Health is not everything, but without it everything is nothing.

• Update 2020: There is an updated version of this article available. HERE.

My whole life I have been quite a happy dude. Curious, well-rounded, sociable. Around the age of 20 this started to change. As I entered med school I started to become more unidimensional, obsessive, rigid, an asshole. No energy.

My attention span and short-term memory started to regress towards kindergarten level. I had to read every sentence 10 times. I couldn´t concentrate. I felt I was becoming dumb.

I started to neglect friends, became withdrawn and secluded. Overall becoming just a pale semblance of my former self.

I chalked it up to the fast-paced curriculum, the deadlines, the huge amount of material I was supposed to learn. My fitness endeavors, lack of sleep, some partying surely didn´t help either.

I felt like shit. It took me forever to wake up. Freezing all the time. No inner peace. My mind was always racing; nonetheless, I was lethargic all day, every day. Everything was drudgery and required a ton of self-discipline. Loads of coffee and painful cold showers were required to get me through life.

Each night I was grateful that another day was over. I was just trying to get by. At best.

Rarely did I laugh.

I stopped caring about friends. Friends stopped caring about me. I wasn´t fun to be around anymore. My mood was worse than “meh”. I was negative, judgemental, irritable all the time. I was dragging others down.

Where before I had seen a bright future, now I saw only darkness on my horizon. At times I just couldn´t bear things anymore. Twice I had a mental breakdown. During these times every good memory seemed to vanish from my catalog of memories.

There was nothing I could do, no way it could get better. In these moments of hopelessness and helplessness people do stupid shit. Shit that is irreversible. Shit that hurts a lot of people.

Thank God some loved ones were there for me, even though I had not been there for them.

Fortunately, these dark spells passed quickly. I was able to pull myself together and get back up again. Falling back into the trap of inexorable self-torture, doing everything necessary to get myself to accomplish what I needed to do.

In retrospect, I cringe when I think about how I was able to make it through this time more or less unscathed. Though without care for myself and caring even less about and for others. I was a parasite, a suffering parasite.

Some astute readers might argue that I was running myself into the ground through my toxic lifestyle, as so many young males in our achievement-driven societies do. Living the sprinter life as if there would be only six months left.

The initial fault was mine. Forced to maintain the lifestyle that got me into this whole mess in the first place, trapping myself into a vicious, never-ending cycle. This was my truth, my reality. I blamed myself.

I tried to dial back, but things just wouldn´t get any better.

Being a medical student, I ran some lab tests. My testosterone turned out to be low. Not just low, but on the low-end of average for a 90-year-old man. I found it. This was the root cause of my poor health and life.

Having brought this upon me, I figured it was also on me to reverse this again. I started to eat more and better food and dialed back on exercise. I began to meditate and forced myself to have sex with the girlfriend I had at this time (despite not feeling like it).

Each new round of blood tests was a new round of disappointment. I was trying out every method under the sun to get it back up (not literally).

Hot showers. Cold showers. I started to look at porn again. Maca root. Clomiphene. Eagerly awaiting each new round of lab reports. Only to be rewarded with the all too familiar globus sensation. Over and over again.

Eventually I came forth with my issues to my professors of endocrinology. After a few more examinations it was clear. It wasn´t just testosterone. It was all of the hormones.

I don´t want to get too technical, but for some reason my pituitary wasn´t sending appropriate signals to my peripheral endocrine glands. My estradiol was unmeasurable. Progesterone, cortisol, thyroid, all rock bottom.

I cried.

Not because I knew what it meant (having to replace what was lacking for the rest of my life), but rather because I found something I could blame. Something I could righteously blame.

Whereas before I was gnawing myself to death about how through my unhealthy habits I might have set myself on a terminal path to self-destruction, now I knew it wasn´t “me”.

The deteriorations in my personality, my health, my life, the pain I had inflicted directly and indirectly upon my loved ones along the way, all of it was not my fault.

I started to replace what was missing.¹ Immediate subjective improvements: I had more energy, was less grumpy, wasn´t freezing anymore. I could now read for much longer without having to drag myself into the cold shower. Or downing a liter of coffee.

No more peeing twenty times per day (not kidding) and multiple times per night. Sleep was much better. No more being ravenously hungry half an hour after eating. My hair and skin became nice and hydrated again. My nails grew again at normal speed. The first normal morning erections. (And more importantly, my sperm quality improved from less than 1% functional to normal levels.) No more racing thoughts. No more nausea in the morning. No need for loads of caffeine.

The magic from interacting with girls came back. I can´t possibly convey to you the feeling you get when you get these butterflies feelings again. Resurrected, after they had been extinct for years.

The comeback of the runner´s highs. Whole-body orgasms after years of mechanical work. (In fact, my first runners high after starting to add small doses of the active thyroid hormone was one of the most beautiful moments in my life.) I don´t give a shit whether it was “biological” or not. It felt real. It was real to me.

I was in heaven, seeing some light in the darkness I had envisioned for my future.

Over the course of just a few months I was being “cured” from the frigid social anhedonia that had been afflicting me for years. Before, whenever I interacted with people, I just wanted to get on as fast as possible doing “my” things. Now though, I didn´t want to be all the time by myself anymore.

Being social was not drudgery and pretense anymore, drudgery to muster the necessary energy and pretense to fake my “old” adolescent personality I had lost. Now I wanted to go out and meet people. I had genuine fun again.

Before, my emotions were dull and grey. Whenever I interacted with the people I love the most in this universe (my family), my emotions were rather cognitive (“I know I love them”). Now though I felt love for my loved ones again. The warm fuzzy feeling I thought I had lost irreversibly.

Initially there was a certain degree of sadness because I experienced first-hand how much of your emotions, their valence, their intensity and their existence in the first place, are in fact influenced by a set of cold biochemical parameters.² But whether I or anyone else likes it or not, there is nothing anyone can do about it. This is just the way it is.

Eventually I came to terms with being a biological creature. What was left was gratitude. Gratitude about the irrational luck being a medical student born in a Western country in the 21st century.

How many others are out there? People who weren´t as lucky as I had been, suffering for years and years, witnessing their outer and inner lives gradually but uncompromisingly falling apart, bit by bit. Dragging down their loved ones along the way and forgoing the opportunity cost to be a meaningful contributor to society. And perhaps worst of all, blaming themselves.

Slowly the upwards spiral started again. Soon after, my professor passed away to cancer. The new endocrinologist taking over my case wasn´t as good. Young, inexperienced and doing everything by the books. Replacing my hormones suboptimally and by the guidelines.

I have become used to the energy, mood and health I was now again being tantalized with. I didn´t want to let this happen to me. I was 23 at that time and I had a long road ahead. For something this important I didn´t want to make any compromises.

I was about to enter my fourth year of med school. Even though not my fault, it is my life and thus my responsibility. I took matters into my own hand. I began to experiment, making many changes to my protocols.

I observed and felt how even slight changes in dosage, substance and timing have potent effects.³ Effects on my energy levels, my mood, sleep needs, concentration, drive, emotionality, each of them manifesting itself in many different ways. Every day.

Delving into the literature. Spending hundreds of hours browsing the internet collecting bits and nuggets from many other patients replacing their hormones.

I measured whatever I could. Keeping track of signs and symptoms. Spending thousands of euros on blood tests. Taking notes about any changes -at least the ones which I was aware of.

All of this was sort of a secret project I had. A thing I was burning for. A thing I knew will pay dividend interest down the line. If you change a hormone, your life will evolve in a way to reflect these changes.

My goal was to create a hormonal profile striking a healthy balance between performance and longevity, marrying these two to the best of my ability. For a long time that was my main instrumental goal, my priority #1, the quadrant-two activity, my purpose.

(If you want to know what I take, how I would start if I had to do it over again, what to test for, what to pay attention to etc. read Quick practical guide to hormone replacement.)

I made continuous improvements to my replacement protocol. Small tweaks were added, bit by bit, keeping what worked and throwing out what did not. I knew that even small changes do make a small difference, whether I was consciously aware or not.

And a small, consistent difference every day will compound over the years. Compound interest, what Einstein called the most powerful force in the universe.

Credit: Samuel Tillian

Changes.

For me, it was a long and rocky road. Over these few years after starting multiple hormone replacement, the ravages of time had again been exerting their influence in the background. But this time these ravages didn´t ravage.

Changes in my moment-to-moment mental states rippled to affect my day-to-day thinking patterns. Along with the increased energy, drive, motivation, health, less need for sleep, memory, and so forth, it started to have a cumulating impact on pretty much every domain of my life.

As old habits die hard, change was slow. But relentless. Cumulative. Whereas some of these changes I could observe in real-time, many I certainly have not noticed at all.

Many of these changes were pointed out to me by others who noticed that something was different. That I had become different. Less rigid, more appreciative of the moment, less judgmental, a little more empathetic towards my loved ones.

Med school was no longer a chore anymore but something I enjoyed. The same is true with my friends. Working on the side in a sales job, I made enough money to sustain myself for half a decade to come.

Health is not everything, but without it, everything is nothing. The biological foundation to do well in my only life is now taken care of.

Without taking my hormones into my own hands, my inner and outer life would be screwed. This is not a “probably” but a “certainly”. It sure did help to arrive at a point where you just got not much to lose anymore.

If I had to, I would sign a contract to rather live 10 more years with my new vitality instead of living to one hundred with the state I was in before.

Is replacing all my hormones healthy?

It might intuitively seem that replacing all your hormones has to be bad somehow. That I am certainly setting myself up for problems later in life. I thought so too for a long time.

We have data from thousands of people whose pituitary glands were destroyed or removed (e.g. cancer, injury, radiation damage, etc.). Within just a few days, their endogenous hormone production drops to zero, forcing them to replace all their hypothalamic hormones for life (growth hormone, thyroid, sex hormones, adrenal hormones). From that point on, all of their hormones are completely introduced from the outside.

Some early studies have shown that mortality for these people is elevated, especially due to cardiovascular diseases. Later it was found that this was due to excessive doses of glucocorticoids (given out of fear patients would suffer from a life-threatening adrenal crisis) and often established without replacement of growth hormone.

Given all your hormones are adequately replaced, then this difference in mortality withers away. What is more, these people actually live longer and healthier lives than their peers, whose hormones naturally drop across the board with aging (although performing adequately designed and sufficiently powered studies is hard, time-consuming and cost-intensive).

What is more, optimizing hormones gives you higher energy, mood, health, all of which also allow for a more healthy lifestyle. If you feel lethargic and unmotivated all the time, eating well, sleeping well, exercising well is simply not in the cards.

Given that around 80% of deaths in Western countries are due to CVD, cancer and neurodegeneration, all of which are lifestyle diseases, replacing your hormones has indirect beneficial effects on your health as well (regardless of each hormone acting pretty much on every cell in your body directly).

Replacing your hormones is a nuisance. But that´s it. It is just a nuisance. It doesn´t cause any subjective suffering like depression does or any debilitating symptoms like physical pain. In fact, if treated well, you can live a long and (very) healthy life. If hormones are optimized I argue a better life overall.

And hormonal optimization is certainly not reserved for just the elderly and sick.

The price you pay is taking pills and doing injections. Though once you are used to it and have tuned and tweaked your replacement protocol to your needs and your liking, it takes less than 5 minutes per day. A tiny price to pay for the prize I get.

My “misfortune” certainly had a silver lining. I would even go so far to say that it turned out to be a blessing in disguise. Now perhaps my hormones will not drop as I get older and I can enjoy the vitality I have now for decades down the road, whereas for almost everyone else hormones drop, dragging your vitality along with it.

And just as there are risks and side effects associated with hormone replacement, there are also risks and side effects if you choose to not replace a (deficient) hormone.

Would you rather not have “side effects + no benefits” or ”side effects + benefits”? And what are the risks/side effects/downsides of not intervening?

Most people forget about this one. We only look at the side effects of action/intervention, but we don´t look at the benefits gained. We need to look at both sides of the equation. It is always a calculation of tradeoffs.

Is hormone replacement unnatural?

Many of us feel bad about any “artificial” intervention whatsoever because we think it is “unnatural”. Well, our modern world isn´t “natural” either.

The constant distress, artificial lightning, pollutants, highly processed foods, fast-spiking carbohydrates, sedentary lifestyles, living beyond the age of 40, sitting in my armchair with an internet connection and my laptop to connect to the whole world.

Our genetic, biochemical, physiological machinery and our mental faculties (e.g. biases) just aren’t adapted to this sort of environment. Evolution adapted them to a completely different world. The workings of our body and mind are outdated.

Well, from a transhumanist point of view you could argue that “altering” yourself to the best of your knowledge and ability (aka. “biohacking”) is just as artificial as it is living in our unnatural world in the first place. Both things are not natural.

You would just “update” your physical and mental operating system to be adapted to these new conditions. (And if there happens any “upgrading” along with it this is nothing I´d complain about.).

Biology is perhaps the main common denominator across all human beings how their life turns out -within cultural and socioeconomic limits of course.

For the first time in history we can think about transcending our individual biological limits. Limits that ever since were a strong determinant of happiness and life success. (For more about this read here.)

Is what I do cheating?

Due to my rather unique situation, I was forced to intervene quite radically into my inner workings. Without this intervention am be nothing.

I have a great hormonal profile now, certainly “better” than what nature intended for me. I keep most of my major hormones in the upper third of the youthful reference range, bestowing me with a kind of vitality some of us naturally experience after sexual maturity, but which I was deprived of.

Optimized both for longevity and performance, I can and do keep the different hormones where I feel and function best.

Keeping all my hormones where I want them to gives me a significant advantage in life across very many areas. Whatever value I get out of it, over the years these dividends are reinvested every single day.

Hormones are much more potent than any changes I would get from lifestyle interventions (sleep, diet, exercise, meditation, ect.), whose gains and losses pale compared to gains or losses from changing a hormone (even in terms of longevity and health promotion).

The increased energy, mood, health will give me a large advantage over my cloned self in an alternate parallel universe that didn´t self-optimize. It will also give me an advantage over people that don´t have the knowledge, means or risk-appetite to intervene in a similar way.

Knowing all of this, in my early days of starting hormone replacement and seeing its effects, I felt bad about “cheating”.⁴ But vitality is certainly not equally distributed, but rather follows a bell-curve distribution. Many people having achieved a lot of (objective) life success on average score certainly higher on their “health/energy/mood scorecard”.

So why should it be cheating if it was never an equal playing field to begin with?

But even though I knew this to be true I still felt like a cheater. The following small conceptual change (an edit in the story I told myself) evaporated any “remorse” I had: Instead of seeing myself as a cheater because I gain an unfair advantage in a competition, I told myself that the world is not just about me. I am just a single fate among billions and nobody really gives a shit about what I do or don’t do. But I will touch many other human beings on my way, either because I directly interact with them or because I intangibly touch them somehow in a myriad of ways through all my actions and inactions. And if my energy/mood/health are better, I will be a better contributor to others (regardless of the fact that my life is easier and more enjoyable). Thus bioenhancement is quite an ethical thing to do. Moral bioenhancement. A win-win for you and others.⁷

Of course, the way you justify yourself for trying to make yourself and the world a better place and for enjoying it more is up to you. (Unless you are evil. Then your capacity to do damage is multiplied.)⁸

Am I becoming “fake”? Am I becoming a robot?

Does such radical intervention into my own cell colony´s signaling make me “fake”? Does it make me a robot?

Many people have an inner resistance against intervening in a way that they feel “alters” themselves. That if they´d take things like antidepressants or hormones they would just not be themselves anymore. They would feel “fake”.
But the line is arbitrary. Most are fine with having caffeine constantly in their system, which certainly does affect neurobiochemistry.

And regarding hormones, 20 years down the line, your hormones will be radically different across the board compared to how they are now. Are you then not “yourself” anymore?

Many people I talked to raised the concern that because I can and do keep my hormones the way I want them to, I am moving into the direction of being a robot. A robot whose biochemistry “I” can control, thus also affecting my emotionality and personality traits.

Even though there certainly is a performance increase from optimizing my hormones, “enhancing” myself does not make me a robot just more effective at solving tasks. We humans are way more than that and no intervention will change that. We are not just about solving tasks, rather about setting them. We humans want the real, the raw. Rather than achievement, we are seeking love and beauty.

My overall emotionality is greater compared to what it was before. The mind is what the brain does and every mind state emerges from a brain state. And on my hormone replacement protocol, my brain can now generate emotional intensities I never experienced before. The highs are much higher and the lows much lower. For example, when my girlfriend broke up with me recently, it almost killed me, but I didn´t care.

There is a reason why people's emotionality (incl. how intense the emotions are experienced) is greatest during puberty. The same reason why postmenopausal women often lose the magic.

Despite biohacking sounding “roboty”, given you do it correctly, it makes you less of a robot. Before I was a robot to my biological chains, a puppet of my neurobiochemistry. In my opinion, transcending my biological limitations is a very, very human thing to do. Now I can act and make choices that are truly my own.

What does this mean for you?

From what I have seen, my guess is that around 1 in 5 of you have a hormonal imbalance severe enough to warrant intervention. This causes life to be much harder, less enjoyable, less healthy compared to how it could be.

There are millions of people worldwide who have been living in states of pitiful energy, mood and health for years. Chronically lethargic, unmotivated, depressed, sick. For many of them hormonal problems are the root cause.

All the focus is on drugs, diet, sleep, exercise, gut health, supplements. Each of them billion-dollar industries. While all these are important, you simply can´t outdrug/outlifestyle a bad hormonal profile. Too bad most people don´t know much about hormones.

Even if not your fault, this is your life, thus also your responsibility. I challenge you to do a complete hormonal panel, measuring the free, bioavailable target hormones. The 100$ is nothing considering the financial loss you could incur by not doing it. Or the indirect financial gain from intervention.

The opportunity cost of not testing your hormones at least once in your life is high, whereas the cost is pretty small. The benefits could be changing your life.

Perhaps a single decision that would or would not have made. Perhaps just the gradual cumulating change in many domains of your life thanks to the most powerful force in the universe.

Hormones determine the evolution of our lives path from very early on. A change in hormone levels at any point throughout life has far-reaching consequences. Fortunately (and unlike genetics) your hormonal profile is something you can negotiate if you choose to do so. Even slight changes to your hormones can nudge the direction of our lives into a completely different path.

If you deliberately change one of your hormones, your life will evolve in a way to reflect these changes. And if you do it correctly, your life, the only one you have got, will (likely) be better off for it. So will the people you directly interact with and all the souls you indirectly or intangibly touch along your way.

Conclusion

I know I said it many times, but again, my point is this: Life is just soooo easy (and enjoyable) if you have great energy, mood, health all the time.

And again, there is nothing as powerful for these as your hormonal profile. Trust me. I know. I have seen the best and the worst of both worlds.

I have experienced how hormones (or a lack of them) can make you feel like dogshit like you could never imagine. I have experienced how hormones brought me from the brink of suicide to bliss. Not over night, but years.

I do not exclusively blame hormones for everything that had gone wrong with me and my life. Nor do I credit them with all the progress I have made. But in both cases better energy, mood, health was of great help with setting me up for certain situations, risks, possibilities, motivations in the first place.

I didn´t feel “magically” well from the get-go, nor do I now. There will be many more ups and downs in my life. Otherwise life would be dull and boring. Periods of suffering are times of identity formation, growth, change. These periods give meaning to our lives. During my lowest lows I grew the most, made many crucial decisions. These times contributed most to the story I tell myself (my identity).

I am still sad, in a bad mood, experience negative emotions (more intense than before), setbacks. Like a human being does and should. But now I have the energy, mood and health to tackle them in a constructive way. To tackle them at all.

My dream is to live in a world where no one is held back the way I was from living an at least decent life . Even though not my fault, it is my life. And thus my responsibility. Without accepting and acting on that I just don´t know where I would be today. For sure I wouldn´t be writing this.

Biological vitality is the single most important condition in my life. In your life. Vitality determines the way our lives turn out, not just our outer lives, but our inner lives as well.

I experienced how a reduction in biological vitality can send you on a relentless downward spiral. The stronger the decrease in your vitality the steeper the slope.

In its wake over months to years my life, the only life I can be sure of having, went to shits. Many people are unsuspecting. Unaware of these invisible forces exerting their power relentlessly every single day.

Along the way it is not just you that is hurt but also your loved ones. And indirectly society is hurt in countless and often quite obscure ways. You aren´t contributing what you otherwise could, perhaps instead you become an involuntary parasite of society's resources.

On the other hand, I experienced how an improvement in my biological vitality sent my life onto an upward spiral. In just a few years of optimizing my hormones my outer and inner life changed, thanks to the most powerful force in the universe.

I started to dream again. I found purpose. I found something I want to contribute. Now I also have the energy, mood and health to keep working on my dreams, to enjoy working on my dreams.

If your hormones are screwed (or deteriorate for some reason) you just can´t keep playing for the long term.⁵ Many fail not because their dreams don’t work out, but simply because they have no energy left, at least not long enough for their dreams to bear fruit.

How different would the world be had these young enthusiastic founders just enough energy to keep burning? How many Bill Gateses didn’t make it because their failing biology put a padlock in front of their dreams? How many Elon Musks didn’t begin to make the world a better place because they just didn’t have the necessary energy to even start their endeavor? To even start to dream in the first place?

My purpose is to raise awareness. People need to know that there are biological shackles many of us carry.⁶ Shackles which make it much harder to live a life we like. Shackles which make it harder to find purpose in the first place. Certainly much harder to have the necessary persistence, drive, energy and health to keep pounding away at it.

Finally, as a doctor, I want to improve the vitality of others. Helping them to greater personal wellbeing while also increasing the impact they have on others. Make the world a better place and help others to do so as well.

Make no small plans in the only life you have got.

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Because this post turned out longer than intended and nobody wants to read such a long-ass post, I split it up.

Part I “How hormones destroyed and saved my life.”

Part II “Lessons learned from replacing all of my hormones.”

Part III: “Your hormones might be screwed.”

Part IV: ”Quick practical guide to hormone replacement.”

Part V: “The science of hormones”.

Footnotes.

1. I have been high and low in all the major hormones, in many different constellations and this I can tell you: hormones are by far the most important factor determining your energy levels and mood, given that your sleep, your gut or your diet is not absolute dogshit. Gains or losses from sleep, exercise, diet, gut health pale compared to gains or losses from changing a hormone.

2. For example, how a small change in estradiol or progesterone levels does affect your overall emotionality, the tendency for experiencing certain emotions in certain intensities. The propensity for you to cry while watching a romantic movie.

3. I don’t want to get too technical. Still, for the nerds, I was varying the degree of aromatase inhibition, changes HcG dosing, swapping some thyroxine for triiodothyronine, adding small dosages of growth hormone, replacing DHEA and progesterone, tweaking fludrocortisone, cortisone acetate instead of hydrocortisone, experimenting with sublingual vs. oral administration, many other things I can´t think of right now.

4. Is there an ethical difference between someone lucky enough to be a genetic freak, someone who works extremely hard on his lifestyle, does everything by the book and someone with the knowledge and risk-appetite required to use pharmacological/endocrinological shortcuts?

5. Many founders and young entrepreneurs are playing the game as if there were only 6 months left, running themselves into the ground (in the process often burning out their hormones. Burnout is mostly a hormonal issue).

6. Even if this means helping just a single person in a similar situation to where I have been 5 years ago. Even if this means something banal as nudging someone towards simply getting a non-useless blood test for the first time in their life, at least pointing in the right direction.

7. Since inaction is also action, you could even argue that it is quite unethical not to intervene if you have the means to do so.

8. Some people just want to see the world burn. Even if statistically rare, in absolute numbers there are more than enough. And as our technologies get more powerful, so does their destructive impact. The same way that our species is uniquely altruistic, the same way are truly spiteful behaviors also pretty much limited to us.