August 26, 2025 • 34 mins
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
It's that time. Time, time, Luck and Load. The Michael
Varie Show is on the air today. Joe is sponsored
(00:27):
by Peanut Butter.
Speaker 2 (00:31):
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 moment and think
about your best peanut butter moment.
Speaker 1 (00:54):
Ramon.
Speaker 2 (00:55):
Your peanut butter moment should not involve sex. But my urologist,
doctor with Kara 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
our life span, doctor Mohicz. Kara is writing a book
called Or about the sex span. How long can a
(01:19):
human being have a functional, fulfilling sex life, Doctor Kara?
Speaker 1 (01:26):
Why does that matter?
Speaker 3 (01:28):
Well, Michael, the first, 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
(01:50):
nine years old, 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 is very unfortunate.
Speaker 4 (02:04):
And all these.
Speaker 3 (02:05):
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.
Speaker 4 (02:14):
My health span.
Speaker 3 (02:16):
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 only have sex till fifty,
that's a problem 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 (02:38):
I know.
Speaker 2 (02:39):
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 important is
(03:00):
sex to the human body in terms of purely physically.
Speaker 3 (03:05):
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 of his Cardiovasker disease,
(03:26):
it's a symptom of his radical procestecto your 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
(03:46):
this is that did you know that if a man
walks in today and has a rectile dysfunction, fifteen percent
of them will have a heart attenic orth 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, thirty
(04:09):
percent of them will have depression or anxiety. So the
biggest mistake I can do is give this man viagra
and send 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 so
(04:30):
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 and the
coal mine, and you can actually save someone's life. I mean,
(04:51):
imagine if I catch someone's cardiovasker disease today or diabetes
today or I catch it ten years from now. It's
a total trajectory in terms of their house span and
their life.
Speaker 2 (05:03):
Well, it goes back to viagra originally being a cardiovascular
disease in an off label benefit being.
Speaker 1 (05:12):
The ability to get erection.
Speaker 3 (05:14):
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 2 (05:31):
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
(05:54):
get viagra, So everybody was faking a heart problem to
go in and get this medication. And the story goes
that the doctors were getting calls from the wives going, hey,
knock it off, take him off.
Speaker 3 (06:06):
Of that, 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.
Speaker 4 (06:16):
People used to make fun of it, and oh he
has ED.
Speaker 3 (06:19):
ED is a very serious condition. Someone gets erected on dysfunction.
Take it seriously. Something else is going on.
Speaker 2 (06:26):
Well, and to oversimplify this, that is because it means
you're not getting proper blood flow or you're not pumping
your blood properly. And that's I guess as good a
way as any for us to check, maybe the easiest way.
Speaker 3 (06:40):
Yeah, And so think about this. I teach their medical
students this new monic called event 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 direction, but I
just can't maintain it. He's telling you the blood flow's
coming out too quickly. The number one cause of e
D in the world. But the event stands for vasco
(07:02):
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 are notorious, for example, beta blockers.
How many people are on 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
(07:25):
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.
Speaker 4 (07:39):
Proud of myself.
Speaker 3 (07:40):
I was able to get these men, these amazing erections,
amazing libido. And one day a woman called me and
said to me, she said, everything was great with our
relationship until he met you.
Speaker 4 (07:52):
We never fought.
Speaker 3 (07:52):
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 low, or
raise both, but you don't raise one without the other.
Speaker 2 (08:11):
Doctor Mohit Kara at the Baylor College of Medicine and
my urologist and friend coming up. The book will be
I've got to get the name of it. It's about
the sex ban maybe called or sex.
Speaker 1 (08:21):
Bennerments A hard problem to librarian. Everyone listens to Michael
Very Show.
Speaker 2 (08:29):
The only downside to having doctor Mohiit Kara on the
air 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.
Speaker 1 (08:44):
Everybody I know.
Speaker 2 (08:46):
Is now his patient after hearing my experience with him.
Speaker 1 (08:54):
He's just fantastic. I think the world of him.
Speaker 2 (08:56):
Doctor Mohit Kara is at Baylor College of Medicine where
he is urologists. He has a forthcoming book. Is the
book called the Sex Span Moment or what is the
book called?
Speaker 3 (09:08):
It is called sex Span and a Proactive Approach, A
proactive approach to prolonging your sexpan.
Speaker 2 (09:16):
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
(09:39):
couple and to an individual emotionally? You tied it to
the antithesis of depression, but talk about that if you would.
Speaker 3 (09:47):
It's extremely important. If you look at couples that engage
in regular sexual activity, they tend to be happier overall,
satisfied with their quality of life. They usually tend to
be healthier and easily tend to live longer. So there
are numerous aspects. So there's one study that I saw
that talked about couples that engage in who do not
engage in sexual activity typically can have a twofold traction
(10:12):
from their relationship. But if they do engage sexual activity,
it actually can add four x to the quality of
the relationship.
Speaker 4 (10:18):
So I mean, let's be honest.
Speaker 3 (10:19):
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 benefits psychological benefit in
patients engaging in sexual activity.
Speaker 2 (10:38):
I have had friends over the years who when they
put their parents in old folks homes.
Speaker 1 (10:42):
They talk about how.
Speaker 2 (10:45):
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, but
we're talking about people in their eighties and nineties, and
I have heard this story consistently.
Speaker 3 (11:06):
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
(11:29):
who are tend to be healthier tend to be more
the ability to engage in sexual activity.
Speaker 2 (11:35):
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 erect all dysfunction is a marker of
other underlying major medical conditions, such as a heart attack.
The screening for testosterone, why is that important?
Speaker 3 (11:54):
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
(12:15):
that a man who has low testosterone is much more
likely to have a heart attack, non negotiable, much more likely.
A man who's low test awso is much more likely
to break a bone. A man who's low test austin
is more likely to have diabetes obesity metabol 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
(12:39):
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 you checking
a 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 testisteral level.
(13:03):
It gives you a marker level 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 testisteral level every single year after the age 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.
Speaker 4 (13:25):
If he's low.
Speaker 1 (13:26):
You suggested testosterone for me ten years ago.
Speaker 2 (13:30):
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 3 (13:45):
Well, the first thing I 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 testoso or no one told me
that the test as can make me infertile. Now we
want to have kids, what do I do? So there's
(14:06):
the ways I can reverse it. So the reality is,
if you're in the reproductive years, if you're planning on
having children and your tea is low, don't take test austone.
But let me give you medications that make you make.
Speaker 4 (14:18):
Testosterone that's safe.
Speaker 3 (14:20):
So I can give you medications to make you make
test alstone 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. We
now have oral testosterone, which is fantastic world. Test Austional
is very new in the United States. It's only been
out for five years. And now we have a pill,
we have injections, we.
Speaker 4 (14:38):
Have pallets, we have patches. But I will tell you
that I.
Speaker 3 (14:41):
Do think that this medication can have a profound effect
on the quality of life. And many patients, I mean
many patients come in they're thanking you, they're telling you
that they have a significant improvement in the directions their
libido muscle mass.
Speaker 4 (14:52):
Not everybody.
Speaker 3 (14:53):
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 2 (15:02):
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.
(15:25):
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 Synergenics is concerned, and I
didn't know you had an association with them.
Speaker 4 (15:38):
No, I appreciate it.
Speaker 3 (15:39):
I mean, I've been very passionate about this for about
twenty five years. So all my basic science of work,
all my lab all my clinical trials are around this topic.
So when it comes to teaching and education to others
about testoscerone, I'm all in one moment.
Speaker 2 (15:54):
Doctor Moltera 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.
Speaker 5 (16:07):
With his finger on the pulse, The kingail Ting continues
on the Michael.
Speaker 2 (16:12):
Berry Show, Baylor 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
(16:38):
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 bloodcot clots.
Speaker 1 (16:54):
I had a.
Speaker 2 (16:55):
Pulmonary embolism and they told me to stop taking testosterone.
I used to go to the low Te Center and
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 4 (17:09):
I do, Michael, so listen.
Speaker 3 (17:10):
There was a concern for that in twenty fifteen, and
the FDA asked to 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 and prostate cancer. What it
(17:31):
did find was there was no increase in heart attack
in those men taking test AWSOM 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 a slight signal. And I
(17:54):
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 that TESTOSA increases the
risk of DVT and pulmonary embolism. I think the difference
was small, but the traversial showed what it showed. Also,
I just want to mention it showed no increased risk
(18:15):
in prostate cancer and no increased risk of worsening of
urinary symptoms. Great study, traverse trial.
Speaker 1 (18:22):
Why do you think this is out there?
Speaker 2 (18:25):
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.
Speaker 1 (18:41):
You need to be careful.
Speaker 2 (18:42):
And my immediate response was, you haven't been on testosterone
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 3 (19:01):
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 their famous paper I'm
showing that when you give a man testos increases the
risk for prostate cancer. If you and I go to
the library right now and pull that paper, you're going
to find something very interesting. It was based on one patient,
one patient, nineteen forty one, and we's instilled fear in
(19:23):
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 you I had metastatic prostate cancer
(19:45):
all 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 metastactasy.
We're learning a lot about testosterer and prostate cancer, and
this concept that testoster increases the risk, I think, to
(20:06):
me is a myth. Michael, I want to bring up
one other important thing. You talked about this earlier about testosterone,
and he said when you give testosterone, does it make
people feel better? But I tell patients that you've got
to understand there's something that's just as important. It's lifestyle modification, diet, exercise,
sleep and stress reduction. I don't have a pill on
(20:26):
the planet stronger than diet, exercise, sleep and stress reduction.
Speaker 4 (20:30):
And every day when we wake up or when we go.
Speaker 3 (20:33):
To sleep, we should ask ourselves what are we going
to do on diet, exercise, sleep in 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 4 (20:53):
So on the defense, every.
Speaker 3 (20:54):
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 four 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.
Speaker 4 (21:09):
It's really important.
Speaker 2 (21:12):
The four on offense, which you have preached since today
I met you, diet, exercise, sleep and stress reduction.
Speaker 1 (21:21):
And do you have four on defense?
Speaker 3 (21:24):
The four on defense are absolutely so it's cancer, which
means it's a heavy cancer screen. Calling off 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 get
(21:47):
certain labs like APO B LP, little A. Sometimes we'll
get a cordery 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
(22:09):
stay away from. And then you know, there's not a
lot you can do with Parkinson's and Alzheimer's. 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, exer, you know, and
doing things. So it's really important to keep the bad
things away and use the diet, exercise, and sleep and
(22:30):
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 2 (22:41):
I don't know if I've told you this. Doctor Mohitz
Kara is our guest k 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 and
(23:03):
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 open the door and tell me.
Speaker 1 (23:16):
And he has.
Speaker 2 (23:17):
It has absolutely changed not only his health but his mood.
I mean, he is consistent, He can work harder, he
can work longer by just stabilizing blood sugar, which obviously
for most people is fluctuating with great volatility.
Speaker 4 (23:34):
I love that story.
Speaker 3 (23:35):
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.
(23:57):
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 your life because that
sugar is just pounding the blood vessels and just pounding them.
Speaker 2 (24:15):
My dad's a lifelong diabetic. He was nineteen when he
got diabetes. He's eighty five now. It's amazing. He has
all ten fingers and toes, but he has monitored he
I've had doctors tell me your dad knows more about
diabetes than we.
Speaker 1 (24:25):
Do because he had to treat it before they was instantly.
Speaker 2 (24:28):
But I take Ramon to see him last week, and
all they talked about was their cgms and their dex
colm CGM and what the reading was 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. Sure, the
book is The Sex Span, and we will double back
to that subject.
Speaker 1 (24:49):
Coming up.
Speaker 5 (25:01):
From Portland to Walbany at all great cities in between these.
The Michael Barry Show is nationwide.
Speaker 1 (25:11):
Doctor Movit Kara is our guest k H. E.
Speaker 5 (25:14):
R A.
Speaker 2 (25:15):
He is my friend and my urologist and an expert
in matters of sex and testosterone.
Speaker 1 (25:23):
I will read to you.
Speaker 2 (25:25):
Email from one fellow says, well, let me go back
to that. Another fellow, actually several fellows said, my wife's libido.
Speaker 1 (25:34):
Is way lower than mine. How can he increase a
woman's libido?
Speaker 3 (25:42):
That's a really important point. So you know I told
you earlier that couplet. The woman that called me it
was very upset. So in two thousand and eight I
actually flew out to California to 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.
Speaker 4 (26:00):
And when you.
Speaker 3 (26:00):
Improve both libidos, you actually it's synergistic. So women, this
female sexual dysfunction is comprised of four components low libido,
for arousal meaning poor blood flow to the genitalia, orgasmic dysfunction,
or pain.
Speaker 4 (26:15):
It was sex.
Speaker 3 (26:15):
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 4 (26:34):
Desire for sex. That's it.
Speaker 3 (26:36):
She takes the pill every day increases her desire for sex.
By Lisa came out several years later. It's an injection
EpiPen she injects strictly to increase her desire for sex. Now,
I just want everyone to be very clear, libido is
more deeper than that. I mean, there could be a
lot of other other factors. I mean, it could be
her stress, it could be her physical condition. It could
(26:57):
be fatigue, so you can't. It could be the quality
of relationship. So I mean, if someone has a terrible
quality and 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.
Speaker 4 (27:08):
But I still also.
Speaker 3 (27:09):
Believe when you improve a woman's diet, exercise, sleep, and stress,
her libido does go up.
Speaker 1 (27:16):
It also helps if you take them to the movies.
Speaker 4 (27:20):
Yeah, that's true. That's true.
Speaker 2 (27:23):
The most these conversations, Alex right, Zar, what if you
can't always afford the treatment for testosterone? Is there a
safe supplement I can take that would help?
Speaker 3 (27:37):
So the good news is that you can get testosterone
even compounded compounding pharmacies. Many of them are called the
five ZHO three B, which are heavily regulated. They make
testosterone at a price of 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 coupon card or you
(27:58):
use Mark Cuban's company, you can get ninety days for
roughly twenty or twenty five dollars ninety days for Siale.
So these medications are extremely affordable and price should no
longer be an issue.
Speaker 1 (28:11):
That's interesting.
Speaker 2 (28:14):
Several of the questions relate to hemoglobin, blood 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 3 (28:30):
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,
agel's twelve percent risk and appeal is 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
(28:54):
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, want to wait till fifty four.
Speaker 4 (29:01):
So it is real. And remember that many of.
Speaker 3 (29:04):
These patients have sleep apnea ac cult to sleep apnea,
and the testostern 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 2 (29:16):
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.
Speaker 1 (29:28):
Their overall health or lack of it that sleep is.
Speaker 2 (29:32):
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 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 3 (29:47):
Michael, You're so right. Listen, when I take care of
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. They are lousy at sleep and stress. Right,
and so, and sleep and stress are so critical, and
you think about sleep, it is a game changer. Even
(30:08):
the 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 4 (30:22):
Right.
Speaker 3 (30:23):
So, the reality it's not just lying there with your
eyes closed. You have to get good deep sleep, good
rem sleep, and even thirty minutes extra of 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
(30:44):
best website I found was the American Sleep Foundation. The
American Sleep Foundation has twenty tips on their website. They're awesome.
Follow those tips. That makes a big difference.
Speaker 1 (30:55):
Salt in the diet. So I've been reading a lot
on salt lately and.
Speaker 2 (31:01):
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
it basically the point of the piece was that we
are now deprived of salt. And what do you do
(31:22):
to treat someone for a number of things is you
give them salt.
Speaker 1 (31:25):
Your thoughts on salt intake, So, I think.
Speaker 3 (31:29):
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 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 the kidney stones. And so
(31:55):
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 (32:06):
But on French Fries, it's okay, right.
Speaker 2 (32:10):
Sometimes, doctor Mohi Kara, you are the absolute best.
Speaker 1 (32:17):
The four phases of offense he has outlined or diet.
Speaker 2 (32:22):
Exercise, sleep, and stress reduction all things you can do
yourself that don't 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'm want to be overwhelmed again.
It's Baylor College of Medicine. It does take a while
(32:44):
to get in to see him, only because he's very popular.
A lot of people like him. I was my own
worst enemy in sending too many patients to him at
the beginning, and 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.
Speaker 1 (33:01):
And when you let me know that is the case,
we will all go and buy it online.
Speaker 4 (33:06):
Will do. Thank you so much, Michael, You're the best.
Speaker 1 (33:08):
My friend, doctor Mohitz A h. E. R A. Baylor
College of Medicine. Yeah.
Speaker 2 (33:17):
So I'm having dinner at Gringos, the new location at
ninety nine and two forty nine with Wayne Wilson, who's
the founder of Centergenics, and he was telling me about
we were talking about the testosterone replacement, but he was
talking about this doctor and he said, I think it's
(33:39):
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 Karen was the first one
that put me on testosterone. We did the pellets for
a couple of years, and then low T Center, which
is also Centergenics, became a show sponsor, so just moved
(34:00):
over there and started doing the weekly shots.
Speaker 1 (34:02):
I like the shots. I like the shots better than
the pellets. Some people like the pellets. I gotta take
my pellet story home.
It's that time. Time, time, Luck and Load. The Michael
Varie Show is on the air today. Joe is sponsored
(00:27):
by Peanut Butter.
Speaker 2 (00:31):
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 moment and think
about your best peanut butter moment.
Speaker 1 (00:54):
Ramon.
Speaker 2 (00:55):
Your peanut butter moment should not involve sex. But my urologist,
doctor with Kara 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
our life span, doctor Mohicz. Kara is writing a book
called Or about the sex span. How long can a
(01:19):
human being have a functional, fulfilling sex life, Doctor Kara?
Speaker 1 (01:26):
Why does that matter?
Speaker 3 (01:28):
Well, Michael, the first, 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
(01:50):
nine years old, 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 is very unfortunate.
Speaker 4 (02:04):
And all these.
Speaker 3 (02:05):
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.
Speaker 4 (02:14):
My health span.
Speaker 3 (02:16):
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 only have sex till fifty,
that's a problem 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 (02:38):
I know.
Speaker 2 (02:39):
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 important is
(03:00):
sex to the human body in terms of purely physically.
Speaker 3 (03:05):
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 of his Cardiovasker disease,
(03:26):
it's a symptom of his radical procestecto your 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
(03:46):
this is that did you know that if a man
walks in today and has a rectile dysfunction, fifteen percent
of them will have a heart attenic orth 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, thirty
(04:09):
percent of them will have depression or anxiety. So the
biggest mistake I can do is give this man viagra
and send 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 so
(04:30):
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 and the
coal mine, and you can actually save someone's life. I mean,
(04:51):
imagine if I catch someone's cardiovasker disease today or diabetes
today or I catch it ten years from now. It's
a total trajectory in terms of their house span and
their life.
Speaker 2 (05:03):
Well, it goes back to viagra originally being a cardiovascular
disease in an off label benefit being.
Speaker 1 (05:12):
The ability to get erection.
Speaker 3 (05:14):
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 2 (05:31):
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
(05:54):
get viagra, So everybody was faking a heart problem to
go in and get this medication. And the story goes
that the doctors were getting calls from the wives going, hey,
knock it off, take him off.
Speaker 3 (06:06):
Of that, 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.
Speaker 4 (06:16):
People used to make fun of it, and oh he
has ED.
Speaker 3 (06:19):
ED is a very serious condition. Someone gets erected on dysfunction.
Take it seriously. Something else is going on.
Speaker 2 (06:26):
Well, and to oversimplify this, that is because it means
you're not getting proper blood flow or you're not pumping
your blood properly. And that's I guess as good a
way as any for us to check, maybe the easiest way.
Speaker 3 (06:40):
Yeah, And so think about this. I teach their medical
students this new monic called event 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 direction, but I
just can't maintain it. He's telling you the blood flow's
coming out too quickly. The number one cause of e
D in the world. But the event stands for vasco
(07:02):
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 are notorious, for example, beta blockers.
How many people are on 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
(07:25):
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.
Speaker 4 (07:39):
Proud of myself.
Speaker 3 (07:40):
I was able to get these men, these amazing erections,
amazing libido. And one day a woman called me and
said to me, she said, everything was great with our
relationship until he met you.
Speaker 4 (07:52):
We never fought.
Speaker 3 (07:52):
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 low, or
raise both, but you don't raise one without the other.
Speaker 2 (08:11):
Doctor Mohit Kara at the Baylor College of Medicine and
my urologist and friend coming up. The book will be
I've got to get the name of it. It's about
the sex ban maybe called or sex.
Speaker 1 (08:21):
Bennerments A hard problem to librarian. Everyone listens to Michael
Very Show.
Speaker 2 (08:29):
The only downside to having doctor Mohiit Kara on the
air 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.
Speaker 1 (08:44):
Everybody I know.
Speaker 2 (08:46):
Is now his patient after hearing my experience with him.
Speaker 1 (08:54):
He's just fantastic. I think the world of him.
Speaker 2 (08:56):
Doctor Mohit Kara is at Baylor College of Medicine where
he is urologists. He has a forthcoming book. Is the
book called the Sex Span Moment or what is the
book called?
Speaker 3 (09:08):
It is called sex Span and a Proactive Approach, A
proactive approach to prolonging your sexpan.
Speaker 2 (09:16):
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
(09:39):
couple and to an individual emotionally? You tied it to
the antithesis of depression, but talk about that if you would.
Speaker 3 (09:47):
It's extremely important. If you look at couples that engage
in regular sexual activity, they tend to be happier overall,
satisfied with their quality of life. They usually tend to
be healthier and easily tend to live longer. So there
are numerous aspects. So there's one study that I saw
that talked about couples that engage in who do not
engage in sexual activity typically can have a twofold traction
(10:12):
from their relationship. But if they do engage sexual activity,
it actually can add four x to the quality of
the relationship.
Speaker 4 (10:18):
So I mean, let's be honest.
Speaker 3 (10:19):
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 benefits psychological benefit in
patients engaging in sexual activity.
Speaker 2 (10:38):
I have had friends over the years who when they
put their parents in old folks homes.
Speaker 1 (10:42):
They talk about how.
Speaker 2 (10:45):
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, but
we're talking about people in their eighties and nineties, and
I have heard this story consistently.
Speaker 3 (11:06):
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
(11:29):
who are tend to be healthier tend to be more
the ability to engage in sexual activity.
Speaker 2 (11:35):
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 erect all dysfunction is a marker of
other underlying major medical conditions, such as a heart attack.
The screening for testosterone, why is that important?
Speaker 3 (11:54):
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
(12:15):
that a man who has low testosterone is much more
likely to have a heart attack, non negotiable, much more likely.
A man who's low test awso is much more likely
to break a bone. A man who's low test austin
is more likely to have diabetes obesity metabol 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
(12:39):
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 you checking
a 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 testisteral level.
(13:03):
It gives you a marker level 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 testisteral level every single year after the age 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.
Speaker 4 (13:25):
If he's low.
Speaker 1 (13:26):
You suggested testosterone for me ten years ago.
Speaker 2 (13:30):
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 3 (13:45):
Well, the first thing I 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 testoso or no one told me
that the test as can make me infertile. Now we
want to have kids, what do I do? So there's
(14:06):
the ways I can reverse it. So the reality is,
if you're in the reproductive years, if you're planning on
having children and your tea is low, don't take test austone.
But let me give you medications that make you make.
Speaker 4 (14:18):
Testosterone that's safe.
Speaker 3 (14:20):
So I can give you medications to make you make
test alstone 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. We
now have oral testosterone, which is fantastic world. Test Austional
is very new in the United States. It's only been
out for five years. And now we have a pill,
we have injections, we.
Speaker 4 (14:38):
Have pallets, we have patches. But I will tell you
that I.
Speaker 3 (14:41):
Do think that this medication can have a profound effect
on the quality of life. And many patients, I mean
many patients come in they're thanking you, they're telling you
that they have a significant improvement in the directions their
libido muscle mass.
Speaker 4 (14:52):
Not everybody.
Speaker 3 (14:53):
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 2 (15:02):
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.
(15:25):
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 Synergenics is concerned, and I
didn't know you had an association with them.
Speaker 4 (15:38):
No, I appreciate it.
Speaker 3 (15:39):
I mean, I've been very passionate about this for about
twenty five years. So all my basic science of work,
all my lab all my clinical trials are around this topic.
So when it comes to teaching and education to others
about testoscerone, I'm all in one moment.
Speaker 2 (15:54):
Doctor Moltera 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.
Speaker 5 (16:07):
With his finger on the pulse, The kingail Ting continues
on the Michael.
Speaker 2 (16:12):
Berry Show, Baylor 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
(16:38):
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 bloodcot clots.
Speaker 1 (16:54):
I had a.
Speaker 2 (16:55):
Pulmonary embolism and they told me to stop taking testosterone.
I used to go to the low Te Center and
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 4 (17:09):
I do, Michael, so listen.
Speaker 3 (17:10):
There was a concern for that in twenty fifteen, and
the FDA asked to 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 and prostate cancer. What it
(17:31):
did find was there was no increase in heart attack
in those men taking test AWSOM 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 a slight signal. And I
(17:54):
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 that TESTOSA increases the
risk of DVT and pulmonary embolism. I think the difference
was small, but the traversial showed what it showed. Also,
I just want to mention it showed no increased risk
(18:15):
in prostate cancer and no increased risk of worsening of
urinary symptoms. Great study, traverse trial.
Speaker 1 (18:22):
Why do you think this is out there?
Speaker 2 (18:25):
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.
Speaker 1 (18:41):
You need to be careful.
Speaker 2 (18:42):
And my immediate response was, you haven't been on testosterone
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 3 (19:01):
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 their famous paper I'm
showing that when you give a man testos increases the
risk for prostate cancer. If you and I go to
the library right now and pull that paper, you're going
to find something very interesting. It was based on one patient,
one patient, nineteen forty one, and we's instilled fear in
(19:23):
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 you I had metastatic prostate cancer
(19:45):
all 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 metastactasy.
We're learning a lot about testosterer and prostate cancer, and
this concept that testoster increases the risk, I think, to
(20:06):
me is a myth. Michael, I want to bring up
one other important thing. You talked about this earlier about testosterone,
and he said when you give testosterone, does it make
people feel better? But I tell patients that you've got
to understand there's something that's just as important. It's lifestyle modification, diet, exercise,
sleep and stress reduction. I don't have a pill on
(20:26):
the planet stronger than diet, exercise, sleep and stress reduction.
Speaker 4 (20:30):
And every day when we wake up or when we go.
Speaker 3 (20:33):
To sleep, we should ask ourselves what are we going
to do on diet, exercise, sleep in 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 4 (20:53):
So on the defense, every.
Speaker 3 (20:54):
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 four 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.
Speaker 4 (21:09):
It's really important.
Speaker 2 (21:12):
The four on offense, which you have preached since today
I met you, diet, exercise, sleep and stress reduction.
Speaker 1 (21:21):
And do you have four on defense?
Speaker 3 (21:24):
The four on defense are absolutely so it's cancer, which
means it's a heavy cancer screen. Calling off 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 get
(21:47):
certain labs like APO B LP, little A. Sometimes we'll
get a cordery 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
(22:09):
stay away from. And then you know, there's not a
lot you can do with Parkinson's and Alzheimer's. 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, exer, you know, and
doing things. So it's really important to keep the bad
things away and use the diet, exercise, and sleep and
(22:30):
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 2 (22:41):
I don't know if I've told you this. Doctor Mohitz
Kara is our guest k 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 and
(23:03):
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 open the door and tell me.
Speaker 1 (23:16):
And he has.
Speaker 2 (23:17):
It has absolutely changed not only his health but his mood.
I mean, he is consistent, He can work harder, he
can work longer by just stabilizing blood sugar, which obviously
for most people is fluctuating with great volatility.
Speaker 4 (23:34):
I love that story.
Speaker 3 (23:35):
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.
(23:57):
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 your life because that
sugar is just pounding the blood vessels and just pounding them.
Speaker 2 (24:15):
My dad's a lifelong diabetic. He was nineteen when he
got diabetes. He's eighty five now. It's amazing. He has
all ten fingers and toes, but he has monitored he
I've had doctors tell me your dad knows more about
diabetes than we.
Speaker 1 (24:25):
Do because he had to treat it before they was instantly.
Speaker 2 (24:28):
But I take Ramon to see him last week, and
all they talked about was their cgms and their dex
colm CGM and what the reading was 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. Sure, the
book is The Sex Span, and we will double back
to that subject.
Speaker 1 (24:49):
Coming up.
Speaker 5 (25:01):
From Portland to Walbany at all great cities in between these.
The Michael Barry Show is nationwide.
Speaker 1 (25:11):
Doctor Movit Kara is our guest k H. E.
Speaker 5 (25:14):
R A.
Speaker 2 (25:15):
He is my friend and my urologist and an expert
in matters of sex and testosterone.
Speaker 1 (25:23):
I will read to you.
Speaker 2 (25:25):
Email from one fellow says, well, let me go back
to that. Another fellow, actually several fellows said, my wife's libido.
Speaker 1 (25:34):
Is way lower than mine. How can he increase a
woman's libido?
Speaker 3 (25:42):
That's a really important point. So you know I told
you earlier that couplet. The woman that called me it
was very upset. So in two thousand and eight I
actually flew out to California to 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.
Speaker 4 (26:00):
And when you.
Speaker 3 (26:00):
Improve both libidos, you actually it's synergistic. So women, this
female sexual dysfunction is comprised of four components low libido,
for arousal meaning poor blood flow to the genitalia, orgasmic dysfunction,
or pain.
Speaker 4 (26:15):
It was sex.
Speaker 3 (26:15):
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 4 (26:34):
Desire for sex. That's it.
Speaker 3 (26:36):
She takes the pill every day increases her desire for sex.
By Lisa came out several years later. It's an injection
EpiPen she injects strictly to increase her desire for sex. Now,
I just want everyone to be very clear, libido is
more deeper than that. I mean, there could be a
lot of other other factors. I mean, it could be
her stress, it could be her physical condition. It could
(26:57):
be fatigue, so you can't. It could be the quality
of relationship. So I mean, if someone has a terrible
quality and 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.
Speaker 4 (27:08):
But I still also.
Speaker 3 (27:09):
Believe when you improve a woman's diet, exercise, sleep, and stress,
her libido does go up.
Speaker 1 (27:16):
It also helps if you take them to the movies.
Speaker 4 (27:20):
Yeah, that's true. That's true.
Speaker 2 (27:23):
The most these conversations, Alex right, Zar, what if you
can't always afford the treatment for testosterone? Is there a
safe supplement I can take that would help?
Speaker 3 (27:37):
So the good news is that you can get testosterone
even compounded compounding pharmacies. Many of them are called the
five ZHO three B, which are heavily regulated. They make
testosterone at a price of 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 coupon card or you
(27:58):
use Mark Cuban's company, you can get ninety days for
roughly twenty or twenty five dollars ninety days for Siale.
So these medications are extremely affordable and price should no
longer be an issue.
Speaker 1 (28:11):
That's interesting.
Speaker 2 (28:14):
Several of the questions relate to hemoglobin, blood 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 3 (28:30):
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,
agel's twelve percent risk and appeal is 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
(28:54):
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, want to wait till fifty four.
Speaker 4 (29:01):
So it is real. And remember that many of.
Speaker 3 (29:04):
These patients have sleep apnea ac cult to sleep apnea,
and the testostern 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 2 (29:16):
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.
Speaker 1 (29:28):
Their overall health or lack of it that sleep is.
Speaker 2 (29:32):
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 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 3 (29:47):
Michael, You're so right. Listen, when I take care of
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. They are lousy at sleep and stress. Right,
and so, and sleep and stress are so critical, and
you think about sleep, it is a game changer. Even
(30:08):
the 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 4 (30:22):
Right.
Speaker 3 (30:23):
So, the reality it's not just lying there with your
eyes closed. You have to get good deep sleep, good
rem sleep, and even thirty minutes extra of 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
(30:44):
best website I found was the American Sleep Foundation. The
American Sleep Foundation has twenty tips on their website. They're awesome.
Follow those tips. That makes a big difference.
Speaker 1 (30:55):
Salt in the diet. So I've been reading a lot
on salt lately and.
Speaker 2 (31:01):
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
it basically the point of the piece was that we
are now deprived of salt. And what do you do
(31:22):
to treat someone for a number of things is you
give them salt.
Speaker 1 (31:25):
Your thoughts on salt intake, So, I think.
Speaker 3 (31:29):
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 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 the kidney stones. And so
(31:55):
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 (32:06):
But on French Fries, it's okay, right.
Speaker 2 (32:10):
Sometimes, doctor Mohi Kara, you are the absolute best.
Speaker 1 (32:17):
The four phases of offense he has outlined or diet.
Speaker 2 (32:22):
Exercise, sleep, and stress reduction all things you can do
yourself that don't 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'm want to be overwhelmed again.
It's Baylor College of Medicine. It does take a while
(32:44):
to get in to see him, only because he's very popular.
A lot of people like him. I was my own
worst enemy in sending too many patients to him at
the beginning, and 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.
Speaker 1 (33:01):
And when you let me know that is the case,
we will all go and buy it online.
Speaker 4 (33:06):
Will do. Thank you so much, Michael, You're the best.
Speaker 1 (33:08):
My friend, doctor Mohitz A h. E. R A. Baylor
College of Medicine. Yeah.
Speaker 2 (33:17):
So I'm having dinner at Gringos, the new location at
ninety nine and two forty nine with Wayne Wilson, who's
the founder of Centergenics, and he was telling me about
we were talking about the testosterone replacement, but he was
talking about this doctor and he said, I think it's
(33:39):
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 Karen was the first one
that put me on testosterone. We did the pellets for
a couple of years, and then low T Center, which
is also Centergenics, became a show sponsor, so just moved
(34:00):
over there and started doing the weekly shots.
Speaker 1 (34:02):
I like the shots. I like the shots better than
the pellets. Some people like the pellets. I gotta take
my pellet story home.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Law & Order: Criminal Justice System - Season 1 & Season 2
Season Two Out Now! Law & Order: Criminal Justice System tells the real stories behind the landmark cases that have shaped how the most dangerous and influential criminals in America are prosecuted. In its second season, the series tackles the threat of terrorism in the United States. From the rise of extremist political groups in the 60s to domestic lone wolves in the modern day, we explore how organizations like the FBI and Joint Terrorism Take Force have evolved to fight back against a multitude of terrorist threats.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com