Dr. Peter Attia

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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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The Peter Attia Drive · #351 ‒ Male fertility: optimizing reproductive health, diagnosing and treating infertility, and navigating testosterone replacement therapy | Paul Turek, M.D. · 2 Jun 2025 podcast

But we know that two-tailed sperm have doubled. I mean, it might be the two-tail might not be the worst thing in the world. It's just extra rocket boosters. But what about the pinhead? What does the pinhead imply? Pinhead means there's no nucleus. It's a tail. So that's a true problem.

It's like a little tiny head and moving along. So if you give somebody credit for their two tails, what does your normal go up to from 4%? Oh, it depends. But maybe 20.

I see. So the more homogeneous the failures are, the more likely that you have a clear etiology.

This is the reason why even if you launch a hundred sperm at an egg, it's only one that can get in because the first guy that breaches sets off the calcium channel that shuts the, I mean, the Star Wars space analogies here are just phenomenal. Million years. Million years. No more breaches in the hull.

Is that something that we know the genetic underpinning of? We're getting there.

So it's coming around. Think about that for a second from an evolutionary perspective. That's a problem. That is the single least desirable genetic mutation you could acquire. Yeah, unless you're not making sperm. Yeah. But this is a dead end to the genome. Right. Right. So does that mean it is only an acquired mutation never inherited?

I mean, it can't be inherited presumably unless it's homozygous, but even still.

God, that's just incredible.

All right. So basically just rounding out the semen analysis. History, physical semen analysis. On the semen analysis, what if motility is the problem?

By the way, do you get that analysis the day he's in the clinic with you or is that something you follow up on an appointment with? Pretty much have it in my hand when I see them.

And this is something that's standardized and automated through microfluidics? How is the assay actually done? So the guy ejaculates in a cup, takes it to a lab? Oh, I mean, it used to be done manually. Okay.

Yeah. Given how good AI is at image recognition, this should be a one-foot putt. Yeah. Okay. You mentioned hormones. You were obviously alluding to LH and FSH. What else are you looking at? Testosterone? Right.

Sorry, these men are not making FSH and LH. No. So they have virtually no testosterone. Right. Nor sperm, but you can give them those signals. Yeah.

So is the problem in the pituitary, not the hypothalamus?

So could you give them Clomid and would they make?

What about estradiol? Does it play a role?

But if you correct for testosterone, so in other words, if a guy has normal FSH, LH, and testosterone, is there an estradiol level by itself that is problematic? Not usually. Okay. So it's really only high estradiol in the context of suppressed testosterone. Right. So that's when you would act on it.

So those are four big pillars. Anything else besides the history, the exam, the analysis, and the hormones?

So never make a decision on one semen analysis. It's really hard. Yeah. Especially if it's the first one, as you said, for all the potential.

So what percentage of drugs that are going through an FDA approval process are having a semen analysis as part of the evaluation? I don't think many. Why is that? Because usually the indications aren't reproductive age men or women for some of them.

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