Dr. Chang (00:01): Icing your testicles four times a day is crazy. Carey (00:03): And how do you get by with that? Does he ice in his car? Jackie (00:06): I was going to say. Dr. Chang (00:10): You are listening to Secret Services where we discuss the procedures nobody admits to, but everyone's curious about. I'm your host, Dr. Christopher Chang. All right, we're back. Great to see everybody. We have another episode of Secret Services on deck. I'm Dr. Chang. Jackie (00:27): I'm Jackie. Dr. Chang (00:28): And of course - Carey (00:29): Carey. Dr. Chang (00:30): We have Carey back. Jackie (00:31): Our little special guest. Dr. Chang (00:33): So there's been a lot going on. It's been a busy summer and a lot of different trends we're seeing on social media and stuff. So we wanted to get a three-way perspective on some of the latest and greatest. Jackie (00:45): All right. A billionaire posted his own sperm count on the internet and half a million men started copying the protocol. That same month, the Department of Defense announced it will test every service member over 30 for low testosterone. Dr. Chang (00:57): Oh, I've been dying to talk about this. Jackie (00:59): Nobody involved seems to have noticed these two projects work against each other. So when a patient brings in a protocol they found online, how do you separate the ones with real science behind them and then the ones that just have a big number behind them? Dr. Chang (01:13): Well, you see a lot of patients that come up with beauty hacks and skincare things they found online. Where do you start? Carey (01:20): I mean, some of them are so silly, but you don't want to embarrass them and be like, "You really think that's going to work?" When someone comes in and they're like, "Oh, I got my own microneedling role online." And I'm just like, "Oh my God, you're going to have breakouts all over. You're going to scar your face." But you kind of have to determine which are actually worth even entertaining. I say it all the time, common sense isn't so common sometimes when it comes to skincare or plastic surgery because you're just like, no. Jackie (01:49): Why would you do this? I keep seeing people doing their own microneedling at home on TikTok and it scares me. I'm like, "What are you doing?" Carey (01:56): Yeah, there's so many things that can happen. Jackie (01:58): They're like, "It's so much cheaper." I'm like, "Yeah, of course." Carey (02:01): Until you get staph infection. Jackie (02:02): Yeah, you're just putting a million holes in your face at home. Carey (02:07): Yeah. Dr. Chang (02:08): It's kind of wild because you see how easily influenced people are - Oh, for sure. From seeing something online and they sort of see a YouTube short or TikTok reel or something. They're like, "Oh, that looks so easy. I'll try it." Jackie (02:22): Just some random girl doing something on her face and everyone's like, "I'm going to do this. I'm going to buy this off Temu." Carey (02:28): Right. Well, that's the other thing too. It's like all these influencers are like, oh like, I like don't want to bash it because I've never tried it, but they're like the Medicube. And it's like all these influencers, but none of these influencers are properly trained on skincare. Dr. Chang (02:41): What's a Medicube? Carey (02:42): It's something on TikTok. It's all over TikTok. Jackie (02:44): But I use the toning pads and they burn my skin. Dr. Chang (02:47): It's a line of Skincare stuff? Carey (02:49): Yeah. Yeah. And I mean, the videos, the skin looks amazing, but I'm like, is it really the product or is it just the influencer? Dr. Chang (02:58): So they've got a whole line of products that they do, which is - Carey (03:01): Yeah. One of the patients came in on Monday and she asked me about it and she's like, "Oh, I got the salmon sperm one." Dr. Chang (03:08): Oh, just mail order salmon sperm? Carey (03:10): Yeah. And I was like, "How'd you like it?" And she says she likes it, but again, I don't know anything about the brand or the product. Jackie (03:17): I did get the salmon sperm masks. I'm easily influenced. Dr. Chang (03:20): You'll try anything. We established that, Jackie, you'll try anything. She'll be your customer. Jackie (03:24): But I feel like the salmon sperm mask is not as invasive as microneedling yourself at home. 100%. And I'm like, "All right, if it sucks, I'll just throw it away." It was fine. I don't think it was anything special. Dr. Chang (03:38): At worst, those kinds of products will do nothing. Essentially, so the biggest effect is from the carrier, which is the ointment that it comes in. You're like, "Oh, my skin's so smooth or glowy." It's basically aveno ointment or lotion. Jackie (03:53): I feel like it was like every other sheet mask. They make your skin a little glowy for a few hours. They're not really doing anything at all long-term. But yeah, if it's on TikTok and it starts trending, everyone's going to start doing it. Dr. Chang (04:08): But try it at least once. Jackie (04:10): Yeah. Dr. Chang (04:10): Yeah, no, actually, I think I sent you this thing or it's funny, I saw it and then you sent it to me maybe. But there was an overnight breast enhancement or non-surgical breast enhancement. Jackie (04:20): A non-surgical breast lift. Dr. Chang (04:22): It was sort of like they had a before and after of a woman who had had a little bit of deflation or a significant amount of deflation. It was like, look, she had no surgery. And it was like she also had no result. It was like she probably spent money and got injected with either sterile water or sterile saline or something. Jackie (04:40): Yeah, I don't even understand it. Frankly, I think the breast almost worse after. Dr. Chang (04:43): Just kind of plump up her breast that looks no different and just basically took her money. Jackie (04:48): Yeah. Dr. Chang (04:49): And it was really weird because the clinic that posted was showcasing this as an advertisement. Jackie (04:54): That's what they specialize in. Dr. Chang (04:56): It's just injecting your body with saline. And as I said, at the very best, it doesn't hurt you. Jackie (05:04): Yeah. Dr. Chang (05:05): Hurts your wallet, I guess. Jackie (05:05): Yeah, it hurts your wallet. Snake oil. All right, so let's talk about this guy on Reddit. Someone said, "My husband has been icing himself four times a day for two months because someone on Reddit said it fixed his sperm count. We've been trying for a year. I don't want to be the person who tells him it's ridiculous if there's a chance it's actually doing something. Is it?" Dr. Chang (05:28): Do you want to get in? So it's funny that this thing about icing or controlling the temperature in your testicles and your groin for men has been around for a long time. It's funny, my dad sent me something about loose underwear, improving your sperm count, an article he saw the other day. So it's funny how contemporary it is, but there was a Seinfeld thing. I don't know if you've ever watched Seinfeld. Jackie (05:53): Oh, yeah. Dr. Chang (05:53): Back in the day, Kramer was talking about switching from jockeys to boxers or something like that. And so it's been around for decades, conversation. Carey (06:02): Well, I heard something years ago that if you want a boy, you wear boxers, but if you want a girl, you wear tighty whities to keep your testicles warmer. I don't know if that's true, but - Dr. Chang (06:17): Well, let's put it this way. Anatomically, it's designed that they're outside the body because the ideal temperature's a little lower than your native body temperature. And it is a biological organ of the scrotum that will bring it closer to body when you need more warmth and relaxed when it's warm and needs to be cooled off. So it is auto-regulating the temperature that it's supposed to be to cook those little sperm cells just right. So that's the way your body's supposed to work. I don't think if you externally start trying to mess with that, that you really know better. Carey (06:52): True. Dr. Chang (06:52): How to control it might, I don't know, might feel good or bad or something like that, but I'm not sure it's really going to, that you know how it's affecting your sperm count. Jackie (07:03): Also, I feel like stuff like this, it's another thing where someone did it and it worked for them, and then they just post it on Reddit and be like, "This is how it is for everyone." Dr. Chang (07:13): I'm sure this also is quite an ordeal. He's doing this four times a day with a bag of ice. Four times a day. Carey (07:19): So is he at his desk with an ice pack? Dr. Chang (07:21): Four times a day to do anything is a big commitment, whether it's exercising four times a day or - Jackie (07:28): That would be crazy. Carey (7:30) Yeah, brush his teeth four times. Dr. Chang (07:33): It's a lot. Icing your testicles four times a day is crazy. Carey (07:37): And how do you get by with that? Does he ice in his car? Jackie (07:40): I was going to say, it sounds like you - Dr. Chang (07:41): This is why his wife is mad at him. "Where are you?" Jackie (07:43): Yeah, he's getting out of doing a lot of stuff around the house. Sorry, I got to go ice again. Dr. Chang (07:49): Yeah. Carey (07:50): And I'm still not pregnant. Jackie (07:51): Yeah. Yeah. Dr. Chang (07:52): Right, right. Oh, don't worry. It's for the good of the baby. That's what he's saying. It's interesting. Some people really do have a lot of difficulty getting pregnant and they get desperate. And fertility treatments are so popular now, but they're so expensive. Jackie (08:08): So icing is just like, why not try this first? Dr. Chang (08:12): Yeah. Yeah, but you'll be in for a lot of crap from your spouse probably. Jackie (08:17): It just seems like, I don't even understand scientifically how this would be treatment. Carey (08:22): To me, I feel like ice would restrict. Jackie (08:24): Right. It seems like it would have the opposite effect. But it says he's icing during sauna session. Dr. Chang (08:28): You can start investigating. Maybe you'll - Jackie (08:30): So he's icing in a sauna session, so he's sitting in a sauna, but icing - Carey (08:34): Oh, so he's trying not to overheat? Jackie (08:36): Maybe. I don't know. Dr. Chang (08:39): I don't know. Jackie (08:40): Protect them. Dr. Chang (08:41): These days, men are really into beauty and wellness treatments, and that's kind of been social trending with peptides. And we talked about Looksmaxxing in one episode, and the male interest in beauty and wellness has really exploded. And it's getting political and stuff too. Obviously when RFK was brought into the Health and Human Services, I thought some stuff that they were talking about was very good. Natural stuff, trying to get dyes and artificial ingredients out of food. But he's also kind of on the fringe of the wellness holistic movement with things that are not FDA approved or trying to get things through peptides that are very, very popular, exciting type of medications that are just a little edgier because they aren't investigated the same way as traditional pharmaceuticals. And so this politics around wellness and holistic medicine has really been a big thing this year. Jackie (09:35): Right. And so that leads into the Department of Defense. They're screening all personnel 30 and older for testosterone deficiency with voluntary hormone therapy offered to anyone testing low. It follows an FDA move last month to strip safety and effectiveness language from testosterone labeling and loosen prescribing limits. The urologist who led the FDA panel told the BBC that men in their reproductive years must be told that therapy will make them fertile. Dr. Chang (10:02): When I saw this announcement from Pete Hegseth about that, I was stunned. It was like of all the things that the military's doing, we're going to talk about the testosterone of the soldiers. Jackie (10:15): Yeah, I thought it was a strange move. Dr. Chang (10:18): Oh, Jackie (10:18): Then all the other people were like, "So you do care about hormone replacement?" Dr. Chang (10:24): I mean, there's so many directions we can go. The political, the medical side of things. There's also this thought that maybe some of that is to uncover or expose transgender service members too. Jackie (10:40): True. Dr. Chang (10:40): It's sort of like this thing where they're trying to be like, okay, well, let's try to expose your personal gender identity. And so I think that the idea of performance enhancing hormones and stuff like that to try to make super soldiers is kind of crazy to be mandated by the government. Jackie (10:58): Well, and I think it's just going to kickstart a trend of people finding random stuff online. Men are going to be like, "Well, do I have low testosterone? I'm going to buy this testosterone offline and start injecting myself." Weird stuff like that I feel like this is going to spark. And then just the Brian Johnson guy, 57% jump in his sperm count. I've had friends that are going through fertility issues and they'll go get checked. And I feel like the men who have really high sperm counts or whatever, they're so proud about it. It's something else for the men to brag about like, "Well, my sperm's great." So I feel like men are going to be like, "Well, I'll increase my sperm. I'll increase my testosterone levels so I can be more of a man." Carey (11:41): Yeah. I mean, also, how old is Brian Johnson now? He's like - Dr. Chang (11:45): You're saying you watched some sort of thing about him and you got to fill us in because I kind of peripherally know he's a very wealthy guy. I'm not sure what his background is on how he generated that career wealth, but now I've heard his whole focus is on trying to maximize how long he can live for and improve his health. Carey (12:04): Yeah, basically what he's trying to do is he's trying to basically regenerate his age cells, I guess what is the essential goal. So it's this guy, the documentary came out, I want to say maybe two years ago, but basically the tech guy from California made millions in tech. And then I guess he sold his company and he basically just focused on how to make his body the best it could possibly be. It is a rigid schedule that he does sun up to sundown. And basically he wakes up the same time every day. He starts off with 80 supplements. Then he puts on his red cap for hair growth, and then he works out. It is just so intense that I'm like, this guy is trying so hard to live as long as possible, but he's not living. He is going every second of his day is doing something to reverse his age. I mean, his skin is flawless. Dr. Chang (13:07): He looks kind of pale, doesn't he? Carey (13:08): Oh, yeah. Dr. Chang (13:09): He's kind of very pale, but maybe he's doing that on a purpose to protect himself from sun damaging. Jackie (13:13): Probably. Carey (13:14): He does the red light. But yeah, no, he's one of those people you just look at him and he looks like - I don't know. Jackie (13:21): Is this the guy that came out saying that his stomach is eating itself or something? Carey (13:27): I don't think it was him, but I did hear a rumor, and I don't want to misquote, but apparently he broke up with his girlfriend because she had cancer and he was like, "You're not healthy enough for me." Jackie (13:42): That's insane. Dr. Chang (13:42): Yeah. This is a crazy excuse to date younger women. Carey (13:45): Yeah. Jackie (13:45): Oh my God. Dr. Chang (13:46): Is that his goal? Carey (13:47): I don't know. She was younger than him. And so then he started doing this and he's testing his numbers. He's going to ridiculous lengths to document what he's doing and how it's helping. No average person would ever be able to. He's going to doctors getting blood tests done weekly, monthly. It's insane. Dr. Chang (14:09): I mean, again, this kind of demonstrates a couple things. We talk about how celebrities can get messed up and things like that. When you are so famous, wealthy, influential, you are going to find people that will just agree with you or take your money or say yes. And that's the Michael Jackson phenomenon I always say about the nose thing. How did he get 25 revision rhinoplasties and deform his skin and face? These things, money can really be bad. People won't tell you no. And he's obviously a very smart person, but being smart, doing the research, having these experts around you can also be confusing. I think just as a social concept, that can be very bad. Carey (14:54): Yeah. Well, he definitely, I'm no doctor here, but he definitely stems from some type of OCD because it is such a rigid schedule. And then the other crazy part is he has now gotten his father and his son to participate in this experiment technically. And they're all going and they're all testing. Jackie (15:19): It's also just like no normal everyday person could even live this life. Carey (15:23): No. Jackie (15:24): You wouldn't have time. You have to go to work and do normal everyday things, not take 80 supplements and have this highly scheduled regimen. Dr. Chang (15:33): I've heard occasional things where it'll say, oh, he had some bad outcome because he tried this experimental protocol or whatever and had an adverse event. So sometimes that'll pop up as a headline on various channels and things like that. But getting back to the testosterone thing, I think people have to understand it's not just some super drug that we're just discovering. I mean, we've had testosterone supplementation for decades, and these things are not just an isolated magic pill in your body that we can say, oh, like any drug that in isolation is perfect for you. So if you take testosterone and you need it, yes, that replenches what your physiologic level should be, and that should be guided by a doctor or somebody measuring that like an endocrinologist. But if you just take it on your own, you amp yourself up full of testosterone, you can have all sorts of other stuff. (16:27): It can get converted in estrogen. You can get gynecomastia and breast tissue growth. You can get oily skin and acne, like a lot of the - Carey (16:34): I was going to say, the bodybuilders - The bodybuilders who aren't following a doctor. Yeah, they have bacne, they have mood swings, they have gynecomastia, hair loss, all these things. Dr. Chang (16:48): Yeah, hair loss and your testicles actually shrink. You can get atrophy of your natural teststicles. Carey (16:53): That's when they go back. Jackie (16:55): Yes. Dr. Chang (16:55): You know a lot about this. Jackie (16:57): So we're telling them - Carey (16:59): I did study it in college. Jackie (16:59): To chase their sperm count. Dr. Chang (17:01): She's not a doctor. Jackie (17:02): While also talking about testosterone, which could suppress it. So it's like, who's actually keeping track of the whole person? And I think that's so important when people are just getting advice off the internet. It's like you're just reading one thing. There's no one telling you, looking at your whole body, what all you need. So people just cherry-picking things off the internet. You don't even know how all these things are reacting with each other in your body. Dr. Chang (17:25): Yeah. I mean, you have to think about all of these ideas and all of these things that we hear about that they're not in isolation in your body. The physiologic part is very complicated, and that's why you go to people that know about all these things in your body, not just one thing. So be careful out there. Don't sign up for those testosterone supplements without - Jackie (17:45): Black market. Dr. Chang (17:46): Without good advice. Jackie (17:47): Go easy on icing your testicles four times a day maybe. Dr. Chang (17:50): Yeah. You stay cool out there. We'll be back for another episode, and thanks for watching. Thanks for listening to Secret Services, to podcast where we see everything and say nothing except right here. I'm Dr. Christopher Chang, double board certified plastic surgeon located in Tysons, Virginia. Follow us on TikTok @congressionalpsurgery or on Instagram @congressionalplasticsurgery. To send us a classified message or to hear more episodes, go to secretservicespodcast.com. Links to everything we talked about on today's show are available in the show notes. Oops, patient's here. We got to go.