men's health new diet

>>mina: : dr. turek is director of the turekclinic, a men's health clinic in san francisco. he is a former professor of urology, obstetricsand gynecology at the ucsf and held the academy of medical educators endowed chair in urologyeducation. dr. turek attended, i think i keep sayingthat wrong,turek? sorry. attended yale college followed by stanford university medical school.after urology residency at the university of pennsylvania, dr. turek was fellowshiptrained at baylor college of medicine. his 175 publications include basic researchthat focuses on germ and stem cell genetics and epidemiologic studies of men's sexualand reproductive health problems. he's on the advisory board of the national men's healthcare network and the nih reproductive medicine

network. he is also the editor of the reproductivevolume of netter's images and oversees an active blog on men's health issues. he recentlyfounded 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 tothank, are you mic'd ok? ok. thank you for having me. thank you hr for bringing me togoogle. it's my first time. i'm very excited. and i wanna teach a little bit about yourlife. so, if you have. this might be a sensitive lecture, so if you do have questions, you'rewelcome to send it to a hashtag or tweet at

theturekclinic. if you wanna do that, we'llanswer those for you. if you want a copy of the slides, do likewise please. mina went over this with google health, whichi 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 googlehealth allows you to own it more. so, i'm a real fan of and would like to getinvolved with google health on that level. so, why was i asked to speak? well, i am amicro-surgeon and i am a urologist and i am a fellowship trained men's health specialistand 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 careabout you. i care about the kind of care that men are getting in america right now. i havedeveloped 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 celltechnology coming out where we can take a skin biopsy potentially in the future, makingit into a stem cell, making it into a sperm in a dish. so, we get that little kid withleukemia 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. theyasked 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 hasa car? most of you. who gets the oil changed on their car regularly? ok. who's been toa doctor in the last one year? wow. ok. didn't work. [laughter]

so, typically, men take better care of theircars than they do the bodies. and you guys are proving me wrong, but so, congratulationsis what i would say to that. but men have issues and typically they don't get greatcare for those issues. and they don't reach out very well. so, menare terrible at reaching out, unlike women. they do not have a monthly biology to respondto. so, they don't get great care for lots of reasons. and i'm just here to say thati care and i have a program for you. so, this is the traditional view of men's health inamerica. 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. andthat 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, butno one really owns the package of men, unlike a gynecologist who does the breast exam anddoes a lot of the typical things that women need periodically. so, that's the problem in america. there'sno ownership of care of men. so it's all fragmented. and i think that needs to change. and we'redoing that. and what needs to change is we

need to bring sexual health into the planetof the whole planet or realm of overall health. and i'm gonna prove to you today that it belongsthere; that you're sexual health is as important as your overall health and is integral tooverall health. and you've got a lot of initiatives here at google. you heard a mindfulness talkyesterday. stress reduction, they feed you, they encourage you to stand. the ergonomics team will help you stand insteadof 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 healthorganization, calls it the integration of the physical, emotional, intellectual andsocial aspects of sexual being.

that's really it. so, here's a cloud tag iput together on the topics i wanna talk about under the realm of sexual health and theirrelative frequency. so, ejaculation disorders are really number one for young men. and sexualdesire disorders, libido, is really number two. and you're gonna learn more about those thanyou ever cared to learn today. but these are important things that matter to men and affecttheir quality of life. so, first start off, how is a man like a vintage maserati? so inthis crowd it's different because you actually probably take care of yourselves as well asa vintage maserati. and i was gonna offer you, if no one raisedtheir 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 itup 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'reimmortal. you hardly ever think about things. you take great abuse, long hours, fluorescentlights, sitting, over-clocked computer. you have no signs of failure basically. andbut when you do fall, you fall hard. so it takes a lot to keep you sick, to keep youat 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 themetal may bend quietly and then break, which is similar to man. so, these are pretty goodanalogies. and you'll see me running through the caveman analogy and the old car analogyquite a bit, because i do think that everyone needs a tune-up. now, in this talk, i've got these blog postswritten. that's on turekonmenshealth.com. it's a blog i write weekly and this one'scalled "the sound and the fury," but if you see that, then it'll talk a lot about thatand expand on it for you. it's on turekonmenshealth.com. and love your input.

so let's talk about erections. near and dearto everyone's heart at your age. this is massachusetts male aging study, which is impressive becauseit showed us that it was done on a cross-sectional population of men in massachusetts and alldifferent kinds of men. and it showed that basically, erectile dysfunctionoccurs in everybody. almost in every age group you'll find erectile dysfunction, troublewith 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 graphwith yellow, orange, and red goes way up as you go down on the graph. and so, even atage 40, which is when the study started, there

are half the men were having problems witherections. half. and you can extrapolate that to 30. it's pretty linear. you can see at 30 thereare 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 seeingthis slide, but this is a cross-section of the member. and this is how it's built. so, there's anartery 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 giveyou tumescence, or engorgement. and those

are called sinusoids. and then, the sinusoids when they fill, slapthe vein shut against the wall of the penis and close off, or cork off, the flow of bloodout of the penis so it stays in. so it's very mechanical, a very mechanical system. andthat'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 thesink itself. and the drain is the venous leak, are the veins that drain. so, to get a gooderection, you would follow the green curve there, where you get,.

it quickly fills up and it stays full. that'sa sink with a good seal and a good inflow. but a lot of problems, a lot of times youmay have problems with the drain. so, you have a kitchen sink and the drain's not tightand you get the yellow curve shows an erection that occurs quickly, but falls quickly becauseit's draining out. that's very common. and the red curve is anerection that takes a while to get because the faucet's weak, but once you get it you'reok. and those are three typical patterns that demonstrate the mechanics of this. but whatelse is going on with the penis? so, that's the mechanical issues, but the erection isnot an isolated event. the problems with erections is not just asimple mechanical problem, because men with

erectile dysfunction we now know, this isestablished science, have twice the, . in their 40s or so, have twice the risk of heartattacks as they get older than men who don't. and that risk, increased risk of heart diseasewith an erection problem as a younger person is the same risk as a smoker or someone inyour family who has a heart problem. same risk. that's pretty important. i callthat a biomarker. women have periods and they have cycles and they go to doctors when they'reirregular. 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 issuesgoing on. yes. >>male audience member #1: inaudible questionfrom audience

>>dr. paul turek: wait. i'll get to it. "anybodywho 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-establishedand influence erections. so, up here, this corner, the upper left-hand corner are themetabolic syndrome risk factors, right? obesity, heart disease, cholesterol, blood pressure,diabetes. that's the metabolic syndrome features. they're all, throughout this talk, they'llbe all in the upper left-hand corner. sleep. stress. stress is a type a personality, exceptthere aren't any type a personalities here i'm sure. medications. organ failure. lowtestosterone. alcohol and drugs. alcohol is

fabulous. so alcohol, you see these young guys comein and they have a problem with intercourse or whatever. and what happens is you're ona date. you're at the bar and you pound a couple of stouts. and you see a woman, orman, 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, becausewhat alcohol does is it's socially uninhibiting. so, you're pretty nervous about it. you'llget relaxed. your libido, you sex drive, will go up and you'll say, "i'm gonna do it." andyou go over there and it works out really well.

and later that evening, you go to use thedevice, and you'll have the activity and it's numb as anything. because alcohol is a localanesthetic. it's an anesthetic. that's what we gave people when we were cutting off armsand legs in the civil war before we had anesthesia. alcohol and a bullet. it's great. so it actuallynumbs the signal and it's sometimes almost impossible to keep an erection if you havea lot of alcohol on board because your sensations are changed. so, it's a two-edged sword. butthis is well-established stuff. so you can see, this very much a part of overallhealth. an erection problem is very much part of overall health. and when i see a man andi'm pretty convinced it's a real erection problem, at the turek clinic, what i willdo is i will evaluate him for metabolic syndrome.

i will do those things because we need toown it. and i'm not gonna send him to a medical doctor to do it. i'm gonna do it and takecare of it and try to get that under control. and taking care of those risk factors willimprove the erection. so, men with heart disease, it's all one big blood vessel, but heart diseasepatients who have poor erections, if you can help their heart disease out, they'll getbetter erections. so you can actually improve things. so, letme 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 outwhether it's really an organic problem, or it's just a stress-related situational problem.

and that's really easy to differentiate withone visit. and then, erectile dysfunction is related to overall health. that's reallyimportant. so you need to take care of your overall health. you need to eat well. youneed to sleep well. you need to exercise. you need to go to the massage and yoga classeshere. 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'redoing a great job of it. and take ownership. let's talk about something more common thanerection problem, which is a sex drive problem. there's very little science here, but clinicallyi treat this all the time. it's probably the most common thing a young man would come infor 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'strue about it, i think clinically, is that levels vary widely among individuals. so oftena couple gets together and the one partner and the other partner have very differentideas of how often they should have sex. and you'll see this in a marriage. it's very different. and that is one of thehardest parts. it's harder than the dishwasher thing where you're putting dishes away andyou say, "am i gonna do this for the rest of my life? am i gonna be putting the dishesaway?" you know, as the guy in the relationship.

it's one of those things. how do you solvethat problem? well, it kind of works itself out. kinda works itself out, but you do haveto 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 frequencyof wanting it, the desire, the urge. there can be times of deadlines and stresswhere it might not be as high. and it's not linked to testosterone levels. so, the guyin the porno flick who wants it all the time doesn't have a higher testosterone than theguy 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 withtheir patterns of sex drives. so, the man

on the top in the green basically has a highsex drive and it's constant. the man on the lower part is lower sex drive and it variesa little bit, but it's got a pattern to it. and those are both normal. those are bothnormal. what's not normal for me is when a man has a pattern that is changing. and changingcan 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'sgetting 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 metaboliccomponent in the upper left-hand corner. low testosterone is a part of this. stress isa huge part of this. sleep is a huge part of this. alcohol and drugs, etc. travel, circadianstress can all affect this. and prolactin. the guy who dropped off the face of the earthwith his sex drive, there's a good chance you're gonna find a benign brain tumor inthat 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 andtry to own it. let's talk about sleep. so, what does sleep affect? well, sleep's reallyimportant. does it kill you not to sleep? probably not, but there are studies goingon that show that mortality is lower in men

who don't sleep well. same with low testosterone and the same withstress. they're not strong. they're epidemiologic studies. but it does affect lots of thingson 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 thenational sleep foundation. it's an ongoing annual survey on the web and the graph showsthe number of hours slept per night in 2010 by people in america. so half the people inamerica 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 lastnight? 6 hours and 30 minutes of sleep. what's considered physiologically important for anadult 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 whoaren't sleeping well. and every generation, humans, get one hour less sleep a night. welcometo 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 disruptersof rhythms and things. less red bull. exercise. take those bicycles from building to buildingon campus. eat dinner early. don't fill late in the day so your metabolisms change. andrelax after work. so, that would be an e-book, a tub, something where you kinda get yourbody down. exercise would be great. and keeping a sleepschedule is really important. and anyone with kids will know kids smile in the morning ifthey're on a schedule. they look great in the morning. i mean, if you keep them offtheir schedule, your life is a mess. it's the same with you. you're basically a big kid. and i mean, basicallyyour body does better on a schedule. so, if

here's a saturday and you always get up atseven or eight, get up at seven or eight o'clock and then go back to sleep. but wake up likenormal. 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 reallyimportant. 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 becauseif i'm in pain, that causes a tremor. if i have a tremor, that's not as good a procedurefor me. so, you have to take care of things. sleep aids and medications, i put them atthe bottom. not a first line approach to things,

but they can help enormously. and there'sa 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 someadvice anyway, william. 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 toyour life. central to your sexual life. central to your overall health. it affects almosteverything. 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 nervoussystem is basically identical to that. but your stressors are not woolly mammothschasing you anymore. so when you're chased by a woolly mammoth, what do you think happensto your erection? it's gone 'cause you gotta get out of there. ok? all right, what happensto 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, longwork days, sleep/wake cycles, emotional stressors. we have financial stressors, especially inthe bay area. and travel stress.

travel is a great form of stress. you're travelingto europe all the time, google london, that can be a problem because your clock is notresetting. you have a pineal gland that likes a rhythm. and that changes all the levelsof things. so, you should know your woolly mammoths on this situation. so what do you do? so, that is the sympatheticnervous system and i just saw a great poster out here in your lobby. massage. great foryour parasympathetic nervous system. i thought, [chuckles] "god, they know the names of thenervous systems. that's great." i never see that anywhere else. it's not relax. it's like it's great for yourparasympathetic nervous system at google.

ok. so this is the sympathetic, . ok, i'lltalk to you that way. this is the sympathetic nervous system. all right? so, this is thefight or flight. that's the stress one. no woolly mammoths, but whatever they are, theymay be small. you may not even know them. but you want the parasympathetic nervous systemand that's how you get it exactly--massage, exercise, acupuncture, or yoga. men are terribleat figuring out if they're stressed or not. they're terrible. i have to ask them thingslike, "how many times do you wake up at night worried about something at work?" that's the kind of question and that's anextreme example of it. but that's how men gauge it. but these are fabulous ways to reduceyour stress. get your body tired. so, more

profound and stressful than libido and erectionsin a lot of couples is infertility, in people your age, especially because it involves apartner. so, that's an important thing to talk aboutas 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 simpleevaluation at the turek clinic. we do it all the time. one visit and maybe a phone call. ok? youdo a personal family history, 220 question questionnaire, a good physical exam like adoctor does, a semen analysis and then potentially a hormone evaluation. that's just a pictureof 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 writtenafter it called "sperm warfare," which is gonna be made into a movie. and it's verymuch a headache movie because you watch and it's all the problems that could happen toa guy in a collection room who can't get it done. like, the women, wife, or partner is callinghim and saying, "come on. is it done? is it done? and the phone's in there." and the nursecomes through and he says, "should i ask her to help?" and then all these things and thenhe says to her, "you know. maybe you just

want me for my dna. i really don't wanna do this. you just wantme for my dna." but anyway, it's a great little show. it'll probably be coming out soon. butif you asked me what's the most important thing, everyone would say it's gotta be thesemen 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'svery little difference between this and erections. the metabolic syndrome group is up there andit's building 41 here. you have heart disease,

testosterone, stress, sleep, all of it isall 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 notan 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'sbusy. a thousand sperm per heartbeat. [snaps fingers] a thousand. two thousand. three thousand.almost like your income here. testicles, they wanna run fast. this is anengine. it's an engine and it's running hard all the time. what you can do to it is bringit down. so, all these things slow it down.

it's like diluting the gas or something, flattenthe 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 googlehealth, the mantra here. treat your body well and keep the engine running. does anyone know what kind of engine thatis? anyone a car guy? [audience member responds to question inaudibly] >>dr. paul turek: there you go. there yougo. you know, i like it 'cause they show it

off. you should show off the parts. it's amechanical thing, show it off. everyone covers it with plastic now. it's not the way to doit. so, there's another thing about infertility that i've been very interested in the past15 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 underlyingconditions. 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 theability of infertile men to repair their dna. here's the car analogy all over again. youhave a car. you drive it to work. you drive it home. you go in and all thosedents you pick up from the parking lot, when it's in the garage those go away. it getsfixed up overnight and it comes out the next day shiny and clean. that's what your bodydoes a million times a day. you get exposed to sun, etc., and your body repairs its dnabreaks. if it couldn't do it, you'd have cancer. skincancer, eye cancer, all that stuff. that's the two-hit theory of cancer. you can't repairthe second hit. you can't repair the hit that occurred with the first. so, you have thesesystems in place called dna polymerase, nucleotide

excision repair, dna mismatch repair, andthey take the dents out of your dna every day. ok? and there's some mice that you can knockout some of these genes that control these things, mismatch repair genes, and you canmake them and make transgenic mice and you look at these mice and a couple papers cameout 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 theysaid, "great. now we have a model for colon cancer." but the problem was they were alsoinfertile. so we looked at these at journal club at ucsf and said, "that's odd." so, thefirst manifestation was the infertility and

then they got cancer 'cause they had thisproblem. so that's a problem for transgenic. you spenda 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 wesaw these pictures of their testicles, the biopsies, and i said, "god, i have guys justlike that." they look just like that. so, we took theguys who had testicle biopsies that looked like these mice and got their blood and gottheir sperm and did all this stuff. and we looked at them very carefully and we lookedat the source of the problem, which is called meiosis.

remember meiosis? high school? biology, maybecollege? 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, welooked at the fidelity of the process of these men versus normal men. and what we're findingis, you can't see these, but there's little yellow nodules, dots, on these chromosomesthat are painted with stains. and some people are missing those dots, or the dots aren'tmade well. and those dots are recombination nodules thatrepair problems. so, those are the nodules that go in and pull the dent out, the suctioncup 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 andsaid, "are you telling me that these guys are all gonna get cancer?" are we passingoff men with infertility as cancer farms? are they gonna have kids with cancer? i said, "we don't know." but quality controlis 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 havea fabulous database of infertility patients in california of 55 thousand or 40 thousandin a fabulous cancer registry."

so we did a really nice epidemiologic studyand we just looked at, over 30 years, the guys who were infertile. and it was basedon 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 thatall men, the standard incidence ratio just means relative to the population of healthycalifornians 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, testicularcancer, after infertility, this is later disease, not the same time, later disease.

but if they had a male factor infertilitythat was three-fold higher, and if they didn't have a male factor infertility, so the infertilitywas a female issue, then it was the same. so, that's a nice control. there's a controland there's a control. negative controls. and cancer was three-fold higher. perfectly consistent with european data. firstdata 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 dowe do?" so, what's going on? i don't know what's going on, but this worries me and itmeans that infertility may be a biomarker. so, here you go on your life. you start outhere, born at a young age, spend some time

at microsoft, facebook's old, you come togoogle. and then maybe something else happens, like infertility. and the question is whatelse is gonna happen because that's the first marker. and you don't know that. but this is wherei 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 lancearmstrong foundation. and i think this is an incredible story, but this is the mostcommon cancer in your age group, essentially. it does go down at 35. there's another peakat 50, but i asked ucsf medical students who were in their 20s who are supposed to be healthconscious, how many of you do testicular self-examinations

once a month in the shower? nobody. or nobodyadmitted it, but nobody. and that's sad because that's real easy todo. and these cancers are rising 36% per year in america, per year, and elsewhere in europemuch higher. and what really gnaws at me is the, this is the men's health thing. the averagedelay in the diagnosis from when the man knows that there's an issue that's not normal towhen 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 factorand pot use is a risk factor, believe it or not.

it's curable, very curable, if you catch itearly. and self-examination is a fabulous way to pick it up early. and i had a patienta couple months ago who found it and just found a little bit of difference between histesticles and i said, "congratulations." i basically took it out and put a fake one inthere. he didn't miss a beat and he's cured, basedon one procedure. not a pleasant one, but it's one. so, there's a blog on the pot oneif you wanna know more called "weed worries." how about this one? have you ever heard aboutthis one? ejaculation. it's not in your head. it's not in your head. ejaculation is a spinalreflex. this is a reflex from the spinal cord, like a sneeze. it's the only two reflexesyou can't control. once they go, they go.

it's a spinal reflex. you can tell her that.[chuckles] but there's disorders of this, which are veryinteresting, that you can be early, or early ejaculation, which is a question of, what'searly? 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 beabsent. it's just never developed. and those are very treatable conditions. i don't knowif there are health risks with them. so i don't know if this is a general health. butquality of life issue? you bet. it's very treatable. i treat themall 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'sa lot of reward. and there's some risk. you're out there and there's some risk of being outthere. contraception is important. so, here are yourchoices. you can use condoms. you can use rhythm method. what the hell is that? youcan 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 malepill, which we'll talk for a minute about. but the number one for std, sexually transmitteddisease, 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 theejaculate having sperm, but in fact, it's a four percent failure rate. it's basicallylike a condom. it's pretty good and everybody uses it. but there aren't very many peoplethat 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'redone. 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 malepill? 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 industriesare not really interested in anything with a risk like this. it's like taking a pill to prevent a heartattack and you get a heart attack. they're just not that interested. so, there's been30 years of research and the hormonal contraceptives are being developed in labs, but the pharmaceuticalindustry's just not really interested. and that's kinda the latest and so there probablywon'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 unwantedlist. 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 numberone and two. and those are literally 25 percenters of reproductive age people. they're not curableeither. although there is a vaccine now for genitalwarts called gardasil, which came out which works really well, but it's not for peoplewith the problem. it's for currently 9 to 13- year old pre-sexually active women toprevent the contraction of warts which can lead to cervical cancer. it's not approved for men, although that'sbeing 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 andthen it doesn't become infectious and it's not really a problem. but chlamydia's on the rise. that's the collegeone. 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 thinkabout. and here's syphilis in california. who doesit occur in? reproductive age men. where is it occurring in california? bing bing bingbing bing. and that's probably most of the

google campus right there. so the best advice is the oldest advice. youtake your history with you when you go into a relationship. so, be safe. pretty plainand simple. hormones. so, everyone talks about testosterone, this or that. is testosterone important? it's got a badrap with sports and stuff, but it is very important. it's very important. it is goodfor your heart. it's good for your muscle. it reduces your fat. it keeps your blood countsup. it prevents depression. it is an elixir. it doesn't get you the car, but it's goodfor your bones. it's good for maintaining your sexual healthtoo and maintaining that area. so, it is important.

and what's influencing testosterone? lookat 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, youthink it'd be higher. if you're a really good athlete, it's not. because it's a moleculethat 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'swhen your testosterone kicks in. so, it's really an anabolic hormone--moreof a rest and restore one. so, stress kills it. does it do a body good? absolutely. it'sthe elixir of life. you have to have a good level of it. is it the root cause of yourproblems? 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. 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 andyou think more testosterone will help your body computer. what happens, what people think is that moreis better and you're just gonna get stronger, this this this, more more more. it's not theway 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 probablywhat's going on with testosterone. i call it "here's the truth" curve. that's it. that'smy advice about these simple sexual health issues. you need to think about them. youneed to take ownership of them. i will help you do that. the medical system right now isn't very goodat that, 'cause everyone's got their own little expertise. but you are an individual and itis 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 thegovernment is spent doing, trying to get grants to go in this direction for men. and not onlythat, treatment will really improve your quality of life. so, that is really the strong, importantthings. i wanna thank some organizations for helping out with this talk. it's through their advice that i have toldyou a lot of this. so, nih helped out and the cdc and a couple of professional organizationsthat i'm a member of and i've had people contribute to this talk. so, i wanna thank you for yourtime. again, if you have questions and you don't want to talk about them here, or youwant the slides from the talk, there's the hashtag and at twitter it's @theturekclinic.thank you very much.