Testosterone, Sex Drive, & Aging: The Ultimate Men’s Health Guide

Today on the Mel Robbins podcast, the. ultimate guide to men's health. >> There's been lots of studies that show. that sperm counts are going down. globally. Over 50, about half of men. have low testosterone. >> With the head of Stanford's male. reproductive medicine and surgery. program, Dr. Michael Eisenberg, >> hormonal health, reproductive health. A. lot of men are not comfortable talking. about this. There's this feeling of. shame a little bit and guilt, concerns. about their own masculinity. We are. talking about my husband's private. If.

he's going to kill me, say this, but. whatever. This is the ultimate guide to. male hormones and men's health. >> This is a very important topic and. something that a lot needs to be done. about and can be done about. Please help me welcome the incredible. Dr. Michael Eisenberg to the Mel Robbins.

podcast. >> It's a pleasure to be here. >> I mean, Dr. Eisenberg, I really. appreciate you getting on a plane and. taking out time from your. extraordinarily busy schedule, clinical. practice, overseeing your fellowship, teaching residents, all the research. that you're doing to be here. So, thank. you. >> You're very welcome. Um, let's just jump. right in. I know what I am hoping to get. out of this, but I would love for you to. speak to the person who is listening, who is here with us right now, and share.

with them based on everything we're. going to cover today related to male. hormone health and men's health in. general. What could possibly change. about their life or the life of a guy. that they love if they take everything. to heart that you're about to teach us? What are we going to learn? >> Yeah. Well, I think we're going to learn. quite a bit. I think that these are. topics that aren't really discussed a. lot. I think people don't understand. them a lot. I think there's a lot of. embarrassment about them. And so I think. there's really an opportunity to learn. and improve. I think that um all these.

things are so fundamental not just to. overall health really but to sort of the. quality of life, right? That's mostly. what we're talking about. So I think. there's, you know, a real opportunity to. improve just enjoyment benefit and then. longevity as well. I think these are. things that people don't necessarily. think about or do as much with, but if. you understand it really, you can. empower things. And I think people also. need to understand that there is a lot. that they can do. They have a lot of. agency with a lot of these things. Um, and it starts with, you know, education, which I think is, you know, one of the.

great things about this podcast. >> Dr. Eisenberg, for the man who is. listening right now who got this episode. sent to them by somebody who cares. deeply about them. What do you want him. to know about what we're going to talk. about today? >> Well, you're going to learn everything. you wanted to know about hormonal. health, sexual health, reproductive. health. You'll learn all the things that. you can do, how to get tested, why to. get tested, why not to get tested. So, we're getting tested for hormones, we're. getting tested for sexual function,

reproductive function. Um, and you'll. just be have a greater appreciation for. how impactful this can be for. quality of life, longevity, everything. Well, I just need to say upfront, I have. my husband Chris's permission, okay, >> to share information because I'm just. going to go on the record, and maybe I'm. going to sound like a giant dummy, but. it's not until I hit pmenopause. and now I'm fully in menopause that I.

even started to think about male hormone. health. >> And I'd love for you, Dr. Dr. Eisenberg. to start by just setting the table for. us. What is male hormone health and what. do you want us to know about it when you. think about the bigger picture before we. dive into specific questions? >> Yeah. So I think it's just sort of. optimum hormone levels and I think when. we think about men the main one we talk. about is testosterone.

>> Um and it's important to know that you. know the normal range of testosterone is. quite wide right 300 to 900 nanogs per. deciliter. And so when we think about. that, you know, there's some men that. are on the lower end, some men are on. the higher end, some men are square in. the middle, but it's a very wide range. because, you know, normal is a little. bit different between everybody and it's. so important. You know, we're obviously. going to talk about all the things that. it does, quality of life things, overall. health things, functional things. Um, so. I think that having that understanding I. think is really fundamental. >> Okay. What age do men start to see.

changes in testosterone? So as we go. through puberty, you know, testosterone. increases and it probably peaks probably. somewhere between 20 to 30 and then. every year thereafter it goes down maybe. 1% a year. So if you look at. epidemiologic data uh of populations, you know, men that have low. testosterone, so kind of below those cut. points below 300, you know, or so, you. know, maybe men in the 40s or probably. 50s, it's maybe about 10 20%. you go in.

the 60s goes to about 20% 70s 30%. in the 80s about 50%. So you know the. kind of statistic that's always talked. about is over 50 you know about half of. men have low testosterone kind of a. serum number. So that's when men should. start to think about that. >> um is something they should get screened. for. >> So I just want to make sure I understand. the math because you just spit out a lot. of numbers right there. So when you were. saying 10%, 20%, 30%, and then you're. going 40, 50, 60, >> were you basically saying that your.

testosterone kicks in for puberty? >> And is it relatively stable until you. hit your 40s or 50s and then you start. to slowly decline? Is that what's. happening? And that's normal. >> It is normal. I think it peaks somewhere. between 20 to 30 and then it goes down a. little bit. So it's not usually kind of. a steep drop off. Okay. Um but it does. slowly go down and there's different. factors age is one but also you know our. metabolic health atosity like how much. weight we have I mean all these things.

um will impact it. >> what are the signs or symptoms that you. may have low testosterone. >> so I would say they're sort of quality. of life things so low energy level sex. drive you know poor mood poor sleep poor. concentration you know I will certainly. admit that these are somewhat. non-specific but if you're having these. you notice these a little bit more. they're bothering you your partner. partner notices them, I think certainly. get screened for low testosterone. And. then again, some more health metrics. So. like low blood counts, so-called anemia, I think that's something that can be a. sign. If you're found to have low bone.

mineral density, you know, with no other. explanation, get screened. Um, and then. again, if you have a history of. chemotherapy, radiation to the testicle. specifically. But, you know, the. symptoms that we'll see are again these. sort of low energy level. Those are. typically the things. Sexual. dysfunction, erectile dysfunction. Those. are things that we want to think, does. this guy have low testosterone? Let's. check it. >> Well, I'm thinking about it from the. partner standpoint because as you're. listing those things off, I was kind of. going like, okay, check, check, check. At least not right now, but certainly.

about 5 years ago, Chris is very open. about the fact that he was struggling. with depression and just was not. himself. Like very low energy, very shut. down, very low sex drive. You know, he. wasn't irritable, but just seemed down. And so it's helpful to hear even though. those are sort of general things that. you may see as a change in your partner, but it's helpful to understand that they. can point to something deeper.

>> Right. Exactly. >> Do you often see patients alone or do. they do they do do the spouses drag them. in? >> I'm always so excited to see the. spouses. I'll say the majority of men. come alone. Uh but anytime I see the. spouse, whether it be for, you know, testosterone related discussions, um. whether it be for like sexual. dysfunction, fertility, I'm always I I. always shake the hand of the spouse and. say, "I'm so glad you're here. This is a. team sport, >> right?" And so then I think that level. of engagement I think is very helpful. And I think I know that. >> the wife is going to be or the partner.

is going to be a huge advocate that's. going to help us get through this and be. more likely we'll get treatment success. >> Well, Dr. Eisenberg, what are the. benefits of going on testosterone? So it. can help with energy level you know. vitality I think you know it can help. with some things and not others but we. do see that consistently we see. improvement in sexual function. So again. such a powerful you know aspect of. quality of life um but it can help with. libido it can help with erectile. function. So those are all things good. you know penile health keeping that can.

help with bone mineral density you know. men that have low blood counts it can. help with that it can improve lean body. mass it can improve metabolic health. There have been some studies that you. know followed men that were kind of. pre-diabetic and those men that were on. testosterone had a lower risk of. developing diabetes. So it can kind of. maintain again longevity in that regard. as well. So I think also sometimes men. talk about increasing their motivation. making them more active. >> And what about some of the things. related to mood or related to energy and.

the things that we see in the negative. in our partners and we're like wow you. don't seem like yourself. Do you see a. boost in mood and muscle development and. just all the other things? >> Yeah, so certainly it can help with, you. know, mood. I think certainly patients. that get a good response. >> um definitely do, you know, they they do. talk about that. People talk about. having sort of better cognitive load as. well. There's different ways that we. give testosterone and so some men come. to the clinic, you know, every few. months for basically a shot or some new. installation of, you know, whatever. treatment we're doing. And they say that.

I know that I needed it because I can't. sleep as well. I can't focus at work and. then as soon as they get on it, you. know, they see that improvement. Again, these are men with low testosterone. So, this is the reason they're having these. symptoms. And so, we see that and also. just lean body mass can help with. strength. All those things, you know, we. do have measurable improvements in. patients that I see, but also we've done. very good trials that do support this um. this improvement. You know, I don't know. if this is something that happens in. your 50s, and I don't know how old you. are, doc, but I notice that when you hit.

your 50s, I'm going to be 58 in a couple. of weeks. Suddenly, people start talking about. testosterone. >> Mhm. >> It starts on walks that women have. together as they're talking about their. partners. >> But I've noticed more and more people. talking about it. And one of the first. things that. I was really wondering about is. how often should men get their. testosterone checked and at what age? >> Yeah, there's many of the different.

reasons that we give it. You know, some. men have uh they don't produce normal. testosterone because of some medical. condition. So, for example, some men. with like testicular cancer lose one or. both testicles. The levels can go down. You know, if there's a history of. chemotherapy, that can affect it. You. know, some men with like anemia has a. very low blood counts, we worry about. that. Men with low bone mineral density, that's another warning sign. So, if. you're having symptoms of low. testosterone, so again, energy level, you know, low energy level, low sex.

drive, mood, sleep, erectile. dysfunction, these are also reasons that. sort of clue you in. Could this be. testosterone? Could this be hormonal? And then you can have it checked. So, just like you go to your doctor and. getting checked for blood pressure, cholesterol, blood sugar. I think it's a. simple test to add on because you know. our levels do change a lot. So getting. checked I think sooner rather than later. is a reasonable thing to do. Probably. you know starting maybe 40 50 but again. if you have some of these other things. you want to check much much earlier. >> And is it just a blood draw or how do. they check testosterone? >> That's exactly right. It's just a blood.

draw. So our levels do change based on. time of day. >> So usually we check it in the morning. ideally in the fasted state. Although, you know, honestly, in my clinic, I'm. not so particular about that, but I say. before 9 or 10 in the morning, and then. we usually also want to repeat it. So, if we get one low level, we'll do. another one. And if those are both. confirmatory and also symptoms, then we. talk about, you know, supplementation. >> The second you said the thing about uh. testicular cancer, I'm like, wait a. minute, my husband had a hernia surgery.

related to I I don't know the technical. name, the balls, so he only has one. ball. And I'm like, whoa, that might. actually be the reason why he has low. testosterone. Dr. Eisenberg, why are we. so embarrassed to talk about this? >> I don't know. I think that, you know, it's gotten a lot better. And I think, you know, to your point, I think people. are more and more comfortable talking. about testosterone just like, >> you know, 20 years ago when Viagra came. on the market for erectile dysfunction. I think that made people a lot more. comfortable. And I think there are. spokesman now. People are very open.

about being on testosterone, all the. benefits. But, you know, I think there's. also just this, you know, feeling of. shame a little bit and guilt some thing, you know, like. sort of concerns about their own. masculinity that if their body can't. produce enough, there's something wrong. And that's absolutely not the case. There's a lot we can do. It's very. common to have these lower numbers. Um, and treatment is certainly underway. But. I was saying with if you lose a. testicle, often times the other one is. able to compensate. It's able to grow. again depending on what happened and. when it happened. >> It's like a super testicle. >> Yeah. So some men with one testicle do.

just fine, but other men obviously it's. a paired organ. So you know, ideally. there's both. And if there's only one, sometimes it's not. >> What does that mean? It's a paired. organ. >> Well, there's two of them, just like we. have two eyes, two lungs, two kidneys. So we have two testicles. It's obviously. super fundamental for our species, right? It's involved in reproduction, but testosterone production is also such. a fundamental role for the testicle and. and you know, making us men. So that's. some redundancy in the system for that. reason. >> I'm going to sound like a real idiot. Mhm. >> I I am almost embarrassed to ask you. this question.

>> Is testosterone produced in the. testicles? >> Oh, primarily. Yes. >> Okay. >> So, the testicle produce most of the. testosterone. Our adrenal glands, which. are these little um you know, endocrine. glands that produce different hormones. that just on top of the kidneys, they. produce a tiny fraction. >> Okay. >> But most of it, 90% or more, is produced. in the testicles. >> Wow. I'd love to ask a few questions. about how specific things. >> can impact your levels of testosterone.

How does poor sleep impact your. testosterone levels? Here we go. Okay, he's got a you've got. a sign. Oh, cool. Poor sleep. >> Poor sleep. So, poor sleep affects. testosterone, you know, through a few. mechanisms, but primarily it really just. blunts our normal, you know, kind of. feedback. So the way that we produce. testosterone is the brain sends signals. to the testicle uh and it kind of senses. when there's enough testosterone. So. there's this elaborate feedback loop and. poor sleep really blunts hormonal.

function just broadly but certainly. involving testosterone production and so. without this sort of normal rhythm that. we see you know higher levels in the. morning and kind of gradually kind of. calming down as we go to sleep without. that basically there's just a general. suppression of testosterone. So that's. one of the main mechanisms. Certainly. men that are very sleepd deprived, we. see that. But even if you're just not. getting enough sleep on a regular basis, you know, ideally 7 to n hours, but. these men that, you know, say they only. need a little or they're, you know, four. to 5 hours a night, we do see that.

suppression, shift work, all these. things that disturb just normal. circadian rhythm can affect it. >> Do you see any kind of connection with. somebody who may struggle with like. sleep apnea and the low testosterone. levels? >> Absolutely. Absolutely. And it, you. know, in some ways it can kind of it. sort of feeds back on itself because low. testosterone is thought to be associated. with sleep apnea and sleep apnea leads. to low testosterone. So in some ways. it's sort of circular. Yeah. >> But we definitely see that association. >> It's interesting and very helpful. How. does excess body fat impact your.

testosterone levels, Dr. Eisenberg? >> All right. So testosterone is made in the testicle. and then in the peripheral tissue some. of it is converted to estradiol and. that's one of the main ways that you. know our body regulates testosterone. production because estradiol is you. think of it as a female hormone but. certainly men have a lot it's very. important for our function as well for. bone health for sexual health but it. also impacts primarily this feedback.

mechanism that our body uses to regulate. testosterone and a lot of that. conversion of testosterone to estradile. happens in fatty tissue. So the more. fatty tissue there is, the more. conversion to estradiol. So you kind of. see this as sort of a leech or pulling. out of testosterone from circulation. So. if we're too big, it can affect that. And also excess body weight can be. insulation. Tesicles are outside the. body because it need to be a little. cooler. Mostly it's for sperm. production, but it can also affect. hormonal health as well. So having. excess body weight, this poor metabolic. state impacts just normal hormonal.

regulation. So can kind of blunt the. normal response that we see for normal. production. If you see a patient go on. one of these life-changing GLP1. medications and they start to lose a lot. of weight, do you typically see. somebody's testosterone levels rise when. that happens? >> Anecdotally, I have seen that. I think. losing body weight from caloric. restriction I think not not if you. starve yourself but if you you know good. diet, exercise, if we see that and they. lose weight, we can also see. improvements. Um, you know, certainly,

you know, GLP1s, I've seen that. beriatric surgery reliably increases. testosterone. So, I think any way you. can lose weight, you know, kind of. getting an ideal body weight, I think. that's really going to be crucial. Anything that's good for your heart is. good for testosterone. >> That makes a lot of sense. How does uh. chronic stress, a lot of people, the. number one word that we're seeing right. now, Dr. Eisenberg, from our audience. globally is exhausted. And I'd love to. know how does chronic stress impact. testosterone levels?

>> Yeah, we get stress from so many things. in our life, right? Work, home, you. know, everything. >> Spouses. >> Yes. Well, >> I'm speaking for myself. I feel like I. really need to lift Chris up now. >> Yeah, I don't want to get in trouble, but yeah, if there's too much stress, we. get this uh cortisol release in our. body, and that basically just blunts the. normal testosterone response. So, you. know, again, it's obviously easier to. say more sleep, less stress, for. example. But if you take that to heart. if there, you know, there's ways that.

you can do that to try and lower the. stress in your life, you can see. improvements in testosterone levels. >> I think it's really interesting that you. use the word blunt. >> Mhm. that you can be doing all the right. things, getting good sleep, moving your. body, you have a healthy body weight, but if you're under chronic stress from. a job or caregiving, or you're going. through something very stressful in your. life, that the rise in cortisol and that. like fight or flight blunts the. testosterone that's there. Can you like.

explain a little bit more about that? >> Your body's just prioritizing survival, right? And so if there's something else. going on and wants you to survive, like. if a tiger comes around, nothing else. matters. You need to get out of there. And so I think we see the same thing. with testosterone, hormonal health, reproductive health, you know, it's just. sort of deprioritized. So you become in. survival mode more than longevity mode. And so that's exactly the response that. we would expect. >> Well, it's helpful to hear from a. doctor. And the reason why is that I.

think a lot of men really feel a lot of. pressure to be providing, to be taking. care of their partner, their family, to. be earning money, to be out in the world. and be successful. And whether that's. societal or self-imposed or both, >> that. men are under a lot more pressure and. stress than I think a lot of us realize. because a lot of them bear it more. quietly. I feel like since guys tend not.

to be that great at talking about the. things that are really weighing on them, you're the one that's seeing how that. can cause health conditions in somebody. >> Yeah. Yeah, I mean I think for these. conditions we're talking about it's. often the first time they've ever gone. to the doctor, the first time they've. ever had really anything's kind of. caught up with them to some extent. Everything's just sort of worked, >> right? I mean the patients that I see, you know, in Silicon Valley, type A, they've been very, very successful, top. jobs, everything is going really well. And here, you know, all the sacrifices.

they've made in their health, getting. little sleep, bearing this unbelievable. stress for a new startup or or what have. you, now they start to see some of these. things fall apart. hormonal health, sexual health, and they feel guilty. They try and, you know, kind of. rationalize it a little bit. But, you. know, I can taking a step back and just. giving them sort of these actionable. things that can be done to try and reset. thing, I think, can be very powerful. >> It's super helpful. Like I'm even. thinking about like some of my male. relatives who are all in the cattle. business or farmers or machinists or.

long haul drivers or police officers and. just the stress of those jobs too that. you bear. It's interesting to really. stop and consider how that's having an. impact on your hormone health and on all. your sexual health. Um so I appreciate. you explaining it in detail. Uh Dr. Dr. Eisenberg, can you talk about the. connection between depression and. testosterone?

>> So, depression and low testosterone, I. think, are very closely linked. And this. is one where we think low testosterone. itself can impair mood. Uh, and but also. depression itself can also impair. testosterone production. Uh and so when. we think about how that would happen, I. think there's a few mechanisms, but you. know really primarily again it's it. leads to the same. sort of lack of ability of the body to. respond to normal stresses and normal. circadian rhythms and it just sort of. blunts that hypothalamic which is you. know a region of the brain that. stimulates this other region called the.

pituitary which then stimulates the. testicle. So all that you know that. signaling is basically lost a little. when these men have depression. And the. other thing I think to think about. depression is a lot of times there are. very effective treatments for it but. those themselves some of these. medications that we talk about are also. very impactful on testosterone. >> meaning they make it rise. >> they make it go down unfortunately. >> Oh no. So you may be treating the. depression with a medication that sort. of lifts the fog but at the same time. it's lowering testosterone which can.

continue to make you feel like you're. moving through sludge as you go through. your day. >> Yeah. It can affect hormonal health and. then sexual health as well. So it is. >> wow. So it's important to understand. that these things can coexist. >> and that it's important to realize that. the treatments for one don't necessarily. take care of the other and vice versa. >> Right. Exactly. So you should think. about them in some ways independently. And so I have, you know, patients that.

you do have depression are on treatment. for it and then we're also treating. their low testosterone and together. hopefully we can get them to a good. place. >> Excellent. super super helpful. Let's. talk about the connection between. alcohol and testosterone. Dr. Eisenberg, so alcohol also is associated with low. testosterone. And what alcohol does. really at every level is blunts the. body's response to the feedback of. regulating normal levels and then the.

signal going down to the testicle, the. testicles ability to make testosterone. All those things are blunted by too much. alcohol. So think moderation. If. patients are telling you they drink a. lot, it's good to try and, you know, regulate. Some men say they have five. drinks a night, seven drinks a night, which is a lot. So which is a lot. >> Yeah. >> Okay, that makes sense. So if and you've. seen that when people curb the drinking, the testosterone can rise. >> It can go back up. That's exactly right. you know, it's it's never quite as easy.

as saying stop and they stop. immediately. But, you know, gradually. cutting down getting in a program, I. think we do see improvements for sure. And it but I think also beyond just. testosterone really it's going to. improve their overall health. That level. of substance abuse and alcohol. dependence is going to have many many. impacts and so they do feel better when. they get through the other side. >> That makes a lot of sense. I want to. talk to parents and grandparents who are. watching right now because school's now. started and you probably have a better. sense of where your kids are thriving. and where they may need a little extra.

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>> I think people are more and more. comfortable talking about testosterone. 20 years ago when Viagra came on the. market for erectile dysfunction, I think. that made people a lot more comfortable. There are spokesman now. people are very. open about being on testosterone, all. the benefits. >> So, guys that end up doing testosterone. or going on testosterone, they it's. literally like they're in a multi-level. marketing organization. They're so. passionate about it and wanting. everybody to get on it. And I've been. very surprised because my husband. >> has been very resistant.

>> to. even considering testosterone. He's just. started talking to doctors about it. And. so I would love to dig in a little bit. to some of the things that at least he's. concerned about cuz I'm sure a lot of. people are concerned about it. I asked. him, "What's your concern about starting. it based on what you know?". >> And he said. that with injections, >> I don't even understand what this means, Dr. >> That with injections, it's a lot of oil.

intake for the next 30 years of my life. Oil intake. and that the long-term. effects of taking it for that long of a. time have not been researched. Those. were his two concerns. The long-term. effect and that it's a lot of I don't. know what oil intake. Maybe that was a a. mistake. Is it oil? >> It is oil. So, the injectable. testosterone No, he's exactly right. Okay. >> Is an oil based um medicine. So, you. basically inject kind of this oil, you.

know, into the in the muscle and you can. do it in different ways. And you know I. usually teach men to do it in their. thigh. If they have a partner can do it. in the buttocks but it is an injection. that's done on a regular basis. For. injections you know the standard is. probably doing every two weeks. You know. you do kind of get this peaks and. valleys. Some men feel that. So. sometimes we shorten the duration. They. do it once or twice a week. >> Uhhuh. >> Um but testosterone therapy has been. done for decades and decades. You know. it's very very safe. Now there's. different ways to give testosterone. So. some men certainly don't like the idea. of injections. Uh, so there longer.

acting injections that can be there. every few months. So that may be more. appealing for him. There's gels that you. could put on, you know, every day. So. again, there's no needle at all. There's. different testosterone pellets that can. be put underneath like usually under the. skin in the hip area is classically. where it's done. So again, there's not. any needles with that. >> Has the pellets been tested by the FDA? Because because I know that we've had. medical experts come on and talk at. least with. >> uh when it comes to women's hormones, there's been several medical experts.

that have come on to say they don't like. the pellets because they haven't been uh. approved by the FDA, but that was a. couple years ago, so maybe things have. changed. >> Yeah, for the men it it certainly has. Yeah, there's no FDA approved. testosterone for women. >> So, Gotcha. >> So, that I think hopefully that's. evolving. I know there's a lot of. advocates for female health that have. seen you know that there is some good. data that it can help. >> but for men it is approved and there's. also uh testosterone oral tablets as. well. So there's many ways that it can. be given. I think most commonly it is.

injections. >> What are the negative side effects Dr. Eisenberg of testosterone? >> Um testosterone has been tested by the. World Health Organization as a. contraceptive. So it can actually lower. sperm production. Does that pretty. reliably probably 90% of the time. >> Wait, I'm confused. Hold on a second. You said testosterone is a contraceptive. >> in men it is. Yeah. >> It lowers your sperm count. >> Mhm. >> Wouldn't it increase it? >> Well, you'd think that, but there's many. reasons that it doesn't. So, uh, if we.

think about how the body makes. testosterone, you know, again, we talked. about the brain signaling the testicle. to make testosterone. >> And then there's a feedback loop. So, your body knows when it needs. testosterone, it's kind of sending the. signal down. So when you take. testosterone exogenously, you know, whether it be injection, gel, any of the. different methods, >> what is ex what is that? >> Oh, exogenous. So outside testosterone. >> Okay, got it. Okay. >> When you do that, your body says, "Oh, there's enough testosterone. I don't. need to make anymore." And so if the. brain doesn't signal the testicle to. make testosterone, it stops doing that, but it also stops making sperm. So those.

signals are very, very closely related. In addition, in the testicle, the. testosterone levels are probably about. 100fold higher. So, if your normal. testosterone is kind of swimming around. in the blood at 500, let's say, it needs. to be, you know, 5,000 or much higher. than that even. And so, when your. testicle doesn't see this super, you. know, 5,000 50,000 level of. testosterone, then you're not going to. make sperm efficiently either because. you need those high levels of. testosterone for efficient sperm.

production or spatogenesis. >> Wow. >> So, there's sort of two different. methods. So, low testosterone in the. testicle and then not that signal to. make sperm. So that's what we h that's. what happens with uh with testosterone. >> That makes a lot of sense. So low sperm. count is one negative side effect. What. are some other potential negative side. effects from taking testosterone? >> There can be skin changes can lead to. oil skin acne can lead to hair loss, breast growth as well because. testosterone is converted to estrogen.

which we do need for normal you know. function but if estrogen levels get too. high there can be some breast growth. So. sometimes we see that as well. Now, there used to also be some concerns. about prostate health and even heart. health with testosterone. But there was. a very landmark study of about 5,000 men. called the Traverse Trial where men were. given testosterone, men were given. placebo. So, you know, kind of a dummy. gel and then just followed to see if. there were higher risks of any of these. adverse outcomes. And it turns out there. weren't. So, we used to worry that if. you add testosterone to men, they're.

going to see more levels of prostate. cancer. That was debunked. And then. there was also some earlier news signals. that men on testosterone a higher risk. of like heart attacks and strokes also. with the study. We didn't see that. So. that's also been debunked. So the FDA is. actually going to update guidance on you. know the prescribing and some of the. warning labels to remove those uh. because I think that was also a barrier. similar to um you know female hormone. replacement. Uh so I think hopefully. that'll help a lot of men as well. >> Dr. Dr. Eisenberg, is it important that. you go see a urologist or your like.

general practitioner and that a doctor's. overseeing this? >> It's so crucial that a doctor oversees. this cuz you can certainly be abused or. misused or misprescribed. You can give. anybody testosterone, but you really. want to make sure you're giving it to. people that need it. Otherwise, you're. just exposing them to all the risks and. none of the benefits. We've seen from. our best evidence that if your. testosterone is normal and you're given. testosterone, it's very unlikely to help. any problem you have. >> Wait, say that again. >> It's such a crucial point that if you.

have a normal testosterone and you're. given testosterone, it's unlikely to. help with some of these other symptoms, you know, that people would come in for. for sexual dysfunction, for example, for. performance. People think that if I take. testosterone, I'm going to be a better. version of me. And that's that's not the. case. There have been studies in the. military thinking about testosterone as. a performance enhancer. Uh, and while it. did help with lean body mass for, you. know, kind of military sort of hero. exercises these men were doing, whether. they got testosterone or whether they.

got placebo, their performance was. similar, their recovery was similar. >> Wow. >> So, if you have normal levels, you. probably shouldn't be on testosterone. And so I do worry that some of these. clinics that'll just prescribe it, right? That's how they make money, right? Is just giving these. prescriptions, upselling, if you don't need it, you shouldn't be. on it because you're going to get. exposed to all these risks that we. talked about, right? Like hair loss, breast growth, you know, higher levels. of, you know, red blood cell count, which can lead to clotting risk. I am so. glad you're saying this because I just.

assumed that if you're a guy in your. 20s, 30s or 40s and you want to look. more ripped and you want to perform. better in the bedroom and you want to be. more energized, just start testosterone. now. It never even occurred to me that. it might not do anything except for. lower your sperm count, raise your blood. count, make you lose hair. Wow. >> Yeah. Yeah. Yeah, I think that's. something that men need to be aware of. that it's not all upside and I think. it's not for everybody. And so I think. seeing somebody that understands all of.

our guidelines from the American. Neurologic Association, the Endocrine. Society, very thoughtful, datadriven. approaches to this. And so I think. that's really crucial. >> One of my husband's big concerns. >> is that once I start this, I have to. >> take this for the rest of my life. And. so Dr. Eisenberg once you start. testosterone do you have to take it for. the rest of your life? >> So I think it depends for men that you. know don't make their own testosterone. So for men like that have lost both.

their testicles or some congenital. conditions where the testicles don't. function properly those men do need to. be on testosterone forever. But for. these other conditions where men you. know have some symptoms low energy level. sexual dysfunction found to have some. lower levels usually we started as a. trial period. I think all the different. societies recommend this. you know, we. start testosterone, we'll check the. levels to make sure you're in a. therapeutic range. Sometimes we'll. switch between formulations so we can. get there so it's convenient. And if. they see the benefit again, which a lot. of men do, they want to be on it because. they do see sort of a better version of.

themselves. But if they really don't. notice any changes, then we'll just stop. it. So after 6 months, after a year, they're not seeing those improvements, then we can stop it. Or if there's other. reasons, you know, we talked about some. of the causes of low testosterone, like. obesity for example. So, if they can. start testosterone, sort of reclaim. their health, >> you know, lose some of that weight, then. the body's own production can kind of. boost up, and then we can wean them off, their body takes over, and hopefully. they're at a normal level after that. >> So, let you bring this up with your. partner cuz I can already hear the.

>> send I I can hear somebody. >> copying the link to this episode as. they're listening to it right now and. texting it to their partner. >> But how do you bring this up? Um, all my. girlfriends and I are talking about this. and the fact that we have all diagnosed. our husbands with low testosterone. Yeah. So, what's the most empowering and. compassionate way to bring this up? >> It's a good question. It's going to be, you know, kind of individualized, but I. think there's many ways to sort of. approach the subject. I think we've.

talked about these symptoms before. Could be testosterone. Have you thought. about bringing it up to Dr. Smith next. time you go in to see her? Um, or heard. this super interesting podcast. um about. testosterone. It sounds like it's really. just uh linked to some function, but. it's also linked to longevity and I love. you. I want you to be there forever. You. know, if you haven't had it checked, it. sounds like it's easy enough to do. Maybe we can do that. So, I think kind. with health, with strength, you know, in. your 30s, everything's super easy to do, but as you kind of getting older, normal. household chores, bringing in a bag of.

groceries, everything gets a little bit. harder. So, I think an easy way to get. checked and maybe there's something that. can be done to to help with some of. those things, too. >> Amazing. Dr. Dr. Eisenberg, thank you. for explaining everything that you just. did about hormone health, testosterone. I want to switch gears and talk about a. topic that can be really difficult to. talk about, which is erectile. dysfunction. >> Yeah. >> What is erectile dysfunction? >> Erectile dysfunction is the consistent.

or recurrent inability of a man to. attain or maintain an erection. sufficient for sexual activity. >> How common is it? It's so common. I. think that, you know, when men come in, they think they're the only one. affected. But if you look at studies, there's a famous study called the. Massachusetts Male Aging Study done here. about, you know, 20 years ago or so that. shows that if you look at men over the. age of 40, over half have some trouble. with erectile dysfunction. >> Over half. >> Over half. And it increases every decade. of life. So men in the 40s about 40%, 50.

is 50%, 60%, 70% have some trouble with. erections. And even men, you know, it. kind of goes all the way down the other. range too. So, you know, men that I see. in their 20s, 30s, probably 15 to 20%. So, it's a very common issue. >> What causes erectile dysfunction? >> There's a host of things. So, ultimately, you know, what erections are. is blood going into the penis and. getting trapped there. And I think it. may be helpful just to. >> Sure. >> We can look at a model here. >> Okay. >> So,

if you can kind of see this. So, this is. the erectile body. There's a urethra on. the bottom here. So, this is where blood. actually goes. So blood go. >> on the top of it. >> on the top. Mhm. >> Okay. >> So these are the erectile bodies. These. are what engorg with blood. >> And essentially what happens is when you. get stimulation whether it be you know. visual, auditory, um. >> touch. Yes, there's many ways it can be. done. Absolutely. um you get different. neurotransmitter release, nitric oxide. release, which releases this other.

chemical called cyclic GMP which then. causes the blood vessels in the penis to. dilate to open up to let more blood in. >> and then that's what leads to erection. So anything that can affect blood flow. anywhere in the body can affect in the. penis. So for example, smoking, diabetes, high cholesterol, high blood pressure, all the things uh. that we think about can can affect like. heart problems can also affect blood. flow in the penis and causing that. Trauma is also notorious for doing that. So for example like um prostate cancer.

surgery can affect a lot of the main. >> nerve supply to the penis. Some bike. saddle seats for example can also put. pressure on some of the main uh nerves. that conduct into the penis. >> Really? Bike saddle seats. Yeah, >> all the cyclists are now going to be mad. at you. >> Well, I think for some men, I think in. general, you know, anything that's good. for your heart is going to be good for. the penis. You know, it's sort of one of. my mantras. So, usually maintaining good. cardiovascular. um health is important. But for some. saddle designs and some men, it can.

actually put a lot of pressure on some. of those nerves and some of the arteries. to the penis. and over a long period of. time. Not everybody, but maybe 20 25% of. men do notice numbness, pain, and. erectile problems, especially after long. rides. So, something to be aware of as. well. >> Hey, it's Mel. I have a crazy amazing. invitation. I want you to come to Vegas. with me and Oprah Win. Please come. because it's going to be the ultimate. aha experience using the sphere as um a.

lighthouse to really ignite the light. within people. they they're going to. feel something really profoundly with a. sense of knowing your greater value to. the planet, to intention, to your. calling and your purpose. That's that's. the whole idea. >> Holy cow. It's at the sphere April 2nd. through the 4th. You do not want to miss. this. It's going to awaken something. incredible in you. You're going to get. exactly what you need. Connection, inspiration, holy cow, community. Your.

mind is going to be blown. Aha. April. 2nd through the 4th live at Sphere. A. call to wonder to joy and the ultimate. aha. Visit ahalive.com for pre-sale sign up. and travel packages. And you better go. fast. I already got my tickets. I'm. going with my daughters and some Oh my. gosh. I'll see you in the audience. How do men feel when they're.

experiencing. erectile dysfunction? >> Yeah. I mean, erectile dysfunction is. such a profound effect on a man. I mean, they feel inadequate, lack of. masculinity. They feel a sense of guilt, like they've done something wrong. >> You know, if they're in a relationship, they feel like they're contributing to. marital problems. They sometimes like. withdraw a little bit. Uh so, we we see. that can lead to depression. Again, these just feelings of inadequacy. So, ultimately, it's a quality of life kind. of function. Um, and you know, reproductive at young age, but you know,

towards the end, it's it's sort of this. way of intimacy and connection with. somebody. And then when you lose that, when you see that you're the issue, when. you feel like you're the issue, you kind. of feel hopeless. A lot of men are not. comfortable talking about this. They. don't realize all the things that can be. done. Um, you know, we see all these. problems. Well, it's an important thing. to stop and really think about because. when I went through pmenopause and. menopause, I absolutely did not feel. like myself. I did not feel attractive. My body started changing in ways that I.

did not like. And it certainly impacted. how I felt about myself. But listening to you, I'm sitting here. thinking, but my vagina still worked. I. mean, I might not have liked what my. body felt like, but I could still be. intimate with Chris. And when you really. stop and think, not just that your body. no longer feels like it's your own and. you can't count on something that you. have for a lot of your life. So, I can.

understand that piece of losing control, >> but also feeling like you can't perform. something. That's one of the most. awesome things about life with your. partner. >> Yeah, I think that's exactly right. I. think and it also something that it just. separates yourself from your part as. you're going through this huge problem. One of the ways it used to connect. >> is now lost. >> and some of these men feel that it's, you know, their problem and there's. nothing that can be done. I think this. hopelessness is something that I. definitely hear about a lot. >> What do you want women in particular to.

know if you are with somebody who is. experiencing erectile dysfunction? >> I think there's two things. I think. that, you know, one is it's very common. So, just know that, you know, man is not. alone. And then I think the other thing. is that there's a lot that can be done. I always like to tell men as long as you. have a penis, we can always make it. hard. So, just let them know that. there's there's therapies that are. available. >> As long as you have a penis, we can. always make it hard. >> Yeah. >> Really? >> That's right. Yeah. >> You can fix anything. >> You can fix anything. Yep. It's there's.

there's things that we do, so you have. to be willing to be very aggressive, but. there's always a therapy. Wow. >> Well, let's talk about what can be done. if you're experiencing erectile. dysfunction. >> All right. So, the first thing we want. to do is look holistically at their. health to sort of understand what. medications are on because there are. some medications that can affect it. Sometimes we see blood pressure. medications are notorious for causing. problems. Sometimes antiscychotics, anti-depressants, those are all things. to think about. Maybe talk to some of. their other doctors. That's one of the.

reasons I do get on the phone with. referring providers sometimes. Um, and. then look at their health, too. What are. they doing? Are they exercising? What is. their diet like? What's their BMI, their. body mass index? Because these are. things that we could potentially. correct. Once we've done that and. everything's optimized as much as. possible, we talked about some. treatments. So the first line is going. to be pills and I actually brought some. here. just so everybody knows. So these are. called phosphodieststerase inhibitors. >> Who? So the things that we hear about.

like Viagra, Selenapil, Bardinophil or. Levitra, Tadalapil, Seialis, these are. the ones that are on TV. Um, so these. are the pills that help with erections. And basically, >> are they all the same by a different. name or do they work differently? >> They are sort of cousins. So they have. the same mechanism of action, the. molecules a little bit different. Some. of their chemical properties a little. different. So some last longer in the. body, some act a little quicker. So. depending on what the goals are, you. know, we prescribe some in different. conditions. And some men do respond. better to one the other. Sometimes men.

have different side effects with all of. them. But again, they're very very. similar, but men kind of react a little. bit differently. >> Do all of these medications impact blood. flow? Is that basically what they're. doing? >> That's basically what they do. The way. that erections work again is, you know, we get the stimulation which lead to. this vasoddilation or opening up of the. blood vessels. So one of the main. signals for that is this medic is this. chemical called cyclic GMP and it's. broken down. So what these medications. do is prevent the breaking down of this. uh this chemical. So the more the.

chemicals there, the more the blood. vessels stay open, the longer the. erection can last, the easier it is to. get erection, all those sorts of things. >> Wow. Can you walk us the drug and like. what are the what's the downside to it. and like why you would prescribe that. one versus a different one? >> Well, >> or and like I don't know if that's a. fair question. I don't like I I. certainly won't turn this into an ad for. anything. I'm just going to come right. out and say it. If you're a woman. >> and you see these ads, a couple things. happen for me. One is where is the.

female version of this? >> And the second one is, okay, >> if my partner starts taking this, is he. going to like pop a boner like. immediately and then I'm going to be. running away from him and now I'm going. to have a different problem than him. being depressed? He's going to want sex. all the time. And so as a woman, I'm. just like now sharing the stuff we say. on a walk when we talk about this stuff. Yeah, that's a good question. No, >> in general, no, this is not going to. give you a permanent erection. Okay, this is basically just going to augment,

you know, a partner's ability to get an. erection when they want it. So, it's an. it kind of helps an on demand erections. essentially. >> Um, and it it can help with performance, you know, for performance anxiety, but. also again when you're just not getting. erections when you need them, when you. want them. >> Gotcha. >> The first one was Viagra. You know, the. way you take it is about an hour before. sex. For most of these, better take it. on empty stomach. So hour before, hour. after you eat makes it easier to get to. keep erections. Um you know also things. to know about is some of the side. effects. So most men do fine but the.

rare side effects would be like. headache, facial flushing, backachches, leg cramps, indigestion or nasal. congestion. So the way they work again. is they open up blood vessels mostly in. the penis but they can do it in other. parts of the body as well. >> So you can get some of those side. effects but again most men do fine. So I. think Viagra is certainly a good one to. start with or Selenapil. Uh Seialis or. Tadalapil is the other one. So this one. lasts a little longer in the system. It's kind of marketed as a weekend pill. So for so for for example Viagra the. halflife like how long it takes to clear.

from our body. So half of it is out of. our body and about 6 to 8 hours. For. seialis it's probably 16 to 18 hours. So. it just. >> it stays around a lot longer. So if you. take a pill on Friday there's still some. on Saturday as well. >> This also allows daily dosing. So you. can give them kind of a lowd dose. medication every day. So it's sort of. always there to help. >> There's also been some studies that show. that it may be cardiorotective in some. ways. It's not FDA approved for that. U. but there's emerging data that you know. if men that are taking the kind of lowd. dose uh seialis every day the lower risk.

of cardiovascular events. And is that. like and I realize we're just kind of. imagining what the connection might be, but do you think that's because if. you're increasing blood flow to the. penis, you're increasing blood flow. everywhere and that helps your heart. >> That's thought to be the mechanism. You. know, originally these medications were. designed as a treatment for blood. pressure, a treatment for anga or chest. pain. >> Oh. >> They didn't work that well at that, but. they this was kind of an unexpected but. very profitable. >> What's happening? It's that's growing,

but this isn't. Okay. >> Exactly. So that's kind of the the. thought about it that it's you know. again cardioprotective by increased. blood flow. But I should also say these. are observational studies. So they. basically you know look back at who was. on seialis for example who was not and. just compared them and those are. different groups. So just to say this. has not been studied in the most. rigorous medical you know trial that we. could do. >> But I think it's at least um sort of. reassuring. Some men do ask is this. going to be safe? Am I going to have a. heart attack when I'm on this? The data. says that that will not happen and may.

even be the other way. And are there. side effects to taking the longer acting. one? >> The same ones. I think the same ones. that we'll see. >> Oh, >> and again, the low dose, maybe it's even. better tolerated. >> So, as a Stanford urologist, when. somebody comes in with erectile. dysfunction, what do you recommend? >> Well, if they've never been on any of. these and we can't correct anything. further than they already have, then I. think I usually start with one of these. medications. >> Gotcha. >> A lot of times when men have seen me, they've already failed these and so. they're ready for second line and third.

line options as well. Oh, and what's the. second line that you would do? >> So, there's also medications that you. can put in the tip of the penis that are. absorbed by the penis. So, if we go back. to to our model here, >> that sounds painful. I'm just going to. say the tip of the penis sounds very. painful to put something in. >> So, just in the urethra, you can uh put. this medication that's absorbed in and. it works in the same way as Viagra does. >> It's like a gel. >> Okay? There's like a little pellet, but. there's also a gel, and it's basically.

just absorbed throughout the whole. penis. It's a vasa dilator, so it works. in a similar mechanism to the pills that. it opens up blood vessels. Men do. describe kind of a tingling or a. low-grade burn. Usually, they get used. to it, say for their partner, any. orifice, and that works probably 60 to. 80% of the time. So, that can also be. pretty effective. >> Got it. And is that something you do. like before you're having sex or you. have to do it every day or. >> It's on demand. So, yeah. So, about 5 to. 10 minutes before you're going to have. sex. it's something you want to do. >> Okay. >> So if those don't work, so the next.

option is injections. So penile. injections are another thing that can be. done. So essentially you take a small. needle and I think in with the GLP1s. people are more used to giving. themselves injections. Maybe not on the. penis but I think there's a lot more. comfort in that and it's a basodilator. you're putting directly into the. erectile bodies leads to this basilation. that works probably 90% of the time. >> 90. >> 90. Now what I'll say is that there is a. huge psychological barrier to putting a. needle in your penis. But if men are. willing to do it, it's very very. effective.

>> Wow. >> And you do it. It's like an ondemand. thing. >> It's an on demand thing. It's it's such. an interesting story because the first. time it was ever discovered and brought. to sort of the medical world was by a a. pharmarmacologist at a national urology. convention in 1980. And what he did is. he injected himself in his hotel room. He went down, delivered a lecture, and. then lowered his pants. >> Oh my god. >> And showed the audience. And beyond. that, he actually walked up and down the. aisles inviting people to inspect it. And you can imagine sort of the level of. >> his penis. >> His penis.

>> Well, it is a audience full of penis. doctors. So you guys know what they look. like. >> Yeah. But the the amount of like shame. and fear, right, that you would normally. have doing something like that, but the. medication is so powerful. It's able to. sort of suppress that response that. would normally cause erections to go. away. So it is a very effective. medication. I certainly don't advocate. men injecting themselves and walking. around naked, but just to say that it. does work. >> Wow. That's I mean he's he's doing one. for all the urologists and men out. there. >> It's a very famous urologist.

>> But I but most conventions are in Vegas. So when you said there was a urologist. in a hotel room in Vegas injecting. himself, I thought, where the hell is. this? You knew where this was going? >> No, I didn't know where this was going. I thought it ended sort of like that. hangover movie. But no, I'm glad to hear. that it was something that he was. willing to not only try, but it had such. a profound breakthrough that he was. willing to remove the shame.

>> and show all of his colleagues that were. at this conference. >> Yeah. It's a very important medication. and a very important option that we give. men. >> Wow. What made you want to go into. urology? Well, I like the problems that we deal. with. When I looked at andrology. specifically, so hormonal, sexual, reproductive health, thought there was. really a lack of treatments that were. available. There were lots of research. opportunities to try and do better by. these men. So, I just found that really. fascinating. Just the powerful impact we. can have on their quality of life, their. overall health, sense of self, all that.

really got me excited about the field. >> That's really cool because it's a it's. an important and unique specialty. Um, I. would love to have you what I've heard. you talk about the connection between. having sex. >> and prostate cancer. >> Can you unpack that for us? >> Yeah. So, there was a famous study that. sort of looked at this 30 years ago now. and it said that the more you a man. ejaculates, the lower the risk of. prostate cancer. So, really fascinating. So what they found is that men that.

ejaculated. 20 times a month or more compared to. those less had about a a 20% lower risk. of developing prostate cancer. >> 20% lower. >> Mhm. So this was a study of about 30,000. men followed for about 20 years and they. saw this pretty consistently. All the. different ways they looked at it, all. the different age groups. This has been. looked at in other studies as well. Hundreds of thousands of men it's been. supported. So why this is is not. certain. It doesn't seem to be tied to. how a man ejaculates. Whether it be sex, masturbation for example, uh all those.

seem to give the same trend. Um it's. thought maybe you're kind of clearing. toxins, you know, from seinal fluid, preventing crystal formation. I think. mechanisms are not clear, but we do see. that association. Now, 20 ejaculations. is a lot a month. You know, maybe for. teenagers, it's a little easier, but you. certainly as you get older, it can get. more challenging. So, I don't want to. prescribe that for everybody. It's. something to do. But it's an interesting. observation. And you know, when men ask, can I masturbate too much? For example, this is sort of the study that I always.

relay that it's probably not harmful. Again, there's some studies say maybe. it's even beneficial. The other thing I. was going to say is that there's also. been studies linking sexual activity um. and a number of ejaculations and orgasms. to longevity as well. We've talked a lot. about how, you know, sexual function is. related to overall health. So it may be. kind of a marker for that. But there. have been studies that show that men. that have sex maybe once or twice a week. compared to men that have sex sort of. rarely, you know, less than once a month. live longer, live twice as long in fact.

And this is again looking at men in. their, you know, when they started. observation kind of in their 50s60s. If. you follow these men, they reported, you. know, regular sexual activity, they'd. live longer. And that maybe having a. partner, all that things were very. beneficial to longevity. Um, but I think. it's also something to be aware of. So. another reason, you know, maybe they get. checked out is that, you know, in. addition to sort of the the joys of sex, which obviously are numerous, it's I. think when you think about longevity, which is a huge push now in our culture, which is great, you can also see some.

benefits for that as well. >> Well, I'm glad you said the thing about. relationships because it is true and so. many renowned medical experts have come. on to talk about the connection between. >> your relationships long term. and the. quality of your life and that when you. don't have great relationships as you. get older and loneliness kicks in that. that is devastating to your physical. health. And so I'm really glad that. you're also highlighting that.

having a healthy sex life, being able to. connect intimately with another person, >> you're right, it's not only one of the. great joys in life, but it is a sign. >> that you have relationships that are. meaningful to you on a consistent basis. Yeah. >> And that intimacy isn't just about the. orgasm, it's about the quality of your. life. >> Yeah. And that's so so crucial. I think. this sort of the studies I always like. to quote are from Scandinavia where they.

have these great population birth and. death registries. So the famous one I. quote from Sweden where they looked at. what effect having a partner has on a. man's longevity and mortality and having. kids. And it turns out if our ideal is a. man that has a partner is living with. her and kids that are living with them. If you get rid of having a partner, the. chance of that man dying goes up 60%. And if you get rid of kids, we see the. same thing. If a man doesn't have any. kids compared to someone that does, 60%. higher risk of death. >> Wow. >> And if a man doesn't have a partner, have children, about a three-fold higher.

risk of death. So, I think to your. point, relationships are so so crucial. They take care of you, but also it just. gives you purpose, right? Hm. And if. you're silently struggling. >> with either issues related to low. testosterone. >> or you're struggling with issues related. to erectile dysfunction which is making. you pull back from those relationships. that has a profound impact on the. overall quality of your life is what. you're saying. >> Absolutely. Absolutely. >> Well, I can see why this is critical.

>> And it's not just about sex. It's not. just about your mood or your energy. It's about your overall health. >> Yeah, exactly right. Hey, you want to be. there as long as you can for your. partner, for everybody, for yourself. So, I think that's one of the reasons. you should pay attention to this. And. this can be like a check engine light, right? That if erections are not as. good, it's not just a convenience issue. This also may be sort of a sense of how. you're doing. And so, you should talk to. your partner, talk to your doctor, go to. a doctor, and get evaluated because I. think powerful insights you can get and. there's a lot that can be done. you do a.

lot of work in male fertility. >> and I'd love to have you speak uh to. what we might find surprising. >> about the issues that you're seeing with. male fertility and if you're not even. thinking about having children right now. why is male fertility an important thing. to pay attention to. >> I'm super passionate about male. fertility as well there's been lots of. studies that show that sperm counts are. going down globally.

So there's a famous study in the '9s. that suggested this was very criticized. They updated it 20 years later still. somewhat criticized. And then just a. couple years ago they did one of the. biggest updates they've ever done have. and showed this all over the world. So. in western countries, eastern countries, really every continent, we see this. decline in sperm counts. And obviously. the question is why? So I think if. you're a male, you should definitely. care that our sperm counts are going. down. Um, and it's still somewhat. controversial how fast that decline is, although the data suggests that it's.

accelerating in the last probably 20. years. We also see declines in. testosterone levels. We see changes in. premortal timing in boys, higher risk of. tesus cancer. So, I think male. reproductive health is declining. So. even if you're not sort of immediately. planning for pregnancy, there's so much. that we can do to help optimize. fertility that I think that you know you. should be aware and kind of get a sense. of you know where you are to get checked. out because it gives us an opportunity. to sort of improve things. I think one.

of the problems just from an education. standpoint when you look at couples that. are having problems with infertility. about half the time there's a male. factor. At a societal level, usually. everybody thinks that all fertility is. related to female partner issues. And so. a lot of times the male's never. evaluated. In this country, probably a. third of the time a male is never seen. by a specialist, never checked, you. know, bypassed to go, you know, through. IVF, for example, which is very. powerful, very effective, but it kind of. removes the opportunity to try and. optimize the male to try and figure out. what's going on. Some things can be.

corrected. Sperm counts also are very. tied to overall health. And so it may. also be kind of a check engine light. Your sperm count's low. But what else is. going on? You know, what do we need to. check out? Is there something really. dangerous going on? There's different. anatomic factors we can look at. We can. measure hormonal health and optimize. that. Look at their overall lifestyle. factors. Look at different medications. are on looking at different health. conditions. So, I think the earlier you. can do that, the better. Because what we. found is that when men come in to see. us, they've already been struggling with.

their partners for a year or more, and. they don't want us to do anything. because they don't want to wait any. longer. It takes 2 to 3 months to make a. sperm, but they wanted to get pregnant a. year ago. So, they don't want to wait 2. months for a surgery or a pill or. anything. They're ready to just go. And. so, I think that's really a disservice. to men to male reproduction because we. can't really fix things. Puts all the. burden on women. We've seen sort of an. abundance of awareness of male. fertility. There's a lot of home testing. now to make it easier for men to see.

where they are. So, you don't have to go. to a doctor anymore. They used to send. patients to like bathrooms to collect. things that are super uncomfortable. There's no question. So now you can just. do it at home. You get the results. immediately. It's very personal, very. private, and I think that's really done. a great job for for awareness of this. and also just, you know, making it more. accessible for everybody. >> Dr. Eisenberg, I want to make sure I. followed the statistics you said and I. got them right. >> Okay. So in 50%. of the cases where there are fertility. issues, it is a male issue, not a female.

issue. >> Right? Well, so what I should say is. that it's all causes 50%. So that's 30%. only men, 20% men and women together. But there is a male factor that we can. optimize in half of these cases of. fertil fertility problems. >> Wow. So in 50% of fertility problems, it's either the dude or it's the woman. and the dude together. And what you're. saying is that what happens for a lot of. couples is when you are having fertility.

issues, you focus on the woman, you race. to IVF. Instead of also looking at this. 50% which is there could be a lot of. issues with your partner. >> That's right. >> Wow. >> Yeah. Yeah. And again, there's so much. that could be done. I think there's, you. know, standard evaluation and if you. look at guidelines like by the American. Society of Reproductive Medicine, the. American Neurologic Association, everybody says you should check out both. members of the couple simultaneously. But for different reasons, I think a lot. of it is just knowledge from patients,

from some of the providers. They just. never think to check the man out. So, it's it's a huge opportunity and I think. a disservice to men. >> Wow. >> And women. >> I it's a disservice to everybody. I'm. really happy that you explained it like. that. So if you're having fertility. issues, both of you should get checked. out immediately. Can you talk about. men's pelvic floor health? Why is it. important to pay attention to and what. is pelvic floor health? >> So there's a lot of muscles in the. pelvic floor that really control.

everything. So they control erections, ejaculation, orgasm. They're also. involved in urine control, bowel. control. So it's very important to sort. of be aware, you know, how important. they are. And a lot of times we just. take it for granted. But there are. sometimes where it can lead to problems. So there could be chronic pelvic pain. We see sometimes some scrotal pain is. due to spasms in some of these muscles. After pelvic surgery like prostate. removal for prostate cancer for example, we teach men how to do some pelvic floor. exercises to strengthen some of these. muscles to try and regain some of the.

urinary control that's sometimes. compromised after surgery. So I think. that there's uh a lot that could be done. having some understanding awareness that. it's very important for men and for. women to know that. >> Let's talk about peeing. So as you age, do you start to drip? Like do you pee. more at night? Like what do you do if. your partner is getting up three or four. times a night to pee? >> Yeah. So yeah, urination definitely. changes with age. So we do see that that.

men wake at night. There's different. reasons for that. The bladder is under a. lot more pressure because as we age the. prostate gets bigger. So the resistance. of the outflow tract. If we go back to. this model which I think is super. helpful. So we see we make urine uh collects in. the bladder then it goes through this. channel the the urethra out. And so this. is the prostate. So you can imagine as. we age the prostate can get bigger out. but it can also get bigger in. So this. can narrow this channel make it harder. to empty. So the bladder has to work a. little harder. It gets [ __ ].

Sometimes it can reduce capacity, the. ability to fill and so sometimes we just. have to wake up at night. Sometimes at. night like with obstructive sleep apnea. or other things, we produce more urine. at night and so that also makes us have. to wake up more. So once a night's. pretty normal, but when it starts to be. a little more disruptive, two, three, four times, I think definitely you want. to get evaluated because there's. different medications that can help with. that, different treatments that are. available. So there are things that can. be done. What about standing there and. it's just taking a lot of time for. anything to come out?

>> It depends how much that bothers you. I. think if you empty your bladder, it's. probably not a problem, but if it does. bother you, bothers your partner. I. mean, there's things that can be done. I. think one of the big issues is just the. prostate resistance. It's harder for. everything to to relax on time, to. contract on time, and so there's. medications that can help optimize that. a little bit, too. So, that's another. option. If you're having trouble with. frequency or emptying your bladder, could it be a sign of a deeper issue. with the prostate? >> Anytime men have any urinary symptoms, we always want to evaluate to make sure. there's nothing we're missing. So, we.

usually check a urine test to make sure. there's no signs of infection, inflammation, those can certainly be. some of the symptoms that we see. A lot. of times, again, depending on the age, we'll check the prostate specific. antigen or PSA. Gives us a sense of how. big the prostate is, but also it's a. screening test for prostate cancer. Usually this is more of a quality of. life issue, not a life and death issue. So I think that's what men should be. aware of. Your partners should be aware. of that as well. Um, and but you know, talk to your doctor about it. I think. that it is something that men just kind. of think is normal and they just tend to.

live with it. And if it's not worth a. pill, you know, maybe that's fine. But. there's usually treatments that are. available that are very effective. >> That's super helpful. Are there any. warning signs that we should be aware of. that may indicate prostate cancer? Usually, most commonly, prostate cancer. is uh is diagnosed just with a blood. test. So, it tends to be asymptomatic. and it's just done by screening. So, if. there's a strong family history, usually. we start screening a little bit earlier. Um but otherwise, guidelines about.

starting in your 50s just with an annual. or semiannual test. >> Terrific. That's so helpful. You have. taught us so much today, Dr. Eisenberg. If the person listening. does just one thing. after hearing all of this, what do you. think the most important action to take. is? >> The most important thing I would say is. just to be aware of your health. Realize. that you have agency, that you can. improve things. Take an internal. inventory because we're not just talking. about sort of quality of life. I think. some of these things could have real.

impacts on longevity, too. Try and be. more active. If you haven't seen a. doctor before, you don't have to go. every year, but getting checked is. important to find out what your blood. pressure is, what your cholesterol is, because all those things tie so closely. to some of these issues that we talked. about, testosterone, sexual function, reproductive function. So, I think those. are also going to be really crucial. And. just know that you can improve them. >> Dr. Eisenberg, what are your parting. words? >> First, I want to thank you for just. highlighting men's health. I think men's. hormonal health, sexual health,

reproductive health. I think it's so. important. It's not talked about. Um, but I just want to let everybody. know that this is a very important topic. and something that a lot needs to be. done about and can be done about. >> Well, what I love about your work and. the way that you talk about it is you. make me believe that you can do. something. The fact that when I asked. about uh erectile dysfunes, we can work this out. and knowing that.

you don't have to live. >> Mhm. >> in shame. You don't have to live feeling. low mood, low energy. That there may be. and there probably are underlying. conditions that medical experts like you. have incredible tools and different. medications that can truly help you not. only feel better, but live a more. fulfilling life. I just think that's so. cool. It is really cool. >> Thank you for taking time out of your.

schedule. Thank you for doing the. research that you do and thank you for. coming here and educating all of us and. giving us the ultimate guide in my. opinion to male hormone health and also. helping us understand why it actually. matters. I love that it's tied to. longevity. I love that it's tied to a. sense of agency over yourself. And I. love that there are things that you can. do for every issue that we talked about. So, thank you. >> Thank you, Mel. This has been a.

pleasure. >> You're welcome. And thank you. Thank you. for making time to listen to this. Thank. you for being generous with Dr. Eisenberg's teaching and all the time. and wisdom that he poured into you. And. thank you for sharing this with the men. in your life that you care deeply about. And in case no one else tells you, I. wanted to be sure to tell you that I. love you and I believe in you and I. believe in your ability to create a. better life. And I'm going to send this. to my husband, to my brother, any man. that you send this to.

This could help him create a better. life. And so, thank you. Thank you. Thank you for making the time to be. here. Thank you for watching all the way. to the end here on YouTube. I love. bringing you worldrenowned experts. I. know you love it, too. Thank you for. hitting subscribe. It's the best way for. you to support me and all these experts. that fly in around the world for one. reason, to help you and the people that. you love create a better life. All. right, I know you want to watch another. amazing episode of the Mel Robbins. podcast. You're going to want to watch. this one next, and I'll welcome you in.

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