Sex Scientist: Phone Addiction Is Killing Your Sex Life More Than Porn!

23:36Now it's not going to be like you do it once and you get this sustained improvement, but continuous sort of regular resistance exercise improves testosterone. There's also data that shows that when men do resistance exercise to maintain muscle mass. So we know that muscle mass decreases about 7 % every decade of life after around 40. When you maintain it through resistance exercise, they're three times less likely to have erectile dysfunction. Oh, really? Yeah, so they maintain erectile function, they maintain sexual desire, they maintain satisfaction with sex. I read a quote yesterday that said muscle is medicine.

24:11And I thought, hmm, that's really true. based on everything I've learned on this podcast around, you know, like glucose control and, and testosterone. And now you're telling me about your sex life. Yeah, it is. I think people push back because they think like, why should I 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. We're not moving. We're not doing manual labor, which is what a lot of our historic history is, right? Doing manual labor, farming, doing things outside, being physical. And we're meant to be physical. We're meant to lift heavy things.

24:46We're meant to move our bodies and we're just doing less and less of it. So I think it's so important. The other thing is we want to prevent sarcopenia. So sarcopenia is muscle loss. And when you have muscle loss, that also increases your risk of having sexual dysfunction. What about the pelvic floor? Like how does that come into this story of the cousins. Oh yeah, so we missed that part. So the pelvic floor, here's your pelvis, right? It's this bony structure where all your organs live. This is a female. So I'm taking out the internal structures, which is the uterus, the rectum, and the bladder.

25:19And so that's what sits inside the pelvis. And so you can see this bowl of muscles here, right? And you can see them from the inside and you could see them from the outside. That's your anus. And in this person, And there's a vagina, so that's the hole for the vagina. So you can see that your anus and your vagina run through the pelvic floor. And in men, your penis 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 they kind of show you the muscles here on the side. Yeah. So these are your pelvic floor muscles that are around the penis and the anus.

25:52Okay. Okay. These structures are very important for a variety of things. They attach to your bony landmarks here. your hips, your sacrum, your pubic symphysis, they attach to all these. And they sort of just work in the background for most people. How they affect your sexual function is when you orgasm, these muscles contract and release at a rhythmic contraction of 0.8 seconds. And so you may feel that, right? There's like this pulsing feeling when you orgasm and that's these muscles sort of doing that. And when men ejaculate, the pelvic floor muscles are contracting to help shoot the ejaculate out.

26:30They squeeze when you need to keep things in. So they'll keep urine in, they'll keep your stool in, and they relax when you need to pee and when you need to defecate. So when you try to hold a wee, you're like tightening your pelvic floor muscles? Correct. But these are also responsive to stress. So just like people get TMJ, where they get tense in their jaw because they are stressed and they like sleep at night and they clench up their jaw, they don't really know they're doing it. The same thing can happen. These muscles can get very tight or they can get misaligned. So say you have a hip injury or say you have a back injury, the muscles can compensate by tightening up.

27:04And so a lot of people unknowingly have tension in these muscles and it can present in multiple different ways. It can present with back pain. It can present with constipation. It can present with urgency frequency because remember your bladder is sitting right here on top of these muscles. So when the muscles are tense, your bladder is feeling like there's something activating it. And so it's like, oh man, I got to pee. That means I have to pee. This tension is telling my bladder I have to pee. But it's really that your bladder is not that full. It's that these muscles are telling you to do that.

27:37You can also have trouble peeing because you can see that your urethra goes through here. And if the muscles are really tight, sometimes it can be difficult to urinate because it clenches off the pee. And then with sex, it can cause pain. If they're really tight, it can prevent blood from getting to the genital organs. So for men, they can have erectile dysfunction. For women, they can have difficulty getting orgasms or difficulty getting arousal because they're not getting blood flow to the clitoris. Sometimes it can also cause premature ejaculation in men. And so these muscles are so important.

28:08And all we hear about is Kegels. And Kegels are exercises to strengthen these muscles. But Kegels are good when you have a normal pelvic floor, meaning like there's no tension. It's completely normal. It's acting normal. You're not having any symptoms at all. But if you have any of the symptoms I talked about, doing Ketols might make it worse because you're now tightening muscles that are already tight. We also talk about pelvic floor relaxation, doing exercises to specifically relax these muscles. So that can be diaphragmatic breathing. That can be doing like a figure four stretch. That can be doing happy baby pose, which are yoga poses or child's pose, all these things can sort of stretch and lengthen these muscles so they can learn to relax again.

28:50Now, when it's really bad, you have to go see a pelvic floor physical therapist who can really work with you to identify which of the muscles are maybe more dysfunctional and maybe work specifically on those. But I think it's so important. It's under-evaluated, under-discussed when it comes to sexual function. It's a hugely important part of sexual function. How many people are struggling with these issues, specifically like erectile dysfunction issues? And what age are they? Yeah, so it starts early. I think 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 all in their head.

29:26That's not necessarily true. Many young men do develop erectile dysfunction because of biologic factors, but the data is really robust on older guys. So above the age of 50, we see 52 % of men having erectile dysfunction, which is half. 52 % of men. And it goes up 10 % every decade. So 60 % of 60-year-olds, 70 % of 70-year-olds. So erectile dysfunction continues to worsen. This happens because, one, our blood vessels get older, they get stiffer, they're not functioning as well as they should. And we're seeing also a rise in all these other comorbid conditions like diabetes, cholesterol, high blood pressure, All these affect how healthy your blood vessels are.

30:07And so with these, they see the problem in their penis or in women's case in their clitoris before they see heart disease or strokes or brain issues or dementia. I think this is worth pausing on, which is a erectile dysfunction problem is often a symptom of a cardiovascular issue, right? Yeah, we call it a canary in a coal mine. So it is like telling you that something bad is coming. So the data would support that when you have erectile dysfunction, if it's because of an organic reason, right, not psychogenic, but most people I think have a combination of both, that within three to five years, you will start developing issues with your heart.

30:46And so it precedes those issues. And if seven years later, 14 % of those guys will have a heart attack. And so it's really an opportunity. Sexual problems are an opportunity to look inside, to figure out what's going on and to investigate and to change your life. And when you say erectile dysfunction, we should probably define what that means because there's going to be a lot of guys that are at home now thinking, oh my God, like my penis is a bit softer than usual. Yeah. So erectile dysfunction is defined as the inability to maintain an erection that's sufficient for intercourse. So you can get an erection, but it goes away before you ejaculate or climax.

31:25and so that's typically i think it's really important to differentiate that from something like premature ejaculation where you climax too soon so you ejaculate before you want to but that doesn't mean that you have a problem maintaining your erection that's a whole different process i've got a friend people are going to think i'm talking about myself because i use that phrase a lot i've got a friend he's um he's almost 40 years old and i've heard him say on several occasions that he's lost his erection during sex. Is that erectile dysfunction? But what if he can keep his erection watching porn?

31:59Well, so that's more multifactorial, right? So I think if you lose it once or twice, right, most guys will have an issue where they lose an erection at some point in their life. I think the important thing is not to catastrophize. It's a problem when it becomes a routine. Now, if someone is telling me, hey, I can watch porn and maintain my erection, but I can't with a partner, there's multiple different reasons for that that could be at play. One is that there's no pressure, right? You're by yourself, you're watching porn, there's no pressure of performance, there's no anxiety of performance, so that may be part of it.

32:29Other thing may be that that level of arousal that you're getting from porn, if you're watching, like, let's say the same kind of porn every time, you're masturbating the same way every time, maybe using a firm grip, or some people will masturbate, like, facing the bed or, you know, against hard objects. And so that - Against hard objects. Yeah, like their fist or something. And so that can't be replicated by a person, right? You can't replicate those behaviors by a vagina or a mouth. If you become habituated to a certain thing that turns you on, and that's the only thing that really gets you going, and that's something that you can't really get with your partner, then it will be difficult to reach the level of arousal that you need to get an erection.

33:14Okay, so two questions then. So that doesn't count as erectile dysfunction if you can get an erection watching porn but can't get it with your partner. Yeah, it may or may not be. So if you wake up with your morning erection, that's great. That's a sign. That's when there's nothing else at play, right? You are just, that tells me that your body's functioning well. You've got good blood flow, good hormones working, got a good amount of testosterone, and your nerves are working well, and you're getting a good morning erection. Now, morning erections or nighttime erections are normal and they're healthy.

33:43So when you're a young boy, you get actually like erections three to five 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 get older, like in your 40s, that drops to about half the time. So maybe erections are a little shorter. They maybe max out at 30 minutes, but sometimes they're shorter. You should still be getting three to five erections a night. You won't know all of these, but typically you wake up with a morning erection. And so if you're not getting morning erections, that tells me that, hey, there's something going on that we should address.

34:13And on your other point about how you masturbate impacting your sex life, I imagine that applies to men and women. Absolutely. And are you saying that if there's a particular way you get yourself off in private, that is very hard for the other person to replicate. You might become desensitized to that. You might just get habituated. I don't I think desensitized, but habituated is like you might just, your body just might respond really well to that particular stimulation. Now that's not inherently a bad thing, right? If that's what gets you off and you and your partner are okay with you doing that together, right?

34:46You may mutually masturbate together and that's fun for you and you guys enjoy it. There's no problem with it. It's just knowing what's going on, right? And sort of deciding like, okay, if this is a problem, let me try to diversify what I do during my solo sex period. So let me take a little break and kind of try something, you know, just not masturbate for a little while and come back to it later. The fact that we get an erection in the morning, does that mean that we're supposed to have sex in the morning from like an evolutionary perspective? Not necessarily. It's just, it's the way your body releases testosterone is one of the reasons this happens is overnight your body is making more testosterone.

35:21That's when your body sort of has nocturnal testosterone production. And so it's highest in the morning, which is why very often you get a morning erection. And, you know, it just means that some people will have more desire also in the morning because testosterone is a hormone of desire. Is it the same for women? Yeah. So women also have nocturnal clitoral tumescence, same sort of pattern, and they won't necessarily know it, right, because they can't visualize it. But, you know, some women may sort of feel that pelvic congestion or like feeling like there's a bunch of like blood flow in the area, but most will not.

35:57And that's okay. But your body protects itself. So you've heard the term use it or lose it, right? People are like, your body's protecting itself. You don't have to have sex. If your body is healthy, it will do this all night to keep your genitals healthy. It will make sure that your genitals are getting blood flow, even if you're not having sex. But if you stop having those nighttime erections, now it becomes more of a problem because over time, say you stop having erections or cloral tumescence for months, years, right and then there's no blood flow to those areas over time and actually i can show you here this is a pelvic model and here this this purple thing here is called the corpora cavernosa and this is like a really nice spongy tissue that fills with blood and when it fills with blood it expands and lengthens and then the blood stays there until you're done with your stimulation and then it goes back.

36:51And so if there's no healthy, fresh blood getting to the penis on a regular basis, either through nighttime erections or through sex with your partner, then you will get fibrosis of these tissues. That means there's a little scar in the tissues. And then over time, you might see some shrinkage of the penis. And so it is really important to maintain also good health of these tissues. And the same goes for women with their clitoris, because it's the same type of tissue in fact if you look at the clitoris it is this is the part that you see we don't we don't have a clitoris do we is it that one no this is the uterus

37:31you're gonna keep that in okay i can show you here is it crazy okay yeah this is good this is good okay They told me they would say clitoris.

37:45That's a little, that's a, yeah. Okay.

37:52You're not going to live that one down. You asked the team where the clitoris was. Did you ask the team where the clitoris was? Well, I'm worried about who said that too. Okay. So let's talk about the female anatomy. This is a pelvic model. And here 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 labia majora, but they would be out here, right? So inner lips, outer lips. Now, this up here is your clitoral glands. So it's the same as the glands of the penis. And so this is all you see, right? It also has a little covering, which you can't see here.

38:28Just like men have foreskin, women have a clitoral hood that covers the head of the clitoris. And so when you look at the clitoris on the inside, which we can't see perfectly here, but I'm going to just take this off. It actually goes all the way back like this. So if you were to feel from the vagina, from the vaginal side, it would be at the very top of the vagina going all the way back. These are the, these blue things are the clitoral bulbs here. And these are the legs of the clitoris here on the side. And so this is essentially the homologue of the penis. So if I take the penis, we don't have like a full model here.

39:07What does homologs mean? So homologs means that they're essentially the same structure. They're made from the same cells, but they're in the male and the female. So here you can 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 here it goes deep into the pelvis. And so here's your testicles, right? And so below the testicles, this area of the perineum, you also have penile tissue sort of that you can palpate from this side that's coming all the way down. And if you had sort of a 3D model, you'd see that it forks out just like the clitoris does.

39:42So does clitoral stimulation feel like stimulating someone's tip of their penis? Exactly. And so you could think if someone just stimulated the head of the penis, it would be fine. It would be nice. But it's probably better if you stimulate more of the clitoris or more of the penis. That's why you could stimulate, obviously, the external, the clitoris. But you can also stimulate from the inside. And some people are more responsive to that than others. What you hear of is like the G spot or the G zone, right? And the G spot or G zone 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 would be about two centimeters in at the top.

40:22And that's because that's an area where there's a lot of nerves endings. One, you can palpate the clitoris basically throughout the entire anterior wall, but also there's the skeins glands without these glands that sit underneath the urethra and they're the homologue of the male prostate. And so they're right there. And then the vagina is there. And so that's an area that can be very enjoyable to stimulate. It's not necessarily always going to lead to orgasm because some Some people have different sort of distance between the clitoral body and the vagina. So some people who have less distance may feel it better than some that don't.

40:57But ultimately, that's why that area is so sensitive for many women. On this point of morning erections, I was thinking, much of the reason why I've always been cautious of having sex in the morning, or even like masturbating in the morning or anything like that, is I'm worried that it will cause a dopamine crash, which will make me feel lazy and lethargic. Well, so when you think about what happens during an orgasm is you have this release of dopamine and then your prolactin goes up and sort of like everything calms down. Now, some people feel a sense of clarity. They call it post-not clarity, right?

41:31They feel clear. They feel like motivated to do stuff. They feel excited to go do something else and they sort of move on from what they're doing. There's some people who feel post-coital dysphoria. They actually feel sad or they feel depressed after the orgasm. and we don't know exactly why this happens but it is because of this dramatic change in sort of neurochemical signaling in the brain and for those people who have it it can be days where they sort of like feel bad it can be hours where they feel sad and so it can be really traumatic so pillar two what's pillar two of the four pillars of men's sexual health we talked about strength okay so we did strength yeah we did fuel what's pillar three pillar three is environment so we can start with the easy stuff and that's stress, right?

42:13Everyone knows stress is bad. But I think the thing is people just think like, I'll just, I'll deal with it. Everyone's stressed. Like what's, it's normal to be stressed. If you are chronically stressed, that means your cortisol is raised all the time, which is dampening your testosterone, which is also keeping you in the sympathetic state. And you just cannot get in your mind space and in the nervous system place to actually have sex. So that's super important. And I think, you know, there's lots of different ways to alleviate stress. You've got to figure out what works for you. For some people using a stress ball, even just at work.

42:49And I think part of it, you can actually incorporate some intimacy. There's some evidence, you know, the Gottmans have been on your podcast doing a 20 second hug. So standing with your partner or loved one and hugging for 20 seconds on your own, like independent gravity actually helps alleviate stress and break sort of a stress loop doing a six second kiss with your partner and so it seems like six seconds no big deal but actually if you time it's like if i'm just doing a kiss and i'm not like actually it's a little bit longer than normal and so these sort of small things can help alleviate stress any type of movement can be really beneficial the gym is great as well the other thing is just having like interactions with people.

43:29And so that's where we're becoming more isolated. But even just like talking to the barista or talking to someone at the grocery store, this again tells your brain that you're in a safe space. Like you're talking to someone, you're having a normal social interaction. So, and then being creative. And we've been trying to work with this, work on this with our kids because there's so much external stimuli all the time, right? They want to play video games. They want to watch TV. They want to play sports, but we want them to be bored and be creative, Like come up with creative ideas to keep themselves interested and engaged in a different way.

44:00So I think that's so, so important. And outside of stress, sleep, there's just so much abundance of data on how sleep affects hormonal health. They looked at data on men sleeping five hours a night versus eight hours a night. So you take the same guy and he sleeps eight hours, then you do five hours for a few days. His test for a week, his testosterone drops by 15%. Wow. that's like as much testosterone drop as would happen with 10 years of life. And do you know how long they did that for? It was short. It was like a week. So a week of sleep deprivation will tank your testosterone. And sleep apnea is another one that I think people, one, don't realize they have, and two, don't realize that fixing it could actually improve their hormonal health.

44:43Wait, so does this mean that people who have chronically bad sleep probably have low testosterone? Probably, yeah. And what is the symptoms of low testosterone? So low testosterone, they're sometimes very vague. So it can be fatigue. It can be brain fog. It can be depression. It can be low desire. It can be erectile dysfunction. That's what people always think. It's just erectile dysfunction, but it's this whole constellation of symptoms. It can also be increased fat mass, decreased muscle mass. So all of these things can happen because we have testosterone receptors all over our body. We have them in our brain.

45:16We have them in our muscle. We have them in our bone. And these can all have really serious consequences. When it's low, when you have sleep apnea and how you know you have sleep apnea is your partner might tell you that you're like waking up in the middle of the night, gasping for air. If you have one really easy way to check is take a measuring tape and measure your neck circumference. If it's more than 17 inches for a guy or 16 inches for a female, it means it's very likely that you may have sleep apnea. and that's because when you have excess mass basically here it's compressing your airway and can make it difficult to get air into your into your body when you improve sleep apnea we've seen improvements in testosterone as high as 200 nanograms per deciliter so huge jumps in testosterone after fixing sleep apnea and the same goes for other sleep disorders although the data is not as abundant but sleep is so important then we talk about what's in your environment so So you get a bottle of water.

46:16So many of my patients, actually, they only buy like cases of plastic bottled water. Once in a while, a plastic bottle of water, like don't stress yourself out. This goes back to stress. People get really stressed. Like what's in my environment? What am I drinking? What am I eating? Like do what you can control. So plastic bottle bottles have things like phthalates and BPAs, which can affect hormonal health. They can mimic estrogen. They can reduce the production of testosterone based on these mechanisms. Also things like plastics in the environment, PFAS, so the things like nonstick cookware, all those things can affect hormone health.

46:52Now, how do you sort of protect yourself, right? I tell people, again, don't stress. There's only so much you can control. So, like, I love that we're not drinking out of plastic. if you have to drink out of plastic because you're at an event or whatever try to make sure it's not a warm bottle so it hasn't been like sitting in the sun for hours and hours and hours because as it gets warm it releases more microplastics and more chemicals into the water when you're eating food 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 when you store food in the fridge put it in a glass container or a metal container.

47:30But don't ever leave the food in the plastic and put it in the fridge. These are simple things you can control. You could also limit sort of your exposure to dust because dust has microplastics. You can try to wear more cotton fabrics, less synthetic fabrics because they shed less microplastics. But again, I think do what you can do, but don't let the stress of these chemicals like derail you because stress is not helping either. And how much of a difference does, you know microplastics make on my hormonal health is it really a big big deal well i think it depends it's all dose dependent right so we're all exposed like if you look at the data like people are you know consuming quite a bit of microplastics and we're seeing them actually even in testicles and penis tissue samples like they're in our bodies and so i think that it's definitely playing a role how much we don't know yet we just know there are mechanisms and we know that they do affect hormonal health.

48:24And so do the best you can. Do you and your family drink out of plastic bottles? No, we drink, we have like metal water bottles for the kids and myself. What about nonstick pans? We buy ceramic. We do our best to like avoid those as much as possible. So the other thing is the company you keep. I think we don't talk about this enough and we talk about it in terms of business, like you want to keep people who are successful around you. You want to keep people who can help you. But it also plays a role in your sexual environment, right? So my husband is in these groups with a bunch of other male physicians.

48:54And there's a lot of discussion about how they never have sex anymore. And they're all just like, oh yeah, this is just like normal. Like we're getting older. Our partners don't want to have sex. It's so frustrating. And there's a lot of discussion about this. And it's almost like, oh, that's okay. Like that's just normal, right? They're normalizing this experience where that sex has not become a priority because life is so stressful. Things are so crazy. Maybe you're having relationship discord. So it absolutely plays a role. And there's actually some evidence that it may help you make better choices.

49:23So there's one study where they looked at, I think it was like 50 ,000 people. And they did an intervention where they tried to encourage these people to surround themselves with positive influences that were like, have safe sex and avoid negative influences. And they saw that these people had an increase in like sexual positive behavior. So like safe sex practices is by 46%. So just by changing who they spent their time with, they saw this major difference in how they approached their sex lives. Okay. So if your friends are very pessimistic about sex and they're not having and they're complaining about it, that's going to become sort of contagious.

50:02Yeah. And I think it extrapolates to everything. What kind of relationships you're in? How do they view their relationship with their partner? Is it a priority? Do they make it a priority? right or are they just busy doing their own thing and they're just like living in parallel lives they're doing their own thing you're doing your own thing you never really spend time with your partner and then when you go hang out with your friends you're like oh god i'm so glad to get away and you're not like talking about how much you enjoy your partner people tend to talk negatively right they want to like sort of like vent and so when you have people who don't make that a part of their lives it also affects you they value their partner and they talk about them in a positive way that's a great thing to say like okay this is the right kind of person i want because i want to value my partner too and i don't want that to rub off on me because it absolutely does and the other thing you said in this category of environmental stuff is things like pornography consumption is it possible to consume too much porn so it's not the amount of porn that you watch it is the sort of the way you feel about it many people watch porn for a variety of different reasons most often it's for pleasure and enjoyment.

51:04But there's some people who watch porn because they want to get away from negative feelings, right? This is giving them dopamine and they're using it as a way to just feel better in the moment. And so that can become a compulsion where they're watching porn and it's like giving them these positive feelings and they feel negative in life and they're going back to porn to sort of, again, have that compulsion to watch porn again. But that's a small subset of people. The other thing is that there's a lot of negative discussion around porn, right? People are like, porn is bad, it's dangerous, it's evil.

51:34And I think, you know, it's more nuanced than that. But if you feel that porn is bad, every time you watch porn, you feel negative, you feel bad about yourself. That's where we see people having the most dysfunction associated with it because they feel guilty. They could watch it once a year and they could feel super guilty about it and it could affect their sexual function. They could see themselves as a bad person. They could see themselves as wrong or immoral. And that's really when it becomes an issue. If you are finding yourself either compulsively watching pornography and using it as a scapegoat, maybe time to reevaluate.

52:07Say, why am I doing this? How can I switch this out for something else that makes me feel better? That might be healthy, like exercise or going for walks or whatever that may be. And then if it's something that's really making you feel like bad or guilty, because maybe that's how you were raised, maybe that's what you feel about morality, then yeah, maybe like you either need to work through that because porn is maybe something that you still want to watch at times or you need to abstain. But usually those are, it's very difficult to abstain for most people to abstain for prolonged periods of time.

52:37So I think it's something that you have to work through if you find yourself having these sort of feelings about pornography or you're compulsively watching it. But for most people, it's adults, for most adults, it is fantasy. It's a place where you can experience, see things that you may never do in real life, that may be enjoyable, that are fun to watch, that have brought you to feel arousal. We see that when couples watch porn together, they are more likely to be more satisfied in their relationship. And when there's a discord, like one person really doesn't like it or doesn't use it and the other one uses it a lot, that's where we see the problem.

53:10Is porn consumption going to impact my intimacy with my partner? So it depends. I think a lot of people watch it without an issue, right? Because if I masturbate and I ejaculate, I'm not going to then be able to ejaculate very quickly necessarily with my partner. Yeah. So that obviously that is, you know, there's a refractory period after you ejaculate. Now, when you're younger, that refractory period could be minutes. And when you're older, that can be a day and a half. And so we see that some people may struggle, especially if they're watching a lot of porn every single day and their refractory period is maybe a day, then they may actually really have trouble ejaculating with their partner because they've not given themselves that time.

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54:27I reached out to them. I became a co-owner in the company. I became an investor in the company. And so it's with great pride that I can tell you that this exists. if you haven't tried these shots, go to ketone.com slash Stephen for 30 % off your subscription order, and you'll also get a free gift with your second shipment. I still buy my ketone shots predominantly online, but thankfully I can now grab them at Target whenever I drive past them here in the United States as well, because we're now stocked in Target, where your first shot is completely free. One of the smartest things a business can do is build like a bigger company without actually hiring like one.

55:01But the problem we all face is that most companies don't have every skill in-house. So when I look at the businesses seeing real success today, the consistent pattern with all of them is how quickly they move. They bring in specialists with skills in emerging areas to keep themselves ahead. Even in our company, we spent the last year pulling in talent across areas like AI-native strategy, no-code builds, and product workflows. And we find this talent through our longtime partner, Fiverr Pro. Their premium service only shows you vetted talent, so you've always got the safeguard that anyone you pull in to help you with a complex project has the skills that you're after and will deliver to the same high standards as your internal team.

55:38And most importantly, they'll keep up with the pace. It's a simple strategy, but it lets us stay agile without compromising on quality. So if you need these kinds of skills in your business, head to pro.fiverr.com to find pioneering talent to fill your business's gaps. That's pro.fiverr.com. And the last one, the last of the four pillars. The last of the four pillars we talked a little a bit about, it's called confidence. And confidence is not like strutting around like a peacock, like I know what I'm doing. It's confidence in knowledge and curiosity. So knowledge we talked about a little bit, understanding female anatomy, like how do female bodies get aroused, right?

56:12What makes them aroused? Where is the clitoris knowing some anatomy? And two, actually talking to your partner or paying attention to their cues. For some reason with sex, it's the only 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. And then when it's not good, you're like, well, you just don't know what you're doing. And it's like, it's wild to me that we actually never got taught how to talk about sex, how to bring it up with a partner, how to, you know, just explore and have fun with sex, maybe add a toy to the bedroom. So there's lots of different types of toys.

56:46This is a Volvo stimulator. So you put this on the outside so you can see that it would, in theory, this was smaller, would stimulate the clitoris on the outside. It also can change in shape. It'll vibrate, right? It'll have different stimulations that you can play around with and decide what you enjoy. So this one's run out of battery.

57:09They're brand new, they've not been used. I didn't say they had been. Very defensive though. So if my pinky finger, if my finger here is the clitoris yeah i put it on like there yeah and then it vibrates correct and then the penis goes correct the hole and there's another version of that this is basically this is basically like the hole goes around the penis and that goes in and that can go in and stimulate and vibrate so you both feel the vibration and you both feel the stimulation i remember i was with um had a partner and she she felt that sex toys were for older people old people specifically what she said and she she was kind of against the use of them i've always been down i think it adds novelty and it's exciting and it just adds something new but she felt like it was almost like giving up well i mean look i think i wonder why i would i would if i she was here i'd ask her why do you think that what belief system do you have that's making you think that this is like not a good thing to use right we use technology in so many places in our lives right so why not and introduce it in our sex lives.

58:14Are you going to become reliant on it though? Because it doesn't make it easier to get off with a sex toy. So they've actually looked at a vibration and can you get desensitized to it? And the way they've looked at it is actually like construction workers where they're using those like vibration tools, right? And seeing if like their hands get desensitized. And what they've seen is yes, for a short period of time, they do lose a little bit of sensation on their fingertips, but then it restores back to normal. And so it's not that you're going to become desensitized forever, right? I think you brought up a great point, which is adding novelty.

58:45Now, I think when I say novelty, people are like, oh my God, I need to role play in a different way or bring some sort of BDSM or whatever into my sex life. And that's not exactly true. So when you think about sex, it's just like eating your favorite ice cream. Maybe you have vanilla ice cream three times a week and you enjoy it. But if you start having vanilla ice cream every single day, you're kind of bored with it, right? And the same goes for sex. Now, having routine in sex, knowing what you like, knowing what your partner likes, it can be very helpful. But it also is nice to add novelty. So if you think about, you could extrapolate from the flow state.

59:23So when you are in a flow state for work, right, things feel really almost effortless and you're just like in a zone. You can also get into a sexual flow state. When you look at the flow state, yeah, you need things to be slightly challenging to get into the flow state. They can't be easy and they can't be so hard that you're going to get frustrated, right? And so you need to add a slight challenge to your sexual encounter to get into that flow state. And that's when you start having really great sex because you're totally immersed, you're feeling great, and it's super fun. right so I think that's another part of being confident is being able to and confident to try new things and explore new things and it can be as simple as like doing it in a different room or maybe getting a pillow or switching where your head position is like it can be so small but it can just add a little bit of uniqueness and novelty and challenge are there certain positions that are...

1:00:16Going to increase the probability that my partner has an orgasm? Yeah, so typically when the female partner is on top, she has more control over where she's getting stimulation to the clitoris because she can angle her body in such a way. So oftentimes that shows that has higher orgasm rates. There's actually like this technique called the coital alignment technique where you sort of move in a rocking motion so that your pubic symphysis, so this bone right here, is sort of like rubbing against their clitoris. Like this area, the skin here is rubbing against the clitoris while you're penetrating.

1:00:57And that has been shown to increase orgasm rate and pleasure. in sex. So really it's about figuring out and trying different things and realizing like that, for example, that coital alignment technique is sort of difficult. Like it's not that easy and intuitive. And so you have to sort of play around with it and figure out like what is going to work best. And yeah, realizing it might not work. You might be like super awkward and be like, okay, like that's okay. Like it's not the end of the world if sex is not perfect every time, because we're learning and we're playing and we're having fun. And so I think that's really the key is like not letting yourself get so frustrated if something doesn't go exactly the way you envision it in your head.

1:01:32I used to think that a woman orgasming was when, this was when I was younger, was when she squirted. So that's what I thought it was. I thought an orgasm was squirting. Yeah, well, you're probably not the only one to think that. And so squirting, not every woman squirts. So about 40 % of women squirt. Squirting is the emission of fluid at the time of orgasm. Usually it's clear, colorless, and it can be quite voluminous. It's coming from the urethra, which is the pee hole essentially. and remember i talked about those skeins glands those skeins glands are the homologue of the male prostate and they have a little bit of fluid in them too typically when you have stimulation and squirting they will release fluid from the bladder as well as the skeins glands that combines together and and it's emitted through through that so it's not pee the way they describe it and there's been a lot of research on this so there's people who say it's pee there's people say it's not.

1:02:25There's a couple studies. So one is they put dye into the bladder and they took women who said they were squirters and they had them orgasm and they saw is there dye in the fluid. And yeah, there was dye in fluid. So it's coming, it has to come from the bladder. The skin glands only hold a small amount, but it's chemically different. It's usually clear, odorless, it doesn't smell like pee. And so there's some theories as to why that might be. It may be that when you're having sex, there's different hormonal signals that change the concentration of what's filtering through your kidneys so that it is a little bit different in composition.

1:03:01There's some theories that when there's more estrogen around that it may change. There may be some fluid filling in the actual interstitia of the organs. Again, it's hard to say, but it's absolutely coming from the urethra, which is connected to the bladder, as well as the Steen's glands. But I think this whole discussion about what it is, it doesn't matter. Is it pleasurable? are you enjoying it? Great. If you squirt and you enjoy it, great. If you don't, that doesn't mean that there's something wrong and that your partner hasn't orgasmed. The way to figure out if your partner orgasmed is you ask her, right?

1:03:32Either she tells you or you ask her. And sometimes it's obvious and sometimes it's not, but you know, you sort of figure it out. There's three theories that emerged in my research about why women squirt from an evolutionary perspective. The first was that, and these are just theories, they're not proven, of course. The first is that squirting contains PSA and zinc, which are naturally antibacterial. And ejaculating these fluids during or after sex may have evolved to flush the urethra and prevent UTIs. The logic being in a pre-antibiotic world, a woman who could flush bacteria out of her system after mating was more likely to stay healthy and reproduce.

1:04:08That's one theory. The other reason - Well, before you go, I want to talk about that really quickly. So that's a really interesting theory. So one, the reason they emit PSA is because Skeen's glands are the homologue of the prostate. So the prostate makes PSA, which is prostate-specific antigen. So this word homologue again. Yeah, so basically the prostate in the male, the same tissue when you're an embryo, becomes a prostate in the male and becomes a skin's glands in the female. So that's why it's emitting PSA. That is an interesting theory because there are a subset of women who get UTIs after sex.

1:04:39Not everybody, but some do. And it's not because of the ejaculate or because of the male harboring some bacteria. it's because of the actual thrusting of the penis. It's taking bacteria from the outside and making it more easy for it to go through the urethra into the bladder. And women 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 there's something wrong with you. It is literally just anatomy. And so some women do get more UTIs after sex. And so that is an interesting theory because maybe that's true. I don't know. The second theory was in ancient ancestors, the hormonal surge during orgasm and ejaculation actually triggered the release of an egg.

1:05:17Humans evolved to ovulate on a cycle now, but we kept the plumbing and the neurohormonal reflex. It's a happy accident, a biological vestige that no longer serves its original reproductive purpose, but remains because it isn't harmful for survival. Interesting. I mean, there is some thought that maybe orgasming, spasms, orgasms help with fertility, but it's not really robust. And the last one kind of matches what you just said there, which is the mate selection theory. the intense pleasure and psychological response of squirting or orgasm act as a reward system. It incentivizes women to seek out specific partners who provide high levels of stimulation, potentially signaling a better genetic compatibility or a more attentive male, which would help with the survival of offspring.

1:06:02Maybe. That makes sense. 40 % of women squirt. Yeah. So the other thing is, obviously a lot of sex is focused on genitals, but there's a whole body of erogenous zones, right? Almost, almost your entire body can be an erogenous zone. We talked a little bit about it. We talked about sensate focus, right? You can explore, you can find areas that people find erogenous. So when you've looked at data, necks, nipples, lips, buttocks, inner thighs, all these areas are considered erogenous by most people, regardless of their sexual orientation, regardless of their cultural upbringing. It seems to be pretty universal.

1:06:40There's actually a famous paper about non-genital orgasms and how people orgasm without any genital stimulation. So lip orgasms, anal sex orgasms. Is that possible? Yeah, it's been documented, absolutely. And so it's nipple orgasms. There's a whole variety of ways. Even women have had orgasms during childbirth. There have been these documented ways to orgasm. And it's because these areas can be very erogenous. and sometimes stimulating multiple areas can like add more erogenous interest and that's why you see people like maybe in the BDSM community they'll be using nipple clamps while they're doing other things right so there's there's a whole bunch of areas that are erogenous and most of the times people are not really spending much time on foreplay or stimulating these erogenous zones as much as they should right you have a whole body to play with and how do you stimulate them.

1:07:34There's actually evidence behind that. So on your skin, we have these special fibers called C-tactile afferents. So when you stimulate these fibers, they help you feel pleasure, enjoyment, those sorts of things. And so there was a study where they took 19 couples, a small study, it was not a London, and they basically told them to stimulate an erogenous zone and a non-erogenous zone, the non-erogenous zone being the forehead. And so they had the couple stimulate, and they told them stimulated at levels of 18 centimeters per second in terms of how fast you're caressing the arm or body part and at three centimeters per second.

1:08:09And what they found was those who stimulated at three centimeters per second had more sexual arousal, had more pleasant stimulation compared to those who were stimulating it at 18 centimeters per second. Now this makes sense because those C-tactile afferent fibers respond very well to that slow, gentle caress. The other interesting thing is that 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 still doesn't work. That's so interesting because in Los Angeles, where we are now, we were viewing an office and we were walking down the street to see what the neighborhood was like.

1:08:45And we walked past one place and it is a robot massage parlor. And I always thought, great. Like, well, part of me thought, maybe my prefrontal cortex thought, oh, great idea because, you know, you can get massages whenever you want. It's going to be cheap. You maybe can have one in your home. But then the other part of me, as I saw it, I thought, actually, I don't actually think that's like why I get massages. I think there's something about human touch, which makes a big difference. Absolutely, there is. And so I think that's, we're evolutionarily built to seek out human touch and human behavior.

1:09:18I wonder if I would want a robot to massage me. I don't know. It wouldn't be as good. I mean think about sitting in a massage chair is it ever as good? it's never as good right and so I don't think a robot's going to be that different maybe a little better than a massage chair massage chairs are never good no they're just like they're okay they're mediocre I want to talk about testosterone how that links to sexual function but also just overall health because I was reading that there's been a 300 % increase in the United States in the last 10 years of testosterone prescriptions and my friends are increasingly having conversation about testosterone, which we weren't having even five years ago.

1:09:56It wasn't a conversation. And now the conversation I'm having amongst my friends is like, is our testosterone high enough? Do we need to go get supplements to increase our testosterone? Testosterone is declining. So when you look at testosterone levels from the 1990s, like late 1990s, the average level was around 600. And if you look at data around 2015, it was 450. So there's been like a 25 % decline in testosterone. Now you're going to ask me why. One, we talked about some of the endocrine disrupting chemicals. That's part of it, certainly. Two, there's a significant rise in obesity. Testosterone has aromatase and testosterone converts to estrogen using this enzyme called aromatase.

1:10:35And so when you have more fat mass, you have more aromatase and more testosterone is being converted to estrogen. And so now you have less testosterone. Sorry, how do you have less testosterone? So because there's more fat mass, there's more aromatase. So that aromatase sees all this testosterone and it converts it to estrogen. Ah, okay. Or estradiol. This is where they say they talk about man boobs. Yeah, so when you have a lot of estradiol around, you can get man boobs. You can get gynecomastia, so a term for it. So that's one. Two is we see a rise in diabetes and insulin resistance, which also causes a decrease in testosterone.

1:11:11We're seeing a rise in ultra-processed food intake, and that doesn't have the optimal nutrition that you need to optimize testosterone. So we're getting, you know, highly caloric, which then leads to obesity. We're getting lack of healthy fats. You know, all these things are super important for testosterone. And the Mediterranean diet is what has been the most studied. And basically an anti-inflammatory diet is what they found for testosterone. So trying to just eat like whole foods, unprocessed foods as much as possible and minimizing the inflammatory foods. Does having high testosterone make me more fertile?

1:11:51No, not necessarily. So I think people inherently think that the higher your testosterone level is when you check your blood work, that that's better. And that's not necessarily true. Now, everyone is different. And what I can't tell you is what your receptors look like, what your testosterone or androgen receptors look like. How sensitive are they to testosterone? And everyone's a little bit different. When you look at the same guy or you look at two different guys, their variability can be so much that a guy who's 900 can be normal and a guy who's 500 can be normal because everyone has individual genetic variations.

1:12:24It's how their cells, how sensitive their cells are, how many cells they have, you know, how many Leydig cells do they have in their testicles. The CAG repeats, which are these DNA repeats on the receptor themselves. People who have more are less sensitive to the testosterone that's around. So they need more testosterone to get the same result. Whereas people who have less repeats have more sensitivity. So they don't need as much testosterone. And so everyone is individual. And And so that's why it's really important to understand how are you feeling, right? It's not about chasing a number. And so absolutely, we know that when your testosterone is low, below 214 nanograms per deciliter, that your risk of mortality goes up by two.

1:13:03So you are going to double your risk of dying if you have low testosterone. But when you go super high, super physiologic, meaning like 1800 or higher, now you're putting yourself at risk for other things. You can have blood thickening, which is a known side effect of testosterone replacement. And that puts you at risk for stroke, heart attack, heart disease. Over long periods of time, it can affect your heart because there's also heart muscle cells that get exposed to this high level of testosterone. And when that happens, they sort of change over time and they become more collagen deposition.

1:13:38They get more fibrosis. and this makes them stiffer. And so that you're not pumping blood as effectively as you would otherwise. And so there are real consequences to going too high. There's also the side effects of having acne, of changes in mood in terms of aggression and things when you get really high. So really it's about finding what you feel good at. More is not necessarily better. Once your testosterone receptors are saturated, meaning they're all bound to testosterone, more doesn't help you. It might help you get more muscles, which is why people abuse anabolic steroids and testosterone because it will continue to help you get bigger muscles.

1:14:14But that's it. It's not going to help you with your brain health, your bone health, your sexual health, any of that. Is there a way to visually spot a person with low testosterone? Are there visual clues? Usually it's someone who feels very fatigued, like they can't get out of bed. They feel just like so drained. Usually they are a little bit more overweight. Skinny fat? So, visceral adiposity, I mean, you can't always tell if they're skinny. It could be because they could have visceral adiposity, which is meaning that the fat is around the organs, right? And so you don't see like a big potbelly necessarily.

1:14:51They may have really low sexual desire. They may have decrease in mood. What about skin and bones? Does it impact skin and bones? Yeah. So if you get high testosterone, you can get acne because it affects the sebum in the skin. Bone health. So testosterone converts to estradiol. And estradiol is really important for bone metabolism. And so when you have low testosterone, you can also have low estrogen. And when your estrogen gets very low, you get a higher risk for fractures, higher risk for osteoporosis. And so that's where your bone health can be in danger. And so that's why testosterone can help protect your bones because of its conversion to estradiol.

1:15:31If you do have low testosterone, should you be considering taking anabolic steroids? And who is testosterone replacement therapy good for? So I'm going to ask you a question. Why are you saying anabolic steroids? I don't know, because I hear that people, big bodybuilders take anabolic steroids. The reason I asked you that is because people think anabolic steroids and testosterone replacement therapy are the same thing. And they're not. And so testosterone replacement therapy is what is given to guys who have low testosterone. If you have truly low testosterone, there's a few things. You can obviously improve testosterone naturally by going back to those pillars of health that we talked about.

1:16:06Improve your sleep, do resistance training, avoid endocrine disrupting chemicals. But if you are still low despite doing all those things or you're like so fatigued that you can't move your body unless you really need to do it, then I think testosterone replacement is very valuable. And so testosterone replacement is getting you to a level of testosterone that is within normal. We're not trying to get you super high. We're not trying to get you to become a bodybuilder. We're trying to get you to normal, what you should be. And so anabolic steroids are different. Anabolic steroids are like all these different oral pills and injectables and things that work on muscle as well as work on your endogen receptors.

1:16:45And so those are typically things that people are taking on their own. They're kind of self-directing their care and they're not really monitoring their testosterone or they don't really care how high they go. They just want the end product of looking muscular. and so they are getting really high testosterone and that has its own host of concerns in addition to the ones we talked about like blood clots and and heart attack but there's a 15 times higher risk of having premature heart failure and a 122 times more risk of cardiac death when you're taking anabolic steroids for the purposes of increasing muscle mass and not and getting really high in your testosterone.

1:17:27So it is a real serious issue when you take anabolic steroids, because it can have real serious health consequences. I've always imagined that once I have kids, so I'm, I think I'm scared that if I have testosterone replacement therapy at this age, at 33, it might impact my fertility. It absolutely will. Okay, good. So I'm not going to do that until I've had all four of the kids. Yeah. As many as I can. And then I figured when I hit like 45, then I'll go on testosterone replacement therapy. Is this a good strategy? Well, first of all, I would want to know why you want to be on testosterone. Is your testosterone low?

1:18:03I have no idea. Right? Are you having any symptoms? I mean, you live a very high-powered, busy life. And so I can guarantee your stress is probably not under control. Like, probably you're not sleeping great. And not to say that those are things that, you know, you can't do in addition to taking testosterone if your testosterone is indeed low. but I think the important thing is realizing like it's only going to help you if your testosterone receptors are not fully saturated and giving you more testosterone is going to saturate them. Doesn't it just drop anyway with age? It does so it drops about one percent a year on average some people drop less some people drop more so if you look at someone who is healthy and they have a normal testosterone they usually won't become what we call hypogonad or have low testosterone even as they age because the drop is so low it's only one percent a year but if you add on these comorbid conditions if you add on a high stress life if you add on poor sleep if you add on exposure to endocrine disrupting chemicals you're going to see that number come down much higher it's actually i was just i pulled up a graph here um that shows testosterone decline with age and it's actually not that steep it's not it is going to decline but it may not decline to the point where you need testosterone.

1:19:20So not everyone needs it. Depending on the data you look at, 20 to 40 percent of guys have low testosterone. And when you look at the number that get treated, it's like 2 percent. And it starts declining from about 20 years old. Yeah, it depends on the person. 20 to 40 years old to start. It's probably more around 30 to 40. And the reason we come up with these numbers, right, these guidelines to guide us on what's normal and what's not, is because you look at population-based data and you look at when these symptoms arise. And there are like clear numbers. You may start having bone loss around 300.

1:19:52You might start having, you know, decreased sexual frequency of thoughts at 215. You might start having feeling less physical vigor around 290, right? And so there are numbers that we know based on population-based data that we're seeing these numbers decline. Now, the other thing to think about when you're looking at testosterone is free testosterone. So testosterone comes in different forms in the body. It comes bound and unbound. So 45 % of testosterone is bound to SHBG, which is a molecule of protein that is really tightly binds to testosterone, doesn't let it go for your body to use. Then there's some that's bound to albumin, which is sort of loosely bound.

1:20:34And then there's 2 % that's free, 1 to 2 % that's free. And that's what we say is like the most available to your body for use. And there's actually, you know, good data that looks at free testosterone, the levels of free testosterone are correlated with these symptoms as well. And so you do have to look at the big picture. So I always check the total testosterone as well as an SHBG because some people can have elevated SHBG. We do thyroid dysfunction due to aging, due to just genetic variability, right? In women, SHBG goes up when you take oral contraceptives, and it stays up for life if you take oral contraceptives.

1:21:09So it can affect their free testosterone. The other thing to think about testosterone is it's for life. Once you take it, your body stops making its own testosterone. Many people over years will notice that their testosterone, their testicles get smaller because their body stops making its own testosterone. So it's not something to take lightly. Now, if you want, say you were low right now and you wanted to conceive, there are ways where you can take other, other pharmaceuticals that will naturally boost your own production like HCG or Clomid or N-clomiphene. These work basically in different ways to either tell your brain that, hey, we need more testosterone, or they mimic the signals that tell your testicles to make more testosterone.

1:21:50And so there are ways to do it. And you definitely need someone who's well-versed in managing hormone management. But there are things that you can do if you're low. But again, I don't think it's... Once you start these things, you can't go... I can get off of it but it's sort of a process and it's not something that everyone will do because you're going to feel good on testosterone if you're taking it and then when you get off it because your body is like no longer making its own you're going to feel horrible so do you think most 50 plus year old men should be taking testosterone replacement therapies only if they're symptomatic and they're low right so would it make them the average man the average 50 year old man if this is the average feel better on a daily basis not necessarily because if they are normal, like I said, if their testosterone receptors are already fully saturated, it's not going to change, right?

1:22:36It's not going to change the, like I said, it may make their muscles look bigger, but it's not going to change their cognition. It's not going to change their mood. It's not going to change their sex drive. It's not going to change their erections when their testosterone receptors are fully saturated. And you know, in this graph, what is showing the decline here, has that got anything to do with whether their testosterone levels are fully saturated? No, you can't tell from that. You can't tell from that. So you can have low testosterone, but still be fully saturated. That's why we talk about symptoms, right?

1:23:03Because that's how I can tell. I think, you know, that's part of what being a doctor is, right? Talking to your patients and figuring out what's going on with them and what their symptoms are and making sure it's nothing else, right? You can have low thyroid and that can mimic what low testosterone feels like. You can have a high prolactin because you might have a benign tumor in your brain that's secreting prolactin and that can reduce your testosterone. So that's the reason to get a full evaluation, to make sure there's nothing else that we're missing that's causing you to have these symptoms if your other levels are normal.

1:23:34Okay, that makes sense. So just because my testosterone levels would be low doesn't mean I necessarily, if I'm not symptomatic, doesn't mean that I should necessarily just assume that I need testosterone replacement therapy. Exactly. Okay. Yeah, I think most of my male friends are just assuming that once we hit 50, we're all on the testosterone. I mean, look, I think when, if you need it, it's a great drug. It's a great option to improve your quality of life. It's obviously preventing bone loss. It's improving your longevity. It's preventing, hopefully having some benefit in terms of cardiometabolic health.

1:24:09And so, yeah, absolutely, if you need it. But it's not something that like everyone should just take because why not, right? Like when you play with hormones, it's serious business, you know? I guess a lot of men are self-conscious in a way that they don't often admit. And they want to have big muscles. And they want to feel strong. And this is the problem I'm seeing with younger guys right now is that there's a lot of young kids taking anabolics because there's so much pressure to look a certain way, right? Because nowadays, how do you meet people on social media through like swiping and all you see is what they look like.

1:24:42And so there's this pressure. And like, I'll see it at the gym. Like I'm like at the gym and there's these young kids who I'm like, there is no way you are naturally that built at that age, right? Like unless you've been lifting since you were like seven years old. And of course, there are some, but it is serious because one, it causes infertility, right? When you're on testosterone replacement, after about 18 months, 70 % of people on testosterone replacement will be infertile. 17. 70. 70%. 70. And even as soon as like 10 weeks, we see some people having drops in their sperm count. So it's variable with how quickly you're going to see impacts on your fertility, but it absolutely happens.

1:25:24and it can come back for the large majority of people, but how long it takes depends on your age and how long you were on testosterone replacement therapy. And in some cases, it can take as long as two years to come back. I really need to get my testosterone levels checked. Yeah, you should. But also you should get your semen analysis checked. I've done that. Good, good. Because that's also a biomarker of health. We've seen that people who have poor semen parameters, they have higher rates of mortality and they actually live, when you look at age, like what age people die, they die younger compared to people.

1:25:57And it's dose dependent. So if you have like normal concentration of sperm and then it keeps going down and down and down, if you look at the age, it's like they live to 78, 77, 76. Like you can actually see it come down, except for people who have no sperm because those are usually genetic disorders. Those live a little longer because it's not necessarily due to cardiometabolic issues. But it's basically a reflection of your overall health.

1:26:24Steve, what are you doing? Just making myself a delicious coffee. From the freezer? From the freezer? Have you not heard about Conteer? No. Oh my gosh, this is going to change your life. A couple of months ago, the founder of this business called Matt sent a big shipment of this coffee to our office in London. What most people don't know is that the processing of coffee takes out a lot of the taste. So what they do is they flash freeze it at the optimal moment when it's most tasty. And they send you in the post, the coffee, in these little frozen ice cubes. Now, Matt sent a big shipment to my office.

1:26:57I moved it to the kitchen. I said to the team, knock yourselves out. And then I saw so many messages in our Slack channel of people going, oh my God, what the hell is that? It's so 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 my hot water in and I mix it. And that is done. You can get$30 off your first order of Cometeer coffee if you go to cometeer.com slash steven. Try it and please Instagram DM me, LinkedIn me and let me know if you love it as much as I do. Make sure you keep what I'm about to say to yourself. I'm inviting 10 ,000 of you to come even deeper into the diary of a CEO.

1:27:36Welcome to my inner circle. This is a brand new private community that I'm launching to the world. We have so many incredible things that happen that you are never shown. We have the briefs that are on my pad when I'm recording the conversation. we have clips we've never released. We have behind the scenes conversations with the guests and also the episodes that we've never ever released and so much more. In the circle, you'll have direct access to me. You can tell us what you want this show to be, who you want us to interview and the types of conversations you would love us to have. But remember for now, we're only inviting the first 10 ,000 people that join before it closes.

1:28:12So if you want to join our private closed community, head to the link in the description below or go to doaccircle.com. I will speak to you there.

1:28:24One of the things I was quite surprised by, I'll be honest, is when I went on your YouTube channel, one of your very high-performing videos, I think it had 31 million views, was about enlarging your penis. Yes. I didn't know that so many men were interested in ways to enlarge their penis? Well, it's interesting because when you look at the data, more men want to, so let's say most guys would love to be taller, right? If you're an average height man, most guys would love to be taller, right? Yeah, true. More men want to have a longer penis than they want to be taller. Really? Mm-hmm. Wow. Wow. Why is this?

1:29:08well I think you know a lot of people 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 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's and it's like this it becomes this like this society thing about who's got a bigger penis like it's very interesting but there's a lot of pressure to feel like and a lot of discussion around bigger is better right it's it's talked about in media. It's subtly joked about. It is everywhere you look, people are talking about like being well endowed as being better.

1:29:46But interestingly, on my podcast, we interviewed the guy who has the largest medically verified penis. It's I think it's like 13 or 14 inches in length. And he actually has a lot of trouble because it's so large that people don't want to have sex with him. And it's uncomfortable for them. And so like, it's not all roses and sunshine on the other side. But the reality is that many people feel what's called small penis anxiety. And they, they, even if they have a normal size penis, they feel consumed with how the 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 resonate with because I'm not a guy, right?

1:30:25And I see patients all the time, but at that time in my career, people weren't coming to me to talk about it. And so I, um, I realized like there's so many people quietly feeling insecure. And we talk a lot about women having body image issues. Men do too, right? They feel insecure about the size of their penis because also they're seeing guys on pornography who have very well-endowed fallacies. And, you know, they chose to be porn actors for a reason, right? Because they are naturally well-endowed. And so you're comparing yourself to the outliers. And the average penis is about 5.3 to 5.5 inches erect.

1:31:00But when you look at like, what do women want? They will say on average, they want a six inch penis. But when you look at like the kind of sex toys they buy, and they did this study because they were looking at people who they were trying to decide what kind of when they were developing phalluses for trans people, like they reconstruct phalluses for they want to, they were making them too girthy. And they're like, well, we need to figure out what girth women want. And so looked at like what women buy on online like what is the most purchased sex toy and it's actually pretty close to average do you say 5.2 inches 5.2 to 5.5 depending on the study you're looking at yeah correct and what size do men think the average is oh they think it's like six or seven inches oh okay so they think the average is bigger and also how does age come into this because i'm presuming that when i get older my penis is going to shrink or something if you have good blood flow to your penis, it shouldn't shrink.

1:31:55So like I said earlier, if you stop having nighttime erections, you're not having erections, now you're no longer getting blood flow to your penis and it will shrink over time. Also, if you're gaining weight, it will appear that it's shrinking because you're getting more fat over here. So if you think about your penis here, this is the fat right above this bone. And as this fat gets more and more, you're seeing less and less of the penis. And is there a way to enlarge the penis? So there are many ways that have been tried, discussed, attempted. So there's definitely surgeries that you can get, but there's not a lot of surgeons who do a lot of penile lengthening surgeries.

1:32:34And they have lots of complications, like very high rates of complications, because the penis is a very vascular organ. And the thing is that when you have the tiniest difference on your penis, you notice it, right? Like I have guys come to make the tiniest little thing on their penis and like, is this okay? Like this is new. and like luckily it's nothing right but I'm like they notice it you notice it when something's wrong so imagine you have a surgery and now something changes right so it is it is really difficult to sort of replicate exactly a normal penis when you're lengthening it through surgery so I don't recommend surgery for lengthening penis there is a safer way and that has been shown to help and that's using a traction device so a traction device we have one here this is one brand you can get many of these online and you can put your penis in this device it really i like i feel like um i get like shivers when i watch you do this to this penis so you drop it it would be more comfortable than just putting this like directly on your penis if you guys that can't see she's clamping the end of the penis into this into this device and then you sort of lengthen it extend it with this 30 minutes twice a day for this particular device they've actually done some research on this one 30 minutes twice a day and you there's like a whole protocol on their website and it does show improvements in length about two centimeters but it is a commitment to increasing length and to doing this process so just on those numbers two centimeter increase over what period of time and does that for about three to six months depending yeah is it permanent so that's what we don't know i mean most of the studies stop at you know once they get the result and we don't know that if you stop, will it just revert back to normal?

1:34:16I don't know. And so the other thing about this particular traction device that's night is if you have a curvature in the penis, like you develop something called Pavroni's disease, this device can actually curve a little bit away from if you like, let's say you have an indentation on the top of the penis, it can actually bend away from that and it can help straighten out the penis. So that's actually a really nice utilization for it because for some people that can be really traumatic and devastating to have a change in the way your penis appears because it starts curving all of a sudden. And this is safe and effective.

1:34:49And you can have bruising. It can be slightly uncomfortable. But you're not going to really hurt yourself too much by doing something like this. I thought a curved penis would hit the G-spot better. Yeah, sometimes a slight curve can be beneficial for some people. But again, I think when you notice there's a dramatic change, you do that more cum. And rip the end off. It's okay. I'm just trying to figure out how this works so I get the penis I put it through yeah clump it down and you want to put it at your normal and then you'll just slightly advance the the length you're not going to pull crazy it's going to do a little bit of traction so it's not uncomfortable it's slight like just a slight tension it shouldn't be like like that it should be a lot much less tension but it is I mean they can vary in price from a hundred dollars to five hundred dollars so it's a one-time cost it is not like i said not dangerous what is dangerous is when people try to do something that became popular on tiktok called jelking and jelking is where you use your your hands and you make like an okay sign with your fingers and you're like stretching the penis with your hands and this can be dangerous because you can create micro tears in the penis and we in the urology community have seen plenty of patients who have now developed erectile dysfunction after doing jelking because they've now created damage to their penis.

1:36:13And so I really caution people because there is so much despair around sexual function, around penile health, that people are willing to try things and they might really hurt themselves. No joke, I had a patient the other day ask me if he should drink hydrogen peroxide because he saw some ad that said hydrogen peroxide will fix your erections. And I said, please don't. But he really was like seriously, earnestly asking me this question. And I didn't want to shame him by any means. And I was like, no, this is actually not safe and it's not going to help you. And there's no pill, there's no drink, there's no anything that's going to give you a longer penis.

1:36:55What are the cases that you see that break your heart? You know, I've seen, so there, I've seen patients who've had surgery to lengthen their penis and they are above average when they at baseline and they have these surgeries to lengthen their penis and they have a bad outcome and now their penis is disfigured forever and that's what really um you never forget that because that person knowing the risks and benefits perhaps made a choice and that choice didn't go the way they wanted and now they have to live with that for the rest of their life and that's really sad gosh imagine that christmas yeah well and it just it doesn't work anymore well like like the one patient i'm thinking of um he uh had a like it basically developed a scar all at the top of the penis so it was like disfigured essentially um and so it was it was really sad before i hit puberty i definitely had a penis anxiety because i was the youngest in my year at school and i i was this i was short very very short very small.

1:38:01I remember what it felt like to like hide my, hide my dick when I was around like guys in the changing room and stuff like that. Um, you know, after puberty things, I changed. And what I want people to understand, I think more than anything is that you don't need a long penis to pleasure a partner. We just talked about how the clitoris is the, is the most reliable route to orgasm. Right. And so you don't need a penis to stimulate the clitoris. You can use your mouth, your fingers, you can use a toy. There's so many ways to help your partner achieve pleasure. And yes, of course, there are a small subset of women who really appreciate a large phallus, but the large majority of women, if you look at survey data, are very happy with the size of their partner, are very content with average or slightly above average or slightly below average, as long as they are feeling intimate and they're feeling pleasure.

1:38:56And so I think there's a misnomer that people think, if I have a longer penis, I'm going to be able to pleasure my partner more. As it relates to women, is there different size vaginas? Yeah, so just like there's averages, there's averages in females. And so average vaginal length is about three and a half inches. So when women get aroused, it expands and widens and lengthens to about double. So the average woman can easily accommodate the average penis, maybe slightly larger than average. And so I think generally speaking, knowing that like you will be able to fit in the average woman and you will be able to please her with the size of your phallus.

1:39:36And like I said, penetration is not as important. In fact, only about 85 % of women orgasm through penetration alone. They need clitoral stimulation to achieve climax. And so again, penetration feels good. I tell guys, it's like somebody rubbing your testicles or your perineum that feels good, but it's not going to make you orgasm. And so penetrating, yeah, if you're getting a lot of clitoral stimulation, because maybe she has a thinner, you know, her clitoral shaft is closer to the vaginal canal, maybe, you know, the size of the penis matters more. But for a lot of women, it's not going to be sufficient, and they're going to need some directed clitoral stimulation.

1:40:14Why do different vaginas feel different? And I guess the inverse is also the case, where like different penises will feel remarkably different, even if they're the same size roughly. and you can have sex with somebody and go it feels really good i mean i think again it's how you it's like the emotion in the ocean right like how you use your so let's talk about the vaginas first so when a vagina is um has more pelvic floor strength they may be able to like tense around the penis better like they may be able to sort of grab the penis with their pelvic floor a little stronger versus someone who doesn't and that's where i think some people get worried when i say oh you need to relax your pelvic floor, they're like, oh, I don't want to be looser, right?

1:40:56And that's not going to happen if you have a normally functioning pelvic floor. So the penis is going in here, right? Correct. So if you're a woman and you do pelvic floor exercises, then it could feel tighter. Well, you're able to contract and squeeze those muscles during sex better, right? Around the penis. Yes. But we don't want you to be tighter. We want you to be able to squeeze the muscles and relax the muscles. Use them like a normal muscle, like your bicep. You squeeze and relax, squeeze and relax. We don't want it to be constantly squeezed. But to the man, it will feel tighter. You will perceive it as tighter, but it will not be that she's actually tighter.

1:41:30It just means that maybe her pelvic floor muscles are doing a better job. So that's for the female. For the male, it's generally like how the penis moves and how the positioning is and where it's, it may be girth that's different. It may be the way that you're moving in the vaginal canal, and that may be why it feels different. They often say that if you've got big feet or big hands, you know, like people think you have a big penis. Not necessarily true. So there's actually no evidence that big hands, big feet correlate to penile size. There's one study in Japan where they looked at nose length.

1:42:06And so the longer your nose is from the bridge down to the tip, that is potential, at least the Japanese population that they studied was correlated with the length of the penis.

1:42:20People also think tall people have big penises. Not necessarily. But nose length, there's some correlation in a study in Japan. Yes. Okay. Let's just check my nose. Okay. The last thing I want to talk to you about is a Zenpec and how this relates to everything we've talked about today, desire, attraction, sex. Is there any early data emerging that shows any correlations? Yeah, so a Zenpec, there's sort of benefits and there's potential downsides. So the benefits are that when you're on a Zempic, we see improvements in metabolic diseases. They have improvements in diabetes, improvements in heart disease, improvements in overall health, right?

1:42:59And so that is going to mean that your blood vessels are healthier. You're more able to get blood flow to your genitals. You're gonna have stronger sexual function and arousal, right? So that's great. The other thing is that you are losing weight so you feel better. You feel more like your body image is feeling good about yourself. Also for men, remember I talked about this fat pad right above your penis, that's getting smaller. And so now you can see more of your penis. So you may have heard of osmopic penis where people are saying, oh, my penis is getting longer. It's not actually that your penis is getting longer.

1:43:32It's that this fat is going down. So now you're seeing more of your penis. Which makes it look longer. Yes, exactly. It's such an reality. Yes, exactly. Well, it is reality to the person looking, right? So those are all great things. And I think that's wonderful. Now, the other part of it is Ozempic works on the brain and it works on the reward pathway. So you now see food and you don't feel like it's that much of a reward. So you don't chase after you have less desire for food. There's emerging data that we're seeing people on these medications, these GLP-1s have less desire for, let's say gambling, let's say shopping, let's say, you know, alcohol, smoking, whatever it is.

1:44:08right? And so there's a theoretical, because it works on the same pathways, that it could also decrease desire for sex. And I think the thing that, you know, there's so many people on these medications, there's so many metabolic benefits that I worry that people may not even realize that their sexual desire is changing, right? They might just be like, oh, you know, I'm eating less, I look great, everything's wonderful. But like slowly in the background, they're like, oh, maybe my desire is less and maybe it's creating discord in the relationship. Hard to say because we don't have data yet. So yeah, I think it's just something that you should be aware of that if you start feeling like you have less desire for sex, or maybe you're like, man, I just really don't feel into anything.

1:44:49Talk to your doctor because maybe your dose is just too high and 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 feel like we're going to start seeing it. Is it possible to do studies on this type of thing? absolutely so you can take people starting ozempic and you can say hey here is or any glp1 you know there's questionnaires so like for women there's a female sexual function index for men there's adam which is a questionnaire about testosterone but you could there's sexual desire questionnaires that you can use um and you can take it at the beginning and then you can take it as they increase their dose and see if there's a change right in terms of their sexual desire you said at the start about knowing how to talk to your partner i think like intimacy desire maybe the conversations like with your partner how to have that conversation when there's a problem yeah i wish i could say there's like a script that you can follow and it's going to work but everyone's so different but i think the important thing is like not giving up because what happens is because we don't ever talk about sex when you bring it up it's immediately like oh my god is something wrong did i do something wrong um do you not like me am i not attractive right you're automatically going down the rabbit hole of worry and concern.

1:45:57And instead of dealing with it, you're going to shut it down. No, I don't want to talk about it. Right. Especially if like, maybe you haven't connected intimately in a while and like, you just don't want to deal with that. Or you're, you have other stressors in life. Maybe you're not feeling like very good about yourself. And so you're like, well, I don't really feel sexy, so I don't want to have sex. And so I think really understanding that whatever reaction you get from your partner, when you do talk to them, it's not about you. It's just usually about how they're feeling. And so don't stress about that.

1:46:24And two, like it's anything that is worth having requires work. So having a good sex life, having intimacy over the long haul with someone, if you are committed to that relationship, it is worth working for. It is worth dealing with a little bit of discord to get there. And so I tell people when you want to talk about sex, first of all, don't do it in the bedroom. Don't do it right before or after sex. Do it at a time where you are both calm, relaxed. Maybe you're out for a walk. Maybe you're in the car. So you're not like looking directly at each other. You're kind of parallel. And always start with a positive thing.

1:46:57Like, I, you know, I really enjoy this about our relationship. And I would love if we could talk about this. And maybe they're going to be like, I'm not ready for that. And you say, maybe we could come up with a time where we can talk about this that works for you. Right? Let them feel like they're coming to the conversation with like, they're not being ambushed or like talking about something. And then be curious. I think the big thing is like being curious, like what's going on with 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 this about us.

1:47:27And I think that there's always these misconceptions. I hear it all the time, right? It'll be like, this partner only wants sex and this partner never wants sex. And, you know, and that's it. Like that's the end of the conversation. But the reality is that it's somewhere in between. So typically, women tend to view sex as like added stress sometimes when they're already stressed. Like they're like, oh, it's just one more thing to do. Whereas men look at it as a stress relief. So one, you're coming at it from two different angles. The other thing is men aren't really taught how to be intimate. And so for a lot of men, sex is their version of intimacy.

1:48:03Like that's how they connect. That's how they feel connected with a partner. And so oftentimes when they're doing these initiations or attempts at sex, it feels like they're being greedy or it feels like they just want sex. And I think we have to reframe how we look at that. Like sex is not just sex. It is intimacy. It is being together, connecting with another human being. So how do we do that, right? And like how do 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 get this done way. I just need to get an orgasm. I just need to get a release.

1:48:37But sex is supposed to be something we look forward to. It's supposed to be something that we're excited about. And so we have to build that in. We have to sort of like build the environment where sex can happen. So it may mean like, hey, we are affectionate during the day. Maybe we send a lovey text message. Maybe, you know, I give you a hug. I caress your back. I tell you you look beautiful. I'm showing you gratitude for how much I care about you in other ways. I think just really taking the time to understand why your partner feels the way they do. I'm curious about on that communication point about how different genders in heterosexual couples have different sort of taboos and things that are just a bit sensitive.

1:49:18And I was looking at the variance between men and women. And the top one for men was around performance anxiety. So like admitting to things like erectile dysfunction because it feels like it's so intrinsically connected to masculinity. and you feel like a failure as a man if you can't get an erection and pleasure your partner. Right. And then for women, it was talking about prioritizing pleasure and asking for more foreplay or, you know, specific stimulation around the clitoris or something like that, because they don't want to be labeled as high maintenance or too much hard work, etc. And it's interesting that on that walk with your partner, there are different things that will trigger each of you.

1:49:58other ones for women were pain and discomfort bringing that up and body image and the mental load explaining why you aren't in the mood and other ones for men are expressing non-sexual needs because it might be seen as unmanly unmanly boundaries and rejection communicating when they don't want sex and lastly the script which is discussing fantasies that deviate from the norm so i want to talk about fantasy but before that i would just say that you know it because of social media we're in a place and i get text messages from my husband 24 hours a day with like not 24 Friday, but like all waking hours with reels and videos.

1:50:30Oh, I think you'd like this. I think you'd like this. You should check this out. And it's like his way of like connecting and like, Hey, let's talk about this later. Like, this is fun. And so I tell my patients, like, send your partner a video that you saw on social media that might help them understand like why this is important to you. Maybe send them a video, send them this podcast, right? Say like, Hey, I watched this. It was great. You know? And I learned so much. And honestly, so many patients bring their partners to me, whether it's women bringing male partners or men bringing female partners, they come to me and they say, look, like, I want you to meet this doctor and I want you to talk to them.

1:51:02And like, it's beautiful to see that. Like, I love it because it's, it's so deeply caring that they like brought 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 lovely to, to, to find someone who's so invested in making sure that sex is good for you. Right. As men though, we're just not good at talking about this stuff. Right, but you know, I think you can't use that as a crutch Yeah Do you know what I mean? Yeah, I do, yeah We're just not good at it though But no one's good at it It's not men Women are not good at it either I think men are worse at it I think in general no one is good at talking about sex Like, you know, I think it's interesting because I talk about it all the time But I have seen very good communicators struggle with talking about sex And so I think it's just, it's just, it's uncomfortable and and 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 can't learn how to talk about sex and it's it's a learning process and it's worth it's worth investing in do people bring you their fantasies yeah i've had i've had well more not not as many fantasies as like real sort of diverse interests in sex what do you mean so i had a patient who came to me and said uh you know after some time this was not like their first visit, like we built a rapport and he told me, you know, the, I really struggle with arousal.

1:52:22And the only time I get aroused is I have a medical kink. And so I go to this person who will put a Foley catheter in me and that's what turns me on. And I was like, that's really interesting. And I was like, okay, like that's, that's great. But like, it took a long time for us to get there for him to feel comfortable. But it also then was like, well, if that's what turns you on, you know, then you've got to sort of explore other ways to incorporate that with a partner maybe not so like a catheter is is um is a tube that you put in the bladder for to drain urine what hole does that go in the urethra it goes in the penis correct and so there's actually a lot of people who enjoy urethral play so they will take sounds they're called sounds like little um uh rods with a frail flared base and they will insert them in the urethra and but people do find not pleasurable.

1:53:12And so, because there is some, you know, there, there's some nerve endings there that can be pleasurable. And so again, it is totally fine to have interests that are, you know, outside what we call conventional. But of course, I think you need to, if that's something that you're really into, you have to sort of bring your partner into the, into the fold, if that's what really gets you turned on. Now, in terms of fantasies, almost everyone fantasizes, right? Almost everyone does. And the interesting thing when you look at fantasies is there's a lot of fantasies that you would think are not common but are so for example being sexually submissive is very common so women fantasize about it like around 60 men are like 20 having this desire of sexual this fantasy of sexual submission it may not mean that they want to be submissive in real life but that's the fantasy they're having men often have a voyeurism fantasy so like watching sex.

1:54:08They also have sex with multiple partners. Women tend to have a lot of like sexual dominance, but also romance in their fantasies. So like in exotic places or or with a lot of times, like 90 % of the time people fantasize about strangers or it could be someone they know, but outside of their relationship. And so that's completely normal and nothing to be worried about. It doesn't mean that like you want that person, it's just a fantasy. It's a safe place in your head to think about fantasy. And I think one realizing if someone fantasizes about something it means nothing about how they feel about you it's just where their brain goes to explore i tell my patients sometimes write down your fantasies for yourself just like write them down don't share that with anybody and have your partner do the same and then if you guys decide you feel comfortable at some point each share one fantasy and you can start talking maybe one that you would want to try and like it allows you to sort of explore and think about different things it could be a negative outcome like you could just like, oh, no, this what didn't do it for me.

1:55:03But it could also be very positive. And so just like, again, I think the big thing is understanding that it doesn't need to be that serious. Like, we can experiment, we can play, we can have fun. And if you bring that back into your life, you are going to be happier, less lonely, live longer. Like, everyone should just be having more sex. It's, yeah, it's interesting that we're getting more and more sexless, because I think the world is stealing our attention and that's causing a big loss in connection but then everyone's lives are more stressful than ever before if a bomb goes off 10 000 miles that way i see it when i open my phone um so it's an interesting time to sort of almost try and reclaim sex and to work on one's sexual health the overall the full picture of one's sexual health um you're working on a book which is i guess endeavoring to do much of that which is coming out in september called the hard truth everything men need to know about good health great sex and long life so if you're watching this after the 1st of september 2026 or around that time then the book is probably available for pre-order or already out it's not available for pre-order yet is it uh will be soon but not yet okay when the book is out i'm going to link it below in the comment section and when it's available for pre-order the hard truth everything men need to know about good health great sex and long life so if the subjects we talked about today have piqued your interest The book, I imagine, is going to go into greater detail on all of these subjects.

1:56:29Absolutely. I think it's a book that really I wish was a part of sexual education. I think all men need to know this. You know, as women, we end up taking care of our male partners. I make all the doctor's appointments. I, you know, I organize all of that. I make sure that my kids get all their vaccines, all that sort of stuff. And, you know, it becomes on us to take care of our fathers too. And so as women, we hold that role. And I think it is so valuable to understand what men go through and also to be able to support them along the way. And I think it's a great gift for, you know, men in your life or for, you know, older sons even to like help people understand their bodies.

1:57:08And honestly, it's a huge motivator. I tell people like for nothing else, people care about sex. And I have seen patients turn around their lives because they want to have better sex. They'll literally improve their blood sugars. They'll improve their blood pressure because they just want to protect their sexual health. Freena, thank you. We have a closing tradition on this podcast where the last guest leaves a question for the next guest, not knowing who they're leaving it for. This is the first time in Diary of Aseo history where the guest has actually stamped it with a stamp that says certified 100 % human.

1:57:40Okay. So you can see there's a little stamp. So it's not AI. So it's not AI. It actually says that in the middle. It says Gen AI free. sign of things to come. But that question, I guess, is somewhat linked to that. The question they've asked for you is, so much of the world feels hopeless about this moment. What would you tell someone to help them reclaim their agency? Wow.

1:58:10I think that we as humans are meant to be with other humans. We are meant to connect. And I think making that a priority will allow people to feel a part of something again. You know, I think there is like an emergence of people starting to look back at religious constructs and go to community and be a part of things and enjoy live events again like we weren't doing before. And I think if we prioritize that, there is still hope that we can come together as a society. And I think, you know, the pendulum always swings, right? In every way, like it's going to go far right or far left and people are going to hate each other and then they're going to love each other and they're going to come back.

1:58:59And I think if you just look at history time and time again, it repeats itself. And we will find unity and we will find togetherness. We are obviously feeling pain from a variety of different sources. And we may feel pain, right, like in terms of other things to come. But ultimately, I'm an optimist. And I think that we'll come together and we will find happiness and joy in human connection. And I hope you're right. I think we're seeing the early signs of that now. for anyone that's listening that wants to learn more from rena and i highly recommend they go to your youtube channel i will collab if we can um and if we do collab on youtube you'll see a little smiling rena um next to the diary of a seal logo where you can click through to her youtube channel she's got almost three million subscribers and she goes through all of the questions which no one has ever answered for us and i was looking at some of the questions that you answer people Everything from why you dribble after you pee and how to stop it.

1:59:58Porn director reveals what scenes are faked in almost every scene of movies. But then also a lot of the stuff we've talked about today around penal health, erectile dysfunction, sex positions, and so much more. So it's a wonderful repository of information that is constantly being updated. That is a great place to subscribe, so I highly recommend you do. Dr. Rina, thank you so much for your time. You're so welcome.

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