Can Your Penis Warn You About Your Heart Health? Erectile Dysfunction After 40, Cialis, Testosterone & Heart Health Explained with Dr. Justin Houman

The following is an operation podcast production. Can a man's penis warn him about a heart attack before his heart does? Definitely. It's a good biomarker for your overall health. What is the youngest age you are now seeing in clinic with a rectal dysfunction? Early early 20s like 1920 years old. 19. Yeah. Can I go dramatic? E.D. That's that's more of the head than the body, but yeah, can a perfectly healthy looking man secretly be metabolically unhealthy enough to lose his erections. Yes. It could diabetes cholesterol. You can't necessarily see it on the body, but you could see inside. Are men using porn, do you think, because they are sexually driven or because they are emotionally avoiding something? Both. Can you become dependent on Viagra psychologically, even when you're not physically dependent on the drug? Yeah, definitely. Definitely. You could definitely be impacted. It becomes a crutch for some men. That's why I always want to use it modestly. You want to use it conservatively. What do you think a man's inability to stay hard reveals about his nervous system? Performance anxiety in certain contexts is which is not abnormal. You're seeing a lot of things are already kind of worrying me. Unfortunately, hearing abnormal around common growing more common health concerns for guys and like 19 20-year-olds having these problems. Man, we got a heated conversation, I think, to get into. Do you think a man can train himself to only become a ral is by novelty? Yeah. I mean, you go through your life that way. Yes. Whether it's through novel experiences or pornography. Yeah. You're just kind of like self-conditioned, I guess. Right. You're just exposing yourself to that versus the normal way life should be. Yeah. Does taking testosterone sometimes make a man less fertile? Absolutely. Are some in treating low confidence with testosterone? Yes. And a lot of clinics are giving men testosterone without them really needing it. What are the most dangerous sexual symptoms men are to embarrassed to mention, you think? Wrecked out of this function and penis size, penis size, all of it, straight, how it looks, how it feels, how it engages all of it. And what does the average man misunderstand about his own penis? That it's the broad, broad majority of men are doing just fine. Oh, good news. Right. Hi, I'm Dr. Justin Human, Men's Health Specialist at Cedar Sinai. Today we talked about everything about men's health, sexual drive, hormonal health, even erectile health. Welcome to ever forward radio. You have probably heard a lot about omega-3s. You might even be taking one daily right now, but there's another fatty acid I think deserves way more attention. C15. C15 is an odd chain saturated fatty acid that researchers now believe maybe an essential fatty acid meaning our bodies needed to function optimally, but we may not be getting enough through our modern diets. And here's why that matters. 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Could erectile dysfunction be the first visible symptom of a cardiovascular problem that a guy cannot feel? We call it a canary in the coal mine, where the blood vessels go to the penis. They're smaller than they are that go to the rest of the body. If you have atherosclerosis or clogging of those arteries that provide blood flow to the penis, because they're so small, that's the first organ you're going to notice it at. So if you're having issues down there at a young age, that's associated with clogging. It could be a sign of other vascular issues throughout the course of your body, and then risk for heart attack and stroke. Like an early indicator for either one of those. So I'm assuming here there's nothing we can do about the size of those vessels. Is there something we can do to strengthen them, to help them open up more, but it's kind of what we got is what we got. Well, most guys are born with normal caliber. The inside of those arteries are just fine. They're getting good blood flow in our early years. If you live an unhealthy life, to the point where it metabolically diabetes, high cholesterol, high blood pressure, those arteries could start to clogged up, tighten down, less blood flow. So to answer your question, how can we improve that? It's really simple. Live a healthy life. I could go into that, but it's really. Yeah, I want to break that down in a little bit, but kind of just staying on this pun intended vein. How far in advance can these erectile problems appear before more obvious cardiovascular problems? We say generally like five to ten years. I'd take probably closer to five. If you are experiencing erectile dysfunction, do it of vascular issues. But the broad thing is you could have ED for a number of reasons. But one of those reasons is vascular. You're not getting enough blood flow. If that truly is the main cause of your ED, it really is an early warning sign of heart attack and stroke. What about genetics? I know a lot of us might ask our parents, you know, hey, do I need to worry about diabetes, high blood pressure? There's more airquart here, typical genetically passed down diseases in this order. It's just things to be concerned about in your health journey. Should we go, hey, Dad, do you have problems getting it up? Should I have a problem getting it up? Is this something that gets passed down? Or is it just a more lifestyle and diet? Well, look, I don't think the getting it up, part gets passed down, but the risk of diabetes, the risk of high blood pressure, risk of high cholesterol, that could get passed down. And ED is just a byproduct of those. So if you have, if you have an increased risk of high cholesterol, because your father, for example, and you also have high cholesterol, you're more than likely to have, it can manifest as erectile dysfunction. Why would the penis show vascular dysfunction before larger organs do? It's just those, the size of those arteries again, it's the size of those arteries. When they get clogged up, when you have bigger arteries, a little bit of clog, you know, you could, you know, bypass it, right? You have more blood, going through it, but these small arteries, if you get a little bit of clog in there, it's going to, you'll notice it much more dressed like it anyway with the bigger arteries. So then when we're talking, this is happening and it's causing, I guess you would say, true clinical erectile dysfunction. Walk us through, like, the frequency, the type, is it just like a one-off, like, when my morning erections are no longer in the morning, or when I'm actively trying, and I can't get it up, is it these kind of like tell-tell signs, is it a frequency thing? How do I know if I'm actually falling into this ED category, or maybe I'm just in my head? Yeah, yeah, so it's not so much of an objective definition, right? It's kind of subjective. There's a number of things that go into it, but if you think you have ED, right, just what I say, if you think you have ED, you should look into it, right? Explore it and see, because if you're not able to have satisfying intercourse, whether you're, let's say you could get an erection, but you can't keep the erection, or you can't even get the erection. Like, all these things fall into the bucket of, you know, ED. So the earlier, like, evaluating that early on is the most important thing. But there's no real definition of this is ED, or I say if you can't- Really? I mean, I would think it would be actual textbook, no? No, it's basically the inability to get an erection, to obtain an erection, or the ability to maintain an erection. That's really what it is. So if you can't do either one of those, right, one or the other, then you probably have some form of ED. Now the cause of it, there's a number of things that go into it. That's a much bigger picture thing. But the earlier you get evaluated as a result of that, the ability to get or maintain an erection, the better off you'll be long term. So when you say get evaluated, should a guy only be going into his doctor, his primary care provider, when he can't get an erection and maintain an erection, or other other kind of telltale signs that, you know, he should bring up, maybe in a standard physical or something. Yeah, I mean, like low energy. So you can fall into the bucket of, let's say, low testosterone. If you have low testosterone, you could potentially have, that could be a cause of your erectile dysfunction as well. So if you have low testosterone, energy levels may not be the same, libido, sex drive may not be the same. When you're exercising, you may not necessarily feel, you may not necessarily notice the gains when it comes to exercising, like, you know, heavy lifting. That's the hormone bucket, morning erections. That's an important thing. not everyone's going to get morning erections every morning, right? That's, you know, especially as you age, if you're, you know, in your late teens, early 20s, maybe potentially. But as you age, you're not going to get it every morning, but if you're not getting morning erections for weeks on end or months on end, that's not a good sign, right? You want to, you want to get evaluated for that too. Morning erections are a good thing to talk to your primary care doctor about, for sure. Okay. So what do you think a guy should do this week if his erections are noticeably different? Well, first off, don't overthink it, right? A lot of guys, a lot of guys will, we go through our lives, never been looking at our penis, never really analyzing our erections, right? So it's very common for a guy to be like, you know, all of a sudden he starts looking at his erections, looks at his penis, like, well, I didn't see this thing, I didn't see this, and you got to get into this mental loop of, oh God, now what do I have, right? This thing, I never saw this vein before, and to get into this kind of a vicious cycle where the, well, to your earlier point, an erection is kind of a stress-free response, you're supposed to, it's a minimal stress, but when you start to get anxious, your cortisol spikes, you start to get worried about different parts of your penis, it starts to kill the erection, weakens the erection, and then you get worsening erectile dysfunction as a result of it. So if you don't have, if you don't have an issue, like, don't, don't go looking for issues, that's okay. Is it also one of those things, like, if you go looking for something, you're going to find it, yeah, that's part of it, right? So don't necessarily go digging for things, but if you really, if you feel like you're not having satisfying intercourse because of the strength of the erection, your libido, whatever it is, it definitely warrants being evaluated for sure. So you've kind of already touched on this, but I want to ask, you know, directly if a man stops waking up with erections, what might his body be trying to tell him? Yeah, I'm hearing you kind of say it's maybe not as big of a concern as we might think it is. Well, you're going to, it's going to happen throughout the course of the week, months, right? You're going to have some days, yes, some days, no, ideally, most days, yes, but it could be your more stressed out, right? You're basically not getting that good. You're not getting to the deep layers of sleep that helps with morning erections, could be a low testosterone, right? Your testosterone is just not as, when you have low testosterone, that could be a cause of morning wood, but more importantly, it could be a cause, it could be a sign of an overall, just, there's a metabolic imbalance going on in your body, that's what it could be. But again, this is a big picture, right? If you do, if it's weeks and months on end where you have no morning wood, that's when you start to worry about things. I want to go back to, you mentioned cortisol earlier, and, you know, I, I know that in the mornings, that's when typically our natural cortisol levels are at their peak where they are peaking, you know, melatonin and all the sleep evening hormones are, you know, coming down and cortisol is coming up, which is a good thing. That's what gets us up and out of bed and, you know, awakens all the organs and just, you know, kind of helps reset or begin that circadian rhythm. So, it seems kind of like a, how can we be in our heightened cortisol state, but also be having these erections, it doesn't more cortisol lead to possible decline and erections. It's, it's like this, you're getting that, so morning, you know, well, the morning woods only lasting like while you're waking up, you know, by the time you get out of bed and the first couple of minutes of being awake, then the cortisol spikes, it's not so much. You're not getting, you're not going to be having morning wood throughout, you know, throughout the first 90 minutes of the day when cortisol spiking. That's kind of the reason why the morning wood goes down, right, because your cortisol spiking. But, if you're, if you had a heightened stress level, right, when you're, you're not really, you're worried going to bed, you're anxious to your point, that kills the morning wood even further, right, you're waking up anxious, you're waking up tight. So, therefore, you're not even getting noticed that morning, well, let's say you had, yeah, that you had morning wood in the middle of the night or early, you know, right before you woke up, that that stress response will kill that morning erection. But most guys are having some form of nocturnal erections throughout the course of the night. We all do four to five erections. We all get it throughout the course of the night. Sometimes we notice it, sometimes we don't. And what's that about? Is that just another natural rhythm, the body? Yeah, exactly. And that's why those, that's very, very important. That's very helpful to the peanut health, for sure. That's definitely, I mean, so if it's important, but we don't know if we're getting it, how do we know if we're, how do we know if we're having it or not, how can we like track this? Well, well, now they have trackers, right, they have like Fitbits for the penis. What? Yeah, yeah, so now that you could, you could truly track it, you could put, there's, they have a different adaptable. Oh, yeah. And you have an app that basically goes over it, for sure. And it tracks the strength of the erection and the frequency. And it gives you, it gives you like a score of how healthy your penis is, based on the, how much it gets dilated, the growth of it. And now this is strictly for kind of this night time erection, we're probably not realizing it or night time. You wouldn't just keep it on all the time, right? No, because the night time gives you some more data, but daytime, unless you're, I mean, most guys, unless you're having a erection, unless you're having, you're trying to use your penis, you're not going to have a daytime erection. True, true. Most guys, most guys. Interesting. How reliable is this device or devices in this data? Pretty good. Yeah, pretty good. I mean, it gives us, it gives us information, right? Something like, like everything else right now, the aura ring, the hoop, some of the information is we want data. We're all, you know, everyone wants more data about how their body is doing. Some of it, you know, gives us good information. Some of it's probably not so important, but for certain patients, that's great. It is good to know. Like, I'll tell you, I'll tell you, please go ahead. You know, like the prostate texted me like guys get the prostate removed for prostate cancer, right? Yeah. Okay. One of the things we know, and this is something that we've learned over the last few years is, or the last decade or so. The nocturnal erections are so important because you're getting good blood flow to the penis, you're getting that stretch. If you remember that joke from 40 year old virgin about, if you don't, is it true? If you don't use it, you lose it. It's actually very, very true because if you're not getting those good nocturnal erections, like you won't have to have prostate texted me, your penis really shrinks in size and lengthening girth. So getting those nocturnal erections is super, super important. Okay. So if a guy feels like his penis size is getting smaller over the years, length girth, everything you just said. Could that be a telltale sign that, oh, maybe I'm not getting these nighttime erections. Therefore, I should go and investigate it. Yeah. So that's why, like, if you're getting, if you're not getting, if you feel like you have weaker erections, I mean, most guys kick that, you know, if they're 56 years old, they're like, yeah, it's part of life, right? This is part of aging. For some guys, it is, but some guys really want to optimize that and keep that going, you know, keep getting good erections into their 70s and 80s. And if you're not getting, again, to your point about, if you're not getting strong erections, yes, you won't notice it over the course of months. It'll take years to notice the shrinkage weaker erections for, I mean, smaller and less girthier erections for sure. So then what can a guy do about that? If it is just a natural thing with time, you know, or can we, like, get ahead of it so that we don't lose length girth or anything? Yeah. I mean, the simplest way or one idea is do things that optimize direct talk quality. Of course, lifestyle things, and we can, you know, talk about that for a while. But one idea is starting at the age of 40, a lot of guys are just taking Cialis regularly, not necessarily. You don't necessarily have to take on a daily basis a couple times a week, once, twice a week without diagnosed ED. No, without diagnosed ED. We're realizing now that Cialis, low dose Cialis, right, not maximum dose. Cialis is the longer acting Viagra, right? Cialis isn't so much, it works, definitely works in the pelvic area. It dilates blood vessels primarily to the penis, but acts in different parts of your body, has receptors in your lower back, your esophagus, that's fincter. But even has some systemic benefits in terms of just dilating the vasculature to your body, and it gets more blood to the end organ. It's less so throughout your body, but definitely in your penis. But to what I was saying earlier, if you're getting super strong erections at night, all that's doing is stretching that smooth muscle in your penis, preserving the length, preserving the smooth muscle more than anything, but giving you that tissue, the nutrients, oxygenate needs in order to continue to maintain healthy levels. Hey guys, quick break from my conversation today to bring your attention to one of my favorite daily wellness hacks. Something I've been using, recommending for years, and that's element. 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Plus there's collagen to help her work toward her daily protein goals and hyaluronic acid to support hydration and healthy skin, which trust me, she appreciates me too. So instead of just handing my wife another cup of coffee, I get to make her something that tastes like a treat but actually supports her throughout the absolute marathon that is being apparent. Upgrade your morning ritual with strong coffee company and use check out code chase to say 15% off of every purchase. She's more of a vanilla latte kind of girly and I'm a dark mocha guy, but either way you can't go wrong hot or ice strong coffee company has you covered again that strong coffee company.com, check out code chase, that's my name, C-H-A-S-E, to say 15% on every purchase. What about side effects with that? See Alice? Yeah. I mean at low dose, I mean 98 out of 100 guys will tolerate very well. There are some side effects, some guys, most guys get the main completions Harper and lower back pain. Very rarely do you guys get visual changes, generally speaking extremely well tolerated. It's generic now, it's very cheap. A lot of these biohackers are doing it quite regularly. Wow. So just like micro dosing say Alice. Yeah. I mean I guess you could call it that. Wow. What about other things that are natural vasodilators like, you know, cordiceps mushroom, beetroot, tart cherry juice, things like that? Yeah. Citrule and arginine. Yeah, yeah. For sure. All along the same vein. Absolutely. I mean these are less panax ginseng, some other stuff, I even heard like vitamin C in certain combinations. Yeah. All of these things are great, right? These things can, they're, they're a, as much as let's say, cialis is, you know, the pharmaceutical, the medical version of it, all of these things are the supplement version of it can only help. Right. Is there any downside to increasing vasodilation? It's an extra oxide. No. No, there's no downside to it. I mean the main concern a lot of guys, they ask about biodegrading cialis is like, I don't want to take it when I'm 40 because I may need it when I'm 60. So biochemically, you never develop any sensitive or resistance to it just from a biochemical standpoint. So it doesn't matter how long you take it. If you feel like your response to the cialis is decreasing over the course of years, it's not that you're becoming sensitized to it or desensitized because you're just, it's kind of like progression of disease, we call it. Would you blanket statements say for most guys, once you hit 40, it's a good idea to consider small dose, I'm using Eric will hear micro dose cialis, cialis for erectile health. I offer it to most of my patients, really. Absolutely. I offer it. I don't tell them to do it, but I always offer it. I try to tell them, hey, listen, there's, there's, we don't have a lot of long term data on this, right? But if you really think about it, like is, and this is the part where medicine is a little bit more of an art than a science, we don't, just because we don't have long term data doesn't necessarily mean it's bad, right? It doesn't necessarily mean it's good, too, doesn't mean it's good, too, but if you think of it, just the theory, at least, you know, the way I think about it and the way patients have responded to it so far, overall, I might think take it on a daily basis, again, just take it once or twice a week, just start there that could only at least preserve, it gives you good blood, good blood flow to your penis at the very least and sometimes to your other end organs. What other, this is kind of just like, I'm really intrigued by this, what other downstream benefits do you see coming from this? You know, you work with guys, you're impatient, you know, you provide this or offer this. It might work for the here and the now for penis health, erectile dysfunction, also just helping guys kind of, as a guy, now in his 40s, I think certain things, just kind of knowing that I can do something now that, you know, I'm experiencing things that I had in my 20s and 30s slip away a little bit or just, it's becoming a little more difficult to maintain certain things with like energy moved and besides, you know, taking testosterone off the table, I think for a lot of guys that's just beneficial information, so like, what are the downstream benefits to see this really happening outside of that main sexual health category for guys? Yeah, so there was a, there was a study and these studies are somewhat, you know, the perspective, they're not, you know, you're not really comparing, you're not doing it in a lab type setting, but there's data to support Seattle, regular, we call these PD5s, right, viagras and Seattle, so it's the enzyme that acts at the increases nitric oxide, regular PD5 use can limit or decrease the risk of Alzheimer's and dementia. Now is that because you're getting more blood flow? Like I said, you're getting more, you know, vasodilation, you're getting more blood flow to the brain, potentially, right? But also generally speaking, if you're, if you're the type of person, and this is the part where you kind of have to take it with the grain of salt, if you're the type of person who's taking viagre and Seattle, who's engaging in air course, you're generally a little bit healthier, right? Probably. Yeah, for your, you're already at decreased risk of Alzheimer's dementia. But again, the, and everything comes with risks, of course, right? Everything comes with some risk. But to me, and again, the way I explain to patients, everyone can decide on their own whether or not they want to take it, to me, the, the, for most patients, the benefits outweigh the risks and, and let's say you don't want to do it, do the supplements you talked about. That's true, yeah, yeah, I don't have any affiliation with them now. But there was one that I really enjoyed called, from Joy Mode, here to this brand. Yeah, the sexual performance booster, they, they were clever, it was basically they labeled it as the pre-workout for sex. But also just those ingredients to your point, taking them on a daily or semi-regular basis, they're actually just generally great for cardiovascular health. Um, again, to your point, if you're more so walking around in a, uh, ready to go state, you know, you have great blood flow, great oxygenation, um, you know, you can, I guess that point would just be a mental block more so than like a physical one, because, you know, physically, you're like primed and ready to go. Definitely. Yeah. Oh, that's another question off the stem of that. What about, uh, you know, maybe if a guy tries this, but then, you know, coming off of it, is it going to be, okay, now all that, all this benefit stop, um, is there like a saturation point, uh, or if I start to have to keep going, you mean with this, yeah, with any of these other, you know, ingredients, uh, natural supplementation or psialis, I can't say the word today. Sialis, there we go. Uh, is it, if I start this, do I have to maintain it always? Uh, that's why I think guys will develop a mental crutch a lot of times and, and, which is okay, right? So then they'll be like, those are the ones where like, I just want to keep doing this forever. I feel great on it. And some guys just, you know, they're content with the idea that they'll be on psialis for the next 20, 30 years, right? They're okay with that. But that's why I never, I don't want to necessarily tell guys to do on a daily basis. Again, like once or twice we, you may notice the benefit for that day, for the neck, you know, for those two days, um, but it's not the type of thing that you're going to constantly rely on. Um, so that's why I generally say that with the supplements now, probably feeling a little bit of a decreased, uh, impact on your day to day, but at night time, I'm sure it could only help in terms of getting you stronger, not terminal erections. When does, um, when does an orc tell dysfunction medication like Viagra or psialis actually solve the problem? And one is it just really helped the guy kind of just avoid investigating the cause. If you're a guy who's 56 years old and you're on Viagra and psialis, you probably need it, right? Because most guys at that age, you know, 60, 70 percent of guys at that age probably have some form of ED based on 60 to 70, 70 percent of guys at 60. Yeah, we say like so 50 percent of guys at 50, 60 percent of guys at 60, you have some form of ED. Yeah. I mean, ED is something we're all going to get, right? It's really. I mean, so it's, it's basically inevitable for guys to get erectile dysfunction. I want to say every single, not every single guy in the world, but broad, broad majority guys will get some form of ED as we age, of course. Yeah. I mean, look, this is, this is what keeps guys coming into my clinic. Absolutely. And we have so many different options for it outside of the medication. But younger guys, younger guys, 20, 30 year olds who have ED, the, the psialis and viagra is more of a band-aid. For most of them, again, I'm kind of, you know, blanket picture because most of those guys, it's, it's psychogenic ED. It's more contextual. It's performance anxiety based. It's not so much they have something wrong with the machinery. Talk to us about that. I feel like performance anxiety induced ED, it's just a vicious cycle, right? You get so worked up and in your head about, about getting an erection, about maintaining an erection that you just, you, you can't actually do the thing. So then you need to do the thing in order to get out of your head about it. So what do you do then? I mean, that's your, your, your early question about how young are the youngest guys, those, those, those are the guys who have the 19, 20 year olds, it's performance anxiety. The, the night of drinking, whatever it is, bad sexual experience. The next time they're trying to have sex, they think about that previous night, quarters all goes up, kills the erection. So one bad experience, two bad experiences, 20 bad experiences, right? Vicious cycle. How do you snap out of it? You got to, basically you want to, they're on a losing streak, you got to just get them on a winning streak. So different ways of doing it, a lot of times, just for them to unload it off their chests, helps, you know, letting them know that this is, you're not the first person, you know, to have this problem. There's quite common. So you're saying here more of like a mental health treatment approach versus treating it's just like a physical health problem? Well, I would treat it a number of ways, but mental health for sure is part of it. But the other thing we do for some of these guys is we put them on a low dose of Cialis, Because we, by doing that, they're. In short term, you get strong directions for a course of time, right? You get back on that winning streak, and then you kind of forget that you had that problem. You get that confidence back, frustration goes away, you snap that cycle, and it works. Talk to us about some like maybe some misconceptions around, we'll just say penile health in general. This is kind of fascinating to me just to hear these unfortunate statistics of how it's probably every guy is going to have it or experience some version of it, and the percentage seems to kind of more or less go up about 10%, 40% in your 40s, 50% in your 50s, so on and so forth. What about size? What's the real average penis size that we need to really be comparing ourselves to? What are these kind of like real numbers versus fake numbers out there when it comes to penile health? Yeah. So the size one is a common question, depends what state you're in, actually they've broken it down by states in America. I mean, nationally, if you want to look internationally, it's a different story, but at least in America. Which state has the biggest penis? It's, it's those, it's like the North Dakota, South Dakota's Minnesota is, yeah, it's that Northern, it's that Midwest, the North Midwest. Some good old Midwest boys, all right. It's, and they're the tallest also, so the, yeah, so the, so it's more of a height correlation. I mean, there's a, there's a rough correlation, but there's some correlation there. So they're probably, they're the largest up there. And then the rest of America is pretty much the same, like 5.6, 5.7 inches. Which state has the smallest minutes? Maybe 5.5 inches nationwide. I forget which state, but I think it's in the South. It's gonna, yeah, it's gonna be in the South. And so I'm sorry, you said 5.5 inches. Yeah, I think it's, I think it's 5.5 is the average penis size in America now, yeah. That's the largest in America. Yeah. I don't know what the largest is. I mean, I can tell you what the largest, like, you know, we've seen, but what is that? Maybe like seven or eight inches? Yeah. I think, I mean, I feel like that's, that's a good size. That's pretty damn big. But I also feel like, I think a lot of guys feel like there are more guys out there that are bigger. And so even to hear seven to eight inches, like I feel, it's, it's not that crazy. It's also not that common. It's not that, no, it's not that common. And the thing is it's like, yeah, guys exposure to other men's penises is all in the context of pornography. And these guys are pros, right? It's like, you know, you're assessing a very, very small sample size of like the cream of the crop, if you will. So you can't, you can't compare. And that's what guys do. They compare, like, oh, my son is big. And then they start to do different things to the size of their penis, which is a huge mistake, kind of just got me thinking, do you have any insight as to erectile dysfunction, developing rectile dysfunction or poor penile health and a guy, poor sexual health and a guy for someone who has never seen pornography, they have no other male comparison versus someone that has. I'm wondering like that, that, that influence level. So I would say the impact it has on the penis itself, there's no impact. But the strength of the erection, it's not just the penis, it's the mind, it's the mind penis connection. So when you watch some guy who watches a lot of porn, it affects it up here, right? It affects dopamine and all the novelty stuff going on up top. It doesn't really affect the blood flow to the penis itself. So anyways, the guys who watch a lot of pornography, the strength of their erections will probably be, depending what age group you're looking at, probably be a little weaker, they'll probably less satisfied sexually as well. The mind body connection, I'm no stranger to, definitely I've talked a lot about it on the show with a lot of different applications. The mind body connection with the penis, walk us through the mind penis connection. If we really want to tap into, call it visualization, how real is that? How do you recommend someone going through that? What can a guy do to, as part of his daily practice, just to embody that mind penis connection? What does that look like? Yeah, I think there's two buckets to it. Number one, pornography, right? Massurbation is fine, right? Massurbation is a very healthy thing, men, women do it. When you watch a significant amount of pornography, and again, you don't want to come across and say all pornography is bad or never ever watch it. Most things in life should be done in moderation. So I got this one from a sex therapist. For every three times you masturbate, do one time with pornography, do the other time to just, you know, your mind, for example, try that, right? That's kind of a little bit more of a healthy practice. The more pornography you watch, right? It desensitizes you, like the excitement you get, especially these days now, right? Where there's AI out there, right? That's going to take this thing to create a lot of worsening erectile death porn. Yeah, there's AI porn now. Yeah, and these younger guys, more and more young guys are coming in with ED because of this. So they can, like, literally create their own fantasy. Exactly right. Exactly right. So you're never going to, so you, once you watch that for days, weeks, months, the real life, it will never, you can't come back from that. You can't come back from that. You can't match that. So, so the excitement, right, that, and we all know, like, porn, or, excuse me, sex and, you know, intimacy, it's a lot of it's appeared, starts here, and, you know, finishes down here, but that excitement, it's hard to get that kind of excitement in real life. It's hard to get that excitement in real life when you're exposed to what you get with AI or any type of pornography, chronic pornography use. Yeah. You kind of already answered it, but, you know, is it more so getting aroused, you know, even just masturbating to pornography versus, you know, non, like, is that like the healthier route to go? It's the healthier route. Yeah, definitely. Okay. Yeah. And there's no hard and fast rule. I think people want to, you know, they want to know, but I would say, for every one time, you met, if every three times you masturbate, one of those times should be the pornography, try to do the other two to your head. Is there a healthy number of times a guy should be masturbating? Is there any, like, masturbating X amount of times? I guess it's really about orgasming, right? Is there a specific number of orgasms that equates to or correlates to, like, just being healthy or, like, is, do we need to ejaculate X amount of times, such as something unique to the male system that, like, getting it out more often is better than keeping it in. Well, there was this study, I mean, like, every urologist will quote this, there was a study about, if you ejaculate 21, 20 or 21 times in the given month, your prostate cancer risk goes down, right? But it doesn't matter how you got there. It doesn't matter how you got there. It's just a number of orgasms. Like, ejaculations. Now, how much is that, like, is that really, is ejaculation, excuse me, is ejaculation going to really prevent prostate cancer, again, probably not because guys were ejaculating more probably healthier, right? How do they track that? How do they study that? It was like, it was a study they were looking backwards to kind of ask. So it was all like self-reported that, probably? Yeah, but it was a little bit better than self-reported, but it was quite accurate. But again, having said that, having said that, it's like, generally, if you're ejaculating more, your hormone levels are higher, you're exercising more because of that. So being able to ejaculate 21 times a month is a strong correlate factor to overall health, which probably really links to the drop in prostate cancer. There you go. Okay. Yeah. And then to think about it, like, is there a certain number? Not every chapter, not every month, every week of your life is going to be like, you know, like the one before or after it. You're going through, you know, work stress, you're not going to be ejaculating three times a week, right? That's a lot. That's a lot. I mean, goals for sure, I guess, but like, yeah, but also then you get into the reality of it. Also, I wonder how many guys are going to hear this and go, go to their wife or partner. Do you want me to have prostate cancer or not, you know? That's right. You've been married 20 years. It's going to be hard to do that. Yeah. Five out of seven nights a week, for sure. So I think it would be remiss to talk about men's health, especially, you know, erectile function and not talk about where I think a lot of other guys are immediately going. That's testosterone. Talk to us about, you know, through the lens of erectile function, penile health, what role really does testosterone play in those columns? Yeah. It's, the role of testosterone with, with erections, it's a couple of things. It can help with, it doesn't necessarily, if you have low testosterone or erectile dysfunction and just fixing the testosterone, it's not going to give you, get you back to where you were, like, a hundred percent of erectile function. It can move the needle in the right direction. It could create stronger erections. But to me, the way I like to explain it is, if you have low testosterone, you're more than likely going to have some form of low libido. So by getting, by getting your, your libido up, getting it kind of stimulated in the mind, your erections are going to be stronger as a result of it. So, but if you have ED and low testosterone, definitely address the low testosterone. It could only help in terms of getting strong erections. And I feel also, now, I guess we got to split hairs a little bit. Let's say you have truly a low T problem. You solve that through lifestyle modification. Maybe you look at TRT to testosterone placement therapy and then that helps with the initial problem of libido and motivation and drive and actual erectile function. But then I think what a lot of guys don't know. And as someone who was formerly on TRT, I've been offered over two years now. Yeah. And this was not really fully explained to me is like, it'll help you get there. But then for a lot of guys, the other side of that is fertility, being able to get pregnant. So I wasn't fully aware of the level of sperm. count that goes down. It was a very moderate approach with my TRT, but yeah, so I talk us through this because I think guys can say, oh, T can help solve my problem of erectile function and my motivation drive libido. But then, like, I get to this point, then I realize, oh, actually, I can have sex, but I can't get pregnant. Yeah. If there's one thing to listen to with, you know, in this conversation, it's this point that you just brought up, it's testosterone replacement therapy will shut down your testicular function. So it shuts down natural testosterone production and it shuts down sperm production. Basically, everything the testicle does, it will shut it down temporarily, right? It's a temporary shutdown of both of those in very, very rare cases. It's permanent. But if you're experiencing a very young guy who has low T and is interested in fertility, observing, or, you know, down the road wanting to have a family, we have better option with very, very different options that will raise your testosterone while preserving or actually enhancing your fertility. What would you do first? What would you recommend for us? And I understand this would be very, you know, case by case basis, but again, blanket statement. If someone presented with clinically low T, let's say 200, right, and symptomatic, low drive, low motivation, low libido, body composition, changing, poor sleep, you know, all this kind of typical stuff. What would you recommend that guy doing first before considering T given that he's already tried it all? You know, like I'm trying to exercise more, I'm trying to sleep more, all the, all kind of the general lifestyle modification stuff that we probably already know and hear. What would you do next before T? The main one is clomid, right? Clomid and clomophine. We use it off label in men. It stimulates, basically, it tells your testicles, produce more testosterone naturally. That's a great place to start. Majority of men do quite well on it. For those that don't, then we can consider something called HCG. And again, similar, it's a more pure cleaner version. That's an injection. It could be quite costly. That's why we do the pill first clomid, but great place. Those are great places to start. I actually use that as a, to come on, stepping down from TRT. For it was like a 90 day protocol. So prevent the crash. We try and have a kid. Is that what it was? Yeah, my goal shifted. My wife and I decided we wanted to actually start trying. So my goal shifted from trying to get my T up and kind of get my mojo back a little bit, so to speak. And then, yeah, we're like, we want to try to get pregnant. So 60, 90 days, I think, with the clomid. It didn't feel as good as the TRT. It was different. Yeah, I honestly say, I forget my exact dose, but it was, it was, it was, I wasn't like aggressively going trying to just like go crazy with T, but for, I ran it for about 13, about 14 months. And would, you know, I wound up going to two doses twice a week to kind of just like keep that continuity cycle going. But then, yeah, I mean, I was running up close to like 1100 T for a while. All my personal goals were accomplished with, you know, getting higher T levels. When I started, I wouldn't even say it was really clinical low T. It was like 500 something, but a lot of symptomatic stuff. Predominally, it was just low motivation, low drive body composition. I was really having to fight to maintain certain things. Of course, I was 36 at the time. As a guy, you're going to go through changes like that. So, yeah, I accomplished that goal. I was able to like get my drive back, get back into the gym, you know, maintain strength and all this stuff, but then just the goal shifted to fertility. See, now we have an oral testosterone. Yeah, I've heard about this. It's just in a capsule form and you have to like take a few a day, right? Twice a day. Yeah, you take two pills. Well, it doesn't, I don't know how many different doctors will describe different pills, but you take it twice a day. But the reason I say this is the half life, like the reason why you probably, your recovery wasn't too bad is because you were giving it twice a week. Yeah, rather than giving a larger dose once a week, that's when you really shut down testicular production. The lower, the lower the dose, the more frequent and lower dose you get of testosterone replacement therapy, the easier it is to recover off of it. So, that's why this oral testosterone is a great option for young guys. Do you feel like it's that better in terms of what you just described, but also, you know, potential side effects? Well, I always, depending on what the guys' goals are, fertility is a goal. I'll put them on clonement. If they don't respond well to the clonement, they're like, I want a little bit more of a boost, or the HCG, I want a little bit, we'll add on the oral testosterone to the clonement, or the HCG. So, we're still getting testicular function, boosting them up, and they want fertility, we just take them off the oral testosterone. Okay. Kind of like on the same vein of if a guy wanted to optimize a rectile function, he could, you know, low dose or micro dose, psialis, but can you do the same thing with clonement? There's no real problem. If I want to just like, you know, do my lifestyle behavior modification stuff and this to like maybe bump me up, you know, 50, 100 points kind of thing. I wouldn't necessarily micro dose it, but I would just take the regular dose. Oh, okay. Yeah, there's no point of micro dose in clonement. Okay. It could only, it has a limit, right? It's telling your testicles produce as much as you possibly can as much testosterone, but your testosterone levels with clonement, it's very rare for them to go above $900,000. We rarely see that. It just maximizes their natural production, which for most guys, again, is in a thousand. Well, even if a guy can get up to $900, I think for a lot of guys, you're going to notice that if you're especially if your natural levels are like five, six, seven, getting to $900, you're going to notice that for sure. Absolutely. Oh, yeah. But it's hard for a lot of guys when you start getting the benefits of being on TRT, or even this, this bump, this natural bump. It's come off of it. Yeah. Because speaking from experience, you know, it's, you just feel like a man times 10. Yeah. You feel unstoppable. Like you're, even if you didn't have issues with sex drive before, like, you know, it's like, it's, it's double. It's triple. You're so motivated. You have so much energy. You, you see, see, and feel results in the gym a lot quicker, you know, in a matter of, you know, four to eight weeks versus maybe before we take you months kind of thing. It's, it's, you can't unknow this. Yeah, it's, look, I always tell patients, I can't wait to the day I'm on TRT, right? I see what it does to guys. It's great. I don't want to oversell it. But yeah, it's great. Yeah. But to your point, there's coming off that TRT, and I'm sure, I mean, you can validate this, but there's nothing that touches those receptors, like, like testosterone placement therapy, no matter natural testosterone will make you feel that same way. Am I right? Yeah. And honestly, yeah, personally speaking, it even got to a point where I was like, okay, it's cool. Like, we'll, we'll come down. Like, it's, uh, it was, like, it's just too much. It was, it was too much. Like, it was just like, my wife was like, get off me. It was just, you know, I was like, I was like, almost over. I was kind of swinging the pendulum the other way. I was like, over prioritizing the gym again, because I, you just get these, these gains and sensations and you just feel like, oh, I can move more weight. I can build more muscle. I can, you know, and I'm not getting as injured or am I bouncing back from injury more and just, again, as a guy, once you cross 30 late 30s, you feel things a little bit differently. And when that goes away, I mean, you're like, I feel like Wolverine Berserker mode, you know. You just, you like, don't want to give it up. And then, yeah, that's what you have a kid. You have your kids. You finish it up and they could get back on it. Yeah. What do you, you know, maybe use me as a case example here. So someone at 36 who ran TRT for about 14 months, just shy of a year and a half and then has been fully off for over two years, just had a kid, just had a hip replacement, you know, I think I'm commonplace for a lot of life events that guys go through, you know, you're aging late 30s, getting to your 40s, you know, maybe settle down, you have a kid, have an injury, you know, things progress, things go differently. What about this off and on T? You know, is it maybe beneficial for a guy to consider just like, okay, now that I'm in this, you know, low phase in my life, using it to kind of help me get back there and then come off again and then get back on there is T should be considered in this off on cycle with like, year gaps kind of thing or is it only, hey, once you cross this like biological age threshold and things are like actually like your labs and symptomatic and everything, you're really on the decline. That's really only the best application. Yeah. Historically, when we, when TRT first gave my cycling was the move, right, it was more common than it is now, two months on, one month off and that's, we don't really, the reason why we did it back then was primarily because the red blood cell counts would go up, right, that's one of the, yeah, blood thickens a bit. Exactly. So then you come off of it, you come off of it, so then your, your body doesn't produce as much and your blood levels normalize and you go back on it. Okay, can you just like go donate blood now? Exactly. So, so some guys, you know, we tell them every three months to go donate blood, but the other thing is we have so many, we've learned so much about it. Now, you can microdose T, right? So because you could microdose it, you're not getting those, the chances of those spikes decreases, right? So, we're able to mitigate or control that a lot better. But to go, you know, you could cycle, you know, two months on, you know, two weeks off kind of thing. That's fine. But in reality, to do like, take it for a year, don't take it for a year, you could do all of these things. Absolutely, no question about it, but I wouldn't necessarily recommend it. I would say if you want to, if you want to be on TRT, but you want to have kids at the same time, then you could, you could go on it in between the kids, just understand that there's that low, right? Well, you're not, you may not necessarily feel the same, you kind of will feel low when you're trying to have a kid, but you could get back on it. TRT is very, for the broad, broad majority of men, if you're done under the watchful eye of someone who knows how to manage it, incredibly safe, incredibly incredibly safe, and incredibly important. We have good long-term about the benefits of having normal testosterone levels for a guy without question. And now we're learning about it with comes the estrogen for women. Do you feel like what's the better, more evidence-based here? Answer please. What would be the better approach you're seeing for a guy to consider TRT injectable versus the oral? I could tell you anecdotally, based on my experience, the younger guys will respond to the oral, right? I'd say generally under 50, under 55, they'll respond better to the oral, not hard and fast, but this is just from my experience, the 55, 60-plus injections you'll respond to the injection. You just don't respond as well to the oral. That's the only downside to how a big picture. Can you be 65 and try the oral? Without question, I have some guys who do that, and they're doing great. And vice versa, younger guys doing the injections. But that's a good framework to start with. OK, and can you expand a little bit more on the microdosing TRT aspect? What would that look like? I mean, look, it's an injection. You have to use-- I don't know if you were using two needles, one to draw it up, one to-- Yes. Yeah. So it could be a little annoying for people, people don't like injecting. But most times, we tell them inject twice a week, Thursdays, Sundays, just divide it up in the middle of the week. I have some patients who do it literally on a daily basis. They take a baby dose every single day. That's a place you can microdose to. There's no hardened fascial. You just don't want to take too much to start from the course of a given week. That's it. Do you have any thoughts? You know, maybe personally speaking here. Do you have any thoughts around hormone therapy, hormone education in general, has become quite common place with, you know, seeing online clinics pop up like crazy. And people just being in the industry, I know this to be true. People can, without ever really actually seeing a provider, whether in person or remote, through some questionnaires can get tea. It's really not that hard. Doesn't make a right, doesn't make a wrong, you know? But what are your thoughts on the access we have to tea and the information of attention? This information out there, do you like this? Is it better to have access to something like this? Is this the overall, for the betterment? Or is it a huge red flag? You know, I like how you said it, it's not good, it's not bad. It's, you know, you could really, you expose. That's what I would say, part of it, you know, you could really frame it in both ways. The one thing I would say is ultimately getting more access for TRT is obviously important because, you know, there's tons of guys out there who don't necessarily want to have an conversation with the doctor and person. So, you know, getting that exposure, getting that ability to get TRT, or get your low testosterone treated. That's how I'll say it. It's great. But like most things in medicine these days, if you're not taking, if you're not an advocate for your own health, like a lot of guys have to do their own research on this. Like to your point, you know how many times like in a given week, I can't tell you how many times guys come in and they're probably in their 30s and 40s. So, like I'm on TRT, I have no sperm. Well, you know, no one ever told you that. I was like, no, I've been on it for a few years, no one ever told me. So, it's, you want these clinics to tell them this, but they don't, right, for whatever reason it is. I don't necessarily know why, but you want to educate yourself. And maybe the point of this podcast is, because it could be a good takeaway here is, TRT will lower your sperm count, almost zero. So just be mindful of that if you're trying to conceive sometime now or in the near future. - Yeah, I think, you know, to kind of take some of their responsibility, at least half their responsibility back on for guys. And when we talk about fertility health, I'm a huge pandemic of like, you know, fertility crisis right now, you know, with lower T with less people having children for a lot of different reasons. But, you know, it used to always be like, oh, women go for easier X. And like I personally think that is a great kind of like insurance bet to make. If you have the ability, it means an access of course, but even if you, if you want to have kids or if you don't, I think if you have, with women, if you have healthy eggs, it's just a great insurance plan. I think the same should be told to guys, even if you don't want to have kids or you don't know, especially if you've been doing T, like freeze your sperm, get an analysis done, there's so many clinics I've used them before, like online in person. You got a great healthy sample now in your 20s, 30s. Why not, you know, do that, got your insurance plan, go on T if you want, but then you just know, like okay, I can do all the things right, you know, work with a great provider, titrate on off, whatever, and then you know, get my sperm count, hopefully back up, but like you just go into it, knowing you've got all your bases covered. - Yeah, there's no, great point about banking sperm, no harmony, it's much, much cheaper these days than it was in years past, definitely. - Yeah, I think, I pay like 250 a year, not even, I think it was like five years or something, I used legacy, legacy, yeah, and it was great. Super easy, they sent me the kid at the house, yeah, you just do it at home sample, it's like super discrete, super easy, and then literally in 48 hours, I think two, three days later, I had this incredible report of my, you know, reproductive health, cement analysis, and it was like, yep, everything looks great, let's freeze it, and then, you know, great, I have a kid, you know, but knock on wood, if I need another one, I've got a great sample. - Yeah, exactly, it's great insurance policy, relatively cheap. - What do you think, besides what we've already discussed, what is the biggest contributing factor to a guy's T-level in a positive way, and what is actually, surprisingly, maybe draining his state? - Like the positive factors, I'd say, exercise is a big one, exercise it, guys who don't really exercise generally, they have lower T levels, the one that people don't know about T is sleep, sleep could really negatively impact your T-levels, we have a lot of good data on that. They've done studies where they compared, in the hospital setting, people, you know, age match, same age, they compared medical residents to the staff in the hospital, relatively the same age, medical residents are obviously getting weird sleep hours, short sleep at night, where it was like, they were getting five hours sleep, the regular staff was getting seven plus, and the medical residents, their T-levels were 180, 190 points lower than, you know, somebody else who was getting regular sleep. So that sleep is incredibly more for T-stostral levels. I can't stress that, amongst all the other benefits of sleep, T-stostral is one as well. - If you had to pick three things for a guy to do to optimize his sleep, what would they be? - In no particular order, but, I'd say minimize, and I'm not saying these are not- - This could be a habit, this could be an actual tool, this could be advice, this could be a supplement, this could be, you know, anything. - I would say, these are the things I do, and I'm exposed to all the other things out there and social media, but I would tell you the things I do. Minimize caffeine after the morning, right? That's a big one for me. Really wind down, like, turn off. I had a horrible habit where I would, I'd still do work into the late night, right? Or right until I went to bed, my mind is still going. So I'll shut stuff down two, three hours before now. Like, I'll let that be, I'll just hang with my wife, like, watch TV, something like that. And then, as hard as this is, but it's quite important, meditation. - Really? - Something as simple as five minutes a day, it's a huge difference, and I'm not that consistent. - I love meditation, I'm saying you're specifically at night as a sleep tour, or anytime, anytime of the day, right? Whether you're doing the morning or the evening, at the very least for me, even as simple as five minutes a day, I noticed for the rest of the day and for that night, it calms me down, it gets me better sleep. What do you think, if we kind of just like wrap up this whole conversation for men's health, sexual health, the rectile health, through the lens of, let's just call it, sex ed. Where do you think, where do you think we're getting it right? We live in a day and age of access and information and social media and, you know, I see growing clinics, you know, we're telehealth, so it's like, even physical access that no longer is as much of a limitation to getting this education for people to, to make the right choice for their lives. What are we doing the best you see right now in terms of sex ed, general information, sex education? And what is the biggest piece of misinformation you see out there? - I think the thing that we're doing right is younger generation of men are more inclined to learn about this and pursue different options to engage and optimize their health. Like, my father's generation, right? In generations before that, men were really like, man never talked about this. Right, they never even engaged in the conversation and let alone act it on it. And we're noticing younger and younger generations are willing to discuss it, vulnerable, vulnerability and act on it. I think that's good, that's great. I think we, in terms of doing it wrong, is we're overly complicating it, right? Take this supplement, do this, cold plunge, sauna for this many minutes. There's so much out there, right? Like, if you spend all day trying to optimize your health and you want to be able to maintain a job, but it's much more simple than we think. It's the joke out here, my morning routine is eight hours. - Right, there's so much to do, right? Yeah, there's so many things you could expose yourself to try to optimize, but it's so simple. It's simple for your sexual health, your overall health, your longevity. I try to keep as simple as possible. Eat, right? Like a well balanced diet. And you know what's gonna be perfect? 80% of the time try to eat complex carbohydrates, lean protein, healthy fat, sleep six and a half to seven hours a night, exercise, three days of weight lifting, one day of cardio, and then try to do, this is the hardest one, whatever you can do to minimize your stress levels. Comb your stress levels down for you. It might be something else than for me, but figure out what it is for you individually and maximize that. - Yeah, kind of on that vein, let's say you know in a typical male, female, heterosexual relationship. Part of this, you know, a man optimizing his sexual life is for his partner. and potentially part of why he is suffering in sexual health, it might be the psychological component or physical component with that same partner. So how can a guy convey to his wife, his girlfriend? Hey, like here's how he can help me. Like to your stress point, here's what I need from you or how can we workshop like the stress portion because ideally, I would think if you can open that door and have that conversation, it's only gonna help you, but it's very sensitive. So like what can a guy do or really what can the woman do to help his partner? Well, I mean, like anything else and not to overly simplify, it's just communicating, right? I don't think there's a correct way of approaching it but just really expressing yourself, telling your partner, telling your wife what it is that's bothering you or what it is that she can do. And then from her end, just not be overly critical about it, non-judgmental, going with an open ear, open heart, open mind, and try to engage. And it's never perturbed, right? It's not always gonna be perfect. You're always gonna have some little bit of back and forth but like anything else, really overly communicated if you can, overly. If you can share like an example, what has been the craziest example, craziest memories to harsh? What has been the most severe experience you've had with a male patient in terms of just like severely low T, horrible rectile dysfunction or rectile health, poor penile health? Like what was this worst case scenario that you've seen and was there a thing or two things that just radically helped resolve this? How do you go from the worst to even just baseline again before I even say, you know, best? - Yeah, a younger, like I had a guy who was a younger guy, he was a college student, I think he was 21, 22 years old, severely low T, severely low rectile erections, but I would say the erections problem, excuse me, the erection problems were more so because of the, he had, again, he was on a losing streak, he had a ton of bad erections, was more so in his head. To the point where he was so anxious and depressed, he actually had to get on SSRI, like an anti-depressant. So for a guy like that, we're able to boost his testosterone levels, get him back on a winning streak, take him off his SSRI on his anti-depressant. Is he, by the end of it, probably so only six months ago, by the end of it, he wasn't necessarily 100% back to where he was, but boy, was he, you know, severely, significantly ahead of where he was when he started. - Wow. - Yeah, we have great options. - Yeah. - We have, if you're a guy who's struggling, just talk to a doctor, there's so many good options. - Yeah, I would agree to kind of wrap it up on a bow, and I really think, as bad as it might actually be, or as bad as the guy is making it out to be, they're barring some crazy examples. There's really not much that we can't do to in a fairly quick turnaround time, see results, feel results, and like to be informed on the front end of like, what can I do here and now, and what is going to be contributing to, you know, even longevity benefits, or what should I be made aware of now in terms of my choices that might change my choices later, there's so many options out there, and you're one of them, isn't it? - Right, if I may include one more thing, if you think fear of a young guy experiencing this or any age guy, come spend the day in the office, like there's many guys who have been before, you many guys who have had the same situation after you, like not to trivialize what any of these guys are going through, but not the first or not the last. There's many guys who are experiencing this. - Yeah, that's true. - They just don't talk about it. - Exactly, yeah. Amazing, well, this has been so informative. Thank you so much for coming on. I'll have a few kind of a wrap up our questions to wrap things up before I ask the final question. What do you think is the most overrated sexual health supplement? - Damn. - Overrated. Supplement, not medication. - I'd say. Damn, I don't know too much about the supplements. - Well, you know, I guess we could probably throw out the window, all the things we see in the gas station that's sketched, right? - Orny Goatweed. - Orny Goatweed. - Yeah, yeah. - Why it doesn't work or doesn't work as much? - It doesn't work and has some significant side effects 'cause what happens is guys will, they don't necessarily feel it with like a low dose, they'll take more and then the higher doses you take, you have more side effects and not the good kinds of side effects, like proper side effects that you don't necessarily ever want to experience. - Yeah, so, orny Goatweed, yeah. All the ones that you mentioned here, they're all very safe. - Okay, are good. - The most underrated treatment for erections. - Supplement or treatments? - I'd say supplement wise, L-citraline. That's a great one. Medication wise, low-dose, regular CLS use. - Okay, and I think L-citraline for maybe a lot of guys in my audience, if you ever take a pre-workout, it's then a fair amount of pre-workouts. - Remember C4? - Yeah. - It's one of the four seasons C4. - Wow, okay. - Yeah, okay. Yeah, you know that pump feeling, you're feeling it? There you go. - Take 3000 milligrams before you work out, you'll notice the difference. - Yeah, yes, absolutely. What do you think is the most misleading testosterone claim? - That it's for everybody. I'd say it's good for a lot of guys, but if you're not experiencing, if you don't have low testosterone, like a low number, being on testosterone placement therapy is not gonna do much for you. What would you say is a fair clinical low number, symptomatic oriented, asymptomatic? - Yeah, I mean, this is the thing, it's the number's just part of it. You obviously wanna treat the symptoms as well as the number, but I'd say if you're, if you're in the 400s or lower, I consider a treatment with symptoms. What do you think is the biggest myth about penis size? Yours is too small, it's very few guys who need surgery and a lot of guys do it, but there's very few guys who actually really need it. - We didn't even get into this. I understand you have done, you conduct penile implants? - Right, what is this about? - So I do penile implants are more for function, they're not for length or, I mean, we're not adding length to it, it's purely for function. So when would a guy need a penile implant surgery? - If they failed everything else before it, right? So the medications don't work, we do something called penile injections. Most guys are on that. In simple terms, they're injecting themselves with liquid viagra, right before sex, right? And the penis gives them good, strong lasting erections, an erection for one orgasm, and then every time they want to have an erection, they do the same thing. It's more common than you think. But once they failed everything else, we do the penile implant surgery. - Walk us through that, what is the penile implant? - It sounds painful. - Yeah, the inflatable penile implant, inflatable. What that's what we call it, the IPP, right? It's the gold standard for erectile dysfunction. Actually, I have to go do one of those after this, seriously. But what it is, it's a three-piece penile implant. So there's two cylinders that go into the inside of the penis. There's a pump that sits between your testicles, and there's a small reservoir of fluid that goes in your lower abdomen. Everything's contained underneath the skin. Every time you want to have an erection, you squeeze the pump. The fluid from the reservoir goes into the cylinders, gives you a rock heart erection for as long as you want, and then there's a release valve. When you're done, you squeeze the release valve and everything goes back. - How long has this been around? What's the like, long decades? - Decades, it's been around for decades. It's usually lasts for about 10, 15 years, depending on usage. And it's more common than you think. A lot of the guys, I mean, obviously, we do more than the average clinic, but still, there's a lot of guys, it's quite common. - And this is more strictly for someone who cannot get and maintain erections. Not just for the guys, like, can I get another inch? It's purely for erectile function. We're not adding length, we're not adding girth, we're not doing it. It's for guys, most of the patients who get this are, you know, 60, 70 years of older, yeah. - Okay, well, good for you guys. The habit most likely to destroy erections. I'd say cigarettes, tobacco use. - It was not expecting that. - Sigarettes or tobacco use? - Whoa, I mean, vapes, cigarettes, those types of things. Definitely, they clog up those arteries. But as part of, I only said that one, just because we haven't talked about that one. We've talked about the metabolic issues. All of those things are quite important, but amongst the things we haven't talked about, I'd say, tobacco. - The fastest way to improve erectile health. Healthy living and sleep, stress, exercise, diet. Easy. Lastly here, the medical tests more men should request. I'd say check your testosterone levels, right? That's not part of your, most annual physicals don't have that, no matter, especially if you're younger. So check your total testosterone, check your free testosterone as well. That's an important one, the free. And then, if I could say one more, the PSA, those three. Actually, I lied, I have one more here as well. I feel like this should be a good question. What does a sexually healthy man understand about himself that an insecure man does not? No one is ever batting 1,000, right? You're gonna have some good days, you're gonna have some bad days. As long as big picture you're doing it, you're having more wins than losses, more good days than bad days, you're doing just fine. Lastly, to bring this all home to the theme of the show, bring experts and medical professionals like yourself on the show to really talk about, you know, unique slivers of our well-being, so that it can help us learn something new, come back to a foundational base. basic that we need to be reminded of so that we can move forward in that area, but then also apply it to everything else, so collectively we're living a life ever forward. What are those words mean to you? How do you live a life ever forward? I'd say being somewhat uncomfortable with the uncomfortable throughout the course of our lives, no matter what chapter, no matter what decade, realistically none of us really have it figured out. And as much as we want to hope that we're figuring it out, hopefully I figure it out next week, next month, next year, at the end of the day, we're never going to really figure it all out, so just be comfortable with the uncomfortability of each chapter of life. Yeah, beautifully said, there's never a right or wrong answer, and the older I get the more I realize, it's just every day you just figuring it out. Figuring it out. And some things going out less, yeah, absolutely. So where can my audience go to, connect with you, learn more about you, maybe even, you know, step into the clinic with you? Yeah, so just look me up online, Justin Human, MD, H-O-U-M-A-N, social media, website, across the world. Amazing.