Barbell Shrugged - Fertility and Men's Reproductive Health w/ Drew Manning, Anders Varner, Doug Larson, and Travis Mash #801

Episode Date: June 4, 2025

Dr. Justin Houman is a board-certified urologist and fellowship-trained Men’s Sexual and Reproductive Health specialist whose practice is focused on male fertility, erectile dysfunction, sexual performance, testosterone management, Peyronie’s Disease, vasectomy reversals, and vasectomies. As a minimally-invasive microscopic surgeon, he specializes in microsurgical varicocelectomies, vasectomy reversals, sperm retrievals, penile implants, Peyronie’s disease, and male incontinence. Dr. Houman’s practice is centered on enhancing men’s quality of life through hormone management, improving sexual function, and achieving reproductive goals. Work With Us: Arétē by RAPID Health Optimization Links: Dr. Justin Houman Website Anders Varner on Instagram Doug Larson on Instagram Coach Travis Mash on Instagram

Shrugged Family, this week on Barbell Shrugged, Dr. Justin Hooman is coming onto the podcast. We're talking men's health, fertility, erectile dysfunction, all things reproductive health for males. As always, friends, make sure you get over to rapidhealthreport.com. That's where Dan Garner and Dr. Andy Galpin will be doing a free lab lifestyle and performance analysis. You can access that free report over at rapidhealthreport.com. Friends, let's get into the show

Welcome to barbell strike. I'm Anders Warner Doug Larson. No Travis mass today. I was just about to say his name and dr Justin who men dude, we're talking fertility today and I have some real questions about this many people I know are Struggling and I feel like fertility has become this weird issue where people aren't getting pregnant easily. And I don't know why. And it seems many times, like you, you're a urologist, it seems like a lot of times it's the, I don't wanna say it's anybody's fault, but it's the mechanics of the male

that are actually the problem. Introduce yourself and then let's just go right into the biggest question that humanity has right now. How do we continue? Absolutely. So I'm Dr. Justin Hooman. I'm a men's health urologist based in Beverly Hills. I'm assistant professor of urology at Cedar Sinai and I specialize in urology and men's sexual and reproductive health. But to answer your question about male fertility, so it takes two to tango, right? Fertility is one of those things that it takes two to tango.

There's obviously the male component and then the female component. When you're looking at, not to say who's at fault, but about half the time it's male factor infertility. So things that could cause infertility from the male side, low sperm counts, abnormal sperm, what have you. But it is a growing issue. There's no question about it.

We're seeing more and more cases in terms of the prevalence, in terms of the numbers of male factor infertility. And we could dive into it, but there's definitely a number of identifiable causes in the current state of things in the United States. Yeah, on like the male side, I'd like to actually stay on the male side of it today.

Most of our audience is male. And what are some of the, I've never been to the clinic, but I hear the one of, I feel like I'm having sperm that have round heads and cannot penetrate the egg seems to be something that I hear from males, some of my friends that is kind of like the cause or maybe like the symptom of the issue? But if we were to like dig back in like in your practice, like what is the root cause

of why that's happening? So that does that really makes sense in terms of that is the idea. The sperm is unable to penetrate the egg because the sperm quality, the sperm DNA, the sperm morphology, the shape of it, they just don't fit. It's like a lock and a key. The key just doesn't fit into the lock. But to break down what the causes of male factor infertility are, I like to simplify it.

There's four main reasons. Number one, and probably this is the biggest one in modern society, is lifestyle. We're eating poor diets. We're sleeping less. We're more stressed out. and probably this is the biggest one in modern society, it's lifestyle. We're eating poor diets, we're sleeping less, we're more stressed out, and we're not exercising as much as we used to. All of these decrease our testosterone counts or hormone production, and as a result of that, sperm quality is being damaged.

The second thing is that we have to look at is actually hormone, testosterone production. Because of our sedentary lifestyles, we're not getting as much vitamin D. We're going from couch to, you know, we're going from, we wake up in the morning, go into our office, sit at our desk for eight hours a day. Not get, again, not getting as much vitamin D, not moving around. So that decreases our hormone production. The third thing is genetic factors.

Now this is, has been around for a long time. We don't have as many tests as we'd like to check for genetic factors, but sometimes men are dealt a particular hand in terms of not being able to produce sperm, so we get tests for that. And then the last one is anatomical things. So that's the fourth thing. And when I say anatomy, some guys are born

with something called a varicoseal, or they develop it throughout the course of their lives. It's varicose veins of their testicles. Now the reason I bring this up is this is the most easily. We've had a client with that. I'd never heard of this before, but we have a client that had that. Yeah, so the reason I bring it up here

is because there's two types of men who typically get this. Number one, tall, lanky men, tall, skinny men. And then secondly, it's bodybuilders, a heavy, heavy weightlifters, because you're increasing that abdominal pressure and it puts pressure on the veins of the scrotum and it basically creates more blood or dilated veins in the scrotum, which increases to circular temperature and then damages the DNA integrity of the sperm. Of all of those, lifestyle feels like one that is very easy to fix in many ways. Does a lot of this come down to

like obesity as kind of like the one of the larger reasons why your body is just like, hey, before we start breeding things, why don't you get your own self back down to a normal body weight so that we don't have to like pass all this stuff on to the next generation? Definitely. I mean, the thing is, we were able to quantify some things of sperm, how they look and whatnot. But when it comes to, if you're an unhealthy male, your sperm are generally going to be unhealthy. You're not breedable. You're not breedable. You're not doing, you're not doing yourself any favors, right? You're

really not doing yourself any favors. As you know, if you're obese, your testosterone levels or your testosterone levels may be okay, but your estrogen levels go up, right? As a result of that, you're increasing your estrogen levels, which is obviously not good for sperm production as well, either, so yeah, if you wanna be, like you gotta take care of yourself if you wanna have good sperm health, no question about it.

I feel like obesity is obviously a huge issue, and those guys are gonna have a million problems, but I know many people, like we surround ourselves with many fairly healthy people, all things considered, and many of them have low testosterone, and many of them have trouble getting pregnant and miscarriages and the whole thing. Even if they've eaten healthy,

basically their entire lives, they've been in the fitness industry their whole lives, like they've lived a waste of their entire lives, they've been in the fitness industry their whole lives, like they've lived a waste of their entire lives, like they prioritize sleep and recovery, and they do quote unquote all the things right, but there's still these persistent problems, even in what I would consider to be some of like the healthiest people that I know,

like the top one percenters of health and fitness are still having issues. Like, how is that occurring independent of obesity and everything else? Yeah, that's a great question. Again, one thing we have to consider here is male factor infertility is only one part of it. It's only half the equation. So the male could be the healthiest, top 1% doing all the right things, has always been

doing the right things, but his female partner may be a little bit on the older side, have lower egg quality. As a result of that, even if you're the healthiest person, you can female partner, you know, maybe a little bit on the older side have lower egg quality. As a result of that, even if you're the healthiest person, you can't overcome some of the issues when it comes to egg quality and egg count. So that's one thing to consider. But the other thing is, and this is something I've seen, is there's a lot of times, you know, we do see it enough where a guy is just so fit, if you will, where he's doing all the right things in terms of exercise.

And when you do too much exercise, that could decrease your testosterone levels as well, which could negatively impact sperm quality. So there's like this fine, there's this narrow range of like a sweet spot where in terms of exercise and performance, where if you're putting your body under too much duress on a daily basis, weekly basis, monthly basis, you're negatively impacting testosterone production, which again, could damage or decrease sperm counts. Are there like environment? Yeah, go ahead, Doug. Sorry.

I was gonna follow up on on some of that. Like, regarding hormones, like we always talk about testosterone, but testosterone in and of itself, like isn't the thing that that affects fertility? Like,. Like how does testosterone and all the downstream effects of low testosterone actually contribute to lower sperm count and or lower sperm quality? Yeah, so this is very important in the sense that, so a guy will hear this and be like,

well, if my testosterone counts are, if my testosterone numbers are low, I'm gonna boost my testosterone, I'm gonna have higher sperm counts. And they'll go to a TRT clinic and get a shot at testosterone placement therapy clinic, get a shot at testosterone. And the thing here, the most important thing I could say here today is by doing that, you're killing your sperm counts.

Synthetic testosterone or testosterone that's not made by the body is gonna decrease your sperm counts. It's actually gonna make you infertile. And that's fine. There's a time and a place for that. If you're 50, 60, 70 years old, you have low testosterone, you infertile. And that's fine, there's a time and a place for that. If you're 50, 60, 70 years old, you have low testosterone, you could do that, that's fine. Because most guys are past the age of fertility

at that point, but if you're a guy in your 20s or 30s, we can boost, there's a way of boosting your testosterone levels naturally. And the key thing here, it's intratesticular testosterone. That's the key thing here. So the downstream effects that you're talking about is if we boost up the amount of testosterone in the testicle with certain medications,

and it's easy to do, we can improve the testosterone levels in the whole body, number one, and number two, improve sperm counts. Dr. Andy Galpin here. As a listener of the show, you've probably heard us talking about the RTA program, which we're all incredibly proud of. It's a culmination of everything Dan Garner and I have learned over more than two decades

of working with some of the world's most elite performers, award-winning athletes, billionaires, musicians, executives, and frankly, anyone who just wanted to be at their absolute best. Arrete is not a normal coaching program. It's not just macros and a workout plan. It's not physique transformation in pre and post pictures. Arate is something completely different. Arate is incredibly comprehensive and designed to uncover your unique molecular signature,

find your performance anchors, and solve them permanently. You'll be working with not one person, but rather a full team of elite professionals, each with their own special expertise, to maximize precision, accuracy, and effectiveness of your analysis and optimization plan. Arate isn't about treating symptoms or quick fixes. It's about unlocking your full potential and looking, feeling, and performing at your absolute best, physically and mentally, when the stakes are the highest to learn more visit our attain lab.com. That's a are Ete lab.com now back to the show

Gosh, that's like a climaphaned type conversation Exactly climaphaned and then HCG, you know pregnant all which is the injectable version of that Yeah, yeah, keep going down that road of the kind of the pharmacology there like how does that all work within the body to to optimize sperm count? Yeah, so so clomaphene is it's a selective estrogen receptor modulator basically tricks the way hormone production is made in the body is the pituitary gland in the brain secretes hormones that tell the testicles to produce testosterone and produce produce sperm, right?

Those two things. And in doing so, that's the normal synthesis of hormones and sperm in the body. Now what happens is because of stress, as a young guy in your 20s or 30s, if you have low T because of stress, poor diet, poor sleep, poor exercise, all of those different things, what happens? The amount of the stimuli from your pituitary gland goes down therefore your testicles not producing sperm or testosterone as much as it should. Clomophene is very unique because it tricks that gland to produce more of that trigger,

those trigger hormones. It's called luteinizing hormone and follicle stimulating hormone. Those two hormones tell the testicles produce more sperm, produce more testosterone and in doing so it resets the cycle, the natural cycle. I call it the Clomid challenge, clomophene challenge. I'll put patients on it anywhere from three to six months, sometimes a little bit longer. It resets the system. Guys start exercising, sleeping right, eating right, reducing their stress, doing those things that maintain normal testosterone levels, and then we take them off the the clomid and then they're able to maintain themselves at a healthy

testosterone level Yeah, very cool. So helps with with sperm count and what-have-you What about other like sexual health issues that help with erectile dysfunction or anything in any other topics? For sure for sure Not the same way and I'll say this it not the same way as testosterone replacement therapy for some men. Clomid, so we use Clomid off-label. It's actually a female fertility drug. We use it for men off-label for low testosterone.

So I'd say about 5% of men actually have a bad reaction to this, but 95% of men, they actually respond so well, like to your point about, increased muscle mass, brain fog, if they have brain fog, it can improve their brain fog, memory, focus, sleep, anxiety, sexual function for sure, is one that Clomid could definitely help out with if you are experiencing low testosterone. So all of the symptoms of low T, if you take Clomid,

it could definitely help with those symptoms. So symptom wise, even if you're like, say you haven't been trying to get somebody pregnant and you're not having challenges there yet, but you're thinking about having a kid, but you haven't really started trying yet, how do you know ahead of time that you may or may not need this until you try?

Or do you just need to try and it doesn't work and then you got to go get checked out or you got labs ahead of time? Yeah, so there's no hard and fast rule. I generally recommend, I'll tell people, so historically we've told patients if you're struggling for one year to have a kid then you should be evaluated. The male should be evaluated, the female should be evaluated. Now in this, you know, here in Los Angeles for example, we have, you know, guys, men are getting married into their 30s, you know, late 30s, early 40s, 50s, if you will, second marriages, whatnot. So these guys aren't being evaluated.

I would generally tell guys, if you're struggling for three months, six months, get evaluated. There's at-home semen analysis, it's a semen analysis test. There's at-home blood tests that you can do. There's so many ways which you can evaluate yourself. At home, convenient, cost effective. The earlier you do it, the better. No question about it. Well, I'd really consider the at home version of it.

I kind of assume we have to go into some type of a office or center, but you can do this on your own at home and just send in the results. Absolutely. There's a handful of companies now that they'll have these well-validated studies that confirm the accuracy of them, but they'll have a preservative at the bottom of the cup. You essentially ejaculate into the cup, nail it in, and within a day or two you'll have your results with a great, great, with a strong accuracy associated with it.

Yeah. This could just be me falling for an Instagram ad, but is the clothing side, like the microplastics, a piece of this conversation, kind of environmentally? Or I always wonder anytime I see like the news article come across and like plastics, stop talking about these things, they're everywhere. But it sounds like there really are like a big issue

when it comes to fertility. So yeah, like plastics and environmental toxins and endocrine disruptors, I think those are like some of the buzzwords now. Yeah, but what I guess the confusion is like, is it like in the top three of things we should be worried about or is it like in the bottom, we let's get a lot of things right before we worry about switching your underwear around? So I actually think, so I do think the underwear with the, they do have some endocrine disruptors in them. I do think certain ones, like you kind of get what you pay for, the cheaper ones can probably

create some problems down there. But as a whole, so I would, to answer your question, I would, I would actually say, like, if you're trying to avoid being on medication, or, or if you're trying to do these lifestyle changes at home, it's in the top three. Try to switch the cotton underwear because you're not doing yourself any favors with the synthetic underwear that can cause not just endocrine disruptors but also it increases the testicular temperatures and it can damage. That was very much the same, yeah. Yeah, so it damages it in that way. Cotton is much – it's more breathable. It's easier for your

Testicles live in a much healthier environment down there That's what you have on right? Yeah, I go commando I go commando You mentioned temperature a number of times here To what degree is that like an acute thing where it's like just, you know, for the for the hours after you were you were hot, say you were in a sauna or hot tub or something like that, you have you have a lower ability to to impregnate somebody versus like, you know, you were you were in a hot environment and then like, you know, a week later, a month later, like what's the what's the time domain there? And kind of what's the what's the range of possibility if you can quantify in some way?

So testosterone from the time, or excuse me, sperm, from the time it's made until the time it's ready to be ejaculated, it's about 72 days, so about two to three months we say. During that time, if it's exposed to increased temperatures, so like a 10-minute sauna once a month or a 10-minute jacuzzi once a month or, you know, maybe a couple of times a month, it's not going to make a huge impact because, you know, you have to remember here that each, you know, every time we ejaculate, there's tens of millions, if not hundreds of millions of sperm, right? And all you need is one of those sperm to reach the finish line.

So along the way during those 72 days, is there a bulk of them that are getting damaged? Of course, right? So I would say it's not so much – a couple times of increased temperature, that's fine, generally speaking. But if you're doing this on a daily basis, sauna every day, steam room every day, jacuzzi every day for months on end, then you're not just lowering the counts of your sperm, but you're also probably damaging the DNA integrity. So it becomes much more difficult to reproduce or conceive as a result of that.

So does that have to be something where you're experiencing an excessively high temperature as opposed to like, say you're a distance runner and you go for an hour long run, but it's 95 degrees out where you live like is that type of temperature enough to cause some type of significance issue or does it have to be sauna hot tub and the like? I would say more likely sauna hot tub because you know look our body 98 99 is where our body that that's our body temperature typical body temperature and the scrotum the scrotum is kind of like a thermostat

It relaxes and contracts in order to keep the testicle within that very narrow temperature range that likes to live in So if you're in unless you're you know, you're sitting outdoors in a hundred twenty degrees for multiple hours in a given day It's not so much that part. It's it's when you're exposing yourself to the extreme temperatures of It's not so much that part. It's when you're exposing yourself to the extreme temperature of the sauna and the jacuzzi is obviously warm, excuse me, water when you have, the way water can increase our body temperature, it's way more significant than air, like being in a sauna. So jacuzzi, sitting in there for long periods of time can definitely impact it. Yeah.

And then on the other side of it, is there any negatives to being in ice baths and colder temperatures? No, not that we know of. Some people seem to support the idea that it can increase testosterone production because you're decreasing the amount of blood flow to the testicle and then opening it up and really stimulating the testicles. I don't know if that's true. It's probably a mild increase in testosterone,

but cold doesn't negatively impact it, no. So cold plungers are safe. Cool. So someone comes in and they've tried clonvid and they've fixed their testosterone, et cetera. Hormonally, they look fine, but it's still not working. Is there like a next step in this progression? Like where do you go from there

if the hormone profile doesn't seem to do the trick? Well, in terms of seeing, let's say they still have an abnormal sperm semen analysis, you mean? Sure, yeah, what are all the scenarios? So let's say you address the hormonal issues. Obviously, a physical exam is quite important to make sure they don't have a varicoseal. Again, a varicoseal is the easiest, it's the most common reason why man has infertility. I'd say about 40 to 50% of the time it's because of a varicoseal. And some guys know they have a varicoseal. They could just feel that bag

of worms feeling or they see it in their scrotum. And sometimes they don't, they need a physical exam. So I would say the next step is a physical exam just to make sure you don't have a varicocele. And let's say we rule out everything that we can think of, right? Improve your lifestyle, your testosterone levels, your hormonal, you're in tip-top shape, you're taking the fertility vitamins, the antioxidants that can help,

you don't have a varicocele. If that's the case, and this is something that I'd say about in single digits, maybe 3% of the time, 5% of the case, and this is something that I'd say about in single digits, maybe 3% of the time, 5% of the time, the guy just has low sperm counts for just for based on current modern 2025 medicine, we don't have an identifiable cause. We'd like to we'd say it's, you know, potentially a genetic reason. And in those scenarios, we'd recommend some form of IUI or IVF, for example, to help really boost sperm production to the next level

or help boost the conceiving process. Right. So is there any treatment for the varicoseal? Absolutely, absolutely. It's relatively straightforward treatment, easily correctable, so it's a surgery, you know, for reproductive specialists like myself, we specialize in this. We use micro surgery, small incision in the pubic hair area.

And all we do is we identify those veins, those engorged veins, and we just tie them off. The surgery takes anywhere from 30 to 45 minutes Outpatient you're really back to your normal lifestyle within a few days But it's an easy easy way of correcting Male factor and if you're experiencing male factor and fertility you should 100% be evaluated for a varicose. Oh Gotcha even before Kind of like these the sperm side of it, have you seen numbers on like erectile dysfunction

increasing? Is that something that along with like the infertility numbers going up? Has that also been on the rise? Well, 200% was ED. But I would say for somewhat of a different reason, I do think low testosterone is contributing to it, but I'd actually say pornography is the bigger reason for young guys. Oh, dig in. Oh, that's only affecting, you know,

hundreds of billions of dollars in revenue a year. Oh yeah, oh yeah. It's just the pornography these days, how accessible it is and how extreme it is, if you will. I mean, and we have, you know, it's everywhere. You it is, if you will. It's everywhere. If you have your phone on you, you could access pornography anywhere,

but that's the main reason, no question about it. Wait, what are the mechanisms in play there that are kind of like creating erectile dysfunction? One would think that if you're watching and practicing erections through porn, the erection wouldn't be the problem. Is it, is it a, like, why is that happening? So, well, I guess it's happened, the EG is happening in the sense, in the context of a relationship, right? It's happening in the context of a relationship where,

sure, they're able to have good strong directions while watching pornography, but when it comes time to engage in intercourse with your partner, you're unable to do it because you're not being stimulated, at least in simple terms. Mentally, you're not being stimulated the same way you are when you're watching

all these videos Hmm, so it's more of a psychological problem or Really? It's somewhat physical if it's just like a receptor sensitivity type thing as well So you just require a higher physical stimulus in addition to the? mental stimulus I Actually think it's your original point I do say I would say that's psychogenic erectile dysfunction where it's what's in the head it's the realities unable to to match up or even come close to the virtual pornography that guys are experiencing. Gotcha so if

a guy comes in and says like I just I just can't get it up no matter what like a porn actual real-life sex with a real human being doesn't matter I just can't do it and that's like a purely physical thing and that's potentially treated one way and then someone comes in and says, yeah, I can get a boner whenever I want to, whenever I choose to, but then when I'm with my partner, it just doesn't happen.

That's a different situation. Yeah, yeah, but along the same vein, because it's this performance anxiety, right? They'll have like, but look, actually, your previous one, they require full on, you know, we have to look require full on – we have to look at their hormones, we have to look at blood flow to the penis if they have chronic illnesses like diabetes, high blood pressure, high cholesterol.

All these things decrease the amount of blood flow to the penis. But the first example that you're using, that's probably more of a physiological thing where it's hormones and blood. It's not so much psychogenic. more of a physiological thing where it's hormones and blood. It's not so much psychogenic, but a younger guy, I could tell you, a 20 or 30 year old guy who comes in, invariably it's psychogenic. And 98, 90% of the time it's psychogenic.

Either pornography or number two, it's a night of drinking, heavy boozing, unable to perform. Next time they try to do it. They remembered the previous time Immediately the erection goes down. So one bad erection leads to two leads to 20. It's just this vicious cycle This downward cycle. Yeah They can see that there's there's in their head about it and have for the first time like oh no What if that happens again? Oh, no Sure. Yeah, it freaks me out how many like environmental factors

are that we've like actually created on our own have or are creating this. And globally there's a massive problem right now with replacement. Like we don't create enough babies and everything on our phones and everything on our on our phones, everything on our bodies, like the way that we eat, everything is going against our ability to create more humans. It's like a giant issue.

Yeah, some countries, some countries are really experiencing negative. China too. Yeah, yeah. and we're gonna get there. We're gonna get there eventually. Oh yeah. For sure, whether it's in our lifetimes or not. But then at that point, you know, you're gonna have, it's gonna find its way, right? The trends will, this can be the first time in human history, I believe, that we're gonna have a, we're gonna be experiencing this, but we'll figure out a response to it in that sense, for sure.

Yeah, what do you think the response is? I'd love to dig into how do we solve the problem? I can't imagine we're going to get less free speech on the internet that would just create a prohibition of porn or is just going to create the same problems that prohibition of alcohol or whatever it is. There's always going to be this stuff that is very easy for us to get. It causes lots of problems.

There's endless downrange effects psychologically of it as well, which leads to the physical side. The speed and power of information and the tools that we have to do it, we haven't even gotten into robots yet. Those are terrifying. Like that's coming. But how do you what do you think overcomes all of this? Um, you're talking about primarily from a fertility standpoint.

Yeah. Like, how do you reverse it and in when the course of people is heading in such a Not great direction of making more people I Would say this I would say it's very hard to intervene for anybody to intervene on this City state Government national government officials like it's hard to intervene on this. People are gonna have babies when they wanna have babies. But I think the bigger thing here is it's tied to society

and economics, right? If the cost of having a kid, if the cost of living is becoming greater and greater, your reproductive ability, your chances of reproducing are gonna go lower and lower. So they're all tied. It's not so much, but I agree with me, like what we're talking about here in terms of the difficulties of fertility for men, that's true, that's real, but I do think it's tied to a bigger

socioeconomic picture that it's way more complex for, at least for myself to discuss. Yeah. Yeah, I fully agree with that. It's not just people can't have kids and everybody's trying to, we just can't seem to pull it off. Like me and people are just choosing not to have kids for many, many reasons that go well beyond the ability to have kids. Yeah, yeah.

And people are content with being by themselves, or whatever, not by themselves, but people are content not having kids more so now than previous generations. Like your needs as a man can be met really in many ways. For a lot of guys, they don't even wanna have sex, right? Like internet pornography does it for them. It's kind of wild.

I faced this front when you said that. I know. That was the silence. If you're listening at home and you're like, did they just cut out? No, Andrew's face just crunched thinking that porn was better than actually No, there's no need to choose between the two you could do both

Or at least pick the real-life one All right, so so yet we have the we have the side of things where Again porn and the psychological issues are one thing. Like, what do you do for an individual that you see where you see that porn is obviously a problem, but that's not really your job to, like, be their therapist or psychiatrist or fix whatever part of their life is causing them to have potentially, like, an addiction issue. Like, you're a medical doctor.

That's not your wheelhouse. Are you able to help those people or do you refer them out or how do you deal with that? So as much as when it comes to the rectalisone, we're not always pointing it to one thing. Generally speaking, it's multifactorial. So the physiological reasons, so like the blood flow issues, the hormone issues,

nerve issues, for example, I'll take care of that. I could fix the physiological reasons, but if it is like a performance anxiety type situation, I'll refer them out to a sex therapist, somebody who could spend time with them, normalizes the conversation. Let's say performance anxiety with their partner, you could figure out ways in which

to reduce the stress there. When it comes to porn addiction, that's a whole different gamut. There's again, there's sex therapists who specialize in porn addiction. So I do refer out the mental aspect of things. I do refer those out to sex therapists who this isn't their wheelhouse. This is what they specialize in. And is this all done in person or is this a virtual thing that you do as well for, for the entire United States or worldwide? Yeah so you definitely I see patients throughout the United States and in international patients as well

some in China some in India but in overall most of my patients are here local but yeah we could you know I see patients throughout throughout the world and throughout the states. Yeah. Do you get any any pushback on that? Like California probably not as much like you could say you're you're seeing a sex therapist in California. People were like, yeah, cool.

That makes sense. But other other parts of us might not be as forward thinking. Do you get any resistance to that? Yeah, you know, I thought I did. It's funny that you asked that because like, I remember when I first started my practice, I was like, well, listen, you should probably see a sex therapist. I was waiting for like a lot of pushback.

But you know, what I've noticed is if they've come to see me, if they've worked their way to seeing, they've broken whatever barriers and mental barriers, taboos in order to come to a doctor to discuss their issue, the next step is much easier. It's easy for them. I don't think maybe one in a hundred will go, oh, you know, I don't want to necessarily

talk to a therapist. But at that point, if they've come to me, they're willing to go the whole way. Sure. Dude, I can see that. I thought it sounded like real problems when I was seeing a doctor about it. I'd be like, dude, I'll fucking do whatever you want.

Tell me, I'll talk to anybody. Yeah, exactly right. Point me in the right direction, I'll do it. The hard part for these guys is normally it's that first step. It's identifying they have a problem and then willing to go to that next step of talking to somebody about it. But my job, if a guy comes in, you know, after a couple months of this, even a couple weeks of this, it's so much easier for me to fix. And if they come in after a couple years of experiencing this, whether it's infertility or erectile dysfunction, it doesn't matter.

I can't stress enough the importance of addressing this earlier on. It makes the patient's outcome obviously a lot better, but it makes my job a lot easier as well. Cool. So we have like fertility, erectile dysfunction. Are there any other categories of things that you treat that are in this in the same? wheelhouse Yeah, I mean this hormones obviously testosterone we talked about testosterone and clomid or at least clomid what it can do

Vesectomies the second me reversals Yes, so the second means I don't know if you guys have ever talked about the second means but they're it's the best form of contraception for any couple for primarily a man obviously, but it has a highest success rate, it's 99.9% success rates. The way I do it, it takes anywhere from about 7 to 8 minutes in the office, pain free, no needle, no scalpel, minimally invasive, and you have great outcomes. You're recovering some ice over the course of a couple days after the procedure, but after that, very easy way of helping your partner out who's gone through a lot for

nine months. But the most common questions I'll get about vasectomies, I can just say this, has zero impact on your testosterone, zero impact on your sexual function, your erections are 100% the same. This does not impact any of that. Even the volume of your ejaculate is essentially the same. The testicles are only giving 1%

of your total volume of ejaculate. So you won't even notice the difference. Gotcha, so sperm specifically is only 1% of the total volume is what you're saying. Yeah, exactly right. The rest of it's just the food, the sugars, some of the alkaline fluids that allow for the passage or the livability of sperm. But sperm is only 1% of your total volume of the ejaculate. Gotcha. So like erectile strength and, or not or not, like orgasm strength rather, like the intensity of it and all that, totally unchanged as well?

Oh, totally unchanged. It doesn't impact the thing. It really doesn't impact the thing. That tube, that tube is only involved in transport of sperm. That's it. So, and has negative impact, no impact on, on your testicular health. Yeah. I've often thought this and I've never actually spoken to a professional about it, but like and has negative impact, no impact on your testicular health. Yeah.

I've often thought this and I've never actually spoken to a professional about it, but part of me wishes that I would have gotten a vasectomy when I was like 16 and then just reversed it when I was 30. Is that a thing? Is that possible? Or is there, if you're out of the game for that long, can you make a full recovery?

Could you say something about a reversal a few minutes ago. To what degree is that possible? So that's funny because like someone had told me one time that like athletes should do this. Athletes should literally when they start their careers they should just get a vasectomy and then reverse it once they retire. But the highest the highest success rates after the highest success rates for vasectomy reversal are about 7 to 10 years after the vasectomy. Once you're getting into the double digits in terms of years, your success rates are lower. When I say lower, it goes 90%. If you get to 15 years, it's probably close to like 60%. But 0 to 10 years, you're looking at like 98, 90% success rate in terms of putting

the two back together and creating viable or ejaculating viable sperm. Yeah, but even the one thing to note here is, you know, I have a lot of couples who do this now is the guy's had a vasectomy after his previous marriage, he has a new partner, he's like, you know what, like I don't want to go through the process of getting a vasectomy after his previous marriage, he has a new partner, he's like, you know what, I don't wanna go through the process of getting a vasectomy reversal. It takes a couple months to recover. We're just getting, my new wife has eggs on,

on frozen eggs, for example, and there's something called a sperm retrieval, which is much easier for the male. I literally go into the testicle using a microscope, but using very small incision of the testicle, I literally take out sperm and use that sperm to fertilize the eggs, create an embryo, and then we implant it into the partner,

into the female partner. But yeah, that's a much more common option that's happening these days, I'll be honest. Sure, I mean, outside of having surgery on my testicles, that sounds like a great move. It's a small, small decision, but yeah. Yeah, right. I didn't actually realize that was the, that was a thing there. What a great idea.

Yeah. Cause you're always producing sperm, right? Even when you have the vasectomy, you're still, you're constantly producing sperm, producing, it's breaking down, producing, breaking down, back and forth. Gotcha. So for the vasectomy, like the, the sperm is being produced and then it's breaking down producing breaking down back and forth gotcha so for the vasectomy like the sperm is being produced and then it's being just kind of pushed down the path but then it's just the path is blocked and so it doesn't go any further it doesn't go any further and at some point your body will or the sperm will degrade and using those same well it'll degrade

and then your body will produce more back you know the continuous process yeah got you got you yo uh if you if you've had a second year or even if you haven't like if you if you like um have like the majority of an orgasm but you don't actually orgasm and it's like you're you're holding it back like to what to what degree is that an issue if you've like put that block in place and you're, I don't know if I know the right way to word this question. If you have like multiple orgasms, but you hold them back, like all that pressure is created, but you don't actually release, is that an issue?

Whether you've had a vasectomy or not? Like, can that cause like physical problems? Are you talking about if you've had a vas're trying to be like, if you've had a vasectomy and you're just trying to ejaculate. Like if you're, if you're having sex, maybe this is a totally different topic, but if you're having sex and you, you get like almost to the point of, of ejaculating, well, he like kind of have an orgasm, but you don't actually ejaculate. Yeah.

And like, and you do that multiple times. You kind of just like extending the fun, so to speak,, to what degree could that cause like an actual physical problem? No, it doesn't. It doesn't. It doesn't cause any long term issues, other than it could cause like some pelvic floor pain or it could cause a little bit of congestion in like the prostate and the seminal vesicles. Those are those are the glands that produce the ejaculate. You create some congestion in there. That's kind of like the idea of blue balls a little bit. Like you get that blue ball type feeling, that pain.

But like long-term effect, no, zero problem. Gotcha, okay. Yeah, I've often wondered that after I had a vasectomy, I've had one myself, like with that having that like block in there, if like you're like putting that pressure up against the block over and over again, or even just for you having that like block in there, if like you're like putting that pressure up against the block over and over again, or even just for having just a normal

orgasm, if over time that would, I don't know what would happen, but if over time that would just cause an issue. Not at all. Not at all. You know, the thing about the reproductive system, specifically for men, like, you know, we've evolved, we've gone to this time, because that area is so resilient, the glands, the penis, we've evolved, we've gone to this time because that area is so resilient, the glands, the penis, like the prostate gland, all that, all, everything that's involved in reproducing, it's gone through the course of time, right?

Like it's so resilient. You know, it's, you punch it a little bit, you cause a little bit of harm. If most of the time it figures its way out and a lot of these things don't really impact it so it's a it's a pretty resilient system and I'm seeing that more and more throughout the course of my career but yeah I'm pretty impressed by how how the reproductive reproductive system is very resilient and men at least. Gotcha. Are there any other like common misconceptions that we we need to cover here that we haven't already mentioned?

Yeah, I would think, you know, fertility issues are quite common in men. Like I said, about 50% of the time it's the male partner. Erectile dysfunction, you know, 40% men at the age of 40, 50% of the age of 50, 60% of men at the age of 60 have some form of ED. The low testosterone, after the age of 30, majority of men, their testosterone goes down. The point I'm bringing all these up, these facts is, it's kind of a fact of life for many men, unless you're super active and leading a clean,

healthy life without wearing synthetic underwear. All these things are very, very common. So if you are experiencing it, just see somebody because you can improve your quality of life, your sexual quality of life, your reproductive quality of life pretty easily and pretty quickly. Yeah. Let's go over kind of all the, what I would call the obvious stuff, at least for listeners of this show, like regarding, regarding fitness and training and sleep and what have you like, do you have standards for all those categories for like, again, you don't want to do too much, as you mentioned earlier, and obviously you don't want to do none at

all or too little, like what's the sweet spot for sexual health, for training, sleep, supplements to take, etc. Yeah, so four things, it's to your point about sleep, stress, exercise and diet, but sleep, ideally at least seven hours. I would actually say if you get like six, six and a half, it's probably good, but ideally seven hours of sleep, That's the hard one. Supplements you can take for that, like ashwagandha is a good one because it helps. We have good data in terms of it helping with sleep, but there's tons of supplements out

there for sleep, but I don't want to sell any snake oil with that one, but ashwagandha is a very good one for sleep. Stress is probably the hardest one. I would say like, I think one of the challenges of life, actually think one… Hey, can you hear me? Sorry, go ahead. I think one of the challenges of life is figuring out what relieves your stress. Now, what relieves my stress is very different than the two of you.

You know, I have patients who they're 88, 90 years old, but they've smoked a cigar every night for the last 50 years. Now if you look at that, you'd say that's pretty unhealthy, but that's what relieves this stress that calms him down, that gives him a good night of sleep, reduces his cortisol levels, and he's able to live his life because of that. So figuring out what reduces our stress is one of the challenges of life and I think once we figure that out individually, it's a huge way of increasing longevity and overall health. Third thing is in terms of exercise, I generally recommend three days of heavy weightlifting, two days of cardio if possible or at least one day of cardio. So, a mix of cardio and strength training. And then lastly with diet, a combination of lean proteins, healthy fats and if you're going to have carbohydrates, complex carbohydrates.

Diabetes to me is worse than an HIV these days. Anything we can do to decrease the amount of sugar that we take, the amount of simple sugars can only help us in terms of sexual health, reproductive health, and most importantly, cardiac health, which is, you know, heart attacks and strokes are very, very common in the American male these days. So that's generally the way I break it down, try to keep it simple. Dude, this has been super informing, man. I appreciate you coming on and hanging out with us. I've had many, many questions and many thoughts about all this. Luckily, I have two kids and I was ready to get a vasectomy on the, on the drive home. They had like a

McDonald's drive through for vasectomies. I would have been waiting in that drive-through line. And lucky enough to have two little humans that are terrorizing my house all the time now. So, but I know that many, many men and families are going through this. So I appreciate coming on and talking to us. I appreciate you guys having me on. This is good. Yeah. Where can people find more out about kind of what you're working on or reach out to you if they wanted to work with you? Yeah absolutely anywhere you can just google my name Justin Hooman on any of the social media platforms on my website. Happy to help in any way or happy to engage in discussion with anybody. Love it man. Doug Larson! You bet. On Instagram, Doug C. Larson.

Justin, appreciate you coming on the show. Of course, you know, my sex life is an important part of my life and the more I know about it the better, so it's always nice to talk to a real expert. Presumably at some point in my life, hopefully not for a long time, I'm going to need some help in this department. Hopefully it's not until

I'm 60 or 70 years old, but the more I know now the better, so this department. Hopefully it's not until I'm 60 or 70 years old, but the more I know now, the better. So, appreciate you. Thank you. Anytime, I'll help you out in any way. Happy to. You gotta go back to California for it too, dude. Nice and sunny out there.

Any sun that I can get. You have to go, he's your doctor. There you go. I'm Anders Varner at Anders Varner and we are barbell shrugged, barbell underscore shrugged, and make sure you get over to rapidhealthreport.com. That's where Dan Garner and Dr. Andy Galpin are doing a free lab lifestyle and performance analysis.

You can access that report over at rapidhealthreport.com. Friends, we'll see you guys next week.