Welcome to the Hey Mami podcast!

Our guest today is one of our favorite people, Dr. Geo Espinosa: a Naturopathic Functional Medicine doctor who is recognized as an authority in Urology and Men’s health. 

He is faculty in Urology at New York University Langone Health and faculty for the Institute for Functional Medicine. 

Dr. Geo is the first naturopathic physician to complete an internship, residency, and fellowship in urology at a conventional medical institution at Columbia University in New York.  

As an avid researcher and writer, Dr. Geo has authored numerous scientific papers and books.

He lectures internationally on the application of science-based holistic treatments for urological conditions.

Or listen on Apple Podcasts | Spotify | Stitcher | TuneIn | YouTube

In today’s episode we are talking about male fertility and sperm health.

Male fertility issues contribute to about 50% of all infertility cases. 

While couples tend to focus most on the mother’s health, the father’s health has just as much bearing on a healthy conception and pregnancy.

So ladies, this should take a little pressure off of you! And for you guys, this is a golden opportunity to optimize your fertility.

Highlights:

• More information about Dr. Geo
• Why it’s important for men to know about their fertility
• Why erectile dysfunction is not just about testosterone
• The impacts of porn on erectile dysfunction
• How can men optimize their fertility?
• What is the association between heavy metals and male infertility?
• What is a preconception detox?

Important Links

Find Dr. Geo online

Quotes

“Many men just are incapable of getting an erection or getting an erection satisfactory enough to have intercourse or to have intercourse and then keep erect while having intercourse.”

“Can you get an erection? And can you sustain an erection as you have intercourse? And can you ejaculate? These things are very important. And how often, right? Because you need to do it with some sort of frequency for fertility to be successful, of course, when the partner’s ovulating.”

004: How Can A Man Increase His Fertility? w/ Geo Espinosa, ND TRANSCRIPT

Dr. Carrasco:                      Welcome back to the Hey Mami podcast. In today’s episode, we are talking all about male fertility and sperm health. Male fertility issues contribute to about 50% of all infertility cases, and while couples tend to focus most on the mother’s health, the father’s health has just as much bearing on a healthy conception and pregnancy. So, ladies, this should take a little pressure off of you and for you guys out there, this is a golden opportunity to optimize your fertility. Our guest today is one of our very favorite people, Dr. Geo Espinoza, he is a naturopathic functional medicine doctor who is recognized as an authority in urology and men’s health.

Dr. Carrasco:                      He is faculty in urology at NYU’s Langone Health and faculty for the Institute of functional medicine. He is the first naturopathic physician to complete an internship, residency and fellowship in urology at a conventional medical institution at Columbia university in New York. He is also an avid researcher and writer and Dr. Geo has authored numerous scientific papers and books. He lectures internationally on the application of science-based holistic treatments for urological conditions. So thank you for being here, Dr. Geo, it is such a pleasure.

Dr. Espinosa:                      Such a pleasure for me, Alex, always a pleasure to connect with you and share some good information to your audience. Even if your audience are primarily females, they’re going to learn a lot about their partner’s health, I’ll tell you that much.

Dr. Carrasco:                      Well, in our practices, Christine and I both see a lot of patients through the mommyhood spectrum and we see a lot of women coming in for preconception health, and they’re very, very hyped up and concerned about their health issues. But then a lot of times the husbands don’t tag along or it’s more of an afterthought. And so since their issues can also play such a big role in fertility, what we really want to talk about is how can men support their health. But if you want to start by just kind of talking a little bit more about yourself and what you do and… then we can go from there.

Dr. Espinosa:                      Well, thank you. I mean, look, there’s not, it’s hard for me to talk about myself. I could get one of my kids, I’m in my home office, they’ll talk about me plenty if you’d like. Let’s see, well as you mentioned in the intro, I specialize pretty much a 100% in men’s health… Excuse me, I’m sorry.

Dr. Carrasco:                      God bless you.

Dr. Espinosa:                      Thank you. Pretty much a 100% in men’s health, I do a little bit of functional urology for females with bladder issues, but the bulk of my practice is men’s health and so I deal a decent amount with male infertility. And I am a faculty at NYU, if you mentioned, and it’s just great to have this specialty. People always ask me how did that happen? Are you wrong? No one really does urology and no one really does just men’s health.

Dr. Espinosa:                      It just came to me, it wasn’t like I was seeking out to be this male health expert, it just sort of came to me I didn’t go to it. And I paid attention, it’s all that happened. I was resistant initially because everybody’s frowned upon it, what are you doing that for? I mean, men don’t go see doctors, they will summit. I don’t know. First of all, I was intrigued and very curious about just how my body functioned, right, as a man. And then I was very intrigued by certain things that women don’t have that men have. Right? So prostate, a penis. I just gave a talk on the erectile dysfunction in the conference of naturopathic medicine for my 15 years experience. It was like, I was fascinated to learn that the first person to actually write about the fact that an erection happens because of blood flow to the penis was Leonardo da Vinci.

Dr. Maren:                          Oh, wow.

Dr. Espinosa:                      The very first person. Before that, they thought it was the air or the vital spirits or things like that that Leonardo da Vinci, by opening up cadavers. So that kind of stuff just, quite honest, he just fascinates me. And essentially I was… Semen, all the things that men… Testosterone, the women of course have testosterone, but men have like 20 times more. Those things of what makes us different, particularly from a male perspective, just that level of curiosity is insatiable. And if you were to look in my office, I won’t show you guys, but I have all kinds of phallic symbols and things. You would think I’m a really weird guy and prostate stuff all over the place, and that’s it, that’s the story. I’m really fascinated with this kind of work and I think it’s very important to help men live longer, live better and achieve the things they want to do including fertility.

Dr. Maren:                          Yeah.

Dr. Carrasco:                      Well, diving into that, I know it’s a broad topic, but can we just start with maybe top tips that you would recommend for men to optimize their fertility and we can dive into, kind of, all the nuances of that as well.

Dr. Espinosa:                      Yeah. Well, before we do that, I want to reaffirm what you’ve mentioned, that 50% of men are involved in that infertility process, and that’s significant. And it used to be thought that “Hey, no, that’s a woman [inaudible 00:05:25] it’s female issue, that’s females 80% of the time” absolutely not. Right? So what I find is, and typically with my, I could tell you that, with my patient population, let’s say with prostate problems, when they subjectively tell me “Hey, I’m getting better” that’s sort of good enough for me. Yeah we look at PSA, we look at numbers, but man, I’m getting better from the, say, prostititus or I urinate better. That’s great.

Dr. Espinosa:                      And with male infertility, I can say with a high level of certainty, these guys, we can, we quantify that, right? So we do a baseline semen analysis and you see that their numbers are off or how the semen looks is not perfect or the quality of the semen is not good. And we can see that, with the use of functional medicine and then we do a semen analysis, that their semen gets healthy and the numbers go up and all these wonderful, they become normal from that perspective. So, it’s important for any family that’s taking, any couple that’s taking a while to get fertile…

Dr. Espinosa:                      I’m kind of chuckling here as reminds me of last week, I have this patient comes in and he says “I think I have a issue with fertility” okay, no problem. So, he says “have you… “, so we started doing the visit and I ask some questions and he says “I have three kids. My wife just wants a fourth. And she just thinks that it’s me” what? I have three kids, you have three kids.

Dr. Maren:                          Yeah, I have three kids, we all got three kids.

Dr. Carrasco:                      Christine does too [crosstalk 00:07:14]

Dr. Espinosa:                      So, I’m like “Alright. Before we do any analysis, let’s just talk a little bit, let’s make sure this is exactly what you want.” So, these are the types of things I see, it’s not infrequent. Looking for their fourth kid. So, you do a semen analysis, you check their hormones and things like that to make sure their testosterone levels aren’t, so testosterone is a very important component to fertility, male fertility. And testosterone was involved in the process, it stimulates not only the Leydig cells of the testicles, which then… I’m sorry, LH stimulates Leydig cells of the testicles to produce testosterone. Very important cause now testosterone is involved in tissue health of the penis and is also involved in the Sertoli cells of the testicles to produce semen. So having healthy testosterone levels is actually very important.

Dr. Espinosa:                      So we look at those kinds of things. We look at metals and things that might be interfering with that process. And then we put them on a protocol. So, what are maybe some of the top things that men should do? Right? To improve their abilities to be fertile. Number one, well to prioritize them is a little bit tricky, but the first thing that needs to happen, of course, is for them to be able to get an erection. And that’s, of course, I mean, are you kidding me? That’s a no brainer. Yeah, of course you have to get it. No, no, that’s actually very important because many men just are incapable of getting an erection or getting an erection satisfactory enough to have intercourse or to have intercourse and then keep erect while having intercourse.

Dr. Espinosa:                      So there’s a lot of male sexual health issues that are occurring, that I think is very important for practitioners to ask if they’re coming in for male infertility. The very simple question of can you get an erection? And can you sustain an erection as you have intercourse? And can you ejaculate? These things are very important. And how often, right? Because you need to do it with some sort of frequency for fertility to be successful, of course, when the partner’s ovulating. So, that’s very important.

Dr. Espinosa:                      I had another patient recently who had sexual anhedonia. Here we go. I mean, what are… Sexual. So what is that? That’s, anhedonia is a situation where you usually get pleasure from a certain activity or something, and now you do that activity or you have that food or that drink or whatever, and you no longer get that pleasure, it’s like, it feels like nothing. So sexual anhedonia for, male sexual anhedonia is a man gets an erection, has intercourse, ejaculates, but no orgasm. So I think there’s a lot of intricacies with, it’s not as simple as just get the semen.

Dr. Carrasco:                      It’s so nuanced. And I would say probably a lot of men don’t just give that information out easily.

Dr. Espinosa:                      I think it behooves the practitioner to ask those questions. And it behooves your practitioner to just download a SHIM score, so Sexual Inventory Health score for Men, it’s a simple Google S H I M, PDF comes up and give that to them so you can quantify their sexual health on a scale of one to 25. Right? So, if they are a 15, well their sexual health is not that great, so that may be part of the problem. So what I’m trying to say is beyond just healthy semen, is what’s your ability of even getting an erection to have a healthy intercourse with your partner?

Dr. Maren:                          Right, yeah. For sure, stage one. Let me ask you, what are the primary, I mean most people think erectile dysfunction is a problem with testosterone, but can you talk a little bit about the psychological piece, the vascular piece, the hormone piece?

Dr. Espinosa:                      Boy. So I just gave a 60 minute lecture on just that topic and I guess I need to give you the two minute version of that. So testosterone is… So what’s the number one part, so what’s the number one thing that I’m asking in my office to a, let’s say, a 32 year old guy that’s coming in for either male infertility or ED. I’m asking them about how much porn they’re watching.

Dr. Carrasco:                      Yeah, absolutely.

Dr. Espinosa:                      Okay? So there’s a lot of sexual dysfunction that’s occurring from the fact that they’re watching way too much porn. And that’s just the psychological aspect, psychological impact of watching porn. That’s negative, it’s not positive at all.

Dr. Maren:                          That’s the anhedonia piece.

Dr. Carrasco:                      Yeah.

Dr. Espinosa:                      Perhaps, perhaps in certain cases, or in other cases, it’s just ED. No erection or getting an erection and it gets flaccid in the middle of intercourse before ejaculating. So that happens quite a bit. So testosterone is other components. So if there is this scenario of I get an erection, I have intercourse, but in the middle of intercourse kind of goes flacid, oftentimes that could be psychological, of course. And there’s always psychological aspects of male sexual dysfunction, it’s about 50% of the issue, always. Performance anxiety, right? It’s a real thing. So there’s several things that need to happen for a man to perform successfully, a lot of pathways needs to function without obstruction. One of them is the nervous system, the autonomic nervous system and brain to penis, right? So that flow needs to happen unobstructedly, right?

Dr. Espinosa:                      Sorry. That flow needs to happen unobstructedly. So there’s injury, there’s MS and things like that, that’ll effect. Right? The other thing is circulation, right? Vasculature, things need to flow from a blood circulatory perspective. If there was any obstructions, any plaques, the helicine arteries, the artery that supplies the blood to the Corpus cavernosum of the penis. So these are the two cylinders called the Corpus cavernosum, and that’s where the blood flow goes where men get an erection. But they’re very small, only like two millimeters big, and they can easily get obstructed. So these kinds of things, so all these things need to be evaluated. Right? But in a nutshell, no pun intended, always a lot of puns in this conversation, porn watching is an important question to ask.

Dr. Maren:                          That’s a good insight. One more. I mean, I think there’s a lot of people with type two diabetes. So how does that influence somebody’s ability get an erection?

Dr. Espinosa:                      Its the metabolic syndrome in general, metabolic syndrome. You have to rule out the metabolic syndrome for sure. What would that [crosstalk 00:14:29].

Dr. Carrasco:                      Even Prediabetes I’d say.

Dr. Espinosa:                      100%. So sometimes it has a, I mean, a cigarette smoking, again, we could have a full conversation with just ED, but you have to rule out metabolic syndrome for sure. My patient population… But here’s the deal, metabolic syndrome is not so much the issue as it relates to men that are 40 years old or younger. It’s a more of an issue of men that are 50 and above. So if the man is 32 years old, 31 years old, yeah, of course it could be a metabolic syndrome, we see this in our offices with younger men, but that may not be the primary thing. The primary thing is psychological, porn watching, yeah understand a 31 year old has had a iPhone or a tablet in his hand since he was already nine years old. Right? So they’ve had easy access to porn.

Dr. Espinosa:                      When you and I were growing up. When you and I wanted to watch porn, we needed to go to blockbuster, corner section XXX nice and big, you’re kind of shy. And then if you actually still got the videos in a paper bag and there’s a lot of work. Now it’s easy, it’s been easy for the last 25 years. So, I would say in a man that’s younger that has performance anxiety, it’s porn, watching, it’s stress, adrenal exhaustion, those kinds of things.

Dr. Carrasco:                      And so, it’s interesting because a lot of men now are becoming fathers at an older age. So in my practice, I see a lot of people that are trying to become pregnant in their middle to late 30s, even early 40s, and a lot of time, their partners are in their forties as well. So, I guess from a kind of optimization perspective, what are like some things that people can do today or they can start doing immediately to support their male fertility.

Dr. Espinosa:                      Right. So I would say rather than shooting blankly, another pun, they should get a semen analysis, make sure they need a semen analysis, that’s their baseline. Then just in general, one of the things they could do, they should do, is keep cell phones away from their front pocket. Okay. Keep cell phones away from their front pocket. Right? So cell phones near the pelvic area starts having a negative effect on semen production, quality of semen. Right? So most guys you and I know sometimes they keep their cell phones in their front pocket. That’s very important. The other thing that’s, so and then you want to look at stress in the adrenals. So I’m a huge fan of adaptogens actually ashwagandha has shown to improve semen quality and semen numbers and semen health in men in randomized trials. ashwagandha can potentially also increase testosterone, as well, to normal, healthy levels.

Dr. Espinosa:                      So ashwagandha is an excellent herb that you want to use. I love all other adaptogens, the rhodiolas and cordyseps, those things are very, very good. But that’s always in a formula that I would prescribe is ashwagandha. Balanced antioxidants, so over production of free radicals starts harming certain cells in a male body, including the Sertoli cells that are involved in sperm production, semen production. So that’s very important. Good antioxidants, your C’s, your Alpha Lipoic acid, your Co Q10 actually, Ubiquinol has shown to help men with male infertility quite well, actually. So Ubiquinol, if I have to choose, if you go in strictly science-based then I’ll have to choose Ubiquinol as the main anti-oxidant to choose. And the last thing is to eat organically. There’s studies that show that when they eat a lot of foods, even if they’re healthy foods and they’re not organic, that negatively impacts male fertility. So eating organic foods, as opposed to foods filled with pesticides and so forth.

Dr. Carrasco:                      You said that the really, the first thing to do is to test. And we always talk about how testing is best because then you can’t master what you don’t measure. But, you know for a man, kind of what would the progression be like? Maybe a couple just wants to get pregnant and they want to optimize their fertility without, and they don’t suspect that there’s any issues in sperm health, but they just want to optimize their health so that they have potentially great outcome. What labs would you look at first? And then when would you go to a semen analysis?

Dr. Espinosa:                      So the basic lab, so I like labs. So I, typically they’re coming to me for male infertility, there is no option here. You have to do a semen analysis. No, they may be coming to me for other things, ED, oh, and by the way, I also want to get pregnant. Okay. That may be the approach is slightly different depending on how much of an interest that really is for them to be fertile. And the other thing is I like to order labs that can, I can have a conversation with either conventional practitioners. And then thirdly is, if I order too many labs that are a huge out of pocket costs, then I want to be sensitive to that as well. Right? So I’m careful and I’m sensitive to all those things. So the main labs that I would order is testosterone, free testosterone, estradiol, HFSH, see making sure that that network is functioning properly. Right? I like to, if I can do a cortisol test, like the DUTCH test, that includes a cortisol test and see what their metabolites are.

Dr. Espinosa:                      And so those are the two. And if I can, New York is very tough, I have a practice in Connecticut as well, I would like to order a metals test. So you want to make sure that those metals mercury, cadmium and things like that are much lower, so that the body’s able to detoxify and so forth. I would say in that order, that’s what I’d do. But it would start, if they’re coming to me for male infertility, then they need a semen analysis.

Dr. Carrasco:                      Yeah. That’s great [crosstalk 00:21:18]

Dr. Maren:                          What is the association between heavy metals and male infertility? Where do you see that problem come into play?

Dr. Espinosa:                      Yeah. I just, it just seems that it stops the process, it’s an obstacle to general good health, right? Brain function and things like that. But certainly even to semen production itself, I think that’s just an obstructive, I mean, it just sort of… The general idea and the philosophy of naturopathic medicine is take the junk out, put good things in, get out of the way. Right? So if there are metals, get them out all right, or the metals are too high, get them out. So I look into their fish intake and things like that.

Dr. Maren:                          Yeah. I see a lot of metals come up with people who have mitochondrial issues and energy production issues.

Dr. Espinosa:                      Yeah. I don’t know that there are, I mean, I love this whole mitochondrial health thing, I mean, I think that if you want to get the most bang for your buck [inaudible 00:22:18] you can treat the mitochondria. Almost on certainly the type of things that I see from the urological male standpoint, you got to do well. Co Q10 right? That’s great for mitochondrial health. So I think that, I’ve gotten, I think the last five years or so, I’ve been a huge fan of that approach. To me, even more than genetics, right? Because genetics, the individualization process, at least in my practice, I could do similar things for different urological conditions up to 80% of the times I’ll get a good result. There’s nuances that occur that are very [inaudible 00:22:54]. If you treat the mitochondria, everybody kind of is, you don’t, there’re less nuances and more benefit. And certainly from male infertility perspective, no question.

Dr. Maren:                          And then when you see testosterone levels, people might have their spouse or their partner go and test their testosterone, but there’s this huge range, right? From 250 to a 1000 so what are you generally looking for in a 30 year old kind of guy? Cause it’s like, 251 you’re normal

Dr. Espinosa:                      Correct. So I’ve had to modify my ranges a little bit. Here’s why. I suspect, and in theory, based on literature, as it relates to COVID-19 and viral infections, what we’re all seeing is that men are more predisposed to being in critical care from COVID-19 and even dying from COVID-19. This is not just COVID-19, this is historically men, whenever there’s been an epidemic or pandemic, a viral pandemic men have suffered more. So this has always been the case. And part of the theory is that testosterone while it’s good, important, and important for male fertility, it also weakens the immune system versus estrogen that actually strengthens the immune system. Thus, women have way more autoimmune diseases than men. Right? If it’s overly active. So I’ve kind of had to look at that and say, man I don’t know that total testosterone of 1100 number one is necessary, number two is even healthy. So that’s kind of how I look at it.

Dr. Espinosa:                      Now. So in terms of total testosterone, what I look out for, so testosterone is also important because as men age, let’s say that you have a 56 year old man that remarried, and this happens a lot, this causes a lot of stress amongst couples I find in my practice, right? So the 56 year old guy he’s been divorced for six years now has the 28 year old wife and she’s like “no, I’m going to get pregnant. If not, I’m leaving.” And he’s like “well, I don’t want any more kids.” And they were in this give and take situation and I’m in the middle to listen. All I can do is help this guy become fertile if that’s what he wants. Absolutely. I have to step out so many times out of my office “You guys discuss, I’ll be right back. You guys talk about this” But anyway, these are real scenarios. And so you do want healthy testosterone levels as we said before, it’s important for penile tissue and things like that.

Dr. Espinosa:                      But as men age, one of the things they complain about is that their semen is more liquidy and less white and less substance in there. Right? And that has to do with lower testosterone levels. Right? So it’s less healthy. There again, we still perform a semen analysis and to kind of, really see. But that’s one of the things that happened with men, whether their semen is kind of less substance in their semen as they age. So what are the numbers? What’s the normal value anywhere from 300 to a thousand. So that’s a wide range, right?

Dr. Espinosa:                      So you can have a guy with 500 that their ratios are good too. So it’s not that their testosterone is a decent amount, I mean, it’s not super high, but their ratio between total testosterone and SHBG is good. The ratio between testosterone and estradiol is good. The ratio between testosterone and DHT is good, right? As opposed to a guy where testosterone 500, estradiol is like 40, now the number’s too high in a man and DHT is too high, so it’s converting too much to other things. So that’s a different scenario. So it really depends on the scenario. I, I think a good number is about 600 to 700, as long as those other ratios are appropriate.

Dr. Maren:                          Yeah. That’s super interesting, I love that piece about super high testosterone cause I didn’t know that. Glad to know.

Dr. Espinosa:                      And I have guys that are on testosterone for sure. And look, it’s just more of a distraction. I just don’t know why, I mean, I know that as men get older, there’s a psychological benefit, both with cognition, not just psychological, but also with how they feel and they want to feel like you’re 25 again. And I’m 47 now, I don’t want to feel like I’m 25, I want to feel like I’m 47. Actually, I’m very happy with my 47 year old body and mind. So it becomes a little bit more of a distraction. It becomes more of a, they kind of interrupt conversations more often, it becomes more of, a term that I necessarily don’t like is male toxicity, but if there’s any male toxicity type of thing, it would be in a man that’s, where their testosterone is over a thousand and they just can’t control themself. It’s just not a, I don’t find it to be a healthy thing necessarily.

Dr. Carrasco:                      Well, I have another question. So a lot of our, kind of, preconception listeners are interested in doing like a preconception detox. And so how do you feel about that for a couple to do together? How would a man kind of support himself in that perspective? Or is that unnecessary?

Dr. Espinosa:                      It’s… I think it’s a fine thing. I think it’s a fine thing for men to participate in that. I always look in the dynamic of a couple, right? So I like to see, I kind of observe the first 15 minutes of the visit, or now a telehealth visit cause that’s what we’re doing a lot of now, it’s kind of, I’m trying to figure out that relationship and if you’re paying attention, it’s not that difficult. So sometimes they are willing and want to do things together, and sometimes they’re like “no, you do your thing. I do my thing and we’ll reconnect and hopefully we make things happen.”

Dr. Espinosa:                      So I think that it depends on, but I think just purely from a biological and just physiological perspective, detoxing is a great thing, right? Again, take the crap out of the body, but put good things in the body and get out of the way that’s kind of the premise of that. So I think it’s a great thing to do. I don’t necessarily do a deep detox protocol with my male patients, although one could make the argument that just the way I change your diet and ask them to exercise and sleep better and certain supplements, one can make the argument that that’s actually happening.

Dr. Carrasco:                      Yeah. Just not labeled. Is that…

Dr. Espinosa:                      Correct.

Dr. Maren:                          Is there a timeline? For women, we kind of tell them “well, you really shouldn’t detox if you’re three months within this point where you’re going to try to conceive” what about with men and with sperm turnover and sperm health?

Dr. Espinosa:                      If there is a timeline I’m not aware of it. Yeah. If there is a timeline, I’m not aware of it. I think that from that perspective, I’ve been so far… The only experience I really have with, at this point, for the last 15 years with treating women other than some urological issues is with my daughters. So they’re teenagers now. So I see what’s happening, I’m like, “oh, that’s what’s happening now. Okay.” And so they’re teenagers, they’re only one year apart. So you can see differences in their hormones right away. Aside from the temples that are growing on their face, the way they respond to certain things like “oh” it’s almost like I’m just in a corner with some popcorn, just observing. Wow. Okay. I see, I remember this. I remember studying this 20 years ago. So that’s the extent of my experience at this point with female hormones.

Dr. Carrasco:                      Well, that’s good to know. Well, let’s see, Christine, what do you think? Any other questions before we wrap up?

Dr. Maren:                          I think the one remaining one is if our listeners have a partner or spouse and just in terms of general lifestyle things, you mentioned exercise and better sleep, what are the kinds of things they can do besides that and stop smoking? Right? Like what do you, what do we need to tell our men to do?

Dr. Carrasco:                      What about hot tubs?

Dr. Espinosa:                      Yeah. So no hot tubs, nothing that compresses their testicles to their body because it’s different temperatures there and that’s mother nature. So temperature around the testicle area needs to be a little bit cooler than inside the body. So no hot tubs. So that’s important. If they are on testosterone, by the way that, so actually let’s talk about this for a second. So let’s just say you do an evaluation, their testosterone is indeed low, right? You could do several things, so you could just do a detox protocol that includes better sleep because that’ll help with their testosterone, includes ashwagandha because that will help and so forth, and then retest.

Dr. Espinosa:                      You could also, rather than, giving them exogenous testosterone, TCP or anything, that’s not the right thing to do, but clomiphene is actually, so you can give him whatever 25 milligrams of clomiphene a day and that’s actually a very scientific clinical and a responsible approach to getting their testosterone levels up and actually helping them get more fertile in a very gentle way from just a conventional standpoint. So clomiphene is very good for men in that scenario. So that would be the main thing that I would consider if their C levels are low.

Dr. Carrasco:                      And then what about weightlifting?

Dr. Espinosa:                      So weightlifting, a side that is a bias of mine cause I do a lot of it. It’s the main, if they’re interested in… So my protocol, so I treat testosterone a 100% naturally. I mean, every now and then I say they need clomiphene I give them clomiphene or actually exogenous testosterone, but that’s an infrequent scenario every now and then I give clomiphene. Part of the protocol requires weightlifting, and not running marathons, not ultra, weightlifting. In fact, I struggled with these marathon ultra endurance athletes because they like their sport. And if they want to be fertile, their adrenal glands are shot because it’s just so much stress to the body and that’s causing testosterone to be low and that’s causing, that’s giving, that’s a domino effect of other issues that come along, particularly they want to be fertile.

Dr. Espinosa:                      So it’s not the best sport to do. Even CrossFit or anything like that, hat’s fine but it is addictive so you want to do it more, you want to improve. So the more, it’s always the poison is in the dose. Right? So I like them to do weightlifting and, and just, they’re not going to get the high they get from an endurance activity, but they’re going to get more benefit just from a growth hormone and testosterone aspect.

Dr. Carrasco:                      Yeah. That’s great info-

Dr. Espinosa:                      You know, sleeping is very important. And I just want to emphasize that for all these things that we’re trying to accomplish with these male infertile men, measuring sleep with any wearable, I have mine [crosstalk 00:34:35]

Dr. Maren:                          We all have it. That’s so funny, we are like represent with our Oura rings here. And I just got one for my husband too, and it’s been fascinating for him to tap into his sleep.

Dr. Espinosa:                      Yep. 100%. And not only, so your husband, like most men, they care about performance. And so it gives you your level of readiness, right. Its like [crosstalk 00:35:00] day I’m like “oh man, I’m not really ready for that meeting at one o’clock according to my read, my Oura ring read”. And it’s important. And now I have all my patients using it because no one really knows how well they sleep. Right? So a lot of men who have a lot of things going on, they get through the day through, by getting a lot of adrenaline and getting things done. But it’s not because they are rested or they have real, what I call, real energy, just adrenaline energy, it’s continuous.

Dr. Espinosa:                      And then you go have a date with your husband and you go to the movies and he’s cranking out after the first 30 minutes. And that’s because he doesn’t have real energy, he has adrenaline energy. So I like the Oura ring because it tells you the amount of time that you’re actually sleeping, not the amount of time that you’re in bed plus deep sleep and all these things. So measuring those types of things, I find really useful. And I think certainly for men interested in fertility,

Dr. Carrasco:                      Yeah. It’s almost like for women wearing an Ava bracelet. I mean, I think the Oura ring gives you very similar information. Cause you can see on your cycle when your heart rate goes up and your body temperature goes up a little bit. And it’s very interesting in females to see the cyclic kind of thing. But I’m sure in males too, I mean, it’s the equivalent thing where you can just sort of hack it and really understand what’s happening with your biology.

Dr. Espinosa:                      Correct,. And you can behavioral changes, right. So if you had, I don’t know, four glasses of wine and they’d be four versus one, you could see the difference perhaps. My poor wife, so we, I also use a Fitbit. I do a lot of wearables and my wife used a Fitbit to measure her sleep. And for women, she’s premenopausal and man, that thing that grabbed us all over the place throughout the night, it’s like there again, I’m learning through my daughters, my wife, what’s going on with that. So I know, I look at her Fitbit score to know how I’m going to approach the day with her [inaudible 00:37:03].

Dr. Carrasco:                      What is her readiness score?

Dr. Espinosa:                      There’s no readiness a Fitbit, but that, I’m trying to figure a way that says. And I’m like, all right, the readiness is not high, I’m going to be very careful with what I say. I’m going to measure my words, not ask for too much. Have a conversation with the kids “hey, today, we’re going to keep low key with mom today, right?”

Dr. Carrasco:                      Yeah. That’s awesome.

Dr. Maren:                          That’s awesome.

Dr. Maren:                          And just a side, quick side note, my Oura ring scores for my sleep have been kind of poor for the last week. And so last night I decided to, it was just the same as all the other days, but I, I added ashwagandha before bed and I had such a great sleep score. So it was just very interesting to kind of play with those things

Dr. Espinosa:                      And you can play with those things and you can see with patients the difference. For example, if you give patients things like melatonin and magnesium at night and things like that, or different formulas that you may like, you can see their scores and see how that changes. So even, for example, there are times where my sleep is like five hours and the total score is not too horrible, because it was an hour and a half of deep and hour and a half of rem. So sometimes, at the end, we still have to get things done and sometimes it’s just not enough time in a day, so we’re all going to break the rules. So sometimes it’s good to know how to best break the rules so that we don’t pay a huge price. And we have a still a decent readiness.

Dr. Carrasco:                      Right? Well, this has been wonderful. Dr. Geo, thank you so much for being with us. And if our listeners are interested with connecting with your work, where can they find you?

Dr. Espinosa:                      So it’s Dr. Geo.com, D-R-G-E-O.com. That’s the best way. And I put up a lot of information there for people.

Dr. Carrasco:                      Yeah. Yeah. Great stuff on your website for sure.

Dr. Maren:                          Awesome, we’re going to send all our men your way.

Dr. Carrasco:                      That’s right.

Dr. Espinosa:                      Including, I write a piece once a year on father’s day on parenting.

Dr. Carrasco an…:            Oh, cool. That’s awesome.

Dr. Espinosa:                      And the last two years has been strictly on, I don’t know. I know you guys have a couple of girls I don’t know if they’re teenagers, but has been on being a father to teenage girls. Very specific.

Dr. Maren:                          My oldest is eight, but she kind of like acts like a teenager [crosstalk 00:39:25].

Dr. Espinosa:                      My oldest is 10 [crosstalk 00:39:25]

Dr. Espinosa:                      Well, you guys had a couple of years and by then I’ll be done with teenage daughters, almost done. I’ve observed closely, I’ve taken close notes and I’ve acted in several ways. So when you’re there, I might have some information.

Dr. Carrasco:                      We’ll definitely reach out. Oh, well thank you so much, Dr.Geo

Dr. Maren:                          Thank you so much.

Dr. Espinosa:                      Alright thanks guys, be well.

Dr. Carrasco an…:            Alright, you too.

Dr. Espinosa:                      Thank you.