This Dude Vasectomized Himself! Meet Dr. Esgar Guarin, the Evangelical Vasectomist

Paul Shapiro: [00:00:00] Welcome to the business for good podcast to show where we spotlight companies, making money by making the world a better place. I'm your host, Paul Shapiro. And if you share a passion for using commerce to solve many of the world's most pressing problems, then this is the show for you. Hello friends, and welcome to the 90th.

Yes, the 90th episode of the business for good podcast. First, let me give a shout to Andrew from the bay area who I recently met at an event at mission Barnes. It's a cool startup that is cultivating fat without animals. And he recently told me that he read one of the books that I had recommended on the show tender is the flesh, which I said novel that I absolutely loved, and I do highly recommend it.

So Andrew, thanks for listening to business for good. And I'm really glad that you enjoyed reading tender is the flesh now. Some of, you may recall that in episode 88, we discussed family planning work going on in Nigeria. Well, in episode 61, we also met your choice therapeutics, which is pioneering new ways for both men and women to take control of their reproductive destinies.

But as I said, in [00:01:00] episode 88, we would soon be talking more about family planning right here in the United States. And so here we are. So what about current options for contraception in places like the good old S of a, well, I had mentioned in your choice therapeutics that for men today seeking to avoid impregnating women, there really are only two options, condoms and vasectomy.

Of course, a lot of people, men and women are like, just don't like using condoms. So the question becomes who is going to be responsible for preventing pregnancy, the. Or the woman and in the us and most of the world, that answer falls unequivocally on the woman. In fact, the ratio of tuba allegations, two VAs activities is nearly 10 to one globally speaking.

Despite the fact that a tuba allegation is a much more invasive procedure that requires general anesthesia, whereas a vasectomy takes mere minutes and it can be done in an office as opposed to a hospital. And there are even scalpel free methods that are now available. So our guest on this episode, Dr.

Esgar Guian is on a crusade to promote vasectomies, and he even gave up his [00:02:00] previous medical career to focus on simply being a full-time VAs, sexist as part of his commitment to making the world a better place. That's right. His entire business is one thing. And one thing. Helping men take greater responsibility in their reproductive lives and avoiding unwanted pregnancies.

But it wasn't enough for Dr. GU to have a doctor's office in Des Moines, Iowa, specializing in vasectomies. This guy has now gone out and built the country's first ever mobile vasectomy clinic, where people can come knock on the truck door and get a vasectomy on demand the message lazed on the side of his vasectomy.

Mobile says one small snip for man one giant leap for human kindness. While this is his livelihood. Dr. Guardian also travels throughout Latin America, performing vasectomies for free and promoting world vasectomy day, the movement and get this, this dude one Friday night even decided to vasectomies himself.

Yes, you heard that right? He auto sterilized now. Is hardcore. Dr. [00:03:00] Guardian's message is very queer. Vasectomies are so simple, so fast and so easy that even he could do it just himself at home alone. In this episode, Dr. Green dispels myths about vasectomies, that will be reassuring to men on the fence. Yes.

You'll still keep your balls. Yes. You'll still produce the same amount of testosterone. Yes. You'll still ejaculate the same amount of steam and yes, you'll still have the same blood flow when you need it. The most. What you won't have is the possibility of creating an unwanted pregnancy. I am super impressed by the way that Dr.

Godin has turned his conventional medical career into an evangelical movement to spread the good word about the benefits of vasectomies. As he points out the number of reasons to get a vasectomy are vast. Maybe you've had kids and don't want anymore. Maybe you've decided you'd rather adopt a kid who needs a family rather than bring another human into an overpopulated world.

Maybe you don't wanna raise any kids at all, either way. Dr. Guian has a message welcoming you to come join his movement. So enjoy this episode hearing from the face of the [00:04:00] international movement to popularize vasectomies. I now bring you

Dr. Esgar welcome to the business for good podcast.

Dr. Esgar Guarin: Well, thank you very much both for having me here. Very excited to, to share some time with you. I am

Paul Shapiro: excited about this, cuz this is a topic that is near to my heart. And I guess it's also near to another part of my body that we'll be talking about because you are a fulltime, VAs, sexist.

I didn't even know that such a thing existed. But that's not what you've always been doing. So I know that you've had quite a storied career. So let's just talk briefly. What were you doing before you were just sniping men's Fest Rines?

Dr. Esgar Guarin: Well, I, I have to tell you Paul, that no full-time VAs sexists.

There are, there are some around. Okay. Vasectomies are a procedure that, you know, are part of the arsenal of procedures that many surgeons have or many physicians

Paul Shapiro: have. I don't know if you wanna use the word arsenal when you're talking about vasectomies man, like, you know, it's a, you know, it's not [00:05:00] a weapon, you know,

Dr. Esgar Guarin: well was not, but it's, it's part of the repertoire, I would say.

Great, great. Thank you. The repoire of procedures that that many physicians have. In fact, in, in, in the rest of the world, the vast majority of vasectomies are performed by general physicians and, and, and family doctors that are places where actually these procedures are, are performed by gynecologists that are procedure.

These procedures are mostly in, into the repertoire of the urologist because they focus on that area of the body. So there, there

Paul Shapiro: are some people who get a vasectomy from a gynecologist.

Dr. Esgar Guarin: Correct. For example, in Ethiopia and in Guatemala, 75% of the vasectomies are performed by gynecologists. And, and if you think a little deeper into that, it makes total sense.

Paul Shapiro: Is there a shortage of ologists or no? No.

Dr. Esgar Guarin: It's, it's been it's been more, the, the opportunity to perform those procedures have, has been there [00:06:00] more for the gynecologists because of the proximity that they have to the family when they are going through the process of pregnancy. So when you think about the interventions that women have gone through, or they go through in terms of reproduction and contraception in general, you know, the gynecologist is not in, in, in actually a bad position to offer a procedure that is definitely less invasive and, and, and offers greater benefit for the woman, obviously, because she doesn't have to get it.

But in general, because the procedure is so simple that he's probably a good person to offer that procedure. So it really shouldn't reside. In, in, in one particular specialty. Now some of us have decided to go into just doing this procedure for specific reasons, and we can chat about those reasons that I have had,

Paul Shapiro: Later.

What, what type of a doctor were you prior to being a full-time vest here?

Dr. Esgar Guarin: So I, I did my medical training back in Colombia, where I'm from. I, I went through medical school there and then after [00:07:00] I finished medical school and fulfill a requirement in, in my country that is expected from every single person who graduates from medical school, which is going to a rural setting in the middle of nowhere and work for the government for a year so that we can get our license.

I came to the state following my wife she's a microbiologist and she went to she's colo as well. She went to the university of Maryland to do some training in immunology and ended up staying there. So what was supposed to be a short period here back in 2002, 2003, ended up being the rest of our lives in the United States.

And, and at that point I decided to start doing all what is required for me to be able to do my specialty training in the United States. Initially during medical school, I was very interested in psychiatry. Human behavior has always been extremely interesting to me. My first love I'd say was [00:08:00] anthropology.

I really wanted to get into anthropology, but in, in, in Columbia, I guess I was very shortsighted and, and, and, and didn't think about the possibilities of what I could do with anthropology. And the next best thing for me was medicine, which is basically an anthropological study of, of, of diseases. So during medical school, I just, I was so interested in psychiatry, but that year that I spend in Colomb in the middle of the mountains, far away from the big city, working for the government, changed my view of what I could do with medicine.

And I had to take care of pregnancies. I had to take care of elderly patients. I had to take care of injuries and, and it was a very, very interesting and. Experience. So when I came here and I was thinking about what I wanted to do in terms of a specialty training, I, I learned about this thing called family medicine, which was not a thing in Columbia and Columbia.

You know, the role of a family physician is done by GPS, [00:09:00] which are people like me back then who graduated from medical school and started working. Yes, we are ill prepared for many things. Cuz a family physician has, has more preparation for, for us to be able to tackle a little more complex diseases. But it was very interesting.

So I, I chose to do that and I was, I was very interested in focusing my work on my maternal and child health. There was no, there's no such thing as pediatrics and obstetrics combined. So the. Thing to combine that with family medicine. So I went with that and and then after I finished that, I, I, I wanted to continue to have more training in, in the obstetric part of, of, of what I was doing.

So I went ahead and did a, a two year, two additional year fellowship at brown university in, in Rhode Island, in maternal and child health. And I was always interested in, on reproductive and reproductive health because of what I was doing. Obviously, if I was interested in pregnancy, I by [00:10:00] default was interested in, in reproduction.

And what was very interesting to me in terms of reproduction was just the provision of services that were not as invasive. And that were, that that were simple enough that you could provide with a huge public health impact and reproductive health impact. So I was very interested on, on the provision of vasectomies for, for, for that very same reason.

But being in the east coast was a little, let's say malignant for me to try to get that kind of training and vasectomies, because there was always this thing of, oh, you, you must be. And that happens in this country. You must be a urologist to be able to do that. Well, no, I need to know the anatomy and I need to a acquire the proper skills to do the procedure adequately.

So during residency, I try to get that training and it didn't happen.

Paul Shapiro: Doctor, let, just ask you, so why vasectomy? Like I, I understand that you were [00:11:00] interested in reproductive health, but you know, so a lot of people who have particular interests, you know, my uncle for example, became really interested in foot and ankles.

And that became like his thing. He was a foot and ankle surgeon. He's now retired, but that was like his thing, just foot and ankles. You thought, you know, I wanna sterilize men. why, why, why was that the thing that you wanted

Dr. Esgar Guarin: to do. Well, that's the thing. So it, it, it, initially it was, it was having that as part of what I was doing, you know, I was able to do eventually, after my fellowship in maternal child health, I was able to do two allegations.

I was placing IUDs. I was placing the implants and, and it was, it was nice to have that because it was a very simple procedure with a huge impact, as I said earlier. But after I, I was full on practicing on my own, and I was delivering, you know, 90 to a hundred babies a year, and I got to see the difficulties that women go through.

That that urge to do more [00:12:00] vasectomies, to include men more into that contraceptive equation. It became a, a very important part of what I was doing. So seeing the difficulties that women go through by just taking simple or contraceptives by using an I U D by having to deal with an implant by having to deal with a pregnancy and giving birth.

And yet we are there as men only having fun, making the babies and not participating anymore was kind of upsetting. It was kind of frustrating to me. And, and I was, and again, I was interested on, on, on the idea of doing this vasectomies for quite some time. I, I have to tell you this. And I had mentioned this before elsewhere.

The very first time I heard the word vasectomy, it was, I was probably about 10 years old, 11 years old. And my mother demanded that from my dad. And when I saw the expression on my FA on my dad's face and the way he [00:13:00] reacted about that demand, cuz she was pretty open about that demand. I realized at that tender age, that that word bear was, was having a, a, a huge weight and a real big impact on, on men and in general.

And I wanted to know that. So I understood obviously what it was when I was in medical school. And later on, I, I realized that it, it would have a, a tremendous impact on trying to balance that that relationship between men and women, in terms of contraception contraceptive decisions and reproductive health in general.

So, I, I, I, I guess I had since a very early age, this curiosity about what the vasectomy was, and eventually, you know, I realized the, the, the, the huge impact and the applicability data vasectomy had. and, and having that experience with women, you know, seeing what they went through was, was extremely, extremely important for me to [00:14:00] make that decision of moving on to just doing it.

But it was difficult to, for me to leave everything that I was doing before. Right. Cuz I was doing a lot of maternal on child health and then I dropped everything just to do vasectomy.

Paul Shapiro: Right. I mean, you could almost say it was a whole new ballgame for you. Sorry. I could not I could not resist. Alright, so you, yes.

Thank you. So you wanna get into this whole new ballgame of just doing vasectomies, but I just wanna chat for a second about this disparity between men and women and the issue of, you know, who is responsible for contraception because we, you know, we've done a past episode on this, on male contraceptives, basically there's condoms and there's vasectomy.

There's not a lot else out there for men. Whereas women have a, a multitude of options, many of which you just named, but all of them are pretty Have, you know, substantial potential side effects. It's not that they're bad. It's not that you shouldn't do them, but you know, taking the pill is, you know, does have some effects.

And so the question is how can men be more involved in [00:15:00] prevention of unintended pregnancies? And I think for a long time, a lot of people have thought of, of vasectomy, like your father as this invasive surgery, something that might come from an arsenal of weapons, that is going to have all types of Dori effects.

It's gonna be painful. It's gonna cause all these problems for you. But you are maybe the country's leading evangelical for vasectomies. And so just do us a favor here, doc, and just dispel some of these myths. So you're doing vasectomies that don't even have a scalpel. You don't even use a scalpel.

It takes mere minutes to do so. Tell us, like, what are you doing and why would somebody who doesn't want kids not want to do it? Well,

Dr. Esgar Guarin: let me, let me answer that in, in two, in two parts, the first part is you were talking about the disparity that exists and, and I think that needs to be highlighted because it, it is true that we only have two contraceptive methods that are currently effective, that we, as men can, can use.

And it's condoms and [00:16:00] vasectomies. The, the disparity that I'm talking about is not just about the fact that we only have two methods is the fact that I, I, I focus specifically on, on the issue that when the time comes for a permanent decision, men are not stepping up to the plate as much as women do.

And then let me put it in perspective. When we look at the numbers, according to United nations, during 2019, the number of vasectomies that were performed through around the world based on, on, on survey data was approximately 16 to 17 million in the entire world. by comparison. That's nothing. When you see the number of tubal allegations, we're talking about 219 million tubal allegations during the same year.

Paul Shapiro: So Al almost a 10 to one ratio.

Dr. Esgar Guarin: That is correct. What that's telling you is that the participation of men, when it comes to a permanent decision is, is, is not even a 10th of [00:17:00] what, what women are. We are not advocating necessarily for more men to be sterilized just for the sake of sterilization.

Right. Let's just for a moment. Sure. Just for a moment, let's set aside that. Yes, it is too many of us on the face of the earth with 7.8 billion people. Let's let's just assume that that's not an issue, but it is, but let's assume

Paul Shapiro: that that's a big, that's a big assumption, but okay. For the sake of this next few minutes, we'll assume that.

Yeah,

Dr. Esgar Guarin: no, but just for, for just 20 seconds, we're gonna assume that that's not an issue. If we look at, at the fact that there are approximately 230 235 million sterilizations, right? In general, including vasectomies and tub allegations, we are not advocating ag personally. I'm not advocating. increasing the number of sterilizations overall, right?

We need to think about how many of us are in on the face of the earth. That's fine, but I'm not advocating necessarily for just more sterilizations. What I'm advocating for is [00:18:00] more male sterilizations when the decision is made for no more children at the expense of reducing the number of tubal allegations.

So we could say that instead of having 230, give or take million sterilizations per year, we'd only 16 million vasectomies. We can have, you know, 150 million vasectomies and 150 million tub allegations. It's just balancing that equation a little bit more to, for men to show that we can actually be part of, of, of that contraceptive definitive decision when the time comes to making it.

The the, the modern methods of contraception have been wonderful. And they have been the reason in many places for a decrease in the use of certain methods of, of permanent contraception and the Apollo, for example, which back in the seventies, contraception with a vasectomy was extremely popular. It went down [00:19:00] the use of vasectomies went down considerably.

Once the mother methods of contraception were introduced. And we're talking about an, an intrauterine device, the implants, the pills, the injections, because there were more, there was, they started using them more and then there was no need for that. But when you look specifically just at the numbers of sterilizations, it turns out sterilizations in women aren't have not DEC.

You know, you could argue that women have been using more, have been, have been taking more ownership on the the control of their, of their fertility by using this, this methods of, of, of modern contraception. But what it seems to me is that men little by little have been, have been getting out of the whole discussion.

Is it the medical establishment telling us, oh, that's not your thing to do. It has to be the woman, or is it as using that as an excuse? Not to be part of it. [00:20:00] I don't know.

Paul Shapiro: Isn't there, isn't there a big difference though, in that ratio between vasectomy and tubal allegation between the United States and Canada,

Dr. Esgar Guarin: it is in fact in the United States, the ratio is about one to two to three.

That is one vasectomy. When, when there's a vasectomy done, there are about two to three tubal allegations done in the United States, in Canada, in, in, in other countries like the UK and Australia. The, the relationship could be actually the opposite in Canada. For example, for every tuba allegation that are tub vasectomies.

And if you go a little bit more specific in, in for example, in Quebec city, in Canada, the ratio is about one tubal allegation per every five vasectomies or so. Wow, fascinating.

Paul Shapiro: So if you're looking at this as the UK, Canada, Australia, I mean, Canada and Australia never rebelled against the UK and had a revolution, whereas the us did.

And we went on our own path. And part of that path, I guess, was favoring tubals as opposed to [00:21:00] vasectomies, but let's get in here doctor to chatting about what this is, because you know, a lot of people. They, you know, they hear vasectomy and they think you're gonna cut their balls off. So, you know, they say, oh, that isn't, that what we do to dogs and cats.

You know, when we when we spay and new to them, when we new to them, that's the vasectomy, but that's not a vasectomy. Right. So what is it and briefly, and how do you do it? That is different from what's been done in the past.

Dr. Esgar Guarin: The 22nd explanation of a vasectomy is this, the testicle produces sperm and produces testosterone.

The production of testosterone, which is the, you know, the male hormone goes through a different channel. Going through the blood vessels. The production of sperm goes out of the testicle through a tiny little tube called the vast deference. And it ends up communicating with the urethra, which is that tiny pipe that brings everything out, you know, the urine and the semen out.

So the vasectomy is nothing but cutting that tube and disrupting the communication between the testicle and everything else.

Paul Shapiro: So they're not, it's not going, so it's not going to interrupt testosterone production. [00:22:00] That's correct. And the volume of semen that is still coming out is the same. It's just not having there's, it's just not having sperm in the

Dr. Esgar Guarin: semen.

Correct. So virtually the same, because you have to remember Paul that 95% of what comes out in an ejaculation, 95% of that liquid that comes out comes from the prostate and the seminal vesicles, which basically are there to nourish and support the sperm that is coming from the testicles. Only 5% of that semen in the ejaculation is coming from the testicles.

So virtually there is no difference in the amount you have to remember that every ejaculation is about 2.5 to five CCS overall in general. So it it's, it's nothing that you see of a.

Paul Shapiro: So just to be clear, you're not cutting the balls off. No, the testosterone is the same. Mm-hmm the ejaculate is essentially the same.

You won't have any hormonal differences. The only thing is that your semen will not have sperm, so you cannot impregnate somebody.

Dr. Esgar Guarin: You're talking something else. And forgive me for [00:23:00] interrupting you. But I think this is extremely important because it, because in the collective mind of men, deep in deep, in the back of the collective mind of men there's this hidden fear.

It doesn't matter how much we read about vasectomies and how much we learn about them. That things might not work the same. So I need to highlight the fact that erections are not going to be effecti either. So no problems with testosterone, the only way for me to affect the testosterone is ripping out the testicle out of your squittle SAC and that's not gonna happen.

And there's no way that the, the, the there's gonna be an effect on, on erections because we don't affect the blood vessels, feeding the, the penis when it gets erected. So there's no effect on that.

Paul Shapiro: Okay, got it. Now in the past, you had to cut these scrotum open to get to the Rines and that's what they were doing, but you don't even do that.

Tell us what are you doing and what is becoming more and more commonplace for vasectomies now? Well,

Dr. Esgar Guarin: this is the sad part of that, Paul, because this technique of no, no scalpel technique is a technique that was [00:24:00] invented in the late seventies, by Dr. Lee chiqua, who was a, who was a urologist back in China.

He came up with this brilliant idea of sharpening, sharpening a, a forceps, which is kind of like a. That was blunt in sharping. It enough that you can,

Paul Shapiro: we, we, we need a better word than clamp here, cuz no man wants a clamp on their scum. Right. But what's better.

Dr. Esgar Guarin: I'm trying, I'm trying to, to think of an instrument.

Paul Shapiro: Yeah. A it's like a massage. Let's just say it's like

Dr. Esgar Guarin: a massage. And this is, imagine, imagine is, is, is like, well, I, I can't think of any word better, cuz if I use the word pliers, it's probably not going to make anybody relaxed. But yeah, that sounds fun. This instrument actually it is very sharp on pointing.

So by, by doing that. You actually penetrate the skin like a needle. Imagine how a needle gets into your [00:25:00] body. You, you put a needle in your arm and then when you take it out, the skin kind of closes on its own. You might drip, a tiny little drop of blood, but the, the skin actually closes. And that's because when you are entering the skin with the needle, the trauma that happens onto the skin is very minimal, right?

It's a kind of a progressive trauma. Whereas when you use a, a, a scalpel, you have to disrupt the skin, you have to cut it and, and a classical approach of, for a vasectomy. You actually make two incisions, one in each side because we have to vast deference and, and then you perform the procedure and then you have to close that because when you break the skin like that, when you cut the skin, you have to put it together, which means you have to thread a needle through the skin and put a stitch doing that increases more trauma.

So Dr. Lewan thought, well, what if we just. Penetrate the skin as if it were a needle, right? And then spread the skin by spreading the skin. You don't break anything. You just spread the fibers of the skin and use that [00:26:00] opening one, single opening to get each one of the vast D friends there and perform the, the vasectomy and then send it back in.

It is so tiny. The incision we're talking about 10 millimeters, less than 10 millimeters, which is less than half an inch. That if you hold pressure 30 to 60 seconds afterwards, you don't even need to put any skin glue or sutures to close the wound. So the trauma's less. And we don't. And we know that for a fact, because many have looked at the evidence.

And for example, one of the dread complications of the vasectomy is the collection of blood. In, in, in this Chron, it's called a hematoma. If you do a classic classical intervention with scalpel and put in sutures, The chances, even in the hands of an experienced surgeon could be up to 3% of having that.

When you do a known scalpel technique, the chances go below 1%. Which is great.

Paul Shapiro: So it still, that's a pretty [00:27:00] minuscule percentage, no matter what, you have a 97 to 99% chance of no hematoma. Absolutely. But how long does it take for you to do this? So some guy comes up to, you says, Hey, Dr. Guian, I'm wanting more kids, or I don't want any kids.

How long is it gonna take you for the time he walks in to the time you're done?

Dr. Esgar Guarin: Well, the, the actual pursuit takes 10 minutes. That's okay. All right. 10 minutes. But I, I, I personally spend about 30 minutes with the patient because I like to well, you know, when you, when you are given the privilege of grabbing this Crum of someone with sharp instruments, you, you ought to take that, you know, with all the seriousness seriousness, you, you can, and, and you have to take your time to talk the patient through the whole process.

You know you have to remember Paul that this is all I'm doing now. So all these patients come to see me once. And once only, I really don't want them to come back. because if they come back, that means there's a problem. Or if they come back, that means that it didn't work. So I need to make sure that [00:28:00] it is, I guess, I don't know if I can use this word, but that the whole experience is unforgettable in a good way.

So , so I give them 30 minutes, you know, even though I could do the whole thing faster, I give them 30 minutes, I stay there, talk with them and then I prep him and do the procedure in 10 minutes and then the rest of the time is just chatting, but it, it okay. Totally takes.

Paul Shapiro: Right. All right. So 10 minutes you don't even have to inject any type of pain relief, right?

It's just like a topical spray. Isn't that? Right? No,

Dr. Esgar Guarin: not that it's not a topical spray. Actually what we do we, we use a precious spray device applicator. I use that. I mean, you can use a needle as well for the administration of. The anesthetic. And in fact, a very good friend of mine, Dr. Michelle Breck from Quebec in Canada uses a, what he calls the mini needle technique, which is a super thin needle about a 30 gauge needle, which is thin as thin as those use for insulin administration.

That is almost imperceptible for the patient when you use the needle and, and provide [00:29:00] the anesthetic. What I use is a, is a pressure spray device applicator that pushes the anesthetic at a very high pressure, close to 1200 PSI. You can imagine how hard that is through a very narrow stream of fluid.

And it's so thin and so much pressure that it pierces the skin down to a depth of about six millimeters. And the vast difference is right under the skin. So it hits the vast difference and it numbs the VA difference. Right?

Paul Shapiro: So I see. So you're not injecting a needle. You're basically just forcing the the liquid in there.

Okay. Okay. Got it. So let me ask you then, like, how did you decide to go from being a doctor who's just performing vasectomies to becoming an evangelical because you've created the country's first ever mobile vasectomy clinic where you're driving around just encouraging people on a whim to come up and get a vasectomy.

Correct. So what happened? Like how did you go from being a doctor who does vasectomies to being the face of the

Dr. Esgar Guarin: vasectomy movement? Well, one of the criticisms that I had regarding the performance of [00:30:00] vasectomies was doing vasectomies. Kinda like on this side as part of what you were doing as a, as a doctor and, and taking care of pregnancies, pregnancies are very demanding.

They, it's not that a PA pregnant patient will wait for me. It's like, I need you now. And, and, and I don't care what you're doing come, cuz my baby's gonna deliver. So I, I, I was, you know, on the go all the time with these patients, but I really wanted to provide this service. And it was the experiences that I was having with my pregnant patients, seeing the difficulties.

And and, and there was a particular time over the course of two years that I delivered five PR five different women pregnant by the same. That really got me thinking about all this. It was, I mean, it was so bizarre that I, I, I don't think I, anybody could have written this, this whole experience of the two years with this five women, you know, initially they all hated each other because, you know, you took him away from me.

Oh, he's with me now. And I [00:31:00] had to hear that, cuz I I'm the kind of guy who talks a lot with the patient. So I knew all this stuff that was happening and, and, and, and eventually they all became friends because they all hated this individual because he left it. And, and, and I had had the opportunity to engage with this gentleman at a certain point for a, a minuscule thing, like a sore throat or something.

So I, I actually had developed a relationship with him. So I approached him. I took advantage of that relationship and approached him. And I said, look, I couldn't have been any more blunt with this, this, this person. And I said, you, you need to, you need to, you know, consider your options. Let me give you a vasectomy.

And and, and opposite to what I thought was gonna happen. Cause I really thought he was going to say something like, oh man, don't do that. It's not my thing. He was very nice. And, but he said no. And I inquired a couple of times about why, and he wouldn't answer it. And obviously I understood I could not push that.

It's not, it's not [00:32:00] my place to do that. but I felt that it was the, one of my biggest failures. I, I, I, I saw that that was not fair for the women that was not even fair for the guy or not that he was paying child support anyways. But it, it got me thinking about what the barriers were that were limiting men from making a decision that when rationally, you think about, it seems like a no brainer, right.

You know, it's 10 minutes. I go to a doctor, 10, 10 minutes, I get it on the local anesthesia anesthesia. It really doesn't hurt. You know, it's better than for a woman to go and get it to a allegation. And, but men still don't do it. So I started thinking about the barriers and, and there's a really good book called the human element by, by Lauren nor grant from, I think it's Northwestern university and the administration the business administration department that talks about frictions, you know, and, and I started thinking about the frictions that men face when.[00:33:00]

Have to make decisions or they wanna make decisions in terms of contraception. And particularly with vasectomy, I realized that there were frictions. You know, I know those of my species. I know those of my gender. And, and, and I know that for something so intimate, you don't wanna talk to a, to a, to, to a receptionist.

You, you want to talk to the person who can give you the answers. You don't want to go to a doctor and, and get, you know, a, an evaluation for five, 10 minutes, and then told, being told that you have to come back in a month for the procedure. And probably a month later when the procedure will be done, they tell you, oh, the doctor has to cancel because he has a more important surgery.

to do, which is fine, but then it delays everything. When, when a man says I'm gonna get a vasectomy, he wants to get it done, period. It's not that a man wakes up one morning and says, Hmm, I think I wanna get snip. And then he gets it done. No, he's been thinking about it. And then, so, so you want to reduce any barriers?

So thinking about those [00:34:00] barriers, I, I came up with this idea of, of making a whole model that was gonna make things as simple as possible for the individual to make that decision. So that at the end of the day, there is no excuse for someone to not get a vasectomy. And, and if the patient doesn't want to have the vasectomy, which is totally fine, it's just because he doesn't want to get it done.

Not because there are barriers, not because it is too expensive, not because you, I have to talk to two, three people before I talk to the doctor. Not because I have to wait two months to get the vasectomy done. Not because I have to. You know, bring a sample within 45 minutes to a, to an office after I've gotten into vasectomy, all those barriers need to be taken away.

And also it was important for me to provide adequate evidence based information and bring so to speak out of the closet, the whole discussion of vasectomies. I think that women, because of what they have to go through with visits [00:35:00] to the gynecologist often, and, and, and allowing somebody to, to, to, to a certain extent, violate their intimate space, by letting them use a speculum and placing instruments down in the general area, they are more open to have discussions about this.

And the example is this, Paul, if you have a woman who gets an I U D and, and, and probably she has a good experience with one of these IUDs with, with, with progesterone that gives them very little bleeding. , they will talk about it. You know, they get together and then they are with their friends and they say, oh my gosh, I got my I U D and I am so happy.

I haven't had a bleed for three months and they talk about that openly. And then the conversation goes on onto all the things men don't do that we don't talk about it. And the reason is because of that deep fear that we have a, about that vulnerability that, that we feel we are gonna have if we let anybody know about it, because they're gonna [00:36:00] think that things are not working the same for me.

And, and to me, those barriers and, and those fears needed to be needed to be addressed. So I changed the way the, the, the vasectomy, at least in, in the clinic that I ended up developing the, the way the patient could access the procedure. So I made it as simple as possible and smooth process. And I said, I need to talk more about this.

I need to, I need to bring it out of the closet. As I said earlier, we need to normalize the discussion of vasectomies. And from the experience that we had had in, in, in Mexico and Indonesia, from what you see in the literature and the power where using mobile units increases the uptake of reproductive services.

I said, we have better roads. Clearly they need some, some work, but there're better roads that in any of those countries, I, I just mentioned why don't we use a mobile unit? Why don't we use a mobile unit to go around just raising eyebrows every time they see [00:37:00] the mobile unit and actually doing the procedure in the mobile unit to convey the message of the simplicity of the procedure.

So we basically, I, I built from the ground up, you know, finally my wife bought into that because I had been toying around with the idea since we went to Mexico with world dissectomy day, For three years and, and she bought into that and she said, all right, let's just do it because she knew it was gonna be a waste of money in, in, in the sense that it was not going to the, the return of investment was gonna be terrible.

But it was, it was part of that activism. It was part of what was driving me, you know, to, to talk about more about this. So we built it. We, there is, you'd be surprised, Paul, there is no regulation about how to build one of these things in the country.

Paul Shapiro: this, you're getting out a, in front of the regulators. I think here, I don't think they have they've foreseen what you would

Dr. Esgar Guarin: be building, gonna say something.

I mean, because I'm not doing anything out of the ordinary in there. If I, if I'm gonna do x-rays, there is clear regulation on that. [00:38:00] If I'm doing dental procedures and I need a dental equipment, I need that are regulations specific for that. But basically one of the reasons why there's no regulation on that is, is because it's an office.

It's an office in wheels, basically. That's what it is because a vasectomy. Should be done in an office setting. So we, we, we designed it. I, I found this company that was willing to work with me and, and we put it together. You know, it has a room with a sink. It has a waiting area, which is not used to the waiting area because I don't have people waiting in there.

They just come in, get the procedure and they leave. And, and there's a restaurant at there and I drive around. Is it

Paul Shapiro: still, is it still one patient per 30 minutes or is it faster than

Dr. Esgar Guarin: that? No, it's one patient per 30 minutes, because to me is the experience of the patient.

Paul Shapiro: And so you mentioned that the ROI is poor.

So somebody comes in, they say, okay, I'm ready to get sniped. What do I owe? What are they gonna pay you?

Dr. Esgar Guarin: We charge I normally charge in the office 6 99,

Paul Shapiro: 699. Okay. [00:39:00] 600, 690 $9. Perfect. And so, but

Dr. Esgar Guarin: in the mobile unit, we charge a hundred dollars less, which sound may sound counterintuitive. Right. Cause it's like, hold on a second.

You're going to the people you're, you're just taking the, the, the service to their place. Why are you far less mm-hmm because to show that it's and part is, is, is it's a joint venture with world vasectomy day. Although I say joint venture, but they've put a lot of. Emotional capital financial capital.

But it's, it's a way to show that, you know, this is accessible. Not only because I'm bringing it to you, but also because it's, it's even cheaper, is it a hundred dollars flipper?

Paul Shapiro: Right. So are you making money per vasectomy or are you offering the service for less than what it costs

Dr. Esgar Guarin: you? No, I do. I do. I, I do make, okay, so it's

Paul Shapiro: okay.

So it's still, so there's still is some profit margin thankfully for you that it's, it's not, you're not, you're not conducting a charity here.

Dr. Esgar Guarin: No, no, no, not necessarily. I mean, I have to pay the bills, you know, and, and , [00:40:00] I, I have to pay the bills. I, I just even if it were a non-profit, I sometimes I think that people have the wrong idea about nonprofits.

They think that nonprofits are not, are not designed to make money. Right. Nonprofits are designed to be designed to make money, not to yes. To the investors, not to give it back to a board of, of, of. Of people who own the company, but just to invest it again into the, into the nonprofit. Well, in my case, you know, I have to pay the bills and, and, and 5% of every single vasectomy we do, whether it's paid by insurance or it's paid by the it's paid out of pocket, 5% of that goes to world vasectomy day, which is a nonprofit that I work with, that we, that I travel with around the world, teaching how to do vasectomies and doing vasectomies for free.

So,

Paul Shapiro: So just to be clear for people who haven't heard of world vasectomy day, it began as a you know, a one [00:41:00] day out of the year, but now it's really a year round movement, right? There's no, I mean, it's in November, but it's, it's really world vasectomy day is really just vasectomy awareness throughout the

Dr. Esgar Guarin: year.

Right? Correct. Correct. So it's actually, this is our 10th year doing this. It all started with Jonathan stack. Jonathan stack is a. As an accomplished filmmaker. Documentalist and he started as many stories with filmmakers trying to document his own vasectomy. And he met the person who was, who's been my mentor.

The person I learned vasectomies from was the Dr. Douglas Stein. Visist in Tampa, Florida who was part of another organization called non scalpel, vasectomy international. And he just saw what he was doing and stuck with him for a year or two. And, and, and realized that vasectomies have a huge impact.

Not, not only from the reproductive standpoint, that socially as well. And you know, Jonathan was doing a bunch of documentaries on, on, on bad things as he describes [00:42:00] it, bad things that men do, you know, he, he would be in war zones, jails all over the world. He, he has done several documentaries in Angola prison and Louisiana.

And, and it was always showing, you know, what happens when men do bad things. And when he started traveling with, with dog Stein he began to ask every single man who was getting a vasectomy, a simple question, why, why are you doing this? And he saw that behind every single one of these guys, there was a man manifestation and expression of love towards somebody or towards something when they were making that decision.

Oh, I'm doing it because, you know, my wife has had enough, you know, we've had seven children and, and, and that she's had complications with the pregnancies. Well, that's an expression of love towards his wife. Oh, I I'm doing it because I have five children already. And, and that's just, this is all I can support or I can't, [00:43:00] I can barely support him.

Well, it's an expression of love towards his family because he wants to be able to allocate his resources in a better way. Or you have this gentleman who comes in and has no children whatsoever. And, and he says, you know what? I, I think it's too many of us on the face of the earth. I, I just don't wanna have children of my own.

And if I changed my mind, I would adopt a child. Well, that's an expression of love towards himself and towards the environment. So it was like a huge eyeopener for him. And, and then he started documenting all these experiences with people and, and they came up with the idea of doing a major event in Adelaide, Australia 10 years ago which was the very, very first world disectomy day.

And they, they televised vasectomies, you know, real time showing the procedures. People obviously were given their consent and, and, and he thought it was a good idea to to get the domain. And the domain was world is T org. And it became a second event, [00:44:00] a third event, and now we're gonna celebrate our 10th anniversary this year.

Paul Shapiro: Amazing. So let me ask you first, do you have any children of your own? I

Dr. Esgar Guarin: do. I do. I have two children. I have a 15 year old who has been a, a wonderful adolescent so far. And I have an 11 year old who thinks it's 20 .

Paul Shapiro: Okay. And are you vasectomies?

Dr. Esgar Guarin: I did. I did have my vasectomy. In fact, I did my own vasectomy.

I think what I think about six years ago, I did.

Paul Shapiro: I know. No, you performed your own vasectomy.

Dr. Esgar Guarin: Yes. And I would, I, I, I cannot take pride on, on, on saying that I'm the only one who's done it. I know of, of a good number of people who've done. Oh, and I did it.

Paul Shapiro: I mean, but you, you hear about like how doctors aren't supposed to perform on immediate family members of theirs, because you know, there could be like emotionally attached that could lead to some bad outcome doing your own vasectomy.

Tell me why. Well,

Dr. Esgar Guarin: I, I, I wanted to put myself through [00:45:00] that. I had this, this thing at every time I was seeing a a patient I was performing a vasectomy on some of them would would say, Hey doc, have you, have you had your vasectomy? And I'd be like, no, Not not yet. And, and, and there was this, this, I guess, disappointment on the, on, on, on behalf of the patient.

And it's like, oh, okay, you haven't gotten it. So it's like, you're doing this to me. You're telling me you do a ton of these and you don't know what this is. Yeah.

Paul Shapiro: Do. As I say, and not as I do. And

Dr. Esgar Guarin: you like do, and I have had that experience delivering babies with women because it is very difficult to show your true empathy to a woman.

Who's trying to push a human being out of her. And, and when you're a guy, when you're a man in front of her, and you're saying, come on, you can do this. I know you can do it. Cuz they look at you like, like you're a total idiot and they're right, right. And the only way for me to show that I really understood what they were going through would, would be to acknowledge that.

And I would tell the woman, I know what you're [00:46:00] thinking that I'm a total idiot and you're right. I don't know what this is. I don't, I will never be in this situation. And I'm so happy. I don't have to go through this because it really takes a woman to deliver a child. But I've seen many of you doing this and I know you're designed to do this and you can do it.

And then it would just make them understand that I really was meaning what I was telling him. But when it comes to a vasectomy, actually I happen to have the same equipment, you know, then the, the, the gentleman who's there in my exam table. Why wouldn't I just put myself through that too? Besides to me it was, it was.

I don't know, it seemed like a Testament to the simplicity of the procedure. I'm not advocating for people who do vasectomies to do their own by any means. And I'm not absolutely for anybody to

Paul Shapiro: get it yourself. Do

Dr. Esgar Guarin: not do it at home. You're not gonna have a

Paul Shapiro: do not try this

Dr. Esgar Guarin: at him. That's right. That should be a disclosure here.

Do not try to particular [00:47:00] at home. But, but it, I don't know. It seems like it was, it was It was a way to show the simplicity of that. It's like what I do with the mobile clinics. Like I, I can show with the mobile clinic that the mobility of the vasectomies is so great that you can even do it on a, on a unit that goes from place to place.

So I did it, it sounds so lame when I tell the story, because I, at the end of the day, it was a Friday night. I finished my clinic and I called my wife and I said, honey, I wanna get my vasectomy done. I'm gonna do it tonight. And it sounds super. And so this was after this, this was after four drinks, I presume.

No, no, not at all. I was totally sober. It may sound, I was not. But it's super sad because people would think, well, this poor guy, he's so sad that he doesn't have anything better to do on a Friday night other than sterilizing himself. So, and, and I did it my wife was there actually, cuz I called her and I said, look, I need to here in case I need to do something, I set up two trays [00:48:00] with a doubled, a number of instruments in case I dropped one.

And, and, and it was just, it took me like five more minutes, but it was, it was, it was actually surreal when I think about that. But the point here is not necessarily the fact that I did my vasectomy, you know, so I think that is

Paul Shapiro: the point actually I'm intrigued

Dr. Esgar Guarin: by the story. So people don't like me telling the story of that, but I think I, I insist on telling it just because I think it, it, it conveys that message of simplicity of the procedure.

The point at the end is that, you know, the procedure is that, is that simple, you know, compared to the alternative, which will be a tuba lation. I'm not here saying my gynecology colleagues are butchering women know they know what they're doing. Absolutely. That, you know, a tub allegation tool allegation is kinda like a bread and butter type of procedure for a, a surgeon, a gynecological surgeon, but we cannot underestimate the risks of general anesthesia.

The fact that a woman has gone through so much already, [00:49:00] and the fact that the alternative is way faster, way safer and way cheaper than tubal Allegion

Paul Shapiro: is. So, let me ask you this doc, you're running around in this mobile clinic. You're driving around anybody who wants to come up, who has like 500 bucks or so can, can get best victimized by you.

Do you ever turn anybody away? Like if a 19 year old comes up to you and says, I wanna get ized and I don't have any kids or, you know, is there anybody who you just say, Hey, listen, come back at some other time. H

Dr. Esgar Guarin: is not necessarily H is not necessarily an issue for me to turn someone away. It H itself it's is demands from me, spending more time with this individual before.

So if somebody knocks on the door of the mobile unit and says, I want to get my vasectomy done, and we're talking about a 19 year old, I probably wouldn't do the vasectomy right on the spot. I probably would have a long conversation with that. Not because I, my not because my interest is to make them change their mind.

I think [00:50:00] that in reproduction, we have to be very careful with that because we owe to respect the decision that somebody makes in terms of their fertility. But I, I have a responsibility which is putting things in perspective for that individual, right? The 19 year old. It's, it's a little, it's a little we feel as the surgeon, a huge responsibility, but this feeling that responsibility doesn't mean I.

Put on top of that responsibility, my personal bias, I have to respect what the individual wants to do, but I wanna make sure that I have adequate feedback on the potential of regret in the future. So I probably mm-hmm do that right away.

Paul Shapiro: Yeah. I mean, what, what if a 19 year old goes to a tattoo artist and says, I, I wanna get some, you know, big tattoo on my back.

Like, are they gonna turn them away? I don't think so. I agree.

Dr. Esgar Guarin: I, I, a hundred percent agree with you. What I was, what I mean with what I said is that usually cuz I've, I've had 23 year old, 24 years old [00:51:00] people men with no children who come to my office, but the process is a little different cuz they have signed up online.

You know, they have come, they, they have, I have had a conversation with them over the phone where I actually put things in perspective and then they come for their procedure. Right. But if I, if I, they knock on the door right away and they want me to do it on this spot, and if I, I guess if I had the conversation with them at the, at the time and the feedback is, is adequate, and you'd be surprised about the deep conversations I, I have had with some of these very young men about their fertility then, and I get convinced right away, I probably would do it.

You know, my, my, my gut reflex initially is like probably I would ask him to look at the consent and all that because they have to sign that consent. And then, you know, he can come back and get it done. Not because I want him to think more about his decision, but I want him to see the, the, the, the prospect of what comes forward.

One of those, one [00:52:00] of those conversations that, that, that were super deep, that happened precisely in Mexico, Mexico, during war vasectomy day, I had, I had a gentleman who came a 23 year old, finished, finished his, his university. He was a graphic designer, single child, no children. The Mexican authorities had set up a, a, a, a, had this set up that included a social worker, a GP, and then the surgeon.

So the, the person, and they were, this were people coming out the street, you know, they went through that process and he comes to me. So I looked at all the information. He's no children. I said, alright, well, you understand that this is a permanent decision. You know, moving forward, there's an increased risk of regret.

I don't, I'm not saying that you will regret it, but I'm saying that statistically, there's a higher chance that you could regret it. You might not. And he's like, yeah, I understand that. And I said, well, alright, we'll do it. Cuz it seems like you've talked to a lot of people and, and I have to respect that.

I think it's, it's, it's a matter of, of pure respect for your decision. But let me just remind you that [00:53:00] of vasectomy is a permanent decision and this guy is that true? Let me lemme finish this Paul, because part of that, he grabs my arm, looks at me in the eye and he said, I understand that doc, but it turns out having children is also a permanent decision and it cannot be deeper than that.

He's absolutely right. You could have children and you could be an awful parent. You may not pay child support. You never see your child. You're not a role model for your child, but it doesn't make the child disappear. The child is gonna be there. So why do we, I don't know, question so much making the decision of when somebody wants to make the decision of, of not having children, but we don't question that decision, that many make of having children and, and turning to awful parents.

And what you said is absolutely true too. You know, you, you have a 17 year old go to an army recruitment office and, and they don't tell him, Hey, [00:54:00] are you sure you wanna join the army? No, they say, well, sure. Sign here. and, and, and, and that's a very consequential decision in the life of someone, you know, at, at a tender age, even before they are adults.

And some people, you know, say, wow, a 19 year old should die. I'm I would never do a, a vasectomy and somebody like that, or, or 25 year old, I had a. I had a guy who was 35 and had been trying to get a vasectomy for eight years and didn't give the vasectomy because he was too young and didn't have any children that's disrespectful anyways.

Paul Shapiro: Yeah. Yeah. It's pretty outrageous. It's very paternalistic to, to deny what an adult wants to do. Even if you think that it's a bad idea. This is why I say like a tattoo artist. Generally, probably won't turn down a young person who wants to get a tattoo, despite the fact that that too is a permanent decision.

But I wanna ask you a doctor because you've said a couple times, this is a permanent decision. I actually saw, not that long ago, a billboard where I was driving. And it [00:55:00] said vasectomy reversals. And it said, call this number. And I thought, you know, that is amazing that somebody makes such a living out of vasectomy reversals.

Like how many people even have vasectomies, then let it alone, regret it and want a reversal that they're gonna, this billboard could have like a good return on their investment for them, but obviously somebody's doing vasectomy reversal. So how permanent of a decision is this? Well,

it,

Dr. Esgar Guarin: when you do a vasectomy, you have to assume that it's a permanent decision.

Yes, the reversal reversals are possible and, and there are microsurgical techniques that make it, make it to an extent easier, you know, in the hands of an experienced surgeon, but it has to be zoom as permanent. Because when we are talking about the, the effectiveness or the success of a reversal, you have to look at two different numbers, you know?

Cause we're talking about success of sperm being back into this. But that that's not translate into the success of having a pregnancy, right? You can do a reversal and you can claim an 85% success rate of having [00:56:00] sperm into the zooming again. But does it translate into an 85% chance of having a pregnancy?

It usually does not. You know, so, so people need to understand that it's a big gamble because reversals could be upwards of, you know, the lowest range could be probably $5,000 if you can get that. But in many places, for example, in California, I don't think you will find anything less than $10,000 cash.

You know, same thing happens on the other coast. So it's a very expensive procedure with a, a considerable margin of failure. So mm-hmm , you have to make that decision of getting a resection and knowing that, you know, you have, you have alternatives. If somebody, somebody says, well, what if I changed my mind?

But I'm really set on making that decision. Now an alternative could be just sperm storage, right? You can freeze sperm and keep it and pay for the, for the store, for the storage of the spring for years, you know? And you get to reflect, you can discard that later, if you just definitely [00:57:00] realize that you never change mind.

Yeah. Right. You could

Paul Shapiro: also just adopt kids. I mean, I agree with you. I, you know, there's a, there's a, there's a, there's a lot of people on the planet and there's a lot of kids who need home. So it's not that bad of an idea. Maybe just to raise an UN, a kid who has no family, you know, not that bad of a, not that bad of

Dr. Esgar Guarin: a thing.

That is what I, that is what I hear from, from, from many of these patients. But as I said earlier, my job is. Put all those things in perspective and say, Hey, these are the alternatives. I'm not gonna tell you what to do, but these are the things that you should look at as a possibility. And the case of the future regret, I would hate for, for a patient like that to, to, I don't know, 10 years down the road, if for some reason he changes his mind, I would hate for that person to say, you know what?

I went to this, this, this doctor, and, and he didn't even ask, ask me questions. He just did my vasectomy. Right. Mm-hmm I, I would, I would love for him to say, you know what? I went to this doctor. He said, this is, this is what happened. It could happen in the future. If I [00:58:00] changed my mind and we had that conversation and he was very respectful of my decision and I went ahead and did it now, I changed my mind.

Yeah. But in retrospect, I love the fact that. Put things in perspective for me and respected my decision. Right.

Paul Shapiro: How, how many vasectomies have you now done, doc? Let's

Dr. Esgar Guarin: see. I was doing when I was busy, busy with my obstetric practice I was doing about, and I was delivering about a hundred babies a year.

I was doing about 250 per year, which by, by, by the standards that I will, I would love to live by was not, that was not enough. I've been doing about 400 a year now. Wow. But, but you know, if you hang out with the people I hang out with, you know, we're talking about people who on an average do a thousand a year.

amazing about 1500 a year. Dog Stein does about 2,500 a year, but they live in different places. Right. You know, dog Stein lives in Florida, 22 million people in [00:59:00] Florida. You know, I live in, in, in, in Iowa 3.3 million people. right. It's it's just a different, it's a different mindset.

Paul Shapiro: Yeah. You, you need to be doing more of these mobile coin in Latin America.

That'll be your that'll be the way that you get your numbers up. I guess. Well, we, we

Dr. Esgar Guarin: actually go to Latin America. I've been in Colombia. We've been in Bolivia Qualo. Oh, I know. Yeah. You

Paul Shapiro: mentioned, you mentioned Mexico, which is why I was alluding to this, that you're you're said that you were doing, you said you're doing 'em for free.

Dr. Esgar Guarin: Mexicans are fantastic doing vasectomy. The problem is in Mexico that they're doing too many, two allegations. The relationship still it's about one to 10. So the one vasectomy 10, two allegations. And, and they're doing a lot of vasectomies, perhaps one of the best vasectomy programs you can find anywhere is the Mexican vasectomy program, because vasectomy is in Mexico are free.

The government pays for them. And even they, they they're, they're done by GPS. And they go through a [01:00:00] very, very disciplined and strict program of six months for them to be able to do them. And they do them better than the urologists. And

Paul Shapiro: Hey, just to be clear it's and just to be clear, it's six months on top of medical school.

It's not just like a

Dr. Esgar Guarin: six month program. No. Six months after they've become physicians,

Paul Shapiro: right? Yeah. I just wanna, yeah. I just wanna make it clear. You said this rigorous six month medical training is after they're already doctors,

Dr. Esgar Guarin: GPS, our physicians are doing got it. We have a really very well established program.

But I think the issue is that still the mentality is let's dump is let's dump this responsibility on women. Actually, we continue to work alongside the, the Mexican authorities. We have a good relationship with four vasectomy there with them. And, and it's, it's all about increasing the awareness.

You know, there's a lot of really good people in Mexico trying to push for more vasectomies at the expense of the, of, of reduction in the tub allegations, but it it's a cultural issue. It's a cultural [01:01:00] issue. And, and it's more of a cultural issue. Some places more than other places, but in, in general, there's a, a big cultural issue that, that, that leads.

Paul Shapiro: Yeah. Yeah. Well, very cool. Very cool. So you've created a whole business here, Dr. Gian on helping men to get best optimized. It's quite a impressive way that you are using the force of commerce and your own career to help make the world a better place. You mentioned earlier, a book called the human element.

Yes. As something that was influential on you, we can link to that in the show notes@businessforgoodpodcast.com. But are there any other resources that you feel have been helpful for you that you think other people might appreciate or might benefit from you dropping right now?

Dr. Esgar Guarin: Well, you, you you are very familiar with this person because he wrote the fore of your book.

You bought Harari one thing that in its. You know, it probably made me think a lot about what we're doing in the world and, and it was his book sapiens, you know, it was just, it was a terrific thing for me, [01:02:00] you know, it was, it, it took me a while to read it because I would read a portion of the book and it would shake me so much that I had to put it down.

Cuz I had to think about everything that was happening around me, around the world, how I viewed the world and I, and then I have to wait and pick it up again and then start reading and I put it again. Yeah, because it was, it was, it's very, it's a, it's, it's a very interesting book. And, and it made me think about, I guess, taking making decisions to really feel as satisfied with the social projection that I was having.

And, and I felt like I was satisfied. Because I was helping families, young families and the pregnancies and all that. But I, I was, I felt like I was lacking that social projection. Every time I came back from overseas doing vasectomies, I would come back incredibly energized. You know, it was, it was excellent.

And then I, I was just [01:03:00] slow down because I was just in the same routine of doing the same thing I was doing already with, with, with every single case of pregnancy, which I absolutely loved. I, I don't get me wrong. I, it, it was hard for me to leave all that and just do only vasectomies, but being able to do only this gave me free a ton of time for me to be able to focus on one vasectomy day, to focus on, on the projection, on, on the discussion and the activism of what I was doing.

Already. So I guess that book was, was really helpful for me on that. It shook me personally and in this other book on, I, I, I listened to, I listened to Shankar Viant in, in hidden brain talk about fuel and combustion. I'm sorry, fuel and friction. It was a, it was a podcast he had. And, and then I started reading more about this and I came across the Lauren nor Grant's book the human element.

And it talks about friction. And I had been thinking about the obstacles of men having having a [01:04:00] vasectomy. And it, it has put a lot of things in perspective for me, I think that not, not just to Mar not with the purpose of marketing something, but with the purpose of understanding why people don't do certain things, that book is fantastic.

And I like it.

Paul Shapiro: Very cool. Well, we will link all of that in the show notes for this episode again, at business for good podcast.com. Let me ask you then finally, a final question here that we ask everybody who comes on the show. Obviously you are devoting your life to sizing as many men as you can, and that is an extremely noble thing, but I'm sure there are, I'm sorry,

Dr. Esgar Guarin: as many men who want to do.

Paul Shapiro: Yeah, you, you're not, you're not yet into the involuntarily involuntary sterilization game. Okay. I, yeah, I'm with you. So the question I I'd have for you though, is, are there other business ideas out there that you hope that maybe somebody listening to this show will pursue themselves could be in contraception or, or anything else?

I mean, there's, you know, you mentioned that only condoms and vasectomies are the [01:05:00] options for men. Maybe there's some business out there to do something else that would help men make an easier time. Maybe it was something that's more reversible than vasectomy. Right. But what else is there that you hope that somebody else might take up?

Let's say take the ball and run with it and create a new business here that will do some good in the world. Well,

Dr. Esgar Guarin: with, with additional methods of contraception, there's a lot in the works right now that are, that are multiple things that have been tried. So that's, I'm just hopeful for those things to, to, for men.

To, to flourish but businesses, I think that one of the biggest problems that we have at least in this country and in, in many other countries, but at least in this country is, is our healthcare system. And I think the healthcare system has been awfully awfully complex. It has become too complex and my own experience doing what I'm doing that we way I doing it, simplifying the access to, to vasectomies is something that I would love to see in other aspects of medicine, you know, the simplification of the patient physician relationship, you know, taking out of that relationship.

So many [01:06:00] third parties that complicate the, the, the, the process. There was a, there has been a movement that has been, has been, has been out for a while already called direct primary care. And, and that movement of direct primary care has, has helped a lot of people to have primary care services at, at a very affordable cost and has allowed.

Physicians to get out of that RA raise that many feel. We were in when you're seeing, when you're seeing patients, when they, when, when you're demanded by, by the relationship you, you have with insurances to see patients every 10 minutes and you don't get to know the patients very well. I think that businesses that look at.

Simplifying the relationship simplifying the, the delivery of healthcare will be, will be businesses that I would love to see flourish more.

Paul Shapiro: All right. Very cool. Well, maybe there will be a future episode of this podcast where someone who is inspired by you to start some cool new business doing just that will be the the guest.

So one can hope, [01:07:00] but Dr. Esgar Gian, thank you so much for all. You're doing really appreciate all the work that you're doing to help men take more control of their own reproductive lives and do some good in the world here for a whole variety of reasons that we've mentioned. So I appreciate what you're doing.

I hope that we get to meet in person sometime, and I really hope that I get to see this mobile clinic, as you say, one small snip for man and one giant leap for human kindness. Very good.

Dr. Esgar Guarin: Thank you very much for having me here, Paul, it's been a total pleasure and, and thank you for spraying the award.

Paul Shapiro: Thanks for listening. We hope you found use in this

Dr. Esgar Guarin: episode. If so, don't keep it to yourself.

Paul Shapiro: Please leave us a five star rating on iTunes or wherever you get your podcast. And as always, we hope you will be in the business of doing good.