Male fertility: optimizing reproductive health, diagnosing and treating infertility, and navigating testosterone replacement therapy | Paul Turek, M.D.

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Dr. Paul Turek. Paul is a world-renowned expert in male fertility and reproductive health. You can think of this as part one of a two-part miniseries we're doing on fertility and reproductive health, with this one, of course, being on the male system. Next week, we'll feature Dr. Paula Amato, who is going to be the female expert on this topic. Paul is the founder and medical director of the Turek Clinic specializing in cutting edge treatments for infertility and men's health, and a pioneer in advancing research on sperm biology, genetics, and reproductive longevity. He's also the host of the Talk with Turek podcast. In this episode with Paul, we explored the intricate and highly evolved process of conception, discussing the challenges sperm face on their journey to fertilization. This, of course, is important to understand all the places where it can go wrong. It's not just an interesting story, it also explains how challenging it actually is. Paul shares insights into male fertility, including how sperm function in coordination to navigate the female reproductive track. We discuss how various factors such as heat exposure, stress and environmental toxins impact sperm quality. We talk about what men can do to optimize their reproductive health. Paul explains the effects of testosterone replacement therapy on fertility, debunking many myths and offering strategies for men looking to preserve their ability to conceive while being on hormone replacement therapy. Talk about the emerging fertility technologies, including advanced sperm sorting techniques, genetic testing, and innovative treatments that could redefine reproductive medicine. We also talk about the differences between the risk in the aging male and the aging female, and this was actually one of the most interesting things I learned about in this podcast. Without further delay, please enjoy the first of two parts on a discussion of fertility and reproductive health, this one with Dr. Paul Turek.
Hey, Paul, thank you so much for coming out to Austin.

**Paul Turek** (3:05)
Peter Attia, the man, the myth, the legend. I am so excited to be here.

**Peter Attia** (3:09)
This is, in many ways, I guess, what's gonna be part one of a two-part series I hope to do on fertility. And given the complexity of it, I think the most logical way to do it would be to break it down into male fertility, female fertility, and there's obviously gonna be things we talk about that'll overlap. But I was trying to think about the best way to start this. The first thing that came to my mind was, can we just explain what's involved in conception and maybe do it through the lens of the sperm? But how much of a challenge is this? I mean, obviously, there's an enormous evolutionary pressure for this to go as easily as possible. But what is actually involved? So what happens for a sperm to fuse with an egg? What are all the things that are standing in its way, so to speak?

**Paul Turek** (3:50)
So reproduction is an incredibly highly evolved million year process and remarkably conserved among mammalian species, even among land species and water species of animals, vaginas, cervixes, uteruses. And the question is, why is it so much work for a sperm to get into the vagina, especially in, say, water, and then have to go through a cervix? And then the immune system in the uterus is very active because there's a hole in the woman to the peritoneum, to the abdomen, so it has to be highly protected. And then you have to go through the uterus. So there's a 10 inch, 12 inch swim, which is equivalent to about a 20 mile swim for a human.

**Peter Attia** (4:30)
Based on the size of the sperm.

**Paul Turek** (4:31)
After ejaculation and how much distance they have to go. And they do that in minutes, which is crazy. So it's an interesting challenge that nature has kept in place for a million years and I really respect evolution. And it is why we're here for Eat Sleep Reproduce. So basically with ejaculation, the penis is shaped to fit into the cervix. Everyone wonders, is it getting to the right spot? It's also interesting that the semen is coagulated and then it liquefies. And that's because there's a lot of species of lower phyla that they have to leave as soon as they have sex. Otherwise, they'll get killed like praying mantises and black widow spiders. So you got to get out of there as a guy. So our ejaculates and humans are sticky.