The Hard Truth About Penis Size: What Most Men Get Wrong

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2:22Welcome back to the mailroom with Dr. Jesse Mills. I am Dr. Jesse Mills, and I am staring in the handsome brown eyes of Jordan Runtop, my man on the street, my man in the studio. I got to be honest, I'm a little nervous about this episode today, Jordan. I just think, you know, I don't get nervous very often, as you know, but I don't know if this episode is going to measure up to what we normally do. There it is. You see what I did there? Yeah, I'm afraid that we are going to talk about something that I think is near and dear and potentially tragic to a lot of guys. And so obviously we're going to do it in our normal way of demystifying what's out there, trying to make guys feel pretty good about what's going on in their lives.

3:08And what we're talking about is penis size today. Yeah, we're going to do a whole episode on what's up with the penis. And, you know, I don't know, this triggered because when we had our guest on a little bit ago, Jordan Ritter Kahn, one of the guys in that book, American Men, which please guys go out, you know, this is a secondary plug, but it truly is a phenomenal book. but uh a guy named Gideon who's the West Point graduate uh really you know resonated with a lot of guys I'm sure because he was fixated on comparing his penis to the other lovers that his both wife and uh and again a little bit later in the book girlfriend and then future wife had and it just you know he was fixated on it yet he had a very uh you know greater than two standard deviations, larger penis than average.

3:58And so he had really nothing to worry about, which means basically that we all have either something to worry about mentally, but not physiologically. So that's the long intro to what we're doing today, which is it's all about the penis. Jordan, what's up, man? Not too much, but I'm glad you mentioned that book, American Man, because it's incredibly powerful. And that whole section with Gideon was really what got me thinking about doing this episode. Yeah. Yeah. So the American, well, actually, we'll just say the penis in general. is, boy, it's, there's a lot of history here we're going to go into.

4:30There's a lot of perceptions we're going to go into. And then there's a lot of my own personal bias in terms of what I see in the clinic on a daily basis. The history being, you know, I mean, think about Michelangelo's David, right? The specimen of a man. But, you know, I think most of us will look at those pecs and tris and delts on that statue and not so much as penis, which is, you know, pretty flaccid and pretty average looking. And it's really, the penis has gone through multiple phases, really almost a lot like obesity. And well, I should say body habitus has gone through phases. Like there were times in history when smaller penises were associated with better social status, better brains, and a large penis was considered, you know, animalistic and, and almost disgusting and, and not, and not desirable.

5:21And so, you know, boy, that is not 2026 or even 1996. And so what happened with all of that? And we're going to talk about that a little bit about my own thoughts. But the history of it is truly fascinating in that guys forever have wanted to measure their penis to everybody around them, either in the locker room or on the battlefield or anywhere else. and it used to be, as I was saying, good penises were kind of what we would consider very average to small these days and large penises were considered a lot more, I don't know, bestial. And we'll just, we'll leave it there. I'm really fascinated by that because you look through the ages and you see the changing beauty standards and there was that time when being pale was considered more beautiful than being tan because it meant you could afford to be indoors and not out in the fields working as a laborer.

6:16So the cultural history of beauty standards is really fascinating. But I think back through the years, and I just remember seeing these ceremonial statues that were very ancient and were meant to represent fertility. And they were all very large. So I always assumed it was pretty consistent through the years that, to be blunt, bigger was better. Yeah, no. Yeah, I mean, you know, big penis, small brain, I think it was for a long time and we had to try to correlate, but it really, really doesn't. So I don't know, where do you think this is all coming from? I guess you're sort of surprised that I even made that historical nod that in fact, it wasn't always cool to be packing something below the belt there.

6:57But I think it's pornography. I really do. I mean, I think when you see a guy, an adult entertainer, obviously he's an athlete of sorts. He's an actor and he often is incredibly well endowed, greater than the standard deviations, which we'll get into. And I think if that's our benchmark for the average guy, especially for kids, and I'd say kids that really start their introduction to porn on our phones is, you know, nine years old, 10 years old, sometimes earlier. And so then you think, OK, well, that's what I'm going to grow into someday. And I think we have to figure out how to stop that dialogue.

7:33And I don't know. We don't do this in professional athletics. Right. I mean, when you when you look at a professional football game, you're not thinking, man, I got to go out and throw darts like Tom Brady or some of the greats and and basketball, same thing. I mean, it's you can really appreciate the athleticism and the fact that that person is a gifted athlete. So maybe if we apply that mentality to what we're watching in adult entertainment, it is great. But also I would I would take the athletic thing a little bit further. This is metaphor, if you will. And I promise I'm not going where you might think I'm going with this next comparison.

8:06But let's talk about three of the all-time NBA greats. Steph Curry, LeBron James, Shaquille O 'Neal. Steph Curry is about 6 '2", right? LeBron is 6 '9", 6 '10", and Shaq is over seven feet tall. They're all-time greats. They have completely different sizes, right? One's my height, and one is a foot taller than I am. And yet they're all professional athletes, and they're all fantastic at it. So before you think of what I'm thinking, what I'm actually trying to say is that that all of these guys are amazing performers, which means that penises of all sizes can also be amazing performers, right? They all get the job done with the body they've been given, and they know how to work it.

8:47So, you know, let's talk about penises in that same context. I have a question for you. What year did you begin practicing urology? Because I imagine that would correlate to roughly when pornography became extremely widely available on the internet. and I was curious if you noticed a change in men's preoccupation with size from the beginning of your practice until more recently. Yeah, you know, we're going to talk about another thing in pornography that drives me crazy as a physician that specializes in this in terms of unreasonable standards, and that is ejaculatory endurance. And, you know, the penis size thing I think has always been around in terms of people thinking that they need to be bigger.

9:29And the surveys go, I mean, the answer to your question, by the way, is about 2001 is when I got into urology. And you're right. I mean, that's sort of when Internet porn started to really take off. So maybe, maybe it's just a fact that I've grown up professionally in a time when access to visuals of large penises has been prevalent. But I think that the real issue is that the standards have been there really not that long, that people have had this, what is it, almost fixation with penis size. And yet they really don't know what they're dealing with. And so if you look at a lot of surveys, then what we've found is that the average penis size fully erect is about five inches.

10:10And I think if you ask most men, in fact, people have done this and they think average penis size should be about six to seven inches and then large would be greater than eight. And so, first of all, then we already have an unfair standard of where we know scientifically that a fully erect penis is really not as big as most people think it should be. And the other crazy thing is that 80 % of guys are not satisfied with the size of their penis, according to some studies. Some studies say it's not quite that high, but there are a lot of guys out there that are like, man, you know, I wish I had this, I had more girth, more length.

10:42And we'll talk about, you know, some of the ways that guys can get in trouble chasing that ideal body metric and also some of the ways that guys, you know, might be able to do it. But truly, there's only a pathology when a guy's penis is well under that five inch standard. What we look at is scientifically we say that a guy that has a small penis has two and a half standard deviations below that five inches, which kind of means that anybody with an erect penis less than three inches definitely has potentially a problem. Now, why do we need to label that, Jordan? Well, you know, I think it's only because if a guy does have what is sometimes referred to as a micro penis or a small penis, that there actually are things we can do for those men.

11:24And I definitely don't want that to, for guys to suffer in silence, if in fact, there may be something to do. And so we'll talk about that as well. In fact, actually, I'll just get into it now, because I was just thinking about this not that long ago, I had a guy in my clinic who was in his mid 20s, I think he was about 25. and he came to me because he actually had problems with his testicle not fully descending, which is also what we just had on Brad Snyder, who talked about his battle with his pediatrician on his undescended testicle. This guy had had some issues with smaller than average size testicle and then also actually never really fully developed in puberty.

12:08And he came to my office really mostly from a testicular concern and that's why his doctor sent him to me, but also on his physical exam and obviously in talking to him, he truly had a micropenis. His penis was very much the size of a neonatal size and he was 25 years old and he was also super tall. And so if somebody out listening fits that description, you really need to find a urologist and probably an endocrinologist to help take care of that because this guy had delayed puberty. He never actually fully went through puberty. And it was because he lacked the precursor hormones in the brain and the pituitary gland to actually stimulate him to go through puberty.

12:50So can you imagine at 25, walking around at 6 '2", a full-grown man, no facial hair, high voice still, and then below the belt, no adult secondary characteristics. And so those are not that uncommon. But somehow, even in this day and age, he made it all the way to 25 without somebody really working this up. And, you know, it came from a farming community in central California, really not great access to care and probably had at some time some poor, you know, documentation status. And so, you know, he was actually working when I saw him, had a job and was getting at least state covered health insurance.

13:28And so he'd kind of done all the right things from a governmental standpoint to finally come in and see me. The cool thing about it is that that guy actually just through some pretty easy blood work, I figured out the problem and was able to cause him to go through puberty, even as a 25 or 26 year old at that point. And then he grew to a normal penis size and he started developing secondary sexual characteristics. And that's not like a crazy medical miracle story. Those guys are out there and there's a few reasons for why we have that delayed puberty. So that was kind of cool. And so that is why if you truly have a micropenis, you really need to get help, right?

14:05Because there are things we can do. It's very rare that we can't find something to stimulate some kind of pubertal growth or penile growth. And the younger you are, the more successful it is. That's incredibly fascinating. I've never heard a case like that. Wow. Yeah, it's something called Kalman syndrome, which we talk about all the time in pediatric endocrinology. and it's just basically where your pituitary gland doesn't really develop the hormones or the anatomy to actually start signaling the testicles. All we have to do is put that guy on replacement hormones to start stimulating testicular and penile growth.

14:39So that's kind of a win, but again, that's micropenis. So those are the guys that truly have very, very small penises. Now, how important do you think penis size is to sexual function? Well, I was just going to ask you that. At what point is it more for the guy's self-esteem rather than any kind of sexual function or pleasure for the person on the receiving end? The answer is yes, of course, because I set you up. But really both in same sex as well as heterosexual relationships, we can do so much and we'll start on the heterosexual side of things. But really the majority of women do not climax through penetrative intercourse.

15:18Usually it's through clitoral stimulation. So only about 20 % of women actually have vaginal derived or penetrative orgasms. And so, you know, it's really not what you do with your penis, but it's what you do with everything else. And it's kind of the entire inclusive aspect of what a sexual experience is. And even in same-sex couples, there's a little bit of that too, where depending on how men engage with sex with other men will depend on whether penis size is that important. And the truth is, is that most of the time, even in those relationships, you know, they figure out ways around it. And again, it's so rare that guys truly have incredibly small penises that it makes a lick of difference anyway.

16:02Maybe I shouldn't say lick of difference. Anyway, we'll just let that one drop. So the answer is that it's okay. You can laugh. It's on radio. There you go. Don't mute yourself. no but uh but seriously though i mean i think that we we do have to kind of get rid of this thought and again going back to our previous guest and gideon and they thought i mean this is real right that this is penile dysmorphism just like you know if i only did a few more bench presses my chest would be bigger if i only did a few more curls my side biceps would get bigger what can i do to enhance penile size and i think that's that's really going to be what what is we think and to change how we engage with the medical community as well as the sort of quasi or ersatz medical community because there have been pills out for generations that that purport to improve penile size and there have been techniques have you ever heard of something called jelking does that sound familiar in any of your feeds no joking i've not heard sounds dangerous yeah yeah it's a jelking uh j-e-l-q-i-n-g it's probably a scrabble word i don't know you'd have to look it up it'd be a good one if it isn't i don't have a u it is a arabic term and it does it dates back probably 500 plus years and it's essentially a systematic way that guys can manually stretch their penis with quite a bit of force and it's something they do almost like physical therapy for the penis where they start at the base there's a lot of different ways and actually i'm not going to teach people how to do it because the last thing i want you to take from this podcast kind and fair listener is to say mills taught me how to joke because i am not going to teach you had a joke.

17:38I don't even want you to look it up other than to know that it's an interesting practice in certain communities that has widespread availability with the advent of the internet. And it actually can be kind of dangerous. I mean, there are guys that try to increase their penis size just by stretching. And just like, you know, there are athletes, professional athletes. I remember meeting a couple of professional wide receivers in my career. And those guys, even when they're teenagers will start pulling on their fingers like really hard every day, thinking they're going to kind of stretch the growth plates and grow bigger fingers so they can catch the football better.

18:16And I don't know. I mean, the guys I've met and the hands I've shook and I've got pretty big hands. Those guys can envelop my entire hand with theirs. And so maybe there's something to this idea of longitudinal traction can improve the growth of certain organs and fingers. And so there are all these devices that are either vacuum erection devices, traction devices that can maybe stretch that flaccid length. The real problem with jolking or penile traction, not only can it be dangerous if not used appropriately. In fact, I just had a guy the other day in the emergency room who jolked himself into a penile fracture.

18:54And remember all the five Ps of the pinocalypse, that was one of them, a penile fracture, where he actually tore the membrane that keeps his erections intact and needed surgery in order to fix that injury that he caused himself through aggressive stretching of his penis. Penile traction, which has been around for decades, and actually I should say 1 ,000 years, I mean there are weights that people would hang on their penis way back in the day to help improve for the length in those cultures that thought that penile length was associated with virility, which I already said, you know, was kind of culturally dependent.

19:30And so traction is just a more modern version of that. And we use traction to treat a medical condition called Peyronie's disease, which is that curvature of the penis to help kind of splint it straight. And if you do it in a medically indicated way for a finite amount of time, usually no more than 30 minutes, then it can be a safe adjunct to some of the things we do to help improve penile curvature. but if you go rogue with it and leave that traction device on overnight for example it can cause nerve injuries stretch injuries and so again not not really recommended it also never really been studied on label or studied with a good a good randomized trial that it does do anything to really improve penile length and the other problem i have with this is just kind of a simple geometric problem is that you have a flaccid cylinder that if you increase the length of the cylinder then you're going to not change the volume you're going to decrease the circumference And so certainly we see that with traction devices that you're not, if you're going to get a longer penis, then you're going to get a less girthy penis.

20:29And if you ask most recipients of penises, if anything, it's the girth that makes more of a difference in terms of filling the orifice that one has penetrated in the length. And especially in penis and vagina intercourse, you know, the average vaginal canal is between three and five inches at most. And so if you're trying to stuff eight inches of stretch penis into a four inch canal, Now there's a lot that's going to be left, you know, on the table or at least in the sheets. And so I think from that perspective, you know, girth might be a bigger deal, which is going to go us right into, okay, Mills, so you're saying that there's no good way to lengthen a penis short of surgery.

21:06And even surgery will get into the problem with that. But again, what we're talking about is not how do you increase the erect penis? There is actually no way to increase erect penile size. There's only a way to increase flaccid penile size or give what I call a locker room penis, meaning that you can look pretty good walking around the locker room, but that's who you're trying to impress, but really not a sexual partner because nothing we do, either penile fillers, which we'll talk about, or even implants that can expand the girth, really do anything to increase penile length. So let that sit for a second.

21:40So there's nothing you can do to increase erect penile length. That's a fixed structure. And why is that? So anatomically, the penis is made up of really three structures, two symmetric structures, and that's called the corpora cavernosa, those are the erectile bodies. And then the third structure is called the corpus spongiosum, and that's what the urethra or our P-tube goes through. And so most of the surgeries, most of the fillers, most of the things we do, you can only really adjust the length of the corpora cavernosa or the appearance of length and girth of the corpora cavernosa. But that urethral length is fixed.

22:16We haven't figured out a way to expand the urethral size. So you're always going to be limited by that. And I think that's the key take-home message is that whatever you're doing, if you're unsatisfied with the size of your penis, that whatever you do to it, either if it's FDA approved, which there are some things out there that are, and it's done by a board-certified urologic surgeon, you're still going to just increase girth. So all those pitches about pumps and creams, that's all snake oil? I mean, pumps will increase the penis while it's in a pump because you're drawing blood into it. You're taking a flaccid penis and making it engorged.

22:51And so, right, any permanent length gain from that is, in fact, full of hot air or hot blood. Yeah, exactly. So myth, not going to work.

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26:24Okay.

26:29okay so let's talk about some of the things we talked about jolking what about the fillers what do you know about penile fillers is that a thing in in new york i have not heard of this actually outside of uh discussions with you yeah yeah i mean so so there are ways that we can improve the girth of the penis and it's the same material that we inject into our faces to improve the fat distribution as we age. So what we put in our cheeks, what we put in our lips, it's some kind of hyaluronic acid or collagen based injection that can increase the girth. And there's a few different brands out there.