Hey everyone, welcome to a sneak peek Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Atia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peteratiamd.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to a special episode of the Drive. In today's debrief, I focus on what I consider the most important learnings and insights from the past quarter of interviews, as well as any behavioral changes I've applied as a result. In this episode, I'll cover a variety of topics, including male and female infertility, women's sexual health, menopause, and hormone replacement therapy, the biology of aging, skincare, facial aging, and rejuvenation strategies, and lessons we can learn about living from the dying. If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. If you are not a subscriber, you can watch the sneak peek of the video on our YouTube page. Without further delay, I hope you enjoy this quarterly podcast summary episode of the Drive. All right, Peter, thank you for showing up to another episode of your podcast. How you doing? Good. Thank you for having me back. I see you brought someone else with you in the studio today. Do you know who that is? I do not. Who's the little guy in your shirt? Oh, Charles. Yeah. Charles. Jump in at all today, providing the insight for us or what's his deal? He might. It's the funniest shirt in the world. It is. Just little Charles just peeking up there, happy as it could be. I know. I know. I love it. Bringing the excitement over there, which is good. Today, we are doing another podcast summary episode to remind people what we do. We pull recent episodes that have come out. We go through them one by one, highlight things you found really interesting, things that were your biggest takeaways, anything you changed your mind on, behavior on, how you work with patients on as a result. These aren't meant to replace people listening to episodes, but these episodes, I think this is our sixth one and to date, we get some of the most feedback compared to any episode on these where people really enjoy them. A lot of times, people will either go back and listen to certain parts, say that things kind of make more sense from this. A lot of good feedback from this, but again, should not be a replacement for these episodes. Today, we got a lot to cover. We have Paul and Paula on male and female fertility. They were two different episodes, but for this, it made the most sense to combine them into one as we look at insights. We'll do that. We have Rachel on women's sexual health, menopause, HRT, something I know you're passionate about and enjoy talking about. Brian Kennedy, which was a really deep dive around biology of aging, kind of a throwback to some of our original episodes where you dive super deep into that. You have Tanuj and Susan, which looked at all things, skincare, facial aging, rejuvenation strategies. On that note, you're looking pretty sharp over there. You've been taking some of their recommendations into your day-to-day practices. We are absolutely going to talk about that because we are probably two and a half months now since that episode. I'm looking forward to discussing exactly what I have done. In fact, of all the episodes, this would be the one where I've had the greatest change in my personal behavior. I can't wait to hear it. Did you do anything different with Charlie or is he still on the same skincare routine? Charles is still doing the exact same skincare routine. It's working for him though, so why fix it? Then we're going to end with episode with BJ and Bridget, which was all around death, dying, but more so what you can learn from people on their deathbed. Huge variety of topics we'll cover. Anything you want to say before we get rolling. No, other than it's interesting that the last and second to last topics we will cover could not be more apart in terms of relevance and superficiality. It will be a stark juxtaposition of something, not to bring any sort of judgment against aesthetics, but ultimately talking about end of life and lessons about life through death versus how to make your skin look better, or about two opposite ends of the spectrum. But nevertheless, it is a spectrum and I think we can find value in talking about everything along it. No one can say we don't have range on the podcast, so we got that going for us. All right, first one, Paul Paula, all things male, female fertility, where do you want to start? Just from a story standpoint, it is remarkable and maybe that's... We try not to do too much summary in these episodes because the show notes do such a great job of that, but I do think there's a couple comments worth making. So the idea that conception is difficult is an understatement. A single ejaculation releases about 100 million sperm, fewer than 5 million of them even make their way past the cervical mucus, and ultimately only somewhere between 100 and 500 reach the fallopian tube and then only one goes on to fertilize the egg. Now, that might be that 20 reach the egg, but obviously there's this really cool force field that comes up the minute the first sperm touches the egg. It creates a chemical barrier that prevents any others from fertilizing, otherwise you'd have this devastating situation of too much genetic material being brought in. Just a couple of interesting things that made me at least go, wow, is that sperm are chemotactic, so they're basically chemical guided missiles that make their way to the egg, and they can traverse 15 centimeters of distance within the vagina to the fallopian tube within minutes. And so it's important to understand given how small a sperm is, that is the analog of a human swimming 20 miles in the ocean in that same period of a few minutes. By the way, just even though we didn't go into this in the podcast, think about the energy requirement to do that, and so you kind of understand what the motor and the ATP generation is like in one of those things. Testes like the brain have kind of a specialized blood tissue barrier. It's very immune privileged and it protects developing sperm from antibodies, but it also means that drugs or toxins that can cross it, such as certain types of chemotherapies, can actually be disproportionately damaging. It's for that reason, of course, that a lot of men who are undergoing chemotherapy will choose to do a sperm donation prior. Spermatogenesis, so the generation of sperm, follows a clock of about 74 days, if my memory serves correct me, and therefore if you're trying to make interventions around sperm health, so if a guy gets his sperm tested, comes back that something's not right, you can identify behaviors that are doing that. You're going to need two to three months of trying a corrective intervention before you can determine if it's worked. That's how long it takes to go through the cycle. Dr. Darrell Bock On that intervention piece, one of the things that was talked about was bike seats. As someone who spent a lot of time on a bike, being you, not me, did that surprise you? Dr. Justin Sperma Yeah, I've always been pretty mindful of bike seats, and I've been very fortunate, despite how much time I used to spend on a bike, I never had any issues. But as Paul points out in the podcast, it's really not a big concern for fertility, but it is much more a concern around erectile function. And basically, based on your anatomy and based on the type of seat you use, you can really traumatize the arteries and nerves that impact directions. So what we tell all of our patients, if they're spending a lot of time on a bike, we have recommendations on bike seats that they should be using. I have two bikes, one for inside, one for outside. I have different bike seats on them because I got them at different times, but they're basically the identical type of seat, which is a seat that has the middle of the saddle is largely absent. And so the istial tuberosities, your sit bones are doing the supporting, but nothing else. And so we can link to a couple of the brands that I think are pretty good. As silly as it sounds, I kind of recommend people buy a couple. So buy from somebody who will let you return them. Buy like three and try them out and figure out the one that's most comfortable. So Peter, back to then fertility. Paul talked a lot about what his work up is for his patients. Do you kind of want to remind people of that and how you also apply that to your patients as well? Thank you for listening to today's sneak peek AMA episode of The Dry. If you're interested in hearing the complete version of this AMA, you'll want to become a premium member. It's extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members. And in return, we offer exclusive member only content and benefits above and beyond what is available for free. So if you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. Premium membership includes several benefits. First, comprehensive podcast show notes that detail every topic, paper, person and thing that we discuss in each episode. And the word on the street is nobody's show notes rival ours. Second, monthly ask me anything or AMA episodes. These episodes are comprised of detailed responses to subscriber questions typically focused on a single topic and are designed to offer a great deal of clarity and detail on topics of special interest to our members. You'll also get access to the show notes for these episodes, of course. Third, delivery of our premium newsletter, which is put together by our dedicated team of research analysts. This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter. Fourth, access to our private podcast feed that provides you with access to every episode, including AMAs, sans the spiel you're listening to now, and in your regular podcast feed. 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