Mark Bell's Power Project - MBPP EP. 687 - Dr Judson Brandeis: What's Causing Erectile Dysfunction & How To Gain 1 Inch In "Length"

Episode Date: March 4, 2022

Dr. Judson Brandeis, voted best urologist in the San Francisco Bay Area for eight consecutive years, is an expert in men's health, a clinical researcher, physician educator, and a caring clinician and surgeon. A graduate of Brown University and Vanderbilt University School of Medicine, with a Urologic Surgery residency at UCLA and a post-doc fellowship at Harvard, today he specializes in the emergent field of sexual health and medicine. Get Dr. Brandeis Book: https://thetwentyfirstcenturyman.com/ Learn about his practice: https://brandeismd.com/ Follow on IG: https://www.instagram.com/judsonbrandeismd/ Special perks for our listeners below! ➢https://markbellslingshot.com/ Code POWERPROJECT for 15% off site wide including Within You supplements! ➢https://eatlegendary.com Use Code POWERPROJECT for 20% off! ➢Bubs Naturals: https://bubsnaturals.com Use code POWERPROJECT for 20% of your next order! ➢Vertical Diet Meals: https://verticaldiet.com/ Use code POWERPROJECT for 20% off your first order! ➢Vuori Performance Apparel: Visit https://vuoriclothing.com/powerproject to automatically save 20% off your first order! ➢8 Sleep: Visit https://www.eightsleep.com/powerproject to automatically save $150 off the Pod Pro! ➢Marek Health: https://marekhealth.com Use code POWERPROJECT10 for 10% off ALL LABS! Also check out the Power Project Panel: https://marekhealth.com/powerproject Use code POWERPROJECT for $101 off! ➢Piedmontese Beef: https://www.piedmontese.com/ Use Code POWER at checkout for 25% off your order plus FREE 2-Day Shipping on orders of $150 Follow Mark Bell's Power Project Podcast ➢ https://lnk.to/PowerProjectPodcast ➢ Insta: https://www.instagram.com/markbellspowerproject ➢ https://www.facebook.com/markbellspowerproject ➢ Twitter: https://twitter.com/mbpowerproject ➢ LinkedIn:https://www.linkedin.com/in/powerproject/ ➢ YouTube: https://www.youtube.com/markbellspowerproject ➢TikTok: http://bit.ly/pptiktok FOLLOW Mark Bell ➢ Instagram: https://www.instagram.com/marksmellybell ➢ Facebook: https://www.facebook.com/MarkBellSuperTraining ➢ Twitter: https://twitter.com/marksmellybell Follow Nsima Inyang ➢ https://www.breakthebar.com/learn-more ➢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 on all platforms ➢ https://direct.me/iamandrewz #PowerProject #Podcast #MarkBell

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All right. Well, might as well just dive right in. Yeah. Doc, tell us what you do. Great. Well, I am a just dive right in. Yeah. Doc, tell us what you do. Great. Well, I am a regenerative urologist. So I started out as a general urologist doing prostate cancer surgery and kidney cancer surgery, kidney stones, that kind of stuff. But about two or three years ago, I became really interested in regenerative urology.

So the ability to improve blood flow to the penis using things like shockwave therapy, platelet-rich plasma, stem cells, because after 50 or 60 or 70, guys lose blood flow to the penis. They lose the ability to perform sexually. And I wanted to be able to help them in a really significant way. And it's really, truly amazing. I mean, I've cured people of cancer. I take kidney stones out. I cure them of incontinence. But I get more joy and satisfaction out of helping men recapture part of their youth, recapture part of a relationship than I ever did curing people of cancer or taking them out of pain. How prominent is this issue?

Because we've had some guests on. We've talked about penis health. By the way, audience, we're going to say the word penis a lot, so get used to it. We might use other references for the word penis here and there, like wee-wee, pee-pee, whatever, what have you. So just be aware and get out of your system. How prevalent is this?

Because when we've had some guests come on and talk about it, we've gotten a lot of views and a lot of people asking more and more and more questions. Yeah. Well, if you ask most guys, the incidence is zero. Not me, bro. Yeah, not me. I heard one of my friends might have it or something like that. But there's something called the Massachusetts Male Aging Study.

It's the largest study of men in the United States as they age. And what they found is 40% of their men in their 40s, 50% of men in their 50s, 60% of men in their 60s, 70% of men in their 70s. And if you take an average of men over 50, about half of men will have some degree of erectile dysfunction. Is this on the rise? Excuse the pun. Yeah, I like it. Yeah, absolutely.

I mean, we're getting less and less healthy, especially since COVID, but those trends were already really prevalent before COVID. And so, yeah, things are getting worse. You think COVID is making it more difficult even? COVID, it's an accelerator. And I think one of the failures of the public health establishment

is they didn't really explain to the American public how COVID actually works and how COVID causes problems. So I was at the Sexual Medicine Society of North America meeting three months ago, and someone presented a paper on the incidence of erectile dysfunction after COVID. And there's a 20% increase in the new diagnosis of erectile dysfunction after COVID. And the reason is that COVID causes a vasculitis. It causes an inflammation in blood vessels, right? So it's not actually that COVID attacks blood vessels, but COVID is present in

blood vessels and your immune system attacks COVID really vigorously. And that creates a vasculitis and inflammation inside blood vessels. And the blood vessels in the penis are some of the smallest blood vessels you have in your body, one or two millimeters. And so those are much more likely to be affected by a vasculitis. And so that you're unable to deliver blood flow to the penis under pressure like you need to, to get and keep an erection. What are some like obvious preventative things that men can do habits in their youth that will maybe help them so that by the time they get to 50 years old or whenever this stuff starts happening, they probably won't have to deal with as much of it. Like I'm assuming things like

exercise is probably going to be pretty beneficial to have as a general habit. But what else? Yeah, that's a fantastic question. And I like that you say youth, because that's really where you have to start. Those are the habits that you have to get into, because the thing is, in your 20s, in your 30s, even in your 40s, you can get away with stuff, right? You can do all sorts of stupid crap. You can drink too much, you can smoke, you can be out partying, and the next day you're like fully functional, right? No big deal. But it's like driving a car, right? When your car is pretty new, you can do anything you want to the car. It's going to keep running, but after a while, if you don't take care of your car, if you don't take care of yourself, you're going to pay the

price for those issues. And so, you know, obviously eating well, right? 40% of men are obese or fat, right? It's estimated by 2030, 50% of men in this country will be obese or fat. I mean, that's really bad because first of all, that makes you more sedentary, right? When you're sedentary,

your body says, well, you know, I don't need to make much testosterone. Right? So hunters had high levels of testosterone because you're out on the field spearing boars and taking down stags. Farmers had less testosterone because you're dropping seeds into the, I don't want to insult farmers, it's hard work, but it's not like hunting boars. But people that are sedentary, their body's smart. It only is going to make what it needs. And so your body says, well, I don't need

to make much testosterone. And then you're obese and fat aromatizes testosterone, so it turns testosterone into estrogen, so you get man boobs, you become more feminine, you have less libido. And so these are some of the things that contribute to erectile dysfunction. So not eating well, not exercising. It's a known fact that when you exercise more, your testosterone level goes up. It's a known fact that when you exercise more, your testosterone level goes up. Anything that hurts circulation, smoking, drinking too much,

all these things when you're in your 20s or 30s, you can get away with it. But when you're in your 40s or 50s or 60s, you can't get away with it anymore. So I think we kind of realize that having excess body fat on us isn't healthy. But I think what you're alluding to is really interesting. And I think that people need to take it more seriously because I've heard a stat more recently, they believe that 50% of the population will have Alzheimer's or dementia by like 2030. And 2030 is like- It's not too far away. It's here. It's around the corner so uh we don't want to fat shame anybody and this isn't always about aesthetics not always about what you look like um and it's not about being single digit body fat necessarily but you do need

to figure out a way to take care of yourself and a way to uh just not over consume what's something that you preach to um your patients on how they can kind of manage and control the energy they consume every day? Yeah. So, you know, in my experience, and I take care of men, right? I don't take care of women. Women are a little bit of a different dynamic, and these are all generalizations, but guys respond to statistics and numbers. And so I have a body composition analysis machine, and I put every one of my patients that comes in on numbers. And so I have a body composition analysis machine and I put every one of my patients that comes in on that. And guys look at the numbers and they sort of,

I mean, if the numbers aren't good, they kind of freeze up. Because now I'm showing you exactly what the problem is. And a lot of my patients are over the age of 40 where you're in a catabolic stage of life, right? So in your teens and 20s and 30s, you're in an anabolic, you're muscle building. But after about 25, if you look at the record for powerlifting, I'm sure it peaks out at about 25. And after that, it slowly drifts down. And then after 60, it really accelerates.

Powerlifters are able to hold on to their strength for a pretty long period of time. It's actually kind of weird. They're able to be pretty strong later on in life, but you're right. The most vibrant, strongest people in the world in some other sports like sprinting and stuff like that, your luck runs out after you're about 30 years old.

Yeah, absolutely. And so really, there are a couple of things, a couple of graphs that I show patients. First of all, I show them the world record for the hundred yard dash and it's pretty flat from 20 to 60, but after 60, the slope changes. And after 80, the slope changes really dramatically. And so you have to prepare for that. You know, you have to know that you can't go on like that forever. And the thing is, people don't really understand that because they're looking at the changes that occur in life from 20 to 60. And so they think, oh, well, for example, from 25 to 40, you hardly lose any muscle

if you do things right. From 40 to 70, you lose 0.8% of muscle per year. And after the age of 70, you lose 1.5% of your muscle mass per year. And that's unavoidable. Whether you're Mark Phelps or the top power lifter in the world, you're not going to be as strong when you're in your 60s or 70s or 80s.

And so really what I wrote the 21st Century Man and what I've dedicated my career recently is to help men live better lives in their 50s, 60s, 70s, and 80s, both physically in terms of muscle mass and in terms of testosterone replacement, and then also in terms of things in the bedroom and helping men understand what they need to do to improve circulation, improve sensation, improve orgasm, improve ejaculation

into their 60s, 70s, and 80s. You know, since you mentioned circulation, it has me kind of curious because there's been a lot of studies on longevity and sauna, especially in Swiss countries. Do you know anything about how sauna could be beneficial if it is, since it does like speed up blood flow since you're sweating a lot? And do you know anything about how the effect of cold would potentially have

since it constricts blood flow, if there's anything there or I'm just, this is just an offshoot, but I'm just wondering if you know anything about those two things. Yeah. To be perfectly honest, I don't, I don't know almost anything about those two things. It's okay. And, you know, so, I mean, you guys are physical specimens.

And you obviously work really hard on doing that. And probably a lot of your listeners are kind of the same way. And so it's really interesting when I talk with biohackers and I talk with, you know, you're looking at the top one or two percent of stuff to get to that next level. You know, whether it's near infrared light or PEMF or vibratory platforms or, you know, yeah, or like, you know, supplements and so on and so forth. But, you know, the 98, 99 percent of the rest of the population isn't as, I wouldn't say fortunate, because you guys work really, really hard to get where you are. But that's not their problem. And sometimes people get confused. Like I had this patient that came in.

He actually flew from Florida to see me for a study that I'm doing. And he was talking about, well, you know, I take this peptide, and I take thymus and alpha-1 and this, and I'm like, dude, you're 50 pounds overweight. Start with the basic stuff. Eat better, exercise more, lose the weight, and then when you get to that 98, 99th percentile of what you should be doing, when you get to that 98 99th percentile of what you should be doing then you can go thymus and alpha-1 and bp-157 and all these other peptides that are sort of biohacker type stuff what are some things that you've seen that maybe surprised you that were like i wasn't really expecting that it would be like this one thing that would help this guy with something like erectile dysfunction

was there anything like that or is it almost always like this one thing that would help this guy with something like erectile dysfunction. Was there anything like that? Or is it almost always like seven or eight different things, like somebody fixing their sleep along with a lot of other habits? That's a great, great question. And I have an algorithm that I use. Because the 21st century man kind of came out of my approach to erectile dysfunction. Because it's really a holistic approach. And when you're in your 20s or 30s, getting an erection and having sex is different than if you're in your 50s or 60s or 70s. It's almost like a Maslow's pyramid. You know that

Maslow's pyramid, right? So for someone in their 50s or 60s or 70s to be having a lot of physical intimacy, you have to get to the top of the pyramid and the bottom of the pyramid is physical condition, right? So if you don't take good care of yourself physically, but then also you have to take care of yourself mentally. So you can't have a lot of anxiety, you can't have a lot of depression.

And then you have to take care of yourself emotionally. And then you have to take care of your relationships, right? And if you do all that stuff, then you're up at the top of the pyramid where you're having a lot of physical intimacy with your spouse. So it's really different than it is when you're in your 20s or 30s. But in your 20s or 30s, that's when you really lay the groundwork for what you need to do in the rest of your life. really lay the groundwork for what you need to do in the rest of your life. Where does like libido and erectile dysfunction cross? I'm curious because like when like I've I've taken stuff that I shouldn't have been taken and when coming off of them like yeah I had erectile dysfunction for a little bit but my libido was still there like but it just I couldn't

get it to work so like at what point like can you like boost your libido and still there, like, but it just, I couldn't get it to work. So like at what point, like, can you like boost your libido and then will that fix erectile dysfunction? Or is it like the opposite even? Yeah, that's a great question because there, that's where two things kind of intersect. So testosterone really drives libido,

right? And erectile dysfunction or erectile function really is a function of blood flow, but there is some crossing of those things and i i've actually seen a fair number of i wouldn't say bodybuilders but but uh younger guys that have played around way too much with testosterone yep right and so i'll i'll use the example of my son which you, my son's 15 and a half and he's probably been mentioned too much in some of these podcasts. But two, three years ago, he was 12 or 13 years old and his testosterone was probably 200, 300.

Right now he's right in the middle of puberty. He's 15 and a half. His testosterone is probably 900 or 1,000. Have you ever gotten him tested? No. Like you tested your son's test. I'm going to test my son for sure. Every year, huh?

Yeah. Well, once he gets a little bit older, but he's definitely getting tested. And he's building muscle like crazy. He's growing. He's so on and so forth. And so these football players and these athletes, if you're a football player, your testosterone is probably going to be 1,000 or 1,100, right? Because you're running around hitting other people. And so your body is going to say, geez, I'm in battle. I need more testosterone.

say, geez, I'm in battle. I need more testosterone. So I bet you if you took the testosterone levels of NFL players, it would be a thousand or 1100. So in order for you to get an advantage as a professional football player, you have to push your testosterone to 2000 or 2500 or 3000. I had a patient the other day, his testosterone was 3,300. He was using exogenous testosterone, correct? Yeah, absolutely. Okay. Absolutely. And so, you know, I mean, that's crazy.

And then, you know, the medical establishment obviously kind of frowns upon that. But the problem is we don't bring our expertise into that helping people that want higher testosterone to build muscle you know and i'm not making a value judgment on that that just is the way it is and so then i asked this guy i was like well you know who gave you advice on testosterone he's like well there's this guy big mike and so these poor guys are getting advice from Big Mike. Big Mike might know a lot of stuff, but he hasn't gone to medical school and done residency and studied like a lot of us have.

And so I really focus on getting testosterone optimized, but not super optimized. And so testosterone really drives libido, but also, you know, you have to have your mental health in good place. So if you're depressed or anxious, you're going to have poor libido. You know, there's a chapter in the book on work-life balance or what I call the work-life pendulum, because I've never actually been in balance. You know, either I'm working too much or I'm spending a lot of time at home, but I feel like I'm not making enough money. So you have to have

that all in place. And then you have to have good relationship skills, good communication. There's amazing chapters in the book written by a family therapist on communication and marital therapy and so on and so forth. And so you have to have all those ducks in a row in order to get the feeling like you have the possibility of physical intimacy with someone, and then your libido definitely goes up. Now, erectile function is something that's totally different. Erectile function is a function of circulation, of blood flow.

On that note, erectile function. We had a guest, Joel Green. We love this guy. We've had him on multiple times, but he talked about the morning boner test. He was like, if there's a certain point you don't get a morning wood anymore, you may want to take a look at something.

So I'm curious about that. But also, along with that, Susan came and she talked to us about the penis pump. We also had another guest that talked to us about it before, but we have used it. We've talked to our audience about it. Some people like I've, it's benefited me and some people in the audience have like purchased it and they've talked about how it's been beneficial for them. But I'm curious, what is, what is your opinion on that?

Because some people say it doesn't work at all. Some people are like, oh wow, it does help. And with all your talk about blood flow, vascularity, all of that, what does it do? Yeah, that's a great question. And also I want to get back to morning erections because that's really a fan. You guys are brilliant. I mean, you guys are totally on point. You guys have done your homework. So penis pumps are really interesting. And to be honest, I don't think someone, you know, guys that are in your physical condition would benefit tremendously from penis pumps. Okay? I mean, it's great that you do.

For me, in my medical practice, I use penis pumps in men that aren't getting nighttime erections. Ooh. I use penis pumps in men that aren't getting nighttime erections. So when you're younger in your 20s or 30s or 40s, whatever, you should be getting 30 to 60 minutes every night of nighttime erections. So anytime you dip into REM sleep, you should be getting erections. And REM sleep will last five or 10 minutes, and you should be in REM sleep three to six times a night. So 30 to 60 minutes of, of erections. Right. So, and I explained that as, have you ever seen that TV show naked and afraid once? Yeah. It's a great show. You can learn so much good stuff. Right. But have you ever seen the two contestants? You know, you got a young, hot woman and a good looking, muscular guy.

And they drop them in the jungle in Belize and no clothes. You know, you got a machete and a fire starter. That's it. Right. You'd think, wow, they should be hooking up all the time. Right. You know, they're in the jungle, but they never do. You know, they're in the jungle, but they never do. How come? Because they spend all their time getting food, building shelters, swatting mosquitoes, keeping themselves safe. That's the natural state.

That's evolution. That's what we all do. And so when do they actually get an erection? When they're asleep. When they're asleep when they're asleep right that's your that's the good lord's way or mother nature's way of sending our our genitalia to the gym right that's cool okay yeah yeah okay so if you're in your i see a lot of diabetics type 1 type 2 diabetics right these guys they typically come in in the late 40s and they're not getting erections anymore.

And, you know, diabetes affects small blood vessels. Right. So they get problems with their eyes because they get small blood vessels in their eyes. They get problems with the kidneys because you have small blood vessels in the kidneys. You have problems with your feet. Right. Neuropathy and vasculopathy in the feet because you get small blood vessels in the feet. And guess what? There's small blood vessels in the penis. So diabetics get erectile dysfunction, right? And so they're not getting nighttime erections.

I give those guys a penis pump. 10 minutes in the morning, 10 minutes at night, right? Otherwise, what happens to the penis? It shrinks, right? So the tissue, the penis is a vascular organ. It's the only organ in the body that moves entirely based on blood flow. Right, and it's the only organ in the body with skin, but no muscle. Right?

So how do you move the penis? You fill it up with blood. And the lining of the erectile body is called the tunica. Right? When you cut that open, sorry. the tunica right when you cut that open sorry when we put penile implants in like uh diabetics or guys that have uh have prostate cancer surgery right the tunica is twice as thick as the aorta so back when i was doing general surgery we'd cut open the aorta to put the aortic grafts in um you know so why would the tissue in the penis be twice as thick

as the largest blood vessel in the body? It's because it has to withstand high blood pressures and it gets banged around a lot. So if you fracture the penis, if you break that tunica, you're not going to be able to procreate. So nature favored. Are you going to be able to procreate so nature favored are you going to be okay do you want i'm fine just like just like morbid penis talk just gets me a little bit i'm good do you need to sit down or i looked up tunica i guess i just wanted to

get a visual i get you some water i'm good i got it right here you got the vapors i'm leaning on the desk so you won't even notice you won't even notice sorry sex injuries oh hey but how often do people come in with sex injuries i'm just curious every valentine's day oh really every time i'm on call on valentine's day you can ask my poor wife she hasn't had a good valentine's day in years because like somehow i find myself on call and either someone like has a priapism or a fractal oh priapism is where um you get an erection that lasts too long oh they took some viagra or something like that yeah viagra actually you know that's actually a gimmick. Oh, really?

If you have an erection that lasts for more than four hours, please call your doctor. So that's not... All my patients are like, if I have an erection that lasts more than four hours, you're the last person that I'm going to call. But guess what? If it lasts more than four hours,

you're going to come in. Oh my God. There's some medications that will do that. if it lasts more than four hours, you want to come in. Oh my God. Okay. Yeah. I mean, there's some, there's some medications that will do that. There's a sleeping pill called trazodone. Cocaine can actually do that.

Oh. And usually it's a sickle cell anemia. You can, you can get that. Unfortunately, people that inject medication into the penis because they've lost the ability to get an erection. So,

yeah, I'm sorry. I forgot what the question was. We were talking about Valentine's day. But we were talking about penis bumps, penis bumps. Yeah. Yeah.

Okay. So, yeah. So it's exercise for the penis, right? And you stretch the tunica. Because when you ask a guy how long his penis is, he's not going to say, oh, it's like three inches

because that's what it is. And when it's flaccid, he's going to say, oh, it's six inches. Or he's going to lie, so he's going to say it's nine inches or 12 inches. Got to drown with a ruler dick. Yeah. Because my guys that are 60s,s 70s 80s and that come in all complain that their penis is shorter than it used to be and it's because they're not getting nighttime erections because they're not getting that stretch but the other thing is inside the

tunica you have uh like spongy tissue right And what happens if you clean your car and then you leave your sponge out in the Sacramento sun over the summer? It gets constricted, right? And so when blood flows into the penis, it has to open up that constricted vascular tissue so that then the sinusoid, sinusoids are like the little spaces on the inside of the penis,

can fill in with blood, right? And so it's all about how much blood pressure you can push into the penis. And if you want me to go into a little bit more detail on how you achieve erection and why circulation is important, I'm happy to do that. Yeah, go for it. Let's go. All right. So your heart pumps, right?

And the two last places they get blood are the toes and the penis. That makes so much sense. Yeah. But you don't get toe erections, right? Yeah. So as the blood flow decreases, at least I don't. There was that Eddiedie murphy movie yeah i was thinking boomerang yeah boomerang yeah wait he got a toe erection no he just kept looking at the feet all the time it's a big thing yeah there's a big red flag if her feet were wrecked isn't there something about

like uh foot fetishes and something in the brain? Probably. I would imagine so, yeah. You know what? We're going off topic. Erections. Toe penis. Okay. So as the blood pressure to the feet decreases, you get cold feet.

And so you put socks on. End of story. Right? But the penis is different. As you push blood flow into the penis, it fills up those sinusoids. And the deep cavernosal artery, the main artery to the penis, sits on the inside of the erectile bodies. And arteries have muscular walls. So they're pushing blood into the penis.

Now, it fills up these things called sinusoids little chambers right and then those chambers drain blood on the outside of the erectile body but veins in your body have thin walls right so they're easily compressed so veins don't pump blood it's more of a passive flow so as you achieve a certain level of blood pressure in the penis, you block the backflow of venous blood, and you trap the blood in the penis, and that's what gives you a rigid erection. Because the goal is to have sort of penetrative intercourse.

So think of it this way. Like you're on a tall building building and the building's on fire and there's another building that's six feet away. So you want to jump six feet to get to the other building. Now, if you jump six feet, it's a good day. If you jump five feet, it's a long way down. So think about it like in the penis,

you want to get 100 millimeters of mercury of blood pressure. If you get 95, it's going to be a frustrating night. And so I've built these algorithms around boosting blood flow to the penis so you can get to the point where you lock that blood flow in and you get a rigid erection and you can have penetrative intercourse. So physical intimacy in sex doesn't always revolve around penetrative intercourse, but in our society or whatever, that's sort of the goal. Now, last question about this maybe.

You said that when you have people use penis bumps, it's usually patients above 40. Maybe they're having some level of erectile dysfunction. But you also mentioned it's like exercise for the dick. Now, for individuals that are younger, that are 20s, 30s, is there a benefit there for them in the long term of using it periodically, once a week or whatever? Is there a long-term benefit or is it null? Yeah. Well, you know, you have two alternatives.

You can either use a penis pump or you can have sex. Well, yeah. Sex is great. I mean. Yeah. So, I mean, I guess you could do both, but if you're getting 30 to 60 minutes of erections every night and, you know, you're using it with your partner, that's probably more than enough.

Now, the other thing is, so I do a lot of clinical research. And one of the studies that I'm doing right now, it's a really, really exciting study, which is going to sound really goofy, but it's called the P-LONG study. And it's a penile elongation study. Well, not just elongation, enhancement.

So it improves both the length and the girth of the male penis, right? And to be honest with you, I could care less how long guys' penises are, right? But as a sexual medicine expert, I see a lot of patients come in who have done things that they regret. So you can get fillers put in your penis, hyaluronic acid, Juvederm, those kind of things. Are you going to be okay? I'm fine. I'm just thinking of it, man. I'm really concerned about you.

My face is very emotive. I can't do anything about it. So I hear things, I act them out for some reason. But yeah, I'm going to be fine. I have my water, I have my electrolytes. I will not think, I'm going to be fine. I have my water, I have my electrolytes. I will not faint. I'm going to send you flowers tomorrow. Please do. I'll give them to my lady.

Alright, so they get fillers. By the way, these fillers, what do you mean? You know that same stuff that people get injected in their lips and their cheeks and all that kind of stuff? Botox? I know they do that too, but this is different. Botox is a neurotoxin. So this is like

you ever see movie stars and their face looks this kind of They turn into a cat. They look like the same thing. The same beast. Yeah. You know, as you get older, you lose fat, you lose skin tone,

so on and so forth. So if you plump out a face, it looks younger. If your job is to be presentable on screen and you're making millions of dollars for a movie or whatever, then you get that kind of stuff. But it's expensive. Five, ten thousand bucks to get

the filler injected into the penis and it lasts for a year or two and then you end up with a lumpy, bumpy penis. Oh. I love it. Lumpy, bumpy penis. Just like a little sack of potatoes down there. Yeah.

What else? Like you're going to list off a few other things. Yeah, yeah. No, well, there's fat transfer. So instead of fillers, you can use autologous fats. So you get liposuction. They spin it down and they inject the fat into the penis. Not into the erectile body, but under the skin, but above the erectile body.

But fat feels like squishy. So you can finally say, I got a fat dick. Well, see, that's the other thing, is you don't change the shape of the head of the penis. So I call it a pig in a blanket penis that's a good visual all right oh god and then so then then there are other things you can use so there's traction devices and there's actually some data on the use of traction devices but most traction devices you have

to keep them on for nine hours a day for about six months. Like a bib hanger? Have you heard of that? No. Traction devices, when you say traction device, it pulls, right? Yeah, it pulls. But it's on an actual thing you put your dick in

and it holds it down and stretches not like a bib hanger. Yeah, and there it's on like an actual thing you put your dick in, and it holds it down and stretches, not like a bib hanger. And there's actually like a half dozen or more of them out there. I know you like to pull stuff up on. But although you might have a porn filter that gets blocked. Oh, we have no porn filters here. I had my computer guy. I used to be, still am, sort of a sexual wellness advisor for Pornhub. And so to look and post my articles, there's like a whole non-pornographic section.

Like, don't look at me funny because... I'm just there for the articles. That's it. I'm just there for the articles. There's a blog section. You were like, then Steve was like, damn, what does he look like

with no clothes on? This is going poor. I'm surfing through the name. What videos has he got posted here? They're all totally clothed. All like really good, high quality information. 4K?

4K. Yeah. All right. Can't you like watch regular movies on there? Sometimes I saw Black Panther on 4K. Yeah. All right. Can't you like watch regular movies on there? Sometimes I saw Black Panther on 4K. I'm serious. I'm serious.

Like what version of Black Panther did you see? No. Not the porn version. Black Panther. It was like, yeah, it was years ago, man. They had it on there before it came out on DVD, so I watched it. That's the one with the three black dudes. Before you said Black Panther. Black Panther. there before it came on on dvd so i watched it that's the one with the three black dudes i should hang out with you guys more often anytime oh god so here's the bib banger so whoa yeah i know it looks pretty mad

like okay but the problem is right right, that's only length. Right. So then you get a pencil penis. Oh. Right? So you don't want pig in a blanket, and you don't want pencil penis. And then there are actually two surgeries that are done. One is to cut the suspensory ligament.

So the suspensory ligament hangs the penis from the pubic ramus, so the underside of yourory ligament hangs the penis from the pubic ramus so the underside of your your pubic bone right and that's to help you elevate the penis when you get an erection so if you cut that then the penis hangs lower but then over time you develop scar tissue so then the penis kind of pulls up just leave your penis alone please yeah exactly and then the final thing is there's a there's a what's called the elist implant which um is kind of like a silicone taco that they put under the skin so you don't need a partner anymore yeah what's it called elist implant e-l-i-s-t uh and that's a guy in beverly

hill so you have a surgeon in beverly hills be careful. But he's actually a very good surgeon, and it's kind of an interesting idea. But I've seen three guys who've had them taken out, and you end up with a mass amount of scar tissue. And it doesn't improve erectile function. And so as a regenerative urologist, I use a lot of PRP, platelet-rich plasma. Oh, yeah.

And platelets are amazing little gizmos, right? They have two functions. Everyone knows the first one, which is to stop bleeding. But if you ever wondered, like I was always a curious kid, like why when I cut myself does that area of skin grow back and the rest of my skin stays the same? And it's because platelets are filled with growth factors, 140 different growth factors in platelets. And so when platelets arrive

and cause a clot, they also release their growth factors and it accelerates or begins the process of regrowth. And so PRP is used for hair growth. It's used in orthopedics and shoulders and knees and joints. It's used in dental surgery. And then a friend of mine, Charles Runnels, decided to be the first person to inject himself with PRP in the penis. And then he trademarked the P-shot, the O-shot, and the vampire facelift. So you do microneedling on the face, so it creates little punctures, and then you put some PRP in there, it accelerates the regrowth.

And actually Charles wrote the chapter on PRP in The 21st Century Man. Wow. Do people use stem cells as well, or is that something different? Yeah, and there's an amazing chapter on stem cells in The 21st Century Man too, because people throw that term out.

And I'm not saying that you don't know what stem cells are, but stem cells are a really, really complicated subject. I don't know what they are, really. of orthopedist and he wrote an amazing chapter on stem cells that explains exactly what stem cells are where they come from different places you can get them than what exosomes are and amnio is and wortons jelly and placenta and bazenkyl stem cells that whole thing um uh it's a you know i could explain it but it's it's really really well done in that chapter. And it explains sort of macro to micro. Because the thing is, we're told what to do, but my patient population in San Ramon in Northern California is really smart because I'm close enough to Apple and Google and Facebook and Lawrence Livermore Labs and Oracle. And in the Bay Area, you've got a lot of really, really smart people and engineers. And those people, you have to be able to explain to them. You can't just give them a pill and say,

take this, you'll do better. They're like, no, why? How does it work? And so I got really good at explaining really difficult concepts to people in a way that they can understand. And so I got really good at explaining really difficult concepts to people in a way that they can understand. And so in the 21st century, man, so many things are explained macro to micro. Like even something like sugar, right? You ask someone what sugar is. Oh, you know, it's something I put in my breakfast cereal. But, you know, I explain sugar as on the second day of genesis there's let there be light you know the sun sun is the source of all energy on this planet and then

trees put up leaves that have chlorophyll that capture the energy of the sun and they have to find a place to store that energy so what what do they do? They create glucose, right? They create sugar. What's the purpose of sugar? Sugar is, the purpose of sugar is to capture energy, right? And then along come animals, and we eat that sugar from plants, and now we have that energy. So it's, I don't know how I got on this subject, but it's the way that i understand difficult subjects is kind of what is the the overall arching purpose before you get down into those little details of you know like

what kind of food should i eat how does a okay yeah yeah so we're talking about the the p long study yeah right so i was like just depressed for all these patients because i really honestly care about my patients and i care that guys are doing things because of their insecurities, whatever, because most of the guys that get these surgeries have normal-sized penises. And so I developed the P-Long study, which is a totally safe, lower-cost way

to grow the penis symmetrically. And so we use high concentration PRP. So we draw 60 cc's and I have an orthopedic grade double spin centrifuge. And then we use a traction device from the Mayo Clinic called the Restorex. And we use a penis pump from Dr. Joel Kaplan. Because the thing is, you want to increase the length of the penis, but you also want to increase the length of the penis, but you also want to increase the girth of the penis.

And then to boost circulation, we use my Affirm nitric oxide boosting supplement, right? Which has both the L-citrulline. So there's really two ways to boost nitric oxide. One is through the citrulline pathway and the other is through the nitrate pathway, which is like why people take beets. Wow. And what were the results of the pilong study yeah so we're actually um i'm going to probably present the results at the international society of sexual medicine so there's actually a bunch of doctors who are crazy like me that you know do research in sexual

medicine yeah and um and so we're actually closing in a week for people to join the study so we can have all our results by that time. But thus far, we've gotten almost an inch of length, about three-eighths of an inch of girth. And then by definition, everyone that's in the study has to have relatively normal erectile dysfunction. So I don't want guys with erectile dysfunction because, of course, their penis is going to be shorter because they're not getting full blood flow. But everyone in the study has remarked that they have had better function. there was a really good double-blind placebo-controlled study out of Greece that looked at PRP and erectile function and shown clearly that PRP, two injections of PRP improves erectile function.

You know, and we're doing six. And actually most of the folks that are local that have been in the study that have completed it have continued to come in for more PRP and are continuing to do suction and traction. So, you know, I'm not curing cancer, but... Mm-hmm. Progress. Progress. When we talked about this a little bit before we came on, but, you know, a dick injection, it's scary.

That sounds scary to me. Very uncomfortable. Now, you said you don't put people under. What is the process? Do they need to be hard when you inject them? Do they need to be flaccid? How big's the needle?

First, we strap them down. Honestly, I would need to be strapped down if you did this to me. But yeah, what's that process like? Looking at you, first we strap them down. Honestly, I would need to be strapped down if you did this to me. Because, yeah. But yeah, what's that process like? Looking at you, I would strap you down. Yeah. No, to be perfectly honest, I use a 30 gauge needle.

So what's? The 30 gauge needle is like the smallest needle. Pretty much the smallest needle you can get. In fact fact most people say that it hurts more to do the blood draw in the arm because you're using an 18 or 20 gauge needle which is a bigger needle um and then i i've developed actually because i try everything in my office on myself first you know because first of all i'm 54 right so i'm not like a spring chicken anymore and second of all i have to understand how something works and how it feels you know i

have a bunch of videos in my uh on my youtube channel on uh me getting prp for my hair um you know by the time i started doing PRP for my hair, it was kind of too late. I was, you know, I have androgenic alopecia like most guys. But I, you know, I'd lost too much hair for it really to make a difference. But I wanted to show my patients that I do it myself. And I wanted to see that how much it improved my,

you know, how much hair I had. So it improved my hair density about 30%. So I was comfortable then offering it to my patients. You know, same thing with shockwave, same thing with, I do Dysport, which is kind of like Botox for the face. And I injected PRP in my penis, right? You know, so I was, we got the new machine. I was the guinea pig.

I've done it, I don't know, so I was, we got the new machine. I was the Guinea pig. I've done it, uh, I don't know, two or three times. And, uh, and I developed a technique injecting on myself where guys don't wince or flinch at all. Wow.

Yeah. What's the recovery like? Oh, there's no recovery. You can just go have sex that night. Uh, we, we recommend not.

Okay. But the next day, no problem is there like a minimum age that you would recommend how old are you i'm 36 uh 37 36 and a half yeah no i'm just curious no no uh no i mean not really because i'm just thinking like i mean i'm not saying like i'm still going to be growing you have a friend right yeah i have a friend who's about 36 years old that's considered not just joking but like yeah i just don't want i mean like if everything's still healthy and good like is there's probably no reason to get it other than like vanity i guess yeah well you know for guys that want a larger penis i wanted to make something that's totally safe with absolutely no negative side effects, right?

PRP is basically, we take blood, we spin it, 10 minutes later, we inject the platelets that are yours back into you, into a vascular space, right? So there's no, and then I use a 30 gauge needle which is like the tiniest needle uh and so there's really no negative effects of that yeah and then penile traction penile suction totally safe a nitric oxide booster like a firm totally safe it's got tremendous benefits in terms of most elite endurance athletes. I know a lot of weightlifters use it in their pre-workout stack, or they use citrulline or they take beets.

It improves brain flow, brain blood flow, so it improves brain function. It's good for immunity. I mean, it's well proven that nitric oxide boosters are one of the best. That and creatine, creatine monohydrate are one of the best, you know, that and creatine, creatine monohydrate are the, pretty much the two supplements that have by far and away the most data. Does anybody have a like penis dysmorphia? We hear about that with bodybuilding people that bodybuild that get jacked and get big.

They don't realize how big they are. They think they're still small. Have you had guys come in and they're like hung like a horse and you're like, bro, you know, I don't know if you know what you signed up for here. We're not trying to shrink it. Yeah, I mean, listen. 300,000 women a year get breast implants.

No one's shaming them, saying, oh, your breasts are big enough. You shouldn't get breast implants. It's a personal choice. As long as you're not hurting yourself and you're not using federal tax dollars, that's your own personal choice. So I just wanted to make sure that people weren't hurting themselves doing that. And there are folks, there's always folks out there that are looking to take advantage of people's insecurities and selling them stuff that has negative consequences. And I saw just way too many of those folks coming through my office. And I just said, listen, I have an idea of what we can do. But I have a strong research background.

So I did research at American Red Cross with Harold T. Merriman, who's the guy that figured out how to freeze blood. So you can't just take blood and put it in the freezer. You got to prepare it because water expands when it's frozen. So red blood cells will pop. So you have to prep the blood with osmotic agents so it doesn't pop. And then I did research at Harvard Medical School with the folks that did the first living related kidney transplant and won the Nobel Prize for that in transplant immunology. And then I did research at UCLA. And so I decided, let me do some research on these kind of things. So I actually presented a paper two, three months ago using technology

we'll take a look at later called HIFAM, High Intensity Focused Electromagnetic Waves, we'll take a look at later called high fam, high intensity focused electromagnetic waves, which, uh, improve the intensity and duration of ejaculation in men. Let's go. So,

uh, well, you know, if you guys come visit my office and I'm going to extend the invitation to come to Brandeis MD, I can, I can show you that it's one of those things where you actually have to be on it to understand how it works.

Just like the M-Scope. I can explain to you until the cows come home what the M-Scope feels like, but I want to see the expression on your face when it kicks in. I'm sorry. When you say be on it. Yeah. You said this machine increases the amount of, not ejaculation, but the length of orgasm, right? Right.

So how does one get on this machine? Yeah, so it's actually just a chair. It just looks like a fancy chair, but you ever heard of Kegel exercises? Yeah, I was going to ask you about that. To strengthen the pelvic floor, right? So really you're strengthening three muscles. One is the pelvic diaphragm or the pelvic floor that hangs off the the pelvic brim okay but then there are other two other muscles that are really important

one is called the ischiocavernosis and the other is called the bulbocavernosis muscles right and so when you strengthen those muscles right when you orgasm you get right, when you orgasm, you get contraction. So when you orgasm, a couple things happen, right? So first of all, the bladder neck closes so that you don't shoot the semen up into the bladder, right? Okay. Then you're going to be okay? Yeah, just laugh. All right.

Just internally laughing. Yeah. We're kids. That's okay. Anyway, continue. He said penis. Hey, man. If you say it like that, you're going to That's okay. And we continue. He said penis. Hey, man. You say it like that,

you're going to make me laugh. You're doing this to me right now. All right. You guys watch too much Beavis and Butthead. That was a good show. It was. It was decent. Yeah.

Okay, sorry. I'm having some Beavis and Bloodhead flashbacks. Okay. So your bladder neck closes, and then you have this thing called the seminal vesicle, right? So vesicle just means like a vessel, like something to hold. So it holds the semen, right? And semen is mostly fructose, mostly sugar, right? So it supports the sperm on its journey to the egg, right? And so the seminal vesicles squeeze, and that's about 80% of your ejaculate.

And then your prostate, and that's the more yellowish part of the ejaculate. And then your prostate makes fluid, and that's about 10%, 15% of your ejaculate. So there's like little prostate glands that makes the whitish part of the fluid. And then the vas deferens, which is where you store the sperm that's ready to fertilize an egg, also contracts. So it pushes about 5% or 10% of the fluid into the ejaculate. That's why when you have a vasectomy, you don't lose ejaculation because that's only a small amount of the total ejaculate. So basically then you push that fluid into the prostatic urethra. The bladder neck is above, so that closes.

And then your urethra goes into spasm, right? And there's this coordinated spasm or contraction of the ischiocavernosis and bulbocavernosis muscle and the pelvic floor. And that pushes the fluid out. And as you get older, those muscles get weaker, right? And you're not using them as much and muscles atrophy as you get older. And so guys either have severely delayed ejaculation or they lose the ability to ejaculate. And I had a patient the other day, 65 years old,

hadn't had an ejaculation in five or six years, right? Like normal guy, you'd look at him and you'd be like, wow, this guy's in pretty good shape, you know, normal guy. I think he was an attorney. You know, and he, after six or seven treatments with the Emcella device, you know know I saw him and he just had this big smile and he came in and he hugged me and it was like tears in his eyes

and he's like you know I was able to ejaculate and have orgasm for the first time in five or six years and you know that's a big deal and that's you know that's just part of life you know we make jokes about it and stuff like that and we're ashamed or judged about it but no one in my office shames anyone judges anyone these are things that happen

to us as we get older i get a lot of guys who are younger who are diabetics you know and they just have diabetes and there's nothing they can do about it and it's to bring that back to someone's life, really, it's a blessing. What's the deal with this sound wave jackhammer thingy? Yeah. That's actually a really fascinating thing. So they discovered that technology during World War II. So soldiers were in the water after bombs exploded

and stuff like that, and they were trying to blow up submarines by using depth charges. And usually when you see movies or something like that, you see shrapnel going out and people getting injured or killed by shrapnel, but there's actually a shock wave or a pressure wave that occurs during an explosion. or a pressure wave that occurs during an explosion. And that's what kind of was injuring these Navy soldiers that were in the water is that intense energy wave was causing massive internal injury. And then in the 60s and 70s in Germany,

they figured out that you could actually focus those waves and use it to break up kidney stones. And so as urologists, we use it to break up kidney stones. And so as urologists, we use that to break up kidney stones so that we don't have to put a scope up your penis and use a laser and break up a kidney stone. It's a much more humane way of doing things. It's not primarily just for kidney stones, right? Well, focused shock waves is for kidney stones, right? Well, focused shock waves is for kidney stones, right?

But if you turn down the power, what you can do is you can trick the body into thinking that there's an injury. And what happens in the body when there's an injury? You get an injury response. And what happens in an injury response? One, you get an upregulation of stem cells. Two, you get a release of growth factor, vascular growth factor, keratin growth factor, platelet growth factor, all those kind of growth factors. And then you get neoangiogenesis, the growth of new blood vessels. Right?

And how do we know this? Because these are hard studies to do, right? You're not going to take a bunch of 70-year-old guys, do shockwave therapy, and then cut their penises off and see if – So there's actually at UCSF, there's a doctor named Tom Liu who did this acoustic therapy on rats and then cut the penises of rats off. So if you're actually going out to dinner in San Francisco and you see a bunch of dickless rats, you can thank them because they participated in these studies. Bro, those rats are going to come back and... That's some fucked up thing, man.

You might as well just like, oh, well, keep on. But that's how we know how it works. There's this kind of urban legend, for lack of a better term, that we break up the calcium in the plaques of the arteries, and maybe that's how it works also, but no one's ever proven that. So I'm like a very data-driven person. I won't say anything unless I can actually prove it. And so I can prove to you that in rats,

the way it works is you upregulate stem cells, you upregulate growth factors, and you grow new blood vessels. Wow. Is it similar, because there's a device that Susan told us about called the Phoenix. Is that what that device, do you know that device? Yeah, I know the Phoenix really well.

Okay. How know that device? Yeah, I know the Phoenix really well. Okay. How's that work? Yeah, so they're making a claim that it works as well as a radial pulse wave device or a shock wave device. And that's a lot of physics that I don't want to bore you with. That's a lot of physics that I don't want to bore you with. But they've actually never tested it, to my knowledge, to see that it works as well as anything else. So the numbers that they throw out in marketing aren't substantiated by any studies that they've ever published in the literature. They say, well, only 2% of people return the device. Well, that doesn't mean 98% of people, it's working.

It just means that a large percentage of people are too embarrassed or ashamed to send something back, which is basically saying that they have erectile dysfunction. So I can't say that it works, and I can't say that it doesn't work. At some point, they actually contacted me about running the clinical study to see that it works because they want to get it FDA approved. So the short answer to a long answer to a really, really good question is nobody knows if it works or not. Okay. What about sleep apnea? Because we talked about sleep and how important

that can be and that we're supposed to kind of have these erections in the middle of the night, but what if we're not getting the right kind of sleep or good quality sleep? That's a great, great question. I saw a patient 42 years old the other day, couldn't get an erection. And I kept asking him like, you know, well, are you smoking? Are you drinking? Are you, you know, are you eating bad food, whatever? And then I said, well, you know, how do you sleep?

Oh, I sleep terrible. You know, I haven't gotten a good night's sleep in 20 years. And it was all about sleep apnea. So I sent him to a friend of mine, Mike Murphy, who's at the Stanford Sleep Center and we'll get him taken care of.

So, you know, that's the thing, and that's what is in the 21st century man is every aspect of taking good care of yourself physically, mentally, emotionally, and sexually kind of wraps up into being able to be physically intimate into your 50s and 60s and 70s. You know, since you deal with erectile dysfunction so much, you've probably heard about porn-induced erectile dysfunction. How often do you see that and what can men do to reverse that? Because that's happening in a lot of young guys, which is quite abnormal because they should be healthy enough to have a healthy erection. Yeah, absolutely. I mean, I think it's a huge problem. I see it a little bit, not that much.

But it's just like, and there's a chapter in the addiction section of the book on pornography. Okay. And I'm not an expert at it, but it's one those things where like you have to keep upping the ante like you know i used to drink half a cup of coffee a day then a cup of coffee a day and now a cup of half a now i now i need two cups of coffee in a day to kind of get me through the day right so then if someone hands me a cup of decaf, you know, it's not working. So like,

if you're used to seeing a man or a woman, then a man and two women, then a man and seven women, then a man. Yeah. Then with a, you know, a donkey and a rooster in a,

yeah. Now she has to have three titties. Yeah, exactly. So then, so then when like a normal woman walks into the room, you're like, well, you know, where's the rest of... You know, and it's hard for people to kind of get that turned on.

I mean, men get turned on three different ways, right? Visually, and then fantasy, you know, up in their head, and then by touch, right? But if you're not turned on visually or by fantasy, you know, up in their head and then by touch. Right. But if, if you're not turned on visually or by fantasy, because porn has spoiled that, you're probably not going to get to the point where a woman's going to want to touch you. And so that, you know, that's my, my sort of two cents on porn.

Gotcha. You know, I'm not saying all porn is bad. I'm not saying no one ever should look at pornography but back in the day I'm 54 I don't know how old you guys are but I would wait every year two weeks after the Super Bowl

when the Sports Illustrated swimsuit issue would come out and that was like our only pornography for the whole year seriously now any idiot can whip out a phone and you know sees a guy having sex with three donkeys i mean why are we talking whatever poor donkeys yeah poor donkeys no animals were hurt in the production of this podcast there

you go good yeah what about um so when sus was here, she talked about some of the supplements, you know, like the pre-long, spunk, all those good stuff. Can you tell us what pre-long actually does? Yeah, so premature ejaculation is kind of an interesting problem, right? Because it doesn't exist in nature, right? You don't have any squirrels

or dolphins or raccoons complaining about premature ejaculation, right? Should we have the dolphins, though? Because those dolphins would be wild, man. Yeah. Well, they say their women are more reasonable. Hey, you suck at shit. That's you. Well, they don't have sex for pleasure, right?

Yeah, they have sex for procreation, right? Wait, pause. Well, they don't have sex for pleasure, right? Yeah, they have sex for procreation. Wait, pause. Dolphins don't have sex for pleasure? They are. You're raping people. Yeah, I don't know. Maybe they do. I don't know.

Okay. All right. And then those one- Maybe mammals do. What were they called? I'll have to remember the species. Bonobos? Yeah, one of those.

I didn't mean to rhyme that. But yeah, something like that, right? That was a good rhyme. I don't mean to rhyme that. But yeah, something like that, right? That was a good rhyme. I don't know. Okay, I'll look it up. But they just fuck all day. That's true. Well, you know, there's always an exception to the rule.

But while animals are copulating, they're like predators are searching for somebody to eat. My office looks back onto this really nice open space field and, you know, there's like tons of ground squirrels and tons of hawks circling around waiting for a ground squirrel to stop moving. So if, you know, a ground squirrel is copulating,

guess what? Hawk's going to see that and boom, they're dead. So, you know, they want to do their business and get out. And that's why, you know, it's interesting. So erectile function is a parasympathetic nervous system function, right? It's the relaxation hormones. But ejaculation or orgasm is a sympathetic outflow, right? And so what does a sympathetic outflow do?

You know, it causes ejaculation, but then it causes constriction of blood vessels. it causes ejaculation, but then it causes constriction of blood vessels. So right after you ejaculate, your penis gets flaccid, and you get a surge of adrenaline because who knows who's going to come out of nowhere to attack you. And so if you want to protect your progeny that you just potentially created, you're going to need to turn around and fight whoever's coming after you wait you've got the same adrenaline right yeah yeah like i mean personal experience after i ejaculate i just want to take a nap i want to nap like i'm not i'm not trying to fight anybody or or protect anything i can't pretend no yeah so well i mean

you get that surge of adrenaline. Okay, okay, okay. But then, you know, if there's no one to fight, then chill out. Interesting. Yeah. Okay. Okay, so anyway, so premature ejaculation is kind of a natural state. And so as humans, what we're doing is we're trying to move away from premature ejaculation to prolonging ejaculation.

Okay, so there are a couple things you can do. One is, first of all, you can use a lubricant like Uber Lube. It's a silicone-based lubricant. That's like a first step that I give to all my patients, right? Because that intense friction, especially if women aren't properly lubricated early in intercourse, can get a guy over the edge really quickly. Another thing you can do is use a delay spray like Promescent

that dulls the sensation of the penile nerves. But another thing, and the thing is there's like nothing, there's like no magic pill for premature ejaculation. It's all just sort of like moving the meter a little bit. Okay. And the other thing is when we started giving people selective serotonin reuptake inhibitor antidepressants. Yeah. Like Zoloft, like Paxil, like Lexapro, what they found is it delayed ejaculation.

Sometimes to the point where guys can't even have ejaculation or orgasm. And so there's an herb called St. John's wort, which is a natural selective serotonin reuptake inhibitor. So it doesn't have, one, the stigma of being an antidepressant, and two, it doesn't have some of the somnolence and the lousy feeling of being on an antidepressant. And so we were able to get an isolate called hyperforin of the St. John's wort.

There's hypericin and hyperforin. Hypericin has more of the negative side effects. Hyperforin has more of some of the beneficial effects. And one of the beneficial side effects. Hyperforin has more of some of the beneficial effects. And one of the beneficial side effects of hyperforin is delaying orgasm as a natural selective serotonin reuptake inhibitor. So Prelong is something that will help men delay ejaculation naturally. You have to take it every day. But one of the other beneficial side effects of it is a mood booster.

So in Europe, it's used as a mood booster. More than pharmaceutical grade antidepressants. Now real quick, with the supplements that you have here, because we actually have some of these. Susan gave us some of them. You mentioned the prelongs

should be taken every day, but what is the frequency of when certain ones should be taken? Are certain ones you take right before you have sex? How do these different ones work? Yeah, so Affirm is a nitric oxide booster. Okay. And so when I was at UCLA, one of my professors won the Nobel Prize

for discovering nitric oxide as a second messenger. And two of my professors wrote the paper on how PDE5 inhibitors like Viagra actually work, right? And so the way that nitric oxide works in your body is when a nerve that innervates a blood vessel wants to send a signal, it uses a neurotransmitter, right? So you have lots of different neurotransmitters in the body. You've got dopamine, you've got serotonin, you've got acetylcholine.

There's a whole bunch of different ones. But for nerves opening up blood vessels, you use nitric oxide. And nitric oxide creates something called cyclic CGMP. And the higher the level of CGMP, the more blood vessels open right and that happens all throughout the body so you know there's a study on weight lifters that taking a nitric oxide booster at appropriate dose which is basically three grams of l-citrulline will boost bench press 13 pounds now if you're lifting pounds, 13 pounds doesn't seem like a lot, but you guys know that could be the difference

between first place and fifth place in a powerlifting competition, 13 pounds. In cyclists, it improved cycling times 1.5%. In competitive racing, that's a big deal. It also improves blood flow to the brain. And that's actually why I became interested in actually creating the supplement because my patients who I was using it

for erectile dysfunction for came back and said, you know, we'd really like to stay on this. And I said, how come? So, well, my short-term memory is better. My cognition is better, right? And so then I looked into literature and sure enough there's this whole body of literature on how nitric oxide boosters help cognition help athletic performance have erectile function um you have to be a little bit in tune with your

own physiology to understand not to understand but to appreciate the effects you know if you just sit on the couch it doesn't matter but if. But if you're in the gym working out, I had a patient who was a cyclist, right? He used to ride with the same group of guys every day. And then he started taking a firm and all of a sudden he was riding ahead of those guys. Really? Yeah.

Wow. Really fascinating. And so I recommend it to my patients who are on the younger side. After 40, your level of nitric oxide goes down about 40 or 50%. It depends. If you're a couch potato, it goes down more. If you're eating really well, a lot of green vegetables and exercising, it goes down less. But it's one of those things as you age

the same way testosterone goes down the same way igf1 and human growth hormone go down your nitric oxide endogenous production the production of nitric oxide that you do on your own goes down and it's kind of like a dimmer switch in a light right so if you're in a room and someone slowly turns the dimmer switch down to 50 you probably won't notice but if someone all of a sudden turns it back on then you notice right so when you start taking a supplement like a firm and i i crafted it's almost like craft beers right i crafted all these supplements based on really good scientific and clinical data. So there's two ways to get nitric oxide.

One is really through arginine, which is the nitric oxide donor. But if you take arginine orally, it doesn't get absorbed. Your intestines, for some reason, don't absorb arginine. So you have to take citrulline. So all those nitric oxide boosters that have a lot of arginine are just basically wasting space in the capsule. You take citrulline. Citrulline is really well absorbed by the intestines. And then citrulline goes to the kidney and gets converted into arginine in the kidney. And then arginine in the endothelium,

the inner lining of blood vessels, grabs an oxygen, breaks the oxygen in half, takes one of the O's, adds an N, there's nitric oxide, and then it gets recycled back to citrulline, which then gets recycled back to arginine. Now, the other thing you can do is you can take nitrates, NO3, right?

And then in your saliva or the stomach, it gets broken down into nitrite, which is NO. And then in the stomach, it gets converted into nitric oxide, NO. That's why they say if you take too many mouthwashes, you can affect your nitric oxide levels. And there's studies that actually, if you take mouthwashes, your blood pressure goes up. That's bizarre, right? That is bizarre. But why is that?

Because you're killing the bacteria that convert nitrate into nitrite. So you're decreasing nitric oxide, your blood pressure goes up. So my blood pressure this year at my annual visit was 110 over 65, right? It usually runs 120 over 70. But I'm taking four firm tablets a day, two in the morning, two at night, and my blood pressure dropped 10 points of Stalic.

And there's a lot of data. I get a lot of my patients off their blood pressure medications because blood pressure medications, they're good, but they're horrible for peripheral circulation. And what do I mean by that? And stop me if I'm talking too much.

Sometimes I go on and on. There are two places in the body where you measure blood pressure. One is the carotid body, and the other is the kidney. Because your body is trying to protect blood flow to the brain, because that's really important, and it's trying to protect blood flow to the kidneys because the kidneys can do something about blood pressure. They can make more urine, or they can make less urine and they modulate your electrolytes. So those two places are really the most important places in your body to measure

blood pressure, right? So if your blood pressure is high, it means that your vascular resistance is high. So the blood vessels are starting to get smaller, right? And so then what happens? Your heart has to pump harder, right? To get more blood pressure to the brain and get more blood pressure to the kidneys. So what happens when your blood pressure goes, you know, when your heart is pumping higher, harder, your blood pressure goes up. So then you take a blood pressure medication, right? You go to your doctors, oh gosh, Nsema, your blood pressure blood pressure is high right let's put you on a blood pressure medication what does that do it artificially opens up your central blood vessels right so then it's easier for your heart to pump so then your heart's like well

that's cool you know i don't have to pump as hard so then your blood pressure goes down but what happens to your fingers and your toes and your penis they're like it just happened you know someone just turned the power off you know what's up with that and they don't have a way to signal the rest of your body that they need more blood because they're less important than the brain and the kidney a lot of times blood pressure medication is like a diuretic as well, right? Yeah, well, all a diuretic does is it decreases the amount of fluid in your arteries and veins, right?

So you're going to decrease the pressure just by reducing the volume. And that works okay, but at the same time, when you want to perform physically, It seems like a bad idea. is it good to be dehydrated or is it good to be adequately or even a little bit overhydrated? Of course, it's going to be easier to maximize your cardiac output when your tank is full. I know there's obviously negative side effects of exercising. People exercise too much.

They diet too hard. I'd imagine that has a major impact on libido, on erectile function. But I've also heard that cycling can be really problematic for the amount of time you're sitting, I guess, might have an issue with a prostate or something like that? Yeah. So I have a really good video on my YouTube channel on cycling and erectile dysfunction. So really, if you're cycling more than three hours a week, then you should be careful about the bike seat that you have. Right? So you sit on your ischial tuberosities your sit bones right and so that's where you should be sitting but when you're racing on a bike you're hunched over right and when you're hunched over that seat is compressing the artery and the nerve to the penis right the internal

pudendal artery right kind of sitting on your taint and a lot of those seats have that cut out in the middle that's even worse because that's basically your urethra is hanging there and so then you're putting even more pressure on the internal pudendal artery and nerve and so really what you want to do is to have a seat that has kind of a cutout, like a step down and a short beak.

And if you're mountain biking or racing and you really need that beak between your legs to help kind of guide the bike, then every five minutes or so just get up off the seat. you know every five minutes or so just get up off the seat um you know so it's i always it's always cracks me up to see like the tour de france you know at the end of the race you know the guy in the yellow jersey and he's got like two beautiful women flanking him and like i know the secret that this guy can't get it up because he's been you know he spent the last five hours climbing up a mountain yeah and uh you know his his perineum and his penis are basically numb jeez so he also probably lost weight going into that competition as well like they try to be a certain weight and have the bike weigh a certain amount like to you know be precise on that bike or on that race rather so yeah so i mean if if you're riding more than three hours a week and you,

and I've had patients, I had this one guy, he was like mid fifties. The guy came in, he was like cut great shape. And so we started talking and I just found out that the guy had gotten divorced like six months, a year ago.

And he was an athlete and he started riding. He was riding one hour a day. Now he's riding three hours a day. And boom, he got erectile dysfunction. So, you know, fortunately we were able to, you know, using Gaines Wave shockwave therapy and some PRP and some FIRM. And, you know, I have a whole algorithm of stuff that I do. Fortunately, we were able to help him and, you know,

he's back to normal and now he's got a different seed. It was actually because of him. See, my patients are like, I love my patients because they challenge me, they push me and their problems present opportunities for me to learn and to teach.

So after talking to him, I made my erectile dysfunction and to teach. So after talking to him, I made my erectile dysfunction and cycling video because I'm like, well, people don't understand this. Let me make a video and let me try to sort of spread the word that these are problems. You're also helping a lot of your patients get in better shape as well, like gain muscle.

And these are people that are, I think, 60 plus years old, right? Yeah. You know, the thing is, guys come to me when they run out of gas, right? And for some people, it's in their 40s, some people in their 50s, some people in their 60s. And, you know, men have gotten really a bad rap lately. You know, almost all the men that I see, if not all the men that I see, are really good

guys. They work hard. They take care of their spouse. They take care of their family. They take care of their job, their community. They're really giving people and they lose sight of themselves. You know, they don't know how to take care of themselves

or they tell other people, listen, don't worry about it. I'm strong. You know, I can take care of myself. No big deal. And then all the muscle that they built up all over those years kind of goes away. They start to put on fat. They get wrinkles.

They lose their hair. They get erectile dysfunction. Their testosterone's down. And then things don't work in the bedroom or their wife pushes them in to see me or they're talking to one of their friends and their friends all of a sudden look so much better than they used to look. What are you doing? And then they come in to see me.

And then the pillars that I built my practice around are looking good, feeling good, and having better physical intimacy. And so, you know, I tell my patients, I can fix your erection, but if you don't lose weight, if you don't get into shape, if you don't fix things at home, you're not going to get a chance to use it. It's not going to last long. What's the protocol, if you can share it, for, because you had mentioned that you were helping patients 16 and above gain like somewhere between like eight to 10 extra pounds of muscle or lose like 10 pounds of fat and then gain muscle. Like, it's a 12 step, not 12 step program, but first of all, you have to optimize testosterone, right? If you're a 60 year old plus guy and your testosterone is 200 or 250 or 300 or 350, you're not going to be able to build muscle. Can I stop you just for a second?

How long have you been a doctor for? 25 years. And then how recent is this new practice of being able to prescribe testosterone fairly easy? Is it new or have you been able to do it for a while? Yeah, I mean I've been prescribing testosterone for 20 years. Oh, okay. But my understanding of testosterone

changed about three years ago. Because as a regular insurance-based urologist, I would get guys back into the quote normal range, right, 500 or 600. And it really wasn't making that much of a difference. You'd put creams on or sometimes we'd get shots, so on and so forth.

And it wasn't until I understood that you have to push a guy into the 1,000, 1,100, maybe 1,200, where a light bulb will go on and a man will feel dramatically better. And that level is not that dangerous. Yeah. Right? So the downsides of testosterone for a man in the 60s, one, if you have aggressive prostate cancer, you should not be on testosterone.

Low-grade prostate cancer probably doesn't make a difference. Intermediate-grade prostate cancer, maybe, maybe not. High-grade prostate cancer is an absolute no. If you have a really big prostate and you have trouble urinating, I brought an ultrasound. We can take a look at your guys' prostates. Just transabdominally, not transrectally. Oh, man.

Sorry. I mean, I wouldn't take a needle to the dick, but I'd take something up the ass. It's just easier. You got to pay extra for that. It's just easier. It is. What are you all tripping about about that's the quote of 2022

so you can't it's impossible to make me blush okay I've seen so many things I've been in so many strange places that yeah

so we sidetracked you but Andrew was asking about the protocol to get jacked okay okay yeah so it's in the it's in the mSculpt it's in the m the m sculpt chapter it's not a it's not a secret you got to build testosterone right if you have a low testosterone you can't build muscle that i have

graphs that i'll show you that show as your testosterone goes your muscle mass goes right so and then m sculpt has been unbelievable for building muscle. And, you know, I'll show that to you guys. Then I do a body composition analysis on all of my patients, right? And we get the basal metabolic rate. And if you want to lose one pound of fat per week, you have to drop 3,500 calories a week. So 3,500 calories for, I'm sure you guys know, is one pound of human fat. So if you divide that by seven, it's 500 calories a day. So you take your basal metabolic rate, which is how many calories you burn if you just

sit on the couch all day, and then you subtract 500 calories, and that's how many calories you need to take in. I like what you're doing here, because you're just giving straight math. 500 calories and that's how many calories you need to take in. I like what you're doing here because you're just giving straight math. You know, you're saying, yeah, here's the body fat percentage. This seems like an issue. Like this is a lot higher than where we would like to see it. We need you to lose some weight.

There's a calorie equation that could be part of this. So let's see what it would look like if we can reduce some calories. Like, do you agree? Do you believe that you need to make these changes? And a lot of times people jump to right away, they tell people all the things that they can't do. And then they get super bummed out. You know, you can't have soda anymore. You can't. Okay, that'll be helpful to enter into the calorie equation that you're describing. But once you tell people a lot of things that they can't do,

they're going to leave your office and they're going to be like, that guy gave me like eight different things to do. And then he told me 10 things that I can't do anymore, which I do every day. They're like, how am I going to live my life this way? Yeah, you got to keep it really simple. So like for, I talk about exercise, working out, right?

And I'm talking to guys in their 50s, 60s, 70s, right? So first of all, I tell them, you have to sweat. If you don't sweat, it doesn't count as exercise. Because I get a lot of these guys that say, well, you know, I go for a walk with my wife or the dog or whatever. Are you sweating? No.

Okay, it doesn't count. So if you're sweating, you're going, you're going to burn about 500 calories an hour. So if you exercise a half an hour a day, you can add 250 calories to your calorie count. If you exercise an hour a day, then you can add 500 calories. So you can basically eat your BMR and you lose one pound of fat. And I look at guys and say, listen, you're 50 pounds overweight. If you do everything right, you will lose 50 pounds in one year, right? So just understand, it's not like people go on these crash diets. What is a crash diet? If you look at body composition analysis, you know,

we have a hundred pounds of water or more. So you dehydrate yourself, you lose 10 pounds of weight, then you have a bag of potato chips and you put that weight back on. So I educate my patients, it's not weight you're trying to lose, it's fat. And fat is really, really, really, really hard to lose. Going back to Naked and Afraid. Those guys lose 20 to 25 pounds in three weeks because calories are really hard to find in nature. You got to kill something to eat.

And so your body holds onto fat really, really intensely. You know, like, have you ever been to Alaska? I have, yeah. Yeah. You see the whales up there? What are the whales doing up there? I don't know. They're eating.

Oh. 23 hours a day. Damn. For five months, the whales in Alaska are eating. Then they swim from Alaska to Hawaii. They have a baby. They feed the baby. And they swim all the way back from Hawaii to Alaska, seven months.

They don't eat a single meal. It's all based on blubber, all based on fat. That's the power of fat. The whale diet. Don't do it, Mark. That sounds great. That sounds pretty awesome. Eating 23 hours a day.

That's all I heard. Then you got to swim to Hawaiii i don't think you're gonna make it you got andy might yeah she'll leave you behind you gotta eat those nasty anchovy fish yeah right so oh no i was i was i don't want to actually i don't want to cut you off i have a question about testosterone but i want you to continue with what you're saying there sure okay so you got to tell someone the calories okay but then want you to continue with what you're saying there. Sure. Okay. So you got to tell someone the calories. Okay. But then you got to educate them.

What kind of calories? Where does the calories come from? Right. If you want to build muscle, you need protein. I mean, you guys know that a million times better than I do. Right. But most people in their fifties or sixties or seventies forget about that. Right.

They're packing on carbs or whatever. I say, you know know take half your body weight in grams of protein and then i give them a little sheet that tells them you know animal protein the plant protein i don't tell them what to eat i don't not i don't i'm not a nutritionist right i don't have that expertise i know the macro? I can tell them this is how many calories, high protein, low carbs, pack on the macronutrients, and then eat a lot of fiber, right? You don't want to get constipated. You don't want to get diverticulosis, diverticulitis. That's a disaster. I've seen, you know, I've taken care of that surgically. It's really a bad, bad problem. And healthy fats. Okay, what are healthy fats?

Okay, here's a handout. These are healthy fats. That's what I want you to eat. I don't care what diet you're on. As long as it evolves around those principles, it's good for me. And the foods are probably pretty natural, right? The foods that are natural to this earth, right? You can eat them.

I got a patient the other day. He's like, well, what's the difference between buffalo protein and beef i'm like i don't know you know i'm like i spend my time talking about the penis not buffalo protein no but i like that though because that first of all it's a great question but secondly it doesn't really matter and we're starting to see that more and more and uh you were pointing out you don't really like to talk a lot about things that haven't been like well-researched. When it comes to like grass-fed meat, there's such a dispute about this and that, but they don't really have a lot of evidence that shows you that grass-fed meat is going to be exponentially that much greater, an improvement in health outcomes. So, and when we're talking about somebody trying to make a choice between two different

packets of meat, it's like, okay, well, at least they're eating protein. Like they're on the right track. And the main thing for most folks to hone in on is losing body fat. We can worry about the diet soda and worry about, you know, whether we think that those things are really problematic and cancerous at some other point. But for now, you're 50 pounds overweight. You're having a hard time in the bedroom. Your life is kind of turned upside down. You're depressed. You're overstressed.

Let's try to mediate a lot of that and bring everything down with some simple techniques. Yeah, absolutely. I mean, I try to keep it really simple. For exercise, my guys have to do something totally different than what you guys do. So first of all, as you get older, it takes longer to recover, right? I go out and play basketball with my son. You know, we play full court basketball one-on-one, right? Half an hour later where I'm exhausted.

He's still going, right? Then the next day he wakes up, he goes, oh dad, that's really fun. Let's go play again. I'm like, no, I need about three days to recover, right? So I tell my guys, listen, do two days of one exercise. A lot of them do like elliptical or treadmill. Do two days of another exercise. A lot of them do like biking or rowing.

And then two or three days of circuit training, right? rowing and then two or three days of circuit training right so high reps low weight and cut the the recovery time between exercises so you get some cardio while you're doing the circuit training right so that way and you don't even have to kind of keep just read your body sounds oddly similar to the way that we work out yeah it really It really does. Yeah, it does. Yeah. There you go. The question I had for you about testosterone, because I know a few people who have great body compositions, a good amount of muscle, and their testosterone is between 300 and 400,

which for most people, that's low. My testosterone is between 650 and 700, which isn't particularly high, but most would expect me to be higher. So with the amount of patients that come into your office and they have low testosterone, you mentioned that like the sweet spots, like a thousand to 1200. And I can understand that, but I'm also curious, like, do you ever have patients that come in with low testosterone that are in very good shape? And I wonder if maybe they, when they do take testosterone, they don't need as much or they don't need to get themselves to as high of a level because they've been already getting by on a low level of testosterone.

Yeah, that's a great question. It really is. And, you know, biologic systems are very different than like cars, right? Car is a car. Like every Toyota that rolls off the factory line is going to perform pretty much the same. But humans are very different, especially in America. We're like all from all sorts of different places.

You know, we're not a homogeneous society. So, you know, who knows certain subtypes of... Certain ethnicities? Ethnicities. Yeah, not even ethnicities. But, you know, I mean, people evolve differently. So people that are from like Northern Europe are going to evolve differently than people from. Anthropology?

Yeah, something like that. You know, it's different. People that grow up at altitude are going to have different physiology than people that grow up at sea level. And so, you know, maybe that has something to do with testosterone. to do with testosterone. And I will only replace testosterone on someone who not only has a low lab level, but is also telling me, you know, I can't keep muscle on. I have low libido. I, you know, I'm putting on weight.

I'm, I'm, I'm lost, losing motivation. I got guys that are, have a testosterone of 200 that are happy as a lark and I won't touch them. And I have guys that have a testosterone of 450 or 500, which most people would consider normal. And when we rule out all the other causes, right, we check their thyroid,

make sure their thyroid's because if you're a hypothyroid, the same symptoms of low testosterone, you know, if you have sleep apnea and you haven't slept in well in 20 years, you're going to have the same symptoms of hypogonadism. So if we've ruled out all those things through physical exam and through labs and so on and so forth, then yeah, I'll put them on testosterone. Absolutely. I think that's a really good thing you mentioned. We work with a company, Merrick Health,

where we get our blood work done, but they also do TRT. And I think what you're mentioning there is super important because a lot of clinics and a lot of doctors with how TRT is kind of like the wild west right now they will literally give every single patient that comes in the same type of thing to just get them up to a blanket level and I just imagine not not and I'm not saying I know the science of this or anything but somebody who is doing okay right maybe they don't need to be taken all the way up to 1200. Maybe that might be, I don't know, worse or worse than better for them in the long run. So it's just, it's great that you're mentioning that. Yeah. Well, I mean, that was the genesis of support, right? Which is another one of the supplements that we have, right? Because I get a lot of patients who are 300, 350, 400,

and they're on the edge, but there are definitely negative effects of being on testosterone therapy in terms of prostate growth, prostate cancer. Sometimes they're a little bit overstated, but also your testicles will shrink unless you put someone on something like Clomid, which will continue to push the testicle to make sperm and testosterone.

Your hematocrit or your blood count will go up a little bit, which probably is not a big deal. You may lose some hair on your head. You may get some acne. You may get oily skin. So, I mean, there are some negative effects of being on high doses of testosterone. So I created support, which is DHEA, which is a testosterone precursor. So your body uses DHEA to make testosterone.

But the knock against DHEA a lot was, well, you make testosterone, but you may also make estrogen, right? Because we're all told, okay, men are from Mars and women are from Venus, right? We're all told, okay, men are from Mars and women are from Venus, right? And so you think, wow, well, like, you know, testosterone and estrogen are totally different molecular structures. But if you look at the molecular structure of testosterone and estrogen, the only difference between the two is a single hydrogen atom.

So one proton, one neutron, one electron, the smallest unit of matter unless you go subatomic, is the difference between estrogen and testosterone. So you can, what we call, aromatize testosterone. So you turn one of the six-sided rings into an aromatic ring, and so it's called aromatizing testosterone into estrogen. And so we have DIM, which probably a lot of bodybuilders take. Like broccoli or something.

Yeah, it's cruciferous vegetables, broccoli. And that is a natural aromatase inhibitor. So it blocks the conversion of testosterone to estrogen. And then it's got some Tonkat Ali and some Ashwagandha, which are two botanicals that have been shown in studies to improve testosterone levels and then some magnesium and some zinc. So basically, like the principles behind the supplements that I created for Affirm Science is like, let's just take only the things that have been shown to work, and we'll make a supplement out of that. It's like some of the supplements that you see, it's like you go to Costco, and oh, there's a brain health supplement. What's in there? Vitamin A, vitamin D vitamin d vitamin c vitamin e

oh well you know there's a uh you know a heart health supplement what's in there vitamin a vitamin d vitamin c you know it's like they just pack with a bunch of stuff right nobody can prove that it works or it doesn't work and it's just basically marketing and so we at affirm science we tried to basically just cherry pick the ingredients that actually work and then have them at appropriate levels. I know you're enjoying this episode, but listen up. We partner with Merrick Health. They're a telehealth network owned by Derek from More Plates, More Dates. When you get your labs done, you work with a client care coordinator that goes over your labs and gives you specific supplementation or nutrition protocols or potentially hormonal protocols for your levels. The problem with a lot of these other telehealth networks is that when they do these things, they give everybody the same exact things, which actually can hurt you long term more than help you.

Andrew, how can they get it? Yes, that's over at MerrickHealth.com. That's M-A-R-R-E-K-Health.com. And if you already know what labs you want to get at checkout, enter promo code PowerProject10 to save 10% off all of those labs. If you don't know where to start, head over to MerrickHealth.com slash PowerProject. You guys will get directed straight to the PowerProject panel that has 26 different labs that will cover everything you need. And at checkout, enter promo code Power Project to save $101 off of that panel. Again, MerrickHealth.com, links to them down in the description, as well as the podcast show notes. With testosterone, is there, and I'm talking total testosterone, is there a,

you know, like a thousand is really good. Does that mean 2000 is going to help you build more muscle better and faster? Like, so then if that's the case, then when 4,000, you know what I mean? Like, yeah, that's a great question. It really is. And I want to selfishly ask, like, without considering like health risks, like if we were to just keep doubling our testosterone, will we just keep adding more muscle right well you know anyone that is in the age where they want to have kids should be really

really careful about being on testosterone okay because boosting testosterone so there's so the testosterone. So the hypothalamus in the brain makes gonadotropin-releasing hormone, right? And then it goes to the pituitary, and the pituitary makes two hormones, LH and FSH. So LH goes to the testicle and tells the testicle to make testosterone, and FSH goes to the testicle and tells the testicle to make sperm. And the bulk of the testicle, 90% of it, is sperm production, and only 10% is testosterone production. But if you're taking exogenous testosterone, testosterone from the outside, what that does is it tells the pituitary and the hypothalamus, we got enough.

So there's a negative feedback loop. And so what that does is the pituitary shuts down the production of LH and FSH. And so then it shuts down the production of sperm. And then the testicle shrinks. I had a patient who I did a vasectomy on who was an all pro defensive end for the Raiders for like 10, 15 years. The guy was like a 350 pound,

just a mountain of a man. And his testicles were the size of peas. You serious? Yeah. Cause he'd been on high dose testosterone for a long time. Right. How do you get to be 350 pounds of muscle? I guess it's possible with natural

bodybuilding, but for most NFL players, I'm sure, they do it through steroid hormones. Then you do the buildup and then the cutting and then all

that kind of stuff that you guys know a lot better than i do because it's sort of part of that bodybuilding culture uh and so you know your your levels are all over the place and stuff in the body works best when it's kind of a routine right everything in your body is like circadian rhythms you're just that's why you check testosterone first thing in the morning because your testosterone level is high at eight o'clock in the morning. And then three, four o'clock when you get sleepy and you need some coffee or whatever, or I need some coffee, your testosterone is lower. And then you go to sleep and by the time you wake up in the morning, it's back high. So everything in your body has a natural cycle. And when you're doing all these crazy wacky things with your testosterone it affects

your bodily systems and one of the systems that affects is fertility your testicles are going to shrink now you can go on clombid but let's be honest that's not like natural it's not the not the way things are supposed to be and so that's i think a reason that a lot of people have infertility issues is they're playing around with stuff that they shouldn't be playing around with on the fertility note because we actually just had somebody that came and talked to us about some he talked about fertility and testosterone recently how can people be careful because there are a lot of younger individuals, guys in their twenties that are hopping on TRT because it's like the popular thing to do to gain muscle.

How should people be careful to make sure that they don't end up becoming infertile in their, in their future? Yeah. If they choose to go down that route. Yeah. I mean, if you, if my, obviously my first recommendation is, you know, obviously my first recommendation is you got enough testosterone. You got testosterone of 1,000. That's sort of like the upper limit of what God gave you. Enjoy it. But if you really feel the need to go on TRT and you're in your 20s or 30s, make sure that you take Clomid or HCG.

But HCG is injectable. It's expensive. Clomid is cheap. It's oral. 25 milligrams is usually all I need. I have patients who are younger that have low testosterone in my office because I see the 0.1% of guys that have issues. I have a patient who's 17 years old that has erectile dysfunction.

And it's totally legit. It's not like his parents are freaking him out or whatever. A girl freaked him out. I totally talked to him man to man, closed the door and, you know, it's legit. So if you're really young and you have in your hypogonadal and you're symptomatic, I can put you on 50 milligrams of Clomid

and it'll push your testosterone up to 900 or 1,000, as long as you don't have testicular failure. If your testicles are fine and you're just not getting the signal from your brain, then there's a lot of stuff we can do. What's going on with this M-Sculpt thing? Oh, yeah. That's my favorite, my absolute favorite gizmo. Yeah.

So, you know, I love building muscle in men. You know, I love building muscle in men. And it makes a big difference in terms of, like, I'm preparing my patients for the next two or three decades. You know, like a lot of my patients are in their 60s, and they've worked really hard, and they've put some money away, and they have a spouse, and and they have kids and they've been taking care of other people for all their life and you end up in a catabolic phase of life where you're losing muscle and so i'll make sure that my patient's testosterone is optimized i'll make sure they're on a nitric oxide booster like a firm i'll make sure that they're on creatine right because you want to re-energize the ATP. And a bunch of the other stuff that I talked about,

about calorie-restricted diet, making sure that they're taking in enough protein because a lot of guys will do a lot of upper body stuff, beach muscles. So then I'll do their in-body, and I'm like, you got 120% upper body, and you got 85% lower body. Right? Because, you know, it's kind of, when you're younger, you're, so some of the things that happen on a cellular or subcellular level as you age. First of all, your DNA gets mutated, right?

Or it gets damaged, right? All the stuff that we're exposed to. Second of all, your mitochondria aren't as efficient. So you're not making ATP like you used to make ATP. And then third of all, your Golgi apparatus and your endoplasmic reticulum aren't cranking out protein the way that they should. So the protein isn't as made as nicely or as completely as it should. So you're already at a disadvantage. And the other day I saw a really, really interesting article out of Tufts by this guy, Dr. Fielding, that looked at gene expression in muscle

in younger men, men in their 20s versus men over 50, which really bummed me out because I was like in the older group, right? And what they found was in muscle that was being built in younger men, 150 genes were expressed. And in men over 50, I won't say older men, but men over 50, only 54 genes were expressed. And in muscle, genes are producing proteins that make new muscle, right? So, you know, you're producing a third of the number of genes in your 50s that you are in your 20s. So you're at a huge disadvantage, right? And then if you lose muscular strength in your legs and you're in your 70s and your 80s, you can't travel. You can't play with the grandkids you can't go upstairs you can't even sort of it's a work even sometimes to just get up out of the easy chair right and so then that affects the quality of your life so you know i'm focused on building muscle

but for a very different reason than than you guys are focused on building muscle you know my my patients are heading towards a different part of their life, but they're really good guys and they've really worked hard to be in a good place in their life. And so I really wanted to help them build muscle. And M-Sculpt, like within a minute or two of trying M-Sculpt, I was just sold because I was a triathlete growing up. I ran competitively in high school and college. And so I'm very in touch with my physiology. And as soon as I felt what it was doing with my muscles, I understood. And it uses something called high intensity focused electromagnetic waves. So when we want to move something, our brain sends a signal down a central

nerve that goes through the spinal cord, and then it sends it out to a peripheral nerve. And that impulse is an ionic gradient. So there's positives on one side, negatives on the other side. So it's kind of like an electrical signal that comes through our nerves. And then it depolarizes a muscle. When a muscle gets depolarized, the actin, myosin, thick and thin fibers kind of contract against each other and contraction is making a muscle shorter, right? So when something contracts, it gets shorter, right?

And so instead of using the nerve, because a nerve has to depolarize, but then it has to repolarize and depolarize and repolarize. It goes back and forth, back and forth. And there's a limit to how much you can do. This uses an electromagnetic field. So if you think about a TENS unit, a TENS unit is direct current, right? So it's, if you think back to high school physics,

it's that kind of like loop. And the direct current will take the path of least resistance so first of all it builds up heat in your skin and second of all it goes very superficially through the muscle right but m sculpt basically uses a coil and when you run electricity through a coil you create an electromagnetic field and so you can set the depth of penetration of that electromagnetic field and you can cause massive contraction of muscles and by using a more and more intense electromagnetic field you can cause more and more contraction of those muscles and so

that allows us to build muscle in my experience 10 to 15 times faster than you can do in the gym, which sounds absolutely crazy, but I'm just submitting a series of my patients who are in their 60s on the Brandeis MD male rejuvenation protocol, and these guys, over a period of four months, have built five to eight pounds of new muscle and have lost attended four months four months okay yeah you know it varies three and a half to five and a half months it's not like in a it's a what's called a case series so it's just like all these guys that come into my office i never really i didn't quite understand how incredibly powerful this technology and this sort of like overall approach. You know, it's kind of interesting because a lot of folks have like, you know, their personal trainers or their dieticians or they do TRT or they just have an Emsculpt machine.

But I've been able to kind of put together that total approach with the supplements and with the diet, I guess, because this is something that I really like I'm passionate about. And this is, I was a competitive athlete. So I understand that kind of stuff intuitively. And, and it's, I've just been absolutely blown away with the results. And it's really, really fun to see guys kind of come in, kind of walk in like this. And then, and then you know three four months later they're really you know they're feeling powerful they're feeling strong they're feeling you know like like their old self you said they gained eight to ten pounds of muscle no no five to eight pounds of muscle five to eight pounds muscle in the fat the fat i've had guys lose up to 40 pounds of fat

what yeah yeah people eat like crap oh yeah oh yeah this is the thing too like you're not only having them on the m sculpt you're also giving them diet practices lifestyle lifestyle so a lot of that's changing but the m sculpt is making a big difference you have to sit there with a guy and and treat them like they need to be treated you you know, with respect, but also stern. Like I tell my patients, listen, I'm not your mother. I'm not going to go home and tell you what to do. Right now I'm giving you this plan that, you know, is I'm as good or better than anyone else in the country for creating a comprehensive plan for you to turn your life around, but then it's up to you.

You know, my first chapter in my book is called The Hero's Journey, which is based on the work of a guy named Joseph Campbell who went through, and you know, it's a pretty well-known theory, but you know, I encourage men to think of themselves as the hero of their own journey. Right? Like Tiger Woods, he's a hero maybe, but he's got his own problems.

Right? You got to focus on your own problems. And you have to be the hero to yourself, to your wife, to your kids, to your workplace, to your community. workplace, to your community. And when you see yourself as the hero of your own journey, then the decisions that you make are going to be completely different than some of the decisions

that you've been previously making. And how does the M-Sculpt work? Is it like a strap and you put it over your biceps and then does your bicep contract and or can you move it like how does it like what does it look like so um we're gonna have to we're gonna have to strap these guys in and see because it's uh it's gonna be hilarious along with um sorry not to

answer your question but i don't want to ruin this the suspense um i'm curious because i think taylor mentioned that you know gronkowski uses it you mentioned that there are some fighters that use it uh the people that listen to this podcast including myself like even if they get on an m sculpt machine we're going to keep like lifting we're still going to be active um because that has its own level of importance but what can it do for an individual that's already doing some consistent resistance training that's already doing some consistent resistance training, that's already having an active lifestyle, what does it do? Does it have any benefits on top of that?

Obviously, it has benefits for someone who's not doing anything, but how about people that are? Yeah, that's a great question, and I have a lot of answers for that question. So first of all, from my own experience, I'm in a maintenance phase of life. So I'm 54, and I'm in a maintenance phase of life. So I'm 54 and I'll do, you know, I'm trying to build lean muscle. I'm not trying to sign up for any bodybuilding competition. So

I would lift 40 pounds five times for each arm. And I've done that for 10, 15 years. After M sculpting for a month, like one arm treatment, biceps and triceps a week for five weeks, I was able to do 10 on each arm. 10 more pounds. You mean? No, 10 reps. Okay.

Okay. Okay. I only have like the barbell. So, um, so, you know, that's pretty significant because it's actually harder to build endurance than it is to build strength,

or at least according to my orthopedic friends um and so you know i've been able to see that just in myself now this is an amazing thing for getting people back into shape because part of the protocol drives out lactic acid i'm not quite sure i've asked for an explanation and they've explained it to me but I don't quite get it but you do it for a half an hour and you don't feel sore the next day that's what I was gonna ask yeah I mean like the first ab work I do after a long time off and I'm walking around like a caveman for the next couple days but with this it really it's amazing you know you feel some strain on the ligaments but in terms of muscular pain it's really not that bad in fact it's almost uh non-existent

so you can do abs you can do glutes you can do quads you can do biceps you can do triceps you can do calves i wish you could do pecs but you would end up defibrillating your heart and that probably is not a good idea. What about for recovery? Because the only thing I have to, I guess, and I know they're not even close, it seems like, but like a TENS unit, you can use that to help some muscle strains and stuff. So how about for recovery? So that's a great point. I have a couple of patients right now that were volleyball players. One was a high school volleyball player.

Another is a semi-pro volleyball player. Both of them busted their ACL. Right? And so I have them doing abs, glutes, quads, and calves. Right? Because it isolates the muscle. Right? So the ACL is basically between the tibia and the

fibula. I mean, the tibia and the femur, right? So it's a, basically it's an isolated ligament. And so you can contract the quad and the glute and the ab and not interfere with the surgical site. And so that's a great way for them to stay in shape. You know, the other thing that I've been able to do is a lot of patients, a lot of people have a bad back problem, right? And a lot of that is because their anterior and posterior chain is weak, right? And then when you have a back problem, then it's harder to do sit-ups and crunches and so on and so forth. So then it's kind of like a cat 22, right? My back is bad. I need to get stronger stronger but i can't get

stronger because it hurts every time i work out so i have these guys on the table and i build their abs and i build their glutes and i teach them how to stand because most people don't understand how to stand right i see andrew kind of wiggling around a little bit but the way you stand is you contract your glutes right really tight and then that pulls you a little bit but the way you stand is you contract your glutes right really tight and then that pulls you a little bit out of alignment then you contract your abs right then you got strong abs strong glutes and that supports your spine if you're doing it right you should feel like your spine is floating because it is right and then it's an active process. Then you're actually getting a little bit of a workout

just standing up. And so that's how you prevent back issues. You know, like six, 12 months ago now, I was lifting a 94-pound bag of concrete in my backyard because my wife and I like to do gardening and landscaping, and that was not a good move. And I ended up getting an epidural, and I really got back onto the Emsculpt, and I really focus now on standing properly and building my anterior and posterior chain,

and I get a lot of guys who, I had this one patient, every month he was getting an epidural, right, because his back was so, and he was in late 40s, right? And you look at him, he looked like he was in pretty good shape. And after six or eight Emsculpt treatments, I never saw him again. Right? He didn't need any more epidurals, and he didn't, you know, then he could start to take over and build strength on his own. So, you know, recovering from injuries, it's great.

And you can dial up and down exactly how much you know if you're lifting 100 pounds of weight it's 100 pounds of weight but on m scope you can kind of dial up and down exactly what you want the resistance at um yeah and then so does it hurt because it yeah no i get patients that actually fall asleep during treatment. So abs and glutes doesn't hurt. Arms is pretty intense. Yeah. So I definitely, like, I count the number of reps backwards. So I know when it's going to, like, because it gets pretty intense.

Because the arms are relatively, at least in me, a small muscle. And so, you know, compared to abs and compared to glutes. And even like, you know, when we look at the in-body, we get a percentage growth. I'm actually going to start very soon a study. It's going to be really fascinating on industrial athletes. So fire guys and the police station, the fire station just down the street from my office. And most of my patients, like I looked at myself and then some of my patients, you build about a half a pound to a pound of muscle on the arm. And like in my case, I have

I think eight and a half, nine pounds of muscle in the arm. You guys probably have like 20 or 30 pounds of muscles in the arm. But the biceps and triceps as a percentage of the total muscles in the arm are probably 60%. So you can see an improvement more in the arm than if you were just doing the abs and then looking at the trunk. Or even just doing glutes and looking at the leg because you have so much more muscle there and so we're going to do m sculpt and see you know when when you've taken a long time off and then you're starting to build muscle it's going to take at least six weeks before you even begin to start to see improvement. Maybe if you have muscle memory like you guys have, it's quicker. One thing, I'm very curious about the

M-Sculpt thing because it sounds really cool, especially since you guys have mentioned that people use it. I have two questions, actually. If somebody were to try to look into finding a place that has an M-Sculpt machine, it's not just in normal hospitals, right? Or is it in general hospitals? Where can people find it? No, it's actually not in hospitals. You know, it's a lot of it.

You know, the interesting thing is they sell it mostly to, like, cosmetic dermatologists and those kind of folks. And 90% of the sales of packages are to women. You know, their spokespeople are like Drew Barrymore and Jennifer Lopez used it to get ready for the Super Bowl and those kind of folks. And I talked to the head of sales, or head of marketing,

who just so happens to live in my hometown. And I said, you know, that's great to make these people look better, but men need it in their catabolic state when they're losing muscle. This is going to be huge for quality of life. Yeah. And then the other thing I was going to mention is people get older. We've had so many people come on the podcast and talk about it.

Their grip strength starts to go away. And the M-Sculpt is great, but there are still things that I think it cannot replace. Well, can it do anything for an individual's grip strength? I should ask that first. So there are certain things that you will still need to do something as far as physically going and working out because your grip strength, there's been a lot of studies that have linked it directly to longevity. And that just goes, you know, people need to get their hands on something to train that and other parts of their body. So I think it sounds like a great addition to doing something physical. For some people that have to not do that, they, for some reason can't do anything in the gym.

It's pretty fucking awesome, but it'd be sick to have along with that, it seems. Yeah. I mean, the thing is it saves me time. Yeah. Yeah, yeah, yeah. You know, I can focus more on cardio. I can focus more on, you know, lats and delts and those kind of things because I don't have to focus. You know, you could hit my abs with a baseball bat now. I wouldn't flinch.

Sheesh. I mean, and I haven't done a sit-up in three years. Yeah. You know, my son, you know, he's got three sisters, right? And so he needs like a dad, but he also needs like a brother, right? So, you know, we go around the house sneak attacking each other. And, you know, he was taking Taekwondo before the COVID happened. And so he was like a lower black belt in COVID.

And I was coming around the corner one time and he nails me in the abs, like on a sneak attack. And I just looked down at him. I'm like, is that all you got, punk? But it was, oh man, it was like one of the greatest moments of my life. I bet.

I forgot to ask you about Spunk. Other than being an amazing name for a supplement. What the heck is it? You know, thank you so much for recognizing that it was so hard to find that name, right? Because I like, I love double entendres, right? And so, and there's no synonym for prostate and all the good prostate names are taken up like prostostacin, Prostax, Prostadiz. And then the only thing that prostate does is it makes semen. But those are not really good semen names. There's actually some product called Semen-X or something like that.

But it's not really a sexy name. But what they call semen in england is spunk and then if you're spunky you're kind of like energetic and then actually in australia if you call someone spunky it's like calling them sexy oh yeah spunky yeah so all right um so spunk is for prostate enlargement and for difficulty with urination. And there are a ton of things in urology. So as a urologist, you spend about half your time dealing with prostate issues. So this isn't to replace medications like Flomax or Proscar or Avidart or office procedures like Urolift or Resume or Terps or any of those kind of things. But it's for a guy who is beginning to have some urinary symptoms.

It has some beta-cidesterol, some pygeum, some pumpkin seed extract, some flax, some magnesium, some zinc, all the things in the literature that have shown some efficacy. Now, you know, if spunk doesn't work, go to a urologist. You know, urologists have a ton of things to offer for men who have trouble urinating. But if you just have mild symptoms and you don't want to go on a pharmaceutical, you're not considering surgery, you know, it really works well for some people. Great. Yeah. Thank you so much for your time today. Where can people find you? Oh, I'm really easy to find because my name is really easily Google. But I have a Brandeis,

M-D-B-R-A-N-D-E-I-S-M-D.com. So my medical practice is in San Ramon, California. I do Skype consultations for people all over the country and all over the world. And I, you know, I have people like, especially with the P long study, I have someone from New York, someone from London, someone from Arizona, someone from Seattle, someone from Colorado, someone from Florida. I mean, you know, the kind of stuff that I do is really super specialized and really unique. And, and so I know we're actually recruiting now for the Mencella 2 study. So that's the orgasm study.

And so using HyFem, we're actually trying to figure out if it also improves erectile function. So our first study wasn't adequately powered. We didn't have enough folks in the study to determine if it improved erectile function, but we have some evidence that it not only does it improve erectile function, but also improves urination. So we're recruiting more folks for a free

study in San Ramon, California on improving, we already know it improves ejaculation, but improving erectile function and improving urination. And we're using, helping to pioneer a new algorithm of microvascular ultrasound to look at the growth of new blood vessels in the penis as a way to show improvements in erectile dysfunction.

Because the thing is, erections are hard to measure, right? And there's so much variability i mean it's like how am i going to say this without straight up you know my wife is here so i have to you know there are psychological factors and there's physiologic or physical factors and so you know if the mood isn't right you know things may not work so well. But that may not be because the physiology is a problem. It may be because the psychology or the relationship psychology or maybe you had too much to drink or maybe you had too much food to eat. So there's a lot of stuff that affects that dynamic.

And so we have to be able to find something that is more objective. And so we have to be able to find something that is more objective. And so using this new microvascular ultrasound technique from a company called Morphometrics up in Calgary is something that we're also testing. Wow. Well, just in case anyone in the audience wants to sign up for the study, because there's probably a lot of guys in our audience that would. Where do they go? Yeah, it sounds like a good time. Yeah, just go to brandicemd.com and just go to our clinical research tab

and then it's the Men's Sella 2. And then if you're interested in the book, this is the most comprehensive and medically accurate men's health book ever written. And I can say that because it's 101 chapters and it's over 900 pages. And I either wrote or edited every single chapter. And the thing that I can say that because it's 101 chapters and it's over 900 pages. And I either wrote or edited every single chapter. And the thing that I can't stand is when you read a 200-page book and you're like, that could have been four pages.

You know, that was like basically four pages of information. This is 900 pages and it's 900 pages of information. Like the information density in this book is really like insane. And it's not just me. Like I'm not one of those people that like I know everything. Like I know what I know and I know what I don't know. But I also know a lot of folks, right? So like if I have a question about cardiovascular disease or the hand or sleep or whatever,

I have a whole network of really, really highly talented, intelligent doctors and men's health experts that write chapters in the book on their expertise, whether it's the heart or brain health or hand health. We have a whole thing on exercise. We have a whole section on food. We have a whole section on addictions, on lifestyle, on how to make the most of your doctor visit, on health insurance. Because health insurance is really just bizarre. Like even people that are in health insurance don't understand it.

And I have a health insurance executive that wrote a fantastic chapter in the book on it. that wrote a fantastic chapter in the book on it. There's a whole section on mental health written by psychologists, a whole section on relationships written by therapists. My patients are amazing because they bring stuff to me like gifts, like I need to know about this

or I have this problem. Oh, that should be a chapter in the book. Awesome. Take us on out of here, Andrew. Sure thing. Thank you everybody for checking out today's episode. Please drop a comment on anything you learned today or maybe if you have more questions

in case we explore another conversation just like this and subscribe if you guys are not subscribed, turn on all those bell notifications so you don't miss any episodes. Follow the podcast at mark bells power project on instagram at mb power project on tiktok and twitter my instagram and twitter is at i am andrew z and links to everything that we talked about today will be down in the description as well as the podcast show notes and sema if people want to see you shirtless where can

they do so and sema it's true though sorry one more time i talked over you where was that seeming on instagram youtube and see my yin yang on tiktok and twitter sir where can people find you on social media did you plug that at all yeah yeah uh like i have a youtube channel uh which is brand ice md i have facebook i have instagram uh i'm too much of a boomer to really know. Respect. Go to the 21st century man, all written out without any numbers, the 21st century man.com to get the ebook,

the hardcover book. It will never be a limp paperback. It'll always be a hardcover book. No limp paperbacks. And then our audio book is going to be coming out very soon. Also, there are all the bios from all the authors, links to where you can get all the products that we talk about in the book. Just a huge amount.

My passion, my mission is to help men over 40 live better, happier, healthier lives. I'm at Mark Smiley Bell. Strength is never weakness. Weakness is never strength. Catch you guys later.