November 24, 2025 • 33 mins
Discover how to boost your healthspan, lifespan, and sexspan with Dr. Mohit Khera, urologist at Baylor College of Medicine. Michael Berry explores testosterone therapy, erectile dysfunction as a health warning, and lifestyle strategies for better energy, intimacy, and longevity. Learn actionable tips for diet, exercise, sleep, and stress reduction to optimize your health and relationships.
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Episode Transcript
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Speaker 1 (00:03):
It's that time, time, time, time, luck and load. So
Michael Varie Show is on the air. Today's show is
(00:26):
sponsored by Peanut Butter for pure versatility of application, ability
to make anything it touches better, and shelf life. I
don't know that there's anything better that comes in a bottle.
I really don't. I really don't. Let's just take a
(00:48):
moment and think about your best peanut butter moment. Ramon.
Your peanut butter moment should not involve sex. But my urologist,
doctor Mohith Care is our guest. Welcome to the program.
Good sir, Thank you, Michael. Everyone has a lifespan, Ramon.
You know that you have a lifespan. We talk about
(01:10):
our life span. Doctor Mohit Kara is writing a book
called Or about the sex span. How long can a
human being have a functional, fulfilling sex life, doctor Kara?
Why does that matter?
Speaker 2 (01:27):
Well, Michael Sphers, thank you for having me on the show.
You know everyone where you go, every where, talks about
lifespan and health span. That's the big buzzwords in the community.
And I'll give you an example. Everybody wants, I assume
their health span to last as long as their lifespan.
But in the United States, the average health lifespan is
seventy seven years old. Women live typically seventy nine years old,
(01:50):
men live typically seventy five years old. But the health
span in the United States is roughly sixty seven years old,
which means most of us for the last ten years
of our life are not going to be living in
a healthy condition, which.
Speaker 3 (02:02):
Is very unfortunate.
Speaker 2 (02:03):
And all these countries talk about how they're expanding their
lifespan and getting people to live longer. In my mind,
that is not what I want do, not expand my
lifespan without expanding my health span. But this concept of
sex span is also important because many men would say, look,
I said, if you're going to live till eighty, but
you can only have sex till fifty, that's a problem
(02:25):
for many men. And so what we want to do
is try to expand our sex span and our health
span as long as our lifespan. I think that's a
really important point.
Speaker 1 (02:37):
I know. One of the things I like about you
is that you don't just rely on what you learned
in medical school and then mail it in every day.
You're constantly reading studies, you're constantly performing research and publishing
and speaking literally around the world, because you're always somewhere
else when I call you just to see what you're
up to giving a speech on this or that. How
(02:57):
important is sex to the human body in terms of
purely physically.
Speaker 2 (03:04):
Yeah, it's extremely important. So I want to just clarify
one thing. A rectile dysfunction is not a disease. It's
a symptom of other underlying diseases. Right, So ED does
not happen in healthy men as they get older. If
a man gets a rectile dysfunction, it is a symptom
of his diabetes, it's a symptom if his Cardiovasker disease,
(03:24):
it's a symptom of his radical procestectomo surgery. Or it's
a symptom of depression or anxiety. So when someone develops
a rectile dysfunction, the second question you should be asking
is what else is going on that's causing this condition?
Because if he was perfectly healthy, that would not happen, right,
And so the best example I can give you is
(03:45):
this is that if did you know that if a
man walks in today and has a rectile dysfunction, fifteen
percent of them will have a heart attack or stroke
within seven years fifteen percent. It's an underlying marker of
cardiovask disease. If a man walks in with ED today,
thirty percent of them have a cult diabetes thirty percent,
which is a lot. And if a man walks in today,
(04:07):
thirty percent of them will have depression or anxiety. So
the biggest mistake I can do is give this man
viagra and getend him on his way, because maybe he
has that occult cardiovask disease, maybe he has diabetes, Maybe
he's suffering from depression or anxiety. So it's really important
to figure out what is causing that ED. And what's
(04:27):
so nice about this is that there's a bi directional relationship.
So if I treat a man's ED, that actually improves
his depression. If I improve a man's depression, it actually
improves his ED. So I think the paradigm is shifting.
No longer do I want to just hand the man
the pill. You've got to figure out what's going on underneath,
because this is what I call the canary in the
coal mine, and you can actually save someone's life. I mean,
(04:49):
imagine if I catch someone's cardiovasker disease today, or diabetes today,
or I catch it ten years from now. It's a
total change in trajectory in terms of their house in
their life.
Speaker 1 (05:01):
Well, it goes back to viagra originally being a cardiovascular
disease in a off label benefit being the ability to
get erection.
Speaker 2 (05:12):
Yeah, Michael, that's a funny story because remember this one.
But they were trying to make a blood pressure medication
and accidentally everyone in this study was getting erections, and
they figured it out because people were not returning the pills.
Speaker 1 (05:29):
I had a friend, I was a baby lawyer at
the time at a firm called Jakins and Gilchrist and
I worked with a guy named Darren Alt who was
my best friend there. And his wife, Tracy, was the
head of Viagra in Houston, which was the top market
for viagra in the country, and they were taking a
trip every other week with their sales reps, and they
had all sorts of stories of people and at that
point it was still you'd go to your cardiologist to
(05:52):
get viagra, So everybody was faking a heart problem to
go in and get this medication. And the story goes
that the doctors getting calls from the wives going hey,
knock it off. Take him off of that.
Speaker 2 (06:05):
Right, right, right right, yeah, absolutely, And so you know
what the issue is is that ED back then was
not considered a very serious condition. People used to make
fun of it, and oh he has ED. ED is
a very serious condition. Someone gets erected on dysfunction, take
it seriously. Something else is going on.
Speaker 1 (06:23):
Well, and to oversimplify this, that is because it means
you're not getting proper blood flow or you're not pumping
your your blood properly. And that's I guess as good
a way as any for us to check, maybe the
easiest way.
Speaker 3 (06:38):
Yeah, And so think about this.
Speaker 2 (06:39):
I teach their medical students this new monic called vent
vascular meaning there's not enough blood flow coming in or
there's too much blood flow coming out. And too much
blood flow coming out is the most common cause of ED.
So the guy will tell you I can get the erection,
but I just can't maintain it. He's telling you the
blood flow's coming out too quickly. The number one cause
of ED in the world. But VENT stands for a
(06:59):
vascal E means androcrine. It's a testosterone. The testosterone goes low,
ED goes up. Neurologic meaning nerve injury and then trauma.
And don't forget medications. Medications from notorious for example, beta blockers.
How many people are Beta blockers shuts down the erections.
Antidepressants shuts down the directions. So you've got to look
at all the different causes for ED. And I just
(07:22):
want to stress one other thing. Sexual dysfunction is a
couple's disease. You know, we're so fixed on these silos.
I got to take care of the woman, I got
to take care of the man. You got to look
at both of them. I'll give you an example. Back
in two thousand and seven, I finished my fellowship, and
I was so proud of myself. I was able to
get these men, these amazing erections, amazing libido. And one
(07:42):
day a woman called me and said to me, she said,
everything was great with our relationship until he met you.
We never fought. We fight all the time because every
day he wants to have sex with me and I
don't want to have sex with him. And you've ruined
our relationship. And I thought to myself, she's right. What
is the point of raising one libido without raising the other.
Either leave both libidos low, It's fine, leave them both
(08:05):
low or raise both, but you don't raise one without
the other.
Speaker 1 (08:09):
Doctor Mohit Kara at the Baylor College of Medicine and
my urologist and friend coming up. The book will be
I got to get the name of it. It's about
the sex ben maybe calver sex ben remontination. It's a
hard problem to everyone listens the Michael Verry Show. The
only downside to having doctor Mohit Kara on the air
(08:31):
as our guest is then people ask me how to
get in to see him because it takes so long
to see him because he is so insanely popular. Everybody
I know is now his patient after hearing my experience
with him. He's just fantastic. I think the world of him.
(08:54):
Doctor Mohit Kara is at Baylor College of Medicine where
he is a urologist. He has a forthcoming book. Is
the book called the Sex Span Moment or what is
the book called?
Speaker 2 (09:05):
It is called sex Span and a Proactive Approach, A
proactive approach to prolonging your sexpan.
Speaker 1 (09:13):
So, as we were going into the break, you made
a statement about if you help a man build his
libido and his sexual function, but you do not concurrently
do that for the woman, you end up causing problems
for them. Let's take the physical out for a moment.
In your opinion, how important is sexual relations to a
(09:35):
couple and to an individual emotionally? You tied it to
the antithesis of depression, but talk about that if you would.
Speaker 3 (09:43):
It's extremely important.
Speaker 2 (09:44):
If you look at couples that engage in regular sexual activity,
that tend to be happier overall, satisfied with their quality
of life, they usually tend to be healthier, and they
usually tend to live longer. So there are numerous aspects.
So there's a one study that I saw that talked
about the couples that engage in do not engage in
sexual activity typically can have a twofold traction from their relationship.
(10:07):
But if they do engage sexual activity, it actually can
add four x to the quality of relationship.
Speaker 3 (10:12):
So I mean, let's be honest.
Speaker 2 (10:13):
I mean it does bring intimacy and closeness to the relationship.
It does strengthen the quality of the relationship, and in
many cases people find this extremely important. So I do
think that there is a medical benefit, psychological benefit and
patients engaging in sexual activity.
Speaker 1 (10:30):
I have had friends over the years who when they
put their parents in old folks homes, they talk about
how it is surprising how much activity there is in
the old folks home. And when I did that for
my dad earlier this year, that was one of the
things that everybody consistently across the board talked about. I
don't know if there's any if there's anything to that,
(10:51):
but we're talking about people in their eighties and nineties,
and I have heard this story consistently.
Speaker 2 (10:57):
You're actually right, So one of the highest levels of
STDs do occur in nursing homes. So you do know
that there's increased sexual activity that does occur in those
in those nursing homes, and so, but part of it
is because there's at some point, there's an inflection point.
As you live longer and longer, those patients that are
the healthiest tend to live the longest, and those patients
(11:19):
who are tend to be healthier tend to be more
the ability to engage in sexual activity.
Speaker 1 (11:24):
When you and I talked about the book the first time,
you said that one of the things that the book
is going to cover is the importance of screening for
testosterone and how rectal dysfunction is a marker of other
underlying major medical conditions, such as a heart attack. The
screening for testosterone, why is that important?
Speaker 2 (11:43):
So, Michael, I am very passionate about this topic because
you know, everyone thinks about testosterone as energy and sex
drive and erections. And yes, it's true if you have
low energy, low libido, rectal dysfunction, giving a man testosterone
can improve these symptoms. But now we're in an era
where it goes way beyond that. So did you know
that a man who has low testosterone is much more
(12:05):
likely to have a heart attack, non negotiable, much more likely.
A man who has low test osoe is much more
likely to break a bone. A man who's low test
osom is more likely of diabetes obesity metabox syndrome. A
diet man who's low test awsome is much more likely
to suffer from depression. And giving a man back his
testosterone can help mitigate improve these conditions. So it's not
(12:25):
just about sex, it's about your overall health. The problem
I have is that when I walk into my primary
care doctor's office every year and he checks my blood,
he does not check an annual testosterone. He'll check a
thyroid he'll check a TSH. I say, why are checking
at TSH? He said, well, we do that every year
to make sure you're not hypothyroid. There is not a
better marker of a man's overall health than a testosterone level.
(12:48):
It gives you a marker of what his health is today,
and it gives you a marker of what his health
will be in the future. And so every man over
the age of forty, every single man, should be getting
a testosteronal level every single year days of forty, because
I do think it's the best predictor of his overall
health currently and in the future. And it's modifiable because
there's things I can do to improve his testosterone if
(13:09):
he's low.
Speaker 1 (13:10):
You suggestive testosterone for me ten years ago. I know
you weren't going to talk about it because you're the doctor,
but I can, and obviously it changed my life. It
made a huge difference for me. But when you do
that for folks, what kind of differences do you typically see?
Speaker 2 (13:28):
Well, the first thing you have to ask yourself is
are they young and do they want to have children?
Because most people don't realize that giving testosterone actually shuts
down your fertility. So I can't tell you how many
patients I see in my practice every week that said, look,
I was started on testosterone or no one told me
that the testosic could make me infertile. Now we want
to have kids, what do I do? So there's the
ways I can reverse it. So the reality is, if
(13:50):
you're in the reproductive years, if you're planning on having
children and your tea is low, don't take testosterone. But
let me give you medications that make you make testosterone.
That's safe. So I can give you medications to make
you make testolstone and that will enhance your fertility. But
if you're older and you're not trying to have children,
then there are many ways to give a man testosterone.
(14:10):
We now have oral test alstone, which is fantastic world
testawsal is very new in the United States. It's only
been out for five years. And that we have a pill,
we have injections, we have peallets, we have patches. But
I will tell you that I do think that this
medication can have a profound effect on the quality of life.
And many patients, many patients come in, they're thanking you,
they're telling you that they have a significantmrovement in the
directions or libido muscle mass.
Speaker 3 (14:31):
Not everybody.
Speaker 2 (14:32):
I mean, there are patients that don't respond, but the
majority of patients who start out low do see a
significant improvement in their quality of life.
Speaker 1 (14:41):
I was talking with one of our show sponsors, Wayne Wilson,
who owns Synergenics, and he said, hey, you're urologist. Is
the one who came when we started, I guess with
pellets or whatever, and came and talked to them about
testosterone and obviously that's what they do all day, every day.
And he went through the various things that you talk about.
(15:04):
I mean he took note. He's a physician's assistant by training.
But it was amazing to me. You were the god
of testosterone as far as Syenergenics is concerned, and I
didn't know you had an association with him.
Speaker 2 (15:17):
No, I appreciate it. I mean, I have been very
passionate about this for about twenty five years. So all
my basic science work, all my lab all my clinical
trials are around this topic. So when it comes to
teaching and education to others about testosterone, I'm all in.
Speaker 1 (15:32):
One this moment. Doctor Moti Kara is our guest. He's
at Baylor College of Medicine, and I'm going to start
with the question everyone always asked, well, am I more
likely to get prostate cancer? Mike, weren't you worried about
prostate cancer? We'll ask him that coming up with his
finger on the pulse. The King of Ten continues on
the Michael Berry Show. Doctor Mois Kara my urologist and
(15:57):
friend of Taylor College of Medicine and international renown as
a speaker on issues of sex, urology testosterone. Forthcoming book
is called sex Span, which talks about the length of
time in which a person has a functional sex life
(16:23):
that will be out relatively soon. Doctor Kara, I received
an email from a fellow named Doug who writes three
minutes ago, I figure your interview is pre recorded, but
if not, I'm curious about blood clots. I had a
pulmonary embolism and they told me to stop taking testosterone.
I used to go to the Low T Center and
(16:44):
had a great experience experience with the treatment. I miss it.
I hate that I can't take it anymore. Does doctor
Kara have a thought about that?
Speaker 2 (16:54):
I do, Michael, so listen. There was a concern for
that in twenty fifteen and the FDA asked a conduct
a large trial. It was called the Traverse Trial. I
was fortunate enough to be involved in that trial with
myself and eight other physicians, and we designed this trial
with several hundreds of millions of dollars and the goal
was to see if it caused increase in cardiovascar events
(17:14):
and prostate cancer. What it did find was there was
no increase in heart attack in those men taking testaws
on versus placebo. We had over five thousand patients. We
followed them for four years, and there was no increased
risk in DVT, but there was a slight increased risk
in pulmonary embolism. And the difference was a difference between
point five percent and point nine percent, So there was
(17:36):
a slight signal. And I think it's very important to
counsel patients when they ask about that. So I guess again,
you know, I don't believe that. I personally don't believe
the test OSA increases a risk of DVT and pulmonary embolism.
I think the difference was small, but the Traverse trial
showed what it showed. Also, I just want to mention
(17:58):
it showed no increased and prostate cancer and no increased
risk of worsting of urinary symptoms.
Speaker 3 (18:04):
Great study, traverse trial.
Speaker 1 (18:07):
Why do you think this is out there? Because I
have a friend who started on testosterone, heard me talking
about it. He starts on it, three months later he
gets prostate cancer. He a text message says, Hey, I
just want you to know I just started on testosterone
and I got prostate cancer. You need to be careful.
And my immediate response was, you haven't been on testosterone
(18:30):
long enough. Even if it did cost prostate cancer for
it to have caused that, if there was no testosterone
supplement out there, men still got prostate cancer at rapid,
at large rates. You can't blame every one of them
on testosterone.
Speaker 2 (18:46):
I absolutely agree with you, And I got to tell
you where it started from. It started in nineteen forty
one when Huggins and Hodges published the famous paper I'm
showing that when you give a man test increases a
risk for prostate cancer. If you and I go to
the library right now, puld that paper, you're going to
find something very interesting. It was based on one patient,
one patient, nineteen forty one, and we'd instilled fear in
(19:07):
us for so many years. The good news is in
twenty eighteen, my society, the American Neurologic Association, said testosterone
does not increase the risk for prostate cancer, strong recommendations,
So we do not anymore have a concern that testoster
increases the risk for prostate cancer. I'll tell you a
very interesting story. If I had metastatic prostate cancer all
(19:30):
over our body and we walked into Johns Hopkins University today,
they would There's a trial where they put us on
high doses of testosterone to reverse the prostate cancer, and
it works. It reduces the PSA, reduces the metastactasey. So
we're learning a lot about testosterone prostate cancer, and this
concept that testoster increases the risk, I think to.
Speaker 3 (19:51):
Me is a myth. Michael, I want to bring up
one other important thing.
Speaker 2 (19:54):
You talked about this earlier about testosterone, and you said
when you give testosterone, does it make people feel better?
But I tell patients that you've got to understand just
something that's just as important. It's lifestyle modification, diet, exercise,
sleep and stress reduction. I don't have a pill on
the planet stronger than diet, exercise, sleep and stress reduction.
(20:15):
And every day when we wake up or when we
go to sleep, we should ask.
Speaker 3 (20:19):
Ourselves what are we going to do on diet, exercise.
Speaker 2 (20:21):
Sleep and such stress reduction. I call that offense I
four things on offense, and then I call it four
things on defense. Only four ways you and I are
going to die. We're going to get cancer, we get
a heart attack, we're going to get metabolic disease, mean diabetes, obesity,
or we're going to get parking center Alzheimer's.
Speaker 3 (20:38):
So on the.
Speaker 2 (20:38):
Defense, every day we should ask ourselves how are we
going to keep those four things away? And our offense,
how we're going to move our health forward with those
four that I think is a really important point I
wanted to get across. We have a big program on that.
I mean every time someone comes in, I have a
program for their offense and defense. It's really important.
Speaker 1 (20:57):
The four on offense, which you have pre since they
I met you, diet, exercise, sleep and stress reduction, and
do you have four on defense?
Speaker 2 (21:09):
The four on defense are absolutely so it's cancer, which
means it's a heavy cancer screen call ANOTS, could be PSA.
Sometimes we'll do imaging as well. There are new tests
that come out called gallery there are others called the
liquid biopsy test. I mean there's ways to image and
to look for patients who may have potential cancer I have.
Cardiac screening is extremely important. You can sometimes you know,
(21:32):
you'll get certain labs like APO, B LP, LITLEA. Sometimes
we'll get a Cornery calcium score to look at the
heart to make sure there's not increase calcium metabolic disease.
You want to make sure that patients are watching their sugars.
It's a silent killer. Sometimes we'll put a CGM, which
is a continuous glucose monitor on them to help them
look at their sugars to make sure that they get
the feedback to say these are the foods I should
(21:54):
stay away from. And then you know, there's not a
lot you can do with Parkinson's and all sign There
are certain tests that you can look at. Some genes
you can look at to see if you're a higher risk.
But you know, if you are at a higher risk,
you can start altering your behavior, expers, you know, and
doing things. So it's really important to keep the bad
things away and use the diet, exercise, and sleep and
(22:16):
stress to move your health forward. In that paradigm. Most
people get the concept of offense and defense four and four,
and it's really worked well for a lot of my patients.
Speaker 1 (22:26):
I don't know if I've told you this. Doctor Mohit
Kara is our guest kh E R at Baylor College
of Medicine. I don't know if I've told you this,
but on Christmas Eve, Ramone got a CGM continuous glucose
monitor and he started monitoring his blood sugar. And he
keeps his blood sugar at a very steady between one
(22:49):
and one thirty, usually about one point fifteen. The first
thing I do when I walk in the studio every
morning is he's already here. Is I ask him for
the number he sees me coming up the stairs and
he will write it down and show it on a
sheet of paper or from the door and tell me.
And it has absolutely changed not only his health but
his mood. I mean, he is consistent, he can work harder,
(23:10):
he can work longer by just stabilizing blood sugar, which
obviously for most people is fluctuating with great volatility.
Speaker 3 (23:19):
I love that story.
Speaker 2 (23:20):
I think that's a see and I see that all
the time because the reality is there are foods that
you're eating that you think are healthy and they're not.
And the foods that you think that are not that
healthy are you know, and you know, I put a
CGM on my wife and we went to the same
restaurant once we ate the exact same thing, and we
got totally different numbers. Because part of it's also genetics, right,
so that can play a role in it as well.
(23:42):
But learning more about what is bad and what to
stay away from is extremely important because if you give
yourself feedback, and those who take feedback very seriously, you
can really alter the quality of their life because that
sugar is just pounding the blood vessels, just pounding them.
Speaker 1 (24:01):
My dad's a lifelong diabetic. He was nineteen when he
got DIABETESES eighty five. Now it's amazing. He has all
ten fingers and toes, but he has monitored. He's I've
had doctors tell me your dad knows more about diabetes
than we do because he had to treat it before
they was instantly. But I take Ramon to see him
last week, and all they talked about was their cgms
and their dex com CGM and what the reading was
(24:21):
and what this was and what that was. It was.
It was pretty funny to watch home with me for
one more segment if you can. Doctor Mohit Kara is
our guest. The book is The Sex Span, and we
will double back to that subject coming up from Portland
(24:48):
through Waldeny at all Greek cities in between. The Michael
Barry Show is nationwide. Doctor Mohick Kara is our guest.
He is my friend and my urologist and an expert
in matters of sex and testosterone. I will read to
(25:10):
you as email from one fellow says, well, let me
go back to that. Another fellow, actually several fellows said,
my wife's libido is way lower than mine. How can
he increase a woman's libido?
Speaker 2 (25:28):
That's a really important point. So you know I told
you earlier that couple that got the woman that called
me that was very upset. So in two thousand and
eight I actually flew out to California to the Many
Fellowship in Female Sexual Dysfunction and I started treating women
for the past seventeen years because you can't just treat
one person without treating the other. And when you improve
both libidos, you actually it's synergistic. So women, this female
(25:50):
sexual dysfunction is comprised of four components low libido for
arousal meaning poor blood floats of the genitalia, or gasmic
dysfunction or pain.
Speaker 3 (26:00):
It was sex.
Speaker 2 (26:00):
If she has any one of those four and is
bothered by it, she suffers from female sexual dysfunction. And
there are many treatment options out there. One could be hormonal,
one could be actually using new Two FDA proved medications
are out. One's called add ADDYI. It came out in
twenty fifteen FDA proved strictly to increase a woman's.
Speaker 3 (26:19):
Desire for sex. That's it.
Speaker 2 (26:20):
She takes the pill every day increases her desire for sex.
By LEASI came out several years later. It's an injection
EpiPen she injects strictly to increase her desire for sex. Now,
I just want, I want to be very clear. Libido's
more deeper than that. I mean, there could be a
lot of other factors. I mean, it could be her stress,
it could be her physical condition. It could be a fatigue,
(26:42):
so you can't. It could be the quality of the relationship.
So I mean, if someone has a terrible quality relationship,
I can't. I can give them all the pill they want.
It's not going to help, you know, So you just
got to look at the whole big picture. But I
still also believe when you improve a woman's diet, exercise, sleep,
and stress, her libido does go up.
Speaker 1 (26:59):
Also helps if you take them to the movies.
Speaker 2 (27:03):
Yeah, that's true. That's true for.
Speaker 1 (27:06):
The most Well. We have all these conversations, Alex writes Zar,
what if you can't always afford the treatment for testosterone?
Is there a safe supplement I can take that would help?
Speaker 2 (27:20):
So the good news is that you can get testosterone
even compounded compounding pharmacies, and many of them are called
the five ZHO three B which are he regulated. They
make testosterone at a price for about thirty dollars a
month without insurance. Most people can afford thirty dollars a
month without insurance. If you look at even medications like Cialis,
if you use a good RX cupon co order, you
(27:40):
use Mark Cuban's company, you can get ninety days for
roughly twenty or twenty five dollars ninety days for CIA.
So these medications are extremely affordable and price should no
longer be an issue.
Speaker 1 (27:53):
That's interesting. Several of the questions relate to hemoglobin Blolood thickness.
I know some people begin giving blood once they get
on testosterone because they're blood thickens. Your thoughts on that,
is that problematic or is that just a side effect?
Speaker 2 (28:12):
It can be and it all depends on what type
of formulation you're using. Injectables have the highest rate. Injections
up to sixty six percent. A pellet's about thirty five percent,
angel's twelve percent risk, and it appeals about five percent.
So if your hermaticrit goes up and the number you
want to remember is fifty four, if it gets above
fifty four, there's a slight theoretical increased cardiovascar risk. And
(28:35):
in my practice, we have these patients start donating blood.
We don't wait till fifty four. We haven't started donating
at fifty one because I don't want to wait to
fifty four.
Speaker 3 (28:41):
So it is real.
Speaker 2 (28:43):
And remember that many of these patients have sleep apnea
cult to sleep apnea, and the testosterone is unmasking it.
So send them for a sleep study because you'll find
that many of them are just suffering from sleep apnea.
Speaker 1 (28:56):
You know, I find a lot of people are suffering
from some sleep disorder and they've just grown. They don't
even realize what a contributor to their overall health or
lack of it that sleep is. It's almost always accompanied
by the person being overweight, or maybe the overweight led
to the sleep. But that's one of those things that
(29:18):
I find when I dig into people often have bad
sleep and they don't think that's they don't realize how
important that is.
Speaker 2 (29:26):
Michael, You're so right. Listen, when I take care a
lot of CEOs, a lot of people, and I talk
about the four pillars diet, exercise, sleep, and stress. They're
all pretty good at diet, they're all pretty good at exercise,
that are lousy at sleep and stress. Right, and so,
and sleep and stress are so critical, and you think
about to sleep, it is a game changer. Even the
(29:47):
way you think about sleep. It's not the hours you
sleep that's multiplied by how efficient you slept. So if
you slept eight hours last night, but you were twenty
percent efficient, and I slept only four hours last night
but I was eighty percent efficient, I'm going to feel
a lot better than you.
Speaker 1 (30:01):
Right.
Speaker 2 (30:01):
So the reality is not just lying there with your
eyes closed. You have to get good deep sleep, good
rem sleep, and even thirty minutes extra either deep sleep
or rem sleep. Every night game changer for the next day.
So I think people need to be very militan. Just
find a way to make sure that you go to
sleep on time, wake up on time. And the best
(30:22):
website I found was the American Sleep Foundation. The American
Sleep Foundation has twenty tips on their website. They're awesome.
Follow those tips. It makes a big difference.
Speaker 1 (30:33):
Salt in the diet. So I've been reading a lot
on salt lately and I have not run this by
you yet, so I'm curious to see what you think
of this. And the theory goes that we were told
to stay away from salt. Salt raises blood pressure, salt
causes all these problems. And basically the point of the
(30:54):
piece was that we are now deprived of salt. And
what do you do to treat someone for a number
of things, is you give them salt. Your thoughts on
salt intake.
Speaker 2 (31:05):
So, I think that I'm still a believer that salt,
particularly in patients who have hypertension, is a risk factor.
And so if someone has hypertension, which most of many
Americans suffer from, that is going to be something that's
the first thing I'm going to ask them to stay
away from. As a urologist. The other thing we worry
about is increased salt intake significantly increases the risk for
(31:28):
the kidney stones. And so I am not a believer
yet that we should be increasing excuse me, increasing salt
unless there's a reason to do so. But I'm more
concerned about the hypertension and the stone risk.
Speaker 1 (31:41):
But on French Fries, it's okay, right Sometimes sometimes, doctor
moh Kara, you are the absolute best. The four phases
of offense he has outlined or diet, exercise, sleep, and
stretch reduction all things you can do yourself that don't
(32:03):
require spending a dollar. Diet, exercise, sleep and stress reduction
is four pillars of offense and defense. I cannot help
you get in to see him, so don't even try
because I would be overwhelmed. Again, it's Baylor College of Medicine.
It does take a while to get in to see him,
only because he's very popular. A lot of people like him.
(32:25):
I was my own worst enemy in sending too many
patients to him at the beginning. He only has so
many hours of the day. The book is The Sex Span,
which is not out yet but will be hopefully soon.
And when you let me know that is the case,
we will all go and buy it online.
Speaker 3 (32:42):
Well do Thank you so much, Michael, You're the best.
Speaker 1 (32:44):
My friend, doctor Mohit p r A Baylor College of Medicine. Yeah.
So I'm having dinner at Gringo's, the new location at
ninety nine and two nine with Wayne Wilson, who's the
founder of Sinergenics, and he was telling me about we
(33:08):
were talking about, well, the testosterone replacement, but he was
talking about this doctor and he said, I think he's
your doctor. He comes out and trains our people on
testosterone and the effects and why it's important and all that,
and it was doctor Kara and I did not know that.
I had no idea. Doctor Karatt was the first one
that put me on testosterone. We did the pellets for
(33:29):
a couple of years, and then low T Center, which
is also Centergenics, became a show sponsor, so I just
moved over there and started doing the weekly shots. I
like the shot. I like the shots, batter the pellets.
Some people like the pellets, but I got to take
my pellet story.
Speaker 2 (33:42):
Hold on
It's that time, time, time, time, luck and load. So
Michael Varie Show is on the air. Today's show is
(00:26):
sponsored by Peanut Butter for pure versatility of application, ability
to make anything it touches better, and shelf life. I
don't know that there's anything better that comes in a bottle.
I really don't. I really don't. Let's just take a
(00:48):
moment and think about your best peanut butter moment. Ramon.
Your peanut butter moment should not involve sex. But my urologist,
doctor Mohith Care is our guest. Welcome to the program.
Good sir, Thank you, Michael. Everyone has a lifespan, Ramon.
You know that you have a lifespan. We talk about
(01:10):
our life span. Doctor Mohit Kara is writing a book
called Or about the sex span. How long can a
human being have a functional, fulfilling sex life, doctor Kara?
Why does that matter?
Speaker 2 (01:27):
Well, Michael Sphers, thank you for having me on the show.
You know everyone where you go, every where, talks about
lifespan and health span. That's the big buzzwords in the community.
And I'll give you an example. Everybody wants, I assume
their health span to last as long as their lifespan.
But in the United States, the average health lifespan is
seventy seven years old. Women live typically seventy nine years old,
(01:50):
men live typically seventy five years old. But the health
span in the United States is roughly sixty seven years old,
which means most of us for the last ten years
of our life are not going to be living in
a healthy condition, which.
Speaker 3 (02:02):
Is very unfortunate.
Speaker 2 (02:03):
And all these countries talk about how they're expanding their
lifespan and getting people to live longer. In my mind,
that is not what I want do, not expand my
lifespan without expanding my health span. But this concept of
sex span is also important because many men would say, look,
I said, if you're going to live till eighty, but
you can only have sex till fifty, that's a problem
(02:25):
for many men. And so what we want to do
is try to expand our sex span and our health
span as long as our lifespan. I think that's a
really important point.
Speaker 1 (02:37):
I know. One of the things I like about you
is that you don't just rely on what you learned
in medical school and then mail it in every day.
You're constantly reading studies, you're constantly performing research and publishing
and speaking literally around the world, because you're always somewhere
else when I call you just to see what you're
up to giving a speech on this or that. How
(02:57):
important is sex to the human body in terms of
purely physically.
Speaker 2 (03:04):
Yeah, it's extremely important. So I want to just clarify
one thing. A rectile dysfunction is not a disease. It's
a symptom of other underlying diseases. Right, So ED does
not happen in healthy men as they get older. If
a man gets a rectile dysfunction, it is a symptom
of his diabetes, it's a symptom if his Cardiovasker disease,
(03:24):
it's a symptom of his radical procestectomo surgery. Or it's
a symptom of depression or anxiety. So when someone develops
a rectile dysfunction, the second question you should be asking
is what else is going on that's causing this condition?
Because if he was perfectly healthy, that would not happen, right,
And so the best example I can give you is
(03:45):
this is that if did you know that if a
man walks in today and has a rectile dysfunction, fifteen
percent of them will have a heart attack or stroke
within seven years fifteen percent. It's an underlying marker of
cardiovask disease. If a man walks in with ED today,
thirty percent of them have a cult diabetes thirty percent,
which is a lot. And if a man walks in today,
(04:07):
thirty percent of them will have depression or anxiety. So
the biggest mistake I can do is give this man
viagra and getend him on his way, because maybe he
has that occult cardiovask disease, maybe he has diabetes, Maybe
he's suffering from depression or anxiety. So it's really important
to figure out what is causing that ED. And what's
(04:27):
so nice about this is that there's a bi directional relationship.
So if I treat a man's ED, that actually improves
his depression. If I improve a man's depression, it actually
improves his ED. So I think the paradigm is shifting.
No longer do I want to just hand the man
the pill. You've got to figure out what's going on underneath,
because this is what I call the canary in the
coal mine, and you can actually save someone's life. I mean,
(04:49):
imagine if I catch someone's cardiovasker disease today, or diabetes today,
or I catch it ten years from now. It's a
total change in trajectory in terms of their house in
their life.
Speaker 1 (05:01):
Well, it goes back to viagra originally being a cardiovascular
disease in a off label benefit being the ability to
get erection.
Speaker 2 (05:12):
Yeah, Michael, that's a funny story because remember this one.
But they were trying to make a blood pressure medication
and accidentally everyone in this study was getting erections, and
they figured it out because people were not returning the pills.
Speaker 1 (05:29):
I had a friend, I was a baby lawyer at
the time at a firm called Jakins and Gilchrist and
I worked with a guy named Darren Alt who was
my best friend there. And his wife, Tracy, was the
head of Viagra in Houston, which was the top market
for viagra in the country, and they were taking a
trip every other week with their sales reps, and they
had all sorts of stories of people and at that
point it was still you'd go to your cardiologist to
(05:52):
get viagra, So everybody was faking a heart problem to
go in and get this medication. And the story goes
that the doctors getting calls from the wives going hey,
knock it off. Take him off of that.
Speaker 2 (06:05):
Right, right, right right, yeah, absolutely, And so you know
what the issue is is that ED back then was
not considered a very serious condition. People used to make
fun of it, and oh he has ED. ED is
a very serious condition. Someone gets erected on dysfunction, take
it seriously. Something else is going on.
Speaker 1 (06:23):
Well, and to oversimplify this, that is because it means
you're not getting proper blood flow or you're not pumping
your your blood properly. And that's I guess as good
a way as any for us to check, maybe the
easiest way.
Speaker 3 (06:38):
Yeah, And so think about this.
Speaker 2 (06:39):
I teach their medical students this new monic called vent
vascular meaning there's not enough blood flow coming in or
there's too much blood flow coming out. And too much
blood flow coming out is the most common cause of ED.
So the guy will tell you I can get the erection,
but I just can't maintain it. He's telling you the
blood flow's coming out too quickly. The number one cause
of ED in the world. But VENT stands for a
(06:59):
vascal E means androcrine. It's a testosterone. The testosterone goes low,
ED goes up. Neurologic meaning nerve injury and then trauma.
And don't forget medications. Medications from notorious for example, beta blockers.
How many people are Beta blockers shuts down the erections.
Antidepressants shuts down the directions. So you've got to look
at all the different causes for ED. And I just
(07:22):
want to stress one other thing. Sexual dysfunction is a
couple's disease. You know, we're so fixed on these silos.
I got to take care of the woman, I got
to take care of the man. You got to look
at both of them. I'll give you an example. Back
in two thousand and seven, I finished my fellowship, and
I was so proud of myself. I was able to
get these men, these amazing erections, amazing libido. And one
(07:42):
day a woman called me and said to me, she said,
everything was great with our relationship until he met you.
We never fought. We fight all the time because every
day he wants to have sex with me and I
don't want to have sex with him. And you've ruined
our relationship. And I thought to myself, she's right. What
is the point of raising one libido without raising the other.
Either leave both libidos low, It's fine, leave them both
(08:05):
low or raise both, but you don't raise one without
the other.
Speaker 1 (08:09):
Doctor Mohit Kara at the Baylor College of Medicine and
my urologist and friend coming up. The book will be
I got to get the name of it. It's about
the sex ben maybe calver sex ben remontination. It's a
hard problem to everyone listens the Michael Verry Show. The
only downside to having doctor Mohit Kara on the air
(08:31):
as our guest is then people ask me how to
get in to see him because it takes so long
to see him because he is so insanely popular. Everybody
I know is now his patient after hearing my experience
with him. He's just fantastic. I think the world of him.
(08:54):
Doctor Mohit Kara is at Baylor College of Medicine where
he is a urologist. He has a forthcoming book. Is
the book called the Sex Span Moment or what is
the book called?
Speaker 2 (09:05):
It is called sex Span and a Proactive Approach, A
proactive approach to prolonging your sexpan.
Speaker 1 (09:13):
So, as we were going into the break, you made
a statement about if you help a man build his
libido and his sexual function, but you do not concurrently
do that for the woman, you end up causing problems
for them. Let's take the physical out for a moment.
In your opinion, how important is sexual relations to a
(09:35):
couple and to an individual emotionally? You tied it to
the antithesis of depression, but talk about that if you would.
Speaker 3 (09:43):
It's extremely important.
Speaker 2 (09:44):
If you look at couples that engage in regular sexual activity,
that tend to be happier overall, satisfied with their quality
of life, they usually tend to be healthier, and they
usually tend to live longer. So there are numerous aspects.
So there's a one study that I saw that talked
about the couples that engage in do not engage in
sexual activity typically can have a twofold traction from their relationship.
(10:07):
But if they do engage sexual activity, it actually can
add four x to the quality of relationship.
Speaker 3 (10:12):
So I mean, let's be honest.
Speaker 2 (10:13):
I mean it does bring intimacy and closeness to the relationship.
It does strengthen the quality of the relationship, and in
many cases people find this extremely important. So I do
think that there is a medical benefit, psychological benefit and
patients engaging in sexual activity.
Speaker 1 (10:30):
I have had friends over the years who when they
put their parents in old folks homes, they talk about
how it is surprising how much activity there is in
the old folks home. And when I did that for
my dad earlier this year, that was one of the
things that everybody consistently across the board talked about. I
don't know if there's any if there's anything to that,
(10:51):
but we're talking about people in their eighties and nineties,
and I have heard this story consistently.
Speaker 2 (10:57):
You're actually right, So one of the highest levels of
STDs do occur in nursing homes. So you do know
that there's increased sexual activity that does occur in those
in those nursing homes, and so, but part of it
is because there's at some point, there's an inflection point.
As you live longer and longer, those patients that are
the healthiest tend to live the longest, and those patients
(11:19):
who are tend to be healthier tend to be more
the ability to engage in sexual activity.
Speaker 1 (11:24):
When you and I talked about the book the first time,
you said that one of the things that the book
is going to cover is the importance of screening for
testosterone and how rectal dysfunction is a marker of other
underlying major medical conditions, such as a heart attack. The
screening for testosterone, why is that important?
Speaker 2 (11:43):
So, Michael, I am very passionate about this topic because
you know, everyone thinks about testosterone as energy and sex
drive and erections. And yes, it's true if you have
low energy, low libido, rectal dysfunction, giving a man testosterone
can improve these symptoms. But now we're in an era
where it goes way beyond that. So did you know
that a man who has low testosterone is much more
(12:05):
likely to have a heart attack, non negotiable, much more likely.
A man who has low test osoe is much more
likely to break a bone. A man who's low test
osom is more likely of diabetes obesity metabox syndrome. A
diet man who's low test awsome is much more likely
to suffer from depression. And giving a man back his
testosterone can help mitigate improve these conditions. So it's not
(12:25):
just about sex, it's about your overall health. The problem
I have is that when I walk into my primary
care doctor's office every year and he checks my blood,
he does not check an annual testosterone. He'll check a
thyroid he'll check a TSH. I say, why are checking
at TSH? He said, well, we do that every year
to make sure you're not hypothyroid. There is not a
better marker of a man's overall health than a testosterone level.
(12:48):
It gives you a marker of what his health is today,
and it gives you a marker of what his health
will be in the future. And so every man over
the age of forty, every single man, should be getting
a testosteronal level every single year days of forty, because
I do think it's the best predictor of his overall
health currently and in the future. And it's modifiable because
there's things I can do to improve his testosterone if
(13:09):
he's low.
Speaker 1 (13:10):
You suggestive testosterone for me ten years ago. I know
you weren't going to talk about it because you're the doctor,
but I can, and obviously it changed my life. It
made a huge difference for me. But when you do
that for folks, what kind of differences do you typically see?
Speaker 2 (13:28):
Well, the first thing you have to ask yourself is
are they young and do they want to have children?
Because most people don't realize that giving testosterone actually shuts
down your fertility. So I can't tell you how many
patients I see in my practice every week that said, look,
I was started on testosterone or no one told me
that the testosic could make me infertile. Now we want
to have kids, what do I do? So there's the
ways I can reverse it. So the reality is, if
(13:50):
you're in the reproductive years, if you're planning on having
children and your tea is low, don't take testosterone. But
let me give you medications that make you make testosterone.
That's safe. So I can give you medications to make
you make testolstone and that will enhance your fertility. But
if you're older and you're not trying to have children,
then there are many ways to give a man testosterone.
(14:10):
We now have oral test alstone, which is fantastic world
testawsal is very new in the United States. It's only
been out for five years. And that we have a pill,
we have injections, we have peallets, we have patches. But
I will tell you that I do think that this
medication can have a profound effect on the quality of life.
And many patients, many patients come in, they're thanking you,
they're telling you that they have a significantmrovement in the
directions or libido muscle mass.
Speaker 3 (14:31):
Not everybody.
Speaker 2 (14:32):
I mean, there are patients that don't respond, but the
majority of patients who start out low do see a
significant improvement in their quality of life.
Speaker 1 (14:41):
I was talking with one of our show sponsors, Wayne Wilson,
who owns Synergenics, and he said, hey, you're urologist. Is
the one who came when we started, I guess with
pellets or whatever, and came and talked to them about
testosterone and obviously that's what they do all day, every day.
And he went through the various things that you talk about.
(15:04):
I mean he took note. He's a physician's assistant by training.
But it was amazing to me. You were the god
of testosterone as far as Syenergenics is concerned, and I
didn't know you had an association with him.
Speaker 2 (15:17):
No, I appreciate it. I mean, I have been very
passionate about this for about twenty five years. So all
my basic science work, all my lab all my clinical
trials are around this topic. So when it comes to
teaching and education to others about testosterone, I'm all in.
Speaker 1 (15:32):
One this moment. Doctor Moti Kara is our guest. He's
at Baylor College of Medicine, and I'm going to start
with the question everyone always asked, well, am I more
likely to get prostate cancer? Mike, weren't you worried about
prostate cancer? We'll ask him that coming up with his
finger on the pulse. The King of Ten continues on
the Michael Berry Show. Doctor Mois Kara my urologist and
(15:57):
friend of Taylor College of Medicine and international renown as
a speaker on issues of sex, urology testosterone. Forthcoming book
is called sex Span, which talks about the length of
time in which a person has a functional sex life
(16:23):
that will be out relatively soon. Doctor Kara, I received
an email from a fellow named Doug who writes three
minutes ago, I figure your interview is pre recorded, but
if not, I'm curious about blood clots. I had a
pulmonary embolism and they told me to stop taking testosterone.
I used to go to the Low T Center and
(16:44):
had a great experience experience with the treatment. I miss it.
I hate that I can't take it anymore. Does doctor
Kara have a thought about that?
Speaker 2 (16:54):
I do, Michael, so listen. There was a concern for
that in twenty fifteen and the FDA asked a conduct
a large trial. It was called the Traverse Trial. I
was fortunate enough to be involved in that trial with
myself and eight other physicians, and we designed this trial
with several hundreds of millions of dollars and the goal
was to see if it caused increase in cardiovascar events
(17:14):
and prostate cancer. What it did find was there was
no increase in heart attack in those men taking testaws
on versus placebo. We had over five thousand patients. We
followed them for four years, and there was no increased
risk in DVT, but there was a slight increased risk
in pulmonary embolism. And the difference was a difference between
point five percent and point nine percent, So there was
(17:36):
a slight signal. And I think it's very important to
counsel patients when they ask about that. So I guess again,
you know, I don't believe that. I personally don't believe
the test OSA increases a risk of DVT and pulmonary embolism.
I think the difference was small, but the Traverse trial
showed what it showed. Also, I just want to mention
(17:58):
it showed no increased and prostate cancer and no increased
risk of worsting of urinary symptoms.
Speaker 3 (18:04):
Great study, traverse trial.
Speaker 1 (18:07):
Why do you think this is out there? Because I
have a friend who started on testosterone, heard me talking
about it. He starts on it, three months later he
gets prostate cancer. He a text message says, Hey, I
just want you to know I just started on testosterone
and I got prostate cancer. You need to be careful.
And my immediate response was, you haven't been on testosterone
(18:30):
long enough. Even if it did cost prostate cancer for
it to have caused that, if there was no testosterone
supplement out there, men still got prostate cancer at rapid,
at large rates. You can't blame every one of them
on testosterone.
Speaker 2 (18:46):
I absolutely agree with you, And I got to tell
you where it started from. It started in nineteen forty
one when Huggins and Hodges published the famous paper I'm
showing that when you give a man test increases a
risk for prostate cancer. If you and I go to
the library right now, puld that paper, you're going to
find something very interesting. It was based on one patient,
one patient, nineteen forty one, and we'd instilled fear in
(19:07):
us for so many years. The good news is in
twenty eighteen, my society, the American Neurologic Association, said testosterone
does not increase the risk for prostate cancer, strong recommendations,
So we do not anymore have a concern that testoster
increases the risk for prostate cancer. I'll tell you a
very interesting story. If I had metastatic prostate cancer all
(19:30):
over our body and we walked into Johns Hopkins University today,
they would There's a trial where they put us on
high doses of testosterone to reverse the prostate cancer, and
it works. It reduces the PSA, reduces the metastactasey. So
we're learning a lot about testosterone prostate cancer, and this
concept that testoster increases the risk, I think to.
Speaker 3 (19:51):
Me is a myth. Michael, I want to bring up
one other important thing.
Speaker 2 (19:54):
You talked about this earlier about testosterone, and you said
when you give testosterone, does it make people feel better?
But I tell patients that you've got to understand just
something that's just as important. It's lifestyle modification, diet, exercise,
sleep and stress reduction. I don't have a pill on
the planet stronger than diet, exercise, sleep and stress reduction.
(20:15):
And every day when we wake up or when we
go to sleep, we should ask.
Speaker 3 (20:19):
Ourselves what are we going to do on diet, exercise.
Speaker 2 (20:21):
Sleep and such stress reduction. I call that offense I
four things on offense, and then I call it four
things on defense. Only four ways you and I are
going to die. We're going to get cancer, we get
a heart attack, we're going to get metabolic disease, mean diabetes, obesity,
or we're going to get parking center Alzheimer's.
Speaker 3 (20:38):
So on the.
Speaker 2 (20:38):
Defense, every day we should ask ourselves how are we
going to keep those four things away? And our offense,
how we're going to move our health forward with those
four that I think is a really important point I
wanted to get across. We have a big program on that.
I mean every time someone comes in, I have a
program for their offense and defense. It's really important.
Speaker 1 (20:57):
The four on offense, which you have pre since they
I met you, diet, exercise, sleep and stress reduction, and
do you have four on defense?
Speaker 2 (21:09):
The four on defense are absolutely so it's cancer, which
means it's a heavy cancer screen call ANOTS, could be PSA.
Sometimes we'll do imaging as well. There are new tests
that come out called gallery there are others called the
liquid biopsy test. I mean there's ways to image and
to look for patients who may have potential cancer I have.
Cardiac screening is extremely important. You can sometimes you know,
(21:32):
you'll get certain labs like APO, B LP, LITLEA. Sometimes
we'll get a Cornery calcium score to look at the
heart to make sure there's not increase calcium metabolic disease.
You want to make sure that patients are watching their sugars.
It's a silent killer. Sometimes we'll put a CGM, which
is a continuous glucose monitor on them to help them
look at their sugars to make sure that they get
the feedback to say these are the foods I should
(21:54):
stay away from. And then you know, there's not a
lot you can do with Parkinson's and all sign There
are certain tests that you can look at. Some genes
you can look at to see if you're a higher risk.
But you know, if you are at a higher risk,
you can start altering your behavior, expers, you know, and
doing things. So it's really important to keep the bad
things away and use the diet, exercise, and sleep and
(22:16):
stress to move your health forward. In that paradigm. Most
people get the concept of offense and defense four and four,
and it's really worked well for a lot of my patients.
Speaker 1 (22:26):
I don't know if I've told you this. Doctor Mohit
Kara is our guest kh E R at Baylor College
of Medicine. I don't know if I've told you this,
but on Christmas Eve, Ramone got a CGM continuous glucose
monitor and he started monitoring his blood sugar. And he
keeps his blood sugar at a very steady between one
(22:49):
and one thirty, usually about one point fifteen. The first
thing I do when I walk in the studio every
morning is he's already here. Is I ask him for
the number he sees me coming up the stairs and
he will write it down and show it on a
sheet of paper or from the door and tell me.
And it has absolutely changed not only his health but
his mood. I mean, he is consistent, he can work harder,
(23:10):
he can work longer by just stabilizing blood sugar, which
obviously for most people is fluctuating with great volatility.
Speaker 3 (23:19):
I love that story.
Speaker 2 (23:20):
I think that's a see and I see that all
the time because the reality is there are foods that
you're eating that you think are healthy and they're not.
And the foods that you think that are not that
healthy are you know, and you know, I put a
CGM on my wife and we went to the same
restaurant once we ate the exact same thing, and we
got totally different numbers. Because part of it's also genetics, right,
so that can play a role in it as well.
(23:42):
But learning more about what is bad and what to
stay away from is extremely important because if you give
yourself feedback, and those who take feedback very seriously, you
can really alter the quality of their life because that
sugar is just pounding the blood vessels, just pounding them.
Speaker 1 (24:01):
My dad's a lifelong diabetic. He was nineteen when he
got DIABETESES eighty five. Now it's amazing. He has all
ten fingers and toes, but he has monitored. He's I've
had doctors tell me your dad knows more about diabetes
than we do because he had to treat it before
they was instantly. But I take Ramon to see him
last week, and all they talked about was their cgms
and their dex com CGM and what the reading was
(24:21):
and what this was and what that was. It was.
It was pretty funny to watch home with me for
one more segment if you can. Doctor Mohit Kara is
our guest. The book is The Sex Span, and we
will double back to that subject coming up from Portland
(24:48):
through Waldeny at all Greek cities in between. The Michael
Barry Show is nationwide. Doctor Mohick Kara is our guest.
He is my friend and my urologist and an expert
in matters of sex and testosterone. I will read to
(25:10):
you as email from one fellow says, well, let me
go back to that. Another fellow, actually several fellows said,
my wife's libido is way lower than mine. How can
he increase a woman's libido?
Speaker 2 (25:28):
That's a really important point. So you know I told
you earlier that couple that got the woman that called
me that was very upset. So in two thousand and
eight I actually flew out to California to the Many
Fellowship in Female Sexual Dysfunction and I started treating women
for the past seventeen years because you can't just treat
one person without treating the other. And when you improve
both libidos, you actually it's synergistic. So women, this female
(25:50):
sexual dysfunction is comprised of four components low libido for
arousal meaning poor blood floats of the genitalia, or gasmic
dysfunction or pain.
Speaker 3 (26:00):
It was sex.
Speaker 2 (26:00):
If she has any one of those four and is
bothered by it, she suffers from female sexual dysfunction. And
there are many treatment options out there. One could be hormonal,
one could be actually using new Two FDA proved medications
are out. One's called add ADDYI. It came out in
twenty fifteen FDA proved strictly to increase a woman's.
Speaker 3 (26:19):
Desire for sex. That's it.
Speaker 2 (26:20):
She takes the pill every day increases her desire for sex.
By LEASI came out several years later. It's an injection
EpiPen she injects strictly to increase her desire for sex. Now,
I just want, I want to be very clear. Libido's
more deeper than that. I mean, there could be a
lot of other factors. I mean, it could be her stress,
it could be her physical condition. It could be a fatigue,
(26:42):
so you can't. It could be the quality of the relationship.
So I mean, if someone has a terrible quality relationship,
I can't. I can give them all the pill they want.
It's not going to help, you know, So you just
got to look at the whole big picture. But I
still also believe when you improve a woman's diet, exercise, sleep,
and stress, her libido does go up.
Speaker 1 (26:59):
Also helps if you take them to the movies.
Speaker 2 (27:03):
Yeah, that's true. That's true for.
Speaker 1 (27:06):
The most Well. We have all these conversations, Alex writes Zar,
what if you can't always afford the treatment for testosterone?
Is there a safe supplement I can take that would help?
Speaker 2 (27:20):
So the good news is that you can get testosterone
even compounded compounding pharmacies, and many of them are called
the five ZHO three B which are he regulated. They
make testosterone at a price for about thirty dollars a
month without insurance. Most people can afford thirty dollars a
month without insurance. If you look at even medications like Cialis,
if you use a good RX cupon co order, you
(27:40):
use Mark Cuban's company, you can get ninety days for
roughly twenty or twenty five dollars ninety days for CIA.
So these medications are extremely affordable and price should no
longer be an issue.
Speaker 1 (27:53):
That's interesting. Several of the questions relate to hemoglobin Blolood thickness.
I know some people begin giving blood once they get
on testosterone because they're blood thickens. Your thoughts on that,
is that problematic or is that just a side effect?
Speaker 2 (28:12):
It can be and it all depends on what type
of formulation you're using. Injectables have the highest rate. Injections
up to sixty six percent. A pellet's about thirty five percent,
angel's twelve percent risk, and it appeals about five percent.
So if your hermaticrit goes up and the number you
want to remember is fifty four, if it gets above
fifty four, there's a slight theoretical increased cardiovascar risk. And
(28:35):
in my practice, we have these patients start donating blood.
We don't wait till fifty four. We haven't started donating
at fifty one because I don't want to wait to
fifty four.
Speaker 3 (28:41):
So it is real.
Speaker 2 (28:43):
And remember that many of these patients have sleep apnea
cult to sleep apnea, and the testosterone is unmasking it.
So send them for a sleep study because you'll find
that many of them are just suffering from sleep apnea.
Speaker 1 (28:56):
You know, I find a lot of people are suffering
from some sleep disorder and they've just grown. They don't
even realize what a contributor to their overall health or
lack of it that sleep is. It's almost always accompanied
by the person being overweight, or maybe the overweight led
to the sleep. But that's one of those things that
(29:18):
I find when I dig into people often have bad
sleep and they don't think that's they don't realize how
important that is.
Speaker 2 (29:26):
Michael, You're so right. Listen, when I take care a
lot of CEOs, a lot of people, and I talk
about the four pillars diet, exercise, sleep, and stress. They're
all pretty good at diet, they're all pretty good at exercise,
that are lousy at sleep and stress. Right, and so,
and sleep and stress are so critical, and you think
about to sleep, it is a game changer. Even the
(29:47):
way you think about sleep. It's not the hours you
sleep that's multiplied by how efficient you slept. So if
you slept eight hours last night, but you were twenty
percent efficient, and I slept only four hours last night
but I was eighty percent efficient, I'm going to feel
a lot better than you.
Speaker 1 (30:01):
Right.
Speaker 2 (30:01):
So the reality is not just lying there with your
eyes closed. You have to get good deep sleep, good
rem sleep, and even thirty minutes extra either deep sleep
or rem sleep. Every night game changer for the next day.
So I think people need to be very militan. Just
find a way to make sure that you go to
sleep on time, wake up on time. And the best
(30:22):
website I found was the American Sleep Foundation. The American
Sleep Foundation has twenty tips on their website. They're awesome.
Follow those tips. It makes a big difference.
Speaker 1 (30:33):
Salt in the diet. So I've been reading a lot
on salt lately and I have not run this by
you yet, so I'm curious to see what you think
of this. And the theory goes that we were told
to stay away from salt. Salt raises blood pressure, salt
causes all these problems. And basically the point of the
(30:54):
piece was that we are now deprived of salt. And
what do you do to treat someone for a number
of things, is you give them salt. Your thoughts on
salt intake.
Speaker 2 (31:05):
So, I think that I'm still a believer that salt,
particularly in patients who have hypertension, is a risk factor.
And so if someone has hypertension, which most of many
Americans suffer from, that is going to be something that's
the first thing I'm going to ask them to stay
away from. As a urologist. The other thing we worry
about is increased salt intake significantly increases the risk for
(31:28):
the kidney stones. And so I am not a believer
yet that we should be increasing excuse me, increasing salt
unless there's a reason to do so. But I'm more
concerned about the hypertension and the stone risk.
Speaker 1 (31:41):
But on French Fries, it's okay, right Sometimes sometimes, doctor
moh Kara, you are the absolute best. The four phases
of offense he has outlined or diet, exercise, sleep, and
stretch reduction all things you can do yourself that don't
(32:03):
require spending a dollar. Diet, exercise, sleep and stress reduction
is four pillars of offense and defense. I cannot help
you get in to see him, so don't even try
because I would be overwhelmed. Again, it's Baylor College of Medicine.
It does take a while to get in to see him,
only because he's very popular. A lot of people like him.
(32:25):
I was my own worst enemy in sending too many
patients to him at the beginning. He only has so
many hours of the day. The book is The Sex Span,
which is not out yet but will be hopefully soon.
And when you let me know that is the case,
we will all go and buy it online.
Speaker 3 (32:42):
Well do Thank you so much, Michael, You're the best.
Speaker 1 (32:44):
My friend, doctor Mohit p r A Baylor College of Medicine. Yeah.
So I'm having dinner at Gringo's, the new location at
ninety nine and two nine with Wayne Wilson, who's the
founder of Sinergenics, and he was telling me about we
(33:08):
were talking about, well, the testosterone replacement, but he was
talking about this doctor and he said, I think he's
your doctor. He comes out and trains our people on
testosterone and the effects and why it's important and all that,
and it was doctor Kara and I did not know that.
I had no idea. Doctor Karatt was the first one
that put me on testosterone. We did the pellets for
(33:29):
a couple of years, and then low T Center, which
is also Centergenics, became a show sponsor, so I just
moved over there and started doing the weekly shots. I
like the shot. I like the shots, batter the pellets.
Some people like the pellets, but I got to take
my pellet story.
Speaker 2 (33:42):
Hold on
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