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Get Your Sex Life Back! What Everyone Gets Wrong About Sex, Libido & Erectile Dysfunction - Dr Khera — Transcript

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0:00this term sex pan which I've never heard
0:02before what is that sex span is how long
0:04you are able to engage in satisfying
0:06sexual activity and most men most women
0:09want their sex fan to last as long as
0:11their lifespan and there's many things
0:13you can do that significantly prolong
0:15your sex fan and I called it the four
0:16pillars so let's talk about sex Dr moit
0:20Cara is a board certified urologist and
0:22Professor who specializes in male and
0:23female sexual dysfunction his
0:25groundbreaking research has
0:26significantly contributed to improving
0:28sexual health and fertility millions of
0:30men and women are suffering from sexual
0:31problems like infertility and sexual
0:33dysfunction for example in the US
0:35roughly 43 to 48% of women suffer from
0:38female sexual dysfunction which involves
0:40four components that we're going to talk
0:42about but we also know that premature
0:44ejaculation affects 30% of men globally
0:47and also 40% of men at 40 will suffer
0:49from erectile dysfunction and it's the
0:51first sign of other major adverse
0:53medical problems for example 66% have
0:55some degree of depression and 15% of
0:58them will have a heart attack or stroke
0:59within 7 years and if you look at the
1:01causes for Ed one of the biggest factors
1:03is obesity which causes the testosterone
1:05levels to go down but men need
1:07testosterone for sexual functions so do
1:08women because low testosterone increases
1:10low Lio but the issue is people don't
1:13talk about their sexual problems they
1:14suffer in silence and they start
1:16avoiding sex but it's curable and I have
1:18two ways to raise their testosterone
1:19techniques to significantly improve the
1:22quality of your directions and natural
1:23ways to improve sexual function in men
1:25and women so number one most important
1:28is this has always blown my mind a
1:31little bit 53% of you that listen to the
1:33show regularly haven't yet subscribed to
1:36the show so could I ask you for a favor
1:38before we start if you like the show and
1:39you like what we do here and you want to
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1:43Subscribe button and my commitment to
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1:47everything in my power me and my team to
1:49make sure that this show is better for
1:50you every single week we'll listen to
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1:54you want me to speak to and we'll
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1:57much
2:01Dr Mo
2:04Hera who are you and what have you spent
2:07your life doing so I'm a urologist and I
2:11specialize in male and female sexual
2:13dysfunction testosterone replacement
2:15therapy and infertility for the past 17
2:18years I've been working as a professor
2:20at Baya College of Medicine Houston
2:22looking at ways to improve sexual health
2:24improve testosterone and improve
2:26fertility and we talked just before we
2:29started recording about this term sex
2:30pan which I've never heard before what
2:32is the sex pan and why do you care about
2:34it yeah so Stephen you know what
2:36lifespan is it's how long you're going
2:37to live right and you also know what
2:39health span is how long you're going to
2:41live in a healthy lifestyle but you may
2:44not have heard of the concept of sex
2:46span sex span is the ability to engage
2:50in sexual activity satisfying sexual
2:52activity and so how long you are able to
2:55engage in sexual activity is important
2:57to most men right um so let's give you
2:59an example the average lifespan in the
3:02United States is 77 years old the
3:05average Health Span in the United States
3:06believe it or not is 67 years old in
3:09fact if you look at the CDC and they
3:11talk about how long you'll live without
3:13a disability it's actually 63 so there's
3:16a Delta here there's at least 10 15
3:18years where you will be in some kind of
3:20disability and cannot live to your
3:22fullest now think about the concept of
3:24sex span how long you'll have the
3:26ability to engage in sexual activity
3:28satisfying sexual ity we most men most
3:32women want their sex span and their
3:34health span to last as long as their
3:36lifespan yes so I think it's
3:39important and there's things that I can
3:41do to make my sex span last as long as
3:44my lifespan there's many things you can
3:46do and I call it the four pillars the
3:48first is Diet exercise sleep and stress
3:51reduction I don't have a pill on the
3:53planet stronger than diet exercise sleep
3:57and stress reduction and each one of
3:59those can significantly improve a man
4:02and a woman's sex span but also their
4:04health span and their lifespan the other
4:06is hormones testosterone extremely
4:09important testosterone supplementation
4:11can significantly improve a man and a
4:13woman's sexual function and fortunately
4:16for women in the United States we don't
4:18have very many options actually globally
4:20for women there's not many options um
4:23but I think it's important a hormone
4:24replacement therapy and I one more thing
4:27I think about the couple think about sex
4:28ban as a couple's disease let me give
4:30you an example tomorrow Stephen are are
4:32you married or yeah well I'm in a
4:34long-term relationship you're your
4:35partner so let's say your partner
4:36tomorrow says to you I am no longer
4:38going to have sex with you unless uh you
4:41cheat on her or you leave her you're not
4:43going to have sex again right think
4:44about the importance of the couple um so
4:47I talk about this quite often keep your
4:50partner engaged keep your partner
4:52healthy if you want to prolong your sex
4:54fan so I got two questions here the
4:56first of which is who have you worked
4:59with in your career and the second
5:02question is what is your CV give me a
5:04rundown of your professional experience
5:06yeah so I started my residency in 2000
5:09and uh I did my residency in 2 one year
5:12of general surgery I did five years of
5:13Urology training and then I did one year
5:15of a fellowship in men's health soon as
5:18I finished my training I joined uh the
5:20University at Baylor College of Medicine
5:22and I started a basic science laboratory
5:24where we do a basic science research in
5:26sexual medicine and testosterone for the
5:28past 17 years and I just started a
5:30clinical trial so I start have a
5:31clinical arm we do clinical research I
5:33see approximately 150 patients a week
5:36every week I do approximately 68
5:37surgeries every week and I still work at
5:40the VA hospital it's a veteran
5:42government Hospital one half day a week
5:44working with the veterans so it's quite
5:45busy um but you know my passion really
5:48is education research and clinical care
5:50and um and that's what we do and so you
5:53know when I started my where how I
5:54really got into this was when I finished
5:56my training I was so proud of myself I
5:58was able to get these men these amazing
6:00erections these great libidos and uh I
6:03realized one day this woman called me
6:05and she was frantic and she said look uh
6:08you're treating my husband you're able
6:10to get him these great erections great
6:11libido but I don't want to have sex with
6:13him and he wants to have sex with me all
6:15the time and now we have a terrible
6:17relationship you've ruined our
6:19relationship and I thought to myself
6:21wait a minute uh you know I this doesn't
6:24make sense but she was right you know in
6:26in sexual medicine either leave both Le
6:29low or raise them both but don't raise
6:32one or the other it's a setup for
6:34disaster so very quickly that year I
6:37went out and flew out to meet with Dr
6:39Irwin Goldstein who's considered one of
6:40the Godfathers of female sexual
6:42dysfunction spent some time with him
6:44went to his courses and for the past 16
6:47years I've been treating women as well
6:49you can't just treat one patient without
6:51addressing the other and so therefore
6:53it's a couple's disease and give me a
6:56flavor of the types of conversations you
6:58have on day one when they walk into your
7:00practice when they come to see you what
7:02is the issue that they say they have and
7:04how do they express it like what are the
7:05words that they use and if you could
7:07just give me like five of the most
7:08popular things people say to you when
7:10they come to see you so listen first of
7:11all men and women are very different how
7:13they express it you know so we'll talk
7:14with men most men uh let's backtrack
7:18most men and women do not get any kind
7:20of medical care when they see their
7:22primary GP in fact most GPS don't
7:25address sexual dysfunction there was a
7:27study looking at medical students only
7:2865% % of us medical students get
7:30training in sexual medicine and of those
7:3365 50% of those students said that the
7:35training was terrible so we don't get
7:37the sexual medicine training to address
7:39the problem for patients so the majority
7:42of patients are never uh discussed about
7:44their sexual problems but when men come
7:46in there's a most of them are coming in
7:48because they already have tried some
7:50medications that haven't worked and
7:51they're looking for other Solutions now
7:53there's a very two simple questions you
7:55can ask a man they're very
7:56straightforward are you able to get an
7:58erection sufficient for penetration it's
7:59either yes or no are you able to
8:01maintain that erection to orgasm or
8:03pleasure it's either yes or no if he
8:05answers no to either one of those
8:06questions he suffers from erectile
8:08dysfunction right and so it's very
8:10important to get a detailed history you
8:13want to ask particularly are you able to
8:14get an erection on your own are you able
8:16to get erection with masturbation do you
8:18wake up with morning erections if he
8:20says look doc I get great morning
8:21erections or with masturbation I have
8:23great erections then this has to be
8:25psychogenic right with my partner I
8:27cannot get an erection but when I'm by
8:28myself everything works fine psychogenic
8:31psychogenic Ed it's a big component what
8:33is psychogenic many something in the
8:35mind that's bothering you or inhibiting
8:38you from engaging in sexual activity and
8:40that's where the sex therapist comes in
8:42right because if I if someone tells you
8:44I get great erections uh by myself but
8:47with my partner I'm not able to get good
8:49erections psychologically when with
8:51their whe they're with their partner
8:53they're not able to achieve a good
8:54erection sex for men and women has a
8:57huge psychogenic component
9:00a huge psychogenic component so I think
9:02it's very important to get detailed
9:04history are they able to get direction
9:06what did they try what medications have
9:07they tried you know you have to query
9:09about
9:10depression 66% of men who come in with
9:13Ed have some degree of depression 66%
9:16right and that's important anxiety 35%
9:18is very important and more importantly
9:21we'll talk about this Ed is the first
9:23sign of other major adverse medical
9:25problems for example if a man comes into
9:28my office today 15% of them will have a
9:31heart attack or a stroke within 7 years
9:3315% the day they get Ed 15% will have a
9:36heart attack or a stroke within seven
9:38years it's the first sign other studies
9:40Dr monori showed that if a man presents
9:43the emergency room with a heart attack
9:45on average 39 months earlier that's when
9:47the Ed started so it is the first sign
9:50now there are many reasons for this one
9:52theory is called the arterial diameter
9:54Theory the penal arteries are the
9:57smallest arteries 1 to 2 mm
10:00the coronary arteries are 3 to 4 mm the
10:03kateed 6 to 7 mm so if you remember from
10:06physiology if you're going to block an
10:08artery 50% occlusion of an artery causes
10:11a damage so if you're going to block an
10:12artery you're going to block the penina
10:14arteries before the coronary arteries
10:15you're going to block the coronary
10:16arteries before you block the kateed
10:18right so men will get Ed before they get
10:20a heart attack more more likely to get a
10:22heart attack before they get a stroke
10:24that's a theory but it makes sense so I
10:27worry when a man comes into my office
10:29could this man have a cult
10:31cardiovascular disease in fact there was
10:33a wonderful study that came out of
10:35Greece they looked at 50 men that walked
10:37in and they gave them an echocardiogram
10:39or stress test if it was positive they
10:42wanted onto a coronary angiogram what
10:45they found is that roughly 20% of men
10:47one in five actually had some occlusion
10:50in their heart whether it was one vessel
10:52two vessel or three vessel disease so I
10:54think to myself every time I'm writing
10:56that prescription is this one of the
10:58five that could have occlusion and is
11:00there opportunity to intervene at this
11:03point so it's really important to think
11:04about cardiovascular disease as well one
11:07of the big subjects that I hear a lot
11:08about even in my friendship groups is
11:10about libido I've I've got so many
11:13stories in my friendship group of either
11:15one or both Partners losing their libido
11:18so on this subject matter of libido is
11:19kind of where I wanted to start this
11:21conversation what is the most frequent
11:23and popular reason why men and women
11:26struggle with libido problems and
11:32how much of of that is about
11:34compatibility yeah good question libido
11:37is multifactorial there's many pieces of
11:40libido it's very complex and I'll give
11:42you some important components first it
11:44could be hormonal and the pneumonic I
11:46teach the residents is pet the four
11:49hormones that can affect someone's
11:50libido are prolactin estrogen thyroid
11:54and testosterone so you have to check
11:56the pet if the prolactin is elevated the
11:58libido goes down the testosterone's low
12:00the libido goes down so maybe it's a
12:02hormonal issue which could be it and
12:04particularly many women who go through
12:05menopause suffer from hormonal issues
12:07and it could be a hormonal issue the
12:09second is something called
12:10neurotransmitters so in other words
12:13serotonin norepinephrine dopamine
12:15dopamine goes up libido goes up
12:17serotonin goes up libido goes down so
12:19these all regulate how someone's libido
12:22will function so one of the biggest um
12:25uh culprits for low libido are
12:27anti-depressants what do
12:28anti-depressants do they increase
12:30serotonin and they decrease libido so
12:33sometimes it's a medication or something
12:35that a patient's taking that will shut
12:37down their libido for example a
12:39medication that men take for urinary
12:41function called finasteride shuts down
12:44their libbido so that is there are
12:46certain things that you have to look at
12:48the other components are um lifestyle
12:51diet exercise sleep and stress reduction
12:53particularly fatigue and stress if a
12:55woman is tired and she's exhausted and
12:58she has to between sex and sleeping at
13:01night many times she may choose sleep if
13:04me as well right I'm just saying so
13:06fatigue is important stress and there's
13:08this cliche this pneumonic this this
13:10saying that um with stress is kind of
13:13interesting typically if a man has a
13:15very stressful day he will want to have
13:17sex to relieve his stress uh women have
13:20to relieve their stress to engage in
13:22sexual activity it's kind of the
13:24opposite you know what I mean so I tell
13:26men if you really want to have sex with
13:27your wife uh do the dish just take out
13:29the trash H do everything you can to
13:30tuck the kids in bed early relieve her
13:33stress because that will significantly
13:35increase her desire to engage in sexual
13:37activity but the other one is uh
13:39psychogenic so you know we talked about
13:41that earlier you know sex has a huge
13:44mental component your relationship with
13:46your partner your uh your the how close
13:49you feel with your partner so sometimes
13:50patients come to me and they're an
13:52abusive relationship and say and they
13:54say give me the pill that improves my
13:55libido I said I it's not going to work I
13:58mean the the essence the core the
13:59foundation is not working and therefore
14:02it's really important for them to see a
14:04sex therapist one thing for men that
14:07actually shuts down their libido is when
14:09they start developing erectile
14:11dysfunction so if a man starts getting
14:13erectile dysfunction let's say he gets a
14:16good erection 50% of the time and he's
14:18starting to have some problems and it's
14:2010 o'clock at night and he says look I
14:21can try to engage in sexual activity but
14:23it may or not work and it may be
14:24frustrating and embarrassing or I can
14:26just go to sleep it's probably just
14:28going to go to sleep right and it
14:29becomes a vicious cycle because the less
14:31sex he has the more difficult it is to
14:34engage in sexual activity later on and
14:37so you may interpret this as a low
14:39libido but he's really just avoiding it
14:41because he doesn't want to deal with it
14:42right but the partner also uh looks at
14:45this as maybe I'm not attractive anymore
14:47maybe there's something about me that's
14:49not appealing and it becomes a vicious
14:51cycle so one thing you can do is
14:53significantly improve the quality of the
14:55erections in a man and that actually
14:58helps improve his libido so for example
15:00if I tell a man if every night you uh
15:03have anere great erection and every
15:05morning you wake up with a great
15:07erection what are you going to probably
15:08do probably going to use it right so
15:10libido inherently goes up right so I
15:13think e Ed and libido are tied very
15:15closely how do you define the Tam labido
15:17in simp it's a desire to engage in
15:18sexual activity right for men and women
15:21and you have to you know when it's a
15:22true problem they have to be bothered by
15:25the condition so I just want to be very
15:26clear there are women who have low
15:28libido and say I really don't care I'm
15:29happy that I have a low libido well then
15:31it's not an issue right you have to be
15:33bothered by the issue so on this
15:35psychogenic element where it becomes a
15:37vicious cycle I've seen this in my own
15:40life um several times Well at least once
15:43and I've seen it in some of my friends
15:44where because there's a bedroom issue
15:47when you go to the
15:48bedroom you're both a little bit anxious
15:52and then one of you can't perform and if
15:54you can't perform it exacerbates the
15:56issue and it creates this sort of
15:58vicious downward spiral of like it makes
16:00the bedroom like a really awkward place
16:02to be and this is how I think about when
16:03you're talking about psychogenic
16:05component so in the in the case of
16:07erectile dysfunction if you're thinking
16:09as a man God if I go to the bedroom I'm
16:10not going to be able to get it hard I'm
16:11not going to keep it up it's going to be
16:13embarrassing she's then going to ask me
16:15questions she's going to think I I'm not
16:16into her which just makes it even harder
16:19because as a man like I perform best
16:23when I'm really not thinking about it
16:24and I'm like not anxious when I'm stress
16:27free right and if seems to me that the
16:29like antithesis the opposite of great
16:33sex is like
16:35overthinking you're 100% correct and
16:37this is what happens let's say a man
16:39gets Ed just one time just one time
16:41young man he says that was really odd
16:44and I I what's wrong you know what he
16:46does next time he has sex as he's having
16:48sex he says to himself I hope I don't
16:50lose my erection I hope I don't lose my
16:52erection the second he says that to
16:53himself as he's having sex he's going to
16:55lose his erection right because he's so
16:57worried that he's going to lose the
16:58erection and not enjoying the experience
17:00so now it's happened twice so now he
17:02engages sex third time and now he's even
17:04more freaked out because it's happened
17:05twice and it happens again we call this
17:08the Vicious Cycle right because the now
17:11sex has become an anxiety event anxiety
17:14provoking event and so you really have
17:16to work on decreasing that anxiety and
17:18not thinking about it that's where Sex
17:20Therapy comes in hand and that's where a
17:22medication called daily Calis has become
17:25unbelievably helpful for my young
17:26patients because daily Calis is a
17:29medication that men take daily you've
17:30heard of Cialis right it's like the
17:32Viagra yeah it's like Viagra right so
17:34there's Viagra there's Calis Levitra
17:36there's stender there's four different
17:37brands but one of the four is meant to
17:40be given daily it's a lower dose 5
17:42milligrams every day and the larger dose
17:45is 20 milligrams when you give a man
17:47Calis 5 milligrams every day what it
17:51does is essentially is having that
17:53medication on board all the time when he
17:55engages in sexual activity he doesn't
17:57have to take a pill he just has has sex
17:59whenever he wants to and I found that to
18:01be unbelievably helpful in Breaking
18:03psychogenic Ed now that's exactly what
18:05that is on the table yeah that's exactly
18:07what it is yeah and so these are these
18:09are these are pills um that are in the
18:11US but what's nice is they used to be
18:13very expensive uh now they if you look
18:16at Mark Cuban and a lot of the uh good
18:18RX um companies they men can get 90
18:21pills for5 or $20 which is very cheap
18:23you use the word young men yes young men
18:26presumably shouldn't be taking pill
18:28shouldn't but what happens when they
18:29have psychogenic Ed cuz they think about
18:31it the most is they need to break the
18:34cycle what's the cost cuz I'm a I'm got
18:36to be honest I'm a pill skeptic yes so I
18:38try and avoid taking pills to solve my
18:40problems if I can right obviously
18:42there's going to be situations where I
18:43can't and I accept that but my bias is
18:45towards figuring out if there's another
18:47way before I take a pill right um
18:49because everything in life comes with a
18:51cost all things yeah so there must be a
18:53cost to taking a pill to solve this
18:55problem well the the actual monetary
18:57cost is unbelievably cheap monetary cost
19:01is I'm thinking about like do I then get
19:03dependent on this do I have to take this
19:04for the rest of my life so so there's no
19:06dependency let me tell you why I think
19:07that drug is so important that daily
19:10seis has one of the only things in my
19:12opinion that actually reverses erectile
19:14dysfunction so let's backtrack I give
19:17you an example let's say today you break
19:19your leg okay I have two options Stephen
19:22I can fix your leg or I can give you
19:24vicadin a narcotic and if I give you the
19:27vicad or the narcotic you'll still be
19:28able to walk until the vicadin no longer
19:31works and we're in trouble Viagra is a
19:34vicadin it is not a cure for your
19:36erectile dysfunction it's just masking
19:38the problem daily seis in my opinion is
19:41one of the few things that helps cure Ed
19:44if you look at studies and you look at a
19:45penal tissue and we biopsy the tissue
19:47and then you biopsy three months later
19:48on daily seals it physically gets
19:51stronger so let's say you go to the gym
19:53today and ask you to lift dumbbells
19:54what's going to happen to your arm it
19:55will hypertrophy with daily seal we see
19:58hypert of the smooth muscle meaning it
20:00gets physically stronger so in my
20:02opinion it's one of the best things to
20:04prevent Ed in the future help reverse
20:07the Ed process more importantly daily
20:10Calis protects the endothelium and we
20:12have to spend some time talking about
20:14that that is the lining of the blood
20:16vessels it's the brains and the lining
20:18of the blood vessels is very important
20:20because once that gets injured you start
20:22getting clot or plaque which will get a
20:24heart attack a stroke and a rectile
20:26dysfunction so it protects the lining of
20:27the blood vessels two other indications
20:30it's FDA approved to help a man urinate
20:32better FDA approved it's FDA approved to
20:35protect the heart in terms of something
20:36called pulmonary hypertension so in my
20:38opinion it's an excellent medication
20:41patients say do I get dependent on I say
20:42you do not get dependent on it and H I
20:44feel like you're better had you taken it
20:46than had you not you take it for three
20:47months you get strengthening of the
20:48penal tissue what happens if I stop
20:50taking it if you stop taking it there's
20:53a wonderful study by a versa and what he
20:55showed was that those patients that
20:57stopped taking it after 3 months versus
20:58Placebo still had benefit in terms of
21:01endothelial function protection and
21:03erectile function protection than those
21:05people that took Placebo so thinking
21:06about saying hey if I go to the gym and
21:08I work out for three months what happens
21:10if I stop I say well Stephen you're
21:11better off had you gone to the gym for
21:12three months that's my opinion what is
21:14the downside they're side effects so
21:16every drug has side effects right but
21:18they're low with five milligrams back
21:20pain stuffy nose um headache can occur
21:23in these but it's quite small but I do
21:25think that this is one of the
21:27medications that really can make an
21:29impact uh in men's health think about it
21:31if I told you there's a medication that
21:32protects your heart helps your prostate
21:35and helps men with erections it's
21:37affordable I think that most men would
21:39say I'm in what are the big side effects
21:41that people report when they're on seis
21:44so on the larger dose headache stos back
21:47pain is more common with Calis and other
21:49medications um but it can be reported
21:52remember you shouldn't take these
21:53medications if you have you're taking a
21:54nitrate because it can drop your blood
21:56pressure um but other than that these
21:58are very commonly used medications
22:00throughout the world and they're not
22:01suitable for certain people that have
22:02certain cardiac disorders I'm guessing
22:04well you know the way this was invented
22:06uh this came at first one Viagra came
22:08out in 1998 Viagra was in the clinical
22:10trials designed to be a blood pressure
22:12medication and accidentally men were
22:14getting erections in the trial so these
22:17medications are in my opinion
22:18cardioprotective a guy named a very
22:21famous uh physician B Dr cloner
22:23published an article recently showing
22:25that those men who took daily seis had
22:28133% reduction in cardiac events and a
22:3125% reduction in mortality that just
22:33came out because of the potential
22:35effects of protecting the endothelial
22:37lining of the blood vessels how does
22:39this work to solve for the sort of
22:41psychogenic component that we talked
22:42about that vicious cycle people get into
22:44with like I'm guessing you're telling me
22:46that increases your probability of
22:48having a good erection right but this
22:51still isn't really working on a liido is
22:53it right so let's say um you started
22:55falling through the Vicious Cycle and
22:56you started having Ed and it was two
22:59times three times and now I put you on
23:00this medication and every time you have
23:03sex you have the most amazing erection
23:04of your life and 30 times 40 times three
23:07six months go by and you're having these
23:09amazing erections you're relaxed and
23:10you're calm then I start going to every
23:12other day you still get amazing
23:13erections then I go to once a week you
23:15still get amazing erections then I stop
23:17you still get amazing erections right I
23:19just need to show you that everything is
23:20perfect again and that has a huge value
23:23what about for women this is the
23:24unfortunate part we don't have a lot of
23:28treatment options for women and if you
23:30look about it if I want to give you an
23:32example in 2015 if you and I went into
23:35the drugstore in the US Walgreens and
23:37said give me all the drugs to treat
23:39women to treat men for sexual
23:41dysfunction they would put 30 drugs on
23:43the counter these are all the wonderful
23:44treatments for men in 2015 there was not
23:47a single FDA approved drug to treat
23:50women for any sexual dysfunction very
23:52sad in 2015 the first drug to treat
23:55women for female sexual dysfunction came
23:57out and it was called ad or fanin and
23:59fanin basically is a drug that a woman
24:01takes every day and increases her desire
24:03for sex that's it that's the FDA
24:05indication increases her desire for sex
24:08several years later the second drug for
24:10women came out this was called VII or
24:13brontide essentially it's an injection
24:15that she takes 45 minutes prior to
24:17intercourse and it increases her desire
24:19for sex but again we have only two drugs
24:22the reason being is because the research
24:24the funding that we have for female
24:26sexual dysfunction is far less than we
24:29have for male sexual dysfunction and
24:31it's unfortunate because as I mentioned
24:33earlier this is a couple's disease and
24:35so many times I have to use drugs that I
24:37use for men to help treat women so I do
24:40use Viagra for women but Viagra for
24:43women helps arousal so let me explain
24:47female sexual dysfunction has four
24:49components one is decreased libido the
24:52second is decreased arousal third is
24:54orgasmic dysfunction and the fourth is
24:56pain with intercourse these are the four
24:59if a woman has any one of these four and
25:02she's bothered by it she suffers from
25:04female sexual dysfunction in the US
25:07roughly 43 to 48% of women suffer from
25:12female sexual dysfunction significant
25:14number only 19% seek therapy will get
25:18therapy so there's a huge number of
25:19women that I say are suffering in
25:21silence they suffer from the condition
25:23they don't know where to get help and
25:25unfortunately they're not many treatment
25:27options available right so it's a big
25:29problem and a big unmet
25:31need and on the hormonal component you
25:34talked about how if dopamine is up we're
25:37much more likely to be aroused and if
25:39serotonin is up then we're much less
25:43likely to be ared correct so this kind
25:46of ties into something I was thinking
25:47when you were talking about stress and
25:48tiredness when I'm stressed and tired is
25:51my dopamine down it can be your cortisol
25:54goes up right your C cortisol goes up so
25:57your ability to get excited will go down
25:59your fatigue goes up so it makes it much
26:01more difficult these and there's more
26:04than just dopamine and serotonin there's
26:05norepinephrin there's melen Corton uh
26:08there's many other neuro neurosteroids
26:11and it's really just what we call a plus
26:13minus game if I have more positives than
26:15negatives I'm going to have desire and
26:17I'm also going to have orgasm right
26:19that's important also so if you give
26:21someone uh too much serotonin and it
26:23goes this way not only does a libido go
26:25down but it's difficult to achieve
26:27climax or an orgasm so one of the ways I
26:30treat premature ejaculation is I give
26:32them an anti-depressant because it
26:33delays the orgasm so we have to be very
26:37careful on these neurotransmitters how
26:38we use them but if you talked about ad
26:40the drug I mentioned all it does is it
26:43increases dopamine and norepinephrine
26:45which increases libido so they increase
26:48neurosteroids many women particularly
26:50with the hisyory breast cancer like this
26:52because they don't want to use
26:53testosterone or estrogen hormones this
26:56is non hormonal right it's just neur
26:58steroids increasing the desire for sex
27:01can I think about dopamine and serotonin
27:03as like a scales yes where if I if I put
27:05weight on one end the other one goes up
27:07and if I put weight on the other end the
27:08other one goes up yes there is a very
27:10famous uh Michael Perman came up with
27:12the Tipping Point and it's basically a
27:14scale looking at the pluses and the
27:16minuses and if you have more pluses than
27:18minuses liido goes up orgasmic function
27:21goes up if you have more minuses
27:23essentially your ability to orgasm and
27:24your liido will go down so I want my if
27:26I want to be aroused and have a desire
27:27for sex and have good sex then I want my
27:29dopamine levels to be high dopamine High
27:32oxytocin High norepinephrine High
27:34serotonin low what are the types of
27:36activities that make my dopamine High uh
27:39well um exercise is can be really high
27:44dopamine other things increase dopamine
27:47as well right so um gambling there's
27:50there's certain things that are highs
27:51like gambling anything that gives you a
27:52high certain foods will cause a dopamine
27:54Rush um but they're temporary right and
27:57so that's a problem right because if it
27:58goes up and it goes goes back down it
28:00crash so you want your dopamine to go up
28:02in men and women so we use medications
28:05like Wellbutrin have you heard of
28:07Wellbutrin it's an anti-depressant but
28:09that anti-depressant increases dopamine
28:12so I use that to help men increase their
28:14libido or women to increase their libido
28:16or sexual function I use ad e in men and
28:19off label in men and in women to
28:20increase dopamine I don't want to do
28:22drugs though I don't want to take any
28:24pills so then I would say I need you to
28:26exercise and you do but exercise is
28:27critical I need you to sleep I need you
28:29to um reduce your stress right those
28:31things will significantly improve uh
28:34your libido so what things then lower
28:37dopamine because I've spoken to a few
28:39like dopamine expert experts on the show
28:40before and they talked to me about this
28:42sort of I mean Andrew hubman was telling
28:43me that yeah when you do an exercise
28:45like let's say gambling or go on Tik Tok
28:47your dopamine's going to go up but then
28:49it's going to crash below the base Point
28:51yes and some of us live in this kind of
28:52dopamine roller coaster where we're
28:54doing these dopamine inducing activities
28:56dopamine goes up it then crashes below
28:58and when it gets low we have cravings
29:00for dopamine inducing activi so we go
29:02out and want to gamble or go on Tik Tok
29:04again or eat something and then it goes
29:06up again and then and we kind of live in
29:08this kind of roller coaster of dopamine
29:09one of the things that I was told by a
29:11dopamine um expert on the show recently
29:14that does that as well that links to
29:15some things I found in your work is
29:17pornography yes and when we talk about
29:19this psychogenic component we talk about
29:22um do dopamine
29:24levels how much is pornography
29:28causing this libido crisis yeah
29:32pornography and Ed in libido is somewhat
29:35controversial there's some data suggest
29:37that it does not cause an issue and
29:39there's some data suggest that it does
29:41the first question I ask a patient when
29:43I ask a man I say is your Ed present
29:46with pornography also so if he says look
29:49I have rectile dysfunction with my
29:50partner and I have a rectile dysfunction
29:53with pornography that's very different
29:55than when he says I have a rectile
29:56dysfunction with my partner and I have
29:58amazing erections with uh pornography
30:01right because then I know that there's a
30:02psychogenic component as well this is
30:05what I believe I believe that when a man
30:07watches excessive amounts of pornography
30:10what his expectation is becomes hair and
30:12his reality becomes hair and that Delta
30:16causes them to have erectile dysfunction
30:19and low libido they're not getting what
30:21they're expecting to get so many times I
30:24question men when they come in uh all
30:26when all men who come in for to ask how
30:28much pornography are you watching in men
30:30who watch excessive pornography if I ask
30:32them to stop watching pornography for a
30:34while many will report improvements in
30:36their rectile function and libido so
30:39again I do think that pornography in
30:41excess can have a negative impact only
30:44because of your expectation and your
30:46reality the Delta uh can be an issue I'm
30:50reading some stats here from jamama
30:51Network that says the percentage of men
30:53between 18 and 24 reporting no sexual
30:55activity in the past year increased from
30:57roughly 18 % to roughly 30% in the space
31:01of what looks like just a few years and
31:04simil similarly the average number of
31:06times American adults engaged in sexual
31:08activity per year has decreased from 60
31:11between
31:131989 and
31:151994 to 50 roughly 50 between 2010 and
31:202024 these shifts suggest a notable
31:23shift in sexual behavior over recent
31:25decades why do you think this is
31:27happening I think it's more
31:27multifactorial so I think one is I think
31:29that Ed and sexual dysfunction is on the
31:31rise uh and if you look at uh the causes
31:34for Ed uh it's very simple you look at
31:37uh obesity diabetes metabolic syndrome
31:40it's a pandemic it's an epidemic
31:41throughout if you look at just diabetes
31:43from 1990 to
31:452022 uh 100% 7% to 14% of the population
31:49one out of eight people globally are
31:51obese one out of eight people so these
31:54can make it very difficult uh as obesity
31:57and diabetes that go on the rise what
31:59happens testosterone levels go down
32:01right so testosterone levels go down so
32:03the ability to engage in sexual activity
32:05the desire to engage in SE activity will
32:07be impaired by these uh conditions I've
32:11got some some graphs here um which show
32:14Global obesity Trends Global diabetes
32:16Trends I'll put them on the screen for
32:17anyone that's watching on video um also
32:20there's been an increase in pornography
32:21consumption from what I was able to tell
32:23from doing some research a 2020 study by
32:27the University of ant found that 40% of
32:29people aged 35 to 45 who watched 300
32:32minutes of porn a week had erectile
32:34dysfunction in a 2021 study by GMA
32:38public health and surveillance and 3,400
32:41men between 18 and 35 years old 20% of
32:44the participants suffered from erectile
32:46dysfunction and researchers found that
32:47the greater the viewing frequency of
32:49pornography the greater the development
32:51of this dysfunction yeah and that's 300
32:52minutes is quite a bit of time a week 5
32:54hours minutes five hours five hours a
32:56week right so this so that's quite a bit
32:59yeah that's quite a bit how important do
33:01you think that is as a component to this
33:03sort of fracturing relationships we
33:05think about people having sex with each
33:06other less yeah we're heading towards a
33:08world of like virtual reality and AI yes
33:11what role do you think that's genuinely
33:12playing and you you must have private
33:14conversations with men that are really
33:15suffering with these things so I I
33:17definitely think it's it's a role and it
33:18definitely plays a factor but not as
33:21much as the epidemic of diabetes obesity
33:24metabolic syndrome we are as a
33:26population becoming more and more
33:28unhealthy right as time goes on and I
33:30look at again as a piie it's
33:32multifactorial right um most of us now
33:34are not our socialization is virtual and
33:37so we are not engaging and going into
33:39seeing everything is done virtually and
33:41so I think that's an issue um and so I
33:44really believe that pornography is a
33:46component but the the decline in overall
33:49health is a major component the decline
33:51in testosterone levels decade by decade
33:54is also another component as well it's
33:56pretty terrifying that young kids at the
33:58age of like 12 13 14 when they open
34:00their phones these days will be exposed
34:02to sexually graphic images yeah whether
34:05they CH chose to seek them out or not
34:07yes and i' I've always wondered what
34:09that's doing to a developing brain you
34:11know how it's adjusting your
34:13expectations how it's creating some of
34:14those psychogenic factors that are
34:16making you less aroused and um and it's
34:20difficult right it's difficult to go out
34:21and find a partner you have to like put
34:22on the After Shave shave take care of
34:24yourself you have to like Risk rejection
34:26spend some money right be interesting
34:29right so it seems like if from a
34:31evolutionary perspective if I was just
34:33trying to like get my nut off or like
34:34yeah I don't know ejaculate I've got
34:37this really easy way now like it's so
34:39easy yes three clicks on a computer
34:41We're Off to the Races versus like all
34:44the effort and rejection and pain of of
34:47trying to find an actual human being to
34:49have sex with right and then when I do
34:52do approach number one when I log on to
34:53some website and click a couple of times
34:56I'm getting no headache I'm getting
34:59whatever I want I can order from a
35:01endless list of menus and I'm sure in
35:02the near future I'll even be able to
35:04make my own yes and in not so distant
35:06future I'll have I'll have it in my
35:08house and it'll talk to me yes yeah so
35:11it's a problem and you think about the
35:13it's it's making it more difficult for
35:14people to socialize right so in other
35:16words now when patients or people engage
35:18in sexual activity um and they're
35:20usually having sex on the Internet or
35:22with pornography when you actually have
35:25actually engage in sexual activity with
35:27another person it can be cause anxiety
35:30right you get anxious it's not something
35:31that you're doing regularly and so I
35:34think that it can become an issue I amum
35:36I saw an article this week from an only
35:38fans Creator who posted that one one
35:40customer of hers had given her $4
35:42million this year oh my God and you
35:45think about like you think about what it
35:47would take for you to spend $4 million
35:50on a parasocial relationship with an
35:53only fans Creator sending you explicit
35:56pictures
35:58and I don't I don't quite believe we
35:59fully understand what's around the
36:00corner I agree these stats I think are
36:03nothing compared to what's what's around
36:04the corner
36:06um and I I don't know I think about it a
36:08lot
36:09because when I read these stats about
36:12erectile dysfunction being on the rise
36:14and I I read that we're having sex less
36:15and less um and then I see this rise in
36:18these parasocial relationships I go
36:20[ __ ] know I think think we're just at
36:21the start of an exponential curve um
36:25let's talk about obesity then yeah
36:26because these these stats here are
36:27pretty shocking um this one shows the
36:30global obesity Trends which just shows
36:32them going straight up yes which is
36:35horrific this one shows Global diabetes
36:37Trends which is pretty much straight up
36:40as well yes has there been any studies
36:42done that show the link between being
36:45overweight and your probability of
36:47having low
36:48libido and some kind of sexual
36:50dysfunction issu yes numerous and so
36:53let's start with this so obesity it's
36:54not surprising that diabetes is going up
36:56because as obesity goes up it causes
36:58insulin resistance so obesity and
36:59diabetes typically go hand in hand the
37:02problem with obesity is the following
37:04obesity significantly drops testosterone
37:07levels so fat cells contain something
37:09called aromatase aromatase eats up the
37:12testosterone and converts it into
37:14estrogen so the more fat you have the
37:16less testosterone you'll have because
37:18you'll convert it into estrogen fat
37:20cells also secrete something called
37:21cortisol and leptin which shut down your
37:24own natural testosterone production so
37:26as it's not Sur surprising that decade
37:28by decade as you see an increase in
37:30obesity you see a decline in
37:32testosterone levels in men because the
37:34testosterone levels will come down as
37:35people become more obese and low
37:37testosterone equals low libido low
37:39testosterone increases low libido the
37:40number one driver the number one hormone
37:42for libido in men and women is
37:44testosterone it's a strong driver men
37:47and women men and women and don't forget
37:49that testosterone is also signif really
37:52important in erectile function men need
37:54testosterone for sexual function so do
37:57women right it's extremely important so
37:59now I have a hormone that's going down
38:00that's going to make it more difficult
38:01to get an erection I have a hormone
38:03that's going down that's going to
38:03decrease my libido and it's mainly due
38:06to this obesity that's occurring one of
38:08the biggest factors so obesity obesity
38:11also um uh if you look at the risk
38:13factors for Ed obesity diabetes
38:16cardiovascular disease these are all
38:17risk factors and so as obesity goes up
38:20erectile dysfunction goes up and the
38:23number one condition is diabetes
38:24diabetics are four times more likely to
38:26have Ed than any other population four
38:29times so I get worried when we see this
38:31obesity diabetes pandemic going up
38:33because it's increasing only the
38:35erectile dysfunction um Stephen if you
38:37look at the Obesity the group that's
38:39having the greatest rise in obesity is
38:42adolescence obesity not adult obesity
38:44the kids younger and younger ages are
38:47having that age group has the greatest
38:49rise of obesity so what does that turn
38:51into the younger population are starting
38:53at at lower tea levels and has an
38:56implication on fertility because you
38:58need testosterone to produce sperm
39:01that's very
39:02important so if I just lose a little bit
39:04of weight that'll have a big impact on
39:06my testosterone levels let's talk about
39:08that it's not a little bit so the best
39:10study was at the European male aging
39:12study Fred woo and what he showed was
39:14this it's a bidirectional relationship
39:17if you lose 10% of your body weight you
39:20can actually gain 85 nanogram per deiler
39:23in serum testosterone if you lose 15% of
39:26your body weight you can actually gain
39:28250 nanogram per deciliter in serum so
39:31it's actually significant if you can
39:32lose but it also goes the other way you
39:34gain weight you drop the tea
39:36proportionally as well the only issue is
39:39I can get the patients to lose the
39:41weight but I can't get them to sustain
39:43it many times they gain it back right
39:46but if they can keep the weight off it
39:48significantly increase uh the
39:50testosterone levels the the best data
39:51we've seen is in the bariatric surgery
39:53data if I do bariatric surgery on a
39:55patient which to help them lose weight
39:57weight you can shrink the stomach we do
39:59surgery to help them lose weight they
40:01lose quite a bit of weight their tea
40:02levels go quite up right and so again
40:05there is a strong correlation between
40:07weight and testosterone have you gotten
40:10examples
40:11of patients where you've given them
40:13testosterone treatment in some form
40:15you've done something to increase their
40:16toest testosterone and you've seen a
40:18remarkable reported difference in their
40:20sex life all the time yeah so so first
40:23let's backtrack there's two ways to give
40:25a person testosterone uh if I give a
40:29young man testosterone remember it
40:31causes infertility so you would never
40:33give someone testosterone if they're
40:34planning to have children right that's
40:36very important right so I have two ways
40:39to raise their testosterone I can give
40:40you medications to raise your natural
40:43testosterone there's several there's a
40:44pill called chopine citrate there's HCG
40:47I can use medications to raise your own
40:49natural testosterone and they preserve
40:52your fertility the second option is I
40:54can give you medications like
40:56testosterone there's seven of them but
40:58they will shut your natural production
41:00down not only will they shut your
41:01natural testosterone production down but
41:03they will shut down your sperm
41:05production now if you've already had
41:07your kids you're 60 years old your
41:09testosterone level is already low in the
41:11first place what are you preserving okay
41:13it makes a lot of sense and there's
41:15seven ways to do it my favorite way are
41:18the injectables and the oral
41:20testosterone they are fantastic oral
41:22testosterone is quite interesting you
41:23know first of all testosterone was
41:25invented in 1935 this is not a new drug
41:281935 and oral testosterone initially was
41:31feared because it would actually cause
41:33liver toxicity and liver cancer and it
41:36wasn't until the 1970s when they were
41:38able to make oral testosterone uno8 and
41:41what's nice about uno8 it bypasses the
41:44liver no cancer but it had to be taken
41:47three to four times a day it was
41:49available in the UK as a drug called
41:50andreal all over the world but not the
41:53US the US we did not get our first oral
41:56testosterone till 2019 and then 2022 we
42:00received two more and now we have tando
42:03jatenzo and Kaiser Trex is our oral
42:05they're taking twice a day with a meal
42:07what's nice about Kaiser TRX it's
42:09actually available in the UK so in the
42:10UK now they can actually get Kaiser TRX
42:12as well but oral testosterone most
42:14patients don't mind taking a pill uh it
42:17seems very easy to do so should someone
42:19like me be taking testosterone if your
42:21levels are low yeah and you're
42:24symptomatic and I think that's very
42:25important if a man comes in with low
42:27levels of testosterone and says I feel
42:30great I have no symptoms I said I'm not
42:31giving it to you these are the symptoms
42:33low energy yeah low libido erectile
42:36dysfunction decreased muscle mass
42:38increased fat deposition poor sleep and
42:40depression these are some of the common
42:42symptoms you'll see most sensitive
42:44symptoms are the sexual symptoms
42:46erectile dysfunction and low libido so
42:48if he says I have these symptoms and my
42:51levels are low and I recheck it and
42:53confirm that it's low that man is a
42:55candidate for testosterone therapy
42:57but if he's young hasn't had has have
43:00children yet I'm going to say look let's
43:02hold off on giving you testosterone and
43:03use medications to make you make
43:06testosterone and if you don't want to
43:08take medications actually there are many
43:10things you can do on lifestyle
43:11modification to raise your testosterone
43:13we talked about weight loss as well so
43:15let's live in this area here you are too
43:18young to take testosterone now but
43:20conversely let's say a patient comes in
43:22and has every single sign and symptom of
43:24low testosterone but his testosterone
43:26levels are normal I'm not giving him
43:27testosterone because it could be
43:29something else maybe he's depressed
43:31maybe he has a low thyroid something
43:33else is going on so you must have signs
43:35and symptoms and a low tea level to be a
43:38candidate and if you fit that then you
43:40may benefit what about women so this is
43:42important in 1935 when testosterone was
43:44invented uh it wasn't many years later
43:46till they actually started using
43:47testosterone in women and early reports
43:50of testosterone women were actually
43:51quite remarkable the earlier manuscripts
43:54describe improve uh quality of life
43:56improve libido and if you and I walked
43:59into the drugstore today and said give
44:01me the testosterone for women it does
44:04not exist there's not a single FDA proof
44:06testost for women in the United States
44:08um but we have well over a dozen for men
44:12can you explain this to me just because
44:13I want to make sure I'm clear why would
44:16a woman take testosterone because when I
44:18think of T testosterone I think of men
44:20yes so women make more testosterone than
44:22any other hormone in their body make
44:24more testosterone than any other hormone
44:26in their body right and when women have
44:29higher levels of testosterone they tend
44:31to see a greater Improvement in libido
44:33muscle mass bone mineral density uh
44:36sense of well-being uh some of reported
44:38improvements in cognition as the
44:40testosterone level goes down we start
44:42seeing these symptoms particularly low
44:44libido if you give a woman back her
44:47testosterone she will many of these
44:48women see a significant Improvement in
44:50their libido but the issue is that we
44:54don't have an FDA approved product for
44:56testosterone in the United States I
44:58think in the UK you call it off license
45:00we call it off label now in the UK they
45:03did have one they had a wonderful patch
45:04called intrinsa and then the women in
45:06the UK could get the patch for
45:07testosterone go into the drugstore NHS
45:09covered it and it was fine uh then they
45:11had andram and andram was actually
45:13approved and now no longer is approved
45:15so now in the UK you also don't have an
45:18onli medication the uh you can still get
45:22andram from Australia but unfortunately
45:25uh it's very difficult to get so do we
45:27do we use the drugs for men and we give
45:30it to the women in on10th the dose
45:32that's all we do so if we have a packet
45:34that's a man puts on a day we say use
45:36one tenth of the packet every day for
45:38the women and they can see significant
45:40improvements it is not illegal to give a
45:42woman testosterone it's just considered
45:44off label or off license but they they
45:46see significant improvements in what
45:49sexual function by far the most libido
45:51goes up no question I many women report
45:54that muscle mass if you think of
45:57testosterone bodybuilders take
45:58testosterone for a reason why it
46:00significantly improves muscle mass it
46:02can decrease fat deposition many
46:04patients will import improvements in
46:06cognition it can help with bone mineral
46:08density as well in men and women and I
46:10also believe in depression so I think
46:12testosterone does help with depression I
46:14just want to just make a very important
46:17Point testosterone is not just about sex
46:20there are five other things that you
46:21need to think about uh in men and women
46:23and I want to talk about those men with
46:26low testosterone l levels are much more
46:27likely to have a heart attack
46:29non-negotiable men with low testosterone
46:31levels are much more likely to have
46:32diabetes obesity men with low
46:34testosterone levels are much more likely
46:36to suffer from depression men with low
46:38testosterone levels are much more likely
46:40to have a bone fracture so it's not just
46:42about sex it's about their overall
46:44health and if you were to check one
46:45blood test to assess a man's overall
46:48health it's his testosterone level one
46:50blood test to check his overall health
46:52it will be because I have it affects
46:54heart diabetes obesity um bone mental
46:57density energy muscle mass erections
47:00libido one blood test I can't think of
47:02another blood test that is a better
47:04barometer of overall health I want to
47:06get clear on something because I've
47:06heard people talking on my podcast
47:08before about HRT yeah and women taking
47:11HRT because of menopause and things like
47:14that should they be does HRT have
47:17testosterone in it no so typically when
47:19we say HRT we're talking about estrogen
47:22and progesterone typically yeah and
47:24typically when we talk about trt
47:26testosterone placement it's a little bit
47:27different in a woman there's something I
47:29call the triangle and it's just
47:31basically estrogen progesterone and
47:33testosterone just simple and if you have
47:36a woman who's deplete in estrogen
47:38testosterone and pro estrogen
47:40progesterone testosterone and replace it
47:42many of those women feel better right so
47:44many of them do there are other hormones
47:46that are also important I call it the
47:48outside Circle cortisol thyroid growth
47:51hormone we look at those as well and so
47:54I think those are also very important
47:55and I tell them we're going to going to
47:57optimize your uh hormones but what
47:59you're going we're going to optimize
48:01your medical condition but that is only
48:0250% of the story the other 50% again is
48:06Diet exercise sleep and stress reduction
48:08and if you do your part and I do my part
48:12we're on fire we're absolutely on fire
48:14but you have to do your part same with
48:15men I put you on the testosterone I
48:17optimize your medical conditions and but
48:20you got to exercise you got to eat right
48:22why aren't women being prescribed
48:23testosterone then right because it's
48:25considered well in many countries it's
48:28on in Australia it's available in the UK
48:30it was available and many women are
48:32being prescribed testosterone it's just
48:34off label it is the first time that I've
48:35seen
48:36someone on my show anyway really
48:38emphasized the point that testosterone
48:40isn't Just For Men it's for women as
48:42well um and it can significantly improve
48:45their quality of life talking about
48:47testosterone one of the big
48:48conversations that's rattling on on the
48:50Internet is about this decline in male
48:52test testosterone over the last couple
48:53of years what exactly is that decline if
48:56you had to sort of quantify it if you
48:59look at the original studies we call it
49:00the Framingham heart study back in the
49:0270s testosterone levels were roughly
49:04around the 700s average men between the
49:07ages of 18 and 40 were around the 700s
49:09and every decade we're starting to see a
49:11decline almost by 50 nanogram per
49:13deciliter and so the latest in the 2015
49:16numbers are roughly in the mid 400 so
49:18we've seen almost a 300 nanogram per
49:20deiler decline in serum testosterone
49:22which is significant because has two
49:24implications uh it's not just about uh
49:27the way you feel and um energy muscle
49:29mass erectile function but that low
49:31testosterone can have implications on
49:33fertility that's really important so we
49:35didn't talk about that but fertility
49:37Testo sperm need testosterone low
49:40testosterone decreases your sperm count
49:42sperm counts have also been on the
49:43decline as well so you know I think it's
49:46really a testament to the fact that
49:48decade by decade we're becoming a more
49:50unhealthy population do you think that's
49:53really the heart of it is that is the
49:54sort of our diets and the way we live
49:56and becoming more sedentary less
49:58exercise more um processed food Etc do
50:00you think that's the hard of I think
50:01that's the key that's absolutely the key
50:03the types of foods we eat the processed
50:06foods that we eat high fructose High
50:08carbohydrate diets um in and if you and
50:10and the way we know that is just look at
50:12the Obesity look at the look at the
50:14diabetes there has to be a reason why
50:16it's on the rise right and on that point
50:19of fertility I'm in a season of life
50:22where I'm going to be trying to have
50:24kids pretty soon what's the most
50:26important things I should be thinking
50:27about from a lifestyle perspective in
50:29your view yeah so I I tell patients
50:31Darwinism in other words survival of the
50:33fittest healthier people are more
50:35fertile right you're passing on the
50:37genes so uh so so essentially uh we tell
50:40patients the number well the number one
50:42cause of infertility in in the world for
50:44men is a verical a verical is the
50:47swelling of the veins around the
50:48testicle you know how women sometimes
50:50can get swelling of the veins in their
50:51legs you see those veins that are kind
50:53of obvious well men can get those veins
50:55dilated around the testicle and those
50:57varicoses can impair sperm production
50:59now 15% of men in the world walk around
51:01with varicus seals but up to 40% of men
51:04with infertility will have verical so
51:06it's really important to assess for the
51:07varic casales but lifestyle modification
51:10each one again diet exercise sleep have
51:12been shown to help improve fertility in
51:14men as well so I say healthier people
51:17are more fertile I need you to start
51:19getting healthier that's very important
51:21we raise the testosterone level in many
51:22of these men naturally we don't give it
51:24to them to help improve their fertility
51:26as well but check Stephen check your SE
51:28analysis that's the simplest thing you
51:30can do check it right I did yeah it's a
51:33great predictor it's not just you know
51:34there was so many amazing studies
51:36showing that a semen analysis is a
51:39phenomenal predictor of overall health
51:41many studies showing that if your semen
51:43analysis today is impaired it's a
51:44predictor of you having comorbid
51:46conditions today like diabetes obesity
51:48metabolic syndrome it's also predictor
51:49of prostate I mean Cancer so we know
51:52that if you have infertility you're at a
51:54higher risk of having testicular cancer
51:56than those that don't have infertility
51:58it's also a predictor of who will have
52:00problems in the future Mike Eisenberg
52:02once showed a very nice study men who
52:05have low sperm counts uh can have a 30%
52:08increased risk in diabetes 50% increased
52:10risk in hemic heart disease in the
52:12future uh Tom wall showed those men
52:14could have 2.5 times higher risk of
52:16high-grade prostate cancer in the future
52:18so again to me it's just a marker of
52:21overall health check the Sean analysis I
52:23did that and it was quite I was actually
52:25to be honest I was really quite nervous
52:26about it because as someone who's you in
52:29my early 30s and wants to have kids I
52:30was really scared that it would come
52:31back and say that like my sperm is um
52:35dysfunctional and I've got a huge amount
52:37of empathy and
52:39um you know feelings for people that do
52:42those analysis and get bad results back
52:4515% of all couples in the world 15%
52:48suffer from infertility that's a lot and
52:50if you think about it um 30% of the time
52:53it's a male Factor 30% 20% the time it's
52:56a male and a female Factor combined so
52:58indirectly a male is involved 50% of the
53:01time when you have infer an infertile
53:03couple and it can be devastating for
53:05that couple I mean psychologically
53:07devastating and what's also interesting
53:09is that um most couples most couples 50%
53:12of couples don't seek therapy and of
53:14those couples that do seek therapy this
53:15is globally only 25% of those couples uh
53:19actually go forward uh and and and and
53:22so I call this a group of individuals
53:24that also suffer in silence they should
53:27know that there are excellent treatment
53:28options
53:29available this um this graph that I had
53:32printed out is just shocking to me it's
53:35going back to the point about
53:35testosterone but the the really shocking
53:38thing is how quickly this has happened
53:40yeah because this is the year 2000 and
53:43this is the year 20156 year and the
53:46decline there is from roughly
53:49600 nanograms is it yes nanogram per
53:52deciliter nanog per deciliter to roughly
53:55for some age group groups here 400 yes m
53:58per deciliter and that's only in 16
54:01years yes so if you play that forward
54:03another 16 years there's going to be a
54:05bit of an infertility crisis there is
54:08fortunately on that graph it's
54:09plateauing a little bit which makes me
54:10feel a little comfortable okay oh yeah
54:12it is actually fling just a little bit
54:14um but you're right it could be a
54:16significant crisis um and again as I
54:18mentioned it's the adolescence the
54:20younger folks who are having the
54:22greatest rise of obesity and that's
54:24where fertility comes in because
54:26fertility obesity in someone in 60s is
54:28not concerned about fertility but a
54:30young patient who has infertility
54:32obesity will have a higher risk of
54:34infertility if you're an entrepreneur
54:36you're probably going to want to listen
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54:47one of those Evolutions that has become
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54:55company is hiring the definition of the
54:58word company is actually group of people
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55:31doac terms and conditions apply if me
55:35and my partner came to you and we said
55:36listen we've got sexual problems in the
55:38bedroom um what are the steps that you
55:41would the things you'd look at that we
55:43haven't focused on so much today is
55:45there anything particular you'd say okay
55:47and I I'm trying to stay away from being
55:49prescribed a pill so I want to do
55:50anything natural I can before I get to
55:52that and then we'll talk about some of
55:53the other more drastic measures one can
55:55take natural things because everyone
55:57wants to know about what's the natural
55:58things I can do so when we talk about
56:00diet there's certain diets that have
56:01been helpful to improve sexual function
56:03for me it's the Mediterranean diet the
56:05Mediterranean diet is rich in whole
56:07grains legumes um fruits vegetables and
56:10if you look at red meat and sweets It's
56:12once a month if you look at poultry it's
56:14maybe once a week but mainly fish those
56:16diets have typically been
56:18anti-inflammatory diets many Studies
56:20have shown that that diet can
56:22significantly improve erectile function
56:24and one study the medita trial actually
56:26showed that it improves sexual function
56:27in men and women so I'm a big believer
56:30in using the Mediterranean diet when
56:32Esposito did her first trial it was a
56:34prospective trial 110 be obese men 55
56:37men get the Mediterranean diet 55 men uh
56:40don't get any intervention at all she
56:42falls in prospectively for two years
56:44what does she find not only a
56:46significant Improvement in endothelial
56:48function remember that lining of the
56:49blood vessel but a significant
56:50Improvement in erectile function in
56:52these men no Viagra no pills nothing
56:55simp simply changing the diet improved
56:58the erectile function the same with
57:00sexual function in women so that's an
57:02important one the second is sleep let's
57:05talk about sleep so studies show that if
57:07you're getting less than six hours of
57:09sleep a night it significant increases
57:11your risk for sexual dysfunction in men
57:13and women right your ideal amount of
57:15sleep should be 7 to8 hours now let's
57:18say you say well that makes sense maybe
57:20I'm going to get sleep sleep for 9 to 10
57:22hours because the more sleep I get the
57:24better my sexual function but that's not
57:25true it plateaus so if above 9 hours it
57:29does not increase your ability or sexual
57:31function so 7 to eight hours of sleep at
57:33night I need you to get third is I
57:35really need you to focus on um uh
57:38exercise so I published a very nice
57:41study looking at uh it was a metanalysis
57:43on how much exercise one needs and what
57:45type of exercise to actually improve
57:47erectile function in this study
57:50typically you need 160 minutes a week so
57:5240 minutes four times a week for a
57:55course of six months of moderate or to
57:57severe exercise vigorous exercise and so
58:00most people can get 160 minutes in a
58:01week of exercise but that's getting your
58:03heart rate up and doing the exercise
58:05significantly improved erectile function
58:07in men if you did that and the more
58:10severe your Ed was the greater
58:12Improvement you saw in erectile function
58:13strictly by exercise alone no other
58:16intervention St just exercise so here
58:18you have a patient that now starts doing
58:20some exercise starts sleeping better
58:22starts changing the diet it's all
58:24additive you are now sick significantly
58:26improving erectile function just by
58:29lifestyle modification
58:30alone pretty profound that exercise can
58:32have such a big impact isn't it is that
58:35the same for women it is true because
58:37many of the things so unfortunately once
58:39again the research we have in women is
58:41not close to what we have in men but the
58:43med trial was also in women the sleep
58:46studies were also in women um and so
58:48these studies also show that sexual
58:50function can be improved with um uh
58:53sleep and with diet um I think that men
58:55and women are not that different I mean
58:57if you see a significant Improvement in
58:58a male sexual function uh with diet
59:00exercise sleep um you can also see it in
59:02women as well actually there was a great
59:04study this looked at 110 women and they
59:07had coronary artery stenosis they did
59:09angiograms on 110 women and they showed
59:12that the greater her stenosis she had
59:15the worse her sexual function so the
59:16greater the blockage in her heart the
59:18worse her sexual function they put those
59:20women on a cardiac rehab program to
59:23actually improve their cardiac function
59:25so a diet and ex exercise program and
59:27those women that actually put through
59:29the were through the program fourfold
59:31increase almost in their sexual function
59:33well 400% fourfold that's right because
59:35we use a questionnaire called the fsfi
59:36which is a questionnaire so significant
59:38Improvement in sexual function just on
59:41improving cardiac function so remember
59:43cardiac function and sexual function are
59:45related and it's bidirectional you
59:47improve one you improve the other it's
59:49very important we didn't we talked about
59:51this earlier 40% of men in the in the
59:54world at 40 will suffer U from erectile
59:56dysfunction 40% 40% Jes 50% at 50 60% at
1:00:0260 70 at 70 80 80 you do the math it
1:00:05essentially is a very prevalent
1:00:07condition this condition is associated
1:00:10with increased cardiovascular vents it's
1:00:12a first sign of a heart attack we talked
1:00:13about that this condition is associated
1:00:15with two and a half times more likely to
1:00:16be anxious three and a half times more
1:00:18likely to suffer from depression and
1:00:20this condition is also associated with
1:00:21diabetes in other words men with Ed two
1:00:24times more likely to have undiagnosed
1:00:27diabetes and yet only 50% of men even
1:00:31talk about it because they're so
1:00:32embarrassed so you show me another
1:00:34condition in the world that affects more
1:00:36men's lives that's associated more
1:00:38adverse conditions and they're too
1:00:40embarrassed to speak about it they
1:00:41suffer in silence there's not another
1:00:43condition there's not another condition
1:00:45but yet we're embarrassed to discuss it
1:00:47I used to give these lectures and I
1:00:48would look out to the audience I'd say
1:00:50please raise your hand if you suffer
1:00:52from
1:00:53hypertension and many people raise their
1:00:55hand and they have high blood pressure
1:00:57they say okay please raise your hand if
1:00:59you suffer from sexual dysfunction no
1:01:02hands go up but statistically you know
1:01:04that over 50% of those people had sexual
1:01:06dysfunction so why is it okay to raise
1:01:08your hand if you have hypertension but
1:01:10not okay to raise your hand if you have
1:01:11sexual dysfunction it's got to stop we
1:01:13have to destigmatize it's okay to have
1:01:15sexual dysfunction it's a common
1:01:17Condition it's curable why don't men
1:01:19raise their hands from a psychological
1:01:21standpoint why is that I think they're
1:01:22embarrassed I think that I think that
1:01:24we're historically sexual dysfunction
1:01:26looks as a like a weakness I'm not a man
1:01:28less of a man you know you have
1:01:30hypertension it doesn't mean you're less
1:01:31of a man right but they have this
1:01:33assumption that it's a weakness a less
1:01:36of a man and I and I think that it's
1:01:38okay you have to be comfortable saying
1:01:40that you have sexual dysfunction there
1:01:41are amazing treatment options for sexual
1:01:44dysfunction amazing that work very very
1:01:47well you just have to raise your hand
1:01:49and let me know that you have it I just
1:01:51want to make one other comment about
1:01:53diabetes there was a study that came out
1:01:55of St Louis looking at young men 18 to
1:01:5840 years old and they were screening
1:02:00them for erectile dysfunction and what
1:02:03they found was when those men came in
1:02:05for erectile dysfunction 30% of those
1:02:08men had pre-diabetes or diabetes on that
1:02:11day on the day they were being diagnosed
1:02:1330% and I thought to myself young men do
1:02:17not go get screened I remember when I
1:02:19was 30 years old I didn't go in for my
1:02:20annual blood pressure check and my anual
1:02:22sugar check there's no way I'd get my
1:02:24glucose checked but if I young man gets
1:02:27erectile dysfunction he is at my front
1:02:29door first thing tomorrow morning they
1:02:30show up that's the first thing they're
1:02:32going to do because it's a very big
1:02:33condition to them and they want to get
1:02:35treated and that is the opportunity to
1:02:38treat these young men and treat the
1:02:41condition if you see a young man or
1:02:42someone who comes in for Ed and you
1:02:44screen them for uh diabetes and I catch
1:02:47the diabetes at 30 as opposed to 40 that
1:02:50is 10 years of damage on the vessels
1:02:53that you're saving because you catch the
1:02:55disease early early so Ed is the gateway
1:02:58to Men's Health and to treating men
1:03:00early before it's too late so I really
1:03:02use Sexual Health as a tool a vehicle to
1:03:05improve overall health because men take
1:03:07Sexual Health much more seriously
1:03:10particularly young men have you ever had
1:03:11sexual dysfunction I have not never in
1:03:14your life I have not I have I have
1:03:17not it doesn't mean that it's not but
1:03:20it's okay if I did it's not it's there's
1:03:22nothing wrong with it right there's
1:03:23nothing it's normal it's okay and it's
1:03:26it can be temporary and come back right
1:03:28it's it's nothing wrong with having
1:03:29sexual dysfunction we must destigmatize
1:03:31it it's completely Okay the reason I'm
1:03:33sharing this is because if anyone else
1:03:35has been in the situations the
1:03:37situations I've been in are um generally
1:03:39my sex life has been been good my whole
1:03:41life but there's been certain times with
1:03:43certain Partners or you know you might
1:03:45be drunk a little bit or in the day when
1:03:48I was single there was like the oldd
1:03:51person who for some reason it just
1:03:54wasn't working for me
1:03:56and or there was other instances in a
1:03:58previous relationship where near the end
1:04:00of the relationship I'd like lose my
1:04:03erection during sex and that became a
1:04:06little bit bothersome for me because I
1:04:07was like oh my God like it almost made
1:04:10me not want to have sleep with this
1:04:11person or it convinced me that maybe I
1:04:13don't like them anymore or something
1:04:15else was going on and for me it has
1:04:16always been what's the word used
1:04:19psychogenic yes it's always been in my
1:04:20head that the problems have arose and
1:04:22the other part of thing that I've
1:04:24experienced a lot is in terms of libido
1:04:26I have like no libido
1:04:28when actually slight
1:04:31different when I'm when work is very
1:04:35very busy and I'm very very tired and I
1:04:37come home very very
1:04:41late it's not that I'm not horny but I
1:04:44just the act of sex is just really
1:04:47unappealing but you're just like
1:04:49everyone else you're not unique when it
1:04:50comes to that yeah but that much of my
1:04:52life is like that like I come home late
1:04:54a lot and
1:04:56so I'm I'm I'm like tired and stressed
1:04:58quite a lot right but what if I took you
1:05:00and your partner and put you on a
1:05:01beautiful island in Hawaii for two week
1:05:03we have great sex okay yeah so that's
1:05:04what we kind of like how we've
1:05:05orientated our life honestly okay that's
1:05:08genuinely how we've orientated our life
1:05:09because I just don't think the way I
1:05:11obviously want to make lifestyle changes
1:05:12to make sure that I'm not always coming
1:05:13home tired and stressed at 11: p.m. but
1:05:16one of the things that's really helped
1:05:17us is you know going away on the
1:05:19weekends right and going away maybe on
1:05:21Friday and coming back on Monday and
1:05:23getting out of the same context so like
1:05:24getting out of the house going to a even
1:05:26like going to a hotel room it's actually
1:05:28a bit of a game changer that you can
1:05:29just like go to a hotel room in the same
1:05:31city like a Booker station yes and that
1:05:34seems to have a big impact because it
1:05:35just removes you from the context right
1:05:37and then like yeah going away for the
1:05:38weekends holidays and stuff a lot of my
1:05:40friends say to me they go when they're
1:05:41struggling with their sex life they just
1:05:43like book A book a local a local sort of
1:05:46station yeah and I wonder why also I
1:05:48don't have kids so I've not experienced
1:05:51the impact that kids can have have a
1:05:53significant impact really right because
1:05:54it increases your stress
1:05:56right particularly for your many times
1:05:57for the partner as well so if you both
1:05:59are stressed because of the children sex
1:06:01goes lower and lower on the totem slept
1:06:04as well right if you're not sleeping if
1:06:05you to wake up and like oh gosh isn't
1:06:07there stats that say like when someone
1:06:08has a kid their sex life like vanishes
1:06:10for 18 months or something I don't know
1:06:12I'm not familiar with that St but I
1:06:13believe it I believe it I believe it I
1:06:15read something about post having a kid
1:06:18liido but also like sexual function it
1:06:20makes sense I see it in in couples and
1:06:23particularly you know many times um it's
1:06:25take years for them to start engaging
1:06:27sexual because the stress is so high
1:06:28particularly when they originally have
1:06:30the child there was a British study done
1:06:32that found over 80% of women experienced
1:06:34sexual problems 3 months postpartum with
1:06:36nearly two3 still affected at 6 months
1:06:39yes which is which is a lot of it's a
1:06:41lot of women a lot of women and that's
1:06:42significant amount of time so what about
1:06:45premature ejaculation let's talk about
1:06:47it very important 30 so sexual
1:06:49disfunction we've been talking about Ed
1:06:50today right but there's many different
1:06:53types of sexual dysfunction there's
1:06:54premature ejaculation there's Peron
1:06:56disease there's delayed ejaculation
1:06:57we're just focusing on one aspect
1:07:00premature ejaculation affects 30% of men
1:07:04globally 30% of men how do you define
1:07:06that there's two ways to think about it
1:07:08when they come in you have to figure out
1:07:09is this lifelong going their whole life
1:07:11or is this acquired it's very important
1:07:13because it takes me down two different
1:07:14roads if you say look I've never had
1:07:15premature ejaculation and yesterday it
1:07:18started that's very different than if
1:07:20you come to me and say my whole life I
1:07:21had premature ejaculation and we now
1:07:23Define premature ejaculation as having
1:07:25an ejaculation less than 2 minutes used
1:07:27to be 1 minute less than 2 minutes you
1:07:29have to have a loss of control like I
1:07:31couldn't control it and you have to be
1:07:33bothered by it so if you tell me Stephen
1:07:35look I ejaculate in 30 seconds and I'm
1:07:37happy I say great then we're done you
1:07:39know you are content you have to be
1:07:41bothered by the condition the EAC
1:07:43average ejaculatory time in the United
1:07:44States is 5.4 minutes on average right
1:07:48the average time for a woman to achieve
1:07:49orgasm is typically 13.4 minutes so
1:07:52there's a big discrepancy here as you
1:07:54can see right so 30% of men suffer uh
1:07:57but we know that only a small percentage
1:07:59of these men 9% of these men will ever
1:08:01seek therapy and it can be a significant
1:08:03problem in a relationship um uh and that
1:08:06needs to be addressed okay so there's
1:08:08not like a time limit it's not like okay
1:08:10if you're coming within two minutes then
1:08:11you got a problem well let's say you're
1:08:13not bothered by it let's say you and
1:08:14your partner are completely satisfied
1:08:15with it what's the problem okay what's
1:08:17the problem and and sometimes let if you
1:08:19think about acquired uh means that
1:08:22typically we Define it as 50% less than
1:08:24your normal time so if you say look I
1:08:27typically used to ejaculate in 8 minutes
1:08:29and now it's 4 minutes and it's
1:08:31bothering me I'd say okay that that's an
1:08:33issue um you know so we talk it's
1:08:36relative what what's comfortable for you
1:08:38and some men will say you know so I
1:08:41think it's very important to look at the
1:08:42definition the treatment options are
1:08:44actually quite simple one of the best
1:08:45treatment options is sex therapy because
1:08:47we can train your mind we can train you
1:08:49to delay that ejaculation there's
1:08:52techniques the start stop technique The
1:08:53Squeeze technique how we can delay it no
1:08:55but there is but most men say just give
1:08:58me a pill I don't I don't have the time
1:08:59for this just give me a pill but there
1:09:01are ways to do it with Sex Therapy which
1:09:03I think are fantastic sex therapy is a
1:09:05cure the pill is just a Band-Aid right
1:09:07Sex Therapy is a cure but the pills that
1:09:09we use the most common Ed pills are
1:09:12anti-depressants because they increase
1:09:15serotonin and make it harder to
1:09:17ejaculate well that's what we want in
1:09:18this situation we want to delay the
1:09:21ejaculation so we can use
1:09:23anti-depressants they sometimes have be
1:09:24taken daily which work better or you may
1:09:27have to take it on demand but if you
1:09:28take it on demand 6 to8 hours ahead of
1:09:31time so you need some notice but there's
1:09:32going to be significant side effects of
1:09:34taking anti-depressants there are side
1:09:36effects of anti-depressants so I try to
1:09:37stay away from them and the other ones I
1:09:39try to use are topical Liane sprays
1:09:42because if I decrease the sensitivity of
1:09:44the penis you're more likely to be able
1:09:46to engage in sexual activity for a
1:09:47longer period of time so those are
1:09:49commonly used so sex therapy and sprays
1:09:51are very easy to use you don't need a
1:09:53prescription for sprays uh and they're
1:09:55common
1:09:56use one thing that we have to talk about
1:09:58that's really important is the Traverse
1:10:00trial it's really big everyone
1:10:03historically has always said that
1:10:04testosterone is dangerous it causes
1:10:07prostate cancer and it causes a heart
1:10:09attack and a stroke and in 2015 there
1:10:13were some studies that suggested
1:10:14testosterone may cause a heart attack
1:10:15before 2015 all the studies suggested
1:10:18that there was no increased risk so in
1:10:19the United States they mandated that
1:10:21there' be a large trial 5,200 patients
1:10:24six years long strictly to decide does
1:10:28testosterone increase the risk of a
1:10:30heart attack so myself and eight others
1:10:33designed the study ran the study for six
1:10:36years and we published it last year it
1:10:38finally came out and it showed that
1:10:40there was no significant increase in
1:10:42cardiovascular events finally but until
1:10:44that time until that came out many
1:10:46people said I still believe that
1:10:47testosterone causes a heart attack but
1:10:49when the Traverse trial came out the
1:10:50largest randomized speciic control trial
1:10:52ever published we finally showed that
1:10:54giving testosterone didn't not increase
1:10:55the risk of a heart attack in fact the
1:10:57study also showed it did not increase
1:10:59the risk of prostate cancer many people
1:11:01were worried that testosterone causes
1:11:02prostate cancer and no negative effect
1:11:06on urinary symptoms so many people have
1:11:09thought that if I give testosterone the
1:11:10urinary symptoms become worse the study
1:11:12showed no worsening of urinary symptoms
1:11:14so very important study the Traverse
1:11:17trial finally came out it's the largest
1:11:19trial in men ever published on
1:11:21testosterone will it reduce my
1:11:23lifespan will at low testosterone I
1:11:26believe will reduce your lifespan I mean
1:11:28taking like testosterone injections and
1:11:30stuff sometimes I think about like again
1:11:32I don't don't really know what I'm
1:11:33talking about here but I think
1:11:35about athletes taking steroids different
1:11:39those athletes are taking super
1:11:41physiologic steroids so the normal range
1:11:43is typically 300 to a th000 is the
1:11:45normal range and they will take
1:11:47testosterone levels to much higher 2,
1:11:492500 okay and there's a reason for
1:11:52that um there's something called a
1:11:54plateau effect so so if you take
1:11:55testosterone and you have better libido
1:11:58you intuitively would think if I take
1:12:00more testosterone I'll feel even better
1:12:03liido but that's not true is's a certain
1:12:05point at which it plateaus so the more
1:12:07you take you've already hit an onoff
1:12:09button you've hit it you're done the
1:12:11exception is muscle the more
1:12:13testosterone you your body sees the more
1:12:15it upregulates uh Androgen receptors in
1:12:18the muscle and you put on more muscle so
1:12:20bodybuilders are addicted to higher
1:12:22levels of testosterone but they're also
1:12:24taking other off Lael medications anavar
1:12:28Deca wistol they're taking other
1:12:30medications and those testosterone
1:12:32formulations have a lower androgenic
1:12:35ratio androgenic means facial hair acne
1:12:37they're more anabolic so it's very
1:12:39different than what you're taking You're
1:12:40simply what you would be taking is just
1:12:42all you're trying to do is take a
1:12:44medication that you had before and put
1:12:47yourself back into the normal range
1:12:48nothing fancy so I The more I've learned
1:12:51about testosterone The more I've started
1:12:52to think that maybe when I've had my
1:12:53kids and I'm done having kids and maybe
1:12:56I'm
1:12:5845 um I should consider it providing
1:13:02that my levels are low and you're
1:13:04symptomatic if you're 45 and you say I
1:13:06feel great I'm gonna say Stephen you're
1:13:08not getting it right I feel great so if
1:13:11you say look I'm 45 my levels are low
1:13:14and I'm starting to have symptoms say
1:13:16Okay Now's the Time to consider taking
1:13:19the medication those symptoms you said
1:13:21were like tiredness energy levels well
1:13:23the most specific are my libido's gone
1:13:24down
1:13:25my are worse my Energy's gone down
1:13:28increased fat deposition decreased
1:13:31muscle mass poor sleep and depression
1:13:33and we have to talk about depression so
1:13:36uh earlier on in my career I conducted a
1:13:38very large trial looking at depression
1:13:40in testosterone and we had almost 850
1:13:43patients and we showed that men with low
1:13:45testosterone levels were much more
1:13:47likely to suffer from depression almost
1:13:4992% of those men with low testosterone
1:13:51had some degree of depression and when
1:13:53we treated 17% of those men actually had
1:13:55severe depression we treated these men
1:13:57for one year with testosterone
1:13:59supplementation that 177% dropped down
1:14:01to 2% now I'm not advocating to treat
1:14:04major depressive disorder with
1:14:05testosterone but what I am advocating
1:14:07for is to at least check a testosterone
1:14:09level in men who are depressed because
1:14:11it can help them in fact in our study
1:14:14even the men who were on an
1:14:15anti-depressant uh like say Prozac we
1:14:17put them on testosterone those men also
1:14:19saw significant improvements in
1:14:21depression so may be some Synergy
1:14:23between testosterone and what we call
1:14:24SSR eyes so again it's very important to
1:14:27check a testosterone level in men who
1:14:29suffer from depression you wrote a book
1:14:32called recoupling yes a couple's
1:14:35four-step guide to Greater intimacy yes
1:14:37and better sex yes what are the four
1:14:40steps in this book and you wrote this
1:14:42alongside over 10 years ago yes so I
1:14:45wrote it with the sex therapist she's an
1:14:46amazing sex therapist her name is Mary
1:14:48Joe Rini and we decided to write a book
1:14:50together to really help couples get
1:14:51through so the four steps really are
1:14:53number one foremost communication
1:14:55you got to communicate you got to at
1:14:57least be able to tell each other did you
1:14:58know that only 44% of men who start
1:15:02developing Ed even tell their Partners
1:15:04now think about that You' say what do
1:15:05you mean they don't tell their partner
1:15:06you know what they do they just start
1:15:07avoiding sex they just start avoiding
1:15:09sex so they got to communicate number
1:15:12one and making excuses right I if if I
1:15:15lost my reaction i' I'd probably say oh
1:15:17sorry I'm just tired or you know because
1:15:20I want to just on this point there's
1:15:23much of the reason why it's hard to
1:15:24communicate
1:15:25is because it it can sound a lot like
1:15:28blame and it also can make someone feel
1:15:31like you're not into them right so if I
1:15:34said and maybe you're not that into them
1:15:36and also maybe you're not like that
1:15:37attracted to them so like that could be
1:15:40yeah that's an issue and that's why the
1:15:42sex therapist is amazing right that's
1:15:45what they do right that's what they do
1:15:46they work through these issues with
1:15:48couples and they're fantastic but the
1:15:50number one step we put in the book was
1:15:52communication you have to communicate
1:15:55the second chapter was my main chapter
1:15:58what I wrote about what can we do to
1:16:00improve sexual dysfunction in men and
1:16:02women testosterone placement therapy
1:16:05using Viagra vaginal lubrications local
1:16:08vaginal estrogen therapy we didn't talk
1:16:09about that it's critical for
1:16:10postmenopausal woman local vaginal
1:16:12estrogen therapy is very important
1:16:14decreases this risk of UTI decreases
1:16:17pain with intercourse um so very
1:16:18important um the third chapter really
1:16:21sir what is that vaginal so uh younger
1:16:24women have estrogen in the vagina that
1:16:28estrogen is so important it keeps all
1:16:31the bad bacteria away and keeps the good
1:16:33bacteria within the vagina it keeps the
1:16:35W the lining of the wall thick it allows
1:16:38for the vaginal wall to function with
1:16:40arousal properly and as she gets older
1:16:44and she goes through menopause the
1:16:46estrogen goes away the bad bacteria come
1:16:48in the risk of urinary tract infections
1:16:51go up the wall starts to atrophy means
1:16:53gets thinner it's more susceptible to
1:16:56injury and tear it hurts okay right so
1:16:59you can't ask a woman to enjoy sex if it
1:17:03hurts every time she has sex a lot of
1:17:05women I've heard a lot of women talking
1:17:06about that about this idea that the
1:17:08reason they don't like to have sex is
1:17:09because it hurts it hurts because when
1:17:11they lose the estrogen the wall gets
1:17:13very thin and it can tear it hurts but
1:17:16even young women young women but it's
1:17:18usually typically a different reason
1:17:20they could suffer from vaginismus
1:17:21there's other things that could cause
1:17:23the cultis but in old older women the
1:17:25most common cause is atrophy of the
1:17:28vaginal wall because of the lack of
1:17:30estrogen so what do you do you give back
1:17:32local estrogen therapy it can be in the
1:17:34form of a suppository form of a cream it
1:17:37doesn't happen overnight I tell my
1:17:38patients it can take up to three months
1:17:40but after three months they notice a
1:17:42difference and the urinary tract
1:17:44infections go away the pain goes down
1:17:46right so these are simple things that
1:17:48women can do to help because again if
1:17:50someone's having pain with intercourse
1:17:52man or woman they will tend to avoid it
1:17:55right it's an important concept so the
1:17:56second chapter is really important on
1:17:58what are the many different things that
1:17:59you can do to improve your sexual
1:18:01function uh the third chapter is really
1:18:03about intimacy it's the really the
1:18:05intimacy and the fourth chapter really
1:18:08is uh ways to improve uh your sexual
1:18:10experience it was written by my sex
1:18:12therapist she talks about vibrators
1:18:13masturbation so there's a four-step
1:18:15guide um that I think is very helpful
1:18:17and I think what's unique about this
1:18:18book is that really it's it's really two
1:18:21perspectives it's one who is the um the
1:18:24medical care that I provide and the
1:18:25psychological care that she provides now
1:18:28she's obviously handling the
1:18:29psychological side of things and she's
1:18:31not here but just on this point of
1:18:33improving communication what is the best
1:18:35advice you give to people that are
1:18:37currently in a situation where they're
1:18:40both kind of suffering in silence
1:18:41because they're just not communicating
1:18:42with each other number one most
1:18:44important is time we don't spend enough
1:18:46time it's basically the shadows in the
1:18:48night you coming in I'm going out and
1:18:50it's you have to make time that's
1:18:52extremely important and the second one
1:18:54is open dialogue you have to be able to
1:18:57express to your partner what you're
1:18:58suffering from otherwise you can't get
1:19:00treated you just have to be able to
1:19:02express it but time I think is important
1:19:04and open communication and dialogue um
1:19:06there's nothing embarrassing about this
1:19:09it really is um something that needs to
1:19:12be D destigmatized and the consequences
1:19:15of addressing it so couples who engage
1:19:18in regular sexual activity have a
1:19:20significant Improvement in their quality
1:19:21of their relationship they tend to be
1:19:23happier and suffer from less uh me uh
1:19:25depression I mean there's there's there
1:19:27are physical and emotional benefits from
1:19:29regular sexual activity in the um opener
1:19:32of the book where you start talking
1:19:33about communication there's a sentence
1:19:35that
1:19:35says when sex isn't going well it can
1:19:38become 90% of the relationship and
1:19:40couples seldom know how to communicate
1:19:42about any of these problems and that is
1:19:44true you know we've done a couple of
1:19:45conversations now on the DIY about sex
1:19:47and Intimacy in these subjects and the
1:19:49amount of messages that I get from
1:19:50couples saying that everything else in
1:19:52their relationship is great yeah
1:19:54everything is great love this person so
1:19:56much but there's this massive elephant
1:19:58in the room right no pun intended which
1:20:00is um the lack of sexual intimacy now
1:20:04when we talk about sexual
1:20:06intimacy does it mean penetration yeah
1:20:10it doesn't because we with the
1:20:12definition of sex span is the ability
1:20:14and the desire to engage in satisfying
1:20:17sexual activity I have patients that
1:20:19come to me and say we do not have
1:20:20penetrative sex but we have a wonderful
1:20:22sex life I say great if this is working
1:20:25for you because it's satisfying sexual
1:20:27activity you're set right it's if you
1:20:30want penetrative sex and you cannot have
1:20:32it then we will address it and we can
1:20:34fix it but you get to Define Stephen you
1:20:36define what is satisfying sexual
1:20:39activity on chapter four where you talk
1:20:41about things like vibrators and stuff
1:20:43like that um I know that was the a
1:20:45chapter handled by your sex therapist
1:20:46according to what you said is there any
1:20:48risk that using vibrators or other toys
1:20:51and tools will impact
1:20:55normal intimacy without vibrators like
1:20:57is there any studies that say okay you
1:20:59get desensitized to the real thing if
1:21:00you start using a vibrator yeah I've
1:21:02seen the opposite I've seen that the
1:21:03studies showing that vibrators and these
1:21:05kinds of uh Toys can actually enhance
1:21:07the ability of the relationship so that
1:21:08you can because you're communicating as
1:21:10you're doing it right so you're
1:21:12communicating with your partner what is
1:21:13giving me pleasure what is not giving me
1:21:15pleasure you're learning about each
1:21:16other it's a great tool to use to learn
1:21:19about each other so when you're engaging
1:21:21a sexual activity you're more aware I
1:21:23think it was a a game changer to me I'm
1:21:25going to be honest I think like just
1:21:26having having other things do you know
1:21:29why do you know why it's a game changer
1:21:30and I'm not just talking about vibrators
1:21:31I'm talking about all toys in the
1:21:33bedroom whether it's like dice or
1:21:35handcuffs or whether it's something else
1:21:36or blindfold is just because novelty
1:21:40doing new things for me is so critical
1:21:43as it relates to being excited sexually
1:21:46yeah and there's only so many things you
1:21:48can
1:21:49do there's kind of there's a a a
1:21:53relatively limited list of things you
1:21:54could do if you're not bringing in other
1:21:59tools and toys and stuff you know so I
1:22:01think that for me it actually has helped
1:22:03me to prolong the novelty of my sexual
1:22:05um relationship in a way that nobody
1:22:08told me about before yeah because I
1:22:10think think as a guy especially I think
1:22:11you kind of think that toys are
1:22:13something your partner buys for herself
1:22:15maybe yeah something she uses for
1:22:18herself and now I think if anything I'm
1:22:19the instigator of using other things
1:22:21yeah that's chapter four I mean and we
1:22:23and we prescribe vibrator for men we use
1:22:25something called vict it helps with men
1:22:26with delayed orgasmia these toys can be
1:22:29very helpful in a
1:22:31relationship I think she prefers the
1:22:33toys to me personally but that's another
1:22:35conversation for another time in terms
1:22:37of energy there are so many reasons why
1:22:39I'm a big matcha fan if you don't
1:22:41already know by now and so much so that
1:22:42I actually invested in the UK's leading
1:22:44matcha company called perfect Ted and
1:22:46one of my favorite perfect Ted products
1:22:48is these delicious matcha pouches that
1:22:50come in every flavor from salted caramel
1:22:52to Peach flavor to mint flavor to Berry
1:22:55flavor one of my favorites is this
1:22:58vanilla flavor which I'm going to make
1:23:00in just two seconds you just take this
1:23:02mixer here get a little bit of the
1:23:04powder pop it on top of the shaker like
1:23:07that put the lid
1:23:10on shake shake
1:23:15shake delicious if you haven't tried
1:23:18this yet you can find perfect Tad at
1:23:19Tesco and Holland Barrett stores or
1:23:21online where you can get 40% off with my
1:23:23code diary 40 head to perfect ted.com
1:23:27and put in code diary 40 to try this
1:23:29delicious multi-flavored match now
1:23:31highly recommend and if you do it please
1:23:33tag me send me a message online what's
1:23:35the um what's the most important thing
1:23:36we haven't talked about that we should
1:23:37have well there's a couple things I want
1:23:38to talk about one is we didn't talk
1:23:40about Peroni disease it's an important
1:23:42disease 9% of men in the world suffer
1:23:44from Peron disease 9% of men in the
1:23:47world Peron disease is an abnormal
1:23:49coverture of the penis when it's erect
1:23:51so I want you to think about this the
1:23:53way I can describe it is I have a
1:23:54balloon I put a piece of tap tape on the
1:23:56balloon I blow the balloon up what's
1:23:58going to happen it's going to curve in
1:24:00the direction of the tape right so if a
1:24:02penis curves greater than 60 degrees
1:24:04it's prohibitive for intercourse these
1:24:07men are suffer many of these men suffer
1:24:09from severe depression it's
1:24:10disfigurement it's disfigurement of the
1:24:12penis right so think about it 9% of men
1:24:14in the world suffer from this condition
1:24:16and most men have never even heard what
1:24:18Peron disease is and uh essentially in
1:24:21the US we have now one FDA approved
1:24:23treatment for this it's an injection
1:24:25called collagenase where we can put an
1:24:27injection into the Rock plaque and break
1:24:29it up there are surgeries that we can do
1:24:32to make the penis straight again but
1:24:33again it's very important to realize
1:24:35that patients who have Peron disease are
1:24:37also suffering in silence they don't
1:24:38know where to get the treatment and
1:24:40there are many good treatment options
1:24:42whether it be surgical or medical to
1:24:44solve this condition so you know my
1:24:46whole takea away from this is this is
1:24:47that I know that millions of people
1:24:50right now men and women are suffering
1:24:51from sexual dysfunction I know they're
1:24:53silent and they're not saying a word
1:24:54because they don't know where to go they
1:24:55don't know what to do but they have to
1:24:57realize that there are excellent
1:24:58treatment options available and they
1:25:00should seek therapy they're not
1:25:01suffering
1:25:03alone what
1:25:05else I want you to think about sexual
1:25:07dysfunction as no no longer a Band-Aid
1:25:11uh we are not looking for Viagra we are
1:25:13looking for a cure we want a cure for ED
1:25:16and a cure for ED could be based on many
1:25:18things as I mentioned earlier diet
1:25:20exercise sleep stress we've also moved
1:25:22into a new generation of regenerative
1:25:24Therapies in my field stem cells PRP
1:25:28shock wave therapy now we're starting to
1:25:30look at radio frequency in our
1:25:31laboratory we're looking at hyperbaric
1:25:33oxygen men are looking for ways to cure
1:25:36this condition they no longer want to
1:25:38take a pill uh to solve the problem and
1:25:41so I think that's very important um and
1:25:43many of these uh new therapies are
1:25:44promising I think Shockwave therapy is
1:25:46very promising where we have a device
1:25:48that deliver shocks to the penal tissue
1:25:49we' been doing this it's like um [ __ ]
1:25:52like said that but but I'll tell you it
1:25:55we've been doing it now for 5 years um
1:25:57and uh it was invented in 2010 it's
1:25:59actually quite brilliant if I take your
1:26:01finger and I take a hammer and I hit
1:26:03your finger multiple times what do you
1:26:04think your finger is going to do your
1:26:06finger is going to start bringing in new
1:26:07blood vessels and new ways to heal your
1:26:10finger so before Urology the
1:26:12cardiologists have been doing it for the
1:26:13heart for many years and they would
1:26:15shock the heart many times and you would
1:26:16see new blood vessels formed it's called
1:26:18neoangiogenesis orthopedic surgeons have
1:26:21been doing it for a long period of time
1:26:22in terms of injury in terms of healing
1:26:24injury that use shock wave therapy we
1:26:26are new to the game but what we see is
1:26:28when you give these shocks it can
1:26:29potentially improve the blood flow and
1:26:31sexual function in men and I think the
1:26:33new era could potentially be hyperbaric
1:26:35oxygen therapy and also radio frequency
1:26:37radio frequency is a a way to increase
1:26:40heat within the tissue and improve
1:26:42sexual function as well so again I think
1:26:43what you're going to see uh 5 to 10
1:26:45years as we move forward is new ways to
1:26:48cure erectile dysfunction stem cells
1:26:50potentially have some promise as well
1:26:52but patients don't want a pill anymore
1:26:56one thing we haven't talked directly
1:26:57about but we've talked about it
1:26:58indirectly is the role that trauma plays
1:27:01in sexual dysfunction and Trauma in all
1:27:03of its forms um I think I had a partner
1:27:06who was very public again about the fact
1:27:09that the reason why they had sexual
1:27:10dysfunction was because in their view
1:27:13because they had been through a sort of
1:27:14traumatic experience how often do you
1:27:16see that in your office how long often
1:27:18do you see a patient come to you man or
1:27:19woman with a some kind of trauma we we
1:27:21we query all men and women if they've
1:27:23had any kind of trauma sexual or just
1:27:25physical trauma it doesn't have to be
1:27:26sexual trauma be any kind of physical
1:27:28trauma um I will tell you that
1:27:32most patients don't disclose or not very
1:27:35commonly described to have having it but
1:27:37they will many times disclose it to the
1:27:38sex therapist and I'll find out on the
1:27:40back end to be honest with you um but I
1:27:43think when someone discloses sexual
1:27:45trauma or trauma it takes more of a
1:27:47relationship and time on the first visit
1:27:49sometimes they're not
1:27:52forthcoming what's that that you haven't
1:27:54in front of you on the desk it's I've
1:27:56been hesitating talking about it so this
1:27:58is a penal implant oh gosh and this yes
1:28:01that's exactly what it is and this is a
1:28:03device that was invented in
1:28:051973 by a very famous uh urologist named
1:28:08Dr Brantley Scott Brantley Scott I will
1:28:11have to brag a little bit was from my
1:28:13institution at Bay College of Medicine
1:28:14and this has been around for 51 years
1:28:17and the the penis actually has two
1:28:19bodies sitting on top and they has the
1:28:21urethra sitting on the bottom and those
1:28:23two bodies have muscle inside them or
1:28:25casing and what this device is a surgery
1:28:27that I warm quite often where we put
1:28:29these balloons or cylinders into those
1:28:32two bodies and fill them up there's a
1:28:34small pump that goes into the scrotum
1:28:37and there's a small Reservoir that just
1:28:39holds water normal saline that goes
1:28:41behind the pubic bone typically when a
1:28:44man squeezes this he starts filling up
1:28:47these cylinders with water and it gives
1:28:49him a very rigid very good erection when
1:28:53he finishes engaging in sexual activity
1:28:55he'll press this button here and it will
1:28:57actually release and all the fluid will
1:28:59come out of the penal bodies and go back
1:29:02into that Reservoir so theoretically
1:29:05anyone who's willing to have this
1:29:07surgery we can cure Ed but it's a
1:29:10surgery and what's the consequence and
1:29:12cost of that in terms of sexual
1:29:14experience monetary cost I would say
1:29:16that in the US Medicare covers this
1:29:18product so that's that's actually quite
1:29:20good in terms of pleasure and Men report
1:29:23no significant decline in pleasure if
1:29:26you look at overall satisfaction is
1:29:27greater than 92% for patient and partner
1:29:30with uh with the penal prosthesis so um
1:29:33it is a very um it's a GameChanger it
1:29:36really is a GameChanger most patients
1:29:38have never heard of it or most people
1:29:40have never heard of this uh penal
1:29:41prosthesis um but you know let's be
1:29:44honest you know if you had a bad
1:29:46shoulder you'd get a prosthetic if you
1:29:48had a bad hip you get a prosthetic it's
1:29:50a prosthetic that fixes an organ um and
1:29:53it Stephen it the satisfaction rate is
1:29:55extremely high but I'll tell you
1:29:56something you owe me something because
1:29:57when I brought this on the plane uh and
1:29:59I went through security they made me
1:30:01pulled us out and explain what this was
1:30:03and nobody had heard of it no one had
1:30:05seen this um yeah well I had to explain
1:30:09it and I had to pump it up and show them
1:30:10and uh but I had a little bit of an
1:30:12audience but um yes but I will tell you
1:30:14this this is a this is something that
1:30:16really has revolutionized the way we
1:30:17treat men for rectile
1:30:19dysfunction but this is surely like a
1:30:22last ditch attempt it is because it is a
1:30:24lastage attempt because if I take it out
1:30:27no other treatments will ever work again
1:30:30oh really it's it's the end right so if
1:30:33I take it out no other the treatments
1:30:35will work again so I want you to try
1:30:39every single option before we come to
1:30:42this what situation does someone have to
1:30:44be in for you to insert this into their
1:30:45penis so remember when I told you that
1:30:4740% man at 40 50% at 50 and most
1:30:50patients will take Viagra but I told you
1:30:51Viagra is not a cure it's a Band-Aid so
1:30:53what's going to happen that Viagra is
1:30:54just like that pain pill and that pain
1:30:56pill eventually going to happen is you
1:30:57can't walk well the same thing happens
1:30:59with Ed eventually the meds stop working
1:31:02so once the meds stop working and then
1:31:04the second level we use something called
1:31:05penal injections some manual we use
1:31:07penal injections once you've tried
1:31:09everything and nothing works what are
1:31:11you going to do okay so this is like a
1:31:13last what are you going to do if you
1:31:15still want to get but if I look at
1:31:17satisfaction rates if I give men
1:31:19questionnaires for the pill for the
1:31:20injections vacuum reduction device for
1:31:22the implant High highest satisfaction
1:31:25with the
1:31:26implant at what point how what you mean
1:31:30how satisfied from the starting point to
1:31:33right if I because from starting at a
1:31:35point where I'm completely unable to get
1:31:37an erection right if anyone helps me get
1:31:39that thing up my satisfaction is going
1:31:41to be really high right but let's say
1:31:42you have an erection with a pill you get
1:31:44an erection with an injection you get an
1:31:46erection with a vacuum and you get an
1:31:48erection with this all all four you know
1:31:50over time gave you an erection which
1:31:52gave you the best erection and which
1:31:53which one were you most satisfied with
1:31:55this will win it's crazy and can you
1:31:57still ejaculate with this yes no
1:32:02issues
1:32:04gosh
1:32:06no I mean again I have I have tremendous
1:32:08sympathy because it's ruins people's
1:32:10lives right it does if if you can't
1:32:12perform in that way and it destroys your
1:32:14relationships and relationships are like
1:32:15the essence of life so but essentially
1:32:17you're taking someone who can't have sex
1:32:18who can now have sex again and some
1:32:20would argue that they can have sex
1:32:21whenever they want as long as they want
1:32:24with this device right it only goes down
1:32:26when you tell it to go down Dr Mo we
1:32:28have a closing tradition on this podcast
1:32:30where the last guest leaves a question
1:32:31for the next guest not knowing who
1:32:32they're going to be leaving it for yeah
1:32:33and the question that has been left for
1:32:35you no is have you ever experienced
1:32:39anything that you cannot explain from a
1:32:42position of rational
1:32:46materialism yeah I mean I think so many
1:32:47things in science that we can't explain
1:32:49so many things that are idiopathic that
1:32:51I have no explanation for um uh for
1:32:54example for fertility which is something
1:32:55we talked about 40% of men who come to
1:32:57me our explanation is no explanation we
1:33:00don't know why you're infertile right so
1:33:03obviously that's very uncomfortable for
1:33:05many patients to hear that but many
1:33:06things in science I have no explanation
1:33:09for um and many things that I do have an
1:33:11explanation for we find out 10 years
1:33:13later were
1:33:14wrong um so I think that's what comes to
1:33:17mind what about any personal experiences
1:33:19at all in your life spiritual religious
1:33:23yeah um I'm very spiritual I'm very
1:33:26religious um sometimes death it's hard
1:33:30to explain hard to understand why um
1:33:34it's real I see it every day uh you know
1:33:38we see it we do at work um my I see it
1:33:42personally in my own life my father
1:33:43passed away at an early age um from
1:33:46idiopathic pulmonary fibrosis um it's a
1:33:49very it's a condition where your lungs
1:33:51start to scar it's probably the worst
1:33:53condition you could asked for and um and
1:33:56he had have a lung transplant at 70 so
1:33:58he pretty young um and he retired at 69
1:34:01um and said you know one he worked very
1:34:03hard he was a general surgeon single you
1:34:05know solo practice and um he said one
1:34:08day I'll enjoy one day I'll enjoy and
1:34:11then at 69 he retires he's ready to
1:34:13enjoy at 70 gets idiopathic pulm
1:34:15fibrosis at 70 gets a lung transplant
1:34:18and lives for five years with someone
1:34:20else's lungs um which is pretty tough um
1:34:24and his one message was you know don't
1:34:26wait till the end enjoy the ride I wish
1:34:29I'd enjoyed the ride because waiting to
1:34:31the end um sometimes there may be no
1:34:36end and by that I interpreted that to me
1:34:38that he had worked his whole life very
1:34:40very hard extremely hard and he sort of
1:34:43delayed the gratification to a point
1:34:45that right it didn't really come
1:34:47necessarily he thought it would come at
1:34:4870 and he' enjoy the last 15 years and
1:34:51enjoy but at 60 9 he got idiopathic
1:34:55pulmonary fibrosis at 70 we got a lung
1:34:57transplant and at 75 he passed away and
1:35:00I think that um if anything I Learned
1:35:04was don't wait to the end enjoy the ride
1:35:08are you doing that I am every second I
1:35:11can and how how do you do that sort of
1:35:13practically when you're so busy so I
1:35:15make time I meditate every morning I
1:35:17work out every morning I have my own
1:35:19time to myself I pray I'm very religious
1:35:22I think those are very important things
1:35:23to keep me going um I spend I I it's
1:35:26it's God family work patience I mean
1:35:28it's an order my family is extremely
1:35:30important to me and I make time for them
1:35:32as well and uh I think that keeps me
1:35:35grounded Dr Mo thank you thank you for
1:35:37the work you're doing because as you say
1:35:39in your work there's a huge proportion
1:35:40of people couples men women that are
1:35:42suffering in silence and there are in
1:35:44search of answers and there's not a lot
1:35:45of people in your friendship group that
1:35:47are necessarily going to know this stuff
1:35:48or even talk about their own experiences
1:35:49with this I think it's important to have
1:35:51these kinds of conversations um that
1:35:53anyone in the private or comfort of
1:35:54their own home or with their airpods on
1:35:57can tune into to get a better
1:35:59understanding if there was a closing
1:36:00message for for those people that are
1:36:02suffering in silence in some way whether
1:36:03they're couples
1:36:05individuals what is that closing message
1:36:07to
1:36:08them it's okay to suffer from sexual
1:36:12dysfunction it's normal as we age and
1:36:15there are many treatment options good
1:36:17treatment options that can help you
1:36:19today and I ask you to seek therapy
1:36:22raise your hand tell your doctor you
1:36:24suffer from sexual dysfunction because
1:36:26they're excellent treatment options and
1:36:27if people want to learn more about you
1:36:29and your work where's the best place for
1:36:31them to find you well uh it's my website
1:36:33Dr drit cara.com and um sexan health.com
1:36:38I have sexan health.com where you can
1:36:39learn all the different ways to improve
1:36:40lifestyle modification I started a
1:36:42nonprofit I just want you to know called
1:36:44the testosterone project just so you
1:36:46know that uh it's really geared at
1:36:48education advocacy for testosterone
1:36:50we're trying to get testosterone approv
1:36:52for women in the United States I that's
1:36:53important we're trying to get testing
1:36:55done uh as well we want everyone to be
1:36:57tested for testosterone it should be
1:36:58Norm as well and we're trying to get it
1:37:01deregulated so the test aom project.com
1:37:03is a great way to get information as
1:37:05well I'll put all of those links below
1:37:08Dr May thank you so much for the work
1:37:09you're doing and please do keep doing it
1:37:10because it's so incredibly important
1:37:11Stephen pleasure to talk to you thankk
1:37:13you do you know that 80% of New Year's
1:37:15resolutions fail by February it's
1:37:17because we focus too much on the end
1:37:19goal and we forget the small daily
1:37:21actions that actually move us forward
1:37:23those actions that are easy to do are
1:37:24also easy not to do in life it's easy to
1:37:27save a dollar so it's also easy not to
1:37:29making one small Improvement each day
1:37:31one tiny step in the right direction has
1:37:33a big difference over time and that is
1:37:35the 1% mindset which is why we created
1:37:38the 1% diary a 90day journal designed to
1:37:41help you stay consistent and focus on
1:37:43the small wins and make real progress
1:37:45over time it also gives you access to
1:37:47the 1% Community a space where you can
1:37:49stay accountable motivated inspired
1:37:52along with many others on the same jour
1:37:53Jour we launched the 1% diary in
1:37:55November and it sold out so now we're
1:37:57doing a second drop join the wait list
1:38:00at theed diary.com and you'll be the
1:38:02first to know as soon as it's back in
1:38:03stock I'll put the link below
1:38:05[Music]
1:38:24oh
1:38:25[Music]

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