I had my appointment today with the pouch guru, Dr. Shen. He really is a great doctor and a great guy. He told me that there are several things that can affect a man's pouch in a negative way; being overweight, especially with a "beer belly," straining the abdominal muscles too much with intense exercise and of course, any other kind of abdominal surgery such as for a hernia. He says that the pouch thrives with good blood circulation to it and it dies without that. This is why he recommends against hormone replacement treatment, i.e. testosterone because it has been shown to thicken the blood and reduce blood flow to the pouch. I agreed to discontinue the hormone treatments and to modify my workout routines to lighter weights with more reps and stay away from direct abdominal stress. He also recommended that I continue playing basketball as a way to stay in shape. We discussed diet for j-pouchers and he recommended a high protein, low sugar, low fiber diet with complex carbs being OK. I feel so much better after meeting with him and I will go back for a follow-up in 4-6 months. Thanks to everyone for your support and feedback. As a good friend once told me, "Either we all hang together or we will all hang separately."