In this episode, Dr. Abraham Morgantaler joins host Dr. Rena Malik to address the alarming trend of lower testosterone levels in ...

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Why Younger Generations Face a Testosterone and Sperm Crisis ft. Dr. Abraham Morgentaler

so I'm seeing a lot more lower levels of testosterone in younger men and I want to get your thoughts on what is optimal age-based testosterone levels so there's a lot of stuff going on with the younger generation now I sound like an old fart when I say that but um you know my my wife uh Dr Maryann Brandon is a psychologist and sex therapist and writes she has a Blog on uh Psychology today which is called future of intimacy and she's really interested in how sex tech is affecting younger folks especially and what effects that's going to have on on relationships so first of all the numbers of uh individuals young individuals by age 30 who have never had this in the Washington Post the other day who have never had a sexual partner by age 30 has been fairly constant for like decades and then I forget what year this was but it's like in the last 5 or seven years the number has skyrocketed used to be about 10% if I remember the numbers right now it's like 177% it's a big difference why because people are into their devices and social stuff maybe it's covid I don't know but there a lot that's going on and sexuality is changing porn is like something that that people from my generation never could have conceived when we were teenagers looking at Playboy magazine and thinking we'd struck it rich right yeah like you had to find a magazine and hide it somewhere it's not just porn but now we have VR porn and like the the experience of all this is and then we add to that some data that is suggestive that testosterone levels are going down sperm numbers are going down and we got a problem now why that's happening the usual answer is it's environmental factors right and there was a scary story the other day about how uh we all have these nanoplastics running through our bloodstreams and unstudied right like who even knows what the significance of that they did like a study of like eight men and found eight testicle biopsies and found some microplastics in them but eight right it's a small number we don't know yet we don't know what that means but it was eight out of a small number that had it had it done right so you know is it global warming and testal you know before I before I sort of became better known for testosterone than anything else I was a male infertility guy and I had a laboratory and a I had a pH D working for me and we were looking at the effect of temperature on the test and people say what you research about and I used to joke that I would have these rats running around the laboratory either in boxers or in but but actually the way we did it is we would anesthetize them we would expose their lower halves including their their testicles and their scrotum into into hot water baths warm water bass they weren't hot but um core body temperature in centigrade is 37° degrees is lethal to making sperm that's why our testicles are outside our body that's why it has to sit outside the body and even variations in a couple of degrees Centigrade a couple degrees Fahrenheit is enough to alter the ability of the testical to make SPM you know it's global warming affecting things is the type of underwear that men um wear affecting things or the or the cut of their trousers there's an amazing story of a guy named Richard Brindley who was this uh uh English physiologist and who became known for a couple of things but one of the things that in he did a lot of self um experimentation and the question is about what happened to testicular temperature over the course of a day and he implanted in his own scrotum a a continuous reading thermometer and he measured and documented the temperature in his scrotum over the course of 24 hours as he was standing clothed sitting clothed lying down clothed and the same when he was naked the same with different types of underwear what happened when he slept what happened when he started walking around it was at the end 24 hours he took that thing out and he had his data on one individual but what amazing data right yeah human IND yeah I can just see already people are going to be like how can I do this right and so you know so you know I've I've looked uh not terribly intensively at the data around the sperm numbers and also testosterone numbers and how they seem to be declining over time and I think it's certainly um plausible that it may be true but I don't know for sure you know when you we're looking at data over many decades and comparing things to 1940s 1950s there can be a lot of differences in techniques and things like that or even how those samples were preserved um uh and whether or not there may be some deterioration over time that leads just a little bit of a question mark but it's plausible and then the question is what could be doing it because if it's happening it's happening all over the world at least in industrialized countries where they have data on things like testosterone values or sperm numbers and so it's got to be something that's affecting all of us yeah and what could that be so temperature could be something could it be stress I don't know I would think it's pretty clear that people are more stressed and have more input and stimuli coming into their heads today than they did 50 years ago before we had Twitter and Instagram and whatever else yeah smartphones yeah so I don't know well I I guess my question also is if you have a 45-year-old guy and his testosterone IS 350 versus a 70-year-old guy and his testosterone is 350 how should we treat those men differently I don't know that you do so this age related criteria for whether or not somebody deserves treatment is interesting a lot of it comes from advocacy for younger individuals who would say well what if if 300 or 350 is the number and we're using it for all men including old men for a young guy shouldn't I be comparing myself to other young guys right where the numbers should be 400 450 500 on average and there's an argument that that's reasonable I always worry about the older guys who um who can get screwed if they're being compared to their compatriots so I wear glasses now I had perfect vision to in my 40s now I wear glasses and thank God I do but here's the thing so to be lower in terms of kind of research or medical or statistical terms you usually to be low on something you have to be more than two standard deviations away from the mean the average my vision is not two standard deviations below the me for people my age MH I know a lot of people have much much worse Vision than I do but it helps me read yeah but if we were rigid about eyeglasses I wouldn't have I wouldn't be allowed to have glasses if we were in a system where glasses were something you needed to go through health insurance whatever sure and so for testosterone treatment if you take a 70-year-old guy for him to be low compared to other 70y olds they have to be incredibly low yeah and so we would be depriving a lot of people and here's the other thing is that especially when you look at free testosterone um the symptoms are the same at 35 and 75 if you have low levels of testosterone where it gets crazy is that total testosterone is impacted by shbg shbg Rises with age yep and so you have a lot of older guys who may have a somewhat decent total testosterone but they're Androgen deficient the real question you're getting at is whether or not there is an absolute value for testosterone below which people are symptomatic and deficient and would benefit from treatment or is it more of like a sliding scale right yeah where younger guys maybe should have more testosterone and what it comes down to partly an answering that is really a um an interesting question that has not been answered which is whether or not the symptoms of testosterone really are um on that kind of sliding scale so like it's let's let's just use total testosterone and say that it's reasonably reflective of what's what right so is a guy at 500 which is a very normal number we normally talk about so the normal range let's say 300 to a th000 okay let's just use that um so is somebody better off at 900 than they are at 700 I would say to they're not is somebody better at 700 than at 500 on the whole I would say to they're not whether they're 35 or 75 MH where it gets tricky is that there becomes a I think of it as a threshold a number below which people start becoming deficient and that deficiency can be mild moderate severe but once you hit normal whatever that is for your body you're fine so there are a lot of PL I use plants and water as an analogy for a lot of things with testosterone if you have a house PL there's a a fairly broad range of how how wet the soil can be where that plant is happy and healthy but there's a point at which where it's deficient in water where it's dry at which that plant starts to shrivel and I think the same is true for testosterone and people and that's why you can have um uh two healthy men who have very different total testosterone levels within the normal range and you cannot detect any difference between them for strength or libido or bone density or anything you want because they're normal yeah and so um I think I don't have a a hard answer for you but but I have a a a strong suspicion that these kinds of sliding scales based on age are probably not reflective of how the B The Body Works do you think that I mean because we can't measure the Androgen receptor sensitivity to testosterone do you think people individually have different set points they do absolutely yeah so first of all it's really important to understand that people you know we do a lot of animal research Those Animals by and large are clones of each other they're identical twins that everything is the same humans aren't like that yeah so we have a ton of variation between US just on a normal basis right like where do people put if people gain weight some people put on in different parts of their bodies right it's sort of genetically based it's different yeah um now the Androgen receptor that's a sophisticated question so the Androgen receptor is what testosterone binds to and cells that have Androgen receptor are able to use testosterone and it's many many many different cells but the Androgen receptor itself can have genetic differences and it's been well demonstrated that the anen receptor sensitivity corresponds with what are called CH rep the sort of these these chemical elements that get repeated over and over again in their DNA M and if I have this right the more repeats they have the less sensitive it is and the fewer repeats the more sensitive is could be opposite but I think that's the right sure but the point is is there some people have medical conditions where they have normal testosterone levels but their body presents as if they're extremely deficient and it's because their Androgen receptor is different different if you enjoyed this clip of the Reena Malik MD podcast make sure you check out the full episode with Dr Abraham 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