Episode 62: Dr. Geo Espinosa, ND on Erectile Dysfunction, Prostate Health, and How Men Can Age Better

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Dr. Geo Espinosa:

When a man for example, doesn’t get an erection has not experienced an erection for, I don’t know, three months or so, red flags are coming up in my head, right? What’s happening? What’s really happening systemically cardiovascular atherogenic disease, diabetes, what’s happening? So you got to look at, you got to look at the metabolic aspect of Edie. Because to me, that’s a sign of, of aging. And that’s a sign that something bigger and more life threatening may happen may happen sooner than later.

Dr. Andrew Wong:

How can men use lifestyle medicine to keep their prostate and sexual function healthy as they age? How can we support men to live better as they age? I’m excited to share this conversation with Dr. Gao Espinosa. Dr. Gao is a naturopathic and functional medicine doctor recognized as an authority in urology and men’s health. Dr. Gao partners with this patience to identify and treat the root causes of their health conditions, not just mass symptoms. I am Dr. Andrew Huang, co founder of capital Integrative Health. This is a podcast dedicated to transforming the consciousness around what it means to be healthy, and understanding the root causes of both disease and wellness. Today, we are going to be discussing with Dr. Gao, how to keep your prostate healthy, how to avoid sexual dysfunction with age and how to use lifestyle medicine to live better with age. Please enjoy conversation. awesome to have you here. Dr. Gao, thank you so much for coming on today to discuss urology, and all things about integrative men’s health.

Dr. Geo Espinosa:

My pleasure, Andrew, it’s been I think we were planning this for a while and so I’m glad to be here.

Dr. Andrew Wong:

Yes. So we started our podcast about a year ago. Now it’s been about a year and I think, you know, you’re definitely one of the first guests so I was like we got to get back to you on because we know that an integrative health and functional medicine and everything. There’s there’s a lot of interests, at least statistically and in, you know, functional medicine and Integrative Health from women. And and, and of course, a lot of times what we see in our clinic because we see men and women is that we’ll see them women first. Yeah. And then you know, maybe a year later, the man kind of strangles in my wife or partner wanted to, you know, want me to come in? I’m not really sure what it’s about. Well, we’ll talk about that. I guess first for the listeners. Let’s talk about you as an authority on men’s health with specialized you know, what motivated you to specialize in? And naturopathic urology and men’s health?

Dr. Geo Espinosa:

Yeah, well, that’s a very good question. i The real answer is that I didn’t choose Men’s Health and urology is sort of like urology and Men’s Health chose me a little bit. Like anyone else. Initially, I was fighting as like, I’m not going to do prostate and penises all day, no way. Not doing that. But then I kept seeing more men than anyone else. This is back when we were doing our clinical rotations and as a naturopathic medical student, and more men and more men. Geez, all these man, can I see a woman? Can I be? Oh, can I see obesity can I was just fighting it. And then I got the opportunity here in New York to intern with a urologist and sort of it just happened. And then I did a fellowship in urology at Columbia University Department of Urology, and that sort of just, it didn’t just happen, I had to work for it, but but it wasn’t, you know, it was like, oh, so then I really started getting interested in this one. Space is one area and really wanted to know everything and learn everything about it. I knew that some of my colleagues, for example, in naturopathic medicine, were really good at knowing all these modalities and herbs and homeopathic medicine, medicine and nutritional approaches for so many conditions. And I felt like, I’m not that smart. I can’t. I can’t do you know, no, everyone knows that conventional pharmaceuticals know, the, the natural for everything, you know, auto immune, this done, you know, every I can’t I was I did feel frustrated about that. But I didn’t know that I was going to head into urology and mental health. So when I discovered urology and mental health or or discovered me, I was like, Whoa, you know, I sort of stopped fighting it and kind of went along with it. And it was great because it was this little area. And most people would say my colleagues will say, Are you bored? Same thing over and over? No, there’s always new things out and not at all. That’s right, and all these clinical situations and responses that you see and you see what works, you see what doesn’t work. It’s so rewarding. So it sort of found me and lastly, I’ll say this, you know my father was about in his mid 40s When I was born So when I was like 10 years old, he was in his mid 50s. And always a prostate problem. I’m 10 years old, I’m like, I don’t even know about the heart. I don’t know about any other organ but you know, the prostate, the prostate, I think my prostate is inflamed. I think my prostate, it’s only a matter of time before I get prostate cancer. So I think that it’s been in me since I was a child. So in one weird way or another, and sort of all the signs and everything led to me doing the work that I’m that I’m doing now.

Dr. Andrew Wong:

And it’s a great answer to start out with a, I think that, you know, a lot of times, our calling, like you said finds us and we just have to listen and open up to them.

Dr. Geo Espinosa:

Right? Not be so hard headed. You know, I’m glad that accidentally like by the 100th lesson that the universe or God gives you whatever is like, Oh, I think I’m gonna listen now.

Dr. Andrew Wong:

Okay, listen that 100 times, yeah, hey, better late than never. And I love how you’re a connector to between conventional and integrative naturopathic functional, because really, there’s not a lot of people in that space that are, especially on the men’s health side, I feel like it’s often either one or the other. And certainly, we kind of get, you know, it’s like a tides or something that kind of like, push us in one way or the other. But, um, let’s talk about men’s health and what motivates men to be healthier. You know, what, what kind of, you know, what is what is something that kind of drives men that you see in your practice?

Dr. Geo Espinosa:

Man, listen, what drives men to take action?

Dr. Andrew Wong:

Yeah. We know a lot of people don’t take it. We know a lot of men don’t take it. Well,

Dr. Geo Espinosa:

most don’t. Right. What drives men to take action is a diagnosis that will not kill them, hopefully. But it’s a beautiful wake up call. You know, on one of my podcasts I wrote about or I spoke about why I love Gleason six prostate cancer. And there is no better diagnosis for a man that a beautiful Gleason six prostate cancer. And the reason for that is because a Gleason skip six will likely not kill anyone. But man is the C word. Oh, I’m going to eat better now. Oh, I will exercise now. Oh, I will. So they reevaluate how they live their life, their relationships, everything and now they live even a healthier, fitter life as a result of that diagnosis. Right? So yeah, it’s a diagnosis. Men typically don’t care about health. They care about performance. Yeah. And that’s it. So the guy that comes in, that doesn’t have a diagnosis is the guy typically, that is dragged in by their spouse?

Dr. Andrew Wong:

It’s not affecting them. So they don’t care. Yeah, basically, it’s not they don’t see the long term effects. Maybe

Dr. Geo Espinosa:

they don’t see the long term they don’t really value health. Also, health is a loose term. So you know, men and women are different, right? That’s, that’s an obvious, right, we function differently. The hormones are different. So So health is a loose term doesn’t mean anything really, oh, I’m gonna do what to be healthier. Yeah, what is healthier? So what men can, what’s more linear, and men like to typically on average, think more linearly, is how can I perform better? Right, whether in the bedroom, and even performing sexually is not so linked to health, though it should be but not in their heads? Right? How do I perform better at work? How do I perform better at you know, thinking energy, things that will help them perform better in their, you know, overall, that’s what they care about.

Dr. Andrew Wong:

Let’s talk about the bedroom performance. Let’s talk about sexual function and dysfunction because I love that connection between what you just said about bedroom performance. And, you know, how’s how’s that man direction? How healthy is that versus like their overall health? People don’t see that connection. So what is that connection between between those two? Great.

Dr. Geo Espinosa:

So, you know, the we there’s several things we have that women don’t have one of them happens to be a penis, and a penis in my mind is a barometer to a man’s overall health. Right? So, watch what you do with it is really not my business. But I do care that men across all ages for them to have get erections, whether is spontaneous erections, or early morning erections or erections when they are willing and wanting to perform sexually. Why? Because when a man for example, doesn’t get an erection has not experienced an erection for I don’t know three every month or so, red flags are coming up in my head, right? What’s happening? What’s really happening systemically cardiovascular atherogenic disease, diabetes, what’s happening? So you got to look at, you got to look at the metabolic aspect of Ed. Because to me, that’s a sign of, of aging. And that’s a sign that something bigger and more life threatening may happen may happen sooner than later. So that so it’s Yeah, quality of life and sexual activity I think is important. But even more so is I’m not getting an erection. What else is happening that I need to know about?

Dr. Andrew Wong:

It sounds like erectile dysfunction is related to heart disease, risk of heart disease, vascular disease, endothelial dysfunction, Mark Houston says that d equals Edie, you know, like erectile.

Dr. Geo Espinosa:

Edie equals Edie and a trip to the ER,

Dr. Andrew Wong:

yes, yes. Oh, my gosh, yes. Very true. Yeah. And so that’s another wake up call to you know, that heart attack would be another wake up call or heart heart disease. So, what are what are ways that you’ve found to, you know, that you found in your patients to improve sexual dysfunction, this is going to get probably into a large area of lifestyle habits.

Dr. Geo Espinosa:

We’re gonna say, Oh, here’s a blank,

Dr. Andrew Wong:

this is the cost.

Dr. Geo Espinosa:

How much time do you have Andrew?

Dr. Andrew Wong:

Probably, probably, let’s say for the man that’s interested in walking into your clinic with kind of like, I want to perform better I want to perform better for you know, for my wife or partner or whoever, what is, what’s those top three things that’s going to improve their his performance? All right. So,

Dr. Geo Espinosa:

you know, the, the brain is the biggest sex, sexual organ that we have, right? So we have to be able to differentiate between psychological Ed and physique, physiological ed. So and oftentimes 50% of the times it is psychological, there’s performance, anxiety, there’s just overall stress, you know, life stress, and things like that all problems in the relationship. I don’t, you know, get a whole lot into that. But if those things come up, I said, Look, you got to look into it, I don’t think you have a physiological problem. Okay. So that needs to be kind of ruled out there. From a physiological perspective, I’m trying to assess their are the health of their arteries without an invasive diagnostic procedure. So we look at, obviously, all sorts of blood work, typically that you will even look for cardiovascular disease, look at their glucose, look at their insulin, look at their anything from metabolic syndrome, that you would look for hypertension, whether they’re, you know, they have a big waist, we circumference, then you look at their hormones. And again, that’s an even another podcast, right? Because there’s Okay, so what’s the what’s the best number for testosterone? I said, Well, it’s not that simple. I know, everybody’s just saying 600. And I used to say 600, quite quite often. But the reality is that is more complicated and more more complicated than that. So you got to look at the hormones as well, because that also contributes to Ed. So then you do that evaluation. And then overall, typically, there’s an atherogenic component, let’s say, from a natural perspective and lifestyle, you get them to if they need if they need if they have a lot of body fat, right, so we do a body composition as opposed to just BMI, of course, yeah. And then we want to improve their body composition, we want to, I really focus a lot on getting that waist size down. You know, so I do a waist to hip ratio. And if the waist is bigger than the hips, we need to reverse that. That’s just the bottom line. Right? So that’s what we focus on. In addition, I, we I get them to do exercise, and it’s very prescriptive. It might be something like, you know, interval training, it depends on their baseline numerous things. Eventually, they have to do weight resistance exercise. So I think you know, my philosophy on that strength training is king, you need physical strength to live longer. It’s harder to die if you’re physically strong overall, right? That’s muscle mass and everything. Yeah. 100 muscle and strength, sometimes some muscle and strength. Sometimes, for example, in a robic, let’s say a runner, may have some decent muscle, unless they run a lot. Then they waste their muscle. Yeah, but they don’t have a lot of strength. Got it? Right. So you want muscle and you want to prevent sarcopenia, which is muscle wasting as your age, but you also want to keep strength you want to stay strong, physically strong, very important. Doesn’t matter if you like it, or if you don’t, or oh, I’m a tennis player on I like golf. At this point. I go out it took me a while and needed to look at the unit Hundreds of the evidence it really comes to this conclusion. It sort of doesn’t matter where you are, for the most part, you need to do physical training. And as it relates to erectile dysfunction, that’s that’s also a must. So that’s typically the the approach. And then some nutraceuticals that I use that I think your audience might be interested in, for the most part is things like L citrulline. I find L citrulline. To be even more important than arginine, though Arginine is very important because it is a precursor to nitric oxide, this gaseous chemical in the arteries that helps dilate the arteries. You want you want these arteries to open up? Yeah, right. And so So Arginine is fine and good. A lot of data supports it, but it gets metabolized very quickly by an enzyme called Arjun Nice. citrulline helps with So bottom line without getting into the weeds. If you want more arginine in your body, it’s better to have more citrulline in your body than even arginine itself. That’s the bottom so I use citrulline.

Dr. Andrew Wong:

And if it’s the arginase, basically, it inhibits No, it just

Dr. Geo Espinosa:

keeps circulating the the the arginine, it kind of keeps circulating. metabolized so quickly, but it’s not an arginase inhibitor now,

Dr. Andrew Wong:

okay, okay. Well, great. Let’s kind of go to a similar topic. I think there is some overlap here with another of your specialties, which is how to keep a healthy prostate. You know, we know that, right? There’s so much about, okay, well, people just can’t have enlarged prostate after certain age and, you know, how do we, how do we keep a healthy prostate? How do we, you know, if someone has prostate cancer, you know, how do we deal with that? So there’s a lot of blood questions in there.

Dr. Geo Espinosa:

Yeah. All right. So, all right. So there’s two parts of the conversation perhaps. And let’s just talk about prevention of prostate problems. And then we could dig deeper into the big three, the big three are prostate cancer, BPH, or an enlarged prostate and prostatitis. They’re different. They all have them with it. And the two benign ones are prostatitis and BPH they do not lead and it’s not a it’s not they don’t it doesn’t lead to prostate cancer. So some people think if I have a big prostate oh my god Lisa prosecute. No. Some people do think that if I have prostatitis because some sort of an inflammatory response that leads to prostate cancer, and it turns out that it may in some people, but you know, I just don’t want people with prostatitis are typically and let’s start there. People with prostatitis are typically younger, not older, so they’re in the 20 sometimes, so you don’t want to say, Oh, my God, you’re gonna get prostate cancer as a result of having prostatitis right. First of all, it doesn’t have to be that way. And second of all, they’re already going through a lot of psychological problems and you’re going to freak them out unnecessarily. Yeah, so prostatitis is the prostate disease that typically happens in the younger group is the only one really, that happens in younger population, I mean, younger than even 40 BPH and prostate cancer typically happens in an older population. And I do I am using the cut off of older which I hate because I’m in that category now, of 40 and above, because I firmly believe that you need to start looking and being proactive as it relates to prostate health in your 40s, not 50s. Like many people think I’ve seen way too many prostate cancer scenarios in men in their early 40s. And they come in, it’s already very aggressive. And it’s just not well managed as a result. So so so I think 40s is the time that you start and I know everybody’s trying to avoid the finger and getting a prostate exam. But that’s just one element of it. Um, there’s other things in other tests, including PSA, we can talk about that if you want that one can do to see what’s happening. So overall, and let me give you a quick takeaway as it relates to what do I do for my prostate? There’s one thing that seems to be associated with almost every year illogical problem, including Edie and all the prostate problems, that’s metabolic syndrome. So metabolic syndrome for your audience is any sort of combination of hyperlipidemia high LDL, quote unquote bad cholesterol, low HDL, good cholesterol, high triglycerides, high glucose, high insulin, big waste, hypertension, any combination is metabolic syndrome. And those things metabolic syndrome is associated with BPH prostate cancer significantly, D significantly. So if you’re interested in preventing, and certainly even as a coal management, you have to deal with metabolic syndrome. For sure,

Dr. Andrew Wong:

I’ll just go back to metabolic syndrome. And in North Carolina studies showed that 88% of us has metabolic syndrome, right? That’s crazy. It’s crazy number,

Dr. Geo Espinosa:

and it’s crazy how, you know, it was a good term all road, do you go back to metabolic syndrome? And you think, of course, of course cardiovascular. No, you’re illogical, as well. And it’s just an overwhelming amount of evidence to support that. Even overactive bladder, actually, it’s just it’s associated with. It’s pretty remarkable. And, you know, it’s pretty not to get on a on a soapbox much, but it’s pretty remarkable with I think, the work that you and I are doing, Andrew, Andrew, in terms of, you know, looking at the body systemically, as opposed to as opposed to separating the body parts.

Dr. Andrew Wong:

We like soapboxes. Dr. Jia, that’s fine. We

Dr. Geo Espinosa:

stand on it proudly. That’s right. I’m not getting law. I’m not getting office. So fuck, you know? I mean, I guess there’s a, there’s a possibility of some bias in this right, because this is what we do. Yeah. But at this point in time, it’s just an overwhelming amount of evidence, you see it clinically that you want to treat, you want to treat almost any condition, certainly most neurological conditions systemically. And the results are much greater than just treating just each body part. So

Dr. Andrew Wong:

I think that point about BMI versus body constant bears repeating for a sec, because people might go to their doctor and say, I’m fine. My BMI is less than 25. Or you know, I’m not, I’m not as overweight as my neighbor jack here who has a potbelly. Right? So I’m not, I’m not overweight. I’m not I don’t have metabolic syndrome, but they need to get on a BIA body body composition to really see if there’s a visual that there. What’s the muscle mass? Like you said,

Dr. Geo Espinosa:

let me take that. Let me take that comment a step further for you. If you were to ask me, Do you know what population you know concerns you the most? The thing guy or the overweight guy? This thin guy concerns me more than than the overweight guy. Wow. Because the overweight guy knows he’s overweight. Yeah, he knows he has a lot of body fat and he’s either deciding to do something or deciding not to do something about it. It’s more obvious. Yeah, it’s more obvious. A oftentimes people assess their overall health based on how much they weigh in their BMI. Yeah, the thin person that I’ve seen clinically many times those people that we call thin fats, right? They’re thin, low BMI, but a lot of visceral fat, the skinny fat skinny, they’re skinny fat, right? skinny fat. The concern me more because they’re like, oh my god, I can’t believe I’m so unhealthy. I can’t believe my PSA is so high. My blood sugar my insulin, so I can’t believe it. But I’m saying I’ve always been thin. So there, it’s this false notion that just if you’re heavy or not heavy, and either you’re thin, you’re in good shape. No, there’s a lot of metabolic disease and these skinny fat people, they just don’t know and their doctors are not, you know, talking about it, because they are skinny. And when you put them on a body composition, their body fat is 30 35%.

Dr. Andrew Wong:

Though their their doctors might be skinny fat as well.

Dr. Geo Espinosa:

Or just fat or? Exactly, yeah. I mean, this is this is the it is what it

Dr. Andrew Wong:

is. Oh, yeah. I mean, that’s, that’s really important to, to really just like you said, realize if people if men need a diagnosis to improve their health span on longevity, then we need to start diagnosing metabolic syndrome better. And man, yeah, it’s

Dr. Geo Espinosa:

a metal button. You know, you need a more life threatening type of diagnosis. Oh, you have metabolic syndrome. Oh, really? All right. Well, thank you. I’m gonna go to the coffee shop and have a couple of donuts with some coffee. You know, you know, you need a little bit more like oh, that’s just why again, Gleason six prostate cancer. I love it. You know, I had a patient yesterday, I think that you and your audience might be interested because it goes along with everything we’re talking about. So he knows this guy is five nine was weighing like, he was weighing like 210 And he said big belly everything. I saw him yesterday. He just got he got diagnosed with a Gleason nine prosthesis a little bit more aggressive. Prostate cancer, and he’s now he weighs 165 He says, You know, I lost you know, 45 pounds. Right? Wow. That’s a great right good. All right. What did you do I you know, I did whatever I got, I just eat better fasting, which is good, all good. He says but you know, my body fat is still 33% I was like how also is I get into a lot of exercise. I mean, I walked so In this type of scenario, I’m encouraging him to alright, we need to build muscle, right? Because now you’re skinny fat,

Dr. Andrew Wong:

but you’re physically lost muscle. Yeah, he lost

Dr. Geo Espinosa:

muscle and water for the most part, it wasn’t fat. So now, not only is you know, 165 is fine, but we’re gonna go to 175 with muscle, because that’s going to help your metabolism better. And that’s going to help you even with prostate cancer better. And if you do need another treatment, I entered the probation therapy or radiation or something, you will be stronger from, you know, building muscle and under and undergo the treatment.

Dr. Andrew Wong:

So we have prostatitis, you talked about SGO and then and then BPH. Is it something that all men are just gonna get a big prostate? Or what’s the deal with BPH?

Dr. Geo Espinosa:

Let me let me let me, let me help. Let me help ask even better question. When does it matter? And when doesn’t? Doesn’t it matter? Yeah. Why is that because you can have, you can get older and have a big prostate, and not have urinary problems. Yeah, you could be younger, or older men, and have a small prostate, and have a lot of urinary problems. It doesn’t matter if your prostate is enlarged. And I think that, and this is why I think that a lot of people are overly prescribed. Some of the medications that I think are not great for overall health, one of the ones that I think that are maybe a problem are five, alpha reductase inhibitors. So these are your two test drives. And finasteride because it inhibits the production of from testosterone to dihydrotestosterone. And I don’t think Dihydrotestosterone is much of a problem, it does can stimulate the growth of the prostate. But so what, and then some studies have indicated that it can increase the risk of more aggressive prostate cancer, and these are very large studies. So it’s not one of my favorites. And a lot of times people are just trying to reduce the size of their prostate, I think they’re missing the whole boat overall,

Dr. Andrew Wong:

if there’s symptoms, and if the urethra is being blocked, that’s when you would potentially go with a five AR or

Dr. Geo Espinosa:

maybe not, maybe not okay. Okay. So actually, you’re raising a good question, right? Because the bottom? Well, first of all, you can have all kinds of urinary problems that are unrelated to the prostate, just like women have, right? And oftentimes, that’s induced by a bladder, overactive bladder, or neurogenic, bladder or something, then, as long as it does relate to the prostate when the stream is too slow, or getting close to retention, right, you can have a small prostate, and then that prostate is squeezing on the urethra. You can have a large prostate, and it’s not squeezing. All that matters is is it squeezing or is it not? Period? Yeah, with one little exception, and there’s not too many people that have this when you have a humongous prostate. Now it starts pushing against nerves, and some of which actually innervates the penis, and some people can have some erectile dysfunction from a humanoid but this is like, you know, for every 50 patients I see, I may see one that has like, you know, like a small arm.

Dr. Andrew Wong:

Okay, so it’s pretty, pretty, pretty uncommon. Okay. Yeah. Okay. And you said that a BPH benign prostatic hypertrophy is not a associated with an increased risk of prostate cancer. I think that’s really good for all the listeners out there to know

Dr. Geo Espinosa:

That’s correct. That’s correct. That’s correct. I mean, we could go down the rabbit hole of if they do have a high PSA. And then their prostate is so big, then then they get a needle biopsy, but they could keeps missing it because it’s such a big prostate. That’s an issue. So you get to find cancers and more effectively and efficiently and smaller prostates and bigger prostates. Right, just because there’s less volume to target. And now the technology is getting better too. But as it relates to inducing or being a precursor, or even correlated to prostate cancer, that’s not the case.

Dr. Andrew Wong:

What let’s go back to the finger question for a second. So at what age do you recommend you said there’s more prostate cancer now? I think there was actually a study recently that showed that an analysis I believe that showed that that people in general are getting cancers across you know, different types of cancers younger and younger. What age do you feel that is good for men to go to their doctor and get a prostate exam?

Dr. Geo Espinosa:

You know, I’m very, I don’t know if conservatives a word or aggressive. I just think there’s nothing to lose with getting it younger and I think I am even speaking, you know, not so aligned to some of the guidelines by some of the institution’s honestly, it’s just that I see what I see clinically. And I cannot ignore it. Yeah. So I think that, for example, oh, man, I’m just thinking of other patients I see. Right. So I had a guy come in who’s 44 years old, whose father died from prostate cancer. And that’s a big deal whose uncle’s died from a paternal uncles died from prostate cancer. And I’m like, Yeah, we’re not only are we ready to get you to look at this now, but we’re ready to look at you, like years ago, like five, six years ago. So I think if this if there’s a strong family history, starting your, you know, at least to get a baseline 37 years old, baseline PSA. Now, there’s even other tests that one can use, because we know the PSA controversy, right. Yeah. So I could give you a 32nd spiel on PSP, because I think it’s important, it’s important. The issue is not the PSA biomarker, the issue is the misuse and abuse of the PSA that takes people right to the biopsy room and it just makes things you know, you get to diagnose on low risk prostate cancer and all these things. Just too much. Yeah, so it’s the use and misuse of PSA. That’s the issue. And PSA is a very good biomarker for for the prostate. Certainly not great for prostate cancer. Okay, because then people get over treated for the disease. However, before we had the PSA test in the 80s, and before that, those that came in with prostate cancer, 40% of them already had aggressive metastatic prostate cancer, as opposed to 4% when, you know, 1012 years after the PSA came about in the late 80s, early 90s. Okay, there is some benefit from it, but from from Europe from the utilization of PSA, but you wouldn’t want to old PSA three, or you need a biopsy, no velocity now, how it changes within time, things like that. All right. That’s the 62nd spiel on PSA. But there’s other tests now, Andrew, that I think that people need to know about. There’s a few but I want to summarize, there’s something called a 4k score, which is a blood test, which is very good, and it’s more sensitive and specific to prostate cancer. Okay, so the higher that number, the more likelihood of there being prostate cancer there.

Dr. Andrew Wong:

Would you recommend screening initially with a 4k or only if the PSA was I recommend

Dr. Geo Espinosa:

screening, you don’t want to overuse a 4k and actually have a couple of more things to say about the 4k because it’s not perfect, but you don’t want to you know, regular person comes in start with a PSA. Regular person comes in very high risk have a family history of prostate cancer. And high risk means the following if the father died from it, so if he was diagnosed in his 70s, and he’s still alive and no problem, that’s not really familial high risk. Okay, if he was diagnosed in his 60s with more or less aggressive disease, that’s high risk, if he died from it, his high risk, etc. Okay, okay. But that’s that, then I would do a PSA and something like a 4k, which leads me to my next point. The 4k is better and more sensitive. However, within its algorithm, it’s still using PSA. Okay. Okay. So what I see is some false positives and even false negatives, actually more false positives. Because if you have a high PSA from benign tissue, then it’s going to be part of the algorithm. So that’s going to be you know, a high 4k score, which may lead to an unnecessary biopsy. Okay, so is it better than just PSA? Yes, it is. But it’s not perfect because of that. You know what I just said,

Dr. Andrew Wong:

Yeah, it sounds like the family history can help in terms of whether or not someone may want to get a biopsy with that score.

Dr. Geo Espinosa:

Correct? Correct. You definitely want to do more screening and someone with a with a strong family history, at least again, to have a baseline. There’s another urine test that I like, I’m probably at this point even more than the four case called an exile DX prostate score, okay, it does not use PSA at all. Okay, okay. And it’s score. So, lately, I’ve used this test more than 4k because, again, it’s not using PSA and its algorithm and it’s a simple urine test cups and that Then they give you a number. And that number, the caught off is 15.6. And one last thing I’ll say is that with regards to this is that I am not interested in figuring out who has prostate cancer necessarily, I’m interested in figuring out who potentially has a aggressive type of prostate cancer, that some where something can be done to save their life from dying for it. So 80% of prostate cancer that’s diagnosed is not aggressive, and oftentimes do not need to be treated. I’m looking for that 20%. So these tests actually helps with sort of ignoring the lower Gleason scores, and really focusing on those sevens and Gleason seven and higher that overall, that’s one of the benefits of a Gleason six is motivation. So, AB, you know, I think it’s a great diagnosis. But at the same time, you don’t want to put the C word into somebody’s head and unnecessarily so these tests help with sort of diagnosing Gleason sevens and higher.

Dr. Andrew Wong:

That’s really helpful. Thank you. What what do you feel are the common root causes? Since obviously, we’re always talking about root cause of prostate cancer? What are your kind of is it metabolic syndrome mostly, as are some some other things going on?

Dr. Geo Espinosa:

root causes of prostate cancer, you know. So, at this point, and I do spend almost every day on something related to prostate cancer these days, I think that the root cause that there’s two, there’s two types of people with prostate cancer, one that has a very strong family history where they’re at higher risk, not only, not only paternal, but if the mom had breast cancer and died from it, that’s a higher risk for the offspring to get prostate cancer that might be aggressive. So that matters. Yeah. There are genetic mutations that we know so BRCA two mutation for prostate cancer, as opposed to BRCA one, which is more associated with breast cancer, these kinds of things. There’s other mutations that you can that you can test for clinically. Right. So, but you and I think would say we’re not enslaved to our genes, right, it can sort of slow that process down by lifestyle, lifestyle, epigenetics, yeah. All these things, right. So yes, what’s the root cause there is a genetic component. But there’s those people that do not have a genetic component and still get it. And and I think everyone needs to know that lifestyle matters a lot. What does that really mean? That means that the less exposure to environmental carcinogens as much as one can, and all the things that helps you reduce the risk of prostate cancer, or eliminate the risk, which is lifestyle, it comes down to my four pillars are diet, exercise, sleep, and proper and targeted nutraceuticals. Oh, God, you didn’t mention stress, stress is not so not associated, you know, when I went through that divorce, that’s when I think I have my prostate. Can I take? Yeah, sure. But when you do these four things, and you’re pretty consistent, you just stress a whole lot less. That stress load goes down. Yeah. goes down by exercise, eating well, yeah. Sleeping and so forth. Right. Yeah, it goes down. So that’s sort of to make it easy. Yeah, meditation. Sure. All the unknown, no question. But then, you know, I live in the real world. I am here in New York City, high pays stress. So I’m not going to tell you, you know, that mountain that they go up to them and be there for three hours, do Transcendental Meditation every day. And when you come back, you’re going to you know, I have to be practical with men that I see the who live in the real world. Yeah, right. Yes, sir.

Dr. Andrew Wong:

I love New York City, although TM is not going to stop the subway noise, right?

Dr. Geo Espinosa:

Unless you’re really good and to

Dr. Andrew Wong:

really good luck it out, you

Dr. Geo Espinosa:

miss your stop,

Dr. Andrew Wong:

miss your stop. Then you got to have a cup of coffee as well, that might work that might work at the Tm plus coffee, and a lot of men to use exercise as a way to mitigate the stress. I mean, that’s actually the solution for a lot of men.

Dr. Geo Espinosa:

It’s active meditation. And actually that’s what I do. I think sitting down for 15 minutes and do deep diaphragmatic breathing I think is very helpful. Yeah, but I can’t do everything. So if I have to choose one what how I respond really well and form of meditation is active meditation, whether running or lifting or something. And now I get a lot of bang for my buck, right? Because I get the physical benefits of mental, the psychological, the spiritual, even hopefully, things like that.

Dr. Andrew Wong:

If you’re mindful when you move, you can really, like you said, kind of hit different birds there with one stone, that’s

Dr. Geo Espinosa:

a good point, actually, if you’re mindful, I find that I get frustrated with running, because it’s just me know, AirPods. And I’m just going and if a thought comes in, I have to do something with that thought, because I’ll slow down or start walking or try to figure out problems. So with running, it could be meditative. And I’ve been in that zone. But I find it to be sometimes difficult, because you know, to get the thoughts out, right, yeah. So but but but certainly possible. And if you do it mindfully, I think it really helps.

Dr. Andrew Wong:

So we talked about men today, you know, men, men are really, you know, an important part of the world, obviously. And, but but we know that, you know, men don’t always care about their health is what we started with. They care and they’re motivated by performance. But what is one thing you wish everyone knew about, about men’s health, whether that’s a man listening to this, whether that’s a woman or someone that that knows a man?

Dr. Geo Espinosa:

You know, I think that if one wants to, If any man is really truly interested, and playing this game of life, and aging really well, then you need to train for that. Like as if you’re on an athlete, because you know, aging as a sport. And you want to train for it like Tom Brady’s training 45 to be this quarterback, right things that you never seen, you have to train for that. And there is no other way. Now one can say, right, so I know the male mentality, there’s numerous but one of them is one male mentality is, well, you know, I’m going to die anyway, or something like that, right? So I want to live my life, I’m going to die anyway. The problem is that you won’t die. Because, yeah, I agree. I’m all about living in life your way. No question. You wanna smoke drink. I’m all about you living your life your way. And if it’s true, then then you just die when you die. No problem. That’s a great way to live. The problem is you don’t die. The problem is that you stay alive. But you hate your life, you’re in excruciating pain. You have half of your body is paralyzed from a stroke. You have you’re on chemo, and now your quality of life is no good. And not only that, you become a burden to those around you. There is no other way. Right, there’s a consequence, there’s a consequence, there’s a consequence dissipating in that yeah, there’s a consequence to yourself. And as a consequence of those around you, yeah. Right. They pay the price to a point a point and you don’t die. Alzheimer’s. When was the last time you seen an Alzheimer patient who dies? They don’t 10 years 12 years and they live a long time they live a long time. Yeah. And

Dr. Andrew Wong:

they live a long time but that the quality is not there. They’re not really fully living the way they

Dr. Geo Espinosa:

are not they’re not my football coach from high school, you know, had a died from it. And you know, his wife who’s a lovely lady really struggled quite a bit because he was more belligerent and so forth. So so the takeaway I think, is you will not just die and if you’re serious about being 7580 85 years old, and playing with your grandchildren, and you know, you may have a new grandchild and you want to actually imagine sitting down on the floor and playing with your grandchild in your 80s which is certainly possible, then you need to train for that. And the training for that is work like a sport you train on notice I’m not saying exercise I think train right improve your strength, improve your balance, do the work here, you know, eat well eat clean, take the right supplements and make sure you pay some attention to sleep, which I know gets worse with age. But I think some of that not all of it is related to just poor sleep habits that you can improve on.

Dr. Andrew Wong:

Yeah, yeah. I love that message. I mean, it’s really a call to all of us men or anyone listening out there who is a man or knows men, that it’s a daily practice a daily a daily training, like you say, Well, I like running but I love I love. I’m trying to do more body weights and more more hit and things I think I think the strength is really important, like you said, but But overall, thank you so much for coming on today. We do have some fun questions for you though. Ah find a little bit of these are all fun. But we have a morning routine question which is sort of like what’s Dr. Joe’s morning routine? Since we know that morning routines are really obsessed with health and kind of in my mind

Dr. Geo Espinosa:

a Tim Ferriss podcast, where am I on? Andrew? Whose podcast? Am I?

Dr. Andrew Wong:

This is that maybe it is? Maybe it is Tim’s in disguise? Yeah, yeah.

Dr. Geo Espinosa:

Yeah, then you look different. They look different. So morning routines is 555 30, just five to six wake up, depending on what’s going on. And it is some movement, whether it’s 10 minutes or 60 minutes. So it’s either some movement to 10 minutes is just to get things going. I do some. What do you call that? So it’s like Cobra position into a push up and oh, yeah, going back and forth. I do those several times, it gets a move, I want to move several joints and I want to get the circulation and my brain going. So I try not to get on the phone, which is not a good idea. So my first thing is kind of a move, or I do my my training that morning whether and oftentimes it is strength training. I have a garage gym and anybody who follows Dr. Gio Espinosa on Instagram knows what that Jim, I heard it. I heard about that. Yeah. Yeah. And so I do strength training with coffee. So I drink coffee during my training, there seems to be some benefits there. I don’t feel like I’m getting an ergogenic benefit are more energy from coffee necessarily. I just like black coffee, my workouts, but some, some studies suggest that there are so those benefits when you drink coffee, just black coffee, I just drink it because I like it. And if those benefits exist and great, but that’s pretty much my morning routine. I wish I did more journaling and things like that. Like everyone says I don’t. But I do start thinking of my day and how I want to live. And I think about my kids as I’m training. So it’s not I wouldn’t say meditation, but I think about how can I how can I how can I how can I be a better father today?

Dr. Andrew Wong:

Well, it’s mindful. It’s your you’re actually focusing on on the service and family and all that. Getting your day off to a great start. And Dr. Gao, I know you have a lot of fun websites out there. how can listeners work with you definitely mentioned that Mr. Happy one, two, I think I love it.

Dr. Geo Espinosa:

For everything. Everything comes from Dr. gao.com. So anyone who’s really interested Dr. G. o.com. There you have the podcast and other things. Other podcasts is it I’m I’m little bit young. I’m about six months in. And it’s all I talk about is your illogical problems and men’s health. Yeah. But if you go to Dr. gao.com. My information is there. And thank you so much is this this was a lot of fun. Thank you. Yes,

Dr. Andrew Wong:

same. Thank you so much, Dr. Chia. Thank you for taking the time to listen to us today. If you enjoyed this conversation, please take a moment to leave us a review. That helps our podcasts to reach more listeners. Don’t forget to subscribe so you don’t miss our next episodes and conversations. And thank you so much again for being with us.