Dr. Peter Attia
speaker
5,258 appearances
36 recordings
6 series
first heard Jan 2024
last heard Jun 2025
Dr. Peter Attia’s voice in public audio — every appearance, attributed to the second.
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Appearances
And it looks like it's algebraic. This is incredible. It's easier for me to think about these things graphically than to think that it basically shuts off at about eight hours. So I'll give some more physiology.
And then we checked the first... Sorry, dumb question. Why didn't they just measure the ejaculate? Why did they have to biopsy the testes? I'm not sure. They just wanted to know about spermatogenesis, but we didn't want to biopsy the testes. They actually wanted to torture the guys, but...
So let's now define infertility. We've been using this term quite a bit. I suspect it actually has a formal definition. It's one year of inability to conceive after sex, using sex.
When someone shows up in your office, is it usually after they've gone down the rabbit hole of troubleshooting the female partner, or are people doing this in parallel?
Okay. Let's talk about your workup. What do you do when a guy comes in and what are the things you want to know about him? So getting a guy in is great.
Can you explain what that, we haven't talked about how a vasectomy works and why a guy still ejaculates, but is infertile. Explain what the vas deferens, how the whole thing works in the plumbing. Right. So we didn't answer that question, which was what's the semen consist of?
And it gets forced out with muscular contractions in seconds. Yeah. So therefore, if the vas deferens is clipped... you're getting essentially 90% of the volume. You're just missing the 10% of the volume that contains the payload.
So physical exam, do you need an ultrasound? How are you able to detect if a person is congenitally missing a vas deferens? Pure physical exam. What, you feel it? Mm-hmm. Interesting.
What percentage of men are congenitally missing their VAS? One in 500. One in 500, okay.
Okay, so what's the Venn diagram of cystic fibrosis and congenital lacking vas deferens? The genes for that were discovered.
So in other words, when you identify a man who does not have CF with a congenitally absent vas, there's a very good probability he's a carrier of CF. Yes. And you can usually define it. Which we can genetically test easily.
Cancers, infections, epididymitis. Yeah. Tell me about epididymitis. Obviously, anything that interferes with that section of the journey is going to be critical. Remind me, is it EBV that we typically, or measles, mumps? What's the infection? Mumps.
It's some kind of, there's an open time. So just one more reason why everyone should really get the MMR vaccine when they're a child, notwithstanding the tragedy of children dying from preventable diseases. But this is another non-lethal but significant complication of the mumps. Absolutely.
Meaning the patient that survived Ebola, the virus managed to survive in the testes? Somewhere, but it was transmitted sexually a year later when he was well. When he was asymptomatic. He had already developed immunity.
But in that case, you have to think wherever the virus hung out, it had to be very, very immune privileged. Yep.
What is the phenotype of their sterility? Aside from the presentation that says I can't get someone pregnant. So sterility means no sperm in the semen. And typically if you measured the signals to the testicle. Oh, that's literally what it means. I'm sorry. Okay. So literally no sperm in semen. They stopped. Understood. It's a primary problem.
Classically anabolic steroid users. Yeah, which I want to talk about in detail. Can we go back to semen analysis? You're looking for obviously the count and the motility. What else do you look for? So in the semen analysis, there's several features.
obviously you rattled off a whole bunch of parameters that you can access there, but are there certain null states that don't exist where everything is amazing, but this one thing is horrible? Like, do you see scenarios where everything is remarkable, perfect motility, but bad morphology or perfect morphology? Isolated, isolated. You do see isolated things. Right.
I'm sorry, I'm still confused on that point. Are you saying that you would consider it perfectly normal if only 4% of the sperm are morphologically perfect and 96% are not? And that means the 96% that are not could be pinhead, could be double tail. Amorphous or tapering in it. As a mathematician, that's not a great number, is it? No. If you look at marine species, 99.9 look perfect in the wild.
Yeah. And presumably that's because their environment is so much more hostile. They're doing this all in the ocean. I don't know, but it's amazing that we're that good with the sperm.
Showing 61–80 of 5,258 · page 4 of 263
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