Noor: Devoted father longtime surfer. Dr. Turik is a board certified urologist and microsurgeon, internationally recognized as the authority on male fertility and sexual health. He is the founder and director of the Beverly Hills and San Francisco based Toric Clinic. He is former endowed chair professor of the University of California San Francisco, and inventor of sperm mapping for the treatment of severe male infertility.

As a master neurosurgeon, he popularized the node scalpel vasectomy, and has among the highest published vasectomy reversal success rates. Dr. Turk's influence extends well beyond the clinic doors. His career has been dedicated to reshaping how we talk about men's health. This commitment is evident through his numerous research publications, global Talks, and Node Will Accolades, including a special invitation to the White House, as well as the prestigious NIH grant, and is an advisor to the NIH in Centers for Disease Control and Prevention.

So. Huge badass. Thanks so much for joining, joining us up. How are you doing? Huge,

Dr. Turek: badass. Good. Thanks for having me. I

Noor: think there's a lot of questions and a lot of misinformation about male fertility, so yes. Could you start by just telling us, you know, what do you think the most important thing in male fertility is that nobody's talking about?

Dr. Turek: Uh, I would say the most important thing would be the fact that people don't realize that fertility's a team sport. And sperm matter. That's a big one. And as a correlation to that, people don't know that for the most part, that you can do something about sperm because it's made regularly. Unlike eggs which sit there for your whole life and get older, sperm are made a new 1000 sperm per heartbeat.

So if you're thinking about. Interventions, lifestyle or medical or anything, you are gonna have a better luck with men than women in trying to improve the quality of GaN eats eggs or sperm.

Noor: So what are some of the things that people can do to improve their sperm quality or their sperm health?

Dr. Turek: I think a lot of people in other sort of misconceptions, people think that, well, if my sperm count's low, then there's something I can take to make it better.

But the real issue is if your sperm counts low, it wants to run harder, but something's holding it down. So normally, if you're perfectly healthy and you surround your genitals with health, good health, balance, diet, sleeping well. Not lean and mean, you'll run as hard as possible. So the system wants to run hard.

People think it doesn't wanna run hard and it's lazy and they can take magic things and and have a change. But that actual fact is just look inside and see how you live your life. Stress is a big one. Diet, weight, exercise, sleep. These are basic things, and so when I see a man in the office who's maybe infer has a low sperm count.

And he says, how can I improve it? The first thing I look at is try to go over his lifestyle issues and then there can be a hormonal problem, and that's stress can cause a hormonal problem. And remember, stress is complicated. Your body sees stress like a cat or a dog, which is, oh, he's, he's either gonna react.

Sympathetically, like, Ooh, what do we do? Or, it's gonna relax parasympathetically. It doesn't discern which, which stimulus is making it do that. So whether it's an email that you jump to or a really mammoth, it can't tell you the difference. It can only respond in a primitive way. So most of the things that don't stress us out, like constantly be connected to the internet or having an 80 R work week, or flying half a million miles a year and getting jet lagged, those are all stressors to the body.

And is viewed by the body as you are running from or mammoth, do you wanna be fertile and have a good testosterone level? No. You want cortisol. You're fight or flight at that point. So if you're fight or flight too long, it's not great for us. We're very good. As a species.

Noor: You recommend people monitoring their cortisol or is it, do you think there's any quantity?

Dr. Turek: No, I don't think so. I think I would rather, I think that that's not that accurate. I think. Their sleep patterns would be monitored for sure. Yeah, because the, one of the biggest stressors is the lack of REM sleep, deep sleep.

Noor (2): Yeah. A

Dr. Turek: lot of variables can help out there and give you an idea of what's going on.

But the first thing is time. I mean, I'd rather blog about this. I, you know, I think sleep is, is, is like third to oxygen. In terms of health, you know, you don't, you won't die without sleep, but you're not gonna be healthy.

Noor: So how much sleep do you think is recommended her? Hardly

Dr. Turek: there's, there's national averages and things, seven hours for an adult and you know, 14 hours or 12 hours for a kid.

Yeah. So, you know, there's lots of things like that, but everyone's different. But I'm just saying that these are all stressors that people don't feel like they're stressors, but they do have that same effect. And one the effects is L libido.

Noor (3): I

Dr. Turek: mean, do you want a high libido when you're chased by a, a giant, a silver tooth tiger?

No. You wanna get out of there. Do you want an erection when you're being chased? No. That's the wrong nervous system. And people say, you know, I men coming in young men. They're perfectly healthy saying, my Li Beatles' in the tank. And, and you know, my answer is, you know what, so maybe you should stop traveling a, a quarter of a million miles a year or whatever, take some time to relax.

Noor (3): Mm-hmm.

Dr. Turek: Other guys say, I have an erection problem. You know, it's just terrible. I can't get a good erection, can't keep it. And I say, well, what if, weren't you just in Borneo? Yeah. Oh yeah, I was fine there. Okay. So when you're relaxed and you're disconnected, it's fine. But when you're busy. It's not so The penis has, its its own measure of stress.

It's got, da Vinci said this penis have, its, has a mind of its own it. It's a great indicator of stress. Libido is a great indicator of stress. I.

Noor: Yeah. And that's a really, there's other

Dr. Turek: ways you have to practically convince men that mm-hmm. But those are the kinds of things that matter the most. I mean, when I see men and I'm looking at their little sperm count and I go over things, most of the time I can figure out what's going on.

If you go to lifestyle and all the basic stuff, it, it's really quite important. It's quite important.

Noor: Yeah. No, I think that's a really good point. I think a lot of people definitely don't consider travel as a stressor, but you know, physiologically, of course it is. Right? It's to disrupt your sleep. It,

Dr. Turek: yeah.

Jet lag is, you can't, you don't get good rem sleep with jet lag.

Noor: So when it comes to diet, what, what do you recommend?

Dr. Turek: It's hard to really say, but I, I like the data behind the Mediterranean diet. It's really good for your heart and whatever's good for your heart's really good for your sex life. And that's, we've known that from erection issues.

It's a harbinger of heart disease, so it looks like it's the all arounder. If you don't want to go back 33 generations, but you wanna go back 333 generations, then paleo is probably the best diet because we're, we're only cavemen a half a million years ago. We're really not that different. Yeah. So those are really good staple diet.

So I love, you know, Mediterranean and basically no white food, no pasta, no rice and no bread.

Noor: Are there any supplements that you think have good data

Dr. Turek: Supplements, like antioxidant supplements you mean, or herbals

Noor: coq 10 or, you know, official

Dr. Turek: Yeah, I mean, I, I, I have a disclosure. I mean, I, I am the founder of, of Alpha Sperum, which is a, is a supplement that is.

All naturally sourced, and the excipients and fillers are all natural. So the ingredients and the fillers and that that's sourced from the best data. And that's a complicated story. And the way I would put it is if you look at antioxidants as kind of the basis for it all, because we think that about half of male infertility is.

And it's oxidants. Mm-hmm. Inflammation of some kind. It's true of cancer and other things too. Autoimmunity, but it's probably true and it's sort of measurable because sperm are really a very delicate DNA payload. And, and think of it as a, a mid car car guy, mid engine car. And you have the engine right behind the passenger, you know, right there heating everything up.

So you have the mitochondria and the motor of the sperm right next to the 75 mitochondria, right next to the DNA payload. So it's very susceptible to, to d to oxidation and oxidative stress. So that's the, the background. And most of the antioxidants that we encourage are antioxidants. To reduce oxidative stress.

So if you look at the data for these in the semen analysis, say you're looking for an outcome like the semen analysis, it's very mixed data. So it does, it's not convincing that a man on a good regimen of antitoxin supplements will improve their steaming qualities. The half the paper say yes, half the paper say no.

So it's a hard outcome because the semen analysis is quite invariable

Noor: variable in the sense that the way that people do it is variable or the same person, everything

Dr. Turek: Biologically variable, technically variable. It's a horrible, I mean, it's a blunt instrument,

Noor: okay? It

Dr. Turek: really is not, it's hardly reproducible.

So even a normal man can have B zero sometimes. So when I consult with companies for the FDA, for their senior analyses. You know, garbage in, garbage out. They submit their data and it's all over the place, and there's a 75% variability in motility. There's a 87% variability in sperm concentrations in a normal man, depends on the time of day, the season, the ejaculate interval, you know, the abstinence.

Noor: Oh wow. So there's that much variability just

Dr. Turek: Absolutely. Absolutely. So if you look at, see the analyses and supplements in men, you don't get a lot of strong signals.

Noor: How did they draw this correlation between oxidative stress being damaging to sperm if, if the analyses are so variable in the first place, how did that Just

Dr. Turek: basic science, if you just look at the basic science of it.

Uh, if you look at, you know, the radicals, the free radicals and stuff, you can measure all that stuff coming with the lessons, measurements and stuff. You can measure oxidative stress. There's this test for it that you can do in sperm. You can actually measure all that stuff and it correlates pretty well with low sperm counts and, and DNA fragmentation and things like that.

Noor: Oh, I see. So the correlation is between oxidative stress and DNA fragmentation, not motility or more fall, everything, other

Dr. Turek: metrics. Yeah, there's a lot of correlations there. It's pretty strong all over. Yeah. But you need fertility in, in antiox and supplements or, or variables or whatever, male supplements.

And then you're really looking at randomized trials or clinical trials. And that's really interesting because the semen analysis data is not convincing either way. You could make an argument either way, you know? Mm-hmm. And it could hold water. But if you look at. If you look at the fertility data in IVF settings where bubbles are trying to conceive and the men put on a supplement, a Cochrane reviews, which are systematic reviews of large pools of data to figure out where the weaknesses are.

They have published four trials in England, four papers summarizing now maybe 60 studies with 10,000 patients. It's very funny for the last 10 years at putting out papers saying, okay, looking at the first 25 trials, it looks like there's an increase in pregnancy rates, a decrease in miscarriage rates at IVF.

When men are on a supplement, it doesn't say, you know, they're all different supplements. It. And they said that can't be true. So they do another run three years later with more studies. It's also positive on both fronts. Then they say that can't be true. They do a third run and it's positive and they do a fourth one.

And it's positive

Noor: just the man, not the female partner.

Dr. Turek: Right, because it's just the male supplements and all the trials. So it's very funny that they keep trying to show that it's not beneficial. But every study they show, and now even a live birth rate study is showing beneficial and you can knock these things forever.

But I mean, Cochrane reviews besides a randomized trial, if you're trying to figure out what to study or what's where the holes are in the science, they're kind of it, and that's four trials that have shown benefit. The benefit has gone down. That's regressing to the mean, but it's very interesting. So I would say that there's a, there, there with male supplements.

What,

Noor: what's the size of those studies and what supplements are they on?

Dr. Turek: Supplements are all different. Mm-hmm. Because it's different and there can be several together. They're not single supplements. There's some single supplement data, like folic acid and stuff. I did a study on Selenium, which was an incredibly good trial with the USDA, looking at selenium supplementation and phe.

But we had guys. You know, in the Presidio in San Francisco eating, or a diet that was prescribed by then with the, you know, really good study that was 20 years ago. And there's differences, you can see differences in the seed analysis when you do it at that level where you're actually controlling everything they eat.

But it's a difficult field to study. But to me, the data of fertility is profound that I consider office sperm to be a prenatal supplement. Absolutely for men, and I think it's, the data is just as strong as women being on prenatal supplement and it's time because it is a team sport and that's what we don't understand.

So, you know, maybe we can't define it yet. Maybe it's a deeper dive. Maybe. Like we presented a study at the SRM this year with our supplement that it massively modified the epigenetic profile of sperm when men over 45 took it for nine months. The sperm were completely different individuals as epigenetically.

We actually don't know the direction it went in, but 43 some odd metabolic pathways were markedly affected by tenfold changes in epigenetics. And that was just, that was just stunning to us.

Noor: Wow. Uh,

Dr. Turek: and we're gonna publish it because that's a deeper reason. Maybe it's not the se analysis, maybe it's a, the fragmentation rate or maybe it's epigenetic modification that's doing it.

Maybe there's something deeper we didn't even know about.

Noor: That's super interesting. So do you think there's, you know, one or two that you'd recommend?

Dr. Turek: I, I'm a big fan of, the best supplement is a great diet.

Noor: I totally agree with that.

Dr. Turek: If you eat a perfect diet and don't eat airport food, then I think you, you know, you fine.

It is not an issue. But, you know, ly aine from tomatoes. Blueberries. The antioxidants of blueberries and tomatoes are massive amounts. Glutathione is one. Acetyl. Cornine is really good in the EPIs. I like that for men who have ectomy reversals and their EPIs is dysfunctional, and I try to get them motil up with that.

So there's some directed stuff, but this is all and alpha sperm. Coq 10 has good data behind it. The B complex I give forecast is methylfolate 'cause it's M-T-H-F-R deficiencies can occur in men as they do in women and they can't be metabolized and things like that. So, you know, it's a complex food science.

Noor: Yeah, that's a really good point. What do you think people are doing right now for sperm health that doesn't actually work, and why do you think they think it works?

Dr. Turek: I don't know what they're doing, but I'd say continuing with bad habits. You know, going to the sauna after you work out or taking a hot bath.

Terrible, terrible. We published that. It was, I mean, I took men in hot baths out of hot baths and watched those sperm counts go up 600% in six months, 400% and four months kind of thing. And it was just stunning. And I calculated after I published it. And what I call a lethal dose of hot baths or, or jacuzzis.

Mm-hmm. 15 minutes, three days a week, 104 degrees. Do that for a month. You could easily be zero Lethal dose means no sperm.

Noor: Wow. So how, how long do people need to stop? Because I don't know if you know that there's like a huge craze right now of like sauna and cold plunge.

Dr. Turek: No, I'm okay with that. You know, I, I, I.

Like Surfing Magazine asked me, you know, are there any feral surf? I said, not feral surfers. They're infer water. It's great. Yeah, I don't, I, I have no issues with cold plunges. I have all these issues in the world with heated seats, saunas, jacuzzis, hot baths, steam rooms and things like that. Hot showers are fine, but if you can't regulate your storm temperature, which it does, you know, faithfully every minute.

And it's one centimeter from the surface of your skin. It's not in the middle of your body. It's gonna be subjected to anything ambient.

Noor: Hmm. So how long do people need to pause on the sauna before going through Ivy? Oh,

Dr. Turek: the same. It takes three months to make a sperm. So if you're taking the prenatal, you wanna do three to six months ahead of schedule.

If you're stopping something through your six months alcohol pot. You know, pot's terrible pot is worse than nicotine. It's an oxidant, like nicotine is, you know, THC is also, uh, it mimics, it binds to this, to the LH receptor, the testosterone receptor and mimics doesn't mimic lh, so it can lower your testosterone and it sticks around your system so it can affect sperm production, sperm quality hormone balance.

And it sticks around so you get high and then you don't, but it's still in your fat and recirculates for a month at lower levels. So it's, it's um, a little bit of a double ab dunny.

Noor: I think you might have just killed people wanting to do pot, so can you explain how it lowers your testosterone levels? I think that's a link that people would be very alarmed about.

Dr. Turek: Well, you know, testosterone responds to LH luteinizing hormone from the brain, and so the gas comes from the brain. It binds to the testosterone receptor and THC bind to that receptor and lock it up and keep it busy so the LH can't bind to it, so it doesn't stimulate the testosterone, so you can get a lazy testicle out of it.

Noor: So you just get high one time and then it's how much fat does it saturate? And then how much longer does it, it's fat

Dr. Turek: soluble. So it sticks around. I think it's been like weeks.

Noor: Wow. So basically, so for weeks you're gonna have lower testosterone?

Dr. Turek: No, I think weeks you get leak of THC into the bloodstream. I don't know.

I don't know the quality of the effect on testosterone for that long. Mm-hmm. But people are doing it nightly for, for relaxation. Right. You know, they're taking to further go to bed. I'm like.

Noor: So do you think sperm is a good overall indicator of male health or do you think they're just uncorrelated? It's not like a great, I

Dr. Turek: happened to be the grandfather of that, of that statement.

Noor: Yeah.

Dr. Turek: Right. I mean, I spent my academic career publishing about how fertility potential as a biomarker of health, and it's not, I gave that lectured Google. That the metroplex, the Google Prox in 2011, that your fertility potential is, or your sex, your sex life is not an unknown already. The planet of health, it is integral to the planet of health and a ref, a direct of reflection of that planet.

It's telling us something about you a lot. Cancer risk comorbidity, burden of diseases, future risk of heart disease, potentially. Some might say that Mike Eisenberg, you know, your lifespan. I'm not sure that's true. It's a lot of epidemiology, but it's quite predictive of things.

Noor: Oh, wow. Okay. So, so go a little bit deeper.

What do you, what do you think? Well, think

Dr. Turek: about it. You put underst stairs to do Yeah. Eat, sleep and reproduce, right?

Noor: Yeah.

Dr. Turek: And if you mess up reproduction, I, I kind of think that's a big one.

Noor: Mm-hmm.

Dr. Turek: And there's gotta be a good reason for it.

Noor: Right.

Dr. Turek: So one of the reasons is you're not doing a good job taking care of yourself and your ill health.

And maybe someone got a, Darwin is saying, you know, you're not really good for production during this, so, et cetera, right? Or extremes, you know, weight loss and stuff like that. You, you're, you know, there's a physiologic response. So a lot of women marathoners or, or you know, endurance runners or whatever, dump cycle because they're too thin.

So the system is saying, Hey. You are not healthy to reproduce because you are so stressed. You must be starving or something. And the body says, you know, turn off all the accessory functions because it doesn't particularly, doesn't matter when you are that thin, it's Right. And it's funny 'cause obese so well fed species are a lot more fertile than, you know, ctic species and, and I remember doing work with the animal industry for zoos and.

If you look at, it's really so funny that animals in captivity, which are generally quote healthier or better weight produce almost exclusively male offspring. This is both land and sea mammals, and it's because if the species is healthy, you just send them out, get the boy, get the boys out, get out there and expand and grow.

And if you look at. They're wild where there's a lot, there's you really starving and stuff like that. There's a lot more females because you need to keep species alive. So a lot of, uh, zoos have trouble keeping their animals because they are getting boys and they don't get any girls. It's really interesting how nature's playing a role here and you can talk about sperm count and this and that, but there's a lot going on.

We think we know what's going on, but.

Noor: That's, that's really interesting. So, can you talk a little bit about sperm aging and what happens to the DNA in sperm as we age?

Dr. Turek: Yeah, there's a lot that happens at sperm as they age. So you think of it as a, uh, so sperm, again, being made at, at massive quantities all the time for 60, 70, 80 years.

And the machinery, the quality control machinery is very good. But after, you know, eggs are made once and they sit there. Dose stem cells and making sperm divide maybe a thousand or 1200 times in a lifetime, and the machinery of quality control gets compromised. That's what we think. So that's one issue.

Second issue with age is that the second issue in general is that human evolution is driven by mutations, which are driven by sperm. So it's not the goal of eggs to throw off mutations, it's the goal of sperm to do it. So their, their division is very loosey goosey. You want, you know, I'd say 20 year olds throw off five mutations in their sperm and it goes up to eight fold at 80.

Seem maybe be throwing off 50 mutations. Um, so as sperm age, the mutational burden and that they're throwing off into the system goes way up. It goes way up and it's because of quality control. Little things like mutations get through the system and they're not picked up. And eggs don't pick those up either because egg picks up eggs, pick up chromosomal issues and big things and say, okay, this isn't going anywhere.

Miscarriage, right. That kind of thing. But so there's that mutational burden goes up a lot and that's, that's a source of a lot of single, single gene mutations that are going up. And these are sort of. Rare but deleterious and significant diseases, they're not lethal typically. Things like bsm, birth defect, retinalblastoma, worms, tumors, cancers, uh, polycystic kidney disease, I.

And you know, about 25 other ones, and they're called sentinel diseases. And they're very important to offspring. They're, they're offspring diseases that that's what's handed out there with these mutations because sperm goes to the next generation. Your liver doesn't but sperm do. Whatever happens in sperm, it becomes very relevant, the kids.

Right? And, and there's, and there's also the psychiatric morbidities from the, maybe from the mutational burden. And those are the concerning ones because there are things like schizophrenia and autism and spectrum disorders and bipolar disorder, dyslexia, maybe, uh, dementias as you get older, these are subtle issues with children and young adults that have picked up years later and you can't really screen for them.

Right now, except for maybe what you're offering, which is really cool.

Noor: Mm-hmm. Because that's

Dr. Turek: the one hope, the orchid hope is that maybe you can screen for these rare diseases that, uh, if you can get the mutations going and figure 'em out. So that's one huge thing that sperm do at the quality of sperm changes with age.

So it throws off mutations which land in the offspring and can be deleterious or bad. Some of 'em are good, some, most of 'em are bad, but we're thinking it's hard.

Noor: It's easy to do something bad. It seems to be hard to do something well. We don't

Dr. Turek: really see the good and, and we can have a really long conversation about what's good and what's bad, because you could argue.

And I had a, a venture capitalist come in who, who funded a very successful company at Silicon Valley, and he came in and for a mastectomy, he said, you know, I, I said, I read your paper on old Ural age that you published. And he said, it's funny, my son is dyslexia. And I realized I had it and I realized that that probably helped me be the venture capitalist I am and get that successful because I was able to screen out.

All the noise and focus on stuff that really mattered because there's a lot of noise out there. And I was like, wow. And if you think about some of these psychiatric diseases, like a lot of very successful people are affected by these diseases, but maybe, maybe these aren't diseases. Maybe this is the way we're headed.

Maybe these are good mutations. And that's the way the, the universe is. It's helping us accommodate to all the noise that's going on. If by blocking a lot of it out, it, it's very co it's very te logical. Interesting to think about this. Yeah. Because on the issue of mutations, men, sperm throw the mutations in the system and they either get, they either go through or they don't.

And half the mutations being thrown out there, and this has been shown in Sperum by the Utah group, are neurodevelopmental.

Noor: Mm-hmm. So

Dr. Turek: if you look at them evolving. True mutations. It's here. We're not getting new fingers and toes and we're getting ill taller maybe. Right? But we're not doing much else. It's all here.

It's half of our evolution's going right in the brain. So those 50 Martian movies where the martians have huge heads, that's exactly what's happening. We're not bigger, but a lot is going on ally with development. And so I think the, you know, the jury's out on whether a lot of these. Psychiatric morbidities are true diseases to me.

I don't know. I mean, I'm not sure.

Noor: Yeah, that's one

Dr. Turek: thing. Another thing that men sperm do is that the quality doesn't change very much. Mm-hmm. The numbers don't change very much. They go down a little bit and pretty regularly, but not until. Menopause, which is around 75 or 80. Okay. And that's when, not menopause, but menopause.

That's when men stop making experiments, stop making hormones similar to women in menopause, which occurs a lot earlier. So they both have clocks, right?

Noor: Yeah. And but the

Dr. Turek: clocks are, the Mayo clock is the attenuated. By about 30 years. And so they can be very fer like along, you know, a lot, you know Al Pacino and Robert De Niro in their eighties.

Noor: Yeah.

Dr. Turek: And I read a blog about that. It's like they're pretty healthy. I mean, that's pretty damn good. That's not a common thing to be that feral at that age. So they're doing something very well that's very special.

Noor: So menopause is in your fifties and menopause within your late eighth? Eighth decade,

Dr. Turek: typically eighth decade.

Yeah. So sperm production, we talked about that. And then the numbers really don't change that much. Fertility changes though, because other things change. Like erections may be bad. There's comorbidity diseases that men get ill or chemotherapy, whatever, that changes their fertility potential. But the other thing that changes dramatically is sperm.

DNA fragmentation not picked up on the SE analysis, but another one of those deeper dives and that we don't know the relationship between that and mutations, but we know that. The quality of the DNA packaging goes down with age and it's, you know, it's normally 15% of the sparing are fragmented, and that's normal with fertility.

But if it's 40% on a test, you are gonna have trouble conceiving naturally. You're gonna have trouble with insemination in the office, and you're gonna have trouble with IVF. And you might not develop good embryos and you may get miscarriages. So it's a sperm dependent and almost very independent process that's biological, and it's not mutations or chromosomes, it's just that the DN a's not packaged well because it's overheated or it's not working well.

Or it's older, and then the egg says to the sperm after fertilization by whatever method, Hey, show me your stuff. And so that Spearman dresses and the egg and this DNA rolls out, and that the ladder, it's a ladder, right? DNA is broken. So you can have the double strand or single strain breaks, and then the egg has to fix those.

And then for the first three days after fertilization, it turned on about 3,500 genes. DNA mismatch, repair genes and fixes, whatever it can. The young eggs are better than older eggs added, and if it passes mustard, it keeps going. If it doesn't pass mustard, you don't know you're pregnant or you have a miscarriage.

So it's a really important toxic phenomenon that happens and it's, you know, toxins of age. And now we're talking about one to 2% per year increase. So if you're only five years old, of 15%, if you're 55 years old. You add 30 points to your fragmentation rate, you're at the 45 level or 60 level even. That could be very significant.

So that's probably a big driver of the infertility. Despite good spring quality in men, I. Right. Chromosomes don't change that much in men, but there's a higher rate of handing off Klein filters, extra sex chromosomes to offspring, and a slight increase of Trisomy 21, which has classically being considered maternal age related.

So we'll talk about DNA, you know, point mutations, DNA, fragmentation and now chromosomes. And the last thing that changes dramatically is epigenetics.

Noor: Which

Dr. Turek: is why I'm excited about our product because we've altered epigenetics in older men massively, and that is very interesting story. It's very new.

Epigenetics is not changes in the DNA, it's just marks on the DNA and I don't know. We know that in, you know, it's a pretty new field. It's known to be causing lots of cancer and lots of autoimmunity, and there's a group in Utah and elsewhere that have shown there's a, there's a signature of marks on Sper DNA that will predict its fertility potential.

I. And it's a pretty good signature of you're gonna fail naturally, just like the fragmentation data. You are gonna fail naturally, but you might do better with IVF if you have a bad outcome, a bad test results, so a diagnostic test. So that field is exploding because we now know that when many h there, there's sperm change, epigenetically, and it's very linear.

So it's like it's gonna happen this way and it's not random. And guess what genes are most affected? Those of psychiatric morbidity. So maybe it may be that the largest driver of autism in children that is attributed to paternal age is epigenetic and not necessarily mutations because these aren't mutations, right?

They're different. It's a fascinating field. I'm all over it. And you can say, what? What are we talking about? So, point mutations. Are, are, you know, that's, that's Darwinian, right? So Darwin said giraffes have long necks because they acquired a mutation somehow and it gave them a longer neck, which gave 'em a selected advantage and they passed it on.

But Darwin never explained how you got the mutation. They thought it was a random event, and Darwin was also religious. You also believe in God, which is, uh, a, a big, it's been something I've been studying for years. It's like, how can he be a revolutionary biologist and, and be religious, right? Because anyway, not a creationist at all.

So I finally figured out when I realized that there was, there was Lamar Jean Patis Lamar, who lived 65 years before Darum, and Lamar said, giraffes have long necks because they spend their entire life reaching as high as possible to get. The, that get the leaves to eat and don't hand off that characteristic.

So the inheritance of acquired characteristics is how evolution could happen. But, but I, I, and Darwin knew about Lamar. He was a predecessor, but he didn't believe it. He, so that was really interesting. But Ma Marcian inheritance is now as of 1942, termed epigenetics. It's where what you do every day determines what you hand off to the next generation.

It's your evolution. It's a micro evolution, and we're doing it every day. For example, if Japanese natives come to America and eat American food, their gastric cancer rates go down in one generation and their colon cancer rates go up to American levels. In one generation, if Americans. You know, generationally go to Japan, the event reverse happens.

That's not mutations.

Noor: Yeah,

Dr. Turek: that's constant exposure to a certain diet that makes changes in your system.

Noor: Then.

Dr. Turek: Fascinating.

Noor: Yeah, that is really fascinating. It's also interesting how different it is for men and women, right? So for women it, it's almost like a more catastrophic failure versus what happens for men across all these different axes like sperm, fragmentation, de novo mutations, epigenetics.

It's almost like paper cuts. Like all these paper cuts are, are, are, are getting introduced.

Dr. Turek: All these paper cuts. Yes. Yeah. And it's really interesting that everyone is focused on the egg, but your, your, your play is sperm. It really is.

Noor: Yeah. Can you tell us what testosterone therapy is and who should get it and who shouldn't get it?

Dr. Turek: Yeah. I mean, testosterone, I think of that as, you know, oil in the car.

Noor: Mm-hmm.

Dr. Turek: Not gas, it's oil. There's good data from VAs following veterans who are low teeth, you know, low testosterone veterans and normal testosterone veterans that, if you look at their Kaplan Myers survival curves, they're different. So men with low testosterones.

Don't live as long as men with normal testosterones, but they don't die of anything particular. They just wear out faster. That parts the oil. So that's kind of what it is. So it's, it's not, it's, you know, it's a vitamin T. It's not essential, but it's sort of life sleep you can do without it a little bit, but it's, you're not gonna live as well at all.

Your bones will get brittle and, and things will happen. Your muscle, a mass and maybe your mentation and things like that. So that's really, it really is important to be normal.

Noor: What is the normal range and what's the best way to get tested?

Dr. Turek: So normal range is 300 to 8,000 nanograms per deciliter. But just remember, that's all men, fertile and fertile, healthy, unhealthy.

That's the normal range. But if you look at age specific ranges, you know, we look at 25 year olds, run around 500, 5 25 on average. And so the 800 is usually, means everyone says that, and you, 800, that's, that's the normal, no, it's not. 800 is usually a, the server called you can, you can either have. Imbalance and testosterone.

Section one bio globulin where you can have things like androgen receptor insufficiency or in insensitivity syndromes that are usually, usually not, not health risk, but they're not normal for other reasons. It's not uncommon androgen receptor problems cause testosterone level to be very, very variable and you don't really have disease that you can say you have, but there is a condition right?

So a healthy level will be four 50. And if we look at the testosterone trials in neuro general medicine, they take older men who are below 300 and they, which is considered low by most endocrine society guidelines and replacement at that level, I. They try to get 'em to four 50. And if you said, well, what happens?

So, so there's replacement and supplements, right? So if you're low and you get replaced, there's medical, there's good evidence for that. That works and that helps and it helps vitality. There's all these testosterone trials that look at specific things, vitality, erections, sex drive, probably thinking a little bit, nothing mass, you know, so, so they went to specific trials.

With men are alone, put 'em on it and watch them for things. There's a big stir without cardiovascular risk when you go on it, and that's kind of wearing thin because of the biases in the studies and the testosterone trials are looking pretty good that it doesn't increase cardiovascular risk. These are all in naming journal papers, so there's that whole field, which is medically evidence-based, and then there's the field of supplementation, which is very evidence.

Right, so I wanna be Jeff Bezos right now. Jeff Bezos isn't getting what he is getting from testosterone. He's getting it because he may be on, who knows, but he is probably working out regularly and he's on a good diet and he's taking really good care of himself and he's getting, you know, so testosterone doesn't build muscle.

It doesn't make you big. It, it gives you the ability to make yourself big 'cause you recover faster, right? So you are running from a loaded mammoth. You don't, you don't need testosterone. You need cortisol. If you outrun the way with Mammoth and you're behind a rock and you find some barriers and you fall asleep and rest, then your testosterone shoots up as a rest in restore molecule to get those muscles in shape for the next run.

So, and about Steroid uses know this all the time and I having hundreds of them to practice, and the answer is, you know. The testosterone that you recover from your workout phosphorus so you can do more, faster, better. So that's what are some

Noor: signs that, uh, as a man that your testosterone might be low.

And do you recommend people to check your testosterone at some regular interval or not really to test it unless there's a certain symptom emerges.

Dr. Turek: I mean, testosterone has, it's an interesting stir because it was a $2 billion market testosterone, now it's 18 billion and it's because the government allowed direct to consumer advertising.

You see drugs all the time. You see the um, like psoriasis drugs on the on on tv. It's like, you know, help you psoriasis and there's five seconds of benefit and there's 25 seconds of complications and side effects. Yeah. And the testosterone was even better doing it because if they did it, they were like.

Do you fall asleep after dinner? Do you have less energy than you? Is your sex drive down? Are you, you know, are you, are your erection's not good all the time? Are you bad at, are you not as good at sports? Right? It's like, this is what happens with age. Most of the, a lot of this stuff happens. It's like, this is like, perfect.

Let us, okay, we don't have to, yeah,

Noor: like this list is just like every inadequacy that,

Dr. Turek: that I got that, you know, so it's called Adam questionnaire. It's really funny. So they do really well because the government let 'em do that and fine. But, um, specifically for testosterone, I would say erections, maybe sex drive.

If someone, if someone's under 35 and comes into the low T, you measure the LH level, which is driving the T. If the LH is low luteinizing hormone, then they have secondary hypogonadism. It's not that the testicle isn't making testosterone because it can't. That's primary. It's not making it because it's not being told to make it, and that's stress, and you don't need testosterone for that.

You need to reduce your stress. Good luck, or take supplements like er, selective estrogen receptor modulators. There's HCG. There's other things that can naturally push it up.

Noor: So who do you recommend to test their testosterone? Or do you think that it just, it's not something that people should be actively monitoring?

Dr. Turek: Think anyone who has symptoms should get tested, and I do think that there's a plague of low testosterone because of stress. And I think that this is the connectedness of, of that we have even to social media and to emails and to work. And I think that that's real, but it doesn't need testosterone replacement.

It's, it's just this primitive body responding to what it's always responding to where it doesn't really know where it's coming from. That, um, it'll worry you down. I mean, anxiety, depression, things like that. It's all part of it. So. And then I put men on elective TRO receptor modular, which are pills, but covid hit and like everyone hit the fan during covid and I put 'em a lot of men on it and they said, okay, take this for six months.

See how it goes. If you feel better, you can stop it. It's not gonna drop your testosterone. It's near natural. It's exercising your system. So there's very good ways. That are very reasonable and cheap to treat secondary hypogonadism, which is the vast majority of it in young men.

Noor: What do you think about Brian Johnsson tracking his nighttime erections?

Dr. Turek: Good. Do it.

Noor: Do you think that's a good variable to track your, your sexual health?

Dr. Turek: Yeah, it's great. I mean, we used to have, we've known that for years, nocturnal erections. Mm-hmm. You should have a normal man has three one hour erections at night. You can ask why do they do that? It's not very useful. And it'd say, well, actually it is because it takes more energy.

More kinetic energy, a TP to keep your erection down than it does to keep it up.

Noor: Mm-hmm. Because

Dr. Turek: it keeps, it's more energy to tighten your arteries and keep the blood from going in than it is to relax them.

Noor: Mm-hmm.

Dr. Turek: So you're, you can think of it tet logically as your penis sighing at night. Take a deep breath and, and relax.

That's what it's doing. So it's a sign of good health. If you have that.

Noor: It takes more energy to, uh, keep

Dr. Turek: it flacid than a leg.

Noor: Oh, got it, got it. All right. I got it backwards. Oh, that's so interesting. So it's actually relaxing. Very interesting.

Dr. Turek: Yeah, it's your penis sign. It's like taking a big breath. It's relaxing.

Okay. 'cause it's not happening during the day.

Noor: Okay. Interesting. Okay, cool. So you think that is a good, that is a good variable to track. It's

Dr. Turek: a very, it's a yes. A nighttime erections are very good measure of, of your health. And if they go away, I think that's a great indicator of a problem.

Noor: Hmm.

Dr. Turek: What about reaction too Morning?

Reaction morning rib mm-hmm. Is a really good measure of the health of your peers. One of the things we ask about and it's, it's a very good indicator of health and it's not, so you have to understand. It's not like. An erection you can hang a tower on. It's not, it doesn't have to be like that. It have to be rigid and hard.

But if you're getting tumescence and it doesn't, it is, no, there's no number. And it is not like it has to happen every day. It's either happening or it doesn't. It's either yes or no. It's, you get some kind of erection or not. 'cause it depends on the one, you know, how full your bladder is and how much blood flow, blah, blah, blah.

Noor: Mm-hmm.

Dr. Turek: But if they're, they're present, that's a good sign. That's a sign of a healthy, uh, healthy body.

Noor: What about Brian Johnson injecting Botox into his penis? You think people should do that?

Dr. Turek: I haven't done that. Uh, why would you do that?

Noor: I think he's doing it to improve his penis health.

Dr. Turek: The only thing that it's really been studied and shown not to be helpful is for early ejaculation.

Mm-hmm. So premature ejaculation is ejaculating for your partners already. Typically, it's a minute or two after intermission. And you're ejaculating and it's socially and awkward and so, and it one third of men. So that's probably what's going on. And that's been tried to try to slow down the transmission of, of, of sensation by blocking nerves.

But it really didn't help in a, in a, a good sham trial. Randomized trial

Noor: trial. Okay. He said he injected Botox into his penis. It increases penis length by one centimeter. It also improves erection, hardness, peak systolic velocity, end of diastolic velocity and sexual health satisfaction. And the therapy was built on a double-blind, randomized placebo controlled study involving 70%, uh, patients with, with ed.

So I don't know. Do you think, do you think there's good evidence for it to improve? Um, no

Dr. Turek: one I know is doing that.

Noor: No. Okay. Is there anything else that you think people should do that might be a little bit under underused to improve? Improve sexual health?

Dr. Turek: Absolutely. Take good care of yourself. The directions of the canary in the coal, the first canary in the coal mine that suggested that if your erections are bad.

These, the men. So men with serious erection problems, not situational, where it's sometimes on, sometimes off, but it's really having a problem consistently. Their risk of heart disease and cardiac events, cardiac or stroke events. So events are, the bottom line are the same as a smoker that doubles or two and a half folds their risk.

It's pretty impressive. So if you have a cholesterol problem and you don't know it and you fix it. For

Noor: the

Dr. Turek: pill, it's almost like probably a third as strong as taking Viagra and helping your erections.

Noor: Wow.

Dr. Turek: Fixing metabolic issues can have the same impact as getting tighter. Control of the diabetes, blood pressure control, et cetera, can have significant impact.

Noor: Okay. Sorry, one more Brian Johnson question. What about shockwave therapy? So he did shockwave therapy three times a week. Or penis rejuvenation to regain teenage like erections.

Dr. Turek: How'd it go?

Noor: I think he's saying it's going well.

Dr. Turek: Yeah. Give, give a little more time.

Noor: Uh, have you heard about shock therapy or what do you think about this whole category?

I know all about

Dr. Turek: shock therapy.

Noor: Okay. What, what is it and what, what should people think about it?

Dr. Turek: The idea is that you shock the penis inside and it causes, you know, minor injury, which causes growth factors to be secreted and improve vasculature and and stuff.

Noor: Okay. It's

Dr. Turek: experimental.

Noor: Okay.

Dr. Turek: And, uh, you know, I don't offer that.

It's gotta have more data for me to offer it, and I would call it pretty close to snake grow with a large placebo effect.

Noor: Hmm. So, so why do you think, why do you think people are

Dr. Turek: there are men do everything they can. Okay. Except the hard work.

Noor: So do you think this whole category, I guess, of penis rejuvenation is, is real or is it all snake oil or which things are real and which things are Oh,

Dr. Turek: certainly real.

It's being used, it's being offered. You go to the sports pages and in the newspaper you'll see we, RP, shockwave, all that stuff being offered. But you know, if you look at really rigorous trials, the PRP Ramas and Home in Miami did a, I think, did the PRP trial and did a sham control, did nothing. The huge placebo effect.

So like I said, let's, let's fit Brian a couple more months, see how it goes and uh, see if he still feels the same way.

Noor: Got it. So are there any things that you do think are, are, are really truly rejuvenating that you think have really good evidence? I mean, because it sounds like you're seeing both PRP shockwave therapy, maybe even Botox, you'd put call kind of all in the, you know, it doesn't really work or doesn't, doesn't have enough evidence yet.

Is there anything that you think, obviously we, you know, we, we know the, the diet and exercise that anti-inflammatory stuff. You've mentioned different

Dr. Turek: topics. I mean, we're talking about Yeah, so we're talking about erections. I would say that they could work, but there's certainly not enough data. For me to offer it with, with a smile on my face, is it gonna help you?

Noor: So for people who are kind of right on the cusp of, you know, having babies, what do you think that they should know that is common knowledge for, you know, uh, urologists like you, but you know, otherwise they, they might not know about.

Dr. Turek: So they're, they're planning to conceive. So one thing is I don't necessarily suggest getting checked out 'cause I'm not, I'm not a sperm edin guy.

Yeah. Ahead of time. But you can, I would say stay healthy, eat well, sleep well. Consider a prenatal supplement for men. Women have been recommended by the CDC for 30, 35 years. Men should be also taking a prenatal and I would say. Stop, alcohol, pot, all that stuff. You know, coffee's okay. But all things in moderation because you can, I've felt so many men outta hot bads and they conceive as soon as they stop.

You know? It's just crazy. And the other big thing that happens is men who are very good at recreational sex often have trouble with timed intercourse and scheduled sex. Mm-hmm. And so it can be difficult for men and it can be very stressful. Because I've had a long day and it's like, I'm Mike, a kid turned color.

You know, I am, I'm, I'm ovulating. Have to have sex of like, you might have to sext him or, you know, put a, you know, put a champagne bottle on the table or something and you know, something to make it a little romantic because the romance goes away and literally, yeah. You know, half, probably a third of men will have trouble with time intercourse when it has to be on the clock, when they never had trouble the other way.

And that's a stressor.

Noor: Mm-hmm. Right?

Dr. Turek: That can, that can stop things and that can, I see that a lot. Mm-hmm. And then also the sometimes inability to climax and things like that because of stress. And you have to realize that. I think another piece of valuable advice is realize that if, you know when you're val layering and you, you are responding to that battalion intercourse, that's too late.

The best time to have sex is way before you ovate and you fill the bucket with sperm and the egg drops into it.

Noor: Mm-hmm.

Dr. Turek: And filling the bucket involves not sex every day, but every other day is fine.

Noor: Mm-hmm.

Dr. Turek: For most men. And five days ovulation and three days and one day, they're all good. You, there's a lot of pregnancies occurring that far out.

Noor: Mm-hmm.

Dr. Turek: And so if the man is really stressed. It's, it is night and it is stressing. He is exhausted. Then wait till morning, you know, and just say, you know, let's just wait till tomorrow. It lasts two days. Don't, don't add all that stress to it. It's not that scientific.

Noor: Yeah. So on the other side of it, when people are, you know, totally done having kids, what is a vasectomy?

How, what actually happens mechanically and you know, who should consider it?

Dr. Turek: Vasectomies. Um, they're the best form of contraception ever developed, and men don't have a lot of choices. They can pull out. They can stop having sex. They can use a condom or they can do a vasectomy. There are things in the pipeline, hormonal based pills, and the issue is not whether men will will take them or not, because they do want them.

It, these shoes, you know, will they work and what are the side effects and nothing's gonna work as well as a vasectomy. Which is 99 9. My problem with a lot of the hormonal contraceptives is you are altering rine balance because you're gonna take it away to stop it and replace it with maybe something else, but they're gonna have a lot of sexual side effects potentially.

And nothing kills sex worse than, worse than a sexual side effect, right. If you can't get an erection. Mm-hmm. So if they have problems with ejaculation or libido or sex drive. It might be a very effective contraceptive for that reason alone, but it might be very popular. So I, we have to see how it plays out that, see how it plays out.

But vases are wonderful. I mean, they're four and a half minutes. I use nitrous oxide and ga, gas and jazz.

Noor: Four minutes. That's it. You're that fast.

Dr. Turek: Maybe four and a half. Yeah. One good jazz song.

Noor: Wow. Okay. So how does it work? What, how does what happens?

Dr. Turek: Well, you have two tubes that connect the testicles to the back of the prostate.

Mm-hmm. The vast difference, and you have to get both of them. And we used to, it's a 200 year old technique and it got popular in American after World War II when all the vets came home. And then, uh, the Chinese passed the one child law in the seventies. Mm-hmm. And that led to thousands per day being dead attendance square in Beijing.

And they didn't like the incisions we were making 'cause we're using instruments that were designed for the procedure to do it. We were borrowing instruments and they designed these two instruments in this script called the Throughing Grip, which is the no scalpel method in America now that came to America in the nineties, and it was a way to do it through a puncture.

I. So you don't need incisions. So you just deal with the punctu one, puncture in the middle and get both tubes through it. And it's really, really an innovation. It really is an innovation. I, I picked it up six months after it came to America. I'd pick out, I'd probably be called one of the earliest adopters in America of the technique 30 years ago, 3000 cases.

And it's still, it's still good. And it's just great because it's fast and this is one of those errors in the body. You don't wanna spend a lot of time there. You want to keep moving.

Noor: Yeah,

Dr. Turek: because men don't talk, so,

Noor: so is it reversible, and if so, how? Like how, how often do people

Dr. Turek: 99.9% effective?

Noor: Mm-hmm.

Dr. Turek: Doesn't change your sex drive. Doesn't change your ejaculation volume. Doesn't change your erections. I don't have a lot of complications. It might be a 2% pinging weight of some kind, but this is stuff I don't see. So for my men, it's great. And men for men, it frees them up. They show better. I mean, they, the sex is better because they're not worried.

Right. And so mens sex act usually gets better with vasectomies, reversibility. Uh, we've got rates that are published that are through the roof. I mean, if you get a vasectomy 15 years ago or less, I can pretty much with a regimen one today, um, you can pretty much get the sperm count back in the semen at the 95 to 99% level.

And then fertility, of course, is a second issue, but that depends on around the of the partner. So I'm not responsible for, for the, I'm responsible for the sperm count. How long

Noor: did the reversal take? Is it also five minutes or is it longer?

Dr. Turek: No, no, no. That's a much more complicated deal with microsurgery.

So a My reversal certificate after on two hours. Vasectomy is under local anesthesia in the office. But I use gas, which is great. And the reversals are done with a light sedation and some men are sort of out because it, they need to be still 'cause it's microsurgery. So we're looking at a three millimeter tube with a where?

With a millimeter hole in it. And the sutures are at 10. The size of a hair can only really be seen under a microscope.

Noor: When do you recommend people get them? Basically, when they're, sure they're done having kids, but then sometimes I do

Dr. Turek: them on all, all men. I don't pass value adjustments on people. Mm-hmm.

You know, and so I'll do it on single men who on Marx or Targets.

Noor: Mm-hmm.

Dr. Turek: For pregnancies, both in LA and the industry there in Silicon Valley. So there's a lot of people who you know, who need protection. And it's one way to control what's going on. And I, you know, I don't find that many men, I author sperm banking and stuff like that.

Not many men bank sperm, not many men, 5% to 7% will get a reversal. So it's usually a good decision. I tell 'em, this is not a decision. You don't have to make it. It's a permanent procedure, but I haven't worked them for a living. Mm-hmm. So it's a decision you should make for two to five years. Okay. And that's why like there's a company called Contraline and others, and then this FLA are part of Contraline, one of their advisors.

But they're coming up with a reversible vasectomy, which uses a polymer gel. Mm-hmm. And so you do the no scalpel method, but you don't pet anything and seal it with vasectomy is typically you'll cut something and seal it off and, and then you go on from there. So the ejaculate volume is driven by other things, not how much sperm comes out.

So you won't notice a difference, but this is a polymer gel that plugs, and it probably has a lifespan and it may melt.

Noor: And then you put your sper pump back.

Dr. Turek: Now it lasts right now, the biology of it. But you might be able to adjust it if I want a two year vasectomy or a quarter year vasectomy and that that is gonna be hot.

And, and when they came to me, I said, you know, I'm gonna join these guys because I'm gonna be out of a job. I know it because, 'cause they got Y Combinator money and you know, I knew that it's gonna go somewhere.

Noor: Mm-hmm.

Dr. Turek: And the clinical trials are going on in Australia and it's working. I did the dogs and the rabbits and worked beautifully.

Noor: Wow. Very cool. Well, you are a world renowned expert. Thank you so much for spending, spending the time and answering all of our, uh, crazy questions about everything from shockwave therapy to testosterone. So yeah,

Dr. Turek: more of it's gonna be on Talk with tur, the podcast.

Noor: Yeah,

Dr. Turek: you got a lot there. If you want to go, we're going deep with men.

Noor: Good, good. Thanks so much for, for joining. Great. Thanks for

Dr. Turek: having me. It's been fun.