Turek On Men's Health » Vasectomy

Reversing Vasectomy Reversal Thinking

Paul Turek, MD — Mon, 21 May 2012 15:00:17 +0000

My favorite drawing of the epididymovasostomy procedure (Courtesy: Netters Images)

You had your wings clipped and now you want more children. What’s a guy to do? Well that depends on who you ask. Your choices include vasectomy reversal or sperm retrieval and assisted reproduction (IVF – ICSI).

Doctors who perform IVF – ICSI might say that vasectomy reversals don’t work. Doctors who do vasectomy reversals say that they do. Other doctors fall in somewhere in the middle and say that “younger” vasectomies are reversible but “older” ones are not. Again, what’s a guy to do?

Facts about Fatherhood after Vasectomy

To get a handle on this, let’s start with the irrefutable facts of the case:

Where does conception occur? Vasectomy reversal allows for conception in the bedroom, whereas it occurs in a fluorescent-lit laboratory test tube with IVF – ICSI.
Who pays? If insurance does not cover either approach, then vasectomy reversal is always cheaper than IVF – ICSI.
Who gets procedures? Reversal involves surgery on the man but not the woman. IVF – ICSI involves procedures on both partners. Good to know if you like sharing such things.
How quickly can we get pregnant? Time to conception is generally faster with IVF – ICSI than vasectomy reversal.
What is the risk of twins? The chance of having twins or higher multiples is 1% with vasectomy reversal (i.e. sex) and 40% with IVF – ICSI.
What is the risk of birth defects? The chance of having a child with birth defects is twice as high (10% vs. 5%) with IVF – ICSI compared to sex.

The Problem of the Older Vasectomy

As I apprise patients of these facts in my daily practice, it recently occurred to me that the issue of the “older” this or that surfaces a lot. I have published research that speaks to relative performance of vasectomy reversal and IVF-ICSI with female partners who are less than 38 years old. I can also address the success of either approach in cases of older men. But there is much less information about the true reversibility of “older” (more than 15 year old) vasectomies. Is there any truth behind the statement that older vasectomies aren’t worth reversing? I really needed to answer this question and so I put my research hat on to do it.

Probably the biggest issue with the “older” vasectomy is that, just like a tire that is continually being filled, a physiological “blow out” of the system is more likely to be observed at reversal. It’s not dangerous or anything, but it does mean that a more “involved” procedure, termed epididymovasostomy, is needed at reversal to restore connectivity and fertility. And, by the way, the epididymovasostomy is one of the hardest microsurgical procedures to perform well on this good earth. So, knowing more about how often “blow outs” happen as vasectomies age could be very informative for doctors and patients alike.

For 25 years the prevailing thought among surgeons is that the rate of “blow outs” increases linearly as vasectomies age. Published algorithms and nomograms confirm the thinking that, given enough time, every vasectomy will “blow out” and need an epididymovasostomy instead of a vasovasostomy to restore sperm counts and fertility. And, as epididymovasostomy success rates are not as good as simpler procedures at reversal, this means that vasectomy reversal success rates should indeed fall with vasectomy age.

But what if it’s not true? What if the occurrence of “blow outs” does not rise along with vasectomy age? If true, then older vasectomies would be much more reversible than previously thought. And the return of sperm counts should be higher in older vasectomies than one would think. Voila, this is precisely what our new research shows and will be presented at our annual international urology meeting in Atlanta tomorrow. I guess that I agree with Don Miguel Ruiz when he said: “It is always better to ask then to make an assumption.” Stay tuned for the findings!

Patient Testimonial: Dr. Turek, “The Miracle Worker!”

Paul Turek, MD — Thu, 08 Mar 2012 20:33:46 +0000

We get a a lot of very special, personal and wonderful news from our patients at The Turek Clinic. Sometimes they are generous enough to share their stories with us. With their permission, we’d like to share their story here – in their own words.

Introducing Cole Michael!

“Here is our story! Please let me know how I can share it with future patients

My wife and I are thrilled to report that we just had our first baby boy!

“Cole Michael” was born on February 28th, 2012 weighing 8 lbs. 1 3oz. and measuring 21.5 inches long. Both mommy and baby are doing great.

Dr. Turek is an ‘angel’ from God that performed a miracle for me and my growing family. A brief history: I went through a divorce 4 years ago that left me with two beautiful boys, and a vasectomy. Shortly afterwards, I met the love of my life. After dating for 11 months we got engaged and decided that we wanted children of our own so I called up my urologist (the same one that performed the vasectomy) and scheduled the surgery to have everything undone.

He assured me that he had done this type of surgery before with enough success to have me commit to moving forward with him (you would think the one that closed it up could open it back up… I was so wrong)! The surgery was very painful; a lot of bruising and I had a huge hematoma that stretched from the top of my right hip bone down to the bottom of my buttocks. The recovery lasted two full weeks – I couldn’t get off the couch for the first week because the pain and swelling was so horrendous. But I kept saying to myself, ‘it will all be worth it if I can get viable sperm again.’ Needless to say, the surgery was unsuccessful and left me with residual amounts of pain, scaring, and a $7,500 bill to pay.

My fiancée and I were very disappointed and desperate to have the procedure done correctly. I went back to my doctor and expressed my deep concern of the outcome of the surgery and the only thing that he could recommend is that I should consult with Dr. Turek in San Francisco. Dr Turek specializes in fixing vasectomies that didn’t take the first time. He’s world renowned, and has an impressive track record of successful outcomes. I just wish he would have referred me from the start versus trying to perform it himself and leaving me nothing to show for it but a lot of pain.

So I took his advice and immediately went on The Turek Clinic Web site. I was very impressed and immediately scheduled a consultation with Dr. Turek. I told him my story: 4 year old vasectomy, with an 8 month old failed vasectomy reversal. Dr. Turek said, “This is my area of expertise. I like challenges so lets see what we can do.” And after going over his success rates it was clear that he is the one that should have been doing this procedure from the very start.

I had the surgery performed in January 2011, was married June 4th, 2011 and we had our first baby February 28, 2012. What an amazing blessing to be celebrating our first wedding anniversary ‘with’ our beautiful baby boy!

There are three things that make Dr Turek the leader in this type of procedure:

Pain management: It’s amazing when the surgery is done correctly the first time how much ‘less’ pain medicine is needed and how the recovery was expedited (I had very little swelling and only had to use the pain medicine for two days).
After care is unparalleled: Dr. Turek is there from surgery all the way up to conception and his staff are amazing. Constant support and communication through: office visits, email and phone calls.
Positivity! Dr Turek’s clinic gave my wife and I a feeling of hope and optimism from day one.

We feel so blessed to have Dr. Turek in our lives and its amazing to think how gifted his talents are to bring life to parents when at one time there was no hope. He is our angel!!”

Kind regards,
Mike and Rachel
Roseville, California

You can read more from our patients on our testimonials page.

Patient Testimonial: Dr. Turek, “The Miracle Worker!”

Paul Turek, MD — Thu, 08 Mar 2012 20:16:10 +0000

Introducing Cole Michael!

We get a a lot of very special, personal and wonderful news from our patients at The Turek Clinic. Sometimes they are generous enough to share their stories with us. With their permission, we’d like to share their story here – in their own words.

“Here is our story! Please let me know how I can share it with future patients

My wife and I are thrilled to report that we just had our first baby boy!

“Cole Michael” was born on February 28th, 2012 weighing 8 lbs. 1 3oz. and measuring 21.5 inches long. Both mommy and baby are doing great.

There are three things that make Dr Turek the leader in this type of procedure:

Pain management: It’s amazing when the surgery is done correctly the first time how much ‘less’ pain medicine is needed and how the recovery was expedited (I had very little swelling and only had to use the pain medicine for two days).
After care is unparalleled: Dr. Turek is there from surgery all the way up to conception and his staff are amazing. Constant support and communication through: office visits, email and phone calls.
Positivity! Dr Turek’s clinic gave my wife and I a feeling of hope and optimism from day one.

We feel so blessed to have Dr. Turek in our lives and its amazing to think how gifted his talents are to bring life to parents when at one time there was no hope. He is our angel!!”

Kind regards,
Mike and Rachel
Roseville, California

You can read more from our patients on our testimonials page.

About Dr Turek

A Dozen Funny Reasons for Vasectomy

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

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

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

Why do Men Get Vasectomies?

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

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

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

Fertility from Sterility

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

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

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

The Affairs of Sperm

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

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

Sperm from a Rock

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

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

Who is Woody?

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

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

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

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

His name is Woody.

Who is Woody?

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

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

Why is Woody Always Around?

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

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

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

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

No related posts.

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!

[End of Transcript]

The Google Wrap (Up)

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

Google: Feels like college all over again…

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

The Guy’s Guide to Maintaining Sexual Health Talk

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

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

Googlers Care

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

The Talk:

Video -

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

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

The Secret Life of a Microsurgeon

Paul Turek, MD — Sat, 23 Apr 2011 15:09:50 +0000

Try doing this with suture much smaller than the finest human hair…

A recent study on hungover surgeons suggests that they are slower and sloppier after a night on the town. Get them toasted, let them sleep it off and they can’t perform surgery on par the next day. Not surprising findings, given the physical and mental demands of many surgeries. But quite alarming for patients who will quickly forgive a heart surgeon for having a terrible personality, but expect and demand that a surgeon be at the top of their game when operating.

Study of Sloshed Surgeons

Eight experienced surgeons and a bunch of medical students were treated to dinner in a restaurant and were instructed to drink until they felt intoxicated. They were then driven home and picked up again the next morning. Brought to a laboratory, they performed virtual reality (fake) surgeries at 9am, 1pm and 4pm. At 1pm, their skills were the worst, but at all three time points, they performed simulated surgeries below baseline, even though they were technically sober at the time of testing. So, surgeons are people too. The problem is that they wield scalpels.

As a microsurgeon, I shuttered when I read this study. It violates the mantra of centeredness that many of us adhere to religiously in practicing such a high art. And although any surgery can be challenging and take years to master, microsurgery places a unique demand on the surgeon: to fix things that are utterly invisible to the naked eye.

The Microcosm of Microsurgery

How demanding is microsurgery? Demanding enough that you would certainly not want your microsurgeon to rave all night before your procedure. In vasectomy reversal surgery, we routinely reconnect tubes that are less than 1/10th of a millimeter in size, slightly bigger than the absolute limit of human hand-eye coordination. For perspective, here are a variety of other dimensions in this subatomic universe:

Thickness, credit card 0.76 mm
Diameter, human egg 0.12 mm
Diameter, average human hair 0.1 mm
Diameter, human vas deferens opening 0.1 mm
Average thickness, plain sheet of paper 0.09 mm
Length, human sperm cell tail 0.04 mm
Limit of human motion 0.03 mm
Wavelength of light emitted by a carbon dioxide laser 0.0011 mm

What’s the Surgeon’s Secret?

The secret of expert surgeons is the same as that of any Olympic-caliber athlete. Natural skill and experience are assumed. If your outstretched hand has a visible tremor, you should probably avoid microsurgery. More importantly, however, are consistency and discipline, which are the true hobgoblins of great surgeons. With this Tao in mind, drinking binges are unacceptable for a master surgeon. Regarding coffee, its allowed, but just drink the same amount every day. Stay consistent. Play sports and keep fit but don’t expect to be Picasso if you’ve thrown a shoulder, your back or sprained a finger-playing ball. Pain diverts critical mental and neuromuscular energy away from the task at hand. Best to heed the words of Aristotle on this: “We are what we repeatedly do. Excellence… is not an act, but a habit.”

But should we define recommendations for alcohol use by surgeons before procedures as the study authors suggest? Fine with me. But what about pilots, school bus drivers and cabbies, to name a few other professions, who also take other’s lives in their hands?

Giving Up the Gavel

Paul Turek, MD — Sat, 02 Apr 2011 14:07:43 +0000

A gavel with teeth for this President…

In two days, I will hand over the gavel. It’s actually a meat tenderizer that I bought to run the meetings this year and it worked just great. A gavel with teeth. Regardless, I surrender it with mixed feelings. On one hand, a year as President of one of America’s leading academic societies is a lot of work. On the other, though, I feel like I am just getting started and that the ship is now running fast with sails full. As we all know from politics, systems with rotating leadership all have their virtues and vices.

The American Society of Andrology

The Society that I lead is the American Society of Andrology. It was founded in 1975 and has about 700 members, most of whom are academic researchers. I guess I have a soft spot for nerdy scientists who care about men’s health. Honestly, though, this group is unique. This week’s annual meeting in Montreal brings together a top-notch group of scientists and clinicians from around the world whose expertise, interest, friendship and collegiality lend to a remarkable cross-fertilization of science and medicine.

What the Heck is Andrology?

My mother still asks me this question. Andrology is the study of men’s health and, in particular, the male reproductive system. It involves all aspects of reproductive fitness, including fertility and infertility, erections, hormones and sexuality. As a reflect upon the Society’s position in the academic world, my elevator pitch is that this Society’s focus is on “The Science of Men’s Health.”

President’s Tribute

The year has been a good one: restoring falling membership, bringing financial stability, initiating a strategic plan and an endowment campaign, and brokering the merger of the Society’s academic journal with that of its European counterpart, the European Academy of Andrology, to ensure its future livelihood.

But, as with most endeavors, the people make the party and I must admit, my colleagues rose magnificently to execute the demanding projects that I put forth this year. And this means a whole lot. In fact, this and only this is substance of my final toast, a limerick, at the Welcome reception tonight. I probably shouldn’t leak it here early, but for you dear reader I submit:

There once was a crazy society,
Subscribed to by much notoriety,
Its goal, so sincere,
To study things dear,
Like sex, with the utmost sobriety.

But not only sex does it foster,
There is but a much longer roster:
Like sperm, prostate, erections,
And most epididymal sections,
And diseases like clap and zoster.

And don’t forget contraception,
The inimitable acrosome reaction,
And ejaculation that’s early,
With low libido that’s surely
A sign of hormonal malfunction.

So as we meet here in old Montreal,
Let’s remember these orders so tall:
To discuss, think and debate,
With friends old, new and irate,
The science to which we are called.

The Ultimate “Green” Book

Paul Turek, MD — Sun, 06 Mar 2011 06:52:06 +0000

If I could only draw like this surgeon could…

It’s the age of “green” no doubt about it. Houses, cars, and even lifestyles with small carbon footprints are part of a larger deeper, planetary respect. You may know of green pencils (from recycled newspapers), sugar cane paper and, of course, green books. But, did you know that the ultimate green book is one that has been around for 54 years and has a huge worldwide following in medicine?

The Netter Green Books are a veritable medical bible that has now been revised for the first time in five and half decades. I am honored to be one of its new editors. Giddy as I write this, Volume One, The Reproductive System, was just sent to me and it is absolutely glorious. Have a look on Amazon and you’ll see.

Who is Frank Netter?

Arguably the finest medical illustrator of the human body since Da Vinci, Dr. Frank Netter’s career as a medical illustrator began in the 1930′s. As a surgeon in training at NYU, he learned by cramming his notebooks with pictures, not words. His professors discovered this talent and offered to pay him for his art and helped to fund his medical education. Near the end of his career, his incredibly detailed, lifelike renderings of the human body in watercolor led the New York Times to hail him as “The Medical Michelangelo.”

How to Update a Masterpiece

Physicians old and young have looked at these images time and again for five decades, seeing in them comfortable sources of clear and clinically succinct information. The privilege of editing this monumental tomb has been both daunting and revealing. Dr. Netter’s art is utterly timeless, highly exact and informed to the point of being prescient. How do you improve on a masterpiece? On the other hand, medicine has change dramatically over the past half century and really demands that entirely new knowledge be revealed. Similar to restoring a Michelangelo painting or translating a Nabokov novel, editing this volume highlighted to me both the vast changes in medicine and the timelessness of Dr. Netter’s art. I chose to let the art do the talking and wrote text to frame it with context, clarification and modern clinical relevance.

Medicine as Art

I come from a family of painters and, as a surgeon, rather fancy myself a craftsman of sorts. This may be why I so enjoyed working with great artists such as Carlos Machado and Tiffany deVanzo who illustrated this volume. As a team, we were able to tackle such complex concepts as ejaculatory duct obstruction, microsurgery and the genetics of sex determination and convey them as medical art. Indeed, some of the figures we proposed for the new Netters took several months to get just right.

Just as challenging for me was my duty to examine the authority of current scientific knowledge. Although I have written and published 60 or more textbook chapters to date, for the first time and for this book, I would constantly ask myself whether what I had written is true not only now, but would be for the next 50 years, until the next edition is written. Trying to tell the difference between what we really know and what we really don’t is a daunting but intensely fulfilling task. My admiration and respect for the wondrously rich and intricate, baffling yet logical, and powerful but delicate workings of the human body have grown in unimaginable ways from this effort. Such are he “soft whisperings” of beauty of which Kahlil Gibran speaks.

That Azoospermic Feeling

Paul Turek, MD — Tue, 08 Feb 2011 06:09:48 +0000

Was Van Gogh Azoospermic?

At the beginning of the office visit, I like to ask men with no sperm in the ejaculate who are unable to conceive a simple question: “What crossed your mind when you first heard that you were azoospermic?” The answers varying greatly but are very telling:

“It must be a mistake.”
“I shouldn’t have joined that fraternity in college…”
“It wasn’t the best sample I’ve ever done.”
“I was simply and utterly devastated.”
“I was in shock and then got really depressed.”
“It changed my life…I always thought that I would be a father.”

The Meaning of Azoospermia

Azoospermia is the lack of sperm in the ejaculate. It can be due to a blockage in the system (obstruction) or failure of the testicles to make sperm (nonobstructive). The most common reason for blockage is a vasectomy. Other causes include infections, prior surgery, injury or congenital absence of certain reproductive tract organs. Failure to make sperm can be due to exposures (hot tubs), medications, varicocele, a history of undescended testicles, cancer and cancer treatment. However the largest chunk of men with poor sperm production have none of these issues. Instead, they have a subtle genetic cause: either they are missing genes on the Y chromosome or have other chromosomes harboring subtle alterations that do not otherwise affect their health or lives.

So, like Captain Renault in the movie Casablanca, most men with azoospermia are “shocked, shocked!” because they feel so normal in every other way. And the vast majority are normal (as normal as men can get) in every other way. Most of the things they worry about, like college indiscretions, are exposures that are entirely reversible with time. My response is usually to allay fear and guilt by saying: “This is not something that you have done to yourself; let’s see if we can do something about it at this point.”

Treating Azoospermia

In fact there is a whole lot that we can do with azoospermia. Men with blockages can often be unblocked with microsurgery, one of my favorite things to do. This gives them the chance to conceive naturally again. And most men with poor production as a cause of azoospermia will have pockets of sperm in the testicles that can be identified by techniques like sperm mapping and that can be used for high-technology pregnancies.

What I have learned after caring for hundreds of azoospermic men over two decades is that they really don’t care what their sperm counts are as long as they can be fathers. And once they are fathers, it is clear that that “azoospermic feeling” goes away, as it should.

The Low Down on Being Knocked Up

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

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

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

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

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

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

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

The Man in the Mirror

Paul Turek, MD — Sun, 05 Sep 2010 04:50:57 +0000

For best fertility: look in the mirror

What is the most commonly asked question in my male fertility practice:

“What can I do to improve my sperm count?”

My answer:

“Treat your body like a temple; all things in moderation.”

I’m sure that this is a disappointing answer for many men, but it’s true. There are no tricks here. Here’s why: Unlike food or water, which we need to live from day to day and without which something will break down in our lives, sperm production is different.

The sperm making process, termed spermatogenesis, wants to run hard and fast—and all the time. The body is happiest making 1200 sperm/second in the normal healthy male. It would rather make sperm than not, given the chance. It is similar to the heart that wants to beat or to a self-winding watch.

So all one can really do is to try not to poison the sperm making process by unhealthy living. Fevers, illness, tobacco, hot tubs, obesity and poor eating habits are all examples of toxins or exposures that “sicken” the body and slow down sperm production. Stay healthy and sperm numbers should be just fine, thank you. A good reproductive body is a good healthy body.

Of course there are reasons to have low or no sperm counts that do not involve impaired sperm production, including vasectomy and lifelong or acquired blockages, but these are unusual. In addition, with infertility due to genetic causes, low sperm counts are likely the consequence of being handed fewer than normal numbers of testis stem cells, the cells that produce sperm. But even in cases of genetic infertility, the stem cells that are present are working their hardest to make as many sperm as possible. It just may not be enough sperm to get out of the testicle and into the ejaculate.

And yes, we have good ways of improving the sperm numbers in men with low sperm counts, but with these treatments we generally will not improve sperm counts to numbers that exceed those that the man would naturally have if he were healthy.

So, lifestyle and daily habits matter greatly for sperm production and fertility. I know it’s trite, but Michael Jackson was right: start with the man in the mirror.

Listen and Learn

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

Listen and listen hard…

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

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

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

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

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

Freud’s Vasectomy

Turek On Men's Health » Vasectomy

Reversing Vasectomy Reversal Thinking

Facts about Fatherhood after Vasectomy

The Problem of the Older Vasectomy

Patient Testimonial: Dr. Turek, “The Miracle Worker!”

Patient Testimonial: Dr. Turek, “The Miracle Worker!”

A Dozen Funny Reasons for Vasectomy

Why do Men Get Vasectomies?

Fertility from Sterility

The Affairs of Sperm

Sperm from a Rock

Who is Woody?

Who is Woody?

Why is Woody Always Around?

Am I a Disruptor?

Getting the Call from The Influence Project

Dr. Turek the Disruptor

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

The Google Wrap (Up)

The Guy’s Guide to Maintaining Sexual Health Talk

Googlers Care

The Talk:

Video -

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

The Secret Life of a Microsurgeon

Study of Sloshed Surgeons

The Microcosm of Microsurgery

What’s the Surgeon’s Secret?

Giving Up the Gavel

The American Society of Andrology

What the Heck is Andrology?

President’s Tribute

The Ultimate “Green” Book

Who is Frank Netter?

How to Update a Masterpiece

Medicine as Art

That Azoospermic Feeling

The Meaning of Azoospermia

Treating Azoospermia

The Low Down on Being Knocked Up

The Man in the Mirror

Listen and Learn

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