Why Men’s Fertility Is Collapsing and What It Means for Our Future with Dr. Michael L. Eisenberg - Transcript

Dr. Michael Eisenberg
Over the last half century or so, think there's been a rise in male infertility, and specifically, the semen quality has gone down.

Dr. Mark Hyman
Yeah. Doctor. Michael Eisenberg is a professor of urology and obstetrics and gynecology at Stanford University School of Medicine and the director of men's health at Stanford. He is also a board certified urologist and leading researcher in male fertility and hormones in men's health. One of the things that came up was this idea of sperm and quality and count and all that as a vital sign, as the sixth vital sign.

Dr. Michael Eisenberg
Interestingly, you know, where their semen quality was when they were 40 predicted their death, you know, thirty, forty years later.

Dr. Mark Hyman
I'm so shocked to read that the bigger a guy's belly, the worse his sperm was. I mean, if you had a fat tummy, your sperm quality and function are gonna

Dr. Michael Eisenberg
be bad. Microplastics are getting more and more attention recently. It's found in most testicles of men.

Dr. Mark Hyman
What is happening with all these young men who have low testosterone? If you look

Dr. Michael Eisenberg
at data age for age, the testosterone levels have gone down. More recently, it is accelerating. It's really incredible. We are seeing increasing rates of erectile dysfunction. A study that I always quote that if you look at men 40, over half have some trouble with erection.

Dr. Mark Hyman
Who should we be thinking about giving hormone replacement therapy to in men?

Dr. Michael Eisenberg
Because I think that selection criteria is not clear. People think about, like, low testosterone is a big driver of erectile dysfunction, but it probably contributes about five percent.

Dr. Mark Hyman
Don't ignore your health. And if you're a woman listening and you got a guy, go send him a get checked. Alright. Michael, welcome to the podcast. Great to have you.

Dr. Michael Eisenberg
Thank

Dr. Mark Hyman
you. You know, we met in Stockholm last summer, and we were on a panel together about sperm. Right. And it was the first time I was on stage talking about sperm, which was interesting. But it really was in the context of what's happening globally, is this increasing challenges with men's health around infertility, sperm quality, sperm counts, sperm function, genetics.

And we're seeing such a massive increase in challenges in men's health. You know, we we see a rise in prostate cancer. We're seeing a rise in male infertility. We're seeing declining sperm counts around the world. We're seeing a lot of erectile dysfunction and low testosterone in young guys, and we're seeing all these men's health issues.

Now in women's health, it's been very neglected Mhmm. And and that needs a lot more research. But, you know, men's health in this particular aspect, I mean, we see a lot of heart disease and other things, but this particular aspect around men's sexual health and sexual function it's just been ignored for the most part. And you're you're at Stanford. You're kind of one of the leading thinkers, researchers, and advocates for rethinking how we approach men's health.

And take it seriously because and as I was sort of reading a lot of your work, one of the things that came up was this idea of sperm and quality and count and all that as a vital sign, as the sixth vital sign. Yeah. Because that was shocking to me to read that as our sperm quality declines, and if you check men's sperm, you test it and won't get into all that, if it's bad, your risk of death is dramatically increased, like more than smoking or getting diabetes, which I was like, wow. That's kinda crazy. So I wanna kinda dive into it with you, and and let's sort of sort of set the stage first to talk about infertility.

Because I think, you know, a lot of times women get blamed. Oh, it's the woman's fault, they go to IVF, they get all these tests, they have all these hormones, they get all these invasive procedures, and nobody actually checks the guy. Right? So talk about the rise in infertility in men, Why you think this is happening? And and what are the potential causes?

And and maybe we can get into like, how do we approach this as a society? Because I think it's it's a bit challenging.

Dr. Michael Eisenberg
Well, think, you know, there's several factors that have led to this. I think that, you know, as you point out, infertility is really thought up to be a female problem. And so, like, in this country, in The United States, you know, when a couple's trying to conceive and they're having difficulty, the first thing that happens is the woman goes to see her gynecologist, and tests begin. And then if there's, you know, no issues, or if there are issues, that sort of starts down a path, often does lead to IVF. And interestingly, up That's to

Dr. Mark Hyman
in vitro fertilization. Test two babies.

Dr. Michael Eisenberg
Yeah. That's right. And you know, maybe a quarter of a third of the time, a man is never evaluated. He's just sort of bypassed. Not even a semen analysis, no evaluations done.

I think there's just a lack of knowledge that man can be the problem. And if you look at couples when they're prospectively collected, when you look at couples that are trying to conceive and do analysis on both, about half the time there's a male factor. So there's some reproductive difficulty in the men. And I think there's just a lack of knowledge. Yeah.

You know, from the general population, also providers as well, I think people just don't realize that. And what we've found is that over the last half century or so, I think there's been a rise in male infertility. And specifically, know, semen quality has gone down. Yeah. The number of sperm that we're making.

And the quality of the sperm. The quality, right. The numbers, the movement, shape, all those sorts of numbers have gone down. And it's interesting because that used to be somewhat of a controversial thought. You know, there were studies that first came out in the seventies that suggested this, then there was a large study in the nineties that got a tremendous amount of press that was published out of Denmark, but it was still very controversial.

And, you know, that group has updated it, you know, in 2017, then most recently in 2023. And really, all the other studies they've added have just just increased the sort of reliability of that data. And it's really shown, you know, not just in Western countries, but Eastern countries, you know, in other countries around the world where we've seen this decline. And I think to your point, the question is why? You know, what has changed over the last fifty years?

And I think there's, you know, been some, you know, discussion about some of the methodologies, but if you just look at what could affect men's reproductive health, I think we're seeing the rise, right? You've taught us a lot about diet, you know, other exposures. Yeah. You know, these chronic diseases are certainly rising, and there is a strong link between a man's overall health and his reproductive health, and then just what we do, we're not

Dr. Mark Hyman
Yeah, I so sorry to interrupt, but I was so shocked to read that the bigger a guy's belly, the worse his sperm was. I mean, if you had a fat tummy, like, your sperm quality and function are gonna be bad.

Dr. Michael Eisenberg
Yeah, it's really interesting. Yeah, if you look at, you know, I always say that, you know, I do talk about fertility and sperm health as being kind of a biomarker, or a vital sign. And it's interesting, if you look at chronic diseases, obesity, hypertension, diabetes, if you look at those, that does give you some information about reproductive health and sperm quality. Know, a healthy man is now, impacts his reproductive health. But as you're pointing out, it's also kind of a metric for the future too, and semen quality now predicts its longevity as well.

It's interesting, there was a large study done in Denmark, where they had, you know, semen quality of about 50,000 men, and when that was done, they were then able to, you know, Denmark has these very sort of large longitudinal databases everybody's monitored, there's National It's

Dr. Mark Hyman
like a homogenous population. Yes, exactly.

Dr. Michael Eisenberg
Don't have to worry about that. But interestingly, you know, where their semen quality was when they were 40 predicted their death, you know, thirty, forty years later. So it's it's really incredible. Know, again, everything that would happen in the intervening time, you know, this one, you know, data point at age 30 or 40, you know, can tell you what's gonna happen in the future. So it's it's really remarkable.

Dr. Mark Hyman
We're seeing some decline in in sperm quality and function. Fertility is going up. This is not normal. Like, something's happened in the last fifty, hundred years. I don't know what how long this has been going on for, but Right.

You know, we're paying attention to it now. But Yeah. This is not how humans were designed to have bad sperm quality. Something is going on. So what what are the causes?

Well, think, you know,

Dr. Michael Eisenberg
it's Unfortunately, it's still relatively unknown, but I think there's lots of hypotheses. And in addition to this decline, what's really interesting is if you look over the last twenty years, the decline has been accelerating. So whatever's causing it is potentially getting worse. So I think, you know, all those things I think are likely contributing. I think that, you know, we're a little less healthy now.

I think, you know, diet, sedentary lifestyle, all those things

Dr. Mark Hyman
do That's generous. A little less healthy. We are the sickest country in the world. Yeah. So bad.

Like, ninety three percent of us have some metabolic dysfunction. Seventy five percent overweight. Six out ten have chronic disease. We're we're we're in bad shape. Yeah.

Dr. Michael Eisenberg
But we see that, you know, in Europe and other countries as well, that this decline, and again, I think that diets may be a little bit different, but I think a lot of these exposures are the same. And again, the sort of the time frame of this suggests that it's not a genetic cause. Right? This is happening over, you know, one or two generations, is much too quick to see any, you know, genetic, you know, causes of some of this stuff. So I think there really is some exposure that's leading to this.

And so endocrine disrupting chemicals have been hypothesized. You know, microplastics getting more and more attention recently. That's been hypothesized. It's found in most testicles of men. If we look, you know, in semen as well.

So it's really everywhere.

Dr. Mark Hyman
It's very prevalent. That's a frightening thought. Microplastics and semen.

Dr. Michael Eisenberg
Yeah. And then, you know, also just what we're doing. We're not walking as much as we used to. I think we spend a lot more time indoors, and I think all of that may also contribute to some of this. But I think it's it's an area that needs to be explored more.

I think that, you know, as male infertility, you know, gets somewhat ignored, or not, you know, not studied, or not really thought about. I think one of the consequences of that is we don't look at these questions. We don't look at, you know, is sperm count going down, how quickly is it going down, and why, obviously, and what can we do?

Dr. Mark Hyman
Well, let's double click on a couple of things you said, because I think, you know, we skipped over pretty quick this idea of endocrine disrupting chemicals. I read a book I mentioned on the podcast before, like, almost twenty five years ago called Our Stolen Future Yeah. By Theo Colburn. It's kinda like the Silent Spring of today. And and Silent Spring was Rachel Carson's book that outlined the problems of DDT and pesticides and the harm to animals and humans.

But she wrote a book called Our Stolen Future, meaning, you know, it's affecting our reproductive health. These endocrine disrupting chemicals are are highly influential, and, you know, they're synergistic. Like and we're exposed to them everywhere. And they're basically all the plastics and pesticides and, you know, industrial chemicals that are just part of our daily life. So can you kinda dive into what what those are, how we're exposed to them, what we can do about it?

Because, you know, it it is concerning when you see so much infertility. Also, I wonder if this affects men's hormones too because, you know, we're seeing higher estrogen levels in some men. We're seeing you know, it's with function health, actually, which is kind of shocking. We're seeing high estrogen levels in a lot of men Wow. Which is kind of perplexing unless you, you know, understand that that when you have increased body fat and belly fat, it converts testosterone to estrogen.

Yeah. So that's why. But men get feminized in this way, which is part of the problem. And I but I wanna sort of go first on the endocrine disrupting chemicals, and let's talk about the metabolic issues? Because I think that's a big one that people can do something about.

Well, think as

Dr. Michael Eisenberg
you point out, it's really everywhere. I think a lot of these exposures, unfortunately, are fairly ubiquitous. But I think that being a little bit more mindful of where we get exposed can help. So I think plastics are certainly, you know, a big cause. I think that, you know, plastics themselves, you know, in theory should be inert, but there's lots of other chemicals or plasticizers that go into that, and they leach out in water bottles, for example, and other things.

So, you know, trying to cut down on exposure there. I think that I think that kids are probably more sensitive than adults for some of these things, and certainly, you know, pregnant women and fetuses, I think, are very sensitive. So I think you wanna be very mindful around that time, but trying to eliminate, you know, plastics. Pesticides are certainly a big, you know, a big exposure that we have in our food, and so trying to eat organic when possible, thoroughly washing things, I think that, you know, there's some foods where just sort of notorious, very difficult to clean off some of the pest pesticide exposure. Strawberries.

Strawberries are a big one. Yeah. Of course. Yeah. Just there's so many nooks and crannies.

So trying to do what you can to avoid that. I think a lot of fruits, anytime you eat the the outside, I think there can still be some some contaminants on it. And then a lot of, like, the beauty products that we use, you know, like sun tan lotion, you know, that oftentimes has some of those. Trying to you know, there's sort of mineral versus organic. Yeah.

I'm trying to be a little bit more mindful of that. So I think those are some of the things. I mean, obviously, you can get overwhelmed by some of this. Yeah. And you just wanna, you know, try and pick some actionable things, but I think those are some aspects that you can try and do to try and minimize exposure.

I mean, there's there's plastic everywhere. Right? I think, you know, probably most of my clothes are plastic, and so I think, you know, trying to make, I guess, more informed decisions, the department store or the clothing store, but it is difficult to try and avoid everything. But I think that, you know, again, as we get more attention around this and understand some of the down filled consequences, you know, what endocrine disruptors do is they disrupt our endocrine system. So some of them, you know, operate and they block, androgen signaling, testosterone signaling, some of them mimic estrogen signaling, and so, you know, obviously They can lower testosterone.

They can lower testosterone. Mean, some of these studies are difficult to do, and a lot of them are association studies, but, you know, certainly we have seen some studies looking at men that are exposed to more pesticides, have lower sperm count, for example. Interesting. So I think there are, again, are things that we can talk to our patients about, and hopefully, over an interval, can try and change things.

Dr. Mark Hyman
Yeah. I mean, I think you laid out a good sort of way of thinking about how do we reduce our exposures where we can. Mhmm. I'm I'm on the board of the environmental working group, and they're a great organization that details what toxins are where and how to avoid them. So it's ewg.org.

It's a nonprofit, and you can there's a web based version. There's apps like Skin Deep, you can look at skin care products, Sunblock, all this stuff. It's got doesn't have this stuff in it. They're talking about household cleaning products that are safe, what vegetables and fruits you could eat that are nonorganic that are okay, but the ones you have to eat organic, strawberries are Yeah. Really bad, or, you know, what kind of fish are okay, what kind of meats are okay.

So it's really a very comprehensive sort of database if you're looking how to avoid any. You don't have do everything overnight, but just slowly reduce your exposures. You know, drink I mean, I don't have plastic Tupperware. I have like glass. Mhmm.

You know, what I don't they call it Tupperware, but it's

Dr. Michael Eisenberg
like Yeah.

Dr. Mark Hyman
This glass thing to store my food in, and you don't wanna heat up a microwave with plastic. And you know, know, it's it's kinda ubiquitous and everywhere. Yeah. I mean, I I try to be really careful, but I recently had my plasma checked for all these toxins. And I was like, goddamn.

You know, like,

Dr. Michael Eisenberg
I try to live a good life, but are you able to eliminate it?

Dr. Mark Hyman
You know, like everybody who's living in this toxic soup in the twenty first century, we're all inundated with it, and the best you can do is sort of avoid them. Yeah. But then there's also things we can do to detoxify. So I think that's a really important thing that I've I've written a lot about. But there's ways to actually help your body improve your detoxification system, drinking a lot of water, making sure pooping, fiber, There's certain supplements like N acetylcysteine that boost glutathione.

So there's ways to help, but it's important. It's something you have a little bit less control over. But the other big factor that you mentioned is people's metabolic health and how that connects to testosterone, sperm health, to sperm quality, not just mortality, but like know, if you wanna have a baby. And what is happening with all these young men who have low testosterone? Like, it's just kind of I'm, like, thinking 300 like, this is like

Dr. Michael Eisenberg
a level you see in a 90 year old. It is incredible. Like, if you look at data on, you know, a cohort of men, like, group of men that were evaluated in the eighties, the nineties, two thousands, every year, like, age for age, the testosterone levels have gone down. We've looked a run. At more recently, it's it's it is accelerating.

It's really incredible. You know, men born after 1970 are much different in terms of testosterone levels, you know, than their fathers. I read an editorial, does my father have higher sperm counts than me? He probably has a higher testosterone than me too. And I think there's a lot of things that contribute to that.

I think some of these same exposures we've talked about, but I think that, you know, these other things, how our lives have changed, I think we're indoors more, we're sedentary more, I think that also contributes as well. But I really, it is sort of imperative to try and figure this out, because it is, you know, some of these things are really existential, right? If we can't produce sperm, think that becomes a big deal. And you know, the testicle does two things that make sperm makes testosterone. And we need testosterone levels to produce sperm.

So, you know, it stands to reason if we're not doing that as efficiently, that may be also one of the causes that we're seeing, you know, lower reproductive health, lower semen quality.

Dr. Mark Hyman
Yeah. I mean, I think big belly, lower testosterone. Mhmm. Yeah. More estrogen, and it's it's all related to sugar and starch and insulin resistance and, you know, the fact that we have such a poor metabolic health in this country.

And, like, yeah, 75% of our weight, but a lot of people are skinny fat. So there's a Yeah. Percentage of those twenty percent of people who are thin actually have have metabolic disease. Even though it looks skinny on the outside, they're fat on the inside. Yeah.

They've lost muscle, and they have belly fat. And so that's like why ninety plus percent of Americans have some degree of this insulin resistance phenomena. And that really is what's driving a lot of the testosterone stuff. And then and also then, obviously, secondarily, the sperm stuff. Yeah.

So it's kind of it's it's something that we just are not talking about, we're not recognizing. And I think the the overall thinking of sperm as a sick as a sixth vital sign is an interesting concept because it doesn't something it's not something you get checked typically. Go to the doctor, they're like, I mean, But you you think it should be?

Dr. Michael Eisenberg
I think it does. I think it could tell us a little bit more. There's an interesting observational study that I'll describe here that I think shows how much information is packed into this. So, you know, we talked about how semen quality can predict later health. Right?

We talked about mortality. And another study, about 5,000 men, showed that it predicts hospitalization. So if you have higher, you know, semen quality, you're less likely to be hospitalized, you know, in the next five or ten years, And it's interesting because if you look at that, you know, you continue to discriminate, you know, the the association between sort of health and semen quality up to about 200,000,000 sperm per milliliter. So the average is probably about 50,000,000. So, you know, if there's a difference if your sperm is 200 versus one eighty versus one sixty in terms of how likely you are to be hospitalized.

When we talk about fertility, that number's way down at about fifteen to twenty million. Even though, you know You Oh, yeah. Could tell you, didn't Yeah. I don't think I explained that well. So when we talk about, you know, what is normal, or what is average, or what is adequate semen quality, like when we're I'm talking to men about a fertility evaluation, that's what they say, do I have enough sperm?

Right? And so the World Health Organization has looked at semen data from fathers, you know, the last several decades. And they say that as long as you have, you know, 15 to 20,000,000 sperm per milliliter, so this concentration, you're likely to have enough sperm. And so if you have To conceive. To conceive, yeah.

So if you have thirty, forty, you know, there's sort of a plateau. Doesn't matter if you have more as long as you have that number. Yeah. But when we look at health, we continue to discriminate sort of how healthy you are, and as we go even higher, so fifty, sixty, seventy, eighty, up to 200, then it starts to plateau. But you continue to see that relationship.

Dr. Mark Hyman
So what's like a normal sperm count? Is it 200, or?

Dr. Michael Eisenberg
The average is probably about 50 to a 100. Okay. Somewhere in that level. But again, we continue to discriminate health well beyond that. So you're certainly healthier if you have above average sperm count.

And, you know, again, we talked about, you know, these men with lower sperm counts are less healthy, right? They're more obese, more metabolic syndrome, so you may sort of expect that this relationship that we're saying that there exists between semen quality and health is maybe just related to healthy that aren't baseline. Right? You know, men that are more obese have lower sperm counts, and that's why they have to be hospitalized, that's why they die, etcetera. But what's interesting is if you then divide men, you know, based on semen quality and obesity, let's say, you see something very different.

So obviously, if a man's obese and has a low sperm count, he's gonna do worse. Right? That sort of makes sense based on everything we've talked about. But then if you have a man that's so let's talk about the next level then. So what would be worse?

Would be having a Being obese and having a high sperm count, or having a low sperm count and being not obese. So what do you think what do you think would be worse?

Dr. Mark Hyman
I mean, think I don't know. I think being obese, but maybe I think maybe you're you're gonna trick me

Dr. Michael Eisenberg
Yes. Exactly. Yeah. So actually, it's worse to have a low sperm count. The discriminator here is really sperm count.

Wow. So if you're obese or not obese, having a low sperm count puts you in a much lower category than if you have a high sperm count. So like you talked about, right, there's sort of this healthy obesity phenomenon where some men are obese, but somehow all their metabolic markers are perfect. Yeah. And it may be that semen quality kind of predicts that.

Some men have more reserve than others, right? Interesting. And so maybe that's what it's telling us. Even even when you do that same sort of trick with smoking, whether you smoke or not is not as predictive if you know that man's sperm count. Wow.

So having a low sperm count and not smoking is worse than smoking and having a high sperm. That's crazy. That's crazy, right? So I think that, you know, again, there's lots of reasons to check a sperm count.

Dr. Mark Hyman
So it's not that the sperm count is secondary to obesity or to smoking? I mean, that's interesting because I I would've thought that it's really directly correlated, but you're saying it's not. It's not correlated. Yeah.

Dr. Michael Eisenberg
I mean, I think that, you know, again, all these things sort of factor together to some extent, but I think that semen quality and sperm count is really telling us something else. It's telling us sort of, again, kind of overall fitness perhaps. But it really tells us how healthy a man is. So, I mean, I think having it checked, you know, early would be very good for reproductive reasons, but I think you'd also get a measure of health too.

Dr. Mark Hyman
And you're talking about sperm quality, you're talking about more than sperm count. So what defines sperm quality? What do you look at, and what are the kind of essential biomarkers in the sperm that you're tracking?

Dr. Michael Eisenberg
Yeah, so there's a lot of different things we look at. So first we look at volume, you know, how much comes out. Then we also look at the sperm concentration, so how many million sperm are every milliliter. We look at motility or movement, so how many sperm are actually moving here to be alive. Are they swimming very well?

Yeah, exactly. And we also measure, you know, how efficiently they're swimming. Are they swimming forward? Are they swimming kinda circular? And then we look at morphology or shape.

And that, again, tells us all about the efficiency of sperm production. And then in some sort of more advanced testing, we can look at the DNA integrity Genetics. Of the sperm, yeah. So we can look to see whether there's fragmentation in the DNA, and that just predicts how efficiently the sperm is likely to fertilize the egg, which is ultimately the goal.

Dr. Mark Hyman
So what we're seeing also is this a lot of older men and people having babies. And so there's some concern about the linkage between the quality of men's sperm and abnormalities in the offspring. Whether it's neurodevelopmental issues or autism. Can you can you talk about the data about this? Because I think, you know, it's a concern for people if you're thinking about, you know, when you're forties or fifties and you wanna have a kid, what's the risk?

You know, I just had a friend who was like late fifties and had a kid, and it had a, you know, weird mutation. Like a GRAS mutation. I'm like, oh, is that because he was older, or is that just random, You know, you

Dr. Michael Eisenberg
just don't know. Yeah, mean, well, always like to start by saying the oldest father ever is 96. The biologic potential Oh, really? Supposedly. Yeah.

So this has Go to the Real Viagra. He said supposedly without. I think he supposedly he had a sex, I think, at least every day. You know, again, well into the eighties Wait, he

Dr. Mark Hyman
had sex every day?

Dr. Michael Eisenberg
This is all this is sort of legend. This is a gentleman that lived in India, and that's sort of what was told. And so he had a child in '94, and then a few years later he had another child. And his wife was also in her fifties, which is also equally miraculous. Wow.

And sadly, he did eventually die, not of old age, but of a in a house fire.

Dr. Mark Hyman
Oh,

Dr. Michael Eisenberg
gee. Yeah. Yeah. So a tragic ending.

Dr. Mark Hyman
So he coulda had a kid at a 100, who knows?

Dr. Michael Eisenberg
Yeah. That's right. But you know, again, the biologic ability does persist. Yeah. But as we get older, you know, some of the functions slow down.

Just like as women ages, fertility goes down, the same thing can happen in men. So, you know, the semen volume declines, motility declines, concentration goes down a little, the number of sperm that we're actually making. And then I think as you're pointing out, there's also more mutations that can accumulate in the DNA as well. So, you know, the way that sperm production is made is we start with these sort of stem cells in our testicles, and they regenerate themselves, and then they also divide and produce cells that go on to divide and produce spermatozoa, or mature sperm. And so this replication event begins in puberty, and basically continues until we die.

And so, generally, this replication is very efficient, but again, mutations can arise, and it's usually

Dr. Mark Hyman
And they persist. And they persist.

Dr. Michael Eisenberg
And they persist probably about two per year. So for example, like a 30 year old will have about 20 more mutations than a 20 year old, for example. And you know, again, there's billions of base pairs in our genome, in all in all of our body. And so, you know, it's unlikely that any of those are gonna be individually relevant. But again, at a population level, if we're getting older, and, you know, since the nineteen seventies to today, you know, average age of a father has increased about three and a half years, four years.

So we are seeing that on average we're getting older, and there's more fathers over forty, forty five, 50, so I think that certainly is happening. And we may see more, you know, mutations come to bear. And what's equally interesting is that, you know, some of these mutations are random, but if they occur in sort of the right gene, some of these genes really proliferate in the testicle. So there are some genes that, you know, for example, where they have to do a cell division. And if you get sort of a mutation in one of those genes, that cell will then divide faster than its brothers or sisters, and so you'll get more of the sperm to harbor that particular mutation.

And so you may see that more in the population. And what we've seen is that, again, there are sort of conditions that are associated with paternal age. So there's neurodevelopmental disorders, schizophrenia, autism, bipolar disorder. Wow. And if you look at sort of academic achievement, they're able to do this in some Scandinavian countries where they, again, they have these large population registries, they know exactly how old the father was Yeah.

And they can follow how the children do. There's, you know, higher degrees of, you know, failing grades, you know, acting up in school, lower educational attainment in some of these in children as well.

Dr. Mark Hyman
So a lot of neurodevelopmental, behavioral, ADD, autism Yeah. Thing. Yeah. And then you also see sort of risk of miscarriage, or

Dr. Michael Eisenberg
Yeah. So I think, you know, as fathers get older, I think it takes longer to get pregnant, less likely to get pregnant. We see a higher risk of miscarriage, preterm birth, all those things. So I think then we're really kind of talking about sort of the next generation, right, because you know, you're talking about how development impacts the rest of our life, right, this developmental origin of adult disease based on the work that David Barker did, you know, half a century ago. And so, you're born premature, know, given that you're there's higher risk of, you know, metabolic disorders and other disorders that may, you know, track later with life.

So I think these are all things we need to be aware of, and it's not just age too. Mean, again, we're talking about health. We've seen that fathers with chronic diseases are more likely to have these same issues, more likely to have miscarriage, more likely to have preterm birth, and so really this can impact the next generation as well. It's not just getting pregnant, but obviously the ultimate goal is to have a healthy child. Yeah.

And may put that at risk to some extent.

Dr. Mark Hyman
Really, paternal health does play a role in pregnancy and conception in a way that we didn't really think about before. But how does the health of the pregnancy determine by the father? Because, you know, most people just think, oh, you have sex, you donate the sperm, and then you're out.

Dr. Michael Eisenberg
Yeah. That's right. Yeah. Well, I mean, we contribute half the genome, so I think we do play some role. But I certainly don't wanna say that the mothers are not important.

They're certainly more important given everything they do with gestation. But I think it's sort of important just to think that the father does contribute to some extent. I think that there's a lot that we do, and you know, in addition to sort of the genetics, I think the other thing is sort of this epigenetic phenomenon. So again, all these diseases are not likely gonna mutate our DNA, but they basically affect sort of the covering and the expression of some of the DNA, this is so called epigenetics. And so, you know, that I think is sort of the the most common hypothesis about how this may be transmitted.

And in addition to the child, we also contribute to the placenta, right, sort of this, you know, the component within the pregnancy that kinda nourishes the child.

Dr. Mark Hyman
Again, does How does the male contribute to the placenta? That's a

Dr. Michael Eisenberg
new Well, there's DNA, yeah. Some of the DNA contributes to that too, and so again, these sort of these epigenetic markers as well. And so if that's not perfect, right, you'd expect that that's also gonna lead to, you know, altered pregnancy trajectory, for example. So we do see, again, miscarriage, but also, you know, even in the mother, a higher risk of preeclampsia, for example, like, you know, hypertension in pregnancy, gestational diabetes. All these things track with paternal age, but also paternal health.

Dr. Mark Hyman
Well, know, one of the things that people are probably thinking is, well, jeez, what do I do to improve my burn quality and health? Right? Because if it's declining, what can I do? And, you know, from a lifestyle perspective, we talked about some the environmental factors, but there's more to it than that. So can you talk about, like, if you wanna sort of advise your patients on how to stay healthy and have healthy sperm quality, what are the parameters that you're really focused on teaching them so that they can have the healthiest sperm quality Yeah.

And the healthiest pregnancy outcomes, and obviously, the the best healthy babies.

Dr. Michael Eisenberg
Yeah. These are the yeah. This is exactly how I counsel patients in clinic. Well, I think the first thing is I think that Okay.

Dr. Mark Hyman
I'm I'm like 65. I wanna have a baby. Like, what do I what think I'm thinking about? Well, you're I

Dr. Michael Eisenberg
think you're living life the right way,

Dr. Mark Hyman
so I'm

Dr. Michael Eisenberg
I'd be very optimistic. I don't know if you've ever checked a semen, you know, a semen I calendar did,

Dr. Mark Hyman
I was actually, I was surprised, because I wanted to see what was going on, and it was like, no genetic stuff, it was really good, and I was like, I got an A plus, I was like, you got excellent. I was like, wow, okay.

Dr. Michael Eisenberg
There you go,

Dr. Mark Hyman
there you go.

Dr. Michael Eisenberg
So I think, you know, getting that knowledge is important. I think not everybody does, and do a semen analysis, we talked about couples in this country, oftentimes, you know, the male fertility gets, you know, gets bypassed. So I think that that's something that'd be important. But you know, assuming there isn't a problem, I think we do counsel men about different things that they can do. So certainly taking ownership of your help, think, is very important.

Know, many times, it's one of the first times a man ever comes to the doctor. Right? Usually you come to the doctor if there's a problem, like, right, if you're in pain, you broke something, you're bleeding, you know, those are really the reasons that men go to see, you know, everybody before. They're half dead. Right?

Yeah. So this may, you know, again, allow them to sorta, you know, take a little more ownership. So when I see these patients, I do talk about these things. Don't have a primary care doctor. Mhmm.

You know, try and get them set up to get evaluated for, you know, blood pressure, cholesterol, blood sugar, all those things that

Dr. Mark Hyman
we know are very important.

Dr. Michael Eisenberg
Yeah. And so then we talk about diet, talk about exercise. I think those are very important as well.

Dr. Mark Hyman
Strength training really helps boost testosterone. Right?

Dr. Michael Eisenberg
Mhmm. All activity, I think.

Dr. Mark Hyman
Or more. And being outside, you said, helps, you know, low testosterone being outside.

Dr. Michael Eisenberg
Yeah. Yeah. Just did, yeah, a study looking at NHANES, the the National Health and Nutrition Examination Survey. So there is an interesting correlate between sunlight exposure and testosterone levels. And it back it basically increased about 10 points for every additional hour you spend outside.

So that can be sort of an easy thing. So when you're exercising, you know, spend time outdoors, or if you're gonna read or do work, you can.

Dr. Mark Hyman
The lifeguards have high testosterone. They must. They must.

Dr. Michael Eisenberg
And then we do look at exposures that potentially are negative. So, like, testosterone supplementation, for example, lower sperm count. Mhmm. Scrotal heat exposure, hot tub saunas, those are also not gonna be

Dr. Mark Hyman
Everybody's don't like saunas these days, and Yeah. And now there's like things you can put on your private parts that's like They're trying to protect it, yeah. Like a cooler. Yeah. Ice pack in the sauna.

Dr. Michael Eisenberg
Yeah. So the testicles are outside the body because they need to be cooler than the rest of the body, and that's sort of ideal for spermatogenesis or sperm production. And so if you heat it up, you know, the levels can go down. So you know, even a short exposure to a sauna, if you're doing it once a week, once a month, you know, it takes two to three months to make a sperm. So if you have an exposure anywhere in that window, you can see effects of that.

Dr. Mark Hyman
I see it to saunas every day, so Yeah. Well,

Dr. Michael Eisenberg
and then, you know, like, being sick too can do that as well. I've seen men that, you know, had normal sperm counts, got the flu, their sperm counts went to zero, and then after they recovered, you know, from these high fevers over a few months, their sperm counts then re normalize. So that can all that can all occur as well. And then the other thing we do talk about is supplements. So there's lots of data that anti oxidants People have to

Dr. Mark Hyman
worry about laptops on their lap.

Dr. Michael Eisenberg
Yeah. That that can also affect it too. So, you know,

Dr. Mark Hyman
again Hot tubs, saunas And laptops.

Dr. Michael Eisenberg
Hot baths. So in just interestingly Hot tubs. If you keep your thighs together, it can actually warm up the scrotum. But if you have a laptop, it increases the temperature even quicker. So, you know, you can actually increase the temperature of your scrotum about a degree in just ten or fifteen minutes with a laptop in your lap.

Oh. And so some people tell me, well, I'm gonna put a pillow. And that helps a little bit, but you still get there about twenty, twenty five minutes. So take breaks, think that's something.

Dr. Mark Hyman
Now they have those like, those like things you can put on and block the radiation. Yeah. Does that work? Those little

Dr. Michael Eisenberg
Radiation exposure, I think that's also something that, you know, it's sort of theoretical.

Dr. Mark Hyman
I don't know it's EMF, or it's for the heat, but it's like it's like a little kind of table, unless you put

Dr. Michael Eisenberg
the thing

Dr. Mark Hyman
on and put it on your lab. I have one of those, but I don't know it works.

Dr. Michael Eisenberg
I mean, think any kind of insulation, I think Insulation is good, I guess, for, you know, again, radiation exposure. Again, if we think that that's gonna be a role, I can talk about some studies that suggest that potentially it could be, but In EMEPS? Yeah. Yeah. Yeah.

But heat is, I think, the thing they're really talking about. So, you know, again, keeping your legs wide, that's something that's been shown about 70 if you can keep it at 70 degrees, that can be beneficial. But also, you know, a table is gonna be beneficial as well. So there is some risk to that as well. Wow.

You know, for the the electromagnetic field, you know, generated by phones or by laptops, there's a study where they took semen, they basically took like sort of a cup of semen and put it next to these Yeah. And they saw some decrease in motility, so the movement of the sperm, some increase in DNA fragmentation as well.

Dr. Mark Hyman
No putting your phones in your pocket?

Dr. Michael Eisenberg
Well, you know, I think it's something to be aware of. I think all of us do it. So again, that's one of those exposures that

Dr. Mark Hyman
Time for men to wear a purse while the phone is there.

Dr. Michael Eisenberg
Or maybe a front pocket. There's other places to put it, or your back pocket. But keeping it, yeah, away from the scrotum may be beneficial. And then again, the other sort of thing that I talk to men about is supplements. So I think there's good data that antioxidants and some, you know, other supplements can help too.

Partnered actually with a company called Swim Club, and what what we did sort of started at First Principles is looked at all the data on all the different supplements and tried to get, you know, the right dosing and all the right supplements to sort of to improve things. And the other thing that this group taught me is it's not just a supplement, it's also sort of the sourcing for all this, so they had experts in the industry as well. So I think that's also something that men can do that could be beneficial.

Dr. Mark Hyman
So let's talk about the nutrients, because people don't think about, like, women take prenatal vitamins. And there's a friend of mine who has a company that is called WeNatal. It is actually a multivitamin and prenatal vitamin for women, but also for men.

Dr. Michael Eisenberg
Mhmm.

Dr. Mark Hyman
And you're you're creating something like that as well. Mhmm. But it's it's really designed to sort of help with male fertility, or with with sperm quality, or what what is the goal here?

Dr. Michael Eisenberg
All that. I think that, you know, these are these are all supplements that have been shown to improve male fertility as measured by semen quality. So improving, you know, the numbers of sperm, the quality of the sperm, lowering DNA fragmentation, increasing movement. And so they operate sort of on many different pathways, so, you know, there's, you know, different ingredients that target sort of mitochondrial health, because, you know, basically sperm are, you know, motors. They're powered by mitochondria.

So there's omega threes, alpha lipoic acid, you know, coenzyme q, then there's, you know, other ingredients that targets, you know, cellular damage, zinc, spermidine, folate, and then obviously antioxidants as well, because there's that's also a sort of a powerful form of damage that can occur to Like selenium, lycopene. Exactly. And acetylcysteine. So I think all those things together help. You know, they also help, you know, individuals with membrane integrity and other components of the sperm.

So these are, you know, biologically targeted agents that can improve that. And there are also other health benefits too.

Dr. Mark Hyman
You're like a Stanford professor, and you're like, hey, these things actually have data behind them. They do.

Dr. Michael Eisenberg
They have strong data behind them. Yeah. There have been large Cochrane meta analyses that suggest benefit from these supplements.

Dr. Mark Hyman
And and you mentioned something that sounds weird, spermidine. Mhmm. Yeah. Talk about what is that? Because people I mean, menacylocysteine, maybe people haven't heard of, but that boosts something called glutathione, which helps detoxify your body.

It's the most powerful antioxidant in the system that kind of neutralizes a lot of other antioxidative stress markers. But bespermitting, I don't think people ever heard about. And it sounds weird.

Dr. Michael Eisenberg
Yeah. It's a sort of a fun name. Right? Yeah. I've I've learned about it during this process too.

But it does help with, you know, many cellular processes, cellular health, DNA health, and so, you know, it it made sense to include it as well.

Dr. Mark Hyman
I I actually you know, looking at the at the supplement, now a lot a lot of supplements out there, you know, they have the ingredients, but they're kind of window dressing. They have not really clinically effective doses. They're not opting in the right forms of the nutrients. So as I'm sort of you know, this isn't my gig, is like understanding supplements and vitamins for thirty years.

Dr. Michael Eisenberg
But, you

Dr. Mark Hyman
know, seeing you've got, you know, things like R alpha lipoic acid, which is the right most bioactive form, where you've got, you know, the the, you know, the right forms of different nutrients that and the doses. Like, you know, for example, selenium is two hundred micrograms, or of omega threes, you've got two grams in there. You've got two hundred milligrams of co q ten. So you've got a lot of the these are at clinically meaningful doses. And and what what have you seen in in people who are using this?

Dr. Michael Eisenberg
Yeah. So we're starting to see some improvements. Think, you know, there have been feedback that we've gotten from some of our patients, you know, about improvements. I remember there's one man that emailed us. His sperm count doubled.

His motility went up 50%. So I think clinically, you know, again, meaningful changes, and we're actually doing a study now, again, you know, one of the other things I wanna just sort of highlight what this company does, and one of the reasons I wanted to work with them is they do things the right way. So they're just created this based on science, but now they're gonna test it as well. And so we're recruiting patients now for studies. Hopefully, we'll get that data in the next few months.

It's important. You're gonna

Dr. Mark Hyman
be looking at validating, okay, this is theoretically in the literature, these different ingredients when you put them all together, like what's the combinatorial effect So on these interesting. I mean, so basically take homes are like, don't eat too much shart and sugar and have a big fat belly.

Dr. Michael Eisenberg
Yes. Exactly.

Dr. Mark Hyman
Follow Doctor. Hyman's advice of how to eat healthy. Two, know, reduce your environmental exposures as best you can. I think the environmental working group is a great site. And three, there are nutrients that really help improve sperm quality, function, production, and so forth.

And that you can do in force to go outside. Yeah. Go outside. Yeah. In sunlight.

Yeah. One one study I read, I don't if it actually matters long term, but, like, stress really has a big effect

Dr. Michael Eisenberg
Mhmm.

Dr. Mark Hyman
On hormones. Yeah. And and it was a football study where they actually showed male testosterone levels before and after the game. If your team won Yeah. You know, your testosterone level went up.

If your team lost, your testosterone level went down.

Dr. Michael Eisenberg
That's right. Yes.

Dr. Mark Hyman
I don't know their motto was like, don't watch football, or just pick the winning team. Pick the winning team. But does stress have a meaningful impact on all this?

Dr. Michael Eisenberg
Yeah. I mean, do you know, we talk about that as well. I think, you know, less stress, again, to the extent that's possible. But, you know, cortisol basically, you know, counteracts testosterone. So as cortisol and stress goes up, we see lower testicular function.

So we can see sperm counts go down, testosterone levels go down. Also talk to men about sleep. Right? You wanna get sort of adequate amounts. And it's interesting, it's sort of a u shaped relationship.

Right? It's possible to get too little, right, that makes sense, but it's also possible to get too much, interestingly. So we start to see, you know, we see declines for men that get less than six hours, but we also start to see declines for men who are getting nine, ten, eleven hours of sleep. Again, why that is not certain, but you know, try and keep in the sweet spot, seven to nine hours.

Dr. Mark Hyman
You know, one of the things that I've seen in the literature is changing in the ratio of male and female births. Mhmm. And and and that may be related to this same phenomenon of environmental chemicals that are endocrine disrupting and and and more estrogenic. Because these are often we call them xenoestrogens. You mentioned some them block androgen receptors or male hormone receptors, but there there's these four molecules that seem to mimic estrogen there and are actually when you add them up, because you don't usually get them, you know, one at a time.

You're exposed to a sue a stew and soup of toxic chemicals that we live in, that that they actually have really significant effects on this. So I'm wondering if you could speak to that.

Dr. Michael Eisenberg
It's very interesting. I think sex ratio is so interesting. Yeah. Because I think as you pointed out, there certainly have been studies in The US, Canada, and other countries that show the sex ratio is changing. Really Yeah.

Sort of phenomenon. It's just truly incredible to think, right, that that would happen. That anything would change the ratio of male to female births. They've also found that, you know, it changes around the time of like stresses. So for example, like around the time of like a financial downturn or war, the sex ratio changes.

To what? To what? It actually goes down a little. So there's more female.

Dr. Mark Hyman
More women. Yeah.

Dr. Michael Eisenberg
And I think you have to think about where this would happen, right? Is it at a sperm level? Is it, you know, at the fetal level? And I think that's sort of a popular belief, that it has to do with sort of selective miscarriage, and it's more likely to have, you know, male miscarriages and female miscarriages. But a lot of it's sort of uncertain, but it is really a fascinating line of questioning.

And people have looked at, you know, how there were some early studies, and I think the nineties, it said that diabetics were less likely to to sire male births compared to female births. So, again, sort of this idea of chronic disease may may see. And unfortunately for a lot of these things, to see a difference in sex ratio takes millions and millions of births. So I think a lot of these things we just don't have adequate data really to look at.

Dr. Mark Hyman
I wanna kinda pivot a little bit to sexual health. Okay. So the sperm thing is good because one, you can get it checked. Two, you can identify problems. Three, you can do something about it.

And that's all the good news. So you don't have to be sort of a victim of it, but it's important for guys to get on this, and for women listening to get their guys on this. Yeah. That's right. Yeah.

Exactly. And and think about it as not just in terms of their own fertility and having a baby, but just in terms of their general well-being and health. As you said, it's a highly predictive vital sign Yeah. Or a biomarker for other things and mortality in general. So I think it's important, and I think you're you're raising this as super important.

And the other thing we're seeing, and I we sort of touched on earlier, is is sort of increasing rates of erectile dysfunction, sexual dysfunction, libido issues, particularly even in younger men. Like I I'm kinda like shocked to hear, you know, how younger guys are like using Viagra. I'm like, what's going on here? Like, I remember when I was younger, I certainly didn't need anything. And I was like so I I just just curious about, you know, what what's happening with this sort of change in in sexual health around libido, sexual function performance, particularly as you were getting older, and like, what what what's what's going on?

Dr. Michael Eisenberg
So we are seeing, you know, increasing rates of erectile dysfunction, and you know, a study that's actually, you know, about twenty years old now that I always quote, that if you look at men 40, over half have some trouble with erection. So it is very, very common. I think people don't realize it. I think that, you know, in addition to being a great therapy, which Viagra is, the other thing that Viagra did is just brought a lot more awareness to it. You know, think men now don't have to suffer in silence.

I think there's, you know, a lot of great treatments that we have, and we'll talk about some of those. Yeah. But even 40, right, it's fairly common too. You know, I usually say, probably like maybe twenty percent of men 40 also have it too. And, you know, I think some of these same conditions can also cause because if you look at why we're getting erectile dysfunction, I think some of these same health aspects, you know, are at play.

You know, we used to think that most erectile dysfunction was due to this kind of psychogenic causes.

Dr. Mark Hyman
It's in

Dr. Michael Eisenberg
your head. Yeah. It's in your head. But now we know that's not the case. It does contribute some, maybe about ten percent, but most of it is due to, you know, metabolic derangements, cardiovascular.

Anything that affects blood flow anywhere in the body will affect in the penis.

Dr. Mark Hyman
Yeah. One of the big one of the biggest, most successful ads for stopping smoking was the Marlboro Man with the limp cigarette.

Dr. Michael Eisenberg
Oh, I remember Cigarettes

Dr. Mark Hyman
caused vascular injury, and then sexual dysfunction. Yeah, smoking's a big one. Exactly.

Dr. Michael Eisenberg
Maybe that's one of the reasons that the rates have gone down so much. Yeah. You know, people think about like low testosterone as a main is a big driver of erectile dysfunction, but it probably contributes about five percent. Interesting. It's actually pretty small.

Wow. So I think most of it is just sort of vascular. So blood vessel flow. Blood vessel.

Dr. Mark Hyman
And the things that cause harm to your blood vessels are all the things we

Dr. Michael Eisenberg
Yeah, we've talked about smoking, diabetes, being overweight, hypertension, you know, diet, all those sorts of things.

Dr. Mark Hyman
Cholesterol issues, right. Exactly. So basically, like, it's almost like the first clue that you might have vascular issues, including disease of your heart and your brain. Yeah. Right?

Because a lot of the consequences of of small vessel disease is you get hardening of the arteries in not just your penis, but in your heart and your brain, which leads to heart attacks and strokes and even dementia. So I think I think that, you know, if you're having that, it's an important indicator, like go get checked. Yeah. Go get checked for your overall health. And it's part of why I created cofounded Function Health was for allowing people to get access to their data.

We do full diagnostics, including testosterone, free testosterone. We look at FSH, LH. We look at a lot of hormones that are often ignored, prolactin levels. And we find so many interesting things that people didn't even know they had. Like high prolactin can affect sexual function too.

And we found people with brain tumors that didn't know they had brain tumors. And it's like you just kind of go along thinking this is me, but actually it's just something wrong. Yeah. So getting checked is really important. People go to functionhealth.com, and it's only a dollar a day now.

Can lower the price to $3.65. So and it'll you a really robust idea, including your metabolic health, your cardiovascular health. And if you're having a, you know, sexual dysfunction or fertility issues, it's important to really see what's going on for the guys. So don't don't ignore your health. And if you're a woman listening and you got a guy, go send him and get checked.

So what you know, besides the vascular issues, are there are other other things like neurologic things that can happen.

Dr. Michael Eisenberg
Yeah. There can certainly be. So I think a lot of those can be a consequence of some of the surgeries that we do. I mean, there can be, you know, back injuries that some men have, you know, from chronic use, weight lifting or injuries. Mhmm.

But also, you know, some of the surgeries that we do, like prostate

Dr. Mark Hyman
surgery Yeah.

Dr. Michael Eisenberg
Yeah. Colon surgery, bladder surgery, you know, the nerves that are involved in erection are right around that area. And so sometimes, they're disrupted by the surgery. Oftentimes, you know, we've gotten a lot better in terms of our anatomic knowledge. Mhmm.

So I think we don't primarily injure them, but scar tissue forms afterwards, and so typically the nerves are stunned, and so we do see that effect too. So neurogenic causes is another one that we need to be aware of.

Dr. Mark Hyman
Let's run through for guys who are listening. This is kind of always embarrassing to talk about, but like, if if you have erectile dysfunction Mhmm. You know, there's a lot of options now. Yeah. Right?

There there is obviously Viagra, and the Salus, and this spindrone, all these different kind of versions of the same kind of drug, which are these vasodilating nitric oxide inducing drugs. And they can be very helpful, but sometimes they don't work. Yeah. And so there's other options. Can you talk about things like, you know, in vacuum, injections?

There's actually a new new technology out of Europe that is a kind of electrical frequency thing that they use called Vertica, which is not quite approved here in The US. But can you talk about some of these things and how they can be used, and and when they should be used?

Dr. Michael Eisenberg
Yeah. Absolutely. Yeah. So what I always like to tell men, as long as you have a penis, we can always make it hard.

Dr. Mark Hyman
Alright? So we

Dr. Michael Eisenberg
can be as aggressive as you wanna be,

Dr. Mark Hyman
and there's lots of great even. Yeah.

Dr. Michael Eisenberg
That's right. So, you know, we usually start with lifestyle modifications. We start with pills, and if those don't work, we move on to other things. And in addition to, you know, lack of efficiency, some men can't tolerate, you know, the Viagra, Cialis, some of those other medications. There can be side effects, sometimes are contraindications with certain conditions or medications.

So there's medications you can put in the tip of the penis, suppositories that are kinda locally active, you know, agents like that that cause vasodilation, blood flow accumulation. Another very effective one is injections. So, you know, something kinda similar to an insulin type syringe you can inject in the penis. Sounds scary, but it's not so bad. Well, there's certainly a psychological barrier to putting a needle in your penis, but it works very well, probably ninety percent of the time.

There's something called a vacuum device. Are there

Dr. Mark Hyman
dangers to that in terms of scarring, your sticking needle in your penis, is it problems long term? So I think that,

Dr. Michael Eisenberg
you know, there's more scar tissue that probably forms from not getting erections on a regular basis than getting erections, but we do want to vary where we do the injections. So we have men vary kind of location along the shaft and the side as well. But in general, you know, I think more erections are gonna be better. So usually we don't see a scarring response. Again, we mitigate it through some of those things.

You you asked about the vacuum erection device. So it's basically a plastic cylinder you put over your penis, then it sucks blood into the penis, kinda treats it like a balloon, so to speak. And then you put a band at the base to trap the blood inside, so you can use that for sex. And then there are these newer therapies that are coming, kind of energy therapies. And the idea is they kind of induce sort of micro damage within And the shock wave?

Shockwave, yeah. Sounds scary and terrible. Yeah.

Dr. Mark Hyman
But it's not so bad.

Dr. Michael Eisenberg
It's not so bad. I think there's not a lot of risk with it. I think we're still, you know, doing a lot of studies to see the efficacy and who the best patients are. I think that it probably helps men with mild erectile dysfunction. When we get into moderate or more severe erectile dysfunction, I think some of those studies are somewhat mixed.

Dr. Mark Hyman
So basically, it kinda shocks the penis It shocks the then you see increased because of the trauma, increased recruitment of repair and blood vessels and new new stem cells Exactly. Coming in to help Yeah. Kind of more natural erections.

Dr. Michael Eisenberg
Yeah. Yeah. So I think for men that are on, like, Viagra, a lot of times these therapies can get them off. So I think that's one of the that's the benefit. And, you know, it's basically a series of obsessions where men go, you know, to their doctor, they get it done for ten, fifteen minutes, and then they do it maybe five to six times.

So Yeah. That could be another option was like

Dr. Mark Hyman
once a week for six weeks. Yeah. And then,

Dr. Michael Eisenberg
you know, the final therapy is implants. So there's basically devices you can put within the penis that help you be erect when you want. And so there's some that are bendable, these are called semi rigid. So when don't wanna have sex, bend it down. When you're ready for sex, you bend it up.

And then there's also inflatable ones. So whenever you wanna have sex, you basically move fluid into the cylinders which are in the penis, and you can use that for sex. And they work very well. You know, would say it's a self selected population, so we don't force men to get these. But for those that do choose this option, they're very happy.

You know, ninety percent of men are very happy, their partners are very happy, they recommend it to friends, sometimes family.

Dr. Mark Hyman
And you have the same sensation? Or Yeah. Yeah. Do they have ejaculations and All that, yeah.

Dr. Michael Eisenberg
So you don't need erections to have an orgasm. So, you know, again, tell couples too as we're going through this, there's other ways to be intimate Yeah. Besides, you know, penetration. But again, the sensation is gonna be unchanged with these devices.

Dr. Mark Hyman
Amazing. And what about this European device? Are you familiar with it? I haven't heard about Verdica, it yeah. Heard about it from Doctor.

Mohith Kara from Oh, yeah. Baylor, and he's a great guy, but they're doing some trials on his studies. But it's available in Europe. And it basically is a the device it almost I don't know how you describe it. It's basically like a looks like a big wing, but inside there's like a circle.

Mhmm. You stick your penis in, and then it kinda makes all this electrical charges, and it prevents the the blood outflow, apparently.

Dr. Michael Eisenberg
Oh, interesting. Yeah. I mean, the penis leak is certainly an issue as well, especially after, like, prostate surgery, for example, like scar tissue forms. And so you can imagine sort of two processes for erection, right? Blood gets into the penis and then gets trapped there.

Yep. And so when scar tissue forms, some of that trapping mechanism is lost, because the elasticity of the expansion is how this occurs, the veins are on the periphery, And so as we expand, we kinda compress those veins. And so there's not a great therapy for that other than some of the surgeries. So great to to see some innovation in that space. Yeah.

Dr. Mark Hyman
It's amazing. In terms of testosterone replacement therapy, or people call it hormone optimization therapy, I'm kinda shocked at the number of young men who are taking it. Mhmm. I mean, know the bodybuilders have been using it forever. Right.

But I'm not talking about bodybuilders. And I'm like talking to friends of mine, I'm like, what? You're in your 40 and you're taking testosterone? Like, what the? Because I I've been prescribing it for a long time, but usually to older men who have very low levels, who have, you know, loss of muscle, who have loss of motivation, energy, depression, sexual dysfunction.

Yeah. There's a lot of benefits to it. Right. And historically, you know, there's been there's sort of a negative view of testosterone therapy because we thought it caused abnormal risk for heart attacks and prostate cancer. And and it does have some effects on your blood count, can cause, you know, thick blood.

But, you know, can you talk about, like, the benefits and the risks and the age we should start? And, like, how do you pick the right patient? And, you know, who should be thinking about it and who should be worried about taking it when they're younger? Because I'm like, wow, you're like because I I was you know, I knew someone was like in his thirties and was taking it. Yeah.

And then he couldn't have a baby, like, wanna have a baby, and they had this whole problem with fertility as a result of him taking testosterone, which shuts off your sperm production.

Dr. Michael Eisenberg
Yeah. Yeah. So I think, yeah, it's a it's a very good point. And I think that we have seen an increase in the number of testosterone prescriptions, you know, over the last several decades. So testosterone, as you point out, is very important for men's health, like energy level, sex drive, mood, sleep, concentration, and sort of quality of life things.

But it gets very low, we also worry about muscle health, bone health, heart health. You know, men that have very low testosterone levels, like castrate levels, which we do for, you know, treat certain conditions. Yep. They have higher risk of metabolic disease, you know, osteoporosis, etcetera. So we do want to keep men normal.

But if men are normal, we don't necessarily wanna make them superhuman. You know, maybe it can help you, you know, compete athletically, but, you know, there are also some harms to testosterone as well. And so, you know, I think there used to be this fear about, you know, prostate cancer growth or heart disease, but there have been large studies now, just completed in the last few years, that really, I think, put that to bed, to a large extent.

Dr. Mark Hyman
But it does raise your cholesterol.

Dr. Michael Eisenberg
It can affect yeah. Well, it can lower your good cholesterol, raise, yeah, bad cholesterol. It can also thicken the blood a little bit.

Dr. Mark Hyman
But even when that, it doesn't seem correlated to heart attacks or strokes.

Dr. Michael Eisenberg
Right. Yeah. It seems independent of that. You know, hair loss, breast growth, acne can occur as well. And I think the one that we worry about the most, especially for reproductive age men, is it can lower testosterone levels.

So, you know, the way that we're we work is that, you know, our brain sends signals to the testicles Lower

Dr. Mark Hyman
lower sperm.

Dr. Michael Eisenberg
Oh, sorry. Lower sperm counts. Yeah. Because yeah. So, yeah, testosterone lowers sperm sperm production.

So the way that we work is that brain sends signals to the testicles to make sperm and testosterone. But if you're taking exogenous testosterone, you know, from gels, injections, whatever, your body senses there's enough testosterone and basically stops that signal down, and so it shuts off testosterone production, but it also shuts off sperm production as well. And actually, the testosterone levels in the testicle are much higher than they are in the rest of the body. You know, and the rest of the body, you know, normal is probably 300 to 900, somewhere in that range. Yep.

But in the testicle, it's in the thousands. Wow. And so, you know, again, your serum level, if it's in the hundreds, it's not gonna be in the thousands in the testicle if you're not producing it at that level. And so all that leads to these lower sperm productions. And testosterone's been tested, it continues to be tested as a contraceptive.

So it does lower sperm counts pretty reliably. So I think that's very important.

Dr. Mark Hyman
Is it male fertility treatment? Yeah. I know. Is it is it a male birth control? Well, they're working

Dr. Michael Eisenberg
on that. So it turns out that testosterone by itself is not quite that reliable. It probably works eighty to ninety percent of the time, so that's not as good, you know, that's not good enough for a contraceptive, but they're working on adding other things, like progestins, for example, that can get you across the threshold. So it's in trials now, and I think, you know, hopefully in the next five or ten years, there'll be some male contraceptive options.

Dr. Mark Hyman
Like a pill or injection?

Dr. Michael Eisenberg
Yeah. I think it'll be transdermal, how they're looking at it. And there's other again, there's also other male contraceptives that are in the pipeline as well.

Dr. Mark Hyman
That'll be make a lot of women happy that the men can take over the contraception.

Dr. Michael Eisenberg
And men too, think.

Dr. Mark Hyman
Who should we be thinking about giving hormone replacement therapy to in men? Because I I think that the selection criteria is not clear. And a lot like I said, a lot of young guys are using it for bodybuilding or for I don't know what. And a lot of and honestly, a lot of guys have low testosterone. We're seeing it in function health, you know, the demographics of people, and we're checking everybody for free testosterone, total testosterone.

It's like, wow, you're a younger population that's kinda got low T, we call it.

Dr. Michael Eisenberg
Yeah. Yeah, I mean, think that if you, you know, meet criteria, then I think it's reasonable to have this discussion with men. So you'd have to have a low serum testosterone. You know, again, it's gonna vary from lab to lab, but generally probably less than 300 nanograms per deciliter. Then And you do have to have some of these symptoms, and we talked about, you know, low energy, low sex drive, mood, sleep concentration.

They're they're somewhat vague, but those, you know, certainly can accompany low testosterone. So I think that's probably the right phenotype for who we wanna have that discussion with. And then you need to, you know, understand where they are. If they're in their thirties and thinking about having a kid in the next few years, I think you don't wanna start testosterone. And there's, you know, other off label options that we use, like clomiphene for yeah.

It's like the estrogen receptor modulators, for example, that can increase your body's own production of testosterone without, you know, the spermatogenesis effects. So I think it's, you know, again, nuanced conversation.

Dr. Mark Hyman
There are some peptides that people are using for this too, like and other ones that Mhmm. Those are yeah. Any comment about that?

Dr. Michael Eisenberg
I think, well, it's it's hard to get them, I think, in some cases. I don't have experience with them in my practice.

Dr. Mark Hyman
Yeah. I know guys who use them, and they're like, yeah, this really works, you know, for increasing their sexual libido and function.

Dr. Michael Eisenberg
You know, I mean, I think talking to other providers that do, you know, that do prescribe them, they do have strong belief. I just, you know, I guess I need to see more data and have, you know, better a good source to get them from for patients. So

Dr. Mark Hyman
you don't think it's dangerous for younger guys, if not as concerned about fertility, to to actually take testosterone?

Dr. Michael Eisenberg
Well, think, again, we wanna make sure that they are truly low. So, you know, two serum testosterone before nine in the morning, because our levels do vary based on time of day. Yeah. You know, it always makes me nervous for any reproductive age man, because where a man is, you know, when he's 20 or 30, he may not be where he is. You know, he may not have met his life partner yet.

Right. So there's lots of things that can change. So, I mean, I think you can talk about sperm cryopreservation in those cases, you know, if you're worried about that. And if you

Dr. Mark Hyman
come off it, does your testosterone level naturally rise again and have more sperm production, or is it a

Dr. Michael Eisenberg
Usually, do recover, but not always. And I think the data on men that are on it for longer term, you know, most of the data we have on recovery are in these contraceptive trials Mhmm. Where men were on testosterone. Testosterone. And stopped it.

And these are very controlled environment, it was a very short duration. So that was, you know, about a year. So if we have men on it for two years, five years, ten years, you know, we do worry about it to some extent. Because when we look at, like, the bodybuilder population, for example, we do have a signal that it may not be recoverable. Yeah.

Interesting. Is a concern.

Dr. Mark Hyman
They use other anabolic steroids, which are little different. Yeah. The testosterone replacement therapy is interesting because, you know, what I found is when I when I work with guys, particularly younger guys and anybody, before I'll even think about testosterone replacement, I'm like, okay, let's look at all the things that are affecting your testosterone. Your diet, exercise, sleep, stress, you know, supplements. Let's let's see what we can do.

And it's amazing when when guys change their diet, they get off the sugar and starch, they lose the belly fat, they start lifting weights, which you know, heavier weights and and lower body, particularly big muscle groups, increase growth hormone and testosterone levels naturally. Yeah. You know, getting in the sun Yeah. Meditating, taking the right supplements. These things can be profoundly effective.

And I've seen dramatic increases in testosterone levels when people get healthy. Yeah. So it's it's one of okay, you're you're unhealthy. Let's just give you testosterone. But I never start there.

I'm all like, well, let's let's start with just see what happens when you stop living a shitty lifestyle.

Dr. Michael Eisenberg
Right? Yeah. I think that's the art of medicine. Right? I think that sometimes your discussion is gonna vary a little based on what you think is going on.

And, you know, again, if you're, you know, a little more nervous about starting a man on testosterone, you know, again in his twenties or thirties versus his fifties or sixties, I think it's a very different discussion. And you talk about risks a little bit differently. And so, yeah, mean, to your point, I think if you can find some things to correct, optimize, and try and talk about, you know, some of the downsides of being on it. Because once you start it, it's very hard to stop. Right?

You're gonna be on it forever. Yeah.

Dr. Mark Hyman
I mean, menopause is something that gets talked about, not studied enough obviously, but it's something that at least people know about. Yeah. Menopause happens to women. But most people don't understand this phenomenon of andropause. Yeah.

Which is sort of a slower, more insidious decline. And that often results in in men having, you know, low muscle mass and increased metabolic issues, lower motivation, you know, kind of just more dwindle. I call it the dwindles, you know? Yeah. And it seems to me that, you know, for older guys, I I find it so helpful.

Do you think it's something that should be used more as a sort of a therapy? Just like women are taking hormone replacement therapy?

Dr. Michael Eisenberg
Yeah. I think there's a lot of barriers to testosterone therapy. And, you know, the FDA just had a hearing on this, you know, championed by Doctor. Brian Christine, who's actually a sexual medicine or reproductive urologist that's now number two in HHS. So it's great that he's sort of being an advocate for men's health.

And so that was one of the topics that came up, who should get testosterone? And I think this hypogonadism of aging is really kind of disregarded, and it's often not covered by insurance

Dr. Mark Hyman
companies. That's a big word. What does that mean, hypogonadism? Oh, it's basically where your

Dr. Michael Eisenberg
gonads aren't working. So your low testosterone, it's also used for low sperm counts as well. But again, you know, as we age, our testosterone levels do go down. Probably starting around age 20, 25, testosterone goes down about 1% every year. So, you know, we have to reset, I guess, what's normal to some extent, but, you know, testosterone still does what it does, and so you do want kinda normal levels.

And so, you know, in some ways, you know, it'd be nice to have a baseline to understand where a man was at his peak, so when you're looking at him, you know, decades later, you can see kinda what target is. Because Yeah. Again, the we talk about the normal range as being fairly wide, three hundred and nine hundred. So

Dr. Mark Hyman
it's Yeah.

Dr. Michael Eisenberg
Hard to know if 300 is normal, that's where you were always, or whether you used to be at nine hundred, now you're at three hundred, so it's a much different deal in terms of what your body needs for, again, energy level, sex drive, muscle mass, bone health, all those sorts of things. So I think that's, you know, one thing I think that could be done to improve prescriptions if we look a little bit more broadly at who's getting it. The other thing is that testosterone is regulated like OxyContin, for example. So it's

Dr. Mark Hyman
Yes. That's a schedule. So

Dr. Michael Eisenberg
it's very difficult to prescribe. You have to go through a central database, and you know, make sure that men aren't getting it from other places. And so that's just a barrier. You also No. No.

Dr. Mark Hyman
I don't find it that hard. I just said to put the prescription, I said I put in my special secret DEA code, and you know

Dr. Michael Eisenberg
But it's it's another step. It's another step. Yeah. And then then also can't get as much. Like, you can't give them, you know, like, month and month, you know, like several months supply Right.

Because they really restrict how much is administered. So I think all those things I think will help with access to testosterone.

Dr. Mark Hyman
And it's interesting because you know, have other biomarkers that matter, the free testosterone and the six hormone binding globulin, which regulates what levels of free hormone there are that does the work in your body. Mhmm. And they can be really odd. Yeah. You know?

So you can have a high testosterone, but also a low free testosterone. You can have a low testosterone, high free testosterone. I've seen the whole gamut. And the sex hormone binding globulin can be elevated, and that can be from inflammation, other factors. So all those things play a role in trying to assess what's going on with somebody.

So getting the right test is really important.

Dr. Michael Eisenberg
Yeah. I think that's absolutely right. I think that, you know, for everybody, it may be a little different what exactly what you're looking at. You know, some men like, right, the systolic blood pressure may be at risk, some diastolic. So I think looking, you know, very comprehensively, you know, hormone panel, I think, is important too.

And, you know, also adding, you know, prolactin like you talked about, estradiol like you talked about, all those things I think are gonna be really crucial. Luteinizing hormone to understand a little bit more about production of testosterone, and understand why levels, you know, aren't where they're supposed to be.

Dr. Mark Hyman
It's really it's really important to kind of monitor those things. Like, most men don't get their estrogen levels checked. Mhmm. Right? Yeah.

Like, that's a female hormone. The the the one we check is estradiol. Estrogen is there's no such thing as estrogen. They're estrogens, and they're different But estradiol is the main one. And what happens is is in men often who have extra belly fat or body fat will convert testosterone into estradiol.

Yeah. And so they'll end up having feminization features. They'll lose their body hair, they'll get soft skin, they'll get breasts. Men, you know, like we call gynecomastia where men get breasts, and you've seen that. You know?

The classic beer belly guy, you know, that that's all from estrogenic effects. And you can measure it. And I I think we're we're sort of shocked to see, like, like, think fourteen percent of the men we're testing have relatively high estrogen levels. Yeah. And I was like, wow.

So all these sort of environmental things and dietary things are all affecting us. And there are things we have some measure of control over Yeah. And can be empowered about. But most of us are walking around blind and have no clue. Yeah.

And and, again, that's why I co founded Function Health, which is to give people access to their data because the average doctor's not checking these things. You go for your checkup, and they're just I mean, if they see you they see you, they'll check they'll check-in, but you're like a Stanford professor who's been studying, you know, papers every day all night long for the last thirty years. So you're very aware. But like it's just the the the unfortunate thing is that people aren't getting, you know, the the most sophisticated care and the answers to their questions. And they may be walking around with all sorts of issues that they don't know about related to both near their their fertility issues, their hormone issues, the quality of your life.

And this is such an important part of, you know, our future generations. And I I'm I'm kind of worried about us as a species as I see, you know, the the you mentioned epigenetics for those who don't really know what that is. Essentially, you've got, you know, 20,000 genes. You but you you know, you've got to determine which genes are turned on or off or expressed or not all switched on. Yeah.

And the epigenome is sort of like the piano player above the genes that controls which songs get played in your book of life or when you're whatever. Page is. Whatever. And so you kind of have to to determine how to regulate those. And the epigenetics is influenced by everything we do.

We call the exposome, which is our diet, exercise, sleep, stress, toxins, our thoughts, our feelings, relationships, our microbiome, pretty much everything you can think of is influencing our epigenome, which in some ways is actually getting worse and worse. And so we now know that if you're in utero and you're exposed to toxins or stress or other things, that that has a huge impact on the the development of the fetus and its later history and health history. So can you talk a little bit more about the sort of understanding of how the epigenetics is affecting reproductive health, and fertility, and all these other things? Because I think, you know, I'm really wondering about how that plays a role. So I

Dr. Michael Eisenberg
think that's potentially a real opportunity for us to try and improve reproductive health. So even beyond, you know, sperm counts, we've talked about a lot, you know, there's sort of a deeper layer here. And so, for example, you know, if a man smokes, or if a man's obese, that's not gonna change the DNA, you know, actually the base pairs, know, all the different molecules, but it will change the epigenetics, sort of the expression. And so our body sort of reacts to this. It says, you know, now I'm in an environment where there's smoke, so I need to get more of this particular gene and less of this gene.

Or if I'm obese, that means there's more food abundance, so I need to turn this on, this off. And so that then is basically hardwired into the DNA. And so the sperm that we're making have that belief about this is how the environment is. And so then, the child that's conceived has those same changes. And these changes really affect everything.

Know, we've seen this in, for example, mouse data too. If you have starved mice, or you know, obese mice, and then they have offspring, you see these metabolic derangements in the children. We see this in people too. You know, men that smoke, men that are obese, we we can measure these metabolic changes in their children. So I think these are things that are very powerful and really proliferate, you know, just us.

You know, again, if we think, you know, I have enough sperm, everything's okay, there really could be effects. And obviously, you wanna, you know, give your child the best possible chance, and you know, optimize everything. I think people are talking about different ways to select the best embryo. Well, is sort of a good way to make sure that your embryo pool is even better, is if you try and maximize and optimize health as much as possible. So all these things, you know, diet, we've talked about.

But just making sure that you're as healthy as you can be, I think those are really powerful influences.

Dr. Mark Hyman
Yeah. It's important. I mean, so, you know, you kinda kinda start thinking about all this early on Mhmm. And people just don't. And most pregnancies are just sort of like not not thoughtfully curated in the sense that you're not doing all the things you need to do before you actually conceive.

Yeah. To make sure you have as healthy baby as possible. Yeah. I wanna I wanna end by a few rapid fire questions about is this bad for your sperm or not? We've touched on some of them, but cell phones in your pocket, yes or no?

Dr. Michael Eisenberg
I think it's probably okay. Probably okay, but in the back pocket. Back pocket probably a little bit.

Dr. Mark Hyman
Yeah. What about boxers or briefs?

Dr. Michael Eisenberg
This has been yeah.

Dr. Mark Hyman
It's a it's a very common question.

Dr. Michael Eisenberg
I think it's unlikely any one clothing layer is gonna make a big difference. Uh-huh. But we do want, you know, I guess as much breathability as possible. So usually, just tell patients whatever's comfortable.

Dr. Mark Hyman
No. This this is all sauna hot tub craze. Like, it it Mhmm. Is this bad for guys? I mean, should we, like, not three saunas, or just or just, like, bringing in, like, an ice pack on our balls when you go on the sauna?

Dr. Michael Eisenberg
I haven't seen good data that ice pack is gonna necessarily mitigate that risk, but heat definitely is bad. I So think while you're trying to conceive, you know, again, takes two to three months to make a sperm. So if that's something you're actively trying to do, I think it's probably best to stay away from the sauna.

Dr. Mark Hyman
Stop saunas for ninety days before you wanna have a baby. Yeah. Okay. How about laptops? You mentioned, yeah, you're worried about I'm worried about those.

Yeah. It's better to put

Dr. Michael Eisenberg
it on a desk. Put it on

Dr. Mark Hyman
a desk. Okay. What about time of year? Does that matter?

Dr. Michael Eisenberg
They're interesting. There is some, like, some variation waste on time of year. So turn into cooler months, you know, winter, fall, sperm counts can actually improve about ten to fifteen percent. So we do see those changes again on a population level. But you know, again, think whenever it's never a right time to have a child, so I wouldn't tell couples to wait necessarily, but we do see changes.

Dr. Mark Hyman
A lot of guys are into cycling, me included.

Dr. Michael Eisenberg
Mhmm.

Dr. Mark Hyman
Is it bad for your sexual health

Dr. Michael Eisenberg
and erectile dysfunction, or fertility, or both? It could affect both. I mean, always say anything that's good for your heart is gonna be good for sexual function and reproductive function. Yeah. But there have been some studies that suggest there could be some issues.

So I think for men that ride over five hours a week, there have been some decreases in semen quality. Oh. So again, why that is maybe it's due to heat. You know, again, you're kind of compressed, obviously, you're generating a lot of heat.

Dr. Mark Hyman
You got those tight spandex bike shorts on.

Dr. Michael Eisenberg
That's right. Yeah. They may look nice, but yeah, they're not all good. So, I usually tell men to try and stand up out of the saddle to try and, you know, get some circulation. I think that could be beneficial.

And then there is some data that, you know, the saddle design can actually impact blood flow Yeah. To the penis. And so, there are certainly men that come in to tell me about numbness, pain. Doesn't affect everybody, but maybe about twenty percent of men report this, and there is a higher risk of dysfunction. Because, you know, we put our weight, especially when we lean forward in the saddle, it compresses against kind of our sit bones, the ischial tuberosities, and the main nerve and artery to the penis are sit right there so they can get compressed.

Mhmm. And usually when you, you know, kinda sit up, blood flow restores, but if you're pushing too much, it can lead to, you know, more permanent damage. So there are different, you know, saddles that can try and mitigate that risk. Again, standing up can help. Or we have a company called V Seat that has a nose less saddle design that can help with that too.

V Sea? V Seat. V s c a t.

Dr. Mark Hyman
Oh, wow. V Seat. I'm gonna check that out. Yeah. For sure.

Yeah. Because I like to ride bikes. I definitely worry about it. How about being sedentary? Is that tech sperm quality?

Dr. Michael Eisenberg
Yeah. So I think, you know, activity is definitely beneficial. So like, there have been studies looking at like hours watching TV, hours sitting around, and it's certainly not good. So I think that, you know, being active, you know,

Dr. Mark Hyman
cannot getting exercise sign on for a run. That can be beneficial, yeah. And alcohol, we didn't talk about that, but that's another toxin. How does that affect sperm health?

Dr. Michael Eisenberg
So I think in moderation, it tends to be okay. I think that, you know, the one study that does support damage to sperm quality is probably about 20 drinks a week, which is a lot, you know, about three a day. So if you're at that level, I think that You're

Dr. Mark Hyman
an alcoholic.

Dr. Michael Eisenberg
There may be some other things. There are also probably some men that are more genetically susceptible to alcohol. So there's a condition called Yeah. Like, flushing, like alcohol flushing.

Dr. Mark Hyman
Oh, the Asians get it. They get really ridden the faders. Exactly. Gene that is the alcohol dehydrogenase gene that is

Dr. Michael Eisenberg
Exactly right. Yeah. So in some populations, about fifty percent. In Taiwan, about fifty percent. Mainland China, it's about thirty to forty percent.

So if you have that mutation, you're more susceptible. And basically, what that does is that when you're metabolizing alcohol, you know, eventually, you get this accumulation of acetaldehyde, which is a toxin. And so that's why you flush, that's why sometimes people get sick with it, but it can also damage sperm quality. So we've seen significant declines in sperm motility or movement, you know, around alcohol drinking. So if you're susceptible to that, it's probably a good idea to avoid it.

Dr. Mark Hyman
And we talked a little bit about sleep, but that that also can affect fertility if

Dr. Michael Eisenberg
you don't sleep enough. Exactly. Yeah. Seven to nine hours, I think, is the sweet spot.

Dr. Mark Hyman
And stress, we talked about. Mhmm.

Dr. Michael Eisenberg
Yeah. I mean, it's easier to say less stress, but again, I think you have some good technique to try and cut it down.

Dr. Mark Hyman
Yeah. I think most people don't realize that, you know, stress comes un unbidden and Mhmm. You know, automatically, whereas relaxation is something you have to work at. Yeah. It's literally like you have to meditate or do breath work or basically, I do this thing called yoga nidra.

Andrew Huberman calls it non sleep deep breaths. But essentially, it's an ancient technique, so just going through a body scan and using your breath and going into a state of deep parasympathetic activation, which really, really help with so many aspects of your health, but even sperm count. Amazing, Michael. Well so where can people learn more about your research and your work and and you?

Dr. Michael Eisenberg
Yeah. Eisenberg Lab at Stanford. So they can just look that up on the Internet.

Dr. Mark Hyman
And and and what about this swim club?

Dr. Michael Eisenberg
Oh, swim club. Yeah. So swimclub.co. There's a lot of information. There's a lot of testimonials.

It's and you can learn a little bit more about the product.

Dr. Mark Hyman
And and is this something that all men should take, or is this just men who are trying to conceive, or is this just a general help for testosterone?

Dr. Michael Eisenberg
Well, I think, you know, you I think you know and you've taught people a lot. I think a lot of these same supplements can also help overall health, metabolic health. So I think it's not unreasonable to think about that, but right now, we're focused on reproductive men or sorry, men that are trying to have children.

Dr. Mark Hyman
And you have I have a book coming out anytime soon?

Dr. Michael Eisenberg
Not yet. I've started about this. You've been very yeah. You really inspired me,

Dr. Mark Hyman
so maybe. Yeah. Well, thank you so much, Michael, for your work, for being a pioneer in this field, for talking about difficult subjects, for bringing things to awareness that, you know, are honestly not talked about a lot in medicine, like our environmental toxin reload, now that's affecting us and changes in in sort of men's sexual health. So great conversation. Thanks for coming all the way to Austin and we'll see you at Stanford sometime.

Dr. Michael Eisenberg
I appreciate it. Thank you.

Dr. Mark Hyman
If you or someone you love is thinking about fertility, whether you're just starting to ask questions or navigating challenges or preparing your body for pregnancy, I want you to know you're not alone. And this year, we're launching something new for our community called the Ultra Learning Series where you can connect directly with my team at the Ultra Wellness Center for deep practical conversations to make functional medicine simple and actionable. Now our first workshop is functional fertility. It's happening Thursday, February 12 at 12PM Eastern Time. Doctor Cindy Geiger, who I work with for, I don't know, thirty years now, a long time, and Lisa Draymond, my nutritionist, will walk you through what really influences fertility from hormones and inflammation, to nutrition, environmental exposures, and whole body health for both partners, because yes it takes two.

This is a compassionate and it's evidence based conversation designed to give you clarity, confidence, and real tools, no matter where you are in your fertility journey. You're gonna find the link in the show notes or just head over to Ultra Wellness Center on Instagram at Ultra Wellness Center, and you'll find out everything you need to know, and I really hope you'll join us.

Dr. Mark Hyman
If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels at Doctor Mark Hyman. Please reach out, I'd love to hear your comments and questions. Don't forget to rate, review and subscribe to the Doctor Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at doctor Mark Hyman for video versions of this podcast and more.

Thank you so much again for tuning in. We'll see you next time on the Doctor Hyman show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests.

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