Doctors Break Down Penile Fillers: Results, Risks, and Reality

Episode 14 | Fertility and Other F Words

In this episode of Fertility and Other F Words, Dr. Amy Pearlman and Dr. Larry Lipshultz sit down with Alex Tatem, MD to discuss one of the most talked-about topics in men’s health right now: penile girth enhancement.

Dr. Tatem is a board-certified, fellowship-trained urologist specializing in men’s health, sexual medicine, and male fertility. He earned his medical degree at the Medical College of Georgia, completed his urology residency at Indiana University School of Medicine, and went on to complete fellowship training in Male Sexual and Reproductive Medicine at Baylor College of Medicine, where Dr. Lipshultz had the opportunity to work alongside him.

He now practices in Indianapolis, helping lead a high-volume men’s health program focused on erectile dysfunction, Peyronie’s disease, male infertility, and complex prosthetic surgery. Beyond the clinic and operating room, Dr. Tatem is also a standout educator on social media, known for breaking down nuanced men’s health topics into clear, practical, and highly engaging content for both patients and clinicians.

In This Episode, We Discuss:

• Penile girth enhancement using hyaluronic acid (HA) dermal fillers (off-label use)
• Non-surgical options for penile enlargement and how they compare to permanent procedures
• The risks and complications of permanent penile girth enhancement treatments
• How HA fillers work for increasing penile girth and improving appearance
• What patients should know before considering penile filler procedures

Key Takeaways:

• Hyaluronic acid (HA) fillers are a temporary, non-surgical option for penile girth enhancement
• These fillers are FDA-approved for facial aesthetics, but are commonly used off-label for penile enhancement
• Product selection matters—viscosity, durability, and reversibility (ability to dissolve with hyaluronidase) are critical
• Injector technique and post-procedure care are essential for achieving a smooth, natural, and symmetric result
• Compared to permanent options, HA fillers offer greater safety, flexibility, and reversibility

Research Highlights (SMSNA 2025 – PhalloFILL Study)

Study overview

• 432 men treated by 28 providers using a standardized protocol
• Focus on relationship quality, intimacy, and self-confidence
• Real-world data collected via anonymous survey

Key findings

• 80% reported improved satisfaction during intimacy
• 75% reported improved partner satisfaction
• 52% reported increased frequency of intimacy
• 81% reported improved self-confidence and overall well-being

Bottom line

• Most men reported meaningful improvements beyond aesthetics, including confidence and relationships
• A small subset reported no change or worsening
• Reinforces the importance of patient selection, counseling, and setting realistic expectations

To watch content by Dr. Alex Tatem subscribe to his YouTube channel, @DrAlexTatem

Notice: 

The Fertility and Other F Words webcast and YouTube channel are intended for general informational purposes only. They do not constitute the practice of medicine nor do they provide medical advice or create a doctor–patient relationship. Use of the information provided through this webcast, YouTube channel, or any linked materials is at the listener’s/viewer’s own risk. The content is not a substitute for professional medical advice, diagnosis, or treatment. 

Listeners/viewers should never disregard or delay seeking medical advice for any health condition and are strongly encouraged to consult their own qualified health care professional with any questions or concerns.

All content from the Fertility and Other F Words webcast is th

Transcript

SPEAKER_01 0:00

So he has recently entered the dating pool and um a woman like mentioned him when they were hooking up, you know, like what's going on with your penis? Why does it look that way? And I want to sit down with her and be like, what's wrong with you? What is wrong with you? Do not say that. Like, all it takes is one freaking comment, especially when you mention about someone's genitals that will impact that person potentially for the rest of their lives.

SPEAKER_03 0:31

I found several articles on toxic masculinity, and they came up with what I thought was very unusual, and that is, I would have thought it would have been the preppy college guys.

SPEAKER_00 0:43

And frat. Yeah. Yeah, and the fraternity. Yeah, yeah, yeah.

SPEAKER_03 0:46

And actually, what it ended up being is the most hostile toxic group that they identified was made up mainly of marginalized, disadvantaged men. These are men without many resources, not men driving around in Lamborghinis.

SPEAKER_01 1:03

And I think that's very on par with the topic of today's discussion because we're gonna be talking about girth enhancement today, and penal size is oftentimes associated with someone's masculinity. Alex, let me ask you this. Oftentimes in medicine we say that men don't care about their health. And we try to actually get to the women to encourage the women to encourage the important men in their lives to seek help.

SPEAKER_02 1:26

Yeah.

SPEAKER_01 1:27

But you are big on the social media platforms, and a lot of your audience are men. So my question for you is do men care about their health?

SPEAKER_04 1:36

You know, it's interesting. I think men honestly have a lot weighing on them, okay? And I think that if you ask a man if he cares about his health, I don't think that any guy, or very few men would say, no, I don't give a shit about my health. But what they're thinking is, well, I mean, I have to make rent next month. I'm the breadwinner for my family, okay? Like I've got to make sure that I get this done, this done, and this done. And so they have so many other competing obligations, along with this, you know, idea of masculinity means you never ask for help or never admit when you're falling short or having a hard time, totally just ignoring the conversation of mental health. And so what happens is not that men don't care about their health, but they feel like they have so many other things they have to do and other expectations that gets shoved down to the very bottom. And you know, what I try to convey to my patients is that, like, yes, like I I it resonates with me so deeply that you are the stalwart, the rock of your family, that you are the one that is the calm and the storm, you are the one that is providing the the sanctity and the peace of your home through providing financially and you know being that you know that figure. But at the same time, if you don't take care of your health, if you don't do that, one day you're not gonna be able to do those things. I ended up getting a phone call from a friend of mine, and he was like, Hey Alex, like you gotta come down here and you gotta see this. You know, it's it's awesome. And standing kind of awkwardly, I stand awkwardly everywhere, but I'm standing awkwardly in a room as he brings in a patient for a follow-up treatment. So it already had you know two or three treatments before then. And you know, the guy's just like dropping his drawers in the room before he goes to the table. And I look at him, I'm like, holy crap, I can't tell this guy's had anything done. Just looks like God likes him more than me. I was like, this is bull crap.

SPEAKER_01 3:22

Welcome to Fertility and Other F-Words, the webcast that tackles fertility, sexual health, and everything in between. No topic too taboo and no question off limits. I'm Dr. Amy Pearlman, board certified urologist with expertise in sexual, hormonal, and genitourinary health, and co-founder of Prime Institute in Miami, Florida.

SPEAKER_03 3:41

And I'm Dr. Larry Lipschultz, professor of urology, Baylor College of Medicine. I'm a board-certified urologist and head of the division of male reproductive medicine and surgery.

SPEAKER_01 3:52

All right, take me to the case files. What have you seen recently, Larry?

SPEAKER_03 3:55

Okay. So this is an interesting case. Okay. So this is a 37-year-old gentleman who was sent to us from another uh physician in San Antonio and found to have azospermia, no sperm in the ejaculate. Not that unusual in our practice, of course, we're a tertiary referral. But the interesting thing about him was that when he was evaluated elsewhere, uh, they had done an ultrasound and it showed a solid mass in one of his testicles. Now, his testicles were small to begin with, but the solid mass, which occupied almost half of one testicle, was very disturbing. So we evaluated him. We did a Y chromosome microdeletion assay, which was normal.

SPEAKER_01 4:37

And that would be standard protocol for someone who's coming with azospermia, correct?

SPEAKER_03 4:41

Standard, absolutely standard. Uh, and then we did a karyotype looking at his, you know, just his gross genetics. And what we found, interestingly enough, is that he was a mosaic Kleinfelder's. So Kleinfelder's is uh 47 XXY, but he was that, and he was 46 XY normal male. Interesting, right? Yeah. And unusual.

SPEAKER_00 5:05

Yeah.

SPEAKER_03 5:06

Uh, but then back to the problem of the solid mass. So we looked at all our tumor markers, uh, our um routine things that we study, uh, and they were all negative. No normal tumor markers, no uh increase in his HCG, alpha feta protein, LDH. So we were left with we have to explore this mass. There's no other way to know what's going on. Um so we underwent a right radical orchiectomy, a groin uh extraction of his testicle, and then we did back table onchotessi, which means we took the testicle, put it on another table, sterile, everything was sterile, bivalve the testicle, and then looked at the normal part of the testis to see if there were sperm. And there was a rim of normal tissue. We could not find sperm. So the tissue then goes to my laboratory.

SPEAKER_01 5:56

So when you're saying you could not find sperm, you have a microscope in the operating room and you were looking at the slides in real time.

SPEAKER_03 6:03

Right, two microscopes, one microscope, operating microscope to make sure we get just the normal tissue and then the microscope in the a phase microscope in the operating room to look for sperm. We don't find any. So we send it over to the lab, to the andrology lab. Now, they spent hours looking through this tissue and they could not find any sperm. And I it was not unpredictable, given the fact Kleinfelder's mosaicism, etc. But the tissue itself looked to us like a seminoma. It was solid, it was flesh-colored, uh homogeneous, but we get back the fact that it's a Lydexel tumor. Now, Lytix cell tumors drive me crazy because they're not that rare in the patients we see with azospermia, and they're usually very small. But you can't be absolutely sure what it is till you get it out, and often you can't get it out without taking the testicle out. So looking up at some statistics on this, uh, just so we have some data, is that men with an abnormal semen analysis, not azospermia per se, but just totally abnormal, have a three to twenty-fold greater incidence of testicular cancer compared to men without infertility issues.

SPEAKER_01 7:17

Wow.

SPEAKER_03 7:18

That's really, really a big difference.

SPEAKER_01 7:20

Let me ask you this. Do you think, I mean, what's a chicken, what's the egg? Or is it because their baseline have infertility issues that predisposes them to testicular cancer, or because they have testicular cancer, it messes up how their testicles are working?

SPEAKER_03 7:32

No, I think it's a dysgenic, it's an abnormal testicle that then has is more likely to undergo malignant change. I think that's been shown.

SPEAKER_01 7:40

Yeah. So the testicle is abnormal and therefore they're gonna have infertility issues and increased risk for the city. Right.

SPEAKER_03 7:45

And you see that with undescended testis as well. More infertility and more testicular tumors. So when we look at the actual data, uh light excels are found in about 0.5% of men presenting with masses.

SPEAKER_01 8:00

Lite excel tumors.

SPEAKER_03 8:01

Litexcel tumors. So it's more common to find non-Lytexcel tumors, but light excel tumors are especially bothersome to us because they're very, very small and they're usually in atrophic testicles. So those men lose those testicles, but there's no other way to be absolutely sure it's not another type of tumor.

SPEAKER_01 8:20

So what's your message for men watching?

SPEAKER_03 8:23

Men, that first of all, the message is guys, once a month, if you're between the ages of 30 and 45, examine the testicles. In and actually, let's say 25. 25 to 35.

SPEAKER_01 8:35

But should teenagers be doing it?

SPEAKER_03 8:37

Well, you I mean, should they? I mean, there's no reason not to.

SPEAKER_01 8:41

Right, right, right.

SPEAKER_03 8:42

So I think that that men should be examining their testes in the shower when everything's warm and relaxed, looking for lumps and bumps. And if you feel a lump or bump, go to your doctor.

SPEAKER_00 8:53

Yeah.

SPEAKER_03 8:53

Because all too often I've seen these guys come in, they've ignored it. I'm sure you have too. And they have large tumors, sometimes metastatic, that could have been prevented from having metastasis if they had gone to the doctor earlier.

SPEAKER_00 9:07

Yeah.

SPEAKER_03 9:07

So, and and it's especially important in men with fertility problems.

SPEAKER_00 9:11

Yeah.

SPEAKER_03 9:12

And that's why, and that's why I don't like male-in semen analyses, because they could give a man a false sense of security because he's not been examined.

SPEAKER_01 9:21

Yeah.

SPEAKER_03 9:21

So if you're having fertility problems, get examined.

SPEAKER_01 9:24

Well, so that's your concern with male-in semen analyses, but also maybe telemedicine clinics that are treating men with infertility, right? Because that physical exam is very important.

SPEAKER_03 9:33

I would hope there aren't telemedicine clinics treating patients for infertility. I mean, you know, we will we will see everybody with infertility has to be seen in the office. The second visit to review data, lab results, could be theoretically telemedicine. I still like looking someone in the eye and telling them what the problem is, especially if it's bad news. I mean, you know, think of it on the on looking at somebody on a computer and telling them he's never going to have a child. I mean, I I just I'm really uncomfortable. What do you do in those situations?

SPEAKER_01 10:05

Well, I think um, I mean, I offer a mix, right? I mean, there are some patients where it becomes prohibitive for many reasons for them to see me in the office. So it depends on the reason for the visit. Like most visits, I can at least do the initial visit through telemedicine. But I agree that a physical exam, at least at one point in that, you know, patient-physician relationship, can be very helpful if only to sit down with a guy and tell him, look him in the eyes and tell him everything looks and feels normal. Right.

SPEAKER_03 10:34

But I think when it's abnormal, I don't like telling people that on a computer.

SPEAKER_01 10:40

Right. And if it's something that you can feel on physical exam that's abnormal, you can point it out to them and say, Can you feel what I feel? And then even if it's something that's, let's say, abnormal, but not something that you have to do something about. For example, men who present with Peron's disease. So let's say they present and they have some penile shortening and a curve in their penis, I will feel the plaque and I will actually have them pinch the plaque themselves so they can feel what I'm feeling too.

SPEAKER_03 11:02

Yeah. So we did a study, and it was a long time ago, around 1990, uh looking at the incidence of other health problems in men with fertility and you know, issues. And it was up close to 10%. Now, it was diabetes, it was CNS tumors, nerve nervous system, brain tumors, uh, and it was testis tumors. Uh, but you're not gonna find out unless you examine these people. And that and that's why I don't think men with fertility issues should have nothing but a telemedicine visit. Yeah. And I'm afraid it could be going on.

SPEAKER_01 11:40

Yeah.

SPEAKER_03 11:40

Uh, but I don't think it's a good idea.

SPEAKER_01 11:42

Yeah, yeah. Well, certainly point taken. All right. So let me bring you into my clinic. So I had this patient, he's actually also 37 years old, and he had presented to me because he was interested in penile girth enhancement. So we ended up injecting hyaluronic acid, uh, filler for his girth enhancement procedure. And honestly, like when I examine him, his penis looks good. Okay.

SPEAKER_03 12:01

Before or after?

SPEAKER_01 12:02

Oh, um, so I saw him after he had seen one of my colleagues for some filler, and then he's local to my area. So then he continued his treatment with me. So I never saw a few.

SPEAKER_03 12:09

So do you So what happens? Yeah, what happens with the man who comes in? He's there for filler.

SPEAKER_01 12:14

Yeah.

SPEAKER_03 12:14

And he lowers his pants, you take a look at him, you say to yourself, This man's normal.

SPEAKER_01 12:18

Yeah.

SPEAKER_03 12:19

What do you say to the man?

SPEAKER_01 12:20

Oh, I mean, I tell him your penis is normal size.

SPEAKER_03 12:22

And he says, but it's not. He says, I'm very uncomfortable with it.

SPEAKER_01 12:25

But I also tell him, but I can safely increase the size of your penis. So my job in those circumstances is not to convince him that he has a normal penis. He already knows for the most part, right? And I can just, it's funny because I have some patients that will say, like, well, um, how do you know it's normal? You just when you know, you know, right? You can just But you or the patient Oh, I know. Yes. I can look at a penis and be like, you don't have a micro penis. I've actually, in my clinical practice, I have never seen a micro penis.

SPEAKER_03 12:52

I've seen micro penises.

SPEAKER_01 12:53

But you're seeing more patients who have more genetic abnormalities. For sure. My patients are because I don't run a primary like infertility penis.

SPEAKER_03 13:00

But let me ask you a question that occurred to me uh when we were talking to Alex about this, and that was, and that is, do you think you're better able to tell a man if he has a normal penis and if he's gonna believe you more than if a male doctor tells him he has a normal penis?

SPEAKER_01 13:18

Um that's a good question. I don't know the answer to that. Come on.

SPEAKER_03 13:21

You in your heart of hearts, you know the answer.

SPEAKER_01 13:24

Um I don't know the answer to that. I um but again, my goal is not to convince him of anything.

SPEAKER_03 13:32

Well, I know, but if a guy is like, you know, it's abnormal, but he's not like terribly upset by it, and uh a pretty nurse doctor says I'm your nurse. No, I I said a woman healthcare provider. Oh my god. See, this is where we get into these anyway. A pretty healthcare provider tells him, Hey sir, look, you're perfectly normal. Yeah. Do you think that carries weight, other than the doctor, a guy saying, Hey, it looks fine to me.

SPEAKER_01 14:02

Yeah. Here's what I'll say to my patients, right? And this is usually like once I put filler in and they're wondering like I had a guy messaging me yesterday that was noting an area of the penis. It's like, what do you think? Should I have filler in this one area? And he sent a picture. And I said, honestly, your penis looks amazing. Because it does. And you used to wear it amazing? Yeah, I said it looks amazing. I don't know if that's inappropriate or not, but I mean, his results look great. Yeah. And I tell him that. I tell, like, you don't need filler. Your penis looks great.

SPEAKER_03 14:28

So are you the only woman urologist doing fillers?

SPEAKER_01 14:31

No.

SPEAKER_03 14:31

Oh, okay.

SPEAKER_01 14:32

There are others. Yeah. Not that I mean, more like with phall fill, most of the providers are men. Yeah. There's like one other woman who does it. Yeah. But I think, you know, my message is not to say that I'm better at it than a man in anything that I do. I just give a different perspective. And there are plenty of men, you know, I have this one guy that loves to troll me on YouTube that's like, what is Amy? What do you know about men's health? It's like, I mean, I know a lot about men's health. You know, I'm never said I'm a man. I never said I know what your lived experience is. That's not my message, you know? And I think some guys like hearing that message from a woman.

SPEAKER_03 15:02

And that's But don't you think that's yeah, but don't you think that's an interesting issue for you as a female urologist?

SPEAKER_01 15:08

Yeah. Well, and I have to be careful with my language too. You know, I definitely don't want to cross that line, but I also want to be able to tell my patient, like, hey, we're doing cosmetics.

SPEAKER_03 15:15

You don't want to, you don't want to say, oh wow. Yeah. Right.

SPEAKER_01 15:18

You know, but I want to be like, you have a great result. And I don't think there's anything that's wrong with that. I don't think that's crossing the line.

SPEAKER_02 15:23

Yeah.

SPEAKER_01 15:23

Um, and so with this guy, he has a slight indent. And actually, so we'll talk about on today's episode um, like people who are like good candidates for filler and people who are not so good candidates for filler. And I will say some of the challenges with getting a really good cosmetic result after filler is guys that really retract. And a lot of people would say, well, penile retraction is normal. And it is normal. It's normal to have the pool penis or whatever you want to call it, right? Where it gets cold or you're stressed and you have retraction of the penis. But some guys are bothered by it. I get it, right? And so for guys that retract more, they tend in their flaccid state, their filler doesn't look completely even. That's just what happens. The filler is going to look a little different between the flaccid and the erect state. So he has a little area of like indentation. So he has recently entered the dating pool and um a woman like mentioned to him when they were hooking up, you know, like, what's going on with your penis? Why does it look that way? And I want to sit down with her and be like, what's wrong with you? What is wrong with you? Do not say that. Like, all it takes is one freaking comment, especially when you mention about someone's genitals that will impact that person potentially for the rest of their lives. Right. I think men know better than to say something in front of a woman. And I think like what? Oh, like if a man says something about uh their, you know, a woman's breasts or her genitals or you know, like you don't say that. Like think whatever you want to think, but don't freaking say it in front of the person, especially when you're hooking up and you're naked. And I just I felt so bad when he said this to me, you know, because also his penis looks fine.

SPEAKER_03 16:52

Yeah.

SPEAKER_01 16:52

It looks fine.

SPEAKER_03 16:53

Yeah, it can be really lifetime damaging to these men when someone tells them a woman tells them something's wrong because that's all they remember. Yeah, right.

SPEAKER_01 17:02

So, ladies, if you're watching, don't make comments about the size or the shape or the evenness of someone's penis. I've seen it in the Peronis guys population, right? Where their partner makes a comment of like, you know, their penis being curved. And if there's a concern and it's painful and you notice a change, I'm not saying don't discuss it, but maybe put some clothes on and have this discussion.

SPEAKER_03 17:24

I think also the variable is the relationship. Yeah, yeah. It's a husband and wife and they've been together for 20 years. Yeah. And she says to him, honey, you know, your penis is curving. Yeah. It's different than first date, and the woman says, Oh my God, what's wrong with your penis? It's got a curve. I mean, there's a big difference.

SPEAKER_01 17:39

Yeah, yeah. So we have to be careful with our words. And a lot of people would think men don't care. Men care.

SPEAKER_03 17:46

I think they're even more sensitive than women.

SPEAKER_01 17:49

Yeah. So kind of on this topic of femininity, masculinity, and how we interact with those concepts, why don't you talk about some breaking bedside news later?

SPEAKER_03 17:57

Yes. So I yeah, that is such a good segue.

SPEAKER_01 18:00

Thank you.

SPEAKER_03 18:01

So I found several articles on toxic masculinity, which I thought was really a very unique topic. Uh, I've heard it, but I didn't know exactly what it meant. So I want to read you the definition. Yeah, let's hear it. Toxic masculinity is a term used in sociology and psychology to describe a narrow and harmful set of cultural expectations placed on men. Not masculinity itself, but the distorted version that pressures men into rigid, often damaging behaviors. And uh so what they've done is this has become something in the media, the mass media, uh where it refers to uh norms that equate manhood with dominance, control, and aggression, discourage emotional expression for men, except anger, uh, frame vulnerability as weakness, uh, promote risk taking and suppression of pain, uh, and reinforce misogyny or homophobia as proofs of masculinity. So, this is what this whole spectrum of toxicity for men is defined as. And apparently it's increasing among certain groups. And there was a study um out of New Zealand looking at this statistically, where they actually developed a questionnaire that they gave to thousands and thousands of men.

SPEAKER_01 19:29

No, that's a huge survey study.

SPEAKER_03 19:31

I know. Unbelievable.

SPEAKER_01 19:32

Yeah. I can barely get 10 people to respond to a survey.

SPEAKER_03 19:34

So I don't know exactly how they did it. It was part of a study called New Zealand Attitudes and Values Values Study. Anyway, so they looked at the groups that were most demonstrable of toxic masculinity as defined by the questionnaire. And they came up with what I thought was very unusual, and that is, I would have thought it would have been the preppy college guys.

SPEAKER_00 20:00

And frat.

SPEAKER_03 20:01

Yeah.

SPEAKER_00 20:01

Yeah, and the fraternity. Yeah, yeah, yeah.

SPEAKER_03 20:03

And actually what it ended up being is uh, as they say, uh it was uh the most hostile toxic group that they identified was made up mainly of marginalized, disadvantaged men. These are men without many resources, not men driving around in Lamborghinis.

SPEAKER_00 20:22

Yeah.

SPEAKER_03 20:23

I thought that was totally not what I was going to predict.

SPEAKER_01 20:27

Yeah, because out of ignorance, I would probably say thinking about being on Miami Beach, you know, where I live, is probably the guys in Lamborghinis have some issues with toxic masculinity, but you're proving me wrong here, Larry. Well, I didn't do it.

SPEAKER_03 20:38

It's it's this study.

SPEAKER_01 20:39

Yeah.

SPEAKER_03 20:40

But I thought there was an interesting thing. Another article I found uh is 21 of the most embarrassingly atrocious displays of toxic masculinity people have ever seen.

SPEAKER_01 20:53

Okay, what I love most about this is that Larry has been pulling these articles.

SPEAKER_03 20:57

I have.

SPEAKER_01 20:57

I know, I love it.

SPEAKER_03 20:59

I thought it was my job.

SPEAKER_01 21:00

It was your job. It is your job.

SPEAKER_03 21:02

But I want to read you some of these and have you comment. All right. We'll just do a couple.

SPEAKER_00 21:06

Okay. Pick your faves.

SPEAKER_03 21:07

Yeah, so here is the men and women in competitive, like in an aerobic class with the men assuming that they were going to do better than the women. And they didn't. Would you have expected that?

SPEAKER_01 21:21

You know, and I don't know if this would be classified as like toxic femininity, but sometimes I'll walk into a group class and think that I'm going to crush it more than others and I'm stopping early and resting in fetal position.

SPEAKER_03 21:32

You are?

SPEAKER_01 21:33

Yeah.

SPEAKER_03 21:34

Why? I mean, I'm not sure.

SPEAKER_01 21:35

I work out, but I don't do classes that often. So when I do it, it's very cardiovascular, and the classes are hard.

SPEAKER_03 21:41

Yeah. How about my brother, who was raised by our single mom, has said that wearing a coat is for girls. What do you think of that? No. Another one is I heard a father tell his son to wipe his face like Man. No. And I think that's where the expression man up, you know, don't cry, man up.

SPEAKER_01 22:06

Yeah.

SPEAKER_03 22:06

I mean, I think this thing is real.

SPEAKER_01 22:07

No, it absolutely is real.

SPEAKER_03 22:08

And and do you think it's recent? Or do you think it's been there all along, but just without social media, we couldn't talk about it?

SPEAKER_01 22:14

Yeah, I think it's been there all along and we're talking about it more.

SPEAKER_03 22:17

You don't think it's more now? I think it's more now. I think these definitions of what's masculine and what's feminine have been brought to the forefront with all the discussions of gender, you know, and what's man, what's woman, what's not either one.

SPEAKER_00 22:30

Yeah.

SPEAKER_03 22:30

And so now so the men have had to kind of like come up with their their own diff definition.

SPEAKER_00 22:36

Yeah.

SPEAKER_03 22:37

How about this last one?

SPEAKER_00 22:38

Okay.

SPEAKER_03 22:39

My husband thinks a woman should never be president because we're quote too emotional.

SPEAKER_01 22:44

Oh. Well, that's a problem.

SPEAKER_03 22:46

You think it is? So you think we should not have a president?

SPEAKER_01 22:50

No, I'm not saying that's a problem. I'm saying that comment is a problem.

SPEAKER_03 22:53

Oh, but you don't agree.

SPEAKER_01 22:54

I don't agree.

SPEAKER_03 22:55

All right.

SPEAKER_01 22:56

Yes, for the viewers, I don't agree.

SPEAKER_03 22:57

Anyway, so that's that's my breaking news of the day is that we're concerned more and more concerned about toxic masculinity and want to call it out when it's inappropriate.

SPEAKER_01 23:08

Yeah. And I think the other important message is the people that might look that part of being toxic and masculine may not actually be the ones with those traits.

SPEAKER_03 23:17

Right.

SPEAKER_02 23:17

Yeah.

SPEAKER_01 23:18

So we shouldn't make those assumptions. Right. Yeah. Okay. I think that's very good. And I think that's very on par with the topic of today's discussion because we're going to be talking about girth enhancement today, and penile size is oftentimes associated with someone's masculinity.

SPEAKER_03 23:31

Yes, unfortunately, it is.

SPEAKER_01 23:32

Yeah. Welcome to today's episode. I am thrilled to introduce our remarkable guest today, Dr. Alex Tatum.

SPEAKER_03 23:39

Dr. Alex Tatum is a board-certified fellowship-trained urologist with expertise in men's health, sexual medicine, and male fertility. He earned his medical degree at the Medical College of Georgia, completed his urology residency at Indiana University, and went on to complete fellowship training in male sexual and reproductive medicine at Baylor College of Medicine, where I had the privilege of working with him.

SPEAKER_01 24:05

He now practices in Indianapolis, where he helps lead a high-volume men's health program, caring for patients with erectile dysfunction, Peronis disease, male infertility, and complex prosthetic cases. Beyond the clinic and operating room, Dr. Tatum is also a standout educator on social media, known for breaking down nuanced men's health topics into clear, practical, and highly engaging content for both patients and clinicians.

SPEAKER_03 24:28

So, Alex, thank you Doctor, Doctor, thank you so much for coming today because I mean it is a trip. Uh, you are away from your family a little extra time, and we do really appreciate you coming down and spending some time with us. Yeah. Uh, you and I go way back, uh, not way, way back, but you were my fellow. And so we've had a long relationship, and it's really special to have you here today.

SPEAKER_04 24:51

I I couldn't be happier to be here, sir. This is uh this is a real treat for me. So God bless my wife who's taking care of the kids right now and making all this possible, right? That's the stuff you don't see on screen. No. Yeah. She is a trooper. She is, absolutely. Yeah. Um, and uh, you know, it's funny. We were just talking about like, you know, I was a fellow from 2018 to 2019, but like it still feels like it was yesterday, even though I've been out in practice for a long time and that sort of thing. Like, you know, that training, that year is just such a pivotal moment in, you know, surgeons' careers that like it just stays with you forever.

SPEAKER_03 25:22

Yeah, but I think you as an individual especially got a lot out of the fellowship because you've taken so much into your own practice.

SPEAKER_04 25:29

Yeah, yeah. I mean, you know, whenever I went through like most people like residency was like that moment for them. And like I had a great residency. I got amazing surgical training in that from a technical aspect, but you know, I didn't know where to direct that. I was, and it wasn't until that I learned about this field of, you know, uh men's sexual health and male fertility that I kind of found like where my passion, my calling, and where I could direct all those skills. And so, in a sense, like that one year of fellowship had an exponentially greater impact on my life than the five years of learning how to manage patients as an inpatient, throw suture in a technical aspect, et cetera, et cetera. Like that's what gave me like the vision and the motivation for what we do today.

SPEAKER_03 26:12

Yeah, and you've certainly taken the ball and run with it. Yeah.

SPEAKER_01 26:16

From all the things that you've taken the balls and he's run, he's run with them.

SPEAKER_03 26:19

Why is Amy laughing?

SPEAKER_04 26:21

It's because she's just laughing at us. She just finds us like hilarious.

SPEAKER_01 26:24

I um love to be on a fly on a wall because I love watching the two of you interact. And Alex, you're one of the best storytellers I've ever heard in my entire life. And I want you to tell us a story of fellowship.

SPEAKER_03 26:34

Oh my gosh. One story, I mean a unique story.

SPEAKER_01 26:38

Yeah, but just like give me a story from fellowship that's resonated with you.

SPEAKER_04 26:42

Oh my gosh. So, I mean, I was don't embarrass me. I will not, I will not embarrass you. But so what I will say is that, you know, when I was so obviously like residency is hyper structured and you're just in the hospital 24-7, and that's fine. Like, that's the role of residency. But uh, what I really loved about fellowship is like it gives you a chance to open your eyes and to look at medicine as a whole and like what is gonna be your role, like what is gonna be your part in this. And so I really, really enjoyed getting to see so many patients that you had been taking care of for years and like to hear their stories about how they were coming in, you know, all the way from, you know, fertility patients that were told that they were never gonna be able to have children. They had seen other doctors that had done things that were inappropriate, and then all of a sudden, like you had seen them, you had taken care of their fertility issues, they have children, and then we're seeing them in follow-up for let's say low-T follow-up, and you're seeing like this entire narrative of their life story and how you were just a pivotal role in that. And so, like getting a chance to see that as a fellow, and you're like, oh, this is the type of impact I can make on people's lives. This is what I want to do. And so, like, from like a philosophical standpoint, that's what really resonated with me. But then on like a uh like a personal enjoyment side, relationship side, like we were just in there every day, big clinics, but it was like an all hands-on, you know, approach. I got to be best friends with my co-fellow John Balin. We had so many fun, like, you know, moments, like John, like bending over backwards to uh get the so uh the uh for our audience, you know, we have these continuing medical education meetings that we all go to, and sometimes you're an attendee, but other times you're an invited speaker. And so there was a uh special meeting that was all the way down in Key West. And funny. And so uh me, uh John worked his butt off to actually arrange it. So you were going to be invited to speak there. Right. But most importantly, from two very tired fellows, we're like, well, Dr. Lipschultz has another meeting that he's got to go to in Philadelphia before that that we're not going on. But what we can do is because this was an approved meeting we had to go to, we would fly down there two days ahead of time and uh goof off, you know, and have a chance to catch up with friends before you got there. And so, like the doctor that I trained with, you know, John, who's you know one of my closest friends now, we're just like goofing off on a Key West, like riding a tandem bike, and you come in on your flight, waiting for your you know, very erudite academic fellows to receive you and have this meeting, review this. And we're both wearing like short shorts and tank tops, you know, on a bike on a on a tandem bicycle. On a tandem bicycle, just cruising around downtown Key West.

SPEAKER_03 29:14

Uh that was my first sight of them at this meeting. Yeah, they meet me on their bicycle in their really short shorts.

SPEAKER_04 29:20

Oh, yeah, totally, totally. Who do we do?

SPEAKER_01 29:22

We're gonna need some b-roll.

SPEAKER_04 29:25

The picture is somewhere, and it's like me and John, we're just like the biggest grins on our faces. Like we have figured out the cheat code for life. Right. And so uh yeah, so I mean, there's there's that story. We've countless, like, fun clinical stories of like where, you know, I I remember one patient that really stuck with me who was a gentleman who had been seen by another urologist, well known in the fertility space, but he had had a mistake made during his fertility workup. We were able to diagnose him with a AZFC deletion, okay, which basically That's a deletion of the Y chromosome. Exactly. And so the thing is that this is someone who had gone to a uh a very well-known male fertility urologist who advertises a lot on Facebook about like his you know amazing uh technique for sticking needles into testicles. But a uh this uh patient's wife had seen that advertisement, gone out to see his urologist, and he had missed a critical step, which is testing the genetics of a man that comes in. Because if they have something like an AZF A, you know, or an AZF B deletion, which is a certain type of deletion on the Y chromosome, then they're just never gonna have sperm. And so, you know, this is a gentleman who had not had an appropriate workup, went underwent this, you know, uh expensive procedure, was told there was no chance. And then we did a genetic test on him, found out he had an AZF C deletion, which meant there was a chance we could find sperm, and we ultimately took him for microtessey and we were able to find sperm on him. And so, like, that was like a really, really powerful moment for me about attention to detail and making sure that you dot the I's and cross the T's. And just as we have very systematic approaches for the operating room that ensure that we get the best possible outcome every time, like we have to bring that same ethos for our medical management on patients. And so we have clinical stories like that. And those are things that are just burned into my brain that are, you know, kind of part of the internal calculus I use when I approach my patients even today. Yeah. Yeah. Attention to detail is very important. Yeah. Yeah. A little bit of autism goes a long way. Just the right amount of tism.

SPEAKER_01 31:19

So this is what I learned in residency from one of my attendings. He said, Stop gilding the lily. Perfection is the enemy of good. And what I learned in fellowship is we should always strive to be perfect.

SPEAKER_04 31:30

Yes. Yes. I mean, like obviously, you have to have a deep understanding of what you're doing. So, for example, like I'm uh like a big part of my practice is penile implant placement for men that have significant erectile dysfunction, where quote unquote, the easy options, like oral medications, aren't working. And the thing is, is that when you go into the operating room, yes, there are individual times where maybe operative efficiency conveys a greater benefit to the patient, as opposed to getting a stitch within a certain millimeter, you know, uh distance. But you're still striving for perfection, but you have to take that within the context of the larger situation. And I think that it can that nuance can be lost whenever you say, oh, don't gild the lily, it's good enough. When in reality, no, it's not good enough. Good enough is not good enough, you know, horseshoes and hand grenades, right? Like you have to look at the larger picture. And yes, there can be greater margins in certain areas, but that is all in pursuit of the best possible end outcome.

SPEAKER_03 32:24

I think also with punile prosthetics, you always at the end of the case, not always, but a lot of times in the case, you look and you say, Yeah, I don't know, maybe I should bend it, it's got a slight curve. And you know, you do you try make it to make it perfect when in actuality that can be an issue, you know, if you try too hard.

SPEAKER_04 32:42

And and the thing is, is that that's where experience matters because what we see on the table may not be what we see in six months after the patient exercising the device and using it. And that's where that clinical volume and clinical experience really matter. Because, you know, for example, there could be like a small angulation to a patient that you know you could add another you know 30 minutes or 45 minutes trying to fix. But if you add the additional surgical risk to that, that increases their risk of an infection or a bad outcome. But if they stick with the post-operative protocol and rehab, much like a orthopedic surgeon would tell his hip replacement patient to stick with that, like that's gonna make the bigger difference. And so the calculus changes. Right.

SPEAKER_03 33:20

Plus, I don't think you can really get into the patient's psyche where he has not had an erection for years. Yes. And you're giving him an erection. Now, in your mind, it's not absolutely perfect, but this man's going to be extremely pleased because he's now functional.

SPEAKER_04 33:35

Yeah, and and that also comes to uh leads into appropriate preoperative counseling and making sure that you're all on the same page. And so, I mean, these are all like things that were demonstrated to me during fellowship that I then, you know, use to structure my own practice. And I mean, listen, I'm always getting better. You know, I'm not gonna say I've got everything quote unquote figured out, but I'm extremely, extremely proud of the results that our team is able to get by sticking to those core principles that I learned as a fellow.

SPEAKER_03 34:04

But I also think it's really important, and uh and Alex keeps bringing it up, and that is a good relationship with your patients is so important, especially with outcomes. Yeah. Because if they know you're trying your best and if they have confidence in you, they're gonna be much happier with whatever outcome they because they know you've done your best.

SPEAKER_04 34:22

Yeah, and you know, I think it gets back to that idea like no one cares what you know until they know you care. And like patients. Oh, I like that. Yeah. It's so you could be the most intelligent, you could be the most gifted surgeon, but if you, if patients don't feel like you give a crap about them as a human being and their final outcomes, well, I mean, you're not gonna have like a great relationship. And that degree of satisfaction, that degree of understanding is gonna get lost. And so, you know, something that I saw demonstrated in your practice is, you know, you commonly like you have a close relationship with your patients, you call them by their first name, you ask them about like their families and how they're doing. And that's not a calculated decision. That's who you are. Okay. But as someone who came from an environment residency where everything was very separated, very formal, Mr. So-and-so, and you were just very focused on the disease, seeing you focus on the patient as a person like fundamentally changed how I approach medicine.

SPEAKER_01 35:12

Well, we went out to dinner last night, and one of your patients came up to you.

SPEAKER_04 35:16

Oh, I know.

SPEAKER_01 35:16

To say hello. Yeah. And you would have never known that he was your patient. I would have thought he was just a friend of yours.

SPEAKER_03 35:22

Yeah. Yeah. Yeah. And and I had not seen him for years. So that was really it was really nice to have seen him.

SPEAKER_04 35:28

Yeah. That so that's what I really, that's what I really want because I mean, I want to make not just a difference in a disease state, I want to make a difference in my patients' lives. Yeah.

SPEAKER_03 35:38

And you do.

SPEAKER_04 35:39

Yeah. I'm sure. We we we do. And I think that, you know, that's one of the reasons I'm so passionate about our subspecialty, but it also kind of drives the other things that, you know, I do. Like that's what drove me to invest more into social media, to invest more in patient communication and resources, because I just want to, you know, utilize every lever I have to try and connect with patients and let them know that we care about them. We want them to get a great outcome. And, you know, let's talk about what that looks like.

SPEAKER_01 36:04

Alex, let me ask you this. Oftentimes in medicine, we say that men don't care about their health. And we try to actually get to the women to encourage the women to encourage the important men in their lives to seek help.

SPEAKER_02 36:15

Yeah.

SPEAKER_01 36:16

But you are big on the social media platforms and a lot of your audience are men. So my question for you is do men care about their health?

SPEAKER_04 36:24

You know, it's interesting. I think men honestly have a lot weighing on them. Okay. And I think that if you ask a man if he cares about his health, I don't think that any guy, or very few men would say, no, I don't give a shit about my health. But what they're thinking is, well, I mean, I have to make rent next month. I'm the breadwinner for my family. Okay. Like I've got to make sure that I get this done, this done, and this done. And so they have so many other competing obligations, along with this, you know, idea of masculinity means you never ask for help or never admit when you're falling short or having a hard time, totally just ignoring the conversation of mental health. And so what happens is not that men don't care about their health, but they feel like they have so many other things they have to do and other expectations that gets shoved down to the very bottom. And, you know, what I try to convey to my patients is that, like, yes, like I, I, it resonates with me so deeply that you are the stalwart, the rock of your family, that you are the one that is the calm and the storm, you are the one that is providing the sanctity and the peace of your home through providing financially and you know, being that, you know, that figure. But at the same time, if you don't take care of your health, if you don't do that, one day you're not going to be able to do those things. You're not going to be able to move your body. You're not going to be able to continue to be that provider. And so my way of interfacing with my patients is saying, you know, if these things are important to you as they should be, well, your health should be equally important because that is what allows you to continue to do those things even as you age and you know advance further in life.

SPEAKER_03 37:55

But you see, you're kind of preaching to the choir because you're giving your patients this talk, but they've already made the decision to go to the doctors. That's true. So we, you know, how do you reach all the men who don't make that decision? I think that's where your social media because you know, all these guys are on social media. They're all looking at their phones, at their computers. Yeah. And I think that's how you get men to prioritize. I don't think they don't necessarily not care about their health. Yeah. Yeah. But it's a low priority, as you said, compared to all the other things. In addition, I think women multitask much better than men.

SPEAKER_01 38:30

Yeah.

SPEAKER_03 38:30

I don't multitask at all. No, it's part of their part of their upbringing.

SPEAKER_01 38:34

That's really true. But the other thing is there's no mandatory training for any healthcare provider when it comes to men's health. So I think a lot of men have really thoughtful questions about their health, like, how often should I masturbate? Is it healthy for me? What if my ejaculatory fluid looks different? My orgasm doesn't feel quite as pleasurable as it did before. And what do we say? Um, are you getting erections? Like, we don't care about any of those other questions. Or we say, Oh, your ejaculatory fluid, I'm sure it looks fine. Right.

SPEAKER_03 39:01

Who is it we when you say we don't care?

SPEAKER_01 39:02

Oh, you the urologists, healthcare providers.

SPEAKER_03 39:04

I mean in in general.

SPEAKER_01 39:05

Premier care doctors don't know how to answer the everyday questions of the average dude walking down the street.

SPEAKER_03 39:12

But you see, part of the problem in defense of the primary care doctor, he's got 10 minutes to do everything.

SPEAKER_01 39:18

Yeah, forever. I mean, I think it's in defense for everyone.

SPEAKER_03 39:20

And I mean, where does this time come from to talk about his ejaculate? Right. Again, prioritizing, that's not on the top list of the primary care doctor in this patient with obesity and hypertension.

SPEAKER_01 39:31

No, I agree. But for that guy, that is his most important question. So I love what you're doing with social media because you are in real time answering the questions of the everyday man in a way that allows him to make decisions that are good for his own. Yeah, I think that's a good thing. You're meeting him where he's at. You're engaging him in healthcare.

SPEAKER_04 39:49

Well, I mean, you know, what is the, what is that phrase, physician, heal thyself? You know, the thing is, is that in a lot of ways, like I, if you look at like our social media, like demographics or the people that we interact with, like I look at it and it's describing me. It's describing like, you know, guys that are in their, I'm not in my 20s anymore, but like, you know, 20s all the way up to like, you know, age 50. And these are people that are interested in health, they're interested in fitness, they want to try and do better, but like they just want, like, they want to get cut through the BS and they just want like an honest take. And I feel like there is a real challenge because there are there's a desperate need in this area. But then there are a lot of people who maybe they're well-intentioned, but they're putting out bad information or they have an ulterior motive or agenda, they're trying to sell a supplement, they're trying to sell a course or something like that. And again, just like we talked about.

SPEAKER_03 40:34

This is on social media you're talking about. Correct. Yeah.

SPEAKER_04 40:36

Correct on social media. And ja, but just like that pay the clinic interaction where like you have to patients need to know that you care about them. Like, I try to translate that into social media. Like, I care about my guys. And if you're taking the time out of your day to like watch one of my videos when there's millions of hours of other content out there, like I want to honor that. I want to let you know I care about you, and I'm trying to present you the best, most solid data so that you can make your life that much better, you know. And I think that the shortcomings of, you know, our modern healthcare system are, I mean, you could fill a book with it, right? You know, we are a sick care system, we're not a healthcare system. We tell people how to make a broken problem a little less broken. We do not tell people how to optimize their health. And something that really resonates with me personally is how mental health is something that is um totally and what that means for a man versus a woman are two totally different things. If we talk about, again, therapy has its role, right? I like therapy, I have been in therapy before, but unfortunately, a lot of therapy training is more uh inclined to how maybe women would think. They want to talk through things and they want to go through things. Guys, like, give me a fucking solution, give me an answer because what makes us feel whole is being useful, being needed, feeling like we're making a difference in someone's lives. And so I feel like that is something else that is just um a missing piece of the puzzle. And you know, I'm just trying to do my part within my expertise to get that information out there.

SPEAKER_03 42:04

Unfortunately, or what you're gonna find out is the busier you get, the less time you have to talk to your people about the things you're interested in. Yeah. You're just, you know, especially when, and we're gonna talk about this when it comes to uh testosterone management, men's, you know, general health management that we do. Yeah, uh, we just run out of time.

SPEAKER_02 42:24

Yeah.

SPEAKER_04 42:24

And you know, it's this is like the biggest irony, okay, is that like I love my testosterone patients. I love my guys that I'm taking care of, but I actually had to turn down taking new testosterone patients, which is like it's a crime because I love taking care of those guys, but there's just not enough time in the day for me to continue to maintain my surgical practice, doing the things that only I can do and still like take care of the waves and waves of men that are coming in. And, you know, we're trying to accommodate that. We're trying to hire new mid-level providers to help us that I train and that do things the way that are correct for our patients. But again, there's only so many hours in the day. And so, you know, the biggest lever I can pull is in you know, maybe the social media thing, maybe public communication. But, you know, my hope is that we can also start to increase the bandwidth of qualified providers who have been educated in this space and can you know prioritize the whole patient as opposed to just you know checking boxes when you come into the see the doctor?

SPEAKER_03 43:18

Yeah, I I agree.

SPEAKER_04 43:19

Yeah.

SPEAKER_01 43:20

So walk us through the typical patients that you would see in a day. What other procedures do you do? I mean, admittedly, you're one of the busiest penile implant surgeons in the world. What else do you do besides that?

SPEAKER_04 43:29

Yeah. So uh I joke that I do uh very little, but I do a lot of it. And so, you know, the core pathologies that I see are uh low testosterone, as we talked about. Okay. Um, and like obviously, you know, what low testosterone means to maybe your average shock clinic or primary care is radically different than what low testosterone management looks like for me and you. Right. But you know clarify that. Yes. Well, I mean, so you know, I have I I will tell you that I've met some really great people from the entire every aspect of the industry, from primary Care doctors to other urologists to people that run these quote unquote shock clinics.

SPEAKER_01 44:05

And endocrinologists.

SPEAKER_04 44:06

Endocrinologists, you know, I every, you know, every walk of life, a provider who provides testosterone therapy. But the thing is, is that something I've seen on and on is people treating it very cookie-cutter of like this every patient that walks in the door gets the same thing, and there's no level of individual nuance. No one really talks to patients about their symptoms. They just look at the number and you know, they don't actually address the reason why the patient came in. Like a patient isn't coming in to see you because, oh, I've got a low number. Not usually. Usually it's because like, oh, like I feel like I am gaining like fat, I'm losing like my muscle. I don't like how I feel. I'm fucking depressed. I don't feel like how I used to, I don't feel right. This doesn't feel right. And so the thing is that yeah, I could just throw some, you know, Sipion A at you, throw some tea at you, but that isn't gonna necessarily be a silver bullet for other things. So, okay, well, let's talk about your diet. Let's talk about exercise. Let's talk about your sleep, bro. Like, when's the last time you got a solid eight hours of sleep? All right. And then you ask them, like, oh, do you exercise? Oh, yeah, I exercise. Oh, cool. What, Jim? How many times have you been the last week? And then it starts to come out. What does your diet look like? And, you know, telling patients, hey, if it comes in a box, a can, or a drive-thru, you probably shouldn't be eating it, right? And so, like those are all things that are part of our testosterone management approach, you know, whole patient as opposed to necessarily like the straight-up cookie cutter, which is I what I think allows our patients to get better results.

SPEAKER_03 45:24

But I also think, just to interject here, that when you compare yourself to these other physicians, and the different way you manage these patients is also the different way you introduce testosterone and when you introduce it. Yes. I mean, that is a huge difference when you compare what we do to primary care and endocrine.

SPEAKER_01 45:42

In terms of intervening sooner.

SPEAKER_03 45:44

Intervening sooner and not being so focused on numbers. Right. Yes.

SPEAKER_01 45:47

I mean, you know, and not making them fail, you know, diet and lifestyle before they prove that they need testosterone.

SPEAKER_03 45:52

And then the other thing is I've noticed is that men who have low T, yes, you can go through all the lifestyle changes, but going to the gym is so important. Exercising is so important. And once you get their testosterone into a reasonable level, they're more likely to go to the gym. Absolutely. You know, and instead of the other way around.

SPEAKER_04 46:09

Absolutely. And so the thing is that instead of withholding care and you know making your patient jump through all these hoops, okay, what makes more sense, and so that's one extreme. The other extreme is just throwing a medication at them and then never talking to them. Right. Really, what you have to do is you have to do better.

SPEAKER_03 46:22

Well, that's a low T clinic.

SPEAKER_04 46:24

I know. I for many of them it is. And so, like, the the ideal way is to say, hey, let's go ahead and yeah, we can address this pharmacologically, but if you really want to get the results you want, like you're gonna have to do these other things, okay? Like, have you ever tracked your macros? Do you know how much protein you eat in a day? What does your breakfast look like? And I'll give patients an example. Like, listen, you know, it's hard like to stick with these things, dude. My alarm goes off at like freaking 4 45 or 5 a.m. every morning. I may I eat eight eggs every single morning, no variability. Like I carry protein shakes in the back of my car. And does that sound crazy? It does, but look at the what is considered normal in our modern American society, and then go look at the average person walking around Walmart. Our normal American society lifestyle leads to looking like the guy who's walking around there. Do you want to look like that? I don't. So, you know what? You gotta be a little crazy. So um, you know, low T management in that context is part of is obviously a significant part of my practice. Also, erectile dysfunction, penile implants, uh, Peyrone's disease. So men that have a nuance at curvature or scar tissue in the penis that deforms their erection, makes uh intercourse difficult or impossible. Um, we also uh male fertility, which includes uh vasectomy reversal and microsurgery, and then uh moving on to uh leakage after radical prostatectomy, because I know that sounds like a bit of a you know red herring compared to the others, but so many of the men that we see for issues of low testosterone rectal dysfunction have also had their prostates removed for prostate cancer. There is a natural connection there, particularly in the surgical realm, because the skills that are required to do it be a really, really good penile implant surgeon often translate to doing the surgeries needed to get men drive to radical prostatectomy really well. And so that's all that I do. Yeah, I don't do anything.

SPEAKER_01 48:01

Well, and you do some cosmetic urology.

SPEAKER_04 48:03

Oh, I do. Yeah, yeah, yeah, yeah. So, you know, that that's uh I was thinking about it. That's why we invited you. Oh God. And here we are here, right? So, you know, the thing is is that like uh whenever you get to do these surgeries at a high level, okay. One thing that you will hear, you know, constantly from you know a lot of guys with a reasonable, you know, uh intention is, you know, doc, you know, gosh, I feel like I've lost a little bit down there as time has gone on, or you know, what can I do to get a little bit more? Or, you know, something that we've all seen is men who, because they know that you are the penile surgeon expert, they have gotten some other enhancement procedure elsewhere and had a really, really poor outcome.

SPEAKER_03 48:39

Can we just drill down on something you said? Yes. The patient's saying, can you can you, you know, I've lost a little down there. Yeah. Are most people, most men, complaining about a decreased in length, decreased in girth? Yeah. Or both? Because what I'm seeing mainly is length. I don't hear them telling me that often my penis is thin or narrow or something.

SPEAKER_04 49:00

I would say that I hear the length loss uh more often than the girth loss, but I do hear the girth loss. Yeah.

SPEAKER_01 49:06

And so and I hear girth loss more because people are specifically coming to me for girth enhancements, which is why I'm seeing a little bit different.

SPEAKER_04 49:14

Right, right. And so the thing is that, you know, for many, many years, we just had nothing to offer those men. You know, nothing substantial, anyways. You know, there had been uh lots of attempts at uh penile enhancement when it comes to suspensory ligament release, which is a disaster because you end up losing the structural support for the penis.

SPEAKER_01 49:30

Which have been some of my most devastated patients where they feel like they've injured their suspensory ligament during like sleep or sex or whatever it is, and they feel like they have no support during sex, and it's devastating for them because they're scared they're gonna hurt themselves.

SPEAKER_03 49:43

Well, I mean, that's a bad problem when you do something to your suspension.

SPEAKER_01 49:46

Well, and the research in the suspensory ligament space doesn't address that key point, which I think is the problem.

SPEAKER_04 49:51

Yeah, I mean, because I'll be honest, you know, who's doing suspensory ligament release? It's not, it's generally not people who have dedicated their lives to sexual medicine and taking care of these men in a longitudinal fashion.

SPEAKER_03 50:01

And certainly not people who've done fellowships.

SPEAKER_04 50:03

Certainly not people, I mean, maybe some plastic surgeons who have done different fellowships, but you know, if you're looking at uh the outcomes of a functional procedure, okay, which is the idea that this is a functional organ of penis that's meant to be used for intercourse, it's not just a single snapshot in time of is the hanging length of your penis better after this procedure or before. It is what does long-term satisfaction look like from a functional standpoint. And that's something that was totally lost in all this suspensory ligament, you know, uh research so far. And so, you know, that is not a good option for patients. I would never recommend it to anyone. You know, we had other things with like fat grafting, which can be done well, but just because the nature of fat, you know, you'll end up getting some fat graft will die, and then you end up with a very lumpy kind of the shape and final result. It's not as perfectly smooth and symmetric. And then, you know, we've had, you know, the disaster of you know girth enhancement uh silicone uh implants. We know, you know, class action lawsuits that have been filed against that investigative journalism pieces that have been done against people who have espoused using that.

SPEAKER_03 51:00

So again, not now you're talking now about kind of the solid implant.

SPEAKER_04 51:03

Yeah, the solid subcutaneous silicone implant for girth, wildly different than penile implant placement for erectile dysfunction, which is single-handedly one of the most beneficial interventions that a man with ED can ever have. Right. Those two things are apples and oranges. Yeah, they're polar. Polar opposite. Do not confuse them.

SPEAKER_01 51:20

And why do you think the silicone implant for girth enhancement is so much riskier?

SPEAKER_04 51:26

Well, I think you have to understand the anatomy. And so the thing is that whenever we are doing a penile implant for erectile dysfunction, we are respecting the natural anatomy of the penis and we are filling what are essentially existing hydraulic cylinders, the corpora cavernosa. They start on the ischial tuberosity, like down deep in the pelvis, go out the shaft of the penis. And we are simply trying to fill the inside of those with our own inflatable tubes that kind of like cinching up against it like a bicycle tire, you know, inner tube up against the actual tire itself. And we know that the tunica of the corporas is the strongest bit of soft tissue in the human body, with the exception of the dura mater. Okay. And so it accommodates and can withstand that, you know, pressure exceedingly well, okay. But, you know, if we look at the subcutaneous silicone implant, it's going underneath DARTOS. Okay. What is Dartos? Dartos is a layer of fascia on top of the penis that just allows for friction up and down without getting a freaking Indian rug burn. Okay. You know, try like if you go into the bedroom and a guy has sex for 30 minutes, like he's not going to come out, like, you know, ideally, obviously lubrication, all that, but he's not going to come out chafed as all get out with a rug burn on his, you know, uh member. Okay. Like, you know, I like do this for a little while and it gets real uncomfortable real fast. And so the thing is that that's what Dartos is meant to do. It is not meant to be a buttress against this large uh bit of foreign body that is put under it to try and puff it out to make it girthier. And so, because of that, you have a very, very high incidence of uh erosion and extrusion. I've had to remove those devices in my practice with horrible, horrible complications.

SPEAKER_03 52:59

Yeah, but I think you need to describe to the people listening in that these silicon are not soft silicon.

SPEAKER_04 53:05

Oh, no, these things it's like a sleeve. Oh, yeah, it's like even worse. It's like it's it's like a freaking hot dog bun, man. Like, you know, these things do not feel soft or natural, they feel firm and rigid. And so, you know, patients have come to me requesting to have them put taken out because they feel so foreign and unnatural. And then 99.9% of the people. But you know what?

SPEAKER_03 53:24

It amazes me, excuse me, how many men have had that operation though?

SPEAKER_01 53:28

Yeah. Well, people like permanent solutions, right? They want kind of like a one and done. And what I tell patients is with permanent solutions come potentially permanent consequences.

SPEAKER_04 53:36

Exactly, permanent problems. Yeah. And so, like, I get it. And the people that espouse that are great marketers. I would argue they're much better marketers than they are surgeons or doctors. Um, but the thing is, is that uh ultimately what happens is patients are left helding the holding the bag with uh a consequence they weren't anticipating. Um, we all know that there is a single surgeon series looking at that. That was published in the Journal of Uh Sexual Medicine many years ago. And although the journal has not officially retracted that article, it is widely accepted within our community that those results are not consistent with what's actually seen in real practice. And there is some serious concern about whether or not that data is true and has integrity. And it would not be consistent with what patients have reported afterwards. Okay. And the reason why I'm using fancy words and I'm saying words like allegedly and blah, blah, blah, and why I'm not actually saying the words pennuma and hemp plant and elist is because this is a group of people that are so notoriously litigious that they will chase after doctors that are trying to advocate for their patients because they feel like it is an impugment upon, you know, their financial interests. Okay. Luckily, I ran out of fucks about two or three years ago. So, you know, this is my personal opinion as a doctor who is taking care of these patients. All right, I can only attest to my personal experience, but you know, this is what we see. And so after we've been through all of this, okay, basically we were kind of left at a position where are there safe options that we can offer patients? Because this is something that patients really, really want.

SPEAKER_01 54:58

Yeah, because we can't just tell patients, oh, you're in the bell-shaped curve of normal, you're normal, don't do anything. There's nothing that we have that's safe.

SPEAKER_03 55:04

Yeah, wait, wait, time. You there are people you have to say that to. Yeah. Well, you know, every man who comes in and says my penis is too thin, yeah, don't look at these guys don't look at other people's penises. What they look at is porn. That is true. And they say, hey, listen, I there's something wrong with me. I don't look like that. They're not realistic. And you've got to be realistic with patients.

SPEAKER_01 55:24

Well, we'll sometimes pull up the graph and show them, hey, you're at like the 65th percentile. And and actually a light bulb like turns on where they're like, oh my god, I am normal.

SPEAKER_03 55:32

Yeah, you have to you have to keep remembering that men don't see other men's genitals who are normal. Yeah. Yeah. They see genitals online. And you've got to bring them back to reality.

SPEAKER_04 55:42

And I I joke with patients. I'm like, listen, man, I see 40 dicks a day. Okay. Like, you know, you're easily in the top 10 too.

SPEAKER_03 55:48

Do you say dicks or do you say penis? Usually dicks.

SPEAKER_04 55:50

Usually dicks, you know. Um I didn't teach you that. No, you did not. No, sir. I brought that one on my own. Um, you know, and we can you can get into I have uh I'm sure criticism, well, I know criticism has been levied at me regarding the topics of professionalism, et cetera, et cetera. But really the thing is, is that I have found that men that are coming to see me are not looking for a white coat and a tie and, you know, oh Mr. So-and-so, X, Y, Z, X, Y, Z. They want to talk to someone that uses the same language that they do, that has the same concerns that they do, and can connect with them on a human level. And so I use the same language to talk to my patients that I use with my buddies or I use my friends because the truth is that I care about my friends, I care about my buddies, I care about my patients. So I'm not gonna necessarily dress things up using language that I learned in medical school. You know, that is something for professional communication amongst peers and colleagues, so that we can be well understood. But whenever I'm talking to like another guy, I'm gonna talk to them like another guy. So, you know, I do think that you got onto something which is really important, which is, you know, trying to tell patients that they cannot seek their permanent happiness and fulfillment and the shape or size of their genitals. Okay. Like personal satisfaction, filling the hole in their heart does not come in a doctor's office. Okay. But that being said, if a patient has a reasonable understanding of that, if they are centered as a human being, but like they just want some more down there, because heck, why not? Then, you know, I don't think it's unreasonable to say, oh yeah, no, we have this option for you. And that option is, you know, what you know, we were fortunately part of, you know, developing, you know, again, it's is we did not invent the use of hyaluronic acid, you know, for the use of you know, penile girth enhancement, you know, but we were, you know, one of the first adopters of it, you know, as your fellowship trained urologists.

SPEAKER_03 57:27

Just to excuse, just to put in perspective, yeah, fillers are fillers. Correct. So to explain where it came from.

SPEAKER_04 57:33

Yeah, so fillers are you know injectable material that is designed to restore volume. Okay. This was first approved, I believe in 2003 was when uh the first hyaluronic acid filler was approved. Um, and uh, I could be wrong on that, but it was first used in the face, in the lips, to try and restore the volume that is lost with age. Right.

SPEAKER_03 57:53

And you know, it's still very popular in all the movie stars. When you see them and they say, Oh, she's had something done, she looks so good. Nine times out of ten, fillers or facelift or a combination.

SPEAKER_01 58:03

Halaluric acid now is pretty much in every dermatologic. Yes.

SPEAKER_04 58:06

Oh, absolutely. I mean, and there's no shame around like it works great for that. Heck, I've had hyaluronic acid, like, you know, in like my not tear troughs, but in the hollows under my eyes.

SPEAKER_01 58:14

Put it in my lips, my cheeks. Yeah.

SPEAKER_04 58:16

Where else have you had it, Amy?

SPEAKER_01 58:18

Not not in my penis. No.

SPEAKER_04 58:20

Thank God. But you know, so we're like, okay, all right, bet. So this works in these other established spaces. Well, where else could we use it? And so the idea was well, could we use this for girth enhancement? But the big challenge was is dealing with migration. All right. And so migration is when where you inject the filler, it doesn't stay there, it moves. And the thing is, is that the lips are relatively static, you know, in like under the hollows under your eyes, a relatively static space. The penis is an incredibly dynamic, you know, organ. And I tell the patients, you know, is there, you know, tell me, sir, is there a difference between your penis coming out of a pool versus, you know, in the bedroom with your wife, like, oh, absolutely. I'm like, God, I hope so. All right. And because of that dynamic change, and because everything is moving so much, it's very easy for that filler to migrate. And so um what uh eventually ended up, you know, being developed, uh, I wish I could take credit for it. I can't, you know, this came from you know Bill Moore, you know, uh with phallifil. Bill, who's you know, not a doctor, he's just a man who's very passionate about penises, um, is you know, keeping the penis on stretch, you know, after the uh administration of hyaluronic acid. And so uh what happened is as I was in practice, I'd already graduated from fellowship, I ended up getting a phone call from a friend of mine who had gone to work with Bill. I had met him when he was working for one of the PNL implant companies. And he was like, hey, Alex, like you got to come down here and you gotta see this. You know, it's it's awesome. The outcomes are really good. And I was like, uh, dude, are you on something? Like we've seen this, right? Like we saw the disasters from, you know, uh silicone, we've seen all these other things. Like, yeah, I I'm not really buying it, but I happened to be traveling to the area to go operate with Al Mori to work on, you know, perfecting AUS technique. And so I was like, okay, all right, I'm gonna be down in that area anyways. Let me go ahead and add an extra day or two. It's a Dallas area. Dallas, yeah. And then so I I show up in a day or two early, and then I end up going to this clinic, which is in a strip mall, okay, and they bring me in the back door, okay, and I'm like, what is going on here? And uh I met Bill for the first time there. And then again, like I felt like a fish out of water. I'm standing kind of awkwardly. I stand awkwardly everywhere, but I'm standing awkwardly in a room as he brings in a patient for a follow-up treatment. So it already had, you know, two or three treatments before then. And you know, the guy's just like dropping his drawers in the room before he goes to the table. And I look at him, I'm like, holy crap, I can't tell this guy's had anything done. Just looks like God likes him more than me. I was like, this is bull crap. And then, you know, you started to see, you know, how it was administered, trying to respect the planes, administer the hyaluronic acid in an even fashion, and keeping the penis on stretch afterwards. And I was like, this is extremely important. When you say keep it on stretch for the audience, how do they keep it on stretch? So uh I can we can finally talk about this, you know, uh more openly. But essentially, uh what Bill had developed was just using a like a modified polymer. It's part silicone, part some other polymers, but just like a sleeve, you know, or a wrapping that kind of goes around the. Oh, yeah, yeah, yeah. So this is a good example. So if we're looking here, you know, ignore like the purple metal part. That's meant to actually uh just simulate the penis itself. But you can see we've got this kind of stretchy brown silicone sleeve that goes on top of it. And okay, this does two things, right? The first is is that it provides a mild amount of compression to the penis that helps keep the filler, you know, against the uh the rectile bodies, okay, and prevents it from moving as much. And then what we can also do is we can use like two or some other accoutrements, whether it's like a little something called a bell device or something around the end, just to keep this from moving. And what this does is, you know, as we know there's a difference in between penile stretch length, you know, pulling on your penis whenever you're warm in the shower or whenever you're sexually aroused, versus in the pool. I was like, this, I tell patients, this avoids pool penis. This avoids it from pulling back into the body when you're exposed to cold and it avoids contraction. And what this does is it allows the filler to seal in place because as we know from penile implant surgery, bodies form protective capsules around foreign, you know, uh objects and form material. And even though hyaluronic acid is a naturally found material, if you actually do surgery on men who have had hyaluronic acid and facelift surgeons can attest to this as well, there is a very small capsule that the body will form around it. And so what we found is that by keeping the penis on stretch for at least about three weeks following administration, that initial capsule will form and then migration risk is exponentially lower.

SPEAKER_03 1:02:34

And so the hyaluronic acid fillers are malleable, moldable for the first so many.

SPEAKER_01 1:02:46

Here, I'm gonna pass these to you. Are you ready to catch it?

SPEAKER_03 1:02:48

No, go ahead. Oh my gosh.

SPEAKER_01 1:02:51

That's about the consistency of the filler that we inject, and it feels soft. So you can feel the filler in the penis. You just pinch the side of the penis, and it feels just like tissue. So you're not wondering what is this cement that you put in the penis, which could be a concern with some of the more permanent filler offs.

SPEAKER_03 1:03:05

Yeah, there are fillers out there that the audience needs to be careful about. Yes, but it does end up feeling like cement.

SPEAKER_01 1:03:12

We are talking about temporary. Especially from Mexico.

SPEAKER_03 1:03:14

We've seen them come up.

SPEAKER_04 1:03:15

Yeah, well, not even from Mexico, you know. Yeah, well, uh, because, you know, again, like I said, I ran out of fucks three years ago. Um, you know, there is a doctor in Miami who is notorious for injecting this con No, not Amy, not Amy. Amy is is one is one of the best in the business. But there's a guy in Miami, we all know him, Dr. Victor Luria, who has become, you know, basically the face of Pinal Girth enhancement for a time because he was so aggressive with his marketing. But the truth is that he uses this concocted, compounded, uh, proprietary mixture that he doesn't reveal what's in it. And I think everyone who has a sexual medicine physician has seen Victor Luria complications. And some of them are absolutely horrific. We have a really fascinating documentary that was just shot by a gentleman, documentarian, Dr. Daniel, or sorry, uh Daniel Lombroso. He's not a doctor, but uh, he's a fantastic, you know, documentary filmmaker who followed the story of a young man who came to me for care for penile reconstruction after uh having basically a very botched uh procedure by uh Dr. Luria. And, you know, again, that's something that the patient told me many times like, I wish I had never done this. I wish I had never been to this doctor. Like I felt abandoned, I felt neglected. And those are his words. And so if you see permanent filler and you see someone advertising that, run as fast as you can because that is why, wholly unnatural and the risks are profound. And so, you know, but fortunately, now we have the option of hyaluronic acid administration, which we know is safe, and not because I'm just sitting here telling you guys this, but we published our data in the Journal of Sexual Medicine and ended up over three years and ended up finding like no trips to the operating room, okay, no permanent changes in erectile function, no permanent changes or in uh sensitivity. And the only quote unquote complications were in uh, I believe at three gentlemen in the initial protocol, we had used some medication to induce erection. They had persistent erections that wouldn't go away, that had to be treated, okay, but that's no longer part of the protocol, not even an issue anymore. And then there were two men that ended up um, you know, God bless them, but they had some issues with compliance with not having intercourse within a certain period of time.

SPEAKER_01 1:05:20

They had like anal intercourse within a couple days of their injections.

SPEAKER_04 1:05:23

Yeah, they had anal intercourse within a few days of their injections, and then obviously you just have a bunch of needle pokes, bro. Like you're gonna get like an infection there. And so, but like an infection uh that was treated with antibiotics and they did fine. Or antibiotics. Yeah, or just take some pills for a few days and just like keep it in your pants, bro. You'll be fine. Okay. And like they still got great results cosmetically, had no like long term outcomes. And if you compare that to the absolute like devastation that we've seen from, let's say, the silicone implants or from the injectable silicone, like this is light years apart. And so what we've essentially managed to do is we've managed to lower the barrier of entry for penile girth enhancement from a Level where it is this, you know, extremely risky, extremely variable endeavor to something that it was really uh like on the par with getting lip filler as a female, right? And that's what I tell patients. I was like, if you want to get penile girth enhancement, just the same way that you know a female patient may want to get her lips done, not the guys can't get their lips done, but you know, if you just want a little extra, absolutely, that is fantastic. We are all in, okay. But much like in the plastic surgery world, if you have someone who is anchoring their entire identity, idea of self-worth, and their ability to attract a partner on, oh, I just need to get this one cosmetic thing and that's gonna fix everything, I this is not it. Okay. You cannot, there's nothing that I can do as a physician, okay, in this context to make you whole as a human being. That is something that you have to be comfortable with and you have to find on your own through deep personal work. And then once you are in a secure place, if you just want some like a penis filler, sure, let's go for it. Yeah.

SPEAKER_01 1:06:55

So how I know Larry has some comments here. No, no, no.

SPEAKER_04 1:06:58

I know. How long is that initial visit? Uh honestly, it's actually pretty uh it's pretty efficient simply because this is unique with phallofil, that they have a really robust communication education process that happens before the patients reach the uh clinic. That was something I was really, really paranoid about.

SPEAKER_03 1:07:16

Oh, wait, wait. So the patient calls in. Correct. And they have to be identified at the call in that that's where they're coming to see you. So this is how it works. So um 1-800 penis.

SPEAKER_04 1:07:27

Whatever Fallafil, the the numbers on the Fallafil website. And, you know, um, you know, I uh and again, like I'm not doing this. Uh this is not a commercial for Phallofil, all right, but I'm just confident in this platform, and that's what I happen to offer personally. But men will reach out directly to Fallafil and you know, they you know, talk to Ben, who is basically the counselor for Phallofil. And what he does is he just walks patients through like, hey, this is you know what's achievable, this is realistic, this isn't. You know, what are you hoping to achieve here? And that filters out uh a lot of patients who have inappropriate expectations. And so we only get the referral and the call from uh from Phallofil with patients that have passed all that screening and selection. And so I was concerned with having you know a lot of patients come into my clinic who had really inappropriate expectations, and that would be a real challenge to try and correct. That has not been the case at all.

SPEAKER_03 1:08:17

All right. So if a patient calls your office, though, yeah, and says, I hear that Dr. Tatum does uh girth enhancement of the penis, I'd like to make an appointment. Do they then say to him, Well, before we see you, we'd like you to call and they they so they defer them to the other place.

SPEAKER_04 1:08:33

I even more, even more pronounced than that. I had a patient of mine that, you know, I am you know personal. We connected as friends uh and outside of um outside of the office before he became a patient of mine. And he, we're I'm taking care of some testosterone, some other things. And he asked me about girth enhancement when I saw him in clinic just this past week. And I said, absolutely happy to talk more about that at the right time. But what we're gonna do is this I'm gonna give you the contact information for phallifil, and that is totally separate from the rest of our management. You need to go through this process and you need to go through this education.

SPEAKER_03 1:09:04

But he was in your office. Yes. But do people get, does your staff know to send them to Fallafil before making the appointment? Absolutely. Okay. And so my phallofil That's a really good you do the same thing.

SPEAKER_01 1:09:14

So my process is a little bit different, but I have a concierge practice, right? So when people call in, sometimes they come through Fallophil, sometimes they come through just some of the social media content that I've posted. So I start with a like full comprehensive visit. I mean, sometimes I'm in the room with them for an hour and a half or two hours. I use a lot of patients come in for one specific reason. They're coming in for girth enhancement. I use that as a door that just open them where I can engage them in the healthcare system as a young man.

SPEAKER_02 1:09:39

Right.

SPEAKER_01 1:09:39

So they might be 35 years old. I might be the first healthcare doctor that they're calling.

SPEAKER_03 1:09:44

Probably. Right.

SPEAKER_01 1:09:44

So I say, I understand, you know, the reason for today's visit, but if you don't mind, I want to expand this visit a little bit because I know it's rare that you get to sit in front of a men's health specialist. Are there any other topics you want to talk about? Have you ever had your testosterone level checked? Any health?

SPEAKER_03 1:09:57

And I'm sure you've got a lot more.

SPEAKER_01 1:09:59

Oh, yeah, because then I end up managing their testosterone. And then I, you know, and managing their, you know, sending them for a sleep apnea referral. So I broaden that discussion and talk about filler in that context.

SPEAKER_03 1:10:08

Yeah, see, that's the advantage of a concierge practice.

SPEAKER_01 1:10:11

Well, I have the I have the luxury of time, but I'm not sure if you're not going to be able to do that. We don't have that.

SPEAKER_04 1:10:13

We don't have that. No, because I mean, you know, we still do a just the way the American healthcare system is, it for a lot of our index surgeries and what we do, like it is uh nigh impossible to do some of that within like a concierge cash pay world. I again, we've talked at length about can you use a hybrid approach? And you know, there may be some needle or that you could thread in that way. But you know, every practice is different. Every doctor is going to have a different setup, different things are going to work for different practices. But this is just the approach that has worked for me. And what I really like though is that we now have you know examples through Amy and other, you know, very different practices that this is something that can be offered safely and in a highly reproducible fashion, you know, even across different practice settings. And another example is that, you know, although, like, yeah, I do growth enhancement, you know, myself, but like one of the most gifted, you know.

SPEAKER_01 1:11:08

Sorry, can you clarify that statement?

SPEAKER_04 1:11:09

No, no, I have not had fallible person. No, no. So I thought you did. No, I did not. My penis is still all natural. So, you know, uh, but the uh because you know, the I often joke, I'm like the only person who could do my injections right next, I don't want to fly down to you know uh Dallas to have Bill inject me because I'm lazy, okay? Is I would have to have one of my you know female PAs do that. And HR doesn't approve that. HR would have complaints about it.

SPEAKER_03 1:11:30

That's that crosses over the line.

SPEAKER_04 1:11:32

There's the line, you know, there's a line. So uh but that's actually kind of getting to the you know my point that uh one of the most like gifted providers that you know does like the best valuable work, you know, at least that I've seen, is you know, my PA Kristen Gump. Like she's incredibly talented and she does an incredible job. And so, you know, it's showing that you know, you can this is a reproducible and teachable technique, and that when you dot the I's and cross the T's, this is something that can now be offered to men amongst multiple practice settings and they can get really good outcomes, which is uh light years. Yeah, light years from where we were even like seven, eight years ago.

SPEAKER_01 1:12:03

I want to touch on something that you said because you made this comparison to people that women that come in and ask for, let's say, nasolabial uh you know, filler or lip filler. And we oftentimes, I mean, this space of penile enhancement is such a freaking polarizing space, right? And it's changed actually over the last couple of years in our societies where people are actually talking about it now at society meetings. I the AUA on two occasions asked for us to write articles, you know, on this topic, and that organization is a pretty conservative organization.

SPEAKER_02 1:12:28

Yes, yeah.

SPEAKER_01 1:12:28

So we pathologize, we pathologize our patients who come in wanting a bigger penis, and we say that we need to screen them for small penis syndrome and we need to screen them for body dysmorphia. I'll tell you from my own personal experience, when I go in to see a dermatologist and if I want lip filler or Botox, if they were to hand me a questionnaire to screen me for body dysmorphia, I would say, why don't you just talk to me for five minutes? Yeah, right. And I would say it's pretty easy to tell someone if they're a normal person where you can satisfy their expectations or if they have unrealistic expectations.

SPEAKER_04 1:12:57

I I could totally agree. And I think that the one of the problems was is that because all of our options before hyaluronic acid and before this particular uh technique of administering hyaluronic acid were so extreme and had so many awful complications that only the most motivated men in the world would ever pursue them. That obviously is going to skew more towards men that are putting an unhealthy emphasis on it. And then if you're a conservative urologist that doesn't, you know, really have any interest in this space or these patients, you just assume that everyone pursuing penile growth enhancement, you know, clearly has their priorities out of whack, which is not the case whatsoever. Okay. Uh honestly, that is very similar to what we saw with breast augmentation when it first came about. Only the most motivated women, you know, women in the you know, uh in the sex industry, you know, uh it would pursue this sort of thing. And then we thought, oh, like this is only for like freaking strippers, okay? All right. Uh, but in reality, like, you know, what woman doesn't want to feel more confident in their clothes, feel more confident in a bikini. And then now we've seen the democratization of, you know, I as to play the devil's advocate.

SPEAKER_03 1:14:02

Yeah. I think there's a big difference. First of all, the breast is not, you know, honestly functional. It's it's cosmetic. Yeah. And that and I think society has become very breast focused. And so it's become not anything deleterious to talk about getting a breast enhancement, a breast augmentation. Yeah. When you go to the penis now, we're talking about something with a lot of psychological overlay. Well, and as you as you were mentioning, and also, as I mentioned before, the whole thing about what's normal, what's not normal, how do men know? I mean, women know what breasts look like. Guys know what breasts look like, normal, large, small, whatever. Penis is something different, you know, because there's flaccid, there's erect. And what do men have to look at? They're looking at porn. And I think, I think it really becomes a little bit dicey as to trying to decide is that man really, really upset? And is it something I can help him with, or does he just not know that he's normal? And I think respond to this. I think that's new, I think that's nuanced.

SPEAKER_04 1:15:04

Yeah, I agree. I do think that there's nuance there. But if I try to like I try to be very like uh systematic and sometimes mathematical when I approach this, the thing is is that because the conversation around breast augmentation has become so normalized and something that is now generally accepted by a wide population, that means that the percentage of women that are pursuing breast augmentation, that have true body dysmorphic disorder is very small. It's very, very small. Okay. And then whenever we were looking at penile girth enhancement prior to the hyaluronic acid area or era, okay, everything was super invasive, super high risk. So that number of men that had, you know, body dysmorphic disorder that were pursuing that was very high because you had to be a little nuts to want somebody to like do some of those procedures. All right. But what we're seeing now is we're seeing this transition where we're having greater societal acceptance of different male enhancement procedures, which means that the incidence of men interested in pursuing this who have body dysmorphic disorder amongst everyone presenting the clinic is decreasing. And so I think that we need to be very mindful. I think that we need to be very cautious whenever we're counseling patients to make sure they don't have inappropriate expectations. Okay. And we have the added layer of the idea of someone's entire masculinity, their ability to attract and please a partner being wrapped up into all this. So I think that there is a greater burden on the provider to try and make sure that we are filtering for that and that we are conveying appropriate expectations. But my expectation is that as years go on and as this becomes a much more widely accepted thing, it will eventually become like lip filler, where like who gives a crap? And like the truth is, is like as a guy who appreciates the female form, like, guess what? Do I love, you know, like uh lip filler in some women? Absolutely. Do I love like lips without filler? Great. Like natural boobs, great. Fake boobs, fantastic, right? Like you just like who gives a crap?

SPEAKER_03 1:16:49

But I think, I think, I think that that this area is ripe for uh misuse, especially with social media, especially with doctors trying to make more money, let's face it, and mid-levels.

SPEAKER_04 1:17:04

Yep.

SPEAKER_03 1:17:05

This could easily be a mid-level clinic, it could, right? And you're and I just think it's a it's a somewhat at this point in time, a slippery slope of what could be offered just for the purpose of making money, versus, unlike you, someone who really cares. I know, but this one is kind of like on the edge. It's kind of like, well, we'll do it to everybody because it's not going to make them worse. But I'm not so sure. Well, I think that I think the patient who you're describing that you have to filter out is the one who has too much tied up in penile girth. Correct. Too much focused on his happiness. And, you know, there's a lot of guys who don't not very self-confident. Yeah. And listen, you know, and especially in this age of social media and everything you see online. I mean, you're not going to see real life.

SPEAKER_04 1:17:57

Yeah. And again, I I think, but if we take a step back, the truth is that this technology, because I thought about this really, really hard before I started offering this, because even whenever I saw how phallofil could be administered or uh safely and efficaciously, I was still like really cautious. Like, is this something that I want to take on? And the what I realized is that the cat's out of the bag. Like, this is something that is going to become more and more ubiquitous. And so the thing is that patients, like the market is going to determine this, patients are going to search this out. So, you know, much like with social media, right? I got irritated all the bad information I was putting out there. Well, how do you counteract that? Well, you put the work in and you put good information out there. Are there bad actors in this space who are opportunistic and take advantage of patients? Absolutely. And those people should be pillowied on social media. But, you know, I saw an opportunity where I could try to pursue things and offer this in hopefully a very ethical and judicious manner. Tell patients, like I've had patients who have come in who have asked for more filler. They're literally on the table. And I tell them, I'm like, more filler is not gonna get you more partners. More filler is not gonna get you more satisfied. You know, let's talk about that for a little bit. And uh I think that by trying to pursue that, we can help point patients in the right direction and slowly start to shape the conversation for what the expectations of professionalism are in this little subject.

SPEAKER_03 1:19:16

And you know what? Kind of kind of what I'm starting to feel, yeah, since this is a relatively untapped area in where where I practice in this city, is if if I don't get my team to start doing it, then someone else is going to do it poorly. Exactly. Well, and here's my concern. And we we could do it the right way with the right counseling, with the right relationships to phallophil for education, and not expose our patients to people who are out to hurt them and make a buck.

SPEAKER_01 1:19:44

Here's my concern, and we've seen it in the testosterone space is we as urologists were not in the testosterone space and we said we couldn't help you. And so what happened? All these other clinics opened up and they started helping people and offering testosterone to anyone who walked in the door. And now we can't believe we're like against all these, you know, T clinics popping up and we're saying, How can they do this? It's our fault because we told that guy who needed our help we could not help him. And so, if we as urologists, we are the penis specialists, if we say we cannot help you, we are losing that patient to another clinic. Right. Or not penis specialists. And then we offer all the treatments on the penis.

SPEAKER_04 1:20:25

And they may not be, and they may or may not be ethical actors.

SPEAKER_03 1:20:28

And that's that's my concern.

SPEAKER_01 1:20:30

Yeah, and that's we should be leading this field as penis specialists.

SPEAKER_03 1:20:33

Yeah, and so I don't like being called a penis specialist.

SPEAKER_01 1:20:35

As urologists, as mental health specialists. We should be innovating the field. He likes it. We should be innovating the field.

SPEAKER_04 1:20:40

I tell my patients I'm just a humble country penis doctor doing doing my best.

SPEAKER_01 1:20:43

But like I mean, true or false, that we should be innovating the field.

SPEAKER_04 1:20:46

I I agree, we absolutely should. And I I find myself constantly walking this tightrope where I will tell like our audience that you do not need penis filler to be happy. Yeah, you do not need penis filler to be whole as a man. That is not what makes you a great partner. That is not what necessarily makes you a great lover, that is not what makes you more attractive to the opposite sex, that is not gonna make you better as a human being because your worth is not freaking determined by the size of your junk. And anyone telling you that doesn't give a shit about you. Okay. And so, like, I that is something that I need to get out there. That like this is not a matter of self-worth. That is something that is deep and internal and part of your own personal journey. Okay, you have value in who you are. But that being said, if you are secure and you are in a place where this is just something that is a nice, a nice to have addition. And it is not an overfinancial burden, okay. You're not neglecting the other important things in life to pursue this. If you don't have inappropriate expectations, and this is just like, again, like a nice to have, then absolutely like let's take care of you and let's get you a an outcome that meets your expectations, that is, you know, uh, you know, pleasurable for you and your partner. And, you know, I often equate it to other forms of body modification. Like, listen, like, for example, like people are like, oh, you know, you love uh you're a big advocate for for this in the appropriate context, but you haven't had it done personally. So what does that say? I'm like, well, the truth is is that like I love tattoos, okay, but like I don't have any tattoos. I love some of my best buddies are tattoo artists and I love seeing it, you know. Uh but I just haven't found a tattoo that is like a lot of people.

SPEAKER_03 1:22:14

Yeah, but I mean people can't fault you for uh offering a procedure that you yourself don't have. I mean, come on, you'd have to have a radical prostatectomy in order to do a radical prostatectomy.

SPEAKER_04 1:22:23

So let me tell you about my implant. Um but uh no, the uh but the thing is that that is something that is a real criticism that'll get levied online because all of a sudden, when we start to interact with our patients writ large amongst social media, that is a different level of scrutiny than when you have someone sitting in front of you in clinic. And so, you know, for for me, when I equate it to other forms of body modification, again, like that is totally cool and it can be done very well, it could be done very tastefully and get a great outcome, but you just can't anchor your identity in that because that's that's a very, very valid point.

SPEAKER_01 1:22:54

Well, I want to talk about some of the work that you and I did. We presented our work at a recent meeting in the fall, and it was looking at characterizing the people who come in for filler. Who are they?

SPEAKER_00 1:23:03

Yes.

SPEAKER_01 1:23:03

And what we found is that people are coming from a place of abundancy. And I actually wrote about this for a recent AOA news article is coming from a place of abundancy rather than from a place of deficiency. And I want to explain what I mean by that. We asked these patients who had at least one filler treatment what their relationships were like, right? What their self-confidence was like. And we found that people coming in were having sex, they were enjoying it, they had good relationships, but after they had filler, a lot of them reported that those were improving. They were having more sex, their relationships were better, their self-confidence was improved, but they weren't coming from a place of desperation. Yes. They were coming from a place of neutrality or a little bit above neutrality, and we were just optimizing them. And I think it's important for people to know that, right? The people that come in to your clinic and my clinic are the normal dudes walking down the streets of Indianapolis and Miami and Houston and all over the country and really the world. I mean, this is it brings in a lot of patients from other areas, and they're saying, I wonder what's possible. But you touched a little bit on the functionality of the penis, and we think about filler as being a cosmetic procedure. I would argue it is also a functional procedure. The number of patients that have come in to say, sex feels amazing now. You know, I mean, great, we resource someone's erectile function, we put them on Cials, and now they get great erections, but they can't feel their partner, that's a functional problem. That's the elephant in the room that no one's talking about. Oftentimes, as women get older, their vaginas get more lax, they might increase in size, the penis oftentimes gets smaller. How are we reconciling those size differences? So when my patients come in and sometimes their partners come in and they say, I enjoy sex more, that is a functional problem that we could actually potentially address with Phil.

SPEAKER_04 1:24:49

I think that's a good point. That is a solid point. And that is something that I've heard from patients as well. But I whenever I address that with patients ahead of time, I have to give them the big caveat that those are anecdotal reports that we have yet to measure objectively simply because we don't have a great mechanism for addressing that. It makes sense in our heads and our patients are telling us these stories. But as someone who tries to make recommendations based off of data, you know, I would never recommend anyone, oh, you should pursue this because it is going to make sex feel better for your wife, okay, or your partner, because we just don't haven't captured that data yet. Absolutely. And so I think that we will, and that is like the next project, the next frontier. But, you know, I'm always very, as we are, you know, still in like this bleeding edge of you know urology and men's health. Like I want to be very, very certain to make sure that we're being uh intellectually honest about what we've uh heard, what is anecdotal versus what we have shown versus validated research.

SPEAKER_01 1:25:46

Yeah. And that's a great point because in the work that we spoke about, we asked the patient about their partner's experience, which is not the same as sitting down with a partner.

SPEAKER_04 1:25:55

Totally different.

SPEAKER_01 1:25:56

And different from having the partner in the room when the patient's in the room and sitting down with them separately.

SPEAKER_04 1:26:01

So, and I will just give a shout out uh the again to this documentary that Daniel Lombroso has done, Manhood, it just premiered at South by Southwest, and they are going through a process to hopefully bring this to the masses via a streaming service. I'm so excited whenever it comes. And I would encourage men that are interested in this space, okay, to sit down and watch it because I watched it through a special preview last night. I mean, it almost brought me to tears at a couple moments, just feeling the pain that so many of these men experience. And I think that that's a very thought-provoking piece that men who are interested in this space or people who care about men interested in the space should watch to get a better understanding of, you know, where it is this fit in my life. And so I think it was a very, very well done piece. I am so proud for my small part in it. And again, just telling the stories of these men. And, you know, I think that there are more stories to be told. Okay. I think that there you could make, you know, a follow-up to that in a couple of years and see how this space has changed and maybe tell more stories of, you know, gentlemen who come from more of a place of abundance. But I think that this is uh I think that's a powerful piece that I'm excited for hopefully our audience to have access to.

SPEAKER_03 1:27:08

I think your point about patient satisfaction uh partner satisfaction is really going to be interesting to look at.

SPEAKER_01 1:27:14

Well, what I've seen is when the partners aren't into it, the patient doesn't seem to be as happy with their results. But when the partner is like, wow, that feels amazing, the guy's like, This is amazing. I love this.

SPEAKER_04 1:27:23

Oh my gosh, I'm Superman.

SPEAKER_01 1:27:24

So it's but it's challenging, right? It's the same thing in the breast augmentation spaces. At what time do you, at what point do you say, like, well, let's get both people involved in this decision? Same thing with penile implant surgery, right? I mean, this affects both people in a partnership, but yet we're we're we're gonna be treating the patient.

SPEAKER_04 1:27:38

Yeah, and ultimately, like bodily autonomy, like, you know, we treat the patient, we don't treat the partner, okay? Um, but uh I whenever we're talking about, for example, penile implant placement, uh, same thing with my girth enhancement guys, I'm like, hey, listen, like if you are in a committed long term relationship, like, please engage your partner. I want to talk to them, I want them to be part of this journey because we have data from the penile implant space that many. Men who have engaged partners do so much better than men that don't. And the time to get your partner engaged is beforehand, not after you've had a lot of people.

SPEAKER_03 1:28:08

But we also have anecdotal reports from wives coming back upset because their husband now has a penile prosthesis, right? Yeah. And they want to have sex all the time, but the wife doesn't want to.

SPEAKER_04 1:28:17

Well, and that also brings in the other aspect of are there untreated women's health sexual issues that have gone by the wayside.

SPEAKER_01 1:28:23

You know, we've had uh if they're having pain, for example, then making them girthier is gonna be a huge problem.

SPEAKER_04 1:28:27

Exactly. You know, and so like we need to address hormonal deficiencies, we need to address genitary urinary symptoms of menopause, and which gets into the whole side of this being, you know, like a sex is a couple's endeavor, you know. So I think that this is uh an exciting space. I think it is a growing space and one that I am very proud to be contributing to in my own way, uh, trying to do it in a very like uh methodical and ethical way that tries to honor the patient rather than uh just one particular aspect of their anatomy or you know what uh the money that comes into a practice, right?

SPEAKER_01 1:29:00

Because we want to normalize the conversation, but we don't want to send the message that everyone needs filler and everyone needs a bigger penis.

SPEAKER_04 1:29:06

Absolutely. I mean, because the honest to goodness truth is that let's be honest, nobody needs filler, okay? But that's okay. Nobody needs lip filler in their lips. I didn't need to get filler in my uh under eyes, okay? This is something that is a nice to have that can give you multiples if you're coming from a place of abundance. If you're coming from a place of abundance, it makes you feel better about yourself. Exactly. And that is and that's which is not vain.

SPEAKER_01 1:29:29

Yes, which is not vain. It is a beautiful thing to wake up in the morning, look in the mirror, and like what you see.

SPEAKER_04 1:29:35

Let's be honest, when I go to the gym, right, you know, and I'm doing like isolated like bicep work at the end, bro. That's not because I want to be able to like lift something heavier, right? Like that's not gonna necessarily make a big difference on my deadlift or quote unquote functional fitness. It's because like, oh yeah, bigger biceps are cool, man. Like, why not? Like that's okay.

SPEAKER_03 1:29:53

You fill out your t-shirt. Well, exactly. And I can get two fingers in my t-shirt sleeves. It's you know so embarrassing.

SPEAKER_04 1:29:59

Well, it it ultimately, like, you know, there there is no shame in wanting to look and feel your best. And I think that, you know, that applies to fitness, that applies to the clothes you wear, that applies to cosmetic procedures that you may want to pursue. But, you know, you have to approach it from a place of personal security and abundance and partner with, in the case of medical procedures, a provider that cares about you as a human being. You do that, you're gonna be okay, dude. You're gonna do, you're gonna do well.

SPEAKER_03 1:30:26

So, Alex, thank you so much. You've been an outstanding guest. I mean, and we knew you would be, but I think you've exceeded our expectations.

SPEAKER_04 1:30:34

Wouldn't you agree?

SPEAKER_01 1:30:34

I would definitely agree, 100%.

SPEAKER_04 1:30:36

I'm just so man, this is just so much fun for me. And um, I appreciate you guys uh, you know, inviting me. And uh hopefully you invite me back sometime. We we will. Very sounds good.

SPEAKER_01 1:30:47

I think today's episode is one that a lot of men and urologists need to hear because it really throws down, you know, what our typical discussions are kind of upside down. We tell people they're normal, there's nothing we can offer them, and these days there are safe solutions. So I'm not saying that like every dude needs to get filler, right? But the key point here, and what was so I think clear in our conversation is we have to normalize the conversation for men that might be interested in some form of enhancement. We can't just poo-poo them.

SPEAKER_03 1:31:16

No, I I I agree. I just worry about defining the normalcy of a penis. Yeah. Uh, because probably if you were to stop 10 men on the street, nine are not going to be happy with the size of their penis. Right.

SPEAKER_01 1:31:32

But here's okay, I want to tell you how I bring it up in my clinic, right? Because I have a lot of guys that come in for other reasons, and I don't want to then just say, Hey, do you want a bigger penis? Like that would never be something that comes out of my mouth.

SPEAKER_03 1:31:42

No, you say, How about a bigger penis? And you wink.

SPEAKER_01 1:31:44

No, I don't. I would never do that. But this is what I say. And tell me what you think. I want your honest opinion. Okay. Let's say someone comes in for a low testosterone erectile dysfunction. As part of my initial questioning, as I'm getting to know them, I will say, Do you have any penal size concerns, length or girth? And some guys say, No. And then we move on. And some guys say, uh, well, yeah, like is there anything that you can do? And then we talk about traction therapy, we talk about penis pumps, and we talk about filler.

SPEAKER_03 1:32:11

But what do I think of that?

SPEAKER_01 1:32:13

No, and and that's and then we just talk about it.

SPEAKER_03 1:32:15

Right.

SPEAKER_01 1:32:15

You know, but the reality is, and it's interesting in the length conversation, right? Because in the length conversation, the guy actually has to put in a lot of effort if he wants to gain length, potentially, right? So we talk about vacuum pumps and we talk about traction, we talk about the protocols. So a lot of guys will say, Well, doc, who doesn't want additional length? And I tell them, yeah, I hear that all the time. The question is, what are you willing to do for additional length, right? Are you willing to use a traction device for potentially 30 minutes a day, five or more days a week for three months? And a lot of guys want additional length, but they're not willing to do it.

SPEAKER_03 1:32:44

Well, I think that that the also the problem with additional length is how much length are you going to get if you have no disease entities in the penis on a traction device, you know, over months? I mean, what is the what is the what is the maximum gain? It's not great.

SPEAKER_01 1:33:00

Well, so that's a great question. And that is a data-free zone. So there's not a single so with the device that I recommend, which is the Restorex, which our colleague Dr. Landon Trost invented from when he was at the Mayo Clinic in Rochester, is they've studied three populations of guys guys with diabetes, guys who have Peron's disease, penile curvature, and then guys who had their prostate removed for prostate cancer and had, you know, length issues afterwards. And so in that population of men, they're able to increase length by one to two centimeters, right? So I tell patients, look, they've only studied these three populations of men. They haven't studied this device in a guy who has a healthy penis without those three conditions. So that's what I can tell you. You may gain size, you may not if you're willing to put in the effort. What if you know is it's safe.

SPEAKER_03 1:33:39

What have you found?

SPEAKER_01 1:33:40

Okay. What I found is this a lot of guys coming in and they say they want additional size, right? So they get all the equipment and then they don't use it. So because they're pretty much coming in, a lot of my patients are coming in for girth because I do offer girth enhancement and they would just kind of like length on the side, they're not willing to put in the effort, even though they purchase a device. So now I tell patients, look, I know you want all these things, but unless you're willing to put in the effort, I would recommend you don't spend money on the device if you're not going to actually use it. Right. And it's a very honest conversation and it takes a couple minutes. Right. And then we address it, but then they know, hey, if I'm willing to put in the effort, there are options. It's honestly a very normal conversation.

SPEAKER_03 1:34:14

Yes, but I would never do that.

SPEAKER_01 1:34:16

Yeah.

SPEAKER_03 1:34:16

I would never ask a man who's there for something unrelated to penile size concern whether or not he has any issues with the length or girth of his penis, unless I didn't offer the procedure and I was going to refer him to somebody. Right. But offer it's kind of like asking him how his car's working. Yeah. Because if it if he's ready, I have I have I can sell him a new car.

SPEAKER_00 1:34:40

Right.

SPEAKER_03 1:34:40

It's kind of like it's self-engrantizement in terms of what I can do for him. Right. And it's, you know, you have to be, it's like what, over underpromise and over-deliver.

SPEAKER_00 1:34:50

Oh.

SPEAKER_03 1:34:50

It's kind of the situation where I don't want to bring up a problem that he's not there for and then create in his mind the fact that he could have a problem. And also coming from a woman physician, yeah, bringing up his penile size when he never even thought about it.

SPEAKER_01 1:35:06

Yeah.

SPEAKER_03 1:35:07

I just think you're a very slippery slope.

SPEAKER_01 1:35:09

Oh, well, a lot of people have thought about it, even if we don't think that they have. But the other thing is actually every urologist could help this guy. Why? Because we talk about vacuum pumps all the time. Right. And so for a lot of these guys, I'm differentiating is this the size penis he's always had his entire adult life, or has he lost size? And I would argue, Larry, that every man who comes into our clinic, this conversation is relevant in why? Because they're coming to us with erectile dysfunction. And what do we know about ED? Men lose size.

SPEAKER_03 1:35:33

But not everybody's there for erectile dysfunction.

SPEAKER_01 1:35:35

That's right. But even guys who have, I mean, but any sort of change in erections over someone's lifetime, even if it isn't a problem with ED, they oftentimes lose size. So if we just even talk to them about rehabilitation programs, vacuum pumps, traction, they can restore size that they've lost. So I think it's more of a relevant conversation.

SPEAKER_03 1:35:52

Yeah, but re rehabilitation is very different than speaking to the guy who's there because he's not getting what he wants out of going to the gym because his T is low. So we already know he's got some body dysmorphia.

SPEAKER_01 1:36:05

Oh, just because someone is going to the gym and it's not a good thing. No, no, no.

SPEAKER_03 1:36:08

Because he's concerned that he's not putting on size.

SPEAKER_01 1:36:10

Uh-huh.

SPEAKER_03 1:36:10

And, you know, and you're looking at him in actuality, he's looks pretty darn good. And then you bring up, well, I mean, if you think your biceps aren't big enough, what about your penis? You know, I just, I just think it's like, yeah, I don't want to go there unless somebody's concerned about it. But I mean, yes, I don't want to go there.

SPEAKER_01 1:36:29

So I hear you, and I think our populations are different, right? Because you do see a lot of those guys who are um very avid gym goers, and not just avid gym goers, but are in the body perfection. Exactly, exactly. So I think it's a very different patient population. Um, and I think that's important to consider because you probably, without even like sending your patients a questionnaire to assess for body dysmorphia, I would guess, and correct me if I'm wrong, that you probably have more patients in your practice with legit body dysmorphia than I do.

SPEAKER_03 1:36:57

And interestingly enough, they know it.

SPEAKER_01 1:36:59

Yeah, yeah.

SPEAKER_03 1:36:59

They know, I mean, uh, you know, when you ask somebody who's there with low T, who's in their 30s, yeah, uh some of their goals, it's always I want to get bigger.

SPEAKER_00 1:37:10

Yeah.

SPEAKER_03 1:37:10

I mean, bigger isn't always better. Yeah, you know, normally, but if you have this body dysmorphia issue, you always want to be bigger.

SPEAKER_01 1:37:18

Yeah. So I I definitely hear what you're saying.

SPEAKER_03 1:37:20

That would then go down to bigger penis. Yeah, you know?

SPEAKER_01 1:37:23

I hear what you're saying, and I I do think our clinics are different in that respect. So fair point. I would think so too. Fair point. So, what did you think of today's episode?

SPEAKER_03 1:37:29

I mean, it was very, very important for me because as you know, I don't offer filler. And I usually think of filler as kind of like a little bit fringe. Fringe. You know, and and and I think I learned today more in terms of the number of people who are coming in for this type of problem. And, you know, and you do it well, Alex does it well, you're well trained. And then I started thinking, you know, here in Houston, you know, if we don't do it well, someone's gonna do it, someone else is going to do it, yeah, and we don't know if they're gonna do it well.

SPEAKER_00 1:38:02

Yeah.

SPEAKER_03 1:38:03

So I mean, I really think this is an area I have to look at personally, a little bit more objectively, and not such a knee-jerk reaction, oh, that's on the fringe. You know, I think what you what you two are doing is legitimizing uh this whole process, which up to now, you know, has been populated by some pretty uh, you know, like iffy characters.

SPEAKER_01 1:38:23

Yeah, who uh Alex certainly mentioned during the episode.

SPEAKER_03 1:38:25

So I'm yeah.

SPEAKER_01 1:38:26

But I think if we don't take it on, someone else will. Someone they are, they are, you know, and we're well you have that in Miami.

SPEAKER_03 1:38:31

We don't have it in Houston. That's what concerns me.

SPEAKER_01 1:38:34

Yeah, yeah.

SPEAKER_03 1:38:36

So so I think we will be looking at it a lot more objectively after today's episode.

SPEAKER_01 1:38:40

Yeah. Well, I think too, especially with someone with your leveled expertise and respect in the field, as you get more and more people that have, you know, fellowship training that are leaders in the field offering some of these cosmetic urology procedures, that helps to legitimize the procedure.

SPEAKER_03 1:38:54

It does. And that and that's I was a really it's a very good point.

SPEAKER_01 1:38:56

Yeah. All right. So give me some foreplay for our next episode.

SPEAKER_03 1:39:00

So next time we are going to hear from Brigham Bueller, who most of you know as a regular on Joe Rogan, who is going to talk to us about the position of uh compounding pharmacies, the FDA, and where we stand with peptides.

SPEAKER_01 1:39:15

Wow, a hot, hot topic.

SPEAKER_03 1:39:17

Yes.

SPEAKER_01 1:39:18

Thank you for joining us today on fertility and other F words.

SPEAKER_03 1:39:22

And please don't forget to like, subscribe, and leave a comment.

SPEAKER_01 1:39:26

Until next time.