Episode 108: From Limp Myths to Hard Facts

Hi, this is Suzanne Noble and you're listening to Sex Advice for Seniors, episode 100 and something rather. There's been a lot of these, but today I'm pretty excited. I'm really excited actually because I'm speaking to someone who's a little bit of a superstar. I say little bit, he is a superstar. His name is Dr. Judson Brandeis. You're calling from all the way in the West Coast, aren't you?

You're Somewhere in California.

Yeah, Northern California. I was just in Napa and it was fab. And he's a urologist, a sexual medicine expert, he's a sex educator. But what we're going to talk about today is that topic that often gets swept under the carpet, except of course when you're talking about the blue pill, which is men's sexual health and what men can do really to improve their sexual health. Especially when they're over 60 years old. So welcome to the show.

Well, thank you. It's so nice to be here. I really appreciate you having me on.

Thank you. So listen, I had a glimpse at your website, looked it over, and there were a whole bunch of different treatments that honestly I knew very little about. And I suspect most men, especially in the UK, which is where I'm based, um, really only know when it comes to Erectile dysfunction, the blue pill. But it— but looking at your website, there's like so many different kinds of options. What are the common complaints and things that men come to you for when they're a bit older?

Yeah, I mean, there are two main things that men come to see me for. One is erectile dysfunction, or the inability to get and maintain an erection sufficient for penetrative intercourse. And the other is for testosterone replacement.

Right. And, and, and what— how does testosterone replacement— does that enhance your ability to have an erection as well, or do they come for testosterone for some other reason?

Yeah, I mean, testosterone and erectile dysfunction are basically parallel tracks, right? So testosterone gives you better libido, but erectile function is really a function of blood flow. And so testosterone really has nothing to do with blood flow.

Oh, interesting. And I know that I've been on this testosterone journey that I just started myself, mainly because I read that Kate Winslet is swearing by it. And what's good enough for Kate is really good enough for me, I thought. So I thought I'd, I'd give that one a go. But it's, it's a fairly laborious process for a woman to get testosterone, but I guess it has the same effect.

Right, so both men and women have levels of testosterone and estrogen. And even though men are from Mars and women are from Venus, the difference in a molecular structure between testosterone and estrogen is a single hydrogen atom. So the smallest unit of matter that exists is the main difference between testosterone and estrogen. So your body is able to convert testosterone into estrogen, which is how men get most of their estrogen. Um, now for men, as— so you're 12 years old, your testosterone's 200. 6 years later, your testosterone's 1,000. You've grown a foot, you know, you've, um, you put on body hair, you put on muscle, you've taken off fat, you're chasing girls around the, the, the parking lot, right? And then your testosterone peaks out at around 20 years old, and it decreases about 1 or 2% per year after that. Right? And so by the time you're 60 or 70 or 80, maybe your testosterone's 400 or 300 or 200, and you're losing muscle, you're losing libido, you're losing energy, you're not sleeping as well, your, your bones and joints aren't working quite as well. And, and so for men that want to get physically and mentally and sexually rejuvenated, testosterone replacement is really an amazing thing. Right? So it helps with your libido, it helps you build muscle, helps you burn fat, helps you sleep better, helps you repair tissue, your aches and pains kind of go away. I mean, it's— it is kind of the miracle. It's not a drug, it's a hormone, right? Yeah. Now, for women, testosterone has very similar effects, right? So it helps women build muscle, it helps the bone, libido. I mean, I have women— I have guys that come into my office and they're like, Doc, you got to help me. My wife went on testosterone and now she's chasing me around the house for sex. He's like, I've been dreaming about this all my life and I'm too unmotivated to do anything about it. Yeah, yeah. So, you know, couples balancing is really important in that respect.

And that's really funny. And with the— because, you know, I've spoken to various people about women taking testosterone and they've said it does depend on whether you use a cream cream or a pill or whether you inject it. Is it the same with guys? Is it— are you prescribing it in different forms, or is it typically in one form when it— when we're, we're talking about men?

Yeah, so, you know, typically men, the, the range of testosterone is anywhere from 300 to 900 or 300 to 1,000. And typically I'll get my patients who I'm doing testosterone replacement on, especially if they're in their 50s or 60s or 70s or 80s, you know, over 1,000. So I'll get it between 1,000 and 1,500. Now, a women's testosterone level is 20, 30, 40, you know, it's lower. Testosterone is more potent in women, so women get sort of more bang for the buck, um, but getting their levels to 50 or 100 or 150, you know, will have a dramatic effect in women.

Oh, interesting. And is that only through injection, or can you get that as a pill as well?

Yeah, so that's a really good question. For men, in order to get the levels over 1,000, I either have to use injection therapy or pellets.

Okay. Oh, right. Okay.

Everything else, you know, anything transdermal like creams, gels, patches, um, any of those kind of things don't give levels high enough that I think are effective. Now, women, it's different, right? To get a woman to a level of 50 or 100 or 150, you can use creams, you can use gels, you can use pellets. You know, you can use injection therapy, but that's probably not necessary to inject a woman because the levels don't have to be nearly as high as they are in men.

Yeah, yeah. Although I've, I've been told, reliably told, that if you, that if you do inject a woman with testosterone, that there are some other kind of side effects that, um, take place where certain parts of their anatomy might start resembling a small boy.

Yeah, I mean, you get It's testosterone, right? So you get what's called clitoral hypertrophy, right? And you get some facials, uh, hair. Yeah, you get masculinizing, um, characteristics. So I mean, it's a balance, right?

Yeah, yeah, yeah, yeah, yeah.

You know, and for men too, I mean, if you put a man on too much testosterone, then their estrogen levels will start to creep up and they get growth of breast tissue, breast tenderness. You know, some men buy Barbra Streisand albums or they go to Celine Dion concerts.

Yeah, well, yeah, I mean, yeah, that's okay though. I don't mind that. So let's go on to some of the other, the other treatments, because I know that we were talking just before the show about, about Viagra. And actually, I was— I did an interview for a newspaper yesterday talking about women and Viagra, not in terms of women taking Viagra, but, but women women's response to men taking Viagra. And I know that some men have said to me— not me, but some— and have said that women that they've been with have said, I would rather you didn't take that because it suggests to me that maybe you don't find me attractive, or maybe I'm not sexually desirable to you anymore. Um, you know, and I think how many men come to you with with that kind of wanting to obviously do something about the fact that they're not able to stay hard enough for as long as they'd like, counterbalance with, you know, the psychological impact of having ED.

Yeah, I mean, some men come to me and they say they want to maintain kind of, quote, natural erections. They don't want to be dependent on a pill. And, you know, I can, I can understand that. But Realistically, as you age, things don't work as well. And for the same reason that men, um, need heart stents or heart surgeries or statin drugs or things to keep blood vessels in the heart open, men need things to keep blood vessels in the penis open. And, you know, I mean, Viagra and Cialis are really miraculous drugs. I mean, I don't think you see too many men saying, listen, I don't want to have heart surgery because I want to keep my heart vessels open naturally and I'm willing to die just to do that because I don't want surgery because it's unnatural, or I don't want a heart stent because it's unnatural. I mean, give me a break. You know, if it's not working or if it could work better and there's a pill you can take and that pill is incredibly safe. Yeah, I mean, incredibly safe. You get the side effects of those pills are a stuffy nose, headache, facial flushing, some reflux, uh, you know, people aren't keeling over from taking Viagra or Cialis.

I mean, they're—

and hundreds of millions of men have taken these drugs. So the side effect profile and the safety profile of these drugs are incredibly well known. And it's, you know, it's been out for 30 years. It's not like a COVID vaccine that's out for a couple weeks and, you know, people are being told to take it. I mean, I've, I've taken— I'm on my 6th or 7th COVID vaccine. I was actually part of the initial study, Pfizer study. Yeah, I was the 8,000th patient in the country, in the world, to have taken the Pfizer vaccine. So I, you know, I'm, I'm all in for medical science, but I mean, give me a break. Yeah, you know, the track record of these medications is like bombproof.

Yeah, yeah. But look, as a woman, I know that I started taking vaginal estrogen of You know, I guess it's been about a year now. And I, and up until that point, I thought that some of the symptoms that I was experiencing, pain during intercourse, you know, like tears, just really, you know, wasn't pleasant.

Well, is that because you don't love your partner? And you're not vaginally lubricated properly?

That's right. But you know, obviously—

You don't love me. Your vaginal lubrication isn't what it used to be. But no, it's getting old. That's what happens, right? You don't get as much blood flow to the penis. That's what happens. You don't get as much blood flow to the female genitalia, so you don't create as much lubrication. That's what happens. Just accept you're getting old and fix it.

Yeah, but listen, people don't talk about this shit, right? So Even as someone that talks about this all the time and was using lots of lube and stuff, and it just wasn't doing quite what it— enough. And then it was somebody else who actually turned me on to vaginal estrogen, just somebody, a friend of mine. And then it was, it was literally miraculous. But firstly, I think we need to, as you said, we need— we're getting old. We have to acknowledge shit happens and, and we have to deal with that, right? So that's the first thing that we have to deal with is we're getting old, which is sometimes quite difficult for people to deal with, right? Because I know, especially with— I was with a guy, sadly he's not with us anymore in the world, but when he started to experience erectile dysfunction and he was in his early 60s, for him, up until that point, he'd been kind of grooving along, you know, he'd been, he'd been able to get a hard-on, we had sex, It was good. It was fine. And then one day it started to become a little bit more of a problem. And at that point he was like, oh, the equipment's not working so well. Now, I did the same thing you did. I just said, honey, you're getting old. You're 63 years old. Wake up. You don't have so much testosterone. The blood's not flowing so much down there. Well, just go and get the pill. Just go and get the pill. But that really was something quite significant for him to have to hear. Because up until that point, he was kind of grooving along. Similarly for me, I was grooving along in my lubricated world until one day. I mean, until one day I wasn't. And then I had to, you know, there's a path, you know, like there's a journey you go on, right? To deal with all this shit.

Yeah, I mean, absolutely. It's a journey and you just have to accept that things change.

Yeah, yeah.

But I mean, fortunately, I mean, fortunately, we actually have medications that actually work. I mean, like, you know, don't bemoan it. Like, thank your lucky stars that these things actually exist.

Yeah. So, um, so some of the other things you were talking about was your, your incredible find about, and I want you to explain it, about the, the even more incredible results you can get with a few nifty combos packages.

Well, yeah, I mean, I have a whole algorithm that I use for men when they come in to see me, but, you know, foundational to that is a nitric oxide booster. And so I created the Affirm Nitric Oxide Booster, but yeah, Affirm's not the only nitric oxide booster out there. And when I was at UCLA, one of my professors, Dr. Lou Ignarro, won the Nobel Prize for discovering how nitric oxide opens up blood vessels. And then Ignarro and Jake Rafer, who was another one of my professors, actually discovered how Viagra works, which is— okay, so I'll throw a little biochemistry because I'm sure your listeners are very, very intelligent and they are So nitric oxide, which is— comes from watermelon, beets, green leafy vegetables, um, gets released by nerves and it makes something called cGMP. And cGMP creates a cascade that opens up blood vessels, right? And this happens in any mammal, men, women, cats, dogs, rhinoceroses, giraffes. Any mammal from head to toe, all blood vessels use nitric oxide to open up. Okay. And they use that— they do that by making cGMP. Now there's an enzyme called a PDE, and PDE breaks down cGMP, right, so that blood vessels don't stay open forever. And really the discovery with Viagra was that Viagra is a PDE5 inhibitor, right? So PDE5 is only in the penis, and that's why those medications work so well. But there should be a synergistic effect between a nitric oxide booster and a PDE5 inhibitor because they're both keeping cGMP around. So the first thing we did was we had our studies— uh, study participants take the Affirm nitric oxide booster before they went to sleep, and we used what's called the FirmTech ring. It's a ring you put around the penis that has a pressure sensor that can determine your nighttime erections. And for those of you who don't know, nighttime erections are critically important for your daytime erections, right? When you're asleep, you should be getting anywhere from 3 to 6 erections every night that last anywhere from 5 to 10 to 20 minutes. And what we found is that taking the Affirm Nitric Oxide Booster increased nighttime erections 30%, and I'm actually, uh, presenting that later this month at the Sexual Medicine Society of North America. Now, the follow-up study to that is theoretically, if you take a nitric oxide booster and boost cGMP and you take a PDE5 inhibitor like Viagra and you block the breakdown of cGMP, you should get an extra boost. And why is this important? Well, this is important because a lot of men out there can't take a full dose of Viagra or can't take a full dose of Cialis because they get side effects. They get headaches, they get facial flushing, they get reflux, they got muscle aches and pains, they get, um, you know, blocked or sinus, uh, you know, sinus congestion. And so if you— if Viagra, 100 milligrams of Viagra is your effective dose, but you can only take 50 or you can only tolerate 50, you know, you're 50 milligrams short. And so what we found, or what we're finding so far in the study, is that by taking a nitric oxide booster like AFIRM, you can increase the effectiveness of Viagra because they're both creating or preventing the breakdown of cyclic GMP. And so, you know, this is, this is early in the study, but, um, what we're finding is really going to be a major, major uh, finding is that taking a nitric oxide booster while you're taking a PDE5 inhibitor like Viagra and Cialis can definitely improve the effectiveness of those medications.

And so with the nitric oxide, do you take it alongside the Viagra? So you take it at the same time, or does it not really matter at what time you take it?

Well, I mean, the amazing thing about nitric oxide boosters is they do an incredible amount of things. And there are really no side effects. So first of all, I use them as blood pressure medications on my patients. So a lot of men over 50 are on blood pressure medications, and blood pressure medications are detrimental to erectile function. So if you can replace a blood pressure medication with a nitric oxide booster, you're so much better off in terms of erectile function. I wouldn't recommend, you know, just not taking your lisinopril or your metoprolol. Talk to your physician. But what I typically recommend is get a home blood pressure uh, machine. Check it 8 AM in the morning, 8 in the evening, record it. Then take a nitric oxide booster like Affirm, record it for a week, and then stop your blood pressure medication or drop the dose of your blood pressure medication and keep following your blood pressure readings. And if your blood pressure readings are still good, then, you know, you can talk to your physician about stopping your blood pressure medication because it's a natural way of decreasing blood pressure. And the thing is, there's no drug company that's ever going to do the study of a nitric oxide booster for blood pressure medication because, you know, there's no money in it, right? So I mean, anyone can take watermelon and beets and, and create a nitric oxide booster.

Um, yeah, I mean, that's— and of course, that's the, that's the whole thing about pharmaceuticals in general, is that there's an— I, I was— I did a documentary last week I filmed for the BBC, and one of the There was one man in our small group, it's just a small group of us, 78 years old. He started experiencing erectile dysfunction, then that led to him finding out he had an enlarged prostate, which of course we know is not unusual. And then he was put on medication where he was told, well, you know, one of the side effects of this medication is your dick's not going to get hard. Like, and said with that degree of lack of concern. Like, this man who still wanted to be sexual— why not— was just told, yeah, well, that's—

yeah. I mean, you know, I think that's really sad. It's— at least in the United States, you're not taught very much, if anything, as a physician about sexual function or sexual medicine, right? So it's like, oh, you're 78, you know, you're not having sex. Bullshit, right? I had a guy a couple years ago, he was 91. He's like— and I was seeing him for enlarged prostate, and at the end of the visit he leaned over to me and he said, 'Can I ask you an embarrassing question?' I was like, 'At 91, what could possibly be embarrassing?' He said, 'Can I get some Viagra samples?' I said, If I was 91 and I was asking for Viagra samples, I would put that up on the billboard on the roadside. That's it. I wouldn't be embarrassed about that.

Yeah, well, I mean, look, I was with a guy back in 2004, was diagnosed with liver cancer, very late stage. He was a heavy drinker. None of it came as a great surprise, unfortunately. The doctor said to him, Is there anything I can do? Sorry, you know, sorry about all of this. Very sad. And he said, yeah, I'd like some Viagra, please, because I just want to have some happy times. And I just want to have lots of sex with my girlfriend. Thank you very much. And the guy said, we can talk about that at your next visit. I don't know. God, he said, I don't think that's appropriate for this visit. And, you know, I mean, I really, really hope for everyone's sake that Times have changed, but I know that there is still a, you know, even, even when you speak to urologists, I know that there's quite a few urologists for whom the sexual side of their business, if you like, is something that kind of like comes with the territory because that's your equipment that you're dealing with. But often I find that the sex stuff, they don't really want to talk about it too much. They want to talk about They're happy to talk about prostate issues and prostate cancer and stuff, but when it comes to sexual pleasure, it's like, don't— sorry, don't they go hand in hand here?

I mean, most doctors are very uncomfortable talking about that kind of stuff. I mean, just to be bluntly, perfectly honest, listen, we're all like Type A personality. We spent all of our time in high school and college in the library trying to get into medical school. We spent all our time in medical school cooped up in the library trying to get into residency. We then We get bombarded during residency. When I was doing it, we were on call every third night. So, you know, you get out, you're 30-some-odd years old, and you're, uh, maybe less experienced as a group, less experienced in these matters than, say, other folks. And then, and then you're like thrown in the clinic and people are asking you about these things and you don't know what to say. You're like, well, I can fix your prostate or I can fix your heart, but, you know, fix your dick? Give me a break. I mean, there's such a stigma. Like, think about it this way, right? You're at work, right? And you, you announce to your co-workers, listen guys, I have to take my dad to the cardiologist. He's having some heart problems. And everyone in the work is like, oh, that's so nice, you're such a good son taking your dad to the cardiologist. So then a week later you're like, hey, listen guys, my dad is old and he's having erectile dysfunction and he can't get his dick hard, and I need to take him to the urologist so that he can get a penis implant. Do you think you're going to get the same response from the people at work? No, of course not. But there's such a stigma attached to it. But it's actually the same physiologic issue, right? The blood vessels are getting clogged to the penis. The blood vessels are getting clogged to the heart, right? Like, if you need Viagra, deal with it. You know, you're not gonna like— you're not gonna not take a heart medication because you want to fix your heart naturally. I mean, you should be trying to fix your heart naturally. You should be exercising, you should be eating right, you should be meditating, you should be doing yoga, you should be out doing walks, you know, you should be decreasing your stress. You definitely shouldn't be smoking, you shouldn't be drinking. All these things that you shouldn't be doing. But at the end of the day, if you need a heart pill to stop from dying, then you take it. If you need a penis pill to stop your penis from dying, then you take it. And, you know, and a nitric oxide booster is like a total no-brainer, right? It helps with blood pressure, it helps with penile circulation, it helps with cognitive function, right? So when I first started mixing up a firm, you know, I had a compounding pharmacy down the street from me, and so I was putting together L-citrulline, which is from watermelon, and beet extract, Beet extract has nitrates, which get converted into nitrites, which get converted into nitric oxide. And citrulline gets converted into arginine, which gives out nitric oxide, right? So these are nitric oxide boosters. And my 70-year-old patients, when I finished treatment with shockwave therapy, said, you know, can we stay on this? And I was— and I asked them, why do you want to stay on it? And they said, because we think better.

Oh, interesting, right?

Because your brain is entirely dependent on blood flow, and if you get better blood flow to your brain, you think better.

Yeah, yeah, right.

So it doesn't do anything to the white matter or the gray matter of the brain. It just brings more oxygen and glucose and nutrients up to the brain. And athletic performance too. There's a big body of literature on athletic performance and nitric oxide boosters. And in elite athletes, you can improve athletic performance anywhere from 1 to 5% by putting them on a nitric oxide booster, right? And that You know, that's the difference between 10th place and 5th place.

Yeah, yeah. And you know, and what you're saying is like, it's so obvious, but, but I'm always surprised at how people are so resistant to understanding that pretty much everything that goes on in your body is dependent on your blood flow, right? If the blood's not pumping effectively, then you're not getting a hard-on, your brain's not getting enough blood, like everything is affected, right? So yeah. You know, if your blood flow is restricted, then obviously that's going to impact all sorts of things, including your erectile functions. But when I've suggested to men that, you know, and I'm sure you agree with me, that if you've got some form of erectile dysfunction, then you have to look at where is the blood flowing effectively, because potentially that's your first problem, right?

Well, yeah, I mean, you bring up a really good point, which is What is your first problem? Yeah, your first problem is that you lose nighttime erections. Yeah, right. That's the, that's the first key that your circulation isn't as good as it used to be. Okay, 10 years after that, you'll develop erectile dysfunction. Okay, and if that doesn't ring a bell for you, then 10 years after that, you're going to end up with a heart attack or a stroke or some cardiovascular complication, right? That's the progression of blockage in your arteries, right? Because the arteries to the penis are 1 to 2 millimeters.

Yeah.

And they're peripheral. The arteries to the heart are 3 to 4 millimeters and they're central. So you're going to block the peripheral arteries 10 to 20 years before you block the central arteries. So it's like you're getting a 10 to 20 year head start on trying to prevent heart disease, if you're stupid enough not to listen to your body and listen to what your body is telling you, you know, what can you do? And then, then 20 years later, you're like, well, I want to fix my heart problem naturally. I don't want to take any heart medicine. Like, you, you missed the train. The train was at the station 10 and 20 years ago.

No, that's right. And that's, you know, that's the whole thing when people are like, oh yeah, I know I should eat healthy food, I know I should do this, I know I should do that. No, no, it's not that you should, it's that you actually have to, because if you don't, the ramifications of that, as you said, is like you might not see them for 10 years, and then 20 years later you're going to end up like 50% of guys over 50, right, with ED. And that's like, you know, pretty startling stats. That's, that's why I get quite passionate about this is because the stats for vaginal atrophy are also really significant. But when I—

Oh yeah, huge.

Like huge, but they're pretty much the same, to be honest. Like it's like 50% of women over 50, and I've heard 50% of men over 50 have some, have experienced some form of ED, right? So, right.

But it's always the other guy. It's not me. If it's 1 out of 2 people, I'm the guy that's okay. It's the other guy that's the problem.

Right. But, you know, it's, it's, these are really significant numbers. And the fact that nobody's talking about it, as you just said, like no one's talking about it. It's ridiculous because—

Yeah. Well, I want to send you a copy of my book, The 21st Century Man.

Yes, please do.

So I have chapters in this book that deal with all of this. And I have a great chapter written by a friend of mine, Russ Bartels, who's a a male gynecologist called What Men Need to Know About Menopause.

Oh, great.

Right. The same, the same way that women get involved in men's health, men should be at least aware, if not involved in women's health and understanding some of the hormonal issues that women undergo and what happens to the aging vagina.

Yeah. Yeah, absolutely. I mean, when I started this podcast a few years ago, my co-host then was a guy that I was, I was kind of going out with. And he said to me after we'd done this for about 6 months, I said, what have you learned in these 6 months, Peter? And he said, honestly, you guys have so many problems. He said, who knew? He said, honestly, I was so naive when I went into all this. I just had no idea how much shit you guys have to go through, like throughout your whole life. And I was like, Welcome to our world, you know. And, and, but yeah, I mean, men don't know, but women, I think it's, it goes both ways. I don't think, like I said before, I think women take men's dick going up and down very personally when, when most of the time it's got nothing to do with them. It's got to do with something that's going on with their own bodies, and they need to be more sympathetic in those situations rather than say Hey, what's happening here? Don't you love me?

Well, yeah, I mean, that's the issue, and that's what people have to understand, is that there's, there's two, two phases of the nervous system that's called sympathetic and parasympathetic, right? So say you're a caveman, right, and you're in a cave with your cavewoman, and there's a saber-toothed tiger outside and it's pacing in front of the cave, right? So you're in what's called full sympathetic outflow, right? So adrenaline and cortisol are the stress hormones that you use. And when you're in stress mode and you're gonna be attacked by a saber-tooth tiger, um, you want your blood going to the muscles, to the brain, to your eyes, right? And that's it. Going to the intestines, you don't want that, right? Cuz you don't need to digest food. Going to the kidney, you don't need to make urine. Going to the penis, you know, you're not going to have sex with the tiger. You're going to try to fight the tiger, right? So then 2, 3 days go by and your cavewoman is starting to get a little anxious, you know. She's like, I'm getting sick and tired of being in this stupid-ass cave and you need to go out and fight this tiger. And then, so then another day goes by and she looks at you and goes, my ex-cave boyfriend would have kicked this tiger's ass and you're just a wimpy ass piece of crap and you're just sitting there. And so, by day 6, it gets so abusive that the caveman was just like, "You know what? I'd rather take my chances against the saber-toothed tiger than spend another minute in this cave." So, he picks up the spear, he charges out of the cave, he kills the saber-toothed tiger, right? This massive sympathetic nervous system outflow kills the tiger, you know, and collapses on the ground just exhausted, right? So then, you know, 10 minutes later, he's pulling the saber-toothed tiger back into the cave. He skins the saber-toothed tiger, puts a nice saber-toothed tiger rug out on the floor of the cave. He's got the saber-toothed tiger meat on the spit, right? Now, you go from sympathetic outflow to parasympathetic, right? So, Now your intestines are digesting the tiger meat, the kidneys are making urine, and then you settle down on the tiger skin rug with your partner and you procreate. Yeah, right. And so you're in full parasympathetic outflow. So the blood is not going to the muscles you need to fight the tiger. Your muscles— I mean, your blood flow is going to procreation. And then you reach orgasm or climax, and that is a full sympathetic outflow once again, because the thing is You know, if you're— I'm looking out onto a big grassy field and there are squirrels out there. When squirrels are copulating, they stand still.

Yeah.

When a squirrel stands still, the hawks in the area are circling around, getting ready to pounce on Mr. Squirrel. So as soon as Mr. Squirrel is done with his business, he's up and ready to fight again or to run away. And so the thing is, there's only one sympathetic and parasympathetic nervous system, right? The same system we have built to protect us from tigers also gets triggered when, you know, you have a problem at work and your boss is mad at you.

You're stressed.

Or, or your, your spouse says, you don't love me anymore. You can't get an erection. What's wrong with you? Right. So that situation just makes it worse.

Yeah, yeah, yeah, yeah, yeah. For sure. For sure. So yeah, ladies out there, just, you know, be sympathetic towards your guy and everybody's going to get what they want. That's my, that's, that's my, my closing statement. Just be nice. Just be nice.

Be nice.

Just be kind. Just be nice and go get yourself some nitric oxide. I'm gonna get myself some nitric oxide after this, or you're gonna send it to me.

I'll send it to you. I'll send you a copy of my book too. You'll see there's so many amazing chapters. They basically cover all aspects of men's sexual health, including You know, I don't know if we had much time to talk about some of the new nifty drugs out there, like the PT-141 peptide, or apomorphine, or oxytocin, or low-intensity shockwave therapy, or Botox injections for the penis, or—

Yeah, there's loads of stuff. My— the guy that I'm with has just been taking peptide injections, actually. And yeah, seems to be for something.

For what?

I don't know, but he's like— he looks great. Yeah.

So I mean, peptide, what a peptide is, is just a string of amino acids.

Yeah. Yeah.

That's all a peptide is. So insulin is a peptide. But there are specific peptides that do certain specific things.

It's a muscle, it's for muscle building.

Yeah. So he's probably on BPC-157, which is supposedly helps muscle recovery.

Yeah. Yeah, exactly. That's the one. Anyway, it's been lovely to speak to you. I normally do 30 minutes, but this has been a very interesting 37 minutes. I could make it 57 minutes, but then, yeah, we find—

we'd have to pop some Viagra if you want to go that long.

Yeah, I call it a Viagra party.

Yeah, or, you know, if we want to go an hour, we just pop some Affirm and some Viagra, and then we're, we're good all night.

We're good to go. Well, you never know. I might be in Northern California, but I haven't asked your marital status, and we don't need to go there for this purpose. It's been really lovely to speak to you. Oh yeah, there's a— there's— he's got a ring on it, and not as— not as Elliot would say, you know, you got to put a ring on. It's on his finger, ladies and gentlemen, because we don't— we don't show the video. It's on his finger, not in the other place. Anyway, it's been lovely to chat to you. Thanks very much. We will be, um, I will put the link to your book and all the rest of it. And awesome. Yeah, have a great day.

You too. Bye-bye.