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

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Speaker 1: Michael Verie Show is on the air. Today's show is

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Speaker 1: sponsored by Peanut Butter.

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Speaker 2: For pure versatility of application, ability to make anything it

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Speaker 2: touches better, and shelf life.

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Speaker 1: I don't know that there's anything better that comes in

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Speaker 1: a bottle. I really don't. I really don't. Let's just

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Speaker 1: take a moment and think about your best peanut butter moment. Ramon.

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Speaker 1: Your peanut butter moment should not involve sex.

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Speaker 3: But my urologist, doctor Mohit Kara is our guest. Welcome

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Speaker 3: to the program. Good sir, Thank you Michael. Everyone has

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Speaker 3: a lifespan, Ramon. You know that you have a lifespan.

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Speaker 3: We talk about our lifespan. Doctor Mohitz Kara is writing

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Speaker 3: a book called Or about the sex span. How long

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Speaker 3: can a human being have a functional, fulfilling sex life,

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Speaker 3: Doctor Kara? Why does that matter?

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Speaker 4: Well, Michael, the first, thank you for having me on

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Speaker 4: the show. You know, everyone where you go, everywhere talks

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Speaker 4: about lifespan and health span. That's the big buzzwords in

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Speaker 4: the community. And I'll give you an example. Everybody wants,

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Speaker 4: I assume their health span to last as long as

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Speaker 4: their lifespan. But in the United States, the average health

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Speaker 4: lifespan is seventy seven years old. Women live typically seventy

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Speaker 4: nine years old, men live typically seventy five years old.

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Speaker 4: But the health span in the United States is roughly

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Speaker 4: sixty seven years old, which means most of us, for

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Speaker 4: the last ten years of our life are not going

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Speaker 4: to be living in a healthy condition, which is very unfortunate.

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Speaker 4: And all these countries talk about how they're expanding their

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Speaker 4: lifespan and getting people to live longer. In my mind,

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Speaker 4: that is not what I want do, not expand my

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Speaker 4: lifespan without expanding my health span. But this concept of

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Speaker 4: sex span is also important because many men would say, look,

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Speaker 4: I said, if you're going to live till eighty, but

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Speaker 4: you can only have sex till fifty, that's a problem

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Speaker 4: for many men. And so what we want to do

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Speaker 4: is try to expand our sex span and our health

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Speaker 4: span as long as our lifespan. And I think that's

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Speaker 4: a really important point.

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Speaker 1: I know.

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Speaker 3: One of the things I like about you is that

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Speaker 3: you don't just rely on what you learned in medical

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Speaker 3: school and then mail it in every day. You're constantly

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Speaker 3: reading studies, you're constantly performing research and publishing and speaking

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Speaker 3: literally around the world, because you're always somewhere else when

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Speaker 3: I call you to see what you're up to giving

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Speaker 3: a speech on this or that. How important is sex

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Speaker 3: to the human body in terms of purely physically, Yeah.

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Speaker 4: It's it's extremely important. So I want to just clarify

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Speaker 4: one thing. A rectile dysfunction is not a disease. It's

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Speaker 4: a symptom of other underlying diseases. Right, So ED does

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Speaker 4: not happen in healthy men as they get older. If

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Speaker 4: a man gets a rectiled dysfunction, it is a symptom

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Speaker 4: of his diabetes, it's a symptom, it is Cardiovaskar disease,

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Speaker 4: it's a symptom of his radical procestectomo surgery, or it's

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Speaker 4: a symptom of depression or anxiety. So when someone develops

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Speaker 4: a rectile dysfunction, the second question you should be asking

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Speaker 4: is what else is going on that's causing this condition,

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Speaker 4: because if he was perfectly healthy, that would not happen, right,

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Speaker 4: And so the best example I can give you is

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Speaker 4: this is that if did you know that if a

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Speaker 4: man walks in today and has a rectile dysfunction, fifteen

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Speaker 4: percent of them will have a heart attantic earth stroke

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Speaker 4: within seven years fifteen percent. It's an underlying marker of

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Speaker 4: cardiovask disease. If man and walks in with ED today,

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Speaker 4: thirty percent of them have a cult diabetes thirty percent,

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Speaker 4: which is a lot. And if a man walks in today,

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Speaker 4: thirty percent of them will have depression or anxiety. So

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Speaker 4: the biggest mistake I can do is give this man

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Speaker 4: viagra and send him on his way, because maybe he

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Speaker 4: has that occult cardiovask disease, maybe he has diabetes. Maybe

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Speaker 4: he's suffering from depression or anxiety. So it's really important

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Speaker 4: to figure out what is causing that ED. And what's

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Speaker 4: so nice about this is that there's a bi directional relationship.

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Speaker 4: So if I treat a man's ED, that actually improves

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Speaker 4: his depression. If I improve a man's depression, it actually

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Speaker 4: improves his ED. So I think the paradigm is shifting.

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Speaker 4: No longer do I want to just hand the man

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Speaker 4: the pill. You've got to figure out what's going on underneath,

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Speaker 4: because this is what I call the canary in the

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Speaker 4: coal mine, and you can actually save someone's life. I mean,

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Speaker 4: imagine if I catch someone's cardiovaskar disease today or diabetes today,

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Speaker 4: or I catch it ten years from now. It's a

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Speaker 4: total change trajectory in terms of their house span in

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Speaker 4: their life.

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Speaker 3: Well, it goes back to viagra originally being a cardigo

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Speaker 3: vascular disease in a off label benefit being.

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Speaker 1: The ability to get erection.

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Speaker 4: Yeah, Michael, that's a funny story because remember this one.

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Speaker 4: But they were trying to make a blood pressure medication

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Speaker 4: and accidentally everyone in this study was getting erections, and

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Speaker 4: they figured it out because people were not returning the pills.

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Speaker 3: I had a friend, I was a baby lawyer at

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Speaker 3: the time at a firm called Jakins and Gilchrist and

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Speaker 3: I worked with a guy named Darren Alt who was

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Speaker 3: my best friend there. And his wife, Tracy, was the

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Speaker 3: head of viagra in Houston, which was the top market

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Speaker 3: for viagra in the country, and they were taking a

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Speaker 3: trip every other week with their sales reps, and they

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Speaker 3: had all sorts of stories of people and at that

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Speaker 3: point it was still you'd go to your cardiologist to

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Speaker 3: get viagra, So everybody was faking a heart problem to

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Speaker 3: go in and get this medication. And the story goes

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Speaker 3: that the doctors were getting calls from the wives going, hey,

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Speaker 3: knock it off, take him off.

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Speaker 4: Of that, right, right, right right? Yeah, absolutely, And so

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Speaker 4: you know what the issue is is that ED back

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Speaker 4: then was not considered a very serious condition. People used

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Speaker 4: to make fun of it, and oh he has ED.

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Speaker 4: ED is a very serious condition. Someone gets erected on dysfunction.

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Speaker 4: Take it seriously. Something else is going on.

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Speaker 3: Well, and to oversimplify this, that is because it means

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Speaker 3: you're not getting proper blood flow or you're not pumping

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Speaker 3: your blood properly. And that's I guess as good a

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Speaker 3: way as any for us to check, maybe the easiest way.

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Speaker 4: Yeah, and so think about this. I teach their medical

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Speaker 4: students this knew monic called vent vascular, meaning there's not

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Speaker 4: enough blood flow coming in or there's too much blood

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Speaker 4: flow coming out. And too much blood flow coming out

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Speaker 4: is the most common cause of ED. So the guy

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Speaker 4: will tell you I can get the direction, but I

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Speaker 4: just can't maintain it. He's telling you the blood flow's

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Speaker 4: coming out too quickly. The number one call of ED

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Speaker 4: in the world. But VENT stands for a vascar E

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Speaker 4: means androcrine. It's testosterone. The testosterone goes low, ED goes up.

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Speaker 4: Neurologic meaning nerve injury and then trauma. And don't forget medications.

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Speaker 4: Medications are notorious, for example, beta blockers. How many people

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Speaker 4: are on beta blockers shuts down the erections. Antidepressants shuts

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Speaker 4: down the directions. So you got to look at all

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Speaker 4: the different causes for ED. And I just want to

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Speaker 4: stress one other thing. Sexual dysfunction is a couple's disease.

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Speaker 4: You know, we're so fixed on these silos. I got

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Speaker 4: to take care of the woman, I got to take

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Speaker 4: care of the man. You got to look at both

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Speaker 4: of them. I'll give you an example. Back in two

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Speaker 4: thousand and seven, I finished my fellowship and I was

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Speaker 4: so proud of myself. I was able to get these men,

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Speaker 4: these amazing erections, amazing libido. And one day a woman

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Speaker 4: called me and said to me, she said, everything was

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Speaker 4: great with our relationship until he met you. We never fought.

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Speaker 4: We fight all the time because every day he wants

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Speaker 4: to have sex with me and I don't want to

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Speaker 4: have sex with him. And you've ruined our relationship. And

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Speaker 4: I thought to myself, she's right. What is the point

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Speaker 4: of raising one libido without raising the other? Either leave

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Speaker 4: both libidos low. It's fine leave them both low or

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Speaker 4: raise both, but you don't raise one without the other.

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Speaker 1: Doctor Mohitera at the Better College.

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Speaker 3: Of Medicine and myroologist and friends coming up the book

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Speaker 3: will be are going to get the name of it.

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Speaker 1: It's about the sex Ben. Maybe callver sex Ben. A

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Speaker 1: moment a hard problem. Everyone listens the Michael Verry Show.

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Speaker 5: Today's show was brought to you by peanut Butter for

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Speaker 5: pure versatility and application ability to make anything get touches

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Speaker 5: better in shelf life. I don't know that there's anything

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Speaker 5: better that comes in a bottle. I really don't. Let's

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Speaker 5: just take a moment and think about our best peanut

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Speaker 5: butter moment.

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Speaker 3: The only downside to having doctor Mohit Kara on the

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Speaker 3: air as our guest is then people it's me how

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Speaker 3: to get in to see him because it takes so

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Speaker 3: long to see him because he is so insanely popular.

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Speaker 3: Everybody I know is now his patient after hearing my

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Speaker 3: experience with him.

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

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Speaker 3: Doctor Mohit Kara is at Baylor College of Medicine, where

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Speaker 3: he is a urologist. He has a forthcoming book is

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Speaker 3: the book called the sex Span moment, or what.

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Speaker 1: Is the book called.

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Speaker 4: It is called sex Span and it's a proactive approach,

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Speaker 4: a proactive approach to prolonging your sex span.

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Speaker 1: So we were going into the break.

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Speaker 3: You made a statement about if you help a man

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Speaker 3: build his libido and his sexual function, but you do

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Speaker 3: not concurrently do that for the woman, you end up

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Speaker 3: causing problems for them. Let's take the physical out for

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Speaker 3: a moment. In your opinion, how important is sexual relations

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Speaker 3: to a couple and to an individual emotionally? You tied

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Speaker 3: it to the antithesis of depression, but talk about that

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Speaker 3: if you would.

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Speaker 4: It's extremely important. If you look at couples that engage

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Speaker 4: in regular sexual activity, that tend to be happier overall,

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Speaker 4: satisfied with their quality of life. These tend to be

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Speaker 4: healthier and easily tend to live longer. So there are

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Speaker 4: numerous aspects. There's one study that I saw that talked

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Speaker 4: about couples that engage in who do not engage in

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Speaker 4: sexual activity typically can have a twofold attraction from their relationship,

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Speaker 4: but if they do engage sexual activity, it actually can

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Speaker 4: add four x to the quality of relationship. So I

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Speaker 4: mean let's be honest. I mean, it does bring intimacy

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Speaker 4: and closeness to the relationship. It does strengthen the quality

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Speaker 4: of the relationship, and in many cases people find this

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Speaker 4: extremely important. So I do think that there is a

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Speaker 4: medical benefit psychological benefit in patients engaging in sexual activity.

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Speaker 3: I have had friends over the years when they put

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Speaker 3: their parents in old folks homes.

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Speaker 1: They talk about.

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Speaker 3: How how it is surprising how much activity there is

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Speaker 3: in the old folks home. And when I did that

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Speaker 3: for my dad earlier this year, that was one of

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Speaker 3: the things that everybody consistently across the board talked about.

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Speaker 3: I don't know if if there's anything to that, but

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Speaker 3: we're talking about these and nineties, and.

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Speaker 1: I have heard this story consistently.

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Speaker 4: You're actually so one of the highest levels of STDs

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Speaker 4: do occur in nursing homes. So you do know that

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Speaker 4: there's increased sexual activity that does occur in those in

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Speaker 4: those nursing homes. And so, but part of it is

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Speaker 4: because there's a at some point, there's an inflection point.

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Speaker 4: As you live longer and longer, those patients that are

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Speaker 4: the healthiest tend to live the longest, and those patients

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Speaker 4: who are tend to be healthier, tend to be more

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Speaker 4: the ability to engage in sexual activity.

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Speaker 3: When you and I talked about the book the first time,

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Speaker 3: you said that one of the things that the book

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Speaker 3: is going to cover is the importance of screening for

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Speaker 3: testosterone and how a rectyal dysfunction is a marker of

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Speaker 3: other underlying major medical conditions, such as a heart attack.

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Speaker 3: The screening for testosterone, why is that important?

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Speaker 4: So, Michael, I am very passionate about this topic because

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Speaker 4: you know, everyone thinks about testosterone as energy and sex

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Speaker 4: drive and erections. And yes, it's true if you have

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Speaker 4: low energy, low lebido rectal dysfunction, giving a man testosterone

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Speaker 4: can improve these symptoms. But now we're in an era

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Speaker 4: where it goes way beyond that. So did you know

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Speaker 4: that a man who has low testosterone is much more

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Speaker 4: likely to have a heart attack, non negotiable, much more likely.

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Speaker 4: A man who's low test also is much more likely

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Speaker 4: to break a bone. A man who's low tests also

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Speaker 4: is more likely have diabetes obesity Metabook syndrome. A diet

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Speaker 4: man who's low test also is much more likely to

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Speaker 4: suffer from depression. And giving a man back his testosterone

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Speaker 4: can help mitigate improve these conditions. So it's not just

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Speaker 4: about sex, it's about your overall health. The problem I

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Speaker 4: have is that when I walk into my primary care

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Speaker 4: doctor's office every year and he checks my blood, he

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Speaker 4: does not check an annual testosterone. He'll check a thyroid.

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Speaker 4: He'll check a TSH. I say, why are checking at TSH?

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Speaker 4: He said, well, we do that every year to make

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Speaker 4: sure you're not hypothyroid. There is not a better marker

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Speaker 4: of a man's overall health than a testosterone level. It

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Speaker 4: gives you a marker of what his health is today,

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Speaker 4: and it gives you a marker of what his health

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Speaker 4: will be in the future. And so every man over

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Speaker 4: the age of forty, every single man, should be getting

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Speaker 4: a testosteral level every single year after the age of forty,

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Speaker 4: because I do think it's the best predictor of his

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Speaker 4: overall health currently and in the future. And it's modifiable

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Speaker 4: because there's things I can do to improve his testosterone

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Speaker 4: if he's low.

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

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Speaker 3: I know you weren't going to talk about it because

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Speaker 3: you're the doctor, but I can, and obviously it changed

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Speaker 3: my life. It made a huge difference for me. But

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Speaker 3: when you do that for folks, what kind of differences

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Speaker 3: do you typically see?

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Speaker 4: Well, the first thing you have to ask yourself is

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Speaker 4: are they young and do they want to have children?

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Speaker 4: Because most people don't realize that giving testosterone actually shuts

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Speaker 4: down your fertility. So I can't tell you how many

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Speaker 4: patients I see in my practice every week they said, look,

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Speaker 4: I was started on testosterone or no one told me

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Speaker 4: that the test also could make me infertile. Now we

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Speaker 4: want to have kids? What do I do? So there's

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Speaker 4: the ways I can reverse it. So the reality is,

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Speaker 4: if you're in the reproductive years, if you're planning on

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Speaker 4: having children and your tea is low, don't take testosterone.

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Speaker 4: But let me give you medications that make you make testosterone.

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Speaker 4: That's safe. So I can give you medications to make

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Speaker 4: you make testolstone and that will enhance your fertility. But

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Speaker 4: if you're older and you're you're not trying to have children,

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Speaker 4: then there are many ways to give a man testosterone.

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Speaker 4: We now have oral testosterone, which is fantastic world test

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Speaker 4: asinal is very new in the United States. It's only

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Speaker 4: been out for five years. And that we have a pill,

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Speaker 4: we have injections, we have pallets, we have patches, but

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Speaker 4: I will tell you that I do think that this

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Speaker 4: medication can have a profound effect on the quality of life.

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Speaker 4: And many patients, I mean many patients come in. They're

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Speaker 4: thanking you, they're telling you that they have a significant

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Speaker 4: improvement directions or libido muscle mass. Not everybody, I mean,

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Speaker 4: there are patients that don't respond, but the majority of

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Speaker 4: patients who start out low do see a significant improvement

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Speaker 4: in their quality of life.

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Speaker 3: I was talking with one of our show sponsors, Wayne Wilson,

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Speaker 3: who owns Synergenics, and.

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Speaker 1: He said, hey, you're urologist.

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Speaker 3: Is the one who came when we started, I guess

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Speaker 3: with pellets or whatever, and came and talked to them

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Speaker 3: about testosterone and obviously that's what they do all day

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Speaker 3: every day, and he went through the various things that

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Speaker 3: you talk about.

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Speaker 1: He took note. He's a physician's assistant by training. But

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Speaker 1: it was amazing to me.

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Speaker 3: You were the god of testosterone as far as Synergenics

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Speaker 3: is concerned, and.

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Speaker 1: I didn't know you had an association with them.

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Speaker 4: No, I appreciate. I mean, I've been very passionate about

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Speaker 4: this for about twenty five years. So all my basic

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Speaker 4: science work, all my lab, all my clinical trials are

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Speaker 4: around this topic. So when it comes to teaching and

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Speaker 4: education to others about Tessaucer, I'm all in one moment.

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Speaker 3: Doctor Mokara is our guest. He's at Baylor College of Medicine,

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Speaker 3: and I'm going to start with the question everyone always asks, well,

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Speaker 3: am I more likely to get prostate cancer?

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

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Speaker 1: that coming.

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Speaker 6: Up with his finger on the pulse, The King of

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Speaker 6: Teing continues on the Michael Berry Show.

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Speaker 3: Doctor Mois Kara my urologist and friend of Baylor College

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Speaker 3: of Medicine and international renown as a speaker on issues

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Speaker 3: of sex urology, testosterone. Forthcoming book is called sex Span,

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Speaker 3: which talks about the length of tom in which a

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Speaker 3: person has a functional sex life that will be out

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Speaker 3: relatively soon. Doctor Kara, I received an email from a

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Speaker 3: fellow named Doug who writes three minutes ago. I figure

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Speaker 3: your interview is pre recorded, but if not, I'm curious

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Speaker 3: about blood clots.

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Speaker 1: I had a.

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Speaker 3: Pulmonary embolism and they told me to stop taking testosterone.

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Speaker 3: I used to go to the Low T Center and

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Speaker 3: had a great experience experience with the treatment. I miss it.

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Speaker 3: I hate that I can't take it anymore. Does doctor

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Speaker 3: Kara have a thought about that?

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Speaker 4: I do, Michael, so listen. There was a concern for

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Speaker 4: that in twenty fifteen and the FDA asked to conduct

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Speaker 4: a large trial. It was called the Traverse Trial. I

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Speaker 4: was fortunate enough to be involved in that trial with

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Speaker 4: myself and eight other physicians, and we designed this trial

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Speaker 4: with several hundreds of millions of dollars and the goal

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Speaker 4: was to see if it caused increasing cardiovascar events and

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Speaker 4: prostate cancer. What it did find with there was no

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Speaker 4: increase in heart attack in those men taking testawsin versus placebo.

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Speaker 4: We had over five thousand patients. We followed them for

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Speaker 4: four years, and there was no increased risk in DVT.

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Speaker 4: But there was a slight increased risk in pulmonary embolism.

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Speaker 4: And the difference was a difference of between point five

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Speaker 4: percent and point nine percent, So there was a slight signal.

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Speaker 4: And I think it's very important to counsel patients when

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Speaker 4: they ask about that. So I guess again, you know,

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Speaker 4: I don't believe that I personally don't believe the test

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Speaker 4: alsa increases the risk of DVT in pulmonary embolism. I

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Speaker 4: think the difference was small, but the Travers trial showed

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Speaker 4: what it showed. Also, I just want to mention it

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Speaker 4: showed no increased risks in prostate cancer and no increased

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Speaker 4: risk of worsening of urinary symptoms. Great study, Traverse trial.

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

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Speaker 3: Because I have a friend who started on testosterone, heard

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Speaker 3: me talking about it. He starts on it, three months later,

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Speaker 3: he gets prostate cancer. He text message says, hey, just

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Speaker 3: I want you to know I just started on testosterone

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Speaker 3: and I got prostate cancer.

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Speaker 1: You need to be careful.

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Speaker 3: And my immediate response was, you haven't been on testosterone

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Speaker 3: long enough. Even if it did cost prostate cancer for

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Speaker 3: it to have caused that, if there was no testosterone

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Speaker 3: supplement out there, men still got prostate cancer at rapid,

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Speaker 3: at large rates.

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

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Speaker 4: I absolutely agree with you, and I got to tell

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Speaker 4: you where it started from. It started in nineteen forty

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Speaker 4: one when Huggins and Hodges published the famous paper I'm

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Speaker 4: showing that when you give a man testoser increases a

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Speaker 4: risk for prostate cancer. If you and I go to

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Speaker 4: the library right now and pull that paper, you're going

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Speaker 4: to find something very interesting. It was based on one patient,

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Speaker 4: one patient, nineteen forty one, and we had instilled fear

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Speaker 4: in us for so many years. The good news is

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Speaker 4: in twenty eighteen, my society, the American Neurologic Association, said

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Speaker 4: testosterone does not increase the risk for prostate cancer, strong recommendations.

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Speaker 4: So we do not anymore have a concern that testoscer

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Speaker 4: increases the risk for prostate cancer. I'll tell you a

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Speaker 4: very interesting story. If I had metastatic prostate cancer all

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Speaker 4: over our body and we walked into Johns Hopkins University

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Speaker 4: of Today, they would there's a trial where they put

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Speaker 4: us on high doses of testosterone to reverse the prostate

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Speaker 4: cancer and it works. It reduces the PSA, reduces the metastactacy.

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Speaker 4: So we're learning a lot about testosteron prostate cancer. And

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Speaker 4: this concept that testoster increases the risk, I think to

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Speaker 4: me is a myth. Michael, I want to bring up

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Speaker 4: one other important thing. You talked about this earlier about testosterone,

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Speaker 4: and you said, when you give testosterone, does it make

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Speaker 4: people feel better. But I tell patients that you know,

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Speaker 4: you've got to understand there's something that's just as important.

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Speaker 4: It's lifestyle modification, diet, exercise, sleep, and stress reduction. I

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Speaker 4: don't have a pill on the planet stronger than diet, exercise,

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Speaker 4: sleep and stress reduction. And every day when we wake

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Speaker 4: up or when we go to sleep, we should ask

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Speaker 4: ourselves what are we going to do on diet, exercise, sleep,

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Speaker 4: in stress reduction. I call that offense like four things

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Speaker 4: on offense, and then I call it four things on defense.

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Speaker 4: Only four ways you and I are going to die.

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Speaker 4: We're going to get cancer, we get a heart attack,

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Speaker 4: we're going to get metabolic disease meaning diabetes, obesit, or

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Speaker 4: we're gonna get parking center Alzheimer's. So on the defense,

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Speaker 4: every day we should ask ourselves how are we going

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Speaker 4: to keep those four things away? And our offense? How

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Speaker 4: are we going to move our health forward with those

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Speaker 4: four that? I think is a really important point I

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Speaker 4: wanted to get across. We have a big program on that.

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Speaker 4: I mean every time someone comes in, I have a

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Speaker 4: program for their offense and defense. It's really important.

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Speaker 3: The four on offense, which you have preached since the

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Speaker 3: day I met you, diet, exercise, sleep and stress reduction,

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Speaker 3: and do you have four on defense?

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Speaker 4: The four on defense are absolutely so it's cancer, which

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Speaker 4: means it's a heavy cancer screen CALLINGOX could be PSA.

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Speaker 4: Sometimes we'll do imaging as well. There are new tests

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Speaker 4: that come out called gallery. There other is called the

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Speaker 4: liquid biopsy test. I mean there's ways to image into

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Speaker 4: look for patients who may have potential cancer I have.

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Speaker 4: Cardiac screening is extremely important. You can sometimes you know,

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Speaker 4: you'll get certain labs like APO b LPLYTLEA. Sometimes we'll

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Speaker 4: get a corniny calcium score to look at the heart

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Speaker 4: to make sure there's not increase calcium metabolic disease. You

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Speaker 4: want to make sure that patients are watching their sugars.

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Speaker 4: It's a silent killer. Sometimes we'll put a CGM, which

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Speaker 4: is a continuous glucose monitor on them to help them

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Speaker 4: look at their sugars to make sure that they get

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Speaker 4: the feedback to say these are the foods I should

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Speaker 4: stay away from. And then you know, there's not a

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Speaker 4: lot you can do. With Parkinson's and Alzheimer's. There are

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Speaker 4: certain tests that you can look at some genes, you

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Speaker 4: can look at the see if you're a higher risk.

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Speaker 4: But you know, if you are at a higher risk,

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Speaker 4: you can start altering your behavior, exer, you know, and

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Speaker 4: doing things. So it's really important to keep the bad

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Speaker 4: things away and use the diet, exercise, and sleep and

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Speaker 4: stress to move your health forward in that paradigm. Most

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Speaker 4: people get the concept of offense and defense four and

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Speaker 4: four and it's really worked well for a lot of

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Speaker 4: my patients.

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Speaker 1: I don't know if I've told you this. Doctor Mohit

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Speaker 1: Kara is our guest. K H. E.

435
00:23:05,640 --> 00:23:09,679
Speaker 3: R A Baylor College of Medicine. I don't know if

436
00:23:09,680 --> 00:23:13,720
Speaker 3: I've told you this, but on Christmas Eve, Ramon got

437
00:23:13,760 --> 00:23:18,560
Speaker 3: a CGM, a continuous glucose monitor, and he started monitoring

438
00:23:18,600 --> 00:23:22,120
Speaker 3: his blood sugar and he keeps his blood sugar at

439
00:23:22,119 --> 00:23:25,000
Speaker 3: a very steady between one and one thirty, usually about

440
00:23:25,000 --> 00:23:26,639
Speaker 3: one point fifteen. The first thing I do when I

441
00:23:26,640 --> 00:23:29,400
Speaker 3: walk in the studio every morning is he's already here.

442
00:23:29,480 --> 00:23:31,000
Speaker 3: Is I ask him for the number he sees me

443
00:23:31,000 --> 00:23:33,120
Speaker 3: coming up the stairs and he will write it down

444
00:23:33,119 --> 00:23:34,760
Speaker 3: and show it on a sheet of paper or open

445
00:23:34,840 --> 00:23:37,600
Speaker 3: the door and tell me, and he has. It has

446
00:23:37,760 --> 00:23:43,080
Speaker 3: absolutely changed not only his health but his mood. I

447
00:23:43,080 --> 00:23:45,399
Speaker 3: mean he is consistent, he can work harder, he can

448
00:23:45,440 --> 00:23:50,080
Speaker 3: work longer by just stabilizing blood sugar, which obviously for

449
00:23:50,160 --> 00:23:53,320
Speaker 3: most people is fluctuating with great volatility.

450
00:23:54,600 --> 00:23:56,680
Speaker 4: I love that story. I think that's that's the see

451
00:23:56,680 --> 00:23:58,800
Speaker 4: and I see that all the time because the reality

452
00:23:58,840 --> 00:24:00,920
Speaker 4: is there a foods that you're eating that you think

453
00:24:00,960 --> 00:24:03,240
Speaker 4: are healthy and they're not. And the fruits that you

454
00:24:03,240 --> 00:24:05,760
Speaker 4: think they are not that healthy are you know? And

455
00:24:06,119 --> 00:24:07,879
Speaker 4: you know, I put a CGM on my wife and

456
00:24:07,880 --> 00:24:09,560
Speaker 4: we went to the same restaurant once we ate the

457
00:24:09,640 --> 00:24:12,720
Speaker 4: exact same thing, and we got totally different numbers. Because

458
00:24:12,760 --> 00:24:15,880
Speaker 4: part of it's also genetics, right, So that can play

459
00:24:15,880 --> 00:24:18,800
Speaker 4: a role in it as well. But learning more about

460
00:24:18,880 --> 00:24:21,560
Speaker 4: what is bad and what to stay away from is

461
00:24:21,680 --> 00:24:25,280
Speaker 4: extremely important because if you give yourself feedback, and those

462
00:24:25,280 --> 00:24:29,080
Speaker 4: who take feedback very seriously, you can really alter the

463
00:24:29,160 --> 00:24:32,440
Speaker 4: quality of their life because that sugar is just pounding

464
00:24:32,600 --> 00:24:34,640
Speaker 4: the blood vessels, just pounding them.

465
00:24:35,640 --> 00:24:38,840
Speaker 3: My dad's a lifelong diabetic. Was nineteen when he got diabetes.

466
00:24:38,840 --> 00:24:40,760
Speaker 3: He's eighty five now. It's amazing. He has all ten

467
00:24:40,840 --> 00:24:43,520
Speaker 3: fingers and toes, but he has monitored he I've had

468
00:24:43,560 --> 00:24:45,880
Speaker 3: doctors tell me your dad knows more about diabetes than.

469
00:24:45,760 --> 00:24:47,199
Speaker 1: We do because he had to treat it before. They

470
00:24:47,240 --> 00:24:47,679
Speaker 1: was awesome.

471
00:24:48,000 --> 00:24:51,159
Speaker 3: But I take ramon to see him last week and

472
00:24:51,240 --> 00:24:54,040
Speaker 3: all they talked about was their cgms and their dex

473
00:24:54,080 --> 00:24:56,440
Speaker 3: Colm CGM and what the reading was and what this

474
00:24:56,640 --> 00:24:58,280
Speaker 3: was and what that was it was. It was pretty

475
00:24:58,280 --> 00:25:01,199
Speaker 3: funny to watch Home with Me for one more segment

476
00:25:01,240 --> 00:25:01,680
Speaker 3: if you can.

477
00:25:01,800 --> 00:25:03,359
Speaker 1: Doctor mohitz Kara is our guest.

478
00:25:03,760 --> 00:25:07,359
Speaker 3: The book is The Sex Span and we will double

479
00:25:07,400 --> 00:25:10,399
Speaker 3: back to that subject coming up.

480
00:25:21,480 --> 00:25:26,480
Speaker 6: From Portland to Walbany at all Greek cities in between.

481
00:25:27,400 --> 00:25:33,280
Speaker 6: Michael Berry Show is nationwide.

482
00:25:36,400 --> 00:25:38,800
Speaker 1: Doctor mohitz Kara is our guest k H. E.

483
00:25:39,000 --> 00:25:39,240
Speaker 5: R A.

484
00:25:39,480 --> 00:25:43,240
Speaker 3: He is my friend and my urologist and an expert

485
00:25:43,359 --> 00:25:48,840
Speaker 3: in matters of sex and testosterone. I will read to

486
00:25:48,880 --> 00:25:53,159
Speaker 3: you an email from one fellow says, uh, well, let

487
00:25:53,200 --> 00:25:56,720
Speaker 3: me go back to that. Another fellow, actually several fellows said,

488
00:25:57,240 --> 00:26:00,480
Speaker 3: my wife's libido is way lower than mine.

489
00:26:01,320 --> 00:26:03,840
Speaker 1: How can he increase a woman's libido?

490
00:26:06,119 --> 00:26:08,080
Speaker 4: That's a really important point. So you know I told

491
00:26:08,080 --> 00:26:10,240
Speaker 4: you earlier that couple that got the woman that called

492
00:26:10,280 --> 00:26:12,120
Speaker 4: me that was very upset. So in two thousand and eight,

493
00:26:12,160 --> 00:26:14,879
Speaker 4: I actually flew out to California to the Many Fellowship

494
00:26:14,960 --> 00:26:17,800
Speaker 4: in Female sexual Dysfunction, and I started treating women for

495
00:26:17,880 --> 00:26:21,720
Speaker 4: the past seventeen years because you can't just treat one

496
00:26:21,760 --> 00:26:25,560
Speaker 4: person without treating the other. And when you improve both libidos,

497
00:26:25,560 --> 00:26:29,600
Speaker 4: you actually it's synergistic. So women, this female sexual dysfunction

498
00:26:29,760 --> 00:26:33,680
Speaker 4: is comprised of four components low libido for arousal meaning

499
00:26:33,720 --> 00:26:37,399
Speaker 4: poor blood floats of the genitalia, or gasmic dysfunction, or

500
00:26:37,480 --> 00:26:40,080
Speaker 4: pain it was sex. If she has any one of

501
00:26:40,119 --> 00:26:43,200
Speaker 4: those four and is bothered by it, she suffers from

502
00:26:43,240 --> 00:26:46,440
Speaker 4: female sexual dysfunction. And there are many treatment options out there.

503
00:26:46,600 --> 00:26:49,160
Speaker 4: One could be hormonal, one could be actually using new

504
00:26:49,200 --> 00:26:53,159
Speaker 4: Two FDA proved medications are out. One's called add ADDYI.

505
00:26:53,160 --> 00:26:56,600
Speaker 4: It came out in twenty fifteen. FDA proved strictly to

506
00:26:56,640 --> 00:26:59,160
Speaker 4: increase a woman's desire for sex. That's it. She takes

507
00:26:59,160 --> 00:27:02,280
Speaker 4: the pill every day, increases her desire for sex by least.

508
00:27:02,320 --> 00:27:04,840
Speaker 4: He came out several years later. It's an injection EpiPen.

509
00:27:05,240 --> 00:27:08,400
Speaker 4: She injects strictly to increase her desire for sex. Now,

510
00:27:08,680 --> 00:27:11,360
Speaker 4: I just want to want to be very clear. Libido

511
00:27:11,440 --> 00:27:12,760
Speaker 4: is more deeper than that. I mean there could be

512
00:27:12,800 --> 00:27:15,440
Speaker 4: a lot of other other factors. I mean it could

513
00:27:15,480 --> 00:27:18,960
Speaker 4: be her stress, it could be her physical condition, it

514
00:27:19,000 --> 00:27:21,280
Speaker 4: could be fatigue, so you can't. It could be the

515
00:27:21,320 --> 00:27:23,439
Speaker 4: quality of the relationship. So I mean, if someone has

516
00:27:23,440 --> 00:27:25,600
Speaker 4: a terrible quality and relationship, I can't. I can give

517
00:27:25,600 --> 00:27:27,200
Speaker 4: them all the pill they want, it's not going to help,

518
00:27:27,480 --> 00:27:29,200
Speaker 4: you know, So you just got to look at the

519
00:27:29,240 --> 00:27:31,840
Speaker 4: whole big picture. But I still also believe when you

520
00:27:31,880 --> 00:27:36,080
Speaker 4: improve a woman's diet, exercise, sleep, and stress, her libido

521
00:27:36,200 --> 00:27:36,880
Speaker 4: does go up.

522
00:27:37,760 --> 00:27:39,640
Speaker 1: It also helps if you take them to the movies.

523
00:27:41,359 --> 00:27:43,040
Speaker 4: Yeah, that's true.

524
00:27:43,600 --> 00:27:50,159
Speaker 3: That's true for the most conversations. Alex writes zar, what

525
00:27:50,280 --> 00:27:53,960
Speaker 3: if you can't always afford the treatment for testosterone, is

526
00:27:54,000 --> 00:27:56,600
Speaker 3: there a safe supplement I can take that would help?

527
00:27:58,040 --> 00:28:01,000
Speaker 4: So the good news is that you can get testosterone

528
00:28:01,040 --> 00:28:03,800
Speaker 4: even compounded compounding pharmacies, many of them are called A

529
00:28:03,800 --> 00:28:07,600
Speaker 4: five ZHO three B, which are regulated. They make testosterone

530
00:28:07,680 --> 00:28:10,520
Speaker 4: at a price of about thirty dollars a month without insurance.

531
00:28:10,800 --> 00:28:13,520
Speaker 4: Most people can afford thirty dollars a month without insurance.

532
00:28:13,760 --> 00:28:16,480
Speaker 4: If you look at even medications like cialis, if you

533
00:28:16,560 --> 00:28:19,320
Speaker 4: use a good RX cupon co order you use Mark

534
00:28:19,359 --> 00:28:23,040
Speaker 4: Cuban's company, you can get ninety days for roughly twenty

535
00:28:23,119 --> 00:28:26,280
Speaker 4: or twenty five dollars ninety days for cias, So these

536
00:28:26,320 --> 00:28:29,879
Speaker 4: medications are extremely affordable and price should no longer be

537
00:28:29,920 --> 00:28:30,520
Speaker 4: an issue.

538
00:28:31,760 --> 00:28:32,560
Speaker 1: That's interesting.

539
00:28:34,600 --> 00:28:39,600
Speaker 3: Several of the questions relate to hemoglobin blood thickness. I

540
00:28:39,640 --> 00:28:42,160
Speaker 3: know some people begin giving blood once they get on

541
00:28:42,200 --> 00:28:46,920
Speaker 3: testosterone because they're blood thickens. Your thoughts on that, is

542
00:28:46,960 --> 00:28:49,240
Speaker 3: that problematic or is that just a side effect?

543
00:28:50,400 --> 00:28:52,680
Speaker 4: It can be and it all depends on what type

544
00:28:52,680 --> 00:28:56,240
Speaker 4: of formulation you're using. Injectables have the highest rate. Injections

545
00:28:56,280 --> 00:28:59,280
Speaker 4: up to sixty six percent, of pellets about thirty five percent,

546
00:28:59,560 --> 00:29:02,920
Speaker 4: a gel twelve percent risk, and a pillarge about five percent.

547
00:29:03,280 --> 00:29:06,120
Speaker 4: So if your hermaticrit goes up and the number you

548
00:29:06,160 --> 00:29:08,960
Speaker 4: want to remember is fifty four, if it gets above

549
00:29:09,000 --> 00:29:13,280
Speaker 4: fifty four, there's a slight theoretical increased cardiovascar risk. And

550
00:29:13,320 --> 00:29:15,720
Speaker 4: in my practice, we have these patients start donating blood.

551
00:29:15,840 --> 00:29:17,800
Speaker 4: We don't wait to fifty four. We haven't started donating

552
00:29:17,840 --> 00:29:19,240
Speaker 4: at fifty one because I don't want to wait to

553
00:29:19,320 --> 00:29:22,800
Speaker 4: fifty four. So it is real. And remember that many

554
00:29:22,800 --> 00:29:26,000
Speaker 4: of these patients have sleep apnea ac cult to sleep apnea,

555
00:29:26,080 --> 00:29:29,000
Speaker 4: and the testoscern is unmasking it. So send them for

556
00:29:29,040 --> 00:29:31,600
Speaker 4: a sleep study because you'll find that many of them

557
00:29:31,760 --> 00:29:33,200
Speaker 4: are just suffering from sleep apnea.

558
00:29:34,760 --> 00:29:39,360
Speaker 3: You know, I find a lot of people are suffering

559
00:29:39,440 --> 00:29:42,360
Speaker 3: from some sleep disorder and they've just grown. They don't

560
00:29:42,400 --> 00:29:47,640
Speaker 3: even realize what a contributor to their overall health or

561
00:29:47,760 --> 00:29:51,480
Speaker 3: lack of it that sleep is. It's almost always accompanied

562
00:29:51,480 --> 00:29:54,480
Speaker 3: by the person being overweight, or maybe maybe the overweight

563
00:29:54,560 --> 00:29:56,440
Speaker 3: led to the sleep. But that's one of those things

564
00:29:56,480 --> 00:29:59,840
Speaker 3: that I find when I dig into people often have

565
00:30:00,280 --> 00:30:02,880
Speaker 3: bad sleep and they don't think that's they don't realize

566
00:30:02,880 --> 00:30:03,640
Speaker 3: how important that is.

567
00:30:04,960 --> 00:30:07,360
Speaker 4: Michael, You're so right. Listen, when I take care a

568
00:30:07,400 --> 00:30:09,400
Speaker 4: lot of CEOs, a lot of people, and I talk

569
00:30:09,480 --> 00:30:12,360
Speaker 4: about the four pillars diet, exercise, sleep, and stress. They're

570
00:30:12,400 --> 00:30:15,280
Speaker 4: all pretty good at diet, they're all pretty good at exercise,

571
00:30:15,520 --> 00:30:19,000
Speaker 4: that are lousy at sleep and stress. Right, and so

572
00:30:19,320 --> 00:30:22,720
Speaker 4: in sleep and stress are so critical, and you think

573
00:30:22,760 --> 00:30:25,720
Speaker 4: about sleep, it is a game changer. Even the way

574
00:30:25,760 --> 00:30:28,400
Speaker 4: you think about sleep. It's not the hours you sleep

575
00:30:28,640 --> 00:30:31,680
Speaker 4: that's multiplied by how efficient you slept. So if you

576
00:30:31,720 --> 00:30:34,480
Speaker 4: slept eight hours last night, but you were twenty percent efficient,

577
00:30:34,640 --> 00:30:36,360
Speaker 4: And I slept only four hours last night, but I

578
00:30:36,400 --> 00:30:38,600
Speaker 4: was eighty percent efficient. I'm going to feel a lot

579
00:30:38,600 --> 00:30:40,959
Speaker 4: better than you, right, So the reality is not just

580
00:30:41,120 --> 00:30:43,720
Speaker 4: lying there with your eyes closed. You have to get

581
00:30:43,800 --> 00:30:47,400
Speaker 4: good deep sleep, good rem sleep, and even thirty minutes

582
00:30:47,440 --> 00:30:49,800
Speaker 4: extra of either deep sleep or rems sleep every night

583
00:30:50,240 --> 00:30:53,080
Speaker 4: game changer for the next day. So I think people

584
00:30:53,200 --> 00:30:56,480
Speaker 4: need to be very military. Just find a way to

585
00:30:56,520 --> 00:30:58,520
Speaker 4: make sure that you go to sleep on time, wake

586
00:30:58,640 --> 00:31:01,880
Speaker 4: up on time. And best website I found was the

587
00:31:01,880 --> 00:31:05,120
Speaker 4: American Sleep Foundation. The American Sleep Foundation has twenty tips

588
00:31:05,120 --> 00:31:08,400
Speaker 4: on their website. They're awesome. Follow those tips. That makes

589
00:31:08,400 --> 00:31:09,160
Speaker 4: a big difference.

590
00:31:11,240 --> 00:31:13,960
Speaker 1: Salt in the diet. So I've been reading a lot

591
00:31:14,000 --> 00:31:15,480
Speaker 1: on salt lately, and.

592
00:31:16,960 --> 00:31:18,640
Speaker 3: I don't I have not run this by you yet,

593
00:31:18,760 --> 00:31:21,800
Speaker 3: so I'm curious to see what you think of this.

594
00:31:22,720 --> 00:31:25,120
Speaker 3: And the theory goes that we were told to stay

595
00:31:25,120 --> 00:31:28,280
Speaker 3: away from salt. Salt raises blood pressure, salt causes all

596
00:31:28,280 --> 00:31:33,240
Speaker 3: these these problems. And basically the point of the piece

597
00:31:33,520 --> 00:31:36,479
Speaker 3: was that we are now deprived of salt, and what

598
00:31:36,520 --> 00:31:39,160
Speaker 3: do you do to treat someone for a number of

599
00:31:39,160 --> 00:31:42,520
Speaker 3: things is you give them salt. Your thoughts on salt intake.

600
00:31:44,040 --> 00:31:46,400
Speaker 4: So I think that I'm still a believer that salt,

601
00:31:46,600 --> 00:31:50,360
Speaker 4: particularly in patience who have hypertension, is a risk factor.

602
00:31:50,600 --> 00:31:53,560
Speaker 4: And so if someone has hypertension, which most many Americans

603
00:31:53,600 --> 00:31:57,040
Speaker 4: suffer from, that is going to be something that's the

604
00:31:57,080 --> 00:31:59,080
Speaker 4: first thing I'm going to ask them to stay away from.

605
00:31:59,360 --> 00:32:02,680
Speaker 4: As ayrlogist. The other thing we worry about is increased

606
00:32:02,680 --> 00:32:08,240
Speaker 4: salt intake significantly increases the risk for the kidney stones.

607
00:32:08,600 --> 00:32:12,680
Speaker 4: And so I am not a believer yet that we

608
00:32:12,760 --> 00:32:16,480
Speaker 4: should be increasing excuse me, increasing salt unless there's a

609
00:32:16,520 --> 00:32:18,800
Speaker 4: reason to do so. But I'm more concerned about the

610
00:32:18,840 --> 00:32:20,360
Speaker 4: hypertension and the stone risk.

611
00:32:20,520 --> 00:32:22,440
Speaker 1: But on French Fries, it's okay, right.

612
00:32:24,520 --> 00:32:31,680
Speaker 3: Sometimes sometimes, doctor moh Kara, you are the absolute best.

613
00:32:31,840 --> 00:32:37,680
Speaker 3: The four phases of offense he has outlined or diet, exercise,

614
00:32:38,080 --> 00:32:41,520
Speaker 3: sleep and stress reduction all things you can do yourself

615
00:32:41,560 --> 00:32:46,440
Speaker 3: that don't require spending a dollar. Diet, exercise, sleep and

616
00:32:46,760 --> 00:32:51,520
Speaker 3: stress reduction is four pillars of offense and defense. I

617
00:32:51,600 --> 00:32:54,040
Speaker 3: cannot help you get in to see him, so don't

618
00:32:54,040 --> 00:32:55,840
Speaker 3: even try, because I'm to be overwhelmed again.

619
00:32:56,400 --> 00:32:57,640
Speaker 1: It's Baylor College of Medicine.

620
00:32:57,680 --> 00:32:59,400
Speaker 3: It does take a while to get in to see him,

621
00:33:00,160 --> 00:33:02,040
Speaker 3: only because he's very popular.

622
00:33:02,120 --> 00:33:03,680
Speaker 1: A lot of people like him.

623
00:33:04,000 --> 00:33:06,560
Speaker 3: I was my own worst enemy in sending too many

624
00:33:06,600 --> 00:33:08,920
Speaker 3: patients to him at the beginning, and he only has

625
00:33:08,960 --> 00:33:11,840
Speaker 3: so many hours of the day. The book is The

626
00:33:11,920 --> 00:33:14,760
Speaker 3: Sex Span, which is not out yet but will be

627
00:33:15,000 --> 00:33:15,760
Speaker 3: hopefully soon.

628
00:33:15,800 --> 00:33:17,440
Speaker 1: And when you let me know that is the case,

629
00:33:17,840 --> 00:33:20,720
Speaker 1: we will all go and buy it online.

630
00:33:20,920 --> 00:33:22,760
Speaker 4: Will do. Thank you so much, Michael, You're the best.

631
00:33:22,840 --> 00:33:24,360
Speaker 1: My friend. Doctor mohit.

632
00:33:25,600 --> 00:33:30,520
Speaker 3: H e r a Baylor College of Medicine.

633
00:33:30,720 --> 00:33:30,960
Speaker 1: Yeah.

634
00:33:31,120 --> 00:33:35,720
Speaker 3: So I'm having dinner at Gringos, the new location at

635
00:33:36,640 --> 00:33:41,040
Speaker 3: ninety nine and two forty nine with Wayne Wilson, who's

636
00:33:41,080 --> 00:33:45,640
Speaker 3: the founder of Synergenics, and he was telling me about

637
00:33:46,920 --> 00:33:51,040
Speaker 3: we were talking about the testosterone replacement, but he was

638
00:33:51,040 --> 00:33:53,000
Speaker 3: talking about this doctor and he said.

639
00:33:52,760 --> 00:33:54,280
Speaker 1: I think it's your doctor.

640
00:33:55,040 --> 00:33:59,160
Speaker 3: He comes out and trains our people on testosterone in

641
00:33:59,160 --> 00:34:01,800
Speaker 3: the effects and why it's important and all that, and

642
00:34:01,880 --> 00:34:03,480
Speaker 3: it was doctor Kara and I did not know that.

643
00:34:03,560 --> 00:34:05,719
Speaker 3: I had no idea. Doctor Karatt was the first one

644
00:34:05,760 --> 00:34:08,080
Speaker 3: that put me on testosterone. We did the pellets for

645
00:34:08,120 --> 00:34:11,040
Speaker 3: a couple of years and then Low T Center, which

646
00:34:11,080 --> 00:34:13,759
Speaker 3: is also Synergenics, became a show sponsor, so I just

647
00:34:13,800 --> 00:34:16,000
Speaker 3: moved over there and started doing the weekly shots. I

648
00:34:16,120 --> 00:34:18,040
Speaker 3: liked the shot. I like the shots better than the pellets.

649
00:34:18,080 --> 00:34:20,000
Speaker 3: Some people like the pellets. I gotta tell you my

650
00:34:20,040 --> 00:34:20,600
Speaker 3: Pellette story.

651
00:34:20,600 --> 00:34:20,880
Speaker 4: Hold on