Turek On Men's Health » erections

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.”

Diabetes Mellitus: The Infertility Triple Threat

Paul Turek, MD — Mon, 26 Mar 2012 15:00:55 +0000

Colors as possibility. Feathers in a kite shop, Beijing, China

Based on the feedback received from doctors reading the blog, we are introducing a new feature: Case of the Month. This Case of the Month is an actual patient from The Turek Clinic. It is presented to recognize American Diabetes Association Alert Day.

The Case of Male Infertility

He is a 31-year old who has been trying to conceive with his 28-year old wife for 2 years. During this time, he has noticed a lower sex drive and has had trouble ejaculating. His medical history is negative except for a 6-year history of diabetes mellitus that is well controlled with insulin injections. Exacerbated, he states “I really don’t know what’s happening to me!”

Upon further questioning, the sex drive issue started even before they were trying to conceive. Regarding ejaculation, the patient states that his erections are not very strong and, although he has the sensation of climax, nothing comes out of the penis with ejaculation. In fact, he is concerned that things might be “backing up” in his body with these symptoms.

A Short Review of Diabetes

First identified as a disease of “sweet urine” in ancient times, diabetes mellitus a metabolic disease characterized by high blood sugar (glucose) levels. It is one of the most common medical diseases in the U.S., affecting 26 million adults and children or about 8% of the population. Among those affected, about 15 million are people of reproductive age.

Normally, blood glucose levels are tightly controlled by insulin, a hormone produced by the pancreas. When the blood glucose rises, say after eating food, insulin is released to decrease the glucose level. In patients with diabetes, there is low or no production of insulin and therefore blood sugar levels are elevated. The sugars spill into the urine, hence the term “sweet urine.” Diabetes is currently a chronic medical condition that is not curable.

Can Diabetes Cause Infertility?

You bet. Diabetes causes male infertility in three ways:

Causes erectile dysfunction-by affecting the health of small blood vessels and lowering testosterone levels
Lowers sex drive-by lowering testosterone levels
Reduces ejaculate volume-by affecting the small nerves that control ejaculation and by lowering testosterone levels

Indeed, this patient had all three issues at the same time along with a low testosterone level. Fortunately, these symptoms are fairly easy to correct with oral medications:

Erectile dysfunction- Viagra, Cialis or Levitra can restore erections
Sex drive and low testosterone-Selective estrogen receptor modulators (i.e. off label use of clomiphene citrate) can correct testosterone deficiency
Ejaculate volume is low because it is emptying backwards into the bladder instead of forward into the penis. This can be treated with over the counter cold medication (alpha agonists) to restore the normal direction of ejaculate flow.

Sure enough, with this combination of pills, the infertility “hat trick” induced by diabetes was overcome and the patient was able to conceive naturally after several months. Another family holiday card on its way to The Turek Clinic this year!

Remember that about 1/3 of infertility is male driven. And diabetes is both a common and quite treatable cause of infertility. So, do yourself and your future family a favor and take the Diabetes Risk Test today.

The Testosterone Tipping Point

Paul Turek, MD — Mon, 06 Feb 2012 16:00:49 +0000

Sex and muscles are different when it comes to testosterone levels

Your car is not running well. It just doesn’t have the pick up it used to have. It’s low on gas so you fill it up, but it runs the same. OK, so it’s not the gas…it must be something else, so you begin looking for other causes. Yes, I’m an “old car guy,” but there is a point here.

Testosterone as Gasoline

Think of testosterone in your body as gasoline in your car. You need it to run and to run well. But a half tank of gas is just as good as a full tank, and topping off the gas tank is not going to help the car run any better. In other words, if you have enough gas—it’s not the problem.

When it comes to building muscle, it is clear that more testosterone is better. The higher the testosterone, the greater the anabolic effect. Weight lifters have known this for years. However, recent studies have shown that when it comes to sexual function, including erections and sex drive, the body may respond differently. More like a car does to gas: at some point adding more doesn’t help it run any better.

The Testosterone Plateau

There is a lot of scientific support for this idea. The most recent is from a European study of 2838 middle age and elderly men (yes, that’s ages 40-79) published last week. It examined the relationship between sexual function and male hormone levels in men who weren’t necessarily seeking care, typically referred to as a “community population.” Here are examples of the many prying questions that these men were asked:

How often do you think about sex?
How often do you attempt to have intercourse?
How frequently do you awake with a full erection?
Are you worried about your level of sexual desire?
Are you worried about your ability to have an erection?
How often do you perform self-stimulation?

What the study found was kind of expected: that testosterone levels correlated with overall sexual functioning in men. But the study also observed that there was a “plateau” effect of testosterone on sexual function. And this plateau occurred at 231 ng/mL (“normal” is 300-800ng/mL). In other words, sexual function worsened when testosterone levels fell below this point, but did not improve when levels increased above it. So, at least in these men, adding more gas to the tank would not necessarily help the car run better.

Notably, in six other clinical studies that have also examined this issue, a similar observation of plateauing testosterone levels was found. Not proof positive, but certainly suggestive of a true biological relationship.

Sexual Function is Not Muscle

So how does this percolate down into clinical practice? Well, I see men every day who have low energy and sex drive and poor erections and who feel “much older” than they feel they should for their age. Accompanying them is a lab report showing that their testosterone level is “low.” Maybe it’s 250 ng/mL, maybe 300 ng/mL. Although I believe that sexual function does not respond to testosterone like muscle does, I also understand that not all men are created equal, unlike assembly-line-built cars. In most cases, I respond “it’s not at all clear where your particular testosterone tipping point is, so lets get you above what you are now and see how you do.”

As with vintage cars, you really have to tinker with men to get them running right. And, it’s important to look beyond the gas issue to solve the problem of the poorly running machine. It’s our duty as good doctors not to just “top off the tank” and needlessly commit men to a life of testosterone replacement.

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!”

Why Urology?

Paul Turek, MD — Mon, 19 Dec 2011 16:00:43 +0000

I am a men’s health specialist, but I started out as a urologist. Not a bad place to begin as urology is a great discipline. It focuses on the upper and lower urinary tracts of males and females and the reproductive tracts of men. If you ever have a kidney stone (and I pray you don’t) then you will come to know a urologist.

Why Urology?

Admittedly, urology is a small, unusual and low-key medical specialty. In fact, for the longest time, my parents didn’t know exactly what I did as a doctor. I kind of like that about it. Feel free to choose a more glamorous, chest pounding, field like neurosurgeon or heart surgery if you like. I’ll stick with urology, thank you. It’s a fantastic balance of medicine and surgery, and involves the care of both adults and kids and men and women. All you have to do is get through six years of surgical training after medical school to join the crowd!

Spreading the Word

Since my time as a decorated professor at UCSF, I have been committed to getting students interested in our little corner of the medical world. This effort has resulted in the publication of a national curriculum for teaching urology to U.S. medical students now hosted on our leading society’s website. As popular as it has become, it is really an essential national resource for the field of urology as it slowly gets squeezed out of the tight, full schedules of medical students nationwide. For some reason, pharmacogenomics now matters more than prostate cancer in medical school.

Even with this under my belt, I felt that more was needed to get students turned on to our specialty. We needed to hear from real life urologists, both those in training and at the top of their game, and see why they chose this field. The field is ripe with superb mentors and I wanted to show them off. So, with the help of our national society, we recently created a short video in which urologists talk about why they chose this field. Well, “Why Urology?” has certainly hit the ground running, and just garnered a national marketing award in its first several months of life!

Love what you do, make a difference doing it and spread the word. These are the tenets of my life in medicine.

The Expert in Each of Us

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.

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.”

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.

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

A Well Lived Life

Paul Turek, MD — Mon, 22 Aug 2011 15:00:59 +0000

Walking barefoot on green moss..one of life's simple pleasures.

Dear William,

You called several months ago from across the country to talk with me, as many others do. The story you told moved me as many others do. But the way your story ends is different from many others and, because of this, is now etched in my memory.

You broke your back at age 16 and you were paralyzed from the neck down. I can’t remember exactly how it happened, a diving accident, skateboarding fall, car accident or a gunshot wound. And for 6 years you had been trying to conceive. I remember telling you that although you cannot move any of your limbs with purpose, remarkably enough, the part of the spinal cord responsible for the ejaculation reflex is still intact and that your fertility potential is very high. Penile vibratory stimulation or electroejaculation are techy ways in which I can routinely stimulate this reflex, much like a sneeze, and offer you the opportunity of fatherhood. Several interesting issues made your case unique but did not pose insurmountable obstacles.

I may have even mentioned that the most rewarding moments of my career have occurred while watching giggling children running around their father’s wheelchairs. The satisfaction of helping spinal cord injured men become fathers is immense and continually motivates me to help.

We had a plan to optimize you medically and then bring you out to California where the sun always shines to make your dream of fatherhood come true.

But then, just like that, it got ugly.

I will never forget the day your wife called to tell me that you were in the intensive care unit at Johns Hopkins Hospital, the worlds best, with a very serious pneumonia. So serious that it had eaten up most of your precious lungs and forced you to be on maximal life support, with little chance of making it out of the hospital.

Yet through all of this, through weeks and weeks of deteriorating health and increasing suffering, you made it crystal clear that your ultimate wish was to be a father and, through the newness of life, be remembered by those who you loved and those who loved you.

My life is now somehow different after knowing you. With your grace, will power and singularity of purpose, you have taught me something about life, and living, that I did not know before. You have clarified once again, what really matters in a well-lived life. You have reminded me of the sound that small flowers make as they open in the morning.

So, William, I salute you. And, in the words of Nobelist Thomas Mann, may you always walk on the greenest of mosses.

Your friend,

Paul

Timing (And Position) Are Everything

Paul Turek, MD — Mon, 18 Jul 2011 15:00:39 +0000

Does timing and position matter for sex like it does for surfing?

Missionary? Doggie? Cowgirl? Kneeling Lotus? Quarter moon? Full moon? No moon? Is there really a best lovemaking time or position to have a girl or boy?

History of Designing Sex for a Boy or Girl

Methods for determining baby gender are ancient, even prehistoric, and range from astrological, to dietary to positional. One of the earliest references to this concept is the Chinese Birth Gender Chart, said to have been discovered in a tomb near Beijing for where it lay for 700 years. It supposedly now resides in the Institute of Science in Beijing. It claims to predict the sex of the child from the month of conception and the age of the mother.

It has also been said the many myths about sex position and timing determining baby gender resulted from the mad rush of lovemaking that followed the end of the World Wars and the return home of soldiers. I’m sure this influx of war torn yet triumphant, and testosterone laden yet depraved men gave new meaning to the term “Honey, I’m home!” for many mid-century modern couples.

The Lovemaking Myths

Here are the most common myths regarding sexual position and timing to help get that boy or girl. Sorry, no pictures. I hear these from patients all the time, as they look at me bright eyed, with heads nodding, searching for my blessing.

Eat meat and salty food to get a boy.
Splurge on desserts to get a girl.
Both partners eat lots of fish and vegetables for a girl.
Make love standing or doggy style and during a quarter moon or at night for a son.
Use the missionary or cowgirl position and during a full moon for a daughter.
The Shettle method suggests having sex as close to ovulation as possible, for a boy, as boy sperm are less robust than girl sperm. Do the opposite for a girl.
If the male partner climaxes first, then a boy will be conceived. The opposite is suggested for a girl.

The Lovemaking Truths

Sorry to be the bearer of bad news. Despite all that you may have heard, there is no real data supporting the idea of a “best” position or time for sex to conceive a boy or girl. In fact, a prospective study of couples starting to conceive was actually published in 1995 in the New England Journal of Medicine that reported no relationship between the timing of intercourse and baby gender. Ah, but they did not study lovemaking position, thus keeping that myth and folklore alive! Come to think of it, that would be an interesting study to do, and one that I imagine would have no trouble enrolling subjects…

A Teaching Moment

Paul Turek, MD — Mon, 11 Jul 2011 12:55:13 +0000

A surfing mentor in Panama: Victor Martinez

They stood on their boards in waist high waves within a couple minutes of my surf lesson. It was magic to see the look on their faces as their arms were wildly gesticulating in the white water. All half dozen of them. Even chilly 60-degree water didn’t seem to matter.

Teaching is fun. And this was certainly a highlight of my week spent in Outer Cape Cod with two-dozen relatives from Connecticut and New Hampshire. Great weather, 80+ degree-days, and the warm sand and grassy bluffs typical of east coast beaches.

An Academic Life

I certainly learned a thing or two about teaching while training as a resident at the University of Pennsylvania for six years and then again during my tenure as a full time faculty member at the University of California San Francisco for almost fifteen years. My experience teaching college and medical school students, residents and fellows has led to a relatively simple teaching philosophy, the secrets to which are below:

Teachers are born and not made. More work than talent is needed to be a great teacher.
Plant the seed of knowledge and let it grow. Don’t try to plant the whole tree. Curiosity is incredibly fertile soil.
Be an example, or mentor, to those taught. Practice what you preach and your teaching will have far more impact.
Take some time to put on the student’s shoes (figuratively of course) to better understand from whence they come and to optimally stimulate learning.
Analogies work wonders. Bring home points with everyday examples.
Storytelling is better than almost any other media imaginable for information retention. (If you haven’t guessed yet, this is precisely the modus operandi of this blog)

Teaching Urologists

From the Cape, I am off to New Orleans to teach an annual board review course to 600 urologists. This teaching scenario presents its own unique challenges including conveying an abundance of critical information (enough to fill a book) in a very short time frame (an hour). My goal: keep it short, keep it sweet, tell some stories and make it memorable. I’ll post the lecture slides this week and see what you think.

A Bank Account to Empty

Paul Turek, MD — Tue, 05 Jul 2011 15:15:08 +0000

Diet like you emptied your piggy bank as a kid…

“You tell me I need to lose weight. How do I do it, Doc?”
“My dear patient, it’s simple: treat your body like a bank account, but one that you should empty. Put less in and take more out.”

Obesity in America

You’ve heard the rumors; here are the facts: The United States is one of the most obese nations in the world, with 31% of Americans currently overweight. Not only that, obesity rates have tripled in the past 3 decades. The most disturbing statistic about all of this is that obese children are leading the way.

The Best Recipe for Weight Loss

Believe it or not, Americans are very motivated to lose weight. In fact, they spend $42 billion annually on weight loss foods, products, and services. Any Joe can name a half a dozen diet plans that populate the American psyche: Atkins, Pritiken, Ornish, Zone, South Beach, Jenny Craig and Weight Watchers to name a few. But do they really work?

A great study was published recently in one of medicine’s most prestigious journals that showed that no particular diet plan works better than any other to help you lose weight. In a Harvard study, 811 overweight adults were assigned to one of four diet programs that each varied carbohydrate, fat and protein content. After two years, each group had lost — and regained — about the same amount of weight regardless of the diet. I say regained because a few months off of the diet, most returned to their usual eating habits. So, despite the different diets, the same results were achieved. Conclusion: popular diet plans are largely ineffective.

Calorie and food group restricted diets are complex, stressful and lead to disappointment when goals aren’t met. Not only that, the math gets too complicated and it makes meals stressful instead of enjoyable. There must be a better way.

Five Easy Ways to Empty Your Bank Account

Give this approach a try. Knowing that the cause of obesity is relatively simple in that weight gain occurs when caloric intake exceeds caloric expenditure, try treating your body like a bank account that you want to empty and keep empty:

1. Eat less but keep it simple. Eat what you like, but first cut out snacks between meals. Then cut out dessert after dinner a couple of times a week. Then cut down on the size of one meal each day. A great way to put less into the bank account.

2. Eat food that requires work. It takes time to consume celery or an apple and requires chewing. The more you chew, the more you decrease hunger.

3. Replace energy drinks with water. Energy drinks have way too many unfilling calories.

4. Although you exercise for your heart, and you at to lose weight, exercise is a great way to help empty the bank account. Go for a 20-minute walk after lunch.

5. Get more sleep: Poor or too little sleep impairs hormones (ghrelin and leptin) that regulate hunger (gherlin) and satisfaction (leptin). Less sleep means less satisfaction with food and more uncontrolled hunger. Try to sleep 30 minutes more nightly than you do now.

I explained this recipe for weight control to a banker one day in the office and he listened intently. He then went home, made a series of small changes in his diet and lifestyle as suggested here. Being the typical number-oriented male that he is, he brought a plot of his weight over the next 4 months to show me. He had lost 30 pounds; about 1-2 pounds a week, and felt great. No fancy diet plan. Just plain ol’ economics: buy low and sell high.

Am I a Disruptor?

Paul Turek, MD — Sat, 25 Jun 2011 18:30:35 +0000

Calling a spade a spade: Jennifer Neeley's distinguished dialog with disruptors.

I did well in high school and I did well in college. I loved medical school and tolerated my surgical residency, as it occurred well before the 80 hour medical workweek was established. After six years, I completed a fellowship in microsurgery and male reproductive medicine and then joined a top ranked university and made full professor in 12 years. Does this sound like the life of a “disruptor?”

Getting the Call from The Influence Project

I was shocked and titillated to get a call from Jennifer Neeley of The Influence Project last week, asking me to do an interview on her blog talk radio show. Jennifer Neeley is probably the closest thing to the “soul” of social media as a social media strategist and new media pioneer. Why did she ask me to be on her show? “Because you are a disruptor.” She heard my Google lecture and wanted to talk more about what I said.

To be honest, I know as much about social media as I do about 17th century dance. But I love what’s happening to media and the transparency and honesty and equality of its new outlets. In fact, I really enjoyed myself on her show and over the hour we covered many aspects of men’s health, including much of the Google talk. Have a listen to the interview below and see if you agree.

Dr. Turek the Disruptor

But where’s the “disruptor” in all of this? Hard to tell but my take is that the following philosophies that I hold dear in taking care of men might be a little new or edgy or even “disruptive:”

Men are best served medically by keeping them in their comfort zone.
The doctor’s office is not a comfort zone. Phone or email is.
Men are best served medically by simply spending time listening to them.
Men are not used to visiting doctors as regularly as women as they lack monthly biological reminders that women have.
Men are linear-thinkers and they like numbers. They try to improve them as much as possible.
Modern medical care can be designed to work with these parameters of the human male.

I’m ok with being a disruptor. Because, in the words of Gandhi, “You must be the change you wish to see in the world.”

Listen to internet radio with Jennifer Neeley on Blog Talk Radio

Show Transcript: Men’s Health Week With Dr. Paul Turek, The Turek Clinic

Aired: 6/17/2011 9:00 PM UTC

Host: Jennifer Neeley

Description: Paul Turek, MD (@TheTurekClinic) is an internationally known thought leader in mens health treatment and research. He specializes in the latest advances in mens sexual health including infertility, libido, vasectomy and vasectomy reversal. Hes the creator of the worlds first and only artificial testicle (Wired, put that on your cover!) and its been said he can get, sperm out of a rock. Hes a board-certified physician by the American Board of Urology and received numerous awards for his work worldwide. When the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) make decisions, they call on Dr. Turek to advise. Unlike others in his field, he actively blogs about mens health issues and is a true disruptor in the field – leading instead of following. Dr. Turek lectures all over the world, including a Mens Health Week keynote at Google. In addition, he is the author of a number of books that are textbooks for those training in the field.

[Start of Transcript]

[Jennifer Neeley]
0:04: Welcome to the A-list with me, Jennifer Neeley. Every week, our show is focused on the intersection of technology, media and business with influencers and change makers around the globe. You are a vital part of this program as you know. Please send in your questions to the program, be at Twitter, Facebook, my blog or email. You’re welcome to do that at any time during the show, be checking us. And today, Friday, June 17, 2011, we have a special treat. Dr. Paul Turek, the premier leader in the area of men’s health as well as an active blogger, which you don’t often see, is here to discuss efforts for Men’s Health Week, which concludes in a couple of days, June 19. Welcome to the program, Dr. Turek.

[Dr. Paul Turek]
0:49: Why thank you Jennifer.

[Jennifer Neeley]
0:51: I am so pleased that you could make the time to join us. I know you’re busy traveling all over the place, helping people, and this week you actually had a toxic kind of hit the radar in terms of social media. You were at Google this week talking about men’s health and in your area of expert — maybe you can explain how your area of expertise landed you at Google talking about men’s health overall.

[Dr. Paul Turek]
1:20: Yeah, I’d love to. So this is a special week. It’s called Men’s Health Week. It is actually part of Men’s Health Month, but there isn’t all that much activity nationally which is kind of a statement about men’s health which needs to change and for that reason I am here with you and I want to make sure people realize that it really does matter. It ends on Father’s Day so that’s a good one. So I think Google Health has a series and they have lectures come in to try to improve the quality of life of their employees which is a quality of life that’s not bad to begin with. They asked me to give a talk about men’s sexual health. And I’m a men’s health specialist in San Francisco and I am a surgeon urologist but I also do a lot of — I take care of young men basically. And a lot of the problems that young men have in this world are sexual health issues. They may not be problems, they may be issues, and they may be normal. They just don’t think they are or whatever. So I kind of addressed eight of those sexual health issues in an hour talk and I thought it was pretty well received. I mean the campus is impressive and the questions were great and I think it got sent to web, sent to 11 sites, 10 or 11 sites across the country at Google. So, I think that’s the segment of population that I think takes the least good care of themselves, men at Google because you know they are immortal, and so to teach them a little bit about life and the basic theme of the talk was that you think sexual health is kind of an elemental orb rotating around the realm of overall health but it’s actually an integral part of overall health of young men. And many of the issues, sexual health issues that men have, erectile dysfunction, sex drive issues, infertility, etc. can come back to reflect on overall health.

[Jennifer Neeley]
3:18: And I think one of the things that’s interesting about Men’s Health Week is earlier in the week when I was looking around, my radar on Men’s Health Week was that not too much was happening. A lot of the questions are being answered by people helping one another out and later in the week, Men’s Health Magazine came out with a coronary quiz, are you a candidate for coronary problems, and so seems like a lot of people are taking the quiz and I know that part of what you talk about is how, to put it bluntly, the penis is a predictor in a lot of ways of heart problems and other problems and I should let you speak to that, you’re the doctor, but can you talk a little bit about that because it seems like today people are really talking about coronary problems as they relate to men’s health.

[Dr. Paul Turek]
4:13: Absolutely. I think — you used the word first so I feel comfortable saying that word now, the P word, but I think…

[Jennifer Neeley]
4:20: The penis word.

[Dr. Paul Turek]
4:22: Yeah, whatever, there you go, okay. Oh, we could hear the shush go through. But basically, erections are a biomarker, a natural biomarker of heart disease, and that’s been kind of drilled into the lurch over the past 10 years because if you have problems with erections, erections are driven by blood vessels, and the heart is a big blood vessel and the penis is essentially a blood vessel, although it’s glorified. The issue is that the penis has blood vessels in it that are smaller than the heart by about half. So, if you’re someone who is going to get heart disease, it’s probably going to show up in the penis first because it’s a smaller system and they’ll clog quicker in a sense. And that’s true. I mean basically, if you have serious erection problems in your 40s, you’re twice as likely to die from heart disease as someone who doesn’t, and that risk is the same as having a family history of heart disease, a brother, a father, mother, or being a smoker, and those are considered serious risks.

[Jennifer Neeley]
5:32: Yeah, and I know smoking is one of the things that in the Men’s Health Week twitter/chatter that’s going on. Smoking is being talked about quite a bit in terms of how it factors into health problems. I am curious you’re take on smoking in terms of, you know, some of the specialty areas the you are very well known for which have to do with fertility, infertility and that sort of thing.

[Dr. Paul Turek]
6:03: I am a rabbit about that. I mean I think that if you’re trying to conceive and you’re smoking, that’s just an example of not taking very great care of yourself and I think I look at them and I say you really want to be smoking around your newborn kid? Do you really want we have the stench smoke around your kid? And I mean talking about the erections later on of the lung cancers, stuff like that. How trendy are you? How trendy do you want? What’s the cost of being trendy in smoking? I actually…I have a great solution for it. There’s a guy named the Mad Russian in Boston. He is called puff daddy. And I have a handout of his __6:44__ and he does hypnosis and the young men love this because they don’t want to take long treatment regimens that are expensive like the gums and the patches and things that provide nicotine without the smoke. They just tend to fail that. It’s a compliance issue. They can’t do that. Men wanted something simple, cut to chase, get it done. So I’d sent a bunch of couple there from my practice and I think he’s a hypnotist but…and he does just focus on smoking but he’s about 65 dollars and you go to be constrict somewhere in a basement, you sit with 20 people and he doesn’t touch you and you close your eyes and 20 minutes later you never feel like smoking again. And what it is is addiction control and it’s kind of weird because I’m a scientist and I’m an evidence-based guy and an evidence-based doctor but this is impressive. It’s called the Mad Russian. And he has been in Glam magazine and on Yelp, you could read about him, but it works. So I sent half dozen couple last year and they call me and say, “Turek, still not smoking.” They’ll email me or twitter me or something. So it’s really fun. But that is the kind of solution that works the best which is addiction control and I think a guy like the Mad Russian could do anything, well, like weight control or anything, but it’s really a matter of addiction control.

7:57: So, I do empathize with men who like really want to stop smoking for infertility or erections or anything. Any sexual health issue, it’s on the chart, is a problem. It’s on the map and is one of the causes. Almost anyone of the eight issues I talked about at Google. But I’d say the most important thing is make sure you don’t just pull the plug on smoking with a young guy and give him something or let something take the hit. So it’s sort of something that has to…it can’t just be pulled, it’s too much of a stressor. So you would tell, you know, you can gain 5 pounds instead or you can eat some sweets or you can do something else. You can exercise rapidly, do something else to take on the stress that the smoking cessation will bring on when you stop it. So, you know, it’s a biological organism and it’s an imbalance and you have to — to go and change the balance, you have to have something to help out.

[Jennifer Neeley]
8:53: Yeah, sort of like that, risk analysis you know. What you’re going to do a major to risk analysis.

[Dr. Paul Turek]
8:59: Something’s going to give. Right.

[Jennifer Neeley]
9:01: Yeah.

[Dr. Paul Turek]
9:01: Something’s going to give and you just accept that something’s going to give and you help him with it because they won’t survive. They won’t be able to do it if you don’t have a plan.

[Jennifer Neeley]
9:14: Yeah. I think that’s one of the key things about what you talked about at Google which was that you have a very good sense that there is a plan men can follow that gets them to a place that is healthy. I think that’s one of the things in terms of Men’s Health Week. It’s sort of like, where do you start? What are the most important issues? You see a lot of women. I notice a lot of women on Twitter sort of reaching out about fertility and fertility issues, which often have to do with their partner rather than themselves. There’s just so many areas and so having a program that addresses overall health, does it really move the needle for these other areas where we’re talking about, things that are very, very near and dear to people’s heart which are being able to have a child and that sort of thing.

[Dr. Paul Turek]
10:14: I think that we need to deal with men entirely differently, especially young men, entirely differently than women. And I think for instance there’s no monthly biology in a man, right? I mean, it’s one of best biomarkers on earth is the female ovulatory cycle. So women notice it’s been regular for 10 years and then all of a sudden there’s three months of something odd. You can bet they’re going to call their doctor. It’s like a clock. I mean it’s a great a sign. It’s just great because men don’t have that and so we have to find those things. And I think for instance that the semen analysis, and I’m telling the government this when I go consult NIH some things that maybe we should consider the semen analysis as a baseline study in your 20s or 30s. If it’s abnormal, we know that that is a general reflector of overall health, maybe there’s things we need to attend to, in addition to infertility or fertility. So I think that men are different beasts and we have to treat them differently than women. The other thing is men judge their productivity and their self-esteem by — they judge their self-esteem by their productivity so the amount of money they make, how hard they work, the firm they work for, what they do in life, it’s very much a part. They are hunter gatherers. They are the ones who set out, get the food for the family. I mean, we work cavemen too long ago and that’s their mentality, which is provide, provide. I understand myself best as a provider. And so if you say they were provider like that whether he’s a caveman or a Googleler, you basically say hey, why don’t you come to my office, why don’t you take a two-hour drive up the Peninsula and deal with traffic and come in in my office for 13 minutes of whatever insurance covers now for a visit and then drive two hours back to let me tell you something that you maybe didn’t want to hear or is not that constructive or whatever. It doesn’t work for men. I mean they just don’t. So in my practice, I see them once for an hour and I listen.

12:14: That’s the only thing we do with men because they don’t talk much. We don’t listen to their bodies. They don’t listen to their bodies and we don’t listen to them, and 12-minute visits just don’t cut it for men. They don’t because don’t know what’s going on and it takes me a while to even get men relaxed enough in the office to be able to the open the book to find out what the real symptoms are. Because they come in with symptom A and that is kind of the tip of the iceberg of a symptom B which is caused by C, and if you solve C, B goes away and A goes away, but men don’t know it’s C. They don’t even know it’s B. Women are already on theory.

[Jennifer Neeley]
12:51: Yeah, and I think speaking from experience unfortunately, I think if semen analysis was done in the 20s or whatever as people get married later in life, knowing what you’re dealing with I guess is everything and it would be nice to know.

[Dr. Paul Turek]
13:12: Yeah. I think from a fertility point of view.

[Jennifer Neeley]
13:15: Before I married my husband and all those times I talk to him and all that, I said I’d love you to have a sperm test. And he, it would have been too difficult for my husband and his personality type to get that done, but I would have learn so much more on the journey that we’ve ended up going on together. We wouldn’t have…it would have increase stress level.

[Dr. Paul Turek]
13:37: That’s a two-edge sword if you’re saying I’m measuring you by your semen. There are religions that with arranged marriages around the world, not usually in America, but I have a lot of patients who come in and say the Orthodox church tell me to get a semen analysis before this arranged marriage and it’s abnormal and now I can’t marry her because it’s abnormal, because I can’t have a kid. And I get called in to court a lot for this kind of thing and my answer is, I’ll say this in a letter, the semen analysis does not a man make. I mean you’re not really infertile until you’re trying and you’re certainly not infertile if you have any sperm count. Don’t assume that at all. In fact, assume the opposite. And you’re only really infertile if you’re sterile, if you’re zero, if the sperm count is zero, and he wasn’t. So we did some things and we made him better and now his sperm count has normalized, and don’t check it again. Just take great care of yourself and go on with your happy life. So it can go both ways that way. I wouldn’t…I don’t…that’s odd. And also the standards for what makes a semen analysis normal are also changing. There’s five editions of the World Health Organization standards for semen analysis and I just gave a talk at our national meetings in urology in Washington last month on the fifth edition and my argument was basically, it’s just a tempest in a teapot. Just a storm in a very small space that doesn’t affect anything by changing these numbers around and stuff because they don’t really mean a lot unless they’re really zero. So it’s a two-edge sword and we have to think about how best to use it and who might get it but if there are other biomarkers, like erectile dysfunction is a biomarker, I think if you’re sex drive is changing or low and it’s not what it used to be, that could be a real biomarker of health. For instance, if your body is ill.

15:36: Think of the caveman. If your body is ill, the last thing you want to do is reproduce. You want to survive first. If you’re stressed by a woolly mammoth as a caveman chasing you, the last thing you want is an erection or sex drive. If you’re woolly mammoth is financial, if it’s the recession or the dot-com bust or your mortgage, or whatever as a provider, that’s just the same as the woolly mammoth chasing you, and that’s the wrong nervous system, to relax and enjoy life and have a great sex life.

[Jennifer Neeley]
16:09: Interesting. But there are things that man can do too and should be doing in a sort of like women do, the breast health check, I just noticed somebody who’s talking about an event on Twitter where there was a stall for men to be able to check your balls (laughs) for Men’s Health Week

[Dr. Paul Turek]
16:32: That’s interesting.

[Jennifer Neeley]
16:33: And everybody and apparently know when. It says apparently testicles are still taboo. Some men went to every other stall at the Men’s Health Week event yet ignored our stall and so that has a tag as check your balls. And certainly, that’s another one of those taboo areas that men don’t have to do. Women, I don’t even enjoy doing sort of the stuff that we’re supposed to do as women and check our breasts, but it’s just a similar type of thing that men could be doing prerogatively to help themselves, is that right?

[Dr. Paul Turek]
17:09: It’s remarkable. I mean it’s remarkable how well you take care of your teeth compared to testicles, but I am stunned weekly in my practice by patients. A couple of weeks ago come in infertile, married infertile and he has no testicles in the scrotum. He is 35. This is not unusual. Now, how many people missed that over 35 years? So yeah, you’re right. I mean it’s cultural and it’s there and that’s another fact. Men have a problem down there. It hurts or he feels something unusual, and then you ask how long is it going to take that person typically to get to care to figure out what that problem is. It could be anything. It could be cancer. Most times it’s not, just a cyst or something. But I did a paper on this because I said a guy notices a third testicle or a lump on his testicle and it’s called a spermatocele, a cyst that means nothing. I mean it can be removed and all that, but it’s benign. But I wrote a paper about guys in my practice and I said how long did it take them to get care when they knew they had something abnormal, unquestionably abnormal to them. It was about four months before they sought care. And testis cancer confirms that the date is four to six months before they seek care and that’s __18:48__ we can find disease that’s curable and metastatic disease that may not be in a lot of cancers, especially testis cancer. So monthly testicular self-examinations are a no brainier, end of the shower, hanging low, just comb them and make sure they’re smooth and make sure the consistency is the same from side to side and they feel the same. And if there’s a change, call me (415) 392 3200, call me and I will see you the next day and you know…

[Jennifer Neeley]
19:20: Yeah, I mean, well, and you do 10 minutes on the phone too for free.

[Dr. Paul Turek]
19:23: Oh, sure.

[Jennifer Neeley]
19:25: So it’s like you know…

[Dr. Paul Turek]
19:26: But that kind of thing probably need check the same, and those guys find a scrotal pearl or their epididymis…

[Jennifer Neeley]
19:33: But even if you’re worried. The thing is that you’ve got a world class doctor and we haven’t even talked about all of your credentials because you’re so, knowing you, you’re so damn modest, but you know, I think __19:44__. I mean you’ve seen sultans, you’ve seen heads of state, you’ve seen major leaders in the Silicon Valley and there is without naming names that you’ve not done with me either but as I’ve known you, you’ve seen all of these amazing people and the problems are the same. It’s sort of like, it doesn’t just because you’re a sultan doesn’t exalt you into anything. It doesn’t you think…

[Dr. Paul Turek]
20:15: No. I don’t think you get better care — I don’t think you get better care with political status or financial status. In fact, they see a lot of concierge doctors who charge a lot of money turning patients into victims. And my whole life is about owning your care, ownership, take some responsibility. Women have an ovulatory cycle. They take a little more responsibility. One way to take responsibility as a man with your own care is to get married or have a partner as a woman because she’ll take better care of you than you will. Another way is to realize you take better care of your car than you do your body and to start taking as good a care of your body as you do with your car. You get your oil changed every six months maybe and you don’t see a doctor for years. In fact, one of the most impressive things about Google wasn’t the campus. It was the question I put to them about, “How many of you guys get your oil changed in your car regularly?” and everyone raised their hand and then I think and maybe you tell me afterward that Google does it or it has something on site. So that impressed me but not that much. The second question was how many of you have been to doctor as regularly as you change your oil or in the last year and half the audience raised their hand and I was really impressed because that is usually a one-percenter for a 31-year-old or 30-year-old. I mean it really is. So that is really proactive care. I mean that is great and I’m just hoping that those doctors do things like examine them down there. Everyone is a little shy about it but…

[Jennifer Neeley]
21:48: Well, I heard it was interesting, obviously I don’t want to talk about — I had the great fortune to be there so I don’t want to call anything out that anybody from Google sad, but certainly, it was something that you thought a lot about before you did the presentation which is talking about libido, sex drive. It’s something that you don’t hear a lot of doctors, having gone through this with my husband, it’s something that you don’t hear a lot of doctors talk about. What advice could or did you give to the folks at Google and would you give to men in general?

[Dr. Paul Turek]
22:31: I think I have a blog on it called “The Science of Libido” or the “Science of Sex Drive.”

[Jennifer Neeley]
22:35: Yeah. We have to say that you have a fantastic blog. I mean one of the reasons that we had to have you on the show was there are two areas where you are great with the sort of technology that my listeners love, which is blogging and social media in general, and your blog really is the 1 2 3 4 5 so here’s what you do if this the issue and you do it in a really fun engaging way. And then the sort of other area is making things that feel like they are huge big problems making them less panicky, so making them sort of like here’s the program that you follow and here’s what you do so it’s a little bit less daunting than you know.

[Dr. Paul Turek]
23:21: They’re digestible, yeah. Digestible.

[Jennifer Neeley]
23:22: Yeah, because that, I mean I know that perks people up but I mean you do lot of — on the other hand, one of the things I want to ask you about was Clinic by the Bay is a free clinic that a number of doctors contribute to. You’re one of the doctors in San Francisco where people can get healthcare and I’m wondering if there was anything during Men’s Health Week or any or if it’s just part of ongoing care in terms of your role there and helping people that don’t get care at all if it wasn’t for things like Clinic by the Bay.

[Dr. Paul Turek]
24:00: Yeah, it’s true. I mean Jennifer, I was a highly decorated professor at the University of California in San Francisco for 15 years and writing hundreds of papers and getting grants and teaching and teaching and teaching but you can get caught up in all that and you can feel like you’re it and I just thought this is not healthy because I know I was surfing all over the world and giving lectures. You’re never home, you’re working all the time and it’s all glory and I think you do a lot of that for yourself. And the family is saying yeah, “So where are you dad? “Where are you?” “I’m not coming at home.” And I just said, “Do I want to live like this?” It was a stressor for me and I just said, so I literally threw the hat and said I got to do it, I want to do it right, give a hand in preaching about men’s health, getting grants about it, writing papers about it, but I really want to do it because I love patients and I really wanted to live the dream that I was proposing. And that’s what my practice is. It’s a man cave and it’s a lot of places that you saw me in. You see cars and you see car magazine, you see a surf board and you say, “This guy has got a personality,” “This doctor has a personality.”

[Jennifer Neeley]
25:21: On the television which you know…

[Dr. Paul Turek]
25:23: Yeah and they could walk outside and take a phone call and there’s Wi-Fi and the chairs are like your living room and it looks like a living room. It ain’t looked like a doctor’s office and the guys came in and that helps. You know why? Because their blood pressure is lower when the nurse takes it and then they actually aren’t as nervous. Men can be very nervous in the doctor’s office and I don’t want to spend 15 minutes trying to figure out — they’ve start the conversation. So they come in and they sit down and they’re a little more relaxed and they say, these guys hardly ever been to a doctor. I mean I have had patients come in for a vasectomy who said, “I’ve never been to a doctor and I have three kids,” and their blood pressure is to the roof and I’ll sit down with them and say, “I know what you’re here for and I’m willing to do it but not today and the reason why is because your blood pressure is stroke level and so what I want to do right now is I’ll promise you I’ll do this if you see this doctor tomorrow or you go to this hospital today,” literally make the appointment for them and make sure they arrive there and have the nurse follow up and have it all go so I do a tit for tat. That’s what you’re dealing with. This is different than women.

[Jennifer Neeley]
26:34: Right, and it’s nice that you have that bargaining structure kind of in place because I know you probably get I mean at least like I said in my personal experience., you get a better compliance rate.

[Dr. Paul Turek]
26:48: Yeah. And the other thing is a man’s practice is just expect them to be 10 minutes late. I mean you should have street parking because guys love to Street Park so I have street parking in San Francisco and they come in 20 minutes late including the Billionaire Club and say, “I did it.” I say, “You did what? You’re 20 minutes late.” “No, no I got street parking.” There’s three lots around the office but the street parking, they did it, they got a spot and I think that’s kind of funny.

[Jennifer Neeley]
27:19: It is. It’s very street parking, too.

[Dr. Paul Turek]
27:22: Men are different. They’re different and they don’t –you got to finish on time. They’ve got appointments, they don’t schedule very well. They’re not multitasking as well and they forget things. So, a man has to follow women. I love it because their intuition is great and they will call me like today they’d come up and say, “Listen, call this guy.” I’d say, “Why, I’m busy?” “No, just call this guy.” And I’ll call him and I’ll find out there’s something brewing up there that the women can figure out but the man can’t and I’ll catch the problem before he realizes it’s a problem. It’s a whole different philosophy about — but if you want to do it right. And the other thing I use, I use an eService called healthloop.com and HealthLoop is a — and I’m an advisor to it so that’s much my disclosure — but it’s a new startup in San Francisco by Dr. Shlain and it’s kind of neat because what I realized in operating on man and doing microsurgery and vasectomy reversals and things is that and a lot of them from out of town is that they don’t ever call you. Call me if there’s a problem, they never call, never, and so I know there may be problems, so this service is great because we set it up so they get an e-mail and they get into a website which is HIPAA secure so it’s secure for patients and then I have a pain scale, a swelling scale, a Twitter box and a place for pictures and I notify them once a day and I can follow them. It’s like having — it’s like a health call and all of a sudden this whole world opens up and they’re so talkative and “I did this today,” “You think this is okay?” and they feel so much more confident about their healing because they’re able to just sit at home and type in to a computer and know that they’re getting care so it’s really, it’s ownership, they’re getting ownership of their care which is the big point here, is that men don’t have ownership nor does medicine in general have ownership of men’s health issues which is why this week is so fragmented because endocrinologists do one thing and internists do one thing, and family practitioners do one thing, and ER doctors do one thing, and neurologists do one thing, and I’m trying to be the general contractor for these guys.

[Jennifer Neeley]
29:41: Yeah. I mean I have to share this story with you about my grandfather. Even in older age, non-reproductive age men having had a high reading on his urine test and so needed to check out prostate issues and he also had heart problems and he had a doctor that was ready to go and do massive heart surgery for a second time and we found out by — I said, wait, wait, wait. We need to find out what’s going on with the prostate because you know God forbid that’s something really awful and it turned out that he had prostate cancer and it has metastasized to the bone.

[Dr. Paul Turek]
30:25: So it was a worse problem than the heart disease.

[Jennifer Neeley]
30:27: It was much worse but because that had been the ongoing problem more or less than the prostate, my grandfather was ready to go with what the doctor said so there’s a lot of convincing especially with his generation to say I’m your granddaughter but logically we need to know what the whole picture is, and I think what you’re saying is you’re trying very much to look at the whole picture and instead of just sort of __30:56__ these problems which can be so frustrating.

[Dr. Paul Turek]
30:59: Yeah, I think the philosophy of care of men is different, but you don’t see men getting angry like this is a great case. Women with breast cancer have to be consented or have to be told about the option of having a breast removed and a replacement artificial implant put in at the same time. That’s one of the options so they don’t missed a beat sort of. It’s a devastating disease and it’s nice to have that option, that you can at least look relatively normal right away. There’s nothing like that for testis cancer. There wasn’t even an implant on the market. It was pulled from the market and no one said a word until one patient of mine found out — who eventually became my patient — found out that you can get neuticles. You can get implants for dogs that are castrated or neutered and put those in at the vet so they look better or whatever and he said unbelievably you can get them for dogs and he got really angry because he’s a testis cancer survivor about last 10 years ago, maybe more. And he came in and went to the press and got a urologist to buy, to get the neuticles and he was going to put the neuticles and he was going to get a doctor to put the neuticle in him because he wanted them and he was just embarrassed that he couldn’t get anything and the FDA found out about it and called the guy if they do this they’re going to shut you down because they weren’t FDA approved and etcetera and so that caused the big roar and the guy went to the press and I got a call because I’m actually at that point heading a study to put a new testis implant on the market in America it’s not the only one that’s on the market that’s FDA approved right now, and I was the marketing head of the study that put it on the market, wrote the paper and I helped design it and the whole thing and it was studying the autoimmune disease and cancer and all that stuff. Anyway, the guy called me up and I said, “Listen,” I said, “Calm down,” and I said, “We’re working on it. You know we have to do it a certain way right now because it’s not the old way anymore. FDA wants to know it’s safe and there’s all these issues with breast implants in the ’90s and 2000s.” So and then I look at…and I went to the press and I said, “Listen you guys. Don’t ignore this. This is how men work. I mean they really, you really sort of have to take care of him a little bit because it’s kind of a little too late reaction there sort of thing but there’s a need here and men don’t really bring it up. They don’t really unless it hurts or it’s going to kill them, they don’t bring it up and we have to work with that. That is not new.”

[Jennifer Neeley]
33:36: So, it’s is interesting because I, in the introduction to your show on the web, I said that your talks about your involvement with the creation of the artificial testicle and if you’re — I don’t know if you follow Wired magazine very much but there were basically breasts on the cover of, very carefully placed breast on the cover of Wired magazine in November 2010 and I sort of challenged Wired to put that on your cover because it create this huge uproar. They had a woman on staff that quit because there were…and it was really about this regenerative tissue technology and sort of it was a bigger picture but I actually thought it was really clever cause I thought a lot of people are going to read this and so my thought was kind of in saying that if Wired had a clever way to put something related to men in their package area on their cover, maybe people would read the story about the need and it would be easier to get funding for it and get it through the process. Where is that in the process?

[Dr. Paul Turek]
34:54: So there are two kinds of artificial testicles. One is the one I just talked about, which is an implant, and the artificial testicle you’re referring to is a way to make sperm in a dish. So the classic user of this technology would be a childhood leukemia survivor of which there are 35,000 a year who were sterilized by the treatment they receive for a horrific disease and never had an opportunity to bank sperm or do something proactive about it because they were kids and so there’s really no opportunity for their fertility. I have developed something called mapping and it’s just been 15 years old which is a way to map out sperm production testicles in a nonsurgical way in an hour under local anesthesia which has been pretty good and I am actually giving a talk on that at our American Society Reproductive meeting in Orlando in October and it’s kind of the big experience. I just put a pretty good paper out in American Journal and the Asian Journal Andrology last month, a review on the whole technology, but basically it’s a way of findings small pockets of a few sperm in the testicle that happened to survive the onslaught of chemotherapy and we’ve got some incredible cases of bone marrow transplant survivors. Bone marrow transplants are the absolute last resort for cancer treatment where you recur and you recur and then you end up getting irradiated. You knocked out all your bone marrow and then you put new bone marrow in from someone else, and you’d basically replaced your whole bone marrow DNA with someone else’s and it’s beautiful curative stuff but it’s say big whack cause the system has to be able to accept it. So I have fathers from that after then. The number of reported pregnancies are probably on, you can count on one finger in the world on that and so we have this mapping patients who come in and they get sperm retrievals and then we use a fancy technology called in vitro fertilization or test tube technology and get it which is relatively routine in other for other reasons but to get these guys to be fathers is really heart warming.

37:04: But there are still a lot of them that it doesn’t work for and that bugs me for years. And I think it’s not that I’m missing sperm with mapping. I think it does a great job. I think it just that it’s not there. And if you don’t have a stem cell in there, it’s going to be hard to make a sperm so I have been working on this for about four or five years and finally have the come from that group of scientists surrounding me that we can get this done including a stem cell biologist and a sertoli cell biologist and a stromal cell biologist and myself and we’ve been wanting for funding. The government doesn’t believe we can do it and keeps rejecting these NIH grants but it’s possible. Basically, the idea would be that you’re to take the stem cell from a testicle which we have a lot of experience with and I published a bit on and turn it into a to sperm outside the body or take an embryonic stem cell which is kind of voodoo because it comes from embryos and embryos are politically charged little cells and try to push it to a sperm in a dish because some embryonic stem cells are supposed to be able to do anything or take the newest thing which is an adult stem cell which is like a skin cell and take that and turn it into an embryonic stem cell by transforming it with certain genes which is a very hot topic and then pushing that to a sperm in a dish. And so we actually have a clinical trial right now and my patients who are sterile who the maps don’t show sperm are candidates. If they have a Y chromosome deletions and the reason they’re sterile is because they have a genetic problem on their Y chromosome and they’re missing a gene and that results in that and that’s it. I mean you’re basically a normal guy and you’re missing this gene, this one little gene and you’re sterile, and that’s hard to fix.

39:00: So we are biopsying their skin and we’re turning their skin into adult stem cells, which we can do now and we’ve done it in almost everybody, and then we’re going to try to push that cell to a sperm in a dish. And Renee Reijo-Pera at Stanford who is working with me, she’s just great. Great, great work she’s done. She has shown that you can take an embryonic stem cell and get it most of the way to a sperm and you can take a testicular stem cell and probably get it most of the way too. But we’re having trouble finishing it because it takes 13 steps to go from a testicular stem cell to a sperm with a tail and clinically we need sperm with a tail. We have tried using stage 11, stage 12 before without the tail and it really has not been successful and it’s gone off the market for about 10 years ago. It’s a voodoo. You really want a cell that’s got everything complete genetically and that be genetically capable and we’re not sure those earlier forms are cell, what we can do is we can get some of the earlier forms but they’re not ready to be used clinically. And so, we’re actually creating an artificial bioreactor, which is going to be essentially a testicle with all the cells in a testicle, in a device and try to put the cells in there and run them all away to the end. And I think you need everything. You doing in a dish is not, you know, sunlight. You don’t need sunlight. You need everything that the cells of the testicle supply each other because there are a lot of cells for any reaction. So, it’s like building a brain sort of. It’s not easy to do but I think I have the critical mass of minds and I think…the government is not interested even though a paper came on nature, the best science journal in the world, about a month and a half ago, it’s on my blog, I think it’s called Mice Sperm in a Dish, there’s a post on it.

[Jennifer Neeley]
41:00: It is, yeah.

[Dr. Paul Turek]
41:01: Mice Sperm in a Dish or something like that. And it was you know, they did it with mice with an organ culture system but they did take the original cell with a mouse testicle cell from a newborn mouse and they turned it into a sperm in a dish, and organ culture, same sort of thing. They built an organ around it and then that sperm was used with technology to have another generation of mice and the generation resulting from that went on to mate normally and have kids of their own, pups of their own. So this is just you know, it’s not revolutionary science. This is just a matter of hard work in getting all the details right and getting it done. The other application is new drug development. I mean why spend a million dollars studying mice and beagles for your cosmetics or your new drug for pulmonary hypertension or high blood pressure, looking for reproductive side effects, when animal models might not have anything to do with the human condition. And why not get a human bioassay that will be cheaper, much more green and much more relevant going. So we want to have an assay for the FDA to use and say okay, the 600 to 800 new drug applications coming out every year, if you want, you can go to the animal route, you can spend a million dollars, your company, or you can go to, you know, use this Turek artificial bio reproductive toxicology model, human-relevant bioassay, not disposable, so sort of green, clean and do it that way and get more relevant data. So those are the goals of that artificial testicle and it’s exciting. I mean it’s just — I don’t know. Maybe I would retire after that just because that would be a holly grail for me.

[Jennifer Neeley]
42:54: So, what’s preventing it from actually…

[Dr. Paul Turek]
42:57: Money.

[Jennifer Neeley]
42:58: Money.

[Dr. Paul Turek]
42:59: Yeah, it’s money.

[Jennifer Neeley]
43:00: So in the Silicon Valley where people are investing in knowing about influence and all these other things, why wouldn’t a VC someone else prominent invest in making babies, allowing people that otherwise wouldn’t be able to?

[Dr. Paul Turek]
43:16: Hard to them. I mean this market is incredibly price insensitive. So, if you’re a VC and you want to invest in something, if you’re doing something in medicine besides sort of robotics, I mean this is the ultimate market because can you — I can’t tell you how much a patient would pay if you could tell him I could make a genetic sperm for you in a dish that’s usable if you couldn’t have an opportunity.

[Jennifer Neeley]
43:38: And otherwise you would be thought of as sterile, right? This is a sterile…

[Dr. Paul Turek]
43:42: No. There’ll be no other opportunity. No other.

[Jennifer Neeley]
43:44: Right.

[Dr. Paul Turek]
43:45: And I can tell, I mean I can tell you how many people in the Middle East would do it because they’re not doing donor sperm and alternatives, non-biological alternatives for children. They just…

[Jennifer Neeley]
43:54: Right. Non-biological children.

[Dr. Paul Turek]
43:55: It’s not what they want. So, I have patients calling me every six months, but yeah, no one has offered to pay for it and it’s — we need about a million and a half dollars in three years. And for a lot of reasons, it’s too early for venture. Angels, it’s too risky for angels.

[Jennifer Neeley]
44:15: I don’t know. I’ll be interested when this show goes around because it seems like this is exactly the kind of thing that would yield a high return, but it’s early so there is a lot of risk factors. But…

[Dr. Paul Turek]
44:28: Yeah, there is a lot of risk in time too. I mean there’s no product. But the short-term product is this reproductive toxicology model and we’re going to work — as soon as we get some money, we’re going to work with the FDA and say, “Listen. We want to develop this with you so that you will say do this or this.” And then there is your money maker and then the ultimate product which may not make the money but will be for the good of civilization is to be able to offer an opportunity to make sperm for those guys who just absolutely had no opportunity to have a kid.

[Jennifer Neeley]
44:59: Yeah. And it’s sort of like, it’s interesting thinking about this because there is such a need and is this the future of medicine. If the future of medicine really having…

[Dr. Paul Turek]
45:10: It’s about personalized as you can get, yeah.

[Jennifer Neeley]
45:12: Having to go out to the VC community potentially and actually solicit their funds for something that will probably yield them a zillion times in their investment when you look at the worldwide need.

[Dr. Paul Turek]
45:27: The worldwide need is a big one, yeah. And California, we have a million dollar grant now at the California Institute for Regenerative Medicine to do some of this testicular stem cell work, so my practice in Stanford and a couple of other co-investigators on this grant has been great. California is…it’s one of the few places on earth that can get it done because that was a great investment prop, 61 I think in 2003, when Schwarzenegger started, when we put 3 billion dollars into that prop, that was fabulous for California medicine. I mean I gave a talk at the Getty Mansion. We had a salon series there on this and I just said, “Thank you for voting for this.” I know pediatric hospitals were also on the bill. Pediatric hospitals always get money but this one started a whole other revolution in science. They’re 14 stem cell institutes in California right now. Those are bricking more to buildings and inside full of scientists. I recruited for Stanford or for UCSF when I was there, I was visiting Korea when that guy came out of cloned humans.

[Jennifer Neeley]
46:38: Oh, yes.

[Dr. Paul Turek]
46:39: Woo-suk Hwang cloning humans in Korea, published in paper in science. I went to see him as a part of a meeting, a mentor meeting, a health meeting. I was in Seoul giving a talk and I just called him up and I said, “Can I tour your lab?” I’ve never, you know, no one ever met any one of his cloned 10 humans, and he was working on it for spinal cord injury patients, very James Bond like Korean guy, very well spoken, very handsome. He was the darling of South Korea, I mean politically. He was funded for nothing, he had bodyguards. He was Hank Aaron, maybe not Barry Bond, maybe Hank Aaron. And that guy may be was Barry Bond.

[Jennifer Neeley]
47:22: Barry Bond has had some help. So…

[Dr. Paul Turek]
47:25: Yeah, but that’s what I’m saying.

[Jennifer Neeley]
47:26: Maybe that’s a good re-analogy.

[Dr. Paul Turek]
47:26: This guy [crosstalk] his lab, he is doing pig stuff. He is making — he wants to make a human compatible pig kidney for kidney transplants for adults, for patients. So, he is trying to make a cross kidney human — cross pig human kidney that will be accepted by humans but made in pigs.

[Jennifer Neeley]
47:46: Wow!

[Dr. Paul Turek]
47:47: That’s what he was working on, which is a gorgeous idea to supply the need for a transplant. So start with the kidney. Anyway, it’s really something.

[Jennifer Neeley]
47:53: We have a…Dr. Turek, I need to interrupt you for one second. We have a caller on the line that I want to welcome in. Who do we have on the line?

[Rita]
48:05: Hi! This is Rita and I am listening. I don’t have internet access, I’m just listening in my phone.

[Jennifer Neeley]
48:11: Did you have a question about fertility or anything else related to the topic here?

[Rita]
48:16: I was listening because I have a partner that has a low sperm count and so I wish…

[Dr. Paul Turek]
48:29: I think I [unintelligible].

[Jennifer Neeley]
48:30: Yeah. That’s a common question, you know.

[Dr. Paul Turek]
48:35: What do you do about a low sperm count?

[Jennifer Neeley]
48:36: Yeah. What do you do by a low sperm count?

[Dr. Paul Turek]
48:37: I can answer that, Rita. So I’d say when I see a low sperm count, I think what is this guy doing poisoning himself? What’s poisoning this man? Or sometimes those are genetic because your stem cell allotment in testicle is low and it could be a genetic issue. So you think about environmental exposures. You start think about things like smoking toxins, any social recreational drugs, excessive use of those things, medications. What diseases do you have? What surgeries have you had? And then what heat exposure, hot tubs, Jacuzzi, saunas, smoking tobacco, things like that, and lifestyle issues, stressors. So this is a stress issue. So if you’re stressed by something, your testosterone level will fall. You testosterone level falls, you sperm production will fall. The plant doesn’t get enough water. And then if it’s none of those things, it could be something on physical exam, one testicle, one doesn’t have a testicle, a varicocele, cancer, testis cancer and things like that. And if it is not of those things in physical and then you could probably involve genetics for a lot of it and check for that, and there’s a couple of genetic tests that you can do.

[Jennifer Neeley]
49:53: So the basic thing is for a listener that has got a partner and because I was one of those women and I was lucky enough to be in the area and find you. You help people all over the world. You can call into the office and get 10 minutes free counsel.

[Dr. Paul Turek]
50:13: Yeah, and that’s simply…

[Jennifer Neeley]
50:14: But you need to come in or whether.

[Dr. Paul Turek]
50:15: Right, not to solve the problem but it will understand whether it’s a good step or whether you should be getting care first of all and maybe care with me. I just do that as a public service basically.

[Jennifer Neeley]
50:25: Yeah, exactly and I think that’s what’s the magic about it. It’s that you know, you’re a world class doctor but for someone like our caller here, you know, her significant other, you know, she could have him get on the phone with her on the other extension and just, you know, turekclinic.com and…

[Dr. Paul Turek]
50:47: And it’s a site where you could put your issue in, you know if you want a call or not.

[Jennifer Neeley]
50:51: Yeah, and you were great with e-mail and those sorts of things too. So I think that’s, that’s something I would, think about the things that Doctor Turek just mentioned, are they smoking, what are the things they’re doing to their body. Are they eating well, are they — what is the stress level like that sort of thing and then if none of those things are helping with the issue then, it’s time to get a counsel something…

[Dr. Paul Turek]
51:23: Yeah and I have to say, the place to start with a guy is not a gynecologist. Because typically the woman goes in and she gets checked out to the tune of thousands of dollars and then they go for another year and then the guy gets the same analysis and there’s a problem there and so, I’ve been banging this drum for a while but basically the guy should see a specialist as soon as the woman does. There’s no reason not to. It’s about that I mean it’s a male issue. So…

[Jennifer Neeley]
51:54: I should — this is very personal but I should tell people that the reason that I know who Dr. Turek is, is because my OBGYN was checking me out and I asked my husband and started to beg and see a little bit but he did it. Once I convinced him it wasn’t going to hurt. To have a semen analysis done so he, we had the results when I went in for my exam and I’ve been seeing my doctor forever, so she knows my very long term history and she’s going everything’s fine I’m not sure what’s going on and the last thing why she picked up the fax at the machine and came back in and she goes “wait, everything is changed”. She wrote your name down on her pad and she said this is your prescription. He needs to see Dr. Turek. We’re lucky he’s in the San Francisco area. I mean, you get people from all over the globe.

[Dr. Paul Turek]
52:46: Oh yeah. We get international patients weekly, yeah. So I want to say is my simple story. So till this famous stencil scientist crashed. So he forged this data. We found out a year later. But in the meantime, when I was visiting his lab and very impressed of what he had done, we were crowded. Do you see yourself now in Stanford one of the people, one of the supposed doctor who had cloned people and that’s how powerful California medicine is. I mean, the whole world would like to come here, except for maybe China which does it on a film but so that’s the end of that story. I just want to finish it because I was just an excited little guy like me picking up, plucking scientist around the world to come to California because it’s a fertile place for stencils science.

[Jennifer Neeley]
53:20: So, this is again, this is the example of the guy that cloned the sheep, right?

[Dr. Paul Turek]
53:38: Yup, Dolly right.

[Jennifer Neeley]
53:39: And it came full circles so he is, is he now at Stanford?

[Dr. Paul Turek]
53:44: You know I don’t that, I don’t know where he is.

[Jennifer Neeley]
53:47: But he is [cross talking]

[Dr. Paul Turek]
53:49: Well, his name is Will Knight. I don’t know where he went. Maybe he was consent, I don’t know.

[Jennifer Neeley]
53:56: Because of the cheese right? But yeah, I mean, it’s fascinating that experiences that you’ve had. I mean, just being able to have the audience with the _54.05_ who are so powerful in terms of political contribution and, you know, they can actually move a needle on a lot of thing.

[Dr. Paul Turek]
54:14: In dealing I wanted to stay with this Clinic by the Bay. I’m one of those guys I was taught in college to get back and, so it’s a party your life. Whether it was academics or not, I always find myself giving back in big ways and because like I tell people and also my patients are not happy with the economy and they work in the internet industry or they retire in the 30s and they say I’m leaving, I’m going to Hong-Kong it’s cheaper. You get fewer taxes taken out, I lose my citizenship if I stayed 10 years but I’m out. It’s like but I stopped them and I closed the door and I looked at them and I say but, we raised you, I mean it takes a village to raise someone like you to be successful. And you did in this environment, why would you not want to stay and get back to it. I just go ask them. And so the Clinic by the Bay is a big give back for me because it’s a free primary care clinic for the working uninsured in San Francisco. So, it is a bright light modern space in which doctors see patients in my model which is an hour of visits but it’s free. About an hour visit and get free care and their families if they qualify and you have to be working in San Francisco and uninsured. So immigrants can do it and there’s now we’re going by zip code. But it’s been a fabulous and all the grants of modern science are now grants for this to go. We have McKesson funding, you see Access funding, we have Walgreen, Cisco. We have three courses of million dollars with the grants and one — and we’ve been open for about six months and it’s just booming. Retired doctors come in and donate four hours of their time who know what to do and there’s electronic medical records. It’s just incredible. And the response by the city with healthy San Francisco has been great. And I’m one of the founders of the, one of the founding board members and also I chaired the advisory committee.

56:14: So I’m the guy responsible recruiting doctors and we were working on it for five years and just launched about nine months ago, it’s called “Clinic By The Bay www.clinicbythebay.org and you’ll see a great video on the landing page of the opening in November when Diane finds, Diane opened it and said you guys have raised so much money I’ve never seen something like this. But it’s just then, it’s just on a great feed and I — if you watched the video, you’ll see my attitude is I’ve been to Africa and I volunteered in places in all over the world and I think it’s a real kick to be a doctor and give back and fix a cleft palate, or help someone in another country of something but you’re really, you’re really not making a big dent. You know, you’re really doing it for yourself, you are helping people but not, not the most efficient way and I like the idea of and I find it very thrilling to do, and I find it actually good about myself but it’s also a little bit of a — I went to Africa and helped people. I really like the concept of giving back in your own backyard. And I like the concept of giving back to your own community because you know I was thinking why did they go there? I could have gone to _57.24_ and probably done more good than Africa. And now I think giving back in my backyard everyday in San Francisco is delightful. It’s like a shot in the arm everyday.

[Jennifer Neeley]
57:36: And there’s a Clinic by the Cay Facebook page. Hopefully there will be soon Clinic by the Bay Facebook cause so people can donate money.

[Dr. Paul Turek]
57:46: Yeah, we get five to ten dollars, I mean, we just look, it’s just opening. It’s great then you feel part of a community.

[Jennifer Neeley]
57:51: Yeah, you’re feeling that — and I’m sure, you know, the volunteers there are just fantastic because it’s, volunteers in San Francisco…

[Dr. Paul Turek]
58:01: We have VISTA volunteers there.

[Jennifer Neeley]
58:03: Yeah.

[Dr. Paul Turek]
58:04: Yup, we have VISTA. We have — we’re going to probably getting students from UCSF where intermediately connected. My biggest thrill from this is — one of my heroes from UCSF was a neurosurgeon named Charlie Wilson. Charlie Wilson is in his 80s now and I never met him there. I was in the parking lot at 6 am parking near him, he had a spot. Okay, in UCSF only Nobel Prize winners get a spot or chairs at department. They are very big people. And I would scramble for a spot as an assistant professor but this guy has his own spot and he had no Jaguar parked there, and I get there when he did sometimes and I just try and run catch him but he ran so fast, I never talked to and he is just one of the shakers and the movers of New York article about him and Tiger Woods and Wayne Gretzky about how you get that good as a neurosurgeon. And you know he is a brain surgeon, right? So he retires, I’m giving a talk about the Clinic by the Bay to the San Francisco medical society, he comes up to me and he says I’m in. He had known where I was in fact.

[Jennifer Neeley]
59:05: Oh, awesome!

[Dr. Paul Turek]
59:06: He knew it was from the stage and I was like, and right now Charlie Wilson, _59:10_ this professor, UCSF is my right hand man and he comes to my clinic for my advisory board meetings and he pipes in and it is — I’m honored to be in a room with him. And he is a buddy, and I take him to the car after in the rain and I put him in his car and he drives off and he writes me a note and says thank you for helping with my car. And you know, it’s just, life is amazing. What you get out of it is simplest things. But you know every word he says is something I would write down.

[Jennifer Neeley]
59:43: That’s so cool. And I, as much as Clinic by the Bay is the most amazing thing. The other thing people out there probably would want know about this again if you’re not in the San Francisco bay area that there are, you know, doctors and resources that are trying to help. So, think getting in touch, maybe writing on the Facebook wall or getting in touch with Clinic by the Bay to see if there is a resource in your area is not a bad idea.

[Dr. Paul Turek]
1:00:14: Yeah. There are Clinic by the Bays all over the country. They’re called Volunteers in Medicine clinics and there is 87 of them in the country. So, it is the only urban one so that’s why it’s kind of been watched closely.

[Jennifer Neeley]
1:00:25: Yeah. And also San Francisco I think just in general having a lot of initiatives around us it’s been a big — big deal. So, you know as I conclude here, you know I wanted to say one — I wanted you to be able to talk about one thing in terms of the empowering that you’ve talked about and that is your connection to the Lance Armstrong Foundation. The sort of guy that’s the foster child for everything that you should do right. You know in terms of taking care of yourself, being international — internationally known and huge superstar around the globe for the _1:01:08_ and everything. And he had — because of testicular cancer had issues with having children and that sort of thing. And now you said on the board of the nonprofit that is behind it all and would your study the weigh in on your experience with that in kind of how you got connected with it because I think it’s a great example of how everyone is touched by…

[Dr. Paul Turek]
1:01:40: Yeah. I mean that you know Lance is like Viagra for the country. Lance did as much from them to help as Viagra did. So, Viagra was the first pill for erection. Then you know guys are storming in to see doctors, but while they’re there you got everything done. Where you examine the prostate or everything else and you get them in the door. So, I get this it’s the wild animal thing. You get them in once and try to do as much as you can while they’re there and not hurt them. And Lance did the similar thing in terms of awareness, public awareness. I mean, you could develop a campaign better than Lance — a guy who came in with metastatic testes cancer because he didn’t — he actually got diagnosed a little late and had it in his brain and then he went to chemotherapy and then he went how many doctors he went after, but most of them he want after is chemotherapy and we talk about Billy.

1:02:32: And so you know and then starting a billion dollar nonprofit and I have a lot of times of had a Lance Armstrong Foundation grant for some — my early science in this area back in UCSF and he was funding. We weren’t even doing testes scan. And I think they’re doing sort of infertility genetics and stuff and he funded that. And then I got involved with Fertile Hope, which is now under the Lance Armstrong offices and I’m on their board. So, I do a lot of the fertility. So they have fertility count at Lance Armstrong’s website. You know Lance Armstrong Foundation has fertility calculators and stuff so that if you have cancer, you can go online and a woman or a man and look at these complex calculators of you know what kind of chemo, what kind of cancer, did you get radiation to get this, get that and then it tells you what your options are. And it’s great as if before that you start or after you start in. We spent hours pouring over these things for accuracy, but there are great reproductive calculators and things like that. I just — I’m just again, I’m a big fan of Lance and I like giving back. He had a quarterly magazine that just started coming out about a year ago and I was in the first edition of it for mapping. We did a nice layout on a cancer survivor who has kids and it was a good story. So, I was really honored to be in their inaugural edition of the Lance Armstrong quarterly _1:03:59_ that was called the LAF Quarterly I think it’s called.

[Jennifer Neeley]
1:04:04: That’s amazing. I think you know it’s such a – it’s a wonderful connection that you have and you have a connection to lots of different things. Textbooks that in terms of men’s health that the men that are in training or women in training in this area or learning and shaping their minds and I thank you so much for spending the time with us.

1:04:24: We actually gone overtime talking all about everything and I feel like there so much more we could talk about, but I’m glad we had a chance to talk about men’s health. We can — your contribution to it in the discussion that you had at Google.

[Dr. Paul Turek]
1:04:24: Absolutely.

1:04:41: Jennifer, I want to thank you for bringing this to light because it is an ignored area of medicine. Men are underserved. It’s complex. It’s their problem — it’s everyone’s fault but men are underserved and this is exactly what we need, public awareness needed like Lance, like this, to bring to light just improve the hell out of care that we give them.

[Jennifer Neeley]
1:05:04: That’s fantastic. Well, thank you so much Dr. Paul Turek. We’ll let you go and get on with your very busy day.

[Dr. Paul Turek]
1:05:11: Thank you Jennifer.

[Jennifer Neeley]
1:05:12: Alright.

[Dr. Paul Turek]
1:05:13: Bye now.

[Jennifer Neeley]
1:05:14: And again that was Dr. Paul Turek who leads. He is the doctor of Turek Clinic in San Francisco. But in the addition, he lectures all over the world, give keen out lectures all over the place. And authors, some of their co-authors in the book — textbooks that lead the area of men’s health and because it’s an underserved area and I’ve had experienced and I met Dr. Turek from my own husband’s issues in this area, I just think it’s something that we can’t shine enough light on. So, this is one of my sorts of bleeding heart episodes of the A-list and I hope — I hope all of you are or some of you at least have gotten some — get information about this. Please spread this around. It’s incredibly shareable. And if we get lots of questions, please send them my way and I’m happy to filter them to Dr. Turek and I’ll have a blog post on this that you can contribute too as well. So, I want to thank each and every one of you for tuning into this very special edition of the A-list with me Jennifer Neeley. We hope you enjoy the program and if so, we’d love it if you’d be so kind to friend us or add as to your favorites here on Blog Talk Radio, or if you are over on iTunes, subscribe and rate us. We can never have enough ratings to know how we’re dealing and we always want to be doing better. As always, you can keep up with the latest on this show, archive and free informational webcast at jenniferneeley.com. Thank you so much for joining us and have a great weekend!

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