What Really Happens to Men’s Sex Lives as They Age? With Dr. Judson Brandeis

In this episode of Causes or Cures, Dr. Eeks speaks with Dr. Judson Brandeis, a board-certified urologist, sexual medicine specialist, surgeon, author, and founder of BrandeisMD, about erectile dysfunction, sexual wellness, aging, intimacy, and the rapidly growing men’s penile enhancement industry.

Dr. Brandeis discusses his recent clinical research exploring whether nitric oxide boosting supplements may work synergistically with medications like Viagra to improve erectile function, as well as broader issues surrounding circulation, lifestyle, vascular health, mental health and sexual performance.

He also describes 10 things men can do right now to improve their sexual health.

The conversation explores:

• What causes erectile dysfunction (ED) and why it becomes more common with aging
• The role blood flow and nitric oxide play in erections
• How ED can sometimes signal broader cardiovascular, metabolic or psychological issues
• The difference between prescription ED drugs and supplements
• Side effects and limitations of Viagra and Cialis
• Shockwave therapy and other emerging approaches in sexual medicine
•  “Sexspan” and maintaining sexual health later in life
•   Relationship dynamics, intimacy, and communication
•   Men understanding women’s bodies and sexuality after menopause
•   The psychology and emotional impact of erectile dysfunction
•   Concerns surrounding the supplement industry and “male enhancement” products
•  The difference between FDA approved medications and dietary supplements

Dr. Brandeis also discusses his “P-Long” protocol, which he describes as a safe and effective way to increase the length, girth and function of a healthy man’s penis.

Dr. Judson Brandeis is a board-certified urologist, surgeon, medical researcher, author, and physician educator with more than 25 years of experience in urology and men’s sexual health. Over his career, he has performed thousands of surgeries, helped pioneer surgical robotics, and served as Chief of Urology at John Muir Hospital and Hill Physicians for over a decade. Dr. Brandeis attended Brown University, earned his MD from Vanderbilt University, received a Howard Hughes research award at Harvard Medical School, and completed his surgery and urology residency at UCLA. In recent years, his work has focused on men’s wellness, sexual medicine, erectile function, intimacy, and “sexspan,” with an emphasis on helping men improve quality of life, physical intimacy, and overall health as they age.

You can learn more about Dr. Brandeis and his work at:
BrandeisMD

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Transcript

SPEAKER_05 0:00

Welcome to the Causes or Cures Podcast, your gateway to understanding health and groundbreaking medical research in a fun and easy to understand way. With Dr. Eeks as your host, join us as we sit down with the world's leading doctors and scientists to unravel the mysteries of health. From practical tips on well-being to the latest breakthroughs in medical research, we cover it all. Don't forget to subscribe. Now, let's ignite our curiosity and together dive into today's episode.

SPEAKER_03 0:31

Hello, everybody, and welcome back to Causes or Cures. If you're new here, hey, how are you doing? I'm Dr. Eeks, your host. So today we are talking about something millions of men experience, but many still struggle to openly discuss erectile dysfunction, uh, sexual health, aging, intimacy, and what happens to men's bodies and relationships over time. And of course, all of those issues impact their partners too. It's fun to get older, guys, isn't it? It can be. Our guest today is Dr. Judson Brandeis. He's a board-certified urologist, a surgeon, healthcare entrepreneur, and he's founder of Brandeis MD. It's a men's health clinic focused on sexual medicine and male wellness. Dr. Brandeis has spent decades working in urology and men's sexual health, and he's currently investigating how nitric oxide-boosting supplements may work alongside medications like Viagra to improve erectile function. So we discuss his recent clinical research how erectile dysfunction connects to broader cardiovascular and metabolic health, even mental health, and why men's sexual health is often more complicated than people think. And while we do talk about supplements here, just so you know, and I say this every time I talk about supplements, but I don't endorse any supplements, but people use them, so I think it's good that we have conversations about them. And I'm sure some are better than others. So, you know, we hear a lot about health span in this age of longevity, but here we get into sex span, as well as intimacy, aging relationships, men understanding women's bodies after menopause, the psychology around erectile dysfunction, devices that measure nighttime erections, and yes, even techniques and therapies marketed to increase penis size. And Dr. Brandeis actually created a technique that he's going to talk about. So importantly, we discuss the limits and the controversies in the space, including the difference between FDA-approved medications and supplements, concerns about the men's enhancement industry, um, and why some physicians remain skeptical of this entire category. Okay, so it's it's a great conversation, actually goes in all different directions. Then and as always, this podcast is for informational purposes only. It's not medical advice. So let's dive in, shall we? Give me a few seconds here, and we'll connect to Dr. Brandeis. All right, everyone, we are connecting with Dr. Judson Brandeis, and we're gonna talk about male health and sex and men and all that stuff.

SPEAKER_01 3:31

Oh, there's so many things to talk about.

SPEAKER_03 3:33

There's so many things to talk about. Um but first, can you, Dr. Brandeis, kind of tell our listeners a little bit about yourself?

SPEAKER_01 3:41

Sure. So I grew up in New York and I went to Brown University as an undergraduate. After Brown University, I went to American Red Cross and did research with Harold T. Merriman, who was the first person to figure out how to freeze blood. Uh, so it was super interesting. We were freezing kidneys for transplantation. And then I went off to Vanderbilt for medical school. And during medical school, I took a year off and did research at Harvard Medical School and the lab where they did the first living-related kidney transplant, won the Nobel Prize for that. And so that was super interesting. I was very interested in kidney transplantation. I went back to Vanderbilt, finished up medical school, and then went off to UCLA, where I did my surgical residency, and then did my urology residency. And uh, and during that time, I did research for Mark Litwin and became really interested in prostate cancer and prostate cancer outcomes research. And so I kind of ditched the idea of being a kidney transplant surgeon. And then in 2001, I moved up to Northern California and started practicing uh general urology, where I helped pioneer surgical robotics. I built a kidney stone center, I helped pioneer MRI guide prostate biopsies. I've been voted top urologist in the San Francisco Bay Area for about 13 years now. And about seven years ago, I became really interested in regenerative urology. So the ability to help guys who no longer can get an erection, help them get an erection, kind of the natural way. And so uh in that field, I've sort of pioneered research. I pioneered um penile enhancement research uh with a safe and effective protocol called the Pelong. And I developed a uh supplement called A Ferm, which uh is a nitric oxide boosting supplement, where recently we found that a firm plus Viagra improves the outcomes of Viagra about by about 34%.

SPEAKER_03 5:33

Okay. So you've done a lot uh in the realm of men's health. And I guess let's start there with um erectile dysfunction. And can you kind of talk about the scope of the problem and maybe some of you know the shortcomings that you saw when it came to current treatments and what's available for men the conventional way, I guess?

SPEAKER_01 5:55

Right. So 50% of men over the age of 50 have some degree of erectile dysfunction. So it's a massive problem. And it really relates to circulation and how well someone has a circulatory system is working, right? So there are other forms of erectile dysfunction. There's neurogenic, psychogenic, hormone-related, by 90% plus is vascular. And so really the issue revolves around how effectively can you pump blood into the penis? And so what really got me interested was a technology called focused shockwave therapy. So using basically intense sound waves, without going into a physics lecture, using intense sound waves to trick the body into thinking that there's an injury. And when your body is injured, you generate an injury response. And part of that injury response is an inflammation that causes the growth of new blood vessels. And so, since a lot of erectile dysfunction is vascular, if you can trick the body into growing new blood vessels, then you can help someone who has erectile dysfunction either get off Viagra or make something like Viagra or Cialis more effective.

SPEAKER_03 7:09

And you so you said about 90% is vascular related?

SPEAKER_01 7:13

About 90% is vascular, give or take. And then there's psychological and right, there's psychogenic, there's hormonal, there's uh neurogenic.

SPEAKER_03 7:22

Yeah. So yeah. Okay, so that's a huge percentage. Yeah. If it's if it's 90%, that's that's pretty much the majority. So can you talk a little bit about, you know, some of the side effects of the cr of the medication that's prescribed and like maybe why someone may not want to be on it or like any issues that people have with the prescribed medication?

SPEAKER_01 7:44

Right. So Via Grassialis livitra uh have generic names like sildenophil, tadalophil, vardenophil. They are amazing medications. Uh really. Uh for what they do, their cytopic profile is incredibly good. But they are what we call vasodilators. So medications that make blood vessels get bigger, right? And there are PDE receptors or PDE enzymes all throughout the body, right? So let me back up if you if you don't mind me doing a little biochemistry. So nerves, when they're stimulated, release uh an a molecule called nitric oxide onto blood vessels. And blood vessels make something called cyclic GMP. And cyclic GMP creates a cascade of events that then leads to opening up blood vessels. And this happens in people from head to toe, in men, women, and really any mammal. When cyclic GMP is broken down, then blood vessels constrict, right? So you don't want blood vessels open all the time, you want them to open when you need, and you want them to close. So, and there are different uh PDE enzymes all throughout the body. So in the eyes, there's PDE6, in the lungs, there's PDE4, in the brain, there's PDE1. In the penis, as it turns out, there's PDE5. And so if you block PDE5 with what's called a PDE5 inhibitor, then you selectively shunt blood to go into the penis. And that's what PDE5 inhibitors like Viagra and Cialis do. Right. But there is some cross-reactivity with other PDE5. So you can get reflux, you can get uh nasal congestion, you can get headaches, you can get facial flushing, all from that cross-reactivity of those medications with other people's PDE. And that's where the side effects come from.

SPEAKER_03 9:43

I remember what someone once told me that side effects are just effects, you know, but just like different receptors. I guess that's kind of like one way you can look at it.

SPEAKER_01 9:51

And everyone has slightly different receptors, and so um these drugs are slightly different in in everyone. And so that was the the amazing thing about the recent study that I published to confirm two study, is uh in order for Viagra to work, you need cyclic GMP. And as people age, they make less nitric oxide, which then makes less cyclic GMP. And so the hypothesis was if we boosted cyclic GMP with a nitric oxide booster, would that make something like Viagra or Cialis more fat? So what we did is we had patients use what's called a firm tech ring. It's a ring that goes around the penis and you can sleep with it at night and it measures pressure, right? Because men, when they're especially when they're younger, will get 30 to 60 minutes of erections every night. That's kind of the way that the penis keeps itself healthy. And so you can actually measure those erections. And what we found was if we put men on 40 milligrams of Viagra, which is a relatively low dose of Viagra, it definitely will improve their erectile function. But if you put them on Viagra plus the affirm nitric oxide booster, you boosted the nighttime erections 34%, but you didn't add anything to the side effects.

SPEAKER_03 11:11

Okay, so let's talk about the supplement, uh, the nitric oxide booster, which you're that's affirmative. Okay. What is in that?

SPEAKER_01 11:22

So there's basically two ways that you can make nitric oxide. You can make it through the citrulline-arginine pathway. These are non-essential amino acids. And so some people take arginine, but arginine actually is not very well digested by the body. So you take citrulline, and then in the kidney, citrulline is turned into arginine. And then arginine grabs an oxygen molecule, splits it in half, makes nitric oxide, which is NO, and then it gets recycled back to citrulline. So it's a it's a cyclone in the body. Body is very good at recycling things, and so things like watermelon have high levels of citrulline, and so it's basically watermelon, and then the other way you get nitric oxide in your body is through nitrates. So things like beets, green leafy vegetables, and that's NO2 and or NO3, and then in your mouth, you have a salivary enzyme that converts it to nitrite, which is NO2, and then in your stomach, the stomach acid converts NO2 into nitric oxide, which is NO. And so there are basically two ways to make nitric oxide. One is through beets, and the other is through watermelon. And so a fern basically has citrulline, it's got beet extract, it's got ginseng, and it's got Miropuama, which is Brazilian potency wood.

SPEAKER_03 12:45

Miro Puama.

SPEAKER_01 12:46

Mira Puama.

SPEAKER_03 12:48

Okay.

SPEAKER_01 12:48

And that's That's also a nitric oxide booster.

SPEAKER_03 12:51

Not nitric oxide booster. Okay. So you have all of these things and it's concentrated. And I suppose if somebody added these things to their diet, they'd also get a similar effect for absolutely.

SPEAKER_01 13:04

Um, but you for for a pill of or tablet of nitric oxide boosting supplement like a firm, you would have to eat about four pounds of fresh watermelon and like three or four beets. Which you know, I like watermelon, but I think that would make me diabetic.

SPEAKER_03 13:19

Also, some of the men may be going to the store now to get watermelon and beets, whatever, whatever floats your boat. Okay, so you talked about this recent study that you did with Viagra, and it showed an improvement, and there wasn't any addition to any negative side effects, which sounds good. I'm curious, did you test this supplement by itself in any capacity?

SPEAKER_01 13:43

We did. That was the confirm one study. And so the confirm one study said showed that a firm just by itself will improve circulation, and it boosted uh nighttime erections also by about 30%, just on its own. And so, you know, if you're a younger guy and um, you know, I'm 58, so anything less than 58 is younger to me. Um, but uh endurance athletes, bodybuilders all take nitric oxide boosters, it helps improve circulation and blood pressure. So I get a lot of my patients off their blood pressure medications. Blood pressure medications in general are really lousy for erectile function. So I have a guy coming in who's on a beta blocker or a calcium channel blocker or a hydrochlorothiazide. If I put them on a high dose of a nitric oxide booster, I can get their systolic and diastolic blood pressures down by about five or ten points naturally. You know, and the thing is, no drug company is ever going to model a nitric oxide booster because it's not something that you can patent. So it's not something that that's sort of well known, even though, you know, my professor at UCLA, Louis Ignaro, won the Nobel Prize for discovering how nitric oxide works. Nitric oxide was voted the molecule of the year in 1998. It's basically how Viagra and all these things work. Um, but it's surprisingly that how little uh the medical establishment knows about it or talks about it.

SPEAKER_03 15:09

Yeah, and I and I have some questions for you down the line, kind of because you're obviously you have all the credentials and then and then you're also, you know, you created the supplement. And I'm just curious about, you know, the type of feedback you get from your peers and that kind of thing. And as you know, there's all it's always like, okay, well, is there the gold standard randomized controlled trial? And is it in a peer-reviewed journal? And then as you just said, a lot of things don't necessarily get studied because you can't patent them. And there's obviously um a for-profit bias in the system. You know, you want something that's going to make you money to get, you know, and that that's what the drug companies tend to study. But let's talk about first the P long protocol, because I'm very curious about that. What is that? And you can say that.

SPEAKER_01 15:52

You know, as a urologist and a surgeon and a sexual medicine expert, I would get lots and lots of guys who would come in who had penile enhancement procedures of some of some sort, whether it was surgeries or a silicone implant or fat transfers or fillers with disastrous consequences. And I'm not saying every single person that has these things had disastrous consequences, but there were enough that I said, you know, this is ridiculous. There's got to be a different or a better way. And so I actually created a protocol uh using uh a stretching device called the Restorex device developed by a friend of mine who is at the Mayo Clinic. I uh used a penis pump by Dr. Joel Kaplan. I used my nitric oxide boosting supplement, and I added uh injections of PRP. So PRP is platelet-rich plasma. Platelets in the body serve two functions. One function is to cause a clot, that's what everyone knows. But the second function is to actually cause regrowth of tissue in the area of trauma. And so there's 140 plus growth factors that live inside platelets. And so when platelets release clotting factors, they also release growth factors, which is why, you know, if you're out and you cut yourself, you get a little bleeding, you get a uh a clot, you get a scab, the scab falls off as that tissue grows back. And the reason that only that tissue grows back is because those growth factors were released locally. And so PRP is used for all sorts of things. It's used in orthopedics, it's used in gum surgery, it's used in hair growth. Uh, but there was a guy about 10 years ago, Charles Runnels, who decided to try to use it on the penis. Uh, and so he developed the P shot, he developed the O shot. And so there's data that it actually improves erectile function and it improves um sensitivity and orgasm in women. And so I decided let me try to use this to accelerate the growth process in penile enhancement. And so what the P long protocol is, is once a month guys come in for uh PRP injection in the penis, and I developed a technique of ultrasound guidance of PRP injection in the penis. It's uh traction uh using the Restorex device for 20 minutes twice a day, suction about 12 minutes twice a day, and two affirmed tablets twice a day. And what I found after six months is that we were able to grow penises eight-tenths of an inch in length, about a half an inch in girth, and improved function.

SPEAKER_03 18:28

Okay, so this is just in general. Are are these are the the folks who come to you for this? Are they the same group of men who are coming for like erectile dysfunction?

SPEAKER_01 18:39

Different.

SPEAKER_03 18:39

It's different. Okay, that's yeah.

SPEAKER_01 18:40

So this is not if you have erectile dysfunction, you're not a candidate for P long because you're you're sort of on the way down. You're not getting nighttime erections, and nighttime erections really is what keeps penile length and size, because you're getting an erection 30 to 60 minutes a day. I mean, you know, if you're a normal person like me and you have a job and you have kids and you have a wife and you have hobbies and stuff like that, you're not having sex for 30 to 60 minutes every single day. And so, what keeps your penis healthy? Nighttime erections keep your penis healthy. Uh, and so if you have erectile dysfunction and you're not getting 30 to 60 minutes of erections every night, your penis over time is going to begin to shrink. And so the P long protocol really is for men, say between 20 and 58. I always like to include myself in that. And um and you have to have normal erectile function.

SPEAKER_03 19:33

Okay, that's that's that's I think that's an important point for people to understand. And so you mentioned the penile pump, like that's part of this. And okay, I've seen that. Like I knew I knew a guy who used it, and I was like, okay, like how does that work? Like, what's the mechanism there?

SPEAKER_01 19:49

Right. So what it does is it creates suction. So it's a it's a it's a airtight seal at the base of the penis, and then you're creating uh negative pressure. And when you have negative pressure, it pulls venous blood from the pelvic plexus into the penis. And so it causes the penis to increase in size. And we use the penis pump mostly for girth, not really for length. Uh, the thing about penis pumps is guys with erectile dysfunction use it, um, but you have to put a ring around the base of the penis in order to trap that blood in the penis. If you as soon as you release the pressure, that venous blood goes back into the pelvic plexus. It's not like a normal erection where you have arterial flow pumping into the penis to help maintain the erection. It's basically works through negative pressure.

SPEAKER_03 20:43

All right. Geez, there's all these little caveats that there is.

SPEAKER_01 20:46

You know, it's like most people just know, you know, the little blue pill, but in and that's that's sort of what's been super interesting about uh focusing really on erectile function and sexual function, is there's a lot of stuff out there that most people don't know about.

SPEAKER_03 21:02

Yeah, that's um well, that's one reason I like to do this podcast because I'm always like learning new things from people, whatever their expertise may be. Okay, let's go back to the shock wave therapy. I thought you explained that well, kind of like creating an injury and increasing inflammation and blood flow, which I think makes sense to a lot of people. Um, but you also this is part of like a triple therapy. Is that like with the supplement?

SPEAKER_01 21:26

This and yeah, with the supplement, right? You want to boost the signal, and the way you boost the signal is by boosting nitric oxide and also by taking a PDE5 inhibitor, because remember that that critical molecule is the cyclic GMP. And so one aspect of the therapy is boosting the signal, the other aspect of the therapy is improving vascularity, and so we do that through uh focused shockwave therapy and also through um the PRP, and then the other aspect of it really is. Keeping penile health, which if you're not getting nighttime erections, it's important to use a penis pump in order to bring oxygenated blood into the penis and nutrients into the penis. Because that, you know, I do a lot of penile Dopplers and ultrasounds in the in the office. And, you know, if I do an ultrasound anywhere pretty much in your body, you're gonna you're gonna show arterial flow. But when I do an ultrasound on the penis, if it's flaccid, which you know most of the time it is, there's very little arterial flow or blood flow into the penis. And so in order to keep the penis healthy, you need oxygen, you need nutrients, proteins, all that kind of stuff.

SPEAKER_03 22:41

How much can you do on your own versus, you know, because you talked about cardiovascular issues, and you know, we're not necessarily the healthiest population on the planet. A lot of us have, you know, cardiovascular issues, circulation issues, obesity, you know, the whole metabolic syndrome, as they call it. So how much can you really help when there's these other types of systemic issues happening?

SPEAKER_01 23:05

Yeah. So, you know, I I'm not just a penis doctor. When someone walks into my office, I do a whole evaluation of them. So we get a full panel of labs, we do body composition analysis. And I I have a, you know, I've been doing this for 25, 30 years. I've been voted top urologist in the Bay Area for 13 years. I have a sit-down, kind of come to Jesus meeting with a lot of patients. Uh, and and for a lot of patients, I have to give them tough love and tell them, you know, look, listen, I have all these wonderful technologies that can help improve your penile health, but it's not gonna work if you don't turn your own health around, if you don't lose weight or lose fat. And, you know, thank God we have these GLP1 inhibitors, our agonists now. I mean, they're just absolutely amazing drugs uh with very little side effects. And I started using them on my patients about six months ago because they're so dreadfully expensive otherwise. Uh, and uh, I teach people how to exercise, I teach people how to stretch, I teach them how to do yoga, uh, you know, I motivate them to stop smoking, stop drinking, you know, how to decrease stress in the workplace. I mean, all these that's why my book ended up being 101 chapters. I didn't intend to write 900 pages on 101 chapters. I intended to write, you know, a 200-book page book about sex. But there are so many things that affect uh sexual function in men that I just kept adding chapter after chapter after chapter as patients would come in and and I would say, Well, listen, dude, you're not getting enough sleep. And so that's the reason your testosterone's so low, and that's the reason your sexual function. And then I said, Okay, well, you know, let me get Mike Murphy, a friend of mine, who's a Stanford professor, to write the chapter on sleep.

SPEAKER_03 24:51

Okay, so you're talking about the 21st century man, which is the book you wrote. And so that's let's talk a little bit about that and um and maybe tell our listeners like what are some of the top things that are impacting men's sexual health or ability to perform? It's not just erectile dysfunction. It, I mean, I guess that's part of it, or maybe that's the end result of it, but I feel like there's a lot more stuff.

SPEAKER_01 25:13

Yeah, I mean, so I'm I'm not talking about guys in their 20s or whatever, because that that's a whole different physiology. Their physiology is totally fine, they can do whatever the heck they want, and they're gonna get a really good erection that day, right? I'm talking about guys over the age of say 40 or 50, where blood flow doesn't come as easily. And so I have this concept of like, you know, the Maslow's pyramid, but for erectile function. And so at the very base is physical function, right? So you need to be in reasonably good physical condition. You can't be fat, you can't be out of shape, you can't be eating poorly, you can't be diabetic, right? Because that's all gonna clog those arteries. And then mentally, you have to be in good shape, right? You can't be depressed, you can't be anxious, you have to be sleeping pretty well. Emotionally, you have to be in good shape. Your relationship has to be in good shape. And so if all of those things coming up the pyramid are in pretty good shape, then you know, in your 50s and 60s, and 70s and 80s and sometimes even 90s, you're able to have satisfying sexual life.

SPEAKER_03 26:19

You you mentioned, you know, you can't be depressed. Um, and that just made me think of you know antidepressants and SSRIs, which, you know, as you know, is one of the side effects is the inability to get erection or weak erections.

SPEAKER_01 26:31

Right, and decreased libido.

SPEAKER_03 26:33

Decreased libido, right, in women too. And um, and then I was thinking about some of the hair loss medications, which also have that side of so medication side effects, like absolutely. Yeah, and that's a something that we don't necessarily focus on, but a lot of people are on these medications. So, what do you do for a person like that?

SPEAKER_01 26:52

You know, so it's really interesting. I'm I'm I'm on usually on the bleeding edge of of any new really interesting technology that comes out. So when I started doing surgical robotics in 2002, it was about four or five years before my colleagues at UCLA and UCSF were even doing that. We had the my hospital had the second Da Vinci surgical robot in the country. Uh, and so when artificial intelligence came out, I was like, this is the greatest thing since sliced bread. And so I actually cloned myself. I created a clone. And the thing about artificial intelligence that people don't really understand is when you go on ChatGPT or Gemini or one of those, and you look up, uh, especially for medical advice, a topic, the top three sources of information that AI uses are Reddit, Wikipedia, and YouTube.

unknown 27:45

Right.

SPEAKER_01 27:46

And if you don't believe me, just really ask ChatGPT.

SPEAKER_03 27:49

It'll tell you. Wikipedia and YouTube?

SPEAKER_01 27:53

Well, the thing is, they're not allowed to use copyrighted sources of information. Right? There's a huge lawsuit between OpenAI and New York Times and uh Wow. And so that's where these and I'm not saying that they're inaccurate all the time, but they're inaccurate enough that it's a problem. And so what I did is I built a clone and I hand selected all of the medical information that went into the clone. And so if you go to global menswellness.com, you can actually talk to my clone and ask my clone any men's health question. And my men's health clone is up on the most recent information on sexual health, hormonal health, cardiovascular health, orthopedic health, stem cells, GOP1 inhibitors, peptides.

SPEAKER_03 28:53

Like talking to you, basically.

SPEAKER_01 28:55

It it really, and you know, the amazing thing is I've beta tested it with hundreds and hundreds of patients. So patients come into my office, I talk to them, I take their history, whatever, I make recommendations. And then in front of the patient, I'll pull up my clone on my computer and I'll feed the information into the clone, and then I'll ask the clone, well, you know, what would you do? What how would you treat their erectile dysfunction? How would you treat their hormone issues, et cetera, et cetera? And there's really a hundred percent concordance between what I tell my patients and what my clone tells my patients. It's really spooky.

SPEAKER_03 29:31

Yeah, I mean, AI is changing the world in so many different ways.

SPEAKER_01 29:34

And the crazy thing is, my clone speaks 30 languages.

SPEAKER_03 29:38

That's cool.

SPEAKER_01 29:39

So I've had I've and I've tested it, right? So I've had patients speak to it in Russian, in Hindi, and Mandarin, in Spanish, in um Croatian, uh, and they say that it's really like um a very professional sounding language.

SPEAKER_03 29:57

All right. So that means that you have access, increased access to all sorts of populations that you otherwise would not have access to, which leads me to my next question. You know, we're talking about all these things that someone at home who's struggling with erectile dysfunction or someone at home who's thinking about the P long protocol. What about what about a person who's who can't go to see you, you know, to your office? Like, what do you suggest to that guy who's like, okay, I have erectile dysfunction? Like, what am I supposed to do?

SPEAKER_01 30:25

Well, I can give you the 10 things in 15 seconds that will make a man healthier than about 95% of men.

SPEAKER_02 30:33

Okay.

SPEAKER_01 30:34

Don't drink, don't smoke, don't do drugs, don't eat too much, exercise every day, stretch every day, do yoga, get good sleep, be nice to other people.

SPEAKER_02 30:47

And that's just okay.

SPEAKER_01 30:49

And I mean, if if it if a listener did that, they would be healthier than about 95% of men.

SPEAKER_03 31:00

I just had a conversation with one of my guy friends about alcohol, and I said, you know, there's new a new standard came out that said, like, for the first time ever, no alcohol. Yeah, zero.

SPEAKER_01 31:10

Is it zero?

SPEAKER_03 31:11

So that's it, but you know, our whole culture.

SPEAKER_01 31:14

Yeah, I mean, you know, alcohol is really four things. One, it's it's very integrated into our culture, right? So, like, you know, you're a guy, you go out drinking with your buddies, you know, you're getting a little older, you know, you go drink some wine with your spouse, you get older than that, you go drink whiskey with your buddies, but no alcohol is good. Alcohol is a depressant, right? That's the class of medication it's in. So it makes people depressed, it disinhibits people, right? So that most of the stupid things that most of us have done in life are under the influence of alcohol. I was having this talk with a patient one time, and I I could see tears kind of welling up in his eyes, and I saw a tear kind of come down his cheek, and then it went over this like big scar that I hadn't noticed before. And as it turns out, you know, he was under the influence of alcohol, got into a big bar fight, and like basically split his face wide open. Right. And then, you know, the other thing is it's empty calories. So I have patients that are overweight, yeah, and I do the math with them. And if you drink a glass of wine a day, that's 13 pounds of fat a year. So if you're drinking two glasses of wine, you know, it's very simple, it's simple math. A glass of wine is I think 125 or 150 calories times 365 divided by 3,500. 3,500 calories equals one pound of fat.

SPEAKER_03 32:43

That's crazy when you when you think about the math like that.

SPEAKER_01 32:45

Yeah, so I mean, simple math, two glasses of wine, 26 pounds of fat a year. And there's no nutritional value of that. So you're basically just taking in empty calories that's gonna make you fat.

SPEAKER_03 33:00

Wow. So let's go back to your supplement. Um, I'm curious about so it's physician formulated, it's classified as a dietary supplement. So it's not FDA-approved medication, just so our listeners know that from the get-go. But what can somebody at home try it if they wanted to? And I know we have to be very careful about like, because you're an MD, and you know, I'm just curious like, is that available to people? And how do you kind of navigate that space?

SPEAKER_01 33:26

Yeah. So if you go to affirmscience.com, AFFIRM science.com, you know, you can buy a bottle. We have it's it's relatively inexpensive compared to a lot of the other nitric oxide boosting supplements that are out there and try it. You know, it's the amazing thing is it's incredibly safe. So I did uh like a video for YouTube where I took 10 affirm tablets at one time, you know, and I had a great workout that day. I woke up in the morning with a great erection, but other than that, I was totally fine. It's an incredibly safe supplement.

SPEAKER_03 34:01

So it wasn't like pre-opism or like where you have the mega erect, like nobody wants that.

SPEAKER_01 34:08

Nobody wants that.

SPEAKER_03 34:10

Like, okay, so you're saying it's very safe. But like, can you talk about kind of like the I know you talked a little bit before about the studies you did, but like what is the evidence base for it?

SPEAKER_01 34:19

Like oh, there's there's a massive amount of evidence uh nitric oxide boosting in the sexual function um area, but also in blood pressure management. There's there's whole journals on nitric oxide. It's I mean, literally tens of thousands of papers on nitric oxide. You know, it's we couldn't live, we wouldn't exist without nitric oxide. It's it's that essential to circulation.

SPEAKER_03 34:46

And so And you feel comfortable kind of telling people, like guys at home, because this is a big issue, you know that, but like guys are always looking for something to try, and you feel comfortable saying, okay, try it, but do you say like discuss it with your physician or just or like what do you tell them?

SPEAKER_01 35:02

Well, you know, like for example, I have a lot of patients who, like I said, I get off their blood pressure medication. And so what I have them do is I I say, check your blood pressure at home morning and night, and then get on a firm, check your blood pressure morning and night for a week, and then get off your blood pressure medication, check your blood pressure morning and night, and then let's see if you actually needed to be on that pharmaceutical. And I'm certainly not against pharmaceuticals, absolutely not, but but if you don't need to be on them, like I got patients that come in and they're on they they're overweight, right? So they're on two type 2 diabetes medications, two blood pressure medications, and a cholesterol medication. And I tell them, you know, if you clean up your life, you can get off five medications. Those medications are sort of keeping you going because your lifestyle sucks. But if you clean up your lifestyle, you eat better, you exercise, you know, you keep well hydrated, then you don't need to be on those medications. And I have a lot of patients in my practice who will get off five medications. It takes them a year, year and a half, but eventually they will. And then, you know, they dramatically change the trajectory of their life.

SPEAKER_03 36:22

Yeah, and I agree with that. I think that there's so much power in lifestyle changes, diet, exercise, and it's just you know, I think the key for me is that when I left uh the practice I was in seven years ago, I do private pay, right?

SPEAKER_01 36:36

So I don't accept insurance. And so I can spend the time that I need with a patient without being a patient. You know, when I was in urology, I would see 30 or 40 patients a day. And I did the best, absolute best I could, but knowing that I had 10 or 15 minutes with patients, you can't do that much with them.

SPEAKER_03 36:58

Well, right, right, yeah. And that's to you have to hit your quota. I feel bad for practicing physicians to in the system. They they have so much, so much pressure on them. So you are functioning outside of the traditional health insurance model.

SPEAKER_01 37:13

I don't I don't accept health insurance.

SPEAKER_03 37:15

Oh, I didn't realize that. Okay, so yeah, patients who come to you pay out of pocket.

SPEAKER_01 37:21

Right.

SPEAKER_03 37:22

Okay. Now, do you do telehealth too?

SPEAKER_01 37:24

Or do you do I I do do telehealth, but I don't really like telehealth. You know, I'll do second opinions for people all over the world. Because I, you know, for me, first of all, I have diagnostics in my office that I don't have access to uh when I don't see a patient. But also it's it's like uh there's a feeling that you get, you know, when you're with someone in person. Um there's body language, there's a closeness that that you totally lose when you're when you're doing it on Zoom. You know, if you want, if you want to do a Zoom, just talk to my clone. My clone knows at least as much, if not more, than I do. You know, and it speaks 30 languages. I only speak one.

SPEAKER_03 38:05

Okay, so is your clone like actually like a picture of you too?

SPEAKER_01 38:09

Yeah, it's a picture of me, and it's my voice.

SPEAKER_03 38:11

How do I know I'm not talking to your clone? I guess I don't. I just have to try to.

SPEAKER_01 38:14

You know, it's it's it's gotten to the point, you know, I'm in the San Francisco Bay Area, so this is where the AI revolution started, and this is where it's all happening. And if you're in San Francisco, I can't even understand what the billboards say. It's uh it it's so esoteric. Um but the clones have gotten so good that you can't tell if you're talking to a real person or or not.

SPEAKER_03 38:44

Oh that's interesting.

SPEAKER_01 38:46

It it's it's astonishing.

SPEAKER_03 38:48

Yeah. And you can you you can clone yourself and keep yourself alive, I guess, perpetually.

SPEAKER_01 38:55

Um, I I read or watch the YouTube video. The the place to get the information or the where I get my information is YouTube, um, because that's the sort of most where the most cutting-edge stuff comes out of. But um, they were talking about Elon Musk and using the Optimus robots and using the uh Cyberlink to basically be able to download somebody's brain in about 10 years into a humanoid robot. Which sounds incredibly far-fetched, but if you see what what's going on now.

SPEAKER_03 39:29

Oh, yeah, I think I mean, I think it's only a matter of time. Like, you know, there's uh I read an a great kind of paper on the ethics of AI and like how we may not even know if AI develops consciousness, you know, we may not know the point when it crosses over, which is kind of cool and also a little scary to think about.

SPEAKER_01 39:49

Um you know, it's it was astonishing. I've I've fed my entire book to AI. And um, you know, we went so I I turned my book into a podcast using artificial intelligence. So if you go to Spotify and you look up the 21st century man, there's a podcast on my book, and so we use Notebook LM, which is a Google app. Uh, and we the initial it we went through a lot of iterations and a lot of prompt engineering to get to the point where we're at. But initially I just fed the whole book in and I created a podcast, and the insights that the AI had on my book were astonishing. You know, it was talking about like how Dr. Brandeis really was focused on the mind-body connection and not just physical health, but also emotional health, relationship health, and like very few people that have read the entire book came up with that level of of insight into my process writing the book. So there the AI has gone way beyond just a summary of facts, but AI has been able to integrate and come up with sort of conclusions based on whatever algorithm it has.

SPEAKER_03 41:09

Let's get back to supplements. Um, you know, because there's a lot of doctors.

SPEAKER_01 41:14

Yeah, I can go on so many different tangents.

SPEAKER_03 41:15

No, that's fine.

SPEAKER_01 41:16

I get so many different things going on.

SPEAKER_03 41:18

I appreciate the tangents, actually. I I I I love that. It's um you're probably pretty creative, I would imagine.

SPEAKER_01 41:24

But um But uh if you want to if you want to hear something mind-blowing, yeah, go on Spotify, go to the 21st Century Man, yeah, and start listening to the the the chapters.

SPEAKER_04 41:35

Okay.

SPEAKER_01 41:35

Uh and you can even read a chapter and then see what the podcast is. And it's uh it it's really it's astonishing.

SPEAKER_03 41:42

If you send me the link or I can find it, I'll include it in the show notes just for so our listeners know. But what do you say? So this is a space when you talk about sexual health. I mean, everybody hears stories about like the mini Mart pill, right? Like some guy or girl will take that like and hope for a good time and you know, get some side effect, or there's studies that come out like, oh, this pill that was actually supposed to help your penis stand up and perform. Actually, there's like stuff in it that shouldn't be in it. It's a space that's been heavily criticized. In addition to that, many of your colleagues who have all the credentials and backgrounds that you have, they're like, don't trust the supplement space at all. And they think it's dangerous. I'm just curious, what would you say to those people who have that criticism?

SPEAKER_01 42:29

Yeah. So there were a couple of supplements maybe 10, 15 years ago, that they put in Viagra into those supplements.

SPEAKER_04 42:37

Yeah.

SPEAKER_01 42:37

Um, but I can tell you now, uh, in order to sell supplements on Amazon, you have to submit your supplements every year to testing to look for impurities. And so the the supplement space is actually very heavily regulated. And so if you're getting something off, not that I'm promoting Amazon, believe me, Amazon isn't necessarily my friend, but um, if you're getting a supplement off Amazon, yeah, uh, especially in the sexual space space, it's actually very heavily regulated. You can't make false claims, you have to submit every year to test for impurities. And so, you know, what what you're saying was definitely true maybe 10, 15 years ago, but is not true now.

SPEAKER_03 43:21

So you are a fan of the supplement space. And like, do you think the two have to? I mean, I always kind of feel like it doesn't have to be one against the other. Like they're always kind of I don't know. That's how it's yeah.

SPEAKER_01 43:32

I mean, there's only two supplements that I routinely recommend to my patients.

SPEAKER_03 43:36

Oh, okay.

SPEAKER_01 43:36

One is a firm nitric oxide booster or a nitric oxide booster, and the other is creatine. You know, those two supplements have a massive amount of data. There's a lot of other stuff that a lot of folks take that, you know, there's decent data, you know, CoQ10. I take vitamin D uh because my vitamin D low is levels are low because I spent too much time inside. Um, you know, NMN, NMR, you know, there's there's a lot of stuff out there that has decent evidence, but creatine and uh nitric oxide booster are totally safe and very effective. And I understand the mechanism of action of the two of them. Like I can, I can, I like I I I'm one of those people like I need to get it. I need to understand like what the science is. The science has to be relatively simple.

SPEAKER_03 44:26

Yeah, no, I I totally hear you on that. And there's always, I mean, I I take some supplements I have and I, you know, just to see. Um for me, it's always like if the safety profile is okay, then like I'll try it. And you know, but I'm always worried, like, where did it come from? What's in it? Um, same thing though with my food, same thing with my dog's food. You know, I want to know like where like the beginning and then the end.

SPEAKER_01 44:50

Yeah, you know, and for me, sometimes it's really sort of overdone, you know, like people well, I mean, we live in a world of of all sorts of crap, you know, microplastics and um toxins and this and that. But at the end of the day, most of us are living into our 80s. So even though there's all this bad stuff floating around, you know, if you don't intentionally poison yourself with alcohol, with tobacco, with drugs, with um, you know, things that have too much cholesterol, so on and so forth, if you don't intentionally poison yourself with those things, you can live a long, healthy life.

SPEAKER_03 45:30

Are you into the whole longevity craze? I guess everybody is.

SPEAKER_01 45:34

I mean, that's kind of what I do.

SPEAKER_03 45:36

That's kind of what you do.

unknown 45:37

Okay.

SPEAKER_01 45:37

I mean, the stuff the stuff that I'm the the stuff that I'm doing um is helping my patients live longer, happier, more fulfilled lives. You know, and then there's life span, there's health span. Now there's even a concept called sex span, right? So how long can you have satisfying sex?

SPEAKER_03 45:57

Well, that's that's interesting. Talk more about that. Like what everyone's like, okay, and you're it decreases by every decade. But then honestly, I'm meeting more and more people who are older, who are like very sexually active and happy, women and men. And I'm like, what's going on there versus somebody who's like, nope, this is it, you know, stop having sex and that's that.

SPEAKER_01 46:18

No, no, I mean it's it's cardiovascular health. I did ultrasound on a patient the other day in his 80s who is a lifelong vegetarian. Oh my god, his the blood vessels in his penis were like amazing, right? Um really and then you know, it's also it's hormonally related in both men and in women, right? So in women, women go through menopause, right? So they're basically all their hormones just take a nosedive in their early 50s. But if I get a lot of guys who come in in their 60s and 70s because all of a sudden their spouse has gotten on hormones and their testosterone's high and they're chasing their husbands around the house. And the husbands are like, I've been waiting for this for like 30 years and now I can't do anything about it.

SPEAKER_03 47:05

That's funny. Yeah, like the time timing is everything. So you kind of want them to match up though.

SPEAKER_01 47:09

Yeah, yeah. Absolutely.

SPEAKER_03 47:10

So what would your what would your advice be to like a couple, like I don't know, who's in their mid-40s or 50s, where one person might be like hormone diving or the other per like erectile dysfunction? Well, yeah.

SPEAKER_01 47:22

I mean, I remember when I was at UCLA in in urology when Viagra came out, and you know, half the couples were ecstatically happy, and half the couples were really pissed off because they had released, they had reached kind of an equilibrium in their relationship, and Viagra all of a sudden changed that equilibrium.

SPEAKER_04 47:40

Yeah.

SPEAKER_01 47:41

And, you know, the the spouse was like, you know, I want to go play tennis and drinking with my friends. I don't want to have sex with you anymore.

SPEAKER_02 47:49

Yeah, yeah.

SPEAKER_01 47:50

And so, you know, it's that's why it's there's a there's the physiology of erectile function, but then there's the whole mental and emotional and psychological component. That's also part of that. That's the interesting thing about doing research in sexual medicine, is that the outcomes aren't necessarily so straightforward.

SPEAKER_03 48:10

That's really interesting. And I wanted to ask you, you know, you talked about 90% cardiovascular, and then we're talking about how there might be incompatibility in partners, depending on hormones and things that come with aging. But what about the psychological factor? Like when when that is the most significant thing, and however that manifests, you know, is it someone's not attractive? Is it somebody attracted? Is it someone feels rejected? Is it you know, what are you doing?

SPEAKER_01 48:37

You know, I mean, that's why like I have a whole section on relationships in the book, I have a whole section on mental health in the book. I have a whole section on aesthetics in the book, right? So I mean, I have a whole section on relationships in the book with with therapists, I have a whole section on mental health, I have a whole section on aesthetics. If you don't find your partner attractive anymore, and I even have a chapter uh written by Susan Bratton on how to make love to a how to please a woman, right? Like I I I live in the Bay Area, right? And I get these patients, a lot of them are sort of Indian software engineers who spend all their time in high school and college and grad school basically studying stuff, and then they go and they get married. A lot of them are in these arranged marriages, and they get to the bedroom, they have no idea what to do, right? That's a problem. Yeah, that's sort of a psychological issue problem, so on and so forth. Then that can cause erectile dysfunction, like a self-esteem type of thing. Yeah, self-esteem, or just not even knowing the anatomy, how things work. Oh, so on and so there's so many, there's so many aspects. Or I I remember this one patient. I I treated him and uh and I was asking him, like, you know, oh, how are things going? He goes, Oh man, doc, a hundred bucks down the drain. I'm like, what do you mean? He goes, Well, you know, I took my wife out the other night, I spent a lot of money on dinner, got a good bottle of wine, loaded up on Viagra. He goes, and then I said one stupid ass thing, and it was a hundred bucks down the drain. Right? I mean, that's it. If you're taking uh, you know, a cardiology medication or curious, yeah. Well, I could I can only imagine. I'm sure I've said my share of stupid things to my wife too.

SPEAKER_03 50:23

So right, right, right. Okay, it goes with the Y chromosome. But you know what else I think there's I think just in my experience, there's this pressure, men feel like come with this pressure to perform versus connect. Do you know what I mean?

SPEAKER_01 50:41

Absolutely. Well, it's and it's it has to do with the sympathetic parasympathetic system, right? So if you're putting pressure on yourself, uh, and then you're not performing the way that you think your partner wants you to perform, then you generate adrenaline or epinephrine, cortisol, right? And what do those hormones do to erectile function? They constrict blood flow to non-essential organs. And one of those non-essential organs is the penis. Same thing if you're running away from a bear, you're not going to get an erection. But when you're running away from a bear, you produce adrenaline, epinephrine, cortisol. When you're nervous that things aren't working out in the bedroom, you're producing those exact same hormones. And so that you know, that's another thing that can significantly affect erectile function and performance.

SPEAKER_03 51:35

Yeah. And I think that also has to do with the dynamic, you know. I think sometimes women well, I mean, I remember a statistic with like how many women lie about having orgasms. And you know, it was a really high percentage, by the way. And I often ask myself, like, why do women do that? Like, what is it like that the percentage is so high that like you're trying to make a guy feel better, but then maybe you're also not saying, hey, do this, like blah, blah, blah.

SPEAKER_01 51:59

But well, and also, you know, like maybe women don't want to feel like they want to tell their spouse that they're not capable of climaxing.

SPEAKER_03 52:08

Well, that's true too. And I and I think um, I have some girlfriends who've told me that like have never had an orgasm during sex, but still enjoy sex. So there's all sorts of things out there.

SPEAKER_00 52:18

It's a it's it's a it's it's it's a really interesting subject.

SPEAKER_01 52:23

And it's it's it's it's very difficult to do good research in it.

SPEAKER_03 52:27

And it's uh Yes, yes.

SPEAKER_01 52:29

Uh, and and there's a lot of research that needs to be done. Um, but there's also not a lot of I remember when I was I was doing the the Pelong study, and we had listed in the uh clinicaltrials.gov, which is the NIH website for clinical trials. So I had this guy call in, he wanted to participate, and I was like, sir, you know, your your area code is in Ohio. Are you know are you are you in the Bay Area? And he's like, No, but isn't this study sponsored by the NIH? You know, can't they fly me in? And I was like, dude, the NIH cares about curing cancer and and and heart disease, they don't care about the size of a guy's penis.

SPEAKER_03 53:10

Yeah, well, I mean, and like just for women's health, we we just had right the hormone therapy, like the black box.

SPEAKER_01 53:15

Yeah, that was wow, that was amazing. That was so, gosh, there there was so much misunderstanding over women's hormones and the risk of breast cancer, and it was just so horrible. And I I the there's another amazing chapter in my book called When Uh Men's Guide to Menopause, right? Written by a friend of mine who's a male gynecologist. And uh it's an amazing, essential chapter that I have all my male patients read because they have to know about menopause and they have to know about the aging vagina. You know, you're not having sex with the same woman you were 20 years ago.

SPEAKER_03 53:51

Right, right. It's so true, it's true. It's all just things I feel that like have to come out more, just have more open conversations about them. And but the good thing now, like there's things people can do. Um and unless you talk about it, you're not gonna know. Uh absolutely. But what's really sad is when someone has such a poor sex life that it like destroys the relationship, you know, and it wouldn't otherwise do that if we had these types of conversations. So I don't know. That's uh I'm just curious. What diet do you follow? Are you a vegetarian?

SPEAKER_01 54:23

Oh no, I pretty much eat everything.

SPEAKER_03 54:25

You eat everything. Okay, okay.

SPEAKER_01 54:26

I'm not you would definitely not be impressed with my diet.

SPEAKER_03 54:32

Okay, okay.

SPEAKER_01 54:33

So, but like you just mentioned vegetarianism, like and the guy has to be like, Yeah, I mean, like I I've I've thought about being a vegetarian, but I like meat too much. I take a little bit of crust or because I like steak and ice cream. Uh, and I have a family history of heart disease. I work out a lot. I think that's my saving grace. I had a heart calcium score, and my heart calcium score was zero. Uh, so I was really happy about that. Uh, I just had a full-body MRI, which I get about every five or six years, and that was all clean. So, you know, I I my my rule basically is uh eat protein first, and then you can eat carbs and sugar after that. I have a very high metabolism for sugar. When I checked my hemoglobin A1C, it was 4.3, which is super low, which means I metabolize sugar really quickly. So I I'm I eat a lot of sugar, even though I'm not supposed to.

SPEAKER_03 55:24

Yeah, no, I I'm kind of the same way, like because when you look at the balancing of glucagon and insulin, and I always try to have like whole foods and eat in moderation and try to get everything from the farmer's market if I can, which I guess is a privilege because I know sometimes it can be.

SPEAKER_01 55:38

I get my stuff from Costco. You know, I I honestly like I nothing against like holistic or functional medicine people or or you know, and people that order you know fish from Alaska and all that kind of stuff. Um, yeah, you know, I think that's great. I don't I don't think it moves the needle all that much. And you know, it's interesting. I have a I have a lot of patients that are farmers that are like industrial farmers. And I had this one farmer tell me, you know, organic food is great, but if we all went organic, you'd have to figure out which 30% of the world population you want to you want to feed.

SPEAKER_04 56:16

Right.

SPEAKER_01 56:17

I mean, there's reasons that you use pesticides, there's reasons that they they they do industrial farming because it it's much more effective in in growing food.

unknown 56:26

Yeah.

SPEAKER_01 56:26

And even like, you know, it's I I I think of it like exercise, right? When you look at the outcomes of exercise, 70% of exercise is just being consistent, just doing it on a daily basis. 20, 25% is kind of what you do, what your rook art routine is. And then 5%, maybe 10% are supplements and massages and red light therapy and cool plunges and all these other little things that that people do that um, you know, if you're an elite athlete, like I take care of some of the 49ers and and nice those kind of uh professional athletes, like those are the things that are the difference between a $2 million contract and a $10 million contract, or making the team and not making the team. But for most of the rest of us, it moves the needle a little bit, but not very much.

SPEAKER_03 57:20

Okay, that's that's fair. I think there's a like a psychological component for a lot of people.

SPEAKER_01 57:24

I had this one guy flew in to see me from Florida, right? Because I'm like, you know, I'm the expert, whatever. And uh he wanted to talk to me about peptides. And he's like, you know, I'm thinking about taking thalmus thymus alpha one and BPC 157 and this and that. And I looked at him, I said, dude, lose 50 pounds. After you lose 50 pounds, then you can focus on peptides.

SPEAKER_03 57:47

Yeah, yeah. Well, that's an excellent point. And I think there's so much free stuff, like free, or I should say, inexpensive stuff people can do. It's like the boring stuff, it's the stuff that doesn't sound sexy. Boring stuff. Yeah, like sleep, eat, eat healthy as you can, exercise, move consistently long term. And yet people are the people who are like most unhealthy or have those unhealthy habits are like, what can I take to like turn my biological age back?

SPEAKER_01 58:12

Hey, people just want a magic pill. Now they have semaglutide, right? Semaglutide is as close to a magic pill as there ever has been in the history of humanity. It's just those drugs, those peptides are amazing. Um, but still, you know, people do that, but they don't change their lifestyle. And as soon as they get off, they put the weight back on, they put the fat back on because you're losing fat and you're losing muscle. Yeah, and so your basal metabolic rate drops. And so, and muscle is much harder to build than it than fat to take off. So uh a lot of those patients that I have on uh semaglutide, I'll put on testosterone.

SPEAKER_02 58:49

Really?

SPEAKER_01 58:50

In order to maintain, oh yeah, the combination of those two are spectacular. Okay, absolutely spectacular.

SPEAKER_03 58:59

Okay, yeah. I mean, and I think that I think it's great that they're increasing access for the GLP ones or the the weight loss medication for our listeners. I do not think that they're going to get us out of the obesity epidemic. I think that a lot of what we have to do has to be prevention. I think since they're gonna be so widespread at the population level, we will see, as with any drug outside of a trial in a limited population, we're gonna see other side effects, we're gonna see other nuances that come up, people are gonna want to stop them, and then what, right? Like, so I think we have to also really, really remember prevention and focus on it for sure. Absolutely.

SPEAKER_01 59:37

I mean, you know, it's it would be nice to be a prevention, proactive driven society. Uh, and you know, I think the current head of health and human services uh is trying to push that, but it's that's that's a generational change. That's not something that's gonna happen overnight.

SPEAKER_03 59:57

Yeah. I and I agree with you. I think he is trying to do that. And there's a lot of backlash to that too, because a lot of this goes back to how we approach kind of chronic diseases and how we talk about them, right? And like, oh, we don't want to um we don't want to make someone feel bad about their current health condition. This is, you know, we're gonna treat it. But I I think we have to also remember like these long-term causes.

SPEAKER_01 1:00:24

People need tough love. I mean, I had a patient, I had a patient the other day, he was 100 pounds overweight, you know, he's was drinking eight beers a day. And I just looked at him and I said, dude, if you don't stop this, you're gonna fucking die a miserable death. What the fuck are you doing?

SPEAKER_02 1:00:42

Yeah.

SPEAKER_01 1:00:43

And he started tearing up. He's like, I've been going to doctors for 25 years, no one's ever talked to me like that. Yeah. And you know what? I saw him two months later. He had stopped drinking. He had lost like 15, 20 pounds already.

SPEAKER_04 1:00:55

Yeah.

SPEAKER_01 1:00:56

He had just totally turned his life around. People need different people need different ways to motivate them. But the thing is, I could do that because I could spend more time with him. Yeah, that's because I don't take insurance. If you're just if you're just 10 minutes a patient and you're just whipping people through, then you're like, all right, well, we'll we'll raise your diabetes medication, we'll increase your your blood pressure medication, we'll we'll add some Libitor, and you know, we'll get a bunch of labs in three months.

SPEAKER_03 1:01:23

So is that why you got out of the kind of the health insurance model?

SPEAKER_01 1:01:26

Well, you know, uh insurance doesn't pay for sexual medicine either.

SPEAKER_03 1:01:30

Really? Nothing.

SPEAKER_01 1:01:32

Shockwave, PRP, any of that kind of stuff they don't pay for.

SPEAKER_03 1:01:36

Okay. Okay. So you are private.

SPEAKER_01 1:01:38

I'm private.

SPEAKER_03 1:01:39

All right.

SPEAKER_01 1:01:40

And loving it. It's a it's a very, very honest way to practice medicine, right? People come in these days, you you produce a note that's like seven pages long with a bunch of gibberish to to upcode, you bill level five to make uh money, but you don't really provide much of a service to the patient. Most of the time it goes into documentation. I I I I understand the game. I played it for a long time. Right. A patient comes to me, I see them, my notes are pretty short, I spend time with the patient, I charge them what I think is fair. And if they if I don't provide value to the patient, they tell me, listen, like I didn't I don't feel like it was worth it. And then if if I if if there's something I can do about it, if I if if I can see them more, like I my goal is to make every patient leave the office happy, feeling like they got something for the the money, or much, much more than the money that they paid me. Uh and it for me it's a very honest way of practicing medicine, a very honest way of doing business, rather than to try to game the insurance company to try to get as much money as you can out of them by writing a 12-page note with all with a review of systems that you never did, a physical exam that you never did, uh, medical decision making that you never did. It's it's really, it's it's an atrocious, horrific system.

SPEAKER_03 1:03:11

Uh I have two more questions. If that's anyway, sorry. No, no, it is an atrocious.

SPEAKER_01 1:03:16

Read the chapter on um how the health system works in my book. It's really very, very well. Like I looked for chapters that I could sort of copy or plagiarize for the book, and I couldn't find them. Like there was no 12, 15 page chapter in anything that I found on how our health system works. And so we had to write it. There was no 10 or 12 page chapter on what men need to know about menopause in the aging vagina. So we had to write it. I mean, there are so many chapters in this book that are so unique.

SPEAKER_02 1:03:51

Yeah.

SPEAKER_01 1:03:51

And believe me, I looked for them because I would have just asked the authors, like, do you mind rewriting that and putting it into my book? Yeah. It would have made my life a lot easier.

SPEAKER_03 1:04:00

I don't even know if there's like a lot of women's books for the aging vagina. Like, you know, it's yeah, I mean, read it.

SPEAKER_00 1:04:07

It's fantastic. It's really one of the amazing chapters.

SPEAKER_03 1:04:10

So, what would you say to a guy who's out there who's struggling with his sexual health, and maybe even a little embarrassed to talk about it? Because sometimes people are embarrassed to talk about these things for whatever reason. How would you tell that guy to start? Like, where what should he do?

SPEAKER_01 1:04:27

Yeah. I mean, first of all, don't drink, don't smoke, don't do drugs, don't eat too much, exercise every day, meditate, stretch, get good sleep, do some yoga, be nice to other people. Like off the bat, do those 10 things. You'll save money, you'll feel better. It's free. Right? Then, you know, get a copy of the 21st century man. That's the next level of information on all of those things. You can go to Spotify, you can listen to the 21st Century Man podcast now in six languages. Pretty soon we'll be in 18 languages. You can go to Global Men's Wellness, which is my YouTube channel, or Brand Icemd. I have two YouTube channels. Brandis MD is my other YouTube channel, and there's a massive amount of health information there. You can go to my clone, which is Global Men's Wellness, and ask my clone, like seriously, it sounds so obnoxious to say it's the greatest men's health resource ever created in the history of the world. But use it, ask it any question, drill down into the most specific question you could ever possibly imagine. Go read it all your labs, read it all your x-ray reports, ask it any question. It you'll be astonished how good it is. Uh, so there's there's a massive amount of resources out there, but especially that I've created to help guys be healthy. Because at the end of the day, that's like that's my mission. That's what I care about.

SPEAKER_03 1:05:54

Are you doing any more research?

SPEAKER_01 1:05:57

So I'm part of a couple of startups. Startups in Silicon Valley. One looking for a new way to treat Peyrone's disease, and another looking at microvascular ultrasound of the penis to evaluate improvements in erectile function, and the other looking at new ways to block the venous outflow from the penis to help improve erectile function. So I got those three things going. But no active studies right now.

SPEAKER_03 1:06:22

No active studies. What about kidneys? I I'm I'm I one of my really good friends is going through like end stage and I just kidneys are fascinating, but but they don't regenerate.

SPEAKER_01 1:06:37

No. I only got two.

SPEAKER_03 1:06:40

Yeah.

SPEAKER_01 1:06:40

You can give away one, but don't don't mess the other one up.

SPEAKER_03 1:06:44

Yeah, that's uh heartbreaking. Anyways, thanks so much for your time. This was really fascinating and my pleasure. I look forward to uh checking out your podcast and your book and uh reading those chapters myself, and definitely will recommend them to uh folks and that kind of thing. Awesome.

SPEAKER_01 1:07:02

When I was at uh Brigham and Women's Hospital working in the lab where they did the first living-related kidney transplant, they also helped develop dialysis. And since there were very few dialysis machines at that time, people would come from all over the place to Brigham for dialysis. And the doctors, the nephrologists there literally were God. They literally could choose which patients lived and which patients died based on access to dialysis.

SPEAKER_03 1:07:30

Yeah.

SPEAKER_01 1:07:31

So that's and the development of dialysis and kidney transplants is fascinating.

SPEAKER_03 1:07:35

Yeah. I I mean, I hear different things about hemodialysis versus peritoneal dialysis. I don't know enough about it. Yeah like one way or the other.

SPEAKER_01 1:07:43

But anyway, I didn't mean I mean I didn't mean to open up a a new screen.

SPEAKER_03 1:07:46

I know. I was like awesome.

SPEAKER_01 1:07:49

Well, thank you for having me on. I really appreciate it.

SPEAKER_03 1:07:51

Yeah, definitely. All right. Thank you. You're welcome. Bye-bye. All right. Thank you everyone for joining in for today's episode. Again, I'll have all those links for Dr. Brandeis in the show notes. Check them out if you want. If you haven't yet, subscribe to the podcast so you know what episodes are coming up. There's some good stuff I'm adding um starting in May, which is right now. Uh and don't forget to subscribe to the newsletter too, so you can keep up to date on everything and get some really fun news blurbs that I create and other stuff and interviews with people. All the good stuff, okay? Uh, also follow me on TikTok or Instagram so you don't miss my public health is weird video trivia bits. Uh, people seem to dig them, and I get it because they're fun. And can you hear the car outside? It's like blasting music. I always ask that, but I don't think you guys can hear it. Anyways. And now it's time for the closing quote. And this one is from Marty Busella. Here it is. When it comes to staying young, a mind lift beats a faced lift any day. Oh, I love that. So many people need to hear that, you know. A mind lift, yeah. Much less to invasive, much less invasive, and probably a hell of a lot more productive for you if you can really do it. All right, that's it. Uh, go out and enjoy your day. I'll see you soon, and goodbye for now.