1254: Justin Houman | Wiggling Out of the Male Fertility Crisis

22:55But anyways, when blood pools around the testicle, it raises the testicular temperature. So it causes a couple of things. It could cause pain. That's probably the main reason guys come in. It causes infertility. One of the biggest factors of male factor infertility, it could cause hormonal disruption. It could lower your T levels as well. It can shrink the testicles. So this is like when your iPhone is old and starts overheating and runs slower, but it's when you're testing. Yeah, yeah. Jeez. Okay, so I'll have to have this checked out again because the TMI part. So if you got little kids in the car or you're with your grandma, fast forward a minute.

23:27But I had a vasectomy and it got infected and it was horrible because I had a grapefruit between my legs. Thankfully, I was on vacation. Mucho dolor. It was not good. And after that, the guy, one of the doctors was like, oh, you have a varicoseal. but I'm not 100 % sure that he was right because I had just gotten over this completely gnarly infection. Which side was it on? Left. Yeah, usually it's on the left. Really? Yeah. Why? Just the way it drains back to the body, the way the veins drain back. But yeah, you probably had one. Yeah, but it can go away, correct? No. No, so it's there forever now?

24:00It either stays the same or it gets worse. Oh, good to know. If you've already had a kid, you don't have testicular pain, nothing to worry about. No, nothing. He didn't check other than by doing the old grab and whatever. So you can just tell by that? You have to do some breathing, like, you know, breathe hard. Yeah. Yeah, you can feel it then. Huh. Okay. So why do so many of these things go undiagnosed? Aren't guys getting physicals or is this not something they look for? Guys aren't really regularly checking in with their doctors until something happens. Not good. Yeah. Come on. And that's a whole different conversation, but men really aren't engaging in the healthcare system.

24:30And then varicocil is really, to do that exam, you're only going to do it for those reasons I discussed, like infertility, pain. Even if you're having low T, no one's going to really check you for varicocel unless you go to certain doctors. He just said it's really easy to check for. It's a field test. So it seems like it should just be done every year. But the thing is, it's hard. For example, primary care doctors are the ones who see you for your physicals. It does take someone to know how to really - Got to feel a lot of balls before you. A lot. A lot. Gotcha. Yeah. You got to know what you're doing.

24:57You got to know what you're doing. Yeah. You think a GP would get a lot of practice anyway because they're still doing the hernia test. Yeah, but that one's pretty black and white. You know when someone has a hernia. Because you drop to the floor in a fetal position when you cough and you have a heartache. But this one, there's varying degrees of it. Sometimes you feel something, sometimes you don't. How do you treat that? Surgery only, huh? It's surgery. Very straightforward surgery. Yeah, they said about my vasectomy and look what happened. I don't know. I don't know if I trust that anymore.

25:22No, this one is. I just got really lucky. My urologist who did the vasectomy, that guy was like 65. He was like, I've done a thousand of these, minimum. And he's like, I've had two infections my entire career. And you're one of them? Every decade, I get one. I guess I'll take off my calendar is what he said. Something like that. It is very rare. Lucky me. But all's well that ends well, right? I mean, it was kind of a joke because I said, what could happen? And he said, you could be infertile. And it's just, urologists love joking about infertility, I guess. So how does the surgery work though?

25:49What do you do to get rid of it? Because the vasectomy, they get in there and they burn something. I don't know. Yeah, well, they cut the cord. Yeah. They cut the vas deferens. So this one is, we use a microscope, surgical microscope. We're looking at it like 15 to 20 times magnification. We make a small incision right in that groin area, pull up the cord, we find the veins, tie them off. In simple terms, that's really what we're doing. We just tie them off and we leave the rest of the structures there in place. Okay. So it's relatively simple, not a big deal. We do a couple of these a week. They're very, very common.

26:17Local anesthetic only kind of thing? No, you need general. You have to be asleep. But it's, yeah, it takes about 45 minutes, maybe an hour. Why is it so much more anesthesia than a vasectomy? We're making a larger incision. I see. The area is a sensitive area. Yes, sir. Yes, it is. I don't think you needed to explain that. Yeah, vasectomies are quick. Yeah, that's true. This was like 20 minutes. I was like, you are not done. I can't even believe it. It took me longer to get parking at Kaiser Permanente than it did for me to get snipped. Come on, Kaiser? Yeah. Nice. Okay, this is something that I've wanted to ask about for a while.

26:49I mean, this whole show is about dicks, but dick size is something that men are obsessed with, and I probably should include myself there. Correct me if I'm wrong. There's been a rise in penis size the last 40 years, average penis size. That's what I read, but how and why would that be true other than endocrine disruptors or making our dicks bigger? Is that it? So there was like a meta-analysis of a study that came out. I think it said we've gone in the last 80 years, we've gone from like 4.7 to 6 inches, which is a huge difference. Evolution doesn't take place that fast. Does sexual selection also not, right?

27:21It's not enough to generate, but it's going so fast. Like that number doesn't necessarily make sense. I think that's like a 25 % increase in 80 years. Imagine what's going to be in 80 years from now. what are we, eight inches? You better hope women's vaginas are keeping up. Right, right. Otherwise, we're going to have a big problem. No one really knows the answer to this, but I think endocrine disruptors are one. I think what's happening is the time when people are hitting puberty and what these endocrine disruptors are doing during the time of puberty when penis is growing in length, it could be throwing things off.

27:48But I also think some of this is just like a selection bias type thing. Who we're sampling, what we're looking at, it doesn't necessarily make sense to me in all honesty. Because you said meta-analysis, and look, those are valid for all kinds of things, but I'm always a little skeptical because you have to see all the studies that were included. And I've noticed, especially with penis size studies, there's huge data sets from other countries. And then when you look at the methodology, it's like, this is self-reported data among dudes in the military in Portugal. And you're like, oh, a bunch of 20-something-year-old dudes in the army in another country were like, yeah, I have a giant penis.

28:20Go figure. They told the female nurse who was writing down in the spreadsheet that they all had giant dicks. What a surprise. And then you see the measured ones where like a person injects a drug into the trimix or whatever it's called, into the penis and then uses like a specific bone press measurement. It's, oh, they match the average everywhere else in the world using that methodology. So I don't know. I'm always a little bit like asterisk whenever I see that penis size is increased. I'm sure it is, but you gotta take it with a grain of salt. That number is massive. It doesn't make sense. Before we talk about why your sperm count is dropping faster than your motivation to go to the gym, here's a quick word from the amazing sponsors that make this show possible.

28:58We'll be right back.

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32:00You can find the course, again, all for free at sixminutenetworking.com. Now, back to Dr. Justin Hooman. There's pollution all over the place, but some countries certainly have it worse than others. Wouldn't the West have different, potentially endocrine disrupting effects than, say, Asia, South America, Africa. I guess the question is, have we polluted the earth uniformly enough to make that a thing or not? That's the question. Because sexual selection would have theoretically been similar across populations, probably. Somebody who studies this, it would be very interesting to see. Measurement bias is the go-to when something like this shows up for me.

32:40A hundred percent. Tell me more about the puberty hormone exposure stuff. Because I know we have endocrine disruptors like in our shampoo, soap, water supply. What else could cause something like this if it's not just spurious data? Yeah. I mean, the endocrine disruptors, there's tons of these things around us. Some people are saying now that even like receipts are causing. That's definitely true. Like 80 % of receipts have some degree of these endocrine disruptors which throw off our hormones. That said, just for people who are worried, you'd have to touch thousands of receipts in order to have that problem.

33:10So if you're a cashier, big time issue, working at a restaurant, big time issue. If you touch a receipt at Chipotle every day, you'd need to like eat the receipts in order to get enough. I think it's BPA or something that's in there. So casual receipt handling, not an issue. But if you work with receipts, but here's the thing. When do men's penises grow during puberty? Because what kid is touching a shitload of receipts? Yeah, so the adult version of the penis. I see. It's during puberty. Okay. But during that time, I think what's happening is because of these endocrine disruptors, puberty is becoming elongated, right?

33:42This is the theory. It's a longer puberty period. As a result of that, your penis is getting exposed to some of these hormones for a longer period of time. Therefore, you're getting a longer length. You're selling it pretty good. Most guys are like, how many receipts do I have to eat after this podcast? I'm quite skeptical of it, in all honesty. I do think things are growing, but to this extent, there's no way. It's tough to predict, and I can only imagine the amount of fake crap out there for penis enlargement. Maybe we'll get to that in a bit. There's ads and stuff like that, but I'm going to go ahead and guess that nobody has quite nailed the ability to take a pill that you've ordered from an ad off Pornhub to make your penis grow.

34:21Get on it, man. Then we'll have the round two on your jet. Yeah, on your yacht. Yeah. So when we're in our 20s, 30s, 40s, can we go decade by decade and talk about how we might preserve or work on our hormones, sexual function, infertility? Is there anything guys should be doing in their 20s other than just not getting fat? Yeah. I mean, your 20s and 30s, you're really laying the groundwork for your 40s, 50s, and 60s. So simple terms, just get a good exercise routine, mix of cardio as well as heavy strength training a couple of times a week as much as you can. I know we've talked about this, but eating right is quite important.

34:55minimize your stress as much as possible and then sleep. Those are the big things there. Early on, it's simple stuff. You don't need to supplement. The supplementation and all that stuff, that's the gravy, but you got to get the mashed potatoes. You got to do those four things in order to set the ground table for everything else going forward. And that's in 20s, 30s, and 40s, I assume. Yeah, 20s, 30s. And then once you hit your 40s, this is when we start talking about some other things. What can guys do at this point to optimize? Our testosterone levels start to declined starting at the age of 30.

35:22We say one to 2 % every year. What can you do at that point? Let's say you're getting poor sleep, you're stressed out, you check your T levels, they're low. Repeat that test in a couple of weeks, see what the levels are at. If they are low, then you have to start thinking about other ways in which you could boost your levels. So there's other ways, like the supplementation, some of those things that you talked about. We talked about Clomid, which is a medication that could basically tell your testicles to produce more testosterone. There's HCG, these are all natural. Well, there's still pharmaceuticals, right?

35:49But HCG I'm familiar with. Actually, I think, isn't HCG and clomid, isn't that what steroid guys use after they come off their cycle to restart? Okay. I see. That restarts the natural testosterone production in the body. And then once you get into your 40s, this is one thing I actually recommend. So starting at the age of 40, I tell guys they should start taking Cialis regularly. Okay. Talk about this because I take this for gym pumps. It's from my doctor, but he's like, you don't need this, but it's good for the gym. And it's somehow cardioprotective because it dilates my veins. Is that right?

36:22The arteries. Arteries. Okay. Yeah. So it's specific for the pelvic area of the penis in terms of dilation, dilates the arteries of the penis. Therefore you get strong erections. What's the difference between a vein and an artery again? I know I should learn this in seventh grade. Artery takes blood flow to the organ and then veins bring blood back. Okay. Got it. Thank you. So it dilates these areas. We do have some idea now that it could help even systemically. There's some blood vessel dilation that could even take place in the rest of your body. And that's not bad for me. No, unless you've had a history of heart attacks where you're on medication because your blood pressure has dropped significantly.

36:56If you're on nitrites for your heart, basically, those are the patients who are at risk of this. Cialis, like a low dose of Cialis, incredibly rare where it actually drops your blood pressure significantly. It is safe to take. What's a low dose? Because I know people right now are looking, you can get it online from an air quotes doctor that looks at your email when you submit the form and then mails you like a packet of it. People are going to overdo it if we don't tell them what a low dose is. So five milligrams is generally the lowest dose and some people actually take two and a half milligrams.

37:26But I'm not saying take it every day, but once or twice a week. Okay. Starting at the age of 40, especially even if you don't have ED, because we're all going to get ED at some point, but it delays the onset of it. That's the idea. biochemically, we never develop a tolerance to this. If you start, let's say 10 years from now, it's working less and less. It's not because of the medication. It's just progression of disease. You want to call ED a disease. Your erections are just getting worse because of other things. Honestly, I'm not sure that I can tell the difference because I'll stop taking it if I forget it on a vacation.

37:56And I honestly don't know the difference. So I take that to be a good thing because that maybe means I don't need it for the activities that happen when you usually take that. But I don't know. I have heard that it's good for your heart because it lowers your blood pressure, but you're saying that not appreciably so unless it's a higher dose. It's not a blood pressure thing. It basically helps to alleate your arteries to the whole body, which is only good. That can only help you. I do notice if I take a 20 minutes before a workout, you get crazy pumps and probably better recovery, which is why they prescribed it in the first place for me.

38:28If you want it, you could do L-citrulline. I take that too. I take both. That's fine. But if people don't want to jump on the Cialis train, Doing L-citrulline, 3 ,000 milligrams, three grams daily, that works well too. And that stuff is cheap, man. I think I got a huge bottle of 300 tabs for 40 bucks, 20 bucks. It's also seemingly noticeable. Look, could be placebo, but it's a pre-work. For sure. We already talked about banking sperm, but what about testosterone tests? When should guys start testing their testosterone? If you're having symptoms, I wouldn't necessarily jump into testing unless you're really having symptoms because this is the thing about testosterone.

39:03The range is 300 to 1 ,000. which is pretty unfair for a number of reasons. But one guy, like for example, for me, when I'm 500, I feel great. For somebody else, if they're not at 750, and anything below 750, they don't feel very good. So if you go to a doctor, they can be like, you're in the normal range, I'm not going to really treat you for it. Also, so what, if you're 301, you're okay, but if you're 299, you're low T. That's how healthcare works though, man. You're a doctor, you know this. Right, unless you go to somebody who knows what they're talking about, right? But anyways, it comes down to, if you're having symptoms, Get it checked out.

39:36Some guys have all the symptoms. Some guys have one of these symptoms, but it's low energy, not exercising the way you used to. Sexual function is a big one. Whether you have poor erections, your libido, your sex drive is not there. Even when you go to the gym, you're not exercising the way you used to. Sleep is a big one too. People feel like they're sleeping. They have a lot of sleep disruptions. Even mood, like anxiety and more so depression than anxiety, but mood's a big one. A buddy of mine who works for this show, actually, Nick Pell, one of the writers for the show, he was depressed. I've known him for a long time.

40:06He was depressed. And then he started using testosterone, essentially steroids. He admits this. It's fine. Everyone's like, oh, it's bad for you. And he's like, you know, it's bad for me. Wanted to kill myself in the morning, literally. And it's hard to argue with that. Now, should he have used other alternative methods to try and raise it naturally? Whatever may be possibly debatable. But there's a lot of guys out there. Whenever people tell me I'm having a midlife crisis, I'm depressed, this, that, And the other thing, I always recommend getting their blood work because you might think your entire life is falling apart, but you might also just have some shitty blood work that needs to get handled.

40:39Yeah, could help. I have a psychiatry buddy who screens when a guy's depressed. He'll screen them for low T. Good. I feel like that should be step one. Agreed. Pretty much. Agreed. I know so many guys who say that they're depressed. And then the mind is weird. We don't want to go, I'm depressed because of no reason. They go, oh, I'm depressed because my career is not where it was supposed to be. And my marriage isn't what it was supposed to be. And I'm stressed out about my kids and I'm not sleeping well. Or did your brain look at all those things and decide that's why you were feeling this way?

41:07Because it needs a reason. And this is what happened to a lot of friends of mine and myself as well. When I get sick, I start to go, I'm not happy with this and this and this and this. And then when I'm better, I'm like, was I tripping about it? It's all fine. And it's because your mind looks for a reason to feel down instead of just going, I have a hormone problem or my blood work. Your mind doesn't know that your mind doesn't know that your body's tripping. So if you feel like crap right now and you're struggling to get out of bed, go get blood work done, even if you have to pay for it out of pocket because your doctor is giving you trouble.

41:39And if you have low testosterone or even if your doctor says your T is normal, but it's under, I don't know. Like low normal, if it's in the low end of the normal range. get a second opinion because my testosterone was normal. But then when it was fixed, I felt like a totally different person. The closest analogy I have is when I started taking Adderall in college because I got diagnosed with ADD. Surprise, surprise. And I took Adderall and I was like, wait, is this how normal people feel every day? They can just listen to a teacher talk for 45 minutes and they don't look at the sky in the room and count the holes in the ceiling tiles.

42:14This is unbelievable. That's what getting my T fixed felt like. It was like, oh, I want to get up in the morning and I want to work hard and I want to work out. And then I want to do all the other things that are intended to having normal testosterone. It was like starting to see in color from black and white. So if you're feeling down or you're feeling a little rough around the edges, go get your blood work done. What about proactive testing strategies for guys who want to stay ahead? What if you don't have symptoms? does it make sense to go get a baseline of testosterone when you're 30 just to see because if you need it again in five years and it's way down or way up you know that you can look back in time like how to optimize well because when i was 33 i got a ceo health check gifted to me by a show fan and it was like vo2 max testosterone all your blood levels i look back at those documents now and i go holy crap i had 39 body fat my testosterone was 250 when I was 33, I'm 45.

43:10I'm objectively healthier in pretty much every single category. Like my triglycerides are lower, my testosterone is higher, my cholesterol is lower, everything. Obviously my body fat is not 40%. So I can look at that and I go, I don't have this delusion that I was healthier when I was younger. I can actually look at the data and it's been helpful for doctors now because they'll go, oh, you've probably always had this level of testosterone. You don't know that it's the medication. And I go, actually, here's blood work from five years ago, 10 years ago, 15 years ago, all laid out nicely, and they can see the trend instead of just guessing.

43:43Is that valuable at all? The trends for sure. Yeah. Definitely. But the first part of your question in terms of what can guys do, younger guys are like, I know I have good, healthy testosterone, but I'm trying to optimize, right? I'm trying to take it to the next level. And now we do have some strategies because there's a lot of advancements in the testosterone replacement therapy world. Take them to the next level very safely, pushing the needle a little bit further. and that's a whole different way of treating these guys. These guys in their 40s and 50s, before 60s, 70s, 80s, these guys are usually in testosterone placement therapy, but 40s, 50s, 60s, we have different combinations of meds we could give them.

44:17What about guys in their 20s and 30s? Is there anything they can do now to, aside from diet and exercise, like we said, to either stay ahead or test for something that might bite them in the ass later? Yeah, in your 20s and 30s, again - You're on easy street, but you don't know that when you're 20 and 30. Exactly. You have no idea. You know, I'm broadly speaking here. Every part of your body's working well. Eat right, sleep right, exercise, minimize your stress. I can't stress enough. Those four things. But the exercise early on in your 20s and 30s is massive. Is it healthier to have kids younger?

44:49Is there a declining health to my offspring if I have kids in my 40s and 50s as opposed to in my 20s and 30s? You have increased risk. For example, as we age, our sperm become, they have different types of DNA issues. One of them can slightly increase the risk of autism, for example. Oh, really? Oh, they know that now. It slightly increases it. Slightly increase. But other genetic issues as well, just as similar to the female with her eggs, the older she gets, like increased risk of Down syndrome. My wife had to do extra screening because we had our second kid. She was 35, I want to say. They call that a geriatric pregnancy, which sounds harsh.

45:23she did not like hearing that. Let me tell you. Yeah. Increased risk. As we age, there's slightly increased. We say autism is one, but there's other ones that can increase as well for sure. Do you notice any psychological impacts from male infertility? It's hard to put myself in the shoes of many of my friends who are having trouble, but there's something about it that kind of like reaches into the core of their identity as a man in a way, Even if it's a problem on the other side of the wife's physical problem, there's just something about it that I think for a couple is uniquely difficult and traumatizing, devastating.

45:59It really gets to the core. If you can't even do this one thing that you're put on this earth to do, I don't know. It screws with you. Have you seen that? Yeah, I'd say it leads to relationship issues. Yeah, okay. Yeah. So I think men for the most part, and obviously there's extremes on both ends of this, but men for the most part, once they get the news, it's a punch in the gut, no doubt, especially if it's them. But fertility issues as a whole can lead to a lot of relationship issues because it becomes a finger pointing thing. It's like, who's at fault? You're smoking a cigarette now. You shouldn't be smoking a cigarette.

46:29Why are you in the hot tub? I'm doing all these things to help myself out, to increase our chances. You're not doing those things. You're out there drinking, whatever it is. But it can lead to a lot of relationship issues because they're trying to get to that end goal. Not so ironically, but that makes things a lot worse. Of course, the stress, right? Yeah. So does mental health stress lower testosterone or does lower testosterone cause depression and worse mental health or both? Yeah, it goes both. Okay. Yeah. As you can imagine, if you have a mental health issue with anxiety, depression, poor sleep, you're not exercising, you're not eating right, you're not out socializing, it's worsening things for you, you're not getting the vitamin D from the sun.

47:06I actually say they go hand in hand. Mental health and hormonal health really do go hand in hand. if you're out there socializing, getting exercise, seeing the sun, those types of things, it's good for everything. That was another thing I was massively deficient in was vitamin D. It was like rock bottom, terrible. And then I started supplementing it ironically, coincidentally, whatever, wanted to go outside all the time. And then my vitamin D was too high because I was outside seven days a week rucking. So I just cut back on the supplementation. And it's like, it was way over the limit because I was getting it from the sun and from supplementation.

47:37How long were you in this period or high T? Oh, high T, probably like four months. Felt great. Oh my God. It was like being a superhero, except for the fact that it's not good for you. I didn't have any real side effects because I wasn't angry or anything, but the testosterone test only went to, I want to say 1500. And it just said greater than 1500. So it means you could be 2500, unlikely because I wasn't taking testosterone itself. But I was like, Where was this energy in my 20s? Because this would have come in handy, I think, back then. People hear this, they're like, I want to get on TRT. Yeah, don't take TRT though.

48:14I took magnesium, vitamin D, some DHEA, and a couple of other magnesium and stuff for sleep. And my hormones went through the damn roof because I was deficient and I was sleeping like shit. Surprise. And then, of course, I was working out and eating vegetables and chicken instead of freaking processed foods. I was also eating some processed foods, but not exclusively like I was when I grew up in Michigan. I love Cheetos. Some nice Flaming Hot. So good. Oh, yeah. Any version of Crunchy Cheetos, I will eat it. I don't care. Lime, Flaming Hot, regular, I'm there. What is your opinion on there's these new pills that men can take for birth control?

48:49I'm not a doctor, but I always recommend women also avoid hormonal birth control, just from what I've read about it. It screws with your whole body. People think you take a pill, it affects one part of you. That's not how anything works medication-wise. Yeah, it's hard for it to be for sure. Like a vasectomy, we've been doing vasectomies for decades. And it's a physical thing. Plumbing is no longer routed in the same way, the end. Yeah. So it's old school, but it works. And I know there's new technologies. They're trying to basically replace the vasectomy. There's different polymers they're trying to inject in there.

49:19They inject it in the lumen, right? In that inner part of the vas deferens. Oh, and then you can dissolve it if you want to reverse it? Exactly. But that procedure itself is basically half of a vasectomy. In order for them to get access to that inside, they're still opening you up. I see. So it's just as invasive? You know, it's basically half as invasive, if you will. Right now, I don't think we're there for any of these procedures or these medications like the pills. I think we'll eventually get there. We're just not there yet. Yeah. Vasectomy is still the gold standard. It's great. I tell guys it takes seven or eight minutes.

49:47I know you had a bad experience, but you're in, you're out. I looked at the stats before and after, and I was just unlucky. I had a one in 2000 or something chance of getting an infection and I got lucky there. And it's like one of those things where you go, oh my gosh, would you have done it? Yes, I did the right thing, even though I had an unlucky roll. I still did the right thing. I still got the right result. If I had to have both my testicles removed or something as a result of that infection, then I would probably have gone like, well, shit, that's not what I wanted at all. But since I'm totally fine now, I think it doesn't really matter.

50:20But I'm worried about these male contraceptives because I feel like this is one of those things where they go, hey, there's no side effects. And if you just stop taking it, you'll make sperm again. And then they find out years later that it causes pancreatic tumors or something, or it stops the production of semen because it stops something else that you need or want. Exactly. So that's what I'm saying. We're not there yet with these things. To shut off sperm production and then to take a pill, I'm sure you have to time it appropriately. Ultimately, the mechanical obstruction of stopping the route of sperm, it's the best way of doing it.

50:53Tell me about porn and sex here because there's a whole bunch of guys, they'll write in or I'll see it online and they'll say things like death grip. It's where they like they masturbate so much that their grip tightens over time to increase stimulation or something because their nerves are desensitized. So then when they have sex with a real woman, it's just too loose, even if it's a normal vagina, which to me is very odd to imagine, because I don't know how much masturbating you have to do to get there. But I can definitely say I've never been close. And I sure as hell tried. What amount do you have to be working on yourself here, cranking it to get desensitized to real sex?

51:34It's both grip and frequency. I mean, years and years, decades of masturbation. But yeah, it's a real thing. And guys, as much as premature ejaculation is a very real thing, delayed ejaculation is a very real thing. There's a friend of a friend, I should say, and he's in the adult entertainment industry. And I was like, wow, you must have crazy stories. And he's like, oh, come out with me and some of the girls. So one of the things the girls told me was that a lot of male stars, they have to use porn while they are on a porn set in order to finish. And I was like, wait, repeat that. You're filming a sexual scene with three women, but you're on your phone in the corner looking at a video of a guy who's not you having sex with three women so that you can finish.

52:15Because this is work. It's crazy to me. I feel bad for that guy. Like this man has ruined his penis, essentially. How do you recover from that? A lot of these guys are doing injections too. They're past the point of Viagra and Cialis. They're doing injections in the penis in order to get erections. Good God. And these guys are like in their 20s and 30s, right? Yeah. It's a job. What are they injecting? Asking for a friend. Think of it like liquid Viagra. There's different chemicals. Prostaglandin is the most common one. Brings more blood flow to the penis. But a lot of these young porn stars, I mean, we've seen them, given where we are, where our office is.

52:46That's good. Where's your office? Right down the street here. Yeah, here in Beverly Hills. I thought they'd be more in the valley, but, you know, times have changed. They come here and we see a lot of these patients. And not only are they young guys who are doing the injections, there's even younger guys who are getting the penile implants. Like guys in their 30s and 40s are getting penile implants. They've exhausted the medications, Viagra, Cialysis. The injections don't work anymore. All they could do now is the penile implants. So is the implant for size or is the implant because they can't get an erection?

53:13Purely for function. Oh my God. Yeah, it's a pump. We literally put a pump in their penis. It's all underneath the skin. How do you pump it up? There's a pump that sits in between the testicles in the scrotum. So you have a third nut. You have a third nut. That's like a Reebok pump from the 90s. And you have a little reservoir in your belly. Get out of here. So every time you want to have an erection, the fluid from the reservoir goes into the cylinders, gives you a rock art erection. I think Reebok pump was 1989. Someone will correct me on this. That's actually incredible technology. Yeah. It's been around for decades too.

53:40We've been doing this for a long time. I have to appreciate that there is a third testicle that you pump and then something in your abdomen puts, I guess, a fluid into an implant in your penis and you can get it. That's actually just amazing. And then when you're done, there's a release button. Oh yeah. I suppose you would want that too. I wouldn't want to have to have that, but it would be nice to not have to have an erection at an inopportune time. You're on the airplane wearing your joggers, hypothetically folks. And yeah, you're like, crap, where's my sweater? I got to tie this thing around my waist.

54:10It's a good problem to have. Yeah. At age 45, Again, for those who might have it It's that daily Cialis, exactly So what is the cure then If you've got the porn brain And you can't get an erection Are you screwed now Or do you just quit porn And it comes back eventually? Yeah, so look I see a lot of young guys Who have porn-induced ED, right? They're watching too much porn When real life comes about This is nothing compared To what I've seen on the screen This girl doesn't match up Whatever it is The good thing is I could tell you, like, anecdotally If guys stop for honestly, like a couple of weeks, you'll start to notice the difference.

54:45Obviously, look, you have to make a long-term change, but within a couple of weeks, I'd say guys are able to notice a change. I'll have these guys come back four weeks later. Some of them, I'd say most of them, the majority of them are like, look, I'm noticing something, right? And the longer they do it, the better off they'll be. There's a lot of plasticity here. So the nerves of the penis get more sensitive, the less you death grip it, you're talking about, the less you do it. So no one is screwed with this. You're not screwed. Just change these habits, break these habits, and things will generally speaking, they'll resolve.

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59:18We're happy to surface codes for you. Yes, it's that important that you support those who support the show. Now for the rest of my conversation with Dr. Justin Hooman. It's really easy to judge guys who get hooked on porn or watch too much porn, but I don't know. Look, as a guy who grew up in the 80s and 90s, I have real sympathy for people who grew up with unlimited pornographic shit on the internet, accessible at all times. How do you stay away from it? There's no chance I would have stayed away from it as a teenager. There's no way. It's not, I'm old enough to know you shouldn't do that. There's no scenario in which I wouldn't have watched porn constantly as a teenager.

59:55Zero chance. I just didn't have access to it. If I wanted to download a pornographic image, it would take 20 minutes on dial. 56K. Yeah. That's even if, or 28 or 14.4, man. And even that was good tech in the early 90s. Go, John. My mom caught me downloading a porn GIF once. I remember it was a woman with a life vest on a jet ski, like touching herself. I was like, almost done. And my mom came in and was like, what are you doing? Turn this off. It was all pixelated. Yeah, it was like probably like a tiny, you know, bitmap or whatever. It's just absolute trash. And it's funny. I remember what that was because it was such an impression on me as a kid.

1:00:31That was all I had access to, man. I didn't have Pornhub streaming to my iPad under my blankets at night at age 13 or whatever kids have now. So I have real sympathy for guys that get stuck with this problem because when you're 13, 14, 15, you don't think, Like, gee, if I do this for a decade, I'm going to cause myself a real problem. That's not something that kids think about. At all. Yeah. I would tell you this. Like, these young guys who come in, this porn-induced ED, it actually leads to these guys get anxiety as a result of it. Of course. It literally leads to mental health issues. They have anxiety.

1:01:03They have ED. And as a result of it, they get anxiety. And then they come to us. I'm a urologist. And I'm thinking about something. You've got to go to a therapist, right? This is past the point of what we do. It's really a bad cascade. I agree, man. And it's awful. I got an email that was like, I'm afraid to date women. And I was like, they're not so bad. What are you scared of? And he's like, no, it's not I'm even bad with women. If I'm good with women and she wants to have sex with me and I can't get it up because porn induced ED, I'm 22. She's going to tell her friends. And I'm like, God, you're not wrong.

1:01:31That could happen. And then what? So he's like, I'm just avoiding it. So he doesn't even go on dates. And I'm like, you're actually handicapping yourself socially because you have porn induced erectile dysfunction at age 22. too. It's really, it's quite tragic. Porn at that age, F's you up. Yes. Yeah. Cause your brain's still developing. So guys stop watching the porn. I know it's fun and entertaining. Minimize it at the very least. Yeah. Instead of daily, I don't know, wait until you're about to explode and then take care of it. I don't know. What's a healthy porn use. I don't even know. I'll tell you, I had a therapist, a sex therapist who told me this, like I refer her patients and she said something good.

1:02:07She was like, for every two times you watch porn for masturbation, one time don't, But really, you could masturbate. It's fine to masturbate, but obviously within a normal amount. But do it without porn. Theater of the mind only? Yeah, use that creative mind. That's crazy. Some guys right now are just like, how do I do that? Yeah, what's that? Yeah, what's that? Imagination? What's that? It's like when your phone battery's low and the video won't play. Yeah, it's slow internet, guys. I did a show recently on insulin. Men and women, for that matter, though, have insulin issues, cortisol issues.

1:02:38Thyroid issues seem to be quite common now. Again, I don't know if there's more thyroid issues or if they're just getting caught more because of testing. How do you manage things like that? Or do you not view those as important as, say, testosterone management? We do know that insulin is part of the bigger picture of diabetes and making sure if your blood glucose levels are high, you always want to change your diet, clean that up to minimize that. That's the insulin part. But thyroid hormone is very closely related to testosterone. So if you have low T, you always want to check your TSH, which is part of the thyroid cascade.

1:03:08TSH? Yeah, thyroid stimulating hormone. You want to check that? So that's part of the panel that most doctors will check. Is that what T3 is? T3 is one of the thyroid hormones themselves. But that's part of the comprehensive hormonal panel. Cortisol, people are checking cortisol more and more. And this is the one that, well, you're going to check your cortisol. Your cortisol levels are high. You can probably change your lifestyle. It's more of these things. What are you going to do with this data? Well, you got to try to minimize your stress levels, which is if anyone knows how to do that. Yeah, let me know.

1:03:35Exactly. Jeez. These tests, we're learning more and more about the whole complete picture. I do think some of these tests, you don't necessarily need them as much, but we're slowly getting there. We're getting better tests to fill in the whole comprehensive picture. I know there's Cialis, for example, but there's also PRP. Can we talk about PRP, shockwave, Botox? Let's talk about these things. I wonder what sort of hype and what's proven. Maybe we start with PRP. That sets off alarm bells because PRP is like, oh, put it in your knee and your knee's better. Put it in your elbow, your elbow's better.

1:04:05People are just injecting this everywhere they can and somehow it fixes everything. that always makes me give some side eye. Yeah, it's made its way to the penis now. Of course, yeah. Yeah, so PRP is you spin down the blood. We draw a large amount of blood from you. We spin it down. And then there's a portion of the blood which is rich in growth factors. And what we do is we inject that into your penis, about 10 cc's of it. Whoa, that's a lot. Yeah, it's a decent amount. You said it's platelet-rich plasma. Is it my plasma? Oh, yeah. Okay, so you take it from my blood. Yeah. Oh, that's cool. The process is you come in, we draw blood.

1:04:37We spin it down for about 30 minutes in order for us to collect that specific platelet-rich component. How much blood do you need to get 10 cc's of the platelet-rich? Yeah, we usually take about 60 cc's of blood. Oh, wow. 60 milliliters. So this is like distilling my blood down to one specific part of it. Yeah, it's like petroleum. When we're refining petroleum, same idea. Huh. You're swollen after you get 10 cc's of liquid. It's a flaccid penis, and then you're injecting it. So it could hold it. I try to keep it in there for like an hour and a half, two hours. I tell patients to keep it. we tourniquet the penis in order to keep it in place.

1:05:08You wear a tourniquet on your penis for an hour? We wrap it. We do a special wrap on it. Oh, because I was like, again, I'm no doctor, but isn't it going to turn blue and fall off? No, no, no. We don't cut it off completely. But it's growth factors in the penis. If you asked me anecdotally a few years ago, guys liked it. Now we have data to support its use. It does help with erections, definitely, in terms of it helps with basically some of the smooth muscle regeneration within the penis to create more elasticity so more blood flow comes in for stronger erections. I would say if you're going to do PRP and whatnot, all of these things that we're going to talk about, these are after doing Viagra and Cialis.

1:05:42Or at least you want to be doing Viagra and Cialis while you're doing these things because they only help. How do you know if you need something beyond Viagra or Cialis? Is it because the Cialis just stops working and you can't get or keep an erection? Like what's the red flag that you're looking for? Because I have no idea if my erection quality is as good as it was 10 years ago. Like there's no meter I put on there. I haven't hooked it up to any machinery. Yeah. It's like there's no objective number. So there's two components. There's two classes, two groups of guys. So one of them is the vagrant cells just aren't working anymore.

1:06:12And they're like, all right, well, I have to try something else. We'll try these things. And sometimes they jump into the injection. Sometimes they jump to the implant. And then there's the other group where they're like, look, I'm young. I'm healthy. I feel good. I microdose Cialis every once in a while, but I want to optimize my erections. And that's when we talk about PRP. Shockwave is a great one. Tell me about that. Shockwave. Yeah. Shockwave is fantastic. fantastic i'd actually say shockwave is probably amongst all these things shockwave is probably the best one the way i came about is as urologists we treat kidney stones right oh i never thought about that i thought you only did erection shit here no that's right you're a real doctor that does other things kidney stones anyways so we treat kidney stones one of the ways we do it is with high energy sound waves from the outside you can just break the stone up into pieces exactly no kidding from the back right okay and long story short one time they looked into the kidney They're like, wow, this kidney, one of these patients who had numerous shockwave treatments, like, wow, this kidney looks very well vascularized.

1:07:06I wonder what this high-energy sound wave is doing. So we've done a lot of studies on this, and we see now that high-energy sound waves can lead to neovascularization or new blood vessel growth. It's creating microtraumas. Yeah, that's what I was going to say. It's rupturing your tissue, so it regrows. That microtrauma essentially, it doesn't kill it, but a little bit of microtrauma eventually leads to new blood vessel growth. Wow. It works. So we do it for the erections. There's orthopedic surgeons who do it for tendons. If you're having any type of tendinopathy, it works there as well. There's some cardiac surgeons who are doing it for the heart because it penetrates deep.

1:07:40And it's great. I would say that if you're trying to optimize your sexual health, like your erections, that's the best way of doing it. How many times do you have to get things like PRP or shockwave? Like, is it around and then it's done or is PRP ongoing, shockwave ongoing? What is it like? So we know what the induction course is, if you will, loading those beginning part, But then the maintenance part, this is the part where we're figuring that part out. Shockwave therapy, it's six treatments over either three or six weeks. And each one takes maybe 15, 20 minutes. And it doesn't really hurt.

1:08:09This little at-home device, which I know is not the same thing as getting it done in a clinic. And I guess I will be, I don't know, shocking my dong with that later on. That thing sounds like a jackhammer. I bet. The neighbors of the hotel are going to be thrilled. They'll be hearing it. And then PRP is just two treatments. But ultimately, I'd say if these work for you. I have patients who come in quarterly or twice a year just for repeat treatments. Wow. Two treatments of PRP in your ED is in some people solved. That's awesome. Not solved. None of this is solved. Are your erections like a six out of 10?

1:08:40Can we get it to eight, maybe a nine out of 10? Like that kind of movement. It moves the needle in the right direction. That's phenomenal. The shockwave thing is quite interesting. I mean, six treatments over six weeks. I'm thinking if you have to do it over that specific period of time or can only do it once a month. Is that helpful or not as much? Not as much. The cumulative effect of these treatments, that's the thing that works best. Gotcha. What about Botox? I've actually heard about this and I did an episode on penile enhancement and I was like curious about this. So I went to a doctor and asked about it and he offered to give it to me.

1:09:09And he put that in. It was like, I'll do this. It's like minimally invasive, right? It's a tiny little, I think, insulin like needle or something. And I will say I don't have EDs, so I can't say that it helped or anything, I probably wouldn't do it again because I'm not a big fan of injecting things into myself for no good reason. I did it for the show, but tell me how this works, supposedly. Did you notice anything? I actually noticed that it maybe did the opposite. And I can't tell, again, because it's like placebo, nocebo kind of stuff. But I'm like, huh, I can't tell if it made things better or if it actually relaxed too much and now it's not as good.

1:09:47Because I noticed that it wore off and I feel like it's better now. So I'm on the fence. Maybe I took too much, or if you don't need it, it does bad things. And if you do need it, it does good things. I really don't know. Or maybe he gave you too little. Too little, I see. Maybe. Huh, okay. It's too small of a dose. But anyways, what does Botox do? It relaxes muscles. So the idea here was it relaxes the smooth muscles. So his arteries dilates them, so more blood flow comes in. It's like Cialis, what Cialis does though. Exactly. Same idea, but this is like a stronger dose. Botox is very concentrated around the penis.

1:10:21We've done penile ultrasounds on patients before and after Botox. And objectively, like the pulse wave, the amount of blood flow, the velocity in which blood is coming into the penis is definitely higher after Botox. So the objective data supports it, but like clinically, does it make an impact? I have some patients who love it. They come in every three months for it. Some guys love this thing and other guys, no response. Huh, interesting. That's why I wouldn't put it at the top of that list. Okay, but what do you think's at the top? Shockwave, you said? Yeah, shockwave and BRP for sure. What about exosomes?

1:10:51Do you use those? Those are like always hit the news cycle. It's like micro RNA type proteins that can only help with the idea. I know people are using it for pain throughout their body. People are injecting it in the veins to see it goes anywhere in the body and people love it. We've done it for the penis. We do it with PRP. So to what extent is it the exosomes? Is it the PRP? TBD on that one. PRP looks like it hurts. I looked up a video of this happening and I'm like, that's a big needle going into your penis. No, do you use small needles for that? Oh, really? Oh yeah. Okay. You could use a small needle for not an insulin needle, but a small one.

1:11:23Okay. Yeah. It just, there's something viscerally unappealing about a needle going into your penis. I try to numb guys up for that. I bet. Yeah. Do them a favor. I'll visit if I ever feel the need to get the PRP. I always want to try this stuff, but I'm also like, I have this, maybe it's a cognitive bias where I'm like, okay, if it ain't broke, don't fix it. And whenever it comes to medicine, you don't just get the one thing that you want. There's always something else that maybe happens if we don't necessarily fully understand. Oh yeah. Everything's a trade-off. Yeah. So it's like, I don't know how much I need X, Y, Z.

1:11:55So even with the Cialis thing, I'm like, I always am looking at, is there new research that says that this maybe isn't so good for you? Is there anything I need to avoid as a result of this? Just, I'm always sort of a little bit risk averse maybe when it comes to medication. What do you make of the whole like penis pump, penis extension device thing? Some of it maybe works. If you stretch tissue for two hours a day for a year, is that going to make it longer? I don't know. Yeah. It's the vacuum erection device. Or just the ones that clamp onto the glands, the head, and they literally pull. Restorax.

1:12:27Yes. I researched that for an episode. They can only help. To what extent are you going to get maybe a centimeter, maybe two centimeters. Yeah. Not even a full inch, basically. Half inch. Yeah, it's hard to get that. I would tell you this. If you're putting the penis on stretch for long periods of time throughout the course of months, yeah, you could get better length on that. The Restorex is one of those things that you can't be functional. You can't move around your daily life with that thing on. No, I saw one because, again, I researched it for our Skeptical Sunday on penis enhancement. And it also helps get rid of curves if you curve left, right, up, down.

1:12:59But it straps in between in your legs. It's this big piece of plastic and then it's got like metal rods. So you're not going to the grocery store with this thing on. You probably can't even walk with the thing on. It's like a scaffold to your penis. Yes, it's a scaffolding around your penis. But continuous weight or stretch, like any other part of our body, it'll add length to it. Small amounts, like you're not going from four to eight inches. But yeah, you could get a few centimeters. Okay. But man, what a commitment to get not even an inch of length. Although I guess if you're below average.

1:13:27We have, what is it, a micropenis? You take whatever you get. Yeah. There's surgeries now that offer girth and length. What kind of surgeries are those? You look into Pneuma. What is that? They call it the hemplant now. Oh, yes. I've heard of that. It's like they put a silicone sheath underneath the skin, but outside the erectile bodies of the penis. And that adds girth. But what we're seeing is over time, because it's continuously stretching, it adds length as well. I see. Yeah. So that's the continuous stretch I talk about. The problem I've seen with that online is that when I researched this, since it's a silicone sheaf, your body responds by basically building a wall around it.

1:14:08A capsule. Yes. And that capsule can become rigid and scar-ish and it can actually shrink. So it pulls inwards. The other problem, I think, was that having rubber or silicone inside your penis can rub against the skin. If that happens a lot, it can just rub through the outside of the skin. Yeah. And then if you ever wrote in that area, you got to take it out. It's an infection. It's a big mess. I don't know how you take something like that out without also destroying other tissue around it. It just makes me clam up thinking of that. Comes with risk. No question about it. That's scary. What about the pumps and things like that?

1:14:46I've seen those. They seemed a little bit harmless at first, but I've also seen, unfortunately, I've seen many photos of guys who claim that they've used it for years. And I'm always like, what is wrong with your penis? Like discolored, weird looking. From the pumps. Yeah, because I guess what it does is it causes the blood vessels to burst if you overdo it. You overdo it, yeah. And then if you do that for long enough, you end up with, I forget what these are called, but basically like discolored rough skin. Like little hematomas? Is that what it is? It's essentially like bruises that don't go away.

1:15:17Is that what a hematoma is? Scars, basically. Yeah, like the skin is just discolored and brown. I talked with another doctor who does hyaluronic acid fillers, and I was like, oh, what about the pumps? And he's like, you can tell, he does a lot of adult stars too. You can tell when these guys come in because their dick looks like it's just been abused from the pump. There is some role for the pumps though. I will say like, for example, with this penile implant idea that I talked about, sometimes you have to take it out due to infection. Anyways, when they scar down as a result of it. So the pump itself really could restore some of that length.

1:15:49It gives them that elasticity. They're doing this for a couple months before we go back in there. But if you're overdoing the pump, it could cause damage for sure. Yeah, it just seems like a tough thing to not overdo. If you're trying to make your penis bigger, you're going to overdo it. That's kind of the idea, right? Yeah. So we've optimized like sexual function, like ED. We've figured out ways of optimizing that hormonal health. But when it comes to optimizing length, we don't have it. Everything comes with risk. So you got to be careful. What do you think of the other enhancement procedures that are out there on the market?

1:16:19There's hyaluronic acid fillers, which I just mentioned. Tell me what you think about that. That seems to be like maybe the only safe-ish thing. Because there's PMMA, which is like a plastic, but you get granulomas over years, which are essentially, what are those again? Those granulomas just come about because either the way they've injected is not uniform or your body is absorbing certain parts of that injectable material, but not other parts of it. So it becomes like your body's absorbing some of it. What's left is this weird... Bumpy, uneven. It really doesn't look good. Imagine trying to take out a little silicone bead, but there's a thousand of them, right?

1:16:56Or a hundred thousand. That surgery is messy. And the thing is the nerves for the penis for sensation are right there. So that surgery gets very messy. Yeah. So hyaluronic acid, what appealed about that when I looked at the safety profile was that it just goes away over time. And also you can dissolve it using enzyme. So like anything where there's an undo switch that takes hours to a day, that seems way safer than injecting silicone or putting an implant in there. Yeah. You just want to go to somebody with anything, whether you're doing any type of surgery, you want to go to someone who knows what they're doing with the filler and you want to just have them guide you through the process.

1:17:30But someone who knows what they're doing, who does this regularly. One of my friends who was also a source on the show is Dr. Joel Pash. I don't know if you know him, but he owns upsized clinics. They have 24, 25 clinics. They only do the hyaluronic acid filler. And I asked why, because, man, you could make so much money doing all this stuff. And he basically told me all the downsides of how unsafe some of the other things are. The horror stories are really, they're bad, man. I know the ones that you've probably heard too, and I don't want to get sued, so I won't mention specific companies, but some of the stuff that we've talked about has complications where they say their complication rate is like 1%, but if I look at pending lawsuits on LexisNexis, there's a lot of them.

1:18:11allegations are pretty severe and the injuries that are caused are not worth it at all yeah like permanent scarring and disfigurement of your penis or having to take out necrotic tissue parts of your penis tissue is dead it's just not something you want to research before lunch and these guys are young guys these guys who are getting the surgery are young guys so be careful the obsession with size is something that i think a lot of guys probably should try to work on and get over, but I'm down for maximizing the health of the erection, especially because it seems like from this conversation, maximizing the erection health is maximizing your health in general.

1:18:51Yeah. There's very few times where I think to go to that extent for length and for girth and whatnot, it's a big leap to your point. Focus on your erectile function, your sexual health. Those things are more important. Get there. Thank you very much, man. Super interesting conversation. I know a lot of the women are like either tuned out or have learned a lot about dicks. But I think for guys, I know I needed to hear this stuff probably several years ago. I think it'll maybe some people who don't really care because they're married. Maybe if they find out that they're letting their dick stop working slowly by eating those Cheetos, this will be the motivation they need to clean it up.

1:19:26So thank you very much. My pleasure. Thank you very much. Really great conversation with Dr. Hooman. And if there's one takeaway here, it's that male fertility isn't just about making babies. It's a long-term health signal. Semen quality reflects cardiovascular function, metabolic health, hormone balance, even cancer risk. The earlier you pay attention, the better your chances of preserving fertility, sexual function, and overall longevity. We'll link Dr. Hooman's practice and resources in the show notes at jordanharbinger.com. If you haven't had a basic workup, testosterone, sperm analysis, vascular health, consider doing it.

1:20:00young guys especially don't wait until you're 40 and panicking be proactive future you will thank you and current me will also thank you for listening to the show advertisers deals discount codes and ways to support this podcast are searchable and clickable on the website at jordanharbinger.com slash deals please consider supporting those who support the show also our newsletter wee bit wiser it's a two-minute read just about every wednesday very practical something that'll affect your decisions psychology and or your relationships if you haven't signed up yet I invite you to come check it out.

1:20:30It is a great companion to the show. JordanHarbinger.com slash news is where you can find it. Don't forget about 6-Minute Networking as well over at 6MinuteNetworking.com. I'm at JordanHarbinger on Twitter and Instagram. You can also connect with me on LinkedIn. In this show, it's created in association with Podcast One. My team is Jen Harbinger, Jace Sanderson, Robert Fogarty, Tata Sidlowskis, Ian Baird, and Gabriel Mizrahi. Remember, we rise by lifting others. That sounds weird in an episode about erectile dysfunction, but I'm going to leave that right there. Anyway, the fee for the show is you share it with friends when you find something useful or interesting.

1:21:03In fact, the greatest compliment you can give us is to share the show with those you care about. So if you know somebody, how do you delicately share, just share this show with guys? How's that? In the meantime, I hope you apply what you hear on the show so you can live what you learn, and we'll see you next time.