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Sex Expert: What Women Actually Need To Enjoy Sex — Transcript

by The Diary Of A CEO · 24,697 words · 3,645 segments · language en · Watch on YouTube

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0:00Is there a way to enlarge the
0:02>> So, you can put your penis in this
0:04device. They've actually done research
0:05on this. So, 30 minutes twice a day and
0:07it does show improvements in length
0:09about 2 cm.
0:11>> Tada.
0:12>> And that's not all. So, they actually
0:13did a study on pistachios where guys at
0:15100 g of pistachios [music] every day
0:17and they saw a decrease in erectile
0:18dysfunction because if you're not having
0:20erections now, you're no longer getting
0:22blood flow to your penis and it will
0:23shrink over time. And the same goes for
0:25women with their clitoris because it's
0:27the same type of tissue. But also, when
0:29you look at people who have sex once a
0:31week, they live 49% longer than people
0:33who only have sex once a year.
0:35>> 49% longer.
0:37>> Yeah. And for every 100 orgasms men had,
0:40they lived like 13% longer.
0:43>> Be right back. [laughter]
0:45>> Dr. Reena Malik has become the world's
0:48most watched urologist. [music]
0:49>> After sharing everything you need to
0:51know about hormones, sexual health,
0:53>> and how to [music] have better sex based
0:55on the data. So, how can you have the
0:57best sex possible? So, there's four main
0:59pillars of sexual health. So, pillar one
1:01is fuel. So, how you nourish your body,
1:03and it's a huge part of sexual activity.
1:06And then pillar two is strength. When
1:08people think about strength, they always
1:09think about going to the gym and lifting
1:11weights. But it's much more than that.
1:12So, when you look at the data, any sort
1:14of cardiovascular exercise is going to
1:16improve sexual function. It's going to
1:17improve blood flow to the penis and to
1:19the clitoris. And then also if you do
1:21150 minutes a week, it is the same
1:23amount of improvement as you would see
1:24when you take a medication like Viagra.
1:27And the other part of it is the pelvic
1:28floor. It's under evaluated, under
1:30discussed, and we'll get into that. But
1:32pillar three is environment. So things
1:34like stress, [music]
1:36sleep, and endocrine disrupting
1:37chemicals. For example, they looked at
1:39data on men sleeping 5 hours a night
1:41versus 8 hours a night. Guys who sleep 5
1:44hours a night, their testosterone drops
1:45by 15%. Yeah.
1:47>> And then the last of the four pillars
1:48that we don't talk about enough is, and
1:52that's still important,
1:53>> I want to talk about morning erections,
1:55squirting, clitorol stimulation, and
1:57certain positions that are going to
1:59increase the probability that my partner
2:01has an orgasm.
2:02>> Let's talk about all of that. First of
2:04all,
2:07>> this is super interesting to me. My team
2:09given me this report to show me how many
2:10of you that watch this show subscribe.
2:12And some of you have told us, according
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2:17all of you. Please could you check right
2:19now if you've hit the subscribe button
2:20if you are a regular viewer of the show
2:21and you like what we do here. We're
2:23approaching quite a significant landmark
2:25on this show in terms of a subscriber
2:26number. So, if there was one simple free
2:29thing that you could do to help us, my
2:30team, everyone here to keep this show
2:32free, to keep it improving year over
2:35year and week over week, it is just to
2:36hit that subscribe button and to double
2:38check if you've hit it. Only thing I'll
2:39ever ask of you, do we have a deal? If
2:41you do it, I'll tell you what I'll do.
2:43I'll make sure every single week, every
2:45single month, we fight harder and harder
2:46and harder and harder to bring you the
2:48guests and conversations that you want
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2:55Please help us. Really appreciate it.
2:56Let's get on with the show. [music]
3:03[music]
3:05Dr. Reena Malik, if somebody was to come
3:09up to you in the street, having watched
3:10your videos online, and they were a a
3:13follower of the content you've produced
3:14over the last couple of years, if you
3:16had to guess the question they would ask
3:18you, because it's probably the most
3:20frequent, popular question you get
3:21asked, what do you think they would say?
3:23>> They would say, "What can I be doing
3:25right now to improve my sex life?"
3:27>> Who would be asking you that question?
3:29And why do you think they'd be asking
3:30it?
3:31>> I think everyone can agree that sex is
3:33something we enjoy. It's something
3:34that's important that we want to have,
3:36right? And there is um a desire to have
3:41good sex or feel like maybe you're
3:42missing out on something that could be
3:44even better. So, how can you have the
3:46best sex possible? Because you hear all
3:48these people talking about amazing sex
3:50in the media. You might see it on
3:52pornography. You might feel like this is
3:54something amazing. Why am I not having
3:56that? I want that. Right.
3:57>> So, on that point, you said it's obvious
3:59that it's important. I think it appears
4:02to be increasingly not obvious that it's
4:04important because when you look at some
4:06of these stats and I'll throw this graph
4:07that I've I found here up on screen and
4:10it shows that people are becoming more
4:12sexless especially young adults between
4:1418 and 30. This graph is pretty stark.
4:17>> Mhm. Think about 50 years ago. There was
4:19no cell phones. There might be some TV
4:21programs but there was ads in between TV
4:23programs and there was only certain TV
4:25shows you could watch at a certain time
4:26that you enjoyed and then there was
4:28nothing to watch. There was no email.
4:30So, you went to work and you came home
4:31and there was really not a lot of
4:32communication between you and your
4:34co-workers or your job. They made dinner
4:35with their family. They hung out and
4:38then maybe they watched a program or two
4:40and then they lied down in bed. They
4:41didn't have a phone to scroll on. They
4:43didn't have anything to keep them up.
4:45And so then they were like next to their
4:46partner and maybe they're talking, maybe
4:48they're cuddling. And so there was more
4:50like opportunity and space for sex,
4:52right? You it was a thing that you did
4:54for enjoyment, for pleasure, for fun.
4:56Now we have all these distractions that
4:59keep our mind away from sex. In order to
5:02enjoy sex, you need to have space for it
5:04to be able to enjoy your partner and
5:07feel like you want that, right? And now
5:09we're sort of [snorts] there's not as
5:11much room for it. That's one. Two is
5:13younger people, how are they dating,
5:15right? How are they meeting each other?
5:17They're meeting each other through apps,
5:19through um DMs. And so they're not
5:22actually like really having these deep
5:24meaningful connections. there have
5:26there's a big hookup culture. There's a
5:28big like fling culture. And imagine
5:30first time sex for most people is not
5:32great. You don't know your partner. You
5:34don't know what they like. And you may
5:35not be able to express what you like.
5:37You're never taught how to talk about
5:38sex, right? So you don't know how to say
5:40like, "Hey, I like it like this." And
5:42you may be self-conscious cuz it's your
5:44first time. So you have like mediocre
5:45sex or bad sex. And they're like, "Well,
5:47I don't really want that." And there's
5:49just no like follow through, right?
5:51There's there's not a lot of um
5:53education on what sex should look like.
5:55like the only education people are
5:56getting are from often erotic films and
5:59so they're seeing sex that's not real
6:01that's curated and they're trying to
6:03emulate that and that's not pleasurable
6:05for most people and younger people these
6:08days are um actually having a rise in
6:10more what we call rough sex so choking
6:13has become very very common as common as
6:16like they call choking almost like
6:17vanilla sex so young people if you look
6:20at data like 60% of women and I think
6:2520% of men have been choked during sex
6:27of that age group, like college age
6:29group. And of those people who get
6:31choked, 20% have been choked 25 times or
6:34more. Now, I think it's fine if you're
6:36into that, but I can't imagine that that
6:38many people are into choking. And
6:40there's data to support that. So, when
6:41you look at qualitative data, and this
6:42is by uh Debbie Herbick, she's a sex
6:44researcher, and she did qualitative
6:46research, and she asked people like,
6:47"What is it like? Do you enjoy being
6:48choked? Tell us about it." Right? Women
6:50were like, "Yeah, it's okay. Sometimes
6:52I'm scared because my partner is big and
6:54strong and I'm, you know, smaller and
6:56they have big hands. Sometimes it's fine
6:58and sometimes I don't really care for
7:00it, but like it's just a part of sex.
7:02It's just as normal as as kissing, for
7:04example. And so if you're having sex and
7:07you're doing things just because you
7:08think that's what your partner wants or
7:10what it should look like and you're not
7:12enjoying it, well, that's not going to
7:14be sex that you want to have. that point
7:16you said about the the lifestyles we
7:18lead and how that might be impacting our
7:20sex lives I thought was really
7:21interesting because we don't talk enough
7:22about this but when you look at some of
7:24the data on this demographic um you know
7:26people 30 and below around that age the
7:30extreme outliers are spending 8 to 10
7:32hours on their phones on social media
7:34and on the internet and roughly about 15
7:38to 20% of young people describe their
7:40usage as almost constant effectively
7:43scrolling during all waking hours while
7:46they're eating, while they're in the
7:47bathroom, and before they go to sleep.
7:48So, and I was wondering from a dopamine
7:50perspective if there's correlation
7:52between these like dopamogenic
7:54activities that are now like hijacking
7:57our lives, whether it's short form
7:58videos on social media, whether it's
8:00pornography or food, whether it's having
8:03an impact on what then happens in the
8:05bedroom and our performance in the
8:07bedroom.
8:08>> If you think about what you need to have
8:10good sex is you need to be sort of in
8:13the mind space for sex. And if you're
8:14constantly like hijacked by all these
8:17other things, you're never like really
8:18getting in the mood, right? You're just
8:20like, "Oh, I'm going to be turned on
8:21when I see my partner and we're going to
8:23have sex and it's going to be over." And
8:25it's just really a mechanical thing at
8:27that point, right? You're not actually
8:28you're just trying to get an orgasm.
8:30You're not actually like spending the
8:32time to enjoy and to experience that
8:34fully because you're just so like you're
8:36just your brain is always doing
8:38something else, right? because people
8:39are constantly scrolling like every 60
8:41seconds there's a new video, there's
8:43something else. And so it's really hard
8:44to focus. And so that can translate to
8:47the bedroom where you're like you're
8:48having sex, but your brain is somewhere
8:50else thinking about something else you
8:52saw or something you have to do or
8:53something you want to see or something
8:55you want to look up, whatever it is, but
8:57you're not really in there in the
8:59moment. You're just going through the
9:00motions. And so I think that's really
9:02where the challenge is is that people
9:04are becoming increasingly distractable.
9:07I find it really hard, I got to be
9:08honest, to have sex if I've had like a
9:09really really busy day or if I'm really
9:11really thinking about something. I
9:13almost have to I have to like
9:14intentionally create quite a lot of
9:15space.
9:16>> Exactly.
9:17>> In order to be able to be in the mood.
9:20>> Yeah. Be aroused, right? It takes like
9:22time and energy. I think I appreciate
9:24you for saying that because a lot of
9:25people think that men are just ready to
9:27go at any moment and that's not fair,
9:29right? Because everyone needs time to be
9:32aroused. It's not just instant for
9:34everybody, especially when you have a
9:35lot of work stress or life stress or
9:37other things going on. It's actually
9:39like you have to make time and space for
9:41it.
9:42>> Yeah. Because as a man, you got to get
9:43an erection. And I I always think that
9:45an erection is a consequence usually,
9:47especially when it comes to sex. And I'm
9:49not talking about morning glories here,
9:50but an erection is a consequence of like
9:52a story.
9:54>> You use the word aroused.
9:55>> There's like a story in my head which
9:57makes me go, "Oh, that's kind of hot."
9:59>> Yeah. You need something. You need some
10:02stimuli, right? You need to think about
10:04something, see something, smell
10:05something, feel something, right? You
10:07need to just be together and and sort of
10:09allow yourselves to be intimate before
10:11that sort of desire and arousal come
10:13together.
10:14>> And for me as well, it's not just touch
10:16like that doesn't necessarily for me, it
10:17really is quite like a psychological
10:19thing. I was wondering if this is
10:21there's any data around this or I mean
10:23just even anecdotally like people get
10:25aroused in very very different ways,
10:26don't they?
10:27>> Yeah, absolutely. I mean some people um
10:30are very like visual so they you know
10:32they see their partner and they get
10:34aroused very quickly. Basically when you
10:36get aroused you need to be in a
10:37parasympathetic nervous system state. So
10:39in order to get an erection you need to
10:41be in the state which is like rest and
10:43digest. So if you're stressed if you're
10:45thinking about other things if you're
10:47essentially on the go you are not
10:49allowing your nervous system to calm
10:51down. And so for some people that's a
10:53whole bunch of different things. Some
10:54people can switch more easily into that
10:56state and some people need more of like
10:59uh you know to feel either mentally
11:03stimulated or they need to have some
11:05associations like it might be like they
11:07need a certain scent, they need to like
11:09relax their body, they need to like go
11:10take a bath, whatever it is, but some
11:13people need different things and knowing
11:15what that is for your partner is super
11:18important, right? Because then you can
11:19incorporate that. Everything is
11:21scheduled in our lives, right? And then
11:22you're like, "Oh, but now sex is like
11:24the last thing on the schedule, right?"
11:25And like I don't even think about it.
11:26Like, "Oh, okay. Now, yeah, maybe let's
11:28have sex." But it's like, if you
11:29actually make time to be intimate, allow
11:31yourself to be in that brain space, be
11:34together, that's when it can actually
11:36happen. Especially when you've been in a
11:37long-term relationship, it doesn't come
11:39as easily like spontaneously, which we
11:41call spontaneous desire. It it comes
11:43more as a response to these other cues
11:46that allow you to feel desire and to
11:48feel aroused.
11:50H I also think I was thinking about a
11:52previous relationship I had where on the
11:55days where I'd been like working very
11:57hard and I was like tired or stressed or
11:58I've been traveling and I was jetlagged.
12:00I think there was also because I didn't
12:03see this person often there was also an
12:05expectation that when I did see them we
12:06were going to have sex
12:07>> and um that was that was very hard
12:11because actually the expectation of it
12:14stressed me out more.
12:16>> Yeah. And that can happen like if it
12:18becomes the elephant in the room it can
12:20become a little bit heavy which then is
12:21sort of counterproductive to performance
12:24>> and this is you know sort of a variation
12:26on performance anxiety. So when you feel
12:29like you have to perform on demand and
12:31maybe you're worried it might not happen
12:33it creates this vicious loop right so
12:35you may maybe have trouble with an
12:36erection or maybe it's like I I'm
12:38expected to have sex but I really can't
12:39get there mentally. whatever it is. Now,
12:41you're thinking about that, right? And
12:43then you're with your partner. You're
12:44like, "Oh my god, am I going to have
12:45trouble?" You're not enjoying the
12:46pleasurable sensations or the visuals or
12:48like feeling each other. You are
12:50literally thinking in your own head
12:51about how you're going to respond. And
12:54then that anxiety makes it so that you
12:56can't get an erection or you can't be
12:57aroused. And so now you're like anxious
12:59and you're not focused. You're almost
13:00spectatoring. You're just watching
13:02yourself have sex. You're not actually
13:04like in the moment. So then, you know,
13:06you have a negative outcome because when
13:08you're stressed, your sympathetic
13:09nervous system is on, right? You can't
13:10really get an erection or you can't
13:12really get aroused. And so then you're
13:15like, "Oh man, now I've let my partner
13:17down. Now I haven't performed," which I
13:19hate that word, but like performed the
13:21way I should or or I'm expected to. And
13:24now something's wrong with me. And now
13:26that just keeps going in a vicious
13:27cycle.
13:28>> Have you spoken to people that have
13:29experienced this?
13:30>> Absolutely.
13:31>> It's common.
13:32>> Very common. I tell people anytime you
13:34have problems in the bedroom, it stays
13:37with you.
13:38>> So, how do you break the cycle?
13:39>> Yeah. So, I tell people when you're with
13:41your partner, take the pressure off um
13:44penetration. Just explore each other's
13:46body. Do what's called like sensate
13:48focus. Like explore the rest of your
13:50body. Figure out other arogynous zones,
13:52other things that can turn you guys both
13:55on that don't involve erections and
13:57penetration. And then once you realize
13:59you're focused on that, you're really
14:00like exploring, enjoying, playing,
14:02you're having a good time, and you're
14:04not thinking about your erection, now
14:05you'll notice, oh, the erection just
14:07comes, right? And then once you get to
14:08that point, then you can start even
14:09touching genitals, but still hold off on
14:11penetration. And then after you've
14:13realized like the genitals are, you
14:15know, it's always working the way I want
14:17it to. I'm not thinking about it. I'm
14:18not stressed. Then finally, you can then
14:20introduce penetrative sex again. So,
14:23it's just sort of like a gradiated sort
14:24of slow advance into um you know, having
14:28sex again, but now kind of focusing on
14:31being more present and mindful and
14:33enjoying those sensations.
14:34>> I think a lot of people will be able to
14:37do that, but there's also a big
14:38contingent of people that just avoid
14:41sex.
14:42>> Mhm.
14:42>> It's it's a sore subject in their
14:44relationship for whatever reason. Both
14:47partners don't know how to communicate.
14:48They haven't got the tools to talk about
14:49these kind of things openly and
14:50honestly. Do you see that a lot as well?
14:53>> Absolutely. I mean, what do you hear in
14:55this regard?
14:55>> So, I think it's really sad. I see
14:58people come in and they're like, I ask
15:00every patient like, "Are you are you
15:02having sex? Why not?" Right? Because
15:03sometimes they'll say no. And most
15:05doctors will be okay. But I always say,
15:06"Why not?" Right? Why are you not having
15:08sex? Is it because you're having an
15:09issue? Is it because you're having pain?
15:11What's going on? Right? And often times
15:13I'll hear from people that my partner is
15:16just not into it and I just sort of gave
15:18up and I'm just we just don't have sex
15:21anymore. You know, for me that's a red
15:23flag because sex is a huge important
15:27part of our lives. It is a way we
15:29connect with another human being. It's
15:32also telling that things are working
15:34really well. So, when you have good
15:36sexual function, meaning you get an
15:38erection well or you get aroused well
15:40and you have a good orgasm and
15:41everything feels good, that tells me
15:43that, hey, you've got great blood flow
15:45to your genitals, your nerves are
15:46working great, your hormones are sending
15:48signals, like all these things are good,
15:50right? But also, sex is more than just
15:53the act of sex. It also helps you live
15:56longer. So, there's been a few studies
15:58looking at sex and longevity. And
16:00[snorts] when you look at people who
16:02have sex once a week compared to people
16:04who have sex once a year, the difference
16:06in all cause mortality is 49%. They live
16:1049% longer than people who only have sex
16:13once a year.
16:14>> 49% longer.
16:15>> Yeah. Yeah.
16:18>> Be right back. No, I'm joking.
16:19[laughter]
16:20>> So, and but even if you're doing like
16:22less than once a week, but more than
16:24once a year, it still improves your
16:26longevity. There was actually
16:27interesting study in 1997, I think it
16:29was, where they looked at the number of
16:31orgasms men had, and they found that men
16:34who had for every hundred orgasms men
16:37had, they lived like 13% longer. They
16:40had a 13% increase in life expectancy.
16:43And so, it was really interesting to me
16:45just just showing you that like this is
16:47not just an act of pleasure and fun. It
16:50is obviously, but it's much more than
16:52that because people who are having sex
16:54clearly have better health and there
16:56this connection with people. I mean,
16:58loneliness is a big issue right now. The
17:00the WHO made loneliness like an
17:02epidemic. So, they've said that
17:03loneliness is as bad as having like 15
17:06cigarettes. And so, sex is a way to feel
17:09connected to another human being.
17:11>> On that data, we're not saying that it's
17:13the sex itself that's causing people to
17:15live longer. We're I guess it's it's
17:16hard to establish causation in terms of
17:18>> Yeah. It's not necessarily sex, but
17:21they've looked at like they try to
17:22control for other things like age and
17:24coorbidities and all these studies and
17:27um it's also like sex is a
17:28cardiovascular workout, right? For many
17:30people is a cardiovascular workout. You
17:32are getting a phys physical physical
17:33activity with your partner. Um you are
17:35increasing your heart rate. You are
17:37doing these things that are also good
17:39for your body. And the fact that you're
17:41able to have sex, right, tells me a lot
17:43about it, right? You're you're able to
17:45hold a certain position. you're able to
17:47u maintain this level of activity
17:49without getting short of breath, right?
17:51Like these are things that having sex,
17:53you know, keeps you healthy to some
17:56degree.
17:56>> If I want to make sure that I have great
17:58sex, what are some of the foundational
17:59things that I need to be thinking of in
18:01terms of my lifestyle?
18:02>> Yeah. So, there's four main pillars of
18:04sexual health. I like to think of it
18:06like your sexual health is your house.
18:08And these pillars are the foundation.
18:09And if you don't have the foundation, it
18:11doesn't matter what else you do. Um, you
18:13can try to do everything else to patch
18:15up your house, but it's always going to
18:16break again because the foundation's not
18:18there. So, you've got fuel, and fuel is
18:22how you nourish your body. A lot of the
18:23data I'm going to talk about is about
18:25men because there's just a lot more data
18:27on men and sexual health, but that
18:29doesn't mean that the same things don't
18:30apply to women. There's just less less
18:32robust data on it. So, when you talk
18:34about fuel, the Mediterranean diet is
18:37the most studied diet. So, including
18:39things like healthy fats like avocados,
18:43leafy greens, nuts, and we're going to
18:45talk about nuts in a little more detail.
18:47These things are super helpful. And
18:49obviously having lean proteins, having
18:52an abundance of fruits, which we're
18:53going to talk about as well. There's a
18:54study called the Health Professionals
18:56Follow-up Study. They look at 20,000
18:57men, and they saw that men who adhered
19:00to a Mediterranean diet had a 22% lower
19:03risk of erectile dysfunction. So what
19:06[clears throat] specific things in that
19:08diet, right? People always like, "What
19:09are the superfoods I need to have?"
19:11Almonds are great, but pistachios, they
19:13actually did a study on pistachios where
19:14they looked at 100 grams of pistachios.
19:16Guys ate 100 grams of pistachios every
19:18day and they saw a decrease in erectile
19:20dysfunction.
19:21>> So pistachio nuts will make my penis
19:23harder.
19:23>> I mean, so I always say like I don't
19:25love to talk about superfoods because
19:27then people like, "Oh, I just got to eat
19:28pistachios [clears throat] and it's all
19:28good, right?" It's it's part of a whole
19:30diet, but certainly having nuts because
19:33they have great omega-3s, they have
19:35healthy fats. These are the reasons that
19:36they they really sort of improve diet.
19:39>> Fruit um anything that has sort of
19:42flavonoids, so like colorful fruit like
19:44blueberries, citrus fruits, um lycopine,
19:47which is red fruits, all of these things
19:49improve antioxidants and also have been
19:52shown to reduce the incidence of
19:53erectile dysfunction. So having stronger
19:55erections. specifically blueberries
19:57actually came out to have I think
19:59something around 20% also improvement in
20:01erectile function when you're eating
20:03blueberries regularly. So [snorts] lots
20:05of I think things in the diet that can
20:07be helpful. Also fiber is one that we
20:09don't talk about enough. When you eat
20:11fiber in your gut it converts to short-
20:13chain fatty acids. These short- chain
20:15fatty acids then sort of have these
20:18endothelop protective mechanisms. They
20:20protect the blood vessels. They make
20:21them healthier. And so when your blood
20:23vessels are healthier, you get better
20:25metabolic health. So you get less
20:26diabetes, less high blood pressure, less
20:28high cholesterol. And these all of these
20:30things together improve erectile
20:32function.
20:33>> So I think making sure that you meet the
20:36criteria for fiber, which is 38 grams
20:38for men, 25 grams for women, um, is
20:41really really important. And then
20:43obviously managing your calories and a
20:45maintenance, right? because we don't
20:46want to gain weight because excess
20:48atapost tissue or excess fat also puts
20:50you at higher risk for erectile
20:52dysfunction and other sexual
20:54dysfunctions. Next we have uh strength.
20:58All right.
21:00So there's strength where we think about
21:02cardiovascular and resistance exercise
21:04but there's also pelvic floor strength.
21:06So we'll start with cardiovascular
21:08exercise. The one study that's quoted
21:10very often is 150 minutes of exercise of
21:13cardiovascular exercise moderate
21:14intensity. when you look at the
21:16improvement in erectile function scores,
21:19it is the same amount of improvement as
21:21you would see when you take a medication
21:23like Viagra. So, literally, if you do
21:26150 minutes a week, you are getting the
21:28same improvement as you could get with a
21:30medication potentially. And so, I tell
21:32people like, look, if you don't want to
21:34take a pill, this is a great way to
21:36improve sexual function. Now, you might
21:38say, okay, well, I, you know, maybe
21:40you're listening and you have heart
21:42issues and you can't really do moderate
21:43intensity exercise. They actually looked
21:45at that too. So there was a group where
21:46they looked at men who had heart disease
21:49and they weren't really able to do
21:51moderate intensity exercise. So they did
21:52like a 5minute warm-up. They did 20
21:54minutes of walking and 5 minutes of a
21:56cool down. And with this supervised
21:58protocol, they still improve erectile
22:00function by 70%. So it's all relative to
22:03where you're starting. But any sort of
22:06cardiovascular exercise that's above
22:08what you are capable like what you're
22:10doing now is going to improve sexual
22:12function particularly erectile function
22:14cuz it's going to improve blood flow to
22:15the genitals going to improve blood flow
22:17to the penis. It's going to improve
22:18blood flow to the clitoris for women. So
22:20that's where cardiovascular exercise is
22:22so so important in terms of resistance
22:24exercise. I know these little weights
22:26are probably not sufficient for doing
22:28much, especially for men, in terms of
22:30improving um muscular health, but
22:32obviously we're not going to bring like
22:34really heavy weights to the table here.
22:35[laughter] So, one, we know that
22:38resistance training is significantly
22:40correlated with testosterone. So when
22:42you do heavy resistance training of your
22:45large muscle groups, so like your lower
22:47extremities, your glutes, you're doing
22:48like Olympic deadlifts, squats, that
22:50sort of stuff, you actually see
22:52improvements in testosterone. Now, it's
22:55not going to be like you do it once and
22:56you get this sustained improvement, but
22:58continuous sort of regular resistance
23:00exercise improves testosterone.
23:03There's also data that shows that when
23:05men do resistance exercise to maintain
23:07muscle mass. So, we know that muscle
23:09mass decreases about 7% every decade of
23:12life after around 40. When you maintain
23:14it through resistance exercise, they're
23:17three times less likely to have erectile
23:19dysfunction.
23:19>> Oh, really?
23:20>> Yeah. So, they maintain erectile
23:21function, they maintain sexual desire,
23:24they maintain um satisfaction with sex.
23:27>> I read a quote yesterday that said
23:28muscle is medicine. And I thought,
23:30that's really true based on everything
23:31I've learned on this podcast around, you
23:33know, like glucose control and and
23:36testosterone. And now you're telling me
23:38about your sex life.
23:40>> Yeah, it is. I think people push back
23:43because they think like, why should I
23:44have to go to the gym? But our lives
23:46have changed. We sit at a computer or we
23:49sit at podcasts or we sit all the time.
23:51We're not moving. We're not doing manual
23:53labor, which is what a lot of our
23:56historic history is, right? doing manual
23:58labor, farming, doing things outside,
24:00being physical, and we're meant to be
24:02physical. We're meant to lift heavy
24:04things. We're meant to move our bodies,
24:06and we're just doing less and less of
24:07it.
24:08>> So, I think it's so important. Um, the
24:10other thing is we want to prevent
24:11sarcopenia. So, sarcopenia is muscle
24:13loss. And when you have muscle loss, um,
24:16that also increases your risk of having
24:19sexual dysfunction.
24:20>> What about the pelvic floor? Like, how
24:21does that come into this story of
24:23>> Oh, yeah. So, we missed that part. So,
24:25um, the pelvic floor, here's your
24:28pelvis, right? It's this bony structure
24:30where all your organs live. This is a
24:32female. So, I'm taking out the, uh,
24:34internal structures, which is the
24:36uterus, the rectum, and the bladder. And
24:38so, that's what sits inside the pelvis.
24:41And so, you can see this bowl of muscles
24:43here, right? Interesting. I've never
24:44seen.
24:44>> And you can see them from the inside,
24:45and you could see them from the outside.
24:47That's your anus. And in this person,
24:49there's a vagina. So, that's the hole
24:50for the vagina. So you can see that your
24:52anus and your vagina run through the
24:54pelvic floor. And in men, your penis
24:56runs through the pelvic floor. And so
24:58this, let me see if I can show you on
24:59this model. In this model, you can see
25:02they kind of show you the muscles here
25:03on the side.
25:04>> Yeah.
25:05>> So these are your pelvic floor muscles
25:06that are around the penis and the anus.
25:10>> Okay.
25:11>> Okay. These structures are very
25:14important for a variety of things. um
25:16they attach to your bony landmarks here,
25:18your hips, your sacrum, your pubic
25:21symphysis. They attach to all these and
25:24they sort of just work in the background
25:26for most people. How they affect your
25:28sexual function is when you orgasm,
25:31these muscles contract and release at a
25:35at a rhythmic contraction of8 seconds.
25:37And so you may feel that, right? There's
25:39like this pulsing feeling when you
25:40orgasm. And that's these muscles sort of
25:42doing that. And when men ejaculate, the
25:45pelvic floor muscles are contracting to
25:47help shoot the ejaculate out. They
25:49squeeze when you need to keep things in.
25:51So they'll keep urine in, they'll keep
25:53um your stool in, and they relax when
25:55you need to pee in, when you need to
25:57defecate.
25:58>> So when you're trying to hold a wee,
25:59you're like tightening your pelvic
26:00floor.
26:01>> Correct. Correct. But these are also
26:03responsive to stress. So, just like
26:05people get TMJ where they get tense in
26:08their jaw cuz they are stressed and they
26:10like sleep at night and they clench up
26:11their jaw. They don't really know
26:12they're doing it, the same thing can
26:14happen. These muscles can get very tight
26:16or they can get misaligned. So, say you
26:18have a hip injury or say you have a back
26:20injury, the muscles can compensate by
26:22tightening up. And so, a lot of people
26:24unknowingly have tension in these
26:26muscles and it can present in a multiple
26:29different ways. It can present with back
26:31pain. It can present with constipation.
26:35It can present with urgency frequency
26:37because remember your bladder is sitting
26:39right here on top of these muscles. So
26:41when the muscles are tense, your bladder
26:43is feeling like there's something
26:46something activating it. And so it's
26:47like, oh man, I got to pee. That means I
26:49have to pee. This tension is telling my
26:50bladder I have to pee. But it's really
26:52that your bladder is not that full. It's
26:53that these muscles are telling you to do
26:55that. You can also have trouble peeing
26:57because you can see that your urethra
26:58goes through here. And if the muscles
27:00are really tight, sometimes it can be
27:01difficult to urinate because it clenches
27:03off the pee. And then with sex, it can
27:06cause pain. If they're really tight, it
27:08can prevent blood from getting to the
27:10genital organs. So for men, they can
27:12have erectile dysfunction. For women,
27:15they can have difficulty getting orgasms
27:17or difficulty getting arousal because
27:19they're not getting blood flow to the
27:21clitoris. Sometimes they can also cause
27:23premature ejaculation in men. And so
27:25these muscles are so important and all
27:28we hear about is keigull and keigull are
27:30exercises to strengthen these muscles.
27:32But keigull are good when you have a
27:34normal pelvic floor. Meaning like
27:36there's no tension. It's completely
27:38normal. It's acting normal. You're not
27:39having any symptoms at all. But if you
27:41have any of the symptoms I talked about,
27:42doing keles might make it worse because
27:44you're now tightening muscles that are
27:46already tight.
27:47>> We also talked about pelvic floor
27:49relaxation. Doing exercises to
27:51specifically relax these muscles. So
27:53that can be diaphragmatic breathing.
27:56That can be doing like a figure four
27:58stretch. That can be doing happy baby
28:01pose which are yoga poses or child's
28:03pose. All these things can sort of
28:05stretch and lengthen these muscles so
28:07they can learn to relax again. Now when
28:09it's really bad, you have to go see a
28:11pelvic floor physical therapist who can
28:13really work with you to identify which
28:14of the muscles are maybe more
28:16dysfunctional and maybe work
28:17specifically on those. Um but I think
28:20it's it's so important. that's under
28:21evvaluated, underd discussed when it
28:24comes to sexual function. It's a hugely
28:26important part of sexual function.
28:29>> How many people are struggling with
28:31these issues, specifically the like
28:34erectile dysfunction issues and what age
28:36are they?
28:37>> Yeah. So, it starts early. I think
28:39there's always been a sort of a
28:40disconnect where we think young guys
28:42don't have this or if they have it, it's
28:43all in their head. That's not
28:45necessarily true. Many young men do
28:47develop erectile dysfunction because of
28:49biologic factors, but the data is really
28:52robust on older guys. So above the age
28:54of 50, we see 52% of men having erectile
28:58dysfunction, which is
28:59>> 52%.
29:01>> And it goes up 10% every decade. So 60%
29:05of 60-y olds, 70% of 70 year olds. So
29:07erectile dysfunction continues to
29:09worsen. This happens because one, you
29:12know, our blood vessels get older, they
29:14get stiffer, they're not functioning as
29:16well as they should. And we're seeing
29:18also a rise in all these other comorbid
29:20conditions like diabetes, cholesterol,
29:22high blood pressure. All these affect
29:24how healthy your blood vessels are. And
29:26so with these, they see the problem in
29:29their penis or in in women's case in
29:31their clitoris before they see heart
29:33disease or strokes or brain issues or
29:35dementia. And I think this is worth
29:37pausing on which is a erectile
29:40dysfunction problem is a often a symptom
29:43of a cardiovascular issue. Right.
29:45>> Yeah. We call it a canary in a coal
29:47mine. So it is like telling you that
29:49something bad is coming. So the data
29:51would support that when you have
29:53erectile dysfunction if it's because of
29:56an organic reason, right? not
29:57psychoggenic but most people I think
29:58have a combination of both that within 3
30:01to 5 years you will start developing
30:03issues with your heart and so it
30:06precedes those issues and if 7 years
30:09later 14% of those guys will have a
30:12heart attack and so it's really an
30:14opportunity sexual problems are an
30:17opportunity to look inside to figure out
30:20what's going on and to investigate and
30:22to change your life
30:23>> and when you say erectile dysfunction we
30:25should probably define what that means
30:26because there's going to be a lot of
30:27guys sat at home now thinking, "Oh my
30:29god, like my penis is a bit softer than
30:31usual."
30:31>> Yeah. So, erectile dysfunction is
30:34defined as the inability to maintain an
30:36erection that's sufficient for
30:38intercourse. So, you can get an
30:40erection, but it goes away before you
30:42ejaculate or climax.
30:44>> And so, that's typically and I think
30:45it's really important to differentiate
30:46that from something like premature
30:48ejaculation where you climax too soon.
30:51So, you ejaculate before you're want to.
30:54Uh, but that doesn't mean that you have
30:56a problem maintaining your erection.
30:57That's a whole different process.
30:59>> I've got a friend, people are gonna
31:01think I'm talking about myself because I
31:02use that phrase a lot. I've got a
31:03friend. He's um he's almost 40 years old
31:06and I've heard him say on several
31:09occasions that he's lost his erection
31:11during sex. Is that erectile
31:13dysfunction? But what if he can keep his
31:16erection watching porn?
31:18>> Well, so that's more multiffactorial,
31:20right? So I think if you lose it once or
31:22twice, right? Most guys will have an
31:24issue where they lose an erection at
31:25some point in their life. I think the
31:26important thing is not to catastrophize.
31:28It's a problem when it becomes a
31:30routine. Now, if someone is telling me,
31:32"Hey, I can watch porn and maintain my
31:34erection, but I can't with a partner."
31:36There's multiple different reasons for
31:38that that could be at play. One is that
31:40there's no pressure, right? You're by
31:41yourself. You're watching porn. There's
31:43no pressure of performance. There's no
31:45anxiety of performance. So, that may be
31:46part of it. Other thing may be that that
31:49level of arousal that you're getting
31:51from porn. If you're watching like let's
31:52say the same kind of porn every time,
31:54you're masturbating the same way every
31:56time, maybe using a firm grip or some
31:58people will masturbate like uh facing
32:00the bed or um you know against hard
32:03objects. And so that
32:05>> against hot objects.
32:07>> Yeah. Like the their fist or something.
32:09And so that u can't be replicated by a
32:12person, right? You can't replicate those
32:14behaviors by a vagina or a mouth. If you
32:18become habituated to a certain thing
32:20that turns you on and that's the only
32:23thing that really gets you going and
32:25that's that's something that you can't
32:26really get with your partner, then it
32:28will be difficult to reach the level of
32:30arousal that you need to get an
32:32erection.
32:32>> Okay. So, two questions then. So,
32:34>> that doesn't count as erectile
32:36dysfunction. If you can get an erection
32:38watching porn but can't get it with your
32:39partner.
32:40>> Yeah, it may or may not be. So, if you
32:42wake up with your morning erection,
32:44that's great. That's a sign. That's when
32:45there's nothing else at play, right? You
32:47are just that tells me that your body's
32:49functioning well. You've got good blood
32:50flow, good uh good hormones working, got
32:52a good amount of testosterone, and your
32:54nerves are working well, and you're
32:56getting a good morning erection. Now,
32:58morning erections or nighttime erections
33:00are normal, and they're healthy. So,
33:02when you're a young boy, you get
33:04actually like erections three to five
33:06times a night, and they can last up to
33:0740 minutes long. So you can spend a lot
33:10of your night with an erection. When you
33:12get older, like in your 40s, that drops
33:14to about half the time. So maybe
33:16erections are a little shorter that they
33:18maybe max out at 30 minutes, but
33:19sometimes they're shorter. You should
33:21still be getting three to five erections
33:22at night. You won't know all of these,
33:24but typically you wake up with a morning
33:25erection. And so if you're not getting
33:27morning erections, that tells me that,
33:29hey, there's something going on that we
33:31should address. And on your other point
33:33about how you masturbate impacting your
33:35sex life, I imagine that applies to men
33:38and women.
33:39>> Absolutely.
33:39>> And are you saying that if there's a
33:41particular way you get yourself off in
33:43private
33:44that is very hard for the other person
33:46to replicate, you might become
33:47desensitized to that?
33:49>> You might just get habituated. I don't
33:50think desensitized, but habituated is
33:53like you might just your body just might
33:54respond really well to that particular
33:57stimulation. Now, that's not inherently
33:58a bad thing, right? If that's what gets
34:01you off and you and your partner are
34:02okay with you doing that together,
34:04right? You may mutually masturbate
34:06together and that's fun for you and you
34:07guys enjoy it, there's no problem with
34:09it. It's just knowing what's going on,
34:11right? And sort of deciding like, okay,
34:13if this is a problem, let me try to
34:15diversify what I do during my solo sex
34:18periods or let me take a little break
34:20and kind of uh try something, you know,
34:22just not masturbate for a little while
34:24and come back to it later. The fact that
34:25we get an erection in the morning, does
34:27that mean that's we're supposed to have
34:29sex in the morning? From like an
34:30evolutionary perspective,
34:31>> not necessarily. It's just it's the way
34:33your body releases testosterone is one
34:35of the reasons this happens is overnight
34:37your body is making more testosterone.
34:39That's when your body sort of has
34:41nocturnal testosterone production. And
34:43so it's highest in the morning, which is
34:45why often you get a morning erection.
34:47And you know it just means that some
34:50people will have more desire also in the
34:52morning because testosterone is a
34:53hormone of desire.
34:55>> Is it the same for women?
34:56>> Yeah. So women um women also have
35:00nocturnal clitoreral tumescence. Same
35:02sort of pattern and they won't
35:04necessarily know it right because they
35:06can't visualize it. But you know you can
35:08some women may know sort of feel that
35:10pelvic congestion or like feeling that
35:12there's a bunch of like blood flow in
35:13the area. But most will not and that's
35:16okay. But your body protects itself. So
35:18you've heard the term use it or lose it,
35:19right? People are like your body's
35:21protecting itself. You don't have to
35:23have sex. If your body is healthy, it
35:25will do this all night to keep your
35:27genitals healthy. It will make sure that
35:29your genitals are getting blood flow
35:30even if you're not having sex. But if
35:33you stop having those nighttime
35:35erections, now is it becomes more of a
35:37problem because over time, say you stop
35:40having erections or cleral tumes for
35:42months, years, right? And then there's
35:46no blood flow to those areas over time.
35:48And actually I can show you here. This
35:50is a a pelvic model. And here this this
35:54purple thing here is called the corpora.
35:57And this is like a really nice spongy
35:59tissue that fills with blood. And when
36:02it fills with blood, it expands and
36:03lengthens. And then um the blood stays
36:06there until you're done with your
36:08stimulation. And then it goes back. And
36:10so if there's no healthy fresh blood
36:12getting to the penis on a regular basis
36:15either through nighttime erections or
36:16through sex with your partner then you
36:18will get fibrosis of these tissues. That
36:21means you get a little scar in the in
36:23the tissues and then over time you might
36:25see some shrinkage of the penis. And so
36:27it is really important to maintain also
36:30good health of these tissues. And the
36:31same goes for women with their clitoris
36:34because it's the same type of tissue. In
36:35fact, if you look at the clitoris, it is
36:38this is the part that you see. We don't
36:39really We don't have a clitoris.
36:41>> That one there.
36:42>> This is a uterus.
36:45[laughter]
36:49>> You're going to keep that in.
36:51>> Okay. I can show you here. There we go.
36:53There's [laughter] this like she told
36:54me.
36:54>> Is it crazy?
36:56>> Okay. Yeah. This is good. This is good.
36:58Okay. They [laughter] told me they don't
36:59say glitter.
37:03[laughter]
37:04>> That's a little That's a Yeah. Okay.
37:08>> They told me [laughter]
37:10>> you're not going to live that one down.
37:11>> You asked the team where the ClariS was.
37:13Did you ask the team where the clitoris
37:15was? [laughter]
37:16>> Well, I'm I'm worried about who said
37:18that, too. Um, okay. So, [laughter] so
37:21[snorts] let's talk about the female
37:22anatomy. This is a pelvic model. And
37:25here, um, you can see this is the
37:26vagina. This is the urethra where you
37:29pee from. This is your labia minora. And
37:32you can't see the labia majora, but they
37:33would be out here, right? So, inner
37:34lips, outer lips. Now, this up here is
37:38your clitorol glands. So, it's the same
37:40as the glands of the penis. And so, this
37:43is all you see, right? It also has a
37:45little covering, which you can't see
37:46here. Just like men have foreskin, women
37:48have a clitoreral hood that covers the
37:50the head of the the clitoris. And so
37:52when you look at the clitoris on the
37:54inside, which we can't see perfectly
37:56here, but I'm going to just take this
37:57out. Um, it actually goes all the way
38:01back like this. So if you were to feel
38:03from the vagina, from the vaginal side,
38:05it would be at the very top of the
38:07vagina going all the way back. These are
38:09the these blue things are the clitoreral
38:11bulbs here. Um, so and these are the
38:15legs of the clitoris here on the side.
38:18And so this is essentially the homalogue
38:21of the penis. So if I take the penis and
38:23we don't have a like a full model here.
38:26What does homalues mean?
38:27>> So homologues means that they're
38:28essentially the same structure. They're
38:30made from the same cells but they're in
38:32the male and the female. So here you can
38:35see this is if this is your penis. This
38:38is what you see up to here. This is the
38:39bone. This is your fat up here. And then
38:42here it goes deep into the pelvis. And
38:45so here's your testicles, right? And so
38:47below the testicles, this area of the
38:49paranneeium, you also have penal tissue
38:52sort of that you can palpate from this
38:54side um that's coming all the way down.
38:56And if you had sort of a 3D model, you'd
38:58see that it forks out just like the
38:59clitoris does.
39:00>> So does clitoral stimulation feel like
39:04stimulating someone's tip of their
39:06penis?
39:07>> Exactly. And so you could think if
39:08someone just stimulated the head of the
39:10penis, they uh it would be fine. It
39:14would be nice, but it's probably better
39:15if you stimulate more of the clitoris or
39:17more of the penis. That's why you can
39:19stimulate obviously the external the
39:21clitoris, but you can also stimulate
39:23from the inside. And some people are
39:25more responsive to that than others.
39:27What you hear of is like the G-spot or
39:29the Gzone, right? And the G-spot or
39:31Gzone is if you were to go in the inside
39:34of the vagina at the top side, which I
39:36can't really stick this in here, but it
39:38would be about 2 cm in at the top. And
39:40that's because that's an area where
39:42there's a lot of nerves endings. One,
39:44you can palpate the clitoris basically
39:46throughout the entire anterior wall, but
39:48also there's the skins glands, which are
39:50these glands that sit underneath the
39:52urethra, and they're the homalogue of
39:53the male prostate. And so, they're right
39:57there, and then the vagina is there. And
39:58so, that's an area that can be very
40:00enjoyable to stimulate. It's not
40:02necessarily always going to lead to
40:04orgasm because some people have
40:06different sort of distance between the
40:08clitoreral body and the vagina. So some
40:11people have less distance may feel it
40:14better than some that don't. Uh but
40:16ultimately um that's why that area is so
40:18sensitive for many women. On this point
40:20of um morning erections, I was thinking
40:23much of the reason why I've always been
40:25cautious of having sex in the morning or
40:27even like masturbating in the morning or
40:28anything like that is I'm worried that
40:30it will cause a dopamine crash which
40:32will make me feel lazy and lethargic.
40:34>> Well, so when you think about what
40:36happens during an orgasm is you have
40:38this release of dopamine and then you
40:40your prolactin goes up and sort of like
40:43everything calms down. Now some people
40:46feel a a sense of clarity. They call it
40:48postnut clarity, right? they feel clear,
40:50they feel like motivated to do stuff,
40:51they feel uh excited to go do something
40:54else and they sort of move on from what
40:55they're doing. There's some people who
40:56feel post-coidal dysphoria. They
40:58actually feel sad or they feel depressed
41:00after they orgasm. And we don't know
41:03exactly why this happens, but it is
41:05because of this dramatic change in sort
41:08of neurochemical signaling in the brain.
41:10And for those people who have it, it can
41:12be days where they sort of like feel
41:14bad. It can be hours where they feel
41:16sad. And so it can be really traumatic.
41:18So pillar two, what's pillar two of the
41:21four pillars of men's sexual health?
41:23>> We talked about strength.
41:24>> Okay, so we did strength, we did fuel.
41:27>> What's pillar three?
41:28>> Pillar three is environment. So we can
41:29start with the easy stuff and that's
41:31stress, right? Everyone knows stress is
41:33bad. But I think the thing is people
41:35just think like h I'll just I'll deal
41:37with it. Everyone's stressed. Like
41:38what's it's normal to be stressed? If
41:40you are chronically stressed, that means
41:43your cortisol is raised all the time,
41:45which is dampening your testosterone,
41:47which is also keeping you in the
41:49sympathetic state, and you just cannot
41:51get in your mind space and in the
41:54nervous system place to actually have
41:56sex. So, that's super important. And I
41:59think, you know, there's lots of
42:00different ways to alleviate stress. You
42:03got to figure out what works for you.
42:04Um, for some people, using a stress
42:06ball, even just at work. And I think
42:08part of it you can actually incorporate
42:10some intimacy. There's some evidence,
42:11you know, the Gottmans have been on your
42:13podcast doing a 20 second hug. So
42:16standing with your partner or loved one
42:18and hugging for 20 seconds on your own
42:21like independent gravity
42:23>> actually helps alleviate stress and
42:25break sort of a stress loop. Doing a
42:27six-second kiss with your partner. And
42:30so it seems like six seconds, no big
42:32deal, but actually if you time it, it's
42:33like hm if I'm just doing a kiss and I'm
42:34not like actually it's a little bit
42:36longer than normal. And so these sort of
42:38small things can help alleviate stress.
42:41Any type of movement can be really
42:42beneficial.
42:43>> The gym is great as well.
42:45>> The other thing is just having like
42:47interactions with people. And so that's
42:48where we're becoming more isolated. But
42:50even just like talking to the barista or
42:52talking to someone at the grocery store,
42:54this again tells your brain that you're
42:56in a safe space, like you're talking to
42:58someone. They're having a normal social
42:59interaction.
43:01So, and then being creative. And we've
43:03been trying to work with this work on
43:04this with our kids because there's so
43:06much external stimuli all the time,
43:07right? They want to play video games,
43:09they want to watch TV, they want to play
43:10sports, but we want them to be bored and
43:13be creative, like come up with creative
43:14ideas to keep themselves
43:17interested and engaged in a different
43:18way. So, I think that's so so important.
43:21And outside of stress, sleep. Um, sleep
43:24is there's just so much abundance of
43:26data on how sleep affects hormonal
43:28health. They looked at data on men
43:30sleeping 5 hours a night versus eight
43:32hours a night. So you take the same guy
43:34and he sleeps eight hours, then you, you
43:35know, do five five hours for a few days.
43:38His test for a week, his testosterone
43:39drops by 15%.
43:41>> Wow.
43:42>> That's like as much testosterone drop as
43:44would happen with 10 years of life.
43:46>> And do you know how long they did that
43:47for? How long?
43:48>> It was short. It was like a week. So, a
43:50week of sleep deprivation will will tank
43:52your testosterone.
43:54>> And sleep apnnea is another one that I
43:56think people one don't realize they have
43:58and two don't realize that fixing it
44:00could actually improve their hormonal
44:01health.
44:02>> Wait, so does this mean that people who
44:03have chronically bad sleep probably have
44:05low testosterone?
44:07>> Probably. Yeah.
44:07>> And what is the symptoms of low
44:09testosterone?
44:10>> So, low testosterone, they're sometimes
44:12very vague. So it can be fatigue, it can
44:15feel brain fog, it can be depression, it
44:18can be low desire, it can be erectile
44:21dysfunction. That's what people always
44:22think. It's just erectile dysfunction,
44:23but it's this whole constellation of
44:25symptoms. It can also be increased fat
44:27mass, decreased muscle mass. So all of
44:29these things can happen because we have
44:31testosterone receptors all over our
44:33body. We have them in our brain. We have
44:34them in our muscle. We have them in our
44:36bone. And these can all have really
44:38serious consequences when it's low. when
44:41you have sleep apnnea. And how you know
44:42you have sleep apnea is uh your partner
44:44might tell you that you're like waking
44:45up in the middle of like gasping for
44:47air. If you have one really easy way to
44:50check is take a a measuring tape and
44:52measure your neck circumference. If it's
44:54more than 17 in for a guy or 16 inches
44:57for a female, it means it's very likely
44:59that you may have sleep apnea. And
45:02that's because when you have excess mass
45:04basically here, it's compressing your
45:05airway and can make it difficult to get
45:08air into your um into your body. When
45:11you improve sleep apnea, we've seen
45:12improvements in testosterone as high as
45:14200 nanogs per deciliter. So huge jumps
45:17in testosterone after fixing sleep
45:19apnea. And the same goes for other sleep
45:22disorders, although the data is not as
45:24abundant. Uh but sleep is so important.
45:27Then we talk about what's in your
45:28environment. So let's grab this. Okay.
45:32So, you get a bottle of water. So many
45:35of my patients actually they only buy
45:37like cases of plastic bottled water.
45:39Once in a while a plastic bottle of
45:41water like don't stress yourself out.
45:42This goes back to stress. People get
45:44really stressed like what's in my
45:45environment? What am I drinking? What am
45:47I eating? Like do what you can control.
45:50So plastic water bottles have things
45:52like phalates and BPAs which can affect
45:55hormonal health. They can mimic
45:57estrogen. They can reduce the production
46:00of testosterone based on these
46:02mechanisms. Also things like plastics in
46:05the environment, PAS, so the things like
46:08non-stick cookware, all those things can
46:09affect hormone health. Now, how do you
46:12sort of protect yourself, right? I tell
46:14people again, don't stress. There's only
46:16so much you can control. So, like I love
46:18that we're not drinking out of plastic.
46:20If you have to drink out of plastic
46:22because you're at an event or whatever,
46:24try to make sure it's not a um a warm
46:28bottle. So, it hasn't been like sitting
46:29in the sun for hours and hours and hours
46:31because as it gets warm, it releases
46:33more microlastics and more chemicals
46:35into the water. When you're eating food,
46:37if you are eating out of say you get
46:39takeout, put it on a plate and warm it
46:41up. Don't ever warm up that plastic. And
46:43when you store food in the fridge, put
46:45it in a glass container or a metal
46:48container, but don't ever leave the food
46:49in the plastic and put it in the fridge.
46:51These are simple things you can control.
46:53You could also limit sort of your
46:54exposure to dust because dust has
46:56microplastics. You can try to wear more
46:59cotton fabrics, less synthetic fabrics
47:01because they shed less microplastics.
47:04But again, I think do what you can do,
47:06but don't let the stress of these
47:08chemicals like derail you because stress
47:11is not helping either. And how much of a
47:13difference does you know microplastics
47:16make on my hormonal health? Is it really
47:18a big big deal?
47:19>> Well, I think it depends. It's all dose
47:20dependent, right? So, we're all exposed.
47:22Like, if you look at the data, like
47:24people are, you know, consuming quite a
47:26bit of microplastics and we're seeing
47:27them actually even in testicles, in
47:30penis tissue samples, like they're in
47:32our bodies. And so, I think that it's
47:35definitely playing a role. How much? We
47:37don't know yet. We just know there are
47:39mechanisms and we know that they do
47:40affect hormonal health and so do the
47:43best you can.
47:44>> Do you and your family drink out of
47:45plastic bottles?
47:46>> No, we drink we we have like metal water
47:49bottles for the kids and myself. And
47:50>> what about non-stick pans?
47:52>> We buy ceramic. We we do our best to
47:54like avoid those as much as possible. So
47:57the other thing is the company you keep.
47:59I think we don't talk about this enough
48:00and we talk about it in terms of
48:02business like you want to keep people
48:03who are successful around you. You want
48:05to keep people who can help you. But it
48:06also plays a role in your sexual
48:08environment, right? So my husband is in
48:10these groups with a bunch of other male
48:12physicians. And there's a lot of
48:13discussion about how they never have sex
48:15anymore. And they're all just like, "Oh
48:17yeah, this is just like normal. Like
48:18we're getting older. Our partners don't
48:20want to have sex. It's so frustrating."
48:21And there's a lot of discussion about
48:22this and and it's it's almost like, "Oh,
48:26that's okay." Like that's just normal,
48:27right? They're normalizing this
48:29experience where that sex has not become
48:31a priority because life is so stressful,
48:33things are so crazy. Maybe you're having
48:34relationship discord. So, it absolutely
48:37plays a role. And there's actually some
48:39evidence that it may help you make
48:41better choices. So, there's one study
48:42where they looked at I think it was like
48:4450,000 people and they um did an
48:48intervention where they tried to
48:49encourage these people to surround
48:52themselves with positive influences that
48:53were like have safe sex and avoid
48:55negative influences. And they saw that
48:57for that these people had an increase in
49:00like sexual positive behavior. So like
49:02safe sex practices by 46%.
49:05So just by changing who they spent their
49:08time with, they saw this major
49:10difference in how they approached their
49:12sex lives.
49:12>> Okay. So if your friends are very
49:14pessimistic about sex and they're not
49:15having and they're complaining about it,
49:17that's going to become sort of
49:19contagious.
49:20>> Yeah. And I think it it extrapolates to
49:22everything. what kind of relationships
49:24you you're in. How do they view their
49:26relationship with their partner? Is it a
49:28priority? Do they make it a priority?
49:30Right? Or are they just busy doing their
49:31own thing and they're just like living
49:33in parallel lives? They're doing their
49:35own thing. You're doing your own thing.
49:36You never really spend time with your
49:37partner and then when you go hang out
49:39with your friends, you're like, "Oh god,
49:41I'm so glad to get away." And you're not
49:42like talking about how much you enjoy
49:44your partner. People tend to talk
49:47negatively, right? They want to like
49:48sort of like vent. And so when you have
49:50people who don't make that a part of
49:52their lives, it also affects you. They
49:53value their partner and they talk about
49:55them in a positive way, that's a a great
49:58thing to say like, okay, this is the
49:59right kind of person I want because I
50:01want to value my partner too and I don't
50:03want that to rub off on me because it
50:05absolutely does.
50:06>> And the other thing you said in this
50:07category of environmental stuff is
50:09things like pornography consumption. Is
50:10it possible to consume too much porn?
50:12>> So it's not the amount of porn that you
50:14watch, it is the sort of the way you
50:17feel about it. Many [snorts] people
50:19watch porn for a variety of different
50:20reasons. Most often it's for pleasure
50:22and enjoyment. But there's some people
50:24who watch porn because they want to get
50:26away from negative feelings, right? This
50:28is giving them dopamine and they're
50:29using it as a way to just feel better in
50:31the moment. And so that become that can
50:34become a compulsion where they're
50:36watching porn and it's like giving them
50:37these positive feelings and they feel
50:39negative in life and they're going back
50:40to porn to sort of again have that
50:42compulsion to watch porn again. But
50:44that's a small subset of people. The
50:46other thing is that there's a lot of
50:48negative discussion around porn, right?
50:50People like porn is bad, it's dangerous,
50:52it's evil. And I think, you know, it's
50:54more nuanced than that. But if you feel
50:56that porn is bad, every time you watch
50:58porn, you feel negative, you feel bad
51:00about yourself. That's where we see
51:03people having the most dysfunction
51:04associated with it because they feel
51:06guilty. They could watch it once a year
51:08and they could feel super guilty about
51:09it and it could affect their sexual
51:11function. They could see themselves as a
51:13bad person. and they could see
51:14themselves as wrong or immoral. And
51:16that's really when it becomes an issue.
51:18If you are finding yourself either
51:20compulsively watching pornography and
51:22using it as a scapegoat, maybe time to
51:24reevaluate, say, why am I doing this?
51:26How can I switch this out for something
51:28else that makes me feel better that
51:30might be healthy, like exercise or going
51:32for walks or whatever that may be? And
51:34then if it's something that's really
51:36making you feel like bad or guilty
51:39because maybe that's how you were
51:40raised, maybe that's what you feel about
51:41morality, then yeah, maybe like you
51:43either need to work through that because
51:46porn is maybe something that you still
51:47want to watch at times or you need to
51:50abstain. But usually those are it's very
51:52difficult to abstain for most people to
51:53abstain for prolonged periods of time.
51:55So I think it's it's something you have
51:57to work through if you find yourself
51:58having these sort of feelings about
51:59pornography or you're compulsively
52:01watching it. But for most people, it's
52:04adults. For most adults, it is fantasy.
52:07It's a place where you can experience uh
52:11see things that you may never do in real
52:12life that may be enjoyable, that are fun
52:15to watch, that have allow you to feel
52:16arousal. We see that when couples watch
52:19porn together, they are more likely to
52:21be more satisfied in their relationship.
52:22And when there's a discord, like one
52:24person really doesn't like it or doesn't
52:26use it, and the other one uses it a lot,
52:27that's where we see the problem. Is porn
52:30consumption going to impact my intimacy
52:33with my partner? [snorts]
52:35>> So, it depends. I think a lot of people
52:37watch it without an issue, right? They
52:39watch
52:39>> if I masturbate and I ejaculate, I'm not
52:42going to then be able to ejaculate very
52:43quickly necessarily with my partner.
52:45>> Yeah. So, that obviously that is, you
52:47know, there's a refractory period after
52:49you ejaculate. Now, when you're younger,
52:50that refractory period could be minutes.
52:53And when you're older, that can be a day
52:55and a half. And so we see that some
52:58people may struggle, especially if
52:59they're watching a lot of porn every
53:01single day and their refractory period
53:03is maybe a day. Then they may actually
53:05really have trouble ejaculating with
53:07their partner because they've not given
53:09themselves that time.
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55:12And the last one, the last of the four
55:13pillars,
55:14>> the last of the four pillars we talked a
55:15little bit about, it's called
55:17confidence. And confidence is not like
55:19stringing around like a peacock like I
55:21know what I'm doing. It's confidence in
55:22knowledge and curiosity. So, knowledge
55:25[snorts] we talked about a little bit,
55:26understanding female anatomy, like how
55:28do female bodies get aroused, right?
55:31what makes them aroused, where is the
55:32clitoris, knowing some anatomy, and two,
55:35actually talking to your partner or
55:37paying attention to their cues. We that,
55:39for some reason with sex, it's the only
55:41time that we just expect people to be
55:43mind readers. We just want you to know
55:44what I like and just go for it, right?
55:46And and then when it's not good, you're
55:48like, well, you just don't know what
55:49you're doing. And it's like, it's it's
55:51wild to me that we actually never got
55:54taught how to talk about sex, how to
55:55bring it up with a partner, how to, you
55:58know, just explore and have fun with
56:00sex. maybe add a toy to the bedroom. So,
56:02there's lots of different types of toys.
56:04This is a uh vulva stimulator. So, you
56:07put this on the outside. So, you can see
56:08that it would in theory, if this was
56:11smaller, would stimulate the um the
56:14clitoris on the outside. It also can
56:16change in shape. It'll vibrate, right?
56:19It'll have different stimulations that
56:21you can play around with and decide what
56:22you enjoy.
56:23>> So, this one's run out of battery. Um
56:26[laughter]
56:27so,
56:28>> they're brand new. They have not been
56:29used.
56:30>> I didn't say they had been very
56:32defensive though. Um, so if my pinky
56:34finger, if my finger here is the
56:35clitoris,
56:36>> Yeah.
56:36>> I put it on like that.
56:39>> Yeah.
56:39>> And then it vibrates.
56:40>> Correct.
56:41>> And then the penis goes through the
56:43hole.
56:44>> And there's another version of that.
56:45This is basically
56:47[laughter]
56:48>> this is basically like the hole goes
56:50around the penis
56:51>> and that goes in
56:52>> and that can go in and stimulate and vi
56:54vibrate. So, you both feel the vibration
56:56and you both feel the stimulation.
56:58>> I remember I was with um had a partner
57:00and she she felt that sex toys were for
57:02older people. Old people specifically
57:04what she said and she she was kind of
57:07against the use of them. I've always
57:08been down.
57:09>> I think it adds novelty and it's
57:11exciting and it just adds something new.
57:13>> But she felt like it was almost like
57:16giving up.
57:17>> Well, I mean, look, I think I wonder
57:19why. I would I would if I she was here,
57:20I'd ask her, why do you think that? What
57:22belief system do you have [laughter]
57:24that's making you think that this is
57:25like not a good thing to use? Right? We
57:28use technology in so many places in our
57:30lives, right? So why not introduce it in
57:32our sex lives?
57:33>> Are you going to become reliant on it
57:34though? Because it doesn't make it
57:35easier to get off with a sex toy.
57:37>> So they've actually looked at vibration
57:40and can you get desensitized to it? And
57:42the way they've looked at is actually
57:43like construction workers where they're
57:44using those like vibration tools, right,
57:46to and and seeing if like their hands
57:48get desensitized. And what they've seen
57:50is yes, for a short period of time they
57:52do lose a little bit of sensation at
57:54their fingertips, but then it restores
57:56back to normal. And so it's not that
57:58you're going to become desensitized
57:59forever, right? I think you brought up a
58:02great point, which is adding novelty.
58:03Now, I think when I say novelty, people
58:05are like, "Oh my god, I need to role
58:08play in a different way or bring like
58:10some sort of BDSM or whatever into my
58:13sex life." And that's not exactly true.
58:15So when you think about sex, right, it's
58:17just like eating your favorite ice
58:19cream. Maybe you have vanilla ice cream,
58:21you know, three times a week and you
58:22enjoy it. But if you start having
58:23vanilla ice cream every single day,
58:25you're kind of bored with it, right? And
58:27the same goes for sex. Now having
58:29routine in sex, knowing what you like,
58:32um knowing what your partner likes, it
58:33can be very helpful, but it also is nice
58:37to add novelty. So if you think about
58:39you can extrapolate from the flow state.
58:41So when you are in a flow state for
58:43work, right, things feel really almost
58:45effortless and you're just like in a
58:46zone, you can also get into a sexual
58:49flow state. When you look at the flow
58:50state, yeah, you need things to be
58:52slightly challenging to get into the
58:53flow state. They can't be easy and they
58:56can't be so hard that you're going to
58:57get frustrated, right? And so you need
58:59to add a slight challenge to your sexual
59:03encounter to get into that flow state.
59:05And that's when you start having really
59:07great sex cuz you're like in you're so
59:09totally immersed. you're feeling great
59:11and it's it's super fun, right? So, I
59:13think that's another part of being
59:15confident is being able to and confident
59:17to try new things and explore new
59:18things. And it can be as simple as like
59:21doing it in a different room or maybe
59:22getting a pillow or switching where your
59:25head position is. Like, it can be so
59:27small, but it can just add a little bit
59:29of uniqueness and novelty and challenge.
59:32>> Are there certain positions that are
59:35going to increase the probability that
59:37my partner has an orgasm?
59:38>> Yeah. So, uh, typically when the female
59:41partner is on top, she has more control
59:43over where she's getting stimulation,
59:46um, to the clitoris because, right, she
59:48can angle her body in such a way. So,
59:50often time that shows uh, that has, uh,
59:53higher orgasm rates. There's actually
59:55like this uh this technique called the
59:57cooidal alignment technique where you
1:00:00sort of move in a rocking uh a sort of a
1:00:03rocking motion so that um your pubic
1:00:06symphysis. So this bone right here um is
1:00:09sort of like rubbing against their
1:00:11clitoris like this area the skin here is
1:00:13rubbing against the clitoris while
1:00:14you're penetrating and that has been
1:00:16shown to increase orgasm rate and
1:00:19pleasure in sex. But really it's about
1:00:21figuring out and trying different things
1:00:23and realizing like that for example that
1:00:24coil alignment technique is sort of
1:00:26difficult like it's not that easy and
1:00:27intuitive and so you have to sort of
1:00:29play around with it and figure out like
1:00:31what is going to work uh best and yeah
1:00:33realizing it might not work. You might
1:00:35be like super awkward and like okay like
1:00:37that's okay like it's not the end of the
1:00:38world if sex is not perfect every time
1:00:41because we're learning and we're playing
1:00:42and we're having fun. And so I think
1:00:44that's really the key is like not
1:00:45letting yourself get so frustrated if
1:00:47something doesn't go exactly the way you
1:00:49envision it in your head.
1:00:50>> I used to think that a woman orgasming
1:00:52was when this was when I was younger. Um
1:00:54was when she squirted.
1:00:56>> Mhm.
1:00:56>> So like that's what I thought it thought
1:00:58an orgasm was squirting.
1:00:59>> Yeah. Well, you're probably not the only
1:01:01one to think that. And so squirting, not
1:01:03every woman squirts. So about 40% of
1:01:05women squirt. Squirting is the emission
1:01:07of fluid at the time of orgasm. Um
1:01:10usually it's clear, colorless, and it
1:01:11can be quite voluminous. um it's coming
1:01:14from the urethra which is the pee hole
1:01:16essentially and remember I talked about
1:01:18those skins glands those skins glands
1:01:21are the homalogue of the male prostate
1:01:23and they have a little bit of fluid in
1:01:24them too typically when you have
1:01:28stimulation um and squirting they will
1:01:30release fluid from the bladder as well
1:01:33as the skins glands that combines
1:01:34together and and it's emitted through
1:01:37through that
1:01:37>> so it's not pee
1:01:39>> the way they describe it and there's
1:01:40been a lot of research on this so
1:01:41there's people who say it's pee. There's
1:01:43people who say it's not. There's a
1:01:44couple studies. So, one is they put dye
1:01:47into the bladder and they took women who
1:01:50said they were squirters and they had
1:01:51them orgasm and they saw is there dye in
1:01:54the uh in the fluid and yeah, there was
1:01:57dy in fluid. So, it's coming, it has to
1:01:59come from the bladder. The skins glands
1:02:00only hold a small amount, but it's
1:02:02chemically different. It's usually
1:02:04clear, odorless. It doesn't smell like
1:02:06pee. And so, there's some theories as to
1:02:08why that might be. It may be that um
1:02:11when you're having sex, there's
1:02:13different hormonal signals that change
1:02:14the concentration of what's filtering
1:02:16through your kidneys so that it is a
1:02:18little bit different in composition.
1:02:20There's some theories that when there's
1:02:21more estrogen around that it may change.
1:02:23There may be some like um fluid filling
1:02:26in the actual interstissia of the
1:02:28organs. Again, it's hard to say, but
1:02:30it's absolutely coming from the urethra
1:02:32which is connected to the bladder as
1:02:34well as the steam glands. But I think
1:02:35like this this whole discussion about
1:02:37what it is, it doesn't matter. Like is
1:02:39it pleasurable? Are you enjoying it?
1:02:41Great. If you squirt and you enjoy it,
1:02:43great. If you don't, that doesn't mean
1:02:45that there's something wrong and that
1:02:46your partner hasn't orgasmed. The way to
1:02:48figure out if your partner orgasm is you
1:02:50ask her, right? Either she tells you or
1:02:52you ask her. And sometimes it's obvious
1:02:54and sometimes it's not, but you know,
1:02:55you you sort of figure it out.
1:02:58>> There's three theories that emerged in
1:03:00my research about why women squirt from
1:03:02an evolutionary perspective. The first
1:03:04was that, and these are just theories,
1:03:06they're not proven. Um, of course, the
1:03:08first is that squirting contains PSA and
1:03:10zinc, which are naturally antibacterial,
1:03:13and ejaculating these fluids during or
1:03:14after sex may have evolved to flush the
1:03:17urethra and prevent UTI. Um, the logic
1:03:19being in a pre antibiotic world, a woman
1:03:22who could flush bacteria out of her
1:03:24system after mating was more likely to
1:03:25stay healthy and reproduce. That's one
1:03:26theory. The other reason,
1:03:27>> well, before you I want to talk about
1:03:28that really quickly. So, that's a really
1:03:30interesting theory. So one the reason
1:03:32they emit PSA is because schemes glands
1:03:35are the homalologue of the prostate. So
1:03:38the prostate makes PSA which is prostate
1:03:40specific antigen.
1:03:41>> So this point this word homalogue again.
1:03:42>> Yeah it's a so basically the prostate in
1:03:44the male the same tissue when they're an
1:03:47embryo becomes the prostate in the male
1:03:48and becomes a skins glands in the
1:03:50female. So that's why it's emitting PSA.
1:03:53That is an interesting theory because
1:03:54there are a subset of women who get UTI
1:03:56after sex. Not everybody but some do.
1:03:59And it's it's not because of the
1:04:01ejaculate or because of the male
1:04:04harboring some bacteria. It's because of
1:04:05the actual thrusting of the penis. It's
1:04:08taking bacteria from the outside and
1:04:09making it more easy for it to go through
1:04:11the urethra into the bladder. And women
1:04:13have a short urethra. And so I want just
1:04:15to debunk that myth that it's like
1:04:17you're getting it from your partner or
1:04:19there's something wrong with you. It is
1:04:20literally just anatomy. And so some
1:04:22women do get more UTI after sex.
1:04:25>> And so that is an interesting theory
1:04:26because maybe that's true. I don't know.
1:04:28The second theory was in ancient
1:04:30ancestors, the hormonal surge during
1:04:32orgasm and ejaculation actually
1:04:33triggered the release of an egg. Humans
1:04:36evolved to ovulate on a cycle now, but
1:04:38we kept the plumbing and the neuro
1:04:40hormonal reflex. It's a happy accident,
1:04:42a biological vestage that no longer
1:04:43serves its original reproductive
1:04:45purpose, but remains because it isn't
1:04:47harmful for survival.
1:04:49>> Interesting. I mean there is some
1:04:50thought that maybe orgasming
1:04:53um spasms orgasm help with fertility but
1:04:56it's not really uh robust.
1:04:59>> And the last one kind of matches what
1:05:00you just said there which is the mate
1:05:02selection theory. The intense pleasure
1:05:03and psychological response of squirting
1:05:05or or orgasm act as a reward system. It
1:05:08incentivizes women to seek out specific
1:05:10partners who provide high levels of
1:05:12stimulation, potentially signaling a
1:05:13better genetic compatibility or a more
1:05:16attentive male, which would help with
1:05:18the survival of of offspring. Maybe
1:05:21>> that makes sense.
1:05:23>> 40% of women squirt.
1:05:25>> Yeah. So, the other thing is obviously a
1:05:27lot of sex is focused on genitals, but
1:05:29there's a whole body of arogynous zones,
1:05:31right? Almost almost your entire body
1:05:34can be an erogynous zone. We talked a
1:05:36little bit about it when we talked about
1:05:37sensate focus, right? You can explore,
1:05:39you can find areas that people find uh
1:05:42erogynous. So when you looked at data,
1:05:44necks, nipples, lips, buttocks, inner
1:05:48thighs, all these areas are considered
1:05:50arogynous by most most people regardless
1:05:53of their um sexual orientation,
1:05:55regardless of their cultural upbringing.
1:05:57It seems to be pretty universal. There's
1:05:59actually a famous paper about
1:06:00non-genital orgasms and like how people
1:06:03orgasm without any genital stimulation.
1:06:06So lip orgasms, anal sex orgasms.
1:06:09>> Is that possible?
1:06:10>> Yeah, it's been documented. Absolutely.
1:06:13And and so it's um nipple orgasms.
1:06:15There's a whole variety of ways even
1:06:17like women have had orgasms during
1:06:18childirth. Like there's there have been
1:06:20these documented ways to orgasm and it's
1:06:23because these areas can be very
1:06:24erogynous and sometimes stimulating
1:06:26multiple areas can like add more
1:06:29erogynous interest and that's why you
1:06:31see people like maybe in the BDSM
1:06:33community they'll they'll be using um
1:06:35nipple clamps while they're doing other
1:06:37things right so there's there's a whole
1:06:38bunch of areas that are erogynous and
1:06:41most of the times people are not really
1:06:43spending much time on foreplay or
1:06:46stimulating these erogynous zones as
1:06:48much as they should Right? You you have
1:06:50a whole body to play with. And how do
1:06:51you stimulate them? There's actually
1:06:53evidence behind that. So on your skin,
1:06:55we have these special fibers called C
1:06:57tactile eference. When you stimulate
1:06:59these fibers, they help you feel
1:07:01pleasure, enjoyment, those sorts of
1:07:03things. And so there was a study where
1:07:06they took 19 couples, a small study, it
1:07:07was out of London, and they basically
1:07:10told them to stimulate an arogynous zone
1:07:12and a non-erogynous zone. The
1:07:13non-erogynous zone being the forehead.
1:07:15And so they had the couples stimulated.
1:07:16And they told them stimulated at levels
1:07:18of 18 cm/s
1:07:21uh in terms of how fast you're caressing
1:07:23the arm or or or body part and at 3 cm
1:07:27per second. And what they found was
1:07:28those who stimulated at 3 cm per second
1:07:31had more sexual arousal had more
1:07:33pleasant stimulation compared to those
1:07:35who were stimulating at 18 cm per
1:07:37second. Now this makes sense because
1:07:39those C tactile aphrant fibers respond
1:07:42very well to that slow gentle caress.
1:07:46The other interesting thing is that
1:07:47these fibers are only responsive to
1:07:50human touch. So if I take a glove and I
1:07:52put it on my hand and I touch you, it
1:07:54still doesn't work.
1:07:55>> Interesting. That's so interesting
1:07:57because in Los Angeles where we are now,
1:07:59we were viewing an office and we were
1:08:00walking down the street to see what the
1:08:02neighborhood was like and we walked past
1:08:04one place and it is a robot massage
1:08:07parlor. M
1:08:09>> and I always thought great like well
1:08:11part of me thought maybe my prefrontal
1:08:13cortex thought oh great idea because you
1:08:15know you can get massages whenever you
1:08:16want it's going to be cheap maybe you
1:08:18can have one in your home but then the
1:08:19other part of me as I saw it thought
1:08:21actually I don't actually think that's
1:08:22like why I get massages
1:08:24>> I think there's something about human
1:08:25touch which makes a big difference
1:08:27>> absolutely there is um and so I think
1:08:29that's uh we're evolutionary
1:08:32evolutionarily built to seek out human
1:08:35touch and human behavior
1:08:37>> I wonder if I would want a robot to
1:08:38massage me.
1:08:41>> It wouldn't be as good. No.
1:08:42>> I mean, think about sitting in a massage
1:08:44chair. Is it ever as good?
1:08:45>> It's never as good,
1:08:46>> right? And so, I don't think a robot's
1:08:47going to be that different from a maybe
1:08:49a little better than a massage chair,
1:08:51but like
1:08:52>> massage chairs are never good.
1:08:53>> No, they're just like they're okay.
1:08:55They're mediocre. M Reena, I want to
1:08:57talk about um testosterone, how that
1:09:00links to sexual function, but also just
1:09:02overall health because I was reading
1:09:04that there's been a 300% increase in the
1:09:06United States in the last 10 years of
1:09:08testosterone prescriptions. And my
1:09:10friends are increasingly having
1:09:11conversation about testosterone, which
1:09:12we weren't having
1:09:14>> even 5 years ago. It wasn't a
1:09:15conversation. And now the conversation
1:09:17I'm having amongst my friends is like,
1:09:18is our testosterone high enough? Do we
1:09:19need to go get supplements to increase
1:09:21our testosterone?
1:09:22>> Testosterone is declining. So when you
1:09:24look at testosterone levels from the
1:09:261990s, like late 1990s, the average
1:09:29level was around 600 and if you look at
1:09:32data around two 2015, it was 450. So
1:09:35there's been like a 25% decline in
1:09:38testosterone. Now you're going to ask me
1:09:39why. One, we talked about some of the
1:09:41endocrine disrupting chemicals. That's
1:09:43part of it certainly. Two, there's a
1:09:45significant rise in obesity.
1:09:47Testosterone has aromatase. And
1:09:49testosterone converts to estrogen using
1:09:51this enzyme called aromatase. And so
1:09:54when you have more fat mass, you have
1:09:55more aromatase. And more testosterone is
1:09:57being converted to estrogen. And so now
1:10:00you have less testosterone.
1:10:01>> Sorry. How do we how do you have less
1:10:02testosterone?
1:10:03>> So because there's more fat mass,
1:10:05there's more aromatase. So that
1:10:07aromatase sees all this testosterone and
1:10:09it converts it to estrogen.
1:10:11>> Okay. This is where they say they talk
1:10:13about man boobs.
1:10:14>> Yeah. So when you have a lot of
1:10:15estradiol around you can get man boobs,
1:10:19>> you can get gynecomastia.
1:10:19[clears throat]
1:10:20So a term for it. So that's one. Two is
1:10:22we see a rise in diabetes and insulin
1:10:26resistance which also causes a decrease
1:10:28in testosterone. [snorts] We're seeing a
1:10:31rise in ultrarocessed food intake and
1:10:34that doesn't have the optimal nutrition
1:10:37that you need to optimize testosterone.
1:10:39So we're getting you know a high highly
1:10:42caloric which then leads to obesity.
1:10:45We're getting um lack of healthy fats.
1:10:47We're you know all these things are
1:10:49super important for testosterone. The
1:10:51Mediterranean diet is what has been the
1:10:53most studied and basically
1:10:54anti-inflammatory diet is what they
1:10:57found for testosterone. So trying to
1:10:59just eat like whole foods, unprocessed
1:11:01foods as much as possible and minimizing
1:11:04the inflammatory foods.
1:11:05>> Does testo having high testosterone make
1:11:07me more fertile? No, not necessarily.
1:11:10So, I think people inherently think that
1:11:12the higher your testosterone level is
1:11:14when you check your blood work, that
1:11:16that's better. And that's not
1:11:17necessarily true. Now, everyone is
1:11:20different. And what I can't tell you is
1:11:22what your receptors look like, what your
1:11:25testosterone or androgen [clears throat]
1:11:26receptors look like, how sensitive are
1:11:28they to testosterone. And everyone's a
1:11:31little bit different. But when you look
1:11:31at the same guy or you look at two
1:11:33different guys, their variability can be
1:11:36so much that a guy who's 900 can be
1:11:37normal and a guy who's 500 can be normal
1:11:39because everyone has individual genetic
1:11:41variations. It's how their cells how
1:11:44sensitive their cells are, how many
1:11:46cells they have, you know, how many
1:11:47latig they have in their testicles. Um
1:11:50the CAG repeats, which are these DNA
1:11:52repeats on the receptor themselves.
1:11:54People who have more are less sensitive
1:11:56to the testosterone that's around. So
1:11:58they need more testosterone to get the
1:11:59same result. Whereas people who have
1:12:01less repeats have more sensitivity so
1:12:03they they don't need as much
1:12:05testosterone. And so everyone is
1:12:06individual. And so that's why it's
1:12:08really important to understand how are
1:12:09you feeling, right? It's not about
1:12:11chasing a number. And so absolutely we
1:12:14know that when your testosterone is low
1:12:16below 214 nanogs per deciliter that your
1:12:20risk of mortality goes up by two. So you
1:12:22are going to double your risk of dying
1:12:24if you have low testosterone. But when
1:12:26you go super high, super physiologic,
1:12:29meaning like 1,800 or higher, now you're
1:12:31putting yourself at risk for other
1:12:33things. You can have blood thickening,
1:12:35which is a known side effect of
1:12:36testosterone replacement, and that puts
1:12:38you at risk for stroke, heart attack,
1:12:40heart disease. Over long periods of
1:12:43time, it can affect your heart because
1:12:45it can um there's also heart muscle
1:12:48cells that get exposed to this high
1:12:50level of testosterone. And when that
1:12:52happens, these they sort of change over
1:12:54time and they become more collagen
1:12:56deposition. They get more fibrosis and
1:12:59this makes them stiffer and so that
1:13:00you're not pumping blood as effectively
1:13:02as you would otherwise. And so there are
1:13:05real consequences to going too high.
1:13:08There's also the side effects of having
1:13:09acne, of changes in mood in terms of
1:13:12aggression and things when you get
1:13:13really high. So really, it's about
1:13:15finding what you feel good at. More is
1:13:18not necessarily better. Once your
1:13:20testosterone receptors are saturated,
1:13:22meaning they're all bound to
1:13:23testosterone more doesn't help you. It
1:13:25might help you get more muscles, which
1:13:27is why people abuse anabolic steroids
1:13:29and testosterone because it will
1:13:30continue to help you get bigger muscles,
1:13:32but that's it. It's not going to help
1:13:34you with your brain health, your bone
1:13:36health, your sexual health, your any of
1:13:38that.
1:13:39>> Is there a way to
1:13:41visually spot a person with low
1:13:43testosterone? Are there visual clues?
1:13:46Usually it's someone who feels very
1:13:48fatigued like they can't get out of bed.
1:13:51They feel just like so drained. Usually
1:13:53they are a little bit more overweight.
1:13:56>> Skinny fat
1:13:58>> visceral adop I mean you can't always
1:14:00tell if they're skinny. So it could be
1:14:01because they could have visceral adopy
1:14:02which is meaning that the fat is around
1:14:04the the organs right and so you don't
1:14:06see like a big pot belly necessarily. Um
1:14:09they may have really low sexual desire.
1:14:12They may have decrease in mood.
1:14:13>> What about skin and bones? Does it
1:14:15impact skin and bones?
1:14:16>> Yeah. So, if you get high testosterone,
1:14:18you can get acne because it affects the
1:14:19sebum in the skin. Um, bone health. So,
1:14:22testosterone converts to estradiol and
1:14:25[snorts] estradiol is really important
1:14:28for bone metabolism. And so, when you
1:14:31have low testosterone, you can also have
1:14:33low estrogen. And when your estrogen
1:14:35gets very low, you get a higher risk for
1:14:38fractures, higher risk for osteoporosis.
1:14:41And so that's where your bone health um
1:14:43can be in danger. And so that's why
1:14:45testosterone can help protect your bones
1:14:47because of its conversion to estradile.
1:14:50>> If you do have low testosterone, should
1:14:51you be considering taking anabolic
1:14:53steroids? Like
1:14:55and who is testosterone replacement
1:14:57therapy good for?
1:14:59>> So I'm going to ask you a question. Why
1:15:00why are you saying anabolic steroids?
1:15:02>> I don't know. Cuz I hear that people big
1:15:03bodybuilders take anabolic steroids. The
1:15:05reason I asked you that is because
1:15:06people think anabolic steroids and
1:15:08testosterone replacement therapy are the
1:15:09same thing and they're not. And so
1:15:11testosterone replacement therapy is what
1:15:14is given to guys who have low
1:15:16testosterone. If you have truly low
1:15:18testosterone, there's a few things you
1:15:20can obviously improve testosterone
1:15:21naturally by going back to those pillars
1:15:23of health that we talked about. Improve
1:15:24your sleep, do resistance training,
1:15:26avoid endocrine disrupting chemicals.
1:15:28But if you are still low despite doing
1:15:30all those things or you're like so
1:15:32fatigued that you can't move your body
1:15:33and like you really need to do it, then
1:15:35I think testosterone replacement is is
1:15:37very valuable. And so testosterone
1:15:39replacement is getting you to a level of
1:15:42testosterone that is within normal.
1:15:45We're not trying to get you super high.
1:15:47We're not trying to get you to become a
1:15:48bodybuilder. We're trying to get you to
1:15:50normal, what you should be. And so
1:15:53anabolic steroids are different. And
1:15:55anabol steroids are like all these
1:15:56different um oral pills and injectables
1:15:58and things that work on muscle as well
1:16:00as work on your uh androgen receptors.
1:16:03And so those are typically things that
1:16:05people are taking on their own. They're
1:16:08kind of self-directing their care and
1:16:10they're not really monitoring their
1:16:12testosterone or they don't really care
1:16:14how high they go. They just want the end
1:16:16product of looking muscular. And so they
1:16:20are getting really high testosterones
1:16:22and that has its own host of concerns in
1:16:26addition to the ones we talked about
1:16:27like blood clots and and heart attack.
1:16:29But there's a 15 times higher risk of
1:16:32having premature heart failure and a 122
1:16:36times more risk of cardiac death when
1:16:39you're taking anabolic steroids for the
1:16:41purposes of increasing muscle mass and
1:16:43not and get getting really high in your
1:16:45testosterone. So, it is a real serious
1:16:48issue when you take anabolic steroids
1:16:50because it can have real serious health
1:16:52consequences.
1:16:53>> I've always imagined that once I have
1:16:55kids, so I'm I think I'm scared that if
1:16:57I have testosterone replacement therapy
1:16:59at this age at 33, it might impact my
1:17:01fertility.
1:17:02>> It absolutely will.
1:17:03>> Okay, good. So, I'm not going to do that
1:17:06until I've had all four of the kids.
1:17:08>> Yeah.
1:17:08>> As many as I can.
1:17:10>> And then I figured when I hit like 45,
1:17:13then I'll go on testosterone replacement
1:17:15therapy. Is this a good strategy?
1:17:17>> Well, first of all, I would want to know
1:17:19why you want to be on testosterone. Is
1:17:20your testosterone low?
1:17:21>> I have no idea.
1:17:22>> Right? Are you having any symptoms?
1:17:24>> I mean, you live a very highpowered,
1:17:26busy life. And so, I can guarantee your
1:17:29stress is probably not under control.
1:17:31Like, probably you're not sleeping
1:17:33great. And not to say that those are
1:17:35things that, you know, you can't do in
1:17:36addition to taking testosterone if your
1:17:38testosterone is indeed low. But I think
1:17:41the important thing is realizing like
1:17:43it's only going to help you if your
1:17:45testosterone receptors are not fully
1:17:47saturated and giving you more
1:17:48testosterone is going to saturate them.
1:17:50>> Doesn't it just drop anyway with age?
1:17:52>> It does. So it drops about uh 1% a year
1:17:56on average. Some people drop less, some
1:17:58people drop more. So if you look at
1:17:59someone who is healthy and they have a
1:18:02normal testosterone, they usually won't
1:18:04become what we call hypogonatal or have
1:18:06low testosterone even as they age
1:18:09because the drop is so low. it's only 1%
1:18:11a year. But if you add on these comorbid
1:18:14conditions, if you add on a high stress
1:18:15life, if you add on poor sleep, if you
1:18:18add on um exposure to endocrine
1:18:20disrupting chemicals, you're going to
1:18:21see um that number come down much
1:18:24higher.
1:18:24>> It's actually I was just I pulled up a
1:18:26graph here um that shows testosterone
1:18:29decline with age. And it's actually not
1:18:32that steep.
1:18:33>> It's not It is going to decline, but it
1:18:36may not decline to the point where you
1:18:38need testosterone. So, not everyone
1:18:40needs it. Depending on the data you look
1:18:41at, 20 to 40% of guys have low
1:18:44testosterone. Um, and when you look at
1:18:47the number that get treated, it's like
1:18:482%.
1:18:49>> And it starts declining from about 20
1:18:51years old.
1:18:52>> Yeah. Depends on the person. 20 to 40
1:18:54years old that start, it's probably more
1:18:55around 30 to 40. And the reason we came
1:18:57up with these numbers, right, these
1:18:59guidelines to to guide us on what's
1:19:00normal and what's not is because you
1:19:02look at population-based data and you
1:19:04look at when these symptoms arise and
1:19:06there are like clear numbers like you
1:19:08may start having bone loss uh around
1:19:10300. You might start having uh you know
1:19:14decreased sexual frequency of thoughts
1:19:16at 215. You might start having feeling
1:19:19less physical vigor uh around 290.
1:19:22Right? And so there are numbers that we
1:19:24know based on population-based data that
1:19:26we're seeing these numbers decline. Now
1:19:28the other thing to think about when
1:19:30you're looking at testosterone is free
1:19:31testosterone. So testosterone comes in
1:19:34different forms in the body. It comes
1:19:36bound and unbound. So 45% of
1:19:39testosterone is bound to SHBG which is a
1:19:43molecule of protein that is really
1:19:45tightly binds to testosterone. Doesn't
1:19:47let it go for your body to use. Then
1:19:49there's some that's bound to albumin
1:19:51which is sort of loosely bound and then
1:19:53there's 2% that's free 1 to 2% that's
1:19:56free and that's what we say is like the
1:19:57most available to your body for use and
1:20:01there's actually you know good data that
1:20:02looks at free testosterone and the
1:20:04levels of free testosterone are
1:20:06correlated with these symptoms as well
1:20:08and so you do have to look at the big
1:20:10picture so I always check a total
1:20:12testosterone as well as an SHBG because
1:20:14some people can have elevated SHBG
1:20:17thyroid dysfunction due to aging, just
1:20:20genetic variability, right? In women,
1:20:22SHBG goes up when you take oral
1:20:24contraceptives and it stays up for life
1:20:27if you take oral contraceptives. So, it
1:20:28can affect their free testosterone. The
1:20:30other thing to think about testosterone
1:20:31is it's for life. Once you take it, your
1:20:33body stops making its own testosterone.
1:20:36Many people over years will notice that
1:20:37their testo their testicles get smaller
1:20:40um because their body stops making its
1:20:42own testosterone. So, it's not something
1:20:44to take lightly. Now if you want say you
1:20:46were low right now and you wanted to
1:20:48conceive there are ways where you can
1:20:50take other um other pharmaceuticals that
1:20:53will naturally boost your own production
1:20:55like hcg or clomid or enclomophene.
1:20:58These work basically uh in different
1:21:00ways to either tell your brain that hey
1:21:02we need more testosterone or they send
1:21:04they mimic the signals that tell your
1:21:06testicles to make more testosterone. And
1:21:09so there are ways to do it and you
1:21:10definitely need someone who's, you know,
1:21:12well-versed in managing hormone
1:21:14management. Uh, but there are things
1:21:16that you can do if you're low. But
1:21:18again, I don't think it's once you once
1:21:20you start these things, you can't go I
1:21:21mean, you can get off of it, but it's
1:21:23sort of a process and it's not something
1:21:24that everyone will do because you're
1:21:26going to feel good on testosterone if
1:21:28you're taking it. And then when you get
1:21:29off it, because your body is like no
1:21:31longer making its own, you're going to
1:21:32feel horrible. So, do you think most 50
1:21:34plus year old men should be taking
1:21:37testosterone
1:21:39replacement therapies?
1:21:40>> Only if they're symptomatic and they're
1:21:42low, right? So,
1:21:42>> would it make them the average man, the
1:21:44average 50-year-old man, if this is the
1:21:45average, feel better on a daily basis?
1:21:48>> Not necessarily. Because if they are
1:21:50normal, like I said, if their
1:21:51testosterone receptors are already fully
1:21:53saturated, it's not going to change,
1:21:54right? It's not going to change their
1:21:56it, like I said, it may make their
1:21:58muscles look bigger, but it's not going
1:21:59to change their their cognition. It's
1:22:01not going to change their mood. It's not
1:22:03going to change their sex drive. It's
1:22:04not going to change their erections when
1:22:06their testosterone receptors are fully
1:22:08saturated.
1:22:09>> And you know, in this graph, what is
1:22:10showing the decline here? Has that got
1:22:12anything to do with whether their
1:22:14testosterone levels are fully saturated?
1:22:15Because
1:22:16>> no, you can't tell from that.
1:22:17>> You can't tell from that. So, you could
1:22:18have low testosterone but still be
1:22:19fully.
1:22:20>> That's why we talk about symptoms,
1:22:21right? Because that's how I can tell. I
1:22:23think, you know, that's part of what
1:22:25being a doctor is, right? Talking to
1:22:26your patients and figuring out what's
1:22:28going on with them and what their
1:22:29symptoms are and making sure it's
1:22:30nothing else, right? You can have low
1:22:32thyroid and that can mimic what what uh
1:22:35what low testosterone feels like. You
1:22:37can have a high prolactin because you
1:22:38might have a benign tumor in your brain
1:22:41that's secretreting prolactin and that
1:22:43can reduce your testosterone. So that's
1:22:44the the reason to get a full evaluation
1:22:46to make sure there's nothing else that
1:22:48we're missing that's causing you to have
1:22:50these symptoms if your other levels are
1:22:52normal.
1:22:53>> Uh okay, that makes sense. So just
1:22:54because my testosterone levels would be
1:22:56low doesn't mean I necessar if I don't
1:22:59if I'm not symptomatic doesn't mean that
1:23:01I should necessarily just assume that I
1:23:03need testosterone replacement therapy.
1:23:05>> Exactly.
1:23:05>> Okay. Yeah. I think I think most of my
1:23:08male friends are just assuming that once
1:23:09we hit 50 we're all on the testosterone.
1:23:11>> I mean look I think when if you need it
1:23:14it's a great drug. It's a great option
1:23:16to improve your quality of life. It's
1:23:19obviously preventing uh bone loss. It's
1:23:22improving your longevity. it's uh
1:23:24preventing hopefully having some benefit
1:23:26in terms of cardioabolic health and so
1:23:28yeah absolutely if you need it but it's
1:23:31not something that like everyone should
1:23:32just take cuz why not right like it's a
1:23:35when you play with hormones it's serious
1:23:36business you know
1:23:38>> I guess a lot of men are self-conscious
1:23:39in a way that they don't often admit and
1:23:41they want to have big muscles
1:23:43>> and they want to feel strong
1:23:44>> and this is the the problem I'm seeing
1:23:45with younger guys right now is that
1:23:48there's a lot of young kids taking
1:23:50anabolics because there's so much
1:23:52pressure to look a certain way, right?
1:23:54Because nowadays when how do you meet
1:23:56people on social media through like
1:23:58swiping and and all you see is what they
1:24:00look like. And so there's this pressure
1:24:02and like I'll see it at the gym like I'm
1:24:03like at the gym and there's these young
1:24:05kids who I'm like there is no way you
1:24:06are naturally that built at that age,
1:24:09right? Like unless you've been lifting
1:24:11since you were like seven years old. And
1:24:13so and of course there are some. But it
1:24:16is serious because one, it causes
1:24:18infertility, right? When you're on
1:24:19testosterone replacement after about 18
1:24:2318 months, 70% of people on testosterone
1:24:25replacement will be infertile.
1:24:27>> 17
1:24:28>> 70 70%.
1:24:30>> 70.
1:24:31>> And even as soon as like 10 weeks, we
1:24:33see some people having drops in their
1:24:36sperm count. So, it's variable with how
1:24:38quickly you're going to see impacts on
1:24:40your fertility, but it absolutely
1:24:42happens. And it can it can come back for
1:24:45the large majority of people, but how
1:24:47long it takes depends on your age and
1:24:49how long you were on testosterone
1:24:50replacement therapy. And in some cases,
1:24:52it can take as long as 2 years to come
1:24:54back.
1:24:54>> I really need to get my testosterone
1:24:56levels checked.
1:24:57>> Yeah, you should. [laughter]
1:24:59But also, you should get your semen
1:25:00analysis checked. And I've done that.
1:25:02>> Good. Good. Because that's also a
1:25:03biomarker of health. We've seen that
1:25:05people who have poor semen parameters
1:25:08they have higher rates of mortality and
1:25:10they actually live when you look at age
1:25:12like what age people die they die
1:25:14younger compared to people and it's dose
1:25:16dependent. So if you're have like normal
1:25:20uh the concentration of sperm and then
1:25:22it keeps going down and down and down.
1:25:23If you look at the age it's like they
1:25:25live to 78 77 76 like you can actually
1:25:28see it come down except for people who
1:25:30have no sperm because those are usually
1:25:31genetic disorders. Those are live a
1:25:33little longer because it's not
1:25:34necessarily due to cardioabolic issues.
1:25:37Um, but it's basically a reflection of
1:25:39your overall health.
1:25:43>> Steve, what are you doing?
1:25:44>> Uh, just making myself a delicious
1:25:46coffee
1:25:47>> from the freezer.
1:25:49>> From the freezer. Have you not heard
1:25:50about Contier?
1:25:50>> No.
1:25:51>> Oh my gosh. This is going to change your
1:25:53life. A couple of months ago, the
1:25:55founder of this business called Matt
1:25:56sent a big shipment of this coffee to
1:26:00our office in London. What most people
1:26:01don't know is that the processing of
1:26:02coffee takes out a lot of the taste. So
1:26:04what they do is they flash freeze it at
1:26:07the optimal moment when it's most tasty
1:26:10and they send you in the post the coffee
1:26:12in these little frozen ice cubes. Now
1:26:14Matt sent a big shipment to my office. I
1:26:16moved it to the kitchen. I said to the
1:26:17team, "Knock yourselves out." And then I
1:26:19saw so many messages in our Slack
1:26:20channel of people going, "Oh my god,
1:26:23what the hell is that? It's so
1:26:24delicious." All I have to do is pop it
1:26:26out in the morning using the little
1:26:27button on the back of this thing. I pour
1:26:30my hot water in and I mix it and that is
1:26:34done. You can get $30 off your first
1:26:36order of Cometier coffee if you go to
1:26:39cometier.com/stephven.
1:26:41Try it and please Instagram DM me,
1:26:44LinkedIn me and let me know if you love
1:26:46it as much as I do. Make sure you keep
1:26:48what I'm about to say to yourself. I'm
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1:27:38I will speak to you then.
1:27:43One of the things I was quite surprised
1:27:44by, I'll be honest, is when I went on
1:27:47your YouTube channel
1:27:48>> Mhm.
1:27:48>> one of your very high performing videos,
1:27:51I think it had 31 million views, was
1:27:55about enlarging your penis.
1:27:56>> Yes.
1:27:59>> I didn't know that so many men were
1:28:02interested in ways to enlarge their
1:28:04penis. Well, it's interesting because
1:28:06when you look at the data, more men want
1:28:08to so I let's say most guys would love
1:28:12to be taller, right? If you're an
1:28:13average height man, most guys would love
1:28:14to be taller, right?
1:28:16>> Yeah. True.
1:28:16>> Um more men want to have a longer penis
1:28:18than they want to be taller.
1:28:20>> Really?
1:28:20>> Mhm.
1:28:23>> Wow. Wow.
1:28:26Why is this?
1:28:28>> Well, I think you know a lot of people
1:28:31um it starts at a young age. I have
1:28:33sons, right? And so I see it like they
1:28:35talk about their penis in such a way
1:28:37like very early in life like oh my god
1:28:39my penis is so big or it should be so
1:28:41big or whatever and and there and it's
1:28:44like this it becomes this like this
1:28:46society thing about who's got a bigger
1:28:48penis like it's very interesting but
1:28:50there's a lot of pressure to feel like
1:28:53and and a lot of discussion around
1:28:54bigger is better right it's it's talked
1:28:57about in media it's subtly joked about
1:28:59it is um everywhere you look people are
1:29:02talking about like being wellendowed as
1:29:04being better. But interestingly, on my
1:29:06podcast, we interviewed the the guy who
1:29:09has the largest medically verified
1:29:10penis. It's I think it's like 13 or 14
1:29:13inches in length. And um he actually has
1:29:16a lot of trouble because it's so large
1:29:18that people don't want to have sex with
1:29:20him and it's uncomfortable for them. And
1:29:22so, like, it's not all roses and
1:29:24sunshine on the other side. But the
1:29:27reality is that many people feel what's
1:29:29called small penis anxiety. and they
1:29:31they even if they have a normalsized
1:29:33penis, they feel consumed with how the
1:29:36size of their penis is. And so that's
1:29:38why this video did so well. I naively
1:29:40had no idea how many people it would
1:29:42resonate with because I'm not a guy,
1:29:43right? And I see patients all the time,
1:29:45but at that time in my career, people
1:29:47weren't coming to me to talk about it.
1:29:48And so I um I realized like there's so
1:29:52many people quietly feeling insecure.
1:29:54And we talk a lot about women having
1:29:55body image issues. Men do too, right?
1:29:58They feel insecure about the size of
1:30:00their penis because also they're seeing
1:30:02guys on pornography who have very
1:30:05well-endowed fallaces and you know they
1:30:07chose to be porn actors for a reason,
1:30:09right? Because they are naturally
1:30:11wellendowed. And so you're comparing
1:30:13yourself to the outliers and the average
1:30:15penis is about 5.3 to 5.5 in erect. But
1:30:19when you look at like what do women
1:30:21want, they will say on average they want
1:30:23a 6 in penis. But when you look at like
1:30:26the kind of sex toys they buy and they
1:30:28did this study because they were looking
1:30:29at people who they were trying to decide
1:30:32what kind of when they were developing
1:30:34fallaces for trans people like they they
1:30:37reconstruct fallacuses for they wanted
1:30:39to they were making them too girthy and
1:30:40they like well we need to figure out
1:30:41what girth women want and so they looked
1:30:44at like what women buy on online like
1:30:47what is the most purchased sex toy and
1:30:49it's actually pretty close to average.
1:30:52>> Do you say 5.2 in
1:30:53>> 5.2 two to 5.5 depending on the study
1:30:55you're looking at. Yeah.
1:30:56>> Correct.
1:30:57>> Mhm.
1:30:58>> H. And what size do men think the
1:31:02average is?
1:31:03>> Oh, they think it's like six or seven
1:31:04in.
1:31:05>> Oh, okay. So, they think the average is
1:31:06bigger. And also, how does age come into
1:31:08this? Because I'm presuming that when I
1:31:10get older, my penis is going to shrink
1:31:11or something.
1:31:11>> If you have good blood flow to your
1:31:13penis, it shouldn't shrink. So, like I
1:31:15said earlier, if you stop having
1:31:18nighttime erections or you're not having
1:31:19erections, now you're no longer getting
1:31:21blood flow to your penis and it will
1:31:22shrink over time. Also, if you're
1:31:24gaining weight, it will appear that it's
1:31:26shrinking because you're getting more
1:31:28fat over here. So, if you think about
1:31:31your penis here, this is the fat right
1:31:33above this bone. And as this fat gets
1:31:35more and more, you're seeing less and
1:31:37less of the penis.
1:31:38>> And is there a way to enlarge the penis?
1:31:40So there are many ways that have been uh
1:31:43tried, discussed, um attempted. So
1:31:46there's definitely surgeries that you
1:31:48can get, but they there's not a lot of
1:31:50surgeons who do a lot of penile
1:31:52lengthening surgeries and they have lots
1:31:54of complications, like very high rates
1:31:56of complications because the penis is a
1:31:58very vascular organ. And the thing is
1:32:00that when you have the tiniest
1:32:03difference on your penis, you notice it,
1:32:05right? Like I have guys come to like the
1:32:06tiniest little thing on their penis and
1:32:08they're like, "Is this okay?" Like this
1:32:09is new. And like luckily it's nothing,
1:32:12right? But I'm like they notice it. You
1:32:14notice it when something's wrong. So
1:32:15imagine you have a surgery and now
1:32:17something changes, right? So it is it is
1:32:19really difficult to sort of replicate
1:32:22exactly a normal penis when you're
1:32:24lengthening it through surgery. So I
1:32:27don't recommend surgery for lengthening
1:32:29penis. There is a safer way and that has
1:32:32been shown to help and that's using a
1:32:34traction device. So a traction device,
1:32:38we have one here. This is one brand. You
1:32:40can get many of these online. And you
1:32:42can put your penis in this device.
1:32:45>> It really I like I feel like um I get
1:32:48like shivers when I watch you do this to
1:32:49this penis.
1:32:50>> So you would wrap it. It would be more
1:32:52comfortable than just putting this like
1:32:54directly on your penis.
1:32:55>> For you guys that can't see, she's
1:32:56clamping the end of the penis into this
1:32:58>> into this device. And then you sort of
1:33:01lengthen it uh extend it with this 30
1:33:04minutes twice a day for this particular
1:33:05device. They've actually done some
1:33:07research on this one. 30 minutes twice a
1:33:09day and you there's like a whole
1:33:11protocol on their website and it does
1:33:13show improvements in length about two
1:33:14centimeters but it is a commitment to
1:33:17increasing length and to doing this
1:33:19process.
1:33:20>> So just on those numbers 2 cm increase
1:33:22over what period of time and does that
1:33:24>> or about 3 to 6 months depending yeah
1:33:26>> and is it permanent?
1:33:27>> So that's all we don't know. I mean most
1:33:29of the studies stop at you know once
1:33:31they get their results and we don't know
1:33:32that if you stop will it just revert
1:33:35back to normal? I don't know. And so the
1:33:37other thing about this particular
1:33:38traction device that's night is if you
1:33:40have a curvature in the penis like you
1:33:41develop something called Peron's
1:33:43disease, this device can actually curve
1:33:46a little bit away from if you like let's
1:33:48say you have um indentation on the top
1:33:50of the penis, it can actually bend away
1:33:52from that and it can help straighten out
1:33:54the penis. So, that's actually a a a
1:33:57really nice utilization for it because
1:33:59um for some people that can be really
1:34:01traumatic and devastating to have a
1:34:03change in the way your penis appears
1:34:05because it starts curving all of a
1:34:06sudden. And this is safe and effective
1:34:08and you can have bruising. It can be
1:34:10slightly uncomfortable, but it's you're
1:34:12not going to really hurt yourself uh too
1:34:15much by doing something like this.
1:34:16>> I thought a curved penis would hit the
1:34:18G-spot better. Yeah, sometimes a slight
1:34:20curve can be beneficial for some people,
1:34:23but again, I think like when you notice
1:34:25like there's a a dramatic change. You do
1:34:28that more. Come [laughter]
1:34:30rip the end off.
1:34:31>> It's okay. Um,
1:34:34>> I'm just trying to figure out how this
1:34:35works. So, I get the penis. I put it
1:34:38>> through. Yeah.
1:34:40>> Clamp it down.
1:34:41>> And you want to put it at your normal.
1:34:42And then you'll just slightly advance
1:34:44the [clears throat] the length. You're
1:34:45not going to pull crazy. easier. It's
1:34:46going to do a little bit of traction so
1:34:48it's not uncomfort. It's slight like
1:34:50just a slight tension. It shouldn't be
1:34:51like like that. It should be much
1:34:53[laughter] less tension, but it is I
1:34:55mean they can vary in price from $100 to
1:34:58$500. So it's a onetime cost. It is not,
1:35:02like I said, not dangerous. What is
1:35:04dangerous is when people try to do
1:35:06something that became popular on TikTok
1:35:08called jelking. And jelking is where you
1:35:10use your your hands and you make like an
1:35:13okay sign with your fingers and you're
1:35:15like stretching the penis with your
1:35:18hands. And this can be dangerous because
1:35:21you can create micro tears in the penis.
1:35:23And we in the urology community have
1:35:24seen plenty of patients who have now
1:35:27developed erectile dysfunction after
1:35:29doing jelking because they've now
1:35:30created damage to their penis. And so I
1:35:34I really caution people because this
1:35:36there is so much despair around sexual
1:35:39function, around penal health that
1:35:42people are willing to try things and
1:35:44they might really hurt themselves. No
1:35:46joke, I had a patient the other day ask
1:35:48me if he should drink hydrogen peroxide
1:35:50because he saw some ad that said
1:35:52hydrogen peroxide will fix your
1:35:54erections and I said please don't. um
1:35:57this is you know but he really was like
1:36:00seriously earnestly asking me this
1:36:02question and I you know I didn't want to
1:36:04shame him by any means and I was like no
1:36:05you know this is actually not safe and
1:36:07it's not going to help you and there's
1:36:09no pill there's no drink there's no
1:36:11anything that's going to give you a
1:36:13longer penis
1:36:15>> what are the cases that you see that
1:36:16break your heart
1:36:18>> you know I I've seen so there I've seen
1:36:20patients who've had surgery to lengthen
1:36:22their penis and they are above average
1:36:25when they at baseline and they have
1:36:27these surgeries to lengthen their penis
1:36:28and then they have a bad outcome and now
1:36:31their penis is disfigured forever. And
1:36:33that's what really um you never forget
1:36:36that because that person knowing the
1:36:38risks and benefits perhaps made a choice
1:36:40and that choice didn't go the way they
1:36:42wanted and now they have to live with
1:36:43that for the rest of their life and
1:36:45that's really sad.
1:36:46>> Gosh,
1:36:48imagine that. Christ
1:36:50>> Yeah.
1:36:51>> Well, and it just it doesn't work
1:36:53anymore. Well, like the one patient I'm
1:36:56thinking of, um, he, uh, had a like it
1:37:00it basically developed a scar all at the
1:37:02top of the penis. So, it was like
1:37:04disfigured essentially. Um, and so it
1:37:08was it was really sad.
1:37:10>> Before I hit puberty, I definitely had a
1:37:12penis anxiety because I was the youngest
1:37:14in my year at school and I I was the I
1:37:18was short, very very short, very small.
1:37:20I remember what it felt like to like
1:37:22hide my hide my dick
1:37:24>> when I was around like guys in the
1:37:26changing room and stuff like that. Um,
1:37:29you know, after puberty things I
1:37:32changed.
1:37:32>> And what I want people to understand, I
1:37:34think more than anything is that you
1:37:36don't need a long penis to pleasure a
1:37:38partner. We just talked about how the
1:37:40clitoris is the is the most reliable
1:37:42route to orgasm, right? And so you don't
1:37:45need a penis to stimulate the clitoris.
1:37:48You can use your mouth, your fingers,
1:37:50you can use a toy. There's so many ways
1:37:52to help your partner achieve pleasure.
1:37:56And and yes, of course, there are a
1:37:58small subset of women who really
1:37:59appreciate a large fallus. But the large
1:38:02majority of women, if you look at survey
1:38:04data, are very happy with the size of
1:38:06their partner, are very content with
1:38:09average or slightly above average or
1:38:10slightly below average as long as they
1:38:12are feeling intimate and they're feeling
1:38:14pleasure. And so I think that there's a
1:38:16misnomer that that people think if I
1:38:18have a longer penis I'm going to be able
1:38:20to pleasure my partner more
1:38:22>> as it relates to women. Is there
1:38:24different size vaginas?
1:38:26>> Yeah. So the a so just like there's
1:38:27averages there's averages in females.
1:38:29And so average vag vaginal length is
1:38:31about 3 and 1/2 in. So when women get
1:38:34aroused it expands and widens and
1:38:37lengthens to about double. So the
1:38:40average woman can easily accommodate the
1:38:42average penis. maybe slightly larger
1:38:45than average. And so I think generally
1:38:47speaking, knowing that like you will be
1:38:49able to fit in the average woman and you
1:38:52will be able to please her with the size
1:38:54of your fallus. And like I said,
1:38:56penetration is is not as important. In
1:38:58fact, only about 85% of women orgasm
1:39:01through penetration alone. They need
1:39:03clitoreral stimulation to achieve
1:39:04climax. And so again, penetration feels
1:39:07good. I I tell guys, it's like somebody
1:39:10rubbing your testicles or your
1:39:12paranneeium. feels good, but it's not
1:39:14going to make you orgasm. And so
1:39:16penetrating, yeah, if you're getting a
1:39:18lot of clitoreral stimulation because
1:39:20maybe she has a thinner, you know, her
1:39:22clitoreral shaft is closer to the
1:39:24vaginal canal, maybe, you know, the size
1:39:26of the penis matters more. But for a lot
1:39:28of women, it's not going to be
1:39:30sufficient and they're going to need
1:39:31some directed clitoreral stimulation.
1:39:33Why do different vaginas feel different
1:39:35to and I guess the the inverse is also
1:39:38the case where like different penises
1:39:40will feel remarkably different even if
1:39:42they're the same size roughly and you
1:39:44can have sex with somebody and go it
1:39:46feels really good.
1:39:48>> I mean I think again it's how you it's
1:39:50like the emotion in the ocean right like
1:39:52how you use your so let's let's talk
1:39:54about the vaginas first. So, when a
1:39:56vagina is um has more pelvic floor
1:39:59strength, they may be able to like tense
1:40:02around the penis better, like they may
1:40:04be able to sort of grab the penis with
1:40:06their pelvic floor a little stronger
1:40:08versus someone who doesn't. And that's
1:40:09where I think some people get worried
1:40:11when I say, "Oh, you need to relax your
1:40:12pelvic floor." They're like, "Oh, I
1:40:13don't want to be looser." Right? And
1:40:16that's not going to happen if you have a
1:40:17normally functioning pelvic floor. If
1:40:19you're
1:40:19>> So, the penis is going in here, right?
1:40:21>> Correct. So, if I if you're a woman and
1:40:23you do pelvic floor exercises, then
1:40:25you're going to feel tighter.
1:40:27>> Well, you're you're able to contract and
1:40:30squeeze those muscles during sex better
1:40:32around the penis.
1:40:33>> Yes. But we don't want you to be
1:40:34tighter. We want you to be able to
1:40:36squeeze the muscles and relax the
1:40:38muscles. Use them like a normal muscle
1:40:39like your bicep. You squeeze and relax.
1:40:41Squeeze and relax. We don't want it to
1:40:42be constantly squeezed.
1:40:44>> But to the man, it will feel tighter.
1:40:46>> You will perceive it as tighter, but it
1:40:47will not be that she's actually tighter.
1:40:49it just means that maybe her pelvic
1:40:50floor muscles are doing a better job. So
1:40:53that's for the female. For the male,
1:40:55it's it's generally like how the penis
1:40:58moves and how the positioning is and
1:41:00where it's uh it may be girth that's
1:41:03different. It may be the way that you're
1:41:05moving in the vaginal canal and that may
1:41:08be why it feels different.
1:41:09>> They often say that if you've got big
1:41:11feet or big hands, you know, like people
1:41:14think you have a big penis.
1:41:15>> Not necessarily true. So there's um
1:41:18there's actually no evidence that big
1:41:19hands, big feet correlate to female
1:41:21size. There's one study in Japan where
1:41:23they looked at nose length. And so the
1:41:26longer your nose is from the the bridge
1:41:29down to the tip, that is potent, at
1:41:32least the Japanese population that they
1:41:34studied was correlated with the length
1:41:35of the penis.
1:41:39>> People also think tall people have big
1:41:41penises. Not necessarily.
1:41:44[clears throat]
1:41:45>> But nose length, there's some
1:41:47correlation in a study in Japan.
1:41:48>> Yes.
1:41:49>> Okay. I was just checking if my nose.
1:41:52[laughter]
1:41:52>> Okay. Um the last thing I want to talk
1:41:54to you about is
1:41:56>> and how this relates to everything we've
1:41:58talked about today, desire, attraction,
1:41:59sex. Is there any early data emerging
1:42:01that shows any correlations?
1:42:03>> Yeah. So ompic there's sort of benefits
1:42:06and there's potential downsides. So the
1:42:08benefits are that when you're on Osmpic,
1:42:10we see improvements in metabolic
1:42:12diseases. They have improvements in
1:42:14diabetes, improvements in heart disease,
1:42:16improvements in overall health, right?
1:42:18And so that is going to mean that your
1:42:20blood vessels are healthier. You're more
1:42:22able to get blood flow to your genitals.
1:42:24You're going to have stronger sexual
1:42:26function and arousal, right? So that's
1:42:29great. The other thing is that you are
1:42:31losing weight. So you feel better. you
1:42:33feel more like your body image is is
1:42:36feeling good about yourself. Also, for
1:42:38men, remember I talked about this fat
1:42:40pad right above your penis.
1:42:42>> That's getting smaller. And so now you
1:42:44can see more of your penis. So you may
1:42:46have heard of ompic penis where people
1:42:47are saying, "Oh, my penis is getting
1:42:48longer." It's not actually that your
1:42:50penis is getting longer. It's that this
1:42:51fat is going down. So now you're seeing
1:42:53more of your penis,
1:42:54>> which makes it look longer.
1:42:56>> Yes. Exactly. Reality. Yes. Exactly.
1:42:58[laughter]
1:42:59Well, it is reality to the person
1:43:00looking. Right. Um so those are all
1:43:03great things and I think that's
1:43:05wonderful. Now the other part of it is
1:43:07ompic works on the brain and it works on
1:43:09the reward pathway. So you now see food
1:43:12and you don't feel like it's that much
1:43:13of a reward. So you don't chase after
1:43:15you have less desire for food. There's
1:43:17emerging data that we're seeing people
1:43:18on these medications, these GLP1s, have
1:43:21less desire for, let's say, gambling,
1:43:23let's say shopping, let's say, you know,
1:43:25alcohol, smoking, whatever it is, right?
1:43:28And so there's a theoretical because it
1:43:30works on the same pathways that it could
1:43:32also decrease desire for sex. And I
1:43:35think the thing that, you know, there's
1:43:36so many people on these medications,
1:43:38there's so many metabolic benefits that
1:43:40I worry that people may not even realize
1:43:42that their sexual desire is changing,
1:43:45right? They might just be like, "Oh, you
1:43:47know, I'm I'm eating less. I look great.
1:43:49Everything's wonderful." But like slowly
1:43:50in the background, they're like, "Oh,
1:43:52maybe my desire is less." And maybe it's
1:43:54creating discord in the relationship.
1:43:56Hard to say because we don't have data
1:43:57yet. So yeah, I think it's just
1:43:59something that you should be aware of
1:44:00that if you start feeling like you have
1:44:03less desire for sex or maybe you're
1:44:05like, "Man, I just really don't feel
1:44:06into anything." Talk to your doctor cuz
1:44:09maybe your dose is just too high and
1:44:11maybe it just needs to come down a
1:44:12little bit. And again, we don't know
1:44:14yet. But I do worry about this because I
1:44:16feel like we're we're gonna start seeing
1:44:18it.
1:44:19>> Is it possible to do studies on this
1:44:20type of thing? [snorts]
1:44:22>> Absolutely. So you can take people
1:44:24starting Ozmpi and you can say, "Hey,
1:44:26here is or or any GLP1." You know,
1:44:29there's questionnaires. So like for
1:44:30women there's the female sexual function
1:44:32index. For men there's Adam, which is a
1:44:33questionnaire about testosterone. But
1:44:35you could there's sexual desire
1:44:36questionnaires that you can use. Um, and
1:44:38you can take it at the beginning and
1:44:39then you can take it as they increase
1:44:41their dose and see if there's a change,
1:44:43right, in terms of their sexual desire.
1:44:45>> You said at the start about knowing how
1:44:48to talk to your partner. I think like
1:44:50intimacy desire, maybe the conversations
1:44:51like with your partner, how to have that
1:44:53conversation when there's a problem.
1:44:54>> Yeah. I I wish I could say there was
1:44:56like a script that you can follow and
1:44:57it's going to work. But everyone's so
1:44:59different. But I think the important
1:45:00thing is like not giving up because what
1:45:03happens is because we don't ever talk
1:45:05about sex, when you bring it up, it's
1:45:07immediately like, "Oh my god, is
1:45:08something wrong? Did I do something
1:45:09wrong? Um, do you not like me? Am I not
1:45:11attractive?" Right? You're automatically
1:45:13going down the rabbit hole of worry and
1:45:15concern. And instead of dealing with it,
1:45:17you're supposed to shut it down. No, I
1:45:18don't want to talk about it. Right? Um
1:45:19especially if like maybe you haven't
1:45:21connected intimately in a while and like
1:45:23you just don't want to deal with that or
1:45:24you're you have other stressors in life.
1:45:27Maybe you're not feeling like very good
1:45:29about yourself and so you're like,
1:45:30"Well, I don't really feel sexy, so I
1:45:32don't want to have sex." And so, I think
1:45:34really understanding that whatever
1:45:36reaction you get from your partner when
1:45:37you do talk to them, it's not about you.
1:45:39It's just usually about how they're
1:45:40feeling. And so, don't stress about
1:45:42that. And two, like it's anything that
1:45:45is worth having requires work. So having
1:45:48a good sex life, having intimacy over
1:45:51the long haul with someone, if you are
1:45:54committed to that relationship, it is
1:45:56worth working for. It is worth dealing
1:45:58with a little bit of discord to get
1:46:00there. And so I tell people when you
1:46:02want to talk about sex, first of all,
1:46:03don't do it in the bedroom. Don't do it
1:46:05right before or after sex. Do it at a
1:46:07time where you are both calm, relaxed.
1:46:09Maybe you're out for a walk, maybe
1:46:10you're in the car, so you're not like
1:46:12looking directly at each other. You're
1:46:13kind of parallel. And always start with
1:46:15a positive thing. like I you know I
1:46:17really enjoy this about our relationship
1:46:19and I would love if we could talk about
1:46:21this and and maybe they're going to be
1:46:23like uh I'm not ready for that and you
1:46:25say maybe we could come up with a time
1:46:27where we can talk about this that works
1:46:28for you right let them feel like they're
1:46:30coming to the conversation with like
1:46:32they're not being ambushed or like
1:46:34talking about something and then be
1:46:35curious. I think the big thing is like
1:46:37being curious like what's going on with
1:46:39you like I want to I want to I want to
1:46:41be there for you. I love you. you know,
1:46:43I miss what we used to have or I miss
1:46:45this about us. And I think that there's
1:46:47always these misconceptions. I hear it
1:46:49all the time, right? It'll be like this
1:46:51partner only wants sex and this partner
1:46:53never wants sex and you know, and that's
1:46:56it. Like that's the end of the
1:46:57conversation. But the reality is that
1:46:59there it's it's somewhere in between. So
1:47:01typically women tend to view sex as like
1:47:05added stress sometimes when they're
1:47:06already stressed. Like they're like,
1:47:07"Oh, it's just one more thing to do."
1:47:10Whereas men look at it as a stress
1:47:11relief. So, one, you're coming at it
1:47:13from two different angles. The other
1:47:15thing is men aren't really taught how to
1:47:17be intimate. And so, for a lot of men,
1:47:20sex is their version of intimacy. Like,
1:47:22that's how they connect. That's how they
1:47:24feel connected with a partner. And so,
1:47:27often times when they're doing these
1:47:29initiations or attempts at sex, it feels
1:47:31like they're being greedy or it feels
1:47:32like they're they just want sex. And I
1:47:34think we have to reframe how we look at
1:47:36that. Like, sex is not just sex. It is
1:47:38intimacy. It is being together
1:47:40connecting with another human being. So
1:47:42how do we do that right? And like how do
1:47:45we make that sex worth having? We get
1:47:48into this frame where we have sex as
1:47:50like in a hurried quick like just got to
1:47:53get this done way. I just need to get an
1:47:54orgasm. I just need to get a release.
1:47:56But sex is supposed to be something we
1:47:58look forward to. It's supposed to be
1:47:59something that we're excited about. And
1:48:01so we have to build that in. We have to
1:48:02sort of like build the environment where
1:48:05sex can can happen. So, it may mean
1:48:08like, "Hey, we are affectionate during
1:48:10the day. Maybe we send a lovey text
1:48:12message. Maybe um you know, I give you a
1:48:14hug. I caress your back. I um tell you
1:48:17you look beautiful. I I'm I'm showing
1:48:18you gratitude for how much I care about
1:48:20you in other ways." I think just really
1:48:23taking the time to understand why your
1:48:25partner feels the way they do.
1:48:26>> I'm curious about on that communication
1:48:28point about how different genders
1:48:31in heterosexual couples have different
1:48:33sort of taboos and things that are just
1:48:35a bit sensitive. Um, and I was looking
1:48:37at the the variance between men and
1:48:39women, and the the top one for men was
1:48:41around performance anxiety. So, like
1:48:43admitting to things like erectile
1:48:44dysfunction because it feels like it's
1:48:46so intrinsically connected to
1:48:47masculinity
1:48:49>> and you feel like a failure as a man if
1:48:50you can't get a erection and pleasure
1:48:52your partner, right?
1:48:53>> And then for women, it was talking about
1:48:54um prioritizing pleasure and asking for
1:48:57more foreplay or um, you know, specific
1:49:01specific stimul stimulation around the
1:49:03clitoris or something like that. um
1:49:05because they don't want to be labeled as
1:49:06highmaintenance or too much hard work,
1:49:09etc.
1:49:10>> And it's interesting that on that walk
1:49:11with your partner, there are different
1:49:13things that will trigger each of you.
1:49:15>> Mhm.
1:49:16>> Um other ones for women were pain and
1:49:18discomfort, bringing that up. Um body
1:49:20image and the mental load, explaining
1:49:22why you aren't in the mood. And other
1:49:24ones for men are expressing nonsexual
1:49:26needs because it might be seen as
1:49:26unmanly, unmanly, boundaries and
1:49:29rejection, communicating when they don't
1:49:30want sex. And lastly, the script, which
1:49:32is discussing fantasies that deviate
1:49:33from the norm.
1:49:35>> So, I want to talk about fantasy, but
1:49:36before that, I would just say that, you
1:49:38know, it because of social media, we're
1:49:40in a place and I get text messages from
1:49:43my husband 24 hours a day with like not
1:49:4424 hours a day, but like all waking
1:49:46hours with reals and videos. Oh, I think
1:49:49you'd like this. I think you'd like
1:49:50this. You should check this out. And
1:49:52it's like his way of like connecting and
1:49:54like, hey, let's talk about this later.
1:49:55Like, this is fun. And so I I tell my
1:49:57patients like send your partner a a
1:49:59video that you saw on social media that
1:50:01might help them understand like why this
1:50:03is important to you. Maybe send them a
1:50:05video send them this podcast, right? Say
1:50:07like, "Hey, I watched this. It was
1:50:08great." Good idea. You know, um and I I
1:50:10learned so much. And honestly, so many
1:50:12patients bring their partners to me.
1:50:14Whether it's women bringing male
1:50:15partners or men bringing female
1:50:17partners, they come to me and they say,
1:50:19"Look, like I want you to meet this
1:50:20doctor and I want you to talk to them."
1:50:21And like it's beautiful to see that.
1:50:24Like I love it because it's it's so
1:50:26deeply caring that they like brought
1:50:28their partner and they want them to feel
1:50:30good and they just want to figure out
1:50:31what's going on and like I think it's so
1:50:33lovely to to to find someone who's so
1:50:35invested in making sure that sex is good
1:50:37for you, right?
1:50:38>> As men though, we're just not good at
1:50:39talking about this stuff,
1:50:41>> right? But you know, I think you can't
1:50:42use that as a crutch.
1:50:44>> Yeah.
1:50:44>> Do you know what I mean? Like
1:50:45>> Yeah, I do. Yeah. We're just not good at
1:50:47it though. We just
1:50:48>> But no one's good at it. It's not men.
1:50:49Women are not good at it either.
1:50:51>> I think men are worse at it. I think in
1:50:53general no one is good at talking about
1:50:54sex. Like I, you know, I think it's
1:50:57interesting because I talk about it all
1:50:58the time, but I have seen very good
1:51:01communicators struggle with talking
1:51:03about sex. And so I think it's just um
1:51:06it's just it's uncomfortable and and
1:51:08it's like if you and I can have this
1:51:10conversation and we can talk about sex
1:51:12openly, like there's no reason that you
1:51:14can't learn how to talk about sex and it
1:51:16it's it's a learning process and it's
1:51:18worth it's worth investing in. Do people
1:51:20bring you their fantasies?
1:51:22>> Yeah, I've had I've had well more not
1:51:24not as many fantasies as like real sort
1:51:27of diverse interests in sex.
1:51:30>> What do you mean by So I had a patient
1:51:32who came to me and said uh you know
1:51:34after sometimes this was not like our
1:51:36first visit like we built a rapport and
1:51:38he told me you know the I I really
1:51:40struggle with arousal and the only time
1:51:42I get aroused is I have a a medical kink
1:51:45and so I go to this person who will put
1:51:47a fully catheter in me and that's what
1:51:50turns me on. And I was like that's
1:51:52really interesting. And I was like,
1:51:53"Okay, like that's that's great, but
1:51:55like it took a long time for us to get
1:51:56there for him to feel comfortable." But
1:51:58it also then was like, "Well, if that's
1:51:59what turns you on, you know, then you
1:52:02got to sort of explore other ways to
1:52:03incorporate that with a partner. Maybe
1:52:05not." So like a a catheter is is um is a
1:52:09tube that you put in the bladder for to
1:52:11drain urine.
1:52:13>> What hole does that go in?
1:52:14>> The urethra.
1:52:15>> It goes in the penis.
1:52:16>> Correct. And so there's actually a lot
1:52:18of people who enjoy urethral play. So
1:52:20they will take sounds, they're called
1:52:22sounds, like little um uh rods with a
1:52:25frail flared base and they will insert
1:52:27them in the urethra.
1:52:29But people do find that pleasurable. And
1:52:31so because there is some, you know,
1:52:33there there are some nerve endings there
1:52:34that can be pleasurable. And so again,
1:52:37it is totally fine to have interests
1:52:39that are, you know, outside what we call
1:52:41conventional. Um, but of course I think
1:52:43you need to uh if that's something that
1:52:45you're really into, you have to sort of
1:52:46bring your partner into the into the
1:52:48fold if that's what really gets you
1:52:50turned on. Now, in terms of fantasies,
1:52:52almost everyone fantasizes, right?
1:52:54Almost everyone does. And the
1:52:56interesting thing when you look at
1:52:57fantasies is there's a lot of fantasies
1:53:00that you would think are not common but
1:53:02are. So, for example, um being sexually
1:53:05submissive is very common. So women
1:53:08fantasize about it like around 60%, men
1:53:11are like 20%, having this desire of sex,
1:53:15this fantasy of sexual submission. It
1:53:16may not mean that they want to be
1:53:18submissive in real life, but that's the
1:53:19fantasy they're having. Um, men often
1:53:22have voyerism fantasy. So like watching
1:53:26sex. Um, they also have uh sex with
1:53:29multiple partners. Um, women tend to
1:53:32have a lot of like sexual um dominance
1:53:34but also romance in their fantasies. So
1:53:36like in exotic places or um that or with
1:53:39and a lot of times like 90% of the time
1:53:42people fantasize about strangers or it
1:53:44could be someone they know but outside
1:53:45of their relationship and so that's
1:53:46completely normal and nothing to be
1:53:48worried about. It doesn't mean that like
1:53:49you want that person. It's just a
1:53:50fantasy. It's a safe place in your head
1:53:52to think about fantasy. And I think one
1:53:55realizing if someone fantasizes about
1:53:57something it means nothing about how
1:53:58they feel about you. It's just where
1:54:00their brain goes to explore. I tell my
1:54:02patients sometimes write down your
1:54:03fantasies for yourself. Just like write
1:54:05them down. Don't share that with anybody
1:54:06and have your partner do the same. And
1:54:08then if you guys decide you feel
1:54:09comfortable at some point to each share
1:54:11one fantasy and you can start talk and
1:54:13maybe one that you would want to try and
1:54:15like it allows you to sort of explore
1:54:17and think about different things. It
1:54:19could be a negative outcome like you
1:54:20could just be like oh no this what
1:54:21didn't do it for me but it could also be
1:54:23very positive. And so just like again I
1:54:25think the big thing is understanding
1:54:26like it doesn't need to be that serious.
1:54:28like we can experiment, we can play, we
1:54:30can have fun. And if you bring that back
1:54:33into your life, you are going to be
1:54:34happier, less lonely, live longer. Like
1:54:38everyone should just be having more sex.
1:54:42>> It's um Yeah, it's interesting that
1:54:44we're getting more and more sexless
1:54:46because I think the world is stealing
1:54:49our attention and that's causing a big
1:54:51loss in connection. But then everyone's
1:54:52lives are more stressful than ever
1:54:54before. if a bomb goes off 10,000 miles
1:54:57that way, I I see it when I open my
1:54:59phone.
1:54:59>> Um, so it's an interesting time to sort
1:55:01of almost try and reclaim sex and
1:55:05>> to work on one's sexual health, the
1:55:08overall the full picture of one's sexual
1:55:10health. Um, you're working on a book
1:55:12which is, I guess, endeavoring to do
1:55:14much of that, which is coming out in
1:55:15September
1:55:16>> called The Hard Truth: Everything Men
1:55:18Need to Know About Good Health, Great
1:55:20Sex, and Long Life. So, if you're
1:55:21watching this after the 1st of September
1:55:242026 or around that time, then the book
1:55:26is probably available for pre-order or
1:55:28already out. It's not available for
1:55:29pre-order yet, is it?
1:55:30>> Uh, it will be soon, but not yet.
1:55:32>> Okay. When the book is out, I'm going to
1:55:34link it below in the comments section.
1:55:35Um, when it's available for pre-order,
1:55:37The Hard Truth: Everything Men Need to
1:55:38Know About Good Health, Great Sex, and
1:55:40Long Life. So, if the subjects we talked
1:55:42about today have piqu your interest, the
1:55:45book, I imagine, is going to go into
1:55:46greater detail on all of these subjects.
1:55:48>> Absolutely. I think it's a book that
1:55:50really I I wish was a part of sexual
1:55:52education. I think all men need to know
1:55:54this. You know, as women, we end up
1:55:57taking care of our male partners. I make
1:55:59all the doctor's appointments. I, you
1:56:01know, I organize all of that. I make
1:56:03sure that my kids get all their
1:56:04vaccines, all that sort of stuff. And
1:56:06and you know, it becomes on us to take
1:56:08care of our fathers, too. And so, as
1:56:09women, we hold that role. And I think it
1:56:12is so valuable to understand what men go
1:56:16through and also to be able to support
1:56:17them along the way. And I think it's a
1:56:20great gift for, you know, men in your
1:56:22life or for, you know, older sons even
1:56:25to like help people understand their
1:56:27bodies. And honestly, it's a huge
1:56:28motivator. I tell people like for
1:56:30nothing else, people care about sex. And
1:56:33I have seen patients turn around their
1:56:35lives because they want to have better
1:56:37sex. They'll literally improve their
1:56:38blood sugars. They'll improve their
1:56:41blood pressure because they just want to
1:56:42protect their sexual health.
1:56:44>> Reena, thank you. We have a um closing
1:56:46tradition on this podcast where the last
1:56:48guest leaves a question for the next
1:56:49guest not knowing who they're leaving it
1:56:50for.
1:56:50>> Mhm.
1:56:50>> This is the first time in Dario history
1:56:53where the guest has actually stamped it
1:56:56with a stamp that says certified 100%
1:56:59human.
1:57:00>> Okay.
1:57:00>> So, you can see there's a little stamp.
1:57:02>> So, when is that AI?
1:57:03>> So, it's not AI and it actually says
1:57:04that in the middle. It says Gen AI free
1:57:08sign of things to come. But their
1:57:10question I guess is somewhat linked to
1:57:11that. They the question they've asked
1:57:12for you is so much of the world feels
1:57:15hopeless about this moment. What would
1:57:18you tell someone to help them
1:57:20[clears throat]
1:57:20reclaim their agency?
1:57:29I think that
1:57:33we as humans are meant to be with other
1:57:36humans. We are meant to connect and I
1:57:40think making that a priority will allow
1:57:43people to feel
1:57:46um to feel a part of something again.
1:57:49You know, I think um I think there is
1:57:51like an emergence of people starting to
1:57:53look back at religious constructs and
1:57:56and go to community and be a part of
1:57:58things and enjoy live events again like
1:58:01we weren't doing before. I think if we
1:58:03prioritize that, there is still hope
1:58:05that we can come together as a society.
1:58:08And I think, you know, the pendulum
1:58:10always swings right in every way, like
1:58:12it's going to go far right or far left
1:58:14and people are going to hate each other
1:58:16and then they're going to love each
1:58:17other and they're going to come back.
1:58:18And I think if you just look at history
1:58:20time and time again, it repeats itself.
1:58:22And we will find unity and we will find
1:58:26togetherness. We are obviously feeling
1:58:28pain from a variety of different sources
1:58:31and we may feel pain right like in terms
1:58:33of other things to come but ultimately I
1:58:36I'm an optimist and I think that we'll
1:58:38come together and and we will find um
1:58:41happiness and joy in human connection
1:58:44>> and I hope you're right and I think
1:58:46we're seeing the early signs of that now
1:58:48for anyone that's listening that wants
1:58:49to learn more from Reena um I highly
1:58:51recommend they go to your YouTube
1:58:52channel I will collab if we can um and
1:58:55if we do collab on YouTube you'll a
1:58:57little smiling Reena um next to the Dar
1:59:00of Seio logo where you can click through
1:59:01to her YouTube channel. She's got almost
1:59:033 million subscribers and she goes
1:59:05through all of the questions which no
1:59:08one has ever answered for us. And I was
1:59:09looking at some of the questions that
1:59:11you answer for people. Everything from
1:59:13>> why you dribble after you pee and how to
1:59:16stop it. porn director reveals what what
1:59:19scenes are faked in almost every scene
1:59:21of movies, but then also a lot of the
1:59:23stuff we've talked about today around um
1:59:25penal health, erectile dysfunction, um
1:59:28sex positions, and so much more. So,
1:59:30it's a wonderful repository of
1:59:32information that is constantly being
1:59:34updated. That is a great place to
1:59:35subscribe. So, I highly recommend you
1:59:36do. Dr. Reena, thank you so much for
1:59:38your time.
1:59:39>> You're so welcome. YouTube have this new
1:59:40crazy algorithm where they know exactly
1:59:42what video you would like to watch next
1:59:44based on AI and all of your viewing
1:59:46behavior. And the algorithm says that
1:59:49this video is the perfect video for you.
1:59:52It's different for everybody looking
1:59:53right now. Check this video out and I
1:59:55bet you you might love

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