From my Parade interview: see a doctor if you're regularly up more than twice a night, it came on suddenly, or it's costing you sleep. Being unable to urinate at all is an emergency. Once we identify the cause, it's usually very treatable.

Varicoceles are common: about 15% of all men have one. Among men who are struggling to conceive, it's about 40%. It's a very correctable cause of infertility, for the man and for the couple. If you're experiencing infertility as a couple, look to the man.

Up at night to pee? Parade asked me why. After 60, the brain releases less of the hormone that slows urine production overnight, so the kidneys make more at night. In men, an enlarged prostate can keep the bladder from emptying, so it fills again sooner.

Varicocele: surgery or embolization? You get two different answers depending on whose office you're in. 12 minutes on both: who needs it fixed, recurrence (0.5 to 1% vs 10 to 13%), recovery, radiation and anesthesia, and what I recommend. New on YouTube: youtu.be/l7EghpTc5kU

How long does sex last on average? About five and a half minutes. Couples in five countries timed it with a stopwatch, and that was the middle of the pack. Younger guys a little longer, older guys a little shorter. If you and your partner are satisfied, that's the goal.

Your hernia is fixed, so why does your testicle hurt even worse? When mesh sits around the spermatic cord, it can irritate nerves like the genitofemoral nerve, which travels to the testicle. If it gets trapped in scar tissue, you really feel it there. This is not in your head.

With a normal semen analysis, no testicular pain, normal development and normal testosterone, a varicocele isn't impacting your testicular function. No role for a varicocelectomy. Fix it for abnormal sperm parameters, testicular pain, or a smaller testicle on that side.

Telehealth is how a lot of my patients start, especially patients outside of Los Angeles. A video call from home: symptoms, history, labs, imaging. A lot of them are second opinions. Some things need an in-person exam, like assessing for a varicocele or a spermatic cord block.

When I tell a man his semen analysis shows zero sperm, he hears that he failed. What I tell him: this is the start of a process, and his stress, sleep, and mental health belong in the treatment plan. Guys: talk about it.

The number on his semen analysis isn't the only thing that needs treatment. In a Harvard study of 718 men at a fertility clinic, the most stressed men tended to have lower sperm counts. And men can feel anxiety and depression after miscarriage too.

Should you freeze sperm before a vasectomy? A vasectomy is supposed to be permanent. Reversals work, especially within 7 to 10 years, but banking sperm first is a great insurance policy, and it's sperm from a younger period of your life. It's easy to do at home now.

Five things I never let my patients do: Kegels with pelvic floor pain. Shockwave for ED from a radial device instead of a focused one. Ignoring ED in your 40s. Giving up on a vasectomy reversal at 10 years. Skipping the semen analysis after a vasectomy.

Check 3: LH and FSH, the signals your brain sends to the testicles. Check 4: a physical exam, including for a varicocele. Then two questions: do you want kids, and do you snore? TRT can drop sperm production to zero in some men, and in some situations it makes sleep apnea worse.

Four checks before anyone starts testosterone. Normal is anywhere from 300 to 1,000, and different men need different levels. Check 1: a morning blood test, then a second. Check 2: free testosterone and SHBG, because a high total can still leave free T quite low.

Before I order anything, I ask three questions. Ever taken testosterone, or anything from a clinic, a gym, or a website? Ever gotten anyone pregnant? What happens when you ejaculate? And I think three months of trying is the right time to check him.

Why does the male infertility workup start so late? I wrote about it for KevinMD. Male factor contributes to roughly half of infertility cases, but most men in their thirties don't have a doctor at all. So her workup starts, and he waits.

Men with varicoceles tend to have lower testosterone. When blood pools in those veins, the testicle runs warmer. Repairing a varicocele can raise testosterone on average. It doesn't work for everyone, but if you have low T, check whether you have a varicocele.

Viagra or Cialis working for months, then slowly fading or just stopping, is normal. That's the progression of the disease, and the pills can only do so much. There are other options: injections, shockwave, Botox, PRP, and if none of those work, a penile implant.

Does a vasectomy cause prostate cancer? It's a myth men have been told, for whatever reason. There's zero evidence of a connection, across numerous analyses. It also has zero impact on your testosterone, your sexual function or your erections.

Three things to check before testicular pain surgery: how many the surgeon does, whether they're a fellowship-trained male fertility specialist, and whether they do a diagnostic spermatic cord block first. Without the cord block, you may or may not have a good outcome.