Transcript for:
Lecture Notes on Men's Health and Testosterone

if you're having hard on early morning spontaneous reactions that means your machine is absolutely fine don't have to worry why are so many white men in America on Joe Rogan's podcast talking about testosterone replacement therapy should Indian men also be looking into it fat and sugar metabolism is linked with testosterone it's not many people understand but you've seen cases where the feeling of sex hurts a guy's penis yes the sensation which should be traveling to your brain as a pleasure turns into a pain I'm assuming a part of your job is also to kind of give sex coaching yes it is male nipples are actually more pleasurable than the female nipples as in male bodies derive more pleasure from the nipples being stimulated than a female women don't know so they don't do it and Men they're hardly bothered because they're bothered more about procreation they are wired in that way you have to do prostate examinations regularly why do so many old men all over the world have to get it removed doesn't it hurt if it hurts the patient the fault lies with the doctor but when you're cutting up penises for a living what more do you understand about it when you see it from the inside I had a gentleman who in a fit of schizophrenia detached his penis it was cut with a blade and thrown into a toilet what this is such an important conversation because a lot of guys are just going through the same performance anxiety problem without hearing this conversation that it is psychological so relax bro welcome to the latest episode of our medical series on the ranir show we've been creating multiple medical and health oriented podcasts in both English and Hindi this one is obviously for the guys mostly it's about men's problems it's about testosterone it's about sexual health it's about the lifespan of your penis you're going to enjoy this episode because it's with one of the country's top urologists Dr Rajesh Tanja this episode is not meant to be watched with your family unless your family is super chill with this kind of conversation it's a lot lot of fun it's very informative this is Dr RT on [Music] TRS Dr rajja maybe my face and my voice is not conveying but I'm very excited to talk to you uh the reason it's not I'm not being able to convey my true inner emotion is because we're shooting in another Studio there was a problem in our old Studio but I'm just really glad I'm getting to do a biology podcast which has now become my comfort zone so it's great even being in your presence you're a very chilled out guy uh I'll begin by saying thank you for being so accommodating and uh giving us time in the middle of this very very busy life that you have thank you so much RI for asking me to be here and it's an absolute pleasure the pleasure is entirely mine don't worry okay and we are good to go okay thank you sir uh want to begin by asking you about our medical podcast which you have seen so it's a little self-obsessed question to begin with and we'll get into deep biology details about surgery surgical stories Etc but you've seen some of the doctor podcast that we've done my question to you is a little bit to understand the medical industry a little bit more why is an experienced busy doctor like yourself even watching my medical podcast is there anything you gain from it because when I'm asking questions it's from the perspective of 18year olds and college students and young professionals are trying to understand biology more but what is it that you gain from those conversations I liked a few of them and I forwarded them because sometimes it is difficult to convey to your near and dear with whom you live or you talk daily and you try to tell them okay there is a gut health that is seen to be you know something wrong there and you need to look at it and things like you know there is a discussion about God so I feel that I'm not the only one who talks about things like that there are others in especially surgeons who talk like that do you think that the process of surgery in the long term like how many years have you been doing surgery so since 1986 so around almost 40 years wow yes almost 40 years yes this process of doing surgery over 40 years how does it change a human's mind as in the human actually doing the surgery what ends up happening to you so the biggest thing is that you should know that me and a cobbler we we both cut the leather or skin and put Stitches the difference is that I cut those stitches after 10 days and the wound heals it doesn't gape and in a cobbler's job even after 10 years when the Stitch is taken out it opens up so there is something which is not in my hand which helps the healing which keeps the tissues together and that power needs to be recognized no one better than a surgeon will recognize the power of healing and be so much depend upon today I'm sitting here you call me because I am perhaps a successful surgeon that success is because when I cut and Stitch it heals and that healing is unfortunately not in my hands I'm just taking credit so that power needs to be recognized there's an element of nature in in your work exactly that's what we are coming to okay specifically there's a lot of young Brothers watching this podcast because we're going to be talking about penises oh yes of course of course I'm an andrologist uh H do you think that 30 year olds 35 year olds and of course then I'm talking about Bros in their 20s as well do we truly understand the penis well we should and I think a lot of you know people boys if they are in a boys hostel they're taught whether they like it or not by other Bros that's right so in our times there used to be a ragging so once I joined the Medical College there used to be a ragging H and that ragging in a boy's hostel would give impart so much of you know the insight into the organ called penis it's and how differently people would look at it and would ask you to imitate them or whatever for example there used to be a hockey game so that is how it used to be so you needed to play hockey with it wow like in like literally you need to play so I do not know that kind of ragging doesn't happen now but then so so I will suggest that if you want a boy to grow into a man send him to a hostel boys hostel true so basically everyone had to expose their own hockey sticks in front of the other guys that was a part of the ragging and therefore you understood it more but when you're cutting up penises for a living what more do you understand about it when you see it from the inside so penis has a structure and has a a function so as a surgeon I can fix a structure but as a function a lot will depend upon how the healing comes as we've been talking about for example I had a gentleman who in a fit of schizophrenia detached his penis it was cut with a blade and thrown into a uh this thing toilet and then his brother picked it up oh somewhere in kurra oh my God and called me up I said you open a bottle of saline from the nearest nursing home put this into a saline wrap it with a cold ice and bring it to me and he brought it and I reimplanted that and I'm talking about 2000 maybe 1999 or 2000 did it work after that of course it worked this guy got married and has got two children oh oh my God but when I was doing that when I was reimplanting a penis I wasn't sure whether it would work or not okay one second I have to ask a very Bas level question as you're speaking about this my body is in pain did you ever have to get past that as a young surgeon uh see if you're talking about pain of the patient if I'm sitting in a chair in my clinic and there's a patient sitting in front of me and he has a pain un as I feel that pain I cannot treat him the only difference between him and me is that he cannot think of a solution and I can think of a solution I'm trained to think of a solution but to think of a solution I need to feel the same pain sitting in my chair whatever it may be it may be cancer it can be injury it can be whatever disease so that is my way of working if I cannot understand or feel the pain or I cannot treat how do you deal with it mentally on for yourself for your own mind and heart does your mental health get affected not at all not at all ever never never it gets affected when so I tell you if I'm if I have operated like for this patient I came back and I slept off we woke up at 1:00 was sitting in my drawing room thinking whether it will work or not what else could I have done how would the family feel if it doesn't work and how would I feel and tomorrow my residents my staff and they would feel that look our boss has done something which has failed so that introspection is a constant thing and my my wife comes up and says at it's 3:00 what are you doing in this drawing room and I tell her look I'm just introspecting initially she didn't understand but now she knows what I'm doing so that we have to go through if I don't go through it so perhaps I'm gathering enough positive energy and putting it into that penis for it to heal or whether I am you know kind of um soothing myself or thinking how next time if I am faced with such a situation what else could have been done and that is a Perpetual path of evolution and progress in my my skill let's talk about this surgery a little bit more because you spoke about skill and even the pain you're actually talking about the mental health related trouble you faced on that evening it's much more to do with your skill than to do with that guy's penis and his pain in terms of you're putting pressure on yourself as a perfectionist as an athlete that how could I have played a better Innings right as a surgeon you're seeing it very surgery Centric uh my question to you is a little bit like more personal in terms of when I'm hearing this it's hurting my body and there's a lot of people listening to this podcast guys who are going through the same thing they're very conscious of their own body parts right now so there's never been that angle you've never seen no that doesn't happen to us okay because I'll tell you for two reasons one the first day of our Medical College is anatomy and we are into a disection hall where there are tables of cers De caders preserved cadavers and you are cutting through them and seeing each nerve each muscle each artery each vein bone whatever this is mbbs that's mbbs the first day that you join mbbs you enter the disection Hall that is the anatomy class and we are all toppers from our various schools that reach there to that level and we see people fainting there did you faint never so I will tell you a small story if you allow so there was this guy who was a very Hefty guy and he was a he was the hockey captain of our class team in college third year we were posted in labor rooms so we used to take deliveries so we were at the end of our nbbs we are supposed to take deliveries because mbbs means you're a doctor you are posted in a post and you are supposed to look after at least the deliveries are minimum so we are posted in the U labor room and we are standing like this four boys like this in a gynecology room Ward and there is a sudden gush of blood and the baby comes out and we hear a thud and this is a 95 kg man standing with me 20-year-old boy he he's on the floor because he could never do it but now he's a neurosurgeon in United States wow but that was his first experience with blood but I think if you tell me if you allow me I'll tell you a story why I'm like like this so I was in class 7th and I we were taken to the biology lab and there was a jar which was empty there were a few jars which were empty and I asked the biology teacher I was in class 7th I said why are these jars empty they said because we don't have specimens enough so if you bring some specimen I'll put it here so I said fine I went home I couldn't sleep I said what kind of specimen can I bring to my teacher because I loved my school life loved my biology I loved everything so next day when I was going actually the school was in an Air Force compound and I was from coming from outside so I entered the Air Force compound and I saw a few guards standing on the on the road side and with this long stick and they were killing a cobra so way back in 1974 75 or maybe so I looked at it I said what are you going to do with this it was a 6t long Cobra so they said what will I do we will just throw it and some bird will come some eagle or Crow or whatever would eat it and go I said can you can I take it he said yes you can so I picked up the cobra with a tail I was standing tall 4 six 4T 6 in with a cobra 6t long and I went to the school so I was the center of the activity in the school so there were all the boys girls standing there and I'm holding the cobra in my hand and suddenly and I I'm asking for where is the biology teacher I brought a specimen for her and suddenly somebody comes and slaps me and I look back and I look at my revered principal standing there a very nice gentleman he's no longer there his son was a friend of mine and he said what are you doing here I said sir balji Madam told me that we need a specimen so I brought a specimen she says suppose this is alive I said no no they have killed it you don't know and then the Pion brought the jar and we put it in and the lab assistant put the form Malahide into it and it started moving yes it was alive yes so I'm That Kind of a person how do you expect me to faint with the sight of blood from real cobras to Metaphor cobras we got to get back to the subject matter though yes sorry for the long answers great this is what podcast are her yeah uh I want to ask you about that same surgery again yes that one where the guy cut off his own penis and threw it in the code commode that's right okay you told the relative to put it in saline water and put it uh in a bag of ice that's right so it stayed fresh it didn't rot uh parall I'm assuming that that guy's body was was bleeding a lot from down there because there's a lot of blood vessels that's right so they uh tied it I told them to tie it make a bandage because they went to the nearest nursing home and somebody just tied it and put a bandage we have what is called Dina plast which is a very stiff plaster and it has an elastic thing so just put it and it sticks and it just holds on so that's how he came what about his balls they were intact nothing he didn't do anything there no he didn't so he used a you know the old style shaving blades they had two edges to that blade oh my God so he used that kind of Blade and he would have like cut it like a piece of wood oh God did you ever ask him why like what was in his head he was not in this state of mind to answer those because nobody in census would do that so he was under treatment for schizophrenia so he was basically going through some kind of a brain situation that's right which was making him hallucinate or something he must have been angry with himself he may have I do not know the story but he may have been following a girl who may have got married so he thought this is useless is the simplest plausible explanation for something like this I think a lot of guys associate the self-belief with their penises that's right right that's absolutely I think men in general do that's right at some age they do and then after a point you realize oh life is much more than this that's true but then at that age they have nothing else to compare how old was he he was uh 24 I think at that time okay now as a surgeon that guy's fully wrapped up you get a bag of ice with his Cobra inside it how do you figure what the first step is in fixing you give that guy anesthesia of course he's taken in for anesthesia we open the dressing under anesthesia ready to clamp any vessel that bleeds or spurts because penis is a very vascular organ so it oozes blood it is supposed to take a lot of blood the blood suppli is there so the moment you open up there will be a you know Fountain of blood literally a fountain it is it is it is actually so when he was lying down there's like blood squirting out so we just hold it we have our technique to hold it so what we do is we just we have a kind of instrument we call it an artery forceps we keep it ready the moment it opens we clamp it it's like a plug like no it is like a CL clip like a hair clip suppose something like that so you just clip it you're talking about the hole that was left in place of the penis no no no the individual arteries that are bleeding oh my God so you have to go in and just just hold them hold them with each of them then repair them but there's been a protocol in the world of penis surgery where these kind of situations have happened earli but someone penis gets cut off very rare and um there were one report from Australia where it was reported that this has been but then later on you know On th in those days we didn't have we didn't have the computers we didn't have those uh so many Web Internet to search and I also moved on into more cases okay let let's talk about this specifically I'm just trying to understand your world a little bit more so you clam up all the blood vessels then what's the surgical protocol so the next is to wash that remove all the dirt wash it generously because you don't want any infected there infected material and then we have an antibiotic solution so multi or what you call um wide spectrum antibiotic solution so there was aasin or another ciprofloxacin solution that we made and added had streptomycin at that time we had a lot of streptomycin with us so we used those things made a solution dipped that organ there made sure that it kills all the germs fortunately this penis is has a it has a cavity which is filled with blood that is how it gets erected so that is all open it is like a sponge so it's actually like a sponge so when you put it into that solution it absorbs all those water that solution of antibiotics and it was washed and then slowly Stitch we we stitched each artery and vein and the layers of the penis the urra the urinary tube because that is also transacted through which the urine passes so the penis has a structure like this it has two corpora kosa two bodies like this which cause erection and the third body houses the urra the passage of urine so it is cut it is actually three structures in a transfer section three pipes you can say that there are two cylinders and a small pipe called urethra which is housed in a spongy tissue so that it can when it erects it has a capability of lengthening elongating and widening and other things so the surgical protocol was you basically refix the pipes exactly that's it pluming Plumbing you're pluming damn that's it so somebody asked me what kind of doctor are you so I say I'm the plumber of the trade wow love it I'm a urologist so I deal with the reservoir I deal with the valves I deal with the condu so okay how long was the surgery so that lasted 4 and a half hours 4 and a half hours to stitch up one pipe at a time etc etc if the same surgery was happening in 2024 how long would it have taken it would have taken maybe a little uh shorter because now we have the availability of microscopes at that time I used Loop but otherwise now we have microscopes so you have a much finer instruments you have much finer uh suture material the threads to stitch so that makes things easier um I've had two surgeries in my life fortunately not on the Cobra but on my shoulders uh for some Judo injuries and they were pretty intense surgeries have to stay in hospital for like 3 4 days and all that the surgeon comes and meets you post um the surgery and just gets an update in terms of how you're feeling and all that if the listeners have not gone through surgery let me have a shot at describing what it's like when you are operated upon have you been operated upon for anything think yes okay so please correct me if I'm wrong and if you have other experience but you totally know when you wake up from surgery there's two things that happened one for me I've had three surgeries totally in my life I've hallucinated every time because of the anesthesia you see hallucinations okay fair you I want to know about this also the second thing is you totally know that your body has been cut open and something has happened inside you can you're very conscious of that body part you kind of feel like there's a fluid buildup inside you're hallucinating you do feel a little sick almost you feel like something's wrong you know you get maybe a little fever Etc um two questions one tell me about this specific guy because there's also schizophrenia mixton so when he would have woken up I don't know what would have been going on in his own head because what if he had woken up in his normal personality and realized that his schizophrenic personality had cut off his penis so what was that experience like talking to him secondly what was your mentality third was he in pain so I'll tell you I'll answer all the three questions the first is that my mentality I'll tell you was that he shouldn't cut it again so we needed to put restrainers so we put restrainers with the thing the second was to give some kind of injectable and psychotropic drugs which keep him calm because this was uh they're different ones so some kind of hello peridol is something which is which is what we used in him seres is the trade name and we also were very clear in getting a psychiatrist evaluating him immediately after he woke up and he was fortunately you know before he came to us he had been administered something like a pain killer with a psychotropic effect so he was calm when he came to us and he was willing for a surgery which was extremely rare to find I was thinking that he would be fighting when he came but he did not so he he was actually he submitted himself for the repair that was the best thing that could have happened on that day and next day morning when I'm talking to him and we don't broach the topic I don't ask him why did you do it it my job is to go and tell him only positive I said I went and told him look you're absolutely fine you're young again so don't even think that something has gone wrong you haven't done anything wrong there was something that went wrong and I fixed it and in all probabilties it will work so don't even think and what would you like to eat so CH something like that so that is the whole idea when you are actually looking at the the patient he's into lot of trouble you need to distract him from feeling pain and discomfort and the best thing that I find is you offer them what they want to eat for example it's a kid we get an ice cream for him or a chocolate for him if he an adult if he's a Punjabi we tell him CH so we tell them what do you want to eat so that is the thing and once you offer something to eat so then he knows that yes I am at home H I've arrived because that's when the body can begin healing that's right positivity is the extremely important thing see we started with the talk that I said that there's a power that heals that power is driven Away by negativity and is brought in by positivity my job after the surgery I've done my job as a car Craftsman but my job is to make sure that it heals and the way it heals is that the person has to be absolutely positive so I go to the room I crack jokes I talk about the weather I talk about his other things and I make him walk and I talk about what he wants to eat what was he saying about this whole thing did he did he address it at all yes so before he was discharged I told him that look you did something which you shouldn't have done and I'm sure you understand that he said yes and I told him look I have been able to fix it God has been very kind to both of us but make sure that you protect it because it is your responsibility to protect it and it is no longer yours because you have cut it and thrown it it is my penis that I'm handing it over to you so this is mine and I'm giving it to you to protect it will you do that he said yes and that's how it is you know when we make a mistake professionally my protocol is always you go back to the mistake you understand why it's done and you respond to the situation I'm assuming that his mistake was that he didn't take his psychiatric medication therefore he went into that aggressive phase right that's the mistake most likely yes so your call to action to him was listen just take care of your brain first because this might happen again correct okay the other question that I have for you related to the same Cas is the penis has a lot of nerve endings that's why it's a sex organ in the first place m now you can repair the pipes you can repair the skin Etc how do you ensure that the nerves also get repaired because he's cut through the nerves also so did he even have sensation he did so body is great nature is great one of the best computers is the human body or any living being on the earth whether it's plants or animals they've been bestowed upon by mechanisms which protect protect them life doesn't go easily even if you try to take it off it's very diff we are very tenacious life is very tenacious it's it's not easy to go similarly you know at that time I did not repair nerves because I didn't have the microscope or something but the nature grows there's something called nerve growth factor that is there so whenever the nerve is cut the nature brings in what is called nerve growth factors the vascular growth vgf and ngf and these are the growth factors which perpetuate and he was young he was 24 is this like a precursor to nerve tissue yes so it allows the nerves to grow so the nerves will start growing here there are nerves here because they're vascularized they don't die but the structure is there so this nerves will come and they will find another nerve and get into it so they'll Bridge the only problem is if something like that happens to your main switch so when you switch on the fan it is the light that switched on so that can be cross connection o beyond that nothing else which means the sensation which should be traveling to your brain as a pleasure turns into a pain oh my God that is the only thing that we have to be worried about because the nerve inste of connecting to the same pleasure receptor connects to a pain receptor maybe that's right oh so what happened in his case he was fine so nothing went wrong no he had sexual activity after that he produced two children but you've seen cases where the feeling of sex hurts a guy's penis yes which is exactly a situation like this where the nerve is actually joining with the pain receptor it is actually not postsurgical but patients who have diabetes or diabetic neuropathies or a neuropathy for another cause what is neuropathy neuropathy is any disease disease of nerves is neuropathy okay so a nerve a disease of the nerve so there is a nerve ending which is going into the penis and it is touching the glands and somebody's touching the glands and a pleasurable sensation is going to go back through the nerve but here the nerve is you know under inflammation so it takes that pleasurable sensation into pain so patients keep complaining that there there is a painful pricking sensation in the penis and that is uh that's very usual I see it very often once in a fortnight in a diabetic man so it's something that gets created over time it is injury to the nerve there is inflammation to the nerve due to a diabetic bodyes diabetes it's important to take care of your health that's right like it can even affect you down there yes imagine just overnight one day you wake up and the same feeling that was giving you pleasure Once Upon a Time now gives you serious pain that's right oh my God next time you're thinking of having that cake just just think of this moment from this podcast oh my God sir um all right uh I want to talk a little bit more about this nerve tissue situation from a biological perspective okay yes now the process of sexual activity is meant to be pleasurable that's right right that's right uh and that pleasure happens because of pleasure based nervous Pathways that's right right so if you're in the act of sex your penis is sending back a pleasure based signal to your brain that this is good do it now that's Nature's Way of procreation so that you create kids and of course then people use sex as Recreation also for the same reason uh my question is why aren't nerves like that present in your hands M okay or maybe the other question I want to ask is you know how how Okay comparing it to the female body girls have more pleasurable points points guys usually just have one but the truth is and we had a uh sexologist also on the show long ago she said that actually even guys have pleasurable points but lots of men don't even know that certain points are pleasurable because they've not exploded sexually now I'm actually asking you this both from a sex perspective and a biology perspective so the same pleasure based nerves Pathways that are present in the penis are they also present on say your back your earlobes your neck yes and it's different for different men like based on their biology that's why being loved in those points gives you pleasure see if you look at a sensation there are various Sensations which we are taught as mbbs students so there is a touch pain temperature vibration these are the pressure these are the five Sensations that the nerves are supposed to to take touch is a sensation which is which can be always pleasurable unless it is a rough touch so we are talking about touch we are not talking about pressure pain or pinch or something so it is about your brain being wired for example I'll give you an example so when you are with your loved ones and she's touching you wherever she touches you it is going to to give you pleasure whereas suppose you are standing in in a crowded place and somebody touches you you may just slap him the touch Remains the Same it is about the wiring and the final interpretation in our cerebral cortex right what because the touch is going to go into the cerebral cortex for processing and after the processing the brain decides or your psyche or your wiring decid Ides how to react to it you can derive pleasure out of it or you can you know div derive offense out of it and react accordingly so somebody rightly said whatever you mentioned was right that the male nipples are actually more pleasurable than the female nipples as in male bodies derive more pleasure from the nipples being stimulated than that's right that's right so is only that women don't know so they don't do it and Men they're hardly bothered because they're bothered more about procreation they're wired in that way I think for men and women at least what I understood based on all the people we've had on the show and conversations with friends I think sex is very different as an activity I think for a lot of men it's just about the final result it's just about the final orgasm and both for themselves and their Partners like there are guys who actually care about the partners orgasm also and who prioritize that in sex often girls will say that these are the best kind of male sex partners but the actual fundamental key differences for men sex is about the orgasms their theirs and their Partners uh but for women it's about the whole process they care about even like the conversation you have before the sex uh as I mean the whole process is prioritized much more than the final orgasm that's absolutely right but there must be some biology in this also you know of course like I in terms of I I would just assume either girls are more ins sync with their own nervous system or girls have more nerve endings like they say the old factory system of a woman is much more developed that's why they can smell perfumes like much more deeply and they can pick up on sents much more easily but I'm sure this spreads across the body there's got to be some biology yes so you have asked so many questions in one statement I need to answer each of them sorry called a professor so I'm supposed to dissect out each statement each way and go for go for it sir so first thing you said is that it is the behavior which is different from men and women if you go back to say thousands of years in the cave era men were supposed to go hunting it would take One Day 2 Day 5 Days 7 days but they would come back with the Bounty they would give it to the Wom woman woman would divide it amongst the children and make sure that the neighboring woman's child doesn't come and eat that that is how the cave was men needed to procreate they had little time at home so they would procreate so men are wired to have sex quickly ejaculate and go finish women on the other hand IM imagine that the man her man is away for a hunt if she's easily stimulated into sexual activity there will be so many men who can come and do that to her so as a protective thing the these women are wired in such a manner that they need to be stimulated at more than one Center maybe multiple Centers before they ready for sex so and biologically does this mean more nerve endings in other body that's right so they're all together only then she would want somebody to have sex for example if you if you understand what a quicky means a man is always ready for a quickie but the woman would would resist and it actually boys down to the nervous system yes and this the reason why that is like that I've just told you the reason why it is difficult to get a woman to sex for that reason because she needs to be wired the the Ambiance should be good if there is dirt around or the house is in disorder or it is smelling bad you know as you mentioned Al Factory Eye Ear everything only then a woman would be ready for sex that is why you have to woo a woman because that is the biology of a woman I'm assuming a part of your job is also to kind of give sex coaching yes it is could you encapsulate that in Five Points for like what do you usually tell guys so I'll tell you in India especially yeah no we're talking okay we have so many things but I'll tell you one this you just mentioned about men who are worried about their orgasm and the partners orgasm so there are couples who come to me and they said that look um I we are trying for a baby and the gynecologist has said that we must have sex on these two days 14 to 16 days of our period but during those two days I can't have an erection so what is there so you have to understand that it is a pleasurable act so when you make a pleasurable act as an act of performance that means you're taking away the pleasure out of the man this pressure so you're taking away the pleasure so the gland penis is supposed to get stimulated it goes to the mind and mind sends the signal for the erection to persist and gets more stimulated and again it goes back to this mind and brain and it gets another stimulus to stay erect but what happens if you are not thinking about that pleasure so you're you say pleasure so you are not worried about the pleasure so s so the boy is worried about ovulation ovulation time fertilization so there's no pleasure no so he's doing performing a duty so when you take away the pleasure the performance goes and then he's into a vicious cycle so there is a poor performance and then there is a guilt because the woman is going to come out and say what the hell have you done you spoiled my evening and you've not been able to fertilize my eggs then he goes into depression and from depression he then takes some courage and again approaches the woman for sexual activity but then in the back of his mind he has pre-performance anxiety which happens to a lot every guy I've ever spoken to has gone through the situation so pre-performance anxiety will reduce the performance and the whole vicious cycle the four things the poor performance guilt and depression and pre-performance anxiety and then poor performance so it's a vicious cycle so most of these people come to us like that we had Dr vijayant on the show on the Hindi version of the podcast we spoke about this in detail and the basic outcome was you actually need the partner in this case to be encouraging verbally just say it's okay and give Comfort give nurturing uh sometimes it even takes a few months for a guy to get out of that anxi performance anxiety cycle but once he's out he's out forever so you actually need the girl to give verbal cues and say it's okay be calm Etc is that what you've seen so I'll come to this sure so this cycle vious cycle published under my name in 2007 Journal of sexual medicine this is when I published this so there are two situations when the couple comes to me in this situation there's a woman who is very harsh so she's like a principal of the school and there's a boy who can't answer what is 2+ 2 because if he answers wrong he's going to get a stick now tell me how can this man have erections with this woman in this situation so you are absolutely right we need to in such a situation counsel the woman so many times women would understand but in today's time I'm talking about 2024 in the last 20 years perhaps women have changed they have their rights they're aware of their rights last week only I had a patient in whom the women said that look we are married only for a year I have the whole life with me I'm going to divorce him there are couples who have been together since say mid school high school they never had sex they get married and the boy is not able to perform and the woman leaves him now you need to find out so what I do is I put them together and I ask the woman do you want to patch up or do you want don't want to patch up so if you want to patch up the first step is the very first step that I accept is that you have come all the way taken my appointment sitting in front of me means that you want to patch up so if you want to patch up then we are willing to work my problem is that you sitting with me for 15 minutes but next time you're going to come after a week but you have one week minus 15 minutes to be with him so I can't do everything in 15 minutes I'll take one step you perhaps have to take 999 so unless you are willing to take those steps I can't treat you and this is very important so this is the counseling to The woman there are women who will say okay I'm willing to do that there are women who would say to hell with it so we have both kinds you know all kinds make this world apart from this there is a pharmacological agent that I use so before I go to the pharmacology I'm not going to be a proponent of alcohol but alcohol inhibits the inhibitions inhibits the inhibitions so if you ask these couples the couples that you are talking about that if they have a drink or two just a drink or two they would perform much better but if they have six drinks then there's a problem that's what the Shakespeare said alcohol will increase desire and reduce performance but first 30 to 60 ml it inhibits the inhibitions and that is exactly what we need so we need to tirate that I'm not a proponent of alcohol but you will see that your friends who can take it who do take take it tell them to limit the drinks and you see the difference the second is we have a pharmacological agent which inhibits the inhibitions so I use that and it works so there's a tablet it's a very cheap tablets it's actually 1950s old tablet nobody uses it these days I it's an anti-depressant nobody uses because we have wonderful anti-depressants or R&D and other newer Medicals I use it because it has a side effect that it causes erection what's the name trazodone so the side effect of this drug is erections so I use the side effect so that is I'm visualizing a depressed guy in the 1950s taking an anti-depressant and then that is how it was found really yes if you look at the pharmacology book so we read what is called Lawrence pharmacology and there's a story about it he was was this Banker who went and reported this so we are we are evolving so that's how it is it's kind of sad about like his life and suddenly out of the blue it's like what so when I was doing my third year mbbs when we are taught pharmacology that was the day I realized that I will use this molecule once and I did that and I'm still doing it published it in journals sexual medicine 2007 so that's how it is yeah and sometimes I think in situations like that like I've had so many Bros of mine confide in another brother that's what you do because you don't know who to talk to exactly so a lot of Bros come and say listen I'm having this issue in most of the cases 99% of the cases the guy is usually anxious about his job he's an anxious guy in general that anxiety is making its way to the bedroom and as a bro all you tell him is listen it happens to every guy chill and it'll be a phase that you'll get past just you need your partner to support if that partner support you you can go through a lot exactly that's the bottom line here that is the bottom line the partner has to be important person I take the fees I take the credit but the treatment has to be done by the partner very clear um in India especially what other kind of sex coaching do you need to give people because this problem is actually very common what we just spoke about uh performance anxiety is performance the most common yes so I will tell you that I will give you the history of the what is written in the books so in 1980s it was thought till 1980s it was thought that 90% of erectile dysfunction I'm quoting Western literature sure 90% of erectile dysfunction is functional that is this means there's nothing wrong with the organ and 10% is there is a problem with the organ for example example diabetes or something which is what we spoke about the that pain that's right diabetes causes Pro sclerosis or fibros or obstruction of the blood vessels so that there's no blood supply it causes inflammation of the nerves so that there is no sensation there's no blood supply there's no sensation so organ has to you know it eventually cannot perform diabetes is basically like it's eating your body from the inside that's right it's a dreadful disease go on so 19 till 198 is the Western literature talked about 90% being U functional we call it or psych psychogenic and 10% being organic means there's a problem in the organ and 1980s we started having what is called penile implants so the literature in 2010 would tell you that 90% is organic and 10% is psychogenic that's a western literature so how does it change obviously I'm not blaming anybody but then there are forces which are industry driven and imagine it is easier for me to treat a couple like this by putting an implant rather than trying to convince the lady that you have to be supportive please correct me if what I'm going to say is wrong what you're effectively saying is there are lots of problems related to sex all those problems boil down to erection or the lack of it in most cases it's actually psychological where the guy is just feeling anxiety what we just spoke about but there's a lot of money to be made in this industry by the Pharma companies and by people who make implants therefore they push for research that suggests that if you're having trouble getting an erection you either get an implant or you take a medicine for it is that what you're trying to say absolutely right absolutely so I'm coming to I will give you a small story sure so I used to go for an after I started my practice I used to go to a place 500 km from New Delhi and I used to conduct an OPD there and there was a big army cantonement there so one day there was this um soldier who came and saluted in very crisp uniform and he said sir I am going on leave tomorrow I said that's very good you should go then this young Soldier tells me that sir but I don't have erection I said how do you know are you with your family here he says no my family is back home and I'm going to go and face my wife but I have lost my erections so I said how do you know that you've lost tions so he said I was guarding my commanding officer's luggage on the railway platform and there was this sadhu who was sitting across the the railway line and he called me and he held my uh wrist and told me he he actually palpated my pulse and told me that means you don't have erections and from that day onwards I stopped having erections now you must understand we were talking about psychogenic and organic in United States if somebody tells a United States Army soldier that you are not having reactions the first reaction will be he'll punch his face in India we are so vulnerable to Suggestions by so-called sadus or revered uh religious people that whatever they say is Gospel truth and we are willing to make ourselves vulnerable and accept that suggestion so this is a damage by suggestion a psychological damage by suggestion so this guy says no sir that sadhu Baba has told me it will not happen so it is not happening so give me do something for me otherwise I going to die because my wife is not going to accept me so coming back to the story of the psychogenic versus organic so we have so many reasons for having psychogenic in importance what did you do for that Soldier give him something no no I there are ways so what we do is I talk to him I gave him that tablet called trodon because I knew that it is just I have to inhibit that negative thought so inhibit the inhibition so inhibition of sex is a negative thought so you inhibit the inhibition and I we this is a test so we put what is called a vasoactive substance and we put it into the penis with a small fine needle inject and he has an erection because this is vasogenic so vogen you did that to him I did it so that he sees that it is erect I said look your organ is fine you have absolutely no reason go home and enjoy he smiled saluted and went back that's all he never seen him again did he have a boner when he went away genuine Quest he walked no no we tell them they cannot walk out like this they have to masturbate ejaculate and I have to see that the erection has come down because I have created the erection it is my responsibility to see that the erection doesn't last long enough to cause a damage to the organ because persistent erections are causing damage to the organs okay now go on you talking about the studies yes so I was trying to tell you that the distinction between psychogenic and organic erections so the psychogenic organ erections obviously we in India have lot of issues which create lot of psychogenic genic reactions for example I just talked about suggestion I talk about you know friends talking in the school or college or high school that look you've had a girl you've had a girl you then they tell okay you don't have man you haven't had sex as of now my God you must be useless so this guy becomes useless then he has a guilt that oh my God perhaps I'm not good enough with a woman that's why no girl comes near me near me that that's how it is so he is actually you know he's he drowned in his own guilt and he will never have an erection so he is an kind of introvert in that manner so we have lot of people like that they come to us so many times newly married people with arranged marriage will come the girls parents the boys parents they're all there four people there two these and uh when I talk individually to each partner I ask this to the boy what is your what is is wrong with you said sir honestly I can tell you I've never touched a girl and I'm scared to have to touch her and her presence makes me so nervous that I can't have an erection and this is not something that I'm talking about a story this happens more often than you can think of okay so then I have to just tell the girl that you're very lucky to have a boy like this I have to tell the parents that your boy is absolutely fine I'll give him something and he'll be fine no more tests now I don't I don't get how parents get involved in this like no they do in India so India is a very unique country I just gave you an example nothing like this can happen in any other country that somebody sitting across a railway line will call you and tell you that you don't have erection you stop having erections so that's the suggestion that we are vulnerable to so what is my practice my practice very simple so how do you differentiate between psychogenic and organic tions the very simple so if I ask one question that when you wake up in the morning do you have hardons or not so if you're having hardons early morning spontaneous reactions that means your machine is absolutely fine don't have to worry till what age any age so even when you're 50 60 70 you still get hard ons in the morning the frequency decreases a lot depends upon testosterone you cannot decide what is the age at which you will go B can you have an age no at what age will you have a gray hair do you have age no so it is not like that this is individual so those people who exercise and continue to exercise their testosterone is high so whether it is a male or a female somebody who is a sports person is likely to have a higher sex appetite because the testosterone even in female male in that case is high and the role of testosterone in females is sexual activity which not many people know M so for example somebody got a vagra for men they say somebody who discovers a vagra for women will be multi-millionaire why I just told you to get a woman to bed you have to touch all the points there are so many things so it is difficult to get a woman to arouse so women have an they have a slow arousal as compared to men there's also an art to it which many guys refuse to learn that's okay but suppose instead of learning that art there's a tablet that you put in okay so that tablet imagine how much it is going to you just have to give that tablet to the woman and she's with you y so the point is that there is a different biology but in men if if you have erections which are spontaneous which are morning erections then first thing is clear I need no more test your organ is fine there's only a disconnection between your organ and the brain so basically your organ has a mind of its own it will eract but not with your efforts or your wish so it has its own wish and command not it is it's not under your command m so there's a disconnection and we need to sort that out so we sort it out in most cases is psychological that's been the underlying Chia that's right this is such an important conversation because a lot of guys are just going through the same performance anxiety problem a lot of guys without hearing this conversation that it is psychological I want to actually talk a little bit about testosterone also yes because if you truly focus on increasing your resting levels of testost tone I would assume that problems like this performance anxiety all won't arise as much uh because testosterone is linked to so many other positive functions of the body also I think it is a hormone that should be spoken about more and every man at least should be educated on how to increase his testosterone levels so I'm going to have a go at it please add stuff to it and this is based on an episode of Dr huberman that I researched upon for the sake of a elaborate testosterone Hindi video that i' done it boils down to the basics clean food high protein intake lots of movement ideally a competitive sport that's been like a recent study uh all these things over time compound and generally your testosterone levels stay good up the age of 50 and right now America for a lot of guys post 50 this has become a very common conversation that they do something called trt which is under the guidance of someone like yourself testosterone repl therapy um before I ask the doctor for his inputs I need to tell the audience that again all the doctors we've spoken to the lifestyle factors are effectively the same and you guys know all these lifestyle factors it's exercise clean food Etc the only added Factor here is a competitive sport if you're able to play a competitive game of football once a week basketball Cricket where you want to win for some reason that's shown an increase in testosterone anything else you'd like to add so yes so testosterone is the food for the body so suppose you're not utilizing it body stops producing it so either use it or lose it and you use it by exercising yes so what does the body mean why why should you have a testosterone and a woman shouldn't have a testosterone what does testosterone do to you it gives you muscle broad shoulders strong bones what are they supposed to do you're supposed to exercise with them you're supposed to go fight you're supposed to go to war you're supposed to go to hunt swim so if you don't do that you're not using your testosterone so the body there is a as I said there a wonderful computer this guy doesn't need it man so take it off in terms of if you're lazy if you're just sitting at home all day watching TV your body will reduce your testosterone level if you're watching TV the testosterone reduces faster even if you're watching Pawn yes okay just just a thought experiment go on because because you are straining to produce to recreate that if you are with a woman then that job is being done by the woman here you're trying to recreate that thing onto yourself sure that is the problem with testosterone so testosterone has lot of functions as we just mentioned muscle bin bone this that and if you don't use it you will lose it so how do you exercise so there is something called basil metabolic rate now you have a basil metabolic rate it is like the RPM the revolutions per minute of a motor car so you have an idling car it has an RPM of 800 to say 1,000 RPM so that that engine will run and it will consume a certain amount of fuel so now when you give a r it goes to, 1500 so the fuel consumption increases so suppose you are getting up in the morning and you're exercising so you are revving up your metabolic rate your RPM increases from 800 to 800 to 1,000 to maybe 2,000 if you are jogging in the morning or swimming in the morning and during the day since you're working you're not coming back to rest you're going to office or you're going to your work it stays the basil rate it may go up to 200 RPM 2,000 RPM and then comes down to maybe 1600 1,800 1,400 which is much more than 800 that you woke up with and then suppose you add on a physical activity you had to run after something or you had to rush or you had to cycle or you had to do something it again goes from 1,400 to, 18800 now imagine if you had not gone for a exercise in the morning you woke up with 800 so you are lingering between 800 and, 800,000 and if I ask you to put an effort you would be unwilling to put an effort and even if you put an effort your RPM is not going to go beyond say 12200 because your basil metabolic rate was 800 now we add another Factor do this thing so we have a what is called a body clock block which runs with sun so we have the pineal gland we have the hypothalamus and we have the melatonin and we have the ccan ltin Circadian rhythm the leutinizing hormone which is released from the pitutary goes to the testes and increases the testosterone so there is a peak of leutinizing hormone releasing hormone from the hypothalamus which is controlled by the Circadian rhythm which is at 4:30 a.m. so SLE early in India in our uh history or in our mythology or whatever it is called Boral that is the or the the main time that you have the peak of lhr or leutinizing hormone releasing hormone from the hypothalamus it goes to the pitutary which is the leutinizing hormone which goes to the testes and kicks it to produce testosterone now imagine you doing a exercise and an activity when the testosterone Peak is there M so you have an inflow of testosterone you're using it at that time so next day morning the hypothalamus knows this guy needs more testosterone so it pumps in more wow now if you are not doing it the hypothalamus also thinks this guy is not going to use testosterone so let it be around 8 his RPM is 81,000 so why should I give him another fuel so there's no testosterone which Rises coming back to another thing I'm sorry it is not against people who exercise at night because they don't have an option if you don't have an option you can still exercise but what is better morning or evening suppose at night you come from office and you go for an exercise you go to the gym and you have revved up your RPM from say 1,000 to 2,000 after 2 hours you're going to sleep so the advantage that you had during the day that you revved up your RPM to 2,000 and it stayed 2,000 because you were working you were running moving around in the office anywhere wherever you are working you are actually RPM is still high against you raise it to 2,000 go off to sleep in 2 hours you that that whole effort is gone waste technically y effectively giving very easy hacks to increase your testosterone yes and the hack is sleep early wake up early work out in the morning like Akay Kumar that's why his voice is like that the actually the way Akay Kumar lives eats goes about life he's a good representation of a high testosterone male yes I would I would argue yes right like just healthy living this is healthy there's also a report I remember tiger sh spoke about this he said that he doesn't drink because it shakes up your testosterone levels even one session of drinking yes so anything that that puts your RPM to downwards like alcohol you can't even balance yourself that is the state of your muscles so your your RPM may be falling below 800 so obviously the testosterone consumption is not there the body computer says oh this guy doesn't need a testosterone so stop producing it and there is another issue to it suppose you have been a football player so I see lot of them so there's this guy I'll give you a story it's an interesting story so there were two people who got married because they used to be playing tennis together now they were playing tennis together they were between 25 and 305 years courtship then they say okay we get married they get married they have a good sex appetite they have a good testosterone both of them and now this guy is a banker and at 35 he wants to become the vice president of the company so is working very hard so he's putting in 14 hours on the chair he stops going to play tennis his wife however continues to play tennis at 35 two of them come to me together with erectile dysfunction so what have you found so you look at him and you see oh my God he's got as CH as what I am you know so this guy's become chubby he has not been playing tennis the girl is Slim like you know any tennis player you can imagine at 35 since she is a tennis player she has a high testosterone she has a high appetite which this guy can't match so he has an impact with psychological thing also because he's not able to match the epetite so he goes into two things both a combination of psychogenic erectile dysfunction and an organic erectile dysfunction because when I check his testosterone his testosterone is low why is his testosterone low two things one his computer says he's not using it so it reduces the second is the stress stress is huge so this guy is stressed he's looking at his his you know counterpart colleague who may become a vice president and he wants to reach there and he doesn't want him to reach there so Round the Clock that stress is there 14 hours in office 10 hours at home 24 hours a day he's only thinking about one thing how to prevent him from being a vice president so that I become a vice president just to put your point uh across even more I want to remind the listeners of how they felt during exam season in school you felt a higher level of stress what was biologically happening was that your cortisol levels in your body had increased cortisol is your stress hormone I'm assuming that it's related to your testosterone of course that if you have a higher Baseline cortisol in your bloodstream it will affect your testosterone certainly certainly anything you'd like to add to this qutool angle so two things so if you look at two things one is of course when there is stress there are stress hormones like cortisol apart from that direct effect of cortisol there is an indirect effect on psyche you stop thinking about sex because you're thinking about failure yes even if your partner is trying to approach you for sex you stop thinking about it because either you're tired or you're scared of non-performance because last time you couldn't perform because while you were performing you suddenly realized that you hav sent a mail which the other guy must have sent so doing that that means that he's he's distracted so he stops performing so he's staying away from sexual activity his testosterone is coming down again if you look at people who unfortunately need corticosteroids say for kidney disease or lung disease or something else rheumatoid arthritis they are given steroids they become plump so they gain lot of fat so fat has an enzyme called aromatase now what that does is it converts testosterone into estrogen so whatever testosterone is being reduced is being converted into estrogen rapidly in that fat in the subcutanous fat and the structure of the body becomes more feminine pair shaped so if you remember there was a movie called kabi Kushi kabigam and there was this Rik ran and there was a child ran do you remember that golu person was plump what is wrong with that fellow and how he became rtic rashan so there is a biology transition between that boy and that honestly this this story that you're giving us of Ric from childhood to actually being muscular Ric russan I have seen so many guys my age younger than me go through that same story arc of not taking care of their health when they were younger and then eventually in life realizing pretty early on that either they got what's pre-diabetes called like yeah that's right so they become this this basically pre-diabetes only latent diabetes and that manifests like for me again same thing I was a judo player very fat but judo player so I was strong uh but unhealthy on the inside I had gall stones at 16 and I had gallbladder removal surgery at age 16 so that surgeon very politely told me that you'll die at 25 if you eat this way and then that just got me very deep into fitness like at age 16 17 I started running at age 18 I started weight training you know and I've I've really taken care of myself a lot in my 20s uh best decision of my life because it changes your personality also thing is that personality change that you go through then applies to your career it applies to your ability to lead Etc but biologically speaking what's truly Happening Here is that your testosterone is high because you're taking care of your body you're sleeping on time you're eating right you're exercising uh and that high level of testosterone genuinely helps your career I truly feel that because it's sort of also called a hormone that's a latent motivator you just feel like going out and achieving more things in the world uh I'd like you to begin this next phase of the podcast wherever you like do you want to begin at the rtic russan part do you want to begin at the personality aspect of testosterone you go for it so I'll touch all of them sure first of all let us uh beg pardon from hi ran because you're losing his name it is not that it is the character in the movie called uh ladu ladu that's right so consider ladu so so he is a he's a golu kind of a person and he eats whatever he wants to eat dietary indiscretion and he's very moody and he doesn't want to focus into anything he maybe not listening to anybody he would eat whatever he wants to eat and not what he should be eating now when somebody has that kind of a habit it is perpetua why is it perpetuated because what you're eating sugars they go straight into your gut and then they go there and change the microbiome of your gut in such a manner that you are only feeding the wrong kind of bacteria in your gut and if you see what the story about the bariatric surgery it is not only about making the gut small the stomach small capacity when you do something there the local hormones change and they reduce the fat they reduce the fat absorption they cause some kind of change in the local hormone meu that the fattening effect of diet reduces so it is not only the direct amount of calories that you're drink taking but it is something else which is happening there and that is related to the the jum the gut microb the jum is the small bubble just next to the the upper small bubble or you can say upper small intestine is jum and that is the seat of all these hormones the Dum and the jum so coming back to the diet so when you're having a dietary in discretion like that a lot of sugars they are immediately absorbed from the small bowel and the small bowel actually thrives with bacteria which are which just need sugar so they keep multiplying and you don't have the the healthy bacteria in your gut so suppose you were to take lot of fibers so if you were to take lot of fibers they do two things one they mechanically displace the colony of these bacteria two they line up the intestinal level in such a manner that what even if you take sugar after that that sugar is not going to give rise to or potentiate the growth of negative bacterias so this is what is the story behind what happens so when something like this is happening a lot of fat is getting accumulated when the fat is getting accumulated as I said it has what is called peripheral uh aromatase aromatase is an enzyme which converts the testosterone into estrogen and if you see these boys they will have breasts they will look like femin bless and uh they will have small external genitalia the hair growth around the genitalia which is the pubic here is of the feminine type Which is less no the hair growth in feminine type is an inverted triangle in a male type it is the upright triangle that's the pubic hair so that is how the pubic hair is supposed to be you're basically biologically turning your body more feminine that's right by giving into your craving to eat sugar as much as you do so anyone who is overweight and this I've seen with anyone struggling with weight issues across there are two major culprits in India one is anything sweet I mostly when you're talking about cold drinks it's a lot of cold drink drinking why do you need that iced tea why do you need that juice with your food just have water the second issue that I have noticed in India is chakna you know salty snacks tea time snacks it's these two issues mainly in India with anyone even trying to to lose weight but people need to understand the biology of not losing weight to get scared because I personally woke up when my body scared me that hey you know this is the kind of physical pain you'll go through if you don't take care of yourself but I feel this kind of pain is even worse it's psychological pain that's right so these people get withdrawn they don't go to play because they cannot run so everybody and especially the boys as you say if they compare their fallace with each other they would find then then they'll make fun of him so this guy becomes more and more introvert and when he's introvert and he's getting depressed he eats more the sugar craing increases the chocolates the easiest ones to have or whatever snacks you lay hand at so this is a vicious cycle the testosterone which is being produced so he becomes stunted the height becomes small the weight increases the insul insulin requirement increases insulin increases the diabetes and other things they come into play the fatty liver happens the injury to the liver happens because there's inflammation and the root causes accumulation of fuel called uh sugar and suppression of testosterone so if you need to reverse this process the first step is of course you cut down on sugar sugar is the first thing to go and the second is exercise and as I said these people will not be able to get up in the morning to start exercising but you tell them to at least start walking and they would today in the era of bariatric surgery a lot of people will be subjected to bariatric surgery and many of them will stay slim many of them will come back if they are not motivated enough because sugar is sugar sugar so they start sipping it if they can't eat it so the issue is testosterone with sugar metabolism is totally linked fat and sugar metabolism is linked with testosterone it's not many people understand so suppose you do a testosterone level on this boy who is a plump uh maybe in his teenage you'll find the testosterone to be low it is low for two reasons one the lhr is a lutenizing hormone releasing hormone also is not effective to push the testosterone Tes become remain small and some people will call it as delayed puberty also but the idea is that whatever be the cause that needs to be reversed and the best way is the diet high fiber diet and exercise these are the two things that happen the Third third is the dial variation the cardian Rhythm if they don't follow cardian Rhythm like sleep early wake up early so I will tell you why I keep talking about that so there is a term in Hindi Nish which means the Nocturnals those who live at night suppose we have bats who were supposed to live at night open their eyes at night and you capture a bat and put him on sunlight then you are torturing him humans are not Nocturnals humans are not supposed to be waking up at sunset they're supposed to go off to sleep so if your body is waking up during this night you are awake during the night your body is crying for help like a bat is crying for help during the day which we all ignore because we have flashlights we have LEDs we have everything we create light but our hypothalamus cannot be fooled and we get into troubles the body is under stress even if we think we are enjoying a party a disco or maybe a game of cards or bards or whatever so simply staying away at awake at night means your body is under tremendous stress and stress reduces testosterone okay okay so if you don't uh follow cardian rthm your testosterone is going to fall anywh I think this is also an infinite topic if you open up all the lifestyle factors and we've covered it you know on the show what I actually want to talk about is something we've not covered on the show which is masculine aging um I would redirect anyone who wants to know more about this topic about increasing testosterone to our past videos which we link below but this masculine aging thing which is the natural decrease of testosterone this happens even into like the healthiest guys and this is the kind of conversation I'm having with a lot of friends my age in terms of we all watch cricket Growing Up Football why do players' performance start dipping at 3035 it's effectively a decrease in testosterone which then leads to other physiological changes in your body we had Mur Daran on the show and I was arguing that no kohi has at least 5 10 years left he's like no you know as a cricketer your eyesight gets affected after a certain age it's just the outcome of age how are you able to see the ball I would argue that it's one of many physiological changes that happen with age but the base physiological change that happens in an active guy's body is a natural decrease in testosterone I also want to talk about prostrate and all that later no I will talk about it oh it's linked to this no no I'll talk of the what is called Androgen deficiency in aging male this called Adam this is natural right this is natural uh so so talk about it starting from my age 30 yeah we talk about what's happening in my body right now so so we have a person who has been exercising who has been looking at his muscles he has a certain testosterone and slowly because all of us are expected to get into our uh routine work which does not involve exercise unfortunately so what happens is that the testosterone because as we have menopause in women there is something called andropause and Men the only difference is that in menopause you have a clinical sign of session of periods whereas in men there is no clear-cut sign and it is a gradual process for example what we believe is that illnesses so you get into an injury suppose somebody some boy gets into an injury at 30 he is bedridden for say 10 days his muscles are not used for 10 days his basil testosterone level Falls then he goes for Rehab everybody doesn't go for training as you see in certain movies where somebody has got a blade and is running and whatnot everybody goes back to work office perhaps so so they don't bother so suppose your testosterone was say 600 nog per ML and you have been in bed for say 15 days because you had a fracture or you had a fever or typhoid or a illness which was prolonged or you're just burnt out because of work no I'm talking about a very specific thing injury to the body which reduces your physical activity Fair okay so when your physical activity is reduced your testosterone consumption is reduced your basil testosterone level Falls so your testosterone was 600 you get hit by a car you get into a hospital for 6 weeks when you wake up after when you get out of the hospital your basil testosterone is supposed to say 400 then you start coming back to work you are not rehabilitating as a physical activity which but then you are good enough to go to office so you start going to good enough to go to office so testosterone may increase from say 450 from 400 to 450 doesn't go to 600 so every single episode that occurs to us Beyond 30 years of age brings down our testosterone to a level which is not recoverable so slowly suppose from 30 to 40 years in those 10 years you had five such episodes where you had to stop exercising your basil metabol your your basil testosterone today is 600 nog per ml but it will drop down to 400 simply because of these conditions snakes and ladow me it's the snakes yes which bring it down that's right here you may go back again but you will never reach there that is the issue what's a practical version of this practically in what kind of career does someone keep getting injured or keep falling ill no no falling ill we all have like viral fever typhoid diarrhea so any small the reason I'm asking that is I'm trying to understand this whole prevention is better than cure situation while there is no complete prevention here maybe one way to prevent The Snakes and Ladder snakes situation happening is you work on your immunity yes so I'll talk about one more Point here so suppose you had 600 you fell down you came out of the hospital at 400 if you consciously want your testosterone to go back to 600 how many of us know that we need to go back you will start exercising you will build up your muscle again you will look at your diet critically so in India what happens if you are sick they give you Des G which increases your fat which increases your decreases your ability to exercise size because if you are running at 45 kgs and now you're running at 60 kgs you're adding 15 kgs load to yourself your performance reduces your testosterone consumption reduces so your testosterone production reduces so if we were to get a lesson from this talk it is that if I get sick and I'm off my exercise for say 15 days I must make sure that I go back to my pre previous exercise level and understand that my stamina should be like that this is the least we should be doing despite this it will still decline there will be factors which will accelerate this decline like competition at work fight with your spouse problems with parent teacher meeting problem with the neighbor all these things because you're thinking suppose you had a fight with your neighbor so the fight doesn't end because you're going to see him again tomorrow so it gets recreated the stress gets recreated so you get into a circle of stress stress stress this stress is the one that accelerates the decline of testosterone basically when your life is stressful there's a steady decrease of testosterone so other than focusing on your immunity and your exercise and your diet try having a slightly stress-free life know how to navigate through stressful situations because stressful situations cannot be avoided that's just how life is I think it's your reaction that you can like exactly so you modulate so so when I go back to my college and meet my friends whom I met in 1981 we are freshers we are being raged by our seniors and four of us are together today we are now 18year old boys H yeah that takes away the stress desser that's right right stress Buster so that is what is stress Buster fair that is important for us family time that's right Etc like all the things time cousins friends travel travel these are all de-stressing I would argue this is just my own experience like my meditation has helped me too much like in terms of navigating through situations and changing my reactions to bad situations because in business there's just it's a stream of laf like problems but to be able to detach yourself from that life so I mean I would argue meditation sound sleep so I'm coming back to if you were to ask me meditation I will talk of yoga yeah so what is meditation basically meditation is something that you want to take yourself away from the surroundings and get yourself within yourself they say you connect with parmatma that is is different that's something which I will not talk of now we'll talk some other time but then if you have confined yourself that means you're taken away from your career from your neighbor from your fight anywhere else and you're able to compose yourself retract and compose yourself that is meditation so when you are doing this you are calming down the sympathetic activity and activating the parasympathetic and parasympathetic activity is good de-stressor but so what are these two so I will tell you so sympathetic is something where where you have fight or flight suppose you are going on a road and suddenly there is a dog or a wolf that attacks you so you have two options either to fight or fly so whether you fight or whether you run away and retract or save yourself the idea is to save yourself your stress that is the stress so that is adrenaline so that is the adrenaline r rush so adrenaline rush is the sudden form cortisol is delayed form adrenaline comes like this and goes back and cortisol goes like this so it is fight or flight is adrenaline so your pulse increases it goes to maybe 120 your blood pressure increases the the blood is taken away from your intestine and is given to your muscles so so they actually the blood is actually flowing from all the internal nonsignificant organ at that time which becomes the stomach the intestine and the reproductive system the blood and the fat and it is all channelized towards your muscles and bones and brain so that is adrenaline and that causes the stress reaction parasympathetic is caling for example if you look at the pulse of 10 people in a class the same age same frame there'll be a person who would have a pulse rate normal pulse rate is 80 so there will be a person who has a pulse rate of 90 so this guy is fidgety all the time and he's doing something or the other some Mischief or somebody is doing a mischief to him or whatever or he's reacting to a Mischief or something then there's a boy whose pulse rate is 50 and you look at him he's a basketball player he's a tennis player so what happens when you're playing your vagal tone increases so parasympathetic reduces the heart rate sympathetic increases the heart rate what is veal vagus is the main nerve from B brain it is a 10th cranial nerve which supplies the heart and other visceral organs and vus is the harbinger of parasympathetic activity like the spine for your parasympathetic nervous system so coming to that because it runs parasympathetic chain runs from there there's a sythetic chain then the Paras sythetic plexuses are there and physic Al where is it physically it comes from here across here and goes into the heart and lungs and then into the goes in deep into the abdomen into the stomach so uh it has activity on the secretion of acid in the stomach it has an activity on the motility of the stomach and the what we call the pacemaker of the gastrointestinal tract fair to say it's responsible for the things that are not voluntary that's right so sympathetic and parasympathetic parts are the autonomic nervous system and autonomic nervous system normally we are not supposed to have a control on them but yogis in our culture they are supposed to control the autonomic nervous system so autonomic means which cannot be controlled they are autonomous but if you happen to control them then you become a yogi and for example uh autonomic would be all the heartbeat Etc even that's happening because of your nervous system versus when you lift your arm this is your motor nerves but that signal to lift the arm is coming from your own brain so it is the involuntary activity going on inside your body is autonomic which means that your brain doesn't control it your conscious brain doesn't control it your brain stem controls it so that is the autonomic nervous system and this is divided into sympathetic and parasympathetic Sy sympathetic is related to fight of light where your body is in a stressful Zone which is actually most of the urban population who are going about their work who are going about traffic who are getting into fights on the road the sympathetic is activated way too much Advanced and here the angle is you need to actually activate your parasympathetic much more so the answer to mental stress is physical stress wow so if you see there are people who will go and bang their heads or whatever they what are they trying to do they're trying to find a solution how to reduce their stress or Outburst what we call so for example if you are angry you go and you have a swim you get calmed down or you go to you hit the gym you do 200 squats and then you are done you get over it you come back and you say to hell with that fight yeah so the the the answer to mental stress is physical stress now you look at parasympathetic and sythetic so physical stress as I said the tennis player he a good tennis player professional tennis player they have a pulse rate of 35 40 which is extremely good and healthy for the heart and you know because they are physically active so their mental stress is supposed to be much less than what mental stress not while they're playing but their Baseline mental they're usually contented if a swimmer you know when he comes back he done his swim and he knows yes I've done I've conquered what my target was enough to hell with everybody else so that's how it works so simpath syc activity and parasympathetic activity so there are ways to control sympathetic parasympathetic activity and one of them is meditation the other is of course certain ASAS for example buang asan or thasan and if you go back what you just mentioned the spine the paraspinous the core muscles of the spine the spine is supposed to be erect because of four pillars of muscles around the paraspinous muscles there the anterior two and the posterior two paraspinal muscles and the if you stretch the spine and divide the weight on this completely it is actually de-stressing wow which is why a yoga session feels so relaxing that's right they start with tasan then they go to bujangan which is Cobra yeah and then they have something like downward dog yeah which stretches your heel right up to your hand yeah so these ASAS and meditations were a yogic way of caling the human body taking away the stress reducing the sympathetic activity and remaining calm with increase in parasympathetic activities and this if you have a parasympathetic activity which is high then obviously uh if you have a you have more testosterone so Sy I activity is adrenaline and cortisol cortisol causes fat and suppresses testosterone so they're all interl I can link autonomic nervous system to testosterone Goa uh I think we gave a very nice angle on a healthy way to age as a man it's all the basics plus play a competitive sport ideally but also try practicing your your yoga and meditation it physiologically will calm you down and therefore elongate the lifespan of your testosterone levels now let's talk about the invariable aspect of human life which is post AG 50 and 60 why are so many white men in America on Joe Rogan's podcast talking about testosterone replacement therapy first question second question should Indian men also be looking into it third question I'm sure you given trt to some patients uh not for treating a disease or something but just because the testosterone levels are low should a guy like me who healthy also concerned with health consider trt at age 50 and how do you go about it so trt so we talk of various segments of men who require trt for example I talked about a couple where the husband and wife both are tennis players the wife is still playing tennis the husband is stopped playing tennis he testosterone has come down now should I give him testosterone because if I give him testosterone it is going to suppress the follicle stimulating hormone in the brain which is going to suppress the spermatogenesis so if I give him a shot of testosterone his sperm counts drop to zero damn and this couple is looking for a child so you need to know when not to give testosterone so testosterone even though if you look at the lab it will show a borderline testosterone it doesn't mean that we have to give testosterone if they are looking for a baby suppose the same couple has had two children you discuss a out with them do you need another child because if I give you a testosterone replacement there are two issues one your testosterone production will seize for life for example if you keep having MacDonald's or something your mother says okay I am shutting down the kitchen why the hell should I produce food food similarly if you keep having exogenous testosterone into the body the endogenous testosterone which is supposed to be produced by your body is going to be shut down by the body computer called hypothalamus even if you do it once or a few times yes it does hurt it is reversible at your age it may not be reversible at 40 you mean if a 40y old does trt once then he is signing up for it for life exactly that is why a Pharma company he hit me damn okay because this is not the image of trt I had in my head at all no so I'm coming to trt again so one was this boy who wants to have a child the couple wants to have a child you should not give testosterone you have to tell them that if I give you testosterone your sperm count is going to go down you're not going to have a baby soe you have to decide today even if you have to give up your job change your job job you have to start doing these things like exercise respect to the cardian Rhythm high fiber diet and meditation yoga Sports competitive Sports and certain dietary things like eggs onions uh seafish uh Seafood oysters these are the things which are which are supposed to be increasing testosterone and for veg people onions is good enough yeah onions is good and high fiber basically so the lettuce and other things they they do increase testosteron so this is what I'll give to this couple but Suppose there is a 45y old person who comes to me with erectile dysfunction or whatever and I do a testosterone and it is low then I have to talk it out to him and I have to tell him look I can uh give you testosterone but make sure that if it is today just below the border line if I give you testosterone you will need it every time that I ask you because the duration changes from 3 weeks to 3 months whatever the dipo preparation we use or a daily preparation that we use then you will need it you your body will stop producing testosterone and I do not know if I stop giving you testosterone will it come back and start producing or not so in all probabilities when I start a testosterone it is for a lifetime contract with the pharmaceutical agent and per session how much does it cost so it is very different there are gels there are capsules there are injections now injections there are certain injections which are short lived injections so there are pure testosterone and uh you give 100 mgram testosterone injection it goes to Supra physiological levels so I will explain what is a physiological suppose there's a physiological window the physiological window is between say 1200 nog to 300 nog so testosterone between 1200 and 300 is what is the ideal for a human body so if I give you a shot today the testosterone shoots to 1400 M it hits very hard the hypothalamus and hypothalamus goes into shock stops producing lutenizing hormone releasing hormone pitutary goes into shock stops producing lutenizing hormone and the testes get ET Fe your balls will shrink that's right because you're shooting into the Supra physiological levels so I don't like this but lot of people give it it's the easiest way I'm sorry I haven't taught anybody no but why are lot of people giving it to make money no I will come to that but let me finish this part you please ask that question why are they so I need to choose a therapy that pushes the testosterone from from say less than 300 to 400 500 so that it is in the physiological range it serves the purpose of the body and does not hit the hypothalamus so hard that it becomes irreversible so capsules gels because they are small doses and then there are certain Depo preparations Depo preparations so you have those injections there are 3 ml injections given in intramuscular once in 3 months which is 12 weeks so every 12 weeks somebody has to take a shot it is released very slowly because there's a Depo so it keeps releasing so it does not cross the super physiological level so if at all I need to give testosterone replacement I will choose something which stays within the testost the story of those shs that I talked about is somebody will come and say I'm going for a weekend so give me a shot for a better erection that's right but unfortunately that's not true that's a placeo so how does testosterone affect erections so I'll give you an example so you have a hand pump at home and you hand pump has some washers and you need to service those parts and you put oil to those parts so that is the maintenance fluid for the hand pump so you do it every Sunday I was made to do that by my my mother so I used to do oil my valves of the hand pump every Sunday and then you stop doing it so what happens it still works on Monday it still works it keeps on working till after 6 months it breaks down because of lack of testosterone or the maintenance fluids similarly the erections erections require a maintenance fluid called testosterone so if you give testosterone today it is not it is not going to maintain it today it is not bagra which is a different drug which is supposed to be used for this so you give a sh of testosterone it does nothing to the erection so for erection that means if the erection is because of lack of testosterone it will take that much time to recover if you give testosterone so it is a maintenance fluid so why give why people give testosterone uh like this is anybody's guess but that is a kind of custom lot of people do it lot of people will go to the doctor and say Friday evening okay give me a shot I'm going to go out with my friend or something but that is actually a disservice because if that shot is going to cause supr physiological level of testosterone and going to hit the hypothalamus so hard that it is going to stop producing your endogenous testosterone that is more about testosterone two questions from a consumer perspective first question is the price like for a good quality trt therapy second question is I'm assuming that this good quality trt therapy is all about this art of reshuffling the hormones which only a doctor like yourself would know so never try doing trt yourself as a basine but even amongst medical professionals how do you know which doctor is giving you the right kind of trt I am assuming the answer is experience yes it is about you know unfortunately I'm I try to tell everybody not to use as much TR as is available because of the single reason that if the single risk is that if I give trt your body stops producing trt therefore try to avoid as much as possible having said that there will be situations where you will require it the cheapest is an injection that you take once in 3 months in the muscle in the muscle and that is maybe for 5,000 rupees in 3 months okay that's pretty that's not very bad as compared to there are certain capsules which you have to take morning evening with a meal or the gel every day that actually seems to be little cost turns out to be a little costlier than this and those shots that I talked about the simple plain testosterone which are not Dio preparations they would uh actually have uh a little less cost than this but the risk is more because they shoot the physiological levels coming down to who should be giving it yes there are experts who should be giving it but experts who understand that I'm giving it with you know giving testosterone trt start in trt is 10% of treatment 90% is education that I just talked about which is movement exercise food circadian rhythm I will refuse to give you testosterone next time if you don't do that Dam that's what I should do okay the way my life is going I take care of myself all that all these factors are do you think I'll need trt at some point no even when I'm 60 no then why is this a culture in the west because it is a shortcut because they're not taking care of the lifestyle because there is so much of Industry pressure I feel the farma industry is much more active there than you yes right like they call it a pill oriented culture and I love Joe Rogan like he's my idol as a podcaster if he's talking about something it sits in my head in terms of this guy is like 50 55 years old he's talking so much about trt now here we have a doctor telling us that no that's not how life should be so first of all you've retaught me something so thank you because I was under the assumption that I'll have to do trt at like 5050 no never so rather it's a curse it's a curse I'm making a recurrent deposit scheme for myself so it's a Pharma company no no the Pharma company puts it on the market and obviously the interest of farma company is to sell it it's a good molecule where it is required but it has to be used judiciously so I need to use it judiciously so when when farma company called me because they thought I was an expert on testosterone and I started talking like this they said man what are you doing I said this is the truth right so I will tell you who requires testosterone for example uh there is this guy who your AG he's a senior executive somewhere and has a good happy life so he's got a raise he's got a Bonus and he goes home and he finds certain kids playing around his house so he puts his hand in his pocket brings out some sweets chocolates or something and says oh enjoy the same scenario there's a 58y old person coming from work and he's grumpy and he's rly poly and he looks at those kids and says oh my God what the hell are you doing haven't you got any other place to play it's only my house irritability irritability so this guy is irritable he's grumpy he is the man perhaps who has to be evaluated for low testosterone so why why can't he just live with low testosterone will there be physiological problems later on yes there will be so the cause and effect are related so what caused the low testosterone is what we need to understand so his lifestyle he's not sleeping on time he's got physical stress mental stress he's not doing enough physical stress he's eating uh something which he shouldn't be eating because you know that's how things are so imagine a roly poly Guy moving like this and is barely able to breathe he's overweight and and he is irritable he does not take um you know he's not able to handle stress crisis so mismanagement of Crisis cognitive disorder that he forgets that okay uh I will whether I was did I lock my door or not or where have I kept the key or did I pick up my phone from my table or not because he forgets and he's not oriented so he will say okay I think I was going towards the market no I was going towards the temple so it's indecisive so indecisiveness is it a way of saying that low testosterone levels are linked to early onset dementia exactly so like you all these things you lose your mind if you don't take care of your balls yes exactly and you'll take care of your balls by fixing your lifestyle and your body yes so I will tell you I've just given you a scenario where the person has lost his testosterone and I'm talking about a boy now so you know there used to be a boy in our College who would go on a motorcycle with speed of 100 without a helmet and we would be oh my God what a m and now my son says I want to do it I say shut up don't do it so what is it I have matured he has testosterone so cost of maturity is loss of testosterone so these are related you know you have to understand so I can if I have that much of drive and testosterone maybe I would also do something foolish like that so again bottom line is for this whole testosterone conversation take care of your body and your diet do the right things which you guys already know and maybe if you're dealing with certain symptoms that sir spoke about in your 40s 50s or if you're dealing with legitimate biological erectile dysfunction then you go to urologist you go to an andrologist who will help you kind of balance out your testosterone levels first and foremost through lifestyle and then through therapy like PRT yes anything else you'd like to add as a bottom line so the point is that if you don't use it you will lose it fair so keep using it okay now another one of my questions this is a whole new segment uh I want to know about the prostate what is it what what is its function why do so many old men all over the world have to get it removed how much does it hurt to get it removed how much does it hurt to get it checked give me like a one1 on all these things so let us talk bit by bit the first thing is prostate is a small organ like a size of a walnut and it is situated between the reservoir which is the urinary bladder and the conduit which is called urethra so there is a reservoir which is urinary bladder and there is an exit which is urethra and prostate is around this urethra so if you see a pair and there's a central core so the central core is the tube through which the urine passes and the spare is actually the prostate so imagine that there's a bladder and there's a urinary passage passing through the prostate and the role of prostate is to produce semen now Cen is different from sperms sperms come from testes semen is the fluid in which the sperms Thrive because they need a medium to be carried to their work so semen the seminal fluid which is maybe 2 to 5 ml every jaculate is being produced by glands within the prostate swimming pool water that's right that is the medium through which the sperms move so it is controlled by testosterone it's a male organ so it is controlled by testosterone and slowly over the period over the fourth decade or so there are changes in the hormones there's a balance between the estrogen and the in the testosterone that ratio slowly starts changing as you start accumulating fat and the peripheral aromatase comes into picture and something goes wrong with the proliferation of cells within the prostate and it starts proliferating it starts proliferating and imagine there is a there is a kind of an organ through which the urinary passage is passing and this organ decides to increase in size so if it increases in size there are two options if the outer shell is elastic it it will expand like this if the outer shell is tight it will compress the passage so it hurts while peeing no so the person has frequent desire to pass Ur in he has urgency so that when he is sitting here he has a desire to pass urine before he reaches the washroom he leaks oh my God then he reaches there he starts to pass urine and he realizes he's not able to start the stream even after some time when he starts the stream he takes longer to evacuate towards the end it is a dribble he keeps waiting he then gets up and Zips his he is trying to come back he has again a desire to pass your in so he goes back again so there is a sense of incomplete evacuation so there's a frequency urgency prolonged stream delayed stream broken stream and sense of incomplete evacuation does this happen to all guys no fortunately not why does it happen to so many though yeah so there is some familial transmission of this so all men will have some we call it benign hyperplasia of prostate or BPH so all men Beyond 40 years of age will have some BPH changes if you do autopsy of these men you'll find that histologically or under microscope if you look at those tissues there will be BPH but that is histological BPH that is not clinical BPS means it does not give symptoms so not all people who have an enlarged prostate will get symptoms for ex what is histological histological means what we see under the microscope okay which is not available to the naked eye that's and and or feelings yes so you don't know but that is a topsy so for example there are patients who will come to us with a prostate gland normal prostate gland is 20 G so I often get a call at 10:00 from somebody who gets my number and says doc I've got into trouble I'm just 45 and my Executive Health checkup told me that my prostate is enlarged I want to see you tomorrow morning so I said how can I do that so how much is the prostate is this 25 G now the normal value which has been designated by the ultrasound is 20 G but you have a 25 G prostate which means that that's okay it is growing but is it causing you trouble that is where we need to understand that it may it should not cause trouble if it is not causing trouble let it be because it is then those one of those prostates where the capsule is too elastic and the increased volume is being taken by stretching of the capsule so there will be men who would have 200 g prostate without an issue couple of questions one you have to do prostate examinations regularly doesn't it hurt to put doesn't hurt the guy with the bum so if it hurts the patient the fault lies with the doctor really yes technique technique what is the technique the technique is you have to explain make the patient comfortable there is a muscle that is very tight you have to allow it to relax which is naturally loose but when you're nervous it becomes tight exactly so if I'm trying to push my finger through that door I'm hurting him you lubricate it well keep talking to him distract him and slowly and there is a way you don't put it like this you put slowly like a thief you enter nobody knows that you've entered that is a trick so there is a lot of variation individual variation so many patients will come and tell me I won't like to get it done but once it is done they say oh is it done last time I had so much of pain so they have a bad experience but then it's an individual training it should not hurt at all and if it is hurting it is the problem of the Doctor Who has done it now why do we need to do that test we need to do that test because we are looking whether there's an enlargement of prostate or not if you person comes to me with the symptoms I want to see if the prostetic enlargement is the cause of symptoms so I do that examination but today we have ultrasounds so I simply ask for ultrasound ultrasound gives me not only the weight volume also gives me the shape and then I know okay and the effect of prosthetic obstruction on the bladder tabulations or cytis whatever they call it so you have ultrasound which can tell you that yes prostate is enlarged then why do you need to do a put in a finger why does one need to put in a finger one was to certain that the prostate is enlarged which we do now with ultrasound the second was to exclude cancer you can tell from the touch that's right my finger is very sensitive to pick up a cancer but the problem is now that we have two tests called PSA a blood test called prostate specific antigen and an MRI so if a person comes to me with a normal PSA I don't have to do a rectal examination to say that you have cancer or not because the PSA is normal so I have to watch him if the PSA starts Rising if there is a Serial PSA rise then I know there may be a cancer that is the time when I will touch it and see if there is a cancer that I can feel or not if I can feel a cancer I order a biopsy if I don't feel a cancer I order an MRI what is a cancer feel like hard like a stone there like that's what so normal prostate is like the uh tip of your nose like soft that's right firm we call it firm got soft will be this this is firm so if there's a nodule there's a like a like a stone stuck there or a pearl stuck there so you feel and suddenly there's a pearl so you know yes this this is a cancer this could be a cancer so we are able to do it but then now now today when we have a PSA which is high we can do an MRI and MRI can tell us whether there's cancer or not this if we are still in doubt we should still look at it then we should do still look at it and see okay if I can feel it or I cannot feel it because I have to take a biopsy sure then another reason why I should put in a finger is when there is a diagnosed case of cancer of prostate and I need to do a robotic surgery I need to feel the prostate and see whether it is stuck to the rectum or not will I be able to remove this prostate can I find a plane between the prostate and the rectum will I be able to safely remove the prostate and not hurt the rectum so all that information a surgeon will get only when he feels the prostate so these are the but now they are very far and few in between as compared to what it was 25 years ago sometimes in the middle of recording an episode as heavy as this I just know that it's time to stop this particular episode this is one of those moments because this is a lot of dense information and I think this particular episode was simply about like lifestyle factors testosterone you know common problems like this performance anxiety situation and uh understanding the penis a little bit more understanding a man's manhood a little bit more uh first of all thank you sir very educative but uh secondly we have to talk a lot more so we will be back very soon guys sorry I'm ending the episode here I just wanted you guys to get basic education here and in the next episode we'll talk about robotic surgery uh different kinds of surgeries related to a man's genitalia yes uh but I hope you had fun on this first recording of course of course it's always a pleasure do you think we were able to convey some important education yes important because I stress that just a strong replacement shouldn't be done well that's your bottom line from this whole episode and shouldn't be used injudiciously like you know weakened injection or something like that because that's going to hurt gotcha and of course um regarding the erectile dysfunction the partner plays a lot of role like there are shortcuts like putting an implant or giving vagra but most important thing is to get the person at ease yeah I think so most of this episode was just about the natural state of the penis we'll talk about alterations and all that in the next one tailoring there is a tailoring angle so Those ads on Pawn s sites are real like you can do certain procedures they are not good they're not good they're not good more on this in the next one uh stay tuned everybody this was only part one of our epic conversation with Dr RT part two is a lot more about penis related surgeries and more extended versions of the same topics we spoke about in this particular episode so make sure you watch out for part two and until then make sure you check out all the other medical and health oriented podcasts that we've been releasing on TRS very recently we're all about unleashing that biology onto the audiences thank you for supporting thank you for listening in DRS and the whole team will be back very very soon [Music] yeah