HolSpan MD

01/30/2026

Zooming out even further:

You can’t reliably out-exercise, out-prescribe, or out-treat bad lifestyles/behaviors.

This is a common theme within my practice that I discuss with people on a daily basis.

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01/30/2026

This is a topic I’m very passionate about. I have found it to be frequently overlooked, but often at the root of varied concerns. 

Don’t Sleep on Sleep Apnea

Sleep apnea is far more than snoring—it’s a systemic condition with neurologic, hormonal, sexual, urinary, and cardiovascular consequences when left untreated.

Repeated oxygen desaturation and sleep fragmentation impair neurologic function, contributing to brain fog, poor concentration, mood changes, and persistent daytime fatigue. These disruptions often drive nocturia, which further degrades sleep quality and worsens exhaustion; urologic guidelines now specifically recommend screening for sleep disorders in patients presenting with nocturia .

From a male health perspective, obstructive sleep apnea (OSA) is closely linked to low testosterone, reduced libido, and erectile dysfunction, likely through altered neuroendocrine signaling and chronic physiologic stress . Importantly, untreated severe sleep apnea is a contraindication to testosterone therapy, reinforcing the need to diagnose and manage sleep disorders before addressing hypogonadism.

The implications extend well beyond symptoms. OSA is associated with hypertension, atrial fibrillation, coronary disease, stroke, insulin resistance, and metabolic dysfunction, driven by repeated sympathetic activation and vascular stress during sleep. While cardiovascular outcome data remain complex, expert consensus emphasizes that symptomatic patients experience meaningful improvements in quality of life and functional outcomes with treatment, and that real‑world patients are often underrepresented in trials.

The encouraging news: sleep testing is getting less invasive. Many patients can now be accurately evaluated with home sleep studies, lowering barriers to diagnosis and timely treatment.

Bottom line:
If sleep is fragmented or unrefreshing—and accompanied by fatigue, nocturia, low testosterone, sexual dysfunction, or cardiometabolic disease—don’t ignore it. Identifying and treating sleep apnea can meaningfully improve brain health, hormones, sexual function, and long‑term cardiovascular risk.

Don’t sleep on sleep disturbances—your brain, heart, and hormones depend on it.

’sHealth

Be rested
Be restored
Be HOL

Sources

1.https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Non-neurogenic-Female-LUTS-2025.pdf . EAU, 2025
2. https://pubmed.ncbi.nlm.nih.gov/27132581 . The Urologic Clinics of North America, 2016
3. https://pubmed.ncbi.nlm.nih.gov/34390882/ . Endocrine Practice, 2021
4. https://academic.oup.com/jcem/advance-article/doi/10.1210/jc.2018-00229/4939465 . The Journal of Clinical Endocrinology and Metabolism, 2018
5. https://www.atsjournals.org/doi/10.1513/annalsats.202409-981st . Annals of the American Thoracic Society, 2025
6. https://jcsm.aasm.org/doi/10.5664/jcsm.7640 . Journal of Clinical Sleep Medicine, 2019

01/29/2026

I see younger and younger men who are referred to me to evaluate their “testosterone”. Their symptoms typically are a mix of the following:

Fatigue
Poor motivation
Weight gain
Sexual concerns

The root of many of these patients’ issues primarily relate to their sleep. 

Circadian Disruption: A Hidden Driver of Low Testosterone & Erectile Dysfunction

Urologic research is increasingly reframing testosterone deficiency and erectile dysfunction (ED) through a circadian lens—an area that remains underrecognized in routine clinical conversations.

Mechanism in brief
Testosterone secretion is tightly linked to sleep architecture and circadian alignment, with peak production occurring during consolidated overnight sleep. Disrupted or fragmented sleep (nocturia, shift work, irregular schedules, late light exposure) blunts this nocturnal rise and increases cortisol and sympathetic tone, impairing endothelial and nitric oxide signaling critical for erections. The AUA has long acknowledged the importance of timing and variability in testosterone testing, noting significant diurnal declines even within a single day .

Why this matters in younger men
We are seeing more men in their 20s–40s with ED or symptoms of testosterone deficiency despite being otherwise healthy. Emerging urology literature suggests that some men may be functionally hypogonadal despite “normal” serum levels when circadian stressors—such as nocturia or chronic sleep disruption—are present. Notably, relieving nocturia has been shown to increase endogenous testosterone levels even in men with preoperative values above traditional cutoffs, challenging the concept of a single static definition of “normal” .

An evolving framework in Urology
Recent work in The Journal of Urology proposes moving beyond one-size-fits-all thresholds toward a model that incorporates organ-specific testosterone needs and circadian context, sometimes described as a “circadian syndrome” linking sleep disruption, nocturia, and suppressed androgen production . Parallel data also highlight how circadian disruption directly contributes to ED via vascular, metabolic, and hormonal pathways .

Key takeaway
Circadian health is an emerging and underappreciated pillar of male sexual and hormonal function. For some men, optimizing sleep timing, consistency, and quality may meaningfully improve testosterone dynamics and erectile function—either alone or alongside standard therapies recommended in AUA guidelines for testosterone deficiency and ED .

Awareness matters. Sometimes the issue isn’t age or anatomy—it’s a disrupted biological clock.

Be aware
Be HOL

Sources

1. Evaluation and management of testosterone deficiency: AUA guideline - http://www.jurology.com/article/S0022-5347(18)42817-0/pdf

2. A new framework for testosterone deficiency: integrating organ-specific and circadian thres
holds - https://pubmed.ncbi.nlm.nih.gov/40705972/

3. Potential effect of the circadian clock on erectile dysfunction - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8782551/

4. Erectile dysfunction: AUA guideline - https://www.jurology.com/article/S0022-5347(18)43100-X/pdf

Sarah P. Psutka, MD, MSC, Associate Professor of Urology, University of Washington, Fred Hutchinson Cancer Center, Seattle, Washington.

01/29/2026

The “nonlinear” theme applies to many things in life…

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01/28/2026

Quality often matters just as much as quantity (and perhaps more).

Sleep Quality Matters More Than Time in Bed

Many patients spend sufficient time in bed yet continue to experience fatigue, impaired concentration, or low motivation. In these cases, the primary issue is often sleep quality rather than sleep duration, as healthy sleep requires adequate duration, continuity, timing, and the absence of sleep disorders.

Obstructive sleep apnea (OSA) is a critical and frequently underrecognized contributor, particularly in patients who are overweight or obese. Recurrent airway obstruction causes sleep fragmentation and intermittent hypoxia, which adversely affect insulin sensitivity, cortisol regulation, cardiometabolic risk, and hormonal balance. Current guidelines recommend routine assessment for OSA in patients with overweight or obesity and further diagnostic testing when clinical suspicion is high .

Common factors that degrade sleep quality include:

- Snoring, mouth breathing, and untreated reflux disrupting normal sleep architecture
- Alcohol use, which worsens airway collapse and suppresses restorative sleep stages
- Evening exposure to blue light that delays circadian signaling
- Late, heavy meals that interfere with nocturnal physiologic recovery

Patients may appear to be asleep, yet these disruptions prevent restorative sleep and normal neurohormonal cycling.

Factors shown to enhance sleep quality include:

- Consistent sleep and wake times aligned with circadian rhythms
- A cool, dark, and quiet sleep environment
- Appropriate evaluation and treatment of sleep apnea when indicated
- Avoidance of alcohol and large meals close to bedtime
- Regular physical activity and resistance training
- Morning daylight exposure to reinforce circadian alignment

An important clinical consideration:

Many prescription and over‑the‑counter sleep aids induce sedation but do not reliably improve restorative sleep. Some medications suppress REM or deep sleep, which may further impair metabolic regulation and hormonal health rather than improve it .

Why sleep quality is foundational to overall health:

- Testosterone and growth hormone secretion are closely linked to deep, consolidated sleep
- Poor sleep increases cortisol and worsens insulin resistance
- Inadequate or fragmented sleep is associated with adverse cardiometabolic outcomes and increased cardiovascular risk
- Energy, mood, libido, body composition, and long‑term metabolic health are all affected

Sleep should be viewed as a core pillar of health, not simply a measure of hours spent in bed.

Optimizing sleep quality is essential for hormonal balance, metabolic health, and long‑term well‑being.

Sources

1. Sleep is essential to health: an American Academy of Sleep Medicine position statement - https://jcsm.aasm.org/doi/abs/10.5664/jcsm.9476

2. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline - http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30972

3. American Association of Clinical Endocrinologists and American college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity - https://pubmed.ncbi.nlm.nih.gov/27219496

4. American association of clinical endocrinology consensus statement: algorithm for the evaluation and treatment of adults with obesity / adiposity-based chronic disease-2025 update - https://www.endocrinepractice.org/action/showAbstract?pii=S1530891X25009772

5. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report - https://pmc.ncbi.nlm.nih.gov/articles/PMC2082098

6. Sleep duration and quality: impact on lifestyle behaviors and cardiometabolic health: a scientific statement from the American Heart Association - https://pmc.ncbi.nlm.nih.gov/articles/PMC5567876

Sleep is increasingly recognized as an important lifestyle contributor to health. However, this has not always been the case, and an increasing number of Americans choose to curtail sleep in favor of other social, leisure, or work-related ...

01/27/2026

Exercise really is medicine, especially when it comes to avoiding the frailty we associate with aging. Skeletal muscle is an endocrine organ—it actively releases myokines that improve insulin sensitivity, reduce inflammation, support cardiovascular health, and protect brain function. Maintaining muscle isn’t just about aesthetics; it’s about preserving independence, resilience, and longevity.

Fat tissue is also an endocrine organ. In healthy amounts, it plays a role in energy balance and hormone regulation. But excess fat mass shifts that signaling toward chronic inflammation, insulin resistance, and metabolic disease. The goal isn’t zero fat—it’s metabolic balance.

The key isn’t perfection or extremes. Consistency beats intensity. Sustainability beats short-term fixes. Strength training, regular movement, and adequate recovery—done in a way that fits real life—compound over time. Keep it practical, keep it repeatable, and think long-term. That’s how exercise truly becomes medicine.

Getting older doesn’t mean slowing down! 🏃‍♂️✨Our clinical care collaborator, Mayo Clinic, explains how staying active- even just 30 minutes a day- can help reduce aging cells and support muscle, bone, and brain health.


Read more here: https://batonrougeclinic.com/news-education/mayo-clinic-minute-aging-and-the-benefits-of-exercising/

01/27/2026

Sleep quantity matters immensely:

How Much Sleep Do Humans Really Need?

Humans aren’t “bad” at sleep — we’re designed for it.

Across evolution, sleep has always been a liability. When you’re asleep, you’re immobile, unaware, and vulnerable. If humans could have evolved to need less sleep without consequences, we would have. The fact that we haven’t tells us something important: sleep is biologically essential, not a cultural habit.

Sleep is not passive downtime. It is an active, tightly regulated biological state critical for brain repair, memory consolidation, emotional regulation, immune function, metabolic control, and hormonal signaling. The central role of sleep in maintaining physiologic stability and health is reflected in modern sleep medicine guidelines, which emphasize that disrupted or inadequate sleep has measurable downstream consequences across multiple organ systems .

The “I’m Different” Myth

Most people believe they are the exception — that sleep rules don’t apply to them. Nearly everyone thinks they “do fine” on 5–6 hours. The reality: almost no one is biologically special when it comes to sleep. True short sleepers exist, but they are exceedingly rare.

What most people experience is not adaptation — it’s acclimation to impairment. You do not get used to less sleep; you simply recalibrate your expectations and accept diminished performance as normal. Objective measures of attention, reaction time, judgment, and metabolic control continue to worsen even as subjective confidence remains unchanged.

Sleep Quantity Matters — A Lot

As total sleep time declines, predictable drop‑offs occur:

- ≈8 hours: Optimal cognitive performance, reaction time, mood, metabolic health, and hormonal balance.
- 7 hours: Subtle but measurable declines in attention, decision‑making, and glucose regulation.
- 6 hours: Clear impairments in memory, focus, insulin sensitivity, testosterone and growth hormone signaling, with increased injury and illness risk.
- ≤5 hours: Marked deterioration in performance, immune function, cardiovascular health, and long‑term health outcomes — even if it “feels normal.”

Sleep is not optional, negotiable, or a sign of weakness. It is a fixed biological requirement shaped by evolution.

If there were a safe way to need less sleep, evolution would have found it.

It didn’t.

Be aware
Be HOL

Sources

1. Treatment of central sleep apnea in adults: an American Academy of Sleep Medicine clinical practice guideline -

The official peer-reviewed journal of the American Academy of Sleep Medicine.

01/26/2026

WHY sleep is important:

Sleep: The Most Overlooked Performance Enhancer (That Just So Happens to Be Free)
January 26, 2026

Sleep is one of the most powerful drivers of health, longevity, and performance—yet it remains one of the most overlooked and underutilized performance enhancers, despite being free. Across public health, clinical medicine, and corporate performance frameworks, sleep is consistently identified as foundational rather than optional.

At a population health level, the evidence is clear: sleep influences nearly every domain of human health, yet sleep health remains under-recognized and under-prioritized globally. Large-scale public health analyses emphasize that insufficient attention to sleep contributes to cardiometabolic disease, impaired cognitive function, reduced quality of life, and widening health inequities, prompting calls for sleep to be elevated alongside nutrition and physical activity in global health agendas . The American Academy of Sleep Medicine (AASM) formally states that sleep is essential to health and safety, advocating for widespread education, screening, and workplace-level interventions to address sleep deficiency and circadian disruption .

From a clinical and preventive care standpoint, adult sleep duration is not arbitrary. Consensus guidelines from the AASM and Sleep Research Society recommend that most adults obtain 7 or more hours of sleep per night on a regular basis to support optimal health, while acknowledging individual variability . Healthy sleep also encompasses regular timing, adequate quality, and the absence of untreated sleep disorders—not merely time spent in bed .

In urology and male health, sleep is directly tied to hormonal balance, sexual function, fertility, and metabolic health. High-quality clinical and epidemiologic data demonstrate that insufficient or disrupted sleep is associated with low testosterone, erectile dysfunction, reduced s***m count, impaired fecundity, and increased cardiometabolic risk. Testosterone production is closely linked to deep sleep and circadian rhythms, and sleep fragmentation or misalignment alters normal hormonal patterns . Improving sleep—whether through behavioral changes or treatment of conditions such as obstructive sleep apnea—has been shown to improve erectile function and cardiometabolic parameters, reinforcing sleep as a modifiable risk factor rather than a passive lifestyle issue .

Sleep also plays a critical role in daytime function and performance. Excessive daytime sleepiness negatively impacts productivity, decision-making, safety, and overall quality of life, making it a meaningful, patient-centered outcome and a key target for intervention .

In the corporate and executive environment, sleep is increasingly recognized as a performance and risk-management issue, not a personal weakness. Research highlights that lack of sleep awareness and cultural norms that glorify exhaustion remain major barriers to participation in workplace sleep health programs. When leaders understand the link between sleep, cognitive performance, and organizational outcomes, engagement improves and the business case becomes clear . Corporate cultures that undervalue sleep inadvertently undermine productivity, increase errors, and accelerate burnout, whereas workplaces that promote sleep health can improve both employee well-being and organizational performance .

The message across guidelines, specialties, and industries is consistent: if sleep is compromised, everything else suffers. Before pursuing more complex interventions, optimizing sleep should be considered a first-order strategy. It is one of the most accessible, evidence-based tools available to improve health, performance, and resilience—making it perhaps the most overlooked performance enhancer we have, and one that just so happens to be free.

If you are sacrificing sleep to pursue the newest gadget, mobility routine, or supplement, you are tripping over $100 bills to pick up pennies…

Be rested
Be HOL

Sources

1. The need to promote sleep health in public health agendas across the globe - https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(23)00182-2/abstract

2. Sleep is essential to health: an American Academy of Sleep Medicine position statement - https://jcsm.aasm.org/doi/abs/10.5664/jcsm.9476

3. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and sleep research society - http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=30048

4. A clinical perspective of sleep and andrological health: assessment, treatment considerations, and future research - https://www.ncbi.nlm.nih.gov/pubmed/31042277?dopt=Abstract

5. Clinical significance of sleepiness: an American Academy of Sleep Medicine position statement - https://jcsm.aasm.org/doi/10.5664/jcsm.11658

6. Barriers and facilitators to participation and key components of sleep health programs: perspectives for the corporate work environment - https://journals.lww.com/joem/fulltext/9900/barriers_and_facilitators_to_participation,_and.430.aspx

01/26/2026

Why New Year’s Resolutions Usually Fail (and What Actually Works)

Every January, motivation is high. Gyms are packed. Diets are strict. By February… reality hits.

The typical resolution timeline looks like this:
- Week 1–2: Maximum motivation. Big changes. All‑or‑nothing mindset.
- Week 3–4: Fatigue sets in. Life gets busy. Small slips start.
- By February: Guilt replaces momentum → most people quit entirely.
- By March: Old habits are fully back.

The problem isn’t discipline — it’s unsustainable strategy.

What works long‑term (and is supported by major medical guidelines):

- Focus on systems, not goals – daily habits beat short‑term intensity.
- Small, repeatable changes – 10–20 minutes of movement most days beats extreme workouts.
- Prioritize sleep – foundational for hormones, metabolism, and mental health.
- Protein and whole foods first – not restriction, but smarter defaults.
- Consistency over perfection – missed days don’t mean failure.
- Stress management – walking, sunlight, breathing, and recovery matter.

These approaches aren’t trendy — they’re the same lifestyle pillars emphasized across cardiometabolic, hormonal, and longevity-focused medical guidelines because they work when done consistently.

Real health/progress isn’t a 30‑day challenge.
It’s what you can still do in September.

If you want 2026 to look different, don’t aim for extreme — aim for sustainable.

Be consistent
Be HOL

01/23/2026

Trying to conceive and feeling stuck? You’re not alone.
According to the new WHO infertility guidelines, infertility affects both partners, and lifestyle factors are a critical first step in evaluation and treatment .

The guidelines emphasize that optimizing overall health can significantly impact fertility—especially early in the journey.

Key lifestyle priorities for couples trying to conceive:
- Healthy body weight and regular physical activity
- Adequate sleep and stress management
- Limiting alcohol, ni****ne, and cannabis
- Nutritious, balanced diet

For men in particular, the WHO highlights that s***m quality is highly responsive to lifestyle changes, with measurable improvements often seen within a few months .

Takeaway: Fertility care isn’t only about medications or procedures. Supporting reproductive health starts with daily habits—and works best when couples approach it together.



Be aware
Be HOL

---

Reference:
WHO infertility guidelines summarized in AUA News, January 2026: “WHO Releases Landmark Infertility Guideline: Practical Takeaways for Urologists”

01/22/2026

Lifestyle and behaviors are not only at the forefront of Urology guidelines, they apply to broader medical guidelines. 

Lifestyle Medicine Is the Backbone of Cardiovascular, Vascular, and Sexual Health Guidelines
January 21, 2026

When you look closely at cardiovascular disease (CVD), peripheral arterial disease (PAD), and erectile dysfunction (ED), the message across major international guidelines is remarkably consistent: lifestyle optimization is first-line, foundational care—not alternative medicine.

Cardiovascular & Peripheral Vascular Disease
Modern CVD and PAD guidelines emphasize that atherosclerosis is driven by metabolic dysfunction, obesity, diabetes, smoking, physical inactivity, and poor nutrition. As a result, guideline-directed care begins with:

- Diet quality (Mediterranean-style, fiber-rich nutrition)
- Regular physical activity and structured exercise
- Weight and metabolic risk management
- Smoking cessation and cardiovascular risk reduction

These recommendations are core components of PAD management and CVD prevention—not adjuncts—because they directly slow disease progression and reduce events .

Erectile Dysfunction = Peripheral Vascular Disease Until Proven Otherwise

ED is not an isolated ge***al issue. It is a vascular and metabolic signal.

ED shares the same root causes as PAD and CVD:

- Endothelial dysfunction
- Insulin resistance and diabetes
- Obesity and metabolic syndrome
- Systemic inflammation and atherosclerosis

Critically, ED often precedes overt cardiovascular events by years, making it an early clinical marker of peripheral and systemic vascular disease .

Because of this, major sexual health guidelines explicitly recommend lifestyle changes and cardiometabolic risk factor modification before or alongside pharmacologic ED therapy . Improving metabolic health and vascular function also enhances response to ED medications .

The Big Picture

Lifestyle-based interventions are not “soft,” optional, or alternative. They are:
- Embedded in ESC, ACC/AHA, EAU, and ESVS guidelines
- Required for optimal outcomes in CVD, PAD, and ED
- The only interventions that treat the root vascular and metabolic pathology

Bottom line:

ED, PAD, and heart disease are different clinical expressions of the same underlying problem. Lifestyle medicine is guideline-directed vascular medicine.

Be aware
Be HOL

Sources

1. 2024 ESC guidelines for the management of peripheral arterial and aortic diseases - https://pubmed.ncbi.nlm.nih.gov/39210722/

2. 2019 ACC / AHA guideline on the primary prevention of cardiovascular disease: a report of the American college of cardiology / American Heart Association task force on clinical practice guidelines - https://pmc.ncbi.nlm.nih.gov/articles/PMC7734661

3. Erectile dysfunction links to cardiovascular disease-defining the clinical value - https://pubmed.ncbi.nlm.nih.gov/30665816/

4. EAU guidelines on sexual and reproductive health -https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Sexual-and-Reproductive-Health-2025.pdf

5. Lifestyle management of erectile dysfunction: the role of cardiovascular and concomitant risk factors - https://pubmed.ncbi.nlm.nih.gov/16387573

01/21/2026

Solid recommendations. Prioritize food sources and your overall health and well-being. 

Below is a caution about high dose vitamin C supplementation and kidney stone risk (dose and time matter):

Vitamin C: Helpful nutrient, but more is not always better—especially for kidney stones

Vitamin C is an essential vitamin and a powerful antioxidant. Getting it from whole foods like citrus fruits, berries, peppers, and leafy greens is safe and important for overall health. Problems tend to arise not from food, but from high‑dose vitamin C supplements taken over long periods.

Why high doses can increase kidney stone risk

When you take large amounts of vitamin C (ascorbic acid), your body converts some of it into oxalate. Oxalate is excreted in the urine, where it can bind with calcium and form calcium oxalate kidney stones, the most common type of stone. Higher supplemental doses raise urine oxalate levels and increase stone risk, particularly in men and in people with a history of stones or kidney disease .

Food vs supplements: an important difference

Vitamin C from foods comes in physiologic doses, absorbed gradually along with fiber and other nutrients. In contrast, supplements—especially doses ≥500–1000 mg/day—can overwhelm normal handling and lead to hyperoxaluria (high urine oxalate) without providing added health benefit for most people .

What this means for patients

- A diet rich in fruits and vegetables is the safest way to meet vitamin C needs
- Long‑term high‑dose supplementation can increase the risk of kidney stones and, in some cases, kidney injury
- People with prior kidney stones, chronic kidney disease, or reduced kidney function should be especially cautious with supplements

Bottom line

Vitamin C is essential—but balance matters. Focus on dietary sources, and be cautious with high‑dose supplements unless there is a clear medical reason. When it comes to kidney stones, more vitamin C is not always better.

Sources

1. Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer: US preventive services task force recommendation statement - https://pubmed.ncbi.nlm.nih.gov/35727271/

2. Chronic kidney disease CKD: guideline recommendations and supporting information (2020) - https://www.andeal.org/topic.cfm?menu=5303&cat=5557

3. Reframing micronutrient deficiencies for modern times: a review - https://link.springer.com/article/10.1007/s11606-025-09481-y #14121788

Vitamin C for colds…myth or medicine? 🍊🤧Our clinical care collaborator, Mayo Clinic, breaks down what science really says: it won’t keep a cold away, but it might slightly shorten symptoms. Worth the sip? Read to learn more!


Read more here: https://batonrougeclinic.com/news-education/mayo-clinic-minute-can-vitamin-c-keep-the-common-cold-away/