In this episode 50 protocols
▶ 27:48 Avoid Scrotal Heat Exposure Behaviors “So I think that there are some risk factors that we do. Like we'll start with semen quality. So we talked about heat. I think that's a big one. So like hot tub saunas, try and avoid those.” ▷ 27:48 Avoid Saunas Tools “So I think that there are some risk factors that we do. Like we'll start with semen quality. So we talked about heat. I think that's a big one. So like hot tub saunas, try and avoid those.” ▷ 28:47 Cold Pack for Sauna Use Tools “And therefore, if one is going to go into a hot sauna for 20 minutes or more to essentially cool the scrotal area... there are studies that have looked at different ways to cool the scrotum and have compared, you know, semen quality before and after. And there's some data that may help.” ▷ 30:48 See a Primary Care Doctor Behaviors “So, you know, if men are in their 20s and 30s getting ready to start a family or 40s in some cases sometimes they haven you know, seen a primary care doctor. So some of these things, some of this relationship has not been established yet. So I think, you know, thinking about ways to start that I think would be important too.” ▷ 31:17 Avoid Testosterone Therapy if Fertility Is Desired Behaviors “I would say that estimates say maybe about 1 in 20 infertile men are that way because of testosterone. So I think when people get testosterone in different places, and hopefully whatever provider you're getting it from tells you that one of the side effects of this is lower sperm production. It's actually been tested as a contraceptive.” ▷ 34:01 Sperm Cryopreservation Behaviors “So I think certainly for reproductive age men, that's a very important conversation to have because there can be some other, you know, ways that we kind of maintain sperm production. I think sperm cryopreservation is a good option for these men as well.” ▷ 35:13 Human Chorionic Gonadotropin Supplements “Yeah, that's one of the therapies that we use. And I think it can work well. Just a low dose, usually, again, for those that know, 500 to 1,000 units every other day is usually adequate.” ▷ 36:54 Exercise Regularly Behaviors “So if somebody is not taking testosterone exogenously, they've gotten their body fat level down to a point where they're not considered obese. So they're hopefully doing some cardiovascular exercise each week, maybe doing some sport or some resistance training too with the intention of maintaining all around good health.” ▷ 38:00 Do Not Smoke Behaviors “So smoking is certainly something you should not do. There have been, you know, lots of studies that do link that to, you know, lower quality, again, all the different measures that we look at. Also looking at fertility, these men tend to have a longer time to get pregnant.” ▷ 38:09 Limit Alcohol Intake Behaviors “Alcohol, I think, is another very common question we get asked as well. And I think for that, there's, you know, I think less of a strong association that we've seen. So there, you know, there have been some studies that show that very high levels of alcohol... when you get above maybe 20 drinks a week, there have been some effects.” ▷ 41:17 Avoid Drug Use Behaviors “And then, you know, I get sort of getting along the lines. I think drug use is also something that we should try and, you know, we do counsel patients about because that can also negatively affect semen quality.” ▷ 45:25 Limit Cannabis Use Behaviors “One of the landmark studies was about 1,200 men, and it found that men that use cannabis daily had significantly lower concentration motility morphology compared to those that didn't use it. So I think that generally how men are counseled.” ▷ 50:57 Good Diet Diet “So I think, you know, in general, like we talked about before, anything that's good for your heart, it's going to be good for fertility. So good diet and exercise, maintaining good body weight.” ▷ 50:57 Maintain Good Body Weight Behaviors “So I think, you know, in general, like we talked about before, anything that's good for your heart, it's going to be good for fertility. So good diet and exercise, maintaining good body weight.” ▷ 51:36 Modify Cycling if Concerned About Fertility or Symptoms Behaviors “So there have been some studies that say maybe five hours a week would be, you know, that may be too much. So if you're above that level, the sperm counts are shown to be lower. If you're less than that, that may be okay.” ▷ 52:55 Anatomically Correct Bicycle Saddle Tools “There are some saddles that, you know, hopefully will be a little safer. And, you know, I think that this sort of first was noted probably around 2000 or so. And there is a big redesign in terms of saddles to try and make them a little bit more, you know, anatomically correct to try and minimize some of this.” ▷ 1:01:51 Seek Medical Evaluation for Abnormal Sexual Function Behaviors “So I think, you know, again, if you're not having normal function, I think that's something you should probably see, you know, a physician about.” ▷ 1:02:01 Seek Medical Evaluation for Urinary Symptoms Behaviors “And then same for like urinary function. I think if it bothers you, if there's, you know, if you're waking up at night, if you have to go to the bathroom often, if your stream is getting weak. Those are all sort of complaints that we hear about.” ▷ 1:04:27 Get 7 to 9 Hours of Sleep Behaviors “So the ideal, I think, as you pointed out, is seven to nine hours. And for men that are not getting that, semen quality tends to be lower. And then for men getting too much, we also see a decline.” ▷ 1:09:16 Semen Analysis Behaviors “Would it be a good idea for males in their 20s and 30s to get a sperm analysis, just to have a baseline?... I mean, I think it's a worthwhile test. I think more information is always good.” ▷ 1:10:25 DNA Fragmentation Testing Behaviors “Should people invest the, I think it was a couple hundred dollars to get a sperm analysis, more costly to get the DNA fragmentation than you get up into the low thousands. But if people have the disposable income, is it a good idea for them to do?” ▷ 1:23:50 Try to Conceive Earlier Behaviors “So I think it's something to certainly be aware of. I think talking about mitigation strategies, I think sort of education would be important for, you know, couples to try earlier, you know, individuals to try earlier to conceive.” ▷ 1:28:28 Taper Fluid Intake Before Bed Behaviors “So if you don't want to wake up at night, that's not a good practice. You may even want to go into bed sort of a little dehydrated just so you can try and last the night.” ▷ 1:28:35 Avoid Bladder-Irritating Foods and Drinks if Urinary Symptoms Are Bothersome Diet “There are some particular drinks or foods that tend to be more irritating. So like spicy foods, acidic foods, those can sometimes irritate the lining of the bladder and make you have to pee a little bit more.” ▷ 1:29:58 Low-Dose Tadalafil Supplements “Looking at placebo trials sort of our highest level of evidence does show that low know low dose of Tadalafil these two and a half to five milligrams these daily dosing can help with these urinary symptoms... And then the added benefit, as you also alluded to, is it can help with erectile function as well.” ▷ 1:33:47 Get Evaluated After a Male Urinary Tract Infection Behaviors “But I think a male urinary tract infection is rare enough that it should be evaluated... So those men should be evaluated because there can be some pathology that we could hopefully identify and correct.” ▷ 1:39:44 Sildenafil Supplements “So usually we start with oral therapy. So phosphodiesterase inhibitor therapy. So that would be like sildenafil or Viagra... Usually we start in the middle to the higher doses.” ▷ 1:39:44 Vardenafil Supplements “So usually we start with oral therapy. So phosphodiesterase inhibitor therapy. So that would be like sildenafil or Viagra, tadalafil, Cialis, avenafil, Stendra, or verdenafil, Levitra.” ▷ 1:39:44 Avanafil Supplements “So usually we start with oral therapy. So phosphodiesterase inhibitor therapy. So that would be like sildenafil or Viagra, tadalafil, Cialis, avenafil, Stendra, or verdenafil, Levitra.” ▷ 1:39:44 Tadalafil Supplements “So usually we start with oral therapy. So phosphodiesterase inhibitor therapy. So that would be like sildenafil or Viagra, tadalafil, Cialis... Tadalafil is somewhat different, and then it lasts longer. The half-life is about 20 hours or so. So it's sort of marketed as a weekend pill.” ▷ 1:40:32 On-Demand PDE5 Inhibitor Use Behaviors “But generally, most men are on just on demand because they're going to fall into that, you know, maybe about, you know, a few times a month category.” ▷ 1:45:07 Urethral Suppository for Erectile Dysfunction Behaviors “So another therapy we have is urethral suppository. So you can actually put a medication in the tip of the penis and then absorbed by the rest of the penis... Sometimes that, you know, is, is okay for men and they tolerate it.” ▷ 1:45:45 Penile Injections Behaviors “Penile injections are another common therapy. So the efficacy of penile injections are probably 80 to 90%... So we teach them how to do it the first time they do it with us in clinic. Ideally, we try and get an erection that lasts probably 20 or 30 minutes. So we usually start at a low dose and then they just increase at home until they get, you know, an erection that lasts for that amount of time.” ▷ 1:47:50 Penile Implant Tools “So then we go into penile implants. So there's actually a surgical procedure we can do to put a device inside the penis that can help men be hard when they want to.” ▷ 1:54:08 Pelvic Floor Physical Therapy Behaviors “So, you know, in the urologist office, there's usually a list of a lot of different providers around the region that can help with some of these. Kegel exercises, though, can be useful... But I think for that man, you know, one of the issues you kind of allude to is he probably needs to relax more. So you know pelvic floor physical therapy can still benefit you because there are some just different feedback exercises that can be done to help with relaxation.” ▷ 1:54:15 Kegel Exercises Behaviors “Kegel exercises, though, can be useful, well, you know, for example, for prostate cancer rehabilitation, some of these men where we're trying to kind of rebuild some of the strength or maintain or improve continence in these men, we do want to strengthen some of these muscles.” ▷ 1:58:44 Seek Evaluation for Split Urine Stream Behaviors “It'd be like a urethral issue, as you're pointing out, a prostatic issue, inadequate speed, you know, of getting urine out, be meadous. So you definitely should see, you know, a physician to get evaluated because there's likely some issue that could be improved.” ▷ 2:08:44 Do Not Use DHT-Like Drugs for Penis Enlargement Behaviors “I would not recommend that.” ▷ 2:10:13 Avoid 5-Alpha-Reductase Inhibitors if Concerned About Sexual Side Effects or Fertility Behaviors “What about finasteride, dutasteride, and these drugs that are effectively DHT blockers?... some, maybe many, not all people who take these drugs, particularly in oral form, experience sexual dysfunction issues.” ▷ 2:13:06 Seek Specialist Care for Post-Finasteride Syndrome Behaviors “Does that mean they should go see you or another male urologist reproductive health specialist? Yeah. I mean, oftentimes they do for, you know, these complaints... they come in, you know, and they see me in clinic erectile dysfunction, low libido, and then we go down all the host of treatments that we talked about and the evaluations that we talked about.” ▷ 2:17:21 Clomiphene Supplements “So clomiphene is a selective estrogen receptor modulator... So by blocking the estrogen receptor, the level of the pituitary or the hypothalamus, you'll stop that. And so the idea behind blocking that is that you'll get more production of FSH, LH, more of these drivers. So you get more testosterone... one of the advantages of clomiphene... is that it doesn't have the same toxic effects on sperm production.” ▷ 2:23:33 Check Estrogen Levels Behaviors “I check estrogen as well. So I think that's another one. Again, because of the relationship with obesity, I think that can be important. Sometimes there's too much aromatization.” ▷ 2:24:50 Get Evaluated for Varicocele if Concerned About Fertility Behaviors “And it's something that everybody should be evaluated for if you're concerned about fertility. So again, we see it very commonly.” ▷ 2:25:07 Seek Evaluation for Scrotal Discomfort or Ache Behaviors “So men will manifest with low sperm counts. We see sometimes discomfort, you know, ache, you know, worse at the end of the day than at the beginning, worse with activity.” ▷ 2:26:55 Collagenase Supplements “There’s now awareness campaigns. Now there's an FDA-approved medicine for it, collagenase or Xyaflex, which is a medicine that solves scar tissue. So that's one of the treatments we have for it.” ▷ 2:27:04 Penile Stretching Device Tools “There's also, you know, different devices, sort of stretching devices, where we try and just mechanically remodel the penis to allow it to be a little bit straighter.” ▷ 2:28:07 Monitor Testicular Changes and Report Abnormalities Behaviors “So, I think that, yeah, kind of being aware, you know, the average size of a testicle for a man is about, you know, it's sort of about a walnut. So, it's about 16 to 20 cc's. usually if you're going to measure it it'd be about four to four and a half centimeters and longest axis to give you know your listeners or viewers some idea if it changes certainly let people know” ▷ 2:30:30 Blood Hormone Profile Testing Behaviors “Numerous times today we've talked about the potential benefit of getting a blood test for hormone profiles, lipid profiles, and other things, as well as a sperm analysis.” ▷ 2:30:30 Lipid Profile Testing Behaviors “Numerous times today we've talked about the potential benefit of getting a blood test for hormone profiles, lipid profiles, and other things, as well as a sperm analysis.” ▷ 2:31:49 Ask a Physician About Fertility Testing Coverage Behaviors “Yeah, I think both are good strategies. I think, you know, insurance is becoming a lot more open to covering some infertility, at least testing, sometimes treatment as well. So I think a lot of insurance does cover that now.”