this term sex pan which I've never heard

before what is that sex span is how long

you are able to engage in satisfying

sexual activity and most men most women

want their sex fan to last as long as

their lifespan and there's many things

you can do that significantly prolong

your sex fan and I called it the four

pillars so let's talk about sex Dr moit

Cara is a board certified urologist and

Professor who specializes in male and

female sexual dysfunction his

groundbreaking research has

significantly contributed to improving

sexual health and fertility millions of

men and women are suffering from sexual

problems like infertility and sexual

dysfunction for example in the US

roughly 43 to 48% of women suffer from

female sexual dysfunction which involves

four components that we're going to talk

about but we also know that premature

ejaculation affects 30% of men globally

and also 40% of men at 40 will suffer

from erectile dysfunction and it's the

first sign of other major adverse

medical problems for example 66% have

some degree of depression and 15% of

them will have a heart attack or stroke

within 7 years and if you look at the

causes for Ed one of the biggest factors

is obesity which causes the testosterone

levels to go down but men need

testosterone for sexual functions so do

women because low testosterone increases

low Lio but the issue is people don't

talk about their sexual problems they

suffer in silence and they start

avoiding sex but it's curable and I have

two ways to raise their testosterone

techniques to significantly improve the

quality of your directions and natural

ways to improve sexual function in men

and women so number one most important

is this has always blown my mind a

little bit 53% of you that listen to the

show regularly haven't yet subscribed to

the show so could I ask you for a favor

before we start if you like the show and

you like what we do here and you want to

support us the free simple way that you

can do just that is by hitting the

Subscribe button and my commitment to

you is if you do that then I'll do

everything in my power me and my team to

make sure that this show is better for

you every single week we'll listen to

your feedback we'll find the guest that

you want me to speak to and we'll

continue to do what we do thank you so

much

Dr Mo

Hera who are you and what have you spent

your life doing so I'm a urologist and I

specialize in male and female sexual

dysfunction testosterone replacement

therapy and infertility for the past 17

years I've been working as a professor

at Baya College of Medicine Houston

looking at ways to improve sexual health

improve testosterone and improve

fertility and we talked just before we

started recording about this term sex

pan which I've never heard before what

is the sex pan and why do you care about

it yeah so Stephen you know what

lifespan is it's how long you're going

to live right and you also know what

health span is how long you're going to

live in a healthy lifestyle but you may

not have heard of the concept of sex

span sex span is the ability to engage

in sexual activity satisfying sexual

activity and so how long you are able to

engage in sexual activity is important

to most men right um so let's give you

an example the average lifespan in the

United States is 77 years old the

average Health Span in the United States

believe it or not is 67 years old in

fact if you look at the CDC and they

talk about how long you'll live without

a disability it's actually 63 so there's

a Delta here there's at least 10 15

years where you will be in some kind of

disability and cannot live to your

fullest now think about the concept of

sex span how long you'll have the

ability to engage in sexual activity

satisfying sexual ity we most men most

women want their sex span and their

health span to last as long as their

lifespan yes so I think it's

important and there's things that I can

do to make my sex span last as long as

my lifespan there's many things you can

do and I call it the four pillars the

first is Diet exercise sleep and stress

reduction I don't have a pill on the

planet stronger than diet exercise sleep

and stress reduction and each one of

those can significantly improve a man

and a woman's sex span but also their

health span and their lifespan the other

is hormones testosterone extremely

important testosterone supplementation

can significantly improve a man and a

woman's sexual function and fortunately

for women in the United States we don't

have very many options actually globally

for women there's not many options um

but I think it's important a hormone

replacement therapy and I one more thing

I think about the couple think about sex

ban as a couple's disease let me give

you an example tomorrow Stephen are are

you married or yeah well I'm in a

long-term relationship you're your

partner so let's say your partner

tomorrow says to you I am no longer

going to have sex with you unless uh you

cheat on her or you leave her you're not

going to have sex again right think

about the importance of the couple um so

I talk about this quite often keep your

partner engaged keep your partner

healthy if you want to prolong your sex

fan so I got two questions here the

first of which is who have you worked

with in your career and the second

question is what is your CV give me a

rundown of your professional experience

yeah so I started my residency in 2000

and uh I did my residency in 2 one year

of general surgery I did five years of

Urology training and then I did one year

of a fellowship in men's health soon as

I finished my training I joined uh the

University at Baylor College of Medicine

and I started a basic science laboratory

where we do a basic science research in

sexual medicine and testosterone for the

past 17 years and I just started a

clinical trial so I start have a

clinical arm we do clinical research I

see approximately 150 patients a week

every week I do approximately 68

surgeries every week and I still work at

the VA hospital it's a veteran

government Hospital one half day a week

working with the veterans so it's quite

busy um but you know my passion really

is education research and clinical care

and um and that's what we do and so you

know when I started my where how I

really got into this was when I finished

my training I was so proud of myself I

was able to get these men these amazing

erections these great libidos and uh I

realized one day this woman called me

and she was frantic and she said look uh

you're treating my husband you're able

to get him these great erections great

libido but I don't want to have sex with

him and he wants to have sex with me all

the time and now we have a terrible

relationship you've ruined our

relationship and I thought to myself

wait a minute uh you know I this doesn't

make sense but she was right you know in

in sexual medicine either leave both Le

low or raise them both but don't raise

one or the other it's a setup for

disaster so very quickly that year I

went out and flew out to meet with Dr

Irwin Goldstein who's considered one of

the Godfathers of female sexual

dysfunction spent some time with him

went to his courses and for the past 16

years I've been treating women as well

you can't just treat one patient without

addressing the other and so therefore

it's a couple's disease and give me a

flavor of the types of conversations you

have on day one when they walk into your

practice when they come to see you what

is the issue that they say they have and

how do they express it like what are the

words that they use and if you could

just give me like five of the most

popular things people say to you when

they come to see you so listen first of

all men and women are very different how

they express it you know so we'll talk

with men most men uh let's backtrack

most men and women do not get any kind

of medical care when they see their

primary GP in fact most GPS don't

address sexual dysfunction there was a

study looking at medical students only

65% % of us medical students get

training in sexual medicine and of those

65 50% of those students said that the

training was terrible so we don't get

the sexual medicine training to address

the problem for patients so the majority

of patients are never uh discussed about

their sexual problems but when men come

in there's a most of them are coming in

because they already have tried some

medications that haven't worked and

they're looking for other Solutions now

there's a very two simple questions you

can ask a man they're very

straightforward are you able to get an

erection sufficient for penetration it's

either yes or no are you able to

maintain that erection to orgasm or

pleasure it's either yes or no if he

answers no to either one of those

questions he suffers from erectile

dysfunction right and so it's very

important to get a detailed history you

want to ask particularly are you able to

get an erection on your own are you able

to get erection with masturbation do you

wake up with morning erections if he

says look doc I get great morning

erections or with masturbation I have

great erections then this has to be

psychogenic right with my partner I

cannot get an erection but when I'm by

myself everything works fine psychogenic

psychogenic Ed it's a big component what

is psychogenic many something in the

mind that's bothering you or inhibiting

you from engaging in sexual activity and

that's where the sex therapist comes in

right because if I if someone tells you

I get great erections uh by myself but

with my partner I'm not able to get good

erections psychologically when with

their whe they're with their partner

they're not able to achieve a good

erection sex for men and women has a

huge psychogenic component

a huge psychogenic component so I think

it's very important to get detailed

history are they able to get direction

what did they try what medications have

they tried you know you have to query

about

depression 66% of men who come in with

Ed have some degree of depression 66%

right and that's important anxiety 35%

is very important and more importantly

we'll talk about this Ed is the first

sign of other major adverse medical

problems for example if a man comes into

my office today 15% of them will have a

heart attack or a stroke within 7 years

15% the day they get Ed 15% will have a

heart attack or a stroke within seven

years it's the first sign other studies

Dr monori showed that if a man presents

the emergency room with a heart attack

on average 39 months earlier that's when

the Ed started so it is the first sign

now there are many reasons for this one

theory is called the arterial diameter

Theory the penal arteries are the

smallest arteries 1 to 2 mm

the coronary arteries are 3 to 4 mm the

kateed 6 to 7 mm so if you remember from

physiology if you're going to block an

artery 50% occlusion of an artery causes

a damage so if you're going to block an

artery you're going to block the penina

arteries before the coronary arteries

you're going to block the coronary

arteries before you block the kateed

right so men will get Ed before they get

a heart attack more more likely to get a

heart attack before they get a stroke

that's a theory but it makes sense so I

worry when a man comes into my office

could this man have a cult

cardiovascular disease in fact there was

a wonderful study that came out of

Greece they looked at 50 men that walked

in and they gave them an echocardiogram

or stress test if it was positive they

wanted onto a coronary angiogram what

they found is that roughly 20% of men

one in five actually had some occlusion

in their heart whether it was one vessel

two vessel or three vessel disease so I

think to myself every time I'm writing

that prescription is this one of the

five that could have occlusion and is

there opportunity to intervene at this

point so it's really important to think

about cardiovascular disease as well one

of the big subjects that I hear a lot

about even in my friendship groups is

about libido I've I've got so many

stories in my friendship group of either

one or both Partners losing their libido

so on this subject matter of libido is

kind of where I wanted to start this

conversation what is the most frequent

and popular reason why men and women

struggle with libido problems and

how much of of that is about

compatibility yeah good question libido

is multifactorial there's many pieces of

libido it's very complex and I'll give

you some important components first it

could be hormonal and the pneumonic I

teach the residents is pet the four

hormones that can affect someone's

libido are prolactin estrogen thyroid

and testosterone so you have to check

the pet if the prolactin is elevated the

libido goes down the testosterone's low

the libido goes down so maybe it's a

hormonal issue which could be it and

particularly many women who go through

menopause suffer from hormonal issues

and it could be a hormonal issue the

second is something called

neurotransmitters so in other words

serotonin norepinephrine dopamine

dopamine goes up libido goes up

serotonin goes up libido goes down so

these all regulate how someone's libido

will function so one of the biggest um

uh culprits for low libido are

anti-depressants what do

anti-depressants do they increase

serotonin and they decrease libido so

sometimes it's a medication or something

that a patient's taking that will shut

down their libido for example a

medication that men take for urinary

function called finasteride shuts down

their libbido so that is there are

certain things that you have to look at

the other components are um lifestyle

diet exercise sleep and stress reduction

particularly fatigue and stress if a

woman is tired and she's exhausted and

she has to between sex and sleeping at

night many times she may choose sleep if

me as well right I'm just saying so

fatigue is important stress and there's

this cliche this pneumonic this this

saying that um with stress is kind of

interesting typically if a man has a

very stressful day he will want to have

sex to relieve his stress uh women have

to relieve their stress to engage in

sexual activity it's kind of the

opposite you know what I mean so I tell

men if you really want to have sex with

your wife uh do the dish just take out

the trash H do everything you can to

tuck the kids in bed early relieve her

stress because that will significantly

increase her desire to engage in sexual

activity but the other one is uh

psychogenic so you know we talked about

that earlier you know sex has a huge

mental component your relationship with

your partner your uh your the how close

you feel with your partner so sometimes

patients come to me and they're an

abusive relationship and say and they

say give me the pill that improves my

libido I said I it's not going to work I

mean the the essence the core the

foundation is not working and therefore

it's really important for them to see a

sex therapist one thing for men that

actually shuts down their libido is when

they start developing erectile

dysfunction so if a man starts getting

erectile dysfunction let's say he gets a

good erection 50% of the time and he's

starting to have some problems and it's

10 o'clock at night and he says look I

can try to engage in sexual activity but

it may or not work and it may be

frustrating and embarrassing or I can

just go to sleep it's probably just

going to go to sleep right and it

becomes a vicious cycle because the less

sex he has the more difficult it is to

engage in sexual activity later on and

so you may interpret this as a low

libido but he's really just avoiding it

because he doesn't want to deal with it

right but the partner also uh looks at

this as maybe I'm not attractive anymore

maybe there's something about me that's

not appealing and it becomes a vicious

cycle so one thing you can do is

significantly improve the quality of the

erections in a man and that actually

helps improve his libido so for example

if I tell a man if every night you uh

have anere great erection and every

morning you wake up with a great

erection what are you going to probably

do probably going to use it right so

libido inherently goes up right so I

think e Ed and libido are tied very

closely how do you define the Tam labido

in simp it's a desire to engage in

sexual activity right for men and women

and you have to you know when it's a

true problem they have to be bothered by

the condition so I just want to be very

clear there are women who have low

libido and say I really don't care I'm

happy that I have a low libido well then

it's not an issue right you have to be

bothered by the issue so on this

psychogenic element where it becomes a

vicious cycle I've seen this in my own

life um several times Well at least once

and I've seen it in some of my friends

where because there's a bedroom issue

when you go to the

bedroom you're both a little bit anxious

and then one of you can't perform and if

you can't perform it exacerbates the

issue and it creates this sort of

vicious downward spiral of like it makes

the bedroom like a really awkward place

to be and this is how I think about when

you're talking about psychogenic

component so in the in the case of

erectile dysfunction if you're thinking

as a man God if I go to the bedroom I'm

not going to be able to get it hard I'm

not going to keep it up it's going to be

embarrassing she's then going to ask me

questions she's going to think I I'm not

into her which just makes it even harder

because as a man like I perform best

when I'm really not thinking about it

and I'm like not anxious when I'm stress

free right and if seems to me that the

like antithesis the opposite of great

sex is like

overthinking you're 100% correct and

this is what happens let's say a man

gets Ed just one time just one time

young man he says that was really odd

and I I what's wrong you know what he

does next time he has sex as he's having

sex he says to himself I hope I don't

lose my erection I hope I don't lose my

erection the second he says that to

himself as he's having sex he's going to

lose his erection right because he's so

worried that he's going to lose the

erection and not enjoying the experience

so now it's happened twice so now he

engages sex third time and now he's even

more freaked out because it's happened

twice and it happens again we call this

the Vicious Cycle right because the now

sex has become an anxiety event anxiety

provoking event and so you really have

to work on decreasing that anxiety and

not thinking about it that's where Sex

Therapy comes in hand and that's where a

medication called daily Calis has become

unbelievably helpful for my young

patients because daily Calis is a

medication that men take daily you've

heard of Cialis right it's like the

Viagra yeah it's like Viagra right so

there's Viagra there's Calis Levitra

there's stender there's four different

brands but one of the four is meant to

be given daily it's a lower dose 5

milligrams every day and the larger dose

is 20 milligrams when you give a man

Calis 5 milligrams every day what it

does is essentially is having that

medication on board all the time when he

engages in sexual activity he doesn't

have to take a pill he just has has sex

whenever he wants to and I found that to

be unbelievably helpful in Breaking

psychogenic Ed now that's exactly what

that is on the table yeah that's exactly

what it is yeah and so these are these

are these are pills um that are in the

US but what's nice is they used to be

very expensive uh now they if you look

at Mark Cuban and a lot of the uh good

RX um companies they men can get 90

pills for5 or $20 which is very cheap

you use the word young men yes young men

presumably shouldn't be taking pill

shouldn't but what happens when they

have psychogenic Ed cuz they think about

it the most is they need to break the

cycle what's the cost cuz I'm a I'm got

to be honest I'm a pill skeptic yes so I

try and avoid taking pills to solve my

problems if I can right obviously

there's going to be situations where I

can't and I accept that but my bias is

towards figuring out if there's another

way before I take a pill right um

because everything in life comes with a

cost all things yeah so there must be a

cost to taking a pill to solve this

problem well the the actual monetary

cost is unbelievably cheap monetary cost

is I'm thinking about like do I then get

dependent on this do I have to take this

for the rest of my life so so there's no

dependency let me tell you why I think

that drug is so important that daily

seis has one of the only things in my

opinion that actually reverses erectile

dysfunction so let's backtrack I give

you an example let's say today you break

your leg okay I have two options Stephen

I can fix your leg or I can give you

vicadin a narcotic and if I give you the

vicad or the narcotic you'll still be

able to walk until the vicadin no longer

works and we're in trouble Viagra is a

vicadin it is not a cure for your

erectile dysfunction it's just masking

the problem daily seis in my opinion is

one of the few things that helps cure Ed

if you look at studies and you look at a

penal tissue and we biopsy the tissue

and then you biopsy three months later

on daily seals it physically gets

stronger so let's say you go to the gym

today and ask you to lift dumbbells

what's going to happen to your arm it

will hypertrophy with daily seal we see

hypert of the smooth muscle meaning it

gets physically stronger so in my

opinion it's one of the best things to

prevent Ed in the future help reverse

the Ed process more importantly daily

Calis protects the endothelium and we

have to spend some time talking about

that that is the lining of the blood

vessels it's the brains and the lining

of the blood vessels is very important

because once that gets injured you start

getting clot or plaque which will get a

heart attack a stroke and a rectile

dysfunction so it protects the lining of

the blood vessels two other indications

it's FDA approved to help a man urinate

better FDA approved it's FDA approved to

protect the heart in terms of something

called pulmonary hypertension so in my

opinion it's an excellent medication

patients say do I get dependent on I say

you do not get dependent on it and H I

feel like you're better had you taken it

than had you not you take it for three

months you get strengthening of the

penal tissue what happens if I stop

taking it if you stop taking it there's

a wonderful study by a versa and what he

showed was that those patients that

stopped taking it after 3 months versus

Placebo still had benefit in terms of

endothelial function protection and

erectile function protection than those

people that took Placebo so thinking

about saying hey if I go to the gym and

I work out for three months what happens

if I stop I say well Stephen you're

better off had you gone to the gym for

three months that's my opinion what is

the downside they're side effects so

every drug has side effects right but

they're low with five milligrams back

pain stuffy nose um headache can occur

in these but it's quite small but I do

think that this is one of the

medications that really can make an

impact uh in men's health think about it

if I told you there's a medication that

protects your heart helps your prostate

and helps men with erections it's

affordable I think that most men would

say I'm in what are the big side effects

that people report when they're on seis

so on the larger dose headache stos back

pain is more common with Calis and other

medications um but it can be reported

remember you shouldn't take these

medications if you have you're taking a

nitrate because it can drop your blood

pressure um but other than that these

are very commonly used medications

throughout the world and they're not

suitable for certain people that have

certain cardiac disorders I'm guessing

well you know the way this was invented

uh this came at first one Viagra came

out in 1998 Viagra was in the clinical

trials designed to be a blood pressure

medication and accidentally men were

getting erections in the trial so these

medications are in my opinion

cardioprotective a guy named a very

famous uh physician B Dr cloner

published an article recently showing

that those men who took daily seis had

133% reduction in cardiac events and a

25% reduction in mortality that just

came out because of the potential

effects of protecting the endothelial

lining of the blood vessels how does

this work to solve for the sort of

psychogenic component that we talked

about that vicious cycle people get into

with like I'm guessing you're telling me

that increases your probability of

having a good erection right but this

still isn't really working on a liido is

it right so let's say um you started

falling through the Vicious Cycle and

you started having Ed and it was two

times three times and now I put you on

this medication and every time you have

sex you have the most amazing erection

of your life and 30 times 40 times three

six months go by and you're having these

amazing erections you're relaxed and

you're calm then I start going to every

other day you still get amazing

erections then I go to once a week you

still get amazing erections then I stop

you still get amazing erections right I

just need to show you that everything is

perfect again and that has a huge value

what about for women this is the

unfortunate part we don't have a lot of

treatment options for women and if you

look about it if I want to give you an

example in 2015 if you and I went into

the drugstore in the US Walgreens and

said give me all the drugs to treat

women to treat men for sexual

dysfunction they would put 30 drugs on

the counter these are all the wonderful

treatments for men in 2015 there was not

a single FDA approved drug to treat

women for any sexual dysfunction very

sad in 2015 the first drug to treat

women for female sexual dysfunction came

out and it was called ad or fanin and

fanin basically is a drug that a woman

takes every day and increases her desire

for sex that's it that's the FDA

indication increases her desire for sex

several years later the second drug for

women came out this was called VII or

brontide essentially it's an injection

that she takes 45 minutes prior to

intercourse and it increases her desire

for sex but again we have only two drugs

the reason being is because the research

the funding that we have for female

sexual dysfunction is far less than we

have for male sexual dysfunction and

it's unfortunate because as I mentioned

earlier this is a couple's disease and

so many times I have to use drugs that I

use for men to help treat women so I do

use Viagra for women but Viagra for

women helps arousal so let me explain

female sexual dysfunction has four

components one is decreased libido the

second is decreased arousal third is

orgasmic dysfunction and the fourth is

pain with intercourse these are the four

if a woman has any one of these four and

she's bothered by it she suffers from

female sexual dysfunction in the US

roughly 43 to 48% of women suffer from

female sexual dysfunction significant

number only 19% seek therapy will get

therapy so there's a huge number of

women that I say are suffering in

silence they suffer from the condition

they don't know where to get help and

unfortunately they're not many treatment

options available right so it's a big

problem and a big unmet

need and on the hormonal component you

talked about how if dopamine is up we're

much more likely to be aroused and if

serotonin is up then we're much less

likely to be ared correct so this kind

of ties into something I was thinking

when you were talking about stress and

tiredness when I'm stressed and tired is

my dopamine down it can be your cortisol

goes up right your C cortisol goes up so

your ability to get excited will go down

your fatigue goes up so it makes it much

more difficult these and there's more

than just dopamine and serotonin there's

norepinephrin there's melen Corton uh

there's many other neuro neurosteroids

and it's really just what we call a plus

minus game if I have more positives than

negatives I'm going to have desire and

I'm also going to have orgasm right

that's important also so if you give

someone uh too much serotonin and it

goes this way not only does a libido go

down but it's difficult to achieve

climax or an orgasm so one of the ways I

treat premature ejaculation is I give

them an anti-depressant because it

delays the orgasm so we have to be very

careful on these neurotransmitters how

we use them but if you talked about ad

the drug I mentioned all it does is it

increases dopamine and norepinephrine

which increases libido so they increase

neurosteroids many women particularly

with the hisyory breast cancer like this

because they don't want to use

testosterone or estrogen hormones this

is non hormonal right it's just neur

steroids increasing the desire for sex

can I think about dopamine and serotonin

as like a scales yes where if I if I put

weight on one end the other one goes up

and if I put weight on the other end the

other one goes up yes there is a very

famous uh Michael Perman came up with

the Tipping Point and it's basically a

scale looking at the pluses and the

minuses and if you have more pluses than

minuses liido goes up orgasmic function

goes up if you have more minuses

essentially your ability to orgasm and

your liido will go down so I want my if

I want to be aroused and have a desire

for sex and have good sex then I want my

dopamine levels to be high dopamine High

oxytocin High norepinephrine High

serotonin low what are the types of

activities that make my dopamine High uh

well um exercise is can be really high

dopamine other things increase dopamine

as well right so um gambling there's

there's certain things that are highs

like gambling anything that gives you a

high certain foods will cause a dopamine

Rush um but they're temporary right and

so that's a problem right because if it

goes up and it goes goes back down it

crash so you want your dopamine to go up

in men and women so we use medications

like Wellbutrin have you heard of

Wellbutrin it's an anti-depressant but

that anti-depressant increases dopamine

so I use that to help men increase their

libido or women to increase their libido

or sexual function I use ad e in men and

off label in men and in women to

increase dopamine I don't want to do

drugs though I don't want to take any

pills so then I would say I need you to

exercise and you do but exercise is

critical I need you to sleep I need you

to um reduce your stress right those

things will significantly improve uh

your libido so what things then lower

dopamine because I've spoken to a few

like dopamine expert experts on the show

before and they talked to me about this

sort of I mean Andrew hubman was telling

me that yeah when you do an exercise

like let's say gambling or go on Tik Tok

your dopamine's going to go up but then

it's going to crash below the base Point

yes and some of us live in this kind of

dopamine roller coaster where we're

doing these dopamine inducing activities

dopamine goes up it then crashes below

and when it gets low we have cravings

for dopamine inducing activi so we go

out and want to gamble or go on Tik Tok

again or eat something and then it goes

up again and then and we kind of live in

this kind of roller coaster of dopamine

one of the things that I was told by a

dopamine um expert on the show recently

that does that as well that links to

some things I found in your work is

pornography yes and when we talk about

this psychogenic component we talk about

um do dopamine

levels how much is pornography

causing this libido crisis yeah

pornography and Ed in libido is somewhat

controversial there's some data suggest

that it does not cause an issue and

there's some data suggest that it does

the first question I ask a patient when

I ask a man I say is your Ed present

with pornography also so if he says look

I have rectile dysfunction with my

partner and I have a rectile dysfunction

with pornography that's very different

than when he says I have a rectile

dysfunction with my partner and I have

amazing erections with uh pornography

right because then I know that there's a

psychogenic component as well this is

what I believe I believe that when a man

watches excessive amounts of pornography

what his expectation is becomes hair and

his reality becomes hair and that Delta

causes them to have erectile dysfunction

and low libido they're not getting what

they're expecting to get so many times I

question men when they come in uh all

when all men who come in for to ask how

much pornography are you watching in men

who watch excessive pornography if I ask

them to stop watching pornography for a

while many will report improvements in

their rectile function and libido so

again I do think that pornography in

excess can have a negative impact only

because of your expectation and your

reality the Delta uh can be an issue I'm

reading some stats here from jamama

Network that says the percentage of men

between 18 and 24 reporting no sexual

activity in the past year increased from

roughly 18 % to roughly 30% in the space

of what looks like just a few years and

simil similarly the average number of

times American adults engaged in sexual

activity per year has decreased from 60

between

1989 and

1994 to 50 roughly 50 between 2010 and

2024 these shifts suggest a notable

shift in sexual behavior over recent

decades why do you think this is

happening I think it's more

multifactorial so I think one is I think

that Ed and sexual dysfunction is on the

rise uh and if you look at uh the causes

for Ed uh it's very simple you look at

uh obesity diabetes metabolic syndrome

it's a pandemic it's an epidemic

throughout if you look at just diabetes

from 1990 to

2022 uh 100% 7% to 14% of the population

one out of eight people globally are

obese one out of eight people so these

can make it very difficult uh as obesity

and diabetes that go on the rise what

happens testosterone levels go down

right so testosterone levels go down so

the ability to engage in sexual activity

the desire to engage in SE activity will

be impaired by these uh conditions I've

got some some graphs here um which show

Global obesity Trends Global diabetes

Trends I'll put them on the screen for

anyone that's watching on video um also

there's been an increase in pornography

consumption from what I was able to tell

from doing some research a 2020 study by

the University of ant found that 40% of

people aged 35 to 45 who watched 300

minutes of porn a week had erectile

dysfunction in a 2021 study by GMA

public health and surveillance and 3,400

men between 18 and 35 years old 20% of

the participants suffered from erectile

dysfunction and researchers found that

the greater the viewing frequency of

pornography the greater the development

of this dysfunction yeah and that's 300

minutes is quite a bit of time a week 5

hours minutes five hours five hours a

week right so this so that's quite a bit

yeah that's quite a bit how important do

you think that is as a component to this

sort of fracturing relationships we

think about people having sex with each

other less yeah we're heading towards a

world of like virtual reality and AI yes

what role do you think that's genuinely

playing and you you must have private

conversations with men that are really

suffering with these things so I I

definitely think it's it's a role and it

definitely plays a factor but not as

much as the epidemic of diabetes obesity

metabolic syndrome we are as a

population becoming more and more

unhealthy right as time goes on and I

look at again as a piie it's

multifactorial right um most of us now

are not our socialization is virtual and

so we are not engaging and going into

seeing everything is done virtually and

so I think that's an issue um and so I

really believe that pornography is a

component but the the decline in overall

health is a major component the decline

in testosterone levels decade by decade

is also another component as well it's

pretty terrifying that young kids at the

age of like 12 13 14 when they open

their phones these days will be exposed

to sexually graphic images yeah whether

they CH chose to seek them out or not

yes and i' I've always wondered what

that's doing to a developing brain you

know how it's adjusting your

expectations how it's creating some of

those psychogenic factors that are

making you less aroused and um and it's

difficult right it's difficult to go out

and find a partner you have to like put

on the After Shave shave take care of

yourself you have to like Risk rejection

spend some money right be interesting

right so it seems like if from a

evolutionary perspective if I was just

trying to like get my nut off or like

yeah I don't know ejaculate I've got

this really easy way now like it's so

easy yes three clicks on a computer

We're Off to the Races versus like all

the effort and rejection and pain of of

trying to find an actual human being to

have sex with right and then when I do

do approach number one when I log on to

some website and click a couple of times

I'm getting no headache I'm getting

whatever I want I can order from a

endless list of menus and I'm sure in

the near future I'll even be able to

make my own yes and in not so distant

future I'll have I'll have it in my

house and it'll talk to me yes yeah so

it's a problem and you think about the

it's it's making it more difficult for

people to socialize right so in other

words now when patients or people engage

in sexual activity um and they're

usually having sex on the Internet or

with pornography when you actually have

actually engage in sexual activity with

another person it can be cause anxiety

right you get anxious it's not something

that you're doing regularly and so I

think that it can become an issue I amum

I saw an article this week from an only

fans Creator who posted that one one

customer of hers had given her $4

million this year oh my God and you

think about like you think about what it

would take for you to spend $4 million

on a parasocial relationship with an

only fans Creator sending you explicit

pictures

and I don't I don't quite believe we

fully understand what's around the

corner I agree these stats I think are

nothing compared to what's what's around

the corner

um and I I don't know I think about it a

lot

because when I read these stats about

erectile dysfunction being on the rise

and I I read that we're having sex less

and less um and then I see this rise in

these parasocial relationships I go

[ __ ] know I think think we're just at

the start of an exponential curve um

let's talk about obesity then yeah

because these these stats here are

pretty shocking um this one shows the

global obesity Trends which just shows

them going straight up yes which is

horrific this one shows Global diabetes

Trends which is pretty much straight up

as well yes has there been any studies

done that show the link between being

overweight and your probability of

having low

libido and some kind of sexual

dysfunction issu yes numerous and so

let's start with this so obesity it's

not surprising that diabetes is going up

because as obesity goes up it causes

insulin resistance so obesity and

diabetes typically go hand in hand the

problem with obesity is the following

obesity significantly drops testosterone

levels so fat cells contain something

called aromatase aromatase eats up the

testosterone and converts it into

estrogen so the more fat you have the

less testosterone you'll have because

you'll convert it into estrogen fat

cells also secrete something called

cortisol and leptin which shut down your

own natural testosterone production so

as it's not Sur surprising that decade

by decade as you see an increase in

obesity you see a decline in

testosterone levels in men because the

testosterone levels will come down as

people become more obese and low

testosterone equals low libido low

testosterone increases low libido the

number one driver the number one hormone

for libido in men and women is

testosterone it's a strong driver men

and women men and women and don't forget

that testosterone is also signif really

important in erectile function men need

testosterone for sexual function so do

women right it's extremely important so

now I have a hormone that's going down

that's going to make it more difficult

to get an erection I have a hormone

that's going down that's going to

decrease my libido and it's mainly due

to this obesity that's occurring one of

the biggest factors so obesity obesity

also um uh if you look at the risk

factors for Ed obesity diabetes

cardiovascular disease these are all

risk factors and so as obesity goes up

erectile dysfunction goes up and the

number one condition is diabetes

diabetics are four times more likely to

have Ed than any other population four

times so I get worried when we see this

obesity diabetes pandemic going up

because it's increasing only the

erectile dysfunction um Stephen if you

look at the Obesity the group that's

having the greatest rise in obesity is

adolescence obesity not adult obesity

the kids younger and younger ages are

having that age group has the greatest

rise of obesity so what does that turn

into the younger population are starting

at at lower tea levels and has an

implication on fertility because you

need testosterone to produce sperm

that's very

important so if I just lose a little bit

of weight that'll have a big impact on

my testosterone levels let's talk about

that it's not a little bit so the best

study was at the European male aging

study Fred woo and what he showed was

this it's a bidirectional relationship

if you lose 10% of your body weight you

can actually gain 85 nanogram per deiler

in serum testosterone if you lose 15% of

your body weight you can actually gain

250 nanogram per deciliter in serum so

it's actually significant if you can

lose but it also goes the other way you

gain weight you drop the tea

proportionally as well the only issue is

I can get the patients to lose the

weight but I can't get them to sustain

it many times they gain it back right

but if they can keep the weight off it

significantly increase uh the

testosterone levels the the best data

we've seen is in the bariatric surgery

data if I do bariatric surgery on a

patient which to help them lose weight

weight you can shrink the stomach we do

surgery to help them lose weight they

lose quite a bit of weight their tea

levels go quite up right and so again

there is a strong correlation between

weight and testosterone have you gotten

examples

of patients where you've given them

testosterone treatment in some form

you've done something to increase their

toest testosterone and you've seen a

remarkable reported difference in their

sex life all the time yeah so so first

let's backtrack there's two ways to give

a person testosterone uh if I give a

young man testosterone remember it

causes infertility so you would never

give someone testosterone if they're

planning to have children right that's

very important right so I have two ways

to raise their testosterone I can give

you medications to raise your natural

testosterone there's several there's a

pill called chopine citrate there's HCG

I can use medications to raise your own

natural testosterone and they preserve

your fertility the second option is I

can give you medications like

testosterone there's seven of them but

they will shut your natural production

down not only will they shut your

natural testosterone production down but

they will shut down your sperm

production now if you've already had

your kids you're 60 years old your

testosterone level is already low in the

first place what are you preserving okay

it makes a lot of sense and there's

seven ways to do it my favorite way are

the injectables and the oral

testosterone they are fantastic oral

testosterone is quite interesting you

know first of all testosterone was

invented in 1935 this is not a new drug

1935 and oral testosterone initially was

feared because it would actually cause

liver toxicity and liver cancer and it

wasn't until the 1970s when they were

able to make oral testosterone uno8 and

what's nice about uno8 it bypasses the

liver no cancer but it had to be taken

three to four times a day it was

available in the UK as a drug called

andreal all over the world but not the

US the US we did not get our first oral

testosterone till 2019 and then 2022 we

received two more and now we have tando

jatenzo and Kaiser Trex is our oral

they're taking twice a day with a meal

what's nice about Kaiser TRX it's

actually available in the UK so in the

UK now they can actually get Kaiser TRX

as well but oral testosterone most

patients don't mind taking a pill uh it

seems very easy to do so should someone

like me be taking testosterone if your

levels are low yeah and you're

symptomatic and I think that's very

important if a man comes in with low

levels of testosterone and says I feel

great I have no symptoms I said I'm not

giving it to you these are the symptoms

low energy yeah low libido erectile

dysfunction decreased muscle mass

increased fat deposition poor sleep and

depression these are some of the common

symptoms you'll see most sensitive

symptoms are the sexual symptoms

erectile dysfunction and low libido so

if he says I have these symptoms and my

levels are low and I recheck it and

confirm that it's low that man is a

candidate for testosterone therapy

but if he's young hasn't had has have

children yet I'm going to say look let's

hold off on giving you testosterone and

use medications to make you make

testosterone and if you don't want to

take medications actually there are many

things you can do on lifestyle

modification to raise your testosterone

we talked about weight loss as well so

let's live in this area here you are too

young to take testosterone now but

conversely let's say a patient comes in

and has every single sign and symptom of

low testosterone but his testosterone

levels are normal I'm not giving him

testosterone because it could be

something else maybe he's depressed

maybe he has a low thyroid something

else is going on so you must have signs

and symptoms and a low tea level to be a

candidate and if you fit that then you

may benefit what about women so this is

important in 1935 when testosterone was

invented uh it wasn't many years later

till they actually started using

testosterone in women and early reports

of testosterone women were actually

quite remarkable the earlier manuscripts

describe improve uh quality of life

improve libido and if you and I walked

into the drugstore today and said give

me the testosterone for women it does

not exist there's not a single FDA proof

testost for women in the United States

um but we have well over a dozen for men

can you explain this to me just because

I want to make sure I'm clear why would

a woman take testosterone because when I

think of T testosterone I think of men

yes so women make more testosterone than

any other hormone in their body make

more testosterone than any other hormone

in their body right and when women have

higher levels of testosterone they tend

to see a greater Improvement in libido

muscle mass bone mineral density uh

sense of well-being uh some of reported

improvements in cognition as the

testosterone level goes down we start

seeing these symptoms particularly low

libido if you give a woman back her

testosterone she will many of these

women see a significant Improvement in

their libido but the issue is that we

don't have an FDA approved product for

testosterone in the United States I

think in the UK you call it off license

we call it off label now in the UK they

did have one they had a wonderful patch

called intrinsa and then the women in

the UK could get the patch for

testosterone go into the drugstore NHS

covered it and it was fine uh then they

had andram and andram was actually

approved and now no longer is approved

so now in the UK you also don't have an

onli medication the uh you can still get

andram from Australia but unfortunately

uh it's very difficult to get so do we

do we use the drugs for men and we give

it to the women in on10th the dose

that's all we do so if we have a packet

that's a man puts on a day we say use

one tenth of the packet every day for

the women and they can see significant

improvements it is not illegal to give a

woman testosterone it's just considered

off label or off license but they they

see significant improvements in what

sexual function by far the most libido

goes up no question I many women report

that muscle mass if you think of

testosterone bodybuilders take

testosterone for a reason why it

significantly improves muscle mass it

can decrease fat deposition many

patients will import improvements in

cognition it can help with bone mineral

density as well in men and women and I

also believe in depression so I think

testosterone does help with depression I

just want to just make a very important

Point testosterone is not just about sex

there are five other things that you

need to think about uh in men and women

and I want to talk about those men with

low testosterone l levels are much more

likely to have a heart attack

non-negotiable men with low testosterone

levels are much more likely to have

diabetes obesity men with low

testosterone levels are much more likely

to suffer from depression men with low

testosterone levels are much more likely

to have a bone fracture so it's not just

about sex it's about their overall

health and if you were to check one

blood test to assess a man's overall

health it's his testosterone level one

blood test to check his overall health

it will be because I have it affects

heart diabetes obesity um bone mental

density energy muscle mass erections

libido one blood test I can't think of

another blood test that is a better

barometer of overall health I want to

get clear on something because I've

heard people talking on my podcast

before about HRT yeah and women taking

HRT because of menopause and things like

that should they be does HRT have

testosterone in it no so typically when

we say HRT we're talking about estrogen

and progesterone typically yeah and

typically when we talk about trt

testosterone placement it's a little bit

different in a woman there's something I

call the triangle and it's just

basically estrogen progesterone and

testosterone just simple and if you have

a woman who's deplete in estrogen

testosterone and pro estrogen

progesterone testosterone and replace it

many of those women feel better right so

many of them do there are other hormones

that are also important I call it the

outside Circle cortisol thyroid growth

hormone we look at those as well and so

I think those are also very important

and I tell them we're going to going to

optimize your uh hormones but what

you're going we're going to optimize

your medical condition but that is only

50% of the story the other 50% again is

Diet exercise sleep and stress reduction

and if you do your part and I do my part

we're on fire we're absolutely on fire

but you have to do your part same with

men I put you on the testosterone I

optimize your medical conditions and but

you got to exercise you got to eat right

why aren't women being prescribed

testosterone then right because it's

considered well in many countries it's

on in Australia it's available in the UK

it was available and many women are

being prescribed testosterone it's just

off label it is the first time that I've

seen

someone on my show anyway really

emphasized the point that testosterone

isn't Just For Men it's for women as

well um and it can significantly improve

their quality of life talking about

testosterone one of the big

conversations that's rattling on on the

Internet is about this decline in male

test testosterone over the last couple

of years what exactly is that decline if

you had to sort of quantify it if you

look at the original studies we call it

the Framingham heart study back in the

70s testosterone levels were roughly

around the 700s average men between the

ages of 18 and 40 were around the 700s

and every decade we're starting to see a

decline almost by 50 nanogram per

deciliter and so the latest in the 2015

numbers are roughly in the mid 400 so

we've seen almost a 300 nanogram per

deiler decline in serum testosterone

which is significant because has two

implications uh it's not just about uh

the way you feel and um energy muscle

mass erectile function but that low

testosterone can have implications on

fertility that's really important so we

didn't talk about that but fertility

Testo sperm need testosterone low

testosterone decreases your sperm count

sperm counts have also been on the

decline as well so you know I think it's

really a testament to the fact that

decade by decade we're becoming a more

unhealthy population do you think that's

really the heart of it is that is the

sort of our diets and the way we live

and becoming more sedentary less

exercise more um processed food Etc do

you think that's the hard of I think

that's the key that's absolutely the key

the types of foods we eat the processed

foods that we eat high fructose High

carbohydrate diets um in and if you and

and the way we know that is just look at

the Obesity look at the look at the

diabetes there has to be a reason why

it's on the rise right and on that point

of fertility I'm in a season of life

where I'm going to be trying to have

kids pretty soon what's the most

important things I should be thinking

about from a lifestyle perspective in

your view yeah so I I tell patients

Darwinism in other words survival of the

fittest healthier people are more

fertile right you're passing on the

genes so uh so so essentially uh we tell

patients the number well the number one

cause of infertility in in the world for

men is a verical a verical is the

swelling of the veins around the

testicle you know how women sometimes

can get swelling of the veins in their

legs you see those veins that are kind

of obvious well men can get those veins

dilated around the testicle and those

varicoses can impair sperm production

now 15% of men in the world walk around

with varicus seals but up to 40% of men

with infertility will have verical so

it's really important to assess for the

varic casales but lifestyle modification

each one again diet exercise sleep have

been shown to help improve fertility in

men as well so I say healthier people

are more fertile I need you to start

getting healthier that's very important

we raise the testosterone level in many

of these men naturally we don't give it

to them to help improve their fertility

as well but check Stephen check your SE

analysis that's the simplest thing you

can do check it right I did yeah it's a

great predictor it's not just you know

there was so many amazing studies

showing that a semen analysis is a

phenomenal predictor of overall health

many studies showing that if your semen

analysis today is impaired it's a

predictor of you having comorbid

conditions today like diabetes obesity

metabolic syndrome it's also predictor

of prostate I mean Cancer so we know

that if you have infertility you're at a

higher risk of having testicular cancer

than those that don't have infertility

it's also a predictor of who will have

problems in the future Mike Eisenberg

once showed a very nice study men who

have low sperm counts uh can have a 30%

increased risk in diabetes 50% increased

risk in hemic heart disease in the

future uh Tom wall showed those men

could have 2.5 times higher risk of

high-grade prostate cancer in the future

so again to me it's just a marker of

overall health check the Sean analysis I

did that and it was quite I was actually

to be honest I was really quite nervous

about it because as someone who's you in

my early 30s and wants to have kids I

was really scared that it would come

back and say that like my sperm is um

dysfunctional and I've got a huge amount

of empathy and

um you know feelings for people that do

those analysis and get bad results back

15% of all couples in the world 15%

suffer from infertility that's a lot and

if you think about it um 30% of the time

it's a male Factor 30% 20% the time it's

a male and a female Factor combined so

indirectly a male is involved 50% of the

time when you have infer an infertile

couple and it can be devastating for

that couple I mean psychologically

devastating and what's also interesting

is that um most couples most couples 50%

of couples don't seek therapy and of

those couples that do seek therapy this

is globally only 25% of those couples uh

actually go forward uh and and and and

so I call this a group of individuals

that also suffer in silence they should

know that there are excellent treatment

options

available this um this graph that I had

printed out is just shocking to me it's

going back to the point about

testosterone but the the really shocking

thing is how quickly this has happened

yeah because this is the year 2000 and

this is the year 20156 year and the

decline there is from roughly

600 nanograms is it yes nanogram per

deciliter nanog per deciliter to roughly

for some age group groups here 400 yes m

per deciliter and that's only in 16

years yes so if you play that forward

another 16 years there's going to be a

bit of an infertility crisis there is

fortunately on that graph it's

plateauing a little bit which makes me

feel a little comfortable okay oh yeah

it is actually fling just a little bit

um but you're right it could be a

significant crisis um and again as I

mentioned it's the adolescence the

younger folks who are having the

greatest rise of obesity and that's

where fertility comes in because

fertility obesity in someone in 60s is

not concerned about fertility but a

young patient who has infertility

obesity will have a higher risk of

infertility if you're an entrepreneur

you're probably going to want to listen

to this it's a message from one of our

sponsors on this podcast which is

LinkedIn if you've listened to me on

this podcast for a while now you'll know

that I've been on a bit of an evolution

as a business owner and entrepreneur and

one of those Evolutions that has become

clearer and clearer as I've matured is

that the single most important thing in

building a business in building a

company is hiring the definition of the

word company is actually group of people

and that is the first responsibility and

job that any entrepreneur has and should

focus on but surprisingly most don't

about 80% of my team have been hired

from LinkedIn and I think there's very

few platforms if any in the world that

could give you that diversity of

candidate with that much information and

data on their profiles it usually cost

money but for the entrepreneurs that are

listening to me I've got you a free job

ad post for your company on LinkedIn

just go to LinkedIn .c doac to post your

free job ad today that's linkedin.com

doac terms and conditions apply if me

and my partner came to you and we said

listen we've got sexual problems in the

bedroom um what are the steps that you

would the things you'd look at that we

haven't focused on so much today is

there anything particular you'd say okay

and I I'm trying to stay away from being

prescribed a pill so I want to do

anything natural I can before I get to

that and then we'll talk about some of

the other more drastic measures one can

take natural things because everyone

wants to know about what's the natural

things I can do so when we talk about

diet there's certain diets that have

been helpful to improve sexual function

for me it's the Mediterranean diet the

Mediterranean diet is rich in whole

grains legumes um fruits vegetables and

if you look at red meat and sweets It's

once a month if you look at poultry it's

maybe once a week but mainly fish those

diets have typically been

anti-inflammatory diets many Studies

have shown that that diet can

significantly improve erectile function

and one study the medita trial actually

showed that it improves sexual function

in men and women so I'm a big believer

in using the Mediterranean diet when

Esposito did her first trial it was a

prospective trial 110 be obese men 55

men get the Mediterranean diet 55 men uh

don't get any intervention at all she

falls in prospectively for two years

what does she find not only a

significant Improvement in endothelial

function remember that lining of the

blood vessel but a significant

Improvement in erectile function in

these men no Viagra no pills nothing

simp simply changing the diet improved

the erectile function the same with

sexual function in women so that's an

important one the second is sleep let's

talk about sleep so studies show that if

you're getting less than six hours of

sleep a night it significant increases

your risk for sexual dysfunction in men

and women right your ideal amount of

sleep should be 7 to8 hours now let's

say you say well that makes sense maybe

I'm going to get sleep sleep for 9 to 10

hours because the more sleep I get the

better my sexual function but that's not

true it plateaus so if above 9 hours it

does not increase your ability or sexual

function so 7 to eight hours of sleep at

night I need you to get third is I

really need you to focus on um uh

exercise so I published a very nice

study looking at uh it was a metanalysis

on how much exercise one needs and what

type of exercise to actually improve

erectile function in this study

typically you need 160 minutes a week so

40 minutes four times a week for a

course of six months of moderate or to

severe exercise vigorous exercise and so

most people can get 160 minutes in a

week of exercise but that's getting your

heart rate up and doing the exercise

significantly improved erectile function

in men if you did that and the more

severe your Ed was the greater

Improvement you saw in erectile function

strictly by exercise alone no other

intervention St just exercise so here

you have a patient that now starts doing

some exercise starts sleeping better

starts changing the diet it's all

additive you are now sick significantly

improving erectile function just by

lifestyle modification

alone pretty profound that exercise can

have such a big impact isn't it is that

the same for women it is true because

many of the things so unfortunately once

again the research we have in women is

not close to what we have in men but the

med trial was also in women the sleep

studies were also in women um and so

these studies also show that sexual

function can be improved with um uh

sleep and with diet um I think that men

and women are not that different I mean

if you see a significant Improvement in

a male sexual function uh with diet

exercise sleep um you can also see it in

women as well actually there was a great

study this looked at 110 women and they

had coronary artery stenosis they did

angiograms on 110 women and they showed

that the greater her stenosis she had

the worse her sexual function so the

greater the blockage in her heart the

worse her sexual function they put those

women on a cardiac rehab program to

actually improve their cardiac function

so a diet and ex exercise program and

those women that actually put through

the were through the program fourfold

increase almost in their sexual function

well 400% fourfold that's right because

we use a questionnaire called the fsfi

which is a questionnaire so significant

Improvement in sexual function just on

improving cardiac function so remember

cardiac function and sexual function are

related and it's bidirectional you

improve one you improve the other it's

very important we didn't we talked about

this earlier 40% of men in the in the

world at 40 will suffer U from erectile

dysfunction 40% 40% Jes 50% at 50 60% at

60 70 at 70 80 80 you do the math it

essentially is a very prevalent

condition this condition is associated

with increased cardiovascular vents it's

a first sign of a heart attack we talked

about that this condition is associated

with two and a half times more likely to

be anxious three and a half times more

likely to suffer from depression and

this condition is also associated with

diabetes in other words men with Ed two

times more likely to have undiagnosed

diabetes and yet only 50% of men even

talk about it because they're so

embarrassed so you show me another

condition in the world that affects more

men's lives that's associated more

adverse conditions and they're too

embarrassed to speak about it they

suffer in silence there's not another

condition there's not another condition

but yet we're embarrassed to discuss it

I used to give these lectures and I

would look out to the audience I'd say

please raise your hand if you suffer

from

hypertension and many people raise their

hand and they have high blood pressure

they say okay please raise your hand if

you suffer from sexual dysfunction no

hands go up but statistically you know

that over 50% of those people had sexual

dysfunction so why is it okay to raise

your hand if you have hypertension but

not okay to raise your hand if you have

sexual dysfunction it's got to stop we

have to destigmatize it's okay to have

sexual dysfunction it's a common

Condition it's curable why don't men

raise their hands from a psychological

standpoint why is that I think they're

embarrassed I think that I think that

we're historically sexual dysfunction

looks as a like a weakness I'm not a man

less of a man you know you have

hypertension it doesn't mean you're less

of a man right but they have this

assumption that it's a weakness a less

of a man and I and I think that it's

okay you have to be comfortable saying

that you have sexual dysfunction there

are amazing treatment options for sexual

dysfunction amazing that work very very

well you just have to raise your hand

and let me know that you have it I just

want to make one other comment about

diabetes there was a study that came out

of St Louis looking at young men 18 to

40 years old and they were screening

them for erectile dysfunction and what

they found was when those men came in

for erectile dysfunction 30% of those

men had pre-diabetes or diabetes on that

day on the day they were being diagnosed

30% and I thought to myself young men do

not go get screened I remember when I

was 30 years old I didn't go in for my

annual blood pressure check and my anual

sugar check there's no way I'd get my

glucose checked but if I young man gets

erectile dysfunction he is at my front

door first thing tomorrow morning they

show up that's the first thing they're

going to do because it's a very big

condition to them and they want to get

treated and that is the opportunity to

treat these young men and treat the

condition if you see a young man or

someone who comes in for Ed and you

screen them for uh diabetes and I catch

the diabetes at 30 as opposed to 40 that

is 10 years of damage on the vessels

that you're saving because you catch the

disease early early so Ed is the gateway

to Men's Health and to treating men

early before it's too late so I really

use Sexual Health as a tool a vehicle to

improve overall health because men take

Sexual Health much more seriously

particularly young men have you ever had

sexual dysfunction I have not never in

your life I have not I have I have

not it doesn't mean that it's not but

it's okay if I did it's not it's there's

nothing wrong with it right there's

nothing it's normal it's okay and it's

it can be temporary and come back right

it's it's nothing wrong with having

sexual dysfunction we must destigmatize

it it's completely Okay the reason I'm

sharing this is because if anyone else

has been in the situations the

situations I've been in are um generally

my sex life has been been good my whole

life but there's been certain times with

certain Partners or you know you might

be drunk a little bit or in the day when

I was single there was like the oldd

person who for some reason it just

wasn't working for me

and or there was other instances in a

previous relationship where near the end

of the relationship I'd like lose my

erection during sex and that became a

little bit bothersome for me because I

was like oh my God like it almost made

me not want to have sleep with this

person or it convinced me that maybe I

don't like them anymore or something

else was going on and for me it has

always been what's the word used

psychogenic yes it's always been in my

head that the problems have arose and

the other part of thing that I've

experienced a lot is in terms of libido

I have like no libido

when actually slight

different when I'm when work is very

very busy and I'm very very tired and I

come home very very

late it's not that I'm not horny but I

just the act of sex is just really

unappealing but you're just like

everyone else you're not unique when it

comes to that yeah but that much of my

life is like that like I come home late

a lot and

so I'm I'm I'm like tired and stressed

quite a lot right but what if I took you

and your partner and put you on a

beautiful island in Hawaii for two week

we have great sex okay yeah so that's

what we kind of like how we've

orientated our life honestly okay that's

genuinely how we've orientated our life

because I just don't think the way I

obviously want to make lifestyle changes

to make sure that I'm not always coming

home tired and stressed at 11: p.m. but

one of the things that's really helped

us is you know going away on the

weekends right and going away maybe on

Friday and coming back on Monday and

getting out of the same context so like

getting out of the house going to a even

like going to a hotel room it's actually

a bit of a game changer that you can

just like go to a hotel room in the same

city like a Booker station yes and that

seems to have a big impact because it

just removes you from the context right

and then like yeah going away for the

weekends holidays and stuff a lot of my

friends say to me they go when they're

struggling with their sex life they just

like book A book a local a local sort of

station yeah and I wonder why also I

don't have kids so I've not experienced

the impact that kids can have have a

significant impact really right because

it increases your stress

right particularly for your many times

for the partner as well so if you both

are stressed because of the children sex

goes lower and lower on the totem slept

as well right if you're not sleeping if

you to wake up and like oh gosh isn't

there stats that say like when someone

has a kid their sex life like vanishes

for 18 months or something I don't know

I'm not familiar with that St but I

believe it I believe it I believe it I

read something about post having a kid

liido but also like sexual function it

makes sense I see it in in couples and

particularly you know many times um it's

take years for them to start engaging

sexual because the stress is so high

particularly when they originally have

the child there was a British study done

that found over 80% of women experienced

sexual problems 3 months postpartum with

nearly two3 still affected at 6 months

yes which is which is a lot of it's a

lot of women a lot of women and that's

significant amount of time so what about

premature ejaculation let's talk about

it very important 30 so sexual

disfunction we've been talking about Ed

today right but there's many different

types of sexual dysfunction there's

premature ejaculation there's Peron

disease there's delayed ejaculation

we're just focusing on one aspect

premature ejaculation affects 30% of men

globally 30% of men how do you define

that there's two ways to think about it

when they come in you have to figure out

is this lifelong going their whole life

or is this acquired it's very important

because it takes me down two different

roads if you say look I've never had

premature ejaculation and yesterday it

started that's very different than if

you come to me and say my whole life I

had premature ejaculation and we now

Define premature ejaculation as having

an ejaculation less than 2 minutes used

to be 1 minute less than 2 minutes you

have to have a loss of control like I

couldn't control it and you have to be

bothered by it so if you tell me Stephen

look I ejaculate in 30 seconds and I'm

happy I say great then we're done you

know you are content you have to be

bothered by the condition the EAC

average ejaculatory time in the United

States is 5.4 minutes on average right

the average time for a woman to achieve

orgasm is typically 13.4 minutes so

there's a big discrepancy here as you

can see right so 30% of men suffer uh

but we know that only a small percentage

of these men 9% of these men will ever

seek therapy and it can be a significant

problem in a relationship um uh and that

needs to be addressed okay so there's

not like a time limit it's not like okay

if you're coming within two minutes then

you got a problem well let's say you're

not bothered by it let's say you and

your partner are completely satisfied

with it what's the problem okay what's

the problem and and sometimes let if you

think about acquired uh means that

typically we Define it as 50% less than

your normal time so if you say look I

typically used to ejaculate in 8 minutes

and now it's 4 minutes and it's

bothering me I'd say okay that that's an

issue um you know so we talk it's

relative what what's comfortable for you

and some men will say you know so I

think it's very important to look at the

definition the treatment options are

actually quite simple one of the best

treatment options is sex therapy because

we can train your mind we can train you

to delay that ejaculation there's

techniques the start stop technique The

Squeeze technique how we can delay it no

but there is but most men say just give

me a pill I don't I don't have the time

for this just give me a pill but there

are ways to do it with Sex Therapy which

I think are fantastic sex therapy is a

cure the pill is just a Band-Aid right

Sex Therapy is a cure but the pills that

we use the most common Ed pills are

anti-depressants because they increase

serotonin and make it harder to

ejaculate well that's what we want in

this situation we want to delay the

ejaculation so we can use

anti-depressants they sometimes have be

taken daily which work better or you may

have to take it on demand but if you

take it on demand 6 to8 hours ahead of

time so you need some notice but there's

going to be significant side effects of

taking anti-depressants there are side

effects of anti-depressants so I try to

stay away from them and the other ones I

try to use are topical Liane sprays

because if I decrease the sensitivity of

the penis you're more likely to be able

to engage in sexual activity for a

longer period of time so those are

commonly used so sex therapy and sprays

are very easy to use you don't need a

prescription for sprays uh and they're

common

use one thing that we have to talk about

that's really important is the Traverse

trial it's really big everyone

historically has always said that

testosterone is dangerous it causes

prostate cancer and it causes a heart