Testosterone Expert: Your Penis is a Warning Sign, and It's Shrinking!
In a Nutshell
Dr. Reena Malik outlines four pillars of sexual health—fuel (Mediterranean diet with pistachios, flavonoids, fiber), strength (150 min/week cardio, resistance training, pelvic floor relaxation), environment (7-8 hours sleep, stress reduction, avoiding plastics/EDCs), and confidence (anatomy knowledge, communication, novelty)—to combat ED, low testosterone, penis shrinkage from poor blood flow, and sexless trends driven by distractions/porn. ED signals cardiovascular risk 3-5 years early; maintain nighttime erections, muscle mass, and weekly sex (49% longevity boost per orgasms) via lifestyle to preserve function, desire, and size (traction devices add ~2cm safely). Focus on clitoral stimulation, realistic anatomy (avg erect penis 5.2-5.5 inches), open talks, and human connection over media pressures for better intimacy and life.
These notes were generated by AI and may contain inaccuracies.
Penis enlargement device: 30 minutes twice a day shows improvements in length about 2 cm. Study on pistachios: guys ate 100 g every day and saw decrease in erectile dysfunction. Lack of erections means no blood flow to penis, leading to shrinkage over time. Same applies to women with clitoris due to same tissue type. People who have sex once a week live 49% longer than those who have sex once a year. For every 100 orgasms men had, they lived 13% longer.
Dr. Reena Malik is the world's most watched urologist, sharing on hormones, sexual health, and better sex based on data.
Four main pillars of sexual health:
- Pillar one: Fuel - How you nourish your body, huge part of sexual activity.
- Pillar two: Strength - Cardiovascular exercise improves sexual function and blood flow to penis and clitoris. 150 minutes a week equals improvement from Viagra. Pelvic floor is underevaluated and underdiscussed.
- Pillar three: Environment - Stress, sleep, endocrine disrupting chemicals. Men sleeping 5 hours/night vs 8 hours: testosterone drops 15%.
- Pillar four - Morning erections, squirting, clitoral stimulation, positions to increase partner's orgasm probability.
Most frequent question: "What can I do right now to improve my sex life?" Everyone wants good sex, feels like missing out, influenced by media and pornography.
Sexless trend especially young adults 18-30. 50 years ago, fewer distractions (no cell phones, limited TV, no email/social media) led to more opportunity for sex, talking, cuddling.
Now distractions reduce space for sex. Younger people date via apps/DMs, leading to hookup/fling culture. First-time sex often mediocre/bad due to lack of communication, no education on talking about sex, self-consciousness. Education from porn shows curated, unrealistic sex. Rise in rough sex: 60% women, 20% men (college age) choked during sex; 20% choked 25+ times. Qualitative data (Debbie Herbenick): many do it thinking it's normal, but often scared or indifferent, not enjoying.
Young people (30 and below): 15-20% constant phone use (8-10 hours/day). Dopamine from short-form videos, porn, food impacts bedroom performance. Constant hijacking prevents mind space for sex; becomes mechanical, focused on orgasm not enjoyment. Scrolling trains distractability, hard to focus in moment during sex.
Arousal requires parasympathetic state (rest and digest). Stress/sympathetics block erections. Needs time, energy, stimuli (think, see, smell, feel). Varies: visual for some, scents, baths, mental stimulation for others. In long-term relationships, responsive desire needs cues/intimacy time, not spontaneous.
Expectations in relationships (e.g., after travel/stress) create performance anxiety, vicious cycle: worry about erection/arousal leads to sympathetic activation, spectatoring, negative outcome, guilt, repetition.
Common: problems stay with you. Break cycle with sensate focus: take pressure off penetration, explore bodies, erogenous zones without erections/penetration. Erection comes naturally when relaxed. Progress: genitals, then penetration.
Many avoid sex due to poor communication. Red flag: patients say partner not into it, gave up. Sex connects, indicates good health (blood flow, nerves, hormones). Sex once/week vs once/year: 49% lower all-cause mortality. Less than weekly but more than yearly still improves longevity. 1997 study: every 100 orgasms, men live 13% longer. Sex as cardiovascular workout, physical activity, connection (loneliness epidemic = 15 cigarettes/day risk).
Four pillars foundation of sexual health house.
Fuel: Mediterranean diet most studied (avocados, leafy greens, nuts, lean proteins, fruits). Health Professionals Follow-up Study (20,000 men): 22% lower ED risk.
- Pistachios: 100 g/day decreased ED (healthy fats, omega-3s).
- Flavonoids: blueberries, citrus, lycopene (red fruits) - antioxidants reduce ED; blueberries ~20% improvement.
- Fiber: 38 g men/25 g women; converts to short-chain fatty acids protecting blood vessels, improving metabolic health (less diabetes/HTN/cholesterol), ED.
- Calorie maintenance to avoid excess fat/ED risk.
Strength: Cardiovascular + resistance + pelvic floor.
Cardiovascular: 150 min moderate intensity/week = Viagra-level ED improvement. Even heart disease patients: 5-min warm-up, 20
21 minutes of walking and 5 minutes of cool down with supervised protocol improves erectile function by 70%. Any cardiovascular exercise above current capability improves sexual function, particularly erectile function, by improving blood flow to genitals, penis, and clitoris.
Resistance training significantly correlates with testosterone. Heavy resistance training of large muscle groups (lower extremities, glutes, Olympic deadlifts, squats) improves testosterone with continuous regular exercise. Men maintaining muscle mass through resistance exercise are three times less likely to have erectile dysfunction. Muscle mass decreases 7% every decade after 40. Maintaining it preserves erectile function, sexual desire, and satisfaction with sex.
"Muscle is medicine."
Modern sedentary lifestyles (sitting at computers, podcasts) deviate from historical manual labor, farming, physical activity. Humans are meant to lift heavy things and move.
Prevent sarcopenia (muscle loss), which increases risk of sexual dysfunction.
Pelvic floor is bowl of muscles supporting organs (uterus, rectum, bladder). Anus and vagina (or penis in men) run through it. Muscles attach to hips, sacrum, pubic symphysis.
During orgasm, pelvic floor muscles contract and release rhythmically for 8 seconds, creating pulsing feeling. In men, they contract to ejaculate. They hold urine/stool and relax to pee/defecate. Tightening pelvic floor holds in wee.
Pelvic floor responsive to stress (like TMJ jaw clenching). Can get tight or misaligned from hip/back injuries. Tension causes back pain, constipation, urinary urgency/frequency (bladder on top of tense muscles), trouble peeing (urethra clenched), sexual pain, reduced blood flow leading to erectile dysfunction (men), arousal/orgasm difficulty (women), premature ejaculation (men).
Kegels strengthen normal pelvic floor but worsen tight/overactive one. Instead, relax with diaphragmatic breathing, figure four stretch, happy baby pose, child's pose, yoga. Severe cases need pelvic floor physical therapist.
Erectile dysfunction (ED) starts early, not just psychological in young men. Above 50, 52% of men have ED, increasing 10% per decade (60% at 60, 70% at 70). Causes: aging/stiff blood vessels, comorbidities (diabetes, high cholesterol, high blood pressure).
ED is a canary in a coal mine for cardiovascular issues. Organic ED precedes heart problems by 3-5 years; 7 years later, 14% have heart attack. Sexual problems are opportunity to investigate and change life.
ED definition: inability to maintain erection sufficient for intercourse (get erection but loses before ejaculation/climax). Differentiate from premature ejaculation (ejaculate too soon, but can maintain erection).
Losing erection once/twice is normal; problematic if routine. Can maintain erection with porn but not partner: no performance pressure/anxiety with porn. Habituation to specific porn, firm grip, masturbating against bed/fist/hard objects can't be replicated by partner/vagina/mouth.
Morning/nighttime erections indicate good function (blood flow, hormones, testosterone, nerves). Young boys: 3-5 erections/night, up to 40 minutes. 40s: half time, max 30 minutes, still 3-5/night. No morning erection signals issue.
Masturbation habits apply to men/women: habituation to specific stimulation hard for partner to replicate.
Morning erections from nocturnal testosterone production (highest in morning), increasing desire. Women have nocturnal clitoral tumescence (may feel pelvic congestion).
Use it or lose it: body maintains genital blood flow via nighttime erections/tumescence even without sex. Lack over months/years causes fibrosis/scarring in corpora (spongy tissue), leading to penis shrinkage. Same for clitoris.
Clitoris: glans (visible, with hood like foreskin), extends internally (bulbs, legs) homologous to penis. Homologous structures from same cells in males/females. Penis also extends deep (perineum tissue, forks like clitoris).
Clitoral stimulation like penis tip; better to stimulate more (external clitoris + internal via vagina top). G-spot/G-zone: 2 cm in anterior vaginal wall (clitoral tissue + Skene's glands homologous to prostate under urethra).
Orgasm: dopamine release, prolactin rise calms. Some get post-nut clarity (motivated); others post-coital dysphoria (sad/depressed, hours/days) from neurochemical changes.
Chronic stress raises cortisol, dampens testosterone, keeps sympathetic state, prevents sexual mindset.
Stress relief: stress ball, 20-second hug, 6-second kiss with partner, movement, gym, social interactions (talk to barista/grocery), creativity/boredom for kids.
Sleep: 5 vs 8 hours/night drops testosterone 15% in one week (equivalent to 10 years aging). Sleep apnea fix improves hormonal health. Chronic poor sleep likely means low testosterone.
Low testosterone symptoms: fatigue, brain fog, depression, low desire, ED, increased fat mass, decreased muscle mass. Receptors everywhere (brain, muscle, bone).
Serious consequences when testosterone is low include sleep apnea. Signs of sleep apnea: partner reports waking up gasping for air. Easy check: measure neck circumference. >17 inches for men or >16 inches for women indicates very likely sleep apnea due to excess mass compressing airway. Improving sleep apnea leads to testosterone improvements as high as 200 ng/dL. Same for other sleep disorders, though data less abundant. Sleep is crucial.
Environmental factors: plastic bottled water contains phthalates and BPAs, which mimic estrogen and reduce testosterone production. Other plastics, PFAS in non-stick cookware affect hormone health.
Advice to protect:
- Don't stress; control what you can.
- Avoid drinking from plastic; use alternatives.
- If using plastic (e.g., at events), avoid warm bottles as heat releases more microplastics/chemicals.
- For takeout, transfer to plate before warming; never warm plastic.
- Store food in glass or metal containers, not plastic in fridge.
- Limit dust exposure (contains microplastics).
- Wear cotton fabrics over synthetics (shed less microplastics).
Microplastics impact is dose-dependent; found in testicles, penis tissue. Mechanisms affect hormones, but exact impact unknown. Speaker's family uses metal water bottles, ceramic pans.
Company you keep affects sexual environment. Example: male physicians normalize lack of sex as aging/normal, despite stress/relationship issues making it non-priority.
Study: 50,000 people intervention encouraging positive influences (safe sex) and avoiding negative ones increased safe sex practices by 46%.
Pessimistic friends complaining about sex is contagious. Observe: do they prioritize relationships? Talk positively about partners? Avoid parallel lives where partners live separately and vent negatively.
Not amount of porn, but feelings about it. Most watch for pleasure. Issues if used to escape negative feelings (dopamine hit, compulsion).
Negative if you feel porn is bad/evil, leading to guilt/dysfunction even from rare use (see self as immoral).
Advice: reevaluate compulsion (replace with exercise/walks). Work through guilt/morality issues; abstinence hard long-term. For most adults, it's fantasy/arousal. Couples watching together more satisfied; discord if one uses heavily, other doesn't.
Impact on partner intimacy: depends. Refractory period after ejaculation/masturbation: minutes when young, up to 1.5 days when older. Daily porn may prevent ejaculation with partner due to insufficient recovery.
Confidence = knowledge + curiosity.
Knowledge: understand female anatomy, arousal, clitoris location. Talk to partner/pay attention to cues. Sex uniquely expects mind-reading; learn to communicate/explore (e.g., add toys).
Demo: vulva stimulator – external clitoral stimulation, vibrates, various shapes/modes. Couple's version: ring around penis vibrates/stimulates both.
Sex toys add novelty/excitement; challenge view as 'for old people' or 'giving up' – technology used elsewhere, why not sex?
No permanent desensitization to vibration (studies on construction workers: temporary fingertip loss, restores).
Novelty prevents boredom (like daily vanilla ice cream). Routine good, but add slight challenge for sexual flow state (like work flow: effortless immersion when slightly challenging, not too easy/hard).
Simple novelty: different room, pillow, head position.
Female on top: higher control, angles for clitoral stimulation, higher orgasm rates.
Coital alignment technique (CAT): rocking motion so pubic symphysis rubs clitoris during penetration; increases orgasm/pleasure. Play around; may be awkward – okay, learn through fun, not perfection.
Misconception: squirting = orgasm. Only ~40% women squirt (clear, voluminous fluid from urethra: bladder + Skene's glands – female prostate homologue).
Research: dye in bladder shows in squirt (from bladder), but chemically different (clear, odorless). Theories: hormonal/kidney changes, estrogen, interstitial fluid.
Doesn't matter if pleasurable. Ask partner to confirm orgasm.
Theories (unproven):
- Contains PSA, zinc (antibacterial); flushes urethra post-sex to prevent UTI (thrusting pushes rectal bacteria in; short female urethra; not partner's fault).
- Ancient hormonal surge triggered egg release (vestigial; humans now cycle-ovulate).
- Mate selection: pleasure rewards choosing attentive/genetically better partners.
~40% squirt. Orgasm spasms may aid fertility (not robust data).
Sex not just genitals; whole body erogenous zones (sensate focus). Universal: necks, nipples, lips, buttocks, inner thighs.
Non-genital orgasms documented: lip, anal, nipple; even childbirth. Stimulate multiple areas (e.g., BDSM nipple clamps).
The body has a whole bunch of erogenous zones, and people often don't spend enough time on foreplay stimulating them. Evidence shows skin has special fibers called C-tactile afferents. Stimulating these fibers promotes pleasure and enjoyment.
A study with 19 couples in London had them stimulate an erogenous zone and a non-erogenous zone (forehead) at 18 cm/s and 3 cm/s caress speeds. Stimulation at 3 cm/s produced more sexual arousal and pleasant sensations than at 18 cm/s, as these fibers respond best to slow, gentle caresses. These fibers only respond to human touch—a glove blocks the effect.
Robot massage parlors exist, but human touch is key evolutionarily. Massage chairs are mediocre at best, never as good as human massage.
Testosterone prescriptions in the US have increased 300% in the last 10 years. Conversations about testosterone levels are now common among friends.
Testosterone levels declined 25% from late 1990s (average 600 ng/dL) to around 2015 (450 ng/dL). Causes include:
- Endocrine-disrupting chemicals.
- Rise in obesity: Testosterone converts to estrogen via aromatase enzyme in fat tissue, leading to less testosterone and risks like gynecomastia (man boobs).
- Rise in diabetes and insulin resistance.
- Ultraprocessed foods lacking optimal nutrition (high calories leading to obesity, lack of healthy fats).
Mediterranean or anti-inflammatory diet with whole, unprocessed foods optimizes testosterone.
High testosterone does not necessarily mean higher fertility. Optimal levels vary individually due to androgen receptor sensitivity, genetics like CAG repeats (more repeats mean less sensitivity, needing higher testosterone).
A guy at 900 ng/dL or 500 ng/dL can both be normal. Focus on symptoms, not chasing numbers.
Low testosterone (<214 ng/dL) doubles mortality risk. Super high levels (>1800 ng/dL) risk blood thickening (stroke, heart attack), heart fibrosis/stiffness, acne, aggression.
More is not necessarily better. Once testosterone receptors are saturated, more doesn't help brain, bone, sexual health—only muscle growth (why anabolic steroids are abused).
Symptoms: fatigue (can't get out of bed), overweight or skinny fat with visceral adiposity (fat around organs), low sexual desire, decreased mood.
High testosterone causes acne via sebum. Low testosterone leads to low estradiol (from testosterone conversion), increasing fracture and osteoporosis risk. Testosterone protects bones via estradiol.
TRT is for men with truly low testosterone, aiming for normal levels after lifestyle fixes (sleep, resistance training, avoid endocrine disruptors). Not for bodybuilding.
Anabolic steroids differ: oral pills/injectables targeting muscle and androgen receptors, self-administered without monitoring, leading to super high testosterone. Risks: 15x higher premature heart failure, 122x cardiac death risk.
TRT impacts fertility: after 18 months, 70% infertile; drops in sperm count as early as 10 weeks. Recovery variable, up to 2 years.
For fertility concerns while low: Use hCG, Clomid, or enclomiphene to boost natural production by signaling brain/testicles.
Testosterone drops ~1% per year with age, but healthy men rarely become hypogonadal unless comorbidities (stress, poor sleep, chemicals) accelerate decline. 20-40% of men have low T; only 2% treated.
Decline starts ~30-40 years old. Symptoms correlate with levels: bone loss ~300 ng/dL, decreased sexual thoughts ~215 ng/dL, less vigor ~290 ng/dL.
Check total testosterone, free testosterone (1-2% unbound, most active), SHBG (45% tightly bound; elevated by thyroid issues, aging, genetics, oral contraceptives in women).
TRT is lifelong: body stops producing own testosterone, testicles shrink. Stopping causes withdrawal as body isn't producing.
Not for all 50+ men—only symptomatic and low. If receptors saturated, no benefits to mood, cognition, sex drive, erections (muscles may grow).
Rule out mimics: low thyroid, high prolactin (e.g., benign brain tumor).
When you play with hormones, it's serious business.
Young men abusing anabolics for looks (social media pressure) risk infertility.
Semen analysis is a health biomarker: poor parameters correlate with higher mortality, shorter lifespan (dose-dependent: normal sperm live to 78, worse down to 76).
31 million-view YouTube video on penis enlargement. More men want a longer penis than to be taller.
Pressure starts young (boys compare sizes). Media portrays bigger as better.
Podcast guest with medically verified largest penis (13-14 inches) has trouble: too large for comfortable sex.
Many people experience small penis anxiety, even with a normal-sized penis. Men compare themselves to well-endowed porn actors, who are outliers. Average erect penis size is 5.2-5.5 inches depending on the study. Women report wanting 6 inches on average, but sex toy purchases match average sizes. A study on sex toys for phalluses reconstructed for trans people found the most purchased sizes close to average girth.
Men think the average is 6-7 inches.
Penis does not shrink with age if good blood flow is maintained via nighttime erections. Lack of erections reduces blood flow, causing shrinkage. Weight gain makes it appear smaller due to fat pad above pubic bone.
Surgery for lengthening has high complication rates due to vascular nature of penis; small changes are very noticeable, leading to dissatisfaction. Does not recommend surgery.
Safer option: traction device (example shown). Protocol: 30 minutes twice a day for 3-6 months, gains ~2 cm length. Permanence unknown; may revert if stopped. Also helps straighten Peyronie's disease curvature by bending away from indentation. Safe with minor bruising/discomfort; costs $100-500 one-time.
A slight curve can sometimes benefit by hitting G-spot better, but dramatic changes are noticeable and traumatic.
Jelqing (hand-stretching with OK sign) is dangerous; causes micro-tears leading to erectile dysfunction.
Patients with above-average penises undergo surgery, suffer bad outcomes like permanent disfigurement (e.g., scar at top). Never forget these cases.
No need for long penis; clitoris is most reliable for female orgasm. Use mouth, fingers, toys. Survey data: majority of women content with average/slightly above/below sizes if intimate. Only 85% orgasm from penetration alone; most need clitoral stimulation.
Average vaginal length 3.5 inches, expands to double when aroused, accommodates average penis.
Penetration feels good but insufficient alone, like rubbing testicles/perineum.
Vaginal differences: stronger pelvic floor allows better tensing/grabbing around penis. Healthy pelvic floor: contract and relax like bicep (squeeze/relax during sex). Perceived as tighter to man without being constantly clenched.
Penis differences: movement, positioning, girth.
No correlation between big hands/feet and penis size. One Japanese study: longer nose (bridge to tip) correlates with penis length.
No necessary correlation with height.
Ozempic (GLP-1s) benefits: improves metabolic diseases (diabetes, heart), healthier blood vessels/blood flow to genitals, stronger arousal. Weight loss improves body image; reduces fat pad, reveals more penis (Ozempic penis effect).
Downside: acts on brain reward pathway, reduces desire for food/gambling/shopping/alcohol/smoking; theoretical decrease in sexual desire. May go unnoticed amid other benefits, causing relationship discord. Monitor; talk to doctor if desire drops (dose too high?).
Studies possible: baseline sexual desire questionnaires (e.g., Female Sexual Function Index, ADAM for men/testosterone) before/during GLP-1 use.
No universal script; everyone's different. Don't give up; reactions stem from partner's feelings (e.g., fear of rejection, added stress). Worth working through discord for good intimacy.
Tips:
- Talk outside bedroom, not before/after sex.
- When calm/relaxed (walk, car for parallel talking).
- Start positive: "I enjoy this about us; love to talk about..."
- Offer to schedule if not ready.
- Be curious: "What's going on? I want to be there for you. I miss what we had."
Women often see sex as added stress; men as stress relief/intimacy. Men use sex to connect; initiations misread as greed. Reframe sex as intimacy/connection. Build environment: daytime affection, texts, hugs, compliments, gratitude.
Men: performance anxiety (e.g., erectile dysfunction tied to masculinity/failure). Women: prioritizing pleasure/foreplay/clitoral stimulation (fear high-maintenance label); pain/discomfort, body image, mental load explaining low mood. Men: expressing non-sexual needs (unmanly), boundaries/rejection, non-normative fantasies.
Use social media: send videos/podcasts (e.g., this one) to explain. Bring partner to doctor.
Everyone struggles talking sex; learnable skill. Invest effort.
Patients share diverse sexual interests after rapport. Example: man struggles with arousal except via medical kink (e.g., full catheter insertion).
A catheter is a tube inserted into the bladder through the urethra to drain urine. Some people enjoy urethral play using sounds, which are rods with a flared base inserted into the urethra. There are nerve endings there that can be pleasurable. It is fine to have interests outside conventional norms, but if it really turns you on, bring your partner into it.
Almost everyone fantasizes. Common fantasies include:
- Sexual submission: 60% of women, 20% of men.
- Voyeurism (watching sex) and sex with multiple partners for men.
- Sexual dominance and romance (exotic places) for women. 90% of the time, people fantasize about strangers or someone outside their relationship. This is normal and does not mean they want that person or reflects how they feel about their partner. Fantasies are a safe space in the brain to explore.
Realizing if someone fantasizes about something means nothing about how they feel about you. It's just where their brain goes to explore.
Advice: Write down your fantasies privately, have your partner do the same. If comfortable, share one and discuss trying it. It may not work, but it allows exploration. Bring playfulness back: experiment, have fun. This leads to happiness, less loneliness, longer life. Everyone should have more sex.
World is stealing attention, causing loss in connection and more sexless relationships. Lives are more stressful; global events are instantly accessible via phone. Reclaim sex and work on overall sexual health.
The Hard Truth: Everything Men Need to Know About Good Health, Great Sex, and Long Life coming out in September 2026. Will be available for pre-order soon. Book goes into greater detail on discussed subjects. Wish it was part of sexual education; all men need to know this.
Women often manage health for male partners, kids, fathers (doctor appointments, vaccines). Valuable for women to understand men's issues and support them. Great gift for men, older sons to understand bodies. Motivator: People improve blood sugars, blood pressure to protect sexual health for better sex.
Podcast tradition: Last guest leaves question for next. Previous guest stamped it certified 100% human, Gen AI free.
Question: So much of the world feels hopeless. What to tell someone to reclaim agency?
We as humans are meant to be with other humans. We are meant to connect and making that a priority will allow people to feel part of something again.
Emergence of returning to religious constructs, community, live events. Prioritize that for hope to come together as society. Pendulum swings: far right/left, hate then love. History repeats; will find unity, togetherness despite pain. Optimist: We'll come together, find happiness in human connection.
Recommend Dr. Reena's YouTube channel (almost 3 million subscribers). Answers questions like:
- Why you dribble after peeing and how to stop it.
- Porn director reveals faked scenes.
- Penile health, erectile dysfunction, sex positions, and more. Wonderful, constantly updated repository. Subscribe there.
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