Med School Minutes-Ep. 62 | Can Erections Predict Cardiovascular Disease w/ Dr. Elliot Justin

What if one of the earliest warning signs of cardiovascular disease had nothing to do with chest pain? 👀❤️

In this episode of Med School Minutes, Elliot Justin discusses the surprising connection between erectile health, nocturnal erections, wearable technology, and cardiovascular wellness. From emergency medicine to health tech innovation, this conversation explores how wearable devices could change the future of preventive healthcare.

Topics include:
• Erectile dysfunction & heart health
• Wearable technology in medicine
• Nocturnal erections as a health indicator
• The future of personalized healthcare

#MensHealth #CardiovascularHealth #WearableTechnology #MedicalPodcast #HealthcareInnovation #ErectileDysfunction #PreventiveMedicine #HealthTech #SexualHealth #MedSchoolMinutes #SJSM #SaintJamesSchoolOfMedicine

Transcript

Intro

SPEAKER_00 0:01

Hello, and welcome to another episode of the Med School Minutes Podcast, where we discuss what it takes to attend and successfully complete a medical program. This show is brought to you by St. James School of Medicine. Here is your host, Kashik Gua.

Meet Dr. Elliot Justin

SPEAKER_04 0:19

Welcome to another episode of Med School Minutes where we talk about everything MD related with the focus on international students, specifically students from the Caribbean. Today, our guest is Dr. Elliot Justin, who has been an emergency physician for several decades and eventually went on to become a serial entrepreneur. With his seventh company, he has actually invented a wearable technology that measures men's health. And today we're going to discuss with him what this actually might mean for the overall implications of men's health in general. So without further ado, let's welcome Dr. Elliot Justin. Thank you so much, Elliot, for joining us today. And you know, I'd like to thrust right in, no pun intended. Penetrate the subject matter. Yeah. Or let's penetrate the subject matter. And I want to start with why you're your nickname or your moniker, which is very interesting. And you are known as the Erection King. Can you elaborate and tell us why that is?

SPEAKER_01 1:25

Well, I prefer being called Lord of the Rings, but I the basically there's a we live in an incredible age of healthcare wearables. Smart watches, smart rings, smart bands, smart scales, smart everything. But there's a gap. And that gap is sex. And what do men care more about? How many steps took yesterday, or some fluctuation of the blood pressure, or the last two or three erections? And the answer to that question is obvious to every man and to every woman who's been involved with men. So we fill that gap. And you know, in the course of I was four years ago, I was challenged by a professor of urology at the University of Utah to come up with a way of counting the number of nocturnal erections.

SPEAKER_03 2:10

Okay.

Erections & Heart Health

SPEAKER_01 2:11

And my reaction, if you don't mind my I'm from New York, my reaction was, what the fuck for? Why should we care? And we we we know about morning wood and we laugh about it. And it's kind of this loose notion that if you have morning wood, you're okay. Um by the way, that's not true. Uh and he said, actually, Elliot, uh, nocturnal erections are a leading indicator of man's cardiovascular health and his sexual health. And that kind of took me aback because in medicine we treat associations. We don't treat there aren't a lot of leading indicators. A leading indicator means it's predictive. So if the number, if a man's number of nocturnal erections goes down by 50%, that man has a significantly higher, some some people claim up to up to 50% chance of having a cardiovascular event, angina, heart attack, something of that nature within the next two years. Well, that kind of when he told me that, that kind of took me aback because this was like another vital sign, and one that men obviously would care more about than pretty much any of their other other vital signs, and past potentially this could motivate men to uh take better care of themselves, lose weight, exercise, eat better, you know, etc. Uh and but this doctor, like most doctors, is what I call a cocking virgin. So uh your audience is rather young, but I want to advise any young man in this audience, frankly, any any woman as well, too. Right, you want to marry someone who's into sex toys. You want to put that on the on the on list you check. So I'm uh my wife's here in the room right now, she's our creative designer. Uh I've been married almost 38 years, and uh she's a sex toy. So consequently, uh I was well aware of the cock ring problem.

unknown 3:44

Right.

SPEAKER_01 3:45

Koshak, do you know about what the cock ring problem is?

SPEAKER_04 3:47

Uh not what the problem is. I am very good at cock ring.

SPEAKER_01 3:51

They they suck. The problem is they suck. So they're you know they're these hard O-rings that they made they're they're made out of hard silicone, they can only be one 20 or 30 minutes safely. They block the turtle flow of blood in, so that so a man has to be wrecked first in order for it to be effective. Okay. And then you put the ring on, sliding down the shaft of the penis, and it's you're essentially lynching your dick, and that's not particularly comfortable. So they've caught on in among gay men, but not among straight men. One of the one of the jokes that we play upon doctors at the American Urality Association or the Introside for Sexual Medicine is how do you tell the difference between a gay doctor and a straight doctor with one question? I can predict your I can predict your sexuality, sexual preference. Koshak, yeah, do you do you use cock rings?

SPEAKER_03 4:33

No, I do not.

The Wearable Technology Behind It

SPEAKER_01 4:33

No, so you're straight. So um, and then you know, when you ask the doctors, the straight doctors, it is, well, why not? It's like, well, you know, I'm I'm good enough. And then they're kind of if if you if you then show them that this is the tech ring, their reaction is kind of like superman kryptonite, oh, not for me, you know, maybe for some of my patients. Well, I I in order to count the number of nocturnal erections overnight, we have to reinvent the cock ring. And I rather call- I call it an erection ring. The urologists call it a constriction band, which really is stupid to my mind. I mean, what man is gonna think positively about putting a constriction band on his penis if he has a problem? That's uh that's like some you know, torture interrogation phrase. Let me put this constriction device on you. It's gonna feel really good. So we had to reinvent it. So instead of making it out of out of hard silicone, it's made out out of out of a soft elastomer.

SPEAKER_03 5:29

Okay.

SPEAKER_01 5:30

Uh it can say it can be worn safely overnight. It um goes on as follows. It doesn't go down the shaft. The balls, the balls get dropped in like that.

SPEAKER_03 5:40

Okay.

SPEAKER_01 5:41

It opens and closes with a hook because it's a safety feature.

SPEAKER_03 5:45

Okay.

SPEAKER_01 5:45

So by the way, I'll share with you that we have documented over 200,000 erections on 4,000 men. We have the world's largest DIC database.

SPEAKER_03 5:55

Okay.

What Causes Erectile Dysfunction?

SPEAKER_01 5:55

Uh, and most of the work in urology for men's health right now is based upon small studies like you know, 25 men, 35 men. This is an enormous database. And and I'll share with you in a moment the three most significant findings that we've made. Anyway, that's what it looks like. There's sensors embedded in this. It will function as an erection ring. It'll help men to have a better better performance, but it's collecting data. So one during sex, it measures duration and firmness. One overnight, it counts number nocturnals, measures duration, measures their firmness, and with that information, men and the doctors can finally get data about the impact of asclerosis, diabetes, hypertension, medications, alcohol, recreational drugs up upon upon upon their sexual health. And that's a game changer because in this world of andrology, what do doctors do? We just pass out pills. Right. And we pass out pills the same the same dose to everyone. It's really stupid. It's it kind of kind of offensive in a way, and a lot of men have figured figured it out. Hey, you because we don't treat blood pressure that way. It wouldn't be like if you were a patient of mine, Koshaki, you said to me, Hey, hey Ellie, Dr. Justin, uh, you know, when I go to the gym, my face gets red, my heart pounds, maybe I have a high blood pressure, and my and my pulse is irregular. And I said, Hmm, sounds like you have a cardiac arrhythmic and hypertension. Here, take these two pills and come back in three months. You would think, what the fuck is this? 1900? I mean, I you can check my blood pressure, you can get a blood test, electrocardiogram, imaging test, but we are treating men, the vast majority of men, just with pills. So getting back to the the nickname, um the uh we're providing data about men's most vital signs that's that that's previously uh unavailable. And what did we discover? So uh the teaching in in in urology is that uh the incidence of erectile dysfunction starts goes up 10% per decade after age 50, it's 50% age 50, it's about 25% age 30. That's an enormous number of men. That that that's that's a that's a pandemic of sexual dysfunction. And obviously there are problems with low-time, we'll talk about that later on. But is that really true? So, what uh what we have discovered is that the definition of erectile dysfunction is fundamentally is flawed. It needs to be changed. And of course, changing anything in medicine. I'm 73 years old. I might be dead before the before it gets changed. But the International Society for Sexual Medicine defines erectile dysfunction this way. And by the way, they don't teach this type of stuff in medical school. They haven't taught you the definition of erectile dysfunction, have they?

SPEAKER_04 8:27

Right.

SPEAKER_01 8:27

No, you haven't.

SPEAKER_04 8:28

No, I mean uh we we do go through it, but also there are a lot of caveats about um how uh ED is essentially primarily uh a psychological aspect, a significant psychological aspect too. So I don't think we get into the physiology as much as we need to.

SPEAKER_01 8:44

Yeah, well, it turns out that what comes first, um what I call the well let me let me start at the beginning. So here's here's a definition. Right first clause inability or difficulty achieving an erection. And that's about 12 to 13 percent of men. And these are men who have uh left side heart failure, they have angina heart attacks, congestive heart failure, arterial insufficiency due to hypertension, diabetes, you know, arterial sclerosis, etc. Um but the vast majority of men don't have that problem. They have they have the second problem. So the second clause is difficulty sustaining an erection or maintaining erection. Well, these two groups don't belong together. One group is not getting blood in for whatever reason, and the other group is getting blood in and losing it for whatever reason, for multifactorial. Uh, and to and to blow this this group off as saying, oh, it's psychological, that's a disservice to them. And and we don't we doctors don't ask questions. You good sexual history takes 20 minutes, and the average doctor, the average urologist spends seven minutes with a patient. Uh so there's no and the average family doctor spends 10 minutes actually talking to a patient. So there's really no time to take a good sexual history. But the key question every doctor should ask is is your problem getting it up or is your problem keeping it up? Because every because the diagnosis and treatment flows from those two things. So the definition is flawed. We and if you these two groups get thrown together into research, and as a consequence, there's misdiagnosis and there's also mistreatment. So the PD5 medications, which Pharma loves, encouraging every guy to take, you go online and get fill out a questionnaire with Roe or Hymns and you know take your pills in 36 hours. Um and the same size dosage for everyone, of course, which is stupid. So the the uh those the pills put a little more blood in, but they don't keep it there. And if men are getting getting an erection and losing it, the primary therapy needs to be directed at keeping the blood there. Of course, you want to assess the long-term reasons why this could be happening. And man could be losing his erection for a whole variety of reasons.

SPEAKER_03 10:51

Okay.

SPEAKER_01 10:51

Um it could be uh he's worried about paying the mortgage. His wife's cheating on him. He shouldn't have had that fourth cocktail. Maybe dancing until two o'clock in the morning would be a problem in terms of sexual performance. It could be due to beta blockers or some other hype and hypertensions that can impact without we prescribe these medications to men without warning them. Getlerite depressants are notorious cock and cliff killers. Uh but if you're getting blood in, the goal, the primary goal of therapy is to keep blood in. Pills don't do that. Only a ring will do that. Now uh of course um no one's gonna do research on rings other than us uh because there's no money in there's no money for far the money in farm for pharma, but there's no money, there's no money in rings. But there are um there are two papers, independent studies, and one study we did. One one um now actually I just got contacted by a doctor in Japan who's doing a study about on these on the benefit of the rings, comparing the rings to to Dalafil, 10 milligrams styalis.

SPEAKER_02 11:59

Okay.

“Fading Erections of Aging”

SPEAKER_01 12:00

So what's more effective for the vast majority of men? It's a rhetorical question. You know I'm leading you here. Right, right, right. Turns out that it turns out the ring is more effective than the vast majority of men. And why is that? Because most men don't the problem is not getting blood in, well, take a pill anyway, but most men's problems is blood leaving. So every man gets, you know, there's a there's a condition called Venus Leak syndrome that I personally never heard of until four years ago three or four years ago. Because I probably got involved in this area. Did they teach you anything about venous leak syndrome?

SPEAKER_03 12:27

No.

unknown 12:27

No.

SPEAKER_01 12:28

Because he has venous leak syndrome. I mean, there are people that there are men, very, very small number of men who are born with venous leaks. They have incompetent valves or incompetent, you know, venous plexi in their in in their uh in their penis that leads to blood leaving very fast. Or no, they can't get erections, they get erections, they lose it because of that. It's a congenital problem. So uh it can be the trauma as well, too. It's it's it's uncommon. So let's not talk about that group. Then there's what what I feel is is is the venous leak of aging, what I call fading erections of aging. And here's why we know this is real. So we we have this with these 200,000 erections on 4,000 men aged 25 to I think 84. Um, the expectation of world-renowned urologists, some of which are on my scientific advisory board, right, was that as men get older and report erectile dysfunction, the number of nocturnal erections will come down, the firmness nocturnal erections will come down, and the and the firmness of sex erection will come down.

unknown 13:29

Okay.

SPEAKER_01 13:30

And that didn't happen. And I remember scratching my head a couple of years ago, like a year and a half ago, when we had 40,000 erections, thinking the data is trying to tell me something unexpected. What is it trying to tell me? And it's got it has to be really simple because the men are reporting more erectile dysfunction, but they're getting hard and losing it. Their problem is not with the left side of the circulation, they're getting blood in. The problem must be on the right side of the circulation. Now, what can trigger a fading erection? And men start to experience this usually in the late 20s, early 30s. Because after all, you know, when we're 13 or 14 years old, we hold a girl's hand, we get a hard arm for an hour and a half. Right. When's the last time that happened to you? So it doesn't that doesn't happen anymore. So and it's multi-factorial, but what but one of the reasons is as as we get older, um the smooth muscles around our venules get weaker, the venules get stiffer, uh, and we get we experience this. If you flip if you you know I'm looking I'm 73 years old. If I get off on a and I fly on a plane for five or six hours, my rings get a little tight, my socks get a little bit tight. That didn't happen when I was in your age. And I'm in good fields condition. It's just so the M in the penis, if the smooth muscles are weaker and the veins are stiffer, blood leaves, but you know, blood will leave the penis faster. And that's a confident, and that is a confidence killer in and of itself. So what what comes first? The fading erection, the loss of confidence?

unknown 14:50

Okay.

SPEAKER_01 14:50

Or the loss of confidence and then fear flight, and then the fate, and then your erections fail because the sympathetic nervous system fires, probably a combination of the two of things. But blue, but but I was taught like you, and I went to medical school in the in the in the 70s, it's psychological, it's either a left-side heart failure or psychological, and that's a real profound simplification. So the most common, and if you start talking to men, as I've I've spoken to several hundred men because I got involved in this area, and uh I open up my my calendar at pretty much uh five hours a week just to free talk to people about sexual issues. The most common situation for a man is uh he'll he and I'm gonna get graphic because this is because this affects young young people as well, too. Right. This this is I use this I usually hear from men who are in committed relationships. Uh I I go to bed with my wife or girlfriend, I get hard, I go down her because that's how she comes, and I lose my erection while she's doing that, and then she wants me to penetrate her, and it's really hard for me to get it up and I lose my confidence. Well, that's where a ring is a solution because the guy puts on a ring when an R-ring's gonna be warned even before you get hard. You don't have to have erection with R rings, R rings don't block the arterial blood in, they just constrain the VS return. So, and that's that fixes the problem. Suddenly, guys, I had one guy tell me spent sixteen thousand dollars on shockwave therapy, P shots, testosterone therapy, trying to fix his problem. He bought a$60 ring from us, like, oh my God, it it was so you know, it was so easy to fit to fix. So that's the big discovery. The biggest discovery is that most men have fading erections of aging in combin and and that can interplay with loss in confidence, alcohol, alcohol, alcohol. Alcohol is a big problem. Um, and uh maybe an issues in the relationship, money worries, but if man gets hard, put a ring on it.

unknown 16:39

Right.

How the Ring Works

SPEAKER_01 16:40

Take the pill too, put a ring on it. So that's how that's how I got called the Erection King or Lord of the Rings because of this this advocacy and this and this discovery. I mean, it's a it's a game changer, even for men your age, you should try it. Right, right to experience the pleasure of ring. So, what is what is a what is a here are the five questions a guy should ask himself, or the female, or a male or female partner should ask them. Do you want to get harder? Because beyond rock hard, there's a erection ring hard. Nothing will get you harder than an erection ring because it's compressing the superficial veins. So my my girth with our non-tech ring, the max PR, goes, you know, increases by about three to four millimeters. Well, no one's gonna walk by and say, oh my god, porn star. But that's more blood. That means and the more blood you're you're you're you're putting into your penis and holding your penis, the more sensitive it sensitive it is.

SPEAKER_03 17:30

Okay.

SPEAKER_01 17:30

So that that's you want a rock harder, every guy wants to love rock harder. Do you want to do you want to feel more confident? Well, every guy wants to feel more confident. Um do you want your partner to feel more confident in you? Of course, because what's your male or female partner worrying about? He's gonna lose it. You know, well, um and do you want to have a more intense orgasm? Yes, of course you do. So how does how does a ring produce a more intense orgasm? Two ways. One, it's holding more blood in the penis, but the other way is we um having come up with a ring that collect that collect the violence on its mass sexual health, my thought was how can we optimize a man's sexual pleasure? Well, women have vibrators and men have nothing. They got these stupid strokers that you know look like you beat someone to death with them. I don't know who use, I don't know you know, they're they they occupy a niche. Uh and they certainly are, you know, the stroker is just a vibrating tunnel. You know, it's uh but the um if you put the right amount of pressure over the urethra here, you can draw out the ejaculatory phase by 50%. So you you can you can achieve that effect with um with our ring by tightening it up. All of the rings are adjustable, but we did design one ring, the uh the max PR, to specifically achieve that effect. So we tested on 28 men, age 28 to 70. I was the oldest person in the group. So we're looking for the right amount of grip with the elastomer. Uh and my jocatory phase goes from four seconds to seven seconds.

SPEAKER_03 19:00

Oh wow.

SPEAKER_01 19:01

Well, that's an incredible orgasm. And you know, at the age of seventy, suddenly find that I could have more intense pleasure. That was a nice discovery. So uh and we hear and that's our most probably our most popular item, and why is it? Because it one, it addresses the most common problem that men have, which is losing their erection. Right. Uh, and two, it produces a more you know a more intense orgasm. And uh, you know, my wife's idea of foreplay is to put on a red lipstick and toss it at me. Uh I'm a guy, I'm easy. So on a more serious note, um, since this is this is medical, uh the uh the ring there there if you go to the side to our science section of on our website and check click on research, you'll see there's five or six published papers and then like another eight or nine studies underway. So what's been discovered? Um well you can use the ring to right dose PD5 medication. Is right dose of Dallasville 5 milligrams, 10 milligrams, 20 milligrams? It's no longer trial and error because you can look at someone's nocturnal blood flow and see what's going on. Okay. If if if if if you're treating a man who has low T and you put with with uh you know with testosterone, you could now actually see move increase the duration of firmness of his nocturnal erections. You can write, you can see the progress. You know, a guy your age should be having five nocturnal erections per night, which means average probably 35 to 45 minutes in duration. Uh and let's suppose you were low T, and there are guys your age, your age who are low T, you might have only two or three nocturnal erections per night. You can still perform sexually, um, and it might be um decreased in you know in duration. So with T you can you can you can maximize that. So we're as I said before, we we fill a gap in in smart wearables, and we're all on the road, all men, women too, on the road from erectile fitness to erectile dysfunction. And we would all like to know where am I on this road?

SPEAKER_04 20:48

Right, right. So uh I uh Elliot, I had a question. One is the fact that you brought up nocturnal erections. I didn't even know men had that. Like basically while you're sleeping and you get erected and you have no idea.

SPEAKER_01 21:01

Is that I call I call it the night shift. What's what is what is your penis trying to tell you on the night shift while you're asleep? By the way, uh there's no uh maybe in a special case you'll have the night nurse, she'll check up on you, but most of us don't have that. Uh so uh you you know, so yeah, uh the nocturnal erections, and I didn't know so, like I said, four years ago, look, I'm a I'm a doctor since 19 uh 79. I had no idea about the significance of nocturnal erections till until in four until four years ago. Okay. Um and you know they are a leading indicator of your cardiovascular and your sexual health, and their their number, duration, and firmness will deteriorate. So way before you you get ED or before you not always, but often before you get a heart attack or a stroke, the numbers will deteriorate. Uh because uh and so the ideally, of course, for the wearable, you know, if you're on this road fitness dysfunction, you'd like to get some like with a car, you'd like to get some, you know, before your car you crash or break down. Right in the middle of nowhere, you'd like to get some warning signals to say, uh hey Kushik, I forgot your name. Kashok. I'm sorry, your name? Koshik, Koshik. Koshik, I apologize. No, Koshik. You know, you need some air on your tire. Or you need, you know, or El hey Elliot, your your oil gauge.

SPEAKER_02 22:14

Right.

SPEAKER_01 22:15

Top it off. So that's the great thing about wearables. Ideally, of course, they they provide people with information at at home that are giving them s signals, flagging signals, before they become problems. Although it's also it's good to know that you're normal too.

SPEAKER_04 22:30

Right. That's true. Um so the other thing is going back to your uh the actual ring, does the ring, other than transmit data or collect data, does it actually uh change the the intensity of the constriction or anything like that on its own automatically?

SPEAKER_01 22:48

It does it automatically um because it's it's a j and you can adjust it. So, you know, um before I have sex, if I'm recording my data, uh I have we have we have this you can you can tighten it up, you pull it away from the shaft. Oops, I dropped it out. You basically you can tighten it up in all directions. Before I have sex, I tighten it up around the shaft, and then for sleep I loosen it up around the shaft, you know, for comfort. But we have had to this one thing that's amazed me with this is the safety. Okay. We've had zero case of preophysis.

SPEAKER_03 23:17

Okay.

SPEAKER_01 23:18

One of the reasons is because it opens and closes with a hook. So it's easy on, easy off, and that was inspired by the bra.

SPEAKER_03 23:26

Okay.

SPEAKER_01 23:26

A bra is a ring that goes on off of the women don't put on bras over their head, you know. So uh I you know I saw my wife's bra on the ground and I thought, uh, why do we make why don't we make an erection ring that opens and close with a hook for safety purposes? Um so we we haven't even had a yeast infection. I mean, I I would guess I mean two hundred thousand, two hundred to two thousand documented erections, and probably well over a million uses of the non-tech rings just for sex. And we given the state of male hygiene I worth up by now, I would have seen at least a couple yeast infections, but not not even yeast infection. I mean, the only thing that we that we see on this uh safety side is guys who manscape and then have sex afterwards that get some chafing. Uh and uh so it's that part of it's been ground, you know, to come up with a safe and effective erection ring that can go ahead.

SPEAKER_04 24:15

And and so as far as the ring is concerned, where is this data actually collected? Do you also have a uh uh a complementary app or or how does it work?

SPEAKER_01 24:22

We're we're in the Google and Apple stores. Okay. I'll show you what the data looks like right now. Let me just turn on my phone. Got to wait a second because I turned it off out of uh talking to you, it'll come on in a moment. But yeah, we're the we're go ahead.

SPEAKER_04 24:36

And and then when this uh when you collect the data, what can say a layman do with this data? Do they take it to their primary care physician? Uh what should they do with it? What is your suggestion on that?

SPEAKER_01 24:47

There's in the app, you can there's there's a under account settings, you can put your doctor's name in there, and your doctor can get the data.

SPEAKER_03 24:54

Okay.

SPEAKER_01 24:54

Most men, truthfully, they don't trust doctors. Most people, unfortunately, don't trust doctors and they deal with it on their own. So, you know, I've I've uh you know, I'll tell people, you know, like uh someone feels that SSRI is impacting their sexual health. You know, we tell people, you know, discuss this with your doctor, but I know these guys are stopping the medications on their own. Uh with the anti-hypertensis. Um and I don't my phone seems to have oh, it's locked now. Anyway, sorry, I can't help you by showing you the app. I don't even have to I don't even have to get out of this. Oh wow.

SPEAKER_04 25:34

So so go ahead. Uh so generally speaking, I mean obviously we've been talking a lot about uh penile health and penile erections and and all of that, but generally speaking, do you think that collecting this data can actually reduce the number of doctors' visits that I would normally do uh in a year?

SPEAKER_01 25:52

So for example, based on the date the data totally changes the okay the assessment of sexual health because hey, right now it's right now it's all too easy.

SPEAKER_03 26:03

Okay.

SPEAKER_01 26:04

Because the doctors don't ask any questions. There are no questions about sexual health and electronic health record. Yeah, you're right. And people are kind of moderately embarrassed about these things. Uh so that they people are reluctant to bring it up. They'd rather go online and go to HIMS or Get Row or the on the online sources. Right. Uh and the doctors are reluctant to bring it up as well, too. And I frankly, it's shameful because there what part of health the men care probably the most about.

SPEAKER_03 26:30

Right.

SPEAKER_01 26:30

Yeah, absolutely. It's up there with you know I mean I mean background emergency medicine doctor, and I know that short of a heart attack or a stroke, there are a few things that concern a man as much as a limp dick. Right. Absolutely. And we should be asking that that we should be asking that question. I I've never had a doctor ask that question unless I unless I sought that question.

SPEAKER_03 26:48

Right.

SPEAKER_01 26:48

And the way in which the the the the urologists handle this right now with older men is they lie. Because uh one of the problems with electronic health record is that is that it is a tool for falsification, it's a tool for over-documentation of things that never get done. Um, so uh and I studied as an emergency medicine for doctor, I once employed over 700 doctors in a company, uh, and I personally studied, followed 30 of them into rooms next door to them, listened in. Every they all lie. Everyone checks boxes and they rationalize it. Hey, I'm a hardworking guy, and blah blah. I got you know, I got pay big payroll, and uh it's really it's it's it's wrong the way in which the system corrupts. Right, right. So let me at least focus on electronic health. Uh on I know what they want to diagnose men as hypogonadal because then the insurance the insurance will pay.

SPEAKER_03 27:39

Okay.

SPEAKER_01 27:40

Uh, but you can't diagnose a man with hypogonadal if his blood if his blood test is within normal limits. So but you can diagnose a hypogonadal if he says answers three questions the right way. And those questions are how's your angi, how's your sleep, and how's your libido? And everyone wants more angi, everyone would like to sleep another hour, and no one knows what libido really means. The question that should be asked when it comes to libido is how often a week are you initiating sex?

unknown 28:06

Right.

SPEAKER_01 28:07

How often a week do you want to initiate sex? It should be an objective question, quantifiable question. I'm sorry I interrupted you.

SPEAKER_04 28:12

No, no, no, no. That's that's exactly the direction I wanted to go at is how do you take this information and how do you take it to a physician, a general practitioner? Now the other question is if I were to take this information to a general practitioner, uh, considering that this is a relatively new tech, um, would this raise eyebrows? Would they potentially brush it off if they do have these instincts of brushing off this data? What can what can uh the patient, like in my situation, what what could I possibly do to say that no, no, this is real wearable tech developed by a physician, uh, et cetera, et cetera.

SPEAKER_01 28:50

We've been we've been in in the market for over two years. We've been to the been to quite a few conferences and quite a few published papers, and I think urologists, except for the really old school ones, the urologists are starting to cat to cat to cat on to understand the value of this. That it isn't simply a case of uh, hey, it's either psychological, go see a therapist, I don't want to spend any time with you, or take this pill, and I'll see you in six months. I think a lot I think the urologists are starting to catch on. And we we we have world-renowned urologists, Mohi Carrot, Baylor, John Mulhill at Morrison Kettering, Javier Otero in Spain, Yoshisato in Japan. We have we have the heads of sexual medicine societies who are utilizing this technology in research, and I'm speaking about possibly the family doctors. Right. I do get some queries from them about what is what is it, what do I do with it? Because they don't want to think about it. They just want to give out pills.

Could This Replace Viagra?

SPEAKER_04 29:41

Right. So and and I kind of want to uh build on that a little bit. Uh you know, I know in our uh healthcare system, obviously, it's uh for lack of a better term, it's really dominated by pharmaceutical companies. Is this something that farm like basically what you're saying is that bas with this device you could potentially replace um Viagra and Cialis type of uh medications? That's right. Uh at least, if not in the long term, definitely in the near term. And do companies like HIMS and all these other, you know, uh startups it's a threat to their potential to their market.

SPEAKER_01 30:19

I mean, right, exactly. Yeah. No, we've we've had conversations with several of the other big companies. I mean, from a business perspective, we're potentially in upsale, but from their perspective, it it complicates things because we're because and a lot of the men don't really need these things, aren't we? They might need it for placebo effect or horse line effect, but they don't but they don't really need them. Uh the sale this of the ultimate sale to insurance companies is to prove to them that they're gonna save money. Hey, you want to get PD5 medication, you pay for it because we're not paying for it because you got four nocturnal erections. Or uh you want to uh you want to get shockwave therapy paid for, sorry, you're not, you know, you don't you're or I mean like the shockwave therapy is interesting because uh there's we utilize our technology. Doctors can find, you know, if someone if someone has four or five nocturnal erections and eat and ED, which probably do com to confidence the venous leak, you're shocking their head. They don't they don't they're fine. Whereas if they have two or three nocturnal erections and they're weak, you probably they probably would benefit from they probably have as basogenic disease and probably would benefit from shockwave therapy. So the game it's kind of a it's kind of a game changer. Okay.

SPEAKER_04 31:32

Yeah, no, I I mean they're definitely from the sound of it, because um I've always uh heard of these uh penile rings are typically not um very healthy because they're constricting blood flow, can lead to some serious complications for prolonged use, etc. etc. Everything that you touched upon earlier on. Um, but now it seems like there is a device out there that is kind of the best of both worlds and also measures um the health benefits. That's quite remarkable. Yeah.

SPEAKER_01 32:03

I know I I I will I didn't understand the impact. I mean, I started seven business. This is the seventh one, and I've had more fun with this than any other one because I fact you can talk about sex all the time. This is a legacy. I mean, in in in in in the long term, it could be companies like uh Medtronics, Boston Scientific, Colo Plast. They will make the money. Um but in the meantime, we are we are pushing and pulling urology and andrology into the 21st century of data-driven objective. Most important, personalized care. Because the great thing about wearables is that we now become an end of one because we respond differently to medications, et cetera. And we want the one that dump things that we do in medicine, we treat everyone's at the one size fits all. Um, you and I are obviously different ages, uh, probably different condition, taking different medications. But if we were started, if if you and I both went to a doctor and said we have high blood pressure, they put us on the same pill, same dose. Uh, and then they tell, and instead of telling us, they tell us to come back a few months or six months or whatever, what we should do is uh get a blood pressure cuff, take your blood pressure twice a day, morning and evening readings, do have a telehealth visit in two in two weeks to see whether it's the right pill or the right or the right dose. Uh, and that's what's a game changer about what we're what we're doing, because we're we can actually tell you, hey, the dose of P5 medication that works for you might not work for me, dose of testosterone that works for you might not might not work for me, even though we're as opposed to a one-size, you know, fits all approach.

SPEAKER_04 33:32

Um, so as far as your device is concerned, I do you worry that sometimes, as you mentioned, a lot of men tend to uh self-diagnose a lot. And especially with uh things like hymns where you can even get testosterone over-the-counter and completely anonymous packages. Do you think that there might be a situation where based on the readings from your um product, somebody might be like, oh, without any medical background or anything like that, they're like or they're chat GPTing this or some some sort of AI, and then they're gonna be like, that's I'm gonna But that's our fault as doctors.

SPEAKER_01 34:04

We've we've created profound distrust. And we one, we've made it hard for people to access us. That's true. Two, we've we've we've created profound distrust because we've actually advocated things that don't work.

SPEAKER_03 34:15

Okay.

SPEAKER_01 34:16

Uh, and so you know, you know, it's whether it's a change in statin recommendations or it's a change in um uh uh hypertensive, you know, you know, hypertension, but worse, COVID. COVID utterly destroyed to my mind the the confidence that people have in physicians, and it's a it's in and it's a tragedy for doctors and a tragedy for people. And if we doctors were more humble, we could deal with it, but we're not humble. Uh and the and and and and to breaking down distrust in the age of a of you know chat GPT, whatever, you know, Claude, Groc, whatever breaking down that distrust is really because we gotta be now be smarter than those machines. And the reality is this device is smarter than all the doctors for say 95% plus of the problems. So if if you if if a man has a sexual problem and his doctor never asks questions, why would he trust the doctor? That's true. And it's but in the tragedy is that he then trusts pharmacy ads or he trusts what he f what a friend tells him or you know or celebrate endorsement. I mean, it when it comes to erectile dysfunction, you know, men will work, will walk on broken glass for a solution.

unknown 35:21

Right.

SPEAKER_04 35:23

Yeah, so I was just gonna add, so for ED, you know, what other complications can ED eventually have for uh men? Like, is this if somebody has ED, should they just ignore it and then can press forward and do whatever they're doing normally? Or does is this something that needs relatively immediate attention because that that's where you have the key question.

SPEAKER_01 35:47

If if any man is listening to this, you take care of any man who struggles to get an erection or can't take an erection, uh-huh, that's that's serious. That's you gotta see a cardiologist and neurologist. You have a significant problem to prove otherwise. But if the more if it's the more common problem of I'm getting older and I'll lose my erections faster, aggravated by alcohol, maybe I shouldn't have smoked the entire joint or whatever, um, then that's that's that's different. And I think that people can we need to encourage people to some degree to take to take better care of themselves. Yeah, my phone started working again.

SPEAKER_03 36:17

Okay.

SPEAKER_01 36:17

So this is what this is what the app looks like.

SPEAKER_04 36:21

Okay. I see. So it looks very much like a normal uh steps app or a normal healthcare monitoring app.

SPEAKER_01 36:28

Yeah, and this is here, this is like a this is last night. I'm having one, two, three nocturnal erections and morning and a strong morning wood. So that you know, and and we provide notifications as in hey Elliot, since you started on that on that medication, your erections are 20% less hard. Or hey, Elliot, your uh the duration of your erections is improved by 25%. Way to go. Any any positive change in your life, you know, blah, blah, blah. So it uh and or it could be go to see a doctor. You know, if you hey your erections are the number your number erections are determined by 50% over three months now. You need to see a doctor.

SPEAKER_04 37:02

That's that's that's wild. And and you're saying your device is absolutely safe to wear 24-7?

SPEAKER_01 37:08

No, no, I don't well, I don't know where 24-7 are gay guys. The um the I uh we where we recommend that people wick wear it overnight.

unknown 37:18

Okay.

SPEAKER_03 37:19

Just overnight.

SPEAKER_01 37:20

Eight to nine. No, and during sex. We're at eight to nine hours. You know, there's uh you know, uh there's a lot of variability. I mean, I you know, I I can my I can range between two or two nocturnal erections and five nocturnal erections, depending upon uh um alcohol, um duration, amount of sleep, whether I had sex before I go to go to bed, medications. No, I I've I really changed I drink less alcohol before I go to bed now. I I when I travel travel internationally, I kind of back off on taking Zolpidem because it it has an impact on nocturnal erections. So um, but one data point isn't enough. And one of the problems the way in which urologists approach patients with ED, some of them will do a doctor in the office because you get to check a box and make money. Uh but that's only one data point. The great thing about our device is that it's at home in privacy under real life circumstances.

SPEAKER_04 38:09

Right. And and what other um uh data points can uh your product actually um rec record other than erections?

SPEAKER_01 38:20

That's it for now. But we're that's different. We're coming up, we're coming out of version 2.0 in November. Uh and version 2.0 will tell people the card their their cardiac rhythm. Okay. Uh it'll tell people um uh it'll tell people actually really precisely the increase to a millimeter in the in in the diameter of your penis. If you can measure the diameter of the penis and you can measure its length, you now know the volume of blood in the penis, which really really excites the urologist as a as a as a data point. Um and no pun intended. Well, I unfortunately, let's let's get real. Once the urologists can bill for analyzing our device, right? Then they will they'll be more enthusiastic about about it. Just the way right now, if there's a box to check an electronic health record and a family doc can make another$25 by asking a few questions about sexual health, they'd ask the questions. Right.

unknown 39:15

Right.

SPEAKER_01 39:16

And that's that's what's so screwed up. But anyway, but that's the whole but we're also adding we're adding a celerometer. Um accelerometer will also tell us uh what positions people are having sex in.

SPEAKER_03 39:26

Okay.

SPEAKER_04 39:27

Wow. So um I have to ask you this. I uh obviously you were a very accomplished uh emergency physician, and then you had six other country uh companies other than this. How did you get into generally entrepreneurship? Because I find you know, being a part of a medical school, the hardest part for most physicians is to uh give up the, for lack of a better term, the relatively safe environment of uh being a hospitalist or being employed by a hospital or a hospital.

SPEAKER_01 39:56

It's so boring, by the way. Entrepreneurship, which is incredibly risky. Well, you have to be you have to be have an independent spirit. And one of the problems with doctors in general, so I'm gonna generalize right now, and uh people I might get some hate mail for this, is we're really smart, but we're also conformist. Right. Hence the mistakes that were made during COVID. I mean, really, doctors. You really thought the six that wearing a mask or six feet distancing was gonna make any difference whatsoever after after the hundreds of papers showing that masks don't work with upper restore infections, really doctors. You know, that's uh you know, you things like that. We so we are conformists. We we go along. Um and and and and and doctors, you know, when I started in my career, doctors are independent.

SPEAKER_02 40:40

Right.

SPEAKER_01 40:41

Hey, I'm I've got to practice in the community, I'm gonna become part of the community, I'm gonna make money, but I'm also gonna have the satisfaction of being you know important important in the community. Uh and now they all they all they're some of them work for corporations. And that that's a I think that that I think burnout is inevitable with that because you're just you're just a cog, you're you're a widget, and the sh and the machine, the electronic cultural now, is telling you what to do and what not to do, and how to maximize your earnings and how black, you know, it's I don't like the changes in medicine. So how did I how did I do it? Well, I thought just I'm just I'm kind of a rebellious sort, and I also want to I want to improve systems. So again, it's a situation I want to improve systems. And so originally my expertise was in um uh pre-hospital care improvements and how to how to uh speed up turnover in the emergency departments without impacting the quality of care.

SPEAKER_03 41:31

Okay.

SPEAKER_01 41:32

The system, by the way, does not reward that. The system rewards slowing down the the uh the turnover in the ER and getting lots and lots of tests. The more we do to people, the more money we make. It's really crazy. Um so that led to and then so now I'm working for a hospital, and the hospital we're like number we're like in the top 25 Prescani hospitals in you know in the United States. And I'm thinking, why am I working for these people?

SPEAKER_02 41:56

Right.

SPEAKER_01 41:58

I want this contract for myself because there's a more more money made here. Let's market ourselves. I mean, how how many hospitals market their ERs? Like almost none. Um, and I got a contract, and that led to a couple more contracts. Uh, and then you know, I with Pegasus, but Pegasus Emergency Group, my largest con you know, uh business, we had like 750 employees, we're in 11 states, we had over 30 contracts. And then I founded a telehealth company, and then then the thought occurred to me most of emergency medicine is just routine. Most of urgent medicine could be delivered on this device if we don't if we allow people to take care of themselves. There's no reason for people to go to an ER with urine tract infection or for birth control or for yeast infection or for aspiratory infection. Do you need an x-ray for that sprained ankle? Is it well we have we have rules that should guide whether you're getting rid of an X ray or not? I mean ideally, ideally we would empower people to take care of themselves with this technology. So that but that got me involved in remote patient management technologies. How can we take care of people at home and with and without the motivation of money, get the right care for themselves. Uh, and then I got interested in sensor technologies, and that eventually led to um my having this career as uh the Lord of the Rings.

SPEAKER_04 43:19

I really like that title, Lord of the Rings. And we're now Yeah, me too.

SPEAKER_01 43:24

We're now we're now working. We're now working on uh on the on the on device we call uh it's probably gonna be called the Clitech or the Clitique. It's the world's first mod health for Clitoris.

SPEAKER_03 43:35

Okay.

SPEAKER_01 43:36

And we are women have nocturnal erections too.

SPEAKER_03 43:38

Okay.

SPEAKER_01 43:39

It hasn't been studied since Master and Johnson. Oh wow. Uh and we are going to uh provide the vital science for Clitoris to women by the end of this year.

SPEAKER_04 43:49

So what's your vision for your product and eventually your company? In say five, five years and then ten years?

SPEAKER_01 43:57

Yeah, well. 73. I'll probably do this about another five years. I want the use of data to become standard in the care of in the care of men and women's sexual health. I want people using wearables to enjoy a longer the longer life of love making than every that everyone aspires to. I want people to use data to prep to prevent dysfunction and maintain their fitness. So what I'm I you know, I I for us it's about more research papers, um, eventually getting insurance coverage. Doesn't happen easily. It'll take it'll take a couple more years. Uh and and and and improving the devices so they can give people more valuable data. So for example, at Bailey University right now, there's there's a study, and they've just reported the preliminary data at the International Society for Sexual Medicine Conference in Porto where I was at a couple weeks ago. There's a study comparing our device to Whoop as a sleep monitor. Well, every every every episode of REM sleep is accompanied by an erection. What's more accurate? A peripheral warn on the wrist or something that's actually directly assessing the duration of your REM sleep. Um that's really interesting. Uh uh anyway, go ahead.

SPEAKER_04 45:12

I I was just gonna say that, you know, I think the biggest um uh eye-opening aspect of this uh discussion has been uh nocturnal erections. I don't think most people know that there is such a thing, and that actually happens, and it can be an incredible marker for your health overall. And some of these statistics that you mentioned that if you do not get uh, depending on the age, a certain number that could be a precursor to larger cardiovascular issues. That's pretty incredible. That's that's just an angle that I just as you mentioned, I've never heard doctors think like that before. So what's wrong with that?

SPEAKER_01 45:55

No, I mean I'm serious. I'm actually serious because the technology that we're using is old. The doctor who who who brought this concept to me uh four years ago, Dr. Jim Hotellan, he's my chief now our chief medical officer, he's at the University of Utah. He'd been working on it for eight eight eight or nine years, unable to figure out how to do it. Uh and you know, uh once you know I say once a month, my wife looks at me and said, It had to be you. It's flattering. But why is that? Well, because it it it would take a doctor who, to your point earlier, I had to be an entrepreneur, it has to be someone who'd be c who is confident, it has to be someone who had because I can I fund this company, it can't raise money. It has to be someone who had made money in previous companies so it could still fund themselves. It has to be someone experienced with sex toys, specifically with you know with cock rings. Um and and someone's interested, someone who's aware of remote patient management technologies and sensors, etc. Uh but it's been the this has been the hardest, most complicated thing, and most fun thing that I've done in my life because it's everything from design, sourcing, manufacturing, retail, wholesale, research. Uh and it's been a real audit, humbling audit of my character and my pocketbook.

SPEAKER_03 47:11

Wow.

SPEAKER_04 47:11

That's that's amazing. And I think uh your overall mission is honestly quite noble because you're really trying to change how uh the the interaction between physician and patient happens, and I think that that's really, really noble. But I do before we go, I do want to mention one thing, Elliot, is that you mentioned that you're 73. I honestly thought when I saw you, I saw some of your podcasts before, that you were probably no more than in your late 50s.

SPEAKER_01 47:41

Well, I'm I'm I'm flattered by that. Uh and I think the key the ans the answer is put a ring on.

SPEAKER_04 47:47

Yes, and I think Beyoncé would have uh, you know, you've completely changed the title of that song on its head. Now it's uh, you know, men can sing that song quite quite confidently too.

SPEAKER_01 48:00

I I think it's important to maintain obviously people have to maintain their cardiovascular health and watch their diet. Um the epidemic of low testosterone is is likely due to things we eat, uh and you know, microplastics specifically. And I I'm not 100% convinced, but I think they're people smarter than me doing research feel that's that that's probably it. But I also think that um people need to be people need to be sexually active. And that one of the problems today is uh what I you know, I see with my kids who are more like clearly like your age, uh, is they all they put off having sex. And I don't I think that's a mistake. I think that people you know you can't um sex is a smooth largest smooth muscle function, right? You can't exercise your uh and maintain your sexual health in the gym. Right.

SPEAKER_04 48:52

That's interesting. But uh thank you so much for a very interesting and insightful conversation, Elliot. Um, I do want to know if uh our viewers want to uh get more are interested in purchasing this. Um uh we would put a link underneath the uh the video. Um and uh at this point, is there any um doctor's prescriptions or anything that is required to purchase this? No, there's not.

SPEAKER_01 49:20

I mean we are covered by FSAs and HSAs, so people can spend the money on that. We're not covered by insurance yet. We should be, but we're not because in a better world, they would come to me and say, wow, this is really incredible what you what you've achieved, and you and the data supports this, the use of making men's social health objective as opposed to subjects. But um, yeah, you go to you you go to myfirmtech, m-f irm t ch dot com. Uh in Europe, you go to myfirmtech.eu. And we are in we're actually all around the world right now.

SPEAKER_04 49:50

Thank you very much, uh, Elliot, for a very, very eye-opening um discussion about how um nocturnal erections can actually be an indicator for overall cardiovascular health. If you really enjoyed this conversation and are interested in downloading more content, you can get our podcast at any one of your favorite podcast platforms. And remember, there's no shortcut to becoming an MD.

SPEAKER_00 50:18

Thank you so much for tuning into our show. We hope you enjoyed another episode of Med School Minutes. If you like our content, please follow us and receive notification when a new show is posted. This podcast is brought to you by St. James School of Medicine. For a video version of this podcast, please check us out on SJSM.orgslash video.