577: Male Sexual Health - Fact vs Fiction About ED with Dr. Anne Truong

One thing that's really empowering about making health changes is very often a change in diet, exercise, sleep, stress management will trickle over into other things. Your libido, your mental health, your energy, your focus, your motivation. But on the flip side, when you have a health crisis, when you have metabolic disease or metabolic dysfunction, it can also go the other way. Couples counselors, therapists will often report that the big two issues with couples, even a leading cause of separation and divor, would be around financial issues, money issues and sexual dysfunction. Sexual incompatibility and sexual dysfunction for men over the age of 40. Something like 50% of men have some degree or another of erectile dysfunction. And this is very often tied to metabolic health. It's often tied to psychological issues. Sometimes there's physiological psychological combos. In any case, it's a big problem. And while there are some solutions, they don't work for everyone. And most importantly, people rarely talk about these things. Many people are even ashamed to talk to their doctor. My guest on this week's podcast is an MDA medical doctor who works specifically with men. Hopefully be able to give you and or your partner some insight into men's sexual health, its importance and some new cutting edge solutions that you might not have heard about before. If you're new here, it's the Lucas Rockwood Show. I'm a yoga teacher and trainer. I'm a serial entrepreneur. I'm the father of three kids. Firstly, I'm a student. I like to learn things. So I find doctors and authors and experts and invite them on the show so we can all live more informed lives. To support the show, scroll down in whatever app you're listening on, leave a rating and review. If you have a question for the show, message me on Instagram. I'm Lucas Rockwood. I have a new program called Yoga Body Daily where Monday through Friday we do stretch strength and steps 15 minute short classes. Really excited about this. We have a thousand people or so all around the world. Love to have you join us. Go to yogabody.com to learn more and you'll find my teaching calendar there as well. Welcome everyone. Lucas here today's show is called Male sexual health fact versus fiction around ED and I am joined here with Dr. Anne Trung. Anne is a medical doctor, anti aging and biological cellular medicine specialist. She has been working in medical field for over 25 years and her recent specialty is in and around men's sexual health and Ed. She has a book called Erectile dysfunction book sorry, Erectile Dysfunction Fix. And she has a group called the Modern Man Club. All of her work, books and everything can be found at her website, which is trungrehab.com and that's spelled T R U N G rehab dot com. We'll link up in the show notes as well. It's a tricky one to spell. Dr. Anne, welcome to the show.

Thank you for having me here, Lucas.

I always like to start with definitions for people listening. How do you define or how does the medical community define erectile dysfunction?

Right, so the official definition of erectile dysfunction is an inability for a man to achieve satisfactory sexual experience. So it's a broad definition and it's very sometimes confusing because most people think that ED means that you cannot get an erection, Right? But ED can span a spectrum of a longer time to get an erection or that when you get an erection it's not as firm and you lose it, or that you're not satisfied with it. Or it can go all the way to like you're not able to orgasm or you know, ejaculation or any of that, all the way to complete impotence. So it's a broad, broad description and it can, with that description it can be applicable to a man in his ch, all the way to a man in his 90s.

So, you know, when people hear about Ed, I think the first thing people wonder is, is it physiological, is there something wrong with my body or is it psychological? Or some combination of the both in your practice when you're dealing with middle aged people? It's just most of my audience is middle age and beyond. What is the breakdown in terms of mental versus physical or the combination?

Well, that's a great question. So the good part is that 90% of ED is really physical, meaning there's something going on in your body that is contributing to the erectile response. And then 10% is more psychological, meaning stemming from trauma or depression and anxiety. But you can start out with physical and then it can also involve the psychological part because, you know, they intertwine as well too. So you can have, you know, let's say you can have ED from diabetes, but then the next time you do it, next time you do it, you keep thinking about can I perform or can I do it? And then it start to become spiral into the psychological arena as well. And the main reason for ED is really due to poor blood flow, poor blood flow to the male genital organ child.

So many people are thinking little blue pill solves it all. I believe they're referred to as PDE5 inhibitors, Viagra, Cialis. What are These class of drugs and are there any new ones that people should be considering and are these the solution? Is it just a little blue pill and off you go?

No, no, actually not. I want to go over the. What is the erectile's respons in your body for a man and a woman? How do you get a sexual response? Actually, it's in the brain. The brain is the largest sexual organ? Yes. Not in your sexual organ. When I say that people go, what? Yes, it starts in the brain because the brain controls everything that goes down south. All right? And so you have five senses that stimulate in the brain to get arousal state. So you get what you see, what you smell, your nose, what you taste, what you hear and what you touch. So there's five senses that feed into your brain and all that sensory input, it goes into the brain and then go to the center where your emotions are at in the brain, where if you're feeling sad, you're feeling anxious, or you're distracted, are you stressed, that get mixed in and then the next organ is the hormone that gets released in your hypopituitary, pituitary gland, the hormones get released. And then when the hormones get released, it parlay to the nerve that's in the back of your head. And the nerve sends messages, the neurotransmitter to your heart. Your heart starts beating faster. And when your heart starts beating faster, the blood vessels start to open up or dilate and then you get more blood flow and then that go to the sexual organ. So there are six system that need to coordinate in synchrony and in harmony, which is the brain, the emotion, the hormone, the nerve, the blood vessels and the muscle. All right, all of that has to work all together. So when you were younger, it all works within a few minutes. But because there's six system and one system is not functioning at 100% is going to throw up the whole cycle. That's why sexual, sexual, you know, ed or for a man or for a woman, you know, sexual dysfunction is very common. As you know, if there are many steps in the whole system, if one thing's not working 100%, it's going to affect all the other system. So getting back to the, to the question of why Viagra is not the solution is because Viagra all it does is just relaxes the smooth muscle of the penis. And because it relaxes the smooth muscle of the penis, it allows the penis to expand. It just work on the muscle. Now I mentioned sick system, right? So it ignore the brain that's why if you don't, if you don't have arousal with Viagra, it doesn't work. You have to have arousal. It ignores the emotion, it ignores the hormone. It ignored the nerve and ignored the heart and the blood vessel. All it does, it just goes to the penis muscle and relaxes the smooth muscle by increasing cyclic gmp. So having said that, if you do take Viagra and you do have result, you're ignoring the other five systems that you need to be restoring in order to get your natural erectile respond back again. Does that make sense? So that's why Viagra doesn't work in everybody. And that's why after a while Viagra stops working because you're ignoring the other five system that you need to restore.

Some people assume that if they're having ED that they're having metabolic health and that it's a canary in a coal mine for other health problems. Is that always the case? Can somebody be metabolically healthy and suddenly hit the age of 50 and things just stop working? How does that play out?

That's a good question. Oftentimes I do see that. And oftentimes it's stress. Stress can be involved. You can be perfectly healthy, but maybe you're stressed and not know it. And I see a lot of professional men and they're healthy, their BMI is good, they exercise, they eat well, they don't smoke and you know, they don't drink a lot. They don't do any other drug, but they have stress. Sometimes you have stress and you don't know it. Especially men, you internalize how you feel a lot. You don't express that out. So stress sometimes could be a big factor. And also other lifestyle modification like you're not getting enough sleep. Sleep is also very important for healing. So you're not, you're not sleeping seven hours at nighttime between the 10pm to 6am you're not allowing your body to heal physically and mentally. So little tricks like that, like sleep, stress is a big deal. And that contribute to what I say about the emotions and the hormone. Because you're not sleeping well, your hormone's not going to be optimized. You're not healing as much. If you're not sleeping well. It actually affects everything. Right? But oftentimes we function. What's the first thing we do when we are working or busy? We compromise sleep. Right? And then sometimes we don't know that we're stressed. You just don't know. I mean, unless you do heart rate variance, you wouldn't know that. You're stressed at all. And it's very, very sometimes it's hard to do self assessment of stress. So Those are the two things that I see a lot in healthy 50 year old male. And another thing too is that a lot of men don't get blood work regularly. Okay. You, especially in the U.S. you know, they have insurance and everything, but they haven't gone to a doctor in like 15, 20 years. So if you start to notice that you're not performing as well, it sounds like you, you can relate to that, right? You have insurance, but you haven't got blood work. And I, the first thing I advocate if you're a man and you're not performing as well, to use two air, maybe things are just not like 100% get blood work because sometimes, you know, the first sign of ED is indication you have diabetes. So I diagnosed early onset diabetes through men that present to me with ED or that they'll find out, oh, you know, they have high cholesterol or that they have high blood pressure, they don't know it. All right. And those are the things that we can see. Also liver, if your liver is not functioning well, your kidney's not functioning well, that will affect your your will affect ED as well. So all of that can be evaluated through blood work and it's something easy that can be done. So I often diagnose new onset high cholesterol, new onset high blood pressure, new onset diabetes just because the guy's coming to see me for ed. So blood work is easy and then stress and then sleep are the things that may be working behind the scene that you're not aware of.

Yeah, I've always thought that public health campaigns should really focus on this issue. You know, they focus on like living a healthy life and being thin and those sort of dangling a carrot in front of people. I think the stick would work a lot better. Like a big billboard that says, you know, if you're not metabolically healthy by the age of 50, you know, your member is not going to work. I think that that might motivate people a lot better.

I think people really realize, yeah, I know what my husband.

I'm saying this half joking, but truly I really think people would take it a lot more seriously if they knew it was on the table. I don't think the expanding waistline or even the long, long term risk of metabolic dysre, I don't think that scares people enough. But if the chief is not performing, I think people would get motivated. I think they'd get motivated I interrupted you. You said, you're right.

I think you're right there. Because the statistics, at least in the US showed that men between the age of 40 to 70, 50% of them have either.

50% don't know it.

They just don't know at that time.

Yeah, yeah. This kind of brings up another question. How much are we just pushing the envelope? You know? So, like, let's say we turn the clock back 200 years. I would be like in end of life care now I'm 45. Right. And so this would be sort of the end of life expectancy. And maybe if I did really well, I'd make it to 60 or something. And, you know, now we see even women giving birth very, very late. But, you know, you see some famous Hollywood stars, Al Pacino or Robert De Niro. I think maybe both of them. I think they're 80 and they just had kids. How much of this is us pushing against nature? Like, are we supposed to drift quietly into the night? And at the same sort of time frame when women become menopausal, are we meant to sort of shut down our drive as well? Meaning, let's say we're in our late mid to late 50s, is it normal to be having sexual intercourse two, three times a week? Is that something we're just. We're making happen through TRT and lifestyle and modern medicine? Any indication?

Well, that's a great question because yes, we are, you know, we are wired to physiologically, men and women, we are wired to procreate. We are wired to have sexual responses. That's what really. We were really wired for all the hormones that's active in the man and a woman. The body for a woman is made to have a baby, right? And the hormone for a man is made so that way he can get an erection. And so that's why we were physiologically programmed to have a sexual active sexual life. Mother Nature said, well, around, you know, late 40s, I'm gonna decrease your hormone only by a little bit, 1% a year. But, you know, we know now, you know, but to Mother Nature said, well, when you're getting older, I'm just gonna decrease your hormones. So that way you're gonna have menopause. And then men will have andropause. So that way you're not having as much. That does not preclude that you shouldn't have enjoy sex as much. Okay, so you may not have babies, but you still can have. You can still have a good sexual experience. And what I'm trying to say Is that hormone? Even though it's decreased 1%, there's other 6 system that I mentioned about that's still functioning well. Now, what we see with men with ed, let's just focus on men. Men having more. Older men have more commonly have ed. Why is that? Because when you get older, you have high blood pressure, you gain weight, you have more stress, you're not exercising as much, you start to have joint problem, you're just not taking care of yourself as well as you should be. And then you can develop diabetes. And so that's the reason why older men have a tendency to have more ed. But doesn't necessarily mean that you are programmed that way physiologically. And I have seen many older men in their 80s still be able to have sex without Viagra naturally. And I've treated several of them as well. But of course, you have to focus on the lifestyle, to optimize your lifestyle, you know, with diet, exercise, sleep and stress. But it is possible and it's not impossible. But you have to set the stage probably early, probably in your, I would say, 30s, 40s, to really have longevity for sexual. Sexual longevity. So it can be done, and it's not against mother nature in any way, because that doesn't mean that if you can't have children, you can't have sex.

Hmm. Some listeners have messaged me recently about a device called Gainswave. And I'm curious if you know about these angiogenic devices and if you have any thoughts in terms of their efficacy.

Right. So the Gainswave is a shockwave device. However, I want to clarify this. That shockwave, there's two types of devices. One is called focus, which is Focus Shockwave or the acronym for that is eswt. Extracorporeal Shockwave Therapy. So it's focus, and that machine was made in Germany and it was exported to the US and think of the focus as like a laser. It goes deep, high intensity. And it does. And it works on the cellular level. The gains wave is the machine that is called radial, kind of like radial tire, R A D I A L. And that is the acronym for that is called epat EP A T. So it doesn't use the energy of sound wave, it uses the energy of. Of more post therapy. Okay. And the radiotherapy or the gainsway, think of it more like superficial. So it uses post therapy to pound on the tissue. Superficial. It only go to about 4, as deep as 4 inches. And it doesn't work on the cellular level as much as the focus shockwave. All the research study that has Shown the benefit of shockwave had been for the focus shockwave, which is like the laser I mentioned, the first one I mentioned.

I see.

Those are the research on that. So there's this confusing part is they're both called shockwave, but the true shockwave is the focus one that I mentioned earlier. The gains wave is really pulse therapy. And as of, you know, this year, I haven't seen any research that has shown that it has been shown to be effective. However, having said that doesn't mean that men cannot use it for ed. It's just that it's not been extensively written about or researched compared to the focus shockwave. And I'm sure there's research being conducted that we have not seen yet. So the handheld devices that your listeners hear about are really the post therapy. And again, there's no study that has shown that had been done that has shown that it's been effective. Doesn't mean that it's not effective to the point I'm trying to say is that if men uses it and they find that's effective, great, I'm all for it. Just be aware that, you know, there's no research study that has looked at that yet. That's all.

And mechanism of action. I know some listeners are not too excited about getting their members zapped. Mechanism of action. This is either sound or laser. And it's stimulating angiogenesis. Is that right? New blood vessel formation or is it activating the ones that are there? What does it do?

Well, the focus is the one that will stimulate more. I would say angiogenesis. I would say that what it does is that for the focus, it goes to the cellular level and it stimulates the mitochondria to start kind of healing the tissue. And it starts kind of like stimulating the cellular level to kind of like reset. Again, we still don't know exactly how it works, but we do see there is more blood flow to the area, but we still don't know physiologically is it angiogenesis, is it, you know, rejuvenation? But we just know that we see increasing blood flow and that we see increasing cytokine and other neurotransmitters that are present in the area after treatment. And so that we do know that. So what? Angiogenesis is a broad term. And I would say that yes, if you use the focus shock wave, you will see tissue healing, you will see more blood flow to the area. And that we have seen it work well in men with ed and we have seen it work well even in treating for pain issue to the joints. You can apply the same technology to the rotator cuff, to the, to the back, to the elbows and to plantar fasciitis for foot and musculosul problem as well too. So we do see that application there. And that's what we use. So in my office we use the focus shockwave for musculoskeletal pain as well as for ed. We use the radial device for more muscle like fascia, fascia movement if we wanted to mainly work on like musculoskeletal pain issues. But we don't use that for ed. So it's like, you know, there's a term, the more you know, the more you don't know. And that's what we were asking the focus shock wave is that the more I know about and how it works, the more we. Like, that's why when you said the word angiogenesis, there's such a broad term that, yes, in some way that does occur, but in some way we don't know.

So.

Good question mark?

Sure.

Yeah, sure.

So platelet rich plasma prp, if I understand correctly, you use this, I know that some of our listeners will have heard about this for potentially joints and, you know, yeah, maybe a shoulder. Can you explain what this is and how it works for ED or how it might be used?

Right. So platelet rich plasma is the utilization of the platelets that are in your blood. So in your blood, 5% of what's floating in your blood is platelet. And the platelet is what's involved. And let's say you cut yourself, you cut yourself. What do you see? You see blood oozing through the cut and then you have a clot. Right? Well, the platelets is what causes that clot, that clot. And then the platelets is what stimulates other cells in the body to come to that clot, to heal it. So after about five to seven days, you start to have a little scar, right. And then after three weeks, the scars seem to go away. The platelets stimulate the healing response and the platelets stimulate the clotting. And that's why we use the platelets if we want to heal a tissue. So instead of, I don't create anything, I just get the blood, your blood out as if you're going to go to the lab and we get out about 120cc to 180cc. And then through the centrifuge process, you put it through the centrifuge and you separate the blood by different, like red blood cells, white blood Cells and then the platelets, and then we keep the platelets. All right, we keep the platelets and that gets injected into an area of either pain or ED to rejuvenate and also to regenerate as well. The word regenerate is pretty broad, but we do know it help rejuvenate, it help heal the tissue and bring in more blood flow. There is a lot of research, studies that had been done on platelet rich plasma over the past 15 years that has shown that we do see increasing blood flow, we do see increased blood vessels as well. So that's why we use it, because it repair and it increasing blood flow. And when you increase blood flow, you bring healing the blood to the area and that's what start the healing cascade. All right, so let's say for ed, when you inject in platelet rich plasma to the sexual organ, what it does is that it rejuvenates the smooth muscle of the penis and then it brings in more blood flow. Remember initially on this podcast I said that 90% of ED is really physical due to blood flow. So it increases the blood flow to the penis muscle and that's why it helped with ed. Also, you can do this for musculoskeletal, you can inject in platelet rich plasma to the rotator cuff and that has shown to heal rotator cuff partial tears. And then you can also do it into the knee. There's a lot of research now that when you're injecting platelet rich plasma into the knee, it help with arthritis, it helped with meniscal tear. In fact, researcher in Spain actually came up with a research recently that just got published in June that has shown that injection with platelet rich plasma has been helpful in meniscus tears. So you don't have to have meniscus surgery if you have a meniscus tear, which is the most common injury in the knee for active, you know, active people. And on the same thing, you can do the same thing to for ED as well. And we have seen it in thousands and thousands of patients that we have treated that. It does help and it helps and it lasts longer. And it's natural as well. And I always ask, what does treatment protocol look like?

Is it once a week or for the prp?

For ed it's actually once a year. You only need like one treatment once a year, depending on the severity of your ed. When I say severity, well, do you have high blood pressure or diabetes, high cholesterol with that, are you overweight? So the more risk factor you have for metabolic disease, the more severe your ED is.

Yeah. So we've got lasers, we've got sound waves, we've got injections. Everyone's terrified. They want to just take the blue pill and run away. Obviously, this is an important thing for people to fix. Sexual health is so crucial for relationships, for self esteem, for mental health, all of the above. But for people who are hesitant to do something, how would you suggest they get started thinking about this? I know a lot of people aren't going to jump right into getting injected or zapped, even though maybe that's where they need to go long term.

Right. So that's. Yeah. So I don't advocate injection until you kind of, look, do an introspection. So if you're a man, you're like, oh, you know, no matter what your age, this can occur in your 20s or even in your 70s. You're feeling like, hey, I'm not as firm as I used to be and maybe I'm losing it more often. Well, the first thing is, number one, look at your diet. Okay, let's look at your weight. Look at your diet. What are you eating? Are you eating more processed food? You should be on a Mediterranean diet, which is eating lean meat and more vegetables. More fruit involved. What diet are you on? And number two, are you exercising? Are you at least even walking, like three hours in one week or four hours in a week? Cumulative. Not at one time, but cumulative. And the next thing is, it's alcohol. Are you drinking a lot of alcohol? Because alcohol more than about, you know, between, you know, 10 to 14 drinks a week is a lot. Because alcohol is toxic to your body. Believe me, I like my wine too, but it is toxic to the body. So with men, the number one, the number one thing that we see is that excess alcohol. So how much alcohol you're drinking. All right, and then number four is, you know, are you smoking either cigarettes or, you know, or vaping or, you know, cigars, you know, how much are you smoking? Because smoking is the number one cause of decreasing blood flow. And then to look at that and then get your blood work done. Always get your blood work done. Because oftentimes diabetes present us ed. Or oftentimes, you know, kidney problem present as ed. And so get your blood work done. You do those five things that do an introspection and then get your blood work done, you're gonna have your answer. And then with that, okay, I can do my diet. I recommend the Mediterranean diet. Maybe you should exercise, maybe could kind of lower your alcohol intake. To maybe like 10 a week, which is not bad, you know, which is like one and a half drinks a day. And then, you know, if you're smoking, you gotta stop. If you want to continue to have your sex life, you gotta stop smoking. There's no. That thing as, oh, smoking one cigarette a day. It's like being pregnant. It's like, yes or no, you know, there's no doubt about it. And then number five, get your blood work done. Is your blood sugar high? Is your cholesterol high? And we both know that you can moderate your cholesterol and blood sugar by what you eat. Right. And the exercise. Right. And then trying to assess to see if your. How's your liver functioning? How's your kidney functioning? Is there inflammatory markers that you can have? Because we can do blood work now to look at inflammation markers. When you look at inflammation marker, that can also tell that the body's inflamed. It could also tell you signs of a heart attack in the future. 67% of men with ED, 7 to 10 years from the time they have ED will have a heart attack. They will. So it's a predictor, a heart attack, unless you change your lifestyle. So if you keep taking that little blue pill and you say, oh, things are going well, you're on your way to getting a heart attack that could be fatal, or you're on your way to getting a stent or even a stroke as well, too.

Yeah. You know, one final question, which I didn't know was a thing, but I had. I guess I just hadn't been paying attention. But I had a listener message me and said he'd been on Cialis for, like, over a decade. Is that safe? Can people take these things forever? And if I understand correctly, he's taking it daily. Is that something that is safe?

Well, it's a synthetic medication, safe to take long term. When I say synthetic, that's not something your body. That is natural for your body. Right. And so Cialis. Cialis do have side effects very similar to sudinophil, which is Viagra. And if you're taking it every day, then you need to get your liver and kidneys evaluated. As with anything, it is synthetic. It is made in the lab. It's not organic. It's not what your body makes. And so your body still have to process it to the liver and to the kidneys. And that's number one. And number two, when you start taking that, you're essentially. You're essentially giving up your manhood. Right. If a guy, if you tell your body, hey, I need Cialis in order for me to get an erection. Your erection response says, well, I don't know what to do, it's messed up. Remember I mentioned earlier the sixth system, the brain, the emotion, the hormone, the nerve, the blood vessel. Right. And the muscle, your body will say, oh, I don't know what to do, I need Cialis in the system order for me to get an erection. You're essentially giving away your manhood and say, cialis here, I need you for me to have an erection. And therefore when that happen, you're creating an imbalance in your body to have a sexual response. And so I essentially said, you're just giving it away to a medicine for something that is natural for you. And I don't know how old this person is, but the men don't realize that, you know, it's easy to pop a pill. We don't think about the consequences. Right. Because the pill gives us the result. We don't think about the long term consequence. But it's kind of like taking opioid pain medication.

Or blood pressure meds or statins or anything. Sure.

Like, it's like, well, we're taking opioid pain medication because it can become a crutch, it can become convicting in that you go, oh, I'm going to have sex tonight. I'm going to need that medicine in order for me to perform. And then the next time, the next time, the next time, because you really don't know where it's becoming mental, becoming a crutch for you or your dad. Most likely. If a guy taking low dose Cialis, he can hardly have an erection without the medication, but he hasn't given his body a chance to, to do that, and he hasn't. And now he's starting to use it as a crutch, you know what I mean? So what, you know the, the, the what? I, and I, I got into the crutch thing where I sprained my ankle and I wore an ankle brace for like six months thinking, oh my God, I can't exercise without this or else I'm gonna hurt my ankle one day. I forgot my ankle brace and I exercised. I didn't hurt at all. So it was becoming, touching my mind that I needed it when I really didn't need it. And I see that with medication a lot. And I see that as I treat my patient. And you know, they're functioning well. They have morning erection and you know, we evaluate, they have increased blood flow, but they go, well, I still need my Viagra because I'm getting together with my girlfriend this week and I want to make sure I'm working okay. I go, yeah. And I told him, I said, it's working fine. You just got to let yourself believe in that. And you need to detox from your ed Men, you need to get that thought out of your head, because if that thought is in your head, it's going to affect you. And what a lot of men don't realize is that their emotional status, their mental status is very important for them when they have an erection. So when you're in the moment with your partner and your mind thinking about something or you're not in the moment, you're not getting aroused, the message to down below, it's not going to happen. And they think that, oh, I have ed when maybe there's something going on up here that's distracting you, maybe you're fatigued, maybe you didn't sleep well last night, or maybe you're thinking about calling mom or mom call earlier. Something happened, you know, but it doesn't really necessitate that. You need to take that ED pill as the first treatment option.

Yeah. Great conversation. And tell people about your book and the Modern Man Club and what you're up to this year.

Right. So I have Erectile Dysfunction Fix book that is on Amazon. I think you can get that worldwide. And it's a best seller, which released in 2018. And I'm actually probably thinking about a second edition number two, because of my passion for helping men with ED and the reason why I got involved with that, because, you know, my husband had initially had ed, and I was in the process of helping him with that, and I created a community of the Modern Man Club, where a community of men with ED that want to restore their sex life again, naturally. And I'm the coach, and we get together twice a month where I will do a little education, and then we do a Q and A and a lot of support and a lot of interesting discussion in there where I will show them how to restore their sex life again without medication. And in that portal, the Modern Man Club, in that portal, I have a course on how to get out erectile dysfunction. And we also have AI in there as well, too. So you have any questions regarding, okay, what is testosterone? What does testosterone help me with? Or what is, you know, why is ED medication bad? You know, you get all the answers from there as well, too. And it's a monthly membership, and we a very active group. And on my. In my practice, in Virginia, I treat men with severe ED through using platelet rich plasma and shockwave therapy and hormone replacement therapy and lifestyle modification.

Well, great and thanks so much. Really great conversation. I know that some people will be listening privately but excited to hear what what you have to offer. So thanks so much for coming on the show and let's keep in touch for the future.

Thank you very much for having me here.

You've probably noticed that in the past couple of years, yoga breathing, pranayama, breathwork of all types has expanded, exploded in popularity. Right about the time when my TED talk on breathing dropped, it seemed like the whole world got the bug at the same time as me and everyone's interested in breathing. The challenge is that most people who subscribe to YogaBody, most of our listeners who are interested in breathing, they're looking for stress management. They're looking for improved sleep, boosted digestion, energy balance. They're not looking to hold their breath for seven minutes. They don't want to swim under a frozen lake. They're not looking for cold exposure or Guinness Book of World Records. Most people that I meet and I talk to, they're looking for ways to control their nervous system that are safe and accessible and really effective. Yoga breathing really offers that. Meditation and other seated practices can be really intimidating and the follow through is really low. Yoga breathing is not intimidating at all. And the compliance, the follow through is really, really high. That's why our breathing coaches are so successful. They're working from home on zoom. They're teaching in yoga studios, crossfit boxes, fitness centers and gyms. And many of them are actually working with corporate clients to help people manage their stress. This breath coach training is such a unique and exciting program. We go over the anatomy, the physiology of breath. We also cover the business and marketing of being a breath coach. And we give you all the tools you need to go from zero to setting up your own own breath coaching business in the span of 12 days. To learn more about the program, please go to breathcoachtraining.com and I hope you can join us. We have a listener question from Kenny on Instagram. Kenny says Lucas I recently heard Dr. Andrew Huberman recommend Tongkat Ali and Fadosia Agrestis for increasing testosterone naturally. I don't want to take trt. Do you think this really works? And more importantly, is it safe? For those of you who don't know, Dr. Andrew Huberman is a Stanford neuroscientist, so brain scientist, Ph.D. and he's quite prolific in terms of publishing information online. He has Started to recommend or maybe just have conversations about some things that are a little bit risky. Specifically Fadosia agrestis and also some peptides, precursors to anabolic hormones, things like human growth hormone and things like this. Very possible that these things are safe. Also just as possible that they're not. The risk here is when somebody who has a big audience starts having conversations about things that they're using, inevitably you have tens of thousands, if not more. At this point it's probably hundreds of thousands plus young men taking these supplements. Here's the thing about Tongkat Ali. Tongkat Ali is not new. For some reason it's in the news cycle right now, probably due to these kinds of conversations. I first saw it about 18 years ago, I guess in Thailand. It is originally from Malaysia, at least from what I understand. Tongkat Ali, Long Jack it's called, it is a root and it's often referred to as Malaysian ginseng. And it absolutely works in terms of libido. And there is some decent research about increasing testosterone. Really strange that libido and testosterone, they're often correlated, but not necessarily. There's people with low T, high libido, there's people with high libido and very low T. Hormones are very complex. That's why I'm always a little bit hesitant to mess with them. I have taken tongkatali a whole bunch of times. In fact I have some right now here in the studio. Here's the biggest challenge with it. There's a bunch of heavy metal toxicity problems, I guess because it's a ground plant and things bioaccumulate. In any case, it's very often on the watch list so you often can't find it. For example, it'll be on Amazon and then not it'll be on iherb.com, very good vitamin seller website and then not. And a lot of this has to do not with Tongkat Ali itself but with the chemical pollutants. The other challenge is it's you need it really concentrated. And so there's a bunch of things in nature that they just don't really do much by themselves. So turmeric, for example, not so anti inflammatory. Curcumin, the active compound inside of turmeric, very anti inflammatory, you have to concentrate it down. With Tongkat Ali, concentrating it down means this stuff is so astringent and so intense that literally if you take it on an empty stomach, at least for me, I vomit and it's very, very difficult to get down if it's in capsules. It's easier, but still pretty rough on the stomach when it's concentrated. The processing, manufacturing also pretty limited. And again comes down to that purity thing. I have used it, I, I really hesitate to use it. I have a pretty high tolerance for this stuff. It's pretty difficult to get down. I haven't been able to stay on it long enough to actually get my blood tested. Now, Fadosia agrestis, I have not taken this and it's creates hypergonadism, so it increases the size of the testes at least anecdotally. You'll see lots of people really reporting this and so men get excited about this for, well, all of the suspected reasons. There are some pretty interesting People on YouTube who have posted before and after tongkataly and Fadosia Agrestis results in terms of testosterone level boost. Here's the challenge with it. When you start messing with hormones, you don't really know the cascading domino effect that will happen. I'm not saying don't do it, but I think it's a real mistake to think that you can do this long term. And if it's short term, then what happens after? Here's what I do know. One of the most proven, most predictable, most effective ways with nothing but upside for increasing T levels is lifting weights. And I recently increased my free T levels by about 46% by doing very moderate, like five sets of five, two days a week, two different exercises. So really hardly any lifting at all. Net net. We're talking about a total of about 45 minutes per week. And within a few months, not even within about six weeks, I was able to double my free T levels and I'd never seen results like that before. My total T levels have been very consistent for a long time. My free T levels will go up and down, which is pretty common. And the reality is there's a lot of variability with hormones and even just one bad day or one good day. So you shouldn't take my results or anyone's results to the bank. But the published literature around resistance training and I don't mean bodybuilding, I don't mean Arnold biceps, I just mean putting your body under load and triggering some type of muscle hypertrophy is really solid. So long term, I think that makes the most sense. Can you do it with body weight? Yeah, absolutely. Is it more efficient with heavyweights? Also true. So that would be my thing. I would not take Fidosia Agrestis and I'm pretty open to experimenting with a lot of things, but I Wouldn't mess around with it. There's a whole number of things that mess around with libido. And then the t. The testosterone effects are a lot more complex. Why do we care at all? Why don't we just go take trt? There's clinics in every strip mall these days. The challenge is, you go on trt, you're probably going to lose the hair on your head or lose what's left of it and start growing hair on your back. Very likely it could worsen your sleep quality and even contribute to something like obstructive sleep apnea. People don't talk about this enough. Creates all kinds of challenges long term. If you have to keep taking this, what do you do? Are you going to inject yourself? Are you going to get pellets? What other downstream effects is this going to have? For some people, it increases body. It improves body composition. TRT for other people, they put on a bunch of weights. It's. Hormones are very, very tricky. I'm not saying don't do it. I'm not saying I won't do it. Probably someday in the not too distant future, I will certainly consider hormone replacement therapy. But in the short term, it's. There's so many different things you can do. And again, without delving into these things, if you go on Tongkar Ali and Fadosia Agrestis, I can almost guarantee you you will have disaster pants, achy belly, and gag reflex. Stuff's not cheap either. So it's not that I'm against it. It just seems like more risk than reward. It's really difficult because nutritional supplements all get lumped into one category. And you have what I would consider experimental stuff like Fadosia Agrestis. And then you have things that are so safe and so common, like magnesium bisclycinate or ascorbic acid, vitamin C. And people get very skeptical, skeptical of the supplement industry in general. And there's reason to be skeptical. But then when you look at some compounds, they're so safe, so simple to manufacture, that it's no different than buying, for example, whole wheat flour at the grocery store. And then there's other things that are kind of weird and wonky. Looping back to your original question. If you take Tongkar Ali and Fadosia Agrestis, will you notice changes? Almost certainly. Can you buy these online? Yeah. Are they cheap? No. Will it hurt your belly? Probably. Will it change your testosterone also? Probably. However, I bet you can get the same results and get a whole bunch of other Positive benefits with 2 days Maximum 3 days per week of some heavy weights. And again, safe, simple stuff can make a big difference. Hope that helps. Carol on Instagram has a question about cyclic hyperventilation. Carol says, Lucas, I have been doing 30 rounds of hyperventilation followed by two breaths. Breath holds in the morning and in the afternoon. I don't do it in the evening because sometimes it can delay my sleep onset. And I love the practice. It creates a lot of energy. But I've started to get tinnitus. Tinnitus in my ears, and I'm wondering if it's related. I've read in some online forums that tinnitus can be caused by breathing practices. I know you teach breathing and I saw your TEDx talk. I know you teach a different style, but is this possible? Yeah. So there's. There is this very uncommon, but common enough that you'll find loads of anecdotal information online about people doing controlled hyperventilation. So on purpose, breathing fast and getting tinnitus, or ringing in the ears. If you remember when you were a teenager and you went out to a club for the first time and you woke up the next morning with a foggy head and a ringing in your ear, that is tinnitus. It goes away. And then sometimes it doesn't. This is a huge issue. I get messages all the time. Causes are really mysterious. There are some antibiotics that can cause temporary tinnitus. It can happen because of music exposure. There are physiological things that seem to trigger it, hormonal things that seem to trigger it. And for whatever reason, controlled hyperventilation can trigger it. Some people in different breathing circles will say silly things like, this is a cleansing response. This is your body releasing emotions. Definitely don't listen to that. It's a really common thing in alternative health to attribute negative reactions to something positive. So people will change diets and get acne, and people will say that it's a cleansing response. Well, that's certainly possible. It's also more likely that it's an allergic reaction to the food that you're eating, because people will. In yoga. I used to be very involved in the Ashtanga yoga community, and people would pull a hamstring and the old school people would say that it's an opening. It's not an injury, it's an opening. Meanwhile, the student is limping around. If you're doing a breathing practice and it's causing tinnitus, back off and stop. There are two, well, three things that happen from controlled hyperventilation common enough that it's worth knowing about. Tinnitus is not so common. Tetany is where your hands clench up. Sort of looks like lobster hands. It's really disconcerting. It goes away. But that's another one. Well, let's say four things it can if you're prone to asthma attacks, it can create an asthmatic event. Probably the most common thing is that it can trigger an anxiety or panic attack. Those are very, very vague in general terms and very subjective. But who cares if you have an anxiety overwhelm moment? However you define that, that's not a good thing. These are single digit percentage point of cases. But when you get enough people doing it, it does happen. So my advice would be back off. Change your practice. You could do less rounds, you could modify. You could do something else. There are lots of different breathing exercises. Sometimes the extreme ones come with some risks that might not be worth it for you. Thanks for listening to the Lucas Rockwood Show. If you enjoy the podcast, I have two asks of you. Number one, share the show on social media with your friends and tag me. My handle is LucasRockwood. Number two is please leave a rating and review in whatever app you're listening on. And last but not least, before you go, if you'd like to be on my mailing list every week I send out information about the podcast, behind the scenes stuff, announcements of online online classes and special events I email about once a week. You can do that@yogabody.com SignMeUp and right now we have a free breathing worksheet on that page as well. It's yogabody.com forward/signmeup. Thanks so much for listening and we'll see you next time.