The Peter Attia Drive - #358 ‒ Peter’s takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying | Quarterly Podcast Summary #6

Episode Date: July 28, 2025

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Paul Turek and Paula Amato on male and female fertility; Rachel Rubin on menopause and hormone replacement therapy; Brian Kennedy on the biology of aging; Tanuj Nakra and Suzan Obagi on facial aging and skin rejuvenation; and BJ Miller and Bridget Sumser on lessons we can learn from the dying about how to live. Peter highlights the most important insights from each episode and any behavioral changes he’s made for himself or his patients as a result of these fascinating discussions. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the episode #358 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Summary of episode topics [1:15]; Episodes on fertility with Paul Turek and Paula Amato: insights on all things male and female fertility [4:45]; How men can optimize fertility [20:15]; How women can optimize fertility [26:00]; Rachel Rubin episode: insights on women’s sexual health, menopause, and HRT [31:45]; How women can prepare for menopause: proactive care, evidence-based HRT, and more [41:45]; Brian Kennedy episode: understanding aging, role of inflammation and mTOR, and current limitations of aging clocks and biomarkers [46:30]; Advice from Brian Kennedy on testing longevity interventions [56:45]; Tanuj Nakra/Suzan Obagi episode: causes of facial aging and practical strategies for prevention and treatment [57:30]; Skincare: making sense of the wide range of skin resurfacing treatments [1:06:45]; How to create a realistic, sustainable skincare routine [1:12:30]; The dangers of following unqualified aesthetic advice online and the importance of getting professional medical guidance for cosmetic treatments [1:18:00]; BJ Miller/Bridget Sumser episode: lessons about living from the dying [1:21:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the Drive Podcast. I'm your host, Peter Atiya. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peteratiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the ask me anything episode.

Welcome to a special episode of The Drive. In today's debrief, I focus on what I consider the most important learnings and insights from the past quarter of interviews, as well as any behavioral changes I've applied as a result. In this episode, I'll cover a variety of topics including male and female infertility, women's sexual health, menopause, and hormone replacement therapy, the biology of aging, skin care, facial aging, and rejuvenation strategies, and lessons we can learn about living from the dying.

If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. If you are not a subscriber, you can watch the sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy this quarterly podcast summary episode of The Drive. All right, Bader, thank you for showing up to another episode of your podcast. How are you doing?

Good. Thank you for having me back. I see you brought someone else with you in the studio today. Do you know who that is? I do not. Who's the little guy in your shirt? Oh, Charles. Yeah.

Charles. So you gonna jump in at all today, provide any insight for us, or what's his deal? He might. It's the funniest shirt in the world. It is. Just little Charles just peeking up there, happy as could be.

I know. I know. I love it. Bring in the excitement over there, which is good. Today, we are doing another podcast summary episode to remind people what we do. We pull recent episodes that have come out. We go through them kind of one by one, highlight things you found really interesting,

things that were your biggest takeaways, anything you changed your mind on, behavior on, how you work with patients on as a result. So these aren't meant to replace people listening to episodes, but these episodes, I think this is our sixth one, and to date we get some of the most feedback compared to any episode on these where people really enjoy them.

And a lot of times people will either go back and listen to certain parts, say that things kind of make more sense from this. And so a lot of times people will either go back and listen to certain parts, say that things kind of make more sense from this. And so a lot of good feedback from this, but again, should not be a replacement for these episodes. Today, we got a lot to cover. We have Paul and Paula on male and female fertility. So they were two different episodes,

but for this it made the most sense to combine them into one as we look at insights. So we'll do that. We have Rachel on women's sexual health, menop this, it made the most sense to combine them into one as we look at insights, so we'll do that. We have Rachel on Women's Sexual Health, Menopause, HRT, something I know you're passionate about and enjoy talking about. Brian Kennedy, which was a really deep dive around biology of aging, kind of a throwback to some of our original episodes where you dive super deep into that. You have Tanuj and Susan, which looked at all things, skin care, facial aging, rejuvenation

strategies. On that note, you're looking pretty sharp over there. You've been taking some of their recommendations into your day-to-day practices. We are absolutely going to talk about that because we are probably two and a half months now, since that episode, and I'm looking forward to discussing exactly what I have done. In fact, of all the episodes, this would be the one where I've had the greatest change in my personal behavior.

Can't wait to hear it. Did you do anything different with Charlie, or is he still on the same skincare routine? No, Charles is still doing the exact same skincare routine. It's working for him, though, so why fix it? And then we're gonna end with the episode with BJ and Bridget, which was all around death, dying, but more so what you can learn from people on their deathbed.

So, huge variety of topics we'll cover. Anything you wanna say before we get rolling? No, other than it's interesting that the last and second to last topics we will cover could not be more a part in terms of relevance and superficiality. It will be a stark juxtaposition of something, not to bring any sort of judgment against aesthetics, but ultimately talking about end of life and lessons about life through death versus how to make your skin look

better are about two opposite ends of the spectrum. But nevertheless, it is a spectrum and I think we can find value in talking about everything along it. Yeah. No one can say we don't have range on the podcast. So we got that going for us. All right, first one, Paul, Paula, all things male, female, fertility. Where do you want to start? Just from a story standpoint, it is remarkable.

And maybe that's, we try not to do too much summary in these episodes, because the show notes do such a great job of that. But I do think there's a couple comments worth making. So the idea that conception is difficult is an understatement. A single ejaculation releases about a hundred million sperm. Fewer than five million of them even make their way past the cervical mucus. And ultimately only somewhere between a hundred and five hundred reach the fallopian tube. And ultimately, only somewhere between 100 and 500

reach the fallopian tube. And then only one goes on to fertilize the egg. Now, that might be that 20 reach the egg. But obviously, there's this really cool force field that comes up the minute the first sperm touches the egg. It creates a chemical barrier that prevents any others from fertilizing. Otherwise, you'd have this devastating situation

of too much genetic material being brought in. Just a couple of interesting things that made me at least go wow is that sperm are chemotactic. So they're basically chemical guided missiles that make their way to the egg and they can traverse 15 centimeters of distance within the vagina to the fallopian tube within minutes. And so it's important to understand given how small a sperm is, that is the analog of

a human swimming 20 miles in the ocean in that same period of a few minutes. By the way, just even though we didn't go into this in the podcast, think about the energy requirement to do that. And so you kind of understand what the motor and the ATP generation is like in one of those things. Testes, like the brain, have kind of a specialized blood tissue barrier. It's very immune privileged and it protects developing sperm from antibodies. But it also means that drugs or toxins that can cross it,

such as certain types of chemotherapies, can actually be disproportionately damaging. It's for that reason, of course, that a lot of men who are undergoing chemotherapy will choose to do a sperm donation prior. Spermatogenesis, the generation of sperm, follows a clock of about 74 days, if my memory serves correctly. And therefore, if you're trying to make interventions around sperm health, so if a guy gets his sperm tested, comes back that something's not right, you can identify behaviors that are doing that, you're gonna need two to three months of trying a corrective intervention before you can determine if it's worked.

That's how long it takes to go through the cycle. On that intervention piece, one of the things that was talked about was bike seats. As someone who spent a lot of time on a bike, being you, not me, did that surprise you? Yeah, I mean, I've always been pretty mindful of bike seats and I've been very fortunate, despite how, I've always been pretty mindful of bike seats and I've been very fortunate despite how much time

I used to spend on a bike, I never had any issues. But as Paul points out in the podcast, it's really not a big concern for fertility, but it is much more a concern around erectile function. And basically, based on your anatomy and based on the type of seat you use, you can really traumatize the arteries and nerves that impact erections.

So what we tell all of our patients, if they're spending a lot of time on a bike, we have recommendations on bike seats that they should be using. I have two bikes, one for inside, one for outside. I have different bike seats on them because I got them at different times, but they're basically the identical type of seat, which is a seat that has the middle of the saddle is largely absent. And so the Istio 2 Berosities, your sit bones are doing the supporting, but nothing else. And so we can link to a couple of the brands that I think are pretty good.

As silly as it sounds, I kind of recommend people buy a couple. So buy from somebody who will let you return them. Buy like three and try them out and figure out the one that's most comfortable. So Peter, back to then fertility, Paul talked a lot about what his workup is for his patients. Do you kind of want to remind people of that and how you also apply that to your patients as well?

Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested in hearing the complete version as well. return, we offer exclusive member only content and benefits above and beyond what is available for free. So if you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. Premium membership includes several benefits. First, comprehensive podcast show notes that detail every topic, paper, person and thing that we discuss in each episode. And the word on the street is, nobody's show notes rival ours. Second, monthly Ask Me Anything or AMA episodes.

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