[Laughter]: hey guys, Nick Toro, so dr. Andrew Steinberg, and welcome to another episode of have the balls to talk about it. For my balls, I forgot my balls balls, please one there we go, we got our balls back, have the balls to talk about it, and this week we are at cardiogenic s– with dr. lumen family doctor, as well as dr. sugar, Sammy, dr. sugar Sammy, your doctor I know, but I am living. My parents dream, so we’re gonna be talking about men’s health. What a men need to know as they’re getting older, especially over 40’s. What can we do to stay healthy and strong? Let’s talk about a topic, that’s dear to your heart, which one erectile dysfunction from what I’ve heard so erectile dysfunction is extremely common. About statistics show about 50 percent of 50 year olds have erectile dysfunction. One third of thirty year olds have some degree of I’m not talking about complete impotence, but I mean varying degrees of erectile dysfunction and there’s so many more people who are who are living without talking without seeking help with it. So we don’t even know the full numbers really. The revolution started with Viagra and that really brought people out out out of the woodwork and started talking about a much more well I think that was a great thing aside from being a great drug that works, but it also it also brought a lot of people starting to talk about it and and shows like this are gonna, hopefully get more people to be able to feel comfortable and talk about it and yeah so and our most of the issues, physical or psychological, because it does happen temporarily psychologically, I have so I. Remember once someone told me I get out of here. It’s too big you monster I was like psychologically yeah, so so many people have that issue, but I I. When I speak to my patients, I normally talk about four things: four erections! You need to have good blood flow. You need to have good hormones. You need to have good good nerve innervation of the prostate, from the prostate, not for the prostate, but from the to the penis, which goes around the prostate, and you need to have good input from above here. So any of those go wrong. That’s can cause temporary or more severe cases of erectile dysfunction Wow. So how do you optimize all of that, so there for us yeah? So so? First of all, for me, every case of erectile dysfunction has a psychological component to it, whether it’s 10%, 20%, 80% and I I really advise. We have a sex therapist in our office. I really advise every man with sexual function to go, see a sex therapist talk about it. It just helps the overall picture, and studies have shown that treating with a sex therapist plus whatever medical therapy is necessary, is better than treating one alone. Having said that, 95 percent the men say: oh, it’s not in my head, it’s not in my head. It’s here, I, don’t need a sex, therapist, I’m! Fine! You know the ancient Greek, god Zeus, all those guys were like tight. It’s not like the Greeks and park X now on a Saturday night or am drinking booze, oh and dancing the bouzouki, that’s a different Casta doctor. So what is your take on that, like erectile dysfunction is okay. You work okay, a great question so, just like dr. Steinberg was saying we think of it from a family medicine, point of view, there’s a psychological component and the organic biologic component. So we think when you’re younger there’s a lot more psychology and as you get older, there’s a lot more biology or like dr. Steinberg was talking about those four points, so we think of the penis as a dipstick of health, so [Laughter] [Laughter] that of course, as we get older, it’s more of the organic part, so the organic part means the artery that supplies led to the penis might be getting blocked for various reasons. So smoking, cholesterol, blood pressure, all of those things and what I worry about is a family doctor. If that’s not working down here- and perhaps that’s because it’s getting blocked, then how about the smaller arteries in your heart, so it’s kind of a harbinger of heart disease. So, although they worry about erectile dysfunction is very important to me. I worry more about the impending heart attack. That’s come on well, I, agree, but and and dealing with patients they come in and they’re overweight and smoking and high blood pressure and so on, and they say look you want to improve your erections well exercise. Let’s see my friend Nick lose weight, stop smoking, stop drinking so much and what’s the at the end of most these conversations, yeah yeah, okay can I, have my Agri yeah, so I agree, yeah and and I say look. This is exactly that. This is really a sign of something bigger and we check for diabetes and we check for all these diseases in these patients, but, like everything, everyone’s looking further for the quick fix, unfortunately, I mean what an excellent point I dr. Steinberg brings up because Viagra now celebrated its over twenty years and it’s true, regardless of the organic or the psychological part, the Viagra can help it can override a lot of that and for men the two obviously are connected and that will take care of that Wow. But but it’s hard to get patients to change. That I mean as if any guy comes in with high blood pressure. It’s hard to get these patients people men to change their lifestyles. Well, what about the one condition we didn’t talk about as men get older and that could contribute to erectile dysfunction, monogamy I think sometimes for men when rectal dysfunction, if they say that they just with their girlfriend, they lose gonna, keep on saying girlfriend their wife. They lose their erection but or boyfriend. They cuz you’d, lose it with your wife and I’ll, be exact.