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April 18, 2019 58 mins

More than 500,000 men get vasectomies every year in the United States. On this very fertile episode of the podcast, Joshua David Stein and co-host Postell Pringle, both vasectomized men, talk to Dr. Joseph Alukal, professor of urology at the Columbia University Medical Center about why and how. He'll also explain what's up with the tufts of smoke commonly seen during the procedure.

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Episode Transcript

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Speaker 1 (00:04):
Hello, and welcome to the Fatherly Podcast. I'm your host,
Joshua david Stein, and I'm infertile, and so's my co host,
Postel Pringle, and so is our engineer Jesse. And today
we're gonna talk about vasectomys, which is why we are
all infertile. And we're gonna talk to the dude who
gave me mine, Joseph Lukel, Dr Joe. He's a professor
of urology at Columbia University Medical Center. When he gave

(00:27):
me mine, who was down at n y U. But
I remember from the experiences he's a great conversationalist and
just a cool guy to hang out with. And I
remember the smoke from my balls. So today on the podcast,
we talk about the procedure itself, why I got it done,
Why five hundred thousand, many years get it done, talk

(00:47):
about how it affects my dating life, which is complicated,
and Dr Joe finally explains the difference between semen and sperm,
which I never understood before. Join us. It's loads of fun.
Welcome ter podcast. I hope you are doing this show. Hey,

(01:11):
Dr Josepha Lucal, how are you doing. I'm good man,
I'm so sorry about this. It's just been a it's
been a crazy few days. It's okay. I think there's
a lot of yours to deal with alcohol kind stuff,
not just not just your but yes, strange things happen
and uh and then all of a sudden, here you
are a little later. Hi, how are you doing? This

(01:35):
is a Pastel Pringle co host. Oh, Hi, how are you?
I'm good. I'm good. I was going to add it also,
two pairs of balls to go with each, so it's like, yes,
now we're getting closer to sometimes the unexpected stuff that
or or the organ that the uitra lives in like
a memoir. Ye think it sounds like a folk song.

(02:01):
Um you are justin Oregon. And then and then all
of a sudden, um um Harmonica. Um so Dr Luco.
First of all, thank you for being a guest on
the father Le podcast. You are talking to me and

(02:25):
pass have both had vasectomies. Jesse, Can I say that? Yeah, Jesse,
your engineer has had a vasectomy. So it's a bunch
of a bunch of dudes, you know, with no sperm. Yeah,
we're spermless dudes. Yeah, that's okay, that's totally Okay is it? Yes, yes,
it is okay. That's the point I just need. I

(02:46):
need reassurance every now and then. Um well, I wanted
to tackle this as part of the father Lea podcast
because obviously as a dad, um, you know, having a
vasectomy it is a big It kind of like cuts
to the root of what it is to be a
father and to be able to procreate so to speak.
I um, you know, I wanted to share a little

(03:07):
bit about like why I got my vasect to me,
and then maybe poss you can talk about yours, and
then Dr Lucal. But should we call you Dr Joe
Dr Joe? That's totally or you could just call me Joe.
I mean either was totally. I like Dr Joe. I
like a Lucal really local is pretty cool too, But
I like Dr Joe. That's really like, I don't know,
it's really homy. It's really like, you know, folksy, I

(03:30):
like Dr Joe, Dr Joe. Yeah, and also kind kind
of sounds tough, okay, you know what I mean? Well, look,
so I forget so you were the one who gave
me my vasect to me like a beautiful present in
my crotch. So thank you very much, Josh. I thought
that was the case, but I wasn't totally certain because
it's a little while so many you know, I've done

(03:53):
a couple of thousand now, and so I was like,
do I know this, dude, and so thank you for
closing the loop for me. And then the other which
is important, was I wasn't entirely sure if I was
right about that, that I could just disclose that. Oh yeah, yeah.
I talked about my vissectomy all the time. It's like
my hopefully hopefully and you remember it fondly and people
are happy to hear about it. I hope that's the case.

(04:15):
It's like a big crowd pleaser when I talk about
my vissectomy. Was about to say, it depends on what
part of the story he gets to. Then it like
it starts off as like a sort of like subtle
fascination and then really it's like a great story and
then it kind of gets gross. Oh man, no, I don't.
I don't. I'm worried about the gross part. No no, no, no, no, no, no, no.
Okay okay, um okay. So basically, uh my idea was,

(04:41):
you know, I was married, um when I got the
sect of me. And I was having conversations with my
wife at the time about the fact that birth control
had been for the duration of our marriage pretty much
her responsibility, and you was taking birth control um and

(05:04):
she didn't want to put the hormones in her body
anymore and I couldn't. And after thinking about it for
a while and discussing it with her, it's like, well,
why is that her responsibility? It's also my it's my sperm,
you know, like there's two in that equation. And the
the surgical procedure of vasectomy is so I mean, it's

(05:27):
been My experience was so um minor it's not major
surgery that I had a hard time justifying not doing it.
So that's so like sort of um parody in the
relationship was really important to me, especially because um hormones
is such an invasive sort of chemical to add to

(05:49):
your body for a woman that did how could I
ask someone to do that every month? Sure, Josh, I
gotta tell you, there's there's a few things about that
I wish that were sort of like the poster boy
in terms of you know, thinking about this and sharing
it with people, Because what you just said, I think
is the logical route that people in a committed relationship
would take towards getting a vasectomy for the guy when

(06:12):
they're done having their kids. And there's there's one piece
you left out of it. But I think it's super
important too, which is, you know, the comparable procedure and
a woman a tubal ligation tying off the tubes that
get her ovaries to her uterus. You know, that requires anesthesia.
It's more invasive, you know, and she's already done the
heavy lifting literally of having your guy's kids. Why not

(06:33):
take this this minor procedure on yourself. Um, that's what
my doctor had on and I can certainly go into
more numbers details like what are the things about a
vasectomy that I think, um, maybe people should know and
they don't know. Um. But the one other thing I
would say is not a doctor, but like a husband
and a dad, I do. Actually, you know, I wish

(06:57):
I had medical data to support it. But it's strikes
me that it's crazy the amount of estrogens that we're
letting out into the wild, and estrogenic compounds in the
form of birth control pills, what do you get into
the wild? I mean that that when the women you know,
take birth control pills every day of the month, every

(07:20):
month of the year. They pee the majority of that
stuff out. Okay, a lot of those compounds have only
been metabolized to some extent, and so they still have
estrogenic capacity even though they're now in the wastewater. Where
do they go from the wastewater, They eventually make it
back into other water, are drinking water, the water we

(07:44):
used to um for agriculture, for farming, for animals. It's
like the human equivalent of like those microbeads that used
to be in beauty. Yeah, no kidding, You know, those
just ended up everywhere, you know when when we're talking
about and I get it, some of the some of
those compounds are coming from other things that we're doing
in nature, plastics, things like that. But I think we've

(08:05):
finally reached a point where many of us, not all
of us, are looking at each other going, Hey, what
can we do to take better care of our earth
in terms of the stuff that we're not even thinking about,
Like the stuff that's affecting our health that's coming back
to us from things like uh, inorganic produce, non organic produce,
from things like our water. And I actually think this
ends up being a much larger problem than people realize. Okay,

(08:27):
now again I can't prove it, and I took off
my doctor held before I said it. And there's probably
some executive with the pharmaceutical company that makes birth control
pills who's literally trying to figure out right now how
he can find me and punch me in the you
know where? Can I him? Well, he didn't have his
doctor head on, and maybe he doesn't have enough estrogen
if he's really getting that like aggressive, Yeah, who knows, Well,

(08:49):
I'll measure his hormone. That is a very interesting aspect
that I had never thought about the environmental impact of
birth control hormones. I never thought about the actually as
a doctor, there's other horror hormone. I don't want to say.
I don't want to say waste. I don't know how
you say it, like the you know that's rich in

(09:12):
hormones which is going into our water table? Is that
something I don't know, not really related to this ACTO means,
but is that something that you feel like is a
concern in the medical establishment. I do think, to put
it differently, I think people are now thinking more certainly
in in medicine their doctors, both men's health doctors and

(09:35):
women's health doctors, so kind of coologists who are thinking
about these questions and ask you about this, and and
so you know, I I've had the chance to interview
gun of colleges before. We're looking into the question of
you know, where are the estrogens in our environment coming from?
And and certainly a big component of that the one
that they really want to point their finger at all
the time, and I do as well as plastics. And

(09:56):
so we are asking ourselves whether or not the plastics
in our environment in this a fashion. It leaches into
the drinking water, then it gets into all of our food,
and then it gets into and as well. You know
what we drink um is that having an impact with
regard to health issues both in men and women, including
things like breast cancer, prostate cancer, including certain kinds of
birth defects that are impacted by the hormones that a

(10:20):
baby is exposed to in the womb. So I know
this is on the radar that people are trying to
answer these questions more scientifically. But I can't tell you
that there's anyone study that says, I know exactly how
much of this stuff is in the environment and how
much of it comes from extra y or z Okay,
I absolutely do know that when somebody tells me, Joe,

(10:40):
you know, I've read the science on where does our
body put this stuff when we're done with it? Or
what happens to the estrogenic compounds that are in plastics
when as the plastic item decomposes that it's a very
real amount. You know that that it's it's not a
negligible amount. And I couldn't tell you, I know, I mean,
you know the amount of plastic it's you know, produced

(11:01):
and in our environment now is wasted in the trillions
of tons? Is that more or less than how much
I'd love it if that were the case, But I
don't know, because then it's a solvable problem. But is
that more or less than the amount that women in
aggregate are peeing out? I don't know. And to walk
it back one more second, it's it's an important public

(11:21):
health question from a different perspective in that we're always
trying to figure out what our best contraceptive strategy is
from a public health perspective worldwide, right, So if you
go to third world countries where unwanted birth is is
it's really a health issue. You know, the burden that
that caring of pregnancy has on a young woman, um,

(11:43):
the burden of caring for that child when they're an
infant and as they grow up. It has an impact
on these societies that are poorer than ours, and certainly
has an impact in our own society. So if we're
going to ask ourselves the question, okay, worldwide, what are
we doing to enable people a chance, it's to have
the family they want and to not have children unexpectedly

(12:03):
and thereby burden our society. We got to actually have
a strategy that's healthy to deploy in terms of saying
to people, Okay, this is what you're gonna do for
birth control. Now. The problem with that is if we're
talking about let's go off for vasectomy two single men
who haven't yet had their families, that becomes a tough
one to justify, you know, because you're making a decision

(12:25):
for that guy that's somewhere along the line if he decides, okay,
I want to have kids, Now, well what's he gonna do?
And we have options for that, but we shouldn't have
to put the whole world through that. Right, I'm rambling Hey,
so I had a question. Um, this pivots a little bit,
but um, um, how did you go from being just
Joe um or Joseph if I may Joseph for Joseph? Yeah,

(12:50):
it does yet to to Dr Joe the urologists. What
was fascinating to you about your ology? Like? How how
did you come to that? Sure? That's um, It's a
question I've been asked for a bunch of times. You know,
It's funny you get asked that question. Seems like all
the time when I'm doing a vasectomy, people always as
I asked you that question when you're getting this is

(13:11):
such a weird thing to be in a room with
a dude messing with your balls. He wanted to talk? Yeah, no,
you you need to talk to people. That's one of
the ways you can keep them comfortable. And you know,
people are doing this procedure and it takes fifteen twenty minutes,
but they're wide awake, you know, so so that you
you really do want to be able to help them
be comfortable, and so you know talking is an important
part of that. But I think lots of people reached

(13:32):
the same question in their head. They're like, why does
this dude, do this? How did that happen? So it's
a it's an interesting story for me, and that it
involved a family member who figured out that they had
a particular kind of kidney cancer. So the guy was
a doctor and he had diagnosed himself with this tumor

(13:53):
because he was having some symptoms, and he got a
cat scan and the cats can showed him that the
tumor was the size of a football, which is way
too big for a kidney cancer. And so I just
started in medical school. I've basically been there just a
few months when he called me and he was like, look,
you know the place you're at, there are some very
very famous urologists. Can you please ask them where I'm

(14:14):
supposed to go near where I live, where I'm going
to have a chance of actually surviving this. And I
got off the phone with him, and I didn't even
know at the time that eurologists did that surgery. We
are also, it seems so far from what you and
I did. Absolutely, and I'll walk you through that, but
we we are surgeons of the following um interesting collection

(14:37):
of organs in the body, so in men and women,
anything in the urinary tract. So our kidneys, make eurin
our bladder story urine, and then anything downstream of that,
Bob Dylan's urethra, and then as well, okay, sorry, all
of the above, Um, the reproductive organs of men and
sometimes women and women. There's an overlap with like certain

(14:59):
kinds of surgeries. We you versus the guyecologist, okay, and
so anatomy wise, you've got to know some strange parts
of the body, certainly the general as you've got to
know what's in the pelvis, which is a strange place
to have to operate, and kind of what's in the
back and around the kidneys. And so I got off
the phone with this guy and I was like, well,
I'll go find these doctors and I'll talk to them
and I'll see what they say. Um, but you know,

(15:21):
I I gotta help my family out, but I don't
necessarily know that this is something I would end up doing.
And so I went to meet with them, and they
ended up being incredibly helpful. The person questions survived this
was you know, twenty years ago, and it wasn't something
you automatically survived back then. They sent him to kind
of the world's experts who took great care of him,
and they were very informative but at the same time

(15:44):
really down to earth good people. And and so they
basically all like a couple of the residents and one
of the doctors on faculty. Theyre were like, look, man
in exchange for for this assist, you know, you've got
to come back and spend some time with us when
you are a more senior medical student and you're in
the hospital. I So I kept my promise and I
went back and I spent a few weeks with them
near the end of my my time in the clinics

(16:06):
in the hospital, and I was sort of like completely
surprised at the fact that I loved what they did.
They were really, really, really exceptional surgeons. Like the first
people to do complex surgery with cameras u S. Laparoscopic
surgery was eurologists. The first people to do complex surgery
in the body with lasers, it was youurologists. The first
people to do complex surgery in the body with robots,

(16:28):
it was Eurologist, and it was I canna understandlogists sharp
freaking laser beams on their head. You're operating on balls
in space. No, that's right, I'm sure one of US
is going to go to space. I'm sure of it,
because if we're going to live in space, we gotta
figure out how are people going to do it? In

(16:52):
arologists And I hope it's me. I wanted to be me. Yes,
you're not a robot and don'ts out of your hands,
but you do. You don't know, man, That's what it
felt like with him, you know, Oh so so gentle.
I wish you had given me given made a reference
for me when I had to have mine, you know,

(17:13):
Dr Joe. Sorry, I've like sent you know, I was
sent to you by a friend, and I feel like
I've sent like five of my friends your name. But
because everyone's getting dissected me now, so no, this is
important though, so so we do about five hundred thousand
every year in the United States. That number varies a lot,
you know, it could go up hundred, go down hundred thousand.

(17:36):
It goes up and down according to things like how
well is the economy going? And yeah, and that's something
I wanted to ask you about it it's inversely proportional
to the health of the economy or is it directly proportional?
Generally speaking, when the economy is crappy people are more
likely to come in because they don't want to have
more kids, you know, conversation with their wife and it's

(17:59):
just too much money. Yeah, but it's interesting that they
wouldn't resort to other forms of birth control temporarily, Like
they're saying, no forever more, we don't want to have
any more kids. Well, I think it may be one
of those things where people aren't sort of aware of
it top down, like they just know they're sitting at
the dinner table, like, we don't have enough money to
make ends meet every month, and we've already on two,

(18:21):
and you know, one of them says, well, I don't
want that to be three. And then he you know,
he goes in and he gets this done and it
is commonly covered by insurance, you know, that sort of stuff.
That's another reason that it's a good option for people.
The other reason why I'm not mad at you, how
could I be mad at you can be mad at
Dr Joe for being hard to track down, is we're
just out of March And isn't March peak sector? Really?

(18:47):
Why is that? Well? I think over the years, somebody
smart did the marketing, you know, uh, genius move of
of suggesting to a guy, Hey, look, you know you're
going to do this the first couple of weekends of
March madness and you've got some free time on the
couch to to watch some basketball. Do you think he
was a marketing guy for the couches or basketball, or

(19:08):
like he wanted to make his practice busier doing vasectomies.
I did it once four years ago. We did the
whole March Badess. Think signed it up top to bottom.
And the problem was, like the Thursday of the tournament
that that first Thursday, I think I did twelve. In
the Friday, I did ten, and then you know, over

(19:30):
the weekend. I'm a basketball fan. It's not like I
didn't want to watch the damn tournament. And you know,
both blowing up with like people are like, oh, you know,
one side swollen, I need some more pay medication, and
I'm sitting there, go what the hell was I think?
I Try call me on Monday. You're about to go
into overtime. We'll be back with more from Dr Joseph

(19:52):
Lucol after a quick word from our sponsors. Part of

(20:21):
the reason I got my vissectomy was that parody reason.
And the other reason is kind of like a less Rosie.
Reason is that, you know, I wasn't sure at the
time whether my marriage would last, and it ended up
not lasting. And I didn't want to be like my dad.
My dad got divorced from my mom and then went

(20:42):
on to have a series of like other kids and
other families. And you know, now I love them. They're
my half brothers, but they're you know, they're like eleven, thirteen,
and fifteen. I'm thirty eight, Like I don't have that
much to do with them, and you know, it's sad
for me, and and I think it's said for them.
And I didn't want my kids to have I didn't

(21:03):
want that to be an option for me when I
was alone, so I thought, okay, better than I make
the decision now and then when I'm desperate and unhinge,
not desperate, just f y, I am unhinged, but not desperate. Um,
I would not that option would be off the table,
kind of like um, hiding your keys when you're sober,

(21:24):
so when you're drunk you can't drive all sure, Sure,
I mean I do think I never know when I'm
never going to judge anybody who's sitting in front of
me and saying, you know, I want to have more
kids and I'm trying to figure out how, and this
is my story. But I do think and I think
that the generationally, you know, our generation has maybe different

(21:46):
points of view about what's a family supposed to look
like and what's the role of a dad in that family,
maybe than one generation before us. Um, I don't. I
don't mean to make a broad generalization, but I mean
at the same time, I just I've heard a lot
of guys say what you said, which is, even if
my relationship didn't persist, if something happened to my wife

(22:07):
and I weren't together, I know that I don't want
more children, and I don't want to try and build
a different family with somebody else. This is my family.
Even if my wife and I aren't together anymore. We're
gonna do what we can to raise our children, and
I'm not going to embark on that with somebody else.
I must have heard that. But the thing is is
you think that the reason why I got a vasectomy

(22:29):
is because I knew. I thought that at the time,
but I was also reasonably certain that if I did
get a divorce and I was lonely in like five years,
I'm lonely and I want to find someone and it's
like a deal breaker that I can't have kids. I
don't want to have to make the decision at that point.
I want the option to be off the table. Now.
I know there are some ways to reverse the vasectomy,

(22:49):
but it's so much more involved than in more expensive. Yeah.
So for me now, like I've gotten some feedback just
like no kids deal breaker. It's usually like you seem cool.
No kids deal breakers really like like like like they
just check the box, like like checking the box they

(23:10):
give you back the application. I'll be checking, you know,
we'll be chatting and it's like, oh, like won't match.
And then I'll be, oh, hey, you seem cool, but
no kids deal breakers, Like yeah, well yeah, well you
know what that's the deal. Yeah, absolutely well I guess
you know, it's been better to know that now. Um
if I may, like I was gonna say, um, so

(23:32):
I actually had my vasectomy or earlier on this year.
It was around super Bowl time, not not March madness.
Um in V date yeah, like my infamous V date.
And you know what, I think I don't have that
much to add in terms I think I had kind
of similar, um similar reasoning for getting it. I am

(23:53):
still with my partner, and when we discussed, when we
discussed the idea of me having a vasectomy and everything
like that, at like a lot of it, um So.
Certainly some of it came down to, like financials, but
that really didn't really so much come into it. A
lot of it came down to, like you said, um,
birth control, uh, contraception and all that kind of stuff,

(24:13):
and like I never want to wear a damn condom again,
never not in like, not in this lifetime. So that
was like the lifetime or the next. Well I don't
necessarily believe in the next lifetime, so but it's like
no more condoms this time or this time. So um
So that that was a huge part of it. But
then I think, also, like what you said, I really

(24:35):
just want to only have one family. I think it
comes from a similar situation. My parents got divorced, um
my dad, and although I'm very very happy with um
with my extended family, um my dad got remarried. He
didn't have more kids, but even just having other siblings,

(24:56):
other step siblings and everything like that, I didn't want
to be in a position of using more kids. I
really just want to concentrate on my own family and
um yeah no. And I guess on top of that,
like like JD S said, like I really it seems
unnecessary and unfair for my lady to have to like

(25:17):
pump more more hormones in her body just for us
to have a comfortable sex life, you know what I mean? Yeah, yeah,
and and and also I don't want a more stinking
as kids. I mean, honestly, when it comes down to it,
I'm forty three years old. The idea of having another
child like I had my my my most recent and

(25:39):
God bless her last child when I was forty one
years old, forty or forty one years old, and like
the idea of having another stinking as kid, like running
around like my knees hurt. I wake up my knees
hurt outside and I got a like a back injury
that came out of nowhere, like you know, getting Yeah,
I'm getting I'm getting old, Like I don't want I
don't wanting more kids. Use Dr Joe, Yes, just for

(26:04):
our listeners who might not a few listeners who might
not have already had a vasectomy. Do you mind just
walking us through what you actually do? Yes, please, and
and then I have a very important question once you
walk through. Okay, so you know I always think of
the family guide joke. You know that that song of

(26:25):
assectomy is a medical procedure. Um. It is a procedure
that's done almost always in the office and almost always
under local anesthdual only. So that means done in the
urologists office. That's right, and and not that different than
say going to the dentist. Okay, you walk in there,
you're talking the whole time until somebody puts something you

(26:47):
know into your mouth, right, you know, at the dentist office.
But in our case, you and I are able to
talk the whole time, and you should be comfortable the
whole time. We have to give you some local anesthetic,
just like the dentist, to get everything numb downstairs. Sometimes
that's the only one comfortable part. Most of the time
it's the only uncomfortable part. And we even have some
tricks upper sleep to make that far more bearable. Okay,
so where are you injecting the So again, we know

(27:12):
we we started off the show with this two testicles.
They've got some attachments, some wiring and like when I'm
trying to explain this to the medical students in terms
of like the anatomy and what are we working on
where when we're doing operations down there, things like that.
I asked people to imagine a big light fixture and
like a big conference room at a hotel. Okay, like
imagine also how I think of my penis. Yeah, right, ticture.

(27:41):
So it's kind of like interchangeable, like you get in
dependent on bault. But yes, no, we could work on
that operation too. That might get us somewhere. But like
the wiring is what I'm talking about. It hangs from
the ceiling, comes down to the fixture. But if you
could imagine looking through the ceiling, if you were the
electrician you got into this ceiling, you know that wiring
runs from the middle of the room in one direction

(28:03):
to one of the walls. And so the wiring that
goes to and from the testicle is bizarre stuff that
once it gets to the wall, once it gets inside
your body, it goes in all kinds of different directions.
There's the one tube that's taking you know, the tube
that we're gonna sniff, that's taking sperm, and it's got
to take it in the direction of your penis. Obviously,
there are the blood vessels going to and from the testicle,

(28:24):
they go in a totally different direction. There the nerves
that go to the testicle, and they go in a
totally different direction. But once you get all that stuff
out of your body and into you know again like
the ceiling, it's all in one bundle, and then it
comes out of the ceiling and you can feel it
above your testicle. And so really, what I'm doing when
I numb somebody up, I gotta put all this numbing
medication into those nerves. I grab all that wiring right

(28:48):
where it's coming out of the ceiling, the ceiling. Just
that we're clear. The ceiling is I don't know that
is it the body cavity? It's like you're the ceiling
is the space where somebody would get a hernia. It's
just say space if you if you could imagine that line,
if somebody goes in and get hernia surgery, the line
that they draw where they make the incision on your groin,
that's exactly the course of the wiring in the ceiling,

(29:12):
and so right where it gets nearer but not immediately
on like the base of your penis. It comes out
of the ceiling and I can get to it, and
that's where I numb you up. And if I put
that numbing medication in there, and then I just wait
a little bit of time, you shouldn't feel a damn
thing that I do after that. And what do That's right? So,

(29:34):
now further down, closer to the testicle. One of the
pieces of wiring is this toobe, the carry sperm from
the testicle, whose job is to make sperm back all
the way up through this convoluted pathway into your pelvis
and then eventually to you know, the the organs near
the base your penis. I can get to that tobe

(29:55):
right where it lives, just above the testicle without too
too much trouble at all. Get it very near the skin,
make a tiny opening in the skin, pull the tube through,
Snip the tube, tie off the edges, burn the edges,
tie some tissue between the two ends of the tube.
Let it pop back into your body. Okay, I have
a question, is where's a slack from that tube coming

(30:17):
from if you're pulling it out of the body. Yeah,
it's a great point. It's again like that same wiring.
Imagine you. When I got up into the ceiling and
tried to pull the light fixture up, we'd grab the
all the wires and pull them back towards us the
same way. You know, your testicles began when you were
in the womb, deep in your body, not where they are,

(30:38):
and so they were attached to all this stuff because
those attachments were made in your body. Well, as they
descend down into the scrotum, the the attachments grew, and
there's plenty of redundant or extra length in them. I
was just gonna say, um, shout out to the guy
that did my um, the guy that did my zectomy,

(31:00):
Jed Kemanevski, you know Jed by the way. Okay, well
you can tell Jed that he should wait longer for
the anesthesia to come, because I don't think he waited
long enough. What did you feel my incision? Oh my god,
it really well. I don't know if I so much
feel you know, I did feel the incision. I felt

(31:21):
like it felt like this, like this intense pen prick.
Although I mean you just felt like a pin prick,
but it was like really intense. And then when he
was working on it, I swear like I just felt that.
I mean, have you ever been kicked in the balls? Yes? Yeah, yeah, Jesse, Okaya.

(31:42):
It really felt it really felt like like this sledgehammer
kicked balls. That the balls felt like they went up
into my abdomen. And I just remember my toes like curling,
but not in a good way, you know. I remember
it reminded me of the Wizard of Oz when when
the which is yeah, the witch's feet kind of curl up.

(32:03):
That's how my feet felt when he was operating on
my balls. What I felt with you, Joe, when you
were operating on my balls was um, I didn't feel
any pain, but I felt like in my body the
tension of pulling that tube such a bizarre feeling. It
wasn't painful, but it's one of those Yeah, it's one

(32:27):
of those like um feelings you get sometimes during surgery
where it's like a visceral sensation which you've never experienced
in a place, you've never experienced like I've never felt
that in my body in that way. Um. But just
so you you you extract this tube, you pull it out,
tie it and you do that on both sides. Was

(32:51):
so well you have to do it four times? I mean,
maybe this is too much in the in the balls.
But it's too because there's two tubes you have to do,
and there's two knots per tube. Yeah, and it leaves
behind us right, they literally behind a knot on each side,
you know, above and below and then right and left.
It's a grand total of four what kind of not
really tiny silk ditch. Silk is something we've been operating

(33:13):
within the human body for like a couple hundred years,
and your body never rejects, it doesn't get allergic to
it for some reason. It's just totally happy with it.
So there's there's four tiny silk knots in your body
as a result of this um And so then when
you then okay, so then you sew us back up.
I remember when you when I got it done, we
were talking about restaurants. You're a big foodie. You're talking

(33:35):
about you and your wife. That was actually the question
that I really wanted to ask. Do you have where
does Dr Joe like to eat? Yes? Man, yes, especially
after doing ball surgery, Like what do you want? What
are you gonna ask? Well, I was actually gonna ask,
do you have a what do you talk about? What
do you think? I mean? Do you have a standard

(33:55):
like points of conversation when you when you're talking to
guys and you're operating on their junk, like you know that.
I imagine that there's some people who are kind of
uncomfortable with talking. It's part of the job. Is part
of the job getting them to relax by talking to
them a little bit. And and you know, some people
just don't want to talk, so you gotta let it be,

(34:16):
and I do. I always encourage people. Look, if you're
really freaked out by this, and you want to bring along,
you know, your phone and your air pods and just
check out, that's fine too. I just there's a couple
of moments I need to be able to talk to
you to make sure that you're not uncomfortable. But the
majority of people, you know, you can get them to
talk and not to think about this just by asking
them simple questions like what do you like to do,
what do you do for a living, tell me about

(34:37):
your family, and and and just be willing to listen
and talk to people up all. Yeah. The only thing
that I remember being a little freaked out by was
when you caught her eyes the two smoke. Yeah, everyone
everyone is nodding around the table. That was like a
very memorable moment, just like just to close and loop
on what happens afterwards. So after you make the incision,

(35:01):
the surgery is complete, Uh you have well, me as
a patient, I don't jerk off for a while, and
then I jerk off, which was very hard, by the way,
that was a very difficult. But so what is going
on and why? Like what is that? What? Yes, I
understand that you make the you you tie up both tubes,

(35:22):
but what are we looking for and what are you
looking for in the recovery. So the reason I asked
people to refrain from any kind of sexual activity for
a couple of weeks after surgery is because if I
gave anybody an out the following one sexual act is okay,
everyone would be doing it NonStop for those two weeks,

(35:42):
and people would also be trying to push the envelope.
So like, we we don't want people having sex immediately
after the procedure, just because we have done some work
down there and it's easy to traumatize it and stir
up leading and it hurts. Yeah, right, but you know,
guys being guys are still going to try and ok, right,
if they are so it is bleeding. I don't care,

(36:03):
I know, but it exactly so. Instead I just tell people,
you can't do anything two weeks. You're gonna survive, just
get through it. Now, what happens at the end of
the two weeks, It's not that anything fundamentally has changed there.
It's just that you've healed up enough that you can
go back to sexual activity and you're not going to
stir up any bleeding. Like that's me having heard on
the side of caution. Two weeks is probably longer than

(36:25):
I need to tell people to wait. But again, I
know that people are cheating. You know, guys who got
the ten days like I gotta do this, you know, Okay, fine,
you know, at least I got him probably to a
point where he's safe and then he shouldn't have any problems.
What's the other issue, though, is that where we did
this work and knocked out this bridge, beyond that point,
they're already were living sperm stacked up in your system. Okay,

(36:49):
So the other thing I got to remind people is
that the majority of people are going to fail a
vasectomy fail it the same way, which is just a
few weeks after surgery, and they figure, I gotta be
all set, you know, Like guy told me, I had
to to a test to check and make sure I
was sterile. I was clean, but everything's got to be fine.
They have unprotected sex with their wife and their girlfriend
or their girlfriend and they get them pregnant, right, And

(37:11):
it's because there's still very much firing live rounds and
so that one. You'll hear different people tell patients different things.
Some people say, wait three months, but you know, again,
I don't know what people are doing in those three months.
Sometimes people get confused. They think the whole three months
are not supposed to ejaculate at all. Sometimes people they
hear three months, but they decided to wait three weeks,

(37:32):
you know instead, I people just get really dumb. No,
this is hey, man, we're we're all men, and I
take I'm never gonna want to offend anybody, and I
take no offense. But there's a talk I've given all
over the world where I used to have a slide
that said young men are dumb. And at the end
of having given that talk, one day someone walked up

(37:54):
me and they go, you know, you could make it
easier on yourself either by putting young in parentheses or
just take it out of the damn fly. It's like, oh, yeah,
that's right. It's standard to have to have a a
fertility analysis, a sperm analysis. Um after you should everybody should?
You know? The correct answer is absolutely you continue to

(38:15):
use contraception until you've done that test, and then you
and I have discussed that test result. And only then
do you have a clean bill of help to stop
using contraception. And I tell people, don't bother doing the
test until you've had ejaculations. I don't care if that
takes you three weeks or three months, but you know,
at that point there's a reasonable to give emptied out

(38:37):
the right three weeks. You know. I'm just saying, I'm yes, yes,
there's you know, hands on experience. Um, so what happens
to the So okay, this is like sex, said one

(38:59):
on one, but quickly the difference between sperm and semen. Yeah, sure, absolutely,
so Again, the sperm are coming from the testicles, okay,
and they're they're what are going to get your wife
or your girl from pregnant, right, But the rest of
the fluid that goes in the semen. In fact, the
overwhelming majority of it comes from the organs around the
base here penis like I was talking about before, that

(39:21):
includes your prostate. And so that's why you can do
this procedure to somebody and there's no noticeable difference in
terms of what they're ejaculating. The fluid comes. The majority
that fluid comes from downstream structures to where we did
this work. So that's not impact at all. The only
reason what else is in semen? Sure? Yeah, so so

(39:45):
fluid that helps to counteract the acidity of the vagina. Okay,
uh no, Like um, it's a protein that's made by
the seminal vesicles, some sugar, a particular kind of sugar, fructose,
which is actually a source of energy for the sperm. Um.

(40:06):
It's like it's like the bit of gatorade, and you
got it. Keep on going, yes, smart, ye, delay your
gratification just one bit. We're gonna hear a word from
our sponsors. We'll be right back. But right, So, the

(40:32):
whole reason anybody has a vasectomy is so that they
can have unprotected sex. Right if something about the procedure.
I have to answer this question all the time when
people come in and there a little bit literia doing
this if something about the procedure fundamentally altered your experience
of sex, whereby you didn't enjoy it as much, nobody
would do the freaking procedure r right, Like if you

(40:52):
told me afterwards, oh, you know, I can't get her pregnant,
You're right, but I don't have any sensation having an
orgasm anymore. Who the hell would do this? So you know,
for the five guys a year who are doing this,
the overwhelming majority of them come through on the other
side and they go there was no discernible difference in
my sex life. Directions are fine. Sensation of sex is fine,
sensation of orgasm is fine. What I ejacutly looks the

(41:13):
exact same. If I didn't know any better, I wouldn't
know that anybody had done this to me. That hap,
And what happens to the semen? Like right? So now
I'm I think I'm a year two years after the procedure.
Am I still producing semen? You mean sperm? You mean
you both? But yes, so the sperm you make up

(41:36):
stream of where we did the work in the testicles,
those have nowhere to go. They hang out for a
little while and then they die. They die like I
don't want to think about that. It's so sad that
just like a bunch of these sperms like sitagraph like, guys,
come on, let's go, let's go, let's h fuck it,

(41:57):
I give up. Yeah, your whole life thiose guys of it.
You know, you think you've literally made trillions of them.
You start caring now, you know, I'm say, how many
kid children do you have to? Okay, so, out of
the trillions of sperm you made in your entire life,
only two actually got the job done that they were
made for. Yeah, you know what, now are all over

(42:19):
God's greener earth losers? Yeah? They those are the only
two sperm that actually like did their job. The rest
for too many, too busy taking coffee breaks, like going yeah,
it's like trying to look busy. You know that guy
that was always just kind of hanging around smoking And
when the boss comes around, they start sweeping up. So
what happens? What so? So the sperm die, Yeah, and

(42:43):
they make a little funeral and the vast deference deference
and the organ immediately upstream of that, which is called
the epidymus. How many times do you hear the joke
that like I'm going to show you vast deference because
you are a professional. Oh but did you there one?
You know, like there is a vast difference between A
and B. Like I got friends from college, we're looking

(43:05):
for every single possibility that they can't joke with me.
You know what's the worst as difference between your old
job and your new one? I like vast deference. It's
kind of what are the other urology jokes that you
you hear? Uh? You know? The best one I heard
was just the other day when I hadn't heard it before.

(43:27):
A patient walks into the hit his way at Dr Joe. Yeah,
patient walks into the doctor. You're gonna have to stop
masturbating quite so much, sir? Why because I'm trying to
examine you like that? Can I steal that? When? Um? Okay, well,

(43:56):
I guess one of the other questions I wanted to
ask It is like maybe a little more serious. But
I feel like we covered vasectomes for a lot of
guys and a lot of our audience. Um, you know,
men's health is something that overall men are kind of
neglectful of or don't consider. And I wanted to give
you a bit of an opportunity to talk about some

(44:17):
of the other things that not only you do, but
some of the other things that men should generally be
aware of. UM. With reproductive I guess it's not reproductive health,
just men's health in general. Sure, there there are a
lot of different doctors who were the doctor of a
men's health, were the hat of a ment health doctor. UM.
And I think urologists as one group of us. You know,

(44:40):
it's there are a lot of guys who were the
only doctor they're going to see between the ages of
twenty and fifty. You know, it's it's something strange that
happened downstairs, will put them in front of the doctor.
And I just try and always I try and remind
the doctors who do what I do. You know, you've
got to remember that that's an opportunity to put this
person on better footing in terms of their health as
they get older. So you know, that guy's talking to

(45:00):
you and he's forty five, and he hasn't seen a
doctor in twenty years, and he's smoking, and he doesn't exercise.
You know, I know it's not what you were trained
to do. You're a surgeon, But take two minutes or
five minutes and talk to him about quitting smoking. That's
going to keep him from getting diseases he gets older
that you don't want to deal with things like bladder
cancer that are almost entirely related to tobacco use. And

(45:21):
we take care of um, get him to exercise. That's
gonna help him in terms of things like diabetes, high
blood pressure. If you have to operate in him on
some other reason when he's sixty, you know that he's
going to be a healthier dude. But do you feel
that that it's more? You know, I read about all
the time about the average time spend of doctors with
patients that's going down and down, and um, do you

(45:45):
find that pressure yourself? I mean you're talking about during
March doing twelve vasectomys a day. It's like, is it
difficult to have that more gp conversation with a patient? Yes? Absolutely?
Is that. I don't know how those people can do
what they do and not only see one patient an
hour and they're asked to do you know, something far

(46:06):
more difficult than that. If if they're seeing you know,
forty patients a day, it's it's really hard for them
to be able to do everything they need to do
to keep somebody healthy. And I think, you know, it
reminds me also that like all of us play a
role in our patient's health. So, you know, I don't
I don't think anybody my trainees don't get the cop
out and say, well I only take care of this No,
you're taking care of this person. You know, You've got

(46:28):
to take time to ask them these questions, listen to
their answers, and be a good physician, you know, tell
them what they should do that's going to keep them healthier.
I do, you know, I worry all the time about
things like, you know, do we not have enough time?
Are we being pressured to do too much? I'm an
eternal optimist. I gotta believe that the future, you know, what,
will technology enable us to be able to do for patients.

(46:49):
Um in five years and ten years and fifty years,
I think it will be more. I think it will
be easier for us to reach more patients and to
be better doctors. But right now, I just need to
get men to understand, yes, it's okay to put yourself
in front of a doctor. And I need doctors you
know who do what I do to understand. Yeah, we
got to take care of these men. Yeah, I was
gonna say, like, um, I know, for myself, I felt

(47:11):
like it was a good opportunity and I joked at
the at the expense of my man, Dr Jack Kemenevsky,
but shout out to him, because I feel like we
were able to have a very real conversation about prostate
health based on yeah, based on having the procedure. And
I was wondering if that, like if having that procedure
allows that conversation to open up for men also just

(47:34):
side all right, you're older than I am, what's going
on with my prostate? Yeah, it is a great question
and nobody knows the answer. So so a strange organ
that um, like I said, it's involved in making the
fluid that goes into seemen, much of it, and as well,
it has a muscular component. It's involved that that muscular
component contracts involuntarily when you have an ejaculation. So it

(47:59):
isn't just making the fluid. It's actually involved in and
getting it to squirt out of your body. You know
why where is it? It's in the base of your pelvis,
the absolute bottom of your pelvis. And again like that's
why you know Moon River, that joke about, you know,
getting a rectal exam. Why do we have to do
this to check people's prostates? We feel one surface of
the prostates? Bugle wallup. You guys not know Fletch from Yeah,

(48:27):
you know, I'm not. I have to remember medical students now.
But yeah, there's a scene in the movie where he
goes to a doctor and the guy checks this project
and his joke is like he's using the whole fist, doc.
This will be over in a moment, and they start
singing Moon River vaguely remember that. Yes, anyway, the joke being,

(48:49):
you know, why do we have to go through that unpleasantness?
And and patients always, always, always they try and duck
out of that. They don't want to get their prostate check.
I get it, and and honestly, I don't want to
check anybody's prostate. It's no fun for me. I or
you know the point you have to get through the
that's like, yeah, yeah, that's the best way we got
right now. Yeah it's correct, that is right. But I'm

(49:18):
going to leave it alone anyway. But you're not. But
you're not. When I said that, you're right, I was lying.
But what are the problems are prostate causes us as
we grow older. Every other organ in your body got
the memo to stop growing when you turned twenty, and
your dumbass prostate keeps growing, and so sometimes it can

(49:38):
grow in a fashion where just because it's bigger, it
can cause you problems in terms of urination because it's
also an next door neighbor to your bladder, and that
happens to guys as they get older in addition, and
some guys that can develop prostate cancer. Wait, is endlessly
fascinating to me that that, of all organs just keeps growing,
like your nose or your ears, which yeah, they all stop.

(50:01):
Why is there an evolutionary explanation why a prostate would
continue to grow larger or is it a function? I've
wondered about this, as bizarre as that sounds like, why
they feel like a good theory would be there might be,
although maybe not that um as our lives have become
artificially elongated and life expected expectancy has risen due to technology,

(50:27):
you know, development. You know, maybe evolutionarily, we should have
died at a point when our prostate was reasonable. Instead
we're living on well beyond prostate age. These completely unreasonable process,
just huge prostates. Sure, no, no kidding. I mean when
when you are a twenty year old, it's probably about
the size of an aprica, between like a cherry and

(50:47):
an aprica. Sometimes in our practice, nine year old guy
who can't be he doesn't have cancery, just cam'tpe and
we'll take out a protect the size of a grapefruit
or larger. Wow. There there is a serious concern for
some people. And you can actually help clarify whether or
not this is a myth or not. Some people are
concerned that it will having a vasectomy will up their

(51:09):
chances of getting prostate cancer. Is that complete? Is that
a complete myth? Or is there something to that. I
believe it to be a complete myth that that assertion
is based on two studies that came from the same place. Um,
it's going to sound bizarre when I say at Harvard,
So the School of Public Health there ran a men's
health study where they looked at men who were in

(51:31):
some sort of health profession, so physicians, nurses, physician assistance.
Dennis and they followed about fifteen thousand men for many years. Okay,
And they were the first and only people to ever
make the suggestion that a disproportionate number of guys in
their group who they had followed who had had a vasectomy. Um,
we're more like the developed prostate cancer. Okay, And so

(51:54):
the criticisms of that study, there's a million of them.
But I think the first is it's way too few
end to establish a relationship between two things that are
really common. Like I said, five hundred thousands of seconds
every year in the US, and as well, two hundred
plus thousand men every year in the US diagnosed with
prostate cancer. In addition, you've got a group of men
who are not men on the street. You've got a

(52:16):
group of men who are far more likely to put
themselves in front of a doctor every year. They are
more likely to get diagnosed with prosty cancer. There's dudes
out there right now outside this clinic who haven't seen
a doctor in thirty years. They might have prostay cancer,
but you know, diagnosing it in them depends upon them
actually seeing a doctor. So that first study came out,
and shortly thereafter, UM, some researchers in Denmark used a

(52:40):
health database for the entire nation of Denmark and found
no relationship. Far many, many, many, many more patients, far
more statistically significant conclusion. I think, um, these guys from
this Harvard Health Professional study just published a fall of
study a couple of years ago. There's people working on
again trying to credited and I'm not right, I trojans right,

(53:06):
you know, I really don't know, you know, what's their
motivation for trying to scare people on this acount. I
don't know, but there's no physical explanation or physiological explanation
as to why that might occur. And as well, I
think it's really really you know, think about it this way.
If we do a half a million vasectomies every year
in the United States, it wouldn't be that long before
we recognize there to be a signal nationwide, you know.

(53:29):
And so I I just think it's got to be.
And last piece of advice. I always remind people about.
You don't know how many urologists our age have had
this procedure done. Like I go to meetings and my
buddies are like, oh, yeah, you know so and So.
I trained with him. He lives in the area. I'm
just going to his office tomorrow. It's closed, but he
was just gonna do my visectory real quick. So you guys,

(53:50):
if we were hiding it from people or if we
were scared about it, we wouldn't be doing it. Yeah.
So the last question I have for you and for you, no, no,
for him, it's it's really simple, but that very important
you do that. Then. Okay, My last piece of advice
for you, if you don't already do this, if not,
holler at your boy jed Um, because I really think

(54:12):
that you should. If you're going to shave the balls
before doing the procedure, please inform the patients about how
itchy they're gonna get when the hair is growing back.
Sure that is, like I really wish he had told me.
That was, like, I mean, you know, my the swelling

(54:33):
and everything that, yeah, exactly what I mean three times that, yeah, exactly,
I'm bleeding from the balls whatever. But but I have
to say, out of everything, that was the discomfort that
I wish I had known about. Sure your Yeah, yeah,
you know the other we sometimes people will come in

(54:55):
and either they regularly shave themselves or they've already shaved
themselves that day and in the last and I look,
it's fine that you did it, but we don't like
people doing that before procedure, because it actually increases their
risk of infection. We should do it ourselves and then
clean the patient up staily immediately afterwards. But yeah, I know,
the people who are least bothered by that are the

(55:15):
ones who are regularly manscaping themselves anyway. Everybody else is
kind of like Doc. That part did suck. I really
not happy with that. Yeah, for for weeks. The last
thing I wanted to ask you is what if you
had to give one piece of advice for not vosectomies,

(55:36):
but for general upkeep that guys can do to keep
themselves safe and healthy. What would your advice be? Sure
I can, I can make it quick, but I can't
say it's only one thing. I you know, hosting the
radio show I did on Serious X and for for
years and years at my former institution, UM, the Mental

(55:58):
Health Show, we have experts from all kinds of different
fields on and the same answers always came up. Exercise,
if you smoke, quit, if you don't smoke, don't ever start, UM,
try and get some more sleep, Try and do what
you can to minimize stress. And those last two are hard.
I know, we're all working our asses off and I

(56:20):
know we're all stressed out about our families at home
and our work lives and everything else. But just do
what you can to try and sleep a little bit more,
and to figure out something you could do to reduce stress.
I used to add in a fifth when I was
talking to men. I used to if if we had
a guest who was on about men's health, I'd make
the point establish a relationship with a doctor you trust.

(56:42):
Say so, I mean, like, now is the right time
for us to do that. We're men in our thirties
and forties. We've got to have a doctor who were
willing to talk to We don't mind seeing them once
a year and let them keep us healthy as we
get older. Can I ask you a question about that,
which I'm actually I know I said last question, But
do you recommend that is a general for atitioner or
can it be a you out? Like who what kind

(57:03):
of doctor should I be connecting with? Sure? I know
the technical answer probably ought to be the general practitioner
like that dude can take care of everything above your belt,
whereas I can't. Like so, if it's your heart, your lungs,
your ears, you knows your throat, but at the same time,
I also know that a lot of those guys, maybe
you're not going to have that relationship with them that

(57:25):
that you know somebody has with me. I don't know,
so I try and wear both hats a little bit.
And we were trying to create a ment health center
here at Columbia where we're going to have the place
stocked with doctors who people are willing to talk to. Well,
Joseph A. Luco, thank you for your service to my
testicles and too the testicles of thousands of men, and
Dr Joe on behalf of my testicles you demand. Thank you,

(57:47):
my friend, a great day. Thank you so much for
being on. This is very insightful, no problem. Thank you
guys for having me. Thank you, sir. So that's it
for this episode of The Fatherly Podcast. I want to
thank Dr Joseph A. Lukel for being such a wonderful guest,
Postl Pringle for being a compelling co host, Jesse Schaltz
for being a sage engineer, Anthony Roman for being a

(58:11):
dedicated producer, Andrew Berman for being a crotchety executive producer
who makes the show better. If you don't know where
to get podcasts, by now I don't know what to
tell you. You should, and if you like this podcast,
make sure you review and rated. If you don't like it,
keep that to yourself, okay, B.

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