The Male Fertility Expert: Delaying Having Kids Is Impacting Your Future Kids! Dr Michael Eisenberg

Intro (0s)

• Dr. Michael Eisenberg is an expert in male sexual function and fertility.
• Sperm counts are declining, and low sperm counts and low testosterone could have devastating effects.
• Chemicals in our environment, such as those found in plastics and creams, could impact sperm count and testosterone levels.
• Sitting all day may negatively impact sperm production.

Why do you do what you do? (2m2s)

• Dr. Eisenberg sees himself as a researcher and advocate for men's health, reproductive health, and sexual health.
• He aims to understand patients' issues and find ways to improve their health.
• As the director of male reproductive and sexual health at Stanford, he collaborates with the department of obstetrics and gynecology to provide comprehensive fertility care.

What does reproductive health encapsulate? (2m58s)

• Reproductive health includes trying to have a baby, but also extends to overall health and well-being.
• Fertility is a window into future health, as genes involved in reproduction also operate in other organ systems.
• Infertile men have lower testosterone levels and may be at higher risk of certain health problems, including cancer.
• Social factors such as having a partner and children are also important for health and longevity.
• Lifestyle behaviors such as obesity and smoking can negatively impact reproductive health.

Fertility health is growing (4m27s)

• There is a growing interest in fertility health, as evidenced by increased research, education, and public conversation on the topic.
• Testosterone replacement therapies and fertility-related searches have skyrocketed in recent years.

Researching on fertility issues (6m14s)

• The speaker has seen tens of thousands of patients and has been working in the field of male health, fertility, and reproductive health for about 10-15 years.

Why are we seeing more infertility? (6m46s)

• There is a growing awareness and concern about infertility, which is reflected in increased discussions and searches for information on the topic.
• Factors such as environmental toxins, lifestyle choices, and delayed childbearing may be contributing to the rise in infertility.

Are you concerned about society's fertility issues? (7m18s)

• Studies suggest declines in testosterone and sperm count over time.
• Assisted reproductive technologies (IVF) have become increasingly common.
• Insurance coverage for IVF has expanded, leading to increased demand.
• Declining fertility rates, rising parental age, and delayed childbearing contribute to the demand for IVF clinics.
• The average age of fathers has increased over the past 30-40 years.
• Delayed childbearing is associated with higher infertility rates.
• Fertility declines for both men and women as they age.
• Sperm counts and testosterone levels decrease with age.
• The risk of problems with the child also increases with parental age.
• Peak fertility occurs in the late teens to early 20s for both men and women.
• Women are born with a set number of eggs, and fertility declines after age 30-35.
• Men's sperm counts decline with age, and the risk of mutations in sperm increases.
• A 40-year-old man has 20 more mutations in his DNA than a 30-year-old man.

What chemicals are reducing our sperm count? (11m14s)

• Chemicals in our environment can cause mutations in our DNA, potentially leading to a decline in sperm count.
• The decline in sperm count is gradual and may become more noticeable in men in their 30s and 40s.
• The oldest woman to conceive a child using her own egg is in her late 50s or early 60s.
• The fertility decline is concerning as it could lead to a decrease in the population and economic problems.

Society measures (13m50s)

• Some countries are implementing measures to encourage people to have more children.
• Hungary offers financial incentives, such as not paying income tax for the rest of your life if you have four or more children.
• These measures are a sign of the importance governments place on maintaining population numbers.

Sperm quality (14m59s)

• A study conducted at a sperm bank in the northeastern US showed a decline in sperm count, movement, and shape over a 10-15 year period.
• The decline was not due to factors such as obesity, sedentary lifestyle, environmental exposures, or cell phone prevalence.
• Other studies have also found a decline in sperm count over the last 20-50 years.
• Sperm quality varies by region, with higher quality found in New York compared to the Midwest in the US.
• The exact cause of the decline is unknown but environmental chemicals may be a factor.
• Studies on rats, mice, and humans have found correlations between chemical traces in the blood and sperm quality.
• The CDC's NHANES study has found correlations between higher exposure to certain chemicals and lower hormone levels.

Micro plastics affecting sperm count (20m37s)

• Microplastics and chemicals in the environment are causing a reduction in sperm quality.
• Chemicals such as phthalates, found in creams and lotions, and bisphenol A, used in the manufacture of plastic, have been linked to endocrine disruption and reduced semen quality.
• Endocrine disrupting chemicals can mimic or block the action of hormones, affecting normal development in boys and girls and potentially impacting semen quality.
• Some of the changes in semen quality may originate during development in the womb or during puberty.
• The speaker has made changes in their own life due to research on the impact of chemicals on fertility.
• They have thrown away all plastic water bottles and ensure their children do not drink from plastic water bottles.
• Plastic water bottles are a common source of exposure to microplastics, as they leach chemicals into the water.

Technology and heat fertility damage (23m57s)

• Heat from activities like frequent sauna use, hot tub use, and hot baths can lower sperm counts.
• Certain illnesses, such as COVID-19 and the flu, can cause temporary decreases in sperm count due to high fevers.
• Tight boxer shorts may affect sperm count if they cause the testicles to overheat.
• Mobile phone use may be linked to lower sperm quality due to DNA damage caused by the phone's signal.
• Cell phones and laptops may impact male fertility due to radiofrequency (RF) exposure and heat.
• Keeping cell phones away from the body, such as in the back or front pocket, is recommended to minimize potential risks.
• Sperm exposed to Wi-Fi signals from cell phones and laptops exhibited DNA damage and reduced quality.
• Laptops can also affect sperm quality due to heat and should not be placed directly on the lap.

Countries with biggest fertility problems (30m7s)

• Sperm count varies based on geographical location.
• Hotter countries tend to have lower sperm counts compared to colder countries.
• Differences in sperm quality between populations may be due to environmental exposures or genetic components.
• Sperm quality varies based on time of year, with lower counts during hotter months and higher counts during cooler months.
• Denmark has a particularly low sperm count, with only 25% of men having normal sperm quality.
• The reasons for Denmark's low sperm count are being investigated, with theories including environmental exposures, social factors, and potential chemical exposures during World War II.

Does sitting for long periods affect our sperm count? (32m41s)

• Sitting for long periods, such as in certain occupations like taxi or truck driving, can be associated with changes in sperm count, likely due to heat.
• Recreational cycling over five hours a week has been linked to lower sperm counts.
• To mitigate the potential effects of heat on sperm count, cyclists can take breaks, stand up while cycling, and try to circulate air in the area.

Fertility issues caused by OBESITY (33m53s)

• Strong correlation between body mass index and semen quality.
• Obesity affects hormonal axis, impacting sperm and testosterone production.
• Heat from obesity can insulate and warm the testicles, potentially reducing sperm count.

Alcohol consumption and sperm count (34m46s)

• Moderate alcohol consumption (1 drink/day) generally doesn't strongly correlate with reduced semen quality.
• Excessive alcohol intake (3 drinks/day or 20 drinks/week) can lead to lower sperm quality.
• East Asian men and women with a mutation in the enzyme that metabolizes alcohol may be more susceptible to alcohol's negative effects on semen quality.
• This mutation causes accumulation of acetaldehyde, a toxin, leading to flushing, headaches, and dizziness.
• Acetaldehyde can also impair sperm movement.
• Up to 50% of the population in Taiwan and a significant portion in Japan, China, and Vietnam may have this mutation.
• Men who experience flushing when drinking likely have this mutation and should be aware of its potential impact on semen quality.

What you can do to give yourself the best chances of conceiving (36m32s)

• Look at overall health and risk factors.
• Check for any medical conditions or surgeries that may affect fertility.
• Review medications that may affect fertility.
• Perform a physical exam, including an examination of the testicles.
• Conduct a semen analysis to measure sperm count, motility, and shape.
• Check hormone levels, including testosterone and other reproductive hormones.
• Encourage your partner to also get evaluated.
• Seek counseling to understand the likelihood of achieving fertility goals.

Man or woman, who has the most issues? (39m8s)

• The stereotype that women typically have fertility issues is a misconception.
• In the United States and other countries, about half of the time there is a male factor contributing to fertility issues.
• About a quarter of the time in the United States, men are never evaluated for fertility issues, despite potentially being a contributing factor.
• Some couples may undergo IVF solely due to low sperm count without evaluating the male partner.
• Conditions that affect male fertility, such as low testosterone or lifestyle factors, may be reversible.

Male testosterone decline (40m6s)

• Testosterone levels in men have declined over the last several decades.
• The decline is about 50 to 100 points.
• Testosterone levels decrease by about 1% every year after the age of 20.
• Obesity can affect testosterone levels as more testosterone is converted to estrogen in adipose tissue.

The impact of exercise on our sperm count (41m31s)

• Regular physical activity, such as walking 4,000 to 8,000 steps a day, can increase testosterone levels.
• Exercise can also help prevent obesity, which can negatively impact testosterone levels.
• Testosterone is important for quality of life, including energy levels, sex drive, mood, sleep, and concentration.
• Low testosterone levels can have negative health implications, including muscle health, bone health, and heart health.

What does Testosterone do? (43m4s)

• Testosterone helps with muscle growth, bone turnover, and bone strength.
• Low testosterone levels can lead to frailer bones, higher risks of osteopenia, and osteoporosis.
• Low testosterone levels can also cause lower sex drive and other symptoms.
• The number of testosterone prescriptions has increased exponentially in the US in the last 10-20 years due to the belief that it is an anti-aging and rejuvenation therapy.
• Randomized trials show that testosterone replacement therapy may not help men with normal testosterone levels or men with low-normal testosterone levels.
• Some men with low testosterone levels do feel better with testosterone replacement therapy, but not everyone benefits from it.
• Testosterone replacement therapy may not be worth the risks for men who do not experience significant benefits.

Side effects of taking testosterone (45m23s)

• Testosterone treatment can have adverse effects, even when necessary.
• Testosterone impacts sperm production and can cause low sperm counts in most men.
• Testosterone therapy can cause infertility in some men.
• Testosterone can cause hair loss, breast growth, and acne.
• Testosterone can affect blood thickness and increase the number of red blood cells.
• There is no increased risk of cardiovascular disease with testosterone therapy.
• Testosterone therapy does not increase the risk of prostate problems or prostate cancer.

Common symptoms of testosterone use (48m18s)

• Finasteride, a common medication for hair loss, may impact semen quality and sexual function in men.
• Men with low sperm counts were excluded from clinical trials for finasteride, so its effects on men with low sperm reserve are not well-studied.
• Testosterone replacement therapy can shut down the body's natural testosterone production, potentially leading to long-term dependence on exogenous testosterone.

Female fertility (51m1s)

• Contraceptive pills can have long-term effects on female fertility, such as irregular periods or even amenorrhea after discontinuation.
• Altering the body's chemical balance through medications or other means can have unintended and potentially permanent consequences.

How is testosterone therapy given? (51m57s)

• Testosterone replacement therapy can be administered in various ways:
  • Gels or patches applied daily.
  • Injections every 1-3 weeks.
  • Testosterone pellets implanted under the skin, lasting 3-6 months.
  • Longer-acting injections lasting about 10 weeks.
  • Oral testosterone therapy.
• Some men may not absorb testosterone well through the skin.
• There's a risk of transferring testosterone to others through skin contact.
• Precautions should be taken when applying testosterone gel or patches, such as letting it dry before putting on clothes.

Exercise and health impact on testosterone (54m15s)

• Regular exercise is generally good for maintaining a healthy hairline.
• Over-exercising, especially to the point of exhaustion, can affect testosterone levels and sperm count.
• Intense exercise can lead to increased cortisol levels, which may lower testosterone levels.

Penis average size increasing (55m4s)

• A study found that the average penis length has increased by 25% over the past 30 years.
• The reason for this increase is not fully understood, but one hypothesis is that earlier puberty may be a factor.
• The increase in penis length is not expected to have a significant impact on sexual function.

Erectile dysfunction treatments (57m24s)

• Erectile dysfunction (ED) is a common condition affecting more than half of men over 40, primarily due to vascular issues rather than hormonal or psychological factors.
• Treatment options for ED include pills, gels or suppositories, self-injections, vacuum erection devices, and surgical implants.
• Penile implants, which involve placing a bendable or inflatable device inside the penis, are becoming increasingly popular but data on their usage is limited.
• Penile prosthesis is a common procedure with a high satisfaction rate among men and their partners, and it offers advantages over other methods like Viagra, such as spontaneity and no lag time.
• Shock wave therapy, an experimental treatment for ED, involves sending shock waves into the penis to induce new blood vessel growth, but more data is needed to determine its effectiveness.

Pelvic floor strength (1h3m58s)

• Pelvic floor strength is important for men as well as women.
• Tight pelvic floor muscles can cause problems with urination, scrotal pain, and other issues.
• Pelvic floor physical therapists can help train patients to relax, strengthen, and increase flexibility in the pelvic floor muscles.
• Over-strengthening the pelvic floor can lead to other dysfunctions.

What causes cancer in the reproductive system (1h5m31s)

• Testicular cancer is usually asymptomatic, but a firm painless mass in the scrotum may be a symptom. It is most common in men between 20 and 40.
• Prostate cancer is more common than testicular cancer, affecting about 1 in 7 men. It is typically diagnosed after men have stopped using the prostate for reproduction.
• Prostate cancer treatments can have side effects on erectile and reproductive functions.
• Regular prostate check-ups, including blood tests (PSA) and monitoring of urinary symptoms, are recommended, especially for men in their 50s with a family history of prostate cancer.
• Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and maintaining a healthy weight, can help reduce the risk of prostate cancer.
• Modifiable risk factors for prostate cancer are limited and mainly related to lifestyle choices. Obesity and inflammation are associated with increased cancer risk.
• Delaying having children can impact the future health and well-being of the offspring. Advanced paternal age is associated with an increased risk of genetic mutations, birth defects, and certain childhood diseases in the children. Older fathers may also have reduced fertility and lower sperm quality.

Other male issues Dr Michael is being asked about (1h14m20s)

• One of the conditions Dr. Michael sees men for is Peyronie's disease, which is a curvature of the penis.
• Scar tissue can form on the tough tissue layers in the penis, preventing uniform expansion during an erection, leading to a curvature or deviation.
• Some men with Peyronie's disease have a 90-degree curve in their penis, making sex challenging.
• Peyronie's disease affects about 5-10% of men and there are effective treatments available.
• Men who are experiencing this condition should talk to their doctor as there are treatments that can help.

Best diets for better fertility (1h15m47s)

• Healthy lifestyle choices, including a balanced diet and regular exercise, are important for optimal fertility.
• Avoid processed foods, fast food, high-calorie foods, and foods with harmful chemicals.
• Treat any underlying medical conditions, such as high blood pressure, as they can affect fertility.
• Depression can exacerbate sexual dysfunction, but treatments should be continued if they are beneficial.
• Lifestyle factors such as diet, exercise, and sleep can impact male fertility.
• Weight loss can improve sperm count, but weight regain can reverse the benefits.
• Certain vitamins and minerals, such as antioxidants and dark berries, may improve fertility.
• Men who delay having children may impact the future health of their offspring.
• Special male fertility supplement blends containing specific supplements believed to be beneficial for fertility, such as coenzyme Q10, are available online.

What's next for Dr Michael (1h24m41s)

• Dr. Michael is passionate about understanding the link between fertility and health, especially the decline in sperm counts.
• He aims to engage the scientific and pharmaceutical communities to develop therapies for male fertility, as there are currently none approved by the FDA in the United States.
• Dr. Michael believes that understanding these issues in more detail will help men with fertility problems.

Biggest concerns (1h26m4s)

• Dr. Michael is concerned that the decline in sperm counts may indicate a decline in overall health for men.
• He notes that older fathers tend to have more comorbidities, such as hypertension and hyperlipidemia, which can have transgenerational impacts on their children's health.
• Dr. Michael sees opportunities to improve male reproductive health and is excited about the potential for future research in this field.

Advice to men who are struggling (1h27m14s)

• Be optimistic and hopeful.
• Talk to friends, primary care doctor, urologist, or a male reproductive specialist.
• There are many options available for men struggling with fertility issues.
• Make infertility services a universal benefit for all of humanity.
• This would help open up the doors for many people who don't have the resources for infertility services.
• It could increase the birth rate, improve relationships, and increase the tax base.
• Dr. Eisenberg believes this would be a profound policy change that would benefit everyone.