[HN Gopher] An end to all this prostate trouble?
       ___________________________________________________________________
        
       An end to all this prostate trouble?
        
       Author : bondarchuk
       Score  : 750 points
       Date   : 2025-04-26 08:39 UTC (1 days ago)
        
 (HTM) web link (yarchive.net)
 (TXT) w3m dump (yarchive.net)
        
       | marvel_boy wrote:
       | So there is a cure for BPH?
        
         | cs02rm0 wrote:
         | 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.
        
           | cactusplant7374 wrote:
           | > 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.
        
             | kevin_thibedeau wrote:
             | > 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?
        
             | Supermancho wrote:
             | > 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.
        
         | gavinray wrote:
         | 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.
        
           | amelius wrote:
           | I've heard a theory that baldness is related to tension in
           | the scalp, which apparently is more prevalent in men.
        
           | hamstergene wrote:
           | 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.
        
         | ekianjo wrote:
         | Not a cure but Tadalafil works very well as a treatment.
        
           | fredsmith219 wrote:
           | It does. I suffer for almost 20 hours of I miss a dose. I'm
           | very sure that doesn't happen.
        
       | smitty1e wrote:
       | > 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.
        
         | forinti wrote:
         | There's also your back, your joints, your teeth, GERD.
         | Everything starts getting flimsy in your late forties.
        
           | Traubenfuchs wrote:
           | 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.
        
             | lostlogin wrote:
             | Older fathers increase the chance of autism, schizophrenia
             | et al.
             | 
             | https://en.m.wikipedia.org/wiki/Paternal_age_effect
        
               | meindnoch wrote:
               | Obviously you would use sperm harvested while they were
               | still young, and kept frozen for 60 years.
        
               | MyPasswordSucks wrote:
               | 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.
        
               | toast0 wrote:
               | 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.
        
               | MyPasswordSucks wrote:
               | 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.
        
             | genghisjahn wrote:
             | Sounds like the end of Dr. Strangelove.
        
             | subscribed wrote:
             | Ms Atwood would like a word with you.
             | 
             | Mr Trump has also expressed his interest, especially if the
             | women are very young.
        
         | Eliezer wrote:
         | Poor eyesight is evolutionarily recent (not enough sunlight
         | exposure in childhood, rare to find in hunter-gatherer
         | societies). Baldness won't kill you.
        
           | cogman10 wrote:
           | > 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.
        
             | Traubenfuchs wrote:
             | https://pmc.ncbi.nlm.nih.gov/articles/PMC6678505/
        
               | cogman10 wrote:
               | 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.
        
           | wkat4242 wrote:
           | Don't forget that hunter-gatherers rarely lived much beyond
           | 30. Modern society isn't so bad :)
        
             | abathur wrote:
             | 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
        
           | MyPasswordSucks wrote:
           | 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.
        
           | rurban wrote:
           | 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, ...
        
         | gavinray wrote:
         | > It's odd for there to be such an easily-removable design flaw
         | in the human body; evolution tends to remove them.
         | 
         | Your appendix and gallbladder would like a word with you ;^)
        
           | lostlogin wrote:
           | Wisdom teeth too.
        
             | tazjin wrote:
             | And tonsils!
        
               | gavinray wrote:
               | Speaking of, I had my tonsils and adenoids removed as a
               | child due to chronic ear infections.
               | 
               | What's up with those things?!
        
             | davidmurdoch wrote:
             | 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.
        
           | Qem wrote:
           | Also the intakes for trachea and esophagus being close to
           | each other, causing chokes.
        
           | subscribed wrote:
           | Both appendix and gallbladder are important. Check the diet
           | for people with gallbladder resection.
        
             | Supermancho wrote:
             | 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.
        
         | cogman10 wrote:
         | 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.
        
         | freddie_mercury wrote:
         | 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."
        
           | smitty1e wrote:
           | 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.
        
         | jansan wrote:
         | > 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.
        
           | AuryGlenz wrote:
           | Most people find it less attractive. Usually things that
           | happen when you age are viewed that way, which makes sense,
           | evolutionarily.
        
             | bladley wrote:
             | 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.
        
         | meindnoch wrote:
         | 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.
        
           | ownlife wrote:
           | https://www.jstor.org/stable/2408423
        
         | jasonthorsness wrote:
         | > surface-to-air missile The one link I have at hand:
         | https://devblogs.microsoft.com/oldnewthing/20180228-00/?p=98...
        
       | blainm wrote:
       | 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.
        
         | mattigames wrote:
         | We lucked out compared to other species, octopus develop
         | dementia soon after breeding.
        
           | amelius wrote:
           | 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.
        
             | 7thaccount wrote:
             | Isn't that usually only in captivity where it can't escape?
        
         | card_zero wrote:
         | 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_
        
           | throwuxiytayq wrote:
           | 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.
        
             | literalAardvark wrote:
             | 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.
        
               | giantg2 wrote:
               | 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.
        
               | tomrod wrote:
               | That in of itself is an external selection pressure
               | though, having enough fit to gather resources to delay
               | reproduction.
        
               | throwuxiytayq wrote:
               | > 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.
        
             | tomrod wrote:
             | Someone needs to remain alive to provide, protect and raise
             | the kids.
        
             | inglor_cz wrote:
             | 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...
        
               | genewitch wrote:
               | 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.
        
           | Workaccount2 wrote:
           | 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!
        
             | the_af wrote:
             | 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.
        
               | Spooky23 wrote:
               | 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.
        
               | fc417fc802 wrote:
               | This all makes perfect sense from a fertility (and thus
               | natural selection) perspective.
        
               | the_af wrote:
               | 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?
        
               | fc417fc802 wrote:
               | > 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?
        
               | the_af wrote:
               | > _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).
        
               | hattmall wrote:
               | 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.
        
               | the_af wrote:
               | 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".
        
               | fc417fc802 wrote:
               | > 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.
        
               | the_af wrote:
               | 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.
        
               | fc417fc802 wrote:
               | 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.
        
               | the_af wrote:
               | Well, it's a problem for actresses for example.
        
               | ccakes wrote:
               | 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
        
               | astura wrote:
               | Exactly - there's no female equivalent of "silver fox."
        
               | rpmisms wrote:
               | Uh, yes there is. Pretty sure there's even an acronym for
               | it.
        
               | notesinthefield wrote:
               | The kids call them cougars or MILF's
        
               | the_af wrote:
               | Even they have an earlier "expiration" date than men in
               | cinema and TV. Women are considered sexy for a far
               | shorter period of time.
        
               | bear141 wrote:
               | 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.
        
               | the_af wrote:
               | 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.
        
               | brigandish wrote:
               | 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?
        
               | the_af wrote:
               | 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.
        
               | FilosofumRex wrote:
               | 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.
        
               | the_af wrote:
               | I hope your second paragraph is not what you truly
               | believe, but that you're describing a regrettable
               | stereotype.
        
           | halgir wrote:
           | 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.
        
           | the__alchemist wrote:
           | Dawkins suggested this might be viable (In an abstract; not
           | politically practical) way in _The Selfish Gene_.
        
           | wkat4242 wrote:
           | 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.
        
             | derektank wrote:
             | 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.
        
           | pavel_lishin wrote:
           | 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.
        
             | justinclift wrote:
             | Name of the novel?
        
               | pavel_lishin wrote:
               | It was one of Stephen Baxter's Xeelee series, I believe
               | it was Ring.
        
           | Qem wrote:
           | We engineered it culturally already. Lots of people delaying
           | childbirth until late 30s, early 40s today, often resorting
           | to expensive treatments.
        
           | magicalhippo wrote:
           | 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.
        
         | nonethewiser wrote:
         | So widen the reproductive age (men only)
        
           | hhh wrote:
           | Why men only?
        
             | ix101 wrote:
             | I think OP was alluding to the fact that risks of
             | complications with pregnancy increases with age.
        
               | hhh wrote:
               | wouldn't the intention be just to fix that as well
        
               | nonethewiser wrote:
               | How do you "fix" menopause?
        
               | nonethewiser wrote:
               | Not exactly that. Menopause.
        
             | nonethewiser wrote:
             | Because you can't for women.
        
         | yapyap wrote:
         | what? so are you implying that prostate dysfunction makes you
         | less wanted as a father if it presents itself in "the
         | reproductive age"?
        
           | rubyfan wrote:
           | I read the comment as insinuating people stop taking care of
           | themselves as much after children and develop unhealthy
           | habits.
        
             | trollied wrote:
             | 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".
        
         | jbd0 wrote:
         | Shouldn't kids with grandfathers have an evolutionary
         | advantage?
        
           | natebc wrote:
           | when humans were still primarily subjected to natural
           | selection the life expectancy likely wouldn't have allowed
           | for many grandfathers.
        
             | Sharlin wrote:
             | 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.
        
               | nkrisc wrote:
               | 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.
        
             | readthenotes1 wrote:
             | Iirc, historically, if you made it to 10 years of age, most
             | humans make it to 60
        
               | inglor_cz wrote:
               | 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.
        
           | bmicraft wrote:
           | They didn't say drops to zero, but the advantage is obviously
           | more limited
        
           | georgeburdell wrote:
           | 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
        
             | mensetmanusman wrote:
             | Two working parents have far below replacement numbers of
             | children, so it would actually cause it to disappear...
        
           | const_cast wrote:
           | Probably barely, and I think in some instances the opposite.
           | You have to care for the elderly.
        
           | Izikiel43 wrote:
           | 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.
        
             | saagarjha wrote:
             | No, plenty of people made it to that age in the past. Life
             | expectancy was significantly depressed by infant mortality.
        
               | Izikiel43 wrote:
               | > in the past
               | 
               | What's "in the past" here? Last 200 years? 500? 1000? In
               | evolutionary scale, those numbers are a blip.
        
           | me_again wrote:
           | 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. h
           | ttps://royalsocietypublishing.org/doi/pdf/10.1098/rspb.2007..
           | .
        
         | lukas099 wrote:
         | But the issue also causes male infertility, so that can't be
         | why it's so prevalent. This is discussed in the article.
        
           | wazoox wrote:
           | Male infertility after 60 is probably not very impactful from
           | a selective point of view. For 300 000 years, almost nobody
           | reached 60 anyway.
        
             | Qem wrote:
             | Before. Now people are delaying childbearing. Anedacta,
             | past year one of my work colleagues had its first child, at
             | 62.
        
               | PKop wrote:
               | And delaying childbearing decreases fertility probably
               | more than anything.
        
           | MyPasswordSucks wrote:
           | 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.
        
       | Traubenfuchs wrote:
       | 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.
        
         | formerly_proven wrote:
         | 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.
        
           | Traubenfuchs wrote:
           | > 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.
        
           | seethedeaduu wrote:
           | Serum DHT is not useful at all.
        
           | qmr wrote:
           | Just buy a razor.
           | 
           | Let go.
        
             | formerly_proven wrote:
             | Telling people to sui is not very nice. (/s)
        
         | manmal wrote:
         | I've been holding off on fin because of some people developing
         | post-fin syndrome. Is Tad addressing this hazard in your view?
        
           | Traubenfuchs wrote:
           | 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.
        
             | manmal wrote:
             | 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.
        
             | bladley wrote:
             | 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.
        
         | ta12653421 wrote:
         | 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.
        
           | Traubenfuchs wrote:
           | 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.
        
             | ta12653421 wrote:
             | 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
        
               | asdiovjdfi wrote:
               | Yes, you must be confusing Sildenafil and Tadalafil. I'm
               | also in the EU and Tadalafil is prescribed for daily use
               | here.
        
         | elric wrote:
         | 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.
        
         | teknico wrote:
         | 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.
        
       | elric wrote:
       | > 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).
        
         | eternauta3k wrote:
         | 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.
        
           | bshacklett wrote:
           | 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.
        
             | rendaw wrote:
             | Really? They just tell me it's stress, the prescribe me
             | chinese medicine just in case and send me away.
        
               | samssf wrote:
               | Damn, they just tell me I'm getting old and wish me luck.
        
             | malfist wrote:
             | If you don't like your doctor, go to someone else
        
               | BobbyTables2 wrote:
               | Indeed but a tiring and expensive game when it takes 4-5
               | tries with experienced specialists to get an actual
               | diagnosis.
        
               | roenxi wrote:
               | 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.
        
               | fwip wrote:
               | 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.
        
               | istjohn wrote:
               | 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/fullarti
               | cle...
        
               | pingou wrote:
               | 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.
        
               | roenxi wrote:
               | 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.
        
               | joshlemer wrote:
               | In some countries like Canada you basically don't have an
               | option.
        
           | BobbyTables2 wrote:
           | My primary care doctor doesn't even have an otoscope!
           | 
           | Have no idea how they have such good reviews.
        
           | tuatoru wrote:
           | 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.
        
         | quantumwoke wrote:
         | Women menstrual cycle tracking works off the same concept.
        
       | raffael_de wrote:
       | 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.
        
         | mr90210 wrote:
         | Thank you.
        
         | wafflemaker wrote:
         | 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.
        
           | anticodon wrote:
           | > 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.
        
             | beacon294 wrote:
             | 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
        
               | spookybones wrote:
               | 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.
        
               | dayjah wrote:
               | 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.
        
               | pegasus wrote:
               | You could try white/pink/grey noise on the headphones, or
               | a binaural beat generator (I use the brainwave app on
               | iOS).
        
               | ajb wrote:
               | 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.
        
               | PKop wrote:
               | All truly great thoughts are conceived by walking.
               | 
               | -Friedrich Nietzsche
        
             | Taek wrote:
             | 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.
        
             | haswell wrote:
             | 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.
        
               | IanOzsvald wrote:
               | +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.
        
               | nkrisc wrote:
               | 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.
        
               | mikestew wrote:
               | 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._
        
               | ajkjk wrote:
               | 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.
        
               | nkrisc wrote:
               | 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.
        
               | ajkjk wrote:
               | 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.
        
             | gedy wrote:
             | 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.
        
               | tonyedgecombe wrote:
               | Were you walking to the cake shop and back?
        
               | gedy wrote:
               | Haha no unfortunately
        
               | YZF wrote:
               | That's pretty much textbook why exercise on its own will
               | not reduce weight. You need to control your intake as
               | well.
        
             | the_af wrote:
             | I find walking very enjoyable.
             | 
             | I do a lot of daydreaming when I walk, too (to my wife and
             | daughter's impatience!).
        
             | astura wrote:
             | Podcasts help me with the boringness.
        
             | Johnny555 wrote:
             | >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.
        
             | barrenko wrote:
             | This is anecdotal as it gets, but I've developed prostate
             | issues almost simultaneously with quitting photography.
             | Didn't think about it until now.
        
             | mgfist wrote:
             | 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).
        
             | hombre_fatal wrote:
             | 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.
        
             | inglor_cz wrote:
             | 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.
        
           | alabastervlog wrote:
           | 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?
        
             | Spooky23 wrote:
             | If true, maybe netcraft did confirm that OpenBSD is dead
             | after all.
        
             | h2zizzle wrote:
             | Not quite. Focusing on your anus when clenching is a good
             | way to develop hemorrhoids.
        
             | Sharlin wrote:
             | Different muscles, but you need practice to learn to
             | control them independently.
        
           | tchock23 wrote:
           | Is there a name for this technique? Interested to research
           | the why behind it.
        
             | PaulHoule wrote:
             | Kegel?
        
             | astura wrote:
             | Kegel exercise
             | 
             | https://en.wikipedia.org/wiki/Kegel_exercise
        
               | wafflemaker wrote:
               | 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.
        
           | mannycalavera42 wrote:
           | <<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-...
        
             | nkrisc wrote:
             | 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).
        
               | failrate wrote:
               | Yes, and you also want to do fast and short Kegel's in
               | different positions.
        
             | wafflemaker wrote:
             | 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.
        
               | jvanderbot wrote:
               | 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.
        
           | stavros wrote:
           | 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?
        
             | mtalantikite wrote:
             | 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
        
               | stavros wrote:
               | 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.
        
           | aruggirello wrote:
           | BTW beware of snoozing or coughing while you're holding
           | yourself.
        
         | oarfish wrote:
         | > 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.
        
       | jakedata wrote:
       | So where's the temperature, pulse/pulseox and orientation
       | monitoring jockstrap with linked smartphone app?
        
         | wafflemaker wrote:
         | Oura ring comes in many sizes. /s
        
         | wkat4242 wrote:
         | 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.
        
       | edem wrote:
       | I've been reading till...I don't know 40% of the article? Is
       | there some sort of conclusion besides surgery?
        
         | tickerticker wrote:
         | Not a surgical procedure. It's catheter access to the spermatic
         | veins.
        
       | tacon wrote:
       | 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/
        
         | unixhero wrote:
         | Do you end up impotent or with incontinence?
        
           | tusharsharma09 wrote:
           | 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.
        
             | sizzle wrote:
             | Got an anatomical diagram for us visual thinkers?
        
               | tusharsharma09 wrote:
               | 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.
        
         | tusharsharma09 wrote:
         | 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.
        
           | derektank wrote:
           | 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.
        
             | tusharsharma09 wrote:
             | 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.
        
           | pstuart wrote:
           | Is the procedure still possible/advisable after a TURP?
        
             | tusharsharma09 wrote:
             | Yes, our procedure could be done before or after any other
             | BPH treatment out there, including TURP.
        
           | aquafox wrote:
           | 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.
        
             | tusharsharma09 wrote:
             | Yes, that's the intent post study completion.
             | 
             | We are collecting PSA data as well. It's a useful parameter
             | for prostate cancer.
        
           | tusharsharma09 wrote:
           | 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.
        
           | Izikiel43 wrote:
           | Would this procedure be advisable on someone currently with
           | varicocele, less than 40 years old, and with family history
           | of prostate cancer (both grandfathers)?
        
             | tusharsharma09 wrote:
             | 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.
        
           | cantrecallmypwd wrote:
           | 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.
        
             | tusharsharma09 wrote:
             | 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.
        
         | bigfatfrock wrote:
         | 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.
        
         | mmooss wrote:
         | 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.
        
           | A_D_E_P_T wrote:
           | > _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.
        
         | aantix wrote:
         | 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?
        
       | raffael_de wrote:
       | 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?
        
         | grok22 wrote:
         | 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"?
        
         | loeg wrote:
         | Based on the proposed mechanism, that would still leave the
         | testicles with low oxygenation blood.
        
         | themantalope wrote:
         | 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.
        
       | svilen_dobrev wrote:
       | 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
        
         | inquirerGeneral wrote:
         | 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.
        
           | 01100011 wrote:
           | 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/
        
             | bawana wrote:
             | 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.
        
       | begueradj wrote:
       | >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.
        
         | pja wrote:
         | 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...
        
           | juunpp wrote:
           | 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.
        
       | jasonthorsness wrote:
       | 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.
        
         | palijer wrote:
         | We require heavy burdens of proof before we subject tens of
         | thousands of people to potentially needless surgeries.
        
           | wussboy wrote:
           | 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.
        
         | derektank wrote:
         | 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.
        
           | amelius wrote:
           | If safety regulations are really such a high barrier, then
           | explain why this passed them:
           | 
           | https://news.ycombinator.com/item?id=15834006
        
             | derektank wrote:
             | 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.
        
           | inglor_cz wrote:
           | Surgeries aren't regulated in the same way that drugs are,
           | though. AFAIK the bureaucratic threshold for experimental
           | surgeries is much lower.
        
             | derektank wrote:
             | 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.
        
               | hbarka wrote:
               | What about the Breakthrough Device Designation or the
               | Investigational Device Exemption?
        
       | bawana wrote:
       | 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.
        
         | xvector wrote:
         | I really do think AI will be key here. It's critical to
         | accelerate towards ASI as quickly as possible.
        
       | compiler_queen wrote:
       | Typical patriarchal attitudes, whenever any disease affects women
       | or non-binary people then it's a shrug of the male shoulders and
       | on to talk about Star Wars.
        
         | n2d4 wrote:
         | This is a silly argument. Breast cancer awareness (rightfully)
         | gets a lot of attention; it's also fine to have an article
         | about prostates every once in a while.
        
           | const_cast wrote:
           | Right, if anything I'd say men's reproductive health is under
           | looked in general. Men rarely go to Urologists and issues
           | with the prostate and penis are very much treated as just a
           | fact of life, as opposed to something to look into it. And,
           | even when we do look at these issues, we do it in such an
           | overly pragmatic sense.
           | 
           | Like, how men feel about their penis not working or their
           | muscle atrophying doesn't matter. What matter is does their
           | penis work, literally? We approach it in such a blunt and
           | apathetic manner. We don't really think about the more
           | emotional side of hormonal changes or changes with age.
        
         | SamBam wrote:
         | Besides the fact that, as others have mentioned, breast cancer
         | gets a ton of attention, I'm not sure what being non-binary has
         | to do with anything. Surely the only question is whether one
         | has a prostate (or breasts) or not?
        
       | rurban wrote:
       | For more insight into "all" this prostate trouble watch the film
       | "Oslo: Love" currently in some cinemas.
        
       | tpoacher wrote:
       | 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
       | -\\_(tsu)_/- ), 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)
        
         | BobbyTables2 wrote:
         | 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.
        
         | mixmastamyk wrote:
         | What exactly does the broccoli do? And why does it have to be
         | boiled? I didn't get many details from the page above.
        
       | theptip wrote:
       | > 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%.
        
         | potato3732842 wrote:
         | 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)
        
         | thehappypm wrote:
         | This sounds a lot like the pitch for Theranos
        
           | bear141 wrote:
           | Which was a great pitch because it's what people want. It
           | just has to be based in reality.
        
           | Robotbeat wrote:
           | So?
        
         | bobthepanda wrote:
         | 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.
        
         | deelowe wrote:
         | 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
        
           | Spivak wrote:
           | Yeah, how can this take possibly be on HN when this approach
           | works on software. We even manufacture the population samples
           | ourselves (fuzzing).
        
           | neves wrote:
           | What is Technet? I've googled it, but there are just a bunch
           | of generic sites.
        
           | SoftTalker wrote:
           | 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.
        
         | Matumio wrote:
         | 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.
        
         | drumttocs8 wrote:
         | The other difference, of course, is that the mechanic can just
         | RTFM
        
         | pif wrote:
         | 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.
        
         | jdyer9 wrote:
         | 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
        
         | LegNeato wrote:
         | 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
        
       | derefr wrote:
       | > 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"!
        
       | bawana wrote:
       | 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)
        
         | loeg wrote:
         | > 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.
        
         | qmr wrote:
         | > craze of T replacement
         | 
         | Please explain how it's a "craze".
         | 
         | T levels and sperm count are tanking. Possibly from micro
         | plastics.
        
       | alejohausner wrote:
       | 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
        
         | kmbfjr wrote:
         | 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.
        
           | xxbondsxx wrote:
           | I hope you'll be OK!
        
           | alejohausner wrote:
           | 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.
        
           | brigandish wrote:
           | 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.
        
       | damnitbuilds wrote:
       | TL;DR: Very likely not.
        
       | vakde wrote:
       | Did no one check the base website (yarchive.net)?
       | 
       | He's archived a mindbogglingly large number of usenet posts, each
       | being extremely high signal
        
       | bccdee wrote:
       | 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.
        
         | gwking wrote:
         | 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.
        
       | ryanobjc wrote:
       | 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.
        
         | SamBam wrote:
         | 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.
        
       | irjustin wrote:
       | This is incredible.
        
       | silexia wrote:
       | Fantastically well written article. I read the entire thing in
       | one go with my tiny attention span and learned about an
       | interesting possible procedure.
        
       | acyou wrote:
       | 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.
        
         | GoatInGrey wrote:
         | Not to be antagonistic to your theory, I think you might find
         | this alternative theory thought-provoking:
         | https://osf.io/preprints/osf/smzc4_v1
        
       | varjag wrote:
       | Fascinating. I wonder what are the consequences of long term zero
       | gravity flight for this.
        
       | phront wrote:
       | i am curious to know can we plan a better vein system and somehow
       | "implement" it
        
       | abhaynayar wrote:
       | Love the writing-style. Quite "to-the-point", without any fluff,
       | and with a nice flow and purpose.
        
       | someonehere wrote:
       | 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.
        
       | ycombinator_acc wrote:
       | Just take finasteride. As a nice side effect, you won't go bald.
        
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