#389 - Thinking scientifically: why it's hard, why it matters, and a practical toolkit

1. View ED as Health Warning

Erectile dysfunction (ED) is often a “canary in a coal mine,” preceding heart issues by 3-5 years. Address ED as an opportunity to investigate and improve overall health, as it signals underlying cardiovascular problems.

2. Prioritize Cardiovascular Exercise

Engage in 150 minutes of moderate-intensity cardiovascular exercise weekly, which can improve erectile function as much as Viagra. Even light walking protocols can significantly boost sexual function by improving blood flow to the genitals.

3. Strengthen Large Muscle Groups

Regular heavy resistance training for large muscle groups (e.g., lower extremities, glutes) improves testosterone levels and helps maintain muscle mass. Men who maintain muscle mass are three times less likely to experience erectile dysfunction and preserve sexual desire.

4. Adopt a Mediterranean Diet

Nourish your body with a Mediterranean diet rich in healthy fats, leafy greens, lean proteins, and colorful fruits (like pistachios and blueberries). This diet can significantly reduce the risk of erectile dysfunction and improve metabolic health.

5. Prioritize Quality Sleep

Aim for consistent, sufficient sleep, as sleeping only five hours a night for a week can drop testosterone by 15%, equivalent to a decade of aging. Addressing sleep disorders like sleep apnea can significantly improve hormonal health.

6. Manage Chronic Stress Effectively

Chronic stress elevates cortisol, dampening testosterone and keeping the body in a sympathetic “fight or flight” state, which hinders arousal. Actively alleviate stress through methods like 20-second hugs, 6-second kisses, movement, and social interactions.

7. Ensure Adequate Fiber Intake

Consume 38 grams of fiber daily for men and 25 grams for women to improve gut health, protect blood vessels, and enhance metabolic health. This helps reduce the risk of diabetes, high blood pressure, and high cholesterol, all linked to sexual dysfunction.

8. Manage Body Weight

Maintain a healthy weight, as excess adipose tissue (fat) increases the risk for erectile dysfunction and other sexual dysfunctions. Weight management also helps prevent testosterone conversion to estrogen.

9. Practice Pelvic Floor Relaxation

Learn to relax pelvic floor muscles, especially if experiencing pain, urgency, or sexual dysfunction, as Kegels can worsen already tight muscles. Incorporate exercises like diaphragmatic breathing, figure four stretch, or happy baby pose, and consult a pelvic floor physical therapist if needed.

10. Address Performance Anxiety in Sex

If experiencing performance anxiety, remove the pressure of penetration. Begin with “sensate focus” by exploring non-genital erogenous zones, gradually reintroducing genital touch and then penetration once comfort and arousal are re-established.

11. Communicate Openly About Sex

Discuss sexual health and desires with your partner in a calm, non-confrontational setting (not in the bedroom). Start with positives, express curiosity, and reframe sex as a form of intimacy to foster understanding and connection.

12. Create Intentional Space for Intimacy

Counter modern distractions by intentionally creating time and mental space for sex and intimacy. Arousal requires a calm, parasympathetic nervous system state, which is difficult to achieve amidst constant scrolling and busy schedules.

13. Reduce Endocrine Disrupting Chemicals

Minimize exposure to phthalates and BPAs from plastics by avoiding plastic water bottles (especially warm ones), not heating food in plastic, and storing food in glass or metal containers. Limit dust exposure and wear cotton fabrics to reduce microplastic contact.

14. Cultivate a Positive Sexual Environment

Surround yourself with people who prioritize and discuss sexual health positively, as negative social influences can normalize sexual inactivity. Actively choose relationships and conversations that support a healthy view of intimacy.

15. Maintain Genital Tissue Health

Ensure regular blood flow to your genitals through sex or nocturnal erections to prevent fibrosis and shrinkage of tissues over time. Your body protects itself by providing blood flow, but lack of use can lead to issues.

16. Check for Sleep Apnea

Measure your neck circumference (over 17 inches for men, 16 for women indicates high likelihood) and address sleep apnea if present. Fixing sleep apnea can lead to significant improvements in testosterone levels and overall health.

17. Diversify Solo Sexual Practices

If you find yourself habituated to specific types of stimulation from pornography or masturbation that cannot be replicated by a partner, diversify your solo practices. This helps maintain responsiveness to varied stimulation during partnered sex.

18. Introduce Novelty and Toys

Incorporate small changes or sex toys to add novelty and a slight “challenge” to sexual encounters, fostering a “sexual flow state.” This can be as simple as a different position or room, enhancing immersion and enjoyment.

19. Use Slow, Gentle Touch

When stimulating erogenous zones (neck, nipples, lips, inner thighs), use a slow, gentle caress (around 3 centimeters per second). C-tactile afferent fibers respond best to this type of human touch, increasing pleasure and arousal.

20. Understand Testosterone’s Role

Recognize that testosterone naturally declines with age, but lifestyle factors significantly impact this. Focus on addressing symptoms of low T and overall health rather than chasing an arbitrarily high number, as excessively high levels carry health risks.

21. Consider Fertility Before TRT

Be aware that testosterone replacement therapy (TRT) can cause infertility, with 70% of men becoming infertile after 18 months. If you plan to have children, explore alternative methods to boost natural testosterone production or delay TRT.

22. Monitor Semen Health

Consider semen analysis as a biomarker of overall health, as poor semen parameters correlate with higher mortality rates and shorter lifespans. This can provide insights into your general well-being.

23. Be Mindful of GLP-1 Medications

If taking GLP-1 medications like Ozempic, be aware that while they offer metabolic benefits, they may theoretically decrease sexual desire by affecting brain reward pathways. Discuss any changes in desire with your doctor.

24. Try Penile Traction Devices

For men concerned about penis length, a traction device used 30 minutes twice a day for 3-6 months can show improvements in length (about 2 centimeters). Avoid dangerous methods like “jelking” that can cause damage.