Search for tag: "u6021567"

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.

Maintaining a healthy diet today seems nearly impossible. The built environment of modern day America makes it so easy to eat poorly. 100 years ago we had to work to get food and spend energy to get energy. Today there's no limit on the foods we can eat, and it's a little too easy to indulge in our built in biological drive to consume high fat and high sugar foods.

Dr. Alex Pastuszak has worked hard to become an "intuitive eater." He's practiced for years to get a good understanding of how much food and the types of food his body needs to stay healthy. He even finds himself looking forward to eating food that makes him feel good like a salad for lunch.

His secret is to make sure that he's never on a "diet." Diets are short term and focused on getting a person to lose weight or gain muscle. These quick-fix approaches to look better don't necessarily lead to good dietary habits. Dr Pastuszak urges people to focus on their health and forming good eating habits that can last a lifetime, rather than a fad diet that will help you lose a couple pounds for just a couple months.

Scot is working towards getting to a place where he can eat intuitively. He watches his diet closely and still weighs out his food. He hates weighing his food all the time, but is teaching himself what portion sizes should look like and how much he should be eating. He looks forward to the day he can stop weighing his food and eat intuitively. Is Testosterone Therapy Right for You?

You may have seen the ads about testosterone therapy or "T" treatments. They make it sound like testosterone can cure just about anything that ails you. Have low energy? Testosterone is the answer. Putting on a few pounds of fat? Get T. Having trouble sleeping? Testosterone will help you sleep like a baby.

"In the right person, testosterone can help a lot," says men's health specialist Dr. Alex Pastuszak, but he admits that it isn't the cure-all the advertisements lead you to believe. Most of Dr. Pastuszak's patients will come in with complaints of low sex drive and general fatigue. They can't seem to power through a day and find themselves tired by lunch time.

The difficulty with diagnosing low-testosterone is that the symptoms are extremely non-specific. For example, if a guy is feeling fatigue, it can be caused by just about anything- lack of sleep, poor diet, depression, etc. Same goes for symptoms like low sex drive and insomnia.

The only way to know if a man is experiencing the symptoms of low testosterone is to get a testosterone level test. What is a Normal Range for Testosterone?

A testosterone level test measures the amount of male hormones in the bloodstream. The results are measured in nanograms per deciliter. A healthy range for a guy is 300 to 1000 ng/dl, with around 600 being average. Anything around or below 300 is considered low by most physicians.

According to Dr. Pastuszak, most men feel better with a level of 600 or higher. Any man with a level below 600 will likely feel better with testosterone therapy and it's worth trying out. It's important to remember that testosterone therapy is typically considered a "lifestyle therapy" meaning you can use the treatment as long as you'd like if it helps you feel better.

Having a low testosterone level between 300 to 400 isn't dangerous to you health. However, if a man's testosterone drops below 300, there is an increased risk for osteoporosis and cardiovascular issues. What Kind of Testosterone Therapy is Available?

Testosterone therapy can be administered in several different ways depending on the patient's needs, wants, and expectations.

The very first question Dr. Pastuszak asks is whether or not a guy plans on having kids in the near future. It may come as a surprise, but testosterone does not improve a guys fertility. In fact, testosterone does the exact opposite. After six months to a year of taking testosterone, most men see a dramatic drop in fertility.

Testosterone therapy is often made up of several different medications:

Testosterone
The basic form of the treatment is to add more of the male hormone to the body. This can be through injections, creams, pills, or even injections under the skin. These hormones aim to raise a man's testosterone levels to a more typical range.

Human chorionic gonadotropin or hCG
hCG is a drug that helps to stimulate the testes to produce testosterone naturally. It is prescribed with testosterone to prevent the testicles from shrinking during treatment. If testosterone is taken by itself, it interrupts the connection between the brain and testicles. The testes will stop producing testosterone and over time will begin to shrink. In some cases, the testicles will shrivel up to the size of raisins. hCG helps keep them the right size during testosterone therapy.

Clomid
Clomid is an oral medication that stimulates the brain and testes to make more testosterone. Clomid has less of an impact on fertility, but is less effective at raising testosterone levels as significantly as T creams and gels. It is often prescribed to men with slightly low levels of testosterone or men looking to have children.

There are many different testosterone treatments available. Work with your doctor to find out what type of therapy will work best for your situation The Side Effects of Testosterone Therapy

Like any medication, testosterone therapy comes with its own set of potential side effects. The two major side effects are infertility and testicular shrinkage. Infertility can be avoided by taking a less intense treatment route like Clomid. Testicle shrinkage is prevented with hCG and should always be taken with testosterone.

Testosterone therapy can also lead to an elevated level of estrogen. It may be confusing that increasing a male hormone would also increase a female hormone. Biochemically, testosterone is a precursor compound to estrogen. The human body needs testosterone to create estrogen. Therefore, in some men, having too much testosterone can lead to the overproduction of estrogen. If a guy's estrogen levels are too high they can develop tender, sensitive nipples, and in extreme cases, begin to develop breasts.

Additionally, testosterone can lead to erythrocytosis, or a significant increase in red blood cells in the blood. If a person's red blood count gets too high it can increase cardiovascular conditions like heart attack and stroke.

If you're on any sort hormone management like testosterone therapy, it's important to maintain regular follow up care. The hormones can keep you feeling really good for a really long time, but it's important to keep tabs on how they're affecting your body with a professional. After first starting testosterone therapy, your doctor may insist on frequent visits and tests to track your treatment and adjust medication as needed. After you and your doctor get the treatments zoned in, you can expect to visit your doctor every 6 months or so to make sure everything is running smoothly. Choosing to Stop Testosterone: Scot's Story

Scot has had his own experience with testosterone therapy. After not feeling his best for a while, he went to a doctor to test his testosterone levels. The results showed that while he was within the acceptable range, his testosterone levels were on the lower end of the range. His doctor prescribed him a testosterone cream that he rubbed on his chest. After using the cream for a while, he didn't feel like he was feeling better. For him, the testosterone didn't turn out to be the cure-all he had been led to believe. He stopped the treatment and started focusing on other aspects of his health.

Scot recognized that his lack of energy may have been caused by something other than low testosterone. At the time, he was only getting around five hours of sleep a night. He says he was a little overweight and wasn't exercising as frequently as he should. Those bad habits were probably the real cause of his low energy levels, and he felt that testosterone couldn't cure his lifestyle.

After focusing on improving those aspects of his health, Scot began feeling better. Even better than he did when he was on testosterone therapy.

Dr. Pastuszak agrees that testosterone therapy isn't the cure for everything that the commercials will lead you to believe, but for some guys, it can get them on the right track. For example, an overweight thirty year old with low testosterone levels may be suffering from extremely low energy. That low energy leads him to not exercise or eat as well as he should. He comes in. Get tested and finds out he has low testosterone. The low testosterone level may likely be caused by the extra weight and lack of exercise, but with how low his energy levels are, it's going to be hard to be active.

Dr. Pastuszak would put this guy on hormone therapy as a "lifestyle intervention." The treatment makes him feel better and improves his energy levels. He then has the energy to go to the gym and exercise, which will bring his weight down, and get his body producing testosterone again. In a case like this, testosterone therapy can break the bad health spiral long enough for a man to improve his health and eventually stop using testosterone.

Testosterone therapy is a deeply personal and complicated issue. If you have any questions about treatments or suspect you may have low testosterone, submit your questions to Dr. Pastuszak by email at hello@thescoperadio.com. ER or Not: Food Poisoning

You've decided to eaIf you've had food poisoning, you know how terrible it can be. You've eaten somewhere that's not so great and now you can't seem to stop throwing up. Should you go to the emergency room?

According to Troy, you don't necessarily need to go to the ER for food poisoning. Food poisoning usually strikes six to twelve hours after eating contaminated food, and will last for about just as long. Over the counter anti-nausea medication can help with the symptoms, but it'll have to run its course before you feel better.

However, if you are vomiting incessantly and can't keep even liquids down, you run the risk of becoming severely dehydrated. In this situation, go to the ER. An emergency room will be able to put you on an IV drip and help keep you hydrated during the food poisoning. Most urgent care facilities lack the means to start an IV, so if you're at risk for severe dehydration, an emergency room will be your best bet for treatment. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot is thinking about the critters in his gut and how the microbiome could help your immune system stay strong and Troy is not ready for winter. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

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.

Activity is vital to a person's health and it's important to get enough every day. Urologist Dr. Alex Pastuszak explains that one of the major reasons he's a doctor is because it's an active job. He's up walking around, interacting with patients. On those long paperwork days where he's stuck at a computer, he makes sure that he gets up at least once an hour just to get his body moving.

Dr. Pastuszak reminds everyone that activity does not necessarily mean your typical exercise at a gym. Shoveling the snow in the morning can get your heart rate up enough to be good for your body. It's best to try to get 30 minutes of exercise a day, at least three times a week to keep your body healthy. What to Do If You're Experiencing Testicle Pain

Guys, if your testicles are hurting, you should seek medical attention. Understandably, any pain down there can worry a man, but it's important to know what type of pain you're experiencing and what steps you need to take for treatment.

If you are experiencing the sudden onset of severe pain in the testicles, you need to get treatment immediately at an urgent care or emergency room. Whether this pain comes from an injury or you wake up in the morning with severe pain, these can be symptoms of something serious.

Acute, severe pain in the testicles can be sign of testicular trauma or torsion. These conditions are an emergency. They can have very serious consequences and require surgery as soon as possible.

Don't wait. Get treatment.

For less serious pain, or more chronic minor pain, you should still go seek a diagnosis, but they are not an emergency. Some of the conditions related to minor testicular pain include:

• Dilation of testicular veins
• Kidney stones
• Problems related to the pelvic floor
• Prostate swelling
• Testicular varicocele

These conditions will require medical intervention, but they often take time to treat and diagnose. They can be handled by a primary care physician or a urologist if needed.

Keep in mind, testicular cancer usually does not cause pain. So if you're feeling pain down there, don't assume you have cancer. Guys, It's Probably Worth Checking Yourself

Dr. Alex Pastuszak nerds out a little over official health recommendations. According to him, the official recommendations for men is that a self check of your testicles is not necessary. This official stance confuses both Dr. Pastuszak and the urologists he's worked with.

A monthly self check in the shower is a convenient, non-embarrassing, zero-cost preventative measure to make sure your testicles are healthy. Dr. Pastuszak suggests getting into the habit of doing a self check regularly is important if you're going to catch anything.

Testicles are not smooth little eggs. They're different for each and every guy. Testicles are not always smooth. They will sometimes have little lumps and bumps that are totally natural. It's important to get familiar with the feel of your own parts so you can be on the lookout for any changes over time. If you notice any changes in the shape or feel of your testicles, it's worth getting them looked at by a professional. ER or Not: Passed Out for No Reason

You are just minding your own business. Then you suddenly wake up on the floor with people surrounding you asking if you're okay. You've passed out for seemingly no reason. Should you go to the ER?

Troy has experienced this first hand on a trip to Washington D.C. While he admits that it was a very scary experience, it's complicated to decide whether or not it's something to go to the emergency room for.

According to Dr. Madsen, 95% of the time that a person randomly loses consciousness, everything is fine. But for that last 5%, passing out can be a sign of something more potentially life threatening. It's worth getting blood work and other tests done to screen for a serious heart condition

If you are passing out for seemingly no reason, go to the urgent care. Especially if you have passed out more than one time. They'll begin the diagnosis process and decide whether you need to go to the emergency room. Are You a Maximizer or Satiscficer?

Scot is the type of guy who agonizes over the work in his Master's courses. He stresses out making sure that every article he includes in a paper is the very best one. He reads over his work over and over to make sure he's creating the very best possible work he can.

Meanwhile, Troy just gets things done.

An article in the New York Times asserts that there are two types of people in the world: maximizers and satisficers. Scot identifies as one, while Troy is more the other.

Maximizers are perfectionists. They agonize over maximizing their efforts to ensure that they are getting the very best possible work done. This often leads to high stress during the process and a lack of satisfaction in their work.

Satisficers do whatever needs to be done to finish the work in front of them. They don't stress about whether the work is perfect and will often finish projects more efficiently than maximizers. Satiscficers also report being satisfied with their work at the end of the day and experience less stress completing tasks.

It's important to remember that a project is never going to be absolutely perfect. There will always be changes that can be made to a piece of work, but at some point, it you need to be done.

Value your mental health. It's just as crucial as your physical health. Make sure you aren't causing undue stress on yourself. Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Troy is surprised to learn just how hard it was to get to the moon after listening to the audiobook The Man Who Knew the Way to the Moon. He highly recommends it. Meanwhile, Scot can't stand when men use their phone next to him at the urinal and urges every man out there to just stop it. Talk to Us

If you have any questions, comments, or thoughts, email us at hello@thescoperadio.com.

Announcer: Health information from experts supported by research. From the University of Utah Health, this is thescoperadio.com.

Interviewer: Peyronie's disease is a very treatable condition, but you have to seek help in order to get that treatment. Up to about 13 percent of men might have it. And those numbers might even be higher because a lot of men just don't even talk about it. Urologist, Dr. Alex Pastuszak is an expert on Peyronie's disease, also called PD, and has received an NIH grant to investigate the genetics and molecular mechanisms of the condition.

So let's talk about this disease because I did a quick internet search. Five minutes later, I was in the black hole. There's a lot of stuff out there. Let's clear up the misconceptions. Let's get the good information. So a couple of issues first, acknowledging that a man has it and then getting help for it. Those are kind of the two big things.

Dr. Pastuszak: Yeah. I think one of the big things with Peyronie's disease that brings guys out of the eaves really is knowing that it's highly treatable and knowing that a lot of other men actually have it, and that they really shouldn't be ashamed to see somebody about it because there are a lot of us that can actually treat it.

Interviewer: Yeah. It comes to shame, you think, is why men don't seek help? Because you've told me that a lot of men don't seek help, even though it's a very painful condition and not much fun.

Dr. Pastuszak: So I'm going to nerd out just for a second, but up to 50 percent of guys with Peyronie's disease can actually have clinical depression because of it. So it's not just shame, but there's a lot of psychological issues that can come with having just what somebody can consider penile curvature.

Interviewer: Okay. So, first, acknowledge that you have it, realize that you have it. Do you find most men that have it actually do know, so we don't really have to talk a lot about what the symptoms are? Is that worth going into?

Dr. Pastuszak: Yeah. That's actually a great question. So most men who have started to get curvature, know that they have it. Soon as they have an erection, they have curvature, they're like, "Wow. That's different than it was X time ago." There are some guys who'll come and see you and say, "You know, Doc, I have some pain in my penis, either when I have an erection or without that." And then you tell them that they need to be on the lookout for it, but they may not have it by definition yet.

Interviewer: Okay. So it sounds like there are two kinds of things to look for. A curvature, how severe is the curvature?

Dr. Pastuszak: It can be just not normal for the guy. That's all you need.

Interviewer: All right, and pain. Does pain always accompany the condition?

Dr. Pastuszak: No. It doesn't always accompany it. And the other thing to look for is sometimes guys find like "a knot" in their penis, a lump. So lump, bump, or curve is sometimes how we refer to it. And they find that troubling. They think, "Oh, wow, you know, hey, I've . . . Oh, shoot, you know, maybe I have penile cancer," and they come running. So those three things really are what bring men into the clinic.

Interviewer: And it's usually men around 50, 55?

Dr. Pastuszak: So the average age is 55. That's nationally. But there are plenty of younger men who have that and plenty of older men as well. I see men as young as in their 20s who have it.

Interviewer: All right. And it's caused by scar tissue building up?

Dr. Pastuszak: That's right. By and large, technically, it's an abnormal scar tissue formation in the penis.

Interviewer: And that's that lump or bump that you start to feel initially?

Dr. Pastuszak: That's exactly right. And then that can sometimes increase in size and that curvature can stay the same, get better or get worse.

Interviewer: All right. And is it something that most men do . . . And we kind of did touch on this, but does this progress pretty quickly, generally, the curving, or is it so slow that you might just one day go, "Look at that, that's not right"?

Dr. Pastuszak: So everybody's a little different when it comes to how quickly they progress. I've had guys come in and say that, you know, within two weeks of feeling pain or getting a bump on their penis, or whatnot, they had really bad curvature. And there are other guys who come in and say that it's been months or years, and it continues to get worse or has been the same for a long time.

Interviewer: So, when you start noticing those initial symptoms, is it pretty important to get in right away, or is it something you can kind of sit on for a bit?

Dr. Pastuszak: So I think it really depends on how important it is to you as the patient, because a big part of what defines what we as doctors end up doing in terms of treatment and treatment recommendations is how much it actually bothers you.

Interviewer: Okay. So if the guy's not feeling any pain and it doesn't bother him, then it's not something you necessarily recommend a patient come in for, or is it going to cause problems eventually?

Dr. Pastuszak: So that's probably going to be the million-dollar question today, to some extent because we don't know, definitively, whether it causes other problems. Some of my research has suggested that it can cause other problems, but we haven't linked it causally to the problem yet so we don't know for sure.

Interviewer: If you seek treatment more quickly, is it more likely you're going to have a successful treatment?

Dr. Pastuszak: Ultimately, you need to seek treatment or the best time to seek treatment is when your curvature is no longer getting worse because that's what's considered the stable phase of the condition. And that can take anywhere from six to 18 months to get to, at least based on the research that we have right now. So, you know, if you're treated when you're stable, great. There's a little bit more of a risk that you take if you're treated when you're in what we call the active or developing phase.

Interviewer: Oh, okay. All right, let's talk about treatments. There are four different categories, you told me. Let's just go ahead and go on down through those.

Dr. Pastuszak: Okay. I'm going to go ahead and start with traction therapy. So, to take a step back, the four categories are:

1. traction therapy,
2. oral therapies,
3. injection therapies, and
4. surgery.

Okay? So with traction therapy, this is something that men can do at home. And I'll tell them upfront, "If you don't want a doctor involved in your treatment right now, then I'll tell you where to get this device. You can go get it online, and then you can start your traction therapy." In terms of efficacy, we don't know exactly how effective it is. There are some early studies now that show that it can help improve curvature, but the jury's still out.

Interviewer: Yeah. I'm looking at one of these devices right now. They don't look fun. It looks like a torture device kind of.

Dr. Pastuszak: So you're probably looking at RestoreX or what's called the Andro-Penis. These things have great names.

Interviewer: Of course, they do, right?

Dr. Pastuszak: The one I actually probably recommend the most to my patients is called the Penimaster PRO. That's right, you can stop and giggle. It's okay.

Interviewer: Well, I mean, come on. This is an embarrassing enough situation and some company named it that?

Dr. Pastuszak: Well, yeah. Except the bottom line is that the thing works.

Interviewer: Okay. Well, you just have to get over . . . Okay.

Dr. Pastuszak: But they can be effective. All right. Moving on to oral therapies. So I actually don't use oral therapies very much, and we don't use them very much in our practice here in Utah because our professional society, the American Urological Association, in 2015, came out with guidance that they don't really work. Well, let me back that up, that there's no evidence that they work right now. That doesn't mean that some of these don't work, it's just that we can't prove it.

Interviewer: Got you.

Dr. Pastuszak: Okay? So I would just caution men who may be considering oral therapies, because some of these can be nutraceutical stuff you get over the counter, to think twice before they use it just based on the evidence that we have.

Interviewer: Are there some side effects that you're worried about? Because I would consider, you know, there's no evidence to show that they work, but maybe there's in some cases they do, then I have to look at, "Well, what are the drawbacks if I do take this?" Are there some drawbacks to these oral therapies if a man did decide to try them?

Dr. Pastuszak: So, ultimately, anything you take, that has drug potential, can have side effects, so that's another thing to consider. It's a good point.

Interviewer: All right. Number three is injections.

Dr. Pastuszak: Yeah. So injection therapies are drugs that we inject directly into this scar tissue that can either help dissolve it or prevent more of it from forming. And there are three, in particular, that have good clinical evidence that they work, and we offer those here at the University of Utah and at other major centers.

Interviewer: All right, number four is surgery.

Dr. Pastuszak: So surgery, there are numerous surgical options. And this is probably a conversation best had with your urologist, particularly a urologist who has done this a lot because the surgeries can get somewhat complicated.

And the right option should be really an intimate discussion between you and your urologist. But these are highly, highly effective, and you can be pretty much straight coming out of the operating room.

Interviewer: If you're counseling a patient on these options, what's your hierarchy of where do you start? Where do you end up? Do you start right at surgery, or do you try injections first?

Dr. Pastuszak: No. So I think shared decision-making is the way to go. You need to talk to your patient and figure out how much they want treatment, and how quickly and, you know, ultimately how much time they're willing to devote to treatment, and how aggressive they want to get will help determine what they end up doing.

Interviewer: All right, so it sounds like, if you're serious, you really should see a urologist, take a look at injections or surgery, probably, are your two best options. That's what I gathered out of this conversation.

Dr. Pastuszak: Yeah. And I think the traction therapies are really good options for guys who don't want to seek help from a physician right now. But, you know, I would encourage guys to come in, at least have a discussion because that way you can know what the evidence is, one way or another, and make your decision based on a level playing field.

Interviewer: And my final question is, a lot of times when you do a search on the internet, you'll see people that have a condition and they say, "I've been to all sorts of doctors and nothing is working." What if a man has seen a urologist and it's just not getting better? What do you do at that point?

Dr. Pastuszak: So I think if a man is seeing a urologist, that's already a step very much in the right direction, but not all urologists are created equal. There are definitely subspecialties within urology. And so, if a man has not seen a male sexual dysfunction specialist, so somebody who is specifically trained in managing these types of conditions, and there are a handful of us across the country, then they should seek someone out like that.

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.

Announcer: Health information from experts supported by research from University of Utah Health. This is thescoperadio.com.

Interviewer: When it comes to vasectomy, there are a lot of myths that you might hear about from friends or maybe you've even read them on the internet and they're simply not true. And a lot of times, these myths could contribute to the fact that maybe not as many men get a vasectomy in the United States compared to other parts of the world.

Dr. Alex Pastuszak is a urologist and a reproductive expert at University of Utah Health. And I'd love to get you as the expert to address some of these common myths that I found out on the internet about vasectomy and find out if they're true or not. I think one of all them that you hear is it's called getting snipped sometimes, which makes me think that this is a pretty major surgical procedure. Is that true?

Dr. Pastuszak: Great first question, great leading question. And ladies and gentlemen, I'm here to tell you that this is one of the least invasive procedures that a guy can have or a human being can have for that matter, because literally we're talking about two half-inch incisions, one or two half incisions in your scrotum and a quick pulling up of your vas -- clipping, cutting, putting it all back in there and suturing it up. All of this takes 15 minutes, very quick, not invasive.

Interviewer: All right. So getting snipped, that's really unfortunate isn't it that people refer to it as that?

Dr. Pastuszak: I mean it is factually correct, but it's not invasive.

Interviewer: Yeah, okay. What about this myth? It's really, really painful. Oh, it's going to hurt.

Dr. Pastuszak: Not true. If we did it back the way they would have done it back in the 1200s or 1400s before there was any form of anesthesia, then yes, maybe. But we use really good local anesthesia. We give you some oral meds that also numb things up a little bit for you. So the pain scale here is really minimal.

Interviewer: All right. And what about recovery pain? Sometimes I hear that it can be kind of painful to recover?

Dr. Pastuszak: Yeah. You know, I'll be frank with you. I tell guys to expect that, you know, they will feel like they got kicked in the boys for a day or so, on and off, so it's not constant and then that goes away.

Interviewer: All right. And that's really kind of a small price to pay when you think about it that from then on out, for the rest of your life, you don't have to think of birth control for you and your spouse?

Dr. Pastuszak: Think about the freedom that comes with a minor bit of pain for a day or two.

Interviewer: Absolutely. All right. What about this myth? It will affect my testosterone production, and all of a sudden I'm going to start watching "Gilmore Girls" and I'm going to have a high-pitched voice. My muscles are going to go away.

Dr. Pastuszak: Two words -- not true. Now, let me say just a word about that, because I think it's important. Okay? So guys, testosterone doesn't come up through your vas up into your body. It goes into your bloodstream. Your testicles make testosterone. Doing a vasectomy is not going to stop your testicles from making testosterone. Your testosterone levels may go down as you get older, but this has nothing to do with whether or not you had a vasectomy.

Interviewer: All right, that's good. What about this one? It's going to change sexual function or it's going to reduce a man's pleasure.

Dr. Pastuszak: Not at all. Your penis stays the way it was before vasectomy. And testosterone is really important in all those processes and, just like we said, we're not messing with that.

Interviewer: The key thing I'm picking up here is it's what are we actually doing, and we're just cutting that one little small tube that allows the sperm to go out into the world.

Dr. Pastuszak: That's right.

Interviewer: What about this one? This is a little bit more serious. It can cause prostate cancer, or it has been linked to cardiovascular disease if you get this procedure done.

Interviewer: There is no convincing evidence right now. There have been a couple of papers, but there is no evidence that would really suggest that vasectomy actually causes prostate cancer or is related to cardiovascular disease. These studies were all based on big cohorts that were not necessarily vetted very well. So there were imperfections in these studies, and in the urologic community right now, there's nobody who has changed practice as a result of any of them. So proof is certainly not 100% or even close to it.

Interviewer: It sounds like perhaps other things could have caused these things, not vasectomy in the data.

Dr. Pastuszak: Right. You know, guys will get prostate cancer as they get older.

Interviewer: That's just going to happen.

Dr. Pastuszak: It's just going to happen, exactly. Same thing with cardiovascular disease. Just because you link it to a vasectomy doesn't mean it's true.

Interviewer: And finally, how about this one that my sperm is going to build up? Now I'm saying this is just what I found on the internet. I mean, I don't know how somebody believes this, but apparently somebody does. My sperm's going to build up, and my testicles will explode as a result.

Dr. Pastuszak: So that, that's one of my favorites. And it's a legitimate question, right, because you are blocking the exit of sperm from the testicles.

Interviewer: And as high schoolers we know what that did.

Dr. Pastuszak: Right. Exactly, the blue and five letter word after that. The answer to this is that know your boys are not going to explode after you have a vasectomy. The body just reabsorbs the sperm that are made in your testicle. I mean, it knows that they have nowhere to go, and then it's just going to soak them right back up. So don't worry about it.

Interviewer: All right. Any other myths out there?

Dr. Pastuszak: You know, I think you've covered it pretty well. I did also just want to touch on the orgasm one, because we talked a little bit about sexual function and we talked about sensation but not orgasm. No effect on orgasm either. Guys, just be reassured that this is a very local thing that we're doing. We're going to keep you from having babies in the future, and it's not going affect anything that you associate with your sexuality, manhood or your livelihood.

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.

Interviewer: You've had all the children you and your partner want. Your family is complete, and now you're considering permanent birth control. But how do you decide who gets it done? Is it the dad, and he gets a vasectomy, or is it the mom, and she gets tubal ligation?

Dr. Alex Pastuszak is a urologist and a fertility expert at University of Utah Health. What is your take on this question, tubal ligation or a vasectomy?

Dr. Pastuszak: So, Scott, I'm going to come right out and say that I would be strongly in favor of the vasectomy.

Interviewer: All right. But that's what you do, so I would expect that. Do you have some more support for it?

Dr. Pastuszak: Right, yeah. So, no, this has nothing to do with my pocket.

Interviewer: Okay.

Dr. Pastuszak: But it has everything to do with the safety and the cost of the two procedures relative to one another.

Interviewer: All right. Break that down.

Dr. Pastuszak: So I would tell you that vasectomy is the safer and cheaper option compared to tubal ligation. So let's go ahead and, just like you said, break that down.

So what are the risks of tubal ligation? So we know that, just like a vasectomy, it can include bleeding and infection. Unlike vasectomy really, though, it can include injury to other organs because you're dealing with the tubes that are inside a woman's pelvis, which are really close to a lot of other sensitive structures.

Tubal ligation requires general anesthetic or strong regional, so the anesthesia is already more significant, and the side effects from that can be more significant than that for a vasectomy. And then just in terms of pregnancy itself. So while tubal ligation is just as effective, effectively, as vasectomy, so more than 99 percent, you can still run the risk of an ectopic pregnancy or incomplete closure of fallopian tube which results in pregnancy.

Now, if you counterpoint those against the risks of a vasectomy, then you're really just talking about bleeding, infection, some pain, and maybe failure of that vasectomy as the main risks. Very few.

Interviewer: And recovery is also much quicker for a vasectomy versus tubal ligation.

Dr. Pastuszak: Right. Because tubal ligation, again, you need to make an actual hole in the abdomen, which by surgical standards in this case, it's a minor surgery, but it's still much more major than a vasectomy.

Interviewer: Gotcha. What about the cost? I think this'll be a short conversation because vasectomy is cheaper.

Dr. Pastuszak: Well, it's cheaper, and the reason it's cheaper is just because you can do it in the office under local anesthesia.

Interviewer: Gotcha, gotcha. Is there a reason why a couple might actually want to get a tubal ligation versus a vasectomy in spite of the reasons that you just gave? Is there anything that you're aware of?

Dr. Pastuszak: So unless there's an actual reason that a man cannot physically get a vasectomy, and I can't think of one off the top of my head, they may exist, or the woman is already undergoing another surgical procedure, like a Caesarian section, and at the time of that procedure wants to go ahead and have that tubal ligation, I don't see any reason why a tubal ligation would be or should be preferred over a vasectomy.

Interviewer: The difference is, though, a tubal ligation, a pregnancy could still occur that could be . . .

Dr. Pastuszak: That could be damaging to the woman.

Interviewer: Yes, exactly.

Dr. Pastuszak: In the setting of, say, an ectopic pregnancy.

Interviewer: Which means?

Dr. Pastuszak: Which means that the pregnancy actually starts in the fallopian tube, and since that fallopian tube is now closed, that fertilized egg can't get to the uterus, and so it starts growing in the fallopian tube, which becomes an urgent or emergent surgical situation for the woman.

Interviewer: And, as of right now, there are more tubal ligations than vasectomies in the United States, isn't there?

Dr. Pastuszak: That's right.

Interviewer: Yeah. Even though the other one is the clear winner, it sounds like, to me.

Dr. Pastuszak: Yes.

Interviewer: So, in this conversation, is there anything else that you would recommend for a couple to consider while having it, other than just kind of the facts that you laid out?

Dr. Pastuszak: So I think the couple really does need to have the facts because, you know, guys are (a) afraid. I shouldn't say afraid, but guys do not tend to seek medical care, right. In the US, women are often the driver of their own and their partner's and family's medical care. So that is one barrier to more men having vasectomies. In fact, maybe not most, but a lot of the men I see in my office come because their partner, their female partner asked them to come, not because they have taken the responsibility.

You know, and I would kind of put this back in the men's court just to sort of say, well, how sexy do you think your woman thinks you are, you know, if you're sitting there and pushing back against this vasectomy? What do you think she would think if you said, "Honey, I'm going to go ahead and get this vasectomy, and I'm going to do this for us and for our family"?

Interviewer: Yes, because it's a safer and a more economically cheaper option. That's pretty sexy.

Dr. Pastuszak: I think so.

Interviewer: So I think, finally, if in spite of all this information, a guy still has it in about getting that vasectomy, what would you say at that point? Because, to me, the course of action seems obvious, but men can still be hesitant. What would you say at that point?

Dr. Pastuszak: So I really do think information is power, and I know that men are hesitant. You know, at the very least, go get the facts. Go see somebody who knows what they're talking about this. Go see your local urologist. Just talk to him about it. He's not going to commit you to having a vasectomy in the office that day. It's your decision, but at least know objectively what you're walking into. And I will tell you, most of you will go with the vasectomy after you talk to him.

Announcer: Health information from experts supported by research. From University of Utah Health, this is thescoperadio.com.

Interviewer: A vasectomy is one of the most effective forms of birth control available. But there can naturally be some apprehension about a procedure that's been nicknamed "getting snipped." Joining us is urologist and male fertility specialist, Dr. Alex Pastuszak from University of Utah Health. And in order to help make this a little less scarier procedure, Doctor, I'd like you to give us an overview from preparation to procedure what to expect during and what recovery looks like. But first of all, let's talk about the procedure itself first. So where does it happen? Where does it all start?

Dr. Pastuszak: Yeah, great question, Scott. So a vasectomy is one of the easiest procedures that anybody can undergo. We either do it in the clinic or in an operating room as a day surgery. So it's very simple.

Interviewer: All right, a very simple operation, which is fantastic. What exactly happens? Now, again, there's that getting snipped thing, which brings up visuals that I don't want to talk about. But it's nothing like that actually. It's very non-invasive.

Dr. Pastuszak: No, exactly. I mean, we make one or two very small holes in your scrotal skin, and we just pluck your vas up. We'll clip it. We'll cut it, make sure the two ends don't come back together, and then we'll put it right back. All of that takes anywhere from 15 to 40 minutes.

Interviewer: So actually, probably preparing for and recovering from it takes a lot longer than the surgery. I mean . . .

Dr. Pastuszak: That's right.

Interviewer: You'll probably spend more time in the waiting room than you will actually getting the procedure done.

Dr. Pastuszak: Absolutely. I actually tell guys to budget about an hour, an hour and a half. And as I just told you, a minority of that is actually spent doing the procedure.

Interviewer: A lot of guys think it's kind of painful. So it does use local anesthetic, which is another advantage, right? You're not completely going under. It's just in the area, like if you went to the dentist, for example, and had a tooth extracted.

Dr. Pastuszak: That's right, and that's part of what makes it really safe. And a lot of guys come in very anxious about it. But we give them some medication to relax ahead of time. And like you already said, they get some local anesthetic. At the end of it, most of them ask me, "Why was I so anxious? I shouldn't have."

Interviewer: Yeah, I got you. And so I guess I'm a little anxious about the fact I'd be awake during this procedure, right? So should I be concerned about that, or how do you kind of alleviate, you know, that stress?

Dr. Pastuszak: Not at all. Well, usually, guys are actually pretty relaxed by that point.

Interviewer: From the medication. Okay.

Dr. Pastuszak: From the medication. But if they're not, please bring your iPad, bring your iPod, bring your iPhone or your Android, listen to some music. And, you know, you should expect to have very professional, courteous staff. They'll help laugh you up during the procedure, too, if you're anxious. We're good at that.

Interviewer: Okay. So the actual procedure, pretty painless. How do you prepare for the operation? So, you know, it only takes 15 minutes there. But what do I need to do before I come in?

Dr. Pastuszak: Well, so you should bring some tight-fitting underwear or a jockstrap because you're going to leave with your scrotum supported and you're going to want to have that for the following week just to sort of prevent your boys from jumping up and down and causing any undue discomfort. You should come in with a clean genital area. We don't necessarily require that you shave. But if you'd like to, you can do that the day of, and we'll do any sort of trimming that we need to in the clinic. And you definitely need to bring someone to drive you home because, like I said, these relaxing medications will basically be like drinking two or three martinis.

Interviewer: Okay. So I got you. What about any sort of medications or anything like that? Do I need to worry about that before surgery?

Dr. Pastuszak: Yeah. We don't want you to be on any anticoagulants. So if you take aspirin regularly, I would stay off of it for about a week. If you take any other prescription medications that would thin your blood, you should also make sure that the doctor who prescribed that is okay that you're off that. But I would be off that for a week. And also fish oil. A lot of guys don't realize that fish oil is an anticoagulant. So I would not take that for at least a few days to a week before the procedure.

Interviewer: What about after the procedure?

Dr. Pastuszak: So these are going to be the best couple of days of your life because . . .

Interviewer: That's what I hear. Pick something to binge-watch.

Dr. Pastuszak: Exactly. No, we don't want you being a complete couch potato, but you kind of have, hopefully, free reign in the house depending your partner. We do want you to rest. No real strenuous activity for three to five days. It's a great idea to buy a bag of frozen peas. In fact, some of my colleagues have branded ones that you put on your scrotum and keep them there not enough to freeze your boys, but just enough to kind of keep the discomfort at bay.

It really only takes a few days to heal from this. The discomfort is transitory. It'll be there for a few days to a week, but it's very minor, and you'll be back up and running before you know it. Point of note, you do want to get up and walk around while you're resting. You don't want to be a complete couch potato because you don't want blood clots in your legs. But sack out for a little bit.

Interviewer: All right. And how long until I'm back to work? So I get the procedure. I go home on, like, say, a Monday. When can I expect to go back to work?

Dr. Pastuszak: Yeah, that's a great question. So, basically, we don't want you lifting anything heavy for three to five days. So depending on what you do, just be aware of that, you know. If you're a guy at a factory who lifts 50-pound boxes every day, desk duty for a few days.

Interviewer: Got you.

Dr. Pastuszak: If you're, you know, a corporate executive, lawyer, doctor who just kind of pushes pencils or stands and does surgery, a day or two should be fine.

Interviewer: All right. And when will the patient know that the procedure was actually effective because it's not immediate?

Dr. Pastuszak: Right. So it takes your body three months to make sperm. So we only know that that tube is occluded with no sperm coming out three or more months after your vasectomy. Also, keep in mind that you need to ejaculate 10 to 20 times to clear the pipes between when you have your vasectomy and when you go in three or more months later to get your semen analysis.

Interviewer: All right, and the great thing about that is this is one of the . . . it might be the only birth control procedure you can test for effectiveness, that's not somebody getting pregnant.

Dr. Pastuszak: That's right. That's right. And, you know, just talking about birth control, you should use a second form of birth control while you're waiting for that three-month period to be over.

Interviewer: Got you. Are there any risks I should be aware of?

Dr. Pastuszak: Yeah. So any procedure comes with risks, but the risks for vasectomy are very minor. And the three main risks include infection, bleeding, and pain in the testicles that is present after the vasectomy itself, or develops weeks to months after the vasectomy itself. All of those risks are less than 1% to 2% of all patients who have a vasectomy.

Interviewer: Wow. So that is about as safe as it gets when you're talking about a surgical procedure, it sounds like.

Dr. Pastuszak: Absolutely. If you want to have a great sex life without worrying about getting your partner pregnant, vasectomy is the way to go.

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.

Interviewer: Six reasons women love men that get a vasectomy. Dr. Alex Pastuszak is a urologist and reproductive expert at University of Utah Health, and he's counseled thousands of patients through this decision. And today we're going to find out the top six reasons that women love men that get a vasectomy. Let's just start with number one.

Dr. Pastuszak: Reason number one, they don't have to think about birth control anymore. I mean, it's one thing less on your to-do list. Instead of having to go get your birth control every month, either from the pharmacy or from your doctor, you've got your guy who's already taken care of it. Once a vasectomy is done and the lab results come back and there's no more sperm, you're good to go.

Interviewer: All right. Yeah, that's awesome, because so often the woman is responsible for birth control, and, you know, even with other long-term options, in three years you've got to go back or whatever. So it's one and done as they say.

Dr. Pastuszak: One and done.

Interviewer: Okay. Six reasons women love men that get a vasectomy, number two.

Dr. Pastuszak: All right. So a vasectomy is really reliable. I mean, just think about the financial and emotional burden that an unplanned pregnancy can have on someone's life. A vasectomy is more than 99 percent effective. It's really only secondary to abstinence, which most couples, once they're in a partner relationship, don't really want to have. You can test to see that it's been effective, and it's going to prevent you from having a pregnancy down the road.

Interviewer: So that reliability, yeah, I mean a financial hardship or a really tough decision could come if you've decided, you know, we're done having children, and then you have to deal with that. So a vasectomy, very reliable. I like that. What about number three on the top six reasons women love men that get vasectomies?

Dr. Pastuszak: Another great reason is that there are no side effects for the woman, and quite honestly there are almost no side effects for the men either. Remember, the risks of side effects are really about in the 1–2 percent range. So other forms of birth control can have significant side effects for women.

Just think about all the hormonal manipulation that all of these birth control options, except tubal ligation, have. And this can leave women feeling awful, gaining weight, and just in general not wanting to continue with that birth control. Why not just one and done it and get that vasectomy?

Interviewer: All right. Six reasons women love men that get a vasectomy, number four.

Dr. Pastuszak: All right. So this kind of following on what I just said about tubal ligation, you don't need a tubal ligation as the female partner if your male partner has gotten a vasectomy. Why is that important? Because vasectomy is just as effective, safer, and cheaper. So why would a woman need to put herself through a more invasive, riskier, and more expensive procedure when a guy can just go ahead and get his done?

Interviewer: All right. And number five on the top six reasons women love men that get a vasectomy?

Dr. Pastuszak: It's a one-time cost. That's it. And it's usually extraordinarily well covered by insurance. Insurance companies don't want people to have babies. They want them to not have babies. So they'll cover this the vast majority of the time. So pay for it once, and that's it, no more ongoing expenses.

Interviewer: All right. And number six and the final reason that women love men that get vasectomies?

Dr. Pastuszak: It makes a man sexier, Scott.

Interviewer: How's that?

Dr. Pastuszak: What is sexier than a man taking responsibility for the family's birth control? I mean, think about it. Women do so much. A woman, in today's day and age, is still very often both a career person as well somebody who takes care of the kids, raises the kids, and runs the household. A guy can step up and do his part. In no way, any evidence that a vasectomy is going to affect a man's masculinity.

You know, there's

• no impact on testosterone,
• no impact on sexual function,
• no impact on an ejaculatory function,
• no impact on cancer risk,
• etc., etc.

There is absolutely zero reason why a man shouldn't get a vasectomy and be rewarded by being that guy who steps up.

Interviewer: How should a woman bring this topic up in a way that a man might be more open to it if he initially is not? Like if there's a woman listening, that's like, "I don't know if my husband is going to buy into this," and she's already laid out it's going to make you sexier, is there anything else that you would recommend?

Dr. Pastuszak: So I would find that a very compelling reason, but . . .

Interviewer: Yeah, I would think so. I think we should be done really, but, you know, maybe there's that one stubborn guy out there, because, you know, we do exist.

Dr. Pastuszak: You know, it may be a process. You know, but ultimately knowledge is power. I think the facts speak for themselves, and, you know, quite honestly, like getting a man in front of somebody who can actually tell him what the experience is going to be like, either somebody who's had a vasectomy or a urologist who does these day in and day out, is a start.

Interviewer: Got you. What's the next step after you get that buy-in from your man?

Dr. Pastuszak: Go see your urologist. Go see somebody who can give you the facts.