Turek On Men's Health » contraception

Your Hair or Your Hormones

Paul Turek, MD — Mon, 30 Jan 2012 16:00:25 +0000

Be nice to have Superman's hair…but at what price? (Courtesy; MovieBlog.com)

It’s the perfect drug for 40 million men in America who are going bald. Take it once a day to keep the hair on your head and shrink the prostate, which also commonly bothers men as they age. It’s a pill that has been used by at least 2 million reproductive age men over the last decade. But is it too good to be true?

The Best Hair Pill Yet

This magic pill is finasteride (trade names; Propecia, Proscar, Avodart). It represents a class of drug called the 5-alpha reductase inhibitors. These pills act as enzyme blockers: they prevent the male hormone testosterone from converting to its metabolite dihydrotestosterone (DHT). Although testosterone is responsible for a lot of our “male” features, DHT is more potent than testosterone for scalp hair and our internal reproductive organs (prostate, seminal vesicle). These drugs work by lowering DHT production and protect the gloriously youthful hair on our heads and the enviable ability to write your name in the snow while urinating.

And these drugs work well. More effective than topical or “rub in” medications, finasteride is great for what’s called “male pattern” hair loss which is due to a receding hairline or balding on the top of the head. In essence, it slows the growth phase of hair in these areas. However, it doesn’t treat hair loss on the sides or temple area.

Finasteride, Sex and Male Fertility

Although it may keep you looking like Clark Kent, many male infertility specialists, including myself, have concerns about finasteride. First, there is a 10% chance of sexual side effects that include erectile and ejaculatory dysfunction and lowering of sex drive. These issues can be subtle while on the pill but become very obvious when men stop it; many of my patients have noted a sexual “curtain being lifted” or “coming alive” after discontinuing the pill.

Second, there is an even more profound concern about finasteride among specialists: male infertility. Before it received FDA approval, the drug trials showed that it lowered ejaculate volume but did not change sperm count or motility on semen analysis testing (actual human fertility studies are not routinely required by the FDA). Now that it has been on the market for 10 years, though, impressive declines in semen quality have been observed and published with finasteride by many of us. This effect is not subtle either, as patients with complete sterility (azoospermia) have had recovery of their sperm counts after stopping finasteride!

There are several clues that this effect on fertility was possible. The rabbit studies done for FDA approval of the drug actually showed this effect. At 3 months, there was no effect on rabbit fertility. But, when followed longer, rabbits showed significant decreases in natural fertility. In addition, while I was writing a recent reproductive physiology chapter for Campbell-Walsh Urology, our leading urology textbook, I researched at what levels the 5-alpha reductase enzyme is found in the human testis and epididymis. Lo and behold, there are gobs of this enzyme in these important organs for sperm production and maturation, implying that the blocking agent finasteride would have an effect. So now what do we do?

At this point, controlled clinical trials are needed to prove this effect on fertility. For the time being, current thinking is that finasteride may not dramatically change sperm production in healthy men, but can impair semen quality in infertile men. Typically, the effects of medications on male infertility are reversible. So, to be proactive men should consider stopping the pill at least 6 months prior to trying to conceive. And, have confidence that she loves you just as much for other reasons. As Telly Savalas once said: “We’re all born bald, baby!”

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.

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.”

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

The Google Wrap (Up)

Paul Turek, MD — Sat, 18 Jun 2011 16:06:40 +0000

Google: Feels like college all over again…

Got a slice of Google life this week with a lecture and lunch on the Googleplex campus. Here’s the Google wrap up. Now, this is a company with great ingredients for a healthy work life: Yoga and massage classes, personal trainers, free bicycles, three squares a day, an on-site doctor, haircuts, car washes, dry cleaning, rubber exercise balls everywhere, and health and wellness lectures at lunch. In the words of CEO Eric Schmidt “The goal is to strip away everything that gets in our employees’ way.” Nothing like the corporate America of yesteryear. Truly, a very tasty wrap.

The Guy’s Guide to Maintaining Sexual Health Talk

My talk was well attended and, as far as I could tell, no one fell asleep. Maybe it’s because I kept up the pace. Or, maybe the young Googlers were riveted by my relatively disruptive philosophy how best to identify and care for men’s sexual health issues. If you just can’t wait for the YouTube video to be posted on Google Health in a week or two, here’s the meat of it:

Young men are medically underserved in America.
One problem that contributes to this is that their care is fragmented and reductionist in nature since it is provided by various doctors.
One helpful solution would be to train more men’s health specialists who “own” all aspects of young men’s health.
Another problem is that men do not have biological reminders, or biomarkers, of their health, unlike the menstrual cycle in women.
Importantly, sexual health issues such as low sex drive, erectile dysfunction and infertility are intimately relatedto overall health. Examples:
- Men with erectile function are twice as likely to have heart attacks later in life.
- Men who are infertile are 2 to 3 times more likely to get testis and prostate cancer, respectively, later in life.
Maintaining good overall health is a great way of optimizing sexual health. The reverse is also true.
Sexual health issues should therefore be considered natural biomarkers of overall health for men.
If we educate men about such natural biomarkers, then they may assume more “ownership” of their health and live healthier, productive and maybe longer lives.

Googlers Care

I have to admit the Googlers surprised me, right off the bat, at start of the talk. Watch the YouTube video and you’ll see. Not surprisingly, when I asked the audience how many of them get regular oil changes for their cars (not knowing that Google provides this service for them), most of them raised their hands. However, when I asked how many of them had been to a doctor in the past year for a personal checkup…again the majority raised their hands. More than I had ever seen among young men. This is a good sign, to see men taking equally good care of their bodies and their cars. I see this as a powerful first step for men to achieve “ownership” of their personal health and wouldn’t you know it, Googlers are leading the way. Happy Father’s Day.

The Talk:

Video -

Slides -
The Guy’s Guide To Maintaining Sexual Health By Paul J. Turek, MD

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.

Eat, Sleep, Reproduce

Paul Turek, MD — Sun, 17 Apr 2011 05:50:36 +0000

This white paper is red hot.

It has been said that we, like many other living creatures, were put on this good earth to eat, sleep and reproduce. In a minimalist, animalistic and mechanistic way, everything else is we do to make the world a better place is icing on the cake. Of course, we have free will and we can choose not to do any or all of these organic functions. However, I personally have not met anyone who has successfully avoided all three.

The Problem with Reproduction

In the big picture, what exactly does it mean if we try to reproduce and are unable to? With women, age is a clear determinant of fertility. They are born with all the eggs they will ever have, and when they run out fertility is no longer possible.

However, with men, the system is entirely different. The healthy adult human male makes 1200 sperm/heartbeat right up until andropause (7^th to 8^th decade) with new sperm produced constantly. So, when young men can’t reproduce because sperm production has ground to a halt, one has to wonder why such an important organic function is compromised. And this has led to boatloads of research over the last several decades into its causes and treatments, to the benefit of both patients and science.

The White Paper on Reproduction

A white paper is an authoritative report that helps solve a problem. White papers try to educate readers and help people make decisions. And I am delighted to announce that a white paper has recently been produced by the NIH regarding the issues surrounding infertility. As you may recall from prior posts, we met several months back in the middle of winter at the NIH headquarters in Washington DC, with the charge of identifying key opportunities in science that will define way we examine reproductive health over the next decade. At this meeting, I led a session on how infertility relates to overall health in men and women. Well, ta da, we now have the official White Paper from this meeting for your review at: www.NICHD.NIH.gov/vision.

White Paper Themes

Here are some of the overall themes of the white paper. What is very satisfying for me is the fact that several of my initiatives were carried through to the white paper:

Overall health affects reproductive health, and reproductive health affects overall health.
Reproductive and sexual health is essential to our wellbeing and serves as a window to overall health in males and females
Reproductive research is the cornerstone of stem cell research and is central to the field of regenerative medicine
Fundamental and applied contraceptive research is critical to this initiative as half of pregnancies in the US are currently unintended and unwanted
A better understanding of human development is necessary to reduce the incidence of adult male and female infertility
The effects of infertility on quality of life should be examined more thoroughly in future studies
We need to develop a national database of prospectively collected reproductive health data (e.g., an NIH social health network).

Now it’s your turn. Do your country and me a favor and take a couple of minutes and glance at the white paper. Tell us if it’s on or off the mark. Send your comments to NICHDvision@mail.nih.gov. We need your opinion to help direct this science over the next decade.

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.

We are the Walrus

Paul Turek, MD — Tue, 23 Nov 2010 02:17:14 +0000

Helping out John Lennon's walrus

Admittedly, he was an unusual patient. It was not only his generous size (2700 lb) but also his lack of clear speech in any discernable language that distinguished him from others I’ve treated. But, like most other men (80%), he had a great idea of what to do to conceive, but had the timing all wrong.

You see unlike humans, walruses are seasonal breeders. The females ovulate only once a year, in the autumn. Human females ovulate monthly. If conception occurs in walruses, an early embryo forms and remains quiet for up to 6 months until spring. Then, it implants and gestation (fetal development) begins. Female walruses are pregnant for 1 year and give birth in the summer when the arctic weather is the most kind to pup survival. This is very different from humans, in which implantation is immediate, gestation is 9 months, and births occur willy-nilly.

The problem with our walrus is that he is infertile because he is having his breeding “rut” in the spring. His timing is way off as the females are only fertile in the autumn. Consequently, there have been no pups born at SixFlags Discovery Kingdom in Vallejo, California. Ever. In fact, there have been only 10 pups born in the past 80 years to walruses in U.S. captivity, likely for the same reason. Why? According to Holley Muraco, the zoologist who contacted me for help, “the circadian day-night patterns in the U.S. are completely foreign to this arctic species and are confusing the normal breeding signals.” Simply stated, walruses in Napa are infertile because they live in Napa and not in the Yukon.

Holley had a great idea, one that I use in men all the time, to make the male walrus fertile, and it worked. She manually adjusted the walrus’s hormone balance with injections of luteinizing hormone (LH), a pituitary hormone. LH normally stimulates testosterone production by the testicle and hence sperm production. She gave the LH injections to the walrus in the early spring and within 8 weeks, he was making sperm again–exactly when it was needed. And violà, the zoo is now expecting its first walrus pup ever next May.

The reason Holley called me is that they are trying again for more pups and this time around, the walrus is not responding to the hormone injections. She thinks that he has developed a tolerance to it (makes antibodies that inactivate it) and she needs to try something else. Well it just so happens that I have another solution and we are trying it out as we speak. It’s a simple pill that I prescribe even more often than LH injections for my patients with a similar problem. It naturally stimulates LH and testosterone production and improves sperm counts.

You see, the goal is to get that human or walrus smiling and happy again by getting that pup or kid, helping each achieve what they want to achieve. In the words of Lewis Carroll in Alice and Wonderland: “The time has come,” the walrus said, “to talk of many things: Of shoes and ships – and sealing wax – of cabbages and kings.”

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.

Where There’s Smoke

Paul Turek, MD — Sat, 11 Sep 2010 07:00:16 +0000

All smokers eventually quit…

Smoking is bad for men’s fertility. Not unexpected, you might add, since 1000 smokers die each day around the world from smoking related diseases. But what else is new? A lot. And this matters because 25 million men in America smoke. Along with 21 million women. Any other condition this common would certainly be considered a frightening epidemic.

Although we always suspected that smoking impairs sperm quality and quantity, two papers published this week shed light on ways in which this could occur. Mechanistic in design, this research approached the problem from different angles and each made unique observations.

One study compared the integrity of sperm DNA in smokers and nonsmokers. As background, realize that a sperm’s job is to deliver a neatly packaged DNA payload to the egg during what is called fertilization. The egg then molecularly “undresses” the sperm DNA and decides over the next day or two whether that genetic payload is of high enough quality or integrity to proceed down the pathway toward becoming an embryo and then a fetus. If not, an executive decision is made by the fertilized egg to stop dividing and call it a day. Protamines are molecules that protect the DNA in sperm so that it remains neatly packaged, and in this study, the smoker’s sperm had significantly disrupted protamine protein levels compared to the sperm of non-smokers. That explains the sperm quality problem: smoking poisons sperm.

A second study took a different look at smoking and infertility. It assessed the impact of maternal smoking habits during early pregnancy on male fetal development. Based on the examination of miscarriages, they found that number of testicular stem cells that are destined to become sperm later in life in the male fetuses of mothers who smoked was half of that of their nonsmoking counterparts. And this observation held true when other social drugs like caffeine and alcohol were taken into account. Fewer stem cells in the developing testicle could mean fewer sperm and a higher risk of infertility in adult sons. This might explain a sperm quantity issue in some infertile men–in men who don’t even have to smoke to have the problem.

So ditch the coffin nails and let your life burn bright in other ways. There are many ways to have your breath taken away. As Woody Allen said: “Remember, if you smoke after sex, then you are doing it too fast.”

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.

One Child China

Paul Turek, MD — Mon, 14 Jun 2010 05:08:59 +0000

China: 5000 years old and on the move.

Just got back from China, from Beijing and Hong Kong to be exact. I lectured to several medical and academic institutions on where I believe men’s health is headed in the future. What I found was an audience eager to push the research frontiers in this field, however I also a sensed a lack of sufficient infrastructure to do this at the highest level. I paused for a moment to think about what was possible, since a monumental tidal wave of increased industrial productivity and change is occurring in China. For example, there are 1000 new cars being put on the road daily in Beijing alone! I sensed that when the might of China’s intellectual potential directs its energy toward medical research and innovation, the world will stand in utter awe at the prodigious output that will result.

Despite the fact that China’s culture is endowed with 5000 years of evolution and is responsible for helping to define human civilization, one thing really surprised me: its decision in 1979 to control its population by mandating a “One Child Only” policy. In the rest of the world, human reproduction is a basic right and for the most part, entirely unregulated. Under China law, families are allowed to have one child. After that, a vasectomy is performed on the male partner. Like it or not.

In addition to great control of population growth, the “One Child Only” policy has also led to the development of the wildly successful “No Scalpel Vasectomy” procedure. Now relatively common in the U.S., the “No Scalpel Vasectomy” is a quicker (10 minute), cleaner, less invasive and more comfortable innovation on a 100-year old American procedure.

But the curse of the “No Scalpel Vasectomy” is now being felt in China. Currently, it is difficult to find enough youth to fill jobs in urban areas within the massive and burgeoning Chinese economy. As a consequence, there has been a softening of the law such that couples that are both products of “one child” parents can now have two children. So can farmers, handicapped couples, and couples who work in “high risk” occupations like coal mining, heavy equipment operations and the like.

Even more fascinating is that infertile couples have a real reproductive edge over fertile couples under this law. How? Well, if they need assisted reproduction to help them conceive and they happen to have twins or triplets as a result (a 30-40% chance), they are not penalized for bearing “extra” children. Can’t help but think that this little known fact may partly contribute to the size of the massive, bustling IVF clinics that I visited in China last week. many of which are 4-10 times the size of U.S. clinics.

The Curse of Women’s Urine

Paul Turek, MD — Sun, 25 Apr 2010 22:21:26 +0000

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.

Are We Replacing Ourselves?

Paul Turek, MD — Tue, 08 Sep 2009 21:55:15 +0000

Where are you? Green means high and red means low.

When a couple decides to have children, they rarely, if ever, contemplate the effect this has on the nation. But population scientists do. The effect that birth rates have on society is critical—as basic as knowing whether a nation is sustaining their population or not. But, trying to figure out if birth rates are going up or down is also complex, not unlike taking our temperature by feeling our foreheads.

A good barometer of birth rate assesses the average number of births per woman, and is generally noted by country. For a country to sustain its population in the future, the replacement rate is 2.1, or 2.1 births to every woman. What has occupied the minds of population scientists over the past 20 years is the fact that birth rates have dropped around the world, especially in Europe, but also in China and Japan. Interestingly, many countries in Africa do not have this problem, with birth rates well above 4.

Also notable is the fact that in the past 20 years, the population of the world has dropped, falling an average of 1% per year. You can imagine how much this issue has occupied the minds of population scientists who seek to explain the phenomenon. Contributing factors include changing attitudes about family size, the cost of raising a child and the wider availability of contraceptives. The birth rate may also be dropping because child mortality on the whole has dropped. Or, because women who choose to have children later create a temporary lull in the birth rate. One concern with population drops is that countries whose populations become too small may not be able to afford to support its infrastructure, causing economic decline. So, on the one hand, it’s expensive to raise a child. On the other, it’s also expensive not to.

A recent study however, does show a change in these trends. Fertility rates now show a recent increase in developed nations. For years it has been thought that for some reason, developed nations, including most of Europe, have steadily dwindling populations. But this may not actually be the case. For example, in the 1970s, the US fertility rate was at a low of 1.74; lately it’s been relatively stable at 2.05. It appears that children are still wanted in a modernized world.

It’s quite hard to see these trends in my daily medical practice, as I perform as many vasectomies as I do vasectomy reversals. It’s even harder to render an opinion when the information is so diffuse and generational. So, to population scientist, I am a professionally “neutral contributor” to fertility rates. Like to think I do more good than that though…