Turek On Men's Health » Vasectomy

The Ins and Outs of Male Fertility Kits

Paul Turek, MD — Mon, 13 Feb 2012 16:00:38 +0000

A scene from Sperm Warfare based on our collection room (Courtesy: DavidRouda.com)

A man’s sperm count. One of the most misunderstood tests in all of medicine. Like naming stars in the sky to help order the universe, we assign “normal” ranges to the features of semen because we can. Unfortunately, except when there are no sperm in the semen (azoopermia) its power to predict male fertility is terrible. Given the choice, I’d take a past history of paternity over a semen analysis any day as a better predictor of a man’s fertility. But what do I know, I only do this for a living.

The Semen Analysis

In its most proper form, the semen analysis is collected at home or in a urologist’s office and evaluated in a certified medical laboratory, according to published standards. The amount of semen (volume), sperm count or concentration and the proportion of moving sperm (motility) are all rigorously assessed. When done right, the natural day-to-day variation in semen output and quality are minimized. But…you have to visit a urologist or hospital for this, and deal with the scheduling and embarrassment. And there’s the rub.

Home Male Fertility Kits

At-home fertility kits for men are not new. Dr Robert Glass at UCSF was working on this in the early 90’s before I arrived there. In the mid 2000’s, a kit called Fertell, quite popular in Europe, was introduced into the U.S., but bombed. Who knows why. Today, there are three kits battling it out in the market:

Micra Sperm Test: allows you to look at your own semen under a disposable microscope and do the counting yourself.
SpermCheck Fertility Check: assesses whether sperm counts are normal but does not look at sperm movement.
Spermeter: tests the count and motility of sperm.

For those skeptical about their partners or kids, there are even at-home kits to determine whether fluids or stains around the house or on clothing are actually semen:

Reactions to Home Male Fertility Kits

Personally, I like the idea of home sperm tests. Currently, in infertility medicine, the semen analysis is typically done only after an intensive (and expensive) evaluation of female fertility is performed. Given that male fertility is 30% of the problem, this seems too little and too late for me. But, what do men think of these tests? Here are some responses:

“I didn’t sign up for this when I was assigned testicles.”
“Give me the peace and quiet of the doctor’s office to my house anyday!”
“This could develop into the All-American pastime.”
“It will be a welcome change from counting sheep.”
“I’ll probably need to take repeated tests to ensure accuracy.”

The Ultimate Collection Room

Although it is no substitute for the real-deal semen analysis, home sperm kits may get men to real medical care earlier than they would otherwise. And to confirm the at-home findings, they would get the opportunity to collect in famous rooms such as ours, termed the masterbatorium and highlighted by Metropolis Magazine. This room has even inspired a play that has toured the west coast called “Sperm Warfare.” Come check it out…by appointment of course

A Dozen Funny Reasons for Vasectomy

Paul Turek, MD — Mon, 16 Jan 2012 16:00:38 +0000

Funny, but not the typical scene of a vasectomy at The Turek Clinic. Photo courtesy of the movie.

As a vasectomist, I realize that a vasectomy, that iconic way to stop family building in its tracks, is not simply a 10-minute procedure. In a man’s life, it is a significant cultural event. I dare you to describe a more personal, scary and misunderstood part of a man’s body with which to meddle. And, recall that men don’t give birth, so their bragging rights after a vasectomy are somewhat limited.

Why do Men Get Vasectomies?

I ask most patients why they are considering a vasectomy. The responses vary, but can be very amusing. Here are a dozen of the funniest answers I’ve heard in my practice:

My wife said: “the factory is closed,” so I’m here.
I was told that they broke the mold after they made me, but I want to make sure of it.
My wife said: “It’s your turn now.”
After this, I won’t ever have to say I’m sorry again.
I’m married! Condoms are sooo high school!
Have you seen the movie ‘One Fine Day?’ That’s why I’m here!
Every time I look at my wife, she gets pregnant.
Apparently, sacrificing some limbs just isn’t the same…
She told me: “Enough, get your wings clipped already!”
I was told that I can shoot the gun all I want and no one will get hit.
I heard that it’s easier than getting your teeth pulled out…
My wife told me that it’s time for juice without seeds.

So, here’s to the most effective contraceptive ever developed and hats off to those men who chose the “emission impossible” way to an unburdened and unbridled sex life.

Fertility from Sterility

Paul Turek, MD — Mon, 07 Nov 2011 16:00:55 +0000

What's inside of a coffee mug depends on how you look at it.

Do you think it is possible to have your own children with absolutely no sperm in the ejaculate?
Why yes. It happens on a daily basis in my practice.
Honestly, the word “sterility” has really lost much of its meaning nowadays with advances in reproductive technology.

The Affairs of Sperm

Azoospermia is the word used to describe the lack of any sperm in the ejaculate. It is a devastating thing for men to hear as they try to conceive. It comes in two forms: as a consequence of blockage in the sperm ducts outside the testis in the setting of normal sperm production in the testicle (i.e. vasectomy) or as a result of poorly functioning testicles and normal, open ducts beyond it. We routinely grab sperm from behind vasectomy sites to use with assisted reproduction to conceive. Finding sperm in men with poor sperm production, termed nonobstructive azoospermia, is a more complex matter.

One way to think about sperm production in men with poorly functioning testicles is to compare it to a mug with coffee in it. Say the mug is filled with ¼ cup of coffee. If you hold shake the mug, you may not see any coffee spill over the side. In this case, you might assume that the mug has no coffee inside. But, if you peer into the mug directly, you will see that there is actually coffee in the mug. Similarly, the testicle makes more sperm (coffee) than is found in the ejaculate (spilling over cup). There exists a threshold of sperm production, over which sperm shows up in the ejaculate and below which it will not. So, now you know the secret of making fathers out of “sterile” men with poorly functioning testicles.

Sperm from a Rock

Of course, it’s not quite that simple. There is one more layer of complexity here. Poorly functioning testicles may not make sperm evenly throughout their substance. In many cases, there are “pockets” or “islands” of sperm within a sea of otherwise empty tissue. Clinically, this makes sperm retrieval more difficult and has pushed this technology to a high art.

To find sperm, fertility specialists use several sophisticated approaches in men with nonobstructive azoospermia. The traditional testis biopsy works about 30% of the time to find sperm and, as a consequence, is no longer the de rigueur technique for this problem. Fine needle aspiration “mapping”, which I invented about 15 years ago, is easily twice as good as a biopsy in finding sperm and much less invasive. Lastly, “microdissection” of the testis another alternative and involves an all-out surgical assault on the testicle to find sperm making it the most invasive approach. The elegance and complication rates for these approaches vary widely, but their intent is the same: to find enough sperm to allow biological fatherhood. Importantly, when expertly performed, these techniques will find sperm in the majority of cases. For the remainder, there is hope as even newer “no touch” scanning technologies are on the horizon…

Insider’s Guide to Vasectomy Reversal

Paul Turek, MD — Tue, 06 Sep 2011 15:00:17 +0000

Beauty (and results) are in the eye of the practiced beholder…

Something like 25,000 American men a year want more children after having a vasectomy. The more popular of two options for fatherhood after vasectomy is a vasectomy reversal; the other choice is sperm retrieval for men and in vitro fertilization (IVF, “test tube baby”) for their partners. Even though it is a surgical procedure that is technically quite challenging and not generally covered by medical insurance plans, clearly reversals have a major leg up on high-tech, IVF conceptions: you can do what you do best and do it at home, the old-fashioned way, to conceive.

Who Does Vasectomy Reversals?

Among the 10,000 or so practicing urologists in the U.S., maybe 5-10% of them are interested in performing vasectomy reversals and far fewer than 1% are fellowship trained microsurgeons who specialize in this procedure. So, how do you decide to whom you should go to have this done?

Deciding on a Surgeon

Not all doctors are same. If you didn’t know this before, you heard it here first. Some are average run-of-the-mill, some are better, and others are truly gifted and talented at what they do. And the difference between an average doctor and a great doctor is the quality of the product. Did you actually get what you asked for, or what you expected to get?

You can read all over the Internet about ways to choose your reversal surgeon. These parcels of advice are helpful and may lead you to find a good surgeon instead of an average one. But if you want the highest quality surgeon, here are six key issues to consider as you search and shop:

Does the surgeon enjoy doing vasectomy reversals? I’ve met countless surgeons who are pleasant enough in or out of the office but who are simply miserable in the operating room. I can’t explain why. Personally, reversals are my favorite thing to do (at work). It is a craft and an art form of the highest caliber, the elixir of a surgical life. A surgeon who loves what he does will do a better job of it.
Does the surgeon pay attention to details? I can’t recall who said this, but life really is in the details. And microsurgery, performed at 1/25 normal scale, is the ultimate detail-oriented surgical procedure. Has the surgeon gotten all of your details? How about your medications? Habits? Your partner’s issues? How neat is their office? How comprehensive and detail-oriented are the staff?
How long will you have to wait to get the procedure done? You may think that if you have to wait a long time to get the reversal performed that the surgeon is very busy at doing reversals. Honestly, it could mean that (s)he doesn’t operate very much or that (s)he spends a lot of time out of the office or doing other procedures. In other words, reversals may not be a priority for the surgeon (see #1 above). Or, the office itself may be disorganized (see #2 above). The better way to assess “busy” is to look them in the eye and ask them how many vasectomy reversal cases they do each year.
What are your surgeon’s success rates? You see success rates of surgeons on every website. And they all look the same and are all very high. What does this mean? How do you decide? Frankly, many surgeons quote the published rates of other surgeons, kind of like selling “knock offs” instead of the real thing. This may be fine for buying purses but not for vasectomy reversals. Peer-reviewed and journal-published data is an excellent measure of quality: it is the certified seal of authenticity. So, ask that simple question: Has the surgeon published their success rates in trade journals?
How many reversals does the surgeon perform annually? Do Olympic athletes or concert musicians win competitions through talent alone? Of course not. It’s all about the training. Similarly, a good predictor of reversal success is surgical volume or the number of cases. Volume means practice and practice makes perfect. This is true for almost all surgical procedures in medicine and is also true with reversals.
Does your surgeon want what you want? You don’t really want a reversal, you really want a kid, right? And you don’t want to sell that old car or mortgage a property to get it. Let’s say that the cost matters a lot for you. If IVF is covered by insurance and a reversal is not, then IVF may be the cheaper way to go. In this case, the surgeon should not keep giving the hard sell for vasectomy reversal. There are several paths to fatherhood. Make sure that your surgeon shares your goals. For me, it’s the holiday card that matters the most.

Who is Woody?

Paul Turek, MD — Mon, 25 Jul 2011 20:00:09 +0000

I'd like you to meet Woody, your buddy.

I’ve been asked in the office. I’ve been asked in the street. Who’s that guy on your website? What’s his name, is it Pete?

I am referring to character on the landing page of my website: The Turek Clinic.com. This line-drawing of a man is captured in various real life scenarios and, like most men, goes with the flow.

His name is Woody.

Who is Woody?

Let me tell you about Woody. He is a regular, decent guy. He opens doors for people he doesn’t know. He stands in line. He is curious but polite. He is thoughtful yet spontaneous. He likes his job but he also likes spending time with his buddies over a beer. He thinks he understands women but at times he is unsure. He is pretty self-realized and stays fit but can often lose sleep over work issues. He asks questions and he seeks answers. He researches before he buys. He dresses not too loud and not too drab, but enough to show his playful personality. He occasionally uses conditioner after shampooing.

He is the guy in high school who didn’t grab a lot of attention, but has turned out to have done quite well, thank you, and lives the smart life in the big city. Woody deals with life’s curve balls and can hit them well enough to get on base most of the time. Most importantly, although he is not loud, he has a story.

Why is Woody Always Around?

Woody hangs out on The Turek Clinic website for several reasons:

He is a regular, task-oriented, common sense guy.
He is the symbol of what is good about men in this world.
He finds the information about men’s sexual and reproductive health on the site helpful.
He was born there, created to participate in the flash animation sequences that appear as refreshable banners on The Turek Clinic’s website and blog.

Life is a journey and often a complicated one. It is my hope that Woody makes it easier for men to relate to the tough sexual health issues that they face in life. In this sense, he is a good buddy.

Does Woody have a girlfriend? Yes, her name is Whoopie. More on her later.

No related posts.

The A through Z of Male Fertility in One Hour

Paul Turek, MD — Sun, 10 Jul 2011 16:27:45 +0000

As promised, I offer for your perusal the review lecture that I gave on male infertility at the annual American Urological Association Review Course this past weekend. For those of you who are academically inclined, here is an outline of the talk:

A. Physiology and Pathophysiology of Male Reproduction

B. Evaluation of the Infertile Male

C. Treatment of the Infertile Male (Surgical and Non-Surgical)

It was a fast paced hour and I must admit that I heard no snoring from the audience during the entire talk. And no one threw anything either. A successful day…

Male Infertility Review 2011 By Paul J. Turek MD FACS, FRSM, Director of The Turek Clinic and Former Professor and Endowed Chair, University of California San Francisco (UCSF)

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

I’ve Been Googled!

Paul Turek, MD — Sun, 12 Jun 2011 06:24:46 +0000

Lecture in the Palazzo Vecchio: Where do you go from here?

I’ve given countless lectures in innumerable countries over the last two decades, but I am most excited about the one I am giving next Wednesday. Google has asked me to speak to them during Men’s Health Week. Right down the road at the Googleplex in Mountain View, in the very heart of Silicon Valley.

The Google Invitation

I was enamored when asked to speak at the Palazzo Vecchio in Florence, beneath Vasari paintings. I was excited to lecture at the University of Istanbul and spend a day staring at the timeless space that is the Hagia Sophia. And I still jump at the chance to advise our government (the NIH) on matters of men’s health as I feel I may actually be influencing the direction of medical care in our country.

But an “ask” at Google, although not as architecturally or nationally historic, is still an important one, because I may, in some small way, directly influence health care attitudes and awareness among a group (young men) that I consider “medically underserved” for various reasons.

Google didn’t exist 14 years ago. Five years ago, the word “Google” was included as a verb in legendary and authoritative Oxford English dictionary. (“He’s been googling all day.”) Lately, I have the impression that Google may be taking over the earth as we know it. A lecture at Google therefore, offers not only the opportunity to bring medical awareness directly to men, but to a population of men who either are or will be primary “influencers” of other men.

Google Health

Although collectively they may understand all of the secrets of the digital universe, at the end of the day, Googlers still eat, sleep and procreate like the rest of us. Google Health, guided by the moniker “better health comes from better information,” is a recent health and wellness initiative at Google that has taken this quite seriously. It offers nifty tools for anyone to maintain their medical record, set personal goals, track progress with personalized tools, and share health information if they desire.

Personally, I think this is an excellent program for young men since, as a group, they 1) tend to feel immortal and 2) absolutely live for numbers and data. And what numerical trend in their lives is more important to realize and act upon than that suggested by their own bodies? It’s similar to the vintage Maserati with gauges that actually work.

Advice to Google on Sexual Health

My advice to them during Men’s Health Week is contained in a talk entitled “A Guy’s Guide to Maintaining Sexual Health.” What do I mean by sexual health? Issues with erections, sex drive, hormones, fertility, testis cancer, contraception and sexually transmitted diseases. Here are the main points that I’ll make:

Having sexual health issues is an easy way to keep from feeling truly immortal.
Most sexual health issues are easily treatable.
Sexual health is intimately tied to overall health
Therefore, a better understanding of sexual health issues will help you on the path toward immortality.

Remember, your body is the only place you have to live; don’t treat it as though you are renting it. I will see you on Wednesday.

The Low Down on Being Knocked Up

Paul Turek, MD — Sun, 19 Dec 2010 00:01:24 +0000

Vasectomy reversal: a sprinkle of art and architecture with biology.

What drives pregnancy rates after vasectomy reversal? Lots of things. The judgment and skill of the surgeon are critical as not all surgeons are the same. Two operations are possible during reversal surgery (vasovasostomy or epididymovasostomy) and choosing the correct one for each side of each patient involves deft surgical judgment. After the type of procedure is chosen, the skill comes in making it all work in some of the smallest organs in the body. To provide perspective, the suture used for this surgery is about 1/5 the size of a hair and is not easily visible to the human eye. The tubes to be reconnected are about 1/10 of a millimeter in diameter (100um) and can test the absolute limit of controllable hand motion (2-3 um). Doing this right takes training, experience, focus, control and good jazz in the operating room. The result is a “patency” rate, or sperm in the ejaculate.

But even with sperm returning to the ejaculate, the natural pregnancy rates are not the same as those in couples without a vasectomy reversal. Why? Think of it this way, you measure your surgeon by the patency rate, which is a technical issue. However, pregnancy rate is a biological outcome that involves many more variables. For example, we have published that female fertility potential is the single most important factor in pregnancy success after reversal. Since it can take up to a year after vasectomy reversal surgery to conceive, I recommend that female partners >35 years of age consider an evaluation of their fertility potential (i.e. get an answer to the question: “Do I have a year of time to conceive?”); I insist that women 37 years of age consider this evaluation and with a stern gaze, I very strongly recommend that women >40 years of age undergo this evaluation. I do this because my goals are aligned with those of patients: at the end of the day, my greatest reward is a holiday card with a kid in it.

Say that the sperm counts are good after reversal and the female partner is young. Why wouldn’t this couple conceive after reversal? Technically, a 30-year-old woman trying to conceive with an unvasectomized partner has a mean cumulative fecundity (pregnancy) rate at 1 year of about 85%. With a vasectomized and reversed male partner, this rate is about 65%. Not a huge difference but a real one.

To explain this, we need to introduce the immune system. Men who have a vasectomy essentially become “inoculated” to their sperm, similar to a mumps or flu vaccine. The immune system actively develops antibodies to sperm and this reaction eventually wears off with time. But, the immune system also has a fabulous memory, for which we are all grateful. Hence, at the time of vasectomy reversal, the immune system becomes inoculated again and antibodies to ejaculated sperm are generated. All things being equal, antisperm antibodies are likely the reason why pregnancy rates after vasectomy reversal are lower than expected. Since the immune response after reversal also wears off with time, this may also explain why it takes longer to conceive after vasectomy reversal.

What’s so incredible about all of this biological and surgical action and reaction, is that gobs of beautiful babies are more likely than not to be the result. Someone, somewhere has prioritized reproduction in the grand scheme of things. As Thoreau said: “Nature is full of genius, full of divinity; so that not a snowflake escapes its fashioning hand.” A toast to the beauty of biology.

The Condom Cha Cha

Paul Turek, MD — Mon, 13 Dec 2010 04:17:23 +0000

Sometimes doing the dance gets old…

It is hilarious and it happened again recently. I had just finished his quick and painless no scalpel vasectomy and was about to hand him his signed “diploma” (really) for “meritorious performance and uncommon bravery” when he said it. Just as the others had said it, with that screechy, high-pitched, Vienna Boy’s Choir voice: “Nice job doc; it didn’t hurt a bit!”

Even though it was made in jest, this comment suggests there is something about the culture of men that equates vasectomy with castration. The truth is that vasectomy is the most successful contraceptive available bar none and, unlike female oral contraceptives, requires virtually no compliance to maintain its effectiveness. It does not alter sex drive, erections, sensation, ejaculate volume or testosterone levels. In fact the way testosterone leaves the testis to supply the rest of the body is through an entirely different route (the bloodstream) than that taken by sperm (the vas deferens).

Nevertheless, something is removed, or different, after a vasectomy. Maybe it’s as simple as shooting blanks instead of having both barrels loaded. Maybe it’s the association of virility with the ability to sire offspring that defines Western culture, although you wouldn’t know this based on the meager birth rates in Western civilization of late. Maybe it’s the utter irreversibility of the decision to have a vasectomy performed. Whatever it is, it bubbles up and surfaces now and again in the gesture and guise of this faint, prepubertal voice.

Because of this subtle yet pervasive response to vasectomy that I have gleaned from patients, I now make it a point to counsel men before the procedure not only about what actually gets altered (fertility) with vasectomy but also what is preserved, which is essential maleness. In fact, many men feel liberated afterwards, not only from the anxiety of unwanted pregnancies but also from the “Condom Cha Cha” of their acne-filled youth to which they might prefer never to return.

I also discuss the fact that men should feel comfortable with the idea that vasectomy is a reasonable form of contraception for the “near future” as the idea of it being drop dead permanent can be seriously off-putting to many reasonable candidates. Simply stated, men’s lives are not filled with that many decisions that hold an equal weight of sheer permanence as that of vasectomy. This is also where the concept of sperm banking and sperm retrieval enter the conversation as ways to preserve or restore fertility after vasectomy. And, given the fact that 5-7% of U.S. men choose to have a vasectomy reversal in the U.S. alone is strong testament to men’s desire to continue to exercise reproductive choice in the face of what was previously understood to be a permanent decision.

So, my take on the shrill, jocular “thanks” occasionally offered after vasectomy is that it represents the well-informed response of the emancipated man who accepts that his manhood has nothing to do with how far his sperm travel.

Bringing It Home

Paul Turek, MD — Sun, 07 Nov 2010 05:46:28 +0000

It's the age of William Carlos Williams all over again.

The workday was winding down. I made a cup of tea and pulled up the dashboard on my computer to review the progress of my patients after surgery. Everyone was progressing beautifully…but one. He reported that his pain had increased over the last 2 days. So I called him on his cell phone:

“John, it’s Dr. Turek. You seem to be having more pain than before after your surgery. Is everything OK?”
“Dr. Turek?? Wow! Yes, everything is fine. I stopped my pain pills yesterday and also went back to work. I guess I pushed it a bit.”
“No problem, John. Just making sure.”

That, my friends, is the new face of great medical care. Taking care of patients in the moment, where they live. Your doctor watching over you when you need it the most.

It’s called Healthloop.com and what a great asset it is to my practice. Why? Because men simply don’t call. However, they will tell you what’s happening on a secure website when asked about how they are doing after surgery. In fact, they will even take the opportunity to “tweet” me on Healthloop when they might not know exactly how they should be doing.

The brainchild of a physician-colleague named Dr. Jordan Schlain, Healthloop is a medical work of art at the vanguard of a whole new field of medicine called “home-based care.” What’s revolutionary about this concept is that it helps patients stay at home, obviates travel to the doctor’s office, opens up new lines of communication and empowers patients. It is also a practical and inexpensive alternative to the vaunted “house call” of generations past. I offer it to every patient under my knife.

The time is now for remote monitoring—taking care of patients from afar. Aged patients are less mobile and harbor more chronic conditions that may just as well be watched from home. In addition, technology is now more widespread (Healthloop is web-based), miniaturized and portable than ever. Finally, there is a constant push to reduce healthcare costs and what better way to do that than by helping patients avoid doctor’s visits or even emergency room visits.

What I like most about home-based care is that it engages patients in self-care as never before. And with young men, the added communication with a provider is empowering. As John said: “Thanks, Dr. Turek…it’s nice to know that my body is healing normally after surgery.” The house call is back. William Carlos Williams would be proud.

The Age of Aquarius

Paul Turek, MD — Sun, 19 Sep 2010 02:11:58 +0000

Is this the dawning of the Age of Aquarius?

It really seems like the moon is in seventh house, and that Jupiter is aligned with Mars. Why? Because our government gets it and want to know how it can help.

Last week, I spoke at a stakeholder meeting about men’s reproductive health, held at the Centers for Disease Control (CDC) in Atlanta. You may have heard of the CDC, begun in 1946, as the American government’s disease surveillance unit. Answering to the executive branch of the government and not to Congress, the CDC has a storied history over the past 60 years, being integral to the worldwide eradication of smallpox and to the control of measles and rubella and more recently, HIV. And who can forget the role that the CDC played in identifying the cause of Legionnaires disease, toxic shock syndrome and SARS? Well now they are interested in men’s reproductive health. You gotta believe.

What’s wrong with men’s reproductive health care in the U.S.? Well, in a sense, it doesn’t exist. Most men who are infertile do not get the care that they should; most male sexual health issues are verboten topics for public discourse; and men’s roles in family life and contraceptive planning are paltry at best.

It warms my heart to know that among all the government branches that could have taken men’s reproductive health seriously, the CDC has picked up the ball. After all, they are interested in assessing populations at-risk and controlling epidemics. And that is exactly the kind of thinking that will improve men’s reproductive health in the U.S., a condition that could certainly be termed an epidemic. A couple of years ago, I wrote an NIH grant (that was funded no less!) to help train male reproductive specialists at UCSF that began with the following sentence: “Men’s reproductive health is a large and underserved area of medicine in the U.S.” Amen.

This first-of-its-kind meeting was brimming with excitement. Attended by non-profits, academics, urologist thought leaders and numerous federal agencies, it was clear that the time had come to rethink the way we take care of young men. The definition of men’s reproductive health that guided the discussion was “the ability to have a responsible, satisfying and safe sex life and the capability to reproduce and the freedom to decide if, when and how often to do so.” In this context, awareness, public health, barriers to care, messaging, resources, engagement, and communication were terms addressed as if this topic were a true, national epidemic. In the words of Wallace Stevens: “Thought is an infection. In the case of certain thoughts, it becomes an epidemic.” For the good of a large chunk of our population, let’s hope that this issue goes viral.

Listen and Learn

Paul Turek, MD — Sat, 28 Aug 2010 23:18:36 +0000

Listen and listen hard…

This week, I refused to perform a vasectomy on a patient of mine. That is, until he saw a doctor about his sky-high blood pressure. Thirty years old and a father of three, he is a productive, hardworking member of society who just happened to never have seen a doctor as an adult. Unusual? Not at all.

Why does this happen? Is it because, in the words of Andy Rooney, that “death is a distant rumor to the young?” What is it about being young and male that instills this concept of immortality? For one thing, men do not have a monthly biological reminder of their health, similar to the female menstrual cycle. Second, the culture of men is imbibed with the “breadwinner” mentality that tends to equate illness with weakness. Lastly, men are terrible goaltenders of their own health. It is simply not on the radar of most men to think about their health unless something a) hurts, or b) is life threatening.

Lets delve into the last of these a bit as there is an interesting corollary to back this up. It is clear from many studies over the last century that married men uniformly outlive their single counterparts. In some studies, the difference in lifespan approached 10 years. Viewed another way, divorce affects a man’s health about the same as picking up a pack-a-day cigarette habit. So, it is clear that one of the best strategies to a longer life is to marry and stay married. If it is in your personality to gain immortality by this approach then so be it.

But that may not be the case of my patient, who in fact came back one week later for his vasectomy, feeling empowered, and with his blood pressure under perfect control. “And I thought the headaches that I had been getting were due to the stress I have been feeling.” He was a changed man, in control of his health for the first time in his life. He also understood the concept that life-threatening illnesses may be subtler than a broken bone.

After 17 years of caring for young men, it is clear to me that they are an incredibly underserved population. In fact, this is one the key points that I will make as an invited speaker to the Centers For Disease Control (CDC) upcoming summit on “Advancing Men’s Reproductive Health in the US” to be held in Atlanta next months. In my practice, I assume that men need help understanding how to take better care of themselves. I know that they would like to find out more about what health issues they may have inherited that can harm them, but they have trouble asking and knowing where to turn. Hence my practice motto: “The way to take great care of men is simple: just listen to them.” And listen quietly, as their voices are soft. Trust me, this hardly ever happens in the standard, 12-minute office visit that is currently de rigueur in this country.

Freud’s Vasectomy

Freud’s Vasectomy

Paul Turek, MD — Mon, 26 Jul 2010 03:06:14 +0000

A man looking for his mojo.

Do you know why Sigmund Freud, esteemed psychoanalyst, had a vasectomy when he was 67 years old? How about William Butler Yeats, the famed writer, having his vasectomy at 69 years of age. Were they that sexually active and worried about conceiving? God bless them if this is true!

Hardly. Believe it or not, vasectomies were done in the roaring twenties and thirties in Austria by an endocrinologist named Steinach for physical and mental rejuvenation. “It revived my creative power,” wrote Yeats in 1937. This may be true as Yeats wrote a crop of poems during this period that rank with his best work. At that time, a vasectomy was considered the “holy grail” of perpetual youth. Steinach felt that by blocking sperm flow, male hormone production in the testis would improve.

The idea of hormonal rejuvenation really started in earnest with an acclaimed endocrinologist named Brown-Sequard who in 1889 injected himself with testicular extracts from rats and dogs. This led to the trend of “organotherapy” in which all sorts of animal organs were injected for every conceivable human illness. Sound familiar at all? It also led to serious and productive experimental research on the function of glands in the body.

The rejuvenating vasectomy was not an isolated claim to fame by Eugen Steinach from Vienna. He was nominated for a Nobel Prize six times for innovative studies that showed that male or female development depended almost entirely on the sex glands and their secretions. Give this theory a pinch of salt to incorporate modern genetics and is it true enough today.

What went wrong with Steinbach’s vasectomy idea was that he believed that narrow biologic principles could be used to treat the wide and complex condition of human sexuality. The funny thing is, almost 100 years later, we are still trying to figure out how to stay young forever.