Dr. Michael Eisenberg: Improving Male Sexual Health, Function & Fertility

Added: Nov 7, 2023

Sperm quality is a key factor in male fertility, and it is determined by factors such as the amount of ejaculate, sperm count, motility, and morphology. The World Health Organization sets the standards for normal and subfertile levels of these parameters. There is ongoing debate about whether there has been a decline in sperm quality over the years, with some studies suggesting a decline while others remain inconclusive.

The decline in sperm quality has been attributed to various factors, including environmental exposures, chemical exposure, obesity, and lifestyle changes. However, the exact reasons for the decline are still not fully understood. Dr. Eisenberg emphasizes the need for longitudinal data to track semen quality over time and across different populations to better understand the trends.

In addition to sperm quality, testosterone levels in men have also been a topic of discussion. Studies have shown a decline in testosterone levels over time, with potential factors including chemical exposure, obesity, and sedentary lifestyles. However, there is also significant variation in testosterone levels among individuals, with some men maintaining high levels even in their later years.

When it comes to optimizing male sexual health and fertility, Dr. Eisenberg highlights the importance of avoiding heat exposure to the scrotum, as it can negatively impact sperm production. He also discusses the potential effects of cell phone exposure on sperm quality, although the evidence is not conclusive. Additionally, he emphasizes the link between obesity and its impact on testosterone levels and sperm quality, suggesting that maintaining a healthy lifestyle is crucial for overall male reproductive health.

Dr. Eisenberg also addresses the importance of regular health screenings and taking ownership of one's health, as comorbid conditions such as obesity, hypertension, and hyperlipidemia can contribute to a decline in testicular function and overall reproductive health.

Testosterone replacement therapy (TRT) is a common treatment for men with low testosterone levels. However, Dr. Eisenberg emphasizes the importance of understanding the potential side effects of TRT, particularly its impact on sperm production. He notes that about one in 20 infertile men may have lower sperm production due to testosterone therapy. It's crucial for men considering TRT to have a thorough understanding of its potential effects on fertility.

Exogenous testosterone use, such as injections, creams, or pills, can significantly reduce endogenous testosterone production and sperm count. Dr. Eisenberg highlights the importance of discussing the potential impact of testosterone therapy on fertility with healthcare providers. He also mentions the use of human chorionic gonadotropin (HCG) as a therapy to stimulate sperm production in men on testosterone therapy.

In addition to testosterone therapy, Dr. Eisenberg addresses the impact of lifestyle factors on male reproductive health. He discusses the potential effects of smoking, alcohol consumption, and drug use on sperm quality and testosterone levels. While moderate alcohol consumption may not have a significant impact, excessive drinking can affect sperm parameters. He also mentions the potential genetic variations in alcohol metabolism that may influence its impact on sperm quality.

Furthermore, Dr. Eisenberg explores the relationship between physical activity and male reproductive health. He discusses the association between step count and testosterone levels, emphasizing the benefits of regular physical activity for maintaining optimal testosterone levels.

The discussion also delves into the potential impact of cycling on male reproductive health. Prolonged cycling, especially with excessive heat exposure, may lead to lower sperm counts. Dr. Eisenberg advises individuals to be mindful of their cycling habits and consider strategies to minimize heat exposure and pressure on the pelvic area.

Regarding prostate health and sexual function, Dr. Eisenberg emphasizes the importance of maintaining normal erectile function. He suggests that regular spontaneous erections, particularly during sleep, are indicative of normal erectile function. Any changes in urinary function, such as increased frequency or weaker urine stream, should prompt individuals to seek medical advice.

Dr. Eisenberg addresses the safety of testosterone therapy in relation to prostate cancer risk. He explains that there is no conclusive evidence linking testosterone therapy to an increased risk of prostate cancer. Longitudinal data suggests that testosterone therapy does not significantly alter prostate cancer risk, providing reassurance for individuals considering this treatment.

Sperm quality is a crucial indicator of overall male vitality and health. Dr. Eisenberg emphasizes the importance of semen quality as a barometer of health, with studies showing a link between semen quality and overall health. He suggests that getting a baseline sperm analysis, especially for men in their 20s and 30s, can provide valuable information for future reference. Additionally, freezing sperm may be a prudent option for those concerned about conceiving children later in life, as advanced paternal age has been associated with an increased risk of certain health conditions in offspring, including autism.

The discussion also delves into the impact of age on male reproductive health. Dr. Eisenberg highlights the potential risks associated with advanced paternal age, including an increased likelihood of genetic mutations and epigenetic changes in sperm. These factors can contribute to a higher risk of neurodevelopmental and psychiatric conditions in offspring. He also discusses the role of DNA fragmentation in sperm and the challenges of selecting the best sperm based on DNA composition.

Prostate health is another key focus of the conversation. Dr. Eisenberg explains the functions of the prostate gland, its role in reproduction, and the common symptoms associated with prostate enlargement. He provides practical tips for maintaining prostate health, such as identifying triggers for urinary symptoms and considering low-dose tadalafil as a potential treatment option for urinary bother and erectile function.

The discussion also touches on the prevalence of urinary tract infections (UTIs) in men. While UTIs are more commonly associated with women, Dr. Eisenberg emphasizes the importance of evaluating male UTIs, as they are relatively rare but should be addressed if recurring. He discusses the anatomical differences between male and female urinary tracts and the potential need for diagnostic imaging in cases of persistent urinary issues.

Dr. Eisenberg also discusses various treatment options for erectile dysfunction, including oral medications, urethral suppositories, penile injections, and penile implants. He highlights the importance of lifestyle optimization and medical treatment before considering these options. He also mentions the potential side effects of these medications, such as headache, facial flushing, and indigestion.

Another topic Dr. Eisenberg addresses is pelvic floor health, which his important for supporting the structures of the pelvis, including the bladder, prostate, and rectum. He emphasizes the need for pelvic floor therapy to address issues related to pelvic floor tension and relaxation.

In addition to discussing erectile dysfunction and pelvic floor health, Dr. Eisenberg also shares insights from a study he conducted on penile length. He explained that the study involved analyzing data from 55,000 men around the world to determine average penile lengths. The study found that penile length varied by region, with the average erect penis measuring between 5 to 6 inches. Dr. Eisenberg also mentions that the study revealed an unexpected finding – penile length has been increasing over time, contrary to the anticipated decline.

One of the key topics discussed is the impact of hormones on the male brain and body, particularly during embryonic development. Dr. Eisenberg explains that exposure to dihydrotestosterone (DHT) during embryonic development plays a crucial role in organizing the male brain and body. He also highlights the potential effects of environmental endocrine disruptors on testosterone levels, as well as the use of DHT-blocking drugs for hair maintenance and the potential side effects associated with these medications.

The conversation also touches on the use of selective estrogen receptor modulators (SERMs) such as clomiphene to increase testosterone levels in men. Dr. Eisenberg explains the mechanism of action of SERMs and their potential benefits for men with low testosterone levels.

Another important aspect of the discussion is the significance of hormone testing and sperm analysis for men's reproductive health. Dr. Eisenberg emphasizes the importance of regular testing for hormone profiles, lipid profiles, and sperm quality, as these parameters are crucial for overall health and reproductive function. He also addresses the accessibility of these tests and encourages individuals to discuss testing options with their healthcare providers.

The conversation also covers common male reproductive health issues such as varicocele, Peyronie's disease, and testicular cancer. Dr. Eisenberg provides valuable insights into the symptoms, diagnosis, and treatment options for these conditions, highlighting the importance of early detection and intervention.

Throughout the discussion, Dr. Eisenberg emphasizes the interconnectedness of male reproductive health with overall well-being, mental health, and quality of life. He encourages open communication and proactive engagement with healthcare providers to address reproductive health concerns and optimize overall health.