Why Men’s Fertility Is Collapsing and What It Means for Our Future | Dr. Michael L. Eisenberg

20:33So, you know, we talked about how semen quality can predict later health, right? We talked about mortality. And another study about 5 ,000 men showed that it predicts hospitalization. So if you have higher, you know, semen quality, you're less likely to be hospitalized, you know, in the next five or 10 years, for example. And it's interesting because if you look at that, you you continue to discriminate you know the um the association between sort of health and semen quality up to about 200 million sperm per milliliter so the average is probably about 50 million so you know there's a difference if your sperm is 200 versus 180 versus 160 in terms of how likely you are to be hospitalized when we talk about fertility that number is way down at about 15 to 20 million so even though you know when oh yeah i could say i didn't yeah i don't think i explained that well.

21:20So when we talk about, you know, what is normal or what is average or what is adequate semen quality, like when I'm talking to men about a fertility evaluation, that's what they say, do I have enough sperm? Right. And so the World Health Organization has looked at semen data from fathers, you know, the last several decades. And they say that as long as you have, you know, 15 to 20 million sperm per milliliter, so this concentration, you're likely to have enough sperm. And so if you have to conceive, to conceive, yeah. So if you have 30, 40, you know, there's sort of a plateau. It doesn't matter if you have more as long as you have that number.

21:49But when we look at health, we continue to discriminate sort of how healthy you are as we go even higher. So 50, 60, 70, 80, up to 200, then it starts to plateau. But you continue to see that relationship. So what's like a normal sperm count? Is it 200? The average is probably about 50 to 100, so more in that level. Well, again, we continue to discriminate health well beyond that. So you're certainly healthier if you have above average sperm count. And, you know, again, we talked about, you know, these men with lower sperm counts are less healthy, right? They're more obese, more metabolic syndrome.

22:19So you may sort of expect that this relationship that we're saying that there exists between semen quality and health is maybe just related to healthy that are on baseline, right? You know, men that are more obese have lower sperm counts and that's why they have to be hospitalized, that's why they die, et cetera. But what's interesting is if you then divide men, you know, based on semen quality and obesity, let's say, you see something very different. So obviously if a man's obese and has a low sperm count, he's going to do worse, right? That sort of makes sense based on everything we've talked about.

22:47But then if you have a man that's, so let's talk about the next level then. So what would be worse would be having a, being obese and having a high sperm count or having a low sperm count and being not obese. So what do you think? What do you think would be worse? I mean, I think, I don't know.

23:02Dr. Mark Hyman:I think being obese, but maybe, I think maybe you're, you're going to trick me. Yes, exactly. Yeah. So actually it's worse to have a low sperm count. The discriminator here is really sperm count. So if you're obese or not obese, if you're having a low sperm count puts you in a much lower category than if you have a high sperm count. So like you talked about, right? There's sort of this healthy obesity phenomenon where some men are obese, but somehow all their metabolic markers are perfect. And it may be that semen quality kind of predicts that. Some men have more reserve than others, right? And so maybe that's what it's telling us.

23:31Even when you do that same sort of trick with smoking, whether you smoke or not is not as predictive if you know that man's sperm count. So having a low sperm count and not smoking is worse than smoking and having a high sperm. That's crazy. It's crazy, right? So I think that, you know, again, there's, I think there's lots of reasons to check a sperm.

23:49Dr. Mark Hyman:So it's not, it's not that the sperm count is secondary to obesity or to smoking. I mean, that's interesting because I would have thought that it's really directly correlated, but you're saying it's not. It's not correlated. Yeah. I mean, I think that, you know, again, all these things sort of factor together to some extent, but I think that semen quality and sperm count is really telling us something else. It's telling us sort of, again, kind of overall fitness perhaps, but it really tells us how healthy a man is. So, I mean, I think having it checked, you know, early would be very good for reproductive reasons, but I think you'd also get a measure of health too.

24:20Dr. Mark Hyman:And you're talking about sperm quality. You're talking about more than sperm count. So what defines sperm quality? What do you look at and what are the kind of essential biomarkers in the sperm that you're checking? Yeah, so there's a lot of different things we look at. So first we look at volume, you know, how much comes out. then we also look at the sperm concentration so how many million sperm in every milliliter we look at motility or movement so how many sperm are actually moving here to be alive and are they swimming very well yeah exactly we also measure you know how efficiently they're swimming are they swimming forward are they swimming kind of circular and then we look at morphology or shape and that again tells us all about the efficiency of sperm production and then in some sort of more advanced testing we can look at the dna integrity genetics of the sperm yeah so we can look to see whether there's fragmentation in the DNA, and that just predicts how efficiently the sperm is likely to fertilize the egg, which is ultimately the goal.

25:12Dr. Mark Hyman:So what we're seeing also is this a lot of older men and people having babies. And so there's some concern about the linkage between, you know, the quality of men's sperm and, you know, abnormalities in the offspring, whether it's neurodevelopmental issues or autism, or can you talk about the data about this? Because I think, you know it's a concern for people if you're thinking about you know when you're 40s or 50s and you want to have a kid what's the risk you know i just had a friend who's like late 50s and had a kid and it had a you know weird mutation like a crass mutation i'm like oh is that because he was older or is that just random or you just don't know yeah i mean well i always like to start by saying the oldest father ever is 96 so the biologic potential really supposedly yeah so this Go to the Real Viagra.

25:59He said supposedly without. I think supposedly he had a sex, I think, at least every day. You know, again, well into 80s, 90s. Wait, he had sex every day? This is all, this is sort of legend. This is a gentleman that lived in India. And that's sort of what was told. And so he had a child in 94. And then a few years later, he had another child. And his wife was also in her 50s, which is also equally miraculous. Wow. And sadly, he did eventually die, not of old age, but in a house fire. Oh, gee. Yeah. Yeah. So a tragic ending.

26:30Dr. Mark Hyman:So he could have had a kid at a hundred. Who knows? That's right. But, you know, again, the biologic ability does persist. Yeah. But as we get older, you know, some of the functions slow down. Just like as women age, as fertility goes down, the same thing can happen in men. So, you know, the semen volume declines, motility declines, concentration goes down a little of the number of sperm that we're actually making. And then I think as you're pointing out, there's also more mutations that can accumulate in the DNA as well. So, you know, the way that sperm production is made is we start with these sort of stem cells in our testicles and they regenerate themselves.

27:02And then they also divide and produce cells that go on to divide and produce spermatozoa, our mature sperm. And so this replication event, you know, begins in puberty and basically continues until we die. And so, you know, generally this replication is very efficient. But, you know, again, mutations can arise. And it's usually. And they persist. And they persist. And they persist probably about two per year. So, for example, like a 30-year-old will have about 20 more mutations than a 20-year-old, for example. And, you know, again, there's billions of base pairs in our genome and in all of our body.

27:38And so, you know, it's unlikely that any of those are going to be individually relevant. relevant but again at a population level if we're getting older and you know since the 1970s to today you know the average age of a father has increased about three and a half years four years so we are seeing that on average we're getting older and there's more more fathers over 40 45 50 so i think that certainly is happening and we may see more uh you know mutations come to bear and what's equally interesting is that you know some of these mutations are random but if they occur in sort of the right gene, some of these genes really proliferate in the testicle.

28:13So there are some genes that, you know, for example, where they have to do with cell division. And if you get sort of a mutation in one of those genes, that cell will then divide faster than its brothers or sisters. And so you'll get more of the sperm to harbor that particular mutation. And so you may see that more in the population. And what we've seen is that, again, there are sort of conditions that are associated with paternal age. So there's neurodevelopmental disorders, schizophrenia, autism, bipolar disorder. Wow. And if you look at sort of academic achievement, they're able to do this in some Scandinavian countries where they, again, they have these large population registries.

28:46They know exactly how old the father was and they can follow how the children do. There's, you know, higher degrees of, you know, failing grades, you know, acting up in school, lower educational attainment in some of these, in children as well.

28:58Dr. Mark Hyman:So a lot of neurodevelopmental, behavioral, ADD, autism. Yeah. All of those. Yeah. Yeah. And then you also see sort of risk of miscarriage or. Yeah. So I think, you know, as fathers get older, I think it's, you know, it takes longer to get pregnant, less likely to get pregnant. We see higher risk of miscarriage, preterm birth, all those things. And so I think then we're really kind of talking about sort of the next generation, right? Because, you know, talking about, you know, how development impacts the rest of our life, right? This developmental origin of adult disease, you know, based on the work that David Barker did, you know, half a century ago.

29:30And so if you're born premature, you know, given there's higher risk of, you know, metabolic disorders and other disorders that may, you know, track later with life. So I think these are all things we need to be sort of aware of. And it's not just age, too. I mean, again, we're talking about health. We've seen that fathers with chronic diseases are more likely to have these same issues, more likely to have miscarriage, more likely to have preterm birth. And so really this can impact the next generation as well. It's not just getting pregnant, but obviously the ultimate goal is to have a healthy child.

29:57Yeah. And may put that at risk to some extent.

30:00Dr. Mark Hyman:Really paternal health does play a role in pregnancy and conception in a way that we didn't really think about before. But how does it, how does the health of the pregnancy determine by, by the father? Cause you know, most people just think, oh, you have sex, you donate the sperm and then you're out. Yeah. Yeah. That's right. Yeah. Well, I mean, we contribute half the genome, so I think we do play some role, but I, I certainly don't want to say that the mothers are not important. They're certainly more important given everything they do with gestation. But I think it's sort of important just to think that the father does contribute to some extent.

30:30I think that there's a lot that we do. And, you know, in addition to sort of the genetics, I think the other thing is sort of this epigenetic phenomenon. So again, all these diseases are not likely going to mutate our DNA, but they basically affect sort of the covering and the expression of some of the DNA. It's still called epigenetics. And so, you know, that I think is sort of the most common hypothesis about how this may be transmitted. And in addition to the child, we also contribute to the placenta, right? Sort of this, you know, the component within the pregnancy that kind of nourishes the child.

30:59Dr. Mark Hyman:And again, how does the male contribute to the percent of that? Well, there's DNA. Yeah. Some of the DNA contributes to that too. And again, these sort of these epigenetic markers as well. And so if that's not perfect, right, you'd expect that that's also going to lead to, you know, altered pregnancy trajectory, for example. So we do see, again, miscarriage, but also, you know, even in the mother, higher risk of preeclampsia, for example, like, you know, hypertension and pregnancy, gestational diabetes, all these things track with paternal age but also paternal health well you know one of the things that that um people probably are thinking is well geez what do i do to improve my sperm quality and health right because if it's declining what can i do and you know from a lifestyle perspective we talked about some of the environmental factors but there's more to it than that so can you talk about like if you want to sort of advise your patients on how to stay healthy and have healthy sperm quality what are the parameters that you really focus on teaching them So that they can have the healthiest sperm quality and the healthiest pregnancy outcomes.

32:00Dr. Mark Hyman:And obviously the, the best healthy babies. Yeah. These are the, yeah, this is exactly how I counsel patients in clinic. Well, I think the first thing is, I think that. Okay. I'm, I'm like 65. I want to have a baby. Like, what do I, what? Well, you're, I think you're living life the right way. So I'd be very optimistic. I don't know if you've ever checked a semen, um, you know, semen. I did. I did. I was actually, I was surprised because I wanted to like see what was going on. And it was like no genetic stuff. It was really good. And I was like, I got an A plus. I was like, you got an excellent.

32:29Dr. Mark Hyman:I was like, wow, okay. There you go. There you go. So I think, you know, getting that knowledge is important. I think not everybody does into a semen analysis. We talked about couples in this country. Oftentimes, you know, the male fertility gets it, you know, gets bypassed. So I think that that's something that'd be important. But, you know, assuming there is or isn't a problem, I think we do counsel men about different things that they can do. So certainly taking ownership of your health, I think is very important. You know, many times, it's one of the first times a man ever comes to the doctor, right?

32:55Usually you come to the doctor if there's, you know, a problem. Like, right, if you're in pain, you broke something, you're bleeding. You know, those are really the reasons that men go to see, you know, a provider.

33:05Dr. Mark Hyman:Yeah. So this may, you know, again, allow them to sort of, you know, take a little more ownership. So when I see these patients, I do talk about these things. They don't have a primary care doctor. You know, try and get them set up to get evaluated for, you know, blood pressure, cholesterol, blood sugar. All those things that we know are very important. And so then we talk about diet, talk about exercise. I think those are very important as well. Strength training really helps boost testosterone, right? All activity, I think, is beneficial. Hormones, and being outside, you said, helps low testosterone being outside.

33:33Yeah, yeah, we just did a study looking at NHANES, the National Health and Nutrition Examination Survey. So there is an interesting correlate between sunlight exposure and testosterone levels. And it basically increased about 10 points for every additional hour you spent outside. So that can be sort of an easy thing. So when you're exercising, you know, spend time outdoors or if you're going to read or do work, if you can.

33:55Dr. Mark Hyman:The lifeguards have high testosterone. They must. They must. And then we do look at exposures that potentially are negative. So like testosterone supplementation, for example, lower sperm count, scrotal heat exposure, hot tub saunas. Those are also not good. Everybody's doing like saunas these days. And now there's like things you can put on your private parts. That's like trying to protect it. Yeah. Like a cooler ice pack in the sauna. Yeah. So the testicles are outside the body because they need to be cooler than the rest of the body. And that's sort of ideal for spermatogenesis for sperm production.

34:25And so if you heat it up, you know, the levels can go down. So, you know, even a short exposure to a sauna, if you're doing it, you know, once a week, once a month, you know, it takes two to three months to make a sperm. So if you have an exposure anywhere in that window, you can see effects of that.

34:37Dr. Mark Hyman:I just saw it every day. So, yeah, well, and then, you know, like, uh, being sick too, can do that as well. I've seen men that, you know, had normal sperm counts, got the flu, their sperm counts went to zero. And then after they recovered, you know, from these high fevers over a few months, their sperm counts then renormalized. So that can all, that can all occur as well. Um, and then the other thing we do talk about is supplements. So there's lots of data that antioxidants. Do people have to worry about laptops on their lap? Yeah. That, that can also affect it too. So, you know, again. Hot tub saunas.

35:06Dr. Mark Hyman:and laptops yes so in just interestingly if you keep your eyes together it can actually warm up the scrotum but if you have a laptop it increases the temperature even quicker so you know you can actually increase the temperature of your scrotum about a degree in just 10 or 15 minutes with a laptop in your lap oh and so some people tell me well i'm going to put a pillow and that helps a little bit but you still get there about 20 25 minutes so take breaks i think that's something Now they have those like, uh, those like things you can put on and block the radiation. Yeah. Is that where those work?

35:39Dr. Mark Hyman:Those little. Radiation exposure. I think that's also something that, you know, it's sort of theoretical. I don't know if it's EMF, but it's for the heat, but it's like, it's like a little kind of table unless you put the thing on and put on your lab. I have one of those, but I don't know if it works. I mean, I think any kind of insulation, I think, um, insulation is good, I guess, for, you know, again, radiation exposure. Again, if, if we think that that's going to be a role and I can talk about some studies that suggest that potentially it could be. but yeah yeah yeah but heat is i think the thing they're really talking about so you know again keeping your legs wide that's something that's been shown about 70 if you can keep it at 70 degrees that can beneficial but also you know a table is going to be beneficial as well so there is some risk to that as well um you know for the uh the electromagnetic field you know generated by phones or by laptops there's a study where they took um semen they basically took like sort of a cup of cement and put it next to these devices.

36:32Yeah. And they saw some decrease in motility. So the movement of the sperm, some increase in DNA fragmentation, um, as well. So no putting your phones in your pocket. Well, you know, I think it's something to be aware of. I think all of us do it. So again, that's one of those exposures that time for men to wear a purse or maybe the front pocket.

36:50Dr. Mark Hyman:There's other places to put or your back pocket, but keeping it away from the scrotum may be beneficial. And then again, the other sort of thing that I talked to men about is supplement. So I think there's good data that antioxidants and some, you know, other supplements can help too. I partner actually with a company called Swim Club. And what we did sort of started at first principles is looked at all the data on all the different supplements and tried to get the right dosing and all the right supplements to sort of to improve things. And the other thing that this group taught me is it's not just a supplement.

37:17It's also sort of the sourcing for all this. So they had experts in the industry as well. So I think that's also something that men can do that could be beneficial.

37:25Dr. Mark Hyman:So let's talk about the nutrients because people don't think about like women, women take prenatal vitamins. And there's a friend of mine who has a company that is, you know, called WeNatal. It is actually a multivitamin and prenatal vitamin for women, but also for men. And you're creating something like that as well. But it's really designed to sort of help with male fertility or with sperm quality or what is the goal here? All that. I think that, you know, these are all supplements that have been shown to improve male fertility as measured by semen quality. So improving, you know, the numbers of sperm, the quality of the sperm, lowering DNA fragmentation, increasing movement.

38:02And so they operate sort of on many different pathways. So, you know, there's, you know, different ingredients that target sort of mitochondrial health because, you know, basically sperm are, you know, motors. They're powered by mitochondria. So there's omega-3s, alpha-lipoic acid, you know, coenzyme Q. Then there's, you know, other ingredients that targets, you know, cellular damage, zinc, spermidine, folate. And then obviously antioxidants as well, because there's, that's also a sort of a powerful form of damage that can occur to. Like selenium, like capene. Exactly. And acetylcysteine. So I think all those things together help, you know, they also help, you know, individually with membrane integrity and other components.

38:43of the sperm. So these are, you know, again, biologically targeted agents that can improve that. And there are also other health benefits too. You're like a Stanford professor and you're like, Hey, these things actually have data behind them. They do. They have strong data behind them. Yeah. There've been large Cochrane med analyses as you just benefit from these supplements.

38:59Dr. Mark Hyman:And, and you mentioned something that sounds weird. Spermidine. Yeah. Talk about what is that? Cause people, I mean, then a cell assisting me, people haven't heard about that boost something called glutathione, which helps detoxify your body. It's the most powerful antioxidant in the system that kind of neutralized a lot of other antioxidative stress markers. But spermidine, I don't think people ever heard about, and it sounds weird. Yeah, it's sort of a fun name, right? Yeah, I've learned about it during this process too, but it does help with, you know, many cellular processes, cellular health, DNA health.

39:30And so, you know, it made sense to include it as well.

39:33Dr. Mark Hyman:I actually, you know, looking at the supplement, a lot of supplements out there, you know, they have the ingredients, but they're kind of window dressing. They have not really, clinically effective doses um they're they're not often in the right forms of the nutrients so as i'm sort of you know this is my gig is like understanding supplements and vitamins for 30 years but you know seeing you've got you know things like r-alpha lipoic acid which is the right most bioactive form or you've got you know the the um you know the right forms of different nutrients that and the doses like you know for example selenium is 200 micrograms or of omega-3s, you've got two grams in there.

40:13Dr. Mark Hyman:You've got 200 milligrams of CoQ10. So you've got a lot of these at clinically meaningful doses. And what have you seen in people who are using this? Yeah. So we started to see some improvements. I think, you know, there've been feedback that we've gotten from some of our patients, you know, about improvements. I remember there's one man that emailed us, his sperm count doubled, his motility went up 50%. So I think clinically, you know, again, meaningful changes. And we're actually doing a study now, again, you know, And one of the other things I want to just sort of highlight what this company does.

40:43And one of the reasons I wanted to work with them is they do things the right way. So they're just, it created this based on science, but now they're going to test it as well. And so we're recruiting patients now for studies. Hopefully we'll get that data in the next few months. It's important. You're going to be looking at valid.

40:56Dr. Mark Hyman:Okay, this is theoretically in the literature, these different ingredients, when you put them all together, like what's the combinatorial effect on these things? So interesting. I mean, so basically take-homes are like, don't eat too much tart and sugar and have a big fat belly. follow Dr. Hyman's advice about eating healthy to reduce your environmental exposures as best you can. I think the Environmental Working Group is a great site. And three, there are nutrients that really help improve sperm quality, function, production, and so forth. And that you can do in force, go outside. Yeah, go outside, yeah.

41:28Sunlight. One study I read,

41:30Dr. Mark Hyman:I don't know if it actually matters long term, but like stress really has a big effect on hormones. Yeah. And it was a football study where they actually showed male testosterone levels before and after the game. If your team won, you know, your testosterone level went up. If your team lost, your testosterone level went down. That's right. Yeah. I don't think Maudo was like, don't watch football or just pick the winning team. The winning team. But does stress have a meaningful impact on all this? Yeah. I mean, I do, you know, we talk about that as well. I think, you know, less stress again, to the extent that's possible, but, you know, cortisol basically, you know, um, counteracts testosterone.

42:09So as cortisol and stress goes up, we see lower testicular function. So we can see sperm counts go down, testosterone levels go down. Also talk to men about sleep, right? You want to get sort of adequate amounts. And it's interesting, it's sort of a U-shaped relationship, right? It's possible to get too little, right? That makes sense, but it's also possible to get too much, interestingly. So we start to see, you know, we see declines for men that get less than six hours, but we also start to see declines men you're getting 9, 10, 11 hours of sleep. Again, why that is not certain, but, you know, try and keep in the sweet spot, 7 to 9 hours.

42:38Dr. Mark Hyman:You know, one of the things that I've seen in the literature is changing in the ratio of male and female births. And that may be related to this same phenomenon of environmental chemicals that are endocrine disrupting and more estrogenic, because these are often, we call them xenoestrogens. You mentioned some of them block estrogen receptors or male hormone receptors but there there's these four molecules that seem to mimic estrogen there and are actually when you add them up because you don't usually get them you know one at a time you're exposed to a stew and soup of toxic chemicals that we live in that that they actually have very significant effects on this so i'm wondering if you could speak to that it's very just i think sex ratio is so interesting um yeah because i think as you pointed out there certainly have been studies in the u.s canada and other countries that show the sex ratio is changing.

43:28It's really incredible to think that that would happen, that anything would change the ratio of male to female births. They've also found that it changes around the time of stresses. So for example, around the time of a financial downturn or war, the sex ratio changes. To what? It actually goes down a little. So there's more female. Yeah. More women. And I think you have to think about where this would happen, right? Is it at a sperm level? is at, you know, at the fetal level. And I think that's sort of a popular belief that it has to do with sort of selective miscarriage and it's more likely to have, you know, male, you know, miscarriages and female miscarriages, but a lot of it's sort of uncertain, but it is really a fascinating line of questioning.

44:14And people have looked at, you know, how there were some early studies and I think the nineties, it said that, you know, diabetics were less likely to sire male births compared to female births. So again, sort of this idea of chronic disease may see. And unfortunately for a lot of these things, to see a difference in sex ratio takes millions and millions of births. So I think a lot of these things, we just don't have adequate data really to look at.

44:36Dr. Mark Hyman:I want to kind of pivot a little bit to sexual health. So the sperm thing is good because one, you can get it checked. Two, you can identify problems. Three, you can do something about it. Yeah. And that's all the good news. So you don't have to be sort of victim of it, but it's important for guys to get on this. And for women listening to get their guys on it. Yeah, that's right. And, and think about it as not just in terms of their own fertility and having a baby, but just in terms of their general wellbeing and health. As you said, it's a highly predictive vital sign or biomarker for other things and mortality in general.

45:12Dr. Mark Hyman:So I think it's important. And I think you're, you're raising this as super important. I mean, the other thing we're seeing, and we sort of touched on earlier is, is sort of. increasing rates of erectile dysfunction, sexual dysfunction, libido issues, particularly even in younger men. Like I, I'm kind of like shocked to hear, you know, how younger guys are like using Viagra. I'm like, what's going on here? Like, I remember when I was younger, I certainly didn't need anything. And I was like, so I, I just, just curious about, you know, what, what's happening with this sort of changed in, in sexual health around libido, sexual function performance, particularly as people getting older and like, Like what's going on?

45:50So we are seeing, you know, increasing rates of erectile dysfunction. And, you know, a study that's actually, you know, about 20 years old now that I always quote, that if you look at men over 40, over half have some trouble with erection. So it is very, very common. I think people don't realize it. I think that, you know, in addition to being a great therapy, which Viagra is, the other thing that Viagra did is just brought a lot more awareness to it. You know, I think men now don't have to suffer in silence. I think there's, you know, a lot of great treatments that we have, and we'll talk about some of those.

46:17but even under 40, right? It's fairly common too. You know, I usually say probably like maybe 20 % of men under 40 also have it too. And, you know, I think some of these same conditions can also cause, because if you look at why we're getting erectile dysfunction, I think some of these same health aspects, you know, are at play. You know, we used to think that most erectile dysfunction was due to this kind of psychogenic causes. It's in your head. Yeah, it's in your head. But now we know that's not the case. It does contribute some, maybe about 10%, but most of it is due to, you know, metabolic derangements, cardiovascular, anything that affects blood flow anywhere in the body will affect in the penis.

46:50Dr. Mark Hyman:Yeah. One of the biggest, one of the biggest, most successful ads for stopping smoking was the Marlboro man with the limp cigarette. Oh yeah. I remember that. Cigarettes cause vascular injury and then the sexual dysfunction. Yeah. Smoking is a big one. Exactly. Maybe that's one of the reasons that the rates have gone down so much. Yeah. You know, people think about like low testosterone as a main, is a big driver of erectile dysfunction, but it probably contributes about five percent interesting it's actually pretty small wow um so i think most of it is just sort of vascular so blood vessel flood and the things that cause harm to your blood vessels are all the things we yeah we've talked about smoking diabetes being overweight hypertension you know diet all those sorts of things cholesterol issues right exactly so basically like it's almost like the first clue that you might have vascular issues including disease of your heart and your brain yeah right because a lot of the consequences of small vessel disease is you get hardening of the arteries and not just your penis but in your heart and your brain which leads to heart attacks and strokes and even dementia so i think i think that um you know if you're having that it's important indicator like go get checked yeah go get checked for your overall health and it's part of why i created uh co-founded function health was for allowing people to get access to their data we do full diagnostics including testosterone free testosterone we look at fsh lh we look a lot of hormones that are often ignored prolactin levels and we find so many interesting things that that people didn't even know they had like high prolactin can affect you know sexual function too and we found people with like brain tumors that didn't know they had brain tumors and it's like you just kind of go along thinking this is me but actually it's it's just something wrong yeah so getting getting checked is really important people go to functionhealth.com and it's only a dollar a day now.

48:32Dr. Mark Hyman:We can lower the price to$3.65. And it'll give you a really robust idea, including your metabolic health, your cardiovascular health. And if you're having sexual dysfunction or fertility issues, it's important to really see what's going on for the guys. So don't ignore your health. And if you're a woman listening and you got a guy, go send him and get checked.

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50:48Dr. Mark Hyman:So what you know besides the vascular issues there are there are other other things like neurologic things that can happen. Yeah there can certainly be so I think a lot of those can be a consequence of some of the surgeries that we do. I mean there can be you know back injuries that some men have, you know, from chronic use, weightlifting or injuries. But also, you know, some of the surgeries that we do like prostate surgery, yeah, colon surgery, bladder surgery, you know, the nerves that are involved in erection are right around that area. And so sometimes they're disrupted by the surgery. Oftentimes, you know, we've gotten a lot better in terms of our anatomic knowledge.

51:19So I think we don't primarily injure them, but scar tissue forms afterwards. And so typically the nerves are stunned. And so we do see that effect too. So neurogenic causes is another one that we need to be aware of. know let's run through for guys who are listening because it's kind of always embarrassing to talk

51:32Dr. Mark Hyman:about but like if if you have erectile dysfunction you know there's a lot of options now yeah right there there is obviously viagra and the salis and this spender and all these different um kind of versions of the same kind of drug which are these vasodilating nitroxide inducing drugs and they can be very helpful but sometimes they don't work yeah and so there's other options can you talk doing things like, you know, in vacuum injections, there's actually a new, new technology out of Europe that is a, um, kind of electrical frequency thing that they use called Vertica, which is not quite approved here in the U S but can you talk about some of these things and how they can be used and when they should be used?

52:11Dr. Mark Hyman:Yeah, absolutely. Yeah. So what I always like to tell men, as long as you have a penis, we can always make it hard. All right. So we can be as aggressive as you want to be. And there's lots of great implants even. Yeah, that's right. So, you know, we usually start with lifestyle modifications. We start with pills. And if those don't work, we move on to other things. And in addition to, you know, lack of efficiency, some men can't tolerate, you know, the Viagra, Seattle, some of those other medications, or it can be side effects, sometimes are contraindications with certain conditions or medications.

52:37So there's medications you could put in the tip of the penis, like suppositories that are kind of locally active, you know, agents like that that cause vasodilation, blood flow accumulation. Another very effective one is injections. So, you know, sort of kind Kind of similar to an insulin type syringe you can inject in the penis. Sounds scary, but it's not so bad. Well, there's certainly a psychological barrier to putting a needle in your penis, but it works very well. Probably 90 % of the time. There's something called a vacuum device.

53:02Dr. Mark Hyman:Are there any dangers to that in terms of scarring? You're sticking a needle in your penis. Is it problems long term? So I think that, you know, there's more scar tissue that probably forms from not getting erections on a regular basis than getting erections. But we do want to vary where we do the injections. So we have men vary kind of the location along the shaft and the side as well. but in general you know i think more erections are going to be better so usually we don't see a scarring response again we mitigate it through some of those things um you you asked about the vacuum erection device so it's basically a plastic cylinder you put over your penis then it sucks blood into the penis kind of treats it like a balloon so to speak and then you put a band at the base to trap the blood inside so you can use that for sex um and then there are these newer therapies that are coming kind of energy therapies and the idea is they kind of induce sort of micro damage within the shockwave shockwave yeah which sounds scary and terrible yeah it's not so bad it's not so bad i think there's not a lot of risk with it i think we're still you know doing a lot of studies to see the efficacy and who the best patients are i think that it probably helps men with mild erectile dysfunction i think when we get into moderate or more severe erectile dysfunction i think some of those studies are somewhat mixed so basically like kind of shocks the penis shocks the penis and then you and then you see increase sort of because of the trauma increased recruitment of repair and blood vessels and new, new stem cells and everything coming in to help kind of more natural erections.

54:20Yeah. Yeah. So I think for men that are on like Viagra, a lot of times these therapies can get them off. So I think that's sort of the, that's the benefit. And, you know, it's basically a series of, um, obsessions where men go, you know, to their doctor, they get it done for 10, 15 minutes, and then they do it maybe five to six times. So that could be another option too. It's like once a week for six weeks. Yeah. Yeah. And then, you know, the final therapy is implants. So there's basically devices you can put within the penis that help you be erect when you want. And so there's some that are bendable.

54:48These are called semi-rigid. So when you don't want to have sex, you bend it down. When you're ready for sex, you bend it up. And then there's also inflatable ones. So whenever you want to have sex, you basically move fluid into the cylinders, which are in the penis, and you can use that for sex. And they work very well. You know, I always say it's a self-selected population, so we don't force men to get these. But for those that do choose this option, they're very happy you know 90 of men are very happy their partners are very happy they recommend it to friends sometimes family and you have the same sensation or yeah like yeah you have ejaculations and all that yeah so you don't need erections to have an orgasm so you know again i tell couples too as we're going through this there's other ways to be intimate yeah besides you know penetration um but again the sensation is going to be unchanged with these devices

55:30Dr. Mark Hyman:amazing and what about this european device are you familiar with it i haven't heard about that vertica yeah i heard about it from dr mohi kara from uh oh yeah baylor and uh he's a great guy but they're doing some trials on his studies but it's available in europe and it basically is a the device it almost i don't know how to describe it's basically like a looks like a big wing but inside there's like a circle you stick your penis in and then it kind of makes all this electrical charges and it prevents the uh the blood outflow apparently oh interesting yeah i mean uh venus leak is certainly an issue as well especially after like prostate surgery for example like scar tissue forms.

56:04And so you can imagine sort of two processes for erection, right? Blood gets into the penis and then gets trapped there. And so when scar tissue forms, some of that trapping mechanism is lost because the elasticity of the expansion is how this occurs. Their veins are on the periphery. And so as we expand, we kind of compress those veins. And so there's not a great therapy for that other than some of the surgeries. So great to see some innovation in that space.

56:29Dr. Mark Hyman:In terms of testosterone replacement therapy or people call it hormone optimization therapy, I'm kind of shocked at the number of young men who are taking it. I mean, I know the bodybuilders have been using it forever. Right. But I'm not talking about bodybuilders. And I'm like talking to friends of mine, I'm like, what? You're in your 40 and you're taking testosterone? Like, what the? Because I've been prescribing it for a long time, but usually to older men who have very low levels, who have, you know, loss of muscle, who have loss of motivation, energy, depression. sexual dysfunction yeah there's a lot of benefits to it right um and historically you know there's been there's sort of a negative view of testosterone therapy because we thought it caused you know abnormal risk for heart attacks and prostate cancer um and it does have some effects on your blood count can cause you know thick blood but you know can you talk about like the benefits and the risks and the age we should start and like how do you pick the right patient and you know who should be thinking about it and who should be worried about taking it when they're younger?

57:29Dr. Mark Hyman:Because I'm like, wow, you're like, because I was, you know, Newson was like in his 30s and was taking it. And then he couldn't have a baby, like you want to have a baby. And they had this whole problem infertility as a result of him taking testosterone, which shuts off your sperm production. Yeah. Yeah. So I think, yeah, it's a very good point. And I think that we have seen an increase in the number of testosterone prescriptions, you know, over the last several decades. So testosterone, as you point out, is very important for men's health, like energy level, sex drive, mood, sleep, concentration, and sort of quality of life things.

57:57But when it gets very low, we also worry about muscle health, bone health, heart health, you know, men that have very low testosterone levels, like castrate levels, which we do for, you know, treat certain conditions. They have higher risk of metabolic disease, you know, osteoporosis, et cetera. So we do want to keep men normal. But if men are normal, we don't necessarily want to make them superhuman. You know, maybe it can help you, you know, compete athletically, but, you know, there are also some harms to testosterone as well. And so, you know, I think there used to be this fear about, you know, prostate cancer growth or heart disease, but there have been large studies now that have just completed in the last few years that really, I think, put that to bed to a large extent.

58:34But it does raise your

58:34Dr. Mark Hyman:cholesterol. It can affect, yeah, well, it can lower your good cholesterol, it can raise, yeah, bad cholesterol, it can also thicken the blood a little bit. But even when that, it doesn't seem correlated to heart attacks or strokes. Right, yeah, it seems independent of that. You know, hair loss, breast growth, acne can occur as well. And I think the one that we worry about the most, especially for reproductive age men, is it can lower testosterone. So, you know, the way that we work is that, you know, our brain sends signals to the testicles. Lower sperm. Oh, sorry, lower sperm counts. So yeah, testosterone lowers sperm production.

59:05So the way that we work is that brain sends signals to the testicles to make sperm and testosterone. But if you're taking exogenous testosterone, you know, from gels, injections, or whatever, your body senses there's enough testosterone and basically stops that signal down. And so it shuts off testosterone production, but it also shuts off sperm production as well. And actually the testosterone levels in the testicle are much higher than they are in the rest of the body. You know, in the rest of the body, you know, normal is probably 300 to 900, somewhere in that range. But in the testicle, it's in the thousands.

59:33And so, you know, again, your serum level, if it's in, you know, in the hundreds, it's not going to be in the thousands in the testicle if you're not producing it at that level. And so all that leads to these lower sperm productions. And testosterone has been tested, continues to be tested as a contraceptive. So it does lower sperm counts pretty reliably. So I think that's very important. Is it male fertility treatment? I know, is it a male birth control? Well, they're working on that. So it turns out the testosterone by itself was not quite that reliable. It probably works 80 to 90 % of the time.

1:00:01So that's not as good, you know, that's not good enough for a contraceptive, but they're working on adding other things like progestins, for example, that can get you across the threshold. So it's in trials now. And I think, you know, hopefully in the next five or 10 years, there'll be some male contraceptive options. like a pill or injection or yeah i think it'll be uh it'll be like transdermal is how they're looking at and there's other again there's also other um male contraceptives that are in the pipeline as well it'll be make a lot of women happy that the men can take over the contraception

1:00:27Dr. Mark Hyman:yeah yeah and men too i think who who should we thinking about um giving hormone replacement therapy to in men because i i think that the selection criteria is not clear and a lot like i said a lot of young guys are using it for bodybuilding or for i don't know what and a lot And honestly, a lot of guys have low testosterone. We're seeing it in function health, you know, the demographics of people. And we're checking everybody for free testosterone, total testosterone. And it's like, wow, you're a younger population that's kind of got low T, we call it. Yeah. Yeah, I mean, I think that if you, you know, meet criteria, then I think it's reasonable to have this discussion with men.

1:01:03So you'd have to have a low serum testosterone. You know, again, it's going to vary from lab to lab, but generally probably less than 300 nanograms per deciliter. And then you do have to have some of these symptoms. And we talked about, you know, low energy, low sex drive, mood, sleep, concentration. They're somewhat vague, but those, you know, certainly can accompany low testosterone. So I think that's probably the right phenotype for who we want to have that discussion with. And then you need to, you know, understand where they are. If they're in their 30s and are thinking about having a kid in the next few years, I think you don't want to start testosterone.

1:01:30And there's, you know, other off-label options that we use like clomiphene for, yeah, it's like the estrogen receptor modulators, for example. that can increase your body's own production of testosterone without, you know, the spermatogenesis effects. So I think it's, you know, again, a nuanced conversation. There's some peptides that people are using for this too, like the peptin and other ones that those are, yeah. Is there any comment about that? I think, well, it's, it's hard to get them. I think in some cases, um, I don't have experience with them in my practice. Yeah.

1:01:57Dr. Mark Hyman:I know guys who use them and they're like, yeah, this really works, you know, for increasing their sexual libido and function. and yeah i mean i think talking to other providers that do you know that do prescribe them they do have strong belief i just you know i guess i need to see more data and have you know better uh a good source to get them from for patients so you don't think it's dangerous for younger guys if you're not as concerned about fertility to to actually take testosterone well i think again we want to make sure that they are truly low so you know two serum testosterone before nine in the morning because our levels do vary based on time of day.

1:02:32Again, it always makes me nervous for any reproductive age man because where a man is, you know, when he's 20 or 30, it may not be where he is. You know, he may not have met his life partner yet. So there's lots of things that can change. So, I mean, I think you can talk about sperm cryopreservation in those cases, you know, if you're worried about that. And if you come off it, does your testosterone will naturally rise again and have more sperm production or is it a... Usually men do recover, but not always. And I think the data on men that are on it for longer term, you know, most of the data we have on recovery are in these contraceptive trials where men were on testosterone for, yeah, and stopped it.

1:03:03And these are very controlled environment. It was a very short duration. So that was, you know, about a year. So if we have men on it for two years, five years, 10 years, you know, we do worry about it to some extent. Cause when we look at like the bodybuilder population, for example, we do have a signal that it may not be recoverable. Yeah. Interesting. It is a concern. They use other anabolic steroids, which are a little different.

1:03:23Dr. Mark Hyman:Yeah. The testosterone replacement therapy is interesting because, you know, what i found is when i when i work with guys particularly younger guys and anybody before i even think about testosterone replacement i'm like okay let's look at all the things that are affecting your testosterone your diet exercise sleep stress you know supplements let's let's see what we can do and it's amazing when when guys change your diet they get off the sugar and starch they lose the belly fat they start lifting weights which you know heavier weights and and lower body particularly big muscle groups, increase growth hormone and testosterone levels naturally.

1:04:00Dr. Mark Hyman:You know, getting in the sun, meditating, taking the right supplements. These things can be profoundly effective. And I've seen dramatic increases in testosterone levels when people get healthy. So it's one thing to say, okay, you're unhealthy, let's just give you testosterone. But I never start there. I'm only like, well, let's start with just see what happens when you stop living a shitty lifestyle, right? Yeah. I think that's the art of medicine, right? I think that sometimes your discussion is going to vary a little based on what you think is going on. And, you know, again, if you're, you know, a little more nervous about starting a man on testosterone, you know, again, in his twenties or thirties versus his, you know, fifties or sixties, I think it's a very different discussion and you talk about risks a little bit differently.

1:04:40And so, yeah, I mean, to your point, I think if you can find some things to correct and optimize and try and talk about, you know, some of the downsides of being on it, because once you start it, it's very hard to stop, right? You're going to be on it forever. Yeah.

1:04:51Dr. Mark Hyman:I mean, you know, menopause is something that gets talked about and not studied enough, obviously, but it's something that at least people know about. Yeah. Menopause happens to women, but most people don't understand this phenomenon of andropause. Yeah. Which is sort of a slower, more insidious decline. And that often results in, in men having, you know, low muscle mass and increased metabolic issues, lower motivation, you know, kind of just more dwindle. I call it the dwindles, you know? Yeah. And it seems to me that, you know, for older guys, I find it so helpful. Do you think it's something that should be used more as a sort of a therapy, just like women are taking hormone placement therapy?

1:05:33Yeah, I think there's a lot of barriers to testosterone therapy. And, you know, the FDA just had a hearing on this, you know, championed by Dr. Brian Christine, who's actually a sexual medicine or reproductive urologist that's now number two in HHS. So it's great that he's sort of being an advocate for men's health. And so that was one of the topics that came up, who should get testosterone. And I think this hypogonadism of aging is really kind of disregarded and it's often not covered by insurance companies. That's a big word. What does that mean, hypogonadism? Oh, it's basically where your gonads aren't working.

1:06:03So your low testosterone, it's also used for low sperm counts as well. But again, you know, as we age, our testosterone levels do go down, probably starting around age 20, 25, testosterone goes down about 1 % every year. So, you know, we have to reset, I guess, what's normal to some extent, but, you know, testosterone still does what it does. And so you do want kind of normal levels. And so, you know, in some ways, it'd be nice to have a baseline to understand where a man was at his peak. So when you're looking at them, you know, decades later, you can see kind of what target is. Cause again, the, we talk about the normal range as being fairly wide, 300 to 900.

1:06:34So it's hard to know if 300 is normal and that's where you were always, or whether it used to be at 900, now you're 300 so it's a much different deal in terms of what your body needs for again energy level sex drive muscle mass bone health all those sorts of things so i think that's you know one thing i think that could be done um to improve prescriptions if we look a little bit more broadly at who's getting it the other thing is that testosterone is regulated uh like oxycontin

1:06:58Dr. Mark Hyman:for example so it's yes it's a schedule it's yeah so it's very difficult to prescribe you have to go through a central database and you know make sure that men aren't getting it from other places and And so that's just a barrier. And you also, I don't find it that hard. I just said, put the prescription. I said, I put in my special secret DEA code and you know, but it's, it's another step. It's another step. Yeah. And then men also can't get as much, like you can't give them, you know, like month and month, you know, like several months supply. Cause they really restrict how much is administered.

1:07:25Yeah. So I think all those things, I think will help with, um, access to testosterone.

1:07:29Dr. Mark Hyman:And it's interesting. Cause you know, uh, you, you, you have other biomarkers that are matter, like the free free testosterone and the six hormone binding globulin, which regulates what levels of free hormone there are that does the work in your body. And they can be really off, you know, so you can have a high testosterone, but also a low free testosterone. You can have a low testosterone, high free testosterone. I've seen the whole gamut and the sex hormone binding globulin can be elevated. That can be from inflammation, other factors. So all those things play a role in trying to assess what's going on with somebody.

1:08:00So getting the right test is really important. Yeah, I think that's absolutely right. I think that, you know for everybody it may be a little different what exactly what you're looking at you know some men like right the um systolic blood pressure may be at risk some diastolic so i think looking you know very comprehensively you know hormone panel i think is important too and you know also adding you know prolactin like you talked about estradiol like he talked about all those things i think are going to be really crucial luteinizing hormone to understand a little bit more about production of testosterone and understand why levels you know aren't where they're supposed to be it's really it's really important to kind of monitor those things like

1:08:33Dr. Mark Hyman:most men don't get their estrogen levels checked right yeah like estrogen that's a female hormone what the the one we check is estradiol with estrogen is there's no such thing as estrogen they're estrogens and they're different ones but estradiol is the main one and what happens is is men often who have extra belly fat or body fat will convert testosterone into estradiol yeah and so they'll end up having feminization features they'll lose their body hair they'll get soft skin and they'll get breasts. Yeah, exactly. Like we call gynecomastia where men get breasts, and you've seen that. The classic beer belly guy, that's all from estrogenic effects.

1:09:14Dr. Mark Hyman:And you can measure it. And I think we're sort of shocked to see, I think 14 % of the men we're testing have relatively high estrogen levels. And I was like, wow. So all these sort of environmental things and dietary things are all affecting us. And there are things we have some measure of control over and can be empowered about, but most of us are walking around blind and have no clue. And again, that's why I co-founded Function Health, which is to give people access to their data because the average doctor is not checking these things. You go for your checkup and they're just, if they see you, they'll check it, but you're like a Stanford professor who has been studying papers every day all night long for the last 30 years.

1:09:58Dr. Mark Hyman:So you're very aware, but like it's just the unfortunate thing is that people aren't getting you know the most sophisticated care and the answers to their questions and they may be walking around with all sorts of issues that they don't know about related to both you know their fertility issues their hormone issues um the quality of your life and this is such an important part of you know our future generations and i i'm kind of worried about us as a species as i see you know the the you mentioned epigenetics for those who don't really know what that is essentially you've got you know 20 000 genes you but you you know you've got um to determine which genes are turned on or off or expressed they're not all switched on yeah and the epigenome is sort of like the piano player above the genes that controls which songs get played in your book of life or when you're whatever whatever and so you kind of have to to determine how to regulate those and the epigenetics is influenced by everything we do we call the exposome which is our diet exercise sleep stress toxins our thoughts, our feelings, relationships, our microbiome, pretty much everything you can think of is influencing our epigenome, which in some ways is actually getting worse and worse.

1:11:10Dr. Mark Hyman:And so we now know that if you're in utero and you're exposed to toxins or stress or other things, that that has a huge impact on the development of the fetus and its later history, health history. um so can you talk a little bit more about you know the sort of understanding of how the epigenetics is affecting our reproductive health and fertility and all these other things so I think you know I'm really wondering about how that plays a role so I think that's you know a potentially a real opportunity for us to try and improve reproductive health so even beyond you know sperm counts we've talked about a lot you know there's sort of a deeper level a deeper layer here and so for For example, you know, if a man smokes or if a man's obese, that's not going to change the DNA, you know, actually the base pairs, you know, all the different molecules, but it will change the epigenetics, sort of the expression.

1:12:04And so our body sort of reacts to this. It says, you know, now I'm in an environment where there's smoke, so I need to get more of this particular, you know, gene and less of this gene. Or if I'm obese, you know, that means there's more food abundance, so I need to turn this on, this off. And so that then is basically hardwired into the DNA. And so the sperm that we're making, you know, have that belief about this is how the environment is. And so then the child that's conceived has those same changes. And these changes really affect everything. You know, we've seen this in, for example, mouse data, too.

1:12:37If you have starved mice or, you know, obese mice, and then they have offspring, you see these metabolic derangements in the children. We see this in people too, you know, men that smoke, men that are obese. We can measure these metabolic changes in their children. So I think these are things that are, you know, very powerful and really proliferate, you know, beyond just us, you know, again, if we think, you know, I have enough sperm, everything's okay. There really could be effects. And obviously you want to, you know, give your child the best possible chance and, you know, optimize everything.

1:13:06I think people are talking about different ways to select the best embryo. Well, this is sort of a good way to make sure that your embryo pool is even better as if you try and maximize and optimize health as much as possible. So all these things, you know, diet we've talked about, but just making sure that you're as healthy as you can be. I think those are really powerful influences.

1:13:23Dr. Mark Hyman:Yeah. It's important. I mean, so, you know, you kind of kind of start thinking about all this early on if people just don't, and most pregnancies are just sort of like not, not thoughtfully, uh, you know, curated in the sense that, you know, you're not, you're not doing all the things you need to do before you actually conceive to make sure you have as healthy baby as possible. Yeah. All right, I want to end by a few rapid fire questions about, is this bad for your sperm or not? We've touched on some of them, but cell phones in your pocket, yes or no? I think it's probably okay. Probably okay, but in the back pocket.

1:13:56Dr. Mark Hyman:Back pocket probably a little bit, yeah. What about boxers or briefs? This has been, yeah, it's a very common question. I think it's unlikely any one clothing layer is going to make a big difference, but we do want, you know, I guess as much breathability as possible. So usually I just tell patients whatever's comfortable. No, this is all sauna hot tub crazy. Like, is this bad for guys? I mean, should we like not do saunas or just like bringing in like an ice pack on our balls? I haven't seen good data that ice pack is going to necessarily mitigate that risk, but heat definitely is bad. So I think while you're trying to conceive, you know, again, it takes two to three months to make a sperm.

1:14:30So if that's something you're actively trying to do, I think it's probably best to stay away from the sauna.

1:14:34Dr. Mark Hyman:Stop saunas for 90 days before you want to have a baby. Okay. How about laptops? You mentioned, yeah, you're worried about, I'm worried about those. Yeah, it's better to put it on a desk. Put it on a desk. Okay. What about time of year? Does that matter? They're interesting. There is some variation based on time of year. So turning the cooler months, you know, winter, fall, sperm counts can actually improve about 10 to 15%. So we do see those changes, again, on a population level. But, you know, again, I think whenever, it's never a right time to have a child. So I wouldn't tell couples to wait necessarily, but we do see changes.

1:15:04Dr. Mark Hyman:A lot of guys are into cycling, me included. is it bad for your sexual health and erectile dysfunction or fertility or both? It could affect both. I mean, I always say anything that's good for your heart, it's going to be good for sexual function and reproductive function. Yeah. But there have been some studies that suggest there could be some issues. So I think for men that ride over five hours a week, there have been some decreases in semen quality. So again, why that is maybe it's due to heat. You know, again, you're kind of compressed and obviously you're generating a lot of heat. That's those tight spandex bike shorts.

1:15:36That's right. Yeah, they may look nice, but yeah, they're not all good. So I usually tell men to try and stand up out of the saddle to try and, you know, get some circulation. I think that could be beneficial. And there is some data that, you know, the saddle design can actually impact blood flow to the penis. And so there are certainly men that come in to tell me about numbness, pain. It doesn't affect everybody, but maybe about 20 % of men report this, and there is a higher risk of dysfunction. Because, you know, we put our weight, especially when we lean forward in a saddle, it compresses against kind of our sit bones, the ischial tuberosity.

1:16:07and the main nerve and artery to the penis are sit right there so they can get compressed. And usually when you, you know, kind of sit up, blood flow restores, but if you're pushing too much, it can lead to, you know, more permanent damage. So there are different, you know, saddles that can try and mitigate that risk. Again, standing up can help. We work with a company called V-Seat that has a noseless saddle design that can help with that too. So - V-Seat? V-Seat, V-S-E-A-T. Oh, wow, V-Seat. I'm going to check that out.

1:16:33Dr. Mark Hyman:Yeah, for sure. Yeah, because I like to ride bikes. that it definitely I worry about it. How about being sedentary? Is that tech sperm quality? Yeah. So I think, you know, activity is definitely beneficial. So like there've been studies looking at like hours watching TV, hours sitting around, and it's certainly not good. So I think that, you know, being active, you know, getting exercise. Get out of the sun and go for a run. That can be beneficial, yeah. And alcohol, we didn't talk about that, but that's another toxin. How does that affect sperm health? So I think in moderation, it tends to be okay.

1:17:01I think that, you know, the one study that does support damage to sperm quality is probably about 20 drinks a week, which is a lot, you know, about three a day. So if you're at that level, I think that they're alcoholic.

1:17:14Dr. Mark Hyman:There may be some other things. Interestingly, there are also probably some men that are more genetically susceptible to alcohol. So there's a condition called like flushing, like alcohol flushing syndrome. How do Asians get it? They get really red in the face. East Asians, exactly. They have a gene that is the alcohol dehydrogenase gene. Exactly right. Yeah. So in some populations, it's about 50 percent. In Taiwan, about 50 percent. Mainland China, it's about 30 to 40 percent. So if you have that mutation and you're more susceptible and basically what that does is that when you're metabolizing alcohol, you know, eventually you get this accumulation of acid aldehyde, which is a toxin.

1:17:49And so that's why you flush. That's why sometimes people get sick with it, but it can also damage sperm quality. So we've seen significant declines in sperm motility or movement, you know, around alcohol drinking. So if you're susceptible to that, it's probably a good idea to avoid it. And we talked a little bit about sleep, but that also can affect fertility if you don't sleep enough. Exactly. Yeah. Seven to nine hours, I think, is a sweet spot. And stress we talked about. Yeah. I mean, it's easier to say less stress, but again, I think you have some good techniques to try and cut it down.

1:18:18Dr. Mark Hyman:Yeah, I think most people don't realize that, you know, stress comes unbidden and, you know, automatically, whereas relaxation is something you have to work at. Yeah. It's like you have to meditate or do breath work or basically, uh, I do this thing called yoga Nidra and Andrew Huber calls it non sleeve deep breaths, but essentially it's an ancient techniques of just going through a body scan and using your breath and going into a state of deep parasympathetic activation, which really, really helped with so many aspects of your health, but even sperm count. Amazing. Michael. Well, so where can people learn more about your research and your work and, and you?

1:18:56Yeah.

1:18:56Dr. Mark Hyman:eisenberg lab at stanford so they can just uh look that up on the internet and and and what about this swim club oh swim club yeah so swim club.co uh there's a lot of information um there's a lot of testimonials it's and you can learn a little bit more about the product and and is this something that all men should take or is this just men who are trying to conceive or is this just a general help for testosterone or well i think you know you i think you know and you've taught people a lot i think a lot of these same supplements can also help overall health, metabolic health. So I think it's not unreasonable to think about that, but right now we're focused on reproductive men, or sorry, men that are trying to have children.

1:19:32Dr. Mark Hyman:Are you having a book coming out in time soon? Not yet. I've heard a book about this. You've been very, yeah. You really inspired me. So maybe. Yeah. Well, thank you so much, Michael, for your work, for being a pioneer in this field, for talking about difficult subjects, for bringing things to awareness that, you know, are honestly not talked about a lot in medicine, like our environmental toxin reload, now that's affecting us and changes in sort of men's sexual health. So great conversation. Thanks for coming all the way to Austin and hopefully see you at Stanford sometime. I appreciate it. Thank you.

1:20:03Dr. Mark Hyman:If you or someone you love is thinking about fertility, whether you're just starting to ask questions or navigating challenges or preparing your body for pregnancy, I want you to know you're not alone. And this year we're launching something new for our community called the Ultra Learning Series, where you can connect directly with my team at the Ultra Wellness Center for deep, practical conversations that make functional medicine simple and actionable. Now, our first workshop is Functional Fertility. It's happening Thursday, February 12th at 12 p.m. Eastern time. Dr. Cindy Guy, who I worked with for, I don't know, 30 years now, a long time, and Lisa Drayton, my nutritionist, will walk you through what really influences fertility from hormones and inflammation to nutrition, environmental exposures, and whole body health for both partners, because yes, it takes two.

1:20:49Dr. Mark Hyman:This is a compassionate and it's evidence-based conversation designed to give you clarity, confidence, and real tools, no matter where you are in your fertility journey. You're going to find the link in the show notes, or just head over to Ultra Wellness Center on Instagram, at Ultra Wellness Center, and you'll find out everything you need to know, and I really hope you'll join us. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Dr. Mark Hyman. Please reach out. I'd love to hear your comments and questions.

1:21:17Dr. Mark Hyman:Don't forget to rate, review, and subscribe to The Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health, where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional.

1:21:52Dr. Mark Hyman:This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at ultrawellnesscenter.com and request to become a patient. It's important to have someone in your corner who is a trained, licensed healthcare practitioner and can help you make changes, especially when it comes to your health. This podcast is free as part of my mission to bring practical ways of improving health to the public.

1:22:23Dr. Mark Hyman:So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.