Episode 23: But, What About the Guys?

All of their other podcasts focus on women's health...but, what about the guys? Dr. Klimczak and Dr. Reed feature their first in person guest: Dr. Stephen Klimczak. He asks us common male fertility questions and we also put him the test to see how much guys know about women's health. And make sure you watch the Youtube version to see him try to place his first tampon!

Transcript

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I am Dr. Beverly Reed. And I'm Dr. Amber Plunzack. And we are Two Peaks in a Pod. Well, hi, everybody. We are so excited because we're making history. We have our very first guest. In person appearance. Dr. Klimczak, thank you for joining us. Thank you. Do you want to introduce yourself? Hi, my name is Steve Klimczak. I am a doctor of hospital medicine at Baylor Dallas. Amber's husband, Dr. Klimczak. Yes, so we cheated. Our special guest is my husband, but we needed a stand in male. Yes. So that we could ask questions and have him ask us questions and so he very graciously Um, agreed. Yes, I volunteered. But we wanted to make sure the guys don't feel left out. I will say I am guilty of this. So sometimes, you know, when patients come in, the female patient's like, oh my gosh, I feels so at home. Everything is amazing. And the guy's just sitting here like. Oh, there's a lot of pink here. And so I think, you know, for you and I, we're so good about thinking about what will our patients like and everything that sometimes I think we don't do as good of a job of really thinking about what is the male partner experiences going through this process and what are things we can do to make it a better process and everything. So that's why we're so happy to have you here to help us. Okay. So, we figured for the format today, Dr. Klimczak is going to be asking us some questions and then we are going to be asking him some questions too. He does not know what questions are coming his way and I think it might be pretty entertaining. Okay, do you want to go first? I'll start easy. You know, what do y'all look at in a sperm analysis? When I come in, if I come in, what are y'all looking for to tell me that I'm doing okay? Yes. Okay. So great question. So whenever we do a semen analysis, we're actually looking at so many different categories and really we're trying to put all those categories together to give you a result to help you understand, do we think you have a good chance of being fertile or do we have some concerns there? So first thing is volume. How much of the semen do we see? Second is concentration. How many sperm are we seeing there per milliliter? Then we've got motility. How many of the sperm are swimming? And then we have morphology. What are the shape of the sperm? So that is what we're looking at. Now look, sometimes you can be low in one category, but if you're high in all the others, sometimes those things can balance out. So the interpretation is really important. And, but at the end of the day, whenever we review our reports, we say, Normal or abnormal and then we try to give some helpful comments if it is abnormal as to what next steps could be Okay, let me get my Okay, so I just wanted to learn more about how much you know about women And so one of my questions here is about tampons So I wanted to know do you know the difference? Sizes that tampons come in. I feel like I know more than the average bear. Sizes? No, no, no. Some small, medium, large. I know that, you know, you have differences like flow. Yes! Okay, yes, yes. I know that you have pads and you have lip balms. Yes! Yes! Um, I know that they're sporty sometimes. Ha ha ha! They have flowers on a box. Yes! Yeah, I agree with all of those assessments. I, that's a pretty good answer, I have to say. I mean, the, I, I like the small, medium, large, like usually it would be more like absorbency, you know, um, but that's very close. And I love that he knew some of the, you know, branded ones too. So I, I give you an A on that answer. A minus. It could have been an A plus, but yes. That's really good. Okay. What's another question you have for us? So. I'm privy to know that. Mm-Hmm. you know certain things, some people have, uh, poor sperm analysis when they come in. Yes. What can people do to improve their analysis? Let's say somebody comes in and the analysis is not favorable. Mm-Hmm. Are there things they can do? Can they change lifestyle? Can they stop bad habits effects? Yeah. So definitely a great question. And sometimes it depends on what we find on the semen analysis, but something that's really important, um, that Dr. Reed and I both do is we really dive into the patient's history. Um, we'll probably start by asking the male partner a lot of questions about prior medical problems, maybe any surgeries that they would have had, medications that they're taking. All of those things may be affecting their ability to produce sperm that are normal shape, that they swim properly, et cetera. And then we really dive into lifestyle, like you had asked about. So certain choices that men are making are certainly going to affect their sperm production and the way the sperm can swim, swim forward and the look of them. Some of the common things that we see. Smoking. All right. And really smoking of any kind, um, cigarette smoking, marijuana, cigarette smoking, things like that. Vaping too. Vaping is really common now. It's a lot of vaping. Yeah. Um, tobacco pouches, dip, all the different ways that you can put tobacco into your body. Drinking, alcohol use, heavy alcohol use, I've certainly seen that affect semen analyses. Heavy caffeine use, um, lifestyle things in terms of, we have some guys that really like to sit in hot tubs. We know high heat can affect. Sperm sitting in, um, I've seen more and more saunas recently. I think it's like a trend that people have saunas in their houses now. Um, even sometimes the guys that work outside during the summer and, you know, luckily we're not in that time of year, but we do see that high, high heat exposure expect. just doing changes to their sperm. So we review all of that with them and try and find anything that may stand out that we think could be causing. The really good thing is that sperm, the life cycle sperm, it's about two to three months. So if we do see something, we recommend some interventions and then we can check again and see if we're going in the right direction to really correct those things. Yeah. And I think probably the other thing I would add to that is whenever we see an abnormal semen analysis, the first thing we do is really just offer a recheck to because they do say sometimes you can just have a fluke. Maybe you were having a bad day. You know, sometimes patients will express concerns. Like I was so stressed out or I spilled most of it out of the cup or something like that. So we do try to factor in all of those things, um, and repeat it and just say, are we seeing a concern? consistent issue on more than one sample so that we can decide if we need to really dedicate a lot of time in trying to, um, improve this. Phase of abstinence, I see a lot of people guys, you know, didn't wait long enough, or they wait a really long time, and that may be affecting things as well. I think that's a really good point too because we usually tell patients, okay, before you do your semen analysis, you need to abstain from ejaculation for two to five days beforehand. But a lot of guys hear that and they say, well, that's good. I'm going to save it up for two weeks because I really want to impress them. And then we're like, yeah, but now this firm's going to look old. So it is important to do the two to five day window. So yes, okay. I have another tampon question for you. Just what you wanted. Okay. How many tampons do you think we need to use during a period? He's testing me on all the amazing stuff. I know all the abnormal answers. I know, based on osmosis from when I know that. You should be worried if you're going through more than one an hour for two consecutive hours. Yeah, yeah, okay. He hasn't heard music a lot of times. This is great! I know, I'm, I'm impressed! So I, I would assume that if you're going through one more than four to six hours, that that would be considered abnormal on, I guess, your heaviest days. Okay. I mean, again, I'm pretty impressed. I think this is really good. Just to give you an idea, these are questions that sometimes they ask guys on social media. So I've seen some of the other answers. So some guys think it's like one tampon per period. So that's, that's a good answer. I think you're, you're doing really good on this. I give it an A plus. Yeah. Because tampons can get crazy if you don't use one. Yeah, that's true. We're serious. See, I've seen what happens if you use one. Yes, yes, yes. Although, you know, some people, instead of tampons, are doing menstrual cups. Do you know what a menstrual cup is? I do. Okay, yes, there you go. Okay. Okay, we're ready for our next question. What are some of the effects? I know, unfortunately, I know men use testosterone a lot. Yes. What? Can be the effects on semen for somebody that frequently uses testosterone site for bodybuilding. Yeah, not necessarily You know steroids use I guess when you're sick, or maybe even if you are sick does it affect your sperm production. Yes Okay, such a great question And I almost actually brought it up when we were just talking about the abnormal semen analysis and before because what is so sad is that there are so many guys that were not appropriately counseled before they were started on testosterone therapy, that it will most likely affect their fertility. So in the Dallas Fort Worth area over probably the past five to 10 years, these low T clinics have popped up everywhere where the sole goal of that clinic is. to tell people that they need testosterone. And this actually gets me really fired up as a hormone specialist because these are usually not hormone specialists who are even giving the testosterone, but they love to tell patients both male and female. Are you tired? Are you having trouble losing weight? Are you, do you have low libido? All your problems are because of low testosterone and then they give you testosterone. So here's the thing that's complicated. In a man, you need testosterone to make sperm. So guys think, Oh, if I take testosterone, my sperm is going to be amazing. But what they don't realize is it specifically has to be local production of testosterone from the testicles to make sperm. But the problem is that when you're taking testosterone, your blood levels are so high and your brain is detecting that, and your brain says, Wow. I have lots of testosterone. I don't need to make my own testosterone. And so then the testicles shrink, and they stop making testosterone, and the sperm drops, and so I call testosterone male birth control. Um, I don't know that I would actually rely on it for birth control, but my point is that it is. severely impacting, um, fertility. And so that is one of the things that it's on our questionnaire for all of our patients. It's something we ask about, because if we see that, we know automatically that's probably a major contributor. Now, the good thing is you can stop the testosterone and. The sperm, in most cases, will recover, but it does take a while. At least two to three months, sometimes up to six months. And the hard part is, too, once your body's used to being on testosterone, you do not feel good when you stop the testosterone. Then you do feel tired, and all the rest of it, too. Although I will say too, whenever somebody, so like a male testosterone normal level is 300 to 1, 000. And so, let's say a guy was taking testosterone, he stops it, and let's say his testosterone level is 350, and he's telling me, I feel so terrible and everything. And I say, okay, like I do feel bad for you, but also like my testosterone level is probably 30. So like, you should also just like feel sorry for women in general, because this is how we feel all the I think it's really true and I really do believe the guys that they I mean, it helps their symptoms. It's a very hard thing to convince them that their fertility is going to improve by going off of it. Truly, they can't really wrap their head around it because it was like this miracle drug that they were started on. And it really does make high school good, apparently. I don't have any personal experience with that testosterone. Yeah! Yes. And I will say to, um, so what I tell my male patients to, I'm like, look, I don't want you to feel bad. Right? So when we stop the testosterone, there are interventions that we can do to help your own testosterone come back faster, come back higher and everything. So a male can actually take Clomid and HCG injections, and those can actually result in higher. testosterone levels from your own testicles which then in turn will increase sperm production in most cases. I do feel like it helps. I do feel like the recovery is a little bit faster. Faster and easier. Tolerable. Is there a safe way then like if a guy's trying to get testosterone replacement or has low T, clinical low T, is there a way to do it safely or it is all testosterone supplementation? That is such a good question because I will see say that I see a lot of patients who are actually being started on testosterone and Clonid and HCG to try to get the best of both worlds. However, when I have consulted with the urology fertility specialists, they say, look, it's really just best not to be on testosterone at all. If your testosterone is low. it's good It's stick to Clomid and HCG during times that you're trying to have a baby. And look, when you get past that phase of you've had your baby and you need to supplement your testosterone later. Okay, fine. But, but for that time being, they said it's best to do, um, just Clomid or, or HCG injections. When I've seen guys on that sort of regimen, it's also really low dose testosterone. It doesn't seem to be anywhere I like, but people really even need to be feeling good. Yes. Yeah. Yeah. Okay. Next tampon question. Okay. What do we do? when we have a tampon in, but we need to pee. Oh, okay. That's, I know the answer. They're close, but they're not the same. Okay, very good. You are good. Give me some credit. Okay, you are a physician, so I think this is good. You know this. That would have been really embarrassing if you didn't know that, but I will say this is a common one that gets missed on social media too, where the guys are like, wait, how do you do that? Yes. Okay. Good. Good. Try another one. Try another one. I've read it. Yes. Okay. Well, I do have one that is kind of more personal. Okay. So, the other Dr. K has been pretty open with the fact that, hey, she's, um, struggled with some fertility issues before. And so I wanted to know, as her partner in that, was she hormonal during those times? But listeners cannot see your facial expressions. You're not allowed, you're not allowed to cheat. Don't be telling him what answer to give. No, of course not. No, of course not. No. No, she was an angel. The whole time. I tell my patients that I was extremely affected by medications. And I always say Latrizole. I think of any, because I did pretty much a lot of fertility medications. I think Ledger's All is the worst. You think? I think that was the worst. We're so bad on Ledger's All. Like, I remember when we were skiing in Zangali, and you were in this ski town, right? Freezing cold outside, and so you'd bundle up in sweaters. In every restaurant we would go to, it was so hot. I'm like a menopausal woman at this point on Ledger's All, highest dose. I'm like, I'm so hot. I've got to get out of here. I've kept having to like excuse myself for dinner. Like, we're there with my in laws and they probably think I'm like a nut, like having to like leave the table. It is so hot. Yes. Yes. The side effects are raw. Yes. Yeah. And I think that we've been fortunate, I mean both, obviously with your careers, but personal life, we've known many, many families that have gone through their own process. And everyone's done different. It's not one size fits all one person gets hormone and you can't predict it either Yeah, people that we thought would be fine. Yes have had more Side effects and people that we thought oh my god, this person's gonna be Changed. Yeah, it's just the exact same Did you ever give her any of her injections? I think I gave them all. Oh, oh, okay. Amber and I have differing feelings about needles. Oh, that's right, because you have your needle phobia. So you probably, you've never given yourself an injection then, right? I have done it. I did Ovidrol and stuff a couple times. But like, real IVF injections, I was working nights. And this is before you started your journey. Yeah. I had to like, wake up and take them, like you would give them to me before I would go to work. And so it was like such a dreary time because you would like work all night, sleep during the day, and be awoken to like a stab, a jab. And rest assured phlebotomists and nurses and everybody else, I am not. I did not receive good feedback. I tried my best, but I was met with not nice things. I blame the hormones. That's right, that's right. But I was told that I was awful. I'm like, I'm doing it. Yes, well, I have to say, um, It's kind of funny because some of my patients have told me that they feel a little bitter towards their husband during this time. And they're like, don't you have some kind of shot we can give him? And one of my patients told me that one day she just took it into her own hands and she just drew out some saline and just Gave her husband a shot. That was so strong. Her husband was so nice. He was like, I'll do it. I'll do it. And everything. And it made her feel better. But you know what? I don't know if you knew this happened the other day. Did you know what happened with your patient where she felt like her husband needed a blood draw? And so I said, Kim, do you have any employees that need to practice on someone? Oh my God. And she said, go ahead and sit down. We're going to let this person draw blood. I have to say, I'm always in admiration of the guys who like really have that empathy and like, we'll do whatever they can. This is not fertility, but you've heard my experience with breastfeeding. I think breastfeeding is miserable. And like kudos to everyone that does it. Yes. I used to threaten to put the. I'm like, you don't understand the breast bump. It's so bad. Never do I do a lot of things. Good decision. I do a lot of things. Good decision. Good decision, Okay. Do you have any more questions? I do, I do. I do. I do. So with the whole process with men, um, obviously I, I know that you can. Allow people to ejaculate at home and bring in a sample or sometimes offer to do it here. Is there a difference between Fresh and not fresh specimens if there is how long do I have to bring it in before it's not useful And then last, can, can I put it in my freezer at home and bring it to you like the next day? That's a really good question. Okay, so for semen analyses or even sperm preps for inseminations, because we actually have to process the sperm, we do allow patients to do that. To collect it home. It just has to be to our office within one hour. Then interestingly, if we're going to do a semen analysis, it needs to be processed right then if we're doing the sperm prep, if we prep it, it actually can last for some time just sitting out after we prep it. Um, we can freeze sperm ahead of time. So also, I think that's kind of what you were asking. Can we freeze it, save it for later, but we do our hope. whole protocol to freeze sperm when we do it in the office. I don't think you could just pop it in your freezer. I don't think that would go well. Yes. Yes. Well, and I know, um, sometimes patients will ask me, um, you know, cause let's say their partner's out of town or something and they want to try to get pregnant that month. They say, can we, you know, freeze the sperm. Does it have as good of chances? And I will say, usually we prefer to use fresh sperm, but we know frozen sperm works because we use frozen sperm all the time for people who use sperm donors and everything. So I certainly think it's, it's a great option for people who need it. Um, and we don't usually have any concerns with that. Okay. Another personal one. Here's a lot easier. Another personal one. And we can edit this one out. So this is a really common one. She would not have approved this one. Okay. So are you on Tik TOK? I'm not. Okay, this is one that's going around on TikTok. Like on TikTok you have these trends, everybody does the same thing. Okay, so the question that's going around on TikTok is, if there were 50 hoo hahs lined up, oh lord, that's what they say on the TikTok video, if there were 50 hoo hahs all lined up, could you pick out Dr. K's hoo hah from the lineup? I'm going to look in my apartment to see if I'm allowed to answer this question. Did you? I feel like it's kind of like hands, right? I don't know, like, people ask you, could you recognize your partner's hands? Um, and I feel like I can recognize your hands. Okay, again, you get an A You are just knocking these out of the park here. Now I've got to start getting creative. Austin is the only one he's seen for a really long time, so Now I'm Austin. Thought about it. 52 hours of running around in his mind right now. I know. He's like, okay, we got it. I can't see this, but there's an escape room, and I'm wondering how much time I'm going to be left in. While you're thinking of your next question, I do have kind of a live demonstration that I was going to ask you to do for us, too. Sure, let's do it. Okay, let me go grab something. Okay. some supplies here. Okay, so let's like maybe make an arrangement. Okay, we're gonna go like this. Okay. All right, so this is a vagina. Okay. Okay. And you know what this is? Can you show us how to put a tampon in? I don't even know how to open it up. All right. Okay. Okay. I think I can figure it out. Okay. Okay. Now what? There we go. It's pretty good. Pretty good. Yes. Yes. Okay. I think that's great. Okay. And then you got, how would you take it out? It's not a candle. I don't know. I've never done it. I would use the paper towel. Okay, alright. I would call that a pass. That's pretty good. Tidy. Very tidy. Yes. Kept it clean. That's important. Next thing you're going to ask me to insert, like, an Uber ring? Hey, you know what an Uber ring does! This is great! Well, I am all out of embarrassing questions for Dr. Klimtach. Did you have any questions for Dr. Klimtach? You've been great. We really appreciate having you. Yes. Yes. Thank you for coming. This was amazing. This might be our podcast that goes viral. Thank you for helping us. We'll tag you. Or not, if you don't want us to. But, um, all right. Well, let's wrap it up for the week. Thank you, everybody. And if you enjoyed our podcast, please like and subscribe. If you will just leave us a good review, that would really help us out. So thank you guys. Take care. Bye.