The Peter Attia Drive

• #352 ‒ Female fertility: optimizing reproductive health, diagnosing and treating infertility and PCOS, and understanding the IVF process | Paula Amato, M.D.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter This is part two of a two-part mini-series on fertility and reproductive health. Paula Amato is a leading expert in female reproductive health and infertility, widely recognized for her contributions to advancing fertility treatment and research. In this episode, which follows last week's conversation on male fertility, Paula explores the biology of female fertility, including how hormonal changes regulate the menstrual cycle and ovulation, what those patterns reveal about fertility potential, and why both partners should be evaluated early in infertility workups. She discusses the role of the fallopian tubes, the causes of miscarriage, the impact of age and lifestyle on fertility, and treatment options for conditions like PCOS—including the emerging use of GLP-1 agonists. The episode also covers the evolution of IVF, advances in pre-implantation genetic testing, egg freezing, and the promise and limitations of next-generation reproductive technologies. We discuss: The finite nature of a woman’s egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00]; How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30]; The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30]; How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15]; Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30]; Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women’s health is needed [41:00]; The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00]; Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00]; The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45]; Barriers to getting informed fertility care for PCOS: limited provider knowledge and access, insurance gaps, and next steps when ovulation treatments don’t lead to pregnancy [55:45]; Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00]; Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00]; The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45]; The step-by-step process of IVF [1:19:30]; The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30]; Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15]; Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30]; Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45]; How to choose the right IVF clinic [1:54:45]; Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00]; Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45]; Promising areas of fertility research [2:15:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #351 ‒ Male fertility: optimizing reproductive health, diagnosing and treating infertility, and navigating testosterone replacement therapy | Paul Turek, M.D.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter This is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility. We discuss: The incredibly complex and hostile journey sperm must take to fertilize an egg [3:00]; How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors [9:00]; The built-in filter that weeds out genetically abnormal sperm [14:45]; How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities [18:30]; How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle [26:30]; Male infertility and Paul’s diagnostic approach: detailed history, a physical exam, and identifying red flags [33:30]; Viral infections that can affect the testes and potentially lead to sterility [40:30]; Semen analysis: morphology, motility, and hormonal clues to male fertility [45:45]; Effects of medication, microplastics, stress, and exercise on fertility [57:15]; Testosterone replacement therapy (TRT) and male fertility [1:06:00]; Restoring fertility after prolonged use of exogenous testosterone [1:25:00]; Effects of heat and cold exposure on fertility and sperm quality [1:36:00]; How different levels of exercise—especially cycling—affect male fertility [1:41:45]; How alcohol, marijuana, and nicotine affect male fertility [1:46:00]; Why type 2 diabetes is a risk factor for male infertility [1:50:00]; How varicoceles—a common cause of male infertility—are diagnosed and treated [1:51:15]; Genetic factors that affect fertility [1:54:00]; The impact of lifestyle and environmental exposures on fertility [1:56:30]; The evidence (or lack thereof) behind stem cell and PRP therapies for male infertility, and how lifestyle and non-invasive interventions often lead to successful conception [2:00:30]; Considerations for sperm banking, and how paternal age impacts fertility planning and offspring health [2:05:00]; Semen quality as a biomarker: linking male fertility, longevity, and preventative health through Medicine 3.0 and epigenetics [2:14:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #350 ‒ Injury prevention, recovery, and performance optimization for every decade | Kyler Brown, D.C.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Kyler Brown is a sports rehab chiropractor who specializes in injury recovery, pre- and post-surgical rehabilitation, and guiding clients from rehab back to peak performance. As co-founder of the private training program 10 Squared alongside Peter, Kyler shares his approach to injury prevention and performance optimization—highlighting how overlooked movement patterns can quietly lead to chronic issues over time. He outlines a practical framework for assessing and treating individuals, highlights the importance of understanding movement dynamics and asymmetries, and discusses personalized rehab strategies through real-world case studies. The conversation also explores the psychological side of recovery, including the role of fear and mental barriers in rehabilitation. Kyler shares actionable tools to evaluate movement patterns and implement training strategies that support long-term strength and health. A companion video series demonstrating exercises for common problem areas—such as the lower back, neck, shoulders, and knees—is available exclusively to subscribers on the show notes page. We discuss: The personalized rehab strategy for Peter’s shoulder surgery that sparked creation of a training program called 10 Squared [3:00]; Training for the marginal decade: why precision and purpose are essential for quality of life [11:00]; The Centenarian Decathlon: how training for long-term capacity enhances both current and future quality of life [18:00]; How the shortcomings of conventional rehab and performance systems led to the creation of 10 Squared, a personalized training model focused on long-term physical capacity and individualized care [23:45]; Case study: how personalized assessment and treatment at 10 Squared helps uncover the root causes of injuries [31:00]; The role of the “core” in movement and injury prevention, and the importance of training stability before strength [40:15]; The layered assessment process used at 10 Squared to determine whether a person is ready to perform dynamic movements [47:45]; Case study: the rehab plan designed to treat a hamstring injury while preserving fitness and preventing reinjury [51:45]; Training approach for clients with minimal training history: risk reduction, habit-building, and long-term consistency [55:30]; How to train foot reactivity, tendon resilience, and explosive capacity in a safe, progressive way [1:00:00]; Peter’s foot and ankle pain: how to diagnose, treat, and strengthen the lower extremities [1:04:15]; How fear and perception influence recovery, what drives back pain, and when to choose surgery vs. treatment [1:13:15]; Could AI and app technology eventually deliver an individualized rehab and training experience? [1:22:30]; Kyler’s professional evolution from traditional chiropractic care to a degree-agnostic, performance-based rehab philosophy [1:25:00]; How 10 Squared provides precision rehab and training in a remote format [1:30:30]; How Peter resolved a severe back pain flare-up using DNS-guided isometric exercise instead of passive treatments [1:33:15]; How to identify and treat common joint pain (neck, back, knee, shoulder) using a rehab framework that strengthens supporting structures and helps avoid surgery [1:39:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #349 - AMA #71: Building strength and muscle mass: how to optimize training, nutrition, and more for longevity

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of muscle mass and strength, examining their essential roles in both lifespan and healthspan. Drawing from over 30 hours of prior discussions with experts including Layne Norton, Andy Galpin, and Mike Israetel, this episode distills the most important insights into one comprehensive and up-to-date conversation. Peter explores why muscle matters for longevity, metabolic health, and injury prevention, and clarifies the differences between muscle mass and strength, including which is more vital for aging well. He breaks down practical strategies for building muscle safely and effectively, including progressive overload, training intensity, rep ranges, and the importance of explosive power. Peter also covers key nutrition strategies—like protein intake, timing, and creatine supplementation—and offers practical advice for everyone from beginners to seasoned lifters on building and maintaining muscle safely and sustainably. If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #71 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Peter’s humorous experience talking nutrition with a second grader [2:30]; Overview of topics, episode structure, and reasoning for focus on muscle mass and strength [6:00]; Defining key terms: muscle mass, strength, hypertrophy, power, and more [8:15]; The importance of muscular strength, muscle mass, and cardiorespiratory fitness for longevity [10:30]; Grip strength as a simple yet powerful predictor of all-cause mortality [16:45]; Is muscle strength causal or just a marker of health? [20:00]; Why VO2 max, strength, and muscle mass are powerful health markers: a reflection of long-term consistent effort [22:30]; How muscle mass and strength enhance healthspan by supporting metabolic health, inflammation control, recovery from illness, mobility, and fall prevention [23:45]; How muscle mass and strength decline with age, and why it's essential to act early to slow decline and preserve function later in life [30:30]; The foundational principles of building muscle strength and size through resistance training [35:30]; How to apply “progressive overload” for long-term strength and muscle gains [39:30]; The difference between concentric and eccentric muscle contractions and how each impacts strength, hypertrophy, and injury prevention [44:45]; The differences between muscle fiber types, and how aging disproportionately affects fast-twitch fibers responsible for power [50:15]; How to effectively train for power [52:00]; Training intensity: the benefits and safety of using the “reps in reserve” method [53:00]; How to balance compound and isolation exercises in a workout routine, and why compound lifts are foundational [55:45]; Can bodyweight exercises build muscle as effectively as weight training? [57:45]; How women can effectively build strength and muscle: key considerations [59:15]; Effective methods for tracking progress in strength [1:01:15]; Effective methods for tracking progress in muscle mass, and how to interpret results from a DEXA scan [1:04:30]; How to balance workout frequency with recovery for optimal results [1:06:45]; How to recognize signs of overtraining and when to consider taking rest days [1:10:15]; Avoiding injury: how beginners or returning lifters can start resistance training safely [1:15:15]; Protein: recommended intake, quality sources, timing of consumption, and more [1:17:30]; How fasting and calorie restriction affect muscle mass and what can be done to minimize muscle loss [1:24:15]; Key nutritional factors beyond protein that support muscle growth: hydration, creatine, and recovery [1:27:45]; The impact of hormones, sleep, stress, and consistency on muscle building and recovery [1:28:45]; How to structure an effective workout routine for a younger person that is new to resistance training [1:31:30]; How to modify beginner resistance training programs for older individuals to prioritize safety and gradual progress [1:35:30]; Should beginners start with machines or free weights when resistance training? [1:36:30]; How experienced lifters should modify their training to support healthspan and performance in later life [1:38:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #348 ‒ Women’s sexual health, menopause, and hormone replacement therapy (HRT) | Rachel Rubin, M.D.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Rachel Rubin is a board-certified urologist and one of the nation's foremost experts in sexual health. In this episode, she shares her deep expertise on the often-overlooked topic of women’s sexual health, exploring why this area remains so neglected in traditional medicine and highlighting the critical differences in how men and women experience hormonal decline with age. Rachel explains the physiology of the menstrual cycle, the complex hormonal shifts of perimenopause, and the wide-reaching health risks associated with menopause, including osteoporosis, cardiovascular disease, dementia, and recurrent urinary tract infections. She also breaks down the controversy surrounding hormone replacement therapy (HRT), particularly the damaging legacy of the Women’s Health Initiative study, and provides guidance on the safe and personalized use of estrogen, progesterone, and testosterone in women. With particular emphasis on local vaginal hormone therapy—a safe, effective, and underused treatment—Rachel offers insights that have the potential to transform quality of life for countless women. We discuss: Rachel’s training in urology and passion for sexual medicine and women’s health [3:00]; Hormonal changes during ovulation, perimenopause, and menopause: why they occur and how they impact women’s health and quality of life [5:30]; Why women have such varied responses to the sharp drop in progesterone during the luteal phase and after menopause, and the differing responses to progesterone supplementation [14:45]; The physical and cognitive health risks for postmenopausal women who are not on hormone therapy [17:45]; The history of hormone replacement therapy (HRT), and how misinterpretation of the Women’s Health Initiative study led to abandonment of HRT [20:15]; The medical system’s failure to train doctors in hormone therapy after the WHI study and its lasting impact on menopause care [29:30]; The underappreciated role of testosterone in women’s sexual health, and the systemic and regulatory barriers preventing its broader use in female healthcare [35:00]; The bias against HRT—how institutional resistance is preventing meaningful progress in women’s health [46:30]; How the medical system’s neglect of menopause care has opened the door for unregulated and potentially harmful hormone clinics to take advantage of underserved women [53:30]; The HRT playbook for women part 1: progesterone [57:15]; The HRT playbook for women part 2: estradiol [1:05:00]; Oral formulated estrogen for systemic administration: risks and benefits [1:13:15]; Topical and vaginal estrogen delivery options: benefits and limitations, and how to personalize treatment for each patient [1:17:15]; How to navigate hormone lab testing without getting misled [1:24:15]; The wide-ranging symptoms of menopause—joint pain, brain fog, mood issues, and more [1:31:45]; The evolution of medical terminology and the underrecognized importance of local estrogen therapy for urinary and vaginal health in menopausal women [1:37:45]; The benefits of vaginal estrogen (or DHEA) for preventing UTIs, improving sexual health, and more [1:41:00]; The use of DHEA and testosterone in treating hormone-sensitive genital tissues, and an explanation of what often causes women pain [1:50:15]; Is it too late to start HRT after menopause? [1:56:15]; Should women stop hormone therapy after 10 years? [1:58:15]; How to manage hormone therapy in women with BRCA mutations, DCIS (ductal carcinoma in situ), or a history of breast cancer [2:00:00]; How women can identify good menopause care providers and avoid harmful hormone therapy practices, and why menopause medicine is critical for both women and men [2:06:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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