Weird Medicine: The Podcast - 458 - Fun With Greek Names

Episode Date: June 10, 2021

Dr Steve and Dr Scott discuss: 1. Pediatric pelvic floor pain 2. Open vs laparoscopic hernia repair 3. Testosterone talk, to supplement or not to supplement 4. Chronic opioid use and low testosterone 5. Blood types, why are they not interchangeable 6. Losing hair/prostate CA 7. A$$crack Rash PLEASE VISIT: stuff.doctorsteve.com (for all your online shopping needs!) noom.doctorsteve.com (lose weight, gain you-know-what) Get Every Podcast on a Thumb Drive (all this can be yours!) roadie.doctorsteve.com (The inexpensive ROBOT guitar and bass tuner!) simplyherbals.net (for all your StressLess and FatigueReprieve needs!) BACKPAIN.DOCTORSTEVE.COM – (Back Pain? Check it out! Talk to your provider about it!) feals.com/fluid (premium CBD, sent to your door!) Cameo.com/weirdmedicine (Book your old pal right now while he’s still cheap!) Learn more about your ad choices. Visit podcastchoices.com/adchoices

If you just read the bio for Dr. Steve, host of Weird Medicine on Sirius XM103, and made popular by two really comedy shows, Opie and Anthony and Ron and Bez, you would have thought that this guy was a bit of, you know, a clown. Your show was better when he had medical questions. Hey! I've got diphtheria crushing my esophagus. I've got Ebola dripping from my nose. I've got the leprosy of the heart valve, exacerbating my impetable woes.

I want to take my brain now Blast with the wave An ultrasonic, ecographic, and a pulsating shave I want to magic pills All my ailments, the health equivalent of citizen cane And if I don't get it now in the tablet I think I'm doomed, then I'll have to go insane I want to requiem for my disease

So I'm paging Dr. Steve It's weird medicine The first and still only uncensored medical show On the History Broadcast Radio, now a podcast. with my little pal, Dr. Scott, the traditional Chinese medical practitioner who keeps the alternative wacko medical assholes at bay. Thank you, Dr. Scott. Hey, Dr. Steve.

This is a show for people who never listen to a medical show on the radio or the internet. If you've got a question, you're embarrassed to take to your regular medical provider. You can't find an answer anywhere else. Give us a call at 347-76-4-3-23. That's 347. Poo-Head. Follow us on Twitter at Weird Medicine, or at DR Scott. I'm on to visit our website at Dr. Steve.com for podcast, medical news and stuff you can buy.

Most importantly, we are not your medical providers. Take everything you hear with a grain of salt. Don't act on anything you hear on this show without talking it over with your doctor. Nurse practitioner, practical nurse, physician, assistant, pharmacist, chiropractor, acupunctures, yoga master, physical therapist, clinical laboratory scientist, registered dietitian or whatever. All right, very good. Don't forget, stuff.com. That's stuff.

dot dr steve.com for all of your amazon shopping needs and please check out noem dot dr steve.com that's n oom.m dot dr steve.com for the weight loss app newm and you get 20% off and if you decide to pay for it but you get two weeks free just to try it out and you can get to your ideal body weight and you can stay there and it's not a damn diet it's a psychology program it'll help you know facets of your life as well then there's back pain dot dr. steve.com if you want to look at the tilt table I bought that really helped me and you know I haven't done it in the last couple of days I took my kid and 11 of his friends to Gatlinburg to just run around and we took him to Dick's last resort and they did all this crazy stuff and it was really fun but I

couldn't just throw the the table in the back and you know my I'm hurting a little bit as soon as you and I get done here, Scott, I'm going to run down there and get on that thing. But backpane. Dot, Dr. Steve.com. You got a spell out doctor on that one until I get unlazy and work it to the other domain as well.

But anyway. All right. Don't forget Dr. Scott's website at simplyerbils.net. Simplyherbils.net. And we were going to do a cameo today because we did one last week and we got some pretty good response

to it. And there's a person who wants us to do one but then I get this phone call you shouldn't do your cameos over the radio they can just listen to that for free yeah

they're paying extra for something special oh okay I get it so he's looking out for the poor person that did you know that we did the cameo that they got to hear it for free but the anybody can look at them for free I was really just kind of

of trying to get it out there that we were doing cameos. And also, I don't know. I thought it'd be kind of fun if somebody did a cameo, but they also broadcast it to the nation on their radio show. Maybe not. Maybe that guy's right. Hell, I don't know. Hell, I don't know.

His phone call changed what I was going to do today because I thought it would be fun to do another one. And I've got one where you get to do a little role play. Oh. Yeah, you get to play this guy's wife. Oh, good. I'll be the guy, and then you get to be his wife. Do we have to practice anything?

No, it'd take two seconds, and there's no, you know. Thank you, thank you. No, none of that. It's not like that. Good. You just get to play the role. Okay, I can play the game, Martini. Yep, there you go.

So don't let me forget that when we hang up, but I'm not going to do it on the show because that guy said it was a bad idea. And I always listen to what everybody says, no matter who, they are or what they're saying. So there you go. All right. You got any stories for us today? Nothing interesting yet, but I'm still looking.

I'm not giving up yet. I know that the CDC had three criteria for declaring COVID over. I do know that even despite increasing opening our society in our area, cases continue to drop. I think I told you last week, our whole health system had up to about 450 cases, I think, in the hospital. And last week it was 52, today it was 38. So it continues to drop, even though more and more people, I mean, it's weird. I'll tell you, it's amazing what you can get used to in a year. And going into the grocery store, and they have a sign says, if you've been vaccinated, you don't have to wear a mask.

I've seen people go, well, I want to wear a mask to show that I care, but. I also want to show that I've been vaccinated, and I don't, you know, I don't know what to do. It's like, just do whatever. Nobody cares. Wear it. Nobody's looking at you. No, no. So, yeah.

So if they say, I don't need to wear one, I don't wear one. I'm not a threat to anybody. And that's the main thing. I keep having to tell this to myself. So, and I work in this. Sure. And I'm sure that other people who don't work in this have some reservations about it. But remember, my mask protects you, so if I don't have it, and I know I don't have it,

and I've been vaccinated, and even if vaccination causes me to get an asymptomatic transmission, or I'm sorry, asymptomatic infection, which we don't have a lot of evidence for, there's some a little bit, then I'm still no danger to you, so why should I wear a mask? I just hate how mask wearing became this political thing. Yep, yep. That if you wore a mask, you were a sheep, and if you didn't wear a mask, well, you didn't care or you were a, you know, a right-winger or whatever. It's like, no, just, you know, we talk about following the science and then nobody followed the science. No, they try to make it political instead of just, just, you know.

Politics plus medicine equals what? the answer is bullshit give yourself a bill that's an equally it's close it it's close isn't it yeah that's an equally excellent answer the answer is politics

politics plus medicine equals politics but yes I will accept bullshit which you did not phrase it in the form of a question that is true yes that is true I failed miserably all right

Oh, wow. Yeah, if we did that on Jeopardy, the answer would be bullshit. What is bullshit? And then you would have to say, what is politics plus medicine? Yes. Right. Okay. Anyway, all right.

So you don't have anything? No, I'll work on it. I'm trying to find some good stuff today. Okay. Look up that thing about the three criteria for declaring the pandemic over. That was from the CDC. All right. Good, good show. All right. Let me try this one again.

All right. So my daughter wakes up every once in a while, like it's odd. It happens. Okay, wait a minute. Number one thing, don't take advice from some asshole on the radio. Just needed to remind you that. It'll happen, you know, after like a month of no incidents. Okay.

Where she says her butt hurts. I mean, we've done, like there's no, we thought it was constipation. maybe causing spasms we go to the UTI the only thing that seems to work are sits bath do you think an eight-year-old could have levator spasms yeah i don't like yeah she'll just like clinch her butt and go and like be crying but then after a little bit it's fine she literally wakes her out at like 10 11 o'clock at night i don't know what that's going on so i don't if you have any opinion on that because i had a patient the other night tell me about elevator spasms.

I'm like, oh, that might be it. Yeah. So, interesting to hear what you think. Yeah, pelvic pain in children can be anywhere from mild to severe. It's usually a sharp stabbing pain in the nether regions, often in the rectum, though. They have rectal spasms. And you know how we've talked about if you get a urethral spasm and a male, if you just dip the male's junk at warm water, not warm, not hot. hot water it'll go away sure that's why sits baths work right on that warmth uh causes a relaxation

of those sphincter muscles blood flow increases all that stuff and it usually starts sporadically and but then it can become more uh frequent and it is interesting that is reported that they commonly occur at the end of the day or when the kid is in bed it can wake them up and then they find relief with heat or a warm bath. So that's pretty much what this is. So it's some sort of pelvic spasm. It can be caused by pelvic floor muscle tension, abdominal muscle tension. Constipation can do it.

Stress, anxiety, lots of different things. So there are actually pelvic pain clinics. I can tell you one, and I don't know where this is, though. Well, this is Australian. Dr. Scott, look and see if there's a pediatric pelvic pain clinic in the United States. This one's actually in Sydney, Australia that I'm looking at. Okay. And what they do is they investigate to make sure there's no underlying serious issues.

And when those have been ruled out, then they've got to figure out what kind of which muscle is spasming. And then they'll usually have them see a physiotherapist, and they may do education, manual therapy, which would be massage, that kind of stuff. Exercises, bladder bowel training, diet and lifestyle changing, and that kind of stuff. They usually do not do internal pelvic exams on children,

but they can, but they may use ultrasound. So have you found anything over there, Dr. Scott? Yeah, you know, I found in Seattle they have a pelvic Floor dysfunction clinic in Seattle. It looks like there's a lot of places throughout the United States. If you just dig a little bit, you should go find it. Most university centers for sure will have it. And you can just look around and just look for pelvic pain and children near me or something like that.

And if you have a teaching school near you, especially a physical therapy school, a physical therapy school might be a good place to reach out to and see if they have any specialist with the beads. Yeah, they say here, although pelvic pain is more common from the teenage years onwards, it can also affect children as young as six years. years old. So, yeah, that's what it is. Good call. And good call on figuring out what helps, which is the sits baths. Give yourself a bill. Give you one of those. All right. Good job. Yeah, let us know what they find and what works and all that stuff. We'll pass it on to other people. Can't be the only people listening to have this problem. God, have you ever had your taint spas? We get a Charlie horse in your taint. Oh, yeah. Oh, God, that's the worst thing. It's pretty miserable. Because, you know, if you get a Charlie horse in your leg, you

can stand up and stretch those muscles because the counter-stretch is the key. Hard to counter-stretch your dang taint. Yes. Yes, it is. I wonder if I am a little magnesium

because you know they have some as far as a magnesium. It's a pository. Might help. People think it's potassium. So they'll eat a bunch of bananas. It's rarely potassium. Right. It may more often,

magnesium. and using tonic water or quinine. Yeah, tonic water with quinine in it, sure can also be helpful, although in a nine-year-old, I don't know. I'd ask my primary care provider about that, but tonic water is pretty benign. Quineine pills in the higher doses was a little bit of an issue, but I wouldn't give that to a kid.

No, there's teeny amounts of quinine. You can just, well, again, ask your pediatrician primary care. Don't listen to us. all right so yeah but do please do let us know what they find but get her checked out hey doc this is ramp salt again hey ramp salt i'm getting ready to have hernia surgery on monday and my surgeon decided to do open instead of the laparoscopy and i was wondering if you could tell me the disadvantages or the advantage and which one this might be better than the other one she's telling me that i'll have about approximately the same amount of pain but she

feels like she can do a better job. Well, then the open one. Let her do it that. Just ask me. Thanks, man. If she thinks that she can do a better job doing it open, then you don't want a hamstring or handcuff her.

No. That's like if the pilot says the plane's not safe to fly, you say, okay, let's do what they say. Yeah, exactly right. She's more comfortable doing it with an open procedure. If there's a mechanical problem on the plane, it's like, take your time.

Yeah, yeah. Let's talk. rest so let's get everybody on the same page this person's having a hernia surgery there are lots of hernias i'm going to assume it's an inguinal hernia in other words one in their grinds there dr scott the grines in the old grinds yep as we would say in tennessee groin as you all would say and um you so basically a hernia is when one structure bloops through another structure and it's not supposed to. So you have a hiatal hernia is where the portion of the stomach works its way above the diaphragm. And the hole in that diaphragm is called the hiatus. So, you know, the esophagus has to pass through the diaphragm. So it has to be a hole in the diaphragm. Then the stomach is

underneath it. When portion of the stomach passes above the diaphragm, it is a hiatal hernia because it passes through the hiatus. This is an inguinal hernia where bowel wall or bowel itself will pass either directly through in the inguinal region in the groin or it'll pass indirectly through one of the rings where the Vazdephrin passes through. So there's two ways that you can do it. Both of those will produce a swelling. in that side of the groin every once in a while people will have a hernia works its way all the way into the scrotum yes i when i was

in medical school there was a patient and he was morbidly obese and he had such a huge stomach that his stomach actually herniated into his scrotum and whenever he would drink coffee his testicles would heat up wow it was interesting That's interesting. Yeah. So in that case, the stomach is passing through a structure it's not supposed to. Therefore, it's called a hernia. And since the area that it comes out is in the inguinal region, we call those inguinal hernias.

So an open inguinal repair is when you just cut the person open with a scalpel and work your way in there, dissect out all the tissues, close up the hernia, close everything up. A laparoscopic one is where you use a laparoscope. Use a scope. smaller incision, you're not, you know, filleting the patient open. And it takes some significant skill to learn how to do that because when you're looking through the scope, you're not just exposing all those tissues and seeing that. You have to start seeing things differently. Yeah, right.

Through the eye of the laparoscope. And some of those structures in there are kind of difficult to identify. Well, sure, they're hard to identify even when you can just look at them with your own two eyes. Yeah, even if you've got to. I'm always amazed by this. but surgeons develop a way where they can see a fold and then another fold on top of it

and say, oh, I know what that structure is. Right. They do a million of them. Yeah, as you'll say, it's called hands on the tool. That's right. So these laparoscopic techniques have been used, you know, really since the early part of the century. But the first laparoscopic procedure on a human was done in 1910,

but it became really popular. for things like gallbladder and hernias and stuff much later than that. Now, most hernia repairs are done doing laparoscopic surgery. The main reasons are shorter recovery times. Usually, no need for a hospital stay at all. Right. It's an outpatient procedure. You get a smaller scar, as I said.

You know, it's one to two centimeters compared to four to five centimeters. And usually it's less pain after the procedure. You know, I'm looking at a study here. It says 66% of patients had very little or no pain compared to 33% for open surgery. Okay. Makes sense. So I'm not sure I agree with her that the pain's going to be the same. Probably it'll be the same.

Or it won't be a whole lot worse anything than that. But, you know, according to the literature, more people will be pain-free laparoscone. Now, there are some drawbacks, and there's two factors involved in that. First, something we already alluded to, the surgeon is using instruments and operating at a distance rather than getting your fingers in there, you're using indirect tools. You know, you're manipulating these long scissors or little rods and stuff to move things around, whereas, you know, if you cut somebody open, you just use your fingers and move them around. Yeah, you can feel things better.

Yeah. Well, you can feel them at all. It's hard to feel them doing it this way. Oh, yeah. Labroscop would be very difficult. These guys are geniuses. I mean, I have mad respect for surgeons who can do laparoscopic surgery because it kind of blows my mind. Given that I'm old school, I've been there and done open gallbladder removals.

We would call that a coli cystectomy, Dr. Scott. Yes. And, you know, it's hard enough doing it that way. It's crazy when you have a hole in the patient's, you know, navel in their belly button. Right. And you've passed this tube through there, and then you've got these other holes where you've got the things that you're manipulating tissues with. But it's all remote. Yep. It's like a Waldo. You know what a Waldo is? No.

Waldo is one of those things where you can manipulate, say, radioactive stuff behind a glass. Oh, you've seen them. Sure. where the hands will mimic the movement that you're doing with your hands. Okay, okay, yeah. And one thing with Waldo's that you can do is you can motorize them, so a little movement on your part could be a big movement on the part of the claw on the other side of the glass. Or vice versa, I would assume.

Yeah. Because this one, I think this one. Yes, that's right. That's robots are kind of that way where they take a big movement and make it much smaller. But you could go the other way, too, and make it sort of cybernetics. that you could do things you couldn't do otherwise, like crush a, I don't know, a brick or something like that. Yeah, bowling bar or something.

Yeah, so you're moving your fingers like you're crushing it, but it's actually the claw that's doing it. A good example of a really shitty Waldo is those games with the claws where you try to pick up the things at the fair or whatever, you know. Yeah, the grocery store you... That's basically a Waldo. Okay. So you kind of have an idea what I'm talking about.

That's cool. And just imagine trying to do surgery that way. Yeah, it'd be difficult. With obviously more dexterity than you have with those dumb games because they do that, they make that difficult on purpose. But, yeah, it's kind of the same thing. So that's one of the issues. And sectionally, the visualization with the video camera doesn't give the same depth of vision as direct eyesight does. You know, it's flat.

Right. A whole lot different. And even if you did it in stereo, it's not the same. So there can be an increased risk of inadvertent injury. So you always want to ask the surgeon, you know, hey, what's your complication rate with this? Open versus laparoscopic. It's about the same, but they're both terrible run. I guess that person is a terrible surgeon.

But if they're both very low and maybe it's a little bit higher with the laparoscopic surgery, you can deal with that. Sure. So that's the big thing. Now, if the hernia is really large or it's been there for a long time, they're going to do the open procedure if they can. Mainly because there's going to be scar tissue and all this other crap that's in there, and it's just big and globby, and it's just hard to do with the laparoscope. Now, every once in a while, when they get in there with the laparoscope,

maybe there's bleeding or they nick an artery or something, and they've got to open, they have to convert it to an open. Right. So that's a possibility. This preference for laparoscopic approach for anguinal hernia repair is backed up by a lot of studies, ranging from 1998 to 2016. You know? So there is good evidence for doing the laparoscopic version. Of course, you know, she may have sent it on an image or something.

He may have a lot more damage in there. than he knows. Yeah, or it could have been there for 10, could have been one of those guys where it's been there for 10 years and he didn't mess with it until his wife said, I'm not going to have intercourse with you again until you have this big lump taken out of this bulge. This bulge that's not an attractive bulge.

Unlike the other bulge, that's very attractive. That's right. They did a randomized clinical try of laparoscopic versus open repair, and they found that operating time was longer for the laparoscopic approach. about 25% longer and blood loss during the procedure was less for the laparoscopic group

complications during surgery were higher in the laparoscopic but it was still both of them were low was 9% versus 2% no statistically significant difference in terms of postoperative pain

between the two prejudice which is interesting because that conflicts with the other article that we just looked at that said it was 66% A percent of patients had no pain for a laparoscopic versus 33 for an open. But this study, and this is more recent, so I'll buy it, showed no statistically significant difference in terms of post-operative pain. So if she's looking at that study, I can't argue with her. I don't.

And recurrence rates are about the same. Neither one of them were better for preventing recurrence. And these things can recur. Shoot you. All right. Anything else? Good luck. All right.

Hang in there. Get you an ice pack. Yeah, let us know how it goes. Well, you could do what Dr. Scott says, or you could just do whatever the surgeon tells you to do. That's true. I'm not trying to give you any improper advice. That's right.

You're a good. All right, here we go. Hey, Dr. Steve, how are you? Good, man. How are you? Me too. Hey, Dr. Scott, how are you? Hey, I just got a question.

Let's talk to testosterone. I just recently got mine checked, and it's at 194 free testosterone, or no, 194, and then free testosterone is 20. So it's fairly low. I'm terrified to start treatment because of the management process and change of life, you know, being dependent on taking the stuff. Oh, I see. So I'm wondering if I start replacement therapy, if now I'm stuck doing this the rest of my life, I have read that your body will shut down production once you start. Already has.

He isn't, but it is it anyway. Testosterone naturally. However, does production start backed up at any point if you stop? No. Also, Dr. Scott, do you recommend any natural methods? A little side note. I think I kind of did this to myself. I was a heavy drinker for many years, about a fifth a day.

So that helps you with your answer. Oh, and a side question, I have a friend that's on some. Suboxin, apparently there's a relationship between low T and Suboxin. Well, yeah. You can touch on that a little bit. Oh, yeah, it's all opioids. So people who are on, I'll answer that part first. That people are on chronic opioids have an increased risk of low testosterone for whatever reason.

And so when I see someone in, let's say in the cancer center and they're on chronic opioids for cancer pain, they complain of fatigue, I don't just throw speed at them, because you can do that, or modafinil, which is pro-vigil. But what I'll always do is there's three main things that can cause fatigue in a male. One is low thyroid. One is anemia or low blood count. And the other one is low testosterone. So I'll check all three of those.

If none of those are abnormal, then, yeah, I don't mind throwing a little speed at them. right um wait and when i say speed i mean we use methylphenidate but you can use dextra amphetamine too and a little bit in the morning not to be confused with methamphetamine no no no no that's a some of them are doing that anyway but but um yeah i mean it just gives you a little pick me up in the morning so to speak but uh so but the low testosterone and opioid chronic opioids are are related. So 90 plus percent, probably almost all of the testosterone that in your body is bound to either a protein called sex hormone binding globulin or albumen, which is very common protein in the blood. And this is referred to as what we call bound testosterone. And then the other

2% is free testosterone. And it's the free testosterone. And it's the free testosterous. testosterone that connects with the testosterone receptors. So all that bound testosterone doesn't do very much. And when the cell kind of absorbs that testosterone molecule, that's when it kicks in and starts doing whatever it's supposed to do, either, you know, increasing muscle or bone density or producing sexual characteristics in men, you know, growth of pubic hair later on.

loss of hair at the top of the head, that kind of stuff. So total testosterone is there to that grand total of all the testosterone that's available. And then the free testosterone is that part that's not bound to something else. So if he has been diagnosed, and he didn't say what the normals are in his lab, but both of those sound relatively low. Yeah. So let's just say that that's low in their lab. Yes, if you go on testosterone replacement therapy, you're basically replacing and bringing up to normal levels the testosterone hormone in your bloodstream. And when you do that, the testicles don't see any reason.

I was working on my Greek this weekend, so I said testicles. That makes sense. Hello, I am testicles of the island of Pinos. But, so the testicles just go, well, hell, what are we hanging around here for? And they just go to slate. Yeah. Because there is a feedback loop in the body where the testicles produce some testosterone and the pituitary gland adjusts it by kind of knowing what level it wants.

So when it detects there's a little bit too much testosterone. It decreases the buy signal. You can think of it that way. You know, like if it was the stock market. It would stop buying more testosterone. And so if you're not buying more testosterone, the testicles will quit selling it or quit producing it. And so the level drops.

And now when the level drops below a certain level, the pituitary gland will secrete these hormones that say, buy more testosterone and then the testosterone level will increase. And almost every hormone system in the body has this feedback loop that keeps

the levels pretty accurate. And the thing about a loop like that is if you need more, it's easy to get more. If you need less, it's easy to get less. And it's very nimble that way because you're always constantly, just constantly adjusting.

Yeah, waxing and waning, isn't it? Yep, yep, yeah. So, and tweaking the levels. You're just constantly tweaking the levels. When you add in exogenous, in other words, testosterone outside the body, so exogenous testosterone, as opposed to endogenous testosterone, that's testosterone that's produced inside the body. So exogenous testosterone, the pituitary gland will receive that signal saying, hey, there's plenty of testosterone. in here, and it'll stop that buy order.

It'll say, hey, you guys cut the, you don't have to produce any, we've got plenty. Right. And the testicles go, okay, and that's it. Yeah. They stop producing. And then they'll shrink in size. Right. So people who are on chronic testosterone replacement therapy, their testicles will shrink in size.

And if they stop it suddenly, the testicles will not rebound. No. If they've, if you've been on it long enough. Yep. Yep. Yep, yep. I have seen people who shut their testicles down to the point where when they were off the testosterone, their testosterone level was zero. Yes.

And, you know, sometimes in certain times of prostate cancers, they will actually do that on purpose. Yeah, they'll actually give medication to make it zero. Yeah. Yeah, because testosterone and prostate cancer is like kerosene and a brush fire. Sure. So you want to minimize the prostate cancer cells, any exposure to testosterone. now if you want to prevent those things if you want your testicles to rebound after you've been on this stuff for a while and you want to retain fertility because that's the other thing

is when the testicles shut down I mean they shut down yeah they quit and you will most likely become infertile after some period of time not producing sperm and anymore and all that stuff. So, because some of the, those hormones that cause the testicles to produce testosterone and also stimulate spermatogenesis or the creation of sperm cells. Right. And so when you shut those down, too, they just, you know, your sperm count drops. Now, if you want to avoid all of that, you can use a drug called clomophene.

And clomophene works differently. and it basically encourages, I won't go through the whole pathophysiology and pharmacokinetics and all that stuff of clomophene. But clomophene basically the end result is that encourages the testicles to make their own testosterone. And when you do that, the testicles don't shrink and you don't lose fertility because it's actually a way to stimulate them to stop being lazy. Because people will become hypogonatic, aka low testosterone, they'll have low testosterone because their testicles become lazy. Right. Okay? Yeah.

So clomaph-and you can talk to your primary or you're treating endocrinologist about that. There are some downsides as there are for everything. Yes. So just talk to them and see if clomophene is for you. We've had some people in our practice that wanted to retain fertility, but they had low tea. They were young, wanted to have kids. Instead of going on testosterone replacement therapy, they went on chlomaphine. They've been doing very well and sired children.

Well, you know, the other part of this question was any kind of, you know, other things. I forgot about the second, the most important part. Does Dr. Scott have any quackery he can throw at this? I don't have any quackery, but I have real things. Well, not on this one anyway, maybe others. But, you know, a couple things. If he's not tried, there are some other things that have shown to increase testosterone. shown, you know, weight loss, exercise, weightlifting had been shown to all help a little bit.

So if he does still have some function, he may be able to boost that function by losing weight by exercising. You know, some vitamin supplements have shown a little bit of help, like maybe zinc, vitamin A, vitamin C, vitamin B. And there are some over the counter supplements that seem to work pretty well that you'll see advertised on television. and some of those, for some people, work pretty well. But they're mostly full of a bunch of vitamins and supplements. Yeah. Well, they'll have precursors to testosterone, too. And it really, you know, when you take things like DHA,

which is dihydroepiendosterone, and when you take that as a, and you're increasing the substrate to make more testosterone, the problem really isn't that you don't have enough substrate, but you're trying to brute force it. Well, look, I'm. I've sent you a hundred times more bricks than you need.

You better build some houses out of it so you don't have a bunch of bricks just laying around. You know? And so that's, but also DHEA, if I'm not incorrect, you might look this up. It's also a substrate for estrogen production. So you could have the wrong

outcome if you metabolize it I agree. Toward estrogen rather than testosterone. And one, can I add one of the... Of course. Yeah, but in real quick, too, lowering stress levels, low in cortisol levels.

Yes. Can also sometimes, you know, maybe getting a better night's sleep. Maybe, and since he did say, he did have, used to be quite a bit of alcohol. I'm going to give you one of these right here. Give yourself a bill. Because I'm looking at a study that says

sleeping seven to eight hours every night will help to boost your testosterone. And if he's not drinking an entire, a liter of alcohol every evening, then he should be sleeping a little bit better and get some energy up, one would hope. Yeah. So you said a bunch of stuff that was right, Dr. Scott.

Well, there you go. Maintaining a healthy weight, overweight men are more likely to have low testosterone, exercising, sedentary men tend to have reduced levels of testosterone. Lack of sleep affects the hormones in your body. There's a 2011 study of 165 men that suggested that vitamin D supplementation might increase their testosterone levels. And you can always do these lifestyle things.

Anyway. Right, or do them anyway. But then go back and get your blood checked again, see if it makes any difference. And Dr. Steve, you know as well as I do. But you don't care if it's a number on a piece of paper. It's right. And it's not necessarily the number if you're feeling better. That's right.

Because if your numbers don't have to go out for you to feel better. That's right. And that's the key to remember here. Yeah, there's some evidence that caffeine may increase your levels And then Dr. Scott already said zinc. Zinc deficiency has been associated with hypogonadism, but taking zinc will only work if you have a zinc deficiency. What were you going to say?

No, that was nothing else. Okay. But I think he's got a bunch of good options. And then if he does need supplementation, you know, I take testosterone supplements. Yeah, me too. Thank goodness, you know. I take the Android gel. And I do the shot, and I love it.

Yep. Love it, love, love it. Our friend Chanda does the shots in her clinic. And we had that doctor on, and I can't remember his name, but he seemed to think that doing the shots was more effective than doing the gel, although I couldn't understand that. He said that swing between right after the shot

where you get a peak and then you get a trough. Somehow that's advantageous, even though it's not physiologic. Yeah, he was saying that's more normal and more ambitious than it. It's not more normal, though. It's more normal to have a steady testosterone level than to have one that waxes and wanes one week high and one week low. That's not how it works. But he was pretty sure of himself.

He was. And it may be that physiology isn't the best way. You know, we know, I mean, our kidneys perfuse themselves a certain way that's physiologic. But if we allow them to just do it willy-nilly, we end up with high blood pressure, and it is better to take a pill to keep your blood pressure down to prevent a heart attack and stroke. So physiology isn't always the answer. So he may be right for other reasons, but he certainly was not right in the idea

that that's somehow more like real life because it's not. But anyway, that was a long time ago. Ok-doke. Yep. Hey, let me pull out a question from the past and odie but goodies, and so I'm not calling it enough questions.

Uh-oh. That's, who is that? Mistace. What was that? There you go. Way too long intro. We need to start it right here. Stacey Deloche is a good old guy.

There you go. Right there. Perfect. No, he is a good old guy. All right. Hey, let me pull out a question from the past of Odie but goodies, since I'm not calling it enough questions. Anyway, blood types.

and why can't why aren't all interchangeable with each other all right thank you bye oh so he's asking why we have blood types that's an interesting damn question um so blood types are interesting in that you can do some cool math with them and the math is really easy there's four main blood types, A, B, A, B, and O. And the reason that they classified them that way was because they found that certain people's blood, when

you mixed them together, coagulated. And then others didn't. It's like, well, what the hell? So, you know, we want to do surgery. You know, a lot of the advances in the stuff came from the military. Okay. And

we got somebody on the battlefield. They've lost a lot of blood. We want to give them blood. Well, you know, you don't want it to be a crap shoot. Right. So they have these molecules on their surface called antigens, and these antigens are the things that cause the blood types to be. So people have different antigens, and it's genetic, and there's more to it than that. There's R.H. factors as well, and there's a whole bunch of other stuff.

You ever talk to somebody in a blood back? There's all kinds of antibodies that are way beyond all of this stuff. But this guy, this Austrian doctor, Carl Lahnsteiner, identified the blood antigens in 1901, which he called A and B. And then he found that some people didn't have either one, and he called them type O. And then he had some students who later on discover that some of the people had both, and those are type A, B. Now, if you have two people, oh, I need paper. pencil, Dr. Scott, can you give me that paper? And if you got

a pen over there? I do. All right. So let's say that you have two parents and they're both A B. So they've got an A gene and a B gene. Both of them do. And you mate them together. So they will

have one kid, if they went by purely statistics, well their kids have a 25% chance of being A. A, so that would be blood type A. Right. Then they had a 50% chance

of being A, B, and then a 25% chance of being B, because you make a little box, you put A and B on the top and A and B down the side, and then you cross them. So they'll have one is A, A, A, one is A, another one is A, B, another one is

B. Okay? So 50% A, B, 25% A and 25% B. None of them can be blood type O, right? Right. I'm going to, there's a reason why I'm telling you this. Because my dad one day declared to, he liked to exaggerate.

He wasn't a liar, but he liked to be special. He said, yeah, I'm type A, B, A, B negative. And I went, well, that's interesting. Then you're not my father. I was in medical school. We had done the blood type. I am type O. Right.

So the only way that, well, there's no way he could be A, B, and be my father, because let's just do the math. So on the left side of the two-by-two box, we'll do my dad, that's A-B. And let's just say my mom was just O-O. Okay, she didn't, well, she'd have to be because she didn't have any of the antigens. Right. Okay. In this scenario. So they, those two people, if those two people had intercourse, and I'm not saying, I'm saying one of them is not my parent, but if they did, they would have one child that was A-O, they'd have another child that was B-O, and if you have A or B and O, then you are type A or B.

Right. They would have another kid that was A-O and another kid that was B-O. So all of their kids, 50% of them would be type A, and 50% would be type B. Or that's the odds, yeah. There is no way. Well, right, right, right. That's right, right. Yeah, they could have six kids and they could all be type A.

They'd just be, you know, they wouldn't be conforming with the statistics that we expect, but that is possible. You could take a two-sided die or, you know, a coin and flip heads six times in a row. Well, they would have 100% chance of being A or B in this scenario. That is correct. Yeah, okay. That is correct. Give yourself a bill. No way could they be.

Type O. Right. So that's how I knew my dad was either lying or my mom cheated on it. And either one of those would be not great answers. So for me to be type O, now my mom could be type A and my dad be type B as long as she was A-O and he was B-O. Right. And he might have had B-O. So that couple, who's A-O and B-O would have 25% chance of having kids that were A-B,

and then another 25% chance of having a kid that was type B, another 25% chance of being type A, and then there I am type O, right? Turns out that my mom was type O, oh, okay? She was type O and I'm type O. So my dad was type B, it turns out. And so in that case, they had one kid who's B, O, no, 50% of kids were BO and B. all the rest of the kids would be typo. So the math is pretty easy.

It's kind of fun genetic thing. Now, as to why? Hell, I don't know. It's just, it's, you know, probably regional. And when we were growing as a species, we may have been separated genetically by mountain ranges or oceans. And we just develop blood slightly differently. and, you know, this article I'm looking at here say the A&B addogens evolved 20 million years ago

and nobody knows why. So maybe, you know, some blood types prevent against regional illnesses, for example. I was just saying maybe it's a food? Could have been cholera. Yeah, water foods. cholera was one of them that's been suggested. You know, the COVID-19 thing,

people with type O had a slight protection against COVID-19 infections, and type A had a slight increased risk of COVID-19 infections. So they play some part in that kind of stuff. But what it is, you know, it's still a mystery, which is interesting. You think we would know everything about this because the damn things were discovered 121 years ago. Long time. Yeah, so it's crazy.

That was my Dave Cecil ringtone. There you know. All right. Um, did me answer that? Yeah, the answer is, if the question is why do we have different blood types, the answer is I have no idea. But is somewhat involved in infectious disease seems to be at least peripherally. All right. You got to fix your mic, though.

It's up to the side. There you go. All right. Hey, Dr. Steve. How are you doing? Good, man. How are you? This is John, the retired pharmacist.

Hey, John. I had, uh, all of a sudden I'm losing. hair. Okay. Uh-oh. Oh, no. About year, two years ago,

prostate cancer. I went through radiation. No side effects. Great choice for me. No surgery. Nothing like that. I'm just wondering if by any chance, over the last six months or so, all of a sudden I'm finding a considerable amount

of hair in my dream. And I'm wondering if there's any chance it has anything to do with going through that treatment or any other ideas you may have. My dad had a forehead of hair. My two boys are bald, but that's probably from the other side. So, anyhow, I appreciate your show, and thank you all right. Yeah, that's a good question. Late onset, male pattern baldness.

It is quite suspicious that he went through prostate cancer treatment. I wonder if he was on Lupron as well. Now, Lupron is a medication that blocks testosterone. But, you know, the thing is that it's a little counterintuitive if that's what it is because when you have male pattern baldness, it's usually caused by exposure of the hair follicles to testosterone. So when you block the testosterone, you would think it would get better. That's when they use phenasteride, some medication for enlarged prostate.

And the prostate would shrink because it's a testosterone blocker at the level of the cell. It also blocks testosterone at the level of the hair follicle cell. And all of a sudden, people start growing hair again. So it's sold as propitia in that case. Now, Dr. Scott, have you ever heard of Lupron causing baldness? I don't know that he's on Lupron. He may be. Yeah.

I've heard of making some hot flashes, hair losses, and sometimes some generalized pain. But, you know, all those medications certainly affect people differently. Yeah, Lupron Depot. And we're just guessing that he's on that. That's a very common treatment. Because we lost part of his question. Lupron can cause hair loss in some people, and they think it's due to hormonal changes that the drug causes. But it is counterintuitive to me that that's what it would be.

So, I mean, that would work that way. It's just, you know, some drugs have the opposite effect than you think that they're going to. And often it's because there's a deeper pathway that's affected and not the sort of sort of. surface bullshit that you learned in a third year medical school, you know. Right, you know. No, I know it. All right. Here's one for you. So, yeah,

I don't know the answer to that. I do know that stopping Lupron, sometimes the hair will grow back, but I would not stop it if they're treating you ongoing because you had prostate cancer that they need to suppress.

So talk to your primary about it. you could try rogain you can buy rogain over the counter we get a six month supply for 30 bucks you can go to stuff dot dr steve com and get that but check with your primary provider i think we got time for dr scott there's i think we have time for this scott we'll see hey dr scott this is dan in texas hey this made me for dr scott here yeah um i heard him talking about suburban medicines i've got i heard him talking about rash. I've got a rash right about my tailbone area, but I've had for a long time. I have allergies and I get this scratching, this weird scratching right above my ass that it just doesn't go

away. And it's always kind of seasonal, but it's always like a single pinpoint scratch area. That's interesting. I wonder if he's got genes that have nickel in them and have a stud there because some people have nickel allergies. What do you got? We've got about a minute. No, I was thinking something like that. I was thinking also sometimes if you're sweating, you'll get ingrained hairs, and that could be part of that rash.

Right at the top of the ass crack, you're always worried about a pylonidyl cyst. I've seen them on people like catchers and athletes and things on the nature of palanautilis. They call it pylonidal because it means a nest of hairs. When you open them up, there's a bunch of ingrown hairs in there. I thought I meant fire. Fire, what the hell? All right, then So get that thing looked at

If it's a pilot nidal cyst Really the only answer is to have it surgically removed Yep Maybe we can wax poetically And it could be seasonal Because it could be just when he's in the heat And the sweating and The sitting and all of that stuff

Can just make it worse But just get it looked at It's impossible to diagnose a rash Really, through photographs It's very difficult for me I had a dermatologist that was really good at looking at pictures and telling what things were, but I never was very good at it. But it's usually pretty easy to do it when you're right in front of somebody,

when you're looking at it with your own two eyes. So, yeah, get that looked at, let us know what they say. In the meantime, you put a little hydrochortisone on it might decrease the itchiness of it. We call it pruritis in the medical profession, because we have to have a different bird for everything. All right, thanks always. Go to Dr. Scott. We can't forget Rob Sprantz, Bob Kelly, Greg Hughes, Anthony Coomia,

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