Low Testosterone, Poor Sperm, and the Silent Crisis in Men’s Health | Justin Houman

Dr. Houman: [00:00:00] If you're thinking about being on testosterone replacement therapy as a young man, just realize that it comes with some form of fertility consequences. Testosterone replacement therapy suppresses or really inhibits your ability to produce normal healthy sperm. If you are a young man experiencing erectile dysfunction, that's not normal.

Sometimes it's hormone based. A lot of times it's just psychogenic. You're in your own head about it being evaluated by somebody early on. It could at least, again, shift the tide or get you outta that cycle so you could normalize your sexual life again. 

Dr. Brighten: What can men do to support their sperm health, to support their mitochondrial health?

To have, you know, everybody wants to brag the strongest, best swimmers. 

Narrator: Dr. Justin Hooman 

Narrator 2: is a top urologist and nationally recognized expert in men's health, male fertility and sexual medicine fellowship trained at Cedars-Sinai and u. CLA. 

Narrator: He's at the forefront of treating erectile dysfunction, testosterone imbalances, and infertility, using the latest medical innovations and minimally invasive techniques, 

Narrator 2: a trusted voice in the field.

Dr. Hooman blends cutting [00:01:00] edge science with a compassionate, no shame approach, 

Narrator: empowering men to take control of their health with confidence and clarity. 

Dr. Houman: Period. In your twenties, your thirties, and you're thinking about having kids and you have low testosterone, there's a whole different way of treating your low testosterone symptoms.

There's a. Regimen we put them on, which is where we decrease their 

Dr. Brighten: testosterone is really all the buzz, and we are seeing younger men getting on testosterone. What do you wish men knew before they started a testosterone prescription? 

Dr. Houman: The most important thing I could tell you is. 

Dr. Brighten: Welcome back to the Dr.

Brighten Show. I'm your host, Dr. Jolene Brighten. I'm board certified in Naturopathic endocrinology, a nutrition scientist, a certified sex counselor, and a certified menopause specialist. As always, I'm bringing you the latest, most up-to-date information to help you take charge of your health and take back your hormones.

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Don't forget to subscribe, leave a comment, or share this with a friend because it helps this podcast get out to everyone who needs it. Alright, let's dive in. Is every cranky low energy not in the mood guy, low on testosterone, or are we just using that as a scapegoat these days for men who are a hot mess?

Dr. Houman: Uh, well, it goes both ways. Um, if you are feeling that [00:03:00] way, your mood's off. To your point, cranky, depressed, anxious, at the very least, it's worth checking your testosterone levels to see if that can be the cause. Um, because if it is, there's many correctable, there's many things we can do to correct it, but definitely worth looking into.

Dr. Brighten: So how does one check their testosterone? And so if a man is feeling this way, or most likely, the women listening right now are like, this is my partner, my husband, my brother, my father, a man in my life. 'cause we know, why do men seek help? For their health. It's usually a woman saying, yeah, I, I think you should get that checked in on, um, what should they be talking to their partner about?

What should men be asking their doctors for? 

Dr. Houman: So it's super easy. Checking your testosterone levels really comes down to just doing a simple thing is getting a blood test. Mm-hmm. Ideally, you want to do it before 10:00 AM. Um, for the male cycle, the way it works, the male hormone cycle, your peak testosterone levels are in the morning, and as the day progresses, your testosterone levels go down.

So you want to check it ideally before 10:00 AM to get a good, good, um, baseline of where you're [00:04:00] at. You want to do it twice? Uh, ideally you wanna do it twice. So you could have two readings. You never want to react just based on one reading. So a simple blood test is all it really takes. 

Dr. Brighten: When you say doing it twice, is it like, you know, people I imagine are gonna be like, oh, so just like, go the next day, or you do it a week apart?

Dr. Houman: I, I generally say try to do it at least a week or two apart. Okay. Um, testosterone levels are gonna fluctuate. Seasonally, um, if you're more stressed out, poor sleep, even if you're not exercising the way you used to. Mm-hmm. There's, there's these variations. So if you, you wanna get two sample, two sample sizes, or at least two data points, at least seven days apart.

Ideally two weeks apart. 

Dr. Brighten: Okay. And what are you looking for? Is this the total testosterone? Free testosterone? You're looking at other markers. 

Dr. Houman: Great question. So we're learning more and more about testosterone. How testosterone are the different ways in which to gauge it? So total testosterone's, generally what we've always used, which is we say the range is anywhere from 300 to a thousand.

Mm-hmm. And that's very unfair because. What, what I need for testosterone. I may need to be in the five, 600 range. Whereas let's say an NFL player, [00:05:00] he's gonna be in the seven to 800 range. So you don't wanna necessarily treat the number, you wanna treat the symptom. So total testosterone is wide range. Now we know, as we are learning more and more about this, free testosterone is even more important.

Free testosterone or your bioavailable testosterone mm-hmm is really the the key, the key number you wanna look at to see. 'cause that's how much you're actually using so many times. A guy will come in, he has a normal total testosterone, but when you look at his free testosterone, it's low. And in those scenarios, when they are having symptoms with a low free testosterone, you want to treat them.

Dr. Brighten: What is leading to that low free testosterone. So your testosterone is normal. You're making it, but you can't actually use it. What are the most common things you see? 

Dr. Houman: Scientifically free testosterone is, or total testosterone is, is. Bound to a hormone called your sex hormone binding globulin. Mm-hmm. And depending on how much of that you have, that changes your free testosterone.

So if you have more of this protein, this binding globulin that's binding your testosterone, you're gonna have a lower free testosterone. [00:06:00] Things that cause that. Really a lot of it, like obesity, liver disease. Mm-hmm. Just overall being like metabolic disorders. When you're unhealthy, you're gonna have more of that, therefore you can have a lower free testosterone.

Dr. Brighten: Mm-hmm. You mentioned seasonality with testosterone, and I'm curious, what seasons can people expect to see lower testosterone in men? So 

Dr. Houman: usually the fall and the spring. Mm-hmm. Or excuse me, the fall and the winter. 

Dr. Brighten: Okay. 

Dr. Houman: So when it, when it's colder out. When you're not engaging in the types of activities that.

Normalize or boost your testosterone levels. Going outside, exercising more. You know, when, when in the winter time the days are shorter. Mm-hmm. So a lot of guys are skipping that, that morning or afternoon gym session. They're not spending time outdoors getting that vitamin D that's important for testosterone production.

Uh, usually it's in those, those times when, in the spring and the summer. Mm-hmm. Your testosterone levels are a little higher. 

Dr. Brighten: When should people test their vitamin D then? Because if you're saying sunlight exposure, vitamin D is needed for testosterone, prote production. I would imagine [00:07:00] there maybe is a seasonality that you like to test patients for their vitamin D.

Do you just check it if somebody has, I. Low testosterone symptoms? 

Dr. Houman: I do. Okay. I try to check their testo, their vitamin D levels. Vitamin D levels don't fluctuate the same way they do with, especially, they don't fluctuate the same way they do as testosterone levels do. Mm-hmm. Especially if you're on some form of supplementation.

So there's no time of the day or time of the year when it comes to vitamin D levels. 

Dr. Brighten: Mm-hmm. But do you ever check people if you're like, I know this patient has issues like every winter, maybe I'm gonna check them in the fall. Or if you know they have issues, you're like, listen, just. Start supplementing now or get yourself some, you know, sun go to like, you know, Mexico and get some sunlight exposure.

Dr. Houman: Well, luckily here in LA we have a lot of sun. Yeah. But, but vitamin D, you know, I just tell them to stay on the supplementation throughout the year. Vitamin D is not just important for hormone levels, your immune system. Mm-hmm. And a bevy of other things. 

Dr. Brighten: So. Testosterone is really all the buzz, and we are seeing younger men getting on testosterone.

What do you wish men knew before they started a testosterone prescription? [00:08:00] 

Dr. Houman: The most important thing I could tell you is knowing what you're getting yourself into. Okay. So a lot of these testosterone is all the buzz, like what you're describing. Mm-hmm. It's been, it's been like this for decades and it's only picking up steam.

The key thing here that I would say is if you're, if you're thinking about being on testosterone replacement therapy as a young man. Just realize that it comes with some form of fertility consequences. Yeah. Testosterone replacement therapy suppresses or really inhibits your ability to produce normal healthy sperm.

Dr. Brighten: Mm-hmm. 

Dr. Houman: It's very important to know that. 

Dr. Brighten: No, it's very important to know that, and I'm glad you bring that up because we see a lot of the time in women's medicine. Women are struggling to get pregnant and doctors only focus on the woman and they don't think to check sperm counts. I've had patients where, you know, they're struggling.

It's been more than six months, more than a year sometimes, and I ask about, well, have they done a semen analysis? And they say, well, no. Yeah. And they get that done. There's hardly any swimmers present to even make it there. And as it turns out, they've been on [00:09:00] testosterone replacement therapy. So, exactly.

Can you talk a little bit more about, you know, how does that impact sperm and what should someone consider if they do wanna get pregnant? Like when should they come off testosterone or what does that look like? 

Dr. Houman: So a lot of great questions here. So the, the idea with testosterone placement therapy, if you're a young guy in your twenties, your thirties, and you're thinking about having kids and you have low testosterone mm-hmm.

Which, which is quite common these days. We know a lot of young guys are having low testosterone 'cause of lifestyle issues. There's the important question you have to ask yourself is if you're interested in having kids, there's a whole different way of treating your, your low testosterone symptoms. Yeah.

Naturally boosting your testosterone levels in a very different form. Unfortunately, there's a lot of clinics these days that provide testosterone placement therapy. Mm-hmm. To young men who are actually interested in fertility without telling them the consequences. In that scenario, to your point, I have a lot of patients who come in who, they're in their twenties or thirties, young, healthy, and you check their sperm, their, their steam analysis, zero sperm.

Mm-hmm. [00:10:00] When you ask 'em, they have low testosterone. They have, they're on testosterone replacement therapy. It, there's a, there's a regimen we put them on, which is where we decrease their, uh, synthetic or exogenous injections of testosterone. Mm-hmm. While at the same time ramping them up with different medications.

One of 'em being H cg. Mm-hmm. Another one being clate or an clomophine. All these things tell the testicle, produce more testosterone, which is good for testosterone and good for sperm count. 

Dr. Brighten: And what does this look like? Is this like a three month protocol? A six month protocol? Because when women want a baby, it was yesterday.

Yeah. And so we need to set realistic expectations. 

Dr. Houman: It's, so we, I generally tell guys it's anywhere from about three to six months. Mm-hmm. Sometimes it's as early as, yeah. Like I said, three months. Other times it could take as long as seven or eight months. 

Dr. Brighten: Yeah. 

Dr. Houman: Um, it, it happens. Uh, you know, we have, we have one published study on this that says essentially 90, almost 98% of men, uh, are able to produce sperm again.

The only, the only downside to it all is no one really feels as good [00:11:00] on these, this other regimen compared to what they felt on testosterone replacement therapy. It just, testosterone replacement therapy feels incredible for a lot of guys. So those three to six month, that time, it's kind of rough for the men.

Dr. Brighten: Mm-hmm. Testosterone replacement therapy feels amazing for anybody who's low on testosterone. Like women as well. Right. Who do it. So I can definitely, I mean, we know how it affects. Mood, motivation, executive function. So I can imagine for people listening, they're like, oh, this is. That's like rough, uh, to have to think about tapering off of testosterone.

So if somebody is facing down the low testosterone, uh, lab, what can they do naturally? Like what's the alternative to starting testosterone 

Dr. Houman: as a young guy? Yeah. Oh. So it's really, you're 

Dr. Brighten: like so much. Yeah. And it, 

Dr. Houman: and it's, it, it, so the easiest way of doing it is, is changing your lifestyle, right? Mm-hmm. So I always try to break it down.

Four reasons why guys have low testosterone. Um, it really comes down to your diet. You wanna eat a complete diet, well-balanced diet of healthy fats, [00:12:00] lean proteins, and, and complex carbohydrates. Mm-hmm. Sleep is a huge one. Trying to get at least seven hours of sleep. They've done numerous studies on this, where they compared guys who get.

Two hours less of sleep versus those who get two hours more, their testosterone levels are 150 to 200 points lower. Whoa. Yeah. Um, exercise. You always wanna do a combination of heavy weight lifting with cardio. And then lastly. It comes to, um, stress levels. Mm-hmm. The same precursor hormone that goes to testosterone is also going towards the cortisol, which is a stress hormone.

So if you could adapt those four things, you wanna change those things in your lifestyle, that's probably the easiest way of doing it, or at least the longest lasting way of doing it. If you don't, then we could talk about medications. Most common one is CH Clomid. Mm-hmm. Clomophine, which is, it tells your testicles, it stimulates your brain to release hormones that tell your testicles, produce more testosterone.

HCG is an injection, does a similar thing. Um, and then end clomophine, which is a, a newer compounded medication. All of these do the same thing. Tell your testicles, produce more testosterone. 

Dr. Brighten: When it [00:13:00] comes to testosterone. It's such a key hormone in building muscle mass and helping your exercise performance, which is one reason men might choose to use it.

What do you say to men who are like, I, I don't feel like I can get the gains at the gym like you're telling me to exercise, but I feel like without the testosterone, I'm not gonna get where I want to go. 

Dr. Houman: So, uh, uh, this is what I'll tell them. So we have this thing called the Clomid Challenge. Mm-hmm. Like the pill I was referring to where I'll put these guys on, um, Clomophine or, and Clomophine for anywhere from three to nine months, they're taking the pill every other day.

It's ramping up their testosterone levels while that testosterone's at where they should be. They're doing those four things I talked about, eating, right, sleeping, exercising, reducing their stress when they're doing those things. They'll, they'll maintain their testosterone levels at that point. Mm-hmm.

Then we could talk about coming off the medication and if they're doing those four things yeah. They'll be able to maintain healthy testosterone levels, get those gains, feel that that pump in the gym, and ultimately maintain a good hormonal balance going forward. 

Dr. Brighten: Mm-hmm. For [00:14:00] men who are listening to this, now, you listed off, you know, several symptoms of low testosterone at the beginning.

If they're experiencing this, how do they approach their provider to have this conversation? 

Dr. Houman: Yeah, so it's a. When it comes, a lot of providers are unfamiliar about prescribing some of these medications I'm talking about. Mm-hmm. The Clomophine and Clomophine HCGs. Um, there's, there's this new field, or it's a newer field within, uh, urology, at least called Men's Health Urologists.

We're all, we've all, we're all fellowship trained in this, in the topic of, of boosting up men's testosterone levels in a natural, um, way. 

Dr. Brighten: Mm-hmm. 

Dr. Houman: Um, that being said, if your primary care doctor. It's uncomfortable. Ask for a referral to see a men's health urologist 

Dr. Brighten: mm-hmm. 

Dr. Houman: To discuss these topics because we're all very well versed, we're, we're not, as we understand that the plight or the difficulties when you have low testosterone, and more importantly, we understand the therapeutics that could really boost your testosterone levels in a healthy, safe way.

Dr. Brighten: Do you think it's easy for men to [00:15:00] approach this conversation with their providers, or is this something that men struggle with? Like it, I can imagine when you are feeling like you have low libido, low motivation, you're having trouble putting on muscle mass, some of these symptoms that can fill, like this is a knee issue or something's wrong with me, and it could be a hard conversation to actually approach a provider about 

Dr. Houman: a lot of.

It's, there's a lot of taboo topics that engage within in men. Mm-hmm. Uh, fertility, sexual health, when it comes to hormonal health, luckily it's not too, men are very open about discussing it, especially the ones who are, you know, have, uh, at the gym. Rats, the ones who exercise a lot, because they engage in these topics at the gym anyway.

Um, and they, they're able to discuss it with them. So when it comes to discussing it with us, it's quite, it's quite easy for them. 

Dr. Brighten: Mm-hmm. I'm curious, you talk a bit about leveraging wearables. When it comes to men's health and are there any like data point points where people can see with their wearables where it's like, that might be pointing towards a testosterone issue or something that [00:16:00] points towards you need to talk to a doctor?

Dr. Houman: So the, when it comes to the wearables, they're obviously getting better and better. They're the sleep one, the ones. Like eight sleep, for example, which tracks your sleep, uh, your sleep that the AA rings, which do sleep and stress to me. Um, there's, there's two data points I like to look at is sleep. Mm-hmm.

As I mentioned is trying to get a 7, 7, 8 hours of sleep a night is very, very crucial to your hormone levels. And then number two, stress. So for example, you know, this aura ring measures your stress. It tells 

Dr. Brighten: you Yeah. 

Dr. Houman: It tells you a lot. And it, and I, and when you measuring your stress levels throughout the course of the day.

You know, single days of, of high stress here and there aren't gonna make a massive difference. Mm-hmm. But for weeks on end, months on end, if you're having more stress and worsening the trend is heading, heading upwards in stress, then you know that you, you, you have to change something up because your, your testosterone levels are probably gonna decline.

Your sleep is gonna get worse because of that, that stress and it becomes this vicious downward cycle. So you have to do something to snap you out of it in order to normalize or help. That [00:17:00] shift the trend in the opposite direction. 

Dr. Brighten: Yeah. And as you were saying before, you know, stress is gonna pull on that pregnenolone, which is what gives way to testosterone.

And it's much like women's health that the body will choose survival over reproductive health. And it, I mean, our number one goal, you know, people always say, oh, number one goal is to reproduce something. I'm like, no, it's survive. Number one is survive. Number two is reproduce. And it goes in that priority.

When you talk about, so you and I are both wearing aura rings. Um. With Aura, you can see stressed and you can see recovered or restorative time. Mm-hmm. On that, what do you recommend to men in terms of getting more of that restorative time in their day? So, you know, it's, it's because it's like we can't control all the stress, right?

We, but we can control scheduling time for like restorative practices. 

Dr. Houman: So this is, it's a, it is a question that a lot of people, uh, you can't necessarily give the same advice to every man. Mm-hmm. Because people respond, people's, the way people relax is generally different. 

Dr. Brighten: Yeah. [00:18:00] Um, 

Dr. Houman: but I can tell you the simplest thing, or one, one common thing that a lot of men can do to normalize their stress is meditate.

Dr. Brighten: Mm-hmm. 

Dr. Houman: And it's as simple as doing it once or twice a day. If you wake up in the morning and do a 10 minute meditation, you can notice a significant difference, impact on your ordering. Yeah. Come home from work, do another 10 minute meditation, so you know, that'll help. And, and again, it's not the type of thing that if you do it one day, you're gonna notice a massive difference.

But if you do it day in and day out for a couple weeks, I promise you you'll notice some difference, at least in your restorative time on the ring. 

Dr. Brighten: Mm-hmm. The other thing I'll say about Aura and Apple watches, so these are the two wearables I have, so I'm most familiar with them. People in the comments.

If you've got other tips, let us know. I would love that. Um, is they actually have meditations in the apps that you can do. And I really love that because it tracks it, but it also gives you data in real time. Like, how did your heart rate variability change? How did your pulse actually change? Did it drop, did it come down?

And then the temperature of your skin. And I think that's a very interesting [00:19:00] one because I don't think people realize, like when they're stressed and they're like, oh, my hands are so cold. It's like. Oh, oh, you are in a bad place. Like we, we've gotta get you into chill out mode. And the other thing is that you said 10 minutes, which I think sometimes when people are new to meditation, they're like, whoa, 10 minutes is so much.

And yet we know in just five minutes that you can shift it. And so. I always tell people like, sure, 10 minutes is great, 15 minutes is great. Like this is great if you could get there. But if you're someone who's like, I feel very resistant, then just try five minutes. Like just give yourself five minutes and see how it goes.

And people are often surprised that they're like, oh, actually 15 was pretty easy because I just told myself like, just give it 15 minutes. 

Dr. Houman: And, and you just, you have to be consistent with it. That's the key. 

Dr. Brighten: Yeah. 

Dr. Houman: Five minutes a day for a couple days, for a couple weeks make a huge difference. 

Dr. Brighten: Mm-hmm. And then you talked about sleep.

And it's not just about the amount of sleep you're getting, we also wanna be looking at REM sleep and restorative sleep. So I'm just, I imagine there's some people listening right now who [00:20:00] are like, I am very data driven. I mean, I am as well. I'm like, I always am looking at my data when. You know, do you ever have patients get to that level where it's like, how is your REM sleep?

How is your, you know, deep sleep, uh, are you looking at that, those kind of data points? 

Dr. Houman: Not so much. Okay. Um, we don't look at it, uh, at that critically. Mm-hmm. Um, but really if, if they're, if patients feel like they're not as fatigued throughout the course of the day when we've normalized their testosterone levels, then uh, we accept that for what it is.

Dr. Brighten: Okay, so I'm gonna switch the conversation because recently we have seen a wave of men who were on hair loss medications and feel like their lives were completely ruined from this. And I wanna talk about this 'cause I think this is a real issue. It's, is problematic is sometimes the way testosterone's being used in men's health.

Dr. Houman: Yeah. So, uh, the. The, the trend towards, as, as testosterone use becomes more common. Mm-hmm. Especially at a younger age. Um. [00:21:00] Men are as a result of that, some of 'em are losing their hair, but more importantly, some men are just genetically losing their hair. Mm-hmm. And a lot of these hair loss treatments, or hair loss medications are becoming more readily available.

You no longer have to go to your primary care doctor, you don't have to go to any doctor. You could just do a telehealth visit online and Yeah. You know, get a mailed to you within a couple days. So there's a lot of use of this. And there's a, what you're referring to is called post Finasteride syndrome.

Mm-hmm. So Finasteride is the common hair loss medication. As a result of that, a lot of guys are. Getting the side effects associated with it. We do know that some of these hormones that Finasteride shutting down are quite important, especially to a young guy from a libido sexual function, um, anxiety, you know, mental health standpoint.

So we are seeing some drastic, um, side effects as a result of men taking these medications. Um, but my only recommendation to this is there's a, there's obviously a role for these medications. Yeah. It works for men. The key thing is you have to understand the side effects going into it, and, and that's the key thing as a young guy.

Make sure you know what you're getting yourself into. 'cause [00:22:00] some of these medications can cause, um, significant side effects. 

Dr. Brighten: Well, the side effects can be as bad as like suicidal ideation. So are there people who are not a good candidate for this to begin with? 

Dr. Houman: It, it's tough to know. We still haven't figured out who responds, who has these worsening side effects.

Dr. Brighten: Yeah. 

Dr. Houman: But it, it, it just takes like anything else, like any other medication, having a good informed discussion with whoever's prescribing this to is very important. Mm-hmm. Knowing that if you are having issues, anxiety, your sexual dysfunction. Um, with these medications to not only immediately stop, but also talk to your provider to see what else you can do.

Dr. Brighten: Mm-hmm. 

Dr. Houman: Because, um, again, there's a role for these meds. It's just you have to be careful and know what you're getting yourself into. 

Dr. Brighten: When it comes to the birth control pill, it's much of the same. We don't know how to identify who's gonna have adverse mood symptoms to begin with, and often when women do have them, their doctor's like, no, it's a you problem, not a pill problem.

Does the same thing happen in men's health? 

Dr. Houman: Similar. Okay. That's a similar idea. And I'm sure with birth control, you could [00:23:00] tell me when, if you come off it, do they tell you stop it immediately if you're having those issues? 

Dr. Brighten: Not necessarily because there's, uh, this concept that the threat of an unintended pregnancy is far worse than you committing suicide sometimes.

Like that's how bad someone's mood can be, and that sounds so awful to say. And yet. That's sometimes the, the, you know, attitude of providers is like, you can deal with the low moods 'cause at least you don't have a baby. Or they'll say things like, oh, if you think your mood is bad now, or Just imagine if you had a kid and it's like.

This is not right. Like, and there's alternatives. 'cause sometimes it's as simple as saying like, well let's switch you to an IUD or let's try a different, you know, pill combination. And so, you know, with Finasteride, I'm curious like is can we switch to a different medication? Are there things that you can do alongside of it?

So let's say someone's gonna start Finasteride. Is there something that they can be doing now to mitigate side effects? 

Dr. Houman: And not so much what they could do to mitigate the side effects associated with [00:24:00] it. Mm-hmm. Because its, it kind of acts in with, you know, from a hormonal standpoint, but if you are experiencing side effects from it, if you came in 10 years ago and you had these issues side effects from Finasteride, it was really probably your, your only option other than RO gain.

Dr. Brighten: Yeah. 

Dr. Houman: Now we have, there's a lot more newer therapies, creams, other pills that can help. Prevent worsening hair loss. Mm-hmm. So if you are experiencing side effects from Finasteride, just stop it and you could explore these other options. These newer creams, as I mentioned, like oral minoxidil. Yeah. Which is, which is a great option for a lot of guys that helps them preserve their hair, uh, at least preserve whatever hair they have.

And then finally, there's, there's, you know, surgeries now mm-hmm. That are getting cheaper, better, more advanced. So there's a lot of options. Um, but if you're gonna do oral Finasteride, it's fine to do it. Yeah. Just know what you're getting yourself into. 

Dr. Brighten: How does it work for people who don't understand like what you're talking about with the hormones and like how it's affecting the body?

How does Finasteride actually work? 

Dr. Houman: So testosterone, uh, it's all testosterone mediated. That's most things in men. It lives in three forms in the body. Mm-hmm. It stays as testosterone, it [00:25:00] gets converted to estrogen, or it gets converted to a hormone called DHT. 

Dr. Brighten: Mm-hmm. 

Dr. Houman: So finasteride blocks that conversion from testosterone to D-H-T-D-H-T is involved in male, male pattern, hair loss and prostate growth.

Dr. Brighten: Mm-hmm. 

Dr. Houman: When older men, we give finasteride to older men a lot of times for enlarging prostates. As the prostates are growing in size, we wanna shrink it. And very, very small, small percentage of men at that age and have sexual side effects because from a neuroendocrine standpoint, they're not So DHT reliant?

Mm-hmm. Younger men. They're just, we're way more DHD reliant. They're very potent androgen. Mm-hmm. And they're way more DH d We don't know which men are more reliant on DHD, but the ones that are, when you shut down that DHD production even, you know, it really puts them into a, for some men, it really puts them into a spiral.

Um, and that's why, you know, if you are experiencing those side effects, just stop it. 

Dr. Brighten: Yeah. And you know, for women listening, DHT is often also problematic in polycystic ovarian syndrome. And I think it gets villainized because the hair loss like all around for [00:26:00] everybody, right? Because irreversible hair loss is not anything anyone wants to experience.

And yet what you're saying I think is really important for people to understand is that DHD does have a place like it's not a bad hormone. It's necessary for libido, for mood. Exactly. And so if you drop it too much too fast, you can have those adverse. Side effects 

Dr. Houman: Precisely. Precisely. Sometimes, I mean, you don't want DHD at the hair root, right?

Yeah. So that's why these newer creams are, are pretty good at just stopping the, the DHD at the hair follicle at that, and then minimizing any of the systemic side effects. 

Dr. Brighten: Let's talk about those newer creams. 'cause I'm sure people are like, give it to me. What can I do other, other than these medications?

Dr. Houman: Yeah. So now they're, they're compounded, so there's. There's a combination of like, there's these Finasteride or dutasteride, which is a form of similar class. They mix it with monil, which is Rogan, and then they'll put different components to it. So one of 'em is retinoic acid. Mm-hmm. It helps really penetrate into the scalp and hit that follicle, you know, hit that follicle while at the same time minimizing any of that.

Uh mm-hmm. That [00:27:00] receptor the, the finasteride from going into the bloodstream and co and blocking the conversion. DHT. 

Dr. Brighten: That seems like an ideal treatment because it's very targeted. So what's the barrier? Why are people not going that route? 

Dr. Houman: It's, it's a daily cream or twice a day cream. Mm-hmm. Or, or it's actually an oil that you have to use.

Um, it, it has a sense to it, which can be sometimes bothersome. 

Dr. Brighten: Mm-hmm. 

Dr. Houman: It's. It's something that you, it takes time every day to do. So it's in terms of compliance or staying on it, it could be bothersome, it could be annoying to some guys. Yeah. And it takes time more than anything. It takes time to see the impact of it.

Um, Finasteride, it's a pill. You should pop it in the morning, evening, whatever it is. Uh, and it, because it's so strong, you can see the impact from a hair, hair growth standpoint pretty quickly. 

Dr. Brighten: Okay. What's the timeframe like difference between the two? 

Dr. Houman: Um. I'd say about Finasteride probably takes anywhere from two to three months to notice some kind of impact.

The oral. Mm-hmm. Whereas the cream's probably four to six months. 

Dr. Brighten: Okay. Yeah. So a couple months to keep your mood and your libido. That's not too bad. But I [00:28:00] think the thing that never really gets talked about, 'cause I feel like in medicine we're like, you're losing your hair, you're not dying. Okay. Like, this is not the end of the world in terms of like, your kidneys are working and your heart's beating.

Like we love that. But mentally, psychologically, I think hair loss has a very significant impact on people. 

Dr. Houman: Huge. 

Dr. Brighten: Yeah. 

Dr. Houman: Huge, massive young guys. Massive. 

Dr. Brighten: Mm-hmm. You talked about oral Minoxidil, which has higher compliance because it's not topical. You're not, and you also don't have it running down your, you know, face.

Right. I always think about like, um, what was it like Inquire Magazine where they have like Wolf Boy and I'm like, someone put my minoxidil on that kid. Like this is what happened. But talk to us about oral Minoxidil. Like when would this be considered? 

Dr. Houman: So oral mono, oral monoxide. If, if you. Generally if you, if you've done the creams or the, the oils and you don't, and you don't like it and you don't wanna do the finasteride, oral monoxide is a good option.

Mm-hmm. It does have some side effects because it's a, it could drop your blood pressure, so some guys get lightheaded. Um, and it's not so much targeted. It's not so, whereas [00:29:00] DHT is male pattern here, loss at the top of the head. This is just minx still kind of acts everywhere. So you could get body hair growth 

Dr. Brighten: Yeah.

Dr. Houman: Through, I mean, throughout your body. So it's, it's not so much just where you want it at the top of your head. Mm-hmm. You could get body hair, um, elsewhere, which some guys, I mean obviously don't necessarily like, but yeah, it does. It doesn't have the side effect associated with significant sexual dysfunction and that small subset of men.

Dr. Brighten: Can you use it if you're wanting to get pregnant? 

Dr. Houman: Oral Minoxidil? Mm-hmm. Yes you can. 

Dr. Brighten: Okay. Yeah. And what about the cream and Finasteride? Yeah, 

Dr. Houman: so. A lot of men are able to have kids when they're on Finasteride mm-hmm. When they're on dutasteride and they do just fine. It's if you're having struggles, if you're struggling to have a kid 3, 4, 6 months into it, it's, it's worth seeing a male fertility specialist look at your SE analysis to your point, see what's going on.

Mm-hmm. Discuss your medications, what treatment options you, you're taking, what medications. 'cause those could alter the DNA of, of, of sperm. So, 

Dr. Brighten: yeah. 

Dr. Houman: Um, yeah, it is important to discuss some of those topics. 

Dr. Brighten: Let's talk about [00:30:00] sperm analysis then, because. It's huge, the range when it comes to a semen analysis and what they're looking at, what's really ideal because you just brought up morphology.

Um, I think sometimes, you know, someone will get a semen analysis and they're like, oh yeah, like everything looks great and they're at the bottom of the range of everything. I always say that like, you know, sperm analysis should be like your bragging rights, like of getting that done and when everything's looking awesome, like your lifestyle is great.

Like that is like your report card of great. Health. So what would be on that report card that people are looking for? 

Dr. Houman: So it's a great point because they've, they just published something recently where they were looking at, um, what your fertility health says about your overall health. Mm-hmm. And if you are, if your fertility markers or if your reproductive health is poor, it's a sign of, of overall health and in many ways overall survival.

Dr. Brighten: Yeah. 

Dr. Houman: So if you're reproductively healthy, you're more than likely overall healthy and you'll live longer. In simple terms. Um, but there's four things we look at on a se [00:31:00] analysis. Number one, we look at the volume, how much is coming out. Uh, you want at least 1.5 or one and a half milliliters. The concentration is the other thing.

We look at how much, how many sperm per milliliter you want, at least 18 to 20 million. Mm-hmm. We look at the motility, how they're moving. Believe it or not, you only want 40% of those to look good. 

Dr. Brighten: Okay. 

Dr. Houman: And the last one is your morphology. And this is, this is always interesting. Only 4% of 'em have to look good.

Mm-hmm. In order for them to get to the, you know, for that to be a normal seam analysis. So those are the four things we look for. 

Dr. Brighten: People get really concerned though, when you have mutant sperm that they're like, that's gonna get, get to the egg, that's gonna cause problems. Is this something people should worry about?

Dr. Houman: No, because those, those eggs don't, uh, generally they don't make it there. And even if they do, let's say those, that egg or that sperm makes it to the, to the, uh, egg and makes, it's not gonna make a healthy embryo. It's not gonna have very, it's not gonna lead onto a, uh, a healthy embryo and implanted and in a pregnancy.

Mm-hmm. So those, it's only one of those 4% of. Normal looking sperm that will make it. 

Dr. Brighten: Yeah, [00:32:00] and I think it's also interesting when you look at some of the newer research that says the egg actually chooses who gets in. So it's not, you know, it's always been the myth of like, oh, the fastest swimmer, whoever gets there first like makes it, and actually the egg is very, it's like the Gandalf moment of like, you shall not pass.

Right? Like, she's picky. She's picky. So I think there's, there's also that, like mother nature is pretty good at like checks and balance when it comes to this. 

Dr. Houman: Definitely, I mean, we've been, we've been procreating for, for thousands and thousands of years, so yes, 

Dr. Brighten: and it's actually kind of amazing when you consider like.

How inefficient we are at it, that we actually exist as a species. 

Dr. Houman: We're very inefficient at it. The chances of actually healthy of procreation are pretty low every time you try. So it's, to get to this point has been quite remarkable. 

Dr. Brighten: Mm-hmm. Break that down for us. Like what can people expect? Like, because I think, you know, this is what women are told, we're young and they're like, you gotta go on the pill.

'cause you could just get pregnant anytime. Anytime, which is not [00:33:00] true. One time, one day in the cycle, you actually get pregnant. Sperm can live three to five days. You call 'em the little loiters, they're just hanging around waiting for that egg to come out of the building. Um, but I think people have the expectation that I should just be able to get pregnant like that.

Like it should just happen easily. And, and there's also this expectation that every embryo that's made in plants and becomes a healthy pregnancy. So what's the expectation people should have around this? 

Dr. Houman: Well, people only tell you about their wins. They don't tell you about their losses. Yeah. So I could tell you, just because I do on the male fertility side, there's a lot of struggles of people trying to achieve, you know, trying to have a kid and they have difficulty with it.

Mm-hmm. And it takes months. Um, so again, everyone tells you their wins. They don't tell you that their losses in terms of how long it took to get there. Uh, but, but each time you, you. Have intercourse and you try to have a child, um, take your chances of actually doing it are like somewhere between 20 and 25%.

Mm-hmm. Which is pretty low. 

Dr. Brighten: Yeah. 

Dr. Houman: But that's why it takes months and months for this to happen. [00:34:00] Um, I. But yeah, I mean, it's, it, the expectations aren't, people shouldn't necessarily expect to always have a kid on the first shot because it really takes time. Um, and it's a process. And it's a process. And don't get frustrated throughout the process.

Easy for me to say, but enjoy the process because everyone goes through it and it just takes time. And, um, the key thing is not to get frustrated. 

Dr. Brighten: It's so hard. It so hard. What are your tips for not getting frustrated? Because I think it's so much easier to say that, but a big thing I see. With the women I work with is that trying to get pregnant becomes a chore.

They don't even wanna have sex anymore because it's not fun. It's just a job, and they're like trying to reach a goal and they keep failing at the goal even though they're not failing, really. But it feels that way. 

Dr. Houman: Yeah. And I could tell you from a male side, guys come in all the time, they're trying to have a kid for, at this point, like six months, for example.

They're like, I can't even have an erection during sex. So I give 'em Cialis, Viagra, young, healthy guys. Yeah. Because it's literally like a job. They're check like, all right, well I gotta, I gotta go to work tonight. 

Dr. Brighten: Mm-hmm. 

Dr. Houman: Um, just in order [00:35:00] to something that's so simple to. Six months ago when they were trying to, they were just, weren't, weren't even trying to have a kid.

Dr. Brighten: Yeah. 

Dr. Houman: Engaging in intercourse was the easiest task. So it becomes quite, um, it becomes a job for them. Mm-hmm. But if I could say one piece of advice is just set the expectations that this is gonna be a process. Yeah. You're not gonna have a kid in the first two months of trying, give it 6, 9, 12 months, and if you are struggling at six months, just be evaluated.

Right? Mm-hmm. You know, pe, that's the key thing. I would say. The earlier you get evaluated, the better. So I try to say no more than six months if anyone's struggling, both the male and the female partner should get evaluated about six months. 

Dr. Brighten: Yeah, well that's important because a lot of OB-GYN's primary care, they'll say if you're under 35, wait a year.

Right. And I think that's far too long, far too long. I also think if you know, you have PCS, if you have a history of irregular periods, if you have had a history of painful periods, if you have thyroid disease, if you have anything else going on. Get evaluated before you start trying. Are there any things that men should get evaluated before trying?

Like are there [00:36:00] any signs of like, if you have X, Y, Z going on, get it checked out before you start trying so you don't spin your wills? 

Dr. Houman: The problem with male fertility is you're not symptomatic from it. Mm-hmm. You could be a very, you know, healthy. I saw a guy last week. Healthy guy, but just genetically, he's unable to produce any sperm.

Mm-hmm. Would he have known this otherwise? No. He had no idea. Yeah, no idea. But, um, because there's no signs to it, make sure you get evaluated, get evaluated early. Mm-hmm. See, see somebody who could evaluate you. The simple test is doing the se analysis nowadays. You could actually do the SE analysis at home.

Yeah. There's online tests that you could just order a kit at home, mail it in, they'll give you your numbers. 

Dr. Brighten: Yeah. As someone who's gone for fertility treatments and I sit in the clinic and we all know when the man's going back, like, what's going on? And I always am like, oh, this is, like, I just imagine how hard that is for you, like what's happening in the clinic.

So to be able to just do it at home, right? In this non artificial environment, um, this, you know, very private. I think it's uh, it's something I'm like, why didn't we have this like decades ago? Like, this is something we really should [00:37:00] have had going on. Are you seeing more men? Struggling to conceive. 

Dr. Houman: Yes.

Mm-hmm. Um. But, and I would say it's for, for two reasons. Number one, I think we're as a younger men are unhealthier. Okay. Because we're more sedentary. We're not spending time as much outdoors. We're, uh, our testicles are exposed to, we're sitting down all day. Mm-hmm. So we're, we're not getting vitamin D levels.

Our testicles, um, are getting warmer as a result of that. Mm-hmm. Sperm, DNA can be damaged. And secondly, men are just having kids at a older age. 

Dr. Brighten: Yeah. 

Dr. Houman: Right. The, from an economic, if you wanna think about a big picture, it's. Careers or people are more focused on their careers, making money for themselves, establishing their lives, and then having, building the family.

So as a result of that, men are getting, uh, married at a, at a later age. Mm-hmm. Starting to have kids at a later age. And with that, sperm can be a little, uh, less healthy the older you get. 

Dr. Brighten: We always hear about age and women's fertility, but we don't hear about this so [00:38:00] much with men because the age old sayings go like, you can be 80 and have kids, you'll be just fine.

Is it just fine? 

Dr. Houman: It's, um, it, it's, the answer is yes and no. Mm-hmm. 

Dr. Brighten: It 

Dr. Houman: depends on what you do. From, can, can, are there certain disorders associated with older male sperm? Yes. Yeah. Like Asperger's, autism along that spec, the Asperger's spectrum. Spectrum can be because of older sperm. But you know, Robert De Niro, Al Pacino, these guys just had kids in their seventies and eighties.

You know, with assisted reproductive technologies, IVF Ixy, these types of things, you can have healthy babies at, at a late, late age. Absolutely. You're producing sper tens of millions of sperm mm-hmm. With each eja in each ejaculation. So, um, you can have healthy sperm, but the question is, how, how healthy would the embryo be?

How healthy would the child be? 

Dr. Brighten: Mm-hmm. 

Dr. Houman: That's all dependent on, um, how the egg and the sperm come together. 

Dr. Brighten: For people who, don't dunno what ixy is. Can you explain that? 

Dr. Houman: Yeah. So we all know I-V-F-I-V-F is in vitro fertilization where an egg and a sperm [00:39:00] come together. Ixy is the next level of that where the embryologist is either, is actually able to get that sperm, that specif, that specific sperm and inject it into the cytoplasm of the e of the egg mm-hmm.

To make a an embryo. So it's more, you're actually putting the two together. Um. I think just mechanically. Yeah. We're, we're, we're putting 'em together rather than letting them, them fuse on their own. 

Dr. Brighten: Yeah. So the alternative is you put the egg in, basically the Petri dish, let the sperm come in and do it as do its own thing.

It would in the fallopian tube. But with iy, they're selecting the best sperm. What are they looking at to select the best sperm? 

Dr. Houman: So a couple what I discussed, the morphology and the motility primarily. Mm-hmm. Uh, you wanna make sure the head looks healthy, the tail looks healthy. Some of these sperm you'll see they look good, but they're swimming in circles.

Yeah, obviously you don't want that. 

Dr. Brighten: No. So 

Dr. Houman: you want the ones that you want 

Dr. Brighten: The smart one. The smart, exactly. Next, where is it going? The one 

Dr. Houman: that's swimming in a particular direction. Yeah. Has a good looking head, um, and a good looking tail. Um, and then, you know, these, these are just from [00:40:00] what we do from microscopic standpoint.

There's some of these AI companies that are coming out here now they're looking at, they have data to look at. Individual sperm. Even even find things that nuances that we don't necessarily see to the naked eye, that they're able to say this one is actually gonna have a better chance of healthy implantation versus one that could probably look the same but is not exactly the same.

Mm-hmm. 

Dr. Brighten: The sperm is gonna contribute to the placenta, which is absolutely necessary for living in utero. Um, it's, it's going to be contributing a lot to the health and the survival of the embryo. The. You know, morphologies parameters you're talking about. The strength of the swimmer and the direction these can be indicative of mitochondrial health.

What can men do to support their sperm health, to support their mitochondrial health? To have, you know, everybody wants to brag the strongest, best swimmers, 

Dr. Houman: so it's pretty simple. What's good for your reproductive health is good for your cardiac health. Mm-hmm. Good for your overall health. So, [00:41:00] not to sound like a broken record here, but eat right, sleep, uh, minimize your stress and exercise.

Minimize any, any increased testicular temperatures. That's a big one. So 

Dr. Brighten: laptop's a problem. Cell phones. 

Dr. Houman: Yes. So I always tell guys, don't put laptops on the front, um, on your lap. Put the cell phone in the back pocket as much as possible. 

Dr. Brighten: Mm-hmm. 

Dr. Houman: Um, saunas, steam rooms, jacuzzis hot yoga. Try to stay away from all of those.

Um, and then a lot of these newer fertility supplements, the ones that Coenzyme Q Antioxidant based. 

Dr. Brighten: Mm-hmm. 

Dr. Houman: Those aren't gonna, you know, swing the needle a lot, but they could only help. Yeah. So being on fertility supplements from a male standpoint is, is important as well. 

Dr. Brighten: Mm-hmm. Well, what's great about this is this is all the stuff we talk to women about doing, and it's why I always say like, you and your partner should be on board together working towards this so that your.

Work out together. If you wanna work out together, but you're working out, like have an accountability partner, which is your partner, the way that you're eating matters, getting good sleep. It's also something too, if you're trying for a baby's sleep now as much as possible because yeah, you're [00:42:00] gonna get robbed of your sleep in the future.

You brought up saunas. Saunas great for cardiovascular health. Saunas have amazing historical data in cultures, but also we're seeing new scientific data supporting it. But if somebody's trying to get pregnant. You're like, maybe this isn't the best deal. What, what if, uh, you followed up with a cold plunge?

Does that make a difference? 

Dr. Houman: So, it's a great question. If you're gonna do, if you're gonna do a sauna, it's, it's actually fine, but just go in there with a, with a bag of ice. 

Dr. Brighten: Oh, okay. That sounds really lovely. Yeah. 

Dr. Houman: It, it's, it helps, yeah, it helps normalize the temperature in that area. But it's as simple as going, you know, with an ice pack, a bag of ice, whatever it is, just to keep that area cool.

Mm-hmm. You don't have to. You're not icing the area as if you, if you have like a sprained knee or anything. Yeah. But just keep the area cool, therefore you're not getting that, that DNA damage that comes with exposed, uh, long-term heat. 

Dr. Brighten: Okay. I imagine some men are going to put ice cubes directly against their skin.

Yeah. Is that wise? 

Dr. Houman: No. 

Dr. Brighten: Okay. Yeah. I'm like, let's make sure we [00:43:00] caveat this. 

Dr. Houman: Just, just keep it, you want to wrap it, or you wanna put it in a way where you could leave it on that area for however long you are in the sauna? Mm-hmm. If you're doing a 20 minute, 30 minute sauna session, just make sure you're, you're wrapping or you're putting the ice 

Dr. Brighten: Like in a towel.

Dr. Houman: In a towel, yeah. In a towel. In a, yeah. Ideally a towel. There you go. Just to keep it. You're comfortable enough to keep it on there for the time you're in the sauna. 

Dr. Brighten: Yeah. 'cause if somebody gets frostbite on their testicles and like I see it in the comments, I'm gonna be like, sir, you needed to warn them.

It's a 

Dr. Houman: whole different problem. 

Dr. Brighten: Yeah. And does like, um, so cold plunges are also something the like. More and more people are doing, does that have any negative or positive impact? 

Dr. Houman: It doesn't have any negative impact. Okay. Um, can it have positive, some people seem to think that the, when you're, when you're in the cold plunge, you're decreasing the amount of arterial blood flow into the testicle.

It depends on how long you're in there. Mm-hmm. And then when you release, when you come out and get the warmth that you're getting a, a surge, and that could boost the, the health of the testicle boost. Testosterone production, sperm production, [00:44:00] you, the data on that is to be determined. Mm-hmm. Um, but it can't hurt.

Dr. Brighten: Yeah. What role is environmental toxins playing in terms of men's testosterone and their fertility? 

Dr. Houman: Definitely from a testosterone standpoint, and as a, as a result of the testosterone impact, it impacts your fertility as well. Mm-hmm. So, we know microplastics, um, there's a lot of, you know, people saying even on receipts, there's Yeah.

All these various hormone modulator that can impact our hormones. Um, so to, to your point, because your testosterone levels are being decreased as a result of some of these endocrine disruptors or environmental toxins 

Dr. Brighten: mm-hmm. 

Dr. Houman: It can impact our or hormonal balance, but more importantly it can impact our fertility.

Dr. Brighten: What do you tell men to avoid? 

Dr. Houman: Um, there's a lot of things you could avoid. Mm-hmm. But to me, the most common thing that a lot of men are doing, or a lot of people are doing is drinking water bottle drinking. Um, out of water bottles. Like plastic water bottles. 

Dr. Brighten: Plastic. Yeah. 

Dr. Houman: So really try to minimize anything when it comes to plastics.

Dr. Brighten: Mm-hmm. 

Dr. Houman: Um. It, you know, [00:45:00] carry, carry a Yeti, but around with you if you can. Just something that decreases the amount of BPAs. Anything that could, the plastics are probably the biggest thing that we're all exposed to. So if you could minimize that, be aware of it at the very least, and try to decrease that, uh, that exposure to it.

Dr. Brighten: Mm-hmm. Anything that's so important, what you just hit on? Plastics we're exposed to all the time microplastics, they're all up in our brain, they're everywhere. I'm bitter about this because we're never walking it back as a species like at this point, we've gone too far. That feels ominous and scary. But what you just said is very simple action that you can take, which is your day-to-day practices.

You can minimize your extra exposure that you're having and that can have a fantastic result. On your fertility, but also your testosterone as well. 

Dr. Houman: Definitely, 

Dr. Brighten: definitely. Yeah. I wanna ask you about blue salt for erectile dysfunction. Oh, does it work? 

Dr. Houman: No, it doesn't. And I know this was a trend on TikTok.

Yeah. But no, the long and short is No, absolutely not. No. Getting good erections it come, it, it's [00:46:00] relatively simple like again. I sound like a broken record here, but eat right, sleep, right exercise and minimize your stress, and you will have good, normal, healthy erections for a very long time. 

Dr. Brighten: If a man is struggling with erectile dysfunction, what could be pointing to?

Because we know that while it might present as erectile dysfunction, there might be something more serious on the surface or below the surface. 

Dr. Houman: Yeah, very well said. So the. We know that a lot of men who are experiencing, uh, erectile dysfunction in their twenties or thirties, uh, we actually published a study about this.

40% of them have some kind of correctable issue or some mm-hmm. Whether their hormones are off. A lot of times these guys have low testosterone 'cause of environmental factors. Yeah. Their lifestyle. So one thing to do is to get, boost their testosterone levels that could help with their erections. But if you are a young man, if you are a young man, if I could summarize this young man who experiencing erectile dysfunction, that's not normal.

You should be evaluated. You should discuss it with somebody. Sometimes it's hormone based. A lot of times it's just psychogenic. Mm-hmm. You're in your own head about it. You're a young guy. You had a [00:47:00] long night of drinking, you couldn't get an erection. You keep thinking about it. Yeah. And you go down this vicious cycle in your own head.

So being evaluated by somebody early on, it could at least. Again, shift the tide or get you outta that cycle so you can normalize your sexual life again. 

Dr. Brighten: Mm-hmm. I talk about in my book is this normal whiskey vagina, as I called it. Yeah. Which is where you drink too much alcohol and then you're unable to have an orgasm.

You can't self lubricate. You feel like nothing's working down there. The same psychological effect can take place. You have one bad experience and now you're like, my body's broken. Something's going on. Talk to us about what alcohol is doing, because sometimes people think if I drink I'll, I'll have a better, like, sexual experience, but that's not the case.

Dr. Houman: Well, it like, like, like anything else in moderation. Yeah. Um, if you're drinking too much alcohol to the point where you're unable to, you're, you carry yourself or unable to engage in intercourse. Um. Orgasm, all those things. To your point, whiskey dick, right? That's the, that's, 

Dr. Brighten: yeah, that's the, that's the male version, the male 

Dr. Houman: analogy of it.

So if you're, if you're [00:48:00] so drunk that you're unable to have an erection or, or have an orgasm, that, that's normal in many ways. But the worst thing you can do, or the hard part is to keep thinking about that one time of, oh my God, I'm broken. No, it's because you were inebriated. Mm-hmm. So the next time, don't necessarily think about it, but as a young guy, yeah.

You, you know, when you're 21 in college and you're like, I can't get an erection. Like, you think something's wrong with you and you don't mm-hmm. Have the awareness to think to, to realize that this is all alcohol based. So I see a lot of young guys who go down that vicious cycle as a result of that. 

Dr. Brighten: Yeah.

I wanna switch gears to vasectomies. These are often pitched as a quick and easy procedure, but is there anything people should know about potential long-term consequences? 

Dr. Houman: So, vasectomies are probably one of the most common procedures I do in the office. Mm-hmm. It's the gold standard for contraception, especially for male contraception.

Dr. Brighten: Yeah. 

Dr. Houman: Um, relatively, they're very straightforward to do, take about eight to 10 minutes pain free. Um, we've advanced the technology for a vasectomy to be done in the office [00:49:00] under local anesthesia, very calm environment, and patients do great. There's a lot of myths associated with vasectomies. Mm-hmm. Um.

Common one, guys ask, is it gonna affect my testosterone levels? Absolutely not. Zero impact. It has zero impact on your sexual performance, doesn't affect your erections at all. Um, can it be reversed? Absolutely. Mm-hmm. Um, generally we say within seven to 10 years are your best, highest likelihood of having a successful mm-hmm.

Vasectomy reversal. And then a question I got a couple weeks ago is, does it cause prostate cancer? 

Dr. Brighten: Oh yeah. 

Dr. Houman: And the answer is absolutely not. No, zero imp So vasectomies are incredibly safe. You wanna go to somebody who does a lot of 'em, ideally mm-hmm. To make like anything else, any other operation. Um, but it's, it's incredibly safe and it's a great option.

I highly recommend it to men. Obviously the female partner has done a lot of, uh, he's given this. It's the easiest sacrifice a guy could make. 

Dr. Brighten: Mm-hmm. And if you are also someone who's very adamant of like, I do not wanna have children. This is a great [00:50:00] route to go because you're not relying on contraceptives that can fail.

We often hear things like the pills, 99% effective IUDs are pretty good, but they still got like that 1% failure. Vasectomies. How effective are they? 

Dr. Houman: 99.9%. Mm-hmm. Yeah. 

Dr. Brighten: But. Do they work immediately? 

Dr. Houman: So we, we try to, they work immediately in terms of the transmission of new sperm, but you're always gonna have swimmers in your, in your track.

Dr. Brighten: Yeah. 

Dr. Houman: So I always tell guys the 

Dr. Brighten: storage facility, right? 

Dr. Houman: So I always tell guys, ejaculate 20, 30 times after the vasectomy. Mm-hmm. Then you do a semen analysis after that, confirm that there's no swimmers, and then you're good to go. 

Dr. Brighten: So from the time of vasectomy until you have that confirmation test. You should not be engaging in unprotected sex.

Right. 

Dr. Houman: So pr, safe, safe forms of contraception at that point. 

Dr. Brighten: Yeah. I think it's really important to clarify that because you will always hear these stories online of people being like, oh, but I got pre, my husband had a vasectomy, but I got pregnant. And [00:51:00] then when you ask clarifying questions, you usually get to like, oh yeah.

'cause he had it done like last week and then we had sex. And so. It also makes me wonder, like, was it ever made clear to them? Did they just not listen? Because you know, when you're undergoing a surgical procedure of any kind, you're not necessarily in your head. Yeah. 

Dr. Houman: Yeah. So you, you that's, I I wish every guy who had a vasectomy recently could hear this actually.

But you have to clear the pipes. Yeah. And you have to confirm, you have to do a confirmatory SEMA analysis in order to prove that you have no, no swimmers left in the system. 

Dr. Brighten: Mm-hmm. And. For people who are like, it's not reversible. Like there's instances where it's not reversible, you know, what's going on there.

Dr. Houman: Um, so a couple things. Depends on, some of it depends on your anatomy. For example, um, some people, because of the, the pressure that a vasectomy, so your testicles are always producing sperm depending on where. You clip the, the VA deference, you could decrease the amount of pressure on the testicle. Mm-hmm.

[00:52:00] Sometimes there's so much pressure in that testicle that the sperm that's being produced is either very, very low counts of sperm, or you have basically no sperm because of it. Mm-hmm. Um, but the, the big one is how long after your vasectomy or you trying to do a vasectomy reversal. 

Dr. Brighten: Okay. 

Dr. Houman: You know, if you're doing it 15, 20, 20 years later, your chances of having a successfully successful vasectomy reversal is much lower.

Dr. Brighten: Okay, so if you're a 20-year-old male wanting to get a vasectomy, now your window is by 27 30. You should be looking at reversal if you're willing to wanna have children in the future. 

Dr. Houman: Yeah, it is 27 to 30, but the, the one thing I'd say, ev, any guy, especially if you don't have children, anyone who's interested in a vasectomy should bank their sperm.

Dr. Brighten: Mm. 

Dr. Houman: Again, it's very easy to do these days, these companies, the same companies that track your semen analysis at home. We'll do it, we'll do storage. They'll store, they'll store your sperm for a couple hundred dollars a year. 

Dr. Brighten: Mm-hmm. 

Dr. Houman: So I highly, highly recommend that to any young guy who has, anybody who has no, no children, who wants to 

Dr. Brighten: have 

Dr. Houman: a vasectomy, bank, your sperm, 

Dr. Brighten: what else can happen that might impact someone's [00:53:00] fertility, that they're gonna look back and say, I wish I would've banked my sperm.

Dr. Houman: What do you mean? 

Dr. Brighten: So possibly testicular cancer or anything else coming up where it's like, now you're not going to have that opportunity. We didn't see this coming. 

Dr. Houman: Yeah. As, as much as women are are, uh, banking their eggs or storing their eggs, there's, there's a, you know, you can have a conversation about men doing the same thing.

Mm-hmm. I know we're talking about how men are able to produce healthy sperm for a long time, but, um, if you're a young guy in your 30, in your late thirties, and. You, you're not anticipating being in a relationship anytime soon. By, by all means, there's no harm in banking. Sperm. Yeah. Storing it. Saving it.

It's, it's truly an insurance policy. There's no harm in just having a good insurance policy. Mm-hmm. Um, that you could use your younger sperm at a later age. 

Dr. Brighten: Mm-hmm. For men who are listening to this right now, experiencing hair loss, concerned about low testosterone, concerned about their fertility, what are like three things that you would say?

Absolutely focus on this this week, put it into place and start making it part of your [00:54:00] lifestyle. 

Dr. Houman: The, the easy, the best thing I can say is just try to live a healthy lifestyle. Okay. Right. And 

Dr. Brighten: well, we know in the United States saying healthy lifestyle can look like a lot of things, 

Dr. Houman: right? 

Dr. Brighten: We've got McDonald's to like, I only eat meat.

Like, so what does that mean within the spectrum 

Dr. Houman: of healthy lifestyle? Um. Eating a, a well-balanced diet. Mm-hmm. Try to eat as much unprocessed food as possible. Yeah. The processed foods, like we're talking about environmental toxins, the processed foods are really what's gonna cause these metabolic derangement.

Um, I'm not here to say that I know any better because I eat the same thing. Right. I'm human, I'll have unprocessed food, I'll have, I'll have processed foods as well, but try to stay, try to stay away from all the processed foods as much as possible. Mm-hmm. Um, exercise. At least four or five times a day a week.

Combination of heavy weight lifting with cardio. Sleep is the big, big one for everybody. Sleep is massive. Um, try to get that seven hours and then finally try to reduce your stress as much as possible. Okay. 

Dr. Brighten: Do you [00:55:00] ever see issues with a vegan diet impacting men's? Hormones. 

Dr. Houman: Yes. Um, it depends on, well, depends on the vegan diet, how much of it they're actually going outta their way to have proteins.

Okay. Healthy vegan proteins, if you're gonna be a, have a vegan diet in many ways. A lot of my oldest living patients, I. Are men who are stay away from meats. Mm-hmm. Um, which is great, especially red meat. But they're very mindful of having healthy plant proteins, uh, peas, um, even they're, they're supplementing with pea protein 

Dr. Brighten: Yeah.

On 

Dr. Houman: a given day. So if you're gonna do that, great, but make sure you're focusing on having some plant proteins every day. 

Dr. Brighten: Carnivore people are going to come for us. 'cause you just said less red meat. What does the science say? 

Dr. Houman: Well, listen, red meat is great. It is fine, but the thing is you have, it has to be sourced properly.

Okay. Right. It's, it's, it's the manufactured red meats or it's the manufactured, anything that's highly processed. Mm-hmm. That's the stuff that's not good for us. Has a lot of growth hormones in it. If you're having organic red meats or organic meats throughout the course of the day, [00:56:00] you know, continuously, that's fine.

That's fine. But it has to be good quality meat. 

Dr. Brighten: Okay. That's 

Dr. Houman: the big thing. 

Dr. Brighten: Well, this has been a fantastic conversation. I really appreciate your time, the insights you've shared, and I cannot wait to hear what people think of this conversation and what comments they have. 'cause I think you just helped a lot of people.

Dr. Houman: Thank you. Thank you for having me. I had fun. 

Dr. Brighten: I hope you enjoyed this episode. If this is the kind of content you're into, then I highly recommend checking out this.