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Dr. Paul Turek: “A Guy’s Guide to Maintaining Sexual Health” | Talks at Google

February 27, 2020


>>Mina: : Dr. Turek is director of The Turek
Clinic, a men’s health clinic in San Francisco. He is a former professor of urology, obstetrics
and gynecology at the UCSF and held the Academy of Medical Educators Endowed Chair in Urology
Education. Dr. Turek attended, I think I keep saying
that wrong,Turek? Sorry. Attended Yale College followed by Stanford University Medical School.
After Urology residency at the University of Pennsylvania, Dr. Turek was fellowship
trained at Baylor College of Medicine. His 175 publications include basic research
that focuses on germ and stem cell genetics and epidemiologic studies of men’s sexual
and reproductive health problems. He’s on the advisory board of the National Men’s Health
Care Network and the NIH Reproductive Medicine Network. He is also the editor of The Reproductive
Volume of Netter’s Images and oversees an active blog on men’s health issues. He recently
founded a volunteer medical clinic, powered by retired physicians for the working uninsured.
And with that, I’ll introduce Dr. Turek. [applause]>>Dr. Paul Turek: Thank you Mina. I want to
thank, are you mic’d OK? OK. Thank you for having me. Thank you HR for bringing me to
Google. It’s my first time. I’m very excited. And I wanna teach a little bit about your
life. So, if you have. This might be a sensitive lecture, so if you do have questions, you’re
welcome to send it to a hashtag or tweet at theturekclinic. If you wanna do that, we’ll
answer those for you. If you want a copy of the slides, do likewise please. Mina went over this with Google Health, which
I think actually is a great initiative. Google Health, one of the problems in men’s health,
and I’m gonna generalize to men’s health, is that men don’t get great care and Google
Health allows you to own it more. So, I’m a real fan of and would like to get
involved with Google Health on that level. So, why was I asked to speak? Well, I am a
micro-surgeon and I am a urologist and I am a Fellowship trained men’s health specialist
and I’m pretty well known in the field. But that’s not why I was asked. I was asked to speak because I care. I care
about you. I care about the kind of care that men are getting in America right now. I have
developed inventions to find sperm from a rock in fertile men and get them pregnant,
help them get pregnant and lead better lives. I have patented inventions. We have stem cell
technology coming out where we can take a skin biopsy potentially in the future, making
it into a stem cell, making it into a sperm in a dish. So, we get that little kid with
leukemia who can’t conceive when he’s an adult and you can give him the option of fatherhood. So, there’s a lot of wild stuff going on.
I am developing an artificial testicle to help that happen with some great scientists.
So these are the things I’m working on. And I also go into the government a lot. They
asked me to come to Washington in the middle of winter. And it’s cold and windy there. And they say,
“Where is men’s health going and what should we be doing?” And I’ll give them my opinion.
And I’ll give you some of that opinion today because it needs to change. Because essentially,
the problem is that men are underserved. Men your age are underserved. So, who has
a car? Most of you. Who gets the oil changed on their car regularly? OK. Who’s been to
a doctor in the last one year? Wow. OK. Didn’t work. [laughter] So, typically, men take better care of their
cars than they do the bodies. And you guys are proving me wrong, but so, congratulations
is what I would say to that. But men have issues and typically they don’t get great
care for those issues. And they don’t reach out very well. So, men
are terrible at reaching out, unlike women. They do not have a monthly biology to respond
to. So, they don’t get great care for lots of reasons. And I’m just here to say that
I care and I have a program for you. So, this is the traditional view of men’s health in
America. There’s sexual health, which is an orbiting,
an orb, next to the mothership or mother planet of overall health and they’re relatively disconnected.
So, I look at it as rotating around overall health as this isolated orb of sexual health,
which is actually a lot of the issues of young men, their sexual health issues. But, and that’s what’s been going on. And
that has fragmented care for men in America. Because what happens is there’s no ownership.
So, an internist might take care of A, and endocrinologist B, a dermatologist C, but
no one really owns the package of men, unlike a gynecologist who does the breast exam and
does a lot of the typical things that women need periodically. So, that’s the problem in America. There’s
no ownership of care of men. So it’s all fragmented. And I think that needs to change. And we’re
doing that. And what needs to change is we need to bring sexual health into the planet
of the whole planet or realm of overall health. And I’m gonna prove to you today that it belongs
there; that you’re sexual health is as important as your overall health and is integral to
overall health. And you’ve got a lot of initiatives here at Google. You heard a mindfulness talk
yesterday. Stress reduction, they feed you, they encourage you to stand. The ergonomics team will help you stand instead
of sitting, ’cause you live longer that way. Lots of things are going on. It’s beautiful.
This is what we want. So what is sexual health? It’s kind of blurry, but WHO, the World Health
Organization, calls it the integration of the physical, emotional, intellectual and
social aspects of sexual being. That’s really it. So, here’s a cloud tag I
put together on the topics I wanna talk about under the realm of sexual health and their
relative frequency. So, ejaculation disorders are really number one for young men. And sexual
desire disorders, libido, is really number two. And you’re gonna learn more about those than
you ever cared to learn today. But these are important things that matter to men and affect
their quality of life. So, first start off, how is a man like a vintage Maserati? So in
this crowd it’s different because you actually probably take care of yourselves as well as
a vintage Maserati. And I was gonna offer you, if no one raised
their hands when I said do you go to the doctor once a year, have you been in the last year,
I would have said, how many of you would sign up for my men’s health tune-up if I put it
up on Google Offerings when it comes out? But you guys are already doing a good job.
But sign up for it anyway. So, like the Geico caveman, OK? So, men are immortal. You’re
immortal. You hardly ever think about things. You take great abuse, long hours, fluorescent
lights, sitting, over-clocked computer. You have no signs of failure basically. And
but when you do fall, you fall hard. So it takes a lot to keep you sick, to keep you
at home, but you stay home and it’s usually a big hit. A vintage Maserati, when it runs,
it runs hard. They run really well. It gobbles up terrible roads. It can eat miles and miles. It’s really fast.
But the gauges may not work, so it’s hard to tell if something’s going wrong. And the
metal may bend quietly and then break, which is similar to man. So, these are pretty good
analogies. And you’ll see me running through the caveman analogy and the old car analogy
quite a bit, because I do think that everyone needs a tune-up. Now, in this talk, I’ve got these blog posts
written. That’s on turekonmenshealth.com. It’s a blog I write weekly and this one’s
called “The Sound and the Fury,” but if you see that, then it’ll talk a lot about that
and expand on it for you. It’s on turekonmenshealth.com. And love your input. So let’s talk about erections. Near and dear
to everyone’s heart at your age. This is Massachusetts male aging study, which is impressive because
it showed us that it was done on a cross-sectional population of men in Massachusetts and all
different kinds of men. And it showed that basically, erectile dysfunction
occurs in everybody. Almost in every age group you’ll find erectile dysfunction, trouble
with erections. And the second thing is it goes up as you get older. So in this graph,
white means basically no problem and yellow, orange, and red mean there is a problem. And you can see the proportion of the graph
with yellow, orange, and red goes way up as you go down on the graph. And so, even at
age 40, which is when the study started, there are half the men were having problems with
erections. Half. And you can extrapolate that to 30. It’s pretty linear. You can see at 30 there
are gonna be people. too. So this is an epidemic. This is not minor stuff. This is an epidemic.
So, let’s go over the erection a little bit. I’m sorry if you’re eating lunch and seeing
this slide, but this is a cross-section of the member. And this is how it’s built. So, there’s an
artery down the middle and the erection starts by the artery dilating. So, from left to right,
you’ll see it dilate. And then that fills these lacunar spaces in the penis which give
you tumescence, or engorgement. And those are called sinusoids. And then, the sinusoids when they fill, slap
the vein shut against the wall of the penis and close off, or cork off, the flow of blood
out of the penis so it stays in. So it’s very mechanical, a very mechanical system. And
that’s called venous compression. So, but I like this analogy. I think you should think about it as a sink.
So the arterial inflow is the faucet. And the venous outflow and the sinusoids are the
sink itself. And the drain is the venous leak, are the veins that drain. So, to get a good
erection, you would follow the green curve there, where you get,. it quickly fills up and it stays full. That’s
a sink with a good seal and a good inflow. But a lot of problems, a lot of times you
may have problems with the drain. So, you have a kitchen sink and the drain’s not tight
and you get the yellow curve shows an erection that occurs quickly, but falls quickly because
it’s draining out. That’s very common. And the red curve is an
erection that takes a while to get because the faucet’s weak, but once you get it you’re
OK. And those are three typical patterns that demonstrate the mechanics of this. But what
else is going on with the penis? So, that’s the mechanical issues, but the erection is
not an isolated event. The problems with erections is not just a
simple mechanical problem, because men with erectile dysfunction we now know, this is
established science, have twice the, . in their 40s or so, have twice the risk of heart
attacks as they get older than men who don’t. And that risk, increased risk of heart disease
with an erection problem as a younger person is the same risk as a smoker or someone in
your family who has a heart problem. Same risk. That’s pretty important. I call
that a biomarker. Women have periods and they have cycles and they go to doctors when they’re
irregular. Men with an erection problem, bing bing bing bing, that’s a sign. That’s a biomarker.
Something not right, yet it has to do with mechanics, but there’s some larger issues
going on. Yes.>>MALE AUDIENCE MEMBER #1: inaudible question
from audience>>Dr. Paul Turek: Wait. I’ll get to it. “Anybody
who believes that the way to a man’s heart is through his stomach flunked geography.”
OK. It’s not. So the answer to your question is here. These are conditions that are well-established
and influence erections. So, up here, this corner, the upper left-hand corner are the
metabolic syndrome risk factors, right? Obesity, heart disease, cholesterol, blood pressure,
diabetes. That’s the metabolic syndrome features. They’re all, throughout this talk, they’ll
be all in the upper left-hand corner. Sleep. Stress. Stress is a Type A personality, except
there aren’t any Type A personalities here I’m sure. Medications. Organ failure. Low
testosterone. Alcohol and drugs. Alcohol is fabulous. So alcohol, you see these young guys come
in and they have a problem with intercourse or whatever. And what happens is you’re on
a date. You’re at the bar and you pound a couple of stouts. And you see a woman, or
man, and you like them. And you say, “You know, I’m gonna say something to them.” But you need those beers to get it done, because
what alcohol does is it’s socially uninhibiting. So, you’re pretty nervous about it. You’ll
get relaxed. Your libido, you sex drive, will go up and you’ll say, “I’m gonna do it.” And
you go over there and it works out really well. And later that evening, you go to use the
device, and you’ll have the activity and it’s numb as anything. Because alcohol is a local
anesthetic. It’s an anesthetic. That’s what we gave people when we were cutting off arms
and legs in the Civil War before we had anesthesia. Alcohol and a bullet. It’s great. So it actually
numbs the signal and it’s sometimes almost impossible to keep an erection if you have
a lot of alcohol on board because your sensations are changed. So, it’s a two-edged sword. But
this is well-established stuff. So you can see, this very much a part of overall
health. An erection problem is very much part of overall health. And when I see a man and
I’m pretty convinced it’s a real erection problem, at the Turek Clinic, what I will
do is I will evaluate him for metabolic syndrome. I will do those things because we need to
own it. And I’m not gonna send him to a medical doctor to do it. I’m gonna do it and take
care of it and try to get that under control. And taking care of those risk factors will
improve the erection. So, men with heart disease, it’s all one big blood vessel, but heart disease
patients who have poor erections, if you can help their heart disease out, they’ll get
better erections. So you can actually improve things. So, let
me summarize. Erections are common. Erectile dysfunction is very common. Your age: 31,
32, 40. It can be a marker of heart disease if it’s real and there’s a way to figure out
whether it’s really an organic problem, or it’s just a stress-related situational problem. And that’s really easy to differentiate with
one visit. And then, erectile dysfunction is related to overall health. That’s really
important. So you need to take care of your overall health. You need to eat well. You
need to sleep well. You need to exercise. You need to go to the massage and yoga classes
here. You need to stand when you’re at your desk.
You need to do the things that Google Health is trying to convince you to do. And they’re
doing a great job of it. And take ownership. Let’s talk about something more common than
erection problem, which is a sex drive problem. There’s very little science here, but clinically
I treat this all the time. It’s probably the most common thing a young man would come in
for besides an infertility problem. What is it? The desire to have sex. It’s basically,
it’s been called an urge that’s instinctual, biological, or primitive. That’s how basic this definition is. What’s
true about it, I think clinically, is that levels vary widely among individuals. So often
a couple gets together and the one partner and the other partner have very different
ideas of how often they should have sex. And you’ll see this in a marriage. It’s very different. And that is one of the
hardest parts. It’s harder than the dishwasher thing where you’re putting dishes away and
you say, “Am I gonna do this for the rest of my life? Am I gonna be putting the dishes
away?” You know, as the guy in the relationship. It’s one of those things. How do you solve
that problem? Well, it kind of works itself out. Kinda works itself out, but you do have
to deal with it because people are different, women from men, men from each other, etc.
But within an individual the pattern is pretty characteristic of the sex drive, the frequency
of wanting it, the desire, the urge. There can be times of deadlines and stress
where it might not be as high. And it’s not linked to testosterone levels. So, the guy
in the porno flick who wants it all the time doesn’t have a higher testosterone than the
guy somewhere else who isn’t in that situation. And the question is can oysters improve it?
And for that, you’ll have to go to the blog. Oyster, men, sex. So, here are two men with
their patterns of sex drives. So, the man on the top in the green basically has a high
sex drive and it’s constant. The man on the lower part is lower sex drive and it varies
a little bit, but it’s got a pattern to it. And those are both normal. Those are both
normal. What’s not normal for me is when a man has a pattern that is changing. And changing
can be it was high and then literally last August, middle of the month, all of a sudden,
it dropped through the roof. It dropped to the floor. That would be abnormal. I jump on that one.
I look for an issue there. And the second one would be it varies a little bit, but it’s
getting a lot worse over time. And that’s something that should be pursued medically.
Why? The usual suspects. The usual suspects. Overall health, right? There’s our metabolic
component in the upper left-hand corner. Low testosterone is a part of this. Stress is
a huge part of this. Sleep is a huge part of this. Alcohol and drugs, etc. Travel, circadian
stress can all affect this. And prolactin. The guy who dropped off the face of the earth
with his sex drive, there’s a good chance you’re gonna find a benign brain tumor in
that guy if you check his blood test for prolactin. That’s not a cancer. It doesn’t need treatment.
That’s a health problem. So, I respect libido. I respect it. And you should respect it and
try to own it. Let’s talk about sleep. So, what does sleep affect? Well, sleep’s really
important. Does it kill you not to sleep? Probably not, but there are studies going
on that show that mortality is lower in men who don’t sleep well. Same with low testosterone and the same with
stress. They’re not strong. They’re epidemiologic studies. But it does affect lots of things
on this graph. So, obesity, your eat/dietary habits, your stress, testosterone, diabetes,
high blood pressure is a stressor. So, let’s talk about sleep. This is from the
National Sleep Foundation. It’s an ongoing annual survey on the web and the graph shows
the number of hours slept per night in 2010 by people in America. So half the people in
America who answered the survey say they’re not great sleepers. 10 to 15 percent say they never get good sleep.
They get an average of 6 hours and 30 minutes of sleep. How many hours did you get last
night? 6 hours and 30 minutes of sleep. What’s considered physiologically important for an
adult is 7 to 9 hours. For most. Everyone is different. Good sleepers,
if you looked at that subgroup, they tend to get an hour more than the sleepers who
aren’t sleeping well. And every generation, humans, get one hour less sleep a night. Welcome
to the Information Age. Stay connected. So, wake is the new sleep.
Short sleep has been linked to, definitively as that graph showed, depression, obesity,
heart disease, and attention disorders. So, it’s subtle but it’s real. Sleep is important.
What do you do about sleep then? And what do you do about the sex drive and sleep? Less caffeine, less alcohol. Those are disrupters
of rhythms and things. Less Red Bull. Exercise. Take those bicycles from building to building
on campus. Eat dinner early. Don’t fill late in the day so your metabolisms change. And
relax after work. So, that would be an e-book, a tub, something where you kinda get your
body down. Exercise would be great. And keeping a sleep
schedule is really important. And anyone with kids will know kids smile in the morning if
they’re on a schedule. They look great in the morning. I mean, if you keep them off
their schedule, your life is a mess. It’s the same with you. You’re basically a big kid. And I mean, basically
your body does better on a schedule. So, if here’s a Saturday and you always get up at
seven or eight, get up at seven or eight o’clock and then go back to sleep. But wake up like
normal. Keep on that schedule and then maybe go down a little bit afterwards to sleep in. But it’s not bad to do that. So it’s really
important. Olympic athletes know this. Anyone who practices anything at high level microsurgery,
it’s all about schedule. I mean, I do surgery on things that you can’t see by eye. And so,
I don’t go play tennis and pull my shoulder the night before a microsurgery case because
if I’m in pain, that causes a tremor. If I have a tremor, that’s not as good a procedure
for me. So, you have to take care of things. Sleep aids and medications, I put them at
the bottom. Not a first line approach to things, but they can help enormously. And there’s
a nice blog called “No Sex, Get Some Sleep: How it can improve your sex life.” I actually wrote one to the royal couple.
And I said I know the invitation probably got lost in the mail, but I’ll give you some
advice anyway, William. [laughter] Get some sleep, you guys. You got a busy life,
but take care of yourselves. So, it’s one of those blogs. Stress. Central. Central to
your life. Central to your sexual life. Central to your overall health. It affects almost
everything. OK. And is affected by things. So, what about libido and stress? So, here you are, the Geico caveman and you’re,
and I have no relationship to Geico by the way, you’re the Geico caveman and your body–.
When were we cavemen? Two hundred thousand years ago? The Paleocene era? And your nervous
system is basically identical to that. But your stressors are not woolly mammoths
chasing you anymore. So when you’re chased by a woolly mammoth, what do you think happens
to your erection? It’s gone ’cause you gotta get out of there. OK? All right, what happens
to your sex drive? Is that a time to have sex? No. Get out. OK? You have the same nervous system.
So what’s your stressor? There are no woolly mammoths. So, ours are physical. So, long
work days, sleep/wake cycles, emotional stressors. We have financial stressors, especially in
the Bay Area. And travel stress. Travel is a great form of stress. You’re traveling
to Europe all the time, Google London, that can be a problem because your clock is not
resetting. You have a pineal gland that likes a rhythm. And that changes all the levels
of things. So, you should know your woolly mammoths on this situation. So what do you do? So, that is the sympathetic
nervous system and I just saw a great poster out here in your lobby. Massage. Great for
your parasympathetic nervous system. I thought, [chuckles] “God, they know the names of the
nervous systems. That’s great.” I never see that anywhere else. It’s not relax. It’s like it’s great for your
parasympathetic nervous system at Google. [laughter] OK. So this is the sympathetic, . OK, I’ll
talk to you that way. This is the sympathetic nervous system. All right? So, this is the
fight or flight. That’s the stress one. No woolly mammoths, but whatever they are, they
may be small. You may not even know them. But you want the parasympathetic nervous system
and that’s how you get it exactly–massage, exercise, acupuncture, or yoga. Men are terrible
at figuring out if they’re stressed or not. They’re terrible. I have to ask them things
like, “How many times do you wake up at night worried about something at work?” That’s the kind of question and that’s an
extreme example of it. But that’s how men gauge it. But these are fabulous ways to reduce
your stress. Get your body tired. So, more profound and stressful than libido and erections
in a lot of couples is infertility, in people your age, especially because it involves a
partner. So, that’s an important thing to talk about
as a sexual health issue. And it’s defined as the inability to conceive after a year.
However you wanna define it. Whatever position you want. One year. And it’s a very simple
evaluation at the Turek Clinic. We do it all the time. One visit and maybe a phone call. OK? You
do a personal family history, 220 question questionnaire, a good physical exam like a
doctor does, a semen analysis and then potentially a hormone evaluation. That’s just a picture
of the room that we collect semen in at work, which is taken after Google. It’s a Wi-Fi, cordless, [audience laughs]
insulated, very efficient. It’s been in a couple magazines. And there’s a play written
after it called “Sperm Warfare,” which is gonna be made into a movie. And it’s very
much a headache movie because you watch and it’s all the problems that could happen to
a guy in a collection room who can’t get it done. Like, the women, wife, or partner is calling
him and saying, “Come on. Is it done? Is it done? And the phone’s in there.” And the nurse
comes through and he says, “Should I ask her to help?” And then all these things and then
he says to her, “You know. Maybe you just want me for my DNA. I really don’t wanna do this. You just want
me for my DNA.” But anyway, it’s a great little show. It’ll probably be coming out soon. But
if you asked me what’s the most important thing, everyone would say it’s gotta be the
semen analysis, right? No. It’s not. It’s the personal and family history. Semen analysis, unless it’s zero, is irrelevant,
almost irrelevant. It’s really the history of that patient. So, why is that important?
Because look at this, the usual suspects. Look what underlies male infertility. There’s
very little difference between this and erections. The metabolic syndrome group is up there and
it’s Building 41 here. You have heart disease, testosterone, stress, sleep, all of it is
all part of it and that’s all part of the personal history. That’s really important.
So your infertility could be due to stress. It could be due to other mechanical problems. It could be due to medical illness. It’s not
an orb rotating some other place. It’s part of your health. It’s not a separate problem.
So, what’s my advice? You make a thousand sperm per heartbeat. That’s busy, right? That’s
busy. A thousand sperm per heartbeat. [snaps fingers] A thousand. Two thousand. Three thousand.
Almost like your income here. [laughter] Testicles, they wanna run fast. This is an
engine. It’s an engine and it’s running hard all the time. What you can do to it is bring
it down. So, all these things slow it down. It’s like diluting the gas or something, flatten
the tires. You do something to the car to slow it down. It wants to run fast. It needs to run fast.
You’re built for this. So, have respect for small things in great numbers, like ants,
sperm. Eat well. Sleep well. Exercise. Reduce your stress. The mantra. The mantra of Google
Health, the mantra here. Treat your body well and keep the engine running. Does anyone know what kind of engine that
is? Anyone a car guy? [Audience member responds to question inaudibly]>>Dr. Paul Turek: There you go. There you
go. You know, I like it ’cause they show it off. You should show off the parts. It’s a
mechanical thing, show it off. Everyone covers it with plastic now. It’s not the way to do
it. So, there’s another thing about infertility that I’ve been very interested in the past
15 years as a researcher is that I think it’s good to know about it because it’s a biomarker. Like erections are a biomarker of health.
Semen analysis is a biomarker of health. It gets treatable, so it can reveal underlying
conditions. Those conditions can be treatable and should be treated in some situations.
And you can avoid technology, like in vitro fertilization test tube baby and that stuff. And it may be a window into future health.
It may be a window and it may be a true biomarker. So, we did a study where we looked at the
ability of infertile men to repair their DNA. Here’s the car analogy all over again. You
have a car. You drive it to work. You drive it home. You go in and all those
dents you pick up from the parking lot, when it’s in the garage those go away. It gets
fixed up overnight and it comes out the next day shiny and clean. That’s what your body
does a million times a day. You get exposed to sun, etc., and your body repairs its DNA
breaks. If it couldn’t do it, you’d have cancer. Skin
cancer, eye cancer, all that stuff. That’s the two-hit theory of cancer. You can’t repair
the second hit. You can’t repair the hit that occurred with the first. So, you have these
systems in place called DNA polymerase, nucleotide excision repair, DNA mismatch repair, and
they take the dents out of your DNA every day. OK? And there’s some mice that you can knock
out some of these genes that control these things, mismatch repair genes, and you can
make them and make transgenic mice and you look at these mice and a couple papers came
out ten years ago where they made this great knock out and they looked at it and got cancer. So the knock out mouse got cancer. And they
said, “Great. Now we have a model for colon cancer.” But the problem was they were also
infertile. So we looked at these at journal club at UCSF and said, “That’s odd.” So, the
first manifestation was the infertility and then they got cancer ’cause they had this
problem. So that’s a problem for transgenic. You spend
a million dollars to make a mouse with a gene that’s missing and you can’t reproduce it.
So what do you do? You write a ton of papers about the infertility. So they did. And we
saw these pictures of their testicles, the biopsies, and I said, “God, I have guys just
like that.” They look just like that. So, we took the
guys who had testicle biopsies that looked like these mice and got their blood and got
their sperm and did all this stuff. And we looked at them very carefully and we looked
at the source of the problem, which is called meiosis. Remember meiosis? High school? Biology, maybe
college? Chromosomes get together, they recombine, then they leave and that’s a new individual.
It’s different from mitosis, which is the rest of your body, which is don’t make a mistake,
don’t change, let the gametes do the changing. Evolution is all about your gametes. So, we
looked at the fidelity of the process of these men versus normal men. And what we’re finding
is, you can’t see these, but there’s little yellow nodules, dots, on these chromosomes
that are painted with stains. And some people are missing those dots, or the dots aren’t
made well. And those dots are recombination nodules that
repair problems. So, those are the nodules that go in and pull the dent out, the suction
cup that pulls the dent out of your car at night. And then it says, “OK, we’re fine.
Let’s keep going.” And they had faulty meiosis. So, they were bad. So we said, “Oh, my God.”
So it came out in The Economist, wrote an article about this paper we published and
said, “Are you telling me that these guys are all gonna get cancer?” Are we passing
off men with infertility as cancer farms? Are they gonna have kids with cancer? I said, “We don’t know.” But quality control
is very high in this system. So I don’t really worry about it. But then, ten years later,
a great fellow came into the department who was an epidemiologist and we said, “We have
a fabulous database of infertility patients in California of 55 thousand or 40 thousand
in a fabulous cancer registry.” So we did a really nice epidemiologic study
and we just looked at, over 30 years, the guys who were infertile. And it was based
on a semen analysis. And we said, “Are they higher risk for cancer if they’re infertile,
and if infertility is due to a male factor?” And we did. We found it. So, in this study, we found that
all men, the standard incidence ratio just means relative to the population of healthy
Californians at the time. It’s 30% higher, but not significant, this crosses one. So,
all men in the study, all part of infertile couples, their rate of cancer, testicular
cancer, after infertility, this is later disease, not the same time, later disease. But if they had a male factor infertility
that was three-fold higher, and if they didn’t have a male factor infertility, so the infertility
was a female issue, then it was the same. So, that’s a nice control. There’s a control
and there’s a control. Negative controls. And cancer was three-fold higher. Perfectly consistent with European data. First
data in America that was real. And then we took a negative cancer, like prostate cancer,
which is late in life, same thing. It was two-fold higher. And I’m like, “Now what do
we do?” So, what’s going on? I don’t know what’s going on, but this worries me and it
means that infertility may be a biomarker. So, here you go on your life. You start out
here, born at a young age, spend some time at Microsoft, Facebook’s old, you come to
Google. And then maybe something else happens, like infertility. And the question is what
else is gonna happen because that’s the first marker. And you don’t know that. But this is where
I think the government should be spending money on how is this a biomarker of health.
What about testis cancer? This is near and dear to my heart. I’m an advisor to Lance
Armstrong Foundation. And I think this is an incredible story, but this is the most
common cancer in your age group, essentially. It does go down at 35. There’s another peak
at 50, but I asked UCSF medical students who were in their 20s who are supposed to be health
conscious, how many of you do testicular self-examinations once a month in the shower? Nobody. Or nobody
admitted it, but nobody. And that’s sad because that’s real easy to
do. And these cancers are rising 36% per year in America, per year, and elsewhere in Europe
much higher. And what really gnaws at me is the, this is the men’s health thing. The average
delay in the diagnosis from when the man knows that there’s an issue that’s not normal to
when he gets care is 12 to 24 weeks. That’s three to six months. Three to six months.
For cancer, that’s a big deal. But we know the risk factors. We know the risk factors.
There’s a family history now. If your testicle’s not descended at birth that’s a risk factor
and pot use is a risk factor, believe it or not. It’s curable, very curable, if you catch it
early. And self-examination is a fabulous way to pick it up early. And I had a patient
a couple months ago who found it and just found a little bit of difference between his
testicles and I said, “Congratulations.” I basically took it out and put a fake one in
there. He didn’t miss a beat and he’s cured, based
on one procedure. Not a pleasant one, but it’s one. So, there’s a blog on the pot one
if you wanna know more called “Weed worries.” How about this one? Have you ever heard about
this one? Ejaculation. It’s not in your head. It’s not in your head. Ejaculation is a spinal
reflex. This is a reflex from the spinal cord, like a sneeze. It’s the only two reflexes
you can’t control. Once they go, they go. It’s a spinal reflex. You can tell her that.
[chuckles] [laughter] But there’s disorders of this, which are very
interesting, that you can be early, or early ejaculation, which is a question of, what’s
early? It’s, we’re starting to define it. It can be late. It may not happen. It may be very difficult,
that’s true. It can be dry. Everything’s working, but just nothing comes out. Or, it can be
absent. It’s just never developed. And those are very treatable conditions. I don’t know
if there are health risks with them. So I don’t know if this is a general health. But
quality of life issue? You bet. It’s very treatable. I treat them
all the time. They don’t even involve pills. Some of it’s just behavioral training. Contraception.
OK. You’re in the bar. You’re doing well. You’re at Google. You got it all. There’s
a lot of reward. And there’s some risk. You’re out there and there’s some risk of being out
there. Contraception is important. So, here are your
choices. You can use condoms. You can use rhythm method. What the hell is that? You
can use withdrawal. There’s a great blog on that, “Pulling Out is In.” You can abstain.
Always works. Vasectomy. A little invasive. I like them, but. And then, there’s the male
pill, which we’ll talk for a minute about. But the number one for STD, sexually transmitted
disease, is a condom. And that’s a two percent failure rate, and that’s a pretty good rate.
Withdrawal, believe it or not, in studies works very well. Everyone worries about the first part of the
ejaculate having sperm, but in fact, it’s a four percent failure rate. It’s basically
like a condom. It’s pretty good and everybody uses it. But there aren’t very many people
that conceive with withdrawal. I don’t know if I’d recommend it, but it is quite good. And men get pretty good at it. Vasectomy,
absolutely the surest, best form of contraception. No compliance issues. You’re done, you’re
done. Seven minute procedure. You come to the office, getting a diploma, congratulations.
It’s a good one. The Turek Clinic. The male pill. What’s happening with the male
pill? Well, it’s probably not gonna happen because there’s ethnic variations in men.
And there is compliance issues with men and men aren’t women and pharmaceutical industries
are not really interested in anything with a risk like this. It’s like taking a pill to prevent a heart
attack and you get a heart attack. They’re just not that interested. So, there’s been
30 years of research and the hormonal contraceptives are being developed in labs, but the pharmaceutical
industry’s just not really interested. And that’s kinda the latest and so there probably
won’t be a male pill. What about the other sexual health issue is you go to the bar,
you come back, do you want the nightmare reminder of that evening? And this is the most unwanted
list. This was provided by the CDC in Atlanta to me for this talk. And basically, number one are the viruses.
So, genital herpes and the herpes virus, sorry. Genital warts and the herpes virus are number
one and two. And those are literally 25 percenters of reproductive age people. They’re not curable
either. Although there is a vaccine now for genital
warts called Gardasil, which came out which works really well, but it’s not for people
with the problem. It’s for currently 9 to 13- year old pre-sexually active women to
prevent the contraction of warts which can lead to cervical cancer. It’s not approved for men, although that’s
being discussed. Should we give it to young boys, too? This is preventative. It’s a vaccine,
essentially. So once you have it, it doesn’t help. But you do control it clinically and
then it doesn’t become infectious and it’s not really a problem. But chlamydia’s on the rise. That’s the college
one. That’s going up. Gonorrhea and HIV are on the decline, which is good. And syphilis.
You probably don’t even know what syphilis is, it’s so old. But syphilis is on the rise,
too. And so that’s something to think about and these are things that you have to think
about. And here’s syphilis in California. Who does
it occur in? Reproductive age men. Where is it occurring in California? Bing bing bing
bing bing. And that’s probably most of the Google campus right there. [laughter] So the best advice is the oldest advice. You
take your history with you when you go into a relationship. So, be safe. Pretty plain
and simple. Hormones. So, everyone talks about testosterone, this or that. Is testosterone important? It’s got a bad
rap with sports and stuff, but it is very important. It’s very important. It is good
for your heart. It’s good for your muscle. It reduces your fat. It keeps your blood counts
up. It prevents depression. It is an elixir. It doesn’t get you the car, but it’s good
for your bones. It’s good for maintaining your sexual health
too and maintaining that area. So, it is important. And what’s influencing testosterone? Look
at the same actors, basically. Metabolic syndrome, diabetes, thyroid, overall health in the body.
Testosterone is a rest and restore molecule. If you’re running from a woolly mammoth, you
think it’d be higher. If you’re a really good athlete, it’s not. Because it’s a molecule
that rebuilds you when you’ve done the run. So when you’re running from the woolly mammoth,
that’s adrenaline. But when you sit down and start to take a couple of breaths, that’s
when your testosterone kicks in. So, it’s really an anabolic hormone–more
of a rest and restore one. So, stress kills it. Does it do a body good? Absolutely. It’s
the elixir of life. You have to have a good level of it. Is it the root cause of your
problems? Probably not. Is replacement the Holy Grail? No. Testosterone replacement is not the Holy Grail.
You can read the blog “A sword with two edges.” Maybe it was for him, maybe not. [laughter] I don’t know. You decide on Schwarzenegger.
This is the fact, though, about testosterone. It’s probably, whatever you put on this curve,
this is the computer and you want your computer to be over-clocked and you’re doing that and
you think more testosterone will help your body computer. What happens, what people think is that more
is better and you’re just gonna get stronger, this this this, more more more. It’s not the
way it works. It’s probably a saturation curve. You get a normal level and at that point,
you’re not gonna improve much. It’s gonna be saturated. So that’s probably
what’s going on with testosterone. I call it “here’s the truth” curve. That’s it. That’s
my advice about these simple sexual health issues. You need to think about them. You
need to take ownership of them. I will help you do that. The medical system right now isn’t very good
at that, ’cause everyone’s got their own little expertise. But you are an individual and it
is all one big happy family inside of you. These issues, called sexual health issues,
are lead indicators of health and they are lead predictors of future health. So, this is what most of my time with the
government is spent doing, trying to get grants to go in this direction for men. And not only
that, treatment will really improve your quality of life. So, that is really the strong, important
things. I wanna thank some organizations for helping out with this talk. It’s through their advice that I have told
you a lot of this. So, NIH helped out and the CDC and a couple of professional organizations
that I’m a member of and I’ve had people contribute to this talk. So, I wanna thank you for your
time. Again, if you have questions and you don’t want to talk about them here, or you
want the slides from the talk, there’s the hashtag and at Twitter it’s @TheTurekClinic.
Thank you very much. [applause]

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