#358 ‒ Peter's takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying | Quarterly Podcast Summary #6

View the Show Notes Page for This Episode https://peterattiamd.com/qps6/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250728-pod-qps6&utm_content=250728-pod-qps6-podfeed Become a Member to Receive Exclusive Content https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250728-pod-qps6&utm_content=250728-pod-qps6-podfeed Sign Up to Receive Peter's Weekly Newsletter https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250728-pod-qps6&utm_content=250728-pod-qps6-podfeed In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Paul Turek and Paula Amato on male and female fertility; Rachel Rubin on menopause and hormone replacement therapy; Brian Kennedy on the biology of aging; Tanuj Nakra and Suzan Obagi on facial aging and skin rejuvenation; and BJ Miller and Bridget Sumser on lessons we can learn from the dying about how to live. Peter highlights the most important insights from each episode and any behavioral changes he's made for himself or his patients as a result of these fascinating discussions. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed https://peterattiamd.com/members/private-podcast-feed/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250728-pod-qps6&utm_content=250728-pod-qps6-podfeedor our website at the episode #358 show notes page http://peterattiamd.com/qps6/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250728-pod-qps6&utm_content=250728-pod-qps6-podfeed. If you are not a subscriber, you can learn more about the subscriber benefits here https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250728-pod-qps6&utm_content=250728-pod-qps6-podfeed. We discuss: Summary of episode topics [1:15]; Episodes on fertility with Paul Turek and Paula Amato: insights on all things male and female fertility [4:45]; How men can optimize fertility [20:15]; How women can optimize fertility [26:00]; Rachel Rubin episode: insights on women's sexual health, menopause, and HRT [31:45]; How women can prepare for menopause: proactive care, evidence-based HRT, and more [41:45]; Brian Kennedy episode: understanding aging, role of inflammation and mTOR, and current limitations of aging clocks and biomarkers [46:30]; Advice from Brian Kennedy on testing longevity interventions [56:45]; Tanuj Nakra/Suzan Obagi episode: causes of facial aging and practical strategies for prevention and treatment [57:30]; Skincare: making sense of the wide range of skin resurfacing treatments [1:06:45]; How to create a realistic, sustainable skincare routine [1:12:30]; The dangers of following unqualified aesthetic advice online and the importance of getting professional medical guidance for cosmetic treatments [1:18:00]; BJ Miller/Bridget Sumser episode: lessons about living from the dying [1:21:45]; and More. Connect With Peter on Twitter https://twitter.com/PeterAttiaMD, Instagram https://www.instagram.com/peterattiamd/, Facebook https://www.facebook.com/peterattiamd/ and YouTube https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:10Dr. Peter Attia?

  Hey everyone, welcome to a sneak peek Ask Me Anything, or AMA, episode of The Drive Podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.

• 0:39Dr. Peter Attia?

  Welcome to a special episode of The Drive. In today's debrief, I focus on what I consider the most important learnings and insights from the past quarter of interviews, as well as any behavioral changes I've applied as a result. In this episode, I'll cover a variety of topics, including male and female infertility, women's sexual health, menopause, and hormone replacement therapy, the biology of aging, skincare, facial aging, and rejuvenation strategies, and lessons we can learn about living from the dying. If you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. If you are not a subscriber, you can watch the sneak peek of the video on our YouTube page. So, without further delay, I hope you enjoy this quarterly podcast summary episode of The Drive.

• 1:30Speaker 01

  All right, Peter, thank you for showing up to another episode of your podcast. How you doing?

• 1:35Dr. Peter Attia?

  Good, thank you for having me back.

• 1:37Speaker 01

  I see you brought someone else with you in the studio today. Do you know who that is?

• 1:43Dr. Peter Attia?

  I do not.

• 1:44Speaker 01

  Who's the little guy on your shirt?

• 1:46Dr. Peter Attia?

  Oh, Charles.

• 1:47Speaker 01

  Yeah. Charles. So you're gonna jump in at all today, provide any insight for us, or what's his deal?

• 1:53Dr. Peter Attia?

  He might. It's the funniest shirt in the world.

• 1:57Speaker 01

  It is, just little Charles, just peeking up there, happy as could be.

• 2:02Dr. Peter Attia?

  I know, I know.

• 2:03Speaker 01

  I love it. Bring in the excitement over there, which is good. Today, we are doing another podcast summary episode. To remind people what we do, we pull recent episodes that have come out. We go through them kind of one by one, highlight things you found really interesting, things that were your biggest takeaways, anything you changed your mind on, behavior on, how you work with patients on as a result. So these aren't meant to replace people listening to episodes, but these episodes, I think this is our sixth one, and to date, we get some of the most feedback compared to any episode on these where people really enjoy them. And a lot of times, people will either go back and listen to certain parts, say that things kind of make more sense from this.

• 2:46Speaker 01

  And so a lot of good feedback from this, but again, should not be a replacement for these episodes. Today, we got a lot to cover. We have Paul and Paula on male and female fertility. So they were two different episodes, but for this, it made the most sense to combine them into one as we look at insights. So we'll do that. We have Rachel on women's sexual health, menopause, HRT, something I know you're passionate about and enjoy talking about. Brian Kennedy, which was a really deep dive around biology of aging, kind of a throwback to some of our original episodes where you dive super deep into that.

• 3:25Speaker 01

  You have Tanuj and Susan, which looked at all things skincare, facial aging, rejuvenation strategies. On that note, you're looking pretty sharp over there. You've been taking some of their recommendations into your day-to-day practices?

• 3:41Dr. Peter Attia?

  We are absolutely gonna talk about that because we are probably two and a half months now since that episode, and I'm looking forward to discussing exactly what I have done. In fact, of all the episodes, this would be the one where I've had the greatest change in my personal behavior.

• 3:59Speaker 01

  Can't wait to hear it. Did you do anything different with Charlie or is he still on the same skincare routine?

• 4:04Dr. Peter Attia?

  No, Charles is still doing the exact same skincare routine.

• 4:07Speaker 01

  It's working for him though, so why fix it? And then we're going to end with episode with BJ and Bridget, which was all around death, dying, but more so what you can learn from people on their deathbed. So huge variety of topics we'll cover. Anything you want to say before we get rolling?

• 4:27Dr. Peter Attia?

  No, other than it's interesting that the last and second to last topics we will cover could not be more apart in terms of relevance and superficiality. You know, it will be a stark juxtaposition of something, not to bring any sort of judgment against aesthetics, but ultimately talking about end of life and lessons about life through death versus how to make your skin look better are about two opposite ends of the spectrum. But nevertheless, it is a spectrum and I think we can find value in talking about everything along it.

• 5:01Speaker 01

  Yeah, no one can say we don't have range on the podcast. So we got that going for us. All right. First one, Paul, Paula, all things male, female fertility. Where do you want to start?

• 5:14Dr. Peter Attia?

  Just from a story standpoint, it is remarkable. And maybe that's, we try not to do too much summary in these episodes because the show notes do such a great job of that. But I do think there's a couple comments worth making. So the idea that conception is difficult is an understatement. A single ejaculation releases about 100 million sperm. Fewer than 5 million of them even make their way past the cervical mucus. And ultimately only somewhere between 100 and 500 reach the fallopian tube. And then only one goes on to fertilize the egg. Now that might be that 20 reach the egg, but obviously there's this really cool force field that comes up the minute the first sperm touches the egg.

• 5:58Dr. Peter Attia?

  It creates a chemical barrier that prevents any others from fertilizing. Otherwise you'd have this devastating situation of too much genetic material being brought in. Just a couple of interesting things that made me at least go, wow, is that sperm are chemotactic. So they're basically chemical guided missiles that make their way to the egg and they can...

• 6:20Dr. Peter Attia?

  Traverse 15 centimeters of distance within the vagina to the fallopian tube within minutes. And so it's important to understand, given how small a sperm is, that is the analog of a human swimming 20 miles in the ocean in that same period of a few minutes. By the way, just even though we didn't go into this in the podcast, think about the energy requirement to do that. And so you kind of understand what the motor and the ATP generation is like in one of those things. Testes, like the brain, have kind of a specialized blood tissue barrier. It's very immune privileged and it protects developing sperm from antibodies.

• 7:02Dr. Peter Attia?

  But it also means that drugs or toxins that can cross it, such as certain types of chemotherapies, can actually be disproportionately damaging. It's for that reason, of course, that a lot of men who are undergoing chemotherapy will choose to do a sperm donation prior. Spermatogenesis, so the generation of sperm, follows a clock of about 74 days, if my memory serves correctly. And therefore, if you're trying to make interventions around sperm health, so if a guy is, gets his sperm tested, comes back that something's not right, you can identify behaviors that are doing that, you're going to need two to three months of trying a

• 7:45Dr. Peter Attia?

  corrective intervention before you can determine if it's worked. That's how long it takes to go through the cycle.

• 7:50Speaker 01

  On that intervention piece, one of the things that was talked about was bike seats. As someone who spent a lot of time on a bike, being you, not me, did that surprise you?

• 8:02Dr. Peter Attia?

  Yeah, I mean, I've always been pretty mindful of bike seats and I've been very fortunate, despite how much time I used to spend on a bike, I never had any issues. But as Paul points out in the podcast, it's really not a big concern for fertility, but it is much more a concern around erectile function. And basically, based on your anatomy and based on the type of seat you use, you can really traumatize the arteries and nerves that impact erections.

• 8:30Dr. Peter Attia?

  So what we tell all of our patients, if they're spending a lot of time on a bike, we have recommendations on bike seats that they should be using. I have two bikes, one for inside, one for outside. I have different bike seats on them because I got them at different times, but they're basically the identical type of seat, which is a seat that has the middle of the saddle is largely absent. And so the istial tuberosities, your sit bones are doing the supporting, but nothing else. And so we can link to a couple of the brands that I think are pretty good. As silly as it sounds, I kind of recommend people buy a couple. So buy from somebody who will let you return them. Buy like three and try them out and figure out the one that's most comfortable.

• 9:08Speaker 01

  So Peter, back to then fertility. Paul talked a lot about what his workup is for his patients. Do you kind of want to remind people of that and how you also apply that to your patients as well?

• 9:21Dr. Peter Attia?

  Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a premium member. It's extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members. And in return, we offer exclusive, member-only content and benefits above and beyond what is available for free. So if you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. Premium membership includes several benefits. First, comprehensive podcast show notes that detail every topic, paper, person, and thing that we discuss in each episode.

• 10:05Dr. Peter Attia?

  And the word on the street is, nobody's show notes rival ours. Second, monthly Ask Me Anything or AMA episodes. These episodes are comprised of detailed responses to subscriber questions, typically focused on a single topic and are designed to offer a great deal of clarity and detail on topics of special interest to our members. You'll also get access to the show notes for these episodes, of course. Third, delivery of our premium newsletter, which is put together by our dedicated team of research analysts. This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter. Fourth, access to our private podcast feed that provides you with access to every episode,

• 10:48Dr. Peter Attia?

  including AMAs, sans le spiel you're listening to now, and in your regular podcast feed. Fifth, the Qualies, an additional member-only podcast we put together that serves as a highlight reel featuring the best excerpts from previous episodes of the drive. This is a great way to catch up on previous episodes without having to go back and listen to each one of them. And finally, other benefits that are added along the way. If you want to learn more and access these member-only benefits, you can head over to peterattiamd.com/subscribe. You can also find me on YouTube, Instagram, and Twitter, all with the handle PeterAtiaMD. You can also leave us a review on Apple Podcasts or whatever podcast player you use.

• 11:32Dr. Peter Attia?

  This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise,

• 12:15Dr. Peter Attia?

  please visit peterattiamd.com/About, where I keep an up-to-date and active list of all disclosures.