June 02, 2025

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

2 hours 19 minutes

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This is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility.

We discuss:

The incredibly complex and hostile journey sperm must take to fertilize an egg [3:00];
How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors [9:00];
The built-in filter that weeds out genetically abnormal sperm [14:45];
How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities [18:30];
How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle [26:30];
Male infertility and Paul’s diagnostic approach: detailed history, a physical exam, and identifying red flags [33:30];
Viral infections that can affect the testes and potentially lead to sterility [40:30];
Semen analysis: morphology, motility, and hormonal clues to male fertility [45:45];
Effects of medication, microplastics, stress, and exercise on fertility [57:15];
Testosterone replacement therapy (TRT) and male fertility [1:06:00];
Restoring fertility after prolonged use of exogenous testosterone [1:25:00];
Effects of heat and cold exposure on fertility and sperm quality [1:36:00];
How different levels of exercise—especially cycling—affect male fertility [1:41:45];
How alcohol, marijuana, and nicotine affect male fertility [1:46:00];
Why type 2 diabetes is a risk factor for male infertility [1:50:00];
How varicoceles—a common cause of male infertility—are diagnosed and treated [1:51:15];
Genetic factors that affect fertility [1:54:00];
The impact of lifestyle and environmental exposures on fertility [1:56:30];
The evidence (or lack thereof) behind stem cell and PRP therapies for male infertility, and how lifestyle and non-invasive interventions often lead to successful conception [2:00:30];
Considerations for sperm banking, and how paternal age impacts fertility planning and offspring health [2:05:00];
Semen quality as a biomarker: linking male fertility, longevity, and preventative health through Medicine 3.0 and epigenetics [2:14:45]; and
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By Peter Attia, MD

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