December 9, 2025 • 29 mins
This week, Dr. Jesse Mills is joined by Dr. Jasper Bash — men’s health expert, researcher, and occasional a cappella tenor — for a candid look at how to build healthier sperm. They unpack the latest findings on marijuana, alcohol, and other environmental exposures, including what’s myth, what’s real, and what’s actually reversible. Dr. Bash also shares practical timelines, clinical tips, and the fitness and nutrition habits that keep him performing at his best.
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Speaker 1 (00:00):
Let's talk about it. Let's talk about the Maro. Let's
talk about it. Let's talk about the man Hero.
Speaker 2 (00:16):
Welcome, Hey, everybody, Welcome back to the mailroom with doctor
Jesse Mills. I'm doctor Jesse Mills, your host. I am
so excited, so excited to be joined by our expert
of the day, doctor Jasper Bash. I've known doctor Bash
for years. He is an accomplished urologist. He's an assistant
Professor of urology at the Oregon Health Sciences University in Portland, Oregon,
(00:40):
where he also did medical school and residency. And then
I was fortunate enough to poach him away to beautiful
sunny Santa Monica for his fellowship at the day of
Geffen School of Medicine at UCLA in Men's Health Maile
Reproductive Medicine and Surgery, and then Oregon was fortunate enough
to steal him right back to the beautiful river town
(01:00):
of Portland, Oregon, where he holds his current position as
assistant Professor of Urology and soon to be named co
director of the Men's Health Program at OHSU. One of
the things you don't know about doctor Bashion. If we're lucky,
maybe we'll get him to hump a few bars. He's
actually also an accomplished a cappella musician. He was in
a band tenor for the band the Testostertones, and they
(01:24):
actually had a hit album still available on iTunes, the Mendorphins.
So this guy not only as a talented musician, but
he eats, breathes, lives, and sleeps testosterone and actually even
sings about it. So it's so great to have you
on board. Jordan is also joining as Jordan as our
producer and on air personality. That baritone and baritone that's right.
(01:48):
And as I said, if we're going to do anything,
all I'm going to do is snap because this raspy
voice ain't good for much else other than carrying a
bucket of water.
Speaker 3 (01:56):
Good to know where well I stand.
Speaker 2 (01:57):
Yeah, I can't tell you how excited I am. I mean,
you know, we met each other last in grape Vine,
Texas at a men's health meeting in Sexual Medicinciety, North America,
where you moderated on one of the subjects and actually
gave a talk on one of the subjects that we're
going to talk about today. And I'm so excited that
you committed to a couple of these shows today, what
I'd like to discuss with you is what about sperm
(02:22):
health and marijuana and the environmental factors in general. Doctor
Bash also did quite a bit of research as a
resident in the effects of marijuana on primates, and so
I think what I would want to do is just
start our conversation just about in general, what can we
do to optimize sperm and then also what kind of
toxins should we be worrying about in sperm health, and
(02:46):
then kind of walk me through all of that. So
just let her rip, Let's do this and let's talk
about it.
Speaker 3 (02:51):
Oh, excellent, let's talk sperm.
Speaker 2 (02:53):
Well.
Speaker 3 (02:53):
I think that there is a lot of hype in
the media that we hear about about declining sperm counts worldwide,
and depending on who you talk to in the sperm community,
they may or may not agree with that, but it
is bringing a lot of interest in people to what's
happening with sperm counts and what can we do to
keep our sperm healthy. The nice thing is, for most
people it's pretty simple. A healthy body produces healthy sperm,
(03:15):
and so anything that you can do for your overall
health in general is going to help your sperm health.
I think when we are thinking about from a men's
health urologist perspective, we're thinking about hormone levels and how
the brain is talking to the testicles and what they're
making of those signals. In terms of someone who just thinks,
what can I do for my own sperm and keeping
them healthy, maintaining a healthy weight, a healthy diet, being active,
(03:40):
and getting good sleep, these are all things that will
help make good sperm. In terms of exposures, when I
think of kind of the three horsemen of exposures to
sperm being tobacco, alcohol, or marijuana, it becomes no surprise
to anyone that none of those things are great for
your sperm health. And there's certainly a negative synergy that
can happen when you start mixing them.
Speaker 2 (04:00):
Yes, well, so that brings up kind of a classic
other point is how much is too much? Or in
other words, you know, I'm a child of Woodstock, and
I'm still here, and I don't know exactly what my
parents did, but somehow I actually I can tell you
they weren't at Woodstock because they were in Russia. But
I will say it touched far. That's right. I don't
(04:20):
think anything got beyond the iron curtain except for a
couple of bootlegs CSN and Y albums that I think
Neil Young is still big over there on X rays.
I believe that's right, exactly right. Yeah, So, you know,
I guess that's the thing is that is there such
a thing as moderation. If a guy's out there listening
today and you say, look, dude, this is too much
(04:43):
like you you got to stop all cigarettes, all alcohol,
all marijuana. A how do you get somebody to comply
with that and be how important is that? Give me
some thresholds of what is okay?
Speaker 3 (04:55):
Yeah, you know, there's been a lot of public health
work around alcohol and pregnancy and so so that has
much clearer messaging. We say, we really don't want women
who are pregnant to be drinking a lot during pregnancy,
if at all, And there may be some changes to that,
but for the most part, that's pretty clear. When it
comes to thinking about sperm health, we have great data
(05:16):
which show us that there is a dose response with
the sperm and the exposure, meaning the more let's say
THHC that you consume, the greater the effect on the sperm.
And that works in the opposite direction too. So if
people say, you know, I'm not going to stop consuming
cannabis completely while I'm thinking about pregnancy, that's okay. If
we can reduce your dose, you're still going to make
(05:37):
gains in terms of having a healthier sperm. Another thing
to think about is that as a men's health guy
and a fertility guy, I usually am seeing guys when
they're actively thinking I might want to make a baby
pretty soon. This is a very specific time of life,
and it is a self contained time and so thinking
that sperm take about three months to make. Anything we
(05:58):
do will take three months to show up with are sperm.
And so if you're thinking I might want a baby
in the next six months, tapering or going off of
whatever exposures you're having, then having a nice, healthy sperm
to make a healthy baby, and then afterwards thinking how
am I going to either be re exposed or change
my lifestyle after that? So a very short window to
(06:21):
think about this doesn't have to be necessarily forever change.
Speaker 2 (06:24):
Okay, I think we want to get into the marijuana thing,
But you brought up something interesting. We were at that
meeting a couple of years ago in Denver where there
was some research presented on the effects of alcohol on
genomic effects on fetuses and for a while. You know, really,
since we were in medical school, right, we always hear
about fetal alcohol syndrome, where alcohol exposure on the female
(06:47):
side is terrible. But yeah, there's some compelling data to
show that even small alcohol exposure on the male side
is bad for sperm and the epigenetic Tell me what
you remember from that as well. I hate to put
you on the spot, but you just kind of really
triggered something in me that I think our listeners should
know that that alcohol also really bad for sperm genomics,
(07:10):
maybe as bad as it is for ovariant function and
egg production as well.
Speaker 3 (07:15):
Yeah, you know, this is the problem with science is
that the closer the look you more you find out
and the more you have to worry about. We see
it time and time again in terms of alcohol. Just
like you said, it used to be all about the
female partner, who's covering making the eggs, what's happening in there.
We did find out that there were epigenetic changes that
happened with alcohol, and so I think it'll come to
(07:36):
as no surprise to the listeners that moderate alcohol intake
in the partner is really important. We see very similar
effects with THHC. So if we look at the actual
DNA of the sperm and changes that are made to
the DNA, we notice there are changes. And I don't
want to sound too inflammatory here, but we have seen
changes in genes related to autism spectrum disorder with THHC exposure,
(08:00):
which brings up a whole host of questions. We also
see changes in the proteins in the ejaculate, So the
proteins that are surrounding the sperm change with THC exposure
and then change back towards being normal with reducing or
removing that exposure. So there is certainly, you know, possibly
generational changes that can happen here more than just what
(08:22):
meets the eye. What number of sperm you have that
we're seeing both with alcohol with THHC I presume with nicotine,
though I don't can't remember that off the top of
my head.
Speaker 2 (08:31):
Yeah, so no booze is good booze, and no weed
is probably good weed. But you hit on a obviously
something that's quite a hot, maybe politically motivated target, and
we try not to get too political in the show,
so we'll maybe ignore what the elephant in the room
is when we talk about autism.
Speaker 3 (08:50):
I'll follow your lead then, but I do think.
Speaker 2 (08:52):
It's, uh, we all know what we're talking about. But
you know, you have actually really good data that THC,
which I think we can all agree has skyrocket in
this country, has actually pretty good evidence that it may
contribute to autism spectrum disorder.
Speaker 3 (09:09):
Yeah. I would say that we have a definite signal
that these things could be related. And you're exactly right.
The availability of cannabis products has far out paced our
understanding of them scientifically. Right, in twenty nineteen, there were
more cannabis defensories per capita in Portland than there were
Starbucks McDonald's Wow, which is shocking. Right, Seattle still had
(09:32):
more Starbucks because it brains supreme there, but similar things
in Denver. And so we've definitely the legal changes and
the availability has way outpaced our scientific understanding, which we're
now doing a pretty good job catching up on.
Speaker 2 (10:09):
Let's get into the weeds here, if we will, And
let's right there, Yes, right, you're already in the weeds.
But how did you get to these data? Tell me
why what you're sharing with me? Let's talk monkey business Jasper.
Speaker 3 (10:22):
Yeah, yeah, let's let's let's get into the monkeys. So
marijuana research is quite challenging for a couple of reasons.
One of them is that a lot of our older
literature that we would go to as kind of the
groundwork is using marijuana products that have no bearing on
current consumption. Right, the amount of THHC in the average
(10:43):
cannabis product now has gone has increased about threefold in
the last two decades. So this is not your grandmother's marijuana.
This is not your mother's marijuana. This is a whole
new thing. And then we're Diesel ultra dank, very loud.
So when we're talking about these products, then we do
things like concentrates or edibles where the TC levels are
way higher, and so it's hard to use older data.
(11:06):
So now we think we need new data. Very hard
to study this in people. You know, there have been
studies in dispensaries just going around, hey, how are your
erections on marijuana. That's not a great way to get information, right,
And you'll hear reports of people saying my sexuality, sex
life is much better with marijuana, and then you'll also
have reports to say it's way worse with marijuana, So
(11:27):
trying to use people for this is very hard. The
best setup you could do would be, let's take a
group of guys who have had no use of cannabis.
Let's put them all on heavy doses every day for
a year, and let's see what happens to their sperm count.
Very hard to find that population, right, we can do
that in an animal model, right. We can take animals.
(11:48):
We can give them a little cookie with THHC on
it every day and we can see what happens to
their sperm count, their testicle size, their testosterone levels. And
we did that. So we have an incredible group here
in Oregon who does amazing research, and we did this
on a primate model. It's a pretty good setup. Getting
(12:08):
a THD cookie every morning and then having your sperm
examined every few months, and we found some pretty remarkable
stuff that I'd be happy to share. We saw that
as these very lifelike in terms of similar to human
dosing doses of marijuana are given, testicles are shrinking and
they shrank by about fifty percent. So that's something that's
(12:28):
pretty easy for guys to wrap their minds and their
hands around. Right, So fifty loss of testicular volume. We
saw those changes we talked about with the sperm DNA,
so concerning changes for sperm DNA and with the proteins
in the fluid around it. These animals have way higher
sperm counts than humans do, and so it's a little
(12:49):
harder to compare them to humans, but we did. The
most interesting thing I think is that once we took
the THHC exposure away and we had a wash out period,
estical volume expanded, testosterone and estrogen levels, those main hormones
we think about fertility went back towards normal. The DNA
changes back towards normal, and I think that's very powerful.
(13:11):
So when I talked to guys in clinic we're using
high doses daily THHC, I say, you know, all is
not lost. We've still got time to decrease or stop
that exposure and get your sperm healthier again.
Speaker 2 (13:24):
So how I'm not trying to ask this. I think
I know where this is going, But there's somebody out
there that's going to ask, how did you How did
you actually study the monkey sperm? How did that happen?
What were you getting up pretty early in the morning
and putting on that that's the thing. Are of primate porn?
(13:45):
Or how do you get monkey sperm to study? Do
you want me to ask?
Speaker 4 (13:48):
Is it better coming for me? I don't have a
medical license?
Speaker 2 (13:55):
Tell us what is the how do you get a
sperm sample out to study? And what are the pitfalls
associated with that? Yeah?
Speaker 3 (14:01):
Well, the hardest part is actually getting there to the
monkeys before they do it themselves. And so the first
thing to do when you show up is look around
the cage and look in their palms and make sure
they haven't already taken care of business for the day.
Speaker 2 (14:13):
So there's wake and bake and wake and shake, is
what you're saying.
Speaker 3 (14:17):
Yes, may they cohabitate beautifully Johnny Carson golf swing.
Speaker 2 (14:21):
There you go.
Speaker 3 (14:22):
And so if that hasn't occurred, then we're able to
do is they're able to sit in a little chair
that we train them to sit in, and then we're
able to do a stimulation that creates a reflex arc
that has them ejaculate. So we're able to do this
doesn't require any sedation. They're trained on how to do this. Again,
it's all about getting there before they do.
Speaker 2 (14:43):
The early bird gets something at least Okay, well, so
essentially what I'm hearing is that cannabis really not good,
but it's reversible. So walk me through. You kind of
gave us a little bit of a clinical scenario. But
you say, I'm a thirty year old guy and my
(15:04):
partner's my female partner is twenty eight, and she is
a teetotaler. It doesn't do anything, But I am a
habitual cannabis user, and we really want to have a baby.
Do you think we just pulled a goalie and go
for it or something I should do to pregame at thirty?
How long is it going to take for me to
(15:25):
wash out? Or or should I or should I just
take the woodstock approach and see what happens?
Speaker 3 (15:30):
Well, I would say that the if your partner is
on the younger side to twenty eight being quite young.
When it comes to fertility, I'd say that even though
often couples want a baby yesterday, there's time here, and
so I think that the prudent thing to do would
be to stop using cannabis if possible. Stop that. We
(15:51):
know again sperm take three months to grow. I would
say six months. We don't really have clear data on
exactly when effects will be gone. I think six months
will be a very reasonable time to say we've had
two cycles of sperm being produced. Six months would be
a great time to start thinking about having trying for
a baby after stopping or at least really reducing cannabis intake.
Speaker 2 (16:13):
And is there anything else you do because you mentioned
that in your primate experiments that not only does particular
volume go down fifty percent, but there are some hormonal
changes as well. Is there anything that you would do
on a routine basis? I mean, I assume you're screening
for testosterone fsh you know, the sperm production hormone. Have
(16:34):
you noticed or do you eve even a data to
show whether doing some kind of hormonal modulation will help
hickstart that for example, you know we're going to talk
about testosterone recovery as well for sperm production, but with
marijuana exposure, THC exposure, do you do any kind of
you know, sort of boost protocols to get these guys
(16:55):
up and optimize sooner or talk to me about that. Yeah.
Speaker 3 (16:58):
Absolutely. When I see a guy clinic for fertility, no
matter if he says, oh, I've had chemotherapy exposure, I've
had THHD exposure, No matter what, he's getting the full
meal deal in terms of work up. So I'm looking
at his testosterone estrogen, I'm looking at the signals from
his brain LH and FSH, they're talking to his testicles.
Of a physical exam looking for things that might be
(17:19):
causing issues, and then a semen analysis for a guy
with THHC our research shows that the issues are both
in the pituitary in the brain as well as in
the testicle, so you're often there are perturbations or issues
in both spots. If a man has low signals from
the pituitary, I will often reach for a medication like
(17:42):
clomaphine or clomate that can boost those signals. Tell the testicles, Hey,
time to do something, wake up a little bit faster.
So I'll use a very similar testosterone recovery protocol as
I would to other exposures that will decrease testosterone to
try to get things going. Get sperm numbers up quickly.
Speaker 2 (17:57):
Great, and I assume you get a baseline even analysis
see where the guy's starting at. Do you routinely and
this is really wonky, but for people that are that
are super granular, do you routinely look at DNA fragmentation
and disease in guys when you're doing that screening seam
analys because I think you also mentioned that a little
bit in your primary studies that the DFI or at
(18:19):
lest their DNA mutations, which a little bit different than
just doing a screening DFI. But is your utility in
that as well.
Speaker 3 (18:27):
Yeah, So DNA fragmentation index somewhat of a new test
looking at double stranded breaks in the DNA of the
of the sperm. We think about that in terms of
overall quality of sperm DNA, and we know that thankfully
the egg can make up for a lot of issues
with the sperm, as partners do later on in life.
But if there's too many breaks in the DNA, we
know that that those can overwhelm the eggs ability to
(18:49):
repair them. I don't routinely check that on patients who
are using THHC because number one, there's a lot of
varry in between different laboratories and how they report with that.
Number number two, there's not a direct connection. And I
like to tell guys, if there's something obvious that we
can fix, let's fix that first, and then if there's
(19:10):
still problems, we can look for DNA fragmentation and look
at that. So if there's something obvious like THHG exposure,
I say, let's just fix that. Now we know that's
a good thing for fertility. If we're still being problems
down the line, recurrent pregnancy loss, it's things aren't working
after you know, eight to twelve months of trying, then
we can do more investigation there.
Speaker 2 (19:53):
Yeah, I love that, And I would say number four
to that, I think you got up to three. Number
four is that you know, why order a test if
it's not going to change your management and you're going
to treat those people the same And I think one
of the things that we run into in this kind
of meta verse of overtesting and granularity is that you're
(20:13):
not going to do anything differently with the guy anyway.
You're going to treat him the same way and you
hope for the same results. And if there's still a deficit,
then you say, okay, well maybe we have to look
at something a little bit more in depth. Exactly makes sense. Okay.
So there's a segment of this program called am I
going to be okay? And essentially what I want to
know is if I had a problem, like I just
(20:35):
love the yeerba, and I can't get off it. And
I still want to edibilize or smoke in moderation, and
I just can't get off it. Can you see? Is
there anything you can tell me that my relative risk
is going to be okay? In other words, would you say, look,
you just shouldn't pro create, or say, you know what,
(20:56):
you're probably going to be okay? Talk me through that,
you know it. Counsel me on a guy that just
is absolutely you know, inable to unable to get off weed.
Because a lot of listeners are hearing this and they're
going to think oof. Man. I mean, this is such
a big part of me. It normalizes my mental health
and h but I really want to be a dad
(21:17):
as well. So I don't want to put you on
the spot because is a physician, You're always going to say,
you know, this is what you should and shouldn't do.
But we live in the real world where guys really
rely on on their marijuana exposure for you know, for
optimal mental health. Am I going to be okay if
I just take a little like a couple of gummies
a day.
Speaker 3 (21:34):
You know? Practicing here in the Northwest, I've got a
lot of guys who come to me and they are
on THHC for medical reasons and really can't find a
way to taper off of it for the fairly extended
duration of time that it takes to make spirm, have
a baby, and then raise that baby. I think that
your comment earlier about how many babies came out of
woodstock and its doing pretty well is very well taken.
(21:55):
Things that one could do if they're thinking, is it
even reason will to try to make a baby? I
think yes, it is things that people could think about doing.
Trying to decrease the dose, if possible, of THHC consumed
every day, if THHC is really the go to for
things that help a person trying to decrease other things
(22:15):
like smoking tobacco or drinking alcohol, and saying, all right,
if this is gonna be what I'm hanging on to,
I'm going to decrease those other exposures because we know
those can have a synergistic effect in a bad way.
And so focusing on decreasing risk of other exposures and
decreasing TC as able, I think that leaves it very
reasonable to pursue pregnancy.
Speaker 2 (22:37):
I love that. Yeah, I think that's you know, a
big part of my practice is meeting guys where they're at,
and I think that gives a lot of hope, and
it also gives them some action items. Because one of
the things that I hate about the way a lot
of men come to our clinic and they're told this
by other physicians that you have to do this, they
have to do this, just a little bit of kind
of patient bashing, and and I think, you know, if
(23:00):
you're what you're doing is you're empowering patients to say, look,
we get it. There's some things that are just unchangeable
for you. But but what if you did this instead?
You know, what if you got an extra hour sleep,
or what if you walked thirty minutes more a day,
Then you know, maybe you counteract some of the habits
that we know are not good for you but maybe necessary.
So that's sage advice for the young professor from Oregon.
Speaker 3 (23:25):
Thank you.
Speaker 2 (23:26):
One of the other things I love about this show
is that that I get to spend time with men's
health experts. And so I'm going to ask you, as
a men's health expert who is svelt and fit, and
I know a lot about what your exercise habits are.
But what are your must have to keep you in
(23:47):
good shape? What do you have to do? What are
your rituals that you can impart to somebody listening out
there about how they can be just a little bit
more like doctor Jasper.
Speaker 3 (23:56):
Pash, Well, let's see, you know, on the eat, move, sleep.
I'm triangle. That changed me pretty drastically about six months
ago with the birth of my daughter. She's amazing. Yeah,
she's incredible. She brings a lot of joy and wellness
to my life. But as you and your listeners who
(24:16):
have children will know, it's real game changer in terms
of schedule, in terms of how life works. So when
I think about that, I think about what I can
control of that triangle. Sleep, no surprise to anyone, is
not something I can control very much anymore. And you know,
and that's okay. Moving is something that I can control moderately.
(24:38):
So my wife is also a physician, and it means
we have for pretty busy weeks, but on the weekends
we can mostly keep time that both of us can
alternate taking care of our daughter and exercising. I'm a runner,
I'm a cyclist. I like to lift heavy things and
I'm very fortunate to have a treadmill, a stationary bike,
and some heavy things to lift in my garage, and
(25:00):
having that so near me and so easy to access
really lowers the bar to me just going out and
exercising during an app when I have a moment free.
The third point of the triangle, being eat is where
I have the most control. I think about what my
grandmother used to say, which is that flexibility is our
middle name, and so I try to not hold on
(25:20):
too tight to any one schedule, because when you have
a baby, there is no schedule. But I think if
I'm having a big workout day, I'm going to eat more.
I'm going to make sure I'm eating more protein. If
I'm having kind of a light week in terms of
being able to exercise during the week, I'm going to
dial it back for more of a calories in, calories
out approach. And then just again being flexible of myself.
(25:41):
And if we're going out to eat on the weekend
because we're having a good time, I'm going to be
a little bit looser. But I think focusing on what
I can control, not worrying as much about what I
can't control, and then focusing on. That nice mix of
cardio and lifting is keeping my body in fairly good shape,
and I I think it'll be give me a longevity boost.
Speaker 2 (26:02):
I love it well. And you know, the thing about
kids is what they lack and sleep they make for
in joy.
Speaker 3 (26:08):
One of these things many times over.
Speaker 2 (26:10):
Many times over. And the other thing about your kid
is if you're lucky enough to have a good relationship
with her as she grows older, if you lift her
every day and she gets heavier, by the time she's twenty,
you'll be lifting you know, one hundred and ten pounds
or something. And one of the reasons I'm in such
great shape is because my kid was an offensive lineman
in college football. So I picked him up when he
was seven pounds, and when he was three hundred and
(26:31):
ten pounds, I actually couldn't pick him up anymore. So
maybe that's a bad example, but.
Speaker 3 (26:35):
I thought, day to carry your fellows every day to clinic,
that's a miracle.
Speaker 2 (26:38):
That's exactly right. Well, I don't, yeah, that's usually you
guys lose weight in my fellowship. That's the problem. You know,
you're so busy that you drop ten pounds. But doctor Bash,
I'm grateful for your time sharing your incredible wisdom not
only on men's health writ large, but also about a
very specific topic about THHC and its effect on sperm
production as well as hormone production. So again, grateful to you.
(27:01):
And I think my take home message from this is
moderation to none at all, abstinence is probably better. And
you really have have you building a great body of
literature on all of the effects of testosterone UH and
sperm production that that marijuana has and and and I
applaud you for your work up there, your your lab,
(27:22):
and your your university as a whole. So thanks very
much for your time, and I appreciate you talking about
it with us.
Speaker 3 (27:30):
That's been a total pleasure. I love sharing this information
because I think it's helpful for people who are thinking
about it. It has a lot of hope in it,
and it has a lot of actual points. So thank
you for having me on. It's a total pleasure.
Speaker 1 (27:48):
Let's talk about it. Let's talk about it a ma,
let's talk about it. Let's talk out of a mailroom.
Speaker 4 (28:11):
The mail Room with Doctor Jesse Mills was a production
of iHeartRadio. It was executive produced by Jordan Runtogg. It
was edited, mixed, and mastered by Beheid Fraser and the
theme was provided by long Transit. If you like what
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(28:33):
or wherever you listen to your favorite shows. This program
is intended for educational and informational purposes only. It is
not a substitute for professional medical advice, diagnosis, or treatment.
Consult your healthcare provider for any medical or other related
questions or concerns. The views and discussions aired on this
podcast or those of doctor Mills and do not represent
(28:56):
the official positions of UCLA or UCLA Health
Let's talk about it. Let's talk about the Maro. Let's
talk about it. Let's talk about the man Hero.
Speaker 2 (00:16):
Welcome, Hey, everybody, Welcome back to the mailroom with doctor
Jesse Mills. I'm doctor Jesse Mills, your host. I am
so excited, so excited to be joined by our expert
of the day, doctor Jasper Bash. I've known doctor Bash
for years. He is an accomplished urologist. He's an assistant
Professor of urology at the Oregon Health Sciences University in Portland, Oregon,
(00:40):
where he also did medical school and residency. And then
I was fortunate enough to poach him away to beautiful
sunny Santa Monica for his fellowship at the day of
Geffen School of Medicine at UCLA in Men's Health Maile
Reproductive Medicine and Surgery, and then Oregon was fortunate enough
to steal him right back to the beautiful river town
(01:00):
of Portland, Oregon, where he holds his current position as
assistant Professor of Urology and soon to be named co
director of the Men's Health Program at OHSU. One of
the things you don't know about doctor Bashion. If we're lucky,
maybe we'll get him to hump a few bars. He's
actually also an accomplished a cappella musician. He was in
a band tenor for the band the Testostertones, and they
(01:24):
actually had a hit album still available on iTunes, the Mendorphins.
So this guy not only as a talented musician, but
he eats, breathes, lives, and sleeps testosterone and actually even
sings about it. So it's so great to have you
on board. Jordan is also joining as Jordan as our
producer and on air personality. That baritone and baritone that's right.
(01:48):
And as I said, if we're going to do anything,
all I'm going to do is snap because this raspy
voice ain't good for much else other than carrying a
bucket of water.
Speaker 3 (01:56):
Good to know where well I stand.
Speaker 2 (01:57):
Yeah, I can't tell you how excited I am. I mean,
you know, we met each other last in grape Vine,
Texas at a men's health meeting in Sexual Medicinciety, North America,
where you moderated on one of the subjects and actually
gave a talk on one of the subjects that we're
going to talk about today. And I'm so excited that
you committed to a couple of these shows today, what
I'd like to discuss with you is what about sperm
(02:22):
health and marijuana and the environmental factors in general. Doctor
Bash also did quite a bit of research as a
resident in the effects of marijuana on primates, and so
I think what I would want to do is just
start our conversation just about in general, what can we
do to optimize sperm and then also what kind of
toxins should we be worrying about in sperm health, and
(02:46):
then kind of walk me through all of that. So
just let her rip, Let's do this and let's talk
about it.
Speaker 3 (02:51):
Oh, excellent, let's talk sperm.
Speaker 2 (02:53):
Well.
Speaker 3 (02:53):
I think that there is a lot of hype in
the media that we hear about about declining sperm counts worldwide,
and depending on who you talk to in the sperm community,
they may or may not agree with that, but it
is bringing a lot of interest in people to what's
happening with sperm counts and what can we do to
keep our sperm healthy. The nice thing is, for most
people it's pretty simple. A healthy body produces healthy sperm,
(03:15):
and so anything that you can do for your overall
health in general is going to help your sperm health.
I think when we are thinking about from a men's
health urologist perspective, we're thinking about hormone levels and how
the brain is talking to the testicles and what they're
making of those signals. In terms of someone who just thinks,
what can I do for my own sperm and keeping
them healthy, maintaining a healthy weight, a healthy diet, being active,
(03:40):
and getting good sleep, these are all things that will
help make good sperm. In terms of exposures, when I
think of kind of the three horsemen of exposures to
sperm being tobacco, alcohol, or marijuana, it becomes no surprise
to anyone that none of those things are great for
your sperm health. And there's certainly a negative synergy that
can happen when you start mixing them.
Speaker 2 (04:00):
Yes, well, so that brings up kind of a classic
other point is how much is too much? Or in
other words, you know, I'm a child of Woodstock, and
I'm still here, and I don't know exactly what my
parents did, but somehow I actually I can tell you
they weren't at Woodstock because they were in Russia. But
I will say it touched far. That's right. I don't
(04:20):
think anything got beyond the iron curtain except for a
couple of bootlegs CSN and Y albums that I think
Neil Young is still big over there on X rays.
I believe that's right, exactly right. Yeah, So, you know,
I guess that's the thing is that is there such
a thing as moderation. If a guy's out there listening
today and you say, look, dude, this is too much
(04:43):
like you you got to stop all cigarettes, all alcohol,
all marijuana. A how do you get somebody to comply
with that and be how important is that? Give me
some thresholds of what is okay?
Speaker 3 (04:55):
Yeah, you know, there's been a lot of public health
work around alcohol and pregnancy and so so that has
much clearer messaging. We say, we really don't want women
who are pregnant to be drinking a lot during pregnancy,
if at all, And there may be some changes to that,
but for the most part, that's pretty clear. When it
comes to thinking about sperm health, we have great data
(05:16):
which show us that there is a dose response with
the sperm and the exposure, meaning the more let's say
THHC that you consume, the greater the effect on the sperm.
And that works in the opposite direction too. So if
people say, you know, I'm not going to stop consuming
cannabis completely while I'm thinking about pregnancy, that's okay. If
we can reduce your dose, you're still going to make
(05:37):
gains in terms of having a healthier sperm. Another thing
to think about is that as a men's health guy
and a fertility guy, I usually am seeing guys when
they're actively thinking I might want to make a baby
pretty soon. This is a very specific time of life,
and it is a self contained time and so thinking
that sperm take about three months to make. Anything we
(05:58):
do will take three months to show up with are sperm.
And so if you're thinking I might want a baby
in the next six months, tapering or going off of
whatever exposures you're having, then having a nice, healthy sperm
to make a healthy baby, and then afterwards thinking how
am I going to either be re exposed or change
my lifestyle after that? So a very short window to
(06:21):
think about this doesn't have to be necessarily forever change.
Speaker 2 (06:24):
Okay, I think we want to get into the marijuana thing,
But you brought up something interesting. We were at that
meeting a couple of years ago in Denver where there
was some research presented on the effects of alcohol on
genomic effects on fetuses and for a while. You know, really,
since we were in medical school, right, we always hear
about fetal alcohol syndrome, where alcohol exposure on the female
(06:47):
side is terrible. But yeah, there's some compelling data to
show that even small alcohol exposure on the male side
is bad for sperm and the epigenetic Tell me what
you remember from that as well. I hate to put
you on the spot, but you just kind of really
triggered something in me that I think our listeners should
know that that alcohol also really bad for sperm genomics,
(07:10):
maybe as bad as it is for ovariant function and
egg production as well.
Speaker 3 (07:15):
Yeah, you know, this is the problem with science is
that the closer the look you more you find out
and the more you have to worry about. We see
it time and time again in terms of alcohol. Just
like you said, it used to be all about the
female partner, who's covering making the eggs, what's happening in there.
We did find out that there were epigenetic changes that
happened with alcohol, and so I think it'll come to
(07:36):
as no surprise to the listeners that moderate alcohol intake
in the partner is really important. We see very similar
effects with THHC. So if we look at the actual
DNA of the sperm and changes that are made to
the DNA, we notice there are changes. And I don't
want to sound too inflammatory here, but we have seen
changes in genes related to autism spectrum disorder with THHC exposure,
(08:00):
which brings up a whole host of questions. We also
see changes in the proteins in the ejaculate, So the
proteins that are surrounding the sperm change with THC exposure
and then change back towards being normal with reducing or
removing that exposure. So there is certainly, you know, possibly
generational changes that can happen here more than just what
(08:22):
meets the eye. What number of sperm you have that
we're seeing both with alcohol with THHC I presume with nicotine,
though I don't can't remember that off the top of
my head.
Speaker 2 (08:31):
Yeah, so no booze is good booze, and no weed
is probably good weed. But you hit on a obviously
something that's quite a hot, maybe politically motivated target, and
we try not to get too political in the show,
so we'll maybe ignore what the elephant in the room
is when we talk about autism.
Speaker 3 (08:50):
I'll follow your lead then, but I do think.
Speaker 2 (08:52):
It's, uh, we all know what we're talking about. But
you know, you have actually really good data that THC,
which I think we can all agree has skyrocket in
this country, has actually pretty good evidence that it may
contribute to autism spectrum disorder.
Speaker 3 (09:09):
Yeah. I would say that we have a definite signal
that these things could be related. And you're exactly right.
The availability of cannabis products has far out paced our
understanding of them scientifically. Right, in twenty nineteen, there were
more cannabis defensories per capita in Portland than there were
Starbucks McDonald's Wow, which is shocking. Right, Seattle still had
(09:32):
more Starbucks because it brains supreme there, but similar things
in Denver. And so we've definitely the legal changes and
the availability has way outpaced our scientific understanding, which we're
now doing a pretty good job catching up on.
Speaker 2 (10:09):
Let's get into the weeds here, if we will, And
let's right there, Yes, right, you're already in the weeds.
But how did you get to these data? Tell me
why what you're sharing with me? Let's talk monkey business Jasper.
Speaker 3 (10:22):
Yeah, yeah, let's let's let's get into the monkeys. So
marijuana research is quite challenging for a couple of reasons.
One of them is that a lot of our older
literature that we would go to as kind of the
groundwork is using marijuana products that have no bearing on
current consumption. Right, the amount of THHC in the average
(10:43):
cannabis product now has gone has increased about threefold in
the last two decades. So this is not your grandmother's marijuana.
This is not your mother's marijuana. This is a whole
new thing. And then we're Diesel ultra dank, very loud.
So when we're talking about these products, then we do
things like concentrates or edibles where the TC levels are
way higher, and so it's hard to use older data.
(11:06):
So now we think we need new data. Very hard
to study this in people. You know, there have been
studies in dispensaries just going around, hey, how are your
erections on marijuana. That's not a great way to get information, right,
And you'll hear reports of people saying my sexuality, sex
life is much better with marijuana, and then you'll also
have reports to say it's way worse with marijuana, So
(11:27):
trying to use people for this is very hard. The
best setup you could do would be, let's take a
group of guys who have had no use of cannabis.
Let's put them all on heavy doses every day for
a year, and let's see what happens to their sperm count.
Very hard to find that population, right, we can do
that in an animal model, right. We can take animals.
(11:48):
We can give them a little cookie with THHC on
it every day and we can see what happens to
their sperm count, their testicle size, their testosterone levels. And
we did that. So we have an incredible group here
in Oregon who does amazing research, and we did this
on a primate model. It's a pretty good setup. Getting
(12:08):
a THD cookie every morning and then having your sperm
examined every few months, and we found some pretty remarkable
stuff that I'd be happy to share. We saw that
as these very lifelike in terms of similar to human
dosing doses of marijuana are given, testicles are shrinking and
they shrank by about fifty percent. So that's something that's
(12:28):
pretty easy for guys to wrap their minds and their
hands around. Right, So fifty loss of testicular volume. We
saw those changes we talked about with the sperm DNA,
so concerning changes for sperm DNA and with the proteins
in the fluid around it. These animals have way higher
sperm counts than humans do, and so it's a little
(12:49):
harder to compare them to humans, but we did. The
most interesting thing I think is that once we took
the THHC exposure away and we had a wash out period,
estical volume expanded, testosterone and estrogen levels, those main hormones
we think about fertility went back towards normal. The DNA
changes back towards normal, and I think that's very powerful.
(13:11):
So when I talked to guys in clinic we're using
high doses daily THHC, I say, you know, all is
not lost. We've still got time to decrease or stop
that exposure and get your sperm healthier again.
Speaker 2 (13:24):
So how I'm not trying to ask this. I think
I know where this is going, But there's somebody out
there that's going to ask, how did you How did
you actually study the monkey sperm? How did that happen?
What were you getting up pretty early in the morning
and putting on that that's the thing. Are of primate porn?
(13:45):
Or how do you get monkey sperm to study? Do
you want me to ask?
Speaker 4 (13:48):
Is it better coming for me? I don't have a
medical license?
Speaker 2 (13:55):
Tell us what is the how do you get a
sperm sample out to study? And what are the pitfalls
associated with that? Yeah?
Speaker 3 (14:01):
Well, the hardest part is actually getting there to the
monkeys before they do it themselves. And so the first
thing to do when you show up is look around
the cage and look in their palms and make sure
they haven't already taken care of business for the day.
Speaker 2 (14:13):
So there's wake and bake and wake and shake, is
what you're saying.
Speaker 3 (14:17):
Yes, may they cohabitate beautifully Johnny Carson golf swing.
Speaker 2 (14:21):
There you go.
Speaker 3 (14:22):
And so if that hasn't occurred, then we're able to
do is they're able to sit in a little chair
that we train them to sit in, and then we're
able to do a stimulation that creates a reflex arc
that has them ejaculate. So we're able to do this
doesn't require any sedation. They're trained on how to do this. Again,
it's all about getting there before they do.
Speaker 2 (14:43):
The early bird gets something at least Okay, well, so
essentially what I'm hearing is that cannabis really not good,
but it's reversible. So walk me through. You kind of
gave us a little bit of a clinical scenario. But
you say, I'm a thirty year old guy and my
(15:04):
partner's my female partner is twenty eight, and she is
a teetotaler. It doesn't do anything, But I am a
habitual cannabis user, and we really want to have a baby.
Do you think we just pulled a goalie and go
for it or something I should do to pregame at thirty?
How long is it going to take for me to
(15:25):
wash out? Or or should I or should I just
take the woodstock approach and see what happens?
Speaker 3 (15:30):
Well, I would say that the if your partner is
on the younger side to twenty eight being quite young.
When it comes to fertility, I'd say that even though
often couples want a baby yesterday, there's time here, and
so I think that the prudent thing to do would
be to stop using cannabis if possible. Stop that. We
(15:51):
know again sperm take three months to grow. I would
say six months. We don't really have clear data on
exactly when effects will be gone. I think six months
will be a very reasonable time to say we've had
two cycles of sperm being produced. Six months would be
a great time to start thinking about having trying for
a baby after stopping or at least really reducing cannabis intake.
Speaker 2 (16:13):
And is there anything else you do because you mentioned
that in your primate experiments that not only does particular
volume go down fifty percent, but there are some hormonal
changes as well. Is there anything that you would do
on a routine basis? I mean, I assume you're screening
for testosterone fsh you know, the sperm production hormone. Have
(16:34):
you noticed or do you eve even a data to
show whether doing some kind of hormonal modulation will help
hickstart that for example, you know we're going to talk
about testosterone recovery as well for sperm production, but with
marijuana exposure, THC exposure, do you do any kind of
you know, sort of boost protocols to get these guys
(16:55):
up and optimize sooner or talk to me about that. Yeah.
Speaker 3 (16:58):
Absolutely. When I see a guy clinic for fertility, no
matter if he says, oh, I've had chemotherapy exposure, I've
had THHD exposure, No matter what, he's getting the full
meal deal in terms of work up. So I'm looking
at his testosterone estrogen, I'm looking at the signals from
his brain LH and FSH, they're talking to his testicles.
Of a physical exam looking for things that might be
(17:19):
causing issues, and then a semen analysis for a guy
with THHC our research shows that the issues are both
in the pituitary in the brain as well as in
the testicle, so you're often there are perturbations or issues
in both spots. If a man has low signals from
the pituitary, I will often reach for a medication like
(17:42):
clomaphine or clomate that can boost those signals. Tell the testicles, Hey,
time to do something, wake up a little bit faster.
So I'll use a very similar testosterone recovery protocol as
I would to other exposures that will decrease testosterone to
try to get things going. Get sperm numbers up quickly.
Speaker 2 (17:57):
Great, and I assume you get a baseline even analysis
see where the guy's starting at. Do you routinely and
this is really wonky, but for people that are that
are super granular, do you routinely look at DNA fragmentation
and disease in guys when you're doing that screening seam
analys because I think you also mentioned that a little
bit in your primary studies that the DFI or at
(18:19):
lest their DNA mutations, which a little bit different than
just doing a screening DFI. But is your utility in
that as well.
Speaker 3 (18:27):
Yeah, So DNA fragmentation index somewhat of a new test
looking at double stranded breaks in the DNA of the
of the sperm. We think about that in terms of
overall quality of sperm DNA, and we know that thankfully
the egg can make up for a lot of issues
with the sperm, as partners do later on in life.
But if there's too many breaks in the DNA, we
know that that those can overwhelm the eggs ability to
(18:49):
repair them. I don't routinely check that on patients who
are using THHC because number one, there's a lot of
varry in between different laboratories and how they report with that.
Number number two, there's not a direct connection. And I
like to tell guys, if there's something obvious that we
can fix, let's fix that first, and then if there's
(19:10):
still problems, we can look for DNA fragmentation and look
at that. So if there's something obvious like THHG exposure,
I say, let's just fix that. Now we know that's
a good thing for fertility. If we're still being problems
down the line, recurrent pregnancy loss, it's things aren't working
after you know, eight to twelve months of trying, then
we can do more investigation there.
Speaker 2 (19:53):
Yeah, I love that, And I would say number four
to that, I think you got up to three. Number
four is that you know, why order a test if
it's not going to change your management and you're going
to treat those people the same And I think one
of the things that we run into in this kind
of meta verse of overtesting and granularity is that you're
(20:13):
not going to do anything differently with the guy anyway.
You're going to treat him the same way and you
hope for the same results. And if there's still a deficit,
then you say, okay, well maybe we have to look
at something a little bit more in depth. Exactly makes sense. Okay.
So there's a segment of this program called am I
going to be okay? And essentially what I want to
know is if I had a problem, like I just
(20:35):
love the yeerba, and I can't get off it. And
I still want to edibilize or smoke in moderation, and
I just can't get off it. Can you see? Is
there anything you can tell me that my relative risk
is going to be okay? In other words, would you say, look,
you just shouldn't pro create, or say, you know what,
(20:56):
you're probably going to be okay? Talk me through that,
you know it. Counsel me on a guy that just
is absolutely you know, inable to unable to get off weed.
Because a lot of listeners are hearing this and they're
going to think oof. Man. I mean, this is such
a big part of me. It normalizes my mental health
and h but I really want to be a dad
(21:17):
as well. So I don't want to put you on
the spot because is a physician, You're always going to say,
you know, this is what you should and shouldn't do.
But we live in the real world where guys really
rely on on their marijuana exposure for you know, for
optimal mental health. Am I going to be okay if
I just take a little like a couple of gummies
a day.
Speaker 3 (21:34):
You know? Practicing here in the Northwest, I've got a
lot of guys who come to me and they are
on THHC for medical reasons and really can't find a
way to taper off of it for the fairly extended
duration of time that it takes to make spirm, have
a baby, and then raise that baby. I think that
your comment earlier about how many babies came out of
woodstock and its doing pretty well is very well taken.
(21:55):
Things that one could do if they're thinking, is it
even reason will to try to make a baby? I
think yes, it is things that people could think about doing.
Trying to decrease the dose, if possible, of THHC consumed
every day, if THHC is really the go to for
things that help a person trying to decrease other things
(22:15):
like smoking tobacco or drinking alcohol, and saying, all right,
if this is gonna be what I'm hanging on to,
I'm going to decrease those other exposures because we know
those can have a synergistic effect in a bad way.
And so focusing on decreasing risk of other exposures and
decreasing TC as able, I think that leaves it very
reasonable to pursue pregnancy.
Speaker 2 (22:37):
I love that. Yeah, I think that's you know, a
big part of my practice is meeting guys where they're at,
and I think that gives a lot of hope, and
it also gives them some action items. Because one of
the things that I hate about the way a lot
of men come to our clinic and they're told this
by other physicians that you have to do this, they
have to do this, just a little bit of kind
of patient bashing, and and I think, you know, if
(23:00):
you're what you're doing is you're empowering patients to say, look,
we get it. There's some things that are just unchangeable
for you. But but what if you did this instead?
You know, what if you got an extra hour sleep,
or what if you walked thirty minutes more a day,
Then you know, maybe you counteract some of the habits
that we know are not good for you but maybe necessary.
So that's sage advice for the young professor from Oregon.
Speaker 3 (23:25):
Thank you.
Speaker 2 (23:26):
One of the other things I love about this show
is that that I get to spend time with men's
health experts. And so I'm going to ask you, as
a men's health expert who is svelt and fit, and
I know a lot about what your exercise habits are.
But what are your must have to keep you in
(23:47):
good shape? What do you have to do? What are
your rituals that you can impart to somebody listening out
there about how they can be just a little bit
more like doctor Jasper.
Speaker 3 (23:56):
Pash, Well, let's see, you know, on the eat, move, sleep.
I'm triangle. That changed me pretty drastically about six months
ago with the birth of my daughter. She's amazing. Yeah,
she's incredible. She brings a lot of joy and wellness
to my life. But as you and your listeners who
(24:16):
have children will know, it's real game changer in terms
of schedule, in terms of how life works. So when
I think about that, I think about what I can
control of that triangle. Sleep, no surprise to anyone, is
not something I can control very much anymore. And you know,
and that's okay. Moving is something that I can control moderately.
(24:38):
So my wife is also a physician, and it means
we have for pretty busy weeks, but on the weekends
we can mostly keep time that both of us can
alternate taking care of our daughter and exercising. I'm a runner,
I'm a cyclist. I like to lift heavy things and
I'm very fortunate to have a treadmill, a stationary bike,
and some heavy things to lift in my garage, and
(25:00):
having that so near me and so easy to access
really lowers the bar to me just going out and
exercising during an app when I have a moment free.
The third point of the triangle, being eat is where
I have the most control. I think about what my
grandmother used to say, which is that flexibility is our
middle name, and so I try to not hold on
(25:20):
too tight to any one schedule, because when you have
a baby, there is no schedule. But I think if
I'm having a big workout day, I'm going to eat more.
I'm going to make sure I'm eating more protein. If
I'm having kind of a light week in terms of
being able to exercise during the week, I'm going to
dial it back for more of a calories in, calories
out approach. And then just again being flexible of myself.
(25:41):
And if we're going out to eat on the weekend
because we're having a good time, I'm going to be
a little bit looser. But I think focusing on what
I can control, not worrying as much about what I
can't control, and then focusing on. That nice mix of
cardio and lifting is keeping my body in fairly good shape,
and I I think it'll be give me a longevity boost.
Speaker 2 (26:02):
I love it well. And you know, the thing about
kids is what they lack and sleep they make for
in joy.
Speaker 3 (26:08):
One of these things many times over.
Speaker 2 (26:10):
Many times over. And the other thing about your kid
is if you're lucky enough to have a good relationship
with her as she grows older, if you lift her
every day and she gets heavier, by the time she's twenty,
you'll be lifting you know, one hundred and ten pounds
or something. And one of the reasons I'm in such
great shape is because my kid was an offensive lineman
in college football. So I picked him up when he
was seven pounds, and when he was three hundred and
(26:31):
ten pounds, I actually couldn't pick him up anymore. So
maybe that's a bad example, but.
Speaker 3 (26:35):
I thought, day to carry your fellows every day to clinic,
that's a miracle.
Speaker 2 (26:38):
That's exactly right. Well, I don't, yeah, that's usually you
guys lose weight in my fellowship. That's the problem. You know,
you're so busy that you drop ten pounds. But doctor Bash,
I'm grateful for your time sharing your incredible wisdom not
only on men's health writ large, but also about a
very specific topic about THHC and its effect on sperm
production as well as hormone production. So again, grateful to you.
(27:01):
And I think my take home message from this is
moderation to none at all, abstinence is probably better. And
you really have have you building a great body of
literature on all of the effects of testosterone UH and
sperm production that that marijuana has and and and I
applaud you for your work up there, your your lab,
(27:22):
and your your university as a whole. So thanks very
much for your time, and I appreciate you talking about
it with us.
Speaker 3 (27:30):
That's been a total pleasure. I love sharing this information
because I think it's helpful for people who are thinking
about it. It has a lot of hope in it,
and it has a lot of actual points. So thank
you for having me on. It's a total pleasure.
Speaker 1 (27:48):
Let's talk about it. Let's talk about it a ma,
let's talk about it. Let's talk out of a mailroom.
Speaker 4 (28:11):
The mail Room with Doctor Jesse Mills was a production
of iHeartRadio. It was executive produced by Jordan Runtogg. It
was edited, mixed, and mastered by Beheid Fraser and the
theme was provided by long Transit. If you like what
you heard, please subscribe and leave a review. For more
podcasts from iHeart Radio, check out the iHeartRadio app, Apple Podcasts,
(28:33):
or wherever you listen to your favorite shows. This program
is intended for educational and informational purposes only. It is
not a substitute for professional medical advice, diagnosis, or treatment.
Consult your healthcare provider for any medical or other related
questions or concerns. The views and discussions aired on this
podcast or those of doctor Mills and do not represent
(28:56):
the official positions of UCLA or UCLA Health
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