A few weeks ago I sat down with Dr. Stephen Dahmer for the Our TIES podcast, and he said something that stayed with me.

Sixty to eighty percent of what he sees as a primary care doctor has stress as the common denominator. He shared that, two percent of primary care visits actually address that stress.

Take a minute on that gap.

Dr. Dahmer is the Director of the Andrew Weil Center for Integrative Medicine at the University of Arizona, where he also holds the Andrew Weil Endowed Chair. He's triple board certified in family, integrative, and lifestyle medicine. He has spent 20 years practicing in the space where conventional Western medicine meets the broader picture of how humans actually heal. When he says something is a disconnect, it's worth listening.

What "upstream" actually means

Most men I know have a mental model of health that goes something like this. Something is wrong. You go to the doctor. The doctor runs tests. The doctor gives you a pill or a referral. You move on.

That model is fine for a lot of things. It's what conventional medicine does well. It's also, by Dr. Dahmer's description, very far downstream from where most problems actually start.

"What we're trying to do in integrative medicine," he told us, "is move that needle upstream a little bit."

Upstream means the stuff that feeds into a problem before it shows up at the doctor's office. Stress. Sleep. Relationships. Movement. Nutrition. Meaning. The things that shape the body over months and years, and that rarely get a script written for them.

For a man thinking about fertility, this matters. Sperm quality is built upstream. What the body does in the 70 to 90 days before conception matters more than what anyone can do in the week after a hard diagnosis. Upstream is where the game gets played.

The stress piece

When I asked Dr. Dahmer what he has seen about stress specifically, he started first with discussing the disconnected system.

"There are estimates," he said, "depending on which research you look at, 60 to 80 percent of what I see as a primary care doctor upstream, the common denominator is stress. And there is also science that in primary care visits around 2 percent of primary care visits will afford some way to mitigate, support, or help with that stress that our patients are facing. That to me is just, what a huge disconnect."

The reason isn't mysterious, nor is it malicious. Conventional medicine is built to treat acute problems with specific interventions. Stress isn't a disease. It's a chronic physiological state that shapes everything else. It doesn't come with a diagnostic code in the way a hernia does.

However, it affects almost everything in the body that matters for fertility. Cortisol, the body's main stress hormone, is on the same regulatory axis as testosterone. Chronic elevation suppresses sex hormone production. Sleep gets worse. Inflammation goes up. The body's ability to do the slow, ongoing work of producing quality sperm takes a hit.

For men who are actively trying to conceive, or thinking about it in the next year or two, stress is not a soft variable.; it's a system-wide one.

The breathwork case

Here's what surprised me most about Dr. Dahmer's approach: he didn't recommend meditation apps or supplements or any of the things I'd expect from a doctor. He kept coming back to breath.

"Something we're doing 16 times a minute, every day, all day, without thinking," he said. "To offset the tremendous stress that exists in society and to help us live better, more powerful, more vital lives."

There are two things I didn't know about breathwork before this conversation. The first is how accessible it is. You don't need equipment. You don't need a subscription. You don't need to set aside 45 minutes. You're already breathing.

The second is that it has to be a practice, not an emergency tool.

Dr. Dahmer shared that he's had patients say, "I got really panicked and I did your breath exercise and it didn't help."  Dr. Dahmer responded, "That's not when you should be doing it. We should be doing it regularly."

He compared it to any other practice. You hit a honeymoon phase. You hit a plateau. Most people fall off at the plateau. If you push through, breathwork eventually reaches a point where, in a genuinely stressful moment, it allows you the pause that keeps your fight-or-flight response from going off the rails.

It's not a hack. It's a habit.

The other piece: "What's strong, not what's wrong"

The reframe Dr. Dahmer came back to most often in our conversation wasn't about stress specifically; it was about how doctors ask questions.

"Rather than what's the matter," he said, "what matters most to you? Imagine your physician asking those questions."

He uses a similar reframe for patients: what's wrong becomes what's strong.

This sounds small. Semantic, almost. In practice, it shifts the entire direction of a conversation. Instead of itemizing what's broken, you identify what's working and build from there.

I keep thinking about what this looks like applied to preparing for fatherhood. Most of the content in the preconception space for men leads with what's gone wrong. Sperm counts declining. Testosterone dropping. Environmental toxins everywhere. That's all real, and TIES has written about all of it. Dr. Dahmer's framing is a useful corrective. The man preparing for fatherhood isn't a collection of problems to solve. He has strengths to lean on. The work of being proactive about health is easier when it's oriented around what you're building, not what you're defending against.

The takeaway

Two things I took away from this conversation that I think apply to any man thinking about his health and his future family.

First, take stress seriously as a system-wide variable. It's upstream of almost everything that matters for fertility and for long-term health. It's not a soft issue. It's the biggest one most men aren't addressing.

Second, if you're open, try out breathwork as a practice, not a tool. A few minutes a day, consistently. By the time you need it, you'll have it.*

We've got more conversations like this one coming. If you want them in your inbox, subscribe to the TIES newsletter. More real answers from real experts, built the hard way, on purpose.

*This post reflects conversations from the Our TIES podcast and is intended for general informational purposes only. It is not medical advice, a diagnosis, or a treatment recommendation, and it should not be used as a substitute for professional medical guidance. Always consult a qualified healthcare provider about any health condition, including questions related to stress management and fertility. Quotes from Dr. Stephen Dahmer have been lightly edited for readability. The meaning remains the same. 

Community notes

• Cortisol is the body's primary stress hormone, produced by the adrenal glands. Chronic elevation of cortisol is associated with suppressed testosterone production, disrupted sleep, and increased inflammation. The relationship between chronic stress and male fertility is well documented across endocrinology and reproductive medicine literature.

• HPG axis (hypothalamic-pituitary-gonadal axis) refers to the communication loop between the hypothalamus, the pituitary gland, and the testes that regulates testosterone and sperm production. Cortisol and sex hormones share regulatory machinery, which is why chronic stress can affect reproductive hormones.

• The 60 to 80 percent figure for stress as the common denominator in primary care visits, and the 2 percent figure for primary care visits that address it, are drawn from research Dr. Dahmer cited in the podcast. Exact figures vary by study and depend on how stress-related presentations are defined. The gap between prevalence and intervention is broadly documented.

• Breathwork encompasses a wide range of practices including box breathing, 4-7-8 breathing, diaphragmatic breathing, and more structured protocols like Wim Hof and holotropic breathwork. Research supports breathwork's effects on heart rate variability, cortisol levels, and subjective stress, though specific protocols vary in their evidence base.

• The Andrew Weil Center for Integrative Medicine at the University of Arizona is one of the oldest and largest integrative medicine academic programs in the United States. Integrative medicine as a field combines conventional Western medicine with evidence-informed complementary therapies.

• This post covers stress and breathwork specifically. Dr. Dahmer's conversation with us covered additional topics including social connection, meaning and purpose, and the research linking loneliness to health outcomes, which we'll address in future posts.