Dr. Michael Eisenberg: Improving Male Sexual Health, Function & Fertility
Andrew Huberman:
安德鲁·休伯曼：
Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.
欢迎来到休伯曼实验室播客，我们在这里讨论科学和基于科学的日常生活工具。
I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine.
我是安德鲁·胡伯曼，斯坦福大学医学院神经生物学和眼科教授。
My guest today is Dr. Michael Eisenberg.
今天我的嘉宾是迈克尔·艾森伯格博士。
Dr. Michael Eisenberg is a medical doctor specializing in urology and an expert in male sexual function and fertility.
迈克尔·艾森伯格博士是一位泌尿外科专家，也是男性性功能和生育方面的专家。
He is both a clinician who sees patients, as well as a research scientist, having published over 300 peer-reviewed articles on male sexual function, urology, and fertility.
他既是一位看诊患者的临床医生，也是一位研究科学家，发表了 300 多篇关于男性性功能、泌尿学和生育力的同行评审文章。
And he is considered one of the world's foremost experts in male sexual health.
他被认为是世界上最重要的男性性健康专家之一。
Today, we discuss a broad range of topics important to all men, including erectile dysfunction and function.
今天，我们讨论对所有男性都很重要的广泛话题，包括勃起功能障碍和功能。
We also discuss prostate health and urinary health.
我们还讨论前列腺健康和泌尿系统健康。
We discuss fertility and sperm count.
我们讨论生育能力和精子数量。
We discuss even topics seemingly esoteric, such as why penile lengths are actually increasing over time, while sperm counts seem to be decreasing.
我们甚至讨论看似深奥的话题，例如为什么阴茎长度实际上随着时间的推移而增加，而精子数量似乎在减少。
Today, you'll also learn some very interesting surprises, such as the fact that a very, very small percentage of erectile dysfunction actually stems from hormone dysfunction.
今天，您还将了解到一些非常有趣的惊喜，例如非常非常小的勃起功能障碍实际上源于激素功能障碍。
Rather, the vast majority of erectile dysfunction stems from issues that are either vascular, that is related to blood flow, or neural.
相反，绝大多数勃起功能障碍源于与血流相关的血管问题或神经问题。
And today, you'll learn about a large variety of treatments for erectile dysfunction.
今天，您将了解多种治疗勃起功能障碍的方法。
Dr. Eisenberg also dispels a lot of common myths that you hear out there, both on the internet and in popular culture, that relate to male sexual health and function.
艾森伯格博士还消除了您在互联网和流行文化中听到的许多与男性性健康和功能有关的常见神话。
By the end of today's episode, I assure you that you will have a thorough understanding of what male sexual health is, how it relates to other aspects of health, and how to think about treating, maintaining, and improving all aspects of male sexual health, fertility, and function.
在今天的节目结束时，我向您保证，您将彻底了解什么是男性性健康，它与健康的其他方面有何关系，以及如何考虑治疗、维持和改善男性性健康、生育能力和功能的各个方面。
Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford.
在开始之前，我想强调一下，这个播客与我在斯坦福大学的教学和研究角色是分开的。
It is, however, part of my desire and effort to bring zero cost to consumer information about science and science-related tools to the general public.
然而，我的愿望和努力的一部分是向公众提供有关科学和科学相关工具的零成本消费者信息。
In keeping with that theme, I'd like to thank the sponsors of today's podcast.
为了与这个主题保持一致，我要感谢今天播客的赞助商。
And now for my discussion with Dr. Michael Eisenberg.
现在我与迈克尔·艾森伯格博士进行了讨论。
Dr. Eisenberg, welcome.
艾森伯格博士，欢迎光临。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Thank you.
谢谢你。
Good to be here.
很高兴来到这里。
Andrew Huberman:
安德鲁·休伯曼：
I've been looking forward to talking to you for a long time, because these days we hear a lot about the diminishing quality of sperm, which in some ways seems to be attached to the conversation about diminishing quality of environment, people, intelligence.
我长期以来一直期待着与您交谈，因为这些天我们听到了很多关于精子质量下降的消息，这在某种程度上似乎与关于环境、人类和智力质量下降的谈话有关。
There's a lot woven into this statement that sperm quality is declining.
这句话包含了很多关于精子质量正在下降的说法。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And some of it, I think people assume is related to environmental changes.
我认为人们认为其中一些与环境变化有关。
Some of it, I think people assume it are related to changes in behaviors, so maybe less exercise, less sunlight, who knows?
其中一些，我认为人们认为这与行为的改变有关，所以也许运动减少，阳光照射减少，谁知道呢？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Hopefully, you'll tell us what's really going on.
希望你能告诉我们到底发生了什么。
But the first question I have is, is sperm quality actually declining?
但我的第一个问题是，精子质量真的在下降吗？
And regardless, what is sperm quality?
不管怎样，精子质量是什么？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, great question.
是的，很好的问题。
So I think it's very controversial, I think as your question alludes to.
所以我认为这是非常有争议的，正如你的问题所暗示的那样。
So I think we'll start by just talking about what sperm quality is and why it's important.
所以我认为我们首先要讨论什么是精子质量以及为什么它很重要。
So for reproduction, as you've covered on the podcast before, a man makes semen, and that has sperm in it.
因此，为了繁殖，正如您之前在播客中介绍的那样，男人会产生精液，其中含有精子。
And so when we're talking clinically about a semen analysis, there's a few things we look at.
因此，当我们在临床上谈论精液分析时，我们会考虑一些事情。
We look at the amount of ejaculate, semen, that comes out.
我们观察射出的精液量。
We look at the sperm, how many there are.
我们观察精子，有多少。
We look at their motility or movement.
我们观察他们的活力或运动。
We look at their morphology or shape.
我们观察它们的形态或形状。
There's some more advanced testing that's done in rare cases, looking at fragmentation of DNA, for example, or there's some newer tests looking at epigenetic profiles of sperm.
在极少数情况下会进行一些更先进的测试，例如观察 DNA 碎片，或者有一些更新的测试着眼于精子的表观遗传特征。
But essentially, these are all markers for fertility.
但本质上，这些都是生育能力的标志。
So fertility in itself is a team sport, right?
所以生育本身就是一项团队运动，对吗？
So it's hard to label a man as fertile or not fertile without knowing about his partner.
因此，在不了解一个男人的伴侣的情况下，很难给他贴上生育力或不生育力的标签。
But nevertheless, based on these different parameters, we try and quantify how likely a man is to be able to achieve a pregnancy.
但尽管如此，根据这些不同的参数，我们尝试量化男性怀孕的可能性。
So the World Health Organization, every decade or so, looks over the existing literature and defines these different cut points of what's normal or what's subfertile for those levels.
因此，世界卫生组织每隔十年左右就会审查现有文献，并定义这些水平的正常或低生育力的不同切点。
So that's sort of the backdrop of what semen is and how these tests are done, or what these tests represent.
这就是精液是什么以及这些测试如何进行或这些测试代表什么的背景。
Now, the question of whether they've declined over time has been a question for a number of years.
现在，它们是否随着时间的推移而下降的问题多年来一直是一个问题。
There was a landmark paper in the early '90s by Carlsen and a group in Denmark that showed this temporal decline over the last 50 years from that time point.
卡尔森和丹麦的一个小组在 90 年代初发表了一篇具有里程碑意义的论文，显示了从该时间点开始的过去 50 年的时间下降。
And so what the investigators had done is looked over the literature for studies that reported semen quality around the world and noted that the quality in the earliest studies, like in the mid-20th century, were here, and then over time, they had sort of declined the more recent studies.
因此，研究人员所做的就是查阅文献，寻找报告世界各地精液质量的研究，并指出最早的研究（例如 20 世纪中叶）的质量就在这里，然后随着时间的推移，他们在最近的研究中有所下降。
Now, that study was very controversial.
现在，这项研究引起了很大争议。
There was questions about weighting from different studies, because as you can imagine, there's not a lot of early studies, so putting a lot more importance on those rather than some of the later ones.
关于不同研究的权重存在疑问，因为正如你可以想象的那样，早期研究并不多，所以更重视这些研究而不是后来的一些研究。
And so since then, there's been many other studies that have come out in time.
从那时起，还有许多其他研究及时出现。
And even today, it remains very controversial.
即使在今天，它仍然充满争议。
I think if I were to say that I believe there's a decline, some of my colleagues and friends would be very upset with me.
我想如果我说我相信经济正在下降，我的一些同事和朋友会对我感到非常不满。
If I say I don't believe it, some of my colleagues and friends would be very upset with me.
如果我说我不相信，我的一些同事和朋友会对我感到非常不满。
So I would say that my opinion really varies based on whose paper I've read.
所以我想说，我的观点确实根据我读过的论文而有所不同。
And there's some very convincing studies on each side of it.
各方面都有一些非常有说服力的研究。
Most recently, just in the last year or so, there was a meta-analysis of tens of thousands of men where they looked at, again, a host of these studies over the last number of decades, all around the globe.
最近，就在去年左右，对数万名男性进行了一项荟萃分析，他们再次审视了过去几十年来全球各地的大量研究。
So prior studies really just focused on the Western hemisphere or Western countries because there was more data from that.
所以之前的研究实际上只集中在西半球或西方国家，因为那里有更多的数据。
But more recently, we've gotten a lot of data from Africa, from Asian countries as well.
但最近，我们从非洲和亚洲国家获得了大量数据。
And those also support this decline.
这些也支持了这种下降。
So one of the counterarguments to why we're seeing that is just an evolution of techniques over time.
因此，对于我们为什么看到这种情况的反驳之一只是技术随着时间的推移而演变。
So that's one of the popular ...
所以这就是流行的一种...
questions about whether there's really a true decline.
关于是否真的出现真正下降的问题。
I think as you're alluding to why there would be a decline is also unknown, but you've labeled perfectly the most common hypothesis.
我认为您所提到的为什么会出现下降也是未知的，但您已经完美地标记了最常见的假设。
So whether it's some environmental exposures, right?
那么是否是一些环境暴露，对吧？
A lot of things have changed over the last 50 years, and I think chemical exposure is certainly one of those.
过去 50 年来，很多事情都发生了变化，我认为化学品接触肯定是其中之一。
And there have been some fairly convincing preclinical studies, mostly done in animals, that show that exposure to different chemicals, phthalates, or BPA, other things, may actually harm reproductive function for men and for women as well.
一些相当令人信服的临床前研究（主要是在动物身上进行）表明，接触不同的化学物质、邻苯二甲酸盐或 BPA 等实际上可能会损害男性和女性的生殖功能。
And so it may be that these chemicals that we're being exposed to as kids and adults, or even probably more sinisterly, when we're developing in utero.
因此，当我们在子宫内发育时，我们可能会在儿童和成人时期接触到这些化学物质，甚至可能更危险。
That may be the most harmful exposure.
这可能是最有害的暴露。
But there's also been an obesity epidemic as well.
但肥胖症也很流行。
And there's a strong link between a man's reproductive function and body weight.
男性的生殖功能和体重之间存在密切的联系。
And so that's also thought to play a role in some of this, too.
因此，这也被认为在其中发挥了一定作用。
So I think there are convincing studies, but the other, I guess, aspect to this is that there's variations in semen quality around the country and around the world.
所以我认为有令人信服的研究，但我想，另一个方面是全国和世界各地的精液质量存在差异。
There's geographic variation.
有地理差异。
And so that's also an unknown explanation.
所以这也是一个未知的解释。
There could be different genetic compositions of men, and so there's different reproductive potential in that source.
男性的基因组成可能不同，因此该来源的生殖潜力也不同。
There could be different environmental exposures, diet, exercise, lifestyle.
可能存在不同的环境暴露、饮食、运动、生活方式。
There's a famous study done a number of years ago where they looked at semen quality among fathers.
几年前进行了一项著名的研究，他们观察了父亲的精液质量。
So these are men that had achieved a pregnancy, and at the first prenatal visit, they had the fathers give a semen sample.
这些都是已经怀孕的男性，在第一次产前检查时，他们让父亲提供了精液样本。
And so this was done in four centers around the country.
因此，这是在全国四个中心进行的。
I think one in California, there was one in the Midwest, there was one in New York.
我认为加利福尼亚州有一个，中西部有一个，纽约也有一个。
So they basically found that semen quality was highest in the urban centers, and New York tended to be the highest numbers, where it was lower in the Midwest.
因此，他们基本上发现，城市中心的精液质量最高，而纽约往往是最高的，而中西部的精液质量较低。
And so the hypothesis was potentially because it was a more rural setting, maybe there was pesticide exposure, and that had led to these lower numbers.
因此，这个假设可能是因为那里是一个更农村的环境，可能存在农药暴露，这导致了这些数字较低。
But another equally plausible explanation may be that a different population and maybe that could explain these differences.
但另一个同样合理的解释可能是不同的人口，也许这可以解释这些差异。
So I think it's very important, and I think one of the lacking things in this is there's not really longitudinal data.
所以我认为这非常重要，而且我认为其中缺乏的事情之一是没有真正的纵向数据。
One of the greatest things would be if we just started tracking semen quality around the country, just like we do obesity, like NHANES, the CDC's survey of health in the US, if we added semen quality onto that.
最伟大的事情之一是，如果我们开始跟踪全国范围内的精液质量，就像我们对肥胖问题进行跟踪一样，就像美国疾病预防控制中心 (CDC) 的健康调查 NHANES 一样，如果我们将精液质量纳入其中。
That way you could really see how it varies around the country and compare like to like to see over time if there's really this progression.
这样你就可以真正看到全国各地的情况如何变化，并比较喜欢随着时间的推移看看是否真的有这种进展。
One of the only studies to do that in Denmark, they started around 2000 and tracked semen quality among volunteers that came in when they were conscripted for military service in Denmark.
他们在 2000 年左右开始进行这项研究，这是丹麦仅有的一项研究，跟踪了丹麦应征入伍的志愿者的精液质量。
They were offered the opportunity to participate in this study.
他们有机会参与这项研究。
And so some men did, and what they found is actually that semen quality was fairly uniform over about 20 years where they had data.
于是一些男性就这么做了，他们发现，在他们掌握的数据中，精液质量实际上在大约 20 年内相当一致。
But another very interesting part of that study is that only about a quarter of those men had normal semen quality.
但该研究的另一个非常有趣的部分是，这些男性中只有大约四分之一的精液质量正常。
So it's very concerning.
所以这是非常令人担忧的。
It was, I guess, reassuring that it wasn't further declining, but very concerning that only a quarter of Danish men had normal semen quality.
我想，这让人放心，它不会进一步下降，但非常令人担忧的是，只有四分之一的丹麦男性精液质量正常。
And they're one of the, I think, thought leaders in this field, just because a reproductive crisis there.
我认为他们是这个领域的思想领袖之一，只是因为那里存在生殖危机。
Andrew Huberman:
安德鲁·休伯曼：
You mentioned that some of this apparent decline in semen quality might be related to the fact that the tools to measure semen quality are getting better and better.
您提到精液质量的明显下降可能与测量精液质量的工具越来越好有关。
And that would make sense if, for instance, one is just looking at total volume, morphology, which means shape, I should have clarified that, how many forwardly motile sperm there are, and then also adding in a very sensitive measure such as DNA fragmentation.
举例来说，如果人们只关注总体积、形态（即形状），那么这就是有意义的，我应该澄清一下，有多少向前运动的精子，然后还添加了一项非常敏感的指标，例如 DNA 碎片。
Essentially, as the instruments get finer and finer, you discover more and more details, and if you are rating quality along a number of different dimensions, then it would make sense that those would tier out into different levels.
本质上，随着乐器变得越来越精细，您会发现越来越多的细节，如果您按照多个不同的维度对质量进行评级，那么将这些划分为不同的级别是有意义的。
So if one were to simply ask for couples who want to get pregnant, and assuming that egg quality is not the issue, what percentage of failures to achieve successful pregnancy are the consequence of deficient sperm, deficient in any way, and is that number increasing over time?
因此，如果只是询问想要怀孕的夫妇，并假设卵子质量不是问题，那么，由于精子缺陷（无论以何种方式）而导致成功怀孕的失败比例是多少？这个数字是否会随着时间的推移而增加？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So I think that's really key.
所以我认为这非常关键。
I think when couples think about fertility, usually it's thought of as a female problem.
我认为当夫妻考虑生育问题时，通常会被认为是女性问题。
And I think there's just historic reasons for that.
我认为这只是历史原因。
If you look at data in the US, when couples do seek care for fertility, the man is bypassed probably a third of the time, even though when you look at the reasons for infertility, the man contributes probably half of the time to infertility.
如果你看一下美国的数据，当夫妇确实寻求生育护理时，可能有三分之一的时间是男性被忽视，尽管当你查看不孕不育的原因时，可能有一半的时间是男性造成的。
So I think there's a-
所以我认为有一个——
Andrew Huberman:
安德鲁·休伯曼：
Half?
一半？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Half.
一半。
Yeah.
是的。
So I think there's a huge need just to understand and evaluate the man.
所以我认为非常需要了解和评估这个人。
And one of the reasons for this, I think, is that one of the main treatments for infertility in the US is IVF, which is very powerful.
我认为原因之一是美国治疗不孕不育的主要方法之一是体外受精，这是非常有效的。
I think one of the greatest marvels of medicine in probably the last quarter-century is our ability to mix a sperm and egg in a dish and create a life.
我认为过去四分之一个世纪最伟大的医学奇迹之一就是我们能够将精子和卵子在培养皿中混合并创造出生命。
It's really remarkable.
这真的很了不起。
But because it now takes just a single sperm through something called intracytoplasmic sperm injection, where you can inject one sperm into an egg, the bar has gone down dramatically.
但由于现在只需要一个精子通过胞浆内单精子注射（即可以将一个精子注射到卵子中），因此门槛已经大幅下降。
For couples just trying without any assistance, probably need 20 to 40 million moving sperm.
对于在没有任何帮助的情况下尝试的夫妇来说，可能需要 20 到 4000 万个移动精子。
But now with these remarkable techniques, you just need one sperm.
但现在有了这些非凡的技术，你只需要一个精子。
And so because of that, I think a lot of our innovation and research on male fertility has probably gone to the wayside just because clinically, we just need a few dozen sperm for most couples.
因此，我认为我们关于男性生育能力的许多创新和研究可能已经半途而废，因为在临床上，我们对大多数夫妇来说只需要几十个精子。
Andrew Huberman:
安德鲁·休伯曼：
What about testosterone levels?
睾酮水平怎么样？
Are those also declining?
这些也在下降吗？
We hear this, and when I look at the literature, I can find evidence for that.
我们听到了这个，当我查看文献时，我可以找到这方面的证据。
But the question is also whether or not the amount of decline in testosterone levels is significant in a way that impacts, let's say, fertility, but also vitality in other ways, energy, mood, sexual health, et cetera.
但问题还在于，睾丸激素水平的下降是否会显着影响生育能力，还会影响其他方面的活力、能量、情绪、性健康等。
What's the story with testosterone levels?
睾丸激素水平有什么故事？
Are they indeed declining on average across the male population in the US and elsewhere?
美国和其他地方的男性人口平均数确实在下降吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think there is pretty convincing evidence that that is happening.
我认为有相当令人信服的证据表明这种情况正在发生。
And I think the reason for that, again, is probably not certain, but there have been some pretty nicely designed cohort studies where they recruited men in the 2000s, the '90s, the '80s.
我认为其中的原因可能还不确定，但有一些设计非常好的队列研究，他们招募了 2000 年代、90 年代、80 年代的男性。
And you can see that depending on when these men are recruited, just matching age for age, these testosterone levels tend to be lower.
你可以看到，根据这些男性被招募的时间，只要年龄与年龄相匹配，这些睾酮水平往往会较低。
And then NHANES, which is, again, this sort of longitudinal study run by the CDC, that has also shown, looking at testosterone levels over decades, that testosterone levels have declined over time.
然后是 NHANES，这也是由 CDC 进行的此类纵向研究，该研究也表明，通过观察数十年来的睾酮水平，睾酮水平随着时间的推移而下降。
So chemical exposure is one possible explanation, again, either in adult or adolescent life or in utero.
因此，化学物质暴露也是一种可能的解释，无论是在成人、青少年生活还是在子宫内。
But obesity, I think, is also a convincing explanation.
但我认为肥胖也是一个令人信服的解释。
As we're more sedentary, we get bigger.
当我们久坐的时候，我们就会变得更大。
That's one of the places that testosterone can decline.
这是睾丸激素可能下降的地方之一。
I think there's different explanations for that.
我认为对此有不同的解释。
As testosterone's produced, it's aromatized in peripheral tissue, in fatty tissue.
当睾酮产生时，它会在周围组织和脂肪组织中芳香化。
Fat has a lot of this aromatase, so that converts testosterone to estrogen.
脂肪含有大量这种芳香酶，可以将睾酮转化为雌激素。
So it necessarily lowers the testosterone level that's circulating in our body.
因此，它必然会降低我们体内循环的睾酮水平。
Also, just insulating the testicles.
另外，只是隔离睾丸。
Our thighs get bigger.
我们的大腿变大了。
Insulating the testes can also sometimes lower the efficiency of production a little bit, too.
隔离睾丸有时也会稍微降低生产效率。
Andrew Huberman:
安德鲁·休伯曼：
Because of heat effects?
因为热效应？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Because of heat effects.
因为热效应。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Yeah.
是的。
I was going to ask about this later, but I'll ask about it now since we're talking about heat effects on sperm and testosterone.
我本来打算稍后再问这个问题，但现在我会问这个问题，因为我们正在讨论热对精子和睾酮的影响。
The heat, of course, being not good for sperm health and testosterone.
当然，高温对精子健康和睾丸激素不利。
Which is, I've read a meta-analysis, I don't know how high quality it is, but that explained that there is some evidence for either heat effects or possibly non-heat related effects of cell phone, smartphone in the pocket-
也就是说，我读过一项荟萃分析，我不知道它的质量有多高，但这解释了有一些证据表明手机、口袋里的智能手机存在热效应或可能与热无关的效应——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
impairing sperm health, maybe even testosterone levels.
损害精子健康，甚至可能损害睾酮水平。
Now you hear this more often in kind of biohacky circles, which I'm not a fan of the word biohacking.
现在你在生物黑客圈子里更经常听到这个词，我不喜欢生物黑客这个词。
It's not clear what it means, but it sounds like it means something about taking a shortcut, using one thing for a purpose it wasn't intended.
目前尚不清楚这是什么意思，但听起来似乎意味着走捷径，将一件事用于非预期的目的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
But it also makes sense to me that a smartphone could generate some heat, some radiation that might impair testicular function and therefore impair sperm quality and/or testosterone levels.
但对我来说，智能手机可能会产生一些热量和辐射，这些热量和辐射可能会损害睾丸功能，从而损害精子质量和/或睾酮水平，这对我来说也是有道理的。
But is there any real solid data that carrying your cell phone in your pocket, let's assume on, that the cell phone is on-
但是，是否有任何真实可靠的数据可以将您的手机放在口袋里，让我们假设手机处于开机状态-
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
is bad for sperm health or testosterone levels?
对精子健康或睾酮水平有害吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So I think there's not convincing evidence that it's going to help testosterone levels.
所以我认为没有令人信服的证据表明它会帮助睾丸激素水平。
I think that-
我认为——
Andrew Huberman:
安德鲁·休伯曼：
It's going to hurt testosterone levels.
它会损害睾丸激素水平。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
It's not going to hurt.
它不会受伤。
Yeah.
是的。
So I should make clear that I think that in terms of production and heat effects, sperm production is much more sensitive than testosterone production.
所以我应该明确指出，我认为就生产和热效应而言，精子的产生比睾酮的产生更敏感。
But there have been some studies looking at cell phone exposure because, again, you're getting this, whether it's heat, whether it's the radio frequency waves coming in, I think you could posit different explanations of why that may be harmful.
但已经有一些研究关注手机暴露，因为，你再次得到这个，无论是热量，还是射频波进入，我认为你可以对为什么这可能有害提出不同的解释。
So there have been some studies that looked early on men that used cell phones more or less, they had lower semen quality if they used it more.
因此，有一些研究早期对或多或少使用手机的男性进行了研究，如果他们使用手机的次数较多，他们的精液质量就会降低。
But you can also imagine there's huge differences in men that do and do not use cell phones.
但你也可以想象，使用手机和不使用手机的男性之间存在巨大差异。
So it's a hard experiment to design.
所以这是一个很难设计的实验。
But there have been some studies doing this in vitro, so in the laboratory.
但已经有一些研究在体外（即实验室）中进行了这项研究。
So taking sperm in a cup, basically, and putting a cell phone next to it or not next to it to try and see if that played a role.
因此，基本上将精子放入一个杯子中，然后将手机放在或不放在它旁边，看看这是否起作用。
There have been studies done where they normalized the heat.
已经进行了一些研究，他们使热量正常化。
They put it on a special stage so that it's not heat necessarily, but maybe it's RF exposure.
他们将其放在一个特殊的舞台上，因此不一定是热量，但可能是射频暴露。
So those studies, I think, don't show a clinically meaningful change.
因此，我认为这些研究并没有显示出具有临床意义的变化。
But there have been some studies that say that maybe DNA fragmentation of sperm can go up a little bit if there's close proximity to a cell phone.
但也有一些研究表明，如果距离手机太近，精子的 DNA 碎片可能会稍微增加一些。
So I think when patients ask me that, which is a common question I get in the clinic, obviously patients are coming in, they want to do whatever they can to try and improve their chances.
因此，我认为当患者问我这个问题时（这是我在诊所经常遇到的问题），显然患者正在进来，他们想尽一切努力来尝试提高机会。
So I think generally, I think the data's not convincing.
所以我认为总的来说，我认为数据没有说服力。
But if it's easy enough, certainly to be aware of it.
但如果它足够简单，当然要意识到这一点。
I think putting a laptop on a desk rather than in your lap, I think for heat exposure is probably the biggest thing that we want to minimize.
我认为将笔记本电脑放在桌子上而不是放在腿上，我认为对于热量暴露可能是我们想要最小化的最大事情。
Andrew Huberman:
安德鲁·休伯曼：
About a year and a half ago, I did an episode about testosterone and estrogen, where it's manufactured in the male and female body, et cetera.
大约一年半前，我制作了一集关于睾酮和雌激素的剧集，睾酮和雌激素是在男性和女性体内产生的，等等。
And I found a very interesting graph in a textbook on behavioral endocrinology by a guy named Randy Nelson, who I happen to know through the field of behavioral endocrinology as it's typically studied in animals.
我在行为内分泌学教科书中发现了一个非常有趣的图表，作者是兰迪·尼尔森（Randy Nelson），我碰巧在行为内分泌学领域认识了他，因为行为内分泌学通常在动物身上进行研究。
So most of that book centers on animal studies, but there's a fraction of the studies that center on human data.
因此，这本书的大部分内容都集中在动物研究上，但也有一小部分研究集中在人类数据上。
And there was a very interesting graph that showed testosterone levels as a function of age in males.
有一个非常有趣的图表显示男性睾酮水平与年龄的函数关系。
And as one might expect, testosterone levels were on average much higher in late teens, early 20s, 30s, and there was a progressive decline.
正如人们所预料的那样，青少年后期、20 岁出头、30 岁的时候，睾丸激素水平平均要高得多，并且会逐渐下降。
But what was remarkable to me about that graph is that even when exploring the scatter plots, because they showed individual points, they didn't just show the averages of testosterone levels in men in their 50s, 60s, 70s, 80s, even 90s.
但该图对我来说值得注意的是，即使在探索散点图时，因为它们显示了单独的点，它们也不仅仅显示了 50 多岁、60 多岁、70 多岁、80 多岁甚至 90 多岁男性的睾酮水平平均值。
There were these outliers, these guys who had testosterone levels that were on par with ...
有这些异常值，这些人的睾丸激素水平与……相当。
testosterone levels of men in their 30s, but these guys were in their 50s, 60s, 70s, 80s, even 90s.
30多岁男性的睾丸激素水平很高，但这些人的年龄是50多岁、60多岁、70多岁、80多岁，甚至90多岁。
So do you observe this clinically?
那么您在临床上观察到这一点吗？
Do you observe that men are coming in who are older than 40 and have testosterone levels, and presumably free testosterone levels as well, that are still very high?
您是否观察到进来的男性年龄超过 40 岁，睾酮水平（可能还有游离睾酮水平）仍然很高？
The reason I ask this is I think we've all been told, and we presume that testosterone levels decline with age, and one would expect some outliers.
我问这个问题的原因是我想我们都被告知，我们假设睾酮水平随着年龄的增长而下降，并且人们会期望一些异常值。
And of course, we don't know whether or not those guys in their 90s who have the testosterone levels that match the averages of men in their 30s didn't have even greater testosterone levels in their 30s.
当然，我们不知道那些睾酮水平与 30 多岁男性平均水平相当的 90 多岁男性是否在 30 多岁时睾酮水平更高。
But given that they were ceilinged out around 900 nanograms per deciliter toward the high-end normal, depending on the scale, already at age 90, it's hard to imagine that earlier they were walking around with 2,000 nanogram per deciliter testosterone.
但考虑到他们在 90 岁时就已经达到了高端正常水平的上限，约为每分升 900 纳克，很难想象他们早些时候的睾酮水平是每分升 2,000 纳克。
So do you see this?
那么你看到这个了吗？
Is there just a lot of natural variation in testosterone levels of men who walk into the clinic at any age?
任何年龄走进诊所的男性睾酮水平是否存在很大的自然变化？
And of course, what is special about these individuals that are maintaining high normal testosterone levels into their later years?
当然，这些在晚年仍保持较高正常睾酮水平的人有何特别之处？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, that's a great question.
是的，这是一个很好的问题。
I think this is such a common question anytime we talk about testosterone.
我认为每当我们谈论睾酮时，这是一个常见的问题。
I think anytime we talk about most clinical tests that we do, what is average, what is normal?
我想任何时候我们谈论我们所做的大多数临床测试时，什么是平均值，什么是正常的？
So we do see great variation.
所以我们确实看到了很大的变化。
I think, just like you're saying, I usually let everybody know that usually testosterone peaks early 20s, and it tends to go down probably 1% a year forever.
我想，就像你说的，我通常会让每个人都知道，睾丸激素通常在 20 岁出头达到峰值，并且往往每年永远下降 1%。
But there are people that have very high levels, just mirroring that graph that you describe.
但有些人的水平非常高，只是反映了你所描述的图表。
I certainly have patients, we screen for testosterone levels when patients come in with complaints where we're worried about that, low energy level, low libido, some of the symptoms of low testosterone, sexual dysfunction.
我当然有病人，当病人进来抱怨我们担心的时候，我们会筛查睾酮水平，低能量水平，低性欲，低睾酮的一些症状，性功能障碍。
And to my surprise, sometimes these men, I've seen 80-year-olds that certainly have the highest testosterone level I'll see for six months.
令我惊讶的是，有时我见过 80 岁的男人，他们的睾丸激素水平肯定是我六个月来所见过的最高水平。
Why that is, I think is not certain.
为什么会这样，我认为还不确定。
Maybe it has to do with-- I would think with everything, there's probably a bell-shaped curve and everybody's a little bit different.
也许这与——我认为一切都可能有一个钟形曲线，每个人都有点不同。
But androgen sensitivity, sensitivity of the receptor, they make it more efficiently.
但雄激素敏感性、受体敏感性，它们使其更有效。
But I have not really noticed, again, because at least in clinical practice when patients come in, they come in with a complaint.
但我并没有真正注意到，因为至少在临床实践中，当病人进来时，他们是带着抱怨而来的。
And so even men with very high levels, they may have some of the same dysfunction as men with low levels.
因此，即使男性的水平非常高，他们也可能有一些与水平低的男性相同的功能障碍。
So I think with low levels, you can try and treat that, and that may be the solution.
所以我认为在水平较低的情况下，你可以尝试治疗，这可能是解决方案。
But for men with what we would consider high levels, there may be other issues going on.
但对于我们认为水平较高的男性来说，可能还会出现其他问题。
Andrew Huberman:
安德鲁·休伯曼：
Let me frame the question I was going to ask a little bit differently.
让我稍微改变一下我要问的问题。
When someone comes into your clinic and you measure their testosterone levels, as you mentioned, they're likely coming in because they have some issue, prostate issue, sexual function issue, et cetera.
正如您提到的，当有人来到您的诊所并且您测量他们的睾酮水平时，他们很可能会因为有一些问题而进来，例如前列腺问题、性功能问题等。
But you do get a read on their crude morphology of their body, right?
但你确实了解了他们身体的原始形态，对吧？
So you could visibly determine whether or not they're likely to be obese or not, regardless of age.
因此，无论年龄如何，您都可以明显地确定他们是否可能肥胖。
So earlier you mentioned obesity as a risk factor for lowering testosterone and sperm quality.
之前您提到肥胖是降低睾酮和精子质量的危险因素。
You mentioned that fat aromatizes testosterone into estrogen, so that's at least one mechanism by which that could happen.
你提到脂肪将睾酮芳香化为雌激素，所以这至少是发生这种情况的一种机制。
But if you were to just step back and say, okay, if somebody who walks into my clinic tends to be, let's say, healthier looking, not obese.
但如果你退一步说，好吧，如果走进我诊所的人往往看起来更健康，而不是肥胖。
Let's just put the cutoff at what you would presume is obese.
让我们将临界值设置为您认为的肥胖程度。
Is there a higher probability that their testosterone levels are going to be within normal range?
他们的睾酮水平处于正常范围内的可能性是否更高？
Conversely, when somebody walks in and they're obese, do you fully expect their testosterone levels to be subnormal?
相反，当有人走进来发现他们肥胖时，你是否完全认为他们的睾丸激素水平低于正常水平？
Or are you sometimes seeing obese people walking in with high testosterone?
或者你有时会看到肥胖的人带着高睾丸激素走进来吗？
And the reason I'm asking this is not to create confusion, is that I think that everybody out there who's thinking about sperm quality and testosterone levels and this apparent decline, trying to figure out, okay, what can we do in order to maintain the health metrics that are going to, of course, increase fertility, but for those that don't want to have kids or who already have kids, are going to at least maintain or improve vitality.
我问这个问题并不是为了制造混乱，我认为每个人都在考虑精子质量和睾酮水平以及这种明显的下降，试图弄清楚，好吧，我们能做些什么来维持健康指标，当然，这会提高生育率，但对于那些不想生孩子或已经生孩子的人来说，至少会保持或提高活力。
Is obesity really the thing to avoid?
肥胖真的是要避免的事情吗？
So is there a, not one for one, but is there a tight correlation between obesity and testosterone levels?
那么，肥胖和睾酮水平之间是否存在某种（不是一一对应的）紧密相关性呢？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I would say that you cannot predict.
我想说你无法预测。
I think that would be the take home.
我想这就是带回家的。
And so I think that more information is always better.
所以我认为信息越多越好。
When I see patients in clinic, some patients are walking around with everything is totally normal.
当我在诊所看病人时，有些病人走来走去，一切都很正常。
They're very healthy.
他们非常健康。
All the numbers come in at the normal range.
所有数字都在正常范围内。
But sometimes when men look totally normal, they talked about taking care of their life.
但有时，当男人看起来完全正常时，他们就会谈论照顾自己的生活。
They exercise five, seven days a week.
他们每周锻炼五、七天。
Their testosterone levels can be very low.
他们的睾酮水平可能非常低。
So even despite having what we would consider should really give them symptoms, they're able to compensate.
因此，即使我们认为他们确实出现了症状，他们也能够补偿。
Maybe they've lived their whole life in that they don't know what normal is.
也许他们一生都生活在不知道什么是正常的状态中。
Now we get them to normal levels, a lot of times they feel better, and again, because they had no idea how they should feel.
现在我们让他们恢复到正常水平，很多时候他们感觉好多了，因为他们不知道自己应该有什么感觉。
But I think that's just important that everybody should be screened.
但我认为每个人都应该接受筛查很重要。
I think that testosterone, semen quality, they've been shown to even be barometers of health.
我认为睾丸激素、精液质量甚至被证明是健康的晴雨表。
So, men with lower testosterone levels have higher risk of heart disease, diabetes, mortality.
因此，睾酮水平较低的男性患心脏病、糖尿病和死亡的风险较高。
The same studies exist for semen quality as well.
对于精液质量也存在相同的研究。
And again, they may have a similar relationship and explanation why that may be.
再说一次，他们可能有类似的关系并解释为什么会这样。
But I think it's hard to just predict based on appearance what testosterone will be, what semen quality will be, what testicular function will be, without actually getting some objective data.
但我认为，在没有实际获得一些客观数据的情况下，很难仅根据外观来预测睾酮水平、精液质量、睾丸功能。
And actually, if you look at the trend of semen quality decline over time, getting back to some of those earlier points you were making, if you were to overlay that on the known association between obesity, its effects on semen quality, that actually doesn't explain the whole decline because the purported decline in semen quality is about 50%.
事实上，如果你观察精液质量随着时间的推移而下降的趋势，回到你之前提出的一些观点，如果你将其与已知的肥胖之间的关联及其对精液质量的影响相叠加，这实际上并不能解释整个下降的原因，因为据称精液质量的下降约为 50%。
But if you were to say, well, what would we expect if we look at-- Because we are able to track exactly how much fatter we are now Than we used to be.
但如果你说，好吧，如果我们观察一下，我们会期望什么——因为我们能够准确地追踪到我们现在比以前胖了多少。
That actually only explains about a 10% decline.
这实际上只能解释大约 10% 的下降。
So I think there is, to your point, something more, and it is not something that you can just identify by eye.
所以我认为，就你的观点而言，还有更多的东西，而且它不是你可以通过眼睛识别的东西。
Andrew Huberman:
安德鲁·休伯曼：
What are the dos and don'ts as it relates to, I don't want to use the word optimizing, it's gotten me into trouble before because the word optimize or optimal suggests that there's a perfect number that one should all attain if possible, but in reality, optimal is a day-to-day thing at least.
与它相关的该做和不该做的事情是什么，我不想使用“优化”这个词，它之前给我带来了麻烦，因为“优化”或“最佳”这个词表明，如果可能的话，每个人都应该达到一个完美的数字，但实际上，“最佳”至少是一件日常的事情。
But what should people avoid in order to get their sperm quality as high as possible, their testosterone level?
但是，为了获得尽可能高的精子质量和睾酮水平，人们应该避免什么？
Again, here I will have to be careful.
再次强调，在这里我必须要小心。
I don't want to say as high as possible because some people might not want excessive androgen.
我不想说尽可能高，因为有些人可能不想要过多的雄激素。
But at the high end of normal, perhaps would be the ideal for many people.
但在正常情况下，也许对许多人来说是理想的。
What should people do?
人们应该做什么？
What should they avoid?
他们应该避免什么？
And here I'm setting aside any prescription clinical treatments such as testosterone injections or things like human chorionic gonadotropin, things that we can talk about a little bit later.
在这里，我搁置任何处方临床治疗，例如睾酮注射或人绒毛膜促性腺激素之类的东西，这些我们可以稍后再讨论。
But what should every male be doing in order to optimize these health parameters?
但是每个男性应该做什么才能优化这些健康参数呢？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So I think that there are some risk factors that we do like.
所以我认为有一些我们确实喜欢的风险因素。
We'll start with semen quality.
我们将从精液质量开始。
So we talked about heat.
所以我们谈论了热度。
I think that's a big one.
我认为这是一件大事。
So like hot tubs, saunas, try and avoid those.
因此，尽量避免使用热水浴缸、桑拿浴室。
Some light data on seat warmers.
关于座椅加热器的一些简单数据。
Any time we get this external heat source to the scrotum, the testicles are outside the body because they need to be a little cooler, so anything that warms them up can certainly be a problem.
每当我们将这种外部热源引入阴囊时，睾丸都处于体外，因为它们需要稍微凉爽一点，所以任何使它们变暖的东西肯定会成为问题。
Andrew Huberman:
安德鲁·休伯曼：
Could I just briefly interrupt there to ask, we've done episodes on sauna and some of the health benefits of sauna.
我可以简单地打断一下，我们已经做了一些关于桑拿和桑拿的一些健康益处的节目。
Is it sufficient for somebody to bring in a cold pack to the sauna and put that up in their groin?
有人带一个冰袋去桑拿房并将其放在腹股沟里就足够了吗？
I actually have suggested that.
我实际上已经建议过。
That's actually what I do when I go into the sauna, and I have suggested this on podcasts, not just for people who are trying to conceive because it seems like heat, as you mentioned, is bad for sperm, not quite as bad for testosterone levels.
这实际上就是我去桑拿房时所做的事情，我在播客上建议了这一点，不仅仅是针对那些试图怀孕的人，因为正如你提到的，热量似乎对精子有害，但对睾丸激素水平却没有那么糟糕。
But is it also true that heating the testicle too much is generally bad for endocrine function in males, and therefore if one is going to go into a hot sauna for 20 minutes or more to essentially cool the scrotal area?
但是，过度加热睾丸通常对男性的内分泌功能不利，因此是否要进入热桑拿房 20 分钟或更长时间才能从根本上冷却阴囊区域？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, I think the spermatogenesis or sperm production is certainly a lot more sensitive.
是的，我认为精子发生或精子产生肯定要敏感得多。
Whether you can sort of thwart the effects of external heat with a cooling pack, I think it makes sense.
无论你是否可以用冷却包来阻止外部热量的影响，我认为这是有道理的。
There are studies that have looked at different ways to cool the scrotum and have compared semen quality before and after, and there's some data that may help.
有研究研究了冷却阴囊的不同方法，并比较了前后的精液质量，并且有一些数据可能会有所帮助。
It just depends how long you're going to spend in the sauna and how cold that pack is going to remain.
这仅取决于您要在桑拿房中度过多长时间以及该包将保持多冷。
Andrew Huberman:
安德鲁·休伯曼：
So ice pack and in the sauna for 20 to 45 minutes.
所以用冰袋敷在桑拿房里 20 到 45 分钟。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
And is the ice pack still cold afterwards?
那么冰袋之后还冷吗？
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
They actually sell, and by the way, I have no relationship to any of these companies, but they actually sell cold packs that are designed to be worn in your shorts.
他们实际上销售，顺便说一句，我与这些公司中的任何一家都没有关系，但他们实际上销售旨在穿在短裤中的冷袋。
So if you go to a-- I'll go to a Russian banya every once in a while now.
所以，如果你去——我现在每隔一段时间就会去一次俄罗斯浴场。
I guess I'm outing myself.
我想我自己也出去了。
Yes, I have a cold pack in my shorts when I go to the Russian banya.
是的，我去俄罗斯浴场的时候，我的短裤里有一个冰袋。
But they have a sort of an insulation so that the very cold surface is cold enough, but it's not right up in contact with the scrotal skin because that could get-- I want to make a bad joke and say it could get sticky, that situation.
但它们有一种绝缘层，因此非常冷的表面足够冷，但它不能直接与阴囊皮肤接触，因为这可能会——我想开个糟糕的玩笑，说它可能会变得粘稠，这种情况。
You don't want it being so cold that it actually would stick to the skin, and then it could potentially damage the skin when you try and remove the cold pack.
您不希望它太冷，以至于它实际上会粘在皮肤上，然后当您尝试去除冷敷袋时可能会损坏皮肤。
So it has a thin insulating layer.
所以它有一层很薄的绝缘层。
And yeah, that's essentially what it is.
是的，本质上就是这样。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Frostbite to the scrotum is not theoretical.
阴囊冻伤并不是理论上的。
It could certainly happen.
这肯定会发生。
So you do want to be careful.
所以你一定要小心。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So in theory, that should be adequate to decrease the risk of that particular effect.
因此从理论上讲，这应该足以降低该特定效应的风险。
I keep coming back to health, how important that is to maintain adequate sperm production because I think these two are very linked.
我不断恢复健康，保持足够的精子产生是多么重要，因为我认为这两者是密切相关的。
There have been studies that show that men with more comorbid conditions, so obesity, hypertension, hyperlipidemia, as these sort of stack up, we see a decline in testicular function, so lower testosterone levels and lower sperm quality.
有研究表明，患有更多合并症的男性，例如肥胖、高血压、高脂血症，当这些疾病叠加起来时，我们会看到睾丸功能下降，因此睾酮水平较低，精子质量也较低。
So I think taking ownership of your health, I think is important as well.
所以我认为掌控自己的健康也很重要。
A lot of times, fertility tends to be one of the first touch points that some men have with healthcare, because generally what brings men to the doctor?
很多时候，生育往往是一些男性接触医疗保健的首要接触点之一，因为通常是什么促使男性去看医生？
It's usually pain or kind of a problem.
这通常是疼痛或某种问题。
So, if men are in their 20s and 30s getting ready to start a family, or 40s in some cases, sometimes they haven't seen a primary care doctor.
因此，如果男性在 20 多岁和 30 多岁准备组建家庭，或者在某些情况下是 40 多岁，有时他们还没有看过初级保健医生。
So some of these things and some of this relationship has not been established yet.
所以有些东西和有些这个关系还没有建立起来。
So I think thinking about ways to start that, I think would be important, too.
因此，我认为思考如何开始这一点也很重要。
And then I know you don't want to talk about testosterone, but testosterone is actually a fairly common problem that we see in fertility clinics.
然后我知道你不想谈论睾酮，但睾酮实际上是我们在生育诊所看到的一个相当常见的问题。
I would say that estimates say maybe about one in 20 infertile men are that way because of testosterone.
我想说的是，据估计，大约二十分之一的不育男性会因为睾丸激素而出现这种情况。
So I think when people get testosterone from different places, and hopefully, whatever provider you're getting it from tells you that one of the side effects of this is lower sperm production.
所以我认为，当人们从不同的地方获得睾酮时，希望无论您从哪里获得睾酮，任何提供者都会告诉您，其副作用之一是精子产量降低。
It's actually been tested as a contraceptive, and with some other agents, it can actually be fairly effective.
它实际上已经作为避孕药进行了测试，并且与其他一些药物一起使用，它实际上相当有效。
So we just want to make sure that if men are starting testosterone, they're doing it for the right reasons and they're doing it safely.
所以我们只是想确保，如果男性开始注射睾酮，他们是出于正确的原因并且是安全的。
I think-
我认为——
Andrew Huberman:
安德鲁·休伯曼：
You're talking about testosterone replacement therapy.
你说的是睾酮替代疗法。
Although, as we were talking about before we started recording, I am really on a push now to rename what people call TRT, testosterone replacement therapy, because indeed, some people have low testosterone and need it replaced-
尽管，正如我们在开始录制之前讨论的那样，我现在确实极力推动将人们所说的 TRT 重新命名为睾酮替代疗法，因为事实上，有些人的睾酮水平较低，需要更换——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
the R in TRT.
TRT 中的 R。
But I think what you're referring to, if I'm not mistaken, is that there are probably millions-
但我认为你指的是，如果我没记错的话，可能有数百万——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
of young men and older men taking exogenous testosterone, injections, creams, pills, pellets, any number, nasal sprays now.
的年轻男性和老年男性现在正在服用外源性睾酮、注射剂、乳膏、药丸、丸剂、任何数量的鼻喷雾剂。
Any number of different routes of delivery of exogenous testosterone, and that- ...
任何数量的不同的外源睾酮递送途径，并且-...
dramatically reduces one's endogenous testosterone production and dramatically reduces one's sperm count, and maybe even quality.
显着降低一个人的内源性睾酮产生，并显着降低一个人的精子数量，甚至质量。
We'll maybe talk about this a little bit later.
我们也许稍后会讨论这个问题。
I've been told that it can perhaps introduce a DNA fragmentation within the remaining viable sperm as well.
有人告诉我，它也许还会在剩余的存活精子中引入 DNA 碎片。
So do I have that correct?
那么我说的对吗？
You're saying that you see 1 in 20 men have issues with fertility because they are taking testosterone.
您是说，您看到二十分之一的男性因服用睾酮而出现生育问题。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
So their testosterone levels presumably are going to be high end normal or more, but they are doing presumably not testosterone replacement therapy, but they're doing what I call testosterone augmentation therapy, meaning they were somewhere in the 300 to 900 nanograms per deciliter range, but decided to start taking testosterone anyway, and then their sperm count essentially diminishes to nil or close to it?
因此，他们的睾酮水平可能会达到正常水平或更高，但他们可能不会进行睾酮替代疗法，而是进行我所说的睾酮增强疗法，这意味着他们的睾酮水平在每分升 300 到 900 纳克范围内，但无论如何决定开始服用睾酮，然后他们的精子数量基本上减少到零或接近零？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
In some cases, yeah.
在某些情况下，是的。
So, I think there's various reasons that you would take testosterone.
所以，我认为您服用睾酮的原因有多种。
I think some people have been treated years ago, and so they do need to replace testosterone, but some people do it for augmentation.
我认为有些人几年前就已经接受过治疗，所以他们确实需要替代睾酮，但有些人这样做是为了增强睾酮水平。
I just usually say testosterone therapy just so it covers-
我通常只是说睾酮疗法，所以它涵盖了-
Andrew Huberman:
安德鲁·休伯曼：
Oh, you kill the R.
哦，你杀了R。
I like that.
我喜欢这样。
That's better than the T-A-T, which doesn't sound very good.
这比 T-A-T 好，后者听起来不太好。
Okay.
好的。
Just testosterone therapy.
只是睾酮疗法。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
But if you had, for example, if we take 100 of my infertile patients that come in to see me in clinic, at least five of those men will be infertile because they're on testosterone therapy.
但是，举例来说，如果我们带 100 名不孕患者来诊所就诊，那么其中至少有 5 名患者会不孕，因为他们正在接受睾酮治疗。
And some of them do have that suspicion.
他们中的一些人确实有这种怀疑。
They say, "I'm going to level with you.
他们说：“我要跟你说实话。
This is why my levels are probably low." But a lot of men were not told that when they started therapy.
这就是为什么我的水平可能很低。”但很多男性在开始治疗时并没有被告知这一点。
So I think certainly for reproductive-age men, that's a very important conversation to have.
所以我认为对于育龄男性来说，这是一次非常重要的对话。
Because there can be some other ways that we maintain sperm production.
因为我们可以通过其他一些方法来维持精子的产生。
I think sperm cryopreservation is a good option for these men as well.
我认为精子冷冻保存对于这些男性来说也是一个不错的选择。
Or there may be other therapies they can think about just because of reproductive toxicity.
或者仅仅因为生殖毒性，他们可能可以考虑其他疗法。
Andrew Huberman:
安德鲁·休伯曼：
What about hCG, human chorionic gonadotropin?
hCG（人绒毛膜促性腺激素）怎么样？
I hear about a lot of people who go on testosterone therapy who take hCG every other day or so.
我听说很多接受睾酮治疗的人每隔一天左右服用一次 hCG。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Typically, the dosages that I hear about, because people write to me about this stuff all the time, really, it's one of the most commonly asked questions.
通常，我听到的剂量是因为人们一直写信给我谈论这些东西，实际上，这是最常见的问题之一。
I get many questions about many topics, but I would say a full 10 to 20% of them are about penises or testosterone.
我收到了很多关于很多话题的问题，但我想说，其中 10% 到 20% 的问题都与阴茎或睾丸激素有关。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, this is perfect, then.
嗯，那么这就完美了。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Exactly.
确切地。
So a number of those guys who are taking testosterone will be prescribed hCG to stimulate sperm production, endogenous sperm production to maintain healthy sperm, presumably because they either want to conceive or are intending to conceive in the future.
因此，许多服用睾酮的男性会服用 hCG 来刺激精子生成、内源性精子生成以维持精子健康，大概是因为他们想要怀孕或打算将来怀孕。
Is that the best line of treatment for maintaining fertility while people are taking testosterone therapy?
当人们接受睾酮治疗时，这是保持生育能力的最佳治疗方法吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
That's one of the therapies that we use, and I think it can work well.
这是我们使用的疗法之一，我认为它效果很好。
Just a low dose.
只需低剂量即可。
Usually, again, for those that know, 500 to 1,000 units every other day is usually adequate.
通常，对于那些知道的人来说，每隔一天 500 到 1,000 单位通常就足够了。
Andrew Huberman:
安德鲁·休伯曼：
So if somebody is not taking testosterone exogenously, they've gotten their body fat level down to a point where they're not considered obese, so they're hopefully doing some cardiovascular exercise each week, maybe doing some sport or some resistance training too, with the intention of maintaining all around good health to stave off cerebrovascular, cardiovascular issues.
因此，如果有人不服用外源性睾酮，他们的体脂水平就会降低到不被认为肥胖的程度，所以他们希望每周做一些心血管运动，也许也做一些运动或一些阻力训练，目的是保持身体健康，避免脑血管、心血管问题。
What are some of the other don'ts?
还有哪些其他禁忌？
I'm going to assume that smoking cigarettes or vaping cigarettes is bad.
我认为吸烟或吸电子烟是不好的。
Are there any studies that have looked specifically at vaping and sperm quality or testosterone levels?
是否有专门针对电子烟和精子质量或睾酮水平的研究？
And is there any evidence that smoking cigarettes is good for testosterone levels or sperm production?
是否有任何证据表明吸烟有益于睾丸激素水平或精子生成？
Because I'm guessing the answer is no. I feel like nowadays we just say, "Don't smoke." But the data are the data.
因为我猜答案是否定的。我觉得现在我们只是说“不要吸烟”。但数据就是数据。
Who knows?
谁知道？
Maybe nicotine can help sperm.
也许尼古丁可以帮助精子。
I have no idea.
我不知道。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
It's possible.
这是有可能的。
I don't think we have the data on that yet.
我认为我们还没有这方面的数据。
But yeah, I think to your point, I think lifestyle factors are certainly a big one, and some of these potentially unhealthy habits.
但是，是的，我认为就你的观点而言，我认为生活方式因素肯定是一个重要因素，其中一些可能是不健康的习惯。
So smoking is certainly something you should not do.
所以吸烟绝对是你不应该做的事情。
There have been lots of studies that do link that to lower quality, again, all the different measures that we look at.
有很多研究确实将其与较低的质量联系起来，同样，我们研究了所有不同的衡量标准。
Also looking at fertility, these men tend to have a longer time to get pregnant.
从生育能力来看，这些男性往往有更长的怀孕时间。
Alcohol, I think, is another very common question we get asked as well, and I think for that, there's less of a strong association that we've seen.
我认为，酒精也是我们经常被问到的另一个问题，而且我认为，我们所看到的这种强烈的关联性并不那么强烈。
So there have been some studies that show that very high levels of alcohol, and I guess that's sort of subjective what some would consider high or not, but when you get above maybe 20 drinks a week, there have been some effects, but usually-
因此，有一些研究表明，酒精含量非常高，我想这有点主观，有些人会认为酒精含量高或不高，但当你每周饮酒超过 20 杯时，就会产生一些影响，但通常-
Andrew Huberman:
安德鲁·休伯曼：
That's a lot of drinking.
那是喝了很多酒。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I would think that's a lot, yeah.
我想这很多，是的。
But some people don't.
但有些人不这么认为。
But yeah.
但是是的。
Andrew Huberman:
安德鲁·休伯曼：
I did an episode on alcohol.
我做了一个关于酒精的剧集。
I know people are going to balk at this, but I think any more than two drinks per week is where you start to see some negative effects on some health parameters.
我知道人们会对此犹豫不决，但我认为每周饮酒超过两杯就会开始对某些健康参数产生负面影响。
But, I'm not a teetotaler, so yeah.
但是，我不是一个滴酒不沾的人，所以是的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
But when you get to this 20 drink, that's when we started to see some effects on semen quality.
但当你喝到这 20 杯饮料时，我们就开始看到对精液质量的一些影响。
But the thing about that is that usually if these men are drinking 20, they're doing other things too, smoking.
但问题是，通常如果这些男人喝了 20 杯，他们也会做其他事情，比如抽烟。
There can be other drug use as well.
也可能有其他药物的使用。
So it's hard to tease that out, but in general, I think certainly anything in moderation is probably better, and so that's how I counsel patients.
所以很难弄清楚这一点，但总的来说，我认为适度的任何事情肯定可能会更好，所以这就是我为患者提供建议的方式。
I think, again, it's very rare that I see men that are at that level, but I certainly let them know when I do.
我再次认为，我很少见到达到这种水平的男人，但当我看到时，我肯定会让他们知道。
There's some new data coming out that we've started to work on looking at if there are different sensitivities to alcohol.
我们已经开始研究一些新的数据，以确定是否存在不同的酒精敏感性。
So, some East Asians have a mutation that leads to flushing, and so that may put those men at higher risk.
因此，一些东亚人有一种导致脸红的突变，因此这可能会使这些男性面临更高的风险。
When they mix alcohol, we may see some slightly lower sperm parameters.
当他们混合酒精时，我们可能会看到一些略低的精子参数。
Andrew Huberman:
安德鲁·休伯曼：
You mean skin flushing because they don't make alcohol dehydrogenase?
你的意思是皮肤潮红是因为它们不产生乙醇脱氢酶？
Is that the idea?
是这个想法吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Exactly, yeah.
没错，是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I've heard about that in Asian cultures.
我在亚洲文化中听说过这一点。
In Asian population, excuse me.
在亚洲人口中，请原谅。
But is there any evidence that other populations might have slight variants on alcohol dehydrogenase that perhaps maybe they don't lack it altogether, but they have, I don't know, they're hypomorphs for whatever gene makes alcohol dehydrogenase, and therefore, they don't metabolize it as well, and therefore, the toxic form of alcohol is- active in their system longer.
但是有没有证据表明其他人群的乙醇脱氢酶可能有轻微的变异，也许他们并不完全缺乏这种变异，但他们有，我不知道，他们是任何产生乙醇脱氢酶的基因的亚型，因此，他们也不会代谢它，因此，酒精的有毒形式在他们的系统中活跃的时间更长。
Is there any evidence for that?
有证据证明这一点吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
No, I think, yeah, you're exactly right.
不，我想，是的，你说得完全正确。
I think the one that we think about is East Asian cultures, where it can be, depending on the region, like Chinese, Taiwanese, probably about 40 to 50% of the population has a mutation in the ALDH2 gene.
我认为我们考虑的是东亚文化，根据地区的不同，比如中国人、台湾人，可能大约 40% 到 50% 的人口有 ALDH2 基因突变。
But other populations, in people of African ancestry, there's a rate of mutation, I think, I'm not going to remember the exact percentage, but I think a few percentage points.
但其他人群，在非洲血统的人中，有一定的突变率，我想，我不会记住确切的百分比，但我认为有几个百分点。
Some individual with Hispanic ancestry, Ashkenazi Jewish ancestry.
有些人有西班牙裔血统，有德系犹太人血统。
So in this particular gene, there's a mutation, not the same one that East Asians have.
因此，在这个特定的基因中，存在一种突变，与东亚人的突变不同。
But again, I think it gets to why a mutation where we see negative effects would persist.
但我再次认为，这就是为什么我们看到负面影响的突变会持续存在的原因。
And the hypothesis that millennia ago, potentially it gave some sort of benefit for maybe an infectious disease or something, similar to cystic fibrosis, why again, this mutation would persist in our population if there's not some sort of advantage to those carrying it.
假设几千年前，它可能对传染病或类似囊性纤维化之类的疾病带来某种好处，为什么如果携带这种突变的人没有某种优势，这种突变将在我们的人群中持续存在。
But we do see in other men as well.
但我们也确实在其他男人身上看到了这一点。
So I think it's a simple question.
所以我认为这是一个简单的问题。
Do you flush?
你冲水吗？
If you flush, then maybe alcohol may have more of a harm than someone else.
如果你脸红，那么酒精的危害可能比其他人更大。
And then, getting along the lines, I think drug use is also something that we should try and-- We do counsel patients about, because that can also negatively affect semen quality.
然后，顺着思路，我认为吸毒也是我们应该尝试的事情——我们确实为患者提供咨询，因为这也会对精液质量产生负面影响。
Andrew Huberman:
安德鲁·休伯曼：
Do you think it's fair to say that, okay, moderation is best, but if somebody had the option to either not drink or drink in moderation, that they should not drink?
你认为公平地说，好吧，适量是最好的，但如果有人可以选择不喝酒或适量饮酒，他们就不应该喝酒？
Would that be even better?
那样会更好吗？
Is there any evidence for that?
有证据证明这一点吗？
It seems like nowadays we take the stance that not smoking at all is better than smoking a little bit.
如今，我们似乎采取的立场是，根本不吸烟比稍微吸烟要好。
Actually, when I was a postdoc at Stanford from 2005 to end of 2010, you could still smoke on the Stanford campus.
事实上，当我从2005年到2010年底在斯坦福大学做博士后时，你仍然可以在斯坦福大学校园里吸烟。
I'm not a smoker, but there was this collection of-- I have to be careful what I say here.
我不吸烟，但有这样的集合——我必须小心我在这里所说的话。
There was a particular group on campus of postdocs and graduate students that would colonize this little area outside the hospital and smoke because that's where you could smoke.
校园里有一个由博士后和研究生组成的特殊群体，他们会在医院外的这个小区域里吸烟，因为那是你可以吸烟的地方。
That was eventually eliminated as a possibility.
这种可能性最终被排除了。
You can't smoke on Stanford campus as far as I know.
据我所知，斯坦福大学校园内不能吸烟。
But they would smoke right outside the hospital.
但他们会在医院外面吸烟。
Actually, a lot of the hospital workers would take a cigarette on their break.
事实上，很多医院工作人员在休息时都会抽烟。
This is very common.
这很常见。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
The irony.
讽刺的是。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
And this was common all over the country.
这在全国都很常见。
This isn't unique to Stanford, but nowadays, you just don't see that because it's not allowed.
这并不是斯坦福大学独有的，但如今，你只是看不到这一点，因为这是不允许的。
And we hear, "Don't smoke.
我们听到，“不要吸烟。
It's terrible for X, Y, Z," and every other letter of the alphabet.
对于 X、Y、Z”和字母表中的所有其他字母来说，这很糟糕。
With alcohol, we tend to hear that if you're going to drink, drink in moderation.
对于酒精，我们往往会说，如果你要喝酒，就适量饮酒。
It's not clear exactly what number that is.
目前还不清楚具体是什么数字。
But is it possible that zero alcohol is better for sperm and endocrine health than any alcohol, or is that not a fair assumption?
但零酒精是否可能比任何酒精都更有利于精子和内分泌健康，或者这不是一个公平的假设？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think that's a good question.
我认为这是一个好问题。
I think your point about tobacco is an excellent one, because I think any smoking is bad.
我认为你关于烟草的观点非常好，因为我认为任何吸烟都是不好的。
But alcohol, I think we don't have that data for yet.
但是酒精，我认为我们还没有这些数据。
And so I think it's harder for me to make that recommendation to patients, especially because people do it for different reasons.
因此，我认为向患者提出这一建议对我来说比较困难，特别是因为人们这样做的原因不同。
And if it's not necessarily going to help them, it'll harm them in social situations or other things.
如果这不一定对他们有帮助，就会在社交场合或其他事情上伤害他们。
Yeah, I usually give the moderation one.
是的，我通常会适度一点。
Unless, again, for the very high drinkers, I definitely talk about that.
除非，再次强调，对于饮酒量很大的人，我肯定会谈论这一点。
Andrew Huberman:
安德鲁·休伯曼：
You mentioned other drug use.
你提到了其他药物的使用。
I'm going to assume that unless prescribed for post-surgical pain or something like that, that benzodiazepines, heroin, opioids of any kind are just bad for sperm and testosterone.
我假设，除非用于治疗术后疼痛或类似情况，否则苯二氮卓类药物、海洛因、任何类型的阿片类药物都对精子和睾酮有害。
I think that we could probably make that a short discussion, right?
我认为我们可以进行简短的讨论，对吧？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I can't imagine any of that would be good for reproductive health.
我无法想象这对生殖健康有什么好处。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, that's true.
是的，确实如此。
There's, again, you'd imagine, or maybe not, but there's not a lot of data on it.
再说一遍，你可能会想象，也可能不会，但关于它的数据并不多。
It'd be difficult to enroll or maybe easy to enroll, but a lot of those studies have not been done.
注册可能很困难，也可能很容易，但其中很多研究尚未完成。
But there's limited ones of people in rehab where they have shown these associations with addicts or users and lower quality.
但在戒毒所中，只有少数人表现出与成瘾者或使用者的这些联系，而且质量较低。
So yeah.
所以是的。
That's how we talk to patients.
这就是我们与患者交谈的方式。
Andrew Huberman:
安德鲁·休伯曼：
What about cannabis?
What about cannabis?
I did an episode of this podcast about cannabis, and I did highlight some of the medical applications of cannabis.
我制作了一集关于大麻的播客，我确实强调了大麻的一些医学应用。
I also highlighted that very high THC cannabis may predispose, especially young males, to later psychotic episodes.
我还强调，非常高的 THC 大麻可能会导致以后的精神病发作，尤其是年轻男性。
There are more and more data coming out about that all the time.
一直有越来越多的数据出现。
I got a lot of flak for saying that, but that's my take on the data.
我这样说遭到了很多人的批评，但这就是我对数据的看法。
And I know a lot of people use cannabis recreationally and in a kind of pseudo-therapeutic way.
我知道很多人使用大麻是为了娱乐，并以一种伪治疗的方式。
I say pseudo-therapeutic because I think a lot of people use cannabis to manage their anxiety and as an alternative to alcohol for a number of reasons.
我说伪治疗是因为我认为很多人使用大麻来控制焦虑，并出于多种原因作为酒精的替代品。
What is the relationship between cannabis use and testosterone and sperm production?
大麻的使用与睾酮和精子的产生之间有什么关系？
Or I should say sperm quality, excuse me.
或者我应该说精子质量，对不起。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So this is also a very common question.
所以这也是一个很常见的问题。
Again, with this wave of legalization across the country, I think more and more men and women are exposed to it.
再次，随着全国范围内的合法化浪潮，我认为越来越多的男性和女性接触到它。
So again, there's data that the more men are exposed to it, it can lead to some harm in terms of sperm morphology and sperm numbers as well.
因此，有数据表明，接触它的男性越多，它也会对精子形态和精子数量造成一些伤害。
One of the landmark studies was about 1,200 men, and it found that men that used cannabis daily had significantly lower concentration, motility, morphology compared to those that didn't use it.
其中一项具有里程碑意义的研究涉及约 1,200 名男性，结果发现，与不使用大麻的男性相比，每天使用大麻的男性的浓度、活力和形态明显较低。
So I think that's generally how men are counseled, but there's also other data that shows really a null effect, and I think that it goes into probably the composition, how men are taking it, the frequency, because a lot of that data is not well teased out in a lot of these studies.
所以我认为这通常是男性接受咨询的方式，但也有其他数据显示实际上是无效的，我认为它可能涉及成分、男性如何服用、频率，因为很多数据在很多研究中都没有得到很好的梳理。
So I think I sometimes struggle with this with patients, because some of them are taking it for some what they consider legitimate reasons, anxiety, sleep, pain.
所以我想我有时会和病人一起努力解决这个问题，因为他们中的一些人因为一些他们认为合理的原因而服用它，比如焦虑、睡眠、疼痛。
And if there's not very convincing evidence that it's going to help, and they're taking it maybe lower than the threshold where I know that there's good data that'll cause harm, I guess I try and be honest about where we are.
如果没有非常令人信服的证据表明它会有所帮助，并且他们采取的措施可能低于我知道有好的数据会造成伤害的阈值，我想我会尽力诚实地说明我们的处境。
But I think with a lot of things related to sperm, I think our level of evidence is not great.
但我认为，对于很多与精子有关的事情，我认为我们的证据水平并不高。
Andrew Huberman:
安德鲁·休伯曼：
Are there any common over-the-counter medications that can negatively impact sperm quality and/or testosterone?
是否有任何常见的非处方药会对精子质量和/或睾酮产生负面影响？
Things like non-steroid anti-inflammatory drugs, Tylenol, Advil type stuff, ibuprofen, acetaminophen, things of that sort that I and others might not be aware of.
像非类固醇抗炎药、泰诺、Advil 类药物、布洛芬、对乙酰氨基酚之类的东西，我和其他人可能不知道。
I'm not probing for anything in particular here.
我不是在这里探究任何特别的事情。
I know that a lot of over-the-counter drugs have effects that we're just simply not aware of.
我知道很多非处方药具有我们只是没有意识到的作用。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, I think we probably need more data, but I think currently we think all those are safe.
是的，我认为我们可能需要更多数据，但我认为目前我们认为所有这些都是安全的。
Andrew Huberman:
安德鲁·休伯曼：
I'm curious about the pituitary.
我对垂体很好奇。
Pituitary gland, as many listeners of this podcast already know, is a gland that receives signals from the brain.
正如该播客的许多听众已经知道的那样，垂体是一种从大脑接收信号的腺体。
The gland sits near the roof of the mouth I think that's fair, and releases critical hormones into the bloodstream that control the output of testosterone from the testes as well as output of hormones from other glands.
该腺体位于口腔顶部附近，我认为这是公平的，并将关键的激素释放到血液中，控制睾丸的睾酮分泌以及其他腺体的激素分泌。
I know a number of people end up playing sports like football or rugby or even lacrosse or even soccer.
我知道很多人最终都参加了足球、橄榄球、长曲棍球甚至足球等运动。
I've read, there are data on this.
我读过，有这方面的数据。
They're heading the soccer ball quite a lot, or martial arts, or they get a head injury at some point.
他们经常踢足球或武术，或者在某些时候头部受伤。
And I certainly hear a lot from people who played these high-contact sports, and then to their surprise, later they have diminished testosterone levels.
我当然从参加这些高接触运动的人那里听到很多，然后令他们惊讶的是，后来他们的睾酮水平降低了。
I also work with a number of military groups that talk about this.
我还与一些讨论这一问题的军事团体合作。
That they leave, and maybe it's from combat-related stress, et cetera, but they wonder whether or not there's any traumatic head injury or maybe pituitary injury-related impairment to the reproductive axis that includes brain, pituitary, and the testes.
他们离开，也许是因为与战斗相关的压力等等，但他们想知道是否有任何创伤性头部损伤，或者可能是与垂体损伤相关的生殖轴（包括大脑、垂体和睾丸）损伤。
Do you see that?
你看到了吗？
And if somebody played a contact sport, in particular a contact sport where the head was hit or they were hitting things with their head often, or if they have a TBI or had a TBI, that their reproductive health can be impaired.
如果有人参加接触性运动，特别是头部受到撞击或经常用头部撞击物体的接触性运动，或者如果他们患有 TBI 或患有 TBI，那么他们的生殖健康可能会受到损害。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
That's fascinating.
这很有趣。
I have not.
我没有。
It's interesting, I guess, what the pituitary does.
我想，垂体的作用很有趣。
You've obviously covered this before, but it does go to a lot of our therapies.
显然您之前已经介绍过这一点，但它确实适用于我们的很多疗法。
So, for your listeners, the pituitary produces two hormones, LH, luteinizing hormone, and FSH, follicle-stimulating hormone, which then stimulates the testicle.
因此，对于听众来说，垂体会产生两种激素：LH（黄体生成素）和 FSH（卵泡刺激素），然后刺激睾丸。
So the luteinizing hormone stimulates the Leydig cells to make testosterone, and then the follicle-stimulating hormone, or FSH, stimulates sperm production.
因此，黄体生成激素刺激间质细胞产生睾酮，然后卵泡刺激素（FSH）刺激精子产生。
So both of those are very key in terms of production.
因此，就生产而言，这两点都非常关键。
And interestingly, when exogenous testosterone is used, it shuts down that axis, as you know, so we get less of these gonadotropins, this LH, FSH, to stimulate the testicle.
有趣的是，当使用外源性睾酮时，如你所知，它会关闭该轴，因此我们获得的促性腺激素（LH、FSH）会减少，以刺激睾丸。
And the other reason that sperm production is lost with exogenous testosterone use is actually the intratesticular testosterone is much higher than serum levels.
使用外源睾酮导致精子产生丧失的另一个原因实际上是睾丸内睾酮水平远高于血清水平。
So our serum levels are between 300 and 900 nanograms per deciliter on average, but in the testicle are probably tenfold higher at least.
因此，我们的血清水平平均在 300 至 900 纳克/分升之间，但睾丸中的水平可能至少高出十倍。
So when men are given exogenous testosterone and they're not producing their own, the levels of testosterone in the testicle, which are necessary for sperm production, are much, much lower.
因此，当男性接受外源睾酮但他们自己不产生睾酮时，睾丸中产生精子所必需的睾酮水平就会低得多。
But it's interesting because I think I'm not aware of how traumatic injuries would do that.
但这很有趣，因为我想我不知道外伤会如何做到这一点。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
That's good to know.
很高兴知道这一点。
I'm curious about the non-endocrine, non-chemical effects on sperm quality and testosterone levels.
我很好奇对精子质量和睾酮水平的非内分泌、非化学影响。
So here I'm thinking about a bunch of news stories we heard a few years ago about how bicycle seat pressure on the prostate, or maybe it was other portions of the-- maybe it was the nerves running to the penis itself, or surrounding areas, maybe it was pelvic floor related, and somehow, you'll tell us, I'm sure, was impairing sexual function.
所以在这里，我想到了几年前我们听到的一堆新闻报道，关于自行车座椅对前列腺的压力，或者可能是前列腺的其他部分——也许是通往阴茎本身或周围区域的神经，也许是与骨盆底相关，不知何故，你会告诉我们，我确信，它正在损害性功能。
Was it impairing sexual function in any way by impairing testosterone levels, cutting off blood flow to the testes?
它是否会通过降低睾丸激素水平、切断流向睾丸的血流来以任何方式损害性功能？
And here, perhaps the most important thing to ask straight off is, is riding a bicycle bad for male reproductive health and sexual health?
在这里，也许最重要的问题是，骑自行车对男性生殖健康和性健康有害吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
These are great questions.
这些都是很好的问题。
These, again, living in the Bay Area, working in the Bay Area, cycling is very, very popular, so these are questions that I get a lot.
再说一遍，生活在湾区，在湾区工作，骑自行车非常非常受欢迎，所以这些是我收到的很多问题。
So I think, in general, like we talked about before, anything that's good for your heart, it's going to be good for fertility.
所以我认为，总的来说，就像我们之前谈到的那样，任何对心脏有益的事情，都会有利于生育能力。
So a good diet and exercise, maintaining good body weight.
所以良好的饮食和锻炼，保持良好的体重。
And so I always try and encourage physical fitness.
所以我总是尝试鼓励身体健康。
I think that's important.
我认为这很重要。
But it's maybe possible that some particular activities may put men at more risk.
但某些特定活动可能会让男性面临更大的风险。
So I think cycling could be one of them, but it would depend on exactly why we think that may be a problem.
所以我认为骑自行车可能是其中之一，但这取决于我们认为这可能是一个问题的确切原因。
So I guess the theory is heat.
所以我猜这个理论是热的。
If you're in the saddle for a long time, for these prolonged rides that men take on weekends, hours, that maybe if there's too much heat exposure, that may be the mechanism where sperm production would decline.
如果你长时间坐在马鞍上，对于男人在周末、几个小时进行的长时间骑行，也许如果暴露在过多的热量下，这可能是精子产量下降的机制。
So there have been some studies say maybe five hours a week that may be too much.
因此，有一些研究表明，每周五个小时可能太多了。
So if you're above that level, the sperm counts have shown to be lower.
因此，如果您高于该水平，则精子数量就会较低。
If you're less than that, that may be okay.
如果你的水平低于这个水平，那可能没问题。
So when I talk to patients about it, I try and just encourage them to stand up in the saddle, to try and, again, air things out, to try and dissipate heat if that's the mechanism we're going to think.
因此，当我与患者谈论这个问题时，我会尝试鼓励他们在马鞍上站起来，再次尝试通风，尝试散热（如果这是我们要考虑的机制）。
Regarding sexual dysfunction, that is thought to be pressure, as you're alluding to.
关于性功能障碍，正如您所提到的，这被认为是压力。
So the way that the saddle is configured, ideally, all the pressure is put on our ischial tuberosities or our sit bones.
因此，理想情况下，鞍座的配置方式是，所有压力都施加在我们的坐骨结节或坐骨上。
That's what I'm sitting on now.
这就是我现在坐的。
But on the saddle, there's obviously the rigid nose, and if there's too much pressure on that, that actually squeezes between the ischial tuberosities where the main blood flow to the penis goes and- ...
但在马鞍上，显然有一个僵硬的鼻子，如果压力太大，它实际上会挤压坐骨结节之间，那里是流向阴茎的主要血液流向的地方，并且-......
the main nerve supply is too.
主要神经供应也是。
And so if there's compression on this, you get this sort of lack of blood flow or ischemia, and you can get a neuropraxia as well if you crush these nerves.
因此，如果受到压迫，就会出现血流不足或缺血的情况，如果挤压这些神经，也会出现神经失用症。
And so that, over time, can lead to problems.
因此，随着时间的推移，可能会导致问题。
So, some patients will say that, "After I cycle, things are numb down there for 30 minutes or a day," or, "I don't get erections for that sort of same amount of time." Or sometimes, men just sort of ride through it, and hopefully things come back in a day or two.
因此，一些患者会说，“在我骑自行车后，有 30 分钟或一天的时间里，下面的东西都麻木了”，或者“在同样的时间内我都没有勃起。”或者有时候，男人只是顺其自然，希望事情能在一两天内恢复正常。
So that could be the mechanism.
这可能就是机制。
There are some saddles that hopefully will be a little safer.
有一些马鞍希望会更安全一些。
And, I think that this sort of first was noted probably around 2000 or so, and there was a big redesign in terms of saddles to try and make them a little bit more anatomically correct, to try and minimize some of this.
而且，我认为这种第一次出现可能是在 2000 年左右，并且在鞍座方面进行了一次大规模的重新设计，试图使它们在解剖学上更加正确，并尽量减少其中的一些。
And there's cycle fit that can be done, or saddle fit, rather, that can be done at some of the cycling shops to try and look at your body position, look at your size, and try and find a saddle that's safer.
可以进行自行车适配，或者更确切地说，可以在一些自行车商店进行车座适配，尝试查看您的身体位置，查看您的尺寸，并尝试找到更安全的车座。
This doesn't happen to everybody.
这不会发生在每个人身上。
I would say maybe if you were to survey cyclists, maybe 20% to 30% of men and women tend to be susceptible to this.
我想说，如果你对骑自行车的人进行调查，可能有 20% 到 30% 的男性和女性容易受到这种情况的影响。
So I think if you are having discomfort when you cycle, whether it be pain, numbness, or you notice dysfunction, I think certainly you should think about changing saddles or think about changing riding style.
所以我认为，如果您在骑车时感到不适，无论是疼痛、麻木，还是注意到功能障碍，我认为您当然应该考虑更换车座或考虑改变骑行方式。
There's other strategies that are sometimes used, but it's absolutely something that everybody should be aware of.
有时还会使用其他策略，但这绝对是每个人都应该意识到的。
Andrew Huberman:
安德鲁·休伯曼：
I meant to ask this earlier, but I seem to recall a study that drew a correlation between amount of walking, and maybe it was sperm quality, but I think it was testosterone levels.
我本来想问这个问题，但我似乎记得一项研究，该研究得出了步行量之间的相关性，也许是精子质量，但我认为是睾丸激素水平。
Maybe some other metrics of male sexual health.
也许还有一些男性性健康的其他指标。
Forgive me, I'm not recalling the details now.
请原谅，我现在不记得细节了。
Is there any evidence that walking more, standing more, maybe even using a standing desk, is beneficial for pelvic floor health, blood flow, prostate health, who knows, could be any and all of those things, in some way that is beneficial for sperm quality, testosterone level, and/or overall male sexual health?
是否有任何证据表明，多走路、多站立，甚至使用站立式办公桌，对骨盆底健康、血液流动、前列腺健康有益，谁知道呢，可能是所有这些事情，在某种程度上有利于精子质量、睾丸激素水平和/或整体男性性健康？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
I think one of the ways that we can characterize activity is step count.
我认为我们描述活动特征的方法之一是步数计数。
I think I have a watch that tells me that.
我想我有一块手表可以告诉我这一点。
It's something that I look at every day and kind of strive for.
这是我每天都会关注并为之奋斗的事情。
And it turns out that the more active you are, it's been shown, looking at large national data pools across different age ranges, that it is associated with testosterone levels.
事实证明，你越活跃，研究不同年龄段的大型国家数据池表明，它与睾丸激素水平有关。
So being more active, I think, is very important, and that's another thing that everybody can do to try and improve sort of testicular function broadly, but testosterone specifically.
因此，我认为更加活跃非常重要，这是每个人都可以做的另一件事，以广泛地尝试和改善睾丸功能，但特别是睾丸激素。
Andrew Huberman:
安德鲁·休伯曼：
And do you know whether or not that can be separated out from the relationship between being more active and less obese?
你知道这是否可以与更活跃和更少肥胖之间的关系分开吗？
I mean, is this something that's independent of obesity?
我的意思是，这与肥胖无关吗？
In other words, can we incentivize people to walk more simply on the promise of improved sexual health?
换句话说，我们能否以改善性健康的承诺来激励人们更加简单地行走？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, I don't know.
嗯，我不知道。
Yeah, sexual health will be a different one.
是的，性健康将会是另一回事。
But I think there is association between testosterone levels and step count, across different BMI, straight up.
但我认为，在不同的体重指数中，睾酮水平和步数之间存在直接关联。
So I think, whether you have the ideal body weight, whether you have a few pounds to lose perhaps, if you walk more, you will see higher levels of testosterone.
所以我认为，无论你有理想的体重，无论你是否还有几磅需要减掉，如果你走得更多，你会看到更高的睾丸激素水平。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
And another question I meant to ask earlier, and then we can close the hatch on exogenous testosterone therapy, at least for the time being, maybe we'll come back to it, is assuming that somebody can maintain adequate sperm production through the use of hCG or some other therapy, or perhaps they don't care if they're still making sperm because they've already had children, or they don't care to have children, maybe they've banked sperm.
我之前想问的另一个问题，然后我们可以关闭外源性睾酮疗法的大门，至少暂时，也许我们会回到这个问题，假设有人可以通过使用 hCG 或其他疗法来维持足够的精子生成，或者也许他们不在乎自己是否仍在制造精子，因为他们已经有了孩子，或者他们不在乎有孩子，也许他们已经储存了精子。
In any event, assuming that somebody takes testosterone therapy because they were prescribed that, let's say in your clinic.
无论如何，假设有人接受睾酮治疗，因为他们是在您的诊所开出的处方。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Let's just use you-
Let's just use you-
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Okay
好的
Andrew Huberman:
安德鲁·休伯曼：
...
...
and your clinic as an example.
以您的诊所为例。
And they are happy with the psychological and physical consequences of that, and they are comfortable with the trade-offs.
他们对由此带来的心理和身体后果感到满意，并且对这种权衡感到满意。
Is there any increased risk of, say, prostate cancer or other forms of cancer?
患前列腺癌或其他癌症的风险是否增加？
And here I'm going to assume that this person is keeping their lipid levels in check, right?
在这里我假设这个人正在控制他们的血脂水平，对吧？
Because you hear about some hyperlipidemia with testosterone therapies.
因为您听说过睾酮疗法会导致一些高脂血症。
Let's assume that they're either taking a statin or they're not taking a statin, they're getting enough cardiovascular exercise, that things are in check in terms of LDL, HDL, ApoB, and all of that.
让我们假设他们要么服用他汀类药物，要么不服用他汀类药物，他们进行了足够的心血管锻炼，LDL、HDL、ApoB 等指标都得到了控制。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And their testosterone levels are now high normal, and they're feeling better, and they don't have to worry about sperm production because they're either maintaining it or it's been banked, or they don't care about that.
他们的睾丸激素水平现在处于正常水平，他们感觉好多了，他们不必担心精子的产生，因为他们要么维持精子，要么被储存起来，或者他们不关心这一点。
Is there an increased risk of prostate cancer?
患前列腺癌的风险是否增加？
My understanding is the answer is no, but what's the real deal?
我的理解是答案是否定的，但真正的问题是什么？
Does taking testosterone therapy, assuming all other things are being held in check, in a healthy check, does it increase the risk of any kind of cancer?
假设所有其他事情都受到控制，在健康检查中，接受睾酮治疗是否会增加患任何癌症的风险？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, this is another great question because I think there's a lot of myths around testosterone, and that's one of them.
是的，这是另一个很好的问题，因为我认为关于睾酮有很多误解，这就是其中之一。
The origin is that prostate cancer is thought to be or is sort of androgen mediated.
起源是前列腺癌被认为是或某种程度上是雄激素介导的。
One of the Nobel Prizes, again, decades ago, was awarded because it was found that when we lowered men's testosterone, the prostate cancer would regress dramatically.
几十年前，诺贝尔奖之一的颁发是因为发现当我们降低男性睾酮水平时，前列腺癌会急剧消退。
So that put that association between testosterone and prostate cancer.
这就是睾丸激素和前列腺癌之间的联系。
So then the concern began, if we were to either replace testosterone or augment testosterone or give a man testosterone, is that going to alter his risk or increase his risk?
因此，人们开始担心，如果我们要替代睾酮或增加睾酮或给予男性睾酮，这是否会改变他的风险或增加他的风险？
So I think we have pretty convincing data that that's not the case.
所以我认为我们有相当令人信服的数据表明事实并非如此。
There's lots of longitudinal data spanning decades where if a man is given testosterone, it doesn't change his risk.
有大量跨越数十年的纵向数据表明，如果男性服用睾酮，并不会改变他的风险。
The reason for that, in a sort of seeming contradiction between prostate cancer therapy where we lower testosterone, where if you give a man testosterone, it doesn't change his prostate cancer risk, is not certain.
其原因是，在前列腺癌治疗中，我们降低睾酮水平，如果你给一个男人注射睾酮，它不会改变他患前列腺癌的风险，这之间存在一种看似矛盾的原因尚不清楚。
But there's this popular model called the saturation model, so that once there's enough testosterone in the body, and it tends to be a fairly low level, that all the sort of the prostate Testosterone receptors, you can think of as have been filled.
但是有一种流行的模型称为饱和模型，因此一旦体内有足够的睾酮，并且它往往处于相当低的水平，所有类型的前列腺睾酮受体，您可以认为已经被充满。
So if you were to give men more testosterone, it doesn't change anything regarding the prostate cancer, prostate growth, any of that.
因此，如果你给男性提供更多的睾酮，它不会改变前列腺癌、前列腺生长等方面的任何情况。
So it is safe when we're looking at prostate cancer as an outcome.
因此，当我们将前列腺癌作为结果时，它是安全的。
Andrew Huberman:
安德鲁·休伯曼：
Getting back to prostate health and neural innervation of the penis and blood flow to the penis, you mentioned the bike seat-related issues.
回到前列腺健康和阴茎的神经支配以及阴茎的血液流动，您提到了与自行车座椅相关的问题。
Are there other things that men should do in order to maintain prostate health, stave off prostate diseases, and to maintain healthy blood flow and neural innervation of the penis, for obvious reasons?
出于明显的原因，为了保持前列腺健康、避免前列腺疾病、保持健康的血液流动和阴茎的神经支配，男性还应该做其他事情吗？
And we'll get into the specifics of those reasons in our later discussion.
我们将在稍后的讨论中详细讨论这些原因。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, I always think of the penis as a use it or lose it organ.
是的，我一直认为阴茎是一个用进废退的器官。
So that doesn't mean necessarily that you have to have sex, but normally we get erections every night, so that should be maintained.
所以这并不一定意味着你必须发生性行为，但通常我们每晚都会勃起，所以应该保持勃起。
And if there's any reason to suspect that that may not be going on, usually in my practice, that would be from some pelvic surgical intervention or something like that.
如果有任何理由怀疑这种情况可能不会发生，通常在我的实践中，那可能是由于某些盆腔手术干预或类似的事情。
Sometimes we can intervene to try and maintain that.
有时我们可以进行干预以尝试维持这一点。
Andrew Huberman:
安德鲁·休伯曼：
You're talking about spontaneous erections during sleep.
你说的是睡眠期间的自发勃起。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
And short of assigning one's partner to check frequency and tumescence, what is the way that men would know that that's happening?
如果不指派伴侣检查频率和肿胀情况，男人如何知道这种情况正在发生？
Are you talking about waking up with an erection?
你是说醒来时勃起吗？
Is that a requisite for knowing that nocturnal erections are occurring?
这是知道夜间勃起发生的必要条件吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, yeah.
嗯，是的。
I think you've caught me.
我想你已经抓住我了。
I think that's a good question.
我认为这是一个好问题。
So I think a lot of times you won't know, but I think if you have normal response, when either by yourself, with a partner, I think that generally means that you are going to get normal erections.
所以我想很多时候你不会知道，但我认为如果你有正常的反应，无论是独自一人还是与伴侣一起，我认为这通常意味着你会得到正常的勃起。
So I guess when I say use it or lose it, it doesn't mean necessarily that the man has to stimulate himself or make sure that he does have adequate function.
所以我想当我说使用它或失去它时，并不一定意味着这个人必须刺激自己或确保他确实有足够的功能。
Because usually, most of that normal function just occurs with this nocturnal penile tumescence, which we all get.
因为通常情况下，大部分正常功能只是在夜间阴茎肿胀时发生，这是我们都会经历的。
I think sometimes men do notice when they wake up at night.
我认为有时男人在晚上醒来时确实会注意到。
Sometimes in the morning, you wake up with an erection.
有时早上醒来时，您会勃起。
Men notice that.
男人注意到这一点。
But the absence of that doesn't mean it's not happening.
但没有这种情况并不意味着它没有发生。
It likely is, just most people sleep through it, which is normal.
很可能，大多数人都在睡觉，这很正常。
Otherwise, men would never get any sleep because it happens many, many times a night.
否则，男人永远无法入睡，因为这种情况每晚会发生很多很多次。
So I think, again, if you're not having normal function, I think that's something you should probably see a physician about.
所以我再次认为，如果您的功能不正常，我认为您可能应该去看医生。
And then same for urinary function.
泌尿功能也同样如此。
I think if it bothers you, if you're waking up at night, if you have to go to the bathroom often, if your stream is getting weaker, those are all complaints that we hear about.
我想如果这让你感到困扰，如果你在晚上醒来，如果你必须经常去洗手间，如果你的水流变弱，这些都是我们听到的抱怨。
Andrew Huberman:
安德鲁·休伯曼：
What is often?
什么是经常？
My understanding is that it's normal to wake up perhaps once during the night to urinate.
我的理解是，晚上醒来小便一次是正常的。
And this is, of course, assuming, and again, forgive me for all the caveats, but I've done this long enough that if I don't get really granular about some of this, then people will say, "Well, what if I drank 32 ounces of fluid right before sleep and I'm urinating three times per night?" Well, we're assuming that people are tapering their liquid intake as they approach bedtime.
当然，这是假设，请原谅我所有的警告，但我已经这样做了足够长的时间，如果我没有真正了解其中的一些内容，那么人们会说，“好吧，如果我在睡觉前喝了 32 盎司液体并且每晚小便 3 次怎么办？”好吧，我们假设人们在临近就寝时间时逐渐减少液体摄入量。
And that waking up once, maybe twice, but once in the middle of the night to urinate is normal for somebody, let's say age, I don't know, 18 to 40, and maybe from 40 to 100, that number might be in the one to two times per night.
醒来一次，也许两次，但是半夜小便一次对于某些人来说是正常的，比如说年龄，我不知道，18到40，也许从40到100，这个数字可能是每晚一到两次。
Is that about right?
是这样吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
I think once a night is normal for most men.
我认为对于大多数男人来说，每晚一次是正常的。
And then I think, if things start to bother you, I think you could certainly see somebody, but it's hard to get better than once or twice a night, yeah, for most men.
然后我想，如果事情开始困扰你，我想你当然可以见某人，但对于大多数男人来说，很难比每晚一两次更好了。
Andrew Huberman:
安德鲁·休伯曼：
My understanding is that there's a pretty good relationship between the nocturnal erection and the amount of REM sleep, rapid eye movement sleep, that one is getting.
我的理解是，夜间勃起与快速眼动睡眠（快速动眼睡眠）的时间量之间存在着很好的关系。
That this tends to be more frequent toward morning as the proportion of rapid eye movement sleep increases.
随着快速动眼睡眠比例的增加，这种情况在早上会更加频繁。
I don't know if that's true or not, but I found a couple of studies that at least point in that direction.
我不知道这是否属实，但我发现一些研究至少指向了这个方向。
No pun intended.
没有双关语的意思。
So that raises a bigger issue that we haven't talked about yet, which is getting adequate amounts of quality sleep each night.
因此，这就提出了一个我们尚未讨论的更大问题，即每晚获得充足的优质睡眠。
And, I think for most people, that's seven to nine hours ideally.
而且，我认为对于大多数人来说，理想的时间是七到九个小时。
Which means getting sufficient slow-wave, deep sleep, as well as rapid eye movement sleep.
这意味着获得充足的慢波睡眠、深度睡眠以及快速动眼睡眠。
But nowadays, a lot of people, including young people who are not working excessive hours, are getting four, five, six hours of sleep per night.
但现在，很多人，包括那些工作时间不长的年轻人，每晚的睡眠时间是四、五个、六个小时。
Is there a direct relationship between getting less than sufficient amounts of sleep and sperm quality, testosterone levels, and sexual health?
睡眠不足与精子质量、睾酮水平和性健康之间是否存在直接关系？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, I think certainly there's reasonable data for semen quality.
是的，我认为肯定有关于精液质量的合理数据。
And there tends to be, what we call in science a U-shaped relationship, so that it's not linear.
而且往往存在我们在科学中所说的 U 形关系，因此它不是线性的。
So as you get more sleep, things are better.
因此，当您获得更多睡眠时，情况会更好。
There's this concept of too much sleep and not enough sleep.
有一个睡眠过多和睡眠不足的概念。
So the ideal, I think as you pointed out, is seven to nine hours.
因此，我认为正如您所指出的，理想的时间是七到九个小时。
And for men that are not getting that, semen quality tends to be lower.
对于没有做到这一点的男性来说，精液质量往往较低。
And then for men getting too much, we also see a decline.
然后，对于男性摄入过多的情况，我们也看到了下降。
And why that is, is again, not certain.
至于为什么会这样，同样还不确定。
Again, if you're able to get that much sleep, maybe there's other things as well that we should look at.
再说一遍，如果您能够获得那么多睡眠，也许我们还应该考虑其他事情。
So I think getting in that ideal sleep amount is best for semen quality and probably for broad testicular function as well.
因此，我认为理想的睡眠时间对于精液质量以及广泛的睾丸功能来说都是最好的。
Andrew Huberman:
安德鲁·休伯曼：
You keep bringing up semen quality in a way that makes me wonder whether or not-- Is semen quality a proxy for overall vitality and health?
你不断提到精液质量，这让我想知道——精液质量是否代表整体活力和健康？
Or is testosterone level a proxy for overall vitality and health?
或者睾酮水平是否代表整体活力和健康？
It sounds like semen quality is the metric that you keep coming back to in a way that I have to assume reflects your clinical experience and the many papers that you've authored in this area.
听起来精液质量是您不断回顾的指标，我必须假设它反映了您的临床经验以及您在该领域撰写的许多论文。
I think for people that hear semen quality and who are not interested in conceiving children now, which of course could include people who've already had children or who don't want children, semen quality sounds like something that relates to fertility.
我认为对于那些听到精液质量并且现在对怀孕不感兴趣的人（当然可能包括已经生过孩子或不想要孩子的人）来说，精液质量听起来像是与生育能力有关的东西。
But is semen quality something that is a good goal for those who are interested in overall male vitality and health?
但对于那些对男性整体活力和健康感兴趣的人来说，精液质量是一个好的目标吗？
Is it one of the better metrics of overall male vitality and health?
它是衡量男性整体活力和健康的更好指标之一吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, I think it's an excellent marker for overall health.
嗯，我认为这是整体健康状况的一个很好的标志。
I think there are studies that support it can be a measure of how healthy you are.
我认为有研究支持它可以衡量您的健康程度。
If you look at men with more health problems, they tend to have lower semen quality.
如果你观察有更多健康问题的男性，你会发现他们的精液质量往往较低。
But also if you look at semen quality just by itself, and then you look into the future how these men tend to do.
但如果你只观察精液质量本身，然后你就会看到这些男人未来的表现。
If they have higher semen quality, they tend to live longer, need to go to the doctor less, lower rates of cancer.
如果他们的精液质量较高，他们往往会活得更长，需要更少的去看医生，患癌症的几率也更低。
So I think there's a lot of different ways that semen quality may be a good barometer of health.
所以我认为精液质量可以通过很多不同的方式成为健康的良好晴雨表。
Why that link exists, I think is not known, but there's lots of theories.
我认为为什么存在这种联系尚不清楚，但有很多理论。
So one is that probably about 10% of the male genome is devoted to reproduction.
因此，其中之一是，男性基因组的大约 10% 可能用于繁殖。
And so it makes sense given that we only have about 24,000 genes in the body, that there's a lot of overlap.
因此，考虑到我们体内只有大约 24,000 个基因，存在大量重叠，这是有道理的。
So one gene that plays a role in reproduction may play a role in the cardiovascular system or the neurological system.
因此，一种在生殖中发挥作用的基因可能在心血管系统或神经系统中发挥作用。
And so if we get the first sign that reproduction is not perfect, there may be some other health consequences down the line.
因此，如果我们首先发现生殖不完美的迹象，可能还会产生其他一些健康后果。
Another hypothesis is that, again, going along this line, that reproduction is one of the first things that we see, is that gestation is very critical to our existence, right?
另一个假设是，再一次沿着这条线，繁殖是我们看到的第一件事之一，妊娠对我们的存在非常关键，对吧？
Perturbations to that system have prolonged effects, the so-called developmental origin of adult disease or the Barker hypothesis.
对该系统的干扰会产生长期影响，即所谓的成人疾病的发育起源或巴克假说。
And so we know that premature children have higher risk of cardiovascular disease.
因此我们知道早产儿患心血管疾病的风险更高。
There have been studies to show that.
有研究表明这一点。
But we also know that these gestational effects can also play out on reproductive function too.
但我们也知道这些妊娠影响也会影响生殖功能。
So that also may be a link, early seeding of reproductive function, and then that's maybe the first marker that we're going to have for other health effects later on.
因此，这也可能是一个联系，即生殖功能的早期播种，然后这可能是我们稍后将获得的其他健康影响的第一个标记。
There are also just inherent similarities between reproduction and some other social effects.
再生产和其他一些社会效应之间也存在固有的相似性。
So one confounding factor when we're looking at some of these studies I talked about, looking at mortality, for example, and semen quality, is that there's factors that necessarily involve reproduction.
因此，当我们查看我谈到的一些研究（例如死亡率和精液质量）时，一个令人困惑的因素是，有些因素必然涉及生殖。
So your children and having a partner.
所以你的孩子和伴侣。
And having a partner prolongs life, having kids prolong life.
拥有伴侣可以延长寿命，拥有孩子可以延长寿命。
Even though it feels like kids are killing you, if you look at studies, men with kids tend to live longer.
尽管感觉孩子正在杀死你，但如果你看看研究，有孩子的男人往往会活得更久。
So that's another possible explanation.
这是另一种可能的解释。
But I think really this health link between fertility, I think is a powerful one.
但我认为生育力与健康之间的联系确实是一种强有力的联系。
So I do think it should be a barometer.
所以我确实认为它应该是一个晴雨表。
When I've given lectures on this, I call it the sixth vital sign.
当我对此进行演讲时，我将其称为第六生命体征。
I think it's something that we should probably check, because if there is lower levels, that may tell us about something else going on.
我认为我们应该检查一下，因为如果水平较低，可能会告诉我们发生了其他事情。
When men come in for infertility evaluations, a lot of times we do diagnose these new medical problems.
当男性前来进行不孕不育评估时，很多时候我们确实会诊断出这些新的医疗问题。
Sometimes we diagnose cancer, alluding to some of the questions you've asked, diabetes, and some other very significant genetic conditions as well.
有时我们会诊断癌症，暗指您提出的一些问题、糖尿病以及其他一些非常重要的遗传疾病。
And the first way that we would identify it is reproductive failure because their sperm counts are low, and other things.
我们识别它的第一个方法是生殖失败，因为它们的精子数量低，以及其他原因。
So it is something, I think that it's very important, I think, for people to realize.
因此，我认为人们认识到这一点非常重要。
And it would be great, I think, another advantage to the Centers for Disease Control, for example, to start tracking it.
我认为，例如，疾病控制中心开始追踪它会是一个很好的优势。
Andrew Huberman:
安德鲁·休伯曼：
Would it be a good idea for males in their 20s and 30s to get a sperm analysis just to have a baseline?
对于 20 多岁和 30 多岁的男性来说，为了获得基线而进行精子分析是个好主意吗？
I confess, I'm 47 now.
我承认，我现在47岁了。
One thing I wish I had done in my 20s was to get my blood hormone profiles and lipid profiles done when I was in my teens and 20s because I'd have something to compare to.
我希望自己在 20 多岁的时候做的一件事就是在十几岁和 20 多岁的时候完成我的血液激素分析和血脂分析，因为我有一些东西可以比较。
I started doing that in my mid-30s, and I'm so glad I did because I can now compare to my mid-30s levels.
我在 30 多岁的时候开始这样做，我很高兴自己这么做了，因为我现在可以与我 30 多岁的水平进行比较。
I started including sperm analysis about eight years ago with the intention of freezing sperm and-
大约八年前，我开始进行精子分析，目的是冷冻精子，然后——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
did that because I was also reading at that time about the increased risk of autism in offspring of males older than 40, something that I really would like your take on.
之所以这么做，是因为当时我还读到了有关 40 岁以上男性后代患自闭症风险增加的报道，我真的很希望您能对此做出看法。
But it seems like it's inexpensive enough to do a sperm analysis.
但它似乎足够便宜来进行精子分析。
I think now people can get it done at home.
我认为现在人们可以在家完成。
They have mail kits, although I don't understand how the motility could be maintained if you're mailing your sperm back at room temperature, or it's heading through the post office.
他们有邮件套件，尽管我不明白如果你在室温下将精子寄回，或者通过邮局，如何保持活力。
Now everyone's imagining all these sperm traveling through the postal service.
现在每个人都想象着所有这些精子通过邮政服务运输。
They're out there, folks.
他们就在那里，伙计们。
Yeah, what are your thoughts?
是啊，你有什么想法？
Should people invest the, I think it was a couple of hundred dollars to get a sperm analysis.
如果人们投资的话，我认为进行精子分析需要几百美元。
More costly to get the DNA fragmentation, then you get up into the low thousands.
获得 DNA 碎片的成本更高，那么你的数量就会达到数千。
But if people have the disposable income, is it a good idea for them to do?
但如果人们有可支配收入，他们这样做是个好主意吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think it's a worthwhile test.
我认为这是一个值得的测试。
I think more information is always good.
我认为更多的信息总是好的。
I think one of the same reasons that you were talking about checking lipid levels or we tell men and women to get blood pressure checked.
我认为这与您谈论检查血脂水平或我们告诉男性和女性检查血压的原因之一相同。
I think getting that early health indicator, I think can be important.
我认为获得早期健康指标非常重要。
I think, going back to not knowing exactly why semen quality is telling us about health, what the exact link may be, means that if somebody is coming in with a low sperm count or a completely absent sperm count, it's hard to know exactly how to counsel that person other than there may be reproductive difficulties.
我认为，回到不知道为什么精液质量会告诉我们健康状况，确切的联系可能是什么，这意味着如果一个人的精子数量低或完全没有精子数量，很难确切地知道如何建议这个人，除了可能存在生殖困难。
But I think just as a marker for reproductive potential, I think it's useful.
但我认为，作为生殖潜力的标志，我认为它是有用的。
And like you said, I think it's become a lot easier.
就像你说的，我认为这变得容易多了。
One of the innovations in the space, and as somebody that is in the reproductive world, I think it's just really great to see this influx in capital and new companies coming in that try to just decrease the barrier to getting a semen test.
作为该领域的创新之一，作为生殖领域的一个人，我认为看到资本的涌入和新公司的加入试图降低精液测试的障碍真是太棒了。
It used to be you have to go to a lab, schedule an appointment.
过去你必须去实验室，安排预约。
Sometimes they would send you to a bathroom, which can be uncomfortable, because you know what people do in a bathroom just next door while you're trying to collect semen.
有时他们会把你送到洗手间，这可能会很不舒服，因为当你试图收集精液时，你知道人们在隔壁的洗手间里做什么。
Andrew Huberman:
安德鲁·休伯曼：
Or they would send them into a common space bathroom.
或者他们会把他们送进公共浴室。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
A common space bathroom, yeah.
公共空间浴室，是的。
Andrew Huberman:
安德鲁·休伯曼：
They wouldn't even give them the quiet room with the red light.
他们甚至不给他们那间亮着红灯的安静房间。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Which is what I hear they do now.
我听说他们现在就是这么做的。
Yeah.
是的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Some of them do have videos.
其中一些确实有视频。
So there are some higher level-
所以还有一些更高层次的——
Andrew Huberman:
安德鲁·休伯曼：
Oh, I didn't even mean videos.
哦，我什至不是指视频。
Okay, yes, I've done this.
好吧，是的，我已经做到了。
I'm trying to normalize things related to all aspects of mental health, physical health.
我正在努力使与心理健康、身体健康各个方面相关的事情正常化。
So yeah, I decided to freeze sperm, and basically they Sent me to a room.
所以，是的，我决定冷冻精子，基本上他们把我送到一个房间。
I went to a university-based clinic.
我去了一家大学诊所。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
It actually wasn't Stanford, but a different university.
它实际上不是斯坦福大学，而是另一所大学。
And yeah, they put the cup through the window.
是的，他们把杯子从窗户里拿出来了。
They give you the cup, they close the door, and they tell you that as long as that red light is on over the door, no one's going to walk in.
他们给你杯子，关上门，然后告诉你，只要门上的红灯亮着，就没有人会走进来。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
And then they leave.
然后他们就离开了。
And I think the assumption now is that you figure it out one way or another, how to provide the sample, and then you put the sample back through the thing.
我认为现在的假设是你以某种方式弄清楚如何提供样本，然后你将样本放回原处。
And then one thing these clinics really need to work out is that anytime you're walking out, you see the people processing your sample as you walk out.
这些诊所真正需要解决的一件事是，每当您走出去时，您都会看到人们在您走出去时处理您的样本。
So there's all this feigning of anonymity, but really it isn't there.
因此，所有这些都假装匿名，但实际上并不存在。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Because they're like, "See you later." And you're like, "Great." They rarely ask you questions on the way out.
因为他们会说，“待会儿见。”你会说：“太棒了。”他们很少在出去的时候问你问题。
But it's a pretty simple process overall.
但总的来说，这是一个非常简单的过程。
And I must say that the data are informative.
我必须说这些数据信息丰富。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
You get the volume, number motile, forwardly motile.
您可以获得音量、活动次数、向前活动次数。
I did opt for the DNA fragmentation data.
我确实选择了 DNA 碎片数据。
And I just love data, so I think it's really interesting.
我就是喜欢数据，所以我认为这真的很有趣。
But again, and maybe this is a good time to flag this set of findings, I believe that there seems to be a small but statistically significant increase in the number of autistic births due to pregnancies where the male was over 40 at the time of conception.
但同样，也许现在是展示这组发现的好时机，我相信，由于男性受孕时年龄超过 40 岁而怀孕，自闭症出生人数似乎略有增加，但在统计上显着。
So I figured why not freeze some sperm, and it's relatively inexpensive.
所以我想为什么不冷冻一些精子，而且它相对便宜。
Yeah.
是的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So I think paternal age is also something that's increasing in this country.
所以我认为在这个国家父亲的年龄也在增加。
So over the last 40 years or so, we've seen that the average paternal age has increased from about 27 and a half to about 31.
因此，在过去 40 年左右的时间里，我们看到父亲的平均年龄从 27 岁半左右增加到了 31 岁左右。
And I should say that this is all fathers.
我应该说，这都是父亲。
So birth certificate data or birth data is collected at maternal level.
因此，出生证明数据或出生数据是在母亲层面收集的。
So, when a child is born, somebody comes in to collect data on the birth.
因此，当孩子出生时，就会有人进来收集出生数据。
So they ask all the characteristics of the mother, and they also ask characteristics of the father.
所以他们询问母亲的所有特征，也询问父亲的特征。
Age, education, obviously region of the country the child was born.
年龄、教育程度、孩子出生国家的地区。
So we don't know what number child that was for the father.
所以我们不知道父亲的孩子是多少号。
We know it for the mother, they do ask is this your first, second, third, et cetera, child.
我们知道母亲的情况，他们确实会问这是您的第一个、第二个、第三个等等的孩子。
So the father, unfortunately, we just have data that's sort of all lumped together.
不幸的是，父亲我们只有一些汇总在一起的数据。
But over the last, again, 40 years, we've seen that increase.
但在过去 40 年里，我们再次看到了这种增长。
Interesting, over the last 40 years, the youngest father was 11 and the oldest was 88.
有趣的是，在过去的 40 年里，最年轻的父亲只有 11 岁，最大的父亲已经 88 岁。
Andrew Huberman:
安德鲁·休伯曼：
11.
11.
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Quite a span.
相当跨度。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
88.
88.
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Goodness.
善良。
Unrelated.
无关。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, I don't know.
嗯，我不知道。
I assume.
我认为。
Andrew Huberman:
安德鲁·休伯曼：
Goodness gracious.
善良仁慈。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
It's anonymized data, but I assume.
这是匿名数据，但我认为。
Andrew Huberman:
安德鲁·休伯曼：
11.
11.
I have to ask this, sorry to take us on a slight tangent, but what is the average age of puberty in males in the United States now?
我不得不问这个问题，很抱歉让我们有点离题，但现在美国男性的平均青春期年龄是多少？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So you're asking about, I guess, sort of sperarchy, when sperm production begins.
所以我想你问的是精子何时开始产生的某种秘密。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
Yeah, there are a lot of markers of puberty-
是的，青春期有很多标志——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
secondary sexual characteristics, beard growth, deepening of voice, et cetera.
第二性征、胡须生长、声音低沉等等。
They happen at different rates in different people.
它们在不同的人身上发生的速度不同。
But yeah, thank you.
但是，是的，谢谢你。
At what point are males undergoing puberty-
男性什么时候进入青春期
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah
是啊
Andrew Huberman:
安德鲁·休伯曼：
...
...
at the level that we're talking about here?
达到我们在这里谈论的水平吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
There has been data that we're going through puberty a little bit earlier now than we used to.
有数据表明，我们现在的青春期比以前要早一些。
But it really varies.
但它确实有所不同。
So, just like testosterone ranges between 300 and 900, that's a wide range for anybody.
所以，就像睾丸激素的范围在 300 到 900 之间一样，这对任何人来说都是一个很大的范围。
I think for most individuals, puberty is probably 12 to 15, 16, in general.
我认为对于大多数人来说，青春期大概是12岁到15岁，一般来说是16岁。
So I just give sort of a very wide range when we're going to say that's okay.
所以当我们说没关系时，我只是给出一个非常广泛的范围。
And some of the data I'm basing it on is when sperm production begins in boys.
我所依据的一些数据是男孩开始产生精子的时间。
And it's actually not that simple to be able to figure that out because we don't generally talk to young boys about how to masturbate, how to collect, and then check on that.
事实上，要弄清楚这一点并不是那么简单，因为我们通常不会与年轻男孩谈论如何自慰，如何收集，然后进行检查。
But there's something called first-morning voided urine, where we can actually look at that, and there have been some studies done, and they see if there are nocturnal emissions, whether there's sperm in there.
但是有一种叫做初晨排尿的东西，我们实际上可以观察它，并且已经进行了一些研究，他们观察是否有遗精，其中是否有精子。
And so generally, it probably starts around, the earliest would be 11, 12, 13, but usually most is probably a little later.
一般来说，它可能大约开始，最早是 11、12、13，但通常大多数可能会晚一点。
So maybe I'll refine that puberty and move it a little bit later.
所以也许我会完善青春期并稍后移动它。
Probably 14 to 16 is when probably about 70, 80% of boys are going to have started producing sperm.
大概 14 到 16 岁的时候，大约 70%、80% 的男孩就会开始产生精子。
Andrew Huberman:
安德鲁·休伯曼：
My understanding is that in females, puberty is also shifting earlier, perhaps at a more dramatic rate than appears to be the case for males.
我的理解是，女性的青春期也在提前，也许比男性的情况更快。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, I think there is some data for males, too.
嗯，我认为也有一些针对男性的数据。
But again, for your listeners, I don't want to have this onslaught of pediatricians seeing kids when boys haven't gone through puberty by a certain age.
但再次，对于你们的听众来说，我不想让儿科医生在男孩到一定年龄还没有经历青春期的时候给孩子看病。
So I think it's still fairly wide.
所以我觉得还是比较宽的。
Andrew Huberman:
安德鲁·休伯曼：
Let's get back to age of the father and issues like autism.
让我们回到父亲的年龄和自闭症等问题。
What are the data there?
那里有什么数据？
And this to me is a practical issue because I think if there's one obvious takeaway from our discussion today, it's that males should probably not wait until they're trying to conceive in order to assess their reproductive health at the level of sperm quality, testosterone levels perhaps, but at least sperm quality.
这对我来说是一个实际问题，因为我认为如果我们今天的讨论中有一个明显的结论的话，那就是男性可能不应该等到他们试图怀孕时才能在精子质量、睾酮水平，但至少是精子质量的水平上评估他们的生殖健康。
But perhaps men should also be freezing their sperm if, in fact, conceiving children after 40 places their children at far greater risk for autism.
但事实上，如果 40 岁以后怀孕会使孩子患自闭症的风险大大增加，那么男性也许也应该冷冻精子。
My understanding is that the rates of autism are somewhere between 1 in 80.
我的理解是，自闭症的发病率约为 80 分之一。
You'll hear as high as 1 in 50 male births, but I think it's probably more like 1 in 60 to 80.
您可能会听到高达五分之一的男性新生儿出现这种情况，但我认为这一比例可能更接近六十分之一至八十。
Is that about right?
是这样吗？
And that the age of the father is a risk factor.
父亲的年龄是一个危险因素。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
I think that this gets into sort of the larger issue of how men perceive fertility.
我认为这涉及到男性如何看待生育能力这一更大的问题。
So, we know that as women age, fertility declines.
因此，我们知道，随着女性年龄的增长，生育能力会下降。
But the oldest father ever is 96, so the biologic potential certainly persists.
但有史以来最年长的父亲已经 96 岁了，所以生物学潜力肯定仍然存在。
Andrew Huberman:
安德鲁·休伯曼：
Wait, I want to know how long he lived to see his child grow up.
等等，我想知道他还能活多久才能看到他的孩子长大。
He conceived at 96?
他96岁就怀孕了？
Amazing.
惊人的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Supposedly.
据说。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
I'm assuming he did not meet his grandchildren, at least not the grandchild of that child.
我假设他没有见过他的孙子，至少没有见过那个孩子的孙子。
So wow, how long did he live?
那么哇，他活了多久？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well This is a man in India.
嗯，这是一个印度人。
It's a sort of a famous story, but supposedly, he had a child.
这是一个著名的故事，但据说他有一个孩子。
He had that child with him on a-- They're waiting at a bus stop.
他带着那个孩子——他们正在公共汽车站等车。
He fell asleep.
他睡着了。
The child was kidnapped.
孩子被绑架了。
Andrew Huberman:
安德鲁·休伯曼：
Oh, Jesus.
哦，耶稣。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
That led to divorce.
这导致了离婚。
So, yeah.
所以，是的。
Andrew Huberman:
安德鲁·休伯曼：
Dreadful.
太可怕了。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Sort of a horrible end.
有点可怕的结局。
But the wife was also old.
但妻子也老了。
Not that old, but in her 50s.
年纪不大，不过50多岁。
Andrew Huberman:
安德鲁·休伯曼：
My goodness.
天哪。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So, yeah.
所以，是的。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Tragic and an incredible story for separate reasons.
由于不同的原因，这是一个悲剧性的故事，也是一个令人难以置信的故事。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
I'll get my head around this 96-year-old conceiving a child.
我会好好想想这位 96 岁的老人怀孕的事。
Okay.
好的。
Please continue.
请继续。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So people, I think, or men think that their fertile road is sort of infinite.
所以我认为，人们或者说男人认为他们肥沃的道路是无限的。
But I think that's very much not the case.
但我认为事实并非如此。
So as you're alluding to, people have looked into risks for older fathers.
正如你所提到的，人们已经研究了高龄父亲面临的风险。
So, about 100 years ago, it was first noticed that dwarfism or achondroplasia was more common in last-born children.
因此，大约 100 年前，人们首次注意到侏儒症或软骨发育不全在最后出生的孩子中更为常见。
So eventually, that link was made.
所以最终，这个链接被建立了。
And since then, other conditions, too.
从那时起，其他条件也随之而来。
So there's these neuropsychiatric conditions you're talking about, like autism is certainly one.
所以你正在谈论这些神经精神疾病，比如自闭症肯定是其中之一。
Bipolar, schizophrenia, people have looked at and also linked that with older age.
人们已经关注双相情感障碍、精神分裂症，并将其与老年联系起来。
Less attainment in school, failing grades, all that has been shown to be a little bit more common with older fathers.
学业成绩较差、成绩不及格，所有这些现象在年长的父亲中更为常见。
So, why I think all these exist, there can be different explanations.
所以，为什么我认为所有这些都存在，可以有不同的解释。
One explanation for the autism association, I'll talk about some of this more genetic or mutational reasons.
对于自闭症协会的一种解释，我将讨论一些更多的遗传或突变原因。
But one thing that some people say is that it could be a hereditary trait.
但有些人说，这可能是一种遗传特征。
And so it may be that men that display some sort of autistic characteristics, maybe they take a little longer to meet a partner, and so it sort of delayed childbearing.
因此，男性可能表现出某种自闭症特征，也许他们需要更长的时间才能见到伴侣，因此这有点延迟生育。
So maybe that's one possible explanation.
所以也许这是一种可能的解释。
But I think there's been a lot of convincing evidence that there could be real epigenetic changes that occur with age and mutational changes that occur with age.
但我认为有很多令人信服的证据表明，随着年龄的增长可能会发生真正的表观遗传变化，并且随着年龄的增长会发生突变变化。
I think I read a statistic, and you would know more, being a neuroscientist, that 84% of the genes in our body expressed somewhere in the central nervous system.
我想我读过一份统计数据，作为一名神经科学家，你会知道更多，我们体内 84% 的基因在中枢神经系统的某个地方表达。
Is that maybe-
那也许是——
Andrew Huberman:
安德鲁·休伯曼：
Sounds about right.
听起来不错。
Yeah.
是的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
I don't want to stamp my name to that.
我不想把我的名字印在上面。
But that sounds about right.
但这听起来是对的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So, it's estimated that every year, we generate about two mutations in our sperm DNA.
因此，据估计，每年我们的精子 DNA 都会产生大约两次突变。
So you can imagine that a 40-year-old is going to have 20 or, sorry, 40 more mutations than a 20-year-old.
所以你可以想象一个 40 岁的人会比 20 岁的人多 20 个，或者抱歉，40 个突变。
So that rate does go up.
所以这个比率确实上升了。
And if you're just randomly sprinkling mutations in a genome, that they're more likely to manifest in maybe neuropsychiatric conditions.
如果你只是在基因组中随机散布突变，那么它们更有可能在神经精神疾病中表现出来。
So there are convincing data that shows that that does occur.
因此，有令人信服的数据表明这种情况确实发生了。
Now, again, there's billions of base pairs in the body, so these random mutations, likely most of them will not result in anything.
现在，体内有数十亿个碱基对，因此这些随机突变，很可能其中大多数不会产生任何结果。
But there can be some meaningful ones.
但可能会有一些有意义的事情。
So, for example, achondroplasia is due to a mutation in fibroblast growth factor receptor.
例如，软骨发育不全是由于成纤维细胞生长因子受体的突变所致。
And what's interesting is that this condition is not that rare.
有趣的是，这种情况并不罕见。
Based on these rare mutations, you'd expect this would occur maybe about one in 100 million.
根据这些罕见的突变，您预计这种情况的发生率约为一亿分之一。
But it turns out these conditions occur in about one in, I think, 30 to 50,000 or so.
但事实证明，这些情况的发生率大约为 30 到 50,000 人左右。
So there's this discrepancy based on mutational rate that we expect based on age and the rate that we actually see.
因此，根据我们根据年龄预期的突变率和我们实际看到的突变率，存在这种差异。
So the explanation for this is something called selfish spermatogonial selection.
所以对此的解释是所谓的自私精原细胞选择。
So what this suggests is that some of these mutations that occur randomly occur in proliferation pathways, and so it gives the sperm that contain these advantages over their brothers and sisters that don't have them, for example.
因此，这表明，其中一些随机发生的突变发生在增殖途径中，因此，包含这些突变的精子比不具有这些突变的兄弟姐妹具有优势。
And so then they outcompete the other sperm, and so they're more likely to lead to a child rather than a random smattering.
因此，它们在竞争中击败了其他精子，因此它们更有可能生下孩子，而不是随机生下孩子。
You can actually see that some of these mutations are more common in older men than younger men, if you screen for some of these mutations in some of these pathways.
如果您在某些通路中筛选某些突变，您实际上可以看到其中一些突变在老年男性中比年轻男性更常见。
Again, the longer that we're exposed to life, there's just more likely to be different chemical exposures or other exposures.
同样，我们接触生活的时间越长，接触不同化学物质或其他接触的可能性就越大。
And so people have looked at epigenetic signatures, these signatures that dictate which genes are going to be expressed and which aren't.
因此，人们研究了表观遗传特征，这些特征决定了哪些基因将被表达，哪些不被表达。
And there are different patterns between older and younger fathers.
年长父亲和年轻父亲之间也有不同的模式。
And what triggering those is not known, but there are differences.
是什么触发了这些尚不清楚，但存在差异。
So those could also potentially explain some of these risks that we see.
因此，这些也可能解释我们所看到的一些风险。
It used to be that people thought that if you're an older father, maybe there's a lot of advantages for the kids.
过去人们认为，如果你是一位年长的父亲，也许对孩子们有很多好处。
Because if you're more resourced.
因为如果你有更多的资源。
I always tell patients that when they come to see me for erection problems or anything, I always say nothing gets better with age.
我总是告诉患者，当他们因勃起问题或其他问题来找我时，我总是说随着年龄的增长，情况不会好转。
And that's mostly true, although they pointed out that salary often goes up with age and wisdom goes up with age.
这基本上是正确的，尽管他们指出工资通常会随着年龄的增长而增长，智慧也会随着年龄的增长而增长。
So you would imagine if you're more resourced, maybe the kids are going to also have an advantage to that.
所以你可以想象，如果你有更多的资源，也许孩子们也会有优势。
But, again, there's a lot of convincing data that that's probably not the case.
但同样，有大量令人信服的数据表明情况可能并非如此。
There's one study that I saw that showed that if you look at MRIs of brains of children just after birth, they're actually a little smaller for older fathers compared to younger fathers.
我看到的一项研究表明，如果你观察刚出生的孩子的大脑核磁共振成像，就会发现，与年轻父亲相比，年长父亲的大脑实际上要小一些。
So, I think there are some talking about neurocognitive development, some of those effects.
所以，我认为有人在谈论神经认知发展，其中一些影响。
And there's also been studies looking at cancer risk, too.
还有一些研究关注癌症风险。
So higher risk of breast cancer, prostate cancer in adult children, higher risk of leukemia or CNS cancers in children as well.
因此，成年儿童患乳腺癌、前列腺癌的风险较高，儿童患白血病或中枢神经系统癌症的风险也较高。
So I think the more we look, the more we find out of these associations with paternal age.
所以我认为我们看得越多，我们就越能发现这些与父亲年龄的联系。
So I think it's something to certainly be aware of.
所以我认为这是一定要注意的事情。
I think talking about mitigation strategies, I think education would be important for couples to try earlier or individuals to try earlier to conceive.
我认为谈论缓解策略时，我认为教育对于夫妇尽早尝试怀孕或个人早期尝试怀孕非常重要。
If we think it's a mutational reason, I think certainly freezing sperm, I think is a good option as well.
如果我们认为这是突变原因，我认为冷冻精子当然也是一个不错的选择。
Andrew Huberman:
安德鲁·休伯曼：
My understanding is that analysis of DNA fragmentation in sperm does not allow for selection of the best sperm on the basis of ...
我的理解是，对精子 DNA 碎片的分析并不能根据...选择最好的精子。
DNA composition translated to English, what I mean is in order to tell whether or not the DNA are mutated in a sperm, you have to kill the sperm, basically.
DNA成分翻译成英语，我的意思是为了判断精子中的DNA是否发生突变，基本上你必须杀死精子。
And since in a given pool of sperm, so to speak, there will be forward motile, non-motile, twitchers twitching in place, dead sperm, some percentage of dead sperm or immotile sperm is presumably normal.
因为在给定的精子池中，可以这么说，会有向前运动的、不运动的、原地抽动的抽动者、死精子，一定比例的死精子或不动精子大概是正常的。
Some small percentage-
一些小比例-
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
hopefully.
希望。
And that some might have some DNA fragmentation, some might not.
有些可能有一些 DNA 碎片，有些可能没有。
So, is the way to address this averages?
那么，有什么方法可以解决这个平均值呢？
What I'm hearing here is that if you haven't already had kids or if you want more kids, that you might want to know about your sperm quality.
我在这里听到的是，如果您还没有孩子或者想要更多孩子，您可能想了解自己的精子质量。
I would say you do.
我会说你会的。
And that if you can afford it, you might want to take a look at DNA fragmentation data.
如果你能负担得起，你可能想看看 DNA 碎片数据。
But having done this, what one receives is a chart that goes from red, bad, to green, good.
但完成此操作后，人们收到的是一张从红色（差）到绿色（好）的图表。
And then they put the arrow, hopefully in the green zone.
然后他们把箭头放在绿色区域。
And then you say, "Oh, good.
然后你说：“哦，很好。
I'm in the green zone.
我在绿区。
I don't have fragmented DNA in my sperm." But really that's an averaging of all the sperm, right?
我的精子中没有断裂的 DNA。”但这确实是所有精子的平均值，对吧？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
It could be that as you age, that some percentage of those sperm have fragmented DNA.
随着年龄的增长，这些精子中可能会有一定比例的 DNA 碎片。
And if one of those is the one that successfully wins the egg, so to speak, fertilizes the egg, then that fragmented DNA-containing sperm is going to propagate that into your offspring.
如果其中一个成功赢得了卵子，也就是说，使卵子受精，那么含有碎片的 DNA 精子就会将其繁殖给你的后代。
So are there any technologies that can allow men to select or improve the DNA of their sperm, not just the motility?
那么有没有什么技术可以让男性选择或改善精子的DNA，而不仅仅是活力呢？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, I wish, right?
是的，我希望，对吗？
That's sort of the Holy Grail, because I think you pointed out sort of a variant of the Heisenberg uncertainty principle, is that if we identify which sperm is bad, we're necessarily going to destroy it.
这就是圣杯，因为我认为你指出了海森堡不确定性原理的一种变体，那就是如果我们识别出哪个精子是坏的，我们必然会摧毁它。
So to tell which one is harboring these mutations would be great, but I think we're not there yet.
因此，如果能知道哪一个基因携带这些突变，那就太好了，但我认为我们还没有做到这一点。
One thing that we do do is wash sperm, so we do sort of select the most motile sperm.
我们所做的一件事就是清洗精子，因此我们确实选择了最具活力的精子。
We clear out the dead ones.
我们清理死者。
And I think embryologists are pretty good at telling which sperm they think are better, but again, we don't have any real objective data to try and understand which are harboring something or other.
我认为胚胎学家非常擅长判断他们认为哪种精子更好，但同样，我们没有任何真正的客观数据来尝试了解哪些精子含有某种东西。
But I think if we understood more about this link with age or again, other conditions, hopefully we would be able to stop some of this pass-through.
但我认为，如果我们更多地了解这种与年龄或其他条件的联系，希望我们能够阻止这种传递。
Andrew Huberman:
安德鲁·休伯曼：
Let's get back to the prostate, this incredible gland.
让我们回到前列腺，这个不可思议的腺体。
Tell us about the prostate.
告诉我们有关前列腺的信息。
I think we hear about the prostate.
我想我们听说过前列腺。
We hear about prostate cancer.
我们听说过前列腺癌。
People might have heard that it's involved in the ejaculatory response.
人们可能听说过它与射精反应有关。
It's involved in erections.
它涉及勃起。
It's involved in a number of things.
它涉及很多事情。
If you could give us a catalog of things that the prostate does.
如果您能给我们一份前列腺功能的目录。
You've spent a lot of time thinking about this gland.
你花了很多时间思考这个腺体。
What are some of the cooler things that it does that we don't know about?
它做了哪些我们不知道的更酷的事情？
How do we keep it healthy?
我们如何保持它的健康？
And what are the consequences of not keeping it healthy?
不保持健康会产生什么后果？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So the prostate is a gland about the size of a walnut.
所以前列腺是一个核桃大小的腺体。
It sits behind the bladder, and it's involved in reproduction.
它位于膀胱后面，参与生殖。
It produces some of the proteins, enzymes that are necessary for sperm to be supported in the ejaculate to kind of keep the sperm healthy in the female reproductive tract.
它产生一些蛋白质和酶，这些蛋白质和酶是精子在精液中得到支持所必需的，以保持精子在女性生殖道中的健康。
So it functions in reproduction, and then basically after reproduction is done, it doesn't really serve any useful function, so then it just becomes a problem, essentially.
所以它在繁殖中起作用，然后基本上在繁殖完成后，它并没有真正提供任何有用的功能，所以它本质上就变成了一个问题。
So the urethra, which is where we pee through, so it connects the bladder to exits the body, runs right through the prostate.
因此，尿道是我们小便的地方，因此它连接膀胱并排出体外，它直接穿过前列腺。
And as we age, the prostate does get bigger.
随着年龄的增长，前列腺确实会变大。
That's sort of a known thing.
这是众所周知的事情。
And as the prostate gets bigger, it creates more resistance in this pipe, and so it makes the bladder have to work harder, and that leads to a lot of the symptoms that we've been talking about already.
随着前列腺变大，它会在这条管道中产生更大的阻力，因此它使膀胱必须更加努力地工作，这导致了我们已经讨论过的许多症状。
Waking up at night, weak stream, this need to urinate urgently, sometimes feeling like you're not emptying all the way.
晚上醒来，尿量少，尿急，有时感觉排不完。
So it's sort of a consequence of the prostate being there.
所以这是前列腺存在的结果。
In terms of ways that you can keep the prostate healthy, I think that there's really nothing necessarily you can do.
就保持前列腺健康的方法而言，我认为您确实无能为力。
I think that one thing I talk to patients about when these sort of symptoms start is to know some of the triggers.
我认为，当这些症状出现时，我与患者谈论的一件事就是了解一些触发因素。
So like you mentioned, drinking a lot before you go to bed.
就像你提到的，睡前喝很多酒。
So if you don't want to wake up at night, that's not a good practice.
因此，如果您不想在晚上醒来，这不是一个好习惯。
You may even want to go into bed sort of a little dehydrated, just so you can try and last the night.
您甚至可能想在有点脱水的情况下上床睡觉，这样您就可以尝试熬过一夜。
There are some particular drinks or foods that tend to be more irritating.
有些特定的饮料或食物往往更刺激。
So like spicy foods, acidic foods, those can sometimes irritate the lining of the bladder and make you have to pee a little bit more.
因此，像辛辣食物、酸性食物一样，这些食物有时会刺激膀胱内壁，让你不得不小便更多。
Caffeine is a diuretic, so it makes us urinate more, and it also can irritate the bladder and give you that sensation.
咖啡因是一种利尿剂，因此它会让我们排尿更多，而且它还会刺激膀胱并给您带来这种感觉。
Alcohol will do the same thing.
酒精也会起到同样的作用。
So I think knowing some of those triggers may stave off some of the symptoms a little bit.
所以我认为了解其中一些触发因素可能会稍微缓解一些症状。
But again, if you enjoy those vices and you're willing to tolerate it, that's okay, too.
但同样，如果你喜欢这些恶习并且愿意容忍它，那也没关系。
Andrew Huberman:
安德鲁·休伯曼：
I'm hearing more and more about a practice of people taking low dose tadalafil, Cialis.
我越来越多地听到人们服用低剂量他达拉非西力士的做法。
Low dose meaning in the neighborhood of 2.5 to five milligrams per day.
低剂量是指每天 2.5 至 5 毫克左右。
Not necessarily for erectile dysfunction, but for prostate health, and was somewhat surprised to learn that those drugs were actually developed first for treatment of prostate health, to increase blood flow to the prostate.
不一定是为了勃起功能障碍，而是为了前列腺健康，并且有些惊讶地发现这些药物实际上首先是为了治疗前列腺健康而开发的，以增加前列腺的血流量。
Is that true?
这是真的吗？
And is there good reason to think about taking 2.5 to five milligrams of tadalafil per day simply for maintaining blood flow to the prostate and thereby maintaining or improving prostate health?
是否有充分的理由考虑每天服用 2.5 至 5 毫克他达拉非，只是为了维持前列腺的血液流动，从而维持或改善前列腺健康？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Certainly it can do that.
当然它可以做到这一点。
It can definitely help with some of these urinary symptoms that we've been talking about.
它绝对可以帮助解决我们一直在谈论的一些泌尿系统症状。
Looking at placebo-controlled trials, our highest level of evidence does show that low dose of tadalafil is two and a half to five milligram.
从安慰剂对照试验来看，我们的最高水平证据确实表明他达拉非的低剂量为两毫克半到五毫克。
These daily dosing can help with these urinary symptoms.
这些每日剂量可以帮助缓解这些泌尿系统症状。
So I think that not necessarily as a preventative measure, but for men that are bothered.
所以我认为这不一定是一种预防措施，而是针对那些受到困扰的男性。
Otherwise, I think most men probably wouldn't want to take a pill every day.
否则，我想大多数男人可能不想每天吃药。
But certainly, if you have some of these symptoms, it can definitely help with urinary bother.
但当然，如果您有其中一些症状，它绝对可以帮助解决排尿问题。
And then the added benefit as you also alluded to, is it can help with erectile function as well.
正如您也提到的，它的额外好处是它也可以帮助勃起功能。
Andrew Huberman:
安德鲁·休伯曼：
Even at the 2.5 to five milligram dosage?
即使剂量为 2.5 至 5 毫克？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Even at those.
即使在那些。
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Yeah, my experience is that there are a lot of people who would love to take pills every day.
是的，我的经验是有很多人喜欢每天吃药。
There seems to be a kind of binary distribution where, and here I'm just thinking about the males that I hear from, because I hear from, of course, males and females.
似乎存在一种二元分布，在这里，我只是考虑我听到的男性，因为我当然听到了男性和女性的声音。
But I get a lot of questions about what can I take.
但我收到很多关于我可以采取什么措施的问题。
But as you point out, there's also a category of men who seem to not want to take anything, not want to measure anything, not want to take anything, but especially not take anything.
但正如你所指出的，还有一类人似乎不想拿任何东西，不想测量任何东西，不想拿任何东西，尤其是不想拿任何东西。
And then there's the other group, and the other group, somewhat surprisingly, seem to be the younger population who maybe grew up in the YouTube era, or maybe in the era where sexual health was discussed more openly than it was certainly when I was in college.
然后还有另一个群体，另一个群体，有点令人惊讶，似乎是年轻人，他们可能是在 YouTube 时代长大的，或者可能是在比我上大学时更公开讨论性健康的时代。
The extent of sexual health discussions at my high school, and I went to a very good high school, were it only takes one sperm, which as you pointed out is true for IVF, but more is better if you're trying to conceive naturally.
在我的高中，我上了一所非常好的高中，性健康讨论的程度，是否只需要一个精子，正如你所指出的，这对于体外受精来说是正确的，但如果你想自然受孕，则更多更好。
And there were discussions about communication and consent, obviously super important.
还有关于沟通和同意的讨论，这显然非常重要。
And then they just kind of turned us loose to learn from our friends and other sources.
然后他们就让我们自由地向我们的朋友和其他来源学习。
And family sometimes had the discussion, sometimes didn't.
家人有时会讨论，有时则不会。
Different families, different discussions, obviously.
显然，不同的家庭，不同的讨论。
So very little information.
所以信息非常少。
Nowadays, I think there's a lot more discussion about these things, and so the 20-to-40-year-old male crowd seems to be the crowd that are asking, "Yeah.
如今，我认为关于这些事情的讨论越来越多，因此 20 至 40 岁的男性人群似乎是在问“是的。
What can I take?" These are also the people who are getting on testosterone therapy early, perhaps without the need.
我能拿什么？”这些人也是早期接受睾酮治疗的人，也许没有必要。
I just want to flag that because, if I understand correctly, you're seeing a lot of testosterone therapy that perhaps people don't need.
我只是想指出这一点，因为如果我理解正确的话，你会看到很多人们可能不需要的睾酮疗法。
Is that right?
是这样吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, I think it's a mix.
嗯，我认为这是一个混合体。
Some people probably do need it, but I think that before starting it, everybody should be aware of all the risks, and you've kind of highlighted some.
有些人可能确实需要它，但我认为在开始之前，每个人都应该意识到所有风险，并且您已经强调了一些风险。
But testosterone, any medication, is going to have some risks, and so everybody needs to be aware of what those are.
但是睾酮，任何药物，都会有一些风险，所以每个人都需要知道这些风险是什么。
And for testosterone, reproduction is certainly one of them.
对于睾丸激素来说，生殖无疑是其中之一。
Andrew Huberman:
安德鲁·休伯曼：
And if they're not already doing all the other things, getting adequate sleep, limiting their alcohol intake, not smoking, getting exercise, et cetera, it seems that testosterone therapy would not be the primary entry point.
如果他们还没有做所有其他事情，获得充足的睡眠，限制酒精摄入量，不吸烟，锻炼身体等等，那么睾酮疗法似乎不会是主要的切入点。
First work out all the-
首先计算出所有的-
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
all the basics.
所有基础知识。
I think that's the big difference.
我认为这是很大的区别。
I think nowadays the what should I take question comes up early when people aren't necessarily doing all the other things that they could do to promote their health.
我认为现在，当人们不一定要做所有其他可以促进健康的事情时，我应该采取什么问题就很早就出现了。
Anyway, this is observational on my part.
无论如何，这是我的观察。
You're the one whose clinic they're showing up to.
他们去的诊所就是你。
I have a question about UTIs.
我有一个关于尿路感染的问题。
We hear about UTIs, urinary tract infections, in women pretty often.
我们经常听说女性患有尿路感染。
Do men get UTIs?
男性会得尿路感染吗？
If they're getting more than one UTI per year, is that abnormal?
如果他们每年患上一次以上尿路感染，这是否异常？
Should men be examined for this bladder, urethra, prostate, penile architecture?
男性应该检查膀胱、尿道、前列腺、阴茎结构吗？
I know there are ways that people can come in, I was reading about this prior to this episode, that you can ingest a dye and then they can dye image the whole apparatus.
我知道人们可以通过多种方式进来，我在这一集之前读到过这一点，你可以摄入染料，然后他们可以对整个装置进行染色成像。
Is that right?
是这样吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
That's true, yeah.
确实如此，是的。
Andrew Huberman:
安德鲁·休伯曼：
Without having to cut anything.
无需切割任何东西。
Is that right?
是这样吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Is that worth people doing, or is that only under conditions where people are experiencing some vexing issue?
这是否值得人们这样做，还是只有在人们遇到一些棘手问题的情况下才这样做？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
I think that some of those tests should only be done if there's a problem, but I think a male urinary tract infection is rare enough that it should be evaluated.
我认为其中一些测试只有在出现问题时才应该进行，但我认为男性尿路感染非常罕见，因此应该进行评估。
So women have very short urethras, but men have a very long urethra.
所以女性的尿道很短，而男性的尿道很长。
It has to go through the entire penile urethra, the prostatic urethra, up into the bladder.
它必须穿过整个阴茎尿道、前列腺尿道，进入膀胱。
And so the way a urinary tract infection would happen, one way would be that a bacteria actually gets all the way back, and that's just a much longer trek.
因此，尿路感染发生的方式之一是细菌实际上一路返回，而这只是一个更长的长途跋涉。
And so if something rare like that does happen, we look for anatomic causes for that.
因此，如果确实发生了类似的罕见情况，我们就会寻找其解剖原因。
So there can be different scar tissue in the urethra, for example.
例如，尿道中可能存在不同的疤痕组织。
There can be stones in the bladder.
膀胱内可能有结石。
There can be stones in the kidney.
肾脏内可能有结石。
Sometimes men aren't emptying their bladders all the way.
有时男人并没有完全排空膀胱。
So those men should be evaluated because there can be some pathology that we could hopefully identify and correct.
因此，应该对这些人进行评估，因为我们有望识别并纠正一些病理现象。
Andrew Huberman:
安德鲁·休伯曼：
Let's talk about erectile dysfunction.
我们来谈谈勃起功能障碍。
I put out the call for questions in anticipation of this episode, and no surprise, at least 30% of the questions from males were about erectile dysfunction, or questions about what's normal in terms of libido level.
我在期待这一集的同时发出了提问，毫不奇怪，至少 30% 的男性问题是关于勃起功能障碍，或者关于性欲水平的正常水平的问题。
Kind of interesting, right?
有点有趣，对吧？
And we'll deal with the first question first, but what are the most common causes of erectile dysfunction?
我们首先解决第一个问题，但勃起功能障碍最常见的原因是什么？
Are they hormonal in nature?
它们本质上是荷尔蒙吗？
I think that's a common belief, that if people are experiencing erectile dysfunction, that it's because their testosterone levels are too low, hence all the interest in testosterone therapy.
我认为这是一个普遍的信念，如果人们出现勃起功能障碍，那是因为他们的睾酮水平太低，因此人们对睾酮治疗很感兴趣。
Or are there other, say, blood flow related, pelvic flow related, neural, brain to body neural connections that are responsible?
或者还有其他的，比如，血流相关的，骨盆血流相关的，神经的，大脑到身体的神经连接负责？
I'm guessing it's all of these things.
我猜这就是所有这些事情。
How do we parse this?
我们如何解析这个？
And tell us about erectile dysfunction, what you most commonly see, what you most commonly do in order to treat it.
请告诉我们有关勃起功能障碍的信息、您最常见的情况以及您最常采取的治疗方法。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So erectile dysfunction as you know is sort of the inability to consistently achieve and maintain an erection, and it's fairly common.
正如您所知，勃起功能障碍是指无法持续实现和维持勃起，而且这种情况相当常见。
Of all the conditions I see, that's definitely the number one.
在我看到的所有条件中，这绝对是第一。
So if you look at men over the age of 40, over half will have some trouble with erections.
因此，如果观察 40 岁以上的男性，超过一半的人会出现勃起问题。
Under age of 40, it's probably about 15% to 20%, so this is a very common condition that we see.
40岁以下，大概是15%到20%左右，所以这是我们看到的一个很常见的情况。
In terms of the etiology, it can vary a little bit.
就病因而言，可能略有不同。
We used to think that they were primarily psychogenic, but that was decades ago.
我们曾经认为它们主要是心因性的，但那是几十年前的事了。
Now we know that most of them are organic, so it's actually a blood flow issue.
现在我们知道大部分都是器质性的，所以实际上是血流问题。
So the most common conditions, just sort of nationally, would be the same things that cause blood flow problems anywhere in the body, so high blood pressure, diabetes, atherosclerosis, anything that sort of can impair blood getting to the end organ.
因此，在全国范围内，最常见的疾病是导致身体任何部位血流问题的疾病，例如高血压、糖尿病、动脉粥样硬化，任何此类疾病都会损害血液到达末端器官。
And sometimes there has been data that trouble with erections can actually predate other more serious vascular conditions.
有时有数据表明，勃起困难实际上可能早于其他更严重的血管疾病。
So the blood vessels in the penis, the penile arteries are about one millimeter and The heart and the brain are much larger.
所以阴茎里的血管，阴茎动脉大约一毫米，而心脏和大脑要大得多。
So, it's much easier to occlude a small vessel than a large vessel.
因此，闭塞小血管比闭塞大血管容易得多。
So that's why there have been some studies to support that it's sort of an early marker for vascular disease.
这就是为什么有一些研究支持它是血管疾病的早期标志物。
So I think looking at those risk factors, of sort of lifestyle, obesity again is a common one.
因此，我认为从生活方式等风险因素来看，肥胖又是一个常见的因素。
Endocrine disorder is actually fairly small.
内分泌失调其实还是比较小的。
It's probably less than 10%, probably around 5% or so.
大概不到10%，大概5%左右。
Pelvic cancer treatment is another very common one.
盆腔癌治疗是另一种非常常见的治疗。
After treatment for prostate cancer, whether it be radiotherapy or surgical therapy, bladder cancer, sometimes rectal, colorectal cancer, that treatment also, anytime we're involving some of the nerves and the vasculature in the pelvis, that can also impact erectile function as well.
前列腺癌治疗后，无论是放射治疗还是手术治疗，膀胱癌，有时是直肠癌，结直肠癌，这种治疗只要涉及到骨盆中的一些神经和脉管系统，也会影响勃起功能。
Andrew Huberman:
安德鲁·休伯曼：
What about hernia?
疝气怎么办？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Hernia, that should be separate.
疝气，那应该分开。
So sometimes if they're-- I always say that in medicine you can never say never.
所以有时候，如果他们——我总是说，在医学上你永远不能说永远。
But generally, if that was going to manifest as erectile function, it would probably be due to maybe some pain symptoms, which can rarely happen during just the early postoperative period.
但一般来说，如果这要表现为勃起功能，则可能是由于一些疼痛症状，而这种症状在术后早期很少发生。
But the blood supply, the nervous supply is separate.
但血液供应、神经供应是分开的。
Andrew Huberman:
安德鲁·休伯曼：
So you said something very important for people to hear, so I'm going to highlight it.
所以你说了一些对人们来说非常重要的事情，所以我要强调它。
You said that less than 10% of erectile dysfunction is due to a hormonal issue.
你说不到 10% 的勃起功能障碍是由于荷尔蒙问题引起的。
I don't know how much time you're spending on YouTube and the internet, but that is going to be a shocker for a lot of males out there because so much of the discussion around testosterone is around libido and sexual function.
我不知道你在 YouTube 和互联网上花费了多少时间，但这对于很多男性来说将会是令人震惊的，因为关于睾丸激素的讨论大多都是围绕性欲和性功能。
So, it's key for people to hear that.
因此，让人们听到这一点很关键。
It's also key for them to know about this other 90%.
了解另外 90% 的信息对他们来说也很关键。
When you say blood flow issue, then what is the common first pass for treatment?
当你说血流问题时，那么常见的第一关治疗是什么？
And again, and forgive me for listing this off over and over, but we are assuming here that people have gotten their body weight down, they're sleeping enough, they're not ingesting excessive alcohol, they're not smoking or vaping, they're not smoking cannabis, or doing the edibles.
再次，请原谅我一遍又一遍地列出这一点，但我们在这里假设人们的体重已经下降，他们睡眠充足，他们没有摄入过量的酒精，他们没有吸烟或电子烟，他们没有吸大麻，或者做食物。
Although maybe we should talk about edibles and cannabis and endocrine effects.
尽管也许我们应该谈谈食品、大麻和内分泌影响。
We'll do that later.
我们稍后会这样做。
Doing all the things right, avoiding doing the wrong things too often or at least completely.
正确地做所有的事情，避免经常或至少完全避免做错误的事情。
So we're assuming they're doing all that correctly.
所以我们假设他们所做的一切都是正确的。
Their testosterone levels are somewhere in that 300 to 900 nanogram per deciliter range.
他们的睾酮水平在每分升 300 至 900 纳克之间。
That's typical for the so-called reference range, at least in the US.
这对于所谓的参考范围来说是典型的，至少在美国是这样。
I think it goes up to 1,200 or maybe 1,400 in other countries.
我认为在其他国家可能会达到 1,200 甚至 1,400。
But as other countries like to point out, but it starts at two...
但正如其他国家喜欢指出的那样，但它从两点开始......
No, I'm just kidding.
不，我只是开玩笑。
But assuming they're doing everything correctly and it's not a testosterone issue, then if it's a blood flow issue, meaning they haven't had treatment for some pelvic cancer, what is the first line of treatment?
但假设他们所做的一切都是正确的，并且这不是睾酮问题，那么如果是血流问题，意味着他们没有接受过某些盆腔癌的治疗，那么第一线治疗是什么？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So assuming that lifestyle and all that has been optimized, medical treatment has been optimized, there's a lot that we can do.
因此，假设生活方式和所有一切都得到了优化，医疗也得到了优化，我们可以做很多事情。
I always tell men, "As long as you have a penis, we can always make it hard." So there's a tremendous amount.
我总是告诉男人，“只要你有阴茎，我们总能让你变硬。”所以数量是巨大的。
Andrew Huberman:
安德鲁·休伯曼：
I'm sure that you're the most popular doctor in your field as a consequence.
因此，我确信您是您所在领域最受欢迎的医生。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
People like to hear that.
人们喜欢听这个。
Yeah.
是的。
That usually does kind of ease everybody.
这通常会让每个人都感到轻松。
So usually we start with oral therapy, so phosphodiesterase inhibitor therapy.
所以通常我们从口服治疗开始，即磷酸二酯酶抑制剂治疗。
So that would be like sildenafil or Viagra, tadalafil, Cialis, avanafil, Stendra, or vardenafil, Levitra.
就像西地那非或伟哥、他达拉非、西力士、阿伐那非、Stendra 或伐地那非、艾力达。
Andrew Huberman:
安德鲁·休伯曼：
Would you be willing to talk about some of the specifics there?
您愿意谈谈那里的一些具体情况吗？
Is the typical thing to put people on this 2.5 to 5 milligrams per day low dose, or to give the higher doses that are more commonly used for erectile dysfunction, per se?
通常是让人们服用每天 2.5 至 5 毫克的低剂量，还是给予更常用于治疗勃起功能障碍的较高剂量？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think it depends why we're putting them on it and how much sex they have too.
我认为这取决于我们为什么要让他们这么做以及他们有多少性行为。
On average, people probably have sex, partnered sex maybe once a week on average, when we're looking at men in their 30s and beyond.
平均而言，当我们观察 30 多岁及以上的男性时，人们可能会发生性行为，平均每周可能发生一次伴侣性行为。
Sometimes it can be a few more times a week than that.
有时每周可能会多几次。
But if they're having sex every day or very often, then sometimes a daily dose can be useful.
但如果他们每天或经常发生性行为，那么有时每日剂量可能会很有用。
But generally, most men are on just on-demand, because they're going to fall into that maybe about a few times a month category.
但一般来说，大多数男人只是按需观看，因为他们每个月可能会陷入这种情况几次。
So that's usually where we start.
所以这通常是我们开始的地方。
And there is sort of a titration that can be done.
并且可以进行某种滴定。
You can go slightly higher doses or lower doses.
您可以稍微提高或降低剂量。
So usually we start in the middle to the higher doses, and we talk about some of the side effects they may have.
因此，通常我们从中等剂量到较高剂量开始，并讨论它们可能产生的一些副作用。
But those probably help 60 to 70% of men, and they work well.
但这些可能对 60% 到 70% 的男性有帮助，而且效果很好。
In terms of another common question is how do we decide which one we're going to start?
另一个常见问题是我们如何决定从哪一个开始？
Sometimes insurance will tell us which one we're going to do.
有时保险会告诉我们要做什么。
That's a common one.
这是一个常见的。
All these medications tend to be somewhat similar.
所有这些药物往往有些相似。
One difference tends to be the time of onset, how quickly they reach peak levels in the body, and then also how quickly they're cleared from the body.
其中一个差异往往是发病时间、它们在体内达到峰值水平的速度以及它们从体内清除的速度。
So tadalafil is somewhat different in that it lasts longer.
所以他达拉非有些不同，因为它的持续时间更长。
The half-life is about 20 hours or so, so it's sort of marketed as a weekend pill.
半衰期约为 20 小时左右，因此它可以作为周末药进行销售。
So some people like the idea of that, taking a pill on Friday, still having some left on Saturday.
所以有些人喜欢这样的想法，周五吃一颗药，周六还剩下一些。
But for others, we start with one of the other ones.
但对于其他人，我们从其他之一开始。
Andrew Huberman:
安德鲁·休伯曼：
The fact that these drugs like tadalafil, also called Cialis, right?
事实上，这些药物就像他达拉非，也称为西力士，对吧？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Cialis, yeah.
西力士，是的。
Andrew Huberman:
安德鲁·休伯曼：
Is Cialis the brand name?
西力士是品牌吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
And Viagra, is that a brand name?
伟哥，这是一个品牌名称吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Stands for, what is the generic name?
代表什么，通用名称是什么？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Oh, sildenafil.
哦，西地那非。
Andrew Huberman:
安德鲁·休伯曼：
Sildenafil.
西地那非。
Okay.
好的。
So because they are effective in such a large percentage of cases, what does that say about the vascular system of all these males that are having erectile dysfunction, but then it's getting resolved by these drug treatments?
那么，由于它们在如此大比例的病例中都有效，那么对于所有这些患有勃起功能障碍但随后通过这些药物治疗得到解决的男性的血管系统来说，这意味着什么呢？
In other words, somebody comes into your clinic, they're having this issue, you prescribe one of these drugs.
换句话说，有人来到您的诊所，他们遇到了这个问题，您就开了其中一种药物。
They come back and say everything's working great, or maybe they don't come back, they just send an email, say everything's great.
他们回来后说一切都很好，或者他们可能不会回来，只是发送一封电子邮件，说一切都很好。
But do you need to have a discussion with that person about their overall vascular health?
但是您是否需要与那个人讨论他们的整体血管健康状况？
Because a few minutes ago, you told us that the fact that they weren't getting erections due to what now appears to be a vascular issue, can be resolved for the penile tissue.
因为几分钟前，您告诉我们，由于现在看来是血管问题，他们无法勃起，这一事实可以通过阴茎组织来解决。
But is it going to solve their other vascular issues, or should those people be on the lookout for cerebrovascular, cardiovascular disease that can potentially cause things at least as bad as erectile dysfunction or maybe worse?
但这是否会解决他们的其他血管问题，或者这些人是否应该警惕脑血管、心血管疾病，这些疾病可能会导致至少与勃起功能障碍一样严重或更严重的情况？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, no, absolutely.
是的，不，绝对。
Well, I think they should be screened.
嗯，我认为他们应该被筛选。
So- Sometimes I'm diagnosing and the first doctor that they're seeing in a long, long time.
所以-有时我正在诊断，也是他们很长一段时间以来见到的第一位医生。
But otherwise, I do encourage them to see a primary care doctor to be screened for blood pressure, lipid levels, fasting blood glucose, all those things, again, sort of for early markers of some of these.
但除此之外，我确实鼓励他们去看初级保健医生，对血压、血脂水平、空腹血糖等进行筛查，再次寻找其中一些早期标志物。
Sometimes they're identified, sometimes not.
有时它们会被识别出来，有时则不会。
But I think we talked about the ideal patient that's perfect body weight, nothing else is going on.
但我认为我们讨论的是理想的患者，即完美的体重，没有其他情况发生。
But that's, as you know, a very rare entity.
但正如你所知，这是一个非常罕见的实体。
So usually there's something that can be done to be optimized.
所以通常可以采取一些措施来优化。
And I try not to be alarmist about this, but I do want to encourage men to take ownership of their health, because that sometimes can improve some of these conditions.
我尽量不要对此危言耸听，但我确实想鼓励男性掌控自己的健康，因为这有时可以改善其中一些状况。
But again, we have terrific medications for men in whom we cannot.
但同样，我们为那些我们无法治疗的男性提供了极好的药物。
Andrew Huberman:
安德鲁·休伯曼：
What are the common side effects of these drugs?
这些药物有哪些常见副作用？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So they're vasodilators.
所以它们是血管扩张剂。
They open up blood vessels, so we get some off-target effects.
它们会打开血管，所以我们会得到一些脱靶效应。
So headache, facial flushing, backaches, leg cramps, indigestion, nasal congestion, those would be the most common.
所以头痛、面部潮红、背痛、腿抽筋、消化不良、鼻塞，这些是最常见的。
Andrew Huberman:
安德鲁·休伯曼：
Before the last Super Bowl, there was some press about the fact that a lot of the players were taking these drugs at low dosages before the game, presumably to increase blood flow to their muscles and brain.
在上届超级碗之前，有一些媒体报道称，许多球员在比赛前服用低剂量的这些药物，大概是为了增加肌肉和大脑的血流量。
Is that what the rationale was?
这就是理由吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think so, yeah.
我想是的，是的。
In other words, we talked about how cycling may lead to erectile problems or sexual problems.
换句话说，我们讨论了骑自行车如何导致勃起问题或性问题。
There has been some data looking at taking like Viagra or one of these medications, Cialis, Tadalafil, before a ride, again, to try and increase circulation to decrease the chance of any of the negative effects of prolonged saddle pressure.
有一些数据研究了在骑行前服用伟哥或其中一种药物西力士、他达拉非，以尝试增加血液循环，以减少长时间鞍座压力产生任何负面影响的可能性。
Andrew Huberman:
安德鲁·休伯曼：
So it sounds like just increasing blood flow and lowering blood pressure slightly is just a good thing all around.
因此，听起来仅仅增加血流量和稍微降低血压就是一件好事。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, I think there's certainly a benefit.
是的，我认为这肯定有好处。
Yeah, because these medications were originally, I think as you're alluding to, were developed as a blood pressure treatment, and this was sort of an amazing off-target effect that has turned into a billion-dollar industry.
是的，因为我想正如你所提到的，这些药物最初是为了治疗血压而开发的，这是一种惊人的脱靶效应，已经变成了一个价值十亿美元的产业。
Andrew Huberman:
安德鲁·休伯曼：
So you mentioned about 10% or less of erectile dysfunction is due to endocrine issues.
所以你提到大约 10% 或更少的勃起功能障碍是由于内分泌问题引起的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Was it 60% to 70% can be resolved with these blood flow enhancers?
这些血流促进剂可以解决60%到70%吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
I know it's a terribly non-clinical, non-scientific way to describe the Viagra, Cialis, Tadalafil, et cetera.
我知道这是一种非常不临床、不科学的方式来描述伟哥、西力士、他达拉非等。
What about the remaining percentage, and are there other treatments that you prescribed or given?
剩下的百分比怎么样？您是否还开出或给予过其他治疗？
In which cases do you need to resort to, I guess, more invasive approaches?
我猜在什么情况下你需要诉诸更具侵入性的方法？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So another therapy we have is urethral suppositories.
所以我们的另一种疗法是尿道栓剂。
So you can actually put a medication in the tip of the penis.
因此，您实际上可以将药物放入阴茎尖端。
It's then absorbed by the rest of the penis.
然后它被阴茎的其余部分吸收。
Also-
还有——
Andrew Huberman:
安德鲁·休伯曼：
It's suppository, not an injection.
这是栓剂，不是注射剂。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
A suppository or a gel, or a jelly, yeah.
栓剂、凝胶或果冻，是的。
So it's also a vasodilator.
所以它也是一种血管扩张剂。
The concept is very similar.
这个概念非常相似。
Sometimes that is okay for men, and they tolerate it.
有时这对男人来说是可以接受的，他们也能忍受。
It's safe for partners as well.
对于合作伙伴来说也是安全的。
It can tingle a little bit, so we definitely let men know because one of the main medications does cause a little bit of a burn as well.
它可能会有点刺痛，所以我们一定要让男性知道，因为其中一种主要药物确实也会引起一点烧伤。
Andrew Huberman:
安德鲁·休伯曼：
Why would somebody do this as opposed to taking the pill form of the drugs we were just talking about?
为什么有人会这样做而不是服用我们刚才讨论的药物的药丸形式？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mostly efficacy would be a big one.
大多数情况下，功效会很大。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
And so this can sometimes help where others cannot.
因此，这有时可以在其他人无法帮助的地方提供帮助。
So that's one.
这就是其中之一。
Penile injections are another common therapy.
阴茎注射是另一种常见的疗法。
So the efficacy of penile injections are probably 80% to 90%.
所以阴茎注射的有效率大概是80%到90%。
Again, we're injecting vasodilators into the penis.
我们再次向阴茎注射血管扩张剂。
So the idea is it just opens up blood vessels, easier to get and to keep erections.
所以我们的想法是它只是打开血管，更容易勃起并保持勃起。
You can imagine there's a huge psychological barrier to putting a needle in your penis.
你可以想象在你的阴茎上放一根针会产生巨大的心理障碍。
But-
但是——
Andrew Huberman:
安德鲁·休伯曼：
Is this something that the patients are doing for themselves at home, or that you're doing?
这是病人在家自己做的事情，还是你正在做的事情？
Is it long-lasting?
是长久之计吗？
Is that something you do at the clinic, and then they come back every few weeks or so?
这是你在诊所做的事情，然后他们每隔几周左右回来一次吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
No. Yeah, this is an on-demand treatment.
不，是的，这是按需治疗。
So we teach them how to do it the first time they do it with us in clinic.
因此，当他们第一次在诊所与我们一起做这件事时，我们就会教他们如何做。
Ideally, we try and get an erection that lasts probably 20 or 30 minutes.
理想情况下，我们尝试勃起大约持续 20 或 30 分钟。
So we usually start at a low dose, and then they just increase at home until they get an erection that lasts for that amount of time.
因此，我们通常从低剂量开始，然后在家中增加剂量，直到勃起并持续一段时间。
Andrew Huberman:
安德鲁·休伯曼：
Is it injected subcutaneous or actually into the goodness, the meatier tissue of the penis?
它是注射到皮下还是实际上注射到阴茎的肉质组织中？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
That's right, yeah.
没错，是的。
Into the erectile bodies directly.
直接进入勃起身体。
Yeah, and you only have to inject one side.
是的，你只需注射一侧。
They do communicate with each other.
他们确实互相沟通。
Most men say it's fine.
大多数男人都说这很好。
It's a very small gauge needle, about as big as a few strands of hair.
这是一根非常小的针，大约有几缕头发那么大。
Andrew Huberman:
安德鲁·休伯曼：
Like I have an appointment over in ophthalmology, and I've seen injections into the human eyeball, and it is incredible how fast and how painless that procedure is when it's done by the right person.
就像我在眼科预约一样，我见过向人类眼球注射，当由合适的人完成时，这个过程的速度和无痛程度令人难以置信。
Nobody should try that at home on their own.
任何人都不应该自己在家尝试。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
But when it's done by a skilled ophthalmologist, it's just striking.
但当它由熟练的眼科医生完成时，效果非常惊人。
You think about needle in the eye, what's worse?
你想想眼睛里被针扎了，还有什么更糟糕的吗？
It's like the childhood rhyme, right?
就像儿时的童谣一样，对吧？
Stick a needle in my eye.
在我眼睛里插一根针。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
It's like you can't think of anything worse, but maybe an injection in the penis sounds almost as bad.
就好像你想不出还有什么更糟糕的了，但也许阴茎注射听起来也同样糟糕。
But you're telling me that if patients are prescribed this, that they can do this with limited, if any, discomfort.
但你告诉我，如果给患者开了这个处方，他们会感到有限的（如果有的话）不适。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, it does have a high dropout rate.
嗯，它的辍学率确实很高。
Andrew Huberman:
安德鲁·休伯曼：
Surprise, surprise.
惊喜，惊喜。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
I think no one's excited about it.
我认为没有人对此感到兴奋。
I guess the mood can sometimes be affected.
我想心情有时会受到影响。
But a lot of couples are very comfortable with it.
但很多情侣都对此感到非常满意。
Again, it's very efficacious.
再说一次，它非常有效。
The man can do it.
男人能做到。
His partner can do it.
他的搭档可以做到。
So it does work well.
所以它确实运作良好。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
And I guess here we're sort of ascending the list of invasiveness.
我想我们在侵略性的名单上正在上升。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
What is at the top tier of invasiveness for erectile dysfunction?
勃起功能障碍的顶级侵入性是什么？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So then we go into penile implants.
接下来我们就开始讨论阴茎植入物。
So there's actually a surgical procedure we can do to put a device inside the penis that can help men be hard when they want to.
所以实际上我们可以通过外科手术将一个装置放入阴茎内，帮助男人在想要的时候变得坚硬。
And that comes in two main forms.
这主要有两种形式。
There's either non-inflatable or inflatable.
有非充气式和充气式之分。
So the non-inflatable is sort of a bendable.
所以不可充气的东西有点像可弯曲的。
It has a metal core, and so when men don't want to have sex, they bend it down.
它有一个金属芯，所以当男人不想发生性行为时，他们会将其弯曲。
When they're ready for sex, they can bend it up.
当他们准备好做爱时，他们可以将其弯曲。
So-
所以——
Andrew Huberman:
安德鲁·休伯曼：
It's really just there on demand.
它确实是按需提供的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Hmm.
嗯。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Interesting.
有趣。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So it's very simple to use.
所以使用起来非常简单。
The more, I guess, natural form would be the inflatable.
我想，更自然的形式将是充气的。
So when you're not using it, it's deflated, and then when you're ready to use it, it's inflated.
因此，当您不使用它时，它会泄气，而当您准备使用它时，它会充气。
And you inflate it with basically a pump that's in the scrotum.
你基本上用阴囊里的泵给它充气。
So all this is surgically implanted inside a man, all under the skin.
所以所有这些都是通过手术植入到一个人体内的皮下。
Unless you know what you're looking for, it'd be very difficult to tell if a man has it or doesn't have it.
除非你知道自己在寻找什么，否则很难判断一个人是否拥有它。
But when he's ready, he pumps it up, and it moves fluid from a reservoir, which usually is also surgically implanted into the penis to get a rigid erection.
但当他准备好时，他会将其泵入，并从储液器中移出液体，该储液器通常也通过手术植入阴茎以获得坚硬的勃起。
Andrew Huberman:
安德鲁·休伯曼：
What is the relationship between psychological arousal and erection as it relates to these technologies?
与这些技术相关的心理唤醒和勃起之间有什么关系？
The way you're describing it sounds purely mechanical.
你描述的方式听起来纯粹是机械的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Right?
对吗？
We're talking about nocturnal erections, which I suppose people could be having erotic dreams, but I don't think that's a prerequisite for nocturnal erections at all.
我们谈论的是夜间勃起，我认为人们可能会做色情梦，但我认为这根本不是夜间勃起的先决条件。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Right?
对吗？
So, is the idea that if adequate blood flow is achieved, then any signal from the brain can initiate a cascade of blood flow that creates the erection?
那么，如果实现了足够的血流，那么来自大脑的任何信号都可以引发血流级联，从而产生勃起吗？
Or is it the case with some of these treatments that it sounds like blood flow is almost autonomous?
或者其中一些治疗的情况听起来像是血流几乎是自主的？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Well, I think a lot of these, yeah, the blood flow is not adequate, and that's why we're having to sort of go beyond.
嗯，我认为其中很多，是的，血液流动不足，这就是为什么我们必须超越。
But generally, as you point out, there's different stimulation, whether it be visual, tactile, or olfactory, that sort of starts that cascade that releases neurotransmitters in the penis that leads to this vasodilation naturally, and men get erections.
但一般来说，正如你所指出的，存在不同的刺激，无论是视觉、触觉还是嗅觉，这种刺激会启动级联反应，释放阴茎中的神经递质，自然导致血管舒张，男人就会勃起。
Andrew Huberman:
安德鲁·休伯曼：
A few years ago, I was reading about vasopressin inhalants.
几年前，我读到有关加压素吸入剂的文章。
There was a bunch of stuff hitting the market.
市场上有很多东西。
By the way, I don't suggest that people get experimental with this stuff.
顺便说一句，我不建议人们对这些东西进行实验。
As a neuroscientist who also knows a thing about neuropeptides and neurohormones that can impact the hypothalamus, I just cover my eyes and kind of cringe when I think about people inhaling vasopressin thinking, "Oh, yeah, there's a study that vasopressin increases sexual desire," or something like that.
作为一名神经科学家，我也了解影响下丘脑的神经肽和神经激素，当我想到人们吸入加压素时，我只是捂住眼睛，有点畏缩，“哦，是的，有一项研究表明加压素会增加性欲”，或者类似的东西。
But nowadays, I'm reading a lot more about a really interesting peptide treatment, which I think is a FDA-approved prescription drug, which relates to a melanocyte-stimulating hormone that comes out of the medial pituitary that is used to increase sexual desire.
但现在，我读到了更多关于一种非常有趣的肽治疗的内容，我认为这是一种 FDA 批准的处方药，它与一种来自垂体内侧的黑色素细胞刺激激素有关，用于增加性欲。
It's prescribed for women, but men are starting to take it.
它是为女性开的，但男性也开始服用它。
And it seems to have, at least from what you read on the internet, a pretty profound impact on libido and on erectile frequency and persistence.
至少从你在互联网上读到的内容来看，它似乎对性欲、勃起频率和持久性产生了相当深远的影响。
Is this something that you're using in your clinic?
这是您在诊所使用的东西吗？
What about these peptides that people are inhaling and injecting?
人们吸入和注射的这些肽怎么样？
And some of them are taken in oral form, but most often I think it's nasal inhalant or it's a subcutaneous injection.
其中一些是以口服形式服用的，但最常见的是我认为是鼻吸入或皮下注射。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So, those are not ones that we use in clinic.
所以，这些不是我们在临床上使用的。
But I think, looking at sort of just sexual dysfunction broadly, there are a lot of things that we do try and help.
但我认为，从广义上看性功能障碍，我们确实可以尝试并提供很多帮助。
And one of the things that kind of relates to that, it's been a proposed treatment for it, is this concept of delayed orgasm or delayed ejaculation.
与此相关的事情之一是延迟性高潮或延迟射精的概念，这是一种拟议的治疗方法。
So I think everybody's familiar with premature ejaculation, where men ejaculate too quickly.
所以我想每个人都熟悉早泄，即男性射精过快的情况。
But on the other end of the spectrum, there's men that it takes a long time to ejaculate.
但另一方面，有些男性需要很长时间才能射精。
And what that is is sort of defined differently, but generally most people would say two standard deviations above average.
它的定义有点不同，但通常大多数人会说比平均值高两个标准差。
So on average, probably around five minutes or so.
所以平均来说，可能大约五分钟左右。
Two standard deviations would be 20 to 25 minutes.
两个标准差为 20 到 25 分钟。
So for men that take that long to ejaculate, that would be considered delayed, or sometimes they don't ejaculate every time that they have relations.
因此，对于那些需要很长时间才能射精的男性来说，这会被认为是延迟，或者有时他们每次发生关系时都不会射精。
So for those, I think there is a need for treatment because there's no FDA-approved therapy for that.
因此，对于这些，我认为需要治疗，因为目前还没有 FDA 批准的治疗方法。
And so that's why I think providers are trying some of these other, more experimental things.
这就是为什么我认为提供商正在尝试其他一些更具实验性的事情。
There's some that we use, just not that one in particular.
我们使用了一些，但不是特别使用的。
There's also some devices that have been trialed as well, but it's a challenge because I certainly really feel for these men.
还有一些设备也已经过试用，但这是一个挑战，因为我确实对这些人有感情。
It's one of the pleasures in life, and some of them are never able to have sex or only-- or sorry, never able to orgasm, and some are only able to do it very rarely.
这是生活中的乐趣之一，有些人永远无法发生性行为，或者只能——或者抱歉，永远无法达到性高潮，有些人只能很少做爱。
So we do want to offer them benefit.
所以我们确实想为他们提供好处。
Andrew Huberman:
安德鲁·休伯曼：
What about pelvic floor health more generally?
更普遍的盆底健康状况如何？
The topic of pelvic floor health is something that comes up more often around female reproductive health and urology.
盆底健康的话题更常出现在女性生殖健康和泌尿科领域。
You hear about Kegels.
你听说过凯格尔运动。
Kegels.
凯格尔斯。
Kegels.
凯格尔斯。
I don't know.
我不知道。
I guess we'll have to ask him, because it turns out Kegel was a person who named the exercise a- after himself.
我想我们得问问他，因为事实证明凯格尔是一个以自己的名字命名这项练习的人。
Whether or not he did them or not, I do not know.
他是否做了这些事，我不知道。
But my understanding is that Kegels are a pelvic floor strengthening exercise, and my understanding is that some people experience urinary or sexual dysfunction because of an overly relaxed, AKA weak pelvic floor, but that some people have the exact same problems because of a hypercontracted, AKA overly tense, tight, strong pelvic floor.
但我的理解是，凯格尔运动是一种骨盆底强化运动，我的理解是，有些人因为过度放松，又称为骨盆底薄弱而出现泌尿或性功能障碍，但有些人因为过度收缩，又称为过度紧张、紧绷、强健的骨盆底而出现完全相同的问题。
Meaning, don't run out and start doing Kegels just because you heard about them.
意思是，不要仅仅因为听说过凯格尔运动就跑出去开始做。
They're not good for everybody.
它们并不适合所有人。
They might be bad for certain people.
它们可能对某些人有害。
But what about pelvic floor health?
但盆底健康又如何呢？
Should men be paying attention to pelvic floor health?
男性应该关注盆底健康吗？
Should men be doing pelvic floor exercises?
男人到底该不该做骨盆底锻炼？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think it's really key that you say that, because not everything you hear about is good, and I think it's not good for the right person.
我认为你这么说真的很关键，因为并不是你听到的一切都是好的，而且我认为这对合适的人来说并不好。
So there are certainly men that I see that have just a lot of tension, a lot of anxiety.
所以我发现有些男人确实非常紧张、焦虑。
Sometimes these men urinate every hour.
有时这些人每小时都会小便。
There's other things, and you can just tell they're just sort of very wound up.
还有其他事情，你可以看出他们有点紧张。
And I think for that man, one of the issues you kind of allude to is he probably needs to relax more.
我认为对于那个人来说，你提到的问题之一是他可能需要更多的放松。
So pelvic floor physical therapy can still benefit you because there are some just different feedback exercises that can be done to help with relaxation.
因此，盆底物理治疗仍然可以使您受益，因为可以进行一些不同的反馈练习来帮助放松。
So in any urologist office, there's usually a list of a lot of different providers around the region that can help with some of these.
因此，在任何泌尿科医生办公室，通常都会列出该地区许多不同的提供者，可以帮助解决其中一些问题。
Kegel exercises, though, can be useful.
不过，凯格尔练习可能很有用。
For example, for prostate cancer rehabilitation, some of these men where we're trying to kind of rebuild some of the strength or maintain or improve continence in these men.
例如，对于前列腺癌康复，我们正在尝试重建其中一些男性的一些力量，或者维持或改善这些男性的节制能力。
We do want to strengthen some of these muscles just so that they can sort of recreate or replace what was lost when the prostate was removed.
我们确实想增强其中一些肌肉，以便它们能够重建或替代前列腺切除时失去的肌肉。
So I think for the right man, they can be useful.
所以我认为对于合适的人来说，它们可能会有用。
But yeah, it could be a dangerous tool in the wrong hands.
但是，是的，如果落入坏人之手，它可能会成为危险的工具。
Andrew Huberman:
安德鲁·休伯曼：
And you mentioned that if people want to learn more about pelvic floor therapy, they can contact their local urologist and find a good pelvic floor Good male pelvic floor specialists, do they tend to specialize male, female?
而且您提到，如果人们想了解更多关于盆底治疗的知识，他们可以联系当地的泌尿科医生，找到一个好的盆底专家，好的男性盆底专家，他们倾向于专门针对男性还是女性？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
They're usually pretty much gender or sex agnostic, so they usually are able to help all.
他们通常对性别或性别不可知论，所以他们通常能够帮助所有人。
Andrew Huberman:
安德鲁·休伯曼：
And forgive me for asking for an abridged anatomy lesson here, but could you describe the pelvic floor muscles and how they relate to the bladder, prostate, urethra, penis anatomy that you talked about before?
请原谅我在这里要求精简的解剖学课程，但是您能描述一下盆底肌肉以及它们与您之前谈到的膀胱、前列腺、尿道、阴茎解剖学的关系吗？
Because I have the picture of the bladder, urethra, prostate, penis in my brain.
因为我脑子里有膀胱、尿道、前列腺、阴茎的图片。
I know my life experience where the testes and scrotum are relative to all of that, but now I'm trying to figure out.
我知道我的生活经历中睾丸和阴囊与所有这些都相关，但现在我正试图弄清楚。
So the pelvic floor, a bunch of muscles that are attached to the pelvis, but how do they interact with those organs?
那么骨盆底是附着在骨盆上的一堆肌肉，但它们如何与这些器官相互作用呢？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
It's a good question.
这是一个好问题。
So they sit beneath, sort of in the perineum, so the area between the scrotum and the anus, and back beyond too.
所以它们位于会阴下方，也就是阴囊和肛门之间的区域，以及更远的地方。
So they basically support all the structures there.
所以他们基本上支持那里的所有结构。
They support the base of the penis, the prostate, the bladder, the rectum.
它们支撑阴茎根部、前列腺、膀胱、直肠。
And they keep adequate tension to keep all those structures up.
他们保持足够的张力来维持所有这些结构。
They relax when different functions are necessary.
当需要不同的功能时，他们会放松。
They're very important for ejaculation.
它们对于射精非常重要。
Some people think that they kind of trigger some of the orgasmic response as well.
有些人认为它们也会引发一些性高潮反应。
Sometimes men will have pain in that area, and the perineal area can transmit to other parts of the body like the scrotum.
有时男性会在该区域感到疼痛，并且会阴区域会传播到身体的其他部位，例如阴囊。
One cause of scrotal pain, and there can be many, can sometimes be pelvic floor dysfunction.
阴囊疼痛的原因之一（可能有很多），有时可能是盆底功能障碍。
So I think, again, pelvic floor therapy can be useful for a constellation of symptoms, again, some urinary symptoms as well.
因此，我再次认为，盆底疗法对一系列症状有效，尤其是一些泌尿系统症状。
So I think for some patients it can be helpful, but again, if you get things too tense, that can sometimes be harmful.
所以我认为对于某些患者来说这可能是有帮助的，但同样，如果你让事情变得太紧张，有时可能是有害的。
Andrew Huberman:
安德鲁·休伯曼：
So presumably these pelvic floor therapists also help people achieve a more relaxed pelvic floor if that's what they need.
因此，如果人们需要的话，这些盆底治疗师可能也会帮助人们实现更放松的盆底。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
Got it.
明白了。
Going to some of the questions that came back to me when I solicited for questions in anticipation of this episode.
谈谈我在期待这一集时征求问题时想到的一些问题。
Several, not a few .
几个，不是几个。
Let's say a couple dozen people asked about split urine stream.
假设有几十人询问有关分流尿流的问题。
Is that a signature of prostate overgrowth?
这是前列腺过度生长的征兆吗？
Is that a urethral issue?
这是尿道问题吗？
Is it perfectly normal?
这完全正常吗？
I'm assuming here they mean a split stream of urine that doesn't unify at any point.
我假设这里的意思是分流的尿液，在任何时候都不会合并。
They're talking about a consistently split urine stream.
他们谈论的是持续分裂的尿流。
And for those of you that don't know what I'm talking about, we're talking about a urine stream that's actually two urine streams, and we're assuming one urethral opening, because I hit the literature on this.
对于那些不知道我在说什么的人，我们谈论的是一条尿流，实际上是两条尿流，我们假设有一个尿道开口，因为我查阅了这方面的文献。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
And there is a case of a failure to fully fuse the urethral duct during development, where some, I'm assuming small fraction of males, have a urethral opening on the base of the penis and at the tip of the penis.
在发育过程中存在尿道管未能完全融合的情况，其中一些（我假设一小部分男性）在阴茎根部和阴茎尖端有一个尿道开口。
Let's rule that out as a-
让我们将其排除为-
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Okay
好的
Andrew Huberman:
安德鲁·休伯曼：
...
...
possibility for now.
目前的可能性。
But now that it's on the table, what percentage of males have that two urethral openings?
但既然它摆在桌面上，那么有两个尿道口的男性比例是多少呢？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, hypospadias, which you're describing, where the actual meatus is not at the tip, but it's along the proximal urethra or even further down sometimes in the scrotum, probably about 1% of births.
嗯，你所描述的尿道下裂，实际的尿道口并不在尖端，而是沿着近端尿道，有时甚至在阴囊中，可能大约占出生的 1%。
And usually it's recognized at birth, and oftentimes it's surgically corrected because it's better to repair it early rather than later.
通常它在出生时就被识别出来，并且通常会通过手术矫正，因为尽早修复比稍后修复更好。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
So ruling that out, what is the cause of split urine stream, and is it a signature of a larger issue?
那么排除这一点，尿流分流的原因是什么？它是否是一个更大问题的征兆？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
One of the reasons that we urinate from an evolutionary standpoint, is to basically deposit in a convenient time, our waste, and we don't want to get it everywhere because we don't want to label ourselves with the smell of urine, because that'll be easier for predators to be able to identify.
从进化的角度来看，我们排尿的原因之一，基本上是在方便的时候沉积我们的废物，我们不想把它弄得到处都是，因为我们不想用尿液的气味来标记自己，因为这样更容易被掠食者识别。
So just similar to today, we'd like everything to get in the toilet without creating a mess.
所以就像今天一样，我们希望所有东西都能进入厕所而不造成混乱。
So anytime there's turbulent flow, it certainly could signal an issue.
因此，只要出现湍流，就肯定可能预示着出现问题。
So it could be urethral issues, or as you're pointing out, a prostatic issue, inadequate speed of getting the urine out the meatus.
所以这可能是尿道问题，或者正如你所指出的，前列腺问题，尿液从尿道排出的速度不足。
So you definitely should see a physician to get evaluated because there's likely some issue that could be improved.
因此，您绝对应该去看医生进行评估，因为可能存在一些可以改善的问题。
Andrew Huberman:
安德鲁·休伯曼：
The most popular question I received from males, however, was about, perhaps no surprise, penis length.
然而，我从男性那里收到的最常见的问题是关于阴茎长度，这也许并不奇怪。
You're an expert in this, actually.
事实上，你是这方面的专家。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Not just because you're a urologist male reproductive health expert, but you published a study recently on the changing trends in penile length.
不仅因为您是泌尿科男性生殖健康专家，还因为您最近发表了一项关于阴茎长度变化趋势的研究。
Tell us about that study.
请告诉我们有关该研究的信息。
I have so many questions about the methodology because I have to assume this didn't involve self-report, right?
我对方法有很多疑问，因为我必须假设这不涉及自我报告，对吧？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Those were excluded, yeah.
这些都被排除在外了，是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, so lying was excluded.
是的，所以撒谎被排除在外。
I'm being facetious here.
我在这里开玩笑。
But yeah, how was this study done?
但是，是的，这项研究是如何完成的？
Pretty incredible study, and the results are, I don't know if they're surprising or not.
相当令人难以置信的研究，结果是，我不知道它们是否令人惊讶。
At first I thought, "Oh, this is surprising," but the results were only surprising in light of what you were talking about earlier about sperm and testosterone levels.
起初我想，“哦，这太令人惊讶了”，但考虑到你之前谈论的关于精子和睾酮水平的结果，结果才令人惊讶。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
I think I'll let you describe the study now rather than giving people the punchline here.
我想我现在应该让您描述这项研究，而不是在这里给人们提供亮点。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So the origin was that we wanted to know average lengths for another project that we were doing, and going down the rabbit hole, this has been reported for decades.
所以起源是我们想知道我们正在做的另一个项目的平均长度，并且深入研究，这已经报道了几十年。
There's different reasons that people have reported penile length.
人们报告阴茎长度的原因有多种。
Sometimes they do it just on volunteers, again, to get the average lengths of different populations.
有时他们只对志愿者进行测试，再次获得不同人群的平均长度。
Sometimes it's done pre and post-surgically to try and understand what changes would occur.
有时会在手术前和手术后进行，以尝试了解会发生什么变化。
So we just culled the literature, found data on 55,000 men all over the world, and wanted to see if there was a time pattern with that.
因此，我们只是筛选了文献，找到了全世界 55,000 名男性的数据，并想看看是否存在时间模式。
And similar to your hypothesis, we assumed, based on all the other data, that we would likely see a decline, whether it be chemical environmental exposure.
与您的假设类似，我们根据所有其他数据假设，无论是化学环境暴露，我们都可能会看到下降。
But if nothing else, if we're getting bigger, the functional penile length should decline because the suprapubic fat pad will get a little bit bigger, and so we'll lose penile length with that.
但如果不出意外的话，如果我们变大了，功能性阴茎长度应该会下降，因为耻骨上脂肪垫会变大一点，所以我们会因此而失去阴茎长度。
And so much to our surprise-
令我们惊讶的是——
Andrew Huberman:
安德鲁·休伯曼：
The suprapubic fat pad, excuse me, being the pad of fat directly over the penis.
抱歉，耻骨上脂肪垫是直接位于阴茎上方的脂肪垫。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
And so if that gets bigger, that'll necessarily compromise penile length.
因此，如果它变大，必然会影响阴茎的长度。
But as you alluded to, what we found is actually the opposite, that penises were getting longer with time.
但正如你所提到的，我们发现实际上恰恰相反，阴茎随着时间的推移而变长。
So how it's measured, it measured differently.
因此，它的测量方式不同。
So one of our inclusion criteria was that all the studies have measured in an office, in a clinical setting.
因此，我们的纳入标准之一是所有研究都是在办公室、临床环境中进行测量的。
So whether it be a clinician or whether it be a researcher that actually did it.
所以无论是临床医生还是实际做这件事的研究人员。
So there's different ways you can measure a penis.
因此，测量阴茎的方法有多种。
You could just do a stretch length So you kind of stretch it up as much as you can, and then use sort of a ruler to measure how long it is.
你可以做一个拉伸长度所以你可以尽可能地拉伸它，然后使用某种尺子来测量它的长度。
Again, from as deep as you can get, the pubic bone ideally up to the tip of the glans or the-
再次强调，从尽可能深的地方，耻骨理想地到达龟头或-
Andrew Huberman:
安德鲁·休伯曼：
Okay, guys.
好吧，伙计们。
So here's what he's describing.
这就是他的描述。
He's talking about measuring from the top, not from the bottom.
他说的是从顶部开始测量，而不是从底部开始测量。
Believe it or not, people ask questions about this.
不管你信不信，人们都会对此提出疑问。
Measuring from the top, not from the bottom.
从顶部测量，而不是从底部测量。
No cheating.
没有作弊。
You're talking about stretching the penis while it's flaccid, presumably.
您可能正在谈论在阴茎松弛时拉伸阴茎。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
And then measuring from essentially a location that's contact with the pubic bone to the tip.
然后从基本上与耻骨接触的位置到尖端进行测量。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
So that length was recorded in 50,000 men?
那么这个长度是由 50,000 人记录的吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Wow.
哇。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So that was one, and then we also looked at erect length.
这就是其中之一，然后我们还研究了勃起长度。
And so there's different ways that an erection can be achieved sort of in a clinical setting.
因此，在临床环境中可以通过不同的方式实现勃起。
So one is you could ask the man to stimulate himself and then measure.
所以一是你可以让男人刺激自己然后测量。
So that was some of the studies, and then the other method, as we have alluded to earlier, is you could inject the man with a medicine to give him an erection, and then measure it.
这就是一些研究，然后是另一种方法，正如我们之前提到的，你可以给男人注射药物，让他勃起，然后测量它。
Andrew Huberman:
安德鲁·休伯曼：
And did 50,000 men participate in that aspect of the study?
是否有 50,000 名男性参与了这方面的研究？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
It was less.
还少了。
No, I think that was about probably 10 to 15,000 men.
不，我认为大概有 10 到 15,000 人。
Andrew Huberman:
安德鲁·休伯曼：
I have to wonder whether or not it's easy or difficult for people to recruit subjects for these studies.
我想知道人们为这些研究招募受试者是容易还是困难。
I don't know.
我不知道。
I could see it going both ways.
我可以看到事情是双向的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, some of the studies actually had a tremendous number, had about 15,000 men.
是的，有些研究实际上涉及的人数非常多，大约有 15,000 名男性。
Some individual studies contributed to that.
一些个人研究对此做出了贡献。
And actually, interestingly, after we published it, there were some men that volunteered for the next study to be measured.
事实上，有趣的是，在我们发表该研究后，有一些男性自愿参加下一项要测量的研究。
Andrew Huberman:
安德鲁·休伯曼：
I'm sure you'll hear from some of them after this episode.
我相信在这一集之后你会听到他们中的一些人的来信。
What was the major finding?
主要发现是什么？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So the major finding we wanted to do is just give normative data.
因此，我们想要做的主要发现就是提供规范数据。
We found that it varied around the world.
我们发现世界各地的情况各不相同。
So based on different regions, the average lengths varied a little bit.
因此，根据不同的地区，平均长度略有不同。
But generally, on average, an erect penis is probably between about five to six inches, somewhere in that neighborhood.
但一般来说，平均而言，勃起的阴茎可能在该附近的某个地方大约五到六英寸之间。
So that was kind of the take home we wanted.
这就是我们想要带回家的东西。
Andrew Huberman:
安德鲁·休伯曼：
That was the average?
那是平均数吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
The average for erect length.
直立长度的平均值。
Andrew Huberman:
安德鲁·休伯曼：
Did you publish the full distributions?
您发布了完整的发行版吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
We didn't.
我们没有。
Our plan was actually to make a follow-on study, so we could show everybody, I guess probably they were interested where they kind of fell on the graph.
我们的计划实际上是进行一项后续研究，这样我们就可以向每个人展示，我想他们可能对自己在图表上的位置感兴趣。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
But it was fairly normally distributed.
但它是相当正态分布的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
I would think that despite the wide availability of pornography, that the distributions, like the scatter plots of all the data would be interesting to men.
我认为，尽管色情内容随处可见，但其分布（如所有数据的散点图）对男性来说会很有趣。
For the same reason that the testosterone by function of age data published as a scatter plot in that textbook I referred to earlier-
出于同样的原因，在我之前提到的教科书中，睾丸激素随年龄数据的变化以散点图形式发布——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
were interesting because the scatter plot distributions, I feel like point to other takeaways.
很有趣，因为散点图分布，我觉得指向其他要点。
That one can be in their 70s and have testosterone levels equivalent to a healthy male in his 30s.
这个人可能已经 70 多岁了，睾丸激素水平相当于 30 多岁的健康男性。
That one can be in their 30s and have testosterone levels that are twice as much or half as much as age-matched cohort, this kind of thing.
这个人可能已经 30 多岁了，睾丸激素水平是同龄人的两倍或一半，诸如此类。
I think there's value in that.
我认为这很有价值。
So what other takeaways arrived with the data from the penis length study that perhaps we didn't hear about?
那么，阴茎长度研究的数据还得出了哪些我们可能没有听说过的结论呢？
What did you find most interesting about the data?
您对这些数据最感兴趣的是什么？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Well, that there was any change over time.
嗯，随着时间的推移有任何变化。
This was a fairly short study.
这是一项相当简短的研究。
It was probably about 30 years or so.
大概有30年左右的时间了。
But we did find that penile length has been increasing over time.
但我们确实发现阴茎长度随着时间的推移而增加。
So that was just sort of fascinating that we would see in such a short interval of time that there would be a change, number one, but that we'd see a lengthening, number two.
因此，这有点令人着迷，我们会在如此短的时间间隔内看到第一点发生变化，但第二点我们会看到延长。
So again, similar to the concerns that arose for these relatively short period of time where you would see changes in semen quality.
同样，与在相对较短的时间内出现的担忧类似，您会看到精液质量的变化。
It suggests something sinister, right?
这暗示着一些险恶的事情，对吧？
It's unlikely to be a genetic change because that would take centuries probably.
这不太可能是基因变化，因为这可能需要几个世纪的时间。
Certainly several generations.
当然是几代人了。
So the fact that this happened so quickly was just surprising.
因此，这件事发生得如此之快，实在令人惊讶。
Andrew Huberman:
安德鲁·休伯曼：
This brings to mind some of work that I was involved in years ago.
这让我想起了我几年前参与的一些工作。
When I was a master's student, I studied early organizing effects of hormones on the brain and body, and I'm sure this has been updated since then, but my recollection is that during embryonic development, males are exposed to a certain amount of dihydrotestosterone.
当我还是一名硕士生时，我研究了激素对大脑和身体的早期组织影响，我确信从那时起这已经更新了，但我的记忆是，在胚胎发育过程中，男性会接触一定量的二氢睾酮。
Not testosterone, but dihydrotestosterone, which organizes the brain male, as they used to say.
不是睾酮，而是二氢睾酮，正如人们常说的，它负责组织男性的大脑。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Now the verbiage around that would probably be a little bit different.
现在，围绕这一点的措辞可能会有所不同。
But the idea is that males are born with penile tissue, of course, but then it's during puberty that the same hormone, dihydrotestosterone, then exerts an activating effects on the genitals, and the genitals grow during puberty.
但这个想法是，男性出生时就有阴茎组织，当然，但在青春期，同一种激素二氢睾酮会对生殖器产生激活作用，并且生殖器在青春期生长。
Penis length increases.
阴茎长度增加。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
So assuming that the study that you did was on males post-puberty-
所以假设你所做的研究是针对青春期后的男性——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
I'm assuming it was.
我猜是这样的
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yes.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Then it would imply that something's changing about the levels or the signaling related to dihydrotestosterone.
那么这意味着与二氢睾酮相关的水平或信号发生了变化。
How could that happen?
怎么会发生这种事？
Do we have any ideas about what might be happening?
我们对可能发生的事情有什么想法吗？
This is the opposite of environmental endocrine disruptors preventing sperm from being as high quality and numerous as they could be, or for-
这与环境内分泌干扰物相反，环境内分泌干扰物会阻止精子达到应有的高质量和数量，或者-
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm
嗯嗯
Andrew Huberman:
安德鲁·休伯曼：
...
...
environmental factors, either in utero or post utero, suppressing testosterone levels.
子宫内或子宫后的环境因素会抑制睾酮水平。
Here we're talking about the opposite effect.
这里我们讨论的是相反的效果。
We're talking about dihydrotestosterone levels presumably being higher in males over the last 30 years, and thereby longer penises.
我们谈论的是过去 30 年来男性的二氢睾酮水平可能较高，因此阴茎更长。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
So I think there's different conjectures that you could make about why this could happen.
所以我认为你可以对为什么会发生这种情况做出不同的推测。
It could be maybe endocrine-disrupting chemicals in utero, some early exposure that some of the mothers had to androgenic effects during the male programming window that may have led to some longer lengths.
可能是子宫内的内分泌干扰化学物质，一些母亲在男性编程窗口期间早期接触到雄激素效应，这可能导致长度更长。
Another hypothesis we had is that if males are going through puberty earlier, the earlier one goes through puberty, the longer length tends to be.
我们的另一个假设是，如果男性提前进入青春期，越早进入青春期，长度往往就越长。
So maybe that provides sort of this link.
所以也许这提供了这种链接。
Andrew Huberman:
安德鲁·休伯曼：
Sure.
当然。
So earlier puberty tends to be longer, potentially means longer duration exposure to dihydrotestosterone-
因此，青春期提前往往会更长，可能意味着接触二氢睾酮的时间更长-
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right
右
Andrew Huberman:
安德鲁·休伯曼：
...
...
longer penises.
更长的阴茎。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
You may be surprised to know you might not be surprised to know that there is a subculture online, I know because they contacted me in anticipation of this episode of post-pubertal males who take a combination of dihydrotestosterone and low levels of growth hormone in efforts to try and increase their penile length.
你可能会惊讶地发现，你可能不会惊讶地知道网上有一种亚文化，我知道，因为他们联系我是为了期待青春期后男性的这一事件，他们服用二氢睾酮和低水平的生长激素来努力增加阴茎长度。
And the ones taking dihydrotestosterone, they're not taking pure DHT, they're taking things like oxandrolone, which very closely mimics the structure of DHT.
那些服用二氢睾酮的人，他们服用的并不是纯粹的双氢睾酮，而是氧雄龙之类的东西，它的结构非常模仿双氢睾酮的结构。
They report some success.
他们报告取得了一些成功。
Fortunately, they did not send me pictures.
幸运的是，他们没有给我发照片。
Otherwise, I would've just forwarded them to you for your next study.
否则，我会把它们转发给您供您下次研究。
But this stuff is happening in post-pubertal males, so it all rests on this dihydrotestosterone hypothesis.
但这种情况发生在青春期后的男性身上，所以这一切都取决于二氢睾酮假说。
I don't know, just a point of interest.
我不知道，只是一个兴趣点。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
I don't know.
我不知道。
Just physiologically, it doesn't make sense why that would work, as you're pointing out, post-pubertally, unless they're doing other things.
只是从生理上来说，正如你所指出的，在青春期后，为什么这会起作用是没有意义的，除非他们在做其他事情。
Some sort of stretching exercises or a thing called jelqing, but yeah, I would not recommend that.
某种伸展运动或称为 jelqing 的东西，但是，是的，我不会推荐这样做。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
Thank you.
谢谢。
That was the response I was looking for.
这就是我一直在寻找的回应。
So, that community will be listening with open ears.
因此，该社区将倾听。
Don't do it.
不要这样做。
As long as we're talking about DHT, dihydrotestosterone, it's only fair to discuss the drugs that many people take to suppress dihydrotestosterone in hopes to keep or grow their hair.
只要我们谈论双氢睾酮（DHT），即二氢睾酮，那么讨论许多人为了保留或生长头发而服用的抑制二氢睾酮的药物是公平的。
Things like finasteride, dutasteride.
比如非那雄胺、度他雄胺。
Some, maybe many, not all people who take these drugs, particularly in oral form, experience sexual dysfunction issues, and other issues related to suppressing DHT.
一些（也许是很多）服用这些药物（尤其是口服药物）的人会遇到性功能障碍问题以及与抑制 DHT 相关的其他问题。
That said, my understanding is that these drugs are also quite useful, maybe even life-saving in some cases, for staving off certain forms of prostate cancer.
也就是说，我的理解是，这些药物对于预防某些形式的前列腺癌也非常有用，在某些情况下甚至可以挽救生命。
What are your thoughts about finasteride, dutasteride?
您对非那雄胺、度他雄胺有何看法？
Do you see people coming into your clinic who are having sexual dysfunction or other types of issues because of their hair, or attempt to maintain or grow their hair issues?
您是否看到来到您诊所的人因头发而出现性功能障碍或其他类型的问题，或试图维持或留出头发问题？
And equally important is that we talk about so-called post-finasteride syndrome.
同样重要的是，我们谈论所谓的后非那雄胺综合症。
I got a lot of questions about post-finasteride syndrome, because I'll describe it in a couple of minutes.
我有很多关于非那雄胺后综合症的问题，因为我将在几分钟内描述它。
It sounds pretty devastating for these people's lives.
这听起来对这些人的生活来说是毁灭性的。
And I'll explain why it's so devastating for them in a moment.
我稍后会解释为什么这对他们来说如此具有毁灭性。
But yeah, what about finasteride, dutasteride, and these drugs that are effectively DHT blockers?
但是，是的，非那雄胺、度他雄胺以及这些有效的 DHT 阻滞剂药物呢？
DHT levels, if they get too high, indeed can miniaturize the hair follicle, cause people to lose their hair, typically up front or in the back, so-called crown or whatever, widow's peak, or everywhere in some cases.
如果 DHT 水平过高，确实会使毛囊缩小，导致人们脱发，通常是前面或后面的头发，所谓的头顶或其他什么，寡妇峰，或者在某些情况下到处都是。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
It also induces hair growth on the back, beard growth, as we understand.
正如我们所知，它还会导致背部毛发生长、胡须生长。
But then people go and take these drugs to try and maintain or grow their hair, and oftentimes they have erectile dysfunction or other issues.
但随后人们服用这些药物来尝试维持或生长头发，他们常常会出现勃起功能障碍或其他问题。
Is that surprising to you?
这让你感到惊讶吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think the men that we see these side effects tend to be younger men in their 20s, 30s, and 40s.
我认为我们看到这些副作用的男性往往是 20 多岁、30 多岁和 40 多岁的年轻男性。
And they take it, as you're pointing out, for hair loss.
正如你所指出的，他们将其用于治疗脱发。
So before it was FDA approved for that indication, or at least finasteride was, they did randomized controlled trials to look.
因此，在 FDA 批准该适应症之前，或者至少非那雄胺批准之前，他们进行了随机对照试验来进行观察。
And one of the other things that we'll talk about, too, is just reproductive effects.
我们还将讨论的其他事情之一就是生殖影响。
So they did lots of studies to see if there were changes in semen quality for men on finasteride versus the placebo.
因此，他们进行了大量研究，看看服用非那雄胺的男性与服用安慰剂的男性精液质量是否有变化。
And there were some very subtle changes, but in post-marketing, now we see these patients in clinic.
还有一些非常微妙的变化，但在上市后，现在我们在临床上看到了这些患者。
Everybody to enroll in these studies had normal function, so I think that's important to understand.
参加这些研究的每个人都有正常的功能，所以我认为理解这一点很重要。
And obviously that's not life, right?
显然这不是生活，对吧？
That people come in with different baselines and different amounts of reserve.
人们带着不同的基线和不同的储备量进来。
And so we now know that there's probably people that are a lot more sensitive to these medications than others.
所以我们现在知道，可能有些人对这些药物比其他人更敏感。
And so there are some men that drop their sperm counts dramatically.
因此，有些男性的精子数量急剧下降。
And usually, if we stop these medications, their sperm counts can recover.
通常，如果我们停止这些药物，他们的精子数量就可以恢复。
And usually a spermatogenic cycle is probably about two to three months, so usually in maybe three to six months, we usually see recovery for most men.
通常，生精周期可能约为两到三个月，因此通常在三到六个月内，我们通常会看到大多数男性的康复。
But similarly for sexual function.
但性功能也类似。
I certainly have a number of patients that do complain of low libido, erectile function, this post-finasteride syndrome.
我确实有很多患者抱怨性欲低下、勃起功能低下，这是非那雄胺后综合征。
And the mechanisms, I think, are less certain because measuring testosterone levels, which we do, sometimes if androgens are low, or even if androgens seem to be in the maybe normal range or low normal range, we'll try and increase testosterone through a variety of means.
我认为，其机制不太确定，因为我们测量睾酮水平，有时如果雄激素水平较低，或者即使雄激素似乎在正常范围或较低的正常范围内，我们也会尝试通过各种方式增加睾酮。
Testosterone, clomiphene sometimes we'll give.
有时我们会给予睾酮、克罗米芬。
It helps some men, but not all.
它对一些男人有帮助，但不是全部。
So I think the exact mechanism of what is going on here, what is changing, I think we need more understanding about the exact sort of pathophysiology neurochemically.
所以我认为这里发生的事情的确切机制，正在发生的变化，我认为我们需要更多地了解神经化学病理生理学的确切类型。
Andrew Huberman:
安德鲁·休伯曼：
It seems like a pretty serious trade-off to either maintain or grow hair or lose sexual function.
保持或生长头发或失去性功能似乎是一个相当严肃的权衡。
I talked about DHT and some of these side effects of finasteride, dutasteride on previous episodes.
我在之前的剧集中谈到了 DHT 以及非那雄胺、度他雄胺的一些副作用。
And I'm not a clinician, but my encouragement is always for people to approach these drugs with a real level of seriousness, if not caution.
我不是临床医生，但我始终鼓励人们以真正的严肃态度（即使不是谨慎）对待这些药物。
The post-finasteride syndrome was described in these online questions as seemingly permanent, even though people had ceased to take finasteride or dutasteride.
尽管人们已经停止服用非那雄胺或度他雄胺，但这些在线问题将非那雄胺后综合症描述为似乎是永久性的。
So in other words, they were taking this stuff, I don't know how they felt while they were on it, but they stopped taking it, and the sexual dysfunction issues don't seem to be resolving.
换句话说，他们服用了这种东西，我不知道他们服用时感觉如何，但他们停止服用了，而且性功能障碍问题似乎没有得到解决。
Does that mean they should go see you or another male urologist, reproductive health specialist?
这是否意味着他们应该去看您或其他男性泌尿科医生、生殖健康专家？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, oftentimes they do for these complaints.
是的，他们通常会因为这些抱怨而这样做。
They start to notice it when they're on the medication, then when they, usually through online research, learn about this potential entity.
当他们服用药物时，他们开始注意到它，然后当他们通常通过在线研究了解这个潜在实体时。
Sometimes they discontinue.
有时他们会停止。
Now, some men do have resolution when they stop, but there is this permanence in some handful of men.
现在，有些人在停下来时确实有决心，但只有少数人能做到这种持久性。
They've done MRI imaging to try and understand more anatomically or functionally what exactly is going on.
他们进行了核磁共振成像，试图从解剖学或功能上更多地了解到底发生了什么。
I think there's still a lot of Unknowns about it, but it can be permanent for some.
我认为仍然有很多未知数，但对某些人来说可能是永久性的。
So they come in and they see me in clinic, erectile dysfunction, low libido, and then we go down all the host of treatments that we talked about and the evaluations that we talked about.
所以他们进来，在诊所看我，勃起功能障碍，性欲低下，然后我们记录下我们谈论过的所有治疗方法和评估。
Again, we have resolution in some, but there are some that seem treatment refractory.
同样，我们对一些问题有了解决方案，但有些问题似乎难以治疗。
Andrew Huberman:
安德鲁·休伯曼：
Yikes.
哎呀。
That's my only response.
这是我唯一的回应。
Permanent effects on sexual health as a consequence of an attempt to maintain one's hair.
试图保养头发会对性健康造成永久性影响。
This is where, in all seriousness, it just sounds like something that people need to think very seriously about because as I understand, there's nothing that can predict whether or not someone will have post-finasteride syndrome.
严肃地说，这听起来像是人们需要认真思考的事情，因为据我所知，没有任何东西可以预测某人是否会患有非那雄胺后综合症。
Right?
正确的？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
And I did a bit of reading on this within the scientific journals as well.
我也在科学期刊上读了一些这方面的内容。
There isn't a lot of information, as you point out, because it's a fairly recent phenomenon.
正如您所指出的，没有太多信息，因为这是一个相当新的现象。
That highlights a different issue.
这凸显了一个不同的问题。
This may be the first time in history where young males are taking finasteride and dutasteride, and that might be the cause of the post-finasteride syndrome.
这可能是历史上第一次年轻男性服用非那雄胺和度他雄胺，这可能是非那雄胺后综合症的原因。
I think you alluded to this earlier.
我想你之前已经提到过这一点。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
These drugs have proven to be very beneficial for older men treating prostate issues.
这些药物已被证明对治疗前列腺问题的老年男性非常有益。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Exactly, yeah.
没错，是的。
Andrew Huberman:
安德鲁·休伯曼：
Right.
对。
So post-finasteride syndrome, I think falls under the category of medical conditions that a few years ago, we would hear the same about chronic fatigue syndrome, even fibromyalgia not long ago was considered one of these, "Oh, is it all a psychosomatic issue?" Now we now clearly know that's not the case for fibromyalgia, by the way.
因此，我认为后非那雄胺综合症属于医疗状况的范畴，几年前，我们会听到同样的慢性疲劳综合症，甚至不久前的纤维肌痛也被认为是其中之一，“哦，这都是心身问题吗？”顺便说一句，现在我们清楚地知道纤维肌痛并非如此。
But I can recall a time not that long ago when people in the medical profession were like, "Well, yeah, I don't know if this is a real thing," but post-finasteride syndrome sounds certainly real for the people that are suffering from it.
但我记得不久前，医学界的人们会说，“嗯，是的，我不知道这是否是真的”，但非那雄胺后综合症对于患有该综合症的人来说听起来确实是真实的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Exactly, yeah.
没错，是的。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Well, the reason I'm spending so much time on this is that I get a lot of questions about it, and there are clearly a lot of young males who take finasteride or dutasteride or are thinking of doing that for cosmetic reasons, and I think they should be aware of the potentially serious consequences.
嗯，我花这么多时间在这上面的原因是我收到了很多关于它的问题，显然有很多年轻男性服用非那雄胺或度他雄胺，或者出于美容原因考虑这样做，我认为他们应该意识到潜在的严重后果。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, agreed.
是的，同意。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
But you did say earlier that if someone has a penis, you can get it hard.
但你之前确实说过，如果某人有阴茎，你可能会感到坚硬。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
So all is not lost even for these post-finasteride syndrome-
因此，即使对于这些后非那雄胺综合征，也没有失去一切——
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
That's true
确实如此
Andrew Huberman:
安德鲁·休伯曼：
...
...
individuals.
个人。
Good.
好的。
Okay.
好的。
We'll hold you to that.
我们会让你坚持下去。
You mentioned clomiphene.
你提到了克罗米芬。
Could you explain what clomiphene is and what it's used for?
您能解释一下克罗米芬是什么以及它的用途吗？
Because again, we want this discussion to be centered around the real science, the real medicine, but there is a growing sub community of people out there who are saying, "Okay, testosterone therapy can cause us these sperm suppressive issues and perhaps some other issues," but doing nothing might not be an option for somebody who wants to increase their libido, other aspects of androgen function.
因为我们再次希望这个讨论围绕真正的科学、真正的医学展开，但是越来越多的人说，“好吧，睾酮疗法可能会导致我们这些精子抑制问题，也许还有其他一些问题”，但对于那些想要增加性欲和雄激素功能其他方面的人来说，什么都不做可能不是一个选择。
And so there are a growing number of people out there who are taking clomiphene only in order to presumably increase testosterone, but my understanding is that it would impact the estrogen pathway as well.
因此，越来越多的人服用克罗米芬可能只是为了增加睾酮水平，但我的理解是，它也会影响雌激素途径。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
What's clomiphene?
克罗米芬是什么？
What are your thoughts about people using clomiphene sort of off-label simply to increase androgens?
您对人们使用克罗米芬这种标签外药物只是为了增加雄激素有何看法？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Andrew Huberman:
安德鲁·休伯曼：
Seems sketchy to me for reasons related to changes in neural circuits, but you'll tell us how it works.
由于与神经回路变化相关的原因，这对我来说似乎很粗略，但你会告诉我们它是如何工作的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
Well, thank you for including the off-label disclosure.
好吧，谢谢您纳入标签外披露。
Anytime I talk about this, I always have to say that.
每当我谈论这个时，我总是不得不这么说。
So clomiphene is a selective estrogen receptor modulator.
因此克罗米芬是一种选择性雌激素受体调节剂。
So basically, it blocks estrogen.
所以基本上，它会阻止雌激素。
And so from our earlier discussions of how the pituitary works, there's sort of an elaborate feedback loop between the pituitary and the gonads in the man, the testes.
因此，从我们之前对垂体如何工作的讨论来看，垂体和男性性腺（睾丸）之间存在着一种复杂的反馈回路。
And so what happens is FSH, LH, these gonadotropins stimulate the testicle to make sperm and testosterone.
所以会发生 FSH、LH，这些促性腺激素刺激睾丸产生精子和睾酮。
Testosterone's peripherally converted to estrogen, and that feeds back on the hypothalamus to stop that.
睾酮在外周转化为雌激素，并反馈到下丘脑以阻止这种情况发生。
So again, you don't get an overproduction.
再说一遍，你不会出现生产过剩。
So by blocking the estrogen receptor at the level of the pituitary or the hypothalamus, you'll stop that.
因此，通过阻断垂体或下丘脑水平的雌激素受体，您就可以阻止这种情况。
And so the idea behind blocking that is that you'll get more production of FSH, LH, more of these drivers, so you get more testosterone.
因此，阻止这一过程背后的想法是，您将获得更多的 FSH、LH 以及更多这些驱动因素，从而获得更多的睾丸激素。
You get higher stimulation of the testicle.
您会得到对睾丸的更高刺激。
The hope is that for fertility, that sometimes it can improve sperm production too, and there's some limited data that can help.
希望对于生育能力来说，有时它也可以提高精子的产生，并且有一些有限的数据可以提供帮助。
But I think as you're alluding to, it's sort of a way to just augment your body's own production of testosterone.
但我认为正如你所提到的，这是一种增加身体自身睾酮分泌的方法。
So it certainly does that.
所以它肯定会这样做。
I think there's no question that testosterone levels do rise.
我认为毫无疑问睾丸激素水平确实会上升。
I think that the reason that doesn't always help is because not every problem is solved by testosterone.
我认为这并不总是有帮助的原因是睾酮不能解决所有问题。
We kind of talked about some in this discussion, but also that you do need some estrogenic signaling as well.
我们在这次讨论中讨论了一些，但你也确实需要一些雌激素信号。
And so by blocking that, even partially, because there's also some partial agonist effects of clomiphene as well, it may limit it.
因此，通过阻止它，即使是部分阻止，因为克罗米芬也有一些部分激动剂作用，它可能会限制它。
And it turns out that estrogen signaling is important for a lot of things.
事实证明，雌激素信号对于很多事情都很重要。
It's important for bone health, but sexual health too.
它对骨骼健康很重要，但性健康也很重要。
It's important for libido.
这对性欲很重要。
So that may be partially blunting some of the hoped-for benefits of testosterone.
因此，这可能会部分削弱睾丸激素所带来的一些预期益处。
I found that men tend to be happier on testosterone than some of these other forms, and that could be a possible explanation.
我发现男性往往比其他形式的睾酮更快乐，这可能是一个可能的解释。
But one of the advantage of clomiphene, if we are thinking about this as a treatment for low testosterone hypogonadism, is that it doesn't have the same toxic effects on sperm production.
但如果我们将其视为低睾酮性腺功能减退症的治疗方法，那么克罗米芬的优点之一就是它不会对精子产生产生同样的毒性作用。
So by maintaining the body's own production of testosterone, by maintaining production of FSH, LH, we'll continue to get sperm production.
因此，通过维持身体自身睾酮的产生，通过维持 FSH、LH 的产生，我们将继续获得精子的产生。
So for this reproductive-aged man that has low testosterone and symptomatic low testosterone, low energy levels, sex drive, mood, sleep problems, it can be a worthwhile treatment.
因此，对于这个睾酮水平低、有低睾酮症状、精力水平低、性欲低、情绪低、睡眠问题的育龄男性来说，这可能是一种值得的治疗。
And it does help a lot of men, but not everybody.
它确实对很多男人有帮助，但不是每个人。
Andrew Huberman:
安德鲁·休伯曼：
I've always been curious why if the goal is to increase sperm production, that the most common treatment is hCG, human chorionic gonadotropin.
我一直很好奇，如果目标是增加精子产量，为什么最常见的治疗方法是 hCG（人绒毛膜促性腺激素）。
Because as you mentioned earlier, luteinizing hormone and FSH, follicle-stimulating hormone, are deployed from the pituitary and travel to the testes where they stimulate testosterone production and sperm production.
因为正如您之前提到的，黄体生成素和 FSH（促卵泡激素）从垂体释放并到达睾丸，刺激睾丸激素的产生和精子的产生。
But it's the FSH specifically that encourages- ...
但 FSH 特别鼓励——...
sperm production.
精子的产生。
So why wouldn't a man who's taking maybe testosterone therapy, or who perhaps just wants increased sperm count and quality, take FSH instead of human chorionic gonadotropin, which is more or less a proxy for luteinizing hormone?
那么，为什么一个正在接受睾酮治疗的男性，或者可能只是想增加精子数量和质量的男性，不服用 FSH 而不是人绒毛膜促性腺激素（它或多或少是黄体生成素的代表）呢？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
That's a really good question.
这是一个非常好的问题。
And so what FSH does, like you said, is it stimulates sperm production, so it seems like it'd be a much more logical treatment.
所以，正如你所说，FSH 的作用是刺激精子的产生，所以这似乎是一种更合乎逻辑的治疗方法。
And actually, in randomized placebo-controlled trials, it does do that.
事实上，在随机安慰剂对照试验中，它确实做到了这一点。
So one of the reasons-
所以原因之一是——
Andrew Huberman:
安德鲁·休伯曼：
It does not?
不是吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
It does do that.
它确实做到了这一点。
Andrew Huberman:
安德鲁·休伯曼：
Oh, okay.
哦，好吧。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
It does help.
它确实有帮助。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
So it's beneficial, and we should give it more.
所以它是有益的，我们应该给予更多。
But one of the reasons that we don't is cost.
但我们不这样做的原因之一是成本。
So it's rarely covered by insurance.
所以很少有保险可以报销。
And hCG, a month of that is in the hundreds of dollars, so let's say like $300 to $500.
而 hCG，一个月要几百美元，所以我们可以说是 300 到 500 美元。
But a month of sort of therapeutic FSH is probably $2,000 to $3,000.
但一个月的治疗性 FSH 可能需要 2,000 至 3,000 美元。
So that cost is really limiting.
所以这个成本确实很有限。
It takes two to three months to make a sperm, so men often would have to be on it for several months.
产生精子需要两到三个月的时间，因此男性通常需要几个月的时间。
But there is reasonable data that would help, and it does make a lot more sense that that should be given as adjuvant therapy with testosterone rather than hCG.
但有合理的数据会有所帮助，而且应该用睾酮而不是 hCG 作为辅助治疗，这确实更有意义。
But hCG does work.
但hCG确实有效。
Everyone's surprised it does actually help.
每个人都惊讶于它确实有帮助。
But yeah, I agree, there is sort of a contradiction there.
但是，是的，我同意，这里面存在着某种矛盾。
So if the price came down, this is another off-label medication for that indication.
因此，如果价格下降，这将是另一种适应症的标签外药物。
It could be worthwhile.
这可能是值得的。
Andrew Huberman:
安德鲁·休伯曼：
One hormone that we haven't discussed is prolactin.
我们尚未讨论的一种激素是催乳素。
I'm familiar with prolactin from a variety of perspectives, but I always think of dopamine and prolactin as kind of a seesaw relationship.
我从多个角度熟悉催乳素，但我始终认为多巴胺和催乳素是一种拉锯关系。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Mm-hmm.
嗯嗯。
Andrew Huberman:
安德鲁·休伯曼：
Dopamine's up, prolactin is down.
多巴胺升高，催乳素降低。
Dopamine is elevated with sexual desire, sexual activity.
多巴胺随着性欲、性活动而升高。
Post-ejaculation, prolactin goes up, sets perhaps the refractory period on erection, ejaculation for some period of time, and then dopamine comes back up.
射精后，催乳素上升，可能会设定勃起不应期，射精一段时间，然后多巴胺恢复。
But this kind of thing.
但这种事情。
And I realize that's far too simplistic, that prolactin is doing many things in the brain and body besides that.
我意识到这太简单了，除此之外，催乳素还在大脑和身体中发挥着许多作用。
But how often do you see hyperprolactinemias?
但是高催乳素血症多久出现一次呢？
I don't know if plural, prolactinemias, is clinically correct.
我不知道复数催乳素血症在临床上是否正确。
But elevated levels of prolactin that are causing problems for men.
但催乳素水平升高给男性带来了问题。
What are some of the telltale signs of that?
有哪些迹象可以说明这一点？
And this I'd like to use as a segue to talking about some of the sexual dysfunction that is commonly discussed around the use of SSRIs and other drugs to treat depression and mental health issues that sometimes create endocrine and/or sexual health issues.
我想以此为契机来讨论一些性功能障碍，这些功能障碍是围绕使用 SSRI 和其他药物治疗抑郁症和有时会产生内分泌和/或性健康问题的其他药物而经常讨论的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So prolactin, hyperprolactinemia, it's a diagnosis.
所以催乳素，高催乳素血症，这是一个诊断。
Not that many times.
没那么多次。
I would say less than 1% of the patients that we see will end up having that.
我想说，我们看到的患者中只有不到 1% 最终会出现这种情况。
But usually it's a handful of times a year because we see a lot of patients.
但通常一年会见几次，因为我们看的病人很多。
Typically, the telltale sort of symptoms would be ones of low testosterone.
通常，最明显的症状是睾丸激素水平低。
That's a common one.
这是一个常见的。
But in my practice, I see it a lot with men with very low sperm production.
但在我的实践中，我经常在精子产量极低的男性身上看到这种情况。
So I've diagnosed several prolactin-secreting tumors, and the manifestation of that was they weren't getting pregnant.
所以我诊断出了几个催乳素分泌肿瘤，其表现就是她们没有怀孕。
We checked the sperm count, it was very low.
我们检查了精子数量，非常低。
That mandates a check of testosterone, which is also very low, and then that leads to a prolactin, which is very high, and then that was diagnosed.
这就要求检查睾酮水平，睾酮水平也非常低，然后检查催乳素，水平非常高，然后就被诊断出来了。
So it's something, I think, to be aware of, but there's not usually a lot of symptoms, and sort of going to a clinician when you're having sexual dysfunction symptoms, low testosterone, or fertility problems will usually be able to diagnose it if it's present.
所以我认为这是需要注意的事情，但通常不会有很多症状，当你出现性功能障碍症状、睾丸激素水平低或生育问题时，去看临床医生通常能够诊断出这些症状（如果存在）。
Andrew Huberman:
安德鲁·休伯曼：
Are there any other hormones in the galaxy of sexual health-related hormones that fall into common clinical practice for you?
在与性健康相关的激素星系中，还有其他属于您常用临床实践的激素吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I check estrogen as well.
我也检查雌激素。
So I think that's another one.
所以我认为那是另一回事。
Andrew Huberman:
安德鲁·休伯曼：
Okay.
好的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Again, because of the relationship with obesity, I think that can be important.
同样，由于与肥胖的关系，我认为这可能很重要。
Sometimes there's too much aromatization, and so sometimes that can be a problem.
有时芳香化过多，有时这可能会成为问题。
I think just like we talked about normal estrogen signaling is important, I think too much can be bad.
我认为就像我们谈到正常的雌激素信号很重要一样，我认为太多也可能不好。
So there are some men where we do see manifestations that it can manifest as gynecomastia in some cases.
因此，在某些男性中，我们确实看到了在某些情况下表现为男性乳房发育症的表现。
Andrew Huberman:
安德鲁·休伯曼：
Male breast tissue.
男性乳房组织。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Male breast tissue, yeah.
男性乳房组织，是的。
Andrew Huberman:
安德鲁·休伯曼：
Mm-hmm.
嗯嗯。
As I was told, what was it?
有人告诉我，那是什么？
That the male breast tissue is sort of like the appendix.
男性乳房组织有点像阑尾。
It's there, but it's not very interesting.
它就在那里，但不是很有趣。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Yeah.
是的。
Everybody has some, and we just don't want the growth to get out of control.
每个人都有一些，我们只是不希望增长失控。
Andrew Huberman:
安德鲁·休伯曼：
Could you tell us about one of the world's most difficult to pronounce words, which is varicocele?
您能告诉我们世界上最难发音的单词之一是精索静脉曲张吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yes.
是的。
So varicocele, it's a very common condition.
精索静脉曲张是一种非常常见的疾病。
Probably about 15% of all men have it, and it's a very common cause of infertility.
大约有 15% 的男性患有此病，这是导致不孕不育的一个非常常见的原因。
If you look at all the etiologies, it can be 30% to 40%.
如果你看一下所有的病因，这个比例可能是 30% 到 40%。
So basically what it is, is dilated veins in the scrotum.
所以基本上它是什么，是阴囊中扩张的静脉。
So obviously we need veins to get blood out of the testicles.
显然我们需要静脉将血液从睾丸中排出。
But sometimes they can be a little larger than average, and there's sort of a normal thermal regulation.
但有时它们可能比平均水平稍大一些，并且存在某种正常的热调节。
So if the veins get too big, it's thought to warm up the testicle.
因此，如果静脉变得太大，就会使睾丸变暖。
The other thought is that it doesn't adequately clear some of the metabolites.
另一种想法是它不能充分清除一些代谢物。
So exactly the pathophysiology is somewhat debated, but I think those probably contribute.
因此，确切的病理生理学存在一些争议，但我认为这些可能有所贡献。
And it's something that everybody should be evaluated for if you're concerned about fertility.
如果您担心生育能力，每个人都应该对此进行评估。
So again, we see it very commonly.
再说一遍，我们很常见。
Given the fact that a lot of men have it, about one in seven men have it, it doesn't always cause a problem, but maybe about 20% to 25% of the time it does.
鉴于很多男性都患有这种疾病（大约七分之一的男性患有这种疾病），它并不总是会引起问题，但大约 20% 到 25% 的情况下会引起问题。
So men will manifest with low sperm counts.
所以男性会表现出精子数量低。
We see sometimes discomfort, ache, worse at the end of the day than at the beginning, worse with activity.
有时我们会看到不适、疼痛，一天结束时比开始时更严重，活动时更严重。
Anytime blood can pool, sometimes it stretches and some men feel that.
任何时候血液都会聚集，有时会伸展，有些男人有这种感觉。
And then in kids, sometimes it can lead to either stunted testicular growth or shrinkage of the testicle.
对于儿童来说，有时它会导致睾丸生长发育不良或睾丸萎缩。
It's also thought to be a progressive lesion, so the longer a man has it, the more damage it can do.
它也被认为是一种进行性病变，因此男性患病时间越长，造成的损害就越大。
It usually manifests around puberty in general.
一般来说，它通常在青春期左右出现。
So it's not a concern for everybody, but I think certainly if couples are having difficulty conceiving, you're having discomfort in the area, and you have one, it's a discussion you should have.
所以这并不是每个人都关心的问题，但我认为，如果夫妻有怀孕困难，你们在该地区感到不适，并且你们有这样的不适，那么你们应该进行讨论。
Andrew Huberman:
安德鲁·休伯曼：
What about Peyronie's disease?
佩罗尼氏病怎么办？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, so Peyronie's is a scarring of the penis, which leads to curvature or deformity.
是的，佩罗尼氏症是阴茎的疤痕，会导致弯曲或畸形。
So the way erections work is everything swells.
所以勃起的运作方式就是一切都膨胀。
And you can imagine if there's a scar tissue, it doesn't swell symmetrically, so you'll get like a curvature deviation.
你可以想象如果有疤痕组织，它不会对称地肿胀，所以你会得到曲率偏差。
Sometimes you can get an hourglass or sort of a banding.
有时你可以得到一个沙漏或某种带子。
If you look it up on the internet, you can see a host of different deformities that men get.
如果你在互联网上查找，你会发现男性有许多不同的畸形。
Probably present in about 5 to 10% of men.
可能存在于大约 5% 至 10% 的男性中。
So it's very common.
所以这很常见。
Sometimes it could be from injury, from a penile fracture or other less severe form of injury to the penis.
有时可能是由于受伤、阴茎骨折或其他不太严重的阴茎损伤所致。
Sometimes men have described hitting it on different things.
有时，男人会描述对不同事物的攻击。
Potentially that could lead to it.
这有可能导致它。
Sometimes it can manifest after prostate cancer surgery or other kinds of surgeries, which can stun the penis or injure some of the nerves of the penis.
有时，它可能在前列腺癌手术或其他类型的手术后出现，这可能会导致阴茎昏迷或损伤阴茎的部分神经。
So that's another condition we see commonly.
这是我们常见的另一种情况。
Obviously, it can lead to bother, when erections are not straight.
显然，当勃起不直时，这可能会带来麻烦。
That can just cause psychologic bother to men.
这只会给男性带来心理困扰。
It can also physically make it difficult for a man to have sex.
它也会使男性在身体上难以发生性行为。
Sometimes it can limit certain positions.
有时它可以限制某些位置。
So that's another common complaint we see.
这是我们看到的另一个常见抱怨。
I think it's something that men should be aware of.
我认为这是男人应该注意的事情。
There's now awareness campaigns now that there's an FDA-approved medicine for it, Collagenase or Xiaflex, which is a medicine that dissolves scar tissue.
现在有宣传活动，现在有 FDA 批准的药物，胶原酶或 Xiaflex，这是一种溶解疤痕组织的药物。
So that's one of the treatments we have for it.
这就是我们的治疗方法之一。
There's also different devices, sort of stretching devices, where we try and just mechanically remodel the penis to allow it to be a little bit straighter.
还有不同的设备，例如拉伸设备，我们尝试机械地重塑阴茎，使其变得更直一些。
And then there's also surgical options, too.
然后还有手术选择。
So there's a lot we can do.
所以我们可以做很多事情。
I always tell men, again, as long as they have a penis, we can make it hard, but we can also make it straight.
我总是再次告诉男人，只要他们有阴茎，我们就可以使其变硬，但我们也可以使其变直。
Andrew Huberman:
安德鲁·休伯曼：
I'm wondering why in the study about penis length, testicular size and volume wasn't also measured.
我想知道为什么在研究中没有测量阴茎长度、睾丸大小和体积。
And that's something that we haven't discussed.
这是我们还没有讨论过的事情。
What is the relationship between testicular size and volume, and some of the other parameters we've been talking about?
睾丸大小和体积以及我们一直在讨论的其他一些参数之间有什么关系？
And maybe this is also a good time to highlight any kind of morphological signals that would warrant people coming to the clinic.
也许这也是强调任何形态学信号的好时机，这些信号可以保证人们来诊所。
So asymmetry in testicle size, for instance, changes in testicular size.
例如，睾丸大小的不对称会导致睾丸大小的变化。
Obviously, a pea-sized lump, they taught us in high school is a warning sign of potential testicular tumor or cancer.
显然，他们在高中时教我们的豌豆大小的肿块是潜在睾丸肿瘤或癌症的警告信号。
We didn't really talk about testicles.
我们并没有真正谈论睾丸。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah.
是的。
So I think that, yeah, being aware.
所以我认为，是的，要有意识。
The average size of a testicle for a man is about a walnut.
男性睾丸的平均大小约为一个核桃。
So it's about 16 to 20 ccs.
所以大约是16到20cc。
Usually, if you were going to measure it, it'd be about four to four and a half centimeters in longest axis to give your listeners or viewers some idea.
通常，如果您要测量它，最长轴约为四到四厘米半，以便您的听众或观众有所了解。
If it changes, certainly let people know.
如果有变化，一定要让人们知道。
If you feel anything, let people know.
如果您有任何感觉，请告诉人们。
Although, our national guidelines on screening practices recommends against regular testicular self-exams, interestingly, because I think the concern is that it leads to more anxiety than cancers that it would diagnose.
尽管我们的国家筛查实践指南建议不要定期进行睾丸自我检查，但有趣的是，因为我认为令人担忧的是，与诊断出的癌症相比，这会导致更多的焦虑。
But I always tell men, "No one knows your scrotum better than you, so if you identify a problem, you should bring it to attention." So the classic appearance or the way that a testis cancer would manifest is a firm, painless mass that you kind of feel coming from the testicle.
但我总是告诉男人，“没有人比你更了解你的阴囊，所以如果你发现问题，你应该引起注意。”因此，睾丸癌的典型外观或表现方式是一种坚硬、无痛的肿块，您会感觉到它来自睾丸。
Andrew Huberman:
安德鲁·休伯曼：
I find it interesting that, at least as I understand, women are encouraged to do regular self-exams of their breasts for lumps.
我觉得有趣的是，至少据我了解，鼓励女性定期自我检查乳房是否有肿块。
But you're telling me that men are actually discouraged from doing regular exams of their testicles for lumps that could be cancer?
但你告诉我，实际上不鼓励男性定期检查睾丸是否有可能是癌症的肿块？
That feels like an unfair asymmetry.
这感觉像是一种不公平的不对称。
It does.
确实如此。
Both seem very important.
两者看起来都非常重要。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Oh, yeah.
哦，是的。
Well, I think there's no question.
嗯，我想这是毫无疑问的。
Obviously, I'm very biased.
显然，我是非常有偏见的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Men's-
男士-
Andrew Huberman:
安德鲁·休伯曼：
I was trying to say it so you didn't have to, right?
我正想说这样你就不用说了，对吧？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Oh, yeah.
哦，是的。
Andrew Huberman:
安德鲁·休伯曼：
Yeah.
是的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I don't want to get in trouble with the US Preventative Services Task Force.
我不想给美国预防服务工作组带来麻烦。
Andrew Huberman:
安德鲁·休伯曼：
I don't want anyone to get cancer.
我不希望任何人得癌症。
I don't even want a dog to get cancer.
我什至不希望狗得癌症。
So I'm surprised that they discourage self-exam.
所以我很惊讶他们不鼓励自考。
But is it because men are getting it wrong?
但这是因为男人误解了吗？
They're coming into the clinic thinking they have testicular cancer, and then most of the time they don't?
他们来到诊所时以为自己患有睾丸癌，但大多数时候他们并没有患上睾丸癌？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
I think that's the concern, that the number of cancers that are diagnosed versus the false lumps that they identify just lead to more anxiety and end up causing more harm than good, I think is the concern.
我认为这就是令人担忧的问题，诊断出的癌症数量与他们发现的假肿块的数量只会导致更多的焦虑，最终造成弊大于利，我认为这就是问题所在。
But, yeah, it was a surprising recommendation when it came down.
但是，是的，这是一个令人惊讶的建议。
Usually, if patients ask about it, I certainly don't discourage them from doing these exams.
通常，如果患者询问，我当然不会阻止他们进行这些检查。
And we've certainly identified cancers through that means before.
我们以前确实通过这种方式识别过癌症。
Andrew Huberman:
安德鲁·休伯曼：
Well, I saw the episode of "ER" where the guy was having trouble breathing when he was an elite runner, and it turned out he had testicular cancer, and he had overlooked the lump on his testicle.
嗯，我看过《急诊室》的一集，那家伙在担任精英跑步运动员时出现呼吸困难，结果发现他患有睾丸癌，而他忽略了睾丸上的肿块。
So I'm going to continue to self-screen.
所以我要继续自我筛选。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Okay.
好的。
Fair enough.
很公平。
Andrew Huberman:
安德鲁·休伯曼：
Numerous times today, we've talked about the potential benefit of getting a blood test for hormone profiles, lipid profiles, and other things, as well as a sperm analysis.
今天，我们多次讨论了进行激素谱、血脂谱等血液检测以及精子分析的潜在好处。
My understanding is that one can only do that if they have the disposable income to elect to do that through some commercial online service.
我的理解是，只有当人们有可支配收入来选择通过某些商业在线服务来做到这一点时，才能做到这一点。
But is there any way that patients who have insurance can approach their physician in a way that this would be covered by insurance?
但是，有什么办法可以让有保险的患者以保险承保的方式联系他们的医生呢？
I don't want to get you into any trouble here, but it's always such a shame.
我不想给你带来任何麻烦，但这总是令人遗憾。
It is such a shame when we're talking about something that is really pervasively related to health, as is sexual health, reproductive health, and people are not aware of a potential problem in the present or in the future that could've been mitigated simply because they didn't get a blood test or do something as simple as a sperm analysis.
当我们谈论一些与健康真正普遍相关的事情时，比如性健康、生殖健康，人们并没有意识到现在或将来的潜在问题，而这些问题本来可以仅仅因为他们没有进行血液检查或进行像精子分析这样简单的事情就可以得到缓解，这真是太遗憾了。
So we can't be presumptuous in saying, "$200 or $1,000, no big deal." For a lot of people, that's a huge deal.
所以我们不能自以为是地说“200 美元或 1,000 美元，没什么大不了的”。对于很多人来说，这是一件大事。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
It's prohibitive for many people.
这对很多人来说都是望而却步的。
So how can people get this stuff assessed?
那么人们如何才能对这些东西进行评估呢？
Should they talk to their primary care physician?
他们应该与他们的初级保健医生交谈吗？
Should they call a urologist?
他们应该打电话给泌尿科医生吗？
What's the best approach?
最好的方法是什么？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Yeah, I think both are good strategies.
是的，我认为两者都是很好的策略。
I think insurance is becoming a lot more open to covering some infertility, at least testing, sometimes treatment as well.
我认为保险对于某些不孕症的承保变得更加开放，至少是检测，有时也包括治疗。
So I think a lot of insurance does cover that now.
所以我认为现在很多保险确实涵盖了这一点。
Sometimes we check semen analyses for other ejaculatory issues.
有时我们会检查精液分析是否存在其他射精问题。
But I think that, again, as more of this data gets out, I think as more recognition of how important the male is, I think we'll get more buy-in and coverage.
但我认为，随着更多数据的公布，我认为随着人们更多地认识到男性的重要性，我认为我们会得到更多的支持和报道。
Obviously, women have the automatic feedback of ovulatory cycles, so they kind of know if there's a problem, they can bring that to the attention.
显然，女性有排卵周期的自动反馈，所以她们知道是否存在问题，可以引起人们的注意。
But men don't have that feedback without some of these testing.
但如果不进行一些测试，男性就不会得到这种反馈。
Andrew Huberman:
安德鲁·休伯曼：
Yeah, and we probably should have mentioned this earlier, so forgive me.
是的，我们可能应该早点提到这一点，所以请原谅我。
This was on me to mention that when we talk about sperm quality, and we sort of shifted back and forth to semen quality, it's possible to have normal semen volume and have very low sperm count, right?
我想提一下，当我们谈论精子质量时，我们在精液质量上来回转移，有可能有正常的精液量，但精子数量非常低，对吗？
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Right.
对。
Andrew Huberman:
安德鲁·休伯曼：
We're not talking about the total amount of ejaculate per se.
我们不是在谈论射精总量本身。
We're talking about the density of forwardly motile, healthy, non-DNA fragmented sperm in that semen.
我们谈论的是精液中向前运动的、健康的、无 DNA 碎片的精子的密度。
Right?
正确的？
So, in other words, it's not sufficient to just assume because you can ejaculate that your sperm are healthy.
所以，换句话说，仅仅因为你可以射精就假设你的精子是健康的是不够的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
That's exactly right.
完全正确。
Yeah, I think about 15% of men have low semen quality, whether it be concentration, movement, shape.
是的，我认为大约 15% 的男性精液质量较低，无论是注意力、运动还是形状。
About 1% of men have no sperm in the ejaculate, and that's something sometimes they have no idea about.
大约 1% 的男性精液中没有精子，但有时他们并不知道这一点。
So the only way to know would be to actually do a formal test.
因此，了解的唯一方法是实际进行正式测试。
Andrew Huberman:
安德鲁·休伯曼：
Well, I'm encouraging people to get these parameters assessed, and I'm making that statement because it's very clear, based on everything that you've told us today, that sperm quality and hormone levels are just oh so important, not just for sexual health, but for urinary health and for reflecting prostate health and other aspects of whole body health.
嗯，我鼓励人们对这些参数进行评估，我之所以这么说，是因为根据您今天告诉我们的一切，很明显，精子质量和激素水平非常重要，不仅对于性健康，而且对于泌尿系统健康以及反映前列腺健康和全身健康的其他方面。
And sexual health relates directly to mental health.
而性健康与心理健康直接相关。
We didn't talk so much about the psychogenic issues, but the two go hand in hand.
我们没有过多谈论心理问题，但两者是相辅相成的。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
Exactly.
正是如此。
Andrew Huberman:
安德鲁·休伯曼：
I want to thank you so much for coming here today and sharing so much knowledge with us.
我非常感谢您今天来到这里并与我们分享如此多的知识。
These really are the issues that males think about and wonder about and have questions about.
这些确实是男性思考、好奇和疑问的问题。
And they do so to varying degrees, depending on where they're at in life.
他们这样做的程度不同，具体取决于他们所处的生活阶段。
But I think especially for younger men who are hearing this, who are not at the point where they want to conceive, it's really important to start thinking about these issues for all the reasons you mentioned.
但我认为，特别是对于听到这个消息的年轻男性来说，他们还没有达到想要怀孕的阶段，出于你提到的所有原因，开始考虑这些问题非常重要。
I think these issues are really important for women to know about as well, just as it's important for men to understand female reproductive health and not just to improve communication, but this, after all, is at the heart of the presence and proliferation of our species.
我认为这些问题对于女性来说也非常重要，就像对于男性来说了解女性生殖健康很重要一样，而不仅仅是为了改善沟通，但这毕竟是我们物种存在和繁殖的核心。
So thanks for taking care of the male half and thanks for doing the work you do.
因此，感谢您对男性的照顾，并感谢您所做的工作。
It's incredible.
太不可思议了。
The large-scale studies, the more detailed the studies on smaller populations.
大规模的研究，对较小人群的研究越详细。
You ask the questions that it seems many people are just afraid to ask, and you get right in there and come out with the really rigorous data and answers.
你提出了很多人都不敢问的问题，然后你就直接进入并给出了非常严格的数据和答案。
So thank you so much for what you do.
非常感谢你所做的事情。
Dr. Michael Eisenberg:
迈克尔·艾森伯格博士：
My pleasure.
我很高兴。
Thank you.
谢谢。
Thank you for highlighting men's reproductive health.
感谢您强调男性生殖健康。
Andrew Huberman:
安德鲁·休伯曼：
Thank you for joining me for today's discussion with Dr. Michael Eisenberg.
感谢您参加今天与迈克尔·艾森伯格博士的讨论。
To learn more about his research and his clinical practice, please check out the links in the show note captions.
要了解有关他的研究和临床实践的更多信息，请查看节目注释标题中的链接。
If you're learning from and/or enjoying this podcast, please subscribe to our YouTube channel.
如果您正在学习和/或喜欢此播客，请订阅我们的 YouTube 频道。
That's a terrific zero-cost way to support us.
这是支持我们的绝佳零成本方式。
In addition, please subscribe to the podcast on both Spotify and Apple.
此外，请在 Spotify 和 Apple 上订阅该播客。
And on both Spotify and Apple, you can leave us up to a five-star review.
在 Spotify 和 Apple 上，您都可以给我们五星级的评价。
Please also check out the sponsors mentioned at the beginning and throughout today's episode.
另请查看今天节目开头和整个节目中提到的赞助商。
That's the best way to support this podcast.
这是支持这个播客的最佳方式。
If you have questions for me or comments about the podcast or guests that you'd like me to consider hosting on the Huberman Lab podcast, please put those in the comments section on YouTube.
如果您对我有疑问或对您希望我考虑在 Huberman Lab 播客上主持的播客或嘉宾有意见，请将这些意见放在 YouTube 的评论部分。
I do read all the comments.
我确实阅读了所有评论。
Not during today's episode, but on many previous episodes of the Huberman Lab podcast, we discuss supplements.
不是在今天的节目中，而是在 Huberman Lab 播客的许多之前的节目中，我们讨论了补充剂。
While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like enhancing sleep, hormone support, and improving focus.
虽然补充剂并不是每个人都需要的，但许多人从它们中获得了巨大的好处，例如增强睡眠、激素支持和提高注意力。
If you'd like to learn more about the supplements discussed on the Huberman Lab podcast, you can go to Live Momentous, spelled O-U-S, so livemomentous.com/huberman.
如果您想了解有关 Huberman Lab 播客上讨论的补充剂的更多信息，您可以访问 Live Momentous，拼写为 O-U-S，即 livemomentous.com/huberman。
If you're not already following me on social media, it's Huberman Lab on all social media platforms.
如果您还没有在社交媒体上关注我，那么所有社交媒体平台上都有 Huberman Lab。
So that's Instagram, Twitter, now called X, Threads, Facebook, LinkedIn.
这就是 Instagram、Twitter（现在称为 X）、Threads、Facebook、LinkedIn。
And on all those places, I discuss science and science-related tools, some of which overlaps with the content of the Huberman Lab podcast, but much of which is distinct from the content on the Huberman Lab podcast.
在所有这些地方，我讨论了科学和与科学相关的工具，其中一些与胡伯曼实验室播客的内容重叠，但其中大部分与胡伯曼实验室播客的内容不同。
So again, it's Huberman Lab on all social media platforms.
再说一遍，所有社交媒体平台上都是 Huberman Lab。
If you haven't already subscribed to our monthly Neural Network Newsletter, the Neural Network Newsletter is a completely zero-cost newsletter that gives you podcast summaries as well as toolkits in the form of brief PDFs.
如果您还没有订阅我们的每月神经网络通讯，神经网络通讯是完全零成本的通讯，它为您提供播客摘要以及简短 PDF 形式的工具包。
We've had toolkits related to optimizing sleep, to regulating dopamine, deliberate cold exposure, fitness, mental health, learning and neuroplasticity, and much more.
我们拥有与优化睡眠、调节多巴胺、刻意寒冷暴露、健身、心理健康、学习和神经可塑性等相关的工具包。
Again, it's completely zero cost to sign up.
再次强调，注册成本完全为零。
You simply go to hubermanlab.com, go over to the Menu tab, scroll down to Newsletter, and supply your email.
您只需访问 hubermanlab.com，转到“菜单”选项卡，向下滚动到“时事通讯”，然后提供您的电子邮件即可。
I should emphasize that we do not share your email with anybody.
我要强调的是，我们不会与任何人分享您的电子邮件。
Thank you once again for joining me for today's discussion with Dr. Michael Eisenberg.
再次感谢您参加今天与迈克尔·艾森伯格博士的讨论。
And last but certainly not least, thank you for your interest in science.
最后但并非最不重要的一点是，感谢您对科学的兴趣。