The Male Fertility Doctor: Delaying Having Kids Is Impacting Your Future Kids! Dr Michael Eisenberg

1. 0:00 – 2:02

   Intro

   1. MEDr Michael Eisenberg0:00

      Men need to understand the average age of the father has gone up about three and a half years. And with that, the chance of problems with the child also can increase and that pregnancy becomes a lot riskier. And this is why.

   2. NANarrator0:11

      Dr. Michael Eisenberg is an expert in male sexual function and fertility who's helping us to learn the truth about optimal sexual health.

   3. MEDr Michael Eisenberg0:20

      If you just look at all the data, sperm counts are declining. But low sperm counts and low testosterone could have devastating effects. For example, men with lower semen quality have higher risk of death.

   4. SBSteven Bartlett0:30

      Wow.

   5. MEDr Michael Eisenberg0:30

      And there's a lot of really interesting questions that need to be answered.

   6. SBSteven Bartlett0:33

      Okay, let's get into that. Is there any evidence that the chemicals in our environment are impacting our sperm count and our testosterone levels?

   7. MEDr Michael Eisenberg0:39

      Yes. It's a chemical that's in a lot of creams and lotions that we use, and then there's a chemical that's used in the manufacture of plastic, and that can have pretty devastating effects. And so don't drink out of plastic water bottles.

   8. SBSteven Bartlett0:50

      What about hair loss? I couldn't figure out if low testosterone or high testosterone causes a receding hairline.

   9. MEDr Michael Eisenberg0:55

      Most men are not gonna like this, but it turns out that...

   10. SBSteven Bartlett0:58

       If I'm sat down all day, is that gonna have an impact on my sperm count?

   11. MEDr Michael Eisenberg1:01

       There are studies that do support that. I would say take breaks, stand up to try and air out the area.

   12. SBSteven Bartlett1:05

       What can I do to give myself the best possible chance of increasing my fertility?

   13. MEDr Michael Eisenberg1:10

       So there's a lot that we can do, and usually we start with...

   14. SBSteven Bartlett1:13

       And then erectile dysfunction.

   15. MEDr Michael Eisenberg1:14

       Hundreds of millions of men all over the world have trouble with erections. But as long as you have a penis, we can always make it hard. For example, we can teach men to give themselves...

   16. SBSteven Bartlett1:23

       Ooh, I just got a shiver down my body.

   17. MEDr Michael Eisenberg1:25

       But it probably works 80% to 90% of the time.

   18. SBSteven Bartlett1:29

       Congratulations, Diary of a CEO gang. We've made some progress. 63% of you that listen to this podcast regularly don't subscribe, which is down from 69%. Our goal is 50%. So if you've ever liked any of the videos we've posted, if you like this channel, can you do me a quick favor and hit the subscribe button? It helps this channel more than you know. And the bigger the channel gets, as you've seen, the bigger the guests get. Thank you, and enjoy this episode.

2. 2:02 – 2:58

   Why do you do what you do?

   1. SBSteven Bartlett2:02

      Dr. Michael Eisenberg, why do you do what you do, and what you do?

   2. MEDr Michael Eisenberg2:08

      It's a pleasure to be here. Certainly an honor. Um, I kind of see myself as a researcher and advocate for men's health and men's reproductive health, sexual health. And so, you know, I think when I see patients in clinic, that's what I'm trying to do to try and understand where they're coming from, any issues they have, and find out ways that we can, you know, work and improve them together. And certainly from my research perspective, I always wanna, you know, try and define what the issues are, um, and just improve our treatments that we have for men. I am the director of male reproductive and sexual health at Stanford, or men's health, uh, in the Department of Urology. Um, I have a joint appointment in the Department of Obstetrics and Gynecology because fertility is a team sport.

   3. SBSteven Bartlett2:47

      Mm.

   4. MEDr Michael Eisenberg2:47

      And so I also help, you know, couples, and I refer women to the female side, and just like I, you know, get lots of referrals from them, you know, when we're kind of worried about the male partner.

   5. SBSteven Bartlett2:57

      When you

3. 2:58 – 4:27

   What does reproductive health encapsulate?

   1. SBSteven Bartlett2:58

      say sort of reproductive health, what, what are all the sort of things that fall within that bucket or underneath that umbrella?

   2. MEDr Michael Eisenberg3:05

      So I think, you know, reproductive health really, I mean, I guess as its sort of name implies would be, you know, trying to have a baby. Um, but I think it's so much more than that because I think what we're really learning is that, you know, fertility is kind of a window into future health. Probably about 10% of the male genome is devoted to reproduction. Um, and given there's only about 25,000 genes in the body, you know, it makes sense that some genes that are operating in reproduction also operate in another organ system. There was a study done where they took biopsies of men that had trouble making sperm and tried to sort of replicate these cells, and they found that these cells had very high rates of mutations in their DNA. So you can imagine, you know, sort of for checks and balances when we're making sperm, it makes sense if you can't sort of faithfully replicate your DNA. You know, there's probably not, there's probably gonna be some blocks where you can't make a sperm, right, if there's gonna be mutations. But also these men may be set up for other problems, right, like cancers or something like that if, you know, the body can't, you know, effectively replicate cells or DNA. There could also be sort of hormonal links, and that's another thing that we commonly look at when we're evaluating men, uh, with infertility. Um, infertile men actually have lower testosterone levels than fertile men. So, you know, there's also been studies to show that men with lower testosterone levels have, you know, sort of lower survival. So it may be that, you know, kind of hormonal links between fertility may kind of put men on a different, you know, trajectory. You know, another, I think very sort of important

4. 4:27 – 6:14

   Fertility health is growing

   1. MEDr Michael Eisenberg4:27

      aspect of reproduction, you know, there's other kind of what I call sort of social factors that are sort of at play. Um, you know, things that kind of necessarily go with reproduction, so like having a partner, um, and having kids, hopefully. And it turns out that those factors actually are very important for health and longevity. So, um, like having a partner actually increases survival. So if you, like, compare sort of if you have like a, you know, a man with a partner and a child. If you then take away the partner, the chance of that man dying goes up 60%. And then if you take away just the child, the chance of him dying goes up 60%. But it turns out if they're, both of those things are absent, the man has a threefold higher risk of death than somebody with a partner and a child. So there's really kind of this sort of important aspect, I think, to health and reproduction I think that men kind of need to understand. And then also, obviously there's also just a lot of, you know, kind of, um, intrinsic things that we do, like lifestyle behavior, obesity, smoking. Those are all very important, um, for health as well. Um, so I think, you know, when I see these men for reproduction, I really try and broaden it a little bit to overall health because I think there's certainly data that, you know, as we improve a man's health, we'll improve their reproduction. Um, and hopefully give them a baby, but also, you know, improve their overall, you know, survival, health, everything.

   2. SBSteven Bartlett5:50

      So how many patients have you seen in your career? If you had to hazard a guess, roughly.

   3. MEDr Michael Eisenberg5:57

      Oh, I mean, I think it would probably be in tens of thousands, I would guess, maybe.... 20,000, 30,000.

   4. SBSteven Bartlett6:04

      And how many years have you been working on this subject of sort of male health, fertility, uh, reproductive health, all these kind of ...

   5. MEDr Michael Eisenberg6:11

      About probably 10 to 15 years.

   6. SBSteven Bartlett6:13

      It

5. 6:14 – 6:46

   Researching on fertility issues

   1. SBSteven Bartlett6:14

      feels like the world has kind of turned towards your work more so in the last couple of years than ever before. It feels like you- you just so happen to be doing research and educating people on a space that quite suddenly, relatively suddenly, has become really important to people. And I was even looking at some of the data around sort of testosterone, uh, replacement therapies and how that's just absolutely skyrocketed in recent times, and also the conversation around fertility. I was looking at the data around fertility, how many people are searching out for information

6. 6:46 – 7:18

   Why are we seeing more infertility?

   1. SBSteven Bartlett6:46

      on it, and it's skyrocketed over the last sort of five years. And even in my c- circle of friends, we weren't talking about fertility or testosterone or sperm count even two years ago.

   2. MEDr Michael Eisenberg6:57

      Mm-hmm.

   3. SBSteven Bartlett6:57

      Whereas this year, and in the last sort of 12 months, it's been a frequent topic of conversation. Why is this, and is my assessment there accurate and can it- that be supported with what you're seeing?

   4. MEDr Michael Eisenberg7:09

      I mean, I think so. I, you know, obviously, I guess I would say I'm biased in that I think this is, um, you know, very interesting, and I think, you know, there is a lot of momentum towards this. You know, there have

7. 7:18 – 11:14

   Are you concerned about society's fertility issues?

   1. MEDr Michael Eisenberg7:18

      been a lot of landmark studies suggesting, like you say, declines in testosterone over time, uh, declines in sperm count over time, and we can certainly talk about that, um, a little bit more. And I think with that, you know, um, there's been really an explosion in assisted reproductive technologies. You know, I'm familiar, you know, in the United States, how that's happening. You know, a few years ago, it was, you know, maybe about half percent of all births in the I- in the US were conceived with IVF. Now it's about 2% and only increasing. You know, it used to be that insurance never covered it. Now insurance commonly covers it. And so with that, there's just really been an explosion in the offerings, the number of cycles that are done. You know, in- in my particular area in Northern California, you know, it seems like every year, a new IVF clinic, um, is opening up, and you're always worried and wondering, how could there be enough business to support it? But instantly, you know, all the patients, you know, all the slots are filled, they're booked out for six months, and I think there's just tremendous amount of demand. And I think that, you know, I- I think to your point, you know, the question really is why. You know, is- is fertility declining? Are more couples becoming reliant on IVF? Um, and I think, you know, again, are sperm counts declining? I think all those things are probably kind of going together, um, that's leading to this, and I think it's- you know, it's something that we're doing to ourselves potentially. Is there some environmental exposure? I think all these things are, you know, really interesting questions that- that need to be answered.

   2. SBSteven Bartlett8:40

      So let's start with why then. If we stay zoomed out a little bit-

   3. MEDr Michael Eisenberg8:43

      Mm-hmm.

   4. SBSteven Bartlett8:43

      ... on some of the social factors that might be leading to, um, infertility issues, but also just correlated issues like things like testosterone and all of these things, what are some of the broader social factors that are causing IVF clinics to become so in demand now?

   5. MEDr Michael Eisenberg8:59

      Yeah, I mean, I think one of the big ones would just be, uh, rising parental age. Um, you know, uh, there's been sort of less data, I think, on male age over time, at least here in the United States, but, um, you know, a few years ago, there was a study done where it showed that over the last maybe 30, 40 years, the average age of the father has gone up about three and a half years. Um, it used to be, like in the '70s, you know, the- an older father, and that would be considered over 40, was maybe about 4% of births. Now it's probably 9, 10% of births. So I think there's just more delay, and with that, um, you know, infertility gets higher. There's usually a close correlation between, you know, a mother's age and a father's age, and so, you know, I think a lot of people are sort of familiar as women get older, um, you know, fertility goes down probably at a steeper rate, but for men, the same thing happens. You know, sperm counts get a little lower. Testosterone gets a little lower. It takes a little longer to conceive. You know, the chance of problems with the chil- the child also can increase. I mean, the oldest father ever is 96, so the biologic potential does persist, um, but it certainly gets a little bit more difficult in that pregnancy becomes a lot riskier.

   6. SBSteven Bartlett10:09

      What is the rate of decline in men and women, um, in terms of fertility?

   7. MEDr Michael Eisenberg10:13

      So I think, you know, if you're- I guess you're looking from an evolutionary standpoint, you know, peak fertility would probably be late teens, early 20s, something like that. And so for women, you know, they're born with a set number of eggs, and so as soon as, you know, the cycles start, they continue to lose them over time, and so usually we think about, you know, over 30, 35, 40. You know, those are pretty big points where fertility gets a little bit more challenging. For men, you know, we- the- the sperm counts do decline. You know, why this sort of cutoff where we say older father is 40 is sort of a consolation of sort of different risks. You know, the sperm counts get a little bit lower, but the other thing that happens is every year, um, you know, we're born with sort of sperm precursors or sperm stem cells in our body, and they are constantly replicated every year. And every time that happens, there's some chance of a mutation occurring. So it turns out that, you know, every year, we probably accumulate sort of two mutations in our DNA, and so over time, you know, that becomes a little riskier. So for, like a 40-year-old is gonna have 20 more mutations than a

8. 11:14 – 13:50

   What chemicals are reducing our sperm count?

   1. MEDr Michael Eisenberg11:14

      30-year-old, for example. So we have, you know, billions of base pairs of DNA in our bodies, so the chance of, you know, 20, you know, mutations making a difference is probably pretty low, um, but, you know, that's at an individual level. At a population level, that's something that you may start to see. And so for men, I think it is just sort of a slow, steady decline, you know, again, probably in the 30s, 40s.

   2. SBSteven Bartlett11:35

      Do you have the data on the oldest ever mother, i.e. the oldest ever woman to conceive a child?

   3. MEDr Michael Eisenberg11:41

      So with, uh, using like a donor egg, I think it's 60s or even- even in the 70s I think it's been described before, but I think with her own egg, I think it's late 50s, early 60s.

   4. SBSteven Bartlett11:54

      Are you concerned about this as a macro trend? Because if we play this forward, it would lead us to assume that fert- fertility is going to be an increasing problem for society.

   5. MEDr Michael Eisenberg12:04

      Yeah, I mean, I think very much so, right? It's existential. I mean, you know, as a disclaimer, obviously I'm in the fertility business, so (laughs) um, you know, I do certainly care about this trend and want to make sure that we reverse it. It's a risk factor that we know about, but I think, you know, the, the solution is not obvious, right? Because asking couples to delay careers, education, all that is very challenging. You know, I think some countries have tried to come up with, you know, ways to support, you know, parenthood, you know, through leave or, you know, other kind of programs like that. Childcare also becomes, uh, you know, very important. Um, but even with those, I think that, um, there's just sort of a perception. It's just, it's not as easy as you'd think, and it turns out actually that, you know, the return on investment for some of these things, you know, having a child is so kind of important for the health of a society, right? There's some, there's this concept called replacement rate. That's the number of children that need to be born to a reproductive-age woman to maintain a population's level. Sort of, this is kind of ignoring immigration. So it turns out you need about 2.1 children per reproductive-age woman for a population level to stay the same. So if, and in some societies, it's lower, like in, uh, the US it's a little lower than that, in some, um, like Asian countries like Korea and Ja- Japan, it's lower than that. And that's really existential because if, you know, if your working population starts to decline, um, you know, tax base, everything, you know, will really collapse. And so from an economic standpoint, it makes sense if these are couples that want to have kids and they, you know, these are wanted children, you know, to try and invest in, you know, allowing them to do that really makes sense because, you know, it'll, it'll kind of pay it back at a soc- at a societal level.

   6. SBSteven Bartlett13:49

      I read

9. 13:50 – 14:59

   Society measures

   1. SBSteven Bartlett13:50

      about in Hungary that if you have four or more babies, then you'll pay no income tax for the rest of your life, according to the Prime Minister. It's an article that I'd seen, and I think this is, speaks to a broader trend of how there's gonna be a top-down approach towards getting us to be, get back to having babies to stop the population collapse and decline that you talked about. Um, Hungary's Prime Minister has announced a raft of measures aimed at boosting the country's declining birthrate and reducing immigration, and one of them is that essentially you'll get, be given a check and you only have to pay that check back if you don't have four kids. So for every kid you have-

   2. MEDr Michael Eisenberg14:26

      Mm-hmm.

   3. SBSteven Bartlett14:26

      ... 25% of the money that you're given is discounted, and once you get to four kids, you never have to pay income tax again, which I thought was a really interesting idea, but it's a sign of things to come.

   4. MEDr Michael Eisenberg14:36

      Yeah. Yeah, I mean, it's fascinating, right? I mean, I think that these, you know, the economic ministers, prime ministers are really thinking about things. I'm sure they've looked at the numbers, right? And realized that, um, you know, society really relies on, you know, maintaining numbers and when, when, you know, when the population starts to slip it could be a problem. I mean, I think that's, that's a very clever solution.

10. 14:59 – 20:37

    Sperm quality

    1. SBSteven Bartlett14:59

       Sperm quality. Sperm quality, I read, is declining.

    2. MEDr Michael Eisenberg15:05

       Yeah, so that's a very... It's interesting 'cause that's such a controversial statement. Uh, you know, I think there is a tremendous amount of data that supports that. A number of years ago, I was actually involved in a study looking at data from a sperm bank here in the United States. Um, it was a sperm bank that was in, uh, the Northeastern US at a few locations, and it wasn't a lot of data. It was just sort of a few years of data, um, about, like, a little over maybe 10, 15 years, but what, what we found is that actually if you looked at men that were coming in to try and be donors, because, you know, at these banks they're very selective, so you have to have, you know, excellent sperm that freezes well, that thaws well, really high numbers, and, you know, they also look at your pedigree a little, make sure there aren't conditions that run in your family. They like you to be fit. You know, these are kind of things that are thought to, you know, sort of make, make a better donor. Um, and when we looked at sort of the candidates that came in over this, you know, really short period of time, probably 10, 15 years, there was declines in, you know, sperm counts, um, you know, the movement, shape, all these sort of parameters that we look at when we're talking about a semen analysis. And what was interesting is that, you know, when people have talked about declines in sperm count, people have sort of attributed it to different things. For example, people have talked about the obesity epidemic, right? And that maybe we're more sedentary now than we used to be or, you know, environmental exposures are another thing. There's more chemicals now than there used to be, or cell phone prevalence and things like that. But, you know, over this short period of time where we did have, you know, a lot of information on these men, they filled out surveys, um, you know, they filled out kind of rich family histories, they filled out information about whether they drank a lot, smoked a lot, things like that. There was really no differences in these men, you know, from the beginning of the study to the end. The only difference was that their sperm counts were lower. So it was really, you know, kind of surprising. Um, very interesting, and so, you know, other investigators have used studies like that, kind of pooled them all together using kind of advanced statistical techniques and found this decline over time, um, you know, over the last maybe 20, 30, 40, 50 years, um, so there is a preponderance of data that supports that. So the counterargument that others have made is that, you know, over that same period of time, some of our techniques have changed, right? We're better at counting sperm now than we used to be. You know, some of the different, um, you know, tools that we use to measure sperm count, some of the analyzers, uh, are better now than they used to be, so we're a little bit more precise than we used to be. The other, um, you know, thing that these studies have done is when they pool together data, they assume that, you know, everybody's the same. Like, right? If we were both in the study, they would assume that I'm like you or you're like me. But it turns out that there's a lot of variation based on, like, region. So there was a study in the United States where they looked at fathers, so men that had kids, at different regions of the country, you know, like, had some in California, New York, some in the Midwest, and even though these were all fathers, similar ages, the sperm quality was much different. Turned out it was really high in, in New York, I think California was next, and the Midwest was a lot lower. Um, so, you know, again, why... You'd think that, right? New York would be kind of hustle bustle metropolis, maybe they would have some poor risk factors, but turns out they had the best sperm. And so why that is is, you know, wasn't certain, but it just shows us that there's a lot of variation in semen quality from individuals. So when you put things together, sometimes it can be difficult to, you know, to identify trends, so ideally what we do is, you know-... I and my neighbor would give sperm maybe every year, every five years, 10 years over time, and you'd see what changed. Um, and those studies aren't available. So, that's sort of the criticism of these studies. But again, if, if you just look at all the data, if you compare studies from the, you know, '70s, '80s, '90s to today, sperm counts are lower.

    3. SBSteven Bartlett18:39

       What is the current best guess as to why sperm counts are lower?

    4. MEDr Michael Eisenberg18:42

       Yeah. I think that's the million-dollar question because I, you know, we've talked about, this is sort of an excidental- existential threat, right? We need a, you know... I think any species has sort of three main functions, right? Eat, survive, reproduce. You eat to survive, you survive, reproduce, spread your DNA. And so if you can't do that, it's definitely gonna be an issue. So, you know, I think that we've talked about, you know, maybe obesity. I think we're certainly different now than we used to be, in terms of walking around, you know, um, sedentary behavior. People have, you know, hypothesized different chemicals in the environment are kind of leaching into our food supply, our water supply.

    5. SBSteven Bartlett19:15

       Is there any evidence for that, that the chemicals in our environment are impacting our sperm count and our testosterone levels and things like that?

    6. MEDr Michael Eisenberg19:22

       Yeah. There are, there are studies, uh, that do support that. Um, you know, there are certainly, like, pre-clinical studies, you know, where you can actually, you know, dose, like, rats, um, and mice, these. There's also human studies where you can, you know, compare sperm quality to, you know, different sort of chemical traces in the blood and see these correlations as well. And then there's, um, a study called NHANES, which is a, a study by our Centers for Disease Control where every year men and women are sort of surveyed, or they collect data on obesity, blood pressure, things like that. Um, and they do collect data on sort of chemical exposures for these, you know, select group of individuals that kind of represent the whole population. This has been done for the last, you know, many, many decades. And so when we talk about obesity kind of rising in prevalence in the United States, it's been, uh, it's based on that data. This is kind of a rigorously sort of researched, you know, group of individuals that's selected every year. And so those same studies collect data on testosterone or estrogen for women, and they collect it on these different environmental chemicals and do see these correlations. I would say that not every study supports this, but there are certainly a good number that do show that, um, there is this correlation that if you have higher exposure to some of these chemicals, uh, there's higher risk of lower hormone levels.

11. 20:37 – 23:57

    Micro plastics affecting sperm count

    1. MEDr Michael Eisenberg20:37

    2. SBSteven Bartlett20:37

       What are those chemicals and where do we find them? 'Cause I, I, I spoke to someone who was a urologist recently, um, I think from NYU, and they were telling me that things like the microplastics... And I'm not particularly aware of what a microplastic is, to be honest, but things like microplastics in our environment are some of the chemicals that are causing sperm quality to reduce.

    3. MEDr Michael Eisenberg20:58

       Mm-hmm.

    4. SBSteven Bartlett20:59

       Is there evidence to support that?

    5. MEDr Michael Eisenberg21:01

       There's a lot of different chemicals to be sort of concerned about or think about. I think, you know, microplastics for one, phthalates for-

    6. SBSteven Bartlett21:07

       What is a phthalate?

    7. MEDr Michael Eisenberg21:08

       A phthalate is, it's a chemical that's in a lot of, like, um, you know, different, uh, like, creams and lotions that we use. Um, and so those also have been shown to affect androgen, you know, and kind of endocrine function inside the body. Uh, bisphenol A is a, you know, common, uh, chemical that's used in the manufacture of plastic, and that's also been found to have these endocrine-disrupting properties. Um, so that's also been correlated with semen quality.

    8. SBSteven Bartlett21:35

       Endocrine disrupting?

    9. MEDr Michael Eisenberg21:36

       Endocrine disrupting.

    10. SBSteven Bartlett21:37

        What does that mean?

    11. MEDr Michael Eisenberg21:38

        So, you know, if you look at sort of pathways for men and women, there's, you know, hormones, right? I'm making testosterone, and that acts on my body as I was a child to help make me a man. Now it kind of helps, you know, keep me a man, you know, with... Grow a beard, all those sorts of things, giving me my, uh, my deeper voice. Um, and so there's some of these chemicals that kind of mimic some of that action or block some of that action. And so if that happens, um, it can affect, you know, normal development of, you know, boys or girls. You know, maybe it can, you know, again, affect sort of semen quality. If we think about sort of the origins of changes in semen quality, some of it may be when we're adults, but some of it also could be during development, you know, either when we're developing inside of our mothers or, you know, during puberty, if something kind of affects the normal timing of that. It could be, you know, again, could have pretty devastating effects. And so one theory for that is some of these chemicals that affect these sort of biologic pathways, these endocrine pathways involved in that.

    12. SBSteven Bartlett22:35

        From the research you've seen on sort of these chemicals, is there any changes that you've made in your own life at all? Anything that you- it's kind of made you think differently about the choices you make in your own life with your kids? 'Cause you've got three kids, so you have an opportunity to kind of influence them at a, at a earlier stage than most of us can influence ourselves, but...

    13. MEDr Michael Eisenberg22:53

        Yeah. So one thing that we do, um, is I've thrown away all plastic water bottles. I'd, I'd say I still use it because I find them very convenient.

    14. SBSteven Bartlett23:00

        (laughs)

    15. MEDr Michael Eisenberg23:01

        Um, and I'm done with reproduction. But, um, but certainly for the kids, um, I make sure they don't drink out of plastic water bottles. So we have either glass or, um, or metal. I do think there's data that that's, um, you know, a very, you know, large exposure that kids get, and I think it's, you know, fairly easy now to remove that.

    16. SBSteven Bartlett23:20

        What does the data say about plastic bottles?

    17. MEDr Michael Eisenberg23:23

        You know, if you look at, um, you know, exposures from that, you know, they have, they just leach a tremendous amount, you know, with wash, with water. It kind of sits there all day. So I think it's a, it's a very... You know, again, most plastic water bottles, I want the, you know, plastic bottle industry to come after us, but-

    18. SBSteven Bartlett23:39

        (laughs)

    19. MEDr Michael Eisenberg23:40

        ... um, that's a common way for, you know, individuals to get exposed to it. So I think if, again, if we're seeing that's one of the main touch points for plastics, um, is, is usually through our kind of food and water supply, then yeah, I think it's easy to, to get rid of it if you can.

    20. SBSteven Bartlett23:56

        Is there

12. 23:57 – 30:07

    Technology and heat fertility damage

    1. SBSteven Bartlett23:57

       anything else? I, I, I've read recently that heat has a, a role in our sort of sperm quality. So if we're, I don't know, if we're going into saunas or something or if we're spending a lot of time, I don't know, sunbathing, then there's science that suggests that will lower our sperm count?

    2. MEDr Michael Eisenberg24:12

       Yeah. So that is right. So, I mean, I think that, you know, and again, so you can kind of look at this sort of in a bigger sort of global warming kind of context, and people have, you know, theorized that maybe that could also play a role because, you know, the testicles are outside the body 'cause they need to be a few degrees cooler for sperm production to occur. So anything that warms them up can definitely be a problem. Um, so when I, when I talk to patients in clinic, for example, we do talk about sauna use, hot tub use. Some men bathe every day, like in a bath, um, and those all can impact sperm production. There have a- there have been studies that show that men that, you know, use, you know, saunas on a regular basis, they have lower sperm counts and then when you withdraw that exposure, um, sperm counts will go back to normal. One, you know, sort of interesting application of this was to try and use this data or use that knowledge to come up with a contraceptive. So there was this weird sort of, like, truss kind of belt that actually pushed the testicles up into the groin, um, which actually turned out did reduce sperm counts, uh, to zero I think in, again, the, the few men (laughs) that volunteered to do that. Um, but you can imagine, I think most men are not gonna be too excited about that, um, 'cause it's probably pretty uncomfortable. Uh, the other way that I've seen it is I've had patients that have gotten sick, certainly around COVID. That happened not infrequently. Men would come in, you know, telling me that, you know, they just got over a COVID infection that where they had high fevers for, you know, a few weeks. Um, and then their sperm counts would be very low, and then, you know, we wait a few months. It takes about two to three months to make a sperm, so we let one of those cycles or two of those cycles go through and their sperm counts came back. I had a patient even before COVID, uh, that was like a 41-year-old guy. He had normal sperm count and then all of a sudden he measured and his sperm count had gone to zero, and it turns out he had a, a flu with fevers about 102 degrees Fahrenheit, um, the week before. And again, we let kind of just sort of nature take its course. He recovered and then his sperm counts came back to baseline. So we do see that, um, as well.

    3. SBSteven Bartlett26:08

       With that belt that you mentioned that holds the sort of test- testicles closer to the body-

    4. MEDr Michael Eisenberg26:13

       Mm-hmm.

    5. SBSteven Bartlett26:13

       ... I'm guessing it's doing that to heat them up basically-

    6. MEDr Michael Eisenberg26:15

       Yeah.

    7. SBSteven Bartlett26:15

       ... which reduces the sperm count.

    8. MEDr Michael Eisenberg26:17

       Mm-hmm.

    9. SBSteven Bartlett26:18

       Obviously then one would think about their boxer shorts. We're all wearing very tight boxer shorts these days.

    10. MEDr Michael Eisenberg26:22

        Mm-hmm.

    11. SBSteven Bartlett26:22

        That's like in vogue or whatever. So is there any studies to suggest that boxer shorts can reduce sperm count if they're tight?

    12. MEDr Michael Eisenberg26:30

        So that's like a very common, that's one of the most common questions I get, like, uh, boxers versus briefs. And that's been studied a lot, 'cause that is a very common exposure. I think I usually just tell men whatever's comfortable. I think it's unlikely that any single layer is gonna make a big difference, unless again you have the specially designed underwear that pushes testicles up into the groin. But otherwise, as long as they're outside the body, it should be okay.

    13. SBSteven Bartlett26:52

        What about mobile phones and technology? Is there any, um, link between fertility and our use of technology, specifically having these devices in our pockets close to our genitals?

    14. MEDr Michael Eisenberg27:02

        (laughs) That's, you know, another common question that I get. Um, and that is certainly something that's changed, right, now versus, you know, 20, 30 years ago. Uh, so there were some studies that, you know, initially showed kind of this signal that men that used cell phones more had lower sperm count. But some of these studies were, you know, they're older and you also worry about some of these kind of confounding things. It may be that people that use phones more do other things more. You know, they have, may have more stress in their life and other things that could affect semen quality. So there was a clever study th- that was done where they actually took ejaculate, so took sperm, put it in a cup and put a cell phone next to it, and tried to measure changes in, you know, the quality of the sperm, and they actually did find some. They found higher rates of, like, DNA damage within the sperm that was exposed to the, the phone versus not, you know, kind of trying to control for temperature, which we, you know, said is important for the health of the sperm.

    15. SBSteven Bartlett27:52

        Wait, so they controlled for temperature?

    16. MEDr Michael Eisenberg27:53

        They controlled for temperature. And just having kind of the cell phone, you know, getting its signal, um, seemed to affect, you know, the DNA damage in sperm. It wasn't, you know, a... It was a statistically significant, you know, difference. Um, it maybe would not be kind of a point where we would get as worried clinically, but it is a change, so I think it's something to think about. I think that, um, you know, aside from that, e- cell phones I think nowadays don't get too hot, so not as worried about heat, but whether this RF, you know, this radio frequency exposure may impact things is a, you know, maybe a theoretical risk. But again, there's not a lot of concrete data. So I think that, you know, again if... So a lot of my patients do tell me that they keep their, try and keep their cell phone in their back pocket or front pocket to try and avoid that. I think that's, I think that's fine.

    17. SBSteven Bartlett28:40

        I've been having this conversation with my partner a lot. She really believes that my cell phone should never be slid under my genitals, which I sometimes do. (laughs)

    18. MEDr Michael Eisenberg28:48

        (laughs)

    19. SBSteven Bartlett28:48

        When I'm like, I don't know, when I'm in the car or something or when I'm o- o- on the sofa, I don't know, when I've got my hands full-

    20. MEDr Michael Eisenberg28:53

        Mm-hmm.

    21. SBSteven Bartlett28:53

        ... I'll just grab it and I'll kind of like slide it between my legs.

    22. MEDr Michael Eisenberg28:56

        Yeah.

    23. SBSteven Bartlett28:56

        And she'll reach in and pull it out and say, and I think 'cause she's concerned about those four kids that we wanna have.

    24. MEDr Michael Eisenberg29:03

        (laughs)

    25. SBSteven Bartlett29:03

        So-

    26. MEDr Michael Eisenberg29:03

        And you. I think she cares about you too.

    27. SBSteven Bartlett29:04

        Yeah, and I, to be fair, uh, she's not someone that's gonna read PubMed and read about the studies-

    28. MEDr Michael Eisenberg29:10

        Mm-hmm.

    29. SBSteven Bartlett29:10

        ... but it's just a feeling she has.

    30. MEDr Michael Eisenberg29:11

        Yeah.
13. 30:07 – 32:41

    Countries with biggest fertility problems

    1. SBSteven Bartlett30:07

       wouldn't we see a sort of big difference between hot countries and cold countries, or sort of warm countries and sperm counts then? So if I'm in sort of sub-Saharan Africa-

    2. MEDr Michael Eisenberg30:15

       Mm-hmm.

    3. SBSteven Bartlett30:16

       I'm assuming my sperm count will be pretty low 'cause I'm gonna be sweating all day.

    4. MEDr Michael Eisenberg30:19

       So, I think that, um, the other sort of element to that, though, is that there are differences in populations, and I think that that has not been well-described, you know. But if you compare, you know, again, we talked about California and New York, the Midwest in the United States, but people have also compared, you know, like Denmark, which they have a lot of sort of problems with reproduction, so they've really studied it very, very aggressively. And if you compare them to other countries nearby or other countries in Europe, it's much different. And so, you know, uh, one possibility could be exposures, you know, and what these men are doing, what they're exposed to, but the other could be, you know, again, there could be some genetic components. But one interesting thing about sort of on that same line is that s- uh, sperm quality does vary based on, uh, time of year. So, during the hotter months it does go down a little bit. You know, not meaningfully. Um, and then during the cooler months it, it goes up a little bit. But the other thing is that, you know, we don't spend, uh, well, some of us do, I guess, or some of us don't, but don't spend all your time outdoors, right? And sometimes in the, um, you know, during the, the cooler months you're, you know, kind of bundled up inside, and during the warmer months you're maybe in, you know, cool air conditioning.

    5. SBSteven Bartlett31:27

       Did you say that there's, Denmark has had a problem with sperm count?

    6. MEDr Michael Eisenberg31:30

       Yes. Yeah. So, um, you know, in the United States I said that about 2% of births are conceived with IVF. In Denmark, it's about 10%.

    7. SBSteven Bartlett31:38

       Wow.

    8. MEDr Michael Eisenberg31:39

       Um, and it's actually, they, they've, again, they have really a crisis of reproduction there, so they've really, um, done some really good research on semen quality and it's estimated that only about 25% of Danish men have normal semen quality.

    9. SBSteven Bartlett31:53

       Have they figured out why?

    10. MEDr Michael Eisenberg31:55

        That's what they're looking into. And they have lots of theories. And again, I think, you know, again, it goes to many of these same topics that we talked about, whether it's environmental exposures on, you know, the mothers, um, or, you know, again, pubertal boys or, you know, adults as well. So, they are trying to figure it out, but it is, you know, it's also one of the countries where the fertility rate is a l- is below replacement, so it's definitely a- a- a- an issue.

    11. SBSteven Bartlett32:18

        One would assume that it's some kind of environmental factor. I guess it could be some other social factor, but, but one would assume that it's, uh, some kind of environmental-

    12. MEDr Michael Eisenberg32:25

        Yeah.

    13. SBSteven Bartlett32:25

        ... factor.

    14. MEDr Michael Eisenberg32:26

        Yeah. Some people have postulated during World War II, they were very isolated, and so potentially there were some chemical exposures that have just, you know, kind of persisted, uh, and remained in the population, and it's kinda tough to work through that, but it's not known.

14. 32:41 – 33:53

    Does sitting for long periods affect our sperm count?

    1. SBSteven Bartlett32:41

       If I'm sat down all day, is that gonna have an impact on my sperm count as well because of the heat generated from me just sitting here? Um, and/or if I'm a cy- if I'm a cyclist or someone that's doing, you know, sat down on my testicles doing something warm.

    2. MEDr Michael Eisenberg32:56

       People have looked at sort of different occupations where you sit a lot, um, and there are associations, like drivers, you know, taxi drivers, truck drivers. They certainly can have changes in sperm count, you know, probably due to heat. You know, again, I think it could be a combination of sort of sitting all day is also, you know, from a probably other health standpoints is not great. And cycling too, you know, people have looked at sort of peak athlete cyclists and there are differences in semen quality. Um, but you know, peak cyclists, you know, they do a lot to their body, and so, you know, it's possible that there could be other effects too. But, you know, looking at men that sort of recreationally cycle too, I think that the number that I use, there's a study that showed, um, if you cycle over five hours a week, there can be lower sperm counts. So, you know, I talk to men about that when they do cycle, you know, more than that, you know, potentially taking breaks, trying to stand up if we think the mechanism is heat to try and sort of circulate air out the area, to spend some time out of the saddle if possible.

15. 33:53 – 34:46

    Fertility issues caused by OBESITY

    1. MEDr Michael Eisenberg33:53

    2. SBSteven Bartlett33:53

       What about men with big thighs?

    3. MEDr Michael Eisenberg33:55

       Yeah. (laughs)

    4. SBSteven Bartlett33:56

       (laughs)

    5. MEDr Michael Eisenberg33:57

       Well, I think, you know, obesity is an issue. There's certainly a strong correlation between body mass index and semen quality. So, as men get bigger, sperm counts go down. Um, and so heat is certainly one of the, the possible mechanisms for that, just kinda insulating that area, warming things up can kind of do it. You know, obesity also affects, you know, the kinda hormonal axis as well, so that also may be at, at play too because, you know, there's kind of a normal stimulation that's given by your pituitary in your brain that tells your testicles to make sperm and make testosterone. And some of that's also affected by, uh, obesity as well. So, it's, it probably a combination, but that is something I, I do think about when I see, uh, you know, my patients, and we do talk about sort of heat exposures as well and see if there's, you know, different sort of strategies they can use to try and allow more circulation in the area.

16. 34:46 – 36:32

    Alcohol consumption and sperm count

    1. SBSteven Bartlett34:46

       Is there a link between, um, sperm counts and alcohol consumption?

    2. MEDr Michael Eisenberg34:50

       I think it depends, is what I would say. So, in general, for most kinda moderate use, I would say kind of a drink a day, um, and some people think that no amount of alcohol, you know, is safe, but probab- if you look at these studies looking at maybe a drink or two a day, it probably doesn't correlate too strongly with semen quality. But it seems like there, you know, there are some studies that say that when men get to three a day, so maybe 20 a week, there can be lower quality, uh, in semen. And there was also another study that we did looking at, you know, to see if some men are more susceptible to, to alcohol intake. So, there are some, um, East Asian men and women that have a mutation in, uh, one of the enzymes that's used to metabolize alcohol, and so they accumulate what's called acetaldehyde, which is a toxin actually. And so when they drink, they flush. I don't know if you have any friends that have this. But, um, we hypothesize that, you know, when you have this, you know, this large load of this chemical in your body that leads to flushing, headache, dizziness, um, maybe it also affects semen quality, and it turns out that it does. So, for these men that have this mutation, um, when they drink, their sperm movement goes down a little bit. So, it turns out that it, there's actually a reasonable number of men on Earth that have this. You know, it's probably in some populations up to 50%, like in Taiwan, um, you know, it's very common in Japan, men with Chinese and Vietnamese ancestry. So, I think it's something to be aware of, and I think usually, you know, men do know if they flush when they drink, it's probably 'cause they have this mutation in aldehy- aldehyde dehydrogenase 2. So, you know, for those men, I think that... it's probably better to, you know, avoid alcohol or, uh, just to sort of be aware because, um, it can affect semen quality.

17. 36:32 – 39:08

    What you can do to give yourself the best chances of conceiving

    1. MEDr Michael Eisenberg36:32

    2. SBSteven Bartlett36:32

       If I, if I came into your clinic and I said, "Dr. Michael, I, uh, uh, I'm trying to have a kid with my partner and I wanna make sure that everything I'm doing is giving me the best chance at having a kid," what is, what's the list of things? Uh, 'cause this is basically where I am at my, in my life now. I'm 31 years old. I wanna have a kid. Um, I ideally wanna have four of them, and I'm thinking about the time... My partner's the same age as me.

    3. MEDr Michael Eisenberg36:55

       Yeah.

    4. SBSteven Bartlett36:55

       We're almost identical in age, and she's 31. So we're, we've got... You know, I wanna have these kids before 40 ideally, so I kinda need to get-

    5. MEDr Michael Eisenberg37:04

       Get going.

    6. SBSteven Bartlett37:04

       ... get going. You know what I mean? So, so, uh, what can I do to give myself the best possible chance of increasing my fertility, my sperm count, so that we have those four kids that I want over the next nine years?

    7. MEDr Michael Eisenberg37:17

       Was the four number, uh, something you came up with before that, uh, tax incentive, or?

    8. SBSteven Bartlett37:23

       (laughs)

    9. MEDr Michael Eisenberg37:24

       (laughs)

    10. SBSteven Bartlett37:24

        Yeah, we are planning to move to Hungary, so... (laughs)

    11. MEDr Michael Eisenberg37:26

        (laughs) There you go.

    12. SBSteven Bartlett37:27

        It was really, it's really about tax avoidance.

    13. MEDr Michael Eisenberg37:29

        (laughs)

    14. SBSteven Bartlett37:29

        It's not that I, I want kids. Um, no, I, I come from a family of four, so for some reason-

    15. MEDr Michael Eisenberg37:33

        Okay.

    16. SBSteven Bartlett37:33

        ... I've always had four in my head. Uh, I think she's fine with it as well. I think we've, we've, we've chatted and she's, she's happy with four to six.

    17. MEDr Michael Eisenberg37:40

        No, that's a good number.

    18. SBSteven Bartlett37:41

        Um, might not have six signed off, but four for sure.

    19. MEDr Michael Eisenberg37:43

        (laughs)

    20. SBSteven Bartlett37:43

        What would you say to me then?

    21. MEDr Michael Eisenberg37:45

        So, I think, you know, we'd look at, you know, your overall health. Um, you know, we'd see any risk factors that you had. Obviously we're talking about saunas, hot tubs, finding out, you know, how you exercise, if there's things that you do that are not, you know, good. Um, look at, you know, if any medical conditions that you have, surgeries that you've had. Some of those can put men at risk for, for that. If there's any medications you're on. There can be medications that affect it. And then we'll do an exam. Um, so we don't have to do that here in front of the cameras. (laughs)

    22. SBSteven Bartlett38:12

        I'm down. (laughs)

    23. MEDr Michael Eisenberg38:14

        (laughs) Uh, I do have, yeah, I do have a California l- medical license.

    24. SBSteven Bartlett38:17

        Okay.

    25. MEDr Michael Eisenberg38:18

        But, um, so, you know, we wanna make sure we look at the size of the testicles, make sure all the other structures are where they're supposed to be. Um, you know, one of the basic evaluations will be a semen analysis. So we'll measure how much comes out, look at how many sperm there are, look at how many are moving, look at their shape as well. And then usually we also check hormones as well. So we'll check testosterone. Again, sort of this very male hormone. The testicle does two things. It makes sperm, it makes testosterone. So we check that. And then usually we check some other hormones involved in the kind of hormonal axis that controls reproduction. And that's usually what we start. And again, fertility is a team sport, so I would encourage your partner to also get evaluated as well. Um, and we'd see. You know, depending on kind of sperm counts, usually then we're able to sort of counsel about, you know, how likely you are to be able to achieve, um, you know, those four kids. But, you know, again, it... If you're kinda thinking about four, I, I would agree that you should get started.

18. 39:08 – 40:06

    Man or woman, who has the most issues?

    1. SBSteven Bartlett39:08

       Fertility issues. We tend to think of it... I think there's a stereotype that it's typically the woman who has the fertility issue and the, and the man is okay. And I think if you... When I looked at the data, that, it... That was kinda supported, this idea that couples assume it's the woman that has the fertility issue. Is that a misconception?

    2. MEDr Michael Eisenberg39:24

       It's a huge misconception. Yeah, so absolutely. I think that, you know, in United States and other countries too, I think usually, you know, women are kind of the gatekeeper of fertility. Everybody assumes that that's where the issue lies. But if you actually look at, you know, the data, probably about half the time there's a male factor contributing. And, you know, this sort of stereotype is so prevalent that probably at least a quarter of the time in the United States, the man's never evaluated. And he could be, you know, one of the issues. So some couples may go to IVF, you know, for the lone reason of, you know, again, low sperm count, and the man was never evaluated. And maybe there is a condition that we can improve. Maybe he's on a medicine. Maybe, you know, he's going to the jacuzzi every day, you know, something like that, that we'd be able to reverse.

    3. SBSteven Bartlett40:05

       You

19. 40:06 – 41:31

    Male testosterone decline

    1. SBSteven Bartlett40:06

       mentioned testosterone would be one of the things that you would measure if you were trying to make sure that my fertility was good. Male testosterone decline. This is another hot topic. Uh, you talked about it at the start of this conversation. Is it true that male testosterone is declining, and how much has it declined by?

    2. MEDr Michael Eisenberg40:22

       Yeah, so um, again, study from this NHANES, this, you know, CDC, you know, measuring men every year for the last several decades. If, um... You know, there's data that shows that testosterone levels have, have gone down over time. You know, people have also looked at, um, you know, other cohorts of men, you know, from the 2000s, the '90s, '80s. And there's just a progressive decline in average testosterone levels over that amount of time. So, you know, the amounts, you know, kind of vary, 50 to 100 points, but, you know, generally these are, you know, meaningful, measurable amounts. In addition to sort of these kinda cohort changes where if you kind of, you know, look at the average 40-year-old now versus, you know, 10 years ago, our, our testosterone levels change too. So I would say that... I usually tell men after the age of 20, your testosterone's gonna go down maybe about a percentage point every year. So as we get older, testosterone does go down, and there's things again that can affect that trajectory. You know, men that get more obese, that also affects testosterone level. A portion of all of our testosterone's converted to estrogen. A lot of that conversion happens in, you know, adipose tissue or fatty tissue. So the more kinda extra tissue there is in the body, the more that conversion will happen, and so your, you know, effective testosterone levels will be lower.

20. 41:31 – 43:04

    The impact of exercise on our sperm count

    1. MEDr Michael Eisenberg41:31

    2. SBSteven Bartlett41:31

       What about movement and exercise? Does that have a, an impact on our testosterone levels in a significant way?

    3. MEDr Michael Eisenberg41:37

       Yeah. I mean, I think that, you know, the more walking you do, the more active you are... We've looked at that as well. You know, step count is directly correlated to testosterone. And, and you don't have to take 20,000 steps a day. You know, 4,000, 8,000 steps a day, you know, just kinda walking around, you know, sort of reasonable amounts can make a big difference. And I think that, um, you know, activity is important. It probably also helps stave off obesity a little bit as well as another mechanism.

    4. SBSteven Bartlett42:02

       Okay, so I'm a Manchester United fan right now and we're losing a lot.

    5. MEDr Michael Eisenberg42:04

       I thought you guys had turned it around.

    6. SBSteven Bartlett42:06

       Yeah. I thought so too, until-

    7. MEDr Michael Eisenberg42:08

       (laughs)

    8. SBSteven Bartlett42:08

       ... last week. Okay, so if you're, if you're supporting a team that is losing, your testosterone l- levels are likely gonna be lower.

    9. MEDr Michael Eisenberg42:15

       Well, I think this is sort of an acute thing. Maybe. We could do that experiment, right?

    10. SBSteven Bartlett42:19

        Where does that s- that research come from, that if your team wins, your testosterone increases?

    11. MEDr Michael Eisenberg42:23

        I don't remember. I s- I... That study's pretty old. I think that even predated my, um...... training. But I do remember reading that. I think that was one of the articles that got picked up by the newspaper.

    12. SBSteven Bartlett42:32

        Ah, okay. Of course. Why, why does testosterone matter?

    13. MEDr Michael Eisenberg42:37

        Well, I think testosterone's very important for, you know, a lot of things. I think it's, it's important for our quality of life, so energy levels, sex drive, mood, sleep, concentration. All those things are very important. Um, when testosterone gets very low, this also has a lot of health implications, so muscle health, bone health, heart health. So, we do wanna keep our levels in a normal range, um, because I think it, yeah, kind of helps us with our function and our life, uh, and happiness.

21. 43:04 – 45:23

    What does Testosterone do?

    1. MEDr Michael Eisenberg43:04

    2. SBSteven Bartlett43:04

       H- how does it impact our sort of muscles and bones? W- what, I don't really understand what testosterone is doing. I, I, I kind of think of it as the chemical that kind of makes you a man. I know women have testosterone too, but I, I just think of it as the chemical that makes my beard grow and my voice deep.

    3. MEDr Michael Eisenberg43:18

       Yeah. Well, that's what it's doing. But it's anabolic. It does help kind of grow. It helps with bone turnover, um, and kind of keeps sort of, uh, you know, the strength of the bones. So, men that have very low testosterone levels have, you know, frailer bones, higher risks of osteopenia, osteoporosis. So, um, you know, I think it helps with muscle growth, bone turnover, bone strength. So, I think all those things are, um, are important. Uh, they usually don't get into those problems unless men are very, very low. I would say that, you know, I don't know you, but you know, the average testosterone levels are probably 300 to 900. I would guess probably on the higher, higher end of that. Um, but you know, you, when men are low, probably less than 200, 100, that's where we start to worry more about, you know, bone health, muscle health. And so, I think that there is some wiggle. But when you get kind of lower than sort of the normal ranges, kind of the 300 range, that's when some men do develop, you know, some of the symptoms of lower energy levels, sex drive problems, things like that.

    4. SBSteven Bartlett44:14

       So, low testosterone typically means lower sex drive?

    5. MEDr Michael Eisenberg44:17

       Uh, it can. It's one of the, it's one of the common symptoms that we see with that.

    6. SBSteven Bartlett44:22

       Does that mean that if I just take loads of testosterone my sex drive's gonna go back up?

    7. MEDr Michael Eisenberg44:25

       You know, over the last probably 10 to 20 years, the number of prescriptions of testosterone written in the US have kind of gone up almost at an exponential rate, and because people did think of it sort of as a, um, kind of an anti-aging, kind of rejuvenation therapy. And so there was hope that it would help people. But if you look at some of the randomized trials, if a man has a normal testosterone level and you give him testosterone, uh, it may not help him that much. Even men that have kind of a lowish testosterone, like we talked about, sort of this 300 cut point. So, I've had plenty of patients, testosterone of 250, let's say. So, we talk about risks and benefits of being on testosterone. Uh, we'll try him on it. And, you know, a lot of men do feel better, but not everybody. Some men say, "I don't feel any... You know, Doc, I don't feel any different." Even though we get his levels, you know, from 250 to 500. Um, and so then it's probably not worth, you know, to be on a medicine every day if it's not helping you. I'm not worried about his bone health. You know, we'll check some other measures to make sure that's okay. Um, so then it's not... You know, again, when you look at risks and benefits, it's probably not worth it. But there are certainly some men who do, who do see improvement.

22. 45:23 – 48:18

    Side effects of taking testosterone

    1. MEDr Michael Eisenberg45:23

    2. SBSteven Bartlett45:23

       So, is testosterone hurting some people, uh, their testosterone treatments? Does it actually have an adverse effect if you take it basically when you don't need to?

    3. MEDr Michael Eisenberg45:33

       I mean, even when you do need to, I think it could cer- m- sometimes cause issues. Yeah, there are certainly side effects to testosterone. Um, you know, one of the big things that I see in my practice is how testosterone impacts sperm production. Um, it actually was tested as a contraceptive by the World Health Organization because it does lows- lower sperm counts in most men. I would say 90% of men. Now, it doesn't do 100%, so it's not that great of a contraceptive yet. They're kind of working on some other ways to tweak it. Um, but I have plenty of patients that come in. You know, some of them suspect that testosterone's the issue. Some don't know. Um, I remember one couple in particular, they came in as a couple together. You know, we measured his sperm count. It was zero. We started talking about risk factors, and he was on testosterone. And I said, "Well, the best thing to do would be to stop testosterone." Um, and for his work, I'm not able to tell you what he did, but for his work, he really couldn't stop it. Um, so there was some other medicines we were able to add while he continued the testosterone, um, and then they ended up with triplets, um, shortly thereafter. So, I think that, you know, men need to be aware of it, um, because that's, you know, certainly one of the big risk factors, at least of reproductive age men, is this risk to fertility.

    4. SBSteven Bartlett46:40

       So, it can impact my sperm count negatively?

    5. MEDr Michael Eisenberg46:42

       Mm-hmm.

    6. SBSteven Bartlett46:43

       Um, I, I, I saw a quote from you that said, "If we take 100 of my infertile patients that I see in the clinic, at least five of those men will be infertile because they're on testosterone therapy. One in 20 infertile men are that way because of testosterone, y- uh, as it relates to infertility." One of the things that I've always worried about is if I take testosterone, then my hair would fall out.

    7. MEDr Michael Eisenberg47:07

       Yeah. So, that can d- definitely happen. So, you know, hair loss, breast growth, acne, those can all occur. I would say those are things that we can monitor. So, you know, one thing I always tell men is that we're not trying to get them to superhuman, right? We're just trying to get you to normal. So, I think if we monitor it closely, most men, you know, will do okay. Again, there are some other therapies that we can do for men that have side effects, uh, you know, from those things. It can also affect the thickness of the blood, something called the hematocrit where we count the number of red blood cells in the body. It can increase that number. So, if it gets too high, that can be an issue. So, that's another number that we follow. There used to be a concern about, um, higher rates of heart attack and stroke with testosterone. So, there were some studies done, um, you know, about maybe 10 year- five, 10 years ago, that suggested that. But, uh, a really large trial just came out, uh, with about 5200 men, half of them randomized to testosterone, half not, and there was actually no difference in the risk of cardiovascular disease. So, I think that's something that we can probably put to bed. The other thing that, uh, men worried about is increase of risk of prostate problems.

    8. SBSteven Bartlett48:09

       Mm-hmm.

    9. MEDr Michael Eisenberg48:09

       Prostate cancer, prostate growth, and, you know, that same trial also showed that, um, from a prostate standpoint, probably not a lot of risk as well.

    10. SBSteven Bartlett48:17

        Do you

23. 48:18 – 51:01

    Common symptoms of testosterone use

    1. SBSteven Bartlett48:18

       have many men coming to you to talk to you about hair loss and balding?

    2. MEDr Michael Eisenberg48:22

       Uh, some men do. I think one of the ways that men talk to me about it is one of the common medications for that is finasteride.

    3. SBSteven Bartlett48:28

       Right.

    4. MEDr Michael Eisenberg48:28

       Or, you know, sold under the trade name Propecia. Um, and so they wanna understand some of the risks of that. And so-You know, when that medicine was approved for hair loss, they, you know, again 'cause the people that are gonna take it are usually in the reproductive age, they did randomized placebo controlled trials to look at s- semen quality, and it turns out that it didn't meaningfully impact things. Maybe it went down a little, but not a lot. Um, but in sort of post, um, you know, analyses of some of this and now seeing lots of patients coming in, we do see men that are on finasteride, some of them are more susceptible. And so one of the interesting thing about trials is there's, you know, kind of inclusion and exclusion criteria, right? Not- not everybody can be in it. And so if men had sperm counts that were too low, they weren't invited to be in these trials. So for men that, you know, don't have as much reserve as others, I think they may be more susceptible. So that's one of the risk factors of finasteride. You know, the other thing in addition- in addition to reproductive health is sexual health that I deal with a lot, and there's also a concern that finasteride impacts sexual function in men too. So, you know, we have these discussions. I've had some men that come in after having been on finasteride and have, you know, different issues with sexual desire, low libido, or erectile dysfunction. And so then we, you know, work through an algorithm to try and improve that as well.

    5. SBSteven Bartlett49:42

       This is one of the things I think about a lot 'cause I don't wanna- I don't wanna have a receding hairline and I also don't wanna have a hair operation or anything like that. But when I hear about some of these testosterone replacement therapies and- and such, my big concern is that if I take testosterone, maybe not now 'cause I'm, you know, probably don't need it right now, but maybe w- when I'm a little bit older, which is when I assume one would start taking it. Maybe when I'm about 50-ish?

    6. MEDr Michael Eisenberg50:05

       On average, but there are m- younger men that are on it as well.

    7. SBSteven Bartlett50:07

       For what reason? Just because they're low on... W- what- what's the sort of symptoms that- that have caused them to take it?

    8. MEDr Michael Eisenberg50:14

       Well, I think there's, you know, with all things, there's a bell-shaped curve, so some men are a little bit lower. Some have genetic conditions. You know, there are, um, some more nefarious testosterone prescribers, so even though men have a normal level, they're offered testosterone to kind of get in these kind of testosterone clinics. And some men, you know, if you kind of look at data, maybe 10 to 20% of, you know, high school athletes have experimented with testosterone and if you stay on that too long, it can really shut down your own axis. So, um, if you take exogenous testosterone, so like, testosterone injections or gels, your body stops making it, and the longer you're on it, the less likely your body's able to sort of restart. And so for some of these men, you know, poor choices or, you know, whatever, they've been on testosterone for a while and they can't ever stop.

24. 51:01 – 51:57

    Female fertility

    1. MEDr Michael Eisenberg51:01

    2. SBSteven Bartlett51:01

       I don't know if you've ever had any experience in it because I know you focus predominantly on male health, but um, I've had a long conversation about contraceptive pills with my partner.

    3. MEDr Michael Eisenberg51:10

       Mm-hmm.

    4. SBSteven Bartlett51:10

       Because she was on, she said this publicly before, that she was on a contraceptive pill for a long time and then... And everyone's relationship with con- contraception is different, but after taking it for seven or eight years, she- she came off it and her period didn't-

    5. MEDr Michael Eisenberg51:23

       Mm-hmm.

    6. SBSteven Bartlett51:23

       ... happen, didn't occur. So she really struggled with that for a while previously, and it made me really, you know, it illuminated the fact that when we start messing with the chemical balances of our body using pills and injections and other things, we could do pretty long term and/or permanent damage to ourselves, and there's no real such thing as a free lunch, is there, in-

    7. MEDr Michael Eisenberg51:43

       Right.

    8. SBSteven Bartlett51:44

       ... biology and chemistry?

    9. MEDr Michael Eisenberg51:45

       Yeah, I think that's what it comes down to. I think a lot of people have said that if they tried to get the, uh, the pill approved now, it would be a much different process and unlikely to succeed for those kind of reasons.

25. 51:57 – 54:15

    How is testosterone therapy given?

    1. SBSteven Bartlett51:57

       If I have low testosterone, um, and I come to see you, what is the typical way of getting a testosterone replacement therapy? Is it a pill? Is it an injection that I have to take? Um, I know that it's quadrupled according to the data in the US since two- since the 2000s, which is staggering, but how are people taking testosterone?

    2. MEDr Michael Eisenberg52:20

       So there's lots of different ways it can be taken. I think one thing, you know, again, we talk about all the risks, so fertility would certainly be a- a, you know, a big one. So if you come in in your 30s, you know, I'd ask you about your reproductive intent. So if you have a low testosterone and you're interested in having four kids, I wouldn't start you on testosterone directly. There are some off-label things, um, you know, so medicines that we kind of repurpose to help increase your body's own testosterone, um, that we would start with. But assuming that, let's say, you're in your 60s, you're not interested in fertility, then, you know, there's gels or patches that you put on every day, testosterone gel or patch, um, because that can work well. Probably 10 to 20% of men don't absorb testosterone that well through the skin. The other thing to be aware of is that there's a risk of, um, like, transference, like to your partner, to anybody that kind of touches your skin.

    3. SBSteven Bartlett53:06

       Ah.

    4. MEDr Michael Eisenberg53:06

       So if you have young kids, just to sort of be aware of. But as long as, you know, you put it on, let it dry, put clothes on over it, it's not a big risk. Um, you know, again, and also have to be, I guess, mindful of laundry as well. Uh, so, you know, gels, patches are one. There's injections, uh, that you can do every usually one to three weeks on average. There's testosterone pellets. Um, so these are pellets that have testosterone that are kind of slow release, so um, they're just injected, uh, we kind of implant them under the skin usually in the hip area and those last probably three to six months. There's longer-acting injections, so those are very common in Europe, um, they're kind of gaining steam in the US, but those are injections that last probably 10 weeks or so. And then there's a new oral therapy, so there's an oral form of testosterone, um, that's available as well.

    5. SBSteven Bartlett53:55

       I was quite confused on the subject of hair loss and testosterone 'cause I couldn't figure out if low testosterone causes me to bald and have a receding hairline or if it's high testosterone that causes me to bald and have a receding hairline or if it's both.

    6. MEDr Michael Eisenberg54:11

       I mean, it could be both. I think usually we think about it as, um, as higher levels.

26. 54:15 – 55:04

    Exercise and health impact on testosterone

    1. MEDr Michael Eisenberg54:15

    2. SBSteven Bartlett54:15

       Okay. It's funny 'cause I've- I've wondered before whether me doing a lot of exercise, which is, I guess, increasing my testosterone levels, is going to accelerate my balding and receding hairline.

    3. MEDr Michael Eisenberg54:25

       Anything that's good for your heart should be good for your hairline.

    4. SBSteven Bartlett54:27

       Okay.

    5. MEDr Michael Eisenberg54:27

       So I would... exercise, I think that's good.

    6. SBSteven Bartlett54:30

       But what if I'm doing like Ironmans and 1000-mile runs and all that kind of thing, which you see in- in certain groups?

    7. MEDr Michael Eisenberg54:36

       So, I don't know that it, I- I do think it's possible to over-exercise. I don't know if it'll affect your hairline, but, um, you know, I think-

    8. SBSteven Bartlett54:44

       Like my testosterone levels?

    9. MEDr Michael Eisenberg54:45

       Uh, it can affect testosterone levels. I do think that it's, you know, when you kind of exercise to the point of exhaustion, you know, we do see declines in sperm counts as well. So, hormone levels can certainly be affected, um ...

    10. SBSteven Bartlett54:57

        As my cortisol goes up, so my testosterone, I'm, I guess goes down?

    11. MEDr Michael Eisenberg55:01

        Can go down. Sometimes.

    12. SBSteven Bartlett55:03

        Interesting.

27. 55:04 – 57:24

    Penis average size increasing

    1. SBSteven Bartlett55:04

       What about penis size? I heard you did some pretty landmark research which suggests that the length of a man's penis is increasing decade over decade in terms of, um, men that are being born and boys that are going through puberty.

    2. MEDr Michael Eisenberg55:18

       Yeah, so (laughs) um, this, this study also got a lot of attention. So, um, you know, similar to how we have tracked testosterone levels over time or sperm counts over time, you know, for different reasons investigators have measured penile length. You know, to kind of give normative data across different populations to understand how different surgeries or conditions may affect, um, penile length. So, you know, we looked at, you know, all the studies, and there were, there were dozens, and so we kind of pooled all that together. And this was tens of thousands of men, and just looked at sort of average penile length over time. And so, you know, again, based on some of the data on semen quality, we would have expected things to get shorter over time, and also 'cause we're more obese now. You know, the way that penises are measured is you kind of pull the penis on stretch and use a tape measure or some sort of ruler or measuring device. So if the m- there's kind of more gut, you know, more fat, in theory, length should be a little bit shorter now than it used to be. Um, but it turns out, at least when you measure erect penile length, uh, that penises are longer now than they used to be. Uh, and so over the, you know, past 30 years or so, they've probably gone up about 25%.

    3. SBSteven Bartlett56:24

       Why?

    4. MEDr Michael Eisenberg56:26

       I mean, it's, it's a good question. I think one hypothesis we had, kind of looking at sort of different endocrine, you know, abnormalities, um, and changes in puberty is that if men go through puberty or boys go through puberty earlier, that tends to correlate with longer penis length. And so if we are shifting puberty, again, through these different environmental exposures, maybe that is leading to, you know, changes in general development, and this may be one of the consequences of it.

    5. SBSteven Bartlett56:52

       Does this have any upstream con- in, like, implications for, for sex?

    6. MEDr Michael Eisenberg56:58

       I think that, well, the numbers we're talking about shouldn't be, um, you know, kind of enough to make a big, big difference. Um, you know, people ha- as this study came out and we talked about, you know, very enterprising patients kind of reaching out, sending emails, some people hypothesized that this was kind of natural selection. So, it's hard to know. Um, but it, you know, again, it's, it's a very short period of time, so it's hard to believe that there's, you know, that's kind of at play.

28. 57:24 – 1:03:11

    Erectile dysfunction treatments

    1. MEDr Michael Eisenberg57:24

    2. SBSteven Bartlett57:24

       Do you have many people that come into your practice that are struggling with ele- erectile dysfunction?

    3. MEDr Michael Eisenberg57:28

       Yeah. So, that's another very common condition we see. And if you look at men over the age of 40, over half have some trouble with erections. So, very, very common. Hundreds of millions of men all over the world are afflicted.

    4. SBSteven Bartlett57:40

       We don't talk about this much. Um-

    5. MEDr Michael Eisenberg57:44

       True.

    6. SBSteven Bartlett57:44

       ... what are, what is the cause of this, and are you seeing it increase over time, the, the prevalence of erectile dysfunction?

    7. MEDr Michael Eisenberg57:50

       I mean, I think, you know, the rates are going up, and I think, you know, the risk factors, you know, are the same risk, uh, largely the same risk factors that affect heart disease. So, you know, diabetes, obesity, high blood pressure, high cholesterol. You know, a minority of these, um, conditions can be caused by low testosterone. Sometimes the outcomes of, you know, surgical treatment for pelvic cancers as well. Um, but by and, by and large, it's vascular. Just, it's a blood flow issue.

    8. SBSteven Bartlett58:16

       'Cause I used to think it was more of like a, like a hormonal thing or a psych- psychology thing.

    9. MEDr Michael Eisenberg58:21

       Mm-hmm.

    10. SBSteven Bartlett58:21

        Like, uh, you know, sexual anxiety or some kind of, you know, change to our testosterone levels is causing us to struggle with getting erections now. But you're saying it's about the-

    11. MEDr Michael Eisenberg58:32

        So, I think, you know, psychogenic used to be thought of, like you're saying, used to be thought of as the kind of the primary, uh, etiology. Um, and maybe for some, you know, populations, it could be a little bit more common. But generally, for most men, sort of all comers, it's gonna be a blood flow issue, a vascular or organic cause.

    12. SBSteven Bartlett58:49

        And how would you go about treating, um, erectile dysfunction?

    13. MEDr Michael Eisenberg58:52

        Um, so there's a lot we can do. We do wanna, you know, kind of reverse anything that we can, kind of understand where the man's coming from, find out if there's, you know, a new relationship or other kind of factors. You know, for men, like, you know, you're suggesting that we do s- like kind of suspect a psychogenic component, work with sex therapists as well. Um, but for other men, you know, I always like to be very positive, so like to say, you know, "As long as you have a penis, we can always make it hard." So there's a lot that we can do. So, usually we start with pills, um, like Viagra, Cialis.

    14. SBSteven Bartlett59:21

        Does that work for people?

    15. MEDr Michael Eisenberg59:22

        It works probably 60% to 70% of the time. So that does work well. Um, e- even for men with a psychogenic cause, sometimes it can kind of help reset the system a little bit, you know, convince them and their body that everything is working well.

    16. SBSteven Bartlett59:33

        Like a placebo effect.

    17. MEDr Michael Eisenberg59:35

        Well, it's, I think to some extent, but even more than that, 'cause it does work. It does help. And then I think once they kind of regain that confidence, if there was some sort of traumatic event-

    18. SBSteven Bartlett59:44

        Ah.

    19. MEDr Michael Eisenberg59:44

        ... traumatic relationship, it can help, um, improve things. If pills aren't enough or they don't like those or they have side effects from those, um, there's other therapies. So there's medicines you can actually put in the tip of the penis, like a gel or a suppository. We can teach men to give themselves injections in the penis.

    20. SBSteven Bartlett1:00:00

        Ooh, I just got a shiver down my body.

    21. MEDr Michael Eisenberg1:00:03

        (laughs) There's certainly a s- uh, a kind of a, a psychological, um, sort of fear of that. But it does work well, probably works 80% to 90% of the time. Um, there is something called a vacuum erection device. So it's like a plastic cylinder you put over the penis that sucks blood into the penis.

    22. SBSteven Bartlett1:00:18

        Mm-hmm.

    23. MEDr Michael Eisenberg1:00:18

        Kind of treats it like a balloon, and then you put a band at the base to trap blood inside. Um, and there's even surgeries that we can do to put a device inside the penis, so whenever a wa- or whenever a man wants to be hard, he can be hard.

    24. SBSteven Bartlett1:00:29

        I didn't know there was surgery you could do.

    25. MEDr Michael Eisenberg1:00:30

        There's a surgery. Mm-hmm.

    26. SBSteven Bartlett1:00:32

        What, what does that do? It puts a... like-

    27. MEDr Michael Eisenberg1:00:34

        So there's, there's two main flavors of it. There's, um... or forms. Maybe that's a better term. Uh, there's one called a malleable, so it's bendable. So it kind of puts this sort of bendable, um, metal, it's a metal core with sort of a plastic-... um, kind of covering. So when they don't want to have sex, you bend it down. When you're ready for sex, you bend it up. Um, or there's inflatable versions, so when you're- whenever you're ready for sex, there's a, basically a pump that goes in the scrotum and you just pump it up. It moves fluid into the cylinders and you'll get a rigid erection.

    28. SBSteven Bartlett1:01:03

        Is that increasing in popularity?

    29. MEDr Michael Eisenberg1:01:06

        I think s- you know, that it's made by a few manufacturers in, uh, in the US or in the world, um, and I, so I think the data is not as freely available. I mean, in my practice, I've seen more and more of it. Um, we're seeing more patients come in. I also say that, you know, my practice is getting a little bit more mature with time as I get older, and so (laughs) you know, naturally, you know, more patients kind of h- hear about these different things. But it does work well. I always say it's a self-selected population, right? We don't hold men down and force them to get it. But generally, they're very happy. Probably 90% of men are very happy. They'd recommend it to their friends. Partner's very happy, recommend it to other couples.

    30. SBSteven Bartlett1:01:44

        And you just, you press a button and then you can, like you can...
29. 1:03:11 – 1:03:58

    Does shock wave therapy work for erectile dysfunction?

    1. SBSteven Bartlett1:03:11

       for erections. Does that work and what is it?

    2. MEDr Michael Eisenberg1:03:14

       (laughs) So the idea is that, um, as kind of the name implies, you're sending shockwaves into the penis. Um, and the energy is, induces kind of some microtrauma which induces new blood vessel growth is the hypothesis. And so, you know, the hope is that with, you know, getting better blood vessel, better blood flow into the penis can improve the quality of erections. So there have been some studies that do show benefit. It's still considered experimental, um, because I think the data is not yet conclusive, but I think for men with milder forms of erectile dysfunction it can help, you know, maybe the men that are on Viagra or sometimes non-Viagra, may- we can get them off those pills. Um, but I think we need more data, uh, to kind of understand really the, kind of the best target population for it.

    3. SBSteven Bartlett1:03:57

       You, you

30. 1:03:58 – 1:05:31

    Pelvic floor strength

    1. SBSteven Bartlett1:03:58

       talk about pelvic floors as well. Um, when we typically think about pelvic floors, we tend to think of women.

    2. MEDr Michael Eisenberg1:04:04

       Mm-hmm.

    3. SBSteven Bartlett1:04:05

       You know, things like these Kegel exercises that people talk about. But is it important for us to think about that as a man as well? Our sort of pelvic floor strength and our pelvic floor muscles?

    4. MEDr Michael Eisenberg1:04:15

       I think in some conditions. I think if you're not thinking about it, it's probably okay, you're not having a lot of problems.

    5. SBSteven Bartlett1:04:20

       Okay.

    6. MEDr Michael Eisenberg1:04:20

       Um, but it can be a trigger for some men, so that can be an etiology of some different, um, like, problems with urination. You'd see men with very tight, you know, pelvic floors and they have a lot, a lot of urgency to urinate. They urinate frequently. It can also lead to scrotal pain sometimes as well, um, 'cause there's a lot of muscles, as you're kind of pointing out, in the area, and sometimes if they're under tension, um, if they're not, um, you know, properly kind of trained and they're, they can kind of trigger some other areas. And so, um, for some of these different conditions, um, we do kind of work with pelvic floor physical therapists to train patients, you know, how to, you know, again, relax the area, strengthen the area, increase flexibility of some of those muscles which can help.

    7. SBSteven Bartlett1:04:59

       Is it plausible that doing pelvic floor exercises will improve one's sex life?

    8. MEDr Michael Eisenberg1:05:05

       I mean, I think that unless we're treating a problem, I would be very hesitant. You know, one of my favorite sayings is the enemy of good is better. So if things are good, you know, to try and get better, you know, there are always, there's always gonna be, like you said, there's no free lunch. There's always some trade-offs. So I think if you work on kind of over-strengthening the pelvic floor, it could lead to some of these other dysfunctions. So you don't want to end up with a floor that's too tight or too tense.

    9. SBSteven Bartlett1:05:30

       Is there any

31. 1:05:31 – 1:14:20

    What causes cancer in the reproductive system

    1. SBSteven Bartlett1:05:31

       correlation between these things, like your pelvic floor strength, your testosterone, your sperm count, and a variety of the different cancers that we see in men, things like testicular cancer and prostate cancer?

    2. MEDr Michael Eisenberg1:05:44

       So, um, I think with, with, uh, pelvic floor kind of strength, I think I usually kind of think about that as separate from, uh, cancer risk. But for testis cancer, you know, one of the risk factors for that is some men are born without testicles in their scrotum, uh, so that's a risk factor, an under- so-called undescended testicle. Low sperm counts are associated with testicular cancer. There is one study I know of years ago that looked at, um, you know, comparing sort of sexual health to prostate cancer risk, found that men that ejaculated more frequently had a lower risk of prostate cancer. The thought was that, you know, there was inflammation that you're kind of clearing out by frequent ejaculations. I think the study had men ejaculating 30 times a month and showed a lower risk. So that's, that's a lot. Um, but that was one study that said at least it's not dangerous to ejaculate more frequently. But I, it's not something that I generally recommend to men to lower their risk.

    3. SBSteven Bartlett1:06:34

       Now, if we talk about testicular cancer then, um, what are the, the common symptoms of testicular cancer?

    4. MEDr Michael Eisenberg1:06:41

       Yeah. So usually it tends to be relatively asymptomatic. I think that, you know, the classic symptom would be-... a firm, painless mass that men find in the scrotum. So if, you know, um, there used to be s- there are screening guidelines, um, even though our preventative services task force thinks that, you know, the utility of doing it for, you know, reproductive age men, to their scrotums may lead to more anxiety than actually, you know, finding testis cancer, 'cause it's such a rare cancer, so it's more likely a man's gonna just worry themselves than actually, you know, diagnose an early cancer. But the recommendations used to be that you would s- you know, once a month in the shower, kind of feel yourself, and if you feel something new or something abnormal, you know, bring it to your doctor's attention. And I certainly see a lot of men with this concern, do an exam and say, "You know, that's normal." Or if there's something that we're worried about, um, we'll kind of dive a little deeper.

    5. SBSteven Bartlett1:07:29

       What is the demographic that's, uh, most likely to get testicular cancer? Is it something that affects young people as well as older people?

    6. MEDr Michael Eisenberg1:07:36

       It's usually mostly a cancer of young men, so I would say probably 20s to 40, uh, is usually the, the kind of the prime demographic.

    7. SBSteven Bartlett1:07:43

       Well, why is it a cancer of young men? Is there any sort of physiological reason for that?

    8. MEDr Michael Eisenberg1:07:47

       Well, I mean, it's a, you know, reproductive aged cancer, so that's the prime reproductive years. Um, so it's possible that it kind of correlates with, you know, sperm counts declining with older age. There is another slight increase for men in their 50s and 60s, um, but again, it's such a ... it is a very rare cancer. So I would usually kind of quote probably one in 100,000 men, um, are gonna be diagnosed with it. So it's, it's-

    9. SBSteven Bartlett1:08:10

       One in 100,000?

    10. MEDr Michael Eisenberg1:08:11

        Pretty un- it's fairly uncommon.

    11. SBSteven Bartlett1:08:12

        But prostate cancer's more, more common.

    12. MEDr Michael Eisenberg1:08:14

        Prostate cancer is more common, yeah. So that, we dia- you know, in the United States, probably at least 200,000 men every year. Um, some studies say that, you know, if you live long enough, everybody will be diagnosed with prostate cancer. But again, most men with prostate cancer die of heart disease, just like every other man in this country. So most men, you know, with prostate cancer die with it, not of it. Um, so usually it's a slower growing disease, although there are some that are more aggressive, and that's why we screen for it and treat it.

    13. SBSteven Bartlett1:08:39

        I read a stat that it affects one out of every seven men, prostate cancer.

    14. MEDr Michael Eisenberg1:08:43

        Mm-hmm. Yes.

    15. SBSteven Bartlett1:08:45

        Okay, so what is a prostate?

    16. MEDr Michael Eisenberg1:08:46

        (laughs) So a prostate is, it's a walnut-shaped organ.

Episode duration: 1:31:58