Live Q&A: Ask Me Anything (Men's Health & Performance Unfiltered)

Alright, okay, hello! We are now live. I have to say, I've been having some bad allergies lately, and so if I found— if I sound nasal or stuffy, my allergies is hitting me right now unexpectedly in the middle of summer. I know. Okay, so just so you guys know, let me see if— okay, all right, if you have a question, drop it in the comment and my team will raise it up to me. If not, I, I know it's been a few weeks since we've been live and back from vacation now with a bunch of allergies. So stay with me here. And my eyes are all watery and itchy right now. Okay. And I don't like to take medication. Medication makes me— allergy medication makes me sleepy. So I try to avoid that. All right. So put your question in the comment and I will answer it. If not, I am gonna answer some questions that we were asked on our comments. Okay, so in fact, I'm, I'm gonna copy this. I'm gonna copy this, John, and post that So that way, okay, so there's another question there too. I see that. Okay. All right. Um, so there was a question, um, there was a question that was asked and there's another one about PT-141. So I'll copy that as well. And put that in there so we can highlight it. So let's go ahead and highlight the question. Let's go ahead and highlight the question. What type— okay, so the question— hold on, let me— my camera. All right, the question says, what type of ED is commonly seen in finasteride-related ED? What you can make it better. Okay, so, um, finasteride— what, what is, what, what is, what is finasteride? Finasteride is a medication, um, um, it's a medication— let me put this in— it's a medication to prevent hair loss, but, um, but Um, it does have side effects as well. So finasteride, um, help with blocking testosterone from to make DHT or dihydrotestosterone. Okay, and, um, men take it to prevent hair loss, and especially if they're on, uh, testosterone, especially if you're on high-dose testosterone. Um, So according to the medication list, um, ED is probably the most common adverse side effects of finasteride. So brand name of finasteride is called Propecia or Proscar. It's usually prescribed— Propecia prescribed around 1 milligram and Proscar is about 5 milligrams. And, um, it's about, uh, about 1% incidence in all patient. Okay, so, um, so, uh, you use it for hair loss, but then one of the side effects is that it can cause, uh, ED, right? So, um, that's something to remember. So when you're taking it, uh, it affects sexual— your libido. It will also affect your, um, your erection. And as well, and it only takes a few months for it to start. Um, so it does affect your erection. Okay, okay, so that's in both Propecia and Proscar. The mechanism is that this is the study in rat that penis tissue, it affect the penis tissue and it also affect the nitric oxide, the nitric oxide production as well too. Okay. So there's a syndrome called post-finasteride syndrome or PFS. All right. P like in, like in P like in post. F like in finasteride and S like in syndrome. It describes persistent sexual, neurological, and psychological symptoms that continue months after discontinuation of the medication. So this is interesting. So it usually comes on around 61 days after discontinuation of the medication. And in some cases, may even go for a year or even years, as well. So if you're taking finasteride, just know that it will affect your erection, and it may even be— once you stop it, may even be present even up to, uh, years. Um, and so just know that, uh, because most men take finasteride pretty commonly, especially when they're on high-dose testosterone, right? So if you're on high-dose testosterone then, and if you need to take finasteride, what you need to do, lower your testosterone level, either you're getting injection or you're getting a pellet. So that way you don't convert to DHT, right? So the key is not to take a medication to block DHT. The key is to get to a good level of testosterone without conversion to DHT. Now, I wanna stress that testosterone receptors or the keyhole for testosterone, that for testosterone to go into the cells and start working, think of receptor like a doorway in your cell. Your cell's like a balloon and it's a little doorway for testosterone to get inside your cell. To get into the DNA for it to start making changes. But the receptor for testosterone is different in every man, is genetically determined. So what that mean is that every man happy level of testosterone is different. Some men are happy at 500, some men are happy at 800, some men are happy at 900. So testosterone replacement therapy should be, The goal should be how you feel, not to raise your level to a high level. High does not necessarily mean good. It's how your symptoms, how you feel with testosterone replacement that matters, because the level is genetically determined by your DNA. So every man is different. So it doesn't necessarily mean high level is necessarily good. Okay, so that's about post-finasteride syndrome. And the adverse side effect is erectile dysfunction. It also affects orgasmic function, sexual desire as well. So something to note, right? So how do you combat this? You're taking testosterone therapy, ask your doctor to lower the dose for you as appropriate. Instead of trying to jack it up and trying to take, uh, finasteride. And if you're taking finasteride just for hair loss, just know that this is one of the side effects, uh, as well, and that one of the side effects is also the post-finasteride syndrome, which could last for months to years. All right, so that is one of the questions, um Um, okay, so, uh, that's one of the questions. Um, so what type of ED is normally, uh, seen? Uh, what type of ED usually is probably the venous leak, right? So what can you do about it if you can't stop finasteride? Penis pumping. Penis pumping. Um, probably lower— ask your doctor to lower your testosterone level. Uh, and follow the Mediterranean diet. Exercise at least 4 times a week for half an hour and get adequate sleep. Okay. And those are the things that you need to optimize your body for optimal state. So that's how you combat it. Okay. All right. So Okay, so I just answered, uh, Libo question. So Libo asked, uh, so that's a follow-up to that, says, I'm 35. Hi, Libo, uh, says, I'm 35, uh, uh, what is the optimal level of testosterone for someone my age? So your answer is, Libo, it's not, uh, it's not the same for every man at 35. Testosterone is personalized because the testosterone receptor It depends upon your genes. So, Libo, you may be happy at 600, and somebody else will be happy at 700. So there is no number for everyone. It is personalized. So think of it as testosterone level that make you feel good. Okay? That is where the range you— that's where you want to be at. And I see this in my practice. In my practice, I give men pellets., or injection. And so I, I never jack up the level to as high as possible. I just get them to a level where they feel good. Now, how do I know they feel good? I have them, uh, do the ADAM test. Uh, the ADAM, I mean, stands for androgen, uh, male, androgen male, uh, androgen, uh, test. ADAM, A-D-A-M. Um, and that test, um Anne Truong MD asks you 7 questions that is related to testosterone deficiency. And if you answer question 1 and question 7 as yes, then you have low testosterone, or 3 out of the 7, you have low testosterone. But most of the time it's how you feel. And testosterone usually affect your libido. The penis also have receptor for testosterone as well too. So Um, the, the answer to your question is, uh, the answer to your question is, um, it, um, is personalized to you. It depends on how good you feel on testosterone. So it's not a number. Don't go by number, go by how you feel. Okay, so that is the answer to, uh, you, uh, Libo. Um, Okay, let's see what else. Okay, so, okay, so let's, let's kind of follow up on here. Is there a way to naturally increase testosterone? I Yes, so follow-up question on Libo. Is there a way to increase testosterone without pharmaceutical? Yes, you can. You can increase testosterone by decreasing your stress. Stress lower testosterone. Decrease your stress. Now in our office, we have a way now to measure your cortisol, which is the stress hormone, through your saliva in the office. And you get, within like 10 minutes, and you get real life data for that, okay? So there, and if you're interested in getting that test, you can contact our office and we'll mail that test for you. And you can actually get the test on your app as well. And you can follow the cortisol, has to be measured through saliva, not through blood work, okay, for more accuracy. And so you can increase it by decreasing your stress, Improving your sleep. Sleep 7 hours at nighttime. What's nighttime? Between 10:00 PM to 6:00 AM. That's when your body make more testosterone. Number 3, Mediterranean diet. If you follow Mediterranean diet, your testosterone level will increase probably 30 to 40% naturally. Stop eating processed food. Exercise. If you do high-intensity interval exercise, you will also increase your testosterone. You gotta do that about, say 30 minutes, 4 times a week. Okay. And then what other, those are the main one because I see with my patient, when they start changing their diet, their testosterone level increase. Sometimes it will go from 300 to like 600, usually within about 6 weeks. And stop smoking because smoking will lower your testosterone. All right. So the big main levers are sleep, stress, reduce your stress, Mediterranean diet, and exercise, stop smoking as well. And so those are the natural things that you can do to raise your testosterone level. And nothing necessarily mean high level is a good level. Like I said earlier, testosterone level is all, It's all personalized. Okay, so that is, that is the answer. I hope I answered that question for you. Just let me know if that is adequate. Okay. Okay, so upon following that, Tommaso asked, my question is I want to know some natural remedy for harder erection. Well, first of all, Before you go for the natural remedy, you have to find out why you're not having hard erection. Not having a hard erection itself is erectile dysfunction. It's having ED. And most of the time it's related. I'm telling you, the younger you are, it's going to be related to your diet, your stress level, exercise, your obesity. Are you sleeping? Are you doing vaping? Are you smoking? I want to tell you this. If you are vaping with nicotine, it's the same thing as smoking cigarettes. Probably even worse because of the vapors that goes into your lungs. Are you using porn? All right, could all those affect your erection? And when you're not having a hard erection, because mainly because it is a venous leak. And so you have to look at what is the reason why you're not having hard erection, because if you're taking supplement or natural remedy, you really don't know why. So first of all, find out why you're not having harder erection. Is it Is it your diet? What type of food are you eating? Are you eating fast food? Are you eating vegetables? Mediterranean diet focuses on lean vegetables and lean vegetables, like not lean vegetable, lean meat, like chicken, fish, pork, and then vegetables, all sorts of vegetables, less of processed food. What is processed food? Anything that's in a can, a bag, or a box. Eat what the earth grows for you. Then exercise. Are you exercising? Are you exercising at least 30 minutes, 3 or 4 times a week? Are you sleeping 7 hours at nighttime? Those are the things that you can do to help with your soft erection. And you can follow the Mediterranean diet at eat4noed.com, right there for the Mediterranean diet. And so when you're not staying hard longer, it's because you're going soft quickly, and that's usually due to venous leak. So everything I'm telling you right now will help with not only staying harder, but staying harder longer as well. And so you get your testosterone level checked. All right, maybe you have low testosterone. That's why you're having delayed ejaculation as well. But you need to get your prostate level checked as well too, if you're having delayed ejaculation. So for what should you do when you are not getting as hard? First of all, check to see what diet you're on. Are you exercising? Right? Are you sleeping? Are you— how is your stress level? You're high stress, then you need to reduce your stress through either exercise or through meditation. And stop porn, stop vaping, stop cigarettes. All right. And look at your medication. Sometimes high blood pressure medication can contribute to it as well. So those are the natural remedy. Find out why you have soft erection. And then once you correct that through diet, exercise, the 4 pillars of diet, exercise, sleep, and stress reduction, then you will see a better improved erection. And sometimes it will take about 3 months, 6 months to get there. So it's almost like weight loss. Everybody that start the Mediterranean diet start to lose weight. So it's really a cue when men— if your erection's not as good as it used to be, it's a cue for you to start getting healthy again. It's really Mother Nature's way of saying you need to get healthy again. And when you follow the Mediterranean diet, most people drop 20 pounds pretty quickly because the Mediterranean diet will help you, um, will help you with, uh, the weight loss as well as anti-inflammation. So here, Miguel here says, uh, Miguel said— thank you, Miguel. Miguel Alvarez said, I wanted to appreciate, have tried Mediterranean diet, have seen my energy improving, sleep better, overall improvement my quality of life. Love it. Thank you, Miguel. Thank you for that positive feedback. If you have not tried the Mediterranean diet, you can get it for free. Scan that QR code or go to Can you put that in? No, no. What is it? What's— oh yeah, e4noed.com. e4noed.com. You can get the Mediterranean diet for free. All right, free. You can get the Mediterranean diet for free and we deliver the PDF to your email. All right, because I want you all to know, to appreciate the Mediterranean diet will make a lot of difference for you. Not only help you lose weight, decrease your blood pressure, good for your heart health, but also, but also is also help you lose weight as well too and help your erection. So, and the simple thing about Mediterranean diet is that you allow red wine, you allow 2 slices of bread a day. So it's not as restrictive as you think. And essentially eat what Mother Earth gave you and you can eat as much as you want. So there's no limit in the quantity, in the quantity that that you can eat and you don't go hungry. Now, if you feed your body what it needs, it's going to tell you to eat less. So if you feed your body healthy food, you actually end up eating less, believe it or not. Okay. Because you notice if you eat like fast food, you end up eating more because there's so much processed, so much processed. It's you end up eating more. Okay, so thank you, Miguel, for that feedback. To go to noed.com to download the Mediterranean diet. I can't tell you how powerful the Mediterranean diet is. It will lower your blood pressure. It will also lower your blood sugar as well, help with your erection. It is a recommended diet by the American Diabetic Association as well as the American Cardiology Association. For, uh, uh, for your heart. Okay, so guys, if you have ED, it's a warning sign that about, uh, 5 to 10 years down the road you may have a heart attack. So it's really your flashing warning sign, all right? And like that says, you know, guys, take care of your health. You don't take care of your health, you're gonna start— you're gonna have a heart problem later on. So it's really Mother Nature's way of saying, um, take care of yourself. Are you gonna start having issues, all right? And it starts— shows up in your sexual function, in your penis, because the penis blood vessel is the smallest in the body, all right? The blood vessel that goes to the penis, it's about 1 to 2 millimeters. The blood vessel that goes to the heart, it's about 3 to 4 millimeters, right? Uh, so it affects your penis first, then affect your heart, and you have about 5 years to take care of it. So the last thing you want to do you have ED, somebody was asking me that earlier, Tomaso, is to take ED medication, 'cause ED medication doesn't address the root cause of why you have ED. It's just a bandaid on an infected wound that's oozing out pus, all right? So it's a wound that's oozing out pus, you just put a bandaid on it, right? It may keep the pus in there, but it's not the solution for it, because over time, men that take ED medication, it stops working, or you have to go up on the dose. But then during the meantime, the reason why you have ED is not addressed. Okay, so something to keep in mind there. So follow the Mediterranean diet there. All right, so let's kind of talk about what are some of the reasons for delayed ejaculation. Sometimes delayed ejaculation It could be insensitivity, less sensation in the penis because of low testosterone also. But also when you have soft erection, it also have less sensation, so it's also due to ED as well too. And all right, and then also Um, it could also be due to, um, let me type this in. It's also be due to a high— I mean, enlarged prostate. When you have a large prostate, um, um, when you have a large— where's my penis model? Uh, when you have a large prostate, um, okay, so here is the bladder. Here's the body cut in half. Here's your bladder, and here is your prostate. The prostate is a little gland that goes— that your urethra, or the tube that you urinate, goes through. So your urethra goes through the prostate and then goes through the penis, right? And it's where you urinate. And this is your testicle. So this is your prostate here. The function of the prostate is to help you produce semen., right? And it's right below the bladder. This is the seminal vesicles where all the sperm are stored, which then is mixed with the fluid, and then you ejaculate that. But the urethra, or the tube that carries your urine to your— out to your penis, it goes through the prostate. But the prostate is enlarged, it's going to clamp down on the urethra, which is like right here. You can see that White, that's the urethra. So if the prostate is enlarged, it will clamp down on that. It will be hard for you to, uh, um, ejaculate. And then also, when you don't have enough water, it will also, uh, cause, uh, delayed ejaculation, um, as well too. Okay, so, um, delayed ejaculation can also be medication-related as well, um, such as, um, Depression medicine, SSRIs, antipsychotics, and finasteride. Finasteride can also cause delayed ejaculation, as well as pain medication, like all the opioids stuff. Depression, anxiety can cause delayed ejaculation. Anxiety as well. Frequent masturbation. When you're masturbating a lot, that can cause delayed ejaculation as well. Now, of course, you know, diabetes can cause delayed ejaculation as well as nerve damage from stroke or multiple sclerosis or spinal cord injury or post-prostatectomy. When you have a prostate removed, you don't ejaculate, actually. Low testosterone will also affect that, um, as well as high prolactin level. Um, sometimes you'll have, um, aging. Sometimes aging will, uh, kind of affect the delayed ejaculation. Sleep apnea will also cause delayed ejaculation, uh, as well, uh, too. So, uh, the workup is to get your prostate checked. Get your PSA checked by rectal exam. So the only way to examine the prostate is through, through the rectum, where the doctor put their hand in there to examine for the prostate. Okay. Medication review and get your testosterone level checked, your prolactin level checked, and your thyroid levels checked. Make sure you get your hemoglobin A1C, measure your, your blood sugar level as well as your lipids level for any type of inflammation or nerve problem. And that continues, make sure that you don't have a high prolactin level. Sometimes you'll need like like an MRI of your brain to make sure there's no pituitary problem or pituitary enlargement, which may cause high or low, low, high prolactin. And also you need to check your thyroid. Okay, so there's many causes of that. So definitely you have to go see your doctor. And I just named most of the causes of delayed ejaculation that you should consider. So guys, you know, when it comes to, you know, having problems such as delayed ejaculation, ED, you really need to go see a sexual health specialist doctor who can really address it comprehensively. The first thing you should do is get blood work done. Get blood work done. Get your blood work done, you know, you can see you have diabetes, inflammation, heart issue. You can find out your blood sugar level, find out your testosterone level, find out your prolactin level. It's easy stuff that can be picked up. Through blood work. Get your blood work done. Don't try to guess. Don't try to go online, try to take this supplement or that supplement. Taking a supplement, it's not going to help your prostate. If you're having delayed ejaculation, taking a supplement isn't going to solve your problem. You have to find out what is causing that first. Those of you that are interested in working with us and see if you're fit, go to renewwithdranne.com. Is where you can fill an application to see if, you know, we're fit to work with one another. Because, you know, your sexual health is complex. Like, it's like having a heart attack. Would you go online, try to Google a heart attack when you're having a heart attack? Well, you know, heart attack is an attack of the heart. ED is an attack of the penis, all right? So when you have ED, it's hard to kind of try to figure it out yourself. It's even hard for physician to try to figure out. ED. But because we have the background training, we can do that. But it definitely takes a specialist to kind of look at ED comprehensively and not just, oh, here, ED, here, take the ED medication, right? Like, if you take an ED medication, it's like putting a Band-Aid on a wound that's oozing out pus, all right? Because sooner or later, it's going to become an issue, all right? So who asked that question? So who asked those questions? Okay. What to eat? Well, Tommaso, I just kind of went over what to eat, the Mediterranean diet, and not so much taking supplement, it's really do something about it. Sometimes it's easy for us to pop a pill and say, oh, you know, this pill is gonna help, but no, Sometimes you got to put in the work when it comes to your sexual health or your sex life. You got to put in the work, guys. You can't just pop a pill and just say, okay, now this, this is, uh, uh, this is gonna solve my problem, uh, for me. Okay, uh, and, uh, let's relate it to that. Um, okay, uh Okay, it's related to that. Um, um, okay, so there was a question on, um, how many Botox injections do I administer? So I— when you have moderate to severe ED, in my office we do Botox injection into the penis. Uh, we inject into the corpus cavernosum. I Uh, and we inject 100 units at a time. Um, so you'll get 50 units on one side, 50 units on the other side, and it's one injection on, on each side. So it's a total of 100 units of Botox, 50 on one side, 50 on the other side. And we literally inject into the penis, not your face. This is the same Botox that women get for their face for their wrinkles. But we put it in the penis because when you put it in the penis, what does it do? Right. I gave a talk in San Diego to a bunch of doctors. And what does the Botox do? Botox actually relaxes the penis muscles. And you need the muscles in the penis to be relaxed in order for it to fill with blood. For a firm erection, because if the muscles are not relaxed, it cannot get filled up with blood. And so it needs to be relaxed. So, and that's how Viagra works. Viagra helps nitric oxide stay longer to help relax the muscles of the penis. And then it also will help increase nitric oxide in the area. And it also, so not only does it help relax the muscle, but also increase nitric oxide. It also help with the nerve conduction, the chemical nerve conduction as well. So it has a lot of benefits. And we usually mix that with your own platelet-rich plasma for the P-Shot, your own stem cell that come from your blood as well, because the Botox, help the muscles, and it stays for about 9 months, and then you're gonna need another one. And then your platelet-rich plasma, which is then injected into the penis itself, or the corpus cavernosum, is injected separately but on the same day. And what the platelet-rich plasma does is that it increases blood flow It makes more blood vessels in the penis, and it also rejuvenates the muscles. So it complements the Botox. The Botox works on the muscle. The PRP, or platelet-rich plasma, increases blood vessels, increases blood flow, and also rejuvenates the muscles as well. Okay. So it's 100 units and we do one injection on both sides. All right, so that's how Botox work for ED. And we've been doing this in 2023. There's been about at least 5 research papers on it, on the benefits of using Botox. And it's also a research paper that demonstrate that Botox along with platelet-rich plasma work together, and it works even better than just Botox alone. Okay. Okay. All right. But we have a bunch of questions here. Okay, um, well, you know, there's a lot of questions. There's, there's a question about penis size increasing length and, uh, and size. Um, yeah, right, increasing length. There's something that you can do that will help increase your size is that get your testosterone level checked. Because if you're low in testosterone, you will actually have atrophy of the penis. So, uh, get your testosterone level checked. If it's low, supplement it with either testosterone pellet or testosterone injection. And then also doing the penis pump, uh, will also, uh, exercise your penis but also give you about an inch in girth, an inch in length as well. And if you want, you know, more than a couple of inches in length, you probably have to consider surgery for that. There are some implant surgery, there are some surgery that insert like a cylinder on your penis to make it look longer. But with any surgery to the penis, there's always complication, okay? It's always complication. Just know, I mean, you guys know your size, but what's the What's an average penis length? It's 5 and 3/4, 5 inch and 3/4 inch, or 5 and a half. Okay, that's the length. And then the girth is 4 and 3/4. So girth is measure, uh, the girth is measure like circumference around, and you, you measure that, uh, at the base, and you also measure it at midway, midway, and also at the base. Okay, so girth is circumference around, and then length that you measure from the base to the tip, and that's about 5¾, 4¾ around. But that's 50th percentile, right? A small penis considered a length of 3 inches or less erect, erect, not flaccid, not non-erect, erect. So when I'm saying 5¾, that's erect, and 4¾, that's erect as well too. So if that's 50th percentile, so if you are considered small, that's, it's 3 inches erect for length. All right, so something to keep in mind. All right, so most, 87, there's a study that shows 87% of men think that they're smaller than they are. I just want to give you that number as a reference, okay? Okay, that is— and the ideal exercise for the penis, penis pump, penis pump, penis pump, penis pump. All right, penis pump. But then every time you have, every time you have sexual intercourse, that's exercise for your penis because that gets to give you an erection as well as, as well as um, you know, getting the plumbing going, right? And just get— getting all the mechanics going as well. You can get the penis pump at ednomore.com. We have an electric pump and we also have, uh, a manual, uh, pump as, uh, well, okay. Um, that— okay. Um, okay. Okay, all right, so check out the store. You can increase the girth with the penis pump, all right? You can increase the length with the penis pump, uh, as well. And, uh, improvement with the, with the pump is not permanent. If you stop pumping Yeah, you stop pumping, all the effects will go back to the way you were before pumping. Okay, so it's not permanent. It's kind of like going to the gym. Yeah, if you bulk up your muscle going to the gym, you need to continue going to the gym to continue bulking your muscle up. You don't go to the gym, you're going to lose the effect of that. Okay. So Miguel says, uh, I use a manual pump, uh, 5-15 minutes a day. So far seeing stronger erection. Uh, all right, well good. Well, that's what the penis pump, uh, help. Uh, traction do, do help. Again, traction is not permanent either. Um, attraction, what it does, it's kind of like, uh, it pulls on the penis to stretch it, uh, and it stretches the muscle. You don't want to— and it does help a lot. Use it with— you use it with— we have a protocol where you can get penis enlargement with injection of platelet-rich plasma once a week for about 3 to 6 times. I mean, not once a week, I'm sorry, once a month for 3 to 6 times, followed by traction therapy along with penis pumping. That does work. Really well in increasing length and girth. Okay, very good. Um, all right, all right. So boy, we are very active today. A lot of people are asking questions. Thank you for asking questions. That's awesome. That's awesome. But I do want to, um, okay, did I answer most of the questions there? Well, what to eat, vitamin, delay ejaculation. So delay ejaculation means that it takes you longer, probably like, you know, 5 minutes or more for, to ejaculate, versus pre-ejaculation is like, like, like a pre-ejaculation before you actually have a full ejaculation. So sometimes that, that, um, uh, it's not as intense as the full ejaculation. All right, um, all right. So we talk about exercise, uh, as well, um. Well, there's somebody here that asks, uh, Mr. Tolu. He had the frenuloplasty. Frenuloplasty is where the ligament and the base of the penis get cut. So your penis is hung— it's like there's like a ligament that hangs from here to here that helps with, you know, um, raising the penis up so it can be more upright. Um, uh, somebody had a surgery, uh, there. And he noticed that with the short frenulum, it limits expansion to pump. Yes, that could happen. That could happen. So you have that done. So are you, is it easier, Mr. Tuliverde? Is it easier for you to pump now that you had the frenuloplasty? Okay. Well, everybody's body is different. Nothing wrong with that. It's just different, all right? Um, somebody asked, why does the penis pump— why the penis pump doesn't hold pressure for a few minutes? We have to keep it pumping. Uh, um, uh, it depends on what penis pump you have. Um, okay, uh, it will— it doesn't hold it for a whole 10 minutes. Sometimes you gotta kind of continue and kind of, you know, do a few pumps here and there to keep it, uh, uh, negative pressure. Um, You don't have to keep pumping the whole 10 minutes. You just want a penis to be erect in the cylinder for 10 minutes. And sometimes you have to do a few pumps. Sometimes you can just— sometimes you don't have to, but if you start to see that it's losing the erection, then you pump. Okay, but it depends on what pump you have. So we have in our store at ednomore.com, We have a manual pump as well as electric pump, and both of it, both of it works well depending on what your preference are. Okay. Okay. All right. You're going to pump, you're probably going to take about 6 weeks to 2 months to start seeing result. Okay, um, and, um, okay, started about 6 months ago, seeing results. Um, um, right, so, uh, with testosterone replacement therapy, are there any negative side effects? Well, there are anything like, um, testosterone replacement therapy, uh, there is some side effect of hair loss, right? Yeah, there's hair loss, and you, you will also see an elevation in your red blood cells. Which is erythrocytosis. Testosterone causes increased red blood cells, and you can have increased red blood cells. If you pass over 52, hematocrit of 52, you need to go get blood donation. All right. Because if your blood becomes viscous or thick above 52, then you're going to clot. So that's why you got to get blood donation. And you're more susceptible to it if you have sleep apnea, okay, uncompensated or untreated sleep apnea. And you also— one of the side effects, it does cause your testosterone— I mean, cause your testicles to shrink. You have shrinkage of your testicles as well, okay. So that's one of the side effects of testosterone. Um, not so much negative, but you know, side effects, um, as well. Okay. Um, okay. All right. And so we're gonna try to take new questions from people that hasn't asked questions. Uh, so just so you guys know, if you already asked a question, you're asking more questions, I may not answer it. I'm trying to get more questions from people that I have not, uh, answered, uh, yet. Um, so, uh, there's a question here by PWG. PWG says, when pumping for daily action, I— do I pump until the penis is fully erect or use a lower pressure set? You pump until the penis is erect, and then you leave the erect penis in the cylinder for 10 minutes. All right. So you want to leave it in there for 10 minutes. And sometimes you kind of have to do a little bit of pumping to kind of continue the negative pressure to maintain that erect penis. So you want to achieve up to about 90% erection and just leave the erect penis in the cylinder. And then sometimes you can use a ring, you know, called the penis ring at the base to keep the blood in there after you're done, uh, with pumping. Um, okay, all right, uh, so you don't need to use a lower setting. Just, uh, you don't want to go over more than 10 millimeters of mercury of pressure, right? So if you're going to use a penis pump, make sure you use one with a gauge. Okay, all right, so what is— so, uh, uh, what is your opinion on shockwave? So Don Parker asked. Good afternoon, Don. Um, what's your opinion on shockwave therapy, and do you recommend getting devices for this at home? Um, there's no study on home shockwave therapy device, whether it helps ED or not. I usually don't prescribe shockwave therapy device for my patient, but I know that there's devices out there that says that it works, do it at home. The one that we do is called Focus shockwave therapy, and that's the one that's been written in the literature for ED. And the Focus— how do you tell the difference between Focus and the radio? First of all, check my channel out. Those of you that are asking questions, please subscribe to our channel and go to Dr. Anne Truong MD, subscribe to our channel. I would appreciate it a lot. So if you're watching right now, the 12 people that are on, you're watching right now, if you're not subscribed to our channel, please do. What I'm getting with this is that I did have a video where I talk about what focus and radio shockwave therapy machine is. The focus machine sounds like a little tick, tick, tick, tick when you get treated. And we put the focus machine on the penis and we go up and down the penis like this, up and down the penis and then at the base. And also we treat the root of the penis, actually goes along the scrotum here. And then we treat the prostate as well with the focus shockwave and also the neurovascular bundle down here. So with the shockwave therapy, how it worked at that, it— think of it like it also increase blood vessels. It also help with the flexibility of the muscles as well. It also break up plaques in the penis and focus Shockwave machine, the one that sounds like tick, tick, tick, tick. If you have one that sounds like a jackhammer, like that, that's a jackhammer. That's radial, radial, R-A-D-I-A-L, radial device. The radial device are not— no research paper has shown that it helps with ED, but many research papers have shown that focused shockwave helps with ED, and it came from Europe. First. And most of the time the protocol is that you can only get a Focus Machine treatment in the office, not at home. And usually the protocol is once a week for 6 weeks. Some patients do 12 weeks. So we do once a week for 6 weeks, sometimes take a 3-week break and then start again once a week for 6 weeks as well. Okay. And so, Shockwave complement the platelet-rich plasma, would then also complement the Botox. That's why our triad, when you come to the office, is that we do the Botox, the P-Shot, and the shockwave, and along with, along with pulsed electromagnetic therapy. Uh, also a Kegel neuromuscular stimulator as well. When you come to office, you actually have a stimulator to go home with, a Kegel stimulator, as well as a penis pump, uh, to go home with, uh, as well. So my opinion, if you're a man over 21, you need to use the penis pump. Not only does it help with ED, but it also helps when you don't have ED to optimize, where it will help getting better, a firmer erection, as well as, um, uh, maintain, all right, uh, as well too. So the best thing a man can have, uh, is the, uh, penis pump. Other than that, thank you for joining me live today on our, uh, live. Uh, if you haven't subscribed yet, it'll mean the world to me if you do. I put all the information out there, uh, on my YouTube channel, and, uh, I hope that is helpful for you guys. And thank you for joining me, and I will see you next Monday.