Dr. Paul Turek (1:47)

Actually, I think it's just a subset of overall health. I think sex is part of health. Right. So if you lose your sex drive or you lose your erection or you can't conceive, those are all elements of health. And so something's wrong. It could be as simple as mental or emotional health is a problem or it could be physical health. So it's a deep reflection, it's a reflection of a deeper problem. If there's a problem, on the other hand, if it works really well, that's a good sign.

Podcast Host (2:20)

Yeah. Is it true that morning erections for men is a good sign of health?

Dr. Paul Turek (2:25)

Morning wood is excellent.

Podcast Host (2:27)

Yeah. Why is that?

Dr. Paul Turek (2:28)

Well, because it's an involuntary erection. So it's not something you want, it's something that happens Normally. Men have three one hour erections every Night. And the penis takes more energy to keep a penis flaccid than it does erect.

Podcast Host (2:43)

Why? Really?

Dr. Paul Turek (2:45)

Because the blood vessels are tight and it's energy. So the nighttime nocturnal erections, we call it, are the penis sighing and taking a breath of fresh air and relaxing. So Morningwood is a similar phenomenon. It's something that occurs with, you know, your bladder's full, you're totally relaxed. Right. You've been in a deep sleep, there's no stress going on. And so Morningwood is a sign of healthy erections. If someone has a trouble with erections during sex or on their own, but they have good morning erections, they probably are normal physiologically.

Podcast Host (3:17)

Oh, wow. Okay.

Dr. Paul Turek (3:18)

It's called morning wood.

Podcast Host (3:19)

Yes.

Dr. Paul Turek (3:19)

And it's very healthy.

Podcast Host (3:20)

It's very healthy. Yeah. I have. I mean, I don't know if there is a statistic on how many erections per day is healthy for a man or how many is a sign of good health, but you're saying that 3 overall in the evening is good.

Dr. Paul Turek (3:34)

During REM sleep, when you're not awake and you're in deep sleep, three half hour to one hour erections is absolutely normal. And in the 80s, like in court cases of rape cases and stuff, men would say, I couldn't because I'm impotent. And they would put stamps on their penis or devices and they check the evening erections or the nighttime erections. And if they'd be normal, they'd say, you're wrong. You don't, you know, you have normal erections. So it is a very valuable sign. And now there's devices you can get that connect to your phone that can assess that. So when I see young men and they say, you know, I lost my erection, I think I have a problem. We'll look at some things, hormones, their lifestyle, et cetera. But then I'll say, I want you to get this device and put it on and read it and give you the readout of it because they're getting better at it.

Podcast Host (4:22)

Look, we've just dived nose deep into this episode. I never thought the first sentence that I'd say on the opening of a podcast would be erection. So why don't we just give the audience just a very brief overview of what you do?

Dr. Paul Turek (4:36)

Oh, I'm called a reproductive urologist. So I started out as a surgeon in the field of urology, which is kidneys, bladder and stuff. And then I had a little bit of a gift of surgery in my hands so I could do microsurgery, which is more intense than regular surgery with a microscope. Then I got into men's sexual health. And because of that, you do vasectomies, reversals, and things like that that are really a lot of fun and all the small part surgery in men and urology does deal with women, but I have a strictly men's health practice. And then you also deal with the hormonal issues in men. So it's a lot of medical and there's a lot of surgical. And I was getting into that, and I realized the surgery's fun, but this is wide open. I mean, men's sexual health since what blew it open is the viagra era, right? 30 years ago, that started most of it. Bob Dole, they had a champion. There are no fertility champions, by the way. It's hard to get a champion in the world of fertility. And there's a very complex story there about how it goes after men's ego id, ego and superego to have a fertility problem, their manliness, et cetera. So it's a little bit behind, but erections blew that blew it open, and it became okay to talk about. And then really good science came out while I was a professor that your erections are the canary in the coal.

Podcast Host (5:55)

Mine for your heart vasodilation.

Dr. Paul Turek (5:58)

Right. So the little vessels in the penis are smaller than the heart. So if you have a major erection problem in your 40s, your chance of events, cardiovascular events, not just measurements, but strokes and heart attacks are double similar to a smoking history or a family history, same risk. And that brought in the whole field of the. Okay, so sexual health is a harbinger of overall health, and it predicts heart disease before. Before anything else, basically.

Podcast Host (6:31)

Oh, my gosh. It's so similar to something I only just found out about a month ago. Did you know? I mean, I'm not sure if you know this, but when a.

Louisa Nicola (6:40)

When.

Podcast Host (6:40)

When a female goes and gets a mammogram, obviously it comes back with, you know, benign cysts, whatever, what have you.

Louisa Nicola (6:47)

If you look deep within the weeds.

Podcast Host (6:48)

Of a mammogram, it'll come up with a zero calcium score in the arteries of your breast. But doctors aren't actually telling their patients about that because there's no billing code for it. And that's an actual early predictor of cardiovascular disease risk in women. Yes, the eye disease, but it's not getting read out. And I just thought that was really interesting as well. And I think that maybe that will be the big phenomenon, hopefully.

Dr. Paul Turek (7:13)

Biomarkers.

Podcast Host (7:13)

Yeah, biomarkers.

Dr. Paul Turek (7:14)

So it started with erections and then now it went to biomarkers for fertility. So my field, you know, I was really interested in it because the surgery is fantastic. I was pretty good at it and I was a professor. And then I realized that we don't know a lot about what causes fertility in men. And that led to years of research and kind of exploded with the biomarker concept of does fertility also predict your health? That's one of my bucket list things. I'd have to say, really.

Podcast Host (7:42)

It's interesting and I don't know if you would agree, but I did a search before, before our episode just around sexual health and reproduction and fertility. And it seems to be on the rise right now. Like a lot of, especially women, of course, a lot of people are really investing on figuring out, you know, what is my fertility. Even if you're in your 20s and your 30s, even if you've had no problems, let's just figure out where we're at. So people are now becoming more aware. You know, we always used to think of infertility as a female problem, but I'm sure you're going to shed light on that in this episode to show us that it's not always just a female problem. Are you finding that more people are becoming aware of fertility issues now or reproductive health?

Dr. Paul Turek (8:23)

I'm so thankful that that's true. It's been a long time coming. It's probably a composite, a compilation of things, a collusion because the Internet, you know, information conveying information, digital stuff. And, you know, the at home semen collection was a boon. Right. There's been several products over 30 years coming out that bombed. But now it's taking hold at home semen collections, the digital semen analysis, that kind of thing. So it's being done. And then egg freezing on the female side has gotten men worried about their sperm. Like, okay, she's doing it. Should I be doing it?

Podcast Host (9:02)

Yeah. Banking sperm.

Dr. Paul Turek (9:03)

And then there's a biological clock for men.

Podcast Host (9:05)

Yeah.

Dr. Paul Turek (9:05)

It's not the same as women, but there is one. But men don't know more. So I get a lot of fantastic new consultations. Men saying, am I okay? Am I fertile or not? And then it's gonna lead to an assessment of their health. And then you've got your foot in the door on a young guy who's never been to a doctor.

Louisa Nicola (9:23)

Yeah.

Dr. Paul Turek (9:23)

And he's asking you about his health and what he can do. And then you have your foot in the door of preventative medicine for the first time in humanity.

Podcast Host (9:30)

I love that.

Louisa Nicola (9:32)

I recently had My labs done through Function Health and one number that really stood out to me was my Homa IR. It came back as 0.4. I bet you've never heard of Homa IR. Well, it's a more intelligent marker of insulin sensitivity and it's one of the most important indicators we have for long term brain health and metabolic longevity. And this result didn't happen by accident. It's the outcome of years of paying attention to blood sugar, inflammation, sleep and training. And function is what lets me actually see those trends instead of hoping I'm doing things right. Function gives you access to over 160 different biomarkers from glucose and lipids to liver, thyroid inflammatory markers.

Podcast Host (10:16)

Guys, absolutely everything.

Louisa Nicola (10:17)

I do a huge, huge blood panel, I would say every six months, but I'm really doing like the basic blood.

Podcast Host (10:23)

Panels like every three months because I.

Louisa Nicola (10:26)

Need to know that what I'm doing every day, the protocols, the supplements, the sleep, the training is actually having an effect on my cells. I use Function Health. They are the best in this for absolutely all of this. If you want to try Function Health, you can sign up@functionhealth.com louisianicola you can use code NEURO25. You will get $25 off. And once you use this and sign up, you will be able to look at all of your data in real time. That is functionhealth.com Louisanicola you can do.

Podcast Host (11:01)

A lot to improve sperm health, which we're going to go into. People come into your clinic, you do a deep, like a deep patient history, which what any fantastic physician would do. I know that you give a huge questionnaire, you get to know them in detail. How much of, in your opinion, what's the percentage of infertility when it comes to both men and women? Would you say it's 50, 50?

Dr. Paul Turek (11:25)

If you could assign blame or whatever or factors, we call them factors, factors. I would say it's pretty much been the same as half is women and half is men. But a third of fertility probably is exclusively male. And then the 20% is probably combined male, female. So men are involved with half, typically a third of all that and then another half is probably female.

Podcast Host (11:50)

Let's go through all of that. I really want to dig into male infertility. I don't even know where to start with that. Do we start with sperm health? Like what's the first thing that you would assess if actually let's define infertility.

Dr. Paul Turek (12:04)

So it's a year of unprotected sex.

Podcast Host (12:07)

Without a conception, one year of unprotected sex without conception. Right.

Dr. Paul Turek (12:12)

I had a couple come in and she says vaginissimus. So she has painful sexual. And so they said, we're trying to conceive and we're infertile. And I said, actually you're technically not infertile because you haven't tried for a year, but I get it. Yes, but that evaluation is different because there may not be a problem with sperm in that situation. So the way it starts is they have trouble and whenever they come in is the right time because if the stress is going up and they're worried, if it's six months, that's fine. If you're a 40 year old woman, six months is plenty to come in for an evaluation. And it should be that both the male partner and the female partner get evaluated at the same time. It tends to be in North America that the female partner gets a lot done and then nothing is found. And then the male gets looked at and they may find something. So it's a little backward. You're trying to fix that. It should be done concurrently with expertise, like a reproductive urologist and a gynecologist. Well, it makes sense, but it hasn't been the way. It's all the guideline recommendations. Right, but it's just not been that way. And then typically the female partner will get a, you know, a $3,000 evaluation. Blood tests, ultrasounds, everything look fine or not. And then the man will get a semen analysis.

Podcast Host (13:28)

Okay? Yeah.

Dr. Paul Turek (13:29)

And that is the start of it all. And that's what most men get if they get something. But that's not the most important thing if you come to reproductive urologist, that history is the most important thing. That 225 question questionnaire where I pick up hot baths every other day or steam rooms or saunas, and you just stop it and you've cured them. Right? So you can pick up a lot of stuff because you're right, you can change sperm. You can't really change eggs. You're born with them, 2 million of them, you end up with a thousand.

Podcast Host (14:00)

Quantity you can't change. You can't change quantity. But can you optimize quality for eggs?

Dr. Paul Turek (14:05)

I won't go there because there's ways of. Yes, you can optimize the environment of the egg, but I don't know if you can change the egg because it's been there for as long as she's, how old she is. But sperm changes every three months. So you have great potential to change sperm. It's like, why haven't we Been doing this. Why don't people know this? If you're going to change one thing, change the sperm.

Podcast Host (14:28)

Yeah.

Dr. Paul Turek (14:29)

I published a hot tub paper and we took men with low sperm counts and infertility out of hot baths. Their sperm analysis went up 600% in six months, 400% in three months, and improved dramatically. So I wrote the paper and it was really hard to publish. It went to the Brazilian Journal of Urology, but it went to the New York Times in the press release because that was you. The editors thought that we already know this. I was like, it's never really been shown. It wasn't a great paper, but it was my most cited paper. It was silly, but it's still, even to this day, people are like, oh, I shouldn't be in saunas, hot tubs, steam rooms. Oh, it's like, yeah. And you know, and why don't you stop that right now and then give it another couple months and see what happens. And it's usually temporary. So the thing, the nice thing about exposures for men. So lifestyle is number one in the evaluation. That's what the questionnaire is for. What are you doing? What are you smoking? What are you talking. What are you, you know, how do you treating your body? Are you overweight? Are, you know, are you. Do you have diabetes? All that stuff. What are you taking medication? Wise? Finasteride, minoxidil, you know, all these things that can change everything. We're built to be run hard. And when I see a guy with low sperm count, I think, what's keeping them down? Something is keeping them down. That's the biomarker concept.

Podcast Host (15:46)

So you've mentioned a few words that I want to define. We've said sperm count, we've said semen analysis, sperm quality. Can we first understand what semen consists of?

Dr. Paul Turek (15:59)

Sure. So an ejaculate is a reflex. It's associated with climax, which is a cerebral event in your head. And that's nice that God or Darwin put those together because it makes you want to do it. Because if ejaculation hurt, you'd stop doing it. Right. And you would not reproduce. So it's really well done. Yeah, well, it's like the best feeling in the world. Right? Dissociative, the whole thing. So you can dissociate the two, too. You can ejaculate without reflex, without having an orgasm. I have spinal cord injury patients who. We can do that. You can get the reflex to go, but they don't feel it. It's kind of interesting. But once the Reflex is kicked off. Three types of fluid in general come together to make an ejaculate. And you think of it as the opposite of epoxy. Starts out a liquid, becomes a solid. This starts out more like tapioca or solid and becomes a liquid.

Podcast Host (16:44)

Okay.

Dr. Paul Turek (16:45)

And that's because they're all mixed together. So one is prostate, 10%. One is the sperm coming from the testicle through the tubes. Where the vasectomy is done is 10%. And then most of the fluid is the seminal vesicle behind the prostate and which adds a lot of nutritious fluid to the semen. And the semen has to be ejaculated as a solid because we're like other species. There are some species where you gotta get out of there after you have sex. Like praying mantises and black widow spiders. They kill their mates after mating. So you gotta run, so it's gotta stick.

Podcast Host (17:16)

Okay.

Dr. Paul Turek (17:17)

So we have that residual of it sticking and then it liquefies slowly. So it sticks at the cervix and then it slowly liquefies. And it has to be protective, ph wise. Cause the vagina is a hostile place. Ph of 5.5. And that'll kill a sperm. So it's gotta stay in that fluid and then get through the cervix.

Podcast Host (17:34)

Well, they're smarter than what I thought then, these little sperms.

Dr. Paul Turek (17:37)

This is millions of years of evolution, Louisa. This is like well done. It's really well done. I learned we have a paper published, gonna be published soon. It's just got accepted that says that the way sperm work in fertilization, naturally, there's no Michael Phelps, there's no one. Sperm is the fastest, best sperm, it gets through and that wins and that fertilizes the win.

Louisa Nicola (17:59)

I thought it was.

Dr. Paul Turek (18:00)

Everyone thinks it is.

Podcast Host (18:01)

Yeah. Because I've heard about something like the Sperm Olympics where some people are like watching them like.

Dr. Paul Turek (18:06)

Yeah, it's called sperm racing and it's getting really popular.

Podcast Host (18:09)

Yeah.

Dr. Paul Turek (18:09)

I might crown the next one of the winners on that one. But what we now know. This is a bunch of really nerdy Harvard people. Been working on this for years and it took me years to understand it. But sperm are ejaculated, they get freed up from the fluid. They go through the cervix, which is a crypt. It's a very tight space. And in waves they neutralize the immune system of the uterus. So women have a hole to the middle of their body, which is the cervix. And then the uterus and anything can get in. So it's gotta have a very good immune system. And then it weakens during ovulation. The fluid gets thinner so sperm can get through. And so the immune system has to stay really strong. So the sperm will jump into the uterus, the first round of, like, a Roman phalanx, and basically get creamed by the immune system. They'll secrete proteins to neutralize antibodies, and maybe another round does the same thing. And the third wave that come through, they may get through, or maybe the fourth gets through to the egg.

Podcast Host (19:08)

Oh, wow.

Dr. Paul Turek (19:09)

So they work in groups, like a football team going an inside run. It's wild and it's brand new. And it's got a cycle. And men actually have an ovulation cycle. Like it's called spermulation. It's about an hour and a half. And sperm are either furler. They're not. So men have cycles too. Men have biological. Men have a lot of things women have. It's a parallel universe.

Podcast Host (19:30)

We never got taught this. So. Okay, you didn't have it.

Dr. Paul Turek (19:33)

It's brand new.

Podcast Host (19:33)

Can you just describe. Okay, so that's what semen is. That's interesting. I didn't know that. What is. Tell me what sperm is like. Describe.

Dr. Paul Turek (19:43)

So the semen has a bunch of cells in it called sperm. Sperm are made every three months. It takes three months to make one and ejaculate it. They're made at about 1000 sperm per heartbeat. So it's a very fast process. And they spend two months in the testicle. They spend in the collecting duct around the testicle called the epidmist. They spend about two weeks. And it's there where they learn to move and smell.

Podcast Host (20:05)

Sperm can smell?

Dr. Paul Turek (20:07)

Yes, sperm can smell.

Podcast Host (20:08)

Wow. These little guys are smart.

Dr. Paul Turek (20:09)

They're really smart. So if you put a sperm from the testicle into the uterus, it won't move very well. And if it did, it would go in circles. But if you take one two weeks later from the epididymis and you put it in there, it's gonna know. Exactly. It's gonna swim straight fast, and it's gonna know where to go. Cause it can smell one part per billion of follicular fluid. Which is better than a shark smelling blood in the ocean.

Podcast Host (20:35)

That's unbelievable. By that moment, it's matured and it knows what it wants.

Dr. Paul Turek (20:39)

Yeah.

Podcast Host (20:39)

Okay.

Dr. Paul Turek (20:40)

And then it sits there in a reservoir in the epididymis at the end of that development phase, waiting to be ejaculated.

Podcast Host (20:45)

What if it doesn't get ejaculated?

Dr. Paul Turek (20:47)

Then it'll typically either be reabsorbed, like having a vasectomy, or you'll have. If the man doesn't ejaculate. All species do this. It'll empty out. With nocturnal emissions, there'll be a soft ejaculation into the urine and they'll pee it out.

Podcast Host (21:06)

Okay, so it's not dangerous because. I don't know, I've heard people. You know, I've heard abstaining.

Dr. Paul Turek (21:11)

Isn't it really bad? For me?

Podcast Host (21:12)

I've heard of men abstaining from masturbation for months and maybe with staining. So I just. I don't know what. Oh, and then I've heard Buddhism. Yeah. I've read other studies where, you know, men who ejaculate 21 times a month on average have higher testosterone. So I'm just. I'm reading so many different things, I don't know what to believe.

Dr. Paul Turek (21:33)

You're gonna stop reading Reddit?

Podcast Host (21:34)

Yeah.

Dr. Paul Turek (21:37)

Are you a researcher?

Podcast Host (21:38)

Yeah. Okay, so how many. How many sperm are actually in? Because only one makes it to the egg.

Dr. Paul Turek (21:46)

Right up there, 100 to fallopian tubes. So a great study was done in the 50s where a guy named Setlage and this tells you how many sperm at each point, he said, have sex the night before your hysterectomy when you're going to remove the uterus. And what he did was he painted, he squabbed different areas of the reproductive tract the next morning. So 12 hours before they had sex, then she had surgery to remove it. And they looked in the system to see where the sperm were. So they. 40 million moving sperm are typically ejaculated into the cervix. That's it. And if the, you know, the shape of the penis and the cervix are very complimentary. This has been worked out by somebody for a million years. Right. And then about a fifth of that will make it into the. About so 40 million in about 5 million, maybe a tenth of those will make it through the cervix, which is a war zone, into the uterus, and then about 100 make it to the oviduct, and one will make it in the egg.

Podcast Host (22:40)

You're saying that that one that makes there is not the strongest or fastest?

Dr. Paul Turek (22:44)

It's not clear yet. It's not a mono event. Right. It's not like you're.

Podcast Host (22:50)

But one makes it stronger.

Dr. Paul Turek (22:51)

We used to think that you need so many sperm because men don't ask for directions. But now we know there's a big fall off and that's very recent. Like it takes a bunch to make it happen. It's a team sport.

Podcast Host (23:02)

Yeah. So when you do a semen analysis, what are you looking for?

Dr. Paul Turek (23:09)

So you look for three liquid issues. Does it liquefy like it's supposed to normally? Because if it doesn't, it stays firm. It's gonna be hard to penetrate to get out. So it has to liquefy normally. And that involves a chemical process and ph and stuff. Then it has to have a certain viscosity. So when it liquefies, you can measure something called viscosity, which is thickness, because if it's too thick, they slow down and so that has to be normal. And then there's agglutination, which is clumping. So those are three liquid issues that are looked at. Then you look at components of it. How much fluid is there? How many sperm are in that fluid? It's count, concentration, are they moving and how well are they moving? That's motility and forward progression. And what's their shape?

Louisa Nicola (23:51)

Morphology?

Dr. Paul Turek (23:51)

Right shape is morphology. It's the hardest one to get right because it's so variable. And then you look for other cells. Are there round cells in there that aren't sperm? Are they pus cells, are they immature? Are they bacteria? You look for other things, red blood cells, et cetera. And so it's a cytologic analysis of a, of the fluid.

Podcast Host (24:11)

What's the most important?

Dr. Paul Turek (24:12)

Are they all single most important thing?

Podcast Host (24:14)

Yeah.

Dr. Paul Turek (24:15)

Motility. What is that movement? Because if you have a bunch of dead sperm, they're not going to be fertile.

Podcast Host (24:20)

And that's what I've seen. When you, when you look at the videos of like, you know, these little sperm, one of them went viral and you see like a bunch of sperm not moving. Like one may be moving. I thought, oh my gosh, that's, that's crazy.

Dr. Paul Turek (24:34)

Remember, it's a several mile swim for sperm to make it from the cervix to the egg to several equivalent of five or eight miles of swimming in about, you know, 30 minutes. It's amazing.

Podcast Host (24:47)

Yeah. I often think about this in terms of conception. You've mentioned that the best time to conceive is to frontload. Can you explain what frontloading means?

Dr. Paul Turek (25:02)

So you gotta think of it as a bucket and you put the sperm in it and the egg drops in. You want the sperm to be there for the egg. Right.

Podcast Host (25:10)

In terms of ovulation.

Dr. Paul Turek (25:11)

Yeah. So women have a certain cycle and the first day of their cycle is their period. And then when the period Ends, they start that follicular phase and then they ovulate. Say it's 30 day period at day 15, if everything's right, you need to know when that is to time it. That's the difference between unprotected sex and timed intercourse is you know when you're ovulating. Great story. Catholic Church, this was figured out 100 years ago, only that women are only fertile two or three days a month. The Catholic Church was not allowing any other kind of contraception. Someone had published this and figured it out in the estrus cycle, and they said, we're giving you money to write a book about it so we can hand it out to people. Because it's timed. It's timing. It's the way you naturally time it. That started that whole process of timing sex to avoid ovulation was. It's only 100 years old. It's wild. That.

Podcast Host (26:04)

That is insane.

Dr. Paul Turek (26:04)

We've only known that for that long. And the Catholic Church was behind it all the way. It wasn't a vasectomy or some other forced contraception.

Podcast Host (26:11)

I look back at my grandmother who had 10 kids, and I think, was she timing her ovulation? I don't think she was. So I don't know.

Dr. Paul Turek (26:20)

It's wild.

Louisa Nicola (26:21)

Yeah.

Dr. Paul Turek (26:21)

So a study was done in New England Journal of Medicine where they took a bunch of couples and they said, okay, we want you to write down what you're doing to conceive. We want to write down when you think you ovulated, when you had sex, what day of the month, et cetera. And then we're going to take your diaries and we're going to evaluate them. So it was sort of a community study of couples. It wasn't a randomized trial or anything, but it was a kind of observational community study of how people conceive, how.

Podcast Host (26:47)

Did they track ovulation?

Dr. Paul Turek (26:49)

Different ways. So it may not have been accurate, but it may have been accurate. So they didn't really assess pregnancy rates. Well, what they did is they assessed the timing and they found that if you know when you're ovulating by a kit or your body temperature or CORA or some other measure, and you say to your partner, I'm ovulating, let's have sex, that's reacting to the information that's about 20% of pregnancies.

Podcast Host (27:17)

When you react to ovulation, it's going to happen.

Dr. Paul Turek (27:20)

Let's have sex. Okay, it's happening like tonight or tomorrow, whatever. And if you looked at the couples who said, I think I'M gonna ovulate in five days and you start having sex before that. Front loading the sex. Every other day is optimal? Not every day. Every other day. If you do it every day to continue. But if you don't, then, you know, men need to recharge. It's like a battery. The system has to reboot a little bit.

Podcast Host (27:45)

Okay.

Dr. Paul Turek (27:46)

So every other day is optimal. And very significant pregnancy rates are occurring five days ahead of ovulation and three days ahead of ovulation.

Podcast Host (27:52)

Ovulation, wow. So if you ovulate on day 15, then you're saying if you're going to front load it for the best chance possible.

Louisa Nicola (27:59)

Yeah.

Podcast Host (27:59)

Okay.

Dr. Paul Turek (28:00)

9, 11, 13.

Podcast Host (28:01)

1113. Wow.

Dr. Paul Turek (28:03)

Yeah. And it was. And 80% of pregnancies occurred in that pattern.

Podcast Host (28:06)

And why is that? Is that because the sperm live for.

Dr. Paul Turek (28:08)

Yeah, they're nurtured. And once they get into the uterus, they can do pretty well. They can live there for a day or two.

Podcast Host (28:13)

A day or two?

Dr. Paul Turek (28:14)

Yeah. They're hanging out waiting for an egg.

Podcast Host (28:16)

Waiting for where's the egg? Okay. And they're just there chilling. And then, you know, 48 hours, if you stand him up, he's going to die.

Dr. Paul Turek (28:23)

Yes, probably. Yeah.

Podcast Host (28:24)

Okay.

Dr. Paul Turek (28:25)

Because the immune system is there. Right. So you've got it held down for a while.

Podcast Host (28:30)

Wow. So they're doing a lot of work.

Dr. Paul Turek (28:31)

So the vagina is rough because it's the real world, but the uterus is much more hospitable.

Louisa Nicola (28:38)

When people ask me what's driving aging, I always say mitochondria. They're the engines inside your cells. And when they slow down, everything slows down. Energy recovery, cognition. That's why I use mito pure from timeline. I do so much to optimize my mitochondria from cold water immersion. I do heat therapy through saunas. I obviously exercise, but I also take supplements that specifically target mitochondrial health. And the one from mitopure contains urolithin A. Urolithin A helps your body recycle damaged mitochondria and produce energy more efficiently. What I feel is, is just the fact that A, I'm recovering better from my workouts and B, just steadier energy, if that makes sense. But if you care about aging, especially brain aging, this is one of the most evidence based tools available. And you can get 20% off@timeline.com neuro even if you go on there, guys, and research what it is, you'll be mind blown 20% off@timeline.com neuro.

Podcast Host (29:45)

How about let's take a Bit of a right turn here. What about iui?

Dr. Paul Turek (29:49)

What about it?

Podcast Host (29:50)

So what about it? So like, how is it still effective if. Let's just say a woman goes in natural ovulation and she wants to do this through iui. Where I'm confused is like when a man donates his sperm, it gets looked at, right? And then does it get cleaned and they only take like a certain part of.

Dr. Paul Turek (30:12)

To do an iui?

Podcast Host (30:13)

Yeah. Yes.

Dr. Paul Turek (30:14)

So there's two ways to do it. So first question is, why do an iui? So anyone with an impotence problem or an erection problem or a delivery mechanism, hypospadias. There's penile abnormalities, spinal cord injury. Some men have trouble ejaculating with sex and can ejaculate with self stimulation. So I have men with disordered ejaculation, early, late, non, et cetera. So I deal with all of those types and you can help most of them. But IUI is one way where they can get the sample without having sex. Or if the sample, the ejaculate. The most common reason is there's not enough sperm to make it through the cervix to get that Magic Number of 5 million moving sperm into the uterus, because they're starting out with 3 million to begin with or something, or 10 million and they need 40. So you can overcome that barrier with IUI. If you can wash whatever you get and put 5 million past the cervix into the uterus, you've essentially negated the cervix issue and you're good. Right. So that's the most common reason from a male point of view. There's female reasons to do it too. That's the most successful way indication for IUI for men is if they don't have enough sperm to make that magic number into the uterus to get that magic number at the egg. And what you would typically, for the last 80 years, what we've done is just wash the sperm in a centrifuge or basically wash it, spin it down, concentrate it into a small volume. You can't put it, the semen into the uterus. It'll cause ridiculous contractions. So it has to be sperm without semen, because the semen doesn't normally get through. No, it doesn't get in, just the sperm get through. So it has to leave the fluid behind. So you do that with a centrifuge technique. You spin it down, you concentrate it and you put it in with a little stylet. Basically, it's like a pap Smear, there's a device and then you put it into the cervix and then that's an iui. It's very simple. A lot of the complexity of IUI is how do you prepare the woman, do you give her medications, how many eggs do you want her to have and all that stuff. And that's what makes it expensive. Now what's really neat is a really neat scientist at Stanford named Utan Demirci. He's a microfluidic physicist.

Louisa Nicola (32:25)

He's a what?

Dr. Paul Turek (32:26)

Microfluidic physicist. He's a good friend and he came up with the idea that let's kind of recreate the cervical path because maybe we can not only get sperm, but better sperm. So we created a microfluidic channel that looks like the cerVix. It's a CrossFit channel. So instead of washing the sperm, you sort it. So not washing it. So you put the semen on a device and it has to do some work. It doesn't get spun, it just runs and it has to run through a gauntlet and it has to do CrossFit. And the sperm that make it there, not all of them make it because not all of them are good, all are much healthier sperm, they're more modal, they're better shaped and their DNA fragmentation, their quality is higher.

Podcast Host (33:07)

Yes.

Dr. Paul Turek (33:08)

And that's another basically relatively new FDA approved way to get to wash sperm.

Podcast Host (33:14)

And what clinics are doing this is like a normal thing.

Dr. Paul Turek (33:17)

It's got a slow uptake. But the biology is wild. And if you look at is the.

Podcast Host (33:21)

Success rates wild too?

Dr. Paul Turek (33:23)

The best study was done not a randomized trial, which we like to see. Right. Where we really get some hard data. But it was a study of 100 couples who were matched well. And half of them went through IUI with the SPIN technique and half of them went through the SORT technique. And so all the parameters were matched pretty well in the women and the men. And the pregnancy rate per cycle per transfer per IUI for the spun was around 9% pregnancy each time they did it. And the ones with the sorting technology was 15. And I would consider a 1% increase from 9 to 10 to be significant. In the animal industry, half percent is significant. So it's almost too good to be true how much better it was. But randomized trials are better. There's probably some biases, but Even if it's 1 to 2% and not 6% increase per cycle, it's still significant. And it does make sense based on the better biology of that sperm.

Podcast Host (34:24)

Yeah.

Dr. Paul Turek (34:24)

So the biology of sperm is not altered that much when it's just spun, and it may be even detrimental to it, but when you have it, do the work it likes to do for a million years. The cervix is around in animals, landed mammals and sea animals for a million years. There's a reason for it.

Podcast Host (34:41)

Right.

Dr. Paul Turek (34:41)

There's some kind of natural selection going on in there. And you're reintroducing it.

Podcast Host (34:45)

Yeah. I always think about why isn't IUI more successful if you're doing it this way? If you're cleaning it, you're getting the best sperm, you're putting it in. Maybe you're watching the. I don't know. If you can watch ovulation and you're doing it the right time, why isn't it more success?

Dr. Paul Turek (34:58)

Well, if you look at the most successful IUIs are donor sperm.

Podcast Host (35:02)

Yeah.

Dr. Paul Turek (35:03)

So not infertile women. Women maybe want kids and aren't infertile, but don't have a partner. And if they buy donor sperm, the pregnancy rate is about 20%. So it's never. It's probably just mimicking the real world pretty much. Same with ivf. It's not that good, but maybe that's just duplicating nature.

Podcast Host (35:23)

That's always interests me. I just want to keep going with the C and because I know you've said something interesting, which is 1 in 500 men have no vas deferens. And I found that really interesting. I've been in a few vasectomies very quick. I think they're like 15 minutes, these surgeries that I went into. Yeah, that's a long one. And then also the reversal as well. And when you told me this, I've never heard this before, and I thought that was really interesting.

Dr. Paul Turek (35:53)

So the most common genetic disease in America is cystic fibrosis. One in 500 couples are affected. One in 500 individuals carries a cystic fibrosis mutation.

Podcast Host (36:04)

2007.

Dr. Paul Turek (36:05)

Yeah. 2000 mutations are very complicated. And it's interesting. When men carry this mutation, their fertility is affected. So if you carry one mutation out of two, you're a carrier. You're basically healthy, but you have no vast deference because that chloride duct that it controls evaporates the vas deferens. You don't make it. And it's wild because if you have two mutations and you have cystic fibrosis, we knew that all those men don't have a vas deferens, but we didn't know that if You're a carrier. And it was really interesting because someone started looking in the 80s, after the gene was elucidated for cystic fibrosis, started looking at men with no vas deferens but no disease, and found that they were carriers of the same disease. So it was kind of a byproduct of the cystic fibrosis syndrome. So it's complicated, but a lot of men can be fertile if you're missing one and you have one, et cetera. But we can use technology. The big issue with these men is you can pass on cystic fibrosis.

Podcast Host (37:07)

Of course. Yeah.

Dr. Paul Turek (37:08)

And so the genetic counseling is really important, whether you have one vas deference, another vas deference, whatever, or you have a sperm count. And I'm happy to say, in my 30 years of seeing this weekly, we have no cystic fibrosis offspring. And that's all about proper counseling and engineering and doing IVF if you need to, et cetera.

Podcast Host (37:28)

And so you've done, right now, 3,000 vasectomies, in your opinion. So can you tell me why? Okay, so let's just say a man wants to come and get a vasectomy for whatever reason that might be. There's probably several reasons, lots of them. But now he's met someone who said, I wanted to have kids, and now he wants to get a reversal. What does that entail? And how long does it actually take for them to be able to conceive after the vasectomy? Reversal.

Dr. Paul Turek (37:59)

So vasectomy reversals are kind of big. Vasectomies. My vasectomies have no incisions. They involve some small incisions, maybe, you know, a centimeter or two. It's a procedure done typically with sedation, some light sedation. So it's more than a local anesthesia procedure like a vasectomy. It takes one to two hours versus four minutes for a vasectomy. It's microsurgery, so it's delicate. So the recovery is not necessarily painful. But you can't do a lot because it's very. I mean, the suture we're using, we're basically putting a piece of spaghetti with a hole in it together with suture. You can't see by eye. That is about a tenth the size of a hair.

Podcast Host (38:40)

Wow.

Dr. Paul Turek (38:40)

So it matters a lot. And so it's funny. Men will typically, they've had a vasectomy. They have a reversal like, I feel fine. I'm back to work. You're not making. I can't exercise. I can't have sex. And so I follow them every day on this app, and they'll ask me, can I? As soon as they feel comfortable, can I? And I've said, you can't have sex for three weeks. Right.

Louisa Nicola (39:03)

Okay.

Podcast Host (39:03)

Why is that?

Dr. Paul Turek (39:04)

Because it's a delicate system. And when you ejaculate, there's a lot of muscular contractions, a lot of force, because the tube is very muscular. Right. So it can pull things apart. We've done studies on this collagen lays down to heal things. And around day five, it starts patching it up and going on top of your delicate microsurgery. And about three weeks into it, if you pull on the tube, it's probably as strong as anywhere else because of the collagen. And I'm early. I'll make them. I'll say, this is relatively fast because I want them using that system and keeping it open. But it's so funny. They'll say, can I? Can I? Can I? Every day I'll say, no, no, no. And you know why? No. And then finally, when I say yes, they say, thank you. All they think about, of course, because I told them I can't have sex. I guess what they think about, they're such simple human beings.

Podcast Host (39:55)

Oh, I know that.

Louisa Nicola (39:57)

Trust me.

Dr. Paul Turek (39:58)

So you do the surgery?

Podcast Host (39:59)

Yes.

Dr. Paul Turek (40:00)

And there's several kinds of surgery that can be done. There's straight connections where you simply connect it up, and there's a more complex surgery, which is called a bypass. If the vasectomy is older, they can blow out because of back pressure and have a second blockage deeper in the system. And that requires much more intense microsurgery called an epididymovasostomy. I happen to be pretty good at that. My vasectomies are pretty old, and so I see a lot of those. Published a paper, actually, on the older vasectomy reversal, meaning the vasectomy is over 15 years and 15 to about 40. And everyone thought, well, it's probably not worth it. And then we're showing, you know, return of sperm counts 85% of the time in men with 40 ovisectomies. It's certainly worth it.

Podcast Host (40:41)

Does it ever get to 100% return?

Dr. Paul Turek (40:45)

Yeah, yeah. In my practice, if you. If you have an ideal situation, young vasectomy, you cut across the tube, you look and see what's there. There's sperm, it's moving. You put them together, I can achieve 100%.

Podcast Host (40:54)

So after a vasectomy during ejaculation, what are they ejaculating? Just the fluid, the semen without this sperm.

Dr. Paul Turek (41:02)

So it's prostatic fluid.

Podcast Host (41:03)

The prostatic fluid, some vesicular fluid. Yeah.

Dr. Paul Turek (41:05)

And most men don't notice the 10% reduction in fluid volume from the vat from the sperm end of things. And it looks the same and it acts the same.

Louisa Nicola (41:14)

I am recording this after traveling from the US to Australia. Long flight, time zone change, disrupted sleep. And this is exactly why I have been taking kion aminos. I know a lot of you probably think it's really hard to meet your protein requirements.

Podcast Host (41:31)

I do.

Louisa Nicola (41:31)

Essential aminos are the building blocks your body uses to maintain muscle and help it recover, especially when you're undereating or you're jet lagged or you're sitting for hours on a plane. Being able to meet your protein requirements can be helped with essential aminos. I take these every day. Better energy, less soreness, staying lean and strong. Like I'm so obsessed with these. I have the watermelon flavor. They're easy to digest. The kion aminos are sugar free and I mix it straight into my water. Even on rest days or days where I skip a meal, they help me stay on track. So if you're traveling training or it's just hard to meet your protein requirements, you should add. Add this in. Go to getkion.com Nero to get 20% off. I highly suggest the watermelon flavor. Getkeon.com neuro.

Podcast Host (42:19)

When you're doing a semen analysis and you find that someone has low semen volume, does that mean low in all three categories?

Dr. Paul Turek (42:28)

No, no. The driver is the seminal vesicle. Always significant. So congenital absence of the VAs.

Podcast Host (42:35)

Yeah.

Dr. Paul Turek (42:37)

Cystic fibrosis patients have low volumes because they don't have a seminal vesicle. All right, so it's got to be something in the seminal vesicle. Or it's five things. It's either you're ejaculating into your bladder and that's called retrograde ejaculation. Diabetics, things like that, and certain medications. Or you're missing your seminal vesicle because of that condition like cystic fibrosis. Or you're blocked in there at the ejaculatory duct, which is one of my areas of interest. Or you have a low testosterone and it's one of those. So you'll always find something if you pursue that.

Podcast Host (43:10)

So let's actually, let's talk about lifestyle factors and we'll start with testosterone. So what's the relationship? Whoops. What's the relationship between testosterone and sperm.

Dr. Paul Turek (43:20)

Testosterone, I would think, is kind of water for the plant. You have to have it to grow it, and it has to be your own. You can't.

Podcast Host (43:28)

Oh, so not trt.

Dr. Paul Turek (43:29)

Right. You can't have any other testosterone besides your own to make sperm.

Louisa Nicola (43:33)

Can you explain that further?

Dr. Paul Turek (43:37)

Just the way it is. So the testosterone, it's the way the feedback works in the hormones in men and women. So if you take testosterone, you're going to turn off the pituitary, which is telling the testicle to make testosterone, because you don't need it, because you have it, but you're not. And it also turns off the other hormones that help make sperm, like the sunlight. So the lights go out and there's no water. That's what happens when you take testosterone. And so you need the light. So the water comes from your own body.

Podcast Host (44:07)

So you have to make your own endogenous.

Dr. Paul Turek (44:08)

And you can take another testosterone, you can take another FSH or another hormone problem for that. You can take it supplies it, but you have to turn it back on. So that's a problem. Yeah. So it's contraceptive.

Podcast Host (44:21)

So 300 nanograms per deciliter is considered testosterone deficient and low.

Louisa Nicola (44:27)

Correct.

Dr. Paul Turek (44:28)

Yeah. Guidelines would say below 300 nanograms per mil.

Podcast Host (44:31)

Per mil. So then what's the optimal. What is it, 500 to 800?

Dr. Paul Turek (44:35)

It's complicated.

Podcast Host (44:36)

Okay.

Dr. Paul Turek (44:37)

Testosterone biology is complicated.

Podcast Host (44:38)

Yeah.

Dr. Paul Turek (44:39)

So if someone's 300, it could be that they're low, but it could be. So that's looking at all the cars in the parking lot, but the cars that actually run and do the work of the day is the free testosterone and that needs to be normal.

Podcast Host (44:52)

Yes. Because you've got free and total. Yes.

Dr. Paul Turek (44:55)

So if the free is normal and the total is 300, then you're normal.

Podcast Host (44:59)

Yes.

Dr. Paul Turek (45:00)

If the free is low and your total is low, you're low.

Podcast Host (45:02)

Yes. So men need their own testosterone in order to make. To be fertile.

Dr. Paul Turek (45:09)

But other than that, testosterone from the outside world can do everything else testosterone does, Obviously.

Podcast Host (45:14)

Yes. Okay, so then we can now move into optimization, reproduction and optimization for males. And I actually, I'm a huge exercise enthusiast and researcher.

Dr. Paul Turek (45:28)

Triathlete.

Podcast Host (45:29)

Yeah, I was. You did your homework, too. But I mainly look at mild cognitive impairment patients. I don't know what the studies say about sperm health and exercise. So what role does exercise play in male reproductive health?

Dr. Paul Turek (45:43)

So any exercise is good. Moderate exercise is excellent. Heavy, intense duration exercise is not good.

Podcast Host (45:51)

Why is that?

Dr. Paul Turek (45:52)

Well, let's talk about the two most convincing studies so you take green berets and you put a line in them and you have them do their hell week or their of 22 hours a day of field work, one hour sleep, one meal. And you look at their testosterone levels with that during that before and during that period. So they come back normally the periodicity, everything of the hormones is normal. They go into that week. They took blood every six hours or eight hours from these guys. Their testosterone fell by 50% and the whole signaling fell by 50%. All the signals to make testosterone fell. The whole system kind of shut down with intense. So that's extreme. Another study was good athletes, moderate exercise, normal hormones, normal semen analysis. Go to intense exercise. So you know, two hours a day, VIO2, 80% maximum capacity. So CrossFit, two hours a day, five days a week, something like that, high exhaustion running, things like that. They fell 50% and their sperm counts fell about 40% and then that was like a 12 week period. Then they went back to moderate exercise, not as much and they returned.

Podcast Host (47:04)

Do you think that's the mechanism of action is cortisol?

Dr. Paul Turek (47:07)

Absolutely. You nailed it.

Podcast Host (47:10)

So you're telling me you don't want.

Dr. Paul Turek (47:12)

Testosterone when you're running from a woolly.

Podcast Host (47:15)

Mammoth all the time. So high intensity exercise at around 85% of maximum heart rate.

Dr. Paul Turek (47:22)

For long enough.

Podcast Host (47:23)

For long enough will plummet your testosterone.

Dr. Paul Turek (47:25)

So won't staying connected to the Internet all the time.

Podcast Host (47:28)

Of course you're not getting natural.

Dr. Paul Turek (47:30)

Our bodies are very primitive. We have nervous systems that are sympathetic, you know, cortisol driven or not parasympathetic. We don't know this or feel this. But if we're constantly reacting to things in the environment, like a cat and you see a screen or an email, you jump a little bit. Your nervous system has the same response as a cat. We just sort of downplay it like man, I'm not stressed. So that response is all cortisol and if you do it chronically enough, you'll burn out. You're just gonna have a cortisol burnout. I'd love to see. I know one Olympic caliber marathoner was just like I feel terrible and had a low testosterone and he gave it up. Is at Stanford. And I would like to see Olympic training. I'd like to see what their testosterones are because they're probably not very good if you're training that long. So fartlick training where you interval training is really good. So you do a couple days a week of. I always see how they balance it out. Weights, aerobics and weights, that kind of thing. But not. But it's too much. So your body is literally running. Your body does not know what you're running from. They don't know you're in a gym or there's a woolly mammoth chasing you. They have no idea. And you do not want testosterone for that. You want testosterone to restore the system. So you finish, you feel great afterwards. Right. You finish. So your testosterone rises not from the exercise afterwards, it recovers. When your system relaxes in the morning, et cetera, when you're really relaxed, that's when your sex drive goes up. That's what people meet in the gym. Right. Because right afterward they feel great. And it's a different nervous system. Then that's when testosterone kicks in, gets the muscle back in shape for the next round. Yeah.

Podcast Host (49:12)

So the testosterone, the hormone itself has a bi directional relationship, I guess, with semen, with sperm creation.

Dr. Paul Turek (49:21)

Yeah, good answer.

Podcast Host (49:22)

And that's interesting. Well, that's interesting because when males take TRT exogenous testosterone, they do have, don't they? Their parts don't their parts shrink.

Dr. Paul Turek (49:36)

Yes. So you get atrophy, you get smaller testicles. Yeah, right, yeah, absolutely. And that's because sperm production.

Podcast Host (49:42)

Basically, yeah. Okay, so let's talk about some more optimization tools that we don't know about. You know, people are huge on supplements. Are there any supplements that can help with sperm health? I know when it comes to females and eggs, I know that CoQ10 at 600 milligrams a day has been seen as something that's good for.

Dr. Paul Turek (50:02)

So I've been interested in this field for about 15 years because you can improve sperm health. The question is, and diet and lifestyle matter. So I started out as a professor doing genetics and epigenetics and metobolomics and proteomics and all this stuff. Because we weren't explaining a lot of male infertility and we came up with some things. And then I realized that we weren't explaining that much. There's a Y chromosome and there's a couple of genes and all this stuff, but there's still a chunk of it we couldn't explain of male infertility. And then the concept of epigenetics came up and I realized the more we know about the genomics, epigenetics, blah, blah, blah, the more I'm realizing that diet and lifestyle matter enormously. So I actually quit academic medicine as a full professor endowed chair and, and walked over to Eastern medicine. And now I lecture at Yo San University of Traditional Chinese Medicine. In la had my first sort of randomized trial of an herbal for pain, an opiate beater, and published it. And I'm very interested because Western medicine is so reactive to, you have a problem, let's try to fix it. And Eastern medicine is so proactive and holistic. So they're doing the lifestyle. I see men with infertility coming in from an Eastern point of view, dialed in their diet, their lifestyle, their stress, they've got it all, whatever. And I usually find an anatomical problem in those men that is causing them that they couldn't solve or couldn't figure out. But the guys who come in from Western referrals are like a mess, right? Their diet's bad, they're overweight, you know, so it's a different spectrum. And we're trying to study that. I have a doctoral student studying, like, how does Eastern medicine contribute? What's their value in this field? But it is very big. So that got me onto diet and lifestyle and the mechanism by which diet and lifestyle will change. Your sperm is epigenetic. It's not genetic. It's not a mutation you got. It's something happening every day, every moment, based on what you eat. So epigenetics, I'm fascinated with it.

Podcast Host (52:07)

Yeah.

Dr. Paul Turek (52:08)

What is it? Darwin said that giraffes have long necks because they've acquired a mutation that gave them a longer neck, and that was a selective advantage. And now they can reach higher and they are going to pass that on. He never explained how they got the mutation because he was religious.

Podcast Host (52:24)

Oh, wow.

Dr. Paul Turek (52:25)

And so he was an evolutionary biologist, but he was religious. And I always tried to figure out, how could you do that? How can you be both?

Podcast Host (52:32)

It doesn't make sense.

Dr. Paul Turek (52:33)

So I was going to go to Cambridge and do a PhD on this and figure it out, read his books, read his diaries. But then I realized that there was a guy named Lamarck 65 years before Darwin. Darwin knew about him, and he said that giraffes have long necks because they spend all their day reaching as high as possible. And you can inherit acquired characteristics. That's how we're evolving. We're not evolving with 50 mutations a generation. We're evolving every day on a microscopic level because of what we do. So what you eat matters because it's being in epigenetics. It's going to every cell in your body. So now we know epigenetics drives a lot of cancer, a lot of autoimmunity, a lot of health, Alzheimer's disease, fertile diet for women. That's an epigenetic thing. It's probably altering the environment of the ovary. You can directly affect sperm. So this is all coming into diet and lifestyle. So I got into this maybe 15 years ago and I developed a supplement. Oh, wow. So I'm calling it the birth certificate of Prenatal supplements for Men.

Podcast Host (53:34)

Okay.

Dr. Paul Turek (53:35)

It's actually pre. Prenatal. Right, because you want them to take it before conception.

Podcast Host (53:39)

Yeah.

Dr. Paul Turek (53:40)

And it's got a lot of goodies in it. It's called alphasperm.com and it's got a lot of. It's all natural, the fillers, excipients, all that. It's got, you know, the best science. And we decided, okay, you think it's really good. I'm a science guy. We just finished a really nice study on how this supplement alters sperm health. Didn't see a lot with the semen analysis, which is kind of true because the background of this is if you look at studies of antioxidant supplements in men and IVF results, you find that the semen analysis isn't really altered. So the numbers on the semen analysis aren't really altered that much. And it looks like short term studies don't look at pregnancy very well, but that may not be very different. So it doesn't look like it alters the semen analysis, the simple descriptive things with sperm. But if you look at the Cochrane reviews, which are the best evidence we have, besides randomized trials that have summarized men taking antioxidants and the part pregnancies at ivf, which is a controlled environment, which is a good place to be because if it's at home, who knows whose baby it is?

Podcast Host (54:46)

Right.

Dr. Paul Turek (54:46)

So IVF is more controlled, there's more variables are under control. So if you look at that, there's consistently a higher pregnancy rate with IVF, a lower miscarriage rate, among four major studies from 2014, 2016, 2019, and every time they do it, they're trying to show it doesn't make a difference. And every time they do it, it shows a difference. Now they're up to about 60 studies, 10,000 men, and it's still showing a benefit, so fertility benefits, but the semen analysis doesn't. And that led me to study epigenetics because there's gotta be some. Somehow we have to reconcile this.

Podcast Host (55:21)

Yeah.

Dr. Paul Turek (55:22)

So we showed massive changes to sperm epigenetic health with our supplement and it's about to be published.

Podcast Host (55:27)

And it's mainly antioxidants.

Dr. Paul Turek (55:29)

Yeah, I'd say, I mean it's you know, lycopene, resveratrol. So lots of things like that. All minerals, nutrients, like an ashwagandha maca root, astrologous, CoQ10, all that in it, but it's CoQ10.

Podcast Host (55:41)

Well, it makes sense because it down regulates reactive oxygen species. Yeah. In different ways.

Dr. Paul Turek (55:45)

The issue is like, which is we don't know which is more bioavailable or which isn't. But it's got four categories. Amino acids, all the vitamins, but all sourced naturally. So the excipients are fillers. So we believe the bioavailability is higher. And I have some preliminary data that. But the changes we saw in the sperm, because epigenetics is new and it's just been studied. What's done by the biggest group in Utah that has really done all the work with epigenetics and sperm is there's a signature of a sperm. There's a fingerprint for a sperm that's fertile and not epigenetically. There's marks on the DNA and there's certain genes that are involved and that can be measured with a test on sperm, a diagnostic test called the Path Fertility QT test. So the men in the study who were abnormal on this epigenetic sperm fingerprint test, most of them normalized on the supplement, which is wild. And then we looked at the rest of the epigenome which controls biology, like your nervous system or cell development or pathways and organs, and many think 29 of those pathways were major altered and those are going to the kid.

Podcast Host (56:54)

Wow.

Dr. Paul Turek (56:54)

So what happens in sperm?

Podcast Host (56:56)

Yes, I actually read that. Because exercise can actually affect your unborn child through sperm. Yeah, obesity.

Dr. Paul Turek (57:03)

We know all this now.

Podcast Host (57:04)

Yeah.

Dr. Paul Turek (57:05)

So sperm are very interesting to me because they're not just a liver cell that will go bad, it's going to the next generation. So if you're an obese dad, there's a different epigenome that goes to your child than if you're a thin exercising dad.

Podcast Host (57:19)

What does that mean? So if you're an obese dad, you can give the obesity gene to your.

Dr. Paul Turek (57:22)

Child through spot A lot of propensities. Yeah. Diabetes, obesity. Absolutely.

Podcast Host (57:27)

So the health of the individual during conception or prior to conception is really important if you want to have a very healthy child.

Dr. Paul Turek (57:36)

This is burgeoning evidence and it's major. So do I think supplements matter for men? Absolutely.

Podcast Host (57:44)

What do you think about creatine?

Dr. Paul Turek (57:46)

It's protein. I mean, I think it's great if you need protein because you have a protein depleted diet and you're trying to build muscle. It's nice to have protein around. It's also good for kidney stones. I mean, you're gonna get. Because it forms a nidus. So if you take too much of it of creatine. Yeah. It precipitates in the urine and you form kidney stones sometimes. So you gotta be careful.

Podcast Host (58:06)

That's the biggest downfall. People think, oh, my creatinine's going to rise.

Dr. Paul Turek (58:09)

And yeah, so it's not. The kidney doesn't like the load of that much protein. But, you know, I think intermittently it's probably not that harmful.

Podcast Host (58:17)

You mentioned the word miscarriages and I just wanted to ask, is it true that 90% of miscarriages are caused by dysfunctional sperm?

Dr. Paul Turek (58:27)

That seems high to me. That number, I don't know if that's the number.

Podcast Host (58:31)

Okay, is it a high number of miscarriage? I would put it this way.

Dr. Paul Turek (58:35)

If you look at miscarriage rates with female age, it's mainly chromosomal. I think most miscarriages are maternal age related and they're chromosomal. When men get older, there's a whole topic of discussion. Paternal age issues. There's also issues, but those are more epigenetic and mutational and not chromosomal. So you don't get miscarriages, you get deleterious diseases. You hand off conditions, syndromes to kids. So I don't think miscarriage is largely driven by the male.

Podcast Host (59:11)

So if you were to give a speech right now and give your top, give you for everyone here in the studio, give your top ways for men to optimise if they are thinking of conceiving in the next three months and they want to be in the best shape, best possible way, but have the best performing sperm. What's the advice that you would give them?

Dr. Paul Turek (59:34)

I wouldn't set your sights on longevity. If you're trying to be fertile, they're not necessarily the same. Health is number one. So if you treat your body like a temple, that doesn't mean take a bunch of supplements and a bunch of things and exercise two and a half hours a day. It's not the thing that may be good for stress, but balance is key. Sleep is like oxygen, I mean bad sleep. And I have a lot of guys like this who wake up and they just don't feel rested. Is like jet lag. It's horrible. It's cortisol driven. It'll drop it just like exercise. So exercise, get rid of the stress. Men, cavemen, they were very physical. We were very physical species and manual labor Is great. The infertility rates among manual laborers is much lower than it is among office workers. I have a blog called Try not sitting because it's like heart attack. Rates are double when you sit more than four hours a day. So balance on that. But exercise. Exercise, absolutely. That's a great way to get rid of stress for men. Exercise, acupuncture, yoga, massage. Women get on the phone with their moms, they're done, or their girlfriend, boom, stress is gone. Men, you've got to get it out of your body. You got to get tired, go for a long walk, something. So that kind of balance is really important. And not staying hooked to your electronics. You have to have sleep, hygiene. You can't go on with the device on all the time. You can't do that. The body's not built. We're not built for that.

Podcast Host (61:01)

That.

Dr. Paul Turek (61:01)

We're built for periods of acute stress like hibernation and starvation and injury. We're really good at that as a species. Intermittent fasting is starvation. Right. We're really good at it. Our bodies do beautifully with that. But we don't do well with chronic low level stress like travel or the Internet or work stress at the desk. We're not good at that. So you have to control all that. So it's all about balance.

Podcast Host (61:28)

So you pretty much just what I always preach on the podcast, which is stack up, you know your odds, which is exercise, good nutrition, proper sleep, sunlight. Everything else after that is a bonus. The accessory items, I call them ice baths, saunas. Maybe not for men, but yeah, yeah.

Dr. Paul Turek (61:47)

I think that the idea is that, you know, people think that they can improve their sperm count, but the way it works is like the body wants to run hard. And if it's not doing a good job making sperm at 1,000 per heartbeat, you have to question what's keeping it down. That's the way I look at fertility. It's like if you lead a perfectly healthy life and you surround your testicles with health, you will run hard, you'll love it. But if you're smoking or you're doing stuff or wet heat or you're going to drop it. And so when I see men with those sperm count, I usually find something. If I take that approach and say, okay, what is he doing? What's his exposure? It could be genetic, it could be his varicocele on his exam, he could have veins. It could be all the exercise, it could be the stress, whatever. That's the way it works. So if you just take care of things and surround it with health, it will run hard.

Podcast Host (62:41)

It's so different for women because it's not like we go in and they say, oh, what's the reason for your low egg count? Well, let's optimize you and get it back up. You know what I mean? It's just such a different ball game completely.

Dr. Paul Turek (62:52)

But you're bringing it out in public, which is really good because no one's realized this for a long time. Right. No one's realized that you can actually change sperm. And they do matter. It's half the battle. It's a team sport.

Podcast Host (63:02)

Yeah. And it takes three months.

Dr. Paul Turek (63:05)

Yeah. And you can change it entirely in three months.

Podcast Host (63:08)

I love that. Thank you so much for coming on the podcast today. Your clinic is here in LA.

Dr. Paul Turek (63:13)

Yeah. In Beverly Hills. Theturicclinic.com Turek and the podcast, you should watch, too.

Podcast Host (63:18)

Oh, yes.

Dr. Paul Turek (63:19)

Talk with Turek, talk with Turk. Including video.

Podcast Host (63:23)

Got a really good sense of humor as well, which I love.

Dr. Paul Turek (63:25)

Who does?

Podcast Host (63:26)

Yes.

Dr. Paul Turek (63:27)

The podcast is fun because I have a Mr. Everyman, Rob Clyde, and he's asking the Everyman questions and I'm trying to answer them.

Podcast Host (63:34)

Oh, my God.

Dr. Paul Turek (63:34)

I'm going to listen to so he can understand it. And if we're talking about all things sexual health with men.

Podcast Host (63:39)

Well, thank you so much for being part of the youe Experience podcast.