144. Dr. Mao Shing Ni: Fertility Optimization, Egg Freezing, and Menopause as "Second Spring"

Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We are living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease and, most importantly, extend your health span. More women than ever are being told in their late 30s and early 40s that their fertility is declining, yet many of them are also being told that their labs look normal. So why do they feel like their body's off and why can't they have kids? In this episode of Extend, I'm joined by Dr. Mao Xing Ni. He is a 38th generation doctor of traditional Chinese medicine. He's a founder of a leading school of Chinese medicine right here in Los Angeles and a pioneer in integrative fertility and longevity care. Dr. Mao explains why Chinese medicine often identifies the same imbalances that shorten fertility years before they show up in standard blood work using diagnostic tools like tongue analysis, pulse diagnosis, and facial mapping. Dr. Mao and I are going to explore why the late 30s to mid 40s isn't a fertility deadline, but a critical hormonal transition and how addressing stress, metabolism, circulation, and nervous system signaling early can either extend reproductive potential or dramatically improve the quality of menopause. This conversation is going to show how integrating Eastern and Western medicine create a far earlier, more personalized approach to fertility, hormonal health, and long-term vitality. Dr. Mao, it's such a pleasure to finally get you on the podcast. Thank you, Darshan. This has been long coming and we've been talking about it. fine. You're right down the street, but you are so busy. I mean, you are one of the foremost Chinese medicine doctors in the world, I would say. You run a school of Chinese medicine. You have a very busy clinical practice. I mean, I know you treat a lot of celebrities. You have a lot of people flying from all over the world to come and see you. So it's incredible what you've done. Well, you know what? I just feel like it's been such an opportunity to serve, really. Ultimately, it's what I love. I love to being of service and make a difference in people's lives. Yeah, I could tell that for sure. And we have so many things that we could talk about because you talk about so many things from longevity to psychedelics to woman's health to men's health. And so I'm excited to dive in today on one of those topics with you, which you've just recently wrote a book on, Second Spring. Yes. Well, actually, it's not a recent book. No. But it's very topical now. Yes, it is. Yeah, exactly. When did you write this book, by the way? Well, let's see. Let's see. Published by Simon Schuster, maybe about a little less than 10 years ago. Oh, okay. Yeah. You've written so many books. You're a prolific author, too. I don't know how you fit all this in. But actually, for example, I have Secrets of Fertility that I brought with me. That's a fairly new one. This is the new one. Okay, got it. Exactly, yeah. And so, again, it's, you know, these are the crossroads. And I love to talk about sort of, you know, women who come into our office in their late 30s, early 40s, and they really want to get pregnant. And now they're starting to have hot flashes, sweats, sleeplessness, mood changes, symptoms of menopause. And their numbers are changing. FSH is starting to go up. They are really panicked because, wait, I haven't had my kids yet. So this is the population that we are seeing today. And then there's a second population that are women in their young 30s, actually, that are looking to freeze their eggs because they're not ready. They're in the career track or they're not with a guy yet or family. It doesn't have to be a guy, but they just haven't had a partner yet. They identify. So they want to put it off, but they know that the eggs are somewhat dated. The younger you are, the better. So they'll go in and do an egg freeze. session, they'll get three. Three. That's not enough. That's not enough, right? I mean, ideally, you want to have 20 or more in the bank. And so they have to do multiple times. And it's very expensive and it's very hard on the body. So we're also getting patients coming in like, hey, Dr. Mao, can you optimize, you know, so that I can have more yield, you know, more eggs, better quality. and that's really the bottom line is how can we help women who are looking to enhance their fertility right and then also population that are you know they're done with your family so but i just don't want to go through the miseries of the aging process of menopause which is quite cruel i mean really so yeah so we're we're you know we've really much very much involved in these two distinct population yeah and sometimes they're the same person that are going to it yeah isn't it so funny how, not funny, but like just interesting how women are waiting longer and longer to have children, but also the age of menopausal symptoms is occurring at a younger age now. Yes. And so, you know, there's definitely societal macro kind of things that are going on that are making women wait longer, which I fully realize. And also, you know, I think a lot of it has to do with maybe even social media and the dating, how dating has completely changed now to where women are just not meeting the right person and men are not meeting the right person until later on in life. That happened to me, certainly. I didn't have my first child until I was 42. And so we actually also had problems having children. And so seeking out a fertility expert seems to be more of the norm now than it is the exception. You're absolutely right. It is interesting how societies move that way. Right. And the good thing, the good news, of course, is that we do have the technology and we also have this this understanding from Eastern medicine, which is, you know, 5000 years old. And I mean, we can we can prove just with our population that it is a successful medicine. Right. It's, you know, fertility doesn't seem to be a problem. But but nevertheless, the older you are, the more challenging, you know, we're going to be dealing with. So, yeah, it's interesting. You know, a lot of people seek out Eastern medicine for fertility issues. I think that's one of the main uses probably that you see people. Right. It's interesting because I think 50 percent of our practice is that is women coming in to try and optimize. And yes. And, you know, I think the way we're framing this is your body is changing, but it's not a it's not a deadline. You know, it's really a opportunity to signal your body properly because ultimately our body can function for a long time. My grandmother had, I think she had 14, 15 kids. One didn't make it, but a lot of kids, right? And her last one, she was 55 years old. 55 years old. It was all natural, right? And so it's about getting your body signaled properly. Like, hey, we're still in our reproductive stage and let's optimize everything. And so, yes, so it's an opportunity. And I want, you know, like listeners out there to really kind of not despair if symptoms of menopause starts to come on, but rather just think about like whether they're looking at fertility or whether they're actually looking to transition gracefully through menopause and not experiencing that typical aging. It's an opportunity to basically signal your body properly so that you can actually feel better. And if, in fact, having kids is a goal you have, you can optimize that. You can increase the chance of success. Right. So on the fertility side of things, we talked about women are freezing their eggs, right? Yes. And that egg freezing process, it's expensive, it's painful. and so you want to maximize the success of that, right? Correct. And so the amount of success you have with that has a lot to do with the number of eggs that are harvested during that procedure. Correct. Which is low because of what? Why are women experiencing lower and lower egg harvest rates now than ever before? There's multiple factors. Obviously, there's not one thing that we can point to that's actually lowering the numbers. But what we do know is this, is that many more women, young women today, are developing conditions like, I mean, hormonal imbalance, like PCOS, polycystic ovarian syndrome, endometriosis, and other kind of conditions. And so, you know, a lot of it actually is diet and environment, right? So environmentally, there's a lot more estrogenic type of foods, you know, processed foods is an example. And then also perhaps the drugs that they're taking. You know, a lot of women are also starting very early with, you know, birth control pill. And it basically sort of kicks a can down the road. You may have issues already, but let's ignore it until you're ready to do something about it. And then you get off the pill and you're like, okay, I'm ready to do egg freeze. And I only get three or two or one. And that's just disappointing. It's just heartbreaking when they see, why is my body failing, right? And then the stress, if we look at what's happening with stress, stress is a signaling, right? If we look at our human body, we have an autonomic nervous system, which essentially helps us survive. So the survival mode is the sympathetic. And the rest and restore and digest mode is a parasympathetic. Well, I would guarantee you, and I see this all the time clinically, that majority of our patients are in the sympathetic mode all the time. They're in survival mode all day long, right? They're running away from whatever saber-to-tiger they're running away from. But what that's going to tell the body is this, is that we got to survive first. So shut the reproductive system down because that's taking up resource. I need all the resource to allow me to run away or climb up a tree. And that's it. Yeah, so the sympathetic nervous system is shutting down the reproductive system. And if you're living in that sympathetic state all the time, you're not going to produce eggs. You're not going to be in a reproductive state. And so I think this is one of the critical factors that can help many women out there get pregnant if that's what you're trying to do or have eggs. Exactly, exactly. I mean, it's very simple. We can explain it in science, right? The adrenal, hypothalamic, and ovarian axis, right? So this signaling process. So when your adrenaline is rising, your cortisol is rising, the hypothalamus is going, whoa, there's a tiger out there. don't even think about getting pregnant. And then it sends a signal to the ovaries like, okay, not this month. Not this month. We're just going to reduce the amount of resources to you. And so I think combination of the factors. There's not one thing but a combination. But even men's sperm. We've got to admit that over the last 30 years, the male sperm has decreased by 50%. 50%. Right. And if we keep going in this direction, I think we're going to have a problem. And we're seeing actually populations are dropping, not increasing. No, exactly. For the first time ever, you know, they're predicting population decline this decade. And so that's a huge potential issue because as a population declines, usually the decline is happening in younger individuals, not older. The older population is living longer. Right. So the entire population is also going to move towards an older average age, which is an issue. We've got to keep having babies. Well, yes, of course. I mean, I think, you know, maybe robots one day will take over all the work that needs to be done. But we still need young people. We still need young people, exactly. And, you know, us. I mean, think about it, right? We're coming into our prime age, right? Sure. I mean, like in our parents' generation, maybe prime was like maybe 30 in our lifetime. The prime is like 60 and 70. Like you, you can still climb Mount Everest if you want to, right? If you know what to do. Well, if you know what to do to really enhance your functions. Right, right, exactly. So a woman comes into your office and she's, you know, 35 years old. She's like, I want to go freeze my eggs. Or she's 35 years old and she's like, I want to get pregnant. What are some of the things you talked to her about? Well, first, you know, I think we look at the basics. Let's look at your diet. Let's make sure that you're eating a diet that's supportive for your goals, whether you're, you know, really enhancing your fertility or, you know, looking to freeze your egg. There are certain foods. I mean, like, for example, protein-rich foods, omega-3, fatty acid-rich foods. I mean, again, these things will help, right? Sugar will definitely not help. No. Alcohol, in fact, it's kind of interesting because there's been so much studies now that show not, unfortunately, not any amount of alcohol is good for your health. Yeah, zero alcohol. It used to be like, oh, a glass of wine or two is okay. But now, and we know that alcohol can destroy and change the DNA and create DNA fragmentation of the egg and the sperm. So not a good thing. So diet is very basic. Secondly is rest. Are you getting enough sleep? Because, again, if you don't get enough sleep, you're naturally going to be high in cortisol. And that cortisol is signaling the body and thinking, okay, it's a survival. We're not going to do it, right? Not this month. And stress management, of course. And finally, exercise. Believe it or not, the right kind of exercise can be very helpful, just the right amount, but too much. Then you have to decide is the body thinking you running away What happening here Like you know women sometimes go out there and they pumping iron they doing CrossFit I not saying CrossFit bad but they doing it you know like really high intensity And again, at some point, the body is going to be signaled incorrectly. So it's more like you want to get pregnant? Let's, you know, let's go to the cave. Let's load you up with lots of food and put a big rock against the opening so you're safe. and you can kick off your shoes and get pregnant. Yeah. That's what you're talking about is reducing sympathetic activity throughout the day, increasing parasympathetic time, and that can be done through many techniques. One is reducing high-intensity intermittent training or just high-intensity training. Secondly is finding time to rest, relax, feel safe, et cetera. Oh, yeah. Meditation, for example. We regularly provide our patients downloads, put on your phone. We have a special fertility meditation. We have a stress release meditation. So, you know, all kinds of different things that people can do to help. Got it. Yeah. And so taking it one step up from the basics then, what are some of the other maybe nutritional supplementation or herbals that we can use to help improve fertility? I know this is where Eastern medicine has typically had some solutions there. Right. Well, so, I mean, we do personalize for every patient because everyone's a little different. And so we have to also look at their labs and see if their FSH is too high, LH. Sometimes someone has high prolactin, usually we look at the pituitary because there might be a little benign tumor that we have to take care of. But there's a number of things that we look at. So personalize. But you can say in general, for example, if you look at supplementation, vitamin D is very critical. It regulates hormonal function and does contribute to fertility. CoQ10, coenzyme Q10, it's an antioxidant. So if you're thinking that some of the issues has to do with DNA fragmentation from environmental toxins, maybe alcohol and other things, then that could also help too. So these are some of the very basics. Of course, omega-3 is always a good thing. And then from an herb side, for example, there's an herb called angelica root, which is called dung kwe, sometimes also called the ginseng for women, right? And it's probably the most important herb for fertility because it regulates menses, regulates hormones, and help enhance ovulation process. The other one would be astragalus, which is an overall, I mean, you probably talk about this, adaptogen, right? So as an adaption, it helps you actually with stress regulation. And so that's another good thing. But there's, I mean, we use like 450 herbs. I know. I've seen your office. Yeah, we have a pharmacy and we custom blend for every patient. Right. Yeah. Yeah, I love that, that you have all the herbs there and you create custom blends and mostly in like tea form for people, right? Yeah. So, I mean, we can make capsules too, but, you know, like the teas are the easiest. We extract them into powder. And so we combine the formula anywhere from 12 to 15 different herbs because, you know, they might be having sleep issues or they might have hot flashes or they might have low libido or, you know, there's all kinds of issues. So we kind of put it all together into one formula. And then that's changed depending on what's going on. And yeah, make a tea, you know, little espresso shots. It's, you know, it's good. Most of our patients are really very willing to take it, even if it doesn't taste great. Yes. And I think what's really cool, too, is you do this via telemedicine as well, right? You don't have to come to California to the clinic. That's correct. You can still go to your website and speak to somebody and have a custom herbal solution made for you and what your goals are and what your biology is at that moment in time. Yes. Yes, we do. And we regularly collaborate with their GYN and their reproductive endocrinologists and other so that we can really be on the same page. right so yeah so can i ask you what are some of the secrets of fertility that you write about in the book beyond this or do we have to buy the book yeah you're making me give away all the secrets in the in the book then they won't have to buy the book anymore give us one yeah yeah yeah well you know it's it's it's interesting if if anything let's let's think for a second right We recognize that there's an energy in every food. Energy in every food. So let's think about for a second, like broccoli, an egg, or a piece of bread. Obviously, nutrition is a little different. But we go beyond that. Chinese medicine recognizes energy. So broccoli, fine. It's got fiber. It's got all kinds of vitamins. Great. Okay. But it's a plant. doesn't do a whole lot for your fertility. It's not that it's bad for you, but it's fine. A piece of bread with wheat, yeah, it's got, you know, maybe if you're lucky, you get 10% protein with American wheat, you know. Heirloom wheat, you get 20, 30%, whatever. It's a carb, and so it's going to signal you a little very differently. But an egg is interesting, right? You're looking at optimizing eggs. So I'm going to pose this question to you. What do you think is more potent, energetically for fertility? A chicken egg, an ostrich egg, or a caviar? I will go with a chicken egg. Interesting. And why? I feel that when you look at those, when you look at fish eggs versus bird eggs, right? The fish eggs are small. They're very energetically different than us as humans. But the birds, they have the most energy. And chickens probably reproduce a lot more than ostriches. I'm just making all this up as I'm talking to you. No, actually, it's interesting you say that because it's true to a certain degree because what animal do you know that can lay an egg a day without fail for three years? Right. I mean, pretty remarkable, right? I mean, so there's a lot of growth factors. So you're right, chicken, egg's fine. But I also want to sort of appeal to you that one chicken egg and the same size, right, how many fish eggs can you fit into that spoon? I mean, probably a couple hundred, 200, 300. I love caviar. Caviar, right. So think about it. Like you have a life potential in each of those eggs. Now you're eating 300 all at once instead of one. How many chicken eggs can you eat? Well, five maybe, right? Yeah. But look at the caviar, right? So there is an idea behind like, oh, what's the energy potential for fertility in this one thing you're eating? Same thing. like a seed, a seed germinates into a tree, as an example, right? So if you look at like a pine nut, right, big pine tree, and so all the nuts and seeds, that's the secret. That's really one of the secrets. And you'll notice that nutritionally, they are fantastic, right? Yeah. I mean, besides the omega-3s, but there's a lot of vitamin E and other kind of wonderful nutrients. So yes, So that's one of the secrets, like eat lots of seeds. Yes, yes. Exactly. And caviar being like a seed. Caviar, yeah, exactly. I love that. It's a little expensive, but anyway, yeah. Yeah, but hey, if it works, it's less expensive than getting an egg donation done. Well, yes, no, for sure. Or fertility treatments. Yeah, fertility treatments, exactly, yeah. What about acupuncture techniques in fertility? I know this was also suggested to us when we were trying to get pregnant. Yes. Well, we've actually done studies. We collaborated very early on with reproductive endocrinologists and published studies on how acupuncture can increase life birth rate. So this is not just pregnancy rate. This is like life birth rate by 40 to 60 percent. 40 to 60 percent? During IVF. So when you combine it, so this is, that study pretty much kicked the door open for us to collaborate with reproductive endocrinologists all over the country. So now every reproductive endocrinologist will actually recommend to their patients, like, hey, listen, I either have someone that comes to my office to do treatments for acupuncture, or you can go see someone, right? And so this is incredible. And that study has been repeated a couple dozen times now. So it's confirmed. It's repeatable, absolutely. And is there a special acupuncture technique people should ask for, or does acupuncturist not understand? No, it's a special protocol. We have a whole doctorate program. This is a postdoc program in our school, Yosan University of Traditional Chinese Medicine. We have the nation's only postdoc program on reproductive medicine. You know, it's two years additional to getting licensed and getting a doctor. Oh, yeah. So people spend extensive time studying these protocols because they are very unique and specific. You know, general acupuncture, okay. It's good for enhancing general health and well-being. But, you know, if you're talking about something very specialized as fertility, this is a training that you should have. So interesting. So if a woman is listening to this and they, first of all, just even the knowledge that acupuncture can increase your fertility rate by 40 to 60% during fertility treatment, that's huge. I mean, that could save you so much money in the long term, having to go through one cycle versus two or three. I have friends that are going through four cycles of fertility treatment. I know. It's crazy. I know. And I don't think they're doing acupuncture. So this is a fantastic data point. But also understanding that the practitioner needs to have a special certification or postdoctoral training. Yes, exactly. And, you know, there's a board that actually for reproductive medicine that kind of creates that kind of certification as well as, you know, again, if you're a graduate of our program, yes, then you're definitely empowered to do that. Very interesting. And then, you know, I know part of what you've taught us, me and my group of people is Tai Chi and movement techniques as well. Is there anything special there around fertility that people can consider? Yeah, so think of that as mind-body practice, right? So you get into a frame of mind, you're breathing, you're focusing on different parts of your body, particularly for fertility enhancement. And so it's a meditative movement, meditative exercise. And so we have actually designed fertility Qigong practice. We have special Tai Chi programs specific for this. and there's also massage that we developed you can do at home right to optimize the blood flow nutrient delivery to ovaries and uterus to build up lining to help enhance ovulation process wow and people can get all of this information how can someone figure out what is the right tai chi kijong massage is this do you have videos on this we do we do have videos but i probably the first thing to start, just go to our website, Dow of Wellness. That's spelled with a T, Dow of Wellness.com. And then from there, you can be directed to all the resources that we have. Yeah, incredible. Why would you not do this, right? If it can increase fertility even 40% is a massive number for people. So that's fantastic. And it sounds like all the things you're doing for fertility also applies to if you're donating eggs, correct? Absolutely. Absolutely. But see, it's the interesting part, right, is that we're talking about fertility, right? And yet we started our conversation about menopause. I know. Because everything we do for fertility helps. Helps with, think about it, menopause, right? Because we're making you more fertile, that means we can extend your cycle that much longer. So instead of taking a bunch of hormones, you might be able to get away without taking it, right? because, again, you don't have the hot flashes or sweats. You're sleeping fine and you're experiencing the weight gain and low libido and all those things. So, again, everything we're doing is optimizing your hormonal health. We're signaling your endocrine system, which is your hormones, your nervous system to be in sync. And so in this case, we have women who actually continue to cycle even into their early 50s and mid-50s, for example, naturally without using any hormonal replacement. Wow. Yeah. I mean, and so, yeah, I mean, for the listeners, basically menopause is a failure of the ovary to produce eggs and estrogen, right? So what you're saying, if you just continue the same pattern in your lifestyle, then it will decrease your symptoms of menopause. It'll keep you fertile for longer as well, potentially, but also just symptom reduction could also be achieved. Most definitely. So that's why, you know, when I wrote the book called Second Spring, which in Chinese medicine, you know, what a nice way of describing menopause. I mean, second spring. It's like you get to live your second spring. And that's exactly what we're doing. We're enhancing what it feels like to be a woman, right? Yeah. And help you reclaim your psycho identity, you know. And so I was writing this book, and I'm thinking, wait, all this, I'm writing, this advice applies to enhancing fertility. So then I decided, you know what, I better sort of get the book on fertility. My brother, actually, he's also a specialist in reproductive medicine, and he has a book called Tao of Fertility. So anyway, we've obviously been in practice together for 40 years. That's amazing. And so what you're saying, there's really not a divide between fertility versus menopause, right? And so I see a lot of times like, you know, women come in with menopausal symptoms and they're not even like, haven't they done having children yet, right? And so they're freaking out, anxious about this. And so like, how do you talk women off a ledge on that? Like, they're not done having children. They want to, you know, they're having menopausal symptoms. Maybe they're missing periods, in fact. What are your thoughts there? Well, I explained that, look, this is what your body is going through. It's just a change, right? And so all we have to do is signal the body correctly That all It wants to go one way and we tell the body whoa wait we not going to go that way We going to get better We going to enhance function We going to signal everything properly so that it an opportunity to shift the direction If you're heading down that way, we can reverse it. We can shift the direction that the body's going. The body's amazing. I mean, you've been talking about longevity forever, but how much you can regenerate, it's pretty awesome. right and the same thing like with fertility i mean you can definitely extend that fertility potential now yeah yeah we see so many patients that come through here and we work a lot with fertility doctors as well and when we start doing you know nutrient infusions we start doing a lot of therapies that we have here at our clinics they get pregnant you know it's it's correcting their metabolic health is another big factor um that we do very well i think here we're using continuous glucose monitors, even using some of the newer peptides like GLP-1. Correct. We've had a lot of what you call those Zempic babies because finally their metabolic health is better, which takes their cells out of such a stress state and they get pregnant. You're absolutely right. A couple of years ago, we have an annual integrative reproductive medicine symposium through our school. And so I presented on that very topic, GLP-1. and the kind of like natural equivalents of it and how that can really change for some of these women who have metabolic health issues, they could really benefit from. Yeah. What are some of the natural equivalents of GLP-1s that you're using? I would say probably the most common one is berberine. Yeah. And so it has a similar kind of action of simulating GLP-1 production. Got it. Got it. So, I mean, there's a lot of things here. How do you put this together in a protocol for women when they come and see you? I know it's very personalized, but in general. Yeah, in general, when someone comes in, we would evaluate them, right? We do a first consult. We'll look at their labs. We look at ultrasound if there's cysts and other things that we need to take care of. A lot of times there's issues like fallopian tubes blocked. We need to rule that out. There's fibroids that we need to shrink. I mean, so there's a number of things, right? But we clear the deck. So after our assessment, then we can give the patient a kind of individualized approach, and then we'll give them a nutrition plan, which includes not just what to eat, what not to eat, but also some of the herbs and supplements they can take, and then the acupuncture protocol, sometimes body work. We'll use infrared. Infrared's a really interesting thing because it really does increase blood flow to the uterus and to the ovaries. So how do you apply the infrared? How does that work? Well, we have a whole, I mean, we have a kind of an igloo that the patient gets in with the head outside. And so it's a 360 infrared that they do in our office. In the old days, we used to heat an herb called mugwort, called moxibushin. And, you know, what happened is at some point it starts to smell like cannabis. And like, wait, wait, wait, wait. We're not like smoking cannabis in our office, but it smelled like it. And it was a lot of smoke. So we just, we went to infrared. and it actually works better anyway. It's more high-tech infrared. It works better anyway. Yeah, yeah, exactly. Yeah, because he does promote blood flow, obviously. For sure. Yeah. But the interesting thing is we don't use it for men because we know that he kills the sperm. The sperm, right, absolutely. So I'm going to send them over here for cryotherapy. Yeah, the opposite way. They can go in for, you know, two minutes and get their, you know, sperm scrotum kind of, you know, cool down. I mean, that's an interesting piece to add to this conversation. We focused on women the entire time, but what should the man in the relationship be doing to promote fertility if they're trying to have a child together? That's such a great idea. I'd love to come back and talk just about male sexual health and male, you know, like this kind of andropause issue, right? Because, you know, we have patients who come in and they're in their 30s and they're already doing testosterone because they're going to the gym and they're bulking up. And their testicles have shrunk, like half of the size. And I said, guy, don't take the testosterone. You're signaling your body incorrectly. If you want to make more sperm, don't do that. So, yeah. So, then we tell them, look, heat is a big killer of sperm. So, just, you know, the typical, you know, don't wear jeans, tight pants. And then, you know, like no hot showers, no hot baths. Of course, avoid alcohol and all that. But there are also the similar kind of nutritional plans that we do. that can enhance sperm health and all that. But like I said, I think we can do a whole segment just on the guy. And I think the guys deserve a whole segment because we're only talking about women here. Yeah, exactly. Yeah, but I think it's an important piece of the conversation for the women that are listening to this, trying to get pregnant, to bring the man into the conversation, obviously, because they're 50% of the problem, usually. They are 50% of the problem. It takes two to tango. Yeah, because just because a woman has low egg count, also there's a high chance a man has low sperm count. And we see that very frequently. You have to address both sides of the issue, right? You know, the funny thing is it's not just the amount, right? Because it only takes one sperm. But most of the sperm is lazy. So motility is so slow or they're going in circles, which is not going anywhere. Or defects, like morphology, right? They're like, the head is defective, neck defective, tail, and now you're down to 1% of normal. So now you've taken your 100 million sperm down to 1 million that's normal. And there's a reason why we need a lot of sperm to make it happen is because, you know, more the merrier, right? You optimize your chances. So anyway, yeah, no, the guys need to really be part of the conversation when it comes to fertility. Yeah, sure. And we do need to do an entire episode just on andropause and other ways to treat this because I think you're right. I mean, I think there's a deficiency of testosterone is occurring population-wide in the Western world, for sure. You can see this in the levels that are being measured at labs. They're about 200, 300 points higher just five decades ago than they are now on the average. And so the actual normal level has been come down on the lab work because on a population basis, the whole level has come down. It's a big problem. And I think, you know, we have a lot of people seeking testosterone replacement therapy, but there's so many other things that can be done. Lifestyle, that can be done with nutritional supplementation, et cetera, right? Acupuncture. For example, we can stimulate testosterone production naturally with no side effects. Have you done research on that? Yes. Testosterone? Yes. Yes. No question. Because acupuncture can improve testicular function. And so that's the key to increasing sperm production and testosterone production. So interesting. Yeah. And so, yeah. And so I think that's something that people really need to consider, men need to consider when they're trying to improve their testosterone levels. This episode was brought to you by Next Health, a health optimization and longevity clinic located in Los Angeles, Manhattan, and soon to be opening in Montecito, Nashville, Miami, and many other cities in the United States and Canada. Next Health is the Apple Store of Wellness, where you can optimize your health span and lifespan using cutting edge technology. I actually founded NextHealth eight years ago to give my patients a place to go get extensive biomarker testing done and provide them with all the tools that I use to get my health in order. The longevity circuit in NextHealth using hyperbaric oxygen, sauna, cryotherapy, and LED light is a game changer. In addition, the doctors at Next Health measure thousands of biomarkers and put into place a longevity optimization plan using advanced tools like ozone, plasma exchange, and peptides. Go to www.next.health to check it out. How do you talk to women about hormone replacement therapy? because that's becoming much more, I mean, you know, for years we've had this women's health initiative that was misinterpreted and women were not offered hormones at all for fear of causing cancer. And now this year, finally, we're seeing kind of a reversal of the conversation at, you know, the Washington DC level where they took the black box warning off of estrogen replacement therapy. And so how does that fit into your overall algorithm of menopause? Yes. No, we work with it. Like, let's, for example, I mean, there is still a small subgroup of women who, let's say, have, you know, estrogen-positive receptor breast cancers. You don't want to take estrogen. People who are prone to blood clots and so forth. So, yes. So, let's, you know, with, you know, if you take precautions, maybe you can be okay with it. But for the most part, you're absolutely right. You know, there's concrete studies now show that first five years of menopause is where the sweet spot is. And taking just a little bit enough to head off, you know, heart disease and osteoporosis and brain decline and so forth is helpful. Now, we also have natural ways, obviously, through the fertility work we do to enhance your own production. So instead of taking exogenous hormone, whether it's through a patch or gel or oral, we can naturally have your body produce more. And that's really where we can also do the same. And we'll measure their estradiol number and it's like, wow, it's as if you're still 35, for example. So we can get the level back up naturally. without. So women will opt to either take the estrogen or take lower dose because we're working with them or not take it because we can do the same thing over the course of the first five years, at least to help them. And that's part of the sort of menopausal care that we do, right? We don't, again, we call it second spring because we are trying to help you re-experience your youthful vitality. And how do you do that? Your hormones have to come back. Yes. You know, I mean, like, seriously, like, I mean, you know, a lot of women, oh, actually, a lot of guys will come in and say, you know, my wife's going through menopause and she has no libido. And that's a very serious thing, right? And then so we start working with her and suddenly, like, you know, he's like... So you're optimizing the testosterone, too, to bring libido back. Both, both, exactly, exactly. And the guy's coming back and says, oh, man, whatever you're doing, keep doing it. Yeah, they're happy about it. Yeah. So, I mean, you know, I've recently read some studies that a lot of the estrogen conversion from an active form to inactive actually happens in the gut as well. And there's some gut bacteria that do that inactivation of estrogen. And so the gut microbiome also changes as we age. And that might have a lot to do with the reduction in hormones through menopause as well. Well, yeah, it's multifactorial. It's not like one thing, right? But we do recognize, you're absolutely right, some studies on that, that over time, you kind of need to reset your gut. I mean, one of the more common problems I get is SIBO, right? Small intestine bacterial growth, they're bloated, they're gassy, and they're constipated, whatever. All the time, we reset it. A lot of our patients don't want to take Zyfax and Neomycin, the typical cocktail for SIBO. and we do our herbal and nutritional and acupuncture cocktail, and they feel great. Amazing. Reset, and so then they are able to convert testosterone again. Yeah. I think SIBO is a really underdiagnosed problem, and there's not a lot of tools in traditional medicine other than one antibiotic that you can take potentially. So it's really good to also consider some Eastern medicine therapies that you can put together for people to help with SIBO. Yeah. And then can I also ask you, you know, you mentioned a little earlier about PCOS, and I think this is also a big underdiagnosed, underrecognized problem. Can you talk a little about PCOS and what it is and how you approach it? Yes, yes, yes. So polycystic ovarian syndrome, essentially the symptoms are usually a woman will begin to form cysts on her ovaries. And they start early. They start in their teenage years and into their 20s. Symptoms may also include acne outbreak, which is really depressing for teenagers. And so instead of really diagnosing the PCOS and looking at the root of it, they take Accutane, which is not so good, right? Because there are side effects. I mean, it works, but high doses of vitamin A can be toxic, right? Can be toxic, right? Yeah, and then also antibiotics, which is also not getting at the root of it. But this problem is actually a metabolic problem. It's an insulin problem. Oh, yeah. So besides just acne, there's weight gain. Yeah, weight gain. Right, exactly. Oh, absolutely. Weight gain, hair on the body. Like teenagers struggle with this, right? Horsetism, too much hair on the body, weight gain, acne. And it's really depressing. So then they get depressed. They have mood disturbances as well. You know, it spirals out of control almost. That's right. Right. And many of them are medicated with the pill, right? The birth control pill. Right. Which sort of does control it. But again, you're kicking the can down the road. You're not dealing with the real problem. But it's a metabolic problem. So what we need to do is to get the body to signal correctly, insulin resistant. So they're producing insulin, but the cells are not opening the doors to take the sugar in. So sugar builds up. And then that has all kinds of ramifications for ovulation, cyst formation, and all these weight gain and other symptoms that you have. And so we do work with them. Diet is very important. The CGM, the continuous glucose monitoring, is very powerful because it will show them like, whoa, what you just ate just really shot up my glucose. So it's an educational process for these young adults. And again, we're happy to say we're able to actually balance the majority of the patients that we see, especially from a fertility standpoint of view. Yeah, I love it. CGM is a great tool for PCOS. And also I've seen a lot more people using GLP-1s also for PCOS now as well. Correct. And the natural ways of if you don want to take a GLP injection berberine and other even just like dietary interventions like doing a little bit of vinegar before you eat sugary food can help too right That right Yeah And also 10 squats after you eat 10 squats. Exactly. 10 squats. Yeah. Squats are so powerful for so many things. I know. I know. Yeah. And it was, you know, very few people ever even squat for anything nowadays. No, no. I mean, like, you know, I tell my patients, I mean, most of them come in with back pain. Yeah. I said, don't bend at your back, bend your knees. right yeah but their knees hurt but anyway um i uh i was talking to a patient the other day and um i was so surprised at this he had a bunch of plaque build up in his arteries this is a male and he was 50 years old and his cardiologist actually told him he asked the cardiologist what can i do to reverse all this plaque he's like well you can eat a mediterranean diet and get on high doses of statins or you can do 30 squats a day and obviously he changed his diet He'd refuse a stance and he'd do the 30 squats a day. And within, you know, a couple of years, his cardiovascular disease had reversed. It's that powerful to doing squats. And so I think it's a forgotten kind of activity in the Western world. But in the Eastern world, like in India, in China, like people squat all the time. They like eat a meal in squat position. I was going to say, I mean, you know, and we have squatting toilets. I mean, not favorable in the West. But yeah, I mean, we use our legs all the time. I mean, you've got to bend down to pick up things, right? Right, right. But today, it's kind of amazing. I kind of watch people who go around with one of those sort of trash can pickers. Yes. Trash pickers. It's like, dude, man, bend down, pick up the piece of trash. No, I can't do that. Oh, my gosh. I mean, I appreciate it if they have back pain. But anyway, but that's part of the problem. If they do squats, they've had less back pain. Right. And the opposite of squatting is sitting all day, too. So staying mobile, getting off of your chair and walking is also incredibly important. Also probably very important for fertility, right, is staying mobile. Oh, absolutely. Yeah, movement. Like I said, movement is key to health, really. I mean, ultimately, if our body needs circulation, you got to move, right? But it's the right amount of movement. Too much overexercise, again, you have a different signaling. property. So, yeah. You know, I feel like it's not intuitive for many people to consider Eastern medicine as part of an overall treatment protocol. I think a lot of times what happens in Western medicine is they'll see their primary care doctor and they'll say, you know, what else is there? And the doctor will say, well, there's nothing else there. You just got to take this pill. And then maybe they have heard, maybe they hear this podcast and they ask their doctor, well, what about acupuncture? And then, you know, more than half a time, I think there's going to be frank negativity or just there's no evidence behind blah, blah, blah, whatever, and they kind of dismiss it. And how do you respond to those types of advice that they're getting from their regular doctor? Yeah, my advice is, first of all, the near-generation doctors coming out of medical school, they are all well-versed. They've read the studies and so forth. So acupuncture is great. A lot of it is just doctors are so busy doing what they do, attending metaconferences. Unless they're interested, they're not going to read the studies on acupuncture. There's like 20,000 research citations on PubMed, on acupuncture alone. 20,000, right? People doing surgery with just acupuncture, no anesthesia. Exactly. I actually participated when I was doing my postgraduate residency in China. I participated in a surgery tonsillectomy with no anesthesia. But there's a lot of evidence. And it obviously works because, again, most things that don't work will not survive 5,000 years. Exactly. Right? And it's still being used by over a billion people around the world today. Right. And so it's one of those things. It's part of this educational process. I think in 20 years, we won't be having this kind of response because the sort of older generation doctors, the old school will have retired. And the newer generation doctors, basically, they've been exposed. And they go, yeah, this works. I agree. I mean, it works so well that even physical therapists are trying to co-opt acupuncture. I know. What do they call it? Dry needling? Dry needling. That's right. So, you know, it's like, okay, really? If it doesn't work, the PTs are not going to, you know, I mean. Do it, right. Exactly. So anyway, so it definitely, there's strong evidence, lots of clinical data and so forth. Yeah. And I agree. I think that the evidence is pretty good that people should at least give it a try because the downside is very minimal, right? Like if you try something and it doesn't work, the side effects of having a failed acupuncture, if you have it. It's nothing, right? Correct. But at the very least, like every time I go in for acupuncture, I feel like it was the best massage I've ever gotten. And they don't do massage you at all, but it's just that mental state, that deactivation of your sympathetic state is massive when you're in there, you know? And I think, and then obviously like we've had extreme success with really good acupuncturists in our family, even for our kids. And so I think 100% should be part of what people consider as an overall part of their wellness routine, but also especially when they're going through a problem like fertility issues, menopause, et cetera, those type of things. Yeah. You know, because we do train. So we have a master's and a doctorate degree program, accredited programs through our school, Yosan University. So we actually function as primary care. So we, so yeah, so many patients will consider it as primary care. So we'll run the blood labs for them and we'll do all the physicals and other things. And we collaborate. That's the key. We collaborate. If they have a PCP, we collaborate with or specialists and so forth. So that's the beauty of it. We are part of the team, right? And it isn't that, oh, see us, don't see your PCP. No, not at all. See both of us because we come from two different perspectives. And, you know, it's about getting the best of both worlds, east and west. Exactly. And so that's where the beauty is. Yeah. That's the way the system works in India. So my dad was a Ayurvedic physician. And the way it works in India is you have your Ayurvedic doctor and then you have your regular Western medicine doctor. Correct, yes. And they work hand in hand. When you get sick, you go see the Western medicine doctor. They maybe prescribe you something. But then you always go back to your Ayurvedic doctor to make you potentially get off the prescription medication, right? And then if you have a surgery, for example, the surgeon will send you back to your Ayurvedic doctor for the healing postoperatively. Right, exactly. And the Ayurvedic doctor functions as your primary care, your real primary care. Right. And then your Western medicine primary care is like your access to the hospital almost. That's how they function. Yeah. And I think, again, you know, I think to speak to what you just said, you know, like what we do essentially is supporting healthy, normal, optimum function. Right. Whether it's Ayurvedic or Chinese medicine, it's all based in the idea that how can we prevent you from getting sick proactively? Let's change your diet. Let's do this. Let's do that. So you don't have to end up in surgery or whatever else, right? And so it's a nice approach to have as part of your team. If you're really serious about living a long life and maintaining wellness, you want to have a team. I mean, it's just like you wouldn't have a business without all the various functions, the team members. It's the same thing. If you're going to be living to 100, that's your goal, and you want to feel well. You want to get up every day with vitality and energy. You have to have a team to help you. Exactly. I use this analogy all the time, become the CEO of your own health. And you become just like a CEO of a company. It doesn't manage a company with just one individual running everything. You have a team approach. And each person in your team has a different function. So you have a nutritionist. You have maybe a trainer. Right, exactly. Someone for mental health. You have your Eastern medicine doctor. And so all of these together will keep you healthy. And then a member of the team is like the disaster specialist, right? Which is your primary care sometimes, your Western medicine specialist. Interventionist. Yeah, your interventionist. That's the way to think of it. Wow. Amazing. Well, Dr. Mao, you mentioned a few times, but I just want to make sure everyone knows you've written many books on these topics. How can people find your books? How can people get your website again? And then the courses on your website also are very accessible for people that are trying to get pregnant, trying to freeze their eggs, or going through menopause, right? So please tell us a lot more about where we can get more information. So Dow of Wellness, that's spelled with a T-T-A-O of wellness.com. And through there, you could sort of get links to the product side, the video that you can download, and to the school if you want to. We have two offices in the LA area, Santa Monica, Pasadena. Our school is based in Culver City. And in quite a number of books, right? You know, The Secrets of Fertility, Second Spring, Ageless. But, you know, I think I'm probably best known for my Secrets of Longevity book, which has been in 22 languages. And anyway, it's... It's a great day. We got to have you just for an episode on that, The Secrets of Longevity. I'm working on a book on men's health, actually. So that's my next one. Yeah. Okay. Well, you know, we're going to make you a regular guest for sure. This is great information. And then, you know, last question I have for you is for someone living in, you know, Tulsa, Oklahoma, Toledo, Ohio, how can they find a reputable, vetted Eastern physician to help them through their, or Eastern practitioner to help them through their journey? Yes. Well, there are directories that you can look up. You can visit acupuncture.com and to look at, you know, exploring directories. And what you want to do is make sure they're licensed, number one. Number two, probably look at their experience, how long they've been in practice. Did they graduate from an accredited school and so forth? So those are basic. And then word of mouth referrals are always the best. And then I also have patients from Tulsa, Oklahoma, who are patients of mine on telemedicine. And then what I end up doing in a lot of cases is, let me find you someone locally. because you can definitely get some benefit acupuncture-wise. But I'll help you put the program together and the herbs and the nutritional aspect and all that. Beautiful. I love it. Well, thank you so much for joining me today and giving some incredible information on this topic. And with your unique perspective, really appreciate you doing this. My pleasure. Thank you for having me on the show. Thank you. That was a great episode with Dr. Mao. He's an incredible wealth of knowledge. Here are my top five takeaways from that episode. Number one, normal labs might not mean that you're fully healthy. You might actually be late. From a Chinese medicine perspective, disease doesn't appear suddenly. It develops quietly over years. By the time traditional Western medicine laboratories can flag a problem, oftentimes the imbalance has been present for a long time. Number two, The late 30s and mid 40s is a hormonal inflection point, not a deadline. Hot flashes, insomnia, irregular cycles, anxiety, and brain fog aren't signs that fertility is over. They often reflect treatable imbalances in stress hormones, circulation, metabolic signaling. Addressing these early can either extend reproductive potential and dramatically improve the quality of menopause using the same underlying framework. Number three, stress signals the body that it's not safe to reproduce or to thrive. Chronic fight or flight suppresses fertility, accelerates aging, and worsens menopausal symptoms. When cortisol is high, the body prioritizes survival or reproduction. Calming the nervous system through rest, acupuncture, breathwork, and nutrition signals safety, allowing hormones to rebalance naturally. Number four, fertility is a 50-50 conversation. Men matter just as much. Declining sperm quality and testosterone levels are a major and offer ignored contributor to today's fertility crisis. Heat exposure, stress, nutrition, and environmental toxins affect men just as profoundly as women. Chinese medicine and acupuncture can significantly improve sperm quality, making fertility a shared physiological responsibility, not just a female one. And number five, integration is the future. East for prevention, west for intervention. Eastern medicine excels at early detection, pattern recognition, and preventative care, while Western medicine is unmatched in acute and emergency treatment. True longevity comes from collaboration, not choosing sides. A team-based approach catches problems earlier, personalizes care, and supports long-term vitality instead of reactive disease management. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance. Thank you.