Strictly Anonymous Confessions - 1155 - Everything You Need to Know About Erectile Dysfunction and More with Urologist Dr. Pazona

Episode Date: June 28, 2025

Sexual Health Saturdays. Dr. Pazona called in to discuss erectile dysfunction, testosterone therapy, trimix and a whole lot more. Tune in to hear all the details including how common erectile dysfunction really is and why your erections are a reflection of your health, how ed is diagnosed and how a lot of issues aren’t ed at all, the two physical reasons for ed and how to test to figure out which is the reason for your ed, what can be done if blood flow is an issue including pills, vacuum devices, trimix ad penile implants, how they all work and the pros and cons of each of them,  normal lab ranges for testosterone and what they mean, the causes of low testosterone even in young guys, different ways to get TRT including pellets, injections, creams and the pros and cons of each other them, how it helps and how long you can be on testosterone therapy, how and why changes in weight effect d*** size, , his podcast Balls Deep and what he talks about plus a whole lot more. Here is link to his podcast Balls Deep on Youtube: https://www.youtube.com/@BallsDeepPod **To see HOT pics of my female guests + hear anonymous confessions + get all the episodes early and AD FREE, join my Patreon! It's only $7 a month and you can cancel at any time. You can sign up here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.patreon.com/StrictlyAnonymousPodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and when you join, I'll throw in a complimentary link to my private Discord! MY BOOK IS NOW OUT FOR PRE-ORDER!!!! Strictly Anonymous Confessions: Secret Sex Lives of Total Strangers. A bunch of short, super sexy, TRUE stories. GET YOUR COPY NOW: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://amzn.to/4i7hBCd⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠   To join SDC and get a FREE Trial! click here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.sdc.com/?ref=37712⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or go to SDC.com and use my code 37712   Want to be on the show? Email me at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[e-mail]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠http://www.strictlyanonymouspodcast.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and click on "Be on the Show" Have something quick you want to confess while remaining anonymous? Call the CONFESSIONS hotline at 347-420-3579. You can call 24/7. All voices are changed.   Sponsors: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://butterwellness.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Use the code “STRICTLY” at checkout for 20% off your entire order ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://vb.health⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ To get 10% off Drive AND LOAD Boost by VB Health use code: STRICTLY ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://bluechew.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Get your first month of the new Blewchew Max FREE! use code: STRICTLYANON ⁠⁠⁠https://beducate.me/pd2516-anonymous⁠⁠⁠  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Use code anonymous to get 50% off your yearly pass plus get a 14 day money back guarantee  ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://shamelesscare.sjv.io/xLQ3Jv⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Get $10 off Shameless Care’s female viagra cream, just click on the link and use code: Strictly    *The information on this episode is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content and information available through this episode is for general information purposes only. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition. Learn more about your ad choices. Visit megaphone.fm/adchoices

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the lifestyle there. You get your in, you know, you could find out where all the gangbings and hotel takeovers and meetups and munches are in your location or in any location. They are worldwide. You want to sign up for SDC and get a free trial. Use my code 37712 or just go to the description and click on the link. The last thing I'm going to say is if you love my show, please write a review. I never asked for reviews. I don't know. I always felt weird about asking for them. But I did on, I think Valentine's Day or Christmas, I don't know, one day I decided to use the holiday to beg for reviews. And so many people wrote me so many nice reviews. And I was like, oh my God, I should ask for them all the time because I really do love hearing from my listeners and hear what people really think about my show. I fucking love it. It makes everything that I do worth it. So keep those great reviews coming. It helps the show. Okay. I have a great sexual health episode today. Dr. Zona is on. He has a center called Bozona MD. He's a board certified urologist. And we talk about sexual health on this episode. We talk a lot about E.D. We talk about the reasons. And then,

you know, depending on the reason, he talks about the fixes, right? So he talks about if it's a blood flow issue, what he does to help guys. He talks about if it's a hormone issue, he talks a lot about testosterone therapy. He gives so much information. I can't even explain it at all. It's super interesting. You're going to love it. He has his own podcast. where he has so much more information. I'm definitely going to have him back on, okay, because he's got a podcast called Balls Deep. And I was like, if you have a podcast called Balls Deep,

you're my kind of doctor. He's really fucking cool. He's up to date with what's going down. He's funny. He's engaging. You're going to love him. And, you know, like I said, if you want more information from him,

and he has a whole podcast called Balls Deep. It's over on YouTube. I'm going to put a link to there. But he does do telemedicine. So if you're looking to go on TRT or something after you hear his episode, you can also go to him. He's in Nashville. I will put a link to his website as well as his YouTube.

He has tons of episodes over there with more information. I'm going to definitely have him back on. I think he's great. You're going to love him. You're going to love all this information. So anyway, I'm going to be right back on with Dr. Posona. Hi, Dr. Posona. Welcome to the Strictly Anonymous podcast.

How are you today? I'm great, Kathy. Thanks for having me on. No, thanks for coming on. You know, you're a board-certified urologist. I've been dying to get a urologist on my show because whenever anyone talks about anything that has to do with like sexual health or ed or misectomies or you know just actual callers who talk about stuff people like write in they have

questions and i always want to give my listeners the answers now your center posona md which is in nashville optimizes guys performance in the bedroom the bathroom the bathroom and the boardroom which i was like oh i love your little tagline you know that's what you specialize in right but you also though do you still have a podcast i do uh so my My podcast name is Balls Deep. I love that name. Let's get people's attention and let's talk about some, you know, uncomfortable discussions in healthcare that don't need to be uncomfortable.

We have these discussions all day, Kathy. Listen, I've looked at more penises than a porn casting agent. So the difference is I do it with a couple letters at the end of my name and the occasion and then scrubs usually. So, you know, we've got to have approachable conversations about sexual health. because sexual health is health. We need to get that point across to people that if you're having trouble in the bedroom, you're likely also having trouble elsewhere.

And we really try and get to the root cause of it, explain it to folks, and not just throw little blue pills of people all day, but really make a difference and make a difference in their overall health. Yeah, which I love, because I believe in that. I'm very into health and fitness, have been all my life. It's something that I Google all the time. I love medical stuff. I love talking to doctors, even about something that has nothing.

to do with me like this, right? It's because I just, it's just something that I'm very interested in. My question to you, and it was like, you kind of like just said, we're having these conversations in the office all the time. And I was wondering, because as a woman, I could go in and talk to my gynecologist. She's a woman, like, and I could tell her all my things. And I, I was wondering, like, when guys come in, is it, like, do you, like, is it easy for them to cop to, like, their male issues? Or is it, like, a thing where a lot of them don't want to tell you? Or is it something that you have a like a relationship with them. So by the time maybe they're having issues, they feel comfortable. Because I would assume that a lot of guys, you know, would find it difficult

to walk in and say, oh my God, I can't get it up or whatever because that's like their manhood, quote unquote. There's no doubt there's still a huge social stigma around sexual performance, Kathy. And certainly I'm seeing the guys who were brave enough to pick up the phone, call our office, show up and get in that room with me. But as soon as we get in, in that intimate environment and they realize I'm a trusted professional that I'm a guy just like them, that I speak to them in real layman's terms and not stiff, stiff doctor talk, although we're going to work on getting them stiff. Yeah.

That, you know, the barrier start breaking down. And one of the first things I always do with them is say, you're not alone. I mean, if we look at erectile dysfunction alone, Kathy, 50% of men by age 50, you. are going to have some degree of erectile dysfunction. Oh, wow. It's that high. It is that high. And every decade thereafter, it goes up another 10%.

So most... Absolutely. And so most of us are going to get ED at some point. And so we've got to start these conversations because, you know, there's, you know, first off, erections are really a report card for your overall health. For sure. And we can dive into that, why it's really kind of the dipstick of your health. literally and figuratively here.

But you need a pot. It's good you have a podcast. You're good with your words. Go on. Well, you know, listen, we've got to make this approachable. Yeah. You know, there's plenty of information out there, but we've got to break it down an approachable way.

We have to show guys, listen. You are not broken. This is part of aging, but we can do things to improve this. Let's have a real conversation. And then I see guys start opening up. And then there are guys, listen, Kathy, they come in and they're just like an open book. And they're like, I've got this, I've got this, I've got this. I mean, even intimate details about their relationships.

Yeah, that's great. You know, I only get ED when I'm with my wife from behind or, you know, they start going into real details about their sexual positions and everything. I'm like, you know, there's no such thing as TMI in my world. Oh, that's good to know. Yeah, you know, if it affects your health, let's talk about it. let's stop thinking that we're not allowed to have these discussions and quote sex is dirty. And that's what I love about your show, Kathy, is you're normalizing a lot of these things and saying, listen, you know, everyone's got a different sort of flavor of ice cream that they like and no judgment,

whether it's chocolate, vanilla, strawberry. But if you do like some of those other flavors, like that's okay. You're not alone. You're not alone. I mean, that like 50 out of 50, when by the time you're 50, 50%, 50%, I think that that's comforting for guys to here if they're having a problem because the most important thing or the greatest thing is to know that you're not the only one and sometimes you know guys aren't talking to their friends about stuff like this so they don't know and that's why they are coming to my podcast to secretly maybe

listen to information like this but it's it's good to know that as a doctor like you want those details that's going to help you figure out what's going on right like when a guy comes in let's like walk through like a scenario where a guy comes in and he's having ed like what because i would assume you have to ask him bunch of questions to figure out like the reason, right? Because there's probably a lot of different reasons that could be happening. Like what, where do you start with that kind of issue? Yeah. So I first want to make sure we're talking about the same thing. Oh, interesting. You'd be surprised, Kathy, how many guys come in saying, and they're very vague. They have, quote, problems down there.

And I'm like, okay. Yeah. Yeah. And I'm like, okay, so let's start off here. Are you interested in sex? Yeah. Okay. Yes. Okay. Well, that's what's. called your libido. Do you have any difficulty getting your penis hard and keeping it hard until you orgasm? No. Okay. Well, that sounds like your erections are healthy. So what's your issue? Well, I ejaculate you quickly. Okay, great. So now we're going to talk about premature ejaculation. And so it's amazing how often a guy comes in and I've got to kind of tease out what actually is going on. Then if we get to it and we go, okay, it's clear this guy has the ED. I'm going to start asking about the situations in which this occurs because you'd be surprised, Kathy, how many guys come in.

And it's 100% situational ED. You know, it's the guy who's, he masturbates, no problem. He's, you know, previous relationships, no problem. I then uncover that his wife has put on 30 pounds since the last pregnancy. And he admits to me, you know, I'm just not quite as attracted to her as I once was. And I say, okay, okay. So now we've got to kind of address that very delicately and go on, but I can now give you confidence like, hey, if when you're alone and, you know, maybe a year ago with your wife, you had no issues whatsoever, the likelihood you have ED because something bad is going on in your body is very, very low. And now we're going to work more on the psychological and the stress aspect of this and maybe get a sex therapist involved versus the guy who comes

in, he's 55, he's got a belly that hangs out further than his penis type of diabetes, just had a heart attack, he's on 50 medications and he's wondering why his penis doesn't work. Okay, we got a blood flow issue there, sir. Let's start working on, let's start working on some of these medical issues here. So we really want to dive deep into, you know, a definition, whether it's situational or not, and then if it looks like, no, this is actual ED. I'm then going to start asking questions and doing an investigation, Kathy, to figure out, is this related to a blood flow issue, a hormone issue, or maybe a combination of both?

Oh, wow. And what are the kinds of tests that you'll do? I'm going to assume a hormone test, right? But how do you determine whether it's a blood flow issue? Yeah, so we can do a test called a penile Doppler ultrasound. So we've got a handheld ultrasound in our office. and what we can do is we can measure the velocity of blood going into and out of the penis before an erection as well as after we can induce an erection in the office.

Now, how do you do that? It's not the way the guys are you're not jerking them off, are you? Sorry. Some guys might be running to your office. Unfortunately, Kathy, that would cost me a medical license. I'm sorry. Not my preferred method, but, so we use what's called a vasodilator, and we have to actually inject it with a very small needle into the erectile chamber of the penis.

So it's called a penile injection. And penal injections are actually the most common cause or the most common treatment for erectile dysfunction because a lot of guys, the Cialis, the Viagra, no longer work. And so we've been prescribing penile injections. Yeah, Trimix is an example. And so what we'll do is give a small dose of that. We will then do the Doppler study to study the blood flow. And then we give them another medication to let the erection go away.

So very often the guys are like, I want to kind of run out of your office and get home to my partner. Oh, my God, that's so funny. I'm like, we're like, sorry, bud. We got to tell your friend to go away for now. That would not be medically safe to potentially let you leave with that. And it may get some stairs in the waiting room. Now listen, I know that most guys don't even use sex toys, but they should. So many guys who have called into my show talk about how stimulating their perineum, aka the male G-spot, can lead to mind-blowing multiple orgasms. And Butter Wellness has created a perineum massager that is used externally. That's right. You can stimulate your male G-spot with the butter massager without putting anything. on the inside. Listeners who have bought the butter massager are very surprised at how powerful it is and

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Run out of your office and get home to my partner. Oh my God. That's so funny. I'm like, we're like, sorry, but we got to, we got to tell this, tell your friend to go away for now. That would not be medically safe. Don't you let you leave with that? And it may get some stairs in the waiting room. Oh my God, that's so funny. All right.

So, now, if you find out it's a blood flow issue. I mean, you said it could be one or the other. And we'll get into the whole testosterone thing. But like, if it's a blood flow issue, what comes next if you figure that that's the issue that's going down? Yeah. So I take two approaches, Kathy. there's there's the immediate we'll call the band-aid approach what's going to help get get this guy active with his partner again ASAP and that's where we're going to walk through the pros and cons and learn more about what he's tried from the we'll call the the the pills or PD 5 inhibitors is the big category to dalafil sylidafil viagra cealis guys know it by different names the blue chew you know my sponsor we love blue ch yeah yeah there there's

go, all the stuff that's out there. And so, listen, if the pills work fantastic, that's likely going to be your best bet. Now, the pills don't work for every guy because they have a ED that's too advanced, or some guys do get side effects from it. And you really can't tell until you try it. Headaches, back aches, facial flushing, changes in your vision. Nothing serious. You know, you hear these commercials and you think your penis is going to fall off. If you take these pills, you're going to die of a heart attack. None of that. None of that's true. Right, but there might be something slight that happens that is you don't want to deal with.

Absolutely. I mean, listen, no one wants to go out sex if they've got an erection with a pounding headache. Exactly, yeah. So if that doesn't work, then we're going to typically talk about the next line therapies, which is going to be a vacuum erection device with a plastic ring and or the trimix injections. So those are typically the next phase. And then if that's not working, we are often sending them to a fellowship trained doctor who specializes in the penile implant surgery. So I tell guys, listen, I've got lots of tools in my tool belt to get you hard.

It's just going to be a matter of what ultimately is what your body needs and what sounds best to you. Yeah, I had a guy call in and go through his whole experience getting the penile implant in. And I thought it was great. And I had a girlfriend of mine and mom friends like, oh my God, word on the street is my father had a penis. I was like, why the fuck do you care? Like, I was like, he's a problem solver. You only live once. Life short just fucking put it in and move on with your life.

Like, why is that a terrible thing? You know what I mean? I don't know. You know, I thought it was like a great episode letting guys know. Like, you can't do that too if like all these other stuff wasn't working or you don't want to take those medication, right? The penile implant actually works. Oh, absolutely.

I mean, for guys who select it. So again, you're going to weed out the guys who are scared shitless of it. Or just it's not for them. but for the guys who are motivated and they go to a good surgeon, they love it. And more importantly, their partners love it because now they can outlast any 18-year-old walking around the street because all they've got to do is pump it on up and they're good to go. Yeah, no, that's what I heard.

And I think it's like a great option. But they have to go to a cert. Like you would send that person to a surgeon. And that's after they would try. You would do first, when you first have them try like the pills. And then if that doesn't work, it's the trimax. And then if that doesn't work, it's, you know, me. they could get the penile implant?

You certainly want to be selected because once you do the implant, you will not have a natural erection ever again. So if something ever happens where you need the implant removed or it's not working, like you're going to have to, you're reliant on that moving forward because they basically are coring out the erectile chambers where the blood would normally flow through and they replace it with these plastic sort of cylinders that can fill up with saline. And so once all that spongy tissue is gone, say goodbye to natural erection. So you certainly hear stories of young guys get it because they, quote, want to perform better.

And I could not recommend against that highly enough. I mean, this is not something you do because you think you want to be a stud. Like, this should be, this should be like nothing else has worked and or you've got some extenuating circumstances. And like, you're ready to make this. And this is the difference between you not being sexually active ever again and getting that enjoyment back in the bedroom. Yeah. Question about Trimex because like is that something that's being used more now? Because I remember hearing about it from people like in the lifestyle and you hear like porn stars would use it and stuff. Is that something that is being prescribed to guys more and more now? Or has it always been something that guys have used? Yeah. It's always always been there. Kathy. Just again, guys are really quick. Yeah. They're not quick. Yeah. They're not quick. raise their hand going, hey, guess what I do to get an eruption? Yeah. But the guys who do it, and I tell

most guys, listen, when I put needle and penis in the same sentence, I understand you already have one hand on the door. However, most guys, you know, liking it to just, you know, what we tell guys to do with the following, take your hand, pinch the skin on the side of your penis as hard as you can. That is about as bad as it's going to hurt. And so it really is not as bad as you think. It's a really tiny needle. When you get good at it, you can do the injection process of probably under 15 seconds. And so the pain that can occur is more often a throbbing erection. So we want to be careful.

And this is where it's so important to go to the right doctor, Kathy. Right. You know, there's a lot of these, quote, sexual men's clinics that are out there. And what they do is they charge these guys an inordinate fee and they slug them full of a giant dose of this trimix. because they want the guy to, quote, be really happy with his result. Yeah. And then the guy has not only pain, but he can end up with a medical emergency, which is called Priypism, which is an erection that lasts more than four hours

and is associated with a lack of fresh blood circulating throughout the penile tissues. Oh, my gosh. That's one of the few emergencies that will get a urologist in an ER with a patient if the ER doc can't get rid of that erection with some medications and certain techniques. So, you know, I treat it, I treat it like barbecue. I go low and slow with the dosing. I go, listen, if you don't like the first time, that's cool. Let's just give it some time.

I'd rather we get you 50% on the first go-round than 150% and then you never do it again. Yeah, that's totally smart. How long does it last and how, you know, when you injected? First of all, how long does it take to like get you hard? Is it immediately? Is it immediate? And then also like, how long does it last? You should be hard within five to 15 minutes after the injection.

rejection, again, depending upon, you know, the dosage and the guy. There's a lot of trial and error. I can't look at a guy or even his Doppler test and no. I know you need exactly X amount of trying. Oh, interesting. Okay. And listen, the ideal situation, a guy gets hard quickly, he performs, he ejaculates, he orgasms, erection then goes away, all the way to the other end of the spectrum of

either it doesn't work at all or he has that erection four hours later and he's calling our officer going to the burn serum. So it varies, but for most guys, it's going to go down shortly after climax like a natural erection would. Oh, that's so interesting. And that's just something that a lot of guys use and you inject it with like a diabetic needle, like a very thin one and goes into your penis or like the tip. Like where do you put it? Yeah. So it is a very small insulin type needle that like a diabetic would use. Yeah. We recommend injecting on the side of the penis. because on the top of the penis are all the important blood vessels and nerves, and on the bottom is the urethra or the urine tube.

Putting it into the head of the penis would be not only very uncomfortable, but probably not as effective either because the head of the penis actually has a bit of a separate blood supply than the two erectile chambers. So anywhere on the side, you're going to push in the needle as far as it goes. And again, these needles are so short. You can't hurt anything if you tried. But what we got to do is get the medicine, Kathy, into that erectile chamber, which is below the skin. And kind of through this thick capsule called the tunica, this is that rigid capsule that keeps an erection so firm.

And, you know, why we call it a boner, because it seems like a bone. It's because that capsule is so thick and it's holding the blood in those spongy tissues. Right. So this is filling that up for that time. Yep. Interesting. All right. Let's get to T or T.

Like, so, you know, when if it's not, if it's not blood flow, right, and you did a guy's lab, labs, right? And you see that it's testosterone. I mean, one of the things, because I've been on hormones since I'm in perimenopause. I've always believed in them. I couldn't wait to get on them the minute I felt like things were changing, you know, I believe in them, right? And I take them and been taking them since. But a lot of guys, you know, they, they have stories where they have zero libido, they're really tired. They went to their doctor. The doctor said, you're normal for your age. They do this to women, too, right? For your age. And so, So are there still doctors out there that are afraid to, like, give testosterone if they're normal

for their age or is it different for guys? Does that make sense? Kathy, absolutely. Kathy, if a man or a woman have been, if you've been told your labs are normal, but you feel like shit, you need a second opinion. Right. Plain and simple. I tell my patients all the time.

I don't care about normal. I care about optimal. And I care about how. the word. And I care about how you feel. And here's the problem with guys. The lab value for total testosterone has such a wide range. It goes from, depending upon the lab testing facility. Yeah. I'll just throw out some numbers just so people have a general context. In general, it goes from about 250 to about 850. And if you fall anywhere in that range, you're, quote, normal. But I know that if I can get guys to that upper range of normal and even sometimes slightly above, they feel so much better and it's safe.

And that even if we look at testosterone, even separate from how you feel, they've got studies showing that in men whose total testosterone is less than 600, which is pretty healthy. 600 would be a good range. If it's less than 600, you have a higher likelihood of dying of all causes. I'll repeat that again. If your total testosterone is less than 600, you are likely to die younger than someone who's level is higher. So the problem with TRT and testosterone, the following, Kathy,

we have two diametrically opposed camps. We'll liken it to like the vegans battling the carnivores. I like that, yeah. And so on one end, we've got the bro science. We've got the tweakers of the gym, the guys who are doing this with, medical attention, the guys who are doing it simply for vanity and to, you know, get that much

bigger of a chest measurement and are completely unsafe and is absolutely dangerous. And I'd throw in there sometimes some of these, you know, quote, low tea places where they're financially incentivized to put as many guys on injectable testosterone as possible. Oh, interesting, right. Okay. So that might be overprescribing. Absolutely. Yeah.

Uh-huh. Yeah. overdosing, over prescribing, or more importantly, not even personalizing it. Yeah, yeah. They're not going, and we can kind of go into the different forms. Yeah, we're right. Unfortunately, Kathy, on the other end of the spectrum, we have the traditional medical community where even as a urologist, so I went to school for, I went to four years of medical

school after college, six years of urology training. So I didn't get my first job, Kathy, it'll have 31. Right. So despite all that, despite all that, despite all that training. training, I will sum up my 10 years of education on testosterone. If a guy's level is above 250, tell them to suck it up and lose weight. If it's less than 250, give him the least amount possible and get him out of your office because he's going to be a pain in the ass. Yeah, sorry, that's what I tell people. Like, I don't care what your doctor said. When was the

last time he was in school? And what did they teach him then? Right? Like, you obviously know more than that now. Absolutely. But the sad thing is, Kathy, I had to learn it all like on my own. This took my own initiative, my own curiosity to go, huh, okay, I was taught X, but I see all these guys out here on testosterone. Maybe it's not optimally managed, but they're singing its praises. There's got to be somewhere in the middle. And that's really what I've strived at Posona MD at our facility here is to be that moral and ethical middle ground where we're curious. We lean into things. We work with patients. We don't live in these rigid boundaries. of everybody should be on the highest dose of testosterone as possible, nor should everybody

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That's dipsy stories.com slash strictly anon. Go there now to get 30 days of free access plus 25% off your subscription. Everybody should be on the highest dose of testosterone as possible, nor should everybody just demonize it and say it's terrible. The truth like most things in life are somewhere in the middle. Yeah. And it's interesting because my brother got on testosterone because I told him to and he did and he felt great.

And he was like angry at some point on a vacation. And my sister's like, oh, he has royd rage because he's taken testosterone. I'm like, you don't understand. Okay. He's just an angry person. I've seen him angry before. Like people think like roid rage, right? Like that whole term.

That is happening. And they made a comment about another guy on my show who was like really fucking jacked and talked about being on TRT and they're like, oh, look at he's overdosing on testosterone. I'm like, you don't get it. He's like jacked because he works his ass off at the gym. Like testosterone's not going to make you jack like that. The void rage happens to like these young guys that already have normal levels and are overdosing. But like when a normal guy is going to his, a real doctor that's prescribing it in the proper way,

there's no fucking road rage, right? Or you have too much and you pull back. But I just feel like some people are assuming it's like, like you said, that one side of the camp that this is what's going down. Absolutely, Kathy. You know, the biggest myth is that TRT is only for bodybuilders. Yeah. It's like that's 1980s. I treat tired dads, stressed out executives, even guys in their 20s and 30s with low T

from just modern lifestyle burnout. The only difference is that their quality of life now is night and day when we optimize their levels. And there are so many myths about it. And in fact, I see the exact opposite most of the time in terms of you mentioned the Royd rage. I'd say most guys with low T self-admitted, self-admittedly are. assholes.

Oh, interesting. Yeah. And their assholes, not because they're bad people. They're assholes because their tea levels are so low. Listen, testosterone affects your energy, your mood, your brain, your hair, everything. It's not just erections and muscles. And the biggest benefit that I see, the guys come back and go, Doc, I'm not a dick anymore. Like, I'm happy.

I don't get pissed off of my partner. My kids don't irritate me as much. We just did a podcast with, with. an ex-marine vet and he shared his journey on TRT and he even said listen I knew I knew I was having issues when my kids started annoying me like to the degree that they did and my spouse at the time he said listen if your family annoys you that much there's a good chance you have a hormone issue so it's if anything it balances guys now again are there the the bros out there who are overdosing and do have true roydrage they do you have true roydrage they

do, but they're not getting medical attention. They're not getting labs checked. They're self-dosing. And that's 100% dangerous. So I'm not going to advocate for that approach either. Yeah, that's totally different than the guy who's getting it for the reasons that people get it now. I mean, I think like, listen, the hormones are all about, like you said, it has to do with like your moods and everything. And it's just like, look at women with periods. I think guys don't believe in their whole fucking lives. Like, they just think that we're crazy. Okay. It's like our hormones go whacked once a month. And it does make you mood. and all that stuff. It's all hormone-related, both men and women. Same thing. Those hormones do affect a lot of different things. And it can affect younger people. And let me ask you this. Do you see more younger people

with low testosterone than in the past? Is that like a real thing? 100%, Kathy. You know, there's a low-tie epidemic going on. What is that about? Well, let's take a look at what causes low-tie in a lot of cases. So, number one, chronic stress. We are walking around wound up stress balls. We are staring at our phone and social media all day. We're taking on not only our own pain, but the pain of everyone in the world who we follow on social media and the news that's out there,

regardless of what side of the aisle you sit on. And that chronic stress is real, and it leads to real changes in your body. It releases the stress hormone called cortisol. Now, cortisol is great when back in the day you had a giant fucking tiger staring you down and you were going to get mauled if you didn't get your ass up and run away or fight back, right? But when it's every day and a low level and it's just nonstop because of your behaviors,

cortisol destroys not only testosterone, but your thyroid hormone as well. Secondly, we have an obesity epidemic that nobody is talking about. 40% of U.S. adults are now obese, and obesity leads to a variety of diseases, including it's linked to low testosterone. And that's both just directly because of the inflammation that's going on in the body, because of the disturbances to your very delicate hormone system that we have in place. But when you're obese, you often don't get good sleep because you have sleep apnea. And we know that people who are chronically sleep deprived,

you have testosterone levels that are that of someone who's 10 years older than you. So we've got 30-year-olds with T-levels of 40-year-olds and 40-year-olds with T-levels of 50-year-olds, and you keep on going. And so, you know, one of the best things you can do to naturally boost your testosterone is put good whole foods in your body. Get up and move your ass, lip some weights. I mean, these things are, they're difficult, but they're simple. And they're the root cause of a lot of this. And so those are just some of the potential theories. Who knows what else in terms of environmental toxins?

and other things might be playing a role. But the big thing is we're chronically stressed, we're out of shape, and sometimes that's going to not only show up with low T, but it's also going to contribute to low libido and sexual performance issue. Because sometimes guys come in and we get them on TRT and they're like, well, Doc, maybe I feel better, but I'm not sure. And I'm like, tell me about what you're doing for your diet. Right.

Are you exercising? Are you starting to sleep like I told you? and like, no. I said, well, listen, dude, I can give you all the tea in the world. It's not going to just automatically turn your life around. Now, for some guys, it does, but it still doesn't mean you get to eat what you want, drink what you want, and completely ignore your health. And just as you said earlier, getting on testosterone is not going to build muscle. Listen, I work out like a fiend.

It is fucking, it is fucking hard to put on muscle. I know. That's what I always say. Yeah. So rude. These guys, yeah, these guys who are jacked, like, trust me, they're working their. That's what I always say. If you see anyone, it's about even like I'm a woman, I'm like jacked in my arms and stuff.

I'm like, I always like really appreciate seeing that in anybody else because I know exactly what they had to do to get that. And, you know, the people that have never worked out have no clue. And I think it's so rude when they say stuff like that to people because it's like just to get a little bump. It's like you're working your ass off. And it's not like you get to the top of the mountain you stay there. You got to work every day or it goes away. Like it's such hard work and I think people are clueless. It's like if you think injecting testosterone is going to build muscle like, I mean,

it'll build a little bit, right? But it's not going to make you jacked. You got to go to the gym and work out and that all does help it, like you said. I was just like, why are people like getting down on a guy that looks amazing for 60? Like what backwards world are we in that instead of like admiring him and wanting to be like him, you're putting him down, you know, it doesn't make sense to me. Because you could still look good nowadays. Like people look, you know, if you work out and you stay in shape,

when you do these things. Absolutely, Ken. And it is a shame, Kathy, that we've gotten to a point in our society where rather than looking at people who are healthy and championing them and making some changes to be closer to, be more like them. Instead, we demonize them and we turn a blind, we turned a blind eye to obesity, which is slowly killing us. And I want to be clear here, I am not at all for fat shaming.

This has nothing to do with beauty or what you're attracted to. Obesity is a medical diagnosis that is linked to 55% of women who have cancer. It's related to obesity. Yeah. That of people who have a heart attack or stroke, 80% of them are obese. Even looking at something like people who died from COVID, 75% of people who died from COVID were obese. Yeah. This is a real epidemic and no one's talking about it.

And, you know, the second the belly grows, the penis shrinks. I was waiting to say that. Let's talk about something that might get guys more interested in losing weight. Like, you might get an inch back, right? An inch back? Yes. Now, let me be clear. If you are a healthy weight, there's no amount of weight you can lose that's going to make your dick.

No, no, no. But I'm talking about the big guys. But the big guys, absolutely. Yeah. Every 30 to 50 pounds you lose, you're going to get penis length back. And it's simply, you know, fat gets distributed in people's bodies in varying ways. You've got some people who got big booties. Are there big bellies?

Some show it in their face. Some don't. And some people carry a lot of their weight in that, you know, the superpubic area, what some people will call the foova area. And what happens is the penis literally gets enveloped. So I'd say hands down, the most common scenario of a guy coming to my office wanting a bigger penis. I have him undress from the waist down. I do an exam. I push back all that extra weight next to his penis.

And I go, is this how you want your penis to look? He goes, yeah, there it is. I said, well, guess what? Yeah. We're going to talk weight loss now. And so that's hands down the biggest thing that is causing smaller penises is the weight. And then secondarily, because obesity is length. to all these diseases that then lead to erectile dysfunction and blood flow, right?

Use it or lose it, Kathy. It's no different than any other part of our body. And if you are no longer getting morning erections, if you're not being sexually active on a regular basis, the penile tissues will scar and shrink. And so changing your waistline is going to change your penis more than any other snake oil you find on the internet or any other, you know, get big dick scheme you see out there. Just listen, Kathy, if there was an easy way to get a guy's penis figure, the richest man in the world would not be Elon Musk and be a urologist.

No, no, no, but I had a guy on, okay? I'm going to tell you, and this is like it's so funny how men act. Sometimes I'm fucking amazed because I had a guy on who's like a plastic surgeon guy that like injects filler into the penis and can make it thicker. And he's not turning guys into porn stores. The before and afters are amazing, just slightly thicker. you know, big difference. And it was like 10 grand, you know, and these guys are all fucking complaining on my

Patreon writing in. Like, I can't believe like, why would I spend? I was like, oh, my God, every girl walking around. My highlights cost me $600. I mean, like, I brought you a guy that can make your dick thicker for 10 grand and you're complaining. Like, you don't understand how much women spent to do things. You know what I mean?

I just think of me, it's like the same weird things. Like, guys just don't want to do what they need to do to be better. I'm like, no girl's ever going to complain that your dick's a little thicker. It's 10 grand. I mean, every girl you see walking around with breast implants, how much you think she's spent. It's so weird. But anyway. Kathy, my wife reminds me every day of how much beauty costs.

Yeah, you know, right? I'm just like, oh, my God, 10 grand, please put it on your credit card and let's move on. All right, let me ask you a quick question because there's different ways to take testosterone. Like there's pellets, there's injections. Do guys use creams or is it just like pellets or injections or is there also creams that guys use and like go through the different types? Yeah, so there are several different types that you alluded to and you hit most of them. Injections, topical therapies and pellets are probably the most common. There is a new FDA-approved oral therapy.

Oh, interesting. Like most new FDA-approved things, though, it's crazy, expensive, and good luck getting insurance to cover it. Right. So in general, the approach we take out of our office is, again, here are the pros and cons of each of the applications. here's what guys similar to you do. What sounds best for you? I tell guys, listen, they're like, well, what's the best? I said, there is no best.

I said, what makes sense to you today? I'd say that injections are the most common because, again, you've got these men's health centers that that's all they do in a very cookie-cutter approach. Now, I'm not a big fan of how they dose it in most cases because, again, there's there's what the experts do and then there's the what is the protocol and the label on the bottle say so those are often different so so a lot of men's health experts use an off-label approach where they inject the testosterone rather than once a week into the muscle with a bigger needle they inject it twice a week with a smaller needle kind of into the belly fat and the benefit

there is you absorb the medicine better so you could be on a lower dose and And the problem with the once a week injections, Kathy, is that you get this high peak and then you come down and usually by the next time you're able to inject, which is typically seven days later, you're not feeling great that last day or so. Whereas if you do a split dosing where it's a lower dose, you don't get the peaks in valleys. So that's what a lot of experts and that's what we do at our practice at Posona MD like to recommend if we're going to do the injections, understanding it's, quote, an off-label use. and we have to explain that to the patient and the pharmacist.

There are the topical therapies. I'd say it's probably the least popular. I've got a couple guys who like it. Most who try it because they, quote, don't like needles or like the idea of just rubbing a cream. They come to find out, number one, it's a bit onerous rubbing the cream on. It's a pretty thick cream. And, you know, you really are sitting there kind of rubbing it in, trying to find an area. You don't have hair in your body.

You'd be really careful washing your hands, making sure that no one else gets. into it. Yes, very careful. If you rubbed it on your partner, your dog, your cat, your kid, not going to be good. That's scary. And then probably the bigger issue is the absorption of medicines through the skin has a really big variability with from man to man. And so I've got some guys, we'll put them on it. They swear they do it. We check their labs in six months and they are six weeks and they don't even budge. So they end up stopping it because they just don't notice the difference and their labs don't come up. So, Again, least popular for those reasons.

And then I think the pellets are a great choice. It's the set it and forget it option where it takes me less than five minutes. We do it in my office. We put some tunes on. You're on your hip. I find an area kind of in the buttocks that you're not going to be sitting on, clean it off, numb it up. And in under five minutes, I've just put in for a guy, anywhere from 8 to 12,

they look like little rice kernels of bioidentical, gradable testosterone pellets that actually made from vegetable products. And they slowly get absorbed into the bloodstream. So for four to six months, a guy doesn't even have to think about testosterone. He's just good to go and nice and even. And then as it starts wearing off in that four to six week rate, four to six month range, he'll call us up, come back in for his next pellet insertion. We do the other butt and then we just keep going back and forth.

Yeah. I tried everything. I've done the pellets. I've done the injections of cream. Quick question. this is about women. Like, why is it, and I think I know the answer, I just want to make sure it's the truth. Like, why is it testosterone approved by, you know, like paid for by insurance for men, but not women? Is it because it's not FDA approved to treat women? And that's why I got

to pay out of pocket, but guys get their testosterone approved by insurance, correct? It's, you're exactly right. There's FDA approval that dictates insurance policies that lead to this. And here's the sad truth. Yeah. Women have, women have been shafted in. health care for decades and it continues to happen. That unfortunately, most studies are done in Caucasian males and that we then think we can interpret those results across gender, ethnicity, however you identify yourself and make it so restrictive. And it drives me absolutely bananas.

And so to be clear, we treat women at our practice as well. Yeah, I saw that. Testosterone for women. testosterone is actually more prevalent in women than estrogen is. Most women don't realize that. The testosterone is so key. And again, it's not just about getting horny in the bedroom for your partner. It affects your mood, your muscle mass, your bone health, even potentially your heart health.

We've got data talking about the importance of HRT and women for preventing Alzheimer's disease. So the biggest travesty in the last, you know, 30 years of health care has been the women's health initiative and how it was, how it was interpreted back in 2002, which is the big study that basically demonized hormones in women. Yeah, but yet they were giving those women birth control pills. Those same women that would never touch a fucking estradiol were taking hormones in their birth control for like, 20 years. I mean, to me, I never took one fucking birth control pill because I was like, I was horrified by it. But I went on hormones the minute I needed them because I saw those as much more natural. But it was like backwards world again. That's what it isn't birth control hormones? Like, think about what you're doing to your body. How could you want to do that? But you don't want to take

some, you know, get your hormones back to levels that would make you feel better. There's so many things that are asked backwards. It's changing. It's changing. It is. And that's, well, And that's why, you know, we have our podcast. That's why, you know, I appreciate you having me on today because we have to bring awareness to this because, listen, I, just to be clear, I am not a conspiracy theorist. I am not anti-government. Most people make me think I'm a very reasonable person. Yes.

But if you look at most FDA recommendations, most recommendations made by these large societies on how to treat X, you could insert any disease process. we have it really wrong, especially in the world of hormones and nutrition and lifestyle. And it's really shameful because, yes, birth control pills are hormones. When you do HRT and a woman who's gone through menopause, all you are simply doing is replacing back to the level she was. Why did we allow women to suffer with hot flashes and mood swings and a complete loss of their sex life and probably increased risks of. of osteoporosis and heart disease and dementia and strokes. And it's all because the study was done 20 plus years ago and they report a 25% increase

in breast cancer. But if you actually look at the data, it was five out of a thousand women got diagnosed of breast cancer instead of four out of a thousand women. So actually a .1% difference. And by the way, it was a non-lethal cancer. know, by the way, it was in the group getting a medication we don't prescribe anymore. Yeah. So, but because of that, we now think HRT causes breast cancer.

So it's, it's imperative, and that's why we're doing what we're doing, Kathy, with our practice and all of the, the podcasts and the social media, we've got to build awareness. And there's a lot of wonderful doctors out there, if you know where to look across the country, who have the accurate information, who are preaching from the rooftops. and I'm just trying to be one of those voices. Yeah, I love it. Who further studied, and I say this, that, like, when was the last time your doctor, like, went to school, like, probably 40 years ago, you know?

So, like, maybe that they don't know that your testosterone level is low. But what I want to ask you, though, about testosterone, I have some questions. Like, one of the questions I got about testosterone is the guy that's on it, totally killing it feels great, but wants to know, is there any kind of, like, negative side effect to be on it long term? Like, is there a time in his life where he, He's going to have to get off of it. That's a great common question we get, Kathy.

As long as you are not concerned about your fertility, that's really the main thing that to stop being on testosterone long term is going to affect. So if you are done having kids, then there is no reason that you are going to ever have to stop testosterone if you're properly managed and if you take good care of yourself in that process. Now, unfortunately, alluding back to what you do, just were talking about, you know, you're going to get these guys who then have a heart attack. You know, listen, it's the number one killer of men in this country and there's going to be guys

on testosterone, off testosterone, obese, not obese, you name it. Lots of guys are going to get heart attacks. But what do we do? We like pointing the finger at the one shiny object in the room that's easy to blame. Ah, it's the testosterone that caused your heart attack. Now you have to get off it. Now you have to feel like shit. Yeah, can you believe it?

It's just not the case. And so it's one of those things that you can stay on testosterone long term. The biggest issue is when young guys get on it or guys, regardless of age, who want to maintain their fertility. We do have some fertility sparing protocols at our practice. And that's where that personalization comes in. And what's often missed at other, you know, low-te places is they don't even ask the guys or notify them of that risk. And then the young guy ends up in my office and going, I had no idea. Oh, wow.

I'd done testosterone two years and I had no idea it affects my fertility. I didn't know that. Yeah, because the, you know, the sperm production relies on the same hormones from the pituitary gland or similar ones that the testosterone production does. The pituitary releases f-sh and LH. And so you need some testosterone to make sperm. And they kind of go hand in hand in that. that realm. So if you go on outside testosterone, the brain gets a signal, oh, hey, testicles, we got it. We don't need you. We don't need you. You could shut down production, but we don't

just tell them to shut down making burgers. We tell them to shut down the fry making too. Wow. So that's where it can affect it. This isn't interesting. This is like a positive to a positive TRT story. Like he had a side effect he didn't realize. And I'm wondering if you see this too. he says like how often do does he see autoimmune diseases triggered by a testosterone deficiency because this is a guy he said he was diagnosed with an autoimmune disorder and he went through like four months he said of conventional therapy and then transition to TRT and after that it all went away like do you see that that typically will help like autoimmune issues and other things that maybe they were on other medications for i'm not at all surprised to hear that story kathy

if we look at the data, 80% of all diseases are due to lifestyle and hormonal issues. And we underestimate the impact of your adrenal hormones, your thyroid hormones, and your sex hormones like testosterone and estrogen in the root cause of a number of diseases. Now, it could also be that the testosterone gave him more energy, started working out more, slept better, put on some muscle mass. And so if we look at a lot of these, quote, mystery diseases that are out there, it's not really a mystery. It's just that we don't have an easy test or a definitive diagnosis or a simple treatment

to fix it. But if we look at truly what the root cause is, it probably is something to do with your hormones, your diet, your movement, your sleep, your stress, your relationships. Yeah. This is a very specific question, but I want to give my guys on Patreon some answers to their specific questions. This is a guy 69 years old, low dose testosterone dejection weekly, right? So he does his testosterone weekly. He also takes Cialis pills at night.

He usually wakes up with a rigid erection, but he has problems getting hard again during the day. Why is that? Or why would that be? Yeah, so that would be something we would want to, you know, really do a deeper dive into. Yeah. I'd want to understand the timing of when he's taking his different medications. both the testosterone and the tadalophil. We want to understand that even on testosterone,

you're still making some natural testosterone. And that typically is peaking in the morning as well. Very often when guys are taking the ED pills, the traditional is, all right, well, we're going to go out to dinner, half a glass of wine. I'll come home. I'll pop my Cialis and we'll get busy. Well, guess what?

Your belly's full of food. You're tired. You've got alcohol on board. That Cialis at this point is likely not going to kick in until the next morning. Yeah. So I'd really want to play around with sort of the timing of when he was doing everything there.

Because the fact that he's waking up with the rigid erection tells me that he's got enough medication on board when it's peaking. Yeah. And some adjustments there might make a big difference. This is a Trimix question. Another one. He said, he says,

60s physically fit. Trimax is a fucking miracle, he said. But he has two issues. Okay. He's taking Trimix. at trimex. He doesn't ejaculate as much, and I don't know if this is correlated, and I only come about one third of the time. Do you think that, like, it's because of the trimax? Could that affect it

anyway? That's a great question. So this, if we help understand what is causing all of these things, then it can answer the question that likely the trimix is not playing a role. So it was the reason why you took the trimics to begin with, maybe. You know, it could be. I think, a lot of this. When we look happy at difficulty orgasming and changes in ejaculate volume, those are probably two of the more poorly

understood things that occur to men throughout their life and from guy to guy. So real briefly, the trimix, all that's doing is dilating blood vessels. That's just making sure the dude is firm and hard and can perform and penetrate.

It has zero to do with the amount of semen coming out. The amount of semen that's coming out is a function of how much semen his body's producing in his seminal vesicles. And those are the little organs or like little swimming pools that kind of sit behind a guy's prostate. So when a guy orgasms, all those pelvic muscles causing that good feeling contract those organs, puts the semen into the prostate, the bladder open closes, and then those muscles

propel the semen out of the penis. So let's say that guy wasn't sexually. active for years and his ducks are just kind of clogged for lack of a better term. I mean, if you didn't ejaculate for several years and then you got on Trimix, guess what? All that nice sort of more watery consistently semen that you're used to having because you used to regularly do it, it just kind of backed up and the pipes could be clogged. So that may be part of it. Number two, like every other muscle in the body, the pelvic floor muscle isn't quite as strong as a man ages. And so it's very common for guys to say, hey, my orgasms aren't as strong as they were when I'm in my 20s.

And that's because those muscles maybe due to hormone issues, maybe aging, not lifting weights, all of that can relate to less strong orgasms. When it comes to actually climaxing, so I reach an orgasm, that's 100% in between the ears. The problem is it doesn't always correlate with, oh, you've just got a, quote, mental problem. Or here's this pill and I'll help you ejaculate quickly. Or you're just stressed, fix the stress. I've got guys, Kathy, come to see me. They're like, Doc, man, I'm like the energizer bunny. I go for 60 minutes.

But by the time I hit that time, we're both exhausted and it's not fun. And so the one thing I've seen anecdotally helped. and I don't have any science. This is more, again, just personal experience. One of the therapies we've been using for natural erection recovery is called the sound wave or shockwave device. And it's a non-invasive soundwave therapy that's delivered to the pelvic floor and the penis to help erections. Well, in my guys who have had delayed ejaculation, this has been the one treatment that they go,

hey, I'm now ejaculating at 20 to 30. minutes, it's stronger. This is fantastic. Now, I don't want guys to hear this and go, well, Doc, I'm only last in five minutes. I want to go get the shock wait. It's not going to help you in that way. But it just goes to show you that there's a huge variability. And on one end, we have guys with premature ejaculation.

And on the other end, guys with delayed. It's actually easier to treat the guys with PE or premature ejaculation. It's really hard to get a guy who has good erections, a good relationship and good sensation to get him to orgasm more easily if that's a struggle for him. Yeah, I've heard of those guys on my show. You know, that's a thing. I mean, we could do a whole episode on all of that. I want to ask my question, which is kind of dumb, but like, I'm just curious if this

is true, what I googled, because micropenuses exist, right? And I heard once that, you know, a micropenus is formed when the baby is being born and created, like, there's not enough testosterone in there. like if you if like that is sort of caught early like it could be fixed and that could be treated and so these guys wouldn't have those micropenuses doesn't have anything to do with that or like what are they caused by is it or is there nothing you could do about it if like that is happening when you're young like babies you know what I mean yeah absolutely well I think the first the most important thing to to say is okay first off a true micropenus is rare right now now again I'm sure

on your Patreon, you're going to see a little bit more of the extremes because your audience is a little bit more geared towards such things. But as a guy, as a guy again who has seen tens of thousands of penises over the past 20 plus years, most of us are about the same. Let's just start there. It's only the extremes that are a comfortable showing, but most of us are about the same. So now of a guy with a true micropenus, you're 100% right, Kathy, that this is likely something that was hormonal in the mother, something genetic, something we don't understand. And the ability to treat that is really something that needed to be done in utero or early in life. Even then, I'm not a pediatric urologist. I don't speak out of turn. It's a very specialized field. But in my limited

experience back in training, I'm not aware of their, I don't recall any studies saying, oh, if you catch it in utero or in a baby. Here's the thing you do. And we're going to prove the guy's penis ends up being fine because pediatric urology stops when you're, you know, by the time you're a teenager, because who's going to want to go see the, you know, the urologist at 13 as you're going through puberty and be like, hey, I know I've had a little dick my whole life. What else can we do?

Like, so we just don't have enough data and information about it. But, yeah, again, listen, there's a lid for every pot. Again, if I can make penises bigger, I'd be on a yacht in the Mediterranean right now, Kathy, but the options to do that are not as great as you think. And there are things that are out there that can be done in select cases. But even then, Kathy, it's interesting. I went and looked at one of the websites that does a penis enlargement surgery. That's mainly around girth.

Yeah. And, you know, I even looked with my wife. And for both of us, you know, from a doctor clinical perspective, as well as a woman's perspective. We looked at the pictures and in most cases, we're like, dude, you were totally fine. Before, right. You were totally fine.

And I wonder how often these guys have this surgery. And then their long-term partner is used to playing with whatever, you know, a joystick or toy that they have in the bedroom go, what the hell did you do? I was fine, you know? You have a guy's in their dicks. My son, he's only 10. Okay.

and like this no he's nine actually and all i mean he really like sort of talks a lot about having a big dick like his penis and he wants a big penis like i guess he gets it like from youtube like somehow it's already put in his head like you know that's how you judge yourself like can you believe at that young age i'm like oh my god that's scary it's scary kathy and i mean again it's someone who looks at a lot of dicks like guys more often than not you are fine and and kathy you can speak from the female perspective yes we do like the time. Yeah, absolutely you do.

But, you know, it's kind of, listen, there's women who love big dicks and there's plenty of women who look at a big dick and go, you ain't putting that thing anywhere near me. Totally. And that there's, again, you got to find the right partner and that very often bedroom performance. Dick size is probably not as high in the list as at least guys think. It doesn't matter.

Yes. But once you get to a certain point, I mean, a vagina is not that big of an organ or space. Oh, oh my gosh. And so, you know, I wish, I wish guys would feel a little bit more confident. And before they did anything crazy, like, you know, going to some foreign country to have something injected underneath the skin of their penis or, you know, doing other. I had that guy on my show. He was legit. Oh, God.

Yeah. So, so anyhow, most of the time, guys, you're okay is the clip nuts version. Yeah. Well, listen, I mean, I, you know, I wasted all these questions. I had to put mine in there because I was just curious. But I saw a micropenus in my life. And then I had another friend who, you know, claimed he had one. And I assumed he did because nobody, you know, would sort of say that.

He was always like, you know, size of his like pinky. So I know that they exist. And I just want, I was just curious of what I read was completely true. But listen, you know, I do telemedicine HRT. That's how I get my HRT done for me. I love it because it's like time, you know, it's quick and it's easy. I do it from my home, you know. And so, and you do offer hormone replacement.

but you offer TRT virtually. So why don't you give out all your information for anyone listening that wants to, you know, seek you out? Yeah. So our website is just P-Z-O-N-A-M-D.com. But honestly, I think what would be most helpful is, listen, if you like this kind of honest, fun, no-b-S-talk from a doctor about sex, health, and everything the other doctors won't explain, then I think checking out my podcast, Balls Deep.

Oh, yeah, for sure. We're on YouTube. I'm Italian, so I use my hands a lot. So we've got some great guests. We've had ex-Marines. We were dropping an episode with a former NFL All-Pro linemen who came into chat with us about men's health. My wife, who is much better looking and funnier than I am

as my co-host for most of these. So, you know, we drop a new episode every week. about optimizing performance in the bedroom, the bathroom, and the boardroom for both men and women. And we just want to give people something that's digestible that, listen, we need the two-hour, three-hour nerdy deep dives. Like, I love those podcasts. But you also need a, hey, I'm on my drive-in. I want something that, number one, is going to entertain me.

But number two, give me some practical real-life information about my body and health that I can instill today. that's really what we're trying to be. No, I love that because like we did start off this conversation talking about how sometimes like guys, it's hard for them to cop to these things or, you know, look their doctor in their face and say they're having these issues. So I think that they do go nowadays. What's great about the internet is you could go online and kind of get information in the privacy of your own home, right? And so you have all of this information on your podcast. I mean, I could do 10 more podcasts with you as well because like we just like talked about one thing. Like I would love to talk to you about vasectomies. I do a whole episode on that

because that's a whole different topic. But I love that you have a podcast that's specific to this because this kind of information is what I know my guy listeners want. Whenever I do a little bit, if there's like even like a five minute part of an episode where we talk about something, like I get so many emails with questions about it. So I'm so happy that you called in. This was a really informative episode. I know my guys are going to love it. I'm going to put a link to your podcast to your website.

I can put both, you know, because I think that, you know, just like the link you want. Yeah, I'll send you the list. Thanks, Kathy. Check out Balls Deep, Pizona on YouTube. It's going to be the best way to get to our podcast. And it's a great place for guys to, you know, ask some questions that we can address. You know, I want to be clear that, you know, nothing I'm doing establishes a doctor-patient relationship, either be a podcast or a YouTube video. But I can certainly educate. It can help guide future episodes. And we can certainly, we love engaging with our audience. So I think it would be a great way for your guys to get. get right to the source and get real expert practical advice on all things related to sexual health.

Oh, I love that. And where do they go to send in their questions that they have for you? Yeah, so they could just comment on the videos. Okay, and then you take them from there. Uh-huh. Okay, great. Yeah, absolutely. Yeah, just subscribe to us on YouTube, watch our videos. We drop a new episode every week. And throw your questions in there. We'd love to hear future podcast episode ideas. I mean, I want to do this to help guys. and women and women get up-to-date accurate medical information in a digestible way because we live in an age of misinformation. And we have too many people who are either self-proclaimed experts or we have the experts who are biased or they put it in such a way that the average listener goes, what the hell did he just talk about?

So we want you to come with those questions and address them. if it's appropriate and, you know, we're licensed in a state that someone lives in, we can absolutely then jump on a telemedicine, do a actual patient physician relationship. And or if not, I've got a network throughout the country. Kathy, there's lots of wonderful doctors similar to me out there that I'd be happy to refer people to. So I would love for them to engage with us on YouTube and see if we can help out some of your listeners. I love that.

I have a very large audience. They're definitely going to check you. you out. I love your vibe. I think it's great. I mean, the fact that you have the podcast and you're out there, you obviously like to help people. My guys also want to know about, you know, their partners. I get a lot of questions about HRT for women, too, and it's great that you also can talk about that. So I'm going to put your link to your YouTube, right? Your YouTube podcast on your podcast on YouTube so people could put their questions there and then see all of the other information that you talk about on all your episodes there. And then we'll have you back on. But thank you so much for calling in.

Like I could have talked to you for another hour. No, I know, Kathy. This is fantastic. I really appreciate this opportunity. I love your show. I've listened. And I think it's great how you are, again, normalizing these discussions. Because listen, I'm the no-judgment doctor. You know. You do you. And as long as it's in a with a consenting adult and you're not hurting anyone, like again, it doesn't all have to be, as you say, chocolate, vanilla, strawberry flavors in the bedroom. We can have to be. We can have. have a little spiciness, but I just want to make sure people are, you know, taking care of their bodies because, listen, you can have the most awesome sex life. But if you're ignoring these things, if you're out partying too much with the lifestyle, I hate to tell you, you're not going to enjoy these bedroom activities forever. And so we want to be able to be that balance to people of, hey, this is going to keep you doing it longer. And I'd absolutely love to come back, talk about vasectomies, women, you name it, Kathy. Yeah, perfect. Put me on speed dial.

All right. Awesome. Well, anyone that has a podcast called Balls Deep, like, it definitely is perfect for my show, okay? We get a lot of new listeners. But thank you so much, Dr. Posona for calling and this was fun. Thanks, Kathy. You take care. We'll be in touch. Bye. Okay. I just want to tell you before you go that my book, it's called Strictly anonymous confession, secret sex lives of total strangers, is now available not only in paperback and ebook, but you can pre-order the other. audio book. It's still not going to be out until August 25th, but you can pre-order it. The book is basically 17 different stories taken from my show. I kind of picked one story from each category that I talk about on my show. Like there's a hot wife story. There's a cuck queen story. There's a cuck story. There's a gangbbing girl story. Like I said, 17 stories. And they're all told in the third person. And they're all true. I took the interview and rewrote it

in the third person. And I wouldn't really call it like a total erotica book. Think like penthouse letters. It's more direct. It's not so over the top like erotica. I don't really like that kind of vibe, right? But these are true stories. 17 of them. They're really short. Chapters, easy read. You could read, you know, one or two and then skip around. You could read the whole book. It's available in eback format, paperback format, and finally, the audiobook is available. coming out August 25th, but you could pre-order it now. And if you buy my book in any format or pre-order it, I will throw in a complimentary link to my Discord. My Discord does not disappoint. Okay, there's no way you get into my Discord any other way than getting the link from me. Okay, I give it to

people who buy my book. There's tons of people in there. Everybody shares content with each other, and that's what you get to do there. You could post your own pictures and videos. There's tons of channels. We have lots of contests where you can win a lot of money. It's a super fun place to be. It's a total strictly anonymous community and you will love it. I will be giving anyone who buys my book access to my Discord. It's private, like I said. All you got to do is email me a screenshot of your purchase, whether you did the audiobook, the ebook or the paperback. Send it to me at Strictly Anonymous Podcast at gmail.com. That's strictly anonymous podcast at gmail.com. and I will send you the link to Discord.

So anyway, thanks so much for tuning in. This is the strictly anonymous podcast.