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.
Are you planning to publish the longitudinal data, esp. of endpoints 2 and 3 (prostate size, urinary flow). It would greatly add to the public understanding of this procedure. Why didn't you go for PSA? It's easy to obtain altough one probably wouldn't expect significant changes in this short time frame.
Have you found that with your procedure, to quote the blog piece, "new venous bypasses grow to replace the destroyed spermatic veins," as found in Gat and Goren's work in follow ups? Or is the long term data not there yet?
Thank you for taking a risk on this by the way. As someone who has family history it's heartening to know there are people taking this seriously.
We actually bypass the spermatic vessels. There is historical evidence that bypassing the spermatic vessels is a superior way to treat varicoceles.
So our procedure shouldn’t have the recurrence (of varicoceles or bph) concerns. But this needs to be established through long term studies.
Thanks for sharing your story. It’s stories like yours — people with family histories and real-world experiences — that fuel everything we’re doing.
We are currently gathering insights to better understand patient preferences and would greatly appreciate your input. If you are interested in participating in a short survey, please contact us at info@vivifimedical.com.
Thank you for helping us shape the future of patient care.
Would this procedure be advisable on someone currently with varicocele, less than 40 years old, and with family history of prostate cancer (both grandfathers)?
While we think this procedure has the potential to be a prophylactic treatment, there is no evidence to back that up.
There is a recent study, however, published by Cleveland clinic that demonstrated higher prostate cancer recurrence rates in patients with high local testosterone levels (around the prostate) post prostatectomies.
Also this procedure is not currently approved for treatment of prostatic issues. But if varicocele results in testicular pain, it’s often times treated.
Nothing in the parent differs from a product promotion; there are no alternatives, no negatives, no considerations, nothing but praise - even of a member of the board of advisors.
> there are no alternatives, no negatives, no considerations, nothing but praise
His account is over ten years old, and active. Maybe he's just impressed? Why don't you provide alternatives or negatives, if you can? Cynicism for cynicism's sake is pointless.
In case you missed it, there's a comment parallel to yours by the founder of the company. They also provide their email in a child comment to that. Link: https://news.ycombinator.com/item?id=43804502
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.
> As a result, there is no risk to any sexual or urinary functionalities.
You can say "based on [X], we believe the risk of [Y] is insignificant." Saying there is "no risk" is far too sweeping a claim given the level of evidence it sounds like you've gathered.
Not at this time, apologizes. As we move along, we intend on releasing data and images through publications.
However, if you are into reading scientific papers, you can look up microsurgical anastomosis for varicocele treatment by Belgrano and Flati (separate bodies of work). That should give you an idea and good visual picture of the procedure.
Super interesting, thank you for your candid post - keep crushing in life as it sounds like you already are, good person! Hope you are staying healthy.
I’ve long felt that the reliance on population-statistics (RCT) rather than individual diagnosis highlights how little we really know about medicine.
A mechanic wouldn’t try to fix a car based on a checklist of symptoms interventions that work X% of the time across the population of cars; they would actually inspect the pieces and try to positively identify e.g. a worn/broken component. Of course, this is harder in the human body.
I’m hopeful that as diagnostics become cheaper and more democratized (eg you can now get an ultrasound to plug into your iPhone for ~$1k), we’ll be able to make “medicine 3.0” I.e. truly personalized medicine, available as standard rather than a luxury available to the 0.1%.
This kind of thinking, that everything can be broken down into pieces and studied in isolation... it has brought us very far, but it has some hard limitations. Especially in biology, where any leak you find may serve some function.
In medicine, the primary goal is to help, rather than understanding why something works exactly. Sure, understanding is an important goal too, it's just much harder to achieve than being able to help. And less important than knowing that your treatment will work, without any major side-effects, for the kind of patient in front of you.
Atomization vs gestalt is mostly orthogonal to the point here.
Taking an extreme example to illustrate the point, if you could image every atom in the body you’d have the opportunity to understand the whole-system dynamics, or try to isolate subsystems if that helps.
> In medicine, the primary goal is to help, rather than understanding why something works exactly.
Right. My point is that each phenotype is different, and so understanding the individual will allow you to help them more.
I don't know about the name "technet" in particular but there are services that aggregate technical service bulletins released by car manufacturers to make them more easily available to independent (non-dealer) mechanics.
What makes professional mechanics fast (and therefore makes them good profit) is knowing from experience when you can shoot from the hip like that.
But yeah, you won't find people doing things that way in any setting where it Actually Matters(TM) (e.g. expensive things where you really can't justify not fixing it right the first time)
Nitpicking on the mechanic point, but this is pretty common, just not at the same level of detail as medicine. Certain brands, models, and parts are more likely to fail in certain ways, so if a model comes in with symptoms of a known, high frequency problem, many times that work will be done first rather than taking more of the car apart to inspect individual parts.
Certainly I didn't think there's huge bodies of work on those statistics the same way there is for medicine, but any car repair forum online will give you some sense of this
Please, do not compare an engineer working on something built by humans with publicly available documentation, and a scientist working on something built by nature without event a single hint of documentation, nor assurance of any logic behind.
They work in different contexts, with wildly different constraints and wildly different expected outcomes.
I worked at an auto parts retailer growing up in high school. I had very basic knowledge of cars. After working there for a year, someone could come in and describe what they were seeing and hearing and 80% of the time I could tell them what is wrong and what is needed. You'd be surprised at how a large population is similar for different 'paths' through the problem and solution space
Diagnostics only really tells you that something is happening but not why; and it is so impractical if not impossible to observe mechanisms of action for much of the body.
Heck, we don’t even know the mechanism of action for acetominophen, and that’s one of the most popular, oldest OTC drugs out there.
> 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.
One of the more exciting AI use-cases is that it should be about competent to handle the conversational parts of diagnosis; it should have read all the studies and so it'll be possible to spend an hour at home talking to an AI and then turn up at the doctor with a checklist of diagnostic work you want them to try.
A shorter amount of expensive time with a consultant is more powerful if there is a solid reference to play with for longer before hand.
AI has a long way to go before it can serve as a trustworthy middleman between research papers and patients.
For instance, even WebMD might waste more time in doctor's offices than it saves, and that's a true, hallucination-free source, written specifically to provide lay-people with understandable information.
This study found that an LLM outperformed doctors "on a standardized rubric of diagnostic performance based on differential diagnosis accuracy, appropriateness of supporting and opposing factors, and next diagnostic evaluation steps, validated and graded via blinded expert consensus."
If you look in the discussion section you'll find that wasn't exactly what the study ended up with. I'm looking at the paragraph starting:
> An unexpected secondary result was that the LLM alone performed significantly better than both groups of humans, similar to a recent study with different LLM technology.
They suspected that the clinicians were not prompting it right since the LLM without humans was observed to be outperforming the LLM with skilled operators.
Stethoscopes are an example where tech can help and is helping. Some sounds (a slightly leaky heart valve, say) are subtle and easily missed, especially if there is traffic outside the doctor's surgery or other noise. Even with good earpieces.
A stethoscope with microphone, analog-to-digital conversion, and digital signal processing can separate out heart sounds from lung sounds and amplify each separately, and AI analysis can learn to identify early stage problems that doctors can't yet hear.
Of course the downside of that may be a loss of skill, as we see happening with ECGs. The ECG analysis algorithms are so good now that lots of doctors don't even bother with anything more than a glance at the waveform, they just look at the text the algo provides. Understandable, when you're near the end of a 12-hour shift.
But potentially, AI based home diagnostic kits with these sorts of devices could save doctors' time.
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.
If it wasn’t in the past, I imagine it will be in the future with how common two working parents is now. We want more kids but we are getting zero grandparent help
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.
Medieval burial grounds, when examined by anthropologists, do contain some people over 60, but the majority of adults buried there died earlier, typically in the 45-55 bracket.
It wasn't just disease, but also wars and famines. And in women, deaths during childbirth, which cluster in the 20-35 bracket.
Cardinals of the Church, who led peaceful lives, didn't give birth and never went hungry, lived into their late 60s and early 70s even during the Middle Ages. But an average peasant wouldn't.
The problem there is with your definition of grandfather. Currently, the age for a grandfather in developed countries is 55+. For most of humanity's history, if there were grandfathers, they would barely make it to 55 years of age.
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.
If you’ve never stumbled across the older OkCupid blog posts or Christian Rudder’s book (Dataclysm[1]) then I can’t recommend them enough. Super interesting content delivered by a smart and engaging writer
Agreed, but once you reach 60 (like Cruise and McGillis) you're well beyond the forces of natural selection and into the unnatural realm that our longer lives have granted us. Both of these actors are outcompeted in real life by younger people (sex/reproduction wise) yet one of them is still able to secure billing in "sexy roles" and the other isn't... and this is just one example.
This could be natural selection acting against us, but since modern society is artificial anyway, why not make an effort to combat it?
> you're well beyond the forces of natural selection
Are you? By all appearances this is a direct result of it. Visual indicators of age haven't been selected against in and of themselves as strongly with regards to men but a great many related things have been.
Arguably your specific example might constitute an edge case that historically didn't occur with enough frequency to be selected against. Seems like little more than a curiosity to me.
> Are you? By all appearances this is a direct result of it.
This is a result of it when it no longer matters, in adults who no longer matter for breeding purposes. When natural selection acts on humans of age 60+, it's mostly irrelevant. There's nothing to select, they've already done their part. It's just that natural selection is blind and doesn't "know" when to stop -- but we humans know better (this is what I meant later by combat/countering it).
> Arguably your specific example might constitute an edge case that historically didn't occur with enough frequency to be selected against. Seems like little more than a curiosity to me.
Why would it be selected against? All else being equal, natural selection wouldn't exert any particular pressure on old people after they've passed their genes. It's "blind" to them. It certainly doesn't know anything about being media star material! ;)
But it's not an "edge case" for modern humans, especially as we live longer and keep working well into our later years. Modern society doesn't always resemble what the forces of natural selection act upon anyway.
> What are you arguing for here?
The same as the thread starter, only with a focus on women since they get the short end of the stick in this aspect (in media).
Except this seems like a direct result of natural selection, because older men can still pass on their genes. Older women can not as readily pass them on.
> modern humans and our society don't reflect natural selection anyway; many things we do are "unnatural".
That's simply not true. Don't get hung up on the word "natural". It's nothing more than the result of a biased random walk (at least until the eugenicists get involved, at which point it goes meta).
Some of the things selected for can get pretty abstract. Cooperative behavior for example. Despite often being to the short term detriment of the individual it is observed in the wild.
I don't think it's false. The forces at play in modern society are no longer (alone) those of natural selection. This has been remarked on by people like Stephen Jay Gould. Society/culture evolves along different (faster) lines. We do a lot that makes no sense from the perspective of natural selection.
Yes, that was exactly my point. The edge case is the potential for the selected behavior to work against reproductive fitness - someone young finding someone old attractive even though they aren't likely to get good offspring out of it.
I'm still not clear what you're arguing for. It isn't media giving women the short end of the stick, it's biology. What exactly are you proposing be done about it? I'm not even clear why it's a problem aside from the general desire that scientific advancement should eventually cure us of age related phenomena entirely.
Men season, while women age - The media's portrayal of desirability of old people is a reflection of societal preferences, not the other way around.
Men become wiser, skilled, kinder, more patient and often better providers. Women tend to become argumentative, quarrelsome, bitter (especially those who date often) and rewarded for it. They also tend to dissociate love from sex and manipulate one for the other.
There would appear to be two poles of explanation - that either the media is reflecting desires and not influencing it, or that the media is influencing desires and not reflecting them - or somewhere in-between.
The reflection of biological reality appears easier to justify: that men remain fertile for longer, that the attractive qualities that women care about most (e.g. wealth and personality) tend to improve with age; and that a women's attractiveness is most tied to her skin, which we all know shows aging the most on the body, and is a sign of her reproductive health or ability.
I'm not sure what the argument for the media being able to influence males to the extent suggested would be? Older men were marrying younger women before the printing press, so where did this pressure originate? And what is its mechanism of action?
I'm not saying media is influencing this; this preference clearly showed before media! The media here clearly reflects a preexisting preference, but in my opinion, it also makes the world worse for old people, especially women and actresses.
I'm saying media could be changed from this tendency, since this preference is less relevant in modern society and it hurts actresses. Media is a human construct that can be adapted to new needs, it's not a tool of natural selection!
Changing media wouldn't change the sexual preferences of men, and nowhere am I arguing this. It's like inclusivity in media -- is it ever going to eradicate racism? No, but it will make the world a tiny bit fairer.
I agree that falling back on "it's natural" can be a poor excuse, mainly because humans have the power and intellect (maybe not intelligence, but I digress) to change even what is considered nature, but I'm also not for social engineering, and I've seen such a wild increase in social engineering in media over the past 15, maybe 20 years, that I'd err on the naturalistic side now.
With this specific example, if McGillis had spent as much time and money and effort on appearing young and attractive as Tom Cruise has, maybe she would have been back in her role as well.
Oh, agreed! But it seems that men can remain "viable love interests" as long as they keep their rugged good looks (yes, with cosmetic help, of course), but in women this takes a stronger requirement of looking youthful.
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.
I don't dispute any of your points in general. But at the same time, it brings a nostalgic smile to my face to envision starting a 250-year project in 2025.
Also the moths that "changed" from white to black during and because of the industrial revolution. That was quick, and to me, the best example of how it all works.
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 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.
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”.
> 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.
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 think you missed the idea. Your explosive device could still come in handy though.
But you freeze the sperm at the peak of freshness. Then you wait and see how the donor does. If they live to a ripe old age without old age diseases, then go select their sperm. Otherwise, destroy it.
You can probably do this with eggs too. When a child is desired, select an egg and a sperm off the shelf, and there you go. Easy peasy. Your device ensures only munitions experts can procreate outside the system, and I think we'll need a lot of munitions experts in the ensuing generations.
I would think the end goal would be to remove the need for frozen sperm, which we can do once we verify that the 60+ year old donors are still producing healthy swimmers. No sense in going just halfway with the Brave New Worlding.
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.
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.
Samson and Delilah would like to have a word with you. Also with Japanese Samurai. You loose your mythological power, leading to lost status, suicide, ...
This work by Gat and Gornish gives a great explanation for prostate enlargement. There's an article by Donaldson [1] that suggests a connection to vitamin K2:
A large study from 2014 by Nimptsch et al found a strong inverse correlation between intake of vitamin K2 and prostate cancer [2]. Dairy foods with K2 had the most effect (K2 is soluble in butterfat).
Vitamin K2 helps remove calcium from the elastin in artery and vein walls, reducing their stiffness. Donaldson hypothesizes that K2 improves venous flow, and hence might reduce the varicoceles that lead to too much free testosterone getting to the prostate and causing enlargement.
So eat more grass-fed butter, or take a K2 supplement. At worst, you might also improve your bone strength. At best, men might prevent prostate cancer.
I had my prostate removed six weeks ago due to Gleason 8 score cancer. The pathology revealed an aggressive cancer.
My prostate was not enlarged, my PSA at the end was 4.2. Only because my doctor was overly cautious about the slope of the PSA rise did he send me for an MRI starting the diagnosis. It remains to be seen if it escaped containment.
The point here is, I don’t think enlargement and cancer are that intertwined. Cancer happens for any number of reasons, pinning hope that it can be staved off by diet and vitamins seems to ignore tons of other environmental factors.
Wow, that sounds scary. I hope it doesn't come back. Weird about the 4.2 PSA; that wouldn't have raised alarms, normally. I guess acceleration is as important as absolute values.
All the best. I had a check up for prostate cancer recently, and fortunately have been told I don't have it, but until that moment I felt the stress of wondering and worrying, so you have my sympathy.
I'm also glad you found a good doctor, the first I found did no checks at all. Told me I'm too young to have any problems (I'm definitely not) and sent me away with some herbal medicine and all that stress I mentioned. The second doctor I found was thorough and reassuring, and shocked by the behaviour of the first.
Good article, but very weird to scroll to the bottom and see "(c) Norman Yarvin" at the bottom. Curtis Yarvin's brother wrote this. I don't have an opinion about that, I just find it strange.
I have no opinion of unlimitedhangout.com or the veracity of that article. But in response to "I just find it strange", I'm beginning to associate this sort of intensely intellectual inquiry into disparate topics with equally intense political positions.
I was first introduced to Urbit as if it was a purely technical, humorous and extremely nerdy lark. It was a joke thing my friend got me to sign up for, to own a slice of an imaginary universe (in a quantity called a "frigate" or whatever it was). When I learned years later about how serious the worldview behind it was, I was quite shocked.
Since then, and especially since the NYT outing of Scott Alexander in 2020, I've become more attuned to the pattern. These hyper-analytical blogs often come with a lot of political implications below the surface.
Again, I'm not taking sides here. If anything, the takeaway for me is that the world is very complicated. We have these rare polymath personalities who go deep into topics, have a strong voice on the internet, and they end up with all sorts of valid criticisms of the status quo. This in turn can align with extreme political views.
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?
I am an interventional radiologist. I’ve done procedures to embolize the prostate (helps shrink it), and gonadal vein embolization (for varices).
The gonadal veins are in a different vascular territory from the prostate. The prostates vascular territory is the anterior division of the internal iliac. The gonadal veins arise directly from the inferior vena cava.
I had not come across this research before it’s interesting because as mentioned above, these organs are in different vascular territories but when venous structures begin to reflux the blood may find other collateral routes through other territories.
I skeptical that this works, but it is really interesting.
>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.
> There’s no proof that ejaculating more actually lowers the chances of prostate cancer. For now, doctors just know they’re connected. It may be that men who do it more tend to have other healthy habits that are lowering their odds.
> Ejaculation doesn’t seem to protect against the most deadly or advanced types of prostate cancer. Experts don’t know why.
I'm not the expert but, like all things, exercise, sleep and diet probably goes a long way.
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.
Thank you! Didn't know I endangered people by suggesting it to them.
I usually got bored halfway and after 3-6 breaths finished peeing normally. It was also because I've noticed that the exercise made it very hard to push out the last of urine from the bladder. Now I know it's also very unhealthy not to empty all the way.
As with any internet post about exercise, someone must eventually come along and mention the good old weighted squat. Squats are well known to strengthen pelvic floor.
My own anecdata confirms the benefits of pelvic floor exercises without any kegels, at least back when I regularly did lift weights.
But is stopping the flow of urine an apt description of the exercise? Is it a case of “do it as if you were doing that, without actually doing it while urinating?” If so, I think I’d be hard pressed to find a simpler way to describe it to any man (no idea if it applies to women as well).
> 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.
I also recommend the Seek app by iNaturalist. Though if you’re like me and use it to identify plants and every bug you see, you may not actually get that much walking accomplished.
Season likely plays a factor too. There are many plants that more or less look identical (to the untrained eye) until they either bloom or grow large enough.
true. it is also pretty bad at IDing things that are half-formed, eg a bud that hasn't bloomed yet, presumably because most photos in the dataset are of the blooming version.
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.
I find thunderstorm noises superior to white/coloured noise - because it's a natural sound the brain filters it out, and obtrustive noises are camouflaged within it, and filtered out too. So the loudness required is less than the loudness needed for white/coloured noise to be effective.
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.
>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.
There is some evidence that we offset all that activity later in the day. I know that if I go for a long bike ride then I will inevitably veg out in front of the TV later.
Exercise is important but it's not because of the burning of calories.
I often listen to podcasts while walking. Or I think. I also own a walking pad and walk while working (1h in the morning, 1h in the afternoon - not every day but most).
You must have been in really bad shape before if you're getting such noticeable health benefits from a rather modest exercise intervention like 8k steps.
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?
I think people give the cue of stopping urination to help others find the muscles that you need to engage. Otherwise, yes, you absolutely can just do them any time you want. In yoga it’s called mula bandha [1]. You’re often instructed to engage it while practicing asana or pranayama. I even focus on engaging it when I’m out for a run or lifting weights.
Thanks, I think I'll practice whole brushing my teeth, probably the easiest to not forget to do, as it's an everyday thing that I'm unlikely to ever stop doing.
Wow, I was so sure it was PC or PV muscle exercise, because author of the book where I learned about the peeing exercise said that men don't have Kegels muscles. I stand corrected.
> 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
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.
Research and subsequently clinical testing is expensive so you have to acquire capital, usually from grant providers or working with private industry. Grant providers tend to be conservative and risk-averse so that means individuals with new ideas often won't be able to explore them until later in their career. Private industry is less risk averse but will only fund research if it has the potential to bring a patentable product to market before the parent expires.
Even once you have funding secured, the regulatory approval process is long and requires hundreds of pages of documentation, reporting, and compliance. Then you have to get insurance to cover it, which can require a procedural code being generated for it by the AMA and requires convincing insurers it's worth it, particularly Medicare in the US which other insurers take their cues from. And even once a procedure is approved and a patient can get it paid for, you still have inertia from human physicians who have been trained to perform certain kinds of treatments and not others.
Safety regulations were just one of the many hurdles in the pipeline from idea to therapy.
But to answer your question, that uterus transplantation was (a) an experimental therapy overseen by an IRB to treat a diagnosed medical condition, (b) almost certainly funded by grants acquired by Baylor and not insurance, and (c) the therapy is still in clinical testing and not available to indicated patients today in 2025, 8 years later, unless they are part of a clinical study, which demonstrates how lengthy the process is.
You're entirely correct. I was trying to speak about medical therapies generally but the FDA doesn't regulate surgical techniques. Some new surgical techniques do require experimental medical devices which would require FDA approval though. And you still have to deal with the bureaucratic hurdles of acquiring grants for clinical trials and getting insurers to cover treatments of course, but it's certainly a lower barrier.
And this area of human interest has been (and is) prone to abuse from unscrupulous individuals/organizations. Rigorous regulation prevents much of that as well.
I’m glad we’re starting to talk about the prostate because I feel like for a long time. Men have been reluctant to talk about this more and more in society. I feel like women have their fair share problems as they get older, but men have equal amount of problems too we just don’t like to talk about it.
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.
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.
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.
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.
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.
Hi - there is no official diagnosis for "PFS". I have it in the sense that I have penile tissue scarring confirmed by medical imaging, with a urologist's opinion that finasteride was the likely cause. Yes, tadalafil does often help in my case, but the reduction in function is permanent and I doubt I will ever be my pre-finasteride self again.
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.
> 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.
> Multiple surgeries is not sustainable. Too much uncertainty
I'm not sure where this is coming from. Multiple cardiac bypasses have a ton of uncertainty, but they are effective because efficacy is measured by quality of life * increased lifespan.
Multiple surgeries (the time it takes to regrow major veins from capillaries that aren't blocked off) to relatively non-lethal parts of the body seems very sustainable for a human lifespan after 60 or 55 or whatever.
There is a reason we are smart enough to develop finasteride and dutasteride that are extremely effective and safe¹ instead of relying on plants & herbs which are just weak versions of taking a drug anyway.
¹ the science is sound, the safety is absolutely a guarantee. There is a group of about 10 individuals who have spent their entire life spreading their neurological issues and obsession with fake reports and exaggerations of the harmful made-up side effects that cannot be repeated in any study whatsoever anywhere..
I actually could not believe the other day that they are still active and have managed to cause the FDA to issue a guidance that there might be higher side effect rates than otherwise were reported .
It's actually ridiculous, and every news article and study about it are almost entirely mentioning people who's just start believing in their heads that they have side effects when they actually don't. And yet the news articles took this as evidence of a story that has been hidden or something .
I really thought that those 10 or so individuals who you used to be able to read their forum posts back in 2006 when they tried to tell every young guy in the world not to take it for hair loss would have fizzled out by now.
Finasteride does seem to be able to cause some issues. It seems that DHT has many protective roles in the body and limiting it may cause problems: https://pmc.ncbi.nlm.nih.gov/articles/PMC7308241/
Finasteride was discovered because of a tribe in south america with a high frequency of a mutant allele in the gene responsible for protein that converts T to DHT. They had no BPH. This led to the search for a competitive inhibitor of that enzyme.While under patent it was extremely lucrative to big pharma. The incentives of fame and greed will continue to plague our civilization as long as we embrace aggregating structures like corporations, advertising, social media, and instant worldwide communication to amplify human traits that were useful in small scale tribes.
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.
> The theory here is largely mechanical; and it’s not just psychiatrists like Scott who are weak at mechanical explanations; it’s doctors in general as well as medical researchers and biologists.
A tangent here, about not just "mechanical" explanations, but "mechanical" treatments —
IMHO, the insistence in modern medicine on treating recurrent bacterial infections purely with antibiotics is wrongheaded, and the cause of a lot of resistant strains of bacteria. Especially for topical/mucosal/epithelial infections, where the infected tissue is accessible without invasive surgery.
In a recurrent bacterial infection, the reservoir of the infection is one or more (almost always macro-scale) biofilms or plaques. And antibiotics just don't do much to biofilms/plaques. (If they could, you could spray Lysol on the walls of an under-ventilated shower that's developed "pink slime" biofilms — and all the slime would dissolve, or detach and run down the drain. But it doesn't do that, does it?)
Even if you kill most of the bacteria, the biofilm itself — the "fortress" of polymerized sugars which the bacterial cells have secreted to secure their position — is not destroyed by antimicrobal compounds. And the few bacteria that remain have a great position to regrow from.
What does work to clean a slimy shower wall?
Scrubbing. Scraping. Peeling. Together with targeted chemicals, that 1. get water out of the polymer (because these biofilm surface polymers are often lubricative when wet, and thus resistant to abrasion — but this effect breaks down when dry), and 2. rough up the surface of the biofilm/plaque a bit, to get a better grip on it.
Biofilms and plaques adhere to themselves — so, when you can break the biofilm or plaque into chunks, you can then get entire chunks out. (And also, by removing chunks, you create paths for antimicrobials to then get past the biofilm surface polymer. You're breaching the fortress.)
If you picture a strep-throat infection — spots on the tonsils and on the throat, etc — those spots aren't a symptom; they are "the enemy" you're trying to fight. Remove them — mechanically! — and you go from using antibiotics (picture tiny cellular infantrymen) to effectively "fight a war of attrition against an enemy with a secure position", to "a defeat in detail of an enemy with nowhere to hide."
---
Interestingly, there are certain medical specialties that think mechanically about infection.
• Dentists, obviously, know that you must abraid dental plaque away. There's no chemical that you can put in your mouth every day that will keep plaque from forming, or reduce it once it has formed. (In fact, ironically, antimicrobial oral rinses [of e.g. chlorhexidine] accelerate plaque formation, because bacterial cells killed "in place" inside their biofilm fortresses will deposit and enrich the surface polymer layer of the biofilm — much as dead sea creatures deposit and enrich limestone sediment.)
• Audiologists know that there's ultimately nothing you can do with drugs or topical treatments to get an ear clear of wax+fat+dust+anything else trapped in there. You have to go digging. Chemicals can soften the wax, to make it easier to remove; but, due to the shape of the ear, and the lack of ability to "come in from behind" (there's an eardrum in the way!), the softened wax will never come out on its own.
• Dermatologists know that a cyst can't just be drained + treated with antibiotics. The body forms a defensive pocket around a cyst — but the inside surface of this pocket ironically provides the perfect medium for a biofilm to grow on, and thus for an infection to recur after drainage. Cysts are only considered well-treated if the pocket itself is removed — thus removing the biofilm.
...and yet, when you look at most other disciplines, you see completely the opposite.
• An ENT is very much not willing to abraid biofilms out of your sinuses or throat "if they can help it", despite those surfaces being accessible to an endoscope without breaking past any barriers. They will always try first to treat "pharmacodynamically", with e.g. oral antibiotics + an antimicrobial sinus rinse — presumably in the hopes that you'll accidentally do something mechanically in the process of treatment (e.g. snorting really hard to get the remnants of the rinse out) that will dislodge the biofilm. You have to go through years of back-and-forth with an ENT before they'll actually bother to look further up inside your sinuses than they can see with an otoscope/anterior rhinoscope. (And IMHO this is why so many people suffer from idiopathic chronic sinusitis, developing into nasal polyps et al. Nobody's ever been willing to go deep up their nose with an endoscope, find impacted biofilm plaques, and say "alright, let's clear those out.")
• Kidney stones, once symptomatic, are treated ultrasonically (lithotripsy); but the thinking on follow-up prevention is entirely about preventing accretion — not in removing the cause. [In many cases, the cause of (struvite or apatite) kidney and/or urinary stones, is very likely a bacterial biofilm within the kidney, spalling off bits of biofilm, which denature into plaques after exposure to the harsh pH of the kidney/uterer/bladder; get caught on some tissue; and then act as nucleation sites for mineralization (stone formation) as dissolved minerals pass through.] Once someone gets one kidney stone, they are generally thought to just be "prone to kidney stones", and will likely get them randomly
for the rest of their life. A lot like the old — pre-infectious-origin — thinking that someone can be "prone to peptic ulcers"!
Here is my pet theory, it's not intended to be political, just thinking about evolutionary biology.
There is an optimum lifespan for peak evolutionary population fitness in any group of organisms. Too short a lifespan means not enough time to gather resources and reproduce. Too long a lifespan could mean competing with future generations for scarce resources, which might in theory marginally improve individual fitness, but in the aggregate decreases overall population fitness, and is therefore not selected for.
Over billions of years, organisms evolved built-in control mechanisms to ensure that they live/survive for the optimum amount of time. The evolution of these mechanisms is driven in part by the fact that an older organism under stress being eliminated from the environment will probably improve the population fitness of close relatives.
I believe this is what cancer is. It's one of many, many built-in mechanisms, reinforced by hundreds of millions of years of evolution, to kill us off when our time has come.
So, if there are tons and tons of evolved mechanisms that exist just to knock you out when your time has come. That is the ultimate reason why men die from heart attacks: they have evolved in past generations that if they have extreme exertion at an advanced age, it's an indication that they aren't contributing to population fitness in a useful manner, and that extreme exertion would be more efficiently done by younger individuals. At an old age, they should be at the top of the food chain, guiding and educating and valued and lazy and consuming, and if they are not, better for the tribe for them to die quickly than lingering on.
And there is hope. If we can eliminate stress from our lives, we send a signal to our bodies that we will improve population fitness by continuing to exist, and our bodies may reward us. That's a big reason for longer lifespans. Better diet and moderate exercise is great for sure, but less stress makes a big difference.
But this is only one of a multitude of dynamics that is happening in the complicated system that is the existence of life, and is not necessarily a dominant dynamic.
For prostate cancer, you might get around it temporarily, but something else will get you. Lifestyle changes, medication, placebo and other interventions that reduce stress probably have a better overall shot at increasing your lifespan than any single magic bullet.
I suspect that prostate cancer has to do with being old and not having sex, if you're an older male. An older male who doesn't have sex would have lower individual fitness than an older male who does have sex, and would be competing for resources with younger individuals who might have higher evolutionary fitness. So, there's another solution to prostate cancer that doesn't involve surgery (or even necessarily having sex), I think I read another article that mentioned that, I won't spell it out.
Given that breast cancer happens more to women who have not breastfed after carrying to full term (citation needed), you can draw a parallel. Females who are decreasing population fitness by not having children, and by extension have lower individual fitness, breast cancer and ovarian cancer are some of the main mechanisms. They also think that breastfeeding reduces the risk of breast cancer. Certainly, even females that don't reproduce, but still breastfeed, probably improve population fitness, even if they don't have good individual fitness.
I read this with great interest, because about a decade ago, I was convinced I had prostatitis (but NHS screwed the diagnostic process up - the GP didn't do a digital rectal exam because the ultrasound would be more diagnostic anyway, and the ultrasound scan was cancelled because the GP didn't do a digital rectal exam which was part of the criteria for going through with the scan ¯\_(ツ)_/¯ ), and ended up reading quite a bit about it, and how I might try to make things better for myself in the absence of antibiotics.
I ended up on this page which I no longer remember (something something prostatitis foundation maybe?), from which I remember two things.
The first was this turkish doctor, who against all advice was suggesting a "Brocolli juice therapy" as a prostatitis cure. Fast forward to 2025 and there's lots of studies supporting this. Anecdotally I tried this back then and it really helped the prostate pain I had at the time for months go away within a week.
The second, which is more relevant here, was this guy who had a very interesting hypothesis, that a lot of the prostate troubles are actually "musculoskeletal" in origin, and muscle imbalance / weakness of the iliopsoas muscles in particular. And that this imbalance affects venous return which "somehow" causes the condition. But he was just a lay person, and the "somehow" was unclear. So this completes that image perfectly. It's interesting that this article mentions the venous insufficiency link, and that veins rely on valves to direct flow, but doesn't mention the muscular link at all.
In any case, this person was saying that in his case, doing lots of iliopsoas stretching and exercises effectively 'fixed' his chronic prostatitis problems. So I've timidly started including a couple of iliopsoas stretching exercises before any workout I do. Anecdotally, I think it helps, but I can't know for sure. But thought I'd mention here in case someone shows interest or can make that link more solid.
It also seems to me that a lot of “prostatis” cases have nothing one to do with bacterial infection but rather pelvic floor issues or is referred pain from spinal issues.
There have been many studies since, which probably provide more evidence and detail. But this guy's current explanation at the time is provided in the link where it says "needs to be boiled" (https://www.oocities.org/iastr/eboil.htm)
Quoting from the linked page:
> WHAT IS THE REASON THAT WE MUST CONSUME BOILED BROCCOLI?
> Fresh broccoli (unboiled) contains some enzymes that must be deactivated. The simple way to deactivate these enzymes is to boil the broccoli in water for 5 minutes. After boiling for 5 minutes, the enzymes will become inactive. If these enzymes aren't deactivated, the broccoli cannot successfully treat those suffering from BPH, prostatitis, or general urinary tract infections.
> Broccoli contains very important compounds. These compounds can only treat those who are suffering from BPH or prostatitis when these enzymes are deactivated. If this is not done, the enzymes which broccoli contains start a different metabolic reaction so that the efficiency is reduced.
Unmentioned is the significance of dietary modificatioon. In one study, Japanese men had 10% of the incidience of problematic bph as americans. The offspring of the japanese in Hawaii had half the iincidence. The second generation had no difference. The analysis suggested that phytoestrogens in tofu, tempeh,etc are responsible of prostatic involution.
Animal fat contains elevated levels of lipid soluble hormones and diets high in fat (meat) are associated w bph as well as elevated risk of prostate ca.
Finally, this craze of T replacement is greatly increasing the risk of symptomatic bph (along with other cardiovascular risk factors)
This article is literally the definition of TL;DR. It's fairly hard to get thru, I spaced and skipped the conclusion, that the treatment isn't permanent and can be undone.
I was interested through the first 20-25 paragraphs, and then the thing just kept going and going and going. It would have been fine, though, if it had some sub-headings and stuff to help guide one through.
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.
I had a look at your trial description (https://clinicaltrials.gov/study/NCT06424912)
Are you planning to publish the longitudinal data, esp. of endpoints 2 and 3 (prostate size, urinary flow). It would greatly add to the public understanding of this procedure. Why didn't you go for PSA? It's easy to obtain altough one probably wouldn't expect significant changes in this short time frame.
Yes, that’s the intent post study completion.
We are collecting PSA data as well. It’s a useful parameter for prostate cancer.
Have you found that with your procedure, to quote the blog piece, "new venous bypasses grow to replace the destroyed spermatic veins," as found in Gat and Goren's work in follow ups? Or is the long term data not there yet?
Thank you for taking a risk on this by the way. As someone who has family history it's heartening to know there are people taking this seriously.
We actually bypass the spermatic vessels. There is historical evidence that bypassing the spermatic vessels is a superior way to treat varicoceles. So our procedure shouldn’t have the recurrence (of varicoceles or bph) concerns. But this needs to be established through long term studies.
Thanks for sharing your story. It’s stories like yours — people with family histories and real-world experiences — that fuel everything we’re doing.
We are currently gathering insights to better understand patient preferences and would greatly appreciate your input. If you are interested in participating in a short survey, please contact us at info@vivifimedical.com. Thank you for helping us shape the future of patient care.
Is the procedure still possible/advisable after a TURP?
Yes, our procedure could be done before or after any other BPH treatment out there, including TURP.
Excellent work, keep it up!
On a selfish note, it'd be nice if it were available from Urology Austin sometime in the next 10-15 years.
Thank you for the kind words!
Urology Austin is certainly on our radar and we will reach out to multiple urology practices as we head towards product launch.
Would this procedure be advisable on someone currently with varicocele, less than 40 years old, and with family history of prostate cancer (both grandfathers)?
While we think this procedure has the potential to be a prophylactic treatment, there is no evidence to back that up.
There is a recent study, however, published by Cleveland clinic that demonstrated higher prostate cancer recurrence rates in patients with high local testosterone levels (around the prostate) post prostatectomies.
Also this procedure is not currently approved for treatment of prostatic issues. But if varicocele results in testicular pain, it’s often times treated.
Nothing in the parent differs from a product promotion; there are no alternatives, no negatives, no considerations, nothing but praise - even of a member of the board of advisors.
> there are no alternatives, no negatives, no considerations, nothing but praise
His account is over ten years old, and active. Maybe he's just impressed? Why don't you provide alternatives or negatives, if you can? Cynicism for cynicism's sake is pointless.
I have a really enlarged prostate. 4x the normal size.
Had it biopsied because it showed a large PSA value (17).
Biopsy came back negative. Psa density function actually puts my levels in normal range.
I still have difficulties urinating.
Currently taking medication to reduce the size of my prostate, but not happy about the meds because of the sexual side effects.
Would this procedure help me?
In case you missed it, there's a comment parallel to yours by the founder of the company. They also provide their email in a child comment to that. Link: https://news.ycombinator.com/item?id=43804502
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.
> As a result, there is no risk to any sexual or urinary functionalities.
You can say "based on [X], we believe the risk of [Y] is insignificant." Saying there is "no risk" is far too sweeping a claim given the level of evidence it sounds like you've gathered.
Got an anatomical diagram for us visual thinkers?
Not at this time, apologizes. As we move along, we intend on releasing data and images through publications.
However, if you are into reading scientific papers, you can look up microsurgical anastomosis for varicocele treatment by Belgrano and Flati (separate bodies of work). That should give you an idea and good visual picture of the procedure.
Super interesting, thank you for your candid post - keep crushing in life as it sounds like you already are, good person! Hope you are staying healthy.
> The theory here is largely mechanical
I’ve long felt that the reliance on population-statistics (RCT) rather than individual diagnosis highlights how little we really know about medicine.
A mechanic wouldn’t try to fix a car based on a checklist of symptoms interventions that work X% of the time across the population of cars; they would actually inspect the pieces and try to positively identify e.g. a worn/broken component. Of course, this is harder in the human body.
I’m hopeful that as diagnostics become cheaper and more democratized (eg you can now get an ultrasound to plug into your iPhone for ~$1k), we’ll be able to make “medicine 3.0” I.e. truly personalized medicine, available as standard rather than a luxury available to the 0.1%.
This kind of thinking, that everything can be broken down into pieces and studied in isolation... it has brought us very far, but it has some hard limitations. Especially in biology, where any leak you find may serve some function.
In medicine, the primary goal is to help, rather than understanding why something works exactly. Sure, understanding is an important goal too, it's just much harder to achieve than being able to help. And less important than knowing that your treatment will work, without any major side-effects, for the kind of patient in front of you.
Atomization vs gestalt is mostly orthogonal to the point here.
Taking an extreme example to illustrate the point, if you could image every atom in the body you’d have the opportunity to understand the whole-system dynamics, or try to isolate subsystems if that helps.
> In medicine, the primary goal is to help, rather than understanding why something works exactly.
Right. My point is that each phenotype is different, and so understanding the individual will allow you to help them more.
My brother is a mechanic and he definitely goes on technet to review a checklist when doing diagnostics. Especially on cars he doesn't see a ton
I don't know about the name "technet" in particular but there are services that aggregate technical service bulletins released by car manufacturers to make them more easily available to independent (non-dealer) mechanics.
What is Technet? I've googled it, but there are just a bunch of generic sites.
Yeah, how can this take possibly be on HN when this approach works on software. We even manufacture the population samples ourselves (fuzzing).
What makes professional mechanics fast (and therefore makes them good profit) is knowing from experience when you can shoot from the hip like that.
But yeah, you won't find people doing things that way in any setting where it Actually Matters(TM) (e.g. expensive things where you really can't justify not fixing it right the first time)
Nitpicking on the mechanic point, but this is pretty common, just not at the same level of detail as medicine. Certain brands, models, and parts are more likely to fail in certain ways, so if a model comes in with symptoms of a known, high frequency problem, many times that work will be done first rather than taking more of the car apart to inspect individual parts.
Certainly I didn't think there's huge bodies of work on those statistics the same way there is for medicine, but any car repair forum online will give you some sense of this
Please, do not compare an engineer working on something built by humans with publicly available documentation, and a scientist working on something built by nature without event a single hint of documentation, nor assurance of any logic behind.
They work in different contexts, with wildly different constraints and wildly different expected outcomes.
I worked at an auto parts retailer growing up in high school. I had very basic knowledge of cars. After working there for a year, someone could come in and describe what they were seeing and hearing and 80% of the time I could tell them what is wrong and what is needed. You'd be surprised at how a large population is similar for different 'paths' through the problem and solution space
Diagnostics only really tells you that something is happening but not why; and it is so impractical if not impossible to observe mechanisms of action for much of the body.
Heck, we don’t even know the mechanism of action for acetominophen, and that’s one of the most popular, oldest OTC drugs out there.
The other difference, of course, is that the mechanic can just RTFM
This sounds a lot like the pitch for Theranos
Which was a great pitch because it’s what people want. It just has to be based in reality.
So?
> 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.
If you don't like your doctor, go to someone else
Indeed but a tiring and expensive game when it takes 4-5 tries with experienced specialists to get an actual diagnosis.
One of the more exciting AI use-cases is that it should be about competent to handle the conversational parts of diagnosis; it should have read all the studies and so it'll be possible to spend an hour at home talking to an AI and then turn up at the doctor with a checklist of diagnostic work you want them to try.
A shorter amount of expensive time with a consultant is more powerful if there is a solid reference to play with for longer before hand.
AI has a long way to go before it can serve as a trustworthy middleman between research papers and patients.
For instance, even WebMD might waste more time in doctor's offices than it saves, and that's a true, hallucination-free source, written specifically to provide lay-people with understandable information.
This study found that an LLM outperformed doctors "on a standardized rubric of diagnostic performance based on differential diagnosis accuracy, appropriateness of supporting and opposing factors, and next diagnostic evaluation steps, validated and graded via blinded expert consensus."
https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
This study is about doctors using an LLM and it doesn't seem like it made them significantly more accurate than doctors not using LLM.
If you look in the discussion section you'll find that wasn't exactly what the study ended up with. I'm looking at the paragraph starting:
> An unexpected secondary result was that the LLM alone performed significantly better than both groups of humans, similar to a recent study with different LLM technology.
They suspected that the clinicians were not prompting it right since the LLM without humans was observed to be outperforming the LLM with skilled operators.
Ah right, very interesting, thank you.
In some countries like Canada you basically don’t have an option.
Really? They just tell me it's stress, the prescribe me chinese medicine just in case and send me away.
Damn, they just tell me I’m getting old and wish me luck.
My primary care doctor doesn’t even have an otoscope!
Have no idea how they have such good reviews.
Stethoscopes are an example where tech can help and is helping. Some sounds (a slightly leaky heart valve, say) are subtle and easily missed, especially if there is traffic outside the doctor's surgery or other noise. Even with good earpieces.
A stethoscope with microphone, analog-to-digital conversion, and digital signal processing can separate out heart sounds from lung sounds and amplify each separately, and AI analysis can learn to identify early stage problems that doctors can't yet hear.
Of course the downside of that may be a loss of skill, as we see happening with ECGs. The ECG analysis algorithms are so good now that lots of doctors don't even bother with anything more than a glance at the waveform, they just look at the text the algo provides. Understandable, when you're near the end of a 12-hour shift.
But potentially, AI based home diagnostic kits with these sorts of devices could save doctors' time.
Women menstrual cycle tracking works off the same concept.
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
If it wasn’t in the past, I imagine it will be in the future with how common two working parents is now. We want more kids but we are getting zero grandparent help
Two working parents have far below replacement numbers of children, so it would actually cause it to disappear…
The grandmother hypothesis https://en.wikipedia.org/wiki/Grandmother_hypothesis is reasonably well-established. The corresponding 'grandfather effect' has not really been demonstrated, as far as I know. https://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2007...
Probably barely, and I think in some instances the opposite. You have to care for the elderly.
Grandparents used to be 40ish when their grandchildren were born.
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.
Your 40s? A man could pretty easily be a grandfather at 26-28, possibly less.
Perhaps less common but 30s would probably be more likely.
Iirc, historically, if you made it to 10 years of age, most humans make it to 60
Medieval burial grounds, when examined by anthropologists, do contain some people over 60, but the majority of adults buried there died earlier, typically in the 45-55 bracket.
It wasn't just disease, but also wars and famines. And in women, deaths during childbirth, which cluster in the 20-35 bracket.
Cardinals of the Church, who led peaceful lives, didn't give birth and never went hungry, lived into their late 60s and early 70s even during the Middle Ages. But an average peasant wouldn't.
The problem there is with your definition of grandfather. Currently, the age for a grandfather in developed countries is 55+. For most of humanity's history, if there were grandfathers, they would barely make it to 55 years of age.
No, plenty of people made it to that age in the past. Life expectancy was significantly depressed by infant mortality.
> in the past
What's "in the past" here? Last 200 years? 500? 1000? In evolutionary scale, those numbers are a blip.
We lucked out compared to other species, octopus develop dementia soon after breeding.
Yes, and there are spiders where the female eats the male after breeding. I bet their pr0n movies are a bit more interesting than ours.
Isn't that usually only in captivity where it can't escape?
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.
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.
If you’ve never stumbled across the older OkCupid blog posts or Christian Rudder’s book (Dataclysm[1]) then I can’t recommend them enough. Super interesting content delivered by a smart and engaging writer
[1] https://www.goodreads.com/book/show/21480734-dataclysm
This all makes perfect sense from a fertility (and thus natural selection) perspective.
Agreed, but once you reach 60 (like Cruise and McGillis) you're well beyond the forces of natural selection and into the unnatural realm that our longer lives have granted us. Both of these actors are outcompeted in real life by younger people (sex/reproduction wise) yet one of them is still able to secure billing in "sexy roles" and the other isn't... and this is just one example.
This could be natural selection acting against us, but since modern society is artificial anyway, why not make an effort to combat it?
> you're well beyond the forces of natural selection
Are you? By all appearances this is a direct result of it. Visual indicators of age haven't been selected against in and of themselves as strongly with regards to men but a great many related things have been.
Arguably your specific example might constitute an edge case that historically didn't occur with enough frequency to be selected against. Seems like little more than a curiosity to me.
> why not make an effort to combat it?
I don't follow. What are you arguing for here?
> Are you? By all appearances this is a direct result of it.
This is a result of it when it no longer matters, in adults who no longer matter for breeding purposes. When natural selection acts on humans of age 60+, it's mostly irrelevant. There's nothing to select, they've already done their part. It's just that natural selection is blind and doesn't "know" when to stop -- but we humans know better (this is what I meant later by combat/countering it).
> Arguably your specific example might constitute an edge case that historically didn't occur with enough frequency to be selected against. Seems like little more than a curiosity to me.
Why would it be selected against? All else being equal, natural selection wouldn't exert any particular pressure on old people after they've passed their genes. It's "blind" to them. It certainly doesn't know anything about being media star material! ;)
But it's not an "edge case" for modern humans, especially as we live longer and keep working well into our later years. Modern society doesn't always resemble what the forces of natural selection act upon anyway.
> What are you arguing for here?
The same as the thread starter, only with a focus on women since they get the short end of the stick in this aspect (in media).
Except this seems like a direct result of natural selection, because older men can still pass on their genes. Older women can not as readily pass them on.
Progressively fewer men 40+ want kids.
We are by nature dopamine machines, and will try to hit it as long as possible.
Well, like I said, this is a result of it when it no longer matters. For reference, we're talking about 60+ year old men.
And, like I also said, modern humans and our society don't reflect natural selection anyway; many things we do are "unnatural".
> modern humans and our society don't reflect natural selection anyway; many things we do are "unnatural".
That's simply not true. Don't get hung up on the word "natural". It's nothing more than the result of a biased random walk (at least until the eugenicists get involved, at which point it goes meta).
Some of the things selected for can get pretty abstract. Cooperative behavior for example. Despite often being to the short term detriment of the individual it is observed in the wild.
I don't think it's false. The forces at play in modern society are no longer (alone) those of natural selection. This has been remarked on by people like Stephen Jay Gould. Society/culture evolves along different (faster) lines. We do a lot that makes no sense from the perspective of natural selection.
Yes, that was exactly my point. The edge case is the potential for the selected behavior to work against reproductive fitness - someone young finding someone old attractive even though they aren't likely to get good offspring out of it.
I'm still not clear what you're arguing for. It isn't media giving women the short end of the stick, it's biology. What exactly are you proposing be done about it? I'm not even clear why it's a problem aside from the general desire that scientific advancement should eventually cure us of age related phenomena entirely.
Well, it's a problem for actresses for example.
Men season, while women age - The media's portrayal of desirability of old people is a reflection of societal preferences, not the other way around.
Men become wiser, skilled, kinder, more patient and often better providers. Women tend to become argumentative, quarrelsome, bitter (especially those who date often) and rewarded for it. They also tend to dissociate love from sex and manipulate one for the other.
I hope your second paragraph is not what you truly believe, but that you're describing a regrettable stereotype.
There would appear to be two poles of explanation - that either the media is reflecting desires and not influencing it, or that the media is influencing desires and not reflecting them - or somewhere in-between.
The reflection of biological reality appears easier to justify: that men remain fertile for longer, that the attractive qualities that women care about most (e.g. wealth and personality) tend to improve with age; and that a women's attractiveness is most tied to her skin, which we all know shows aging the most on the body, and is a sign of her reproductive health or ability.
I'm not sure what the argument for the media being able to influence males to the extent suggested would be? Older men were marrying younger women before the printing press, so where did this pressure originate? And what is its mechanism of action?
I'm not saying media is influencing this; this preference clearly showed before media! The media here clearly reflects a preexisting preference, but in my opinion, it also makes the world worse for old people, especially women and actresses.
I'm saying media could be changed from this tendency, since this preference is less relevant in modern society and it hurts actresses. Media is a human construct that can be adapted to new needs, it's not a tool of natural selection!
Changing media wouldn't change the sexual preferences of men, and nowhere am I arguing this. It's like inclusivity in media -- is it ever going to eradicate racism? No, but it will make the world a tiny bit fairer.
I agree that falling back on "it's natural" can be a poor excuse, mainly because humans have the power and intellect (maybe not intelligence, but I digress) to change even what is considered nature, but I'm also not for social engineering, and I've seen such a wild increase in social engineering in media over the past 15, maybe 20 years, that I'd err on the naturalistic side now.
Exactly - there's no female equivalent of "silver fox."
The kids call them cougars or MILF’s
Even they have an earlier "expiration" date than men in cinema and TV. Women are considered sexy for a far shorter period of time.
With this specific example, if McGillis had spent as much time and money and effort on appearing young and attractive as Tom Cruise has, maybe she would have been back in her role as well.
Oh, agreed! But it seems that men can remain "viable love interests" as long as they keep their rugged good looks (yes, with cosmetic help, of course), but in women this takes a stronger requirement of looking youthful.
Uh, yes there is. Pretty sure there's even an acronym for it.
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.
> in less than 250 years
I don't dispute any of your points in general. But at the same time, it brings a nostalgic smile to my face to envision starting a 250-year project in 2025.
Someone needs to remain alive to provide, protect and raise the kids.
Evolution is still a thing at relatively short time periods.
Icelanders are a well-studied population when it comes to genetics. Frequency of some traits meaningfully changed among them in last 100 years.
Source: this book: https://www.amazon.de/dp/0198821263?ref_=pe_109184651_110380...
Also the moths that "changed" from white to black during and because of the industrial revolution. That was quick, and to me, the best example of how it all works.
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.
Dawkins suggested this might be viable (In an abstract; not politically practical) way in The Selfish Gene.
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.
Name of the novel?
It was one of Stephen Baxter's Xeelee series, I believe it was Ring.
Cool, yeah those are pretty good. :)
We engineered it culturally already. Lots of people delaying childbirth until late 30s, early 40s today, often resorting to expensive treatments.
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.
But the issue also causes male infertility, so that can’t be why it’s so prevalent. This is discussed in the article.
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.
And delaying childbearing decreases fertility probably more than anything.
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.
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”.
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.
Not exactly that. Menopause.
wouldn’t the intention be just to fix that as well
How do you "fix" menopause?
Because you can't for women.
> 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.
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.
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.
I think you missed the idea. Your explosive device could still come in handy though.
But you freeze the sperm at the peak of freshness. Then you wait and see how the donor does. If they live to a ripe old age without old age diseases, then go select their sperm. Otherwise, destroy it.
You can probably do this with eggs too. When a child is desired, select an egg and a sperm off the shelf, and there you go. Easy peasy. Your device ensures only munitions experts can procreate outside the system, and I think we'll need a lot of munitions experts in the ensuing generations.
I would think the end goal would be to remove the need for frozen sperm, which we can do once we verify that the 60+ year old donors are still producing healthy swimmers. No sense in going just halfway with the Brave New Worlding.
Sounds like the end of Dr. Strangelove.
Ms Atwood would like a word with you.
Mr Trump has also expressed his interest, especially if the women are very young.
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.
https://www.jstor.org/stable/2408423
> surface-to-air missile The one link I have at hand: https://devblogs.microsoft.com/oldnewthing/20180228-00/?p=98...
Both appendix and gallbladder are important. Check the diet for people with gallbladder resection.
I don't have a gallbladder. My diet is that I eat less fried foods and avoid certain dark syrups.
The gallbladder is not important for humans in the aggregate. The aorta, yes.
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?!
> 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.
For me it was mostly just a major psychological stressor because it happened at a young age. I felt like an old man at 20 years old.
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.
> 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.
Don't forget that hunter-gatherers rarely lived much beyond 30. Modern society isn't so bad :)
This is an incorrect generalization from average life expectancies that include incredibly high infant/childhood mortality.
The life expectancy cited by Wikipedia for the paleolithic is around 39 additional years for those surviving to 15.
https://en.wikipedia.org/wiki/Life_expectancy
Samson and Delilah would like to have a word with you. Also with Japanese Samurai. You loose your mythological power, leading to lost status, suicide, ...
This work by Gat and Gornish gives a great explanation for prostate enlargement. There's an article by Donaldson [1] that suggests a connection to vitamin K2:
A large study from 2014 by Nimptsch et al found a strong inverse correlation between intake of vitamin K2 and prostate cancer [2]. Dairy foods with K2 had the most effect (K2 is soluble in butterfat).
Vitamin K2 helps remove calcium from the elastin in artery and vein walls, reducing their stiffness. Donaldson hypothesizes that K2 improves venous flow, and hence might reduce the varicoceles that lead to too much free testosterone getting to the prostate and causing enlargement.
So eat more grass-fed butter, or take a K2 supplement. At worst, you might also improve your bone strength. At best, men might prevent prostate cancer.
1: DOI: 10.1016/j.mehy.2014.12.028
2: DOI: 10.1093/ajcn/87.4.985
I had my prostate removed six weeks ago due to Gleason 8 score cancer. The pathology revealed an aggressive cancer.
My prostate was not enlarged, my PSA at the end was 4.2. Only because my doctor was overly cautious about the slope of the PSA rise did he send me for an MRI starting the diagnosis. It remains to be seen if it escaped containment.
The point here is, I don’t think enlargement and cancer are that intertwined. Cancer happens for any number of reasons, pinning hope that it can be staved off by diet and vitamins seems to ignore tons of other environmental factors.
Wow, that sounds scary. I hope it doesn't come back. Weird about the 4.2 PSA; that wouldn't have raised alarms, normally. I guess acceleration is as important as absolute values.
I hope you'll be OK!
All the best. I had a check up for prostate cancer recently, and fortunately have been told I don't have it, but until that moment I felt the stress of wondering and worrying, so you have my sympathy.
I'm also glad you found a good doctor, the first I found did no checks at all. Told me I'm too young to have any problems (I'm definitely not) and sent me away with some herbal medicine and all that stress I mentioned. The second doctor I found was thorough and reassuring, and shocked by the behaviour of the first.
Good article, but very weird to scroll to the bottom and see "(c) Norman Yarvin" at the bottom. Curtis Yarvin's brother wrote this. I don't have an opinion about that, I just find it strange.
I merely saw the domain name 'yarchive' and had a strange inkling that there might be a connection. A quick search yielded this: https://unlimitedhangout.com/2021/08/investigative-reports/t....
I have no opinion of unlimitedhangout.com or the veracity of that article. But in response to "I just find it strange", I'm beginning to associate this sort of intensely intellectual inquiry into disparate topics with equally intense political positions.
I was first introduced to Urbit as if it was a purely technical, humorous and extremely nerdy lark. It was a joke thing my friend got me to sign up for, to own a slice of an imaginary universe (in a quantity called a "frigate" or whatever it was). When I learned years later about how serious the worldview behind it was, I was quite shocked.
Since then, and especially since the NYT outing of Scott Alexander in 2020, I've become more attuned to the pattern. These hyper-analytical blogs often come with a lot of political implications below the surface.
Again, I'm not taking sides here. If anything, the takeaway for me is that the world is very complicated. We have these rare polymath personalities who go deep into topics, have a strong voice on the internet, and they end up with all sorts of valid criticisms of the status quo. This in turn can align with extreme political views.
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?
I am an interventional radiologist. I’ve done procedures to embolize the prostate (helps shrink it), and gonadal vein embolization (for varices).
The gonadal veins are in a different vascular territory from the prostate. The prostates vascular territory is the anterior division of the internal iliac. The gonadal veins arise directly from the inferior vena cava.
I had not come across this research before it’s interesting because as mentioned above, these organs are in different vascular territories but when venous structures begin to reflux the blood may find other collateral routes through other territories.
I skeptical that this works, but it is really interesting.
Based on the proposed mechanism, that would still leave the testicles with low oxygenation blood.
That makes sense to me too. Why wouldn't that be an option or is not really just a small vein between the two, but a bunch of "blood vessels"?
>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.
Interestingly, daily masturbation appears to have a protective effect against developing prostate cancer, although no one knows why: https://www.webmd.com/prostate-cancer/ejaculation-prostate-c...
From your own link:
> There’s no proof that ejaculating more actually lowers the chances of prostate cancer. For now, doctors just know they’re connected. It may be that men who do it more tend to have other healthy habits that are lowering their odds.
> Ejaculation doesn’t seem to protect against the most deadly or advanced types of prostate cancer. Experts don’t know why.
I'm not the expert but, like all things, exercise, sleep and diet probably goes a long way.
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-...
Thank you! Didn't know I endangered people by suggesting it to them.
I usually got bored halfway and after 3-6 breaths finished peeing normally. It was also because I've noticed that the exercise made it very hard to push out the last of urine from the bladder. Now I know it's also very unhealthy not to empty all the way.
As with any internet post about exercise, someone must eventually come along and mention the good old weighted squat. Squats are well known to strengthen pelvic floor.
My own anecdata confirms the benefits of pelvic floor exercises without any kegels, at least back when I regularly did lift weights.
But is stopping the flow of urine an apt description of the exercise? Is it a case of “do it as if you were doing that, without actually doing it while urinating?” If so, I think I’d be hard pressed to find a simpler way to describe it to any man (no idea if it applies to women as well).
Yes, and you also want to do fast and short Kegel's in different positions.
> 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.
I also recommend the Seek app by iNaturalist. Though if you’re like me and use it to identify plants and every bug you see, you may not actually get that much walking accomplished.
My wife and I have a running joke about the Seek app: "Dicots. It's always dicots."
Too often, pointing Seek at a plant results in "dicots", which is about half the flowering plants out there.
I feel like seek's IDs are not as good as they should be given the state of ML. Maybe a dataset problem but still.
Season likely plays a factor too. There are many plants that more or less look identical (to the untrained eye) until they either bloom or grow large enough.
true. it is also pretty bad at IDing things that are half-formed, eg a bud that hasn't bloomed yet, presumably because most photos in the dataset are of the blooming version.
+1 Merlin. I also stop and do a few minutes with Duolingo in the park, then take a breath and just listen to the wind and birdsong.
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.
You could try white/pink/grey noise on the headphones, or a binaural beat generator (I use the brainwave app on iOS).
I find thunderstorm noises superior to white/coloured noise - because it's a natural sound the brain filters it out, and obtrustive noises are camouflaged within it, and filtered out too. So the loudness required is less than the loudness needed for white/coloured noise to be effective.
All truly great thoughts are conceived by walking.
-Friedrich Nietzsche
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.
>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.
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
That's pretty much textbook why exercise on its own will not reduce weight. You need to control your intake as well.
There is some evidence that we offset all that activity later in the day. I know that if I go for a long bike ride then I will inevitably veg out in front of the TV later.
Exercise is important but it's not because of the burning of calories.
This is anecdotal as it gets, but I've developed prostate issues almost simultaneously with quitting photography. Didn't think about it until now.
I often listen to podcasts while walking. Or I think. I also own a walking pad and walk while working (1h in the morning, 1h in the afternoon - not every day but most).
Podcasts help me with the boringness.
I find walking very enjoyable.
I do a lot of daydreaming when I walk, too (to my wife and daughter's impatience!).
You must have been in really bad shape before if you're getting such noticeable health benefits from a rather modest exercise intervention like 8k steps.
My average over the last year is ~13K steps a day. But I am usually not bored when walking, I enjoy it, in fact. So it is not a burden.
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.
Not quite. Focusing on your anus when clenching is a good way to develop hemorrhoids.
Different muscles, but you need practice to learn to control them independently.
Can't I just do kegels when I'm sitting or standing? It's not like they're obvious or take much effort, and the result should be about the same, no?
I think people give the cue of stopping urination to help others find the muscles that you need to engage. Otherwise, yes, you absolutely can just do them any time you want. In yoga it’s called mula bandha [1]. You’re often instructed to engage it while practicing asana or pranayama. I even focus on engaging it when I’m out for a run or lifting weights.
[1] https://en.m.wikipedia.org/wiki/Bandha_(yoga)#Mula_bandha
Thanks, I think I'll practice whole brushing my teeth, probably the easiest to not forget to do, as it's an everyday thing that I'm unlikely to ever stop doing.
BTW beware of snoozing or coughing while you're holding yourself.
Is there a name for this technique? Interested to research the why behind it.
Kegel exercise
https://en.wikipedia.org/wiki/Kegel_exercise
Wow, I was so sure it was PC or PV muscle exercise, because author of the book where I learned about the peeing exercise said that men don't have Kegels muscles. I stand corrected.
Kegel?
> 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
citation needed.
Thank you.
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
Love the writing-style. Quite "to-the-point", without any fluff, and with a nice flow and purpose.
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.
Research and subsequently clinical testing is expensive so you have to acquire capital, usually from grant providers or working with private industry. Grant providers tend to be conservative and risk-averse so that means individuals with new ideas often won't be able to explore them until later in their career. Private industry is less risk averse but will only fund research if it has the potential to bring a patentable product to market before the parent expires.
Even once you have funding secured, the regulatory approval process is long and requires hundreds of pages of documentation, reporting, and compliance. Then you have to get insurance to cover it, which can require a procedural code being generated for it by the AMA and requires convincing insurers it's worth it, particularly Medicare in the US which other insurers take their cues from. And even once a procedure is approved and a patient can get it paid for, you still have inertia from human physicians who have been trained to perform certain kinds of treatments and not others.
If safety regulations are really such a high barrier, then explain why this passed them:
https://news.ycombinator.com/item?id=15834006
Safety regulations were just one of the many hurdles in the pipeline from idea to therapy.
But to answer your question, that uterus transplantation was (a) an experimental therapy overseen by an IRB to treat a diagnosed medical condition, (b) almost certainly funded by grants acquired by Baylor and not insurance, and (c) the therapy is still in clinical testing and not available to indicated patients today in 2025, 8 years later, unless they are part of a clinical study, which demonstrates how lengthy the process is.
Surgeries aren't regulated in the same way that drugs are, though. AFAIK the bureaucratic threshold for experimental surgeries is much lower.
You're entirely correct. I was trying to speak about medical therapies generally but the FDA doesn't regulate surgical techniques. Some new surgical techniques do require experimental medical devices which would require FDA approval though. And you still have to deal with the bureaucratic hurdles of acquiring grants for clinical trials and getting insurers to cover treatments of course, but it's certainly a lower barrier.
What about the Breakthrough Device Designation or the Investigational Device Exemption?
We require heavy burdens of proof before we subject tens of thousands of people to potentially needless surgeries.
And this area of human interest has been (and is) prone to abuse from unscrupulous individuals/organizations. Rigorous regulation prevents much of that as well.
I’m glad we’re starting to talk about the prostate because I feel like for a long time. Men have been reluctant to talk about this more and more in society. I feel like women have their fair share problems as they get older, but men have equal amount of problems too we just don’t like to talk about it.
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.
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.
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.
Serum DHT is not useful at all.
Just buy a razor.
Let go.
Telling people to sui is not very nice. (/s)
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.
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.
Hi - there is no official diagnosis for "PFS". I have it in the sense that I have penile tissue scarring confirmed by medical imaging, with a urologist's opinion that finasteride was the likely cause. Yes, tadalafil does often help in my case, but the reduction in function is permanent and I doubt I will ever be my pre-finasteride self again.
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.
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
Yes, you must be confusing Sildenafil and Tadalafil. I'm also in the EU and Tadalafil is prescribed for daily use here.
Fascinating. I wonder what are the consequences of long term zero gravity flight for this.
Very interesting article. Well-explained.
Just take finasteride. As a nice side effect, you won’t go bald.
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 wish we all could agree on a terminology where taking a pill daily is management, not a cure.
A cure should be a one-off measure after which one stays cured. If not forever then at least for years.
Something that needs to be repeated, esp. daily, should have a different word. That’s not a cure.
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.
> Multiple surgeries is not sustainable. Too much uncertainty
I'm not sure where this is coming from. Multiple cardiac bypasses have a ton of uncertainty, but they are effective because efficacy is measured by quality of life * increased lifespan.
Multiple surgeries (the time it takes to regrow major veins from capillaries that aren't blocked off) to relatively non-lethal parts of the body seems very sustainable for a human lifespan after 60 or 55 or whatever.
> 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.
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
There is a reason we are smart enough to develop finasteride and dutasteride that are extremely effective and safe¹ instead of relying on plants & herbs which are just weak versions of taking a drug anyway.
¹ the science is sound, the safety is absolutely a guarantee. There is a group of about 10 individuals who have spent their entire life spreading their neurological issues and obsession with fake reports and exaggerations of the harmful made-up side effects that cannot be repeated in any study whatsoever anywhere..
I actually could not believe the other day that they are still active and have managed to cause the FDA to issue a guidance that there might be higher side effect rates than otherwise were reported .
It's actually ridiculous, and every news article and study about it are almost entirely mentioning people who's just start believing in their heads that they have side effects when they actually don't. And yet the news articles took this as evidence of a story that has been hidden or something .
I really thought that those 10 or so individuals who you used to be able to read their forum posts back in 2006 when they tried to tell every young guy in the world not to take it for hair loss would have fizzled out by now.
Finasteride does seem to be able to cause some issues. It seems that DHT has many protective roles in the body and limiting it may cause problems: https://pmc.ncbi.nlm.nih.gov/articles/PMC7308241/
Finasteride was discovered because of a tribe in south america with a high frequency of a mutant allele in the gene responsible for protein that converts T to DHT. They had no BPH. This led to the search for a competitive inhibitor of that enzyme.While under patent it was extremely lucrative to big pharma. The incentives of fame and greed will continue to plague our civilization as long as we embrace aggregating structures like corporations, advertising, social media, and instant worldwide communication to amplify human traits that were useful in small scale tribes.
For more insight into "all" this prostate trouble watch the film "Oslo: Love" currently in some cinemas.
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.
I really do think AI will be key here. It's critical to accelerate towards ASI as quickly as possible.
i am curious to know can we plan a better vein system and somehow "implement" it
Fantastically well written article. I read the entire thing in one go with my tiny attention span and learned about an interesting possible procedure.
Did no one check the base website (yarchive.net)?
He's archived a mindbogglingly large number of usenet posts, each being extremely high signal
This is incredible.
> The theory here is largely mechanical; and it’s not just psychiatrists like Scott who are weak at mechanical explanations; it’s doctors in general as well as medical researchers and biologists.
A tangent here, about not just "mechanical" explanations, but "mechanical" treatments —
IMHO, the insistence in modern medicine on treating recurrent bacterial infections purely with antibiotics is wrongheaded, and the cause of a lot of resistant strains of bacteria. Especially for topical/mucosal/epithelial infections, where the infected tissue is accessible without invasive surgery.
In a recurrent bacterial infection, the reservoir of the infection is one or more (almost always macro-scale) biofilms or plaques. And antibiotics just don't do much to biofilms/plaques. (If they could, you could spray Lysol on the walls of an under-ventilated shower that's developed "pink slime" biofilms — and all the slime would dissolve, or detach and run down the drain. But it doesn't do that, does it?)
Even if you kill most of the bacteria, the biofilm itself — the "fortress" of polymerized sugars which the bacterial cells have secreted to secure their position — is not destroyed by antimicrobal compounds. And the few bacteria that remain have a great position to regrow from.
What does work to clean a slimy shower wall?
Scrubbing. Scraping. Peeling. Together with targeted chemicals, that 1. get water out of the polymer (because these biofilm surface polymers are often lubricative when wet, and thus resistant to abrasion — but this effect breaks down when dry), and 2. rough up the surface of the biofilm/plaque a bit, to get a better grip on it.
Biofilms and plaques adhere to themselves — so, when you can break the biofilm or plaque into chunks, you can then get entire chunks out. (And also, by removing chunks, you create paths for antimicrobials to then get past the biofilm surface polymer. You're breaching the fortress.)
If you picture a strep-throat infection — spots on the tonsils and on the throat, etc — those spots aren't a symptom; they are "the enemy" you're trying to fight. Remove them — mechanically! — and you go from using antibiotics (picture tiny cellular infantrymen) to effectively "fight a war of attrition against an enemy with a secure position", to "a defeat in detail of an enemy with nowhere to hide."
---
Interestingly, there are certain medical specialties that think mechanically about infection.
• Dentists, obviously, know that you must abraid dental plaque away. There's no chemical that you can put in your mouth every day that will keep plaque from forming, or reduce it once it has formed. (In fact, ironically, antimicrobial oral rinses [of e.g. chlorhexidine] accelerate plaque formation, because bacterial cells killed "in place" inside their biofilm fortresses will deposit and enrich the surface polymer layer of the biofilm — much as dead sea creatures deposit and enrich limestone sediment.)
• Audiologists know that there's ultimately nothing you can do with drugs or topical treatments to get an ear clear of wax+fat+dust+anything else trapped in there. You have to go digging. Chemicals can soften the wax, to make it easier to remove; but, due to the shape of the ear, and the lack of ability to "come in from behind" (there's an eardrum in the way!), the softened wax will never come out on its own.
• Dermatologists know that a cyst can't just be drained + treated with antibiotics. The body forms a defensive pocket around a cyst — but the inside surface of this pocket ironically provides the perfect medium for a biofilm to grow on, and thus for an infection to recur after drainage. Cysts are only considered well-treated if the pocket itself is removed — thus removing the biofilm.
...and yet, when you look at most other disciplines, you see completely the opposite.
• An ENT is very much not willing to abraid biofilms out of your sinuses or throat "if they can help it", despite those surfaces being accessible to an endoscope without breaking past any barriers. They will always try first to treat "pharmacodynamically", with e.g. oral antibiotics + an antimicrobial sinus rinse — presumably in the hopes that you'll accidentally do something mechanically in the process of treatment (e.g. snorting really hard to get the remnants of the rinse out) that will dislodge the biofilm. You have to go through years of back-and-forth with an ENT before they'll actually bother to look further up inside your sinuses than they can see with an otoscope/anterior rhinoscope. (And IMHO this is why so many people suffer from idiopathic chronic sinusitis, developing into nasal polyps et al. Nobody's ever been willing to go deep up their nose with an endoscope, find impacted biofilm plaques, and say "alright, let's clear those out.")
• Kidney stones, once symptomatic, are treated ultrasonically (lithotripsy); but the thinking on follow-up prevention is entirely about preventing accretion — not in removing the cause. [In many cases, the cause of (struvite or apatite) kidney and/or urinary stones, is very likely a bacterial biofilm within the kidney, spalling off bits of biofilm, which denature into plaques after exposure to the harsh pH of the kidney/uterer/bladder; get caught on some tissue; and then act as nucleation sites for mineralization (stone formation) as dissolved minerals pass through.] Once someone gets one kidney stone, they are generally thought to just be "prone to kidney stones", and will likely get them randomly for the rest of their life. A lot like the old — pre-infectious-origin — thinking that someone can be "prone to peptic ulcers"!
Here is my pet theory, it's not intended to be political, just thinking about evolutionary biology.
There is an optimum lifespan for peak evolutionary population fitness in any group of organisms. Too short a lifespan means not enough time to gather resources and reproduce. Too long a lifespan could mean competing with future generations for scarce resources, which might in theory marginally improve individual fitness, but in the aggregate decreases overall population fitness, and is therefore not selected for.
Over billions of years, organisms evolved built-in control mechanisms to ensure that they live/survive for the optimum amount of time. The evolution of these mechanisms is driven in part by the fact that an older organism under stress being eliminated from the environment will probably improve the population fitness of close relatives.
I believe this is what cancer is. It's one of many, many built-in mechanisms, reinforced by hundreds of millions of years of evolution, to kill us off when our time has come.
So, if there are tons and tons of evolved mechanisms that exist just to knock you out when your time has come. That is the ultimate reason why men die from heart attacks: they have evolved in past generations that if they have extreme exertion at an advanced age, it's an indication that they aren't contributing to population fitness in a useful manner, and that extreme exertion would be more efficiently done by younger individuals. At an old age, they should be at the top of the food chain, guiding and educating and valued and lazy and consuming, and if they are not, better for the tribe for them to die quickly than lingering on.
And there is hope. If we can eliminate stress from our lives, we send a signal to our bodies that we will improve population fitness by continuing to exist, and our bodies may reward us. That's a big reason for longer lifespans. Better diet and moderate exercise is great for sure, but less stress makes a big difference.
But this is only one of a multitude of dynamics that is happening in the complicated system that is the existence of life, and is not necessarily a dominant dynamic.
For prostate cancer, you might get around it temporarily, but something else will get you. Lifestyle changes, medication, placebo and other interventions that reduce stress probably have a better overall shot at increasing your lifespan than any single magic bullet.
I suspect that prostate cancer has to do with being old and not having sex, if you're an older male. An older male who doesn't have sex would have lower individual fitness than an older male who does have sex, and would be competing for resources with younger individuals who might have higher evolutionary fitness. So, there's another solution to prostate cancer that doesn't involve surgery (or even necessarily having sex), I think I read another article that mentioned that, I won't spell it out.
Given that breast cancer happens more to women who have not breastfed after carrying to full term (citation needed), you can draw a parallel. Females who are decreasing population fitness by not having children, and by extension have lower individual fitness, breast cancer and ovarian cancer are some of the main mechanisms. They also think that breastfeeding reduces the risk of breast cancer. Certainly, even females that don't reproduce, but still breastfeed, probably improve population fitness, even if they don't have good individual fitness.
Not to be antagonistic to your theory, I think you might find this alternative theory thought-provoking: https://osf.io/preprints/osf/smzc4_v1
I read this with great interest, because about a decade ago, I was convinced I had prostatitis (but NHS screwed the diagnostic process up - the GP didn't do a digital rectal exam because the ultrasound would be more diagnostic anyway, and the ultrasound scan was cancelled because the GP didn't do a digital rectal exam which was part of the criteria for going through with the scan ¯\_(ツ)_/¯ ), and ended up reading quite a bit about it, and how I might try to make things better for myself in the absence of antibiotics.
I ended up on this page which I no longer remember (something something prostatitis foundation maybe?), from which I remember two things.
The first was this turkish doctor, who against all advice was suggesting a "Brocolli juice therapy" as a prostatitis cure. Fast forward to 2025 and there's lots of studies supporting this. Anecdotally I tried this back then and it really helped the prostate pain I had at the time for months go away within a week.
The second, which is more relevant here, was this guy who had a very interesting hypothesis, that a lot of the prostate troubles are actually "musculoskeletal" in origin, and muscle imbalance / weakness of the iliopsoas muscles in particular. And that this imbalance affects venous return which "somehow" causes the condition. But he was just a lay person, and the "somehow" was unclear. So this completes that image perfectly. It's interesting that this article mentions the venous insufficiency link, and that veins rely on valves to direct flow, but doesn't mention the muscular link at all.
In any case, this person was saying that in his case, doing lots of iliopsoas stretching and exercises effectively 'fixed' his chronic prostatitis problems. So I've timidly started including a couple of iliopsoas stretching exercises before any workout I do. Anecdotally, I think it helps, but I can't know for sure. But thought I'd mention here in case someone shows interest or can make that link more solid.
PS. found the turkish doctor page (or at least a mirror of it): https://www.oocities.org/iastr/ebroc.htm
I wish I could find that comment about the iliopsoas ... but alas I think it's probably lost in the sands of time now.
UPDATE: Well what do you know. Found it: https://web.archive.org/web/20230203201759/https://prostatit...
(and https://web.archive.org/web/20230127101206/https://prostatit... more generally)
It also seems to me that a lot of “prostatis” cases have nothing one to do with bacterial infection but rather pelvic floor issues or is referred pain from spinal issues.
Men’s medicine is in the dark ages.
What exactly does the broccoli do? And why does it have to be boiled? I didn't get many details from the page above.
There have been many studies since, which probably provide more evidence and detail. But this guy's current explanation at the time is provided in the link where it says "needs to be boiled" (https://www.oocities.org/iastr/eboil.htm)
Quoting from the linked page:
> WHAT IS THE REASON THAT WE MUST CONSUME BOILED BROCCOLI?
> Fresh broccoli (unboiled) contains some enzymes that must be deactivated. The simple way to deactivate these enzymes is to boil the broccoli in water for 5 minutes. After boiling for 5 minutes, the enzymes will become inactive. If these enzymes aren't deactivated, the broccoli cannot successfully treat those suffering from BPH, prostatitis, or general urinary tract infections.
> Broccoli contains very important compounds. These compounds can only treat those who are suffering from BPH or prostatitis when these enzymes are deactivated. If this is not done, the enzymes which broccoli contains start a different metabolic reaction so that the efficiency is reduced.
Unmentioned is the significance of dietary modificatioon. In one study, Japanese men had 10% of the incidience of problematic bph as americans. The offspring of the japanese in Hawaii had half the iincidence. The second generation had no difference. The analysis suggested that phytoestrogens in tofu, tempeh,etc are responsible of prostatic involution.
Animal fat contains elevated levels of lipid soluble hormones and diets high in fat (meat) are associated w bph as well as elevated risk of prostate ca.
Finally, this craze of T replacement is greatly increasing the risk of symptomatic bph (along with other cardiovascular risk factors)
> Finally, this craze of T replacement is greatly increasing the risk of symptomatic bph (along with other cardiovascular risk factors)
TRT does not increase the risk of BPH; this is discussed in the article, along with a hypothetical mechanism. Nor does TRT seem to have CVD risk.
> craze of T replacement
Please explain how it's a "craze".
T levels and sperm count are tanking. Possibly from micro plastics.
This article is literally the definition of TL;DR. It's fairly hard to get thru, I spaced and skipped the conclusion, that the treatment isn't permanent and can be undone.
I was interested through the first 20-25 paragraphs, and then the thing just kept going and going and going. It would have been fine, though, if it had some sub-headings and stuff to help guide one through.
TL;DR: Very likely not.
I’ve been reading till…I don’t know 40% of the article? Is there some sort of conclusion besides surgery?
Not a surgical procedure. It's catheter access to the spermatic veins.