Hard Data: Can Your Erections Predict a Heart Attack?

24:05So what do we do? Well, biohackers want to hack health, but you can't hack health unless you can track it. You can't really fix things, in my opinion, unless you can actually measure them and measure them objectively. So our device, we embedded sensors into an erection ring. I don't like calling it a cock ring because that puts it in the context of a sex-torn novelty. I suppose something that is providing both valuable data, but also is a form that's going to optimize someone's sexual performance. So in better senses, into an erection ring. One overnight, we count the number of nocturnal directions, measure their duration of firmness.

24:42One during sex, we measure duration of firmness. And with this information, we provide people what we call an erectile fitness score. We're a fitness-oriented culture. All of us, including both of you young guys on this call, are on the road from erectile fitness to erectile dysfunction. and we don't know where we are on the road. When we drive a car, we have a dashboard. If you don't have a dashboard, we're likely to break down, crash, run out of gas, have problems. So we're giving men and the healthcare providers data that tells them where you are on that road, in addition to which we're also optimizing their performance because an effective erection ring is not one of these O-rings that you see in sex toy stores that is essentially like a gasket for your dick.

25:24You have to have an erection for it to work. You slide it down your penis. it chokes off your penis it's like lishing your penis it's coming off the arterial blood flow uh and you know they're considered to be dangerous they're worn for more than 20 or 30 minutes it's probably more like an hour but if people have diabetes hypertension compromised circulation they can be quite problematic boy do i have stories that involve dremel saws and late nights in the emergency room bolt cutters jaws of life uh you're absolutely right i'm sure you've seen it too as an er doctor so we've documented a quarter million 200 000 erections last time we overlooked on over 4 ,000 men.

25:58We have the world's largest database and researchers are mining that data to say, well, what really works, what doesn't work? And when it comes to men's sexual health, a lot of the things that have been recommended have been either untested, frankly, quite a few of them don't work. And in addition to which, you know, there are several papers underway right now correlating nocturnal erection parameters with CT calcium scores for cardiac high vascular risk and the blood and the markers, APOB and other markers of cardiovascular health. And those papers will come out. One will be presented this fall.

26:34The other ones will come out next year. As you know, the academic wheels of research turn slowly. But I can tell you what the research shows because the big research shows that what men and doctors think is leading cause of retold dysfunction is actually the second leading cause. Do you want to know? Yeah, tell me what your thoughts are because I definitely have thoughts. You probably know some of the people that we're working with, Dr. John Mulhall, Morrison Kettering, Mohit Kera from Baylor, who's on our board, Javier Otero-Omero from Spain, Yoshi Sato from Japan. We have some of the world's leaders in men's sexual medicine are on our advisory board or doing research with the device.

27:13So the expectation, the incidence of reptile dysfunction, and by the way, I got to talk about the definition moment because the definition is flawed. But the incidence of rectal dysfunction goes up 10 % per decade after age 30. I'm 73 years old, but my age is 70%. So it goes up 10 % per decade. So the expectation of the academics was as the incidence of rectal dysfunction goes up, the number of nocturnal erections will come down, the firmest nocturnal erections will come down, and the firmest sex erections will come down. It didn't happen. So I remember looking at the data when we had like 40 ,000 erections, I got seventh or sixth of what we have right now.

27:51I'm thinking, the data is trying to tell me something. It's going to be really simple. Why are we reporting more rectal dysfunction, but men's erections are staying just as hard in their 60s as men's erections in their 30s? Men having just made nocturnal erections in their 60s as men are having in their 30s. What's going on here? So 12 % to 13 % of men, they do deteriorate. And these are men with significant cardiovascular disease. These are men with diabetes, hypertension, usually poorly controlled. But that's not the vast majority of men. The vast majority of men are reporting rectal dysfunction, but they're staying just as hard.

28:26So what's going on? The flaws in the definition, in my mind. So definition of rectal dysfunction, called International Society for Sexual Medicine, has three clauses. The first clause, inability to get an erection or difficulty getting an erection. I don't mean because you're drunk. I mean on some sort of sustained basis. Well, those are the men with bad cardiovascular, what we doctors call left-side heart failure. They've got narrowing their arteries due to diabetes or hypertension. Well, they have had heart attacks or vagina, congested heart failure or myocarditis. A heart's not pumping enough blood to the penis.

28:56The arteries are narrow. They're struggling to get an erection because they have some cardiovascular problem. The second part of the definition is difficulty maintaining an erection. That's all men. That's all of us as we get older. All of us as we get older, don't just say erections the way we did when we were younger. It's multifactorial. I'll pick on you. I'm guessing, look at you, that when you were 12 years old, if a girl put a tongue in her mouth for 10 seconds, you get a hard-on for an hour and a half. When was the last time it happened to you? Which one of us? Yeah, exactly. You're looking right at the camera of both of us.

29:30Yes. And I would say that, yeah, you know, well, the answer is not that long ago because I've been happily married as well. But you know the point of talking. I know, well, cause I actually would, I put, I will tell you this. I mean, I talk about with my patients all, all the time. I call it the NRB or the no reason boner. And it's, you know, for me, it's a question is, you know, when I was sitting in algebra class in ninth or 10th grade, and all of a sudden something happened, you know, under my textbook, those are the things that are very tough as we get older to get the NRBs. Yeah. I mean, direct stimulation, boy, I'm, you know, I'm good to go not to TMI with my audience.

30:08Oh, of course. I'm not talking about direct simulation. I'm talking about, yeah. So I think what we've done is pathologize the aging process. Sure. I'll pick on both of you guys again. Or myself. Hey, I'm 73. Do I run as fast as I did when I was 20? No, of course not. I must have RD, running dysfunction, and I need to see a running dysfunction specialist, and I need a special series of exercises. I need pills, I need supplements in order to cure my RD. And that's what we've done with ED. The majority of men get up and then lose it faster than they did when they were younger. Now, this could be multifactorial.

30:43Obviously, there's a confidence issue. There's a baby crying next room. You're worried about paying the mortgage. There are business issues. You and your wife had a fight. Someone's cheating on someone else, or you've had too much to drink. And then the pills that we doctors prescribe that make it harder for people to sustain erections. There's certain anti-hypertensives, the entire class of SSRI, antidepressants. But if you're getting blood in, these guys are getting blood in and then losing it. the primary goal of therapy should be not immediate therapy, not the root cause. The primary cause of therapy should be to keep blood in.

31:14Well, the pills that pharma has so popularized, the PD-5 pills, Viagra and Silas being the big ones, they put more blood in, but they don't keep it there. And the problem is you're getting hard. Ah, take a little more blood. Yeah, keep the tap open. That's great. But how are you going to keep blood in there? And the answer is a mechanical solution for most men. The answer is a ring. There are three papers, one we did internally and two that will be published, comparing our rings to 10 milligrams to Dalafil, Cialis, the most commonly prescribed erection pill in the United States, maybe the world.

31:48And in one of the papers, the equivalent, and two of the papers, a ring superior. And why is that? Because the problem for most men is not getting blood in, it's keeping it there. So here's how the studies work. One of them, we looked at, the researcher rather, looked at detumescence. the time it takes for an erection to go down after climax. So with nothing, it was 25 to 35 seconds. With Tadalafil, it was around two minutes. With the ring, it was close to three minutes. And both together, it was close to four minutes. Well, the takeaway for all men should be, if you want to optimize your performance, take a pill and put a ring on it.

32:27There's a Dr. Yoshi Sato. He did a paper looking at men with an erectile hardness scores of two and three. you're familiar with EHS, aren't you? Oh yeah. Not validated, but yes, kind of validated, but true. Yeah. So the EHS, so an EHS at two, this is fourth point scale, and this is how urologists think about often grade erections, just for your audience. A four is normal. A one is a dead penis. A two is you can get hard, but you can't penetrate. A three is you can get hard enough to penetrate, but you can't sustain an erection for satisfactory intercourse. So with EHS three being probably the most common statistically with a large number of men, And all these men were taking a PD-5 medication, and half of them were injecting Trimix.

33:09Which is an injection drug to induce an erection for those of us that don't know that. Yes, before we had Viagra, we had the injectables, which just caused overwhelming blood flow into the penis to get an erection, whether you were sexually stimulated or not. Yeah, go on. 50 % of the men in the EHS-II group were able to have satisfactory intercourse for 10 minutes and stay hard for an average 8 minutes just by using a ring. 100 % of the men, granted a small number and a 20 in the group, 100 % of the men in VHS-3 category, men who with a pill and an injection were not able to have satisfaction intercourse, were able to have satisfactory intercourse and stay hard for close to 10 minutes on average afterwards.

33:49So the power of rings, to my mind, is clear, but we doctors are focused on things that we can write prescriptions for. And if you told me four years ago, Dr. Justin, you're going to be talking about rings for the rest of your life, I would have said no way. And now I understand that we all could benefit from rings. And I don't have sex without a ring. My wife's idea of foreplay is to put on red lipstick and toss a ring at me. I'm a guy. I'm easy. So talk to me about what the rings are – essentially, just to back up, we had discussions about this before on the podcast. as our listeners are pretty familiar with the idea of the institution of an erection, the achieving phase is an arterial mediated event, as you talked about.

34:32And the maintenance phase is a venous mediated event where essentially what happens, the erection is a giant ball of smooth muscle. And as we get older, that smooth muscle goes through hyaluronization or atrophy. And it doesn't trap the blood flow in those veins as much. And so you have something that is a ring is basically allowing arterial inflow in because the arterial pressure is a lot higher. Venous outflow keeps it in the penis because venous outflow pressure is much lower. Like physiologically should be less than about five centimeters a second, whereas arterial inflow is upwards of 36 to 40 to 60 plus centimeters a second.

35:09So your ring is essentially trying to keep the arterial flow in to maintain the erection as well as to do the occlusive band. So that's kind of the physiology. It makes perfect sense. Love it. I recommend rings all the time. Tell me about the data added. So what do you get as a consumer? Because, yeah, sure, rings are great for having sex, and people have known about this since the times of the ancient Egyptians and beyond. But talk to us, Dr. Justin, about what kind of data you get out of a guy when he's wearing a tech ring or a wearable tech device. Sure. Well, the question that men need to ask themselves is, am I having three to five nocturnal directions per night?

35:48Because that's what you should be having. All those erections lasting 40 to 45 minutes on average, because that's what you should be having. And are they at least a six on a 1 to 10 firmness scale? Because we have two data points and we turn that into a firmness scale of 1 to 10. So when a man buys our device, he's comparing himself to now close to 5 ,000 men. Well, that's a really powerful data set. And utilizing the app or the Google and Apple stores and utilizing one of the screens on the app, you can compare yourself to men within five years older than you and five years younger than you. So you'll know whether you're below average, average, above average in terms of these parameters.

36:25And of course, we all want to be above average, right? So then that should get you thinking about, well, gee, if I'm below average, what's wrong? Why am I below average? Or if I'm above average, what can I do to maintain it? And that's the power of data. So with this data, you can say, how bad is my diabetes or hypertension? So there are some men who are even ignorant about these things. We've had six men that we're aware of get cardiac catheterizations. Why? Because in all these cases, their wives or girlfriends bought them device. I've only had substantive email communications with four of these people, but I'll relay the anecdotes for just a moment.

36:59Wives and girlfriends bought device for their men. The men were blaming their erectile dysfunction on their female partner because their technique was lousy or they were overweight or whatever the reasons were. And it turned out that all these guys had significant cardiovascular problems. One guy had no nocturnal erections, and the other guys had weak one to two nocturnal erections and weak in firmness, and they got cardiac catheterizations. And three of those relationships resulted in divorce or breakup because the women fed up with the guys. At the other extreme, we've had five men not get penile implants.

37:31Why? Because their nocturnal erection data was good. The problem was in their head or in their relationship or alcohol. Those are great. Love it. And those are extremes. Yeah. How has the data benefited me personally? so probably because I'm involved in this startup my own personal money my blood pressure two years ago my blood pressure went up not disastrously went up and my internists recommend that I take lisinopril and my erections went from they lost 15 % in firmness 15 % is not enough to be noticeable but why would I take a medication that's decreasing blood flow to my penis because it's probably decreasing blood flow to other vital organs as a matter of fact So, you know, so I switched medications.

38:16I also realized that I would sometimes take zolpidem for sleep, Ambien, and wipe out my nocturnal erections. So I stopped taking it. 100%. That's right. Data is really powerful. Yeah, I love that, Elliot. I think actually, yeah, so I'll, you know, throw in a little bit of what's happening to you just for the audience is that, you know, blood pressure medicines in general, except for the ARBs, which probably is what they switched you over to, But a lot of these blood, especially better blockers, even in calcium channel blockers, they can, you know, essentially the idea is to shunt blood away from less vital organs like our penis so that, you know, your heart's protected.

38:53A very, very poor man's description of what's happening. And so a lot of times guys with hypertension have erectile dysfunction. Then they, at some degree, however we define it, they go to the doctor, they say, you need to be on this pill for blood pressure. And then it gets worse. And then they come to the urologist's office to say what happened. And so your device told you that, that you were starting to have a little creep and then all of a sudden it got really bad. So that's huge. But I think one of the other things that you reminded me of a story that I think is very indicative of where the power of your data set can be.

39:23And there was an old, and I can't remember, Jordan, if we brought this up or not on the podcast, but there is a classic quote from a Mayo cardiologist from years ago. I can't remember the guy's name either, but I bring it up all the time. But he said essentially that men can hide angina or chest pain from their partners, but they can't hide erectile dysfunction, which is kind of what you were saying, is that you actually have a device where the partners are like, no, you need to wear this. And then all of a sudden the guy needs a cath. I just had a guy in my office the other day, which is even more important to what you brought up earlier in the whole idea of patching men's health together by going online and getting boner pills, right?

40:00Which I've kind of rallied a career against. I've published against it. I've gotten in trouble for not trouble, but I've gotten, you know, people tried to, to sort of take down some of the literature I have that show that you can actually miss really critical health issues by just going online to get a prescription for an ED pill. And I had a guy in my office the other day that was so indicative that he was 45 years old, and he was surreptitiously buying pills online. And he ended up hiding his erectile dysfunction from his partner because the pills worked for a while until he had a heart attack because he had no diagnostic workup.

40:33He was just buying boner pills without any medical supervision, other than just an online, you know, five minute visit in a brown bag envelope in your mail. This guy was able to mess the system up even more because he actually hid ED from his partner who was probably willing to help. If he had a device that was telling him, dude, you're in trouble. And it's something that a pill is probably not going to save your life, he would have not had to have, you know, three vessel stenting and almost die. At 45. You know, Dr. Mohit Karam, certainly among the most, five most famous andrologist serologists in the world.

41:07He said, a couple months ago on a podcast, Viagra is Vicodin. What do you mean by that? He meant that for the 12 to 15 % of men who have a cardiovascular root cause for their sexual, the poor sexual performance, guys take Viagra, like you just they could just they could be masking a problem one of my goals with what we're doing is to get the measurement of sexual health parameters embedded in clinical preventive medicine and i'm confident that with all the you know we have several research papers they're more underway uh it's hard to change medical practice it takes a long time it took 22 years for electric chirograms to become a standard of care sure so i mean took pulse oximetry on a finger over a decade to become a standard of care but i'm confident what we're doing in time and by time in like three to five years if a man is 40 45 years of age and go see a doctor for preventive health care visit they will want to know his baseline erectile fitness score and his nocturnal parameters because you're going to want it's a piece of data like lib proteins or blood pressure that you're going to want to follow over time yeah and again and i think we have we have the literature to show that it does precede by appreciable amount of interventional time, whether it's one year, two years, five years, that you can tease that out.

42:26And then also, it's a good way of sussing out how much of this is what we call psychological, but it is, I think, there's a little bit of this parasympathetic-sympathetic drive that, you know, if you're nervous, if you're not motivated sexually, then you may have ED during spontaneous attempts at intercourse, but when you're sleeping, that's all down, right? That is pure physiology. And it also involves sleep medicine. Like the other point I was going to bring up for the reader or the listeners, because we talked about this with the sleep doc a few episodes ago, that, you know, the medications that are ostensibly for sleep, they actually don't really let you get into that deep, deep delta sleep or that REM sleep, which is where our nocturnal erections have to happen.

43:08And so that's a really good indicator of what you just said, is that you notice that taking a sleep drug actually was counterproductive to erections because you weren't really getting as deep asleep as you needed. I think that our device is a sleep monitor device as well, too. Although there needs to be research on it. So and I'll start, you know, look, we are coming out with an advanced version 2.0 later on this year that will allow us to look at heart rate variability at night as well, too. But our engineers a couple of years ago, our engineers guys who have, you know, they got an apple watch they got whoop they got or they got you know they're they're they're dated people and they noticed that they were getting slightly more erection time on utilizing our device measuring nocturnal erection time than they were getting on on their or which makes sense that our device would be more accurate because every episode of quality sleep is accompanied by an erection assuming that a man is not on a block or some medication block that's blocking it and there's The paper right now, Dr.

44:05Karras Shop in Baylor has a paper comparing, looking at WHOOP, continuous glucose monitoring, and our device, just to track these parameters in men at night. And our device correlates with what the WHOOP device is showing. So people can monitor not only their cardiovascular and sexual health, but also their sleep using our device. Yeah, it's a lot more discreet at the gym, or at least the gyms I go to. But, yeah, I think that's important. Can you imagine if the teenage Dr. Justin had an Oura ring and a FernTech device, you may have been kept out of the doctor's office and you could have just showed your mom your data and say, look how healthy I am, mom.

44:44I just keep shaving my palms and getting on with my life. I think that's powerful.

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49:17Tell me some new advances. Tell me what the next chapter is here in your evolution. I just wanted to add, it's maybe one other point, because, you know, I got into this for the data. I didn't realize that I was also going to be solving the cock ring problem. So the cock ring problem is that these hard plastic rings you buy online in a sex store for$14.95, they pinch, they're uncomfortable, they're not safe. So in order to count them to nocturnal erections overnight, we had to reinvent the material. You know, our rings are made out of soft elastomers, not made out of hard silicone. our rings don't block the arterial flow you know flow and they only constrain the venus return uh and then i realized oh wait a second how can i improve a man's pleasure women have vibrators and men have shit they've got this we always have these stupid strokers that you know get like it beats someone to death with i think that's where the term comes from actually my thought was how if we can put the right amount of pressure over the urethra to prolong only ejacutary phase, we can produce a more powerful orgasm for men.

50:21So the typical response of a male, heterosexual male urologist to cock ring is, I don't need it. Maybe some of my patients might need it. Like you, I recommend it to people all the time, but I bet you don't use them all the time. Maybe I recommend, I don't need it. It's almost like the reaction of Superman to kryptonite. No, not to me. You know, it's like, so my thought was if we can produce a more intense orgasm, Everyone should want them. So we designed our maximum performance rate, but the right amount of pressure, we tested on 28 men, age 28 to 70, our oldest test group. Our goal was to increase the ejaculatory phase in a man by 50 % with the right amount of grip, if you will, from the elastom on the urethra.

51:06So with this device, our ejaculatory phase goes from 4 seconds to 7 seconds. And that's an incredible orgasm. because obviously orgasm lasts, the sensation of orgasm lasts longer than just seven seconds. This is something men need to think about. It's not about, do I need this? I got a problem, do I need it? It's about, do I want to have more pleasure? Women have vibrators and men have nothing. And now the data shows that this R device, and I assume other rings probably too, but R device can safely produce more intense orgasm. Do you want to have more intense orgasm? Who doesn't? Who doesn't, exactly.

51:43Seriously, who doesn't? Put a ring on it. Ours, of course. Exactly right. So what do you think is happening there? Is it perineal stimulation? Is it posterior urethra stimulation? No, I think it's simply drawing up the ejaculatory phase. Got it. The longer the ejaculatory phase lasts, the longer the parasympathetic glow, if you will. But you asked about the future. Well, aside from the fact that, again, I think they all mentioned these rings, here's what we're doing in the future. So we're coming, we're working right now on the critique, the world's first monitor of the health of the clitoris.

52:17Nice. And I think that this will be just the way, I think this will take gynecology and sexology for women. It's a 21st century of objective, personalized, you know, care. Yeah. We have all the same problems that men do with diabetes, hypertension, atherosclerosis, obesity, poor physical condition. but they also do two things that men don't have don't deal with well we actually do with one of them one is pre-menopausal women take hormones that have a negative impact upon their sexual health performance and they also take sri antidepressants depending upon the study four to ten times as much as men do we don't know what the right doses are with these things because you know unlike in blood you know blood pressure or cardiac arrhythmia we actually measure the impact of our therapy When it comes to men's sexual health, TRT, or PD-5 medications, we don't know what the right doses are with that data.

53:12When it comes to women's sexual health, what's the right dose of a hormone? What's the right dose of antidepressant that will have the least effect upon the Clarus? We don't know without data. So we're going to come out with that device by December this year. And then we're also working on a more advanced version of the male device because we want to make it more sensitive and specific. We want to eliminate what I call data fuzziness. so I'll pick on my own device. My natural erections are seven. Was it seven or was it a six? Was it really an eight? Because it's just, you know, the same thing about the blood pressure cuff on your desk or the pulse oximetry or your aura or whoop ring.

53:47There's a certain data, you know, acceptable, maybe 10 % data fuzziness. I want to eliminate that. I also want to, we're adding the ability to measure the pulse so we can really nail down the quality of sleep. And then we're also, So I'm going to actually be able to tell you the delta change in the volume of blood in your penis between the flaccid state and the erect state. How much blood is your penis holding? And then measure the impact of medications, diseases, et cetera, upon that. Yeah, I love it. I mean, I see a lot of, you know, one of the things I do a lot of research in and treat a lot of guys for is Peyronie's disease.

54:26And, you know, we have static ways of looking at penile blood flow, doing ultrasounds in the office. but the number of guys that have Peyronie's and have what I call a fixed external obstruction in other words the scar tissue itself can can cause this extrinsic obstruction of blood flow we don't have a great way of monitoring it you know me basically I talk to guys and they talk about this concept and we've we've had a whole series in fact we're kind of finishing up in real time the the big series we've done on Peyronie's but they talk about what we call distal flaccidity where you get an erection, the plaque is externally compressing like a thumb over a garden hose, and then you get sort of this poor blood flow pose.

55:07But again, we're doing that by history and then duplex ultrasonography, which is cumbersome and has to be done in the office, etc, etc. So yeah, there may be, you know, we should talk offline about looking at some of the ways that we improve Peyronie's disease through incremented medical dosing or interlesional therapy. And yeah, it'd be a really interesting study, honestly, Elliot, to look at that because happy to work with you. Yeah, that's one of the things that guys complain about is that not only as my penis bent, and I'm not getting the same rigidity. But because of the bent and difficulty penetrating, I'm also losing that stability, what we call axial stability.

55:43So okay, yeah, that's good. See, I love, I love having thought provoking guests, people that are really trying to figure out problems that have never had a really organic solution. And I think this is what you're doing is you're looking at a device that diagnoses without treating, but then coming up with unique and specific treatment patterns based on the data you're providing, as well as potentially, you know, helping cardiovascular fitness using this erectile function. Well, it's just the gap here. Yeah. You know, if you are seeing patients who have problems with their kidneys, their bowels, their lungs, their heart, we can get imaging tests.

56:20We can get blood tests that will help make that problem objective. And then we can measure the impact objectively of any interventions that we undertake with our patients. But when it comes to men's sexual health, pretty much nothing. Other than an office stopper, there's pretty much nothing. And we rely upon these subjective questionnaires. I frankly think the IAF is embarrassing. Embarrassing because this is the year 2026. This is not the year 1910. and we should not be relying upon subjective questionnaires when it comes. Look, I love making it subjective. I'm not, you know, there's this obvious, you know, a profound subjective component to our social response.

57:00We are supposed to be scientific. We're supposed to be objective in our approach and we need data for that. That's right. It's still mostly heteronormative, as we say, as well. So you're missing same-sex couples. And so it really does become very limited to what we define sexual function as. hard enough to penetrate the vagina and long enough to maintain that penetration. Let's get at that for a moment because these objective questionnaires are focused on, by the way, penetrative sex, we couldn't call it intercourse wasn't good enough. Why do we reinvent these words all the time? By the way, I can penetrate it with my tongue and with my fingers too.

57:37So really haven't made this definition any better. But the definitions are focused and the outcomes that we're looking for is satisfactory. that's the third phrase the definition of adult dysfunction satisfactory intercourse well is it good for you yeah well yeah exactly and also if you speak to men older men and i'm the older than 40 45 years of age intercourse is not the end all and be all because of friction they're not getting they don't they're not getting the friction they do from from a hand hand or mouth uh and that's their preference and a real study should should get should be asking those questions because I've got patients, you probably have many more, I'm not a urologist, who tell me that, you know, I don't enjoy intercourse, but I certainly enjoy other ways of, and I get hard other ways.

58:29But yet they've been diagnosed having ED. Yeah, no, it's true. I mean, it's a very narrow definition that gets into our science and then we make huge outcome studies based on very poorly captured data. So, no, I applaud this. I applaud what you're looking at. Well, talk to me about this. We always like to do a you're going to be okay section where I take a health expert and I say, here's a scenario. Is this guy going to be okay? And I think your ring, you may have already kind of alluded to this, but I'm going to give you a patient scenario. I'm going to see how would you work this guy up based on your medical knowledge as well as your tech knowledge.

59:03And so a guy goes online. He buys your firm tech device. He starts wearing it and he starts seeing when he's 46 that he still has all of the scores top of the charts. He's doing great. And then insidiously, he starts to see month after month to the point where he's 48 years old, that he's seen this decline in rigidity and decline in frequency of erections. He has data. How is this guy going to be OK? hey, what are you going to do to reverse this guy's ED that you diagnosed based on your device that maybe his partner hasn't noticed yet? Maybe he's noticed but is too ashamed to go to his doctor with.

59:45And also he knows if he goes to the doctor, the guy's going to be like, dude, you're still having sex. What do you want from me? So how is this guy going to be okay, Elliot? Well, you're getting at a real problem here because if he goes to his doctor, the doctor will probably say, hey, take a pill. And now back in the world that Dr. Carra went about, Viagra's Vicodin, because you're describing someone's having decreased rigidity in the nocturnal parameters to my mind has a cardiovascular primary cardiovascular problem until proven otherwise might be neurological but more likely to be primary cardiovascular problem until proven otherwise and he's cardiovascular workup and most doctors are not thinking that way now the guy could let's assume this patient have a have a strong free tea is free tea greater than 20.

1:00:27yeah let's say it is just for fun to make it easy yeah so optimize his tea yeah His hormonal workup is normal. He's got a cardiovascular problem to improve and otherwise. I want to be certain that he sees – he probably needs an interventional radiology study. And you and I both know that's not common. I just got contacted today by a guy in South Africa, a very sophisticated man in South Africa, who bought our tech ring. He was 15 years old in what you're describing. But his doctor recommended a P5 medication. He's taken 20-sialis now, and he's still unable to perform what he did two years ago.

1:01:05He has cut out drinking completely. He finally got a radiology study which showed a blockage of his penal lottery. In my experience, and yours is greater than mine in this area, an interventional radiology study is not common when it comes to the workup of ED, and that's unfortunate. Right, it is. I mean, we usually, in fact, that's one of the reasons I do a lot of duplex ultrasonography, because I can pick those things up and then refer appropriately. And we start to incorporate preventative cardiology into the men's clinic at UCLA for that reason. But you're right, not common, not standard of care.

1:01:43And again, it's sort of here's a pill and hope for the best. And we're trying to do better. And I think that you're at the forefront of looking at this in an early way. So Jordan, what do you got for our good doctor and entrepreneur here? What thoughts have come up? Are you already getting online to buy AffirmTech? Tell me what your thoughts are. Well, I have a few other questions, but now just based on what you just said, I'm curious, why is radiology not standard of care? Well, yeah, I have my thoughts. But first of all, it's probably cost prohibitive for a little bit. Diagnostic sensitivity is not that great.

1:02:17But certainly, I think if you appropriately screen and if you had a screening device, which is essentially what a penile duplex ultrasound or an even cheaper and much more easily accessed like a firm tech ring could help screen who would actually benefit most from a radiologic intervention. Yeah, let me speak up for a second. So there's a paper at the University of Utah. It's going to be presented this fall at SSMNA by Dr. Kelly Gross. so I don't really know her, but she's comparing our device to an office Doppler. And our device is, I'll share with you, is as accurate as an office Doppler. And actually superior because from my perspective, of course I did invent this thing, but why is it superior?

1:02:59Because we provide more data points. And an office Doppler is just one data point, whereas our device provides multiple data points. And therefore I think our device in time will demonstrate to be superior. But the urologists have been trained and the billing system drives them to do the endorphous doppler. There's no box. I don't think urologists are thinking about interventional radiology. They probably should think about it more. Yeah. No, for sure. I think that's it, Jordan. I think the other problem in general in medicines we talk about a lot is there has become a siloing of our specialties.

1:03:31And the fact that as a board-certified urologist and specially trained microsurgeon that actually trained with, you know, Mo and I go back years, Elliot. We both trained with Lipschulz years ago. And, yeah, here I am spending a lot of my life talking about cardiovascular preventative strategies. Not common, you know, but most of the time we're very siloed in our specialty. And I have a surgical practice. So my entire existence and the reason that I trained so hard was to be able to operate on people and have great surgical outcomes. But, you know, there is a holistic lack in a lot of medicine these days of looking at symptoms and treating just the symptom without looking at the genome.

1:04:11And that's what we're trying to do a little bit at a time through better individualized screening. And so a lot of the, I think the future of wearables is very interesting. and I didn't really mean to dig that hard on the continuous glucose monitors at the beginning because you actually will find people diagnosing diabetes. They didn't know they had it just by starting their CGMs. But I do think there's a huge ability for, especially as it becomes cheaper and cheaper. And this, I mean, what is your device retail for? Now I'm going to give you a sales pitch, Justin, but these are not expensive devices.

1:04:41It retails at$2.75. Yeah. About the same price as two good bottles of wine. There you go. So in an in-office Doppler ultrasound, you know, I think even Medicare allowable somewhere on eight or 900 bucks. And so you have one device that, you know, they can give multiple data points. And if we look at that over same thing, CGMs are like 30 bucks now. I mean, there are all of these things in at home blood pressure cups. For goodness sakes, you can get for 30,$40 to get all this information before you get to your doctor's office. And I think that's the hope is that we're able to really tailor our medicine towards these.

1:05:14So, yeah. What else you got for him, Jordan? I mean, I'm a warrior by nature. Some men are warriors. I'm a warrior. Sexual health data, it's among the most private information that a device can collect. What data does FirmTech store? Who can access it? And could it ever be shared with advertisers, insurers, or outside companies? Sure. Well, I appreciate the fact that you're a warrior. I don't like whiners. But I'm a big fan of wieners. Yeah. Our data is stored in Amazon Web Services as a healthcare, along with thousands and thousands and thousands of doctors and hospitals. We're HIPAA compliant.

1:05:57There are only two people who have signed a HIPAA contract in the company. I'm one of them. Our hair technology is the other. All the data is anonymized. It goes to the cloud. It's given a code. So we can use research purposes anonymously. We can't attribute anything to anyone in particular. I personally have never, you know, if someone wants to consult with me or have me look at their data, they have to give me permission. And permission is a two-step process. So, I mean, could it be hacked? What can't be hacked if someone really wants to get at it? But it's as secure as we can possibly make it.

1:06:35And we are, you know, using usual and customary for hospital and physician offices, security protections. Great. So before I let you go, I also have a question I ask everybody that is a men's health specialist, or actually just anybody, honestly, that comes on the show, is what is it that makes you you that's non-negotiable on a daily basis? I have an idea based on what we just talked about. But tell me, you know, before you get your day started, you know, what do you have to do to know that you're going to have a good day and you're going to be able to take great care of your patients, great care of your company and stewardship of what you're doing now?

1:07:12So what is the non-negotiable that makes Dr. Justin Dr. Justin? I think she has sex every day. Yeah. You know, we talk about how, you know, like Mother was saying, apple day gives the doctor away because you want to eat fruit. And fruit's certainly healthy. I think an orgasm day gives the doctor away. and that's something that everyone should aspire to. There you go. How do I start my day to be in a good mood? Look, I'm blessed. I live in Montana. I get up with Dawn. I'm now married 38 years. I make my wife coffee. We spend about the first half hour of our day in bed together. I can't say we make love in the morning.

1:07:44We're kind of nighttime people. But starting that day with intimacy, with love every day, makes my life rich. I wake up. Look, this is the most fun I've ever had in my life. I started seven companies. This one, to talk about sex and health every day, to be involved with research and wearables that are taking men's health into the 21st century, objective, personalized care. I'm having a lot of fun, and it's the legacy. That's great. I mean, I love this. This is why we do this. This is why we talk about what we talk about on the show. And also, those are some actionable items. I think that what we learned today is that for the right guy, which maybe in your case is every guy should have some better control, not only of his metrics, but what this could be an indicator of, as well as it actually works as a functional improvement to enhance sexual experience.

1:08:35And so, Dr. Justin, you delivered on the mailroom. I mean, I'm so happy you came and that we had a good objective talk. We talked about science. We talked about how not all science is created equal. And where can guys find you? Now I will give you your plug in terms of how is this device accessible? Where can people learn more about it? Sure. You can find us at myfirmtech, M-Y-F-I-R-M-T-C-H, myfirmtech.com. You can reach me personally at Elliot, L-L-I-O-T, at myfirmtech.com. And it was great being here. Thanks for the opportunity. So much. Well, I look forward. We'll talk offline. As I know all the guys you mentioned, we all hang in the same circles.

1:09:15So I think there could be some interesting research we could do in Peyronie's as well. So, yes, I'm sure we'll be in touch and hope to have you back with some more interesting device, especially as you look in the world of female sexual dysfunction, which I think is very understudied, as you know. So I applaud you for exploring that as well to level the playing field, level the bedroom. So I appreciate it. Thanks so much. Everybody have a great rest of your day. Thanks so much. Take us out, Jordan. Long transit.

1:09:53Let's talk about it. Let's talk about it in the mail room. Let's talk about it. Let's talk about it in the mail room. Let's talk about it. Let's talk about it in the mail room. The Mailroom with Dr. Jesse Mills was a production of iHeartRadio. It was executive produced by Jordan Runtog. It was edited, mixed, and mastered by Bahid Frazier. And the theme was provided by Long Transit. If you liked what you heard, please subscribe and leave a review. For more podcasts from iHeartRadio, check out the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows. This program is intended for educational and informational purposes only.

1:10:46It is not a substitute for professional medical advice, diagnosis, or treatment. Consult your health care provider for any medical or other related questions or concerns. The views and discussions aired on this podcast are those of Dr. Mills and do not represent the official positions of UCLA or UCLA Health.

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1:13:04collaborators, and friends, including director Jonathan Kreisel, the mayor himself, Kyle McLaughlin, legendary musician Amy Mann, and many more. Kyle is going for it here. You fully improvised, not just words, but a song. Well, I thought you were all going to write a song. I remember you thinking that. Listen to Podlandia, A-O Rewatch on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is Chelsea Handler from Dear Chelsea. Every week, the news gets worse, the world gets crazier, and Yamanika is here to tell whoever's responsible you're the problem. Do you know I just found out who Sidney Sweeney was?

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