B (2:33)

Wow. So no wonder people feel like crap. What happens to a man when his testosterone is low?

A (2:39)

A number of things. So testosterone is involved in a lot of systems in our body. From our, our mood, you know, as we work our way down from our mood. So anxiety, depression, that's a big, that could be a real warning sign for low testosterone, even cardiovascular effects. So metabolic syndromes, high cholesterol levels, diabetes, all those things. When you have low testosterone levels, you're predisposed to having higher cholesterol levels, higher blood sugar levels, and then the things we know of like energy performance, lean muscle mass, sexual performance, libido, erectile function, all these things are involved. Or testosterone is involved in all these parts of your body, so. Which is why it's such a, you know, very, very important hormone.

B (3:21)

That's kind of a laundry list of how to make your life suck. Right?

A (3:24)

Yeah. Yeah.

B (3:26)

Okay. What happens in relationships when guys have adequate testosterone versus low testosterone?

A (3:31)

For one, you know, guys who have low testosterone levels, you're gonna. Sexual performance could obviously be compromised. So that could create some issues in terms of relationships. But one thing I'll say is actually we found out that if you have normal testosterone levels, or, excuse me, if you're in a stable relationship, you're more likely to actually have normal testosterone levels than, than the alternative. Just because your cortisol levels are a lot lower or, you know, your stress,

B (3:55)

they're lower when you're not in a relationship. Right. Just kidding.

A (3:59)

Well, I'll say this, I'll say a happy relationship, and as long as those levels are lower, your testosterone levels are going to be higher. So we do know. We do know. Especially when you look at large cohort of men, especially older men, stable relationships, happy, stable relationships, your testosterone levels are more stable.

B (4:16)

I, I believe that there's all, all kinds of reasons for it. I'm feeling called to ask you this question. I was gonna ask it later, but when guys ejaculate, their Testosterone drops for 24 hours and their prolactin goes up for 24 to. So is ejaculating all the time something that maybe isn't a good idea?

A (4:32)

It depends. So there's two ways of thinking about this. So from a hormone standpoint, there's actually a quick rise and then, and then there's a normalization of it all. But more importantly, actually from a fertility standpoint, ejaculating often Is quite important. Keep the pipes clean.

B (4:48)

You want to have fresh swimmers?

A (4:49)

Yeah, absolutely. Like, I had a guy. I had a guy that came in today, he's having fertility issues. You know, I asked him how often he's ejaculating, and he's saying every three, four weeks.

B (4:57)

How old is he?

A (4:58)

He's 32.

B (5:00)

Oh, my gosh. That's not going to work.

A (5:01)

That's not going to work. But in his mind, he's thinking, I got to save. I got to save as much as possible. But over time, again, that, that, that area, those. Those sperm get damaged. So to back to your original question, you do want to ejaculate regularly. You do.

B (5:14)

Got it. The reason I ask is years ago, I read a Taoist book, and they're saying there's an equation for men. You want to not ejaculate too much because it depletes you. And they say, you know, when you're a young guy, it's every day or two, and as you get older, you want to space it out more. And so it's actually a linear equation. And I tested this out for a year, and they. They say that. And this is not about fertility at all. I think they would tell you to ejaculate more for fertility. They're just saying, you know, if you want to live a very long time, ejaculate once every 30 days, but have a lot of sex in the meantime. So I track this for. For an entire year. Like, daily happiness, satisfaction with life. And there really is an ejaculation hangover from the prolactin. And I was. I was surprised that every 30 days is hard to do, but, like, hundreds of followers have reached out and said, you know, I tried that. You know, I'm only going to do it once a week. They're having sex all the time, but they're just ejaculating once a week. And they're like, I got a raise. I started a company. Like, you know, like, it's transformed their lives. I think it's because it raises their testosterone and because hyperlactin never feels good. It just makes you slow, depressed.

A (6:20)

Yeah, there's something to be said for that because there's some people who are way more sensitive to that prolactin effect. Like port, there's post. We call it pois, post Orgasmic illness syndrome. And that's a real thing for a lot of guys.

B (6:31)

Is it really?

A (6:32)

Yeah. Yeah.

B (6:32)

So I always thought it was post nut clarity,

A (6:37)

which is. Which is another thing. Which is another real thing. But There is something real to that, but for some people. Some people are much more sensitive to it than others.

B (6:45)

That's really interesting. Okay, what is post not clarity and what causes it?

A (6:49)

Just all the excitement, the excitement in there. Just the clearance of it really does. I think we could all attest to it. The clearance of it really does. There is something, some truth to post not clarity for sure.

B (6:58)

Do we know the neurobiology of it yet?

A (7:00)

Not yet.

B (7:00)

Not yet. Someone's got to be studying that.

A (7:02)

That's. That'll be our next project.

B (7:04)

Nice. Can I be a test subject?

A (7:05)

Okay, we'll get you in. We'll get you into Cedars. All right.

B (7:10)

Thanks for, for walking through that. And that's new information about some people being more sensitive to prolactin than others. And we're going to talk more about like, appropriate testosterone levels, but I gotta ask you the juicy questions up front. So the refractory period and guys, and if, if that's not a term you're familiar with, refractory period is just the amount of time it takes you to get hard again after you finish the first time. It's pretty low. In young people. You can usually go a couple times, and as you get older, it takes longer and longer. Why?

A (7:37)

Couple things. For one, it's the nerves. The nerves for triggering orgasm, they're more sensitive at a younger age because of the hormones are fresher, the receptors are more fresh. The nerves, more importantly, the nerves themselves, from a friction standpoint, are quite sensitive for an 18 year old versus, like, say a 38 year old. So the amount of friction it takes for a 38 year old to orgasm the first time, second time, third time, is going to be a lot higher than it is for someone who's, you know, engaging intercourse early on in life. That's for one. And then the other thing is the, the effects, like the prolactin effects, like highlighted the prolactin effects, the amount of time it takes for it to clear out after, after each orgasm going forward, it takes longer each time as the older you get. Therefore, I mean, the refractory period can be longer. And then the last thing I'd say is hormones, right? Testosterone being the big one. As we age, our testosterone levels go down. The desire for a second, third, fourth performance is a hell of a lot lower than it was when we were in our twenties.

B (8:42)

Unless we just keep our testosterone levels up where we want them, even then.

A (8:45)

Yes, yes, you are correct when you say that. But even then, it's not so much the levels, it's you know, how the testosterone is reacting, interacting with the different receptors is just having high testosterone is not going to fully correct that. It could make some corrections to that, but it's not going to make you again, revert. Excuse me, Revert back to where you were when you were in your 20s.

B (9:04)

So if I wanted to revert back to where I was in my 20s,

A (9:07)

what would I do from a refractory point standpoint? Yeah, it's a. Ejaculate a lot less. Okay. You know, less intercourse, less masturbation. If you do want to have that second or third performance, all that keeps the, the nerves more fresh. I maintain healthy testosterone levels as high as you possibly can in a safe way. Those are probably two good places to start.

B (9:31)

Less intercourse though, doesn't that defeat the point?

A (9:33)

How's this start off by doing less masturbation.

B (9:35)

There you go.

A (9:36)

Yeah, okay. Yeah, that'll help a lot.

B (9:38)

Gotta have a few friends who really should have this sent to them.

A (9:41)

A lot of people, a lot of young guys these days, in all honesty.

B (9:44)

Yeah. Especially if there's porn involvement. That is not good for your brain. Do you see a lot of guys with ED because of porn?

A (9:50)

Oh, yeah.

B (9:51)

How do you treat that as a

A (9:52)

young guy when you have, when you have ed? It's the worst thing in the world. Right. And they don't know. They don't know what the cause is. Right. They have no idea what the cause is. But a lot of times just letting them know, hey, look, based on what you're telling me, it sounds like it's porn induced. Hearing that and knowing that they have a correctable cause behind a correctable issue behind it, that helps them a lot in terms of reducing a lot of the anxiety associated with it. And then in simple terms, just minimize the amount of times you watch porn or honestly eliminate it. Yeah.

B (10:18)

So don't watch porn. There you go. You heard it here first.

A (10:22)

As little as you can.

B (10:23)

Yeah. You know, or if you watch it with a partner, it's probably different too.

A (10:26)

Right?

B (10:26)

Right. Okay. One of the things that I like to do is if I do choose to ejaculate, and I say that because, guys, you can have sex many, many, many times and not ejaculate and it's really fun. But most people here don't ejaculate and then their brain process that to don't have sex. So we're talking about two entirely different things. But if I do choose to ejaculate, I will take half of a cabergoline and cabergoline is a pharmaceutical that blocks prolactin. Is this a good thing?

A (10:55)

You do it each time?

B (10:56)

Well, I mean, I'm only going to ejaculate every couple of weeks probably.

A (10:59)

So we prescribe cobrigaline when patients have elevated prolactin levels.

B (11:04)

Well, if you ejaculate, it'll be a prolactin. It'll be elevated for 24 hours.

A (11:07)

Right, right. So you're doing a half milligram, whatever

B (11:11)

the smallest pill is.

A (11:11)

I take half. It's like a baby dose of it. There's no harm with that, I would say. I'm actually curious to know if it like, if you don't do that, how your body would react.

B (11:20)

If I don't do that on the next day, my energy isn't as high as it normally is. And if I do it, my energy is totally good. And then I don't really have a refractory period. I could go again that day if I wanted to, but I just don't ejaculate that frequently because I don't think it's good for me.

A (11:33)

Interesting. You really might be one of those guys who's highly sensitive to that prolactin.

B (11:36)

Could easily be.

A (11:37)

Yeah, yeah. So just a half milligram does the trick for you?

B (11:41)

Yeah, it's just a blunting the. The spike that happens. And because I know my testosterone is going to drop, I'll take instead of like 2 of the testosterone pills, I take the Kaiserrex, I'll take three. So I'm just naturally supporting my hormones being ident after I ejaculate. As they were before.

A (11:59)

Yeah. Wow. And you're really in synergy with it.

B (12:01)

Yeah, I mean, I know the biochemistry works and I tried it with and without. I'm like, I like it better with, you know.

A (12:07)

That's great. That's interesting that you do that. Yeah. I haven't heard that, to be honest with you.

B (12:10)

Okay.

A (12:11)

But for these guys who have that post orgasmic illness in room, it's something to try.

B (12:15)

Interesting. And maybe if you just have I don't respect you in the morning and you know, terrible post nut clarity. Maybe it's prolactin. Right.

A (12:22)

Blame it on prolactive.

B (12:23)

I'm going to make a T shirt that says that.

A (12:25)

How do you like Kaiser Tracks?

B (12:27)

I like Kaiser Tracks. And for guys listening, I did a whole episode with the CEO of Kaiser Tracks. It's the first oral testosterone formula available. And I've been stabbing myself Since I was 26 with injections of testosterone when I was 26, I had lower testosterone than my mom, so it was, you know, medically recommended. And I was obese and I had very low thyroid levels, which are part of this whole equation. And low testosterone levels and high estrogen levels. So fixing all that was kind of important as a 26 year old and I'm happy that I do that. So my testosterone, I keep it around a thousand. I like to keep my free tea around 20. What levels are you targeting in men today for testosterone?

A (13:09)

So we, I'll say this, it's. I don't so much chase the number. My whole thing is I chase the symptoms.

B (13:14)

Good idea.

A (13:15)

Right. So it's, there's no, especially with Kaiser tracks. Right. It's, you have to check the spike is four hours after you take it. So I'll have guys who, their testosterone levels are at 350 on Kaiserrex and they're like, I feel amazing, I feel fantastic. So it's, it's the, it's the symptoms, not so much the number, but having said that, the number is part of the equation, at least the mental equation for us in terms of diagnosing low T and then managing their testosterone regimen.

B (13:40)

So let's say that they're not taking Kaiser tracks, they're injecting or using a cream or a gel or something. What's an appropriate number for a healthy virile male, depending on your age?

A (13:51)

Right. But I would say I always try to shoot for at least 500, 500, 600 for a guy. And I, I, the way I do it, at least mentally is based on size. Right. If a guy is 160 pounds, his testosterone demands are going to be slightly lower versus a guy who's 250 pounds. And that's the way we dose our testosterone as well for like even Kaiser tracks whether it's testosterone sipionate and anti the injections. We, we dose it in that manner based on their physical size and that does help in terms of addressing their needs early on in the treatment regimen and their maintenance doses as they Progress.

B (14:25)

I'm surprised 5, 500, 600 seems relatively low.

A (14:30)

Again, it's, it's all about. So with the injections, it's when you're checking the blood work relative to the last injection. So there's a lot of, most of, I would say a lot of my patients are, are doing injections once a week. That's what I used to do, which I, in, in reality I'd recommend. I hope I try to tell most of my patients to do twice a week injections.

B (14:50)

It's much better twice a week. I just got tired of stabbing myself.

A (14:52)

Right. Is annoying. The testosterone injections, you have to use one needle to draw it out, another to inject. It's a thicker needle. So twice a week dosing, kind of the micro dosing of the injections is great. But I would say just because of the frequency of which we check the testosterone levels in our office. As long as they're above 500 and it's not precise, again, we're not precisely tracking this, but as long as it's above 500 and their symptoms are addressed, this is the symptoms they originally came in with. I'll be very happy.

B (15:21)

I really like that answer. And it's one reason that I recommend young men. If they're healthy. Get your hormones checked so you know your testosterone levels when you feel good. Because some guys need 1400 to feel good. Yeah, right. And some people need 500. It's such a wide range that it took me a while to play around to figure out the range that felt best for me.

A (15:40)

Yeah. Like I could tell you, for me, 5, 600 is great for me, if I'm. If I'm above that, I'm irritable. I'm irritable. I'm easy. You know, I could get pissed off.

B (15:48)

Wow.

A (15:49)

Yeah. For real. I've played around with this.

B (15:51)

Okay.

A (15:52)

And if I'm in the 400s, you know, I'm not at my best.

B (15:56)

And do you inject?

A (15:57)

I don't. I don't. So I'm. I only do supplements at this point. I'm 38. I don't necessarily. I'm not at that point yet. But when I'm exercising more, when I'm doing heavy weightlifting, when I'm sleeping better, when I'm eating better, my levels are better. Closer to that 600 number that I like. But at some point, 100 I'll do. I'll be on TRT and I can't wait for that day.

B (16:17)

It's a really good idea. Don't go on TRT if you don't need it. And if you can get there with supplements or something, that's a great idea. What? Supplements help guys keep their testosterone levels high.

A (16:27)

There's a couple of. I like ashwagandha. Ashwagandha is good for. For two things. Testosterone support, hormone support, and cortisol levels. At least you take it before bed. Will reduce some of your stress. It'll get you better sleep, which is good for your testosterone production. Tonga Ali is also A good one. Fidocia works as well for FSH and lh. Exactly. I would say different people respond to Tonga Ali and Fedosha Agrettis in different ways. I'd say most people respond better to one versus the other. I have a handful of patients who do both at the same time. Those are probably the three I like to start with.

B (17:02)

No tribulus trusters.

A (17:03)

Yeah. So tribulus is a small subset of patients. I would say more like the heavy bodybuilders who are cycling. Off they go. They go on tribulus. For the average man, I haven't had a lot of success with it.

B (17:12)

Interesting.

A (17:13)

Yeah, for the average. The average Jo. Usually Tonga and Fidosia are better for them.

B (17:21)

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A (19:50)

Yeah. You know, I feel like some guys actually have to cycle even the supplements.

B (19:54)

Yeah. I think there's a great argument for cycling supplements. Yeah, it's especially ashwagandha because have you heard about anhedonia and difficulty to reach orgasm from Ashwagandha is.

A (20:05)

No, I haven't heard that one.

B (20:06)

There's actually a study on it.

A (20:07)

I believe it.

B (20:08)

Denmark actually banned ashwagandha because they were concerned about that. I think some kind of liver thing. I like ashwagandha but I wouldn't want to use it every single day because people get flat emotions if they overdose on it and then it's really hard to reach orgasm. So if you have someone who's just pounding it, you can overdo Ashwagandha.

A (20:28)

But it really. People swear by it in terms of just cooling their anxiety levels.

B (20:32)

Oh, it totally works.

A (20:33)

It works.

B (20:33)

And so does, you know, things like St. John's Wort for brief periods can also be really helpful.

A (20:39)

Old reliable.

B (20:40)

Yeah, it works like an SSRI or saffron. How much of ED do you think comes from anxiety versus hormones? Ed?

A (20:47)

Yeah, for young men a lot of it. Yeah, for young men, a lot of. So if a guy comes in under the age of 30, under the age of 35, I'd say 98 of the time. It's. It's anxiety based.

B (21:00)

It's wow. Yeah.

A (21:01)

And we see a lot of it. I'm telling you. We see and it's more and more. Ever since COVID we're seeing more and more of this.

B (21:06)

Why do you think that is?

A (21:07)

Think there's a lot of. There's a big argument to make about the resilience of a young man these days. There's a lot of stress. There's a lot of built up expectations young men have in their head in Terms of how they should be, how they should perform, how viral they should be. And they see it on social media, they see it on pornography. And when they don't meet that bar, their mind really goes into a tailspin and, you know, one bad direction leads to two, it leads to 20 bad directions and becomes this whole thing.

B (21:34)

So how much of your work is like therapy?

A (21:36)

Yeah, great question. It really is. I'm a trained urologist. Right. Like, I operate. Right. Like, why are people coming to me as a. In order to. You know, I find that quite interesting because it's, they, it's a lot of. It's therapy, at least for these young guys. You're going to be fine. And we have a whole regimen in terms of. We have a protocol for addressing young guys with ED that works. It does work, I will say. But it's, it's sad to see these young guys, you know, some of them, luckily they recover within a few months, but some of them, it takes them years to recover from this.

B (22:05)

So you kind of refer out to

A (22:07)

a therapist sometimes, you know, sex therapists, sometimes a therapist just for like their general generalized anxiety. Ideally, the problem is these guys. A lot of them should be on SSRIs, but the problem is SSRIs worsen. They can worsen libido, they can worsen erectile function. So we try to minimize that. We try to do everything from a, A non pharmacologic standpoint.

B (22:27)

You know, I feel like for a lot of these guys, if they would just hire a tantrica and spend a day with her, that would probably cure

A (22:34)

them, give them all the confidence they need.

B (22:37)

I mean, fully awakened women can do amazing things for men. It's totally true.

A (22:41)

Yeah.

B (22:42)

When you talk about a sex therapist, is that what we're talking about or something different?

A (22:46)

No, I don't. I think there's something about that. They used to have them in la. They don't.

B (22:52)

Oh, they're still around.

A (22:53)

Yeah, they're still. They're. Yeah, under. I have a little harder to find

B (22:57)

quite a few friends in that space. Yeah. We're not talking sex workers here. We're. No, this is just like esoteric Taoist people. Yeah.

A (23:04)

Yeah. These are therapists who specialize in the sexual experience. Got it. Okay. Yeah.

B (23:08)

And I think if you're young and dealing with that, get your hormones tested. I mean, let's make sure it's not thyroid, it's not testosterone. But look, it may be the porn, it may be the only fans, and it may just be the voice in Your head. And all of those are hackable in one way or another, right?

A (23:23)

It very well said. A lot of times it is that voice in your head. Exactly right. But check your hormones. At the very least, you'll get a baseline of where you're. Where you're at.

B (23:30)

Let's talk about enhancement. I've had stem cells injected in my penis, I think five times now. Usually I go down to RMI in Costa Rica. When I'm down there, I'm like, well, if we're doing stem cells, might as well do them everywhere. I did a Facebook live once while I was getting injected. It was kind of funny because you can't show anything. So you see the blanket here and I'm filming and then you see the needle come down. You see my toes go, hey, yeah. And then I'm like, is it going to give me width and girth? You know, because I'm laughing about the whole thing. But it's not that painful because they use lidocaine. Do you do stem cells?

A (24:03)

So we. We don't do stem cells. We do some other forms of regenerative therapy.

B (24:08)

Exosomes or what do you do?

A (24:09)

Yeah, so we do PRP plus exosomes, that combo. We do Botox injections, which is not stem cell based.

B (24:14)

But you do that for scrotums?

A (24:16)

No, we actually do it for the. For in the penis.

B (24:18)

How does it help the penis?

A (24:20)

So the penis itself is the. Within the erectile bodies, it's smooth muscle. And the smooth muscle, over time. Well, the way it works is in normal penile physiology, for an erection, it dilates more blood flow. Blood flow comes into the penis and it gives you a strong erection. What the Botox does is it basically helps with increasing the dilation of that smooth muscle. So we did a study on this. Not. Not after us, obviously, but in the literature, where they looked at the peak systolic velocities within those arteries and they were elevated when. After they were. They were higher after the Botox injections. So clinically we've tried this and we still do it, you know, in my office today, where patients, you know, anecdotally, they actually like it a lot. They respond. Not everybody, but first for a subset of patients, they come in every three, four months and they get an injection of Botox in the penis and they

B (25:10)

like it to relax those muscles so more blood can flow. Yeah, it's interesting.

A (25:14)

It's not going to cure your ED, but if you're taking Cialis on a daily basis, 10, 15, 20 milligrams it could lower your dose of Cialis. It could. If you're taking a low dose of Cialis, maybe you could come off the cialis. But it's a good combination. It's a good adjuvant to, let's say your. Your oral PD5 regimen.

B (25:31)

Botox in the scrotum. Is that really a thing?

A (25:33)

It is, it is. Some guys. Some guys really, really like it. It's purely cosmetic. It's purely aesthetic.

B (25:38)

Tell me if you. If you've seen this one. They took pictures of a thousand scrotums and they showed them to women and they said, rate this on a scale of 1 to 10 for attractiveness. No scrotum scored over 5. So basically your ball sack is ugly. That's how life is. It feels like wasting Botox there because it does neuro accumulate. Wasting it there versus all the other places, you might get more results. Seems kind of funny.

A (26:05)

I wouldn't disagree. I mean, look, I operate on the scrotum quite regularly. It's. It's not the nicest part of the body.

B (26:11)

It's just how it is. So that's not really what's attracting the women. I just have to say all the guys. If you're into guys that like, I don't know, maybe it is. I don't know.

A (26:21)

And people do it. It's a real thing.

B (26:22)

It's hilarious.

A (26:23)

It's a real thing.

B (26:24)

That and butthole bleaching. I do not understand it.

A (26:26)

Yeah, that's a real thing too.

B (26:27)

Yeah, I guess. You're in la, so you get all the. All the cutting edge stuff.

A (26:31)

That's more of a porn star thing.

B (26:32)

Is it?

A (26:33)

Yeah, porn stars do a lot of the anal bleaching, the colorectal surgeons. Actually, I have a couple colleagues who specialize in that. Yeah.

B (26:41)

I don't know. I was in the New York Post for butthole sunning, so I'm probably. It was a joke. I literally did a joke post and like, biohacker bro burns bum. It was hilarious.

A (26:50)

I saw that.

B (26:51)

Okay, but it's not a real practice, guys.

A (26:53)

It's good for the vitamin D though.

B (26:55)

You know, sunlight on the balls increases testosterone. That's real. But on the butthole, I can't find any literature. Even like ancient literature from esoteric practices. I can't find anything, but there are a few people swear by it. So, hey, if it works for you, go for it.

A (27:09)

A placebo effect maybe.

B (27:10)

Okay. What's the effect of sunshine just hitting the body on erections and on testosterone?

A (27:16)

It could only help. Good for Vitamin D. We know we need you. We, we know you need healthy vitamin D levels for testosterone.

B (27:22)

That's why they call it vitamin D, right?

A (27:24)

That's right. I used to make that joke too. I do think there's something to be said for sunlight exposure earlier in the day. So if you're doing that earlier in the day, it's good for your circadian rhythm. It's better for sleep. Back to what we talked about in terms of what sleep does to your good, adequate sleep does to your healthy hormone levels. So to your question, without question, it does help.

B (27:46)

It also releases nitric oxide, which is beneficial because nitric oxide helps with blood

A (27:50)

flow dilation of those blood vessels. Yep.

B (27:52)

So we're still on the. How do I have a bigger. Can I say this on whatever clip this will be on? How do I have a bigger dick? Let's just say it that way. So we talked about Botox to increase blood flow. Right. And you talked about injecting PRP and exosomes in your clinic. And I've done stem cells and exosomes. What else is available? It's.

A (28:13)

So there's two ways of thinking about this. There's how do you like peanut like erectile function, longevity and then girth with enhancement. Those are two, like two separate length and girth.

B (28:23)

Tell me how to get that.

A (28:24)

Yeah, so we haven't, there's. There's options out there. We haven't really figured out a great way of doing it yet. The least invasive way is literally putting like a contraption on your penis to increase the length direction. So two, two ways of doing it. There's a vacuum erection device that can help. Some people are going to respond to it better than others. But there's that one. There's another device called the Restorex, which I don't know if you've heard of. It's a scaffold that goes around your penis. It basically keeps your penis on stretch.

B (28:51)

Yep.

A (28:52)

For 20, 30 minutes twice a day. There's good data to support. You could add maybe a centimeter or two to the length of your piece.

B (28:59)

I like to just use that during meetings at work because, you know.

A (29:01)

And no one will see it.

B (29:03)

I'm kidding that. But that does work. So a centimeter or two is available just by stretching. And I had another guest on who'd done a lot of work with vacuum devices, and she said if it's the right amount of pressure, not too much, not too little, that they're seeing substantial results from that, both length and girth. Right. What about Shockwave.

A (29:24)

Great. So I love Shockwave. Right. I, I in. And that really, I would say in that bucket of, like, what you can do for longevity of your erections. It's the best option we have out there. Right. In terms of this newer, this newer regenerative form of erectile dysfunction treatment, it's fantastic. It's high energy sound waves that create microtrauma within the erectile bodies of the penis, creates new blood vessel growth in the penis. And ultimately what that does is it brings more blood in. It works.

B (29:51)

It, it is, it works for ed, but for enhancement, like, I, I added two inches.

A (29:58)

You really think so?

B (29:59)

Oh, I wasn't just me. I mean, my partner at the time, there were positions we couldn't do anymore because it was too long.

A (30:05)

Yeah. So what I would say is, at least I could tell you from my standpoint in terms of seeing it from patient stories. We do see if guys have, as we age, if you're, if you don't use the penis, you lose it. There's some shrinkage and fibrosis that goes on. Shockwave can reverse some of that.

B (30:21)

Right.

A (30:21)

So. So some patients will say, look, you know, I feel like I have a little bit more in my mind. The way I think about it is they're getting some of that original length back.

B (30:29)

I literally didn't recognize myself getting out of the shower in the mirror. Like, I became a, A shower and more of a grower. And I, I was truly astounded. But I'm also on every longevity supplement there is.

A (30:41)

You drink the Cialis daily?

B (30:43)

I do 5 milligrams of cialis for longevity. The studies are really good now for reduction of dementia risk and even cardiac risk. So if you're on a aggressive longevity program like me, I think 5 milligrams of cielis should be just a standard thing. And for women, too.

A (30:59)

Right.

B (30:59)

Because they're getting the vascular benefits as well.

A (31:02)

Well, that's the key thing. We're noticing you have systemic benefits to it too. And I generally recommend it for guys in their late 30s, starting in their late 30s or 40s. But there are guys who just can't. Can't tolerate that. So we do two and a half.

B (31:15)

What happens if they get. They're just too turned on all the time?

A (31:20)

Well, that could be a problem too, but it's the heartburn, the lower back pain. Some of these guys are quite sensitive.

B (31:25)

Okay.

A (31:25)

So we usually tell them two and a half.

B (31:27)

Okay.

A (31:28)

Daily.

B (31:28)

Yeah. Microdose. And that's. You might notice a slight difference in your morning Kickstand. But that's more of a whole body systemic benefit, right?

A (31:35)

Yeah, for sure.

B (31:37)

And then there's also the ability to inject fat into the penis.

A (31:42)

So there's fat, there's hyaluronic acid, there's like plastic or silicone pieces that.

B (31:48)

Wow, that's pretty hardcore.

A (31:49)

It's hardcore. The results with that. Some guys have great results, some guys don't have such great results. The fat transfer, the problem with that is it's. It could be uneven. It's not uniform the way it's distributed. Your body may resorb some of the fats and parts of the. The penis where it was put in versus other parts. So when it's all said and done and maybe a little lumpy, dumpy hyaluronic acid, that's. That's a newer one that we've been doing. That's a little bit better. I would say it's a little bit better. You could also reverse it. There's also a reversal agent, so if things don't look good, you could reverse it. And then there's that silicone piece that they put in there called the penuma, which is more of a surgery. It's a little bit more aggressive. But these are the penile enhancement techniques.

B (32:29)

Got it. I had fat injected in my penis and I don't particularly have issues. I'm well enough endowed. And all of this is because I'm a biohack. I'm like, what's possible? And I figured I'll just have better erections from shockwave. And when it changed size, I'm like, this is cool. And guys, shout out to wasabi method, which is the shockwave that I use. The fat. I wasn't planning on doing it, but I went down for a stem cell treatment. And they just happen to have a top specialist in this in the room learning. And I'm like, well, if you're going to put stem cells there, you might as well do some fat. So they have a hard time finding fat. Cause I'm really leaning. But they found enough and they put a little bit in and then they tell me at the end of the procedure, oh, you're not allowed to use it for three weeks now if you inject stem cells in your penis, you're going to be really horny. Like, so you're torturing me. So you're telling me just being incredibly horny and not to use it for three weeks. Thanks, guys. Right. But it didn't end up lumpy or anything like that. I don't Know if it made much

A (33:25)

of a difference, but damaging your sperm in the process too.

B (33:28)

Exactly. I had it done for whatever that's worth. But it's one of those things where a lot of guys just don't talk about it. But shockwave, you have Ed, I'm like, they should see you or a specialist in, in your field, get your hormones, get on that microdose or maybe larger dose Cialis if you need it. Right. And do some sessions of Shockwave. And the results are really profound even for people who haven't had an erection in a while. Right.

A (33:53)

Yeah. It's, I would say as a young guy, as a young guy, if you're interested in the longevity biohacking space, that's a great, great starting point. It really is. The only thing I would say is there's a lot of question have about Cialis. They're like, when I want to take it later in life, it's going to decrease my, my response to it.

B (34:09)

Will it?

A (34:09)

No, it won't. So, so it's a key thing. It's biochemically the way Cialis works is you never develop any sensitivity to it or any resistance to it. Yeah. So if, if your response to it gets worse over time, it's more of a, it's the progression of disease rather than you're, you're, you're losing sensitivity to the drug itself.

B (34:28)

There's also a little known supplement called Cnidium. Do you know that one?

A (34:32)

I don't.

B (34:33)

C N I D I U M I think via PDE5. And there's also something that I wrote about in one of my books called Grains of Paradise or Alligator Pepper. Do you know this one?

A (34:44)

I don't know that one either.

B (34:45)

It's a PDE5 herb that tastes like black pepper, but you take it and it works like Cialis. It also enhances BDNF in the brain. So if you come to my house and have steak, that's what's on the steak. So for people who are just opposed philosophically to pharmaceuticals, I would say get over it. Some pharmaceuticals have a very good safety profile and extend your life and others you really don't want to mess with unless you're about to die. So like, they're not all the same. Just like all proteins are the same. Those are sort of my, my natural alternatives that I would talk about with people.

A (35:21)

Citrulline is also one to consider. L citrulline amino acid.

B (35:24)

Have you noticed a difference from that?

A (35:26)

For, for performance? Yeah, yeah. For, for guys who are working out they like it it.

B (35:31)

I had a, a top expert in nitric oxide on the show, the guy who makes N101 and we talked a lot about the pathways for arginine and citrulline and making nitric oxide and why they usually are dysfunctional in people. And so I haven't noticed a difference in erections and neither have most of the people I've talked with from those. But you do see the pump if you're working out. But man, if you want to see the pump, take some Cialis.

A (35:57)

Amen. Yeah, amen. And if it's great, it really is okay. Yeah. And it's, the side effects are minimal.

B (36:04)

Yeah. And the side effects are beneficial like oh, you live longer and your all cause mortality risk goes down from taking this. So Cialis is a longevity drug in my book. Yeah.

A (36:14)

At the low dose is very well thought and it's generic now. It's dirt cheap.

B (36:17)

Yeah, it's one of the cheapest longevity drugs out there. So now we've talked about how to enhance function. Now let's say it's game time. What do I take before or during so that I'm going to have, you know, the biggest, hardest erection possible.

A (36:31)

I, I'm a big fan of of Cialis stuff works. Yeah, yeah. So a daily low dose of of Cialis like we talked about. So the, the benefits of of cialis, it lasts 24 hours, right. So whether you want to perform in the morning, whether you want to perform in the evening, you have that steady baseline dose in you. For most men that does the trick. Right. They're able to go 0 to 100 when they want to to not when they don't want to, but when they want to, they'll be able to. Game time is ready. As we age, our erectile function starts to get worse. Then we have to start thinking about adding different elements to it. And a lot of this comes down to timing of these pharmaceuticals. So in the pharmaceutical space, what I like to tell guys is do Viagra. The key thing about Viagra that everyone forgets is number one, you have to take it at least an hour before. But number two, and the more important one is it has to be on an empty stomach.

B (37:20)

Oh, interesting.

A (37:20)

Yeah. So Cialis, it doesn't matter Viagra, it matters. It has to be empty stomach.

B (37:25)

Okay. So you just recommend cells most of the time for, for ED or just for sexual pleasure. Yeah, okay, got it. I also like to take two wafers of N101 which is a short acting nitric oxide donor and that's, you know, 20 minutes before you get a lot of nitric oxide available from that.

A (37:45)

And that could only help.

B (37:46)

Oh, yeah.

A (37:46)

You.

B (37:46)

You feel it. Even if you have perfectly great sexual function. I could open a beer bottle with that thing. Like. Like it. It is a big difference.

A (37:53)

Do you feel like you develop the less effect it has?

B (37:57)

No, I do a couple of them every day just for nitric oxide function in the body.

A (38:02)

Or the gym.

B (38:03)

Yeah. Before the gym or I just do when I wake up and then before I go to bed because I want lots of blood flow in my brain.

A (38:10)

Right.

B (38:10)

That's the best way to not get Alzheimer's or dementia.

A (38:13)

Right, right. It's a blood flow issue.

B (38:15)

Yeah. And I probably. In fact, I know genetically I have one problem with my nitric oxide genes, so I'm overcoming that. That. So I have healthier vasculature and I'm, you know, relatively vascular anyway, relatively dehydrated now, but I'm. I'm pretty veiny. So you. I just see a huge difference from that. And the combination of those two is good. Do you ever use apomorphine?

A (38:35)

We use it in. So in combination with other treatments like these compound versions of sildenopil, which is Viagra, Tadalafil, which is Cialis, and then Epimorphine. And it moves the needle. I will be honest. It does move the needle. It moves it a little bit.

B (38:51)

It.

A (38:51)

I wouldn't necessarily say it makes a huge, huge difference, but the caveat to me telling you this is most guys who are coming to see me, these guys have moderate to severe erectile dysfunction. Right. They've. They've done. They've. They're not young guys who are trying to optimize. They're right. They're past that point.

B (39:07)

I like apple morphine because. And it's not related to morphine. A lot of people. What you're talking about. No, it's. It just has a dumb name. So Apomorphine. It increases desire in an interesting way that's different from just increasing blood flow. Right.

A (39:21)

The push for desire. A lot of times it actually helps with getting a little bit more blood flow down there.

B (39:26)

It seems like they work really well together.

A (39:28)

Synergistically, for sure.

B (39:30)

So your doctor can write. If they're into that kind of stuff. They can write a script for a little lozenge.

A (39:35)

Exactly.

B (39:37)

Yeah. That has apomorphine. And what's. When do you take that? That's like an hour before.

A (39:41)

Yeah. With. With the lozenge, though, you're kind of limited in terms of the effectiveness of the rest, but generally like 30, 30 minutes to an hour before should do the trick.

B (39:48)

Got it.

A (39:49)

It.

B (39:49)

So if you do that before date night or during date night, I don't know, there's a, There's a pretty big difference. What was already going to be a fun date night, but it's, it's just another level, I would say.

A (39:59)

Yeah, yeah. And practice. One thing I'd say is practice. Or at least try it at home.

B (40:04)

Yeah, yeah. You don't want to be the first time.

A (40:06)

I always tell guys, like, whatever regimen you're on, like, do a couple trial runs at home, make sure you're, you're not getting, you know, flushed where your eyes are just burning red and your

B (40:16)

nose is swelling up because you have erectile tissue in your nose that's the same as your penis.

A (40:20)

Yeah, yeah.

B (40:21)

So I've noticed that when I've experimented with anything over like 30 milligrams of Cialis, like, I get sinus congestion. This is very fun. So you don't want that.

A (40:30)

You get all congested. Yeah, yeah. It's a real thing.

B (40:32)

And you can use Afrin to turn that off if you have to.

A (40:34)

But, but ideally, yeah, ideally you take a little less.

B (40:37)

And it's kind of like taking smart drugs for the first time during your final exam. Don't do that. That.

A (40:42)

Great analogy. That's really what it is. Yeah. Do a trial run at home. Practice, practice, practice.

B (40:46)

How much cardio do you guys need to do in order to have a healthy penis?

A (40:50)

Great question. We, There was a public, there was a study that actually just came out about this. This was talking more about heavy weightlifting and muscle mass associated with erectile function. But I, I tell guys at least one day of cardio a week, at the very least. Whether it's high intensity training, whether it's sprints, at the very least, you got to do one, two to three days of heavy weightlifting is, is important as well. But at least one day of, of, of real cardio feel.

B (41:15)

Okay. So the, the standard recommendation is, guys, lift something heavy once a week and do something that makes you breathe hard once a week. Not just sex or does sex count?

A (41:24)

Nice sex doesn't count.

B (41:25)

What if it's really good sex?

A (41:26)

Well, it depends how, how hard, how high your heart rate is and for how long. At that point. At that point, it's, I mean, if you're doing that, if that's your cardio, you're doing something right.

B (41:37)

Tell you that I'm asking all the questions that you're not supposed to answer as a doctor.

A (41:41)

That's pretty impressive if you could do that.

B (41:43)

Yeah, no kidding. Your heart rate's at 185. Talk to me about red and infrared light. One of the things that makes me really happy is when supplements kick pharmaceuticals ass. And I've got something for you. It's called C15 from a company called Fatty 15. And it's more effective than metformin or rapamycin. In fact, scientists are calling this newly discovered essential fat the longevity nutrient because it's the first essential fat to be discovered in the last 90 years. Years. C15 is unlike anything else out there because it's a true geroprotector, meaning it actually slows biological aging in studies. How does that work? By strengthening your cell membranes by 80%, activating AMPK and MTOR, which you've read about in my books. That means less inflammation and a reduction of oxidative stress by 45%. Scientists have found over 36 clinically relevant health benefits from fatty 15. Public estimates are that that 1 in 3 people have low C15 levels in their bodies. And if you don't have enough C15, you have fragile cells and you age more quickly. Fatty 15 supports your cells better than omega 3s or fish oil with three times more benefits for your cells. I use both. In clinical studies, 72% of fatty 15 users reported deeper sleep, better mood, healthier joints, and better energy improvement in 16 weeks. It's a pretty incredible story and it's real. Better yet, they're giving you 15% off their 90 day subscription starter kit. Just go to fatty15.com Dave

A (43:14)

if you're doing red light the right way, it works, right? It only works. Again, it's not for everybody, but it only works. So younger guys, it could only benefit them. It does a couple things for the penis. For one, it could help with getting more blood flow to the penis, dilation of the blood vessels, getting more blood, minimizing a lot of the fibrosis that we get as we age with our erections. So what I mean by that is what the red light can do is it can help strengthen your nocturnal erections. And those are the erections that really are probably the most important for us because it prevents the penis from shrinking in length and in girth as we age. So red light helps there. The other thing red light does is it's good for your testicles, right? So it's good for the testicular health. And what does that mean? It's good for your hormonal health, your testosterone production, it's good for your sperm health, so it's. It's good from that standpoint.

B (44:05)

So if you're into fertility and you're trying to have a healthy baby, red light every night before bed would be a really good idea. Right. If you're doing.

A (44:12)

It has to be the correct wavelengths, though.

B (44:14)

660.

A (44:15)

660. I think it's 850.

B (44:17)

So 850 is the infrared and 660

A (44:19)

is the near infrared.

B (44:21)

Yeah. Or 660 is just the red. Red, that combination is. Yeah, that's the powerful one. And increasing the. The viscosity of the water that's in the cells. And red is adding electrons. And one of them has an effect on nitric oxide. I don't remember which one.

A (44:36)

I don't know that one either.

B (44:38)

So what? And if you don't believe this, here's how to test it. Take whatever red light device you have, assuming it uses the correct wavelengths, and when you go to bed at night, put it right on your. Your reproductive system for, I like, 20 minutes. But 10 minutes is probably enough, right?

A (44:54)

10 minutes is more than enough.

B (44:55)

Yeah. And then when you wake up in the morning, just look at the kickstand and see the difference. It's. It's very noticeable.

A (45:02)

It does take some time. Does it notice it? I mean, depending on your age, obviously. But the caveat to that is you don't want to put it too close. These. These red lights don't increase the temperatures. But if you notice it, increasing temperatures keep it away from the testicles.

B (45:16)

One thing I've been doing for quite a while is when I go in the sauna, I have a bag of usually frozen blueberries on my balls. Because cooling your testicles anyway is a way to increase testosterone, so you don't want to overheat them. And there's lots of studies for that. So I've been doing that for a while. And then I get to make a blueberry smoothie. And I don't tell people what I.

A (45:38)

Okay.

B (45:38)

Just kidding. I use the same bag of blueberries. Just don't eat that one in my freezer.

A (45:44)

But it's great. By the way, you like cooling. Cooling when you're doing the sauna. There's a lot of good. There's a lot of good data on that one, too.

B (45:51)

And I do have a hot tub and a cold plunge. And I was doing the hot tub quite a lot because you can heat up faster in that than you can in a sauna. And there's pros and cons for each. But the problem was you're overheating the testes every single time. So I don't think hot tubs are a good idea in general for testosterone, but specifically for fertility. They're terrible, right?

A (46:10)

Terrible for fertility.

B (46:11)

Okay.

A (46:12)

Terrible. Absolutely. Yeah. No sauna. Steam moves, Jacuzzi is what I say. If you're trying to.

B (46:16)

No sauna at all or no sauna without an ice bag?

A (46:18)

No sauna without an ice bag.

B (46:19)

Okay, got it.

A (46:19)

Yes. Anything that increases. No laptops on the lap. That's. That's all fertility stuff. Anything that you know, to your point, Nothing that increases testicular temperatures.

B (46:27)

Okay. How bad are plastic underwear, which means nylon or polyester?

A (46:33)

It depends. I. I think there's. There's a lot of truth to these microplastics and how they impact us. We're learning more and more about it. I will say. Like, a few years ago, I didn't know there was a lot. If there was a lot of truth to this, but we are seeing the impacts of this. I can't necessarily say it doesn't matter where the microplastic is, whether it's. Whether, you know, plastic underwear, whether it's, you know, something. Your shirt. But all in all, trying to minimize that. It can only help us. We're caught, especially around your family, Jules, you know, wearing cotton. The one thing I will say, the one thing I do know of is as long as that area can breathe, it can only help you. So, you know, wearing. Putting cotton. Wearing cotton underwear, cotton boxers. Those types of things can help.

B (47:16)

There was one study I came across that looked at testosterone levels and sperm motility with polyester underwear in men, and it was not pretty. I don't remember the results off the top of my head, but they did find a noticeable difference. I generally do merino wool, just boxers, because they breathe and. Yeah. And they also. Wool seems better than cotton for a lot of things, just in terms of water retention and stuff. I wrote my first book on fertility, and I talked about, you know, here's what men need to do, women need to do. And one of the concerns that people have is like, oh, my gosh, if I go on testosterone, I might be infertile. And then there are these, like, kind of 1970s longevity guys, if you can call it that, who are like, I'm afraid to use testosterone. I'm like, dude, you're 40 and your testosterone levels are low. You gotta do something about this. This. So what's the scoop on using testosterone and remaining fertile?

A (48:10)

So exogenous or synthetic testosterone like trt, it shuts down your Gadot tropins. It shuts down spermatogenesis. So anything. Basically, it shuts down the testicular sperm production and it shuts down testicular fertility production.

B (48:23)

Right.

A (48:24)

Or, excuse me, testosterone production. It just shuts those down. If you check a semen analysis on a guy who's been on TRT for four to six weeks. Weeks, his sperm. Her sperm counts are going to be very, very low, if not essentially zero. This is just pure trt. Are there ways now in which we can adjust that in terms of optimizing testosterone while preserving fertility? Absolutely. So clomiphene and Clomiphene hcg. I don't know how familiar you are with those, but those are great options for young guys who have low testosterone while trying to preserve their fertility and

B (48:56)

for the people who are afraid of that. I started taking testosterone regularly all of the time at 26 years old. And I was, I think, 34 and 36 when I had my two kids with no issues. Why? Because I was taking Clomid every other week, maybe. And Clomid is one of those drugs that turns FSH and LH back on.

A (49:17)

Exactly.

B (49:18)

And that's something we've known about. That was more than 25 years ago. So if you have testosterone because of fertility, it's just because the doctor doesn't know what they're doing. Doing.

A (49:28)

Right, Right. I mean, it's you. The problem is there's a lot is, you know, the testosterone industry is massive. A lot of people are going to shopping center, men's, men's health clinics, and they're just getting testosterone injections, massive doses of it, without being told about the fertility risk. I mean, in a given week, I still, I see a handful of patients, young guys who are infertile, and the first question I ask is, are you on trt? Yeah, I've been on it for, you know, three, four years. No one's ever told me that Anti fertility. So. So.

B (49:54)

And when they go on Clomid, though, does it come back?

A (49:57)

Yeah, it does.

B (49:57)

See, there you go.

A (49:59)

It does. It takes time, but it does come back.

B (50:01)

And so there's one guy in particular I'm thinking of who charges his clients only a quarter million a year to tell them not to take testosterone because he's afraid of this. I'm like, dude, read the literature. Like, come on.

A (50:10)

Yeah, well, testosterone's safe.

B (50:12)

Yeah. In fact, it's not just safe. Men with adequate testosterone have a much lower risk of all cause mortality. Less cardiovascular, less dementia, less Stroke, Stroke, like less cancer. It's one of the most important things yet. It was just this year, I think, that the FDA took the black box warning off testosterone. Why did they think testosterone caused cancer?

A (50:35)

So in the, in the 90s, the first study that came out looking at testosterone, it came out and it showed it had increased risk of heart attack, increased risk of cardiovascular events. And when you look at the data, if you look at that sample size, they, they did deep dive into it. There were like women who were included in the sample size. It was very, it was very poorly conducted. It was a horrible study.

B (50:54)

Study.

A (50:54)

Since then, I think there's been maybe 24, 25 studies. Literally all of them have disproven that original study. But to this day, they still won't redact that original study.

B (51:03)

I think they just said, oh, they won't redact the study, but they at least took the warning off the box.

A (51:07)

They took the warning which is, which is a step in the right direction. It's not, it's not ultimately where we want to be. But to your point, we've done long term studies. Guys who have normal testosterone levels, they live longer, they have less risk of heart attack, less risk of stroke. But the key thing here is, is you just want to make sure you're doing it, you know, a normal testosterone levels. You're not trying to shoot into, you know, bodybuilder type levels. But normal testosterone levels are incredibly healthy, incredibly important.

B (51:30)

They really are. I quit using Clomid years ago and what I use now is something called crisin, which is an herb that has a similar effect. And I use that. Fadoga.

A (51:41)

Yeah.

B (51:42)

Fidosia.

A (51:42)

Yeah.

B (51:43)

Which increases FSH and lh. And I'm not looking to have more kids anyway. In fact, I should. I have measured my FSH and LH and they're fine. So that's working for me. But the list that we talked about, for people who are taking notes or reading the transcript, it's Clomid, it's enclomophene and hcg. Talk to me about how men would use HCG because it's a women's pregnancy hormone.

A (52:05)

Yeah. So these are all. So is Clomid. It's. We use them off label. Use them off label for men. So Clomid is easier to get. It's a little bit cheaper. That's why we, we prefer Clomid or enclomiphene, which is a different isomer of it. HCG is probably the best. It's, it's, it's better in all honesty, but it's. It's more expensive. It's an injection every other day. That's more for guys who aren't responding to the Clomid will add HCG to it. Or it's for guys who are on TRT who are. Their testicles are shrinking. We give them HCG in order to help preserve their testicular size.

B (52:39)

So I did notice the shrinking of balls. And given that sperm production is the same, unless your partner is into really big balls, it doesn't have any meaningful effect. It's just a cosmetic thing.

A (52:53)

I will say that's one of the things that surprised me. A couple things I hear and like, complaints wise, that's the one that's. I'm like, why do you care so much about it? But people care about it.

B (53:01)

None of my partners have ever cared about it.

A (53:04)

It's. It's a guy thing.

B (53:05)

Yeah, it's.

A (53:06)

The guy cares about him for himself. It's. He looks down and he's like, got it. I want my balls.

B (53:11)

So I, I did have a negative experience with hcg. So I decided, you know, I'll try this because, you know, hey, let's see what it's like to grow bigger balls. Being very vulnerable here, guys. So anyway, I tried this and I took the low dose, the recommended dose, and after about two months, I'm like, I am growing boobs in an ass, I swear to God. And, like, I feel feminine. And so I went back as the doc I was working with, and he's like, what the hell? Like, stop. Like, this isn't normal. I swear to God, my body thought I was pregnant. Is that. Have you ever seen that? It was the weirdest thing.

A (53:43)

Well, I went off.

B (53:44)

It went away. Thank God.

A (53:45)

But I think you may have been aromatizing. Your estrogen levels may have gone up.

B (53:49)

I do tend to aromatize pretty well. But HCG just made it worse because I used to have man boobs. All the guys in my family have man boobs. I don't anymore because I control my estrogen levels. But, man, that was the weirdest two month experience ever. I'm like, I'm growing junk in the trunk back. It took me a while to figure out what was causing it. It was the hcg. And he just said, I've never seen that response in a guy before, but let's just not use that.

A (54:10)

That. Yeah. Or at least go on. Go low on the dose.

B (54:13)

Yeah. I mean, at that point I'm like, I think I'm done with this. I don't want man boobs again. I had those enough as a kid. Right.

A (54:19)

It's injecting every other day. It's not fun.

B (54:20)

Yeah, it's not fun at all. So I think I would say Clomid or I guess I didn't mention the other thing that I do. I take crisin, which helps to block the testosterone turning into estrogen and I take the Fadosia, which raises F8, FSH and LH. I also take calcium D glucarate which helps the body get rid of excess estrogen. And that stack seems to have worked really well for me as a long term user. But I switched to Kaiser tracks recently. One thing that people don't understand is that testosterone circadian.

A (54:50)

Right.

B (54:50)

It's like, what's the best time to inject or to take testosterone?

A (54:53)

Ultimately most guys, what they do is they inject when it's most convenient.

B (54:57)

That's most important is that you get it in. I agree.

A (54:59)

Yeah. So, but if you're really trying to be on it, if you're really trying to be on it, you want to inject it first thing in the morning.

B (55:05)

Yeah.

A (55:05)

Yeah.

B (55:05)

Right. So I take my first dose orally, first thing in the morning because that's when it should be highest.

A (55:09)

Yeah.

B (55:09)

And if you take it right before bed, it can interfere with sleep. Right.

A (55:13)

Yeah. So can I ask when you take your, your second dose?

B (55:15)

Ideally I take it at lunch or in the afternoon, but I take it at 9 o' clock sometimes just because it's the only time I'm going to take it because I didn't take it earlier. Right.

A (55:23)

Yeah. But really I completely stopped telling guys to take Kaisertrex in the afternoon. Or like it's like in the evening.

B (55:29)

We're not going to do it.

A (55:29)

No.

B (55:30)

Oh, not. Did you say only in the morning?

A (55:31)

No, no. Morning and then lunchtime.

B (55:33)

Okay. I think that's better from a circadian perspective. I totally agree. You just have to carry it around with you.

A (55:39)

You have to carry it around.

B (55:40)

Yeah.

A (55:40)

And it's two pills, which is.

B (55:42)

Yeah. Like if you miss it, it's not the end of the world to take it at night. But I agree it's better in the morning.

A (55:46)

Yeah. Nighttime it's. Yeah. You don't want to be. Have high tea, you know, one in the morning.

B (55:51)

Yeah.

A (55:51)

Or maybe you do it sometimes.

B (55:53)

Yeah. Like if I'm, if I'm gonna go to a party, I might accidentally take an extra Kaisertrex also.

A (55:57)

Accidentally.

B (55:58)

Oh, no. This is kind of a master class in, you know, how to Manage libido interactions and an ed, which is, which is really, really fun.

A (56:07)

On.

B (56:08)

Does creatine help with libido or with erections?

A (56:11)

It does. So the way I, I think about this is I'd love to get your thoughts too, but I would say it's, you're gonna get more pumps in, you're going to work out more vigorously, especially when you're doing the big muscle groups. So the chest, the back, the legs, all those things are very testosterone conducive. So when, if you're doing that, it'll boost those levels, which is only good for your erection, it's only good for your libido. I can tell you anecdotally for myself, I've the days I do creatine before working out, I go a lot harder. And those next couple days, that night, I do feel, from a sexual performance standpoint, I do feel different.

B (56:44)

Ultimately, your testosterone production is governed by mitochondrial energy because every production is governed and we know really well now creatine improves ATP and it does it globally. So it's going to be in the testes, it's going to be everywhere. So I would say it's secondary. But having more energy is good for better sex. Right. So I would add that, you know, at least 10 grams a day as, as a stack or maybe just on, on date night, at least.

A (57:09)

How much are you doing?

B (57:10)

I do between 10 and 15 a day.

A (57:12)

Nice. Capsules. Powder.

B (57:14)

I take a powder and I dissolve it in my danger coffee. I do that because when you put creatine in a hot liquid like that, it becomes four times more bioavailable than taking the powder directly or taking capsules. So that's really interesting because that creates a peak in your plasma that's much higher, which means it goes into the brain bed, et cetera. And there was one study in the 1990s of nine people that said that caffeine and creatine cancel each other out, but they clearly don't because you can just try it. Yep, I got both of those kicks. So there are three studies since then that show that that isn't the effect. So I just would say dissolve it in something hot and you'll get much better results for it.

A (57:55)

Nice. Good to know.

B (57:56)

Yeah, and it's one of those pharmagokinetic things where in solution versus in suspension, particles changes everything. So there's my creatine hack. How does over training affect fertility and libido?

A (58:08)

So like anything else, there's always a sweet spot. Right. So too little training is obviously not good. Too much training. Too much training can really impact your, your hormone production. It actually, I'll say this like too much over training. Like marathon runners, those guys who do hardcore long term cardio, they have low T levels always. Yeah, Their body is just, I guess the testicles really are just on overdrive for way too long. That chronic stress for those long marathon runs really puts in, really decreases their testosterone levels, so that negatively impacts their libido. Also, from a fertility standpoint, it could really, you know, you, you need healthy intra testicular testosterone levels. So when those numbers are lower, inevitably it's going to impact your sperm count, your sperm quality and your fertility potential.

B (58:55)

So guys, if you're looking to be more fertile, maybe that chronic cardio isn't a good idea. Oh, wait, it wasn't a good idea in the first place because it's just not good for you. But that's another conversation.

A (59:05)

It is. Chronic cardio is not good for you. Not too much of it. Yeah.

B (59:08)

Talk to me about peptides and penises. What do we need to know?

A (59:11)

I like to think of peptides as. It depends which peptide you're talking about. But generally the peptides that guys ask me for, that's like the gravy, right? Whereas hormones are the mashed potato.

B (59:19)

There you go.

A (59:20)

So you don't want to do peptides until you have your house in order with, you know, your hormones.

B (59:24)

Well said.

A (59:25)

Get, get your hormones in check. Like we talked about all the various hormones, testosterone, estrogen, make sure all of those are optimized. If, if you're not at a place where you want to be mentally, physically, sexually, then you can start talking about peptides. So the peptides that most guys like to talk about, at least from the, like the big one, is PT141.

B (59:41)

Love that stuff you do.

A (59:42)

You use it.

B (59:43)

Oh yeah. I like Melanotan, which is its parent. That also gives you a tan.

A (59:47)

It does give you a tan.

B (59:48)

But man, PT141. And it takes a while to kick in, but once it kicks in it. You're horny. And I don't know that it directly affects erectile strength, but man, you're just good to go.

A (59:58)

Do you, you inject or.

B (59:59)

Yeah, I inject it.

A (60:00)

You inject it? Yeah, yeah. So I'd say it's kind of a flip of a coin. Half the guys like it, half of them, they don't really respond.

B (60:06)

It makes you nauseous if you take too much.

A (60:08)

I actually had a guy who really got. He got dark, right? He really got Dark for a couple weeks. Yeah. He had to stop. He was. He's actually a doctor. He had to stop it.

B (60:16)

Oh, from Linotan.

A (60:17)

Yeah.

B (60:17)

Oh, yeah. If you come from people who have dark skin, you will gain like three or four shades of darkness. I had a friend from India who tried it. He was like, I never felt better. But. And this is about MSH or Melanotan 2 or Melanotan 1 we're talking about. You can take PT141. It will not affect your skin color. But for someone who's butt white like me, when I use a little bit of Melanotan, I get a protective suntan, which is really healthy for you. In a half hour in the sun, like literally, you inject it, you go outside for half hour, you come in, you have a tan the next day. So I think that's profound. But if you're already dark. Yeah. Maybe you just want to use PT141. Right?

A (60:54)

Yeah. This guy got pretty dark, actually. He's predisposed to being dark. But to your question, it works for half the guys. The other half, not as much. These are older guys who usually do it. It does help with their libido, it does help with their erectile function. So PT141 is a big one that a lot of guys ask about. And then these other ones that now are a little bit more common are like, they talk. Guys are asking about CJC IPamorlin.

B (61:18)

These are more growth hormone stimulators.

A (61:20)

Exactly. Well, they still fall into that. That peptide category, which are good. They're good. They're the. What Clomid does to testosterone, these due to growth hormone. Do be careful with. Grow these, the growth hormone ones, because you definitely have to cycle. You definitely want. Don't want to do too much of it. But again, you want to make sure your hormones are good before you do any of these. Right.

B (61:41)

That's. That's really good advice. We haven't talked too much about food. So what is the ultimate set of food for guys who want to be more fertile or have more libido?

A (61:50)

Yeah. I ask myself this question quite often, actually. And the conclusion I've come to is, in simple terms, as close to a Mediterranean diet as you can get to.

B (62:01)

What actually does that mean? Because everyone says it's different.

A (62:04)

So the way I think about Mediterranean diets are, and I'll give you my adjustment to it, but like a meal, like in a perfect meal on a given day, it's eggs in the morning, egg whites, ideally, not yolk.

B (62:17)

Do you want the testosterone from the yolk?

A (62:18)

Well, the thing is. And I'll tell you why. Okay. Because we'll get. You'll get the cholesterol later on, but egg whites in the morning with Greek yogurt, berries, nuts.

B (62:26)

Okay, so you're getting some saturated fat in the yogurt.

A (62:28)

Yeah. Walnuts in particular, because we do know walnuts. If you could have 15 to 20 walnuts in a given day, that's actually proven to help with sperm health.

B (62:36)

Yeah, that's a lot of walnuts.

A (62:37)

It's a lot of walnuts. And it's a lot of calories that come with it. It is, it is. But that's. The data on that. 75 grams of walnuts is quite. But it helps. Lunch is a combination of. You want a complex carb, so like a. A sweet potato mixed with. You want some kind of salmon. Healthy protein, whether it's chicken or fish and vegetables, whether broccoli, cauliflower, carrots.

B (63:00)

Okay.

A (63:00)

Grilled or roasted or even steamed works. And then for dinner, this is the part where I actually think you should have some form of a red meat.

B (63:08)

You should ribeye every day if you can afford it.

A (63:10)

I tell guys to have a red meat two to three times a week. Okay. With a complex, with a healthy veget in the evening, and try to minimize as much of your carbohydrates as you can in the evening. That's the. The rough sketch. If you could stick to that, 80% of the time, I think you're doing well.

B (63:25)

Got it.

A (63:26)

Not amazing, but I think you're doing well.

B (63:27)

So how many grams of protein should

A (63:29)

the average guy have for overall health?

B (63:32)

Yeah. Or I mean, we're really talking about libido.

A (63:35)

Libido. Ideally, your body weight. Let's say 1.3, 1.2 times your body weight. Okay, so, like, in terms of kilos.

B (63:42)

Oh, in terms of kilos. Okay. So about a half a gram per pound of body weight is what? Or 0.6 is what are.

A (63:46)

So let's say, like, average guy is like 70 kilos. I'd say if you're having like 100 gram, 80 to 100 grams a day.

B (63:53)

Got it. Okay. In my longevity book, I looked at all the data around 0.6 grams per pound, which, if you convert it, it's like, man, it's hard to convert that. In my head. Then I've also tested. There's another big set of data that says 1 gram of protein per pound of body weight. And when I moved to that, man, huge improvements for me. So it's somewhere between.06 and, and 1, and 1 gram per pound is 2.2 grams per kilo. So some somewhere in like a hundred grams is, is if you weigh a hundred pounds, that'd be about there. So I, I would say that's within that range for sure. And I think it varies by, by type of protein and by guy. If you're eating rice brand protein or some kind of weird pea thing, you get what's coming to you. For all that plant protein, you probably need more. More.

A (64:38)

Yeah, good point. Let me ask you what kind of protein? Like what's your source of protein?

B (64:43)

Steak and milk.

A (64:44)

Okay, good, good clean steak.

B (64:46)

Grass fed only? Well, I can't say only if I'm on the road and there's no grass fed, I'll cheat. But yeah, I eat grass fed all the time and I've been on this and I cook in butter or tallow and I add olive oil about 2 ounces a day max. And I've been doing that for 15 years and I have clear arteries and it's, it's working really well. So I haven't had that volume of protein that's just the last maybe four or five years.

A (65:11)

And you've noticed a difference?

B (65:12)

Yeah. Shifting from 0.6 to 1 gram was really almost life changing in terms of leanness, muscle mass, energy and satiety.

A (65:21)

Wow.

B (65:21)

But I think it varies by probably your genetics. You know, if you're from India, this is not a high protein diet unless you're from really far north India. So maybe you're better on less protein, but it's worth playing around with. Somewhere in that range, 0.6, which is the same range you were talking about up to 1.

A (65:37)

I think what you said is fantastic. Everybody, people's biology is going to respond differently to this. Exactly right. All right. Some ancestors, they don't eat meat.

B (65:45)

Well, we don't have many of those. At least they eat dairy. Right.

A (65:48)

They eat some form of meat. Yeah. Right. But they're not so protein dependent.

B (65:52)

Yeah. And there's also genetics. Some people handle saturated fat better than others. But no one, I don't think corn oil is good for libido or testosterone, right?

A (66:00)

No, no, definitely not this usual was. But back to your original point. Get a baseline, get a baseline level, see where you're at. And then you could plan from there, make changes from there.

B (66:08)

Well said. Well, this has been a, a fascinating masterclass. Thanks for letting me ask all the, the hard questions. See what I did there? I look, I, I went this long without a seventh grade joke. That was pretty good.

A (66:22)

I'm gonna use that one.

B (66:24)

Your website is Human MD H O U M A N M D dot com yeah. And guys, if you're curious about your testosterone levels, you could go to Axo Health, which is part of Upgrade Labs, and we can send someone to your house to dry your blood, get your levels so you know, and you can take it to your doctor and do what you want, or you can just look at whether your diet's working or not. That's a XO Health. Appreciate you coming out.

A (66:50)

Thanks for having me. This was great. I had a lot of fun.

B (66:52)

Yeah, me too. See you next time on the the Human Upgrade Podcast.

C (67:02)

The Human Upgrade, formerly Bulletproof Radio, was created and is hosted by Dave Asprey. The information contained in this podcast is provided for informational purposes only and is not intended for the purposes of diagnosing, treating, curing, or preventing any disease. Before using any products referenced on the podcast, consult with your healthcare provider carefully, read all labels, and heed all directions and cautions that accompany the products. Information found or received through the podcast should not be used in place of a consultation or advice from a healthcare provider. If you suspect you have a medical problem or should you have any healthcare questions, please promptly call or see your healthcare provider. This podcast, including Dave Asprey and the producers, disclaim responsibility for any possible adverse effects from the use of information contained herein. Opinions of guests are their own and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guest qualifications or credibility. This podcast may contain paid endorsements and advertisements for products or services. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. This podcast is owned by Bulletproof Media.