The Mel Robbins Podcast - The Ultimate Guide to Male Hormones & Men’s Health

Episode Date: October 8, 2026

This is the ultimate guide to male hormones and men’s health.If a man you love has seemed a bit off lately, this episode will help you understand why. It’s for both men - and the people who love them.This conversation, the first-ever men’s health episode of The Mel Robbins Podcast, was inspired by Mel wanting to learn more about her husband Chris and what she can do to help him with his hormones. Specifically, it all began with the question: should he be taking testosterone?That led Mel to the world-renowned Stanford urologist Dr. Michael Eisenberg, who joins her today to talk all things men’s health.No topic is off limits – Mel asks the questions that may be on your mind – including everything you and your loved ones need to know about testosterone, erectile dysfunction, sexual health, and prostate health.Dr. Eisenberg explains what happens to men’s hormones as they age, what symptoms to keep a close eye on, and what you and the men you love can do about them.Dr. Eisenberg is a board certified urologist and Professor of Urology at Stanford University. He also leads Stanford's Male Reproductive Medicine and Surgery Program. He specializes in men’s health, testosterone, fertility, and sexual dysfunction.He will also explain why reproductive health is not separate from the rest of a man’s health. It isn't just directly tied, but it is also a window into what's happening throughout a man’s body. You’ll learn:-The signs of low testosterone – and when it makes sense to get tested.-Who may benefit from testosterone therapy and who probably should not be taking it.-How sleep, stress, excess body fat, depression, and alcohol can affect testosterone levels.-The side effects and fertility implications every man should understand before starting testosterone.-What erectile dysfunction is, what causes it, and why it can be an important signal about a man’s overall health.-The differences between Viagra, Cialis, and other treatments for erectile dysfunction.-Why erectile dysfunction can deeply affect confidence, intimacy, and relationships, and how a partner can help.-Why male fertility matters even if you are not trying to have children right now.-What changes in urination and prostate health are worth bringing up with a doctor.-Why pelvic floor health matters for men.If there is a man in your life who has seemed more tired, withdrawn, less interested in sex, or simply not like himself lately, this conversation will help you understand what may be going on and what the two of you can do next.And whether you are listening for a man you love, or you’re a man who wants to take control of your health, you’ll be empowered by what Dr. Eisenberg has to share today.For more resources related to today’s episode, click here for the podcast episode page. If you liked the episode, check out this one next: MIT Longevity Expert: Do These 3 Things Now to Stay Young, Live Longer, & Keep Your Freedom Mel also wants to tell you:Try the 23g protein shot I drink every single morningJoin 2 million readers loving my weekly newsletter - full of tips, tools, and inspirationThe Let Them Theory: read the book everyone’s talking about Watch the episodes on YouTube Connect with me on InstagramFollow the show’s Instagram for clips, behind the scenes, and more Find some daily positivity on my TikTokWant zero ads? Subscribe to SiriusXM Podcasts+ to listen to new episodes ad-freeDisclaimer Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. Today, you and I are learning all about male hormone health from one of the greatest medical experts alive today, Dr. Michael Eisenberg. Dr. Eisenberg is the head of Stanford's male reproductive medicine and surgery program, and today he is here in our Boston studios to teach you and the men that you love, everything you need to know about men's health. We're going to cover low testosterone, erectile dysfunction, fertility issues, and so much more. And I just have to tell you, I have been dying to do an episode on male hormone health for over a year. This is something that my husband, Chris and I, have been talking about. We've been talking about testosterone for two years. Should Chris go on it?

Should he not? I have his permission to tell you all of this. Well, today, Dr. Eisenberg is here. And he says, look, reproductive health. for men, it's more than having a healthy sex life. It's more than being successful at trying to have a baby. Men's hormone health is a window into his future health. So if you have a man in your life who just doesn't seem like himself anymore, if you've been badgering him like I have, saying you should go talk to your doctor, you don't seem like yourself, if you've been on the

receiving end of badgering from your partner who's pushing you to go talk to your doctor, because you don't seem like yourself. That's why we're doing this episode. Dr. Eisenberg is going to answer all your questions and he's going to help you and your partner understand what may be changing, what deserves attention, and what the two of you can do to help the men in your life be happier and healthier at any age. This is the ultimate guide to male hormones and men's health. Hey, it's your friend Mel, and welcome to the Mel Robbins podcast. I am so excited about the topic. I'm excited that you're here with me. It's always an honor to be together and to spend time with you. And if you're new here, or if someone sent this episode to you,

like, I'm going to send this episode to my husband, I just want to welcome you to the Mel Robbins podcast family. In fact, I should welcome you. If you're a man and someone you love sent this to you, you're going to love Dr. Michael Eisenberg. You're going to love everything we cover today because this episode is the ultimate guide to male hormones and men's health, Dr. Michael Eisenberg is the absolute authority on the topic. He's a professor of urology at Stanford University. He leads Stanford's Male Reproductive Medicine and Surgery Program and serves as the director of the International Azo-Spermia Center, which is basically a male infertility center. Dr. Eisenberg is a world-renowned board-certified urologist and surgeon who specializes in men's health, low testosterone,

erectile dysfunction, sexual dysfunction, and male infertility. I cannot wait to dig into this topic, so please help me welcome the incredible Dr. Michael Eisenberg to the Mel Robbins podcast. It's a pleasure to be here. Dr. Eisenberg, I really appreciate you getting on a plane and taking out time from your extraordinarily busy schedule, clinical practice, overseeing. your fellowship, teaching residents, all the research that you're doing to be here. So thank you. You're very welcome. Let's just jump right in. I know what I am hoping to get out of this, but I would love for you to speak to the person who is listening, who is here with us right now,

and share with them, based on everything we're going to cover today related to male hormone health and men's health in general, what could possibly change about their life or the life of a guy that they love if they take everything to heart that you're about to teach us. What are we going to learn? I think we're going to learn quite a bit. I think that these are topics that aren't really discussed a lot. I think people don't understand them a lot. I think there's a lot of embarrassment about them. And so I think there's really an opportunity to learn and improve. I think that all these things are so fundamental, not just to overall health, really, but to sort of the quality of life, right? That's mostly what we're talking about. So I think there's real opportunity to improve just

enjoyment, benefit, and then longevity as well. I think these are things that people don't necessarily think about or do as much with, but if you understand it, really, you can empower things. And I think people also understand that there is a lot that they can do. They have a lot of agency with a lot of these things. And it starts with education, which I think is one of the great things about this podcast. Dr. Eisenberg, for the man who is listening right now, who got this episode sent to them by somebody who cares deeply about them, what do you want him to know about what we're going to talk about today. Well, you're going to learn everything you wanted to know about hormonal health,

sexual health, reproductive health. You'll learn all the things that you can do, how to get tested, why to get tested, why not to get tested. Getting tested for hormones, we're getting tested for sexual function, reproductive function, and you'll just have a greater appreciation for how impactful this can be for quality of life, longevity, everything. Well, I just need to say up front, I have my husband, Chris, is permission to share information because I'm just going to go on the record and maybe I'm going to

sound like a giant dummy. But it's not until I hit perimenopause and now I'm fully in menopause that I even started to think about male hormone health. And I'd love for you, Dr. Eisenberg, to start by just setting the table for us. What is male hormone health? And what do you want us to know about it when you think about the bigger picture before we dive into specific questions? Yeah, so I think it's just sort of optimum hormone levels. And I think when we think about men, the main one we talk about is testosterone. And it's important to know that the normal range of testosterone is quite wide, right, 300 to 900 nanograms per deciliter. And so when we think about that, you know, there's some men that are on the lower end, some men are on the higher end, some men are square in the middle.

But it's a very wide range because normal is a little. bit different between everybody. And it's so important, you know, we're obviously going to talk about all the things that it does, quality of life things, overall health things, functional things. So I think that having that understanding, I think, is really fundamental. What age do men start to see changes in testosterone? So as we go through puberty, you know, testosterone increases, and it probably peaks probably somewhere between 20 to 30, and then every year thereafter, it goes down maybe 1% a year. So if you look at epidemiologic data of populations, men that have low testosterone, so kind of below those cut points, below 300 or so, maybe men in the 40s or probably 50s, maybe about

10, 20%, you go in the 60s, goes to about 20%, 70s, 30%, then the 80s is about 50%. So, you know, the kind of statistic that's always talked about is over 50, you know, about half of men have low testosterone, kind of a serum number. So that's when men should start to think about that is something they should get screened for. So I just want to make sure I understand the math because you just spit out a lot of numbers right there. So when you were saying 10%, 20%, 30%, and then you're going 40, 50, 60, were you basically saying that your testosterone kicks in for puberty? And is it relatively stable until you hit your 40s or 50s?

And then you start to slowly decline. Is that what's happening? And that's normal? It is normal. I think it peaks somewhere between 20 to 30 and then it goes down a little bit. So it's not usually kind of a steep drop off. But it does slowly go down. And there's different factors. Age is probably one. But also, you know, our metabolic health at a policy, like how much weight we have. I mean, all these things will impact it. What are the signs or symptoms that you may have low testosterone? So I think that there's sort of quality of life thing. So low energy level, low sex drive, you know, poor mood, poor sleep, poor concentration. I will certainly admit that it's either. somewhat non-specific. But if you're having these, you notice these a little bit more. They're bothering you. Your partner notices them. I think certainly gets screened for low testosterone. And then again, some more health metrics. So like low blood counts, so-called anemia.

I think that's something that can be a sign. If you're found to have low bone mineral density, with no other explanation, get screened. And then again, if you have a history of chemotherapy, radiation to the testicle specifically, but the symptoms that we'll see are, again, these sort of low energy level, those are typically the things, sexual dysfunction, or Actulitis function. Those are things that we want to think. Does this guy have low testosterone? Let's check it. Well, I'm thinking about it from the partner standpoint, because as you're listing those things off, I was kind of going like, okay, check, check, check. At least not right now, but certainly about five years ago, Chris is very open about the fact that he was struggling with depression and just was not himself. Like, very low energy, very shut down, very low sex drive. He wasn't irritable. but just seem down. And so it's helpful to hear,

even though those are sort of general things that you may see as a change in your partner, but it's helpful to understand that they can point to something deeper. Right, exactly. Do you often see patients alone, or do the spouses drag them in? I'm always so excited to see the spouses.

I'll say the majority of men come alone, but any time I see the spouse, whether it be for testosterone-related discussions, whether it be for like sexual dysfunction, fertility. I always shake the hand of the spouse and say, I'm so glad you're here. This is a team sport, right? And so then I think that level of engagement,

I think is very helpful. And I think I know that the wife is going to be, or the partner is going to be a huge advocate that's going to help us get through this and be more likely it will get treatment success. Well, Dr. Eisenberg, what are the benefits of going on testosterone? It can help with energy level, you know, vitality. I think it can help with some things and not others,

but we do see that. Consistently we see improvement in sexual function. So again, such a powerful aspect of quality of life, but it can help with libido, can help with erectile function. So those are all things good, you know, penile health keeping that. It can help with bone mineral density, you know, men that have low blood counts, it can help with that. It can improve lean body mass. It can improve metabolic health.

There have been some studies that followed men that were kind of pre-diabatic, and those men that were on testosterone had a lower risk of developing diabetes. So it can kind of maintain, again, longevity in that regard as well. So I think also sometimes men talk about increasing their motivation, making them more active. What about some of the things related to mood or related to energy and the things that we see in the negative in our partners? And we're like, wow, you don't seem like yourself. Do you see a boost in mood and muscle development and just all the other things? Yeah.

So certainly it can help with, you know, mood. Certainly patients that get a good response, they do talk about that. People talk about having sort of better cognitive load as well. there's different ways that we give testosterone. And so some men come to the clinic every few months for basically a shot or some new installation of whatever treatment we're doing. And they say that I noted I needed it because I can't sleep as well. I can't focus at work. And then as soon as they get on it, they see that improvement.

Again, these are men with low testosterone. So this is the reason they're having these symptoms. And so we see that. And also just lean body mass, can help with strength, all those things. You know, we do have measurable improvements in the patients that I see, but also we've done very good trials that do support this improvement. You know, I don't know if this is something that happens in your 50s, and I don't know how old you are, Doc, but I notice that when you hit your 50s, I'm going to be 58 in a couple of weeks. Suddenly people start talking about testosterone. It starts on walks that women have together as they're talking about their partners.

But I've noticed more and more people talking about it. And one of the first things that I was really wondering about is how often should me? men get their testosterone checked and at what age? Yeah, there's many different reasons that we give it. Some men, they don't produce normal testosterone because of some medical condition. So, for example, some men with, like, testicular cancer to lose one or both testicles, the levels can go down. If there's a history of chemotherapy, that can affect it.

Some men with echinemia, the very low blood counts, we worry about that. Men with low bone mineral density, that's another warning sign. So I think if you're having symptoms of low testosterone, so again, low energy, you're not energy level of sex drive, mood, sleep, erectile dysfunction. These are also reasons that sort of clue you and could this be testosterone, could this be hormonal? And then you can have a check. So just like you go to your doctor and getting checked for blood pressure, cholesterol, blood sugar. I think it's a simple test to add on because, you know, our levels do change a lot. So getting checked, I think, sooner rather than later is a reasonable thing to do. Probably, you know, starting maybe 40, 50,

but again, if you have some of these other things, you want to check much, much earlier. And is it just a blood draw or how do they check testosterone? That's exactly right. It's just a blood draw. So our levels do change based on time of day. So usually we check it in the morning, ideally in the fasted state, although, you know, honestly in my clinic, I'm not so particular about that, but I say nine or ten in the morning. And then we usually also want to repeat it. So if we get one low level, we'll do another one. And if those are both confirmatory and also symptoms, then we talk about supplementation. The second you said the thing about testicular cancer, I'm like, wait a minute, my husband had a hernia surgery related. to, I don't know the technical name, the balls, so he only has one ball. And I'm like, whoa, that might actually be the reason why he has low testosterone. It could be. Dr. Eisenberg, why are we so embarrassed to talk about this? I don't know. I think that, you know, it's gotten a lot better. And I think, to your point, I think people are more and more comfortable

talking about testosterone. Just like 20 years ago when Biagra came on the market for erecta dysfunction, I think that made people a lot more comfortable. And I think there are spokesman now, people are very open about being on testosterone and all the benefits. But I think there's also just this feeling of shame a little bit and guilt, sort of concerns about their own masculinity that if their body can't produce enough or something wrong, and that's absolutely not the case. There's a lot we can do. It's very common to have these lower numbers. Treatment is certainly underway. But I was saying with if you lose a testicle, oftentimes the other one is able to compensate, it's able to grow again, depending on what happened and when it happened. It's like a super testicle. Yeah. So some men with one testicle do just. fine, but obviously, you know, it's a paired organ. So, you know, ideally there's both. And if there's only one, sometimes it's not adequate. Wait, what does that mean? It's a paired organ? Well, there's two of them, just like we have two eyes, two lungs, two kidneys, so we have two testicles. It's obviously super fundamental for our species, right? It's involved in reproduction, but testosterone production is also such a fundamental role for the testicle and making us men.

So there's some redundancy in the system for that reason. I'm going to sound like a real idiot. I'm almost embarrassed to ask you this question. Is testosterone produced in the testicles? Oh, primarily, yes. Okay. So the testicle produced most of the testosterone are adrenal glands, which are these little endocrine glands that produce different hormones that just on top of the kidneys. They produce a tiny fraction. Okay.

But most of it, 90% or more is produced in the testicles. Wow. I'd love to ask a few questions about how specific things can impact your levels of testosterone. How does poor sleep impact your testosterone levels? Here we go. Okay, he's got a, you've got a sign. Oh, cool, poor sleep. Poor sleep.

So poor sleep affects testosterone, you know, through a few mechanisms, but primarily it really just blunts our normal kind of feedback. So the way that we produce testosterone is the brain sends signals to the testicle. And it kind of senses when there's enough testosterone, so there's this elaborate feedback loop. And poor sleep really blunts hormonal function. just broadly, but certainly involving testosterone production. And so without this sort of normal rhythm that we see, you know, higher levels in the morning, kind of gradually kind of calming down as we go to sleep. Without that, basically, there's just a general suppression of testosterone. So that's

one of the main mechanism. Certainly men that are very sleep deprived, we see that, but even if you're just not getting enough sleep on a regular basis, you know, ideally seven to nine hours is ideal, but these men that kind of say they only need a little or they're, you know, four to five hours the night, we do see that suppression, shift work, all these things that disturb just normal circadian rhythm can affect it. Do you see any kind of connection with somebody who may struggle with, like, sleep apnea and the low testosterone levels? Absolutely, absolutely. And, you know, in some ways, it can kind of, it sort of feeds back on itself because low testosterone itself is thought to be associated with sleep apnea, and sleep apnea leads to low testosterone. So in some ways, it's sort of

circular, but we definitely see that association. Interesting. And very helpful. How does X, body fat impact your testosterone levels, Dr. Eisenberg. All right. So testosterone is made in the testicle. And then in the peripheral tissue, some of it is converted to estradial. And that's one of the main ways that, you know, our body regulates testosterone production. Because esterdial is, you know, you kind of think of it as a female hormone, but certainly men have a lot. It's very important for our function as well, for bone health, for sexual health. But it also impacts primarily the feedback mechanism that our body uses to regulate testosterone. And a lot of that conversion of testosterone to estradial happens in fatty tissue.

So the more fatty tissue there is, the more conversion to estradial. So you kind of see this as sort of a leech or pulling out of testosterone from circulation. So if we're too big, it can affect that. And also excess body weight, a lot of it can be insulation down on the testicles. The testicles are outside the body because it need to be a little cooler. Mostly it's for sperm production, but it can also affect hormonal health as well. So having excess body weight, this poor metabolic state impacts just normal hormonal regulation. So you kind of blunt the normal response that we see for normal production.

If you see a patient go on one of these life-changing GLP-1 medications and they start to lose a lot of weight, do you typically see somebody's testosterone levels rise when that happens? Anecdotally, I have seen that. I think losing body weight from caloric restriction, I think, not if you starve yourself, But if you, you know, good diet, exercise, if we see that and they lose weight, we can also see improvements. Certainly, you know, GLP-1s have seen that. Bariatic surgery reliably increases testosterone. So I think any way you can lose weight, you know, kind of getting an ideal body weight, I think that's really going to be crucial.

Anything that's good for your heart, it's good for testosterone. That makes a lot of sense. How does chronic stress, the number one word that we're seeing right now, Dr. Eisenberg from our audience, globally, is exhausted. And I'd love to know how does. chronic stress impact testosterone levels? Yeah, we get stress from so many things in our life, like work, home, everything. Spouses. Yes.

I'm speaking for myself. I feel like I really need to lift Chris up now. Yeah, I don't want to get in trouble, but yeah. If there's too much stress, we get this cortisol release in our body, and that basically just blunts the normal testosterone response. You know, again, it's obviously easier to say more sleep. less stress, for example. But if you take that to heart, if there's ways that you can do that to try and lower the stress in your life, you can see improvements in testosterone levels. I think it's really interesting that you use the word blunt, that you can be doing all the right things, getting good sleep, moving your body, you have a healthy body weight.

But if you're under chronic stress from a job or caregiving or you're going through something very stressful in your life, that the rise in cortisol and then, that like fighter flight blunts the testosterone that's there. Can you like explain a little bit more about that? Your body's just prioritizing survival, right? And so if there's something else going on and wants you to survive, like if a tiger comes around, right, nothing else matters. You need to get out of there. And so I think we see the same thing with testosterone, hormonal health, reproductive health. It's just sort of deprioritized. So you become in survival mode more than longevity mode. And so that's exactly the response that we would expect. Well, it's helpful to hear from a doctor.

And the reason why is I think a lot of men really feel a lot of pressure to be providing, to be taking care of their partner, their family, to be earning money, to be out in the world and be successful. And whether that's societal or self-imposed or both, that men are under a lot more pressure and stress than I think a lot of us realize. because a lot of them bear it more quietly, I feel like since guys tend not to be that great at talking about the things that are really weighing on them, you're the one that's seeing how that can cause health conditions in somebody. Yeah, I mean, I think for these conditions we're talking about,

it's often the first time they've ever gone to the doctor, the first time they've ever had really anything's kind of caught up with them to some extent. Everything's just sort of worked, right? I mean, the patients that I see in Silicon Valley, type A, they've been very, very successful. all the top jobs, everything is going really well. And here, you know, all the sacrifices they've made in their health, getting little sleep, bearing this unbelievable stress for a new startup or what have you,

now they start to see some of these things fall apart, hormonal health, sexual health. And they feel guilty. They try and, you know, kind of rationalize it a little bit. But, you know, I can taking a step back and just giving them sort of these actionable things that can be done to try and reset thing, I think can be very powerful. It's super helpful. Like I'm even thinking about, like, some of my. male relatives who are all in the cattle business or farmers or machinists or long-haul drivers

or police officers and just the stress of those jobs too that you bear, it's interesting to really stop and consider how that's having an impact on your hormone health and on all your sexual health. So I appreciate you explaining it in detail. Dr. Eisenberg, can you talk about the connection between depression and testosterone? So depression and low testosterone, I think, are very closely linked. And this is one where we think low testosterone itself can impair mood, but also depression itself can also impair testosterone production. So when we think about how that would happen, I think there's a few mechanisms.

But, you know, really primarily, again, it leads to the same sort of lack of ability of the body to respond to normal stresses and normal circadian rhythms. And it just sort of blunts that hypothalam. which is, you know, a region in the brain that stimulates this other region called the pituitary, which then stimulates a testicle. So all that signaling is basically lost a little when these men have depression. And the other thing I think to think about depression is a lot of times there are very effective treatments for it. But those themselves, some of these medications that we talk about are also very impactful on testosterone. Meaning they make it rise?

They make it go down, unfortunately. Oh, no. So you may be treating the depression with a medication that sort of lifts the fog. But at the same time, it's lowering testosterone, which can continue to make you feel like you're moving through sludge as you go through your day. Yeah, it can affect hormonal health and then sexual health as well. Wow. So it's important to understand that these things can coexist and that it's important to realize that the treatments for one don't necessarily take care of the other and vice versa. Right, exactly. So you should think about them in some ways, in a penalty.

And so I have patients that do have depression are on treatment for it. And then we're also treating their low testosterone. And together, hopefully we can get them to a good place. Excellent. Super, super helpful. Let's talk about the connection between alcohol and testosterone, Dr. Eisenberg. So alcohol also is associated with low testosterone. And what alcohol does really at every level is it blunts the body's response to the feedback of regulating normal levels.

And then the signal going down to the testicle, the testicle's ability to make. testosterone, all those things are blunted by too much alcohol. So moderation. If patients are telling you they drink a lot, it's good to try and, you know, regulate that. Some men say they have five drinks a night, seven drinks a night, which is a lot. So which is a lot. Yeah. Okay. That makes sense. So if, and you've seen that when people curb the drinking, the testosterone can rise? It can go back up. That's exactly right. You know, it's, it's never quite as easy as saying stop and they stop immediately, but, you know, gradually cutting down, getting in a program, I think we do see improvements for sure. But I think also beyond just testosterone, really, it's going to improve

their overall health. That level of substance abuse and alcohol dependence, I think, is going to have many, many impacts. And so they do feel better when they get through the other side. That makes a lot of sense. Dr. Eisenberg, thank you so much for being here. I am learning so much. I know my husband is going to be grateful that you're answering these questions, too. I want to take a quick break so we can give our amazing sponsors a chance to share a few words. And I know you're thinking about the men in your life. I knew that I was going to send this to my husband, Chris, but I'm also going to send this to my brother, Derek. So get ready, Derek.

This one's incoming. And don't you go anywhere. When we return, Stanford's Dr. Eisenberg is going to dive into everything you and your partner need to know about erectile dysfunction. That and so much more when we return. to stay with me. People are more and more comfortable talking about testosterone. 20 years ago when Biagra came on the market for rectitis function, I think that made people a lot more comfortable.

And I think there are spokesmen now. People are very open about being on testosterone and all the benefits. That was Stanford's Dr. Michael Eisenberg. And today, you and I are getting the ultimate guide to male hormones and men's health. So let's just jump right back in. So guys that end up doing testosterone or going on testosterone, It's literally like they're in a multi-level marketing organization. They're so passionate about it and wanting everybody to get on it.

And I've been very surprised because my husband has been very resistant to even considering testosterone. He's just started talking to doctors about it. And so I would love to dig in a little bit to some of the things that at least he's concerned about because I'm sure a lot of people are concerned about it. I asked him, what's your concern about starting it based on what you know? And he said that with injections, I don't even understand what this means, Dr. Okay. That with injections, it's a lot of oil intake for the next 30 years of my life, oil intake, and that the long-term effects of taking it for that long of a time have not been researched.

Those were his two concerns, the long-term effect, and that it's, a lot of, I don't know what oil intake. Maybe that was a mistake. Is it oil? It is oil. So the injectable testosterone, no, he's exactly right. Okay. Is an oil-based medicine. So you basically inject kind of this oil, you know, in the muscle. And you can do it in different ways. And, you know, I usually teach men to do it in their thigh. If they have a partner, it can do it in the buttocks. But it is an injection that's done on a regular basis. For injections, you know, the standard is probably doing every two weeks. You know, you do kind of get this peaks and valleys. Some men feel that, so sometimes we shorten the duration. They do it once or twice a week. But testosterone therapy

has been done for decades and decades. So it's very, very safe. Now, there's different ways to give testosterone. So some men certainly don't like the idea of injections. So they're longer acting injections. It can be never a few months. So that may be more appealing for him. There's gels that you could put on every day. So again, there's no needle at all. There's different testosterone pellets. It can be put underneath, like usually under the skin and the hip area, classically where it's done. So again, there's not any needles with that. Has the pellets been tested by the FDA? Because I know that we've had medical experts come on and talk at least with when it comes to women's hormones.

There's been several medical experts that have come on to say they don't like the pellets because they haven't been approved by the FDA. But that was a couple years ago. So maybe things have changed. Yeah, for the men, it certainly has. Yeah, there's no FDA approved testosterone for women. Oh, gotcha. So that, I think, hopefully that's evolving. I know there's a lot of advocates for female health that have seen there is some good data that it can't help.

For men, it is approved. And there's also testosterone oral tablets as well. So there's many ways that it can be given. I think most commonly it is injections. Okay. What are the negative side effects, Dr. Eisenberg, of testosterone? Testosterone has been tested by the World Health Organization as a contraceptive. So it can actually lower sperm production.

Does that pretty reliably, probably 90% of the time. Wait, I'm confused. Hold on a second. You said testosterone is a contraceptive? And men, it is, yeah. It lowers your sperm count? Mm-hmm. Wouldn't it increase it? Well, you'd think that, but there's many reasons that it doesn't.

So if we think about how the body makes testosterone, we talked about the brain signaling the testicle to make testosterone, and then there's a feedback loop. Your body knows when it needs testosterone, it's kind of sending the signal down. So when you take testosterone exogenously, you know, whether it be injection, gel, any of the different methods. What is it? Oh, exogenous.

So outside testosterone. Okay, got it. Okay. When you do that, your body says, oh, there's enough testosterone. I don't need to make anymore. And so if the brain doesn't signal the testicle to make testosterone, it stops doing that, but it also stops making sperm. So those signals are very, very closely related.

In addition, in the testicle, the testosterone levels are probably about 100-fold higher. So if your normal testosterone is kind of swimming around in the blood at 500, let's say. and the testicle, it needs to be, you know, 5,000 or much higher than that even. And so when your testicle doesn't see this super, you know, 5,000, 50,000 level of testosterone, then you're not going to make sperm efficiently either because you need those high levels of testosterone for efficient sperm production or spermatogenesis. So there's sort of two different methods. So low testosterone and the testicle and then not that signal to make sperm.

That's what happens with testosterone. That makes a lot of sense. So low sperm count is one negative side effect. What are some other potential negative side effects from taking testosterone? There can be skin changes, can lead to oil skin acne, can lead to hair loss, breast growth as well. Because testosterone is converted to estrogen, which we do need for normal function. But if estrogen levels get too high, there can be some breast growth. So sometimes we see that as well.

Now, there used to also be some concerns about prostate health and even heart health with testosterone. But there was a very landmark study of about 5,000 men called the Traverse Trial, where men were given testosterone, men were given placebo, so, you know, kind of a dummy gel, and then just followed to see if there are higher risks of any of these adverse outcomes. And it turns out there weren't. So we used to worry that if you add testosterone to men, they're going to see more levels of prostate cancer. That was debunked. And then there was also some earlier due signals that men on testosterone, a higher risk of like heart attacks and strokes. Also with the study, we didn't see that. So that's also been debunked. So the FTA is actually going to, update guidance on prescribing and some of the warning labels to remove those. Because I think that was also a barrier, similar to female hormone replacement. So I think hopefully that'll help a lot of men as well. Dr. Eisenberg, is it important that you go see a urologist or your general practitioner and that a doctor's overseeing this? It's so crucial that a doctor oversees this because I think it can certainly be abused or misused

or misprescribed. You can give anybody testosterone, but you really want to make sure you're giving it to people that need it. Otherwise, you're just exposing them to all the risks and none of the benefits. We've seen from our best evidence that if your testosterone is normal and you're given testosterone, it's very unlikely to help any problem you have. Wait, say that again? It's such a crucial point that if you have a normal testosterone and you're given testosterone, it's unlikely to help with some of these other symptoms that people would come in for. For sexual dysfunction, for example, for performance. People think that if I take testosterone, I'm going to be a better version of me. And that's

not the case. There have been studies in the military thinking about testosterone as a performance enhancer. And while it did help with lean body mass for, you know, kind of military sort of hero exercises these men were doing, whether they got testosterone or whether they got placebo, their performance was similar, their recovery was similar. So if you have normal levels, you probably shouldn't be on testosterone. And so I do worry that some of these clinics that'll just prescribe it, right, that's how they make money, right? It's just giving these prescriptions upselling. If you don't need it, you shouldn't be on it because you're going to get exposed to all these risks that we talked about, right? Like hair loss, breast growth, you know, higher levels of, you know, red blood cell count, which can lead to clotting risk.

I am so glad you're saying this because I just assumed that if you're a guy in your 20s, 30s, or 40s, and you want to look more ripped and you want to perform better in the bedroom and you want to be more energized, just start testosterone now. It never even occurred to me that it might not do anything. except for lower your sperm count, raise your blood count, make you lose hair, wow. Yeah. Yeah, I think that's something that men need to be aware of, that it's not all upside. And I think it's not for everybody. And so I think seeing somebody that understands all of our guidelines from the American Neurologic Association, the Endocrine Society, very thoughtful, data-driven approaches to this. And so I think that's really crucial. One of my husband's big concerns is that once I start this, I have to. take this for the rest of my life. And so Dr. Eisenberg, once you start testosterone, do you have to take it for the rest of your life? So it depends. For men that, you know, don't make

their own testosterone, so for men, like, that have lost both their testicles or some congenital conditions where the testicles don't function properly, those men do need to be on testosterone forever. But for these other conditions where men have some symptoms, low energy level, sexual dysfunction, found to have some lower levels. Usually we start it as a trial period. I think all the different society is recommend this. You know, we start testosterone. We'll check the levels to make sure you're in a therapeutic range. Sometimes we'll switch between formulation so we can get there so it's convenient. And if they see the benefit, again, which a lot of men do, they want to be on it because they do see sort of a better version of themselves. But if they really don't notice any changes, then we'll just

stop it. So after six months, after a year, they're not seeing those improvements, then we can stop it. Or if there's other reasons, you know, we talked about some of the causes of low testosterone, like obesity, for example. So if they can start testosterone and sort of reclaim their health, you know, lose some of that weight, then the body's own production can kind of boost up

and then we can kind of wean them off, their body takes over, and hopefully they're at a normal level after that. How do you bring this up with your partner? Because I can already hear the send, I can hear somebody copying the link to this episode as they're listening to it right now and texting it to their partner.

But how do you bring this up? all my girlfriends and I are talking about this and the fact that we have all diagnosed our husbands with low testosterone. Yeah. What's the most empowering and compassionate way to bring this up? It's a good question. I think everyone's going to be kind of individualized, but I think there's many ways to sort of approach to subject. One is we've talked about these symptoms. It could be testosterone.

Have you thought about bringing it up to Dr. Smith next time you go in to see her? Or I heard this super interesting podcast about testosterone. It sounds like it's really not just linked to some sexual function, but it's also linked to longevity. And I love you. I want you to be there forever. So if you haven't had it checked, it sounds like it's easy enough to do. Maybe we can do that. So I think kind of this tying with health, with strength, you know, in your 30s, everything's super easy to do. But as you kind of get older and older, normal household chores, bringing in a bag groceries, everything gets a little bit harder.

So I think an easy way to get checked and maybe there's something that can be done to help with some of those things too. Amazing. Dr. Eisenberg, thank you for explaining everything that you just did about hormone health, testosterone. I want to switch gears and talk about a topic that can be really difficult to talk about, which is erectile dysfunction. What is erectile dysfunction? Arectile dysfunction is the consistent or recurrent inability of a man to attain or maintain an erection sufficient for sexual activity. How common is it? It's so common. I think that when men come in, they think they're the only one affected. But if you look at studies, there's a famous study called the Massachusetts male aging study done here about 20 years ago or so that shows that if you look at men over the age of 40, over half have some trouble with erectile dysfunction.

Over half? Over half. And it increases every decade of life. So men in the 40s, about 40 percent, 50 is 50 percent, 50 percent, 60, 60 percent, 70, 70, 70 percent, have some trouble with erections. And even men, you know, getting younger. It kind of goes all the way down the other range. too. So, you know, men that I see in their 20s, 30s, probably 15 to 20 percent. So it's a very common issue. What causes erectile dysfunction? There's a host of things. So ultimately, you know, what erections are is blood going into the penis and getting trapped there. And I think it may be helpful just to... Sure. We can look at a model here. Okay. So if you can kind of see this, so this is the erectile body. There's the urethras on the bottom here. So this is where blood actually goes. So blood goes... On the top of it? On the top. Okay. So these are the erectile bodies. These

are what engorge with blood. Yep. And essentially what happens as when you get stimulation, whether it be, you know, visual, auditory. Touch. Touch.

Yes. There's many ways it can be done. Absolutely. You get, you know, different neurotransmitter release, nitric oxide release, which releases this other chemical called cyclic GMP,

which then causes the blood vessels in the penis to dilate, to open up, to let more blood in, and then that's what leads to erection. So anything that can affect blood flow anywhere in the body can affect it in the penis,

So, for example, smoking, diabetes, high cholesterol, high blood pressure, all the things that we think about can affect, like, heart problems can also affect blood flow in the penis and causing that. Trauma is also notorious for doing that. So, for example, like prostate cancer surgery can affect a lot of the main nerve supply to the penis. Some bike saddle seats, for example, can also put pressure on some of the main nerves that conduct into the penis. Really? Mm-hmm. Bike saddle seats? Yeah.

all the cyclists are now going to be mad at you. Well, I think for some men, I think in general, you know, anything that's good for your heart is going to be good for the penis. You know, it's sort of one of my mantras. So usually maintaining good cardiovascular health is important. But for some saddle designs and some men, it can't actually put a lot of pressure on some of those nerves and some of the arteries to the penis. And over a long period of time, not everybody, but maybe 20, 25 percent of men do notice numbness, pain, and erectile problems, especially after long ride. So something to be aware of as well. How do men feel when they're experiencing erectile dysfunction?

I mean, erectile dysfunction is such a profound effect on a man. I mean, they feel inadequate, lack of masculinity. They feel a sense of guilt like they've done something wrong. If they're in a relationship, they feel like they're contributing to marital problems. They sometimes, like, withdraw a little bit. So we see that can lead to depression. Again, these just feelings of inadequacy. So ultimately, it's a quality of life function and, you know, reproductive at young age.

But, you know, towards the end, it's sort of this way of intimacy and connection with somebody. And then when you lose that, when you see that you're the issue and you feel like you're the issue, you kind of feel hopeless. A lot of men are not comfortable talking about this. They don't realize all the things that can be done. We see all these problems. Well, it's an important thing to stop and really think about because when I went through perimenopause and menopause and menopause. pause, I absolutely did not feel like myself. I did not feel attractive. My body started changing in ways that I did not like. And it certainly impacted how I felt about myself. But listening to you,

I'm sitting here thinking, but my vagina still worked. I mean, I might not have liked what my body felt like, but I could still be intimate with Chris. And when you really stop and think, not just that your body no longer feels like it's your own and you can't count on something that you have for a lot of your life so I can understand that piece of losing control. But also feeling like you can't perform something that's one of the most awesome things about life with your partner. Yeah. I think that's exactly right. I think, and it also is something that it just separates yourself from your parlor. As you're going through this huge problem, one of the ways he used to connect is now lost. And some of these men feel that it's their problem and there's nothing that can be done.

I think this hopelessness is something that I definitely hear about a lot. What do you want women in particular to know if you are with somebody who is experiencing erectile dysfunction? I think there's two things. I think that one is it's very common. So just know that man is not alone. And then I think the other thing is that there's a lot that can be done. I always like to tell men, as long as you have a penis, we can always make it hard. So just let them know that there's therapies that are available.

As long as you have a penis, we can always make it hard. Yeah. Really? That's right. Yeah. You can fix any. You can fix anything. Yep.

There's things that we do. So you have to be willing to be very aggressive. But there's always a therapy. Wow. Mm-hmm. Dr. Eisenberg, I just want to thank you. This is the kind of information that every couple needs to hear. I really appreciate how you're sharing it, how compassionate you are.

I feel empowered. I know as you're listening right now, you feel empowered. because when something changes in your sex life, it's so easy to take it personally and to avoid talking about it or to assume that something's wrong with the relationship or that there's nothing you can do. And I'm really learning that there is always something you can do. Now, I need to take a quick break, but please take the time and share this extraordinary guide to male hormone health and to men's health with somebody that you love. It might be your partner. Maybe it's a male friend.

Maybe it's one of your friends who doesn't have a clue why their husband is off a little lately. And don't go anywhere because after the break, Dr. Eisenberg is going to tell you exactly what all men need to start doing today to protect their hormone and sexual health as they age. Stay with me. As long as you have a penis, we can always make it hard. Yeah. Really? That's right. Yeah.

You can fix any. Any penis. You can fix anything. Yep. There's things that we do. So you have to be willing to be very aggressive, but there's always a therapy. That was Dr. Michael Eisenberg talking about male hormone health. He's a professor of urology at Stanford, and today he is sharing the ultimate guide to male hormones and men's health.

Let's talk about what can be done if you're experiencing erectile dysfunction. The first thing we want to do is look holistically at their health. Just sort of understand what medications are on because there are some medications that can affect it. Sometimes we see blood pressure medications are notorious for. causing problems, sometimes antipsychotics, antidepressants. Those are all things to think about, maybe talk to some of their other doctors. That's one of the reasons I do get on the phone with referring providers sometimes. And then look at their health, too.

What are they doing? Are they exercising? What is their diet like? What's their BMI, their body mass index? Because these are things that we could potentially correct. Once we've done that and everything's optimized as much as possible, we talked about some treatments. So the first line is going to be pills.

And I actually brought some here, this is everybody knows. So these are called phosphoesterase inhibitors. Who? So the things that we hear about like Viagra, Stildenafil, Bardenifil or Lovetra, Todalafil, Cialis, these are the ones that are on TV. So these are the pills that help with erections. And basically... Are they all the same by a different name, or do they work differently?

They're sort of cousins. So they have the same mechanism of action. The molecule is a little bit different. some of their chemical properties a little different. So some last longer in the body, some act a little quicker. So depending on what the goals are, you know, we prescribe some in different conditions. And some men do respond better to one, the other. Sometimes men have different side effects, you know, with all of them.

But again, they're very, very similar. But men kind of react a little bit differently. Well, we're going to take them one at a time. But do all of these medications impact blood flow? Is that basically what they're doing? That's basically what they do. So the way that erections work, again, is, you know, we get the stimulation, which lead to this basal dilation or opening up the blood vessel. So one of the main signals for that

is this chemical called cyclic gmp, and it's broken down. So what these medications do is prevent the breaking down of this chemical. So the more of the chemicals there, the more of the blood vessels stay open, the longer the erection can last, the easier just to get erection, all those sorts of things. Wow. Can you walk us through each one and just kind of tell us what the drug does and, like, what's the downside to it and, like, why you would prescribe that one versus a different one? I don't know if that's a fair question. I certainly won't turn this into an ad for anything. I'm just going to come right out and say it.

If you're a woman and you see these ads, a couple things happen for me. One is, where is the female version of this? And the second one is, okay, if my partner starts taking this, is he going to, like, pop a boner, like, immediately, and then I'm going to be running away from him, and now I'm going to have a different problem than him being depressed. He's going to want sex all the time. And so as a woman, I'm just like now sharing the stuff we say on a walk when we talk about this stuff. Yeah, that's a good question. No.

In general, no, this is not going to give you a permanent erection. Okay. This is basically just going to augment the partner's ability to get an erection when they want it. So it kind of helps an on-demand erections, essentially. And it can't help with performance, you know, for performance anxiety, but also, again, when you're just not getting erections when you need them when you want them. Gotcha. So the first one was Viagra.

You know, the way you take it is about. an hour before sex. For most of these, it's better to take it on an empty stomach, so hour before, hour after you eat. Makes it easier to get to keep erections. You know, it also things to know about as some of the side effects. So most men do fine, but the rare side effects would be like headache, facial flushing, back aches like cramps indigestion or nasal congestion. So the way they work, again, is they open up blood vessels, mostly in the penis, but they can do it in other parts of the body as well. So you can get some of those side effects. But again, most men do fine. So I think Biagra is certainly a good one to start with, or Sildenafil. Cialis or

Tadalafil is the other one. So this one lasts a little longer in the system. It's kind of marketed as a weekend pill. So for example, Viagra, the half-life, like how long it takes to clear from our body. So half of it is out of our body in about six to eight hours. For Seales, it's probably 16 to 18 hours. So it just, it stays around a lot longer. So if you take a pill on Friday, there's still some on Saturday as well. This also allows a daily dosing, so you can give them kind of a low-dose medication every day, so it's sort of always there to help. Also in some studies that show that it may be cardio-protective in some ways.

It's not FDA-approved for that, but there's emerging data that, you know, if men that are taking the kind of low-dose, Seattleis every day, the lower risk of cardiovascular events. And is that, like, and I realize we're just kind of imagining what the connection might be, but do you think that's because if you're increasing blood flow to the penis, you're increasing blood flow everywhere, and that helps your heart?

That's thought to be the mechanism. You know, originally these medications were to design as a treatment for blood pressure, a treatment for angina or chest pain. It didn't work that well at that, but this was kind of an unexpected but very profitable side effect. You're like, whoa, look at what's happening. That's growing, but this isn't. Okay. Exactly.

So that's kind of the thought about it, that it's, you know, again, cardioprotective by increased blood flow. But I should also say these are observational studies. So they basically, you know, look back at who was on. See Alice, for example, who was not and just compared them. And those are different groups. So just to say this has not been studied kind of in the most rigorous medical trial that we could do. But I think it's at least sort of reassuring. Some men do ask, is it going to be safe? Am I going to have a heart attack when I'm on this? The data says that that will not happen. It may even be the other way. And are there side effects to taking the longer acting one? The same ones. I think the same ones that we'll see. Oh. And again, the low dose, maybe it's even better tolerated. So as a Stanford urologist, when somebody comes in with erectile dysfunction, what do you recommend?

Well, if they've never been on any of these, and we can't correct anything further than they already have, but I think I usually start with one of these medications. Gotcha. A lot of times when men have seen me, they've already failed these, and so they're ready for second line and third line options. Oh, and what's the second line that you would do? So there's also medications that you can put in the tip of the penis that are absorbed by the penis. So if we go back to our model here. That sounds painful. I'm just going to say the tip of the penis

sounds very painful to put something in. So just in the erythro, you can put this medication that's absorbed in. And it works in the same way as Viagradas. It's like a gel. Okay. There's like a little pellet, but there's also a gel. And it's basically just absorbed throughout the whole penis. It's a vasodilator, so it works in a similar mechanism to the pills that it opens up blood

bustles. Men do describe kind of a tingling or a low-grade burn. Usually they get used to it, safe for their partner, any orifice. And that works probably 60 to 80 percent of the time. So that can also be pretty effective. Got it. And is that something you do like before you're having sex or you have to do it every day? It's on demand. So yeah, so about five or ten minutes before you're going to have sex, it's something you want to do. Okay. So if those don't work, so the next option is injection. So penile injections are another thing that can be done. So essentially you take a small needle, And I think with the GLP1s, people are more used to giving themselves injections, maybe not on the penis. But I think there's a lot more comfort in that.

And it's a basidilator you're putting directly into the erectile bodies, leads to this basidylation. That works probably 90% of the time. 90? Now, what I'll say is that there is a huge psychological barrier to putting a needle in your penis. But if men are willing to do it, it's very, very effective. Wow. And you do it, it's like an on-demand thing. It's an on-demand thing.

It's such an interesting story because the first time it was ever discovered, and brought to sort of the medical world was by a pharmacologist at a national urology convention in 1980. And what he did is he injected himself in his hotel room. He went down, delivered the lecture, and then lowered his pants.

Oh, my God. And showed the audience. And beyond that, he actually walked up and down the aisles inviting people to inspect it. And you can imagine sort of the level of... His penis? His penis?

Well, it is a audience full of penis doctors. That's right. So you guys know what they look like. Yeah. But the amount of like shame and fear, right, that you would normally have doing something like that, but the medication is so powerful, it's able to sort of suppress that response that would normally cause erections to go away. So it is a very effective medication. I certainly don't advocate men injecting themselves and walking around naked, but just to say that it does work. Wow. That's, I mean, he's, he's doing one for all the urologists and men out there. It's a very famous urology story. But most conventions are in Vegas. So when you said there was a urologist in a hotel room in Vegas, injecting himself. I thought, where the hell is the story? You knew where this is going? No, I didn't know where this is going. I thought it ended sort of like that hangover movie. But no, I'm glad to hear

that it was something that he was willing to not only try, but it had such a profound breakthrough that he was willing to remove the shame and show all of his colleagues that were at this conference. Yeah. It's a very important medication. And a very important medication. and a very important option that we give men. Wow. What made you want to go into urology? Well, I like the problems that we deal with. When I looked at andrology specifically,

so hormonal, sexual, reproductive health, I thought there was really kind of a lack of treatments that were available. I think there were lots of research opportunities to try and do better by these men. So I just found that really fascinating. Just the powerful impact we can have on their quality of life, their overall health, sense of self. All that really got me excited about the field.

That's really cool, because it's an important and unique specialty. I've heard you talk about the connection between having sex and prostate cancer. Can you unpack that for us? Yeah, so there was a famous study that sort of looked at this about 30 years ago now, and it said that the more a man ejaculates, the lower the risk of prostate cancer. So it really fascinating. So what they found is that men that ejaculated 20 times a month or more compared to those less,

had about a 20% lower risk of developing prostate cancer. 20% lower? So this was a study of about 30,000 men fought for about 20 years, and they saw this pretty consistently, all the different ways they looked at it, all the different age groups. This has been looked at in other studies as well, hundreds of thousands of men, it's been supported.

So why this is is not certain. It doesn't seem to be tied to how a man ejaculate, so whether it be sex, masturbation, for example, all those seem to give the same trend. It's thought maybe you're kind of clearing toxins, you know, from seminal fluid, preventing crystal formation. I think mechanisms are not clear. We do see that association. Now, 20 ejaculations is a lot a month.

You know, maybe for teenagers it's a little easier, but certainly as you get older, it can't get more challenging. So I don't want to prescribe that for everybody. It's something to do, but it's an interesting observation. And, you know, when men ask, can I masturbate too much, for example, this is sort of the study that I always relay that it's probably not harmful. Again, there's some studies say maybe it's even beneficial. The other thing I was going to say is that there's also been studies linking sexual activity and a number of ejaculations and orgasms to longevity as well. We've talked a lot about how sexual function is related to overall health.

So it may be kind of a marker for that. But there have been studies that show that men that have sex maybe once or twice a week compared to men that have sex sort of rarely, you know, less than once a month, live longer, live twice as long, in fact. And this is, again, looking at men in their, you know, when they started observation kind of in their 50s, if you follow these men, they reported regular sexual activity, they live longer.

And that may be, you know, having a partner, all that things were very beneficial to longevity. But I think it's also something to be aware of. So another reason, you know, maybe they get checked out is that in addition to sort of the joys of sex, which obviously are numerous, it's, I think, when you think about longevity, which is a huge push now, I think, in our culture,

which is great, you can also see some benefits for that as well. Well, I'm glad you said the thing about relationships, because it is true, and so many renowned medical experts have come on to talk about the connection between your relationships long term and the quality of your life. Yeah. And that when you don't have great relationships as you get older and loneliness kicks in, that that is devastating to your physical health. And so I'm really glad that you're also highlighting that having a healthy sex life. being able to connect intimately with another person, you're right. It's not only one of the great joys in life, but it is a sign that you have relationships that are meaningful to you on a consistent basis. And that intimacy isn't just about the orgasm. It's about the quality of your life. Yeah. And that's so crucial. I think this sort of the studies I always like to quote are from Scandinavia where they have these great population birth and death registry. So the famous one I quote from Swedish.

where they looked at what effect having a partner has on a man's longevity and mortality and having kids. And it turns out our ideal is a man that has a partner is living with her and kids that are living with them. If you get rid of having a partner, the chance of that man dying goes up 60 percent. And if you get rid of kids, we see the same thing. If a man doesn't have any kids compared to someone that does, 60 percent higher risk of death. And if a man doesn't have a partner or have children about a threefold higher risk of death. So I think to your point, relationships are so, so crucial. They take care of you, but also it's a chance. just gives you purpose, right? And if you're silently struggling with either issues related to low

testosterone, or you're struggling with issues related to erectile dysfunction, which is making you pull back from those relationships that has a profound impact on the overall quality of your life, is what you're saying. Absolutely. Absolutely. Well, I can see why this is critical. And it's not just about sex. It's not just about your mood or your energy. It's about your overall health. Exactly right. You want to be there as long as you can for your partner, for everybody, for yourself. So I think that's one of the reasons you should pay attention to this. Again, this can be like a check engine light, right? That if erections are not as good, it's not just a convenience issue. This also may be sort of a sense of how you're doing. And so you should talk to your

partner, talk to your doctor, go to a doctor and get evaluated because I think there's some powerful insights you can get and there's a lot that can be done. You do a lot of work in male fertility, and I'd love to have you speak to both what we might find surprising about the issues that you're seeing with male fertility. And if you're not even thinking about having children right now, why is male fertility an important thing to pay attention to? Yeah, so I'm super passionate about male fertility as well. And there's been lots of studies that show that sperm counts are going down globally. So there's a famous study in the 90s that suggested this. It was very criticized.

They updated it 20 years later, still somewhat criticized. And then just a couple years ago, they did one of the biggest updates they've ever done and showed this all over the world. So in Western countries, Eastern countries, really every continent we see this decline in sperm counts. And obviously, the question is why. So I think if you're a male, you should definitely care that our sperm counts are going down. And it's still somewhat controversial, how fast that decline is, although the data suggests that it's accelerating in the last probably 20 years.

We also see declines in testosterone levels. We see changes in prebuttal timing in boys, higher risk of testis cancer. So I think male reproductive health is declining. So even if you're not sort of immediately planning for pregnancy, there's so much that we can do to help optimize fertility that I think that, you know, you should be aware and kind of get a sense of, you know, where you are to get checked out because it gives us an opportunity to sort of of improve things. I think one of the problems, just from an education standpoint, when you look at couples

that are, you know, having problems with infertility, about half the time there's a male factor. But at a societal level, usually everybody thinks that all fertility is related to female partner issues. And so a lot of times the males never evaluated. In this country, probably a third of the time, a male's never seen by a specialist, never checked, you know, bypass to go, you know, through IVF, for example, which is very powerful, very effective. But it kind of removes the opportunity to try and optimize the male, to try and figure out what's going on, some things can be corrected. Spurn counts also are very tied to overall health. And so it may also be kind of a check engine light. Your sperm counts low, what else is going on? What do we need to check out? Is there something

really dangerous going on? There's different anatomic factors we can look at. We can measure hormonal health and optimize that. Look at their overall lifestyle factors. Look at different medications are on, looking at different health conditions. So I think the earlier you can do that, the better because what we've found is that when men come in to see us, they've already been struggling with their partners for a year or more, and they don't want us to do anything, because they don't want to wait any longer. It takes two to three months to make a sperm,

but they wanted to get pregnant a year ago, so they don't want to wait two months for a surgery or a pill or anything. They're ready to just go. And so I think that's really a disservice to men, to male reproduction, because we can't really fix things. They just put all the burden on women. We've seen sort of an abundance of awareness,

of male fertility. There's a lot of, you know, home testing now to make it easier for men to see where they are. So you don't have to go to a doctor anymore. You don't have to send, you know, patients to like bathrooms to collect, things that are super uncomfortable. There's no question. So now you can just do it at home. You get the results immediately. It's very personal, very private. And I think that's really done a great job for awareness of this and also just, you know, making it more accessible for everybody. Dr. Eisenberg, I want to make sure I followed the statistics, you said, and I got them right. Okay. So in 50% of the cases where there are fertility issues, it is a male issue, not a female issue.

Right. Well, so what I should say is that it all causes 50%. So that's 30% only men, 20% men and women together. But there is a male factor that we can optimize in half of these cases of fertility problems. Wow. So in 50% of fertility problems, it's either the dude or it's the woman and the dude. And what you're saying is that what happens for a lot of couples is when you are having fertility issues, you focus on the woman, you race to IVF, instead of also looking at this 50%, which is there could be a lot of issues with your partner. That's right.

Wow. Yeah. And again, there's so much that can be done. I think there's, you know, standard evaluation. And, you know, if you look at guidelines like by the American Society of Reproductive Medicine, the American Neurologic Association, Everybody says you should check out both members of the couple simultaneously. But for different reasons, I think a lot of it is just knowledge from patients, from some of the providers. They just never think to check the man out.

So it's a huge opportunity, and I think a disservice to men. Wow. And women. It's a disservice to everybody. I'm really happy that you explained it like that. So if you're having fertility issues, both of you should get checked out immediately. Can you talk about men's pelvic floor health? Why is it important to pay attention to? And what is pelvic floor health?

So there's a lot of muscles in the pelvic floor that really control everything. So they control erections, ejaculation, orgasm. They're also involved in urine control, bowel control. So it's very important to sort of be aware of how important they are. And a lot of times we just take it for granted. But there's sometimes where it can lead the problem. So there can be chronic pelvic pain we see. Sometimes some scrotal pain is due to spasms in some of these muscles.

After pelvic surgery, like prostate removal for prostate cancer, for example, we teach men how to do some pelvic floor exercise to strengthen some of these muscles to try and regain some of the urinary control that sometimes compromised after surgery. So I think that there's a lot that can be done. And I think just having some understanding awareness that it's very important for men and for women to know that. Let's talk about peeing. So as you age, do you start to drip? Like, do you pee more at night? Like, what do you do if your partner is getting up three or four times a night to pee?

So, yeah, urination definitely changes with age. So we do see that, that men wake at night. I think there's different reasons for that. You know, the bladder's under a lot more pressure because as we age, the prostate gets bigger. So the resistance of the outflow tract, I think if we go back to this model, which I think is super helpful. So we see we make urine, it collects in the bladder, then it goes through this channel, the erythra out. And so this is the prostate. So you can imagine as we age, the prostate can get bigger out, but it can also get bigger in.

So this can narrow this channel and make it harder to empty. So the bladder has to work a little harder. It gets spastic. Sometimes it can reduce capacity, the ability to fill. And so sometimes we just have to wake up at night. Sometimes at night, like with obstructive sleep apnea or other things, we produce more urine at night. And so that also makes us have to wake up more. So once a night's pretty normal, but when it starts to be a little more disruptive two, three, four times, I think definitely you want to get evaluated because there's different medications that can help with that, different treatments that are available.

So there are things that can be done. What about standing there and it's just taking a lot of time for anything to come out? It depends how much that bothers you. I think if you empty your bladder, it's probably not a problem. But if it does bother you, bothers your partner, I mean, there's things that can be done. I think one of the biggest issues that we see if the prostate resistance, it's harder for everything to relax on time, to contract on time. And so there's medications that can help optimize that a little bit, too. So that's another option.

If you're having trouble with frequency or emptying your bladder, could it be a sign of a deeper, issue with the prostate? Anytime men have any urinary symptoms, I think we always want to evaluate to make sure there's nothing we're missing. So we usually check a urine test to make sure there's no signs of infection, inflammation. Those can certainly be some of the symptoms that we see. A lot of times again, depending on the age, we'll check the prostate-specific antigen or PSA. And that gives us a sense of how big the prostate is, but also it's a screening test for prostate cancer. Usually this is more of a quality of life issue, not a life-and-death issue. So I think that's what men should be aware of. Your partners should be aware of that as well. But talk

your doctor about it. I think that it is something that men just kind of think is normal and they just tend to live with it. And if it's not worth a pill, you know, maybe that's fine, but there's usually treatments that are available that are very effective. That's super helpful. Are there any warning signs that we should be aware of that may indicate prostate cancer? Usually most commonly prostate cancer is diagnosed just with a blood test. So it tends to be asymptomatic and it's just done by screening. So if there's a strong family history, usually we start screening a little bit earlier. But otherwise, you know, there's guidelines about starting it in your 50s just with an annual or semi-annual test. Terrific. That's so helpful.

You have taught us so much today, Dr. Eisenberg, if the person listening does just one thing after hearing all of this, what do you think the most important action to take is? I guess the most important thing I would say is just to be aware of your health, realize that you have agency, that you can improve. things. Take a, you know, kind of an internal inventory because we're not just talking about quality of life. I think some of these things could have real impacts on longevity, too, try and be more active. If you haven't seen a doctor before, I think you don't have to go every year, but I think getting check is important to find out, you know, what your blood pressure is, what your cholesterol is, because all those things tie so closely to some of these issues that we talked about, testosterone, sexual function, reproductive function. I think those are also going to be really crucial.

Just know that you can improve them. Dr. Eisenberg, what are your parting with? words. First, I want to thank you for just highlighting men's health. I think men's hormonal health, sexual health, reproductive health. I think it's so important. It's not talked about. But I just want to let everybody know that this is a very important topic and something that a lot needs to be done about and can be done about. Well, what I love about your work and the way that you talk about it is you make me believe that you can do something. The fact that when I asked about erectile dysfunction, you're like, Oh, no, no, no, no. You got a penis. I can make it hard. Oh, no, no, no, no. It's testosterone. We can work this out.

And knowing that you don't have to live in shame, you don't have to live feeling low mood, low energy, that there may be, and there probably are underlying conditions that medical experts like you have incredible tools and different medications that can truly help you not only feel. better, but live a more fulfilling life. I just think that's so cool. It is really cool. Well, thank you for taking time out of your schedule. Thank you for doing the research that you do, and thank you for coming here and educating all of us and giving us the ultimate guide, in my opinion, to male hormone health and also helping us understand why it actually matters. I love that it's tied to longevity. I love that it's tied to a sense of agency over yourself. And I love that there are things that you can do for every issue that we talked about. So thank you.

Thank you, Mel. This has been a pleasure. You're welcome. And thank you. Thank you for making time to listen to this. Thank you for being generous with Dr. Eisenberg's teaching and all the time and wisdom that he poured into you. And thank you for sharing this with the men in your life that you care deeply about. And in case no one else tells you, I wanted to be sure to tell you,

that I love you and I believe in you and I believe in your ability to create a better life. I'm going to send this to my husband, to my brother. Any man that you send this to, this could help him create a better life. And so thank you. Thank you, thank you for making the time to be here. Alrighty. I'll see you in the next episode. I'll welcome you in the moment you hit play.

In fact, Dr. Eisenberg, reproductive health. And, oh, great. Go ahead. Let's do this. He leads Stanford's male reproductive medicine and surgery program and serves and serves of the International AzoSpermia Center, which is basically their male infertility center. Hold on a second. Let me say international Azo. Dr. Michael Eisenberg, the head of Stanford met.

Dr. Eisenhower. Hold on a second. And one more thing. And no, this is not a blooper. this is the legal language. You know what the lawyer's right and what I need to read to you. This podcast is presented solely for educational and entertainment purposes. I'm just your friend. I am not a licensed therapist and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Got it? Good. I'll see you in the next episode.

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