00:00:00
Is there a way to enlarge the >> So, you can put your penis in this device. They've actually done research
00:00:05
on this. So, 30 minutes twice a day and it does show improvements in length about 2 cm.
00:00:11
>> Tada. >> And that's not all. So, they actually did a study on pistachios where guys at
00:00:15
100 g of pistachios every day and they saw a decrease in erectile dysfunction because if you're not having erections
00:00:21
now, you're no longer getting blood flow to your penis and it will shrink over
00:00:24
time. And the same goes for women with their clitoris because it's the same type of tissue. But also, when you look
00:00:29
at people who have sex once a week, they live 49% longer than people who only have sex once a year.
00:00:35
>> 49% longer. >> Yeah. And for every 100 orgasms men had, they lived like 13% longer.
00:00:43
>> Be right back. >> Dr. Reena Malik has become the world's most watched urologist.
00:00:49
>> After sharing everything you need to know about hormones, sexual health,
00:00:53
>> and how to have better sex based on the data. So, how can you have the best sex
00:00:57
possible? So, there's four main pillars of sexual health. So, pillar one is fuel. So, how you nourish your body, and
00:01:04
it's a huge part of sexual activity. And then pillar two is strength. When people
00:01:08
think about strength, they always think about going to the gym and lifting weights. But it's much more than that.
00:01:12
So, when you look at the data, any sort of cardiovascular exercise is going to improve sexual function. It's going to
00:01:17
improve blood flow to the penis and to the clitoris. And then also if you do 150 minutes a week, it is the same
00:01:23
amount of improvement as you would see when you take a medication like Viagra. And the other part of it is the pelvic
00:01:28
floor. It's under evaluated, under discussed, and we'll get into that. But
00:01:32
pillar three is environment. So things like stress, sleep, and endocrine disrupting chemicals. For example, they
00:01:39
looked at data on men sleeping 5 hours a night versus 8 hours a night. Guys who sleep 5 hours a night, their
00:01:45
testosterone drops by 15%. Yeah. >> And then the last of the four pillars that we don't talk about enough is, and
00:01:52
that's still important, >> I want to talk about morning erections, squirting, clitorol stimulation, and
00:01:57
certain positions that are going to increase the probability that my partner has an orgasm.
00:02:02
>> Let's talk about all of that. First of all, >> this is super interesting to me. My team
00:02:09
given me this report to show me how many of you that watch this show subscribe. And some of you have told us, according
00:02:13
to this, that you are unsubscribed from the channel randomly. So, favor to ask all of you. Please could you check right
00:02:19
now if you've hit the subscribe button if you are a regular viewer of the show
00:02:21
and you like what we do here. We're approaching quite a significant landmark
00:02:25
on this show in terms of a subscriber number. So, if there was one simple free thing that you could do to help us, my
00:02:30
team, everyone here to keep this show free, to keep it improving year over year and week over week, it is just to
00:02:36
hit that subscribe button and to double check if you've hit it. Only thing I'll
00:02:39
ever ask of you, do we have a deal? If you do it, I'll tell you what I'll do.
00:02:43
I'll make sure every single week, every single month, we fight harder and harder
00:02:46
and harder and harder to bring you the guests and conversations that you want to hear. I've stayed true to that
00:02:50
promise since the very beginning of the D of Sio. And I will not let you down. Please help us. Really appreciate it.
00:02:56
Let's get on with the show. Dr. Reena Malik, if somebody was to come up to you in the street, having watched
00:03:10
your videos online, and they were a a follower of the content you've produced
00:03:14
over the last couple of years, if you had to guess the question they would ask you, because it's probably the most
00:03:20
frequent, popular question you get asked, what do you think they would say? >> They would say, "What can I be doing
00:03:25
right now to improve my sex life?" >> Who would be asking you that question?
00:03:29
And why do you think they'd be asking it? >> I think everyone can agree that sex is
00:03:33
something we enjoy. It's something that's important that we want to have,
00:03:36
right? And there is um a desire to have good sex or feel like maybe you're missing out on something that could be
00:03:44
even better. So, how can you have the best sex possible? Because you hear all these people talking about amazing sex
00:03:50
in the media. You might see it on pornography. You might feel like this is something amazing. Why am I not having
00:03:56
that? I want that. Right. >> So, on that point, you said it's obvious that it's important. I think it appears
00:04:02
to be increasingly not obvious that it's important because when you look at some
00:04:06
of these stats and I'll throw this graph that I've I found here up on screen and
00:04:10
it shows that people are becoming more sexless especially young adults between 18 and 30. This graph is pretty stark.
00:04:17
>> Mhm. Think about 50 years ago. There was no cell phones. There might be some TV
00:04:21
programs but there was ads in between TV programs and there was only certain TV shows you could watch at a certain time
00:04:26
that you enjoyed and then there was nothing to watch. There was no email. So, you went to work and you came home
00:04:31
and there was really not a lot of communication between you and your co-workers or your job. They made dinner
00:04:35
with their family. They hung out and then maybe they watched a program or two and then they lied down in bed. They
00:04:41
didn't have a phone to scroll on. They didn't have anything to keep them up.
00:04:45
And so then they were like next to their partner and maybe they're talking, maybe
00:04:48
they're cuddling. And so there was more like opportunity and space for sex, right? You it was a thing that you did
00:04:54
for enjoyment, for pleasure, for fun. Now we have all these distractions that keep our mind away from sex. In order to
00:05:02
enjoy sex, you need to have space for it to be able to enjoy your partner and feel like you want that, right? And now
00:05:09
we're sort of there's not as much room for it. That's one. Two is younger
00:05:14
people, how are they dating, right? How are they meeting each other? They're
00:05:17
meeting each other through apps, through um DMs. And so they're not actually like
00:05:23
really having these deep meaningful connections. there have there's a big hookup culture. There's a big like fling
00:05:29
culture. And imagine first time sex for most people is not great. You don't know
00:05:33
your partner. You don't know what they like. And you may not be able to express
00:05:36
what you like. You're never taught how to talk about sex, right? So you don't
00:05:40
know how to say like, "Hey, I like it like this." And you may be self-conscious cuz it's your first time.
00:05:44
So you have like mediocre sex or bad sex. And they're like, "Well, I don't
00:05:48
really want that." And there's just no like follow through, right? There's
00:05:51
there's not a lot of um education on what sex should look like. like the only
00:05:55
education people are getting are from often erotic films and so they're seeing
00:06:00
sex that's not real that's curated and they're trying to emulate that and
00:06:04
that's not pleasurable for most people and younger people these days are um actually having a rise in more what we
00:06:11
call rough sex so choking has become very very common as common as like they call choking almost like vanilla sex so
00:06:19
young people if you look at data like 60% of women and I think 20% of men have been choked during sex of that age
00:06:28
group, like college age group. And of those people who get choked, 20% have been choked 25 times or more. Now, I
00:06:35
think it's fine if you're into that, but I can't imagine that that many people
00:06:38
are into choking. And there's data to support that. So, when you look at qualitative data, and this is by uh
00:06:43
Debbie Herbick, she's a sex researcher, and she did qualitative research, and
00:06:46
she asked people like, "What is it like? Do you enjoy being choked? Tell us about
00:06:49
it." Right? Women were like, "Yeah, it's okay. Sometimes I'm scared because my
00:06:53
partner is big and strong and I'm, you know, smaller and they have big hands.
00:06:57
Sometimes it's fine and sometimes I don't really care for it, but like it's
00:07:00
just a part of sex. It's just as normal as as kissing, for example. And so if
00:07:06
you're having sex and you're doing things just because you think that's
00:07:09
what your partner wants or what it should look like and you're not enjoying it, well, that's not going to be sex
00:07:14
that you want to have. that point you said about the the lifestyles we lead and how that might be impacting our sex
00:07:20
lives I thought was really interesting because we don't talk enough about this
00:07:23
but when you look at some of the data on this demographic um you know people 30 and below around that age the extreme
00:07:30
outliers are spending 8 to 10 hours on their phones on social media and on the internet and roughly about 15 to 20% of
00:07:39
young people describe their usage as almost constant effectively scrolling during all waking hours while they're
00:07:46
eating, while they're in the bathroom, and before they go to sleep. So, and I
00:07:49
was wondering from a dopamine perspective if there's correlation between these like dopamogenic
00:07:54
activities that are now like hijacking our lives, whether it's short form videos on social media, whether it's
00:08:00
pornography or food, whether it's having an impact on what then happens in the
00:08:05
bedroom and our performance in the bedroom. >> If you think about what you need to have
00:08:10
good sex is you need to be sort of in the mind space for sex. And if you're constantly like hijacked by all these
00:08:17
other things, you're never like really getting in the mood, right? You're just
00:08:20
like, "Oh, I'm going to be turned on when I see my partner and we're going to
00:08:23
have sex and it's going to be over." And it's just really a mechanical thing at
00:08:27
that point, right? You're not actually you're just trying to get an orgasm.
00:08:30
You're not actually like spending the time to enjoy and to experience that fully because you're just so like you're
00:08:36
just your brain is always doing something else, right? because people are constantly scrolling like every 60
00:08:41
seconds there's a new video, there's something else. And so it's really hard
00:08:44
to focus. And so that can translate to the bedroom where you're like you're
00:08:48
having sex, but your brain is somewhere else thinking about something else you saw or something you have to do or
00:08:53
something you want to see or something you want to look up, whatever it is, but you're not really in there in the
00:08:59
moment. You're just going through the motions. And so I think that's really
00:09:02
where the challenge is is that people are becoming increasingly distractable. I find it really hard, I got to be
00:09:08
honest, to have sex if I've had like a really really busy day or if I'm really
00:09:11
really thinking about something. I almost have to I have to like intentionally create quite a lot of
00:09:15
space. >> Exactly. >> In order to be able to be in the mood. >> Yeah. Be aroused, right? It takes like
00:09:22
time and energy. I think I appreciate you for saying that because a lot of people think that men are just ready to
00:09:27
go at any moment and that's not fair, right? Because everyone needs time to be
00:09:32
aroused. It's not just instant for everybody, especially when you have a lot of work stress or life stress or
00:09:37
other things going on. It's actually like you have to make time and space for
00:09:41
it. >> Yeah. Because as a man, you got to get an erection. And I I always think that
00:09:45
an erection is a consequence usually, especially when it comes to sex. And I'm
00:09:49
not talking about morning glories here, but an erection is a consequence of like
00:09:52
a story. >> You use the word aroused. >> There's like a story in my head which
00:09:57
makes me go, "Oh, that's kind of hot." >> Yeah. You need something. You need some
00:10:02
stimuli, right? You need to think about something, see something, smell something, feel something, right? You
00:10:07
need to just be together and and sort of allow yourselves to be intimate before that sort of desire and arousal come
00:10:13
together. >> And for me as well, it's not just touch like that doesn't necessarily for me, it
00:10:17
really is quite like a psychological thing. I was wondering if this is there's any data around this or I mean
00:10:23
just even anecdotally like people get aroused in very very different ways, don't they?
00:10:27
>> Yeah, absolutely. I mean some people um are very like visual so they you know
00:10:32
they see their partner and they get aroused very quickly. Basically when you get aroused you need to be in a
00:10:37
parasympathetic nervous system state. So in order to get an erection you need to
00:10:41
be in the state which is like rest and digest. So if you're stressed if you're
00:10:45
thinking about other things if you're essentially on the go you are not allowing your nervous system to calm
00:10:51
down. And so for some people that's a whole bunch of different things. Some people can switch more easily into that
00:10:56
state and some people need more of like uh you know to feel either mentally stimulated or they need to have some
00:11:05
associations like it might be like they need a certain scent, they need to like relax their body, they need to like go
00:11:10
take a bath, whatever it is, but some people need different things and knowing what that is for your partner is super
00:11:18
important, right? Because then you can incorporate that. Everything is scheduled in our lives, right? And then
00:11:22
you're like, "Oh, but now sex is like the last thing on the schedule, right?"
00:11:25
And like I don't even think about it. Like, "Oh, okay. Now, yeah, maybe let's
00:11:28
have sex." But it's like, if you actually make time to be intimate, allow
00:11:31
yourself to be in that brain space, be together, that's when it can actually
00:11:36
happen. Especially when you've been in a long-term relationship, it doesn't come
00:11:39
as easily like spontaneously, which we call spontaneous desire. It it comes more as a response to these other cues
00:11:46
that allow you to feel desire and to feel aroused. H I also think I was thinking about a
00:11:52
previous relationship I had where on the days where I'd been like working very
00:11:57
hard and I was like tired or stressed or I've been traveling and I was jetlagged.
00:12:00
I think there was also because I didn't see this person often there was also an
00:12:05
expectation that when I did see them we were going to have sex >> and um that was that was very hard
00:12:11
because actually the expectation of it stressed me out more. >> Yeah. And that can happen like if it
00:12:18
becomes the elephant in the room it can become a little bit heavy which then is sort of counterproductive to performance
00:12:24
>> and this is you know sort of a variation on performance anxiety. So when you feel
00:12:29
like you have to perform on demand and maybe you're worried it might not happen
00:12:33
it creates this vicious loop right so you may maybe have trouble with an erection or maybe it's like I I'm
00:12:38
expected to have sex but I really can't get there mentally. whatever it is. Now,
00:12:41
you're thinking about that, right? And then you're with your partner. You're
00:12:44
like, "Oh my god, am I going to have trouble?" You're not enjoying the
00:12:46
pleasurable sensations or the visuals or like feeling each other. You are literally thinking in your own head
00:12:51
about how you're going to respond. And then that anxiety makes it so that you
00:12:56
can't get an erection or you can't be aroused. And so now you're like anxious
00:12:59
and you're not focused. You're almost spectatoring. You're just watching
00:13:02
yourself have sex. You're not actually like in the moment. So then, you know,
00:13:06
you have a negative outcome because when you're stressed, your sympathetic nervous system is on, right? You can't
00:13:10
really get an erection or you can't really get aroused. And so then you're
00:13:15
like, "Oh man, now I've let my partner down. Now I haven't performed," which I
00:13:19
hate that word, but like performed the way I should or or I'm expected to. And
00:13:24
now something's wrong with me. And now that just keeps going in a vicious cycle.
00:13:28
>> Have you spoken to people that have experienced this? >> Absolutely.
00:13:31
>> It's common. >> Very common. I tell people anytime you have problems in the bedroom, it stays
00:13:37
with you. >> So, how do you break the cycle? >> Yeah. So, I tell people when you're with
00:13:41
your partner, take the pressure off um penetration. Just explore each other's
00:13:46
body. Do what's called like sensate focus. Like explore the rest of your body. Figure out other arogynous zones,
00:13:52
other things that can turn you guys both on that don't involve erections and
00:13:57
penetration. And then once you realize you're focused on that, you're really
00:14:00
like exploring, enjoying, playing, you're having a good time, and you're
00:14:04
not thinking about your erection, now you'll notice, oh, the erection just comes, right? And then once you get to
00:14:08
that point, then you can start even touching genitals, but still hold off on penetration. And then after you've
00:14:13
realized like the genitals are, you know, it's always working the way I want
00:14:17
it to. I'm not thinking about it. I'm not stressed. Then finally, you can then
00:14:20
introduce penetrative sex again. So, it's just sort of like a gradiated sort
00:14:24
of slow advance into um you know, having sex again, but now kind of focusing on being more present and mindful and
00:14:33
enjoying those sensations. >> I think a lot of people will be able to do that, but there's also a big
00:14:38
contingent of people that just avoid sex. >> Mhm. >> It's it's a sore subject in their
00:14:44
relationship for whatever reason. Both partners don't know how to communicate.
00:14:48
They haven't got the tools to talk about these kind of things openly and honestly. Do you see that a lot as well?
00:14:53
>> Absolutely. I mean, what do you hear in this regard? >> So, I think it's really sad. I see
00:14:58
people come in and they're like, I ask every patient like, "Are you are you
00:15:02
having sex? Why not?" Right? Because sometimes they'll say no. And most
00:15:05
doctors will be okay. But I always say, "Why not?" Right? Why are you not having
00:15:08
sex? Is it because you're having an issue? Is it because you're having pain?
00:15:11
What's going on? Right? And often times I'll hear from people that my partner is
00:15:16
just not into it and I just sort of gave up and I'm just we just don't have sex
00:15:21
anymore. You know, for me that's a red flag because sex is a huge important part of our lives. It is a way we
00:15:29
connect with another human being. It's also telling that things are working really well. So, when you have good
00:15:36
sexual function, meaning you get an erection well or you get aroused well and you have a good orgasm and
00:15:41
everything feels good, that tells me that, hey, you've got great blood flow to your genitals, your nerves are
00:15:46
working great, your hormones are sending signals, like all these things are good,
00:15:50
right? But also, sex is more than just the act of sex. It also helps you live longer. So, there's been a few studies
00:15:58
looking at sex and longevity. And when you look at people who have sex once a week compared to people who have sex
00:16:05
once a year, the difference in all cause mortality is 49%. They live 49% longer than people who only have sex once a
00:16:13
year. >> 49% longer. >> Yeah. Yeah. >> Be right back. No, I'm joking.
00:16:20
>> So, and but even if you're doing like less than once a week, but more than
00:16:24
once a year, it still improves your longevity. There was actually interesting study in 1997, I think it
00:16:29
was, where they looked at the number of orgasms men had, and they found that men
00:16:34
who had for every hundred orgasms men had, they lived like 13% longer. They had a 13% increase in life expectancy.
00:16:43
And so, it was really interesting to me just just showing you that like this is not just an act of pleasure and fun. It
00:16:50
is obviously, but it's much more than that because people who are having sex
00:16:54
clearly have better health and there this connection with people. I mean, loneliness is a big issue right now. The
00:17:00
the WHO made loneliness like an epidemic. So, they've said that loneliness is as bad as having like 15
00:17:06
cigarettes. And so, sex is a way to feel connected to another human being. >> On that data, we're not saying that it's
00:17:13
the sex itself that's causing people to live longer. We're I guess it's it's
00:17:16
hard to establish causation in terms of >> Yeah. It's not necessarily sex, but
00:17:21
they've looked at like they try to control for other things like age and coorbidities and all these studies and
00:17:27
um it's also like sex is a cardiovascular workout, right? For many people is a cardiovascular workout. You
00:17:32
are getting a phys physical physical activity with your partner. Um you are increasing your heart rate. You are
00:17:37
doing these things that are also good for your body. And the fact that you're
00:17:41
able to have sex, right, tells me a lot about it, right? You're you're able to
00:17:45
hold a certain position. you're able to u maintain this level of activity without getting short of breath, right?
00:17:51
Like these are things that having sex, you know, keeps you healthy to some degree.
00:17:56
>> If I want to make sure that I have great sex, what are some of the foundational
00:17:59
things that I need to be thinking of in terms of my lifestyle? >> Yeah. So, there's four main pillars of
00:18:04
sexual health. I like to think of it like your sexual health is your house. And these pillars are the foundation.
00:18:09
And if you don't have the foundation, it doesn't matter what else you do. Um, you
00:18:13
can try to do everything else to patch up your house, but it's always going to
00:18:16
break again because the foundation's not there. So, you've got fuel, and fuel is
00:18:22
how you nourish your body. A lot of the data I'm going to talk about is about
00:18:25
men because there's just a lot more data on men and sexual health, but that doesn't mean that the same things don't
00:18:30
apply to women. There's just less less robust data on it. So, when you talk about fuel, the Mediterranean diet is
00:18:37
the most studied diet. So, including things like healthy fats like avocados, leafy greens, nuts, and we're going to
00:18:45
talk about nuts in a little more detail. These things are super helpful. And obviously having lean proteins, having
00:18:52
an abundance of fruits, which we're going to talk about as well. There's a
00:18:54
study called the Health Professionals Follow-up Study. They look at 20,000 men, and they saw that men who adhered
00:19:00
to a Mediterranean diet had a 22% lower risk of erectile dysfunction. So what specific things in that diet, right?
00:19:08
People always like, "What are the superfoods I need to have?" Almonds are
00:19:11
great, but pistachios, they actually did a study on pistachios where they looked
00:19:14
at 100 grams of pistachios. Guys ate 100 grams of pistachios every day and they saw a decrease in erectile dysfunction.
00:19:21
>> So pistachio nuts will make my penis harder. >> I mean, so I always say like I don't
00:19:25
love to talk about superfoods because then people like, "Oh, I just got to eat
00:19:28
pistachios and it's all good, right?" It's it's part of a whole diet, but
00:19:31
certainly having nuts because they have great omega-3s, they have healthy fats. These are the reasons that they they
00:19:37
really sort of improve diet. >> Fruit um anything that has sort of flavonoids, so like colorful fruit like
00:19:44
blueberries, citrus fruits, um lycopine, which is red fruits, all of these things
00:19:49
improve antioxidants and also have been shown to reduce the incidence of erectile dysfunction. So having stronger
00:19:55
erections. specifically blueberries actually came out to have I think something around 20% also improvement in
00:20:01
erectile function when you're eating blueberries regularly. So lots of I think things in the diet that can be
00:20:07
helpful. Also fiber is one that we don't talk about enough. When you eat fiber in
00:20:12
your gut it converts to short- chain fatty acids. These short- chain fatty acids then sort of have these endothelop
00:20:18
protective mechanisms. They protect the blood vessels. They make them healthier.
00:20:22
And so when your blood vessels are healthier, you get better metabolic health. So you get less diabetes, less
00:20:27
high blood pressure, less high cholesterol. And these all of these things together improve erectile
00:20:32
function. >> So I think making sure that you meet the criteria for fiber, which is 38 grams
00:20:38
for men, 25 grams for women, um, is really really important. And then obviously managing your calories and a
00:20:45
maintenance, right? because we don't want to gain weight because excess atapost tissue or excess fat also puts
00:20:50
you at higher risk for erectile dysfunction and other sexual dysfunctions. Next we have uh strength.
00:20:58
All right. So there's strength where we think about cardiovascular and resistance exercise
00:21:04
but there's also pelvic floor strength. So we'll start with cardiovascular
00:21:08
exercise. The one study that's quoted very often is 150 minutes of exercise of
00:21:13
cardiovascular exercise moderate intensity. when you look at the improvement in erectile function scores,
00:21:19
it is the same amount of improvement as you would see when you take a medication
00:21:23
like Viagra. So, literally, if you do 150 minutes a week, you are getting the same improvement as you could get with a
00:21:30
medication potentially. And so, I tell people like, look, if you don't want to
00:21:34
take a pill, this is a great way to improve sexual function. Now, you might say, okay, well, I, you know, maybe
00:21:40
you're listening and you have heart issues and you can't really do moderate
00:21:43
intensity exercise. They actually looked at that too. So there was a group where
00:21:46
they looked at men who had heart disease and they weren't really able to do moderate intensity exercise. So they did
00:21:52
like a 5minute warm-up. They did 20 minutes of walking and 5 minutes of a cool down. And with this supervised
00:21:58
protocol, they still improve erectile function by 70%. So it's all relative to
00:22:03
where you're starting. But any sort of cardiovascular exercise that's above
00:22:08
what you are capable like what you're doing now is going to improve sexual function particularly erectile function
00:22:14
cuz it's going to improve blood flow to the genitals going to improve blood flow
00:22:17
to the penis. It's going to improve blood flow to the clitoris for women. So
00:22:20
that's where cardiovascular exercise is so so important in terms of resistance
00:22:24
exercise. I know these little weights are probably not sufficient for doing much, especially for men, in terms of
00:22:30
improving um muscular health, but obviously we're not going to bring like really heavy weights to the table here.
00:22:36
So, one, we know that resistance training is significantly correlated with testosterone. So when you do heavy
00:22:43
resistance training of your large muscle groups, so like your lower extremities,
00:22:47
your glutes, you're doing like Olympic deadlifts, squats, that sort of stuff,
00:22:51
you actually see improvements in testosterone. Now, it's not going to be like you do it once and you get this
00:22:57
sustained improvement, but continuous sort of regular resistance exercise improves testosterone.
00:23:03
There's also data that shows that when men do resistance exercise to maintain
00:23:07
muscle mass. So, we know that muscle mass decreases about 7% every decade of life after around 40. When you maintain
00:23:14
it through resistance exercise, they're three times less likely to have erectile
00:23:19
dysfunction. >> Oh, really? >> Yeah. So, they maintain erectile function, they maintain sexual desire,
00:23:24
they maintain um satisfaction with sex. >> I read a quote yesterday that said
00:23:28
muscle is medicine. And I thought, that's really true based on everything I've learned on this podcast around, you
00:23:33
know, like glucose control and and testosterone. And now you're telling me about your sex life.
00:23:40
>> Yeah, it is. I think people push back because they think like, why should I
00:23:44
have to go to the gym? But our lives have changed. We sit at a computer or we sit at podcasts or we sit all the time.
00:23:51
We're not moving. We're not doing manual labor, which is what a lot of our
00:23:56
historic history is, right? doing manual labor, farming, doing things outside, being physical, and we're meant to be
00:24:02
physical. We're meant to lift heavy things. We're meant to move our bodies,
00:24:06
and we're just doing less and less of it. >> So, I think it's so important. Um, the
00:24:10
other thing is we want to prevent sarcopenia. So, sarcopenia is muscle loss. And when you have muscle loss, um,
00:24:16
that also increases your risk of having sexual dysfunction. >> What about the pelvic floor? Like, how
00:24:21
does that come into this story of >> Oh, yeah. So, we missed that part. So,
00:24:25
um, the pelvic floor, here's your pelvis, right? It's this bony structure
00:24:30
where all your organs live. This is a female. So, I'm taking out the, uh, internal structures, which is the
00:24:36
uterus, the rectum, and the bladder. And so, that's what sits inside the pelvis.
00:24:41
And so, you can see this bowl of muscles here, right? Interesting. I've never
00:24:44
seen. >> And you can see them from the inside, and you could see them from the outside.
00:24:47
That's your anus. And in this person, there's a vagina. So, that's the hole
00:24:50
for the vagina. So you can see that your anus and your vagina run through the pelvic floor. And in men, your penis
00:24:56
runs through the pelvic floor. And so this, let me see if I can show you on this model. In this model, you can see
00:25:02
they kind of show you the muscles here on the side. >> Yeah. >> So these are your pelvic floor muscles
00:25:06
that are around the penis and the anus. >> Okay. >> Okay. These structures are very
00:25:14
important for a variety of things. um they attach to your bony landmarks here, your hips, your sacrum, your pubic
00:25:21
symphysis. They attach to all these and they sort of just work in the background
00:25:26
for most people. How they affect your sexual function is when you orgasm, these muscles contract and release at a
00:25:35
at a rhythmic contraction of8 seconds. And so you may feel that, right? There's
00:25:39
like this pulsing feeling when you orgasm. And that's these muscles sort of doing that. And when men ejaculate, the
00:25:45
pelvic floor muscles are contracting to help shoot the ejaculate out. They squeeze when you need to keep things in.
00:25:51
So they'll keep urine in, they'll keep um your stool in, and they relax when
00:25:55
you need to pee in, when you need to defecate. >> So when you're trying to hold a wee,
00:25:59
you're like tightening your pelvic floor. >> Correct. Correct. But these are also
00:26:03
responsive to stress. So, just like people get TMJ where they get tense in their jaw cuz they are stressed and they
00:26:10
like sleep at night and they clench up their jaw. They don't really know they're doing it, the same thing can
00:26:14
happen. These muscles can get very tight or they can get misaligned. So, say you
00:26:18
have a hip injury or say you have a back injury, the muscles can compensate by tightening up. And so, a lot of people
00:26:24
unknowingly have tension in these muscles and it can present in a multiple different ways. It can present with back
00:26:31
pain. It can present with constipation. It can present with urgency frequency because remember your bladder is sitting
00:26:39
right here on top of these muscles. So when the muscles are tense, your bladder is feeling like there's something
00:26:46
something activating it. And so it's like, oh man, I got to pee. That means I
00:26:49
have to pee. This tension is telling my bladder I have to pee. But it's really
00:26:52
that your bladder is not that full. It's that these muscles are telling you to do
00:26:55
that. You can also have trouble peeing because you can see that your urethra goes through here. And if the muscles
00:27:00
are really tight, sometimes it can be difficult to urinate because it clenches off the pee. And then with sex, it can
00:27:06
cause pain. If they're really tight, it can prevent blood from getting to the
00:27:10
genital organs. So for men, they can have erectile dysfunction. For women, they can have difficulty getting orgasms
00:27:17
or difficulty getting arousal because they're not getting blood flow to the clitoris. Sometimes they can also cause
00:27:23
premature ejaculation in men. And so these muscles are so important and all we hear about is keigull and keigull are
00:27:30
exercises to strengthen these muscles. But keigull are good when you have a normal pelvic floor. Meaning like
00:27:36
there's no tension. It's completely normal. It's acting normal. You're not
00:27:39
having any symptoms at all. But if you have any of the symptoms I talked about, doing keles might make it worse because
00:27:44
you're now tightening muscles that are already tight. >> We also talked about pelvic floor
00:27:49
relaxation. Doing exercises to specifically relax these muscles. So that can be diaphragmatic breathing.
00:27:56
That can be doing like a figure four stretch. That can be doing happy baby pose which are yoga poses or child's
00:28:03
pose. All these things can sort of stretch and lengthen these muscles so they can learn to relax again. Now when
00:28:09
it's really bad, you have to go see a pelvic floor physical therapist who can
00:28:13
really work with you to identify which of the muscles are maybe more dysfunctional and maybe work
00:28:17
specifically on those. Um but I think it's it's so important. that's under
00:28:21
evvaluated, underd discussed when it comes to sexual function. It's a hugely
00:28:26
important part of sexual function. >> How many people are struggling with these issues, specifically the like
00:28:34
erectile dysfunction issues and what age are they? >> Yeah. So, it starts early. I think
00:28:39
there's always been a sort of a disconnect where we think young guys don't have this or if they have it, it's
00:28:43
all in their head. That's not necessarily true. Many young men do develop erectile dysfunction because of
00:28:49
biologic factors, but the data is really robust on older guys. So above the age of 50, we see 52% of men having erectile
00:28:58
dysfunction, which is >> 52%. >> And it goes up 10% every decade. So 60%
00:29:05
of 60-y olds, 70% of 70 year olds. So erectile dysfunction continues to worsen. This happens because one, you
00:29:12
know, our blood vessels get older, they get stiffer, they're not functioning as
00:29:16
well as they should. And we're seeing also a rise in all these other comorbid
00:29:20
conditions like diabetes, cholesterol, high blood pressure. All these affect how healthy your blood vessels are. And
00:29:26
so with these, they see the problem in their penis or in in women's case in their clitoris before they see heart
00:29:33
disease or strokes or brain issues or dementia. And I think this is worth pausing on which is a erectile
00:29:40
dysfunction problem is a often a symptom of a cardiovascular issue. Right. >> Yeah. We call it a canary in a coal
00:29:47
mine. So it is like telling you that something bad is coming. So the data would support that when you have
00:29:53
erectile dysfunction if it's because of an organic reason, right? not psychoggenic but most people I think
00:29:58
have a combination of both that within 3 to 5 years you will start developing issues with your heart and so it
00:30:06
precedes those issues and if 7 years later 14% of those guys will have a heart attack and so it's really an
00:30:14
opportunity sexual problems are an opportunity to look inside to figure out what's going on and to investigate and
00:30:22
to change your life >> and when you say erectile dysfunction we should probably define what that means
00:30:26
because there's going to be a lot of guys sat at home now thinking, "Oh my
00:30:29
god, like my penis is a bit softer than usual." >> Yeah. So, erectile dysfunction is
00:30:34
defined as the inability to maintain an erection that's sufficient for intercourse. So, you can get an
00:30:40
erection, but it goes away before you ejaculate or climax. >> And so, that's typically and I think
00:30:45
it's really important to differentiate that from something like premature ejaculation where you climax too soon.
00:30:51
So, you ejaculate before you're want to. Uh, but that doesn't mean that you have
00:30:56
a problem maintaining your erection. That's a whole different process. >> I've got a friend, people are gonna
00:31:01
think I'm talking about myself because I use that phrase a lot. I've got a
00:31:03
friend. He's um he's almost 40 years old and I've heard him say on several
00:31:09
occasions that he's lost his erection during sex. Is that erectile dysfunction? But what if he can keep his
00:31:16
erection watching porn? >> Well, so that's more multiffactorial, right? So I think if you lose it once or
00:31:22
twice, right? Most guys will have an issue where they lose an erection at some point in their life. I think the
00:31:26
important thing is not to catastrophize. It's a problem when it becomes a routine. Now, if someone is telling me,
00:31:32
"Hey, I can watch porn and maintain my erection, but I can't with a partner."
00:31:36
There's multiple different reasons for that that could be at play. One is that
00:31:40
there's no pressure, right? You're by yourself. You're watching porn. There's
00:31:43
no pressure of performance. There's no anxiety of performance. So, that may be
00:31:46
part of it. Other thing may be that that level of arousal that you're getting
00:31:51
from porn. If you're watching like let's say the same kind of porn every time,
00:31:54
you're masturbating the same way every time, maybe using a firm grip or some
00:31:58
people will masturbate like uh facing the bed or um you know against hard objects. And so that
00:32:05
>> against hot objects. >> Yeah. Like the their fist or something. And so that u can't be replicated by a
00:32:12
person, right? You can't replicate those behaviors by a vagina or a mouth. If you
00:32:18
become habituated to a certain thing that turns you on and that's the only thing that really gets you going and
00:32:25
that's that's something that you can't really get with your partner, then it
00:32:28
will be difficult to reach the level of arousal that you need to get an erection.
00:32:32
>> Okay. So, two questions then. So, >> that doesn't count as erectile
00:32:36
dysfunction. If you can get an erection watching porn but can't get it with your
00:32:39
partner. >> Yeah, it may or may not be. So, if you wake up with your morning erection,
00:32:44
that's great. That's a sign. That's when there's nothing else at play, right? You
00:32:47
are just that tells me that your body's functioning well. You've got good blood
00:32:50
flow, good uh good hormones working, got a good amount of testosterone, and your
00:32:54
nerves are working well, and you're getting a good morning erection. Now, morning erections or nighttime erections
00:33:00
are normal, and they're healthy. So, when you're a young boy, you get actually like erections three to five
00:33:06
times a night, and they can last up to 40 minutes long. So you can spend a lot of your night with an erection. When you
00:33:12
get older, like in your 40s, that drops to about half the time. So maybe erections are a little shorter that they
00:33:18
maybe max out at 30 minutes, but sometimes they're shorter. You should still be getting three to five erections
00:33:22
at night. You won't know all of these, but typically you wake up with a morning
00:33:25
erection. And so if you're not getting morning erections, that tells me that,
00:33:29
hey, there's something going on that we should address. And on your other point
00:33:33
about how you masturbate impacting your sex life, I imagine that applies to men and women.
00:33:39
>> Absolutely. >> And are you saying that if there's a particular way you get yourself off in
00:33:43
private that is very hard for the other person to replicate, you might become desensitized to that?
00:33:49
>> You might just get habituated. I don't think desensitized, but habituated is
00:33:53
like you might just your body just might respond really well to that particular stimulation. Now, that's not inherently
00:33:58
a bad thing, right? If that's what gets you off and you and your partner are
00:34:02
okay with you doing that together, right? You may mutually masturbate together and that's fun for you and you
00:34:07
guys enjoy it, there's no problem with it. It's just knowing what's going on,
00:34:11
right? And sort of deciding like, okay, if this is a problem, let me try to diversify what I do during my solo sex
00:34:18
periods or let me take a little break and kind of uh try something, you know, just not masturbate for a little while
00:34:24
and come back to it later. The fact that we get an erection in the morning, does
00:34:27
that mean that's we're supposed to have sex in the morning? From like an
00:34:30
evolutionary perspective, >> not necessarily. It's just it's the way
00:34:33
your body releases testosterone is one of the reasons this happens is overnight your body is making more testosterone.
00:34:39
That's when your body sort of has nocturnal testosterone production. And so it's highest in the morning, which is
00:34:45
why often you get a morning erection. And you know it just means that some people will have more desire also in the
00:34:52
morning because testosterone is a hormone of desire. >> Is it the same for women?
00:34:56
>> Yeah. So women um women also have nocturnal clitoreral tumescence. Same
00:35:02
sort of pattern and they won't necessarily know it right because they can't visualize it. But you know you can
00:35:08
some women may know sort of feel that pelvic congestion or like feeling that there's a bunch of like blood flow in
00:35:13
the area. But most will not and that's okay. But your body protects itself. So
00:35:18
you've heard the term use it or lose it, right? People are like your body's
00:35:21
protecting itself. You don't have to have sex. If your body is healthy, it will do this all night to keep your
00:35:27
genitals healthy. It will make sure that your genitals are getting blood flow even if you're not having sex. But if
00:35:33
you stop having those nighttime erections, now is it becomes more of a problem because over time, say you stop
00:35:40
having erections or cleral tumes for months, years, right? And then there's no blood flow to those areas over time.
00:35:48
And actually I can show you here. This is a a pelvic model. And here this this purple thing here is called the corpora.
00:35:57
And this is like a really nice spongy tissue that fills with blood. And when it fills with blood, it expands and
00:36:03
lengthens. And then um the blood stays there until you're done with your stimulation. And then it goes back. And
00:36:10
so if there's no healthy fresh blood getting to the penis on a regular basis
00:36:15
either through nighttime erections or through sex with your partner then you will get fibrosis of these tissues. That
00:36:21
means you get a little scar in the in the tissues and then over time you might see some shrinkage of the penis. And so
00:36:27
it is really important to maintain also good health of these tissues. And the same goes for women with their clitoris
00:36:34
because it's the same type of tissue. In fact, if you look at the clitoris, it is
00:36:38
this is the part that you see. We don't really We don't have a clitoris.
00:36:41
>> That one there. >> This is a uterus. >> You're going to keep that in.
00:36:51
>> Okay. I can show you here. There we go. There's this like she told me.
00:36:54
>> Is it crazy? >> Okay. Yeah. This is good. This is good. Okay. They told me they don't say
00:36:59
glitter. >> That's a little That's a Yeah. Okay. >> They told me
00:37:10
>> you're not going to live that one down. >> You asked the team where the ClariS was.
00:37:13
Did you ask the team where the clitoris was? >> Well, I'm I'm worried about who said
00:37:18
that, too. Um, okay. So, so let's talk about the female anatomy. This is a pelvic model. And here, um,
00:37:25
you can see this is the vagina. This is the urethra where you pee from. This is your labia minora. And you can't see the
00:37:32
labia majora, but they would be out here, right? So, inner lips, outer lips. Now, this up here is your clitorol
00:37:39
glands. So, it's the same as the glands of the penis. And so, this is all you
00:37:43
see, right? It also has a little covering, which you can't see here. Just like men have foreskin, women have a
00:37:48
clitoreral hood that covers the the head of the the clitoris. And so when you look at the clitoris on the inside,
00:37:55
which we can't see perfectly here, but I'm going to just take this out. Um, it
00:37:59
actually goes all the way back like this. So if you were to feel from the vagina, from the vaginal side, it would
00:38:05
be at the very top of the vagina going all the way back. These are the these blue things are the clitoreral bulbs
00:38:12
here. Um, so and these are the legs of the clitoris here on the side. And so this is essentially the homalogue of the
00:38:21
penis. So if I take the penis and we don't have a like a full model here. What does homalues mean?
00:38:27
>> So homologues means that they're essentially the same structure. They're
00:38:30
made from the same cells but they're in the male and the female. So here you can
00:38:35
see this is if this is your penis. This is what you see up to here. This is the bone. This is your fat up here. And then
00:38:42
here it goes deep into the pelvis. And so here's your testicles, right? And so
00:38:47
below the testicles, this area of the paranneeium, you also have penal tissue sort of that you can palpate from this
00:38:54
side um that's coming all the way down. And if you had sort of a 3D model, you'd
00:38:58
see that it forks out just like the clitoris does. >> So does clitoral stimulation feel like
00:39:04
stimulating someone's tip of their penis? >> Exactly. And so you could think if
00:39:08
someone just stimulated the head of the penis, they uh it would be fine. It would be nice, but it's probably better
00:39:15
if you stimulate more of the clitoris or more of the penis. That's why you can
00:39:19
stimulate obviously the external the clitoris, but you can also stimulate from the inside. And some people are
00:39:25
more responsive to that than others. What you hear of is like the G-spot or the Gzone, right? And the G-spot or
00:39:31
Gzone is if you were to go in the inside of the vagina at the top side, which I can't really stick this in here, but it
00:39:38
would be about 2 cm in at the top. And that's because that's an area where
00:39:42
there's a lot of nerves endings. One, you can palpate the clitoris basically
00:39:46
throughout the entire anterior wall, but also there's the skins glands, which are
00:39:50
these glands that sit underneath the urethra, and they're the homalogue of the male prostate. And so, they're right
00:39:57
there, and then the vagina is there. And so, that's an area that can be very
00:40:00
enjoyable to stimulate. It's not necessarily always going to lead to orgasm because some people have
00:40:06
different sort of distance between the clitoreral body and the vagina. So some people have less distance may feel it
00:40:14
better than some that don't. Uh but ultimately um that's why that area is so
00:40:18
sensitive for many women. On this point of um morning erections, I was thinking much of the reason why I've always been
00:40:25
cautious of having sex in the morning or even like masturbating in the morning or
00:40:28
anything like that is I'm worried that it will cause a dopamine crash which will make me feel lazy and lethargic.
00:40:34
>> Well, so when you think about what happens during an orgasm is you have
00:40:38
this release of dopamine and then you your prolactin goes up and sort of like everything calms down. Now some people
00:40:46
feel a a sense of clarity. They call it postnut clarity, right? they feel clear,
00:40:50
they feel like motivated to do stuff, they feel uh excited to go do something else and they sort of move on from what
00:40:55
they're doing. There's some people who feel post-coidal dysphoria. They actually feel sad or they feel depressed
00:41:00
after they orgasm. And we don't know exactly why this happens, but it is because of this dramatic change in sort
00:41:08
of neurochemical signaling in the brain. And for those people who have it, it can
00:41:12
be days where they sort of like feel bad. It can be hours where they feel sad. And so it can be really traumatic.
00:41:18
So pillar two, what's pillar two of the four pillars of men's sexual health?
00:41:23
>> We talked about strength. >> Okay, so we did strength, we did fuel.
00:41:27
>> What's pillar three? >> Pillar three is environment. So we can
00:41:29
start with the easy stuff and that's stress, right? Everyone knows stress is
00:41:33
bad. But I think the thing is people just think like h I'll just I'll deal
00:41:37
with it. Everyone's stressed. Like what's it's normal to be stressed? If
00:41:40
you are chronically stressed, that means your cortisol is raised all the time, which is dampening your testosterone,
00:41:47
which is also keeping you in the sympathetic state, and you just cannot get in your mind space and in the
00:41:54
nervous system place to actually have sex. So, that's super important. And I
00:41:59
think, you know, there's lots of different ways to alleviate stress. You got to figure out what works for you.
00:42:04
Um, for some people, using a stress ball, even just at work. And I think part of it you can actually incorporate
00:42:10
some intimacy. There's some evidence, you know, the Gottmans have been on your
00:42:13
podcast doing a 20 second hug. So standing with your partner or loved one and hugging for 20 seconds on your own
00:42:21
like independent gravity >> actually helps alleviate stress and break sort of a stress loop. Doing a
00:42:27
six-second kiss with your partner. And so it seems like six seconds, no big deal, but actually if you time it, it's
00:42:33
like hm if I'm just doing a kiss and I'm not like actually it's a little bit
00:42:36
longer than normal. And so these sort of small things can help alleviate stress.
00:42:41
Any type of movement can be really beneficial. >> The gym is great as well.
00:42:45
>> The other thing is just having like interactions with people. And so that's
00:42:48
where we're becoming more isolated. But even just like talking to the barista or
00:42:52
talking to someone at the grocery store, this again tells your brain that you're
00:42:56
in a safe space, like you're talking to someone. They're having a normal social
00:42:59
interaction. So, and then being creative. And we've been trying to work with this work on
00:43:04
this with our kids because there's so much external stimuli all the time, right? They want to play video games,
00:43:09
they want to watch TV, they want to play sports, but we want them to be bored and
00:43:13
be creative, like come up with creative ideas to keep themselves interested and engaged in a different
00:43:18
way. So, I think that's so so important. And outside of stress, sleep. Um, sleep
00:43:24
is there's just so much abundance of data on how sleep affects hormonal health. They looked at data on men
00:43:30
sleeping 5 hours a night versus eight hours a night. So you take the same guy and he sleeps eight hours, then you, you
00:43:35
know, do five five hours for a few days. His test for a week, his testosterone drops by 15%.
00:43:41
>> Wow. >> That's like as much testosterone drop as would happen with 10 years of life.
00:43:46
>> And do you know how long they did that for? How long? >> It was short. It was like a week. So, a
00:43:50
week of sleep deprivation will will tank your testosterone. >> And sleep apnnea is another one that I
00:43:56
think people one don't realize they have and two don't realize that fixing it
00:44:00
could actually improve their hormonal health. >> Wait, so does this mean that people who
00:44:03
have chronically bad sleep probably have low testosterone? >> Probably. Yeah.
00:44:07
>> And what is the symptoms of low testosterone? >> So, low testosterone, they're sometimes
00:44:12
very vague. So it can be fatigue, it can feel brain fog, it can be depression, it
00:44:18
can be low desire, it can be erectile dysfunction. That's what people always
00:44:22
think. It's just erectile dysfunction, but it's this whole constellation of
00:44:25
symptoms. It can also be increased fat mass, decreased muscle mass. So all of these things can happen because we have
00:44:31
testosterone receptors all over our body. We have them in our brain. We have them in our muscle. We have them in our
00:44:36
bone. And these can all have really serious consequences when it's low. when
00:44:41
you have sleep apnnea. And how you know you have sleep apnea is uh your partner might tell you that you're like waking
00:44:45
up in the middle of like gasping for air. If you have one really easy way to check is take a a measuring tape and
00:44:52
measure your neck circumference. If it's more than 17 in for a guy or 16 inches
00:44:57
for a female, it means it's very likely that you may have sleep apnea. And that's because when you have excess mass
00:45:04
basically here, it's compressing your airway and can make it difficult to get
00:45:08
air into your um into your body. When you improve sleep apnea, we've seen improvements in testosterone as high as
00:45:14
200 nanogs per deciliter. So huge jumps in testosterone after fixing sleep apnea. And the same goes for other sleep
00:45:22
disorders, although the data is not as abundant. Uh but sleep is so important. Then we talk about what's in your
00:45:28
environment. So let's grab this. Okay. So, you get a bottle of water. So many
00:45:35
of my patients actually they only buy like cases of plastic bottled water. Once in a while a plastic bottle of
00:45:41
water like don't stress yourself out. This goes back to stress. People get really stressed like what's in my
00:45:45
environment? What am I drinking? What am I eating? Like do what you can control.
00:45:50
So plastic water bottles have things like phalates and BPAs which can affect hormonal health. They can mimic
00:45:57
estrogen. They can reduce the production of testosterone based on these mechanisms. Also things like plastics in
00:46:05
the environment, PAS, so the things like non-stick cookware, all those things can
00:46:09
affect hormone health. Now, how do you sort of protect yourself, right? I tell people again, don't stress. There's only
00:46:16
so much you can control. So, like I love that we're not drinking out of plastic.
00:46:20
If you have to drink out of plastic because you're at an event or whatever, try to make sure it's not a um a warm
00:46:28
bottle. So, it hasn't been like sitting in the sun for hours and hours and hours
00:46:31
because as it gets warm, it releases more microlastics and more chemicals into the water. When you're eating food,
00:46:37
if you are eating out of say you get takeout, put it on a plate and warm it up. Don't ever warm up that plastic. And
00:46:43
when you store food in the fridge, put it in a glass container or a metal container, but don't ever leave the food
00:46:49
in the plastic and put it in the fridge. These are simple things you can control.
00:46:53
You could also limit sort of your exposure to dust because dust has microplastics. You can try to wear more
00:46:59
cotton fabrics, less synthetic fabrics because they shed less microplastics. But again, I think do what you can do,
00:47:06
but don't let the stress of these chemicals like derail you because stress is not helping either. And how much of a
00:47:13
difference does you know microplastics make on my hormonal health? Is it really a big big deal?
00:47:19
>> Well, I think it depends. It's all dose dependent, right? So, we're all exposed.
00:47:22
Like, if you look at the data, like people are, you know, consuming quite a bit of microplastics and we're seeing
00:47:27
them actually even in testicles, in penis tissue samples, like they're in our bodies. And so, I think that it's
00:47:35
definitely playing a role. How much? We don't know yet. We just know there are
00:47:39
mechanisms and we know that they do affect hormonal health and so do the best you can.
00:47:44
>> Do you and your family drink out of plastic bottles? >> No, we drink we we have like metal water
00:47:49
bottles for the kids and myself. And >> what about non-stick pans? >> We buy ceramic. We we do our best to
00:47:54
like avoid those as much as possible. So the other thing is the company you keep.
00:47:59
I think we don't talk about this enough and we talk about it in terms of business like you want to keep people
00:48:03
who are successful around you. You want to keep people who can help you. But it also plays a role in your sexual
00:48:08
environment, right? So my husband is in these groups with a bunch of other male physicians. And there's a lot of
00:48:13
discussion about how they never have sex anymore. And they're all just like, "Oh
00:48:17
yeah, this is just like normal. Like we're getting older. Our partners don't
00:48:20
want to have sex. It's so frustrating." And there's a lot of discussion about
00:48:22
this and and it's it's almost like, "Oh, that's okay." Like that's just normal,
00:48:27
right? They're normalizing this experience where that sex has not become a priority because life is so stressful,
00:48:33
things are so crazy. Maybe you're having relationship discord. So, it absolutely
00:48:37
plays a role. And there's actually some evidence that it may help you make better choices. So, there's one study
00:48:42
where they looked at I think it was like 50,000 people and they um did an intervention where they tried to
00:48:49
encourage these people to surround themselves with positive influences that were like have safe sex and avoid
00:48:55
negative influences. And they saw that for that these people had an increase in like sexual positive behavior. So like
00:49:02
safe sex practices by 46%. So just by changing who they spent their time with, they saw this major
00:49:10
difference in how they approached their sex lives. >> Okay. So if your friends are very
00:49:14
pessimistic about sex and they're not having and they're complaining about it,
00:49:17
that's going to become sort of contagious. >> Yeah. And I think it it extrapolates to
00:49:22
everything. what kind of relationships you you're in. How do they view their
00:49:26
relationship with their partner? Is it a priority? Do they make it a priority? Right? Or are they just busy doing their
00:49:31
own thing and they're just like living in parallel lives? They're doing their
00:49:35
own thing. You're doing your own thing. You never really spend time with your
00:49:37
partner and then when you go hang out with your friends, you're like, "Oh god,
00:49:41
I'm so glad to get away." And you're not like talking about how much you enjoy
00:49:44
your partner. People tend to talk negatively, right? They want to like sort of like vent. And so when you have
00:49:50
people who don't make that a part of their lives, it also affects you. They value their partner and they talk about
00:49:55
them in a positive way, that's a a great thing to say like, okay, this is the
00:49:59
right kind of person I want because I want to value my partner too and I don't
00:50:03
want that to rub off on me because it absolutely does. >> And the other thing you said in this
00:50:07
category of environmental stuff is things like pornography consumption. Is it possible to consume too much porn?
00:50:12
>> So it's not the amount of porn that you watch, it is the sort of the way you
00:50:17
feel about it. Many people watch porn for a variety of different reasons. Most often it's for pleasure and enjoyment.
00:50:23
But there's some people who watch porn because they want to get away from negative feelings, right? This is giving
00:50:28
them dopamine and they're using it as a way to just feel better in the moment.
00:50:32
And so that become that can become a compulsion where they're watching porn and it's like giving them these positive
00:50:38
feelings and they feel negative in life and they're going back to porn to sort
00:50:41
of again have that compulsion to watch porn again. But that's a small subset of
00:50:45
people. The other thing is that there's a lot of negative discussion around porn, right? People like porn is bad,
00:50:51
it's dangerous, it's evil. And I think, you know, it's more nuanced than that.
00:50:55
But if you feel that porn is bad, every time you watch porn, you feel negative, you feel bad about yourself. That's
00:51:02
where we see people having the most dysfunction associated with it because they feel guilty. They could watch it
00:51:07
once a year and they could feel super guilty about it and it could affect their sexual function. They could see
00:51:12
themselves as a bad person. and they could see themselves as wrong or immoral. And that's really when it
00:51:17
becomes an issue. If you are finding yourself either compulsively watching pornography and using it as a scapegoat,
00:51:24
maybe time to reevaluate, say, why am I doing this? How can I switch this out for something else that makes me feel
00:51:29
better that might be healthy, like exercise or going for walks or whatever that may be? And then if it's something
00:51:35
that's really making you feel like bad or guilty because maybe that's how you
00:51:40
were raised, maybe that's what you feel about morality, then yeah, maybe like
00:51:43
you either need to work through that because porn is maybe something that you still want to watch at times or you need
00:51:49
to abstain. But usually those are it's very difficult to abstain for most people to abstain for prolonged periods
00:51:55
of time. So I think it's it's something you have to work through if you find
00:51:58
yourself having these sort of feelings about pornography or you're compulsively
00:52:01
watching it. But for most people, it's adults. For most adults, it is fantasy.
00:52:07
It's a place where you can experience uh see things that you may never do in real
00:52:12
life that may be enjoyable, that are fun to watch, that have allow you to feel arousal. We see that when couples watch
00:52:19
porn together, they are more likely to be more satisfied in their relationship. And when there's a discord, like one
00:52:24
person really doesn't like it or doesn't use it, and the other one uses it a lot,
00:52:27
that's where we see the problem. Is porn consumption going to impact my intimacy
00:52:33
with my partner? >> So, it depends. I think a lot of people watch it without an issue, right? They
00:52:39
watch >> if I masturbate and I ejaculate, I'm not going to then be able to ejaculate very
00:52:43
quickly necessarily with my partner. >> Yeah. So, that obviously that is, you
00:52:47
know, there's a refractory period after you ejaculate. Now, when you're younger,
00:52:50
that refractory period could be minutes. And when you're older, that can be a day
00:52:55
and a half. And so we see that some people may struggle, especially if they're watching a lot of porn every
00:53:01
single day and their refractory period is maybe a day. Then they may actually really have trouble ejaculating with
00:53:07
their partner because they've not given themselves that time. >> This has had probably the single biggest
00:53:13
impact on my office. Of all the products that I've tried that have given me productivity gains or cognitive boosts,
00:53:20
I would say that exogenous ketones are in the top three most pivotal things that have given me a massive
00:53:27
productivity gain. It's some Stanford graduates that have been able to basically bottle up the effect you get
00:53:33
from being in a ketogenic diet in a small shot that you can take that makes you feel incredibly focused and gives
00:53:40
your brain an incredible source of energy. And the clinical studies that have been done on exogenous ketones have
00:53:44
absolutely blown my mind. I reached out to them. I became a cooner in the company. I became an investor in the
00:53:49
company. And so it's with great pride that I can tell you that this exists. If
00:53:52
you haven't tried these shots, go to ketone.com/stephven for 30% off your subscription order. And
00:53:59
you'll also get a free gift with your second shipment. I still buy my ketone
00:54:03
shots predominantly online, but thankfully I can now grab them at Target whenever I drive past them here in the
00:54:08
United States as well because we're now stocked in Target. where your first shot
00:54:11
is completely free. One of the smartest things a business can do is build like a
00:54:16
bigger company without actually hiring like one. But the problem we all face is that most companies don't have every
00:54:22
skill in house. So when I look at the businesses seeing real success today, the consistent pattern with all of them
00:54:28
is how quickly they move. They bring in specialists with skills in emerging areas to keep themselves ahead. Even in
00:54:33
our company, we spent the last year pulling in talent across areas like AI native strategy, no code builds, and
00:54:40
product workflows. And we find this talent through our longtime partner, Fiverr Pro. Their premium service only
00:54:45
shows you vetted talent, so you've always got the safeguard that anyone you pull in to help you with a complex
00:54:51
project has the skills that you're after and will deliver to the same high standards as your internal team. And
00:54:57
most importantly, they'll keep up with the pace. It's a simple strategy, but it
00:55:00
lets us stay agile without compromising on quality. So, if you need these kind of skills in your business, head to
00:55:04
pro.fr.com to find pioneering talent to fill your business's gaps. That's
00:55:09
pro.fr.com. And the last one, the last of the four pillars, >> the last of the four pillars we talked a
00:55:15
little bit about, it's called confidence. And confidence is not like stringing around like a peacock like I
00:55:21
know what I'm doing. It's confidence in knowledge and curiosity. So, knowledge
00:55:25
we talked about a little bit, understanding female anatomy, like how do female bodies get aroused, right?
00:55:31
what makes them aroused, where is the clitoris, knowing some anatomy, and two, actually talking to your partner or
00:55:37
paying attention to their cues. We that, for some reason with sex, it's the only
00:55:41
time that we just expect people to be mind readers. We just want you to know what I like and just go for it, right?
00:55:46
And and then when it's not good, you're like, well, you just don't know what
00:55:49
you're doing. And it's like, it's it's wild to me that we actually never got
00:55:54
taught how to talk about sex, how to bring it up with a partner, how to, you know, just explore and have fun with
00:56:00
sex. maybe add a toy to the bedroom. So, there's lots of different types of toys.
00:56:04
This is a uh vulva stimulator. So, you put this on the outside. So, you can see that it would in theory, if this was
00:56:11
smaller, would stimulate the um the clitoris on the outside. It also can change in shape. It'll vibrate, right?
00:56:19
It'll have different stimulations that you can play around with and decide what
00:56:22
you enjoy. >> So, this one's run out of battery. Um so, >> they're brand new. They have not been
00:56:29
used. >> I didn't say they had been very defensive though. Um, so if my pinky
00:56:34
finger, if my finger here is the clitoris, >> Yeah. >> I put it on like that.
00:56:39
>> Yeah. >> And then it vibrates. >> Correct. >> And then the penis goes through the
00:56:43
hole. >> And there's another version of that. This is basically >> this is basically like the hole goes
00:56:50
around the penis >> and that goes in >> and that can go in and stimulate and vi
00:56:54
vibrate. So, you both feel the vibration and you both feel the stimulation. >> I remember I was with um had a partner
00:57:00
and she she felt that sex toys were for older people. Old people specifically what she said and she she was kind of
00:57:07
against the use of them. I've always been down. >> I think it adds novelty and it's
00:57:11
exciting and it just adds something new. >> But she felt like it was almost like
00:57:16
giving up. >> Well, I mean, look, I think I wonder why. I would I would if I she was here,
00:57:20
I'd ask her, why do you think that? What belief system do you have that's making
00:57:24
you think that this is like not a good thing to use? Right? We use technology in so many places in our lives, right?
00:57:31
So why not introduce it in our sex lives? >> Are you going to become reliant on it
00:57:34
though? Because it doesn't make it easier to get off with a sex toy. >> So they've actually looked at vibration
00:57:40
and can you get desensitized to it? And the way they've looked at is actually
00:57:43
like construction workers where they're using those like vibration tools, right,
00:57:46
to and and seeing if like their hands get desensitized. And what they've seen
00:57:50
is yes, for a short period of time they do lose a little bit of sensation at their fingertips, but then it restores
00:57:56
back to normal. And so it's not that you're going to become desensitized
00:57:59
forever, right? I think you brought up a great point, which is adding novelty. Now, I think when I say novelty, people
00:58:05
are like, "Oh my god, I need to role play in a different way or bring like some sort of BDSM or whatever into my
00:58:13
sex life." And that's not exactly true. So when you think about sex, right, it's
00:58:17
just like eating your favorite ice cream. Maybe you have vanilla ice cream, you know, three times a week and you
00:58:22
enjoy it. But if you start having vanilla ice cream every single day, you're kind of bored with it, right? And
00:58:27
the same goes for sex. Now having routine in sex, knowing what you like, um knowing what your partner likes, it
00:58:33
can be very helpful, but it also is nice to add novelty. So if you think about you can extrapolate from the flow state.
00:58:41
So when you are in a flow state for work, right, things feel really almost effortless and you're just like in a
00:58:46
zone, you can also get into a sexual flow state. When you look at the flow state, yeah, you need things to be
00:58:52
slightly challenging to get into the flow state. They can't be easy and they
00:58:56
can't be so hard that you're going to get frustrated, right? And so you need
00:58:59
to add a slight challenge to your sexual encounter to get into that flow state. And that's when you start having really
00:59:07
great sex cuz you're like in you're so totally immersed. you're feeling great
00:59:11
and it's it's super fun, right? So, I think that's another part of being
00:59:15
confident is being able to and confident to try new things and explore new things. And it can be as simple as like
00:59:21
doing it in a different room or maybe getting a pillow or switching where your head position is. Like, it can be so
00:59:27
small, but it can just add a little bit of uniqueness and novelty and challenge.
00:59:32
>> Are there certain positions that are going to increase the probability that
00:59:37
my partner has an orgasm? >> Yeah. So, uh, typically when the female partner is on top, she has more control
00:59:43
over where she's getting stimulation, um, to the clitoris because, right, she
00:59:48
can angle her body in such a way. So, often time that shows uh, that has, uh, higher orgasm rates. There's actually
00:59:55
like this uh this technique called the cooidal alignment technique where you sort of move in a rocking uh a sort of a
01:00:03
rocking motion so that um your pubic symphysis. So this bone right here um is sort of like rubbing against their
01:00:11
clitoris like this area the skin here is rubbing against the clitoris while you're penetrating and that has been
01:00:16
shown to increase orgasm rate and pleasure in sex. But really it's about figuring out and trying different things
01:00:23
and realizing like that for example that coil alignment technique is sort of difficult like it's not that easy and
01:00:27
intuitive and so you have to sort of play around with it and figure out like what is going to work uh best and yeah
01:00:33
realizing it might not work. You might be like super awkward and like okay like that's okay like it's not the end of the
01:00:38
world if sex is not perfect every time because we're learning and we're playing
01:00:42
and we're having fun. And so I think that's really the key is like not letting yourself get so frustrated if
01:00:47
something doesn't go exactly the way you envision it in your head. >> I used to think that a woman orgasming
01:00:52
was when this was when I was younger. Um was when she squirted. >> Mhm. >> So like that's what I thought it thought
01:00:58
an orgasm was squirting. >> Yeah. Well, you're probably not the only one to think that. And so squirting, not
01:01:03
every woman squirts. So about 40% of women squirt. Squirting is the emission of fluid at the time of orgasm. Um
01:01:10
usually it's clear, colorless, and it can be quite voluminous. um it's coming
01:01:14
from the urethra which is the pee hole essentially and remember I talked about those skins glands those skins glands
01:01:21
are the homalogue of the male prostate and they have a little bit of fluid in them too typically when you have
01:01:28
stimulation um and squirting they will release fluid from the bladder as well as the skins glands that combines
01:01:34
together and and it's emitted through through that >> so it's not pee
01:01:39
>> the way they describe it and there's been a lot of research on this so
01:01:41
there's people who say it's pee. There's people who say it's not. There's a
01:01:44
couple studies. So, one is they put dye into the bladder and they took women who
01:01:50
said they were squirters and they had them orgasm and they saw is there dye in the uh in the fluid and yeah, there was
01:01:57
dy in fluid. So, it's coming, it has to come from the bladder. The skins glands
01:02:00
only hold a small amount, but it's chemically different. It's usually clear, odorless. It doesn't smell like
01:02:06
pee. And so, there's some theories as to why that might be. It may be that um
01:02:11
when you're having sex, there's different hormonal signals that change the concentration of what's filtering
01:02:16
through your kidneys so that it is a little bit different in composition. There's some theories that when there's
01:02:21
more estrogen around that it may change. There may be some like um fluid filling
01:02:26
in the actual interstissia of the organs. Again, it's hard to say, but it's absolutely coming from the urethra
01:02:32
which is connected to the bladder as well as the steam glands. But I think like this this whole discussion about
01:02:37
what it is, it doesn't matter. Like is it pleasurable? Are you enjoying it? Great. If you squirt and you enjoy it,
01:02:43
great. If you don't, that doesn't mean that there's something wrong and that
01:02:46
your partner hasn't orgasmed. The way to figure out if your partner orgasm is you
01:02:50
ask her, right? Either she tells you or you ask her. And sometimes it's obvious
01:02:54
and sometimes it's not, but you know, you you sort of figure it out. >> There's three theories that emerged in
01:03:00
my research about why women squirt from an evolutionary perspective. The first was that, and these are just theories,
01:03:06
they're not proven. Um, of course, the first is that squirting contains PSA and
01:03:10
zinc, which are naturally antibacterial, and ejaculating these fluids during or after sex may have evolved to flush the
01:03:17
urethra and prevent UTI. Um, the logic being in a pre antibiotic world, a woman who could flush bacteria out of her
01:03:24
system after mating was more likely to stay healthy and reproduce. That's one
01:03:26
theory. The other reason, >> well, before you I want to talk about that really quickly. So, that's a really
01:03:30
interesting theory. So one the reason they emit PSA is because schemes glands are the homalologue of the prostate. So
01:03:38
the prostate makes PSA which is prostate specific antigen. >> So this point this word homalogue again.
01:03:42
>> Yeah it's a so basically the prostate in the male the same tissue when they're an
01:03:47
embryo becomes the prostate in the male and becomes a skins glands in the female. So that's why it's emitting PSA.
01:03:53
That is an interesting theory because there are a subset of women who get UTI after sex. Not everybody but some do.
01:03:59
And it's it's not because of the ejaculate or because of the male harboring some bacteria. It's because of
01:04:05
the actual thrusting of the penis. It's taking bacteria from the outside and
01:04:09
making it more easy for it to go through the urethra into the bladder. And women
01:04:13
have a short urethra. And so I want just to debunk that myth that it's like you're getting it from your partner or
01:04:19
there's something wrong with you. It is literally just anatomy. And so some women do get more UTI after sex.
01:04:25
>> And so that is an interesting theory because maybe that's true. I don't know.
01:04:28
The second theory was in ancient ancestors, the hormonal surge during orgasm and ejaculation actually
01:04:33
triggered the release of an egg. Humans evolved to ovulate on a cycle now, but we kept the plumbing and the neuro
01:04:40
hormonal reflex. It's a happy accident, a biological vestage that no longer serves its original reproductive
01:04:45
purpose, but remains because it isn't harmful for survival. >> Interesting. I mean there is some
01:04:50
thought that maybe orgasming um spasms orgasm help with fertility but it's not really uh robust.
01:04:59
>> And the last one kind of matches what you just said there which is the mate
01:05:02
selection theory. The intense pleasure and psychological response of squirting or or orgasm act as a reward system. It
01:05:08
incentivizes women to seek out specific partners who provide high levels of stimulation, potentially signaling a
01:05:13
better genetic compatibility or a more attentive male, which would help with the survival of of offspring. Maybe
01:05:21
>> that makes sense. >> 40% of women squirt. >> Yeah. So, the other thing is obviously a
01:05:27
lot of sex is focused on genitals, but there's a whole body of arogynous zones,
01:05:31
right? Almost almost your entire body can be an erogynous zone. We talked a little bit about it when we talked about
01:05:37
sensate focus, right? You can explore, you can find areas that people find uh erogynous. So when you looked at data,
01:05:44
necks, nipples, lips, buttocks, inner thighs, all these areas are considered arogynous by most most people regardless
01:05:53
of their um sexual orientation, regardless of their cultural upbringing. It seems to be pretty universal. There's
01:05:59
actually a famous paper about non-genital orgasms and like how people orgasm without any genital stimulation.
01:06:06
So lip orgasms, anal sex orgasms. >> Is that possible? >> Yeah, it's been documented. Absolutely.
01:06:13
And and so it's um nipple orgasms. There's a whole variety of ways even like women have had orgasms during
01:06:18
childirth. Like there's there have been these documented ways to orgasm and it's
01:06:23
because these areas can be very erogynous and sometimes stimulating multiple areas can like add more
01:06:29
erogynous interest and that's why you see people like maybe in the BDSM community they'll they'll be using um
01:06:35
nipple clamps while they're doing other things right so there's there's a whole
01:06:38
bunch of areas that are erogynous and most of the times people are not really spending much time on foreplay or
01:06:46
stimulating these erogynous zones as much as they should Right? You you have a whole body to play with. And how do
01:06:51
you stimulate them? There's actually evidence behind that. So on your skin, we have these special fibers called C
01:06:57
tactile eference. When you stimulate these fibers, they help you feel pleasure, enjoyment, those sorts of
01:07:03
things. And so there was a study where they took 19 couples, a small study, it was out of London, and they basically
01:07:10
told them to stimulate an arogynous zone and a non-erogynous zone. The non-erogynous zone being the forehead.
01:07:15
And so they had the couples stimulated. And they told them stimulated at levels of 18 cm/s
01:07:21
uh in terms of how fast you're caressing the arm or or or body part and at 3 cm
01:07:27
per second. And what they found was those who stimulated at 3 cm per second had more sexual arousal had more
01:07:33
pleasant stimulation compared to those who were stimulating at 18 cm per second. Now this makes sense because
01:07:39
those C tactile aphrant fibers respond very well to that slow gentle caress. The other interesting thing is that
01:07:47
these fibers are only responsive to human touch. So if I take a glove and I put it on my hand and I touch you, it
01:07:54
still doesn't work. >> Interesting. That's so interesting because in Los Angeles where we are now,
01:07:59
we were viewing an office and we were walking down the street to see what the neighborhood was like and we walked past
01:08:04
one place and it is a robot massage parlor. M >> and I always thought great like well
01:08:11
part of me thought maybe my prefrontal cortex thought oh great idea because you know you can get massages whenever you
01:08:16
want it's going to be cheap maybe you can have one in your home but then the
01:08:19
other part of me as I saw it thought actually I don't actually think that's
01:08:22
like why I get massages >> I think there's something about human touch which makes a big difference
01:08:27
>> absolutely there is um and so I think that's uh we're evolutionary
01:08:32
evolutionarily built to seek out human touch and human behavior >> I wonder if I would want a robot to
01:08:38
massage me. >> It wouldn't be as good. No. >> I mean, think about sitting in a massage
01:08:44
chair. Is it ever as good? >> It's never as good, >> right? And so, I don't think a robot's
01:08:47
going to be that different from a maybe a little better than a massage chair, but like
01:08:52
>> massage chairs are never good. >> No, they're just like they're okay.
01:08:55
They're mediocre. M Reena, I want to talk about um testosterone, how that links to sexual function, but also just
01:09:02
overall health because I was reading that there's been a 300% increase in the
01:09:06
United States in the last 10 years of testosterone prescriptions. And my friends are increasingly having
01:09:11
conversation about testosterone, which we weren't having >> even 5 years ago. It wasn't a
01:09:15
conversation. And now the conversation I'm having amongst my friends is like,
01:09:18
is our testosterone high enough? Do we need to go get supplements to increase our testosterone?
01:09:22
>> Testosterone is declining. So when you look at testosterone levels from the
01:09:26
1990s, like late 1990s, the average level was around 600 and if you look at data around two 2015, it was 450. So
01:09:35
there's been like a 25% decline in testosterone. Now you're going to ask me
01:09:39
why. One, we talked about some of the endocrine disrupting chemicals. That's
01:09:43
part of it certainly. Two, there's a significant rise in obesity. Testosterone has aromatase. And
01:09:49
testosterone converts to estrogen using this enzyme called aromatase. And so when you have more fat mass, you have
01:09:55
more aromatase. And more testosterone is being converted to estrogen. And so now
01:10:00
you have less testosterone. >> Sorry. How do we how do you have less testosterone?
01:10:03
>> So because there's more fat mass, there's more aromatase. So that
01:10:07
aromatase sees all this testosterone and it converts it to estrogen. >> Okay. This is where they say they talk
01:10:13
about man boobs. >> Yeah. So when you have a lot of estradiol around you can get man boobs,
01:10:19
>> you can get gynecomastia. So a term for it. So that's one. Two is we see a rise
01:10:23
in diabetes and insulin resistance which also causes a decrease in testosterone.
01:10:30
We're seeing a rise in ultrarocessed food intake and that doesn't have the
01:10:36
optimal nutrition that you need to optimize testosterone. So we're getting you know a high highly caloric which
01:10:43
then leads to obesity. We're getting um lack of healthy fats. We're you know all
01:10:48
these things are super important for testosterone. The Mediterranean diet is what has been the most studied and
01:10:54
basically anti-inflammatory diet is what they found for testosterone. So trying to just eat like whole foods,
01:11:00
unprocessed foods as much as possible and minimizing the inflammatory foods. >> Does testo having high testosterone make
01:11:07
me more fertile? No, not necessarily. So, I think people inherently think that the higher your testosterone level is
01:11:14
when you check your blood work, that that's better. And that's not necessarily true. Now, everyone is
01:11:20
different. And what I can't tell you is what your receptors look like, what your
01:11:25
testosterone or androgen receptors look like, how sensitive are they to testosterone. And everyone's a little
01:11:31
bit different. But when you look at the same guy or you look at two different guys, their variability can be so much
01:11:36
that a guy who's 900 can be normal and a guy who's 500 can be normal because
01:11:40
everyone has individual genetic variations. It's how their cells how sensitive their cells are, how many
01:11:46
cells they have, you know, how many latig they have in their testicles. Um the CAG repeats, which are these DNA
01:11:52
repeats on the receptor themselves. People who have more are less sensitive to the testosterone that's around. So
01:11:58
they need more testosterone to get the same result. Whereas people who have less repeats have more sensitivity so
01:12:03
they they don't need as much testosterone. And so everyone is individual. And so that's why it's
01:12:08
really important to understand how are you feeling, right? It's not about chasing a number. And so absolutely we
01:12:14
know that when your testosterone is low below 214 nanogs per deciliter that your
01:12:20
risk of mortality goes up by two. So you are going to double your risk of dying if you have low testosterone. But when
01:12:26
you go super high, super physiologic, meaning like 1,800 or higher, now you're
01:12:31
putting yourself at risk for other things. You can have blood thickening, which is a known side effect of
01:12:36
testosterone replacement, and that puts you at risk for stroke, heart attack, heart disease. Over long periods of
01:12:43
time, it can affect your heart because it can um there's also heart muscle cells that get exposed to this high
01:12:50
level of testosterone. And when that happens, these they sort of change over time and they become more collagen
01:12:56
deposition. They get more fibrosis and this makes them stiffer and so that you're not pumping blood as effectively
01:13:02
as you would otherwise. And so there are real consequences to going too high. There's also the side effects of having
01:13:09
acne, of changes in mood in terms of aggression and things when you get really high. So really, it's about
01:13:15
finding what you feel good at. More is not necessarily better. Once your testosterone receptors are saturated,
01:13:22
meaning they're all bound to testosterone more doesn't help you. It might help you get more muscles, which
01:13:27
is why people abuse anabolic steroids and testosterone because it will continue to help you get bigger muscles,
01:13:32
but that's it. It's not going to help you with your brain health, your bone
01:13:36
health, your sexual health, your any of that. >> Is there a way to visually spot a person with low
01:13:43
testosterone? Are there visual clues? Usually it's someone who feels very fatigued like they can't get out of bed.
01:13:51
They feel just like so drained. Usually they are a little bit more overweight. >> Skinny fat
01:13:58
>> visceral adop I mean you can't always tell if they're skinny. So it could be
01:14:01
because they could have visceral adopy which is meaning that the fat is around the the organs right and so you don't
01:14:06
see like a big pot belly necessarily. Um they may have really low sexual desire.
01:14:12
They may have decrease in mood. >> What about skin and bones? Does it impact skin and bones?
01:14:16
>> Yeah. So, if you get high testosterone, you can get acne because it affects the
01:14:19
sebum in the skin. Um, bone health. So, testosterone converts to estradiol and estradiol is really important for bone
01:14:28
metabolism. And so, when you have low testosterone, you can also have low estrogen. And when your estrogen gets
01:14:35
very low, you get a higher risk for fractures, higher risk for osteoporosis. And so that's where your bone health um
01:14:43
can be in danger. And so that's why testosterone can help protect your bones
01:14:47
because of its conversion to estradile. >> If you do have low testosterone, should
01:14:51
you be considering taking anabolic steroids? Like and who is testosterone replacement
01:14:57
therapy good for? >> So I'm going to ask you a question. Why why are you saying anabolic steroids?
01:15:02
>> I don't know. Cuz I hear that people big bodybuilders take anabolic steroids. The
01:15:05
reason I asked you that is because people think anabolic steroids and testosterone replacement therapy are the
01:15:09
same thing and they're not. And so testosterone replacement therapy is what is given to guys who have low
01:15:16
testosterone. If you have truly low testosterone, there's a few things you can obviously improve testosterone
01:15:21
naturally by going back to those pillars of health that we talked about. Improve
01:15:24
your sleep, do resistance training, avoid endocrine disrupting chemicals. But if you are still low despite doing
01:15:30
all those things or you're like so fatigued that you can't move your body
01:15:33
and like you really need to do it, then I think testosterone replacement is is very valuable. And so testosterone
01:15:39
replacement is getting you to a level of testosterone that is within normal. We're not trying to get you super high.
01:15:47
We're not trying to get you to become a bodybuilder. We're trying to get you to
01:15:50
normal, what you should be. And so anabolic steroids are different. And anabol steroids are like all these
01:15:56
different um oral pills and injectables and things that work on muscle as well as work on your uh androgen receptors.
01:16:03
And so those are typically things that people are taking on their own. They're
01:16:08
kind of self-directing their care and they're not really monitoring their testosterone or they don't really care
01:16:14
how high they go. They just want the end product of looking muscular. And so they
01:16:20
are getting really high testosterones and that has its own host of concerns in addition to the ones we talked about
01:16:27
like blood clots and and heart attack. But there's a 15 times higher risk of
01:16:32
having premature heart failure and a 122 times more risk of cardiac death when you're taking anabolic steroids for the
01:16:41
purposes of increasing muscle mass and not and get getting really high in your testosterone. So, it is a real serious
01:16:48
issue when you take anabolic steroids because it can have real serious health consequences.
01:16:53
>> I've always imagined that once I have kids, so I'm I think I'm scared that if
01:16:57
I have testosterone replacement therapy at this age at 33, it might impact my fertility.
01:17:02
>> It absolutely will. >> Okay, good. So, I'm not going to do that
01:17:06
until I've had all four of the kids. >> Yeah. >> As many as I can.
01:17:10
>> And then I figured when I hit like 45, then I'll go on testosterone replacement
01:17:15
therapy. Is this a good strategy? >> Well, first of all, I would want to know
01:17:19
why you want to be on testosterone. Is your testosterone low? >> I have no idea.
01:17:22
>> Right? Are you having any symptoms? >> I mean, you live a very highpowered,
01:17:26
busy life. And so, I can guarantee your stress is probably not under control. Like, probably you're not sleeping
01:17:33
great. And not to say that those are things that, you know, you can't do in addition to taking testosterone if your
01:17:38
testosterone is indeed low. But I think the important thing is realizing like it's only going to help you if your
01:17:45
testosterone receptors are not fully saturated and giving you more testosterone is going to saturate them.
01:17:50
>> Doesn't it just drop anyway with age? >> It does. So it drops about uh 1% a year
01:17:56
on average. Some people drop less, some people drop more. So if you look at someone who is healthy and they have a
01:18:02
normal testosterone, they usually won't become what we call hypogonatal or have
01:18:06
low testosterone even as they age because the drop is so low. it's only 1% a year. But if you add on these comorbid
01:18:14
conditions, if you add on a high stress life, if you add on poor sleep, if you add on um exposure to endocrine
01:18:20
disrupting chemicals, you're going to see um that number come down much higher.
01:18:24
>> It's actually I was just I pulled up a graph here um that shows testosterone
01:18:29
decline with age. And it's actually not that steep. >> It's not It is going to decline, but it
01:18:36
may not decline to the point where you need testosterone. So, not everyone needs it. Depending on the data you look
01:18:41
at, 20 to 40% of guys have low testosterone. Um, and when you look at the number that get treated, it's like
01:18:48
2%. >> And it starts declining from about 20 years old. >> Yeah. Depends on the person. 20 to 40
01:18:54
years old that start, it's probably more around 30 to 40. And the reason we came
01:18:57
up with these numbers, right, these guidelines to to guide us on what's normal and what's not is because you
01:19:02
look at population-based data and you look at when these symptoms arise and there are like clear numbers like you
01:19:08
may start having bone loss uh around 300. You might start having uh you know decreased sexual frequency of thoughts
01:19:16
at 215. You might start having feeling less physical vigor uh around 290. Right? And so there are numbers that we
01:19:24
know based on population-based data that we're seeing these numbers decline. Now
01:19:28
the other thing to think about when you're looking at testosterone is free testosterone. So testosterone comes in
01:19:34
different forms in the body. It comes bound and unbound. So 45% of testosterone is bound to SHBG which is a
01:19:43
molecule of protein that is really tightly binds to testosterone. Doesn't let it go for your body to use. Then
01:19:49
there's some that's bound to albumin which is sort of loosely bound and then
01:19:53
there's 2% that's free 1 to 2% that's free and that's what we say is like the
01:19:57
most available to your body for use and there's actually you know good data that
01:20:02
looks at free testosterone and the levels of free testosterone are correlated with these symptoms as well
01:20:08
and so you do have to look at the big picture so I always check a total testosterone as well as an SHBG because
01:20:14
some people can have elevated SHBG thyroid dysfunction due to aging, just genetic variability, right? In women,
01:20:22
SHBG goes up when you take oral contraceptives and it stays up for life if you take oral contraceptives. So, it
01:20:28
can affect their free testosterone. The other thing to think about testosterone is it's for life. Once you take it, your
01:20:33
body stops making its own testosterone. Many people over years will notice that their testo their testicles get smaller
01:20:40
um because their body stops making its own testosterone. So, it's not something
01:20:44
to take lightly. Now if you want say you were low right now and you wanted to conceive there are ways where you can
01:20:50
take other um other pharmaceuticals that will naturally boost your own production
01:20:55
like hcg or clomid or enclomophene. These work basically uh in different ways to either tell your brain that hey
01:21:02
we need more testosterone or they send they mimic the signals that tell your testicles to make more testosterone. And
01:21:09
so there are ways to do it and you definitely need someone who's, you know, well-versed in managing hormone
01:21:14
management. Uh, but there are things that you can do if you're low. But again, I don't think it's once you once
01:21:20
you start these things, you can't go I mean, you can get off of it, but it's
01:21:23
sort of a process and it's not something that everyone will do because you're
01:21:26
going to feel good on testosterone if you're taking it. And then when you get
01:21:29
off it, because your body is like no longer making its own, you're going to feel horrible. So, do you think most 50
01:21:34
plus year old men should be taking testosterone replacement therapies? >> Only if they're symptomatic and they're
01:21:42
low, right? So, >> would it make them the average man, the average 50-year-old man, if this is the
01:21:45
average, feel better on a daily basis? >> Not necessarily. Because if they are
01:21:50
normal, like I said, if their testosterone receptors are already fully saturated, it's not going to change,
01:21:54
right? It's not going to change their it, like I said, it may make their muscles look bigger, but it's not going
01:21:59
to change their their cognition. It's not going to change their mood. It's not
01:22:03
going to change their sex drive. It's not going to change their erections when
01:22:06
their testosterone receptors are fully saturated. >> And you know, in this graph, what is
01:22:10
showing the decline here? Has that got anything to do with whether their testosterone levels are fully saturated?
01:22:15
Because >> no, you can't tell from that. >> You can't tell from that. So, you could
01:22:18
have low testosterone but still be fully. >> That's why we talk about symptoms,
01:22:21
right? Because that's how I can tell. I think, you know, that's part of what
01:22:25
being a doctor is, right? Talking to your patients and figuring out what's going on with them and what their
01:22:29
symptoms are and making sure it's nothing else, right? You can have low thyroid and that can mimic what what uh
01:22:35
what low testosterone feels like. You can have a high prolactin because you might have a benign tumor in your brain
01:22:41
that's secretreting prolactin and that can reduce your testosterone. So that's
01:22:44
the the reason to get a full evaluation to make sure there's nothing else that
01:22:48
we're missing that's causing you to have these symptoms if your other levels are
01:22:52
normal. >> Uh okay, that makes sense. So just because my testosterone levels would be
01:22:56
low doesn't mean I necessar if I don't if I'm not symptomatic doesn't mean that
01:23:01
I should necessarily just assume that I need testosterone replacement therapy. >> Exactly.
01:23:05
>> Okay. Yeah. I think I think most of my male friends are just assuming that once
01:23:09
we hit 50 we're all on the testosterone. >> I mean look I think when if you need it
01:23:14
it's a great drug. It's a great option to improve your quality of life. It's
01:23:19
obviously preventing uh bone loss. It's improving your longevity. it's uh
01:23:24
preventing hopefully having some benefit in terms of cardioabolic health and so yeah absolutely if you need it but it's
01:23:31
not something that like everyone should just take cuz why not right like it's a
01:23:35
when you play with hormones it's serious business you know >> I guess a lot of men are self-conscious
01:23:39
in a way that they don't often admit and they want to have big muscles >> and they want to feel strong
01:23:44
>> and this is the the problem I'm seeing with younger guys right now is that
01:23:48
there's a lot of young kids taking anabolics because there's so much pressure to look a certain way, right?
01:23:54
Because nowadays when how do you meet people on social media through like swiping and and all you see is what they
01:24:00
look like. And so there's this pressure and like I'll see it at the gym like I'm
01:24:03
like at the gym and there's these young kids who I'm like there is no way you
01:24:06
are naturally that built at that age, right? Like unless you've been lifting
01:24:11
since you were like seven years old. And so and of course there are some. But it
01:24:16
is serious because one, it causes infertility, right? When you're on testosterone replacement after about 18
01:24:23
18 months, 70% of people on testosterone replacement will be infertile. >> 17
01:24:28
>> 70 70%. >> 70. >> And even as soon as like 10 weeks, we see some people having drops in their
01:24:36
sperm count. So, it's variable with how quickly you're going to see impacts on
01:24:40
your fertility, but it absolutely happens. And it can it can come back for the large majority of people, but how
01:24:47
long it takes depends on your age and how long you were on testosterone replacement therapy. And in some cases,
01:24:52
it can take as long as 2 years to come back. >> I really need to get my testosterone
01:24:56
levels checked. >> Yeah, you should. But also, you should get your semen analysis checked. And
01:25:01
I've done that. >> Good. Good. Because that's also a biomarker of health. We've seen that
01:25:05
people who have poor semen parameters they have higher rates of mortality and they actually live when you look at age
01:25:12
like what age people die they die younger compared to people and it's dose dependent. So if you're have like normal
01:25:20
uh the concentration of sperm and then it keeps going down and down and down. If you look at the age it's like they
01:25:25
live to 78 77 76 like you can actually see it come down except for people who have no sperm because those are usually
01:25:31
genetic disorders. Those are live a little longer because it's not necessarily due to cardioabolic issues.
01:25:37
Um, but it's basically a reflection of your overall health. >> Steve, what are you doing?
01:25:44
>> Uh, just making myself a delicious coffee >> from the freezer. >> From the freezer. Have you not heard
01:25:50
about Contier? >> No. >> Oh my gosh. This is going to change your life. A couple of months ago, the
01:25:55
founder of this business called Matt sent a big shipment of this coffee to our office in London. What most people
01:26:01
don't know is that the processing of coffee takes out a lot of the taste. So
01:26:04
what they do is they flash freeze it at the optimal moment when it's most tasty
01:26:10
and they send you in the post the coffee in these little frozen ice cubes. Now Matt sent a big shipment to my office. I
01:26:16
moved it to the kitchen. I said to the team, "Knock yourselves out." And then I
01:26:19
saw so many messages in our Slack channel of people going, "Oh my god, what the hell is that? It's so
01:26:24
delicious." All I have to do is pop it out in the morning using the little button on the back of this thing. I pour
01:26:30
my hot water in and I mix it and that is done. You can get $30 off your first order of Cometier coffee if you go to
01:26:39
cometier.com/stephven. Try it and please Instagram DM me, LinkedIn me and let me know if you love
01:26:46
it as much as I do. Make sure you keep what I'm about to say to yourself. I'm
01:26:50
inviting 10,000 of you to come even deeper into the diary of a CEO. Welcome to my inner circle. This is a brand new
01:26:58
private community that I'm launching to the world. We have so many incredible
01:27:01
things that happen that you are never shown. We have the briefs that are on my iPad when I'm recording the
01:27:06
conversation. We have clips we've never released. We have behind the scenes conversations with the guests and also
01:27:11
the episodes that we've never ever released. And so much more. In the circle, you'll have direct access to me.
01:27:19
You can tell us what you want this show to be, who you want us to interview, and
01:27:22
the types of conversations you would love us to have. But remember, for now, we're only inviting the first 10,000
01:27:28
people that join before it closes. So, if you want to join our private closed community, head to the link in the
01:27:33
description below or go to daccircle.com. I will speak to you then. One of the things I was quite surprised
01:27:44
by, I'll be honest, is when I went on your YouTube channel >> Mhm. >> one of your very high performing videos,
01:27:51
I think it had 31 million views, was about enlarging your penis. >> Yes. >> I didn't know that so many men were
01:28:02
interested in ways to enlarge their penis. Well, it's interesting because when you look at the data, more men want
01:28:08
to so I let's say most guys would love to be taller, right? If you're an
01:28:13
average height man, most guys would love to be taller, right? >> Yeah. True.
01:28:16
>> Um more men want to have a longer penis than they want to be taller. >> Really?
01:28:20
>> Mhm. >> Wow. Wow. Why is this? >> Well, I think you know a lot of people
01:28:31
um it starts at a young age. I have sons, right? And so I see it like they talk about their penis in such a way
01:28:37
like very early in life like oh my god my penis is so big or it should be so big or whatever and and there and it's
01:28:44
like this it becomes this like this society thing about who's got a bigger penis like it's very interesting but
01:28:50
there's a lot of pressure to feel like and and a lot of discussion around bigger is better right it's it's talked
01:28:57
about in media it's subtly joked about it is um everywhere you look people are
01:29:02
talking about like being wellendowed as being better. But interestingly, on my podcast, we interviewed the the guy who
01:29:09
has the largest medically verified penis. It's I think it's like 13 or 14
01:29:13
inches in length. And um he actually has a lot of trouble because it's so large
01:29:18
that people don't want to have sex with him and it's uncomfortable for them. And
01:29:22
so, like, it's not all roses and sunshine on the other side. But the reality is that many people feel what's
01:29:29
called small penis anxiety. and they they even if they have a normalsized penis, they feel consumed with how the
01:29:36
size of their penis is. And so that's why this video did so well. I naively had no idea how many people it would
01:29:42
resonate with because I'm not a guy, right? And I see patients all the time,
01:29:45
but at that time in my career, people weren't coming to me to talk about it.
01:29:48
And so I um I realized like there's so many people quietly feeling insecure.
01:29:54
And we talk a lot about women having body image issues. Men do too, right? They feel insecure about the size of
01:30:00
their penis because also they're seeing guys on pornography who have very well-endowed fallaces and you know they
01:30:07
chose to be porn actors for a reason, right? Because they are naturally wellendowed. And so you're comparing
01:30:13
yourself to the outliers and the average penis is about 5.3 to 5.5 in erect. But
01:30:19
when you look at like what do women want, they will say on average they want a 6 in penis. But when you look at like
01:30:26
the kind of sex toys they buy and they did this study because they were looking at people who they were trying to decide
01:30:32
what kind of when they were developing fallaces for trans people like they they reconstruct fallacuses for they wanted
01:30:39
to they were making them too girthy and they like well we need to figure out what girth women want and so they looked
01:30:44
at like what women buy on online like what is the most purchased sex toy and it's actually pretty close to average.
01:30:52
>> Do you say 5.2 in >> 5.2 two to 5.5 depending on the study you're looking at. Yeah.
01:30:56
>> Correct. >> Mhm. >> H. And what size do men think the average is?
01:31:03
>> Oh, they think it's like six or seven in. >> Oh, okay. So, they think the average is
01:31:06
bigger. And also, how does age come into this? Because I'm presuming that when I
01:31:10
get older, my penis is going to shrink or something. >> If you have good blood flow to your
01:31:13
penis, it shouldn't shrink. So, like I said earlier, if you stop having nighttime erections or you're not having
01:31:19
erections, now you're no longer getting blood flow to your penis and it will
01:31:22
shrink over time. Also, if you're gaining weight, it will appear that it's
01:31:26
shrinking because you're getting more fat over here. So, if you think about your penis here, this is the fat right
01:31:33
above this bone. And as this fat gets more and more, you're seeing less and less of the penis.
01:31:38
>> And is there a way to enlarge the penis? So there are many ways that have been uh
01:31:43
tried, discussed, um attempted. So there's definitely surgeries that you can get, but they there's not a lot of
01:31:50
surgeons who do a lot of penile lengthening surgeries and they have lots of complications, like very high rates
01:31:56
of complications because the penis is a very vascular organ. And the thing is that when you have the tiniest
01:32:03
difference on your penis, you notice it, right? Like I have guys come to like the
01:32:06
tiniest little thing on their penis and they're like, "Is this okay?" Like this
01:32:09
is new. And like luckily it's nothing, right? But I'm like they notice it. You
01:32:14
notice it when something's wrong. So imagine you have a surgery and now something changes, right? So it is it is
01:32:19
really difficult to sort of replicate exactly a normal penis when you're lengthening it through surgery. So I
01:32:27
don't recommend surgery for lengthening penis. There is a safer way and that has
01:32:32
been shown to help and that's using a traction device. So a traction device,
01:32:38
we have one here. This is one brand. You can get many of these online. And you can put your penis in this device.
01:32:45
>> It really I like I feel like um I get like shivers when I watch you do this to
01:32:49
this penis. >> So you would wrap it. It would be more comfortable than just putting this like
01:32:54
directly on your penis. >> For you guys that can't see, she's clamping the end of the penis into this
01:32:58
>> into this device. And then you sort of lengthen it uh extend it with this 30
01:33:04
minutes twice a day for this particular device. They've actually done some research on this one. 30 minutes twice a
01:33:09
day and you there's like a whole protocol on their website and it does show improvements in length about two
01:33:14
centimeters but it is a commitment to increasing length and to doing this process.
01:33:20
>> So just on those numbers 2 cm increase over what period of time and does that
01:33:24
>> or about 3 to 6 months depending yeah >> and is it permanent? >> So that's all we don't know. I mean most
01:33:29
of the studies stop at you know once they get their results and we don't know
01:33:32
that if you stop will it just revert back to normal? I don't know. And so the
01:33:37
other thing about this particular traction device that's night is if you have a curvature in the penis like you
01:33:41
develop something called Peron's disease, this device can actually curve a little bit away from if you like let's
01:33:48
say you have um indentation on the top of the penis, it can actually bend away from that and it can help straighten out
01:33:54
the penis. So, that's actually a a a really nice utilization for it because um for some people that can be really
01:34:01
traumatic and devastating to have a change in the way your penis appears because it starts curving all of a
01:34:06
sudden. And this is safe and effective and you can have bruising. It can be slightly uncomfortable, but it's you're
01:34:12
not going to really hurt yourself uh too much by doing something like this. >> I thought a curved penis would hit the
01:34:18
G-spot better. Yeah, sometimes a slight curve can be beneficial for some people,
01:34:23
but again, I think like when you notice like there's a a dramatic change. You do
01:34:28
that more. Come rip the end off. >> It's okay. Um, >> I'm just trying to figure out how this
01:34:35
works. So, I get the penis. I put it >> through. Yeah. >> Clamp it down.
01:34:41
>> And you want to put it at your normal. And then you'll just slightly advance
01:34:44
the the length. You're not going to pull crazy. easier. It's going to do a little
01:34:47
bit of traction so it's not uncomfort. It's slight like just a slight tension.
01:34:51
It shouldn't be like like that. It should be much less tension, but it is I mean they can vary in price from $100 to
01:34:58
$500. So it's a onetime cost. It is not, like I said, not dangerous. What is
01:35:04
dangerous is when people try to do something that became popular on TikTok called jelking. And jelking is where you
01:35:10
use your your hands and you make like an okay sign with your fingers and you're
01:35:15
like stretching the penis with your hands. And this can be dangerous because you can create micro tears in the penis.
01:35:23
And we in the urology community have seen plenty of patients who have now developed erectile dysfunction after
01:35:29
doing jelking because they've now created damage to their penis. And so I I really caution people because this
01:35:36
there is so much despair around sexual function, around penal health that people are willing to try things and
01:35:44
they might really hurt themselves. No joke, I had a patient the other day ask me if he should drink hydrogen peroxide
01:35:50
because he saw some ad that said hydrogen peroxide will fix your erections and I said please don't. um
01:35:57
this is you know but he really was like seriously earnestly asking me this question and I you know I didn't want to
01:36:04
shame him by any means and I was like no you know this is actually not safe and it's not going to help you and there's
01:36:09
no pill there's no drink there's no anything that's going to give you a
01:36:13
longer penis >> what are the cases that you see that break your heart >> you know I I've seen so there I've seen
01:36:20
patients who've had surgery to lengthen their penis and they are above average
01:36:25
when they at baseline and they have these surgeries to lengthen their penis and then they have a bad outcome and now
01:36:31
their penis is disfigured forever. And that's what really um you never forget
01:36:36
that because that person knowing the risks and benefits perhaps made a choice and that choice didn't go the way they
01:36:42
wanted and now they have to live with that for the rest of their life and that's really sad.
01:36:46
>> Gosh, imagine that. Christ >> Yeah. >> Well, and it just it doesn't work
01:36:53
anymore. Well, like the one patient I'm thinking of, um, he, uh, had a like it
01:37:00
it basically developed a scar all at the top of the penis. So, it was like disfigured essentially. Um, and so it
01:37:08
was it was really sad. >> Before I hit puberty, I definitely had a penis anxiety because I was the youngest
01:37:14
in my year at school and I I was the I was short, very very short, very small. I remember what it felt like to like
01:37:22
hide my hide my dick >> when I was around like guys in the changing room and stuff like that. Um,
01:37:29
you know, after puberty things I changed. >> And what I want people to understand, I
01:37:34
think more than anything is that you don't need a long penis to pleasure a partner. We just talked about how the
01:37:40
clitoris is the is the most reliable route to orgasm, right? And so you don't
01:37:45
need a penis to stimulate the clitoris. You can use your mouth, your fingers, you can use a toy. There's so many ways
01:37:52
to help your partner achieve pleasure. And and yes, of course, there are a small subset of women who really
01:37:59
appreciate a large fallus. But the large majority of women, if you look at survey
01:38:04
data, are very happy with the size of their partner, are very content with average or slightly above average or
01:38:10
slightly below average as long as they are feeling intimate and they're feeling
01:38:14
pleasure. And so I think that there's a misnomer that that people think if I
01:38:18
have a longer penis I'm going to be able to pleasure my partner more >> as it relates to women. Is there
01:38:24
different size vaginas? >> Yeah. So the a so just like there's averages there's averages in females.
01:38:29
And so average vag vaginal length is about 3 and 1/2 in. So when women get aroused it expands and widens and
01:38:37
lengthens to about double. So the average woman can easily accommodate the average penis. maybe slightly larger
01:38:45
than average. And so I think generally speaking, knowing that like you will be able to fit in the average woman and you
01:38:52
will be able to please her with the size of your fallus. And like I said, penetration is is not as important. In
01:38:58
fact, only about 85% of women orgasm through penetration alone. They need clitoreral stimulation to achieve
01:39:04
climax. And so again, penetration feels good. I I tell guys, it's like somebody
01:39:10
rubbing your testicles or your paranneeium. feels good, but it's not going to make you orgasm. And so
01:39:16
penetrating, yeah, if you're getting a lot of clitoreral stimulation because
01:39:20
maybe she has a thinner, you know, her clitoreral shaft is closer to the vaginal canal, maybe, you know, the size
01:39:26
of the penis matters more. But for a lot of women, it's not going to be sufficient and they're going to need
01:39:31
some directed clitoreral stimulation. Why do different vaginas feel different to and I guess the the inverse is also
01:39:38
the case where like different penises will feel remarkably different even if they're the same size roughly and you
01:39:44
can have sex with somebody and go it feels really good. >> I mean I think again it's how you it's
01:39:50
like the emotion in the ocean right like how you use your so let's let's talk
01:39:54
about the vaginas first. So, when a vagina is um has more pelvic floor strength, they may be able to like tense
01:40:02
around the penis better, like they may be able to sort of grab the penis with their pelvic floor a little stronger
01:40:08
versus someone who doesn't. And that's where I think some people get worried
01:40:11
when I say, "Oh, you need to relax your pelvic floor." They're like, "Oh, I
01:40:13
don't want to be looser." Right? And that's not going to happen if you have a
01:40:17
normally functioning pelvic floor. If you're >> So, the penis is going in here, right?
01:40:21
>> Correct. So, if I if you're a woman and you do pelvic floor exercises, then
01:40:25
you're going to feel tighter. >> Well, you're you're able to contract and
01:40:30
squeeze those muscles during sex better around the penis. >> Yes. But we don't want you to be
01:40:34
tighter. We want you to be able to squeeze the muscles and relax the muscles. Use them like a normal muscle
01:40:39
like your bicep. You squeeze and relax. Squeeze and relax. We don't want it to
01:40:42
be constantly squeezed. >> But to the man, it will feel tighter. >> You will perceive it as tighter, but it
01:40:47
will not be that she's actually tighter. it just means that maybe her pelvic
01:40:50
floor muscles are doing a better job. So that's for the female. For the male,
01:40:55
it's it's generally like how the penis moves and how the positioning is and
01:41:00
where it's uh it may be girth that's different. It may be the way that you're
01:41:05
moving in the vaginal canal and that may be why it feels different. >> They often say that if you've got big
01:41:11
feet or big hands, you know, like people think you have a big penis. >> Not necessarily true. So there's um
01:41:18
there's actually no evidence that big hands, big feet correlate to female size. There's one study in Japan where
01:41:23
they looked at nose length. And so the longer your nose is from the the bridge down to the tip, that is potent, at
01:41:32
least the Japanese population that they studied was correlated with the length of the penis.
01:41:39
>> People also think tall people have big penises. Not necessarily. >> But nose length, there's some
01:41:47
correlation in a study in Japan. >> Yes. >> Okay. I was just checking if my nose.
01:41:52
>> Okay. Um the last thing I want to talk to you about is >> and how this relates to everything we've
01:41:58
talked about today, desire, attraction, sex. Is there any early data emerging that shows any correlations?
01:42:03
>> Yeah. So ompic there's sort of benefits and there's potential downsides. So the
01:42:08
benefits are that when you're on Osmpic, we see improvements in metabolic diseases. They have improvements in
01:42:14
diabetes, improvements in heart disease, improvements in overall health, right? And so that is going to mean that your
01:42:20
blood vessels are healthier. You're more able to get blood flow to your genitals.
01:42:24
You're going to have stronger sexual function and arousal, right? So that's
01:42:29
great. The other thing is that you are losing weight. So you feel better. you feel more like your body image is is
01:42:36
feeling good about yourself. Also, for men, remember I talked about this fat pad right above your penis.
01:42:42
>> That's getting smaller. And so now you can see more of your penis. So you may
01:42:46
have heard of ompic penis where people are saying, "Oh, my penis is getting
01:42:48
longer." It's not actually that your penis is getting longer. It's that this
01:42:51
fat is going down. So now you're seeing more of your penis, >> which makes it look longer.
01:42:56
>> Yes. Exactly. Reality. Yes. Exactly. Well, it is reality to the person looking. Right. Um so those are all
01:43:03
great things and I think that's wonderful. Now the other part of it is ompic works on the brain and it works on
01:43:09
the reward pathway. So you now see food and you don't feel like it's that much
01:43:13
of a reward. So you don't chase after you have less desire for food. There's
01:43:17
emerging data that we're seeing people on these medications, these GLP1s, have
01:43:21
less desire for, let's say, gambling, let's say shopping, let's say, you know,
01:43:25
alcohol, smoking, whatever it is, right? And so there's a theoretical because it
01:43:30
works on the same pathways that it could also decrease desire for sex. And I think the thing that, you know, there's
01:43:36
so many people on these medications, there's so many metabolic benefits that
01:43:40
I worry that people may not even realize that their sexual desire is changing, right? They might just be like, "Oh, you
01:43:47
know, I'm I'm eating less. I look great. Everything's wonderful." But like slowly
01:43:50
in the background, they're like, "Oh, maybe my desire is less." And maybe it's
01:43:54
creating discord in the relationship. Hard to say because we don't have data
01:43:57
yet. So yeah, I think it's just something that you should be aware of that if you start feeling like you have
01:44:03
less desire for sex or maybe you're like, "Man, I just really don't feel
01:44:06
into anything." Talk to your doctor cuz maybe your dose is just too high and
01:44:11
maybe it just needs to come down a little bit. And again, we don't know yet. But I do worry about this because I
01:44:16
feel like we're we're gonna start seeing it. >> Is it possible to do studies on this
01:44:20
type of thing? >> Absolutely. So you can take people starting Ozmpi and you can say, "Hey,
01:44:26
here is or or any GLP1." You know, there's questionnaires. So like for women there's the female sexual function
01:44:32
index. For men there's Adam, which is a questionnaire about testosterone. But
01:44:35
you could there's sexual desire questionnaires that you can use. Um, and you can take it at the beginning and
01:44:39
then you can take it as they increase their dose and see if there's a change,
01:44:43
right, in terms of their sexual desire. >> You said at the start about knowing how
01:44:48
to talk to your partner. I think like intimacy desire, maybe the conversations like with your partner, how to have that
01:44:53
conversation when there's a problem. >> Yeah. I I wish I could say there was
01:44:56
like a script that you can follow and it's going to work. But everyone's so
01:44:59
different. But I think the important thing is like not giving up because what happens is because we don't ever talk
01:45:05
about sex, when you bring it up, it's immediately like, "Oh my god, is something wrong? Did I do something
01:45:09
wrong? Um, do you not like me? Am I not attractive?" Right? You're automatically
01:45:13
going down the rabbit hole of worry and concern. And instead of dealing with it,
01:45:17
you're supposed to shut it down. No, I don't want to talk about it. Right? Um
01:45:19
especially if like maybe you haven't connected intimately in a while and like
01:45:23
you just don't want to deal with that or you're you have other stressors in life.
01:45:27
Maybe you're not feeling like very good about yourself and so you're like,
01:45:30
"Well, I don't really feel sexy, so I don't want to have sex." And so, I think
01:45:34
really understanding that whatever reaction you get from your partner when you do talk to them, it's not about you.
01:45:39
It's just usually about how they're feeling. And so, don't stress about
01:45:42
that. And two, like it's anything that is worth having requires work. So having
01:45:48
a good sex life, having intimacy over the long haul with someone, if you are committed to that relationship, it is
01:45:56
worth working for. It is worth dealing with a little bit of discord to get there. And so I tell people when you
01:46:02
want to talk about sex, first of all, don't do it in the bedroom. Don't do it
01:46:05
right before or after sex. Do it at a time where you are both calm, relaxed. Maybe you're out for a walk, maybe
01:46:10
you're in the car, so you're not like looking directly at each other. You're
01:46:13
kind of parallel. And always start with a positive thing. like I you know I really enjoy this about our relationship
01:46:19
and I would love if we could talk about this and and maybe they're going to be
01:46:23
like uh I'm not ready for that and you say maybe we could come up with a time
01:46:27
where we can talk about this that works for you right let them feel like they're
01:46:30
coming to the conversation with like they're not being ambushed or like talking about something and then be
01:46:35
curious. I think the big thing is like being curious like what's going on with
01:46:39
you like I want to I want to I want to be there for you. I love you. you know, I miss what we used to have or I miss
01:46:45
this about us. And I think that there's always these misconceptions. I hear it
01:46:49
all the time, right? It'll be like this partner only wants sex and this partner
01:46:53
never wants sex and you know, and that's it. Like that's the end of the conversation. But the reality is that
01:46:59
there it's it's somewhere in between. So typically women tend to view sex as like
01:47:05
added stress sometimes when they're already stressed. Like they're like,
01:47:07
"Oh, it's just one more thing to do." Whereas men look at it as a stress
01:47:11
relief. So, one, you're coming at it from two different angles. The other thing is men aren't really taught how to
01:47:17
be intimate. And so, for a lot of men, sex is their version of intimacy. Like, that's how they connect. That's how they
01:47:24
feel connected with a partner. And so, often times when they're doing these initiations or attempts at sex, it feels
01:47:31
like they're being greedy or it feels like they're they just want sex. And I
01:47:34
think we have to reframe how we look at that. Like, sex is not just sex. It is intimacy. It is being together
01:47:40
connecting with another human being. So how do we do that right? And like how do
01:47:45
we make that sex worth having? We get into this frame where we have sex as like in a hurried quick like just got to
01:47:53
get this done way. I just need to get an orgasm. I just need to get a release. But sex is supposed to be something we
01:47:58
look forward to. It's supposed to be something that we're excited about. And
01:48:01
so we have to build that in. We have to sort of like build the environment where
01:48:05
sex can can happen. So, it may mean like, "Hey, we are affectionate during the day. Maybe we send a lovey text
01:48:12
message. Maybe um you know, I give you a hug. I caress your back. I um tell you you look beautiful. I I'm I'm showing
01:48:18
you gratitude for how much I care about you in other ways." I think just really
01:48:23
taking the time to understand why your partner feels the way they do. >> I'm curious about on that communication
01:48:28
point about how different genders in heterosexual couples have different sort of taboos and things that are just
01:48:35
a bit sensitive. Um, and I was looking at the the variance between men and women, and the the top one for men was
01:48:41
around performance anxiety. So, like admitting to things like erectile dysfunction because it feels like it's
01:48:46
so intrinsically connected to masculinity >> and you feel like a failure as a man if
01:48:50
you can't get a erection and pleasure your partner, right? >> And then for women, it was talking about
01:48:54
um prioritizing pleasure and asking for more foreplay or um, you know, specific specific stimul stimulation around the
01:49:03
clitoris or something like that. um because they don't want to be labeled as
01:49:06
highmaintenance or too much hard work, etc. >> And it's interesting that on that walk
01:49:11
with your partner, there are different things that will trigger each of you. >> Mhm.
01:49:16
>> Um other ones for women were pain and discomfort, bringing that up. Um body
01:49:20
image and the mental load, explaining why you aren't in the mood. And other ones for men are expressing nonsexual
01:49:26
needs because it might be seen as unmanly, unmanly, boundaries and rejection, communicating when they don't
01:49:30
want sex. And lastly, the script, which is discussing fantasies that deviate from the norm.
01:49:35
>> So, I want to talk about fantasy, but before that, I would just say that, you
01:49:38
know, it because of social media, we're in a place and I get text messages from
01:49:43
my husband 24 hours a day with like not 24 hours a day, but like all waking hours with reals and videos. Oh, I think
01:49:49
you'd like this. I think you'd like this. You should check this out. And
01:49:52
it's like his way of like connecting and like, hey, let's talk about this later.
01:49:55
Like, this is fun. And so I I tell my patients like send your partner a a video that you saw on social media that
01:50:01
might help them understand like why this is important to you. Maybe send them a video send them this podcast, right? Say
01:50:07
like, "Hey, I watched this. It was great." Good idea. You know, um and I I
01:50:10
learned so much. And honestly, so many patients bring their partners to me. Whether it's women bringing male
01:50:15
partners or men bringing female partners, they come to me and they say, "Look, like I want you to meet this
01:50:20
doctor and I want you to talk to them." And like it's beautiful to see that.
01:50:24
Like I love it because it's it's so deeply caring that they like brought
01:50:28
their partner and they want them to feel good and they just want to figure out what's going on and like I think it's so
01:50:33
lovely to to to find someone who's so invested in making sure that sex is good
01:50:37
for you, right? >> As men though, we're just not good at talking about this stuff,
01:50:41
>> right? But you know, I think you can't use that as a crutch. >> Yeah.
01:50:44
>> Do you know what I mean? Like >> Yeah, I do. Yeah. We're just not good at
01:50:47
it though. We just >> But no one's good at it. It's not men. Women are not good at it either.
01:50:51
>> I think men are worse at it. I think in general no one is good at talking about
01:50:54
sex. Like I, you know, I think it's interesting because I talk about it all the time, but I have seen very good
01:51:01
communicators struggle with talking about sex. And so I think it's just um it's just it's uncomfortable and and
01:51:08
it's like if you and I can have this conversation and we can talk about sex openly, like there's no reason that you
01:51:14
can't learn how to talk about sex and it it's it's a learning process and it's
01:51:18
worth it's worth investing in. Do people bring you their fantasies? >> Yeah, I've had I've had well more not
01:51:24
not as many fantasies as like real sort of diverse interests in sex. >> What do you mean by So I had a patient
01:51:32
who came to me and said uh you know after sometimes this was not like our first visit like we built a rapport and
01:51:38
he told me you know the I I really struggle with arousal and the only time I get aroused is I have a a medical kink
01:51:45
and so I go to this person who will put a fully catheter in me and that's what
01:51:50
turns me on. And I was like that's really interesting. And I was like, "Okay, like that's that's great, but
01:51:55
like it took a long time for us to get there for him to feel comfortable." But
01:51:58
it also then was like, "Well, if that's what turns you on, you know, then you
01:52:02
got to sort of explore other ways to incorporate that with a partner. Maybe not." So like a a catheter is is um is a
01:52:09
tube that you put in the bladder for to drain urine. >> What hole does that go in?
01:52:14
>> The urethra. >> It goes in the penis. >> Correct. And so there's actually a lot
01:52:18
of people who enjoy urethral play. So they will take sounds, they're called sounds, like little um uh rods with a
01:52:25
frail flared base and they will insert them in the urethra. But people do find that pleasurable. And
01:52:31
so because there is some, you know, there there are some nerve endings there that can be pleasurable. And so again,
01:52:37
it is totally fine to have interests that are, you know, outside what we call conventional. Um, but of course I think
01:52:43
you need to uh if that's something that you're really into, you have to sort of
01:52:46
bring your partner into the into the fold if that's what really gets you turned on. Now, in terms of fantasies,
01:52:52
almost everyone fantasizes, right? Almost everyone does. And the interesting thing when you look at
01:52:57
fantasies is there's a lot of fantasies that you would think are not common but
01:53:02
are. So, for example, um being sexually submissive is very common. So women fantasize about it like around 60%, men
01:53:11
are like 20%, having this desire of sex, this fantasy of sexual submission. It may not mean that they want to be
01:53:18
submissive in real life, but that's the fantasy they're having. Um, men often
01:53:22
have voyerism fantasy. So like watching sex. Um, they also have uh sex with multiple partners. Um, women tend to
01:53:32
have a lot of like sexual um dominance but also romance in their fantasies. So like in exotic places or um that or with
01:53:39
and a lot of times like 90% of the time people fantasize about strangers or it could be someone they know but outside
01:53:45
of their relationship and so that's completely normal and nothing to be worried about. It doesn't mean that like
01:53:49
you want that person. It's just a fantasy. It's a safe place in your head
01:53:52
to think about fantasy. And I think one realizing if someone fantasizes about something it means nothing about how
01:53:58
they feel about you. It's just where their brain goes to explore. I tell my patients sometimes write down your
01:54:03
fantasies for yourself. Just like write them down. Don't share that with anybody
01:54:06
and have your partner do the same. And then if you guys decide you feel comfortable at some point to each share
01:54:11
one fantasy and you can start talk and maybe one that you would want to try and like it allows you to sort of explore
01:54:17
and think about different things. It could be a negative outcome like you could just be like oh no this what
01:54:21
didn't do it for me but it could also be very positive. And so just like again I
01:54:25
think the big thing is understanding like it doesn't need to be that serious.
01:54:28
like we can experiment, we can play, we can have fun. And if you bring that back
01:54:33
into your life, you are going to be happier, less lonely, live longer. Like everyone should just be having more sex.
01:54:42
>> It's um Yeah, it's interesting that we're getting more and more sexless
01:54:46
because I think the world is stealing our attention and that's causing a big
01:54:51
loss in connection. But then everyone's lives are more stressful than ever before. if a bomb goes off 10,000 miles
01:54:57
that way, I I see it when I open my phone. >> Um, so it's an interesting time to sort
01:55:01
of almost try and reclaim sex and >> to work on one's sexual health, the
01:55:08
overall the full picture of one's sexual health. Um, you're working on a book
01:55:12
which is, I guess, endeavoring to do much of that, which is coming out in September
01:55:16
>> called The Hard Truth: Everything Men Need to Know About Good Health, Great
01:55:20
Sex, and Long Life. So, if you're watching this after the 1st of September 2026 or around that time, then the book
01:55:26
is probably available for pre-order or already out. It's not available for pre-order yet, is it?
01:55:30
>> Uh, it will be soon, but not yet. >> Okay. When the book is out, I'm going to
01:55:34
link it below in the comments section. Um, when it's available for pre-order,
01:55:37
The Hard Truth: Everything Men Need to Know About Good Health, Great Sex, and Long Life. So, if the subjects we talked
01:55:42
about today have piqu your interest, the book, I imagine, is going to go into greater detail on all of these subjects.
01:55:48
>> Absolutely. I think it's a book that really I I wish was a part of sexual
01:55:52
education. I think all men need to know this. You know, as women, we end up taking care of our male partners. I make
01:55:59
all the doctor's appointments. I, you know, I organize all of that. I make sure that my kids get all their
01:56:04
vaccines, all that sort of stuff. And and you know, it becomes on us to take care of our fathers, too. And so, as
01:56:09
women, we hold that role. And I think it is so valuable to understand what men go
01:56:16
through and also to be able to support them along the way. And I think it's a
01:56:20
great gift for, you know, men in your life or for, you know, older sons even to like help people understand their
01:56:27
bodies. And honestly, it's a huge motivator. I tell people like for nothing else, people care about sex. And
01:56:33
I have seen patients turn around their lives because they want to have better sex. They'll literally improve their
01:56:38
blood sugars. They'll improve their blood pressure because they just want to
01:56:42
protect their sexual health. >> Reena, thank you. We have a um closing tradition on this podcast where the last
01:56:48
guest leaves a question for the next guest not knowing who they're leaving it
01:56:50
for. >> Mhm. >> This is the first time in Dario history where the guest has actually stamped it
01:56:56
with a stamp that says certified 100% human. >> Okay. >> So, you can see there's a little stamp.
01:57:02
>> So, when is that AI? >> So, it's not AI and it actually says that in the middle. It says Gen AI free
01:57:08
sign of things to come. But their question I guess is somewhat linked to that. They the question they've asked
01:57:12
for you is so much of the world feels hopeless about this moment. What would you tell someone to help them reclaim
01:57:21
their agency? I think that we as humans are meant to be with other humans. We are meant to connect and I
01:57:40
think making that a priority will allow people to feel um to feel a part of something again.
01:57:49
You know, I think um I think there is like an emergence of people starting to look back at religious constructs and
01:57:56
and go to community and be a part of things and enjoy live events again like we weren't doing before. I think if we
01:58:03
prioritize that, there is still hope that we can come together as a society. And I think, you know, the pendulum
01:58:10
always swings right in every way, like it's going to go far right or far left
01:58:14
and people are going to hate each other and then they're going to love each other and they're going to come back.
01:58:18
And I think if you just look at history time and time again, it repeats itself. And we will find unity and we will find
01:58:26
togetherness. We are obviously feeling pain from a variety of different sources and we may feel pain right like in terms
01:58:33
of other things to come but ultimately I I'm an optimist and I think that we'll
01:58:38
come together and and we will find um happiness and joy in human connection >> and I hope you're right and I think
01:58:46
we're seeing the early signs of that now for anyone that's listening that wants
01:58:49
to learn more from Reena um I highly recommend they go to your YouTube channel I will collab if we can um and
01:58:55
if we do collab on YouTube you'll a little smiling Reena um next to the Dar of Seio logo where you can click through
01:59:01
to her YouTube channel. She's got almost 3 million subscribers and she goes through all of the questions which no
01:59:08
one has ever answered for us. And I was looking at some of the questions that you answer for people. Everything from
01:59:13
>> why you dribble after you pee and how to stop it. porn director reveals what what
01:59:19
scenes are faked in almost every scene of movies, but then also a lot of the stuff we've talked about today around um
01:59:25
penal health, erectile dysfunction, um sex positions, and so much more. So, it's a wonderful repository of
01:59:32
information that is constantly being updated. That is a great place to subscribe. So, I highly recommend you
01:59:36
do. Dr. Reena, thank you so much for your time. >> You're so welcome. YouTube have this new
01:59:40
crazy algorithm where they know exactly what video you would like to watch next based on AI and all of your viewing
01:59:46
behavior. And the algorithm says that this video is the perfect video for you. It's different for everybody looking
01:59:53
right now. Check this video out and I bet you you might love