Sperm Health 101: THC, Toxins, and the Path to Better Fertility

0:00This is an iHeart Podcast. Guaranteed human. Eczema is unpredictable, but you can flare less with Epglyss, a once-monthly treatment for moderate to severe eczema. After an initial four-month or longer dosing phase, about 4 in 10 people taking Epglyss achieved itch relief and clear or almost clear skin at 16 weeks. And most of those people maintain skin that's still more clear at one year with monthly dosing. EbGliss, Librikizumab, LBKZ, a 250 milligram per two milliliter injection is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema, also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies.

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3:55Hey, everybody. Welcome back to the mailroom with Dr. Jesse Mills. I am Dr. Jesse Mills, your host. I am so excited, so excited to be joined by our expert of the day, Dr. Jasper Bash. I've known Dr. Bash for years. He is an accomplished urologist. He's an assistant professor of urology at the Oregon Health Sciences University in Portland, Oregon, where he also did medical school and residency. And then I was fortunate enough to poach him away to beautiful sunny Santa Monica for his fellowship at the David Geffen School of Medicine at UCLA in men's health, male reproductive medicine and surgery.

4:31And then Oregon was fortunate enough to steal him right back to the beautiful river town of Portland, Oregon, where he holds his current position as assistant professor of urology and soon to be named co-director of the men's health program at OHSU. One of the things you don't know about Dr. Bashan, if we're lucky, maybe we'll get him to hum a few bars, is he's actually also an accomplished a cappella musician. He was in a band, a tenor for the band The Testoster Tones. And they actually had a hit album, still available on iTunes, The Mendorphins. So this guy not only is a talented musician, but he eats, breathes, lives, and sleeps testosterone own and actually even sings about it.

5:13So it's so great to have you on board. Jordan is also joining us. Jordan is our producer and on-air personality that - And baritone. And baritone. That's right. And as I said, if we're going to do anything, all I'm going to do is snap because this raspy voice ain't good for much else other than carrying a bucket of water. Good to know where I stand. Yeah, I can't tell you how excited I am. I mean, You know, we met each other last in Grapevine, Texas at a men's health meeting, the Sexual Medicine Society of North America, where you moderated on one of the subjects and actually gave a talk on one of the subjects that we're going to talk about today.

5:50And I'm so excited that you committed to a couple of these shows. Today, what I'd like to discuss with you is what about sperm health and marijuana and environmental factors in general. Dr. Bash also did quite a bit of research as a resident in the effects of marijuana on primates. And so I think what I would want to do is just start our conversation just about, in general, what can we do to optimize sperm? And then also, what kind of toxins should we be worrying about in sperm health? And then kind of walk me through all of that. So just let her rip. Let's do this, and let's talk about it. Excellent.

6:28Let's talk sperm. Well, I think that there is a lot of hype in the media that we hear about, about declining sperm counts worldwide. And depending on who you talk to in the sperm community, they may or may not agree with that. But it is bringing a lot of interest in people to what's happening with sperm counts and what can we do to keep our sperm healthy. The nice thing is, for most people, it's pretty simple. A healthy body produces healthy sperm. And so anything that you can do for your overall health in general is going to help your sperm health. I think when we are thinking about from a men's health urologist perspective, we're thinking about hormone levels and how the brain is talking to the testicles and what they're making of those signals.

7:07In terms of someone who just thinks, what can I do for my own sperm and keeping them healthy, maintaining a healthy weight, a healthy diet, being active and getting good sleep, these are all things that will help make good sperm. In terms of exposures, when I think of kind of the three horsemen of exposures to sperm being tobacco, alcohol, or marijuana, it'll be kind of no surprise to anyone that none of those things are great for your sperm health. And there's certainly a negative synergy that can happen when you start mixing them. Yes. Well, so that brings up kind of a classic other point is how much is too much?

7:43Or in other words, you know, I'm a child of Woodstock and I'm still here. And I don't know exactly what my parents did, but somehow I actually can tell you they weren't at Woodstock because they were in Russia. But I will say that it touched far. That's right. I don't think anything got beyond the Iron Curtain except for a couple of bootlegs, CSN and Y albums. I think Neil Young is still big over there. On X-rays, I believe. That's right. Exactly right. Yeah. So, you know, I guess that's the thing is that is there such a thing as moderation? if a guy's out there listening today and you say, look, dude, this is too much.

8:19Like you, you got to stop all cigarettes, all alcohol, all marijuana. A, how do you get somebody to comply with that? And B, how important is that? Give me some thresholds of what is okay. Yeah. You know, there's been a lot of public health work around alcohol and pregnancy. And so that has much clearer messaging. We say, we really don't want women who are pregnant to be drinking a lot during pregnancy, if at all. And there may be some changes to that. But for the most part, that's pretty clear. When it comes to thinking about sperm health, we have great data which show us that there is a dose response with the sperm and the exposure.

8:57Meaning the more, let's say, THC that you consume, the greater the effect on the sperm. And that works in the opposite direction too. So if people say, you know, I'm not going to stop consuming cannabis completely, while I'm thinking about pregnancy, that's okay. If we can reduce your dose, you're still going to make gains in terms of having a healthier sperm. Another thing to think about is that as a men's health guy and a fertility guy, I usually am seeing guys when they're actively thinking, I might want to make a baby pretty soon. This is a very specific time of life, and it is a self-contained time.

9:31And so thinking that sperm take about three months to make, anything we do will take three months to show up with our sperm. And so if you're thinking, I might want a baby in the next six months, tapering or going off of whatever exposures you're having, then having a nice healthy sperm to make a healthy baby. And then afterwards thinking, how am I going to either be re-exposed or change my lifestyle after that? So a very short window to think about. This doesn't have to be necessarily forever change. Okay. I think we want to get into the marijuana thing, but you brought up something interesting.

10:04we were at that meeting a couple of years ago in Denver where there was some research presented on the effects of alcohol on genomic effects on fetuses. And for a while, you know, really, since we were in medical school, right, we always hear about fetal alcohol syndrome where alcohol exposure on the female side is terrible. But yeah, there's some compelling data to show that even small alcohol exposure on the male side is bad for sperm and the epigenetic. Tell me what you remember from that as well. I hate to put you on the spot, but you just kind of really triggered something in me that I think our listeners should know that alcohol also really bad for sperm genomics.

10:46It may be as bad as it is for ovarian function and egg production as well. Yeah, you know, this is the problem with science is that the closer the look, the more you find out and the more you have to worry about. We see it time and time again. In terms of alcohol, just like you said, it used to be all about the female partner. Who's making the eggs? What's happening in there? We did find out that there were epigenetic changes that happened with alcohol. And so I think it'll come as no surprise to the listeners that moderate alcohol intake in the partner is really important. We see very similar effects with THC.

11:21So if we look at the actual DNA of the sperm and changes that are made to the DNA, we notice there are changes, and I don't want to sound too inflammatory here, but we have seen changes in genes related to autism spectrum disorder with THC exposure, which brings up a whole host of questions. We also see changes in the proteins in the ejaculate. So the proteins that are surrounding the sperm change with THC exposure and then change back towards being normal with reducing or removing that exposure. So there are certainly possibly generational changes that can happen here more than just what meets the eye, what number of sperm you have that we're seeing both with alcohol, with THC, I presume with nicotine, though I can't remember that off the top of my head.

12:07Yeah. So no booze is good booze and no weed is probably good weed, but you hit on a, obviously something that's quite a hot, maybe politically motivated target. And we try not to get too political on the show. So we'll, we'll maybe ignore what the elephant in the room is when we talk about autism. I'll follow your lead then. But I do think it's, I think we all know what we're talking about. But you have actually really good data that THC use, which I think we can all agree has skyrocketed in this country, has actually pretty good evidence that it may contribute to autism spectrum disorder. Yeah, I would say that we have a definite signal that these things could be related.

12:50And you're exactly right. The availability of cannabis products has far outpaced our understanding of them scientifically, right? In 2019, there were more cannabis dispensaries per capita in Portland than there were Starbucks or McDonald's, which is shocking, right? Seattle still had more Starbucks because it reigned supreme there, but similar things in Denver. And so we've definitely, the legal changes and the availability has way outpaced our scientific understanding, which we're now doing a pretty good job catching up on.

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14:26Also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBCLIS can be used with or without topical corticosteroids. Don't use if you're allergic to EBCLIS. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EBCLIS. Before starting EBCLIS, tell your doctor if you have a parasitic infection. Ask your doctor about EBCLIS and visit ebglis.lily.com or call 1-800-LILY-RX or 1-800-545-5979.

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17:10let's get into the weeds here if we will uh and let's say right there yes right you're already in the weeds but uh how did you get to these data tell me why what you're sharing with me Let's talk monkey business, Jasper. Yeah, yeah, let's get into the monkeys. So marijuana research is quite challenging for a couple of reasons. One of them is that a lot of our older literature that we would go to as kind of the groundwork is using marijuana products that have no bearing on current consumption, right? The amount of THC in the average cannabis product now has increased about threefold in the last two decades.

17:50So this is not your grandmother's marijuana. This is not your mother's marijuana. This is a whole new thing. This is double-dank diesel. Ultra-dank, very loud. So when we're talking about these products, then we do things like concentrates or edibles where the THC levels are way higher. And so it's hard to use older data. So now we think we need new data. Very hard to study this in people. You know, there have been studies in dispensaries just going around, hey, how are your erections on marijuana? That's not a great way to get information, right? And you'll hear reports of people saying, my sexuality, sex life is much better with marijuana.

18:25And then you'll also have reports that say, it's way worse with marijuana. So trying to use people for this is very hard. The best setup you could do would be, let's take a group of guys who have had no use of cannabis. Let's put them all on heavy doses every day for a year. And let's see what happens to their sperm count. Very hard to find that population. We can do that in an animal model. We can take animals, we can give them a little cookie with THC on it every day, and we can see what happens to their sperm count, their testicle size, their testosterone levels. And we did that. So we have an incredible group here in Oregon who does amazing research, and we did this on a primate model.

19:08It's a pretty good setup, getting a THC cookie every morning and then having your sperm examined every few months. And we found some pretty remarkable stuff that I'd be happy to share. we saw that as these very lifelike, in terms of similar to human dosing, doses of marijuana are given, testicles are shrinking. And they shrank by about 50%. So that's something that's pretty easy for guys to wrap their minds and their hands around, right? So 50 % loss of testicular volume. We saw those changes we talked about with the sperm DNA. So concerning changes for sperm DNA and with the proteins in the fluid around it.

19:46These animals have way higher sperm counts than humans do. And so it's a little harder to compare them to humans. But we did, the most interesting thing I think is that once we took the THC exposure away and we had a washout period, testicle volume expanded, testosterone and estrogen levels, those main hormones we think about fertility went back towards normal. The DNA changes back towards normal. And I think that's very powerful. So when I talk to guys in clinic who are using high doses daily THC, I say, you know, all is not lost. We've still got time to decrease or stop that exposure and get your sperm healthier again.

20:25So how, I'm not trying to ask this in a very tactful way, but there's somebody out there that's going to ask, how did you actually study the monkey sperm? How did that happen? Were you getting up pretty early in the morning and putting on a PCR of primate porn? Or how do you get monkey sperm to study? Do you want me to ask? Is it better coming from me? That's true. I don't have a medical license. Tell us, how do you get a sperm sample out to study? And what are the pitfalls associated with that? Yeah, well, the hardest part is actually getting there to the monkeys before they do it themselves.

21:06And so the first thing to do when you show up is look around the cage and look in their palms and make sure they haven't already taken care of business for the day. So there's wake and bake and wake and shake is what you're saying. Yes. May they cohabitate beautifully. Johnny Carson golf swing. There you go. And so if that hasn't occurred, then we're able to do is they're able to sit in a little chair that we train them to sit in. And then we're able to do a stimulation that creates a reflex arc that has them ejaculate. So we're able to do this. Doesn't require any sedation. They're trained on how to do this.

21:41Again, it's all about getting there before they do. The early bird gets something at least. Okay. Well, so essentially what I'm hearing is that cannabis, really not good, but it's reversible. So walk me through, you kind of gave us a little bit of a clinical scenario. But say I'm a 30-year-old guy and my female partner is 28. And she is a teetotaler, doesn't do anything. But I am a habitual cannabis user. And we really want to have a baby. Do you think we just pull the goalie and go for it? or something I should do to pregame at 30, how long is it going to take for me to wash out? Or should I?

22:28Or should I just take the Woodstock approach and see what happens? Well, I would say that if your partner is on the younger side, to 28 being quite young when it comes to fertility, I'd say that even though often couples want a baby yesterday, there's time here. And so I think that the prudent thing to do would be to stop using cannabis if possible. stop that we know again sperm take three months to grow i would say six months we don't really have clear data on exactly when effects will be gone i think six months would be a very reasonable time to say we've had two cycles of sperm being produced six months would be a great time to start thinking about having trying for a baby after stopping or at least really reducing cannabis intake and is there anything else you do because you mentioned that uh in your primate experiments that not only the testicular volume go down 50%, but there are some hormonal changes as well.

23:25Is there anything that you would do on a routine basis? I mean, I assume you're screening for testosterone, FSH, you know, the sperm production hormone. Have you noticed, or do you have enough data to show whether doing some kind of hormonal modulation will help kickstart that? Like, for For example, we're going to talk about testosterone recovery as well for sperm production. But with marijuana exposure, THC exposure, do you do any kind of boost protocols to get these guys up and optimized sooner? Talk to me about that. Yeah, absolutely. When I see a guy in clinic for fertility, no matter if he says, oh, I've had chemotherapy exposure, I've had THC exposure, no matter what, he's getting the full meal deal in terms of workup.

24:11So I'm looking at his testosterone and estrogen. I'm looking at the signals from his brain, LH and FSH. They're talking to his testicles. A physical exam looking for things that might be causing issues. And then a semen analysis. For a guy with THC, our research shows that the issues are both in the pituitary in the brain as well as in the testicle. So you're often, there are perturbations or issues in both spots. if a man has low signals from the spituitary i will often reach for a medication like clomiphene or clomid that can boost those signals tell the testicles hey time to do something wake up a little bit faster so i'll use a very similar testosterone recovery protocol as i would to other exposures that'll decrease testosterone to try to get things going get sperm numbers up quickly great and i assume you get a baseline semen analysis see where the guy's starting at.

25:04Do you routinely, and this is really wonky, but for people that are super granular, do you routinely look at DNA fragmentation indices in guys when you're doing that screening semen analysis? Because I think you also mentioned that a little bit in your primate studies that the DFI, or at least their DNA mutations, which a little bit different than just doing a screening DFI, but is there a utility in that as well? Yeah. So DNA fragmentation index, somewhat of a new test looking at double-stranded breaks in the DNA of the sperm. We think about that in terms of overall quality of sperm DNA, and we know that thankfully the egg can make up for a lot of issues with the sperm, as partners do later on in life.

25:46But if there's too many breaks in the DNA, we know that those can overwhelm the egg's ability to repair them. I don't routinely check that on patients who are using THC because, number one, there's a lot of vary between different laboratories and how they report that number. Number two, there's not a direct connection. And I like to tell guys, if there's something obvious that we can fix, let's fix that first. And then if there are still problems, we can look for DNA fragmentation and look at that. So if there's something obvious like THC exposure, I say, let's just fix that now. We know that's a good thing for fertility.