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Is Men’s Sexual Health a Biomarker for Overall Health? Dr. Paul Turek Thinks So · Get Real with Jim Weiss

0:00
Speaker 1: So we had the most amazing doctor on who happens
0:02
Speaker 1: to also be your doctor.
0:04
Speaker 2: He is a Turk, one of them. I have an
0:07
Speaker 2: army now.
0:08
Speaker 1: I've an army since working with you.
0:10
Speaker 2: Yeah, that's what it takes. Well, Look, everything is very specialized,
0:14
Speaker 2: you know. So what's cool about what doctor Turk talks
0:17
Speaker 2: about and what his business is all about relative to
0:21
Speaker 2: fertility and enhancing that. Like some of the other guests
0:25
Speaker 2: we've had, he's taking some of the stigma out of
0:29
Speaker 2: male medicine, where a lot of these things interrelate, especially
0:33
Speaker 2: as we now think about healthy longevity and if you know,
0:38
Speaker 2: guys are having kids wait later in their lives. You know,
0:42
Speaker 2: I think you and I have talked about that trend.
0:44
Speaker 2: You know. So while it's always been an issue for
0:47
Speaker 2: women and they have to store their eggs and there's
0:50
Speaker 2: all kinds of issues that gets covered a lot in
0:53
Speaker 2: lots of different forums, the men's side doesn't really get
0:58
Speaker 2: talked about as much, but the issues are there totally.
1:02
Speaker 1: But he talked about a term that he uses in
1:03
Speaker 1: a practice called manopause. Because this is the field that's
1:07
Speaker 1: been ignored for so long, people tend to just not
1:10
Speaker 1: consider that men's testosterone will drop precipitously from forty on,
1:15
Speaker 1: not in the way that it changes for women, but
1:17
Speaker 1: over time certainly, like he said, by the time you're
1:21
Speaker 1: in your sixties, it is a higher risk to have
1:23
Speaker 1: a child, you know. So it was interesting too that
1:25
Speaker 1: he said that the Women's Health Initiative has been around
1:28
Speaker 1: for forty years in the US, but we can't get
1:31
Speaker 1: one past for men. And he's been in Washington fighting
1:34
Speaker 1: for men's health to get more consideration. But it's just
1:38
Speaker 1: one of those areas where men are totally siloed.
1:41
Speaker 2: Yes, it's very surprising and maybe counterintuitive. And then the
1:46
Speaker 2: conversation that is testosterone or other markers, you know, like
1:50
Speaker 2: you get a papsmerr on the women's side of it,
1:53
Speaker 2: are there standardized tests that guys would take at certain points?
1:58
Speaker 3: Totally?
1:59
Speaker 1: And he was very anti hot tub just for all
2:01
Speaker 1: your listeners, listener, hot tubs, Stay.
2:05
Speaker 2: Away from the hot tub time machine. For anyone who
2:09
Speaker 2: wants to just the beer. Yeah, going to actually just
2:13
Speaker 2: go in the smell, you know, just lay down in
2:16
Speaker 2: the snow.
2:16
Speaker 3: That's really good for you.
2:18
Speaker 2: Yeah, it is. Actually it's good for your impulse.
2:20
Speaker 1: That's my favorite takeaway.
2:22
Speaker 2: Yeah, all right, totally. Hey doctor Turk, I'm excited to
2:27
Speaker 2: share your expertise on men's sexual and reproductive health, fertility
2:31
Speaker 2: and early detection with my audience. Your work is changing lives.
2:36
Speaker 2: Mine included when you started your career, what did you
2:40
Speaker 2: want to contribute to this field that hadn't been brought
2:44
Speaker 2: to the table before.
2:45
Speaker 3: You know, my dad was a blacksmith from Slovakia, came
2:49
Speaker 3: to America and as a teenager became a welder. And
2:54
Speaker 3: I grew up with a craft tradition, the old school
2:57
Speaker 3: European craft tradition, so I knew to be a craftsman.
3:01
Speaker 3: And I think I realized later in life that one
3:03
Speaker 3: of the reasons I'm in medicine is because two of
3:06
Speaker 3: my friends died when they were seven and fourteen, and
3:09
Speaker 3: I was about the same age, and I was always
3:11
Speaker 3: wondering what happened, and it sort of came to me later.
3:14
Speaker 3: Then I go into medicine, and I decided it could
3:18
Speaker 3: do internal medicine or surgery. But I had a skill
3:21
Speaker 3: set because I worked with my hands all my life
3:23
Speaker 3: like my dad, and I went into surgery and realized
3:26
Speaker 3: urology is a lot of fun. They're surgeons with a personality.
3:30
Speaker 3: Even urine is like colored by the kinds of wine,
3:33
Speaker 3: like pino. Is that a Cabernet or a pino? Oh,
3:36
Speaker 3: that's a rose. That's good. Ob He's okay. And then
3:40
Speaker 3: I go into urology and realize that I have gifted
3:43
Speaker 3: hands and I can do really small things, and become
3:45
Speaker 3: a microsurgeon, which is something if you have a tremor
3:48
Speaker 3: you can't do. Then I go into field microsurgery and
3:51
Speaker 3: realize that's an area of mental health. Then an interned
3:54
Speaker 3: microsurgery is a fellow, and realize it's wide open in
3:57
Speaker 3: terms of what we know or don't know about men.
4:00
Speaker 3: And that's when I became a professor. We just don't
4:02
Speaker 3: know much about certainly men's sexual health and men's fertility.
4:06
Speaker 3: It's just an uncovered rock. For example, when I was
4:09
Speaker 3: in the field, and I started thirty years ago, say
4:12
Speaker 3: when men came with inert couples come in with in fertility.
4:15
Speaker 3: If a man has part of the problem, we couldn't
4:17
Speaker 3: explain why. About half the time, I'm not sure what's
4:21
Speaker 3: going on. Then my early research career was in genetics
4:25
Speaker 3: with Renee rio Para, who's the finest. She discovered the
4:29
Speaker 3: Y chromosome had deletions on it. In MIT, she joined me,
4:33
Speaker 3: and then we're busting open the field with genes and
4:35
Speaker 3: things like that. Everyone's learning about genes and that explains
4:40
Speaker 3: a little bit more of it, and then we learn
4:41
Speaker 3: about lifestyle and things like that. The genetics explained. So
4:45
Speaker 3: now I would say when I see the same couple
4:48
Speaker 3: and the same man, it's probably five percent of the
4:51
Speaker 3: time when I can't explain why it is infertile, which
4:54
Speaker 3: is pretty good.
4:55
Speaker 2: Wow, all right with AI and genomics, I mean, do
4:59
Speaker 2: you see things going in a more rapid direction?
5:03
Speaker 3: For absolutely, we're off to the basis. It's fabulous. This
5:06
Speaker 3: was a great story of translational medicine at its best.
5:11
Speaker 3: So Renee Reilpair is a PhD in a lab in
5:13
Speaker 3: germ cell biology and sperm biology egg biology. And there's
5:17
Speaker 3: a journal club where people talk about an article. And
5:21
Speaker 3: I go to journal clubs because I'm an MD. But
5:23
Speaker 3: I love the basic science, you know, I was always
5:26
Speaker 3: into it as a professor. So I'm talking about mice
5:29
Speaker 3: that have a genetic defect microsatellite instability in some DNA
5:35
Speaker 3: repair mismatched gene So they knock these mice out of
5:38
Speaker 3: a gene that repairs DNA. So back up a little bit.
5:42
Speaker 3: What does that mean. Think of a car leaving the garage,
5:46
Speaker 3: going into the real world and it gets dense during
5:49
Speaker 3: the day and then it comes back into the garage
5:51
Speaker 3: at night, and this would be repaired at night, so
5:53
Speaker 3: the next day it goes out healthy again. The car
5:56
Speaker 3: goes out in good shape. We wish we had this,
5:58
Speaker 3: we don't, but the system, our bodies do this all
6:01
Speaker 3: the time. A sun ray hits your skin cell, it
6:05
Speaker 3: causes a mutation, and there's a repair process called DNA
6:07
Speaker 3: mismatch repair that repairs that mutation. And cancers are typically
6:12
Speaker 3: your inability to repair the first hit. You lose the
6:14
Speaker 3: second hit to repair the first hit. Right, So the
6:16
Speaker 3: two theory of cancer. First it is you get the mutation,
6:19
Speaker 3: second as you can.
6:19
Speaker 2: And that plays a role in whether you're a candidate
6:22
Speaker 2: for immuno therapy. Right, That's how I understand it.
6:24
Speaker 3: Yeah, so that's a classic story of cancers. So we're
6:28
Speaker 3: looking at mites that were a paper about knocked out
6:31
Speaker 3: of DNA mismatch repair genes and they developed cancer. Now,
6:34
Speaker 3: the problem is they were infertile and that was the
6:37
Speaker 3: unexpected outcome. They were getting cancers later in life, colons
6:40
Speaker 3: and this and that, and they were infertile. So you
6:43
Speaker 3: spend a lot of money, millions of dollars making a
6:45
Speaker 3: knockout mice, and you can't reproduce it because it's infertile.
6:48
Speaker 3: So they read papers about the infertility, and we read them,
6:51
Speaker 3: and I saw a picture in this paper happen to
6:53
Speaker 3: be there of a mouse testicle the pattern inside the
6:56
Speaker 3: testicle of cells, and it's called the maturation arrest. And
7:00
Speaker 3: I said to myself, I have men who look just
7:03
Speaker 3: like that. Their testicles look just like that. They have
7:05
Speaker 3: no sperm in the ejaculate and they're inside their testicle
7:07
Speaker 3: few biopsy. It looks just like these. And I had
7:10
Speaker 3: a picture and put right next to it, and they're identical.
7:13
Speaker 3: You could not tell which is mouse which is man.
7:15
Speaker 3: We all said, I wonder if the same thing may
7:18
Speaker 3: be occurring in men to make them infertile. So we
7:22
Speaker 3: did a parallel study in men with no sperm with
7:27
Speaker 3: this pattern and other patterns, and found lo and behold yes,
7:31
Speaker 3: in their testicles, the DNA mismatch repair genes were not
7:34
Speaker 3: working well. Someone were mutated and that started it all
7:38
Speaker 3: published it about twenty five years ago with daved Audell,
7:41
Speaker 3: and that kind of blew it open. That asked the
7:43
Speaker 3: bigger question, which is, oh, my god, if they're infertile
7:47
Speaker 3: when they're young, what's going to happen when they're older
7:50
Speaker 3: with this problem like the mice And another fellow of mine,
7:53
Speaker 3: Tom Walsh, we did the EPI study that was a
7:56
Speaker 3: basic science paper. They were the EPI study with a
7:58
Speaker 3: large Mary krogan A. You see, had a database of
8:01
Speaker 3: twenty five thousand couples or maybe forty thousand couples over
8:05
Speaker 3: twenty five years, followed through great data NH sponsored Epidemiology
8:10
Speaker 3: of Infertility, and we looked at them and we said,
8:13
Speaker 3: are these infertile men developing cancers higher than they would
8:17
Speaker 3: expect it to? And lo and behold we found that
8:19
Speaker 3: and published it in major scientific journals that prosty cancer
8:22
Speaker 3: rates were higher later in life and these men and
8:25
Speaker 3: tests cancer later in life, so not at the time
8:29
Speaker 3: of the infertility, but later. And it was a powerful
8:32
Speaker 3: study because we have the cancer registries in California and
8:35
Speaker 3: we have the NH data, and it's not like insurance
8:38
Speaker 3: claims data. This is like the real deal. Abstracted data.
8:42
Speaker 3: So you have longitudinal follow up on men for twenty
8:45
Speaker 3: five years showing they're getting more cancers, and that was
8:50
Speaker 3: very concerning.
8:51
Speaker 2: Anyway to prevent it based on that knowledge.
8:54
Speaker 3: That's the secret Sauce. I mean, that's what I'm very
8:56
Speaker 3: proud of. Is knowing that there's risk ahead of time
9:01
Speaker 3: leads you to preventative medicine, which we've never done in
9:05
Speaker 3: young men ever. So the point you make is we
9:09
Speaker 3: now have our foot in the door to potentially warn
9:13
Speaker 3: men preventive care, get them care earlier for things that
9:16
Speaker 3: could happen to them based on a SEAMA analysis. Probably
9:19
Speaker 3: give me more complex like more based on maybe some
9:22
Speaker 3: hormones and a seam analysis and their fertility status. But
9:25
Speaker 3: since that time, that was about fifteen years ago, it's
9:29
Speaker 3: blown up. The biomarker concept has blown up. It's not
9:33
Speaker 3: only a measure of your future health potentially in terms
9:36
Speaker 3: of those two cancers, but other things including cardiovascular risk
9:41
Speaker 3: and maybe even longevity. And there's also it been shown
9:46
Speaker 3: now that your fertility potential by a Steamer analysis is
9:50
Speaker 3: related to your current health. It's called comorbidity burden. So
9:54
Speaker 3: infertile men have a higher burden of issues health care
9:59
Speaker 3: issues than fertile men. And so your question is when
10:01
Speaker 3: does this become fact? It's all theory, it's all associations.
10:05
Speaker 3: And the answer is, I'm not sure, but I think
10:08
Speaker 3: to me this became fact because remember, theory is what
10:13
Speaker 3: we think it is, in fact is what it really is, right,
10:16
Speaker 3: and that takes time. It always takes time for theories
10:18
Speaker 3: to become fact.
10:19
Speaker 2: Yeah, I mean, so fertility should it be that catch
10:22
Speaker 2: all phrase? I know it's often men's fertility issues and
10:26
Speaker 2: it's kind of catching up with those of women. It
10:29
Speaker 2: seemed to be much more of an issue there. But
10:31
Speaker 2: you know, I like these reality shows now they're talking
10:34
Speaker 2: about guys sperm counts and stuff.
10:37
Speaker 3: So what sealed the deal for me on theory versus fact?
10:40
Speaker 3: When does science become fact? Was a recent study from
10:45
Speaker 3: Rigalo hospitalet in Copenhagen, And the ultimate measure of this
10:50
Speaker 3: biomarker concept is does the sperm count relate to something
10:54
Speaker 3: later in life? It's cardiovascular risk life, does it relate
10:58
Speaker 3: to anything? So the ultimate measure of success is longevity.
11:02
Speaker 3: And that paper came out seventy eight thousand men in
11:06
Speaker 3: a well controlled you know, medical care system, and Denmark
11:09
Speaker 3: is really good and they have one system. So they
11:12
Speaker 3: followed seventy eight thousand men for fifty years, and they
11:16
Speaker 3: took two groups of men, and they had men with
11:18
Speaker 3: low sperm counts and men with normal sperm counts when
11:22
Speaker 3: they were young. And they looked at one thing longevity.
11:26
Speaker 3: How long did they live? All causes everything, and a
11:30
Speaker 3: different in longevity of a year is huge, right, this
11:33
Speaker 3: was almost three years. It was eighty point three versus
11:37
Speaker 3: seventy seven something. It was hegoge and that to me,
11:41
Speaker 3: like it's the ultimate measure. I'm kind of convinced it's
11:43
Speaker 3: real and I don't need more than that.
11:46
Speaker 2: Can we fix sperm count these days? You can?
11:48
Speaker 3: Well, the first thing is to detect it, right, So
11:51
Speaker 3: how do you get right? So when you look at
11:52
Speaker 3: sperm racing and these eighteen year olds racing their sperm
11:56
Speaker 3: on megatrons and you know USC versus UCLA, I'm like,
12:00
Speaker 3: that's great. And then they're doing it for awareness because
12:02
Speaker 3: they're worried about sperm count's falling. So it's all about
12:05
Speaker 3: awareness and awareness brings testing and then we can get
12:08
Speaker 3: men in. But that's never happened before, and that's what
12:11
Speaker 3: I'm excited about.
12:12
Speaker 2: Well, let's talk about sperm. Why is sperm health a
12:15
Speaker 2: biomarker for overall health.
12:17
Speaker 3: So now and I see a patient with a low
12:19
Speaker 3: sperm count, we used to say, I don't know. I
12:22
Speaker 3: guess it just happened to you if we couldn't figure
12:25
Speaker 3: it out. Right Now I say to everyone, I see
12:29
Speaker 3: why is this count blow? Because if it should be normal,
12:32
Speaker 3: if everything's okay, if it's not normal, then something's going on.
12:36
Speaker 3: We have to find it. So it's changed the way
12:38
Speaker 3: I deep into deep in the men, and so now
12:41
Speaker 3: I do medical evaluations on men. It's health right, you're diabetic,
12:45
Speaker 3: your blood pressure, your clusterol, that all matters. Your overall
12:49
Speaker 3: health matters the most. And diet wise, lifestyle. Same thing
12:53
Speaker 3: that keeps you a healthy keeps you fertile, the Mediterranean diet.
12:56
Speaker 3: All that stuff wrapping your testicles in a body needs
13:00
Speaker 3: to be healthy. You know, no hot tubs, stop smoking pot.
13:03
Speaker 3: All that stuff's terrible. Great choices about exercise regularly. Sleep
13:07
Speaker 3: is important. Reduce your stress. Stress kills fertility. It's the
13:11
Speaker 3: wrong nervous system. If you're stressed, your body, we're cave people.
13:16
Speaker 3: Your body would say, what are we running from, Well,
13:18
Speaker 3: we're running from something, taber tooth, tiger, I don't know, Facebook,
13:22
Speaker 3: you know, let emails, whatever. Keeping us running is the
13:25
Speaker 3: wrong nervous system for fertility because it's like we're running
13:28
Speaker 3: for our lives. Turn that stuff off. It's we have
13:30
Speaker 3: to conserve energy. Here saying with like intermittent fasting. If
13:34
Speaker 3: you do it too much, you lose a lot of weight.
13:35
Speaker 3: Your body's catabolic. That's not good for fertility. Your body's saying, hey,
13:39
Speaker 3: we're starving. I don't know why what we're starving. So
13:42
Speaker 3: turn everything off that's not needed right now. Conserve energy.
13:45
Speaker 3: It's a classic nervous system response. And then I look
13:49
Speaker 3: for you know, the medical history and left cell, and
13:51
Speaker 3: then I look for medical hormonal issues, low testosterone, things
13:55
Speaker 3: like that and things that alterate medications, et cetera. And
13:59
Speaker 3: then I look at the physical exam and a varico
14:01
Speaker 3: seal comes up, which is the most common correctible cause
14:05
Speaker 3: of low sperm count. And it's simply a vein in
14:08
Speaker 3: the scrotum that is larger than normal, like a verical
14:11
Speaker 3: savy in your leg, and it's in your scrotum. And
14:14
Speaker 3: it happens only in humans because we stood up five
14:17
Speaker 3: hundred thousand years ago, and we're draining the testical to
14:20
Speaker 3: the kidney uphill. All of a sudden, when we were
14:22
Speaker 3: draining it this way without gravity, now we're fighting gravity
14:25
Speaker 3: and it's coming back down and it's fixable. So my
14:29
Speaker 3: belief on Varica seal is it was a really good
14:31
Speaker 3: idea to develop the opposable thumb as a human being,
14:34
Speaker 3: but not a great idea to stand up for our fertility.
14:37
Speaker 2: Wow. A lot of this is addressable too, which is
14:39
Speaker 2: why people should understand. So we've read a lot of
14:43
Speaker 2: theories on microplastics and tech exposure. I mean, is that
14:47
Speaker 2: all real relative to sperm count? And why we're seeing
14:52
Speaker 2: it falling on.
14:53
Speaker 3: A microplastics I would say we know now we can
14:57
Speaker 3: measure it now. So it wasn't really measurable before and
15:00
Speaker 3: now it is and it's measured everywhere. The question is
15:04
Speaker 3: what's the pathology. It's probably industrialization, it's not new. Probably
15:09
Speaker 3: it's just now been measured and that's what's gotten all
15:11
Speaker 3: the press. And there are now association studies coming in
15:15
Speaker 3: looking at stuff. And now I'm getting calls from companies
15:18
Speaker 3: that are able to sort of reduce microplastics, but they're
15:21
Speaker 3: just very small micrometer particles of plastic. So I don't
15:26
Speaker 3: know where it goes. I think there could be an issue,
15:29
Speaker 3: but I don't know, you know, I mean it's in
15:31
Speaker 3: every organ everyone that a're sociated with Alzheimer's disease, infertility
15:35
Speaker 3: and things like that. But you can find it everywhere.
15:38
Speaker 3: The question is how bad is and how long has
15:40
Speaker 3: it been there and is it really all that relevant?
15:43
Speaker 2: Yeah? And then the other one is that men and
15:44
Speaker 2: boys are struggling with mental health issues, often in silence.
15:48
Speaker 2: How does that affect testosterone, sperm and epigenetics of awesome.
15:53
Speaker 3: It's terrible because four out of five suicides are men
15:57
Speaker 3: and it's completely untapped. It's just an situation right now.
16:01
Speaker 3: And the Attorney General when he announced that there's a
16:03
Speaker 3: mental health crisis in America, I mean, you're really talking
16:06
Speaker 3: about man. They are isolated. That's a huge dark hole.
16:09
Speaker 3: That's a rabbit hole right now. But I would say
16:12
Speaker 3: with the fertility thing, the foot in the door, we've
16:15
Speaker 3: never had this before. And so the question is how
16:17
Speaker 3: do you get men in for any care? Because remember
16:20
Speaker 3: women have kids, have pediatricians at sixteen, they lose their pediatrician.
16:25
Speaker 3: Girls get gynecologists, they have them for the rest of
16:28
Speaker 3: their lives. That's our primary care doctor. There are no
16:31
Speaker 3: dui gynecologists. Men go off and they're siloed care in America,
16:37
Speaker 3: but not good comprehensive care for them. I was also
16:40
Speaker 3: one of the first to get the first national grant
16:43
Speaker 3: from the NH to start a men's health specialty. So
16:46
Speaker 3: I'm a neurologist, but remember I saw the need and
16:49
Speaker 3: the surgery's fun. But this is the need is men
16:53
Speaker 3: don't get any care. They don't get good fertility care,
16:55
Speaker 3: they don't get a care, and so we're figuring all
16:57
Speaker 3: this out. But it was hard because they're suicide rates
17:00
Speaker 3: are high, their cancer their death rates from cancer are high,
17:03
Speaker 3: their mental health is awful, and they don't live nearly
17:06
Speaker 3: as long as the women, and there's just a bias
17:09
Speaker 3: against it. It's always been pro women because men make decisions.
17:12
Speaker 3: And I don't know what's going on, but for example,
17:15
Speaker 3: the sorriest thing I could think of, the saddest thing
17:17
Speaker 3: is there's been an Office of Women's Health and National
17:20
Speaker 3: Office of Women's Health in the government for forty years.
17:24
Speaker 3: It's done incredible things for breast cancer, consolidating nonprofits and
17:28
Speaker 3: it's done a lot from awareness of breast cancer, beautiful work,
17:32
Speaker 3: great idea. There have been three major attempts to get
17:35
Speaker 3: an Office of Men's Health that it fails every time.
17:37
Speaker 3: And I've been there because I work for a lobby
17:40
Speaker 3: group in Washington called Men's Health Network, and we went
17:43
Speaker 3: to the White House and we're doing all this stuff
17:44
Speaker 3: and it just fails every time. It's like you saw
17:47
Speaker 3: the benefits. I think a lot of it right now
17:51
Speaker 3: is partisan politics. If someone believes in it, the opposite
17:55
Speaker 3: side would not just because of the side they're on,
17:57
Speaker 3: not because of the meaning of it. My secret is
18:00
Speaker 3: get men to their partners because men aren't going to
18:04
Speaker 3: show up, and my practice we get men where they are.
18:07
Speaker 3: I mean, virtual care is great from it's been great
18:09
Speaker 3: because they'll just literally roll out of bed, sit in
18:13
Speaker 3: front of the camera and you got them. And then
18:15
Speaker 3: what happens is the women, if they're partnered with them
18:18
Speaker 3: in trouble, they'll say, I want you to see a doctor.
18:20
Speaker 3: And the secret sauces they're not going to do it
18:22
Speaker 3: for themselves unless they're in pain or their life is threatened,
18:26
Speaker 3: but they will do it. If someone says, do it
18:29
Speaker 3: for me. So the secret sauce to men are the
18:32
Speaker 3: partners we're getting there.
18:33
Speaker 2: Well, we know women get pap smears as a matter
18:35
Speaker 2: of course, do you think steemen analysis would be the
18:38
Speaker 2: equivalent for men or the other important tests than markers.
18:42
Speaker 3: So I was talking I have a podcast called Talk
18:44
Speaker 3: with Turrek, and I had the Maven CEO or CMO
18:48
Speaker 3: or Neil Shaw, and Neil said, yeah, so there's janitary
18:52
Speaker 3: progeny and then there's Neil Shaw of Maven, which is
18:55
Speaker 3: seventeen million lives and they're starting to cover. So I'm
18:58
Speaker 3: involved with both of those good organizations because they've been
19:00
Speaker 3: doing a great job with women's sexual health and now
19:03
Speaker 3: they're turning toward men and I'm like, perfect, Another way
19:07
Speaker 3: to raise awareness is get insurance coverage for it. So
19:10
Speaker 3: that is happening now. I'm very excited. It's a very
19:13
Speaker 3: important time. I had the idea of getting our foot
19:15
Speaker 3: in the door, and now it's like, how do we
19:16
Speaker 3: do that? So their partners, insurance coverage awareness, these are
19:22
Speaker 3: all coming together, the sperm racers, the seventeen year olds
19:25
Speaker 3: at USC and Perfect perfect, whatever it is, just just
19:29
Speaker 3: get the awareness going and it's ground swells, grassroots stuff.
19:33
Speaker 3: So we're working from all angles. And before I die,
19:36
Speaker 3: I want to see it on par I would love
19:38
Speaker 3: to see men live as long as women by the
19:40
Speaker 3: time I diamond how much time we have?
19:42
Speaker 2: But you look like you got all a few more minutes.
19:45
Speaker 2: I was going to ask you the obvious question, Can
19:48
Speaker 2: the golp ones help sperm counts because they help everything else?
19:52
Speaker 3: But yes, yes, it's a favorable situation.
19:55
Speaker 2: Really yeah, I was kind of half kidding when I
19:58
Speaker 2: said that, but no.
19:59
Speaker 3: It's real. Well, I think you know you're looking at
20:02
Speaker 3: less diabetes and less obesity. And if you said, if
20:06
Speaker 3: men's sperm counts are truly falling and developed countries, what
20:09
Speaker 3: could be the reasons? And the answer is could say
20:12
Speaker 3: industrialization and toxic exposures and then con disruption on plastics,
20:16
Speaker 3: But you could also say obesity because it's a perfect fit.
20:20
Speaker 3: The problem with the glps is you get an amazing
20:23
Speaker 3: start on the process because you lose weight sort of involuntarily,
20:28
Speaker 3: But if you don't learn to maintain those habits, you're
20:32
Speaker 3: just going to gain it back. So you have to
20:34
Speaker 3: change the way you view food. You have to change
20:37
Speaker 3: the way you eat forever, you can't go back. It's
20:40
Speaker 3: the same reason why diets fail.
20:42
Speaker 2: I mean, I guess they're looking at keeping people on
20:44
Speaker 2: them forever.
20:45
Speaker 3: But you know, like the stat I'm not sure I'm
20:47
Speaker 3: a fan of that, but I think it's excellent and
20:50
Speaker 3: I just wish people could keep it off and then
20:52
Speaker 3: we'd be back to where we were. And maybe it's
20:54
Speaker 3: great for kids to get them started that way. I'm
20:56
Speaker 3: not sure there's a lot of data.
20:58
Speaker 2: Well maybe in those fertility years is where you want
21:01
Speaker 2: to get that now, but I guess, and you do
21:03
Speaker 2: want to avoid diabetes, like you said, But you published
21:06
Speaker 2: a study with a notable contrasted retinoic acid right, a
21:11
Speaker 2: vitamin A derivative, and acutane, which, okay, now this is
21:15
Speaker 2: where this gets weird. Helps sperm production while it causes
21:18
Speaker 2: birth defects in utero. How often is it the case
21:23
Speaker 2: in fertility that something that helps men hinders women and
21:26
Speaker 2: vice versa.
21:26
Speaker 3: So this is a first.
21:28
Speaker 2: This is a first.
21:29
Speaker 3: Yeah, So acutane is bacni right, and it came out
21:32
Speaker 3: in this eighties or nineties a FDA approved and women
21:36
Speaker 3: pregnant girls teenagers who getting get pregnant all higher rate
21:40
Speaker 3: of birth effects. Men never had any issue with it.
21:43
Speaker 3: There's no higher rate of birth effects in couples in
21:46
Speaker 3: whom men were on acutaining, and that's eight million men.
21:49
Speaker 3: So it's completely safe for men. But John Amory, who's
21:53
Speaker 3: at University of Washington, is an old friend, and he
21:56
Speaker 3: was trying to look at We also know that acutitane
21:59
Speaker 3: was important to make a sperm, had several stages in
22:01
Speaker 3: the process of twelve stages precursor sales to make sperm
22:05
Speaker 3: surroundedgonial stem cells, et cetera. Retinoic acid, which is a derivative,
22:09
Speaker 3: is important for that process to go on, and you
22:11
Speaker 3: remove it, you stop it. So he was looking at
22:14
Speaker 3: it as a contraceptive, an oral, non hormonal contraceptive. Really
22:18
Speaker 3: cool idea, hard to get to work, complicated biology. And
22:22
Speaker 3: then he sort of said, well, maybe an infertile memilos
22:25
Speaker 3: sperm counts. It's low and we could give them more.
22:29
Speaker 3: And he published a couple of pilot studies and then
22:31
Speaker 3: I met him in a meeting the Andrectmeric Society of
22:34
Speaker 3: Andrology in San Diego at a surf session. Came in
22:37
Speaker 3: in the morning, you know, all disheveled and relaxed and
22:41
Speaker 3: sat down with a cup of coffee with him and said,
22:43
Speaker 3: you know something's going on here. I think we can
22:45
Speaker 3: help these men out. So I said, let's do it.
22:48
Speaker 3: And so we put a group of men with no
22:51
Speaker 3: sperm and a production problem who had failed almost everything.
22:56
Speaker 3: I had multiple procedures, sperm atrievals, this and that, and
22:59
Speaker 3: some men who had faint sperm production single digits, unreliable,
23:04
Speaker 3: so not candidates for much and put them on the
23:09
Speaker 3: clinical dose of acutane and a third of them went
23:13
Speaker 3: on and developed ejaculated sperm. That's quite nowhere, and it
23:18
Speaker 3: goes along with his theory because he did his study
23:20
Speaker 3: where he looked at men with low sperm counts and
23:22
Speaker 3: their retinal gacid levels in the test this were low.
23:24
Speaker 3: And then he supplemented another study supplemented man with nose
23:28
Speaker 3: sperm counts with and he got higher sperm counts. So
23:31
Speaker 3: there is a correlation. It's biological. I've known about some
23:34
Speaker 3: relationship for one hundred years, but he took it home
23:37
Speaker 3: and I just went with it. And to see the
23:40
Speaker 3: worst hardest cases of male in fertility developing enough ejaculated
23:44
Speaker 3: sperm to avoid surgical sperm atriial procedures and be able
23:48
Speaker 3: to go to IVF. I think we're on our third
23:50
Speaker 3: berth now. It's a pilot study which published it in August,
23:53
Speaker 3: and it's really funny. You know, I care about ment health.
23:55
Speaker 3: I don't just care about their fertility. I care if
23:58
Speaker 3: I can get them to stop smoking, then not only
24:01
Speaker 3: are they going to be fertile, they're going to live longer.
24:03
Speaker 3: And so one of the things with this severe fertility
24:06
Speaker 3: is they get big procedures on their testicles basically filay
24:09
Speaker 3: them open and try to find sperm, and their taisocial
24:12
Speaker 3: levels can fall. They're thirty years old, they're looking at
24:14
Speaker 3: sixty years of testoster and placement. This is a medication
24:18
Speaker 3: that avoids all that. So you're developing the sperm and
24:20
Speaker 3: the seamen. You don't need safe surgery. So here, my
24:23
Speaker 3: guy with that kind of I would call it enlightened view,
24:25
Speaker 3: which is, let's be good to men too, and let's
24:28
Speaker 3: get to live a hunger. And I presented at urology
24:31
Speaker 3: meetings this data, and you know, we're kind of excited
24:33
Speaker 3: about it, and they go like, aren't whatever. And I
24:36
Speaker 3: present it to IVF groups the girls side, and like,
24:38
Speaker 3: this is great, you know, because we're more's being new
24:40
Speaker 3: candidates for IVF that were never candidates before. They're getting
24:43
Speaker 3: an opportunity to be biodads when they weren't, and it's safer.
24:48
Speaker 3: It's just safer. I mean, it makes so much sense
24:50
Speaker 3: to me.
24:50
Speaker 2: So this is fully alive, safer for the woman, right
24:53
Speaker 2: because even though it's that which cause birth effects, we
24:57
Speaker 2: wash it out or something, what happens.
24:59
Speaker 3: Only if the women are taking it, And if the
25:01
Speaker 3: men take it, it's not in their semen and there's
25:03
Speaker 3: not in their testicles, and it's not shit, it's not
25:05
Speaker 3: sweated out, so there's no exposure risk. But we've known
25:09
Speaker 3: that for thirty years and eight million men.
25:11
Speaker 2: All right, So I swear I'm not asking for a
25:15
Speaker 2: friend this next question. There's a lot of chatter around
25:19
Speaker 2: women taking precautions when having kids later in life due
25:22
Speaker 2: to risk factors, egg quality, you know, all the things
25:26
Speaker 2: production and what risk do men face having kids forty
25:30
Speaker 2: plus and even into their eighties like de Niro and
25:34
Speaker 2: Jagger and people like that. Is there an age to
25:38
Speaker 2: sperm that matters are not? Really?
25:42
Speaker 3: So the statement is that like women, men have a
25:44
Speaker 3: biological clock. H with know that and they're hormones, but
25:50
Speaker 3: it's a more attenuated clock. Right, So, menopause forty five
25:54
Speaker 3: point fifty, you lose ability to conceive and your hormones go,
25:57
Speaker 3: and women menopause manopaul use is more of a slow
26:02
Speaker 3: decline from forty to seventy to eighty and then there's
26:06
Speaker 3: probably a real drop after that of hormones and fertility.
26:11
Speaker 3: But men maintain their fertility longer.
26:13
Speaker 1: Now.
26:13
Speaker 3: Both have clocks, but they're very different time frames of clocks,
26:17
Speaker 3: and they are similar issues going on in those times,
26:20
Speaker 3: for fertility is lost and then hormones are lost. But
26:23
Speaker 3: the real issue is what's the risk the children of
26:27
Speaker 3: men who get older paternal age of risks to offspring.
26:30
Speaker 3: I've been interested in that for years and I've published
26:33
Speaker 3: on it, and it's very concerning and it's very new
26:37
Speaker 3: because technically we've never lived this long to have this problem.
26:41
Speaker 3: So here's what I would do to reassure men. Because
26:43
Speaker 3: as I was writing a published paper on reproductive genetics
26:47
Speaker 3: and the aging mail, i was fifty years old and
26:49
Speaker 3: I had a baby, and I'm like, I'm one of
26:52
Speaker 3: those guys. Forty years old is considerable eternal age. Fifty
26:54
Speaker 3: for sure, but I would say this. First of all,
26:58
Speaker 3: the relative risk that men older men bring to bear
27:01
Speaker 3: and their offspring genetically is much lower than women. So
27:05
Speaker 3: the absolute value of impact is much lower for men
27:08
Speaker 3: than it is for women. And the way it works
27:11
Speaker 3: is different. So women kind of go up slowly, and
27:14
Speaker 3: then it's like a hockey stick, so it's sort of
27:16
Speaker 3: relatively flat from twenty one to forty, and then at
27:19
Speaker 3: forty kind of goes up like the blade of a
27:22
Speaker 3: hockey stick, So it goes up much higher, more logarithmic
27:25
Speaker 3: than linear, and men it's sort of the same curve,
27:27
Speaker 3: but it's sort of like twenty to sixty, twenty to
27:30
Speaker 3: fifty five is pretty linear, and then it would go
27:33
Speaker 3: up like the hockey stick and go up logarithmically. So
27:37
Speaker 3: the relative risk for most men is pretty low, and
27:40
Speaker 3: it may go from say one percent to three percent
27:43
Speaker 3: of total risk. And so I had to rationalize it
27:46
Speaker 3: for my own life, and I sort of say to
27:47
Speaker 3: men when they get worried about it, they say, do
27:49
Speaker 3: you know what the rate of birth effects is among
27:51
Speaker 3: couples in America who are conceiving, And they don't know,
27:54
Speaker 3: and it's about three three and a quarter percent. The
27:57
Speaker 3: rate that you would worry about with men is around
27:59
Speaker 3: the same as the rate of birth effects in women.
28:02
Speaker 3: And if you're uncomfortable with that, then you know she'd
28:06
Speaker 3: think twice and.
28:07
Speaker 2: Your kid's doing fine, right, Yeah, okay, that's I go.
28:11
Speaker 2: But positive, So is man a positive thing?
28:14
Speaker 3: Here's an example.
28:15
Speaker 2: I have a man.
28:16
Speaker 3: A heart surgeon comes in. He's seventy, he has kids,
28:18
Speaker 3: he had of a sectomy. He mits a medical student
28:21
Speaker 3: and he wants more kids. She wants kids, He wants kids.
28:24
Speaker 3: He's seventy. He reverses vasectomy and he has a normal
28:28
Speaker 3: sperm count. To thank you very much, We're going to
28:29
Speaker 3: hold off for a year or two to try to conceive.
28:32
Speaker 3: And then they try to conceive it is seventy two
28:34
Speaker 3: or three and there's no sperm. So it's either well,
28:38
Speaker 3: procedure failed, like he had a sperm count and I
28:40
Speaker 3: don't went away, or he's not making it anymore. It's
28:43
Speaker 3: seventy four. You just look at that the testicle, get
28:46
Speaker 3: a sample. I invented something called mapping. It's a way
28:49
Speaker 3: to figure out what's going on a testicle without surgery.
28:51
Speaker 3: It's a procedure, but it's very benign and he stopped
28:54
Speaker 3: making it no more. And it happens in the eighth decade.
28:57
Speaker 2: And nothing you can do to bring it back, even
28:59
Speaker 2: giving him to stosterone or things like that.
29:01
Speaker 3: No, that would be a bad idea.
29:03
Speaker 2: But why is that a bad idea.
29:05
Speaker 3: It's a contraceptive. Testosterone is a contraceptive, Okay. So the
29:09
Speaker 3: only testosterone to make sperm, that the testicle can use
29:12
Speaker 3: to make sperm is your own. So all the antabolic
29:15
Speaker 3: storied users are infertile little raisins, all right.
29:18
Speaker 2: So the bottom line is get on this before seventy.
29:21
Speaker 3: That's a good advice. Yeah, right, record for sperm is
29:24
Speaker 3: eighty seven. And so when you look at like al
29:26
Speaker 3: pacino and that's exceptional if that's good work, I was like,
29:31
Speaker 3: nice child, especially if the kids are healthy.
29:34
Speaker 2: Exactly.
29:35
Speaker 3: So what's an interesting is that this is brand new
29:38
Speaker 3: to the species. And I read a blog about this
29:40
Speaker 3: years ago Turk and Ment's health. I think we lived
29:42
Speaker 3: in nineteen hundred, about thirty eight years, nineteen thirty, around
29:46
Speaker 3: forty forty five to fifty nineteen sixties. We are living
29:49
Speaker 3: in the seventies and now you know we're seventy seven
29:53
Speaker 3: as men. So this whole issue of paternal age and
29:57
Speaker 3: birth effects or effects on children is only two generations old,
30:01
Speaker 3: so it's never existed before because we've never lived long
30:04
Speaker 3: enough to have the problem with the brand new disease
30:06
Speaker 3: of the species.
30:07
Speaker 2: Right, and we're breaking new ground talking about it brand
30:11
Speaker 2: new because you have your podcast. I mean, there's a
30:13
Speaker 2: few guys out there now maybe talking about it. Do
30:16
Speaker 2: you think we'll see more famous male faces and influencers
30:21
Speaker 2: talking about this topic.
30:22
Speaker 3: I hope. So I think it's led to a lot
30:25
Speaker 3: of men banking sperm, which is a healthy response because
30:29
Speaker 3: if they're not coupled. But I do go over the data,
30:31
Speaker 3: it's like, it's not really that different between thirty five
30:34
Speaker 3: and forty and now the sperm banking community is blown
30:37
Speaker 3: up with online banking and all that, so it's much
30:39
Speaker 3: easier to do. And to me, sperm banking is low
30:43
Speaker 3: hanging fruit. It's really I mean, cancer whatever. It's a
30:46
Speaker 3: great way to preserve your fertility. So I'm a big
30:49
Speaker 3: fan of it. A disclosure and with Legacy another advisor
30:52
Speaker 3: to give Legacy as one of the first and maybe
30:54
Speaker 3: the largest one of those banks. But that's the part
30:57
Speaker 3: of my mantra, right, which is keep men healthy, keep
31:00
Speaker 3: the kids healthy, and do healthy things.
31:02
Speaker 2: Yeah, it makes sense. On my podcast, Mary Clairhaber ran
31:05
Speaker 2: my audience through optimizing women's health by a decade. Can
31:09
Speaker 2: we do that for men?
31:10
Speaker 3: Well, it's a different process, right, So it makes sense
31:13
Speaker 3: for women because they're born with a million eggs and
31:17
Speaker 3: they just lose them. So you ovulate a thousand, you're
31:20
Speaker 3: born with a million, you waste the rest, and the
31:23
Speaker 3: ones that you ovulated forty are forty years old because
31:26
Speaker 3: you don't make new ones. Sperm is an ongoing process,
31:30
Speaker 3: so it's constant and rejuvenating. So if you're going to
31:33
Speaker 3: think of one thing that you can change in fertility,
31:36
Speaker 3: it's men. Men are the most adaptable to stuff. So
31:40
Speaker 3: you go ahead and do your hot tubs of twenty
31:42
Speaker 3: for a while, but then stop when you're trying to
31:44
Speaker 3: conceive because your system will restore, right, I mean, there
31:46
Speaker 3: are things even to sawstware replacement. Short term, you'll recover
31:50
Speaker 3: from it. So most insults and toxins are reversible in men.
31:55
Speaker 3: If you do smoking as a woman, that's cumulative, right,
32:00
Speaker 3: pot you're gonna cook your eggs. Toxin in women is
32:03
Speaker 3: not the same as men. Men will get that sperm
32:06
Speaker 3: bunch will be abnormal or whatever. They'll be less quality,
32:11
Speaker 3: but then three months later it'll come back when you're
32:13
Speaker 3: sitting there with the same eggs all your life. It's
32:15
Speaker 3: a very different biology. So decade by decading women makes sense,
32:18
Speaker 3: but not really for men. I would say, stay healthy,
32:22
Speaker 3: treat your body like a temple fit or stress the etc.
32:25
Speaker 3: And stay alive. And then if we want to conceive,
32:29
Speaker 3: you really have to take great care of yourself like
32:31
Speaker 3: an Olympic sport. You really need to take great care
32:33
Speaker 3: of yourself to be the most fertile. But all these
32:36
Speaker 3: behaviors to be fertile are the same behaviors that are
32:39
Speaker 3: gonna make you live longer. So if you can just
32:41
Speaker 3: hang on and do it, we got youa We'll get
32:45
Speaker 3: that difference eliminated.
32:46
Speaker 2: Right, So on, get real. We talk a lot about
32:49
Speaker 2: early detection. Men are typically resistant to that, especially going
32:54
Speaker 2: to the doctor. As your podcast changing that, what are
32:57
Speaker 2: other things you're doing to change the mind set of
33:00
Speaker 2: men relative to early detection and get into the doctor.
33:04
Speaker 3: I'm not a huge fan of the effect of social
33:07
Speaker 3: media and our culture and young people, but I think
33:11
Speaker 3: it's been great for awareness so I'm excited to see
33:15
Speaker 3: men commit because I have got insurance. My insurance covers
33:20
Speaker 3: fertility preservation, fertility testing, and so that I mean, I'm
33:25
Speaker 3: work at the highest levels. I was the architect, along
33:28
Speaker 3: with my staff Jennifer Harris and the progeny folks Janet Choi,
33:33
Speaker 3: of the first national insurance policy for men's sexual health
33:39
Speaker 3: for men's fertility. I mean, that's another bucket list item
33:41
Speaker 3: for me. And so those kinds of things. If it's
33:44
Speaker 3: accessible and affordable, people will do it right. You're more
33:48
Speaker 3: likely to do it if it's there's awareness going on
33:50
Speaker 3: socially with social media with these young people and sperm
33:53
Speaker 3: racing and things like that, and then they'll get aware
33:55
Speaker 3: and they'll look covered and that's the start of it all.
33:58
Speaker 3: It really is all grassroots, I think. But I'm working
34:00
Speaker 3: at every level I can. I want to office some
34:02
Speaker 3: mental health. I want to come from the top. That's
34:05
Speaker 3: what it's going to take, because it's been ignored forever.
34:07
Speaker 3: And I'm really pleased where it's come from thirty years
34:12
Speaker 3: ago when I first entered the field, and it's been
34:14
Speaker 3: a lot.
34:14
Speaker 2: Feel the new administrations more open to it, this concept
34:18
Speaker 2: or not.
34:18
Speaker 3: There's some talk about IVF being more covered and things
34:22
Speaker 3: like that. So you know, I've always I have a
34:24
Speaker 3: love hate relationship with IVF because they're corporatized now feature
34:30
Speaker 3: fertilization programs largely corporatize venture back and so they will
34:35
Speaker 3: do IVF on anyone with a sperm count. That's unfortunate
34:38
Speaker 3: because there's a man attached that sperm count and that
34:41
Speaker 3: is not his story. There's other things going on, right,
34:44
Speaker 3: so that ignores the biomark concept. But on the other hand,
34:47
Speaker 3: when IVF is more accessible, more men will get semen analyses,
34:51
Speaker 3: so that's good. And then if they get seaman Elys's
34:53
Speaker 3: the partner, he may even say, let's figure out what's
34:56
Speaker 3: going on before they go to IVF. So it's a
34:59
Speaker 3: love hate I think it's all good because we're raising
35:01
Speaker 3: a wars like we've never done before, and that's going
35:04
Speaker 3: to help men live longer.
35:04
Speaker 2: So you talked about diet, exercise, treating your body like
35:08
Speaker 2: a temple. Are there supplements that can help and vitamins
35:12
Speaker 2: and you know that's such a big thing these days.
35:15
Speaker 3: I would say that fifty percent of mail infertility is
35:19
Speaker 3: oxidative stress. That's what we think oxidative stress is oxidants
35:24
Speaker 3: and antioxidants are a way to go. So think of
35:27
Speaker 3: sperm as you've got a nuclear payload and it's a
35:31
Speaker 3: mid engine, and right behind it is the engine for
35:33
Speaker 3: the tail, which is all mitochondria and it's hot and
35:36
Speaker 3: it's baking, and it's right next to the delicate nuclear payload.
35:39
Speaker 3: So it's all oxidative stress balanced redox stuff and antox
35:44
Speaker 3: and supplements have always been a good idea. I have
35:46
Speaker 3: strong opinions about this. I do have a supplement on
35:48
Speaker 3: the market called alphaspern dot com and it is heavily
35:52
Speaker 3: naturally sourced and the excipients and fillers as well as
35:55
Speaker 3: the ingredients. We just finished a study which I can't
35:58
Speaker 3: talk about, but it's very promising that when men take
36:03
Speaker 3: it for nine months, it massively alters the health of
36:05
Speaker 3: the sperm. And that's nearly never been shown. When you
36:08
Speaker 3: look at studies of semen analysis data with men taking
36:12
Speaker 3: prenatal supplements like this other ones in the past, you
36:16
Speaker 3: see mixed data. You see no change whatever. If you
36:20
Speaker 3: look at fertility and not the seam analysis in men
36:23
Speaker 3: taking supplements. The Cochrane reviews are the best data we
36:27
Speaker 3: have which are summarizing all data, and there's four of
36:30
Speaker 3: them out there over ten years. And each time they
36:32
Speaker 3: said an IVF setting says it helped fertility, the answer
36:36
Speaker 3: was it in previous pregnancy rates and decreases miscarriage rates.
36:39
Speaker 3: Every time they did it, they said it can't be true,
36:41
Speaker 3: so they do it again, it can't and then they
36:43
Speaker 3: finally went from you know, high levels to still benefit
36:46
Speaker 3: but not as much. And that's what happens things regrets
36:48
Speaker 3: to the mean as you build numbers. But they're talking
36:51
Speaker 3: about ten thousand men and sixty studies they're still seeing
36:54
Speaker 3: benefit for fertility, and the latest one actually saw a
36:58
Speaker 3: live birth rate benefit which is a third. So how
37:01
Speaker 3: does something that does not change your seamaur analysis improve
37:05
Speaker 3: your fertility potentially? And that's what our study was based on.
37:08
Speaker 3: We looked at epigenetics, which is a deeper dive, and
37:11
Speaker 3: we found there's a there there with epigenetics. So the
37:15
Speaker 3: secret may not be the seam analysis. It may be
37:18
Speaker 3: a quality play. And so my opinion is, if you
37:22
Speaker 3: eat a perfect diet paleo Mediterranean, go back three hundred
37:25
Speaker 3: and thirty three generations, you go paleo, go back thirty three.
37:28
Speaker 3: You go to Mediterranean, you probably don't need anything.
37:30
Speaker 2: So listen. We go off topic a little bit, because
37:33
Speaker 2: God knows, we learned a lot today. But two questions
37:36
Speaker 2: I ask every guest before we take off, what's your
37:39
Speaker 2: dream vacation? And is there a vacation that's better for
37:43
Speaker 2: sperm count?
37:45
Speaker 3: My dream vacation as a surfer is probably Indo. Not
37:51
Speaker 3: go to Indo and maybe hang out there, eat great
37:53
Speaker 3: food on an island, and just catch the waves twice
37:56
Speaker 3: a day. But I would say parts of California you're
37:58
Speaker 3: pretty good too, but it's a little testy on the waves.
38:00
Speaker 3: But somewhere like the Endless Summer. You know, I surfed
38:04
Speaker 3: in Africa, and I give lectures as a professor. I'd
38:06
Speaker 3: only take lectures where I could go surfing or see
38:08
Speaker 3: great architecture. So my favorite place is Constantinople issemble, but
38:13
Speaker 3: you know, South Africa was incredible, Costa Rica was incredible,
38:17
Speaker 3: and so there are places. But the dream is a
38:19
Speaker 3: place where it no one's serfed and you catch it
38:22
Speaker 3: and that's happened a couple of times. Panama and stuff.
38:24
Speaker 3: And the safest vacation for men is probably athletic. I
38:27
Speaker 3: think Grappa, tasting all day and then having a telling
38:31
Speaker 3: you know at night and just eating and drinking is
38:33
Speaker 3: probably not healthy.
38:34
Speaker 2: For you, none as good. So you're gonna be sent
38:37
Speaker 2: to a desert island. What's the album you'd take with you?
38:41
Speaker 3: You know, I've getten into Steely Dan again.
38:44
Speaker 2: Oh wow, I haven't heard that. And I love Steely Dan,
38:48
Speaker 2: I know, I.
38:48
Speaker 3: Just and it's just because you grew up with it.
38:50
Speaker 3: And they if you listen to lyrics, they make no sense.
38:53
Speaker 3: They were high the whole time, a beautiful and I
38:57
Speaker 3: have to say I listened to it, didn't like it
38:59
Speaker 3: great as a kid. But I've been in jazz a lot.
39:01
Speaker 3: I'm just really in the classic jazz. Every operation I do,
39:04
Speaker 3: I'm in jazz. My kids, no jazz. Every carved in
39:07
Speaker 3: the car, it's always jazz. It's always classical stuff. And
39:10
Speaker 3: like Brian Meldow's Blackbird just blows me away. I would
39:13
Speaker 3: think someone like Gregor Reporter's baritone voice is the best
39:16
Speaker 3: I've ever heard. It just brings you into the world.
39:19
Speaker 3: So I've listened to twenty years of jazz. You go
39:21
Speaker 3: back to Steely Dan and the instrumentals, and they're gorgeous.
39:25
Speaker 2: Yeah, they're gorgeous. I agree. That would be a big contender,
39:29
Speaker 2: I know for me, And it's always makes the party
39:32
Speaker 2: a little bit different when you put it on. Yeah
39:35
Speaker 2: for sure. Well thanks doctor Turk. This was just awesome.
39:40
Speaker 2: I need to be thank you, Jail. It's easy to
39:42
Speaker 2: talk to you since you've got your own show.
39:44
Speaker 3: It's Talk with Turk and it's monthly and where it's fun.
39:47
Speaker 3: We're going deep on men. We're just like no hole spark.
39:51
Speaker 2: Any big highlights recently? What stood out to you on
39:54
Speaker 2: the show recently?
39:56
Speaker 3: Oh, let's see, we've had an infertile couple talk about
39:58
Speaker 3: their trail and I would say Neil Shaw running seventeen
40:03
Speaker 3: million lives of insurance saying, is the Seman analysis the
40:08
Speaker 3: new pap smear? Yeah, maybe it is. Maybe we need
40:11
Speaker 3: a pap smear for men.
40:12
Speaker 2: All right, I think we got to leave it there. Well,
40:14
Speaker 2: let's drop the mic, all right, Kate.
40:18
Speaker 1: I also listened to that Neil Shaw episode. I think
40:21
Speaker 1: that was on an earlier draft of our questions. Actually,
40:24
Speaker 1: thank you, doctor t that was amazing.
40:26
Speaker 2: I think that went well. Yeah, sometimes I ask one
40:28
Speaker 2: question at the end, and I do have one.
40:30
Speaker 1: If you have a minute, Jim asked when he was
40:33
Speaker 1: asking about having children as a man later in life,
40:35
Speaker 1: you asked about taking HRT and doctor T you quickly said,
40:39
Speaker 1: it is not a good idea for someone in their
40:41
Speaker 1: seventies to take testosterone for fertility for fertility. So my
40:45
Speaker 1: question is, I feel like I'm thirty six, and so
40:48
Speaker 1: all of my cohort is having kids right now or
40:51
Speaker 1: thinking about having kids.
40:52
Speaker 3: And so many men and women I know.
40:54
Speaker 1: Who are seeing doctors are being prescribed or talking to
40:57
Speaker 1: their doctor about taking HRT. And I'm finding myself in
41:01
Speaker 1: conversation a lot where is this a fad or is
41:04
Speaker 1: this something that's necessary? And I would be curious as
41:09
Speaker 1: to what your take is.
41:10
Speaker 3: Are you talking about women or men?
41:12
Speaker 1: Women and men? Actually I had just this weekend spoke
41:15
Speaker 1: to one woman who was taking a testosterone cream and
41:17
Speaker 1: a man who is going to start taking testosterone two
41:21
Speaker 1: at thirty four and thirty six.
41:22
Speaker 3: The male end of things is not new, Okay, the
41:25
Speaker 3: women and the things with the sauso, it's very new,
41:28
Speaker 3: and a lot of it's for sex drive and things
41:30
Speaker 3: like that. So that's kind of recent data. I know,
41:33
Speaker 3: the big data, which is the women's health initiative. Replacing
41:36
Speaker 3: women after metapause got early benefit but late risk breast cancers,
41:41
Speaker 3: uterine cancer, strokes, I mean clots. There's no men's health initiative,
41:46
Speaker 3: but it looks like men got a lot of benefit.
41:49
Speaker 3: And then that's a whole episode. And then the traverse
41:52
Speaker 3: trial just came out because the FDA said to pharma
41:56
Speaker 3: because it's exploding in men, because it's so many forms
41:58
Speaker 3: and stuff, saying listen and you guys, we need a
42:01
Speaker 3: study to show risk here because you're all showing benefit.
42:04
Speaker 3: But you need to spend a billion dollars and do
42:06
Speaker 3: a randomized trial and show the risk for cardiac risk
42:09
Speaker 3: cholesterol in men who replace. And it came out really negative. Really,
42:14
Speaker 3: so it's really safe. Yeah, amazing.
42:16
Speaker 1: So are you prescribing testosterone or estrogen even depending on
42:19
Speaker 1: if people are low or high or.
42:21
Speaker 3: The men you work with, I don't do any estrogen
42:23
Speaker 3: for them now they don't want that, but yeah, I'll
42:25
Speaker 3: do it all day.
42:26
Speaker 1: It's always positive, it's always effect.
42:28
Speaker 3: Very low risk.
42:29
Speaker 2: Yeah, but you didn't start there with when we talked
42:31
Speaker 2: about it, you went clomid first.
42:34
Speaker 3: Right, depends on what the problem is. Young stressed men
42:37
Speaker 3: who want to high testosterone, you give them esostero. The
42:40
Speaker 3: gud infertile, so you give them clonid because it's usually
42:43
Speaker 3: due to stress, and you can counteract that with bills
42:45
Speaker 3: called SERMs or ACG so you can get around it.
42:48
Speaker 3: It's called treating the young type of gunnadom mail. It's
42:50
Speaker 3: a couple of blogs on it, given national lectures, but
42:53
Speaker 3: that's not popular because then the chronologists don't prescribe things
42:57
Speaker 3: that are not FDA approved, But fertility doctors we do
43:00
Speaker 3: this and we've done it for fifty years, so it's
43:01
Speaker 3: a natural for us. But women are different. So that's
43:04
Speaker 3: the other big issues. Like women with low libido have
43:07
Speaker 3: an FT approof pill. Men will never have that, fascinating
43:11
Speaker 3: because that's a rape drug. You'll never see it. No
43:14
Speaker 3: one's gonna put that in the market. I couldn't do it.
43:16
Speaker 3: I couldn't help myself.
43:18
Speaker 1: Blame it on the drug. Fascinating.
43:20
Speaker 2: Okay, that's another episode episode.
43:23
Speaker 3: Let's do it a year.
43:24
Speaker 2: Letus all right, Well, thanks, let this doctor go treat
43:28
Speaker 2: his patience. Thank you doctor, But that was great. Hey everyone,
43:34
Speaker 2: thanks for joining me on the Get Real podcast. You know,
43:36
Speaker 2: I hope you feel a little healthier hanging out with me.
43:40
Speaker 2: You know it's going to be a lot of fun.
43:42
Speaker 2: Passing this along to others. Please subscribe below, Please share.
43:46
Speaker 2: I'm excited not just to talk about healthcare, but a
43:50
Speaker 2: lot of other fun topics. It's about making healthy talk
43:54
Speaker 2: about healthcare. It is not a lecture. This is supposed
43:57
Speaker 2: to be fun and look forward to spend more time
44:00
Speaker 2: with you in the future.