Sex With Emily - Shoot Your Best Shot with Dr. Josh Gonzalez

Episode Date: July 23, 2024

Tune into this conversation with the incredible Dr. Josh Gonzalez, a board-certified urologist fellowship-trained in sexual medicine and specializing in the management of male and female sexual dysfunctions. Dr. Gonzalez has been featured in Vogue and is a medical contributor to Men’s Health and Cosmopolitan, among others. He is a sexual health expert who has built a following on TikTok and Instagram, where he uses social media to educate on sexual and reproductive health. He is also the co-founder of Popstar, a men’s supplement addressing semen health. I loved talking with Dr. Gonzalez. I can’t wait to share his incredible work with you. In this episode, you’ll learn: That 50 percent of infertility cases are related to male factor infertility. That’s half of the cases, but somehow, we default label infertility as a female issue. How oral contraceptive pills cause an elevation in a protein called sex hormone binding globulin in women. This is a protein you don't want large amounts of in your body, as it binds up all of your hormones. When the hormones are bound, they can't be effectively used. About the groundswell of men coming into Dr. Gonzalez’s office requesting vasectomies after the overturning of Roe v. Wade. How you can easily test your sperm with at-home collection kits. For not much money, you can freeze your sperm, too. Show Notes: More Dr. Josh Gonzalez: Instagram | Website | TikTok Try the Popstar Volume & Taste Supplement & Popstar Fertility for Men Today! Save 20% with code "EMILY" at popstarlabs.com/emily Try our FREE Guides Today! SHOP WITH EMILY! (free shipping on orders over $99) The only sex book you’ll ever need: Smart Sex: How to Boost Your Sex IQ and Own Your Pleasure Want more? Sex With Emily: Home Let’s get social: Instagram | X | Facebook | TikTok  Let’s text: Sign Up Here Want me to slide into your inbox? Sign Up Here for sex tips on the regular. See the full show notes at sexwithemily.com.

We're seeing 50 plus percent reduction in sperm counts since the 1970s. There's some estimates that say that if this trend continues that most people won't be able to have children without some sort of assisted reproductive technology as early as like 2060. So, and these numbers are really alarming and no one is talking about them. Like, I don't think if you ask the average man that he would understand, number one, how important sperm killing is, and number two, how drastically on the decline it has been. You're listening to Sex with Emily. I'm Dr. Emily and I'm here to help you prioritize your

pleasure and liberate the conversation around sex. Today I'm joined by Dr. Josh Gonzalez, a board certified urologist, fellowship trained in sexual medicine, who specializes in the management of male and female sexual dysfunctions. In this conversation, we're talking about hormone replacement therapy and what we do and don't know about the use of hormones.

He's also answering your top penis and vulva questions, and we're discussing load versus sperm count and how that affects men's pleasure because a smaller load sometimes feels like a less intense orgasm. Also, men need to be proactive about their fertility. And hint, hint, it's a lot easier and cheaper to freeze sperm than eggs.

Just if you're curious about conceiving. I love talking with Dr. Gonzalez and I can't wait to share his incredible work with you. Please rate and review Sex with Emily wherever you listen to the show, just do it right now. It takes you two seconds and it really helps get the show out to more people and more sex positive people like you,

who wanna have better sex. You can also find me on all social media at Sex with Emily. If you're there, I'm there. Check out my new articles, Is My Vagina Normal? And How to Have an A-Spot Orgasm. They're up on sexwithemily.com. Also, don't forget to sign up for my emails. You can find the link in the show notes. All right, everyone, enjoy this episode. Listen, alcohol is just out in 2024. There is a rising trend of going alcohol free

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Me too. Okay. So let's talk about what you do. What is a urologist? It's a good question. A lot of people do not know. I did not know when I started medical school. So urologists generally manage everything having to do with the genitourinary system. So that includes urination, sexual function with things like erectile function, ejaculatory function, but it's really broad. So we manage urological cancers, bladder cancer, kidney cancer, prostate cancer. We do benign urological health conditions, kidney stones, difficulty urinating, and then of

course there's the whole sexual health aspect of it, managing you know various sexual dysfunctions. It's nice because it's a broad spectrum of things that you can do and you can kind of choose which path you'd like to take. Okay got it and you also specialize in sexual health and wellness, sexual medicine you studied with the OG. The grandfather Dr. Goldstein. Erwin Goldstein is just, he's done so much for women's sexual health too, but everyone. Oh especially, yeah. Yeah, so he was really, I mean,

he was involved in the initial Viagra trials. He's been doing this since like the late 70s, early 80s. And then, you know, the last, I would say 20 plus years of his career have been really focused on elevating, you know, awareness of female sexual health because so much of the conversation in sexual health focused on men for so long. Well, I love that you're carrying that torch too.

So if I'm coming to your office, what am I coming for, would you say? So, I mean, I see, first of all, both men and women who have sexual health issues. I would say the most common things I see are erectile dysfunction, low libido in both men and women. We do a lot of hormone management. So women in menopause offering them

hormone replacement therapy, men with low T putting them on treatments to increase their testosterone levels. I'd see actually a lot of pelvic pain, a lot of women who experience pain with sex. There's someone who will listen to like, I have pain and it could be so many different areas, right? Do you think they start with you?

What would be your first thing? If I just said, I have pain, how would you take that down? So we try to get like them to be more descriptive about what exactly is different areas, right? Do you think they start with you? What would be your first thing? If I just said, I have pain, how would you take that down? How would you work it out? So we try to get them to be more descriptive about what exactly is going on, right? Because being clued into the details of their pain can help you diagnose what the problem might be. So for instance, if you're talking about a woman

who experiences pain with sex, right? I asked them, how would you describe that pain? Is it burning? Is it raw? Is it a tight feeling? Is it sharp? Do you experience pain with initial penetration or with deeper thrusting or both? Have you had this pain your whole life?

Or is this something that came on at some point? And those are clues that help us figure out what the source of the problem is. A lot of women have pain from sexual activity related to hormone deficiencies, right? A lot of younger women that I see that are on oral contraceptive pills can develop dyspareunia and sometimes not even be able to have sex or they can't lubricate. And so we often will have to kind of undo the damage from some of those medications and put them on hormones

to give them back the hormones. To regular, right? Because it's really just a depletion. Can we talk about that for a minute? I'm finding this, the birth control pill, this is controversial. I don't know why it still is, but I feel like there's been so much information out about how much a woman takes it and then goes off of it.

It's really hard for her to balance her hormones once again. And there's a whole protocol and it might never go back to the level, right? That it was at or you see that. Yeah, I mean, so one of, I would say the biggest damage that is done by oral contraceptive pills is that they cause an elevation in a protein called sex hormone binding globulin.

And that protein, you don't want large amounts of it because what it does is it binds up your hormones. And when the hormones are bound to it, they can't essentially be used by the body, right? So we only use the free circulating forms of testosterone and estradiol on those sorts of hormones, right? So when you get an elevation in SHBG,

you functionally are in kind of a hormone deficient state. And even when you stop the birth control pill, sometimes you'll see some correction of that SHBG value, but it usually doesn't go back to what it was prior to starting the medication. I'm not gonna get on a soapbox about oral contraceptive pills. They do serve a purpose, right?

And it's not like I tell all of my female patients, I don't want you having an unwanted pregnancy, so we need to figure do serve a purpose, right? And it's not like I tell all of my female patients, I don't want you, you know, having an unwanted pregnancy. So we need to figure out some other alternative, right? But maybe we'll consider an IUD, which doesn't cause these issues. You know, we talk about alternatives to the birth control pill. So the first step is getting them off of it. And then often we'll have to put them on testosterone. It's usually the hormone that's the biggest culprit of sexual pain. And so we'll put them on testosterone. It's usually the hormone that's the biggest culprit of sexual pain. And so we'll put them on testosterone to essentially cause higher levels of T

to overcome the SHBG problem. Okay. So if you think about it like as a pool of testosterone, we're increasing the pool so that that binding protein is binding a smaller percentage of the total testosterone. What other treatments do you offer in your office? I know there's been so much advancements lately in technology for sexual health.

Yeah, probably the most exciting thing that we do is kind of in the regenerative space, right? So how can we restore the function of tissue that may not be working the way it should? Or how can we use other types of regenerative therapies as an adjunct to hormone replacement therapy. Okay. So we do low intensity shockwave therapy in my office for men who have erectile dysfunction. So a lot of men don't think they have ED because they can get hard

but if you can't stay hard then you also technically have erectile dysfunction. So yeah difficulty achieving or maintaining an erection. There can be a whole host of things that could be wrong, right? It could be performance anxiety. It could be a hormone problem. It might be a cardiovascular issue, right? They might have a blood flow issue.

So we do hormone testing. We evaluate men's erections using an ultrasound to measure their blood flow, make sure that that's normal. And then we start talking to them about treatments. you know, and a lot of times it's multiple things. We're putting them on hormones, we're giving them medications that improve blood flow, we're talking to them about the potential benefits of shockwave therapy. And so the way that therapy works is that it's an energy-based therapy, sounds terrible,

shock sounds really painful, it's not painful at all. And what it does is it stimulates the body to release growth factors that then promote new blood flow to the area, help cellular turnover, so that you get essentially better functioning tissue. Yeah, a lot of times it's just blood flow challenge, right? Yeah, and these are technologies that are used elsewhere in medicine, right? Like, for instance, we do laser treatments

for women who have sexual pain or dryness. It's a CO2 laser, similar to the CO2 lasers that people use on their face to help promote collagen. The Mona Lisa is the one that we use. There's a few of them out there. Yep, there's a few different ones. It goes internally, right? You use lasers to stimulate collagen.

Exactly. Yeah, so it essentially plumps up the vaginal mucosa. We also use it to treat externally on the vulvar tissue. A lot of women have vulvar pain or vestibular pain, and so we can use the laser to treat that as well. But you're going to see a lot more of this. Yes. And right now the data isn't the best. I mean, there does need to be better studies that are done. In most of these cases, especially when you're talking about something like shockwave therapy, there has been little to no evidence that it causes any harm, right? So if you're somebody who's looking for any solution to

help you perform better, many, many men benefit from shockwave therapy with little to no risk. And so if they do that, then do they have to... Can they throw away their Viagra? Sometimes, yeah. I mean, it just depends on how good or bad their blood flow is. So I have some guys who, you know, don't even respond to Viagra. And then we do the shockwave therapy

and suddenly they start responding and they're thrilled with that. Because once you stop responding to Viagra, we're talking about injection therapy, we're talking about penile implant surgery. It's really comprehensive. That's what's really impressive about what you do. There's some places that just like have just the treatments

right or the technology, but it's like you are doing the multi-care but you have to, right? And treatment and we partner with a lot of other types of providers, a lot of therapists, sex therapists specifically, pelvic floor physical therapists. So it's a team of people that you really have to bring on board a lot of times because these issues are so complex, right?

They're not just one thing. Going back to HRT, hormone replacement therapy, not just for, I guess people think it's always about gender, about gender reassignment. It's like, no, it's actually something, especially for women. We had that bunk Women's Health Initiative study, was it 2002, I guess, when that came out and it was like, hormones are bad, women can't take

hormones or women weren't taking hormones 40 years, probably like my mom was taking it, right? So now this whole generation of women has been like, I just got to suffer through perimenopause, menopause. I don't even know what it is though, because no one ever talked to me about it. But the studies now are saying, right, estrogen is probably safe for most women. So I mean there's a what's your take on it? Most of what you said is pretty accurate. I think that the biggest issues with the women's health initiative aside from them having analyzed the data now 20 years later and shown no difference in mortality between hormone replacement therapy and placebo aside from that which is a huge huge point is that in

the initial trials they were looking at women who were taking essentially synthetic hormones, not the type of hormone replacement therapy that we're doing. These were oral conjugated estrogen treatments, right? That's not what we do when we replace estradiol now. Secondly, a lot of the women in the study were very old. They were older, right? And so when you're talking about risks of blood clots and strokes, right, like a lot of those women were probably at, you know, increased risk already because of age and what we know happens to the cardiovascular system. Yeah. So a lot of the

conclusions that were drawn, you know, you could argue weren't totally valid. And then when you talk about real risk the increased risk in breast cancer, which is one of the things that people were really terrified was Statistically significant when they reanalyze the data 20 years later, but we're talking about like a miniscule Increased risk of something that's already pretty low risk, but that's not how it was Portrayed it was if you take hormones you will get breast cancer or you will have a heart attack or stroke and die. Exactly. So all these women which it's about eight to ten years of their life they're in perimenopause to menopause didn't have any solution so now women

are like they're coming at it and they have questions. I know personally for me like I've tried it all I guess it's been about seven years I've tried the pellets the hormone pellets I've tried the progesterone, estrogen, estradiol, all of it. Every woman at a certain age, and this is probably, I mean, you could argue starting in her late 30s, benefits from vaginal estradiol. There is a ton of data, and this is going back 20 plus years from the 90s, that has shown a reduction in urinary tract infections just with vaginal estradiol. So you could even take sex out of it and argue that there are plenty of health benefits for women as they get older to be put on vaginal

estradiol because so let me think about how many elderly women are hospitalized because of UTIs. So many. Right exactly. And so and some of those people will never make it out of the hospital. They will pass away or die from their from their urinary tract infection because it spreads elsewhere or something. And so, you know, as a preventative measure, vaginal estradiol, in my opinion, should be offered to any woman starting in middle age. Yeah, I think so too.

I know that my mom is 81 now and she's been on it since her 50s. She uses the ring, the S-ring. Yeah, yeah. Do you still prescribe? Like, how do you know which one is right for you? I usually, I mean, it just depends on what someone's preferences are. I usually will start with either a cream

or they make a vaginal estradiol tablet that's so easy to put in its own little applicator. Yeah, just insert it like a tampon. We try to meet women where they're at. I see women in their 20s and their 30s and their 40s and their 50s. And depending on where they're at, they need different things, right?

So younger women are gonna need higher levels of hormones just to function than a woman who's older than that. So it just kinda depends on what kinda symptoms they're having, we tailor their hormone plan to kinda what they need. What about testosterone? Is it still off-label use for women? Yeah, yeah, so there's no. What about testosterone? Is it still off label use for women? Yeah, yeah.

So there's no- What the hell? I know. Literally you can't get it anywhere. No, there's no FDA approved testosterone treatments for women in this country. I mean, until 2015, there wasn't any FDA approved medications, period,

for female sexual health. 2015, so almost 10 years ago. That's when I started practice. I think it was right around there. You go to your doctor, you're having paramanopause symptoms, which again, just to remind you is a space of time in a woman's life that could last eight to 10 years. And a lot of symptoms can happen

and usually because it's the loss of their hormones. But because we couldn't give hormones, they'd go to their gyno and they'd be like, maybe just have a glass of wine, take an antidepressant. Yeah, you're depressed, you're anxious, you're not happy in your marriage. Yeah. There's a lot of gaslighting.

That medical gaslighting that happens to women. More for women than men, yeah. I think so, yeah. I mean, when a man says he can't get an erection, no one's questioning that. No, they're like, Viagra in every corner. Here's a bill. Here's a vending machine, get your Viagra.

Exactly, and we've had these pills since the 90s, and there were commercials with Bob Dole talking about them, you know, so the normalization of male sexual dysfunction has been around for a while. There's a whole separate, you know, discussion that you could have that talks about individual men having a lot of shame about sexual dysfunction. But I would say as a society, we're much more accepting

of male sexual health issues than we are female. Someone comes to you and says, like, I have like a low desire, how do you handle that? as a society, we're much more accepting of male sexual health issues than we are female. Someone comes to you and says, I have low desire, how do you handle that? First, I believe them, right? These are tough conversations to have. So when you have someone being vulnerable enough to speak up and say, listen, I have this sexual health issue,

the worst thing that you could do to that person is not believe them or dismiss them. And it happens so commonly. It happens with young men who say that they're having believe them or dismiss them. And it happens so commonly. It happens with young men who say that they're having problems with their erections. It happens with women when they say they have no sexual desire. So it's happening to a lot of people. And then, you know, a lot of times I'm seeing them and I'm like the third, fourth provider that they've seen.

And they're told things like drink a glass of wine, or if they're a young man with ED, it's all in your head. But it's not always in your head. So if someone hasn't taken the time to try to really diagnose what the problem is then they can't say that and be sure about it. And there's so much damage that is done to people with sexual dysfunction who are dismissed because then they spin out in their head, right? And we know psychology is a really important part of sexual health and if they are told that there's something wrong with them mentally they're gonna just carry that into future sexual encounters. We also

don't have a lot of education around our bodies. People don't know about their bodies. Because as a society we do a terrible job of educating people and you know sex education for us I'm sure was similar in similar in junior high. Your PE coach talks to you about how to not get pregnant and how to not get STDs, and that's basically where the conversation stops. We don't learn about body parts, we don't learn about pleasure. So you're left to kind of figure that out

through friends, media, right? And those are warped perspectives of what sex is really supposed to be like. So, yeah, and then that's just the general population and then doctors are horribly educated about sex. I mean we get very little sex education as part of our medical education. So we don't have the education. You're in high school or middle school you get a really bad information that says don't get pregnant, do an SDI but then go have sex. We're not gonna tell you anything else. Right. But then a lot

of women like we're saying is that they're put on birth control pills. I'm just always wondering, like, why can't men be more responsible? Like, male fertility is really something that I think that we need to focus on too, that men could, they could do things too. They could get vasectomies, or they could, we're freezing our eggs, they could freeze their sperm.

Right? Yeah, totally. Yeah, I mean, I think in the same way that you're seeing kind of movements from women related to their sexual health, there is a little bit of a groundswell around men, I think, feeling more responsible, to be more responsible in the reproductive conversation. I mean, given the climate of reproductive rights being kind of rolled back, I've seen men come to my practice requesting vasectomy and I ask them what their motivation is.

And there's data showing increases in the vasectomy consultations following the overturning of Roe. And so I think you're seeing men, whether that be from pressure from their female partners or just them feeling a sense of responsibility on their own wanting to be more involved in that conversation.

They don't understand, actually your sperm might not be all that. Exactly, exactly. It might just be about our eggs. I mean, 50% of infertility cases are related to male factor infertility. Half of the cases, but somehow we kind of always think about infertility as kind of a female problem

or that's the default. Yeah. And it's just not accurate. All right, it is not accurate. And I know something that you've worked on I'd love to talk about is why has there been such a drastic decline in sperm count and really testosterone, right? The last 40 years. I remember reading these studies to like in the 70s, I think, or in the 80s. I think in the 70s, or in the 80s, they have all this conclusive data about why, like so much less testosterone, which means less sperm, right? Yeah, usually, I mean, there's a relationship between- Correlation. Exactly. What we do know is that it's a global problem, right? So there's sort of a global decline

in men's sexual and reproductive health. Namely, like we're seeing lower levels of testosterone earlier in life. We're seeing 50 plus percent reduction in sperm counts since the 1970s. There's some estimates that say that if this trend continues that most people won't be able to have children without some sort of assisted reproductive technology as early as like 2060. So, and these numbers are really alarming and no one is talking

about them. Like, I don't think if you ask the average man that he would understand, number one, how important sperm count is, and number two, how drastically on the decline it has been in the last, you know, since... Absolutely. Could the low sperm count also be... Would you say that that is where a little testosterone is related to why all the young men are having ED now at an earlier age? A lot of studies that have come out recently looking at the accumulation of microplastics in our bodies, right? So they've seen it in testicle specimens. They've seen it in semen specimens. So there's definitely an environmental impact here.

I mean, that, in my opinion, is the only reason you could really explain this global phenomenon. The whole world is experiencing this increase in pollutants. OK, so what can men do? What can we do now to help their fertility? Yeah, so I think being proactive, first of all, we need to just educate men better, right? So understanding that this is like an alarming trend.

It's alarming. Knowing that, you know, your sperm production is best in your early 20s, right? And maybe you don't imagine yourself having a family for another 15, 20 years after that. If you wait to that point You may have a problem and so, you know, you can pretty easily test your sperm They have at-home collection kits now you can very easily and for not that much money freeze your sperm

So if it's something that you are interested in preserving I would suggest that men Have a semen analysis Earlier rather than later. Okay. And if they are concerned about it, freezing their sperm and then looking at taking supplements, making lifestyle changes that have been shown to promote, you know, sperm health. Yeah. Okay. So freezing their sperm. I mean, really, why? It's so expensive. We freeze our eggs. It's like I could buy a house or I could freeze my eggs.

And then men are like, yeah, freeze your sperm right now every guy can just go in the bathroom and like shove it in the freezer now I know you have to do it more technically speaking no but they have at home kits where you can literally do that so you just you you collect it at home they have a preservative you pour the preservative in the cup you send it to the lab and they analyze it and they give you the option to freeze it if you want. It's a lot more invasive for women to retrieve eggs. I'll be right back after a quick break for our sponsors. So just stick around. Sex with Emily has launched several downloadable guides full of tips and

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You started this pop star. Yeah. Yeah. I was like, wait, what? This exists? Tell me more about the origin of pop star. My business partner, Brian and I sort of like a little pandemic project when both of our practices for obvious reasons kind of slowed down, had been seeing a lot of men complaining

of a decrease in their ejaculatory volume. Right. obvious reasons kind of slowed down, had been seeing a lot of men complaining of, you know, a decrease in their ejaculatory volume, right? And at a certain age or just... I was seeing a lot of young gay men. That's just kind of the population that my practice attracts. But we see it in men of all ages. And we know that there's a decline in volume as men get older naturally. So they were coming to you and saying, when I ejaculate now, it's just not as much.

Exactly. It dribbles out. I don't shoot the way I used to. I don't make as much semen as I used to. And at the time when I first kind of brought the idea up to Brian about like, can we find a solution for this problem? It was all related to pleasure, right? So I was seeing guys saying, sex doesn't feel, it isn't as fun.

My orgasms aren't as intense. And it's because I've noticed this problem. And so we launched the initial Popstar product, which was a volume and taste enhancer a couple of years ago, as just sort of a pet project and have been really thrilled with how many people have found this product and said like, oh, this is something that bothered me, but I never knew to talk about it or I didn't know that there was a natural option because there are some medicines that we can

prescribe but a lot of men, you know, that's not a problem that they want to take a medication for. Right. It's a supplement they could take every day. Exactly. Yeah. So let's break down the volume and the taste part of it. So volume is more like, I just want more.

I want it. It doesn't feel good when nothing comes out. Yeah. Yeah. So I mean, if you think about it from like, like a physiological phenomenon, right? The idea of ejaculation and orgasm. When you orgasm, the intensity of that orgasm is often related to things like pelvic muscle contractions, right? Your pelvic muscles are going to have to contract more if you have more to expel, right? So a lot of men will report more intense or more pleasurable orgasms if their volume is higher. And a lot of people, when they first hear about our product, they're like, why would you want more? You know what

I mean? And that's what we tell people is that for a man, when you are expelling more fluid, more contractions, more intense orgasms. So that was our initial product launch. And when we were kind of formulating it, we thought, well, can we make a supplement that is kind of, hits all the aspects of ejaculatory health? What are other things that people complain about when it comes to semen? And a lot of people like talk about taste, right?

So we're like, can we put things in there that neutralize the taste or make it less bitter or sweeter tasting. Gromolin is the primary ingredient. So it's the pineapple. So the joke is that we tell people is, if you wanted the same effect that this gives you from just eating pineapples, you'd have to eat like,

you know, piles of pineapple. It's all concentrated in there. And again, it's not gonna necessarily make your stuff taste like pineapple, but what it does is it kind of neutralizes a lot of the bitterness that people come in there. And again, it's not gonna necessarily make your stuff taste like pineapple, but what it does is it kind of neutralizes a lot of the bitterness that people come in about. Where does the bitterness come in? If someone has bitter sperm, could it also be related

to the foods they're eating, the nutrition, right? So what we consume ends up in our, the fluids that we produce, right? So classically, like asparagus, right? People eat asparagus, their pee starts smelling, right? Smokers will often have more bad tasting semen. All the things that we do to our bodies, alcohol, you know, certain- Fried foods.

Yeah, exactly. All those have to make it out somehow, right? So they come out in our urine, they come out in our tears, they come out in our stools, and they come out in our semen. That would make sense. Let's talk about, you were in Poosh, your article about cum velocity. Yeah. I just love that. A jackalatory force. Yeah. Like in larger

volumes are important for fertility though, which is going back to the conversation of men taking responsibility for their fertility. We got a lot of men asking us about the potential effects on fertility. Would this make it easier for me to have kids when we launched the first product? And then Brian and I individually have been on our own reproductive journeys. Brian is open about how he's had both of his children through IVF.

I'm currently navigating the surrogacy process. And so we just felt like it was a natural next step to make the second product a fertility-focused product, because while there were some ingredients in the initial product launch that do support semen health We wanted to make sure that we created a formula that was specifically designed to like make you make better sperm How does popstar actually work then you take it every day? Yep. Okay. Yes You take the volume and taste enhancers for capsules daily with 16 ounces of water and the fertility supplement is three capsules a day.

Okay, okay. And you've seen babies being born. We actually have, I mean, like people on Amazon writing reviews being like, we've been trying for so long, we finally got pregnant, which is just like, you know, it's fun to hear when people are like, oh, my sex is so much better. It's a completely different feeling when someone's like, I'm gonna have a family now.

That's such a great service to provide. Like, it seems like it's, I just, it's a question that comes up a lot about semen, about how to make it healthier. Exactly, and there's stuff in the formulation that is a promoter of men's sexual health in general. So, zinc is really important for male sexual health. Zinc. El arginine,

which is a vasodilator. So, a lot of our customers will report that their erections are better, they're getting more morning erections, some men will even report that their desire has improved. So there are ingredients in there that promote men's sexual health in general. I mean sex is so, that's the silly part to me and what I like can't wrap my head around is like we're simultaneously both like obsessed with sex and don't talk about it. Media is like sex, sex, sex, sex, sex, but then like no one has conversations about like well how do we navigate this? How do we have satisfying pleasurable sex, right? And so this like dichotomy,

these two worlds that we kind of live in, right, it's just so silly. This is it. It's frustrating. That's why we got to keep doing the work we're doing. Exactly. Every freaking day all day. No, we don't have, yes, we're sex society. You can download sex. You can look at sex 24-7. You can find it, but you don't really know your own body and what makes you feel good. I want to talk about the overturning of Roe. Plus also people have this resistance to IVF. The people who say, oh, we're investing in families, they're also this resistance to IVF like the people who say like oh we're investing in families they're also saying no to IVF so how does like our country like actually invest in the

future of family creation? The ridiculous part of that argument and what people really and maybe they'll learn eventually is going back to what I said earlier, this is a global problem, right? So a lot of people that use IVF now, the perception is that those are people that have non-traditional families, right? The reality is that if that if the current trends continue, everybody is going to have non-traditional families in the future. So if we're about promoting family building, then we should really get on board with these assisted reproductive technologies and understand how they help people have families because we're all going to be in the same boat unless something drastically changes.

God, every day we learn something else about the future. Like it's just not looking great right now. But I mean, really, I just love what I do, what you do, because we're actually giving people really useful steps to be preventative. This is happening, people. We're telling you. It's on the decline. Your sperm is on the decline.

Your sex life may be on the decline. Yeah. And I think, as with a lot of things in health, we need to shift more towards prevention and not reactive care, right? Like I can do so much more for you if you come in wanting to be proactive about maintaining or optimizing your sexual health, as opposed to you having been dealing

with some problem for five to 10 years, right? There's still solutions for you and we're still gonna be able to help you. But like if you are proactive about seeking care for these issues, so much more can be done, right? And we can be given the tools earlier to prevent some issues from coming up. I wanted to get into the questions that we have for you

from our sector family. Let's talk about circumcision. So dear Emily, I have an uncircumcised penis and I worry when I'm with someone that they're gonna judge me, how do I increase my confidence? Do you get a lot of questions about, or do people come in like they're worried about their- Yeah, I think there's, there is,

in this country obviously like more men than not are circumcised usually when they're initially born as infants, right? Right. And so there's a lot of misconceptions about what it means to be a man with foreskin. The reality is that globally, it's more common to be uncircumcised, right?

And again, I think it goes back to education, right? People with foreskins have problems when they're not taught how to take care of their foreskin, right? So we see people develop infections, we see a condition called phimosis where the skin gets tight and can't be retracted and that can cause pain during sex or you can develop like little lacerations or abrasions because the skin is too tight but a lot of that can be prevented by teaching young people how to take care

of this part of their body. They've seen owner's manual. Yeah, exactly. It's like, this is how you do your answer. I think we should, going back to the sex education piece, like the conversations that we had in junior high, that's like too late, right? You need to start talking to children

about their body parts, right? And not having it be this weird, oh, you know, your private spot or your pee pee or, you know. Kids can handle it, right? You can say penis, you can say vulva, and it's gonna help them understand that this part of their body is the same as their hand, right? It's just another part of their body

that they have to take care of and to give them the tools early on. That's when the shame starts then. If you're like, oh, it has no name, well then if it has no name, then it must be something I can't talk about. Exactly. So, sorry, to get back to your listener's question,

I think that, well, first of all, I would say if there should be no shame about having a foreskin, it doesn't make your penis weird, it functions exactly the same way. And so I would encourage that person to try to continue to tell themselves that so that they don't feel ashamed or have a lack of confidence.

Secondly, if you run into a partner who makes you feel that way, you probably should try to find a new partner because there should be no reason that someone reacts that way to, again, an otherwise normal body part. Lack of education, we should know that it's really no different. And men who do a foreskin tend to, again, I don normal body part. Lack of education, we should know that it's really no different. And men who do a foreskin tend to,

again, I don't know, I don't have a penis, but they can have more sensitivity, they can have a lot of pleasure. Exactly, yeah. We need different ways, that could be really exciting. We only recommend circumcision in my practice when people have these very specific issues. I never encourage someone to undergo circumcision

for cosmetic reasons. I tell them. Right, people come in and they want it later in life. Yeah, and I have to have a conversation with them about, I understand your motivation, maybe they had a partner that shamed them or whatever, but this is a really sensitive part of your body, right? That I'm sure has provided you a lot of pleasure

over the years that we're going to remove. And once it is removed, I can't put it back. So, I really encourage them to think about that before they pursue circumcision for purely cosmetic reasons. Okay, that's helpful. That's helpful. Love your body, love how it is. Accept it, work with it.

Everything's okay. You're all fine. So what would you say, when could someone start taking hormone replacement therapy? What is that age that you think is appropriate for men and for women? So I don't think there's a specific age. I think it just depends on the person.

So let's talk about women and menopause, right? If the average age of menopause is 51, that's an average. There are a lot of women that started that process earlier and then you tack onto that 10 years before, right? so there are some women that will start menopause at 45 that means that at 35 they might start having symptoms of perimenopause and they can be really subtle symptoms they can be forgetfulness trouble concentrating brain fog fatigue low sexual. And so a lot of women don't know to look out for these symptoms, don't understand why they're experiencing them, maybe

mention them to their doctors and are dismissed again, drink the glass of wine, you know, you'll feel better. Women in their 30s can start, if they're having symptoms, having those conversations with providers and say, hey, something feels off. People are very intuitive about their bodies, right? You know when something feels different, is not responding the way it used to. And so when that process starts, at any age, it could be a man with erectile dysfunction in his 20s. Just because he's in his 20s doesn't mean there may not be a problem there that's causing them to have problems with his erections. And I would encourage anybody if you've noticed a change in how your body normally functions, speak up about it. What are some changes that they might exceed in

their genitals as they age? So, um, yeah. So penises get smaller, everything gets smaller, everything atrophies, right vulvas atrophy vaginas atrophy Penises atrophy that just all means shrinkage right yeah It withers away, but that's that's because our body you know the circulatory system doesn't work as well So you're not getting blood flow to the erectile tissue So you're not getting as good quality erections or when you talk about the clitoris you're not getting clitoral engorgements in the same way So all of that stuff atrophies Related to a decline in our cardiovascular function and a decline in our hormonal function

so there are a lot of men who see me in my practice who complain about like their penis having shrunk over the last couple of years and Unfortunately, we don't have a lot of things that regrow penises. So again, it's about prevention, right? It's about doing things lifestyle-wise, dietary-wise, things like exercising regularly, eating healthy, getting good sleep. These all promote, you know, better cardiovascular health, better hormonal health to try to prevent or stave off that atrophy. It could be preventative, but it's still my drink. Exactly. Yeah, I mean, we're all battling time, right? We all are on that journey together.

And there are certain things that are inevitable, but I don't think people appreciate how much can be done to prolong that process. Yeah. And for women, if they're seeing that atrophy or the pain or the thinning of the vaginal walls adding the estrogen can help them with the regrowth. Exactly yeah and younger women you know it's it's crazy to me because I see younger women who are you know years away from perimenopause and menopause having very similar symptoms as women in perimenopause and menopause. What do you think that's about? So a lot of them it's because of their birth control right they cause cause this. It can cause

atrophy of their genital tissues. It can cause dryness. It can cause pain. And we don't take women seriously a lot of times when they're younger complaining about these things or attribute it to other things. Depression, anxiety, problems in their relationship. And a lot of times it can be solved by you know getting them off birth control and putting them on some sort of hormone. And a lot of times it can be solved by, you know, getting them off birth control and putting them on some sort of hormone. And then a lot of times I found too, exactly like they get on the pill,

but then they do get anxious so then they're probably antidepressant. And that's like a double whammy. Exactly. Because then that's impacting their desire perhaps. Totally, yeah. Okay, so I've got one more question. What's your take on semen retention

and men holding their ejaculation? I know it's trending. Men just ejaculate. It's like one of the few things that you have in life that's pleasurable, right? So no, there is this whole no fap semen retention movement online that is a little like weirdly in my opinion, based in like kind of misogyny.

Like it's this weird, like, you know, it's about like male power and you lose your power or sacrifice your power like through ejaculation. And so be stronger and more masculine and more virile. You like hold on to your semen for as long as possible. It's a very weird space and it's not based in any kind of science. Maybe someone feels a little bit more energetic if they're, you know, not ejaculating as often, but that's an individual feeling. That doesn't mean that somehow not ejaculating is going to make you more powerful or have more energy. Yeah. You know, and some people will say like, well, you know, Olympic athletes, like when they're

training or when they're at the Olympics, like they're not having sex and they're told by their coaches not to have sex. Like that's a very specific kind of person. Not Olympian. And again, I think you could still make the argument that I think if they ejaculated, it wouldn't really affect their performance all that much. Yeah, I just, I think it's a silly thing

because there's so much going on around us, right? That's just hard to get through every single day. Like sex and ejaculation is like one of the few things that we have as a people that's pleasurable. Exactly, like you got a hot punch, cold punch, not ejaculate. Like what the fuck are we doing? I guess, yeah, I've heard some of the same things

and that's sort of based in like an ancient, like in Taoist practices, right? Where men are holding onto their energy and then it's like this, you know, it's like their chi every time they orgasm, they're giving away their chi. So you have to learn and a lot of men I know are taking more of the spiritual route of it of like they are Learning to orgasm without ejaculation. Yeah, just a practice. Yeah, but I can't imagine

I know many men are really gonna sit like some do right, but that's a whole journey and there is you know There is the idea of edging which when done properly can the idea of edging, which when done properly can heighten the sexual experience, right? It can make that final orgasm more intense. But this sort of intentional, like, I am not going to ejaculate for the entire month of November, like, is just silly. You know what I mean?

I understand- Could be powerful though, or just? I mean, there, well, there's not a lot of data on it, but there was a study that showed a reduction in prostate cancer incidence in men who ejaculated more than those that didn't, right? So, I mean, who knows? That's convoluted, but like, you know, if anything, there's more data to support ejaculating

more often is better for your health. Okay. They heard it guys. This is a lot of semen information that I don't think we've done such a deep dive into semen. Well, that's what we're about. A lot of semen. This is what I love.

You really, no, I know. Yeah. And it's like, I love that you're all about the health of semen and how we can have more written, stronger eruptions, cause you know, happy penis is like happier life. Yeah. Yeah. Your penis is more like- Happy general's happy life.

Happy general's happy life. Yeah. For sure. Okay. That was very helpful. Now I'm going to ask you the five cookie questions we ask all of our guests. Okay. Are you ready? Like, we don't have to think it firstly that comes to your mind. Okay. Ready? Okay. Okay, that was very helpful. Now I'm gonna ask you the five quickie questions we ask all of our guests. Are you ready? Like we don't have to think it first

when it comes to your mind. Ready? Okay. Your biggest turn on. Ooh, intelligence. Biggest turn off. Closed mindedness. What makes good sex?

Whatever feels good to you. Something you would tell your younger self about sex and relationships. Don't overthink it. What's the number one thing you wish everyone knew about sex? That if it's not good that there's a way to make it good. Oh I love that. Okay Dr. Josh Gonzales, this was wonderful. It's so nice to meet you. You're doing such incredible work. How can people find you, work with you? Instagram I'm at Joshua Gonzales MD. Popstar has accounts to popstar labs

on TikTok and Instagram. And yeah I I mean, I just use my social media as you've seen to kind of help do what we did here today, right? Educate people, do it in a disarming, entertaining kind of way. Yeah. Yeah. And then if you're in LA, or you're interested in a virtual appointment, we offer those Joshua Gonzales MD.com. Oh, yeah. We'll put link in the show notes. Yeah. That's great. They can see you virtually. Yeah. Okay. Thank you so much.

Of course. Yeah. I really appreciate you and your time. Yeah. Oh, that's great. They can see you virtually. Yeah. Okay. Thank you so much for being here. Of course. I really appreciate you and your time. Yeah. And the good work you're doing. Thank you so much.

Thanks. That's it for today's episode. See you on Friday. Thanks for listening to Sex with Emily and be sure to like, subscribe and give us a review wherever you listen to the podcast and share this with a friend or a partner. You can find me on Instagram, YouTube, TikTok, Twitter, or X, and Facebook, all at Sex with Emily. Oh, and I've been told I give really good emails, so sign up at SexWithEmily.com.

And while you're there, check out my free guides and articles for more ways to prioritize your pleasure. And if you want to ask me about your sex life, dating, or relationships, call my hotline 559-TALK-SEX. That's 559-825-5739. Or go to SexWithEmily.com slash Ask Emily. Was it good for you? Email me, feedback at SexWithEmily.com.