Erectile Dysfunction Is an Early Warning Sign: What Your Body Might Be Telling You

If you are experiencing changes in your erectile function, your body may be trying to tell you something important about your health. Today we are talking about men's sexual health as an early indicator of their overall well-being. My guest is Dr. Arthur Burnett II, a world-leading urologist at Johns Hopkins Hospital whose research helped make treatments like Viagra possible and who has spent decades advancing prostate care, nerve-sparing surgery. And sexual health across the lifespan. Welcome, Dr. Burnett.

Well, delightful to be with you. Thank you for welcoming.

Oh, it's a pleasure to have you on, on the show. And obviously your work has just been amazing across the decades in, you know, pioneering. I believe that some of your work helped pioneer Viagra. Oh yes, it's incredible what you've done. We're going to be talking about men's sexual health across the lifespan and what that actually means. And what I love about your approach is that you seem to take a holistic look at a man, you know, not just his erectile dysfunction but what's behind that and his overall life in general. So in terms of men's sexual health, what checks should a man get before, you know, dysfunction starts?

Pleased to tell you what kind of, you know, practical considerations you're saying. That men should be thinking about. But let me preface by just, you know, expanding a little bit on what you just said early on, which is the holistic aspect of men. Because, you know, I think that men oftentimes, you know, associate their manhood with what's hanging between their legs.

And then—

And I'd like to just kind of make the point just to start that, you know, men, it is important to have good erections and sexual function and sexual prowess and all this kind of stuff. But, you know, know that, you know, we're men who are more than our penises. And, and, and, and, and, and, and I want guys to understand that, you know, in a way, your sexual function is a good barometer of your general health. Okay, your general medical health. It's also, you know, a gauge, I think, with regard to your, your, your mental health and your, and your, your general well-being overall in terms of life and relationships and so forth. The basic message that I think you may be getting to is this, you know, how can a man stay healthy for his sexual function, which also translates into his general health? And anything that's good for your cardiovascular system relates to the penile vascular system because erections really is blood flow that has to do with the nervous system and hormones having some sort of influence over how blood flow occurs and how a man's health of his erections occur is directly related to his overall general health and his cardiovascular health. So, what are the checkups? Well, if your blood pressure is not good, you know, that probably is an indication of having some blood vessel or vascular issues. If you have some cardiovascular disease issues that may manifest itself elsewhere with, with heart disease or strokes and things of that sort. Diabetes, a big one, a big one. So for those who are perhaps living an adverse health and lifestyle with too much of the bad foods and unprocessed foods and not a balanced diet and cigarette smoking and all these kinds of things, these kinds of things do affect your overall general health, your vascular health. So what are considerations in all practical terms? Get your best health. It'll help your erections. Get your best health. You know, talk with your doctor, get a checkup. You know, get, you know, get, get a good fitness program, eat a good diet, and then know, you know, your height, your weight, your, you know, your blood pressure, know how to maintain your cholesterol levels, all these kinds of things, because that translates into how your erections work.

So does high sugar level— is it because it affects the vascular system?

What is it about sugar that really, you know, affects erectile We talk about sugar in a basic way, and, you know, but, you know, we talk about glucose now on the medical side. And glucose here is how our body metabolizes various substances that get into our body. And just to be, you know, easier for the audience here, you know, when your blood sugars are not well normalized, it affects the nerves in your body, it affects the blood vessels in your body, it affects your metabolic system and how you you know, basically have various molecular and biochemical kind of functions within our body, how we digest food, how we process food, how we have the energy that we want to have, how our muscles and our bones work, and blood vessels and our nerve tissue. Diabetes can affect all of this. And I don't want to get into all the medical aspect of it too heavy here, but really diabetes does have such broad effects on just maintaining your normal, you know, your basic metabolism. and how your metabolic system works. So getting your sugars under control, eating a more balanced diet is key. If you're a diabetic, please do your best to follow recommendations there with your medications. But certainly, I think one of the things that we certainly recognize is, you know, really the epidemic of type 2 diabetes that relates to— and distinguished from type 1, but relates to type 2 with much of the way of our lifestyles. Being overweight, eating the wrong foods, all these sorts of things. And I think, you know, the unfortunate thing in our modern society, we have conveniences of not having to just walk to an activity 2 or 3 blocks away. Let's take the car, you know, things of that sort. You know, we probably are harming ourselves not to get at least a normal daily routine of some activities and movements in our bodies. And And so in a way, diabetes is almost like a premature aging effect, you know. And, you know, you know, our longevity is very important, and it does kind of really damage all kinds of structures, probably from head to toe, uh, in various ways.

So many, I guess, men— because that's who we're talking about— may not see the correlation between their high sugar and what it's actually doing. Like, a lot of people talk about, you know, like you said, stroke, heart disease. They talk about that, but it's not really talked about for erectile dysfunction out in the public, or I haven't heard it. When you speak— when you hear of erectile dysfunction and the men's sexual health, you automatically think hormones like we do with women. We, you know, we think hormones. How does hormones like testosterone play in this dysfunction?

Well, you know, testosterone is the male hormone that we commonly think of now.

Cool.

You know, and we think of androgens as a kind of the more global term, but testosterone being a specific one, and it affects the bodies of men. Okay, much like estrogen we think about in women, women's bodies. So kind of putting that in some sort of context, you know, the thought here is that testosterone is responsible for what makes men men, what makes muscles, what makes us strong and larger in terms of physical body than women in many respects. It accounts for the hair on our body, the depth and deepness of our voices, and maybe the strength of our bodies. But it's also associated with how we think about our sexual prowess, our ability to perform sexually. And testosterone then, I think, has this association in that way. But I think it's important to understand here that testosterone largely has to do with sexual drive or sexual libido. And that does impact a person's kind of inclination to be sexual, but it may not necessarily be the direct factor in how erections occur. It may prime some of the mechanisms that we think erections are involved with, but these other topics we talked about a moment ago have a greater role in either keeping the health or creating ill health of the erections. Testosterone has more to do with sexual drive and sexual libido. And that's a separate thing than just getting an erection. Erection is, is how the penis becomes firm with kind of a sexual stimulus. And there are many men whose testosterone levels could be at variable levels and they can still get erections. So we don't always associate that, even though many may say that, get your testosterone checked, get some more testosterone and your erections will recover or get better or even be as strong as they can be. And that's not always true. There's a certain level of testosterone that our bodies need. But, you know, it's not the wonder drug that many people are considering out there. More importantly, you know, understand these other factors that I think play a bigger role here in getting your best health in general with regard to all these other disease states and lifestyle factors and maybe environmental exposures. All these things affect erections to a much greater extent.

You actually covered the libido part for me. I was going to ask about the libido, whether that had a direct effect on it, but you're saying it's not necessarily a direct effect. It can contribute, but it's not a direct effect on erection.

That's right. And it's related because generally if you're aroused and have more sexual interest, you may be more inclined to pursue sexual activity and then maybe find stimulus and various stimuli, if you will, that help create the erection response. But there are many men who have great libido and they're just not getting erections and There's others who, who may have poor libido and then getting erections. And so it's not a direct correlate necessarily. They do kind of almost go hand in hand a little bit, but we do think about that being somewhat separate. You know, like the male sexual response cycle has libido as one end of it, erections as another part of it, and then even a 3rd component we think of, which is the orgasmic and, and, and, and The climax aspect, which all have different physiologies in the body. They're interrelated here, but really the factors that govern each of these aspects of sexual response is very different.

Across the board, a particular exercise that sort of helps more with blood flow to the penis or a particular diet that you've seen, like, is it more cardiovascular or do they, as long as they exercise, like pumping weights is good enough? Do you see it going in a particular way?

You know, there's always a question out there about, you know, what specifically should I be doing? And the answer is any kind of exercise and movement is important. And just, you know, just making some changes in your diet if it's truly an unhealthy diet makes some sense. I'm not going to try and act like I'm an exercise physiologist or a nutritionist here all of a sudden, but I do think that You know, all too often, even just the most basic things, just work into your lifestyle, you know, some activity, work in getting some exercise 3 days a week. There is both the— if you go to the weight room and doing, you know, the weights and building muscle strength, but also just purely just getting out there and even just walking. And just getting in a number of steps and just pushing your body to do something more than just sitting. So, yeah, I think that's key. And diet-wise, yes, there may be all kinds of diets out there. Nutritionists may promote things like the Mediterranean diet and specific kinds of fruits and vegetables and so much quantities of this and so much, not so much of that. And there's controversy, you know, I think even the US FDA kind of suggested that red meat is not so bad as we used to think. But I think that, you know, the reality is eating things probably in some sort of balanced way, not overeating. And finding just a kind of a balance of all the food products probably makes the most sense.

Kind of sounds like just living a simple, sensible life in a way, you know, towards good food, exercise, you know, like our grandparents used to do, you know.

Well, then they're probably healthier than we are these days because they're probably forced to get out there and walk, you know.

That's right.

Exactly. They didn't have all this processed food, you know, that, you know, they've done processed, just root the food out the garden and things like that. They're probably a lot healthier than we are.

Yeah, their life definitely wasn't convenient like ours is. A lot more convenience. Men who do struggle with this could be asking, does their anxiety, depression, or any other mental health challenge affect their erectile dysfunction?

Sure, yeah, it does have a— have some interplay there, and I'm glad you talked about that because, you know, again, you know, this whole thing about erectile dysfunction has gone through some evolution. You know, we used to think 20, 30 years ago, maybe longer now, time moves on us too fast. But, you know, we used to think that, you know, back in the era of psychoanalysis and all this kind of thing, that it was a kind of indicator of depression or some sort of mental illness and, you know, some other kinds of mysterious factors that had to do with, you know, your mental processing, your sexual abilities. And I think we've come to realize that the majority of presentations do relate to adverse health conditions, really. You know, your cardiovascular system, how well you're keeping your blood sugars in order, and you're getting your fitness. And I think we kind of understood that now in the past few decades. But at the same time, now we do understand that having sexual function is a mind-body experience, you know. And sometimes, you know, really not just, you know, with animals running around on the floor with getting erections. I mean, we're human beings here. And how our bodies work in terms of You know, the mental aspect and the psychological and interpersonal relationship aspect goes hand in hand with the more physical aspect of how erections occur. So, I mean, I'm supportive of all of that. And then you mentioned the holistic aspect right from the outset here. This gets to the point I was making, I think, earlier that, you know, your health at all these levels, your physical health, your mental health, your interpersonal relationship health. All these things contribute to your best sexual function. And certainly, if you identify some anxieties and some depression and some other kinds of things, and sometimes in my years of being a surgeon and a healthcare physician and clinician, if you will, because I want to make sure all care providers, not just those physicians, are involved. But know that, you know, recognizing that sometimes it's how we are dealing with sexual situations. And we can create kind of anxiety and stress and things of that sort.

Hmm.

And there may be some real, you know, biochemical changes in our body with some adrenaline and various other kind of— I don't want to throw out too many fancy words, but things that drive kind of reactions in our body that sometimes don't really support— they're not conducive to the best blood flow getting to aspects of the body during sexual situation. And sometimes patients sometimes have to be counseled in a way to say, you know, it's not just take a Viagra pill and go on your way. Maybe it's worth Talking to us, to a sexual therapist, a psychosexual therapist who may help you kind of adjust to a sexual situation or deal with some stresses or figure out what's going on between you and a partner, and then figure out how you go about a better sexual kind of repertoire to have the best response you have. So that— so it's not just me as a physician or surgeon just handing you a pill or doing a surgery on you and expect that's going to solve all of that. That's just not always true.

From a surgeon, We're hearing this holistic approach from you, you know, taking all aspects into account, which is just fabulous. It just shows how, you know, progressive you are in the area. And in that, you are a surgeon around prostate cancer, is that correct?

Yeah, that is true. Yep. Then many of, many of these surgeries over the past 30, 35 years. You're right.

How does prostate cancer affect erectile Function, you know, because prostate cancer is prevalent.

It's a prevalent cancer, and and and does certainly impact many lives out there. We know prostate cancer, certainly in the United States, affects one in nine men, and so it's not a small rate here. And while much a good portion of it may be certainly amenable to surveillance, we're recognizing some forms of it we can watch a little bit more more, but others. It can actually be aggressive enough that it can take lives, and we do hear about men who die of prostate cancer. So it's a no-joke thing.

Yes, it is.

But the relationship there is that prostate cancer in itself does not cause sexual dysfunction, but some of the treatments that we have— or now, of course, any cancer that gets progressed and spread through the body is going to cause all kinds of bodily changes, including, you know, losing weight and losing energy and strength and, you know, affecting Various processes that have to do with how the body works, kidney function, you know, the metabolic functions, all kinds of things. So indirectly, these more late-stage cancers can do anything to the body. Prostate cancer, at least in its earliest stages, does not really directly cause erection problems. Where it comes into play is how much it can be a consideration with regard to being treated for prostate cancer. And then, of course, there's always been this, this, this widely understood, you know, kind of consideration that getting treated for prostate cancer can have some adversity with regard to sexual function. The prostate, which is deep in the pelvis at the base of the bladder, and urine passes through it. And this is an organ in men. It is a very precarious place where surgery, radiation, which is typical early treatments for prostate cancer, has historically been associated with men losing their erections and their sexual abilities. And so, really, the association there is deep, and we recognize this in the field of urology. As a urologic surgeon myself here who does a lot of prostate cancer surgery, we want to save men's lives because obviously, if you're not having erections, you're not alive. You can't have erections. So, that's the ultimate form of erectile dysfunction. But the same way, we want to do these surgeries when needed, and we think a man may have an aggressive form. If we can diagnose them early, get treated, but do these surgeries well, Whereby we have improved over recent decades where we can do this surgery, recognize the deep structures in the pelvis that have to do with erection abilities, and remove the prostate. Whereby men who do have good function going into surgery don't have a lot of other illnesses that are in an insidious way changing their erections, and they don't really know how badly it is starting to affect things. But it is. But if they go to surgery and we make an early diagnosis, Many times we can remove the prostate and preserve functions much more easily than if it gets to be more late stage. And then that's when things require much more aggressive treatments whereby some of the structures deep in the pelvic region, the blood vessels, the nerves, get more likely traumatized by the interventions we need to bring. So that's where the association comes in. And I'd like to just tell the audience that, you know, we want to make sure that, you know, you get your checkups here because the name of the game— Mm-hmm. Is the earlier we can make diagnoses, the earlier we can treat something when it's appropriate, the better likelihood we have of bringing therapies that are less invasive, that are less traumatic to the body. Address it early, preserve functions better. I mean, I hope that message is clear that just you know men get your PSA, your blood test for your prostate. Yeah, it's a blood test. You get it, you know, at least by the time you're fifty, get it checked if you have a strong family history or African American or from a from African descent, you may want to get it somewhere in your 40s, even early 40s. I've seen men in their 40s with prostate cancer, and what you think is always an old man's disease, it's not always true. So, so get at least a screening test. And then if you do have a high PSA that's outside the normal range, go, go far, go further with your primary doctor to say, I need to see a urologic doctor to have this worked up further and determine whether it has any association with prostate cancer. The PSA being elevated does not always mean prostate cancer, and we have to talk— think about getting a biopsy of the prostate done to see whether that really is related.

Mm-hmm.

The PSA elevations can occur for other reasons too now, but at least get on the right path here with your checkups. You know, I talked about your checkups for your general health, your checkup for your prostate. If we make a diagnosis, let's get it addressed early. If it's addressed early, you can get it cured and live a long life, and so let's— and preserve your sexual function. And we do have treatments now. You mentioned, Rita, you know, how do you address it? Well, first, the way you address it is, is, is, is, is, is, is to, to, if you're diagnosed with it, get treated in such a way we can bring a treatment that less likely damages your sexual functions. So, so know that. But along the way now, if a man does have some erectile dysfunction in the setting of having had a treatment for prostate cancer, be it surgery, radiation, or even some of these newer things with focal therapies, Coming along. We do have other options. In some men, it's possible that they recover erections but just need a little help, a little help with the pill, you know, the Viagra, these others. If these don't work, we have other options. There's external vacuum pumps and injections that we can teach a man to inject in the penile area that can create an erection effect. And then for them, men who may have a more severe form of erectile dysfunction, there is a surgical intervention called a penile prosthesis device that we can implant. And we've had that for a few decades as well. So we do have a range of options that can be there. And I've counseled men over all the years that I've been involved with men's health and sexual dysfunction to say, let's talk about all the options and let's see what's right for you, Mr. Jones, Mr. Smith, Mr. Green. You know, because each man may have a different, you know, perspective on what makes sense for him. You know, and then depending on the severity of the erectile dysfunction, the options that we have available. the pros and cons that make sense for each man, then we have a range of options that can still address the problem when needed.

You touched on if you're an African American, you should actually be getting the test because this all talks to what I mentioned right in the beginning about prevention, to actually have the test in your 40s. Why being African American is, or being from African descent, why is that different? Why test earlier?

The reason to do that is, is we have just made population-based observations about the real risk of prostate cancer that unfortunately does affect certain families where there may be many in the families who've had prostate cancer, as well as men of African descent. It may be a genetic basis. There may be genes in our bodies that account for why certain families get certain kinds of diseases more prevalently than somebody else. And so it just so happens that in the United States, To be clear, while there's 1 in 9 men in general who get prostate cancer, there's 1 in 6 men of African American descent. So it's a much more prevalent disease. Genetics may play a role. There may be some other kinds of factors in terms of life exposures, diet, living in environments where maybe some certain kinds of chemicals and exposures that occur that may have more to do with getting disease states and cancers more prevalently.

Mm-hmm.

So there's a whole host of factors that are involved here. But I do mention that if you have a family history of any kind of racial and ethnic population or background, don't wait till you're 50 or 55, as some guidelines may even say 55. You may want to at least get this PSA sometime in your 40s and even early 40s. Maybe you hit 40, go ahead and get a PSA. If your brother, your dad had prostate cancer, you may want to just go and get a PSA. Just see where it is. If it's in the normal range, that's reassuring. May not need to repeat it 5 years— until 5 years later, maybe, to see where you stand. But if it looks even in the high normal range, you may want to say, let me come back next year and see whether it's starting to change, because if it's starting to change, that's also indicative of something's not right with your prostate. But again, you know, what are all the factors? It may have to do with the diet. It may have to do with, you know, the kind of occupational exposures. It may have to do with cigarette smoking. things that we're doing to our bodies here that we're more exposed to, and maybe certain kinds of living conditions affect certain populations more than others. So it's just a reality. We still don't have a handle on it altogether from, you know, a healthcare perspective. But the facts are out there. The statistics, if you will, are out there that it does affect certain populations to a greater extent.

And what would you say to men who have gone to the doctor and the doctor says, oh, your PSA is a little elevated. Now, men normally are not known for being preventative or going to the doctor, and it's usually us women who've put our foot on their back. Pushing them through the door. I can attest to that with my husband. You know, I feel like I'm dragging him through the door, the doctor's door. When we talk about prevention, and you said to get on top of these things, Would you say for men it's better to advocate for themselves and say, look, I know my elevation, my PSAs are slightly elevated, but I would like more investigation, as opposed to what, say, them saying, come back in a year and we'll check then?

You know, for those who are being more proactive, I salute you. All too often, too many men, as you say, are challenged for various reasons. Maybe they're just too stoic, maybe they're just too proud, maybe too ashamed. to get checked. Maybe they also— that applies to sexual dysfunction sometimes. Some men don't want to admit they're starting to have some problems. And so, you know, hopefully we're talking more openly about these kind of subject matters, letting men know that this is, you know, a reality of life, and that you're no less a man to admit to saying, I want to get checked out. You know, you're no less a man to having exams done on you. I know women get exams all the time from their teenage years. And so men lose track of that and feel like, well, they're invincible and this and that. Well, maybe we just need to come to terms with the fact that it's just basic human reality that health disturbances do occur and that health adversity does occur. And then how do you move forward? Well, you know, if you think something's a little bit abnormal with that PSA, insist on your primary care doctor saying, I want to repeat this next year. I want to see whether it's changing. Take charge of yourself because As men, you know, we need to take charge of ourselves, we need our lives and thrive and, and then not be ashamed to just get your best health checkups and, and be on top of what's going on.

I know with my husband, it almost feels like it's like a fear of knowing. It's like a fear of knowing that something's not right. You know, they'd rather not know that, that something's right, rather live with something than know that something is happening inside their body. I can, I can tell you mine is like that, but You really would like to encourage men to have these open discussions about sexual health. So why don't they?

Yeah, it is something where, you know, perhaps, you know, our cultures have kind of created kind of a way of, of, of how we process, you know, who we are as men. And I think unfortunately, maybe it's even getting more problematic with too many, you know, the The stereotypes out there that are created in media that are just unreal about, you know, somebody who needs to be, you know, the Marlboro Man or the Don Juan Man or this or that. And if you're not that, you're not, you're not truly a man. And that's just, you know, not right. There's too many ads out there saying that guys need to get on these medications. Why, why, why are, why are men in their 20s being coaxed by their, their lady friends? They say, oh, you're not a man unless you're taking these, these, these Viagra pills. And these guys in their 20s are functioning perfectly fine. They don't need to be kind of led astray with this kind of misinformation and misdirection. So I think there's all of this that plays into our society, the myths surrounding, you know, what is true manhood. And I think that hopefully we can have these conversations. Hopefully our podcast here is helping to make the point that let's just talk in terms of what's real. And what what being a man's about, and just getting your health checkups and understanding that performance is is not all about just what's going on down there, you know, between the legs. And and that you can still address it too. But but but you know that we want men to be functional. But let's let's certainly do it in a realistic way. Let's not take all kinds of bizarre supplements. Let's not do crazy things in our lives. Let's not do things quietly behind the door because you're too ashamed to talk about it. Talk to somebody who can really be a professional like myself or, or others, even sometimes talking to women healthcare providers. Some men have a lot of trouble with that sometimes. I think our culture is going to have to change because I can tell you, you know, I've been here at Johns Hopkins 42 years, and I can tell you that the med school classes are increasingly more women, and they're going to be more women in urology too. So, fellas out there, you're going to see— you're going to see women out there as not just allied health professionals and nurses and So forth, but they may be your doctor and you got to be able to say, listen, let's just talk about it because the women doctors out there, they're professionals and they want to look after you too. So you just have to just step it up and know you got to get your checkups.

Is there a connection between urinary function and erectile dysfunction?

Well, there is this kind of thought here that, you know, I don't need to get down and I'll speak for a man as if to say, Oh, I don't need to get my checkup here unless I start to have urinary issues because urinary issues would be really the telltale sign I'm starting to have something wrong with my prostate in terms of prostate cancer, and that is just completely erroneous. Erroneous prostate cancer really is not a symptomatic disease state in its earliest stages, and that's why the PSA test is so critical. If you're thinking that you should have urinary symptoms and that's going to be kind of the indicator of something really going wrong, well, it may have something. gone wrong, but probably more often than not in a benign way. We know that men, as they get older, they start to have urinary symptoms of sometimes frequency and urgency and a slow stream and getting up at night and all these kinds of things, and sometimes some women do that too as they get older, and I don't know that a woman has a prostate, not that I've ever seen in my many years of being a physician. So, so, so, so I think the truth is that we can't rely on saying I've got to have some symptoms and that's going to then tell me I go and see a doctor. If you start to have symptoms, Well, you should go see a doctor because, you know, maybe it's something that's affecting your best urinary health and your urinary tract health, but it's not always going to be an indicator of prostate cancer, and it really never is. But we do have ways of addressing that so men can have healthier urinary lives, and some women too, you know, who are back and forth to the bathroom. Sometimes they get older. Sometimes we have to talk about various medications, some lifestyle adjustments, some risk factors, and ways to address the problem. But much of the time, urinary symptoms have to do with benign conditions, and that's the bottom line. Much of the time, it's benign conditions, but it's just the kind of just disturbances of aging for many. But think about it more in that context. Signs and symptoms for prostate cancer don't really exist, but urinary symptoms probably do. They're out there, but they probably have benign associations.

So men are proactive and don't hide behind what may be a myth. Is erectile dysfunction Normal as men age?

Associated with aging, uh, in a way normal to the extent that we accept that many men, as they will get older, will have a decline in their sexual abilities. And that's kind of normal, you know. I don't think we can all go say we're still dunking basketballs as we did when we were 20 years of age when we're getting into our 60s. And here in my mid-60s, I could— I long ago put down that basketball except for just taking long-range shots. But the point of it all is, is that You know, we do know that, you know, you're maintaining your best health correlates probably more than anything, and aging may be a factor. The reason why so many more men getting older have erectile dysfunction is there's a greater prevalence of health disorders as you get older— diabetes, cardiovascular diseases.

Mm-hmm.

But at the same time, there are many men, you know, in their 70s, 80s, and maybe 90s who say, my erections are working, I'm good. And probably their health is good too. So really, I think it's the greater association is just keep your health, keep your health, and that will keep your erection.

What advice would you like to leave our male, especially our male listeners today?

And I just first want to just salute all those male listeners and say, I'm glad you joined the program and you've, you know, hopefully taken something away from all of this. Hopefully you can be encouraged and supported and recognize that, that, uh, you know, you know, maintaining your best health is what manhood's all about. denying it is not. So maybe that's the message. The message is, is, is manhood can be thought of in many different dimensions. It's not just a matter of your penile erection, but erections are there. And we do know that's part of how men do sense their abilities and who they are and their identities. And I don't want to deny that, but recognize it's more than that too. And we want to make sure you're supported in all respects.

Great advice, Dr. Burnett. Thank you so much for coming on Beyond Diagnosis and sharing all about men's overall health, which is, you know, then part of their sexual health. And for anybody who would like more information, you can go on to Dr. Burnett's website. He's got lots of information there, and I believe you've got a couple of books that people can buy, your latest one being Manhood Rx, is it?

That's right, Manhood Rx. And then we have one coming out this next year, uh, that we're, you know, getting it together here with. It's going to be kind of a manhood series, maybe a Manhood Confidential or something of that sort, that's going to bring in more of these holistic aspects and more of these practical lifestyle and behavioral things to do and understanding what manhood is all about. The Manhood Rx really gets into just sexual ability directly and just conditions of a man's sexual abilities. But we want to kind of broaden the discussion, and that'll be in the next book too.

I love the sound of that. Thank you so much. And you can find those links in the show notes. Thank you so much for coming on.