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A baby that is wanted and planned for, a child by choice and not by chance, that is what modern contraception offers men and women. But you have to know what's out there, how it works, and where to get it. This is really important now more than ever.

This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health, and this is the "7 Domains of Women's Health" on The Scope.

Women and men all over the world have wanted to plan their families for thousands and thousands of years, but methods used in Cleopatra's time in ancient Egypt probably weren't as effective as what is available now. If no method of contraception is used, women in sexual relationships that would make them pregnant could expect to have more than 11 babies. That's in these days of good obstetrical and pediatric care, where women are less likely to die in childbirth and babies are much less likely to die in the first five years of life. Eleven babies sound like too much? One more baby sounds like too much right now?

Let's talk about contraception. It's an egg and a sperm problem. You need to stop egg production, stop sperm production, or stop the sperm from getting to the eggs. These are the main ways that modern contraception works.

About 50% of unplanned pregnancies happen to people who are "using" contraception but using it incorrectly. This is the most common reason that methods like abstinence or periodic abstinence, think natural family planning, or methods like barrier methods like condoms or diaphragms actually fail. They weren't used correctly or at all. Methods that you have to think about at the time of sex are more likely to fail because you're more likely to fail to use them. If you combine two methods, abstain during your fertile period and use condoms all the rest of the time, your chance of getting pregnant by accident is much lower. Two methods are better than one, and this is a combo where men can be the important user. You can get condoms most anywhere, and anyone with some smarts and gumption can figure out their fertile period.

So let's talk about hormonal pills, patches, and rings. They are considered moderately effective methods or ones that have an annual failure rate between 1 in 10 to 1 in 100. That means if women use them, the chance of getting pregnant is about 1 in 10 to 1 in 100 per year. Of course, you might be at risk for pregnancy for multiple years, so these chances literally add up. Considering a lifetime of contraception using these methods, it was calculated that women would have about two unplanned pregnancies. These methods work by blocking ovulation and by changing cervical mucus so sperm cannot get to the eggs, but women don't always take the pills, or patches or rings correctly. They miss some days or they stop for a week as directed, but they stop for longer than seven days, and they are very likely to ovulate. But you could team up with your sex partner and use a moderately effective method and condoms and get much more bang for your buck birth control-wise.

Hormonal methods aren't right for everyone, and you should know by reading up or asking knowledgeable clinicians if they're right for you. Now, there may be immense hormonal contraception on the horizon, transdermal hormones to block sperm production. If it has about a 10% failure rate per year, and women taking the pill as they will, not perfectly, have a failure rate of about 10% per year, if both members of the sexually active couple use the method not perfectly, the failure rate would be about 1 in 100 per year. The two methods multiply in terms of their effectiveness. If they both used effectively, if they both, men and women used hormonal methods effectively, it would be about 1 in 10,000 women per year, and that is effective contraception.

Now for highly effective methods, these methods have failure rates of about 1 per 1,000 women per year. They are so good because you don't have to think about them and using them correctly almost always happens. These include copper IUDs, hormonal IUDs, and hormonal implants under the skin. The hormonal implants' primary method of action is to work by blocking ovulation. The IUDs' primary method of action is by blocking sperm. Copper in the copper IUD kills sperm on their way up to the egg, and the hormonal IUD blocks sperm from getting through the cervix. The IUDs and implants are highly successful at preventing pregnancy but require a trained clinician to put them in. They last a long time, the copper IUD for 12 years, the hormonal IUD for 5, and the implant for 3, but they are immediately reversible as soon as they come out.

Now, all contraceptive methods have some side effects and risks, but none have as many risks and side effects as an unwanted pregnancy. Uh-oh, did you just say, "Oops?" Did you forget to take your pills? Did the condom slip off or stay in his back pocket? Was sex forced on you and you weren't using anything? Emergency contraception is for people who had unprotected or under-protected sex. They are pills over the counter or by prescription, that must be used in the first three to five days after the unprotected sex act, and the earlier, meaning the next day or the day after, the better. The copper IUD and hormonal IUD can also be used for emergency contraception, but they aren't FDA approved for that use, and you have to find a clinician to place one in a timely manner.

Using contraception means some work on your part. You have to know what you can use and want to use. You need to know where you can get them. You need to know how you can pay for them. All this information is available from many sources, but an overall good resource is bedsider.org. Many clinics around the country provide contraception on a sliding fee scale based on the ability to pay. Most insurance plans pay for a significant amount of the cost of contraception. There's a national family planning grant called Title X, that provides low-cost contraception to anyone who needs it, and it's available in most states. But you have to lace up your boots or put on your flip-flops and do it. Children deserve to be by choice and not by chance now more than ever. Thanks for joining us on The Scope.

The clinical trial is looking for participants in Utah and elsewhere. Find out if you qualify for the study by clicking here.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Who has a dog?

Troy: Sorry.

Scot: Was that yours? Was that Charlotte?

Troy: That was Charlotte. If I didn't let her in the room, she would be scratching at the door. So that's where we are.

Scot: Today on "Who Cares About Men's Health," we're going to learn more about a new male contraceptive. It's a gel. It's in clinical trial, but you're going to learn more about the contraceptive. You'll also learn how you can participate in the clinical trial if you wanted to.

This is "Who Cares About Men's Health." My name is Scot Singpiel I bring the BS. Bringing the MD to the table is Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: And our guest today is Dr. David Turok. He is an OB-GYN and also a family practice physician. He is interested in family planning, and he is . . . Are you running this clinical trial? How are you involved exactly?

Dr. Turok: Yeah. I am the site lead for the Utah site, and there are 10 other sites.

Scot: All right. So, Dr. Turok, tell me about this male contraceptive gel that you're running the clinical trials on. What do we need to know?

Dr. Turok: So this is an awesome opportunity for our team and for men in Utah to make a real contribution to increasing the range of contraceptive methods that are available for people. So this is the first study that's been available for people in Utah for a male hormonal method. And this study is looking at a gel that will be applied daily on the shoulders. Literally, this study rests on the shoulders of male participants.

Scot: And what's in the gel? What's going on here?

Dr. Turok: So it's a combination of progestin or progestogen called nestorone and testosterone. And the way this stuff works is very similar to the way the birth control pill or the patch or the ring work in female contraception. Basically, this outside hormone tricks your brain into not producing the sex hormones. In women, it prevents ovulation, and in men, it prevents sperm production. It also prevents testosterone production, and that's why the gel also has some testosterone as add-back.

Troy: Interesting. So it's going to actually maybe drop your body's production of testosterone, but not necessarily affect your body's level of testosterone?

Dr. Turok: Correct. That's the goal.

Scot: Yeah. Okay. Explain that. I'm not buying into this quite yet. What did you just say, Troy?

Troy: I'll let David explain it. I'm guessing.

Scot: I would think a lot of men would be like, "Oh, I don't know about putting something on that's going to decrease my body's level of testosterone." That didn't sound like a great idea.

Dr. Turok: Right. For decades, we've been willing to have millions and millions of women across the globe use methods that interfere with their normal hormonal cycle in ways that are safe and effective. And this is similar to that.

So the bottom line on this is there's messaging from the brain at two levels in the brain for gonadotropin-releasing hormone, and then for FSH and LH in the pituitary. And those sex hormones trigger the production . . . There are two groups of cells in the testes that are affected by those. And getting these hormones from the outside, as application of the gel will produce, essentially deactivates one group of cells that makes sperm and the other group of cells that makes testosterone among other things.

And at that point, in order to avoid side effects that people would not like, the testosterone in the gel essentially adds back what you need.

Scot: Obviously, I'm the one without the MD, so you're going to have to explain this to me a couple of times. But we've done previous shows where we've talked about men who take testosterone, and it can cause side effects like testicle shrinkage and other sorts of things. What is preventing this from causing those types of side effects of taking artificial testosterone?

Dr. Turok: First of all, it's dosing. There likely will be some decrease in the size of the testicles. Not as much as people who are using high levels, for example, of injectable testosterone. And the other side effects are . . . There are some minor cholesterol changes with decreases in HDL. There's maybe a slight bump that can happen with hematocrit, the amount of red blood cells that you have circulating in your body. And the progestogen, the nestorone, can also cause a slight increase in weight.

There are very few things that are side-effect-free. But the vast majority of people who have used this combination and others like it have had very few side effects.

So, in the last large study of a combination of an injectable progestin and testosterone combination, there were fewer than 10% of people who quit the trial because of side effects. And if you compare that to studies of oral contraceptive pills in females, that's actually quite favorable. So I think we're seeing something that's headed in the right direction.

And again, we can only get the answers for newer and better methods if people are willing to participate in trials like this. And this is not just, "Hey, here's something you can try and tell us how you like it." This is a rigorously designed study that's going to have up to 400 couples in it. Everyone is going to get the same evaluation. It's going to be extremely thorough, looking at those outcomes that we talked about, pregnancy and side effects, as well as blood tests with chemistry and looking at people's blood levels of the drugs, of the hormones, of their red blood cell counts.

We're going to have enough people to really evaluate this to see if this is truly safe and effective. And the early signals are from this study and others like it that they are very favorable.

Troy: That's great. And for anyone who's listening who wants to participate, what kind of benefits . . . Obviously, a huge benefit is just contributing to science, which I'm sure you and I would agree is a great benefit. I don't know if Scot would agree.

Scot: Yeah. How much am I going to get paid?

Troy: Scot, that's what we're getting at. Is there any financial . . . Scot is like, "Where's the money? Show me the money." Is there a financial incentive to participating or any other benefits?

Dr. Turok: This is not a casual study. The demands of participants are significant and people are compensated for their time and effort and, I think, in a reasonable and generous way. But the combination reimbursement, if you go through the full trial for a couple, is over $3,000.

Scot: Is another prerequisite for the couples you're looking for couples that are open to if it doesn't work that they were planning on having children anyway? Because you're using a trial for a birth control method that you're not exactly sure of the efficacy yet. They could end up becoming pregnant, right?

Dr. Turok: That is an absolute risk. And people who are entering the study need to be willing to accept that. This is something where there's going to be very close observation. So we're going to be checking people's sperm counts regularly, every month throughout the study.

In normal use, something like that wouldn't happen. But this is something where if there ever was a problem or somebody had initially had a low sperm count and then it came back up, we would be able to identify that and ideally intervene before there was a risk of pregnancy.

And again, that coupled with the inherent relatively low risk of pregnancy makes this a safe and reasonable thing.

Scot: Is there a minimum amount of sexual intimacy? Is there a minimum amount of sex that you have to have while you're in this study?

Dr. Turok: Yeah.

Troy: Is this an additional incentive? Is that what you're trying to get at, Scot?

Scot: Maybe. I don't know.

Troy: Like, "Well, we've got to have sex at least three times a week."

Scot: "The study says so."

Troy: "The study says. This is for science."

Dr. Turok: Yeah, that is for couples to determine. But the minimum, the only requirement . . . And this is true for all contraceptive efficacy studies, not particular to this. But couples have to have at least one episode of intercourse where they're relying only on this method each month for that month to count in the efficacy data. So that's true whether we're studying an IUD or a pill or a new injection or the ring, anything.

Troy: And so hearing this, maybe someone is listening and thinking, "Well, I don't know that I want to be part of a study. I don't know that I would qualify. I don't know that I have the time to do this." But maybe they're thinking, "This sounds really cool." What do you think longer, bigger picture, if this next phase is successful, before this actually becomes a realistic option for men to use? Would you say realistically five years out before you think this would potentially be available by prescription?

Dr. Turok: Five years would be greased lightning.

Troy: So that would be a very optimistic scenario?

Dr. Turok: Yeah. In 2007, I wrote this paper that was a summary. It was called "The Quest for Better Contraception: Future Methods." And I was a young contraceptive researcher at the time and really wanted to do a landscape analysis of all the methods that were out there. And there was a section in that paper on male hormonal methods. 2007. And at the time, for that and several other things, we were like, "Yes, we're 5, maybe 10 years away." And we're still 5 or 10 years away, but we've made significant progress.

All of these things take time because the FDA wants to assure that these are truly safe and there are not going to be harms associated with newly approved medications. This certainly seems like it's on track and has great potential to deliver a safe and effective method over time that will be reversible.

And that's another aspect of the study, looking at what happens when you stop it. How long does it take for sperm counts to come back? And that hasn't been an issue in any of the male hormonal contraceptive studies. Nearly all the participants have had return to normal fertility.

Troy: So it's a ways out. If there's a guy now who's 20, maybe by the time he's 30, he could look at using this.

Scot: Well, sounds more like if there's a guy that's 20, maybe his son will be able to use it.

Dr. Turok: No, no, no.

Troy: I didn't want to go that far with it.

Scot: Troy, we're running out of time here. Do you have any final questions?

Troy: Yeah. Have you talked to anyone who's used this? And if so, what do they say about it? Do they like it? Do they find it's fairly convenient? Any personal feedback you've gotten from any participants?

Dr. Turok: Yeah. So the feedback from some other people who've participated at other sites has been extremely favorable and people have been very satisfied. The gel is easy to use. It's easy to apply. The desired results are delivered, and actually, the decrease in sperm counts is occurring a little bit faster than anticipated, which is great, but still takes two to three months. And the initial efficacy signal has been really good.

So the participants have really done a great job and have had very few concerns and negative aspects of feedback thus far, which is great.

Scot: Cool. We'll put the link to your survey site on our website. Thank you very much, Dr. Turok, and thanks for caring about men's health.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Not only does body fat impact how we look and feel about ourselves, excess body fat has been associated with a lot of diseases that can significantly impact our health. And one of the organs, I didn't even know this, that's particularly susceptible to becoming damaged by excess body fat is the liver. And today on "Who Cares About Men's Health, what to know and what to do if you've been diagnosed with fatty liver disease.

Got a big crew here today. This is going to be a lot of fun. The MD to my BS, it's emergency room physician Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: All right. And we also have Dr. Susan Pohl, who is in family medicine. And she's also very passionate about wellness for disease prevention. So you're in the exact right place. Welcome, Dr. Pohl.

Dr. Pohl: Thank you. Good to be here.

Scot: And the star of this week's show . . . What do you think of that, Listener Brett? You're the star. You're the reason we're all here today.

Brett: Oh, I'm so excited. Thank you.

Scot: Yeah. So Brett wrote an email to us that I'll get to here in a second. But essentially, he was diagnosed with fatty liver disease during his last physical. So first thing, Brett, when your provider told you that, what was your reaction, being told that you had a fat liver? That kind of doesn't sound like a fun thing to be told.

Brett: It was a little scary because, "Do I need a liver transplant? Am I going to die soon? Or is this just because I am overweight?" That's the question.

Scot: We talk about the core four on this podcast, which is to be healthy today and in the future, you should watch your activity, your nutrition, your sleep, your emotional health, and then you've also got to know that plus one more, which is your genetics. I have a feeling we're going to be delving into a lot of those today.

So here is the email. "I've been listening for a while and thought I'd ask a question after my last physical. Diagnosed with fatty liver disease, but my physician didn't explain it too well. And I've been searching for more answers on what it is, why I should worry about it, and what I should do to treat it. I've Googled a lot of stuff, but I'm unsure what to do. My doctor recommended I avoid fatty, greasy, fried foods. But I wasn't sure if I should consult a dietitian or do anything else."

So that is Brett's condition. I want to ask you, when you searched on the web, what did you find about fatty liver disease? I'm kind of curious what's out there.

Brett: I found actually a couple of previous interviews that The Scope did for fatty liver disease. And I found pretty much the . . . Healthline, I think there was an article for it, and basically it said, "Take it seriously and lose weight," is the main thing, which is good, but easier said than done also.

Scot: So is the concern, actually, how to accomplish what it suggested to do? Or did you really truly find that you didn't find a lot of information that explained what this condition was, why you should be concerned, that sort of thing?

Brett: A bit of both. I wasn't really sure how I got it. Am I drinking too much soda? Am I eating the wrong foods? And then should I be exercising differently? These are things . . . Then what's the long-term prognosis? I was really scared that, "Am I going to need a liver transplant in 10,15 years? Or is this more like something that will eventually kill me when I'm 90 and that's okay?"

Troy: I'm curious, Brett, how did your healthcare provider diagnose you with fatty liver disease?

Brett: Well, there were a couple of ways. First, the blood work said that that indicated it. But then there . . . he sent me downstairs in his clinic. They had this thing called a FibroScan. It was essentially an ultrasound that looked at my liver and found the tissue was consistent with that diagnosis.

Troy: Okay, interesting. Obviously, we're all kind of spread out everywhere recording, so I haven't met you in person. But if you wouldn't mind sharing with us a little bit more about your health. Do you consider yourself overweight? Do you exercise, or did this come as a surprise to you to hear, "Wow, I've got a fatty liver and this doesn't make any sense"? I'm just a little curious about kind of where things came from there.

Brett: Effects of weight gain were definitely not a surprise to me. I've been a stay-at-home dad for the past three years, and it's been a more sedentary lifestyle than it was when I was working. I do work out, especially in the past year and a half, four to six days a week. Mostly a lot of cardio, but also weightlifting and things like that. I do it at night because as a stay-at-home dad, I don't have a lot of time in the day to run to the gym, and there's no daycare there.

So I've gained probably 25 to 30 pounds over these past three years. I've not been happy with it, but I've also thought that some of that could be from not just diet but also exercise. My body mass index is about 32 right now. So it's in the obese range, but it's on the lower range.

Going back to the episode a few weeks ago, when you had Scott on, the listener, I believe that was his name, I'm bit more average in my eating and exercise, average American, than he is. So growing up liking the normal food groups, which includes some of the fattier and sweeter foods. But also, I like to cook. I like to make meals that are healthy. I also have kids who are picky eaters, so sometimes I have to sacrifice good food for what they will actually eat. So it's a balancing act always.

Troy: Yeah, for sure. Like you said, though, you are exercising regularly. You have put on some weight just in the last few years. But again, it sounds like this kind of blindsided you to hear this, like, "I've got fatty liver disease." Like you said, you're searching all over trying to get answers. What does this mean? What are the implications of this?

Brett: Yeah. I mean, I expected things like higher cholesterol and things like that. Those things I've actually seen over the past few years of physicals. But this was kind of more surprising. Moving from heart to liver was more surprising.

Scot: Dr. Pohl, let's have you jump in right here. I want to ask a question, but I also just kind of want to let you go with what it is you would want to know at this point. I think Brett's main concern is, "Is this something he needs to worry about? And what can he do about it?" That's what he wants to ultimately walk away from. But we could also learn more about this condition. So, Dr. Pohl, where do we go from here?

Dr. Pohl: Thank you so much for having me on the show. Just as a clarification, I am a family physician. So I work at University of Utah, and I'm board certified in family medicine. I'm also board certified in obesity medicine, so I treat people who are having complications from weight. I'm not a hepatologist. A hepatologist would be someone that just specializes in liver disease.

Scot: So let me jump in for a second. Is that ultimately who Brett should go see at this point, or . . .

Dr. Pohl: So one of the things to think about . . . I'm just going to start from a big 10,000-foot informational view, and I think Brett can then get some more information from his doctor.

First of all, when we think about the liver, the liver has hundreds of functions, including clotting and digestion and regulating your blood sugar. The liver itself also stores fat, and everybody has fat in their liver. So fat in the liver is normal, but when the amount goes up, that's considered abnormal.

Again, from a 10,000-foot view, the liver can become diseased. The two main classifications of liver disease are related to alcohol or non-alcoholic liver disease.

So the first thing I would want to know is how much alcohol you drink, because that in and of itself can be a toxin and is one of the most common causes that can progress liver disease. Brett, do you mind if I ask how much alcohol you drink?

Brett: I don't drink at all. The most I do is I throw some wine or something into a recipe for . . . But I don't drink any alcohol.

Dr. Pohl: Okay, so that makes it easy. We can classify this as non-alcoholic liver disease. So as we branch into the non-alcoholic liver disease, there are some interesting terms. I don't want to get too much into the weeds, but the term non-alcoholic fatty liver disease, or NAFLD, actually means that you just have more fat than is generally considered "normal."

Normal fat content would be somewhere around 5% to 10% of the liver content is fat. And so you've been diagnosed with a little bit more than that, and I don't know what your level is.

Now, excess fat in the liver, actually the body can tolerate that in a lot of people. And NAFLD, or non-alcoholic fatty liver disease, is actually incredibly common. One out of every four adults in the US is considered to have some level of NAFLD, or higher than what we consider normal fat in the liver. But only some of those patients will then progress to some level of fibrosis.

So fibrosis is where the fat is actually more inflammatory and there's starting to be a little bit of scarring in the liver. Scarring in the liver is fibrosis, and we can pick that up on scans, like the FibroScan that you talked about or MRI.

What we want to avoid is this becoming very progressive and it leading to cirrhosis and liver failure. And I think that's what you were concerned about, Brett.

So it's important that you had the FibroScan and that they did look for some fibrosis. Now, if we're starting to see some fibrosis, then we're talking about NASH, which is non-alcoholic steatohepatitis. Only a few people with fatty liver are starting to get some inflammation and fibrosis in their liver.

But the good news is that the liver is incredibly resilient. The liver is an organ that is just an incredibly resilient organ. So the fact that you've been found to have this, this is one of those things that you are in control of, and you can be the captain of your ship and help your liver recover and heal from this.

Troy: So hearing all that, Dr. Pohl, where do you think Brett falls on that? I know it's probably hard to tell without actually seeing results, but you think he kind of falls maybe in that fibrosis phase or maybe just a little bit more fat than the average person in the liver?

Dr. Pohl: Well, I would have to see the result of his FibroScan. I mean, verbally, that story that he's telling me . . . the fact that your doctor was concerned about it makes me think . . . I'm playing Sherlock here. But from that story, there was enough fibrosis that the doctor was concerned and would classify you more in the NASH.

Now, I'm not sure if that's true, so I would contact your doctor and say, "What level of fibrosis . . ." We score that with numbers. "What level of fibrosis do I have? And do I have NASH?" And so just ask your doctor, "Do I have NASH, non-alcoholic steatohepatitis?"

Brett: Non-alcoholic steatohepatitis.

Brett: Yeah, or N-A-S-H. You can do a lot with this. And that's the good news, is that lifestyle medicine is the way, really, to approach this. It's the best way to improve the fat distribution that you have. Everyone needs fat, but the way your body is distributing its fat is causing some issues for you.

So I'm just going to segue into some lifestyle things you can do. You mentioned things like soda and sugar. Your doctor had mentioned things like fat, and obviously excess fried foods are going to be calorically rich, and so that can lead to weight gain in general. But tell me about the sugar that you eat regularly, including sugary sodas and drinks.

Scot: They always go after the good stuff, don't they, Brett?

Brett: Yeah. Well, it's true. I think I'm a little better than average in terms of soda intake. I probably have one or two a week, maybe. My post-workout drink, because it's at night, is a cup of chocolate milk. I looked online and it says eat chicken breasts and things like that. But when I get home from the gym at 11:00, that's not exactly appetizing. So that's my main sugar intake.

I feel like I'm pretty normal on things like candy and things like that. Not a lot, but like I said, I'm also around kids, so sometimes they make me eat. "Make me." Yeah.

Troy: Dr. Pohl, do you think that for Brett it's just flat out you've got to get your BMI down and this is all going to reverse? Or maybe he continues on at a BMI of 32 but drops the sugar, and then that's the key to reversing this.

Dr. Pohl: Most people with a BMI of 32 that have fatty liver or NASH will benefit most easily from weight loss. So unless there's a profound transformation of fat to muscle, most people need weight loss.

Scot: It sounds like really it's just a matter you're decreasing your total body fat and, in turn, you're decreasing the fat in the liver, and that's really what you're trying to do here.

Dr. Pohl: Yes, exactly. And sugar does tend to be very toxic to the liver. When we get big spikes of sugar, that's very inflammatory and actually produces inflammation in the liver.

I never say no to . . . I like chocolate cake, and I never say no to those things, and an occasional soda. I mean, all those things are part of my diet. But just realize that those should be kind of the peak of your pyramid. So if you really need that piece of pumpkin pie around Thanksgiving, have that piece of pumpkin pie. I mean, that's important to you. Have that piece of pumpkin pie. But don't have rolls and pasta and pumpkin pie and a Coke and chocolate milk after your workout. That is five servings of carbohydrates that your body is going to turn into sugar.

So think about what's important to you. Just don't waste those calories on things that . . . waste those sugar grams. If you want to get really technical, talk to your doctor about monitoring the sugar and actual grams of sugar in your diet. Most people do well by keeping it under 50. A lot of people do really well if they keep it . . . Getting it under 25 would be awesome, but that's hard to do, because it hides in so many things like ketchup and salad dressing and those kind of things. So decreasing your sugar is really important.

And then there is some data that shows that increasing the good foods in your diet will also help. So the nice thing about this is it's the same diet that we talk about for heart health. So we're not talking about a different liver diet than heart health. The Mediterranean diet is what tends to promote weight loss. It tends to decrease inflammation.

I'm sure you've talked about the Mediterranean diet before, but that's a diet that's high in foods like salmon and cod and fatty fish, and then high in dark vegetables like greens and kale, and adding some nuts.

Now, the key with nuts is measure those nuts because they're very calorically dense, but nuts are a good part of your diet. And by decreasing the empty carbs and adding some of these good nutritious foods to your diet usually you can heal that liver.

Brett: I do think that's something that I haven't done too much, is doing a detailed monitoring of the food that I've eaten, looking at the . . . That's good to know the level for the sugar content to have in a day, because I haven't really tried to measure that. And I think that's a good idea to get started.

I've really struggled about how to start approaching this, whether to start cutting out 20% of my portion size of my meal or whether to just cut out certain foods entirely or whether to do certain things.

One of the questions I had to my doctor, and he was kind of saying, "Yeah, maybe, but you could try these other things," is should I look at going to a dietician to help me get started on this? Or should I start with some more basic steps?

Dr. Pohl: I think consulting with a dietitian is fine. And I think you can talk to your insurance about whether they'd pay for it. I think if you've got inflammation in the liver, they likely will, but sometimes that becomes a barrier. Sometimes insurance doesn't want to pay for that. But investing in that or accessing your insurance for that is a great tool.

One of the things to start with, though, is to start with just the easy things. I'm not getting paid by MyFitnessPal, I promise, but I'm a big fan and I recommend it all the time. Just for three days, if you enter in all the foods that you eat, it'll actually show you how many sugar grams you're eating. Just for three days, enter in all your foods and see at the end of the . . . Don't modify anything. Just enter it in and see how many sugar grams you end up with at the end of the day.

Then you can start thinking about, "Oh, goodness, maybe some of those empty calories that . . . Do I really need the barbecue sauce with the sugar or can I substitute some Tabasco sauce or something else?" So there are some easy substitutes, if you start looking at that.

My suggestion for most people is start monitoring with one of those easy online apps, and MyFitnessPal is pretty easy to use. Just put your information in. You can take that information to your dietician, and then they can help you with some easy substitutions as well.

Scot: Dr. Pohl, it sounds like really the place that you recommend Brett to start is just those added sugars. That's what we're talking about, right? So monitor what you're eating for three or four days and find out what those added sugars are and see if you can get rid of some of those with something else. Is that accurate?

Dr. Pohl: Yes. Get rid of those easy, added sugars. Yes, that's a good summary.

Scot: Yeah. And I will tell you a soda, I think, has like 50 grams of added sugar. And you said you want to try to keep it at 50 grams a day?

Dr. Pohl: Yeah, exactly. So even that one soda is a lot for your day. Now, I don't like to tell people you can never have a soda, but just realize that you're spending those grams of sugar on a drink. Do you really want to do that? If we talk about it as a cost, it's an expensive cost to have all of your sugar in one can of soda.

Scot: We had an episode called "Hidden Sugar." It's really shocking where sugar hides. Like Dr. Pohl said, in barbecue sauce, in salad dressings. We talked about you think you're eating a fruit-flavored yogurt and that's healthy, but there's a lot of added sugar in that. The little packets of instant oatmeal that you get, half of that is added sugar. So it really kind of hides in very insidious ways.

You might be surprised after looking at packages and monitoring just how much added sugar you're actually getting. Even I used MyFitnessPal and I eat pretty clean, and my added sugar was higher than I ever would have expected. So I think that is good advice.

Dr. Pohl: I want to admit that I had been advising people about diet and exercise, and then I looked at my low-fat yogurt and found the exact same thing. It was 24 grams of sugar. So it was a day's supply of sugar in my low-fat, healthy yogurt.

These things that are sold to you in packages, make sure you look at those packages, because a lot of the things in the health food aisle like granola and low-fat yogurt and things that have the word "fruit" on it, fruit snacks, fruit juice, all those things, they're in the health food aisle, so we feel like, "Oh, these must be great." But check those sugar grams because they hide in these "healthy foods."

Scot: Especially low-fat food, because when you take the fat out, you've got to add something back in to make it taste good. And sugar is what they do. They add sugar back in.

Troy: Yeah, I saw something about a junior high that has their healthy foods vending machine, and they would sell applesauce in there. And the applesauce was just selling out like crazy, and they're so excited, like, "The kids are eating applesauce. Yay." Each little thing of applesauce has like 15 grams of added sugar or something ridiculous. It's amazing.

But I went through that same process with yogurt as well. I was thinking I was eating healthy. We had Thunder on here, Thunder Jalili, who talked about hidden sugars. I looked at the yogurt I was eating, same thing, just tons of added sugar. It's just amazing.

Brett: Yeah, I do try and monitor some of that, and I try and not do as many processed meals and things like that, try to make meals from scratch. Even things like pancakes and waffles, I make from scratch so I can see what exactly I'm putting in there, and not relying on a box mix or something like that. I like to make even macaroni and cheese from scratch, but sometimes my kids aren't fooled by the difference between the colors.

But that's the thing. I do like to try and control those hidden sugars after . . . I did listen to that episode, and that's one of the things I tried to control through the recipes that I've gotten. But I'm absolutely not perfect in that way, and I'm eating plenty of things I know are sugary, too, though.

Scot: I'm really trying to make this simple for any guy that's listening, and sometimes it can get really complex and it can get confusing as to "What should I really, really do?"

So I think we've established to really critically look at those sugars. You might think you're doing well, but after a three- or four-day examination, you might discover, "Not doing as well as I thought." So if you can maybe replace some of those calories with healthier choices, limited seeds and nuts and some vegetables, that's another strategy to try.

I think a lot of people don't realize how many calories are in the foods they eat. I think it's really easy to eat way too many calories. So perhaps monitoring those through MyFitnessPal will give you some insight into that.

And maybe really having two or three meetings with a nutritionist also have just a separate set of eyes on what's going on might be advantageous too.

Dr. Pohl, what do you think of that advice? Brett, do you think that's . . . is that a little bit more straightforward of a plan that you think you could follow?

Dr. Pohl: I love that summary. I think it's a great, actionable summary. Brett, what do you think you could do?

Brett: Yeah, that sounds like a very good idea to start monitoring, start there. It's the easiest thing to do for me personally, and it gives me some data to go to the nutritionist and see what to move forward from there.

Dr. Pohl: And the biggest thing is also just talk to your doctor about it and just find out what your level of fibrosis is and what kind of weight loss plan you should be on.

The caution I want to give you at the very end is that dramatic weight loss, which would be something more in the line of two to four pounds a week, we would recommend . . . If you're going for dramatic weight loss quickly, that can actually worsen fatty liver because of the stress that you're putting your body under. So slow and steady weight loss, something in about the range of one to two pounds per week, is kind of that sweet spot of sort of detoxifying your body.

Troy: And how long do you think Brett should give it before he really goes back to his doctor and says, "Hey, I'd really like you to take a look at my liver again and see where things are"? I mean, are we talking a few months, six months, a year?

Dr. Pohl: Well, talk to your doctor about what level of fibrosis you have. And then the goal would be if you're starting to see some changes on the scale, and you've made some changes consistently for at least three months, then go talk to your doctor about whether you should be rescanned and see whether that level of fibrosis is less. Three to six months.

It's interesting to see . . . the studies show that even small amounts of weight loss, like 5 to 10 pounds, which is only a couple of percentage points, can actually make big changes on the inflammatory properties of the liver.

So set a goal of a certain amount of weight loss. But if you've had some success with 5 or 10 pounds, definitely talk to your doctor about if it's time to look.

Scot: I hear Troy's voice in my head right now, Brett. So I'm going to share some additional thoughts here. And I'd like to get both Troy and Dr. Pohl's thoughts on this.

So it doesn't have to be all at once. Don't expect you're going to change overnight what you eat, or you're going to go from one person to another. It doesn't have to be radical changes. You don't have to all of a sudden go to eating chicken breasts and a plateful of vegetables. The nutrition can still be good. Just start making some minor changes.

Is there one thing that you could do in the first week? Maybe that's to eliminate one soda, or maybe that's to eat an extra serving of vegetables. Give yourself a little bit of time, I think, to go through this process.

I think a lot of times we think, "Oh, I've got to eat healthy now." And then that comes with a lot of baggage of what it is you're going to eat, and sometimes then you get miserable and it's not sustainable.

Troy always says just make those little, small changes one at a time.

Troy: Yeah, that's the key too. I think you have to give yourself credit for what you're doing as well. You're exercising a lot. I think that's great. You're doing more exercise, far more, than the average person does. So you really need to give yourself credit there.

Dr. Pohl has given some great advice just in terms of maybe dropping some sugars here and there. I'm sure you'll start to see that weight loss. Again, one pound a week sounds like that's the goal. And as you see that, again, give yourself credit for it. Say, "Hey, I'm making progress. This is where I need to go." It's not a dramatic change. It's going to be something over several weeks and months.

Scot: And that weight fluctuates from week to week, right? So if all of a sudden you gain a pound, don't worry about that. Sometimes it's just the time of day you've weighed yourself on that scale. Dr. Pohl, a half-pound would be fine, right? This is a long-term game right now. He's got time.

Dr. Pohl: Oh, yeah. In fact, if there's no weight loss, but you're making those dietary changes . . . Like I said, if you're exercising and making dietary changes and you're weight-neutral, that's fine. But I just don't want you to go for dramatic weight loss because that can be harmful as well.

Brett: Well, thank you so much. I really appreciate you doing this and for giving me all the congratulations for actually caring about my health. I'll take all the praise I can get, and hopefully I don't die from this soon. No, just kidding. This was very reassuring. Thank you.

Scot: Brett, thank you very much. Appreciate having you on the show. Hope you have a great rest of your day.

Brett: Thank you.

Scot: Awesome. Dr. Pohl, thank you as always. I appreciate your time.

Dr. Pohl: Thank you for inviting me. It's so much fun to talk about health and helping people become more healthy and reach their fitness goals and their health goals.

Scot: Hey, it's me, Scot. You made it to the end. Good for you. That must make you a super fan. Just wanted to throw this out there. If you found this podcast helpful, or if you've enjoyed "Who Cares About Men's Health" episodes, and you know somebody else that could get benefit out of it, please let them know. That's the way we can grow the show.

We'd also love to hear from you at any time. Listener Brett reached out to us so we could answer his question. You can email us at hello@thescoperadio.com. You can also go to our Facebook page. It's facebook.com/whocaresmenshealth. And you can also call and leave a message on our listener line at 601-55SCOPE.

Would love to hear from you. Love it if you'd recommend the show to somebody. Thanks for listening, and thanks for caring about men's health.

Interviewer: Here to speak with us about vasectomy reversal is Dr. James Hotaling, a urologist and the director of the men's health program here at University of Utah Health. Now, Dr. Hotaling, when it comes to a procedure like this, what are some of the reasons a patient might be looking for a reversal?

Dr. Hotaling: About 6% of people who have a vasectomy will ultimately want it reversed. The most common reason is that they have gotten divorced and have a different partner and want kids with that new partner. Although we do see couples who have had kids, had a vasectomy and then decided they want more kids. So those are usually the most common reasons people want it reversed.

Interviewer: I've been seeing some rates that say, "Hey, you know, a reversal is only 30% to 90% effective." How effective is a procedure like this?

Dr. Hotaling: Yeah. It works about a 90% to 95% of the time.

Interviewer: Oh, wow.

Dr. Hotaling: So it's pretty effective. It depends a little bit on how far out you are from your vasectomy. If you're like 20 years out, it has a lower chance of success. Although it, you know, that chances of success still may be like 80%, 85% than if you're two years out, just because there's more scar tissue.

Interviewer: And we're determining success by being the ability to get pregnant.

Dr. Hotaling: Yeah. That's exactly right. You're determining success by having swimming sperm in the ejaculate.

Interviewer: And so what other factors besides just length of time since you've had the procedure?

Dr. Hotaling: Yeah. A little bit it can be exactly how the procedure was done. When you go back in there, you can either put the vas deferens back to the vas deferens, and that has the highest chance of success rate. Sometimes you have to put the vas deferens back to the epididymis or the sperm-holding tank, and that's smaller and that has like a 60% to 70% chance of success. It's lower. But if you can put the vas deferens back to the vas deferens, that success rate is really high. So if you look at all comers, you end up around 90% to 95%. That's really the biggest thing in determining the success rate and then also just, like we mentioned, how far out you are from having the reversal and to some degree just how the individual surgeon did the vasectomy.

Interviewer: If someone say listening to this and considering whether or not they should have their vasectomy reversed, what is, you know, what is the ideal candidate for a procedure like this? Like is anyone say, you know, not a good candidate? What makes a good person for this?

Dr. Hotaling: That's another really good question. So obviously somebody who wants to have kids in the future and somebody who if the wife is younger, that can be helpful, although it's not impossible to do it if their wife is older. Also for couples who want, you know, multiple kids, it can be helpful as well. And just cost considerations. You know, the cost of a vasectomy reversal is a lot less expensive than the cost of in vitro fertilization. It's like a third the price. So that's kind of the other option, the other consideration.

Interviewer: And is reversal ever covered by insurance?

Dr. Hotaling: No.

Interviewer: Okay. So it's out of pocket?

Dr. Hotaling: It's always out of pocket. Yeah.

Interviewer: What are some of the risks with getting this type of procedure, of getting it all back together?

Dr. Hotaling: Well, the biggest risk would be that it wouldn't work, which is really, really low. You know, the recovery is usually pretty minimal, a little bit of bruising, but not terrible, sore for, you know, maybe five days afterwards. We do use long-acting numbing medication that lasts for four days. So patients really don't have much pain from that. And then you have to take it easy for three weeks or so. In terms of the complication, some patients can get pain that lasts longer than that afterwards. As I mentioned, the chance that it couldn't work or just chance of some bruising or a very rare chance of infection, although that is exceptionally, exceptionally rare as in I've been doing this for eight years and I've only ever seen it happen once.

Interviewer: Wow.

Dr. Hotaling: So that's not common.

Interviewer: Okay. So here on The Scope we've talked before about vasectomies and what the procedure is like, what to expect. It's an outpatient procedure, you come on in and, you know, you heal up for a week or so, right? With a reversal, you know, like the day of the surgery, what are they expecting?

Dr. Hotaling: So they'll, you know, they won't have anything to eat or drink after midnight. They'll come in, in the morning. You know, they'll get an IV put in. They'll get drifted off to sleep. They'll go to sleep. Once they're asleep, we make two small incisions, one on either side of the scrotum, and then we go in and find where the blockage and we bring a high powered . . . we have this new digital microscope, it's like a $700,000 microscope that actually allows us to see in 3D with special glasses on.

Interviewer: Wow.

Dr. Hotaling: It actually is really helpful to do the procedure. So we bring that in. Then we put the tubes back together again with 12 sutures that are finer than a human hair and then put the local numbing medication and close everything up. Each incision is shorter than an inch on either side.

Interviewer: Oh, wow.

Dr. Hotaling: So two incisions, really small. Then you would wake up with some . . . And all the stitches melt away on their own. You'd wake up with some sort of biologic superglue over the incisions and then some gauze on the scrotum. And then you'd go home later that day. And most patients just take some Ibuprofen and Tylenol and that's it.

Interviewer: Wow. And you were saying that it's take it easy for a little bit and then three weeks until you're back to . . .

Dr. Hotaling: Yeah. It's really just no like sex, bike riding, or heavy lifting for three weeks. But you could be back on your computer doing work the next day. Often if I do the surgery on a Thursday, patients are back at work again certainly by Monday. And if I did the surgery on say a Tuesday, often by Thursday or Friday.

Interviewer: Once they're all healed up and once they're feeling good, how do we know, I guess, if it was a success?

Dr. Hotaling: Yeah. It's a great question. You know, we have had patients who get pregnant before we ever checked the first semen analysis.

Interviewer: Wow.

Dr. Hotaling: But usually we check in like 8 to 10 weeks, we check the sperm test. And it can take up to a year, even up to a year and a half, depending on the type of like reconstruction that we do.

Interviewer: Oh, wow. So it's not just you magically are?

Dr. Hotaling: Most patients, when it's successful, have sperm right away.

Interviewer: Oh, wow.

Dr. Hotaling: But it can take longer.

Interviewer: Okay. So, you know, you'll do a test and find out if it was successful and go on from there?

Dr. Hotaling: And then we would repeat it again in three to six months if we didn't show any sperm.

Interviewer: And I would imagine that this type of procedure is something you want to make sure you go to a good doctor, a good surgeon, or a good urologist. You know, what should a man be looking for in a doctor to perform this?

Dr. Hotaling: Yeah. So typically somebody who's done a fellowship in male infertility, which both myself and Dr. Gross here have. We're actually getting another partner, who's starting in September, who's also done a fellowship in male infertility. So you want someone who's fellowship trained. You want someone who does a lot of these. And I think also doing it, you know, in the operating room with the patient asleep, with kind of the best equipment you have, and we sort of tick all those boxes here. Some people do do them in the office with local numbing medication. You know, I don't believe that that's necessarily the best way to do it in my opinion.

Interviewer: So we're looking for someone with a fellowship, someone who's performed the procedure a few times and probably a lot of times, right? And a good center, right?

Dr. Hotaling: Yeah. That's exactly right.

Interviewer: For a patient who is considering getting this procedure done, what is it about say University of Utah Health or maybe another medical center? What is the things that a big center like ours can offer to them with their procedure?

Dr. Hotaling: Yeah. Typically we can also . . . we offer the ability, because we have a full IVF lab and andrology or sperm lab, we can do a little biopsy of the testis at the same time and freeze some of that testicular tissue in case the reversal doesn't work, you know, and you could use that, which saves the patient a significant amount of money because they don't have to have another procedure in case it doesn't work. You want somewhere, you know, that does a lot of them and really has the best equipment.

Interviewer: You were just telling me that you have fellows, you have other . . .

Dr. Hotaling: Mm-hmm. We have other people that we work with. And the surgeons here are still doing the entire surgery, but we have really good assistants. A lot of places, it may be, you know, a surgical technician who's assisting the surgeon, and it really helps to have, you know, great assistants, or if it's a super complicated case, myself and my partner, you know, we'll sometimes do those together.

Dr. Jones: I was talking to a group of 11 college students, all women, about family planning. They said, "We aren't really interested in family planning because we aren't planning any children right now." Really? What am I not getting here?

Announcer: Covering all aspects of women's health, this is "The Seven Domains of Women's Health" with Dr. Kirtly Jones on The Scope.

Dr. Jones: Sometimes you think people you are talking to know what you mean. Well, that's a mistake for sure. I make assumptions that young people in college know how their bodies work and about contraception, but maybe I'm wrong.

Today in The Scope studio we're talking to Grace Mason, a college student who knows a lot about contraception and is learning a lot about what her fellow students know and don't know. She is the founder and President of the Campus Contraceptive Initiative here at the University of Utah. Welcome, Grace.

Grace: Thanks for having me.

Dr. Jones: So, Grace, by the time young people get to college with all that's out there on the internet, they're pretty well-informed about contraception. Right?

Grace: Well, you would hope so, but unfortunately since less than half of the United States mandates contraceptive education and sexual education broadly, a lot of students come into college without having any sex ed. And a lot of students don't experience medically accurate sex ed in that regard. So if they come out, they may come out of high school with misinformation.

And so when we hope that students will turn to the internet to get better information, there's also a lot of misinformation on the internet that they're quite easy to find as many different people will tell teenagers what they should believe about sex ed rather than what their bodies do and how their bodies function.

So I think that students frequently come in believing things or not knowing anything and hoping that anyone will tell them the truth about how their bodies work.

Dr. Jones: Well, there's a lot of sex in the media, and there are books and there are songs, but none of them actually represent sexual initiation or contraception at all. No one says, "Oh, yeah, what are you using for contraception?" They never had that on the TV. So I read that one of the main reasons that men and women don't finish community college in the way they planned was an unplanned pregnancy. How can we change that?

I mean, if people are coming to college, they planned their college. But now they have to stop or have an interrupted course because of a baby that they didn't plan. What are we going to do about that?

Grace: I think that it is a broad issue, and it's something that Healthy People 2020, it's a huge part of their initiative is reducing the unintended pregnancy rate and increasing the intended pregnancy rate, because at the moment, 45% of pregnancies are unintended. And for students in college, who are 18 to 25, they are the most likely to experience an unintended pregnancy and they're also the most likely to be uninsured.

So there's a variety of issues there when it comes to a lack of knowledge and education coming into college. There's a coverage gap. There is the expense of care, which tends to be about $600 or more out of pocket for uninsured students.

Dr. Jones: For contraception?

Grace: For contraception.

Dr. Jones: If they want a long-acting method. It's cheaper if you're using condoms, of course.

Grace: Of course, but condoms are less reliable, and a lot of students don't like condoms in the sense of like their pleasure. And as they are less reliable, students are hoping to find a method that works with them.

Dr. Jones: So tell me about the Campus Contraceptive Initiative.

Grace: So the Campus Contraceptive Initiative is a interdisciplinary group of students, researchers and providers who are all targeting that issue of college completion, graduation and promoting family planning.

And so we are working through research and education to expand access to services, because we find that a lot of students don't know about the different options that they have when it comes to contraception. And so when it comes to finding the best method, they first need to have the education and that step of these are all the methods available to you. And then what does it look like in pricing? What does that look like for coverage? Where can you actually get those services?

Dr. Jones: So you've been doing a survey. You did a little survey last year, and you've been working on one this year. Any clues from your science so far in terms of what are people thinking out there?

Grace: Yes. We have definitely found out a lot of interesting things. That first survey, that went out last February, we got about 330 students to respond, and they were asked questions about their current sexual health, their knowledge as well as their desire or interest in a low-cost contraceptive clinic on campus.

We found out that 1% of students are currently going to the Student Health Center on campus, and that really blew us away because we found out that a lot of students are going to their doctor, but we know that a lot of students aren't comfortable with telling their parents about the services that they get.

And so that we have this huge uninsured gap of students where if they were able to access care at the Student Health Center, maybe they're being turned away because of the out-of-pocket prices, maybe they're being turned away of not knowing their options.

Dr. Jones: The Student Health Center, it may be student health, but it still has to be paid for. So students, unless they have that particular kind of student health insurance, still have to come up with money, and maybe their parents, if they use their parents' insurance, then their parents are going to get the bills or get the copays or get the information at home, so privacy becomes an issue.

Grace: It definitely does. And we saw that students, when asked about if they could have low-cost, affordable methods, 95% of students said, "Yes, I am interested in that." And many of those students said that they would actually partake in a service like that.

But broadly students want to know about the methods. We found that it wasn't just the birth control pill that was popular. If we were to have this contraceptive clinic, it was options. Across the board students want options for their birth control.

Dr. Jones: So where can college students get information about contraception? What methods are out there? How they work and where and how to get them? What's good information? What could they do right now?

Grace: Well, I would say that there are two wonderful resources out there. Bedsider.org is one. They have an incredible comprehensive list of different options, how they work, the different varieties. For example, since the IUD, there are several different types of IUDs, being able to click on each one and seeing how they're different and what they might do.

And they are wonderful because they also can connect you with emergency contraception to your door or sending your monthly birth control to your door rather than going in clinic. And so they have a great set of resources. Also Planned Parenthood Learn, which is an offshoot of the broader Planned Parenthood website, also has a really user-friendly interface that can compare methods and look at methods and connect you to one of their clinics.

Dr. Jones: Okay. So both of these options have a place where you could put in your ZIP code and you can find out clinics where you could get healthcare?

Grace: Yes.

Dr. Jones: Well, that's good to know, and people need to know more. And having a reproductive life plan, a family planning plan is important if you want to have the family that you want when you want it, or if you don't want it, get the knowledge that you need and get it right. You worked hard to get into a university and you're working hard to finish, and this part of your life takes a little effort, but it's worth it. And thanks for joining us on The Scope. And thanks, Grace.

Grace: Thank you.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.