The Truth About Men’s Vitality: Fertility, Testosterone & Heart Health. | ANEW Insight EP 121

In this compelling episode of The ANEW Insight Podcast, Dr. Supatra Tovar sits down with Men’s Health Specialist Dr. Kian Asanad, fellowship-trained urologist and Director of the USC Fertility and Men’s Sexual Health Center, to unpack the science and solutions behind male infertility, low testosterone, and erectile dysfunction. Together, they explore how lifestyle, hormones, and even diet converge to influence men’s vitality, longevity, and reproductive potential.

Dr. Asanad reveals how hormonal imbalances, metabolic syndrome, obesity, and cardiovascular health all play a role in male fertility and sexual performance. He explains why erectile dysfunction can serve as an early warning sign of heart disease, since the penile arteries are smaller than coronary arteries—making vascular issues appear there first. What’s good for the heart, he reminds us, is truly good for the penis.

The conversation goes beyond surface-level advice, diving deep into diagnostics and treatments for male reproductive health—from hormonal testing and semen analysis to microsurgical procedures that restore fertility, even decades after a vasectomy. Dr. Asanad shares how innovative approaches like microsurgery and sperm extraction can help couples achieve pregnancy naturally or through IVF, with success rates that continue to climb thanks to advances in medical technology.

Dr. Tovar and Dr. Asanad also discuss the impact of lifestyle choices on testosterone—from exercise and strength training to diet and stress management. Referencing the Mediterranean and Blue Zone diets, they explore how plant-forward nutrition and regular movement can preserve hormone balance and optimize sexual function as men age. As Dr. Asanad notes, simple daily habits—such as staying active, maintaining a healthy weight, and reducing alcohol intake—can dramatically boost natural testosterone levels and fertility potential.

Listeners will gain a clear understanding of how men’s reproductive health is a window into their overall well-being. This episode sheds light on congenital and genetic conditions, like Klinefelter syndrome and Y-chromosome microdeletions, that affect sperm production and fertility—and how these are being successfully treated today. Dr. Asanad underscores the power of early screening and proactive care in preventing lifelong reproductive challenges.

Whether you’re a man seeking to optimize your health, a partner wanting to understand the science behind male fertility, or a clinician looking for evidence-based insight, this episode delivers practical, compassionate, and forward-thinking knowledge.

Tune in to learn how modern medicine, lifestyle optimization, and holistic care are transforming the conversation around men’s health—one patient at a time.

🔑 What You’ll Learn in This Episode

• How male infertility is diagnosed and treated through modern urology
• Why erectile dysfunction can signal early cardiovascular disease
• The role of hormones like testosterone, LH, and FSH in fertility
• How

Thank you for joining us on this journey to wellness. Remember, the insights and advice shared on the ANEW Body Insight Podcast are for educational and informational purposes only and do not constitute medical advice. Always consult with a healthcare professional before making any changes to your health routine. To learn more about the podcast and stay updated on new episodes, visit ANEW Body Insight Podcast at anew-insight.com. To watch this episode on YouTube, visit @my.anew.insight. Follow us on social media at @my.anew.insight on Facebook, Instagram, TikTok, and Threads for more updates and insights. Thank you for tuning in! Stay connected with us for more empowering stories and expert guidance. Until next time, stay well and keep evolving with ANEW Body Insight!

Transcript

Dr. Supatra Tovar: 0:00

Hello and welcome. I am honored to have Men's Health Specialist Dr. Kian Asanad with us today, Dr. Kian, welcome. He earned his medical degree from UCLA with Alpha Omega Alpha Honors, and completed his urology residency at Keck Medicine LA General Medical Center. He went on to complete his advanced training in male infertility, microsurgery and sexual medicine at Northwestern University, one of the nation's top programs for an andrology. I'm excited to hear about this and Microsurgical techniques to deliver individualized evidence-based care that supports both sexual health and reproductive goals. Okay, you've done just a little in your career. I mean, you know, come on, catch up with the rest of society. Dr. Kian. You're kind of an amazing guy.

Dr. Kian Asanad: 0:03

And I had an amazing mentor during my training, Dr. Mary Samplaski. And I did some really cool research projects with her and she really opened my eyes to the world of microsurgery, taking care of young men, you know, who wanna build a family. And something I've always been really passionate about that drew me to urology in general, was taking care of men with very sensitive issues and focusing on surgery that really emphasizes quality of life, and I'm really able to accomplish that with whether, you know, a couple wants to achieve another pregnancy after a vasectomy 10 years ago, or, prostate cancer treatment, resulting in a man being impotent and trouble getting an erection and being intimate with his wife and focusing on surgery or injections or ways to help optimize their quality of life and the men's health world really helps accomplish those goals.

Dr. Supatra Tovar: 0:04

Oh, I think that that's so wonderful. I like how that you couch it at. It's trying to, bring back, the quality of life to men. And so many men experience difficulties with erectile dysfunction or with fertility issues, especially, um, from the age of like 40 up. What can you tell us? And I, I think this will help many men.

Dr. Kian Asanad: 0:05

Yeah. So, when I see a man in the office with or without their partner looking to evaluate their fertility, nowadays seeing guys who have not even tried to achieve a pregnancy, I just want to know where things stand and that's become very common. And so the evaluation is pretty straightforward for men. Just like in women includes hormones. Hormones are important for men. We check a testosterone, other hormones important for sperm production known as FSH, LH, we check a prolactin level, estradiol level, wanna make sure that the hormones are optimized. Up to 10 to 15% of men who present for a fertility evaluation are found to have a hormonal imbalance, meaning low testosterone levels and testosterone is important for overall vitality of men and sexual health, but also plays a big role in sperm production and sperm quality. So. That's something that we check. Um, it needs to be a morning blood test, right? ' cause that's when testosterone levels peak and are accurate. I send men for two semen analysis Why two? There could be a lot of variability from sample to sample and kind of wanna see where your, where numbers stand. So have 'em abstain from ejaculation for two to three days. Semen sample in the lab and we get those results. And finally, the third part is a physical exam. The physical exam is critical in the fertility world. I wanna examine the size and the consistency of the testicles. We're feeling if there is a vas deferens on both sides, which is the two that carry sperm, some men have a congenital absence of the vas deferens, either on both sides or on one side, making them completely infertile from an obstruction standpoint. Those men need a sperm extraction procedure. I'm also feeling for something called a varicocele, which is one of the most common cause of male infertility. About 40% of men who present for a fertility evaluation will have a varicocele. Varicoceles are dilated veins around the testicle and the spermatic cord, and what they do is they can heat up the testicle and the excessive heat around the testicle causes problems with sperm production, testosterone production, and over the time the testicle can actually shrink, it can atrophy. So all these kind of play a key role. Once we get that basic evaluation I'll see the patients pretty quickly in the office, three weeks later, review all their results and discuss kind of next steps from there. Yeah. So, when I see a man in the office with or without their partner looking to evaluate their fertility, nowadays seeing guys who have not even tried to achieve a pregnancy, I just want to know where things stand and that's become very common. And so the evaluation is pretty straightforward for men. Just like in women includes hormones. Hormones are important for men. We check a testosterone, other hormones important for sperm production known as FSH, LH, we check a prolactin level, estradiol level, wanna make sure that the hormones are optimized. Up to 10 to 15% of men who present for a fertility evaluation are found to have a hormonal imbalance, meaning low testosterone levels and testosterone is important for overall vitality of men and sexual health, but also plays a big role in sperm production and sperm quality. So. That's something that we check. Um, it needs to be a morning blood test, right? ' cause that's when testosterone levels peak and are accurate. I send men for two semen analysis Why two? There could be a lot of variability from sample to sample and kind of wanna see where your, where numbers stand. So have 'em abstain from ejaculation for two to three days. Semen sample in the lab and we get those results. And finally, the third part is a physical exam. The physical exam is critical in the fertility world. I wanna examine the size and the consistency of the testicles. We're feeling if there is a vas deferens on both sides, which is the two that carry sperm, some men have a congenital absence of the vas deferens, either on both sides or on one side, making them completely infertile from an obstruction standpoint. Those men need a sperm extraction procedure. I'm also feeling for something called a varicocele, which is one of the most common cause of male infertility. About 40% of men who present for a fertility evaluation will have a varicocele. Varicoceles are dilated veins around the testicle and the spermatic cord, and what they do is they can heat up the testicle and the excessive heat around the testicle causes problems with sperm production, testosterone production, and over the time the testicle can actually shrink, it can atrophy. So all these kind of play a key role. Once we get that basic evaluation I'll see the patients pretty quickly in the office, three weeks later, review all their results and discuss kind of next steps from there.

Dr. Supatra Tovar: 0:07

Wow, that is a very thorough diagnostic screening for sure. I am curious what might cause some of these issues like low testosterone. I mean, we can talk about the congenital issues in a, in a moment, but what are the lifestyle factors that contribute to low testosterone and. maybe even eventual, uh, infertility issues.

Dr. Kian Asanad: 0:08

Some men are actually incredibly healthy. They exercise, they're fit, they're not obese, and for some reason the testicle just doesn't respond as much and make as much testosterone as others. But things that can result in low testosterone that we talked about, obesity, these lifestyle issues there's some data as you get older, your testosterone dips down a little bit. Studies reported 1% a year, but there's some newer studies that show even as you get older, if you maintain a healthy lifestyle testosterone levels can remain normal. So I don't put a lot of stock in the as you get older i'm 40 years old. My testosterone should be low now, not usually the case. So I, I tell men it's not like you need to go to the gym for an hour a day every day, right? Even moderate activity, especially weight training in the large muscle groups chest, quads, thighs play a big role in improving natural testosterone production.

Dr. Supatra Tovar: 0:11

diets for their lifetime tend to have higher levels of testosterone, tend to experience things like menopause in a much different way than we do in our western cultures. So I always encourage people to try to make their diet as plant forward as possible, incorporating a lot of, plant proteins as well, because there's some evidence that animal protein itself can contribute to some hormonal fluctuations as well.

Dr. Kian Asanad: 0:12

Yes. So the arteries of the penis are even smaller than the coronary artery vessels, they can be prone to signs of erectile dysfunction with hardening and plaque buildup. Even before signs of heart problems. So that's why we can kind of really see that cavernosal arteries compared to coronary arteries are different diameters. We get a history, we do some blood work, right? And so if they haven't had a primary care doctor, I'll order things like a screening lipid panel, a hemoglobin A1C to rule out underlying diabetes, check a testosterone level to see if their hormones are optimized, and, and then go from there. So that's the underlying reason for why men with erectile dysfunction are at an increased risk for cardiovascular disease, especially if the ED vascular in nature, like organic and not, anxiety related or something like that. Sure. Yeah. So, so man has had a vasectomy and for one reason or another, they like to achieve another pregnancy. Most commonly has to do with a separation and a new partner. And really, you know, what I find in my practice, you know, achieving a pregnancy together really helps cement that relationship. So yeah, I totally get it. You know, they wanna have a child together and that makes sense for a lot of couples. So, there's some other less common reasons That can include if you had a vasectomy at a really young age, is kind of a risk factor. Very rarely could be a death of a child and wanting another pregnancy. But up to five to 6% of men will undergo a reversal process. So. Options for fertility after vasectomy, we can reverse the vasectomy, which is a microsurgical procedure. Something that I perform in the operating room, it takes a couple hours. We freshen up the ends of the vas deferens, examine the fluid that comes out of the vas deferens and look for sperm. And if I see sperm there, it tells me the whole pathway to the vas deferens is nice and open, I use a microscope to reattach the vas deferens to the other side of the vas deferens. it's really remark. I mean, every time I do it, I'm, I'm still mind blown about the end result because the sutures, the stitches we use are finer than human hair. That's how tiny they are. And it's a two layer closure. I mean, we're closing the inner layer of the vas deferens, the outer layer of the vas deferens. It's definitely a process. The good news is the success rates are north of 95%. If I see sperm in the operating room, the chance that I get sperm back in the ejaculate is very high even if your vasectomy was 20 years ago. in the operating room reconnection over 95% success rate. Of course, getting sperm in the ejaculate doesn't translate into a take home baby, right? Female factors need to come into play. So, you know, if a female partner is 42 and the man is 50, the vasectomy was 30 years ago, you know, we might think about an alternative approach which could be considered in any situation, and that's extracting sperm, right? The testicle is still making sperm. It's just there's a roadblock. It's not going anywhere. It gets reabsorbed by the body, so it could take a pinch of tissue from the testicle directly. Or the epididymus, which is the gland behind the testicle, and use that for in vitro fertilization or IVF, where they inject a single sperm into an egg to create an embryo and ultimately implant that in the uterus. The final approach, which is sometimes what I do in practice, is a combination of both. Maybe we're kind of not a hundred percent confident that a natural pregnancy is achievable based on patient's age, their history. So we'll do a reversal procedure and at the same time we can freeze sperm and take a pinch of tissue from the testicle. And that way if the reversal's not successful or didn't result in a natural pregnancy, patient already has frozen sperm ready to go, and if they want to pivot and do IVF with that they don't, that could spare them a second procedure. So those are really the kind of the three options available.

Dr. Supatra Tovar: 0:18

Can you just give us a picture? I can't even imagine trying to sew something thinner with that thread thinner than a human hair. Very, very cool. Well, I'm so glad you're able to restore people's fertility. Now let's touch on some congenital and genetic issues that can cause male infertility, how can men find out if that's affecting them?

Dr. Kian Asanad: 0:20

So two hormones from the brain, they interact with the testicle. One makes testosterone, one makes sperm. When we do these tests, the reason I check them is to see if there is, why, why is the testosterone low? If it's low, is it the testicle is not making a lot of testosterone, or is the brain not making this hormones needed to tell the testicle to make sperm and testosterone? So with that, so if the LH and FSH come back undetectable, there's zero. That tells me the brain's not making these hormones. It's either there's a tumor in the brain compressing the pituitary gland, or there is a congenital absence of the hormone production from the pituitary. So what we do is we get, we order an MRI of the brain to make sure there's no tumor there. Sometimes that comes up. That is pretty rare. Most of the time it is a congenital absence of production of those two hormones. The good news is it is incredibly treatable. Super treatable. We basically just, I just replace those hormones. I give men the LH, which is a medication called HCG. And then about six months later, I give them FSH through a medication. They're both injections and they could stimulate normal testosterone production and normal sperm production. Over 90% success in getting sperm back in the ejaculate to achieve a natural pregnancy. So that's one congenital reason men may be infertile. It is, it's pretty uncommon. It's about 5% or less. That's kind of one way congenitally can cause infertility. Other congenital causes of infertility can include, we talked about absence of the vas deferens, right? The tube that carries sperm. So men with cystic fibrosis, CF, cystic patients have all are infertile. So, Kleinfelter syndrome is relatively common, right? Men having an extra X chromosome, so men have 46 chromosome and X and Y chromosome. they could have a second X chromosome. So there's 47 chromosomes, XXY. Most, the majority of patients, over 90% of patients with Kleinfelter syndrome are infertile. They don't have any sperm in the ejaculate. It is remarkable. We can open the testicle and surgically look for sperm, about 50% chance of finding sperm in that could be used for IVF to achieve a pregnancy. I've had patients in the office present with infertility. Totally normal looking guy. We do an exam, like his testicles are really atrophic, comes back with zero sperm, send him for genetic testing, and he has Klinefelter syndrome. The, the majority of them are pretty uncommon. You know, Klinefelter syndrome is a, is a little bit more common. It's about one in 500 men have Kleinfelter syndrome, so it's not that uncommon, right? But the congenital absence of the hormones from the brain to the testicle, you know, cystic fibrosis is also relatively common. It's very important to know why. If the A or B is abnormal. There's 0% chance of finding sperm. We don't do any sperm extraction for those patients. Unfortunately, they need to consider donor sperm or adoption. If there's a c micro deletion, those patients can have sperm in at the time of a sperm extraction. But most importantly, men with a Y chromosome micro deletion, if they're able to achieve a pregnancy all of their male offspring will also have this deletion, meaning they will also be infertile. Depending on the center. Yeah, it's usually, you know, I mean, it's, it's not marketed as that, I would say, but, you know, you develop embryos. If there's male and female embryos, you could pick what embryo you wanna choose. Nobody's choosing for you, but. If you, you know, the, the rules behind, let's do IVF because we wanna have a boy still, probably

Dr. Supatra Tovar: 0:28

And everyone, oh my goodness, come back, uh, to hear more because we are talking with somebody who is at the cutting edge of infertility restoration men's sexual health erectile dysfunction. So come on back and tune in for Men's Health specialist, Dr. Kian Asanad. Thank you, Dr. Kian.