Mark Bell's Power Project - Stop Sabotaging Your Sex Life: Secrets Every Man SHOULD Know - Dr. Mohit Khera || MBPP Ep. 1102

Episode Date: September 16, 2024

In Episode 1102, Dr. Mohit Khera, Mark Bell, Nsima Inyang, and Andrew Zaragoza talk about how erectile dysfunction may be an indicator of a much severe issue. They also discuss cures and remedies for erectile disfunction and what helps Dr. Khera's patients better than testosterone replacement therapy. Follow Dr. Mo on IG: https://www.instagram.com/drmohitkhera/   Official Power Project Website: https://powerproject.live Join The Power Project Discord: https://discord.gg/yYzthQX5qN Subscribe to the Power Project Clips Channel: https://youtube.com/channel/UC5Df31rlDXm0EJAcKsq1SUw   Special perks for our listeners below!   🥜 Protect Your Nuts With Organic Underwear 🥜 ➢https://nadsunder.com/ Use code: POWERPROJECT to save 15% off your order!   🍆  Natural Sexual Performance Booster 🍆 ➢https://usejoymode.com/discount/POWERPROJECT Use code: POWERPROJECT to save 20% off your order!   🚨 The Best Red Light Therapy Devices and Blue Blocking Glasses On The Market! 😎 ➢https://emr-tek.com/ Use code: POWERPROJECT to save 20% off your order!   👟 BEST LOOKING AND FUNCTIONING BAREFOOT SHOES 🦶 ➢https://vivobarefoot.com/powerproject   🥩 HIGH QUALITY PROTEIN! 🍖 ➢ https://goodlifeproteins.com/ Code POWER to save 20% off site wide, or code POWERPROJECT to save an additional 5% off your Build a Box Subscription!   🩸 Get your BLOODWORK Done! 🩸 ➢ https://marekhealth.com/PowerProject to receive 10% off our Panel, Check Up Panel or any custom panel, and use code POWERPROJECT for 10% off any lab!   Sleep Better and TAPE YOUR MOUTH (Comfortable Mouth Tape) 🤐 ➢ https://hostagetape.com/powerproject to receive a year supply of Hostage Tape and Nose Strips for less than $1 a night!   🥶 The Best Cold Plunge Money Can Buy 🥶 ➢ https://thecoldplunge.com/ Code POWERPROJECT to save $150!!   Self Explanatory 🍆 ➢ Enlarging Pumps (This really works): https://bit.ly/powerproject1 Pumps explained:      ➢ https://withinyoubrand.com/ Code POWERPROJECT to save 15% off supplements!   ➢ https://markbellslingshot.com/ Code POWERPROJECT to save 15% off all gear and apparel!   Follow Mark Bell's Power Project Podcast ➢ https://www.PowerProject.live ➢ https://lnk.to/PowerProjectPodcast ➢ Insta: https://www.instagram.com/markbellspowerproject ➢ YouTube: https://www.youtube.com/markbellspowerproject   FOLLOW Mark Bell ➢ Instagram: https://www.instagram.com/marksmellybell ➢https://www.tiktok.com/@marksmellybell ➢ Facebook: https://www.facebook.com/MarkBellSuperTraining ➢ Twitter: https://twitter.com/marksmellybell   Follow Nsima Inyang ➢ Become a Stronger Human - https://thestrongerhuman.store ➢ UNTAPPED Program - https://shor.by/JoinUNTAPPED ➢YouTube: https://www.youtube.com/c/NsimaInyang ➢Instagram: https://www.instagram.com/nsimainyang/?hl=en ➢TikTok: https://www.tiktok.com/@nsimayinyang?lang=en   Follow Andrew Zaragoza ➢ Podcast Courses and Free Guides: https://pursuepodcasting.com/iamandrewz ➢ Instagram: https://www.instagram.com/iamandrewz/ ➢ TikTok: https://www.tiktok.com/@iamandrewz   #PowerProject #Podcast #MarkBell #FitnessPodcast #markbellspowerproject

Penile implants. The number one thing that most men say after this is, I wish I'd done this sooner. I can have sex whenever I want, as long as I want. These men are still able to come and do everything. Everything. And still keep going. Of course, because the penis is still erect.

A salesman. Yeah. 180 minutes of exercise does what for us? Exercise alone significantly improved erectile function rates. Erectile dysfunction could be the first red flag of heart disease or maybe diabetes. If a man gets erectile dysfunction today,

15% will have a heart attack or a stroke within seven years. Do you have like just real concerns about where the world is going in general with diabetes, heart disease, and all these other things that are happening to us? Yeah, as you're gaining weight as a society, you're shutting down your testosterone more and more and more.

So decade by decade, we're becoming more and more unhealthy. There's only one thing that you found that helps people feel better than testosterone over the past three years. I found something that probably makes them feel even better. If you guys have been enjoying the concept we've been bringing here on the power project, consider leaving us a review on Spotify and Apple. We've had podcasts with people from Functional Patterns to Ben Patrick to Jack Cruz who roasted us on air,

but we did that for you to bring you some of the best information in fitness. We're learning along with you and leaving a review with how you dig the podcast is really gonna be something that helps the podcast move forward. So if you can, leave us a review there and enjoy the rest of the show. Dr. Mo, how long you've been a urologist for?

17 years, Baylor College of Medicine. And you mentioned to me a study, which I think is a great place to start some of this podcast out with. I think it's great that you're actually like conducting these studies. This is a study that you did 180 minutes of exercise does what for us? Yeah, so we talked about exercise

and the effects of sexual dysfunction. So last year we published a study looking at what we call meta-analyses. These are the biggest studies you can look at meta-analyses, looking at the benefits of exercise on sexual function. And we found that those men who exercise was typically on most studies, 180 minutes a week, significantly improved erectile function rates.

Now I want you to think about that. I'm not just giving you Viagra. I'm not giving you some medication to help your erections. It's just exercise, exercise alone, significantly improved erectile function rates. We use a questionnaire called the IIEF. It's our standard questionnaire. Significant improvements in IIEF with exercise alone.

And what type of exercise was this like? Lifting weights or was it walking, running? Yeah. So out of the 11 studies, all 11 had cardio, but three also had weight lifting as well. So it wasn't standardized, right? They just took 11 studies. Three had cardio plus weight lifting, right? And the others were just cardio alone.

But I can't stress the importance of muscle mass. So great study came out this year showing the protective effects of muscle strength on sexual dysfunction. So this is what they did. They looked at men who had diabetes, smoking, cardiovascular disease, and they looked at those men who had good muscle strength

and poor muscle strength. Same population, those men who had good muscle strength and poor muscle strength. Same population, but if you had good muscle strength, it negated the effects of diabetes, cardiovascular disease, and smoking, and those patients had better erectile function. So some protective effect with muscle on overall sexual function. And we're gonna get into testosterone replacement

and all these different things that people can do in regards to erectile dysfunction. But you mentioned something to me earlier about, you were mentioning something to me earlier about how erectile dysfunction could be the first sign, first red flag of maybe some heart disease or maybe diabetes, right? I think it's really important.

You know, the old days when patients come in for ED, I used to give them Viagra, maybe a little testosterone, and let them go. And we kept on doing that. And that was a big lost opportunity because many of these men have underlying medical conditions that could be life-threatening. The best examples are cardiovascular disease.

If a man gets rectal dysfunction today, 15% will have a heart attack or a stroke medical conditions that could be life threatening. The best examples are cardiovascular disease. If a man gets rectal dysfunction today, 15% will have a heart attack or a stroke within seven years, 15%. And numerous studies have shown that the best window to understand a man's cardiovascular health is his erectile function. It's the first sign of a heart attack or stroke. Other studies have shown that if a man gets ED today, twice as likely to be diagnosed with diabetes in the future.

He's in the ages of 40 to 60. He's almost five times more likely to get diagnosed with diabetes in the future. Don't forget that ED is a first sign of depression and anxiety in most men. So giving that man that Viagra and letting him go, you are missing a whole slew of other medical conditions you could catch. And why I think that's really important is young men. I want you to think about this. When we were all 30 years old, how often do we go in for our physical?

32, I think. Yeah. How often? I mean, most men, if you look at the statistics, if a man's between the ages of 19 and 39, only 45% of those men go in for an annual checkup. Only 45%. Why? They're not going to go in and get their blood pressure checked, not going to go get their glucose checked. But if that man between the ages of 19 and 39 gets erectile dysfunction, he is at my door the next morning. So lining up, he's ready to get treated, right? That's a serious condition to that.

This doesn't normally happen to me. I don't have too many beers. Yeah, but I'm just telling you, so when you get that man who's like say 32 years old, who has ED, that's the opportunity to catch those medical conditions. Because I call it area under the curve. The longer I have diabetes, the longer I have hypertension,

it's the more pounding on my blood vessels I'm taking year after year after year. If I catch it early in that 29 year old and I start treating it then, I save all those years of damage, right? So the gateway to particularly young men's health, to their health is erectile dysfunction. They will come in for that. Don't just hand them the viagra and let them go. Figure it out. What else is going on? Make sure it's not depression, anxiety. Many of these men are suffering from depression and anxiety. That's why I have the ED.

This is your opportunity to intervene and engage. Doc, I have a question. For younger guys who, let's say that they're using Viagra and Cialis every single time they want to have sex, right? And it becomes something that they feel that they need. Is there any downside, long-term health risk? Because in the fitness industry, there are guys that just take a little bit of Cialis,

not even for sex, but just for blood flow, for like workouts and extra pump, et cetera. But are there downsides to that? Yeah, so in 2003, Cialis came out in the United States, and there is a version of Cialis called Daily Cialis. It's five milligrams, it's meant to be taken every day. It's FDA approved to be taken every day. It's FDA approved to be taken every day. It is by far one of my favorite medications to treat men for ED. I'll give you

an example. A man walks into a clinic and he has a broken leg. You and I have two options. We can fix the leg or we can give him Vicodin. Because if I give him Vicodin, pain goes away and he keeps walking, right? Viagra is Vicodin. It is not solving the problem. Viagra is not curing your ED. It's just letting it get worse every day until the Viagra stops working. Daily Cialis is curing that ED, in my opinion. If you look at Daily Cialis, what it does, it causes hypertrophy or enlargement of the muscle in the penile tissue.

So if I asked you today, I said, I want you to lift a dumbbell every day and you lift that dumbbell every day, your arm gets larger and larger. Hypertrophy is right. No, come on. It does. Same thing with Cialis. Cialis helps with hypertrophy of the smooth muscle. It actually helps prevent the lining of the blood vessels called the endothelium, protects

the lining. FDA approved to help you urinate better. That's interesting. Same daily drug. Helps a man urinate better, helps him have better erections. It's also FDA approved for pulmonary hypertension. So I protect the heart, protect the penis, protect the prostate.

It's a great medication. I'm a big believer on it. So we put the patients on that daily Cialis and it doesn't make a difference. Okay. No, I was gonna ask, how come, so I have taken it for workouts and stuff, but I instantly regret it because I get like...

You get hard while working out? I wish. I got a hard time. Great sweatpants on the bench. Yeah. Terrible headaches. Yes. Why does that happen?

Let's talk about it. So there are side effects that can occur and it's a dose response curve. So the higher the dose, the more likely you are to get side effects. If you have a 20 milligram dose, it can be up to 20%, we'll get headaches. If you take the 5-milligram dose, it's less than 6%, we'll get headaches. And it does happen. Side effects can be headache, flushing

of the face, back pain. There are side effects. It's low if the dose is low. Now, what I've found in my practice is that if I decrease the dose, not to 5 milligrams a day, but maybe even 2.5 milligrams a day, or 2.5 milligrams every other day, and I have them use it for a period of time, it desensitizes them, and I slowly can get back up to the five milligrams a day. But in some patients, you can't, they have side effects. So if you happen to be that 6%, unfortunately,

we can't use it. And you're also not someone who's just like, hey, you're gonna do this five milligrams of salis and all your problems are solved. Right. You've got a diet behind it, exercise behind it, and a lot of other things. You mentioned something before the show

and I wanna make sure that we talk about this. There's only one thing that you found that helps people feel better than testosterone. Yeah, so the story goes like this. For 17 years, I've been treating men and women with testosterone replacement therapy, and they feel great. Many of them see a significant improvement

in their qualities of life. Over the past three years, I found something that probably makes them feel even better. It's weight loss. You take a guy or a woman, you take a woman who's 50 pounds overweight, and she drops that 50 pounds, she's a new person. Same with a man.

You take a man who's 40, 50 pounds overweight, you drop that weight, they feel amazing psychologically, physically, and think about weight loss. Weight loss is gonna help your diabetes, your blood pressure, your inflammation, your joint pain. I can go on and on and on about what the impacts of weight loss are on the body, right? So when you combine weight loss with hormone optimization, now you're on fire.

And that really, now we talked about this, that's one aspect. The other aspect is meet me halfway, diet, exercise, sleep, and stress reduction. The many patients say, give me the pill and give me the medication and I'm not going to eat, all right, I'm not going to exercise, I'm not going to sleep, and I want magic to occur. It's not going to happen. Meet me halfway. Diet, exercise, sleep, stress reduction. I don't have a pill on the planet stronger than diet, exercise, sleep, and stress reduction. And all three of us can do better on all four.

Absolutely. I have a question on the testosterone portion of things, right? Because we've had this conversation with so many professionals, a lot of younger guys are just getting on TRT, it's a normal thing for them, right? And I know you use it in your practice, but who would you say, if they're like, I should be on TRT, how do they know

if they're truly a candidate or they just need to work on those things you mentioned and maybe that's the trick and that's the trigger? And how do you also know when to actually start someone on that, because if they do change those habits and they end up at a better place, but then they're also using TRT, well, you usually don't see people stop TRT once they start.

Right, so very important point. Let's talk about this young population. So most young men don't know that testosterone can cause infertility. A lot of them don't. Great article came out this week in the Wall Street Journal talking about testosterone vitality but causing infertility. Great article.

So when you put a man on testosterone and you shut down his sperm count, many clinics will say, but you know what? If you stop, you'll recover. Not exactly true. Let's say I start out at 80 million sperm per ml. I take testosterone, I shut myself down, but then I say I want to have kids. So I stop the testosterone and I recover

up to 20 million sperm per milliliter. Yes, I did recover, but I'm only a fourth as fertile as when I started. And that's normal for that to happen? It can happen. Now, some can recover higher levels, some don't recover. It's all contingent upon how long did I treat them and how high was the dose, right?

Now many years ago, we have a protocol. We use HCG, gonal F, Clomid. We use medications to reverse it. But it's very important to counsel somebody, particularly if they're going to try to conceive in the near future. Hey, wait a minute. Are you sure you wanna do this?

You may be altered forever. You may, it can potentially alter you forever and you gotta be very careful. Now secondly, I am very reticent on starting a young man on testosterone. Because I say, look, you're 32 years old. If I put you on this, I will shut down your natural testosterone and your natural sperm production.

And if I do, in many ways, you're kind of hooked. You're on this now for life. You're 32, we gotta go 60 more years. Are you sure you wanna do this for 60 more years? Why don't we talk about using medications to help you make testosterone? So I'm not gonna give it to you. Let's use medications to help you make testosterone.

Clomiphene Citrate, HCG, sometimes a Narsal. I can use those medications. And why don't we talk about using lifestyle modification to help you raise your natural testosterone. For example, if I improve sleep apnea, T levels go up. If I improve your exercise, improve your diet, right? There are many things I can do, weight loss. So remember, obesity shuts down T, right?

Because fat cells contain something called aromatase. Aromatase eats testosterone and converts it to estrogen. So the more fat cells I have, the more I'm chewing up the tea I have and I'm losing it. I start losing the fat, I start increasing the tea. An amazing study with obesity and testosterone came out of what we call the E-mass study, the European male aging study.

Did you know that if any of us lose 10% of our body weight, we'll gain about 85 nanogram per deciliter in testosterone. But if we lose 15% of our body weight, we gain 250 nanogram per deciliter in testosterone. But it works the other way. If you gain weight, you'll lose 10%. You see, it goes both ways. So losing weight significantly increases

natural testosterone levels. The problem is many times it's not sustainable. They lose weight, then they gain it. They lose weight, then they gain it. So, you know, we do use a lot of these GLP-1 medications that are pretty popular right now. They help people lose weight, but you have to be careful. When you put someone on a GLP medication like Ozembic, yes, they will lose the weight, but some can lose up to 30%

muscle mass. That's a problem. That's a big problem. So we push them hard on protein, taking the right amount of protein, lifting weights. You mentioned something earlier, I asked them to buy dumbbells. I tell them to put the dumbbells in the living room and while you're watching TV, every time it's commercial, you could do so much with dumbbells. It's unbelievable.

I said, take the dumbbells while you're watching, use them, right? Take in the protein because I do not want to pull your muscle mass down while I give you this medication. Yeah, you have a whole squad, a whole entire team of people working with you and working under you and learning from you and you must be insanely busy. I mean, from you and you must be insanely busy. I mean, doctors work many, many hours and something you told me in the gym was incredible. The way that you start every day is with what?

Every morning I start the morning with exercise and meditation and prayer. I mean, I just do it every single morning. And for me, it's made a big difference. And meditation has really grounded me. And people say, how do you find the time? But the days I do the meditation, exercise, prayer, my day goes really good.

The days I skip it, the day doesn't go so good. So maybe I'm superstitious, I don't know, but it does work. It just clears my mind. So I take care of a lot of people and they say, I just don't have the time to exercise, for example. I just don't. I say, if you give of people and they say, I just don't have the time to exercise, for example. I just don't. I say, if you give me 30 minutes of exercise, I will give you an hour back in terms of efficiency

in your work that day. You'll get it back. They say, I don't get it. I say, just do it. You will think clearer, you'll produce better. You give me 30 minutes, I'll give you an hour. It makes a big difference. These commercials that we've seen over the years,

always has the guys so happy and the girls so happy. The guy's taking the Viagra or they got the two individuals like in a tub on the top of like a mountain somewhere with this cool view. Or there's, my favorite one is the one with the Santa Claus and the girls are like all happy to sit on his lap and everything. But if we're not. It's so creepy.

Oh, I know. It's so creepy and weird. But if we're not cognizant of the recipient of these erections, then maybe we're causing some problems in the household, right? Yeah. Let me tell you a story. So in 2007, I finished my fellowship and I felt really good about myself. I was able to get these men, these amazing erections, great libido, they go home, they had no one to have sex with, right? These women said, look, I haven't had sex with him in 10 years, all he wants to do is have sex right now.

Things were great until he met you. We had the best relationship until he met you. And you know what? And one woman actually threatened to sue me. She said, I can't, we can't do this. And I realized they were right. I was wrong. They were right. It's okay to leave both libido's low.

That's fine. They'll get along great. It's okay to leave both libido's high. You are not going to raise one libido and not the other. It's a setup for disaster. So in 2008, I went out and learned how to treat female sexual dysfunction. I've been treating it now for 16 years

because a sexual dysfunction is a couple's disease. By treating one partner, you're actually treating the other. Right? It's not just about that patient sitting across from me in that exam room. What about their partner at home? Right? What about their partner at home is extremely important. So again, I can't think of another condition that affects the other partner. My blood pressure doesn't affect my wife.

My diabetes doesn't affect my wife directly, but my sexual dysfunction will affect her life and that's really important. God, those commercials are good. They're all lining up for it. That's so creepy. Doc, I wanted to ask, so I'm 39 now and while I don't know if my libido is still high or what the true diagnostics of that would be, but I know when I got on testosterone three years ago, we'll say four years ago now, as soon as I got on my libido was through the roof and everything was as like, I mean,

it was like I was a teenager again, right? And except now I had a wife and I had access to having sex and so it was great for all parties. I don't know if it's just me or if this is normal, but for me at least, that super high raging libido totally faded away and now it's definitely more manageable. I'm gonna use that word manageable because in that moment it's like, holy, it was pretty bad.

Is that normal? And then also, why does that happen? It's the same levels. I've only gotten healthier since being on testosterone, but yet the libido isn't nowhere near as high as it was. Yeah, so there's an accommodation effect. So when you have a patient who has low testosterone and you put them at a normal level,

that delta, that rapid change can significantly improve someone's libido. And over time, you become used to your new normal, right? Same thing happens in women also. I see it all the time. I prescribe a lot of pellets. I do a lot of procedures. And after the first pellet,

these, a lot of these women say, this was incredible. After the third pellet, fourth pellet, they say, it's not working anymore. I don't think this is really effective. We check the blood. I say, this was incredible. After the third pellet, fourth pellet, they say, it's not working anymore. I don't think this is really effective. We check the blood, I say, it's working. Somehow you become used to your new normal. So that is important. Libido is multifactorial.

It's not just about testosterone. Everyone thinks, oh, it's just testosterone. There's four hormones that you think about. It's called PET, prolactin, estradiol, thyroid, and testosterone. We teach the residents that. You check the PET on everybody if they have low libido. You look at neurotransmitters, dopamine, and serotonin, norepinephrine, right?

So if you look at the new FDA-approved drug for women, now it's been about nine years to treat her for low libido. It's called Adi or filibanserin. Essentially, all it does is increase dopamine in the brain, it improves norepinephrine, and it makes her wanna have sex, right? So we have an FDA-approved drug for women, she takes it every day, and it makes her wanna have sex. That's the indication, but it's neurotransmitters.

Things that take away are serotonin. What do you think an SSRI does? What do you think Prozac is, Lexapro? Shuts down that libido so fast, you have no idea. Shuts it down because it's serotonin. What about the quality of the relationship? We don't talk about it, it's critical. You can have a terrible marriage and tell me,

I take all the testosterone I want, it's not gonna help your libido. You have to focus on the fact that the relationship, we use a sex therapist, a counselor, really important. So it's not just about tea, it's also diet, exercise, sleep, stress. If a woman has a poor body image, her libido goes down. So everyone's like, give me the tea and my libido will go up.

No, let's talk about every other thing that's a factor. You think about fatigue and stress, right? So stress is interesting because if a woman is stressed, she doesn't want to engage in sexual activity typically, right? If she's fatigued, she won't. Men are a little bit different. Sometimes in men when they're stressed,

they use sex as a stress relief. And sometimes when they're stressed, they avoid sex. We can go both ways. So I tell men, you want to have sex with your wife? Decrease her stress. Do the dishes, do the laundry. Shut down her stress. Your chance of engaging in sexual activity

goes up significantly, right? So multifactorial, don't think about just T as the only factor for libido. And I'm curious about this because I know for myself, if I have a hard day of jujitsu and I get back home, I could want to, but I just, I don't have the energy for sex. And I wonder if guys get on know, guys get on testosterone,

now they have all this energy, right? They have all this sexual energy, but now they have all this energy to work out and start being productive there. So let's say they start working out a lot and would that probably even things out? Cause like, Andrew, when you mentioned that, I was like, well, maybe you weren't doing Jiu-Jitsu

back then and you're doing 5 a.m. Jiu-Jitsu classes, you're super active. Maybe the increased activity in other places, right, would also maybe affect or- It could, it could, but what you're bringing into is fatigue, right? I don't care how you get the fatigue, but fatigue will be a decrease in libido.

So think about it, it's 10 o'clock at night, you're exhausted, you have two choices, engage in sexual activity or sleep. Many times you'll choose sleep if you're very fatigued, particularly women will, right? She's very fatigued. The option is gonna be sleep or sex. She's gonna choose sleep, right?

So you wanna decrease the fatigue the best you can. And that jujitsu is just an example of something that's gonna increase the fatigue. Yeah, all right. Yeah, overtraining I think is definitely a huge factor for a lot of people. Is there any like long-term or have you seen anything long-term with people utilizing TRT and having erectile dysfunction? It depends on what type of TRT you're using.

So we know that certain types of anabolic, like nandrolone, DECA, has been associated with increased erectile dysfunction, right? And typically it's dose dependent. So the higher the DECAose, the more likely you are. Typically I don't see long-term TRT in physiologic ranges causing ED. So that's very important. We, I was involved in the AUA ED guidelines.

This is about guidelines, how you prescribe testosterone for erectile dysfunction. Testosterone is very important for overall erectile function. It's actually really important. Some of the highest receptors of testosterone are in the penile tissue. And what testosterone is really good at is making the Viagra work better. Let me give you an example. If a man has low testosterone and he says, my Viagra stopped working, if you put that

man on testosterone, 30 to 50% of those men will say, my vagus started working again, right? So you take non-responders and make them responders again, which is very important. So testosterone is really important for keeping the penile tissue healthy. How important is our sleep? Critical. So there are studies showing that less than six hours

a night of sleep consistently will not only result in worsening of erectile function, but increases cardiovascular risk, metabolic risk, meaning obesity, diabetes, and inflammation. So that is one of my four pillars. My patients come in, a lot of them are CEOs, they're really good at diet and exercise. Oh, they're going to the gym, they're exercising. They are horrendous at sleep and stress. And those are the silent killers, right?

Sleep, everyone's looking for this fountain of youth. It's your sleep, it's your exercise, that's your fountain of youth, right? Get the sleep. And it's not just about the hours you sleep, it's times percent efficiency. So Mark, if you went to bed last night and you went to bed for eight hours, but you only were 20% efficient, I went to bed for four hours, I was 80% efficient, I'm going to feel better than you, right? I have more efficiency, right?

More deep sleep, more REM sleep. That's really important. Also remember that the timing is important. You want to be consistent. Go to bed every night at the same time. Wake up at the same time. So if you're getting seven hours a night, don't say, well, one night I'm going to go 10 to five,

next night 12 to seven. The body wants consistency. Same time every night. You fine tune that sleep. Even if you get wants consistency. Same time every night. You fine tune that sleep even if you get 30 minutes of better sleep every night, game changer on the next day. Game changer. So focus on the sleep. Take it very seriously. I'm really curious about this because when I was younger, I was copious. I watched copious and copious amounts of porn when they started when I was 13. And there's this term on the internet known as P.I.E.D.

or porn induced direct child dysfunction. That guys that have had that type of issue where they watched a lot, now they want to go have sex with a girl and they can't, they can't get it up. That has happened to me in the past. Now, have you dealt with men like this? Has that been an issue or do you think it's in their head?

It's a real phenomenon. It does occur. This is why it typically occurs. When you watch porn, your expectation is here. And when you're with your partner, you're getting this. There's a Delta and the greater the Delta, the more likely to get ED, right? Cause you're expecting X and you're getting Y, right?

And so some men, as you, and we ask about porn every time they come in with ED, particularly younger men, but all men are asked, we ask them to mitigate the porn, but we have a sex therapist and that sex therapist, she is fantastic at getting men to slowly decrease the porn. If you decrease the porn, rectal function rates can improve.

Truth. So it's really important to ask at least, when they come in again, you can hand them the Viagra and that's fine, but are you solving the problem? No, you're band-aiding it. Viagra is a band-aid on the problem. Could porn in some way be helpful at all, you think? In some ways, couples that watch porn together

can be helpful, right? But typically, most of the cases we see are men watching porn secretly, not telling their partner, right? And their ED is getting worse. We talk about physical performance so much and how important it is to be healthy, but how about your sexual performance? And I'm being serious.

So for all the guys in here, being real, sometimes you're just a little bit stressed. Maybe you didn't get much sleep. Blood flow doesn't work the way it should. You go in and it's time for some fun and oh this is what you're working with. Whereas this is what you should be working with. That's why we partnered with Joy Mode. And I'm again, I'm being serious here because Joy Mode has ingredients within their product that is going to massively help with blood flow. And we know that if you wanna be working with

something that doesn't have any give to it, you need good blood flow into your manhood. All right, the ingredients on Joy Mode are as follows. Vitamin C, citrulline, arginine nitrate, Pan-X ginseng root. This is legit stuff mixed into easy packets that you can pour in a drink and 30 minutes later your blood's going to be flowing like it should.

So Andrew, where can they get it? Yes, that's over at usejoymode.com and at checkout use promo code power project to save 20% off your entire order. Again usejoymode.com links in the description as well as the podcast show notes. Damn it. Oh, shit. Oh. How does somebody bring that up to their regular GP doctor? Right, like they come in for a checkup or whatever.

Do they just, because it's a hard subject to bring up. It's a hard question for me to ask right now, to put it in the right words, but like how do you ask your doctor, or how do you talk to your doctor? How do you let them know, hey, like I'm having some trouble downstairs. Is the doctor going to be receptive or is it one of those things where they're like, oh, okay, yeah, let me send you somebody else. So you have to spill your guts to another person. Right. Such an important point.

I'll just give you an example. My wife is a family practitioner and I said, do you screen with sexual dysfunction? And she said, look, I got 15 minutes to go through diabetes, hypertension, sleep apnea, and you want me to start talking about sexual dysfunction. I said, yes, I do. I think it's extremely important and it could be underlying medical problems that you could be picking up.

She said, look, most of my colleagues, we were not really trained very well in this. Most people are uncomfortable bringing the topic up. And do I really have the time, right? So we don't bring it up. An amazing survey that came out in 2022, they sent out a survey to the United States, all the country, men between the ages of 18 and 80. And 40% of men responded on the survey saying, I actually have a sexual problem. 53% said, if you told me where to go, I would go. I just don't know where to go. But the clincher was 51% of those men said, I spoke with my doctor, 49 were too embarrassed or the doctor never asked.

And then 44% spoke to their partner about it. Now you may say, well, how could they not speak to their partner? Because what do men do when they start developing erectile dysfunction? They start avoiding sex, right? They don't discuss it with a partner. They just avoid it. So it sounds like they have decreased libido, but they want to have sex, but start avoiding sex. They don't discuss it with a partner, they just avoid it. So it sounds like they have decreased libido, but they want to have sex, but they can't. They're embarrassed.

So this is a population that suffers in silence. This is a very prevalent condition. 40% of men at 40 have ED, 50% at 50, 60 at 60, 100 at 100. This is a prevalent condition that suffers in silence because they're tumors and they live inside with it with the depression, with the anxiety, and all the other things that go with it. Let's not forget about female sexual dysfunction.

48% of women in the United States suffer from female sexual dysfunction. Only 19% seek therapy, only 19%. This is another population that suffers in silence and you can't discount that as well. Where should a female start? Many women go to the OBGYN, but you should be able to go to your primary care physician.

But the concern is the following. Many of the clinicians are not trained to treat female sexual dysfunction. What is female sexual dysfunction? Many people don't even know that. So it's four conditions, right? It's decreased libido, decreased arousal. Arousal means blood flow to the genitalia, lubrication,

orgasmic dysfunction, or pain within her course. If she has one of these four and she's bothered by it, she suffers from FSD. So if a woman says, I have low libido and orgasmic dysfunction, but I am not bothered by it, I like it this way, then she doesn't suffer from FSD. So if a woman says, I have low libido and orgasmic dysfunction, but I am not bothered by it. I like it this way. Then she doesn't suffer from FSD, right? She has to be bothered by it.

48% of women in the United States have FSD, 19%, they get therapy. What's sad is the research in this field is minimal, very minimal. Only nine years ago, we got the first drug ever to treat women for FSD, which is called adiflobancin, which was designed strictly to increase her desire for sex. She takes it every day, dopamine goes up, norepinephrine goes up, and she wants to engage

in sexual activity. Right? But before that, we had no drugs. We had no medications to treat women. We do off-label things. Do I give women sometimes Viagra to help them with arousal? Sure, it helps men, it can help women, but it's off-label. Do I give women testosterone?

A lot of women I give testosterone, but it's off label. Meaning, if you and I went into Walgreens and said, can you give me that testosterone for men? They'd say, yeah, here's over 12 products. Oh, by the way, can I have that testosterone for women? No, it doesn't exist. We don't have a single drug for women. If we were in UK or Australia,

we could walk in and get the testosterone for women at the drug store, but we can't get it in the United States, which is a shame, because women also suffer from low testosterone. Women also significantly benefit from low testosterone, yet we don't have a single FDA-approved testosterone product for women,

even though we've been treating these women since 1935 in the United States. Very sad. But so what do we do? We compound it. Call my compounder up, I make an injectable, I call my compounder up, I make a cream, right? And we use it.

Extremely effective in treating signs of low energy, low libido, depression, osteoporosis. It's not just about sex. You know, testosterone is way more than just sex. It's about your health. And just so people maybe understand a little bit better, a vial of testosterone may have around 200 milligrams per every milliliter.

Yes. In the case of a woman that is just trying to get better sexual function, that would not be a great idea to mess with that bottle because it would be very hard to get the precise right amount. It would be this tiny little speck and it would be hard to measure. And so therefore compounding and having a compound pharmacy, make it in smaller derivatives would make more sense.

Much more sense. So remember that the conversion from man to woman is 10 to 1. What I use in a man, I use one tenth in a woman. But typically I have to convert and I use compounded testosterone, Sipunate, and I use 50 milligrams per ml, and I have her inject 0.1 cc's once a week. And then we see what the levels are,

and we can then decide what to do. I have really gone to sub-q injections for men and women. I think it works fantastic. You don't have to use as much as you use IM. It's about the conversion's 80%. So if I use 100 milligrams IM, I can use 80 milligrams in sub-q for a man or a woman, get the same levels and we split the dose.

You wanna do it on Sunday and Thursday. Why? Because injectables peak in 24 hours. So if you do it Sunday and Thursday, you're ready for Monday and you're ready for Friday. Those are the two biggest days of your week. And when you split the dose, I decrease the erythrocytosis rate. So the red blood cells go up.

There's a theoretical cardiovascular risk. If it gets to 54, I split the dose. It's much smoother, not many peaks and troughs. And I decrease the erythrocytosis rate. So I love splitting it. I love you sub-q. Wow. Doctor, are there any side effects? Because I know in the fitness space,

some women take extra testosterone, there's virilization and all these things, right? With the low dose that you have these women taking, are there side effects that are negative that they should be thinking about if they choose to go that route? So in women, the key is called low and slow. That's the low and slow, start low and go slow.

It'd be great for sex too. Yeah, yeah. But if I overshoot a man, okay, you readjust either. But in a woman, we start low intentionally and then we work our way up. That's extremely important. And typically you're right. So typically you can get acne

and you can get facial hair. At larger doses, you can get clitoromegalia and you can also get deepening of the vocal cords, but you don't let them get there, right? So as you go low and you start increasing the dose, as long as you're not getting acne or facial hair, the erythrocytosis is not there, they do really well. We're just about to publish a paper

that we've done on pellets in women. So I've been treating pellets in women for 15 years. We have long data now. Can you just explain a little bit at what that is for maybe people that- Yeah, so there's many ways to get testosterone in the body. Let's say an injection, you can use a patch, you can use a cream, you can use a pellet.

A pellet looks like a grain of rice that you make a little tiny incision in the buttocks, typically, and you place the pellet in the fat and you just put a band-aid, okay? Pellets were the first type of testosterone used in women, right? Dr. Alfred Lozier, this was 1940, was using pellets in women, described significant improvements in women, right? Dr. Alfred Lozier, this was 1940, was using pellets in

women, described significant improvements in their libido and well-being, and that was the first type, and they dissolve over time, and typically about three to four months, and then they come back in again, and they're fine. I think pellets work well. We don't have any pellets for women. We do have a FDA-approved pellet for men called testipel. So in women, again, I have to compound it. So I compound it and put it in. But those pellets tend to work very well. So I think the key is that in our study that we just about to publish, long-term data, when you put testosterone in women, for some reason, they don't get the erythrocytosis

that we see in men for some reason. They don't get the hypertension that we see in men as well. So maybe there's something biologically different about using testosterone in women. We don't go to super physiologic doses. So I think that's very important. So that may be part of the reason why. Testosterone does cause hypertension. Testosterone does cause increase in red blood cell count. Reason being testosterone likes to hold sodium, it holds salt. When you hold salt, then you hold water, right? And so that causes hypertension.

Sipunate is more anabolic than ananthate, so I won't use a sipunate in older men. We use ananthate, but again, don't be misconstrued. Testosterone does cause hypertension. And TRT in general for male or female, the side effects are somewhat minimal. You are mentioning the red blood cell count going up. And if you already have preexisting high blood pressure

with now the thickening of your blood, now we're actually talking about something that could be quite dangerous. Yeah, you wanna monitor it, right? But remember, testosterone is a molecule. It's a compound. It doesn't matter if it's in a pellet or injection or a gel. It's the same drug, right?

These are different ways to get it into the body. But those different ways have different side profiles. We published a study many years ago saying that if someone's on an injectable, he has high as a 66% rate of getting a thickening of the blood. If he goes to a pellet, it's about 35%. If he goes to a gel, it's about 12%.

And now the United States has new orals. We have three orals on the market. Someone can go out and get an oral now, and they only have a 5% risk for erythrocytosis. So let's say someone's getting a high red blood cell count on injectable. Switch them. Switch them to an oral. He still gets the testosterone. He still gets the level, but you decrease the bad stuff that goes on.

On the orals, the only 7% will have to start a hypertensive medication or increase their dose. So it's not very high, it's pretty low. But we should talk about the orals for a second because the orals historically were thought to cause liver cancer, right? That's why we never used, they were methylated. First oral came out in 1935 and it did cause hepatotoxicity.

And then in 1970s, a drug called andriol came out. It's called testosterone and decanoate, oral, and it bypassed the liver, but you had to take it three to four times a day with a fatty meal. Well, the sad part is the US never approved andriol in the US. It was available in Canada and Asia.

It wasn't until 2019 when the US finally got our first oral. And these now, there's three in the market. There's Jitenzo, Tolando, and Kaisertrex is the newest one. Kaisertrex you can get directly from the pharmacy. And these medications are really effective. And you just take it twice a day and it doesn't have to be a fatty meal. It just has to be with a meal, but very effective.

At Baylor, we're doing a study right now and we are going to present the data next month in Arizona. I believe that the orals may not shut down your sperm count. So we were always taught that testosterone shuts you down. Well, this may be the one that may not. So in the data we're presenting next month, 80% of men did not shut down their sperm count despite being on orals, 20% did. Now the study's still ongoing, this is just preliminary data, but again, this may be a hedge maneuver

where you can take the exogenous, but not shut yourself down too much. What's something that kind of scares you? You know, you've been doing this for nearly 20 years and you've been studying this and practicing this and seeing so many patients over the years. Are you starting to see like younger and younger people? Like, do you have like just real concerns about

just not even the US, but just like where the world is going in general with diabetes, heart disease, and all these other things that are happening to us? Yeah, good point. Two points. One is decade by decade, our testosterone levels as a society are dropping.

They're just dropping. I said, that's so interesting. Why is our average testosterone levels every a society are dropping. They're just dropping. I said, that's so interesting. Why is our average testosterone levels every decade dropping? If you put a graph right next to it on the incidence of diabetes, metabolic syndrome, obesity in the world, decade by decade, those numbers are skyrocketing, right? And so we talked about this, obesity,

they shut down your testosterone levels. Obesity has many mechanisms for shutting down your T. Aromatase is one that we talked about this, obesity, they shut down your testosterone levels. Obesity has many mechanisms for shutting down your T. Aromatase is one that we talked about, increases cortisol, increases leptin, there's a lot of mechanisms. So as you're gaining weight as a society, you're shutting down your testosterone more and more and more. So decade by decade, we're becoming more and more unhealthy. At the same time, our T levels are dropping. What bothers me the most is when a young man starts T and not appropriately.

So in 2015, a very nice study came out showing that 27% of men who started T never had a T level checked in the first place. They just started it, 27%, pretty high, right? And what's more interesting is once they started, 50% of men, five zero, never had a fallout blood test. So I just took it. And so it bothers me.

You know, it bothers me again, erythrocytosis, what's the blood pressure, what's happening to them? Do they really even need it in the first place? Are they now shutting themselves down and are they hooked on it now? So that really bothers me. When a young man comes in and says, I want tea, I said, let's talk about it. We're going to talk about using natural ways to raise your testosterone or medications that help you. But I am very reticent on giving that young gentleman

testosterone for life. When it comes to those testosterone levels, what do you consider to be normal? Because that has changed a lot. And then I guess a second part of that question, just to get it out with now is, does the testosterone level truly even matter? If I come to you and I say,

Doc, I feel terrible when you test me, I'm 800. And then another case might be, I feel great and my testosterone level is 300. Does it truly matter? And then again, where are your levels for normal? Where do you consider those levels? So it never made sense to me that when you look at the guidelines,

the number we use as a society is 300. If a man's less than 300, he's gotta be low. If a man's above 300, he's gotta feel good, right? Well, when you look at those guidelines, that number was made up. It was absolutely made up. You have to pick a number, so pick a number. So you're telling me every man at 290 feels bad

and every man at 310 feels good. That just makes no sense at all. What the reality is, is that each one of us have our own number. And the way I know that is because 15 years ago in my lab, I took the blood from every single man and I look at something called their sensitivity of their androgen receptor, the DNA,

and it's called the CAG repeat. We showed that those men who have very insensitive receptors need more tea. Those men who have very sensitive receptors need less tea. We're all different. You cannot assume that all of us have the same number. So some men who come in at 250 feel great. Okay, let's leave it.

Some men come in at 450 feel lousy. Okay, let's talk, right? And if you put a man on testosterone and he's in the mid range, I have no problem in raising him to the upper quartile of normal because maybe I haven't got to his number, right? So again, I think it's very important to realize

we're all different, we have our own numbers. I never understood this, but let's say a woman who's post-menopausal comes into an office and says, a doctor, I have hot flashes, I have vasomotor symptoms. What is the standard of care in the United States? The standard of care is to give her estrogen. It's not to check her estrogen, it's to give her estrogen. Then she goes home and she says, I'm feeling better.

A month later, she says, I feel better, but I still have some more hot flashes, but they're better. What's the standard of care? You give her more estrogen. We don't check the level, we treat the symptoms, right? That's very important. Why is testosterone different, right? It's a symptom driven condition.

We're so fixated on the numbers, but we really should be fixated on the symptoms. What is menopause? Menopause is when a woman for 12 months stops having her periods, right? So it's a 12 month consistency. At average age of the United States is 52 years of age. And at this time, many of those women

will start experiencing vasomotor symptoms, but other symptoms as well. Brain fog, depression, anxiety, decreased bone mineral density, increased fat deposition, decreased muscle mass, right? It's a very important condition. It's not talked about. And what's unfortunate is the treatment for that typically is using medications like estrogen

progesterone. And I also believe testosterone, but the society is reticent to give women these medications because there's fear, unfounded fear, which started in 2002 and 2003 from the Women's Health Initiative saying that if you give to estrogen progesterone, you will increase cardiovascular risk and breast cancer. Remember that that difference was four in 1,000 versus five in 1,000. So the relative risk is very different

from the absolute risk, right? The difference was one in 1,000. Let's be very clear, right? So many women who suffer from menopause will have symptoms of the following, low energy, low libido, depression, increased fat deposition, decreased muscle mass. I want you to be aware that those are the following, low energy, low libido, depression, increased fat deposition, decreased muscle mass. I want you to be aware that those are the exact same

signs and symptoms of low testosterone in men and women. Same same signs and symptoms. And many times putting them on testosterone and estrogen progesterone, I call it the triangle, give her her T, E and P back, back into the normal range. She feels great. She makes a big difference in her quality of life. But she's still going through menopause, correct?

Still going through menopause, but this mitigates the symptoms, right? That's the important part. It mitigates the symptoms of menopause. Have you seen that work pretty quickly? Very quickly. I mean, think about it. You make a hormone, you're low,

and I put it back into the normal range, you typically feel well. You tell me any hormone, thyroid, let's talk about any hormone. I'm low, you put me back into the normal range, you typically feel well. You tell me any hormone, thyroid, let's talk about any hormone. I'm low, you put me back into the normal range, I feel better, right? Hormone replacement therapy is not rocket science, it's essentially taking someone who's low

and putting them back into the normal range, right? That's the point. Any speculation or idea on why it seems like our society's maybe less interested in sex than we have been? Do you think it's because of some of these issues, the food, poor exercise, poor habits, and maybe that's leading to just maybe the drive isn't as much as it was? Because you did mention the testosterone levels coming down with the rise of obesity and stuff.

Yeah, so I think the problem is that as a society, our health is declining over time. We are, if you look at obesity, diabetes, metabolic syndrome, cardiovascular risk, it's getting worse and worse. A lot of the food, I think 80% of the problem also is like the food we eat, right? If you look at the processed foods that we eat, the certain types of carbohydrates that

we're eating, I'm not surprised that obesity is an epidemic in the United States or throughout the world, right? I'm not surprised that diabetes metabolic syndrome is an epidemic throughout the world. And with those comes other sequela such as ED, you know? And so I think it's a major problem. And I know we talked about this earlier, but there's this concept called lifespan, health span, and sex span, three different criteria. Lifespan, okay, how long the three of us are gonna live.

It's binary, we're either dead or alive. So whatever that number is, that's the number. It's important, you've heard the whole world talk about health span. All three of us want our health span to be great and last as long as our lifespan, right? But health span can be graded. Let's call it 10 to one, 10 meaning the best health,

one being the worst health. I want my health span the day I die to be a 10. That's all I want. I wanna be a 10 on health span till the day I die. I don't wanna be a two or a three. So everything I should do right now is to focus on making sure that my health span is a 10 on the day that I die, right?

But the problem is this, in the US, the average lifespan is 77 years old. Women live 79, men live 75. The average health span, according to the WHO, 67 years old. According to the CDC, 63 years old, which means that there's a portion of our lives where we're not gonna be living very healthy and it's about 10 years. And we keep bragging about improving our lifespan. Hey, our lifespan's going up.

In fact, by 2050, lifespan should go up to 80, okay? Do not increase my lifespan without increasing my health span, right? That's the, I can't think of anything worse, right? Making me live longer in poor health. What you should be focusing on is increasing my health span, right? That's the, I can't think of anything worse, right? Making me live longer in poor health. What you should be focusing on is increasing my health span, not my lifespan, improve my health span. That's what I want you to focus on. And the way you focus on health span is diet, exercise, sleep, stress reduction, and prevention. Prevent cardiovascular disease, prevent cancer, prevent neurodegenerative disease, metabolic disease.

These are very important. We call this offense and defense. Most men and women understand my offense and defense game plan. My game plan is on offense, you've got four things, diet, exercise, sleep, and stress, right? You focus on those, your health will move forward. What's defense? I'm a big fan of Peter Rettia. Peter Rettia tells me this. He said there's four ways you can die and only four ways besides if you get in a car accident or plane crash, four ways you're gonna die are the following.

You're gonna get cancer, you're gonna get a heart attack, you're gonna get metabolic disease, meaning obesity, diabetes complications, or neurodegenerative disease, meaning Parkinson's, Alzheimer's. That's it. So if you knew that, you should do everything in your power today

to prevent those four, right? That's defense, right? So we have a program on preventing these four, these four and offense. And if you play just the four offense and defense, you're unstoppable. That is, I think, my playbook. Offense, defense, four on each side, right? And so the concept, the last one is called sex ban. It's important.

Yeah. Okay, because sex ban is the portion of your life where you will have the ability and the desire to engage in satisfying sexual activity, okay? Unfortunately, in the United States at the age of 70, only 52% of men are having sex. These are married couple, 36% of women. So the sex ban significantly declines.

I want my sex span to last as long as my lifespan. I don't want my sex span to be 50, my lifespan to be 80. To me, that would be depressing. Tough. Right, it'd be depressing. And for most men, they get it. And most women too, we want our sex span and we want a good number.

We want a 10 on our sex span the day we die. Well, how do you keep your sex span to last as long as your lifespan? It's the same playbook as your health span. Diet, exercise, sleep, stress, go ahead and prevent the four on the defense, same playbook and you get the same benefit. So when a man comes to me and he's 65 years old

and has full blown ED, I say, where could I have prevented this earlier on on the trip? Maybe if he came to me at 45, Maybe if he came to me at 50. Because he's coming to me now and it's a little late. It's not prevention. It already happened. And I should have seen him earlier to prevent this from occurring in the first place.

Yeah. What do you got going on over there, Andrew? I'm just curious along those same lines, especially with like the porn induced erectile dysfunction. How young can somebody be to be prescribed erectile dysfunction medications? FDA is 18 years of age. So it's right now it's 18. Clearly people do use medications off label, but the age is 18. Okay.

Yep. I have a question on the defense side when you mentioned the cancer thing, because I saw a post from this young guy the other day. He mentioned his father just died. And he mentioned how like up until that point his dad was jacked, healthy, had no signs and boom just hit him. And then a year later, dead. Right? We know a guy, Clark Bartram, he's a friend of ours, also just got cross-strait cancer. And it just got me thinking like,

we're doing all these things to try to be as healthy as possible. What can we do to prevent as much as possible or at least understand or catch it before it becomes something that could get much worse. What you're saying is most of us spend all our time on offense, we're all looking good, we're healthy, and all of a sudden he just died of something, right?

But we're not paying attention to defense, right? He had a cancer that we didn't know about. You got to screen, you got to screen early. And now we moved our colonoscopy screening down to 45 years of age instead of 50. PSA screening at 55 years of age to 70. But I screened earlier if you're to screen early. And now we moved our colonoscopy screening down to 45 years of age instead of 50. PSA screening at 55 years age to 70. But I screened earlier if you're at high risk African-American family history. Within their 40s, I'm going to get a PSA, right?

So screen the cancers early. There are certain technologies that are coming out called full body MRI. There's the grail, Pronovo's a full body MRI, which you can catch certain things. So there are ways to be more aggressive on cancer screening if you want to. It's not standard of care yet, but many people are using it and finding benefit. How about cardiovascular disease and metabolic disease? Metabolic disease, I think it's extremely important. Check your hemoglobin A1C.

So look, I call it five. You got to know five numbers. That's all I'm going to ask you. You got to know your blood sugar. I want, oh, we have to know your blood you. You got to know your blood sugar. I want all, we have to know your blood sugar. He even goes, you got to know your blood pressure, right? You got to basically know your testosterone level, right? It's very important.

It very important. You got to know your PSA. I think that's very important as well. And you got to know your lipids. Five numbers, every man should know. Simple, non-negotiable. If I turn around and say, what's your PSA? What's your blood pressure? What's your cholesterol? What is your blood sugar?

You have to know those numbers, right? That's important. If you don't know those numbers, you're running that risk of falling in that group that, hey, all of a sudden something bad happened to me, right? Just know your numbers. Know your numbers. And to know those numbers, you know, people that might be adverse to seeing a doctor or something like that. I mean, there's TRT clinics and people that you can, you can use Merrick Health, which sponsors this show,

get your blood work done and know some of this stuff from the inside out. I realized, cause some people are just like, I'm not going to the doctor. I don't know why people are so immensely terrified of that process. Or they think they don't need to. I'm 35 years old, I'm not sick.

I'm great, I'm working out, I look good. How am I sick? But the reality, just because someone looks good doesn't mean internally we're safe. That's the defense. About in terms of supplementation or peptides, have you seen anything like that move the needle when it comes to like sexual dysfunction? So we looked at, we published a paper many years ago looking at IGF-1 levels, so growth

hormone levels, as a correlate for sexual function. So finding that those patients who have higher IGF levels tend to have better sexual function. But the data is soft. It's really soft. If I, I don't believe in prescribing growth hormone, but I do use peptides to help raise natural IGF-1 levels. So I think there could be some benefit. As you know, the FDA has now no longer approved, as of September of 2023, pulls their approval for certain peptides that have been pulled off the market, right?

So again, but there may be some benefit. I do like certain amino acids a lot. So if you look at the literature and the science, So again, but there may be some benefit. I do like certain amino acids a lot. So if you look at the literature and the science, certain amino acids like arginine, carnitine, and citrulline have all been beneficial in helping improve blood flow, particularly the genitalia independently.

Then you ask yourself, why arginine, carnitine, citrulline? Because if you look in a biochemistry textbook and you put all three of those in a petri dish, that equals nitric oxide. Those are the building blocks for nitric oxide. Wait, say that again. Arginine? Carotene and citrulline. Yeah, arginine.

Hey, good stuff. The ingredient I enjoy most. It's important, right? And so it's natural. And so the problem with the supplement world is it's so confusing. You don't know. You know, look, a three of us could make a supplement. We can put it on a counter.

No one has to test it. No one tests it for safety or efficacy. There are some spot checking. Don't get me wrong. But in terms of let's just go to safety, that's important. Then about efficacy and then claims out what's in it. Is it really in it? Right?

So it's kind of difficult and not all these patients will get their products tested and say, okay, it is valid, it's there, but show me the safety and efficacy data. Show me that it doesn't cause problems with my liver. I mean, I have patients that have come in, young men have come in on a supplement where their liver enzymes are through the roof, where their gonadotropes, we call LH and FSH, are suppressed. You take them off the supplement and everything goes back to normal, but it's never been tested. So just careful. That's all never been tested. So just careful.

That's all I'm asking. Just be careful. Are there any specific ingredients that people need to be careful of when they look at some of these supplements? Yeah. So the one that's little concerning is when you look at supplements that help with erectile function, many times they have the, what we have like Viagra like substance in it, they're called phosphodiesterase, okay, inhibitors.

Well, the problem is if you don't know that you take that medication with a nitrate, a nitrate is what we take for our heart, you can drop your blood pressure and kill you, right? So remember, you don't take viagra with a nitrate, but if you don't know that the supplement has viagra like material in it, and you take a nitrate, you're done, you're in a little bit of trouble, right?

So that's where I get a little concerned. In the gym, we were talking about penile implants, which I think is a topic that makes people like, yeah, you know, really, really cringe, right? But as we were mentioning earlier, if somebody's sex span, you know, unfortunately dies off when they're 50 and they're going to live to be 85 or 90, maybe they need to have an intervention that's a little different than just Viagra or Salus.

How prevalent are these? Yeah, so first of all, one of the greatest inventions ever made for treating sexual dysfunction, it was invented by Dr. Brantley Scott in 1973 at Baylor College of Medicine at my institution. The guy was a genius. I mean, literally a genius. He invented the artificial urinary sphincter. He invented the penile implant. And the way it works is this.

Essentially, the penis has two cylinders on top. These are called cavernousal bodies. They have muscle in them. And so when the blood flow comes in, those muscles expand and you get an erection. Over time, the muscle atrophies, it gets diseased. So what we do is we put, think of it like balloons, cylinders.

Zoom in on it and see his face. No, but think about this. It's starting to get really good. There's a pump in the scrotum, so no one knows that you have this. You reach down the scrotum and you pump it and there's a little reservoir behind your pubic bone that holds water. All it's doing is pulling water out of the reservoir and making the penis harder and harder and harder every time you press it. A man engages in sexual activity as long as he wants, whenever he wants.

When he's done, he releases it, all the water goes back. I will tell you that the number one thing that most men say after this is, I wish I'd done this sooner. I wish I didn't... I can have sex whenever I want, as long as I want, when I could not have sex before. Yeah. Right. But think about it.

Can you get three for one? Yeah. I mean, it's a big deal. And a lot of these men, you know, think about it, you know, Medicare covers 100%, which is a big deal. You know, so many of these men are 62, 63, just waiting to turn 65. Right? Right? So they can get their implant. But it is a very effective product. And it is a game changer in terms of men

being able to have sex again. Wow. So you said as long as they want. Right. That seems like it would cause an issue. No, the only, so that's- They just go forever? Friction.

I mean, as long as you want to engage in sex activity. So some men say, I would like to have sex 45 minutes an hour. Because there is a, so we know that premature ejaculation is a problem globally. 30% of men suffer from premature ejaculation, 30% of men, and only 9% seek therapy. But this would mitigate that problem, right? Because your erection will only go down when you tell it to go down, right?

So that's important. So you can still also, these men are still able to come and do everything. Everything. Wow. can still also, these men are still able to come and do everything. Everything. Wow. Right. And still keep going. Of course, because the penis is still erect.

So that's really important. Robotic. Sales just went through the door. At first everyone's like, ah, I don't know about it. So let me ask you this, what are those nightmare implants that men need to stay away from? Because I've seen some videos of people talking. There can be. So look, every surgery could have complications.

One of them is a risk for infection. If it gets infected and you catch it early, you potentially could, we call salvage, save it. Otherwise, you've got to take it out. And if you take it out, you've got to put a new one in and it can compromise the results later on. It can break. They last about 10 years,

so you can then change it out, it's not hard to change it out. And those are the two main complications with the procedure. But besides those two, it's very well received. Satisfaction typically is 90% or greater for the patient and for the partner, right? They do partner satisfaction for the penile implant as well. Now, this is the question I had mainly though, because this penile implant, it's different, this is the question I had mainly though, because this penile implant,

it's different from other things I've seen, right? And there are other types of penile surgeries and stuff that just are, they just end up bad. So what are the things that if the guy's looking into this, they stay away from that type? I think you just have to be very careful. I think no matter what surgery you choose, you're referring to also cosmetic surgery.

So there's elongation surgery, there's fillers. And the end of the story is the following. You have to go to someone who's experienced, right? That's the end. No matter what you choose, as long as you choose someone who has experience and has done it for quite a bit of time, that's going to change the outcome. The problem is when you're choosing any of these and someone is not out of experience, you can, I've seen complications, penile necrosis, you can lose the penis, amputate the penis, there are things that can occur, right?

You just have to be careful. If you're someone that's taking supplements or vitamins or anything to help move the needle in terms of your health, how do you know you really need them? And the reason why I'm asking you how do you know is because many people don't know their levels of their testosterone, their vitamin D, all these other labs like their thyroid,

and they're taking these supplements to help them function at peak performance. But that's why we've partnered with Merrick Health for such a long time now, because you can get yourself different lab panels like the Power Project Panel, which is a comprehensive set of labs to help you figure out what your different levels are.

And when you do figure out what your levels are, you'll be able to work with a patient care coordinator that will give you suggestions as far as nutrition optimization, supplementation, or if you're someone who's a candidate and it's necessary, hormonal optimization to help move you in the right direction so you're not playing guesswork with your body. Also, if you've already gotten your lab work done but you just want to get a checkup, we also have a checkup panel that's made so that you can check up and make sure that everything is moving in the right direction if you've already gotten comprehensive lab work done. This is something super important

that I've done for myself. I've had my mom work with Merrick. We've all worked with Merrick just to make sure that we're all moving in the right direction and we're not playing guesswork with our body. Andrew, how can they get it? Yes, that's over at MerrickHealth.com slash Power Project. And check out enter promo code Power Project to save 10% off any one of these panels or any lab on the entire website. Links in the description as well as the podcast show notes. We've been talking a little bit about like, you know, heart health and things like that.

Are there medications that someone could take because if they are going to the doctor, they have erectile dysfunction, then they get their blood work done, they get some other scans done, turns out their heart's not great either. What can they do in those circumstances? I realize exercise and food and, but there are there other interventions that could help as well? Yeah. So we are pretty aggressive on screening cardiac health. We use coronary calcium scores as well, and what we will do is the following.

The cardiologists figured this out way before the urologists. They figured out, if you remember the Dean Ornish studies a long time ago, a lot of the diets, the programs that you put a people on, they can reverse cardiovascular disease. You can reverse plaque by using techniques on diet, exercise, sleep, stress reduction, cutting out smoking, you can reduce. So there's a lot of things that the cardiologists do. If you believe that the endothelium is the same for ED and cardiovascular disease, just copy the cardiologists.

We use those, as I talked about earlier in the study I published last year. Exercise alone significantly improved erect last year. Exercise alone significantly improved erectile function. Exercise alone. A study by Esposito in early 2000s, the Mediterranean diet, two-year study, prospective. Diet alone significantly improved erectile function. Yes, they take more work, they take time, but that's the cure, right? That's not the magic pill. So I think that it's very important to use these. I use, I think testosterone is extremely effective as well in helping patients with sexual functions. We tweet men as well.

But I want to just digress a little bit. Testosterone, I want to go back to that for a second. We spent a lot of time talking about testosterone and you guys know the results, energy, sex, drive, libido, erections. I want you to for a second take it a little bit deeper for me. Think about all the negative things that are associated with testosterone besides sex. If a man has low testosterone, he's much more likely to have a heart attack, non-negotiable, much more likely to have a heart attack.

He's much more likely to have diabetes, much more likely to have osteoporosis, much more likely to have depression, and it's now been associated with prostate cancer, low T associated prostate cancer. You show me one other blood test that is a better indicator of a man's health, one other blood test that can show you it's a better indicator of a man's overall health. I can't. Testosterone is a great marker. And I would just say also, you know, we don't check testosterone regularly,

but it should be checked in my opinion as an annual blood test. If someone, why do you think low test would have a correlation to heart disease when women typically have less heart disease than men and obviously their testosterone levels are lower? So there's two ways to look at it. There's a direct effect and an indirect effect. Okay? The indirect effect is the following. When a man has low testosterone,

you're much more like you have obesity. Let's be fair. You're much more like you have diabetes, right? You're much more like you have metabolic syndrome, right? Low T, we've seen this over and over, particularly in urology, we give men a medication that takes away their testosterone. For prostate cancer, you induce diabetes,

obesity, metabolic syndrome. Well, what are the risk factors for heart attack? Diabetes, metabolic syndrome, obesity. That's the same risk factor. So is it an indirect effect? Am I inducing risk factors for heart disease? Or others would say it's a direct effect. Abdul Trash, one of the greatest scientists I know in this space has said, look, it's a direct effect.

Low T significantlyate cardiovascular risk. You should know something. The Traverse trial came out last year. The Traverse trial, I was involved in this study for six years. There was nine of us investigators in the steering committee. The Traverse trial is the largest randomized placebo control trial ever published on men on testosterone versus placebo. We had 5,200 patients in this trial.

In randomized, we started in 2018, we finished in 2022. And the goal of the trial was to say, does testosterone cause a heart attack? That's it. We just simply looked. And we only took high risk patients who are more likely to have a heart attack, either had to have cardiovascular disease or risk factors for cardiovascular disease to be in the study, right? What did it show?

No significant increased risk in heart attack in men who took testosterone over placebo. There were seven other studies that we just, they're all done now. We have published them all. We also showed no increased risk in prostate cancer in those men taking testosterone, no worsening of lower urinary tract symptoms. Cause you'll read on the package insert, if you take testosterone, be careful, because it can make your urination worse. Not true.

And this locked it. No worsening. It helped with depression, so it helped with libido as well. So the Traverse Trial is a big deal. If you're prescribing testosterone, you have to know the Traverse Trial and the results of the Traverse Trial in all seven of those studies.

And again, the results are gonna be different if somebody's like abusing testosterone. Yeah, so we got dinged a little bit because the testosterone we used in the Traverse Trial was androgel, okay? And we define normal as anyone above 350. So if someone was 380 in the trial, they were considered normal.

So many people came to me and said, hey, Dr. Carroll, so I got a patient on injectables. My levels are 800. Can I transfer this data to that data? Because your guys are at 350. I think that's low. And you're right. You're probably right.

It may be hard to transfer the traversed trial at every step of the way to say someone aren't an injectable. Some of the things you can, like prostate cancer. But again, I think you just have to be careful. Different formulations have different levels. And use the endogel in this study. I'm curious about this. Actually, you know what?

I'll ask this first because we talked a little bit about premature ejaculation earlier. You kind of just mentioned it, right? If a man is dealing with that, what are some things that he should figure out to do or who should he try to talk to if that's just a recurring issue? Yeah, this is a really difficult topic for many men, right? And premature ejaculation. So there's two ways to look at it. The first thing you walk into my office, I'm gonna ask you, I'm gonna figure out is this lifelong or is this acquired? Okay, they're treated a little bit differently. Have you had this your whole life or did this recently happen?

Okay, if it's lifelong, the definition now has changed under two minutes. So if it's under two minutes, it used to be under a minute, but now it's under two minutes, it could be considered a condition. You have to have three things. Has to be under two minutes. You have to have a sense of lack of control.

I couldn't control it. And B, see, I'm bothered by it. Let's say I orgasm in a minute, I'm happy. It doesn't bother me. Okay, great. Then you don't have premature ejaculation. Right, so that's great. But if you're bothered by it, you have a lack of control

and it's under two minutes, let's talk, right? And if it's, so the average man, the ejaculatory time in the US is roughly about seven minutes, right? You see, you know, it changes from 5.4, but seven minutes. So if you're bothered by it. Now, acquired means that, you know, I used to take me 15 minutes and now it's seven minutes

and it really bothers me. Well, okay, it's usually about a 50% reduction and you still are, even though it's seven minutes, but it bothers you and you're bothered by it, let's treat you. How do you treat it? We have different levels. The easiest is using a topical lidocaine spray.

The one that most people use is called Promessent. It's a spray that you put on, it's lidocaine, it numbs the penis. Don't spray too much or it'll numb it too much. It'll get an ED, right? So you gotta be a little careful, but it numbs it and it prolongs it. There's no decreases of sensitivity.

So it helps. The ones that work really good are antidepressants. You put someone on Paxil, which has the best, or Zoloft, it will delay it. Now, many men don't wanna take a daily antidepressant, but it does work. If you take it on demand, it's about six hours at a time,

so it's kind of hard to plan, right? There's one called clomeprimine, which may be also a beneficial effect, but antidepressants can be helpful. There's some off-label uses. Believe it or not, that drug we use to help men urinate better, Flomax has been shown to help. And Tramadol, unfortunately it's a narcotic,

so you gotta be a little careful, has also been shown. And I stopped writing the narcotic because many years ago I had this man that came in and he started asking for more and more and more. And clearly it wasn't that he was having sex every day, he was basically getting addicted, right? So you just had to be a little careful. But really you wanna hear the best treatment?

It's sex therapy, right? Sex therapy, it's to treat the problem, not put a pill on it, is really the best way to go. They have the start stop technique, the squeeze method. The Kegels. Yeah, they help. They help. The Kegels help.

And they teach you how to prolong the ejaculate time. What about a penis pump? There you go. Well, you could, right? So the penis pump will be, you can use, that's not really a treatment for premature ejaculation, right, but it does mitigate that problem. The other thing that we didn't talk about

is that we prescribe a lot of penile injections in the United States. So essentially what it is, it's a tiny needle at the base of the penis, it puts a medication in, induces a really good erection within five to 10 minutes, right? But the erection doesn't go away till the medication wears off. So it's about two or three hours, right? So the erection doesn't go away till the medication wears off.

So it's about two or three hours, right? So essentially, if you have an ejaculate, it will not go down till the medication wears off. Now you gotta be careful because if you inject too much medication, you'll get something called a priapism, which is a prolonged erection. And if it goes longer than six hours,

there can be irreversible damage to the penile tissue. So you gotta be a little careful. We do the first injection in the office, we teach you how to do it, we may we teach you how not to prevent that priapism, but that many men... Do the injection in the office and you sprint home. But think about it, if you do, if you take that medication and you ejaculate, it still stays erect, right? That's something to think about. And what about the penis pump just for...

ED? Yeah, I mean, it's a fun... So the vacuum erection, I think that's different. So one is the penile implant. The other one's called a vacuum erection device. I've been around for years. It's essentially what it sounds like. It's a vacuum and it brings blood and oxygen

to the penile tissue. And I have patients use that for rehabilitation, particularly after a prostate cancer surgery for rehab. It's just like going to the gym. I say, think of it like going to the gym for the penis. It's two muscles. The only problem a little bit with the vacuum, it pulls in more venous blood than arterial blood.

Venous blood has poor oxygen. So it has, you know, so again, it's a, it's a, it does help, but it's not like giving someone an injection or Viagra, which is 100% arterial. And that low dose Viagra could be something that's just continually helping with like blood flow and maybe for some men that are not getting erections at night or in the morning, maybe that would be a good idea because it's keeping the blood flow going. Really important, remember people use daily Cialis

to help men get erections. It does give you spontaneity. So when you have sex, you never take a pill. But for me, it's that protection. It's actually making the penis stronger and preventing a problem down the road. That's what's important to me. Yes, it's great that you're having erections today,

but the fact that it's preventing ED, helping with endothelial function, increasing hypertrophy of the smooth muscle. That's really important. So if a guy's going to have prostate cancer surgery, I start him two weeks prior to the surgery on the daily Cialis. I keep him on all the way through. A young man starts getting a little bit of ED.

A lot of young men have psychogenic ED, right? New girlfriend, something goes on. All you need to do is show them that they have greater actions again. I put them on daily Cialis. They say, wow, past 20 times has been great sex. I'm okay. We go to every other day. Then we stop. They they have great erections again. I put them on Daily Cialis, they say, wow, past 20 times it's been great sex, I'm okay. We go to every other day, then we stop, they still have great sex. They just need to see that everything's perfect.

Question, would you keep them on that just for the other things that you were talking about and let's say that's no erection problems at all, but just for the other health benefits, would you suggest? I personally, so it's off label, yes, but I would. I really believe that it has a lot of beneficial effects, particularly if you look at the literature

on endothelial protection. I need to start doing that again. I was using it for a while, but then I stopped because I was like, I'm very careful about taking things and building dependency on it. So I was like, what if I can't get hard without it? And I could, but then I'm like, maybe I should start taking it again. So maybe so maybe I think I'm gonna start taking it.

Yeah, well again, it's off label you so we're talking about some of these. Yeah Yeah, but if you look at the trial by Aversa Aversa gave men daily Cialis every day Or just gave it to him on demand and he followed them and we have in the blood markers of endothelial dysfunction, right? You can look at C-reactor protein in a look in six You can look at markers and you can also do certain kinds of tests to look at your protection of your endothelium. He showed that the daily Cialis patients had a significant improvement in their endothelial function. Then he stopped the trial three months later, he checked everything again, and those had taken it still had improvements in endothelial function. It was sustained,

right? So to me me that's important. I was curious about this. We kind of talked about it, but you know, when a lot of guys start taking tests, they don't take it to just get themselves to a good level. They'll start going too high, right? I don't know if we talked about risks of that, but you know, I think a lot of guys, when they start this stuff, they just think more is better, more is better. And even if they continue to be told more is not necessarily better, they'll just do that, right? What should they watch out for? Yeah.

So first you bring up a point. There's something called a plateau effect. A plateau effect means at a certain number of testosterone, giving you more offers no benefit. That's really important. So let's say I hit my number on bone mineral density or hit my number on libido or rectal dysfunction. If I double it,

I don't get twice as good erectile function, right? The mild exception is muscle because muscle when it sees more T can upregulate more testosterone receptors. So there's a mild exception where the more you have the more muscle mass you can see. But other than that, when patients say, look, my libido is better, but I wanna double it

because I'll have better libido. No, it's not this dose response curve. So that's very important. I think that patients need to understand that that it's not the more you have, the better. I still always want just to go back to this, be careful on giving the young men tea. You're shutting them down

and you're going to keep them on it for life. And life is a long time. Yeah. In the practice of like a sex therapist, do you have any idea? You mentioned the Kegels and there's some other exercises like that, but is there any like manual therapy that someone does?

Do you have any idea? Like we're big in like mile fascia. Yes, oh yeah. We're rolling out our feet and our arms and our back and stuff like that. And areas of the pubic. Yeah, yeah. And down by the guts and all thatascia stuff. We're rolling out our feet and our arms and our back. And the areas of the pubic. Yeah. And down by the guts and all that kind of stuff.

So, yeah, so I didn't mention this, but we have a lot of access to support. And one of them is a sex therapist. The next one is a pelvic floor therapist. She's amazing. And she, I've been working with her for 10 years. And believe it or not, you can treat a lot of conditions with pelvic floor therapy, right?

There's some data on premature ejaculation. Some have used it for ED. Some have used it for other conditions. years and believe it or not you can treat a lot of conditions with pelvic floor therapy. There's some data on premature ejaculation, some have used it for ED, some have used it for other conditions, not mainstream but it does help pelvic pain for sure. And I use it for men and women. It's really helpful to have a good pelvic floor therapist available to look for those pressure points. If a man is experiencing ED, does that mean that he might not be attracted to his partner anymore? So if a man develops ED, they undergo something that's very interesting.

It's called subconscious aversion. Let me give you an example. It's 10 o'clock at night. He knows he has ED. If he engages in sexual activity, it's about a 50-50. It'll work. It's a 50% of work, 50% won't work, but I'm exhausted, I'm tired. So I have two choices, I can try, and it could be frustration, or I can go to bed. He's gonna go to bed, right? Cause he doesn't wanna deal, right?

But if a man knows, that same man knows that he's gonna have the most amazing erection every time, 100% guarantee, he's gonna have great erection, 10 out of 10, it's gonna be great sex. Now it's 10 o'clock at night and he has an erection. What do you think he's going to do? He's going to use it, right? That's what he's going to do, right?

So ED can decrease libido. If you want to increase his libido, skyrocket the quality of his erections, right? So he's still attracted to his wife then? Because he's attracted to his wife. He's just not ready for the disappointment, the frustration to her, to him, and to deal, right? That's what he's trying his wife, he's just not ready for the disappointment, the frustration to her, to him and to deal. That's what he's trying to avoid.

He doesn't wanna deal. And if he goes to sleep, cause he's tired too, not dealing with anything. But the problem is this, the longer you stop having sex with your partner, the harder it is to start then re-engaging. And it has psychological consequences on both partners. So sex is important.

I mean, let's not, and besides procreation, there are many benefits of sex, right? If couples who engage in frequent and satisfying sexual activity have a better relationship, they're happier in life, that's been shown as well, and significantly decreases risk for depression, right? So if I told you there's something that decreases your depression, improves your relationship with your partner, right? And it makes you happier in life, right? So if I told you there's something that decreases your depression, improves your relationship

with your partner, right? And it makes you happier in life, you take me seriously. It's your sexual activity with your partner. And so that's why it is a very important condition to address. You have any experience with a peptide like a Melanotan or PT-141, I think there's also- It's called by Lisi for women now.

Oxytocin. Yeah, these are all medications to help with libido and orgasmic function. Oxytocin you can use as a nasal spray, you can use it as a trochee, this is off label. Oxytocin levels go up, we can use them to help with orgasmic dysfunction. We didn't talk about it, you brought premature ejaculation,

but another big problem in the United States is delayed ejaculation or an ejaculation. I mean, I can't reach, I can go for 20 minutes, I can't ejaculate, right? That's a problem. And now when you have a patient who has delayed ejaculation, you have to ask them, can you, does this happen with masturbation? They say no, then it's psychogenic. It's with their partner, right?

Same with the man with ED. He says, I have ED, I can't take it anymore. How about masturbation? Oh, no problem. Well, it's your partner, right? The very important ask about masturbation, morning erections, and a delayed ejaculation. How about by yourself? Oh, no problem. Then there's something with the partner. That's a very important question. But oxytocin can help with ejaculatory time and decrease ejaculatory time.

Anything that it uses dopamine can do it as well. Bremelanotide is now used in women called Vilece to help them with orgasmic. I mean, it's in the libido, but it can help with orgasmic it as well. Bremelanotide is now used in women called Vilece to help them with orgasmic, I mean, it's in libido, but it can help with orgasmic function as well. It's Bremelanotide, that's all it is. It's called Vilece is the trade name. So there are medications that can help and we use all of these off label that can help.

You know, I had a patient, I published this last year, I had a 28 year old man who never had an orgasm in his life, never. It's called primary anorgasmia. And we- Even when he? Anything, nothing, 28 year old man. So we tried everything. We tried brimelanotide, we tried sex therapy,

we tried Wilbutrin, testosterone's important to check. And we tried the medication that we give to women called Adi, which is flibansin, which you take every day and increase their desire for sex. And we tried the medication that we give to women called ADD-E, which is flibanserin, which you take every day and increases their desire for sex. And he had his first orgasm. And now, so that was a really big deal. So we published it in a journal because sometimes the medications we use for women, we can use off-label for men, we use for men off-label for women.

Again, it's important to let the notes off-label, but men and women are not that different, right? When it comes to neurotransmitters in the brain, if it increases sex drive in women, it can increase sex drive in men. So many years ago, this drug, Addi came out, I went to the FDA and I got an IND to have permission to give sort of randomized placebo control trial

to give half the men Addi, half the men placebo to see if it improves their desire for sex. Because again, I think men and women, the biology is very similar. I have a question for you real quick. When it comes to morning wood, we had so many guys come onto the podcast, like if you don't have morning wood every morning,

there's a problem. And some mornings I wake up, I'm not, I don't have morning wood, I'm like, what the fuck? I'm pretty sure I'm okay. So I mean, I know it's a sign, but is it one of those things where you gotta have it every day? And if you don't, there's a bit of an issue.

No, you don't have to have it every day. But remember that the penis lives in typically what I call a hypoxic state. Blood oxygen content is low. If we did a blood gas right now, it's a low. So where do men get most of their rehab and their exercise? They get it at night when they're sleeping. Every 90 minutes, they'll typically get an erection.

That's where the oxygen's coming in the blood. So it's important. Now, if other factors start affecting that and your rehab goes down at night, it's gonna affect you later on when you wanna engage in sexual activity. Gotcha. But the daily Cialis, many men, the first thing,

the first thing they tell you is, man, I'm getting up every morning with erections again. All right. I'm just trying my hardest to be as mature as possible back here. Thinking about the guy that had his first orgasm at 28 years old. Just the scene from scary movie comes to mind, where he shoots the girl all over the place. Do men ask you for that, like, information, like how to shoot bigger,

more volume and that sort of thing? No. You know, I've not been... There are patients who will have no volume and that bothers them. Okay? So if they have no volume, that bothers them. One of the reasons why you could have no volume is a drug that you take.

The most notorious one are medications to help you urinate better. So Flomax, uroxazole, they cause retrograde ejaculation. So that means when you ejaculate, the semen goes into the bladder, and then when you urinate, it comes out, right? That's called retrograde ejaculation. But when a man comes in, I say, there's no ejaculate for three reasons.

One, you could be blocked, and that could happen, we call it by a cyst, and I can unblock you. Two, it's retrograde, or three, you're not making it. And if it really bothers you, we can figure out which one it is and try to mitigate that problem. But you have to think about those three algorithms if a man has no ejaculation.

To some men, it really bothers them. If I do a surgery sometimes called a chirp, which means when I open up someone's prostate through surgery, it can cause retrograde ejaculation. And some men say, I don't want that surgery. I know I can't urinate very well, but I'm not going to, I don't, it really bothers me. So now there are new minimally invasive surgeries we can do called Urolift Resume. There's others that we can do that actually preserve the ejaculatory function, which is very important

for many men. Should there be a certain amount of ejaculations a guy has a week? Because you know, sometimes for religious reasons, some men don't masturbate at all. And then there was also, they're not in a relationship. So maybe the only time they're getting ejaculated is through wet dreams, right? But for the health of the penis, is there any type of anything that you think about there? There's no data specifically on how many ejaculates is a healthy amount of ejaculates to see. I can tell you that when we have patients

who have prostate cancer surgery, I tell them that we want them to have at least two to three erections per week to keep the tissue healthy. So that's important. But the number of ejaculates, I've not seen the data on how many ejaculates do you have to have as a minimum for overall health.

Gotcha. Thank you so much for your time today. I really appreciate it. Thank you, appreciate me. Thank you for having me on the show. Where can people find you? What's your Instagram handle? Drmohitkira. Thank you so much.

Strength is never weakness. Weakness is never strength. Catch you guys later. Bye.