Mark Bell's Power Project - Doctor-Approved Secrets To Supercharge Your Penis - Dr. Rena Malik || MBPP Ep. 1106

Episode Date: October 9, 2024

In Episode 1106, Dr. Rena Malik teaches Mark Bell, Nsima Inyang, and Andrew Zaragoza all about penis health, gives sex advice and educates us on what the heck "Squirting" really is. 🍆  Natural Sexual Performance Booster 🍆 ➢https://usejoymode.com/discount/POWERPROJECT Use code: POWERPROJECT to save 20% off your order! Self Explanatory 🍆 ➢ Enlarging Pumps (This really works): https://bit.ly/powerproject1 Pumps explained:      Follow Dr. Malik YouTube: https://www.youtube.com/channel/UCV66hp0qxx2Xq273N0bo7uQ IG: https://www.instagram.com/renamalikmd   Official Power Project Website: https://powerproject.live Join The Power Project Discord: https://discord.gg/yYzthQX5qN Subscribe to the Power Project Clips Channel: https://youtube.com/channel/UC5Df31rlDXm0EJAcKsq1SUw   Special perks for our listeners below!   🥜 Protect Your Nuts With Organic Underwear 🥜 ➢https://nadsunder.com/ Use code: POWERPROJECT to save 15% off your order!   🚨 The Best Red Light Therapy Devices and Blue Blocking Glasses On The Market! 😎 ➢https://emr-tek.com/ Use code: POWERPROJECT to save 20% off your order!   👟 BEST LOOKING AND FUNCTIONING BAREFOOT SHOES 🦶 ➢https://vivobarefoot.com/powerproject   🥩 HIGH QUALITY PROTEIN! 🍖 ➢ https://goodlifeproteins.com/ Code POWER to save 20% off site wide, or code POWERPROJECT to save an additional 5% off your Build a Box Subscription!   🩸 Get your BLOODWORK Done! 🩸 ➢ https://marekhealth.com/PowerProject to receive 10% off our Panel, Check Up Panel or any custom panel, and use code POWERPROJECT for 10% off any lab!   Sleep Better and TAPE YOUR MOUTH (Comfortable Mouth Tape) 🤐 ➢ https://hostagetape.com/powerproject to receive a year supply of Hostage Tape and Nose Strips for less than $1 a night!   🥶 The Best Cold Plunge Money Can Buy 🥶 ➢ https://thecoldplunge.com/ Code POWERPROJECT to save $150!!   ➢ https://withinyoubrand.com/ Code POWERPROJECT to save 15% off supplements!   ➢ https://markbellslingshot.com/ Code POWERPROJECT to save 15% off all gear and apparel!   Follow Mark Bell's Power Project Podcast ➢ https://www.PowerProject.live ➢ https://lnk.to/PowerProjectPodcast ➢ Insta: https://www.instagram.com/markbellspowerproject ➢ YouTube: https://www.youtube.com/markbellspowerproject   FOLLOW Mark Bell ➢ Instagram: https://www.instagram.com/marksmellybell ➢https://www.tiktok.com/@marksmellybell ➢ Facebook: https://www.facebook.com/MarkBellSuperTraining ➢ Twitter: https://twitter.com/marksmellybell   Follow Nsima Inyang ➢ Become a Stronger Human - https://thestrongerhuman.store ➢ UNTAPPED Program - https://shor.by/JoinUNTAPPED ➢YouTube: https://www.youtube.com/c/NsimaInyang ➢Instagram: https://www.instagram.com/nsimainyang/?hl=en ➢TikTok: https://www.tiktok.com/@nsimayinyang?lang=en   Follow Andrew Zaragoza ➢ Podcast Courses and Free Guides: https://pursuepodcasting.com/iamandrewz ➢ Instagram: https://www.instagram.com/iamandrewz/ ➢ TikTok: https://www.tiktok.com/@iamandrewz   #PowerProject #Podcast #MarkBell #FitnessPodcast #markbellspowerproject

How seriously can you take yourself for dealing with dick all day? I just pee this way. Sometimes something just veers off to the side and I'm like, what the hell is that about? If you were to take a hose and plug up the hose, it's going to spray all over the place. If you have a prostate that's blocking that flow, it's going to cause a sprayed stream.

Do you do anything with men or help them get better at breathing? Doing HIIT exercise was shown to increase time to ejaculation. Sort of like what people describe as edgy. I'm already done. What exactly is squirting? It's a large amount of clear odorless fluid. That's typically called a squirt. You can also have an ejaculate.

You're getting like a whitish little small amount of fluid. That's female ejaculate. Another study did ultrasounds of the bladder. So they scan their bladder before they had sex. People really trying to get to the bottom. I love that. And then they had sex and they scan their bladder before they had sex. People really trying to get to the bottom. I love that. And then they had sex and they scan their bladder and the bladder restarted.

One of the great mysteries of the world, yo. If you guys have been enjoying the content we've been bringing here on The Power Project, consider leaving us a review on Spotify and Apple. We've had podcasts with people from Functional Patterns, to Ben Patrick, to Jack Cruz, who roasted us on air, but we did that for you, to bring you some of the best information in fitness.

We're learning along with you and leaving a review with how you dig the podcast is really gonna be something that helps the podcast move forward. So if you can, leave us a review there and enjoy the rest of the show. All right, so I'm super confused, you know, about the streams.

I try to, you know, I try to pee straight. No, okay. Yeah, just like the, you know, about the streams. I try to, you know, I try to pee straight. No, okay. Yeah, just like the, you know, the toilet, like you're in front of the toilet. You're like, I know if I aim this way, the trajectory, it's been the same for many years. I'll just pee this way.

Almost all of it's going to go in the toilet. Maybe there'll be some splash or something, but sometimes something just veers off to the side. I'm like, what the hell is that about? What is that? Yeah, yeah. So we brought you all the way from Long Beach to explain this to us today on this podcast.

Yeah, well, I'm excited to be here. So basically when you have a urinary stream, most of the time it should go straight, but obviously, as you guys know, this is not always the case. Now there's a few reasons this happens. One is as you age, your prostate gets bigger. So the prostate is a walnut-shaped gland.

It sits above the urethra or the P-tube and behind the bladder. So it's like around the urethra, below the bladder, and it can block the flow. And so you're thinking about if you were to take a hose and plug up the hose, it's going to spray all over the place, right? It's not going to go in a straight stream. So very similarly, if you have a prostate that's blocking that flow, not going to go in a straight stream. So very similarly, if you have a prostate that's blocking that flow, it's going to cause a sprayed stream. So that's one cause. It's very, very common. BPH is extremely common or enlarged prostate. And this happens if you look at

men in their 80s, almost 80% of guys will have an enlarged prostate. That doesn't mean they have cancer. It just means that they have an enlarged prostate. And so because of that, a lot of guys are going to have an enlarged prostate at 40 or 50 or 60 years old, and they're going to start having those symptoms. If you're younger than that, you can still have an enlarged prostate, but sometimes you'll have a stricture,

like a narrowing of the P-tube. Now that can happen from a trauma, like some guys will say, oh yeah, I remember I had a trauma during sex maybe, or maybe something, I fell on something like a bike. Sex injury. Sex injury, yeah. Be careful with those.

That's where my meniscus in that was. Oh yeah, I remember. I forgot. I mean, I wasn't there, but I remember. I remember you telling us a story about it. That was not, shame on me. Keep on, I'm sorry. There's no shame.

All the sports you played, all the dangers. Actually, it was quite embarrassing. I got out of the bed and I went, my knee and then I couldn't walk. It was shameful. It's shame on your knee, but if you did it again, then it would be shame on you. True.

Yeah. Probably you had a good time. Yeah. You can't even remember, right? So, wasn't that great? Yeah. He just even remember, right? So wasn't that great? He just remembers the injury. So, and then, you know, I'm sure you guys all know this, but when you have some semen left in the urethra or the P tube,

that is also going to act like a blockage, and then it's going to make it spray all over the place. So there's a lot of different reasons it can happen. That's why you sit afterwards. Yes. Yes. You want to keep a clean seat, especially if you're at... Oh yeah, do we sit or do we stand? Great question, great question. So did you know that in, I think it's Germany,

that the large majority of men sit and they don't stand. So it's not a universal thing that people stand to pee or men particularly. And so why, right? The reason being is that some people find that when they sit, they can one, relax their pelvic floor, which is the muscles that sit underneath the bladder and urethra. And so that allows their pee stream to be a little better.

Two, they can even lean forward a little bit. So they're adding a little abdominal pressure onto their bladder so the pee comes out more easily. So for some people, they find it that it actually helps them pee, especially if they have- And three, you can get on your phone. You can. Send a quick text message.

But usually it doesn't end up being a quick thing. So you don't want to sit on the toilet for too long, right? That's true, legs fall asleep. Yeah, so then, yeah, that's why some people sit. So it helps their stream be a little better and they don't make a mess. But if you're fine standing, there's no like better way to pee. It's whatever you feel comfortable with,

unless you're having trouble emptying your bladder, in which case then sit and see if you empty it a little better. And that may be a reason to do so. I find that when I sit, because like whether it's like in the middle of the night or my son chases me into the bathroom and you know, if I try standing up, he's like, cool, water fountain. And I'm like, no, it's not cool, bro, don't do that.

But when I sit down, it's almost like, no, no, no, check this out, he'll do this too. He'll look, he'll be like, it's big. I remember doing that to my dad when I was younger. I remember, I was like, dad, why is yours? And then he left soon after. True story. Damn it, I didn't see what.

So back to what I was saying. When I sit though, it's like I can kind of pee forever. It's sort of like, all right, I guess I'll get up now. But I feel like it's just like never ending. Is that just because I'm like always storing more pee or is it just, I don't know, they got something else going on there? Well, it could be that if you are sitting, is your stream the same? Like as terms of

strength of stream? No. You stand and sit? Like initially, yes, but then towards the end, it's just like kind of, you know, I guess I'll say dribbles. Yeah. So, I mean, it may be that you're not completely emptying when you stand and then when you sit, you can empty a little better. And so that sometimes happens. Sometimes we'll tell guys who are having trouble peeing

is to go twice. So like maybe stand and then walk away, like do a little walk around the bathroom and then sit down and pee again and you might get a little bit more. I have a question, Reena. Do you, being a urologist, do you run into men that have a problem

with relaxing their pelvic floor? And why would that potentially be an issue if a man has an issue with that? Absolutely. So that is a very under diagnosed, under recognized problem, but I see it all the time. And so what happens is man or woman, we all have a pelvic floor.

Pelvic floor is this bowl of muscles that sits there. It has a lot of functions. It helps us walk. It helps, it keeps us stable when walking, keeps our organs up and in the right place. It helps with, you know, when we take a breath, when we take an inhale and exhale, we're activating our pelvic floor. We're using it all the time. And so just like people get TMJ, like when they're sleeping and they clench their jaw

at night, they have no idea they're doing it, but they wake up with a headache, right? Same thing, you can do that to your pelvic floor. And why does that happen, right? Stress is very common cause, anxiety, type A personalities who are just really busy doing a lot. Trauma in the past can sometimes cause this. Sometimes you might have had a specific event that caused it, right? Like maybe you had like for women childbirth, sometimes they'll have that. Or you've had surgery and then your pelvic floor tenses up because of pain, right? And it's responding to that. And so I describe it a lot like as if floor tenses up because of pain, right? And it's responding to that.

And so I describe it a lot like as if you were doing bicep curls, right? A normal bicep curl, you're taking the full range of motion. But when you have a bicep curl that's in your arms is stuck like this, now you can't do a full range of motion, right? And it hurts a little bit. And maybe not just your bicep hurts, but your shoulder hurts, your elbow hurts, your wrist hurts, right? So you're going to have pain or potentially dysfunction in multiple areas.

So how it can present is so variable person to person. It can present as back pain, hip pain, urinary frequency or urgency, like going to the bathroom a lot or having to rush to the bathroom, constipation, erectile dysfunction, because when the muscles are too tight, right, blood flow is not getting through as well. And so then you can have difficulties with erections. You can have pain with erections, pain with ejaculation, even testicular pain. So sort of a whole host of different symptoms.

And some people will just have one. They might just have constipation or they might just have urinary symptoms or they might have a whole host of symptoms. But usually when you dig deep, you'll find something that, oh, this happened when I started being really stressed at work or I was sitting a lot during COVID. We saw a lot of it. People were sitting all day long, which is great. We're not sitting today, right?

We're not stressing. We're not a tense, shortening our pelvic floor by sitting all day. And so that's, you know, that's a problem when you're not moving, you're not stretching your pelvic floor regularly and using the full range of motion, then it can get tense. Yeah, and in your example of like the bicep curl, I think the way that a lot of parts of the body work is if you have to flex them and tense them a lot,

like to say like hold your pee, you're kind of in a compromised spot. And what I've found is getting a little older, it gets harder to hold your pee, that's the same way that you did when you were younger. And what I've learned is like, I need to actually relax and not flex, like if I flex harder, it makes it worse.

Or if I try to, you know, you have to sort of distract yourself a little bit, but then also you need to at some point relax, then you relax and it's way easier to hold your urine. Yeah, sometimes if you think about like, if you're taking a hot bath, like you're in the submergence in warm water, you're like, oh, I feel like peeing.

Like your muscles are all relaxed and sometimes the pee flows better. You're like, God, I'm in a bath, that sucks, it's annoying. But like, you know, it does help relax the pelvic floor. So sometimes I'll tell like anyone with pelvic floor dysfunction, take a warm bath, 20 minutes a day, take a warm bath, it's gonna help stretch and relax those muscles.

And so that's really helpful. And then, you know, doing things that stretch and lengthen those muscles. So like yoga poses, like happy baby pose and child's pose or doing like deep low squats, those are all going to stretch and lengthen those muscles. Maybe some like myofascial release type stuff, like getting into the gut smashing.

And I even saw one woman was talking about using a tennis ball and you like sit on a tennis ball and you basically put the tennis ball on your taint. I don't know if you've ever seen anything like that. Yeah, absolutely. So you're basically, yeah, those are all great ways. So when you go to a pelvic floor physical therapist, say you have real dysfunction,

they'll actually do myofascial release with you and they'll figure out where the tension is because the pelvic floor muscles is- Human garage, shout out. There's- You know human garage is- No. No, okay.

They're great. Yeah. Yeah. So there's- A lot of butt stuff. There's a, so yeah, the pelvic floor muscles, how you access them is through the butt, right? Through the rectum. And so when you go to a pelvic floor physical therapist, they'll work on different ways to help one, identify where your trigger points or your

attention points are. And they'll teach you how to do exercises that target those areas. For some people, yeah, it might be lower abdominal muscles or, you know, in the hip area or something external, like in the perineum. You go to the doctor and like, we got to go through your butt. You're like, wait, what? Yeah, I mean, so we do, so that's a whole other topic, but we do rectal exams, right? And we do them for prostates to examine the prostate. Now there's a lot of discussion about is this necessary, right? Do we need to examine the prostate. Now there's a lot of discussion about is this necessary, right? Do we need to examine the prostate? We now have blood tests that screen for prostate cancer. And you asked me this earlier, like, is that all you need for prostate cancer screening? And probably, right? Like,

there's 3% of cancers, prostate cancers that don't emit a PSA, but the large majority of prostate cancers will. So doing a prostate exam is good to test for detection, but that's not the only reason that urologist does a prostate exam. We do it to assess the size of your prostate. And then also, if you have a good urologist who understands the pelvic floor, they'll also examine the pelvic floor and see if you have tension in those muscles, or if sometimes palpating those muscles causes your symptoms to recur. Sometimes we'll palpate those muscles and be like,

yeah, I feel like I gotta pee. Or, yeah, I feel pain. And so we'll be able to tell where exactly the tension is, and then we can refer you to a physical therapist to help you work through that. And a cool deep cut for all the podcast listeners, if you're new to the podcast, we did a podcast with this guy named Gil Hedley.

He's working, he's worked with probably the most cadavers in anybody, right? And one thing he's worked with probably the most cadavers anybody, right? And one thing he's noticed with the fascia there is like a lot of people are very tight because a lot of people when pooping, they're pushing rather than relaxing. So there's something there, you guys can check that out. But I also have a question about pelvic floor dysfunction and is there any link between that and premature ejaculation for men? Yeah, so certainly they're all interconnected, right? So premature ejaculation for just to sort of define what it is, is ejaculation before you or your partner desires. Now you can have it lifelong or you can get it.

Very often it's sort of a combination of things, but more often it's due to the sense you're becoming more sensitive to sensation that's particularly at the head of the penis. That's where we think that it's coming from, that like sensation that's quite strong at the head of the penis. Well then, because ejaculation is a spinal cord reflex. So that sensation gets sent to the spinal cord and gives you a sensation as you may all know, when you're about to ejaculate, you feel this like sense of it's coming and

I can't stop, right? And so that's not something under your control, but to kind of manage the sensation and manage your focus around the sensation and then do things like that can be very helpful. So things like stop start technique, which is where you, you know, you get to the point almost of climax and then you stop. And then you maybe you have your partner grab the penis and like sort of stop and then you restart again. Sort of like what people describe as edgy. I'm already done.

Count me out. No self-control. So yeah, those things can be used to help with training that. But then when you do that to excess, so sometimes when people are edging over and over and over again, that can actually lead to pelvic floor dysfunction, right? Because you're tensing your pelvic floor to hold it back from climaxing, right? And so then if you're doing that all the time,

and say you're like, some people are like masturbating, edging for hours, right? Then they're gonna say- It's like the best one, teenage years. You can develop some pelvic floor dysfunction because of it. And so it's more so that it could be a sequelae, and then of course it's contributing to things, but usually it's more of like a sensory thing. Can I ask you this also?

When it does come to that and men, do you do anything with men or help them get better at breathing? Because one thing you notice with a lot of people is they're very, and then take that to sex and you're excited, it's gonna be likely that, I don't know. Yeah, so a lot of you basically wanna work at reducing your sympathetic nervous system, right?

That's an overdrive when you are having sex, obviously, but also in people who have premature ejaculation, their sympathetic nervous system is overdrive. So some of the things that we do are to try to reduce that, to sort of balance your sympathetic and your parasympathetic nervous system. So for example, diaphragmatic breathing can be really helpful.

But I actually read a really interesting, I read a few interesting studies recently on exercise. And so doing HIIT exercise, so high intensity interval training for seven minutes for 14 days was shown to increase time to ejaculation or what we call intra vaginal ejaculatory latency. And so that, because you're now more, one, they think it's balancing the nervous systems,

but two, you're really focused on something for seven, for those one minute or 30 second intervals. And so your body's getting used to being really aware of where it is in time and space. And then also you're being really focused and sort of mindful, right? And so that is actually translating to improvements in the bedroom.

And then also, I think a cool thing, I've never read the study, but doing a lot of HIIT, I do a lot of sprints, you become better at, you finish a sprint or you finish some HIIT, you get better at bringing your heart rate down so that you can do the next one after you've done it for a while. So you can just imagine how that can apply to the bedroom.

That makes sense. Absolutely. I think it's important to discuss overtraining. I think that a lot of us get into a situation where we can handle quite a bit. We can lift and run and do jujitsu and do a lot of these things. But then, you know, your lady hits you up

when you go home and you're like, oh, you know, I can't do what I want to do tonight. And I think, you know, if people are being honest, I do believe a lot of men have run into that. I know I've had many discussions with people in the past. And so training is great because it can do so many things, right? But this idea of overtraining,

we've gotta be pretty cautious of that. Absolutely. So one, obviously fatigue, right? Anyone who's tired, you're tired, you're not gonna wanna have sex, right? You have to decide between restoring your body and giving it the sleep it needs to be able to do the things it needs to do the next day or having sex.

And sometimes that will, you know, the balance will go towards sleep. But also if you think about testosterone in men, right? It goes through a cycle. So in the morning it's high and then it starts to drop and it goes in like a little bit of a bump and then it goes down again. It starts replenishing overnight.

So not only have you now over trained and that may affect your testosterone because as you put more stress on the body, you have more cortisol release and your testosterone then responds by going lower. So that's one way. And then two, it's late in the day. So your testosterone is at its potentially lowest.

And then you're like, oh, so that's the hormone of desire. And so if your hormone is low and you're not having as much desire and you're tired and you're stressed, your body is stressed, all those things together are gonna make it so that maybe you're not gonna have the energy to have sex. And so I think it's really important to sort of figure out that balanced spot where you're training but you're obviously still have energy.

I mean, obviously you're going to feel fatigued, but you want to still be able to do the things that you want to do. And so it's really tough, I think, to figure that out. Maybe you guys have some tips on that and how to really dial in so that you're not stressing your body out so much that it's causing the negative effects of overtraining. I think we have a lot of ways to train that aren't super stressful. For me, I like to walk a lot.

I do run, but I also have shortened the amount of time that I'm running. The frequency, you got like frequency, duration, intensity. So these are all things that if you're paying attention to them, you should still be okay from an energy production standpoint and still be able to do a lot of the things

that you enjoy and that you love. But you should also just be aware, like if you go out for a two mile run, the odds of you being able to do, and you're my age, you being able to do something you did in your 20s in the bedroom is probably less likely to happen for that particular day. And so you might have to just something you did in your 20s in the bedroom is probably less likely to happen for that particular day.

And so you might have to just kind of account for that and you have to try to account for, how much do you want this other goal and how much do you want these other things to be part of your life? Yeah, and go ahead. Well, I think physical stress, but also mental stress, right? Like I think we, a lot of us are high performers,

we're working hard, we're mentally strained and taxed and that also plays a role. And I think the one point you bring up is running, right? So cardiovascular, high, like aerobic exercises are the ones that are going to increase your cortisol the most. So you want to do those, obviously, you want to at least at a minimum be getting 150 minutes of that per week. But, you know, in terms of like overdoing it, where we see low testosterone often is like ultra marathoners, like really high intensity performers who do primarily cardiovascular exercises.

And so not that they're bad, but they are the ones that can cause harm to your hormones if you're overtraining. One thing I do want to add on actually with what you mentioned in terms of recovering better, and you've mentioned this many times too, is learning how to nasal breathe during exercise because inherently when somebody gets better at that, they're going to

start breathing more into their diaphragm. But one thing that also ends up, I think would be very good for guys in the gym is learning how to breathe through all of their exercises. What tends to happen is when you're trying to build muscle, you will, even when you're doing a bicep curl, it's when you're doing a squat, it's everything is holding of the breath. But when you start to do actual sports, like jujitsu or basketball or running,

when are you ever holding your breath? You're breathing through the whole thing. Now, I think guys can relate to this. When you want to come really fast during sex, what do you do? You hold your breath a little bit, and bam. But I think a lot of guys are probably doing that inherently. When they get excited, they're just holding their breath.

And then what happens? You're not a little bit earlier than you want to. So, it's a big concept, but just learning how to breathe during all of your exercise, even your lifting, can go a very, very long way in helping you recover faster because you're not tensing yourself up so much. So you're gonna recover faster,

but then also it's gonna pass into other ways, other things you do in life. Yeah, and it's also really important for your pelvic floor. So, you know why you guys, bodybuilders, personal trainers, everyone's always gonna tell you, exhale on exertion, right? The reason being is because when you exhale, you activate your pelvic floor,

you stabilize it so that you can actually do the activity that you're doing. And so if you are constantly either, most often it's breath holding, right? If you're breath holding all the time, you're gonna develop pelvic floor dysfunction. So we'll see, you know, bodybuilders really like, people who do a ton of lifting

with pelvic floor dysfunction because they're not breathing. And so it's really like people who do a ton of lifting with pelvic floor dysfunction because they're not breathing. And so it's really important. Like I find myself like breathe, breathe, breathe. I tell my son, we work out and like breathe, breathe, breathe. Like don't hold your breath. Like we have to work on it. It's hard, your natural intention,

your natural idea is to hold your breath because it'll help you push more, right? You actually have to make a thoughtful effort to keep breathing. And then end of your breath is the end of your range of motion. So I want people to think about that the next time they wake up in the morning and they're picking up

their socks or whatever is on the floor. When they go to bend down, they're gonna go, probably a lot of times. So you wanna try to think about that. And instead you can breathe your way through that or you can just work on, there's a lot of ways you can kind of work on that. Like for myself, I've actually thought of,

instead of like bending down and thinking about my back and my hamstrings, I actually just think of my quads, my shins, and my abs, and I actually go down to the ground faster and I just try to breathe through it, which sounds silly. I know like we're talking about like picking up something that doesn't weigh anything off the ground, but sometimes in the morning,

like your body is a little stiff, but also doing the rope flow stuff has been really helpful the morning, like your body is a little stiff. But also doing the rope flow stuff has been really helpful as well. And we showed you a little bit of that, we'll do more of that later today. I think it's important for individuals to find activities that can be done with a pretty good duration,

but they don't cost you much of anything. And that's where something like walking is really good. This rope flow is gonna be really good. Walking with a weighted vest, like activities that are like just not super stressful. And then also picking and choosing times, appropriate times of the day. Like in the summertime,

a lot of times I'll run like right in the middle of the highest heat, you know, be a hundred something degrees. And that's on purpose to test myself sometimes. But I also have to recognize that that is a very stressful environment. That's 104 degrees, I'm running for an hour, and that is going to cause a cascade of bad hormones in a way. Sometimes it's good to have some of those, you know, quote unquote, bad hormones, because there's no mother nature doesn't make any mistakes. There are no bad hormones probably. So it's good to have a little bit of a kind of back and forth with your training.

But the main thing is to have things that are simple, easy to do that you can do frequently that don't cost your body that much. We talk about physical performance so much and how important it is to be healthy. But how about your sexual performance? And I'm being serious. So for all the guys in here, being real, sometimes you're just a little bit stressed. Maybe you didn't get much sleep.

Blood flow doesn't work the way it should. You go in and it's time for some fun and, oh, this is what you're working with. Whereas this is what you should be working with. That's why we've partnered with Joy Mode. And again, I'm being serious here, because Joy Mode has ingredients within their product that is going to massively help with blood flow.

And we know that if you wanna be working with something that doesn't have any give to it, you need good blood flow into your manhood. All right, the ingredients on Joy Mode are as follows. Vitamin C, citrulline, arginine nitrate, Panax, ginseng root. This is legit stuff mixed into easy packets that you can pour in a drink,

and 30 minutes later, your blood's gonna be flowing like it should. So Andrew, where can they get it? Yes, that's over at usejoymode.com and at checkout, use promo code powerproject to save 20% off your entire order. Again, usejoymode.com, links in the description, as well as the podcast show notes.

Oh, shit. Oh. Yeah, and occasionally stress it, right? If you want to grow, you're going to have to stress yourself out. So we don't want you to always play it safe, but I think in terms of like balancing that out, right? It's a balancing act and just figuring out things

that are easy that you can incorporate in your day-to-day routine that don't end up like really being so stressful that you're like, I don't wanna do it, right? Like you should have, if you're constantly pushing yourself to lift or go to failure every single day, like you're not gonna do it for a long period of time because you're gonna burn out.

I have a question for you. Again, you see so many men and women, and I know it's coming to the breathing thing, but within fitness, you know, everyone wants to keep their stomach tight and flat. So when you see that, what other things do you see from there when people are just, everything is trying to keep their abs tight? Yeah, so actually, it can be really harmful

to constantly suck in your abdominal muscles because then again, this is all part of your core, right? The pelvic floor muscles and the abs and your back muscles are all part of your core. And so when you tense one part all the time, you're going to create dysfunction in other parts. So I have one patient that comes to mind who has really tense abdominal muscles and he has really bad overactive bladder. Like he's going to the bathroom all the time,

urgency, frequency, it's ruining his life. And so we work a lot on trying to down regulate those muscles. And we're talking about energy. I think for your significant other, it'd be good idea for people to think about how to make your significant other's day a little easier. So, you know, men are always like, well, what does having sex have to do with doing dishes?

But I was somebody recently, the video went viral. I'm not sure which actress it was, but she was like, my husband does the dishes. He's getting a blow job. And I was like, damn, like a lot of people saw that and were like, shit, that's all I gotta do. Maybe I'll start doing some dishes, but taking some workload from each other, I think can be something that can really be helpful in the bedroom as well. Absolutely, and I think a lot of people, there's a few things here we need to touch on,

but I think one is that when women look at sex, they look at sex as another stressor, something they have to do, not as something they're gonna do for stress relief, whereas men tend to look at stress as sex as another stressor, something they have to do, not as something they're going to do for stress relief, whereas men tend to look at sex as more of a stress relief for activity. So if a female partner has a lot on their plate, like they're working, they're taking care of the kids, maybe they're taking care of their parents too,

they're helping out with their parents, they're doing a lot and they come home and then they got to do the dishes, do the laundry, whatever else there is. If you can help alleviate some of that stress, that is a huge gift, right? That's a huge gift that you're giving to your partner. And that allows them to get in the mindset to then be able to receive pleasure, right?

Because when they're tired and stressed, they don't wanna have pleasure. So if you can alleviate stress, that's gonna be really, really helpful for your partner. And I think it's hard for guys to see that sometimes. Like why would, as you mentioned, why would doing dishes or helping with laundry make any difference? But it really does, right? And so I think, especially when it comes unprompted, right? Like if you're like, hey, I did this for you, like not even saying anything, but just doing it, right?

It can be really helpful. You see all those TikToks where like guys are vacuuming and like putting folding clothes and the woman's like, let's go to the bedroom right now. Like there's a reason those go do really well on social media. And then the other thing is desire changes over lifetime, right? So when you're young, we all, a lot of us have what's called spontaneous desire,

which is what you see in the movies. And it's you see someone, you want to jump them, you want to have sex right away. Knocking all the stuff off the table all the time. Right, right. And like you have sex, you see someone, you want to jump them, you want to have sex right away. Knocking all the stuff off the table all the time. Right, right, right. And like you have sex, you get together, you climax, it's done in like minutes, right? That's obviously not real life.

But what happens is a lot of people develop what's called responsive desire. So what that means is like, let's say you go to the gym. You don't want to go to the gym, but you go. Once you're there, you're like, oh, I'm glad I went to the gym, right? Very similarly, when you are intimate with your partner and you are like, okay, let's just be, let's be together. Let's be close. Let's touch. Let's whatever. We're

not focused on sex. We're focused on being together. And then you start receiving that and then you're like, Oh, now I remember that I used to like this and now I have desire and now I want to have sex. So the arousal comes first and the desire comes after and that's completely normal. So sometimes it's how you approach your partner, right? Like do you just approach them like roll over and you know in the bed like I'm ready, right? Like I'm ready and they know that's what you want. But maybe it's like hey we schedule time where we're going to be intimate. Like we're going to be with each other, Sex may be on the table, maybe not.

But the goal is to connect, not to have sex. And then they're like, oh yeah, I like this. Of course they like you. They chose you as a partner, right? They want to be with you. And so it's like, it's just reminding them of that. And then the desire comes and then you can have great sex. Let's make sure the dog is in the room and the four-year-old kid and, you know, make sure. All that stuff plays into it too, right?

And it's like trying to find appropriate times where some of that shit's not around and it's hard. So it's difficult to find the time sometimes. Okay, on this topic, this is quite interesting because what you said is totally right, you know, over time it's not gonna be as spontaneous, but what if there is a partner that's like, I want the spontaneous aspect of our sex back, right?

And they don't like the scheduling. Like, because you hear a lot about that, right? So what's the option? Because spontaneity isn't always there. Yeah, I mean, I think you got to be open to both, right? So like, it can be one or the other. You got to be open to both because some people, like let's be real, right? Especially you've got kids, you've got work,

you've got stuff to do. And like we'll schedule time to go on a date, right? Sure, we'll go for a dinner, but like dinner is not sexy. Let's like, let's actually schedule time to be with each other, right? Then have dinner. Sure, if you got time afterwards, go for dinner. Do all the stuff you wanna do.

Go for a movie, but like be together. Like we're, especially nowadays, we're in our phones, we're doing so much stuff. Even in the evening when you get home with your partner, how much time do you spend interacting with them, right? So it's like really having that quality time and then the spontaneity will come, right? Like you'll rediscover the affection and enjoyment you have in each other and then yeah, it may just come on its own, but like you have to get there and then having some novelty is also really helpful. So like when you're in a long-term relationship you have your script. You know what works. You know what's gonna you know get you both to come and like it's gonna be great.

But sometimes you need something new because everyone gets bored a little bit right? So it doesn't have to be like you don't have to you know go crazy unless that's your interest right? But you can it's simple as like having sex somewhere else. It can be as simple as... Yeah, you can definitely bring toys to the bedroom. It can be as simple as role playing. But anything that can change it up a little bit can be very exciting for the other partner. Or, and you, right?

Because you're doing something new with someone that you already enjoy. And so it can be really fun and make that idea of spontaneity even more appealing, because hey, it's going to be different this time. Some men think the toy will replace them. So, question, are the toys going to replace us all? Like, should we be worried about the toys? No, no, not at all. So like, I think that the reason this is a concern, right, is like,

do, let me put it to you this way, do all your orgasms come from your partner? Wow. Right? Marcus Schenck said yes. Good for you, man. Okay, so. Alright. Well, for a lot of people, that's not the case.

And so, very similarly, all a female's orgasm doesn't have to come from their partner, right? A toy is just a convenient way for them to climax. It's convenient, it's easy, it's accessible, it happens much quicker. So, when you look on average, how long it takes for a female to climax in partnered sex is around 12 to 14 minutes. With a toy, 8 minutes. So, a little faster, right? A little more convenient. It's better than you. And it doesn't mean it's better. in partnered sex is around 12 to 14 minutes. With a toy, eight minutes. So a little faster, right?

A little more convenient. It's better than you. And it doesn't mean it's better. It's not doing anything else besides stimulating the genitals, right? But we've also looked, there's actually been lots of studies looking at how women view toys,

how that affects their sex life. And when a woman generally uses a toy to augment her sex life, meaning she's having a good relationship, she's satisfied in her relationship, she's happy with it, they're having sex, it just augments the relationship. It's just making their sex life better. They're actually having more sex with their partner rather than less.

So it's actually like if your partner's using a toy and you guys have sex, like she's probably going to have more sex with you and it's probably going to be more fun. So really not going to replace you, but if you're having sex that's not great and you're not having fun with your partner, then they're gonna choose something that's more convenient, right?

So I think it really depends on your baseline relationship. Gotcha. In helping so many people with erectile dysfunction, helping people maybe with their hormones and stuff, have you seen a split in sexual appetite? So you help someone with their hormones and stuff. Have you seen like a split in like sexual appetite? You know, so like you help someone with their hormones, maybe they lose a little bit of weight, they get a little bit better shape,

maybe you find out they need TRT, maybe they discover Cialis and some different interventions and they work really well, and you find out the partner is not as into it because the relationship hasn't been that way in the past. Yeah, so I think it's important to treat the couple, right? Like to figure out what's going on in the bedroom, right? Like what is, I always ask my men and my women,

like, how does your partner feel about it? Like, what are they thinking? Have you talked to them about it? Because nine times out of 10, probably more than nine times out of 10, that the guy has, or the female has never brought it up or they've tried to, and it's been a disaster. And so they don't know what the partner is thinking.

And so I always encourage people to incorporate their partner in the discussion about what's going on, right? Of course your partner wants you to feel good. But if they are maybe silently struggling with something else, like maybe they also have a libido or maybe they're having pain or maybe there's something else going on that they haven't brought up to you, then you might get your libido up and roaring and then they're having pain or maybe there's something else going on that they haven't brought up to you, then you might get your libido up and roaring and then they're like, oh wait, I don't still don't want to have sex and now you're frustrated. Right? So I think it's really important to do that. But talking about what is the mismatch is very, very common that

couples will have mismatch at some point in their relationship. Okay, it's not you're not always going to be having the same amount of desire all the time. Right? That's great if that is the case, but it's very unlikely, right? Because life is a fluctuation. And so, more commonly, we see women with low libido. About 40% of women, when you give them survey questionnaires, get low libido. Now, does that mean it's bothersome to them and their partner? Only about 12%, but still, that's a pretty high number.

And again, I think what we talked about, some of the reasons, it's really biopsychosocial. some to them and their partner only about 12%, but still that's a pretty high number. And again, I think that we talked about some of the reasons it's really biopsychosocial. It could be a hormone issue, absolutely, but it also can be stressors in their life. It can be other mental aspects if they're suffering with depression or anxiety. It can be the medications they're on, whether it's like antidepressants or even sometimes birth control pills can cause issues with desire. And so very rarely, I don't wanna hate on birth control pills,

but I think it can happen. And so I think ultimately there's a lot of factors that go into it, but we certainly see it more commonly in women. And fortunately now we do have a lot of things that we can offer them. There's always sex therapy, there's always sort of managing your stressors,

and we gotta fix the whole problem, but we also now have medications and off-label testosterone that we can give to women who are suffering from low libido that can often help with libido. Is there other things that women can explore for, like I know that men have Viagra, Cialis, and maybe some other things that you can tell us about in a little bit, But what about for females?

Is there stuff that works really well? Absolutely. So there's these two medications I was talking about. So flabanserin is a pill or Addi, it's called, it's like the little pink pill. You take it once every night before bedtime and it over time, after about three months, you'll start seeing an increase in desire.

So it's very subtle. It's not this like, oh my God, I see you, I wanna rip off your clothes. It's more like, hey, I didn't used to find this person attractive and now like, I'm like looking at the TV and like, oh, I'm turned on. Right? And I never used to feel that way before.

Or like I'm doing the dishes and all of a sudden I sort of feel this desire to have sex and I never thought of that before. So really like subtle changes and it takes time. But it does work in about 40 to 60% of women. So it is a great option for women. The other one is called Vilece, which is also used off label for men.

Many people talk about it called Bremelanotide or PT-141 is the other term that people use for it. It's an injectable medication. You use it 45 minutes before you wanna have sex and it gives you a very sudden, strong desire for sex. Now this does have some side effects. Nausea is very, very common. About 40% of people will have nausea. So I give them an anti-nausea medication to take at the same time. Cause the last thing you want is to be nauseous and horny. Like that's

not great. But it does work pretty well. So those are a couple medications that we have. I mentioned off-label testosterone. We're not checking, you know, when women come in, we'll often check testosterone. The more I check, the more I see that women have low testosterone for women. Women actually have more testosterone in their bodies than estrogen.

And it's also a hormone for desire in women. It's also good for muscle growth. It's also good for all the same things it's good for men for, right? And so when it's low and you replace it, oftentimes you will see an improvement in libido as well as sometimes mood, sometimes muscle growth if they're working out. All those things can be beneficial with taking on-label testosterone, off-label testosterone. It's one-tenth of the dose of the guy. So you can use, like you can even prescribe just androgel, which

is male topical testosterone. They can take a 10 put in a syringe and take one half cc of it every single day and rub it on their thigh and they're good to go. So those are sort of things that we use for libido. Now the medications you mentioned like to dalafil and sildenafil, those are used for arousal, right? They're used for, so men have erections, women's have clitorises that get too messed. So just like a guy's penis gets long and hard, women's clitoris gets long and wide and hard, right? It just, you can't see it.

It's mostly internal. There's a little bit external, but very similarly the same thing is happening. So if they're noticing a decrease in arousal, so maybe they're not getting that pressure feeling, that can help with that. Now, the other part of arousal is often lubrication, right? And so what happens if lubrication goes on?

Very commonly happens all the time when women are going through perimenopause and menopause and post menopause, right? This is because your estrogen decreases and then you're not making as much lubrication. So what can you do for that? So obviously you can use lubricants. There's great lubricants available over the counter. You can use moisturizers, which are like high ironic acid bases. People use moisturizers for their face. They use it for their vagina, put it on every day.

Those are great too. And then if you want to treat the issue, you can use vaginal hormones, vaginal estrogen or vaginal DHEA, which can then cause an increase in lubrication and also kind of keep the tissues thin, I mean, thick and elastic and flexible because as they go through those changes, their vulva and their vagina are going to change. They're going to get thin, they're going to, their labia will shrink, their clitoris might get smaller, the head of their, the foreskin of their clitoris may also shrink a little bit and so we're trying to keep those tissues healthy, pink and supple.

And so that's going to help treat that. On the topic of lubrication, we've... First off, this is going to be a two-parter. What exactly is squirting? And we've had multiple people on the podcast mention that every woman can squirt. Is that true? Is that... Is that the goal? Is that a goal?

Good question. You know? Yeah, so squirting is very controversial Is that true? Is that just- Is that the goal? Is that a goal? Like, you know? Yeah, so squirting is very controversial because so they've done a couple studies on this, right? They've looked at squirting. They've actually taken like samples of squirt. You know, who's doing these studies? Who's looking at this?

Yeah, so there's some academic researchers who've actually taken samples of squirt and they've looked at it and said, what is it made up of? And so one study looked at it and said, it's like a dilute urine, but it also has PSA in it. So PSA is, you guys commonly know of, is something we test for prostate cancer, right? It's prostate-specific antigen.

But women don't have a prostate gland, right? But in fact, they do. It's called the skein's gland. And it's actually where people describe the G spot. It's actually a zone. The G zone is where you have these skeins gland, duct-like glands that are sitting underneath the urethra that also have some fluid. Now, they don't have a ton of fluid. They have like one to five cc's probably of fluid, not a lot. And so when that's stimulated and you have a climax, you're gonna have some fluid come out and that's typically squirting.

Now, if it's a large amount of clear odorless fluid, that's typically called a squirt. You can also have an ejaculate, which is probably primarily from the skein's gland, you're getting like a whitish little small amount of fluid. That's female ejaculate. And then obviously there's lubrication. There's different kinds of fluids.

So this is where the flaw is with these studies. Like what fluid are you really testing, right? So then there's been a couple studies that have actually looked at like what is coming out, right? So there's one study where they put blue dye into the bladder and then they had them sport. And then they saw the blue dye come out. So like, oh, it's urine. Okay, we know it's urine. Another study did ultrasounds of the bladder. So they scan their bladder before they had sex. People really trying to get to the bottom.

I love that. And then they had sex and they scan their bladder and the bladder restarted. What are the great mysteries of the world, yo? Well, look, I mean, everyone's interested, right? Yeah. And then they're seeing that the bladder's empty, right? So clearly it has to come from the bladder because that's where you're gonna get the most fluid from

if you're squirting a large amount of fluid, right? But is it urine, right? Is it the exact same thing as urine? So there's a couple theories behind this, right? Because a lot of people are like, well, I pee right before sex and then I squirt. And like, how is this happening, right? But some people are probably getting a lot of fluid in their bladder before they have sex and then maybe they're having a strong contraction and sometimes you can't have leakage of urine when you climax if you have a weak pelvic floor. So really depends on like

how you define squirting, right? But there's some there's one guy who was on my podcast Dr. Barry Kamisurek who's you know really thought about this a lot. He does a lot of research on MRIs and orgasm and he said he thinks there's something like imbibation where when you give rats estrogen, what happens is their organs swell with fluid. And then when they climax, those organs contract and squeeze and that fluid comes out.

So maybe there's a theory that the bladder wall is filling with that fluid and then it contracts. How did he test these rats? That's the first thing that came to mind. Some wild shit going on. Yeah, I don't know the specifics of that study, but that's his theory. And then of course, this is just urine.

Regardless of what it is, right? It doesn't really matter what it is. It's cool, either way. I think, yeah, it can be really fun for some people, but interestingly, when you look, you ask women how they feel about squirting, and this study has been done too, where they've asked women and they've said, how do you feel about it? So someone like, it's great, you ask women how they feel about squirting, and this study has been done too, where they've asked women,

and they've said, how do you feel about it? So someone like, it's great, it's a superpower, I feel amazing that I can squirt. But there's also some women who are like, this is a big mess. And I'm embarrassed and I don't actually like it, right? And I don't know what it is and it makes me uncomfortable. And so I think like, for guys, it's like this is the only visual of pleasure and climax, right? So for guys, it's really fun. Like, oh, I see a squirt. I know she's climaxing.

I know she's feeling great. Right? But you know, ultimately, that's not the only visual. So you guys will know this from having sex, right? That when a woman climaxes, her pelvic floor will contract at a rate. Like it will contract about every 0.7, 0.8 seconds. So you'll actually feel those rhythmic contractions or you'll see them because they'll actually have those contractions.

So that's, you know, one way that you can get that feedback. But ultimately, like squirting, could people do it? Sure, I'm sure if you fill your bladder and you stimulate the G-spot, some people may be able to force a squirt. But like, what's the goal, right? The goal is pleasure, the goal is climax, the goal is having fun, and if squirting's part of it for you, great,

and if it's not, that's okay, right? It's completely fine as long as you're having fun and you're having pleasure. Someone wants me to ask this question. Where is the G-spot? So the G-spot is actually a zone. As I mentioned, there's no like button, there's no magic place that you're gonna touch.

It's two to three centimeters in at the top of the vagina. So you put your finger at the top and do like a come hither motion and you're gonna hit it, right? And so that is sort of where the G zone is. And again, this is where the skeins glands are. And those are like the male prostate. So like some guys enjoy prostate play, right?

They may feel that that is pleasurable. Very similarly, some women will find that that's pleasurable, but it doesn't mean that every woman is gonna climax from that stimulation, right? Because not every guy is gonna have an orgasm from prostate stimulation. So it's sort of analogous to that, but it is pleasurable, it can be enjoyable.

It's going to a different nerve ending than the clitoris, right? So when you think about how women climax or from what stimulation women climax from, clitoral is the most common, most reliable, easy way for women to climax. 85% of women need clitoral stimulation to climax. They're not going to climax any other way. That's like somebody stimulating your penis, you're going to climax, right? Same thing, you stimulate a woman's clitoris, she's going to climax.

G-spot? stimulating your penis, you're gonna climax, right? Same thing, you stimulate a woman's clitoris, she's gonna climax. G-spot? Yeah, some women climax from that and some women climax from stimulation around the cervix, which is at the very top of the vagina. But not everyone does. And those are all different sort of pleasure centers or pleasure nerves that are sending signals to the brain. And so they may even experience the climax as a little bit different. But ultimately, it's really about each individual person. But like I said, if you're wondering, you're not sure, the clitoris is probably the surefire

way to go. If a woman can't squirt, is she missing out on a like big different type of orgasm as opposed to what she's currently having? No, it's not going to change your orgasm. You're just going to feel the sensation of fluid coming out, right? You're still going to have the same contraction. So what happens when you climax is your pelvic floors have this very strong contraction,

which is part of what feels so good about it. You're having this big buildup of tension and then a strong release. And so that's what's happening. And so you're still gonna have that. It's just that is fluid coming out or not. And some people find that really exciting and fun and some people find it like it's a mess, right?

But I think ultimately, again, pleasure is the goal. I have a question for you on this topic. We're spending a little bit too much time on squirting. But I do have a friend who had a, she learned that she could squirt with a situation with another woman where she was like, ah, I have to go pee. And then the woman was like, just don't pee, just come back.

And then she realized, oh, a superpower, right? So is that something common where women feel the need to pee but that could potentially be that situation where they're just gonna squirt? Yeah, it could be, absolutely, absolutely. All right. Switching gears here a little bit. You know, when it comes to erectile dysfunction, I've heard, you know, from a lot of people,

they say like that Viagra salus doesn't work for them as much anymore. And you were mentioning some of that in the gym. So like what's going on there? What's happening there? Yeah. So let's talk about why ED happens, right? So we can kind of start there. So the number one cause for ED is vascular problems. So problems with blood flow, right? So we can kind of start there. So the number one cause for ED is vascular problems. So problems with blood flow, right? And that happens most commonly in the US because of three things. Hypertension, diabetes, high cholesterol, right? And high cholesterol is the one where I

will see guys like you come into my office and their cholesterol is through the roof, right? So like you can look like the perfect specimen of a man and you can still have high cholesterol. And so I think it's really important to make sure those three things are on point. But say you do develop ED and then you start these medications, which are going to help you because they're going to increase blood flow in that time period where you're taking the medication. So they're going to help push blood flow through to the penis. But if your vessels continue to have problems because maybe

your blood pressure is not controlled, maybe your cholesterol is still going up or remaining high, or your diabetes is continuing to progress and affecting the health of those blood vessels, then it doesn't like you can only push so much, right? If your blood vessels become unhealthy, then you can't keep pushing through them. The medication is going to stop working. It's not that the medication itself is failing, it's that you yourself are having issues with your health that you're not really understanding. Now there's other causes of ED, right?

It's not always blood flow, that's probably the most common as I mentioned, but a lot of times what I'm seeing more and more, especially with younger guys is psychogenic ED or performance anxiety as people describe it, right? They have an issue where usually it starts with one episode, right? They have a problem in the bedroom. They can't get it up and then they're stressed about it, right?

Like you're thinking about it over and over again. You're with your partner. Am I gonna be able to have an erection? Is it gonna go away? Am I gonna let her down? Am I gonna let myself down? Is it gonna happen? That's all you're thinking. You're not like, hey, I've got this beautiful partner here. I'm gonna have great time with her. You're like, I'm really stressed about this. And so, of course, you're not gonna have? That's all you're thinking. You're not like, Hey, I've got this beautiful partner here. I'm going to have great time with her. You're like, I'm really stressed about this. And so of course you're not going to have an erection because you're stressed and then that just cycles and cycles and cycles until you're like, I'm broken.

I can't fix it. I don't know what's going on with me. Right. And so then it's like, now you've created this big stressful situation around sex. And so how do we fix that? Very often we will use the help of sex therapists and they'll do things like tell you to stop having sex and start being intimate with each other in different ways. So start by, it's called sensate focus. So start exploring your body. Don't touch genitals. Don't have penetrative sex. Just find out other areas of the body that are erogenous. Enjoy each other. You're not thinking about your erection. You're focused on being with your partner.

Then slowly as you start noticing like, yeah, I am really focused. I'm really here. I'm really present. Now I'm going to start genital touching. So then you start genital touching and again focusing on the task at hand, being with your partner, being present, enjoying the touch, right? And once you finally are like, okay, I'm not thinking about my erection,

then you go back to penetrative sex and hopefully that will help cure some of those issues. Now there's a lot more that they can do with you, but that's sort of where you start and you work through things that are affecting you mentally that can affect your erections. So that's very common. Then there's hormonal,

which is low testosterone most commonly, but it's also a very small proportion of men who have ED have low testosterone. It's only like three to six percent. So that's usually, I mean, it can be a contributor, but it's not the only cause and only about three to six percent of guys. And then neurologic. So if you have certain conditions like multiple sclerosis, Parkinson's disease, spinal cord

injuries that can affect erections. And then of course, medications. So we commonly see ED from medications like antidepressants, certain high blood pressure medications. Now that doesn't mean you shouldn't be on high blood pressure medications. It means you just need to switch your blood pressure medications.

Because thinking back to what I said earlier, if you have high blood pressure, you don't treat it, your ED is just gonna get worse. Don't sometimes the lipid, some of those drugs that help control your lipids, don't they sometimes cause situations of ED? Well, it depends on which one, but more commonly with the blood pressure medications.

And again, you gotta figure out how to improve your, and of course, diet and exercise are first and foremost. You gotta do those things first and you won't need to be on medications. So improving your diet, diet and exercise are first and foremost, right? Like you got to do those things first and you won't need to be on medications, right? So improving your diet, improving your exercise are really hard to do. And they take consistency and they take consistent effort. But never give up and keep working at it because that's going to be the key, right? You don't want to take medications for the rest of your life.

You don't want to do those things because again, they do have side effects. But until you've done those, the medications will help maintain the health of your tissues, right? So I think thinking like, yeah, I'm gonna do all these things, but my cholesterol is like 250, 300. No, bring it down and then keep doing those things and hopefully you'll be able to get off the medications.

Something I wanna mention, a few years back, there was a point that I had a lot of work and a lot of training for jujitsu for some stuff I was getting ready for, and I wanted to have sex with my girlfriend, and my dick didn't work the right way. That shit messed me up, because I literally, I was like, oh god, I hope this doesn't happen again.

Then it happened again, right? And I was just like, fuck, fuck, fuck, fuck, fuck, fuck. Then I was like super scared of having sex, because I was like, am I going to, what's going on? At the time, a lot of training, wasn't getting a lot of sleep. It really messed me up in the head. But then I was like, okay, let me just try to fix this.

Let me start getting sleep. Let me start getting on top of things. And then things started working the way that they should. So I just want to mention, it's like, that shit happens. Don't beat yourself up about it. It's all good. And your calories are a big thing. Your food. The food, yeah.

So like, and Seam and I, we've done like one meal a day, we've done like a lot of fasting, and if you're doing a lot of that stuff and then you're recognizing that you're having some trouble, start to eat, start to get a lot of food back in. And the way to get lean a lot of times is to cut out a lot of fats and cut out a lot of carbs. That's a way to get totally shredded,

but it's a way to lose your dick, basically. So be very cautious with it. And you have to kind of, you know, maybe if it's someone that's going to compete and get on stage, maybe they have to make particular sacrifices at certain periods of time. But just understand that it's,

these things, they can obviously be like a real bummer. You know, they can really, more than just a bummer, they can obviously be like a real bummer. They can really, more than just a bummer, they can make you like depressed. Yeah. Well, yeah, and you think about it, you take a lot of pride in the way you look and the way you exercise and you show up. And then this is the thing that's not working.

And you're like, what? Like I'm trying to be the best I can be. And now I'm not able to be the best in other areas of my life. So it makes sense. And the other thing is you mentioned, like if you're not eating enough fats, right? Fat, testosterone is from cholesterol.

It's made from the cholesterol pathways. If you're not eating enough fat, like healthy, good, nutritious fats, your testosterone is gonna go down too. So important to maintain a balanced diet and include some healthy fats. Are there some other things that work well, you know, like Viagra, Cialis,

has been around for a long time, is there anything new? So in terms of things, yeah, so there are some new things. So just the basic pathways that we use as sort of evidence-based treatments for ED would include medications, which would be Viagra, Cialis, Levitra, Stendra, those are the medications for ED. They all are PDE5 inhibitors.

They work by preventing the breakdown of some enzymes that help you maintain the erection. Then there's intra-urethral suppositories, like a little pill you can put in the pee hole. I personally don't prescribe it very often because it doesn't work that much better than the pills. Then there's vacuum erection devices, which help you get an erection by using a vacuum. Like it forces blood flow into the penis

and often used with a constriction band to maintain that blood flow. Don't just use your Dyson. Yeah, no, no, no, no, no. You want to use ideally medical grade devices because they have safety things within them to help prevent you from using too high of a vacuum suction, so you don't injure yourself.

And then you use them with a constriction band to help maintain that erection. Now those don't always feel completely normal because they're not all arterial blood flow. They do include venous blood flow. So it might look a little blue, it might feel a little cooler, it might feel a little different, but you still are getting blood flow and you can still get a good erection with it, and it takes practice I think with those things it's like it's not gonna work the first time you're gonna have to learn there is a learning curve And so you got to be up for the challenge of you know using it and trying to figure it out What works for you because it's gonna be individual from person to person and then there's injection

So there's what's called inter cavernousal injections that you, they're really small needles like insulin needles that you inject medication directly into the penis. They work really, really well. But it is a mental block of like putting a penis, a needle near your penis is really hard for a lot of guys. But they work really, really well. About 80% of guys who are having trouble will be able to get an erection. So those are the on-label options. Now, in terms of off-label newer things, so one is Botox injections, so that's relatively new. There's a few studies on injecting Botox into the penis, and the reason I like this is because they did these studies on guys who were so bad that they were about to get surgery,

they were about to get a penile implant because they could not get an erection anymore. Medications were not working, nothing was working. So they gave these guys Botox and then they were able to then not have the surgery about 80, depending on the guy. So 80% of guys with mild ED, 50% of guys with moderate ED, 30% of guys with severe ED were responding.

Meaning they were then able to take medications or not take any medications and get an erection. So that was pretty impressive data, even though there's only been a few studies. So that's why it's not prime time yet, but I think it's very low risk and has the potential to work. It lasts between three to six months, depending on the dose you get. The other thing is shockwave therapy. So shockwave therapy, how it works is it's using sound waves.

It's going to cause sound waves that create micro-mechanical traumas to the penile erectile tissue. And then your body sends its own growth factors into the penis to then recreate blood vessels. So it's actually creating new blood vessels in the penis over time. And so that has been shown to be effective in like the three month timeframe, about 60, 70%. And then when you go out to a year, it drops to about 50%. And likely again, because probably there's some ongoing process that caused the ED, right?

And it's still going on. So you probably need some maintenance, but that's where I think the data becomes a little murky. We don't have clear maintenance protocols yet. They haven't been really rigorously studied, but we've been looking at this for about 10 years. So there's a lot of data and I think the issue is that it's been using different machines, different, you know, different endpoints. And so we have not yet come to a consensus on like from the AUA, American Urological Association about is this, you know, should

this be part of a treatment plan? But I think it works for the right person. Now, if you're using it for somebody who has really severe vascular ED or ED due to a non blood flow issue, it's not gonna help you. So I think you gotta find the right guy, mild to moderate blood flow issues. That's the right guy for shockwave. And then there are some other things.

I think the data is really minimal on those. That includes PRP injections and stem cells. I would say at this point, I would not be convinced that PRP, there was a really good randomized controlled trial, meaning guys got randomized to either get PRP in their penis or saline that showed there was no difference in erection quality. And so based on that, and of course, every study has its limitations. So I might be proven wrong later on, but for now based on that data I don't recommend it. And then the same thing with stem cell, there's just not enough data.

Question about, because when we've been talking about Viagra and Cialis, we've been mentioning it synonymously, but these two very different effects, especially long-term, correct? Absolutely. So the difference is when you're taking them, you can take them on demand and to Dalafil or Cialis, you can also take daily, which is like my favorite medication by far. But let me explain the difference. So Viagra has a half-life of about four hours.

So after about eight hours, it's pretty much gone from your system. It's gonna work the day you take it. And you're gonna have sex that day and then it's gonna go away, right? So it's gonna help improve blood flow for that short period of time. It's gonna go away. The one side effect with that can be vision changes that doesn't happen

as often with Cialis because PDE5 is also in the eye. And so sometimes people will have blue green vision discoloration. If that happens, stop it immediately. Don't take any more. Okay? It's very rare, but I just public service announcement. The other one is Tadalafel, that works on PDE6. So that one has a longer half-life, meaning it lasts up to three days. So you can take it on a Friday and have sex all weekend, right? And also it has, because it's PDE6, it also can have some muscle aches as a side effect,

which you won't see with the Viagra or the system. And this would be at higher dosages? It's depending on the dose you take, but that's a known risk with any dose of the Tadalafel. Now the on-demand, I guess in the Tadalafel, you could take daily or on-demand. It can be five, 10, 20 on-demand. And then daily is usually a five milligram dose.

Now I love daily Tadalafel because, one, it takes the anxiety out of it, right? Like you take it daily, you don't have to think about it. It's always on board. You always have a little bit of increased blood flow to the genitals, which is good for the health of the genitals. And overall, I mean, we're seeing a lot of uses for it in urology. So we're using it for enlarged prostate because it helps relax the smooth muscle of the prostate.

There's even some data that I was reviewing on like after certain surgeries on the urethra where they're using it and they're seeing good blood flow and better recovery and less recurrence rates. So like there's, there's a lot on there, but there's also in the, in the cardiovascular literature, there shows potentially some cardiovascular benefit and in the muscular health space that it may improve blood flow to the muscles. And so I think those are all theoretical benefits, but ultimately I think there's very little risk and a lot of benefit to taking it daily. If you especially if you're suffering with ED and difficulty with urination, like kill

two birds with one stone and it can be really, really useful. Taking the like a scenario that that Encima just explained earlier, you know, a man's working really hard. He's exhausted mentally and physically, goes to have sex, can't get an erection, maybe tries to clean things up, get some better sleep. But then the next time he goes, it's in the back of his head, it happens again.

Yeah. It's kind of like a- Self-fulfilling prophecy. Right, it's a snowball effect, right? Would he be able to use like ED medications as like a confidence booster short term, or is our ED meds similar to like TRT? Like you take it, you feel great, but then you come off of it, and then you probably feel worse than you did initially. Like is it something that you would just need to do perpetually to maintain that performance?

No. So you don't, that's the, to answer your question, no. If you take, I often do this for guys with psychogenic EDs, I'll give them daily to daily, we'll get them feeling confident, we'll get them to the point where they're having great sex, and then we'll slowly taper them off. And it just allows them to like have a little help, right? A little help when they're stressed out. And so that's one way. Sometimes people will then get stressed about going off of it, right?

Because like, no, now I need it, now I need it. That's a whole other issue, right? So there's two ways to look at it, but I find that if we can help somebody get an erection, feel confident in their erection, then, you know, that's part of it. And then take that and maybe go to sex therapy or talk to someone about it. And then you're probably going to be in great shape, right? So in an ideal world, you do both those things. I think everyone should if they can, maybe go to sex therapy or talk to someone about it, and then you're probably gonna be in great shape, right? So in an ideal world, you do both those things. I think everyone should if they can,

if they have the means and access to a sex therapist, I think you should. And I think you're gonna be in good shape. For years on this podcast, we've been talking about the benefit of barefoot shoes. And these are the shoes I used to use back in 2017, 2018, my old Metcons. They are flat, but they're not very wide and they're very stiff

and they don't move. That's why we've been partnering with and we've been using Vivo Barefoot Shoes, these are the Modest Strength Shoe, because not only are they wide, I have wide ass feet and so do we here on the podcast, especially as our feet have gotten stronger, but they're flexible.

So when you're doing certain movements, like let's say you're doing jumping or you're doing split squats, or you're doing movements where your toes need to flex and move, your feet are able to do that and perform in the shoe, allowing them to get stronger over time. And obviously, they're flexible. So your foot's allowed to be a foot. And when you're doing all types of exercise, your feet will get stronger, improving your ability to move.

Andrew, how can they get the hands on these? Yes, head to vivo barefoot.com slash power project and enter the code that you see on screen to save 20% off your entire order. Again, that's at vivo barefoot.com slash power project links in the description as well as the podcast show notes. There's not a lot of women in urology, is there? No, it's only 11% of women practicing urologists. How'd you get into it? Yeah, so I actually didn't even know what urology was. I thought I was going to be a cardiologist. I went to medical school and like hated medical medicine.

So meaning like taking care of patients with long-term chronic conditions and just giving them pills. Like that was not fun to me. Then I went to surgery and I was like, this is amazing. I love being able to do something physically with my hands and fix a patient and send them out, right? So I was like, oh man, I like surgery, but I didn't love general surgery.

I didn't love the personalities, I didn't love the surgeries. And I was like, okay, let's think about the subspecialties within surgery. So there's ophthalmology, which is eye surgery. I went to one surgery and was like, I don't like eyeballs. It's a great, great specialty, but not for me. And then I looked at ortho, which I'm not into power tools. So that was not for me. And then I went to ENT and Urology.

And that was sort of my, okay, which one of these is for me? They both are really great, cool surgeries. But when I went into Urology, I was like, I love these people. Like they're really cool. Like how seriously can you take yourself for dealing with dick all day, right? Like you're, you're yourself for dealing with dick all day, right? Like you're gonna be... Cut that.

That's the one. That's the one. Yep. You're gonna be like a fun jovial person, right? And so generally I find that urologists are my people. They're great. They're fun to be around. And I didn't have a problem, obviously, as you guys can see,

talking about things that are really intimate. And so I went for it. And I think a lot of people who are in training, like you do things because you kind of have a hunch that it might work for you, but you don't know what it is until you're really into it. And it worked out. Like I love urology.

I love all of urology. I think urology is great. I love taking care of the patients. And I think it's just like, it's one of the, we do a lot of cool surgeries. So we do like robotic surgery. We do minimally invasive stuff all through like the urethra. So like, you know,

and so we can do stuff without even a cut on your body and we can do minimally invasive stuff in the office. So there's a whole range of things and we get to see our patients over time. So like I see my patients all the time, I get a relationship with them. It's not like I just took out their appendix and I'll see you never, right?

Like I get to see you. And so that is really kind of the best of both worlds. There's so many puns. There's so many- Oh yeah. Just leaving yourself wide open for that's what she said, or maybe even a that's what she didn't say. Yeah, yeah, yeah.

It's great. I mean, you talk to your urologist and you always have a good story. Why do you think in our society younger folks are having a lot less sex? You know, I think there's a lot of factors. One is I think that younger people are interacting with people differently than we did when we were younger, right?

They're using devices like you'll see them hanging out and they're all like on their phones interacting with each other through their phones rather than interacting in person. So I think there's that. I think there's a communication issue like how do you approach somebody that's changed, right? Like there's, you know, you have to, not that this is bad, but you have to ask for permission. You have to, you know, it's very awkward to ask. You don't want to get in trouble.

You don't want to, so there's a lot of like, I don't know how to do this, right? I don't know how to navigate this. They call it a drone kill in the gym, I guess, is what I've heard. Yeah, I mean, it's tough. And then I think there's also COVID was a problem, right? Like we were isolated as people.

And so those people who spent a lot of their young years in COVID, like isolated at home, are like struggling, right? And then also I think there's access to a lot of other materials now that there weren't, right? So access to pornography is so easy. When we were younger, you had to find a magazine or find a VCR and find a tape, if anyone knows what those are anymore, and find a room where nobody was so you could watch it. No one ever made it past this part of the tape, which is disturbing. You think about it.

You know, give that some thought. It's like this seven second segment. No one ever made it past. But like it was hard, right? You had to work for it. And now it's too easy, right? It's too accessible. And then you're seeing young people seeing this and thinking,

this is what sex is. And sex education in our country sucks, right? Like you learn, I mean, you learn the important things of like, how to put on a condom, how to ask for consent, and how to avoid pregnancy and STIs. Those are very important things. They give very little time to sex education in school, right? Like they just don't.

And then, and so you're not learning, what is your body? What's normal? Is it normal to not get an erection sometimes? Yes, it's normal, right? It's normal. It's gonna happen. That doesn't mean you're broken, right? That doesn't mean you're never gonna have an erection again. And what is it? What does female anatomy look like, right? Like women don't even know their own anatomy.

How can you expect a man to know their anatomy, right? So there's such a gap in education. And then they're getting education through pornography. If you look at, they've actually looked at studies of like how are people learning about sex. Very few learn from their parents or from school. It's mostly from pornography. Jizzhot.com when I was a teen. But that's harmful, right?

Because that's a produced product. It's not meant to emulate real sex. You don't just have fast and furious sex and everybody comes and you're great and it's done. That's not real sex, right? And so I think they then have these expectations of what sex is going to look like. And then it doesn't happen that way. And then they're like, this is awkward. I don't feel good about it. This wasn't great.

And like now I have this other thing in my head about sex, right? So I think that's a problem. And there's another interesting fact I'll share with you is that people are now choking or strangulating their partner much more commonly. Did you guys know this? I did not know this until very recently. Things are a lot more violent in the bedroom. Yeah.

And so like this is as normal as kissing, right? Like this is so normal and it's like, but are they even really asking for permission? Is this really okay? Are they really liking it? We don't know, right? And they've actually studied this and they found that the women who are, it's most often women receiving the choking and they are, they're like, yeah, it's okay. Or, no, I don't really like it.

Or, yeah, sometimes I'm scared. Like there is a variety, not everyone's like, yeah, that's really hot. And some people can find it really hot. But like, it's not what we're thinking it is. So is the uptick of that or the uptick of the performance of that because of porn? We think so. I mean, we can't be sure, but it was not— Like, think about the things that are available to people on porn now. That was not something we saw growing up.

Like, you know what I mean? Like, now it's like so wild and crazy, more novel, more exotic, more, you know, out there. And so I think you're just exposed to different things. I think I saw a segment from Joe Rogan and he was like, how are they gonna figure out this point in history when women completely lost their pubic hair? He's like, how are they going to... You know, people had pubic hair, they got it like at 13 or whatever.

It's like, and then this point in time, you know, it just disappeared. Like completely disappeared. But so I think that the other thing is that there's other kinds of porn out there, right? It's usually behind a paywall, but it's more varied. It shows pubic hair, it shows different kinds of vulvas, different kinds of penises, right? And so like, that's great. Like that's fun. And it's more of a story, more about getting together and actually having sex. It's organic.

Yeah. And so that's still very erotic, but it's just not on the free sides, right? And I think that is great to incorporate. In fact, we know that couples who watch porn together, if they both have a good thought about porn, have better sex. So on these pay sites, you can watch two people that just came home from Costco that didn't take a shower. Why does this make me think of like vegans? Like, I feel like this is like, for some reason when she was talking about that,

it just feels like vegan porn. It's too organic for you? Oh, you know what I mean? Like... That's great. But who knows? It just feels like vegan porn. It's too organic for you? Oh, I see. You know what I mean? Like. That's great. But who knows? Are people? Protein free.

Are people like approaching you, in your opinion, are people like kind of approaching you or approaching medical intervention maybe a little too late, well not too late, but like, would you like for people to consider this earlier? Yeah, I mean, I would love it if people had basic understanding of their bodies, right?

So like one of my goals in life at some point is to make a really good sex ed course, right? That's freely available, that people can share with their kids, that people can watch themselves, because I think it's never gonna, like any other way it's not gonna work, right? Like schools are not gonna implement it,

they don't have the time, right? So we gotta figure out a way that it makes easier for parents to share with their kids, like sex ed. I think that is probably the first and foremost. Then when you're having issues, absolutely people are delayed, right? I like, on these like, now we have all these like online telehealth clinics. And for some part of me, I'm like, I'm glad there's access, right? Because there's a lot of people who will never come see me because they're just not going to,

they're gonna be too nervous to see someone in person. And so for that, that's great. But I do worry about like them getting the proper education around the things they're getting, right? And the proper monitoring, right? Because if I just give you Viagra or Cialis, I don't tell you like, hey, your blood pressure and your cholesterol and your diabetes need to be under control. I'm not fixing you Viagra or Cialis. I don't tell you like, hey, your blood pressure and your cholesterol

and your diabetes need to be under control. I'm not fixing you, right? I'm just giving you a band-aid. And so I do, I think sexual education and issues with sex are a great place to start talking about overall health, to start counseling about diet, start counseling about exercise

and to really introduce that. Because let's be real, if I tell you, you wanna have sex for the rest of your life, you want to have great heart erections for the rest of your life, diet and exercise, bring your cholesterol down, you're going to do it. You're going to do it. I'll tell you, these guys who I operate on for penile prostheses or implants, they have to have, at least for me and everyone's a little different, I make sure their hemoglobin

A1C, which is a marker of diabetes, is below eight. So I'll see guys whose hemoglobin A1c is bad, like nine, 10, and I'm like, don't come back until it's below eight and then we can talk about it. Oh, they come back and they've had a high hemoglobin A1c for years, but they come back within six months and they're like, I'm at seven, I'm great. And I'm like, that's all you needed? Like, you know, to get your erections, you're going to change your life? Okay, you know? And so, it's really powerful. It's a really powerful tool that we have, that we can use,

and that everyone should think about, right? Let's help future you. Like, let's help future your erections, your sex life, because sex is so important. It's such an easy, free activity that you can do with your partner, that's playful, that's fun and pleasurable. And like, let's not forget the benefits of sex, right?

And how they can help improve your life. What are some things to think about with nutrition in terms of people's sexual performance, whether it's male or female? Is there any particular diet that seems to show? Yeah. So the best studied diet is the Mediterranean diet, right? So that is very low in processed foods, right? No processed foods, lots of fruits and vegetables, some meat, fish, some healthy fats, olive oil, things nuts, things like that. But basically what I tell people

is avoid as much processed food as you can. Try to make sure you're getting good fiber intake through your diet, you're getting good protein intake through your diet, and that you're getting, you know, a good amount of vegetables too, and fruit. Like I think those are really, really important. And so, and just minimize our processed food. I mean, the issue is that it's everywhere. It's ubiquitous.

You can't go anywhere without getting hit by an ad for processed foods. I mean, influencers are making Lunchables and like, you know, all sorts of things, right? And like, I think, you know, like cook food at home, you know? Limit how much fat you're putting in your meals. But just, you know, make sure you're getting a small amount of healthy fats. And really like think about your meals. And even if you can start by just changing one meal

to be healthier and do something super easy. I tell all my patients, don't go home and be like, I'm going to start meal planning and meal prepping and do three meals a day. Starting on Monday. It's like, it's never going to work. It's not going to be sustainable, right? You might do it for a month or two, but there's the rare person who will keep doing it. Most people will fall off. So you need to do sustainable, small changes and do them over time, like the Atomic Habits book. I'm like, apply that to your food, right? Apply that to your exercise.

Make small habits that will make changes over time. We're not talking about changing tomorrow. We're talking about changing for future you. So a year, two years, three years, I don't care how long it takes you to get there, as long as you're constantly committed in making progress. And someone just losing like five to 10% of their body weight could have huge impact, right?

Absolutely. And you know, exercising has been shown to be as effective as a Viagra. So if you exercise cardiovascular at least 150 minutes a week, you're gonna see improvements in sexual function. Weight loss, exercise, improve your diet. I mean, you won't need Viagra. You'll be fine.

You gotta really focus in on doing those things and helping yourself improve your overall health. What's good for your penis is good for your heart, is good for your brain. So all the things you see online, good for your heart health, good for your brain health, those are the same things that are good for your penis. Go ahead. How about supplementation? Like things like ginseng, panics ginseng, citrulline, arginine, right?

What are some good supplements for that? Yeah, absolutely. So I did a whole like review of every supplement that I could think of like on my YouTube channel. So if anyone's interested in learning about each individual supplement, you can. But because of that, I can confidently say we don't have a ton of data and we probably never will because people will buy supplements without the data and there's no financial incentive for companies to do more data.

Right. Um, but in terms of the best data that we have is probably for L-Arginine and L-Citoline is a, is a, is a more bioavailable version of L-arginine. It's a precursor. So those tend to show the most benefit in terms of improving erectile function and they're going to improve it because they're improving nitric oxide. And so anything that's going to improve your nitric oxide may have potential benefit because that is the ignition for erections.

So when you get aroused, your vessels will release nitric oxide, which is then the ignition that tells your body to start the process of creating an erection. And so if you have more nitric oxide, you're going to be able to get a better erection. And so then, you know, those are the things that I would say can be helpful potentially. But again, I caution everybody, like do the basics first. Add supplementation once you've got all those things down because you can't just take that and assume things are going to get better, right? If your diet sucks and you're not moving your body, then you know, that's not going to help

that much either. I echo that sentiment. And then I have a question about another supplement. Horny goat wheat. We've heard a few people mention this on our podcast before. I actually purchased some, I'm waiting for it to come in. I'm going to see what I feel. But anything on horny goat weed?

Yeah, there's actually very shockingly very little data on it. Very little data. So minimal studies on it? Minimal studies, yeah. And so I was not convinced that it really works that well. But you know, people say it does, but let me remind you that the placebo effect, it is a great name.

The placebo effect of any pill, I give you a sugar pill, 40% of guys erections will get better. So there's a huge placebo effect. And that's why we always ask for these randomized controlled trials, right? That somebody should be taking a pill and they should be taking,

another group should be taking a sugar pill, a matched group, right? That's what a randomized controlled trial is. And until you've seen that data, you can't ever confidently say that something works because what they'll do is they'll give these pills to a hundred guys and say, yeah, their erections are better from beginning to end,

but like, what if I gave them a sugar pill? Would their erections improve the same way? So that's why you always want to compare those. You mentioned starting out as potentially wanting to be a cardiologist. So much of what we're talking about today seems to be pretty linked to the heart, right? Yeah, so maybe I am.

I'm a cardiologist of the penis and clitoris. We have another heart down there, so. A lot of times when the heart. It's the other brain too. There we go. When you're also a neurologist. When the heart starts to have some dysfunction, that's when other things can have dysfunction, right?

Well, actually, it's the other way around. So the penis, probably the same in women. But we just don't have a marker of clitoral tumescence. So we're not, women can't see that their clitoris gets big and large, so they can't tell when it stops getting big and large, right? And so, but in men, what we find is that when they start developing ED due to vascular issues, blood flow issues, that about 15% of those guys will go on to have a heart attack in seven years because that's the first sign.

The blood flow to the penis going down is going to be the first sign before blood flow to the heart starts decreasing because the blood vessels to the penis are about one to two millimeters, and the blood vessels to the heart are about three to four millimeters. So you're gonna block those blood vessels quicker than you will. And then a smart priority by the body.

Because like, hey, let's stay alive. Yeah, yeah. Let's shunt our blood flow where it needs to go. Right. Amazing stuff. Thank you so much for sharing all that today. Where can people find you? Where they can find out more?

Oh, you guys want more questions? Go ahead. One more question. PEDs, can they potentially negatively affect penis health? Yes, some of them can. Okay. Absolutely, some of them can cause ED as a side effect. And so generally speaking, I mean, as a doctor,

we don't recommend them. And so I would say that if you are looking to improve, like say your testosterone, talk to your doctor about you're getting your testosterone checked. And then also a lot of things, I think, so when you look at the guidelines, right? And a lot of doctors will just look at guidelines and say, that's it.

They'll say, here's your number for testosterone. And if it's below that, that's the only way I'm gonna treat you. But what we don't look at is like, what's your free testosterone? So a lot of people will not actually test your free testosterone, which is actually the testosterone

that's available to your body. So that can be easily calculated. So if you get your testosterone and you check your sex hormone binding globulin, you can go online, Google free testosterone calculator, it'll give you a number, right? And then based on that, you can see is my free testosterone high or low? Because that is a better indicator of your real total testosterone. And so that may then qualify you to at least as a, based on that number, that you may be

eligible for testosterone. Now insurance may not cover it, but if you find an astute doctor who has expertise in managing hormones and they'll be able to prescribe it for you, you'll just have to pay for it. Thank you so much. Where can people find you? Yeah, so I have a podcast, the Rena Malik MD podcast,

also on my YouTube channel, Rena Malik MD, and then I'm on all platforms as Rena Malik MD. Thank you so much. Strength is never weakness, weakness is never strength. Catch you guys later. Bye.