Live Q&A - Ask Me Anything

Okay, hello, hello, hello. Okay, let me test my— okay, my audio is good. Very good, very good. Oh, OK, how's everyone doing today? So I'm Dr. Anne Truong MD. I'll be going live every Monday at 12:00 Eastern Standard Time for AMA, Ask Me Anything. And so that way you all know when I'm going to be here. I'll be going live when I'm not on vacation. Uh, it'll be this Monday, the following Monday, uh, I mean today and then next week. Um, but I won't be here on, uh, I won't be, uh, I will do it on the 11th as well. So the next, uh, uh, 2 more weeks after today. But, uh, I'm here. You have any questions, um, put it in the comment. And I will see that at this point, and I will answer your questions. If not, then I will be answering questions that I get on my channel. If you guys have not subscribed to my channel yet, it's @DrAnneTruong MD. YouTube. That's where I— my mission is to make sexual health information accessible for all men. The information is actually disjointed, is confusing, it is sometimes not even accurate, and it's not helpful for you guys that are trying to look for a some real solutions that work to restore your sexual performance again. As a man, it's important to know that you can perform, right? And that's really part of who you are. And I know because I have a spouse that has had challenges with his sexual performance when he was having heart issues and was on heart heart medication, and it really affected his relationship as well as his sense of being. But when you try to find information online, most of it is not appropriate for you and is misinformation, and they're just trying to shove medication and ED medication and some supplements to you. And most of the time, it's actually come down to the basics, guys. If you're a guy that is noticing that you're not performing as you usually are, and you're just noticing that most of the time it shows up as you're able to get an erection, but you're unable to maintain it or you lose it. That's how it really shows up. First thing you should be looking at is the 4 things. Is it alcohol? You were drinking too much alcohol that day? You've been stressed? Have you slept well? Were there any— do you smoke nicotine? If you do, then nicotine, the big erection killer. As well. The consensus about marijuana is still out there, but if you smoke a lot, then it may affect it. But the thing is, oftentimes, just checking those checkboxes, whether you do it or not, and then just tweaking it or decreasing it will actually even restore your performance again. And even just changing your diet to eating a more healthy diet that is, you know, chicken, salmon, following the Mediterranean diet, chicken, salmon, and more vegetables and fruit and less processed food. When I say processed food, it's anything that is in a can or bag, anything that the earth not growing for you. Okay. Those are processed food because when food are being processed, they have to add in preservatives, which are chemicals in the food, and our body senses that as foreign. So therefore, it causes imbalance in the body to process that type of food. So, what the point I'm trying to say is, you're a guy and you're starting to notice that you're not performing as you usually are, sometimes you don't need to take that ED meds. Sometimes it's just doing a checklist. Okay, did I sleep okay? What's my diet like? I've been eating pretty good or not? Am I smoking cigarette? Did I drink too much alcohol that may affect my performance that night? How much is too much? You shouldn't drink more than about 14 drinks a week. If you're drinking 14 drinks that day or 7 drinks that day, it's definitely going to cause your performance, right? And then on top of that, are you watching porn? These are the things that you can do a a checklist and see if you're doing any of that. And if you are, then either decrease it or stop using it. And you will probably see an improvement. So, first, diet, and then lifestyle factors. And then number 2 is exercise. How's your weight? Are you overweight? Are you exercising 3 times a week? I'm not talking about hardcore exercise, just talking about just walking exercise. Just walking 30 minutes a day is appropriate. You don't need to go to a gym. Sometimes it's up and down the stairs, and going up and down the stairs where you're working as well. Those are the things that I want you to be aware of, and that's the message I want to get out there for you guys, is that when you first notice that you are starting to not perform as usual, you used to, oftentimes you can actually fix it with just doing the things that I just talked about, right? Because it can be reversible. But you start taking ED medication, even though, yeah, it will work in the short term, but in the long term, not helping you any because it's not really working at reversing the reason why you had ED in the first place. So when you start taking ED meds, it's just going to go into a deeper black hole that will make your ED actually worse. So you're kind of ignoring the cause of the problem. And note that only 70% of men respond to ED medication. And that even you take ED medication for a period of time, over years, it's going to wear off and that it's not going to work as well. And Studies have shown that 60% of men that has ED from 7 to 10 years down the road will have a heart event, meaning a heart attack, and about a small percentage of those, about 5 to 6%, will have more fatal So what I'm trying to say, if you ignore your ED, you're ignoring heart disease problem in the future. That's why taking ED pills is dangerous in that it's a short-term result, but long-term, you're making your actual ED worse. Are you guys following this? It's like taking pain medicine for your back pain. If you keep taking oxycodone or Vicodin or Percocet or morphine for your back pain, it may help in the short term, but after a while it doesn't work anymore and your pain returns and your pain may get worse. So actually fixing ED sometimes it's actually even easier again, treating pain because sometimes pain is due to perhaps in the back, maybe due to herniated disc, maybe to nerve being pinched, maybe due to arthritis. And those are the things that may need more surgery or intervention. But with ED, if you heard what I said earlier, you can really stop ED by simply just eating better, exercise, sleep, moderate your alcohol, and stopping smoking. So ED can be reversed, guys. So it's not like you got it, you got to live with it. No. But how often do I hear men with ED that they feel despondent, they feel it's over, and they try things and it hasn't work yet. And those are the ones that probably been taking ED medication for a while and then find that nothing seems to work. So my mission and passion is to really distill research-based information for men with ED to things that you can do and know that you can actually reverse it when you first have it. And that taking ED medication is not the answer when you first have ED. You can really reverse it. You guys all hear about taking pain medicine. Well, you take ED medicine, you're going to be dependent upon it like you would take pain medicine. All right, so I like my black tea. Here is noon time and me and you spending lunch together and, uh, tea. Okay, uh, let's take some questions here. I was gonna do some questions from my channel, but seems like, um, seems like not— Naz— Nazmu 2181 is asking a question here. Hi, Doctor, big fan. Thank you. Thank you, Nat Mu. I need really best advice about this, how to overcome porn-induced ED, right? Porn-induced ED and subsequent performance anxiety. Avoidance of intimacy, a lack of any response to real-life stimuli, and probable PE or premature ejaculation for real. What you're describing is, I would say, Nazmu, what you're describing is very, very typical of men addicted to porn. Essentially, when you're watching porn, it gets processed. What you see gets processed through your brain. And then initially it's stimulating because it raises dopamine level. And dopamine is the feel-me-good hormone. All right. Raise the dopamine level in your brain. But as you watch more and more of it, your brain needs more dopamine release in order for it to get that feel-me-good feeling. But if it doesn't get that high release of dopamine, it makes you anxious and makes you kind of apathetic and makes you kind of non-motivating. And what you said, lack of response. Okay. So your body said, oh, I like the dopamine. But I don't have the same amount of dopamine, I'm going to be the opposite. Because dopamine makes you feel good, make you feel like on top of the world, confident. But then when you don't have it, it's the opposite. So that's what porn does, is that in the beginning, it releases that dopamine. But then after a while watching it, even after a week or a couple of weeks of watching it, your brain needs more dopamine input in order to make you feel good. All right. So it's kind of like the analogy is that when you eat one scoop of— like when you smoke a cigarette, in the beginning, one or two cigarettes feels good, but then you need more cigarettes to give you that feel-good feeling. Right? The same thing. And the dopamine in your brain works the same way as cigarette smoking. So when you don't have enough dopamine in your brain, you become apathetic and you have anxiety, you have depression, and you have lack of real response to stimuli. And also you're just not interested in intimacy because you're just apathetic. And that even if you do have intimacy, you actually have ED because you're not able to get that arousal response because porn has kind of what's called sensitized your brain, or porn has kind of messed up the hormone in your brain that your brain needs more dopamine doses. It's kind of like you needing a pack of cigarettes, but you don't have that pack of cigarettes. Anymore to make you feel good. All right, so that's why you have lack of intimacy. And this is real. I see this all the time. And you probably have PE because you probably have PE because of the chemical disturbances going on in your brain. So Porn, um, it can really mess up your, uh, brain, your arousal system. Now, an erection starts in the brain, guys. It doesn't start down below the belt. It starts in your brain, okay? It starts in your brain, and, uh, because it starts with arousal first. If it doesn't start in here, nothing's gonna go below the belt. Just know that, right? Because if you're depressed, if you're apathetic, if you're anxious, if you're worried, if you're stressed, it's going to be hard for you to get an erection. And you get aroused by the 5 senses that you have, which feed signal to your brain, right? What are the 5 senses? What you see, eyes, nose, what you smell, what you taste, what you hear, and what you touch. These are the senses that feed into your brain that will bring that arousal up, the release of chemicals that get released out. But that's filtered through your emotions. All right. So the stimuli goes in, But then it has to go to the filter of your emotion, and then the chemical gets released. Okay? So if your emotion is anxious, then it's going to get filtered. Not enough. It's going to be— not enough chemicals going to be released in your brain, or hormones going to be released in your brain to start a chain reaction. Okay, so that's why performance anxiety affects erection, even though physically you don't have any erection problem. Okay, so I hope I explained that well, Nazmu, and the key is stop porn. Uh, the key is really just stop it. And there are multiple resources, uh, for you to, uh, seek, uh, and stop porn. And honestly, um, once you do that, you're gonna stop porn. Second, uh, start eating a Mediterranean diet, start exercising, start meditating. And when I mean meditation, uh, download an app Call Calm onto your phone. It's free, minimal charge, and just reset your mind again. All right, you can stop porn by finding a coach that will help you cope with not watching porn, or you could do it yourself and go cold turkey. All right. You just go cold turkey. Yeah, you will have withdrawal, but you can do it. It's like people stopping smoking, right? Sometimes people need hypnosis. Sometimes people need a patch. Sometimes some people just stop smoking, period. Right? So same thing with porn. You can do it yourself, which may be harder. You can get a coach that will help you with getting off of porn, but you got to make decision to stop it yourself and stick with it. Because if you don't, Nat Liu, if you keep doing what you're doing, all your problems are going to be worse. Okay? So I hope that helps, because if you keep doing what you're doing, you're going to get more anxiety and you're going to get lack of response to life and PE, and then you're gonna get less of probably, um, you know, meaningful relationship, and you're definitely gonna get more of ED. Okay, so, uh, think about, think about that. I hope that was helpful. I'm, I'm only coming from a position of education. Of course, check with your doctor first, um, and, uh, trying to get real with you guys. And sometimes it's not like, uh, a shiny object or magical supplement or magical pill that's going to fix all of this. It's really coming down to your willpower to do this. Okay, so let me know what you think, Nazmil. Great question. All right, he was the first one that asked the question at 12:04. I'll be here to 1 o'clock. as well. Okay, another good question. Libo, Libo. All right. Hi, I got a question if I may. Of course. Is there a way to naturally boost testosterone level without any pharmaceutical or any medical intervention? Great question, Labu. Love this question. Okay, so it depends on how old you are. Uh, Lebeau. I, I can't pronounce your last name, maybe Lebeau. What it depends on how old you are. Okay. So let's be real. So if you're like under 40, then you can probably, uh, increase your, uh, your testosterone level, uh, naturally. If you're under 40 years old, because your testicles can still make good testosterone, um, uh, to have you in, if you're under 40, and you are pretty healthy, you don't have diabetes, you don't have high blood pressure, and you don't have high blood pressure, you don't have high cholesterol, I assume, okay? You can increase your testosterone by following the Mediterranean diet. You follow the Mediterranean diet, it's an anti-inflammatory diet and that will increase your testosterone. If you exercise more of high intensity, it's called HIIT, high intensity interval exercise, that build more muscle. And when you build more muscle, testosterone will increase. Okay? Because muscle need testosterone. And when you build more muscle, You're sending a message to your body, you need more testosterone. All right. Number 2 is sleep. You sleep 7 hours, 7:00 PM to 6:00 AM, because when you sleep is when your testicles make more testosterone. And that happens between 10:00 PM 2 AM. If you don't sleep, your body's not going to have time to heal and make more testosterone. So when you don't sleep, you're compromising your body's ability to heal. That's why if you don't sleep at nighttime, you feel tired the next morning, right? You don't have the same energy. You just feel tired. So sleep is important. And I would tell you this is also stress management. Stress, when it's increased, when you have stress, you have high cholesterol. I mean, not cholesterol. When you have stress, you have high cortisol. When you have high cortisol, which is a stress hormone, that decreases testosterone. Cortisol up, testosterone down. Cortisol is released when you have stress. And how do you know you have stress? Most men don't realize they have stress, but most men actually are stressed, but they don't know that. How do you know you have stress? Oftentimes, it's increase in your heart rate. Increase in your heart rate. If you wear an Apple Watch, you'll you'll notice that your heart rate increases. And also, if you have Apple Watch, more of the newer version, you'll see a change in your heart rate variance. So you have an increase in heart rate variance, it's heart rate and then variance, then you have more stress. But stress is a physiological response. Stress is a physiological response that your body responds to. Now, hundreds of thousands of years ago, or when we were made, the stress response protects us because when we have stress, our heart rate goes up, our body releases more epinephrine, is to get away from danger, to get away from dinosaurs, get away from from dangerous environment. But it's short-term and it's helpful. But stress is not good when it's not short-term. It lasts for months on end instead of just a day or just a few hours. It lasts for months. When it lasts for months, then it starts affecting your heart, and then it starts producing imbalance in your hormones. And that's why stress is not good for your body. And when you have stress, testosterone level decrease. Okay. So I have seen my patient with low testosterone come in with testosterone level of like 300. And I seen him change a diet to be less carb, less processed food, and eat more of lean meat like salmon. More vegetables and fruit, I literally will see his testosterone level almost double from 300 to 600 within— and it appears fairly quickly within 6 weeks or so. Fairly quick. So within 6 weeks, you can actually see improvement as well. We see that in the blood work. So those are the things that you can do on your own. And you really do not need a supplement if you eat a healthy diet, honestly. Supplements do help some, but we've been a species for millions of years and 50,000 years ago, you don't need a supplement to increase your testosterone. Why do we need it now? As long as you eat a healthy diet, you should be able to increase your testosterone. So, those are the things that mainly increase testosterone. Porn decreases testosterone. Okay? But I precede that with saying, well, if you're under 40, Now, if you're over 40, you just don't make enough testosterone as you get older. It's almost like a factory. Testosterone is made in your testicles. So the factory is just not as efficient as it was when it was first made. So for men after the age of 35, testosterone production dropped 1%. Okay. Now, 1% is not a lot. Let's say you're 60, and so that means it dropped 25%, right? Well, it dropped 25%, but then if you account for like if he has diabetes or he's overweight, diabetes is inflammatory, being overweight is inflammatory, anything that's inflammatory would decrease testosterone as well. Then if you're 60, you already have less, you have 25% less production. Then on top of that, if you had the other medical condition, like I mentioned, like high blood pressure, high cholesterol, and diabetes, that's going to make it dip down lower. Okay. So testosterone is very sensitive to other medical conditions. Right. And so if you're over 40 and you probably going to need testosterone supplementation, meaning additional testosterone, either through injection or pellet implant or even now an oral testosterone. Or even gel, testosterone gel. Now, I have seen testosterone gel work well in applying to the testicles, better than on the arm as well. So if you're over 40 and you have other medical conditions, you may want to consider taking testosterone supplementation such as testosterone injections. That's what I mean, testosterone injections and testosterone pellets and testosterone oral. And you can check my YouTube channel. If you guys are watching this and you're not subscribing to my YouTube channel at Dr. Anne Truong MD, I would really appreciate it if you do. That would mean It will mean the world to me if you do. So here is my channel, uh, at Dr. Anne Truong MD here. I would definitely appreciate it if you guys can do that. I would— it will be lovely. Okay, so where is my channel? Not even here. Okay. It's not even here. All right, so that's the channel, Dr. Anne Truong MD. So was that helpful? All right, was that helpful there? That's a good question, uh, label, uh, so it depends on your age. All right, but if you eat well, if you eat a Mediterranean diet, if you exercise, and if you, uh, sleep 7 hours at nighttime. And, you know, like we said, stress management before bed. It's like, oh, what the heck does that mean, right? What it means is, um, uh, what it means is, uh, enjoy life and take things in stride. Smile more, be with the people you love, and exercise. Uh, honestly, you know, that Enjoy life and don't let the little things in life bother you. Don't let the little things in life just bother you or make you feel anxious or feel irritable. Because sometimes you may not have the Apple Watch to know that your heart rate increases. But when you're feeling irritable, somebody bothers you. Just enjoy life. If you don't have an Apple Watch to measure your heart rate variance. Okay? All right. So let me know if that was helpful. Okay? Okay. Boy, we have a ton of questions. Thank you guys for being here. Okay. This is Mr. Now I'm gonna put, um, if you're watching this, I'm also gonna put, um, the Mediterranean diet, um, QR code right up here. You scan that QR code, you, uh, it's gonna give you the free Mediterranean diet, okay? Essentially, guys, it's really eating more lean meat like chicken, pork, salmon, or fish. Fish. More vegetables. So fill your plate with half vegetables and the lean meat and eat fruit. Right? Don't eat anything in a bag or in a can. Okay, it's really that's it. All right, let's get the answer from Mr. Tula Verde. I've been using a penis pump 5 to 6 times per week. Awesome, thank you. Awesome, Mr. Tula. Um, 2 sets of 4 minutes, 2 sets of 4 minutes at 5 inches of mercury of pressure. I've been noticed my bone— I have been noticed my bone press flaccid stretch length increase. Yep. Could this be a sign of gain? Yes, absolutely, Mr. Tula. This is definitely a sign of gain because when you do the penis pump, you are bringing blood into the penis, right? When you're doing the penis pump, I just move, I can't find the penis pump somewhere. But when you do the penis pump, it creates like a negative pressure, right? It's a vacuum. So when it creates a negative pressure, it will pull blood, right? So here's your testicle, the penis, and here's the pubic bone right here. Right? So you're pressing the cylinder against the pubic bone. So when the, when you do the pump, it creates like kind of a negative pressure, like a vacuum, and it pull blood from your body to go into the penis and it make the penis engorge with blood. So when the penis gets engorged with blood, it stretches the muscle. So when it stretches the muscle, then it will lengthen your penis. It's like going to the gym and you do bicep curls with weights, right? When you do bicep curls with weights enough, you're going to notice that your arm muscle, your bicep, gets bigger, right? Because every time you do that, you bring in blood to the muscle, and that muscle is engorged with blood. When it's engorged with blood, it actually stretches the muscle. When the muscle stretches, your body will make more muscle. And that's why when you go to the gym and you work out with the gym, and when you do weights, you bring more muscle in. More blood comes in, more blood comes in, more muscle development. Same thing happened to the penis. You bring more blood in, the penis muscle stretches, right? And you will gain more length, about an inch in length, and you'll probably gain about half an inch to a quarter of an inch in girth as well. And the benefit for penis pump is It stretches your muscle, stretches the penis muscle, it prevents fibrosis or scar tissue development in your penis, and it also brings in fresh oxygen that is in your blood to the penis muscle. When you bring in oxygen to the tissue, that tissue heals. Heal. All right, uh, it heals, uh, and becomes stronger. And when you do the penis pump, it will, uh, actually, um, uh, give, uh, uh, almost like train your penis to have an erection. When it trains your penis to have an erection, it Pump is like exercising your penis to be ready for an erection, right? So when you have ED, if you don't use the pump and you're having difficulty with intimacy, how else can you have an erection, right? You don't, right? So then what happens? You don't have an erection. What happened to the penis muscle? It shrivels up. Shrivels up and it starts to atrophy, or it starts to shrink. The muscle starts to kind of get smaller and start to shrink. And then when it starts to shrink, and then you start seeing scar tissue in the penis. And I have seen that with the patient that come in to see me with 20 years of ED, 40 years of ED, their muscle literally shrink and it goes almost like hidden inside the foreskin. It gets so small that it gets inside the foreskin and you don't even see the penis, you see more of the foreskin because of muscle atrophy. And because if you don't bring oxygen to a muscle, the muscle is going to start dying, right? It's going to start dying. And then when the muscle is being replaced, when the muscle starts dying, the muscle is going to be replaced with scar tissue. And scar tissue doesn't expand, right? It doesn't expand. So when you start, when you have an erection, if the muscle gets stiff and it doesn't expand, then you're going to have ED, right? And that's going to happen even if you take Viagra or Cialis. But the penis pump will actually— if you do the penis pump, the penis pump will actually stretch that scar tissue area to try to make it more flexible. So that way, your penis can be engorged with blood. Now, your body is made so well that within minutes, you know, you can have 40 times more blood flow down to the penis. 40 times, 40x more blood flow to the penis to give you an erection. But the muscle have to be soft and flexible The corpus cavernosum, or the shaft of the penis muscle, has to be soft and flexible in order for it to be engorged with blood to have a functional erection. Does that make sense? All right. So, what you're seeing, Mr. Tula, is that what you're seeing is you are having increase in length. As well as in girth. And how do you measure that, guys? So you measure that, um, from the base. So let's say you measure it, uh, you can measure when it's flaccid, so from the base right here and then all the way to the tip. So you measure it when it's non-erect, right, from the top to the tip. And then you measure the base at the circumference, at the base. Around. It's a circumference, not diameter. Circumference of the base. You measure when it's flaccid, you measure it when it's erect. Okay, so that's how the convention of measuring it. Well, thank you for sharing this, Mr. Tula. All right, next one. Uh, okay, next one. Okay, so Nazmu here said, uh, all right, thanks. Okay, I appreciate that. Well, let me know what you decide to change and how it goes. It's going to take you about 90 days, 6 weeks to 90 days to see a difference. Okay, Nazmul. All right. Is there a natural way? Is there a natural way? So Reasoning Bean, Reasoning Bean, very interesting names I see here. Reasoning Bean says, what natural way is there to increase girth rather than length? You can't just increase girth and not length. It's gonna usually go together. And the way to increase girth or length is probably what I just talked about, the penis pump. Okay. But when you increase girth, you're going to increase length. And I will tell you this, guys, 87% of men think that they are not well endowed. But in reality, research studies have shown that they look at 20 men of all different ethnicity and age, and average, average erect penis is 5.5 to 5.75 in length and 4.75 in circumference. So if you're around there, you're average. All right. A small penis is considered 3-inch erect, erect 3-inch in length is what is considered a smaller penis. All right. So oftentimes we are harsh critics of ourselves. And when most of the time you're probably average. All right. Very good. Uh, okay, all right, so, uh Okay, I don't know some of this, uh, questions here. And, um, here's another penis pump question from Strange C73. Okay, uh, can you use a penis pump every day, sort of like you're doing a workout routine? Will that help with performance? I got one and still not sure if I can use it regularly. That's a good question, Strange. That's a good question. What— you can use it every day, right? You can use it every day. And if you have ED, I suggest that you do use it every day if you have ED. So I'm not sure if you have ED or not. Can use it if you have ED. But if you're using it for maintenance, if you don't have ED and you're using it for size, you don't have to use it every day. You won't harm your penis if you use it every day. Now, if you use it 5 times a day, then you will— your penis will get fatigued and you will harm your penis. Use it once a day, it it won't harm it. All right. So if you have ED, you really do need to use it every day to train the penis on what's it like to have an erection. Now, if you don't have ED and you're doing it just for length and girth, then you're probably okay with doing it like 3 times a week, but doing it every day is not bad as well. And yeah, and it doesn't— yeah, yeah, you'll probably, you're probably okay. Now, if you're doing it 5 times in one day, then that's not too good. But again, everything in moderation. Okay, I hope that helped. Okay, let me know if that helped. Okay, so Libo said, um, thank you very much. I'm 35 years old. I'm gonna start exercising and take your suggestion real soon. Yes, your response to my 3 questions. Oh, thank you, thank you. That— I, I hope that was what was helpful. Listen, you know, like I said, sometimes the most meaningful things that you need to do is right in front of you and it's free. You don't need to chase that shiny object, guys, okay? You really don't need to. Oftentimes we think, oh, I'm going to buy this supplement from Africa, tree bark, that's going to solve all my problem. It's actually probably not. Because remember, our body, it's all— our bodies are like almost, you know, a million years old. So the way that it operates doesn't require other synthetic material or chemicals. Okay? So just know that. All right. Okay. Very good. Um, Tula, Mr. Tula says that he's increased 0.2 inches longer right after 2 sets of 4 minutes. That's great, that's great. Um, okay, so somebody just asked that question. Um, okay. Okay, so, um, that's the penis pump. Okay, all right, okay. So Dr. Anne Truong MD, a D, a DDO. Okay. Dr. Anne, what do I have to do to put an end to my ED? I've stopped smoking. I used to have oxygen deficiency. I don't know what that means. You used to have oxygen deficiency because of your lungs, because of smoking. You have emphysema or COPD and you don't have enough oxygen. Is that what you mean? Because you have emphysema or COPD. I have ED since I was a teen. Um, you know, I don't know how old you are. Um, I don't know how old you are, uh, right now. Um, and I don't know how long you've been smoking, right? Um, uh, so the longer you smoke, it's just the worst your ED is going to be, right? If you are a smoker, you might as well say goodbye to your erection, period, right? And if you take pain medicine, you might as well say goodbye to your erection as well too, because pain medicine will affect your erection as well, decrease your testosterone. And so when you smoke to a point where you have oxygen deficiency, which I assume is from emphysema or COPD, then your penis not going to get enough oxygen either if your lungs not going to get enough oxygen. So, I don't know how long you've been smoking. And so, if you had ED since you were a teen, it could be due to other things. You're a teen, I assume that the smoking hasn't affected by then. Yeah, the ED may be more psychological than physical. Assuming there's no more— assuming that physically that there's no curvature or your testosterone level is good. You know, smoking do decrease testosterone level. Okay, so if you just recently stop, it's gonna take years for your body to recover from the smoking. And but it can recover, so it's not too late. And for you right now, if you're having ED, it's best to probably get, get right now a penile Doppler ultrasound and see what the blood flow is in your penis. If they see that the arterioles or the inflow of blood is not coming in, uh, well, then, um, that's not a good time. Okay, um, so you may want to get your testosterone level checked and get an assessment of your, um, vascular, uh, uh, um, status, like how's your heart doing and how is the arteries that come out of your heart and go down to your penis, like involving the arteries of the legs. If the legs— artery to the legs is compromised of oxygen, most likely you will have compromised oxygen to your penis as well. So for you, I would suggest seeing a doctor and getting evaluated for your vascular status. Anne Truong MD: right, which is your blood flow status. First, as first, and see if you're getting enough blood flow down to the penis there because of ED when you were a teen, as well as a history of smoking. Okay, I hope that was helpful. It doesn't hurt to use the penis pump. It really does not hurt. When you use a penis pump, it brings in blood to the penis, it brings in oxygen to the penis, and it also, it also makes the penis muscle more flexible. So it doesn't hurt. So with you, I would suggest using the penis pump daily. Okay. All right. Very good. All right. So Anthony here says, I'm 63, have diabetes for 27 years. Testosterone is, uh, 163. Absolutely, um, uh, it's 163. So what I would suggest for you, Anthony, is, um, to work on improving your hemoglobin A1c, right? Your hemoglobin A1c is the marker for your blood sugar level. Within the last 6 weeks. So if you lower your hemoglobin A1c to less than, hopefully less than 7, optimal less than 6, if you lower your hemoglobin A1c, then your testosterone level will improve some, but you're probably going to need supplementation because you you're 63. Um, but your goal should be lowering your, uh, testosterone— your diabetes, uh, your blood sugar, which is your hemoglobin A1c. Because if you lower your hemoglobin A1c, um, uh, it will help with your erection. Uh, but you're still gonna need testosterone replacement therapy with either testosterone injection or testosterone pellet, which is implantable. A pellet that gives you testosterone every day. We implant that just underneath the skin on your buttock. But also, your goal is to work on lowering your hemoglobin A1c, because if you lower your hemoglobin A1c, it will also help with your erection because when your diabetes is better controlled, you have more blood flow. Think of diabetes, which is like, meaning there's more sugar floating in your blood than normal. Think of diabetes as inflammation or fire in your bloodstream, which causes decreased blood flow. Okay? So I hope that helped, Anthony. All right, thanks for asking, um, uh, the question. Well, doctors have given up on me. Oh well, I don't know about that. Um, if you're 60, I don't know if you're in the US or not, but you're in the US, you definitely has, uh, options. So don't give up on yourself, don't give up. Uh, if you're in the US, you definitely have some options. I weigh 140. Well, you definitely need, uh, uh, you probably need to go to a medical center, a big medical center, university center, and get a second opinion. Okay, here we go. All right. Okay, so John, John Nesbitt says, hiya, Dr. Anne. Hiya, John. I have just had my testosterone check and the reading was 23.4. 4, uh, well, it depends. It sounds like a free testosterone because testosterone total ranges from 300 to 900. Uh, it could be that low for free. Um, free testosterone usually it's about less than about 14. Uh, you're 66 years old with ED. Is that level okay? It should be higher. Councilman people said it should be higher. Well, you have to find out whether that number is total testosterone or free testosterone. If that number is the free testosterone, then it's high. If that number is the total testosterone, then it's low. Okay. So that number could— you need to clarify that. It will say on there free testosterone. It will say on your lab report either free testosterone or total testosterone. Now I have seen men Total testosterone that low, as low as 50 or 20-something, and when it's that low, your testosterone is rock bottom barrel. Literally, you're not making anything. Is it that low? Then you need to see a hormone specialist doctor who can run comprehensive blood work, on you before you start taking testosterone. Guys, do not go to this, go to some online dispensary. They see you for 5 minutes, they don't measure your testosterone level, and they give you a prescription for testosterone. Don't buy prescription from Canada or buy from somebody for testosterone. If you're taking testosterone, you need to be monitored for your blood levels. First. You cannot mess around with testosterone without monitoring your blood level. You're playing Russian roulette. Because testosterone control your brain, control your nerve, control your muscle, control your heart, and control your blood level, controls every cells in your body. And if it too high, it's going to cause your blood to become thickened. If your testosterone level too high, it'll cause your blood to become thickened. And when it becomes thickened, it can become a clot. And therefore, you can have a heart attack. You can have a pulmonary embolus. You can have restriction of blood flow down to an extremity. So it has very severe consequences if you don't monitor your blood work or if you're taking too high of a level. I've seen some of my patients get it from, you know, their personal trainer and get it from Canada and they'll be taking it without even getting blood work monitored. So you have to get your blood work monitored to check for high hemoglobin. You also need to check for PSA level, which is a level for your prostate, because sometimes testosterone will, if it's too high, it's going to raise your PSA level as well. And testosterone, if you take too much testosterone, it's going to be converted to estrogen. And when it's converted to estrogen, That's the female hormone. Men do need it because estrogen do help with your libido, but too much of it is not too good either. And oftentimes your body senses you have too much testosterone, it's going to convert to the estrogen level. Okay? And so you also need to monitor whether your body's making dihydrotestosterone or DHT. And DHT is very inflammatory. It irritates the prostate to make the prostate enlarge. So, and it also causes hair loss, right? So if you don't monitor the testosterone level, it's going to cause hair loss. It's going to cause increase of— enlarge your prostate. It's going to cause your blood to thicken. And it's going to be converted to estrogen. So if you're on testosterone replacement therapy, before you do it, always get blood work ahead of time and monitor what is your level to start out with. And then once you're on testosterone replacement therapy, either injections or pellets or oral or cream or gel, then you need to be followed with blood work about every 2 to 3 months, probably like 3 times in the first year and then once every year once your dose is stabilized. If you're doing a clinic and they're not checking your blood level in the first year at least 2, 3 times, then you need to be more follow, uh, uh, closely. All right, uh, because there are a lot of bad, bad, bad side effects if you— if your testosterone is not being, um, monitored. Okay. All right, all right, John, good question. Um, uh, good question there. Um, all right, let's do one more question and, uh, That is it. So Plato, Plato, no. Can I use Cialis and Viagra together? No, the answer to that is no. Viagra is a short-acting medication. It works in about an hour, lasts for about 4 to 6 hours. Cialis works in about 2 hours, and it lasts about 36 hours. So if you use it together, what happens is it's going to lower your blood pressure. It's going to lower your blood pressure and you're going to pass out. And it could even lead to a heart attack because your blood pressure drops, you're not getting enough oxygen, and it's going to cause some heart issues. And it also depends like what dose of Cialis, what dose of Viagra. So I do not suggest you take it together. And if you find that Viagra is not working well, then you need to work on the root cause of why you have ED. If you're taking ED medicine, it's like taking pain medicine for your back pain. You're not addressing the root cause of why you have ED. If you find the Viagra is not working and you want to add Cialis to it, then you're really burying your head in the sand, not trying to figure out why you have the ED. And you're taking a medicine, you keep going up on the dose, you're digging yourself a deeper hole. All right? So I don't suggest you take it together. I suggest that you need to look at why you have ED. Is it Your diet? Is it smoking? Is it porn? Too much marijuana? Too much alcohol? Are you exercising? How's your weight? Are you sleeping well? How's your stress level? Those are the things that you guys have to get real on. You have to really get down and be real with yourself and work through this because, you know, It's not easy, but it definitely can be done if you have the willpower to do it. So, and I have seen men just changing their diet. Once they change their diet, they start exercise, they lose weight. When they lose weight, they feel more confident, they have more energy, they do more stuff, their testosterone level increase, and they start doing penis pump. And they're starting to notice, they're starting to notice morning erection again. And these are men that have been on taking ED medication for years and their erection, they start to notice morning erection without ED medication. Right? Just changing their diet and their exercise and sleeping better. And they're also are also using the Good Morning Wood Smoothie here. Good Morning Wood Smoothie, if you take it for about— here, go to goodmorningwoodsmoothie.com. If you take the smoothie daily, even once a day or even twice a day for 6 weeks, you're going to start seeing a difference. But of course, you got to change your diet along with that too. We're seeing men that have prostate cancer that had their prostate removed and they take the smoothie every day. They follow the Mediterranean diet and they start exercising more. They start to lose weight and they start to see morning wood again. Without ED medication, without even treatment, other than just by doing that alone. Just by doing that alone. All right, uh, so sometimes you gotta put in the work, you got to stay consistent, you gotta stay dedicated if you want your sex life, uh, back. Uh, um, at this point, sometimes it's doing the hard work for the result that you want. Okay? All right. Got lots of good questions. I'm glad you guys were with me today. And I will be back next Monday again at noon. If I didn't answer your question today, I'm sorry, but save those questions for next week and I'll answer that. Very good question today. I'll make sure to save it. I may even do a video on my YouTube channel. And let me know what question you would like me to address. All right? I appreciate you guys. All right? Thank you for being here with me. Thank you for the great question. I hope that was helpful. And check out my— if you're not subscribed to the YouTube channel, I hope you do. Is that Dr. Anne Truong MD. I'll see you in there, and I'll see you in the live next week again. Have a great one.