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#093_ STORY INSPIRE: Sex Expert Reveals What Women Really Need to Enjoy Sex — The Truth Most People Miss · INSPIRE STORY

0:00
Speaker 1: Is there a way to enlarge the.
0:02
Speaker 2: So you can put your penis in this device. They've
0:05
Speaker 2: actually done research on this. So 30 minutes twice a day.
0:07
Speaker 2: And it does show improvements in length about two centimeters.
0:10
Speaker 1: Ta-da!
0:12
Speaker 2: And that's not all. So they actually did a study
0:13
Speaker 2: on pistachios where guys ate 100 grams of pistachios every
0:16
Speaker 2: day and they saw a decrease in erectile dysfunction. Because
0:19
Speaker 2: if you're not having erections, now you're no longer getting
0:21
Speaker 2: blood flow to your penis and it will shrink over time.
0:24
Speaker 2: And the same goes for women with their clitoris because
0:27
Speaker 2: it's the same type of tissue. But also when you
0:29
Speaker 2: look at people who have sex once a week, they
0:31
Speaker 2: live 49% longer than people who only have sex once
0:35
Speaker 2: a year.
0:35
Speaker 1: 49% longer? Yeah.
0:37
Speaker 2: And every hundred orgasms men had, they lived like 13% longer.
0:42
Speaker 1: Be right back. Dr.
0:46
Speaker 2: Reena Malik has become the world's most watched urologist.
0:49
Speaker 1: After sharing everything you need to know about hormones, sexual health.
0:53
Speaker 2: And how to have better sex based on the data.
0:55
Speaker 2: So how can you have the best sex possible? So
0:58
Speaker 2: there's four main pillars of sexual health. So pillar one
1:01
Speaker 2: is fuel. So how you nourish your body. And it's
1:04
Speaker 2: a huge part of sexual activity. And then pillar two
1:07
Speaker 2: is strength. When people think about strength, they always think
1:09
Speaker 2: about going to the gym and lifting weights. It's much
1:11
Speaker 2: more than that. So when you look at the data,
1:13
Speaker 2: any sort of cardiovascular exercise is going to improve sexual function.
1:17
Speaker 2: It's going to improve blood flow to the penis and
1:19
Speaker 2: to the clitoris. And then also if you do 150
1:21
Speaker 2: minutes a week, it is the same amount of improvement
1:24
Speaker 2: as you would see when you take a medication like Viagra.
1:27
Speaker 2: And the other part of it is the pelvic floor.
1:29
Speaker 2: It's under evaluated, under discussed, and we'll get into that.
1:32
Speaker 2: But pillar three is environment. So things like stress, sleep,
1:36
Speaker 2: and endocrine disrupting chemicals. For example, they looked at data
1:40
Speaker 2: on men sleeping five hours a night versus eight hours
1:42
Speaker 2: a night. Guys who sleep five hours a night, their
1:45
Speaker 2: testosterone drops by 15%. And then the last of the
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Speaker 2: four pillars that we don't talk about enough is, and
1:52
Speaker 2: that's so important.
1:53
Speaker 1: I want to talk about morning erections, squirting, clitoral stimulation,
1:57
Speaker 1: and certain positions that are going to increase the probability
2:00
Speaker 1: that my partner has an orgasm.
2:02
Speaker 2: Let's talk about all of that. First of all.
2:07
Speaker 1: This is super interesting to me. My team gave me
2:09
Speaker 1: this report to show me how many of you that
2:10
Speaker 1: watch this show subscribe. And some of you have told us,
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Speaker 1: according to this, that you are unsubscribed from the channel randomly. So,
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Speaker 1: favour to ask all of you, please could you check
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Speaker 1: right now if you've hit the subscribe button, if you
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Speaker 1: are a regular viewer of the show and you like
2:22
Speaker 1: what we do here. approaching quite a significant landmark on
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Speaker 1: this show in terms of a subscriber number so if
2:27
Speaker 1: there was one simple free thing that you could do
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Speaker 1: to help us my team everyone here to keep this
2:32
Speaker 1: show free to keep it improving year over year and
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Speaker 1: week over week it is just to hit that subscribe
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Speaker 1: button and to double check if you've hit it only
2:39
Speaker 1: thing i'll ever ask of you do we have a
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Speaker 1: deal if you do it i'll tell you what i'll
2:42
Speaker 1: do i'll make sure every single week every single month
2:46
Speaker 1: we fight harder and harder and harder and harder to
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Speaker 1: bring you the guests and conversations that you want to
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Speaker 1: beginning of the Diary of a CEO, and I will
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2:56
Speaker 1: Let's get on with the.
3:01
Speaker 2: Show. Dr.
3:06
Speaker 1: Reena Malik, if somebody was to come up to you
3:09
Speaker 1: in the street, having watched your videos online, and they
3:12
Speaker 1: were a follower of the content you've produced over the
3:14
Speaker 1: last couple of years... If you had to guess the
3:17
Speaker 1: question they would ask you, because it's probably the most
3:20
Speaker 1: frequent popular question you get asked, what do you think
3:22
Speaker 1: they would say?
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Speaker 2: They would say, what can I be doing right now
3:25
Speaker 2: to improve my sex life?
3:27
Speaker 1: Who would be asking you that question? And why do
3:29
Speaker 1: you think they'd be asking it?
3:31
Speaker 2: I think everyone can agree that sex is something we enjoy.
3:34
Speaker 2: It's something that's important that we want to have, right?
3:37
Speaker 2: And there is... a desire to have good sex or
3:41
Speaker 2: feel like maybe you're missing out on something that could
3:44
Speaker 2: be even better so how can you have the best
3:46
Speaker 2: sex possible because you hear all these people talking about
3:50
Speaker 2: amazing sex in the media you might see it on
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Speaker 2: pornography you might feel like this is something amazing why
3:55
Speaker 2: am i not having that i want that right.
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Speaker 1: So on that point you said it's obvious that it's
3:59
Speaker 1: important i think it appears to be increasingly not obvious
4:04
Speaker 1: that it's important Because when you look at some of
4:06
Speaker 1: these stats, I'll throw this graph that I found here
4:09
Speaker 1: up on screen. And it shows that people are becoming
4:11
Speaker 1: more sexless, especially young adults between 18 and 30. This
4:15
Speaker 1: graph is pretty stark.
4:17
Speaker 2: Think about 50 years ago. There was no cell phones.
4:20
Speaker 2: There might be some TV programs, but there was ads
4:23
Speaker 2: in between TV programs. And there was only certain TV
4:25
Speaker 2: shows you could watch at a certain time that you enjoyed.
4:27
Speaker 2: And then there was nothing to watch. There was no email.
4:30
Speaker 2: So you went to work and you came home and
4:31
Speaker 2: there was really not a lot of communication between you
4:33
Speaker 2: and your coworkers or your job. They made dinner with
4:36
Speaker 2: their family. They hung out and then maybe they watched
4:39
Speaker 2: a program or two and then they lied down in bed.
4:41
Speaker 2: They didn't have a phone to scroll on. They didn't
4:43
Speaker 2: have anything to keep them up. And so then they
4:45
Speaker 2: were like next to their partner and maybe they're talking,
4:48
Speaker 2: maybe they're cuddling. And so there was more like opportunity
4:51
Speaker 2: and space for sex, right? It was a thing that
4:54
Speaker 2: you did for enjoyment, for pleasure, for fun. Now we
4:57
Speaker 2: have all these distractions. that keep our mind away from sex.
5:01
Speaker 2: In order to enjoy sex, you need to have space
5:04
Speaker 2: for it, to be able to enjoy your partner and
5:06
Speaker 2: feel like you want that, right? And now we're sort of,
5:09
Speaker 2: there's not as much room for it. That's one. Two
5:13
Speaker 2: is younger people, how are they dating, right? How are
5:16
Speaker 2: they meeting each other? They're meeting each other through apps,
5:19
Speaker 2: through DMs. And so they're not actually like really having
5:24
Speaker 2: these deep, meaningful connections. There's a big hookup culture. There's
5:28
Speaker 2: a big like, fling culture. And imagine first time sex
5:31
Speaker 2: for most people is not great. You don't know your partner.
5:33
Speaker 2: You don't know what they like. And you may not
5:35
Speaker 2: be able to express what you like. You've never taught
5:37
Speaker 2: how to talk about sex, right? So you don't know
5:40
Speaker 2: how to say like, hey, I like it like this.
5:42
Speaker 2: And you may be self-conscious because it's your first time.
5:44
Speaker 2: So you have like mediocre sex or bad sex. And
5:47
Speaker 2: you're like, well, I don't really want that. And there's
5:49
Speaker 2: just no like follow through, right? There's not a lot
5:52
Speaker 2: of education on what sex should look like. The only
5:55
Speaker 2: education people are getting are from often erotic films. And
5:59
Speaker 2: so they're seeing sex that's not real, that's curated, and
6:03
Speaker 2: they're trying to emulate that. And that's not pleasurable for
6:05
Speaker 2: most people. And younger people these days are actually having
6:09
Speaker 2: a rise in more, we call rough sex. So choking
6:13
Speaker 2: has become very, very common. As common as like, they
6:16
Speaker 2: call choking almost like vanilla sex. So young people, if
6:20
Speaker 2: you look at data, like 60% of women and I
6:22
Speaker 2: think it's 20% of men have been choked. during sex
6:27
Speaker 2: of that age group, like college age group. And of
6:30
Speaker 2: those people who get choked, 20% have been choked 25
6:33
Speaker 2: times or more. Now, I think it's fine if you're
6:36
Speaker 2: into that, but I can't imagine that that many people
6:38
Speaker 2: are into choking. And there's data to support that. So
6:41
Speaker 2: when you look at qualitative data, this is by Debbie Herbenick.
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Speaker 2: She's a sex researcher and she did qualitative research and
6:46
Speaker 2: she asked people like, what is it like? Do you
6:48
Speaker 2: enjoy being choked? Tell us about it, right? Women were like, yeah,
6:51
Speaker 2: it's okay. Sometimes I'm scared because my partner is big
6:54
Speaker 2: and strong and I'm smaller and they have big hands.
6:57
Speaker 2: Sometimes it's fine and sometimes I don't really care for it,
7:00
Speaker 2: but it's just a part of sex. It's just as
7:02
Speaker 2: normal as kissing, for example. And so if you're having
7:06
Speaker 2: sex and you're doing things just because you think that's
7:09
Speaker 2: what your partner wants or what it should look like
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Speaker 2: and you're not enjoying it, well, that's not going to
7:14
Speaker 2: be sex that you want to have.
7:16
Speaker 1: That point you said about the lifestyles we lead and
7:18
Speaker 1: how that might be impacting our sex lives, I thought
7:21
Speaker 1: was really interesting because we don't talk enough about this.
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Speaker 1: But when you look at some of the data on
7:24
Speaker 1: this demographic, you know, people... 30 and below, around that age,
7:30
Speaker 1: the extreme outliers are spending eight to 10 hours on
7:33
Speaker 1: their phones, on social media and on the internet. And
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Speaker 1: roughly about 15 to 20% of young people describe their
7:40
Speaker 1: usage as almost constant, effectively scrolling during all waking hours
7:46
Speaker 1: while they're eating, while they're in the bathroom and before
7:47
Speaker 1: they go to sleep. So I was wondering from a
7:49
Speaker 1: dopamine perspective, if there's correlation between these like dopamogenic activities
7:55
Speaker 1: that are now like hijacking our lives, whether it's short
7:58
Speaker 1: form videos on social media, whether it's pornography or food,
8:03
Speaker 1: whether it's having an impact on what then happens in
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Speaker 1: the bedroom and our performance in the bedroom.
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Speaker 2: If you think about what you need to have good
8:10
Speaker 2: sex is you need to be sort of in the
8:13
Speaker 2: mind space for sex. And if you're constantly like hijacked
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Speaker 2: by all these other things, you're never like really getting
8:18
Speaker 2: in the mood, right? You're just like, oh, I'm going
8:21
Speaker 2: to be turned on when I see my partner and
8:23
Speaker 2: we're going to have sex and it's going to be over.
8:25
Speaker 2: And it's just really a mechanical thing at that point, right?
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Speaker 2: You're not actually, you're just trying to get an orgasm.
8:30
Speaker 2: You're not actually like spending the time to enjoy and
8:33
Speaker 2: to experience that fully because your brain is always doing
8:37
Speaker 2: something else, right? Because people are constantly scrolling. Every 60 seconds,
8:42
Speaker 2: there's a new video, there's something else. And so it's
8:44
Speaker 2: really hard to focus. And so that can translate to
8:47
Speaker 2: the bedroom where you're having sex, but your brain is
8:50
Speaker 2: somewhere else thinking about something else you saw or something
8:52
Speaker 2: you have to do or something you want to see
8:54
Speaker 2: or something you want to look up, whatever it is,
8:57
Speaker 2: but you're not really in there in the moment. You're
8:59
Speaker 2: just going through the motions. And so I think that's
9:02
Speaker 2: really where the challenge is, is that people are becoming
9:05
Speaker 2: increasingly distractible.
9:07
Speaker 1: I find it really hard, I've got to be honest,
9:08
Speaker 1: to have sex if I've had like a really, really
9:10
Speaker 1: busy day or if I'm really, really thinking about something.
9:12
Speaker 1: I almost have to, I have to like intentionally create
9:15
Speaker 1: quite a lot of space.
9:16
Speaker 2: Exactly.
9:17
Speaker 1: In order to be able to be in the mood.
9:20
Speaker 2: Yeah, be aroused, right? It takes like time and energy.
9:23
Speaker 2: I think I appreciate you for saying that because a
9:24
Speaker 2: lot of people think that men are just ready to
9:27
Speaker 2: go at any moment. And that's not fair, right? Because
9:30
Speaker 2: everyone needs time to be aroused. It's not just instant
9:33
Speaker 2: for everybody, especially when you have a lot of work
9:36
Speaker 2: stress or life stress or other things going on. It's
9:39
Speaker 2: actually like you have to make time and space for it.
9:41
Speaker 1: Yeah, because as a man, you've got to get an erection.
9:44
Speaker 1: And I always think that an erection is a consequence, usually,
9:47
Speaker 1: especially when it comes to sex. and I'm not talking
9:49
Speaker 1: about morning glories here, but an erection is a consequence
9:52
Speaker 1: of like a story. You use the word aroused. There's
9:56
Speaker 1: like a story in my head, which makes me go, oh,
9:58
Speaker 1: that's kind of hot.
9:59
Speaker 2: Yeah. You need something. You need some stimuli, right? You
10:03
Speaker 2: need to think about something, see something, smell something, feel something, right?
10:07
Speaker 2: You need to just be together and sort of allow
10:09
Speaker 2: yourselves to be intimate before that sort of desire and
10:12
Speaker 2: arousal come together. Yeah.
10:14
Speaker 1: And for me as well, it's not just touch. Like
10:16
Speaker 1: that doesn't necessarily, for me, it really is quite like
10:18
Speaker 1: a psychological thing. I was wondering if this is, there's
10:22
Speaker 1: any data around this or, I mean, just even anecdotally,
10:24
Speaker 1: like people get aroused in very, very different ways, don't they?
10:27
Speaker 2: Yeah, absolutely. I mean, some people are very like visual.
10:32
Speaker 2: So they, you know, they see their partner and they
10:34
Speaker 2: get aroused very quickly. Basically when you get aroused, you
10:36
Speaker 2: need to be in a parasympathetic nervous system state. So
10:39
Speaker 2: in order to get an erection, you need to be
10:41
Speaker 2: in this state, which is like rest and digest. So
10:44
Speaker 2: if you're stressed, if you're thinking about other things, if
10:46
Speaker 2: you're essentially on the go, you are not allowing your
10:50
Speaker 2: nervous system to calm down. And so for some people,
10:52
Speaker 2: that's a whole bunch of different things. Some people can
10:54
Speaker 2: switch more easily into that state. And some people need
10:58
Speaker 2: more of like to feel either mentally stimulated or they
11:04
Speaker 2: need to have some associations. It might be like they
11:07
Speaker 2: need a certain scent. They need to relax their body.
11:10
Speaker 2: They need to go take a bath, whatever it is.
11:12
Speaker 2: But some people need different things. And knowing what that
11:16
Speaker 2: is for your partner is super important, right? Because then
11:19
Speaker 2: you can incorporate that. Everything is scheduled in our lives, right?
11:22
Speaker 2: And then you're like, oh, but now sex is like
11:24
Speaker 2: the last thing on the schedule, right? And I don't
11:26
Speaker 2: even think about it. Like, oh, okay, now, yeah, maybe
11:28
Speaker 2: let's have sex. But if you actually make time to
11:30
Speaker 2: be intimate, allow yourself to be in that brain space,
11:33
Speaker 2: be together, that's when it can actually happen. Especially when
11:37
Speaker 2: you've been in a long-term relationship, it doesn't come as easily,
11:39
Speaker 2: like spontaneously, which we call spontaneous desire. It comes more
11:43
Speaker 2: of as a response to these other cues that allow
11:46
Speaker 2: you to feel desire and to feel aroused.
11:51
Speaker 1: I also think, I was thinking about a previous relationship
11:53
Speaker 1: I had where on the days where I'd been like
11:56
Speaker 1: working very hard and I was like tired or stressed
11:58
Speaker 1: or had been traveling and I was jet lagged, I
12:00
Speaker 1: think there was also Because I didn't see this person often,
12:04
Speaker 1: there was also an expectation that when I did see them,
12:06
Speaker 1: we were going to have sex. And that was very
12:11
Speaker 1: hard because actually the expectation of it stressed me out more.
12:16
Speaker 2: Yeah.
12:16
Speaker 1: And that can happen if it becomes the elephant in
12:18
Speaker 1: the room. it can become a little bit heavy, which
12:21
Speaker 1: then is sort of counterproductive to performance.
12:24
Speaker 2: And this is, you know, sort of a variation on
12:26
Speaker 2: performance anxiety. So when you feel like you have to
12:29
Speaker 2: perform on demand and maybe you're worried it might not happen,
12:33
Speaker 2: it creates this vicious loop, right? So you maybe have
12:36
Speaker 2: trouble with an erection or maybe it's like, I'm expected
12:38
Speaker 2: to have sex, but I really can't get there mentally.
12:40
Speaker 2: Whatever it is, now you're thinking about that, right? And
12:43
Speaker 2: then you're with your partner and you're like, oh my God,
12:44
Speaker 2: am I going to have trouble? You're not enjoying the
12:46
Speaker 2: pleasurable sensations or the visuals or like, feeling each other,
12:50
Speaker 2: you are literally thinking in your own head about how
12:52
Speaker 2: you're going to respond. And then that anxiety makes it
12:55
Speaker 2: so that you can't get an erection or you can't
12:57
Speaker 2: be aroused. And so now you're like anxious and you're
12:59
Speaker 2: not focused. You're just almost spectatoring. You're just watching yourself
13:02
Speaker 2: have sex. You're not actually like in the moment. So then,
13:06
Speaker 2: you know, you have a negative outcome because when you're stressed,
13:08
Speaker 2: your sympathetic nervous system is on, right? You can't really
13:11
Speaker 2: get an erection or you can't really get aroused. And
13:14
Speaker 2: so then you're like, oh man, now I've let my
13:16
Speaker 2: partner down. Now I haven't performed, which I hate that word,
13:20
Speaker 2: but like performed the way I should or I'm expected to.
13:24
Speaker 2: And now something's wrong with me. And now that just
13:26
Speaker 2: keeps going in a vicious cycle.
13:28
Speaker 1: Have you spoken to people that have experienced this?
13:30
Speaker 2: Absolutely.
13:31
Speaker 1: It's common?
13:32
Speaker 2: Very common. I tell people anytime you have problems in
13:35
Speaker 2: the bedroom, it stays with you.
13:37
Speaker 1: So how do you break the cycle?
13:39
Speaker 2: Yeah, so I tell people, when you're with your partner,
13:42
Speaker 2: take the pressure off penetration. Just explore each other's body.
13:47
Speaker 2: Do what's called like sensate focus, like explore the rest
13:50
Speaker 2: of your body. Figure out other erogenous zones, other things
13:53
Speaker 2: that can turn you guys both on that don't involve
13:56
Speaker 2: erections and penetration. And then once you realize you're focused
13:59
Speaker 2: on that, you're really like exploring, enjoying, playing, you're having
14:03
Speaker 2: a good time, and you're not thinking about your erection,
14:05
Speaker 2: now you'll notice, oh, the erection just comes, right? And
14:07
Speaker 2: then once you get to that point, then you can
14:09
Speaker 2: start even touching genitals, but still hold off on penetration.
14:12
Speaker 2: And then after you've realized like the genitals are, you know,
14:16
Speaker 2: it's always working the way I want it to, and
14:17
Speaker 2: I'm not thinking about it, I'm not stressed, then finally
14:19
Speaker 2: you can then introduce penetrative sex again. So it's just
14:23
Speaker 2: sort of like a gradiated sort of slow advance into sex.
14:27
Speaker 2: you know, having sex again, but now kind of focusing
14:30
Speaker 2: on being more present and mindful and enjoying those sensations.
14:34
Speaker 1: I think a lot of people will be able to
14:36
Speaker 1: do that, but there's also a big contingent of people
14:39
Speaker 1: that just avoid sex. It's a sore subject in their
14:44
Speaker 1: relationship for whatever reason. Both partners don't know how to communicate.
14:48
Speaker 1: They haven't got the tools to talk about these kinds
14:50
Speaker 1: of things openly and honestly. Do you see that a
14:52
Speaker 1: lot as well? Absolutely.
14:53
Speaker 2: I mean, I think it's really sad. I see people
14:58
Speaker 2: come in and they're like, I ask every patient, like,
15:01
Speaker 2: are you, are you having sex? Why not? Right. Because
15:03
Speaker 2: sometimes they'll say no. And most doctors are like, okay,
15:06
Speaker 2: but I always say, why not? Right. Why are you
15:07
Speaker 2: not having sex? Is it because you're having an issue?
15:09
Speaker 2: Is it because you're having pain? What's going on? Right.
15:12
Speaker 2: And oftentimes I'll hear from people that my partner is
15:16
Speaker 2: just not into it. And I just sort of gave
15:18
Speaker 2: up and I'm just, we just don't have sex anymore.
15:22
Speaker 2: For me, that's a red flag because sex is a
15:26
Speaker 2: huge important part of our lives. It is a way
15:29
Speaker 2: we connect with another human being. It's also telling that
15:33
Speaker 2: things are working really well. So when you have good
15:36
Speaker 2: sexual function, meaning you get an erection well, or you
15:39
Speaker 2: get aroused well, and you have a good orgasm and
15:41
Speaker 2: everything feels good, that tells me that, hey, you've got
15:44
Speaker 2: great blood flow to your genitals. Your nerves are working great.
15:47
Speaker 2: Your Sex is more than just the act of sex.
15:54
Speaker 2: It also helps you live longer. So there's been a
15:58
Speaker 2: few studies looking at sex and longevity. And when you
16:01
Speaker 2: look at people who have sex once a week compared
16:03
Speaker 2: to people who have sex once a year, the difference
16:06
Speaker 2: in all-cause mortality is 49%. They live 49% longer than
16:09
Speaker 2: people who only have sex once a year. 49% longer? Yeah, yeah.
16:18
Speaker 1: Be right back. No, I'm joking.
16:21
Speaker 2: But even if you're doing like less than once a
16:23
Speaker 2: week but more than once a year, it still improves
16:25
Speaker 2: your longevity. There was actually an interesting study in 1997,
16:29
Speaker 2: I think it was, where they looked at the number
16:31
Speaker 2: of orgasms men had. And they found that men who
16:34
Speaker 2: had– for every hundred orgasms men had, they lived like
16:38
Speaker 2: 13% longer. They had a 13% increase in life expectancy. Wow.
16:43
Speaker 2: And so it was really interesting to me just showing
16:46
Speaker 2: you that this is not just an act of pleasure
16:49
Speaker 2: and fun. It is, obviously, but it's much more than
16:52
Speaker 2: that because people who are having sex clearly have better health.
16:56
Speaker 2: And this connection with people, I mean, loneliness is a
16:59
Speaker 2: big issue right now. The WHO made loneliness like an epidemic.
17:03
Speaker 2: So they've said that loneliness is as bad as having
17:05
Speaker 2: like 15 cigarettes. And so- Sex is a way to
17:09
Speaker 2: feel connected to another human being.
17:11
Speaker 1: On that data, we're not saying that it's the sex
17:13
Speaker 1: itself that's causing people to live longer. I guess it's
17:16
Speaker 1: hard to establish causation in terms of....
17:26
Speaker 2: And it's also like sex is a cardiovascular workout, right?
17:30
Speaker 2: For many people as a cardiovascular workout, you are getting
17:32
Speaker 2: a physical activity with your partner. You are increasing your
17:36
Speaker 2: heart rate. You are doing these things that are also
17:38
Speaker 2: good for your body. And the fact that you're able
17:41
Speaker 2: to have sex, right, tells me a lot about it, right?
17:44
Speaker 2: You're able to hold a certain position. You're able to
17:47
Speaker 2: maintain this level of activity without getting short of breath, right?
17:51
Speaker 2: Like these are things that having sex, you know, keeps
17:54
Speaker 2: you healthy to some degree.
17:56
Speaker 1: If I want to make sure that I have great sex,
17:58
Speaker 1: what are some of the foundational things that I need
18:00
Speaker 1: to be thinking of in terms of my lifestyle?
18:02
Speaker 2: Yeah. So there's four main pillars of sexual health. And
18:05
Speaker 2: I like to think of it like your sexual health
18:07
Speaker 2: is your house and these pillars are the foundation. And
18:10
Speaker 2: if you don't have the foundation, it doesn't matter what
18:11
Speaker 2: else you do. You can try to do everything else
18:14
Speaker 2: to patch up your house, but it's always going to
18:16
Speaker 2: break again because the foundation's not there. So you've got fuel.
18:20
Speaker 2: And fuel is how you nourish your body. A lot
18:23
Speaker 2: of the data I'm going to talk about is about
18:25
Speaker 2: men because there's just a lot more data on men
18:28
Speaker 2: and sexual health. But that doesn't mean that the same
18:30
Speaker 2: things don't apply to women. There's just less robust data
18:33
Speaker 2: on it. So when you talk about fuel, the Mediterranean
18:36
Speaker 2: diet is the most studied diet. So including things like
18:41
Speaker 2: healthy fats, like avocados, leafy greens, nuts, and we're going
18:45
Speaker 2: to talk about nuts in a little more detail. These
18:47
Speaker 2: things are super helpful. And obviously having lean proteins, having
18:52
Speaker 2: an abundance of fruits, which we're going to talk about
18:53
Speaker 2: as well. There's a study called the Health Professionals Follow-Up Study.
18:56
Speaker 2: It was a 20,000 men. And they saw that men
18:59
Speaker 2: who adhered to a Mediterranean diet had a 22% lower
19:03
Speaker 2: risk of erectile dysfunction. So what specific things in that diet, right?
19:08
Speaker 2: People are always like, what are the superfoods I need
19:10
Speaker 2: to have? Almonds are great, but pistachios, they actually did
19:13
Speaker 2: a study on pistachios. They looked at 100 grams of pistachios.
19:16
Speaker 2: Guys eat 100 grams of pistachios every day. And they
19:19
Speaker 2: saw a decrease in erectile dysfunction.
19:21
Speaker 1: So pistachio nuts will make my penis harder.
19:23
Speaker 2: I mean, so I always say, like, I don't love
19:25
Speaker 2: to talk about superfoods because then people are like, oh,
19:27
Speaker 2: I just got to eat pistachios and it's all good, right?
19:29
Speaker 2: It's part of a whole diet. But certainly having nuts
19:32
Speaker 2: because they have great omega-3s, they have healthy fats. These
19:35
Speaker 2: are the reasons that they really sort of improve diet. Yeah. Fruit,
19:40
Speaker 2: anything that has sort of flavonoids, so like colorful fruit,
19:44
Speaker 2: like blueberries, citrus fruits, lycopene, which is red fruits, all
19:48
Speaker 2: of these things improve antioxidant and also have been shown
19:52
Speaker 2: to reduce the incidence of erectile dysfunction. So having stronger erections,
19:55
Speaker 2: specifically blueberries actually came out to have, I think something
19:59
Speaker 2: around 20% also improvement in erectile function when you're eating
20:03
Speaker 2: blueberries regularly. So lots of, I think, things in the
20:06
Speaker 2: diet that can be helpful. Also fiber is one that
20:09
Speaker 2: we don't talk about enough. When you eat fiber in
20:12
Speaker 2: your gut, it converts to short-chain fatty acids. These short-chain
20:15
Speaker 2: fatty acids then sort of have these endothelial protective mechanisms.
20:19
Speaker 2: They protect the blood vessels. They make them healthier. And
20:22
Speaker 2: so when your blood vessels are healthy, you get better
20:24
Speaker 2: metabolic health. So you get less diabetes, less high blood pressure,
20:28
Speaker 2: less high cholesterol. And all of these things together improve
20:31
Speaker 2: erectile function. So- I think making sure that you meet
20:35
Speaker 2: the criteria for fiber, which is 38 grams for men,
20:39
Speaker 2: 25 grams for women, is really, really important. And then
20:43
Speaker 2: obviously managing your calories and maintenance, right? Because we don't
20:46
Speaker 2: want to gain weight because excess adipose tissue or excess
20:49
Speaker 2: fat also puts you at higher risk for erectile dysfunction
20:53
Speaker 2: and other sexual dysfunctions. Next, we have strength. All right.
21:00
Speaker 2: So there's strength where we think about cardiovascular and resistance exercise,
21:04
Speaker 2: but there's also pelvic floor strength. So we'll start with
21:07
Speaker 2: cardiovascular exercise. The one study that's quoted very often is
21:10
Speaker 2: 150 minutes of exercise, of cardiovascular exercise, moderate intensity. When
21:15
Speaker 2: you look at the improvement in erectile function scores, it
21:19
Speaker 2: is the same amount of improvement as you would see
21:22
Speaker 2: when you take a medication like Viagra. So literally, if
21:26
Speaker 2: you do 150 minutes a week, you are getting the
21:28
Speaker 2: same improvement, as you could get with a medication potentially.
21:32
Speaker 2: And so I tell people like, look, if you don't
21:33
Speaker 2: want to take a pill, this is a great way
21:36
Speaker 2: to improve sexual function. Now you might say, okay, well,
21:40
Speaker 2: maybe you're listening and you have heart issues and you
21:42
Speaker 2: can't really do moderate intensity exercise. They actually looked at
21:45
Speaker 2: that too. So there was a group where they looked
21:46
Speaker 2: at men who had heart disease and they weren't really
21:50
Speaker 2: able to do moderate intensity exercise. So they did like
21:52
Speaker 2: a five minute warmup. They did 20 minutes of walking
21:55
Speaker 2: and five minutes of a cool down. And with this
21:58
Speaker 2: supervised protocol, they still improved erectile function by 70%. So
22:01
Speaker 2: it's all relative to where you're starting, but any sort
22:06
Speaker 2: of cardiovascular exercise that's above what you're doing now is
22:11
Speaker 2: going to improve sexual function, particularly erectile function, because it's
22:14
Speaker 2: going to improve blood flow to the genitals. It's going
22:16
Speaker 2: to improve blood flow to the penis. It's going to
22:18
Speaker 2: improve blood flow to the clitoris for women. So that's
22:21
Speaker 2: where cardiovascular exercise is so, so important. In terms of
22:24
Speaker 2: resistance exercise, now these little weights are probably not sufficient
22:28
Speaker 2: for doing much, especially for men, in terms of improving
22:32
Speaker 2: muscular health. But obviously, we're not going to bring really
22:34
Speaker 2: heavy weights to the table here. So one, we know
22:37
Speaker 2: that resistance training is significantly correlated with testosterone. So when
22:42
Speaker 2: you do heavy resistance training of your large muscle groups,
22:46
Speaker 2: so like your lower extremities, your glutes, you're doing like
22:49
Speaker 2: Olympic deadlifts, squats, that sort of stuff, you actually see
22:52
Speaker 2: improvements in testosterone. Now, it's not going to be like
22:55
Speaker 2: you do it once and you get this sustained improvement,
22:57
Speaker 2: but continuous sort of regular resistance exercise improves testosterone. There's
23:03
Speaker 2: also data that shows that when men do resistance exercise
23:06
Speaker 2: to maintain muscle mass. So we know that muscle mass
23:10
Speaker 2: decreases about 7% every decade of life after around 40.
23:14
Speaker 2: When you maintain it through resistance exercise, they're three times
23:17
Speaker 2: less likely to have erectile dysfunction.
23:19
Speaker 1: Oh, really? Yeah.
23:20
Speaker 2: So they maintain erectile function. They maintain sexual desire. They
23:24
Speaker 2: maintain satisfaction with sex.
23:27
Speaker 1: I read a quote yesterday that said, muscle is medicine.
23:29
Speaker 1: And I thought, that's really true. Based on everything I've
23:32
Speaker 1: learned on this podcast around, you know, like glucose control
23:35
Speaker 1: and testosterone. And now you're telling me about Your sex life.
23:40
Speaker 2: Yeah, it is. I think people push back because they
23:43
Speaker 2: think like, why should I have to go to the gym?
23:45
Speaker 2: But our lives have changed. We sit at a computer
23:48
Speaker 2: or we sit at podcasts or we sit all the time.
23:51
Speaker 2: We're not moving. We're not doing manual labor, which is
23:54
Speaker 2: what a lot of our history is, right? Doing manual labor, farming,
23:59
Speaker 2: doing things outside, being physical. And we're meant to be physical.
24:03
Speaker 2: We're meant to lift heavy things. We're meant to move
24:05
Speaker 2: our bodies and we're just doing less and less of it.
24:08
Speaker 2: So I think it's so important. The other thing is
24:10
Speaker 2: we want to prevent sarcopenia. So sarcopenia is muscle loss.
24:14
Speaker 2: And when you have muscle loss, that also increases your
24:18
Speaker 2: risk of having sexual dysfunction.
24:20
Speaker 1: What about the pelvic floor? Like, how does that come
24:22
Speaker 1: into this story?
24:22
Speaker 2: Oh, yeah. So we missed that part. So the pelvic floor,
24:27
Speaker 2: here's your pelvis, right? It's this bony structure where all
24:30
Speaker 2: your organs live. This is a female. So I'm taking
24:33
Speaker 2: out the internal structures, which is the uterus, the rectum,
24:37
Speaker 2: and the bladder. And so that's what sits inside the pelvis.
24:41
Speaker 2: And so you can see this bowl of muscles here, right?
24:44
Speaker 2: And you can see them from the inside and you
24:46
Speaker 2: could see them from the outside. That's your anus. And
24:48
Speaker 2: in this person, there's a vagina. So that's the hole
24:50
Speaker 2: for the vagina. So you can see that your anus
24:52
Speaker 2: and your vagina run through the pelvic floor. And in men,
24:55
Speaker 2: your penis runs through the pelvic floor. And so this,
24:58
Speaker 2: let me see if I can show you on this model.
25:00
Speaker 2: In this model, you can see, they kind of show
25:02
Speaker 2: you the muscles here on the side. So these are
25:05
Speaker 2: your pelvic floor muscles that are around... the penis, and
25:09
Speaker 2: the anus.
25:10
Speaker 1: Okay. Okay.
25:12
Speaker 2: These structures are very important for a variety of things.
25:16
Speaker 2: They attach to your bony landmarks here, your hips, your sacrum,
25:20
Speaker 2: your pubic symphysis. They attach to all these and they
25:24
Speaker 2: sort of just work in the background for most people.
25:27
Speaker 2: How they affect your sexual function is when you orgasm,
25:31
Speaker 2: these muscles contract and release at a rhythmic contraction of 0.8 seconds.
25:37
Speaker 2: And so you may feel that, right? There's like this
25:39
Speaker 2: pulsing feeling when you orgasm and that's these muscles sort
25:42
Speaker 2: of doing that. And when men ejaculate, the pelvic floor
25:46
Speaker 2: muscles are contracting to help shoot the ejaculate out. They
25:49
Speaker 2: squeeze when you need to keep things in. So they'll
25:51
Speaker 2: keep urine in, they'll keep your stool in and they
25:54
Speaker 2: relax when you need to pee and when you need
25:56
Speaker 2: to defecate.
25:57
Speaker 1: So when you're trying to hold a wee, you're like
26:00
Speaker 1: tightening your pelvic floor muscles.
26:01
Speaker 2: Correct, correct. But these are also responsive to stress. So
26:05
Speaker 2: just like people get TMJ where they get, tense in
26:08
Speaker 2: their jaw because they are stressed and they sleep at
26:10
Speaker 2: night and they clench up their jaw. They don't really
26:12
Speaker 2: know they're doing it. The same thing can happen. These
26:14
Speaker 2: muscles can get very tight or they can get misaligned.
26:18
Speaker 2: So say you have a hip injury or say you
26:19
Speaker 2: have a back injury, the muscles can compensate by tightening up.
26:23
Speaker 2: And so a lot of people unknowingly have tension in
26:26
Speaker 2: these muscles and it can present in multiple different ways.
26:30
Speaker 2: It can present with back pain. It can present with constipation.
26:35
Speaker 2: It can present with urgency frequently because remember your bladder
26:38
Speaker 2: is sitting right here on top of these muscles. So
26:41
Speaker 2: when the muscles are tense, your bladder is feeling like
26:45
Speaker 2: there's something activating it. And so it's like, oh man,
26:48
Speaker 2: I got to pee. That means I have to pee.
26:49
Speaker 2: This tension is telling my bladder I have to pee,
26:51
Speaker 2: but it's really that your bladder is not that full.
26:53
Speaker 2: It's that these muscles are telling you to do that.
26:55
Speaker 2: You can also have trouble peeing because you can see
26:57
Speaker 2: that your urethra goes through here. And if the muscles
27:00
Speaker 2: are really tight, sometimes it can be difficult to urinate
27:02
Speaker 2: because it clenches off the pee. And then with sex,
27:06
Speaker 2: it can cause pain. If they're really tight, it can
27:08
Speaker 2: prevent blood from getting to the genital organs. So for men,
27:12
Speaker 2: they can have erectile dysfunction. For women, they can have
27:16
Speaker 2: difficulty getting orgasms or difficulty getting arousal because they're not
27:20
Speaker 2: getting blood flow to the clitoris. Sometimes it can also
27:22
Speaker 2: cause premature ejaculation in men. And so these muscles are
27:26
Speaker 2: so important. And all we hear about is Kegels. And
27:29
Speaker 2: Kegels are exercises to strengthen these muscles. But Kegels are
27:33
Speaker 2: good when you have a normal pelvic floor, meaning like
27:36
Speaker 2: there's no tension. It's completely normal. It's acting normal. You're
27:39
Speaker 2: not having any symptoms at all. But if you have
27:41
Speaker 2: any of the symptoms I talked about, doing Kegels might
27:43
Speaker 2: make it worse because you're now tightening muscles that are
27:46
Speaker 2: already tight. We also talk about pelvic floor relaxation, doing
27:50
Speaker 2: exercises to specifically relax these muscles. So that can be
27:54
Speaker 2: diaphragmatic breathing. That can be doing like a figure four stretch.
27:59
Speaker 2: That can be doing happy baby pose, which are yoga
28:02
Speaker 2: poses or child's pose. All these things can sort of
28:05
Speaker 2: stretch and lengthen these muscles so they can learn to
28:08
Speaker 2: relax again. Now, when it's really bad, you have to
28:11
Speaker 2: go see a pelvic floor physical therapist who can really
28:13
Speaker 2: work with you to identify which of the muscles are
28:15
Speaker 2: maybe more dysfunctional and maybe work specifically on those. But
28:19
Speaker 2: I think it's so important. It's under evaluated, under discussed
28:23
Speaker 2: when it comes to sexual function. It's a hugely important
28:26
Speaker 2: part of sexual function.
28:29
Speaker 1: How many people are struggling with these issues, specifically like
28:34
Speaker 1: erectile dysfunction issues? And what age are they?
28:37
Speaker 2: Yeah, so it starts early. I think there's always been
28:39
Speaker 2: a sort of a disconnect where we think young guys
28:42
Speaker 2: don't have this, or if they have it, it's all
28:44
Speaker 2: in their head. That's not necessarily true. Many young men
28:46
Speaker 2: do develop erectile dysfunction because of biologic factors, but the
28:51
Speaker 2: data is really robust on older guys. So above the
28:54
Speaker 2: age of 50, We see 52% of men having erectile dysfunction,
28:59
Speaker 2: which is half.
29:00
Speaker 1: 52% of men?
29:01
Speaker 2: And it goes up 10% every decade. So 60% of 60-year-olds,
29:05
Speaker 2: 70% of 70-year-olds. So erectile dysfunction continues to worsen. This
29:10
Speaker 2: happens because, one, our blood vessels get older. They get stiffer.
29:15
Speaker 2: They're not functioning as well as they should. And we're
29:18
Speaker 2: seeing also a rise in all these other comorbid conditions
29:21
Speaker 2: like diabetes, cholesterol, high blood pressure, all these affect how
29:24
Speaker 2: healthy your blood vessels are. And so with these, they
29:27
Speaker 2: see the problem in their penis or in women's case
29:31
Speaker 2: in their clitoris before they see heart disease or strokes
29:34
Speaker 2: or brain issues or dementia.
29:36
Speaker 1: I think this is worth pausing on, which is a
29:40
Speaker 1: dysfunction problem is often a symptom of a cardiovascular issue, right?
29:45
Speaker 2: Yeah, we call it a canary in a coal mine.
29:47
Speaker 2: So it is like telling you that something bad is coming.
29:50
Speaker 2: So the data would support that when you have erectile dysfunction,
29:54
Speaker 2: if it's because of an organic reason, right, not psychogenic,
29:57
Speaker 2: but most people I think have a combination of both,
30:00
Speaker 2: that within three to five years, you will start developing
30:03
Speaker 2: issues with your heart. And so it precedes those issues.
30:08
Speaker 2: And if seven years later, 14% of those guys will
30:12
Speaker 2: have a heart attack. And so it's really an opportunity.
30:15
Speaker 2: Sexual problems are an opportunity to look inside, to figure
30:20
Speaker 2: out what's going on and to investigate and to change
30:22
Speaker 2: your life.
30:23
Speaker 1: And when you say erectile dysfunction, we should probably define
30:26
Speaker 1: what that means because there's going to be a lot
30:27
Speaker 1: of guys at home now thinking, oh my God, like
30:30
Speaker 1: my penis is a bit softer than usual.
30:31
Speaker 2: Yeah. So erectile dysfunction is defined as the inability to
30:35
Speaker 2: maintain an erection that's sufficient for intercourse. So you can
30:40
Speaker 2: get an erection, but it goes away before you ejaculate
30:43
Speaker 2: or climax. And so that's typically, I think it's really
30:45
Speaker 2: important to differentiate that from something like premature ejaculation, where
30:49
Speaker 2: you climax too soon. So you ejaculate before you want to,
30:54
Speaker 2: but that doesn't mean that you have a problem maintaining
30:56
Speaker 2: your erection. That's a whole different process.
30:59
Speaker 1: I've got a friend. People are going to think I'm
31:01
Speaker 1: talking about myself because I use that phrase a lot.
31:03
Speaker 1: I've got a friend. He's almost 40 years old and
31:07
Speaker 1: I've heard him say on several occasions that that he's
31:10
Speaker 1: lost his erection during sex. Is that erectile dysfunction? But
31:14
Speaker 1: what if he can keep his erection watching porn?
31:18
Speaker 2: Well, so that's more multifactorial, right? So I think if
31:21
Speaker 2: you lose it once or twice, right, most guys will
31:23
Speaker 2: have an issue where they lose an erection at some
31:25
Speaker 2: point in their life. I think the important thing is
31:27
Speaker 2: not to catastrophize. It's a problem when it becomes a routine. Now,
31:31
Speaker 2: if someone is telling me, hey, I can watch porn
31:33
Speaker 2: and maintain my erection, but I can't with a partner,
31:36
Speaker 2: there's multiple different reasons for that that could be at play.
31:39
Speaker 2: One is that there's no pressure, right? You're by yourself.
31:42
Speaker 2: You're watching porn. There's no pressure of performance. There's no
31:45
Speaker 2: anxiety of performance. So that may be part of it.
31:48
Speaker 2: Other thing may be that that level of arousal that
31:50
Speaker 2: you're getting from porn, if you're watching, like, let's say
31:53
Speaker 2: the same kind of porn every time, you're masturbating the
31:55
Speaker 2: same way every time, maybe using a firm grip. Or
31:58
Speaker 2: some people will masturbate, like, facing the bed or, you know,
32:03
Speaker 2: against hard objects. And so that... Against hard objects. Yeah,
32:07
Speaker 2: like their fist or something. And so that can't be
32:11
Speaker 2: replicated by a person, right? You can't replicate those behaviors
32:15
Speaker 2: by a vagina or a mouth. If you become habituated
32:19
Speaker 2: to a certain thing that turns you on, and that's
32:23
Speaker 2: the only thing that really gets you going, and that's
32:25
Speaker 2: something that you can't really get with your partner, then
32:28
Speaker 2: it will be difficult to reach the level of arousal
32:30
Speaker 2: that you need to get an erection.
32:32
Speaker 1: Okay, so two questions then. So That doesn't count as
32:36
Speaker 1: erectile dysfunction if you can get an erection watching porn
32:39
Speaker 1: but can't get it with your partner.
32:40
Speaker 2: Yeah, it may or may not be. So if you
32:42
Speaker 2: wake up with your morning erection, that's great. That's a sign.
32:45
Speaker 2: That's when there's nothing else at play, right? You are just,
32:48
Speaker 2: that tells me that your body's functioning well. You've got
32:50
Speaker 2: good blood flow, good hormones working, got a good amount
32:53
Speaker 2: of testosterone and your nerves are working well and you're
32:56
Speaker 2: getting a good morning erection. Now, morning erections or nighttime
32:59
Speaker 2: erections are normal and they're healthy. So when you're a
33:02
Speaker 2: young boy, you get actually like erections three to five
33:06
Speaker 2: times a night and they can last up to 40
33:08
Speaker 2: minutes long. So you can spend a lot of your
33:10
Speaker 2: night with an erection. When you get older, like in
33:13
Speaker 2: your 40s, that drops to about half the time. So
33:16
Speaker 2: maybe erections are a little shorter. They maybe max out
33:18
Speaker 2: at 30 minutes, but sometimes they're shorter. You should still
33:21
Speaker 2: be getting three to five erections a night. You won't
33:23
Speaker 2: know all of these, but typically you wake up with
33:25
Speaker 2: a morning erection. And so if you're not getting morning erections,
33:28
Speaker 2: that tells me that, hey, there's something going on that
33:30
Speaker 2: we should address.
33:32
Speaker 1: And on your other point about how you masturbate impacting
33:35
Speaker 1: your sex life, I imagine that applies to men and women.
33:38
Speaker 2: Absolutely.
33:39
Speaker 1: And are you saying that if there's a particular way
33:42
Speaker 1: you get yourself off in private, that is very hard
33:45
Speaker 1: for the other person to replicate? You might become desensitized
33:48
Speaker 1: to that.
33:49
Speaker 2: You might just get habituated. I don't think desensitized, but
33:52
Speaker 2: habituated is like you might just, your body just might
33:54
Speaker 2: respond really well to that particular stimulation. Now that's not
33:58
Speaker 2: inherently a bad thing, right? If that's what gets you
34:01
Speaker 2: off and you and your partner are okay with you
34:03
Speaker 2: doing that together, right? You may mutually masturbate together and
34:06
Speaker 2: that's fun for you and you guys enjoy it. There's
34:09
Speaker 2: no problem with it. It's just knowing what's going on, right?
34:12
Speaker 2: And sort of deciding like, okay, if this is a problem,
34:14
Speaker 2: let me try to diversify what I do during my
34:17
Speaker 2: solo sex period. So let me take a little break
34:20
Speaker 2: and kind of try something, you know, just not masturbate
34:23
Speaker 2: for a little while and come back to it later.
34:25
Speaker 1: The fact that we get an erection in the morning,
34:27
Speaker 1: does that mean that we're supposed to have sex in
34:29
Speaker 1: the morning from like an evolutionary perspective?
34:31
Speaker 2: Not necessarily. It's just, it's the way your body releases
34:34
Speaker 2: testosterone is one of the reasons this happens is overnight
34:37
Speaker 2: your body is making more testosterone. That's when your body
34:40
Speaker 2: sort of has nocturnal testosterone production. And so it's highest
34:43
Speaker 2: in the morning, which is why very often you get
34:46
Speaker 2: a morning erection. And, you know, it just means that
34:49
Speaker 2: some people will have more desire also in the morning
34:52
Speaker 2: because testosterone is a hormone of desire.
34:55
Speaker 1: Is it the same for women?
34:56
Speaker 2: Yeah. So women also have nocturnal clitoral tumescence, same sort
35:02
Speaker 2: of pattern. And they won't necessarily know it, right, because
35:05
Speaker 2: they can't visualize it. But, you know, some women may
35:09
Speaker 2: sort of feel that pelvic congestion or like feeling that
35:12
Speaker 2: there's a bunch of like blood flow in the area.
35:14
Speaker 2: But most will not. And that's okay. But your body
35:17
Speaker 2: protects itself. So you've heard the term use it or
35:19
Speaker 2: lose it, right? People are like, your body's protecting itself.
35:22
Speaker 2: You don't have to have sex. If your body is healthy,
35:24
Speaker 2: it will do this all night to keep your genitals healthy.
35:28
Speaker 2: It will make sure that your genitals are getting blood flow,
35:30
Speaker 2: even if you're not having sex. But if you stop
35:33
Speaker 2: having those nighttime erections, now it becomes more of a problem.
35:38
Speaker 2: Because over time, say you stop having erections or clitoral
35:41
Speaker 2: tumescence for months, years, right? And then there's no blood
35:46
Speaker 2: flow to those areas. Over time, and actually I can
35:49
Speaker 2: show you here, this is a pelvic model. And here,
35:54
Speaker 2: this purple thing here is called the corpora cavernosa. And
35:57
Speaker 2: this is like a really nice spongy tissue that fills
36:01
Speaker 2: with blood. And when it fills with blood, it expands
36:03
Speaker 2: and lengthens. And then the blood stays there until you're
36:07
Speaker 2: done with your stimulation. And then it goes back. And
36:10
Speaker 2: so if there's no healthy, fresh blood getting to the
36:13
Speaker 2: penis on a regular basis, either through nighttime erections or
36:16
Speaker 2: through sex with your partner, then you will get fibrosis
36:20
Speaker 2: of these tissues. That means there's a little scar in
36:23
Speaker 2: the tissues. And then over time, you might see some
36:25
Speaker 2: shrinkage of the penis. And so it is really important
36:29
Speaker 2: to maintain also good health of these tissues. And the
36:31
Speaker 2: same goes for women with their clitoris because it's the
36:34
Speaker 2: same type of tissue. In fact, if you look at
36:36
Speaker 2: the clitoris, it is... This is the part that you see.
36:39
Speaker 2: We don't have a clitoris, do we?
36:41
Speaker 1: Is it that one there?
36:41
Speaker 2: This is the uterus. You're going to keep that in. Actually,
36:49
Speaker 2: I can show you here. This is crazy. Okay, yeah,
36:52
Speaker 2: this is good. This is good.
36:53
Speaker 1: That's a little... Yeah, okay. Okay. You're not.
37:10
Speaker 2: Going to live that one down.
37:11
Speaker 1: You asked the team where the clitoris was. Did you
37:14
Speaker 1: ask the team where the clitoris was?
37:16
Speaker 2: Well, I'm worried about who said that, too. Okay, so.
37:21
Speaker 2: So let's talk about the female anatomy. This is a
37:23
Speaker 2: pelvic model. And here you can see this is the vagina.
37:27
Speaker 2: This is the urethra where you pee from. This is
37:30
Speaker 2: your labia minora. And you can't see the labia majora,
37:33
Speaker 2: but they would be out here, right? So inner lips,
37:35
Speaker 2: outer lips. Now, this up here is your clitoral glands.
37:39
Speaker 2: So it's the same as the glands of the penis.
37:42
Speaker 2: And so this is all you see, right? It also
37:44
Speaker 2: has a little covering, which you can't see here. Just
37:46
Speaker 2: like men have foreskin, women have a clitoral hood that
37:49
Speaker 2: covers the head of the clitoris. And so when you
37:53
Speaker 2: look at the clitoris on the inside, which we can't
37:55
Speaker 2: see perfectly here, but I'm going to just take this up,
37:59
Speaker 2: it actually goes all the way back. like this. So
38:02
Speaker 2: if you were to feel from the vaginal side, it
38:05
Speaker 2: would be at the very top of the vagina going
38:08
Speaker 2: all the way back. These blue things are the clitoral
38:11
Speaker 2: bulbs here. And these are the legs of the clitoris
38:16
Speaker 2: here on the side. And so this is essentially, the
38:21
Speaker 2: homologue of the penis. So if I take the penis,
38:23
Speaker 2: we don't have a full model here.
38:25
Speaker 1: What does homologues mean?
38:27
Speaker 2: So homologues means that they're essentially the same structure. They're
38:30
Speaker 2: made from the same cells, but they're in the male
38:33
Speaker 2: and the female. So here you can see if this
38:36
Speaker 2: is your penis, this is what you see up to here.
38:39
Speaker 2: This is the bone. This is your fat up here.
38:41
Speaker 2: And then here it goes deep into the pelvis and
38:45
Speaker 2: And so here's your testicles, right? And so below the testicles,
38:48
Speaker 2: this area of the perineum, you also have penile tissue
38:52
Speaker 2: sort of that you can palpate from this side that's
38:55
Speaker 2: coming all the way down. And if you had sort
38:57
Speaker 2: of a 3D model, you'd see that it forks out
38:59
Speaker 2: just like the clitoris does.
39:00
Speaker 1: So does clitoral stimulation feel like stimulating someone's tip of
39:06
Speaker 1: their penis?
39:06
Speaker 2: Exactly. And so you could think if someone just stimulated
39:10
Speaker 2: the head of the penis, they... It would be fine.
39:13
Speaker 2: It would be nice, but it's probably better if you
39:15
Speaker 2: stimulate more of the clitoris or more of the penis.
39:18
Speaker 2: That's where you could stimulate, obviously, the external, the clitoris,
39:22
Speaker 2: but you can also stimulate from the inside. And some
39:24
Speaker 2: people are more responsive to that than others. What you
39:27
Speaker 2: hear of is like the G-spot or the G-zone.
39:30
Speaker 1: Right?
39:30
Speaker 2: And the G spot or G zone is if you
39:32
Speaker 2: were to go in the inside of the vagina at
39:35
Speaker 2: the top side, which I can't really stick this in here,
39:37
Speaker 2: but it would be about two centimeters in at the top.
39:40
Speaker 2: And that's because that's an area where there's a lot
39:42
Speaker 2: of nerves endings. One, you can palpate the clitoris basically
39:46
Speaker 2: throughout the entire anterior wall. But also there's the skeins glands,
39:50
Speaker 2: these glands that sit underneath the urethra, and they're the
39:53
Speaker 2: homologue of the male prostate. And so they're right there,
39:57
Speaker 2: and then the vagina is there. And so that's an
39:59
Speaker 2: area that can be very enjoyable to stimulate. It's not
40:02
Speaker 2: necessarily always going to lead to orgasm because some people
40:05
Speaker 2: have different sort of distance between the clitoral body and
40:10
Speaker 2: the vagina. So some people who have less distance may
40:13
Speaker 2: feel it better than some that don't. But ultimately, that's
40:17
Speaker 2: why that area is so sensitive for many women.
40:20
Speaker 1: On this point of morning erections, I was thinking, much
40:23
Speaker 1: of the reason why I've always been cautious of having
40:26
Speaker 1: sex in the morning or even like masturbating in the
40:28
Speaker 1: morning or anything like that is I'm worried that it
40:30
Speaker 1: will cause a dopamine crash, which will make me feel
40:32
Speaker 1: lazy and lethargic.
40:34
Speaker 2: Well, so when you think about what happens during an
40:36
Speaker 2: orgasm is you have this release of dopamine and then
40:40
Speaker 2: your prolactin goes up and sort of like everything calms down. Now,
40:45
Speaker 2: some people feel a sense of clarity. They call it
40:48
Speaker 2: post-not clarity, right? They feel clear. They feel like motivated
40:51
Speaker 2: to do stuff. They feel excited to go do something
40:54
Speaker 2: else and they sort of move on from what they're doing.
40:55
Speaker 2: There's some people who feel post-coital dysphoria. They actually feel
40:59
Speaker 2: sad or they feel depressed after the orgasm. And we
41:02
Speaker 2: don't know exactly why this happens, but it is because
41:05
Speaker 2: of this dramatic change in sort of neurochemical signaling in
41:09
Speaker 2: the brain. And for those people who have it, it
41:11
Speaker 2: can be days where they sort of like feel bad.
41:15
Speaker 2: It can be hours where they feel sad. And so
41:17
Speaker 2: it can be really traumatic.
41:19
Speaker 1: So pillar two, what's pillar two of the four pillars
41:22
Speaker 1: of men's sexual health?
41:23
Speaker 2: We talked about strength. Okay.
41:24
Speaker 1: So we did strength. We did fuel. What's pillar three?
41:28
Speaker 2: Pillar three is environment. So we can start with the
41:30
Speaker 2: easy stuff and that's stress, right? Everyone knows stress is bad,
41:33
Speaker 2: but I think the thing is people just think like,
41:36
Speaker 2: I'll deal with it. Everyone's stressed. It's normal to be stressed.
41:40
Speaker 2: If you are chronically stressed, that means your cortisol is
41:44
Speaker 2: raised all the time, which is dampening your testosterone, which
41:48
Speaker 2: is also keeping you in the sympathetic state. And you
41:50
Speaker 2: just cannot get in your mind space and in the
41:54
Speaker 2: nervous system place to actually have sex. So that's super important.
41:59
Speaker 2: And I think there's lots of different ways to alleviate stress.
42:02
Speaker 2: You've got to figure out what works for you. For
42:05
Speaker 2: some people, using a stress ball even just at work.
42:08
Speaker 2: And I think part of it, you can actually incorporate
42:10
Speaker 2: some intimacy. There's some evidence, the Gottmans have been on
42:12
Speaker 2: your podcast doing a 20-second hug. So standing with your
42:17
Speaker 2: partner or a loved one and hugging for 20 seconds
42:20
Speaker 2: on your own like independent gravity actually helps alleviate stress
42:25
Speaker 2: and break sort of a stress loop doing a six
42:27
Speaker 2: second kiss with your partner. And so it seems like
42:31
Speaker 2: six seconds, no big deal, but actually if you time it,
42:33
Speaker 2: it's like, Hmm, if I'm just doing a kiss and
42:34
Speaker 2: I'm not like, actually it's a little bit longer than normal.
42:37
Speaker 2: And so these sort of small things can help alleviate stress.
42:41
Speaker 2: Any type of movement can be really beneficial. The other
42:45
Speaker 2: thing is just having like interactions with people. And so
42:48
Speaker 2: that's where we're becoming more isolated. But even just like
42:50
Speaker 2: talking to the barista or talking to someone at the
42:53
Speaker 2: grocery store, this again tells your brain that you're in
42:56
Speaker 2: a safe space. Like you're talking to someone, you're having
42:58
Speaker 2: a normal social interaction. So, and then being creative. And
43:02
Speaker 2: we've been trying to work on this with our kids
43:05
Speaker 2: because there's so much external stimuli all the time, right?
43:08
Speaker 2: They want to play video games. They want to watch TV.
43:10
Speaker 2: They want to play sports, but we want them to
43:12
Speaker 2: be bored and be creative. Like come up with creative
43:14
Speaker 2: ideas to keep themselves interested and engaged in a different way.
43:19
Speaker 2: So I think that's so, so important. And outside of stress, sleep,
43:24
Speaker 2: there's just so much abundance of data on how sleep
43:27
Speaker 2: affects hormonal health. They looked at data on men sleeping
43:30
Speaker 2: five hours a night versus eight hours a night. So
43:33
Speaker 2: you take the same guy and he sleeps eight hours
43:35
Speaker 2: and you do five hours for a few days. His
43:38
Speaker 2: test for a week, his testosterone drops by 15%. That's
43:42
Speaker 2: like as much testosterone drop as would happen with 10
43:45
Speaker 2: years of life.
43:46
Speaker 1: And do you know how long they did that for?
43:48
Speaker 2: It was short. It was like a week. So a
43:49
Speaker 2: week of sleep deprivation will tank your testosterone. And sleep
43:54
Speaker 2: apnea is another one that I think people, one, don't
43:57
Speaker 2: realize they have, and two, don't realize that fixing it
44:00
Speaker 2: could actually improve their hormonal health.
44:02
Speaker 1: Wait, so does this mean that people who have chronically
44:04
Speaker 1: bad sleep probably have low testosterone?
44:06
Speaker 2: Probably, yeah.
44:07
Speaker 1: And what is the symptoms of low testosterone?
44:10
Speaker 2: So low testosterone, they're sometimes very vague. So it can
44:13
Speaker 2: be fatigue. It can be brain fog. It can be depression.
44:18
Speaker 2: It can be low desire. It can be erectile dysfunction.
44:21
Speaker 2: That's what people always think. It's just erectile dysfunction, but
44:23
Speaker 2: it's this whole constellation of symptoms. It can also be
44:26
Speaker 2: increased fat mass, decreased muscle mass. So all of these
44:30
Speaker 2: things can happen because we have testosterone receptors all over
44:33
Speaker 2: our body. We have them in our brain. We have
44:34
Speaker 2: them in our muscle. We have them in our bone.
44:37
Speaker 2: And these can all have really serious consequences. When it's low.
44:40
Speaker 2: When you have sleep apnea and how you know you
44:42
Speaker 2: have sleep apnea is your partner might tell you that
44:45
Speaker 2: you're like waking up in the middle of the night
44:47
Speaker 2: gasping for air. If you have one really easy way
44:50
Speaker 2: to check is take a measuring tape and measure your
44:53
Speaker 2: neck circumference. If it's more than 17 inches for a
44:56
Speaker 2: guy or 16 inches for a female, it means it's
44:59
Speaker 2: very likely that you may have sleep apnea. And that's
45:02
Speaker 2: because when you have excess mass, basically here, it's compressing
45:05
Speaker 2: your airway and can make it difficult to get air
45:08
Speaker 2: into your into your body. When you improve sleep apnea,
45:12
Speaker 2: we've seen improvements in testosterone as high as 200 nanograms
45:15
Speaker 2: per deciliter. So huge jumps in testosterone after fixing sleep apnea.
45:20
Speaker 2: And the same goes for other sleep disorders, although the
45:22
Speaker 2: data is not as abundant, but sleep is so important.
45:27
Speaker 2: Then we talk about what's in your environment. So you
45:33
Speaker 2: get a bottle of water, So many of my patients actually,
45:36
Speaker 2: they only buy cases of plastic bottled water. Once in
45:39
Speaker 2: a while, a plastic bottle of water, don't stress yourself out.
45:42
Speaker 2: This goes back to stress. People get really stressed. What's
45:45
Speaker 2: in my environment? What am I drinking? What am I eating?
45:48
Speaker 2: Do what you can control. So plastic water bottles have
45:52
Speaker 2: things like phthalates and BPAs, which can affect hormonal health.
45:56
Speaker 2: They can mimic estrogen. They can reduce the production of
46:00
Speaker 2: testosterone based on these mechanisms. Also things like plastics in
46:05
Speaker 2: the environment, PFAS, so those things like nonstick cookware, all
46:09
Speaker 2: those things can affect hormone health. Now, how do you
46:12
Speaker 2: sort of protect yourself, right? I tell people, again, don't stress.
46:15
Speaker 2: There's only so much you can control. So I love
46:18
Speaker 2: that we're not drinking out of plastic. If you have
46:21
Speaker 2: to drink out of plastic because you're at an event
46:24
Speaker 2: or whatever, try to make sure it's not a a
46:27
Speaker 2: warm bottle. So it hasn't been like sitting in the
46:29
Speaker 2: sun for hours and hours and hours because as it
46:32
Speaker 2: gets warm, it releases more microplastics and more chemicals into
46:35
Speaker 2: the water. When you're eating food, if you are eating
46:38
Speaker 2: out of, say you get takeout, put it on a
46:40
Speaker 2: plate and warm it up. Don't ever warm up that plastic.
46:43
Speaker 2: And when you store food in the fridge, put it
46:45
Speaker 2: in a glass container or a metal container, but don't
46:48
Speaker 2: ever leave the food in the plastic and put it
46:50
Speaker 2: in the fridge. These are simple things you can control.
46:53
Speaker 2: You could also limit sort of your exposure to dust
46:55
Speaker 2: because dust has microplastics. You can try to wear more
46:59
Speaker 2: cotton fabrics, less synthetic fabrics because they shed less microplastics.
47:04
Speaker 2: But again, I think do what you can do, but
47:06
Speaker 2: don't let the stress of these chemicals derail you because
47:10
Speaker 2: stress is not helping either.
47:11
Speaker 1: And how much of a difference does, you know, microplastics
47:16
Speaker 1: make on my hormonal health? Is it really a big,
47:18
Speaker 1: big deal?
47:19
Speaker 2: Well, I think it depends. It's all dose dependent, right?
47:21
Speaker 2: So we're all exposed. Like if you look at the data,
47:24
Speaker 2: like people are consuming quite a bit of microplastics and
47:27
Speaker 2: we're seeing them actually even in testicles and penis tissue samples,
47:31
Speaker 2: like they're in our bodies. And so I think that
47:35
Speaker 2: it's definitely playing a role how much we don't know yet.
47:38
Speaker 2: We just know that there are mechanisms and we know
47:39
Speaker 2: that they do affect hormonal health. And so do the
47:43
Speaker 2: best you can.
47:44
Speaker 1: Do you and your family drink out of plastic bottles?
47:46
Speaker 2: No, we drink, we have like metal water bottles for
47:49
Speaker 2: the kids and myself.
47:50
Speaker 1: What about nonstick pans?
47:52
Speaker 2: We buy ceramic. We do our best to like avoid
47:55
Speaker 2: those as much as possible. So the other thing is
47:57
Speaker 2: the company you keep. I think we don't talk about
48:00
Speaker 2: this enough when we talk about it in terms of business.
48:02
Speaker 2: Like you want to keep people who are successful around you.
48:04
Speaker 2: You want to keep people who can help you. But
48:06
Speaker 2: it also plays a role in your sexual environment, right?
48:09
Speaker 2: So my husband is in these groups with a bunch
48:10
Speaker 2: of other male physicians, right? And there's a lot of
48:13
Speaker 2: discussion about how they never have sex anymore. And they're
48:16
Speaker 2: all just like, oh yeah, this is just like normal.
48:18
Speaker 2: Like we're getting older. Our partners don't want to have sex.
48:20
Speaker 2: It's so frustrating. And there's a lot of discussion about this.
48:23
Speaker 2: And it's almost like, oh, that's okay. Like that's just normal, right?
48:27
Speaker 2: They're normalizing this experience where that sex has not become
48:31
Speaker 2: a priority because life is so stressful. Things are so crazy.
48:34
Speaker 2: Maybe you're having relationship discord. So it absolutely plays a role.
48:37
Speaker 2: And there's actually... some evidence that it may help you
48:40
Speaker 2: make better choices. So there's one study where they looked at,
48:43
Speaker 2: I think it was like 50,000 people. And they did
48:47
Speaker 2: an intervention where they tried to encourage these people to
48:51
Speaker 2: surround themselves with positive influences that were like, have safe
48:54
Speaker 2: sex and avoid negative influences. And they saw that these
48:58
Speaker 2: people had an increase in like sexual positive behavior. So
49:02
Speaker 2: like safe sex practices by 46%. So just by changing
49:07
Speaker 2: who they spent their time with, they saw this major
49:10
Speaker 2: difference in how they approached their sex lives.
49:13
Speaker 1: Okay, so if your friends are very pessimistic about sex
49:15
Speaker 1: and they're not having and they're complaining about it, that's
49:18
Speaker 1: going to become sort of contagious.
49:20
Speaker 2: Yeah. And I think it extrapolates to everything. What kind
49:23
Speaker 2: of relationships you're in? How do they view their relationship
49:27
Speaker 2: with their partner? Is it a priority? Do they make
49:29
Speaker 2: it a priority, right? Or are they just busy doing
49:31
Speaker 2: their own thing and they're just like living in parallel lives?
49:34
Speaker 2: They're doing their own thing. You're doing your own thing.
49:36
Speaker 2: You never really spend time with your partner. And then
49:38
Speaker 2: when you go hang out with your friends, you're like,
49:40
Speaker 2: oh God, I'm so glad to get away. And you're
49:42
Speaker 2: not like talking about how much you enjoy your partner.
49:45
Speaker 2: People tend to talk negatively, right? They want to like
49:48
Speaker 2: sort of like vent. And so when you have people
49:50
Speaker 2: who don't make that a part of their lives, it
49:52
Speaker 2: also affects you. They value their partner and they talk
49:55
Speaker 2: about them in a positive way. that's a great thing
49:58
Speaker 2: to say like, okay, this is the right kind of
49:59
Speaker 2: person I want because I want to value my partner too.
50:03
Speaker 2: And I don't want that to rub off on me
50:04
Speaker 2: because it absolutely does.
50:06
Speaker 1: And the other thing you said in this category of
50:07
Speaker 1: environmental stuff is things like pornography consumption. Is it possible
50:11
Speaker 1: to consume too much porn?
50:12
Speaker 2: So it's not the amount of porn that you watch.
50:15
Speaker 2: It is the sort of the way you feel about it.
50:18
Speaker 2: Many people watch porn for a variety of different reasons.
50:20
Speaker 2: Most often it's for pleasure and enjoyment, but there's some
50:23
Speaker 2: people who watch porn because they want to experience get
50:26
Speaker 2: away from negative feelings, right? This is giving them dopamine
50:29
Speaker 2: and they're using it as a way to just feel
50:31
Speaker 2: better in the moment. And so that can become a
50:35
Speaker 2: compulsion where they're watching porn and it's like giving them
50:37
Speaker 2: these positive feelings and they feel negative in life and
50:39
Speaker 2: they're going back to porn to sort of, again, have
50:41
Speaker 2: that compulsion to watch porn again. But that's a small
50:45
Speaker 2: subset of people. The other thing is that there's a
50:47
Speaker 2: lot of negative discussion around porn, right? People are like,
50:50
Speaker 2: porn is bad, it's dangerous, it's evil. And I think
50:54
Speaker 2: it's more nuanced than that. But if you feel that
50:57
Speaker 2: porn is bad, every time you watch porn, you feel negative,
51:00
Speaker 2: you feel bad about yourself. That's where we see people
51:03
Speaker 2: having the most dysfunction associated with it because they feel guilty.
51:06
Speaker 2: They could watch it once a year and they could
51:08
Speaker 2: feel super guilty about it and it could affect their
51:10
Speaker 2: sexual function. They could see themselves as a bad person.
51:13
Speaker 2: They could see themselves as, wrong or immoral. And that's
51:16
Speaker 2: really when it becomes an issue. If you are finding
51:19
Speaker 2: yourself either compulsively watching pornography and using it as a scapegoat,
51:24
Speaker 2: maybe time to reevaluate. Say, why am I doing this?
51:26
Speaker 2: How can I switch this out for something else that
51:29
Speaker 2: makes me feel better that might be healthy, like exercise
51:31
Speaker 2: or going for walks or whatever that may be. And
51:34
Speaker 2: then if it's something that's really making you feel like
51:38
Speaker 2: bad or guilty because maybe that's how you were raised.
51:40
Speaker 2: Maybe that's what you feel about morality. Then yeah, maybe
51:43
Speaker 2: like you either need to work through that because porn
51:46
Speaker 2: is maybe something that you still want to watch at
51:48
Speaker 2: times or you need to abstain. But usually those are,
51:51
Speaker 2: it's very difficult to abstain for most people to abstain
51:54
Speaker 2: for prolonged periods of time. So I think it's something
51:56
Speaker 2: you have to work through if you find yourself having
51:58
Speaker 2: these sort of feelings about pornography or you're compulsively watching it.
52:03
Speaker 2: But for most people, it's adults, for most adults, It
52:06
Speaker 2: is fantasy. It's a place where you can experience, see
52:11
Speaker 2: things that you may never do in real life that
52:13
Speaker 2: may be enjoyable, that are fun to watch, that are
52:15
Speaker 2: ready to feel arousal. We see that when couples watch
52:19
Speaker 2: porn together, they are more likely to be more satisfied
52:21
Speaker 2: in their relationship. And when there's a discord, like one
52:24
Speaker 2: person really doesn't like it or doesn't use it and
52:26
Speaker 2: the other one uses it a lot, that's where we
52:28
Speaker 2: see the problem.
52:29
Speaker 1: Is porn consumption going to impact my intimacy with my partner?
52:35
Speaker 2: So it depends. I think a lot of people watch
52:37
Speaker 2: it without an issue, right?
52:38
Speaker 1: Because if I masturbate and I ejaculate, I'm not going
52:42
Speaker 1: to then be able to ejaculate very quickly necessarily with
52:45
Speaker 1: my partner.
52:45
Speaker 2: Yeah, so obviously there's a refractory period after you ejaculate. Now,
52:50
Speaker 2: when you're younger, that refractory period could be minutes. And
52:53
Speaker 2: when you're older, that can be a day and a half.
52:56
Speaker 2: And so we see that some people may struggle, especially
52:59
Speaker 2: if they're watching a lot of porn every single day,
53:02
Speaker 2: and their refractory period is maybe a day, then they
53:04
Speaker 2: may actually really have trouble ejaculating with their partner because
53:08
Speaker 2: they've not given themselves that time.
53:11
Speaker 1: This has had probably the single biggest impact on my office.
53:15
Speaker 1: Of all the products that I've tried that have given
53:17
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53:21
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54:13
Speaker 1: One of the smartest things a business can do is
54:15
Speaker 1: build like a bigger company without actually hiring like one.
54:19
Speaker 1: But the problem we all face is that most companies
54:21
Speaker 1: don't have every skill in house. So when I look
54:24
Speaker 1: at the businesses seeing real success today, The consistent pattern
54:27
Speaker 1: with all of them is how quickly they move. They
54:30
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54:32
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54:35
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55:02
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55:08
Speaker 1: business's gaps. That's pro.fiverr.com. And the last one, the last
55:13
Speaker 1: of the four pillars.
55:14
Speaker 2: The last of the four pillars we talked a little
55:15
Speaker 2: bit about, it's called confidence. And confidence is not like
55:19
Speaker 2: strutting around like a peacock, like I know what I'm doing.
55:22
Speaker 2: It's confidence in knowledge. and curiosity. So knowledge we talked
55:26
Speaker 2: about a little bit, understanding female anatomy, like how do
55:29
Speaker 2: female bodies get aroused, right? What makes them aroused? Where
55:32
Speaker 2: is the clitoris knowing some anatomy? And two, actually talking
55:36
Speaker 2: to your partner or paying attention to their cues. For
55:39
Speaker 2: some reason with sex, it's the only time that we
55:42
Speaker 2: just expect people to be mind readers. We just want
55:44
Speaker 2: you to know what I like and just go for it, right?
55:46
Speaker 2: And then when it's not good, you're like, well, you
55:48
Speaker 2: just don't know what you're doing. And it's like, it's
55:51
Speaker 2: wild to me that we actually never got taught how
55:54
Speaker 2: to talk about sex, how to bring it up with
55:56
Speaker 2: a partner, how to just explore and have fun with sex,
56:00
Speaker 2: maybe add a toy to the bedroom. So there's lots
56:03
Speaker 2: of different types of toys. This is a vulva stimulator.
56:07
Speaker 2: So you put this on the outside so you can
56:08
Speaker 2: see that it would, in theory, this was smaller, would
56:12
Speaker 2: stimulate the clitoris on the outside. It also can change
56:16
Speaker 2: in shape. It'll vibrate, right? It'll have different stimulations that
56:21
Speaker 2: you can play around with and decide what you enjoy.
56:23
Speaker 1: So this one's run out of battery.
56:28
Speaker 2: They're brand new. They've not been used.
56:30
Speaker 1: I didn't say they had been. Very defensive there. So
56:33
Speaker 1: if my pinky finger, if my finger here is the clitoris,
56:36
Speaker 1: I put it on like that. Yeah. And then it vibrates.
56:40
Speaker 2: Correct.
56:41
Speaker 1: And then the penis goes through the hole.
56:43
Speaker 2: And there's another version of that. This is basically... This
56:48
Speaker 2: is basically like the hole goes around the penis.
56:51
Speaker 1: And that goes in.
56:52
Speaker 2: And that can go in and stimulate and vibrate. So
56:55
Speaker 2: you both feel the vibration and you both feel the stimulation.
56:57
Speaker 1: I remember I was with her partner and she felt
57:01
Speaker 1: that sex toys were for older people.
57:03
Speaker 2: Old people.
57:04
Speaker 1: Specifically what she said. And she was kind of against
57:07
Speaker 1: the use of them. I've always been down. I think
57:10
Speaker 1: it adds novelty and it's exciting and it just adds
57:12
Speaker 1: something new. But she felt like it was... Almost like
57:16
Speaker 1: giving up.
57:17
Speaker 2: Well, I mean, look, I think, I wonder why. I would,
57:19
Speaker 2: I would, if I, she was here, I'd ask her,
57:21
Speaker 2: why do you think that? What belief system do you
57:23
Speaker 2: have that's making you think that this is like not
57:26
Speaker 2: a good thing to use, right? We use technology in
57:28
Speaker 2: so many places in our lives, right? So why not
57:31
Speaker 2: introduce it in our sex lives?
57:33
Speaker 1: Are you going to become reliant on it though? Because
57:34
Speaker 1: it doesn't make it easier to get off with a
57:36
Speaker 1: sex toy.
57:37
Speaker 2: So they've actually looked at vibration and can you get
57:40
Speaker 2: desensitized to it? And the way they've looked at it
57:42
Speaker 2: is actually like construction workers where they're using those like
57:45
Speaker 2: vibration tools, right? And seeing if like their hands get desensitized.
57:50
Speaker 2: And what they've seen is yes, for a short period
57:51
Speaker 2: of time, they do lose a little bit of sensation
57:54
Speaker 2: on their fingertips, but then it restores back to normal.
57:57
Speaker 2: And so it's not that you're going to become desensitized forever, right?
58:01
Speaker 2: I think you brought up a great point with just
58:02
Speaker 2: adding novelty. Now, I think when I say novelty, people
58:05
Speaker 2: are like, oh my God, I need to role play
58:08
Speaker 2: in a different way or bring like some sort of
58:11
Speaker 2: BDSM or whatever into my sex life. And that's not
58:14
Speaker 2: exactly true. So when you think about sex, right, it's
58:17
Speaker 2: just like eating your favorite ice cream. Maybe you have
58:20
Speaker 2: vanilla ice cream, you know, three times a week and
58:22
Speaker 2: you enjoy it. But if you start having vanilla ice
58:24
Speaker 2: cream every single day, you're kind of bored with it, right? Right.
58:27
Speaker 2: And the same goes for sex. Now, having routine in sex,
58:30
Speaker 2: knowing what you like, knowing what your partner likes, it
58:33
Speaker 2: can be very helpful. But it also is nice to
58:37
Speaker 2: add novelty. So if you think about, we could extrapolate
58:40
Speaker 2: from the flow state. So when you are in a
58:42
Speaker 2: flow state for work, right, things feel really almost effortless
58:46
Speaker 2: and you're just like in a zone. You can also
58:48
Speaker 2: get into a sexual flow state. When you look at
58:50
Speaker 2: the flow state, yeah, you need things to be slightly
58:52
Speaker 2: challenging to get into the flow state. They can't be easy.
58:55
Speaker 2: And they can't be so hard that you're going to
58:57
Speaker 2: get frustrated, right? And so you need to add a
59:00
Speaker 2: slight challenge to your sexual encounter to get into that
59:03
Speaker 2: flow state. And that's when you start having really great
59:07
Speaker 2: sex because you're totally immersed. you're feeling great, and it's
59:11
Speaker 2: super fun. So I think that's another part of being
59:15
Speaker 2: confident is being able to and confident to try new
59:17
Speaker 2: things and explore new things. And it can be as
59:20
Speaker 2: simple as doing it in a different room or maybe
59:22
Speaker 2: getting a pillow or switching where your head position is.
59:26
Speaker 2: Like it can be so small, but it can just
59:29
Speaker 2: add a little bit of uniqueness and novelty and challenge.
59:32
Speaker 1: Are there certain positions that are going to increase the
59:36
Speaker 1: probability that my partner has an orgasm? Yeah.
59:39
Speaker 2: So typically when the female partner is on top, she
59:42
Speaker 2: has more control over where she's getting stimulation to the
59:47
Speaker 2: clitoris because she can angle her body in such a way.
59:49
Speaker 2: So oftentimes that shows that has higher orgasm rates. There's
59:54
Speaker 2: actually like this technique called the coital alignment technique, where
59:59
Speaker 2: you sort of move in a rocking motion so that
1:00:05
Speaker 2: your pubic symphysis, so this bone right here, is sort
1:00:09
Speaker 2: of like rubbing against their clitoris, like this area, the
1:00:12
Speaker 2: skin here is rubbing against the clitoris while you're penetrating.
1:00:16
Speaker 2: And that has been shown to increase orgasm rate and
1:00:19
Speaker 2: pleasure So really it's about figuring out and trying different
1:00:23
Speaker 2: things and realizing like that, for example, that coil alignment
1:00:25
Speaker 2: technique is sort of difficult. Like it's not that easy
1:00:27
Speaker 2: and intuitive. And so you have to sort of play
1:00:29
Speaker 2: around with it and figure out like what is going
1:00:31
Speaker 2: to work best. And yeah, realizing it might not work.
1:00:35
Speaker 2: You might be like super awkward and be like, okay,
1:00:36
Speaker 2: like that's okay. Like it's not the end of the
1:00:38
Speaker 2: world if sex is not perfect every time because we're
1:00:41
Speaker 2: learning and we're playing and we're having fun. And so
1:00:43
Speaker 2: I think that's really the key is like not letting
1:00:45
Speaker 2: yourself get so frustrated if something doesn't go exactly the
1:00:49
Speaker 2: way you envision it in your head.
1:00:50
Speaker 1: I used to think that a woman orgasming was when,
1:00:53
Speaker 1: this was when I was younger, was when she squirted.
1:00:55
Speaker 1: So that's what I thought it was. I thought an
1:00:58
Speaker 1: orgasm was squirting.
1:00:59
Speaker 2: Yeah, well, you're probably not the only one to think that.
1:01:02
Speaker 2: And so squirting, not every woman squirts. So about 40%
1:01:05
Speaker 2: of women squirt. Squirting is the emission of fluid at
1:01:08
Speaker 2: the time of orgasm. Usually it's clear, colorless, and it
1:01:11
Speaker 2: can be quite voluminous. It's coming from the urethra, which
1:01:15
Speaker 2: is the pee hole essentially. And remember I talked about
1:01:18
Speaker 2: those Skeen's glands. Those Skeen's glands are the homolog of
1:01:22
Speaker 2: the male prostate and they have a little bit of
1:01:24
Speaker 2: fluid in them too. Typically... when you have stimulation and squirting,
1:01:30
Speaker 2: they will release fluid from the bladder as well as
1:01:33
Speaker 2: the skin's glands that combines together and it's emitted through that.
1:01:37
Speaker 1: So it's not pee?
1:01:39
Speaker 2: The way they describe it, and there's been a lot
1:01:40
Speaker 2: of research on this. So there's people who say it's pee,
1:01:42
Speaker 2: there's people who say it's not. There's a couple of studies.
1:01:45
Speaker 2: So one is they put dye into the bladder and
1:01:48
Speaker 2: they took women who said they were squirters and they
1:01:51
Speaker 2: had them orgasm and they saw, is there dye in
1:01:54
Speaker 2: the bladder? fluid. And yeah, there was dying fluid. So
1:01:58
Speaker 2: it has to come from the bladder. The Skene's glands
1:02:00
Speaker 2: only hold a small amount, but it's chemically different. It's
1:02:04
Speaker 2: usually clear, odorless. It doesn't smell like pee. And so
1:02:07
Speaker 2: there's some theories as to why that might be. It
1:02:10
Speaker 2: may be that when you're having sex, there's different hormonal
1:02:14
Speaker 2: signals that change the concentration of what's filtering through your
1:02:16
Speaker 2: kidneys so that it is a little bit different in composition.
1:02:20
Speaker 2: There's some theories that when there's more estrogen around that
1:02:22
Speaker 2: it may change. There may be some like... fluid filling
1:02:26
Speaker 2: in the actual interstitia of the organs. Again, it's hard
1:02:29
Speaker 2: to say, but it's absolutely coming from the urethra, which
1:02:32
Speaker 2: is connected to the bladder, as well as the Steen's glands.
1:02:35
Speaker 2: But I think this whole discussion about what it is,
1:02:37
Speaker 2: it doesn't matter. Is it pleasurable? Are you enjoying it?
1:02:41
Speaker 1: Great.
1:02:42
Speaker 2: If you squirt and you enjoy it, great. If you don't,
1:02:44
Speaker 2: that doesn't mean that there's something wrong and that your
1:02:46
Speaker 2: partner hasn't orgasmed. The way to figure out if your
1:02:49
Speaker 2: partner orgasmed is you ask her, right? Either she tells
1:02:51
Speaker 2: you or you ask her. And sometimes it's obvious and
1:02:54
Speaker 2: sometimes it's not, but you sort of figure it out.
1:02:58
Speaker 1: There's three theories that emerged in my research about why
1:03:01
Speaker 1: women squirt from an evolutionary perspective. The first was that,
1:03:05
Speaker 1: and these are just theories, they're not proven, of course,
1:03:07
Speaker 1: The first is that squirting contains PSA and zinc, which
1:03:11
Speaker 1: are naturally antibacterial. And ejaculating these fluids during or after
1:03:15
Speaker 1: sex may have evolved to flush the urethra and prevent UTIs.
1:03:19
Speaker 1: The logic being in a pre-antibiotic world, a woman who
1:03:22
Speaker 1: could flush bacteria out of her system after mating was
1:03:24
Speaker 1: more likely to stay healthy and reproduce. That's one theory.
1:03:27
Speaker 1: The other is.
1:03:27
Speaker 2: Well, before you go, I want to talk about that
1:03:28
Speaker 2: really quickly. So that's a really interesting theory. So one,
1:03:31
Speaker 2: the reason they emit PSA is because skin's glands are
1:03:35
Speaker 2: the homologue of the prostate. So the prostate makes PSA,
1:03:39
Speaker 2: which is prostate specific antigen.
1:03:41
Speaker 1: So at this point, this word homologue again.
1:03:42
Speaker 2: Yeah. So basically the prostate in the male, the same
1:03:46
Speaker 2: tissue when they're an embryo becomes a prostate in the
1:03:48
Speaker 2: male and becomes a skin's glands in the female. So
1:03:50
Speaker 2: that's why it's emitting PSA. That is an interesting theory
1:03:53
Speaker 2: because there are a subset of women who get UTIs
1:03:56
Speaker 2: after sex. Not everybody. But some do. And it's not
1:04:00
Speaker 2: because of the ejaculate or because of the male harboring
1:04:04
Speaker 2: some bacteria. It's because of the actual thrusting of the penis.
1:04:08
Speaker 2: It's taking bacteria from the outside and making it more
1:04:10
Speaker 2: easy for it to go through the urethra into the bladder.
1:04:12
Speaker 2: And women have a short urethra. And so I want
1:04:15
Speaker 2: just to debunk that myth that it's like you're getting
1:04:18
Speaker 2: it from your partner or there's something wrong with you.
1:04:20
Speaker 2: It is literally just anatomy. And so some women do
1:04:23
Speaker 2: get more UTIs after sex. And so that is an
1:04:26
Speaker 2: interesting theory because maybe that's true. I don't know.
1:04:28
Speaker 1: The second theory was in ancient ancestors, the hormonal surge
1:04:31
Speaker 1: during orgasm and ejaculation actually triggered the release of an egg.
1:04:35
Speaker 1: Humans evolved to ovulate on a cycle now, but we
1:04:38
Speaker 1: kept the plumbing and the neurohormonal reflex. It's a happy
1:04:41
Speaker 1: accident of biological vestige that no longer serves its original
1:04:44
Speaker 1: reproductive purpose, but remains because it isn't harmful for survival. Interesting.
1:04:49
Speaker 2: I mean, there is some thought that maybe orgasming... spasm, orgasm,
1:04:55
Speaker 2: help with fertility, but it's not really robust.
1:04:59
Speaker 1: And the last one kind of matches what you just
1:05:00
Speaker 1: said there, which is the mate selection theory. The intense
1:05:03
Speaker 1: pleasure and psychological response of squirting or orgasm act as
1:05:07
Speaker 1: a reward system. It incentivizes women to seek out specific
1:05:10
Speaker 1: partners who provide high levels of stimulation, potentially signaling a
1:05:13
Speaker 1: better genetic compatibility or a more attentive male, which would
1:05:18
Speaker 1: help with the survival of offspring. Maybe.
1:05:21
Speaker 2: That makes sense.
1:05:22
Speaker 1: 40% of women squirt.
1:05:25
Speaker 2: Yeah. So the other thing is, obviously a lot of
1:05:27
Speaker 2: sex is focused on genitals, but there's a whole body
1:05:30
Speaker 2: of erogenous zones, right? Almost your entire body can be
1:05:35
Speaker 2: an erogenous zone. We talked a little bit about it
1:05:36
Speaker 2: when we talked about sensate focus, right? You can explore,
1:05:39
Speaker 2: you can find areas that people find erogenous. So when
1:05:43
Speaker 2: you looked at data, necks, nipples, lips... buttocks, inner thighs,
1:05:49
Speaker 2: all these areas are considered erogenous by most people, regardless
1:05:53
Speaker 2: of their sexual orientation, regardless of their cultural upbringing, it
1:05:57
Speaker 2: seems to be pretty universal. There's actually a famous paper
1:06:00
Speaker 2: about non-genital orgasms and like how people orgasm without any
1:06:05
Speaker 2: genital stimulation. So lip orgasms, anal sex orgasms.
1:06:09
Speaker 1: Is that possible?
1:06:10
Speaker 2: Yeah, it's been documented. Absolutely. And so it's nipple orgasms.
1:06:15
Speaker 2: There's a whole variety of ways. Even like women have
1:06:17
Speaker 2: had orgasms during childbirth. There have been these documented ways
1:06:22
Speaker 2: to orgasm. And it's because these areas can be very erogenous.
1:06:25
Speaker 2: And sometimes stimulating multiple areas can like add more erogenous interest.
1:06:30
Speaker 2: And that's why you see people like maybe in the
1:06:32
Speaker 2: BDSM community, they'll be using nipple clamps while they're doing
1:06:37
Speaker 2: other things, right? So there's a whole bunch of areas
1:06:39
Speaker 2: that are erogenous. And most of the times people are
1:06:42
Speaker 2: not really spending much time on foreplay or stimulating these
1:06:47
Speaker 2: erogenous zones as much as they should, right? You have
1:06:49
Speaker 2: a whole body to play with. And how do you
1:06:52
Speaker 2: stimulate them? There's actually evidence behind that. So on your
1:06:54
Speaker 2: skin- We have these special fibers called C-tactile afferents. When
1:06:59
Speaker 2: you stimulate these fibers, they help you feel pleasure, enjoyment,
1:07:03
Speaker 2: those sorts of things. And so there was a study
1:07:05
Speaker 2: where they took 19 couples, a small study, it was
1:07:07
Speaker 2: not a London, and they basically told them to stimulate
1:07:11
Speaker 2: an erogenous zone and a non-erogenous zone, the non-erogenous zone
1:07:14
Speaker 2: being the forehead. And so they had the couple stimulated
1:07:16
Speaker 2: and they told them stimulated at levels of 18 centimeters
1:07:19
Speaker 2: per second in terms of how fast you're caressing the
1:07:23
Speaker 2: arm or body part. and at three centimeters per second.
1:07:27
Speaker 2: And what they found was those who stimulated at three
1:07:29
Speaker 2: centimeters per second had more sexual arousal, had more pleasant
1:07:34
Speaker 2: stimulation compared to those who were stimulating at 18 centimeters
1:07:37
Speaker 2: per second. Now this makes sense because those C-tactile afferent
1:07:40
Speaker 2: fibers respond very well to that slow, gentle caress. The
1:07:46
Speaker 2: other interesting thing is that these fibers are only responsive
1:07:50
Speaker 2: to human touch. So if I take a glove and
1:07:52
Speaker 2: I put it on my hand and I touch you,
1:07:54
Speaker 2: It still doesn't work.
1:07:56
Speaker 1: That's so interesting because in Los Angeles, where we are now,
1:07:59
Speaker 1: we were viewing an office and we were walking down
1:08:01
Speaker 1: the street to see what the neighborhood was like. And
1:08:03
Speaker 1: we walked past one place and it is a robot
1:08:07
Speaker 1: massage parlor. And I always thought, great. Like, well, part
1:08:11
Speaker 1: of me thought, maybe my prefrontal cortex thought, oh, great
1:08:14
Speaker 1: idea because, you know, you can get massages whenever you want.
1:08:17
Speaker 1: It's going to be cheap. You maybe can have one
1:08:18
Speaker 1: in your home. But then the other part of me,
1:08:20
Speaker 1: as I saw it, thought, actually, I don't actually think
1:08:21
Speaker 1: that's why I get massages. I think there's something about
1:08:24
Speaker 1: human touch, which makes a big difference.
1:08:27
Speaker 2: Absolutely, there is. And so I think we're evolutionarily built
1:08:33
Speaker 2: to seek out human touch and human behavior.
1:08:37
Speaker 1: I wonder if I would want a robot to massage me.
1:08:41
Speaker 1: It wouldn't be as good.
1:08:42
Speaker 2: I mean, think about sitting in a massage chair. Is
1:08:44
Speaker 2: it ever as good?
1:08:45
Speaker 1: It's never as good. Right.
1:08:46
Speaker 2: And so I don't think a robot's going to be
1:08:48
Speaker 2: that different from a, maybe a little better than a
1:08:50
Speaker 2: massage chair, but like.
1:08:52
Speaker 1: Massage chairs are never good.
1:08:53
Speaker 2: No, they're just like, they're okay. They're mediocre.
1:08:56
Speaker 1: I want to talk about testosterone. how that links to
1:09:00
Speaker 1: sexual function, but also just overall health. Because I was
1:09:03
Speaker 1: reading that there's been a 300% increase in the United
1:09:06
Speaker 1: States in the last 10 years of testosterone prescriptions. And
1:09:10
Speaker 1: my friends are increasingly having a conversation about testosterone, which
1:09:12
Speaker 1: we weren't having even five years ago. It wasn't a conversation.
1:09:16
Speaker 1: And now the conversation I'm having amongst my friends is like,
1:09:18
Speaker 1: is our testosterone high enough? Do we need to go
1:09:19
Speaker 1: get supplements to increase our testosterone?
1:09:22
Speaker 2: Testosterone is declining. So when you look at testosterone levels
1:09:25
Speaker 2: from the 1990s, like late 1990s, the average level was
1:09:29
Speaker 2: around 600. And if you look at data around 2015,
1:09:34
Speaker 2: it was 450. So there's been like a 25% decline
1:09:36
Speaker 2: in testosterone. Now you're going to ask me why? One,
1:09:40
Speaker 2: we talked about some of the endocrine disrupting chemicals. That's
1:09:43
Speaker 2: part of it, certainly. Two, there's a significant rise in obesity.
1:09:47
Speaker 2: Testosterone has aromatase and testosterone converts to estrogen using this
1:09:52
Speaker 2: enzyme called aromatase. And so when you have more fat mass,
1:09:55
Speaker 2: you have more aromatase and more testosterone is being converted
1:09:58
Speaker 2: to estrogen. And so now you have less testosterone.
1:10:01
Speaker 1: Sorry, how do you have less testosterone?
1:10:03
Speaker 2: So because there's more fat mass, there's more aromatase. So
1:10:06
Speaker 2: that aromatase sees all this testosterone and it converts it
1:10:09
Speaker 2: to estrogen.
1:10:11
Speaker 1: Ah, okay. And this is where they talk about man boobs.
1:10:14
Speaker 2: Yeah, so when you have a lot of estradiol around,
1:10:16
Speaker 2: you can get man boobs. You can get gynecomastia, so
1:10:20
Speaker 2: term for it. So that's one. Two is we see
1:10:23
Speaker 2: a rise in diabetes and insulin resistance, which also causes
1:10:27
Speaker 2: a decrease in testosterone. We're seeing a rise in ultra-processed
1:10:32
Speaker 2: food intake, and that doesn't have the optimal nutrition that
1:10:37
Speaker 2: you need to optimize testosterone. So we're getting highly caloric,
1:10:43
Speaker 2: which then leads to obesity. We're getting lack of healthy fats.
1:10:48
Speaker 2: All these things are super important for testosterone. The Mediterranean
1:10:51
Speaker 2: diet is what has been the most studied. And basically,
1:10:54
Speaker 2: an anti-inflammatory diet is what they found for testosterone. So
1:10:58
Speaker 2: trying to just eat like whole foods, unprocessed foods as
1:11:01
Speaker 2: much as possible and minimizing the inflammatory foods.
1:11:05
Speaker 1: Does having high testosterone make me more fertile?
1:11:09
Speaker 2: No, not necessarily. So I think people inherently think that
1:11:12
Speaker 2: the higher your testosterone level is when you check your
1:11:15
Speaker 2: blood work, that that's better. And that's not necessarily true. Now,
1:11:19
Speaker 2: everyone is different. And what I can't tell you is
1:11:22
Speaker 2: what your receptors look like, what your testosterone or androgen
1:11:26
Speaker 2: receptors look like. How sensitive are they to testosterone? And
1:11:30
Speaker 2: everyone's a little bit different. When you look at the
1:11:31
Speaker 2: same guy or you look at two different guys, their
1:11:35
Speaker 2: variability can be so much that a guy who's 900
1:11:37
Speaker 2: can be normal and a guy who's 500 can be
1:11:39
Speaker 2: normal because everyone has individual genetic variations. It's how their cells,
1:11:44
Speaker 2: how sensitive their cells are, how many cells they have,
1:11:47
Speaker 2: how many latex cells do they have in their testicles,
1:11:50
Speaker 2: the CAG repeats, which are these DNA repeats on the
1:11:53
Speaker 2: receptor themselves. People who have more are less sensitive to
1:11:56
Speaker 2: the testosterone that's around. So they need more testosterone to
1:11:59
Speaker 2: get the same result. Whereas people who have less repeats
1:12:02
Speaker 2: have more sensitivity. So they don't need as much testosterone.
1:12:05
Speaker 2: And so everyone is individual. And so that's why it's
1:12:08
Speaker 2: really important to understand how are you feeling, right? It's
1:12:10
Speaker 2: not about chasing a number. And so absolutely, we know
1:12:14
Speaker 2: that when your testosterone is low, below 214 nanograms per deciliter,
1:12:19
Speaker 2: that your risk of mortality goes up by two. So
1:12:22
Speaker 2: you are going to double your risk of dying if
1:12:24
Speaker 2: you have low testosterone. But when you go super high,
1:12:28
Speaker 2: super physiologic, meaning like 1800 or higher, now you're putting
1:12:32
Speaker 2: yourself at risk for other things. You can have blood thickening,
1:12:35
Speaker 2: which is a known side effect of testosterone replacement. And
1:12:38
Speaker 2: that puts you at risk for stroke, heart attack, heart disease.
1:12:42
Speaker 2: Over long periods of time, it can affect your heart
1:12:45
Speaker 2: because there's also heart muscle cells that get exposed to
1:12:50
Speaker 2: this high level of testosterone. And when that happens, they
1:12:53
Speaker 2: sort of change over time and they become more collagen deposition,
1:12:57
Speaker 2: they get more fibrosis, and this makes them stiffer. And
1:13:00
Speaker 2: so that you're not pumping blood as effectively as you
1:13:03
Speaker 2: would otherwise. And so there are real consequences to going
1:13:06
Speaker 2: too high. There's also the side effects of having acne,
1:13:10
Speaker 2: of changes in mood in terms of aggression and things
1:13:13
Speaker 2: when you get really high. So really, it's about finding
1:13:16
Speaker 2: what you feel good at. More is not necessarily better.
1:13:19
Speaker 2: Once your testosterone receptors are saturated, meaning they're all bound
1:13:23
Speaker 2: to testosterone, more doesn't help you. It might help you
1:13:26
Speaker 2: get more muscles, which is why people abuse anabolic steroids
1:13:29
Speaker 2: and testosterone because it will continue to help you get
1:13:32
Speaker 2: bigger muscles. But that's it. It's not going to help
1:13:34
Speaker 2: you with your brain health, your bone health, your sexual health,
1:13:38
Speaker 2: any of that.
1:13:39
Speaker 1: Is there a way to visually spot a person with
1:13:43
Speaker 1: low testosterone? Are there visual clues?
1:13:46
Speaker 2: Usually it's someone who feels very fatigued, like they can't
1:13:50
Speaker 2: get out of bed. They feel just like so drained.
1:13:53
Speaker 2: Usually they are a little bit more overweight.
1:13:56
Speaker 1: Skinny fat?
1:13:57
Speaker 2: So visceral adiposity, I mean, you can't always tell if
1:14:00
Speaker 2: they're skinny. It could be because they could have visceral adiposity,
1:14:02
Speaker 2: which is meaning that the fat is around the organs, right?
1:14:05
Speaker 2: And so you don't see like a big pot belly necessarily.
1:14:09
Speaker 2: They may have really low sexual desire. They may have
1:14:12
Speaker 2: decrease in mood.
1:14:13
Speaker 1: What about skin and bones? Does it impact skin and bones?
1:14:16
Speaker 2: Yeah. So if you get high testosterone, you can get
1:14:18
Speaker 2: acne because it affects the sebum in the skin. Bone health.
1:14:22
Speaker 2: So testosterone converts to estradiol. And estradiol is really important
1:14:28
Speaker 2: for bone metabolism. And so when you have low testosterone,
1:14:32
Speaker 2: you can also have low estrogen. And when your estrogen
1:14:35
Speaker 2: gets very low, you get a higher risk for fractures,
1:14:38
Speaker 2: higher risk for osteoporosis. And so that's where your bone
1:14:42
Speaker 2: health can be in danger. And so that's why testosterone
1:14:46
Speaker 2: can help protect your bones because of its conversion to estradiol.
1:14:50
Speaker 1: If you do have low testosterone, should you be considering
1:14:52
Speaker 1: taking anabolic steroids? Like And who is testosterone replacement therapy
1:14:57
Speaker 1: good for?
1:14:58
Speaker 2: So I'm going to ask you a question. Why are
1:15:00
Speaker 2: you saying anabolic steroids?
1:15:01
Speaker 1: I don't know. Because I hear that people, big bodybuilders
1:15:04
Speaker 1: take anabolic steroids.
1:15:05
Speaker 2: The reason I asked you that is because people think
1:15:07
Speaker 2: anabolic steroids and testosterone replacement therapy are the same thing.
1:15:10
Speaker 2: And they're not. And so testosterone replacement therapy is what
1:15:14
Speaker 2: is given to guys who have low testosterone. If you
1:15:17
Speaker 2: have truly low testosterone, there's a few things. You can
1:15:20
Speaker 2: obviously improve testosterone naturally by going back to those pillars
1:15:23
Speaker 2: of health that we talked about. Improve your sleep, do
1:15:25
Speaker 2: resistance training, avoid endocrine disrupting chemicals. But if you are
1:15:29
Speaker 2: still low despite doing all those things, or you're like
1:15:32
Speaker 2: so fatigued that you can't move your body unless you
1:15:34
Speaker 2: really need to do it, then I think testosterone replacement
1:15:36
Speaker 2: is very valuable. And so testosterone replacement is getting you
1:15:40
Speaker 2: to a level of testosterone that is within normal. We're
1:15:45
Speaker 2: not trying to get you super high. We're not trying
1:15:47
Speaker 2: to get you to become a bodybuilder. We're trying to
1:15:50
Speaker 2: get you to normal, what you should be. And so
1:15:53
Speaker 2: anabolic steroids are different. Anabolic steroids are like all these
1:15:56
Speaker 2: different oral pills and injectables and things that work on
1:15:59
Speaker 2: muscle as well as work on your androgen receptors. And
1:16:04
Speaker 2: so those are typically things that people are taking on
1:16:06
Speaker 2: their own. They're kind of self-directing their care and they're
1:16:11
Speaker 2: not really monitoring their testosterone or they don't really care
1:16:14
Speaker 2: how high they go. They just want the end product
1:16:17
Speaker 2: of looking muscular. And so they are getting really high testosterone.
1:16:22
Speaker 2: And that has its own host of concerns. In addition
1:16:26
Speaker 2: to the ones we talked about, like blood clots and
1:16:29
Speaker 2: heart attack, but there's a 15 times higher risk of
1:16:32
Speaker 2: having premature heart failure and 122 times more risk of
1:16:38
Speaker 2: cardiac death when you're taking anabolic steroids for the purposes
1:16:41
Speaker 2: of increasing muscle mass and not and getting really high
1:16:45
Speaker 2: in your testosterone. So it is a real serious issue
1:16:49
Speaker 2: when you take anabolic steroids because it can have real
1:16:52
Speaker 2: serious health consequences.
1:16:54
Speaker 1: I've always imagined that once I have kids, so I
1:16:56
Speaker 1: think I'm scared that if I have testosterone replacement therapy
1:16:59
Speaker 1: at this age at 33, it might impact my fertility.
1:17:02
Speaker 2: It absolutely will.
1:17:04
Speaker 1: Okay, good. So I'm not going to do that until
1:17:06
Speaker 1: I've had all four of the kids, as many as
1:17:09
Speaker 1: I can. And then I figured when I hit like 45,
1:17:13
Speaker 1: then I'll go and testosterone replacement therapy? Is this a
1:17:16
Speaker 1: good strategy?
1:17:17
Speaker 2: Well, first of all, I would want to know why
1:17:19
Speaker 2: you want to be on testosterone. Is your testosterone low?
1:17:21
Speaker 1: I have no idea.
1:17:22
Speaker 2: Right. Are you having any symptoms? I mean, you live
1:17:24
Speaker 2: a very high powered, busy life. And so I can
1:17:29
Speaker 2: guarantee your stress is probably not under control. Like probably
1:17:32
Speaker 2: you're not sleeping great. And not to say that those
1:17:34
Speaker 2: are things that, you know, you can't do in addition
1:17:37
Speaker 2: to taking testosterone if your But I think the important
1:17:42
Speaker 2: thing is realizing like it's only going to help you
1:17:45
Speaker 2: if your testosterone receptors are not fully saturated and giving
1:17:47
Speaker 2: you more testosterone is going to saturate them.
1:17:50
Speaker 1: Doesn't it just drop anyway with age? It does.
1:17:53
Speaker 2: So it drops about 1% a year on average. Some
1:17:56
Speaker 2: people drop less, some people drop more. So if you
1:17:59
Speaker 2: look at someone who is healthy and they have a
1:18:01
Speaker 2: normal testosterone, they usually won't become what we call hypogonadal
1:18:06
Speaker 2: or have low testosterone even as they age because the
1:18:09
Speaker 2: drop is so low. it's only 1% a year. But
1:18:12
Speaker 2: if you add on these comorbid conditions, if you add
1:18:15
Speaker 2: on a high stress life, if you add on poor sleep,
1:18:18
Speaker 2: if you add on exposure to endocrine disrupting chemicals, you're
1:18:21
Speaker 2: going to see that number come down much higher.
1:18:24
Speaker 1: It's actually, I was just, I pulled up a graph
1:18:26
Speaker 1: here that shows testosterone decline with age, and it's actually
1:18:31
Speaker 1: not that steep.
1:18:33
Speaker 2: It's not. It is going to decline. but it may
1:18:36
Speaker 2: not decline to the point where you need testosterone. So
1:18:39
Speaker 2: not everyone needs it. Depending on the data you look at,
1:18:42
Speaker 2: 20 to 40% of guys have low testosterone. And when
1:18:46
Speaker 2: you look at the number that get treated, it's like 2%.
1:18:49
Speaker 1: And it starts to... from about 20 years old.
1:18:52
Speaker 2: Yeah, it depends on the person, 20 to 40 years old.
1:18:54
Speaker 2: It's probably more around 30 to 40. And the reason
1:18:57
Speaker 2: we came up with these numbers, right, these guidelines to
1:19:00
Speaker 2: guide us on what's normal and what's not, is because
1:19:02
Speaker 2: you look at population-based data and you look at when
1:19:05
Speaker 2: these symptoms arise. And there are like clear numbers. You
1:19:08
Speaker 2: may start having bone loss Around 300. You might start
1:19:12
Speaker 2: having decreased sexual frequency of thoughts at 215. You might
1:19:17
Speaker 2: start feeling less physical vigor around 290, right? And so
1:19:22
Speaker 2: there are numbers that we know based on population-based data
1:19:26
Speaker 2: that we're seeing these numbers decline. Now, the other thing
1:19:29
Speaker 2: to think about when you're looking at testosterone is free testosterone.
1:19:32
Speaker 2: So testosterone comes in different forms in the body. It
1:19:35
Speaker 2: comes bound and unbound. So 45% of testosterone is bound
1:19:39
Speaker 2: to SHBG, which is a molecule of protein that is
1:19:45
Speaker 2: really tightly binds to testosterone, doesn't let it go for
1:19:47
Speaker 2: your body to use. Then there's some that's bound to albumin,
1:19:51
Speaker 2: which is sort of loosely bound. And then there's 2%
1:19:54
Speaker 2: that's free, 1% to 2% that's free. And that's what
1:19:56
Speaker 2: we say is like the most available to your body
1:20:00
Speaker 2: for use. And there's actually good data that looks at
1:20:03
Speaker 2: free testosterone, the levels of free testosterone are correlated with
1:20:07
Speaker 2: these symptoms as well. And so you do have to
1:20:09
Speaker 2: look at the big picture. So I always check the
1:20:11
Speaker 2: total testosterone as well as an SHBG because some people
1:20:15
Speaker 2: can have elevated SHBG due to thyroid dysfunction, due to aging,
1:20:20
Speaker 2: due to genetic variability, right? In women, SHBG goes up
1:20:23
Speaker 2: when you take oral contraceptives and it stays up for
1:20:26
Speaker 2: life if you take oral contraceptives. So it can affect
1:20:29
Speaker 2: their free testosterone. The other thing to think about testosterone
1:20:31
Speaker 2: is it's for life. Once you take it, your body
1:20:34
Speaker 2: stops making its own testosterone many people over years will
1:20:37
Speaker 2: notice that their testicles get smaller because their body stops
1:20:42
Speaker 2: making its own testosterone. So it's not something to take lightly. Now,
1:20:46
Speaker 2: say you were low right now and you wanted to conceive,
1:20:48
Speaker 2: there are ways where you can take other pharmaceuticals that
1:20:53
Speaker 2: will naturally boost your own production like HCG or Clomid
1:20:56
Speaker 2: or Enclomafine. These work basically in different ways to either
1:21:00
Speaker 2: tell your brain that, hey, we need more testosterone or
1:21:04
Speaker 2: They mimic the signals that tell your testicles to make
1:21:07
Speaker 2: more testosterone. And so there are ways to do it.
1:21:10
Speaker 2: And you definitely need someone who's well-versed in managing hormone management.
1:21:15
Speaker 2: But there are things that you can do if you're low.
1:21:18
Speaker 2: But again, I don't think it's... Once you start these things,
1:21:20
Speaker 2: you can't go... I mean, you can get off of it,
1:21:22
Speaker 2: but it's sort of a process. And it's not something
1:21:24
Speaker 2: that everyone... Will do because you're going to feel good
1:21:26
Speaker 2: on testosterone if you're taking it. And then when you
1:21:29
Speaker 2: get off it, because your body is like no longer
1:21:31
Speaker 2: making its own, you're going to feel horrible.
1:21:33
Speaker 1: So do you think most 50 plus year old men
1:21:36
Speaker 1: should be taking testosterone replacement therapies?
1:21:40
Speaker 2: Only if they're symptomatic and they're low, right?
1:21:42
Speaker 1: Would it make the average man, the average 50 year
1:21:44
Speaker 1: old man, if this is the average, feel better on
1:21:47
Speaker 1: a daily basis?
1:21:48
Speaker 2: Not necessarily, because if they are normal, like I said,
1:21:51
Speaker 2: if their testosterone receptors are already fully saturated, it's not
1:21:53
Speaker 2: going to change, right? It's not going to change the...
1:21:56
Speaker 2: Like I said, it may make their muscles look bigger,
1:21:59
Speaker 2: but it's not going to change their cognition. It's not
1:22:01
Speaker 2: going to change their mood. It's not going to change
1:22:03
Speaker 2: their sex drive. It's not going to change their erections
1:22:06
Speaker 2: when their testosterone receptors are fully saturated.
1:22:08
Speaker 1: And you know, in this graph, what is showing the
1:22:10
Speaker 1: decline here... Has that got anything to do with whether
1:22:13
Speaker 1: their testosterone levels are fully saturated?
1:22:16
Speaker 2: No, you can't tell from that.
1:22:17
Speaker 1: You can't tell from that. So you could have low
1:22:18
Speaker 1: testosterone but still be fully saturated.
1:22:20
Speaker 2: That's why we talk about symptoms, right? Because that's how
1:22:22
Speaker 2: I can tell. I think that's part of what being
1:22:25
Speaker 2: a doctor is, right? Talking to your patients and figuring
1:22:27
Speaker 2: out what's going on with them and what their symptoms
1:22:29
Speaker 2: are and making sure it's nothing else, right? You can
1:22:31
Speaker 2: have low thyroid and that can mimic what low testosterone
1:22:36
Speaker 2: feels like. You can have a high prolactin because you
1:22:38
Speaker 2: might have a benign tumor in your brain, right? that's
1:22:41
Speaker 2: secreting prolactin, and that can reduce your testosterone. So that's
1:22:44
Speaker 2: the reason to get a full evaluation to make sure
1:22:47
Speaker 2: there's nothing else that we're missing that's causing you to
1:22:50
Speaker 2: have these symptoms if your other levels are normal.
1:22:53
Speaker 1: Okay, that makes sense. So just because my testosterone levels
1:22:56
Speaker 1: would be low doesn't mean I necessarily, if I'm not symptomatic,
1:23:01
Speaker 1: doesn't mean that I should necessarily just assume that I
1:23:03
Speaker 1: need testosterone replacement therapy.
1:23:04
Speaker 2: Exactly.
1:23:05
Speaker 1: Okay. Yeah, I think most of my male friends are
1:23:08
Speaker 1: just assuming that once we hit 50, we're all on
1:23:10
Speaker 1: the testosterone.
1:23:11
Speaker 2: I mean, look, I think when, if you need it,
1:23:14
Speaker 2: it's a great drug. It's a great option to improve
1:23:17
Speaker 2: your quality of life. It's obviously preventing bone loss. It's
1:23:21
Speaker 2: improving your longevity. It's preventing, hopefully having some benefit in
1:23:26
Speaker 2: terms of cardiometabolic health. And so, yeah, absolutely. If you
1:23:30
Speaker 2: need it, but it's not something that like everyone should
1:23:32
Speaker 2: just take because why not, right? Like it's, when you
1:23:35
Speaker 2: play with hormones, it's serious business, you know?
1:23:38
Speaker 1: I guess a lot of men are self-conscious in a
1:23:39
Speaker 1: way that they don't often admit and they want to
1:23:41
Speaker 1: have big muscles and they want to feel strong.
1:23:44
Speaker 2: And this is the problem I'm seeing with younger guys
1:23:47
Speaker 2: right now is that there's a lot of young kids
1:23:49
Speaker 2: taking anabolics because there's so much pressure to look a
1:23:53
Speaker 2: certain way, right? Because nowadays, how do you meet people
1:23:57
Speaker 2: on social media? Through swiping and all you see is
1:24:00
Speaker 2: what they look like. And so there's a And like,
1:24:02
Speaker 2: I've seen at the gym, like I'm like at the
1:24:04
Speaker 2: gym and there's these young kids who I'm like, there
1:24:05
Speaker 2: is no way you are naturally that built at that age, right? Like,
1:24:10
Speaker 2: unless you've been lifting since you were like seven years old.
1:24:13
Speaker 2: And so, and of course there are some, but it
1:24:16
Speaker 2: is serious because one, it causes infertility, right? When you're
1:24:19
Speaker 2: on testosterone replacement, after about 18 months, 70% of people
1:24:24
Speaker 2: on testosterone replacement will be infertile. 17. 70, 70%. 70.
1:24:27
Speaker 2: And- Even as soon as like 10 weeks, we see
1:24:34
Speaker 2: some people having drops in their sperm count. So it's
1:24:37
Speaker 2: variable with how quickly you're going to see impacts on
1:24:40
Speaker 2: your fertility, but it absolutely happens. And it can come
1:24:45
Speaker 2: back for the large majority of people, but how long
1:24:47
Speaker 2: it takes depends on your age and how long you
1:24:49
Speaker 2: were on testosterone replacement therapy. And in some cases, it
1:24:52
Speaker 2: can take as long as two years to come back.
1:24:55
Speaker 1: I really need to get my testosterone levels checked.
1:24:57
Speaker 2: Yeah. Yeah. You should. But also you should get your
1:25:00
Speaker 2: semen analysis checked.
1:25:01
Speaker 1: I've done that.
1:25:02
Speaker 2: Good, good. Because that's also a biomarker of health. We've
1:25:05
Speaker 2: seen that people who have poor semen parameters, they have
1:25:09
Speaker 2: higher rates of mortality and they actually live, when you
1:25:11
Speaker 2: look at age, like what age people die, they die
1:25:14
Speaker 2: younger compared to people. And it's dose dependent. So if
1:25:17
Speaker 2: you have like normal semen, concentration of sperm and then
1:25:22
Speaker 2: it keeps going down and down and down if you
1:25:24
Speaker 2: look at the age it's like they live to 78
1:25:27
Speaker 2: 77 76 like you can actually see it come down
1:25:29
Speaker 2: except for people who have no sperm because those are
1:25:31
Speaker 2: usually genetic disorders those are live a little longer because
1:25:34
Speaker 2: it's not necessarily due to cardiometabolic issues but it's basically
1:25:38
Speaker 2: a reflection of your overall health.
1:25:40
Speaker 1: Steve what are you doing uh just making myself a
1:25:46
Speaker 1: delicious coffee from the freezer from the freezer have you
1:25:49
Speaker 1: not heard about conti it No. Oh my gosh. This
1:25:52
Speaker 1: is going to change your life. A couple of months ago,
1:25:54
Speaker 1: the founder of this business called Matt sent a big
1:25:57
Speaker 1: shipment of... this coffee to our office in London. What
1:26:00
Speaker 1: most people don't know is that the processing of coffee
1:26:02
Speaker 1: takes out a lot of the taste. So what they
1:26:05
Speaker 1: do is they flash freeze it at the optimal moment
1:26:08
Speaker 1: when it's most tasty. And they send you in the
1:26:11
Speaker 1: post the coffee in these little frozen ice cubes. Now
1:26:14
Speaker 1: Matt sent a big shipment to my office. I moved
1:26:16
Speaker 1: it to the kitchen. I said to the team, knock
1:26:18
Speaker 1: yourselves out. And then I saw so many messages in
1:26:20
Speaker 1: our Slack channel of people going, oh my God, what
1:26:23
Speaker 1: the hell is that? It's so delicious. All I have
1:26:25
Speaker 1: to do is pop it out in the morning using
1:26:27
Speaker 1: the little button on the back of this thing. I
1:26:29
Speaker 1: pour my hot water in and I mix it. And
1:26:33
Speaker 1: that is done. You can get $ 30 off your first
1:26:36
Speaker 1: order of Cometeer coffee if you go to cometeer.com slash steven.
1:26:41
Speaker 1: Try it and please Instagram DM me, LinkedIn me and
1:26:44
Speaker 1: let me know if you love it as much as
1:26:46
Speaker 1: I do. Make sure you keep what I'm about to
1:26:49
Speaker 1: say to yourself. I'm inviting 10,000 of you to come
1:26:52
Speaker 1: even deeper into the diary of a CEO. Welcome to
1:26:55
Speaker 1: my inner circle. This is a brand new private community
1:26:59
Speaker 1: that I'm launching to the world. We have so many
1:27:00
Speaker 1: incredible things that happen that you are never shown. We
1:27:04
Speaker 1: have the briefs that are on my iPad when I'm
1:27:06
Speaker 1: recording the conversation. We have clips we've never released. We
1:27:09
Speaker 1: have behind the scenes conversations with the guests and also
1:27:11
Speaker 1: the episodes that we've never, ever released. And so much more.
1:27:17
Speaker 1: In the circle, you'll have direct access to me. You
1:27:19
Speaker 1: can tell us what you want this show to be,
1:27:21
Speaker 1: who you want us to interview, and the types of
1:27:22
Speaker 1: conversations you would love us to have. But remember, for now,
1:27:26
Speaker 1: we're only inviting the first 10,000 people that join before
1:27:29
Speaker 1: it closes. So if you want to join our private
1:27:31
Speaker 1: closed community, head to the link in the description below
1:27:33
Speaker 1: or go to doaccircle.com. I will speak to you then.
1:27:38
Speaker 1: One of the things I was quite surprised by I'll
1:27:45
Speaker 1: be honest, is when I went on your YouTube channel,
1:27:48
Speaker 1: one of your very high performing videos, I think it
1:27:52
Speaker 1: had 31 million views, was about enlarging your penis.
1:27:56
Speaker 2: Yes.
1:27:59
Speaker 1: I didn't know that so many men were interested in
1:28:03
Speaker 1: ways to enlarge their penis.
1:28:05
Speaker 2: Well, it's interesting because when you look at the data,
1:28:07
Speaker 2: more men want to, so let's say most guys would
1:28:11
Speaker 2: love to be taller, right? If you're an average height man,
1:28:14
Speaker 2: most guys would love to be taller, right?
1:28:15
Speaker 1: Yeah, true.
1:28:16
Speaker 2: More men want to have a longer penis than they
1:28:19
Speaker 2: want to be taller.
1:28:20
Speaker 1: Really? Wow. Wow. Why is this?
1:28:28
Speaker 2: Well, I think, you know, a lot of people, it
1:28:32
Speaker 2: starts at a young age. I have sons, right? And
1:28:34
Speaker 2: so I see it. Like they talk about their penis
1:28:36
Speaker 2: in such a way, like very early in life. Like,
1:28:39
Speaker 2: oh my God, my penis. is so big or it
1:28:40
Speaker 2: should be so big or whatever. And it's like this,
1:28:44
Speaker 2: it becomes this like this society thing about who's got
1:28:48
Speaker 2: a bigger penis. Like it's very interesting, but there's a
1:28:50
Speaker 2: lot of pressure to feel like, and a lot of
1:28:53
Speaker 2: discussion around bigger is better, right? It's talked about in media.
1:28:58
Speaker 2: It's subtly joked about. Everywhere you look, people are talking
1:29:02
Speaker 2: about being well-endowed as being better. But interestingly, on my podcast,
1:29:06
Speaker 2: we interviewed the guy who has the largest medically verified penis.
1:29:11
Speaker 2: I think it's like 13 or 14 inches in length.
1:29:14
Speaker 2: And he actually has a lot of trouble because it's
1:29:18
Speaker 2: so large that people don't want to have sex with
1:29:20
Speaker 2: him and it's uncomfortable for them. And so like, it's
1:29:23
Speaker 2: not all roses and sunshine on the other side, but
1:29:26
Speaker 2: the reality is that many people feel what's called small
1:29:29
Speaker 2: penis anxiety. And even if they have a normal size penis,
1:29:33
Speaker 2: they feel consumed with how the size of their penis is.
1:29:37
Speaker 2: And so that's why this video did so well. I
1:29:39
Speaker 2: naively had no idea how many people would resonate with
1:29:42
Speaker 2: because I'm not a guy, right? And I see patients
1:29:44
Speaker 2: all the time. But at that time in my career,
1:29:46
Speaker 2: people weren't coming to me to talk about it. And
1:29:49
Speaker 2: so I realized there's so many people quietly feeling insecure.
1:29:54
Speaker 2: And we talk a lot about women having body image issues.
1:29:56
Speaker 2: Men do too, right? They feel insecure about the size
1:30:00
Speaker 2: of their penis. Because also they're seeing guys on pornography
1:30:03
Speaker 2: who have very well-endowed fallacies. And, you know, they chose
1:30:08
Speaker 2: to be porn actors for a reason, right? Because they
1:30:10
Speaker 2: are naturally well-endowed. And so you're comparing yourself to the outliers.
1:30:15
Speaker 2: And the average penis is about 5.3 to 5.5 inches erect.
1:30:19
Speaker 2: But when you look at like, what do women want?
1:30:22
Speaker 2: They will say on average, they want a six inch penis.
1:30:25
Speaker 2: But when you look at like the kind of sex
1:30:27
Speaker 2: toys they buy, and they did this study because they
1:30:29
Speaker 2: were looking at people who they were trying to decide
1:30:32
Speaker 2: what kind of, when they were developing phalluses for trans people,
1:30:36
Speaker 2: like they reconstruct phalluses for, they wanted to, they were
1:30:39
Speaker 2: making them too girthy. And they're like, well, we need
1:30:40
Speaker 2: to figure out what girth women want. And so they
1:30:43
Speaker 2: looked at like what women buy on online, like what
1:30:47
Speaker 2: are the most purchased sex toy? And it's actually pretty
1:30:50
Speaker 2: close to average.
1:30:52
Speaker 1: Did you say 5.2 inches?
1:30:53
Speaker 2: 5.2 to 5.5, depending on the study you're looking at.
1:30:56
Speaker 1: Yeah. Correct. And what size do men think the average is?
1:31:03
Speaker 2: Oh, they think it's like six or seven inches.
1:31:05
Speaker 1: Oh, okay. So they think the average is bigger. And
1:31:07
Speaker 1: also how does age come into this? Because I'm presuming
1:31:09
Speaker 1: that when I get older, my penis is going to
1:31:10
Speaker 1: shrink or something.
1:31:11
Speaker 2: If you have good blood flow to your penis, it
1:31:13
Speaker 2: shouldn't shrink. So like I said earlier, if you stop
1:31:17
Speaker 2: having nighttime erections or you're not having erections, now you're
1:31:20
Speaker 2: no longer getting blood flow to your penis and it
1:31:22
Speaker 2: will shrink over time. Also, if you're gaining weight, it
1:31:25
Speaker 2: will appear that it's shrinking because you're getting more fat
1:31:29
Speaker 2: over here. So if you think about your penis here,
1:31:31
Speaker 2: this is the fat right above this bone. And as
1:31:34
Speaker 2: this fat gets more and more, you're seeing less and
1:31:37
Speaker 2: less of the penis.
1:31:38
Speaker 1: And is there a way to enlarge the penis?
1:31:41
Speaker 2: So there are many ways that have been tried, discussed, attempted.
1:31:46
Speaker 2: So there's definitely surgeries that you can get, but there's
1:31:49
Speaker 2: not a lot of surgeons who do a lot of
1:31:51
Speaker 2: penile lengthening surgeries. And they have lots of complications, like
1:31:55
Speaker 2: very high rates of complications because the penis is a
1:31:58
Speaker 2: very vascular organ. And the thing is that when you
1:32:01
Speaker 2: have the tiniest difference on your penis, you notice it.
1:32:05
Speaker 1: Right?
1:32:05
Speaker 2: Like I have guys come in with the tiniest little
1:32:07
Speaker 2: thing on their penis and like, is this okay? Like
1:32:09
Speaker 2: this is new. And like, luckily it's nothing, right? But
1:32:12
Speaker 2: I'm like, they notice it. You notice it when something's wrong.
1:32:15
Speaker 2: So imagine you have a surgery and now something changes, right?
1:32:18
Speaker 2: So it is really difficult to sort of replicate exactly
1:32:23
Speaker 2: a normal penis when you're lengthening it through surgery. So
1:32:27
Speaker 2: I don't recommend surgery for lengthening penis. There is a
1:32:30
Speaker 2: safer way, And that has been shown to help and
1:32:34
Speaker 2: that's using a traction device. So a traction device, we
1:32:38
Speaker 2: have one here. This is one brand. You can get
1:32:40
Speaker 2: many of these online. And you can put your penis
1:32:44
Speaker 2: in this device.
1:32:45
Speaker 1: I feel like I get shivers when I watch you
1:32:49
Speaker 1: do this to this penis.
1:32:50
Speaker 2: So you would wrap it. It would be more comfortable
1:32:53
Speaker 2: than just putting this directly on your penis.
1:32:55
Speaker 1: For you guys that can't see it, she's clamping the
1:32:57
Speaker 1: end of the penis into this.
1:32:58
Speaker 2: Into this device. And then you sort of lengthen it,
1:33:02
Speaker 2: extend it with this. 30 minutes twice a day for
1:33:05
Speaker 2: this particular device. They've actually done some research on this one.
1:33:08
Speaker 2: 30 minutes twice a day. And there's like a whole
1:33:11
Speaker 2: protocol on their website. And it does show improvements in
1:33:14
Speaker 2: length about two centimeters, but it is a commitment to
1:33:17
Speaker 2: increasing length and to doing this process.
1:33:20
Speaker 1: So just on those numbers, two centimeter increase over what
1:33:23
Speaker 1: period of time?
1:33:23
Speaker 2: And does that- For about three to six months, depending. Yeah.
1:33:26
Speaker 1: And is it permanent?
1:33:27
Speaker 2: So that's what we don't know. I mean, most of
1:33:29
Speaker 2: the studies stop at, you know, once they get the results.
1:33:32
Speaker 2: And we don't know that if you stop, will it
1:33:34
Speaker 2: just revert back to normal? I don't know. And so
1:33:36
Speaker 2: the other thing about this particular traction device that's nice
1:33:39
Speaker 2: is if you have a curvature in the penis, like
1:33:41
Speaker 2: you develop something called Pavroni's disease, this device can actually
1:33:45
Speaker 2: curve a little bit away from, if you like, let's
1:33:48
Speaker 2: say you have an indentation on the top of the penis,
1:33:51
Speaker 2: it can actually bend away from that and it can
1:33:53
Speaker 2: help straighten out the penis. So that's actually a really
1:33:57
Speaker 2: nice utilization for it because for some people that can
1:34:00
Speaker 2: be really traumatic and devastating to have a change in
1:34:03
Speaker 2: the way your penis appears. because it starts curving all
1:34:06
Speaker 2: of a sudden and this is safe and effective and
1:34:09
Speaker 2: you can have bruising. It can be slightly uncomfortable, but it's,
1:34:12
Speaker 2: you're not going to really hurt yourself too much by
1:34:15
Speaker 2: doing something like this.
1:34:16
Speaker 1: I thought a curved penis would hit the G-spot better.
1:34:19
Speaker 2: Yeah. Sometimes a slight curve can be beneficial for some people.
1:34:23
Speaker 2: But again, I think like when you notice like there's
1:34:25
Speaker 2: a dramatic change, you do that more calmly.
1:34:29
Speaker 1: It's okay. Um, I'm just trying to figure out how
1:34:35
Speaker 1: this works. So I get the penis. I put it through.
1:34:39
Speaker 2: Yeah.
1:34:40
Speaker 1: Clamp it down.
1:34:41
Speaker 2: And you want to put it at your normal. And
1:34:42
Speaker 2: then you'll just slightly advance the length. You're not going
1:34:45
Speaker 2: to pull crazy. It's going to do a little bit
1:34:47
Speaker 2: of traction. So it's not uncomfortable. It's slight, like just
1:34:50
Speaker 2: a slight tension. It shouldn't be like that. It should
1:34:52
Speaker 2: be a lot much less tension. But it is, I mean,
1:34:56
Speaker 2: they can vary in price from $ 100 to $ 500. Yeah.
1:35:00
Speaker 2: So it's a one-time cost. It is not, like I said,
1:35:02
Speaker 2: not dangerous. What is dangerous is when people try to
1:35:05
Speaker 2: do something that became popular on TikTok called jelking. And
1:35:09
Speaker 2: jelking is where you use your hands and you make
1:35:13
Speaker 2: like an okay sign with your fingers and you're like
1:35:16
Speaker 2: stretching the penis with your hands. And this can be
1:35:20
Speaker 2: dangerous because you can create micro tears in the penis.
1:35:23
Speaker 2: And we in the urology community have seen plenty of
1:35:25
Speaker 2: patients who have now developed erectile dysfunction after doing jelking
1:35:30
Speaker 2: because they've now created damage to their penis. And so
1:35:33
Speaker 2: I really caution people because there is so much despair
1:35:37
Speaker 2: around sexual function, around penile health, that people are willing
1:35:43
Speaker 2: to try things and they might really hurt themselves. No joke,
1:35:46
Speaker 2: I had a patient the other day ask me if
1:35:48
Speaker 2: he should drink hydrogen peroxide because he saw some ad
1:35:52
Speaker 2: that said hydrogen peroxide will fix your erections. And I said,
1:35:56
Speaker 2: please don't. But he really was seriously, earnestly asking me
1:36:01
Speaker 2: this question. And I didn't want to shame him by
1:36:04
Speaker 2: any means. And I was like, no, this is actually
1:36:06
Speaker 2: not safe and it's not going to help you. And
1:36:08
Speaker 2: there's no pill, there's no drink, there's no anything that's
1:36:12
Speaker 2: going to give you a longer penis.
1:36:15
Speaker 1: What are the cases that you see that break your heart?
1:36:18
Speaker 2: You know, I've seen patients who've had surgery to lengthen
1:36:22
Speaker 2: their penis and they are above average at baseline and
1:36:26
Speaker 2: they have these surgeries to lengthen their penis and then
1:36:29
Speaker 2: they have a bad outcome and now their penis is
1:36:32
Speaker 2: disfigured forever. And that's what really, you never forget that
1:36:36
Speaker 2: because that person, knowing the risks and benefits, perhaps made
1:36:39
Speaker 2: a choice and that choice didn't go the way they
1:36:42
Speaker 2: wanted and now they have to live with that for
1:36:43
Speaker 2: the rest of their life. And that's really sad.
1:36:46
Speaker 1: Gosh, yeah. Imagine that. Christ.
1:36:49
Speaker 2: Yeah.
1:36:50
Speaker 1: Well, and it just, it doesn't work anymore.
1:36:54
Speaker 2: Well, like the one patient I'm thinking of, um, he, uh,
1:36:59
Speaker 2: had a, like it, it basically developed a scar all
1:37:02
Speaker 2: at the top of the penis. So it was like
1:37:03
Speaker 2: disfigured essentially. Um, and so it was, it was really sad.
1:37:10
Speaker 1: Before I hit puberty, I definitely had a penis anxiety
1:37:13
Speaker 1: because I was the youngest in my year at school.
1:37:16
Speaker 1: And I, I was short, very, very short, very small.
1:37:20
Speaker 1: I remember what it felt like to hide my dick
1:37:24
Speaker 1: when I was around guys in the changing room and
1:37:26
Speaker 1: stuff like that. After puberty, things changed.
1:37:32
Speaker 2: And what I want people to understand, I think more
1:37:35
Speaker 2: than anything, is that you don't need a long penis
1:37:38
Speaker 2: to pleasure a partner. We just talked about how the
1:37:40
Speaker 2: clitoris is the most reliable route to orgasm, right? And
1:37:44
Speaker 2: so you don't need a penis- to stimulate the clitoris.
1:37:47
Speaker 2: You can use your mouth, your fingers, you can use
1:37:50
Speaker 2: a toy. There's so many ways to help your partner
1:37:54
Speaker 2: achieve pleasure. And And yes, of course, there are a
1:37:58
Speaker 2: small subset of women who really appreciate a large phallus,
1:38:01
Speaker 2: but the large majority of women, if you look at
1:38:03
Speaker 2: survey data, are very happy with the size of their partner,
1:38:07
Speaker 2: are very content with average or slightly above average or
1:38:10
Speaker 2: slightly below average, as long as they are feeling intimate
1:38:14
Speaker 2: and they're feeling pleasure. And so I think there's a
1:38:16
Speaker 2: misnomer that people think, if I have a longer penis,
1:38:20
Speaker 2: I'm going to be able to pleasure my partner more.
1:38:22
Speaker 1: As it relates to women, is there different size vaginas?
1:38:26
Speaker 2: Yeah, so just like there's averages, there's averages in females.
1:38:29
Speaker 2: And so average vaginal length is about three and a
1:38:32
Speaker 2: half inches. So when women get aroused, it expands and
1:38:37
Speaker 2: widens and lengthens to about double. So the average woman
1:38:41
Speaker 2: can easily accommodate the average penis, maybe slightly larger than average.
1:38:45
Speaker 2: And so I think generally speaking, knowing that like you
1:38:49
Speaker 2: will be able to fit in the average woman and
1:38:52
Speaker 2: you will be able to please her with the size
1:38:54
Speaker 2: of your phallus. And like I said, penetration is not
1:38:57
Speaker 2: as important. In fact, only about 85% of women orgasm
1:39:00
Speaker 2: through penetration alone. They need clitoral stimulation to achieve climax.
1:39:05
Speaker 2: And so again, penetration feels good. I tell guys it's
1:39:09
Speaker 2: like somebody rubbing your testicles or your perineum. That feels good,
1:39:14
Speaker 2: but it's not going to make you orgasm. And so penetrating, yeah,
1:39:17
Speaker 2: if you're getting a lot of clitoral stimulation because maybe
1:39:20
Speaker 2: she has a thinner, you know, her clitoral shaft is
1:39:23
Speaker 2: closer to the vaginal canal, maybe, you know, the size
1:39:26
Speaker 2: of the penis matters more. But for a lot of women,
1:39:29
Speaker 2: it's not going to be sufficient and they're going to
1:39:30
Speaker 2: need some directed clitoral stimulation.
1:39:33
Speaker 1: Why do different vaginas feel different? And I guess the
1:39:37
Speaker 1: inverse is also the case where like different penises will
1:39:40
Speaker 1: feel remarkably different even if they're the same size roughly.
1:39:43
Speaker 1: And you can have sex with somebody and go, it
1:39:46
Speaker 1: feels really good.
1:39:48
Speaker 2: I mean, I think, again, it's like the motion in
1:39:51
Speaker 2: the ocean, right? Like how you use your... So let's
1:39:54
Speaker 2: talk about the vaginas first. So when a vagina has
1:39:58
Speaker 2: more pelvic floor strength, they may be able to... like
1:40:02
Speaker 2: tense around the penis better. Like they may be able
1:40:04
Speaker 2: to sort of grab the penis with their pelvic floor
1:40:07
Speaker 2: a little stronger versus someone who doesn't. And that's where
1:40:10
Speaker 2: I think some people get worried when I say, oh,
1:40:11
Speaker 2: you need to relax your pelvic floor. They're like, oh,
1:40:13
Speaker 2: I don't want to be looser. Right. And that's not
1:40:16
Speaker 2: going to happen if you have a normally functioning pelvic floor.
1:40:19
Speaker 1: So the penis is going in here, right?
1:40:21
Speaker 2: Correct.
1:40:21
Speaker 1: So if you're a woman and you do pelvic floor exercises.
1:40:25
Speaker 2: They tend to feel tighter.
1:40:26
Speaker 1: Yeah.
1:40:27
Speaker 2: Well, you're able to contract and squeeze those muscles during
1:40:31
Speaker 2: sex better, right?
1:40:32
Speaker 1: Around the penis.
1:40:33
Speaker 2: Yes. But we don't want you to be tighter. We
1:40:35
Speaker 2: want you to be able to squeeze the muscles and
1:40:37
Speaker 2: relax the muscles. Use them like a normal muscle, like
1:40:40
Speaker 2: your bicep. You squeeze and relax, squeeze and relax. We
1:40:42
Speaker 2: don't want it to be constantly squeezed.
1:40:44
Speaker 1: But to the man, it will feel tighter.
1:40:45
Speaker 2: You will perceive it as tighter, but it will not
1:40:47
Speaker 2: be that she's actually tighter. It just means that maybe
1:40:49
Speaker 2: her pelvic floor muscles are doing a better job. So
1:40:53
Speaker 2: that's for the female. For the male, it's It's generally
1:40:56
Speaker 2: like how the penis moves and how the positioning is
1:41:00
Speaker 2: and where it's, it may be girth that's different. It
1:41:03
Speaker 2: may be the way that you're moving in the vaginal canal.
1:41:07
Speaker 2: And that may be why it feels different.
1:41:09
Speaker 1: They often say that if you've got big feet or
1:41:11
Speaker 1: big hands, you know, like people think you have a
1:41:14
Speaker 1: big penis.
1:41:15
Speaker 2: Not necessarily true. So there's actually no evidence that big hands,
1:41:20
Speaker 2: big feet correlate to penile size. There's one study in
1:41:22
Speaker 2: Japan where they looked at nose length. And so the
1:41:26
Speaker 2: longer your nose is from the bridge down to the tip,
1:41:30
Speaker 2: that is potential, at least the Japanese population that they
1:41:34
Speaker 2: studied was correlated with the length of the penis.
1:41:39
Speaker 1: People also think tall people have big penises.
1:41:42
Speaker 2: Not necessarily.
1:41:45
Speaker 1: But nose length, there's some correlation in a study in Japan.
1:41:48
Speaker 2: Yes.
1:41:49
Speaker 1: Okay. Let's just check my nose.
1:41:51
Speaker 2: Okay.
1:41:53
Speaker 1: The last thing I want to talk to you about
1:41:54
Speaker 1: is Ozempic and how this relates to everything we've talked
1:41:58
Speaker 1: about today, desire, attraction, sex. Is there any early data
1:42:01
Speaker 1: emerging that shows any correlations?
1:42:03
Speaker 2: Yeah. So Ozempic, there's sort of benefits and there's potential downsides.
1:42:07
Speaker 2: So the benefits are that when you're on Ozempic, we
1:42:10
Speaker 2: see improvements in metabolic diseases. They have improvements in diabetes,
1:42:14
Speaker 2: improvements in heart disease, improvements in overall health, right? And
1:42:18
Speaker 2: so that is going to mean that your blood vessels
1:42:21
Speaker 2: are healthier. You're more able to get blood flow to
1:42:24
Speaker 2: your genitals, you're going to have stronger sexual function and arousal, right?
1:42:28
Speaker 2: So that's great. The other thing is that you are
1:42:31
Speaker 2: losing weight, so you feel better. You feel more like
1:42:34
Speaker 2: your body image is feeling good about yourself. Also for men,
1:42:38
Speaker 2: remember I talked about this fat pad right above your penis,
1:42:42
Speaker 2: that's getting smaller. And so now you can see more
1:42:45
Speaker 2: of your penis. So you may have heard of a
1:42:49
Speaker 2: It's not actually that your penis is getting longer. It's
1:42:51
Speaker 2: that this fat is going down. So now you're seeing
1:42:53
Speaker 2: more of your penis.
1:42:54
Speaker 1: Which makes it look longer.
1:42:56
Speaker 2: Yes, exactly. Well, it is reality to the person looking, right?
1:43:02
Speaker 2: So those are all great things. And I think that's wonderful. Now,
1:43:06
Speaker 2: the other part of it is Ozempic works on the
1:43:08
Speaker 2: brain and it works on the reward pathway. So you
1:43:11
Speaker 2: now see food and you don't feel like it's that
1:43:13
Speaker 2: much of a reward. So you don't chase after it.
1:43:15
Speaker 2: You have less desire for food. There's emerging data that
1:43:18
Speaker 2: we're seeing people on these medications, these GLP-1s, have less
1:43:21
Speaker 2: desire for, let's say, gambling, let's say, shopping, let's say, alcohol, smoking,
1:43:27
Speaker 2: whatever it is, right? And so there's a theoretical, because
1:43:30
Speaker 2: it works on the same pathways, that it could also
1:43:32
Speaker 2: decrease desire for sex. And I think the thing that,
1:43:36
Speaker 2: there's so many people on these medications, there's so many
1:43:39
Speaker 2: metabolic benefits that I worry that people may not even
1:43:42
Speaker 2: realize that their sexual desire is changing, right? They might
1:43:45
Speaker 2: just be like, oh, you know, I'm eating less. I
1:43:48
Speaker 2: look great. Everything's wonderful. But like slowly in the background,
1:43:51
Speaker 2: they're like, oh, maybe my desire is less and maybe
1:43:54
Speaker 2: it's creating discord in the relationship. Hard to say because
1:43:57
Speaker 2: we don't have data yet. So yeah, I think it's
1:43:59
Speaker 2: just something that you should be aware of that if
1:44:01
Speaker 2: you start feeling like you have less desire for sex,
1:44:04
Speaker 2: or maybe you're like, man, I just really don't feel
1:44:06
Speaker 2: into anything. Talk to your doctor because maybe your dose
1:44:10
Speaker 2: is just too high and maybe it just needs to
1:44:11
Speaker 2: come down a little bit. And again, we don't know yet,
1:44:14
Speaker 2: but I do worry about this because I feel like
1:44:17
Speaker 2: we're going to start seeing it.
1:44:19
Speaker 1: Is it possible to do studies on this type of thing? Absolutely.
1:44:22
Speaker 2: So you can take people starting Ozempic and you can say, hey,
1:44:26
Speaker 2: here is, or any GLP-1, you know, there's questionnaires. So
1:44:29
Speaker 2: like for women, there's a female sexual function index. For men,
1:44:32
Speaker 2: there's ADAM, which is a questionnaire about testosterone, but there's
1:44:35
Speaker 2: sexual desire questionnaires that you can use. And you can
1:44:38
Speaker 2: take it at the beginning and then you can take
1:44:40
Speaker 2: it as they increase their dose and see if there's
1:44:42
Speaker 2: a change. right? In terms of their sexual desire.
1:44:45
Speaker 1: You said at the start about knowing how to talk
1:44:48
Speaker 1: to your partner. I think like intimacy desire, maybe the
1:44:51
Speaker 1: conversations like with your partner, how to have that conversation
1:44:53
Speaker 1: when there's a problem. Yeah.
1:44:55
Speaker 2: I wish I could say there's like a script that
1:44:56
Speaker 2: you can follow and it's going to work, but everyone's
1:44:58
Speaker 2: so different. But I think the important thing is like
1:45:01
Speaker 2: not giving up because what happens is because we don't
1:45:04
Speaker 2: ever talk about sex, when you bring it up, it's
1:45:07
Speaker 2: immediately like, oh my God, is something wrong? Did I
1:45:09
Speaker 2: do something wrong? Do you not like me? Am I
1:45:11
Speaker 2: not attractive? You're automatically going down the rabbit hole of
1:45:14
Speaker 2: worry and concern. And instead of dealing with it, you're
1:45:17
Speaker 2: just going to shut it down. No, I don't want
1:45:18
Speaker 2: to talk about it. Especially if maybe you haven't connected
1:45:21
Speaker 2: intimately in a while and you just don't want to
1:45:23
Speaker 2: deal with that or you have other stressors in life.
1:45:27
Speaker 2: Maybe you're not feeling very good about yourself. And so
1:45:30
Speaker 2: you're like, well, I don't really feel sexy, so I
1:45:32
Speaker 2: don't want to have sex. And so I think really
1:45:34
Speaker 2: understanding that whatever reaction you get from your partner, when
1:45:37
Speaker 2: you do talk to them, it's not about you. It's
1:45:39
Speaker 2: just usually about how they're feeling. And so don't stress
1:45:42
Speaker 2: about that. And two, it's anything that is worth having
1:45:47
Speaker 2: requires work. So having a good sex life, having intimacy
1:45:51
Speaker 2: over the long haul with someone, if you are committed
1:45:54
Speaker 2: to that relationship, it is worth working for. It is
1:45:57
Speaker 2: worth dealing with a little bit of discord to get there.
1:46:00
Speaker 2: And so- I tell people when you want to talk
1:46:02
Speaker 2: about sex, first of all, don't do it in the bedroom.
1:46:04
Speaker 2: Don't do it right before or after sex. Do it
1:46:07
Speaker 2: at a time where you are both calm, relaxed. Maybe
1:46:09
Speaker 2: you're out for a walk. Maybe you're in the car.
1:46:11
Speaker 2: So you're not like looking directly at each other. You're
1:46:13
Speaker 2: going to kind of parallel. And always start with a
1:46:15
Speaker 2: positive thing. Like I, you know, I really enjoy this
1:46:18
Speaker 2: about our relationship. And I would love if we could
1:46:21
Speaker 2: talk about this. And maybe they're going to be like,
1:46:24
Speaker 2: I'm not ready for that. And you'll say, maybe we
1:46:26
Speaker 2: could come up with a time where we can talk
1:46:27
Speaker 2: about this that works for you. Right? Let them feel
1:46:30
Speaker 2: like they're coming to the conversation with like space. they're
1:46:32
Speaker 2: not being ambushed or like talking about something. And then
1:46:35
Speaker 2: be curious. I think the big thing is like being curious,
1:46:38
Speaker 2: like what's going on with you? Like, I want to
1:46:41
Speaker 2: be there for you. I love you. You know, I
1:46:43
Speaker 2: miss what we used to have, or I miss this
1:46:45
Speaker 2: about us. And I think that there's always these misconceptions.
1:46:49
Speaker 2: I hear it all the time, right? It'll be like,
1:46:51
Speaker 2: this partner only wants sex and this partner never wants sex. And,
1:46:55
Speaker 2: you know, and that's it. Like that's the end of
1:46:57
Speaker 2: the conversation. But the reality is that it's somewhere in between.
1:47:01
Speaker 2: So typically- Women tend to view sex as like added
1:47:05
Speaker 2: stress sometimes when they're already stressed. Like they're like, oh,
1:47:08
Speaker 2: it's just one more thing to do. Whereas men look
1:47:10
Speaker 2: at it as a stress relief. So one, you're coming
1:47:13
Speaker 2: at it from two different angles. The other thing is
1:47:15
Speaker 2: men aren't really taught how to be intimate. And so
1:47:18
Speaker 2: for a lot of men, sex is their version of intimacy.
1:47:22
Speaker 2: Like that's how they connect. That's how they feel connected
1:47:24
Speaker 2: with a partner. And so oftentimes when they're doing these
1:47:29
Speaker 2: initiations or attempts at sex, It feels like they're being
1:47:32
Speaker 2: greedy or it feels like they're, they just want sex.
1:47:34
Speaker 2: And I think we have to reframe how we look
1:47:36
Speaker 2: at that. Like sex is not just sex. It is intimacy.
1:47:39
Speaker 2: It is being together, connecting with another human being. So
1:47:42
Speaker 2: how do we do that? Right. And like, how do
1:47:45
Speaker 2: we make that sex worth having? We get into this
1:47:48
Speaker 2: frame where we have sex as like in a hurried, quick,
1:47:52
Speaker 2: like just got to get this done way. I just
1:47:54
Speaker 2: need to get an orgasm. I just need to get
1:47:55
Speaker 2: a release. But sex is supposed to be something we
1:47:58
Speaker 2: look forward to. It's supposed to be something that we're
1:48:00
Speaker 2: excited about. And so we have to build that in.
1:48:02
Speaker 2: We have to sort of like build the environment where
1:48:05
Speaker 2: sex can happen. So it may mean like, hey, we
1:48:09
Speaker 2: are affectionate during the day. Maybe we send a lovey
1:48:12
Speaker 2: text message. Maybe um you know i give you a
1:48:14
Speaker 2: hug i caress your back i um tell you you
1:48:17
Speaker 2: look beautiful i i'm showing you gratitude for how much
1:48:20
Speaker 2: i care about you in other ways i think just
1:48:22
Speaker 2: really taking the time to understand why your partner feels
1:48:26
Speaker 2: the way they do i'm curious.
1:48:27
Speaker 1: About on that communication point about how different genders in
1:48:31
Speaker 1: heterosexual couples have different sort of taboos and things that
1:48:34
Speaker 1: are just a bit sensitive um And I was looking
1:48:37
Speaker 1: at the variance between men and women. And the top
1:48:41
Speaker 1: one for men was around performance anxiety. So like admitting
1:48:43
Speaker 1: to things like erectile dysfunction, because it feels like it's
1:48:46
Speaker 1: so intrinsically connected to masculinity. And you feel like a
1:48:49
Speaker 1: failure as a man if you can't get an erection
1:48:51
Speaker 1: and pleasure your partner. And then for women, it was
1:48:54
Speaker 1: talking about prioritizing pleasure and asking for more foreplay or
1:49:01
Speaker 1: specific stimulation around the clitoris or something like that. because
1:49:05
Speaker 1: they don't want to be labelled as high maintenance or
1:49:08
Speaker 1: too much hard work, etc. And it's interesting that on
1:49:11
Speaker 1: that walk with your partner, there are different things that
1:49:14
Speaker 1: will trigger each of you. Other ones for women were
1:49:18
Speaker 1: pain and discomfort, bringing that up, body image and the
1:49:21
Speaker 1: mental load, explaining why you aren't in the mood. And
1:49:24
Speaker 1: other ones for men are expressing non-sexual needs because it
1:49:26
Speaker 1: might be seen as unmanly, boundaries and rejection, communicating when
1:49:30
Speaker 1: they don't want sex. And lastly, the script, which is
1:49:32
Speaker 1: discussing fantasies that deviate from the norm.
1:49:35
Speaker 2: So I want to talk about fantasy. But before that,
1:49:37
Speaker 2: I would just say that, you know, because of social media,
1:49:40
Speaker 2: we're in a place and I get text messages from
1:49:42
Speaker 2: my husband 24 hours a day with like, not 24
1:49:44
Speaker 2: hours a day, but like all waking hours with reels
1:49:48
Speaker 2: and videos. Oh, I think you'd like this. I think
1:49:50
Speaker 2: you'd like this. You should check this out. And it's
1:49:52
Speaker 2: like his way of like connecting and like, hey, let's
1:49:54
Speaker 2: talk about this later. Like, this is fun. And so
1:49:56
Speaker 2: I tell my patients, send your partner a video that
1:50:00
Speaker 2: you saw on social media that might help them understand
1:50:03
Speaker 2: why this is important to you. Maybe send them a video,
1:50:05
Speaker 2: send them this podcast, right? Say like, hey, I watched this.
1:50:08
Speaker 1: It was great.
1:50:10
Speaker 2: And I learned so much. And honestly, so many patients
1:50:13
Speaker 2: bring their partners to me, whether it's women bringing male
1:50:15
Speaker 2: partners or men bringing female partners, they come to me
1:50:18
Speaker 2: and they say, look, I want you to meet this
1:50:20
Speaker 2: doctor and I want you to talk to them. And
1:50:22
Speaker 2: it's beautiful to see that. I love it because It's,
1:50:25
Speaker 2: it's so deeply caring that they like brought their partner
1:50:28
Speaker 2: and they want them to feel good and they just
1:50:30
Speaker 2: want to figure out what's going on. And like, I
1:50:33
Speaker 2: think it's so lovely to, to, to find someone who's
1:50:35
Speaker 2: so invested in making sure that sex is good for you.
1:50:38
Speaker 1: Right. As men though, we're just not good at talking
1:50:40
Speaker 1: about this stuff. Right.
1:50:41
Speaker 2: But you know, I think you can't use that as
1:50:43
Speaker 2: a crutch.
1:50:44
Speaker 1: Yeah.
1:50:44
Speaker 2: Do you know what I mean?
1:50:45
Speaker 1: Like. Yeah, I do. Yeah. We're just not good at
1:50:47
Speaker 1: it though.
1:50:47
Speaker 2: But no one's good at it. It's not men. Women
1:50:49
Speaker 2: are not good at it either.
1:50:50
Speaker 1: I think men are worse at it.
1:50:52
Speaker 2: I think in general, no one is good at talking
1:50:54
Speaker 2: about sex. Like, you know, I think it's interesting because
1:50:57
Speaker 2: I talk about it all the time, but I have
1:50:59
Speaker 2: seen very good communicators struggle with talking about sex. And
1:51:04
Speaker 2: so I think it's just, it's just, it's uncomfortable. And
1:51:08
Speaker 2: it's like, if you and I can have this conversation
1:51:11
Speaker 2: and we can talk about sex openly, like there's no
1:51:13
Speaker 2: reason that you can't learn how to talk about sex.
1:51:16
Speaker 2: And it's a learning process and it's worth investing in.
1:51:20
Speaker 1: Do people bring you their fantasies?
1:51:22
Speaker 2: Yeah, I've had, well, not as many fantasies as like
1:51:26
Speaker 2: real sort of diverse interests in sex.
1:51:30
Speaker 1: What do you mean by that?
1:51:30
Speaker 2: So I had a patient who came to me and said,
1:51:33
Speaker 2: you know, after some time, this was not like their
1:51:36
Speaker 2: first visit, like we built a rapport and he told me,
1:51:39
Speaker 2: you know, I really struggle with arousal and the only
1:51:42
Speaker 2: time I get aroused is I have a medical kink.
1:51:45
Speaker 2: And so I go to this person who will put
1:51:47
Speaker 2: a Foley catheter in me and that's what turns me on.
1:51:51
Speaker 2: And I was like, that's really interesting. And I was like, okay,
1:51:54
Speaker 2: that's great. But it took a long time for us
1:51:56
Speaker 2: to get there, for him to feel comfortable. But it
1:51:58
Speaker 2: also then was like, well, if that's what turns you on,
1:52:01
Speaker 2: then you've got to sort of explore other ways to
1:52:03
Speaker 2: incorporate that with a partner. What is that? So like
1:52:06
Speaker 2: a catheter is a tube that you put in the
1:52:10
Speaker 2: bladder to drain urine.
1:52:13
Speaker 1: What hole does that go in?
1:52:14
Speaker 2: The urethra.
1:52:15
Speaker 1: It goes in the penis?
1:52:16
Speaker 2: Correct. And so there's actually a lot of people who
1:52:18
Speaker 2: enjoy urethral play. So they will take They're called sounds
1:52:22
Speaker 2: like little rods with a flared base and they will
1:52:27
Speaker 2: insert them in the urethra. But people do find that pleasurable.
1:52:31
Speaker 2: And so because there is some, you know, there's some
1:52:34
Speaker 2: nerve endings there that can be pleasurable. And so, again,
1:52:37
Speaker 2: it is totally fine to have interests that are, you know,
1:52:40
Speaker 2: outside what we call conventional. But of course, I think
1:52:43
Speaker 2: you need to, if that's something that you're really into,
1:52:46
Speaker 2: you have to sort of bring your partner into the
1:52:48
Speaker 2: fold if that's what really gets you turned on. Now,
1:52:51
Speaker 2: in terms of fantasies, almost everyone fantasizes, right? Almost everyone does.
1:52:55
Speaker 2: And the interesting thing when you look at fantasies is
1:52:59
Speaker 2: there's a lot of fantasies that you would think are
1:53:01
Speaker 2: not common, but are. So for example, being sexually submissive
1:53:06
Speaker 2: is very common. So women fantasize about it, like around 60%.
1:53:11
Speaker 2: Men are like 20% having this desire of sex, this
1:53:15
Speaker 2: fantasy of sexual submission. It may not mean that they
1:53:17
Speaker 2: want to be submissive in real life, but that's the
1:53:19
Speaker 2: fantasy they're having. Men often have voyeurism fantasies, so like
1:53:24
Speaker 2: watching sex. They also have sex with multiple partners. Women
1:53:31
Speaker 2: tend to have a lot of like sexual dominance, but
1:53:34
Speaker 2: also romance in their fantasies. So like in exotic places
1:53:38
Speaker 2: or with a lot of times, like 90% of the
1:53:41
Speaker 2: time people fantasize about strangers. Or it could be someone
1:53:44
Speaker 2: they know, but outside of their relationship. And so that's
1:53:46
Speaker 2: completely normal and nothing to be worried about. It doesn't
1:53:49
Speaker 2: mean that like you want that person. It's just a fantasy.
1:53:51
Speaker 2: It's a safe place in your head to think about fantasy.
1:53:54
Speaker 2: And I think one realizing that if someone fantasizes about something,
1:53:57
Speaker 2: it means nothing about how they feel about you. It's
1:53:59
Speaker 2: just where their brain goes to explore. I tell my
1:54:02
Speaker 2: patients sometimes, write down your fantasies for yourself. Just like
1:54:04
Speaker 2: write them down. Don't share that with anybody and have
1:54:07
Speaker 2: your partner do the same. And then if you guys
1:54:09
Speaker 2: decide you feel comfortable at some point to each share
1:54:11
Speaker 2: one fantasy and And you can start, and maybe one
1:54:13
Speaker 2: that you would want to try. And like, it allows
1:54:15
Speaker 2: you to sort of explore and think about different things.
1:54:18
Speaker 2: It could be a negative outcome. Like you could just
1:54:20
Speaker 2: be like, oh no, this didn't do it for me.
1:54:22
Speaker 2: But it could also be very positive. And so just like, again,
1:54:25
Speaker 2: I think the big thing is understanding like it doesn't
1:54:27
Speaker 2: need to be that serious. Like we can experiment, we
1:54:29
Speaker 2: can play, we can have fun. And if you bring
1:54:32
Speaker 2: that back into your life, you are going to be happier,
1:54:35
Speaker 2: less lonely, live longer. Like everyone should just be having
1:54:39
Speaker 2: more sex.
1:54:41
Speaker 1: Thank you. It's interesting that we're getting more and more
1:54:45
Speaker 1: sexless because I think the world is stealing our attention
1:54:49
Speaker 1: and that's causing a big loss in connection. But then
1:54:52
Speaker 1: everyone's lives are more stressful than ever before. If a
1:54:54
Speaker 1: bomb goes off 10,000 miles that way, I see it
1:54:58
Speaker 1: when I open my phone. So it's an interesting time
1:55:01
Speaker 1: to sort of almost try and reclaim sex and to
1:55:05
Speaker 1: work on one's sexual health, the full picture of one's
1:55:10
Speaker 1: sexual health You're working on a book, which is, I guess,
1:55:13
Speaker 1: endeavoring to do much of that, which is coming out
1:55:15
Speaker 1: in September called The Hard Truth. Everything men need to
1:55:18
Speaker 1: know about good health, great sex and long life. So
1:55:21
Speaker 1: if you're watching this after the 1st of September, 2026,
1:55:24
Speaker 1: or around that time, then the book is probably available
1:55:27
Speaker 1: for pre-order or already out. It's not available for pre-order yet,
1:55:30
Speaker 1: is it?
1:55:30
Speaker 2: It will be soon, but not yet. Okay.
1:55:33
Speaker 1: When the book is out, I'm going to link it
1:55:34
Speaker 1: below in the comment section when it's available for pre-order.
1:55:37
Speaker 1: The Hard Truth, Everything Men Need to Know About Good Health,
1:55:39
Speaker 1: Great Sex, and Long Life. So if the subjects we
1:55:41
Speaker 1: talked about today have piqued your interest, the book, I imagine,
1:55:45
Speaker 1: is going to go into greater detail on all of
1:55:47
Speaker 1: these subjects.
1:55:48
Speaker 2: Absolutely. I think it's a book that really I wish
1:55:51
Speaker 2: was a part of sexual education. I think all men
1:55:54
Speaker 2: need to know this. You know, as women, we end
1:55:56
Speaker 2: up taking care of our male partners. I make all
1:55:59
Speaker 2: the doctor's appointments. I organize all of that. I make
1:56:03
Speaker 2: sure that my kids get all their vaccines, all that
1:56:05
Speaker 2: sort of stuff. And it becomes on us to take
1:56:08
Speaker 2: care of our fathers too. And so as women, we
1:56:10
Speaker 2: hold that role. And I think it is so valuable
1:56:13
Speaker 2: to understand what men go through and also to be
1:56:17
Speaker 2: able to support them along the way. And I you know,
1:56:21
Speaker 2: men in your life or for, you know, older sons
1:56:25
Speaker 2: even to like help people understand their bodies. And honestly,
1:56:28
Speaker 2: it's a huge motivator. I tell people like for nothing else,
1:56:31
Speaker 2: people care about sex. And I have seen patients turn
1:56:34
Speaker 2: around their lives because they want to have better sex.
1:56:37
Speaker 2: They'll literally improve their blood sugars. They'll improve their blood
1:56:41
Speaker 2: pressure because they just want to protect their sexual health.
1:56:44
Speaker 1: Reena, thank you. We have a closing tradition on this
1:56:47
Speaker 1: podcast where the last guest leaves a question for the
1:56:48
Speaker 1: next guest, not knowing who they're leaving it for. This
1:56:51
Speaker 1: is the first time in Diary of a Serial History
1:56:53
Speaker 1: where the guest has actually stamped it with a stamp
1:56:56
Speaker 1: that says certified 100% human.
1:56:59
Speaker 2: Okay.
1:57:00
Speaker 1: So you can see there's a little stamp.
1:57:02
Speaker 2: So it's not AI.
1:57:03
Speaker 1: So it's not AI. And it actually says that in
1:57:05
Speaker 1: the middle. It says, Gen AI free. Sign of things
1:57:09
Speaker 1: to come. But that question, I guess, is somewhat linked
1:57:11
Speaker 1: to that. The question they've asked for you is, So
1:57:14
Speaker 1: much of the world feels hopeless about this moment. What
1:57:18
Speaker 1: would you tell someone to help them reclaim their agency?
1:57:29
Speaker 2: I think that we as humans are meant to be
1:57:36
Speaker 2: with other humans. We are meant to connect. And I
1:57:40
Speaker 2: think making that a priority will allow people to feel
1:57:44
Speaker 2: a part of something again. I think there is an
1:57:51
Speaker 2: emergence of people starting to look back at religious constructs
1:57:56
Speaker 2: and go to community and be a part of things
1:57:59
Speaker 2: and enjoy live events again like we weren't doing before.
1:58:02
Speaker 2: And I think if we prioritize that, there is still
1:58:04
Speaker 2: hope that we can come together as a society. And
1:58:08
Speaker 2: I think you know, the pendulum always swings, right? In
1:58:11
Speaker 2: every way, like it's going to go far right or
1:58:13
Speaker 2: far left and people are going to hate each other
1:58:16
Speaker 2: and then they're going to love each other and they're
1:58:17
Speaker 2: going to come back. And I think if you just
1:58:19
Speaker 2: look at history time and time again, it repeats itself
1:58:22
Speaker 2: and we will find unity and we will find togetherness.
1:58:27
Speaker 2: We are obviously feeling pain from a variety of different
1:58:30
Speaker 2: sources and we may feel pain, right? Like in terms
1:58:33
Speaker 2: of other things to come. But ultimately, I'm an optimist
1:58:37
Speaker 2: and I think that we'll come together and we will
1:58:39
Speaker 2: find happiness and joy in human connection.
1:58:44
Speaker 1: And I hope you're right. I think we're seeing the
1:58:46
Speaker 1: early signs of that now. For anyone that's listening that
1:58:49
Speaker 1: wants to learn more from Reena, I highly recommend they
1:58:52
Speaker 1: go to your YouTube channel. I will collab if we can.
1:58:54
Speaker 1: And if we do collab on YouTube, you'll see a little,
1:58:58
Speaker 1: Smiling Rina, next to the Diary of a Seal logo
1:59:00
Speaker 1: where you can click through to her YouTube channel. She's
1:59:03
Speaker 1: got almost 3 million subscribers and she goes through all
1:59:06
Speaker 1: of the questions which no one has ever answered for us.
1:59:09
Speaker 1: And I was looking at some of the questions that
1:59:10
Speaker 1: you answer for people, everything from why you dribble after
1:59:14
Speaker 1: you pee and how to stop it. Porn director reveals
1:59:19
Speaker 1: what scenes are faked in almost every scene of movies.
1:59:22
Speaker 1: But then also a lot of the stuff we've talked
1:59:23
Speaker 1: about today around penal health, erectile dysfunction. sex positions, and
1:59:29
Speaker 1: so much more. So it's a wonderful repository of information
1:59:33
Speaker 1: that is constantly being updated. That is a great place
1:59:35
Speaker 1: to subscribe. So I highly recommend you do.
1:59:37
Speaker 2: Dr.
1:59:37
Speaker 1: Rina, thank you so much for your time.
1:59:39
Speaker 2: You're so welcome.
1:59:40
Speaker 1: YouTube have this new crazy algorithm where they know exactly
1:59:43
Speaker 1: what video you would like to watch next based on
1:59:45
Speaker 1: AI and all of your viewing behavior. And the algorithm
1:59:48
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1:59:52
Speaker 1: It's different for everybody looking right now. Check this video out.
1:59:55
Speaker 1: I bet you, you might love it.