The Ultimate Men’s Health Guide: Testosterone, Sex Drive, & Aging

1. 0:00 – 3:43

   Meet the Guest

   1. MRMel Robbins0:00

      Today on The Mel Robbins Podcast, the ultimate guide to men's health

   2. MEDr. Michael Eisenberg0:05

      There's been lots of studies that show that sperm counts are going down globally. Over 50, about half of men, have a low testosterone

   3. MRMel Robbins0:11

      With the head of Stanford's Male Reproductive Medicine and Surgery Program, Dr. Michael Eisenberg.

   4. MEDr. Michael Eisenberg0:20

      Hormonal health, reproductive health, a lot of men are not comfortable talking about this. There's this feeling of shame a little bit, and guilt, concerns about their own masculinity.

   5. MRMel Robbins0:29

      We are talking about my husband's private. He's gonna kill me- [laughs]

   6. MEDr. Michael Eisenberg0:32

      [laughs]

   7. MRMel Robbins0:32

      ... [laughs] saying this, but whatever. This is the ultimate guide to male hormones and men's health.

   8. MEDr. Michael Eisenberg0:39

      This is a very important topic, and something that a lot needs to be done about and can be done about. [upbeat music]

   9. MRMel Robbins0:57

      Please help me welcome the incredible Dr. Michael Eisenberg to The Mel Robbins Podcast.

   10. MEDr. Michael Eisenberg1:02

       It's a pleasure to be here.

   11. MRMel Robbins1:04

       I mean, Dr. Eisenberg, I really appreciate you getting on a plane and taking out time from your extraordinarily busy schedule, clinical practice, overseeing your fellowship, teaching residents, all the research that you're doing, to be here, so thank you.

   12. MEDr. Michael Eisenberg1:19

       You're very welcome.

   13. MRMel Robbins1:20

       Um, let's just jump right in. I know what I am hoping to get out of this, but I would love for you to speak to the person who is listening, who is here with us right now, and share with them, based on everything we're gonna cover today related to male hormone health and men's health in general, what could possibly change about their life or the life of a guy that they love if they take everything to heart that you're about to teach us? What are we gonna learn?

   14. MEDr. Michael Eisenberg1:46

       Yeah, well, I think we're gonna learn quite a bit. I think that these are topics that aren't really discussed a lot. I think people don't understand them a lot. I think there's a lot of embarrassment about them, and so I think there's really an opportunity to learn and improve. I think that, um, all these things are so fundamental, not just to overall health really, but to sort of the quality of life, right? That's mostly what we're talking about. So I think there's, you know, a real opportunity to improve just enjoyment, benefit, and then longevity as well. I think these are things that people don't necessarily think about or do as much with, but if you understand it, really you can empower things. And I think people also need to understand that there is a lot that they can do. They have a lot of agency with a lot of these things. Um, and it starts with, you know, education, which I think is, you know, one of the great things about this podcast.

   15. MRMel Robbins2:32

       Dr. Eisenberg, for the man who is listening right now, who got this episode sent to them by somebody who cares deeply about them, what do you want him to know about what we're gonna talk about today?

   16. MEDr. Michael Eisenberg2:45

       Well, you're gonna learn everything you wanted to know about hormonal health, sexual health, reproductive health. You'll learn all the things that you can do, how to get tested, why to get tested, why not to get tested. So we're getting tested for hormones. We're getting tested for sexual function, reproductive function. Um, and you'll just b- have a greater appreciation for how impactful this can be for quality of life, longevity, everything.

   17. MRMel Robbins3:12

       Well, I just need to say up front, I have my husband Chris's permission [laughs]

   18. MEDr. Michael Eisenberg3:16

       Okay. [laughs]

   19. MRMel Robbins3:17

       ... to share information, because I'm just gonna go on the record, and maybe I'm gonna sound like a giant dummy-

   20. MEDr. Michael Eisenberg3:24

       [laughs]

   21. MRMel Robbins3:24

       ... but it's not until I hit perimenopause, and now I'm fully in menopause, that I even started to think about male hormone health.

   22. MEDr. Michael Eisenberg3:37

       Mm-hmm.

   23. MRMel Robbins3:37

       And I'd love for you, Dr. Eisenberg, to start by just setting the table for us.

2. 3:43 – 8:06

   Signs You May Have Low Testosterone

   1. MRMel Robbins3:43

      What is male hormone health, and what do you want us to know about it when you think about the bigger picture, before we dive into specific questions?

   2. MEDr. Michael Eisenberg3:54

      Yeah, so I think it's just sort of optimum hormone levels, and I think when we think about men, the main one we talk about is testosterone.

   3. MRMel Robbins4:00

      Mm-hmm.

   4. MEDr. Michael Eisenberg4:00

      Um, and it's important to know that, you know, the normal range of testosterone is quite wide, right, 300 to 900 nanograms per deciliter. And so when we think about that, you know, there's some men that are on the lower end, some men are on the higher end, some men are square in the middle, but it's a very wide range, because, you know, normal is a little bit different between everybody. And it's so important. You know, we're obviously gonna talk about all the things that it does, quality-of-life things, overall health things, functional things. Um, so I think that having that understanding I think is really fundamental.

   5. MRMel Robbins4:29

      Okay. What age do men start to see changes in testosterone?

   6. MEDr. Michael Eisenberg4:37

      So as we go through puberty, you know, testosterone increases, and it probably peaks probably somewhere between 20 to 30, and then every year thereafter it goes down maybe 1% a year. So if you look at epidemiologic data, uh, of populations, you know, men that have low testosterone, so kind of below those cut points, below 300, you know, or so, you know, maybe men in their 40s or probably 50s, it's maybe about 10, 20%. You go in the 60s, goes to about 20%, 70 is 30%, then the 80 is about 50%. So, you know, the kind of statistic that's always talked about is over 50, you know, about half of men have a low testosterone, kind of a serum number. So that's when men should start to think about that, um, as something they should get screened for.

   7. MRMel Robbins5:20

      So I just wanna make sure I understand the math-

   8. MEDr. Michael Eisenberg5:21

      Mm-hmm

   9. MRMel Robbins5:21

      ... 'cause you just spit out a lot of numbers right there.

   10. MEDr. Michael Eisenberg5:23

       Mm. [laughs]

   11. MRMel Robbins5:23

       So when you were saying 10%, 20%-

   12. MEDr. Michael Eisenberg5:26

       Mm-hmm

   13. MRMel Robbins5:26

       ... 30%, and then-

   14. MEDr. Michael Eisenberg5:27

       Yeah

   15. MRMel Robbins5:27

       ... you were going 40, 50, 60-

   16. MEDr. Michael Eisenberg5:28

       Mm-hmm

   17. MRMel Robbins5:28

       ... were you basically saying that your s- testosterone kicks in for puberty-

   18. MEDr. Michael Eisenberg5:34

       Mm-hmm

   19. MRMel Robbins5:35

       ... and is it relatively stable until you hit your 40s or 50s, and then you start to slowly decline? Is that what's happening? And that's normal?

   20. MEDr. Michael Eisenberg5:44

       It is normal. I think it peaks somewhere between 20 to 30, and then it goes down a little bit.

   21. MRMel Robbins5:47

       Okay.

   22. MEDr. Michael Eisenberg5:48

       So it's not usually kind of a steep drop-off-

   23. MRMel Robbins5:50

       Okay

   24. MEDr. Michael Eisenberg5:50

       ... um, but it does slowly go down. And it, there's different factors. Age is one, but also, you know, our metabolic health, adiposity, like how much weight we have. I mean-

   25. MRMel Robbins5:59

       Yeah

   26. MEDr. Michael Eisenberg5:59

       ... all these things, um, will impact it.

   27. MRMel Robbins6:01

       What are the signs or symptoms that you may have low testosterone?

   28. MEDr. Michael Eisenberg6:05

       So I would say they're sort of quality of life things. So low energy level, low sex drive, you know, poor mood, poor sleep, poor concentration. You know, I will certainly admit that these are somewhat nonspecific, but if you're having these, you notice these a little bit more, they're bothering you, your partner notices them, I think certainly get screened for low testosterone. And then again, some more health metrics. So like low blood counts, so-called anemia.

   29. MRMel Robbins6:28

       Huh.

   30. MEDr. Michael Eisenberg6:28

       I think that's something that can be a sign. If you're found to have low bone mineral density, you know, with no other explanation, get screened. Um, and then again, if you have a history of chemotherapy, radiation to the testicle specifically. But, you know, the symptoms that we'll see are, again, these sort of low energy level. Those are typically the things, sexual dysfunction, erectile dysfunction. Those are things that we wanna think, "Does this guy have low testosterone? Let's check it."
3. 8:06 – 13:52

   Do You Need Testosterone?

   1. MRMel Robbins8:06

      Well, Dr. Eisenberg, what are the benefits of going on testosterone?

   2. MEDr. Michael Eisenberg8:10

      So it can help with energy level, you know, vitality. I think, you know, s- it can help with some things and not others, but we do see that. Consistently, we see improvement in sexual function. So again, such a powerful, you know, aspect of quality of life. Um, but it can help with libido. It can help with erectile function. So those are all things good. You know, penile health, keeping that. It can help with bone mineral density. You know, men that have low blood counts, it can help with that. It can improve lean body mass. It can improve metabolic health. There have been some studies that, you know, followed men that were kind of pre-diabetic, and those men that were on testosterone had a lower risk of developing diabetes. So it can kind of maintain, again, longevity in that regard as well. So I think also sometimes men talk about increasing their motivation, making them more active.

   3. MRMel Robbins8:54

      And what about some of the things related to mood or related to energy and the things that we see in the negative in our partners-

   4. MEDr. Michael Eisenberg9:03

      Mm-hmm

   5. MRMel Robbins9:03

      ... and we're like, "Wow, you don't seem like yourself." Do you see a boost in mood, in muscle development, and just all the other things?

   6. MEDr. Michael Eisenberg9:10

      Yeah. So certainly it can help with, you know, mood. I think certainly patients that get a good response-

   7. MRMel Robbins9:14

      Uh-huh

   8. MEDr. Michael Eisenberg9:15

      ... um, definitely do, you know, they, they do talk about that. People talk about having sort of better cognitive load as well. There's different ways that we give testosterone, and so some men come to the clinic, you know, every few months for basically a shot or some new installation of, you know, whatever treatment we're doing. And they say that, "I know that I needed it because I can't sleep as well. I can't focus at work." And then as soon as they get on it, you know, they see that improvement. Again, these are men with low testosterone, so this is the reason they're having these symptoms. And so we see that. And also just lean body mass. It can help with strength, all those things. You know, we do have measurable improvements in patients that I see, but also we've done very good trials that do support this, um, this improvement.

   9. MRMel Robbins9:53

      You know, I don't know if this is something that happens in your 50s, and I don't know how old you are, Doc, but I notice that when you hit your 50s, I'm gonna be 58 in a couple weeks, suddenly people start talking about testosterone.

   10. MEDr. Michael Eisenberg10:07

       Mm-hmm.

   11. MRMel Robbins10:08

       Uh, uh, it, it starts on walks that women have together-

   12. MEDr. Michael Eisenberg10:11

       [laughs]

   13. MRMel Robbins10:11

       ... as they're talking about their partners. [laughs]

   14. MEDr. Michael Eisenberg10:14

       Mm-hmm.

   15. MRMel Robbins10:14

       But I've noticed more and more people talking about it. And one of the first things that I was really wondering about is how often should men get their testosterone checked, and at what age?

   16. MEDr. Michael Eisenberg10:30

       Yeah. There's many of the different reasons that we give it. You know, some men have ... Uh, they don't produce normal testosterone because of some medical condition. So for example, some men with, like, testicular cancer lose one or both testicles. The levels can go down. You know, if there's a history of chemotherapy, that can affect it. You know, some men with, like, anemia, the very low blood counts, we worry about that. Men with low bone mineral density, that's another warning sign. So if you're having symptoms of low testosterone, so again, energy level, you know, low energy level, low sex drive, mood, sleep, erectile dysfunction, these are also reasons that sort of clue you in, could this be testosterone? Could this be hormonal? And then you can have it checked. So just like you go to your doctor and getting checked for blood pressure, cholesterol, blood sugar, I think it's a simple test to add on because, you know, our levels do change a lot. So getting checked, I think, sooner rather than later is a reasonable thing to do. Probably, you know, starting maybe 40, 50. But again, if you have some of these other things, you wanna check much, much earlier.

   17. MRMel Robbins11:26

       And is it just a blood draw, or how do they check testosterone?

   18. MEDr. Michael Eisenberg11:29

       That's exactly right. It's just a blood draw. So our levels do change based on time of day.

   19. MRMel Robbins11:33

       Okay.

   20. MEDr. Michael Eisenberg11:33

       So usually we check it in the morning, ideally in the fasted state, although, you know, honestly in my clinic I'm not so particular about that. But I say before 9:00 or 10:00 in the morning. And then we usually also wanna repeat it. So if we get one low level, we'll do another one. And if those are both confirmatory and also symptoms, then we talk about, you know, supplementation.

   21. MRMel Robbins11:52

       The second you said the thing about, uh, testicular cancer, I'm like, wait a minute. My husband had a hernia surgery related to, I, I don't know the technical name, the balls. So he only has one ball.

   22. MEDr. Michael Eisenberg12:05

       Okay.

   23. MRMel Robbins12:05

       And I'm like, whoa. That might- ... actually be the reason why he has low testosterone. Dr. Eisenberg, why are we so embarrassed to talk about this?

   24. MEDr. Michael Eisenberg12:14

       I don't know. I think that, you know, it's gotten a lot better. And I think, you know, to your point, I think people are more and more comfortable talking about testosterone. Just like, you know, 20 years ago when Viagra came on the market-

   25. MRMel Robbins12:24

       Mm-hmm

   26. MEDr. Michael Eisenberg12:24

       ... for erectile dysfunction, I think that made people a lot more comfortable. And I think there are spokesmen now and people are very open about being on testosterone, all the benefits. But, you know, I think there's also just this, you know, feeling of shame a little bit and guilt, something, you know, like sort of concerns about their own masculinity-

   27. MRMel Robbins12:42

       Hmm

   28. MEDr. Michael Eisenberg12:42

       ... that if their body can't produce enough, there's something wrong, and that's absolutely not the case. There's a lot we can do. It's very common to have these lower numbers, um, and treatment is certainly underway. But what I was saying with if you lose a testicle, oftentimes the other one is able to compensate. It's able to grow, again, depending on what happened and when it happened.

   29. MRMel Robbins12:58

       It's like a super testicle.

   30. MEDr. Michael Eisenberg12:59

       Yeah.
4. 13:52 – 20:49

   What Causes Low Testosterone in Men?

   1. MRMel Robbins13:52

      I'd love to ask a few questions about how specific things-

   2. MEDr. Michael Eisenberg13:58

      Mm-hmm

   3. MRMel Robbins13:58

      ... can impact your levels of testosterone. How does poor sleep-

   4. MEDr. Michael Eisenberg14:04

      Hmm

   5. MRMel Robbins14:04

      ... impact your testosterone levels? Here we go. Okay, he's got a, you've got a sign. Oh, cool. Poor sleep.

   6. MEDr. Michael Eisenberg14:12

      Poor sleep. So poor sleep affects testosterone, you know, through a few mechanisms, but primarily it really just blunts our normal, you know, kind of feedback. So the way that we produce testosterone is the brain sends signals to the testicle. Uh, and it kind of senses when there's enough testosterone, so there's this elaborate feedback loop. And poor sleep really blunts hormonal function just broadly, but certainly involving testosterone production. And so without this sort of normal rhythm that we see, you know, higher levels in the morning and kind of gradually kind of calming down as we go to sleep, without that, basically there's just a general suppression of testosterone. So that's one of the main mechanisms. Certainly men that are very sleep-deprived, we see that, but even if you're just not getting enough sleep on a regular basis. You know, ideally seven to nine hours, but these men that, you know, say they only need a little or they're, you know, four to five hours a night, we do see that suppression. Shift work, all these things that disturb just normal circadian rhythm can affect it.

   7. MRMel Robbins15:07

      Do you see any kind of connection with somebody who may struggle with, like, sleep apnea and the low testosterone levels?

   8. MEDr. Michael Eisenberg15:13

      Absolutely. Absolutely. And it, you know, in some ways it can kind of ... It sort of feeds back on itself, 'cause low testosterone is thought to be associated with sleep apnea, and sleep apnea leads to low testosterone. So in some ways it's sort of circular.

   9. MRMel Robbins15:25

      Yeah.

   10. MEDr. Michael Eisenberg15:25

       But we definitely see that association.

   11. MRMel Robbins15:27

       It's interesting.

   12. MEDr. Michael Eisenberg15:27

       Mm-hmm.

   13. MRMel Robbins15:28

       And very helpful. How does excess body fat impact your testosterone levels, Dr. Eisenberg?

   14. MEDr. Michael Eisenberg15:35

       All right. So testosterone is made in the testicle, and then in the peripheral tissue, some of it is converted to estradiol, and that's one of the main ways that, you know, our body regulates testosterone production. 'Cause estradiol is ... You know, think of it as a female hormone, but certainly men have a lot. It's very important for our function as well, for bone health, for sexual health. But it also impacts primarily this feedback mechanism that our body uses to regulate testosterone. And a lot of that conversion of testosterone to estradiol happens in fatty tissue.

   15. MRMel Robbins16:07

       Huh.

   16. MEDr. Michael Eisenberg16:07

       So the more fatty tissue there is, the more conversion to estradiol. So you kind of see this as sort of a leech or pulling out of testosterone from circulation. So if we're too big, it can affect that. And also excess body weight can be insulation. Testicles are outside the body 'cause they need to be a little cooler. Mostly it's for sperm production, but it can also affect hormonal health as well. So having excess body weight, this poor metabolic state impacts just normal hormonal regulation, so can kind of blunt the normal response-

   17. MRMel Robbins16:34

       Huh

   18. MEDr. Michael Eisenberg16:34

       ... that we see for normal production.

   19. MRMel Robbins16:36

       If you see a patient go on one of these life-changing GLP-1 medications-

   20. MEDr. Michael Eisenberg16:42

       Mm-hmm

   21. MRMel Robbins16:42

       ... and they start to lose a lot of weight, do you typically see somebody's testosterone levels rise when that happens?

   22. MEDr. Michael Eisenberg16:48

       Anecdotally, I have seen that. I think losing body weight from caloric restriction, I think, and not, not if you starve yourself-

   23. MRMel Robbins16:54

       Yeah

   24. MEDr. Michael Eisenberg16:54

       ... but if you, you know, good diet, exercise, if we see that and they lose weight, we can also see improvements. Um, you know, certainly, you know, GLP-1s I've seen that. Bariatric surgery reliably increases testosterone. So I think any way you can lose weight, you know, kind of getting an ideal body weight, I think that's really gonna be crucial. Anything that's good for your heart's good for testosterone.

   25. MRMel Robbins17:13

       That makes a lot of sense. How does, uh, chronic stress... A lot of people, the number one word that we're seeing right now, Dr. Eisenberg, from our audience globally is exhausted.

   26. MEDr. Michael Eisenberg17:23

       Mm-hmm.

   27. MRMel Robbins17:24

       And I'd love to know how does chronic stress impact testosterone levels?

   28. MEDr. Michael Eisenberg17:30

       Yeah, we get stressed from so many things in our life, right? Work, home, you know, ev- everything. And so-

   29. MRMel Robbins17:37

       Spouses. [laughs]

   30. MEDr. Michael Eisenberg17:38

       Yes.
5. 20:49 – 25:25

   Can Depression Cause Low Testosterone?

   1. MRMel Robbins20:49

      Uh, Dr. Eisenberg, can you talk about the connection between depression and testosterone? Ah.

   2. MEDr. Michael Eisenberg21:00

      So depression and low testosterone I think are very closely linked. And this is one where we think low testosterone itself can impair mood. Uh, and but also depression itself can also impair testosterone production. Uh, and so when we think about how that would happen, I think there's a few mechanisms. But, you know, really primarily, again, it, it leads to the same sort of lack of ability of the body to respond-

   3. MRMel Robbins21:23

      Mm

   4. MEDr. Michael Eisenberg21:23

      ... to normal stresses and normal circadian rhythms. And it just sort of blunts that hypothalamic, which is, you know, a region in the brain that stimulates this other region called the pituitary, which then stimulates the testicle. So all that, you know, that signaling is basically lost a little when these men have depression. And the other thing I think to think about depression is a lot of times there are very effective treatments for it. But those themselves, some of these medications that we talk about, are also very impactful on testosterone production.

   5. MRMel Robbins21:49

      Meaning they make it rise?

   6. MEDr. Michael Eisenberg21:50

      They make it go down, unfortunately.

   7. MRMel Robbins21:52

      Oh, no. So you may be treating the depression-

   8. MEDr. Michael Eisenberg21:54

      Mm-hmm

   9. MRMel Robbins21:55

      ... with a medication that sort of lifts the fog.

   10. MEDr. Michael Eisenberg21:57

       Yeah.

   11. MRMel Robbins21:58

       But at the same time, it's lowering testosterone, which can continue to make you feel like you're moving through sludge as you-

   12. MEDr. Michael Eisenberg22:07

       Yeah

   13. MRMel Robbins22:07

       ... go through your day.

   14. MEDr. Michael Eisenberg22:08

       Yeah. It can affect hormonal health and then sexual health as well. So it is-

   15. MRMel Robbins22:11

       Wow. S- so it's important to understand that these things can coexist.

   16. MEDr. Michael Eisenberg22:17

       Mm-hmm.

   17. MRMel Robbins22:17

       And that it's important to realize that the treatments for one don't necessarily take care of the other, and vice versa.

   18. MEDr. Michael Eisenberg22:25

       Right. Exactly. So you should think about them in some ways independently. And so I have, you know, patients that, you know, do have depression, are on treatment for it-

   19. MRMel Robbins22:32

       Yeah

   20. MEDr. Michael Eisenberg22:32

       ... and then we're also treating their low testosterone. And together, hopefully we can get them to a good place.

   21. MRMel Robbins22:36

       Excellent. Super, super helpful. Let's talk about the connection between alcohol and testosterone, Dr. Eisenberg.

   22. MEDr. Michael Eisenberg22:51

       So alcohol also is associated with low testosterone. And what alcohol does really at every level is blunts the body's response to the feedback of regulating normal levels, and then the signal going down to the testicle, the testicle's ability to make testosterone. All those things are blunted by too much alcohol. So think moderation. If patients are telling you they drink a lot, and it's good to try and, you know, regulate. Some men say they have five drinks a night, seven drinks a night.

   23. MRMel Robbins23:15

       Oh.

   24. MEDr. Michael Eisenberg23:15

       Which is a lot. [laughs] So which is a lot. Yeah.

   25. MRMel Robbins23:19

       Okay. That makes sense.

   26. MEDr. Michael Eisenberg23:20

       Mm-hmm.

   27. MRMel Robbins23:20

       So if-- And you've seen that when people curb the drinking, the testosterone can rise?

   28. MEDr. Michael Eisenberg23:27

       It can go back up. That's exactly right.

   29. MRMel Robbins23:29

       Huh.

   30. MEDr. Michael Eisenberg23:29

       And you know, it's, it's never quite as easy as saying stop, and they stop immediately. But, you know, gradually cutting down, getting in a program, I think we do see improvements for sure. And it-- But I think also beyond just testosterone, really, it's gonna improve their overall health. That level of substance abuse and alcohol dependence is gonna have many, many impacts. And so they do feel better when they get through the other side.
6. 25:25 – 28:01

   The Different Ways to Take Testosterone

   1. MRMel Robbins25:25

      get on it. And I've been very surprised, because my husband has been very resistant-

   2. MEDr. Michael Eisenberg25:31

      Mm-hmm

   3. MRMel Robbins25:31

      ... to even considering testosterone.

   4. MEDr. Michael Eisenberg25:35

      Mm-hmm.

   5. MRMel Robbins25:35

      He's just started talking to doctors about it, and so I would love to dig in a little bit to some of the things that at least he's concerned about, 'cause I'm sure a lot of people are concerned about it. I asked him, "What's your concern about starting it, based on what you know?"

   6. MEDr. Michael Eisenberg25:51

      Mm-hmm.

   7. MRMel Robbins25:51

      And he said that with injections-

   8. MEDr. Michael Eisenberg25:55

      Mm-hmm

   9. MRMel Robbins25:55

      ... I don't even understand what this means, Dr. Eisenberg.

   10. MEDr. Michael Eisenberg25:57

       Okay.

   11. MRMel Robbins25:58

       That with injections, it's a lot of oil intake for the next 30 years of my life. Oil intake? And that the long-term effects of taking it for that long of a time have not been researched. Those were his two concerns, the long-term effect and that it's a lot of... I don't know what oil intake. Maybe that was a, a mistake. Is it oil?

   12. MEDr. Michael Eisenberg26:21

       It is oil.

   13. MRMel Robbins26:22

       Oh.

   14. MEDr. Michael Eisenberg26:22

       So the injectable testosterone-- No, he's exactly right-

   15. MRMel Robbins26:24

       Okay

   16. MEDr. Michael Eisenberg26:24

       ... uh, is an oil-based, um, medicine.

   17. MRMel Robbins26:27

       Okay.

   18. MEDr. Michael Eisenberg26:27

       So you basically inject kind of this oil, you know, into the, in the muscle. And you can do it in different ways and, you know, I usually teach men to do it in their thigh. If they have a partner, can do it in the buttocks. But it is an injection that's done on a regular basis. For injections, you know, the standard is probably doing every two weeks. S- You know, you do kind of get this peaks and valleys. Some men feel that, so sometimes we shorten the duration. They do it once or twice a week.

   19. MRMel Robbins26:48

       Uh-huh.

   20. MEDr. Michael Eisenberg26:49

       Um, but testosterone therapy has been done for decades and decades. You know, it's very, very safe. Now, there's different ways to give testosterone. So some men certainly don't like the in- idea of injections.

   21. MRMel Robbins26:59

       Uh-huh.

   22. MEDr. Michael Eisenberg27:00

       Uh, so there are longer-acting injections that can be done every few months, so that may be more appealing for him. There's gels that you could put on, you know, every day. So again, there's no needle at all. There's different testosterone pellets that can be put underneath, like, usually under the skin in the hip area is classically where it's done. So again, there's not any needles with that.

   23. MRMel Robbins27:18

       Has the pellets been tested by the FDA?

   24. MEDr. Michael Eisenberg27:21

       Mm-hmm.

   25. MRMel Robbins27:21

       Because, because I know that we've had medical experts come on and talk at least with, uh, when it comes to women's hormones.

   26. MEDr. Michael Eisenberg27:29

       Mm-hmm.

   27. MRMel Robbins27:29

       There's been several medical experts that have come on to say they don't like the pellets because they haven't been, uh, approved by the FDA. But that was a couple years ago, so maybe things have changed.

   28. MEDr. Michael Eisenberg27:40

       Yeah. For the men, it, it certainly has.

   29. MRMel Robbins27:42

       Okay.

   30. MEDr. Michael Eisenberg27:42

       Yeah, there's no FDA-approved testosterone for women.
7. 28:01 – 30:56

   What Are the Side Effects of Testosterone?

   1. MRMel Robbins28:01

      What are the negative side effects, Dr. Eisenberg, of testosterone?

   2. MEDr. Michael Eisenberg28:06

      Um, testosterone has been tested by the World Health Organization as a contraceptive, so it can actually lower sperm production. Does that pretty reliably, probably 90% of the time.

   3. MRMel Robbins28:15

      Wait. Oh, I'm confused.

   4. MEDr. Michael Eisenberg28:17

      Mm-hmm.

   5. MRMel Robbins28:17

      Hold on a second. You said testosterone is a contraceptive?

   6. MEDr. Michael Eisenberg28:21

      In men it is, yeah.

   7. MRMel Robbins28:22

      It lowers your sperm count?

   8. MEDr. Michael Eisenberg28:24

      Mm-hmm.

   9. MRMel Robbins28:25

      Wouldn't it increase it?

   10. MEDr. Michael Eisenberg28:27

       Well, you'd think that, but there's many reasons that it doesn't. So, uh, if we think about how the body makes testosterone, you know, again, we talked about the brain signaling the testicle-

   11. MRMel Robbins28:36

       Mm-hmm

   12. MEDr. Michael Eisenberg28:36

       ... to make testosterone, and then there's a feedback loop. So your body knows when it needs testosterone to kind of sending the signal down. So when you take testosterone exogenously, you know, whether it be injection, gel, any of the different methods-

   13. MRMel Robbins28:46

       What is exo- do- what does that-

   14. MEDr. Michael Eisenberg28:48

       Oh, exogenous.

   15. MRMel Robbins28:48

       Yeah, what does that mean?

   16. MEDr. Michael Eisenberg28:48

       So outside testosterone.

   17. MRMel Robbins28:49

       Okay, got it. Okay.

   18. MEDr. Michael Eisenberg28:50

       When you do that, your body says, "Oh, there's enough testosterone. I don't need to make any more." And so if the brain doesn't signal the testicle to make testosterone, it stops doing that, but it also stops making sperm. So those signals are very, very closely related. In addition, in the testicle, the testosterone levels are probably about a hundredfold higher. So if your normal testosterone is kind of swimming around in the blood at 500, let's say, it needs to be, you know, 5,000 or much higher than that even. And so when your testicle doesn't see this super, you know, 5,000, 50,000 level of testosterone, then you're not gonna make sperm efficiently either, because you need those high levels of testosterone for-

   19. MRMel Robbins29:30

       Huh

   20. MEDr. Michael Eisenberg29:30

       ... efficient sperm production or spermatogenesis.

   21. MRMel Robbins29:32

       Wow.

   22. MEDr. Michael Eisenberg29:32

       So there's sort of two different methods, so low testosterone in the testicle and then not that signal to make sperm. So that's what we ha-- that's what happens with, uh, with testosterone.

   23. MRMel Robbins29:42

       That makes a lot of sense. So low sperm count is one negative side effect.

   24. MEDr. Michael Eisenberg29:46

       Mm.

   25. MRMel Robbins29:47

       What are some other potential negative side effects from taking testosterone?

   26. MEDr. Michael Eisenberg29:52

       There can be skin changes, can lead to oil skin acne, can lead to hair loss, breast growth as well, as testosterone is converted to estrogen, which we do need for normal, you know, function. But if estrogen levels get too high, there can be some breast growth, so sometimes we see that as well. Now, there used to also be some concerns about prostate health and even heart health with testosterone, but there was a very landmark study of about 5,000 men called the Traverse Trial, where men were given testosterone, men were given placebo, so, you know, kind of a, a dummy gel, and then just followed to see if there were higher risks of any of these adverse outcomes, and it turns out there weren't. So we used to worry that if you add testosterone to men, they're gonna see more levels of prostate cancer- That was debunked.

   27. MRMel Robbins30:33

       Yeah.

   28. MEDr. Michael Eisenberg30:33

       And then there was also some early signals that men on testosterone are higher risk of like heart attacks and strokes. Also with this study, we didn't see that, so that's also been debunked. So the FDA's actually gonna update guidance on, you know, the prescribing and some of the warning labels to remove those, uh, because I think that was also a barrier similar to, um, you know, female hormone replacement. Uh, so I think hopefully that'll help a lot of men as well.

8. 30:56 – 33:10

   What to Know Before Starting Testosterone

   1. MRMel Robbins30:56

      Dr. Eisenberg, is it important that you go see a urologist or your like general practitioner and that a doctor's overseeing this?

   2. MEDr. Michael Eisenberg31:05

      It's so crucial that a doctor oversees this, 'cause you can certainly be abused or misused or misprescribed. You can give anybody testosterone, but you really wanna make sure you're giving it to people that need it, otherwise you're just exposing them to all the risks and none of the benefits. And we've seen from our best evidence that if your testosterone is normal and you're given testosterone, it's very unlikely to help any problem you have.

   3. MRMel Robbins31:26

      Wait, say that again.

   4. MEDr. Michael Eisenberg31:28

      It's such a crucial point that if you have a normal testosterone and you're given testosterone, it's unlikely to help with some of these other symptoms, you know, that people would come in for, for sexual dysfunction, for example, for performance. People think that if I take testosterone, I'm gonna be a better version of me, and that's, that's not the case. There have been studies in the military thinking about testosterone as a performance enhancer. Uh, and while it did help with lean body mass for, you know, kind of military sort of hero exercises these men were doing, whether they got testosterone or whether they got placebo, their performance was similar, their recovery was similar.

   5. MRMel Robbins32:03

      Wow.

   6. MEDr. Michael Eisenberg32:03

      So if you have normal levels, you probably shouldn't be on testosterone. And so I do worry that some of these clinics that'll just prescribe it, right? That's how they make money, right? Is just giving these prescriptions, upselling. If you don't need it, you shouldn't be on it because you're gonna get exposed to all these risks that we talked about, right? Like hair loss, breast growth, you know, higher levels of, you know, red blood cell count, which can lead to clotting risk.

   7. MRMel Robbins32:28

      I am so glad you're saying this because I just assumed that if you're a guy in your 20s, 30s or 40s and you wanna look more ripped, and you wanna perform better in the bedroom, and you want to be more energized, just start testosterone now. It never even occurred to me that it might not do anything except for lower your sperm count-

   8. MEDr. Michael Eisenberg32:47

      Yeah

   9. MRMel Robbins32:48

      ... raise your blood count, make you lose hair. Wow.

   10. MEDr. Michael Eisenberg32:52

       Yeah. Yeah, I think that's something that men need to be aware of, that it's not all upside, and I think it's not for everybody. And so I think seeing somebody that understands all of our guidelines from the American Urologic Association, the Endocrine Society-

   11. MRMel Robbins33:05

       Yeah

   12. MEDr. Michael Eisenberg33:05

       ... very thoughtful, data-driven approaches to this. And so I think that's really crucial.

9. 33:10 – 35:47

   How Long Should You Take Testosterone?

   1. MRMel Robbins33:10

      One of my husband's big concerns-

   2. MEDr. Michael Eisenberg33:12

      Mm-hmm

   3. MRMel Robbins33:12

      ... is that once I start this, I have to-

   4. MEDr. Michael Eisenberg33:15

      Mm-hmm

   5. MRMel Robbins33:16

      ... take this for the rest of my life. And so Dr. Eisenberg, once you start testosterone, do you have to take it for the rest of your life?

   6. MEDr. Michael Eisenberg33:24

      So I think it depends. For men that, you know, don't make their own testosterone, so for men like that have lost both their testicles or some congenital conditions where the testicles don't function properly, those men do need to be on testosterone forever. But for these other conditions where men, you know, have some symptoms, low energy level, sexual dysfunction, found to have some lower levels, usually we start it as a trial period. I think all-

   7. MRMel Robbins33:45

      Yeah

   8. MEDr. Michael Eisenberg33:45

      ... the different societies recommend this. You know, we start testosterone. We'll check the levels to make sure you're in a therapeutic range. Sometimes we'll switch between formulations so we can get there so it's convenient. And if they see the benefit, again, which a lot of men do, they wanna be on it because they do see sort of a better version of themselves. But if they really don't notice any changes, then we'll just stop it. So after six months, after a year, if they're not seeing those improvements, then we can stop it. Or if there's other reasons. You know, we talked about some of the causes of low testosterone, like obesity, for example. So if they can start testosterone, sort of reclaim their health-

   9. MRMel Robbins34:16

      Mm

   10. MEDr. Michael Eisenberg34:16

       ... you know, lose some of that weight, then the body's own production can kind of boost up and then we can wean them off. Their body takes over, and hopefully they're at a normal level after that.

   11. MRMel Robbins34:26

       So let you bring this up with your partner, 'cause I can already hear the send ... I, I can hear-

   12. MEDr. Michael Eisenberg34:32

       Yeah. [laughs]

   13. MRMel Robbins34:32

       ... somebody copying the link to this episode-

   14. MEDr. Michael Eisenberg34:35

       Mm-hmm

   15. MRMel Robbins34:35

       ... as they're listening to it right now and texting it to their partner. But how do you bring this up? Uh, all my girlfriends and I are talking about this and the fact that we have all diagnosed our husbands with low testosterone. [laughs]

   16. MEDr. Michael Eisenberg34:48

       Yeah.

   17. MRMel Robbins34:49

       So what, what's the most empowering and compassionate way to bring this up?

   18. MEDr. Michael Eisenberg34:55

       It's a good question. It's gonna be, you know, kind of individualized, but I think there's many ways to sort of approach the subject. I think we've talked about these symptoms before. Could be testosterone. Have you thought about bringing it up to Dr. Smith next time you go in to see her? Um, or heard this super interesting podcast, um, about testosterone. Sounds like it's really just, uh, linked to some function, but it's also linked to longevity, and I love you, I want you to be there forever. You know, if you haven't had it checked, it sounds like it's easy enough to do. Maybe we can do that. So I think kind with health, with strength. You know, in your 30s everything's super easy to do. But as you're kind of getting older, normal household chores, bringing in a bag of groceries, everything gets a little bit harder. So I think an easy way to get checked, and maybe there's something that can be done to, to help with some of those things too.

   19. MRMel Robbins35:38

       Amazing. Dr. Eisenberg, thank you for explaining everything that you just did about hormone health, testosterone.

10. 35:47 – 39:56

    What Causes Erectile Dysfunction?

    1. MRMel Robbins35:47

       I wanna switch gears and talk about a topic that can be really difficult to talk about, which is erectile dysfunction.

    2. MEDr. Michael Eisenberg35:54

       Yeah.

    3. MRMel Robbins35:55

       What is erectile dysfunction?

    4. MEDr. Michael Eisenberg35:57

       [laughs] Erectile dysfunction is the consistent or recurrent inability of a man to attain or maintain an erection sufficient for sexual activity.

    5. MRMel Robbins36:07

       How common is it?

    6. MEDr. Michael Eisenberg36:09

       It's so common. I think that, you know, when men come in, they think they're the only one affected. But if you look at studies, there's a famous study called the Massachusetts Male Aging Study done here about, you know, 20 years ago or so, that shows that if you look at men over the age of 40, over half have some trouble with erectile dysfunction.

    7. MRMel Robbins36:24

       Over half?

    8. MEDr. Michael Eisenberg36:25

       Over half. And it increases every decade of life. So men in their 40s, about 40%, 50 is 50%, 60, 60%, 70, 70% have some trouble with erections. And even men, it kind of goes all the way down the other range, too. So, you know, men that I see in their 20s, 30s, probably 15 to 20%. So it's a very common issue.

    9. MRMel Robbins36:43

       What causes erectile dysfunction?

    10. MEDr. Michael Eisenberg36:46

        There's a host of things. So ultimately, you know, what erections are is blood going into the penis and getting trapped there. And I think it may be helpful just to-

    11. MRMel Robbins36:52

        Sure

    12. MEDr. Michael Eisenberg36:54

        ... we can look at a model here.

    13. MRMel Robbins36:56

        Okay.

    14. MEDr. Michael Eisenberg36:59

        So if you can kind of see this, so this is the erectile body. There's a- urethra's on the bottom here.

    15. MRMel Robbins37:05

        Uh-huh.

    16. MEDr. Michael Eisenberg37:06

        So this is where blood actually goes. So blood goes-

    17. MRMel Robbins37:08

        On the top of it?

    18. MEDr. Michael Eisenberg37:09

        On the top, mm-hmm.

    19. MRMel Robbins37:09

        Okay.

    20. MEDr. Michael Eisenberg37:10

        So these are the erectile bodies. These are what engorge with blood.

    21. MRMel Robbins37:13

        Yep.

    22. MEDr. Michael Eisenberg37:13

        And essentially what happens is when you get stimulation, whether it be, you know, visual, auditory, um, you can ch-

    23. MRMel Robbins37:21

        Touch

    24. MEDr. Michael Eisenberg37:21

        ... touch. Yes. There's many ways it can be done. Absolutely. Um, you get different neurotransmitter release, nitric oxide release, which releases this other chemical called cyclic GMP, which then causes the blood vessels in the penis to dilate, to open up, to let more blood in.

    25. MRMel Robbins37:38

        Okay.

    26. MEDr. Michael Eisenberg37:38

        And then that's what leads to erection. So anything that can affect blood flow anywhere in the body can affect in the penis. So for example, smoking, diabetes, high cholesterol, high blood pressure, all the things, uh, that we think about can, can affect, like heart problems-

    27. MRMel Robbins37:53

        Yeah

    28. MEDr. Michael Eisenberg37:53

        ... can also affect blood flow in the penis, in causing that. Trauma is also notorious for doing that. So for example, like, um, prostate cancer surgery can affect a lot of the main nerve supply to the penis. Some bike saddle seats, for example, can also put pressure on some of the main, uh, nerves that conduct into the penis.

    29. MRMel Robbins38:11

        Really?

    30. MEDr. Michael Eisenberg38:12

        Mm-hmm.
11. 39:56 – 41:58

    The Emotional Impact of Erectile Dysfunction

    1. MRMel Robbins39:56

       How do men feel when they're experiencing erectile dysfunction?

    2. MEDr. Michael Eisenberg40:03

       I mean, erectile dysfunction has such a profound effect on a man. I mean, they feel inadequate, lack of masculinity. They feel a sense of guilt, like they've done something wrong.

    3. MRMel Robbins40:11

       Hmm.

    4. MEDr. Michael Eisenberg40:11

       You know, if they're in a relationship, they feel like they're contributing to marital problems. They sometimes, like, withdraw a little bit. Uh, so we, we see that can lead to depression. Again, these, just feelings of inadequacy. So ultimately, it's a quality of life kind of function. Um, and you know, reproductive at young age, but, you know, towards the end it's, it's sort of this way of intimacy and connection with somebody. And then when you lose that, when you see that you're the issue, when you feel like you're the issue, you kind of feel hopeless. A lot of men are not comfortable talking about this. They don't realize all the things that can be done. Um, you know, we see all these problems.

    5. MRMel Robbins40:47

       Well, it's an important thing to stop and really think about. Because when I went through perimenopause and menopause, I absolutely did not feel like myself. I did not feel attractive. My body started changing in ways that I did not like. And it certainly impacted how I felt about myself. But listening to you, I'm sitting here thinking, "But my vagina still worked." I mean, I might not have liked what my body felt like, but I could still be intimate with Chris. And when you really stop and think not just that your body no longer feels like it's your own and you can't count on something that you have for a lot of your life, so I can understand that piece-

    6. MEDr. Michael Eisenberg41:32

       Mm-hmm

    7. MRMel Robbins41:32

       ... of losing control. But also feeling like you can't perform something that's one of the most awesome things about life with your partner.

    8. MEDr. Michael Eisenberg41:42

       Yeah. No, I think that's exactly right. I think, and it also is something that, it just separates yourself from your partner.

    9. MRMel Robbins41:47

       Right.

    10. MEDr. Michael Eisenberg41:47

        As you're going through this huge problem, one of the ways you used to connect is now lost.

    11. MRMel Robbins41:52

        Yeah.

    12. MEDr. Michael Eisenberg41:52

        And some of these men feel that it's, you know, their problem and there's nothing that can be done. I think this hopelessness is something that I definitely hear about a

12. 41:58 – 52:08

    The Best Treatments for Erectile Dysfunction

    1. MEDr. Michael Eisenberg41:58

       lot.

    2. MRMel Robbins41:58

       What do you want women in particular to know if you are with somebody who is experiencing erectile dysfunction?

    3. MEDr. Michael Eisenberg42:06

       I think there's two things. I think that, you know, one is it's very common. So just know that, you know, man is not alone. And then I think the other thing is that there's a lot that can be done. I always like to tell men, as long as you have a penis, we can always make it hard. So just let them know that [laughs] there's, there's therapies that are available.

    4. MRMel Robbins42:21

       [laughs] As long as you have a penis, we can always make it hard.

    5. MEDr. Michael Eisenberg42:26

       Yeah.

    6. MRMel Robbins42:26

       Really?

    7. MEDr. Michael Eisenberg42:27

       That's right. Yeah.

    8. MRMel Robbins42:28

       You can fix any.

    9. MEDr. Michael Eisenberg42:29

       Mm-hmm.

    10. MRMel Robbins42:29

        Any penis.

    11. MEDr. Michael Eisenberg42:29

        We can fix anything. Yep. It's li- yeah. There's, there's things that we do. So you have to be willing to be very aggressive, but there's always a therapy

    12. MRMel Robbins42:36

        Wow.

    13. MEDr. Michael Eisenberg42:37

        Mm-hmm.

    14. MRMel Robbins42:38

        Well, let's talk about what can be done if you're experiencing erectile dysfunction.

    15. MEDr. Michael Eisenberg42:42

        All right, so the first thing we wanna do is look holistically at their health to sort of understand what medications they're on, 'cause there are some medications that can affect it. Sometimes we see blood pressure medications are notorious for causing problems. Sometimes antipsychotics, antidepressants. Those are all things to think about. Maybe talk to some of their other doctors. That's one of the reasons I do get on the phone with referring providers sometimes. Um, and then look at their health, too. What are they doing? Are they exercising? What is their diet like? What's their BMI, their body mass index? 'Cause these are things that we could potentially correct. Once we've done that and everything's optimized as much as possible, we talked about some treatments. So the first line is gonna be pills, and I actually brought some here, just so everybody knows. So these are called phosphodiesterase inhibitors.

    16. MRMel Robbins43:28

        Who?

    17. MEDr. Michael Eisenberg43:28

        [laughs] So the things that we hear about, like Viagra, sildenafil; uh, vardenafil or Levitra; tadalafil, Cialis. These are the ones that are on TV. Um, so these are the pills that help with erections. And basically-

    18. MRMel Robbins43:41

        Are they all the same by a different name, or do they work differently?

    19. MEDr. Michael Eisenberg43:44

        They are sort of cousins.

    20. MRMel Robbins43:45

        Okay.

    21. MEDr. Michael Eisenberg43:46

        So they have the same mechanism of action. The molecule's a little bit different. Some of their chemical property is a little different. So some last longer in the body. Some act a little quicker. So depending on what the goals are, you know, we prescribe some in different conditions. And some men do respond better to one than the other. Sometimes men have different side effects with all of them. But again, they're very, very similar.

    22. MRMel Robbins44:05

        Okay.

    23. MEDr. Michael Eisenberg44:05

        But men kinda react a little bit differently.

    24. MRMel Robbins44:07

        Do all of these medications impact blood flow? Is that basically what they're doing?

    25. MEDr. Michael Eisenberg44:12

        That's basically what they do. The way that erections work, again, is, you know, we get the stimulation, which lead to this vasodilation or opening up of the blood vessels.

    26. MRMel Robbins44:20

        Mm-hmm.

    27. MEDr. Michael Eisenberg44:20

        So one of the main signals for that is this medi- is this chemical called cyclic GMP, and it's broken down. So what these medications do is prevent the breaking down of this, uh, this chemical. So the more of the chemical's there, the more the blood vessels stay open, the longer the erection can last, the easier it is to get erections. All those sorts of things.

    28. MRMel Robbins44:37

        Wow. Can you walk us what the drug does, and, like, what are the, what's the downside to it, and, like, why you would prescribe that one versus a different one?

    29. MEDr. Michael Eisenberg44:47

        Well, I th-

    30. MRMel Robbins44:47

        Or, and l- and, like, I don't know if that's a fair question. I don't-
13. 52:08 – 54:42

    The Surprising Health Benefits of Sex

    1. MRMel Robbins52:08

       Um, I would love to have you... Y- what I've heard you talk about the connection between having sex-

    2. MEDr. Michael Eisenberg52:16

       Mm-hmm

    3. MRMel Robbins52:16

       ... and prostate cancer

    4. MEDr. Michael Eisenberg52:18

       Mm-hmm

    5. MRMel Robbins52:19

       Can you unpack that for us?

    6. MEDr. Michael Eisenberg52:21

       Yeah, so there was a famous study that sort of looked at this 30 years ago now, and it said that the more you had, a man ejaculates, the lower the risk of prostate cancer. So really fascinating. So what they found is that men that ejaculated 20 times a month or more compared to those less had about a, a 20% lower risk of developing prostate cancer

    7. MRMel Robbins52:38

       20% lower?

    8. MEDr. Michael Eisenberg52:39

       Mm-hmm. So this was a study of about 30,000 men followed for about 20 years, and they saw this pretty consistently all the different ways they looked at it, all the different age groups. This has been looked at in other studies as well, hundreds of thousands of men, and it's been supported. So why this is is not certain. It doesn't seem to be tied to how a man ejaculates, so whether it be sex, masturbation, for example. Uh, all those seem to give the same trend. Um, it's thought maybe you're kind of clearing toxins, you know, from seminal fluid, preventing crystal formation. I think mechanisms are not clear. We do see that association. Now, 20 ejaculations is a lot a month. You know, maybe for teenagers it's a little easier, but y- certainly as you get older, it can get more challenging. So I don't want to prescribe that for everybody as something to do, but it's an interesting observation. And, you know, when men ask, "Can I masturbate too much?" for example, this is sort of the study that I always relay, that it's probably not harmful. Again, there's some studies say maybe it's even beneficial. The other thing I was gonna say is that there's also been studies linking sexual activity, um, and a number of ejaculations and orgasms to longevity as well. We've talked a lot about how, you know, sexual function is related to overall health, so it may be kind of a marker for that. But there have been studies that show that men that have sex maybe once or twice a week compared to men that have sex sort of rarely, you know, less than once a month, live longer. Live twice as long, in fact. And this is, again, looking at men in their, you know, when they started observation kind of in their 50s, 60s. If you follow these men, they reported, you know, regular sexual activity, they live longer. And that may be having a partner, all that. Things were very beneficial to longevity. Um, but I think it's also something to be aware of. So another reason, you know, maybe they get checked out is that in, in addition to sort of the, the joys of sex, which obviously are numerous, it's, I think when you think about longevity, which is a huge push now in our culture, which is great, you can also see some benefits for that as well

    9. MRMel Robbins54:31

       Well, I'm glad you said the thing about relationships-

    10. MEDr. Michael Eisenberg54:33

        Mm-hmm

    11. MRMel Robbins54:33

        ... because it is true, and so many renowned medical experts have come on-

    12. MEDr. Michael Eisenberg54:40

        Mm-hmm

    13. MRMel Robbins54:40

        ... to talk about the connection

14. 54:42 – 1:01:50

    Why Male Fertility Is Declining

    1. MRMel Robbins54:42

       between your relationships long term- And the quality of your life.

    2. MEDr. Michael Eisenberg54:47

       Yeah.

    3. MRMel Robbins54:48

       And that when you don't have great relationships as you get older and loneliness kicks in-

    4. MEDr. Michael Eisenberg54:54

       Yeah

    5. MRMel Robbins54:54

       ... that that is devastating to your physical health. And so I'm really glad that you're also highlighting that having a healthy sex life, being able to connect intimately with another person-

    6. MEDr. Michael Eisenberg55:07

       Mm-hmm

    7. MRMel Robbins55:07

       ... you're right, it's not only one of the great joys in life, but it is a sign-

    8. MEDr. Michael Eisenberg55:12

       Mm-hmm

    9. MRMel Robbins55:12

       ... that you have relationships that are meaningful to you on a consistent basis.

    10. MEDr. Michael Eisenberg55:18

        Yeah.

    11. MRMel Robbins55:18

        And that intimacy isn't just about the orgasm, it's about the quality of your life.

    12. MEDr. Michael Eisenberg55:24

        Yeah. And that's so, it's so crucial. I think this, sort of the studies that I always like to quote are from Scandinavia where they have these great population birth and death registries. So the famous one I quote from Sweden, where they looked at what effect having a partner has on a man's longevity and mortality and having kids. And it turns out if our ideal is a man that has a partner who's living with her and kids that are living with them, if you get rid of having a partner, the chance of that man dying goes up 60%. And if you get rid of kids, we see the same thing. If a man doesn't have any kids compared to someone that does, 60% higher risk of death.

    13. MRMel Robbins55:56

        Wow.

    14. MEDr. Michael Eisenberg55:56

        And if a man doesn't have a partner or have children, about a threefold higher risk of death. So I think to your point, relationships are so, so crucial. They take care of you, but also it just gives you purpose, right?

    15. MRMel Robbins56:06

        Hmm. And if you're silently struggling-

    16. MEDr. Michael Eisenberg56:09

        Mm-hmm

    17. MRMel Robbins56:09

        ... with either issues related to low testosterone-

    18. MEDr. Michael Eisenberg56:13

        Mm-hmm

    19. MRMel Robbins56:13

        ... or you're struggling with issues related to erectile dysfunction, which is making you pull back from those relationships, that has a profound impact on the overall quality of your life is what you're saying.

    20. MEDr. Michael Eisenberg56:26

        Absolutely. Absolutely.

    21. MRMel Robbins56:27

        Well, I can see why this is critical.

    22. MEDr. Michael Eisenberg56:29

        Mm-hmm.

    23. MRMel Robbins56:30

        And it's not just about sex. It's not just about your mood or your energy. It's about your overall health.

    24. MEDr. Michael Eisenberg56:36

        Yeah, exactly right. Yeah, you want to be there as long as you can for your partner, for everybody, for yourself. So I think that's one of the reasons you should pay attention to this. And this can be like a check engine light, right? That if erections are not as good, it's not just a convenience issue.

    25. MRMel Robbins56:49

        Hmm.

    26. MEDr. Michael Eisenberg56:49

        This also may be sort of a sense of how you're doing. And so you should, you know, talk to your partner, talk to your doctor, go to a doctor and get evaluated, 'cause I think powerful insights you can get and there's a lot that can be done.

    27. MRMel Robbins57:01

        You do a lot of work in male fertility.

    28. MEDr. Michael Eisenberg57:03

        Mm-hmm.

    29. MRMel Robbins57:03

        And I'd love to have you speak, uh, to what we might find surprising-

    30. MEDr. Michael Eisenberg57:09

        Hmm
15. 1:01:50 – 1:05:40

    What Causes Frequent Urination?

    1. MRMel Robbins1:01:50

       men's pelvic floor health? Why is it important to pay attention to, and what is pelvic floor health?

    2. MEDr. Michael Eisenberg1:01:57

       [laughs] So there's a lot of muscles in the pelvic floor that really control everything. So they control erections, ejaculation, orgasm. They're also involved in urine control, bowel control. So it's very important to sort of be aware, you know, how important they are. And a lot of times we just take it for granted. But there's some times where it can lead to problems. So there can be chronic pelvic pain we see. Sometimes some scrotal pain is due to spasms in some of these muscles. After pelvic surgery, like prostate removal for prostate cancer, for example, we teach men how to do some pelvic floor exercises to strengthen some of these muscles to try and regain some of the urinary control that's sometimes compromised after surgery. So I think that there's, uh, a lot that can be done, having some understanding, awareness that it's very important for men and for women to know that.

    3. MRMel Robbins1:02:42

       Let's talk about peeing. So as you age, do you start to drip? Like, do you pee more at night? Like, what do you do if your partner is getting up three or four times a night to pee?

    4. MEDr. Michael Eisenberg1:02:56

       Yeah, so yeah, urination definitely changes with age. So we do see that, that men wake at night. There's different reasons for that. The bladder's under a lot more pressure 'cause as we age, the prostate gets bigger. So the resistance of the outflow track. If we go back to this model, which I think is super helpful. So we see, we make urine, uh, it collects in the bladder, then it goes through this channel, the, the urethra out. And so this is the prostate. So you can imagine, as we age, the prostate can get bigger out-

    5. MRMel Robbins1:03:23

       Mm

    6. MEDr. Michael Eisenberg1:03:23

       ... but it can also get bigger in. So this can narrow this channel and make it harder to empty. So the bladder has to work a little harder. It gets spastic. Sometimes it can reduce capacity, the ability to fill. And so sometimes we just have to wake up at night. Sometimes at night, like with obstructive sleep apnea or other things, we produce more urine at night. And so that also makes us have to wake up more. So once a night's pretty normal, but when it starts to be a little more disruptive, two, three, four times, I think definitely you want to get evaluated. 'Cause there are different medications that can help with that, different treatments that are available. So there are things that can be done.

    7. MRMel Robbins1:03:55

       What about standing there and it's just taking a lot of time for anything to come out?

    8. MEDr. Michael Eisenberg1:04:00

       It depends how much that bothers you. I think if you empty your bladder-

    9. MRMel Robbins1:04:03

       Uh-huh

    10. MEDr. Michael Eisenberg1:04:03

        ... it's probably not a problem.

    11. MRMel Robbins1:04:05

        Okay.

    12. MEDr. Michael Eisenberg1:04:05

        But if it does bother you, bothers your partner, I mean, there's things that can be done. I think one of the big issues is just the prostate resistance. It's harder for everything to, to relax on time, to contract on time. And so there's medications that can help optimize that a little bit too. So that's another option.

    13. MRMel Robbins1:04:19

        If you're having trouble with frequency-

    14. MEDr. Michael Eisenberg1:04:21

        Mm-hmm

    15. MRMel Robbins1:04:21

        ... or emptying your bladder, could it be a sign of a deeper issue with the prostate?

    16. MEDr. Michael Eisenberg1:04:26

        Anytime men have any urinary symptoms, we always want to evaluate to make sure there's nothing we're missing. So we usually check a urine test to make sure there's no signs of infection, inflammation. Those can certainly be-

    17. MRMel Robbins1:04:35

        Huh

    18. MEDr. Michael Eisenberg1:04:35

        ... some of the symptoms that we see. And a lot of times, again, depending on the age, we'll check the prostate-specific antigen, or PSA. It gives us a s- a sense of how big the prostate is, but also it's a screening test for prostate cancer. Usually, this is more of a quality-of-life issue, not a life and death issue. So I think that's what men should be aware of. You know, partners should be aware of that as well. Um, and but, you know, talk to your doctor about it. I think that it is something that men just kind of think is normal, and they just tend to live with it. And if it's not worth a pill, you know, maybe that's fine. But there's usually treatments that are available that are very effective.

    19. MRMel Robbins1:05:07

        That's super helpful. Are there any warning signs that we should be aware of that may indicate prostate cancer?

    20. MEDr. Michael Eisenberg1:05:16

        Usually, most commonly, prostate cancer is, uh, is diagnosed just with a blood test. So it tends to be asymptomatic, and it's just gotten done by screening. So if there's a strong family history, usually we start screening a little bit earlier. Um, but otherwise, guidelines about starting in your 50s, just with an annual or semi-annual test.

    21. MRMel Robbins1:05:33

        Terrific.

    22. MEDr. Michael Eisenberg1:05:33

        Mm-hmm.

    23. MRMel Robbins1:05:33

        That's so helpful. You have taught us so much today, Dr. Eisenberg. If the person

16. 1:05:40 – 1:09:07

    The Health Signs Men Shouldn’t Ignore

    1. MRMel Robbins1:05:40

       listening does just one thing after hearing all of this, what do you think the most important action to take is?

    2. MEDr. Michael Eisenberg1:05:49

       The most important thing I would say is just to be aware of your health. Realize that you have agency, that you can improve things. Take an internal inventory, 'cause we're not just talking about sort of quality of life. I think some of these things could have real impacts on longevity too. Try and be more active. If you haven't seen a doctor before, you don't have to go every year, but getting checked is important to find out what your blood pressure is, what your cholesterol is, 'cause all those things tie so closely to some of these issues that we talked about, testosterone, sexual function, reproductive function. So I think those are also gonna be really crucial. And just know that you can improve them.

    3. MRMel Robbins1:06:22

       Dr. Eisenberg, what are your parting words?

    4. MEDr. Michael Eisenberg1:06:25

       First, I want to thank you for just highlighting men's health. I think men's hormonal health, sexual health, reproductive health, I think it's so important. It's not talked about. Um, but I just want to let everybody know that this is a very important topic and something that a lot needs to be done about and can be done about.

    5. MRMel Robbins1:06:41

       Well, what I love about your work and the way that you talk about it is you make me believe that you can do something. The fact that when I asked about, uh, erectile dysfunc- You're like, "Oh, no, no, no. We can... You got a penis."

    6. MEDr. Michael Eisenberg1:06:55

       [laughs]

    7. MRMel Robbins1:06:55

       "I can make it hard. Oh, no, no, no, no, no. Testosterone, we can work this out." And knowing that you don't have to live-

    8. MEDr. Michael Eisenberg1:07:02

       Mm-hmm

    9. MRMel Robbins1:07:03

       ... in shame. You don't have to live feeling low mood, low energy, that there may be, and there probably are, underlying conditions that medical experts like you have incredible tools and different medications that can truly help you not only feel better, but live a more fulfilling life. I just think that's so cool.

    10. MEDr. Michael Eisenberg1:07:28

        It is really cool.

    11. MRMel Robbins1:07:29

        Thank you for taking time out of your schedule. Thank you for doing the research that you do, and thank you for coming here and educating all of us and giving us the ultimate guide, in my opinion, to male hormone health, and also helping us understand why it actually matters. I love that it's tied to longevity. I love that it's tied to a sense of agency over yourself, and I love that there are things that you can do for every issue that we talked about. So thank you.

    12. MEDr. Michael Eisenberg1:07:59

        Thank you, Mel. This has been a pleasure.

    13. MRMel Robbins1:08:00

        You're welcome. And thank you. Thank you for making time to listen to this. Thank you for being generous with Dr. Eisenberg's teaching and all the time and wisdom that he poured into you, and thank you for sharing this with the men in your life that you care deeply about. And in case no one else tells you, I wanted to be sure to tell you that I love you, and I believe in you, and I believe in your ability to create a better life. And I'm gonna send this to my husband, to my brother. Any man that you send this to, this could help him create a better life. And so thank you, thank you, thank you for making the time to be here. Thank you for watching all the way to the end here on YouTube. I love bringing you world-renowned experts. I know you love it too. Thank you for hitting subscribe. It's the best way for you to support me and all these experts that fly in around the world for one reason: to help you and the people that you love create a better life. All right. I know you want to watch another amazing episode of The Mel Robbins Podcast. You're gonna want to watch this one next, and I'll welcome you in the moment you hit play. [outro music]

Episode duration: 1:09:07