Men’s Health: Male Fertility, Vasectomies and Family Planning
Episode 51: Men’s Health: Male Fertility, Vasectomies and Family Planning with Dr. Justin Dubin & Dr. Kevin Chu @themanuppodcast
We often speak so much about women and fertility but it is important that we also begin destigmatizing conversations around men's health! Rachael kicks off this episode with a conversation with her husband Marley about his decision to get a vasectomy several months ago and what that process was like.
Next, Rachael has on doctors Justin Dubin and Kevin Chu to discuss all about male infertility, health, and the details of what to expect with a vasectomy procedure!
Here’s what they discuss inside this episode:
Highlighting the role of men in fertility
How common male infertility REALLY is
The various factors that can cause male infertility
Genetic conditions, anatomy issues, medications, and lifestyle choices impact on men's health
Tips for improving fertility outcomes
All about the vasectomy procedure: the benefits and who is a good candidate for it
Addressing common concerns with pain and recovery for vasectomies
Are vasectomies reversible?
And so much more!
Dr. Justin Dubin and Dr. Kevin Chu are the current co-hosts of the men’s health podcast Man Up: A Doctor’s Guide to Men’s Health. They are fellowship trained urologists with focuses in Male Infertility and Sexual Medicine who bring their passion about men’s health and education with the goal of improving both the lives of men and their partners. Dr. Chu and Dubin have published multiple papers on male infertility and sexual health, and have been quoted in the NY Times, Insider, GQ and Men’s Health. Dr. Dubin is currently the Men’s Health specialist in South Florida and Dr. Chu is a Men's Health specialist in Los Angeles, California.
Mentioned in this episode:
Dr. Justin’s Instagram: @justindubinmd
Dr. Kevin’s Instagram: @kevinchumd
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Rachael is a mom of 3, founder of Hey, Sleepy Baby, and the host of this podcast.
Listen to the full episode
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Welcome back to the podcast. No One Told Us. I'm your host, Rachel. And today is a very special episode because we're going to be talking all about men's health, fertility, reproduction, vasectomies. My husband Marley is joining just for a hot sec before I bring on our guests because I really kind of wanted to hear your personal experience with your vasectomy,which you had about eight, six months ago, November. Yeah. Yeah. So What made you want to choose a vasectomy, first of all?
Well, we decided that we were done having kids. Yeah, for sure. You and I have had discussions for the entirety of our relationship about your birth control, how it makes you feel. I will just say, you know, candidly, men often benefit from women bearing the brunt of birth control and contraception because I was done it felt like it felt like the right and fair thing to do to absorb some of the burden of what women and women's bodies endure to regulate birth control.
Yeah so you decided and then once you landed on that decision or we landed on that decision actually it really wasn't even ever a huge discussion…. it was just like understood that that was what we were going to do. How long did it take you to like get your appointment to get seen, what was that process like?
I mean, really, it took me coming to the end of my health insurance and doing it right before I left my job. And it wasn't really that I was delaying it for any particular reason. I mean, I'm just a procrastinator by nature, but... Yeah, because we waited until Leni was a year. We originally had planned on doing it much sooner than that.
Yeah, we wanted to ensure that we were, that our baby, that your pregnancy was healthy, that our baby was healthy, that we were certainly done with growing our family, and so that there would be no, like, undoing it. I feel like the narrative around undoing vasectomies is a little bit misleading. It's not super easy. It's very expensive, and it's not guaranteed. And so we wanted to be sure. And so we waited until we were sure.
Yeah. And so to get the appointment and stuff was easy?
It was pretty easy. Yeah, through my health insurance, I think they just really want to make sure that you know what you're committing to.
So they ask you a bunch of times, like, are you sure, are you sure?
Yeah, sort of like, they want to make sure that you know, one of the points they hammered the most was like, this is not guaranteed to be reversed. Because I think, you know, in movies and television, it's made to seem as though you can just like turn it back on. Yeah. And that was very much not the case. It's not a super pleasant experience.
Yeah, you don't want to have to go through it again. No. So let's talk a little bit about that. What was the experience like from start to finish?
It was relatively straightforward. Like, you know, sure, it's a little bit like awkward and uncomfortable. Just having your privates out with a person. I had never met this doctor before. It wasn't the same person. I like did my consult. It was a woman you know there's a lot of things that go into it… it was a little bit painful… it didn't, the pain didn't persist I was like I experienced some discomfort for maybe like a month afterwards but the whole thing took like 45 minutes maybe.
You were definitely sore that day and like a couple days.
Yeah and like you know I ride a bike a lot like it yeah there was some discomfort for maybe like a month afterwards and then And then it was done. I will say that post vasectomy,
I've had a lot of conversations or been just like around people talking about them. And if your partner is considering it or you want them to consider it, just acknowledge that there is some like mental stuff that goes on with men in terms of losing their virality. Is that a word?
Yeah, that's the word. Yeah.
You know, it can be sort of like whether it's toxic male culture or not, but like it can be a source of where men feel like they get their masculinity or their confidence or all this kind of stuff. And like I've had people say that they feel like they're being neutered or, you know, castrate. You know, it just feels like, you know.
It's like their manhood. Their manhood and their masculinity is being taken away from them. And that, like, is a real thing, right? It is in human nature to, like, for a lot of people to want to procreate and you are essentially taking away that tool. So I think men should do it. I think that men benefit from birth control. If you've been sleeping with women for most of your life, the likelihood is that they were on birth control and you have benefited from your whole life. And it's only fair to not have to subject their bodies to anymore, especially after they've given you children. Do the right thing, fellas.
Man up. Man Up. All right. With that, we are going to dive into the episode with our guests from the Man Up podcast, Dr. Choo and Dr. Dubin. Thanks, honey.
Welcome back to the No One Told Us podcast where we tell the truth about parenting and talk about all the stuff you wish you knew before having your kids. I'm your host, Rachel, and today I'm speaking with doctors Justin Dubin and Kevin Chu. They are the current co -hosts of the Men's Health podcast, Man Up, a doctor's guide to men's health. Their fellowship trained urologists with focuses in male infertility and sexual medicine, and they bring their passion about men's health and education to their podcast and their social media platforms with the goal of improving the lives of both men and their partners.Doctors Chu and Dubin have both published multiple papers on male infertility and sexual health, and they've been quoted in the New York Times, Insider, GQ, and men's health. Dr. Dubin is currently the men's health specialist in South Florida, and Dr. Chu is a men's health specialist in Los Angeles. So thank you both so much for joining. I know this is not my usual type of episode, but I think it's really important, so I appreciate it.
Thanks for having us. This is really exciting. And, you know, this is part of it where it takes two to tango and, you know,coming across the aisle and trying to, you know, help a lot of women educate themselves on men's health topics and How do, you know, get their partners involved is an important part. So thanks for having us on.
Yeah, I was sharing with you guys before we started recording that my husband back in the fall had a vasectomy. And I got so many questions about it. So he's going to come on at some point and share his experience whenever we can find the time. We have three kids. So it's tough. But we have three kids. So that was why we decided to get the vasectomy. We were like, we're done. this needs to happen. And he was totally on board, but I think so many men are hesitant or scared. So we're going to get to that in a little bit. But first, I would love to just kind of hear both of your journeys into, you know, this specialty and just hear a little bit about your background.
Yeah, sure, absolutely. I'll take the first one. I'll start here. Urology is kind of actually the field that overcompasses, you know, what Justin and I do. You know, we specialize a little bit. We're men's health specialists. But urologists are, you know, we take care of anything in the general urinary kind of system. So for me, I actually, what got me in was robotic surgery. I loved robotic surgery kind of back in medical school. And I thought I was going to be a robotic surgery. But, you know, as I got, went through urology, I realized one of the important things for me was just men's health topics. And so that's what really drew me into the specialty. I wanted to take care of guys and kind of promote this idea that guys, you know, you shouldn't be so destigmatized and taking care of your own health. And that's what's really kind of brought me, you know, kind of my journey to becoming a men's health specialist.
Yeah. And, you know, in similar fashion for me, I'm originally from New Jersey. I grew up over there. And I actually thought I'm a big New York Giants fan. So I always thought I wanted to be a sports medicine doctor for many, many years. And I had, after college, I went to Johns Hopkins. I had been trying to work and I stumbled upon urology where I had been applying for jobs and I had no idea what urology was. And I just ended up working in urology at Cornell for two years in Upper East Side of Manhattan. And come medical school, I had to make a decision. I was back in Rutgers in New Jersey. And I just felt like urology was my path. And Kevin and I had actually both done our residency at the University of Miami, which is where we had met and became very, very good friends. We were co -resident. So we went through it for five years together. And during that time, we both really got interested in men's health.
And similar to Kevin, you know, the stigma of talking about men's health was very appealing to me, but what I really liked is when we're talking about men's health, male infertility, sexual medicine, testosterone replacement therapy, we're talking about improving quality of life. And a lot of medicine, in many ways, you're thinking about don't die, don't die, don't die, don't die. And now we're thinking about, okay, you know, let's create life. Let's make a good life. You know there's life after cancer. There's life, even if you're not feeling great. We can make that better. And that felt really compelling to me. And so I did my fellowship at Northwestern University in men's health. And Kevin ended up staying and did his fellowship at University of Miami. Now I came back to South Florida. Kevin's in L .A., so we're a bi -coastal podcast. But, yeah, so that's kind of our story and we've been doing the podcast man up for about three years.
Our goal is to really destigmatize these conversations, provide a safe space for guys to get good, accurate information because there's a lot of bad information online. And that's why we really commend you, Rachel, because I think that was one of the reasons why you started your podcast and started this topic because, you know, you couldn't get the information that you wanted. And so we're hopefully all on the same page. And that's we're trying to achieve the same goal for men.
Yeah, I love that so much. And I think you really touched on this where it seems like there is more now of a push to talk about infertility. And at least in the mom space, that's where I am. I definitely see, you know, an increase in people being willing to talk about things like miscarriages and pregnancy loss and secondary infertility and all these things seems to be destigmatized a little bit, which I think is so great. But I do think that there is another side of it, which is the men's side, right? That's only when we're talking about women's infertility, that's only one piece of the puzzle. So I'm definitely not seeing it talked about quite as much from that perspective. So I'm really happy to have you on. And I think maybe that's where we should start our conversation today is what is male infertility and what are kind of the things that could be potentially impacting fertility for men.
So, you know, male infertility basically deals with, you know, men who are having issues contributing towards, you know, the actual, you know, conception process. I'll tell you, in terms of stats, quite startling, actually, almost about 50 % of men will be contributing towards some sort of infertility. Actually, a sole male factor, it's only about 20, 30%. Correct me if I'm wrong there, Justin. I think that's around. And so it's, for the longest time, we've always assumed, yeah, it's the female, it's the female, that's kind of been the stigma. And over time, though, you know, hopefully with education, we're seeing that the male needs to be kind of worked up in that instance.
And it's so a lot of the times, a lot of reasons is in relation to having sperm parameter issues, having lower sperm concentration. And I think those are some of the things we're going to get into, right, Justin?
Yeah. And I also think, you know, it is quite common. Couples and fertility, about 15 % of couples, one in seven couples, struggle with infertility. That by definition for women, and unfortunately, the woman age is determining that time frame. And it's for couples with a female partner under the age of 35. It's one year. It starts to, you know, be a little bit shorter after that. But like Kevin said, in those couples, one out of seven couples who have infertility, at least around 50 % of the time there is a male factor involved. So Kevin's right, we have to change this conversation and change the unfair stigma and pressure that women have when it comes to fertility because there is a clear factor in 50 % of the time and 30 % of the time is just a man that, you know, they need to be assessed as well.
Wow, that's actually a shocking stat to me. I had no idea that it was that high. You mentioned before to this, you this problem of misinformation on social media. So there are lots of claims and lots of people saying crazy things about what causes infertility, what could help infertility? What can you tell us about some of the things that may contribute to male infertility? What's causing it?
So I'll start with this one. So, you know, I think when we're talking about infertility, there are a whole bunch of things that can cause fertility. And sometimes the simplest way to look at infertility is blockage, meaning you're making sperm and you can't get it out versus production, right? And both of these things can be broken into several categories. So fertility, sometimes you have a genetic component, right? You could have something called cystic fibrosis where you know you're making sperm but it can't get…. out you could have something called Kleinfelters…. you could have these other things called why micro deletions that can decrease your ability to make sperm…. there's anatomy issues…. you can have
something called a varicocele which is in 15 % of men but 40 % of men who have fertility issues have them and you can have just a blockage issue, and typically you can see that,
right, if you had a vasectomy. So you obviously can't get sperm out if you had a vasectomy.
There's a lot of other things, medications that, you know, the one that I do, we do want to always highlight is testosterone replacement therapy does cause infertility. In fact, about 65 % of men with a normal sperm count become sterile with zero sperm within just four months of taking testosterone replacement therapy and the longer you're on it, the more likely to have zero sperm. So that's something that people don't know. Obviously, if you have a history of cancer, chemotherapy, radiation, health conditions, you know, obesity, diabetes, having low testosterone.
And one of the more important things that I'm sure we're definitely going to get into is lifestyle, right? Smoking, vaping, hot tub, sauna, steam room, jacuzzis, lubricant during sex, ejaculatory frequency, you know, endocrine disrupting chemicals. There's so many things that can impact your fertility.
And what we like to say is that a man's fertility is a window into their health. So, you know, if you're not taking good care of yourself, if you're not taking good care of your lifestyle,
you're running yourself to the ground, there's a good chance your fertility may suffer and your ability to have a child. You may struggle with that as well. But the good news is oftentimes there's a lot of things we can do after an assessment.
Okay, that's really helpful to know. So you mentioned lifestyle. What are, again, lots of misinformation out there. What are some things that people could be doing, you know, with their diet or exercise or things like that? What are things that they could be doing to maybe help their fertility or increase their chances of getting pregnant?
So that's an excellent question. And I often lead this in my, when I consult with patients, you know, things that you can do to make, you know, optimize your fertility as much as possible. So a healthy diet, eating a balanced diet in fruits, vegetables, whole grains, lean proteins, healthy fats, that's going to help optimize, all right, including any foods behind antioxidants such as berries, nuts, and leafy greens, that's only going to help prevent any sperm from kind of really getting the oxidative stress that they may get.
I also tell my patients to maintain a healthy weight. You know, obesity does not help with sperm production, as well as being underweight also does not help as well. And just exercising regularly, engaging in regular physical activity helps just boost first off endogenous testosterone, and that's only going to help with your sperm health as well.
And then just in general, kind of what Justin touched on, you know, avoiding smoking, trying to moderate your alcohol consumption. These are all things. In general, when you step back, it's just leading a healthy lifestyle is going to help contribute to good male fertility.
Yeah. And just to piggyback off of that, you know, some people, you know, say smoking, vaping is starting to show that too because there's a lot of vapors. There's actually, you know,
a lot of people have come into my office recently. They're using zinc pouches or something else like nicotine pouches to get off of vaping. And there is some data in mice. There's no data in humans, though, suggesting it can lower your testosterone, potential fertility, too.
You know, so all these kinds of chemicals, including marijuana, there is some data showing that heavy usage can compromise your testosterone levels, your fertility, and other things. Like, you know, a lot of guys, even though ones that are in shape, they like to go to hot tub, sauna, steam room, jacuzzis. Oh, the hot tub. That's a good. A hot tub is a big one because if you think about it, and this is funny, but this is an anatomy lesson, right?
Your testicles are outside of your body for a reason. They want to be a few degrees cooler than the rest of your body because that's the ideal temperature for sperm to develop. So, you know, when you're going in a hot tub, you're cooking those boys. And you're actually, you're not hurting your testicles, but you're killing your sperm. And something that's very important when we're talking about lifestyle and fertility is that you have to understand the sperm cycle is about three months.
So every three months you generate new sperm, which means that anything you do right now will potentially impact you for three months or you won't see an effect on even something positive for three months. So we often see guys- they come in, they go, oh, yeah, I stopped smoking last week. Let's do a repeat semen analysis. I'm like, dude, you got at least three months to go. Right. You know, it is a process. You have to be committed. It's not just a small five -day time span here. We're talking about bigger periods of time, but still there's time and room to change and improve your parameters.
Okay, that's really good to know. So if you're trying for a baby, do not let your man go into a hot tub three months prior if you're on vacation. I would have never thought it was that long that it could be affected. Okay, that's really, really interesting. We're going to take a quick break and we'll be right back to talk a little bit more about what to do if you feel like you might be infertile. We'll be right back.
Okay, we are back with doctors, Justin and Kevin, and you guys have given us some really amazing tips already on improving fertility. What is kind of like a red flag as far as fertility?
How long should it be taking to try to conceive? What are some signs that you might not be super fertile or not have a very high sperm count? And what should you do?
Those are all excellent questions. I'll kind of lead off, you know, we, based off the guidelines, any couple that's been engaging in, you know, trying to conceive for about six months, if they're not successful in conceiving, they should undergo a workup. Now, it's a little bit earlier time frame, depending on if, let's say, the female was older than 35 years old, you know, consider earlier workup. But in general, for most couples, if they've been trying for six months and have been unable, both the male and female should undergo a workup. And I'll let Justin kind of get into what a male workup is.
Yeah. And I think that what Kevin says is very important because both the male and female have to get worked up. There's data out of Northwestern that showed that of men who are concerned about their fertility, only 30 % are willing to go talk to a doctor about it. So most guys don't even want to see a doctor, even though they're worried about it. Why? Because there's this huge stigma. Guys picture themselves as these macho dudes who, you know, are going to be providers and they don't want to hear that there may be a problem, especially when you're younger, you feel invincible. And this is kind of like a wake up call for a lot of people. And most of the time, everything's fine.
But, you know, when we're, and you shouldn't be afraid is my point, because, you know, the workup for fertility is really not bad, especially when it's compared to women, okay? Women have a much more invasive, much more thorough, you know, exam, and they have a lot more workup. But the way I talk about it with my patients is when I look at male infertility, I want to know four things.
One, I want to get a history. I want to learn about you. I want to learn about your lifestyle. I want to learn about your partner. I want to learn about whether you've had kids in the past, achieved pregnancies in the past, how long it's been taking you, et cetera. Two, I want to do a physical exam. We mentioned some anatomical issues that you can notice, and that's important that there's certain things that we can look for that can compromise your fertility.
Three, I want to get blood work. I want to make sure your testosterone levels are normal. I want to look at your other hormone panels to make sure that the communication they're all communicating in the appropriate way and then for um i want to get the gold standard which is a semen analysis and you know the semen analysis is really going to be the major determining factor on what the next steps would be if any because sometimes you have some of these other problems but it's still and we can treat them but it's not that big of a deal because your fertility is normal. And that can kind of guide, you know, the practice and guide our plans. But, you know, as you can hear, you know, ejaculating into a cup is the most invasive thing that we're really doing. It's really not that big of a deal.
Still sounds a lot better than what the women are going through. I've got to say.
Oh, yeah. Oh, yeah. 100%.
Well, I love that you kind of demystified that. So it doesn't really sound that bad. It doesn't sound that scary. It doesn't sound that invasive and I think just hearing what to expect can be so helpful because I think a lot of guys probably just avoid it because they think it's going to be super scary or really embarrassing or things like that. So yeah, I think it's super helpful that you just kind of laid it all out there for us. When we get back from this quick break, we're going to talk about vasectomy. We'll be right back.
So we just got done talking about how to improve fertility, how to treat infertility, and how to have a baby. And now I'd love to chat about how to not have any more babies. And there are lots of options out there, but most of them kind of fall on women so I would love to hear all about vasectomy.
I was telling you guys earlier that my husband just had one in November …yes thank you we're very happy with it… and it I mean he definitely said it hurt more than he was expecting it to, he was more sore afterwards than he was expecting it to, but it wasn't terrible. Like it was doable, he was absolutely fine he was walking around that day helping me care for our kids in our house like he was not bedridden. So to me that was a win and he had you know no complications… he said he was sore but wasn't that huge of a deal.
So many people asked me when I was sharing about this online which you know he was thrilled about of course, so many people asked how did you get him to do it? how did you convince him? and I really didn't, it just was something that we had kind of assumed would happen so that I don't have to be on birth control for the rest of my life. I would love to kind of hear everything about vasectomies.
So first, why is this a good option, who's a good candidate, who should or should not look into vasectomies?
All right, I'll start it. I'll start this one. So vasectomy is a procedure in which we are cutting the vast deference. The vast deference, what I call is the highway that connects your testicle to the outside world. So basically your testicle makes sperm. And when it's time to engage in sex and ejaculate, that sperm travels from your testicle in the epididymis and then through that highway into your urethra, which is the tube you pee out of or ejaculate out of and goes out into the outside world. And what we do is we are, you have two testicles normally and so there for- you have two vast deference and what we do is we make one or two incisions depending on the surgeon and there's no right or wrong answer… it's whatever's comfortable for the surgeon.
And we cut the tubes and make sure that the highway is closed forever and we cut the tubes sometimes, we burn them, we clip them, we tie them, we bury them, we do whatever we can to make sure that those tubes are gone, and are not connected again. And in general, it is a very, very high success rate. It's over a 99 % success rate of working, of having no sperm in your ejaculate. And once we confirm you have no sperm in your ejaculate, the chances of having a child through intercourse is one and 2 ,000. It's about 40 times more effective than oral birth control.
So it's a great procedure. We love doing it. It doesn't take long. It takes about 15 to 20 minutes at max. You can do it while you're awake or while you're sleeping. And I'll let Kevin explain who's a good candidate, who's not a good candidate, and take it from here, Kev.
Yeah. So, you know, the most important thing, first off, if you have a vast deference and they can be palpated by a urologist, you're a good candidate to get the procedure done. It can be done. So that's first off. So as long as you have two vast and we can feel it, it's a procedure that can be done.
But it's important, you know, as, you know, the patient and their partner, you have to be ready. So a couple of things I go over with my patient, you know, one, are you certain at this point that you do not want children anymore that's a very important question. All right, second i asked him are you comfortable with the idea that this you know this this this vasectomy we're intending it as a permanent form of sterilization.
Now it's important to consider this is a reversible procedure right i get that a lot of times patients will come to me like doc. This is not going to be reversible… it this one and done right and i actually go like no actually it is a reversible procedure. As long as, you know, they're specialists such as Justin myself that can reverse it, but the success rate is never 100%. So going into a vasectomy, you still have to keep it with that perspective that this is a permanent form of sterilization.
Also, as long as the patient understands that there is alternatives, those are kind of what make, you know, a patient, as long as you're ready and okay with all those answers, a good candidate for the procedure. Now, if you have some other medical conditions, if you're on immunosuppressive medications, some blood thinners, these are some things that, you know, you talk with the urologist to kind of see how you can adjust. But otherwise, for the most part, most patients are good candidates. Do you agree, Justin? Oh, yeah, 100%.
And, you know, I've done vasectomies on people who don't have partners. I've done it on people who don't have kids. This is a place where we don't have judgment and, you know, this is something that you should not be afraid of. And that's okay to not want kids or to be in a relationship where you don't want kids. And we've also, I've done that for newly married couples.
I've done it with the partners come in and said, we're not doing it. We don't want kids. We're going on our honeymoon. Let's get rid of this now. And so, you know, and I do have a lot of patients, you know, even worried about their age. You know, I've had guys who had came in. They had two kids. And they were like, I only wanted one, but this was five years ago. And then I got worried because I was young. And so I didn't come in and now I have two. It's great, but I don't want any more, please.
So there is no real age limit. There is no child limit. It is really truly us talking with you to achieve what you want as a man. And if you're with a partner, what you and your partner want. And if you want to bring them in, and they often come in to make sure that the guys follow through with it, and I encourage that, you're welcome to do so. So it is a really,
really good high satisfaction surgery. If you talk to any urologist who performs, it's usually one of their favorite surgeries because everyone leaves happy.
You know, I just want to say one thing. You know, I, I watch my wife give birth to two of my children. And, you know, just seeing what women have to go through through pregnancy, a vasectomy, 15, 20 minutes, go through it, you know, it's the least that us guys can do.
And you better not complain. You better not complain about how bad it hurts. No, but, okay, so this is actually something I want to touch on too, because, You know, I see a lot of discourse about this on social media, Instagram, TikTok. And I do feel bad sometimes for guys that, like, they go through this. And to them, it's a really big deal. And it does hurt. Like, it's not fun. And they're told, like, they, you know, their pain isn't real. They're not allowed to complain. They're not allowed to talk about it. So just give us, like, the real. How painful is it actually?
Well, Kevin's going to get one soon. So he'll tell soon so he'll have to report back okay.
I'm on the docket for one so amazing so maybe you don't want to talk about how painful it is. Well no look it's it's important first off as as physicians we don't want our patients to be in pain I think it's very very important so undergoing a procedure I'll tell you my train of thought ……so first off I tell patients we're going to use local anesthesia. We're going to be injecting medication to numb up the area. Now, guys, like, I myself, too, I'll be frank and say it, I don't love needles. I don't love it. And so you're telling me to have a needle like in the scrotal area, extra kind of, you know. And so a lot of the anxiety can kind of be around that. And so we do offer patients. They can take some anti -anxiety medications. There are other things such as, you know, nitrous gas, sometimes offered in clinics that can kind of help with the experience and the anxiety that you're going through. We want that addressed. We don't want patients to be very nervous before they're going through the procedure.
And the local anesthesia, when I give it, I'm talking to my patient, because I do awake, I'm talking to patients throughout the procedure. I'm like, hey, are you feeling okay? Are you having pain? You shouldn't be having pain during this procedure. And if you are, I can give you some more anesthesia. Get enough local anesthesia to an area. Some guys need more,
have a higher threshold. And once that's achieved, then we kind of proceed. I'm not there to try to push you through. And I know other urologists are not, to just try to do it, even though you're having pain. That's not it.
Yeah, it's not a torture chamber. I love that you offer all those different pain management. I feel like that should be available to women who are getting similar procedures. Like, the IUD, I've never been offered any of that stuff when I've, my IUDs put in or taken out. But no, I think that I think that's really important and probably makes it a lot more enjoyable. And what about the aftercare? So I think a lot of men are probably also averse to doing this because they feel like they're going to be out of commission for several days. They can't miss work. They don't want to, you know, take time off from helping with the kids or the house or whatever. So how long is recovery time typically?
So I think in general it's really not bad, right? And it depends on your job, of course. And I think that because of your job, we can usually accommodate during what day during the week. You know, a lot of urologists do these on Thursdays and Fridays so you can be back and work on Monday. But in general, you know, what I tell my patients is the first two days after surgery you know you're going home you're icing your nuts…. Tylenol and ice that's it. You really don't need anything stronger I've never gotten a call for anyone asking anything else more than Tylenol and ice. You're going to have some bruising you're going to have some swelling you're probably going to feel like you got kicked in the nuts a little bit but those first two days your your feet are up you're hanging out.
The first week take it easy no serious heavy lifting, no gym, nothing heavier than 25 pounds,
I usually say, no sexual activity for that first week. But after one week, I say you're full go, man, you can do everything. There's no reason that you can't, you know, be enjoying yourself. The one thing I will tell you that this is the most important thing in the post -operative course is that you are not sterile right away. And I'm sure you know that, Rachael.
I'm so glad you brought this up because that was something we did not know and like we I was fine to wait… yeah that was something that I feel like people don't really talk about I had never heard it before before he got his like post -op instructions that… no you're actually not good for like a while so…
So remember I describe the vast deference as a highway and we're breaking that highway and we're disconnecting it but there's still cars on both sides of the highway so you got to clean out the cars or let those cars die. So usually we say 20 ejaculations or two to three months. Some guys come in, they go, doc, what's the fastest you've seen someone do 20 ejaculations?
It sounds like a challenge. Yeah, it sounds like a challenge. Go for it.
But, you know, you do have to use protection until that time. Two to three months, 20 ejaculations. And often we either provide you with a cup to do a semen analysis and bring it into the office or an at -home semen analysis kit, which Kevin and I now offer. There's various companies that do that. So that is probably the most important thing because I've never seen anyone get burned or achieve a pregnancy after I vasectomized them after three months. The only time was when they didn't follow the directions. And I said, why didn't you listen? And they said they just wanted to roll the dice. So, you know, that is probably the most important thing.
But realistically, you know, the risks involved with a vasectomy are infection, bleeding, injury to your testicle, very low risk. There is a 1 to 2 % chance, maybe a little bit higher of something called post -vasectomy pain syndrome, which men should be counseled on, which is chronic pain after a vasectomy. It's very rare, but it's not 0%. The good news is if you do have a specialist in your area, there are many ways to manage it. But, you know, so once in a while, do you hear a story from someone that you probably knew about that? Yes, is it real, yes, but it is a very, very, very low risk. And I don't think it's going to stop Kevin. And when the time comes from me, it's not going to stop me from getting my vasectomy either.
Got to do your part. I love it. Well, thank you so much for talking us through all of that. I think that'll be really helpful for the parents that are listening who are maybe thinking about using this as their form of birth control going forward once they're done having all of their babies.
And I think it's just super helpful to have you just run down like the real risks and benefits. And it sounds like a no -brainer to me, but that's just me.
Guys, I appreciate you coming on the podcast so much. You also have a podcast, so anybody that's listening that wants more of a deep dive into these types of topics, what can they expect to hear on your podcast? What kind of episodes do you guys do?
So, yeah, we, Justin and I are the co -host of the Man Up podcast, a Dr. Guide to Men's Health, and we talk, you know, we talk about a whole broad spectrum of it. We really focus on, you know, men's health stuff, such as sexual medicines, which can include erectile dysfunction, Paironi's disease. We talk about male fertility, how to optimize.
Recently, we talked about potential endocrine disruptors, things in our environment that may be affecting male fertility, and also on testosterone. But those are things that Justin and I specialize in. We still talk with other specialists regarding mental health and just ways to improve your life.
Yeah, and our goal is, you know, we are the specialists in a lot of men's health and urology focused, but there's a lot of bad information about pretty much any men's health topic out there, and guys really don't know where to go to get good resources. I can't tell you, and I'm sure Kevin agrees, I have all my friends that are not doctors sending me, you know, products to buy or all these things. All of this kind of, it's all BS. Most of it's not accurate- so you know we we really cover a whole plethora of things.
One thing that we do often do is we have a perspective series so we do have an interview with one of my friends who had a vasectomy so if if your partner is concerned you can come to our podcast and look up that episode and have a you know someone’s story about how they got a vasectomy and how it wasn't a problem. So we've done that for other problems as well. So, yeah, that's our podcast and our Instagram and socials at the man up pod. You can find us on YouTube. You can find us on iTunes, Spotify, Amazon, all over.
The one final thing I forgot to say about vasectomy that I thought was very, very important that most guys want to know is what happens to your ejaculate after? Is it dust? Is it glass?
It's dust. It's dust. No, no. Sperm is only about 5 to 10 % of your ejaculate. So actually, everything's the same. All right. It looks the same. Your testosterone levels are the same. Your erections are the same. We're not touching your penis. Your orgasms are the same. Everything is the same.
That's the most important part. That's why you get the vasectomy, right? But yeah, so just to clarify, everything feels the same, it looks the same, you're good to go. Thank you for clarifying that. And I will put your podcast and your socials in the show notes so that everybody can go find you.
Thank you guys so much for joining today. It was really, really fun to talk to you,
even about something so weird.
Thanks so much for having us. Thanks, Rachael. I appreciate it. Thanks for having us on.
