Turek On Men's Health » Men’s Health

Try It, You’ll Like It?

Paul Turek, MD — Mon, 07 May 2012 15:00:09 +0000

The pill that started it all in 1998.

As if it’s not top of mind anyway, here’s an update on the state of erection pills. Another one was just approved by the FDA and will hit the streets soon. Its name: Stendra (avanfil). Who names these drugs anyway?

The PDE5i Drugs

This new pill works similarly to the holy triumvirate of Viagra, Levitra and Cialis; it is a full-fledged member of the phosphodiesterase inhibitor (PDE5i) family. In essence, they are like taking coffee for the penis. Stendra is the first such pill to be approved in the last decade and it will certainly be interesting to see how it fares in this field of household giants.

What These Pills Do for You

You may be curious to try one of these pills, even if you don’t need it. You may even have thought to open that email spam folder that says “Bigger, Better, Badder” for quite some time. What can expect when you take these pills? Well, it depends on why you are taking it.

Goal: Trying it for Kicks

All pharmaceutical grade, FDA-approved pills share benefit and risk. The same is true for the PDE5i’s. If you don’t really need any help with your erection, this is termed “recreational use.” In fact, this is more common than you might think. It is estimated that 1 in 5 men ages 18-30 years have tried one of these erection pills for fun. But we know even more. Men claim that the pills prevent sexual failure and improve sexual performance and stamina. And, these pills tend to be used with other recreational drugs and alcohol that can decrease erections. More concerning however, is the well-defined association between illicit drugs, PDE5is and an increase in unsafe sexual behavior and increased HIV transmission.

In the simplest scenario, when they are taken in isolation by healthy young men, there may be a shorter latency period (“down time”) between ejaculation and the next erection. Others observe that the time to ejaculation can be extended.

But, for the most part, a normal erection is a normal erection and these pills would not be expected to offer much benefit to men who don’t really need them. In such cases, the common side effects of these medications such as headaches, facial flushing, nasal stuffiness, upset stomach may be more evident.

Goal: Trying it for Special Situations

Some men need a little help with erections. They may have normal erections at times but at other times, it’s not quite up to speed. This is termed situational erectile dysfunction. Whether it’s early in the relationship, associated with condom use or because of scheduled sex needed to conceive, the associated stress can be a killjoy. For these men, the PDE5is can be man’s best friend since 90-95% of men will recover normal, on-demand erections. Again, if the PDE5is are not really “needed” the side effect profile of these agents can be bothersome and limit their use.

Goal: Trying it Because You Need it

It is for men with true erectile dysfunction that these pills are intended. For those unable to achieve or maintain an erection, these pills are a holy grail. In fact, from 60-85% of men with erectile dysfunction will respond to the PDE5is as first line therapy, a great achievement for any pill. Unfortunately, men in this category may also have associated medical conditions such as diabetes, cholesterol imbalance or heart disease that make medical supervision of patients mandatory. In addition, other medications, including statins (cholesterol lowering) drugs, diltiazem, Zoloft and protease inhibitors to name a few, can interact with PDE5is and affect drug metabolism and produce, at times, life-threatening side effects. Clearly, doctors need to be involved in determining whether or not a patient should consider PDE5is for erectile dysfunction.

The reason these drugs are so popular is obvious. In the words of the self-help author Wayne Dyer, men fully realize that “miracles come in moments. Be ready and willing.”

Why I Love Medicine-Redux

Paul Turek, MD — Mon, 23 Apr 2012 15:00:12 +0000

One great book–but patients also make a great read.

I was recently asked why I love medicine by a health care blog. They published what they could, but there is really more than my response to them revealed. I’d like to set the record straight.

We all grow up reading in school. A book is a pile of paper with words on it. But when viewed carefully and thoughtfully, it can stir the imagination, take you to faraway places and let you drift into the minds of others. In the words of Thomas Mann in Joseph in Egypt, books allow you to experience a barefoot walk “on the greenest of mosses.”

Patients are the Best Books

I first fell in love with medicine when I realized that patients, in a way, are like books. The look of their skin, the movement of their eyes, the tilt of their head, their posture and walk, they way they talk, how they shake your hand and what they tell you is all a part of their story. It is there for the reading.

In the field of men’s health, in which I specialize, I have come to realize that men are books that may be particularly difficult to open and read. Often the books are shut tight. They may even be locked. Maybe it’s cultural, maybe it’s the species, but this makes them hard to read. And, as a consequence, they barely or never get read (i.e. cared for).

My love for medicine grew further when I realized that the key to taking great care of men is figuring how to open the book. It’s there in all of its glory: you just need to figure out how to open it.

Secret #1

Here is a secret: You must be patient and you must listen. Men need to know that they can trust you, not only as a doctor, but also as a human being. Men need to know that you are on their side and honestly 12-minute office visits simply don’t cut it. By listening and observing, instead of dominating the conversation, you can take in the small signs that are otherwise missed, including the doorway conversations that can change everything.

Secret #2

But there’s another secret. Most women do not understand why a have a balsa wood surfboard hanging on the wall of my office. Guys get it. Having a real and palpable personality as a doctor helps patients trust you. And if they trust you, they start to relax. And if they relax, the book opens up, in all of its wonder and richness.

The stories of many famous lives have made great reading. But the stories of everyday lives make equally great books. The mystery, passion, sadness, joy, desires, struggles, hopes and dreams found in the best written books are far more illuminated and intense, magnified and distilled, in everyday life. As the artist Cezanne once said: “…there is a magnificent richness of color that animates nature.”

April Fools in Saudi Arabia?

Paul Turek, MD — Mon, 02 Apr 2012 15:00:17 +0000

Kings Castle, Riyadh, Saudi Arabia, during an evening stroll.

Had April Fools Day come weeks early half way around the world? The thought had crossed my mind just before harsh reality hit.

A Short Trip to Saudi Arabia

It was a long day and I had given several lectures the day before at a medical symposium in Riyadh and headed to King Khalid Airport with just under two hours of sleep. It was just after midnight and I was anxious to get on that long, polar flight home and see my family.

“Sir, your return flights have been cancelled,” said the airport attendant in broken English.

Thinking that exhaustion was affecting my hearing, I leaned over and politely said: “Excuse me?”

He repeated the sentence and then watched me in silence. Both flights. 18 hours. All gone.

A First World Human

In our particular “first world” culture, we are surrounded by, and have access to, lots and lots of things, including information. Much of what we need can be mailed to us from Amazon in neat little packages. We expect our food to arrive fast and hot. We like to place our coffee orders using 4 to 5 adjectives (“triple decafe soy latte”) like the brunch scene in Steve Martin’s LA Story. We also tend to live by written contracts and agreements. We sign for everything. And dammit, I’m sure there was something written somewhere that I could use to get back on these flights.

But I was not in America. I was in Saudi Arabia, where things are different. This is a place where handshakes and eye contact matter far more than a signature. And this has been true for thousands of years, since the time of Mesopotamia and Babylon. As a man named Richard kindly reminded me at the airport, the information age has been incredible, but unlike people, “the Internet does not care, only people do.”

An Old World Human

I wasn’t thinking about all of this at that moment in the airport. I am a surgeon and all I saw was bleeding. Something had to be done and done quickly as the flights were nearly boarding. Unfortunately, I was alone. No colleagues were with me nor available to call at 1 am. I briefly considered responding impulsively, with anger. But, having just spent the better part of a week in the middle of this remarkable country and remarkable people, I thought about it for a moment. The reality was that I was utterly and completely…powerless.

“I really need your help getting home today” I said softly, admitting this to them.

The attendant nodded. As I waited patiently, he moved quickly and grabbed his superiors and they put their heads together. Over the next half an hour, it was as if the seas had parted. After several minutes tapping away on a computer one of them looked up at me and said: “We can get you standby on one of your flights.”

I responded “that’s a great start, thank you” with an encouraging smile.

Several tense minutes later, another attendant looked up and said that my ticket had been restored. I smiled, shook their hands and said “Shukar” or thank you in Arabic.

I still have no idea why my ticket was cancelled. But having access to the world with a smart phone served me no purpose during that tense hour. Trusting in my fellow man, however, made all the difference. I will always remember this old and sturdy concept in our new and fragile world.

No related posts.

Try Not Sitting

Paul Turek, MD — Mon, 27 Feb 2012 16:00:24 +0000

The chair: good for the eye, but bad for health

Have you heard about a new disease that affects almost half of Americans and is lethal if it goes unchecked? It’s called “sitting disease.” It’s real and it’s the new smoking.

The Chair as Enemy

Sitting is an example of a “sedentary” behavior. Either at work or at home as a couch potato, it is considered a “low fitness” activity. Some might argue that it should not even be considered an “activity” given how unfit it is for you. So, why is screen-watching so bad for you?

It’s because several recent studies on sitting, conducted in America and elsewhere, have all observed similar results. People who sit a lot have 50% higher rates of heart disease, diabetes and obesity. And, conversely, if people who sit a lot also take frequent small breaks like standing up to stretch or walk down the hall, they have smaller waists and improved sugar and fat metabolism than those who don’t take breaks. Could this explain the obesity epidemic in our country? Many think it does, and in both children and adults.

Another interesting finding from these studies is that the risk of disease with sedentary lifestyles is unrelated to overall exercise levels. The amount of time you spend sitting and the amount of time you exercise each have their own separate risk for heart disease. So, the cure for too much sitting isn’t more exercise, it’s less sitting.

Facts about Standing

What if you just stand up more? Could this help? You bet and here’s why:

There are roughly 639 muscles in the human body. 300 of them are used for balance when you stand still. Far fewer are needed to sit.
Standing instead of sitting for 4 hours daily burns an extra 200 calories a day
Standing improves your posture and reduces aches and stiffness.
By using large muscle groups, standing improves fat and sugar metabolism
And walking is even better than standing for overall health

The Cure for Sitting Disease

The good news is that this disease is curable and curing it can add years to your life.You know what to do at home: spend less time sitting in front of a screen, whether TV or computer. At work, here are some useful suggestions:

Get up more often throughout the day
Walk to talk to your colleague down the hall, don’t email
Hold walking staff meetings
Take a walk during your lunch break
Park farther away in the parking lot
Use ergonomically designed, elevated desks
Use slow treadmill-based desks

At this point, I’m afraid that I have to disagree with Albert Einstein when he said: “A table, a chair, a bowl of fruit and a violin; what else does a man need to be happy.”

It’s in the Steak

Paul Turek, MD — Tue, 21 Feb 2012 16:00:48 +0000

Hope is a core value of children (Drawing courtesy Sophia Turek, age 7)

In quiet moment on the couch, I recently asked my 8-year old daughter what the word “hope” means to her. “If life were a meal, hope belongs in the steak,” she said.

The food metaphor didn’t surprise me, as with most kids her age, she thinks about it a lot. What did interest me was that, in her view, hope takes center stage. It’s not the cupcake for dessert. Or a sweet milk shake, or potato chips. To kids, hope is serious stuff, right smack in the middle of the main meal. Just a hunch, but I am convinced most adults would not put it there.

A Telling Telephone Call

He called from Kentucky. Having read about our recent research story about obtaining grant funding to build an artificial testicle, he wanted to know more. As a cancer survivor, he had no chance of fathering a child. He asked great questions about where the research was going and the expected time line for generating sperm from stem cells. I answered frankly as I am not a fan of dangling carrots or pipe dreams in front of others. He listened intently and thanked me kindly. I asked him to keep in touch, and that was that.

Little did he know such brief but meaningful conversations stokes my fire and fuels me to imagine, begin, execute and finish such far-fetched research projects.

Little did I know how that single, brief exchange also affected him. The next day, the Clinic received a new Yelp review (don’t get me started on this…just compare the visible reviews on the page with the invisible “filtered” accessed at the bottom). Curious, I read it. It blew me away. It went something like this (edited for brevity):

“H-O-P-E; that’s what Dr. Turek has given me; new found hope…..” After a 16-year nightmare with testicular cancer, once in 1996 and again in 2002, a good friend of mine forwarded me the most shocking, exciting, uplifting, inspiring article I had EVER read. I anxiously and carefully read it word for word, line for line, as I could not believe what my eyes were reading and my mind was comprehending. My instinct, was to call Dr. Turek’s office immediately as I was yearning for more information.”

“After talking with his office staff, a phone conference was scheduled for Dr. Turek and I within the next 3 days…Dr. Turek gave me “me” and he gave the rest of the testicular cancer world a vision that we never imagined possible… I will strive daily to do everything in my power to assist Dr. Turek in seeing this miracle discovery come to life. I will do whatever, whenever, whereever it takes to be a part of this life changing miracle. I am inspired, encouraged, and relieved with the hope of tomorrow for me and for others.”

For the first time in years, the man from Kenucky felt a ray of hope. And in some small way, his life is different today than yesterday.

Hope not Hype

So what is it about being an adult that takes the hope out of our “steak?” Why do long, strong doses of reality make it harder to dream the unimaginable? There is so much promise in hope that I, for the record, refuse to give it up. I agree with the old French Proverb that “hope is the dream of a soul awake.” You can expect more of the unimaginable out of me before my time is up on this good earth.

How is a Medical Visit Like A Ball Game?

Paul Turek, MD — Mon, 23 Jan 2012 16:00:30 +0000

The ultimate male bonding experience in 2012

The world came to San Francisco this weekend. The 49ers hosted the NFC Championship footba ll game at Candlestick Park and it was a day for ages. Friends clamored for tickets, taking seats at any price. Some bought tickets like they were playing the stock market: buy sooner if it rains, later if it doesn’t, or the day before, but not on game day. Not only tailgating, burgers and beer, but stories and tales all flowed freely. A perfect male-bonding experience.

The Culture of Men

As any ball game will convey, clearly the culture of men is fundamentally different from that of women. During my previous life as a decorated academic, my medical office was situated squarely in the middle of a women’s health center, complete with fake impressionist paintings on pink walls, flowers in cute vases and bathrooms with tampon dispensers. Magazines like “Shape,” “Woman’s World” and “O-The Oprah Magazine” covered the waiting room coffee tables. Simply not the best place for male DNA to visit, say nothing of being comfortable there.

The Turek Clinic as Man Cave

Having close to an allergic reaction to this, when I ventured out to create a men’s health clinic, I tried to replicate the ball game experience in a medical office. Here are the essential elements that I considered:

Street parking. For some reason, men prefer it; don’t ask me why.
Convenience. Ball games start on time and (generally) finish on time. Medical visits should also be on time. No long lines, no waiting.
One chance. There are no second chances in playoffs games. When helping men, do as much done as possible in a single office visit. Use follow-up phone appointments after that.
Personality. Sports teams have players and, as everyone knows, players have personality. Men want to know their doctor’s personality. It helps them to develop trust. Sure, a “power wall” of diplomas is nice, but how about hanging a balsa wood surf board in the lobby along with a stylized picture of a late 60s Maserati Ghibli. Men need to trust that their doctor is human and understands them.
Space. Ball games are often outdoors, often in chest-beating, cold weather. Bringing that outdoor feeling inside is important. Floor to ceiling windows facing the San Francisco Bay is perfect, with plenty of room to lounge around on Wi-Fi. And cover the coffee table with men’s magazines, a whole slew of them. Oh, also make sure that there’s ESPN or surfing movies on a large flat screen TV.
The Staff. Here’s where a medical office can beat a ticket taker at a ball game. Imagine being greeted first thing in the morning by a smiling face and an offer of coffee or tea. The essence of The Turek Clinic approach.
Long visits. Ball games take time. Medical office visits should too. Most men are nervous for the first several minutes of any doctor’s visit. Honestly, what can you expect to learn from a patient during that time? The book is just opening. This is precisely why I never understood the average, 12-minute doctor’s visit. Men need time to open up and relax. Not only that, I am convinced that listening to men is the secret to curing their ills.

So is a visit to The Turek Clinic the same as attending a NFC playoff game? Probably not. But it is about as comfortable as men will ever be in a doctor’s office. And they will remember this comfort and trust in the doctor. And if they remember, instead of quietly suffering through another problem in the future, they will reach out and call again. And that is the key to great care for men.

Why is Awake the New Sleep?

Paul Turek, MD — Mon, 28 Nov 2011 16:00:01 +0000

Sleeping Beauty definitely gets enough sleep (Source: Disney)

It was no surprise to me to read a recent study that showed that when Stanford men’s basketball players got more than 10 hours of sleep nightly, their on-court performance improved dramatically. They ran faster sprints, took more accurate shots and were less fatigued. Another example of more sleep translating into improved awake performance.

Facts About Sleep Deprivation

According to a recent national survey and the American Academy of Sleep Medicine, here are the current facts about sleep:

Adults should get 7-9 hours of sleep nightly.
Short sleep is defined as less than 6 hours of sleep.
Almost half (48%) of Americans say that they are not great sleepers.
More than 35% of Americans get less than 7 hours of sleep.
On average, “good” sleepers get 1-hour more sleep every night than poor sleepers.
13% say that they never get a good night’s sleep.
1 in 20 Americans have fallen asleep at the wheel while driving in the past month.
1 in 5 Americans have sex less often or have lost interest in sex because they are too sleepy.
In general, we sleep one hour less every night with each passing generation.

Sleep as Oxygen

During sleep, body temperature falls, muscles relax, the heart beats more slowly, blood pressure and pulse rate fall, and breathing slows. Clearly, sleep is more than simply rest and relaxation. It is a time of growth, recuperation and repair. Losing sleep may not physically kill you like being oxygen-deprived, but short sleep patterns are linked to depression, obesity, heart disease, loss of sex drive, attention disorders and a higher likelihood of developing a work-related disability. One Swedish study even showed that sleep deprived people look tired and less healthy and therefore less attractive to others.

Not only that, it’s not that easy to bounce back after losing sleep. The impairments caused by sleep-deprivation remain even after sleeping in for a day. Full recovery after sleep deprivation may take several nights of extended sleep.

So why does our society applaud those who stay up working all night rather than sleeping? Sleep deprivation is no badge of honor; it’s a threat to your health. Maybe this is why the Guinness Book of World Records refuses to recognize any record claims for lack of slumber. In my view, sleep ranks up there with nutrition and exercise as important pillars for a healthy, long and fulfilling life.

Are Fathers Better Citizens?

Paul Turek, MD — Mon, 21 Nov 2011 16:00:01 +0000

What wouldn't you give to help one of these? (Source: Leonardo Da Vinci, 1468)

As a surfer, I remember charging pretty big walls of cold, wintery Northern California water with the goal of getting a fast, albeit short, adrenaline-stoked ride. Years ago on Thanksgiving, I was pummeled by a big swell to the point that I wondered whether I would make it out of the water alive. But once I married and had kids, the risk element of waves larger than a single story high became less attractive to me. It wasn’t worth it. Too much at stake. Does fatherhood also reduce other types of risky behavior?

Fatherhood is Transforming

It apparently does. It is well known that fatherhood can be “transformative” or “tempering” for men. But what shape that transformation takes has not been studied very much, despite the fact that unattached men are considered by some to be a source of society’s ““suffering” or “instability.” Loose cannons so to speak.

Fatherhood and High Risk Behavior

A newly published study has tackled this issue. It addressed the changing patterns of crime and substance abuse in new fathers, as these behaviors can threaten both health and society. Specifically, the study asked whether men are less likely to drink, use tobacco or commit crimes after they become fathers. In other words, do tough guys straighten out after having kids?

The authors followed over 200 men ages 12 to 31 who demonstrated high rates of juvenile delinquency in a metropolitan area. They were assessed annually for self-reported acts of crime and court records were reviewed for arrests. Self-reported rates of beer, wine, hard liquor, tobacco and marijuana use were documented, as were co-habitation, marital status and age at first fatherhood. And remarkably, this study was conducted over 19 years!

It has been previous shown that marriage itself and getting older can reduce men’s negative behavior, but this study clearly demonstrated a real association between fatherhood by itself and reduced crime and substance abuse patterns. And, the effects were large and long lasting. Of note, these changes were greater amongst the older men in the group (late 20’s and 30s) and were distinct from those changes expected as men age. Lastly, unlike marriage, cohabitation alone was not shown to reduce risky behavior in young men.

A Golden Opportunity to Help Men Help Themselves

Why is this important? One reason is because it suggests that first fatherhood may present a real opportunity to improve the health and behavior of young men. God knows that there are not many opportunities to do this with those who consider themselves otherwise immortal. New fathers might be more willing to hear messages and make life style changes when they are holding what might be their noblest work in their arms. And these changes in behavior could affect the health of the individual, his children and his family. After all, and I am not sure who said this, “A baby will make love stronger, days shorter, nights longer, bankroll smaller, home happier, clothes shabbier, the past forgotten, and the future worth living for.”

Guide to Surviving the Holiday Season

Paul Turek, MD — Mon, 14 Nov 2011 16:00:30 +0000

Cleaning a set of these every week is one way to "busy your hands."

Two patients told me that they were getting divorced this week. They came to the office and thanked me for all that I have done for them. They wished that the assisted reproductive technology had worked and given them children, but it didn’t. The relationships simply couldn’t tolerate the strain and gave way. Unfortunately this is not uncommon.

The Stress of Infertility

Don’t doubt for a minute that being infertile doesn’t have the same impact as having cancer. Very little can tear holes in the fabric of a relationship like infertility can. Add to this the romance of the holiday season and you have a recipe for potential disaster. Gathered families encircled by the howling laughter of children; smartly dressed kids at parties just learning to be polite; parents reveling in the enchantment written on the faces of children hearing holiday stories. To the infertile, its like having walking pneumonia—it just never seems to get better or go away.

Eight Ways to Reduce Your Holiday Stress

Maybe it’s not that bad. Maybe the holiday season is just more stressful. What can you do about it? Here are some tips for men as the holidays approach:

Take smaller steps. Stress and depression are like the flu: give them some time to run their course and pass through. You will make it, and you will be stronger because of it.
Make a plan. Spinning out of control without a plan for the problem can cause great anxiety. Simply agreeing to take the next month off and start again in the New Year can make all the difference in the world.
Enjoy each other. After all, you have found a soul mate that is going through the same experience. Give and get that big hug that can make all the difference in the world
Express yourself. Cry on her shoulder and not in a closet. Vent about that wicked day by journaling. A belly laugh or a primal scream is even better. Empathy is a very rich and particularly human experience with immense healing power.
Relieve your stress. Exercise, yoga, massage and acupuncture are fabulous ways for men to “vent” and relax. There is something about those endorphins that waft through the body after a long run…
Be mindful. Take your eyes off the Ipad and lose circular thoughts that lead to nowhere. Take note of the present. Quietly observe life. Breathe to relax. You are an organism, not a machine.
Try fasting. From emails, texts, news, stock quotes. Do you really think that you can keep up with the web growing at a rate of 7.3 million pages per day?
Busy your hands. There is enormous therapy to be found by working with your hands. In the words of Michael Crawford, author of Shop Class as Soulcraft: “Fixing things feels good.”

Humanizing Medspeak

Paul Turek, MD — Mon, 31 Oct 2011 15:00:33 +0000

A humanizing force: The book in my white coat

“Doctor, could you speak to me in plain English, please?!”

I rarely hear this in my men’s health practice. It’s likely because I am aware that Medspeak, or the language of medicine, is a second tongue, and a very foreign one to boot.

The Language of Medicine

There are 750 muscles, 206 bones, 428 named nerves and 60,000 miles of named and unnamed arteries and veins in the adult human body. Add to this all known body organs and physiological and molecular pathways and it becomes clear that the first two years of medical school involves learning 20,000 new vocabulary words, the equivalent of an entirely new language. Suddenly, sweating becomes diaphoresis, vomiting becomes emesis and red becomes erythematous. Throw in normal physiology and disease states in the second two years of medical school, and you have another 20,000 word vocabulary lesson. For some reason, patients now ambulate, visualize, articulate and masticate when the rest of us walk, see, talk and chew. That’s two whole languages to be learned in 4 years.

The Beauty of Medspeak

The vocabulary of medicine can be elegant, efficient and sound oh-so beautiful with all those Latin words. There is something poetic and mellifluous about the word “vestigial” which is a leftover structure with no current function, like the appendix. Another example: I recently hurt my thumb after my 7-year old daughter’s ace tetherball serve. Presenting my black and blue thumb to my favorite orthopedic surgeon, he said: “A minor bruise to your flexor pollicis longus and brevis muscles.” Just sort of rolls off your tongue. Felt better already.

The Vagaries of Medspeak

But Medspeak can also dehumanize. In the field of men’s health, I hear the words “idiopathic epididymitis” all the time. That’s eleven syllables of Medspeak in just 2 words. Sounds impressive but what does it really mean? How’s this: “unexplained scrotal pain that is not due to cancer or other badness.” When put in front of another word, “essential” also means unexplained. Admittedly, Medspeak can make even the vague and unknown sound official.

When commenting on written Medspeak, the late author-doctor Michael Crichton wrote: “I don’t agree… that medical writing is inept. I argue that it is actually a highly skilled, calculated attempt to confuse the reader.” Agreed. When used excessively or carelessly, it is dehumanizing and can change the moment and direction of a patient’s life.

While I was a resident at the University of Pennsylvania years ago, a college friend who trained with me gave me a small book of poems to carry around. I opened it during those rare, quiet moments that can happen while on call. The book was by William Carlos Williams, a noted doctor-poet. Dr. Williams fully understood the two edged sword of Medspeak when he noted: “It is not what you say that matters but the manner in which you say it; there lies the secret of the ages.”

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The Dream of Free Medical Care

Paul Turek, MD — Mon, 24 Oct 2011 15:00:57 +0000

The first of its kind in an urban setting…

This is not your average 1-year old. No, the Clinic by the Bay was conceived by a few individuals and gestated over a 4-year period before coming to life. As a living, breathing free clinic in San Francisco, it is a testament to hard work, commitment and the belief that we can make a difference in our urban communities. As with any child of love and labor, it also puts a smile on the faces of those involved practically every day.

Free Care for the Working Uninsured

There are many medical clinics in San Francisco that attend to the needs of the homeless. Some, like the Haight-Ashbury Free Clinic and Glide Memorial Church Health Services, are famous. However, another large, medically underserved population (about 63,000) in San Francisco are the working uninsured. Clinic by the Bay is the only volunteer-powered free clinic that specifically targets those individuals who live and work in San Francisco (and Daly City) but who cannot afford to pay for health insurance for either themselves or their families.

Celebrating the First Year

In its first year of life, Clinic by The Bay has amassed some impressive accomplishments:

• Has a staff of 75 volunteer doctors, nurses and other staff providing care.
• Has enrolled 450+ patients and families into its medical home, an enrollment that is growing by 5-10% monthly.
• Has served an incredible diverse and needy community that is largely (85%) comprised of minorities.
• Has garnered over $1 million of non-federal funding and support from foundations, universities, corporations and individuals to carry out its mission.
• Has developed critical and rewarding collaborations with industry (i.e. Walgreens), other medical non-profits (Operation Access), universities such as UCSF, and prestigious hospitals like California Pacific Medical Center, Seton Hospital and San Francisco General Hospital that have insured the seamless delivery of quality care to its patients.
• Has played an active role in keeping our community not only healthy, but also productive.

When I left Africa after volunteering as a medical student, I wondered if I could ever again feel as attached to the community in which I lived. As a Founding Board member and Advisory Board Chair of Clinic by the Bay, I find that that feeling has returned again, stronger than ever, and in my own backyard! Please consider making a donation of any size to the Clinic’s great work on its first birthday.

Bringing Africa Home

Ways to Naturally Boost Testosterone

Paul Turek, MD — Tue, 11 Oct 2011 15:00:28 +0000

Sunset or sunrise? You choose.

Honestly, it seems like testosterone is to blame for everything these days. The epidemic of low testosterone has been linked to economic recession, wars, bank failures and even global warming. Ok, so maybe I am exaggerating, but many men feel (or are told) that their testosterone levels are the root cause of much of the way they feel. Leaving aside causality and association, what can you do about it?

Testosterone and You

I am the first one to say that testosterone is important for a healthy, long life. Clearly, men with low levels, termed hypogonadism, do not live as long as men with normal testosterone levels. I understand too, what testosterone isn’t and can’t do.

So, I am entirely empathetic to patients who ask: “Doc, what can I do to naturally increase my testosterone levels?” Forget about expensive gels, creams, injections, pellets or patches of testosterone that have side effects. They want to know what they can do, on their own, to improve their testosterone balance. As a big fan of self-empowerment, I dedicate this post to these men.

Lifestyle Changes to Improve Testosterone Balance

Lose weight. Fat converts testosterone to female hormones called estrogens. Less fat means less circulating female hormone levels.
Exercise. Although it is true that while you exercise, testosterone levels may be lower, exercise stimulates muscle recovery and growth through increased testosterone at rest.
Don’t overtrain. Rest between exercise sessions allows testosterone to work its magic.
Get good sleep. Poor sleep habits stress the body as a whole and stress reduces testosterone levels. Perpetual jet lag is no place to be.
Eat smart and cut the alcohol. Eat healthy meals regularly; skipping is not allowed. Also cut down on alcohol as it tends to impair testosterone production and increase conversion to estrogens.

Dietary Supplements That Improve Testosterone Balance

Get zinc. Zinc is a co-factor for testoterone production. Oysters, peanuts, chicken, lamb and (how timely) pumpkin seeds are excellent source.
Get vitamin B. This vitamin is also a co-factor for making testosterone. Bananas, avocados, watermelon, eggs and raspberries are excellent sources.
Control cholesterol. Eat plenty of monounsaturated fats, as found in fish, yogurt, almonds, and olive oil.
Eat garlic. Some evidence suggests that allicin within garlic can help improve testosterone balance. Watch your breath, though.
Herbal remedies: Tongkat ali, Catuaba bark-Muira pauma, Mucuna pruriens, Tribulus, Yohimbine and Ginseng. You know my opinion on these so take at your own risk.

Medical Treatments that Improve Testosterone Balance

If all else fails, see a specialist, as there are excellent prescription medications that can boost your body’s testosterone production, which is not the same as testosterone replacement. Clomiphene citrate, tamoxifen and human chorionic gonadotropin (hCG) are not anabolic steroids, but nor are they FDA approved in the U.S. for this purpose. But they are drugs that either convince the brain to send more gas (luteinizing hormone, LH) to the testicles to make more of your own testosterone, or directly provide the LH to stimulate testicles to make it. Unlike anabolic steroids, they encourage bioidentical (read: “your own”) testosterone production and do not impair fertility or shrink testicles.

You should try to optimize testosterone balance naturally, as these behaviors are generally healthy and good for a long and happy life.

How to Avoid Male Infertility

Paul Turek, MD — Mon, 03 Oct 2011 15:00:51 +0000

Advice as you carve up the roads of life…

Some day, you may want kids…or you may not. It’s not on the top of your mind now as it’s still early in the relationship and you are in that wonderful phase of discovery with your partner. If this is your station then read on because, in the words of Ben Franklin, “an ounce of prevention is worth a pound of cure”.

A Short List of Things To Avoid

Male infertility is either handed to you (genetic) or is a consequence of life on this earth (acquired). You can’t do much about the former, but you can have some say in the latter. Here is a list of common acquired reasons for male infertility organized by severity. Try to avoid these exposures or conditions if you can, and well in advance of family building. Also enclosed are the slides from a very popular lecture on this topic that I first gave to infertility specialists at the American Society of Reproductive Medicine.

Definite Risk of Male Infertility

Anabolic steroids
Testosterone replacement
Opiate pain medication (codeine, hydrocodone, Demerol)
Hot baths, tubs
Smoking
Recreational drugs
Cancer chemotherapy
Radiation
Chronic fevers

Probable Risk of Male Infertility

Overweight (BMI >30)
Stress (physical, emotional, financial)
Excessive alcohol consumption
Finasteride (prostate and hair loss medication)
Varicocele
Pituitary (brain) tumors
Ketoconazole (antiandrogen)
Cimetidine (anti-ulcer)
Spironolactone (blood pressure medication)
Calcium channel blockers (blood pressure medication)
Azathioprine (for autoimmune disease)
Industrial toxins (BPA, PCBs)
Testis cancer

Possible Risk of Male Infertility

Pesticides
Sexually transmitted disease
Diabetes mellitus
Herbal supplements (estrogenic)
Heavy metal exposure (lead, arsenic, cadmium, mercury)
Anti-depressants (SSRI)
Sulfa-based drugs (sulfasalazine, sulfamethoxasole, nitrofurantoin)
Colchicine (anti-gout)
Excessive X-ray exposure
Biologic response modifiers (TNF-alpha blockers for autoimmune disease)
HMG-CoA Inhibitors (cholesterol drugs)

Remember sperm production is an engine that wants to run fast. Avoiding the above risk factors can help it run free and easy. As the ever quotable Franklin also said: “A little neglect may breed great mischief…for want of a nail the shoe was lost.”

Acquired Disorders of Spermatogenesis By Paul J. Turek MD, Professor and Endowed Chair in Urology Education, Department of Urology, University of California San Francisco and Director of the The Turek Clinic

View more presentations from Dr. Paul Turek | The Turek Clinic

What Testosterone Isn’t

Paul Turek, MD — Mon, 12 Sep 2011 15:00:17 +0000

Testosterone: a molecule for life

I see a lot of patients who think that their testosterone levels should be higher for various reasons. I would like to set the record straight.

Even I have been heard to say that it is the “elixir of a man’s life.” Indeed, testosterone is one seriously important molecule throughout men’s lives. In the womb, it determines anatomic maleness. And during puberty, when another splash of testosterone hits boys and sticks for good, I don’t have to tell you what it does: feeds the growth spurt, cracks the voice, encourages hair growth, acne, stronger muscles and is the ultimate governor of teenage thought and action.

Testosterone in Adults

Testosterone in men is essential for health and well-being. First isolated in 1935, it is an anabolic hormone in that it generally induces growth. And it does this all over the body. In the brain, it influences sex drive, assertiveness, mood, energy and some aspects of thinking and verbal memory. In the heart, it helps dilate the arteries, which is good. Testosterone increases muscle strength and maintains normal bone density. It also reduces belly fat. In the kidney, it stimulates a hormone called erythropoietin that keeps blood counts normal. It also strengthens the immune system and helps blood to clot. In the male sexual organs, normal testosterone levels are important for erections and sperm production. So, it’s about as close to an “elixir” as any single circulating molecule in our bodies.

A List of What Testosterone Isn’t

Testosterone is not as vital to us as oxygen. For the record, here is what testosterone isn’t or doesn’t do:

It is not a common reason for erectile dysfunction (<6% of cases).
It is not a common cause for low sex drive.
It will not help you get more dates or make you a sex machine.
It will not magically make you a muscle man.
It will not magically cause weight loss or reduce fat. This requires a diet and exercise program.
It will not help you live forever; it falls with age.
It does not cause prostate cancer or liver cancer.
It is not higher during periods of stress; in fact, stress lowers testosterone levels.
It is generally lower in athletes than non-athletes.
It does not by itself cause baldness. Baldness is mainly genetic.
It does not get lower the more you masturbate.
It will not make you taller or your hands bigger as an adult.
More testosterone will not solve all of your problems.

What’s absolutely key to testosterone management is that there are symptoms present in association with low levels. In such cases, the benefits of treatment are clear. Think of testosterone as oil in your car: it helps everything work better, but when a problem occurs, it is usually something else that has gone wrong.

Will Operate for Food

Paul Turek, MD — Mon, 29 Aug 2011 15:00:48 +0000

Is the Internet the true, universal soul of man and woman?

Here it goes again. Doctors are out of a job because of _____ (fill in the blank with antisepsis, antibiotics, vitamins, lasers, robots, etc). Now, it’s the Internet.

A recent newspaper article discussed that 60% of Americans and 70-90% of Europeans now seek health information online. Especially impressive is the number of older individuals, or “silver surfers” that find themselves there looking for help. With this powerful informational tool in their hands, the article raised the issue of whether empowered patients will make doctors extinct.

After reading the article, I wrote an Op-Ed piece to the paper, but never saw it published. Just to get it off my chest, I present it here:

Sir, Ms. Bird has absolutely hit the nail on the head when discussing the fact that today’s patients are truly educated consumers. In my men’s health practice, I routinely see patients who have the latest published paper on their condition tucked under their arms as they sit in front of me at the visit. Kudos to them! I am delighted that patients are informed and ready to “own” their healthcare–it is long overdue in the field of men’s health. Patient ownership of their health means that their best advocate (themselves) tags along at every visit like a loyal dog and helps them safely navigate within a super-specialized and highly fragmented health care system.

Although medically empowering, the Internet cannot provide two critical components of quality health care that will ensure the ongoing value of doctors in medicine: knowledge and wisdom.

The Internet is extremely informative but lacks the judgment necessary to distinguish wheat from chaff. Likewise, it lacks experience, the learning that accrues from seeing the same problem a thousand different ways, and a trait fundamental for quality decision-making in any profession.

We as doctors cannot possibly know all there is to know in a profession that doubles in informational size every decade. However, through rigorous training, experience, discipline and focus, we can comfortably tread where even the best-informed patients have not considered, or cannot imagine, going alone.

In fact, medicine owes a great deal to the rise of the information age. Doctors can now “walk the walk” with patients in a truly informed partnership. And patients can better judge the quality and character of their providers as they make life-changing decisions about their health.

Respectfully,

Paul Turek MD, FACS, FRSM