How Often Should Guys Go to the Doctor?

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1:54At Rasmussen University, we find ways to remove barriers, not build them. Like a new laptop if you're eligible and enroll in select online or on-campus programs. That means flexible and engaging online courses and resources, tuition savings options if you qualify, exceptional student support, and much more. Online nationally or check out their 20 campuses across six states. Start when you're ready and get the support you need. Visit rasmussen.edu. Go on, get a little out there, into the big heart of Nevada, where you can go off-road and off the map, on two lakes or on horseback. Dip into hot springs and dive into deserts.

2:32Climb a mountain or make your best effort. See thousands of stars in some of the darkest skies. Stake out haunted hotels. Can you make it to sunrise? there's always something new to see because we've got plenty of space to just be. Plan your trip at travelnevada.com. When Kohler, global design leader in luxurious kitchen and bath products, asked me to be their ambassador for timeless, elegant, durable cast iron, I said, I'm in. Soon after, I was in their Kohler, Wisconsin foundry, watching molten iron poured, enamel applied by hand and the beautiful finished pieces ready to ship. Since 1883 Kohler cast iron has been crafted by incredible artisans and seeing it firsthand gave me a whole new appreciation for their craftsmanship.

3:22Now I'm proud to lend my stamp of approval to my favorite Kohler cast iron products for their durability, beauty, and enduring style. Shop my curated picks at Kohler.com. As the Kohler Cast Iron Ambassador, I say, long live Cast Iron. Let's talk about it. Let's talk about it in the mailroom. Let's talk about it. Let's talk about it in the mailroom. Welcome to the mailroom. Hey, everybody. Dr. Jesse Mills here. Welcome to The Mailroom, the podcast where we are going to discuss all things about guys and the people that love those guys and how to make those guys even better than they already are.

4:12So excited that you're part of this podcast. I want you to feel the enthusiasm that I feel every time I come to work in the morning and treat an exam room full of guys. Try to get them educated about their own healthcare literacy. Try to separate the hype. Try to separate the science. The world of men's health is this crazy mixed up place where all kinds of therapies have been put out there that may make sense, may not make sense. Some things that you think are completely wacky actually have scientific evidence. And so over the course of these episodes, what I want to do is I want to get to know you and I want you to get to know me and how I look at things.

4:50And I'm a very practical guy. I went to medical school, the University of Iowa, which is one of the phenomenal top research institutions. but it still is a good rooted midwestern experience where we try to teach common sense after finishing medical school at iowa i trained in general surgery and urology at the university of colorado doing everything from taking out appendices to major prostate cancer surgeries and that's when i developed the niche in men's health and male reproductive surgery and so for that training i went down to to baylor college of medicine and and studied with a legend in the field, Larry Lipscholz, who's still very active today.

5:28He taught me the nuances of microsurgery as well as hormone therapy and management. And after doing that, I established one of the first comprehensive men's clinics in the state of Colorado. And then a big bucket of what I've developed is treating sexual dysfunction, especially problems with erections, how it pertains back to cardiovascular health and overall men's health, and then a condition called Peyronie's disease. It's a very nuanced condition that affects millions of guys in that they develop scar tissue in the penis that causes them to not be able to have normal penetrative intercourse anymore.

6:03And after doing that in Denver for about eight years, I was thrilled to have the opportunity to be recruited back to UCLA where I did my undergraduate research and start the men's clinic at UCLA Health, which is now celebrating its 10th year of open treatment to men coming from all different backgrounds, all different issues that affect their reproductive health, their hormonal health, and their sexual health. And now I would say on an annual basis, we're seeing somewhere north of 20 ,000 men to help guys live their best lives and optimize their care. And we're going to learn and simulate what it is going to be like if you were in my office and I was taking care of you as if you were one of the thousands of guys I'm able to help.

6:48So that's it. The ground rules are none. We're just going to let this organically develop. We're going to bring in a bunch of guests that are going to have different perspectives than I do. And we're going to hash out how to make you the best possible guy you can be. It's going to be a day in the mailroom. And I'm super excited to be joined by my producer, Jordan Runtaw, who's going to be my on-air presence to keep me focused, to ask questions as if he were a patient himself, as if he were the guy in my waiting room I was going to see next. And Jordan, it's so great that you bring a wealth of recording experience here.

7:24But more important, you're going to be an active participant in this entire venture. I'm going to bounce ideas off you. I'm going to ask you what you think. And you're going to ask me what I think. And then we're going to do this as a comprehensive look at men's health. So that's what we're here for. But thanks again, Jordan. It's going to be a blast. Oh, I'm so excited for this. It's going to be great. Thanks for having me. But, you know, as we kind of were talking about all the logistics about how to set this up and what it entails, I realized I don't really know that much about who you are, what are you doing, and what are you looking for out of this podcast other than just a couple of guys talking and bringing on some really smart guests.

8:01I mean, I kind of view myself as the voice of the audience here as I just turned 37 and I've just started to hit the age where I think, oh, geez, I really got to start taking an active interest in my own health. Just selfishly, I'm so happy that I can be here and learn from you and maybe sort of pose some questions to you that I imagine a lot of listeners might have, too, that aren't as steeped in the knowledge and of the training that you have. Yeah, man, I don't want to harsh or mellow, but you're 37. You know, when did we start aging? Just come up with a number. Or when is it like, when is the start is?

8:32Is it 37? Is it, there's an actual scientific answer to this. So what do you think? When do you think we stop being young and we start to grow old from a molecular cellular mechanism? Well, doesn't the brain stop, the neuroplasticity begins to harden, I wanna say at age 26? Damn, bro. Yeah, you got some skills. Yeah. So that's about right. The first signs of senescence, which is kind of the scientific term for aging, the neurons start to sort of die off somewhere around 25, 26, which is, I'm sure, I'm sure that's what the rental car companies had in mind. You know, you can go to war at 18, you can drive when you're 16, you can drink when you're 21, but you can't rent a car till you're 25.

9:12They're waiting for that last stupid frontal impulsive neuron to die off before you could actually rent a car. But, but you're right. That's it. 25. And then in my world, in the world of urology, which encompasses is everything from kidney stones to prostates to sexual dysfunction in both men and women, we look at something called the endothelial cell, which lines everything from your coronary arteries to the heart arteries to the back of your eye, the retina to, in my world, the lining of the penis. And there's this amazing molecule called nitric oxide. And nitric oxide, it's the simplest, tiniest little molecule that won the Nobel Prize in around 1992.

9:52And we found that nitric oxide levels start to drop right around age 25 to 28. And that is the first sign of atherosclerosis, which is the hardening of the arteries. And so when we stop producing high levels of nitric oxide, that's when the wheels start to come off. The great thing is that so much of this arterial sclerosis and so much of this endothelial cell dysfunction, you can start to reverse that. And you actually can start to see levels of nitric oxide increase either through improved exercise, improved nutrition, or sometimes medications. We'll get into that. But yeah, we're going to figure out how to take a 37-year-old, how to take a 47, how to take an 87-year-old and figure out what that 87-year-old can do to reverse some of this degradation or this loss of nitric oxide.

10:43I mean, that's what it's all about is this very simple breakdown of what you can do in the kitchen, what you can do in the gym or outside, and then what you can do in the bedroom. And you can interpret that however you want. But mostly at this point, we'll talk about how you can sleep better. But then there are other things you can do in the bedroom that I'm sure our listeners will be interested in figuring out how to optimize as well. So it's going to be totally cool.

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13:05When it comes to advancing your education, you have more options than you think. At Rasmussen University, we find ways to remove barriers, not build them. Like a new laptop if you're eligible and enroll in select online or on-campus programs. That means flexible and engaging online courses and resources, tuition savings options if you qualify, exceptional student support, and much more. Online nationally or check out their 20 campuses across six states. Start when you're ready and get the support you need. Visit rasmussen.edu. Go on, get a little out there into the big heart of Nevada, where you can go off road and off the map on two lakes or on horseback.

13:44Dip into hot springs and dive into deserts, climb a mountain or make your best effort. See thousands of stars in some of the darkest skies. Stake out haunted hotels. Can you make it to sunrise? There's always something new to see because we've got plenty of space to just be. Plan your trip at TravelNevada.com.

14:19Very recently, earlier this year, I started going to the gym, seeing a trainer, started to talk to him more about nutrition and went to get my first checkup in a decade, which I am not very proud of, but also I know is an embarrassingly common thing among men. Yeah. As guys, the traditional narrative is that we don't go to the doctor unless we broke a bone and we've got some piece of our ear hanging off our face after a mountain lion attack or something. Depends which bone. That's right. And that's it. You know, really, when you look at the literature traditionally in medicine about how guys engage the physician, over 40 % of primary care visits for guys between the age of 18 and 60 is for something urologic, which means basically, you know, they can't pee, they can't have sex, or they have a kidney stone or something like that.

15:10And so actually, that's one of the reasons that drove me into urology as part of my creation story. When I got there, I realized how much I loved taking care of patients and having the dialogue, but also how much I loved the idea of being able to go into an operating room and fix a problem, put a couple stitches in the skin and send the guy home and make them better than they were before they started the operation was what drove me into this. And then when I learned also from all of my internal medicine and primary care rotations and working even in rural farming communities, how many men don't really have those touch points in how they engage the medical community and why it's not their fault.

15:48It's not our fault. I mean, maybe a little bit of is we have a pathologic level of stoicism where we're constantly playing through pain and we're constantly thinking, you know what? I mean, if it doesn't kill me, it makes me stronger. And that's kind of true because the human body is amazing at regenerating itself. So if we do break that bone and we kind of get the ends a little bit close together, it'll probably heal up okay. And you can get back on your tractor and make a living for your family. And you certainly don't want to take any time off work during the harvest or during planting season.

16:20And so all of those things together, you know, unless you really are in extremis, as we say in the medicine community or dying, then you don't go in. And so, yeah, you can go decades without a checkup. And maybe the other thing that drives men's health into existence is that we realized early on that women do have a built-in touchpoint on an annual basis with their primary care or their gynecologist in that they have to do, I don't know, cancer screening and particularly the pap smear. And often in this society, most of the birth control decisions are made by women since it seems to be they're the ones that carry the burden, whether they went to or not, you know, going in for their oral contraceptive pill renewals.

16:59And guys, we don't have that. Although we do have an oral contraceptive coming on the market for guys at some time in the not too distant future. That's a cliffhanger we'll come back to at some point. But yeah, I mean, that's it, is that if we don't have to go in on an annual basis, then you just chug along. You get your last high school physical when you're 18. And then, you know, you don't go back in to see a doctor until your appendix ruptures. And, you know, sometimes that's at 37. Sometimes it's at 27. Sometimes it's at 70. And so it's amazing. Even in my practice in urban Los Angeles, the number of guys that I see in their 60s that don't have a regular doctor is about 30%.

17:38So in other words, they've jumped through every single hoop to just get to a super subspecialist. And I start with the same conversation that we just started with you, which is, well, what got you here today? You know, so I'll ask you with that preamble is what was it that got you into your first checkup? Were you just chugging along and thinking, you know what, I'm starting to read a lot about things in the health sphere and I should probably be a little bit more informed? Or was it something that said, wow, man, you know, I've got this pain in my knee? No, for me, it was a little bit more, okay, that I think for a lot of people, the pandemic kind of threw off a lot of our routine.

18:15I, you know, instead of going into the office every day and moving around and being out in the world, sort of working from home, just a much more sedentary lifestyle than I really wanted. And I just finally was like, you know what, it's New Year's early in this year, just, you know, New Year's resolution kind of thing. Going to get back out there, going to go to the gym and really take this seriously. And then from there, you know, as anyone who starts to dig into the health sphere knows, it's such a rabbit hole. I mean, there's just so many different sections you go into. It becomes a full-time job if you let it.

18:45And yeah, I just thought, okay, well, a real baseline thing I should probably do is go to see a physician and see if there's anything that I should know about that I should keep an eye on or deal with, you know, God forbid. Luckily, I'm pretty much okay. But yeah, it was really trying to get back in the swing of things after a weird couple of years, which I think is something a lot of people can relate to. Yeah, no, I think you reminded me of a patient I saw maybe towards the tail end of, I mean, I don't even know where we are in this pandemic. It's still going around, I guess, but we'll call it, you know, the shutdown, the lockdown.

19:17And I saw him and he looked, even with his mask on, I could tell he just looked amazing. And I said, yeah, what's the deal? You know, I said, well, I realized early on in this deal that we have all this time and I could have either become a chunk, a drunk or a hunk. And I decided to become a hunk. and it always resonated with me because unfortunately I saw a lot of drunks during that time period too and a lot of chunks and it's easy oh well you know gym shut down you know I remember going to my gym in the early days with nitrile gloves on my hand and a mask and I was spraying hand sanitizer and everything and thinking somehow that was going to keep back the tide of uh you know I was going to single-handedly take on the pandemic and keep this gym open and within a couple more days that was it you know, we lost it all.

20:03They started refunding gym memberships and then trying to get weights online. That was, that was hilarious. You couldn't get anything. So, so no, I think that's, that's an interesting wake up call. And it's one that a lot of people, we went two ways on, we either went way in and said, no, this is great. I'm, you know, I'm not driving two hours a day at a commute. And especially in a city like Los Angeles, where the average commute, I'll make up a number, but it's probably somewhere about 45 minutes to an hour for most people that work anywhere within the Los Angeles area. So that's an hour to two hours a day that people had on their hands that they could be much more efficient.

20:42So I love that. I mean, terrible thing to go through as a world to get us a wake-up call. But I also think one other thing that is critical to our mission here with this podcast is you're saying that there's just massive information overload and so much of healthcare is being delivered by clickbait these days. And what I'm looking for, you know, as Led Zeppelin said a long time ago, a voice above the din, right? The din is every time you open your browser, if you click on anything health related, instead of getting, you know, another supplement or another, another apple cider vinegar cure, you know, let's get into this, right?

21:20Let's get into what works, what's worthless, and really make something out of our time together. So that's kind of the creation story for what we're doing here. I mean, as you mentioned, in the same way that the pandemic in a roundabout way brought me into the realm of health, it also delivered a whole lot of misinformation, probably more than I've ever seen in my lifetime in terms of different health things. So yeah, I think this is a very necessary mission now more than ever. Sure. Right. And I think it divided us. We all became armchair physicians and we all tried to consume the literature and make something out of it.

21:55And I think that's the other thing that we have an obligation as a health care community is to teach people a little bit about how to read a paper. You know, and I think that'll be fun. And not every paper is the same. Not every journal is the same. There's kind of this minefield in the medical literature that's been going on for the last, oh, 10 years at least of what we call pay-to-play journals, where let's say that I decided today, even though, you know, the whole point of our time together on the show is that I'm not going to sell you anything. But let's say I decided to. Let's say that I was feeling a little light in my wallet and I wanted to come up with a supplement.

22:30And this supplement is going to be amazing, Jordan. You're going to want this, right? Every day you take a Mills extract and I'm going to figure out exactly what do you want out of this drug. Well, I want to drop 20 pounds and I want to get the best erections I've had since I was 17. I want to be able to last as long as I can to please as many partners, one or many that I can. I want to get chiseled abs. And I want to always be happy. I want to wake up every day and I want to be happy. Is there a pill for that? Well, yeah, because I invented it. And it might look exactly like a green M &M. It might taste exactly like a green M &M.

23:11But I'm going to give you one of these a day. It'll come in 30. If you buy six months at a time, I'm going to give you a deal. It'll be$10 off a month. So we're going to come up with, I don't know, say 90 bucks for the first introductory six months of my pill. Well, how do I know this works? I mean, where is the literature? Is it scientifically proven? Well, of course, because I wrote a paper in the Journal of Supplement Research. It's incredibly well vetted. It's on PubMed. And I did a trial. Don't worry. You know, I know it looks kind of strange that I paid$3 ,000 to this Journal of Supplemental Research in order to get it published.

23:46But it is published and it's indexed on PubMed. So that actually happens. So a lot of the science that you think is science is coming from journals that are barely peer-reviewed that I'm paying cash to get published. So there's a lot of conflict of interest. We're gonna have a lot of shaggy dog stories, by the way. That's just the kind of the way that my brain works. But somehow maybe with editing, it'll make sense or maybe not, you just let her rip. But you go back to what you said about the misinformation. I get why there's a frustration because as a physician, I'm really specialized. I'm really good in the world of men's health.

24:21That's where I lecture. That's where I teach. That's where I publish. But if I have a rash on my knee, I don't know what to do about that. And if I Google rash on knee, and even with my level of education, I can still get sucked into that because dang, this thing itches and it's driving me crazy. And I can't wear pants because of this thing. And it's just amazing how quickly you can go into this clickbait sphere of just, well, you know, for 40 bucks, I can buy this topical cream and make this go away. So that's the crux of what we got to do here is we've got to arm people with enough knowledge of how to consume the knowledge that they're getting flooded with.

25:01And what I hope that we're going to get out of this is that you're probably going to be okay, that whatever we're talking about, you're probably going to be okay because the human body is so amazing. And we've had people that have lived to 100, you know, well before we even had antibiotics. And so some of this is going to be genes. Some of this is going to be common sense. Some of this is knowing what we already know, but we don't want to hear, which is that you probably shouldn't eat yourself into a Thanksgiving day coma seven days a week, five days a week. It'll be the opposite of cheat days.