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Paul Turek, MD (@TheTurekClinic) is an internationally known thought leader in men's health treatment and research. He specializes in the latest advances in men's sexual health including infertility, libido, vasectomy and vasectomy reversal.
Welcome to the A-list with me, Jennifer Neeley. Every week, our show is focused on the intersection of technology, media and business with influencers and change makers around the globe. You are a vital part of this program as you know. Please send in your questions to the program, be at Twitter, Facebook, my blog or email. You're welcome to do that at any time during the show, be checking us. And today, Friday, June 17, 2011, we have a special treat. Dr. Paul Turek, the premier leader in the area of men's health as well as an active blogger, which you don't often see, is here to discuss efforts for Men's Health Week, which concludes in a couple of days, June 19. Welcome to the program, Dr. Turek.
Why thank you Jennifer.
I am so pleased that you could make the time to join us. I know you're busy traveling all over the place, helping people, and this week you actually had a toxic kind of hit the radar in terms of social media. You were at Google this week talking about men's health and in your area of expert -- maybe you can explain how your area of expertise landed you at Google talking about men's health overall.
Yeah, I'd love to. So this is a special week. It's called Men's Health Week. It is actually part of Men's Health Month, but there isn't all that much activity nationally which is kind of a statement about men's health which needs to change and for that reason I am here with you and I want to make sure people realize that it really does matter. It ends on Father's Day so that's a good one. So I think Google Health has a series and they have lectures come in to try to improve the quality of life of their employees which is a quality of life that's not bad to begin with. They asked me to give a talk about men's sexual health. And I'm a men's health specialist in San Francisco and I am a surgeon urologist but I also do a lot of -- I take care of young men basically. And a lot of the problems that young men have in this world are sexual health issues. They may not be problems, they may be issues, and they may be normal. They just don't think they are or whatever. So I kind of addressed eight of those sexual health issues in an hour talk and I thought it was pretty well received. I mean the campus is impressive and the questions were great and I think it got sent to web, sent to 11 sites, 10 or 11 sites across the country at Google. So, I think that's the segment of population that I think takes the least good care of themselves, men at Google because you know they are immortal, and so to teach them a little bit about life and the basic theme of the talk was that you think sexual health is kind of an elemental orb rotating around the realm of overall health but it's actually an integral part of overall health of young men. And many of the issues, sexual health issues that men have, erectile dysfunction, sex drive issues, infertility, etc. can come back to reflect on overall health.
And I think one of the things that's interesting about Men's Health Week is earlier in the week when I was looking around, my radar on Men's Health Week was that not too much was happening. A lot of the questions are being answered by people helping one another out and later in the week, Men's Health Magazine came out with a coronary quiz, are you a candidate for coronary problems, and so seems like a lot of people are taking the quiz and I know that part of what you talk about is how, to put it bluntly, the penis is a predictor in a lot of ways of heart problems and other problems and I should let you speak to that, you're the doctor, but can you talk a little bit about that because it seems like today people are really talking about coronary problems as they relate to men's health.
Absolutely. I think -- you used the word first so I feel comfortable saying that word now, the P word, but I think...
The penis word.
Yeah, whatever, there you go, okay. Oh, we could hear the shush go through. But basically, erections are a biomarker, a natural biomarker of heart disease, and that's been kind of drilled into the lurch over the past 10 years because if you have problems with erections, erections are driven by blood vessels, and the heart is a big blood vessel and the penis is essentially a blood vessel, although it's glorified. The issue is that the penis has blood vessels in it that are smaller than the heart by about half. So, if you're someone who is going to get heart disease, it's probably going to show up in the penis first because it's a smaller system and they'll clog quicker in a sense. And that's true. I mean basically, if you have serious erection problems in your 40s, you're twice as likely to die from heart disease as someone who doesn't, and that risk is the same as having a family history of heart disease, a brother, a father, mother, or being a smoker, and those are considered serious risks.
Yeah, and I know smoking is one of the things that in the Men's Health Week twitter/chatter that's going on. Smoking is being talked about quite a bit in terms of how it factors into health problems. I am curious you're take on smoking in terms of, you know, some of the specialty areas the you are very well known for which have to do with fertility, infertility and that sort of thing.
I am a rabbit about that. I mean I think that if you're trying to conceive and you're smoking, that's just an example of not taking very great care of yourself and I think I look at them and I say you really want to be smoking around your newborn kid? Do you really want we have the stench smoke around your kid? And I mean talking about the erections later on of the lung cancers, stuff like that. How trendy are you? How trendy do you want? What's the cost of being trendy in smoking? I actually...I have a great solution for it. There's a guy named the Mad Russian in Boston. He is called puff daddy. And I have a handout of his __6:44__ and he does hypnosis and the young men love this because they don't want to take long treatment regimens that are expensive like the gums and the patches and things that provide nicotine without the smoke. They just tend to fail that. It's a compliance issue. They can't do that. Men wanted something simple, cut to chase, get it done. So I'd sent a bunch of couple there from my practice and I think he's a hypnotist but...and he does just focus on smoking but he's about 65 dollars and you go to be constrict somewhere in a basement, you sit with 20 people and he doesn't touch you and you close your eyes and 20 minutes later you never feel like smoking again. And what it is is addiction control and it's kind of weird because I'm a scientist and I'm an evidence-based guy and an evidence-based doctor but this is impressive. It's called the Mad Russian. And he has been in Glam magazine and on Yelp, you could read about him, but it works. So I sent half dozen couple last year and they call me and say, "Turek, still not smoking." They'll email me or twitter me or something. So it's really fun. But that is the kind of solution that works the best which is addiction control and I think a guy like the Mad Russian could do anything, well, like weight control or anything, but it's really a matter of addiction control.
So, I do empathize with men who like really want to stop smoking for infertility or erections or anything. Any sexual health issue, it's on the chart, is a problem. It's on the map and is one of the causes. Almost anyone of the eight issues I talked about at Google. But I'd say the most important thing is make sure you don't just pull the plug on smoking with a young guy and give him something or let something take the hit. So it's sort of something that has to...it can't just be pulled, it's too much of a stressor. So you would tell, you know, you can gain 5 pounds instead or you can eat some sweets or you can do something else. You can exercise rapidly, do something else to take on the stress that the smoking cessation will bring on when you stop it. So, you know, it's a biological organism and it's an imbalance and you have to -- to go and change the balance, you have to have something to help out.
Yeah, sort of like that, risk analysis you know. What you're going to do a major to risk analysis.
Something's going to give. Right.
Something's going to give and you just accept that something's going to give and you help him with it because they won't survive. They won't be able to do it if you don't have a plan.
Yeah. I think that's one of the key things about what you talked about at Google which was that you have a very good sense that there is a plan men can follow that gets them to a place that is healthy. I think that's one of the things in terms of Men's Health Week. It's sort of like, where do you start? What are the most important issues? You see a lot of women. I notice a lot of women on Twitter sort of reaching out about fertility and fertility issues, which often have to do with their partner rather than themselves. There's just so many areas and so having a program that addresses overall health, does it really move the needle for these other areas where we're talking about, things that are very, very near and dear to people's heart which are being able to have a child and that sort of thing.
I think that we need to deal with men entirely differently, especially young men, entirely differently than women. And I think for instance there's no monthly biology in a man, right? I mean, it's one of best biomarkers on earth is the female ovulatory cycle. So women notice it's been regular for 10 years and then all of a sudden there's three months of something odd. You can bet they're going to call their doctor. It's like a clock. I mean it's a great a sign. It's just great because men don't have that and so we have to find those things. And I think for instance that the semen analysis, and I'm telling the government this when I go consult NIH some things that maybe we should consider the semen analysis as a baseline study in your 20s or 30s. If it's abnormal, we know that that is a general reflector of overall health, maybe there's things we need to attend to, in addition to infertility or fertility. So I think that men are different beasts and we have to treat them differently than women. The other thing is men judge their productivity and their self-esteem by -- they judge their self-esteem by their productivity so the amount of money they make, how hard they work, the firm they work for, what they do in life, it's very much a part. They are hunter gatherers. They are the ones who set out, get the food for the family. I mean, we work cavemen too long ago and that's their mentality, which is provide, provide. I understand myself best as a provider. And so if you say they were provider like that whether he's a caveman or a Googleler, you basically say hey, why don't you come to my office, why don't you take a two-hour drive up the Peninsula and deal with traffic and come in in my office for 13 minutes of whatever insurance covers now for a visit and then drive two hours back to let me tell you something that you maybe didn't want to hear or is not that constructive or whatever. It doesn't work for men. I mean they just don't. So in my practice, I see them once for an hour and I listen.
That's the only thing we do with men because they don't talk much. We don't listen to their bodies. They don't listen to their bodies and we don't listen to them, and 12-minute visits just don't cut it for men. They don't because don't know what's going on and it takes me a while to even get men relaxed enough in the office to be able to the open the book to find out what the real symptoms are. Because they come in with symptom A and that is kind of the tip of the iceberg of a symptom B which is caused by C, and if you solve C, B goes away and A goes away, but men don't know it's C. They don't even know it's B. Women are already on theory.
Yeah, and I think speaking from experience unfortunately, I think if semen analysis was done in the 20s or whatever as people get married later in life, knowing what you're dealing with I guess is everything and it would be nice to know.
Yeah. I think from a fertility point of view.
Before I married my husband and all those times I talk to him and all that, I said I'd love you to have a sperm test. And he, it would have been too difficult for my husband and his personality type to get that done, but I would have learn so much more on the journey that we've ended up going on together. We wouldn't have...it would have increase stress level.
That's a two-edge sword if you're saying I'm measuring you by your semen. There are religions that with arranged marriages around the world, not usually in America, but I have a lot of patients who come in and say the Orthodox church tell me to get a semen analysis before this arranged marriage and it's abnormal and now I can't marry her because it's abnormal, because I can't have a kid. And I get called in to court a lot for this kind of thing and my answer is, I'll say this in a letter, the semen analysis does not a man make. I mean you're not really infertile until you're trying and you're certainly not infertile if you have any sperm count. Don't assume that at all. In fact, assume the opposite. And you're only really infertile if you're sterile, if you're zero, if the sperm count is zero, and he wasn't. So we did some things and we made him better and now his sperm count has normalized, and don't check it again. Just take great care of yourself and go on with your happy life. So it can go both ways that way. I wouldn't...I don't...that's odd. And also the standards for what makes a semen analysis normal are also changing. There's five editions of the World Health Organization standards for semen analysis and I just gave a talk at our national meetings in urology in Washington last month on the fifth edition and my argument was basically, it's just a tempest in a teapot. Just a storm in a very small space that doesn't affect anything by changing these numbers around and stuff because they don't really mean a lot unless they're really zero. So it's a two-edge sword and we have to think about how best to use it and who might get it but if there are other biomarkers, like erectile dysfunction is a biomarker, I think if you're sex drive is changing or low and it's not what it used to be, that could be a real biomarker of health. For instance, if your body is ill.
Think of the caveman. If your body is ill, the last thing you want to do is reproduce. You want to survive first. If you're stressed by a woolly mammoth as a caveman chasing you, the last thing you want is an erection or sex drive. If you're woolly mammoth is financial, if it's the recession or the dot-com bust or your mortgage, or whatever as a provider, that's just the same as the woolly mammoth chasing you, and that's the wrong nervous system, to relax and enjoy life and have a great sex life.
Interesting. But there are things that man can do too and should be doing in a sort of like women do, the breast health check, I just noticed somebody who's talking about an event on Twitter where there was a stall for men to be able to check your balls (laughs) for Men's Health Week
And everybody and apparently know when. It says apparently testicles are still taboo. Some men went to every other stall at the Men's Health Week event yet ignored our stall and so that has a tag as check your balls. And certainly, that's another one of those taboo areas that men don't have to do. Women, I don't even enjoy doing sort of the stuff that we're supposed to do as women and check our breasts, but it's just a similar type of thing that men could be doing prerogatively to help themselves, is that right?
It's remarkable. I mean it's remarkable how well you take care of your teeth compared to testicles, but I am stunned weekly in my practice by patients. A couple of weeks ago come in infertile, married infertile and he has no testicles in the scrotum. He is 35. This is not unusual. Now, how many people missed that over 35 years? So yeah, you're right. I mean it's cultural and it's there and that's another fact. Men have a problem down there. It hurts or he feels something unusual, and then you ask how long is it going to take that person typically to get to care to figure out what that problem is. It could be anything. It could be cancer. Most times it's not, just a cyst or something. But I did a paper on this because I said a guy notices a third testicle or a lump on his testicle and it's called a spermatocele, a cyst that means nothing. I mean it can be removed and all that, but it's benign. But I wrote a paper about guys in my practice and I said how long did it take them to get care when they knew they had something abnormal, unquestionably abnormal to them. It was about four months before they sought care. And testis cancer confirms that the date is four to six months before they seek care and that's __18:48__ we can find disease that's curable and metastatic disease that may not be in a lot of cancers, especially testis cancer. So monthly testicular self-examinations are a no brainier, end of the shower, hanging low, just comb them and make sure they're smooth and make sure the consistency is the same from side to side and they feel the same. And if there's a change, call me (415) 392 3200, call me and I will see you the next day and you know...
Yeah, I mean, well, and you do 10 minutes on the phone too for free.
So it's like you know...
But that kind of thing probably need check the same, and those guys find a scrotal pearl or their epididymis...
But even if you're worried. The thing is that you've got a world class doctor and we haven't even talked about all of your credentials because you're so, knowing you, you're so damn modest, but you know, I think __19:44__. I mean you've seen sultans, you've seen heads of state, you've seen major leaders in the Silicon Valley and there is without naming names that you've not done with me either but as I've known you, you've seen all of these amazing people and the problems are the same. It's sort of like, it doesn't just because you're a sultan doesn't exalt you into anything. It doesn't you think...
No. I don't think you get better care -- I don't think you get better care with political status or financial status. In fact, they see a lot of concierge doctors who charge a lot of money turning patients into victims. And my whole life is about owning your care, ownership, take some responsibility. Women have an ovulatory cycle. They take a little more responsibility. One way to take responsibility as a man with your own care is to get married or have a partner as a woman because she'll take better care of you than you will. Another way is to realize you take better care of your car than you do your body and to start taking as good a care of your body as you do with your car. You get your oil changed every six months maybe and you don't see a doctor for years. In fact, one of the most impressive things about Google wasn't the campus. It was the question I put to them about, "How many of you guys get your oil changed in your car regularly?" and everyone raised their hand and then I think and maybe you tell me afterward that Google does it or it has something on site. So that impressed me but not that much. The second question was how many of you have been to doctor as regularly as you change your oil or in the last year and half the audience raised their hand and I was really impressed because that is usually a one-percenter for a 31-year-old or 30-year-old. I mean it really is. So that is really proactive care. I mean that is great and I'm just hoping that those doctors do things like examine them down there. Everyone is a little shy about it but...
Well, I heard it was interesting, obviously I don't want to talk about -- I had the great fortune to be there so I don't want to call anything out that anybody from Google sad, but certainly, it was something that you thought a lot about before you did the presentation which is talking about libido, sex drive. It's something that you don't hear a lot of doctors, having gone through this with my husband, it's something that you don't hear a lot of doctors talk about. What advice could or did you give to the folks at Google and would you give to men in general?
I think I have a blog on it called "The Science of Libido" or the "Science of Sex Drive."
Yeah. We have to say that you have a fantastic blog. I mean one of the reasons that we had to have you on the show was there are two areas where you are great with the sort of technology that my listeners love, which is blogging and social media in general, and your blog really is the 1 2 3 4 5 so here's what you do if this the issue and you do it in a really fun engaging way. And then the sort of other area is making things that feel like they are huge big problems making them less panicky, so making them sort of like here's the program that you follow and here's what you do so it's a little bit less daunting than you know.
They're digestible, yeah. Digestible.
Yeah, because that, I mean I know that perks people up but I mean you do lot of -- on the other hand, one of the things I want to ask you about was Clinic by the Bay is a free clinic that a number of doctors contribute to. You're one of the doctors in San Francisco where people can get healthcare and I'm wondering if there was anything during Men's Health Week or any or if it's just part of ongoing care in terms of your role there and helping people that don't get care at all if it wasn't for things like Clinic by the Bay.
Yeah, it's true. I mean Jennifer, I was a highly decorated professor at the University of California in San Francisco for 15 years and writing hundreds of papers and getting grants and teaching and teaching and teaching but you can get caught up in all that and you can feel like you're it and I just thought this is not healthy because I know I was surfing all over the world and giving lectures. You're never home, you're working all the time and it's all glory and I think you do a lot of that for yourself. And the family is saying yeah, "So where are you dad? "Where are you?" "I'm not coming at home." And I just said, "Do I want to live like this?" It was a stressor for me and I just said, so I literally threw the hat and said I got to do it, I want to do it right, give a hand in preaching about men's health, getting grants about it, writing papers about it, but I really want to do it because I love patients and I really wanted to live the dream that I was proposing. And that's what my practice is. It's a man cave and it's a lot of places that you saw me in. You see cars and you see car magazine, you see a surf board and you say, "This guy has got a personality," "This doctor has a personality."
On the television which you know...
Yeah and they could walk outside and take a phone call and there's Wi-Fi and the chairs are like your living room and it looks like a living room. It ain't looked like a doctor's office and the guys came in and that helps. You know why? Because their blood pressure is lower when the nurse takes it and then they actually aren't as nervous. Men can be very nervous in the doctor's office and I don't want to spend 15 minutes trying to figure out -- they've start the conversation. So they come in and they sit down and they're a little more relaxed and they say, these guys hardly ever been to a doctor. I mean I have had patients come in for a vasectomy who said, "I've never been to a doctor and I have three kids," and their blood pressure is to the roof and I'll sit down with them and say, "I know what you're here for and I'm willing to do it but not today and the reason why is because your blood pressure is stroke level and so what I want to do right now is I'll promise you I'll do this if you see this doctor tomorrow or you go to this hospital today," literally make the appointment for them and make sure they arrive there and have the nurse follow up and have it all go so I do a tit for tat. That's what you're dealing with. This is different than women.
Right, and it's nice that you have that bargaining structure kind of in place because I know you probably get I mean at least like I said in my personal experience., you get a better compliance rate.
Yeah. And the other thing is a man's practice is just expect them to be 10 minutes late. I mean you should have street parking because guys love to Street Park so I have street parking in San Francisco and they come in 20 minutes late including the Billionaire Club and say, "I did it." I say, "You did what? You're 20 minutes late." "No, no I got street parking." There's three lots around the office but the street parking, they did it, they got a spot and I think that's kind of funny.
It is. It's very street parking, too.
Men are different. They're different and they don't --you got to finish on time. They've got appointments, they don't schedule very well. They're not multitasking as well and they forget things. So, a man has to follow women. I love it because their intuition is great and they will call me like today they'd come up and say, "Listen, call this guy." I'd say, "Why, I'm busy?" "No, just call this guy." And I'll call him and I'll find out there's something brewing up there that the women can figure out but the man can't and I'll catch the problem before he realizes it's a problem. It's a whole different philosophy about -- but if you want to do it right. And the other thing I use, I use an eService called healthloop.com and HealthLoop is a -- and I'm an advisor to it so that's much my disclosure -- but it's a new startup in San Francisco by Dr. Shlain and it's kind of neat because what I realized in operating on man and doing microsurgery and vasectomy reversals and things is that and a lot of them from out of town is that they don't ever call you. Call me if there's a problem, they never call, never, and so I know there may be problems, so this service is great because we set it up so they get an e-mail and they get into a website which is HIPAA secure so it's secure for patients and then I have a pain scale, a swelling scale, a Twitter box and a place for pictures and I notify them once a day and I can follow them. It's like having -- it's like a health call and all of a sudden this whole world opens up and they're so talkative and "I did this today," "You think this is okay?" and they feel so much more confident about their healing because they're able to just sit at home and type in to a computer and know that they're getting care so it's really, it's ownership, they're getting ownership of their care which is the big point here, is that men don't have ownership nor does medicine in general have ownership of men's health issues which is why this week is so fragmented because endocrinologists do one thing and internists do one thing, and family practitioners do one thing, and ER doctors do one thing, and neurologists do one thing, and I'm trying to be the general contractor for these guys.
Yeah. I mean I have to share this story with you about my grandfather. Even in older age, non-reproductive age men having had a high reading on his urine test and so needed to check out prostate issues and he also had heart problems and he had a doctor that was ready to go and do massive heart surgery for a second time and we found out by -- I said, wait, wait, wait. We need to find out what's going on with the prostate because you know God forbid that's something really awful and it turned out that he had prostate cancer and it has metastasized to the bone.
So it was a worse problem than the heart disease.
It was much worse but because that had been the ongoing problem more or less than the prostate, my grandfather was ready to go with what the doctor said so there's a lot of convincing especially with his generation to say I'm your granddaughter but logically we need to know what the whole picture is, and I think what you're saying is you're trying very much to look at the whole picture and instead of just sort of __30:56__ these problems which can be so frustrating.
Yeah, I think the philosophy of care of men is different, but you don't see men getting angry like this is a great case. Women with breast cancer have to be consented or have to be told about the option of having a breast removed and a replacement artificial implant put in at the same time. That's one of the options so they don't missed a beat sort of. It's a devastating disease and it's nice to have that option, that you can at least look relatively normal right away. There's nothing like that for testis cancer. There wasn't even an implant on the market. It was pulled from the market and no one said a word until one patient of mine found out -- who eventually became my patient -- found out that you can get neuticles. You can get implants for dogs that are castrated or neutered and put those in at the vet so they look better or whatever and he said unbelievably you can get them for dogs and he got really angry because he's a testis cancer survivor about last 10 years ago, maybe more. And he came in and went to the press and got a urologist to buy, to get the neuticles and he was going to put the neuticles and he was going to get a doctor to put the neuticle in him because he wanted them and he was just embarrassed that he couldn't get anything and the FDA found out about it and called the guy if they do this they're going to shut you down because they weren't FDA approved and etcetera and so that caused the big roar and the guy went to the press and I got a call because I'm actually at that point heading a study to put a new testis implant on the market in America it's not the only one that's on the market that's FDA approved right now, and I was the marketing head of the study that put it on the market, wrote the paper and I helped design it and the whole thing and it was studying the autoimmune disease and cancer and all that stuff. Anyway, the guy called me up and I said, "Listen," I said, "Calm down," and I said, "We're working on it. You know we have to do it a certain way right now because it's not the old way anymore. FDA wants to know it's safe and there's all these issues with breast implants in the '90s and 2000s." So and then I look at...and I went to the press and I said, "Listen you guys. Don't ignore this. This is how men work. I mean they really, you really sort of have to take care of him a little bit because it's kind of a little too late reaction there sort of thing but there's a need here and men don't really bring it up. They don't really unless it hurts or it's going to kill them, they don't bring it up and we have to work with that. That is not new."
So, it's is interesting because I, in the introduction to your show on the web, I said that your talks about your involvement with the creation of the artificial testicle and if you're -- I don't know if you follow Wired magazine very much but there were basically breasts on the cover of, very carefully placed breast on the cover of Wired magazine in November 2010 and I sort of challenged Wired to put that on your cover because it create this huge uproar. They had a woman on staff that quit because there were...and it was really about this regenerative tissue technology and sort of it was a bigger picture but I actually thought it was really clever cause I thought a lot of people are going to read this and so my thought was kind of in saying that if Wired had a clever way to put something related to men in their package area on their cover, maybe people would read the story about the need and it would be easier to get funding for it and get it through the process. Where is that in the process?
So there are two kinds of artificial testicles. One is the one I just talked about, which is an implant, and the artificial testicle you're referring to is a way to make sperm in a dish. So the classic user of this technology would be a childhood leukemia survivor of which there are 35,000 a year who were sterilized by the treatment they receive for a horrific disease and never had an opportunity to bank sperm or do something proactive about it because they were kids and so there's really no opportunity for their fertility. I have developed something called mapping and it's just been 15 years old which is a way to map out sperm production testicles in a nonsurgical way in an hour under local anesthesia which has been pretty good and I am actually giving a talk on that at our American Society Reproductive meeting in Orlando in October and it's kind of the big experience. I just put a pretty good paper out in American Journal and the Asian Journal Andrology last month, a review on the whole technology, but basically it's a way of findings small pockets of a few sperm in the testicle that happened to survive the onslaught of chemotherapy and we've got some incredible cases of bone marrow transplant survivors. Bone marrow transplants are the absolute last resort for cancer treatment where you recur and you recur and then you end up getting irradiated. You knocked out all your bone marrow and then you put new bone marrow in from someone else, and you'd basically replaced your whole bone marrow DNA with someone else's and it's beautiful curative stuff but it's say big whack cause the system has to be able to accept it. So I have fathers from that after then. The number of reported pregnancies are probably on, you can count on one finger in the world on that and so we have this mapping patients who come in and they get sperm retrievals and then we use a fancy technology called in vitro fertilization or test tube technology and get it which is relatively routine in other for other reasons but to get these guys to be fathers is really heart warming.
But there are still a lot of them that it doesn't work for and that bugs me for years. And I think it's not that I'm missing sperm with mapping. I think it does a great job. I think it just that it's not there. And if you don't have a stem cell in there, it's going to be hard to make a sperm so I have been working on this for about four or five years and finally have the come from that group of scientists surrounding me that we can get this done including a stem cell biologist and a sertoli cell biologist and a stromal cell biologist and myself and we've been wanting for funding. The government doesn't believe we can do it and keeps rejecting these NIH grants but it's possible. Basically, the idea would be that you're to take the stem cell from a testicle which we have a lot of experience with and I published a bit on and turn it into a to sperm outside the body or take an embryonic stem cell which is kind of voodoo because it comes from embryos and embryos are politically charged little cells and try to push it to a sperm in a dish because some embryonic stem cells are supposed to be able to do anything or take the newest thing which is an adult stem cell which is like a skin cell and take that and turn it into an embryonic stem cell by transforming it with certain genes which is a very hot topic and then pushing that to a sperm in a dish. And so we actually have a clinical trial right now and my patients who are sterile who the maps don't show sperm are candidates. If they have a Y chromosome deletions and the reason they're sterile is because they have a genetic problem on their Y chromosome and they're missing a gene and that results in that and that's it. I mean you're basically a normal guy and you're missing this gene, this one little gene and you're sterile, and that's hard to fix.
So we are biopsying their skin and we're turning their skin into adult stem cells, which we can do now and we've done it in almost everybody, and then we're going to try to push that cell to a sperm in a dish. And Renee Reijo-Pera at Stanford who is working with me, she's just great. Great, great work she's done. She has shown that you can take an embryonic stem cell and get it most of the way to a sperm and you can take a testicular stem cell and probably get it most of the way too. But we're having trouble finishing it because it takes 13 steps to go from a testicular stem cell to a sperm with a tail and clinically we need sperm with a tail. We have tried using stage 11, stage 12 before without the tail and it really has not been successful and it's gone off the market for about 10 years ago. It's a voodoo. You really want a cell that's got everything complete genetically and that be genetically capable and we're not sure those earlier forms are cell, what we can do is we can get some of the earlier forms but they're not ready to be used clinically. And so, we're actually creating an artificial bioreactor, which is going to be essentially a testicle with all the cells in a testicle, in a device and try to put the cells in there and run them all away to the end. And I think you need everything. You doing in a dish is not, you know, sunlight. You don't need sunlight. You need everything that the cells of the testicle supply each other because there are a lot of cells for any reaction. So, it's like building a brain sort of. It's not easy to do but I think I have the critical mass of minds and I think...the government is not interested even though a paper came on nature, the best science journal in the world, about a month and a half ago, it's on my blog, I think it's called Mice Sperm in a Dish, there's a post on it.
It is, yeah.
Mice Sperm in a Dish or something like that. And it was you know, they did it with mice with an organ culture system but they did take the original cell with a mouse testicle cell from a newborn mouse and they turned it into a sperm in a dish, and organ culture, same sort of thing. They built an organ around it and then that sperm was used with technology to have another generation of mice and the generation resulting from that went on to mate normally and have kids of their own, pups of their own. So this is just you know, it's not revolutionary science. This is just a matter of hard work in getting all the details right and getting it done. The other application is new drug development. I mean why spend a million dollars studying mice and beagles for your cosmetics or your new drug for pulmonary hypertension or high blood pressure, looking for reproductive side effects, when animal models might not have anything to do with the human condition. And why not get a human bioassay that will be cheaper, much more green and much more relevant going. So we want to have an assay for the FDA to use and say okay, the 600 to 800 new drug applications coming out every year, if you want, you can go to the animal route, you can spend a million dollars, your company, or you can go to, you know, use this Turek artificial bio reproductive toxicology model, human-relevant bioassay, not disposable, so sort of green, clean and do it that way and get more relevant data. So those are the goals of that artificial testicle and it's exciting. I mean it's just -- I don't know. Maybe I would retire after that just because that would be a holly grail for me.
So, what's preventing it from actually...
Yeah, it's money.
So in the Silicon Valley where people are investing in knowing about influence and all these other things, why wouldn't a VC someone else prominent invest in making babies, allowing people that otherwise wouldn't be able to?
Hard to them. I mean this market is incredibly price insensitive. So, if you're a VC and you want to invest in something, if you're doing something in medicine besides sort of robotics, I mean this is the ultimate market because can you -- I can't tell you how much a patient would pay if you could tell him I could make a genetic sperm for you in a dish that's usable if you couldn't have an opportunity.
And otherwise you would be thought of as sterile, right? This is a sterile...
No. There'll be no other opportunity. No other.
And I can tell, I mean I can tell you how many people in the Middle East would do it because they're not doing donor sperm and alternatives, non-biological alternatives for children. They just...
Right. Non-biological children.
It's not what they want. So, I have patients calling me every six months, but yeah, no one has offered to pay for it and it's -- we need about a million and a half dollars in three years. And for a lot of reasons, it's too early for venture. Angels, it's too risky for angels.
I don't know. I'll be interested when this show goes around because it seems like this is exactly the kind of thing that would yield a high return, but it's early so there is a lot of risk factors. But...
Yeah, there is a lot of risk in time too. I mean there's no product. But the short-term product is this reproductive toxicology model and we're going to work -- as soon as we get some money, we're going to work with the FDA and say, "Listen. We want to develop this with you so that you will say do this or this." And then there is your money maker and then the ultimate product which may not make the money but will be for the good of civilization is to be able to offer an opportunity to make sperm for those guys who just absolutely had no opportunity to have a kid.
Yeah. And it's sort of like, it's interesting thinking about this because there is such a need and is this the future of medicine. If the future of medicine really having...
It's about personalized as you can get, yeah.
Having to go out to the VC community potentially and actually solicit their funds for something that will probably yield them a zillion times in their investment when you look at the worldwide need.
The worldwide need is a big one, yeah. And California, we have a million dollar grant now at the California Institute for Regenerative Medicine to do some of this testicular stem cell work, so my practice in Stanford and a couple of other co-investigators on this grant has been great. California is...it's one of the few places on earth that can get it done because that was a great investment prop, 61 I think in 2003, when Schwarzenegger started, when we put 3 billion dollars into that prop, that was fabulous for California medicine. I mean I gave a talk at the Getty Mansion. We had a salon series there on this and I just said, "Thank you for voting for this." I know pediatric hospitals were also on the bill. Pediatric hospitals always get money but this one started a whole other revolution in science. They're 14 stem cell institutes in California right now. Those are bricking more to buildings and inside full of scientists. I recruited for Stanford or for UCSF when I was there, I was visiting Korea when that guy came out of cloned humans.
Woo-suk Hwang cloning humans in Korea, published in paper in science. I went to see him as a part of a meeting, a mentor meeting, a health meeting. I was in Seoul giving a talk and I just called him up and I said, "Can I tour your lab?" I've never, you know, no one ever met any one of his cloned 10 humans, and he was working on it for spinal cord injury patients, very James Bond like Korean guy, very well spoken, very handsome. He was the darling of South Korea, I mean politically. He was funded for nothing, he had bodyguards. He was Hank Aaron, maybe not Barry Bond, maybe Hank Aaron. And that guy may be was Barry Bond.
Barry Bond has had some help. So...
Yeah, but that's what I'm saying.
Maybe that's a good re-analogy.
This guy [crosstalk] his lab, he is doing pig stuff. He is making -- he wants to make a human compatible pig kidney for kidney transplants for adults, for patients. So, he is trying to make a cross kidney human -- cross pig human kidney that will be accepted by humans but made in pigs.
That's what he was working on, which is a gorgeous idea to supply the need for a transplant. So start with the kidney. Anyway, it's really something.
We have a...Dr. Turek, I need to interrupt you for one second. We have a caller on the line that I want to welcome in. Who do we have on the line?
Hi! This is Rita and I am listening. I don't have internet access, I'm just listening in my phone.
Did you have a question about fertility or anything else related to the topic here?
I was listening because I have a partner that has a low sperm count and so I wish...
I think I [unintelligible].
Yeah. That's a common question, you know.
What do you do about a low sperm count?
Yeah. What do you do by a low sperm count?
I can answer that, Rita. So I'd say when I see a low sperm count, I think what is this guy doing poisoning himself? What's poisoning this man? Or sometimes those are genetic because your stem cell allotment in testicle is low and it could be a genetic issue. So you think about environmental exposures. You start think about things like smoking toxins, any social recreational drugs, excessive use of those things, medications. What diseases do you have? What surgeries have you had? And then what heat exposure, hot tubs, Jacuzzi, saunas, smoking tobacco, things like that, and lifestyle issues, stressors. So this is a stress issue. So if you're stressed by something, your testosterone level will fall. You testosterone level falls, you sperm production will fall. The plant doesn't get enough water. And then if it's none of those things, it could be something on physical exam, one testicle, one doesn't have a testicle, a varicocele, cancer, testis cancer and things like that. And if it is not of those things in physical and then you could probably involve genetics for a lot of it and check for that, and there's a couple of genetic tests that you can do.
So the basic thing is for a listener that has got a partner and because I was one of those women and I was lucky enough to be in the area and find you. You help people all over the world. You can call into the office and get 10 minutes free counsel.
Yeah, and that's simply...
But you need to come in or whether.
Right, not to solve the problem but it will understand whether it's a good step or whether you should be getting care first of all and maybe care with me. I just do that as a public service basically.
Yeah, exactly and I think that's what's the magic about it. It's that you know, you're a world class doctor but for someone like our caller here, you know, her significant other, you know, she could have him get on the phone with her on the other extension and just, you know, turekclinic.com and...
And it's a site where you could put your issue in, you know if you want a call or not.
Yeah, and you were great with e-mail and those sorts of things too. So I think that's, that's something I would, think about the things that Doctor Turek just mentioned, are they smoking, what are the things they're doing to their body. Are they eating well, are they -- what is the stress level like that sort of thing and then if none of those things are helping with the issue then, it's time to get a counsel something...
Yeah and I have to say, the place to start with a guy is not a gynecologist. Because typically the woman goes in and she gets checked out to the tune of thousands of dollars and then they go for another year and then the guy gets the same analysis and there's a problem there and so, I've been banging this drum for a while but basically the guy should see a specialist as soon as the woman does. There's no reason not to. It's about that I mean it's a male issue. So...
I should -- this is very personal but I should tell people that the reason that I know who Dr. Turek is, is because my OBGYN was checking me out and I asked my husband and started to beg and see a little bit but he did it. Once I convinced him it wasn't going to hurt. To have a semen analysis done so he, we had the results when I went in for my exam and I've been seeing my doctor forever, so she knows my very long term history and she's going everything's fine I'm not sure what's going on and the last thing why she picked up the fax at the machine and came back in and she goes "wait, everything is changed". She wrote your name down on her pad and she said this is your prescription. He needs to see Dr. Turek. We're lucky he's in the San Francisco area. I mean, you get people from all over the globe.
Oh yeah. We get international patients weekly, yeah. So I want to say is my simple story. So till this famous stencil scientist crashed. So he forged this data. We found out a year later. But in the meantime, when I was visiting his lab and very impressed of what he had done, we were crowded. Do you see yourself now in Stanford one of the people, one of the supposed doctor who had cloned people and that's how powerful California medicine is. I mean, the whole world would like to come here, except for maybe China which does it on a film but so that's the end of that story. I just want to finish it because I was just an excited little guy like me picking up, plucking scientist around the world to come to California because it's a fertile place for stencils science.
So, this is again, this is the example of the guy that cloned the sheep, right?
Yup, Dolly right.
And it came full circles so he is, is he now at Stanford?
You know I don't that, I don't know where he is.
But he is [cross talking]
Well, his name is Will Knight. I don't know where he went. Maybe he was consent, I don't know.
Because of the cheese right? But yeah, I mean, it's fascinating that experiences that you've had. I mean, just being able to have the audience with the _54.05_ who are so powerful in terms of political contribution and, you know, they can actually move a needle on a lot of thing.
In dealing I wanted to stay with this Clinic by the Bay. I'm one of those guys I was taught in college to get back and, so it's a party your life. Whether it was academics or not, I always find myself giving back in big ways and because like I tell people and also my patients are not happy with the economy and they work in the internet industry or they retire in the 30s and they say I'm leaving, I'm going to Hong-Kong it's cheaper. You get fewer taxes taken out, I lose my citizenship if I stayed 10 years but I'm out. It's like but I stopped them and I closed the door and I looked at them and I say but, we raised you, I mean it takes a village to raise someone like you to be successful. And you did in this environment, why would you not want to stay and get back to it. I just go ask them. And so the Clinic by the Bay is a big give back for me because it's a free primary care clinic for the working uninsured in San Francisco. So, it is a bright light modern space in which doctors see patients in my model which is an hour of visits but it's free. About an hour visit and get free care and their families if they qualify and you have to be working in San Francisco and uninsured. So immigrants can do it and there's now we're going by zip code. But it's been a fabulous and all the grants of modern science are now grants for this to go. We have McKesson funding, you see Access funding, we have Walgreen, Cisco. We have three courses of million dollars with the grants and one -- and we've been open for about six months and it's just booming. Retired doctors come in and donate four hours of their time who know what to do and there's electronic medical records. It's just incredible. And the response by the city with healthy San Francisco has been great. And I'm one of the founders of the, one of the founding board members and also I chaired the advisory committee.
So I'm the guy responsible recruiting doctors and we were working on it for five years and just launched about nine months ago, it's called "Clinic By The Bay www.clinicbythebay.org and you'll see a great video on the landing page of the opening in November when Diane finds, Diane opened it and said you guys have raised so much money I've never seen something like this. But it's just then, it's just on a great feed and I -- if you watched the video, you'll see my attitude is I've been to Africa and I volunteered in places in all over the world and I think it's a real kick to be a doctor and give back and fix a cleft palate, or help someone in another country of something but you're really, you're really not making a big dent. You know, you're really doing it for yourself, you are helping people but not, not the most efficient way and I like the idea of and I find it very thrilling to do, and I find it actually good about myself but it's also a little bit of a -- I went to Africa and helped people. I really like the concept of giving back in your own backyard. And I like the concept of giving back to your own community because you know I was thinking why did they go there? I could have gone to _57.24_ and probably done more good than Africa. And now I think giving back in my backyard everyday in San Francisco is delightful. It's like a shot in the arm everyday.
And there's a Clinic by the Cay Facebook page. Hopefully there will be soon Clinic by the Bay Facebook cause so people can donate money.
Yeah, we get five to ten dollars, I mean, we just look, it's just opening. It's great then you feel part of a community.
Yeah, you're feeling that -- and I'm sure, you know, the volunteers there are just fantastic because it's, volunteers in San Francisco...
We have VISTA volunteers there.
Yup, we have VISTA. We have -- we're going to probably getting students from UCSF where intermediately connected. My biggest thrill from this is -- one of my heroes from UCSF was a neurosurgeon named Charlie Wilson. Charlie Wilson is in his 80s now and I never met him there. I was in the parking lot at 6 am parking near him, he had a spot. Okay, in UCSF only Nobel Prize winners get a spot or chairs at department. They are very big people. And I would scramble for a spot as an assistant professor but this guy has his own spot and he had no Jaguar parked there, and I get there when he did sometimes and I just try and run catch him but he ran so fast, I never talked to and he is just one of the shakers and the movers of New York article about him and Tiger Woods and Wayne Gretzky about how you get that good as a neurosurgeon. And you know he is a brain surgeon, right? So he retires, I'm giving a talk about the Clinic by the Bay to the San Francisco medical society, he comes up to me and he says I'm in. He had known where I was in fact.
He knew it was from the stage and I was like, and right now Charlie Wilson, _59:10_ this professor, UCSF is my right hand man and he comes to my clinic for my advisory board meetings and he pipes in and it is -- I'm honored to be in a room with him. And he is a buddy, and I take him to the car after in the rain and I put him in his car and he drives off and he writes me a note and says thank you for helping with my car. And you know, it's just, life is amazing. What you get out of it is simplest things. But you know every word he says is something I would write down.
That's so cool. And I, as much as Clinic by the Bay is the most amazing thing. The other thing people out there probably would want know about this again if you're not in the San Francisco bay area that there are, you know, doctors and resources that are trying to help. So, think getting in touch, maybe writing on the Facebook wall or getting in touch with Clinic by the Bay to see if there is a resource in your area is not a bad idea.
Yeah. There are Clinic by the Bays all over the country. They're called Volunteers in Medicine clinics and there is 87 of them in the country. So, it is the only urban one so that's why it's kind of been watched closely.
Yeah. And also San Francisco I think just in general having a lot of initiatives around us it's been a big -- big deal. So, you know as I conclude here, you know I wanted to say one -- I wanted you to be able to talk about one thing in terms of the empowering that you've talked about and that is your connection to the Lance Armstrong Foundation. The sort of guy that's the foster child for everything that you should do right. You know in terms of taking care of yourself, being international -- internationally known and huge superstar around the globe for the _1:01:08_ and everything. And he had -- because of testicular cancer had issues with having children and that sort of thing. And now you said on the board of the nonprofit that is behind it all and would your study the weigh in on your experience with that in kind of how you got connected with it because I think it's a great example of how everyone is touched by...
Yeah. I mean that you know Lance is like Viagra for the country. Lance did as much from them to help as Viagra did. So, Viagra was the first pill for erection. Then you know guys are storming in to see doctors, but while they're there you got everything done. Where you examine the prostate or everything else and you get them in the door. So, I get this it's the wild animal thing. You get them in once and try to do as much as you can while they're there and not hurt them. And Lance did the similar thing in terms of awareness, public awareness. I mean, you could develop a campaign better than Lance -- a guy who came in with metastatic testes cancer because he didn't -- he actually got diagnosed a little late and had it in his brain and then he went to chemotherapy and then he went how many doctors he went after, but most of them he want after is chemotherapy and we talk about Billy.
And so you know and then starting a billion dollar nonprofit and I have a lot of times of had a Lance Armstrong Foundation grant for some -- my early science in this area back in UCSF and he was funding. We weren't even doing testes scan. And I think they're doing sort of infertility genetics and stuff and he funded that. And then I got involved with Fertile Hope, which is now under the Lance Armstrong offices and I'm on their board. So, I do a lot of the fertility. So they have fertility count at Lance Armstrong's website. You know Lance Armstrong Foundation has fertility calculators and stuff so that if you have cancer, you can go online and a woman or a man and look at these complex calculators of you know what kind of chemo, what kind of cancer, did you get radiation to get this, get that and then it tells you what your options are. And it's great as if before that you start or after you start in. We spent hours pouring over these things for accuracy, but there are great reproductive calculators and things like that. I just -- I'm just again, I'm a big fan of Lance and I like giving back. He had a quarterly magazine that just started coming out about a year ago and I was in the first edition of it for mapping. We did a nice layout on a cancer survivor who has kids and it was a good story. So, I was really honored to be in their inaugural edition of the Lance Armstrong quarterly _1:03:59_ that was called the LAF Quarterly I think it's called.
That's amazing. I think you know it's such a - it's a wonderful connection that you have and you have a connection to lots of different things. Textbooks that in terms of men's health that the men that are in training or women in training in this area or learning and shaping their minds and I thank you so much for spending the time with us.
We actually gone overtime talking all about everything and I feel like there so much more we could talk about, but I'm glad we had a chance to talk about men's health. We can -- your contribution to it in the discussion that you had at Google.
Jennifer, I want to thank you for bringing this to light because it is an ignored area of medicine. Men are underserved. It's complex. It's their problem -- it's everyone's fault but men are underserved and this is exactly what we need, public awareness needed like Lance, like this, to bring to light just improve the hell out of care that we give them.
That's fantastic. Well, thank you so much Dr. Paul Turek. We'll let you go and get on with your very busy day.
Thank you Jennifer.
And again that was Dr. Paul Turek who leads. He is the doctor of Turek Clinic in San Francisco. But in the addition, he lectures all over the world, give keen out lectures all over the place. And authors, some of their co-authors in the book -- textbooks that lead the area of men's health and because it's an underserved area and I've had experienced and I met Dr. Turek from my own husband's issues in this area, I just think it's something that we can't shine enough light on. So, this is one of my sorts of bleeding heart episodes of the A-list and I hope -- I hope all of you are or some of you at least have gotten some -- get information about this. Please spread this around. It's incredibly shareable. And if we get lots of questions, please send them my way and I'm happy to filter them to Dr. Turek and I'll have a blog post on this that you can contribute too as well. So, I want to thank each and every one of you for tuning into this very special edition of the A-list with me Jennifer Neeley. We hope you enjoy the program and if so, we'd love it if you'd be so kind to friend us or add as to your favorites here on Blog Talk Radio, or if you are over on iTunes, subscribe and rate us. We can never have enough ratings to know how we're dealing and we always want to be doing better. As always, you can keep up with the latest on this show, archive and free informational webcast at jenniferneeley.com. Thank you so much for joining us and have...
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