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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It just seems to me that in this day and age with people reproducing at older and older ages, we shouldn't just assume that because we've developed a drug for blood pressure or diabetes, that it's not going to be used by people with fertility. I'll give you a silly example. Have GLP-1 agonists been tested for fertility? No, because it's sort of an off-label use of a diabetic medication. off-label.
It's an on-label use today. But it looks like it might be helping with fertility. But even if it was on-label, I mean, I'm just using that as one example of a drug that was initially approved when we thought, ah, this is going to be for people who are not having kids. But the truth of it is you're going to have lots of people that are trying to reproduce on many of these drugs.
Absolutely.
Yeah.
Why don't we just talk about some of those things then now? So this is, I'm sure, a contentious topic, but as you know, lots of discussion around microplastics. So I don't know how far we want to go down that rabbit hole. I recently did a podcast on this topic. I didn't really touch on fertility because I just didn't see any great evidence.
I talked more about things where I thought there was a little bit more evidence. Obviously, with the microplastic story, there's quite a bit of smoke, but there's no real fire. My conclusion from the analysis was there is enough smoke that takes steps where they are reasonable and reduce your exposure to these things.
So everything from microplastics to PFAS chemicals to phthalates and even the PM2.5s, like there's no reason to expose yourself unnecessarily to this. If you can take relatively straightforward steps, eliminate 60 to 80% of it in your life, do it. Tell me what your impression is of the effect of any or all of the above on fertility.
And what is your advice to a guy when you're giving him counsel on everything he can do? We're going to talk about everything, but on this particular domain, if he says, hey, should I stop drinking Starbucks coffees in those plastic cups with the plastic lids? And should I get a reverse osmosis filter in the house? Like, where are you telling him to draw that line?
I'm not great at that because the stress level goes up so much.
Should have had a pretty good. Total T, 220 nanograms per deciliter. Did you measure LH? It's probably low. Yeah, I'm sure FSH and LH were totally low. I don't remember what they were. Free testosterone of like three to four. Well, the sleep deprivation, the stress.
Yeah. Let's talk about the use of anabolic steroids. Let's talk about it more broadly with the three most commonly used approaches to testosterone replacement. The way I see it is the three most common approaches are using either clomiphene or enclomiphene, using HCG, or using exogenous testosterone in one of its derivatives. Would you agree that those are kind of the big three? Okay.
We'll just briefly highlight for everybody why each is a little bit different. Exogenous testosterone, you're just giving testosterone. The body senses it and immediately shuts down the hypothalamus.
Yep. So LH and FSH will go to zero. Testosterone will be as high as you want it to be. There's no limit to how high it goes. I've had a couple of people on this podcast who have blown my mind with how much testosterone they've talked about taking. Not clear how that's possible, but nevertheless, they're doing it. HCG is synthetic luteinizing hormone.
So you give a person HCG, they will make testosterone. So it's endogenously produced. But they're making so much of it that they'll also suppress LH and FSH. So LH and FSH will come down, testosterone will go up. And then clomiphene or enclomiphene block the signal of estrogen at the level of the hypothalamus. So the hypothalamus thinks- Doesn't see any. Oh my gosh, we need more testosterone.
It ramps up FSH and LH production, which has the same effect as making more testosterone, but you'll now see high normal FSH and LH.
It's tightly regulated. So question one, if a guy is taking exogenous testosterone, and let's just say he's been on it now for a few months. Is he able to create sperm? 95% chance he's not. Wow. While he's on it. Yep, understood. But can he create it once he stops? And we'll definitely address that.
But just to be clear, even a couple of months on exogenous testosterone in any form, injection, topical, oral, whatever, You basically have shut off the ability to make sperm because your testes themselves have shut down. Right.
I don't want to go so far as to call it the marketing material, but for lack of a better term, the marketing material is suggestive that the more frequently delivered variants. So for example, the intranasal variant, which is delivered three times a day, the oral variant delivered twice a day.
have less of a negative impact because they're producing far lower surges than if you did a weekly injection. Is that what you're referring to? Yeah, so they do more physiologic.
is too much. Yeah. So in your experience, has that borne out? Yeah. You've seen men taking Natesto three times a day, doing a nasal- Keeping their sperm count. Keeping their sperm counts. Okay. That's interesting to note. What about the oral testosterone, the twice a day? Love it.
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