Archive for April, 2010

The Curse of Women’s Urine

Sunday, April 25th, 2010
Estrogens and the manly man.

Estrogens and the manly man.

There must be something in the air… or water. The Bolivian President Evo Morales recently asserted publicly that hormones found in mass-produced foods are “feminizing” men. Speaking about chicken in Bolivia, which he believes are “loaded with feminine hormones,” he suggested that when men eat chicken “they are diverted from their nature as men.” So, is this how metrosexuals came to be?

But wait, the Vatican commented on this issue a year earlier, although they blamed female hormones from birth control pills for the increased estrogens in ground water. Pedro Castellvi, writing in the Vatican newspaper L’Osservatore Romano in 2009, stated: “we have sufficient data to affirm that one of the reasons for the not insignificant rise in male infertility in the west, is the environmental contamination caused by the pill.” Actually, it’s not the birth control pill itself but the urine from women taking the pill.

In fact, to date, the urine of women taking birth control pills has been blamed for worsening sperm counts in men, the growth of female sex organs in male fish, breast growth in young men and the early onset of puberty in young girls. What next?

Can I add a little balance to this discussion? First of all, exactly what is happening to men in Bolivia such that the President is not happy with them? Are they more civilized and less disruptive? Second, male infertility is not necessarily increasing in the western world; it may even be true that men have lower sperm counts now than a generation ago not because they are less fertile but because women are more fertile. Third, estrogens are found everywhere in the environment including in many plants (phytoestrogens) such as soy and legumes, and are not produced exclusively from the urine of women. Fourth, the intersex conditions that have been reported in many animal species tend to be caused by a very specific exposure at a very specific time point during fetal development and have been linked to pesticides, bisphenol A, dioxins and other environmental contaminants (xenoestrogens). Fifth, did we somehow forget about the worldwide obesity epidemic in humans and the fact that fat converts male hormones to female hormones? Lastly, there is little evidence that substantially increasing a man’s estrogen levels as an adult will dramatically alter anything, except maybe waist size and color preferences. Where the truth lies in all of this is currently unknown, but it is hard for me as a urologist to see how women’s urine could be blamed for so much.

Getting it Just Right

Sunday, April 18th, 2010
Caetano Veloso, a masterful, otherworldly voice and an eye on the potential of youth

Caetano Veloso, a masterful, otherworldly voice and an eye on the potential of youth

Had a wonderful evening out with my wife last night at a Caetano Veloso concert at Masonic Hall on Nob Hill in San Francisco. Caetano Veloso is Brazil’s equivalent of Frank Sinatra and is endowed with an absolutely otherworldly voice and reigns from Bahia. He is an historically important figure having led the Bossa Nova and Tropicalia movements in the late 1960’s. He plays it all: Jazz, pop, world beat, folk and ballad styles with an Ellingtonian understanding of harmonic richness.

As the Rolling Stone once said: “He’s a sublime and seductive melodist, a curious musician capable of taking sharp left turns, a historian whose compositions tie past and present together…at once upholding tradition and transcending it.” I have been a fan of his since the mid-1990’s, having seen him perform both in Brazil and in San Francisco. He is now 67 years old, and was simply outstanding again last night.

So how does one get this good? I think I discovered his secret last night, listening to him for the umpteenth time. In addition to his obvious musical gifts, he is at once historically grounded and very modern. And he is a fan of youth. His following remains a generation or two younger than he, and time and again he connects them to their past and to the future. It’s really a form of wisdom that he brings to music.

It is precisely this balance that I seek to achieve in the field of men’s health. Lets forget the stylistic aspects of Caetano Veloso that would be pretty difficult to match. But, bringing the wisdom of old fashioned medicine into the modern age has a certain timeless value. Making it a point not to forget that what has mattered in the doctor-patient relationship since the beginning of time, including trust, communication and empathy also still counts.  And leading the way with original and creative ideas that result in more innovative, efficient and personalized care is undoubtedly “modern.”

Caetano Veloso’s band is always filled with youthful musicians, all in their 20s or 30s. Surely he knows that youth have their ears to the ground and possess an uncanny sense of future…of their future.  Youth holds creativity, brilliance and fire, all forces strong enough to move mountains. Youths take paths that are characteristically unchartered, often “left turns,” and make decisions untainted and undaunted by experience. This all fits in nicely with my philosophy about taking care of men: “Want to take great care of men? Just listen to them.” I move with them just as I move with Caetano.

No Fizzy Colas in the Cathedral

Sunday, April 4th, 2010
Did Warhol know about the "cola limit?"

Did Warhol know about the "cola limit?"

How much coffee or tea do you consume everyday? Since many of us buy Slurpee sized cups of coffee in the morning, you should break those down into units of 8 ounce cups. How about cans of soda and in particular colas? Might be a good idea to keep track of this for a moment, as a recent study of 2,554 young Danish man has suggested that excessive cola intake could lead to lower sperm counts.

For comparison, the average young Danish military recruit consumes about 1 cup of coffee and 1 can of soda daily. This is in addition to about a half of cup of tea and 2 small chocolate bars (why not, Danish chocolate is yummy). This intake was associated with normal semen quality. However, the semen quality of young Danish men who consume more than 2 liters (2.1 quarts) of fizzy colas daily had a 30% less ejaculated sperm than men who drank no colas.

Interestingly, although colas are a weak source of caffeine (ounce for ounce, colas have 65% of the caffeine in coffee) there were no strong correlations between any amount of caffeine intake (even up to 7 cups of coffee a day!) and semen quality in these men. So, it is not likely that caffeine is the issue.

So what is the issue among those men who drink colas in excess? Well, the same issue as those who drink almost anything in excess—they have unhealthier lifestyles than those who consume in moderation. More burgers, more smoking, more alcohol, and fatter.

So, does drinking cola make men infertile? I doubt it, as the average sperm counts in men from all different levels of cola intake in the study were all normal by established fertility standards. Plus, fertility was not actually studied in these men, only a single semen sample. And even a good man can have a bad day.

There is a deeper truth running through this though. And you have heard this from me before. To be the best that you can be reproductively (and in life), do all things in moderation and treat your body like a temple.