Paul Turek
speaker
358 appearances
1 recordings
1 series
first heard Jun 2025
last heard Jun 2025
Paul Turek’s voice in public audio — every appearance, attributed to the second.
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So for me, it's usually their weight and their count maturity are low. I'm looking for a chronic exposure. And then they have polyuria or polydipsia or something like that, where they're drinking a lot and they're peeing a lot because the sugar is dragging it out and you check their UA and it's full of sugar. And then some of them have an A1C that's a little pre-diabetic.
But I think a lot of it is neurogenic too. They can develop an ED. A third of type 2 diabetics have low testosterone. So that's a clue. And that's secondary. So you can clone it. You can bend them right back. But that's probably the common one is the look, the sugars, and then the low T and the low sperm count.
You can develop varicose veins in your leg and need treatment. And this is the same thing in the scrotum, but it's not related. And it happens typically at puberty. You'll develop this. You won't know it sometimes unless it hurts. It's a reflux of blood in the wrong direction. So the testicle drains to the kidney, which is uphill, and it wants to drain back down.
The reason why it drains back down is because as a species, we stood up a half a million years ago, maybe three quarters of a million years ago. And when you're an animal, your kidney and your testicle drains this way. There's no gravity. But when you stand up, you're now draining uphill. The system was never made for valves. And if you said to me, what's the reason our sperm counts are falling?
I would say, we stood up as a species. Probably not a good idea for male fertility because that would... that's supposed to be staying up there, comes back down to the testicle, pulls around it like a hot bath, is warmer. And usually the first sign is a testicle on that side, which is the left, usually is smaller than the right. So the physical exam will reveal a testicular discrepancy in size.
That's the first thing you see. And then you feel above it and you feel a bag of worms.
But there might be a few during puberty, but the growth spurt, those blow the angle of the renal vein and there's a right angle. The right side has a natural valve off the vena cava. So it's kind of has to go around 270 degrees. So you don't reflux on the right. Left-sided lesion in most men. You can be perfectly fertile with it.
If you look at statistically, 85% of men conceive naturally without varicoceles, 80% will conceive naturally about a year. So the curves are very similar. Clinically, maybe insignificant, but there is a difference and it's statistical. But if you multiply that by millions of people, it becomes important. And you'll figure that out easily on a physical exam? The best way is easy.
I don't order ultrasound. If I can palpate it, then it's clinical. That's an office repair? It's an outpatient surgery. It takes an hour. We do microsurgery.
So it's more involved than a vasectomy. Yes, it is. And you're doing it at microsurgery at the level where you don't cut muscle. You want him to recover quicker. It's an involved area with lots of veins. But he's not under general. I use twilight sedation. Yep. So that's the most common.
Wow. And most men are fertile. But so again, you look at the semen analysis as a poker hand and you see count motility being down, nothing else going on. And you see a varicocele and it's implicated. All right, have we missed any other of the major? Yeah, I'd say the major ones are varicocele, and then I would look for hormonal issues. So varicocele's maybe 40, hormonal maybe 10 or 15, genetics.
The most common one is for zero sperm is client filter, is extrax chromosome. The most common one for low sperm count is Y chromosome deletions. This is an interesting area. What does that phenotype look like?
In general?
Yeah. Because it's only the long arm and it's only a couple of floors on the building. There's regions that are missing. I see. Okay.
Got it.
So it's the long arm and it's deletions, regions. Yeah. Rhyme of deletion. You're right. So Randy Riopera found... at MIT 20, 30 years ago now that the Y chromosome is a hall of mirrors. And in meiosis, every chromosome has a partner, except the Y and the X and a man. The Y plays with itself. It combines with itself. Instead of finding a partner, it has to do the dance too.
And so it changes a lot. So it's very adaptable. It actually comes from the X through evolution. So there's a lot of X genes that are on the Y, and the Y, we thought it was sort of a wasteland, maybe hairy ears and tooth decay and things like that, but now it's probably more important. So there are regions on the long arm of the Y. The short arm of the Y is very important.
It has a gene called SRY, which makes you male. The SRY is the male sex-determining gene. If you have that gene, your phenotype will be male. If you don't have that gene, you're probably going to be female. It's complicated now, but that's sort of what it is.
But the long arm has these genes that control fertility, and some of them, so typically we order it in men with a low sperm count of below 5 million. That would be a pretty common cause of a sperm count lower than 5 million.
And I published a study that if you have a Y chromosome deletion and you have a varicocele and they both cause low sperm counts and you fix the varicocele, you're not going to improve because it's non-modifiable in all ways. It's who you are. But if you didn't have the Y chromosome deletion and you fix the varix, you'll expect a good response.
Showing 281–300 of 358 · page 15 of 18
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