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Speaker 1: It's that time time, time, luck and load. So Michael

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Speaker 1: Varie show is on the air. Got lies cooking into

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Speaker 1: mic We gotta feed it Beard.

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Speaker 2: I don't plan to shave, and it's good thing, but

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Speaker 2: I just gotta see.

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Speaker 1: That show is sponsored by Peanut Butter.

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Speaker 3: For pure versatility of application, ability to make anything it

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Speaker 3: touches better, and shelf life.

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Speaker 4: I don't know that there's anything better that comes in

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Speaker 4: a bottle. I really don't. I really don't.

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Speaker 1: Let's just take a moment and think about your best

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Speaker 1: peanut butter moment. Ramon. Your peanut butter moment should not

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Speaker 1: involve sex.

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Speaker 4: But my urologist, doctor mohicth Care is our guest, Welcome

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Speaker 4: to the program. Good sir, Thank you Michael. Everyone has

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Speaker 4: a lifespan, Ramon. You know that you have a lifespan.

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Speaker 4: We talk about our life span. Doctor Mohit Kara is

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Speaker 4: writing a book called or about the sex span. How

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Speaker 4: long can a human being have a functional, fulfilling sex life,

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Speaker 4: doctor Kara?

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Speaker 1: Why does that matter?

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Speaker 2: Well, Michael, first, thank you for having me on the show.

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Speaker 2: You know everyone where you go, every where talks about

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Speaker 2: lifespan and health span. That's the big buzzwords in the community.

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Speaker 2: And I'll give you an example. Everybody wants, I assume

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Speaker 2: their health span to last as long as their lifespan.

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Speaker 2: But in the United States, the average health lifespan is

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Speaker 2: seventy seven years old. Women live typically seventy nine years old,

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Speaker 2: men live typically seventy five years old. But the health

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Speaker 2: span in the United States is roughly sixty seven years old,

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Speaker 2: which means most of us, for the last ten years

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Speaker 2: of our life life are not going to be living

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Speaker 2: in a healthy condition, which is very unfortunate. And all

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Speaker 2: these countries talk about how they're expanding their lifespan and

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Speaker 2: getting people to live longer. In my mind, that is

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Speaker 2: not what I want. Do not expand my lifespan without expanding.

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Speaker 5: My health span.

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Speaker 2: But this concept of sex span is also important because

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Speaker 2: many men would say, look, I said, if you're going

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Speaker 2: to live till eighty, but you can only have sex

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Speaker 2: till fifty, that's a problem for many men. And so

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Speaker 2: what we want to do is try to expand our

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Speaker 2: sex span and our health span as long as our lifespan.

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Speaker 2: I think that's a really important point.

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Speaker 1: I know.

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Speaker 4: One of the things I like about you is that

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Speaker 4: you don't just rely on what you learned in medical

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Speaker 4: school and then mail it in every day. You're constantly

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Speaker 4: reading studies, you're constantly performing research and publishing and speaking

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Speaker 4: literally around the world because you're always somewhere else when

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Speaker 4: I call you to see what you're up to giving

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Speaker 4: a speech on this or that.

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Speaker 1: How important is to the human body in terms of purely.

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Speaker 2: Physically, Yeah, it's extremely important. So I want to just

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Speaker 2: clarify one thing. A rectile dysfunction is not a disease.

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Speaker 2: It's a symptom of other underlying diseases. Right, So ED

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Speaker 2: does not happen in healthy men as that get older.

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Speaker 2: If a man gets a rectile dysfunction, it is a

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Speaker 2: symptom of his diabetes, it's a symptom if his cardiovaskar disease,

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Speaker 2: it's a symptom of his radical proces detectingosurgery. Or it's

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Speaker 2: a symptom of depression or anxiety. So when someone develops

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Speaker 2: a rectile dysfunction, the second question you should be asking

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Speaker 2: is what else is going on that's causing this condition,

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Speaker 2: because if he was perfectly healthy, that would not happen, right,

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Speaker 2: And so the best example I can give you is

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Speaker 2: this is that if did you know that if a

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Speaker 2: man walks in today and has a rectile dysfunction, fifteen

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Speaker 2: percent of them will have a heart attack or stroke

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Speaker 2: within seven years fifteen percent. It's an underlying marker of

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Speaker 2: cardiovask disease and walks in with ED today. Thirty percent

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Speaker 2: of them have a cult diabetes thirty percent, which is

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Speaker 2: a lot. And if a man walks in today, thirty

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Speaker 2: percent of them will have depression or anxiety. So the

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Speaker 2: biggest mistake I can do is give this man viagra

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Speaker 2: and send him on his way, because maybe he has

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Speaker 2: that occult cardiovask disease, maybe he has diabetes, maybe he's

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Speaker 2: suffering from depression or anxiety. So it's really important to

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Speaker 2: figure out what is causing that ED. And what's so

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Speaker 2: nice about this is that there's a bi directional relationship.

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Speaker 2: So if I treat a man's ED, that actually improves

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Speaker 2: his depression. If I improve a man's depression, it actually

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Speaker 2: improves his ED. So I think the paradigm is shifting.

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Speaker 2: No longer do I want to just hand the man

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Speaker 2: the pill. You've got to figure out what's going on underneath.

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Speaker 2: Because this is what I call the canary and the

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Speaker 2: coal mine, and you can actually save someone's life. I mean,

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Speaker 2: imagine if I catch someone's cardiovaskar disease today, or diabetes today,

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Speaker 2: or I catch it ten years from now, it's a

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Speaker 2: total trajectory in terms of their house span and their life.

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Speaker 4: Well, it goes back to viagra originally being a cardiovascular

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Speaker 4: disease in a off label benefit being.

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Speaker 1: The ability to get erection.

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Speaker 2: Yeah, Michael, that's a funny story because remember this one.

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Speaker 2: But they were trying to make a blood pressure medication

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Speaker 2: and accidentally everyone in this study was getting erections, and

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Speaker 2: they figured it out because people were not returning the pills.

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Speaker 1: I had a friend.

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Speaker 4: I was a baby lawyer at the time in a

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Speaker 4: firm called Jakins and Gilchrist and I worked with a

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Speaker 4: guy named Darren Alt who was my best friend there.

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Speaker 4: And his wife, Tracy, was the head of viagra in Houston,

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Speaker 4: which was the top market for viagra in the country,

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Speaker 4: and they were taking a trip every other week with

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Speaker 4: their sales reps, and they had all sorts of stories

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Speaker 4: of people and at that point it was still you'd

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Speaker 4: go to your cardiologist to get viagra, So everybody was

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Speaker 4: faking a heart problem to go in and get this medication.

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Speaker 4: And and the story goes that the doctors were getting

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Speaker 4: calls from the wives going, hey, knock it off, take

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Speaker 4: him off of that.

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Speaker 5: Right, right, right right?

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Speaker 2: Yeah, absolutely, And so you know what the issue is

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Speaker 2: is that ED back then was not considered a very

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Speaker 2: serious condition. People used to make fun of it. And

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Speaker 2: oh he has ED. ED is a very serious condition.

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Speaker 2: Someone gets erected on dysfunction, take it seriously. Something else

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Speaker 2: is going on.

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Speaker 4: Well, And to oversimplify this, that is because it means

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Speaker 4: you're not getting proper blood flow or you're not pumping

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Speaker 4: your blood properly. And that's I guess as good a

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Speaker 4: way as any for us to check, maybe the easiest way.

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Speaker 2: Yeah, And so think about this. I teach their medical

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Speaker 2: students this new monic called vent vascular, meaning there's not

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Speaker 2: enough blood flow coming in or there's too much blood

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Speaker 2: flow coming out. And too much blood flow coming out

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Speaker 2: is the most common cause of ED. So the guy

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Speaker 2: will tell you I can get the direction, but I

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Speaker 2: just can't maintain it. He's telling you the blood flow's

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Speaker 2: coming out too quickly. The number one cause it in

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Speaker 2: the world. But VENT stands for vasco e means androcrine.

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Speaker 2: It's a testosterone. The testosterone goes low, ED goes up

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Speaker 2: neurologic meaning nerve injury and then trauma. And don't forget medications.

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Speaker 2: Medications are notorious, for example, beta blockers. How many people

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Speaker 2: are on beta blockers shuts down the erections. Anti depressants

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Speaker 2: shuts down the directions. So you've got to look at

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Speaker 2: all the different causes for ED. And I just want

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Speaker 2: to stress one other thing. Sexual dysfunction is a couple's disease.

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Speaker 2: You know, we're so fixed on these silos. I got

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Speaker 2: to take care of the woman, I got to take

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Speaker 2: care of the man. You got to look at both

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Speaker 2: of them. I'll give you an example. Back in two

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Speaker 2: thousand and seven, I finished my fellowship and I was so.

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Speaker 5: Proud of myself.

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Speaker 2: I was able to get these men, these amazing erections,

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Speaker 2: amazing libido. And one day a woman called me and

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Speaker 2: said to me, she said, everything was great with our

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Speaker 2: relationship until he met you. We never fought. We fight

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Speaker 2: all the time because every day he wants to have

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Speaker 2: sex with me and I don't want to have sex

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Speaker 2: with him. And you've ruined our relationship. And I thought

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Speaker 2: to myself, she's right. What is the point of raising

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Speaker 2: one libido without raising the other. Either leave both libidos low.

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Speaker 2: It's fine, leave them both low, or raise both, but

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Speaker 2: you don't raise one without the other.

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Speaker 4: Doctor Mohit Kara at the Baylor College of Medicine and

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Speaker 4: my urologist and friend.

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Speaker 1: Coming up the book will be I'm going to get

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Speaker 1: the name of it.

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Speaker 4: It's about the sex ben maybe called or sex Beanermontine,

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Speaker 4: A hard problem to Libian.

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Speaker 1: Everyone listens the Michael Arry Show.

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Speaker 4: The only downside to having doctor Mohit Kara on the

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Speaker 4: air as our guest is then people ask me how

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Speaker 4: to get in to see him because it takes so

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Speaker 4: long to see him because he is so insanely popular.

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Speaker 4: Everybody I know is now his patient after hearing my

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Speaker 4: experience with him.

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Speaker 1: He's just fantastic. I think the world of him.

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Speaker 4: Doctor Mohi Kara is at Baylor College of Medicine where

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Speaker 4: he is a yearrologist. He has a forthcoming book. Is

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Speaker 4: the book called the Sex Span. What is the book called?

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Speaker 2: It is called sex Span and a Proactive Approach, A

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Speaker 2: proactive approach to prolonging your sex span.

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Speaker 4: So as we were going into the break, you made

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Speaker 4: a statement about if you help a man build his

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Speaker 4: libido and his sexual function, but you do not concurrently

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Speaker 4: do that for the woman, you end up causing problems

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Speaker 4: for them.

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Speaker 1: Let's take the physical out for a moment.

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Speaker 4: In your opinion, how important is sexual relations to a

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Speaker 4: couple and to an individual emotionally? You tied it to

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Speaker 4: the antithesis of depression, but talk about that if you would.

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Speaker 2: It's extremely important. If you look at couples that engage

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Speaker 2: in regular sexual activity, that tend to be happier overall,

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Speaker 2: satisfied with their quality of life, they usually tend to

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Speaker 2: be healthier and easily tend to live longer. So there

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Speaker 2: are numerous aspects. So there's a one study that I

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Speaker 2: saw that talked about couples that engage in who do

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Speaker 2: not engage in sexual activity typically can have a twofold

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Speaker 2: traction from their relationship. But if they do engage sexual activity,

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Speaker 2: it actually can add four x to the quality of relationship.

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Speaker 2: So I mean, let's be honest. I mean it does

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Speaker 2: bring intimacy and closeness to the relationship. It does strengthen

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Speaker 2: the quality of the relationship, and in many cases people

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Speaker 2: find this extremely important. So I do think that there

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Speaker 2: is a medical benefit, psychological benefit, and patients engaging in

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Speaker 2: sexual activity.

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Speaker 4: I have had friends over the years when they put

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Speaker 4: their parents in old folks homes. They talk about how

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Speaker 4: it is surprising how much activity there is in the

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Speaker 4: old folks home. And when I did that for my

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Speaker 4: dad earlier this year, that was one of the things

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Speaker 4: that everybody consistently across the board talked about. I don't

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Speaker 4: know if there's any if there's anything to that, but

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Speaker 4: we're talking about people in their eighties and nineties, and

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Speaker 4: I have heard this story consistently.

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Speaker 2: You're actually right. So one of the highest levels of

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Speaker 2: a TVs do occur in nursing homes. So you do

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Speaker 2: know that there's increased sexual activity that does occur in

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Speaker 2: those in those nursing homes and so, but part of

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Speaker 2: it is because there's at some point, there's an inflection point.

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Speaker 2: As you live longer and longer, those patients that are

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Speaker 2: the healthiest tend to live the longest, and those patients

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Speaker 2: who are tend to be healthier tend to be more

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Speaker 2: the ability to engage in sexual activity.

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Speaker 4: When you and I talked about the book the first time,

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Speaker 4: you said that one of the things that the book

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Speaker 4: is going to cover is the importance of screening for

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Speaker 4: testosterone and how erectyal dysfunction is a marker of other

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Speaker 4: underlying major medical conditions, such as a heart attack. The

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Speaker 4: screening for testosterone, why is that important?

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Speaker 2: So, Michael, I am very passionate about this topic because

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Speaker 2: you know, everyone thinks about testosterone as energy and sex

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Speaker 2: drive and erections. And yes, it's true if you have

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Speaker 2: low energy, low labido, rectal dysfunction, giving a man testosterone

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Speaker 2: can improve these symptoms. But now we're in an era

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Speaker 2: where it goes way beyond that. So did you know

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Speaker 2: that a man who has low testosterone is much more

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Speaker 2: likely to have a heart attack, non negotiable, much more likely.

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Speaker 2: A man who has low test osoe is much more

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Speaker 2: likely to break a bone. A man who's low test

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Speaker 2: OSMO is more likely of diabetes, obesity, metabox syndrome. A

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Speaker 2: diet man who's low test auso is much more likely

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Speaker 2: to suffer from depression. And giving a man back his

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Speaker 2: testosterone can help mitigate improve these conditions.

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Speaker 5: So it's not just.

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Speaker 2: About sex, it's about your overall health. The problem I

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Speaker 2: have is that when I walk into my primary care

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Speaker 2: doctor's office every year, and he checks my blood. He

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Speaker 2: does not check an annual testosterone. He'll check a thyroid,

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Speaker 2: He'll check a TSH. I say, why are you checking

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Speaker 2: at TSH? He said, well, we do that every year

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Speaker 2: to make sure you're not hypothyroid. There is not a

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Speaker 2: better marker of a man's overall health than a testosteron level.

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Speaker 2: It gives you a marker vel what his health is today,

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Speaker 2: and it gives you a marker of what his health

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Speaker 2: will be in the future. And so every man over

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Speaker 2: the age of forty, every single man, should be getting

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Speaker 2: a testosteral level every single year after days of forty,

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Speaker 2: because I do think it's the best predictor of his

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Speaker 2: overall health currently and in the future.

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Speaker 5: And it's modifiable because there's things.

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Speaker 2: I can do to improve his testosterone if he's low.

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Speaker 1: You suggested testosterone for me ten years ago.

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Speaker 4: I know you weren't going to talk about it because

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Speaker 4: you're the doctor, but I can, and obviously it changed

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Speaker 4: my life. It made a huge difference for me. But

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Speaker 4: when you do that for folks, what kind of differences

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Speaker 4: do you typically see?

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Speaker 2: Well, the first thing you have to ask yourself is

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Speaker 2: are they young and do they want to have children,

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Speaker 2: because most people don't realize that giving testosterone actually shuts

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Speaker 2: down your fertility. So I can't tell you how many

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Speaker 2: patients I see in my practice every week that said, look,

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Speaker 2: I was started on testosterone or no one told me

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Speaker 2: that the test osk could make me infertile.

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Speaker 5: Now we want to have kids? What do I do?

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Speaker 2: So there's the ways I can reverse it. So the

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Speaker 2: reality is, if you're in the reproductive years, if you're

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Speaker 2: planning on having children and your tea is low, don't

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Speaker 2: take testosterone. But let me give you medications that make

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Speaker 2: you make testosterone.

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Speaker 5: That's safe.

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Speaker 2: So I can give you medicaida to make you make

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Speaker 2: test alstone and that will enhance your fertility. But if

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Speaker 2: you're older and you're not trying to have children, then

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Speaker 2: there are many ways to give a man testosterone. We

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Speaker 2: now have oral testosterone, which is fantastic world Testallsinal is

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Speaker 2: very new in the United States. It's only been out

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Speaker 2: for five years. And that we have a pill, we

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Speaker 2: have injections, we have palaty patches. But I will tell

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Speaker 2: you that I do think that this medication can have

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Speaker 2: a profound effect on the quality of life, and many patients.

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Speaker 2: I mean, many patients come in they're thanking you, they're

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Speaker 2: telling you that they have a significant improvement the direction

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Speaker 2: as their libido muscle mass. Not everybody, I mean, there

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Speaker 2: are patients that don't respond, but the majority of patients

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Speaker 2: who start out low do see a significant improvement in

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Speaker 2: their quality of life.

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Speaker 4: I was talking with one of our show sponsors, Wayne Wilson,

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Speaker 4: who owns Synergenics, and he.

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Speaker 1: Said, hey, you're urologist.

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Speaker 4: Is the one who came when we started, I guess

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Speaker 4: with pellets or whatever, and came and talked to them

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Speaker 4: about testosterone and obviously that's what they do all day,

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Speaker 4: every day. And he went through the various things that

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Speaker 4: you talk about. I mean he took note. He's a

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Speaker 4: physician's assistant by training. But it was amazing to me.

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Speaker 4: You were the god of testosterone as far as Synergenics

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Speaker 4: is concerned. And I didn't know you had an association

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Speaker 4: with him.

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Speaker 5: No, I appreciate it.

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Speaker 2: I mean I have been very passionate about this for

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Speaker 2: about twenty five years. So all my basic science who work,

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Speaker 2: all my lab, all my clinical trials are around this topic.

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Speaker 2: So when it comes to teaching and education, to others

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Speaker 2: about testoscerone.

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Speaker 1: I'm all in one moment. Doctor Moti Kara is our guest.

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Speaker 1: He's at Baylor College of Medicine, and I'm going.

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Speaker 4: To start with the question everyone always asked, Well, am

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Speaker 4: I more likely to get prostate cancer?

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Speaker 1: Mike, weren't you worried about prostate cancer? We'll ask him

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Speaker 1: that coming up.

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Speaker 4: With his finger on the pulse, The King of Team

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Speaker 4: continues on the Michael Berry Show. Doctor Motith Kara my

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Speaker 4: urologist and friend of Baylor College of Medicine and internet

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Speaker 4: renown as a speaker on issues of sex urology, testosterone.

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Speaker 4: Forthcoming book is called sex Span, which talks about the

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Speaker 4: length of time in which a person has a functional

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Speaker 4: sex life that will be out relatively soon. Doctor Kara,

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Speaker 4: I received an email from a fellow named Doug who

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Speaker 4: writes three minutes ago. I figure your interview is pre recorded,

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Speaker 4: but if not, I'm curious about blood clots. I had

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Speaker 4: a pulmonary embolism and they told me to stop taking testosterone.

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Speaker 4: I used to go to the Low T Center and

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Speaker 4: had a great experience experience with the treatment. I miss it.

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Speaker 4: I hate that I can't take it anymore. Does doctor

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Speaker 4: Kara have a thought about that.

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Speaker 2: I do, Michael, so listen. There was a concern for

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Speaker 2: that in twenty fifteen and the FDA asked to conduct

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Speaker 2: a large trial. It was called the Traverse Trial. I

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Speaker 2: was fortunate enough to involved in that trial with myself

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Speaker 2: and eight other physicians, and we designed this trial with

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Speaker 2: several hundreds of millions of dollars and the goal was

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Speaker 2: to see if it caused increasing cardiovascar events and prostate cancer.

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Speaker 2: What it did find was there was no increase in

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Speaker 2: heart attack in those men taking testaws and versus placebo.

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Speaker 2: We had over five thousand patients. We followed them for

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Speaker 2: four years, and there was no increased risk in DVT,

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Speaker 2: but there was a slight increased risk in pulmonary embolism.

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Speaker 2: And the difference was a difference of between point five

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Speaker 2: percent and point nine percent, So there was a slight signal.

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Speaker 2: And I think it's very important to counsel patients when

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Speaker 2: they ask about that. So I guess again, you know,

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Speaker 2: I don't believe that. I personally don't believe that test

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Speaker 2: OSA increases the risk of DVT and pulmonary embolism. I

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Speaker 2: think the difference was small, but the traverse trial showed

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Speaker 2: what it showed. Also, I just want to mention it

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Speaker 2: showed no increased risks in prostate cancer and no increased

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Speaker 2: risk of worsening of urinary symptoms.

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Speaker 5: Great study, traverse trial.

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Speaker 1: Why do you think this is out there?

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Speaker 4: Because I have a friend who started on testosterone, heard

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Speaker 4: me talking about it. He starts on it, three months later,

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Speaker 4: he gets prostate cancer.

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Speaker 1: He a text message says, Hey, I.

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Speaker 4: Just want you to know I just started on testosterone

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Speaker 4: and I got prostate cancer.

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Speaker 1: You need to be careful.

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Speaker 4: And my immediate response was, you haven't been on testosterone

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Speaker 4: long enough. Even if it did cost prostate cancer for

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Speaker 4: it to have caused that, if there was no testosterone

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Speaker 4: supplement out there, men still got prostate cancer at rapid,

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Speaker 4: at large rates.

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Speaker 1: You can't blame every one of them on testosterone.

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Speaker 2: I absolutely agree with you, And I got to tell

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Speaker 2: you where it started from. It started in nineteen forty

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Speaker 2: one when Huggins and Hodges publish the famous paper I'm

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Speaker 2: showing that when you give a man test increases the

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Speaker 2: risk for prostate cancer. If you and I go to

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Speaker 2: the library right now and pull that paper, you're going

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Speaker 2: to find something very interesting. It was based on one patient,

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Speaker 2: one patient nineteen forty one, and we had instilled fear

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Speaker 2: in us for so many years. Good news is in

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Speaker 2: twenty eighteen, my society, the American Neurologic Association, said testosterone

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Speaker 2: does not increase the risk for prostate cancer, strong recommendations.

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Speaker 2: So we do not anymore have a concern that testoster

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Speaker 2: increases the risk for prostate cancer. I'll tell you a

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Speaker 2: very interesting story. If you I had metastatic prostate cancer

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Speaker 2: all over our body and we walked into Johns Hopkins

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Speaker 2: University today, they would there's a trial where they put

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Speaker 2: us on high doses of testosterone to reverse the prostate

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Speaker 2: cancer and it works. It reduces the PSA, reduces the metastatasy.

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Speaker 2: So we're learning a lot about testosterone prostate cancer. And

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Speaker 2: this is the concept that testoster increases the risk. I think,

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Speaker 2: to me is a myth. Michael, I want to bring

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Speaker 2: up one un important thing. You talked about this earlier

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Speaker 2: about testosterone, and you said when you give testosterone, does

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Speaker 2: it make people feel better? But I tell patients that

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Speaker 2: you know, you've got to understand there's something that's just

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Speaker 2: as important. It's lifestyle modification, diet exercise, sleep, and stress reduction.

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Speaker 2: I don't have a pill on the in it stronger

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Speaker 2: than diet, exercise, sleep and stress reduction. And every day

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Speaker 2: when we wake up or when we go to sleep,

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Speaker 2: we should ask ourselves what are we going to do

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Speaker 2: on diet, exercise, sleep instead of stress reduction. I call

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Speaker 2: that offense. I four things on offense, and then I

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Speaker 2: call it four things on defense.

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Speaker 5: Only four ways you and I are going to die.

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Speaker 2: We're going to get cancer, we get a heart attack,

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Speaker 2: we're going to get metabolic disease, mean diabetes, obesity, or

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Speaker 2: we're going to get Parkinson's or Alzheimer's. So on the defense,

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Speaker 2: every day we should ask ourselves how are we going

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Speaker 2: to keep those four things away? And our offense, how

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Speaker 2: we're going to move our health forward with those four

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Speaker 2: that I think is a really important point I wanted

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Speaker 2: to get across.

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Speaker 5: We have a big program on that.

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Speaker 2: I mean every time someone comes in, I have a

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Speaker 2: program for their offense and defense. It's really important.

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Speaker 4: The four on offense, which you have preached since the

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Speaker 4: day I'm at you, diet, exercise, sleep and stress reduction,

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Speaker 4: and do you have four on defense?

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Speaker 2: The four on defense are absolutely so it's cancer, which

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Speaker 2: means it's a heavy cancer screen calling off could be PSA.

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Speaker 2: Sometimes we'll do imaging as well. There are new tests

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Speaker 2: that come out called gallery. There are other it's called

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Speaker 2: the liquid biopsy tests. I mean, there's ways to image

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Speaker 2: and to look for patients who may have potential cancer

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Speaker 2: I have. Cardiac screening is extremely important. You can sometimes

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Speaker 2: you know, you'll get certain labs like APO B LP

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Speaker 2: little A. Sometimes we'll get a coordinate calcium score to

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Speaker 2: look at the heart to make sure there's not increase

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Speaker 2: calcium metabolic disease. You want to make sure that patients

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Speaker 2: are watching their sugars. It's a silent killer. Sometimes we'll

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Speaker 2: put the CGM, which is a continuous glue ghost monitor

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Speaker 2: on them to help them look at their sugars to

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Speaker 2: make sure that they get the feedback to say these

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Speaker 2: are the foods I should stay away from. And then

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Speaker 2: you know, there's not a lot you can do with

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Speaker 2: Parkinson's and Alzheimer's. There are certain tests that you can

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Speaker 2: look at some genes. You can look at the see

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Speaker 2: if you're a higher risk. But you know, if you

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Speaker 2: are at a higher risk, you can start altering your behavior.

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Speaker 2: Exer you know and doing things. So it's really important

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Speaker 2: to keep the bad things away and use the diet,

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Speaker 2: extricize and sleep and stress to move your head forward.

438
00:22:01,160 --> 00:22:02,000
Speaker 5: In that paradigm.

439
00:22:02,040 --> 00:22:04,480
Speaker 2: Most people get the concept of offense and defense four

440
00:22:04,520 --> 00:22:06,639
Speaker 2: and four, and it's really worked well for a lot

441
00:22:06,680 --> 00:22:07,680
Speaker 2: of my patients.

442
00:22:08,560 --> 00:22:09,600
Speaker 1: I don't know if I've told you this.

443
00:22:09,680 --> 00:22:14,119
Speaker 4: Doctor Mohit Kara is our guest kh E R At

444
00:22:14,160 --> 00:22:17,160
Speaker 4: Baylor College of Medicine. I don't know if I've told

445
00:22:17,160 --> 00:22:21,560
Speaker 4: you this, but on Christmas Eve, Ramone got a CGM

446
00:22:21,880 --> 00:22:26,639
Speaker 4: continuous glucose monitor and he started monitoring his blood sugar

447
00:22:27,160 --> 00:22:30,200
Speaker 4: and he keeps his blood sugar at a very steady

448
00:22:30,240 --> 00:22:32,600
Speaker 4: between one and one thirty, usually about one point fifteen.

449
00:22:32,640 --> 00:22:34,040
Speaker 4: The first thing I do when I walk in the

450
00:22:34,040 --> 00:22:36,800
Speaker 4: studio every morning is he's already here. Is I ask

451
00:22:36,880 --> 00:22:38,440
Speaker 4: him for the number he sees me coming up the

452
00:22:38,440 --> 00:22:40,480
Speaker 4: stairs and he will write it down and show it

453
00:22:40,520 --> 00:22:42,240
Speaker 4: on a sheet of paper or open the door and

454
00:22:42,280 --> 00:22:42,560
Speaker 4: tell me.

455
00:22:43,160 --> 00:22:44,120
Speaker 1: And he has.

456
00:22:44,240 --> 00:22:49,840
Speaker 4: It has absolutely changed not only his health but his mood.

457
00:22:50,040 --> 00:22:52,280
Speaker 4: I mean, he is consistent, He can work harder, he

458
00:22:52,320 --> 00:22:57,000
Speaker 4: can work longer by just stabilizing blood sugar, which obviously

459
00:22:57,040 --> 00:23:00,360
Speaker 4: for most people is fluctuating with great volatility.

460
00:23:01,640 --> 00:23:02,520
Speaker 5: I love that story.

461
00:23:02,600 --> 00:23:04,359
Speaker 2: I think that's a see and I see that all

462
00:23:04,400 --> 00:23:06,760
Speaker 2: the time because the reality is there are foods that

463
00:23:06,800 --> 00:23:09,199
Speaker 2: you're eating that you think are healthy and they're not.

464
00:23:09,680 --> 00:23:10,919
Speaker 2: And the foods that you think that are not that

465
00:23:11,000 --> 00:23:13,959
Speaker 2: healthy are you know, and you know, I put a

466
00:23:13,960 --> 00:23:15,680
Speaker 2: CGM on my wife and we went to the same

467
00:23:15,680 --> 00:23:18,159
Speaker 2: restaurant once we ate the exact same thing, and we

468
00:23:18,240 --> 00:23:21,720
Speaker 2: got totally different numbers. Because part of it's also genetics, right,

469
00:23:21,800 --> 00:23:24,280
Speaker 2: So that can play a role in it as well.

470
00:23:24,320 --> 00:23:27,320
Speaker 2: But learning more about what is bad and what to

471
00:23:27,359 --> 00:23:31,320
Speaker 2: stay away from is extremely important because if you give

472
00:23:31,320 --> 00:23:34,439
Speaker 2: yourself feedback, and those who take feedback very seriously, you

473
00:23:34,480 --> 00:23:37,760
Speaker 2: can really alter the quality of their life because that

474
00:23:37,960 --> 00:23:41,840
Speaker 2: sugar is just pounding the blood vessels, just pounding them.

475
00:23:42,800 --> 00:23:46,000
Speaker 4: My dad's a lifelong diabetic. Was nineteen when he got diabetes.

476
00:23:46,000 --> 00:23:47,960
Speaker 4: He's eighty five now. It's amazing. He has all ten

477
00:23:48,040 --> 00:23:50,720
Speaker 4: fingers and toes, but he has monitored, he's I've had

478
00:23:50,720 --> 00:23:52,919
Speaker 4: doctors tell me your dad knows more about diabetes than

479
00:23:52,960 --> 00:23:54,359
Speaker 4: we do because he had to treat it before they

480
00:23:54,440 --> 00:23:56,640
Speaker 4: was as one. But I take ramon to see him

481
00:23:57,400 --> 00:23:59,880
Speaker 4: last week, and all they talked about was their CG

482
00:24:00,359 --> 00:24:02,840
Speaker 4: and their dex com c GM and what the reading

483
00:24:03,000 --> 00:24:04,679
Speaker 4: was and what this was and what that was.

484
00:24:04,720 --> 00:24:04,960
Speaker 5: It was.

485
00:24:05,000 --> 00:24:07,480
Speaker 4: It was pretty funny to watch Home with Me for

486
00:24:07,560 --> 00:24:08,920
Speaker 4: one more segment if you can.

487
00:24:09,000 --> 00:24:10,560
Speaker 1: Doctor Mohit Kara is our guest.

488
00:24:11,000 --> 00:24:14,560
Speaker 4: The book is The Sex Span, and we will double

489
00:24:14,640 --> 00:24:17,639
Speaker 4: back to that subject coming up.

490
00:24:28,720 --> 00:24:33,760
Speaker 1: From Portland to wal beneath at all great cities in between.

491
00:24:32,720 --> 00:24:40,639
Speaker 1: The Michael Berry Show is nationwide. Doctor Mohit Kara is

492
00:24:40,680 --> 00:24:42,359
Speaker 1: our guest k H. E. R A.

493
00:24:42,640 --> 00:24:46,400
Speaker 4: He is my friend and my urologist and an expert

494
00:24:46,560 --> 00:24:52,119
Speaker 4: in matters of sex and testosterone. I will read to

495
00:24:52,160 --> 00:24:56,639
Speaker 4: you an email from one fellow says, uh, well, let

496
00:24:56,640 --> 00:25:00,000
Speaker 4: me go back to that. Another fellow, actually several fellows said,

497
00:25:00,760 --> 00:25:05,520
Speaker 4: my wife's libido is way lower than mine. How can

498
00:25:05,560 --> 00:25:07,560
Speaker 4: he increase a woman's libido?

499
00:25:09,920 --> 00:25:11,880
Speaker 2: That's a really important point. So you know I told

500
00:25:11,920 --> 00:25:14,160
Speaker 2: you earlier that couple that got the woman that called

501
00:25:14,160 --> 00:25:16,040
Speaker 2: me that was very upset. So in two thousand and eight,

502
00:25:16,080 --> 00:25:18,840
Speaker 2: I actually flew out to California to the Many Fellowship

503
00:25:18,920 --> 00:25:21,800
Speaker 2: in Female Sexual Dysfunction and I started treating women for

504
00:25:21,840 --> 00:25:25,680
Speaker 2: the past seventeen years, because you can't just treat one

505
00:25:25,720 --> 00:25:29,520
Speaker 2: person without treating the other. And when you improve both libidos,

506
00:25:29,560 --> 00:25:30,719
Speaker 2: you actually it's synergistic.

507
00:25:31,119 --> 00:25:33,040
Speaker 5: So women, this female.

508
00:25:32,760 --> 00:25:36,560
Speaker 2: Sexual dysfunction is comprised of four components low libido, po

509
00:25:36,720 --> 00:25:40,760
Speaker 2: arousal meaning poor blood flows of the genitalia, orgasmic dysfunction,

510
00:25:41,280 --> 00:25:44,040
Speaker 2: or pain it was sex. If she has any one

511
00:25:44,040 --> 00:25:47,040
Speaker 2: of those four and is bothered by it, she suffers

512
00:25:47,080 --> 00:25:50,159
Speaker 2: from female sexual dysfunction. And there are many treatment options

513
00:25:50,160 --> 00:25:52,719
Speaker 2: out there. One could be hormonal, one could be actually

514
00:25:52,760 --> 00:25:55,800
Speaker 2: using new Two FDA proved medications are out. One's called

515
00:25:55,840 --> 00:25:59,760
Speaker 2: add ADDYI. It came out in twenty fifteen. FDA proved

516
00:26:00,040 --> 00:26:02,680
Speaker 2: strictly to increase a woman's desire for sex. That's it.

517
00:26:02,880 --> 00:26:05,639
Speaker 2: She takes the pill every day, increases her desire for sex.

518
00:26:06,000 --> 00:26:07,879
Speaker 2: By lease, he came out several years later. It's an

519
00:26:07,920 --> 00:26:12,520
Speaker 2: injection EpiPen. She injects strictly to increase her desire for sex. Now,

520
00:26:12,840 --> 00:26:15,600
Speaker 2: I just want everyone to be very clear, libido is

521
00:26:15,640 --> 00:26:17,040
Speaker 2: more deeper than that. I mean, there could be a

522
00:26:17,040 --> 00:26:19,600
Speaker 2: lot of other fi other factors. I mean, it could

523
00:26:19,600 --> 00:26:23,119
Speaker 2: be her stress, it could be her physical condition, it

524
00:26:23,160 --> 00:26:25,439
Speaker 2: could be patigue, so you can't. It could be the

525
00:26:25,480 --> 00:26:27,639
Speaker 2: quality of the relationship. So I mean, if someone has

526
00:26:27,640 --> 00:26:29,760
Speaker 2: a terrible quality of relationship, I can't. I can give

527
00:26:29,760 --> 00:26:31,400
Speaker 2: them all the pill they want, it's not going to help,

528
00:26:31,680 --> 00:26:33,399
Speaker 2: you know, So you just got to look at the

529
00:26:33,400 --> 00:26:36,040
Speaker 2: whole big picture. But I still also believe when you

530
00:26:36,080 --> 00:26:40,280
Speaker 2: improve a woman's diet, exercise, sleep, and stress, her libido

531
00:26:40,400 --> 00:26:41,120
Speaker 2: does go up.

532
00:26:42,000 --> 00:26:43,880
Speaker 1: It also helps if you take them to the movies.

533
00:26:45,600 --> 00:26:47,280
Speaker 5: Yeah, that's true.

534
00:26:47,840 --> 00:26:51,440
Speaker 1: That's true for the most conversations.

535
00:26:52,960 --> 00:26:56,240
Speaker 4: Alex writes zar, what if you can't always afford the

536
00:26:56,320 --> 00:26:59,960
Speaker 4: treatment for testosterone, is there a safe supplement I can

537
00:27:00,080 --> 00:27:00,880
Speaker 4: take that would help?

538
00:27:02,320 --> 00:27:05,240
Speaker 2: So the good news is that you can get testosterone

539
00:27:05,320 --> 00:27:08,080
Speaker 2: even compounded compounding pharmacies. Many of them are called the

540
00:27:08,119 --> 00:27:11,120
Speaker 2: five ZHO three B, which are heavily regulated. They make

541
00:27:11,160 --> 00:27:13,720
Speaker 2: testosterone at a price of about thirty dollars a month

542
00:27:13,880 --> 00:27:17,040
Speaker 2: without insurance. Most people can afford thirty dollars a month

543
00:27:17,080 --> 00:27:20,320
Speaker 2: without insurance. If you look at even medications like Cialis.

544
00:27:20,600 --> 00:27:22,879
Speaker 2: If you use a good RX cupon co order you

545
00:27:22,960 --> 00:27:26,639
Speaker 2: use Mark Cuban's company, you can get ninety days for

546
00:27:26,760 --> 00:27:30,040
Speaker 2: roughly twenty or twenty five dollars ninety days for ciais.

547
00:27:30,080 --> 00:27:33,840
Speaker 2: So these medications are extremely affordable and price should no

548
00:27:33,880 --> 00:27:34,880
Speaker 2: longer be an issue.

549
00:27:36,160 --> 00:27:36,920
Speaker 1: That's interesting.

550
00:27:39,000 --> 00:27:43,480
Speaker 4: Several of the questions relate to hemoglobin blood thickness.

551
00:27:43,920 --> 00:27:46,400
Speaker 1: I know some people begin giving blood once.

552
00:27:46,200 --> 00:27:50,879
Speaker 4: They get on testosterone because they're blood thickens. Your thoughts

553
00:27:50,920 --> 00:27:53,000
Speaker 4: on that, is that problematic or is that just a

554
00:27:53,040 --> 00:27:53,680
Speaker 4: side effect?

555
00:27:54,840 --> 00:27:57,119
Speaker 2: It can be and it all depends on what type

556
00:27:57,119 --> 00:28:00,680
Speaker 2: of formulation you're using. Injectables have the highest rate. Injections

557
00:28:00,720 --> 00:28:03,760
Speaker 2: up to sixty six percent, A pellet's about thirty five percent,

558
00:28:04,040 --> 00:28:07,399
Speaker 2: angel's twelve percent risk, and appill is about five percent.

559
00:28:07,760 --> 00:28:10,600
Speaker 2: So if your hermaticrit goes up and the number you

560
00:28:10,640 --> 00:28:13,439
Speaker 2: want to remember is fifty four, if it gets above

561
00:28:13,480 --> 00:28:17,800
Speaker 2: fifty four, there's a slight theoretical increased cardiovascar risk. And

562
00:28:17,840 --> 00:28:20,240
Speaker 2: in my practice, we have these patients start donating blood.

563
00:28:20,359 --> 00:28:22,359
Speaker 2: We don't wait to fifty four. We haven't started donating

564
00:28:22,359 --> 00:28:23,760
Speaker 2: at fifty one because I don't want to wait to

565
00:28:23,840 --> 00:28:24,320
Speaker 2: fifty four.

566
00:28:24,400 --> 00:28:27,480
Speaker 5: So it is real. And remember that many.

567
00:28:27,320 --> 00:28:30,360
Speaker 2: Of these patients have sleep apnea, a cult to sleep apnea,

568
00:28:30,640 --> 00:28:33,560
Speaker 2: and the testosterone is unmasking it. So send them for

569
00:28:33,600 --> 00:28:36,160
Speaker 2: a sleep study, because you'll find that many of them

570
00:28:36,320 --> 00:28:37,800
Speaker 2: are just suffering from sleep apnea.

571
00:28:39,360 --> 00:28:43,920
Speaker 4: You know, I find a lot of people are suffering

572
00:28:44,040 --> 00:28:46,960
Speaker 4: from some sleep disorder and they've just grown. They don't

573
00:28:47,000 --> 00:28:52,280
Speaker 4: even realize what a contributor to their overall health or

574
00:28:52,360 --> 00:28:56,120
Speaker 4: lack of it that sleep is. It's almost always accompanied

575
00:28:56,120 --> 00:28:59,120
Speaker 4: by the person being overweight, or maybe maybe the overweight

576
00:28:59,200 --> 00:29:01,120
Speaker 4: led to the sleep. But that's one of those things

577
00:29:01,120 --> 00:29:04,560
Speaker 4: that I find when I dig into people often have

578
00:29:04,920 --> 00:29:07,560
Speaker 4: bad sleep and they don't think that's they don't realize

579
00:29:07,560 --> 00:29:08,320
Speaker 4: how important that is.

580
00:29:09,640 --> 00:29:12,040
Speaker 2: Michael, You're so right. Listen, when I take care a

581
00:29:12,080 --> 00:29:14,080
Speaker 2: lot of CEOs, a lot of people, and I talk

582
00:29:14,160 --> 00:29:17,080
Speaker 2: about the four pillars diet, exercise, sleep, and stress. They're

583
00:29:17,120 --> 00:29:20,000
Speaker 2: all pretty good at diet, they're all pretty good at exercise,

584
00:29:20,240 --> 00:29:23,720
Speaker 2: that are lousy at sleep and stress. Right, And so

585
00:29:24,040 --> 00:29:27,440
Speaker 2: in sleep and stress are so critical, and you think

586
00:29:27,480 --> 00:29:30,480
Speaker 2: about sleep, it is a game changer. Even the way

587
00:29:30,480 --> 00:29:33,160
Speaker 2: you think about sleep. It's not the hours you sleep,

588
00:29:33,400 --> 00:29:36,440
Speaker 2: that's multiplied by how efficient you slept. So if you

589
00:29:36,480 --> 00:29:39,240
Speaker 2: slept eight hours last night, but you were twenty percent efficient,

590
00:29:39,400 --> 00:29:41,160
Speaker 2: and I slept only four hours last night, but I

591
00:29:41,200 --> 00:29:43,360
Speaker 2: was eighty percent efficient. I'm going to feel a lot

592
00:29:43,400 --> 00:29:45,760
Speaker 2: better than you. Right, So the reality is not just

593
00:29:45,920 --> 00:29:48,480
Speaker 2: lying there with your eyes closed. You have to get

594
00:29:48,600 --> 00:29:52,240
Speaker 2: good deep sleep, good rem sleep, and even thirty minutes

595
00:29:52,240 --> 00:29:54,640
Speaker 2: extra are either deep sleep or rem sleep every night

596
00:29:55,080 --> 00:29:58,000
Speaker 2: game changer for the next day. So I think people

597
00:29:58,040 --> 00:30:01,320
Speaker 2: need to be very military. Just find a way to

598
00:30:01,360 --> 00:30:03,400
Speaker 2: make sure that you go to sleep on time, wake

599
00:30:03,480 --> 00:30:06,640
Speaker 2: up on time. And the best website I found was

600
00:30:06,680 --> 00:30:09,680
Speaker 2: the American Sleep Foundation. The American Sleep Foundation has twenty

601
00:30:09,720 --> 00:30:13,000
Speaker 2: tips on their website. They're awesome. Follow those tips. That

602
00:30:13,080 --> 00:30:14,080
Speaker 2: makes a big difference.

603
00:30:16,120 --> 00:30:18,880
Speaker 1: Salt in the diet. So I've been reading a lot

604
00:30:18,920 --> 00:30:20,400
Speaker 1: on salt lately and.

605
00:30:21,880 --> 00:30:24,200
Speaker 4: I have not run this by you yet, so I'm

606
00:30:24,240 --> 00:30:27,960
Speaker 4: curious to see what you think of this. And the

607
00:30:27,960 --> 00:30:30,800
Speaker 4: theory goes that we were told to stay away from salt.

608
00:30:30,840 --> 00:30:34,880
Speaker 4: Salt raises blood pressure, salt causes all these problems. And

609
00:30:35,640 --> 00:30:39,760
Speaker 4: basically the point of the piece was that we are

610
00:30:39,880 --> 00:30:42,080
Speaker 4: now deprived of salt. And what do you do to

611
00:30:42,120 --> 00:30:45,000
Speaker 4: treat someone for a number of things is you give

612
00:30:45,040 --> 00:30:45,760
Speaker 4: them salt.

613
00:30:45,840 --> 00:30:49,760
Speaker 1: Your thoughts on salt intake, So I think.

614
00:30:49,600 --> 00:30:52,480
Speaker 2: That I'm still a believer that salt, particularly in patience

615
00:30:52,520 --> 00:30:56,160
Speaker 2: who have hypertension is a risk factor, and so if

616
00:30:56,200 --> 00:30:59,200
Speaker 2: someone has hypertension, which most of many Americans suffer from,

617
00:30:59,680 --> 00:31:02,320
Speaker 2: that is going to be something that's the first thing

618
00:31:02,320 --> 00:31:04,440
Speaker 2: I'm going to ask them to stay away from. As

619
00:31:04,480 --> 00:31:07,480
Speaker 2: a urologist. The other thing we worry about is increased

620
00:31:07,480 --> 00:31:13,000
Speaker 2: salt intake significantly increases the risk for the kidney stones.

621
00:31:13,400 --> 00:31:17,480
Speaker 2: And so I am not a believer yet that we

622
00:31:17,600 --> 00:31:21,320
Speaker 2: should be increasing excuse me, increasing salt unless there's a

623
00:31:21,360 --> 00:31:23,640
Speaker 2: reason to do so. But I'm more concerned about the

624
00:31:23,680 --> 00:31:25,240
Speaker 2: hypertension and the stone risk.

625
00:31:25,400 --> 00:31:27,400
Speaker 1: But on French Fries, it's okay, right.

626
00:31:29,440 --> 00:31:36,640
Speaker 4: Sometimes sometimes, Doctor Mohi Kara, you are the absolute best.

627
00:31:36,800 --> 00:31:43,479
Speaker 4: The four phases of offense he has outlined or diet, exercise, sleep,

628
00:31:43,640 --> 00:31:46,680
Speaker 4: and stress reduction all things you can do yourself that

629
00:31:46,760 --> 00:31:52,240
Speaker 4: don't require spending a dollar. Diet, exercise, sleep and stress

630
00:31:52,360 --> 00:31:57,160
Speaker 4: reduction is four pillars of offense and defense. I cannot

631
00:31:57,160 --> 00:31:59,479
Speaker 4: help you get in to see him, so don't even try,

632
00:31:59,480 --> 00:32:00,720
Speaker 4: because I'm overwhelmed.

633
00:32:00,720 --> 00:32:02,800
Speaker 1: Again. It's Baylor College of Medicine.

634
00:32:02,840 --> 00:32:04,560
Speaker 4: It does take a while to get in to see him,

635
00:32:05,280 --> 00:32:07,240
Speaker 4: only because he's very popular.

636
00:32:07,320 --> 00:32:08,920
Speaker 1: A lot of people like him.

637
00:32:09,200 --> 00:32:11,800
Speaker 4: I was my own worst enemy in sending too many

638
00:32:11,800 --> 00:32:14,160
Speaker 4: patients to him at the beginning, and he only has

639
00:32:14,200 --> 00:32:17,120
Speaker 4: so many hours of the day. The book is The

640
00:32:17,200 --> 00:32:20,040
Speaker 4: Sex Span, which is not out yet but will be

641
00:32:20,280 --> 00:32:22,240
Speaker 4: hopefully soon, and when you let me know that.

642
00:32:22,280 --> 00:32:26,040
Speaker 1: Is the case, we will all go and buy it online.

643
00:32:26,280 --> 00:32:27,800
Speaker 5: Well do Thank you so much, Michael.

644
00:32:27,640 --> 00:32:32,520
Speaker 1: You're the best. My friend, Doctor mohit h e r.

645
00:32:32,800 --> 00:32:35,920
Speaker 4: A Baylor College of Medicine.

646
00:32:36,120 --> 00:32:36,479
Speaker 1: Yeah.

647
00:32:36,560 --> 00:32:41,160
Speaker 4: So I'm having dinner at Gringo's the new location at

648
00:32:42,120 --> 00:32:46,520
Speaker 4: ninety nine and two forty nine with Wayne Wilson, who's

649
00:32:46,560 --> 00:32:51,160
Speaker 4: the founder of Syenergenics, and he was telling me about

650
00:32:52,440 --> 00:32:56,400
Speaker 4: we were talking about, well, the testosterone replacement, but he

651
00:32:56,520 --> 00:32:58,520
Speaker 4: was talking about this doctor and he said.

652
00:32:58,360 --> 00:32:59,880
Speaker 1: I think he's your doctor.

653
00:33:00,640 --> 00:33:04,800
Speaker 4: He comes out and trains our people on testosterone and

654
00:33:04,800 --> 00:33:07,520
Speaker 4: the effects and why it's important and all that, and

655
00:33:07,520 --> 00:33:09,200
Speaker 4: it was doctor Kara, and I did not know that.

656
00:33:09,240 --> 00:33:11,400
Speaker 4: I had no idea. Doctor Kara was the first one

657
00:33:11,440 --> 00:33:13,800
Speaker 4: that put me on testosterone. We did the pellets for

658
00:33:13,840 --> 00:33:16,760
Speaker 4: a couple of years, and then low T Center, which

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00:33:16,800 --> 00:33:19,520
Speaker 4: is also Cynergenics, became a show sponsor, so I just

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00:33:19,560 --> 00:33:21,440
Speaker 4: moved over there and started doing the weekly shots.

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00:33:21,640 --> 00:33:23,840
Speaker 1: I liked the shot. I like the shots better the pellets.

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00:33:23,840 --> 00:33:25,800
Speaker 1: Some people like the pellets. I gotta take you my

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00:33:25,840 --> 00:33:26,680
Speaker 1: pellette store hold on