#358 ‒ Peter's takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying ｜ Quarterly Podcast Summary #6
Episode Stats
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Summary
In this episode, Dr. Peter Atiyah reviews the most important learnings and insights from the past quarter of interviews, as well as any behavioral changes he's applied as a result. Topics covered include: Male and female infertility, women's sexual health, menopause, and hormone replacement therapy, the biology of aging, skincare, and rejuvenation strategies, and lessons we can learn about living from the dying.
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can access
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the AMA episodes in full, along with a ton of other membership benefits we've created,
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or you can learn more now by going to peteratiyahmd.com forward slash subscribe. So
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without further delay, here's today's sneak peek of the ask me anything episode.
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Welcome to a special episode of the drive. In today's debrief, I focus on what I consider
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the most important learnings and insights from the past quarter of interviews, as well as any
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behavioral changes I've applied as a result. In this episode, I'll cover a variety of topics,
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including male and female infertility, women's sexual health, menopause, and hormone replacement
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therapy, the biology of aging, skincare, facial aging, and rejuvenation strategies, and lessons
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we can learn about living from the dying. If you're a subscriber and you want to watch the full video
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of this podcast, you can find it on the show notes page. If you were not a subscriber, you can watch
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the sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy this
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quarterly podcast summary episode of the drive. All right, Peter, thank you for showing up to
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another episode of your podcast. How are you doing? Good. Thank you for having me back. I see you brought
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someone else with you in the studio today. Do you know who that is? I do not. Who's the little guy in
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your shirt? Oh, Charles. Yeah. Charles. So you're going to jump in at all today? Provide any insight
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for us or what's his deal? He might. It's the funniest shirt in the world. It is. Just little
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Charles, just peeking up there, happy as could be. I know. I know. I love it. Bringing the excitement
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over there, which is good. Today, we are doing another podcast summary episode to remind people
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what we do. We pull recent episodes that have come out. We go through them kind of one by one,
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highlight things you found really interesting, things that were your biggest takeaways, anything
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you changed your mind on, behavior on, how you work with patients on as a result. So these aren't meant
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to replace people listening to episodes, but these episodes, I think this is our sixth one. And to date,
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we get some of the most feedback compared to any episode on these where people really enjoy them.
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And a lot of times people will either go back and listen to certain parts, say that things kind of
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make more sense from this. And so a lot of good feedback from this, but again, should not be a
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replacement for these episodes. Today, we got a lot to cover. We have Paul and Paula on male and female
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fertility. So they were two different episodes, but for this, it made the most sense to combine them
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into one as we look at insights. So we'll do that. We have Rachel on women's sexual health,
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menopause, HRT, something I know you're passionate about and enjoy talking about. Brian Kennedy,
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which was a really deep dive around biology of aging, kind of a throwback to some of our original
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episodes where you dive super deep into that. You have Tanuj and Susan, which looked at all things,
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skincare, facial aging, rejuvenation strategies. On that note, you're looking pretty sharp over there.
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You've been taking some of their recommendations into your day-to-day practices.
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We are absolutely going to talk about that because we are probably two and a half months
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now since that episode. And I'm looking forward to discussing exactly what I have done. In fact,
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of all the episodes, this would be the one where I've had the greatest change in my personal
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behavior. Can't wait to hear it. Did you do anything different with Charlie or is he still on the
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same skincare routine? No, Charles is still doing the exact same skincare routine.
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It's working for him though. So why fix it? And then we're going to end with episode with BJ and
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Bridget, which was all around death, dying, but more so what you can learn from people on their
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deathbed. So huge variety of topics we'll cover. Anything you want to say before we get rolling?
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No, other than it's interesting that the last and second to last topics we will cover could not be
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more apart in terms of relevance and superficiality. You know, it will be a stark juxtaposition of
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something not to bring any sort of judgment against aesthetics, but ultimately talking about end of
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life and lessons about life through death versus how to make your skin look better are about two opposite
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ends of the spectrum. But nevertheless, it is a spectrum and I think we can find value in talking
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about everything along it. Yeah. No one can say we don't have range on the podcast. So we got that
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going for us. All right. First one, Paul, Paula, all things male, female fertility. Where do you want
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to start? Just from a story standpoint, it is remarkable. And maybe that's, we try not to do too much
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summary in these episodes because the show notes do such a great job of that. But I do think there's a
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couple comments worth making. So the idea that conception is difficult is an understatement.
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A single ejaculation releases about a hundred million sperm, fewer than five million of them
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even make their way past the cervical mucus. And ultimately only somewhere between a hundred and
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five hundred reach the fallopian tube. And then only one goes on to fertilize the egg. Now that might be
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that 20 reach the egg, but obviously there's this really cool force field that comes up the minute
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the first sperm touches the egg, it creates a chemical barrier that prevents any others from
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fertilizing. Otherwise you'd have this devastating situation of too much genetic material being brought
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in. Just a couple of interesting things that made me at least go, wow, is that sperm are chemotactic.
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So they're basically chemical guided missiles that make their way to the egg and they can traverse 15
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centimeters of distance within the vagina to the fallopian tube within minutes. And so it's important
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to understand given how small a sperm is, that is the analog of a human swimming 20 miles in the ocean
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in that same period of a few minutes. By the way, just even though we didn't go into this in the
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podcast, think about the energy requirement to do that. And so you kind of understand what the
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motor and the ATP generation is like in one of those things. Testes like the brain have kind of a
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specialized blood tissue barrier. It's very immune privileged and it protects developing sperm from
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antibodies, but it also means that drugs or toxins that can cross it, such as certain types of
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chemotherapies can actually be disproportionately damaging. It's for that reason, of course, that a
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lot of men who are undergoing chemotherapy will choose to do a sperm donation prior.
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Spermatogenesis, so the generation of sperm, follows a clock of about 74 days, if my memory serves
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correctly. And therefore, if you're trying to make interventions around sperm health, so if a guy
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gets his sperm tested, comes back that something's not right, you can identify behaviors that are doing
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that, you're going to need two to three months of trying a corrective intervention before you can
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determine if it's worked. That's how long it takes to go through the cycle.
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On that intervention piece, one of the things that was talked about was bike seats. As someone who spent
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a lot of time on a bike, being you, not me, did that surprise you?
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Yeah, I mean, I've always been pretty mindful of bike seats and I've been very fortunate despite how
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much time I used to spend on a bike, I never had any issues. But as Paul points out in the podcast,
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it's really not a big concern for fertility, but it is much more a concern around erectile function.
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And basically, based on your anatomy and based on the type of seat you use,
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you can really traumatize the arteries and nerves that impact erections. So what we tell all of our
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patients, if they're spending a lot of time on a bike, we have recommendations on bike seats that
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they should be using. I have two bikes, one for inside, one for outside. I have different bike
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seats on them because I got them at different times, but they're basically the identical type of
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seat, which is a seat that has the middle of the saddle is largely absent. And so the ischial
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tuberosities, your sit bones are doing the supporting, but nothing else. And so we can link
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to a couple of the brands that I think are pretty good. As silly as it sounds, I kind of recommend
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people buy a couple. So buy from somebody who will let you return them by like three and try them out
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and figure out the one that's most comfortable. So Peter, back to then fertility, Paul talked a lot
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about what his workup is for his patients. Do you kind of want to remind people of that and how you also
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apply that to your patients as well? Thank you for listening to today's sneak peek AMA episode of
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