In February I happened to attend a lunch 'n learn presentation at TMCi by a company doing clinical trials based on exactly this venous insufficiency principle. I think I may have been the only one in the audience with gray hair... TMCi is the startup accelerator attached to the Texas Medical Center in Houston.
The startup company is Vivifi Medical[1] and they have clinical trials underway with ten men in a Central American country (El Salvador?). They claim that BPH reverses in a few months after their procedure. Their procedure uses a minimally invasive tool of their own invention to snip the vertical blood vessels that are backflowing from age and gravity, and splice them into some existing horizontal blood vessels. On their board of advisors is Dr. Billy Cohn[2], the wildly innovative heart surgeon who is famous for shopping for his medical device components at Home Depot. Dr. Cohn is on the team building the BiVACOR Total Artificial Heart. Vivifi presented their estimated timeline to FDA approval, with proposed general availability in 2028. My personal BPH will be at the head of the line for this procedure.
As far as a startup, their TAM is about 500 million men. I had the Urolift procedure for BPH three years ago, and it cost about $15K on the Medicare benefits statement, though Urolift's clips amounted to only a few thousand dollars. Similarly, Vivifi's charges for this procedure are only a few thousand dollars per procedure, but it holds the promise of being a final solution. Currently Urolift is much less disruptive than TURP, which needs a couple of days in the hospital and almost always leads to retrograde ejaculation (into the bladder).
Thanks for the shout out. I am the CEO of Vivifi medical. We are building off the gat and Goren’s work and making it better and more robust. More importantly making it more accessible to patients through urologists.
Our early clinical trial data from Panama is looking highly encouraging and we are working hard to bring this to the market in the fastest manner possible.
Not at all. Our device does not go through the penis, doesn’t damage the urethra or resect prostatic tissue. As a result, there is no risk to any sexual or urinary functionalities. There is no post op catheter.
The text brushes over the importance of healthy muscle motion for venous blood flow against gravity. Staying physically active, including pelvic floor exercises into the routine and correct belly breathing utilizing the diaphragm are probably the best options for preventing issues with reduced venous blood flow from the testicles passing by the prostate back to the heart.
Once per day, when peeing, do it differently.
1. Release the stream during the in-breath. 2. Stop and hold the stream on the outbreath. 3. If not yet bored or tired go back to 1. Else - finish peeing normally.
That's it.
And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.
Huh. So that “happiness through clenching your butthole daily” or whatever-it-was copy-paste troll that was so common on Slashdot back in the day, was… very close to being excellent advice?
> And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.
I've experienced all those benefits when I started walking two times a day, 8-10 thousands of steps a day continuously for several weeks. I haven't performed any other exercises.
But it's really boring and you need to do it every day. I do it only because I need to walk a dog.
Photography has made me realize how much I was previously ignoring. There’s so much to see, and even when walking the same route over and over, there’s an astounding amount of change over time. Often little things.
The Bird ID app made me realize just how many unique birds were making up the sounds I was hearing. As I learned to distinguish between them, I found myself fascinated in a way that I’d never been before.
Walks became almost meditative over time, and the sights and sounds a kind of salve for my often tired brain.
I often feel like I can think more clearly when walking as well, and thought processes kind of just sort themselves out as I go.
I highly recommend making walks more than just a way to move your body. They can be much more, and getting the benefits of movement almost feels like a happy side effect.
Walking is considered by einstein and pretty much all thinkers to be critical to deep work. It's also covered in Cal Newport's book "deep work" briefly. Which is a short audiobook worth reading.
One such prescription would be to do deep work early in the day then walk after and walk again 2 hours before bed. Another would be split the deep work with a 1 hour walk and do the 2nd walk after the 2nd block.
It may be more fulfilling with lots of interesting ideas rattling around. YMMV
I desperately want to do this type of walking, but I live in a major city. There’s always something to distract me, which is great for boredom perhaps, but ruins any sense of zen or reflection. I would say half of every walk involves people yelling, loud vehicles, and louder music. Noise-cancelling headphones are only useful for distraction through podcasts and music, not for decompressing. I’m starting to wonder if the solution, the sad solution, is to walk on a treadmill at a gym during off-peak hours.
Have you considered earplugs? The firearms community have some pretty great ones which are readable and fit really well. Check out Axil x30i for example.
>But it's really boring and you need to do it every day. I do it only because I need to walk a dog.
I'm lucky enough to have a pedestrian path to do my long walks (so no cars or even bikes to contend with, bikes have a dedicated parallel path), so I listen to a podcast while walking around 1 hour/day.
I don't find walking to be boring at all! Especially when I'm working on something new, I will walk as many as 10 miles a day while thinking through all of the design corners.
Even when I'm not working, I like taking long walks to think about family, friends, video games, etc.
Its a great way to get into your head without the distraction of a phone or feed or forced message.
> Screening for this disorder is simple: use a thermal camera and compare testicular temperature sitting up (or standing) versus lying down, in each case waiting five minutes or so for temperatures to equilibrate, and taping the penis up so that it does not affect the measurement.
Interesting. I wonder how many how many other issues we could screen for using such simple, low cost tools. Some scales can already detect reduced blood flow in the feet (which can be a sign of all sorts of nastiness).
Stethoscopes are pretty cheap and versatile. Human doctors in general have lots of senses which they (in some medical systems) use for diagnosis before reaching for lab tests and MRTs.
If they bother. The vast majority of appointments I’ve had, in recent memory, are the provider typing a bit on their laptop, then sending me to someone else.
Issues like these reflects an evolutionary blind spot: selective pressure drops off after reproductive age, allowing defects like prostate dysfunction to persist. It's the same reason late-onset neurological diseases remain prevalent.
You only have to live to your 40s to become a grandparent in natural conditions, and your chances of living to at least your 50s have always been pretty good conditional on living long enough to reproduce at all.
The article sort of mentions this in passing, but doesn't subject it to much rigor, and the (completely obvious?) counterargument is that by the time it causes male infertility, the affected have already reproduced.
I know you're joking, but it's women that get the short end of the stick in media.
Men are (within reason) considered handsome in media even in old age. Wrinkles and gray hair can be seen as sexy (again, within reason), but only in men.
Women are discarded or relegated to sexless granny roles (except maybe for comedic purposes, where sexuality is the butt of a joke). Actresses are replaced by younger women because they are not sexy enough even when their male equivalents aren't (looking at you, Top Gun: Maverick).
I'm not saying there aren't exceptions in particular movies that deal with this topic; I'm talking about the general trend.
When you ask men who they are attracted to, at least on the surface, it’s always young women. I’m pretty sure the OkCupid stats showed that girls age 20 give or take were peak attractiveness. Reality is of course that guys will “work for food” or attention.
Women are different. It ranges — alot, and is more about EQ and scarcity. If you have a moderate baseline level of physical attractiveness, moderately fit (Jon two miles let’s say), not an asshole, and not living with mom, a 40-60 year old guy is a hot commodity.
With our modern health systems we are pretty much a huge evolutionary blind spot ourselves. Many illnesses that would be filtered out because the carrier wouldn't survive, are now trivial. And on the journey hand we can screen for known illnesses.
I think we are already post evolutionary, or control it ourselves. Not a big issue either IMO, it's totally ok that this is happening.
We are definitely not post-evolutionary; the selection pressures have simply changed. Before industrialization the big two were starvation and infectious disease. Now? Well, it's anybody's guess decade to decade. Certainly sexual selection is still with us.
The main problem is that evolution is just not a thing at our modern civilizational time scale.
And I don’t see any problems with late-life reproduction, assuming we can make it reliable and healthy. If anything, some countries desperately need it.
Evolution is really slow on average, but locally it moves quite quickly and probably explains the large variation between members of a species.
Add strong selective pressure to that high local speed and you can change a good part of the genotype within a couple of generations. See: animal husbandry. You can breed a new race of dog within 5-10 generations.
Ethics aside we could probably breed people who can sniff out Alzheimer's in less than 250 years.
Our current late reproduction style will very likely influence future generations health at older ages.
It's probably a wash. Sure people are reproducing later, but it's also more likely that they have recieved some major medical intervention to allow them to make it to that stage. For example, it could be stuff like freezing eggs before starting chemo.
No. The grandparent comment was essentially saying that we, as a species, were not designed to live as long as we do. It’s only been <10 generations since medicine has been a thing. Cancers, dementia etc just weren’t a thing before because we evolved to live long enough to bring our children up to be self sufficient and reproduce, then our job is done. Like the rest of the animal world do.
Modern medicine has messed with this. We weren’t meant to “old”.
>In women, breast cancer has a similar death toll, but the breasts have an excuse: they’re much bigger; there are many more cells to go bad. They’re also much more metabolically active, capable of producing enough milk to feed a baby; the prostate’s output is tiny in comparison.
Except that you make work your prostate everyday, multiple times, since your adolescence, whereas a woman doesn't breastfeed everyday since adolescence.
Based on the simplified sketches and reasoning I'd assume that it made more sense to sclerose the two small vein sections connecting the testicles with the prostate. Does somebody know why that's not the suggested option?
Why do ideas like this take so long to be tested/adopted? Is it because the alternatives are “good enough”? I would think the evidence would lead to a fast shift; though maybe moving slowly is a good thing when it is surgeries.
At 50 cents a capsule on amazon , prostamol uno (serenoa repens) is more expensive than finasteride so it will forever remain an unrecognized herb. Also, remember we dont really know how these pills are made. Remember the story of that miracle herb, PC-SPES? Widely regarded as a miracle drug when it started selling over the counter, it did indeed significantly improve voiding symptoms as well as out even advanced prostate cancer into remission. It became so widespread that the California Department of Health Services (CDHS) investigated PC-SPES and discovered that it was adulterated with drugs, including warfarin, alprazolam, and diethylstilbesterol (DES). Each capsule had potent estrogens in it! Then the FDA recalled it.
Although the rest of the world benefitted from this research, it was the US that paid for it and did it. I am sad that we are now entering a 'transactional democracy' (you only get as much democracy as you can afford) but then again, that's where the rest of the world has been since WW2. Anecdotal data has driven 'old wives tale medicine' for millenia. I am hoping though that big data, the internet, AI, and the judicious use of Bayes' theorem can distill real knowledge from the vast sea of misinformation that surrounds us.
> It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them.
I wouldn't say so at all. Poor eyesight carries on smartly. Baldness. I enjoy both.
But an old story about the controller code for a surface-to-air missile comes to mind.
Someone looking at the memory allocator spots an obvious resource leak: "This code is going to crash."
The reply was that, while the point was theoretically valid, it was irrelevant, since the system itself would detonate long before resource exhaustion became an issue.
So too prostate cancer back in the day: war, famine and plague were keeping the lifespan well below the threshold of every man's time bomb.
Evolution selects for one thing and one thing only, reproduction.
The answer to every "why hasn't evolution done x" question is selection pressure.
An enlarged prostate is something that people get in their 60s and later. Most people are done with reproduction long before that event. There is simply very little and very low selection pressure.
It's pretty much the reason why most humans have peak health into their 40s.
Don't expect evolution to "fix" anything for humans that doesn't commonly impact 20yos.
Weird that you pull the one quote but ignore the rest of that paragraph which is about how being the leading cause of infertility is exactly the kind of thing evolution normally fixes.
"It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them. Since it strikes at advanced ages, BPH doesn’t make a big impact on a man’s ability to pass on his genes. But being the leading cause of male infertility sure does. Their explanation is that evolution hasn’t had much time to work on the problem; in animals the spermatic vein is horizontal, and doesn’t have or need one-way valves. It’s our standing upright that yields the problem; in evolutionary terms that’s a recent development."
Not only is it recent in terms of human history; back to my point, it is only in the last few centuries that men in gneral have reached ages that expose the posture shift as a flaw.
Baldness and grey hair are indicators of male maturity. In many primate species elder males look different than younger ones, which guides their social dynamics. Similar reason why our kids stay small for their first 12 years or so - it's hard to teach someone who can physically overpower you.
It would probably take too long, but a human breeding program centered around the healthiest still fertile old men we can find and young women with spotless genetic heritage would uplift our whole species.
But then you wouldn't necessarily know that their current sperm is valuable.
A better method would be to confine the program to monozygotic twin pairs of young women with spotless genetic heritage, and inseminate one twin with frozen sperm and the other with current sperm. The "current sperm" child (CS) could be closely monitored, and the "frozen sperm" (FS) child fitted with an explosive chastity device which, in the event that CS is found to have developmental issues, are remotely-detonated to ensure the tainted line does not persist.
I once read that wisdom teeth don't fit anymore only because we use forks and knives now. Previously we would tear our food with our teeth, always widening our pallet.
I couldn't find the source just now (in the 30 seconds I searched for it), but I always thought it was an interesting idea.
I'd be interested to see sources for the claim that poor eyesight is evolutionarily recent.
I strongly suspect it's more a matter of "won't kill you". Nearsightedness is far more common than farsightedness, and it's only in the last two hundred or so years that there's been any major benefit in seeing fine details at distance. The fuzzy shapes afforded by 20/80 vision are plenty enough to hunt a mammoth.
Having 20-20 vision is nice for avoiding lions and tigers, but it's a luxury spec, because movement acuity doesn't decrease linearly with nearsightedness, and movement acuity (plus traveling in groups, as prehistoric humans were wont to do) can take care of business decently-enough on its own - so I wouldn't call it "evolutionary-pressure"-nice.
Do you have any source for this? As someone born in the summer to a farming family with poor eyesight, I find it hard to believe that happened because I wasn't exposed to enough sun as an infant or child.
Interesting study. Myopia can definitely be caused by focusing too much on nearby things.
I just so happen to have Hyperopia with astigmatism, neither of which came from a lack of outdoor exposure. (If anything, I needed less time outside).
That's a bit of the issue I have with such a broad generalization. It's true that for some, a lack of time outdoors damaged their eyesight, it's not universally true that all or perhaps even most poor eyesight is a result of staying indoors.
> In any case, the paper makes no comment as to whether the problem can be solved the same way a second time; obviously in principle it can, but finding all the new bypasses and sclerosing them might be difficult in practice.
Multiple surgeries is not sustainable. Too much uncertainty.
Finasteride or dutasteride. They control BPH perfectly, while also treating male pattern baldness. Combine with daily tadalafil to offset any chance of the dubious sexual side effects, while also reducing gynecomastia (it's also an aromatase inhibitor!). Make sure to have regular 5ari-aware PSA screenings to make sure high grade cancers are caught and you are golden.
fin/dut + tad are my favorite medications to keep men fresh for many more years than intended by nature.
Have your children before you start though, as dut will probably make you sterile eventually.
I’ve been prescribed, and taking for a while now, daily Dutasteride plus Silodosin (Urorec). However, the latter has the unpleasant side effect of suppressing ejaculation.
Tadalafil (Cialis) does not seem to do the same, however other potential side effects involving sight and hearing are listed.
I’ll ask my doctor if such a swap would be advisable.
Two lifelong medications + frequent screening does not sound like "a solution" to me.
That being said, the article does state that its proposed treatment doesn't last forever, though I couldn't find any numbers on how long it is expected to last.
In a framework where one believes PFS to exist (I strongly believe it doesn't), tad would, at best, treat a few of the symptoms of PFS.
I believe people with self diagnosed PFS have a mix of mental illness and (sometimes) non diagnosed physical illness.
I'd like to see a self diagnosed PFS sufferer not get an erection, pumped up on 150 mg sildenafil + 10g L-Citrullin.
> Is Tad addressing this hazard in your view?
Let me address your question from a different angle: Being on an sufficient amount of daily tadalafil would certainly reduce the chance of you believing you got PFS, because it would guarantee you a working erection in any situation.
Thanks for sharing your view. I think the possibility of something like PFS existing is real, simply because 5ARIs have widespread physical effects - I mean they regrow hair and reduce sperm motility. Why would the brain or nervous system be excluded from being affected? Eg one male hormonal contraceptive pill study was aborted in 2016 because one participant got suicidal.
Giving 90% of the gender that looks actually great with hair on their head MPB is easily one of the biggest sleights evolution has committed against our species.
I've personally had very little luck with official channels there. Most won't prescribe anything for hair loss, several dermatologists said to just get used to it, one would prescribe fin pills, i.e. systemic - which did eventually give me pain in the breast tissues (so I ceased using it), but not topical, citing that it's too new on the market. I was unable to find anyone who would or even could look at serum DHT. I eventually settled on just paying one of these apparently legal telemedicine vendors 20 bucks per topical fin prescription.
> which did eventually give me pain in the breast tissues (so I ceased using it)
You already decided to take one hormonal disruptor, so why not go all the way? Find a private andrologist that prescribes you fin/dut + an aromatase inhibitor. Daily tadalafil also acts as aromatase inhibitor by the way. Should be enough to offset the estrogen increase from finasteride. It's worth a try.
I personally don't really believe in topical min/fin/dut: You are probably just getting the same effects and side effects you'd get from a lower oral dose.
The studies on topical finasteride support this. You just believe it's not in your blood and thus there is no nocebo effect to give you ED but it very much is.
In February I happened to attend a lunch 'n learn presentation at TMCi by a company doing clinical trials based on exactly this venous insufficiency principle. I think I may have been the only one in the audience with gray hair... TMCi is the startup accelerator attached to the Texas Medical Center in Houston.
The startup company is Vivifi Medical[1] and they have clinical trials underway with ten men in a Central American country (El Salvador?). They claim that BPH reverses in a few months after their procedure. Their procedure uses a minimally invasive tool of their own invention to snip the vertical blood vessels that are backflowing from age and gravity, and splice them into some existing horizontal blood vessels. On their board of advisors is Dr. Billy Cohn[2], the wildly innovative heart surgeon who is famous for shopping for his medical device components at Home Depot. Dr. Cohn is on the team building the BiVACOR Total Artificial Heart. Vivifi presented their estimated timeline to FDA approval, with proposed general availability in 2028. My personal BPH will be at the head of the line for this procedure.
As far as a startup, their TAM is about 500 million men. I had the Urolift procedure for BPH three years ago, and it cost about $15K on the Medicare benefits statement, though Urolift's clips amounted to only a few thousand dollars. Similarly, Vivifi's charges for this procedure are only a few thousand dollars per procedure, but it holds the promise of being a final solution. Currently Urolift is much less disruptive than TURP, which needs a couple of days in the hospital and almost always leads to retrograde ejaculation (into the bladder).
[1] https://www.vivifimedical.com/
[2] https://www.texasheart.org/people/william-e-cohn/
Thanks for the shout out. I am the CEO of Vivifi medical. We are building off the gat and Goren’s work and making it better and more robust. More importantly making it more accessible to patients through urologists. Our early clinical trial data from Panama is looking highly encouraging and we are working hard to bring this to the market in the fastest manner possible.
Do you end up impotent or with incontinence?
Not at all. Our device does not go through the penis, doesn’t damage the urethra or resect prostatic tissue. As a result, there is no risk to any sexual or urinary functionalities. There is no post op catheter.
The text brushes over the importance of healthy muscle motion for venous blood flow against gravity. Staying physically active, including pelvic floor exercises into the routine and correct belly breathing utilizing the diaphragm are probably the best options for preventing issues with reduced venous blood flow from the testicles passing by the prostate back to the heart.
Please also mention how easy those exercises are:
Once per day, when peeing, do it differently. 1. Release the stream during the in-breath. 2. Stop and hold the stream on the outbreath. 3. If not yet bored or tired go back to 1. Else - finish peeing normally. That's it.
And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.
<<Don't do Kegels while you urinate. Stopping your bladder from emptying could raise your risk of a bladder infection.>> https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-...
Huh. So that “happiness through clenching your butthole daily” or whatever-it-was copy-paste troll that was so common on Slashdot back in the day, was… very close to being excellent advice?
If true, maybe netcraft did confirm that OpenBSD is dead after all.
Different muscles, but you need practice to learn to control them independently.
Not quite. Focusing on your anus when clenching is a good way to develop hemorrhoids.
Is there a name for this technique? Interested to research the why behind it.
Kegel exercise
https://en.wikipedia.org/wiki/Kegel_exercise
Kegel?
> And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.
I've experienced all those benefits when I started walking two times a day, 8-10 thousands of steps a day continuously for several weeks. I haven't performed any other exercises.
But it's really boring and you need to do it every day. I do it only because I need to walk a dog.
Two ways I’ve made walks less boring:
- I started carrying a camera
- I started using the Merlin Bird ID app
Photography has made me realize how much I was previously ignoring. There’s so much to see, and even when walking the same route over and over, there’s an astounding amount of change over time. Often little things.
The Bird ID app made me realize just how many unique birds were making up the sounds I was hearing. As I learned to distinguish between them, I found myself fascinated in a way that I’d never been before.
Walks became almost meditative over time, and the sights and sounds a kind of salve for my often tired brain.
I often feel like I can think more clearly when walking as well, and thought processes kind of just sort themselves out as I go.
I highly recommend making walks more than just a way to move your body. They can be much more, and getting the benefits of movement almost feels like a happy side effect.
Walking is considered by einstein and pretty much all thinkers to be critical to deep work. It's also covered in Cal Newport's book "deep work" briefly. Which is a short audiobook worth reading.
One such prescription would be to do deep work early in the day then walk after and walk again 2 hours before bed. Another would be split the deep work with a 1 hour walk and do the 2nd walk after the 2nd block.
It may be more fulfilling with lots of interesting ideas rattling around. YMMV
I desperately want to do this type of walking, but I live in a major city. There’s always something to distract me, which is great for boredom perhaps, but ruins any sense of zen or reflection. I would say half of every walk involves people yelling, loud vehicles, and louder music. Noise-cancelling headphones are only useful for distraction through podcasts and music, not for decompressing. I’m starting to wonder if the solution, the sad solution, is to walk on a treadmill at a gym during off-peak hours.
You could try white/pink/grey noise on the headphones, or a binaural beat generator (I use the brainwave app on iOS).
Have you considered earplugs? The firearms community have some pretty great ones which are readable and fit really well. Check out Axil x30i for example.
>But it's really boring and you need to do it every day. I do it only because I need to walk a dog.
I'm lucky enough to have a pedestrian path to do my long walks (so no cars or even bikes to contend with, bikes have a dedicated parallel path), so I listen to a podcast while walking around 1 hour/day.
I don't find walking to be boring at all! Especially when I'm working on something new, I will walk as many as 10 miles a day while thinking through all of the design corners.
Even when I'm not working, I like taking long walks to think about family, friends, video games, etc.
Its a great way to get into your head without the distraction of a phone or feed or forced message.
Podcasts help me with the boringness.
Taking long walks daily was great but damn if it didn't increase my appetite. I gained weight over a couple years in spite of 4+ miles a day.
Were you walking to the cake shop and back?
Haha no unfortunately
I find walking very enjoyable.
I do a lot of daydreaming when I walk, too (to my wife and daughter's impatience!).
Thank you.
> Screening for this disorder is simple: use a thermal camera and compare testicular temperature sitting up (or standing) versus lying down, in each case waiting five minutes or so for temperatures to equilibrate, and taping the penis up so that it does not affect the measurement.
Interesting. I wonder how many how many other issues we could screen for using such simple, low cost tools. Some scales can already detect reduced blood flow in the feet (which can be a sign of all sorts of nastiness).
Stethoscopes are pretty cheap and versatile. Human doctors in general have lots of senses which they (in some medical systems) use for diagnosis before reaching for lab tests and MRTs.
If they bother. The vast majority of appointments I’ve had, in recent memory, are the provider typing a bit on their laptop, then sending me to someone else.
Really? They just tell me it's stress, the prescribe me chinese medicine just in case and send me away.
Issues like these reflects an evolutionary blind spot: selective pressure drops off after reproductive age, allowing defects like prostate dysfunction to persist. It's the same reason late-onset neurological diseases remain prevalent.
Shouldn't kids with grandfathers have an evolutionary advantage?
They didn't say drops to zero, but the advantage is obviously more limited
when humans were still primarily subjected to natural selection the life expectancy likely wouldn't have allowed for many grandfathers.
You only have to live to your 40s to become a grandparent in natural conditions, and your chances of living to at least your 50s have always been pretty good conditional on living long enough to reproduce at all.
But the issue also causes male infertility, so that can’t be why it’s so prevalent. This is discussed in the article.
The article sort of mentions this in passing, but doesn't subject it to much rigor, and the (completely obvious?) counterargument is that by the time it causes male infertility, the affected have already reproduced.
Male infertility after 60 is probably not very impactful from a selective point of view. For 300 000 years, almost nobody reached 60 anyway.
Before. Now people are delaying childbearing. Anedacta, past year one of my work colleagues had its first child, at 62.
Hmm. If we engineer late-life reproduction, that might create evolutionary pressure for healthy old age.
Hides long list of ethical problems with the concept
We missed the boat for that a few million years ago. If we're engineering anyway, we might as well engineer for healthy old age directly.
If we're ignoring ethics, then we don't need late-life reproduction.
Just kill all offspring if one of the parents die of some unwanted cause.
Allows people to still get kids in the optimal age, yet applying old-age selection pressure.
We just have to get the media to portray geriatric men as sexy, and we'll be well on our way to living to 200!
I know you're joking, but it's women that get the short end of the stick in media.
Men are (within reason) considered handsome in media even in old age. Wrinkles and gray hair can be seen as sexy (again, within reason), but only in men.
Women are discarded or relegated to sexless granny roles (except maybe for comedic purposes, where sexuality is the butt of a joke). Actresses are replaced by younger women because they are not sexy enough even when their male equivalents aren't (looking at you, Top Gun: Maverick).
I'm not saying there aren't exceptions in particular movies that deal with this topic; I'm talking about the general trend.
When you ask men who they are attracted to, at least on the surface, it’s always young women. I’m pretty sure the OkCupid stats showed that girls age 20 give or take were peak attractiveness. Reality is of course that guys will “work for food” or attention.
Women are different. It ranges — alot, and is more about EQ and scarcity. If you have a moderate baseline level of physical attractiveness, moderately fit (Jon two miles let’s say), not an asshole, and not living with mom, a 40-60 year old guy is a hot commodity.
Exactly - there's no female equivalent of "silver fox."
[dead]
We engineered it culturally already. Lots of people delaying childbirth until late 30s, early 40s today, often resorting to expensive treatments.
With our modern health systems we are pretty much a huge evolutionary blind spot ourselves. Many illnesses that would be filtered out because the carrier wouldn't survive, are now trivial. And on the journey hand we can screen for known illnesses.
I think we are already post evolutionary, or control it ourselves. Not a big issue either IMO, it's totally ok that this is happening.
We are definitely not post-evolutionary; the selection pressures have simply changed. Before industrialization the big two were starvation and infectious disease. Now? Well, it's anybody's guess decade to decade. Certainly sexual selection is still with us.
I read a pretty entertaining novel where that was one of the sub-plots.
The ethical problems were fun to read about! But would be significantly less fun to live through.
Dawkins suggested this might be viable (In an abstract; not politically practical) way in The Selfish Gene.
The main problem is that evolution is just not a thing at our modern civilizational time scale.
And I don’t see any problems with late-life reproduction, assuming we can make it reliable and healthy. If anything, some countries desperately need it.
From my reading this is wrong in principle.
Evolution is really slow on average, but locally it moves quite quickly and probably explains the large variation between members of a species.
Add strong selective pressure to that high local speed and you can change a good part of the genotype within a couple of generations. See: animal husbandry. You can breed a new race of dog within 5-10 generations.
Ethics aside we could probably breed people who can sniff out Alzheimer's in less than 250 years.
Our current late reproduction style will very likely influence future generations health at older ages.
It's probably a wash. Sure people are reproducing later, but it's also more likely that they have recieved some major medical intervention to allow them to make it to that stage. For example, it could be stuff like freezing eggs before starting chemo.
That in of itself is an external selection pressure though, having enough fit to gather resources to delay reproduction.
Someone needs to remain alive to provide, protect and raise the kids.
We lucked out compared to other species, octopus develop dementia soon after breeding.
So widen the reproductive age (men only)
Why men only?
I think OP was alluding to the fact that risks of complications with pregnancy increases with age.
wouldn’t the intention be just to fix that as well
what? so are you implying that prostate dysfunction makes you less wanted as a father if it presents itself in “the reproductive age”?
I read the comment as insinuating people stop taking care of themselves as much after children and develop unhealthy habits.
No. The grandparent comment was essentially saying that we, as a species, were not designed to live as long as we do. It’s only been <10 generations since medicine has been a thing. Cancers, dementia etc just weren’t a thing before because we evolved to live long enough to bring our children up to be self sufficient and reproduce, then our job is done. Like the rest of the animal world do.
Modern medicine has messed with this. We weren’t meant to “old”.
>In women, breast cancer has a similar death toll, but the breasts have an excuse: they’re much bigger; there are many more cells to go bad. They’re also much more metabolically active, capable of producing enough milk to feed a baby; the prostate’s output is tiny in comparison.
Except that you make work your prostate everyday, multiple times, since your adolescence, whereas a woman doesn't breastfeed everyday since adolescence.
Based on the simplified sketches and reasoning I'd assume that it made more sense to sclerose the two small vein sections connecting the testicles with the prostate. Does somebody know why that's not the suggested option?
Why do ideas like this take so long to be tested/adopted? Is it because the alternatives are “good enough”? I would think the evidence would lead to a fast shift; though maybe moving slowly is a good thing when it is surgeries.
So how the usual otherwise-harmless treatment with extract of Serenoa repens works? Seems even that is not clear - [1] is ~2011, [2] is 2024
it seemed to work for me, took it for few months, 10y+ ago. "Lasted" 8-9 years.. - until recently..
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3175703/
[2] https://wjmh.org/DOIx.php?id=10.5534/wjmh.230222
[dead]
So where's the temperature, pulse/pulseox and orientation monitoring jockstrap with linked smartphone app?
I'm sure companies like lovense will come up with stuff like that.
The problem is really prudeness in society, especially the American one (the main market for many industries). It's holding back things like sex tech.
Oura ring comes in many sizes. /s
At 50 cents a capsule on amazon , prostamol uno (serenoa repens) is more expensive than finasteride so it will forever remain an unrecognized herb. Also, remember we dont really know how these pills are made. Remember the story of that miracle herb, PC-SPES? Widely regarded as a miracle drug when it started selling over the counter, it did indeed significantly improve voiding symptoms as well as out even advanced prostate cancer into remission. It became so widespread that the California Department of Health Services (CDHS) investigated PC-SPES and discovered that it was adulterated with drugs, including warfarin, alprazolam, and diethylstilbesterol (DES). Each capsule had potent estrogens in it! Then the FDA recalled it.
Although the rest of the world benefitted from this research, it was the US that paid for it and did it. I am sad that we are now entering a 'transactional democracy' (you only get as much democracy as you can afford) but then again, that's where the rest of the world has been since WW2. Anecdotal data has driven 'old wives tale medicine' for millenia. I am hoping though that big data, the internet, AI, and the judicious use of Bayes' theorem can distill real knowledge from the vast sea of misinformation that surrounds us.
> It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them.
I wouldn't say so at all. Poor eyesight carries on smartly. Baldness. I enjoy both.
But an old story about the controller code for a surface-to-air missile comes to mind.
Someone looking at the memory allocator spots an obvious resource leak: "This code is going to crash."
The reply was that, while the point was theoretically valid, it was irrelevant, since the system itself would detonate long before resource exhaustion became an issue.
So too prostate cancer back in the day: war, famine and plague were keeping the lifespan well below the threshold of every man's time bomb.
Evolution selects for one thing and one thing only, reproduction.
The answer to every "why hasn't evolution done x" question is selection pressure.
An enlarged prostate is something that people get in their 60s and later. Most people are done with reproduction long before that event. There is simply very little and very low selection pressure.
It's pretty much the reason why most humans have peak health into their 40s.
Don't expect evolution to "fix" anything for humans that doesn't commonly impact 20yos.
Weird that you pull the one quote but ignore the rest of that paragraph which is about how being the leading cause of infertility is exactly the kind of thing evolution normally fixes.
"It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them. Since it strikes at advanced ages, BPH doesn’t make a big impact on a man’s ability to pass on his genes. But being the leading cause of male infertility sure does. Their explanation is that evolution hasn’t had much time to work on the problem; in animals the spermatic vein is horizontal, and doesn’t have or need one-way valves. It’s our standing upright that yields the problem; in evolutionary terms that’s a recent development."
Not only is it recent in terms of human history; back to my point, it is only in the last few centuries that men in gneral have reached ages that expose the posture shift as a flaw.
Baldness and grey hair are indicators of male maturity. In many primate species elder males look different than younger ones, which guides their social dynamics. Similar reason why our kids stay small for their first 12 years or so - it's hard to teach someone who can physically overpower you.
> surface-to-air missile The one link I have at hand: https://devblogs.microsoft.com/oldnewthing/20180228-00/?p=98...
There's also your back, your joints, your teeth, GERD. Everything starts getting flimsy in your late forties.
It would probably take too long, but a human breeding program centered around the healthiest still fertile old men we can find and young women with spotless genetic heritage would uplift our whole species.
Sounds like the end of Dr. Strangelove.
Older fathers increase the chance of autism, schizophrenia et al.
https://en.m.wikipedia.org/wiki/Paternal_age_effect
Obviously you would use sperm harvested while they were still young, and kept frozen for 60 years.
But then you wouldn't necessarily know that their current sperm is valuable.
A better method would be to confine the program to monozygotic twin pairs of young women with spotless genetic heritage, and inseminate one twin with frozen sperm and the other with current sperm. The "current sperm" child (CS) could be closely monitored, and the "frozen sperm" (FS) child fitted with an explosive chastity device which, in the event that CS is found to have developmental issues, are remotely-detonated to ensure the tainted line does not persist.
Simple-as.
Both appendix and gallbladder are important. Check the diet for people with gallbladder resection.
Also the intakes for trachea and esophagus being close to each other, causing chokes.
Wisdom teeth too.
I once read that wisdom teeth don't fit anymore only because we use forks and knives now. Previously we would tear our food with our teeth, always widening our pallet.
I couldn't find the source just now (in the 30 seconds I searched for it), but I always thought it was an interesting idea.
And tonsils!
Speaking of, I had my tonsils and adenoids removed as a child due to chronic ear infections.
What's up with those things?!
Poor eyesight is evolutionarily recent (not enough sunlight exposure in childhood, rare to find in hunter-gatherer societies). Baldness won't kill you.
I'd be interested to see sources for the claim that poor eyesight is evolutionarily recent.
I strongly suspect it's more a matter of "won't kill you". Nearsightedness is far more common than farsightedness, and it's only in the last two hundred or so years that there's been any major benefit in seeing fine details at distance. The fuzzy shapes afforded by 20/80 vision are plenty enough to hunt a mammoth.
Having 20-20 vision is nice for avoiding lions and tigers, but it's a luxury spec, because movement acuity doesn't decrease linearly with nearsightedness, and movement acuity (plus traveling in groups, as prehistoric humans were wont to do) can take care of business decently-enough on its own - so I wouldn't call it "evolutionary-pressure"-nice.
Don't forget that hunter-gatherers rarely lived much beyond 30. Modern society isn't so bad :)
> not enough sunlight exposure in childhood
Do you have any source for this? As someone born in the summer to a farming family with poor eyesight, I find it hard to believe that happened because I wasn't exposed to enough sun as an infant or child.
I've worn glasses since I was 2.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6678505/
Interesting study. Myopia can definitely be caused by focusing too much on nearby things.
I just so happen to have Hyperopia with astigmatism, neither of which came from a lack of outdoor exposure. (If anything, I needed less time outside).
That's a bit of the issue I have with such a broad generalization. It's true that for some, a lack of time outdoors damaged their eyesight, it's not universally true that all or perhaps even most poor eyesight is a result of staying indoors.
> I wouldn't say so at all. Poor eyesight carries on smartly. Baldness. I enjoy both.
What is the problem with baldness other than having a cheap excuse for not being successful in life? I actually enjoy looking a bit like Larry Fink.
Most people find it less attractive. Usually things that happen when you age are viewed that way, which makes sense, evolutionarily.
wuyïy rye krytktktktjttj
So there is a cure for BPH?
You can use 5-alpha-reductase inhibitors like finasteride.
One of the primary causes of BPH is from androgens, specifically the conversion of testosterone -> dihydrotestoerone via the 5-ar enzyme.
The prostate is an androgen-sensitive tissue, and DHT causes enlargement.
It's not guaranteed to fix it, but it's one option.
I've heard a theory that baldness is related to tension in the scalp, which apparently is more prevalent in men.
Sounds like it reoccurs, but potentially the procedure is repeatable. I didn't see a frequency.
I wonder how many potential answers to such problems are out there, known to a few but not acted on by the masses.
> In any case, the paper makes no comment as to whether the problem can be solved the same way a second time; obviously in principle it can, but finding all the new bypasses and sclerosing them might be difficult in practice.
Multiple surgeries is not sustainable. Too much uncertainty.
> they then have the patient close off the bottom of the vein with finger pressure while they inject a sclerosing agent into the vein
It seems highly failure prone. If you don't block the flow are you going to stroke out?
Not a cure but Tadalafil works very well as a treatment.
It does. I suffer for almost 20 hours of I miss a dose. I’m very sure that doesn’t happen.
We already have one solution to the problem.
Finasteride or dutasteride. They control BPH perfectly, while also treating male pattern baldness. Combine with daily tadalafil to offset any chance of the dubious sexual side effects, while also reducing gynecomastia (it's also an aromatase inhibitor!). Make sure to have regular 5ari-aware PSA screenings to make sure high grade cancers are caught and you are golden.
fin/dut + tad are my favorite medications to keep men fresh for many more years than intended by nature.
Have your children before you start though, as dut will probably make you sterile eventually.
I’ve been prescribed, and taking for a while now, daily Dutasteride plus Silodosin (Urorec). However, the latter has the unpleasant side effect of suppressing ejaculation.
Tadalafil (Cialis) does not seem to do the same, however other potential side effects involving sight and hearing are listed.
I’ll ask my doctor if such a swap would be advisable.
Two lifelong medications + frequent screening does not sound like "a solution" to me.
That being said, the article does state that its proposed treatment doesn't last forever, though I couldn't find any numbers on how long it is expected to last.
I‘ve been holding off on fin because of some people developing post-fin syndrome. Is Tad addressing this hazard in your view?
In a framework where one believes PFS to exist (I strongly believe it doesn't), tad would, at best, treat a few of the symptoms of PFS.
I believe people with self diagnosed PFS have a mix of mental illness and (sometimes) non diagnosed physical illness.
I'd like to see a self diagnosed PFS sufferer not get an erection, pumped up on 150 mg sildenafil + 10g L-Citrullin.
> Is Tad addressing this hazard in your view?
Let me address your question from a different angle: Being on an sufficient amount of daily tadalafil would certainly reduce the chance of you believing you got PFS, because it would guarantee you a working erection in any situation.
Thanks for sharing your view. I think the possibility of something like PFS existing is real, simply because 5ARIs have widespread physical effects - I mean they regrow hair and reduce sperm motility. Why would the brain or nervous system be excluded from being affected? Eg one male hormonal contraceptive pill study was aborted in 2016 because one participant got suicidal.
Giving 90% of the gender that looks actually great with hair on their head MPB is easily one of the biggest sleights evolution has committed against our species.
I've personally had very little luck with official channels there. Most won't prescribe anything for hair loss, several dermatologists said to just get used to it, one would prescribe fin pills, i.e. systemic - which did eventually give me pain in the breast tissues (so I ceased using it), but not topical, citing that it's too new on the market. I was unable to find anyone who would or even could look at serum DHT. I eventually settled on just paying one of these apparently legal telemedicine vendors 20 bucks per topical fin prescription.
Serum DHT is not useful at all.
> which did eventually give me pain in the breast tissues (so I ceased using it)
You already decided to take one hormonal disruptor, so why not go all the way? Find a private andrologist that prescribes you fin/dut + an aromatase inhibitor. Daily tadalafil also acts as aromatase inhibitor by the way. Should be enough to offset the estrogen increase from finasteride. It's worth a try.
I personally don't really believe in topical min/fin/dut: You are probably just getting the same effects and side effects you'd get from a lower oral dose.
The studies on topical finasteride support this. You just believe it's not in your blood and thus there is no nocebo effect to give you ED but it very much is.
daily Taladafil in combination with daily Finasterid?
Good luck :)
I do not know about Finasterid in detail, but the small-printing for Taladafil says clearly its _not_ for daily use.
Daily use of cyalis (tadalafil) is officially marketed.
https://www.hims.com/blog/daily-cialis-costs-benefits
https://investor.lilly.com/news-releases/news-release-detail...
It's superior to taking it on an as-needed basis because it has positive long term effects on your cardiovascular and penile tissue.
I'm in the EU; i tried this casually several times already - the Doc always says, do not throw them daily?
Apart from that: I do not expect the skeletal pain after D2 to be less when dropping it daily? :-D
EDIT: Or i'm mixing up Sindenafil and Taladafil? Im not a medic :-D
I’ve been reading till…I don’t know 40% of the article? Is there some sort of conclusion besides surgery?
[dead]