Testosterone and its impact on men's health

S1: Welcome in San Diego. It's Jade Hindman on today's show. Why more men are struggling with their fertility and what can be done about it. This is KPBS Midday Edition. Connecting our communities through conversation. For this week's Wellness Wednesday segment , we turn towards men's health and our men struggling with fertility more now than in the past. That is the question doctors and researchers have been wrestling with , because some new data represents are presented. Earlier this week , rather says testosterone levels in men have fallen by half over the past 50 years. This is all happening in a culture of biohacking and health maxing , which often promotes health advice via social media , often in place of a doctor's office. So here to talk more is Doctor Ryan Nazari. He is a urologist and assistant professor with UC San Diego Health. Doctor Nazari , welcome to midday edition. Hi.

S2: Hi. Thank you so much for having me. It's a pleasure to be here.

S1: I'm so glad to have you here for this discussion. What can you tell us about this supposed decline in male fertility? Is there a definite trend here?

S2: So , you know , there's several studies from different areas of the world. And we see both with sperm counts and with testosterone levels , that these have been steadily dropping. However , when it comes to the sperm counts and fertility levels , some of those may be confounded by a few things. Number one is , um , some studies are out of countries where where semen testing and sperm testing is part of a wellness exams as , as people go into compulsory um , military service. But , um , in the United States. You know , the men that I see that are getting semen tests are are probably more likely to have lowered fertility compared to the average man , because they're coming to me because they're having difficulty conceiving. So while there probably is some decline in fertility , um , some of it can be attributed to just , you know , some dietary changes that we've had over years , um , higher rates of chronic diseases amongst younger people. Um , but we definitely do see lowered testosterone and lowered fertility , um , kind of on the rise and neat. And couples needing help with fertility. Um , on the rise as well.

S1: Talk to me a bit more about the connection there between testosterone and fertility.

S2: So there is not it's not a direct 1 to 1 causal link between the two , but they both the testicles are responsible for fertility and for testosterone production in men. Um , you know , there's essentially a work order that comes from the brain sent to the , to the testicles to start making sperm and also producing testosterone. And , um , once those have been fulfilled , then , you know , levels kind of can kind of get steadier. But what we do see , though , is that , um , you know , often men that struggle with fertility and have sub fertility tend to have , uh , and tend to have lower levels or kind of be on the borderline of low testosterone.

S1: And so infertility , I guess , for some , may be the first indication that they have , um , low testosterone , which is a health concern for men whether or not they're looking to have kids or not. Correct.

S2: That is absolutely correct. And , you know , treating low testosterone in a man who's looking to have children and and wanting fertility is totally different than , than one who is not. But either one of these events is actually often one of the first ways that men get diagnosed with with some of their issues. Um , you know , I see a lot of guys that are in their 20s and 30s coming in for fertility testing , and it's one of their first times since , you know , they were kids , that they really have a regular follow up with a position. Um , and there's plenty of , um , correlations and studies that show that there's clear relationships between impaired fertility and overall health.

S1: So how does testosterone play a role in men's health more broadly? Tell me about that. Totally.

S2: Totally.

S1: Uh , Doctor Nasser , I think you're you may have muted yourself. Can you hear me?

S2: There you go. You guys got me back. I apologize for that. That's all right. Okay , so what I would say is , uh , more broadly , um , testosterone plays a lot of roles in , first of all , how men feel about different things and throughout the day , but also , um , a lot of bodily function. So testosterone is responsible for it's a building hormone. It's responsible for building muscle , maintaining good lean body mass , making sure that fat content isn't getting too high. Uh , it plays a role in metabolism. It also plays a role in maintaining your bone density , and we know that it plays some role in cardiac health along with estrogen , because we know that men that have low testosterone are at higher cardiac risk , having risk of heart attacks and cardiac events. The parts of it , though , that men definitely feel is that a lot of guys with low testosterone will come to me and say , doctor , I feel like I'm just kind of just on autopilot. I wake up in a fog and I'm not really steering in any direction. My energy levels are never great , even though I sleep 7 or 8 hours a night. I just never feel rested. I go work out and I hardly can get through a workout or when after I work out , it takes me days to recover. And then also they feel like their sex drive , their libido has completely gone. Hmm.

S1: Hmm. So is there anything that that causes this drop in testosterone?

S2: We know that there are certain things that that people can do that they're definitely in control of , you know , substance abuse , heavy drinking that can really affect your your testosterone levels and production in your body. But we also know that high stress , high chronic stress , poor sleep , poor dieting , um , those can all also lead in lack of regular exercise. Those are going to all decrease testosterone levels where exercising regularly has been shown in lifting weights , has been shown to increase testosterone level. Um , we we know that , you know , having a good diet and keeping regular good exercise. Usually what we say is what's good for the heart is going to be good for everything else. And maintaining those good , healthy habits can at least help improve testosterone levels. But in some cases , men , um , do require some supplementation.

S1: Well , so there's obviously , you know , symptoms that , that show up that , that you kind of mentioned , um , for low testosterone , but is testing something that men should be advocating for in their regular checkups.

S2: I absolutely think they should be. I think that for testosterone men who feel any of the symptoms that I described , if they feel like , you know , for lack of a better way of describing you , don't feel like you have the same zip or drive that you used to have , um , or that you're just constantly feeling like you're fighting fatigue. Um , I think that testosterone , along with the rest of your , your hormonal panel is , is where to start. Um , and , you know , once we've kind of worked through it , oftentimes we can unmask other causes. It's not always testosterone that's responsible for these things , but it is important to get tested because testing at least can lead to some answer.

S1: And if you if a man does find that their testosterone is is low , what does treatment look like?

S2: Yeah , there's a lots of options. It depends. You know often my first conversation is do you plan for future fertility or are you not planning for future fertility? Um , and men who are not planning for future fertility. It comes down to just replacing testosterone through an exogenous way , meaning either through creams or pills or injections , something to supplement their testosterone levels in men who are interested in fertility. It's looking at ways in medications that may be able to increase their bodies capacity to produce more testosterone.

S1: So , and when you say just taking supplements , are these supplements sold at the store or is this something you see in infomercials on TV? We always see those commercials.

S2: We always I try to steer people away from anything like that. Um , these are all I when it comes to testosterone therapy. I highly recommend that whoever you seek treatment from is a trained professional in the field. Um , whether a urologist or an endocrinologist or your family medicine practitioner , your general practitioner , somebody who has familiarity with prescribing testosterone or testosterone , um , supplementation in terms of fertility care. You want to have somebody who understands the medications that they're giving you. Who knows all the risks? Who knows what to look out for and knows how to properly monitor you , to be sure that you're getting the most out of your treatment and getting it safely.

S1: So what are some of the side effects of testing? Yeah.

S2: Yeah. And so one of one of the things that many people that take testosterone and unfortunately I do see this all the time is , um , starting testosterone , exogenous testosterone injections. Uh , creams , they do impact. It actually impairs fertility because it actually sends the signal back to your brain that you have enough testosterone and it shuts down your body's natural production. And so a lot of people starting on testosterone are unaware that it actually can negatively impact their fertility and make it more difficult to achieve pregnancy in the future. So that's one of them. It can affect your blood cell counts. It can certainly affect mood. Um , and it can affect skin. And you know , in in inappropriate doses. We know that it can affect your liver and kidney function as well. So , you know , I really think it's important for people to be sure that when they're getting their testosterone , that it's through professional and somebody who's very familiar with how to monitor you.

S1: Yeah , definitely sounds like something you need to be monitored for. Um , evidence shows men seek medical care less frequently than women. Um , the decline is most pronounced in younger adults. But I'm wondering if you've noticed that in your own practice. And if you think it's that that is changing at all.

S2: It is actually a conversation. We have a lot in my specific sphere. Um , and one of the things that we relate to the way I related is I think that when it comes to young men , um , you know , I think for young women , oftentimes they are used to more regular appointments , uh , whether it is with a regular schedule , with a gynecologist , that that sort of appointment doesn't exist for a young man. Um , and so oftentimes , uh , the , their first interactions , especially in today's world. A lot of times , the first interaction any of these patients have with the medical system , with , aside from going to an E.R. or an urgent care , is with me when they're talking about either some sort of sexual problem or they're talking about fertility. Um , and it's actually the first opportunity I have to actually make sure that these patients get plugged in properly and cared for properly. Um , making sure that patients have a good experience through me is one way that I can make sure that they actually get plugged in with the help they need for other issues.

S1: And you're a urologist. Does this take a do you have to be referred to see you? So tell me.

S2: That is a good question. That is a good question. Um , a bit complex depending on who what your coverage is or anything like that when it comes to referrals. But oftentimes these conversations in some insert in the primary care as the primary care physician's office about not feeling so great , some of it also comes directly to me. And I would say that in the direct to consumer market that we live in , in terms of online availabilities and such , I do see a lot more people self referring , meaning that they've never seen anyone for any of these problems. And I'm the first person they're there they're speaking to.

S1: So well , not everyone , you know , maybe seeing their doctor as regularly as they could. As you mentioned , there are a lot of other places to get medical advice. You touched on , you know , the internet and through social media is what people are kind of gearing moving towards. How do you view this , this whole wellness industry that has become so popular in our culture?

S2: Yes , I would I would call it broadly , I would say a mixed bag. On the one hand , I think that it is great that we do have opportunities for people to have easier access to some of the care , that they're more sensitive or less inclined to speak to someone about whether that's weight or sexual medicine , fertility care. I think that it's great that we now have at home fertility testing , and that you can get your foot in the door. Um , however , I , I personally am , um , one to think that , um , you know , I do see a lot of patients that start off on some of the websites or direct to consumer or direct to patient marketing. Um , and then after a few months , they end up in my office because they feel they want somebody who's actively monitoring them. They want kind of the personal interaction , and they want to feel like their doctor knows who they are and is tailoring their , their medication and treatment towards them. On the other hand , though , what I do fear is that , um , I always tell people to make sure they can verify whether it's on social media or what have you about who your source is and what you're listening to. Um , to be able to get the information when it comes to testosterone and fertility , unfortunately , because it is such a Desirable and , and and you know , popular space. There is a there is a lot of people out there who truly are just giving wrong information to fortunately.

S1: Wow , that's all important information. Um , I've been speaking with Doctor Ryan Nasser. He's a urologist and assistant professor with UC San Diego Health. Uh , Ryan , thank you so much for for your insight.

S2: Thank you so much for your time. It's been a pleasure.

S1: That's our show for today. I'm your host , Jade Hindman. Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.