The Megyn Kelly Show - Testosterone, Libido, and Infertility： Deep Dive on Men's Sexual Health, with Dr. Mohit Khera

00:00:00.480 Welcome to The Megyn Kelly Show, your home for open, honest, and provocative conversations.

00:00:11.920 Hey everyone, I'm Megyn Kelly. Welcome to The Megyn Kelly Show. Today we are bringing

00:00:16.260 you something a little different, something that's actually really important and I think

00:00:20.560 you're going to enjoy whether you're a man or a woman. Today's show is a deep dive on

00:00:25.580 men's sexual health and we have a world-renowned expert with us. Next week we'll be doing a full

00:00:31.460 show on women's sexual health, but obviously the two are very much related. Full disclosure,

00:00:38.560 I got this idea from Dr. Peter Attia, who's been on the show, whose book has been on the New York

00:00:44.040 Times bestseller list for a long time now. Very talented longevity doctor who's a friend of the

00:00:48.740 program and he did. He did two shows like this and you should check out his podcast as well.

00:00:52.820 And I thought this is a great thing and I bet my audience would really like it. And don't we need

00:00:56.900 a little break from politics every once in a while? Good God. I know I do. So this is a topic

00:01:01.800 that does not get anywhere near the attention it deserves, but it does impact millions of men

00:01:07.700 every year. Millions. In fact, I've heard some doctors now in preparing for today's segment

00:01:13.160 refer to erectile problems as an epidemic, an epidemic for men. So if you are suffering from this,

00:01:19.820 you're not alone and you may be too embarrassed to talk about it, but you shouldn't be too embarrassed

00:01:24.660 to listen to a talk about it. And so we'll get to that today and we will hear from you.

00:01:30.140 We're going to take calls later as well. Today we'll be discussing men's sexual function,

00:01:34.800 changes during aging, STDs, porn, all of it. And as we dive into some of the major issues,

00:01:42.200 we will discuss causes, effective treatments, and just lifestyle changes. Even if you never want

00:01:48.240 to talk to a doctor about this stuff, we'll give you some lifestyle changes you can make

00:01:51.860 that could improve your function and your sex life. And if your sex life is off,

00:01:57.160 the relationship is off, right? As Dr. Phil used to say, when sex is good, it's 10% of the marriage

00:02:03.180 or the relationship. When sex is bad, it's 90%. Nothing's off the table. I'm excited to bring you

00:02:08.460 this conversation. Today with me is Dr. Mohit Kara. He's a board certified urologist with expertise in

00:02:15.120 sexual medicine and testosterone, who works as a professor of urology at the Baylor College of

00:02:21.520 Medicine. Welcome to the show, doctor. It's great to have you. Thank you so much for the invitation.

00:02:28.380 Yeah. Okay. So I want to cover it all, but let me start here. So I think women have an advantage in

00:02:33.380 this department in a way because we go to an OBGYN pretty much at least once a year. And we do that in

00:02:41.500 addition to our primary care physician. So this is a person who, if you get a good one,

00:02:46.100 takes your overall health as a woman into consideration. It's not just, forgive me,

00:02:51.380 a vag doctor. You know, she's, she's checking out the whole woman, you know, your energy levels,

00:02:56.660 your sleep, the breasts. Yes. Down South and Rio, all the stuff. But like, whenever I leave my GYN,

00:03:03.340 I feel like, okay, I'm, I'm well looked after. She wants to know everything. She wants to know about

00:03:07.780 my blood pressure. She wants to know everything. And I feel like there's not, you know, men don't

00:03:11.820 really have that. They don't have that extra on top of the primary care physician. I think they do

00:03:16.500 the turn your head and cough thing when they go to the primary care physician. But for most men,

00:03:20.480 that's about it. Am I right? So I think you nailed it. I mean, you have to think about this.

00:03:25.680 Erectile dysfunction affects 40% of men at 40, 50% at 50, 60 at 60, 70 to 70. You live long enough,

00:03:33.840 a man's going to get erectile dysfunction. The problem is that many men are embarrassed to talk

00:03:39.240 about it. I think one of the best studies I've ever seen came out last year, 1500 men between the

00:03:45.240 ages of 18 and 80, and they put out a survey. And what they found was that 40% of men, 40% of men had

00:03:51.460 some degree of sexual dysfunction, but 50% of them said, I don't know where to get the help. 70% said,

00:03:57.980 I wish I could get the help. And what was surprising is that 53% of those patients

00:04:03.400 didn't even tell their physician. Now, I think one of the problems is if you look at physicians,

00:04:07.800 they don't ask the question, do you have erectile dysfunction? My wife is a primary care physician.

00:04:13.860 And she says, look, I have about 15 minutes to go through diabetes, hypertension, obesity,

00:04:19.500 erectile dysfunction tends to be at the bottom of the list. So again, it's a patient embarrassment

00:04:23.900 problem and physicians aren't asking about it. That's so troubling because not only does it affect

00:04:31.420 your relationship and your happiness and your wellness, but now in reading up for today, I

00:04:36.080 realized it actually can be a clue that something else is wrong, like potential heart disease even

00:04:44.240 could be related to in particular ED. Is that correct? You're so right. So I think that one of

00:04:50.400 the best barometers of a man's health is his sexual health. Why? Because it not only does it encompass

00:04:56.100 your physical health, but it also encompasses your mental health. And so sexual health is one

00:05:01.420 of the best barometers of our overall health, but you bring up a very good point. There was a study

00:05:06.340 that came out in 2005 that showed if a man gets erectile dysfunction today, 15% of them will have

00:05:13.740 a heart attack within seven years, 15%, which is quite large. That same year, other studies came out

00:05:19.880 showing that if a man has a heart attack, typically 39 months prior, he started developing erectile

00:05:25.240 dysfunction. And we know this because of the coronary arteries are much smaller, one to two

00:05:30.620 millimeters, excuse me, the penile arteries are much smaller, one to two millimeters compared to

00:05:34.940 the coronary arteries. So if you're going to block an artery, you're more likely to block the penile

00:05:39.040 artery before you block the coronary arteries. So I really do think that, you know, a young man who has

00:05:44.180 ED and no other signs, this could be one of the first signs of having a potential MI in the future.

00:05:49.900 And if you are too embarrassed to talk to your doctor about it, let's say your doctor

00:05:54.260 is a female, then get a male doctor or just somehow work up the nerve because now you're

00:05:59.460 talking about, you know, your, your actual life. And what if like, what a great canary in the coal

00:06:04.940 mine, you know, if you just like, it's not great to have ED, of course, but like much rather have to

00:06:09.460 fix that problem than have to fix a heart attack. I read the following. Is it true? The penis works on

00:06:16.040 blood pressure. Yes. So it's important that, you know, when the, the important part of the penis

00:06:22.060 is blood going in and blood going out. And so the way you get erectile dysfunction is not enough blood

00:06:27.520 coming in or the blood's coming out too fast. And so it's a very clever system. The artery goes down

00:06:32.620 the center and then the veins are on the periphery. And so the first sign of erectile dysfunction is

00:06:38.040 typically the blood is coming out too fast. This is called venous leak. So what does a patient tell

00:06:43.780 you? They say, doc, I can get the erection, but I can't maintain the erection. He's telling you,

00:06:49.520 look, I got the, one of the first signs of ED, which is called venous leak. So there's many ways

00:06:54.760 to fix this. One way to fix it is to increase the blood flow. And that's what many of these pills do

00:07:00.160 like Viagra or injections or to decrease the outflow. But again, this is the most common type

00:07:06.120 is venous leak. And this is so like, you don't want to just get a prescription for Viagra. You want to

00:07:12.560 figure out what's going on that could fix the symptom. But if there, if this is linked to high

00:07:17.860 blood pressure or a heart disease, you need to get to the bottom of it. It's not a matter of just

00:07:22.660 like getting your friends Viagra, you know, you really need to know. Well, so let's talk about

00:07:26.440 erectile dysfunction because I can say like, I'm sure, uh, thankfully I haven't had this issue in

00:07:32.180 my life. My husband and I are still relatively young, but I think as a woman, I would start blaming

00:07:37.120 myself. If my husband had this, I'd be like, some happened. I gained weight. It's my, and then I can

00:07:43.000 see how this would turn into an issue really quickly between the couple. Yes. Megan, ED has

00:07:49.640 a devastating impact, not only on the patient, but on the couple. And I didn't go through these

00:07:54.080 statistics, but 30% of men, 33% of men who have erectile dysfunction are severely depressed because

00:07:59.060 they have ED. 37% of men who have ED have severe anxiety. And you talked about this earlier, but we know

00:08:05.260 that couples that engage in sexual activity have a significant improvement in the quality of

00:08:09.520 relationship, say 2X. Those that do not engage in a sexual activity have a significant decrease in

00:08:15.980 the quality of relationship, almost 4X. So double. So again, sexual, uh, sexuality is really important

00:08:22.140 for the couple. When a man starts getting erectile dysfunction, something very interesting happens.

00:08:27.900 He starts avoiding sex because he says, what's the point of engaging in sexual activity? If it's going to

00:08:33.660 maybe work or not work, I'm tired. It's 10 o'clock at night. I might as well go to sleep.

00:08:38.240 We call this subconscious aversion. They tend to avoid it. Um, and so the female partner or the

00:08:43.980 partner in general takes this as rejection. And she says, or he says, I'm not, why are they not

00:08:49.460 interested? What is going on? But the inside the brain, the patient's saying, I just don't want to

00:08:54.400 go through all the frustration of this not working.

00:08:57.520 Hmm. My gosh, I, it's reminding me, this is an off color story. So forgive me, but a friend of

00:09:03.180 mine once had a sexual interlude with a man. P.S. It turned out he was gay. So this is why the

00:09:08.720 problem was manifesting, but he, he couldn't, he couldn't get an erection. And finally, after a long

00:09:14.200 time, he got one. And I remember her telling me about it after the fact and her statement was,

00:09:17.920 it should come to me in this condition. And I think there is an expectation in normal relationships

00:09:25.760 where the person is not secretly desiring somebody of the opposite sex, um, by women that it should

00:09:30.940 come to me in this condition without thinking, Oh my God, maybe he has a problem. Like maybe what if I

00:09:38.180 were just really cool about this issue and we talked about it and I was, and I was supportive of

00:09:43.200 him in fixing it. So, but that, I guess as a doctor, that would make you ask, is this a new thing or is

00:09:50.520 this something you've always struggled with? Right. So remember that as men get older, they acquire

00:09:56.440 comorbid conditions, diabetes, epidemic United States, obesity, metabolic syndrome. Uh, think of

00:10:03.140 other risk factors like smoking, certain medications, like a beta blocker. How many people are on a beta

00:10:08.080 blocker? It's notorious for causing erectile dysfunction. Remember beta blockers are used for

00:10:12.160 hypertension, thiazides. So as we get older, as we develop new conditions, we start taking new

00:10:17.040 medications that can make a significant impairment on erectile function, but we start getting more

00:10:21.620 conditions that are associated with ED. So this is the issue. I forgot to mention one of the things

00:10:26.880 earlier, you know, in that survey, I talked about 44% of men, 44% of men did not mention to their

00:10:33.900 partner that they had ED. Now you may say, how did they not mention it? What they do is they just stop

00:10:38.640 engaging in sexual activity, right? Which is a problem. But as these men get older and they start

00:10:44.120 developing more and more sexual dysfunction, our job is to try to find out what we can reverse

00:10:49.260 reversible causes of ED. Now, my dream, my wish is that, you know, you know, lifestyle modification,

00:10:56.300 diet, exercise, sleep, and stress reduction. Again, diet, exercise, sleep, and stress reduction

00:11:01.260 are very powerful tools in preventing a man from ever, ever developing erectile dysfunction. So

00:11:07.180 to me, that's a form of a prevention, preventing ED.

00:11:10.940 So that, and those are the key things to every area of wellbeing. Like if you improve those four

00:11:17.500 things, everything about your life will improve, not the least of which is your longevity. And you

00:11:23.300 know what I recently discovered is I wear this Fitbit now. This is my, this is in honor of my friend's

00:11:28.580 on the orange band, but this is my Fitbit. And the reason I've been wearing this Fitbit nonstop

00:11:34.080 is because your Fitbit, if you wear it overnight, will monitor your sleep. And it will not just

00:11:37.780 monitor how many hours of sleep you got. It'll tell you how many hours of REM sleep you got and

00:11:41.740 how many hours of deep sleep you got, which are not the same thing. And if you can get like an hour,

00:11:46.020 15 of REM sleep, and if you can get two hours, like over an hour, hour and a half of deep sleep,

00:11:50.800 that's awesome. And if you're not getting that, you could do something to address it. You know,

00:11:55.540 there are all sorts of things. You don't have to go on a prescription medication. You could

00:11:58.040 exercise more. You can take whatever, tryptophan, that stuff. That's a supplement. There's all

00:12:02.040 sorts of, but like fixing sleep is, I would say like one of the first things, no?

00:12:07.720 Right. So you nailed it. So I take care of a lot of patients and they tend to say, look,

00:12:11.320 doc, I eat healthy and I exercise, but they don't sleep and they're stressed through the roof.

00:12:15.880 And that's 50% of it. It's all four. If you decided today that you were going to focus on just one of

00:12:21.460 them, diet, exercise, sleep, or stress reduction, it would have a profound effect on your quality of

00:12:27.980 life. And imagine if you did all four. And so what you just said is exactly what I tell my patients.

00:12:34.640 I don't have a pill stronger on the planet, stronger than diet, exercise, sleep, and stress

00:12:39.740 reduction. Not only will it help your physical health, but actually it helps your sexual health

00:12:43.740 as well. And fatigue, poor sleep is one of the reasons why many patients don't engage sexual activity.

00:12:51.040 Poor sleep, increased fatigue, lower libido.

00:12:53.880 And then if you have poor sleep, you tend to make, I think, poorer food choices the next day,

00:13:00.060 right? Because your will powers down, you don't feel good, you seek comfort in food. And so it's

00:13:06.140 like a downward spiral.

00:13:07.420 It's a snowball effect, right? It's a snowball effect because they're all interrelated,

00:13:11.060 right? So if you exercise, you'll sleep better. If you sleep better, you'll eat better food.

00:13:15.120 Now it's all related. If you sleep better, exercise, and eat good food, you tend to see stress is not as

00:13:22.240 big as it would be, right? So one of the big reasons why we see stress as such a big thing

00:13:26.140 is because we're fatigued. If you're not so fatigued, stress typically doesn't look as big.

00:13:30.440 So it's all related. And so when patients come in and say, doc, just give me the Viagra and the

00:13:35.680 testosterone, I say, there's more to it than this. You know, this is a partnership and your 50%

00:13:40.160 is diet, exercise, sleep, and stress. My job is to modify it and make sure that your hormones and

00:13:45.980 your medical condition is optimized. But together, it's a partnership. And if we do the partnership,

00:13:50.960 those patients tend to do the best. So if you are suffering from ED, any form of it,

00:13:58.140 you know, like a light form or a severe form, and you go to the doctor, he's going to tell you,

00:14:03.000 think about those modifications in lifestyle. And then what's the first line medical defense?

00:14:08.080 Is it Viagra? And also now I read about Cialis. Is that basically the same thing as Viagra? What's

00:14:13.800 that? Let's talk about it. So there are, think of it like three different categories. And the first

00:14:18.700 category is going to be medications. And there are four types of medications, but they're all like

00:14:24.100 Viagra. There's Viagra, there's Cialis, there's Levitra, and there's Stendra, four different types

00:14:30.460 of medications. Stendra has the fastest half-life. And so it has an onset is actually as fast as 15

00:14:36.500 minutes. Cialis has the longest half-life. So it's 17 hours. So many patients will take a daily Cialis

00:14:42.880 every day and it lasts throughout the day. And so these medications- Wait, what does that mean?

00:14:48.600 What does that mean? Because of course, you know, as a woman, I'm like, no woman wants to see a 17

00:14:52.180 hour erection coming at her. Yeah. Great question. So this is very important. So Cialis is the only

00:14:57.560 medication that has a daily dose and an on-demand dose. And the daily dose is a five milligram dose

00:15:04.200 that you take every day. And the on-demand dose is a 20 milligram dose that you take several hours

00:15:09.800 before sex. One of my favorite medications is that daily dose of Cialis. Why? Because when a patient

00:15:16.560 takes that daily dose of Cialis every day, over time, the muscle in the penis becomes stronger.

00:15:22.300 To me, it's like rehab. It's making the penis stronger. Let's be honest. Viagra is not a cure

00:15:27.960 for rectile dysfunction. Because if you remember, I said ED 40% at 40, 50% at 50, 60% at 60. Viagra only

00:15:35.680 covers your problem that night. It doesn't cure you. It just covers your problem while the disease

00:15:40.160 gets worse every day. So giving someone daily Cialis to me is more like a curative, preventative

00:15:45.260 measure. So most of my patients are on daily Cialis every day. What's nice about it is when they engage

00:15:51.300 in sexual activity, many of them don't need to take a pill. They're always ready. And that really works

00:15:56.420 well for young patients who like the spontaneity. So again, daily Cialis, very effective.

00:16:01.300 And what about those other two that you mentioned? I'd never heard of those. Why would you go with

00:16:06.360 those two over the first two that are better known? Yeah. So one of them is cost. So remember

00:16:11.040 that these used to be very expensive. It could be $20, $30 a pill. But if you've heard of GoodRx,

00:16:16.760 if you've heard of Mark Cuban's new company, Cost Plus, the medications are now very cheap. You can get

00:16:22.720 90 pills for less than $20. Anybody can. So that's very affordable. But in the past, we had to work

00:16:29.080 with the costs. The newer one you have not heard of probably was a Vanafil, which came out in 2015.

00:16:34.620 So it's the newest one that came out. But again, we have four pills that we can use to treat men for

00:16:39.640 rectal dysfunction. If one doesn't work, you can always just switch it for another one. So sometimes

00:16:44.840 some patients respond better to one than the other and side effect profile. Now in this first category,

00:16:50.120 I also like to offer patients a sex therapist because sex therapists are extremely effective in helping

00:16:55.440 with this condition. And we also want to consider lifestyle modification, stop your smoking,

00:17:03.140 change your medications. There's also something called a vacuum erection device, which many men can

00:17:07.940 use. It's exactly what it sounds like. It's a vacuum. It brings in suction, makes the penis erect.

00:17:13.040 They place a band at the base of the penis and it maintains the erection. Sometimes if those are not

00:17:18.140 effective, I'll go into something called penile injections. Those are very effective. It's a small

00:17:23.200 injection that the patient places at the base of the penis and it induces an erection within about

00:17:27.940 five to 10 minutes. The erection can last about one to two hours. So even if the man has an orgasm,

00:17:33.260 it still stays erect. And then the last option, which is a great option, is something called the

00:17:38.820 penile prosthesis. Now the penile prosthesis was invented exactly 50 years ago here at my institution

00:17:44.800 at Baylor by a guy named Dr. Brantley Scott. And now it's used throughout the world. And it's a very

00:17:50.380 effective form treatment for erectile dysfunction. What is it?

00:17:54.800 So it's a surgery that we do. I typically form these surgeries. It takes about 45 minutes to do

00:17:59.780 the procedure. And it has, if you think about the anatomy of the penis, there are two cylinders and

00:18:04.840 each of those cylinders have muscle and carry blood in them. So when the man gets erect, those cylinders

00:18:09.220 expand. And what we're essentially doing is putting balloons inside those cylinders. There's a small pump

00:18:15.560 that goes in the scrotum and there's what we call a small reservoir that goes behind the pubic bone

00:18:20.540 that holds water, say normal saline. So when a man wants to engage in sexual activity, he just pumps

00:18:27.080 the pump in the scrotum. It fills those balloons and gives him a very good erection. He engages in

00:18:32.820 sexual activity as long as he wants. When he finishes engaging in sexual activity, he'll release the pump

00:18:38.080 and all that fluid will go back into the reservoir. So it's extremely effective. If a man took off his

00:18:43.620 clothes, you would not be able to tell that he has a penile prosthesis. But really what it's done

00:18:48.520 is revolutionize the way we treat ED because essentially a man can have an erection as long

00:18:52.780 as he wants, whenever he wants. And it's, it's very effective. I mean, if you were having sex with

00:18:58.880 a man, would you know that there was a pump? Well, many women would state as that. They, they don't,

00:19:04.820 they really can't tell the difference when a man has a penile prosthesis. If a woman was to touch

00:19:09.440 his scrotum, she would be able to tell that there was a pump there. But during sexual activity,

00:19:14.220 it's reported that the sensation is the same. The satisfaction rate is very high with the penile

00:19:20.080 prosthesis, over 90% for patient and partner with the penile prosthesis. And that's higher than almost

00:19:25.820 any other treatment I can offer a man. How painful is that surgery and the recovery from those implants

00:19:32.280 for the man? Yeah. So you'll be surprised. It's very well tolerated. I tell patients to take the first

00:19:38.100 week off and during the second week, you're about 50%. By the third week, you're back into your normal

00:19:42.720 activity. Um, we typically have the patients come back in about two weeks and cycle the pump. Um,

00:19:47.840 but with new techniques in pain control, um, it is very well tolerated. Hmm. All right. Now you

00:19:54.200 mentioned sex therapist. What is a sex therapist and like, how could they help you with ED?

00:20:00.120 Right. So many patients have psychogenic ED, and these are younger patients who have psychogenic ED

00:20:05.500 typically. So maybe it was a bad relationship. Maybe it was something that went on stress.

00:20:10.240 And what they do is they work through the reason why you have sexual dysfunction and see if there's

00:20:15.540 something that they can do psychologically to help you. Sometimes they give you homework,

00:20:19.460 you and the partner. They like to sometimes meet with you and the partner to talk about ways to slowly

00:20:24.240 get back into engaging in sexual activity. Um, but they can be very effective. The only problem is,

00:20:30.740 is that when most men come into my clinic, they say, doc, just give me the pill. I don't have time for

00:20:35.120 sexual, uh, sex therapist, um, which revolutionize our ability to treat men with sex therapy is the

00:20:41.040 internet. And during COVID, many of the sex therapists were offering this benefit through,

00:20:45.940 uh, zoom. And so this has really been great because men say, look, I don't want to drive in

00:20:50.960 and go into a sex therapist's office, but a lot of them say, I don't mind doing a zoom call.

00:20:55.020 And that's been very helpful. I'm curious, is it usually the woman or is it usually the man,

00:21:00.920 if you know, who suggests a sex therapist? Well, so I suggest the sex therapist to both

00:21:09.640 women and men and men and women typically take me up on the offer. Men typically don't,

00:21:15.780 um, which is unfortunate. Now, sometimes when a woman will go to a sex therapist,

00:21:19.840 she'll, the sex therapist will ask if you can bring your partner. And sometimes the partner will go.

00:21:24.240 Um, but the sex therapist is very helpful to just talk through the issues. Um, sometimes,

00:21:30.920 you know, there are many psychological issues that could be affecting or withholding the patient

00:21:35.200 from engaging in sexual activity. And it's very healthy to talk about it. You'll be surprised how

00:21:40.100 many times couples don't communicate or talk about their sexual problems with one another.

00:21:45.780 Oh no, I wouldn't be surprised. I remember seeing some comedian talk about how, um, it was a guy and he

00:21:50.900 was saying, for the love of God, would you women please give us direction in the middle of sex?

00:21:55.920 You know, whether it's up or down, like give us some direction. We won't even pull over to ask for

00:21:59.440 directions because we rely on only maps. Like we're too embarrassed to say we're lost. Nevermind down

00:22:05.020 there. We're definitely not going to say we're lost. So just volunteer direction. So no, I wouldn't

00:22:09.520 be shocked. Um, that sounds just right. What about insurance? Does insurance cover any of this?

00:22:15.460 Viagra, Cialis, sex therapy, any of it?

00:22:17.540 What you'd be surprised. So the, one of the best payers for the penile prosthesis is Medicare,

00:22:22.320 right? So Medicare, the government is a very good pair. So a lot of patients are 63, they're 64.

00:22:27.580 They're just waiting to turn 65 so they can get their penile prosthesis, which is, which is very

00:22:32.180 interesting. Um, but now it doesn't matter about insurance for the, uh, oral pills, because as I

00:22:39.240 mentioned earlier, you can pay cash, uh, Mark Cuban's cost plus it's a, I looked last, it was $9 for 90

00:22:45.660 pills, which was amazing cash, no insurance, uh, good RX and $20 for 90 pills. So that's very

00:22:51.980 affordable for most Americans, uh, to pay this amount for, uh, the medication. So that has been

00:22:57.360 very, very helpful. What's also interesting, the penile injections I mentioned, these are compounded

00:23:01.900 and they come out to about $3 an injection. So again, very affordable. So, you know, the take home

00:23:07.500 messages, there are treatments out there and they're affordable treatments. If someone out there is

00:23:12.060 suffering from erectile dysfunction. Now, what, what are these, I have listed here, other treatment

00:23:17.680 options, stem cells, PRP and shock therapy. What's that about? We have to talk about this because

00:23:25.720 over the past 10 years, there has been a boom in these three areas. As I mentioned earlier, there's

00:23:31.600 no real cure for ED, but over the past 10 years, there's been a quest to cure or reverse erectile

00:23:38.060 dysfunction. And the way that this has been going has been looking at stem cell therapy,

00:23:43.220 shockwave therapy, and PRP. Let's first talk about shockwave therapy because it's the most commonly

00:23:48.080 used. Back in 2010, a European physician by the name of Dr. Vardy started taking a shockwave machine,

00:23:55.040 very similar to what we use for kidney stones, a shockwave machine, and applying those shocks to

00:23:59.940 the penis. Now I'll be honest. When I first saw that, I thought it was ridiculous. This doesn't make

00:24:03.620 any sense, but it's actually brilliant because what you're doing when you give those shocks to the

00:24:07.940 penile tissue is you're tricking the body to think that there's some kind of trauma. When the body

00:24:12.820 thinks that there's some kind of trauma, it starts bringing in growth factors, new blood vessels,

00:24:17.800 stem cells to heal that area. And so there's been a huge boom in the US to use shockwaves to help

00:24:24.560 reverse and cure ED. The problem is, is that there are different types of machines. There are class

00:24:30.920 one machines that actually don't do very much at all, almost nothing. And these are called radial

00:24:36.460 machines. And there are class two machines that are in class three machines that are actually

00:24:41.180 better and more effective. And patients, many providers are buying the class one machines and

00:24:48.060 charging patients 500 to a thousand dollars of treatment when it really doesn't do very much at

00:24:52.260 all. And that's my concern. So if you're going to use a machine, you want to use one that's focal.

00:24:58.020 We like the electrohydraulic, the electromagnetic machines. You just want to use it where it's legitimate.

00:25:02.420 And I just want to qualify that this is still investigational. This is not mainstream. So

00:25:09.020 more studies need to be done to say that we can call this standard of care. So more studies need

00:25:15.220 to be done. So shockwave may be beneficial. I have to mention a very cool phenomenon. So

00:25:20.020 if you think about ED, there's a very large placebo effect. If I give a hundred men a sugar pill,

00:25:27.340 and I tell them, you're going to have the best erections of your life, if I give you the sugar

00:25:31.580 pill, 30% of men come back and say, this was the best erection I ever had. Cause there's a huge

00:25:37.240 placebo effect when it comes to sexual dysfunction. And so if you're giving someone a shockwave that

00:25:41.680 doesn't do anything, you better believe 30% of people are telling their friends, this is the best

00:25:45.360 thing since sliced bread when really it's a large placebo effect.

00:25:49.160 Yes. This, your description of it reminds me of what we women are doing to our faces.

00:25:54.340 You know, you can get the micro needling, which is like you're damaging your face and that's

00:25:59.160 supposed to stimulate collagen and make the face younger. You know, it's kind of similar concept,

00:26:04.760 like to, to stimulate not estrogen. That's not what's coming out, but, uh, something else is

00:26:10.760 going to help the ED.

00:26:12.140 Yes. Stem cells is the other one. I just got to mention that we've been using stem cells for a

00:26:16.440 long time. We, we back, we were the first to use an FDA approved product for stem cells,

00:26:20.620 where you take the fat out of the man's abdomen, you put it into a machine. The machine's called

00:26:25.060 an accelerator. It would give us 37 to 50 million stem cells. We'd inject those stem cells into the

00:26:30.040 penile tissue. Um, and, uh, we would see if it would improve erectile function. So there may be some

00:26:35.100 potential benefit with stem cells, but again, it's still investigational. Um, and then the last one is

00:26:40.300 PRP. Now PRP has the least data and PRP is really a platelet rich plasma.

00:26:46.440 And some people may call it the private shot or the P shot. And the rate for that is anywhere from

00:26:51.820 1500 to $3,000 in injection, but it really has the least amount of data to support it. So I,

00:26:58.200 I just caution a lot of patients. They come in and they say, um, you know, I, I spent 3000 for the

00:27:03.020 P shot. I spent 6,000 for this shockwave and nothing's really happened. And so you just got to

00:27:07.680 be careful to counsel that there may be some potential benefit, but you don't want to say that,

00:27:12.360 you know, this is main treatment as of today. That middle one, it's like, well,

00:27:17.120 so you didn't solve your ED, but your waist is slimmer. You know, your, your belly's flatter.

00:27:21.720 Yeah. Tiny, tiny little lipo going there. All right. Well, all of that is so interesting. Now

00:27:27.460 in terms of prevention, you told Peter Atiyah, patients who are not using the penile muscle

00:27:34.760 will start getting atrophy. That's terrifying. So it's a use it or lose it situation. What about,

00:27:41.660 what does that mean for guys who aren't partnered up or don't have anybody interested in them for

00:27:45.960 whatever reason, it's just constant masturbation. How often, like, what, what does this mean?

00:27:50.420 You nailed it. So that's exactly right. So think of the two penile muscles are just two muscles

00:27:54.320 running in parallel, just muscles, just like your arm as a muscle. So if you lift weights every day with

00:28:00.420 your arm, what happens? It hypertrophies and gets bigger. If I put your arm in a cast for six months

00:28:06.020 and I take the cast off, it atrophies, right? So atrophy means that you weren't using it in the

00:28:10.860 muscle contracts. One of the best examples I can give you is we see men after a radical prostatectomy,

00:28:17.200 that's prostate cancer surgery. Second most common cause of cancer in the world in men. This year

00:28:22.720 will be 300,000, almost 300,000 men diagnosed. When you have that surgery, many times men will have

00:28:27.680 erectile dysfunction immediately right after. And what you'll see is you'll see some atrophy of the

00:28:32.220 penile tissue. And so the goal is to try to continue to keep that muscle going. You can use

00:28:37.100 a vacuum erection device. I really like them using the daily Cialis that makes a big impact in my

00:28:42.560 opinion. And you're right, more sexual activity keeps the tissue healthy. As men stop having sexual

00:28:49.340 activity, and then it becomes more and more difficult to get the erection. As it becomes more difficult to

00:28:54.940 get the erection, they have less sexual activity, and it just spirals, right? So it's very important

00:28:59.260 to use it or lose it, just like you mentioned. Well, of course, that has everybody asking how

00:29:05.140 often, right? Because most men want it more than the women are willing to do it, just as a general

00:29:11.840 biological evolutionary principle. But like, what does that mean? You know, is there a number you can

00:29:17.000 put on that? How often must they use it? Yeah, so there's not a number to show, but I can just tell

00:29:22.320 you statistically what people are doing. So if you look at couples or young people between 25 and 30

00:29:27.380 years of age, couples, they're engaging in sexual activity two times per week, on average. When you

00:29:33.400 get to roughly 50 years of age, it's about one time per week. And when you get to roughly 70 to 75

00:29:39.100 of age, it's about one time per month. You can see the trajectory. What's interesting, though, on that

00:29:44.480 slide is that as you get to 80 years of age, you start seeing an uptick. So if you live till 80 and

00:29:50.160 you're healthy, you start engaging in more and more sexual activity on that graph. But the reality

00:29:54.780 is that twice a week, I would say, would keep the tissue healthy. The problem is that women go

00:30:02.620 through menopause at roughly 52 years of age. When a woman goes through menopause at roughly 52 years

00:30:07.860 of age, there's a precipitous drop in her testosterone, which is one of the number one drivers for sexual

00:30:13.020 desire. And there's a significant drop in estrogen in the vagina as well. So now she has a low desire for

00:30:18.740 sex. And she has pain when she engages in sexual activity. So she doesn't want to engage in sexual

00:30:23.540 activity. And thus, I believe men will start developing more atrophy of the penile tissue

00:30:28.040 when their partners go through menopause.

00:30:31.440 My mom's 82. And I was giving her a hard time about this subject. We were just joking around the

00:30:36.060 other day. And she said, Megan, when you're 82, you can fulfill all of your sexual fantasies.

00:30:40.820 And then you realize you don't have any.

00:30:42.640 I mean, but you're right on both ends. It's a use or lose a situation because like the less,

00:30:49.880 the less you do it, the less important it is to you. And the more you do it, the more you sort of

00:30:53.560 keep everything alive and you want it more. I think that's true for men and for women.

00:30:57.400 There's so much more to discuss. I want to get to libido. We have to talk about testosterone.

00:31:01.680 You mentioned testicular cancer, infertility. And there's so many topics. The more I got into this,

00:31:07.600 the more I was like, this is all fascinating. And lots I want to talk to you about, including

00:31:11.040 we'll spend some time on boys who are coming of age, because that's tricky too in today's day and

00:31:16.600 age. Stand by more with Dr. Mohit Kara right after this. All right. So I would love to talk to you

00:31:24.540 about testosterone and libido. I thought testosterone controlled libido. And in preparing for today,

00:31:33.580 I realized that's not true. So men who I think are suffering a loss of libido, I think a lot of them

00:31:40.600 probably go to a doctor like you and say, I need testosterone. But what's really going on there?

00:31:45.220 Can you talk about both of those things? Absolutely. So listen, testosterone is just

00:31:50.200 a piece of the pie. When a man has low libido, there could be multiple factors. It could be his

00:31:54.880 relationship with his partner. It was immense. It could be stress. It could be fatigue. It could be

00:31:59.600 hormones. And not only is it testosterone, but there are four hormones we worry about. It's,

00:32:04.380 we tell the mnemonic PET, prolactin, estrogen, thyroid, and testosterone. So there are many

00:32:11.180 factors. It could be neurotransmitters. So example, dopamine, serotonin could be effect as well.

00:32:16.180 So I tell patients when you come in and you have low libido, they say, just give me the testosterone.

00:32:19.860 It's going to fix everything. I say, it's not going to fix everything, but it will help. It will make a

00:32:23.940 big difference in your libido. What are the signs and symptoms of low testosterone? Low libido,

00:32:29.120 erectile dysfunction, decreased muscle mass, increased fat deposition, poor sleep, some depression.

00:32:36.920 And many times when you replace the testosterone, many of these patients can see a significant

00:32:41.040 improvement in these signs and symptoms. Is it true that antidepressants can lead to

00:32:47.960 some libido problems? And so, you know, people, maybe you don't need an antidepressant. Maybe you

00:32:54.040 need some testosterone. I don't like, how does that interact? Right. So now you nailed it.

00:32:58.960 So antidepressants are notorious for shutting down a man's libido. They also shut down the

00:33:05.340 ejaculatory time. So if a man ejaculates in seven minutes and he takes an antidepressant,

00:33:10.240 it could take 20 minutes or longer. In fact, one of the treatments for premature ejaculation

00:33:15.320 is to give them an antidepressant. So many times if they come in and they have low libido,

00:33:19.940 you want to look at the medication list and you say, oh, you're on an antidepressant or you're

00:33:23.860 on an antiandrogen. There are many meds that can cause low libido. What's interesting is that there is

00:33:28.560 one antidepressant that doesn't cause low libido. It may improve libido, which is Wellbutrin. So

00:33:33.920 many times I'll try to get them off the antidepressant like Prozac or Lexapro and put

00:33:37.940 them on a Wellbutrin type of medication to help improve the libido. But it's multifactorial.

00:33:42.620 Again, a lot of the times it's a relationship issue as well. And so I say this testosterone is

00:33:47.360 not going to fix your relationship with your wife. It may improve your libido slightly, but there are

00:33:51.860 other factors you have to focus on. And the women have to participate. You know,

00:33:56.920 the more you telegraph to him, you want him, the more it will help. I mean, if you're walking around

00:34:02.280 all day saying like, I'm not into it, get off of me. No, it's a no. Again, the less he's going to want

00:34:08.020 you. I think that one of the things that turns the guy on the most is him thinking you want him and you

00:34:12.940 want it. Right. Megan, you nailed it. So listen, I got to tell you a story. So when I started my

00:34:18.220 practice back in 2008, I was able to get these men, these amazing erections, great libido,

00:34:25.020 everything was fantastic. And then they would go home and they'd have no enough sex with because

00:34:29.120 the wives would say, we haven't had sex in 10 years and now we won't have sex. And they were

00:34:32.980 furious. Many women called, they were very upset, said everything was great before he met you.

00:34:37.000 And now we're fighting all the time. And so essentially what you want to do is if you're

00:34:41.320 going to raise one partner's libido, you should raise the other partner's libido or just leave them both

00:34:46.980 low, but you don't want a discrepancy between one libido and the other. And that's why in 2008,

00:34:52.220 I started treating women for female sexual dysfunction. And just by treating one partner,

00:34:57.520 you actually can improve the libido of the other. In other words, if I skyrocket a woman's libido,

00:35:03.060 the libido and sexual function in a man also improves. So the take home point, this is a couple's

00:35:09.020 disease. You just can't focus on one person. This is a couple's disease. By treating both,

00:35:13.840 you're actually treating the whole entire couple. That's so good. That's so good to know. Now,

00:35:18.680 what about testosterone? Because you hear it mentioned all the time now, this guy's on it,

00:35:23.780 he's on it, he needs to go on it. Who does need testosterone?

00:35:27.720 It's important to realize that there is some abuse with testosterone. And there are many,

00:35:31.780 several years ago, there was a study showing that 27% of men who started testosterone never even had a

00:35:36.500 blood test prior to starting testosterone. Many men will get it from the gym. It needs to be monitored.

00:35:41.940 There can be some significant side effects that can affect your health. One meaning that your red

00:35:46.740 blood cell count can get very high, which can affect your health. And it can cause infertility.

00:35:52.260 So many young patients do not know that taking testosterone makes you infertile. Then they come

00:35:57.160 to our clinic and they say, no one told me that it can make me infertile. So the reality is that

00:36:02.140 younger men, we try to stay away from using testosterone. We try to use meds that make them make the

00:36:08.360 testosterone. That's safe, right? Helps keep the fertility, makes it safe. But the perfect candidate

00:36:14.020 for someone who needs testosterone is someone who has a low testosterone value. And most of the

00:36:19.380 country uses the number 300 nanogram per deciliter, and they have signs and symptoms. So you have to

00:36:25.280 have both low testosterone value and signs and symptoms. And then we go through the seven different

00:36:30.600 treatment options we can offer you to see if we can improve your symptoms.

00:36:34.200 And so what a guy who goes on testosterone, let's say two months later, what, what, what do you hear?

00:36:40.900 Like, what's how, how has his life been improved?

00:36:44.100 So not everyone sees a significant improvement, but the majority of men in our practice do see a

00:36:49.480 significant improvement. And that means my sex drive has gone up. My energy has gone up my muscle

00:36:55.160 mass. Remember bodybuilders take testosterone because they get very cut in the gym. It's the same

00:36:59.360 testosterone, right? The difference is bodybuilders are starting at a normal level and they're trying to go

00:37:03.760 super high. We're going from someone who's low and just getting them into the normal range. But they

00:37:08.480 say my muscle mass, I've lost weight, my energy, my libido, my rectal function has improved. Some

00:37:14.480 patients report improvements in depression and sleep. We don't talk about depression, but in 2011, I

00:37:20.180 published a big paper, almost 850 patients and looking at men who have low testosterone. And we'll be

00:37:26.880 shocked to find that majority of these men actually suffer from some degree of depression. And in our study,

00:37:32.300 when we gave men testosterone back, many of these men saw significant improvement in their depressive

00:37:36.740 symptoms, even if they were on an antidepressant, suggesting maybe a synergistic effect between

00:37:42.080 testosterone and an antidepressant. Now, I don't want the listeners to think that you should use

00:37:46.200 testosterone to treat depression, but I definitely think that if you suffer from depression, you should

00:37:51.280 check your testosterone level because adding it may help.

00:37:55.220 How do you take testosterone?

00:37:56.380 Yeah, so there's many ways to do it. The new exciting ways to do it are the oral testosterone

00:38:03.320 levels or testosterone pills, excuse me. So oral testosterone came out in 1970, called

00:38:10.600 andrial, it's called undecanoate. And it was available throughout the world, but it never made

00:38:15.680 it to the United States. In 2019, the US, we got our first oral testosterone undecanoate pill

00:38:22.280 called Jatenzo. And then last year, we got two more, Talando and Kaisotrex. So now we have three

00:38:28.860 oral testosterone on the market, and they're very good, but you have to take it twice a day. And

00:38:34.120 Americans don't mind taking pills. So these medications are very effective in raising the

00:38:38.720 testosterone level, and they have a very good side effect profile. So they don't have too many

00:38:43.080 side effects compared to the other ones. But most Americans will use an injection or a gel or a cream.

00:38:48.400 And I like the injections because they're very easy to get. And most of my patients will inject

00:38:54.300 into the fat twice a week. I ask them to inject Sunday and Thursday, because if you inject Sunday,

00:38:59.260 these peak in 24 hours. So if you inject Sunday, you're ready for Monday. If you inject Thursday,

00:39:04.200 you're ready for the weekend. And they're very, very effective. Other forms as a gel, you rub a gel

00:39:09.940 on your shoulder every day. There's a nasal formulation. There are patches that you can use.

00:39:15.100 There's pellets. So the patient comes in once every three to four months, and I insert a tiny pellet in

00:39:20.600 the fat, and that dissolves over three to four months, which is also very effective. So as you

00:39:25.120 can see, there are numerous different types of formulations. It's just really what the patient

00:39:28.680 prefers. What are the risks? Is it like a heart attack? There's got to be some downside.

00:39:36.220 I'm glad you brought that up because in 2015, there was some concern that testosterone causes a heart

00:39:43.120 attack. And at that year, the FDA had requested that there be a large trial conducted to assess if

00:39:51.360 testosterone causes a heart attack. This trial was called the TRAVERSE trial started in 2018. And it

00:39:58.760 ended this year in January. And two months ago, the article was published. And I was one of the authors

00:40:06.440 of this article. It was 5,200 patients, randomized placebo-controlled trial, five years. And what it

00:40:14.340 showed was there was no increase in heart attack. So finally, we got the study that shows no increase

00:40:19.600 in heart attack. But there can be some side effects. In other words, if you want to monitor the red blood

00:40:23.960 cell count, it can get elevated. You can get hypertension. Some people can increase in blood

00:40:28.120 pressure. So you want to be careful. We talked about infertility as well. Some patients at very high

00:40:34.240 levels can get what we call roid rage, some changes in behavior. So you just want to be careful as

00:40:38.620 well. So we wanted to monitor. Good news, 2018, the AUA, the American Urologic Association, showed

00:40:45.520 no increase in prostate cancer. So that's important to know that as well.

00:40:49.360 Yeah. Yeah. Thank God. So should every, like when, when should a man get his testosterone tested? Like

00:40:55.120 a lot of guys feel tired and as they age, maybe libido falls a little. What, you know,

00:41:00.000 how do you know, I want to have this tested and see where my levels are?

00:41:03.740 So most guidelines would say you should get your levels tested. If you have symptoms,

00:41:07.940 right? Low libido, low energy, erectile dysfunction, that would be a good time to get

00:41:11.280 your levels checked. I believe that every man in their 40s should get at least one testosterone

00:41:15.720 level because later on in life, you could compare the drop to see where you started,

00:41:19.780 be very helpful. And to me, the best blood test for a man's overall health is his testosterone.

00:41:25.740 It's a marker of fertility. It's low testosterone has been implicated in cardiovascular risk,

00:41:30.360 low testosterone, prostate health. So metabolic syndrome. So I think testosterone to me is the

00:41:36.780 best marker of overall health. And I think men in their 40s should at least have one testosterone

00:41:41.240 value checked. Now, I am not asking you to diagnose RFK Jr., but he put out a videotape of himself.

00:41:49.460 He's 69 doing like pushups and all these athletics without his shirt on. And he looks amazing.

00:41:54.660 He looks great. He doesn't look 69 at all. And he looks ripped. And then the Internet was set on

00:42:01.140 fire with people saying he's on testosterone, which in his case they thought would be controversial

00:42:05.460 because he's not a big pharma fan. But is it possible for a 69 year old man, not him, but one in

00:42:12.960 general to look ripped, to be totally fit, to be agile, to be spry without testosterone, without

00:42:21.200 taking it? Absolutely. So I used to think that there was this concept called male menopause,

00:42:27.520 just like women go through menopause. I would tell my patients there's something called male

00:42:30.920 menopause. As you get older, your testosterone will get lower and lower, and then you will need

00:42:35.000 to start testosterone. But male menopause is not true. Actually, you can see many patients in their

00:42:40.000 70s, even 80s that can have normal testosterone as long as they are healthy. The reason why the

00:42:46.000 testosterone falls is because we acquire comorbid conditions as we get older. Diabetes, obesity is

00:42:53.260 one of the worst. Metabolic syndrome. As you acquire those conditions, your testosterone will

00:42:57.500 fall. But if you maintain overall good health, you should not see a precipitous drop in your overall

00:43:03.000 testosterone levels. A slight decline, that's true, but it's not a precipitous drop. So if you take care

00:43:07.940 of yourself, eat healthy, exercise, sleep, maintain your stress, it's not unheard of to have someone at

00:43:13.860 that age be in good shape and be ripped. See, this is why, like, with all these weight loss drugs that

00:43:20.900 everybody loves to rip on, this is why I think that they could be key. I mean, if you're obese

00:43:27.520 and you cannot lose the weight, look at all the health benefits that could come to you if you

00:43:33.100 potentially, you know, use, let's say you don't have a gastric bypass or one of the other procedures,

00:43:38.280 you use one of these drugs, your sexual function could go up, your testosterone could go up,

00:43:43.220 you would feel better, your brain health will go up, you'll sleep better, your heart attack risk

00:43:47.460 will go down. There's so many good things.

00:43:50.260 Megan, you nailed it because I've been treating men for many years. I treat many women many years

00:43:54.460 and we'll use hormones to help them feel better. And over the past two years, we found that there's

00:43:59.220 something else that actually makes them feel fantastic. And it's weight loss. If a man or a

00:44:03.820 woman loses 20 or 30 pounds, the libido goes up, the sexual function goes up, they sleep better.

00:44:08.180 Weight loss has a profound effect on a patient's overall health and sexual health as well. And so

00:44:14.600 many of these medications like semaglutide, we do use in our practice because it does affect their

00:44:20.320 overall sexual health. Lower testosterone levels are associated with obesity. The best study I found

00:44:26.880 was that if you lose 10% of your body weight, you'll increase your testosterone by 100 in men. If you lose 15%

00:44:33.360 of your body weight, you almost increase your testosterone by 300. So that's a big, big bump.

00:44:38.780 And so weight loss really makes a big impact, as you mentioned, not only on testosterone,

00:44:43.160 but sexual health.

00:44:45.360 It's funny because I had comedian Andrew Schultz on the show a year ago or so, and he's hilarious.

00:44:52.720 And he's made the point to me a couple of times that women get very self-conscious when they're having

00:44:57.880 sex with their partners or taking off their clothes, especially in the early part of a relationship.

00:45:01.620 Oh God, I've got this insecurity. I've got that insecurity. Something weird happened in the act.

00:45:06.180 You know, and he was basically like, we don't care at all. If we don't care, all we want is access.

00:45:13.860 But the truth is for a man or a woman, yes, if we feel we look good, we're going to want sex more.

00:45:20.980 So it's like not necessarily about attracting your partner. It's about in your own head.

00:45:24.500 Absolutely. Body self-image has a profound effect on person's libido, right? If I take care of a lot

00:45:31.860 of women, we put them on medications to help them lose weight. If she loses 30 or 40 pounds,

00:45:37.200 she feels very sexy. She feels very good. Her libido goes up significantly just with the weight

00:45:42.740 loss alone. Putting her also on testosterone therapy in addition has significantly increased

00:45:47.420 her libido. So it's not just about giving her testosterone. It's really the whole thing,

00:45:52.240 sex therapy, lifestyle modification, but weight loss has a profound effect.

00:45:57.760 And like I said, we are going to get, we'll do a deep dive on women's health next week too,

00:46:02.280 but testosterone is potentially available to women. I know a couple of women who are on it

00:46:06.780 and they love it. But there are also ways of like increasing your drive as you get older

00:46:13.240 without taking testosterone. We'll talk about that for women as well. So there's all sorts of options

00:46:17.440 available. Yeah. What were you going to say? We got a minute before.

00:46:18.940 Just make sure, you know, it's off label. So you can't walk into Walgreens today and say,

00:46:23.220 give me testosterone for women. It doesn't exist. It exists for men. So you have to get it compounded

00:46:28.720 or get a cream, but there are two new medications. We can talk about them that are really good for

00:46:33.220 libido in women that just came out over the past eight years. Uh, and that's, you can get them a

00:46:38.060 prescription for these medications.

00:46:39.740 We should talk about that. I, my one friend said she was getting her testosterone from Australia

00:46:44.780 because they actually had a version that was for women, which led me to say like, how effed up are

00:46:50.460 we here in America that like half the population is not being serviced with this? Why are the Aussies

00:46:55.500 thinking about the ladies and the Americans aren't like, we got to step up our game. Uh, all right, doc,

00:47:00.240 standby. I want to get into a lot of other things, including most men obsessed about size.

00:47:05.640 They're obsessed about size. They think women are obsessed with size. I don't know if that's true.

00:47:10.240 Um, and also deformities. A lot of guys have them and it's very embarrassing and it could be painful,

00:47:16.000 uh, much, much more to go through, including cancer and porn. Don't go away. Uh, and don't

00:47:21.420 forget folks, you can find the Megan Kelly show live on Sirius XM triumph channel one 11 every weekday

00:47:25.740 at noon East, the full video show and clips at youtube.com slash Megan Kelly. If you prefer an audio

00:47:31.460 podcast, follow us wherever you get your podcast for free and you on Apple and elsewhere can find

00:47:36.860 our full archives of more than 600 shows now. Okay. So I had one follow-up question on testosterone,

00:47:45.540 Dr. Carol, one of our viewers and listeners on Twitter wrote in with this on the subject of low

00:47:50.300 T low testosterone. Is there an epidemic of it? You know, are we falling? You hear a lot of, um,

00:47:56.440 you know, experts suggest all the plastics, you know, the water contaminant contamination we read

00:48:02.920 about are causing like an epidemic of low T that may be manifesting in a number of different ways

00:48:08.140 in our society. Is that true? No, it is true. And there is a study looking at testosterone levels

00:48:13.160 decade by decade, showing that our testosterone levels are dropping. Now, what that may correlate with

00:48:19.140 is where if you look at obesity decade by decade, it's now an epidemic in the United States,

00:48:24.620 diabetes and epidemic. So maybe those comorbid conditions are contributing to the low T.

00:48:30.200 What's also interesting, remember a man needs testosterone for sperm production. So our sperm

00:48:35.500 counts are also going down. Men's sperm counts are going down as well. And it all may be related.

00:48:42.040 Hmm. Does it have anything to do? I mean, I know this is a thin ice, but does, do you think it has

00:48:47.440 anything to do with the trans craze and like so many more people saying that they're trans?

00:48:51.920 Is there any study underway to see whether these things are related? Low T in a man who might be

00:48:57.940 then confused? No, I don't. I have not seen any studies like that whatsoever. I really think if

00:49:03.920 you look decade by decade, you know, um, the T levels go down, but if you look at a graph and

00:49:08.780 superimpose it, obesity, every decade is going up. Diabetes is going up. It's really an epidemic in the

00:49:15.060 United States. And it's no, no surprise that you'll start seeing those lower and lower testosterone

00:49:20.680 levels correlate with those rises in those comorbid conditions. Um, and it's unfortunate,

00:49:25.260 but I do think that as men tend to lose weight, tend to take care of themselves,

00:49:28.060 we should start seeing a return, uh, in the other direction, but, um, we have work to do.

00:49:33.000 Is it, if a man has low sperm count, I, this is a weird question, but is it a fertility issue

00:49:40.540 given how many sperm they produce, you know, it just on a one-time basis, like, does it matter?

00:49:47.700 They've got so many. Let's talk about it. Very important. So 15% of all couples in the United

00:49:52.640 States will have some infertility issues. And we know that 50% of the time it's a female factor,

00:49:58.120 30% of the time it's a male factor, and 20% of the time it's combined male and female.

00:50:04.220 So indirectly 50% of the time the male is involved in infertility. And, uh, you're right. The average

00:50:10.840 used to be roughly 80 million per ml. The numbers are coming down 80 million sperm per ml, but you have

00:50:16.160 to multiply that by how many ml's you have. The average man has 1.5 to 5 milliliters of seminal

00:50:22.220 fluid. So that's important. And you have to multiply that by how many are moving. Let's say a man has

00:50:27.260 a hundred million sperm, but none are moving. Well, that doesn't help me very much. Right. So

00:50:31.720 they have to be moving and it's an odds game. So the odds game means the more you have moving,

00:50:36.960 the greater the chances for fertility. And so, yes, um, you know, as you, it sounds like a lot,

00:50:42.000 but again, the more you have the greater the chances for fertility. Okay. A hundred ml,

00:50:47.860 you mean on, on for each ejaculate or how many a hundred million sperm for what?

00:50:53.400 Yeah. So, so each ejaculate will typically have, um, 1.5 to 5 milliliters of fluid, 1.5 to 5 milliliters

00:51:02.840 of fluid. And each milliliter, a normal cutoff should be roughly about 60 to 80 million per

00:51:10.260 milliliter. So that's a lot of sperm now. Yeah, it's a lot, but you only need the new guidelines

00:51:16.180 came out. The cutoff for when you may fall in trouble is 15. So as a man falls below 15 million

00:51:22.920 per milliliter, that's when we start seeing more difficulty in natural conception. And so there

00:51:28.520 are new technologies available now to help men. Um, remember male infertility is not hard either.

00:51:33.320 He's blocked or he's not making it. There's only two options. He's either blocked or not making it.

00:51:38.200 And we just have to figure out what side he's on and then we can treat that side to make it better.

00:51:44.360 And while we're on the subject of making babies, uh, I heard another urologist giving a talk at Google

00:51:49.480 saying that withdrawal actually works pretty well. I was like, that's exactly the opposite of what

00:51:56.040 they told us when we were young Catholics and especially girls growing up. It was like,

00:51:59.640 if that thing comes anywhere near you, you're pregnant.

00:52:01.880 I would be very careful on that technique for your fertility, uh, uh, to try to avoid pregnancy,

00:52:09.080 uh, with the, the most common form of birth control in the world is a vasectomy. It's, uh,

00:52:14.920 takes, uh, less than 10 minutes. Uh, it's extremely effective. Um, they talk about the failure rate

00:52:20.680 as one in 2000. And so, I mean, I've never seen it, but that that's the failure rate.

00:52:25.560 Um, but it is a very, very good form of birth control and it does, but the men don't get that

00:52:30.760 because they're afraid they don't want the procedure, right? They're worried it's going to

00:52:33.960 hurt or lead to ED, right? Yeah. So what they think about is men worry that they may lose their

00:52:39.800 ejaculatory volume. Remember that 90% of the seminal fluid comes from the prostate or the,

00:52:47.640 or the seminal vesicles, which means that if you do a vasectomy, a man loses only 10%

00:52:53.400 of his seminal volume. In fact, if I remove a man's testicles, he will still have 90% of his

00:52:59.400 seminal fluid. So that's this misconception that I'm going to lose a lot of fluid. Um,

00:53:03.880 and, uh, it's going to feel different, but the reality is that's not true.

00:53:07.320 So you basically don't notice very mild. You really don't notice. Okay. Okay. All right.

00:53:14.040 So let's talk about something called Peyronie's disease, which I understand is sort of a,

00:53:20.120 I don't know if we should say disfigured, but it's a, it, it makes the penis look different.

00:53:24.200 And, um, I guess a fair amount of men suffer from this. What is this?

00:53:27.880 This is so important because so many men suffer from this up to 9% of men suffer from

00:53:33.640 Peyronie's disease, but not many people have heard of it. And what I want you to think about

00:53:37.400 when Peyronie's disease, it's an abnormal curvature of the penis when it's erect. When the penis curves

00:53:43.720 greater than 60 degrees, it's prohibitive for intercourse. And the most common cause for

00:53:49.560 Peyronie's disease is injury to the penis, a buckling trauma during intercourse. And so these men are

00:53:55.480 very, very depressed. It's a disfigurement. Um, and now there are treatment options. The first FDA

00:54:01.160 approved treatment came out in 2015 called Zyflex, which is an injection, which I placed into the

00:54:07.080 plaque and break the plaque up. I think the best way I can explain to patients is this. I have a

00:54:12.040 balloon. I put a piece of duct tape on the balloon and I blow the balloon up. What is going to happen?

00:54:17.960 Everything's going to expand except that tape. And it's going to curve in the direction of the tape.

00:54:21.720 That's the exact same thing. So those injections are trying to break the tape off and let the penis

00:54:27.400 become straight again. Or I can do a surgery called the plication where I put stitches on the opposite

00:54:32.920 side and straighten the penis. But again, this is something that many men suffer from, and they

00:54:38.360 don't discuss it because they don't think there are any treatment options. So you get this by like

00:54:43.880 having rough sex where you, where you get injured. It's not really a disease. It's, it's trauma. And so

00:54:49.880 remember in a theoretical sense, sex is trauma to the penis, right? And what happens is if you start

00:54:56.680 getting a small amount of erectile dysfunction, that's when you're in trouble. If a man has 100%

00:55:01.880 rigid penis, he's not going to injure it. If he has a 70, 80% rigid penis, he will be able to penetrate,

00:55:08.440 but he's going to undergo a buckling trauma that's going to injure that penis. And then he starts

00:55:12.600 getting a scar in that area. And then it starts curving over time. Now, besides the injections,

00:55:18.040 there are other treatment options. There is a stretching device called the one we use is called

00:55:22.520 Restorex. And he wears a stretching device for 30 minutes, twice a day, at least. And that can help

00:55:28.360 also improve curvature as well. But, but there is an FDA approved treatment. And when many times

00:55:34.120 patients come into my office, they say, I never even knew that there was a treatment for this

00:55:38.280 condition I've been suffering from. Right, right. And I'm sure it's embarrassing and it's painful as you

00:55:42.360 point out. Um, so yeah, so you can, you can get treatment on Peyronie's and this is the thing

00:55:48.200 that's, you're not alone. If you have it, you don't have to live like that. What about guys? Cause I,

00:55:52.280 you know, the unspoken thing is guys worry about penis size. I really think having spent, you know,

00:55:57.800 52 years with women, this is not the issue that the movies and television would have men believe

00:56:04.040 that it is. I think it's more about technique, um, and loving your partner and all that stuff. But

00:56:09.320 there are guys who are obsessed with it. And now you hear more and more about the micro penis.

00:56:13.720 Why are, why are we having so many micro penises in today's day and age? And what,

00:56:17.720 what about size? What can men do if they really do want to work on this?

00:56:21.560 Right. So there is an obsession. There are many men who are obsessed with penile size. So just a

00:56:26.040 good way to think about it. There was a study that came out in 2014. The average erect penis was 14

00:56:31.160 centimeters or 5.5 inches. Now there's variation depending on race and age, but that's just one way to think

00:56:37.480 about it in the flaccid state. If you look at a flaccid man without an erection, the average

00:56:42.520 growth in that study was roughly four centimeters. Now, 26, 26% of men grew more than four centimeters,

00:56:48.680 but these are just some rough numbers to remember. But there is an obsession and there are many ways

00:56:52.920 to increase penile length. I'm not a big proponent on doing surgeries to increase penile length.

00:56:58.280 I think one of the safest ways to increase penile length, if a man is bothered by this,

00:57:02.440 is to use a stretching device. These devices, any part of our body, if we apply traction,

00:57:07.880 will change. Braces will change. You put anything on your ear, any kind of traction will change the

00:57:13.400 body, but it's called the plasticity of the body. So a stretching device can be very effective and,

00:57:19.080 but you just got to do the work. But I am not a big proponent on surgical procedures for penile

00:57:24.520 elongation. Is a stretching device just like stretching the skin? So now you just have sort of a long,

00:57:29.720 flabby penis as opposed to, you know, if it's not going to get erect and do the thing that you want

00:57:34.360 it to do, who cares? It's actually stretching the entire penis. The penis has two bodies called

00:57:38.680 cavernosal bodies. Think of them like cylinders. It's actually stretching the cylinders to make the

00:57:43.880 penis longer. And what's really interesting about those studies was that it actually increases the

00:57:48.360 girth as well. So remember, these are off label. So I just want to be very clear. These are not

00:57:52.760 indicated for penile elongation on label by the FDA, but off label use, not only does it increase penile length,

00:57:59.000 but it can increase penile girth. And for the Peyronie's patients, it can make the penis straighter.

00:58:04.280 So an easy way to do it as long as you're willing to put in the time.

00:58:09.080 What are we talking about here? Like, you know, if you watch television late into the evening,

00:58:13.480 or at least used to be, you know, these ads would come on trying to get men to call in and get some

00:58:17.960 sort of penile supplementation device, whatever. That all seemed like bullshit to me. But is you're

00:58:23.720 saying there actually is something I imagine they should get it from their doctor. And is it a

00:58:28.360 painful situation? Like, what is a machine? What is it?

00:58:31.000 Very interesting. So you're right. These originally came from the porn sites. And then in 2010,

00:58:36.920 we started using these devices medically, but they have been significant advancements in these types

00:58:42.600 of machines. It's basically a device. It's a traction device that's spring loaded. A man can control the

00:58:48.120 amount of spring and tension he can use. The Restorec is very nice because you can actually

00:58:53.080 bend the penis in the opposite direction where you're curving. So if a man's penis is curving up,

00:58:57.640 he can wear the device and it will bend it down for 30 minutes twice a day. And that's been shown to

00:59:03.240 significantly improve the curvature and the length and the girth. But you are right, Megan. These

00:59:09.320 actually came from penile elongation porn sites and those late night videos. We just have adapted them

00:59:14.760 since 2010 and now use them more medically. Again, it's off label. So I do think it's important

00:59:20.120 that patients know that. And I definitely think you should speak to your provider or your physician

00:59:24.360 as opposed to just going to get them for some counseling. That is unbelievable. Oh, who knew?

00:59:29.720 Okay. Good to know it's out there for the guys who have to labor under this problem or this,

00:59:34.360 you know, if you feel embarrassed about it. Let's talk about ejaculatory issues because there's

00:59:39.800 there's premature ejaculation and then there's like delayed ejaculation or no, no ejaculation.

00:59:46.920 Some men have a problem of not being able to do it at all, which seems like a really tough problem.

00:59:52.440 But can you talk about those are three problems that a lot of guys deal with?

00:59:57.080 Big problems. Think about it. 30% of men in the US, one out of three suffers from premature ejaculation.

01:00:04.040 That is a astounding number. And there's two types of premature ejaculation. There's the type

01:00:08.680 where someone has it their entire life. That's important. Or someone who has it acquired. In

01:00:14.360 other words, everything was going great till I was 40. And all of a sudden I started getting

01:00:17.640 premature ejaculation and we treat them a little bit differently. But both of them have to have

01:00:22.040 three components. One is that you have to have a loss of control, meaning you tried not to ejaculate,

01:00:27.240 but it just happened. That's loss of control. Number two is that you have to have a decreased

01:00:31.640 ejaculatory time. And we now use two minutes if it's lifelong. If it's acquired, it's about a 50%

01:00:37.400 reduction of what you're used to having. And then you have to be bothered by it. And that's really

01:00:41.560 important because if a man comes to me and says, look, I ejaculate in 30 seconds and I'm fine with

01:00:45.480 it, then it's not an issue. So those are very important. And what you want to do is start some

01:00:51.240 medications. And the medications, as we talked about earlier, were those antidepressants.

01:00:55.240 Antidepressants significantly delay the ejaculatory time. So I think that is very,

01:01:00.360 very important. Sex therapy, really, really helpful. I think that could be very helpful.

01:01:05.240 And then also we sometimes use off-label medications like Tramadol or Flomax or some

01:01:11.160 alpha blockers. These are all in the guidelines. So again, this is treatable. One of the best

01:01:16.440 treatments also, which you can get online is a lidocaine spray. It's called Promescent and they

01:01:22.120 ship it to you and it numbs the penis so that your excitement's not that high. And then you can

01:01:27.240 go longer as well. So the lidocaine spray is simple, easy. Will you still have a climax if you do that?

01:01:33.160 You won't if you put on too much spray, right? So you've got to kind of up to eight sprays. The

01:01:37.800 more sprays you put on, the more numb the penis becomes.

01:01:40.280 So does that numb your partner too?

01:01:43.640 You wipe it off before you engage in sexual activity,

01:01:46.520 but it penetrates the skin and gets in there. So it numbs the penis. And so when it numbs the penis,

01:01:52.200 you can go longer because there's not that heightened sense of excitement.

01:01:55.480 Okay. Now here too, I read that. What was that? Hold on. I wrote it down.

01:02:03.160 Okay. If you have premature ejaculatory problems, that when you're masturbating,

01:02:09.400 you have to quote masturbate for longevity. You shouldn't rush through it. Like basically,

01:02:15.160 you need to practice extending the minutes. Is that true?

01:02:19.800 So there is a technique, a start stop technique and squeeze technique, but these are done by a sex

01:02:25.800 therapist to teach you how to delay the time. I've never, we never counsel truly with masturbation

01:02:31.880 itself because the problem is really when you're having sex with your partner typically. And two of

01:02:36.680 the best techniques out there are called the start stop technique. So when you're about to get

01:02:40.440 increased pleasure, you stop, or you can squeeze the glands, which takes away the ability or desire

01:02:46.360 to ejaculate. So these techniques are a cure. So I tell patients, if you're looking for a cure,

01:02:51.240 go see the sex therapist. If you're looking for a bandaid, take the meds. But I really,

01:02:55.320 really think that a sex therapist, this is a high value for a visit with a sex therapist.

01:03:00.840 Very important.

01:03:03.160 I'm going to get to the other problems as well, but we have a couple of callers,

01:03:05.800 so I'm going to fold them in throughout the next half an hour while we have you.

01:03:08.760 Scott in Pennsylvania has a question about something we were just discussing. Scott. Hi,

01:03:13.400 thanks for calling in. What's your question for the good doctor?

01:03:16.200 I cannot believe I'm calling a national radio show about this. But hey, what the heck,

01:03:20.680 can we live one?

01:03:21.480 Why not?

01:03:23.160 So I had P. Droni's disease. I got the Zyoflex. And it's very bizarre. It seemed to work,

01:03:31.400 like as the doctor probably knows, you get four injections over so many months. And I got,

01:03:37.000 the first two seemed to really help. And then it got worse or back to normal at the second two.

01:03:43.960 So I have, you know, appointment to go back to my doctor and we're going to talk about, you know,

01:03:49.480 what to do. But I think you answered my question. So you're saying, like he said,

01:03:53.960 there is surgery available, but could you do the injections again? Would that help? Or you just

01:04:00.920 mentioned like the traction device. So I should probably do that is what you're saying. Great

01:04:07.160 question. So remember, it's a total of eight injections. And after you complete the eight

01:04:11.160 injections on average, patients see about a 30 to 35% improvement. And not all men will see that

01:04:16.360 amount of improvement, but it varies. But if sometimes what happens is you may develop a new

01:04:22.040 plaque along the shaft. So you're treating one, but if you have Peyronie's disease,

01:04:27.080 you have a higher predilection of having a new plaque somewhere along the shaft. So you may be

01:04:31.320 seeing a manifestation of another plaque. Now, I do think that if you want to get the full effect

01:04:36.200 of the medication, finish the four rounds or the eight injections. And then once you're done,

01:04:42.600 say, okay, where am I? And if you decide you want to go more conservative, you can use the

01:04:47.240 stretching devices again, off label, or you can do the surgery. What's nice about the surgery is it will

01:04:52.520 fix the problem. It's a placation procedure. The only downside, biggest downside of the

01:04:57.240 placation procedure is you will lose some penile length. You lose about four millimeters for every

01:05:02.200 10 degree of curvature. So some men say that's a no deal breaker.

01:05:06.040 Four millimeters. That's, that's a small amount.

01:05:08.600 I mean, that's for every 10 degree of curvature. So if you're 40 degrees,

01:05:12.120 1.6. So every 10 degrees, so it can vary, but you're right.

01:05:16.440 How does he, if he wants to get the machine that you were talking about that, you know,

01:05:19.800 strengthens it and, or like lengthens it and straightens it. What is that thing called?

01:05:24.920 The one that I use is called Restorex. It comes out of the Mayo Clinic. There are many different

01:05:28.840 types. What I like about the Restorex out of the Mayo Clinic is it bends the penis in the opposite

01:05:34.040 direction as it's pulling it. So not only is it making it larger, but it's helping with the curve

01:05:39.000 as well. That's why I typically use that again, off label. So guys, I hope you're what,

01:05:44.200 I hope what you're taking away from this conversation is this, it may sound scary to talk about,

01:05:48.120 but it's not that scary to talk. We should be talking about it. You want good sexual health.

01:05:51.480 It's part of your overall health. There's nothing wrong with you. If you have a curved penis or if

01:05:56.120 you have ED or if you have premature ejaculation, these are all normal things that can be addressed.

01:06:01.000 You just have to be willing to matter of factly discuss it with your doctor and get the help you

01:06:05.400 need and that you deserve. Jones has got a call. Jones is calling from Oklahoma and has a question for

01:06:13.240 you, Dr. Cara. Jones, what's your question? Okay. I'm on Citalopram Celexa and that basically takes

01:06:23.400 the sex drive to zero, which is very frustrating for my wife. And we're both in our 50s. So is there

01:06:31.400 something, I've tried a couple of different medications. It's all the same as far as close to the

01:06:38.440 Celexa, but the sex drive is just gone. Is there something I can do to improve that?

01:06:45.160 So very helpful. And that is true. Celexa's side effect is a significant decrease in libido.

01:06:50.200 What's really interesting about these medications is that there's a dose response curve, meaning that

01:06:55.560 if you're on a high dose, let's say 60 of Celexa, could you possibly come down to 30, still get the

01:07:01.400 benefit, but you will have a significant improvement in libido and sexual function. So one option is to try to

01:07:08.120 get down to only the lowest dose that you need. So that will preserve your sexual function the best

01:07:13.480 you can. The other option is to try, as I mentioned earlier, a different antidepressant like Wellbutrin.

01:07:20.280 Now I do want, you need to speak to your provider, make sure that they're comfortable with this,

01:07:25.080 but there are other types of antidepressants that actually enhance libido and sexual function

01:07:30.680 in ejaculatory time, such as Wellbutrin. So you may want to ask if that can be an alternative,

01:07:36.200 or you may want to see if you can lower the dose. If you can't, then we use other types of medications

01:07:41.640 to try to do what we call a workaround to get you there. Because it is, I mean, if you're not having sex,

01:07:47.960 it's depressing. And having sex, just the stimulation, not to mention climax, all that

01:07:53.000 stuff is very good for your mental health and your well-being. So it's like that these drugs that are

01:07:58.200 supposed to cure your depression, but actually cause you not to be able to have any sexual function or not,

01:08:01.960 you know, it's one step forward, two step backwards. Um, so it's a good, it's a good question to ask.

01:08:07.160 Let me ask you, um, about the, the men who can't ejaculate. That's also a problem apparently for some

01:08:13.400 guys. Right. So this is either delayed ejaculation or an ejaculation means I can't ejaculate at all.

01:08:20.920 And that can be very frustrating. Now in this population, you have to ask them, is there any

01:08:26.120 problem with masturbation? They say, yeah, with masturbation, no problem. But with my wife,

01:08:30.200 if it takes forever, then that's a psychologic issue and they need to see a sex therapist.

01:08:34.200 So that's a very important question, but delayed ejaculation typically can happen with, um,

01:08:39.560 medications like antidepressants. And typically that has the same three components. They have to

01:08:44.360 be bothered by it. So, uh, no control. And they basically have to have a delayed time. Typically

01:08:50.360 we do two standard deviations, uh, up to 20 minutes can be delayed ejaculation and it's a problem.

01:08:57.000 Um, and there's no FDA approved treatment for this. So we use off label medications. And so

01:09:03.480 any medication that can increase dopamine in the brain may be beneficial. Uh, anything that increases

01:09:09.320 norepinephrine may be beneficial and anything that decreases serotonin may be beneficial. There are

01:09:15.000 male vibrators. Vibrect has been used to help men with their ejaculatory time as well. So that may be

01:09:21.400 beneficial. Absolutely check the testosterone level because if the testosterone level is low,

01:09:26.360 that could be an impact as well. Um, so there are many things that we have to do to look at,

01:09:30.680 to improve the ejaculatory time. I know we talked about this earlier, but there are some off label

01:09:34.600 medications. One of them is the one we for women. So in 2015, there was a drug called Addy, A-D-D-Y-I,

01:09:41.480 that came out first drug ever for women for sexual dysfunction. It's a big deal. So in 2015,

01:09:46.920 if I walked into Walgreens, I said, put on the table, all the medications for men for sexual

01:09:51.080 dysfunction, they'd put out 33 drugs. I said, give me all the drugs for women for sexual

01:09:55.320 dysfunction. Zero, not one for sexual dysfunction till that year. And what does Addy do? It increases

01:10:02.440 dopamine, increase norepinephrine, decreases serotonin. And it's the first drug ever for women,

01:10:08.360 FDA approved strictly to increase her desire for sex. That's the FDA approval strictly to increase

01:10:14.600 their desire for sex. So several years later, I went to the FDA and said, I want to give it to

01:10:19.080 men and I want to do it in a clinical trial. So I got permission. I got an IND to give it to men in

01:10:23.720 a clinical trial, uh, to see if I can improve their libido. So I do think there's some other

01:10:27.720 medications that we can use. Is Addy, uh, is that a, like a, an oral tablet? How does that work?

01:10:33.880 It's an oral tablet that she takes every single day strictly to increase her desire for sex.

01:10:39.240 Now, uh, I, I worry, like, I don't want men slipping this into their wives' coffees in the

01:10:44.520 morning. There you go, honey. I'll make it for you again. It just needs to be regulated. The

01:10:48.760 woman needs to choose and it has to be done right now. There's two drugs. There's a new one that came

01:10:53.320 out after that called by Lisi, which is an EpiPen that she injects 45 minutes before sex strictly to

01:10:59.320 increase her desire for sex. So now we have two drugs out there strictly for low libido in women.

01:11:05.000 Oh, that's awesome. I'm very glad to hear that. And I, I would think like that when I was reading

01:11:10.840 about the, like the delayed ejaculation, like that, that would be a deal breaker for a lot of

01:11:15.480 women too. It's like, you want it to be the sweet number of minutes. It can't be too short,

01:11:18.840 but it can't be too long either. We're busy and we're tired. And it's like, I don't have 45 minutes

01:11:23.640 for you. It was like, you know, you get up and get down. Like we're going to have to get down to

01:11:27.240 business. So we should talk about it again and see a urologist. Is it, by the way, is it

01:11:32.520 like a urologist? Is that your first line of defense? Like I'm having an issue. I got to get

01:11:36.660 a urologist. Well, yeah, for these types of issues, which are more complicated, I would definitely see

01:11:41.440 a urologist for strict ED. I mean, you could see your primary care physician, you know, but when it

01:11:45.780 gets to more like, you know, a detailed delayed ejaculation, delayed orgasmia, a significant PE,

01:11:51.220 premature ejaculation, Peyronie's disease, that's where you absolutely need to see a urologist.

01:11:55.580 Mm-hmm. Can we talk about masturbation and porn? Because I just feel like this is ruining the sex

01:12:04.060 lives, somewhat ironically, of a lot of men. They think it's going to help the sex lives and it does

01:12:09.860 exactly the opposite. And I think probably double, you can double that impact on the young men, you

01:12:15.720 know, the teenagers who have discovered online porn. Can you give us your thoughts?

01:12:19.360 Yes. So it's been a big problem because as pornography increases, what happens is the

01:12:25.660 libido and erectile function in men decline, the more pornography that he sees. And the reason being

01:12:32.240 is because he now has a new reality expectation. He expects X because he sees this on the screen

01:12:38.620 and he gets Y. And there's a big delta from what he's expecting and what he's getting. And so that

01:12:44.840 tends to cause decreased desire to engage in sexual activity with your partner, decreased

01:12:48.840 erectile function, decreased libido. And that's an issue. And so a lot of times we have to send

01:12:54.020 these patients, a sex therapist is very helpful to help them with their porn addiction. Porn

01:12:57.740 addiction is a reality, particularly now that we have the internet. And so, you know, whenever

01:13:03.340 you see someone, particularly a younger patient who comes in, who has ED, why is this 35-year-old

01:13:09.560 having ED? You have to ask them about their pornography usage.

01:13:12.860 Hmm. If a man is just masturbating all the time, is that going to cause problems? And same

01:13:21.860 question for a woman, you know, like I, does that increase your desire for your partner or does it

01:13:26.960 decrease your desire for your partner?

01:13:29.860 You know, I have not seen any study suggestion that it may increase or decrease. There's,

01:13:33.440 there's no negative long-term effects, um, of, uh, masturbation that I'm aware of. I do know

01:13:39.860 that when patients, uh, uh, engage in sex, for example, if a woman, uh, starts, has an orgasm

01:13:46.320 after a long time, it's been some time that reminder of the pleasure that is associated with

01:13:52.000 it may signal her to engage in sexual activity. Again, if she's not having sex for a long period

01:13:56.440 of time, then it's just out of sight, out of mind. So the pleasure itself is a reminder.

01:14:03.120 Maybe I do want to engage in this again. Hmm. Because you know, we're, we're telling them use

01:14:08.420 it or lose it, but if they're with a sexual partner who doesn't want to do it or they don't

01:14:13.380 have a sexual partner, so they only have themselves as their last option, but porn could be bad for

01:14:20.380 them. Like, I guess you're just supposed to use your imagination. Like what's the way forward?

01:14:25.400 Yeah. So the way forward obviously is to limit porn to, I would say to also work on their quality

01:14:30.340 of the relationship. You know, there's this big difference between men and women. It's called

01:14:33.720 stress. This is one of the dichotomies. If a man, uh, has a very stressful day, typically that man

01:14:40.180 will want to engage in sexual activity to relieve his stress. If a woman has a very stressful day,

01:14:45.740 then the last thing she typically is thinking about is sex, right? So in order to engage in a woman

01:14:50.500 into sexual activity, you want to relieve her stress, uh, and that will increase her desire to

01:14:54.480 engage in sexual activity. So there's, there are many things that you can do to work on a relationship.

01:14:58.780 Um, and that's where sex therapist comes in to enhance the amount of times the couple will engage

01:15:04.400 in sexual activity. These always get circulated on the internet, but like whenever the study comes

01:15:08.700 out showing the more housework the man does, the more sex he gets. I totally believe it. Right.

01:15:14.080 It's just like if you're, if you're feeling overworked and underappreciated and dirty all day,

01:15:18.860 like physically, actually physically dirty, you don't, you don't want it. But if you see your husband

01:15:22.920 pitching in and you're both working together toward a common goal, you're just, you're a little

01:15:26.980 lighter on your feet. That's it. That's actually, that's one of the best ways to engage, have sex

01:15:32.180 with your wife is to reduce her stress. Men listen up. All right, wait, I'm going to take another

01:15:37.460 call and then we'll take a break and we'll take more calls when we come back. Uh, let's go to Matt

01:15:40.520 in Michigan who has a doc, a question for Dr. Kara. Hi, Matt. What's your question?

01:15:46.020 Hi. Um, I'd like, uh, first, thank you for taking my call. But secondly, I wanted to know that

01:15:53.100 I've, I've been on opiates, actually Percocet can 10, 10, three, 25, whatever it is. And for over 20

01:16:01.420 years. And I have noticed for a long time, a difference in, and you know, the sex me and my

01:16:09.220 wife have. So I wanted to ask number one, does it, uh, take longer to ejaculate? It seems like

01:16:17.220 sometimes when you're, when you're on opiates. And number two, I went, uh, because of the

01:16:24.760 testosterone level, I thought it might be low. So I got the ageless male pill and started taking

01:16:30.220 it. And then I had, uh, uh, um, uh, embolism from, um, with, uh, I got them in my lungs and

01:16:38.820 everything. And the doctor said, that's because you're taking the testosterone pills, get rid of

01:16:43.200 them. So I just wanted to touch base on those two things. Let's talk about that. You bring up

01:16:49.280 a very important point. Three things can happen with opioids. The first thing is that when a man

01:16:54.280 take opioids, 74% of those men will have a precipitous drop in their serum testosterone levels

01:16:59.640 as early as four hours. So any man who's on chronic opioids, I strongly urge you to check your

01:17:05.200 testosterone level. It's the number one, one of the number one reasons why a man will have a drop in

01:17:10.340 a serum testosterone. Opioids will also delay the ejaculatory time, as you mentioned significantly,

01:17:15.300 and they can also lead to erectile dysfunction. So, so clearly you want to check your testosterone.

01:17:21.860 I don't believe in using a lot of the over the counter testosterone boosters, which you're

01:17:27.020 mentioning. Uh, if someone, um, uh, needs testosterone, I think they should, uh, get their

01:17:31.540 testosterone level checked and see a provider and get a prescription if it's warranted. Um, so I think,

01:17:38.000 you know, this concern that testosterone causes a cardiovascular event, um, was really mitigated

01:17:44.260 by the recent traverse trial, um, which showed that there was no increased risk in a cardiovascular

01:17:48.860 events. Um, but I do think that more studies are done in the traverse trial. There was a slight,

01:17:55.020 when I say slight 0.4 to 0.9% increase, um, in, uh, DVT. Um, so I think, uh, more studies need to

01:18:02.920 be done in that area. Deep vein thrombosis. What is, what is, is that related to pulmonary embolism?

01:18:08.000 Yes, there was. And so it was a very small statistically significant. So I don't want to

01:18:13.640 discount that at this point. Okay. What about, well, we're on the subject of sort of dulling

01:18:18.500 yourself alcohol. What, what's like, who should be questioning their use of alcohol when it comes

01:18:26.360 to sexual function? Yeah. So remember that alcohol can cause significant damage to the testicles.

01:18:33.320 And the way you want to remember is 40 grams, roughly 40 grams of alcohol can cause damage

01:18:38.640 to the testicle. Each drink that we have on average is about 14 grams. So that two drinks

01:18:43.940 is fine. When you get to that third drink per night, you're starting to cause some testicular

01:18:48.240 damage. So you just want to be like permanent, permanent testicular damage. Well, it depends how

01:18:53.620 long you drink. So not, so not one night, but if you're chronically drinking greater than three

01:18:58.560 drinks per night for an extended periods of time, then you can be susceptible to permanent

01:19:05.740 testicular damage. And so you just want to be a little bit careful. So alcoholics tend to have

01:19:11.560 a higher rate of infertility and lower rates of testosterone. And so, so those are, that's

01:19:17.020 important to remember that. So, so alcohol in moderation is okay. One of my favorite diets is

01:19:22.860 the Mediterranean diet and the Mediterranean diet, I think is probably the best diet for longevity and

01:19:27.880 overall health. And it encourages daily use of alcohol, uh, in moderation. And so I do think it

01:19:34.900 can be beneficial, but I think anything in excess, uh, can be an issue. Hmm. People use it as a,

01:19:41.700 to dull their inhibitions, right? So that they can go ask the woman out at the bar, but that that's not

01:19:49.100 all. It dulls, you know, for men and for women. Right. So it's like, be aware to be aware.

01:19:57.280 Hi, Scott, go ahead. Hi, uh, just have a question regarding resug, which is a reversible

01:20:02.880 male vasectomy. I first heard about, about 10 years ago that it seems like it's been stuck in the,

01:20:08.740 uh, approval process for all this time. And I'm trying to figure out if it's ever going to be

01:20:13.620 improved or not. Yeah, there, there's, there are many types of, uh, products that are coming out

01:20:19.180 for a reversible vasectomy. One of them obviously is putting a, so for example, a gel or a binding

01:20:25.100 agent that can put into the vas deferens and then it will dissolve over time. Um, none have made it out

01:20:31.080 yet. Um, my concern is that, you know, being almost, uh, a hundred percent is not a hundred percent.

01:20:38.340 So we have to make sure that in the clinical trials, uh, the chances of an unwanted pregnancy

01:20:44.400 are almost at least almost as good as a complete vasectomy. And I think that's what they're

01:20:49.480 struggling on is getting those numbers. Hmm. What about on the subject of, you know,

01:20:54.560 pregnancy and so on, you said the withdrawal, don't count on it. Condoms are obviously the

01:20:59.420 best to prevent against STDs, but what about STDs and male health and male birth control? For a while,

01:21:06.860 they were working on the male birth control pill. Is that still a thing? And also, can we talk about

01:21:12.280 the HPV vaccine? Because we had a debate on that about whether boys should be getting it,

01:21:16.860 whether girls should even be getting it, but what are your thoughts on those two things?

01:21:19.900 So you're right. So one of the best ways to control against STDs is condoms, right? That makes

01:21:23.920 a big difference. Um, but the reality is, is that, you know, um, that you can still get the, uh, the, uh,

01:21:30.440 STI. And so, uh, you know, we tell patients, um, that, you know, the Gardonella, you're talking

01:21:36.760 about the HPV vaccine. Those are typically best to use in patients prior to getting, engaging in

01:21:42.380 sexual activity. That's the best time. So you look at the teens, uh, women, uh, prior to engaging in

01:21:48.280 sexual activity, that's the best time to get the vaccine. Um, you remember that the HPV is a very

01:21:54.240 prevalent condition. People, when they come to me and say, I can't believe I have HPV. I say,

01:21:58.540 you know, it would be, you'd be surprised, uh, up to 30% of patients can have HPV in certain

01:22:03.300 populations. They just don't know it. Um, and most of these, uh, particularly like even herpes

01:22:08.640 will stay dormant, um, and they will not manifest, uh, until there's a stressful situation, stress,

01:22:14.720 meaning weather, uh, uh, stress, and just a mental stress, um, getting diabetes, immunocompromise.

01:22:21.020 Many patients don't know it, uh, that they have these conditions.

01:22:24.560 Hmm. And is that treatable or no?

01:22:28.540 Well, you know, herpes obviously is treatable. HPV is, uh, treated, uh, as, uh, usually it's

01:22:35.360 surgical. When we see patients coming with HPV lesions, we'll use, um, uh, uh, uh, electrocautery,

01:22:41.980 we'll use freezing. There's medications you can use as well to, for the HPV lesions. So there are

01:22:47.280 things you can do, but unfortunately they come back, right? Cause they usually stay dormant. Uh,

01:22:53.080 and so you're chronically having to address.

01:22:56.360 Hmm. But if you get the vaccine, then you don't have to deal with it.

01:23:00.120 Yeah. It'll significantly reduce the risk, but the best time to take the vaccine is before you're

01:23:03.660 sexually active.

01:23:05.300 Yeah. Yeah. Right. Exactly. Okay. Um, right. And we did, and we did a whole show on those

01:23:09.240 vaccines so you can go back and check it. Steve will get me the episode number for our audience.

01:23:13.660 Uh, okay. Let's see. Uh, okay. A lot of, a lot of people calling in with some questions. Good for

01:23:19.820 you guys. Appreciate that. Let's, let's talk to yeah. Gary in Mississippi, who's getting to a topic

01:23:25.200 we haven't yet discussed. Hi, Gary. What's your question? Hey, Megan. Hi doc. Listen, thanks for all

01:23:31.120 this. Um, I'm a prostate cancer survivor, you know, and having fun through the process of treatment and

01:23:38.880 then my sexual health after that, could the doctor just kind of touch on the thought process that men

01:23:46.120 go through when we're facing treatment and ultimately, you know, keeping that sexual function

01:23:52.160 going. You bring up a really important point. You know, it is devastating when a man undergoes a

01:23:59.280 radical prostatectomy or surgery for prostate cancer that the next day, uh, immediately most men will have

01:24:05.040 erectile dysfunction. Now over time, their erectile function will regain in many men, not all. And so

01:24:10.920 think about it. If you're 55 years old and you're going to have this surgery tomorrow. And then the day

01:24:15.220 after you say, okay, so I can't have sex with my wife. Uh, it can be very devastating because it's

01:24:19.960 abrupt. It's all of a sudden. And so there are many programs we, we try to do called a penile

01:24:25.080 rehabilitation program, put patients on daily Cialis. We have them on injections. We have them on vacuum.

01:24:30.220 We may use testosterone early in certain patients to help regain their sexual function. So

01:24:34.840 the comment we use earlier about use it or lose it. You want to make sure that you're using the

01:24:39.960 tissue and exercising it because over the course of that year, those nerves undergo something called

01:24:46.340 neuropraxia. They get paralyzed, but as they start recovering, then you're going to want to make sure

01:24:51.440 the tissue is healthy so that everything can come together and you can start engaging in sexual

01:24:56.120 activity and having erections. So we do think that it's important. I do for penile rehabilitation after

01:25:01.240 this type of surgery. And also, I just want to be fair, the surgeon skill makes a big difference.

01:25:06.620 Those surgeons that are very good and have done a lot of these cases tend to have very good outcomes

01:25:11.620 because of the experience in avoiding injuring what we call the cavernosal nerves during the procedure.

01:25:18.300 Just quick note, it was episode 565 where we had our HPV debate 565. So we're talking a little bit

01:25:25.840 about prostate cancer. Can we spend one minute on testicular cancer? I did not realize how important

01:25:31.960 self-exams are for guys on this. As a woman, you hear about the breast self-exams in the shower at

01:25:38.180 least once a month. You're supposed to be feeling for lumps. That's also true for guys in the testicles?

01:25:44.040 18 to 35. Just remember those numbers, Megan. It meant 18 to 35 should be examining the testicles.

01:25:49.700 We say at least once a month because that's the prime years for the testicular cancer. And the best

01:25:54.500 way to think about this is if you make a fist. If you make a fist and you press between the knuckles,

01:25:59.280 that's the consistency of normal testicular tissue, just kind of soft, spongy. And if you move over

01:26:04.460 and feel the knuckle, that's the consistency of what a tumor would feel like. So what you're trying

01:26:09.700 to do is make sure that you're not feeling the knuckle and you're feeling the consistency between

01:26:13.360 the knuckles, the spongy area. So very important for men to do self-testicular exams between those

01:26:19.680 ages. Is it true that pot use makes you more likely to get testicular cancer?

01:26:26.640 I have not seen data to support that. Okay. What are the risk factors for getting that?

01:26:32.100 Well, I mean, the risk factors are an undescended testicle is the biggest risk factor. So some

01:26:37.120 children are born with a testicle that's not descended all the way. That testicle that's not

01:26:41.860 descended all the way has a very high risk of having testes cancer. What's interesting is that when you

01:26:47.680 bring the testicle down, as a child, we bring it down. The reason we bring it down is because we

01:26:52.440 want to be able to examine it so that if it does get cancer, we would know. So leaving it up in the

01:26:57.860 abdomen, you'll never be able to know because you can't examine it. Even if you bring that testicle

01:27:03.040 down and you're able to examine it, you also have a higher risk of having testicular cancer

01:27:07.520 in the other testicle. So you really want to examine both testicles. But again, those testicles

01:27:13.840 that we bring down have a higher risk. Okay. Well, that's good to know, but it's,

01:27:18.120 it's very treatable, right? Testicular cancer, like all the more reason to get ahead of it.

01:27:22.400 Very treatable, but, but this is one where you, you catch it earlier. I have a much better outcome,

01:27:27.440 right? So that's really important. It's sometimes men will say, I felt something,

01:27:32.040 just ignored it. I felt it. It got a little bit bigger. I thought it'd go away because with a

01:27:36.040 problem with testicular cancer, it's not painful. So there's no pain. It's just a mass. And so as the

01:27:41.380 mass gets bigger, you're thinking, ah, I think if it was very painful, most men would try to go in

01:27:45.580 and get some kind of treatment, but there's no pain. It gets larger. And the problem is

01:27:49.480 this can metastasize very quickly into the abdomen. And so, and it requires sometimes

01:27:55.140 chemotherapy or radiation. And so the take-home message is if you feel a mass in the testicle,

01:28:01.300 please go to your urologist and get it checked out. While we're on the subject of 18 to 35 year olds,

01:28:06.460 for those of us who have, um, you know, young teenagers, like I have a 13 year old boy,

01:28:11.440 I have a 10 year old boy. Um, is there anything we need to be thinking about for them as they sort

01:28:15.980 of mature into young adulthood? You know, to me, it's crazy because they say like at the average,

01:28:20.500 like 50% of all 12 year olds have seen porn already. Um, this is crazy. I realized that like

01:28:26.200 they're capable soon of actually having sex, but like, and they're biologically wired to be able to

01:28:31.640 do it at a very young age, but they're not mentally ready at all. So what in your business,

01:28:36.360 you know, what should we as parents be thinking about? Yeah. You know, I don't see a lot of kids.

01:28:40.220 Obviously I'm more on the adult side, but you're right. I have teenage, I'm a teenage boy. And so

01:28:44.620 the issues are relatively the same. The problem is the access to pornography is rampant. You know,

01:28:49.760 many of them have their own iPhones and they can see, uh, different things whenever they want.

01:28:53.580 The thing I worry about at that age is that many of them do take testosterone in high school.

01:28:59.460 They take testosterone in high school because they want to improve their athletic performance.

01:29:05.100 And that's where they get in trouble because they don't have the maturity to understand to

01:29:09.220 know that by taking this enhancement drug, they can become infertile. So that's what I worry about

01:29:13.940 in my business. No, that's very smart. Oh gosh. I dated a guy a long, long time ago as a bodybuilder

01:29:19.220 and he was taking steroids and I'd never even heard of steroids. I didn't, I mean, there's a short

01:29:22.740 little like couple of week romance. And I remember running around being like, Hey, he's on steroids.

01:29:26.760 He might know. And he was like, don't stop telling people that. But we, we were young and I'm sure

01:29:31.060 he had no idea that it, those also carry these kinds of risks. Okay. Let's get to, um, Corey in

01:29:36.720 British Columbia. Who's got a question for you, doc. Hi, Corey. What's your question?

01:29:40.900 Hi. Um, I was on an SRS or I need press and I'm experiencing genital numbness even after I stopped

01:29:49.120 using it. Um, I've been off medication well over a year and I'm still experiencing it. What,

01:29:55.420 what's the issue here? Yeah. So this phenomenon, sorry, go ahead. Yeah. No, he said he's genital

01:30:02.920 numbness after a medication. Yes. So there are two phenomenons. One is SSRI, uh, where patients

01:30:10.420 take an antidepressant and even after they stop the antidepressant, they can have persistent sexual

01:30:15.520 side effects. The second one is with a medication called finasteride, which has been documented where

01:30:20.580 they take finasteride typically for hair loss. And after they take the medication, after they stop it,

01:30:25.520 they have persistent sexual side effects. It doesn't happen in all men, but it does happen in some men.

01:30:30.340 And I think that it's real. Uh, the problem is, is that trying to find, um, the, the etiology,

01:30:36.980 why does it occur? We don't know. And what's the best treatment for it? We still don't know.

01:30:40.700 Many times when patients come to see me for, for example, post finasteride syndrome or post SSRI

01:30:45.700 syndrome, we try to work around it. We try to use medications such as daily Cialis to increase the

01:30:50.880 blood flow into the penis to help with blood flow, to help with nerve regeneration and growth. We try

01:30:55.040 to use testosterone as well, but it's a very delicate situation because, um, I don't have a cure nor do I

01:31:02.140 know the etiology for why it occurs. Hmm. That's the Cialis sounds like a great drug from what you're

01:31:07.520 saying. Let's go to Kaya in Nevada, who has a question about her husband. Hi Kaya. What's your

01:31:12.920 question? Hi Kaya. Uh, hi Megan. This is Kaya. Um, I just, my husband has an enlarged testicle

01:31:20.940 that he did have looked at and the doctor said he could aspirate it, but he preferred not to. And

01:31:27.820 that was probably 10 years ago. And it's just getting bigger. So enlarged testicle typically means

01:31:36.560 something called a hydrocele. And let me explain what that is. The testicle has a casing around it.

01:31:42.420 Think of it like it's in a sack. And sometimes when the testicle is injured or there's some trauma,

01:31:48.300 what they'll do is develop fluid between the testicle and the sack. And the sack will get

01:31:52.880 larger and larger and larger. And that's fluid around the testicle. So it's not necessarily that

01:31:57.840 the testicle is larger, but there's a significant amount of fluid around that testicle. So you can

01:32:02.940 aspirate it and put a needle in and remove the fluid, but it has a very high recurrence rate up

01:32:09.360 to 90% will those patients recur and you'll keep aspirating for life. So one of the best ways to

01:32:15.920 treat it is to go in and remove the fluid. This is surgical. And then I remove the sack. And once

01:32:22.000 you remove the sack and the fluid, the problem is typically solved. Now, I don't know much about

01:32:26.940 your husband's condition, but you just do want to make sure that you're not missing anything else,

01:32:30.100 like a testis tumor or something else. But it sounds like to me that this is a hydrocele.

01:32:36.400 Hmm. Ron in Georgia has a question about pot. Hi, Ron. What's your question?

01:32:42.280 I'm just curious about the effects of cannabis on testosterone levels.

01:32:47.820 Yeah. So we do know that excessive use of cannabis can significantly reduce testosterone levels and

01:32:53.960 cause erectile dysfunction. I've never seen a study talking about the quantity, like, hey, if it's one

01:32:59.320 joint a day, two joints a day, I've not seen that. But we know that patients who do have excessive

01:33:03.920 cannabis use will see a decline, not only in testosterone levels, but also sperm production

01:33:09.880 as well. Hmm. Okay. And last but not least, I'm just going to repeat, John in New Hampshire has got

01:33:15.520 a question about motivating sexual desire. I'll just paraphrase it. I think we covered that,

01:33:20.780 but just sum it up in the time we have left for the guys who worry about that.

01:33:26.380 Yeah. So remember, sexual desire is multifactorial. It's not just about a pill. It's about your

01:33:30.820 relationship. It's diet, exercise, sleep, stress reduction. It's about some meds that you're on that

01:33:35.860 could cause an impairment in sexual desire. Just don't think if I take testosterone, the world is

01:33:40.400 going to be great. It's multifactorial. Hmm. Doc, this has been so interesting. Gosh,

01:33:46.100 thank you so much for sharing your expertise. We could have gone for another hour, I'm sure,

01:33:50.160 because so much to cover. Really appreciate you sharing all your knowledge with us.

01:33:54.620 My pleasure. Thank you so much for the invitation.

01:33:57.000 You bet, Dr. Mohit Cara. And don't forget, next week, we will be doing our women's sexual health

01:34:03.760 show. And you can email in now if you have questions or thoughts on today's show or questions

01:34:08.360 in advance of that show, Megan, M-E-G-Y-N at MeganKelley.com. Okay, looking forward to that as well.

01:34:16.100 Thanks for listening to The Megan Kelly Show. No BS, no agenda, and no fear.

The Megyn Kelly Show - August 09, 2023

Testosterone, Libido, and Infertility： Deep Dive on Men's Sexual Health, with Dr. Mohit Khera ｜ Ep. 604

Episode Stats

Length

Words per Minute

Word Count

Sentence Count

Misogynist Sentences

Hate Speech Sentences

Summary

Transcript