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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.

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.

Interviewer: Kidney stones, could they happen to you? And what can you do to prevent them? We'll examine that next on the scope.

Announcer: Health tips, medical news, research and more, for a happier, healthier life. From University of Utah Health Sciences, this is the scope.

Interviewer: Dr. Gary Faerber is a urologist at the University of Utah Health Care. Dr. Ferber, do you get a lot of patients with kidney stones? I hear it's on the rise like 30% in the last 30 years.

Dr. Faerber: Yes, it is. Absolutely, there's no question about it. And people with kidney stones probably make up a good . . . almost half of my practice.

Interviewer: Wow, you deal with them a lot.

Dr. Faerber: Absolutely. And if you look at urologists across the country, about 20 to 30% of their practice is managing patients with kidney stones. So it's a big, big job for all of us.

Interviewer: So why the increase in the past 30 years? Thirty percent in 30 years, that's quite a bit.

Dr. Faerber: It is. And there probably . . . it's multi-factorial, to be honest with you. I think obviously, one of the reasons why is because Americans tend to be dehydrated. They don't drink enough water.

Interviewer: You're kidding me. You can't go outside without seeing somebody with a water bottle.

Dr. Faerber: I know, and it's crazy. About one in 10 patients are people that are in the United States drink the right amount of water.

Interviewer: Just one in 10?

Dr. Faerber: One in 10.

Interviewer: Okay.

Dr. Faerber: A full quarter percent or a 25% don't drink any water at all in the day.

Interviewer: They're just getting their water from sodas, and juices, and stuff like that?

Dr. Faerber: Right. Which is not a good thing, to honest with you.

Interviewer: So it's . . . dehydration is a big part of it. So just by drinking more water, it helps your system flush that stuff out and prevents it from kind of building up into those stones?

Dr. Faerber: That's absolutely right. If you can recall back to your grade school experiments where you would put the string in a bowl of sugar water and then you'd see the sugar precipitate out on the string. Well, the same thing sort of happens in a kidney. When the water or the urine isn't concentrated, then those crystals can't form. But when urine is concentrated, that's when you get the crystals forming, and then those crystals grow into stones.

Interviewer: Okay. So . . .

Dr. Faerber: Same thing happens.

Interviewer: If I want to prevent kidney stones, drink water. Be sure that I'm getting the right amount. What is the right amount, by the way? We were having a debate about this other day. Is it eight glasses a day?

Dr. Faerber: I tell people six to eight glasses of water a day.

Interviewer: And if that's just a normal person. If you're doing outside stuff sweating a lot, exercising a lot, even more?

Dr. Faerber: You obviously need to drink more. And I think probably a good rule of thumb is that if the urine looks yellow, you're probably not drinking enough. If it's nice and clear, then you're probably just fine.

Interviewer: All right. So what else could cause kidney stones? Like if I'm drinking the right amount of water, am I immune now?

Dr. Faerber: No.

Interviewer: Okay. I've got a better chance, but . . .

Dr. Faerber: You have a better chance. The other thing is that what diet you eat certainly affects your chances of forming kidney stones. The American diet is really conducive to forming kidney stones. We eat way too much salt. We have a lot of animal protein in our diet, and we have a relatively high amount of fats.

Of all those things, probably the most worrisome is the amount of salt that we ingest. The kidneys, when they see all that salt, excrete calcium in the urine, and that calcium in the urine forms kidney stones. Calcium oxalate are the most common kidney stones that we see in the US. So by limiting salt, we can certainly reduce the amount of calcium that you see in the urine.

Interviewer: If I have a relative that had kidney stones, am I my more likely?

Dr. Faerber: Yes. You can't run away from your genes, unfortunately. So . . .

Interviewer: So that's just the way my body works is . . .

Dr. Faerber: It's . . . clearly, there's a significant familial component to the risk of forming kidney stones.

Interviewer: So if you have a family history, then it's really important to watch your diet, drink water.

Dr. Faerber: Yes, absolutely. There is no question about it.

Interviewer: And when you finally find out if you have them, there's no real lead up, is there? You don't . . . there aren't any symptoms that present till the excruciating pain comes along?

Dr. Faerber: Typically, what you describe is the most common thing is that people are perfectly fine, and then they suddenly develop this quite severe flank pain that is really debilitating. If you speak to women who've undergone childbirth and who have also had the unfortunate episode of having a kidney stone, they would say that having a child is much, much easier than trying to pass a kidney stone. So yeah, on a scale of one to 10, with 10 being the worst pain, most people say it's around a 12.

Interviewer: Wow. Other than the pain, and you have to go to the ER to have them removed, can there be long-term damage caused by kidney stones? Because there might be somebody that says, " You know, I really like my energy drinks. I can deal with every few years having a stone, even though they're excruciatingly painful."

Dr. Faerber: Fortunately, the chances of having a permanent injury secondary to the stone are relatively small. Most people, when they're in a significant amount of pain, would like to have the stone removed. Fortunately, most patients who have the typical kidney stone will pass the stone on their own.

It may take some help, but certainly, they can pass it on their own. Those who can't, we have very minimally invasive ways of taking care of those stones. If patients pass them on their own or they're treated effectively, the long-term damage to the kidney is really quite small, which is fortunate.

Interviewer: Is there evidence that supports the correlation with sugary drinks, salt, diet, that sort of thing? Do have like a number that if I have that kind of lifestyle, I've got three X or four X times more chance to get kidney stones?

Dr. Faerber: There are some . . . there are some numbers. The relative risks of those who drink sugary drinks, for example, their risk might be more than . . . more than double. It's really true of those who have a high salt rate intake. Their risk is three to four times that of someone who has a normal intake of sodium. So there are studies that have shown the significant risks of kidney stone formation in patients who eat too much sodium and drink too much soft drinks.

Interviewer: And the more of those things you do, it just keeps building upon that multiplying and multiplying

Dr. Faerber: Right.

Interviewer: So if you drink sugary stuff but, boy, I'm in the sodium and sugary stuff, that just means I have even more of a chance.

Dr. Faerber: That's exactly right. Which factor is the most important is unclear at this point, but certainly, if you have a family history, you're overweight, you drink sugary drinks, high sodium, you're at significant risk of forming a kidney stone.

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