Kind: captions
Language: en
you're doing sex wrong you're taking
advice from the wrong people you don't
understand female anatomy and you're
almost certainly abusing your body and
making all of your deepest insecurities
worse the good news is for most men it's
pretty straightforward to turn it all
around even if the thing you're most
worried about is your penis size
researching for this episode absolutely
blew my mind and it's going to blow
yours as well so buckle up because
joining me today is urologist and
YouTube sensation Dr Dr Reena Malik men
are obsessed with getting as big as they
can get mhm should they be assuming
they're in a heterosexual relationship
how much do women care so this is a
great question I'm glad you asked it
because ultimately 85% of women need
some form of clitoral stimulation to
achieve orgasm which means that they
don't need a penetrating a penis
penetrating them to achieve orgasm and
so some women actually find it
uncomfortable to have a large penis
penetrating them and actually when you
look at the data so the average penal
length is about 5.1 to 5.7 in depending
on the study you look at when you look
at the type of sex toys women by it's
about 6 in in length which is obviously
they're not putting the whole sex toy in
right they're holding it at the end so
it's probably around the same length as
it as the average length and the girth
is also so similar to average girth and
so what that lends to itself is to say
that women prefer what's around average
on average so the average woman
appreciates the average size for them
and so having more can actually be
painful so some women find when it's
longer right it's going to hit the
cervix more likely some women find that
very pleasurable and can even orgasm
from that whereas some women don't find
that pleasurable and find it painful and
so it's really individual based on the
pur person if they find that uh
comfortable or enjoyable and so not
every woman wants a very large penis we
joke about it all the time we talk about
it all the time because society makes it
like seem like this is the be all end
all having a big penis right women talk
about it men make fun of other men like
it's it's a whole thing right but it's
all societal it's not actually what
happens in the bedroom I was looking up
studies to see like okay is there data
backing this up and there was a really
interesting one that I may have heard
from you that uh if you look at the toys
that women buy like across all these
different companies that sell it that to
your point like they could get any size
they want and they fall within that sort
of average-ish range so then what is it
that you think because I I don't think
that Society happens alone first
celebrating a big penis and then oh it
just gets in our heads I think there's
probably a mix of it matters on some
level now maybe that's just purely
psychological but do you have a sense of
psychological for men do you have a
sense of like what creates this societal
obsession with size well I think that
ultimately as we were talking about kind
of earlier there's a lack of knowledge
about how to pleasure women and so women
the the clitoris is the only organ in
all of the the human body that is
specifically made for pleasure and the
clitoris is located above the urethra so
above the vagina and goes wraps around
the vagina like a wishbone and so if you
have a more girthy or larger penis you
may be more likely in some cases to
cause orgasm through penetration than
you would if you had maybe a a a more
narrow or less you know smaller penis
and so I think that's probably where it
comes from is that you know obviously we
know penetration is needed for
reproduction like you have to have
penetration you have to deposit sperm
like maybe having a longer penis makes
sperm more likely to get into the cervix
but that hasn't been at least shown in
the data to my knowledge um so
ultimately my thought is and this is
just a a hypothesis is that because if
you're looking at only penetration as a
source of pleasure and you're not
looking at cliteral stimulation then if
you have a more girthy or a larger penis
you may be more likely to stimulate or
push on some of that clitoral tissue to
cause more pleasure can a man actually
enlarge his penis is that real yes so
the short answer is yes but can he do it
safely so there's lots of Investigation
in this area in terms of length um
they've looked at traction devices which
do show some benefits so you can buy
over the counter traction devices that
if you use for prolonged periods of time
the first studies were were like 6 to 8
hours a day for like months right and
then you will see some improvement in
length like 2 cenm which by the way the
first time I heard you say that I
thought that was a tiny amount cuz I was
thinking 2 millimeters 2 centimeters is
like 3/4 of an inch it's yes it's so I I
said the same thing I'm like it's not
that much but you know it is something
so it's 15% based on the average right
based on the average so certainly you
can um there are now newer traction
devices on the market that claim to do
similar with like 30 minutes twice a day
um so you can use traction devices uh
vacuum erection devices which are
different they actually cause um the way
they work is blood flows into the penis
and um it causes erections right and
then um that over time they they found
it does not contribute to length now
girth um some people will claim that it
does but when you look at sort of large
like large scale data in humans it has
not shown to really be beneficial in
terms of girth um and then there's just
pump harder I'm kidding I'm kidding well
I mean some people will say you to pump
for 20 minutes a day or whatever I I
don't you know I don't claim to think
that it really does that much but maybe
maybe there's some you know small
studies that prove that um ultimately in
terms of other things right so you can
have surgical things to lengthen the
penis now they've done a whole bunch of
different studies they've used like um
bone graphs they've used fat they've
used all sorts of different things the
the newest thing on the market is called
panuma which is an implant that you put
in the penis that's like a sleeve um
it's like a silicone sleeve that goes on
top of the erectile tissue now the
initial data was very promising um I
will say that I have seen personally
patients with issues with that
particular surgery and they do that to
enlarge the penis it g makes it girth
your and enlarges it so again there is
nothing that you can do that is not
without risk of true serious damage to
your penis like losing sensation um
having a bad outcome having to have
repeat surgery so at this point in time
we don't have anything that is even
nearly as safe as like a breast implant
for SE per se because that's what people
compare it to they're like well women
can enlarge their breasts why can't I
enlarge my penis and right now you could
but it's certainly not safe yeah surgery
terrifies me that strikes me as a really
bad idea unless you are just like in the
micro Zone yeah uh but the traction
thing so I literally stopped the entire
office yesterday and I was like Hey for
a second can I talk as the host of a
show and not the CEO of the company yeah
and I was like yeah sure I said penis
enlargement is real so when I first
heard you say it about traction I was
like there's no way this is real and so
I started like doing more research and
one I went and looked at the actual
study that you've been citing the 2 cm I
I was flabbergasted to see that that is
actually a thing so the let's set aside
all the super highrisk stuff cuz that
really freaks me out and I would not
want anybody because look guys are so
insecure about this and so I don't want
somebody to hear this and uh go grab a
vacuum cleaner and try to like get
somewhere right bad idea you don't want
to do something certainly surgically
that could end up damaging the tissue
now you're just in a way worse situation
but the traction so what what is
traction mhm
and how on the spectrum of safety where
does that one fall so essentially the
way this particular traction device
works or this family of traction devices
work is it has like a little circle that
goes on the around the penis and then
you put the penis in like the traction
part of it and then it gently puts it on
stretch so sort of like tissue expanders
like you're slowly using stretch a
tissue expander so sorry in medicine we
do tissue expanders for for example for
breast implants you will use a tissue
expander to help make space for the
implant and so it's in variety of
different uses in medicine but that's
the most commonly known one so
essentially you're using constant
tension on the tissue to stretch it out
basically and so that's how it works and
there's a whole variety of different
ones but generally speaking they're just
stretching the penis is it like creating
micro damage that then is being healed
and because you're stretching it so much
in the damage position it gets bigger
well so you're this is actually a good
point because some people will try to
stretch it manually with a technique
called jelking and so it's essentially
using your fingers and like pressure to
stretch it yourself in that case you can
get micro tears and micro traumas that
can eventually lead to erectile
dysfunction and so I don't recommend
that these devices are actually meant to
just put enough tension that you're just
causing stretch but you're not causing
damage so ideally you want to get
medical grade traction device devices if
it looks too good to be true don't buy
it right like but medical grade traction
devices are typically you know tested
and assessed for safety so that they're
not going to harm the tissue now risks
are bruising certainly they can be feel
uncomfortable um it's just very
difficult to sort of arrange your life
in a way that you're constantly doing it
but if you're motivated enough certainly
people will make the time I'm telling
you right now there are guys out there
that have the motivation because I know
in the beginning of this you were saying
that uh people were having to do it like
six hours a day or something outrageous
and people were still doing it yeah uh
that seems crazy but
hey now if it's 30 minutes twice a day
my question becomes is there an upper
limit so I looked at the study and it
was like okay if you do 30 days it's
like this increase 60 days it's more
increase 90 days then it went all the
way to the 2 centimet but they didn't
say 120 days there's no additional
benefit so 10 years from now are people
going to be backing up dump trucks to
carry their stuff around like where
where are we going do you think there's
an upper bound I yeah there probably is
like there's only so much you can
stretch tissue right you're not going to
um to the point where yeah I guess at
some point you may start saying like
Okay like I like this is not leading to
more results um but again they haven't
studied that so I couldn't tell you
exactly when that's going to be I mean
some people may see that their upper
limit is at 30 days some people may see
that it's at 90 days I think it's going
to be variable personto person um but
ultim Ely you know the other issue is
right these are probably young healthy
guys they recruit in the study once
you've developed issues with erection so
say you have that the most common cause
is vascular problems or blood flow to
the penis say you've developed vascular
problems because you've got high blood
pressure diabetes or some other like
cholesterol or other issues that affect
blood flow then the tissues themselves
will change if they're not getting
regular erections you won't have as much
collagen content in your tissues and it
will then cause fibrosis or scarring and
then you're not going to be able to
stretch that tissue as much as you would
have if you did it when you were
healthier per
se okay so uh erectile dysfunction is a
super interesting topic in terms of what
I will call a self-inflicted wound so I
know a lot of the conversation about it
is is this hormonal is this about low
testosterone from what I've seen in the
literature it seems to be like way way
way more more than um sorry way out
getting close to 100% is blood flow
problems um so how do we keep it healthy
and if somebody has gone down the Ed
path and they want to use traction how
do they back into a healthy state so
that then they can yeah extend so for
erectile dysfunction let's just start
from the basics right erectile
dysfunction is caused by five major
things blood flow being the most common
es particularly when you're older above
50 in the younger age group psychogenic
causes are more common meaning that it's
because of stress anxiety or other
factors that are playing perance
performance anxiety but it can be
pervasive not just around performance
with a partner and so that can make you
feel like there's something organically
wrong with you if you have a lot of
anxiety surrounding getting an erection
period um then there's neurologic issues
so diabetes does have both vascular and
neurologic concerns if you've had like
prostate surgery it can affect the
nerves um so nerve conditions spinal
cord injuries those sorts of things can
also affect directions then hormonal is
a really small subset it's like 3 to 6%
of all people who have Ed is it solely
hormonal now giving you testosterone if
you're low and you have Ed May improve
it incrementally it's not going to
reverse it completely and I think that's
really important it may help somewhat
but that's really not the purpose of
replacing testosterone by itself um and
then there's medications that you're
taking very often high blood pressure
medications will cause uh side effects
of low uh inability to get erections as
well as anti-depressants those are
probably the most common medications we
see so in those in those categories
again vascular is number one and that's
because we have high rates of high blood
pressure diabetes and high cholesterol
in our society and so we're seeing over
50% of men having erectile dysfunction
above the age of 50 so it's like 50% at
50 60% at 60 70% at 70 it's very very
common and so how do you prevent that
well anything you do that's good for
your heart is going to be good for your
penis because the blood vessels to the
penis are about 1 to 2 millimet when you
look at the blood vessels to the heart
the coronary arteries are 3 to 4
millimet so when you develop some sort
of plaque or build up because of blood
flow issues like high high cholesterol
or um diabetes or high blood pressure
that will include blood flow but you
won't see it in terms of chest pain
right away you're going to first see it
as erectile dysfunction so we always
tell our patients who have Ed to make
sure they get their heart checked
because about 15% of men seven years
after they get diagnosed with Ed will
have a heart attack wow so back to your
question is what can you do to prevent
that is what is the best thing for your
erections in your heart so eating a
heart healthy diet now there's a lot of
debate about diet but the things we know
is definitely eating low processed foods
eating healthy fruits and vegetables and
then trying to avoid processed Meats for
sure we know that um and so those sorts
of things will U make your diet you know
increase your risk of these
cardiovascular issues so ultimately that
is one two is exercise so we actually
see data that exercising particularly
cardiovascular exercise like three to
five times a week trying to get 150
minutes of exer exercise a week will
actually improve erections and will
reduce erectile dysfunction so that's
probably those two things are the most
powerful ways to keep yourself healthy
and prevent erectile dysfunction okay I
I have got to ask this is the question
that eats up my entire brain when it
comes to
sex why on Earth is the clitoris on the
outside it at least like the or maybe
the better way to ask the question in
fact uh please dear editor in the
playback of this put put an image of the
female anatomy it
is super unintuitive to me so um I know
which image I want them to put up so I'm
going to describe it so you one uh the
clitorus looks very much like a flaccid
penis same sort of shaping if you
understand the part that's inside the
male body mhm okay so hopefully
everybody knows that all uh humans we
start female and then we become male so
it is literally the same tissue that
makes the clitorus that makes the penis
it is really interesting to see that
they are essentially the same shape
pretty crazy however there's additional
do they call them legs or something
there's additional parts of the curus
two on each side one that's quite sort
of close to the um the vaginal Canal but
then two more one on each side that are
quite far and so it begs the question
why bury so much of the clitorus inside
the body so girth cool I'm here for that
I understand that um but why the
additional pieces that are so far away
is that for like really
big I literally can't understand in
terms of um the male so the male anatomy
right if you think about it the penis
also goes deep into the pelvis and goes
down right but men are not getting
paranal stimulation all the time I mean
sometimes they may get a little bit of
pressure when they're having intercourse
or if it's intentional they might be
getting paranal pressure which is you
know that space underneath the scrotum
in front of the anus and so you're there
are ere there is erectile tissue there
so you know I don't think that
evolutionarily I'm not sure why we're
built the way we are in terms of like
why is there legs of the of a rectile
tissue that go that far but ultimately I
think in terms of female andal I think
yes is the bigger question to me is like
why is it not obvious like why is it not
obvious to stimulate the clitoris like
if you just saw anatomy and you didn't
know anything you would just think okay
penis goes in vagina that is what makes
sense right why not line the the inside
of the vagina with the clitorus like why
isn't it just there's Ure in the way so
I don't you know the the the issue is
the urethra is there and so I think that
is um you think that's what evolution
has to contend with well so in a man
right the urethra is underneath the
erectile tissue as well right so very
similarly the female urethra is below
clitoral the clitoral shaft and um and
so I think ultimately it just sort of
that's how it came about but yes I agree
I think it's very
counterintuitive that um that the organ
for pleasure is separate from the vagina
and I I think the other important thing
is that some women have a shorter length
between the clitoris and the vaginal
opening than others and they've actually
looked at studies that have shown that
people with a shorter length between the
clitoris and the vaginal opening are
more likely to orgasm through vaginal
penetration and more likely to enjoy
vaginal penetration or find that to be
their primary route of
orgasm okay this is so interesting uh I
am going to guess that these studies
don't exist yet but if anybody out there
is listening I beg of you to do this
study um given the way the anatomy is
where two parts of of the clitorus hug
the um the vaginal Canal be very curious
to know if the if there's like a tighter
that hug is the more likely they are to
orgasm from penetration um but going
back to the stat you said at the
beginning 80% of women cannot Climax
from penile thrusting alone which has
been the the shock of my life when I
came across that um longtime listeners
of my show will know that I became
obsessed as a teenager with learning
female anatomy CU I did not want to be
the guy that didn't know where the
clitorus was so everybody listening to
this I highly encourage you to
familiarize yourself with the female
anatomy I asked my wife this morning uh
I said look I can draw the the female
anatomy can you she can't so anyway a
pat on on my own back there for uh
learning that um but understanding how
that works so I'd love to know if if
there's any relationship there but it
begs the question the placement of the
clitorus internally why women don't
prefer bigger toys so if your hypothesis
is right that that's to to provide
pleasure based on girth why don't they
go for crazy girthy toys well so that's
interesting the that study that I told
you about the sex toy study was built
was made because they were designing so
with transgender surgery they were
figuring out what is the optimal girth
for a neop phalus so that's where they
sort of came about with this study is
because they don't want to make them too
girthy CU they often use forearm flaps
and so you can imagine if you take a big
flap of tissue from your forearm and you
roll it up it can get quite girthy and
so patients were coming back and saying
I love the way it looks but I can't
penetrate my partner and so there is
sort of a um an average width and length
of the vagina which then doubles when
you're getting aroused but there is a
limit to it right it will stretch
obviously you can push a baby out of a
vagina so it will stretch but sometimes
that's not comfortable now there's a lot
of reasons why maybe they choose smaller
uh toys but also they can manipulate
those toys to stimulate different parts
of the vagina right they can angle it a
certain way or move it up or down or to
the side and so that I think allows them
to be more directed and not feel so
unwieldy about putting a very girthy
instrument in the
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this is so intriguing to me uh okay
so in an N of one
experiment it would seem that vaginas
come in as many shapes and sizes as
penises uh but what you just said makes
it seem like there's a relative and
maybe it's just bell curve again that
there's a relatively narrow um variation
they're going to come in all different
shapes or sizes um just like man does
right but we know the averages just like
we know the averages for men and we also
know that they will increase in width
and length to prepare for intercourse
and there's sort of variation in terms
of also pelvic floor muscle tone so when
you think about your pelvic floor which
is this bowl of muscles that you sit on
and um and they're essentially hold up
your organs your bladder your rectum in
women the vagina and the urethra these
these can get tense and so when they're
tense that can cause narrowing of the
the idus or discomfort with penetration
and so very often when you you're trying
to penetrate yourself if you're like in
a rush and just want to um get it done
and you put some lube on essentially
you're not allowing yourself time to
prepare for the insertion of you know
whatever it is and I think ultimately um
you know yes I think there's variation I
think again when you're pelvic floor is
maybe a little weaker because of having
multiple babies or having um a lot a job
where you're standing a long time
putting pressure on those muscles for
years and years and years those muscles
will weaken and then you will be you
know you will have essentially a more
relaxed or pliable vagina than you would
if it was tense and so we often see like
younger women who haven't had babies
have a little bit more tension in their
pelvic floor than women who've had
babies um because they've sort of
relaxed those muscles and they've gotten
a little weaker so when people talk
about vaginal reconstruction post giving
birth MH are they talking about the
pelvic floor like is there a tear in the
muscle or what what's being
reconstructed yeah so it depends but um
typically when you're talking about um
pelvic floor weakness after giving birth
that will typically result in U maybe
like a bulge or like a hernia almost
called prolapse and then what's
prolapsing the the vaginal skin is
prolapsing and whatever is behind it so
people will say my bladder's falling out
it's not actually your bladder it's
actually the vagina but the bladder
behind it or the uterus or the rectum
and so you're essentially getting a
weakness in the floor of the pelvis and
then when you reconstruct that you're
essentially re rebuilding that pelvic
floor and that pelvic floor is muscles
but it's also ligaments that hold up
those muscles and um and so all those
things together you can use those things
to reconstruct now if you're talking
about like um cosmetic
reconstruction that's typically trying
to um tighten the muscles at the very
bottom the L muscles to make them a
little to make the idus smaller to make
it a little bit the opening sorry the
vaginal opening yeah and so that is
typically done for people who have
prolapse as a non-cosmetic like if you
have prolapse then making the vaginal
opening smaller because it does open or
get wider when you have weakness can
actually help prevent the prolapse from
coming back but in some cases people
want it to look a certain way and
they'll they'll do this surgery
electively to sort of make that opening
smaller uh okay so that one sounds more
Aesthetics but if you're doing vaginal
reconstruction is is the obviously I'm
going off of only jokes that I've heard
because my wife doesn't we've never had
kids um but the joke you hear is that
that actually can make women tighter is
that actually accurate so it's only
gonna it's only going to make the Inus
smaller and it may help um pull together
some of those muscles right but in order
to keep your pelvic floor if your pelvic
floor is weak let's specify if your
pelvic floor is weak then you need to
work it out just like you do anything
else like you do keegle exercises or
other exercis to strengthen those
muscles and remain keep them
strengthened um and then whereas if it's
tight you don't want to do things to
strengthen them you want to do things to
relax
it uh one hypothesis I have long had
about um things that make guys insecure
is a mismatch so if you have a a guy
with a um large penis and a woman with a
small vagina you're going to have a
problem if you have a woman with a large
vagina and a man with a small penis
you're going to have a problem um as a
urologist is that something you
encounter or am I just way off base no
you you are absolutely correct in fact
there is actually a um a a purchasable
item that you can buy that will you can
put on your penis if you're very well
endowed that will actually shorten the
length of the amount that will be
inserted and so will be more comfortable
for your partner so clearly it's a
problem that uh someone has decided to
try and rectify with the with an item
that actually works quite well I hate
everyone with that
problem and then in terms of the other
way around I mean you know like like
we've talked about already yes it can be
a problem in terms of um orgasming with
penetration but again there's other
alternatives to achieve pleasure and
that's sort of what I I tell patients if
they're having that trouble is like you
know you have 10 fingers you have
devices you can buy there's lots of
things you can do to help uh get your
partner to achieve pleasure that do not
involve penetration glad you bring that
up so I heard I think it again I think
it was you that said this uh let me see
if I can remember this correctly 45% of
women do uh have an orgasm with a
firsttime male partner but 95% of women
have an orgasm with a firsttime female
partner yeah that is outrageous it if
you're insecure about whether you are
pleasuring your partner take heed of
that stat it's obviously not a
requirement anyway um for you to have a
a
jumbo but why is it that um lesbian
encounters have just a demonstrably
higher I mean an order of magnitude
higher uh ability to make each other
orgasm on first encounter well so two
reasons
one is they've spent their whole lives
learning how to pleasure themselves
right and so they know how to achieve
pleasure in female anatomy they're more
familiar with female anatomy they know
what to do but the other big thing is
when you have two people of the same
gender they have to talk because one
person can give pleasure and one person
can receive pleasure right and you don't
know who that's going to be unless you
actually talk about it right so there's
open communication from the very
beginning whereas I think in
heterosexual encounters we're so focused
on being polite right we don't want to
like oh I don't like that you don't want
to you don't want to hurt someone's
feelings so you might not open up and
say oh I actually like this better or I
like it this way in fact we see in
studies where there's people women of
all different ages that women who are a
bit older tend to have better um
satisfaction with their sex life and
better orgasmic outcomes probably
because they're more likely to talk
about what they want and know what they
want
yeah this
um this comes back to just I am I'm
utterly shocked that the clitorus is on
the outside I have a hypothesis that I
want to run by you yeah I'm obsessed
with Evolution um research a lot of it
trying to understand The Human
Experience through the lens of evolution
has been transformative for me in being
able to predict the outcome of my own
actions to be able to predict other
people's
behaviors um I would say ignore that at
one's own
peril when I look at our close relatives
the bonobos one thing that they do for
um inter tribe cooperation or I should
say inra tribe
cooperation is if uh there's friction
between two females they will go up and
they will touch each other's genitals
reassure each other I don't know that
they go all the way to climax but it it
is certainly genital based contact
and I would imagine that at this stage
in human evolution that's probably not a
big role but um it's interesting to
think that if you if you start stacking
these things so you have to contend with
their urethra and so that's going to um
maybe cause a a if you understand the
idea of the blind watch maker which I
think is a great analogy given to us I
think by Richard Dawkins um around okay
you have all these things that look
incred incredibly complicated but they
were not made with intention they were
just over extraordinarily long periods
of time you have one little um mutation
and another and another and another and
you get there and so if you are like the
draff has a vein or a excuse me a a
nerve in it that like just makes this
ridiculously circuitous trip down around
the neck and back up but if you assume
that the neck was sort of growing at the
same time that this thing was growing in
the beginning it might not have been a
big deal but over time becomes very um
weird so if you think of that same thing
with the clitorus that if it one had to
contend with urethra two that there was
some sort of um advantage to some part
of it being exposed that meaning it it
is exposed specifically for
non-penetrative reasons because I think
you would agree with me just from a if
you were trying to make a woman orgasm
from penetrative sex you would just make
the inside of the vagina as sensitive as
the the outside of the penis I mean it
it is crazy uh how sensitive that is
so what do you think about that
hypothesis yeah I think that I think
it's an interesting hypothesis
particularly with the with the backdrop
of how women used to reassure other
women maybe that was a thing like maybe
that was a big part of society back in
the day or maybe you know if you think
about Evolution and this is again
hypothesis is as you're talking I'm sort
of formulating this but maybe you know
the goal is procreation right if women
were constantly being stimulated during
penetrative intercourse perhaps it
wouldn't be you know then it would be
like okay well men are going to you need
men to climax to ejaculate so maybe it's
to make sure that women will not climax
you know first and then say oh I don't
want any more penetration because the
goal is to deposit sperm and maybe
that's I don't know this is again
hypothesis but as you're as you're
talking that's what's going on in my
head that oh my God I don't know how
that never occurred to me but a woman
climaxing first if I mean look I suppose
because women are multi-orgasmic maybe
that doesn't answer the question h i man
for a second I was so there well you
know the the the refractory period you
know as we know men have some portion of
an absolute refractory period where they
cannot have sex again whether it's it's
minutes to hours to whatever and so
there is some portion of time where like
you could not get an erection if you
wanted to now that could be really short
in young guys and it can be really long
in older guys and it's variable personto
person but perhaps it's because like the
orgasm from direct stimulation would be
uh would also cause some so sorry to go
back when you have that refractory
period very often there's increased
sensitivity to of the penis so maybe
that's where I'm thinking that maybe if
you had um sort of erectile tissue right
around the vagina it would become too
sensitive for you to allow continued
penetration whereas if a woman orgasms
it's sensitive but it's not where you're
penetrating so that's why you can
continue man that's really interesting
do you have a hypothesis on why women
are multi-orgasmic I get why men would
be single because certainly the shape of
the penis will just then create its own
problem as it removes the Cen it just
deposited uh but why are women
multi-orgasmic well so not all women are
but yes there's certainly more evidence
of women being multi-orgasmic in the
literature and we hear about it but it
may be that again like I said this
because the sensitivity is only in the
clitoris and you can continue to
penetrate uh vaginally then you're
you're still stimulating the area but
it's it's okay that it's sensitive and
so you probably get past that absolute
refractory period quicker and and you
can keep going whereas like with with a
man you'd like you know I really can't
right now I need a few minutes right
before you can go
again yeah that that one is um very
intriguing and I won't lie that I am a
little jealous uh of the
ability okay
um setting monkeys and evolution aside
what does good sex look like because I
think that there is there is an
astonishing lack of understanding which
which I would not have predicted you and
I were talking before we started rolling
um I would have thought that in the
internet age everybody would have an
understanding of female anatomy
everybody would understand what women
are looking for um but there's something
I think about just the velocity and
volume of information that people are
just sort of dizzied um by it so help
people what what do women want so I
think let's just talk about in general
what makes good sex first so I think the
big key that people are missing is
everyone's rushing to get an orgasm but
the point of good sex is to allow
yourself to be completely vulnerable to
that person so being able to be
completely vulnerable it doesn't have to
be that you're intimate with them like
in a loving relationship but you have to
be vulnerable to allow yourself to have
good sex you have to be mindful in the
moment to enjoy the sex that means you
have to forget about all the stress in
your life and like be really focused on
the moment and you have to enjoy the the
the journey right every it's not just
about the the orgasm it's about actually
enjoying every little bit of sex for you
and your partner and that's different
for every person some people may like a
leisurely long bodily exploration that
follows you know until you finally
penetrate and then you find the orgasm
some people may not want penetration at
all some people may want a really quick
um you know experience but whatever it
is you should be enjoying that entire
experience and not just waiting for
climax and I think that's the key is
that that one is really being mindful
being vulnerable and two also talking to
your partner now it doesn't mean talking
to them in that exact moment of course
feedback is good and important but you
want to be thoughtful this is a very
like Sacred Space for a lot of people
and they don't know how to take
constructive criticism until you've
started talking about it outside the
bedroom and so I think that's really
important in general for good sex
because if your brain is there if you're
focused on it if you're enjoying the
journey you're going to have great
orgasms and it's going to be great right
and so I think that's one and then two I
think for men to know about women is one
is that women take time to get aroused
so during the arousal process um as I
mentioned earlier the vagina prepares
itself for penetration it increases
lubrication it lengthens it widens the
cervix moves up and out of the way to
allow for the phus to penetrate so if
you don't allow that to happen sex will
be painful or at at worst painful but at
best you know okay mediocre not as good
as it could be and so ultimately it's
really important to include enough
foreplay so that your partner is ready
and each person's a little bit
individually different the other thing I
would say is adding lubricant to the
bedroom is not scandalous like it's
great it can add a lot of fun and
pleasure and women's amount of
lubrication is not always correlated
with how excited they are about the
encounter so some women will make a lot
and not be really that into it some
people will make little and it's a
variety of different factors s it can be
genetic it can be hormonal it can be
medications they're on can be the age of
Life they're in the stage of Life
they're in but
ultimately um that's not a reflection of
how turned on they are and so don't take
it personally if you're with someone and
they're not as lubricated or vice versa
like you need to be communicating and
make sure they're into it so I think
those are things that are really easy
for people to include and then you know
I think ultimately a lot of men focus on
like making sure their partner orgasms
ideally um if you're not you should be
thinking about that because their
pleasure is obviously just as important
but I think ultimately like if they are
not orgasming with whatever you're doing
it's okay to bring toys in the bedroom
right like we use uh microwaves to heat
up our food instead of using a fire so
we can use toys to enhance our sexual
experience and I think ultimately those
sorts of things are are really valuable
in terms of transforming your sexual
experience and then the other big key is
talking to your partner so not in the
bedroom but like outside of the bedroom
in the kitchen in the car figuring out
like hey what what do you like what
turns you on and you know really getting
into that and being non-judgmental if
someone says something but even for you
you should give feedback like hey babe I
really like it when you do this it
really turns me on and you giving
feedback too about what you like and
sort of like really making it so that
you both are getting an experience that
you're excited about and realizing like
some things that turn you on may not
turn her on or vice versa in a
heterosexual relationship we're being
specific here about heterosexual but I
think it all applies to any gender um
but really just writing down what you're
into incorporating different things
incorporating novelty and and just keep
keep keep the doors of communication
open okay uh yes communication for sure
I would say is a key part of this that
was one of the things in my early before
I was actually successful with women
just reading about article after article
it was always communication
communication and my mom once said
something to me uh that I think goes
along with your first tip which was she
said a woman has to trust you to be able
to have an orgasm and I was like what
like that didn't ever occur to me
because as a guy that just is not on the
menu of things that I would think about
I mean if I actively distrusted the
person maybe um it would be harder but
even then I'm pretty sure uh we'd be
just fine um but that was that was
really eye- opening and so discovering
what the person likes
now what about people that don't know
what they like so I can pretty much
guarantee that there are people
listening to this right now um that have
never used any toys and so they don't
even maybe understand what do you mean
toys for what like I already have a
penis penis is whatever um I can't come
from pen now thrusting so why would I
want a dildo is basically what I can
hear people thinking right so one I
think as a couple you can experiment and
then by yourself so you know in terms of
our of our Sensations like the areas of
our spinal cord that take um outputs or
inputs and then send them to our brain
it can be touch which is what we're
always using Right Touch temperature and
vibration and so you can experiment with
all those things you can use light touch
like a feather you can use firm touch
you can use different pressures of touch
you can use different temperatures of
lubricants or things like for example I
have I had a spinal cord patient I
remember he had a injury to a spinal
cord and the only way he could orgasm
because his his connections were messed
up were when he put his feet in ice cold
water whoa and so how do he discover
that that I mean I think you know he was
told experiment with temperature and so
he really experimented and that's how he
got there um and so you know there's
things and vibration is very powerful in
fact there's plenty of data that
vibration with a toy or or whatever can
actually improve orgasms improve blood
flow to the genitals so it's not just
that it's the sensation but it's
actually increasing blood flow of the
area I assume we're talking about for
women for both for both so men don't use
vibration enough and they may actually
find that it's quite pleasurable to use
vibration and they may have more intense
orgasms so in terms of um exploring your
body as a as a female would be you know
again
identify take a mirror and look down
there right that's the first step I
think so many women haven't even done
that that first you men look at their
penis every day right but you can't
imagine the number of women where they
come into my office I bring a mirror in
while I examine them and they're like
I've never looked at myself whoa yeah
and so it's really and so I will go
through all their Anatomy with them so
they feel empowered about what they're
looking at down there so they know where
their clitoris is where their urethra is
where the lips which lip is which and
what does this mean and you know that
there's this area is different than this
area and so that is is powerful so take
a mirror look down there and then just
explore feel the different areas use
your hands see what feels good and you
know when you stimulate the clitoris you
need to have Lube there's no lubrication
that the clitoris is making so you'll
need some lube for it to be comfortable
for most people so explore that area
figure out what feels good some people
like you know stimulation on the right
side some people like on the left side
some people like in a circular motion
everyone's a little bit different right
but really exploring what you enjoy and
if you feel weird about it get your
partner in on it with you cuz they'll
find it fun right like if you guys are
in in exploratory mode you can start you
know one of the Sex Therapy techniques
you do is called sensate Focus so when
you're having issues in in the bedroom
you'll say okay we're not going to focus
on penetration today we're just going to
focus on touching non- erogenous areas
like your arm or your your belly or
whatever you're just going to touch all
the areas and see what you like and then
after that you move towards genital
touching and you find different areas of
genitals like what feels good and then
you finally move to penetration and by
that point you've sort of mapped out
your body to figure out what really
feels good and what is actually
pleasurable and the same thing can be
done for men right experiment with what
parts of the penis feel good does it
feel better on the head does it feel
better on the shaft feel the perineum
the area where the the the erectile
tissue is underneath the skin and you
may find pleasure there some men even
find pleasure with prostate play because
there's a lot of uh nerves there and so
you know if you feel open to that that's
fine I think ultimately just figuring
out what is enjoyable to you and is is
very empowering in leading to better
sexual
experiences how long should sex last so
that's a good question I think when you
talk about how long average sex lasts
when you look at the data and they only
look at penetrative sex so they actually
gave people stopwatches to like measure
like from the woman would measure start
to finish of penetrative intercourse and
that's how they got this data um and so
what they found was that the average
length of sex was about 5 to 6 minutes
and it was actually variable by country
so in the UK it was like 10 minutes and
in like turkey it was like I forget it
was like five minutes or something but
it it's variable by country the UK is
actually double the average yeah I think
it was like 10 minutes that's so
unexpected my wife is British like okay
uh intriguing so yeah but ultimately I
mean it's not as long as we think it is
right it's usually about 5 to 6 minutes
on a and that's penetration that doesn't
include the foreplay and any other type
of sex right we're not talking about
oral sex anal sex this is just penis in
vagina penetrative sex and so that's the
average now how long it should last
really depends on you and your partner
right you can't there's certain things
in terms of like how long it takes till
you ejaculate that is sort of you know
very individual but in terms of the
entire encounter that's totally up to
you and your partner what you're in the
mood for some people like long luxurious
love making some people like quick like
you know quickies few minutes and done
because that's what makes brings them
pleasure and joy and they get to feel
connected and bonded even in that short
period of time so I think it really
depends on what your ultimate goal is
how in control do you think guys should
be uh I know there's there is a medical
definition for uh premature
ejaculation um but you watch a porn and
you see a guy go for 50 minutes of just
like insane acrobatic hit it like as
hard as he can and I'm just like good
Lord uh so how in control should a guy
be well let's talk about porn briefly so
a lot of these porn uh porn actors will
use things to help them last longer so
some of them will have penile implants
get out of here some of them will have
is there data on that uh this is just
anecdotal like I know people who work in
areas with lots of porn actors and they
they treat a lot of them so some of them
will have um implants some of them will
inject themselves right before uh the
the act and obviously these are
Productions right so they're edited and
cut and but they they they have trained
themselves right to last for long
durations so you can TR yourself you
know I I think there is some degree of
being able to train yourself uh but I
don't like people to stress about it
because I don't that's their profession
that's what they chose to do as their
job now if you talk about how long women
want sex to last on average it's about
25 minutes and that includes the whole
thing right men say about 16 minutes
well so are heard but do they want 3
minutes of Fourplay and 22 minutes of
penetrative sex and we have a huge gap
that it normally lasts five minutes and
really want more I would venture to say
probably not I would say most women
probably are are sufficiently satisfied
with average to a little bit above
average but I think and again it's
variable person some women don't even
like penetrative intercourse right
because they don't Climax from
penetrative intercourse they want
clitoral stimulation right so like yeah
they like it feels good it feels great
but it's not going to make them orgasm
so you know those people may say you
know I don't really care I like the rest
of the stuff we're doing and some people
may love penetrative intercourse because
that's how they orgasm and they want
more of it but again it's very
individualized you know and I think we
put a lot of um a lot of pressure on
people so in terms of medical
definitions premature ejculation is like
within a minute or 2 minutes if you look
at whichever Society you look at but my
definition is is is it bothering you or
your partner because that's what really
matters right like it doesn't matter if
it's if it's 3 minutes or four minutes
but if you're not happy and your
partner's not happy then we can work on
it right in terms of 50 minutes that
would be considered delayed ejaculation
based on medical definition so we
usually say if it's like 30 minutes or
longer it's it and it's bothersome it's
considered delayed ejaculation and I
will tell you I see patients with
delayed ejaculation they are not happy
they are frustrated because it takes so
long and so much effort for them to
ejaculate and their partner is probably
not that happy although they're not
going to say anything to them because
it's a long time and you know at some
point it's like okay like let's let's
move on so I think it really depends um
this is fun but I've got places to be
but you know I think ultimately like
there's a lot of a lot of things that
media has perpetuated like oh sex should
be long sex should be a certain way it
should be there should be so much
ejaculate volume there should be so much
squirting and all this stuff and like in
reality like what matters is that you're
satisfied and your partner's satisfied
and that you're connected whatever way
you're trying to get to be connected if
you're in an intimate relationship that
you're feeling bonded if it's just for
sex that you're actually both feeling
pleasure and enjoying the time all right
uh let's ask the hard question
so first time encounters consenting
adults we will make that
assumption uh that that's the
anxiety-ridden one like my wife and I
now we've communicated so much in fact
my wife and I have communicated so much
you run the risk of like we have the
greatest hits and we just play the
greatest hits album every time and so
there you almost have to do things that
are suboptimal just to keep it spicy
like this isn't my favorite but because
if we do my favorite every time it gets
boring anyway uh first
encounters when you take your pants off
is this going to be a wow moment are we
matched up
uh how what assumptions should I make so
again going back to that stat 45% of
women orgasm the first encounter with a
male that means 55% don't MH so the odds
are not with us on the first encounter
so what can we do to up our odds that
that will be an amazing encounter so the
first thing you can do is before the
encounter be like hey what turns you on
what what excites you really right cuz
that way you go in with a map you go in
with a blueprint you know what is going
to make them what date do you think okay
this is this is very interesting so a
lot of guys going to try to close on
date number one yeah but ah man this is
just n of one admittedly so maybe guys
are more sex is moving in the wrong
direction as far as I can tell right now
so I'm going to assume these guys are in
a way worse situation than I was uh so
say they've just met is your kind of
Point yeah and like admittedly you are
trying to like play with that line right
because to go from hi my name is Tom to
we're having sex like that's that's a
big Chasm to cross yeah so admittedly
you you do start to get playful but if
if you're going for first or second date
sex I can't imagine having like a really
sort of hey like what turns you on kind
of conversation you're hoping that that
spark happens you can feel it you see
the look in their eye you go for the
kiss they reciprocate and it goes well
um could failure of imagination on my
yeah in those circumstances I would say
while you're in the act you can sort of
be like hey do you like this is this
good you're asking for feedback right
you have an instinct that women will
like that kind of conversation I mean it
has to be done in the right way right
but like if you're attentive and you
want to pleasure a woman I think she's
going to find that very sexy right like
she's going to be like wow he's really
wanting to make sure that I feel good
like that's great you know
55% of the time women are not having an
orgasm and this one guy is like oh my
God I want to I want to make sure that
you're feeling good like wow that's kind
of hot right that's kind of actually
good and so I think it's really
important yeah fine I get that I think
the firsttime sex again I think it's a
lack of knowledge I think if lesbians
can have 95% orgasm rate there is a lack
of knowledge of what pleasure what women
enjoy and so there needs to be some
evaluation are you providing clitoral
stimulation are you um you know what
works for the majority of women is
cliteral stimulation so maybe you're not
doing enough of that or maybe you're too
aggressive or too too light or like
whatever but kind of evaluate what
you're doing um but likely if you're
providing good cital stimulation she's
going to orgasm so I think that's
probably the biggest key in these first
time encounters yeah you might get it
wrong sometimes but like everyone's a
little different but as you get into
more of a serious relationship I think
those conversations about what turns you
on is is really important yeah no doubt
whatsoever uh yeah I mean as a PSA if
you are having a first time encounter um
guys I will say that the beline to the
clitorus um technically actually okay in
fact I'm going to run you through what I
would say this is the Playbook to run um
I'm a guy I only have so much experience
um so it be amazing given that you've
seen so many people people and are a
woman yourself tell me where this advice
goes astray so that guys can really um
do a good job okay uh first and foremost
respect for your
partner so you want to make it fun and
exciting but you want to make sure she
feels safe 100% uh trust is going to be
if my mom is right and and life has
certainly taught me that this seems like
a very good rule that the woman has to
trust you before she's going to be able
to have an orgasm so I get it you want
to be tough and manly and all that but I
I would advise against leading with like
hand on the throat and all this crazy
[ __ ] that you will see in porn uh so I
want her to feel desired I want her to
feel seen as an individual so um to your
point I'm G to try something and I'm GNA
I'm really going to be paying attention
to cues I'm going to hit the erogenous
zones I'm not the reason that I started
this is I said be line to the clitorus I
actually wouldn't do that so I would
tease I would be playful um starting in
other areas um I and this maybe where
you tell me my advice goes astray on a
first encounter I'm going to keep it
pretty vanilla I'm not going to try any
of the more extravagant things maybe at
some point I do want to try but would
not want to try without
communication um so uh yeah I'm going to
go slow I'm GNA try to warm her up I'm
going to remember something I've heard
you say that women take like 25 minutes
to uh you said for the whole experience
but some significant portion of that is
going to be what we traditionally call
foreplay so pre penetration um again
really looking for signals that she's
enjoying what I'm doing if I'm unclear
I'd probably ask in the sexiest way I
can muster do you like this um and
then often times not always so I'd have
to really read the situation but often
times a woman will make it clear when
she wants you to go for penet ative sex
um I would operate under the philosophy
to if this is a first time encounter I'm
not going to be able to make her orgasm
through penetrative sex so I'm going to
go straight for oral if I'm completely
honest uh to try to make her orgasm
first if she introduces a toy oh my God
so much easier but uh and at least in my
experience the toys that are effective
are going to be external they're going
to be vibrative in nature and cool if
it's one that can be used simultaneously
with penetration amazing if it can't
then I'm going to make sure she's taken
care of first um and all the while
again you want to be confident you I
would say you want to take leadership
you don't want to wait for her to tell
you what to do I mean if that's her
thing you'll figure that out pretty fast
but I would base assumption it's not
base assumption you want to be in the
leadership role base assumption you want
to keep a vanilla you want to make her
you want to show that you're paying
attention mention that that you can be
trusted um how does that feel as first-
time encounter advice I think that's
excellent advice I would say that four
play though starts at the beginning of
the date a facts so you yes this is all
great this is exactly what I think the
majority of women would want there's
probably some women who would be like no
way that's not me I don't like a lot of
four player whatever but the majority of
women this this blueprint would work and
I would refer your listeners to a book
called she comes first by Ian Kerner it
actually has like um images and visuals
like draw out animations like howto
literally it's a how-to guide it's very
very good it focuses on cliteral
stimulation um and so I think it's a
great guide for people to look at um and
I think ultimately yes Fourplay starts
at the beginning of the day so the palm
of the hand is very powerful so even
just touching the palm of the hand and
getting that touch in early on is a part
of foreplay and can actually be really
powerful that's really smart um yes so
the brain is the biggest sexual organ in
the body and so being able to tap into
that
um here would be my best advice for guys
and I forget uh who said this damn it I
heard this recently too my apologies is
to whoever said this um but if you want
to be intimate with a woman become a man
who's worthy of that
give and
that begins even before the date and
then on the date it's really about um
demonstrating that that you can be
interested in them that you ask
questions and you're really listening
and that your answers show that you're
engaged and that you're dialed into to
what they're talking about that you're
not trying to please them that you are
being yourself one thing that went
really right for my now wife and I on
our first date we both thought it was
going to be a fling so we were both
completely unafraid of loss like H if
she's into me cool then this can go
somewhere if she's not whatever yeah and
so and admittedly my journey and again
my listeners will have heard this a
thousand times but my journey was going
from and this is literal showing up on
the first date with flowers and a custom
written poem Oh My Gosh and getting
nowhere right cuz what a turnoff that's
a lot it seemed like a brilliant idea it
was terrible would like everybody to
hear that uh and then finally
understanding that that this really is a
game about finding your own confidence
knowing what you're about not being
afraid to be that and then being a
filtering mechanism for who's into who I
actually am yeah and then you have a
shot and I would I just want to
emphasize respect right and I think that
we spent a lot of time talking about how
men should please women I do too but I'm
a mother of two sons and I will say you
feeling respected is just as important
and so like if you feel like you're on a
date with someone and you're not getting
that respect then they're not warranting
all that time and attention and pleasure
from you either so I think just like we
talk a lot about this and it's important
it's super important but I also want to
say like as a man you are worthy of
pleasure and you are worthy of attention
and
respect I love that I'm very glad that
you said that uh there's a weird thing
happening now are you familiar with the
red pill movement a little bit Yeah okay
it
please I beg of you your content is so
good I would love for you to really go
into that because the guys that are
coming to you if they're under 35 they
are at a minimum familiar with the ideas
being purported in the red pill
Community uh and it's possible that
they're a devote and so as somebody who
wants to see men be successful and I
understand what it is that they're
responding to positively in the red pill
movement which I think think is a
reaction to a real push to sort of a
feminize men and to tell them that their
um sort of natural inclinations to
aggression or whatever or ambition are
bad and so now you have these guys that
are like not only is it not bad like
take over the world conquer everything
um I want to play you a clip okay so in
fact if we can cue that up
um I love that you're saying that men
are worthy of that I think that's
incredible and and Men I hope you hear
that but if you let yourself go down a
particular path you set up an antagonism
between men and women that is
devastating and so this clip sort of
sums that up for me
why female vaginas are disgusting no
they're not do you eat
vagina exactly Point proven my point
proving you don't do it why should I do
it women are supposed to do certain
things that men can't do women are very
talented beautiful creatures you can
give life we can't do that it's fine you
can give head we can't do that this is
not for the G's I'm not I don't know
who's out here doing this but it ain't
me like I'm sure there's plenty of men
out there who will do it do you don't
want to please your woman though there's
plenty of ways to please a woman without
doing that that's a big factor that's a
good one Sally maybe for you I think
that it's possible to please a woman
without it yeah it can be okay so I I
don't I don't think it's something that
is conducive to a healthy relationship
it's not something I'm very interested
in personally maybe I'm crazy yeah it's
fine I go crazy for me don't understand
is like why it's such a Stern no because
why wouldn't you want to please your
woman you know because have you not ever
seen like I said before it's woman's job
to please a man not the other way around
no that is actually ridiculous when it
comes to being intimate and in the
bedroom it's not it's like when when
when you do something for someone have
you not seen how and they like it have
you not seen how much they perform
better and I'm not just talking sexually
like in general I don't want to like
like an [ __ ] but a woman's
ejaculation is
irrelevant you only need one ejaculation
to create life and that's the mans now
with that said this doeses that mean I'm
not going to please my girl or whatever
of course I will but it's elective
definitely sh embeds just like a woman's
you know duty to go to work is elective
my duty to please her sexually is
elective that is ridiculous how's that
ridiculous because oh no oh you know how
about this with that logic I'm just
going to stop paying the bills okay that
would be ridiculous sex in in and of
itself is boring any man who sits and
says that sex is great or sex is fun
just clearly hasn't had enough sex
because sex is boring sex is a
sex is like food you don't really care
unless you're really hungry and then you
eat he's not having good sex a guy
getting his girl off is elective they
should do it but they don't have to just
like I think a man has to work in his
woman okay we'll just do it and then
just see what you get different results
that's all I'm saying I I don't do that
I we get the gist you can stop it it's
pretty horrifying yeah so what what do
you think about that you know I think
that this is just inappropriate right
like there is a quality there should be
equality in pleasure and if you respect
someone this comes down to respect right
I'm saying there should be equal respect
men and women should respect each other
and if there's disrespect on either side
then that's not a relationship worth
having right and same thing goes with
sex if you their partners are not going
to feel safe and vulnerable to actually
enjoy sex these people might as well
just go by a flashlight because they
don't need a person they just need
something to get them off and they're
not even valuing what that
is yeah um so this worries me a lot
because the there's something happening
in because I think there is a real shift
in culture that this is an echo of and
so I don't want anybody watching this to
think that I don't empathize with
whatever is happening culturally that's
leading people down this path but down
that path is you will by my estimation
you will end up up missing out on
something incredible which is having an
equal partner that you can contend with
so when I think of my wife as uh because
in the beginning of our relationship I
thought I needed to be better than her
at everything and that was the only way
that she would find me sexually
attractive and it ends up creating this
hilarious moment where we're playing
pool and uh I'm about to win and so she
Whispers something crazy sexy in my ear
that she's going to do to me
uh that night and I end up missing the
shot and I got mad God and so instead of
being like okay now I'm going to take
you up on that thing you just whispered
in my ear I was actually mad now I was
mad because of insecurity because I
thought if she could beat me at pool
that she wouldn't be attracted to me so
anyway I was headed down unintentionally
that path of I just had wrong base
assumptions about what it was that would
attract a woman and so once I began to
realize oh wait a second what what this
is even from an evolutionary perspective
perspective is two halves of a hole
coming together CU From Evolution uh you
need to stay alive long enough to have
kids that have kids so that means it's
not enough just to get the person
pregnant and look I'm I'm I am hyper
aware of the fact that we fall in the
middle in terms of our uh morphology so
we have uh testicles that are relatively
large we produce a large volume of semen
but not compared to some animals that
truly it's just a spray and prey
methodology so we're we're in the middle
so I get it there's sort of a ention
there but when I think of my wife as my
equal my partner my other half that were
uh in this to make each other better
that I have somebody with whom I can be
not weak but vulnerable that I can share
what's really going on in my life um
that can do the same for me then it the
there is a reason Despite All of My
Success and wealth that the thing I
prize above everything is is my marriage
because nothing has given me more mental
well-being than my marriage and so when
I hear guys talk like that they've
they've adopted a base assumption that
there's an antagonistic relationship
between men and women now again I get it
there's something happening in culture
right now which I can map out sort of my
hypothesis on that but I want to hear
from you first so I get it but wow does
that lead you to somewhere you don't
want to be yeah well I will start by
saying I think I agree with you
wholeheartedly that having a good
relationship is a GameChanger for your
life you could not be as wealthy and
successful as you are without your wife
I could not be where I am without my
partner and I think ultimately if we
didn't have supportive Partners at home
yeah you could probably get somewhere
you could still get success you
absolutely can but the amount of um uh
joy and happiness and overall health
that brings to you with having that deep
emotional connection with another being
is really important so we know that
loneliness is killing people like people
are dying because of loneliness like
that's one of the indicators of
mortality in fact it's it's not just
loneliness of having close friends
that's an important one but it's also
just having nice social interactions so
you know having good positive social
interactions with people around you and
so ultimately when you take on a
Viewpoint where you think that some
people are not worthy or disposable then
you are setting yourself up you may be
fine you're wealthy or young these guys
will sleep with lots of women and
probably be fulfilled sexually but in
terms of having deep emotional
connections with somebody they're going
to miss out on that and then eventually
everyone ages you need those connections
to help you age gracefully to keep you
healthy keep you happy it's a huge part
of health and my husband I told you
before we started he worked in Subacute
rehabs and he would see people close to
the end of their their lives right A lot
of them were very old and so many people
would have no one come visit them nobody
came to visit them at the end of their
lives and so yeah you can think whatever
you want now but 20 30 years from now
you're going to be that person sitting
alone with no one coming to visit you
and dying because you're lonely and it
is so impactful and I I realize that
Society is changing and I wish for the
same as you that I I hope my sons find
really amazing partners that will that
will be similar to my relationship with
my husband and I think um it's it's
really sad to see this movement taking
hold and I realize it's in reaction to
things that are happening in society but
it's ultimately a really toxic way of
thinking agreed why do you think this is
happening so I think that you know
there's um there's a lot of factors so
one is that we're being
distanced co naturally distanced us um
which then made it more difficult for
people to interact but then on top of it
because of things like social media
media technology the accessibility of uh
pornography and things like that young
people are not going out and meeting
people of the opposite sex because of
all these different factors why does
porn make them less likely to go after
the opposite sex so think about when you
were a kid if you wanted to watch a porn
or see a porn you had to find a magazine
you had to find a VCR get a tape I know
little kids don't know what a VCR is you
to go to VCR find a tape put it in a
room where nobody was going to walk in
on you and watch it right that was
exceedingly difficult yes and now all
you got to do is turn on your phone it
is so accessible that kids as young as
eight are seeing pornography and their
brains are not fully formed I have no
problem with pornography I think when
used it can be a great tool to enhance
your pleasure and also make you feel
good and when Ed healthy but if you're
you in a young age you don't know what
it is you don't know is this real is
this not real um it can really release a
lot of dopamine which can then make you
feel like you're seeking that again over
and over again so I think when used
inappropriately or especially in young
ages it can be very harmful and it can
make you be like well why should I go
approach someone of the opposite sex and
deal with rejection when I can just have
it right on the phone and I don't need
to go through all that hassle it's just
so easy to access porn
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off yeah I think that is uh a big part
of the problem is it becomes a it's they
call it sedating Behavior so when I
think about when I was a kid I remember
thinking wait one day I'm actually going
to be inside a woman like that's
actually going to happen I remember I
was freaking out I could not I would get
giddy at the thought that oh my God one
day mhm now I really worry I don't have
an addicted
personality however if I was a kid that
had access to porn the way the kids do
now I don't know that's the one thing I
feel like when I was um like 13 14 I
would try to set a record for the number
of times I could masturbate in a single
day like if I had porn like whoa
like that's really that one really
worries me because of it it's it is a
hunger you have that propels you out
into the world and you can satiate
yourself simply by masturbating and so
if you're not going after a woman and
facing rejection is hard it's really
hard and if you aren't really hungry if
you don't really want what's on the
other side of that risk you're never
going to do it and so if you and look I
make video games for a living but if
you've got video games which have this
incredible ability to deliver goal
accomplishment dopamine reward it's
unbelievable so you have that so you
have this sense of I'm making progress
in my life uh you have all the porn in
the world so you're seeing more
attractive women nude than any man other
than gask Khan throughout history would
have seen in his entire lifetime you can
see in an afternoon of scrolling your
favorite porn site and so and then on
top of that we you touched on this
briefly but uh diet people's diets are
out of whack they're overweight just
crushing their libido down you didn't
say that but I will I think people if
they are eating poorly they are not
working out their libido is going to get
hammered graham crackers were originally
invented to suppress libido that is a
true story you can go look it up so
we're Kellogg Kellogg's facts yep facts
so it so yeah so we've got that whole
bolus of all this sedating Behavior
which is making people not want to take
the risk and then we've got the men are
bad toxic don't be aggressive all that
then you get the red pill confounding
variable of no no no women are the enemy
they're trying to hold you back they're
not your partner they're not somebody to
contend with they're somebody to control
and that they're pleasure is elective
that is the craziest thing I've ever
heard in my life horri it is horrible
yeah this is bad it's a lot and I think
I mean I think I want to make the
clarification a lot of people use
pornography in a healthy way my concern
is with kids and and I you know as a
parent what I've done I will share and
what I've shared on my channel is talk
to your kids about what they're going to
see I know this is an awkward
conversation but they're going to come
across it whether you restrict access to
the computer whether you restrict access
to a phone they will see it from a
friend they will see it somewhere there
is no way unless you're with them 24
hours a day that you they will not see
it which would be its own problem yes so
in those cases I would say talk to your
kids say you may see something that you
may find confusing that you may find
interesting I talk to them about what
sex is and have that conversation
because if they don't hear it from you
they're going to hear it from
misinformative sources they're not
hearing it at school all they learn
about at school is how to put on a
condom and have consent both and avoid
STDs these are all important things to
talk about but they are not they're not
enough and so we have to have these
conversations at home with our children
whether it feels awkward whether it
feels weird you are the adult like have
the conversation figure out a way that
makes sense for you when they age
appropriate to have the conversation so
that when they come across pornography
because Unfortunately they will um that
you they feel comfortable to talk to you
about it and to be like oh this is not
normal this is not what sex looks like
this is a pro this is a program this is
an entertainment this is not real life
this is adult doctored lighted all these
things to make it look better and so you
know just like I think that's the only
thing that we can do currently in in the
state of the way things are right now is
to protect at least educate our children
yeah to your point I am Pro pornography
I love the most think it's great I've
I've enjoyed my fair share uh what I
worry about is when it gets out of
control and I do worry admittedly about
kids looking at it so young and almost
getting like a cynical attitude like
there is something about just the
prevalence where like uh so I'm I'm a
big believer that people should have
rules in their life now I'm saying that
as an adult with a fully formed brain as
a kid this is probably nonsensical but
um as an adult you just say okay what's
my goal what is it that I want what are
the rules I need to put in place to make
sure I don't end up having a problem and
so if thankfully by the time online
pornography was a thing I was an adult
and I had all those rules and so it was
like a fun thing to dip into and out of
when you know whatever my wife and I
weren't going to be able to have sex or
she didn't want to have sex or whatever
um
but if I don't even think it has to be
meeting the clinical threshold for
addiction for it to stop people from
being in the right position so just like
there's all the food in the universe at
the grocery store and quite frankly in
my house but I will still
fast because of all of the benefits of
it I would highly encourage people to
create a sexual hunger in themselves
that is sufficient to get them to
because that's Nature's Way of
propelling you forward to go find a mate
who will then have all these other
benefits but certainly for guys that's a
really big thing like as a kid I didn't
think one day I'll have a woman who
loves me I thought one day I will be
able to have sex with a woman like that
was just an allc consuming thought like
when you were describing I I will just
say uh if there are any women listening
to this that have kids if you have a son
and he sees pornography for the first
time it is the most allc consuming image
he will have ever encountered in his
life like it it hits you like a drug
it's like whoa this is exciting and and
so uh if people develop a habit of like
oh that's my go-to and you're showing up
for work on time you hang out with your
friends you do things yeah cool but you
never hit that threshold where just the
desire for real people sex yeah like
that that it propels you out into the
world of risk yeah I think that's super
important I think um you know I see a
lot of people who will develop bad
habits because they have now um
masturbated to pornography or to excess
uh with you know things like the death
grip or whatever they're they've gotten
so used to that they they've habituated
is the term we use to that action or
that viewing and that can't be
replicated with normal sex and so then
you have to retrain your body to be
aroused by your partner or to be um or
to uh to to get the same stimulation
with lighter uh lighter or force or
whatever so I think ultimately it's
really important to never do everything
the same way every time to vary it up to
make sure that you are not finding that
more pleasurable than being with your
partner or seeking a partner for that
matter because it's that's how we're
going to perpetuate Society right
finding Partners having babies and um
and it's super important and I think
like yeah it's it's it's a tough
situation but I think we'll we'll uh
ultimately I think people will figure
out rules for themselves and their kids
and it'll be okay it's interesting as I
see Society really struggling with how
do we re this all in it's it's a very
interesting conversation now I'm just
thinking through what I'm about to say
um now I'm sort of at the beginning of
this so uh I don't know your thoughts on
Jordan Peterson I am very compelled by
him I find him very very interesting
look he can tweet like a mad man
sometimes however um what I felt like he
was the internet's dad and then he got
sick and when he came back back he was
very religious and I didn't understand
it and so in I I'll see this happen a
lot um I'm having a weird thing with Sam
Harris right now sort of same thing
where I'll see somebody really really
smart that I respect a lot and they've
helped shape my thinking they will say
something I don't understand and I try
to go form a worldview where I say okay
for what they're saying to be true the
following things would have to be true
anyway I did that with Jordan and uh
what it seems like to me is
if nii is right and when God dies he
said something like uh we'll have so
much blood in our hands we'll never be
able to wash it off now he didn't mean
obviously literally that we killed God
he means once the idea of God is no
longer there and you don't you don't
have a way to get a lump of like live
life like this um people start trying
all kinds of things and I feel like
we're living through an era where people
are going to run these experiments on
how we put the genie back in the bottle
because when I look at the future I see
sex robots I see AI girlfriends um and
so people are going to have to make a
decision am I going down that path or do
I just have a rule set in my life that
says I'm not and
so it will be very interesting to read
Jordan's upcoming book we who contend
with God I don't believe in God uh
and I have a feeling
though that the reason religion has a
kind of staying power that it's had is
that it's a bunch of
experiments that have been run that if
you do these things you will get a
positive outcome so for instance I
didn't know this but I learned this
recently uh Orthodox Jews one month a
year one week out of the month one week
out of the month I think that's accurate
one week out of the month oh God I hope
that's correct
uh they are not allowed to have sex so
that they can build that desire even
though they're in a committed
relationship so do you see a way for us
to put this Genie back in the bottle as
somebody staring at two young
boys what what's the path to them
leading a good life that the current
Internet age does not seem to naturally
lead us to I mean I'm figuring out just
like every other parent but I think in
terms of what me and my husband try to
model is we try to show them what a
healthy relationship is and why it's so
valuable to us we do that on a regular
basis you know we are affectionate in
front of them we tell them how much we
value each other and how valuable our
lives are because of each other and we
talk about it right like when uh I'll
give you a story so my son is in school
and he has a girl who always comes up to
him and hugs him with uh without
necessarily getting consent and he's
like Mommy she keeps hugging me and I
don't know what to do and I said do you
want her to hug you and he said not
really and I said well then just say no
right but he feels comfortable to talk
to me about those things right and I
think it comes from a place where I've
always been open with him I've always
answer to any question you have I will
answer it whether it makes me
uncomfortable or not I will answer it to
the best of my ability as soon as he
turned like was seven or 8 we started
having those conversations and I said
you know it'll just be you and me we
don't have to have anyone else in the
room you can talk to me cuz he doesn't
you know he feels comfortable at this
age to talk to me about those things and
then eventually he'll feel more
comfortable talking to his dad about
those things and so I think you know
that's what we're trying to do to show
them that like nothing can replace true
human connection and it really can't it
can make you feel good in the short term
and the AI robot sort of freaks me out a
little bit because it will be like it'll
say everything you want it to say it'll
do everything you want it to do and so
that's going to be hard um and I think
we'll have to cross that bridge when we
come to it but nothing is sort of as
exciting as the spontaneity of being
with someone because they have their own
brain their own thoughts and you know
you think about it you don't always want
everything to be hunky dory sometimes
you want to fight sometimes you want to
have an argument or a debate with
someone or feel like you're being
challenged like that's where I think you
can't replace that with an AI like that
needs to be that's sort of autonomous
human uh brain thought power let me say
that in a slightly different way and
tell me what you think about this you're
never going to want that but your life
will be better if you have that and so
you have to look at things where it's
like like what I was saying earlier with
my wife and I know the greatest hits of
our sex
life but we know the danger of doing it
the quote unquote best way every time
because it suddenly stops being the best
way
and one thing in and this is super
pervasive uh I did not think this would
come up I don't know how you'll respond
to this but um I see an attack on Free
Speech right now that really scares me
and the reason it scares me is you need
to seek this confirming evidence you're
going to have a lot of terrible ideas
and if there are things that you're not
allowed to talk about you may never get
rid of said terrible idea and that can
be at the individual level that can be
at the societal level and so getting
people to understand that the right way
to think about a long-term partner is
it's someone to contend with it's
someone who will not want to do things
like you all the time and you will have
to compromise and that compromise is
going to be really annoying and so it
becomes a question of how do we make
sure that this relationship is valuable
enough that all of those compromises are
going to make sense because if you
really have an equal partner they will
make you so much better than you would
have been by yourself one of the my
favorite things to remind my wife of is
I don't know who I would have become had
I not met you CU I met her when I was
24 so legitimately my brain didn't stop
developing theoretically till I was 25
so I mean quite literally I don't know
who I would have
become but convincing somebody who is
playing video games they have an only
fans account or they subscribe to only
fans accounts uh they get that a simal
lacum of sex all the time they're
smoking weed they're
drinking um they're having fun and so it
they again going back to its sedating
Behavior they just never have the
threshold met to make them go do the
uncomfortable thing I mean think about
when you say this I think about like
when you've been in a relationship or
had a friend or what it could be
romantic or unromantic and everything's
been fine it's been nice right right use
the word nice it's been nice it's been
really great there's been no conflict
things have been fine but you're just
not settled you feel like something's
not right like I've heard that many
times from my female friends I've felt
that myself and you're like you know
what it's just there's nothing wrong
with it but it's just not that great and
that's what I think we have to rely on
human behavior in terms of like that's
what AI is going to be it's going to be
real nice it's going to be real nice but
at some point you're going to be like
it's okay like it's not there's
something unsettling about it and I'm
sure there's a neurological reason or
Neuroscience reason behind that but I
think that that's hopefully a like a
deep need that we have as humans to have
some sort of um whether we believe it or
not some sort of challenge in our lives
that we have to overcome because think
about it you take a day off and you
watch Netflix for the whole day like
it's a whatever maybe that's something
you wanted to do or not and maybe you
enjoyed that day but you can't do two
three four five 10 20 days of it right
you're going to be like okay I I need to
get do do something with purpose and
have some have something that's bringing
me to closer to a goal right and um and
so I think with the AI like you said
when you when you build things you need
them to give you a goal and so yeah
maybe AI will give you a goal but
probably not early on like what's the
goal like are you going to play hard to
hard to get with your AI robot that's
not why you got the robot right so like
I don't know you bring up something
that's really interesting which is that
everything can be nice but there's some
something missing it was the one thing
in my story of how I think people should
approach that first sexual encounter
that doesn't like everything holds up
even over a long-term relationship
except
for there does come a point where again
I'm assuming consent this is two people
that want to be together uh but it can
be hot to be a little surprising to
catch somebody off guard to do something
they weren't expecting how do you keep
sex from getting boring yes so again
this is with consent and everything um
novelty is super important and just like
anything else novelty is what keeps it
spicy particularly in long-term
relationships so what I tell people who
are in long-term relationships is to
like write down your kinky thoughts and
whatever you're into like whatever
you've never tried but you want to do
and don't feel like you don't have to tr
this if you don't want to but just write
it down for yourself and have your
partner do the same thing and then
slowly you can sort of share these
things and maybe start incorporating
them um because in a long-term
relationship that's sort of a cool thing
when you're just getting to know someone
it's a little bit hard to know what's
okay and what's not so you have to tread
that a little carefully because it may
not be consensual because you don't know
them well enough to make sure that it is
if you're just surprising them um and so
yeah or you can you know there's ways to
do it that I think would work but
ultimately I think really the key is to
just like to be open to new experiences
like yeah and and I and realizing that
not every sexual encounter will be
mindblowing sometimes you will have
mediocre sex and that's okay but you
know you want to keep it fresh you want
to keep it interesting and so try
different things and you know use you
can do it in different locations it can
be as simple as moving from one room to
the other um it doesn't have to be like
going out and buying handcuffs and all
this sort of stuff it can be very simple
but enough that it changes something
about the
encounter
um as you think
about trying to do things that your
partner would be into but that is going
to be a little bit surprising to them
how do you think about um introducing
that is it always going to be
communicating ahead of time or is it
going to be trying something in the
moment that um you've never talked about
I think you have to know your partner I
think if you're in a safe secure
committed relationship it's probably
fine to surprise them in the moment but
you know know your partner it may be
like you don't have to talk about it but
you can just like put something new on
the bed and be like hey like we're going
to try this and if they if their
reaction is like oh no then you're just
going to stop right but sometimes you
need to talk about it right like if
you're doing anal penetration for the
first time you have to prepare you have
to talk about it you have to use the
right kind of lubricant there's a whole
process right so certain things you have
to talk about beforehand speaking of
anal sex
[Music]
um how why is that a thing and then what
are
reasons why a woman might actually
consider it so in terms of um why is it
a thing well once it one it's sort of
like a forbidden area like it's
something that when you look at studies
about anal sex there's not many but the
one thing is like it's sort of exciting
and new and something that you're saving
for that partner or doing with that
partner and that could be really
exciting um two it's safe in terms of
like you're not going to get pregnant
you can still get STDs but like a lot of
times for women the big concern is
getting pregnant so that's is Splash
contraception a real thing um you want
to use
contraception the the penis owner should
use contraception because you can still
get STDs because it's such a Frable area
that bleeding of those tissues it's a
thin area and so bleeding of those anal
tissues is more common and can cause sex
STD so you should use a condom when
you're having anal sex unless you've
both been tested and you're very sure
that there's no risk of STDs um and so
that that's there and then you know I
think in some cases um it it's sort of
like it's sort of like um again I think
it's more like the taboo thing people
and then it's also like a gift they feel
like they're giving to their partner so
sometimes their partner wants to try it
and it's like a gift they're giving to
them and it's just a different area of
stimulation right you're ultimately
there's there's lots of nerve endings
around the inner third of the vagina and
so the back end of the vagina has those
nerve endings too so when you're
stimulating the rectum you're going to
stimulate those nerve endings as well
and in men you can stimulate the
prostate um which has a lot of nerve
endings as well so there's you know
there is uh pleasurable nerves there
that can be enjoyable will you orgasm
from anal sex less likely um but it can
still be
pleasurable so some people do orgasm
from that that's seem you know I think
if you are I mean you can orgasm from
like nipple stimulation you can orgasm
from all sorts of things if you are
really really focused on that sensation
of pleasure you can um you know you can
some people can train themselves or can
get so turned on that they orgasm from
something like that now it's not
everybody and it's it's not certainly
mandatory um but I think you know it's I
would say the more purpose is like if
you enjoy you you can find pleasure from
it because of those nerve endings and
that's really the goal like the goal is
not always to orgasm right it's really
to to get enjoy the pleasure and so
that's really the purpose of that the
goal isn't always to orgasm I will be
honest the small handful of times that I
have had sex and not orgasmed have been
lame like it feels like a failure well
that's I mean part of that yes
evolutionarily WR the goal is to orgasm
but I think if we look at sex in a way
where we're enjoying the journey and not
just the destination it can transform
the way we think about sex right because
if you're enjoying the journey you're
going to you're they more likely than
not going to orgasm but I think
sometimes yeah stuff happens right you
had too much a drink you took a
medication whatever it is and you're not
going to climax but that doesn't mean
that you didn't enjoy it it doesn't mean
that you weren't turned on but yeah it
can be a huge letdown that you didn't
reach Climax and that's unfortunate but
that doesn't mean that like we that
should be the only thing we're focused
on right because I think then you miss
that whole part of like oh this feels
good like this is still nice it feel
still feels intimate it still feels
great that I still feel pleasure it may
just not be that like mind-blowing
ending to it which all you know was is a
nice bonus but not not necessary I think
for every single time do you think men
and women view that differently I think
that men don't have to deal with it as
often um so I think that's why it's
different because as you said earlier
there's an orgasm Gap right women are
more likely not to orgasm um than men on
you know in general and so I think um
it's it's partially evolutionary right
you want an orgasm because you want to
ejaculate and you want to spread your
seed um um and then so there's more of a
desire to do that just
biologically uh and then you know I
think also there's like a it's always
been pretty easy so like you pretty much
always do it so when you don't it's a
huge mind let down too on top of it all
what are some um big misconceptions that
men have about women that they would be
surprised so I'm queuing off
of when my wife and I first got together
it was really hit or miss whether I
could make her or orgasm or not and it
took a ton of
effort and so there were times where it
was like we just didn't have time and I
had a hard time wrapping my head around
the fact that she was still enjoying it
so I'm like is this just for me because
that makes me feel uncomfortable and she
was like no not at all like it's still
fun I I love feeling close to you so
what are some things that guys get wrong
about women so the number one thing is
how long it takes women to orgasm so
like I said men average penetrative
length is about 5 to six minutes women
it's about 14 minutes so if you don't
start pleasuring your partner your
female partner first it's unlikely she's
going to orgasm because she needs more
stimulation than the average male again
we're talking averages here some women
will obviously climax sooner but for the
general population you would say average
it takes longer so you you may say like
oh man I always come and she doesn't but
it may be that like you there's just not
enough time there's not enough dedicated
stimulation to her again it doesn't if
you are like tired or exhausted bringing
in toys doesn't make you less of a
person it doesn't make you um less uh
desirable it just makes you focused on
her pleasure which is great all right uh
any other things that you know on
average guys get wrong what
else
think I think the big one we we've
touched on a few right one is like
knowing that the clitoris is the primary
route of pleasure and the other one is
um is is knowing that like the size is
not all it's that's that's not the most
important thing for women yes we've been
conditioned to talk about it we've
talked about all those reasons but I
think ultimately like if you have an
average size or even below average penis
that doesn't mean that you can't
pleasure women and that you cannot be
very desirable for your abilities to
pleasure women here's an interesting
stat that I found
mind-blowing uh they used uh computer
generated images of men
and they showed them to women and asked
them to rate them on attractiveness they
renewed and they found that a tall man
you could increase his attractiveness by
adding as little as a half inch to the
penis and his score would go up but to
get the same score increase on a short
guy you had to double the size of the
penis double yeah so now what I took
away from that is that
Heights the thing far more than penis
eyes which I don't know if I'm more or
less terrified by well neither of them
can you control right so I think
partially it's it's really frustrating I
think you know when you think about what
women desire when you talk to women in
general they want a sixf figure man a
six inch dick a six figure salary like
and and that's like a very small subset
of the population right and um and so I
think
ultimately what you want and what you
get are two different things but yes
height is is part of that for for
whatever reason probably evolutionarily
women tend to be gravitated towards
taller men but again none of those
things can you control so you can only
control the things that you know how
which can be how well you pleasure a
woman right all right so to pleasure the
woman though you have to I mean let's
just put them at a bar or uh to make it
less cliche they're at a charity event
whatever you got get past the obvious
your short what's your advice to short
guys so I'm not a relationship expert
but I will say humor Works quite well so
if you are funny um or charming funny
but I think humor works very very well
in breaking the ice and so it's a learn
skill you don't have to be born funny
you can learn to be funny um and I think
that helps quite a bit what do guys have
the most anxiety about so your YouTube
channel you must hear from people left
right and Center I know you have a
predominantly male audience what are
they most anxious about I mean you we've
talked about all the the big ones are
penis size that's the big one that comes
up all the time pleasuring women and um
and hor like are their hormones okay
like is their testosterone okay those
are sort of the biggest things what are
they worried about with their
testosterone well you know how can they
boost it what can they do what can they
do naturally is testosterone replacement
safe that sort of stuff why are they
worried about that well I think as as
you probably already know I think you've
alluded to on some of your older
podcasts but testosterone levels are
going down in the nation in general and
um we know this that testosterone
decreases with age but now the number of
people we're seeing with low
testosterone is more and more now
whether that's um because we're getting
better at reporting these things or
because we're doing better studies I
think unlikely I think it's there there
is truly a decline in testosterone due
to changes in health Health which we've
talked about um having poor diet not
getting enough sleep um not getting
enough exercise um and and then uh you
know doing other activities like drugs
and marijuana and smoking those things
can all negatively impact your
testosterone including being exposed to
endocrine disrupting chemicals which are
unfortunately quite predominant nowadays
um and so I think all of those things
together are causing a decline in
testosterone and and it's causing a lot
of symptoms testosterone is a very
important hormone it increases um it's
often linked with desire but it's also
great for muscle mass it's great for um
cognitive function is great for um
decreasing fat cells and also now
there's more and more data showing that
it's actually beneficial for
cardiovascular health so lots of things
that testosterone is valuable for and it
going down is concerning do you know
what's triggering that is it uh are
these guys that can't grow a beard are
they
the internet tells them that they're a
bigger man if they have more
testosterone like I I've had my
testosterone levels checked multiple
times but honestly I don't even remember
what the levels are because whatever the
testosterone insecurity trigger is I
don't encounter it yeah so uh it's
symptoms I mean so I don't know why
they're I think they're just seeing
there's so much stuff on social media
about like you know why you need more
testosterone and so I think people are
are now like oh do I need more
testosterone like it's more of a
curiosity I don't think everyone has
symptoms of low testosterone but
certainly when you have symptoms like
your your brain fog you're feeling more
fatigue than usual you're having less
desire maybe you're having issues with
erections maybe you're going to the gym
and doing the same routine you were 10
years ago and you're not gaining muscle
like those sorts of things are clear and
depression is another one so those are
sort of testosterone impact that so dep
testosterone can improve mood and um in
fact there's good studies that show so
people who are low hypog grenal with
symptoms and have depression actually
improve their mood with testosterone
replacement so ultimately if you are in
that category I think it's absolutely
valuable to get your testosterone
checked and consider natural ways to
boost it or replacing
testosterone okay uh before we talk
about how you can naturally boost it you
started touching on this at the end of
that my my running hypothesis around why
guys would be anxious about it is they
assume that if they have higher
testosterone levels that they'll get
jacked not thinking about just how
brutally you have to work out that hey
I'm going to get jacked um I actually
don't know the answer to this question
but I don't think there's a big
relationship they uh probably are
getting obese their erections are
getting worse and they think ah if I
raise my testosterone levels I'll get
better erections yes yes is that true
absolutely so it so when you're obese
right you're probably developing some
sort of metabolic syndrome whether it's
high blood pressure high cholesterol
diabetes and that will then negatively
affect your erections so testosterone
may help a little bit right because
there is a hormonal impact if your
testosterone is truly low if it's not
low it's not going to help so if it's
truly low whether it's your total
testosterone your free testosterone if
it's truly low then boosting it may help
your erections but it is not a fountain
of youth and it's not going to restore
everything back to the way it was 100
100% I will say the the number one thing
that patients come back and tell me what
they notice the most is that their brain
fog is better they're like oh I feel
clear that's like actually the first
thing they notice huh uh okay that's
very interesting um how so you were
saying it's not a fountain of
youth what is in terms of Lifestyle what
is the Fountain of Youth I know there's
nothing that's probably going to move
you backwards but I'm sure you have a
lifestyle that you would prescribe to
people and say look do this if if you
want to have uh good libido great
erections yada yada do the following
yeah so first thing is get good sleep
sleep is extremely powerful it's been
shown in multiple studies when you're
getting more than seven hours of good
quality sleep and quality is the
important thing right if you're drinking
a ton of caffeine or alcohol before bed
the quality of your sleep even if you're
getting 7 hours is not going to be great
so sort of optimizing your sleep as best
possible
and that would include like making sure
you have some sort of bedtime routine so
that your body knows it's time to sleep
um trying to avoid blue lights uh before
bed so trying not to scroll your phone
or looking at a computer I'm guilty I
still do it but I think um I think
that's the goal and then um trying to uh
uh then get that good seven at least
seven hours of quality sleep um has been
shown to boost testosterone and in the
same way testosterone follows our cirane
Rhythm so trying to what another thing
that will improve your quality of sleep
is like seeing daylight in the morning
and then before bed seeing it again at
dusk so that you can sort of tell your
your brain starts figuring out like okay
it's getting time to go to bed and your
body can start doing all the necessary
physiologic changes outside or can you
get it through the window uh it should
be outside ideally uh but the window is
if you can't do it look out the window
at least um but uh and then um so that's
one two in terms of diet the best
studied diet is the Mediterranean diet
now that's not to say there's not other
diets that have been studied they've
looked at the ketogenic diet they've
looked at other things but in terms of
the best when it's Mediterranean and so
what I tell people is you know you may
find different things that work for you
but avoiding processed foods getting
more plants and vegetables trying to
have healthy fats because actually when
you go too low fat of a diet you will
actually drop your testosterone so
making sure you're getting good healthy
fats um olive oil avocado nuts those
sorts of things um are are important for
testosterone and then in terms of
exercise the thing that boosts
testosterone is really uh resistance
training of the large muscle groups so
like lower extremity large muscle groups
so squats deadlifts those sorts of
things are going to help you boost your
testosterone now they're not going to
boost it like you're not going to work
out once it's going to be boost forever
it's like a constant ongoing you keep
doing resistance training with your
exercise and it will help now if you're
doing really extensive endurance
training like ultramarathons marathons
you may actually find your testosterone
dropping because testosterone is working
the opposite of cortisol so when
cortisol goes up which is a stress
hormone um your testosterone goes down
so you want to sort of avoid high high
stress constant stress over long periods
of time will reduce your
testosterone um and then the last thing
is uh endocrine disrupting chemicals so
what I tell people is we can only
control so much there's plastic
everywhere but try to drink out of
nonplastic water bottles try to not warm
up your food in plastic and those are
simple changes you can make to sort of
try to limit at least the majority of
your plastic consumption through through
those sorts of things what's your take
on Teflon frying pans I think that the
more and more we know we don't use
teflon so for those reasons I think um I
I'm not an expert in that area but I
would say try to use like alternative
options what do you use my husband buys
all the cookware
but I know we threw away all our Teflon
pans yeah we did a similar thing we're
now using um ceramic I think we're also
using ceramic yeah it's hard to take
care of those but they're yeah it's
really when they're brand new like
everything just comes right off and then
like a couple weeks in it starts to get
real difficult yeah so I think there's a
trick to to managing them I'm sure
there's a YouTube video on how to do
that better I am sure you're right about
that um okay uh do you know know who
Brian Johnson is yes what do you think
about his quest for the 18-year-old
erection yeah so I don't know enough
about all that he's doing I know he did
Shockwave therapy and I can speak on
that oh yeah yeah so Shockwave therapy
is um we've been using shock waves in
medicine for a long time and so shock
waves we use in urology for kidney
stones so we'll Shockwave small kidney
stones to get them to break into tiny
pieces so you can pee them out and um
and they've started doing studies on
shock wav for erectile dysfunction
probably over a decade ago so we have
lots of data but the issue with the data
is that it didn't follow one specific
protocol it didn't use one specific
machine and so that's why we can't find
consensus on whether this is um at least
from the society view whether this is
good or bad now if you look at the sum
totality of the data shock wave
essentially how it works is you do shock
waves on the penis at different parts of
the penis is this like radio waves what
what are we shocking with you're
shocking with um what is the the
technology
um piso electric there's like different
types of shock waves essentially that
you're using so essentially you're
you're shocking you're delivering these
shocks that are at a depth of
penetration so they're getting to the
erectile tissue so this is focused shock
waves does it feel like electricity no
it it feels like if you were to feel it
when you do kidney stones so you
shouldn't feel it when you do penis
shock wave because it's a little bit
different but with the with the shock
waves on the on the kidney we tell them
it's like someone's like punching you in
the back like but you're asleep for
those so for these um it's it's at the
depth of penetration where it's just
getting the erectile tissue and so what
happens is it creates this little
mechanical trauma your body then
releases a whole bunch of growth factors
to heal that area including vascular
endothelia growth factor which then
leads to new blood vessel formation so
this is one of the few things that we
have in our Arsenal that causes
regenerative uh treatment for erectile
dysfunction mean we're trying to fix the
problem which is blood flow by doing
Shockwave and So based on the totality
of the data what we see is that you
typically people will do one shock wave
treatment every every six weeks um every
week for six weeks and then that that
that's basically what all the Studies
have shown that's that's it now there
are some maintenance protocols that
haven't been well studied yet or haven't
been published yet but but essentially
after those 6 weeks we're seeing like 70
to 80% success and then after one year
it goes down to 50% so likely what that
means is that you need some sort of
Maintenance right like you can't just do
six weeks and be done you probably need
to do some maintenance and probably
there's other factors that are causing
Ed as you age and other things so um So
based on that you know I would say it's
currently not approved for um erectile
this function in terms of in terms of
the Societies in the US in the you in
the European Society actually approves
it for vascular erectile dysfunction So
based on that I would say I think it is
safe it's definitely safe um it's like
it's you know maybe might get some
bruising but overall it's it's very very
safe and um but it's costly because
insurance doesn't cover it and so if you
have the disposable income and you want
to try it I think knowing that this is
what the data shows if you're if I think
it's not going to harm you um and it may
benefit you especially with maintenance
protocols we're seeing pretty reasonable
results um and what what are reasonable
results just that you're sustaining yeah
yeah you're getting increased erectile
function um so these are people who are
having maybe mild to moderate Ed once
you get to severe Ed you're not going to
see a difference so if you're like not
getting an erection at all or it's very
difficult to get one it may be difficult
and there's a there's a questionnaire
that we use it's called the shim
questionnaire and you can actually score
yourself to find out mild moderate and
severe and so it's not really
recommended for severe Ed it's really
only recommended for Ed that's vascular
in nature so meaning it's a blood flow
problem um and so that's really the the
the main problem not if you've had a
prostate surgery not if you have a nerve
problem but really for the arterial
blood flow problem why does a
prostectomy cause problems so the
prostate is in a location where there's
a lot of things around it so it's around
the urethra it also has nerves on the
lateral aspect of the prostate that we
try our best to spare when we can when
the prostate canc nerves going to
they're going to the penis and to and to
the urethal sphincter and so these these
nerves are sort of they're the cavernous
nerves and they they sort of like the
the neurovascular bundles that are right
alongside the prostate and so we reflect
those when we do surgery to try and
spare those when you have localized
prostate cancer now can I ask sorry yes
uh the nerves run from the prostate to
the penis is that to coordinate
ejaculation like why would those two
have nerves so they can communicate
presumably well so when you think about
the nervous system you're getting um
you're getting nerves that are coming
like in these sort of like areas I'm
trying to think of the word why is it
escaping me right now
um you're you're basically getting areas
of nerves from the spinal cord that will
then go off and do a whole bunch of
these are bundles of nerves that will
then go off and and stimulate a whole or
innervate a whole bunch of different
areas including the penis and so when
you if you accidentally cut those nerves
or burn those nerves during prostectomy
for cancer then you will notice that you
will not be able to get erections
anymore and so that's why when you talk
about prostate cancer and surgery
there's sort of a whole host of options
not just surgery but there's a whole
bunch of options that you can talk about
and and assess because it really depends
on you know quality of life versus how
aggressive the cancer is and all those
sorts of things so it's sort of a
complex decision to make but ultimately
if you have injury to those nerves you
will then have difficulty getting
erections and so this this shock wave is
not going to work for those patients at
least not yet that we know of okay uh
just a little bit more on this bundle of
nerves I've always been curious about
this uh is that the only bundle of
nerves that inates the penis and that
and it just happens to be by the
prostate and be at risk or does it
create communication between the
prostate and the penis it's not between
the prostate and the penis it's between
the spinal cord and the penis got it and
they just have to be by the prostate so
when you take it out you just have this
high risk of bumping into something
exactly got it got it got it okay uh all
right so if Shockwave therapy is not yet
approved in the US what is our go-to for
somebody and so is that the part the
only part of Brian Johnson's protocol
that you know I I don't know I think
he's doing I he may be doing some PRP
injections or stem cells I don't know
those are stem cells those are two of
the the also regenerative therapies but
they're very nent in terms of the data I
have have not yet been convinced in
terms of their um because we still don't
know again these are so PRP is an
interesting an interesting thing because
it is not regulated in terms of like you
don't need approval to offer PRP because
it's a blood product so you're basically
taking your own blood and you're uh
you're spinning it down to just get the
platelet rich plasma part of your blood
and then injecting it back into yourself
and so that's why people are using a lot
of it okay time out mhm uh so he is
presumably I if he's doing PRP I don't
know if is uh so anyone doing PRP let's
set Brian Johnson aside anyone doing PRP
is taking their own blood and injecting
it back into the penis so yeah there're
there're basically you take the we take
the blood well I don't I don't
particularly do it in my office but we
take the blood you put it in a
centrifuge you spin it down you
basically take off the platelet rich
part of the of the blood you remove the
rest and then you inject that in area so
people are using it for all sorts of
things hair loss has pretty good data
people are doing it like for cosmetic
purposes but they're also doing it for
Ed and there is some positive data I'm
not going to say there's not any there's
some positive data but again you can't
really measure how much platelet like
you would have to do a lot of
Investigation to like be like okay how
much platelet per ml or per you know is
in this particular person's PRP and then
measure that and then see if they're
getting enough and and is that then
going on to give them the results that
you want and so the the most recent
study was a randomized control trial
last year in um at the American
neurological Association it did not show
benefit for erectile dysfunction but
that again was sort of um criticized
because it didn't do all these
measurements of exactly how much
platelet they were spinning down and
blah blah blah and how often and so um I
think ultimately based on that I have
not offered it yet and I think there may
be benefit but it's certainly not as
strong as the data we have for Shockwave
and stem Stell is even less like we have
very little data on stem cell at this
point for Ed but it's certainly ongoing
in terms of
Investigations okay uh I don't
understand platelets at all so I while
definitely not a medical professional I
have a sort of working understanding of
stem cells and why they might work
um what are platelets what's the
purported mechanism of action so it's
similar in terms of like you are
injecting this it's creating a response
even though it's your own blood it's
creating like more growth factors and
things again to uh bring more uh growth
of blood vessels and things like that so
that's theoretically how it works um in
terms of at a very basic level um but
ultimately that's that's what's what the
purported um mechanism is okay so stem
cells um look into the future educate
guest obviously you don't know you're
waiting for the data like everybody else
but would you expect stem cells to be
effective you know it's interesting so
the where I have seen stem cells do a
lot of Investigation in in my field also
is uh for stress incontinence for women
and so far the data has uh is has been
Mo moderate not great um and so that's
muscle derived stem cells are actually
taking a biopsy of muscle and then it um
re um injecting it into the urethra um
and so far the data is not uh to to then
bulk up the urethra to prevent leakage
but so far the data is not not to the
point where I'm like oh convinced that
we should be offering this yet now it's
still evolving and same thing with stem
cells so I don't know yet I think that
it's um it's a tossup to be honest
because it sounds great in theory but
like how much do you really need like
like in for the whole like amount of the
the surface area of a rectile tissue
like I don't know so I think it's still
really hard to to make a
projection
um hair any medication that you take
daily makes me a little nervous now I
actually was thinking about this this
morning and I should say every time I
say that uh if your doctors prescribed
something and it is necessary for your
health obviously obviously
but if there's something you can do from
a lifestyle perspective probably always
better to avoid a pill that you take
every day just because the law of
history is the law of unintended
consequences there's probably some
Downstream effect
um while I wouldn't characterize myself
as balding my hair has gotten thinner
over time and obviously I'm aware that I
could take something and theoretically
it would make my hair thicker again uh
but that terrifies me
um I've also in researching for this
episode came across oh God I wrote it
down finasteride yes yeah post
finasteride syndrome um talk to me about
that that that scares me it is scary and
so finasteride is a medication that you
can get in two doses one is a low dose
four hair loss right so there it's one
one in the lower dos is for hair loss
and then the higher dose we use for
enlarge prostate um and it basically
shrinks the prostate
um but it's a DHT blocker right so it it
it blocks the conversion of testosterone
to DHT and um but is that dihydro
testosterone correct yes sorry I didn't
clarify so um ultimately in terms of uh
what this does in some men it causes
really significant decrease in desire
that is persistent for some time now the
exact amount of time we don't know but
we there's a small subset of men who
have a very strong change in sexual
symptoms right after starting
finasteride and so I actually will
Almost Never prescribe it unless someone
is like I want to avoid surgery at all
costs and their prostate is very very
big and they there's nothing else is
working then maybe but for the most part
because of this small subset of patients
I'm and I take care of sexual health I'm
very cautious now it's a very small
subset of patient so the large majority
of people who take it won't have these
issues they won't have sexual side
effects they'll be just fine in every
other way similar to oral contraceptives
the majority of women will be fine but
there's a small subset of women who take
oral contraceptives who will notice a
drop a significant drop in libido
because it increases your sex hormone
binding globulin which then makes less
testosterone available to your body and
so those two medications are probably
the ones that I worry about because
they're so ubiquitously used and then
people can develop low libido and they
won't necessarily correlate the two
meaning I started this medication
because I wasn't thinking it was going
to affect my libido that it
did that's worrisome uh how persistent
is the problem well so interestingly
when you look at the data it's a really
small number of people but if you go on
like Reddit forums or other public
forums we're seeing more people
complaining of it and it's so variable
depending on how long you took it I mean
some people it goes away in 3 months 6
months some people it's a little longer
um we just don't know enough yet to know
exactly but essentially like when I see
a patient with this issue it's sort of
like supporting them through that
difficult time and getting them through
it with other means if necessary to
improve their libido because it can be
as you can imagine very traumatic for
them yeah this is um when you were
talking about testosterone and I don't
know that this is actually the effect
but I have a friend that did um trt at
one point I can't remember if they were
trying to have a pregnancy or something
anyway I don't remember why he did it um
but what he described
is it brought that sexual hunger back
for
him and I remember so I'm about to turn
48 so but I remember in my 20s um when
my wife and I would go on vacation she's
like hey what do you want to do while
we're here it literally did not matter
where we were my answer was always I
just want to have sex twice a day and as
long as I could have sex twice a day I
was amazing this is I'm happy yay I
don't need to go to museums I don't need
to lay on the beach just that was my
thing um
now on vacation once a day is amazing
but if we miss a day no big deal and so
that level of intense hunger for sex is
awesome and I won't lie like I do even
though I still have what I would
consider certainly a normal or maybe
even um above normal libido for my age
there's something fascinating there's
something deeply pleasurable about being
in the grips of that that
hunger
um does testosterone actually bring that
back and do you think given that if I'm
right about the literature people with
post syndrome uh they have an increased
likelihood of suicide so to to answer
your second part of the question yes
they do because it can be very traumatic
as I mentioned it's um again not highly
reported but any sort of dramatic change
in your sex life can be extreme
uh problematic psychologically extremely
for men or for men and women both both
but I think um I think the one thing we
see in women that's more likely to cause
suicide is actually when you have a
persistent genital arousal syndrome or
disease pad it's called and sounds like
it sounds awesome it's horrible it's
horrible imagine feeling like that all
the time and not and no matter what you
do no matter masturbate orgas
it doesn't go away and so they feel
miserable they just feel aroused like at
the level of their genitals correct
so uh like they're they feel um flush or
they feel like I really want to have sex
it's it's just like feeling that
uncomfortable feeling think about like
blue balls like that uncomfortable
feeling of like feeling full and feeling
um and everyone describes it a little
differently and they actually have a
hard time describing it because they
don't they're like what is this like
what's going on with me like it's not
normal to feel this way all the time
right so they don't describe it as
arousal but essentially when you when
you deep down like that's exactly what's
happening is they're feeling this
persistent genital arousal so that in
women more likely leads to Suicide wow
that's terrifying it's really sad so
when these patients come to us we are
like we got to get you don't like we got
to keep an eye on you make sure you get
the treatment you need very often pelvic
floor Physical Therapy can help and so
uh because it's really a a part of it is
that pelvic floor tension is really
really tight and that's what's causing
the discomfort cuz it's it's mimicking
arousal um and so that that's usually
the the first line but there's other
sort of things you can do um and then
the first part of your question uh in
terms of that sexual desire does it
always come back um so with trt uh yes
sometimes it does but desire is very
complex so the goal obviously is if
you're coming in for low liido or low
desire um that we replace the
testosterone desire should come back and
now there's different types of trt so
sometimes your tesser number will look
fine but maybe it's um uh maybe it's not
as effective like sometimes the gels are
like depending on how well it's absorbed
um may or may not be if you're taking
off label medications sometimes they
don't do the same thing um and and so
it's it's variable but essentially
trying to figure out like you know it's
sort of tinkering to figure out what
works for you individually to help you
get that desire back but desire is very
multifactorial so there's other factors
that play into it like um uh stress
anxiety uh relationship issues are a big
one right if you're fighting with your
partner all the time certainly your
desire is going to go down um and then
you know other conditions or other
medications can affect desire so making
sure we're optimizing all of that is
really uh really the most important
thing because yeah I can get your
testosterone to a number but does it
matter like if you're say you're at 500
and your full your testosterone
receptors are fully saturated at 500 and
I get you to 900 it's not going to make
difference we're not going to we're not
going to move the needle and I can't I
don't know what number it is that your
testosterone receptors are fully
saturated at but at some point like it's
a law of diminishing returns we might
actually harm you with giving you excess
testosterone when you don't need it um
if so the the goal is always when you
start something like trt to make sure
you're getting the intended benefit and
if not let's let's move things around
let's switch things up because we want
to make sure we're optimizing for you as
an
individual it's really interesting okay
so uh the post for
naside uh syndrome a lack of sexual
desire Leading Men to commit suicide at
a higher rate obviously not a guarantee
um that makes me think of something that
uh also when you said if you're arguing
with your partner all the time
so when I think about male and female
desire um communicating with my wife
helping her understand me and me trying
to come to understand her um I have a
quick rule of thumb it's obviously very
complicated but uh for a man if you make
him feel
powerful you're pretty much done like it
you've done it like everything that he
basically needs um there's a great quote
Oh this is going to get me in trouble
but uh I can't remember who said it
maybe Oscar wild uh everything is about
sex except sex that's about power and
they're obviously given what you and I
have already talked about love respect
trust vulnerability um that quote isn't
literally true but there is something
to I think that part of the reason that
men are obsessed with the size of their
penis part of the reason that men are
just destroyed when they lose sexual
desire part of the reason that if they
have erectile dysfunction that what may
start out as a physiological problem
very quickly becomes a psychological
problem confounding
it
is and I I I really think I know I said
this at the beginning I think that
Things become a thing in society because
they are evolutionarily
true for a
man it's possible there's just an
evolutionary algorithm running that I
have not thought through well enough to
know why it would be there but you so
associate your penis with your
masculinity and
um I remember one time with my wife I've
said this before I'm not embarrassed by
this at all but uh we were having sex
and the we lived in an apartment we were
so broke at the time and the neighbor
upstairs had a really flemy cough and he
just started [ __ ] hacking up a lung
and we were having this really
spontaneous moment on the living room
floor and I just lost my erection
because it was so gross and there was no
sound we weren't playing music nothing
and so it's just like oh God and so that
it it feels like you're manhood is dying
on the
vine and so all of that like sense of
being a man and being powerful is echoed
in your penis it's crazy and if
something is going wrong or if you're
just insecure about
it like this is why yesterday when I
said to the team hey I think penis
enlargement is actually real I can't
believe this
you could hear a pin drop except for the
jokes of course everybody starts making
the uncomfortable jokes but everybody
was locked in everybody was paying
attention and it it is there there is
something that can't be denied about
that 100% I mean I think when you talk
to you know I've talked to many people
and over the years people like you know
you spend your whole young years
defining as a as a boy and a young man
is like all around how you're going to
get your partner or get a partner it may
not be your partner but like you decide
where you're going to hang out you
decide what clothes you're going to wear
you decide where you might go to college
you might decide even what kind of
career you get because of you know
chasing a certain partner to get them to
notice you or to get partners to notice
you and and it is very uh is very
ingrained in people's um lives and I I
see men every day who have issues with
directions and I know how it breaks them
I know how upset they are and how how
much it derails them and the hard part
is that we say women suffer in signs but
so do men like they they will go online
they'll buy a gas station pill they'll
they'll do a lot of other stuff before
they finally come to the doctor because
they're freaked out right and so they'll
they'll get taken advantage of by a lot
of online clinics or other things and
I'm glad there's online clinics because
it allows accessibility for people who
won't see it doctor but sometimes
they're charging so much that you're
like well you could get the same thing
from a pharmacy with a coupon for like
20 bucks you know and so it's sort of
like um it it's really important and I
think that um if anything if any men are
listening like you're worth taking care
of yourself and like seeing a doctor and
getting evaluated and getting like
there's you're not alone if half of men
over 50 are suffering You are not alone
and I know it sucks but like you can get
better yeah you can get better and I
think understanding the that Dynamic of
okay guys want to feel powerful for
better or worse uh the locus the Locust
of power is definitely in your mind it
isn't your penis but it very much you
have a relationship to that um do you
know who Andrew Schultz is he's a
comedian he's very funny uh he had a
joke that I was like that is way too
true and he said uh ladies if you really
want to say something sexy to a man you
only need one word and that word is
ouch and I I almost piss my pants with
laughter I thought that that is a little
too true like just that sense of like oh
yeah I'm I'm big and powerful like it
it's just all tied up in a
knot and uh even going back to
testosterone I have a huge hunch that
part of it is just guys think if I have
high tea I'll be jacked and so getting
your Physique in a place where you feel
strong you look strong both of those I
think are part of the equation um your
penis is where you want it to be you get
as hard as you want to be you have that
hunger um and so when I look at Modern
Life it's a big part of what I think is
going wrong you touched on phalates by
another name
microplastics um I don't know what the
truth is there but I am terrified that
that's causing
part of the lowering of testosterone
which then has this just incredible
knockout effect because I have a
hypothesis that the effects in utero are
going to be the biggest effects and so
if you're and I know women are so
sensitive to this but if your mother is
taking in phalates or whatever because I
don't have data on this but taking in
any sort of toxins during pregnancy and
moms is not your fault like this is
Modern Life this where we're at but and
that lowers your testosterone or
whatever naturally down the
line you just spiral because if you
still have that algorithm running in
your mind that feeling powerful is like
one of the most important
things and there's things just you're
being assaulted in every angle can
really get into trouble and so this is
one of the things that I say to women
one you want to it has to be real you
can't fake it but you want to help your
man feel powerful and guys you want to
earn that feeling of power and failing
to do that is brutal yeah yeah it's I
mean I think the testosterone plummeting
also and I I know like many of your
audien is probably very fit and and eats
well but I would say that the large
majority of the population is obese and
overweight and they're not exercising
and they want a quick fix and they're
not eating right and like you got to do
the hard work you have to do the hard
work to change your diet and exercise
and if that doesn't work absolutely
there are definitely plenty of healthy
people who are fit and physically fit
eating right doing all the right things
whose sassone still isn't as high as it
should be and that's okay like then we
can fix it then we don't feel like we're
you know we're we're fixing something
but then like you're you're going 10
steps back and we're going two steps
forward you know like I think you got to
do that work first and you'll actually
notice your penis will get bigger too
because your fat will get less and then
when you look down you're seeing more of
your penis so you want to get a longer
penis lose the
weight that's so true um I'm gonna say
something I don't know if you're going
to hate this or not but um if you are
experiencing erectile dysfunction odds
are that that is a blood flow problem
which by the way is a signifier as you
said a potential heart disease
uh don't pass go don't collect $200 go
straight to getting your body fat
percentage to
10% I don't know that you need to push
it much below that but if you haven't
done that you have not done what in my
non-medical opinion is the single most
obvious thing that you could do and then
on your path to doing that which by the
way I only encourage people to do it in
a healthy manner you need to be eating
well otherwise you'll just end up being
skinny fat um but if you do that and you
are pushing yourself in the gym in a
sensible way because to your point you
can actually exercise so much that your
testosterone actually moves in the
opposite direction but I would say
that's going to be a narrow band of
humanity the vast majority of people
will stop long before they get there um
but I just have a burning this one I'll
say is a thesis this is this is beyond a
hypothesis at this point there's so much
data that if you
aren't if you aren't really pushing
yourself to be obviously in shape you're
doing yourself real dirty
psychologically and physiologically yeah
and I think um I don't know about 10% I
don't know if there's any data on what
specific body fat you need to be um I
think you know making a goal and having
one is important but getting into a
healthy BMI and that's sort of not the
best indicator right because when you
have a lot of muscle mass your BMI can
be high and you can still be healthy but
um generally speaking I think most
people who the average person can use
BMI as an indicator and uh trying to be
in a healthy BMI it's variable for
different races so like Asians for
example need to be a lower BMI to be
healthier than Caucasians for example
really yeah why yeah because we have
higher risk factor so this actually and
this is not my area of expertise but
I've watched videos on this but
apparently because in in South Asian
culture say when you say we are you
putting yourself in the Asian South
Asian more so than Asian but I think
Asian falls into the category but with
South Asians we had famines for many
years generationally you know back a few
generations and so that's apparently
impacted our our um metabolic needs and
so we actually need to be at a lower BMI
and a lower waste circumference than the
average uh the Caucasian numbers which
are what we share in the US um to be
healthy uh I had no idea that was true
yeah that is really fascinating okay so
uh anybody listening along they um they
want to turn it all around obviously
we've given them um some great lifestyle
hacks and stuff but let's say that
they're still struggling with erectile
dysfunction um Shockwave therapy is not
approved in the US for that I don't know
if that means you can't get it you still
get it you can pay out of pocket I mean
we offer it too but again I tell
everyone I tell everyone the data I tell
them the caveats and and it's like yes
it may work it may be beneficial it's
the only thing that you know there's
only a few things we have that can turn
back the clock in terms of blood flow in
the penis and that's one of them what's
your take on daily Calis so I really
like daily Calis in fact I think it
should be in the water it is like so
safe and I think it works really well
you know I'm paranoid about daily
anything but this is interesting well it
it works basically I mean all these pde5
Inhibitors work by inhibiting pd5 which
breaks down you know CMP which is a so
let's talk let's go take it backwards so
nitric oxide is the ignition for
erections it causes the release of CP
which creates the erection pd5 breaks it
down and so when you prevent pde5 you're
then allowing that erection to be
sustain longer and in some cases get you
the erection sooner or earlier and so um
It ultimately that whole process means
that you get better blood flow to the
penis right and better blood flow means
better healthier tissues and so our
bodies men's bodies typically take care
of this by doing nighttime erections so
men will have three to four to six
erections over the course of the night
and that's completely normal and
physiologic and healthy they'll often
wake up with an erection and again
that's all normal healthy physiology and
so your body is constantly giving blood
flow to the area whether you want it to
or not and there's nothing you can do to
stop it it's actually a good thing I
actually get comments on my YouTube like
how can I stop this I'm like no no no
this is a good thing I think it's more
like International people are worried
about like is this bad or something why
I I think it's I think it's more of like
a a like they're worried culturally like
is this bad like why am I having
erections like I don't know I don't
really understand that is utterly FAS
think it's a moral thing maybe I I can't
speak to it but they they one they
definitely get worried about nocturnal
emissions um and that will happen almost
every guy will have a wet dream at some
point in their lives and if you are
holding off with or you're sustaining
from ejaculation for whatever reason
whether it's through you know your you
will just your body will take care of it
either will absorb the semen or you will
ejaculate it at night okay I'm going to
say something I don't know if this is
controversial people are going to be
like yeah exactly uh before I got
married having a wed dream was like the
most amazing thing in the universe
you're literally having a dream where
the dream is so erotic that without any
stimulation you have an orgasm like yeah
if that didn't require a level of
abstinence that I find wholly
uninteresting uh they're rat I don't
it's messy that's not fun but man that I
don't know it might be worth the
tradeoff but there's a lot of Shame
people feel a lot of Shame right they
wake up with sticky sheets and they feel
shameful like some of them feel like
maybe like that was bad and like
culturally depending on how you grow up
that can be really um looked upon as a
negative and you know a lot of the way
you think about sex is all about how
you're raced right how how was sex
talked about like even when you're a
little kid every kid touches their
genitals every single kid touches their
genitals they may even like try to
stimulate themselves in front of you
that's they don't know their kids right
that's it feels good it's like whatever
and so um as a parent a lot of people
like don't do that that's that's dirty
or that's shameful or don't do that and
so that kid internalizes that that
that's bad I shouldn't touch myself
that's bad and that can and usually most
people will get over it but there's some
people who carry that with them and
they're like oh touching myself
masturbating being sexual with myself is
bad and then having night wet dreams
they in the same vein maybe like maybe
their parent woke up and their sheets
were dirty this is disgusting you know
and then they then internalize
that man that's so interesting uh that
never made my radar so not that people
don't find shame around sex obviously
but that people would be tripped out out
or ashamed of uh having a dream you have
dreams about the weirdest stuff in the
world yeah so I'm actually a little sad
that more of my dreams aren't about sex
that that is a very entertaining way to
spend a night uh that's
really
surprising huh okay so back to the
tadala yeah so yeah I think because it
increases blood flow for example if
you're getting erectile dysfunction you
may stop having those night erections
and over the course of many many years
if you're not getting as many erections
you're not getting as much blood flow or
increasing the oxygen content of those
tissues and you can then have tissue
changes and ultimately fibrosis and
scarring and shortening of the penis and
so that's why I love it if you're having
any issues say shortening of the penis
yes we going in the wrong direction here
put it in the water so that's why I say
like for men I say tadalfil and for
women I say vaginal estrogen like
everyone should have access to vaginal
estrogen it's super safe it's super
healthy and helps prevent UTI and helps
keep tissues healthy and all that stuff
so um those are the two things I think
should be skip over that so vaginal
estrogen is it a suppository you can do
a suppository you can do a cream or you
can do a ring that is inserted by your
doctor um and those emit vaginal
hormones so after menopause the vulva
goes through many changes so the major
the manora shrink the vaginal tissues
become thinner and More Fry
the um and and then you can have more
discomfort with sex you can have more
UTI because the pH of the vagina changes
because you no longer have estrogen
converting uh lactobacilli converting
into lactobacilli causing a conversion
into lactobacilli which prevent UTI and
keeping the pH low so then giving
vaginal estrogen keeps the health of the
tissues um and then prevents that
thinning of the tissues that can make
sex uncomfortable that can make you
generally uncomfortable and a lot a lot
of women get recurrent UTI after
menopause and magag estrogen fixes it
going back to Calis um that was
originally developed as a blood pressure
medication so selenop or Viagra was
originally developed as a blood pressure
medication and it was they did the study
this big randomized control trial and
they found out that people weren't
returning the samples at the end of the
trial and they were like what's going on
the guys like oh I'm getting good
erections with this and so that's when
they realized that this didn't work for
blood pressure but it worked great for
erections and so that's when Selena came
along and honestly thank God it did
because we didn't have many options
before seleny so does Calis work on a
totally different mechanism same
mechanism it works on um pd6 instead of
pd5 but basically the same sort of
mechanism so why is nobody saying daily
Viagra why daily seales because of the
halflife so tadalafil has a halflife of
36 hours um and or it's tadalfil has a
half lifee of four to eight hours what
what's uh so I'm always tense so if
something's giving me an erection it's
doing something to my blood flow surely
it's
systemic why would that be advantageous
to me at a systemic level I certainly
understand if I have Ed but if well I
think yeah if you don't have Ed you
probably don't need it right but like it
there is some data that it may um have
less again these are like not great
studies but like there's some data that
maybe it's also reducing cardiovascular
risk because there is some blood flow
Improvement throughout other parts of
your body but ultimately I think if
you're having Ed It's very effective one
it works but you know again there's
caveats all medications don't work on
everyone's success word is probably 60
to 70% of medications but um in terms of
why I think it's so great it's like you
remove that psychological barrier like
oh I have to remember to take this pill
an hour before I have sex or it could be
you know a day before with tadalfil or
whatever but you still have to remember
to take it and then like is it gonna
work is it gonna work uh I just took the
pill is it gonna work I'm not sure like
there's a lot of anxiety even around
doing something right before sex that's
new and so I find that especially in
younger patients it just like takes that
stress out of the picture so sometimes
in men who I can tell it's pretty much
psychogenic like young guys but yes you
should see a sex therapist you should
see a psychologist to kind of work on
your thoughts around sex but in the
meantime try this because once you get
the confidence back that you can get an
erection you may not have the problem
anymore because you're not going to come
to the encounter being stressed right
you're like okay I can have an erection
I'm
good it's very interesting what are the
side effects of Calis so side effects
with both medications any pd5 inhibitor
you can have some nasal congestion you
can have flushing sort of like a
headache feeling um with selenophile
what we worry about if you have vision
changes like blue green Vision
discoloration you got to stop that
medication immediately um with tadalfil
sometimes people have muscle aches um
the other thing that people forget is
that with s denail or Viagra you have to
take an empty stomach if you take it
with a lot of food it's not going to
work and you'll still get the side
effects so it's not really great whereas
tadalfil you can eat if you if you like
to have like evening sex and you want to
have dinner
before so I'm getting a headache but
that I mean that stri anything that
messes with my brain I am so paranoid
about what is it doing that causes the
headache is it increasing my blood
pressure it's just that it's working on
other pde inhibitor other uh variations
of pd5 and so that causes I forget the
exact mechanism but that's why you get
the side effects now that's another
reason I like the low dose of tadalfil
because the side effects are lower got
it okay um very
intriguing um all right what are other
lifestyle tips that you recommend you've
got guys coming in all the time um sex
therapists you just mentioned what are
what's like that package of goods that
you give people that we haven't touched
on yet yeah I mean I think anyone can
benefit from Sex Therapy you know
because even if you have organic Ed
you're stressed about it you're anxious
about it and that's not going to help
you get an Direction that's going to
hinder it so I think like being able to
accept that issue and moving past it and
not having that stress even if it's like
yeah I got bad diabetes my hemoglobin
A1c is 10 like if you have the time and
you have the means to see a therapist it
will help you know um it's not going to
reverse your diabetes but it will it
will help your thoughts around sex um
and then I think ultimately um in terms
of other lifestyle things I mean fixing
those issues so if it's your blood
pressure if it's your cholesterol if
it's your diabetes first and foremost
work on those so if you're hemoglobin
A1c is high bring it down if your blood
pressure is high bring it down like
whatever you need to do the hard part
with blood blood pressure is we want to
bring it down if we use pharmacologic
medication to bring it down some of the
pharmacologic medications have side
effects um and so we got that also cause
ED so you got to talk to your your
regular doctor and make sure you tell
them like I want to make sure I don't
have side effects of Ed because there
are some that don't don't have those
side effects um and then you know the
same things as testosterone like
exercise exercise is the biggest one I
can say is continue exercising and in
this case you want to do cardiovascular
endurance exercises at least 150 of
moderate intensity exercise every
week okay getting the vascular system in
place makes a lot of sense oh and quit
smoking so if you're smoking you have to
quit smoking will kill your erections
let me say it again smoking will kill
your erections I've heard that smoking
also shortens your penis is that really
true or is that well again it's a same
thing if you're not getting erections
you'll develop fibrosis and then it'll
shrink and it it does change your tissue
quality so I think that's another
component is the the carcinogens or the
um chemicals in smoke has have some
effect on tissue quality overall that's
why smokers don't heal as well after
surgery really I have no idea uh what
about weed so weed is sort of
complicated like in in small doses
people will say it increases my desire
it's great you know but if you're using
it more regularly it's absolutely going
to have a negative impact first on your
sperm quality so if you're trying to get
a pregnant like don't smoke weed because
it's going to me mess up your semen
quality um and then uh in terms of
erectile function it does have some
effects in that realm but more so in the
desire realm after you using it a lot
you're just not going to want to have
sex okay so I am a super infrequent user
of
marijuana however in low doses yeah I'm
a I'm I'm a Noob for sure but so in low
doses infrequently it makes sex
unbelievable yeah it's not even the same
sport I'm so conflicted saying this
because I I'm just a big fan of not
doing a lot of drugs I don't have a
moral thing against it at all like if
you want to drink you want to smoke do
drugs I literally cool no beef
whatsoever I worry about longevity and
so but oh man if I'm being honest uh my
wife really enjoys marijuana and she has
convinced me
to try it and one time oh man I would go
years between smoking because I just
hated it I hated the way it made me feel
lethargic and like the third time I
smoked I I don't remember why but I
rubbed my hands across my legs and I was
like whoa that felt amazing and so we
took advantage of that and I was like
this is
unbelievable so on the occasion we do we
do see that we do see that in small
doses people find their libido increases
with marijuana and so again as long as
it's not becoming a habit forming thing
you're not going to have negative
long-term consequences like but you know
once in a while I think it's fine but if
you're doing it a lot you could run into
trouble correct what about alcohol again
same holds true now we know that no
amount of alcohol is really safe in
terms of cancer prevention um so now
more that's come out mhm yep there's no
amount of alcohol that is safe because
any amount will increase your risk of
breast cancer and a few other cancers as
well um so generally speaking it's the
whole like have a glass of wine for your
heart not not good enough to prevent
cancer so um generally speaking no
amount of alcohol is is safe for that
that being said um in terms of erections
and sexual function again if you're
doing it all the time every day and you
may start noticing some unintended
consequences in terms of Desire um but
and erections cuz whiskey dick is a real
thing like people will have difficulty
getting erections when they're too
inebriated um and so uh that that
becomes an issue but again in small
doses we don't see an issue so speaking
of whiskey dick
SSRI dick strikes me as a a terrifying
one what's is there data on that yeah
there's a lot of data so ssris we know
uh cause low libido for sure that's a
very common cause and erectile
dysfunction but it's dose dependent so
if you need ssris for anti-depressant
one you can switch to a different type
of anti-depressant um that has less side
effects well buttin is the one that I
always tell my patients to talk to their
psychiatrist or primary care doctor
about but even if say you're doing
really well on like zolof or something
else you can go down on the dose and if
you're still getting benefit you may see
your erections come back and your desire
come back but it is a strong side effect
of those
medications yeah getting back into into
the you just get into a horrible Loop um
I'll paint a picture for people and I'm
sure a lot of people are going to be
like oh whoa that sounds a little bit
too much like me uh you start eating bad
food uh tastes amazing so you eat a lot
of it puts you in a way better mood so
you're loving it for the short time yep
but uh you start putting on fat and you
start feeling a little bit less great
about yourself uh your penis starts
getting a little bit it seems smaller
less visible um you then are also
starting to have weaker erections you
get in your own head both about not
looking good your penis looking smaller
uh being uncomfortable naked in front of
somebody getting paranoid that you're
going to lose your erection because it
is a little bit weaker and you do start
losing it uh you no longer feeling
powerful um that starts some darker
thoughts some unhappy thoughts uh you
don't have the you know cogn behavioral
therapy training to pull yourself out of
that so then that begins to exacerbate
itself the thing that cheers you up is
some more food bit of
pornography uh that only founds
subscription that you have um and all of
the sudden the things you're doing to
pull yourself out of that are actually
making it worse you're smoking a ton of
weed you're
drinking um and now you in a real
downward spiral and all the things that
give you the dopamine hits that you need
to feel better and they really do work
and they really do make you feel better
um but they have second and third order
consequences that are actually making
this worse and now the downward spiral
really speeds up you finally seek help
which I am actually glad despite me
painting a picture that is something you
can control uh if you need help man get
it I don't care how self-inflicted the
wound is I don't want you feeling guilty
about that so you go get on the SSRI and
now that's lowering your libido even
more and now you're feeling even worse
oh God and now we're just in a really
really dark place speak up seek help but
did that sound like a thing you see a
lot yeah so it's like what comes first
the chicken or the egg right so is it
the depression that came first or was it
the sexual dysfunction that caused the
depression that then got them on the
SSRI that made the sexual dysfunction
worse so yeah we don't always know what
the issue is and um and as I said sexual
dysfunction sex is powerful in terms of
how it affects your brain it can be
devastating and so it is really um it is
your story is like a lot of men's
stories a lot of you know a lot of
people's story in general like this is
something that people struggle with and
I think there's there's no easy way but
you got to sort of like you got to do
the hard work like you said you got to
seek help and yes sometimes you might
need an SSR for a short period of time
but that may help you get back in the
mood so you can actually feel energetic
and excited to do things again and then
you can start doing things and improving
your life and your quality of life and
exercising and eating right again and
sort of getting yourself back on track
or you may find other things that help
you do that that are not medication But
ultimately like yes seeking help is the
key before sooner the better right
because as you can see the downward
spiral you you painted there can start
pretty small and it can get really
really really really deep and so trying
to like get help when you notice
yourself struggling that's takes a lot
of insight and a lot of Courage but it's
really important Reena this has been a
joy where can people follow you so I'm
on Reena Malik MD on all the platforms
uh you can follow me on YouTube my
channel is Reena Malik MD and I also
have a podcast Reena Malik MD podcast
everything's really consistent and if
you want to see me as a patient I
practice in Newport Beach California and
Beverly Hills and I'm also licensed in
eight states so I can see you virtually
I love it thank you so much for coming
on thank you so much for having me of
course guys if you haven't already be
sure to subscribe and until next time my
friends be legendary take care peace if
you like this conversation check out
this episode to learn more then what you
realize is your capacity to tap into
dopamine as a motivator not just seeking
dopamine rewards that is infinite and I
I can say with with great certainty that
this is how you were able to build a big
company and sell it how you've been able
to build a successful podcast and S