is that taking a low dose more frequently is going to be more beneficial than the kind of old school way of giving one hundred or even two hundred milligrams in a single injection once every two weeks.

是这样吗？

Is that right?

那您平时是怎么给病人处理的？

And what do you do with your patients?

我来举个假设的例子。

So let me give you a hypothetical.

有人来你诊所做检查，血液显示睾酮水平大约是每分升600纳克，雌激素也在正常范围，其他指标也都正常，但本人反映性欲略有下降，运动后恢复较慢，动力和干劲也有些减退，不过并没有严重抑郁。

Somebody comes into your office, they do their blood work and they have blood levels of, let's say 600 nanograms per deciliter testosterone, their estrogen is also in normal range, everything else checks out, but they're complaining of slightly diminished libido, slightly poor recovery from workouts, maybe reduced motivation and drive, although no major depression.

你会认为，这种情况下，使用睾酮治疗——不是替代，而是增强治疗——值得考虑？

And you come to the conclusion that testosterone therapy, not replacement, but testosterone therapy might be a good option to explore?

那通常你会考虑用什么剂量和给药频率？

What's a typical dosage range and frequency of administration range that you might consider exploring?

这部分在一定程度上取决于

Some of this depends on

SHBG和游离睾酮水平。

the SHBG and free testosterone as well.

如果同一个患者SHBG非常高——也就是那种结合睾酮和其他雄激素、雌激素的结合蛋白——如果它特别高，而游离睾酮只有2，那可能就需要调整剂量，因为必须保证有足够的游离睾酮达到正常生理水平。

So if that same individual had a very high SHBG, which again is the binding protein that binds up the testosterone in all androgens and estrogens, if it is extremely high and they have a free testosterone of two, then they might need a different dose because they need enough testosterone in order to have a normal eugenadal free testosterone.

一般来说，对于刚开始治疗的人，推荐的剂量范围是每周100到120毫克，分次注射。

But a general normal dosing range, especially for someone starting, is around one hundred to one hundred and twenty milligrams divided over the course of a week.

通常是隔天一次，或者每周三次，偶尔也会安排每周两次。

Usually either every other day or three times a week, occasionally twice a week.

很多SHBG偏高的人，每周注射两次就足够了。

Many people with SHBG a bit higher can get away pretty easily with twice a week.

这里假设使用的酯类是庚酸酯或环戊丙酸酯。

This is assuming that the ester is sipionate or enanthate.

所以每周两次，每次60毫克的环戊丙酸睾酮。

So two sixty milligram injections of testosterone siponate per week.

是的，这是非常常见的剂量。

Yeah, very common dosing.

达到

To hit

120毫克左右作为普遍的平均值。

that 120 as kind of the typical average.

没错。

Correct.

我会把这种剂量视为一种生理性的正常水平。

And I would consider this like a physiologic eugenadal dose.

对很多人来说，即使每周200毫克也远高于正常参考范围。

For many people, even two hundred milligrams a week is far above the reference range.

所有这些都要考虑到，睾酮在体内通常是脉冲式释放的。

All of this is said with the caveat that testosterone is normally released in a pulsatile manner.

所以早晨水平高，晚上就低。

So it's high in the morning, low in the evening.

但如果你在进行睾酮替代治疗，体内的水平就会保持稳定。

Whereas if you're on a testosterone therapy, then you're going to have a steady state.

所以即使到了晚上，你的睾酮水平也基本不会变化。

So your testosterone level is going be pretty much the same, even in the evening.

根据你的经验，当患者接受这种治疗时，我猜他们通常会报告一系列正面效果，比如情绪好转、精力提升、睡眠改善、恢复加快等等。

In your experience, when patients do that, I'm guessing they report the normal constellation of positive effects, you know, improved mood, improved energy, improved sleep, recovery, etcetera.

那在血液检查或主观感受上，有哪些警示信号能说明，即使每周分两到三次注射总共120毫克，也可能剂量偏高？

What are some of the hazards or things that can crop up in blood work or just subjectively that can be warning signs that even a dosage of one hundred and twenty milligrams divided into these two or three dosages per week is too high.

这时候你必须对各个器官系统都有深入了解，不能只关注生殖系统。

So this is when you really have to be at least well versed in every organ system, not just the gonadal, like, you know, genital system.

你还需要具备一定的皮肤科知识。

You need to have, you know, dermatology prowess.

长痘是非常常见的反应。

Acne is a very common change.

很多皮肤问题，甚至容易淤青，都可能与激素替代治疗有关。

Lots of different skin pathologies, or even bruising can be related to hormone replacement.

脱发也很常见。

Hair loss is very common to see as well.

精神状态也会有变化。

Mental status changes.

有时候甚至会引发躁狂或双相情感障碍，因为睾酮也有多巴胺作用。

Occasionally it even induces a manic or a bipolar episode because testosterone is also dopaminergic.

从心血管角度看，不仅关乎心脏，还可能带来微血管缺血、铁蛋白升高——因为雌激素也会上升，此外还有生育问题和血脂异常的风险。

And then cardiovascularly, not just in the heart, but also concerns for like microvascular ischemic disease, ferritin buildup, because the estrogen also increases, and then fertility concerns as well, and lipid concerns too.

所以你真的得懂血液科、皮肤科、心内科、血脂管理，方方面面都得掌握。

So you really have to be, you know, hematologist, dermatologist, cardiologist, lipidologist, the whole nine yards.

所以，如果考虑接受睾酮治疗，另一个重要原因就是必须和一位经验丰富的医生密切配合，毕竟要监测的项目实在太多了。

So another reason or set of reasons rather to, if one is considering using testosterone therapy to really do this in close communication with a really good physician, because that's a lot to monitor.

知道自己有没有长痘是一回事，但要判断LDL和载脂蛋白B是不是在上升，那就是另一回事了，这得靠抽血检查，我理解的没错吧。

Knowing whether or not you have acne or not is one thing, but knowing whether or not your LDL is going up, your APOB is going up, that's a whole other biz, and that needs to be done through blood work is what I'm hearing.

没错。

Correct.

如果你的医生在管理或开具睾酮替代或激素治疗处方时，对这些系统不够熟悉，那你最好让他或她加入一个多学科团队，让其他专家一起来监测这些指标。

And if your physician that is managing or prescribing your testosterone therapy or your HRT is not well versed in these systems, you would want him or her to be part of an interdisciplinary team where they have other experts that can monitor those systems.

确实有一些男性希望提升自己的睾酮或其他激素水平，比如生长激素之类的，但他们选择不使用外源性睾酮。

There are males out there who want to increase their testosterone and other hormones, maybe growth hormone, etcetera, who opt to not take exogenous testosterone.

他们既不用药膏，也不用植入剂、口服药，也不打庚酸酯注射剂，而是决定每周服用几次克罗米芬。

So no cream, no pellet, no pill, no injectable sipientate, but decide to take Clomiphene a couple times a week.

我的理解是——我自己没试过，但如果真要试，我听说大家一般每周吃两片50毫克的克罗米芬，这能提升什么？

My understanding, I've never done this, I would say if I had, my understanding is that taking Clomiphene, maybe two fifty milligram tablets a week is what I hear people are doing, will increase what?

促黄体生成素，还有各种雌激素受体亚型。

Luteinizing hormone, the various estrogen receptor subunits.

你能解释一下，克罗米芬到底对人有什么好处吗？

Could you explain how Clomiphene would benefit anyone?

这算是一种好办法吗？

And is this a good strategy?

我听说现在挺多人在这么做的。

I'm hearing that it's being done quite a lot now.

它会以剂量依赖的方式提升睾酮水平，但还有许多其他药理作用，不只是影响下丘脑和垂体。

It will increase testosterone in a dose dependent manner, but it has many other pharmacodynamic effects, which is the effect of the drug on the body, other than its effect on the hypothalamus and the pituitary.

在下丘脑和垂体里，它起到负反馈抑制的作用，或者说阻断了雌激素的信号。

So in the hypothalamus and the pituitary, it does what's called negative feedback inhibition, or it blocks the oxygen of estrogen.

它会抢占下丘脑和垂体上雌激素受体的位置，让雌激素没法结合上去。

So it crowds out estrogen from the estrogen receptor on the hypothalamus in the pituitary.

我为什么要吃一种会增强雌激素受体活性的药呢？

Why would I want to take something that would increase the activity of an estrogen receptor?

我真的想不通这么做的道理。

I just can't find the rationale for that.

服用选择性雌激素受体调节剂的主要理由，是作为一种短期过渡手段，不会抑制垂体或下丘脑的功能。

The main rationale behind taking a SERM is as a very temporary measure that is not going to suppress pituitary or hypothalamic function.

只有当你的睾酮水平低得离谱，几乎不可能自然恢复的时候，才可能考虑。

If your testosterone is just so drastically low that it is unlikely to recover anyway.

所以大多数情况下，这种药并没有实际临床价值，不建议经常开，更不该作为长期的睾酮替代或优化方案。

So most of the time it is not clinically useful and SERM should not be prescribed very often, certainly not as long term testosterone replacement or testosterone optimization in most individuals.