@Judson Brandeis : 我是一名泌尿科医生，专注于男性健康，特别是性功能的恢复和优化。我的职业生涯始于对肾移植的兴趣，后来转向了前列腺癌和机器人手术。大约六七年前，我开始对男性的性功能再生治疗产生兴趣，例如低强度冲击波疗法、高强度聚焦电磁波、干细胞和PRP。我的诊所专注于男性的整体健康，包括性功能、荷尔蒙功能和身体优化。我撰写了《21世纪男人》一书，总结了50位顶级医生和男性健康专家的建议，旨在帮助男性在中年及以后保持身心健康。 我发现90%的性功能障碍是血管生成的，这意味着阴茎的血管开始堵塞，这可能是由衰老、吸烟、饮酒、久坐不动的生活方式、饮食不当和遗传因素造成的。性功能障碍是一个连续的过程，从丧失晨勃和夜勃开始，然后发展为勃起功能障碍，最终可能导致心血管疾病。勃起功能障碍是男性健康状况的预警信号，提示循环系统可能存在问题。 为了改善整体健康和勃起功能，男性应该戒酒、戒烟、戒毒、控制饮食、每天锻炼、每天拉伸、每天冥想、保证充足的睡眠以及善待他人。在诊所中，我会为患者进行全面的实验室检查、病史记录和身体成分扫描，以制定个性化的治疗方案。睾酮替代疗法有多种途径，例如注射、贴片和乳膏，但注射和植入疗法能达到更高的睾酮水平，对于想要改善身体和性功能的男性来说，是更好的选择。 睾酮注射后，男性几乎可以立即感受到改善，包括提高动力、性欲、肌肉增长能力、脂肪燃烧能力、睡眠质量和情绪。一项大型研究表明，睾酮替代疗法对心脏健康有益，不会增加心脏病发作或中风的风险。睾酮注射可能会导致肿块，但可以通过旋转注射部位以及使用冲击波疗法来缓解。皮下注射系统，如Zyastad，可以提供约700-750的睾酮水平，对于难以进行肌肉注射的人来说是一个不错的选择。睾酮是一种大分子，很难通过皮肤吸收，因此睾酮霜的效果有限。 长期服用外源性睾酮会抑制下丘脑-垂体-睾丸轴，导致睾酮和精子的产生减少。为了维持睾丸功能，我会让我的患者服用克罗米芬等药物来阻断负反馈回路。进行睾酮替代疗法时，需要监测睾酮和雌激素水平以及睾丸功能。滥用性能增强药物可能会导致不育和其他严重的健康问题。勃起功能主要取决于血液循环，因此评估血管状况比单纯关注睾酮水平更重要。超声检查可以评估阴茎血管的状况，这对于评估勃起功能非常有帮助。心脏钙化评分可以评估血管堵塞的程度，这与勃起功能障碍密切相关。 VO2 max测试可以评估心血管健康状况。勃起功能障碍可能是心脏疾病的早期预警信号。低强度冲击波疗法可以促进阴茎血管新生。富血小板血浆（PRP）可以促进阴茎血管的生长。一氧化氮可以促进血管扩张，而补充剂如西特律林和甜菜可以增加一氧化氮的产生。伟哥通过抑制PDE5酶来维持环鸟苷酸（cGMP）的水平，从而保持血管开放。一项临床研究表明，将伟哥与一氧化氮增强剂联合使用可以增强疗效，并减少伟哥的副作用。服用非那雄胺或度他雄胺等药物可能会导致严重的勃起功能障碍。可以通过阅读我的书、访问我的网站和YouTube频道以及咨询性医学专家来获得更多关于勃起功能障碍的信息和帮助。关注男性性功能不仅关乎生活质量，也关乎身心健康，勃起功能障碍可能是其他健康问题的预警信号。
@Richard Jacobs : 我是理查德·雅各布斯，主持《寻找天才》播客。我的嘉宾是Judson Brandeis博士，他是一名泌尿科医生和性医学专家。我们将讨论他的新书《21世纪男人》，以及如何帮助男性在中年及以后保持身心健康。大多数专业人士只是合格的，只有极少数人才能做到卓越。勃起功能障碍的早期症状是什么？
supporting_evidences Judson Brandeis: 'Well, you know, I'd say 90% of sexual dysfunction is vasculogenic, meaning that the blood vessels to the penis start to get clogged. And that can become from aging, from smoking, from drinking, from sedentary lifestyle, from not eating the right foods, from genetics…' Judson Brandeis: 'Yeah, well, I mean, you know, there are 10 things that I recommend men do that will improve their health in general and certainly will also improve erectile function. And that is don't drink alcohol, don't smoke, don't do drugs, don't eat too much, exercise every day, stretch every day, meditate every day, get enough sleep and be nice to other people.' Judson Brandeis: 'Yeah, actually, I've heard that it can raise your risk of like, you know, I don't know what the circumstance would be, but, you know, stroke or heart attack. Yeah. So actually, there was a recent study that came out called the Traverse Study, which was a massive study that showed that testosterone replacement actually was heart healthy…' Judson Brandeis: 'So you get nighttime erections so that your penis is ready to have daytime erections. So it would be rare to just have a guy who only gets erections when he needs to get erections. So typically you'll get 30 to 60 minutes of erections every night when you're sleeping, and that brings oxygenated blood and nutrients into the penis…' Judson Brandeis: 'So I think that really is the best way for me to assess with a single test what someone's erectile function is going to be, is to actually look at the blood vessels in the penis and assess what those blood vessels look like.' Judson Brandeis: 'Yeah. So one of the most popular ones and one of the best ones is called low-intensity shockwave therapy. And what that is is pulsed You can think of them as sound waves or energy waves that go into the penis…' Judson Brandeis: 'And then that's also how Viagra works, right? So Viagra targets a specific enzyme that's only in the penis called PDE5, and PDE5 is breaks down cyclic GMP. So if you inhibit PDE5, which is what Viagra does and Cialis does, then you maintain cyclic GMP and keep the blood vessels open.' Judson Brandeis: 'Yeah. So, you know, one super easy thing to do is just to buy a copy of my book, The 21st Century Man. So it provides information on really all the topics that are related to sexual function…' Richard Jacobs: 'Forget frequently asked questions. Common sense, common knowledge, or Google. How about advice from a real genius? 95% of people in any profession are good enough to be qualified and licensed. 5% go above and beyond. They become very good at what they do, but only 0.1%.' Richard Jacobs: 'Hello, this is Richard Jacobs with the Finding Genius podcast. My guest today is Dr. Judson Brandeis. He's a urologist and a sexual medicine expert. So we're going to talk about the 21st century man, advice from 50 top doctors and men's health experts to help you feel great, look good, and have better sex. His book.' Richard Jacobs: 'Yeah. But again, what does this mean? So is the average man supposed to get multiple erections a day or in the night or… You know, what is a normal circumstance and what is a non-normal one that you run into?'
我是一名泌尿科医生，专注于男性健康，特别是性功能的恢复和优化。我的职业生涯始于对肾移植的兴趣，后转向前列腺癌和机器人手术。大约六七年前，我开始对男性的性功能再生治疗产生浓厚兴趣，例如低强度冲击波疗法、高强度聚焦电磁波、干细胞和PRP疗法。我的诊所专注于男性的整体健康，涵盖性功能、荷尔蒙功能和身体优化。我撰写的《21世纪男人》一书，汇集了50位顶级医生和男性健康专家的建议，旨在帮助男性在中年及以后保持身心健康。
性功能障碍：血管生成问题与整体健康
我发现90%的性功能障碍源于血管生成问题——阴茎血管开始堵塞。这可能是衰老、吸烟、饮酒、久坐、不良饮食和遗传因素等多种因素共同作用的结果。性功能障碍并非突发事件，而是一个循序渐进的过程：首先是晨勃和夜勃消失，然后是勃起功能障碍，最终可能发展成心血管疾病。勃起功能障碍实际上是男性健康状况的预警信号，提示循环系统可能存在问题。
改善健康和性功能的十个关键步骤
为了改善整体健康和勃起功能，我建议男性遵循十个关键步骤：戒酒、戒烟、戒毒、控制饮食、每天锻炼、每天拉伸、每天冥想、保证充足的睡眠以及善待他人。
个性化治疗方案：实验室检查、病史记录和身体成分扫描
在我的诊所，我会为每位患者进行全面的实验室检查、详细的病史记录和身体成分扫描，以制定个性化的治疗方案。
睾酮替代疗法：注射、植入优于贴片和乳膏
睾酮替代疗法有多种途径，包括注射、贴片和乳膏。然而，注射和植入疗法能达到更高的睾酮水平，对于希望改善身体和性功能的男性来说，是更有效的选择。
睾酮疗法的益处和潜在风险
睾酮注射后，男性几乎可以立即感受到改善，包括提高动力、性欲、肌肉增长能力、脂肪燃烧能力、睡眠质量和情绪。最近一项大型研究（Traverse Study）表明，睾酮替代疗法对心脏健康有益，不会增加心脏病发作或中风的风险。然而，睾酮注射可能会导致肿块，但这可以通过旋转注射部位以及使用冲击波疗法来缓解。皮下注射系统，如Zyastad，可以提供约700-750的睾酮水平，对于难以进行肌肉注射的人来说是一个不错的选择。由于睾酮是一种大分子，很难通过皮肤吸收，因此睾酮霜的效果有限。
长期睾酮疗法与睾丸功能
长期服用外源性睾酮会抑制下丘脑-垂体-睾丸轴，导致睾酮和精子的产生减少。为了维持睾丸功能，我会让我的患者服用克罗米芬等药物来阻断负反馈回路。在进行睾酮替代疗法时，必须密切监测睾酮和雌激素水平以及睾丸功能。滥用性能增强药物可能会导致不育和其他严重的健康问题。
超越睾酮：关注血管健康
勃起功能主要取决于血液循环，因此评估血管状况比单纯关注睾酮水平更重要。超声检查可以有效评估阴茎血管的状况，这对于评估勃起功能非常有帮助。心脏钙化评分可以评估血管堵塞的程度，这与勃起功能障碍密切相关。
VO2 max测试：评估心血管健康
VO2 max测试可以有效评估心血管健康状况。勃起功能障碍可能是心脏疾病的早期预警信号，不容忽视。
先进疗法：低强度冲击波疗法、PRP和一氧化氮增强剂
低强度冲击波疗法可以促进阴茎血管新生。富血小板血浆（PRP）可以进一步促进阴茎血管的生长。一氧化氮可以促进血管扩张，而补充剂如西特律林和甜菜可以增加一氧化氮的产生。伟哥通过抑制PDE5酶来维持环鸟苷酸（cGMP）的水平，从而保持血管开放。一项临床研究表明，将伟哥与一氧化氮增强剂联合使用可以增强疗效，并减少伟哥的副作用。
非那雄胺/度他雄胺的潜在风险
服用非那雄胺或度他雄胺等药物可能会导致严重的勃起功能障碍，这需要引起高度重视。
寻求帮助：多种途径获取信息和支持
可以通过阅读我的书《21世纪男人》、访问我的网站BrandeisMD.com和YouTube频道BrandeisMD，以及咨询性医学专家来获得更多关于勃起功能障碍的信息和帮助。
结语：关注男性性功能，关乎整体健康
关注男性性功能不仅关乎生活质量，也关乎身心健康。勃起功能障碍可能是其他健康问题的预警信号，及早发现、积极治疗至关重要。
◉
00:16 大多数专业人士只是合格的，只有极少数人才能做到卓越。
◉
00:55 我的访谈嘉宾Judson Brandeis博士是泌尿科医生和性医学专家，我们将讨论他的新书《21世纪男人》。
◉
01:24 我在泌尿科领域的职业生涯始于对肾移植的兴趣，后来转向了前列腺癌和机器人手术，最终专注于男性的性功能再生治疗。
◉
03:19 90%的性功能障碍是血管生成的，这意味着阴茎的血管开始堵塞，这可能是由衰老、吸烟、饮酒、久坐不动的生活方式、饮食不当和遗传因素造成的。
◉
03:39 男性性功能障碍是一个连续过程，从丧失晨勃和夜勃开始，然后发展为勃起功能障碍，最终可能导致心血管疾病。
◉
04:34 勃起功能障碍的早期症状是什么？
◉
04:52 勃起功能的“正常”情况因人而异，但重要的是关注功能的丧失。
◉
05:20 男性通常每晚睡眠时会有30到60分钟的勃起，这有助于为性行为做好准备。
◉
06:49 为了改善整体健康和勃起功能，男性应该戒酒、戒烟、戒毒、控制饮食、每天锻炼、每天拉伸、每天冥想、保证充足的睡眠以及善待他人。
◉
07:13 当医生建议男性改变生活方式时，他们通常会如何回应？
◉
07:28 男性通常会对数字更敏感，因此我会根据他们的实验室检查结果、身体成分扫描结果等数据来制定个性化的治疗方案。
◉
08:19 我的书《21世纪男人》涵盖了男性健康的各个方面，从身体健康到情感健康、人际关系健康以及美学健康等等。
◉
08:42 睾酮替代疗法有多种途径，例如注射、贴片和乳膏，但注射和植入疗法能达到更高的睾酮水平。
◉
10:34 睾酮注射后，男性几乎可以立即感受到改善，包括提高动力、性欲、肌肉增长能力、脂肪燃烧能力、睡眠质量和情绪。
◉
11:11 一项大型研究表明，睾酮替代疗法对心脏健康有益，不会增加心脏病发作或中风的风险。
◉
12:11 睾酮注射可能会导致肿块，但可以通过旋转注射部位以及使用冲击波疗法来缓解。
◉
12:48 皮下注射系统，如Zyastad，可以提供约700-750的睾酮水平，对于难以进行肌肉注射的人来说是一个不错的选择。
◉
09:45 睾酮是一种大分子，很难通过皮肤吸收，因此睾酮霜的效果有限。
◉
10:34 对于想要改善身体和性功能的男性来说，注射或植入睾酮是比使用乳膏更好的方法。
◉
15:37 滥用性能增强药物可能会导致不育和其他严重的健康问题。
◉
15:58 长期服用外源性睾酮会抑制下丘脑-垂体-睾丸轴，导致睾酮和精子的产生减少。
◉
16:49 为了维持睾丸功能，我会让我的患者服用克罗米芬等药物来阻断负反馈回路。
◉
18:29 进行睾酮替代疗法时，需要监测睾酮和雌激素水平以及睾丸功能。
◉
19:55 哪些生物标志物可以提示男性应该关注他们的性功能？
◉
20:19 勃起功能主要取决于血液循环，因此评估血管状况比单纯关注睾酮水平更重要。
◉
20:44 超声检查可以评估阴茎血管的状况，这对于评估勃起功能非常有帮助。
◉
21:07 心脏钙化评分可以评估血管堵塞的程度，这与勃起功能障碍密切相关。
◉
22:33 勃起功能障碍可能是心脏疾病的早期预警信号。
◉
22:33 VO2 max测试可以评估心血管健康状况。
◉
26:08 低强度冲击波疗法可以促进阴茎血管新生。
◉
26:26 富血小板血浆（PRP）可以促进阴茎血管的生长。
◉
26:52 一氧化氮可以促进血管扩张，而补充剂如西特律林和甜菜可以增加一氧化氮的产生。
◉
27:33 伟哥通过抑制PDE5酶来维持环鸟苷酸（cGMP）的水平，从而保持血管开放。
◉
27:54 一项临床研究表明，将伟哥与一氧化氮增强剂联合使用可以增强疗效，并减少伟哥的副作用。
◉
28:59 服用非那雄胺或度他雄胺等药物可能会导致严重的勃起功能障碍。
◉
30:31 可以通过阅读我的书、访问我的网站和YouTube频道以及咨询性医学专家来获得更多关于勃起功能障碍的信息和帮助。
◉
31:34 关注男性性功能不仅关乎生活质量，也关乎身心健康，勃起功能障碍可能是其他健康问题的预警信号。
00:00
Forget frequently asked questions. Common sense, common knowledge, or Google. How about advice from a real genius? 95% of people in any profession are good enough to be qualified and licensed. 5% go above and beyond. They become very good at what they do, but only 0.1%. 语法解析
00:16
Richard Jacobs has made it his life's mission to find them for you. He hunts down and interviews geniuses in every field. Sleep science, cancer, stem cells, ketogenic diets, and more. Here come the geniuses. This is the Finding Genius Podcast with Richard Jacobs. 语法解析
00:37
Hello, this is Richard Jacobs with the Finding Genius podcast. My guest today is Dr. Judson Brandeis. He's a urologist and a sexual medicine expert. So we're going to talk about the 21st century man, advice from 50 top doctors and men's health experts to help you feel great, look good, and have better sex. His book. 语法解析
00:55
So welcome, Judson. Thanks for coming. Oh, it's my pleasure. Thanks for having me on. Yeah. Tell me a bit about your background. What got you into this, I guess, uncommon area of study? Oh, gosh. I had a kind of a surreptitious way of ending up where I ended up. So I was a history major at Brown University. And after graduating, I went and worked at American Red Cross for a guy named Harold T. Merriman, who was the first person to figure out how to freeze blood. And we were actually figuring out how to freeze kidneys for transplantation. 语法解析
01:24
And I got really interested in kidney transplants. I went off to Vanderbilt for medical school. And then during medical school, I decided to take a year off and do a year of Howard Hughes Medical Institute-sponsored research at Harvard Medical School at the lab that did the first living-related kidney transplant. 语法解析
01:41
And then I went back, finished up medical school and went off to UCLA, did two years of surgical training and then four years of urology training where doing kidney transplants was part of what I was doing. But I became really interested in prostate cancer and the emerging technologies of surgical robotics. And so I helped pioneer surgical robotics. We had the second DaVinci surgical robot in the country and went into private practice in Northern California. 语法解析
02:08
And helped pioneer kidney stone center and MRI guided prostate biopsies. But about six or seven years ago, I became really interested in regenerative treatments for men for sexual function. So things like low intensity shockwave therapy, high intensity focused electromagnetic waves, stem cells, PRP. 语法解析
02:27
And now I have a practice in Northern California that focuses on men's health, exclusively men's health, help men restore their sexual function, their hormonal function, and physical optimization. And the 21st century man was kind of an outgrowth of learning about all the different technologies and all the things that you can do to help men live a better, more productive, happier life. So what's, I don't know, what are things that are common to many men that cause them sexual dysfunction in their life? 语法解析
02:55
Well, you know, I'd say 90% of sexual dysfunction is vasculogenic, meaning that the blood vessels to the penis start to get clogged. And that can become from aging, from smoking, from drinking, from sedentary lifestyle, from not eating the right foods, from genetics. And so, you know, we're all fighting an uphill battle as we age, especially after we get to 50. Yeah. 语法解析
03:19
to maintain not just lifespan, but health span, and even what we call sex span, the ability to be sexually active as you age. So what are the common things that happen to men? What do they start to experience as they get older that tells them they're starting to have some dysfunction? Well, I mean, sexually, the first thing that happens is you lose morning erections or nighttime erections. 语法解析
03:39
And then after about 10 years of that, you begin to develop erectile dysfunction. So the ability to maintain an erection, when you want to maintain an erection, you begin to lose. And then 10 years after that, you begin to get cardiovascular disease, heart attacks, strokes, those kinds of things. And so it's really a continuum. And the important thing is to be aware of 语法解析
04:00
your loss of function and what that might mean. So, you know, a lot of guys lose morning erections, don't really think much about it. Then they start to have erectile dysfunction and they just order some blue pills from a 语法解析
04:11
you know, an online doctor. And then 10 years later, they have a heart attack. So, you know, the erectile dysfunction is kind of the canary in the coal mine for men's health. It means that your circulation isn't as good as it should be. And you begin, you should begin to generate some awareness that you need to take better care of yourself. Yeah. But again, what does this mean? So is the average man supposed to get multiple erections a day or in the night or… 语法解析
04:34
You know, what is a normal circumstance and what is a non-normal one that you run into? Yeah, well, I mean, normal is kind of all over the place. I like to think more of aspirational. What if you only get an erection when you're about to have sex with your partner? Otherwise, you never get one. Is that a real bad sign? No. 语法解析
04:52
What should men expect and look out for early on? Well, I think that would be unusual, right? So you get nighttime erections so that your penis is ready to have daytime erections. So it would be rare to just have a guy who only gets erections when he needs to get erections. So typically you'll get 30 to 60 minutes of erections every night when you're sleeping, and that brings oxygenated blood and nutrients into the penis. It stretches the connective tissue of the penis into it. 语法解析
05:20
prepares the penis so that when there is opportunity to have penetrative intercourse, that you're ready. Does that make sense? How are you supposed to know, though, if you're sleeping? How can anyone know that? Yeah, I mean, a lot of guys will wake up in the morning with an erection. The other thing is that there is a device called the FirmTech. It's a ring that you can put around the penis, and that will help you figure out if you're getting erections. People won't then choke up blood and stop the ability of the penis to become erect and die. 语法解析
05:49
you know, in the beginning or in the first place? No, because the blood flow that goes into the penis goes through something called the deep cavernosal artery. And you have one deep cavernosal artery in each erectile body. And so what a ring would do to prevent blood from returning back to the body, that's how you actually get a rigid erection. So the blood will continue to pump into the penis, but the drainage of blood out of the penis is impeded. 语法解析
06:15
But as the pressure of blood coming through the deep capillanus artery decreases, then the erection won't start to go away. 语法解析
06:24
So what can men do at these various stages of dysfunction? Yeah, well, I mean, you know, there are 10 things that I recommend men do that will improve their health in general and certainly will also improve erectile function. And that is don't drink alcohol, don't smoke, don't do drugs, don't eat too much, exercise every day, stretch every day, meditate every day, get enough sleep and be nice to other people. 语法解析
06:49
Okay, so what happens when you get people that are having dysfunction and you tell them this, and then what do they say? Yeah, that sounds great. Or like what specific protocols do you suggest to people? Well, you know, when I see my patients in the office, especially when I see new patients, you know, we'll get a full set of labs. We'll take a full history. We'll do a body composition scan. Because what I find is that men really respond to numbers. 语法解析
07:13
right? So if a guy's testosterone is 250 and the testosterone that he should be at is six or 700 and he's tired and he's got low libido and less motivated, then we talk about testosterone replacement. If a guy has, you know, 语法解析
07:28
not enough muscle and too much fat, then we talk about what that really means. And we talk about calorie-restricted diet, and we talk about exercise and how to build muscle and where to build muscle. So everyone's an individual, but everyone, to a certain extent, needs the same sort of things. And that's the beauty of the 21st Century Man book, is it's 101 chapters that focus on really every aspect of men's health, from physical health to emotional health to relationship health to aesthetic health to… 语法解析
07:56
uh, you know, addictions, all, all sorts of things. And it's written specifically for men, uh, in a voice that men will relate to. Okay. What about testosterone replacement therapy? What are some of the nuances there? Should people do creams or injections or patches? What have you seen? Yeah, that, that also is a very complicated question. Uh, but in general, creams and patches, uh, 语法解析
08:19
And anything that's transdermal, I mean, that has to go through the skin, will only get you to a level of around 500. And quote, normal testosterone for men is between, say, 300 and 900. But I find that the best physical performance really happens from around 900 to 12 or 1300. And the only way to get to those levels are either injection therapy or pellets. And so… 语法解析
08:42
The less expensive way to get it is through injection of testosterone, meaning you have to inject yourself either once or twice a week with testosterone. And the other way to do it are to place little pellets. So I'm a BioT testosterone provider. We make a tiny little puncture. We place these pellets, which look like little grains of rice under the skin. And those pellets will last for about four to six months. And that gives you a nice, even level of testosterone. 语法解析
09:10
Okay. So what should, again, what is injectable a safe procedure for people or pellets better? You know, what about creams, topical creams you rub on? Yeah. Topical creams, like I said, they're not going to give you the levels that men need, especially as they age. I've heard with those, you put them on the scrotum itself, the underside is supposed to be more efficacious than just on your stomach or arm, let's say. 语法解析
09:32
Slightly more, but think about it this way. When you jump into a swimming pool, do you become waterlogged? No. No. Of course not, right? So water is H2O. It's a very small molecule. Testosterone is a 27-carbon chain, right? It's a very… 语法解析
09:45
Compared to water, it's a very, very big molecule. And so it's very hard to get a molecule that size to go through the skin and into the bloodstream where it needs to be. And so it doesn't matter if you put tons of testosterone cream on you. It's very hard to get levels that will make really a big difference. I use creams and those kind of things for, say, men with prostate cancer where you want to boost their testosterone a little bit, but you don't want to get too high. 语法解析
10:12
But for an average 50, 60, 70-year-old that has a low testosterone that wants to improve their physical performance, sexual performance, etc., shots or pellets are a much, much better way to go. Okay. So what are the physiological effects when someone does this? How do they tend to feel? How long does it take? Yeah. So, you know, with shots, they can feel better almost overnight. Okay. 语法解析
10:34
And it improves their motivation, their drive, their sex drive, their ability to build muscle, their ability to burn fat, sleep, mood. It really, you know that expression, everything's better with bacon. Right. Everything's better with testosterone. Well, that is a good point. 语法解析
10:50
Not necessarily. I mean, what about cardiovascular inputs? Yeah, actually, I've heard that it can raise your risk of like, you know, I don't know what the circumstance would be, but, you know, stroke or heart attack. Yeah. So actually, there was a recent study that came out called the Traverse Study, which was a massive study that showed that testosterone replacement actually was heart healthy. 语法解析
11:11
and actually did not have any negative effects on cardiovascular fitness. Didn't increase heart attacks, didn't increase strokes, and they're actually removing the warning label on testosterone products based on the Traverse study. Oh, that's good. Yeah, so it's actually very good for heart. It's actually very good for diabetes as well. What about lumps and bumps and stuff, you know? 语法解析
11:32
I've gotten, I've done injectable testosterone. I get lumps and I had to get acupuncture to get them down. And then people that testosterone plays like, Oh, it's just normal. And I asked about different carrier oils and they, I, 语法解析
11:44
I don't know, didn't really know anything. They just had to inject you. So what have you seen that works well and doesn't work in terms of TRG? Yeah. So, you know, honestly, injection therapy is great. And to be honest, I haven't seen any of my patients complain of lumps or bumps, but I have a shockwave therapy device in my office that if there's any little lumps or bumps, we could easily kind of iron that out. If you rotate the injection site, you know, left, right, and it's 语法解析
12:11
And testosterone is best injected intramuscular. So if you inject into your deltoids, into your quads, into your glutes and rotate that around, not every single time in the same place, then you're much less likely to generate scar tissue. 语法解析
12:25
There are also subcutaneous injection systems like Zyastad that give levels that are around 700, 750. So if you're having difficulty injecting intramuscular, you might want to consider something like Zyastad. I mean, has anyone ever looked into the carrier oils? I know one's cottonseed. You know, there's like testosterone, anathate, cyprinate, etc., 语法解析
12:48
You know, there are forms that you recommend or don't recommend or, again, carrier oils that can be changed that make it more efficacious or easy for somebody or less of a problem. Yeah, you know, that's a really good question. I mostly use testosterone cypionate. And although some patients specifically request an anthate for I don't know what reason. And, you know, honestly, I don't have an expertise in the different carrier oils. Yeah. 语法解析
13:11
But to be honest, I don't know. What are bodybuilders doing? I mean, from what I understand, they're using much, much, much more than a normal person would. I actually have a really good e-book on performance-enhancing drugs. And… 语法解析
13:25
You can basically think of it as three categories. So a lot of those guys will use a testosterone base, right? So they'll inject high doses of testosterone. And then beyond the testosterone base, they'll use what are called dihydrotestosterone. So testosterone is converted by something called 5-alpha reductase into dihydrotestosterone or DHT. 语法解析
13:49
And DHT has a higher binding affinity to the testosterone receptor, meaning it sticks to the testosterone receptor three to four times more intensely than regular testosterone. And DHT is what causes male pattern hair loss and also growth of the prostate. But also it has a much greater effect on muscle. And by altering the chemical structure of DHT, you can get more intense muscle building effects, more… 语法解析
14:18
you know, what bodybuilders do when they, they bulk or they shred or, because these are all steroid hormones. And so there are a number of different corticosteroids. So there's glucocorticoids, there's mineral corticoids. So mineral corticoids without getting too deep into physiology are things that affect your kidney to affect your fluid levels. And so, uh, 语法解析
14:40
I think part of the reason all these things got tweaked was one, because of the slightly different effects, but also when bodybuilders and athletes were being tested for these different hormones, they would chemically alter them to avoid being discovered. 语法解析
14:59
And then they found different purposes and different effects of all these different hormones. So then there's DHT. And then there's another category called the 19-NORS, which is another kind of tweak of that DHT molecule that helps guys bulk and have more effects. So the bodybuilders that you see competing, they're not just doing testosterone. They're doing DHT derivatives like DECA or TRAN or Winstroll. 语法解析
15:24
But those are really, really dangerous drugs or hormones, especially when you're doing it and you don't really know what you're doing. So I've seen guys in their late 20s that come in to see me that can no longer get erections, can no longer have babies. 语法解析
15:37
because testosterone has an effect on fertility, right? If you're taking high levels of testosterone and you're in your 20s, you're going to be sterile. You're just pushing it too far, I guess. Exactly. Well, you're shutting off what we call the hypothalamic pituitary testicular axis, right? So the hypothalamus is in your brain and it reads how much testosterone you have. 语法解析
15:58
And then it sends a message to the pituitary and the pituitary sends out two messages. LH, which tells your testicle to make testosterone and FSH, which tells your testicle to make sperm. But if you're taking testosterone from the outside, the hypothalamus says, oh, well, we got enough. So let's shut the engines down because we don't need to make any. So not only do you not make testosterone, but you also don't make sperm. 语法解析
16:20
And if you do that for long enough, then you can lose the ability to make sperm and you can actually lose the ability to make testosterone. What happens to people that just take, uh, do injections only, you know, therapeutic instead of bodybuilders. Does any of that stuff happen or is it not enough to do that? Yeah. I mean, if you do it for long enough, so I put my, my patients on a medication called Clomid or Clomiphene, which is, uh, blocks the negative feedback loop. And so those patients continue to get a production of testosterone, um, 语法解析
16:49
From the testicles. Would it stop the production of estrogen? Or what does it do? Is it like diendolomethane? Or like, what do you mean? It's, yeah. So DIM, it helps reduce the conversion of testosterone to estrogen. But I use a medication called anastrozole. Anastrozole is much more effective in blocking the conversion of testosterone to estrogen, right? So we think like testosterone and estrogen are radically different substances. 语法解析
17:13
Men are from Mars and women are from Venus, right? But the difference between testosterone and estrogen is a single hydrogen atom. So the smallest unit of matter is the difference between men and women. And so it's very easy for your body to convert testosterone into estrogen. So when you're getting testosterone shots and you're getting levels of 1,000 or 1,200, it's important to get your patients on something like an Astrozole or DIMM. But DIMM is much, much less effective. 语法解析
17:39
and anastrozole in order to get the estrogen levels from being too high because like I had a patient a 语法解析
17:45
A couple of months ago, he came to see me as a second opinion because the doctor that he was seeing didn't really know much about testosterone other than just tell him to take shots. And he was like, yeah, man, every time I watch the Niner game and the Niners score a touchdown, I start bawling my eyes out. And so that's what happens when your estrogen levels are too high is that you get overly emotional. You get some breast tenderness, breast growth. 语法解析
18:08
It actually has negative effects on libido. And so testosterone replacement isn't just about sticking a needle into your muscle and injecting testosterone. You have to maintain and watch levels. You have to watch your estrogen levels. And you have to make sure that your testicular function, your fertility is okay. So what kind of blood work would you do on someone that's having erectile dysfunction? 语法解析
18:29
And what will you look for? Yeah. So, you know, I have a big panel of labs that I draw when someone comes in initially for erectile dysfunction, looking at liver function, kidney function, thyroid function, B12, testosterone, 语法解析
18:44
even cholesterol numbers, right? Because if you have high cholesterol, that's going to clog your arteries and that's going to lead to erectile dysfunction. So really, erectile function is a manifestation of your overall physical health. And so I talk to patients about the technologies that I can use to help treat their erectile function, like shockwave therapy and supplements and medications and hyphem and PNL. 语法解析
19:08
and PRP and stem cells. But at the end of the day, if you're not taking care of yourself, if you're not doing cardiovascular exercise, if you're not watching your weight, if you're not watching what you eat, if you don't drink too much, if you don't smoke, then anything that I do in the office isn't going to work long term. So really, I'm looking to turn someone's life around and improve their overall physical health and fitness. At the same time, I'm looking to improve the blood flow to the penis. 语法解析
19:31
Right, but what are some common biomarkers that would tell someone, whether they got them through you or their own doctor, that something's going on, they should pay attention to this? Do you see sex binding, globulin hormone, high or low? What do you see? Yeah, I mean, SHBG, certainly testosterone has effects on almost all physical functions of men, but testosterone is actually not directly involved in men. 语法解析
19:55
erectile function, right? Erectile function is really a function of circulation of blood flow. And so that's more directly related to your overall physical fitness. And so when someone comes in, I have an ultrasound and I'll actually do ultrasounds of their deep cavernosal arteries to look at whether their arteries are narrow or the walls of the arteries are thickened or whether their arteries look relatively normal. 语法解析
20:19
So I think that really is the best way for me to assess with a single test what someone's erectile function is going to be, is to actually look at the blood vessels in the penis and assess what those blood vessels look like. Does that correlate with the rest of the circulatory system with heart? Absolutely. Or can you look at the heart and correlate that with the penis or no? Both. So there's a test called the heart calcium score. Yeah, the calcium. Yeah. And I had a patient the other day. 语法解析
20:44
And he didn't respond to the shockwave therapy like I thought he would. And I said, dude, you need to go and get a heart calcium score right away. And so he talked to his primary care and his primary care said, no, no, no, I don't think you need it. I said, so he came back to me and I said, you need it. Only cost 250 bucks. I'm going to write you a requisition. Go get it. His levels came back at 1100 and he's going to have heart surgery next week. 语法解析
21:07
What does that mean? What do they have? High calcium? What are they doing? It means your blood vessels are clogged. And if your blood vessels are clogged, so a quarter of men, their first sign of heart disease is sudden death. Okay. 语法解析
21:20
So, my daughter, this happened to her two days ago. She works at the Orange Theory, you know, as a front desk. And she told me there was a 56-year-old police officer, a little bit overweight, did a class. Right after class, slumped over, fell down, massive heart attack. They needed to defibrillate the guy. And fortunately, he made it, right? But that's his first sign of heart disease was after Orange Theory. He did the full class. 语法解析
21:47
Seemed to do okay. Came out, slumped over. And if it wasn't for my daughter calling 911 and the coach doing heart compressions, I kind of would be dead. Never had a warning. Never had a warning sign whatsoever. You know, so here this guy has been working for 30, 35 years trying to support a family, et cetera, et cetera. 语法解析
22:05
And then he dies at 56 because, you know, he never went, didn't go to the doctor or the doctor didn't know the right tests or he didn't hear the warning signs. Right. I'm sure that guy's had erectile dysfunction. So is it a good canary in the coal mine for heart health? Absolutely. Absolutely. So what is some, so what is some of the most important testing that you'll do with people, for instance? You know, so I do a test in the office that's super valuable called the VO2 max. So VO2 max is, 语法解析
22:33
is a measure of fitness really, but it, it, 语法解析
22:37
You basically ride an exercise bike or get on a treadmill and go to exhaustion where you get to anaerobic, right? And your ability to push yourself into anaerobic is basically your VO2 max. And that's a high correlation with your overall cardiovascular fitness. Okay. Like what? What is the range of VO2 max? What's a good range, a bad range? What does this tell you? Yeah. 语法解析
23:04
Okay. So think about it this way. You're walking down the street. You use two liters of oxygen a minute. And then you start jogging. You use three liters of oxygen a minute. Then you start running. You use four liters of oxygen a minute. Then… 语法解析
23:19
A bear jumps out from behind a tree and starts chasing you. So you start sprinting. You use five liters of oxygen a minute. And then the whole bear family starts chasing after you. And you use 5.2 liters of oxygen a minute. But you can't get any more, right? That's your VO2 max, right? Because… 语法解析
23:38
Glucose is the fuel that we burn in our body. And when you break down glucose, you add oxygen to glucose and that breaks it up into carbon dioxide, which we breathe out and water and it releases energy. And that energy is in the form of ATP, right? And so there's a… 语法解析
23:58
point where you can't bring in enough oxygen to properly oxygenate the breakdown of glucose and to liberate energy. And that's your VO2 max. And so the better athletes in the world, like Jonas Vingegaard, the cyclist has one of the highest VO2 maxes ever measured at 97, right, is going to be able to extract oxygen and use glucose to a much greater degree than someone like you or I. Does that make sense? 语法解析
24:26
Okay. So how can you tell if, uh, you know, what's the standard for a normal person? Is their B02 max lower than they're in trouble or what? Yeah. I mean, my B02 max was 45 when I tested myself and I'm 57. So that's, you know, top maybe 2% for someone who's 57. My son, he's a cross country runner. Uh, he's 18 years old. His was 70. The average for a man, uh, 语法解析
24:51
in this 40s, I think it's about 35. And for women, it's a little bit lower than that. The thing is, you could do a stress test, right? You go to the cardiologist, they put you on the stress test. But the stress test really tells you, like, either you're going to have a heart attack or you have blood vessels that give you ischemia or areas of the heart that aren't getting properly perfused. 语法解析
25:11
or you're not. Whereas a heart calcium score will give you a score of, say, 0 to 1,000, and a VO2 max will give you a measure of cardiovascular fitness. So one is an imaging test, and the other is a functional test. Whereas things like stress tests are going to either say you're at risk for a heart attack, you're not at risk for a heart attack. 语法解析
25:32
So what are some of the therapies that you've developed or used to help people with dysfunctional? How do some of the top ones work? Yeah. So one of the most popular ones and one of the best ones is called low-intensity shockwave therapy. And what that is is pulsed 语法解析
25:47
You can think of them as sound waves or energy waves that go into the penis. And what that does is it tricks the penis into thinking that there's an injury, even though there's no injury. And what that does is it generates an injury response. And that injury response creates what's called neovascularization or the growth of new blood vessels. So what you're looking to do is to increase… 语法解析
26:08
new blood vessels. We also add what we call PRP or platelet-rich plasma. So the platelets in your body contain growth factors in addition to clotting factors. And so we can draw blood, spin the blood down, isolate the platelets and re-inject the platelets back into the penis, almost like adding fertilizer to a growing plant. 语法解析
26:26
And so that improves the vascularization. Now, the other thing you want to do is to improve the signal that your body uses to generate blood flow. And so there's something called nitric oxide. It's a naturally occurring molecule that is released by nerves. And when those nerves release nitric oxide, it generates something called cyclic GMP. And cyclic GMP creates a cascade of events that opens up blood vessels. And so as we age, we're 语法解析
26:52
the amount of nitric oxide that we produce reduces. And so that's one of the reasons we get higher blood pressure, less blood flow to the brain, less blood flow to the muscles. And so there are supplements, like I created a supplement called Affirm, which has citrulline and beets. 语法解析
27:09
So there's two ways to boost nitric oxide. One is through the citrulline arginine pathway, and the other is through the nitrate nitrite nitric oxide pathway. And that boosts the amount of nitric oxide, which boosts cyclic GMP, which opens up blood vessels, right? And then that's also how Viagra works, right? So Viagra targets a specific enzyme that's only in the penis called PDE5, and PDE5 is 语法解析
27:33
breaks down cyclic GMP. So if you inhibit PDE5, which is what Viagra does and Cialis does, then you maintain cyclic GMP and keep the blood vessels open. And I'm doing a really cool clinical research study in my office called the CONFIRM-2 study, which combines Viagra and Affirm. And what we're beginning to see 语法解析
27:54
as we gather the data is that there's a synergistic relationship between a nitric oxide booster like Affirm and Viagra. And the really importance of that is that a lot of men can't take high doses of Viagra because of side effects. It gives them headache, facial flushing, reflux, stuffy nose, muscular aches. And so… 语法解析
28:15
If you can't take a high dose of Viagra, you can add something like Affirm, which is a nitric oxide booster, and reduce the dose of your PDE5 inhibitor like Viagra and Cialis and get the same clinical effect. Okay. I mean, what are some of the real tough cases you've had to deal with and why? What things can happen that can make it very difficult for men to have any sexual function? Oh, man, I've seen it all. Hmm. 语法解析
28:37
You know, some of the things that people need to watch out for, there's something called the post-finasteride syndrome, right? So people take something called finasteride or dutasteride, or it's also called Propecia, which is a medication that people take for hair growth. But maybe one out of a thousand guys has a devastating effect on erectile function. 语法解析
28:59
So we know that it decreases libido because it blocks the production of DHT, and DHT is partially responsible for libido. But for some reason, guys will get severe erectile dysfunction from taking these medications. And so those are really challenging folks to take care of, and so we actually… 语法解析
29:17
kind of throw the kitchen sink at them. So we put them on Affirm, we put them on Cialis, we put them on shockwave therapy, we put them on PRP, we put them on the Amcelic chair, which uses high intensity focused electromagnetic waves to improve blood flow to the penis and ejaculatory function. Oh gosh, there's a whole bunch of other stuff that we can do like injecting Botox into the penis. 语法解析
29:39
Eroxon, which is a topical medication that we can use to help improve erectile function. But if you're out there taking finasteride or dutasteride or Propecia for hair growth, just be careful that if you begin to develop erectile dysfunction, you got to stop those things right away. It permanently destroy it? Permanently destroys it. 语法解析
29:58
We don't understand the mechanism of action. And I didn't believe that it was actually a real thing until I started to see patients coming in to see me when I started to become a sexual medicine expert. And there are millions of guys out there on those medications. So one out of a thousand is a real number. Yeah, that's amazing. 语法解析
30:13
So what's the best way for someone if they're having trouble, how do they start getting help? I mean, you're in California. I don't know if you could work in other states. How can people seek out an expert? What do they call them? Yeah. So, you know, one super easy thing to do is just to buy a copy of my book, The 21st Century Man. So it… 语法解析
30:31
provides information on really all the topics that are related to sexual function. In addition, I have a YouTube channel, BrandeisMD, and on my website, BrandeisMD.com, I have a lot of e-books and other information. There's also something called the Sexual Medicine Society of North America. So if you look up SMSNA, there are urologists that… 语法解析
30:55
have an expertise in sexual function that you can seek out to find out about some of the more advanced concepts. You know, if you go to your primary care doc or if you go to most urologists and complain of erectile dysfunction, they'll hand you a bunch of Viagra and tell you to get lost. But there are a lot of things out there that we can do to help men that go way beyond handing you some Viagra. 语法解析
31:15
That's great. It's great. You know, and this is it's really it's important to for so many reasons, it's important to have this discussion because obviously sexual function is a very important part of quality of life for men. It also really helps define who we are as men. It gives us self-confidence. And it also like we talked about, it's a canary in the coal mine. 语法解析
31:34
Right. So if you have erectile dysfunction, but you just stick your head in the sand, then you might be that 56 year old police officer that almost died the other day at the Orange Theory and right in front of my daughter. You know, that's crazy. One quarter of men. Just let me repeat this. One quarter of men. The first sign of heart disease is sudden death. And do you want to live your life and be that guy? No. 语法解析
31:58
Not unless I was 120. Yeah, there you go. Then it wouldn't be so bad. Well, very good, Judson. Well, thank you for what you do and for coming on the podcast. I appreciate it. You got it. Thanks a lot, Richard. Thanks for having me. If you like this podcast, please click the link in the description to subscribe and review us on iTunes. You've been listening to the Finding Genius Podcast with Richard Jacobs. 语法解析
32:27
If you like what you hear, be sure to review and subscribe to the Finding Genius Podcast on iTunes or wherever you listen to podcasts. And want to be smarter than everybody else? Become a premium member at FindingGeniusPodcast.com. This podcast is for information only. No advice of any kind is being given. Any action you take or don't take as a result of listening is your sole responsibility. Consult professionals when advice is needed. 语法解析
Edit:2025.04.13
