1
00:00:03,720 --> 00:00:11,039
Speaker 1: It's that time, time, time, time, luck and load. So

2
00:00:11,240 --> 00:00:26,400
Speaker 1: Michael Varie Show is on the air. Today's show is

3
00:00:26,520 --> 00:00:34,720
Speaker 1: sponsored by Peanut Butter for pure versatility of application, ability

4
00:00:34,760 --> 00:00:41,479
Speaker 1: to make anything it touches better, and shelf life. I

5
00:00:41,520 --> 00:00:43,960
Speaker 1: don't know that there's anything better that comes in a bottle.

6
00:00:44,159 --> 00:00:48,199
Speaker 1: I really don't. I really don't. Let's just take a

7
00:00:48,240 --> 00:00:54,200
Speaker 1: moment and think about your best peanut butter moment. Ramon.

8
00:00:54,640 --> 00:00:58,960
Speaker 1: Your peanut butter moment should not involve sex. But my urologist,

9
00:00:59,080 --> 00:01:02,800
Speaker 1: doctor Mohith Care is our guest. Welcome to the program.

10
00:01:02,800 --> 00:01:08,000
Speaker 1: Good sir, Thank you, Michael. Everyone has a lifespan, Ramon.

11
00:01:08,080 --> 00:01:10,160
Speaker 1: You know that you have a lifespan. We talk about

12
00:01:10,200 --> 00:01:13,880
Speaker 1: our life span. Doctor Mohit Kara is writing a book

13
00:01:14,080 --> 00:01:19,039
Speaker 1: called Or about the sex span. How long can a

14
00:01:19,080 --> 00:01:25,360
Speaker 1: human being have a functional, fulfilling sex life, doctor Kara?

15
00:01:25,440 --> 00:01:26,240
Speaker 1: Why does that matter?

16
00:01:27,880 --> 00:01:29,679
Speaker 2: Well, Michael Sphers, thank you for having me on the show.

17
00:01:29,880 --> 00:01:32,319
Speaker 2: You know everyone where you go, every where, talks about

18
00:01:32,440 --> 00:01:36,360
Speaker 2: lifespan and health span. That's the big buzzwords in the community.

19
00:01:36,680 --> 00:01:39,880
Speaker 2: And I'll give you an example. Everybody wants, I assume

20
00:01:40,280 --> 00:01:43,120
Speaker 2: their health span to last as long as their lifespan.

21
00:01:43,560 --> 00:01:46,399
Speaker 2: But in the United States, the average health lifespan is

22
00:01:46,440 --> 00:01:49,960
Speaker 2: seventy seven years old. Women live typically seventy nine years old,

23
00:01:50,040 --> 00:01:53,040
Speaker 2: men live typically seventy five years old. But the health

24
00:01:53,040 --> 00:01:56,680
Speaker 2: span in the United States is roughly sixty seven years old,

25
00:01:56,920 --> 00:01:59,160
Speaker 2: which means most of us for the last ten years

26
00:01:59,200 --> 00:02:01,240
Speaker 2: of our life are not going to be living in

27
00:02:01,280 --> 00:02:02,560
Speaker 2: a healthy condition, which.

28
00:02:02,360 --> 00:02:03,520
Speaker 3: Is very unfortunate.

29
00:02:03,920 --> 00:02:06,160
Speaker 2: And all these countries talk about how they're expanding their

30
00:02:06,160 --> 00:02:08,920
Speaker 2: lifespan and getting people to live longer. In my mind,

31
00:02:08,960 --> 00:02:11,840
Speaker 2: that is not what I want do, not expand my

32
00:02:11,880 --> 00:02:16,440
Speaker 2: lifespan without expanding my health span. But this concept of

33
00:02:16,520 --> 00:02:19,880
Speaker 2: sex span is also important because many men would say, look,

34
00:02:19,919 --> 00:02:22,240
Speaker 2: I said, if you're going to live till eighty, but

35
00:02:22,280 --> 00:02:25,440
Speaker 2: you can only have sex till fifty, that's a problem

36
00:02:25,480 --> 00:02:27,639
Speaker 2: for many men. And so what we want to do

37
00:02:27,880 --> 00:02:31,400
Speaker 2: is try to expand our sex span and our health

38
00:02:31,400 --> 00:02:34,320
Speaker 2: span as long as our lifespan. I think that's a

39
00:02:34,360 --> 00:02:35,679
Speaker 2: really important point.

40
00:02:37,440 --> 00:02:39,360
Speaker 1: I know. One of the things I like about you

41
00:02:40,240 --> 00:02:42,960
Speaker 1: is that you don't just rely on what you learned

42
00:02:42,960 --> 00:02:45,120
Speaker 1: in medical school and then mail it in every day.

43
00:02:45,160 --> 00:02:50,240
Speaker 1: You're constantly reading studies, you're constantly performing research and publishing

44
00:02:50,320 --> 00:02:52,880
Speaker 1: and speaking literally around the world, because you're always somewhere

45
00:02:52,919 --> 00:02:54,799
Speaker 1: else when I call you just to see what you're

46
00:02:54,880 --> 00:02:57,720
Speaker 1: up to giving a speech on this or that. How

47
00:02:57,800 --> 00:03:01,600
Speaker 1: important is sex to the human body in terms of

48
00:03:01,680 --> 00:03:03,280
Speaker 1: purely physically.

49
00:03:04,240 --> 00:03:07,320
Speaker 2: Yeah, it's extremely important. So I want to just clarify

50
00:03:07,360 --> 00:03:11,480
Speaker 2: one thing. A rectile dysfunction is not a disease. It's

51
00:03:11,520 --> 00:03:16,280
Speaker 2: a symptom of other underlying diseases. Right, So ED does

52
00:03:16,320 --> 00:03:18,600
Speaker 2: not happen in healthy men as they get older. If

53
00:03:18,600 --> 00:03:21,280
Speaker 2: a man gets a rectile dysfunction, it is a symptom

54
00:03:21,520 --> 00:03:24,760
Speaker 2: of his diabetes, it's a symptom if his Cardiovasker disease,

55
00:03:24,960 --> 00:03:28,120
Speaker 2: it's a symptom of his radical procestectomo surgery. Or it's

56
00:03:28,160 --> 00:03:32,240
Speaker 2: a symptom of depression or anxiety. So when someone develops

57
00:03:32,280 --> 00:03:34,800
Speaker 2: a rectile dysfunction, the second question you should be asking

58
00:03:34,920 --> 00:03:38,960
Speaker 2: is what else is going on that's causing this condition?

59
00:03:39,000 --> 00:03:42,600
Speaker 2: Because if he was perfectly healthy, that would not happen, right,

60
00:03:42,680 --> 00:03:45,080
Speaker 2: And so the best example I can give you is

61
00:03:45,120 --> 00:03:47,320
Speaker 2: this is that if did you know that if a

62
00:03:47,360 --> 00:03:50,560
Speaker 2: man walks in today and has a rectile dysfunction, fifteen

63
00:03:50,600 --> 00:03:52,520
Speaker 2: percent of them will have a heart attack or stroke

64
00:03:52,720 --> 00:03:56,720
Speaker 2: within seven years fifteen percent. It's an underlying marker of

65
00:03:56,800 --> 00:04:00,160
Speaker 2: cardiovask disease. If a man walks in with ED today,

66
00:04:00,520 --> 00:04:04,080
Speaker 2: thirty percent of them have a cult diabetes thirty percent,

67
00:04:04,120 --> 00:04:06,720
Speaker 2: which is a lot. And if a man walks in today,

68
00:04:07,520 --> 00:04:10,520
Speaker 2: thirty percent of them will have depression or anxiety. So

69
00:04:11,040 --> 00:04:14,000
Speaker 2: the biggest mistake I can do is give this man

70
00:04:14,120 --> 00:04:16,760
Speaker 2: viagra and getend him on his way, because maybe he

71
00:04:16,839 --> 00:04:20,159
Speaker 2: has that occult cardiovask disease, maybe he has diabetes, Maybe

72
00:04:20,200 --> 00:04:24,560
Speaker 2: he's suffering from depression or anxiety. So it's really important

73
00:04:24,560 --> 00:04:27,960
Speaker 2: to figure out what is causing that ED. And what's

74
00:04:27,960 --> 00:04:30,960
Speaker 2: so nice about this is that there's a bi directional relationship.

75
00:04:31,240 --> 00:04:33,839
Speaker 2: So if I treat a man's ED, that actually improves

76
00:04:33,880 --> 00:04:36,359
Speaker 2: his depression. If I improve a man's depression, it actually

77
00:04:36,360 --> 00:04:39,400
Speaker 2: improves his ED. So I think the paradigm is shifting.

78
00:04:39,520 --> 00:04:41,600
Speaker 2: No longer do I want to just hand the man

79
00:04:41,680 --> 00:04:45,040
Speaker 2: the pill. You've got to figure out what's going on underneath,

80
00:04:45,360 --> 00:04:47,039
Speaker 2: because this is what I call the canary in the

81
00:04:47,040 --> 00:04:49,720
Speaker 2: coal mine, and you can actually save someone's life. I mean,

82
00:04:49,839 --> 00:04:54,119
Speaker 2: imagine if I catch someone's cardiovasker disease today, or diabetes today,

83
00:04:54,400 --> 00:04:57,280
Speaker 2: or I catch it ten years from now. It's a

84
00:04:57,320 --> 00:05:00,600
Speaker 2: total change in trajectory in terms of their house in

85
00:05:00,640 --> 00:05:01,239
Speaker 2: their life.

86
00:05:01,800 --> 00:05:05,120
Speaker 1: Well, it goes back to viagra originally being a cardiovascular

87
00:05:05,160 --> 00:05:10,760
Speaker 1: disease in a off label benefit being the ability to

88
00:05:10,760 --> 00:05:11,280
Speaker 1: get erection.

89
00:05:12,680 --> 00:05:15,560
Speaker 2: Yeah, Michael, that's a funny story because remember this one.

90
00:05:15,600 --> 00:05:17,480
Speaker 2: But they were trying to make a blood pressure medication

91
00:05:17,680 --> 00:05:22,120
Speaker 2: and accidentally everyone in this study was getting erections, and

92
00:05:22,160 --> 00:05:27,960
Speaker 2: they figured it out because people were not returning the pills.

93
00:05:29,560 --> 00:05:32,600
Speaker 1: I had a friend, I was a baby lawyer at

94
00:05:32,600 --> 00:05:34,520
Speaker 1: the time at a firm called Jakins and Gilchrist and

95
00:05:34,800 --> 00:05:36,440
Speaker 1: I worked with a guy named Darren Alt who was

96
00:05:36,440 --> 00:05:38,839
Speaker 1: my best friend there. And his wife, Tracy, was the

97
00:05:38,880 --> 00:05:41,159
Speaker 1: head of Viagra in Houston, which was the top market

98
00:05:41,200 --> 00:05:43,680
Speaker 1: for viagra in the country, and they were taking a

99
00:05:43,680 --> 00:05:46,120
Speaker 1: trip every other week with their sales reps, and they

100
00:05:46,160 --> 00:05:49,039
Speaker 1: had all sorts of stories of people and at that

101
00:05:49,120 --> 00:05:52,080
Speaker 1: point it was still you'd go to your cardiologist to

102
00:05:52,120 --> 00:05:55,080
Speaker 1: get viagra, So everybody was faking a heart problem to

103
00:05:55,120 --> 00:05:58,599
Speaker 1: go in and get this medication. And the story goes

104
00:05:58,920 --> 00:06:02,120
Speaker 1: that the doctors getting calls from the wives going hey,

105
00:06:02,200 --> 00:06:03,840
Speaker 1: knock it off. Take him off of that.

106
00:06:05,760 --> 00:06:08,440
Speaker 2: Right, right, right right, yeah, absolutely, And so you know

107
00:06:08,480 --> 00:06:12,039
Speaker 2: what the issue is is that ED back then was

108
00:06:12,080 --> 00:06:14,400
Speaker 2: not considered a very serious condition. People used to make

109
00:06:14,440 --> 00:06:17,240
Speaker 2: fun of it, and oh he has ED. ED is

110
00:06:17,279 --> 00:06:21,000
Speaker 2: a very serious condition. Someone gets erected on dysfunction, take

111
00:06:21,040 --> 00:06:23,160
Speaker 2: it seriously. Something else is going on.

112
00:06:23,680 --> 00:06:28,839
Speaker 1: Well, and to oversimplify this, that is because it means

113
00:06:28,880 --> 00:06:31,599
Speaker 1: you're not getting proper blood flow or you're not pumping

114
00:06:31,640 --> 00:06:34,600
Speaker 1: your your blood properly. And that's I guess as good

115
00:06:34,600 --> 00:06:36,279
Speaker 1: a way as any for us to check, maybe the

116
00:06:36,320 --> 00:06:37,000
Speaker 1: easiest way.

117
00:06:38,320 --> 00:06:39,479
Speaker 3: Yeah, And so think about this.

118
00:06:39,520 --> 00:06:42,000
Speaker 2: I teach their medical students this new monic called vent

119
00:06:42,520 --> 00:06:45,440
Speaker 2: vascular meaning there's not enough blood flow coming in or

120
00:06:45,480 --> 00:06:48,080
Speaker 2: there's too much blood flow coming out. And too much

121
00:06:48,080 --> 00:06:50,240
Speaker 2: blood flow coming out is the most common cause of ED.

122
00:06:50,600 --> 00:06:52,400
Speaker 2: So the guy will tell you I can get the erection,

123
00:06:52,560 --> 00:06:55,039
Speaker 2: but I just can't maintain it. He's telling you the

124
00:06:55,040 --> 00:06:57,159
Speaker 2: blood flow's coming out too quickly. The number one cause

125
00:06:57,160 --> 00:06:59,520
Speaker 2: of ED in the world. But VENT stands for a

126
00:06:59,600 --> 00:07:03,360
Speaker 2: vascal E means androcrine. It's a testosterone. The testosterone goes low,

127
00:07:03,800 --> 00:07:07,920
Speaker 2: ED goes up. Neurologic meaning nerve injury and then trauma.

128
00:07:08,279 --> 00:07:12,880
Speaker 2: And don't forget medications. Medications from notorious for example, beta blockers.

129
00:07:13,000 --> 00:07:15,840
Speaker 2: How many people are Beta blockers shuts down the erections.

130
00:07:16,120 --> 00:07:19,400
Speaker 2: Antidepressants shuts down the directions. So you've got to look

131
00:07:19,400 --> 00:07:22,680
Speaker 2: at all the different causes for ED. And I just

132
00:07:22,720 --> 00:07:26,280
Speaker 2: want to stress one other thing. Sexual dysfunction is a

133
00:07:26,320 --> 00:07:29,280
Speaker 2: couple's disease. You know, we're so fixed on these silos.

134
00:07:29,320 --> 00:07:30,640
Speaker 2: I got to take care of the woman, I got

135
00:07:30,640 --> 00:07:32,200
Speaker 2: to take care of the man. You got to look

136
00:07:32,200 --> 00:07:34,080
Speaker 2: at both of them. I'll give you an example. Back

137
00:07:34,120 --> 00:07:36,640
Speaker 2: in two thousand and seven, I finished my fellowship, and

138
00:07:36,760 --> 00:07:38,680
Speaker 2: I was so proud of myself. I was able to

139
00:07:38,680 --> 00:07:42,840
Speaker 2: get these men, these amazing erections, amazing libido. And one

140
00:07:42,880 --> 00:07:45,920
Speaker 2: day a woman called me and said to me, she said,

141
00:07:46,080 --> 00:07:49,280
Speaker 2: everything was great with our relationship until he met you.

142
00:07:49,640 --> 00:07:52,040
Speaker 2: We never fought. We fight all the time because every

143
00:07:52,080 --> 00:07:53,840
Speaker 2: day he wants to have sex with me and I

144
00:07:53,840 --> 00:07:55,760
Speaker 2: don't want to have sex with him. And you've ruined

145
00:07:55,760 --> 00:07:59,000
Speaker 2: our relationship. And I thought to myself, she's right. What

146
00:07:59,160 --> 00:08:02,520
Speaker 2: is the point of raising one libido without raising the other.

147
00:08:02,640 --> 00:08:05,800
Speaker 2: Either leave both libidos low, It's fine, leave them both

148
00:08:05,840 --> 00:08:08,559
Speaker 2: low or raise both, but you don't raise one without

149
00:08:08,560 --> 00:08:08,840
Speaker 2: the other.

150
00:08:09,280 --> 00:08:12,280
Speaker 1: Doctor Mohit Kara at the Baylor College of Medicine and

151
00:08:12,360 --> 00:08:16,000
Speaker 1: my urologist and friend coming up. The book will be

152
00:08:16,360 --> 00:08:17,800
Speaker 1: I got to get the name of it. It's about

153
00:08:17,800 --> 00:08:20,560
Speaker 1: the sex ben maybe calver sex ben remontination. It's a

154
00:08:20,640 --> 00:08:28,360
Speaker 1: hard problem to everyone listens the Michael Verry Show. The

155
00:08:28,360 --> 00:08:31,360
Speaker 1: only downside to having doctor Mohit Kara on the air

156
00:08:31,760 --> 00:08:35,600
Speaker 1: as our guest is then people ask me how to

157
00:08:35,640 --> 00:08:37,680
Speaker 1: get in to see him because it takes so long

158
00:08:37,760 --> 00:08:43,440
Speaker 1: to see him because he is so insanely popular. Everybody

159
00:08:43,520 --> 00:08:49,400
Speaker 1: I know is now his patient after hearing my experience

160
00:08:49,720 --> 00:08:54,000
Speaker 1: with him. He's just fantastic. I think the world of him.

161
00:08:54,440 --> 00:08:57,440
Speaker 1: Doctor Mohit Kara is at Baylor College of Medicine where

162
00:08:57,480 --> 00:09:01,960
Speaker 1: he is a urologist. He has a forthcoming book. Is

163
00:09:02,000 --> 00:09:04,360
Speaker 1: the book called the Sex Span Moment or what is

164
00:09:04,360 --> 00:09:05,040
Speaker 1: the book called?

165
00:09:05,840 --> 00:09:10,440
Speaker 2: It is called sex Span and a Proactive Approach, A

166
00:09:10,480 --> 00:09:12,360
Speaker 2: proactive approach to prolonging your sexpan.

167
00:09:13,040 --> 00:09:15,440
Speaker 1: So, as we were going into the break, you made

168
00:09:15,480 --> 00:09:19,280
Speaker 1: a statement about if you help a man build his

169
00:09:19,360 --> 00:09:23,640
Speaker 1: libido and his sexual function, but you do not concurrently

170
00:09:23,679 --> 00:09:26,160
Speaker 1: do that for the woman, you end up causing problems

171
00:09:26,480 --> 00:09:29,760
Speaker 1: for them. Let's take the physical out for a moment.

172
00:09:30,040 --> 00:09:34,920
Speaker 1: In your opinion, how important is sexual relations to a

173
00:09:35,000 --> 00:09:38,720
Speaker 1: couple and to an individual emotionally? You tied it to

174
00:09:39,000 --> 00:09:42,160
Speaker 1: the antithesis of depression, but talk about that if you would.

175
00:09:43,360 --> 00:09:44,559
Speaker 3: It's extremely important.

176
00:09:44,600 --> 00:09:47,599
Speaker 2: If you look at couples that engage in regular sexual activity,

177
00:09:47,920 --> 00:09:51,040
Speaker 2: that tend to be happier overall, satisfied with their quality

178
00:09:51,040 --> 00:09:53,520
Speaker 2: of life, they usually tend to be healthier, and they

179
00:09:53,559 --> 00:09:55,840
Speaker 2: usually tend to live longer. So there are numerous aspects.

180
00:09:55,880 --> 00:09:57,840
Speaker 2: So there's a one study that I saw that talked

181
00:09:57,840 --> 00:10:00,760
Speaker 2: about the couples that engage in do not engage in

182
00:10:01,920 --> 00:10:07,280
Speaker 2: sexual activity typically can have a twofold traction from their relationship.

183
00:10:07,480 --> 00:10:10,040
Speaker 2: But if they do engage sexual activity, it actually can

184
00:10:10,080 --> 00:10:11,960
Speaker 2: add four x to the quality of relationship.

185
00:10:12,080 --> 00:10:13,240
Speaker 3: So I mean, let's be honest.

186
00:10:13,280 --> 00:10:16,160
Speaker 2: I mean it does bring intimacy and closeness to the relationship.

187
00:10:16,200 --> 00:10:18,680
Speaker 2: It does strengthen the quality of the relationship, and in

188
00:10:18,720 --> 00:10:22,120
Speaker 2: many cases people find this extremely important. So I do

189
00:10:22,160 --> 00:10:26,360
Speaker 2: think that there is a medical benefit, psychological benefit and

190
00:10:26,520 --> 00:10:30,359
Speaker 2: patients engaging in sexual activity.

191
00:10:30,720 --> 00:10:32,719
Speaker 1: I have had friends over the years who when they

192
00:10:32,720 --> 00:10:36,120
Speaker 1: put their parents in old folks homes, they talk about

193
00:10:36,200 --> 00:10:40,199
Speaker 1: how it is surprising how much activity there is in

194
00:10:40,240 --> 00:10:41,800
Speaker 1: the old folks home. And when I did that for

195
00:10:41,920 --> 00:10:44,040
Speaker 1: my dad earlier this year, that was one of the

196
00:10:44,080 --> 00:10:48,840
Speaker 1: things that everybody consistently across the board talked about. I

197
00:10:48,880 --> 00:10:51,160
Speaker 1: don't know if there's any if there's anything to that,

198
00:10:51,200 --> 00:10:53,160
Speaker 1: but we're talking about people in their eighties and nineties,

199
00:10:53,200 --> 00:10:55,400
Speaker 1: and I have heard this story consistently.

200
00:10:57,240 --> 00:10:59,440
Speaker 2: You're actually right, So one of the highest levels of

201
00:10:59,520 --> 00:11:02,040
Speaker 2: STDs do occur in nursing homes. So you do know

202
00:11:02,080 --> 00:11:06,360
Speaker 2: that there's increased sexual activity that does occur in those

203
00:11:06,440 --> 00:11:09,719
Speaker 2: in those nursing homes, and so, but part of it

204
00:11:09,760 --> 00:11:12,760
Speaker 2: is because there's at some point, there's an inflection point.

205
00:11:13,040 --> 00:11:15,880
Speaker 2: As you live longer and longer, those patients that are

206
00:11:15,920 --> 00:11:19,280
Speaker 2: the healthiest tend to live the longest, and those patients

207
00:11:19,320 --> 00:11:20,920
Speaker 2: who are tend to be healthier tend to be more

208
00:11:21,679 --> 00:11:23,320
Speaker 2: the ability to engage in sexual activity.

209
00:11:24,559 --> 00:11:27,080
Speaker 1: When you and I talked about the book the first time,

210
00:11:27,480 --> 00:11:29,959
Speaker 1: you said that one of the things that the book

211
00:11:30,000 --> 00:11:32,280
Speaker 1: is going to cover is the importance of screening for

212
00:11:32,400 --> 00:11:35,600
Speaker 1: testosterone and how rectal dysfunction is a marker of other

213
00:11:35,679 --> 00:11:39,160
Speaker 1: underlying major medical conditions, such as a heart attack. The

214
00:11:39,200 --> 00:11:42,160
Speaker 1: screening for testosterone, why is that important?

215
00:11:43,200 --> 00:11:45,720
Speaker 2: So, Michael, I am very passionate about this topic because

216
00:11:46,160 --> 00:11:49,880
Speaker 2: you know, everyone thinks about testosterone as energy and sex

217
00:11:50,000 --> 00:11:53,400
Speaker 2: drive and erections. And yes, it's true if you have

218
00:11:53,480 --> 00:11:57,280
Speaker 2: low energy, low libido, rectal dysfunction, giving a man testosterone

219
00:11:57,280 --> 00:11:59,600
Speaker 2: can improve these symptoms. But now we're in an era

220
00:11:59,720 --> 00:12:02,400
Speaker 2: where it goes way beyond that. So did you know

221
00:12:02,640 --> 00:12:05,000
Speaker 2: that a man who has low testosterone is much more

222
00:12:05,080 --> 00:12:07,880
Speaker 2: likely to have a heart attack, non negotiable, much more likely.

223
00:12:08,000 --> 00:12:09,640
Speaker 2: A man who has low test osoe is much more

224
00:12:09,679 --> 00:12:11,640
Speaker 2: likely to break a bone. A man who's low test

225
00:12:11,679 --> 00:12:14,920
Speaker 2: osom is more likely of diabetes obesity metabox syndrome. A

226
00:12:14,960 --> 00:12:17,000
Speaker 2: diet man who's low test awsome is much more likely

227
00:12:17,040 --> 00:12:20,440
Speaker 2: to suffer from depression. And giving a man back his

228
00:12:20,520 --> 00:12:25,679
Speaker 2: testosterone can help mitigate improve these conditions. So it's not

229
00:12:25,760 --> 00:12:28,800
Speaker 2: just about sex, it's about your overall health. The problem

230
00:12:28,800 --> 00:12:31,120
Speaker 2: I have is that when I walk into my primary

231
00:12:31,120 --> 00:12:33,960
Speaker 2: care doctor's office every year and he checks my blood,

232
00:12:34,280 --> 00:12:37,240
Speaker 2: he does not check an annual testosterone. He'll check a

233
00:12:37,280 --> 00:12:39,480
Speaker 2: thyroid he'll check a TSH. I say, why are checking

234
00:12:39,480 --> 00:12:41,040
Speaker 2: at TSH? He said, well, we do that every year

235
00:12:41,080 --> 00:12:43,600
Speaker 2: to make sure you're not hypothyroid. There is not a

236
00:12:43,640 --> 00:12:47,800
Speaker 2: better marker of a man's overall health than a testosterone level.

237
00:12:48,000 --> 00:12:50,400
Speaker 2: It gives you a marker of what his health is today,

238
00:12:50,840 --> 00:12:52,440
Speaker 2: and it gives you a marker of what his health

239
00:12:52,440 --> 00:12:55,360
Speaker 2: will be in the future. And so every man over

240
00:12:55,400 --> 00:12:57,640
Speaker 2: the age of forty, every single man, should be getting

241
00:12:57,640 --> 00:13:00,960
Speaker 2: a testosteronal level every single year days of forty, because

242
00:13:00,960 --> 00:13:03,880
Speaker 2: I do think it's the best predictor of his overall

243
00:13:03,920 --> 00:13:06,880
Speaker 2: health currently and in the future. And it's modifiable because

244
00:13:06,880 --> 00:13:09,240
Speaker 2: there's things I can do to improve his testosterone if

245
00:13:09,280 --> 00:13:09,720
Speaker 2: he's low.

246
00:13:10,640 --> 00:13:14,280
Speaker 1: You suggestive testosterone for me ten years ago. I know

247
00:13:14,280 --> 00:13:15,880
Speaker 1: you weren't going to talk about it because you're the doctor,

248
00:13:15,880 --> 00:13:19,440
Speaker 1: but I can, and obviously it changed my life. It

249
00:13:19,480 --> 00:13:23,160
Speaker 1: made a huge difference for me. But when you do

250
00:13:23,240 --> 00:13:27,000
Speaker 1: that for folks, what kind of differences do you typically see?

251
00:13:28,120 --> 00:13:29,800
Speaker 2: Well, the first thing you have to ask yourself is

252
00:13:29,840 --> 00:13:31,800
Speaker 2: are they young and do they want to have children?

253
00:13:31,920 --> 00:13:36,160
Speaker 2: Because most people don't realize that giving testosterone actually shuts

254
00:13:36,200 --> 00:13:38,800
Speaker 2: down your fertility. So I can't tell you how many

255
00:13:38,800 --> 00:13:40,960
Speaker 2: patients I see in my practice every week that said, look,

256
00:13:41,000 --> 00:13:43,240
Speaker 2: I was started on testosterone or no one told me

257
00:13:43,240 --> 00:13:45,760
Speaker 2: that the testosic could make me infertile. Now we want

258
00:13:45,760 --> 00:13:48,080
Speaker 2: to have kids, what do I do? So there's the

259
00:13:48,120 --> 00:13:50,640
Speaker 2: ways I can reverse it. So the reality is, if

260
00:13:50,640 --> 00:13:53,160
Speaker 2: you're in the reproductive years, if you're planning on having

261
00:13:53,240 --> 00:13:56,839
Speaker 2: children and your tea is low, don't take testosterone. But

262
00:13:56,920 --> 00:13:59,960
Speaker 2: let me give you medications that make you make testosterone.

263
00:14:00,160 --> 00:14:02,560
Speaker 2: That's safe. So I can give you medications to make

264
00:14:02,720 --> 00:14:06,120
Speaker 2: you make testolstone and that will enhance your fertility. But

265
00:14:06,559 --> 00:14:08,640
Speaker 2: if you're older and you're not trying to have children,

266
00:14:08,760 --> 00:14:10,880
Speaker 2: then there are many ways to give a man testosterone.

267
00:14:10,920 --> 00:14:13,440
Speaker 2: We now have oral test alstone, which is fantastic world

268
00:14:13,480 --> 00:14:15,280
Speaker 2: testawsal is very new in the United States. It's only

269
00:14:15,320 --> 00:14:17,440
Speaker 2: been out for five years. And that we have a pill,

270
00:14:17,520 --> 00:14:19,840
Speaker 2: we have injections, we have peallets, we have patches. But

271
00:14:19,880 --> 00:14:21,720
Speaker 2: I will tell you that I do think that this

272
00:14:21,840 --> 00:14:25,040
Speaker 2: medication can have a profound effect on the quality of life.

273
00:14:25,160 --> 00:14:27,880
Speaker 2: And many patients, many patients come in, they're thanking you,

274
00:14:27,920 --> 00:14:29,680
Speaker 2: they're telling you that they have a significantmrovement in the

275
00:14:29,680 --> 00:14:31,800
Speaker 2: directions or libido muscle mass.

276
00:14:31,960 --> 00:14:32,520
Speaker 3: Not everybody.

277
00:14:32,600 --> 00:14:34,720
Speaker 2: I mean, there are patients that don't respond, but the

278
00:14:34,720 --> 00:14:37,200
Speaker 2: majority of patients who start out low do see a

279
00:14:37,240 --> 00:14:39,840
Speaker 2: significant improvement in their quality of life.

280
00:14:41,360 --> 00:14:45,320
Speaker 1: I was talking with one of our show sponsors, Wayne Wilson,

281
00:14:45,360 --> 00:14:49,640
Speaker 1: who owns Synergenics, and he said, hey, you're urologist. Is

282
00:14:49,680 --> 00:14:52,920
Speaker 1: the one who came when we started, I guess with

283
00:14:52,960 --> 00:14:56,920
Speaker 1: pellets or whatever, and came and talked to them about

284
00:14:57,000 --> 00:15:00,720
Speaker 1: testosterone and obviously that's what they do all day, every day.

285
00:15:01,160 --> 00:15:04,640
Speaker 1: And he went through the various things that you talk about.

286
00:15:04,800 --> 00:15:07,840
Speaker 1: I mean he took note. He's a physician's assistant by training.

287
00:15:08,360 --> 00:15:10,560
Speaker 1: But it was amazing to me. You were the god

288
00:15:10,600 --> 00:15:14,480
Speaker 1: of testosterone as far as Syenergenics is concerned, and I

289
00:15:14,520 --> 00:15:16,680
Speaker 1: didn't know you had an association with him.

290
00:15:17,560 --> 00:15:19,600
Speaker 2: No, I appreciate it. I mean, I have been very

291
00:15:19,600 --> 00:15:22,600
Speaker 2: passionate about this for about twenty five years. So all

292
00:15:22,600 --> 00:15:24,920
Speaker 2: my basic science work, all my lab all my clinical

293
00:15:24,920 --> 00:15:27,680
Speaker 2: trials are around this topic. So when it comes to

294
00:15:27,800 --> 00:15:31,400
Speaker 2: teaching and education to others about testosterone, I'm all in.

295
00:15:32,200 --> 00:15:34,840
Speaker 1: One this moment. Doctor Moti Kara is our guest. He's

296
00:15:34,840 --> 00:15:37,240
Speaker 1: at Baylor College of Medicine, and I'm going to start

297
00:15:37,280 --> 00:15:39,760
Speaker 1: with the question everyone always asked, well, am I more

298
00:15:39,880 --> 00:15:42,440
Speaker 1: likely to get prostate cancer? Mike, weren't you worried about

299
00:15:42,480 --> 00:15:46,680
Speaker 1: prostate cancer? We'll ask him that coming up with his

300
00:15:46,880 --> 00:15:51,240
Speaker 1: finger on the pulse. The King of Ten continues on

301
00:15:51,280 --> 00:15:57,600
Speaker 1: the Michael Berry Show. Doctor Mois Kara my urologist and

302
00:15:57,720 --> 00:16:03,080
Speaker 1: friend of Taylor College of Medicine and international renown as

303
00:16:03,160 --> 00:16:13,120
Speaker 1: a speaker on issues of sex, urology testosterone. Forthcoming book

304
00:16:13,240 --> 00:16:16,880
Speaker 1: is called sex Span, which talks about the length of

305
00:16:16,960 --> 00:16:22,600
Speaker 1: time in which a person has a functional sex life

306
00:16:23,440 --> 00:16:28,440
Speaker 1: that will be out relatively soon. Doctor Kara, I received

307
00:16:28,480 --> 00:16:32,680
Speaker 1: an email from a fellow named Doug who writes three

308
00:16:32,720 --> 00:16:36,760
Speaker 1: minutes ago, I figure your interview is pre recorded, but

309
00:16:36,840 --> 00:16:39,760
Speaker 1: if not, I'm curious about blood clots. I had a

310
00:16:39,800 --> 00:16:42,840
Speaker 1: pulmonary embolism and they told me to stop taking testosterone.

311
00:16:42,880 --> 00:16:44,280
Speaker 1: I used to go to the Low T Center and

312
00:16:44,320 --> 00:16:47,760
Speaker 1: had a great experience experience with the treatment. I miss it.

313
00:16:47,960 --> 00:16:50,640
Speaker 1: I hate that I can't take it anymore. Does doctor

314
00:16:50,720 --> 00:16:52,080
Speaker 1: Kara have a thought about that?

315
00:16:54,160 --> 00:16:56,520
Speaker 2: I do, Michael, so listen. There was a concern for

316
00:16:56,560 --> 00:17:00,560
Speaker 2: that in twenty fifteen and the FDA asked a conduct

317
00:17:00,600 --> 00:17:03,640
Speaker 2: a large trial. It was called the Traverse Trial. I

318
00:17:03,720 --> 00:17:05,720
Speaker 2: was fortunate enough to be involved in that trial with

319
00:17:05,800 --> 00:17:09,000
Speaker 2: myself and eight other physicians, and we designed this trial

320
00:17:09,080 --> 00:17:11,880
Speaker 2: with several hundreds of millions of dollars and the goal

321
00:17:11,960 --> 00:17:14,479
Speaker 2: was to see if it caused increase in cardiovascar events

322
00:17:14,480 --> 00:17:17,240
Speaker 2: and prostate cancer. What it did find was there was

323
00:17:17,320 --> 00:17:20,040
Speaker 2: no increase in heart attack in those men taking testaws

324
00:17:20,040 --> 00:17:23,199
Speaker 2: on versus placebo. We had over five thousand patients. We

325
00:17:23,280 --> 00:17:26,320
Speaker 2: followed them for four years, and there was no increased

326
00:17:26,400 --> 00:17:29,760
Speaker 2: risk in DVT, but there was a slight increased risk

327
00:17:29,840 --> 00:17:33,560
Speaker 2: in pulmonary embolism. And the difference was a difference between

328
00:17:33,560 --> 00:17:36,639
Speaker 2: point five percent and point nine percent, So there was

329
00:17:36,680 --> 00:17:39,840
Speaker 2: a slight signal. And I think it's very important to

330
00:17:39,880 --> 00:17:43,840
Speaker 2: counsel patients when they ask about that. So I guess again,

331
00:17:44,000 --> 00:17:47,679
Speaker 2: you know, I don't believe that. I personally don't believe

332
00:17:47,680 --> 00:17:52,360
Speaker 2: the test OSA increases a risk of DVT and pulmonary embolism.

333
00:17:52,480 --> 00:17:56,520
Speaker 2: I think the difference was small, but the Traverse trial

334
00:17:56,560 --> 00:17:58,680
Speaker 2: showed what it showed. Also, I just want to mention

335
00:17:58,840 --> 00:18:02,600
Speaker 2: it showed no increased and prostate cancer and no increased

336
00:18:02,640 --> 00:18:04,720
Speaker 2: risk of worsting of urinary symptoms.

337
00:18:04,840 --> 00:18:06,560
Speaker 3: Great study, traverse trial.

338
00:18:07,520 --> 00:18:10,399
Speaker 1: Why do you think this is out there? Because I

339
00:18:10,440 --> 00:18:14,520
Speaker 1: have a friend who started on testosterone, heard me talking

340
00:18:14,600 --> 00:18:17,080
Speaker 1: about it. He starts on it, three months later he

341
00:18:17,080 --> 00:18:21,960
Speaker 1: gets prostate cancer. He a text message says, Hey, I

342
00:18:22,040 --> 00:18:25,360
Speaker 1: just want you to know I just started on testosterone

343
00:18:25,440 --> 00:18:27,400
Speaker 1: and I got prostate cancer. You need to be careful.

344
00:18:27,440 --> 00:18:30,680
Speaker 1: And my immediate response was, you haven't been on testosterone

345
00:18:30,680 --> 00:18:33,679
Speaker 1: long enough. Even if it did cost prostate cancer for

346
00:18:33,800 --> 00:18:36,760
Speaker 1: it to have caused that, if there was no testosterone

347
00:18:36,800 --> 00:18:41,080
Speaker 1: supplement out there, men still got prostate cancer at rapid,

348
00:18:41,560 --> 00:18:44,160
Speaker 1: at large rates. You can't blame every one of them

349
00:18:44,160 --> 00:18:45,159
Speaker 1: on testosterone.

350
00:18:46,359 --> 00:18:48,560
Speaker 2: I absolutely agree with you, And I got to tell

351
00:18:48,560 --> 00:18:50,399
Speaker 2: you where it started from. It started in nineteen forty

352
00:18:50,400 --> 00:18:53,880
Speaker 2: one when Huggins and Hodges published the famous paper I'm

353
00:18:53,880 --> 00:18:56,240
Speaker 2: showing that when you give a man test increases a

354
00:18:56,359 --> 00:18:58,639
Speaker 2: risk for prostate cancer. If you and I go to

355
00:18:58,720 --> 00:19:01,119
Speaker 2: the library right now, puld that paper, you're going to

356
00:19:01,160 --> 00:19:03,840
Speaker 2: find something very interesting. It was based on one patient,

357
00:19:04,240 --> 00:19:07,879
Speaker 2: one patient, nineteen forty one, and we'd instilled fear in

358
00:19:07,960 --> 00:19:10,600
Speaker 2: us for so many years. The good news is in

359
00:19:10,600 --> 00:19:15,880
Speaker 2: twenty eighteen, my society, the American Neurologic Association, said testosterone

360
00:19:15,920 --> 00:19:19,720
Speaker 2: does not increase the risk for prostate cancer, strong recommendations,

361
00:19:19,720 --> 00:19:22,600
Speaker 2: So we do not anymore have a concern that testoster

362
00:19:22,880 --> 00:19:25,159
Speaker 2: increases the risk for prostate cancer. I'll tell you a

363
00:19:25,240 --> 00:19:30,160
Speaker 2: very interesting story. If I had metastatic prostate cancer all

364
00:19:30,200 --> 00:19:33,919
Speaker 2: over our body and we walked into Johns Hopkins University today,

365
00:19:34,320 --> 00:19:36,359
Speaker 2: they would There's a trial where they put us on

366
00:19:36,560 --> 00:19:41,040
Speaker 2: high doses of testosterone to reverse the prostate cancer, and

367
00:19:41,080 --> 00:19:44,639
Speaker 2: it works. It reduces the PSA, reduces the metastactasey. So

368
00:19:44,920 --> 00:19:48,159
Speaker 2: we're learning a lot about testosterone prostate cancer, and this

369
00:19:48,880 --> 00:19:51,760
Speaker 2: concept that testoster increases the risk, I think to.

370
00:19:51,680 --> 00:19:53,639
Speaker 3: Me is a myth. Michael, I want to bring up

371
00:19:53,680 --> 00:19:54,439
Speaker 3: one other important thing.

372
00:19:54,480 --> 00:19:56,840
Speaker 2: You talked about this earlier about testosterone, and you said

373
00:19:56,840 --> 00:19:59,920
Speaker 2: when you give testosterone, does it make people feel better?

374
00:20:00,359 --> 00:20:02,840
Speaker 2: But I tell patients that you've got to understand just

375
00:20:02,920 --> 00:20:08,280
Speaker 2: something that's just as important. It's lifestyle modification, diet, exercise,

376
00:20:08,640 --> 00:20:11,919
Speaker 2: sleep and stress reduction. I don't have a pill on

377
00:20:11,960 --> 00:20:15,840
Speaker 2: the planet stronger than diet, exercise, sleep and stress reduction.

378
00:20:15,880 --> 00:20:18,000
Speaker 2: And every day when we wake up or when we

379
00:20:18,040 --> 00:20:19,439
Speaker 2: go to sleep, we should ask.

380
00:20:19,320 --> 00:20:22,119
Speaker 3: Ourselves what are we going to do on diet, exercise.

381
00:20:21,760 --> 00:20:24,720
Speaker 2: Sleep and such stress reduction. I call that offense I

382
00:20:24,920 --> 00:20:27,280
Speaker 2: four things on offense, and then I call it four

383
00:20:27,320 --> 00:20:29,840
Speaker 2: things on defense. Only four ways you and I are

384
00:20:29,840 --> 00:20:32,080
Speaker 2: going to die. We're going to get cancer, we get

385
00:20:32,080 --> 00:20:35,680
Speaker 2: a heart attack, we're going to get metabolic disease, mean diabetes, obesity,

386
00:20:35,960 --> 00:20:37,840
Speaker 2: or we're going to get parking center Alzheimer's.

387
00:20:38,119 --> 00:20:38,560
Speaker 3: So on the.

388
00:20:38,560 --> 00:20:40,760
Speaker 2: Defense, every day we should ask ourselves how are we

389
00:20:40,840 --> 00:20:43,560
Speaker 2: going to keep those four things away? And our offense,

390
00:20:43,840 --> 00:20:45,760
Speaker 2: how we're going to move our health forward with those

391
00:20:45,800 --> 00:20:48,320
Speaker 2: four that I think is a really important point I

392
00:20:48,320 --> 00:20:50,760
Speaker 2: wanted to get across. We have a big program on that.

393
00:20:50,800 --> 00:20:53,000
Speaker 2: I mean every time someone comes in, I have a

394
00:20:53,000 --> 00:20:56,040
Speaker 2: program for their offense and defense. It's really important.

395
00:20:57,600 --> 00:21:00,520
Speaker 1: The four on offense, which you have pre since they

396
00:21:00,520 --> 00:21:06,440
Speaker 1: I met you, diet, exercise, sleep and stress reduction, and

397
00:21:06,520 --> 00:21:07,960
Speaker 1: do you have four on defense?

398
00:21:09,480 --> 00:21:12,880
Speaker 2: The four on defense are absolutely so it's cancer, which

399
00:21:12,920 --> 00:21:16,320
Speaker 2: means it's a heavy cancer screen call ANOTS, could be PSA.

400
00:21:16,800 --> 00:21:19,679
Speaker 2: Sometimes we'll do imaging as well. There are new tests

401
00:21:19,680 --> 00:21:21,679
Speaker 2: that come out called gallery there are others called the

402
00:21:21,680 --> 00:21:24,679
Speaker 2: liquid biopsy test. I mean there's ways to image and

403
00:21:24,720 --> 00:21:27,760
Speaker 2: to look for patients who may have potential cancer I have.

404
00:21:28,000 --> 00:21:32,080
Speaker 2: Cardiac screening is extremely important. You can sometimes you know,

405
00:21:32,119 --> 00:21:35,439
Speaker 2: you'll get certain labs like APO, B LP, LITLEA. Sometimes

406
00:21:35,480 --> 00:21:37,760
Speaker 2: we'll get a Cornery calcium score to look at the

407
00:21:37,760 --> 00:21:41,320
Speaker 2: heart to make sure there's not increase calcium metabolic disease.

408
00:21:41,520 --> 00:21:43,960
Speaker 2: You want to make sure that patients are watching their sugars.

409
00:21:44,000 --> 00:21:47,080
Speaker 2: It's a silent killer. Sometimes we'll put a CGM, which

410
00:21:47,119 --> 00:21:49,760
Speaker 2: is a continuous glucose monitor on them to help them

411
00:21:49,880 --> 00:21:52,000
Speaker 2: look at their sugars to make sure that they get

412
00:21:52,040 --> 00:21:54,520
Speaker 2: the feedback to say these are the foods I should

413
00:21:54,520 --> 00:21:56,879
Speaker 2: stay away from. And then you know, there's not a

414
00:21:56,880 --> 00:22:00,399
Speaker 2: lot you can do with Parkinson's and all sign There

415
00:22:00,400 --> 00:22:02,240
Speaker 2: are certain tests that you can look at. Some genes

416
00:22:02,280 --> 00:22:03,840
Speaker 2: you can look at to see if you're a higher risk.

417
00:22:04,240 --> 00:22:05,920
Speaker 2: But you know, if you are at a higher risk,

418
00:22:06,160 --> 00:22:09,199
Speaker 2: you can start altering your behavior, expers, you know, and

419
00:22:09,240 --> 00:22:12,080
Speaker 2: doing things. So it's really important to keep the bad

420
00:22:12,119 --> 00:22:16,119
Speaker 2: things away and use the diet, exercise, and sleep and

421
00:22:16,160 --> 00:22:19,760
Speaker 2: stress to move your health forward. In that paradigm. Most

422
00:22:19,800 --> 00:22:22,520
Speaker 2: people get the concept of offense and defense four and four,

423
00:22:22,920 --> 00:22:25,399
Speaker 2: and it's really worked well for a lot of my patients.

424
00:22:26,400 --> 00:22:28,160
Speaker 1: I don't know if I've told you this. Doctor Mohit

425
00:22:28,359 --> 00:22:32,879
Speaker 1: Kara is our guest kh E R at Baylor College

426
00:22:32,880 --> 00:22:35,600
Speaker 1: of Medicine. I don't know if I've told you this,

427
00:22:35,760 --> 00:22:41,320
Speaker 1: but on Christmas Eve, Ramone got a CGM continuous glucose

428
00:22:41,520 --> 00:22:45,879
Speaker 1: monitor and he started monitoring his blood sugar. And he

429
00:22:46,000 --> 00:22:49,040
Speaker 1: keeps his blood sugar at a very steady between one

430
00:22:49,080 --> 00:22:51,240
Speaker 1: and one thirty, usually about one point fifteen. The first

431
00:22:51,240 --> 00:22:53,119
Speaker 1: thing I do when I walk in the studio every

432
00:22:53,119 --> 00:22:55,359
Speaker 1: morning is he's already here. Is I ask him for

433
00:22:55,359 --> 00:22:57,520
Speaker 1: the number he sees me coming up the stairs and

434
00:22:57,600 --> 00:22:58,960
Speaker 1: he will write it down and show it on a

435
00:22:59,000 --> 00:23:00,879
Speaker 1: sheet of paper or from the door and tell me.

436
00:23:01,440 --> 00:23:07,399
Speaker 1: And it has absolutely changed not only his health but

437
00:23:07,560 --> 00:23:10,480
Speaker 1: his mood. I mean, he is consistent, he can work harder,

438
00:23:10,480 --> 00:23:14,720
Speaker 1: he can work longer by just stabilizing blood sugar, which

439
00:23:14,840 --> 00:23:18,680
Speaker 1: obviously for most people is fluctuating with great volatility.

440
00:23:19,920 --> 00:23:20,800
Speaker 3: I love that story.

441
00:23:20,880 --> 00:23:22,680
Speaker 2: I think that's a see and I see that all

442
00:23:22,720 --> 00:23:25,040
Speaker 2: the time because the reality is there are foods that

443
00:23:25,080 --> 00:23:27,520
Speaker 2: you're eating that you think are healthy and they're not.

444
00:23:27,960 --> 00:23:29,199
Speaker 2: And the foods that you think that are not that

445
00:23:29,280 --> 00:23:32,239
Speaker 2: healthy are you know, and you know, I put a

446
00:23:32,240 --> 00:23:33,960
Speaker 2: CGM on my wife and we went to the same

447
00:23:34,000 --> 00:23:36,439
Speaker 2: restaurant once we ate the exact same thing, and we

448
00:23:36,520 --> 00:23:40,000
Speaker 2: got totally different numbers. Because part of it's also genetics, right,

449
00:23:40,119 --> 00:23:42,560
Speaker 2: so that can play a role in it as well.

450
00:23:42,600 --> 00:23:45,639
Speaker 2: But learning more about what is bad and what to

451
00:23:45,640 --> 00:23:49,600
Speaker 2: stay away from is extremely important because if you give

452
00:23:49,600 --> 00:23:52,720
Speaker 2: yourself feedback, and those who take feedback very seriously, you

453
00:23:52,760 --> 00:23:56,080
Speaker 2: can really alter the quality of their life because that

454
00:23:56,240 --> 00:24:00,640
Speaker 2: sugar is just pounding the blood vessels, just pounding them.

455
00:24:01,080 --> 00:24:03,600
Speaker 1: My dad's a lifelong diabetic. He was nineteen when he

456
00:24:03,640 --> 00:24:06,040
Speaker 1: got DIABETESES eighty five. Now it's amazing. He has all

457
00:24:06,080 --> 00:24:08,840
Speaker 1: ten fingers and toes, but he has monitored. He's I've

458
00:24:08,840 --> 00:24:11,120
Speaker 1: had doctors tell me your dad knows more about diabetes

459
00:24:11,119 --> 00:24:12,560
Speaker 1: than we do because he had to treat it before

460
00:24:12,560 --> 00:24:15,120
Speaker 1: they was instantly. But I take Ramon to see him

461
00:24:15,720 --> 00:24:18,640
Speaker 1: last week, and all they talked about was their cgms

462
00:24:18,680 --> 00:24:21,399
Speaker 1: and their dex com CGM and what the reading was

463
00:24:21,440 --> 00:24:23,200
Speaker 1: and what this was and what that was. It was.

464
00:24:23,320 --> 00:24:25,800
Speaker 1: It was pretty funny to watch home with me for

465
00:24:25,880 --> 00:24:28,440
Speaker 1: one more segment if you can. Doctor Mohit Kara is

466
00:24:28,480 --> 00:24:32,320
Speaker 1: our guest. The book is The Sex Span, and we

467
00:24:32,359 --> 00:24:47,879
Speaker 1: will double back to that subject coming up from Portland

468
00:24:48,040 --> 00:24:53,320
Speaker 1: through Waldeny at all Greek cities in between. The Michael

469
00:24:53,320 --> 00:24:59,880
Speaker 1: Barry Show is nationwide. Doctor Mohick Kara is our guest.

470
00:25:01,520 --> 00:25:05,240
Speaker 1: He is my friend and my urologist and an expert

471
00:25:05,400 --> 00:25:10,879
Speaker 1: in matters of sex and testosterone. I will read to

472
00:25:10,920 --> 00:25:15,359
Speaker 1: you as email from one fellow says, well, let me

473
00:25:15,400 --> 00:25:18,760
Speaker 1: go back to that. Another fellow, actually several fellows said,

474
00:25:19,280 --> 00:25:23,920
Speaker 1: my wife's libido is way lower than mine. How can

475
00:25:23,960 --> 00:25:25,880
Speaker 1: he increase a woman's libido?

476
00:25:28,160 --> 00:25:30,120
Speaker 2: That's a really important point. So you know I told

477
00:25:30,119 --> 00:25:32,280
Speaker 2: you earlier that couple that got the woman that called

478
00:25:32,320 --> 00:25:33,960
Speaker 2: me that was very upset. So in two thousand and

479
00:25:34,000 --> 00:25:36,360
Speaker 2: eight I actually flew out to California to the Many

480
00:25:36,400 --> 00:25:39,480
Speaker 2: Fellowship in Female Sexual Dysfunction and I started treating women

481
00:25:39,760 --> 00:25:43,439
Speaker 2: for the past seventeen years because you can't just treat

482
00:25:43,520 --> 00:25:46,560
Speaker 2: one person without treating the other. And when you improve

483
00:25:46,640 --> 00:25:50,720
Speaker 2: both libidos, you actually it's synergistic. So women, this female

484
00:25:50,760 --> 00:25:54,480
Speaker 2: sexual dysfunction is comprised of four components low libido for

485
00:25:54,760 --> 00:25:58,200
Speaker 2: arousal meaning poor blood floats of the genitalia, or gasmic

486
00:25:58,240 --> 00:25:59,760
Speaker 2: dysfunction or pain.

487
00:26:00,359 --> 00:26:00,880
Speaker 3: It was sex.

488
00:26:00,920 --> 00:26:03,199
Speaker 2: If she has any one of those four and is

489
00:26:03,280 --> 00:26:06,800
Speaker 2: bothered by it, she suffers from female sexual dysfunction. And

490
00:26:06,840 --> 00:26:09,679
Speaker 2: there are many treatment options out there. One could be hormonal,

491
00:26:09,800 --> 00:26:12,760
Speaker 2: one could be actually using new Two FDA proved medications

492
00:26:12,760 --> 00:26:15,600
Speaker 2: are out. One's called add ADDYI. It came out in

493
00:26:15,600 --> 00:26:19,760
Speaker 2: twenty fifteen FDA proved strictly to increase a woman's.

494
00:26:19,400 --> 00:26:20,520
Speaker 3: Desire for sex. That's it.

495
00:26:20,760 --> 00:26:23,520
Speaker 2: She takes the pill every day increases her desire for sex.

496
00:26:23,880 --> 00:26:26,200
Speaker 2: By LEASI came out several years later. It's an injection

497
00:26:26,400 --> 00:26:30,400
Speaker 2: EpiPen she injects strictly to increase her desire for sex. Now,

498
00:26:30,680 --> 00:26:33,440
Speaker 2: I just want, I want to be very clear. Libido's

499
00:26:33,480 --> 00:26:34,879
Speaker 2: more deeper than that. I mean, there could be a

500
00:26:34,880 --> 00:26:38,160
Speaker 2: lot of other factors. I mean, it could be her stress,

501
00:26:38,400 --> 00:26:41,840
Speaker 2: it could be her physical condition. It could be a fatigue,

502
00:26:42,160 --> 00:26:44,280
Speaker 2: so you can't. It could be the quality of the relationship.

503
00:26:44,359 --> 00:26:46,800
Speaker 2: So I mean, if someone has a terrible quality relationship,

504
00:26:46,840 --> 00:26:48,360
Speaker 2: I can't. I can give them all the pill they want.

505
00:26:48,400 --> 00:26:50,560
Speaker 2: It's not going to help, you know, So you just

506
00:26:50,560 --> 00:26:52,639
Speaker 2: got to look at the whole big picture. But I

507
00:26:52,680 --> 00:26:56,320
Speaker 2: still also believe when you improve a woman's diet, exercise, sleep,

508
00:26:56,400 --> 00:26:58,840
Speaker 2: and stress, her libido does go up.

509
00:26:59,720 --> 00:27:01,600
Speaker 1: Also helps if you take them to the movies.

510
00:27:03,320 --> 00:27:06,800
Speaker 2: Yeah, that's true. That's true for.

511
00:27:06,720 --> 00:27:11,880
Speaker 1: The most Well. We have all these conversations, Alex writes Zar,

512
00:27:12,040 --> 00:27:15,800
Speaker 1: what if you can't always afford the treatment for testosterone?

513
00:27:15,840 --> 00:27:18,560
Speaker 1: Is there a safe supplement I can take that would help?

514
00:27:20,000 --> 00:27:22,920
Speaker 2: So the good news is that you can get testosterone

515
00:27:23,000 --> 00:27:25,679
Speaker 2: even compounded compounding pharmacies, and many of them are called

516
00:27:25,680 --> 00:27:28,480
Speaker 2: the five ZHO three B which are he regulated. They

517
00:27:28,560 --> 00:27:31,080
Speaker 2: make testosterone at a price for about thirty dollars a

518
00:27:31,119 --> 00:27:34,439
Speaker 2: month without insurance. Most people can afford thirty dollars a

519
00:27:34,440 --> 00:27:38,080
Speaker 2: month without insurance. If you look at even medications like Cialis,

520
00:27:38,160 --> 00:27:40,480
Speaker 2: if you use a good RX cupon co order, you

521
00:27:40,560 --> 00:27:44,199
Speaker 2: use Mark Cuban's company, you can get ninety days for

522
00:27:44,320 --> 00:27:47,399
Speaker 2: roughly twenty or twenty five dollars ninety days for CIA.

523
00:27:47,600 --> 00:27:51,320
Speaker 2: So these medications are extremely affordable and price should no

524
00:27:51,440 --> 00:27:52,440
Speaker 2: longer be an issue.

525
00:27:53,680 --> 00:28:01,000
Speaker 1: That's interesting. Several of the questions relate to hemoglobin Blolood thickness.

526
00:28:01,400 --> 00:28:04,000
Speaker 1: I know some people begin giving blood once they get

527
00:28:04,000 --> 00:28:08,600
Speaker 1: on testosterone because they're blood thickens. Your thoughts on that,

528
00:28:08,760 --> 00:28:11,160
Speaker 1: is that problematic or is that just a side effect?

529
00:28:12,320 --> 00:28:14,560
Speaker 2: It can be and it all depends on what type

530
00:28:14,560 --> 00:28:18,120
Speaker 2: of formulation you're using. Injectables have the highest rate. Injections

531
00:28:18,160 --> 00:28:21,200
Speaker 2: up to sixty six percent. A pellet's about thirty five percent,

532
00:28:21,480 --> 00:28:24,840
Speaker 2: angel's twelve percent risk, and it appeals about five percent.

533
00:28:25,200 --> 00:28:28,000
Speaker 2: So if your hermaticrit goes up and the number you

534
00:28:28,040 --> 00:28:30,840
Speaker 2: want to remember is fifty four, if it gets above

535
00:28:30,880 --> 00:28:35,159
Speaker 2: fifty four, there's a slight theoretical increased cardiovascar risk. And

536
00:28:35,200 --> 00:28:37,600
Speaker 2: in my practice, we have these patients start donating blood.

537
00:28:37,720 --> 00:28:39,680
Speaker 2: We don't wait till fifty four. We haven't started donating

538
00:28:39,720 --> 00:28:41,120
Speaker 2: at fifty one because I don't want to wait to

539
00:28:41,200 --> 00:28:41,680
Speaker 2: fifty four.

540
00:28:41,720 --> 00:28:42,800
Speaker 3: So it is real.

541
00:28:43,640 --> 00:28:46,440
Speaker 2: And remember that many of these patients have sleep apnea

542
00:28:46,640 --> 00:28:49,880
Speaker 2: cult to sleep apnea, and the testosterone is unmasking it.

543
00:28:49,960 --> 00:28:52,840
Speaker 2: So send them for a sleep study because you'll find

544
00:28:52,840 --> 00:28:55,080
Speaker 2: that many of them are just suffering from sleep apnea.

545
00:28:56,640 --> 00:29:01,200
Speaker 1: You know, I find a lot of people are suffering

546
00:29:01,320 --> 00:29:04,240
Speaker 1: from some sleep disorder and they've just grown. They don't

547
00:29:04,240 --> 00:29:09,520
Speaker 1: even realize what a contributor to their overall health or

548
00:29:09,600 --> 00:29:13,320
Speaker 1: lack of it that sleep is. It's almost always accompanied

549
00:29:13,360 --> 00:29:16,560
Speaker 1: by the person being overweight, or maybe the overweight led

550
00:29:16,600 --> 00:29:18,440
Speaker 1: to the sleep. But that's one of those things that

551
00:29:18,480 --> 00:29:22,400
Speaker 1: I find when I dig into people often have bad

552
00:29:22,520 --> 00:29:24,800
Speaker 1: sleep and they don't think that's they don't realize how

553
00:29:24,840 --> 00:29:25,480
Speaker 1: important that is.

554
00:29:26,800 --> 00:29:29,200
Speaker 2: Michael, You're so right. Listen, when I take care a

555
00:29:29,240 --> 00:29:31,240
Speaker 2: lot of CEOs, a lot of people, and I talk

556
00:29:31,280 --> 00:29:34,200
Speaker 2: about the four pillars diet, exercise, sleep, and stress. They're

557
00:29:34,240 --> 00:29:37,120
Speaker 2: all pretty good at diet, they're all pretty good at exercise,

558
00:29:37,360 --> 00:29:40,840
Speaker 2: that are lousy at sleep and stress. Right, and so,

559
00:29:41,160 --> 00:29:44,560
Speaker 2: and sleep and stress are so critical, and you think

560
00:29:44,560 --> 00:29:47,360
Speaker 2: about to sleep, it is a game changer. Even the

561
00:29:47,360 --> 00:29:49,760
Speaker 2: way you think about sleep. It's not the hours you

562
00:29:49,840 --> 00:29:53,440
Speaker 2: sleep that's multiplied by how efficient you slept. So if

563
00:29:53,440 --> 00:29:55,560
Speaker 2: you slept eight hours last night, but you were twenty

564
00:29:55,600 --> 00:29:58,000
Speaker 2: percent efficient, and I slept only four hours last night

565
00:29:58,040 --> 00:30:00,240
Speaker 2: but I was eighty percent efficient, I'm going to feel

566
00:30:00,240 --> 00:30:00,920
Speaker 2: a lot better than you.

567
00:30:01,240 --> 00:30:01,400
Speaker 1: Right.

568
00:30:01,480 --> 00:30:03,680
Speaker 2: So the reality is not just lying there with your

569
00:30:03,680 --> 00:30:06,760
Speaker 2: eyes closed. You have to get good deep sleep, good

570
00:30:06,800 --> 00:30:10,480
Speaker 2: rem sleep, and even thirty minutes extra either deep sleep

571
00:30:10,560 --> 00:30:13,760
Speaker 2: or rem sleep. Every night game changer for the next day.

572
00:30:13,840 --> 00:30:16,880
Speaker 2: So I think people need to be very militan. Just

573
00:30:17,280 --> 00:30:19,200
Speaker 2: find a way to make sure that you go to

574
00:30:19,200 --> 00:30:22,240
Speaker 2: sleep on time, wake up on time. And the best

575
00:30:22,760 --> 00:30:25,480
Speaker 2: website I found was the American Sleep Foundation. The American

576
00:30:25,520 --> 00:30:28,600
Speaker 2: Sleep Foundation has twenty tips on their website. They're awesome.

577
00:30:29,040 --> 00:30:30,960
Speaker 2: Follow those tips. It makes a big difference.

578
00:30:33,000 --> 00:30:35,760
Speaker 1: Salt in the diet. So I've been reading a lot

579
00:30:35,800 --> 00:30:40,040
Speaker 1: on salt lately and I have not run this by

580
00:30:40,080 --> 00:30:43,320
Speaker 1: you yet, so I'm curious to see what you think

581
00:30:43,360 --> 00:30:46,480
Speaker 1: of this. And the theory goes that we were told

582
00:30:46,560 --> 00:30:49,440
Speaker 1: to stay away from salt. Salt raises blood pressure, salt

583
00:30:49,520 --> 00:30:54,680
Speaker 1: causes all these problems. And basically the point of the

584
00:30:54,720 --> 00:30:58,080
Speaker 1: piece was that we are now deprived of salt. And

585
00:30:58,120 --> 00:31:00,800
Speaker 1: what do you do to treat someone for a number

586
00:31:00,840 --> 00:31:03,360
Speaker 1: of things, is you give them salt. Your thoughts on

587
00:31:03,480 --> 00:31:04,680
Speaker 1: salt intake.

588
00:31:05,800 --> 00:31:08,160
Speaker 2: So, I think that I'm still a believer that salt,

589
00:31:08,360 --> 00:31:12,120
Speaker 2: particularly in patients who have hypertension, is a risk factor.

590
00:31:12,360 --> 00:31:14,880
Speaker 2: And so if someone has hypertension, which most of many

591
00:31:14,880 --> 00:31:18,520
Speaker 2: Americans suffer from, that is going to be something that's

592
00:31:18,560 --> 00:31:20,080
Speaker 2: the first thing I'm going to ask them to stay

593
00:31:20,120 --> 00:31:23,160
Speaker 2: away from. As a urologist. The other thing we worry

594
00:31:23,160 --> 00:31:28,360
Speaker 2: about is increased salt intake significantly increases the risk for

595
00:31:28,800 --> 00:31:33,320
Speaker 2: the kidney stones. And so I am not a believer

596
00:31:33,440 --> 00:31:36,560
Speaker 2: yet that we should be increasing excuse me, increasing salt

597
00:31:36,960 --> 00:31:39,360
Speaker 2: unless there's a reason to do so. But I'm more

598
00:31:39,360 --> 00:31:41,480
Speaker 2: concerned about the hypertension and the stone risk.

599
00:31:41,640 --> 00:31:48,880
Speaker 1: But on French Fries, it's okay, right Sometimes sometimes, doctor

600
00:31:48,960 --> 00:31:54,400
Speaker 1: moh Kara, you are the absolute best. The four phases

601
00:31:54,440 --> 00:31:59,640
Speaker 1: of offense he has outlined or diet, exercise, sleep, and

602
00:31:59,680 --> 00:32:03,040
Speaker 1: stretch reduction all things you can do yourself that don't

603
00:32:03,080 --> 00:32:08,800
Speaker 1: require spending a dollar. Diet, exercise, sleep and stress reduction

604
00:32:09,320 --> 00:32:13,400
Speaker 1: is four pillars of offense and defense. I cannot help

605
00:32:13,440 --> 00:32:15,560
Speaker 1: you get in to see him, so don't even try

606
00:32:15,600 --> 00:32:18,800
Speaker 1: because I would be overwhelmed. Again, it's Baylor College of Medicine.

607
00:32:18,840 --> 00:32:20,560
Speaker 1: It does take a while to get in to see him,

608
00:32:21,280 --> 00:32:24,920
Speaker 1: only because he's very popular. A lot of people like him.

609
00:32:25,200 --> 00:32:27,800
Speaker 1: I was my own worst enemy in sending too many

610
00:32:27,800 --> 00:32:30,280
Speaker 1: patients to him at the beginning. He only has so

611
00:32:30,320 --> 00:32:33,960
Speaker 1: many hours of the day. The book is The Sex Span,

612
00:32:34,360 --> 00:32:37,040
Speaker 1: which is not out yet but will be hopefully soon.

613
00:32:37,120 --> 00:32:38,760
Speaker 1: And when you let me know that is the case,

614
00:32:39,160 --> 00:32:42,080
Speaker 1: we will all go and buy it online.

615
00:32:42,280 --> 00:32:44,120
Speaker 3: Well do Thank you so much, Michael, You're the best.

616
00:32:44,160 --> 00:32:52,360
Speaker 1: My friend, doctor Mohit p r A Baylor College of Medicine. Yeah.

617
00:32:52,560 --> 00:32:57,160
Speaker 1: So I'm having dinner at Gringo's, the new location at

618
00:32:58,120 --> 00:33:02,640
Speaker 1: ninety nine and two nine with Wayne Wilson, who's the

619
00:33:02,680 --> 00:33:08,560
Speaker 1: founder of Sinergenics, and he was telling me about we

620
00:33:08,560 --> 00:33:12,600
Speaker 1: were talking about, well, the testosterone replacement, but he was

621
00:33:12,640 --> 00:33:15,080
Speaker 1: talking about this doctor and he said, I think he's

622
00:33:15,160 --> 00:33:19,000
Speaker 1: your doctor. He comes out and trains our people on

623
00:33:19,960 --> 00:33:23,400
Speaker 1: testosterone and the effects and why it's important and all that,

624
00:33:23,440 --> 00:33:25,200
Speaker 1: and it was doctor Kara and I did not know that.

625
00:33:25,240 --> 00:33:27,400
Speaker 1: I had no idea. Doctor Karatt was the first one

626
00:33:27,440 --> 00:33:29,800
Speaker 1: that put me on testosterone. We did the pellets for

627
00:33:29,840 --> 00:33:32,760
Speaker 1: a couple of years, and then low T Center, which

628
00:33:32,800 --> 00:33:35,520
Speaker 1: is also Centergenics, became a show sponsor, so I just

629
00:33:35,560 --> 00:33:37,760
Speaker 1: moved over there and started doing the weekly shots. I

630
00:33:37,880 --> 00:33:39,840
Speaker 1: like the shot. I like the shots, batter the pellets.

631
00:33:39,840 --> 00:33:41,719
Speaker 1: Some people like the pellets, but I got to take

632
00:33:41,760 --> 00:33:42,360
Speaker 1: my pellet story.

633
00:33:42,400 --> 00:33:42,680
Speaker 2: Hold on