Dr. Paul Turek - "A Guy's Guide to Maintaining Sexual Health"


Uploaded by AtGoogleTalks on 11.07.2011

Transcript:
>>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]