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Scot: Hey, Troy?
Troy: Yes, Scot.
Scot: I'm going to start over.
Mitch: All right. Here we go.
Dr. Smith: And we're off to a terrible story.
Scot: It's amazing. Two words and I screwed it up.
Dr. Smith: AAnd we're done.
Scot: Yeah. Troy, Mitch was telling me about something called super gonorrhea. Have you heard about this?
Troy: Okay. I will say yes, I have. I don't know that I've heard it called super gonorrhea. That's maybe more of just a term that's come up elsewhere. But I am aware of a resistant gonorrhea that's requiring higher doses of antibiotics. So, yeah, in that sense, I have heard of super gonorrhea, yes.
Scot: Mitch, I like the way Troy described it better, resistant, as opposed to super gonorrhea. Super gonorrhea sounds scary.
Mitch: It is not scary enough. It needs to be scarier if we're going to make it stop happening.
Troy: Okay. Super gonorrhea. Yes, I have heard . . .
Mitch: Super gonorrhea.
Troy: I have heard of it.
Scot: On this show, we talk about all things related to men's overall well-being, but we have never talked about sexually transmitted diseases, which in light of a thing called super gonorrhea, perhaps we should.
So everywhere from your head to . . . well, you know . . . we talk about men's health, and today it's STDs, sexually transmitted diseases, the symptoms, potentially gnarly long-term effects, and most importantly why it's important to prevent them.
Welcome to "Who Cares About Men's Health," where we aim to give you some information, inspiration, and perhaps a different interpretation about men's health. My name is Scot. I bring the BS, and I guess I'm lucky because everything I know about STDs I think I could summarize in one sentence, and I've never had one.
Mitch: Oh, okay.
Troy: Would you admit if you had, Scot?
Scot: Well, I'll tell you what that one sentence is coming up. The MD to my BS, Dr. Troy Madsen. What do you know about STDs? I'd imagine being a doctor you'd know more than me.
Troy: I have seen a lot of STDs. Yes, I have seen many, many STDs over the course of my career. I will say I just haven't seen a lot lately for whatever reason. It's just probably luck of the draw, but lots of STDs.
Scot: Mitch Sears always bringing his unique perspective to the show. What do you know about STDs?
Mitch: Quite a bit, actually. I took a bunch of sexual diversity and psychology and physiology courses in my undergrad.
Mitch: And so I've seen a lot of pictures and I also have never had one.
Troy: Was I supposed to say that too, guys? Was I supposed to say I've never had one? Is that part of this?
Scot: And Dr. John Smith, urologist at University of Utah Health, a guy that hopefully knows a lot about STDs and that's why he is here. Welcome.
Dr. Smith: Thank you. Thanks for having me. I see them quite a bit. I probably don't know as much as Mitch, if he took multiple courses. I think in medical school we get one or two PowerPoints. So that's probably a trump card for Mitch.
Scot: So Dr. Smith, is it usually the urologist that you would go to if you suspect you have an STD? Or where would you end up?
Dr. Smith: I think there's a list of places people go. We see quite a few of them. I think primary care sees them, urgent care sees them, and across the board, I think that there's a myriad of places to go.
Scot: All right. Is there a better place to go than others if you suspect you have one?
Dr. Smith: I think you go to the closest place you think you can get the best treatment. That's where I would head.
Scot: Okay. All right.
Dr. Smith: And I have not had one either, so I think we need to put that in there.
Troy: Oh, good. I'm glad you clarified. Your silence was really making me curious, John.
Scot: Dr. Smith, why is this topic so important to men? Why is this a big deal? Why is this an episode that men should listen to?
Dr. Smith: Well, I mean, it can have long-term effects to your health if they go untreated, especially some sexually transmitted diseases like syphilis that can kind of worsen over time. It can also affect your partners, your sexual partners, and have long-term consequences there as far as fertility goes and just other overall undesirable side effects.
Scot: And those serious side effects aside, I mean, if you or your partner has one, then that kind of changes the dynamic of sex in the relationship.
Dr. Smith: Absolutely, especially sexually transmitted diseases that are not able to be treated, but you just . . . Well, you treat them, but the ones that can reoccur. Certain ones you can treat and then they're gone and you don't have to worry about them within your relationship, but others do become long-term as far as monitoring sexual practices. If you have something like herpes, it's going to come and go and you're going to have to watch that the rest of your relationship.
Scot: So I didn't know . . . Now, all of us said we've never had STDs, but I have to admit, I've never been checked for one.
Scot: Wow. All right. The guy who's read multiple books is completely concerned about that. I mean, I guess I just assumed that I would know because I've never had symptoms, right? I've never had any issues. Is that wrong?
Dr. Smith: If you're talking to Mitch, I would wait for Mitch to answer, but I can answer that.
Mitch: I was like, "I don't want to talk over the doc."
Troy: Mitch can answer that question.
Scot: I think I know how Mitch feels by his gasp and how offended he sounded. So I'm looking for you, John.
Dr. Smith: Okay. I mean, Mitch has probably read more books, it sounds like, in the courses that he's taken, but you can definitely be asymptomatic with chlamydia. And then gonorrhea tends to be more symptomatic in men, and women tend to be asymptomatic. So you may not know.
Scot: All right. So is it something that men should do? Get checked?
Dr. Smith: I think yes, especially if you've had new partners or you're unfamiliar with your partner's sexual history. I think it's a smart thing to do. I've had a few gentlemen say, "Well, my wife got checked when she was pregnant, so I'm sure I'm good." I don't know that that's a good scapegoat. I think that you should look to be proactive and take good care of your sexual health.
Scot: Hey, Troy, have you ever been checked? Have you ever had tests for it?
Troy: I've been tested for HIV. I believe it's part of just routine health maintenance recommended, because it showed up on MyChart, "You're due. You haven't had an HIV test," or something. And I saw my primary care doc, and I think that was just one of the tests he sent.
So you may have been checked. I don't know. You may or may not know, but I guess you would know if you had been checked for HIV. But it is one of those things that is recommended just as part of your routine checkups.
Scot: Mitch, obviously, you've been checked. Do you do it often?
Mitch: Oh, yeah, regularly. There's a medication that I'm on that to get my prescription re-upped, I have to get tested every three months, three to six months. So I'm getting tested pretty regularly, but for me, it's always been that way. It's always been really important. I don't know if it's the communities I'm part of, the cultures, the spooky, terrible pictures I've seen in books. I take this stuff pretty seriously and it's worthwhile to get checked.
Troy: I'm curious though, Mitch, are you talking about HIV testing or are they doing gonorrhea, chlamydia, syphilis? What kind of testing are they doing?
Mitch: They swab everything.
Troy: Okay. You're getting the swab? They're doing a urethral swab? They're not nice and just letting you do a dirty urine test?
Mitch: And then some, yeah. No, it's not my favorite thing in the world, but I have a pretty solid peace of mind.
Troy: Yeah, that's great.
Scot: And you're not currently in a relationship, whereas Troy and I both have been married for many, many years. John, should Troy and I consider getting tested for those other things? I think I was tested for HIV because I think that's just something the healthcare systems are doing now, but should I consider getting those other tests?
Dr. Smith: That is a good question. I think if you and your partner both feel that you're pretty honest with each other and monogamous, and depending on your sexual history in the past, it may or may not be a good idea to do it.
If that's the only partner you've ever been with and they're the only partner you've ever been with, the likelihood you have a sexually transmitted infection is very, very low. However, if you had multiple partners before you settled down and got married and you never got tested for it, it may be a good idea to do so. I would kind of leave that up to the discretion of you and your partner after having a discussion and based on your sexual history,
Scot: I would think, though, that after 20 years of being married, it's too late now at this point, right?
Dr. Smith: Well, I mean, you could say that, yes. But also, some people do . . . Like I mentioned earlier, I've had people come in and say, "Well, my wife got tested when she was pregnant for sexually transmitted infections." I mean, you could say there is some validity to that if you're in a monogamous relationship and have been for quite some time, that your partner being negative for an STD makes it that you're a lot less likely to have one.
Again, it's probably not the most necessary thing for you to do in your relationship if you've been together for 20 years. However, if there are any doubts or any concerns, you can always get tested.
Scot: And is there a panel that kind of tests for all of them, or do you test just for particular ones?
Dr. Smith: So, usually, when people come in, depending on their sexual history, usually you'll check for gonorrhea, chlamydia, syphilis, HIV. Those are the main ones, unless there's anything specific that they have concerns about. But that's pretty much the extent of most of the panels that will get run.
Scot: Are those the major ones that we need to know about? I mean, as men, do we need to know about all the different types of sexual diseases, or are there kind of some commonalities that we should be aware of? How involved do we have to get in our knowledge of this? Do we have to have a Mitch level or a Scot level?
Mitch: I have some disturbing photos that I can post in the chat if we need to.
Scot: I mean, does each guy have to have a vast knowledge of all the different diseases out there?
Dr. Smith: No, I don't think it's necessary for you to go read Mitch's books. But if Mitch wants to post them in the chat of good books to read, I think it's appropriate.
But the major diseases that are out there are . . . chlamydia is the most common sexually transmitted disease in the United States, followed by gonorrhea and then syphilis. HIV and other diseases are much further down the list. But those are the main ones that you need to be aware of and concerned about at this point.
The reason that chlamydia is so prevalent is it's one of those that oftentimes goes undetected until someone is symptomatic and then goes and gets tested, and then their other sexual partners should be tested and treated as well.
And like I said earlier, gonorrhea is one of those where it's often asymptomatic in women and men tend to be symptomatic. It's got the old nickname of "the clap" because men tended to have urethral discharge that would dry over the meatus of the penis and they would end up clapping the head of their penis to break free that discharge.
Scot: That's where the name comes from?
Dr. Smith: Uh-huh.
Mitch: I didn't learn that in my books. I love that.
Scot: My favorite part of that whole thing was Troy. "Huh."
Troy: I had no idea. I had not learned that. Yeah.
Dr. Smith: Yeah, that's one of the folklore that's going to be out there and I think it's pretty prevalent. People also called it "the drip" because you would have the urethral discharge, which I think nowadays drip has taken on a new meaning for the kids.
Scot: Out of those, are the symptoms all kind of similar for sexually transmitted diseases across the board? I mean, are there just kind of some symptoms you want to look for and then worry about what it is you've got afterwards? Or are they really different?
Dr. Smith: I mean, they are different. Different diseases have different symptomology, but oftentimes there are urinary symptoms involved throughout. Burning with urination, frequency, urgency. Sometimes you'll develop kind of a lesion or a skin breakdown on the outside of the penis in a male or the external vagina of a female that you would notice that would be abnormal, especially given the circumstances.
Troy: I will say too, John, one thing I've seen in the emergency department that's not uncommon is people come in with testicular pain and swelling. And in those cases, not always, but sometimes it is related to an STD where it works its way down and then it causes epididymo-orchitis where it affects the testicle. That's when I often see them, is when it really becomes an issue for them and they're having a lot of pain and just say, "I've got to get this checked out."
Dr. Smith: Yeah, that and prostatitis in younger men as well who are sexually active. That's another concern that we'll test them for.
Scot: Could you have an STD then and have no visible symptoms, but have the other symptoms like Troy mentioned or that you mentioned, this "need to go"?
Dr. Smith: Yeah. I mean, sometimes people come in and they're like, "I don't know." And so getting a good sexual history when folks come into my office can be helpful. If you're not sexually active, then I probably am not going to go searching for a sexually transmitted infection. But if you've had multiple partners in the last 12 months or in the last 6 months or whatnot, then it's probably a higher probability that we're looking for something that may be problematic.
Troy: Yeah, and I agree. I think in my experience, in the cases I've seen where people come in with that testicular pain and swelling or pain at the top part of the testicle on the epididymis, it seems like most of the time they don't tell me they've really had a lot of discharge from their penis or anything really abnormal. So it does seem like it's not unusual for someone. Maybe that's the first symptom they really notice, is that testicular pain.
Or like John mentioned, prostatitis where they're having a lot of pain with urination and their prostate is swollen, they're having difficulty urinating, those kind of things.
Scot: All right. So, guys, I feel like we should have a drum roll because now Scot is going to reveal his one sentence. The depth of his sexually transmitted disease knowledge is one sentence. I want to find out if this is true, and maybe this is the takeaway. I don't know.
All right. Dr. Smith, this is what I know about sexually transmitted diseases. Wear a condom, you're going to be good.
Scot: Oh, boy. Mitch again.
Dr. Smith: I'm going to let Mitch take this one because I feel like he's well qualified to answer this question.
Mitch: Well, a condom is a big part of it, but there are other sexual behaviors, interactions, etc., that if there are single dudes out there that think that is the only thing they need to be doing . . . It goes a long way as far as I've read and in my research, but there are other things, like having a healthy discourse and being regularly tested between partners and things. There's more than that, but I think if you're looking for baseline, most effective from what I've read, condom is where it's at.
Dr. Smith: Yeah, condoms are great. They're effective at blunting the transmission of sexually transmitted diseases. You also have to keep in mind that there are other things that people can do sexually where you can transmit diseases, a la Michael Douglas.
Troy: A la Michael Douglas.
Scot: Are we talking oral sex? Is that what we're . . .
Dr. Smith: Yeah.
Mitch: There we go.
Dr. Smith: Those are things to keep in mind as well, because a lot of times, people think, "Oh, I put on a condom. I'm good. I'm not in a position to get an infection." Oral sex with an oral lesion, an oral herpes lesion, like a cold sore, you can put that right onto the genitals.
Scot: Oh, really?
Dr. Smith: Oh, yeah.
Scot: Oh, I thought it was a different kind of herpes.
Dr. Smith: Well, it used to be predominantly that type one, type two were genitals and then oral, and now it's pretty much 50/50 because of oral sex being prevalent.
Scot: Huh. Okay.
Dr. Smith: And so those are things to keep in mind. Some people may not know or may not understand that you've got to be careful with those things. If your partner had a lesion on their genitals and then you had oral sex, you could put that lesion on your mouth. Those types of things where you've got to be careful all around.
And like Mitch said, you've got to be careful and you've got to have those conversations with your partner, understanding the history between the two of you, testing is important, all those things to keep yourself safe and not put your genitals in harm's way.
Scot: Hey, Mitch, I'm trying to hark back, although it's a long hark, to when I was single and perhaps had more than one partner over the course of my life.
Scot: How do you even have that conversation? I never had that conversation once.
Mitch: Yeah. Well, I guess within the LGBT community in particular, my experience has been that it's pretty top of mind. We might get talking about HIV transmission today, but really, there is an importance in that community to make sure everyone is healthy, right?
On some of the dating apps, your HIV status and your last testing date are on the profiles. So not only do you see pictures and descriptions of the people, you also know what their sexual health is like. It is such a major cultural part of that particular community.
But that being said, there are people that you come across that are shocked when I say things like, "Hey, things are going well, right? Just wondering when was the last time you were tested? Can I ask about your sexual health? Are we monogamous? Are we monogamish? What is our situation? Are you having sexual contact with other people?"
I think from the get-go, it's a conversation that if you want to keep your genitals out of harm's way and you want to have healthy partners and make it a positive type of interaction, you should probably be able to have those conversations.
And I know they're awkward sometimes, and I know it can kill a mood, and I know all of those things, but for me, if someone isn't receptive to those, it worries me. It's a red flag, right? If I ask these questions and you're not willing to answer, or if my partner asks me and I don't feel 100% forthcoming, why am I having sex with this person? But that's just me.
Dr. Smith: I agree. I have a lot of those conversations with individuals and I think, Scot, 20 years ago, I don't think that the climate may have been as easy to have those conversations. But I think given the rise of sexually transmitted infections, HIV, all of those things, these are conversations that people need to have with their partners and that their partners deserve to be had.
I think Mitch is very smart to have those conversations and make that the forefront because, again, if those people don't care about your sexual health, why would you want to have that intimate relationship with them given that a lot of these things do have consequences long-term?
Scot: It's kind of crazy really, isn't it? Sex is such an intimate thing, but then . . . I don't know. Maybe like you said, the newer generations less so, but there's always this kind of not wanting to talk about it. Why wouldn't you? It's just so weird.
So you had mentioned something, that it's a different climate, that people are talking about it. Are there more sexually transmitted diseases out there now than there were 5 years ago, 10 years ago, 20 years ago?
Dr. Smith: I don't know that there's more. I think that as you see more of these superbugs . . . as you hear the buzzwords, they're superbugs. But they're multi-drug resistant.
If you go to the CDC's website, there's a great little video that's like three or four minutes on the rise of resistant gonorrhea, which is I think where we started. You have a million cases of gonorrhea every year in the United States. And over the course since the '60s and '70s, we were using penicillin, and then that became resistant.
And then we started using fluoroquinolones. And by the mid '90s, those were becoming resistant. And in the year 2000, we stopped using those in Asia. In 2002, they stopped using fluoroquinolones in California.
And then by 2005, we had widespread resistance to it. And now we're onto an IM Cephalosporin drug and a second drug to try to decrease the resistance patterns to it.
And I think anybody who doesn't think that these things are serious is kidding themselves. I don't mean to get a super serious tone, but I think that that's the reason these conversations are so important. And that's why I think Mitch is so smart to have those conversations and want to have those conversations, because once we create multi-drug resistance to these bacteria, we don't have much else we can do because we're not making a ton of new antibiotics.
Scot: I guess I have two sentences of things I knew. Most of the time most of those diseases can be kind of knocked out with a pill or a shot if they're caught early on, but that's becoming not quite so much the case.
Dr. Smith: Exactly. I mean, still with gonorrhea, it's still a shot of ceftriaxone and then either doxycycline or azithromycin, usually a nice heavy dose to help you kick it.
And then syphilis is seeing antibiotic resistance. Chlamydia has some antibiotic resistance forming, but they're still good treatments for them. But at some point, if we're not smart about it and we continue these patterns, it's not going to look good in the future.
Troy: Yeah. It's interesting, like you mentioned, John. I think back over my career and the way I used to treat these diseases, gonorrhea and chlamydia in particular, and just how much that has changed. I used to send people home with a couple pills or they'd take them in the ER, and it's like, "Okay, you're good to go." Now, we're giving larger and larger doses of antibiotics as a shot and longer courses of antibiotics that they take at home. So I've clearly seen that just in my career in medicine.
Dr. Smith: I think Troy said he doesn't see as many STDs in Utah, and where we're located, we are below the national average. We're about 50% of the national average for cases of gonorrhea and a little bit higher than that for chlamydia.
And the most recent data we have is from 2020. There were 3,000 cases of chlamydia in Utah, and Salt Lake County is almost at the national average. And then you've got gonorrhea cases, we're at 1,000. HIV cases in Utah, we're said to be about 28. And then there are a bunch of other diseases like . . . Syphilis had 33 or 35 cases.
And so national average is double most of those numbers, if not a little bit more. So we do have a problem in Utah. We just don't see as much of it as maybe other parts of the country.
Scot: And if an individual gets an STD and doesn't get to it in time or the treatments don't work, what kind of sort of gnarly things can happen? Now, this is where Mitch could probably describe some of the photos, I suppose. I don't know.
Mitch: Safe search on, go Google them on yourself. Listeners, everyone else, just do yourself a favor and then you'll always use a condom. I promise.
Scot: All right. Dr. Smith, do you have words that you'd like to put to that?
Dr. Smith: I have no words for that. I think if you see it, a picture is worth a thousand words. But I think that there are consequences to these things. They can cause infertility, especially in female partners. You can have other issues, rashes, fevers. Brain, heart, and liver damage with syphilis. You can get tertiary syphilis, which causes dementia. Those are the long-term consequences if you were to not do anything with, say, syphilis.
Gonorrhea and chlamydia, less problems long-term other than you're going to be giving it to any other partners that you're with, which is kind of irresponsible and rude.
Scot: After you're treated, are there lingering effects that you can have from any of those?
Dr. Smith: Well, if syphilis has already hit secondary or tertiary, sometimes there are longer treatment times, but most of the time, just getting treated . . . You may still have some urinary symptoms for a short duration, but usually things clear up for the most part.
Mitch: So I guess one of the other things I kind of wanted to talk about as we kind of wrap up this is when we talk about prevention, there are sometimes some really strange ways that people think that it might help prevent things. And it seems, to me at least, always to work around condom use.
But Dr. Smith, is there any validity to, say, washing yourself after sex? Does that help prevent sexually transmitted diseases from going from one person to another? Or is it condoms and I guess correct condom use that we really should be championing?
Dr. Smith: I think if we're going to champion something, it's got to be the correct use of a condom. Putting them on the right way. If you go to put on a condom, you put it on upside down, throw it in the garbage, put on a new condom, and do it smart. They're not that expensive. Let's get serious. Especially if there's a chance you could end up with something big, bad, and not fun.
As far as washing goes, I haven't seen any literature that specifically gives a robust, "Hey, if you go home and scrub your genitals with Hibiclens for five minutes, you're decreasing your risk if you had unprotected intercourse." I think that's where some of the medications that are out there for prevention after the fact come into play.
I'm happy to look into that and get back to you on another episode if that's a real thing. But I think if we're going to champion something, it's to use a condom, be smart, keep your genitals out of harm's way. That would be kind of my 10 cents.
Scot: How often does improper use actually cause somebody to get an STD? I mean, you kind of brush by very quickly what you should do. Are there a lot of steps to use it properly for STD prevention?
Dr. Smith: No. I mean, it only rolls one way.
Dr. Smith: If you've never put on a condom and you try to roll it on the opposite way that it's supposed to go and there's any chance . . . I mean, why would you take a chance?
Scot: Is it a coverage thing? I mean, what's the difference between proper and improper use for preventing STDs with condoms?
Dr. Smith: Well, putting on a condom that's the correct size, number one. Number two, never put on a second condom, the friction will break both of them.
Troy: So double-gloving is not recommended.
Dr. Smith: Yeah. Double-bagging is not a good idea.
Scot: And the right size is so it doesn't come off during, right?
Dr. Smith: Correct. Yeah. And if there is a mishap during intercourse, replacing with a fresh condom or just ending that intercourse episode, just being smart in that way.
Looking at some of the spermicidal things, things like that that people use, they may not look at it. It may degrade. The condom, those are less and less likely to occur nowadays because most everything is safe to be used with the latex condoms. Knowing that some people who say, "I have a latex allergy," there are other things out there like lambskin condoms. Those are not foolproof for preventing STDs.
Scot: So do not expect that.
Dr. Smith: They'll prevent pregnancy, but they're not going to . . . I mean, you're washing that thing afterwards and reusing it. If you've never seen one of those, you can Google that too. They're not super common, but I have had patients ask me about them because their partners have been allergic to latex. There are non-latex condoms out there as well. And so those are things just to keep in mind.
Scot: All right. Well, I think we're at a position where we can wrap this up. Hopefully, the point has been made that this is something that men should be aware of, not only for their own health, but you don't want to be spreading this stuff around, like Dr. Smith said earlier. It's just kind of irresponsible and not cool.
So any particular takeaways, any insights? I have a feeling I'm probably the one that learned the most, but let's start with Mitch.
Mitch: It's interesting to me, when I was doing some of this research, just coming across some of the most common questions. There are blank spots for men I think in . . . I think what we're mostly told is, "Put a slicker on and you'll be fine," when it's really like, "Oh, man, there's more that needs to be thought about and talked about." I was shocked at just some of the misinformation and lack of education that some guys have had.
And then we just don't talk about it ever again, and so we carry on not knowing what we could be exposing ourselves/our partners to and how to be safe.
Troy: Well, I think the things Mitch talked about with testing were really eye-opening because I think a lot of people aren't doing that, I'm sure. And my recommendation and my thought, and Mitch, correct me if I'm wrong, would be if you've listened to this and you're thinking, "Wow, I really should be doing that and I should be getting tested," I think you can just call the health department, your county health department, head right down, they can do the testing for you.
And I think exactly like you said, Mitch, if you're getting tested regularly, if you're having multiple partners, that's something that you really should be doing.
Scot: I learned that I was lucky because I never had one. Although I guess I was practicing some safe practices throughout my wild oats sowing period. So that's good.
I think the talking thing would be difficult, but I can see how that would definitely be valuable.
And I guess my biggest takeaway is I'm glad I'm not out there and have to worry about this as much as some people might, because it sounds kind of scary. Super gonorrhea does not sound super fun, if you know what I'm saying.
Mitch: No, not at all.
Scot: Yeah. Dr. Smith, any last thoughts that you'd like to leave our listeners with before we sign off?
Dr. Smith: No, I think we've covered it. I think the biggest thing is just to be smart.
Scot: And maybe educate yourself. Maybe you need to go surf a couple reputable websites and learn what safe practices are and safe behaviors are in addition to what you've done here, and just protect yourself. Be safe. Be smart.
Dr. Smith: Absolutely.
Scot: All right. Well, thank you very much for listening. We do appreciate it. If you have any questions, you can always direct those to firstname.lastname@example.org. Thank you for listening, and thank you for caring about men's health.
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