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Paul Turek

👤 Person
716 total appearances

Appearances Over Time

Podcast Appearances

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

Well, have a flu and try to get your testosterone level up. You can't do it. You have to spray it in your nostril, each nostril three times a day. And it's gooey and it's gel-like and men within a week will call and say, can't do this. Yeah. We've had more luck getting women to use this. So the other big difference is between the two types of testosterone replacement or supplements.

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

Well, have a flu and try to get your testosterone level up. You can't do it. You have to spray it in your nostril, each nostril three times a day. And it's gooey and it's gel-like and men within a week will call and say, can't do this. Yeah. We've had more luck getting women to use this. So the other big difference is between the two types of testosterone replacement or supplements.

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

one is, we'll call it the natural ones versus the exogenous ones, is side effect profiles differ widely. It's very difficult to get polycythemic or thickening in your blood with the physiologic levels. It just doesn't happen very often. I've seen it once or twice, but if you take testosterone exogenously, you're at risk for polycythemia or blood thickening.

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

one is, we'll call it the natural ones versus the exogenous ones, is side effect profiles differ widely. It's very difficult to get polycythemic or thickening in your blood with the physiologic levels. It just doesn't happen very often. I've seen it once or twice, but if you take testosterone exogenously, you're at risk for polycythemia or blood thickening.

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

So testosterone stimulates epipotent in the kidney, you make more blood. Athletes love it, but if you went on a long flight and you're dehydrated, you're going to throw a clot. And people look at it for longevity, and it's like, be careful. Because I've seen 70-year-old men want longevity in taking this stuff, and then they have a clot, and they have a stroke, and now they're 71.

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

So testosterone stimulates epipotent in the kidney, you make more blood. Athletes love it, but if you went on a long flight and you're dehydrated, you're going to throw a clot. And people look at it for longevity, and it's like, be careful. Because I've seen 70-year-old men want longevity in taking this stuff, and then they have a clot, and they have a stroke, and now they're 71.

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

So, I mean, the studies aren't broad, but Ramasamy just did another paper on it. The most significant event occurring with testosterone replacement or supplementation is polycythemia and events. The high level for hemoglobin 17, Maticrit 50, you start seeing events happen about 18, definitely 19.

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

So, I mean, the studies aren't broad, but Ramasamy just did another paper on it. The most significant event occurring with testosterone replacement or supplementation is polycythemia and events. The high level for hemoglobin 17, Maticrit 50, you start seeing events happen about 18, definitely 19.

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

So once a week, and I think twice a week, you can have the dose, right? So that is a little safer, but then it becomes the intensity and just, I can't do it like that or whatever. I want a pellet instead. Do you put pellets in?

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

So once a week, and I think twice a week, you can have the dose, right? So that is a little safer, but then it becomes the intensity and just, I can't do it like that or whatever. I want a pellet instead. Do you put pellets in?

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

You know, in the arm, they put it in subcutaneously. We put it in the butt, and it's a couple-minute procedure in the office. You don't have to worry about anything. There's no compliance issues. We don't have a lot of side effects or consequences from it. It's done with a trocar and a thick needle.

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

You know, in the arm, they put it in subcutaneously. We put it in the butt, and it's a couple-minute procedure in the office. You don't have to worry about anything. There's no compliance issues. We don't have a lot of side effects or consequences from it. It's done with a trocar and a thick needle.

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

And pretty quickly, within a couple days, you'll get a level, and then it'll slowly decay, pretty much half of it by three months or so, and then the rest by four to six. It's supposed to be a six-month physiologic level. But normally it's four, four or five. And men feel great for a while and they can feel it because it's slow, but it is even.

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

And pretty quickly, within a couple days, you'll get a level, and then it'll slowly decay, pretty much half of it by three months or so, and then the rest by four to six. It's supposed to be a six-month physiologic level. But normally it's four, four or five. And men feel great for a while and they can feel it because it's slow, but it is even.

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

And you do have this risk of polycythemia and things like that. But there's a three-month perivariate risk. And then usually when you're in the normal range, it kind of goes away. So I don't see a lot of consequences with that if it's six months.

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

And you do have this risk of polycythemia and things like that. But there's a three-month perivariate risk. And then usually when you're in the normal range, it kind of goes away. So I don't see a lot of consequences with that if it's six months.

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

Might even improve it. HCG depends on the dose. So like you said, high doses suppresses. Normally, for all you want LH and FSH going to the testicle, you want the water and the sunlight. You want the testosterone. If you've got the testosterone, but your FSH is, if you don't have any sunlight, you're not going to bloom.

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

Might even improve it. HCG depends on the dose. So like you said, high doses suppresses. Normally, for all you want LH and FSH going to the testicle, you want the water and the sunlight. You want the testosterone. If you've got the testosterone, but your FSH is, if you don't have any sunlight, you're not going to bloom.

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

So I usually add Clomid to HCG if the dose is above 1500 units three times a week, because that's going to start suppressing the FSH and Clomid will keep it going.

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

So I usually add Clomid to HCG if the dose is above 1500 units three times a week, because that's going to start suppressing the FSH and Clomid will keep it going.