Turek On Men's Health » Men’s Health

Try Not Sitting

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

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

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

The Chair as Enemy

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

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

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

Facts about Standing

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

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

The Cure for Sitting Disease

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

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

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

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!”

How is a Medical Visit Like A Ball Game?

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

The ultimate male bonding experience in 2012

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

The Culture of Men

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

The Turek Clinic as Man Cave

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

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

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

A Dozen Funny Reasons for Vasectomy

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

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

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

Why do Men Get Vasectomies?

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

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

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

The Artificial Testicle: Funded!

Paul Turek, MD — Mon, 02 Jan 2012 16:00:01 +0000

Whole Earth Catalog: the old Google, according to Steve Jobs

It is the stuff of dreams in academic medicine: an NIH (National Institutes of Health) research grant. Get one of these and you’re pretty much assured of getting tenure and succeeding at any major U.S. university. It is the ultimate stamp of approval from the government and society that your thoughts and ideas have merit and value.

And I was just awarded one!

NIH Funds the Artificial Testicle

Yes, the federal grant that we submitted recently to build a human artificial testicle was funded. To be clear, this grant is not about creating a testicular implant for a man who is missing a real one. We did that a decade or so ago. This award is to develop a sperm making biological machine. I wrote it along with Dr. Connie John, CEO at MandalMed, Inc., a biotechnology company in the Bay Area. We now have a couple of years to create human artificial sperm in a dish, or more formally, a “bioreactor.” A fancy dish to be sure.

You’ve seen the posts on how successful this research has been in mice models using various stem cells as a starting point: embryonic stem cells, adult stem cells and early germ line (spermatogonial) stem cells. In labs all over the world, real, live, fertile sperm have been made in animal models from each of these stem cell precursors. Honestly, given this success over the past several years, surely we can figure out how to do the same in humans.

Why Do I Need NIH Funding?

Funny thing is, I am not in academic medicine anymore. No tenure to deal with and no need to prove anything to anyone but myself and to legions of loyal patients who depend on cutting edge innovation for their infertility care. Personally, feeling the suffering of patients with infertility is far more motivating than doing science for the sake of science, or for the sake of tenure.

Not to compare myself to Steve Jobs in any way, but I can’t help think one of his favorite mottos from the Whole Earth Catalog. This is what guided him in his quest to build a better computer for everyone: “Stay hungry; stay foolish.” It feels absolutely fabulous to be able to dream it, write it and finally to do it. The essence of science for the good of people.

Press Release

Effort to Build Artificial Testicle Awarded NIH Grant

Released: 1/9/2012 1:45 PM EST
Source: The Turek Clinic

Proposal to make human sperm from stem cells receives government funding

Newswise — SAN FRANCISCO, CA. January 9, 2012. Dr. Paul Turek, Director and Founder of The Turek Clinic, a men’s health medical practice, and Dr. Constance John, chief executive of MandalMed, Inc, a San Francisco-based biotech company, were recently awarded a Small Business Innovation Research (SBIR) grant from the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) to construct an artificial human testicle and research how sperm are made from stem cells.

“Fertile sperm can be made from various stem cells in mice, but making human sperm from these same sources has been elusive,” says Turek, a practicing male infertility specialist in San Francisco. In this project, they will try to produce mature human sperm in a live laboratory model of a human testicle.

This work extends on previously published research by Dr. Turek on human testicular stem cells, the forerunners of sperm. Dr. John is an expert on human Sertoli cells, which critically nurture sperm as they develop in the testicle. “This grant is quite an honor and comes after several years working together on this idea,” notes Turek. “We have assembled a great group of scientists who are very committed to its success.”

A functioning artificial testicle has important implications for the field of reproductive biology. It could shed enormous light on the intricate details behind the mysterious and complicated process of spermatogenesis or sperm production. Even further, it could be used to later develop patient-specific, fertile sperm for men who simply do not make sperm due to genetic or acquired causes.

About Paul Turek, MD
Paul Turek, MD is founder of The Turek Clinic and a former professor and endowed chair at the University of California San Francisco. As a men’s reproductive health expert, he has pioneered innovative techniques for treating male infertility, including Testicular Mapping. In addition to his appointment to the Cooperative Reproductive Network Advisory Board, Dr. Turek sits on the Advisory Board for the Men’s Health Network, Fertile Hope and is President-Elect of the Society of Male Reproduction and Urology. He is Chief Medical Officer at MandalMed, Inc, and is also Past-President of the American Society of Andrology and of the Northern California Urology Society and is an Editorial Board member of several journals including Systems Biology in Reproductive Medicine, the Asian Journal of Andrology and the International Brazilian Journal of Urology.

A complete biography of Dr. Turek is available on Wikipedia at http://en.wikipedia.org/wiki/Paul_J._Turek.

About The Turek Clinic
The Turek Clinic, founded in 2008, is a men’s reproductive health practice specializing in male infertility, vasectomy, vasectomy reversal, varicocele repair, and other minimally invasive procedures using innovative and cutting-edge techniques. For more information, visit www.TheTurekClinic.com, www.TurekVasectomy.com, or Dr. Turek’s blog (here).

About MandalMed, Inc.
MandalMed is a privately held biotechnology company located in San Francisco- the home of more bioscience companies than any other region in the world. MandalMed’s mission is to develop pharmaceutical products of worldwide significance. Areas where there is a great need for better treatments, including cancer and neurological conditions, are the targets of MandalMed’s research and development programs. For more information, see www.MandalMed.com.

The Wall of Holiday Cards

Paul Turek, MD — Mon, 26 Dec 2011 16:00:32 +0000

The Turek Clinic Team and the wall of holiday cards

I always tell grateful patients that the kindest thing that they can do for me is to send a holiday picture of the family. We have a wall in the clinic that is dedicated to this once a year event.

Well, you have outdone yourselves this year! The wall is full of cards and The Turek Clinic Team loves it. We received cards with photos of little kids, bigger kids, ultrasound photos of kids yet to be, dreams of kids and much more. Each telling their own story. What a way to fuel the fire of desire to continue to do what we can to help build families all over the world. Magical. So, thanks and

Have A GREAT Holiday!

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

Wi-Fi, Sperm Counts and Fertility

Paul Turek, MD — Mon, 05 Dec 2011 16:00:03 +0000

Does the radiation danger icon apply to Wi-Fi?

Maybe it’s time to rename the “laptop” computer something else and keep if off our laps (how about mobile computers or “mobees”?). First we hear that they generate heat that elevates scrotal temperature, and now the Wi-Fi radiation itself may be a problem.

The Effect of Wi-Fi on Sperm

The Wi-Fi issue was published last week and has my patients all worked up. In this Argentinean study, researchers placed one half of the semen samples from 29 healthy men under a laptop connected to the Internet via Wi-Fi. They put the other half far away from a Wi-Fi equipped computer. A better control group would have been to keep the control sperm under the computer like the exposed sperm but with the computer turned on but disconnected to Wi-Fi. The temperature of the sperm dishes was kept constant, so any effect would not be thermal in nature. After four hours, 25% of the sperm exposed to Wi-Fi stopped moving forward, and 9% showed DNA damage. In contrast, only 14% of the sperm placed some distance from the Wi-Fi equipped computer stopped moving forward and 3% showed DNA damage.

Importantly, the proportion of sperm that was dead was exactly the same in each case, so the exposure did not actually kill the sperm. The biggest difference they found was that sperm exposed to Wi-Fi lost the ability to move forward purposefully. It would have been a better study if these sperm were then followed for 4 more hours without exposure to Wi-Fi to see if there was a recovery of motility. The authors “speculated” that Wi-Fi could affect male fertility.

An Alternate View of Wi-Fi and Sperm

Does this bench top test accurately reflect real life biology? Hardly. Is this the natural environment of sperm, bare-naked in a half ounce of fluid spilled onto a computer with Wi-Fi all around? No, but I guess it depends what kinds of websites the computer’s owner is perusing and what kind of personal activity that it generates. So, it’s really impossible to infer that a man using a laptop with Wi-Fi on his lap for more than four hours will be less fertile.

A lesson in electromagnetic fields (EMFs) might better convince you of this belief. The strength of Wi-Fi (wireless fidelity) and W-LAN (wireless local area network) electromagnetic fields is considered weak. Although Wi-Fi moves data quickly, it emits very weak signals that do not travel very far. Typically only 30 to 200 mW of power is emitted from Wi-Fi devices. For a comparison, below is a list of power levels associated with devises that we normally hold near our heads:

Blue tooth headset 100 mW
Cell phone 200-600 mW
CB radio 4000 mW

In addition, Wi-Fi operates at far lower power densities (2.4 to 5 GHz) than cell phones (900MHz to 1.9 GHz). Lastly, the power density, and therefore any effect, from Wi-Fi (as with any other form of energy) rapidly decreases with distance away from the Wi-Fi antenna, following the “inverse-square law.” Thus overall, the exposure from Wi-Fi is 10-fold less than cell phone exposure, as one normally does not hold the Wi-Fi antennae that close to the body – as is done with cell phones.

So if you want to, worry about cell phones and blue tooth headsets rather than Wi-Fi networks in terms of exposure and health. Honestly, there is no real evidence yet that exposure to radio signals from Wi-Fi adversely affects any health issue in the general population. Maybe if we wore computers like hats or kept them in our underwear we might be at risk…maybe. For now, put a pillow between your privates and your laptop.

Why is Awake the New Sleep?

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

Sleeping Beauty definitely gets enough sleep (Source: Disney)

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

Facts About Sleep Deprivation

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

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

Sleep as Oxygen

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

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

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

Are Fathers Better Citizens?

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

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

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

Fatherhood is Transforming

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

Fatherhood and High Risk Behavior

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

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

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

A Golden Opportunity to Help Men Help Themselves

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

Guide to Surviving the Holiday Season

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

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

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

The Stress of Infertility

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

Eight Ways to Reduce Your Holiday Stress

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

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

Humanizing Medspeak

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

A humanizing force: The book in my white coat

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

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

The Language of Medicine

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

The Beauty of Medspeak

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

The Vagaries of Medspeak

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

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

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

Your DNA Barcode

The Dream of Free Medical Care

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

The first of its kind in an urban setting…

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

Free Care for the Working Uninsured

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

Celebrating the First Year

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

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

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

Bringing Africa Home

An Ounce of (Fertility) Prevention

Paul Turek, MD — Mon, 17 Oct 2011 15:00:19 +0000

Kokopelli, the ancient fertility symbol.

“I’ve been told that my cancer is now cured… how do I get my fertility back?

Patients ask me this question weekly all the time and I am glad to help. Some of the most satisfying medical moments I’ve had are associated with these patients.

But when I hear this call for help, it also reminds me how medicine has been remiss in preventing the infertility in the first place. We can do better and we can do it right now.

The topic of fertility preservation is the substance of my recent lecture at the annual meeting of the American Society of Reproductive Medicine (ASRM) in Orlando, Florida. This well-attended course focused on the prevention, treatment and restoration of male fertility in the setting of sterilizing treatments typical of cancer therapy.

The goal of my lecture was to review and update providers on current and future strategies for the preservation and restoration of male fertility. Here are some of the ideas discussed. I’ve also included a link to the lecture slides if you are so inclined.

Preserving Male Infertility

Sperm banking. A 200-year old technique that is the purest form of preventative medicine, it is vastly underutilized, not covered by insurance, and not routinely offered to many cancer patients before treatment. What gives? Here is where we need to do the most work in this field.
Sperm Harvest. For 15 years, it has been possible, nay routine, to harvest sperm from men who want children after having a vasectomy without reversing the vasectomy. This same technology is easily applied to men before, during and after sterilizing cancer treatments. One very successful example of this in my practice is fine needle aspiration “mapping” of testicles for sperm in cancer survivors. Indeed, no-touch, metabolic imaging for sperm may be the ultimate iteration of this concept.
Electroejaculation. Based on decades of successful use in spinal cord injured men, artificial stimulation of ejaculation can be a very effective way to bank sperm or restore fertility in men or post pubertal teens who have had nerve damage to reproductive organs from cancer surgery.
Shielding Sperm Production. Physical shields are routinely used to block the effects of aberrant X-rays from hurting sperm production during treatment. In animal models, hormonally induced shut down of sperm production can protect the testicle during the storm of chemotherapy as well.

Restoring Male Infertility

Stem cell transplantation. Currently possible in animal models, this involves taking the delicate testicle stem cells from either pre- or post-pubertal boys or men and freezing the cells before cancer treatment. Subsequently, the stem cells are thawed and replaced back into the testicle to restore sperm production after the cancer is cured.
Sperm Maturation in a Dish. A variant of the above, also demonstrated in animal models, this technique involves maturing stem cells harvested from the testicle before cancer treatment in the laboratory all the way to their final form: a sperm with a tail.
Sperm from Stem Cells. Yet another variant of the above that has been demonstrated in animals, this involves growing usable sperm from early, pluripotent stem cells such as embryonic or adult pluripotent stem cells. One example would be to take a skin biopsy from a sterile man, coercing them to become adult stem cells and then push those cells to sperm in a dish. Truly, a fantastic outcome of America’s investment in stem cell technology.

Fertility Restoration after Cancer: Current and Future Therapies by Paul J. Turek MD, FACS, FRSM Director, TheTurek Clinic, San Francisco (WARNING: Images in slides not appropriate for all audiences due to subject matter)

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

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.