Episode 127: Half of Men by 50 Have ED—And What It Does to Marriage
Why Erectile Dysfunction Is More Than Just a Physical Issue
Erectile Dysfunction Isn’t Just Physical—Here’s What Every Couple Should Know
Let’s be honest—sexual health isn’t something most people talk about openly. And when it comes to erectile dysfunction (ED), the silence can feel even heavier. But here’s the truth: it’s incredibly common, deeply human, and far more connected to overall health and relationships than most people realize.
If you or your partner have ever wondered, “Is this normal?”—you’re not alone.
It’s More Common Than You Think
ED isn’t rare—it’s expected to some degree as men age. In fact, about half of men experience some level of erectile difficulty by age 50, and the percentage increases with each decade.
Yet despite how common it is, many men don’t seek help. Why? Shame, embarrassment, or the belief that something is “wrong” with them.
But ED isn’t a personal failure. It’s often a signal—sometimes even an early warning sign—that something else in the body or mind needs attention.
The Hidden Mental Load
One of the most surprising realities about ED is how much it affects a man mentally.
Many men think about it constantly:
Will I be able to perform next time?
What if I disappoint my partner?
How do I avoid intimacy without raising suspicion?
This internal pressure can actually make things worse. When the brain is stuck in anxiety mode, the body struggles to respond naturally. It becomes a cycle—worry leads to performance issues, which leads to more worry.
And here’s the part many couples misunderstand: ED is rarely about attraction. It’s not that he doesn’t want his partner—it’s that his body isn’t cooperating the way it used to.
The Relationship Impact
Without open communication, ED can quietly damage a relationship.
Partners may interpret it personally:
“He’s not attracted to me.”
“I must be doing something wrong.”
Meanwhile, the man may avoid the conversation altogether to protect his partner’s feelings.
This disconnect creates distance—not just physically, but emotionally.
The couples who navigate this best are the ones who talk about it honestly. Even a simple, supportive conversation can shift the dynamic from blame to teamwork.
It’s Not Just About Sex—It’s About Health
ED is often linked to underlying physical conditions, including:
Cardiovascular disease
Diabetes
Poor sleep
High stress levels
In many cases, erectile issues are one of the first signs that something deeper is going on—especially with blood flow or nerve function.
That’s why improving overall health can significantly improve sexual function. Better sleep, regular exercise, and managing stress aren’t just “nice to have”—they’re essential.
The Role of Lifestyle (and Modern Habits)
There’s also a growing issue affecting younger men: overstimulation from pornography.
When the brain becomes conditioned to constant novelty and high-intensity stimulation, real-life intimacy can feel less engaging. This can lead to difficulty getting or maintaining an erection in partnered situations.
The good news? This is often reversible with intentional changes—like reducing exposure, taking breaks, and retraining the brain to respond to real connection.
Treatment Options: More Than Just a Pill
Most people are familiar with medications like Viagra or Cialis—and yes, they can be incredibly effective. But they’re just one piece of the puzzle.
Other options include:
Lifestyle improvements (sleep, fitness, stress management)
Therapy or counseling (especially when anxiety is involved)
Hormone support in certain cases
Medical treatments like injections or devices for more advanced ED
The right approach depends on the individual. What matters most is taking that first step to explore solutions.
Why Communication Changes Everything
One of the most powerful things a couple can do is talk about it—without blame or judgment.
Instead of:
“What’s wrong with you?”
Try:
“Hey, I’ve noticed something feels different. Are you okay?”
Framing it as a shared challenge—not an individual failure—can completely change the outcome.
Some couples even use podcasts, articles, or videos as conversation starters:
“I came across something interesting today—can we talk about it later?”
It takes the pressure off and opens the door.
A Different Way to Think About It
Here’s a perspective shift that helps: sexual health isn’t just about performance—it’s about connection.
Yes, physical function matters. But so does:
Feeling desired
Feeling confident
Feeling emotionally safe
When those elements are in place, everything else becomes easier to work through.
Final Thoughts
Erectile dysfunction isn’t just a “bedroom issue.” It’s a health issue, a mental health issue, and often a relationship issue all at once.
But it’s also highly treatable—and in many cases, a turning point.
For some couples, addressing ED doesn’t just fix a problem—it opens the door to deeper communication, better intimacy, and a stronger relationship overall.
If there’s one takeaway, it’s this:
Don’t ignore it. Don’t personalize it. And don’t face it alone.
Start the conversation. That’s where real change begins.
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0:00
Understanding Men's Vulnerability in Romantic Gestures
My favorite suggestion?
Sex before you go out.
Who wants to have sex when you're all full and fat after dinner anyways?
So pop your Viagra mid afternoon, have sex before you go out, then go have date nights.
It's so common and it's such an important part of their personal ego, their relationship status that affects guys mentally, emotionally, and relationally.
0:20
If they are not getting good quality erections and being able to perform at the drop of a hat when their partner wants it, by the time they're in their 20s and 30s and they're starting to watch really hardcore porn, when they are in a partnered situation, they can't get off, they can't get hard, they can't do anything.
0:36
It's a big problem.
0:39
Speaker 2
Welcome to Marriage IQ, the podcast helping you become an intelligent spouse.
0:45
Speaker 3
I'm Heidi Hastings.
0:47
Speaker 2
And I'm Scott Hastings.
0:48
Speaker 3
We are two doctors, 2 researchers, 2 spouses, 2 lovers, and two incredibly different human beings coming together for one purpose.
To change the stinky part parts of your marriage into scintillating ones.
Using intelligence makes with a little fun.
1:10
Speaker 2
We are excited to jump right in today on this timely topic and we have invited Doctor Stephanie Zwanitzer, a Doctor of Nursing Practice on the program today to discuss sexual functioning in men as they age.
Hi.
1:24
Speaker 1
Thank you for having me.
1:25
Speaker 2
Yeah, Stephanie, you've worked as a cardiac nurse, right?
1:29
Speaker 1
Yeah, absolutely.
1:30
Speaker 2
What got you into this realm of urology?
1:34
Speaker 1
That's a great question because it's not what you go to kindergarten thinking you're gonna do when you grow up, that's for sure.
So I was job hunting and this urology job came up and I talked to some of my friends who happened to also work for the company.
And I said, am I gonna like it?
And I said, oh, with your personality, you're gonna love urology.
1:51
You get to have fun with patients, You get to help them.
And you know, I'm always the one who has the lovely innuendos and things at dinner conversations.
I took the job and have completely fallen in love with urology and sexual medicine.
It's definitely where I belong and where I have found the most gratifying sense of helping of.
2:10
Speaker 3
Stephanie, for those who may not have a lot of experience with what urology is, can you just give a very simplified explanation of that?
2:19
Speaker 1
Absolutely.
So anything related to your bladder and your kidneys and your prostate for men.
So kidney stones or kidney, bladder, prostate cancer, those kinds of things.
Everything from overactive bladder and recurrent UTI's to erectile dysfunction and orgasm disorders, everything in between.
2:38
So it's a very wide gamut within urology.
Although at work I see mostly general urology because I work with some sex Med physicians who do different surgeries in that area.
That's kind of where I've been allowed to focus in and get the nitty gritty of sexual medicine with my patients.
2:54
Speaker 3
So that's kind of your niche, yeah.
2:56
Speaker 2
Great.
So we want to talk about sexual functioning in men as they age and I think drilling down a little bit on this phenomenon of erectile dysfunction.
3:07
Embracing Leadership and Polarity for a Scintillating Marriage
Yeah, it's huge.
So just the facts behind it. 50% of men by age 50 have some type of erectile dysfunction and it goes up as you guys age.
So by 60 there's 60%.
Eighty, 80% of men have some type of erectile dysfunction.
3:22
Speaker 2
Well, I would like to be the 20% when I'm 80.
That would be freaking awesome.
Yeah, 20% don't have any problems with erectile this function at age 80.
Wow.
3:32
Speaker 1
Yeah, it's pretty incredible, isn't it?
3:34
Speaker 2
I think that you're right.
Like it's something that just happens, right?
And a lot of men don't think about it.
They don't talk about it, and they think that nothing's wrong, right?
Or that something's wrong with them.
3:45
Speaker 3
We want to normalize some of that today.
3:47
Speaker 1
Absolutely, because there's a lot of shame.
A lot of the guys come in.
I actually have posters in my exam rooms about erectile dysfunction because it's difficult for men to bring that up.
And, you know, it's kind of like 5050 in my practice.
Some of the men don't want to see a male provider.
4:04
They like to see me because they don't want to admit to another man that they're having these issues.
And some men don't want to talk to me about it because I'm a woman.
And so I have these posters up in my exam room so that the guys can point at it and be like, well, we're here, can we talk about that?
And it's like, yeah, we can because it's so common and it's such an important part of their personal ego, their relationship status, all of these things that really effects guys mentally, emotionally and relationally if they are not getting good quality erections and being able to perform at the drop of a hat when their partner wants it.
4:38
Speaker 2
That would be nice, yeah.
I wonder who gets that?
4:41
Speaker 1
Yeah, how many times are we all in the mood at the same time, right?
4:44
Speaker 2
Yeah, that's a unique perspective, Stephanie, that you have.
I have my perspective from primary care, and I do manage that a lot too, quite frankly, in primary care.
It is interesting because for all the people who are out searching for this, there's a lot more who don't, you know, they're too worried about it, nervous, embarrassed.
5:01
And it's interesting too, because sometimes it appears that the wives are the beneficiary of these medications.
I think for the men, though, to just feel more confidence in their ability.
But I think that there's a lot more men out there who probably struggle with it, not intentionally.
5:20
They don't think about a lot.
They're wives, probably don't think about a lot.
5:23
Speaker 3
Or they may think about it a lot.
Very unhappy about.
5:26
Speaker 2
It yeah, and they don't tell them.
5:27
Speaker 1
Yeah, I would say the vast majority of my guys, it affects them every day, all day long.
They think about it constantly.
They are worried about when their partner is going to want to have sex next and are they going to get the erection?
How are they going to tell them no this time?
What excuse are they going to use?
Because they don't want to admit there's a problem?
5:43
Because a lot of times in a heterosexual relationship, women take a man getting or not getting, I should say, an erection, having this erectile dysfunction as a personal.
He's not turned on by me.
I'm doing something wrong.
He doesn't want me.
He's getting it somewhere else because he's not getting an erection with me.
6:00
And the men don't want to give that to their partner because almost always that's not the case, right?
There are certain circumstances where that is, but a lot of times it's it's not.
And so then they feel guilty that they're making their partner feel bad and they don't want to have to go through that.
6:16
So it's really interesting how much these guys will open up to me and say, I can't even talk to my partner about this because I don't want her to think it's her and it's not.
And I have written notes to guys and to their partners like his Ed is not your fault, signed by Doctor Stephanie, this is not your fault.
6:33
Like these guys really are bothered by it and they think about it a lot and it really is consuming.
6:39
Speaker 3
And one of the things with erectile dysfunction is I always tell my guys it's their head to
6:55
They're not going to get a good erection because they're so overly focused on it that their body can't relax into it and get a good erection.
So there's a high correlation between stress and anxiety and just more severe.
7:08
Speaker 1
Ed Absolutely.
I just sitting here thinking of that head to head connection being kind of like the tollway and for women the head to I guess clitoris connection is like a country Rd.
Yeah, you got to pass through the heart for women, right?
7:25
Speaker 2
There's no tollway, there's like little 2 lane roads through every little small town.
7:31
Speaker 1
Men are on the freeway, yeah.
7:32
Speaker 2
Look, I don't, I don't want to over generalize here stereotype, but that is kind of reality for the vast majority of people a lot.
7:40
Speaker 3
And it's important to to state that I think because we don't want people to think because my husband's not like me, there's something wrong with me or vice versa.
7:49
The Power of Re-Proposals and Unwavering Faith in Love
I think to a point, Stephanie, you say the vast majority of men, this is not an issue.
There is this issue I want to just touch on quickly, not too much.
I don't want to get too much into it, but so the erectile dysfunction caused by porn use, it's growing exponentially.
It's still pretty, it's pretty minor, but with the ubiquitous availability of pornography, that is an issue.
8:09
That's a problem erectile function or dysfunction men who are incessantly viewing porn and masturbating.
8:16
Speaker 1
Right.
Well, and those are one of some of my first questions.
And what's interesting is I know we're going to talk about the more of the aging male today.
But what I'm finding and maybe you've seen this in your practice too, are the 20 and 30 year old guys who are coming in with erectile dysfunction.
And at that age it is not physiological.
8:34
You should be getting a boner when the wind blows at 20 and 30 years old.
And so when you're having erectile dysfunction that young, my first question is, are you watching porn?
How often and how often are you masturbating?
8:47
Speaker 2
OK, great question.
Great insight on that one because I agree, I think when I see these 25 year olds coming, I'm like whoa dude what?
What's up?
This just isn't the way Physiology works.
8:58
Speaker 3
For an induced erectile dysfunction.
9:00
Speaker 2
Does it does happen that way if your mind is incessantly absorbed with pornography?
I mean the brain wasn't built that way to see so many different images.
Just not built that way.
9:11
Speaker 1
Right.
And when we were younger, it was, could you flip through the magazine, through the plastic cover at the grocery store, or could you find one that your uncle had under the bed or whatever you had to work for it.
Yeah, now you don't.
It's right there on every Ave.
These kids know what year to put in for the 18 year old whatever on these apps.
9:30
So they're starting super, super young.
By the time they're in their 20s and 30s, that's all they know.
And they're starting to watch some, like really hardcore porn burn that.
Then when they are in a partnered situation, it's not the same and they can't get off, they can't get hard, they can't do anything.
It's a big problem.
9:45
Speaker 2
So if you're in your 20s and you have this issue, man out there on your watching porn.
We got to deal with that first before we jump into this other stuff because.
9:55
Speaker 3
How do you do it, Stephanie?
9:56
Speaker 1
So I kind of hit it multifactorial.
So I will give them a little low dose of Cialis to give them that confidence when they are with their partner and help them get past this.
But we do usually complete withdrawal from porn.
I usually suggest a two or three-week break from anything partnered or masturbation.
10:14
And then I send it to a sex therapist because they need to work through why the addiction side of that is usually pretty strong in these guys.
So we take a break, we get them the mental help that they, you know, the therapy side that they need.
And then I give them a little low dose B medication to just give them that little extra confidence when they are trying to get back into partnered sex.
10:32
Speaker 3
That's interesting.
That's kind of mirrors what I've seen with sexual betrayal in married couples and more long term relationships.
But instead at that point they recommend a 90 day abstinence period.
So maybe as you age it takes.
10:47
Speaker 2
Long abstinence.
10:48
Speaker 3
From sexual relationships within your OK and abstinence from porn.
10:52
Speaker 2
Because in the world of Scott Hastings, it's a lifetime abstinence from porn.
Cool.
Yeah, this is bad all the way around.
We've done a lot of deep dives on in past episodes using scientific research and it's a dead end on that eventually.
11:07
Speaker 3
From our perspective from people who want committed long term relationships.
11:11
Speaker 2
Scientific literature is pretty robust on that.
11:13
Speaker 1
It's definitely depends on what the people want out of their relationship and certainly focusing on a good quality marriage, which I know is what you guys focus on it.
Yeah, it seems to not have a place in that.
11:24
Speaker 2
So some people, Stephanie, say that erectile function is like a Canary in the coal mine for other physiologic issues.
Can you kind of go over maybe what some of those might be, maybe is a segue into other health?
11:39
Speaker 1
Absolutely.
So one of the biggest things is cardiovascular health.
If you are not able to get the blood flow to your penis and you stop waking up with morning erections or middle of the night erections, they're something wrong probably physiologically with your cardiovascular system.
11:54
Some of the other things that factor in there, diabetes because it affects your nerves and your nerves to your penis have to be getting the sensations to get you aroused and get that blood flow there.
We see a lot with stroke patients, patients who have had strokes can have issues depending on where in the brain your stroke was.
12:11
And so there's a lot of different things that way.
But I would say diabetes and heart disease are the two biggest factors that we see.
And there are times where I will have, again, on the young side of men, maybe in their late 30s, early 40s that are coming in with significant Ed and you're like, OK, well, you're on blood pressure medicine.
12:29
How are your blood sugars?
And you're start to work through this and you're like, all right, you really need to go talk to your cardiologist because there's not much I can do until we get your cardiovascular health under control and things like that.
So the other thing that guys really lack on is good quality sleep.
12:44
And sleep is super important for your erections for multiple reasons, but one of the biggest ones is your testosterone produced while you sleep.
And you need good testosterone for good quality erections.
It's not the only factor in erections, but it's a big one.
And a lot of my guys with erection issues come in and they're like, I don't sleep, I don't exercise because I'm stressed out from work and these other things.
13:04
And you're like, OK, we gotta, we gotta get these physiological things in play first so that we can get to the erections.
So you're not going to get healthy erections if you're unhealthy in general.
So we need good blood flow to the penis.
We need good sensory on the nervous system and we need like being able to breathe while you're having sex.
13:24
There's a lot that goes into this that you need.
And if your blood sugars are all over the place, your blood pressure's all over the place, you're smoking and you got COPD or something like that, all of those things are going to factor into not having good quality erections.
13:37
Speaker 2
Yeah, I remember this ad.
It was very effective.
It showed a cigarette that was limpy.
Yeah, Meaning, you know, if you smoke then for the guys.
So I tell my patients.
Yep, all five of them who still smoke.
13:51
Speaker 1
So weird when I pull up to someone at a stoplight I'm like, you're smoking.
13:54
Speaker 2
I know it's like smokes anywhere, but I also, so I ran across this.
It's called low intensity pulse ultrasound.
I guess kind of a new thing, new technology.
I guess there's some studies behind it.
It is a medicine free approach to erectile function.
14:11
Have you had some experience with that?
Or in what results have you seen pair to say Viagra, Cialis?
14:16
Speaker 1
Yeah, it's a great question because it's very expensive and it's not covered by insurance.
So I always tell my guys to make sure they do their research and really decide whether or not they want to invest in that.
So what I would say is early onset Ed, maybe it takes you a little bit more stimulation than it used to get the erection.
Maybe you're not as firm as you want to be, but you're still pretty much there.
14:36
Real early phases of erectile dysfunction.
It works pretty well for you, can get some good results and increases the blood flow, things like that.
If you're already needing some decent doses of Viagra or Cialis, it's really not going to do much for you and you're just not going to see the results that are worth the 356 grand that you're going to pay to do it.
14:54
The guys that I've seen it work on early onset IED, it works for 6 to 12 months, so really not that long.
Some of them and get like shorter repeat bursts of the treatment.
There's studies out there that say it works really well.
You got to look at who's funding those studies.
15:10
But what I've seen clinically is it has to be very early stage Ed and it may or may not last long enough.
That makes the money worth it.
15:18
Speaker 2
So early stage.
So you said early 40s like pretty young guys, right?
If you're in there, you're 60.
It's not going to be as.
15:26
Speaker 1
Well, it depends, right?
Some guys at 60 are just starting to have Ed issues and they've been fined until then.
So it's really early phase in the fence that whatever your age is, you just started having Ed issues.
15:39
Speaker 3
Does it slow down the progression of it then or you've got to expect to lay down 3 to 6000 every few months?
15:46
Speaker 1
Yeah, and that's essentially what it is, is you're going to basically continue to repeat that process and with that investment every six to 12 months ongoing if you want to maintain where you're at.
But again, if you have any of the other comorbidities with diabetes or heart disease, high cholesterol, things like that, it's probably just not even worth your money.
16:05
You're going to need to go on to stronger things.
And you would be better off spending your money on working on your blood sugar, spending money on a personal trainer to get you better, get a nutritionist, things like that.
That's gonna get you more bang for your buck than going and getting some sound wave therapy.
16:18
Speaker 2
Yeah, I like that.
Yeah, that's good to know because it's out there and people are like, oh, this is what's up with this.
16:24
Speaker 1
Yeah, the commercials sell it real hard.
16:26
Speaker 2
Yeah, I mean, in some guys to the side effects are so brutal from these medicines that it's like, what do I do?
16:32
Speaker 1
Yeah.
And some of them can't take it because they're on medications that interact and things like that.
16:37
Speaker 2
So others, everyone kind of get back a little bit to the whole Physiology too, because I think a lot of men don't understand the real Physiology and Edie really is a vascular issue right now.
You mentioned that testosterone does help with that and I agree to some extent.
16:53
I think that's true.
Testosterone is a hormone and Ed is primarily A vascular issue.
And so it is, I know there are guys who do come in and maybe I'm telling them wrong, I don't know, you correct me, but they want testosterone because they have Edie.
17:08
And I say, OK, let's talk a little bit about libido because I know that there's libido issue.
It can help with sex drive, with that spontaneous desire.
But do you put people on testosterone with just Ed?
17:21
Speaker 1
I'm very frank with them.
Testosterone will absolutely help with your libido.
It may or may not help with your erections.
For some guys it does because a testosterone makes you create more red blood cells so you have more blood flow.
So for some guys, you do see an increase in firmness in their erections, but you are not going to go from never getting an erection to having fabulous erections with just testosterone therapy.
17:44
You're going to need more than that.
But it does boost a little bit of what you already have and you may get some of the morning erections, which then you can take advantage of that you weren't getting with lower levels of testosterone.
Because when your testosterone is lower, your body's just not creating that nocturnal erection like you do when you have adequate testosterone.
18:04
So there's some of that, you can use it to firm up the erections.
But no, I'm very prank with my guys.
It is not going to be the only thing that fixes.
If you are coming in here not getting erections, there is more that we have to do than just testosterone.
18:15
Speaker 2
OK, good.
That's what I say.
I guess looking at it too, there's secondary effects, right?
Because if you're feeling more sexy as a guy, more in the mood, it translates psychologically into other things that work better to getting back to the whole When your wife sees a very erect penis, she's gonna feel more excited too, just by virtue of that.
18:38
Absolutely.
And there's a lot of psychology that goes into improving that.
18:42
Speaker 1
Yeah, if my partner has a raging erection versus a semi hard on, I feel like he wants me more with that raging erection.
I feel more attractive, I feel more look at he thinks I'm sexy, he thinks I'm ready.
So there is there's psychological side of it for both partners.
18:57
Speaker 2
I was talking to Heidi this morning and I came up with a little analogy and she thought it was funny but also a little silly.
But I want to paint a picture that's accurate.
And so let's say, say the guy, he's the delivery guy, right?
And his wife is the receptionist at the office.
19:14
And so she receives these packages every day, right?
Yep.
He brings it in and she takes it.
Yep.
And everything's great.
Everything's good day after day.
And then one day he brings in a really big box.
19:29
It's a lot bigger than normal and it's just kind of exciting for the receptionist, right?
So she's never thought about it before, but now that it's there, it's like, oh, I like these big boxes now.
And so I guess my point is.
19:45
Speaker 3
What is your point?
19:46
Speaker 2
For a lot, for a lot of people who don't know about this, they have the sex life.
That's fine.
It's like the delivery guy and the receptionist.
It's like we're doing our thing and then you introduce this new thing and it's like, well, it's because nothing was really bad before.
20:02
I mean, when do you decide?
Boom, right now I have Ed like when does that happen?
20:07
Speaker 1
So I think it's different for everybody, right?
For some of the guys, it's as soon as they're not as firm as they used to be, they're coming in and being like, what is wrong with me?
I'm not as firm.
I can still penetrate, I can still last until climax, but I'm not as girthy as I used to be.
It doesn't get as long as it used to.
20:22
Other guys are perfectly happy as long as they can penetrate, but then all of a sudden it's not even firm enough for penetration and that's when they come in.
So it really is individual as to when they feel like it's truly affecting their sex life.
I think women can tell when the erection is not full and thick and when it is.
20:41
So you can tell when you're oh, you're losing it, you're semi right now.
This isn't I can't bounce like I normally do or whatever.
Like women can tell whether their partner is fully erect or not.
And if you don't have a good quality relationship, I know you guys stress this in your pillars.
If you don't have that good quality relationship where you're having communication, then you just go on about your day.
21:01
Like, OK, well that wasn't great, but whatever, I'm not going to bring it up.
If you have that quality conversation in that communication style, you can say, hey, babe, what's going on?
I noticed that you weren't as into it today as you were.
Like, are you?
Is something going on where you're stressed and you're mentally at it, or are you having some erection issues?
21:17
Like where are we at?
What do we need to do?
And then you can go forward with that.
If it's consistently being a problem, if he's someone who masturbates, if he has that problem while masturbating and with partnered sex, that's more of a red flag that it's truly Edie.
If it's only happening with partnered sex but not masturbation, then maybe we need to do some relationship thinking.
21:34
Maybe I need to send them to the therapist and get in more on that side of things.
Maybe things are stressful at work.
You guys have a financial issue, something else that is getting in his way when he's trying to focus on that activity?
21:46
Speaker 3
Do women go very often with their husbands to the appointments?
21:49
Speaker 1
I would say maybe 25 to 30% of my guys have their partner come with and I love it when they do because it is so eye opening and sometimes we actually get to that.
Part of it is that it's not really erectile dysfunction, it's more along the lines of you guys aren't connecting well and we need to fix that part of it before we can give you.
22:08
And we can still give a low dose medicine just to help the blood flow and help again get them over that hump.
But that's where I need Someone Like You to come in and help them work on the relationship side of things.
22:18
Speaker 2
Right.
You give them a card that says marriage IQ on it, Don't listen to that and then come back.
22:23
Speaker 3
That's great.
What kind of questions do they ask?
Especially the women?
Yeah.
22:27
Speaker 1
They want to know if it's them or if it's their partner.
Is it something they're doing or not doing that's getting their partner there?
And a lot of my patients, partners want to know about the side effects of the medicine.
OK, we're going to try this medicine.
How is it going to affect them?
Is it really worth it?
22:43
And for most of them, at the end of the conversation, it is.
Some of them we have other things that we can try.
And certainly as erectile dysfunction progresses and Viagra and Cialis are no longer working for that individual or they are on medicines, have health issues that they can't take those medicines, then I really like it when the partner's involved because the next steps are choosing injections or a penile implant.
23:05
And those are really conversations that need to be had as a team.
You need to figure out whether you're both on board with that because that's more invasive for the penile implant.
You're having surgery, you're out of Commission for a while.
You know, your partner's gonna have to help take care of you.
The injections can be scary, you know, upfront when you don't even know what you're doing.
23:22
So really having that partner on board, especially once it's more progressive Ed, is really important.
23:28
Speaker 3
That's so helpful, I think for listeners to see, first of all, what some of the options are.
But let's go back just a second.
What are some of the things that you see the spouses, what are they most concerned about with side effects?
23:39
Speaker 1
The heart, because everybody's heard of, we've watched the movies, we've seen things where, oh, I have to tell them that I took this because I'm now I'm having chest pain, I'm having a heart attack.
They really want to know what are the cardiovascular issues.
People have heard of blue vision with Viagra.
What does that mean?
23:55
Are they are going to see blue forever?
Those kinds of things.
So they really want to know is their heart going to be OK?
Are their eyes going to be OK?
And those are the biggest things I would say.
A lot of guys will get flushing in their cheeks on these medicines.
They want to know, like, does that mean they're having a heart attack?
Is that a bad sign?
24:10
And so we have to talk through what are actual bad things and what are things that these are typically to be expected.
You might have them and they're OK.
They're going to wear off as soon as the medicine wears off.
24:20
Speaker 3
So do you also talk about the side effects of not taking something?
24:24
Speaker 1
Absolutely.
And the side effects of not getting regular erections and having that intimacy and that emotional connection.
We talk about all of that and even for my guys too that are earlier in erectile dysfunction, we'll talk about a penile exercise program and how using an external penis pump regularly, almost like you'd go to physical therapy, can help you regain your ability as well.
24:46
And sometimes they will incorporate that into their sex life and that will be part of it.
And some of them look at it more as a physical therapy program and they will do their penis pump exercises on their own and then they will have sex separately to keep that more of a exercise regimen versus intimacy kind of thing.
25:03
So it depends on the individual couple, but there's different ways that we can kind of finagle things, get things working for them do.
25:08
Speaker 3
You talk at all about the mental health side of of him not being able to have an erection and all of the anxiety and all of the maybe even depression and.
25:19
Speaker 1
Yeah, for sure.
Granted, my appointments are 15 minutes, so I don't have the time like you do to dive into this.
But yeah, I absolutely ask those questions because I need to refer them out because I don't have that quality time.
But yes, I certainly start those conversations.
Is this a affecting your day-to-day life?
25:35
Is this.
And usually by the time they've come to me instead of their primary care, it is affecting their daily life.
They are thinking about it all the time.
They're having relationship issues.
It's consuming them and so they are depressed, they are frustrated, They are their relationship is struggling.
25:51
I've had guys come in on the brink of divorce and if we've been able to get their erections better and get the relationship a little bit healthier, we've been able to save the marriage kind of thing.
So it really is huge on their life.
So I do talk about it, but generally in my quick appointments I have to do the medicine side of things.
26:09
I hear what you're saying about the psychological things.
Here's a referral and someone that can spend more time with you than I am allowed to.
26:16
Speaker 3
So on my end, I see a lot of middle-aged women that have husbands who refuse to get help for Ed, and there's a lot of frustration there, but they say it's because of shame.
If you had a woman come into your office for something else inside of the posters there and just asked a question about it, what would you recommend her approach to be to convince her husband?
26:39
Speaker 2
To give her husband.
26:40
Speaker 1
It's a great question and you'd be surprised how often it happened.
26:43
Speaker 3
I'm serious.
26:44
Speaker 1
It does all the time.
Or women who are going through menopause and they're uncomfortable and they're painful.
So their husband has given up on trying to have sex with them and we get that fixed with hormones and stuff.
And now all of a sudden they want sex again and their husband's like, I'm good.
They'll be like, get my husband on board.
So I will say first of all, bring them in.
27:01
I'm happy to see them too.
I see both males and females and and I have a sex podcast as well and so I'll hand them my things here.
Go check out some episodes on Ed.
27:10
Speaker 3
Between the sheets.
27:11
Speaker 1
Between the sheets.
Yep, Yep.
And that's a great tool to say here, just pass them this card.
There's some great episodes on there.
One of the other things that I'll suggest is just a gentle conversation with him and just say, look, it doesn't bother me.
I know it's not me, let's go get some help.
Maybe we can talk to them together.
27:26
I'll go with you making it more of like a partnership thing that he's not alone.
There's not something wrong with him.
This is just another pump that we have to get over, just like we had to get over raising kids or we had to get over whatever in our relationship.
27:39
Speaker 2
You just take a Viagra and you slip it in this hot dog.
27:42
Speaker 1
Yeah, I feel like that's not ethical.
And the other part is I don't give my female patients prescriptions for Viagra so.
27:49
Speaker 3
That would be a problem.
27:51
Speaker 1
That would be a little problem.
I like where you're thinking.
27:53
Speaker 2
Jake, I'm just kidding.
I would never do that.
27:56
Speaker 1
Sure, here's a.
27:57
Speaker 3
Question, and maybe this is more a question for Scott than you, because when people come to you, they come a lot of times with that in mind, but how do you feel about patients who say I have this thing and I need some help, Do you view them?
28:10
Speaker 2
As Oh my gosh, he's got this problem.
Oh heavens no.
28:14
Speaker 3
Does that happen frequently that?
28:16
Speaker 2
Happened some, but when it does happen, like I allow some sacred space there and I'm like, I'm really proud of you right now dude.
You're rocking it because first, first of all, you're not alone at all.
And this happens.
And so I really try to roll out the red carpet for this guy psychologically when when he kind of just just moves a little bit, tests out the water a little bit.
28:37
And when I see where he's going, then I take it and I just open it up, say, OK, I'm proud of you because this is hard to do.
And we can talk about it because this is just life, man.
And we want to help you thrive in life.
28:52
Speaker 1
Yes.
28:52
Speaker 2
So thank you.
28:53
Speaker 3
Yeah, I love that, Stephanie.
28:55
Speaker 1
That's almost exactly the same thing.
I'm like, all right, let's talk about it.
Tell me, do you have issues getting the erection, maintaining the erections?
Both Like where where are you having issues and breaking that ground?
Like, OK, this is totally a safe place to talk to me.
I deal with this all day long.
And one of my favorite sayings to say to my patients is I play with penis for a living.
29:12
You're not going to tell me anything that I haven't already heard.
This is what I do all day long.
I'm not a hooker, but I play with penis for a living legally.
So bring it on.
29:22
Speaker 3
That takes the shame out of it a little bit, I think.
Just the humor part of it, right?
29:26
Speaker 1
Yeah, it helps to break the ice a lot.
29:27
Speaker 2
I've never had a woman, never been a wife, don't have any idea what it's like on that end of the sex.
And I think we're getting a little bit older saying this because it's just so true.
A lot of women don't know what they don't know.
They don't know, hey, this could be better.
Now, there are those women who think this could be better, and those are the ones like you're talking about.
29:45
But I'm talking about the other group of women who don't really know that things could be improved, and neither spouse really talks about it.
They don't have that space to talk about it, and they don't even know to talk about it.
29:56
Speaker 3
They don't have the language.
29:58
Speaker 2
I think perhaps this episode today might be a starting point for those women and men actually who are married, they love each other, they're committed, they're monogamous, and they're in their 40s or 50s or 60s.
It's just not things aren't as hard as they used to be.
30:15
And it if it's gradual, you don't notice it.
And so maybe today people can say, OK, let's think about this.
Can we improve on this?
And I'm not saying everyone should go get on Viagra at all.
I'm not saying that.
I'm just saying it's a game changer for a lot of people, a lot of marriages, the game changer.
30:31
So that's all.
Have anything?
30:34
Speaker 1
I think you're right.
I think it is a game changer and I think it is really important.
And one of my favorite things again, is to just say, hey, go listen to this episode, go watch this, go read this article and then let's talk about it tonight because this has been on my mind or I read this really interesting article.
Do you want to read it too?
30:50
And then let's talk about it because it was just really interesting to me and made me question, hey, maybe there's something that we're missing.
And especially people who have been with the same person their entire life and maybe they don't have other sexual experience to have anything to compare it to, right?
They think that this is OK.
31:06
They think this is normal.
If you read something and you're like, hey, I kind of want to try that.
I, I think this sounds cool, whether it's related to Ed or not.
Show it to your partner, talk about it.
See.
Maybe you just unlocked a new box.
31:17
Speaker 2
Pandora's box.
That's what I call.
31:18
Speaker 1
It a new delivery box.
31:20
Speaker 2
A big one.
I want to move forward to different types of medicines.
There are two main ones.
I prescribe the generic what used to be called Cialis.
The generic used to be called Viagra.
It's still in Dafil to Dafil.
Are there other ones that that you prescribe or you kind of stick with those two or what?
31:35
Speaker 1
Yeah, those are my 2.
I do have probably a handful of guys, maybe 5 or less.
That's still like Levitra and they are willing to pay for it.
It is very expensive and hard to come by and I have two that are on Stendra.
Again, they want to pay for it out of pocket, but I would say the vast majority are on sildenafil or tadalafil.
31:52
They're dirt cheap now.
31:53
Speaker 2
1010 bucks for 30 of them or.
31:55
Speaker 1
Whatever.
Yeah, absolutely.
And I always recommend the grocery stores or the big box stores like Costco, BJ's, whatever, because the CVS and Walgreens, they're making their money off of the drugs, They're always going to be slightly higher even at the cash price.
So a lot of my guys who are very financially concerned, I will make those suggestions to them.
32:13
But they really are pretty cheap at this point.
But those are the two orals that I go to.
I will do cocktails.
If straight Cialis or straight Viagra aren't working for you, I'll do low dose 1, high dose of the other, vice versa.
32:25
Speaker 2
And why would you do that?
32:26
Speaker 1
Yeah.
So a lot of times I'll do a daily dose of tadalafil, which is Cialis because it also helps with the prostate.
And a lot of my guys are fifties, 60s and having some peeing issues with their prostate anyway.
So we'll do a daily dose of the tadalafil, 5 milligrams, and then I'll give them the 100 milligrams of sildenafil to use on the as needed basis.
32:45
It just gives them a little extra push.
Or we'll flip it and we'll do a 20 milligram dose of sildenafil with a 20 milligram dose of tadalafil on an as needed basis.
And just that little combination sometimes is enough.
If they're not quite ready to go to injections next, but a straight dose isn't working anymore, that little extra combination can help.
33:04
Speaker 2
Yeah, and the tadalafil is a longer acting too, right?
It has a longer half life.
So for those guys who want like two or three days, Yep, without having to take a new one.
33:15
Speaker 1
The little spontaneity back to right and the sildenafil.
The Viagra generic has to be taken on an empty stomach to absorb correctly.
A lot of times sex night is date night and you don't have an empty stomach, so the tadalafil can come in easier for that too.
33:29
Speaker 2
Yeah, you're the fat really inhibits absorption.
33:32
Speaker 1
And I'll give my guys some tips to get around that.
I say, you know, take it before you go out to dinner because it's going to last in your system for four to six hours.
You're generally not at dinner for four to six hours.
You know, take it before you go to dinner.
By the time you get home, it's in.
Or my favorite suggestion, sex before you go out.
Who wants to have sex when you're all full and fat after dinner anyways?
33:49
So pop your Viagra mid afternoon, have sex before you go out, then go have date night.
Perfect.
33:54
Speaker 2
Solution.
Yeah, and if you're going to do it after dinner, don't eat a big steak.
33:58
Speaker 1
Yeah or Mexican.
Yeah my my partner and I have a no post Mexican rule.
34:04
Speaker 2
Okay, I like that.
Yep.
So those are all practical.
Yeah, practical tips on this.
There's also I guess this topical over the counter which doing some further research, it looks like it's kind of a no go.
So.
34:17
Speaker 1
I've had mixed clinical results.
Exeron is the name of it.
You can get it by the condoms and lubes and stuff.
Again, it's for early onset.
If you're needing oral Viagra, oral Cialis, you're past the point of it working for you.
If you're the guy who's just not getting hard enough anymore, not as quite as thick as you used to be, that's when the Exeron is still working pretty well.
34:36
Or I've also had it work well for my guys with penile prosthesis, because the prosthesis doesn't go all the way to the tip of the penis.
Some of them will use it on the glands of the penis, just the very head of the penis, to get that a little bit more engorged.
So there's a couple uses I've found for it.
34:52
But yeah, if you're needing Viagra and Cialis, it's not going to do anything for you.
34:55
Speaker 2
And is there like side effects?
I know there are some rare things like priapism.
I've seen priapism.
It's a you get an erection that's there for multiple hours and doesn't go down.
And so then it creates an ischemic that cuts off your blood supply.
I don't recommend that.
35:12
Speaker 1
Yeah, I always try and stress to my guys, it truly is a medical emergency and please do not be ashamed or embarrassed to come to the emergency room because we have a medicine that reverses it and yet it's can affect your heart and stuff too.
So it's not one that we just give you to keep at home.
We need to have you on a monitor while we're giving it to you.
35:29
So please come in.
It's a quick, easy fix as long as you come in quickly.
If you've let your erection go for 1824 hours, you are most likely not going to get erections again in your life.
Your Dick's not going to fall off, but you're not going to get erections and you're going to need a penile implant is important.
35:43
Speaker 2
And the other thing.
So I the one patient I did have, he actually did regain his function.
I was sweating bullets there for a little bit.
It wasn't for me, but he had an injection anyway.
It worked out and but that's a scary thing.
35:56
Speaker 1
It is.
And so we generally see the priapisms which by definition is 100% erection for at least 4 hours, right.
I always tell my guys, if you're still 100% erect at 3 hours, get going because by the time you drive to the emergency room, we get set up and get you the medicine, you're easily at 4 hours or more.
36:13
But what I when I see that clinically is young men who don't need it, who try to take it for that extra boost because they heard it works.
Men who probably only need a lower dose and try and take a higher dose.
Or with the injections, like you said, if they're moving up because the injections are a titratable dose, it's not one dose fits all.
36:30
And if they're not happy with the 20 units and they're like, oh, I'm not going to go up slowly like Doctor Steph told me to, I'm going to go ahead and jump to 50 units.
They're the ones who end up with a priapism.
But if they go up slowly, it generally doesn't happen.
But I work in urology.
36:45
I've seen many, but if you are careful and go up and use the correct doses and things like that, it's very rare.
36:51
Speaker 2
And then the very rare, the ischemic optical neuropathy, which is this blindness, again, very rare, but it's there, it's a thing, it's possible.
36:59
Speaker 1
It is.
I fortunately have never seen any of my patients get that, which is a testament to how rare it is.
I have more patients that get blurred vision or see blue for the duration the medicine is in them, but not outside of when they take the medicine.
I.
37:12
Speaker 2
Didn't know.
37:13
Speaker 1
OK.
So one of the other options for our guys are these injections that I've been mentioning.
The most common medication is called Trimix.
It's called that because it's actually 3 medications put in one.
And the cool thing about these is there's no full body, what we call systemic side effects.
All it does is tell your body, hey body, give me blood right here, right now.
37:32
So we teach the guys to give themselves an injection into their penis with a very, very small needle.
I promise it's really not as scary as it sounds, but it's a small amount of medication and it tells your body flood me with blood.
And so this medicine kicks in within about 10 minutes and guys get these wonderful erections that last for 30 to 60 minutes and regardless of climax.
37:52
So it's a little weird in the sense that, you know, normally when a man has his climax and has an ejaculation, his erection goes down very quickly.
This medicine doesn't care about when you climax.
It's just going to wear off when it wears off.
So that's a little different, which for some of my guys with premature ejaculation, it's a beautiful benefit for them and their partner, but it works really well and it doesn't have any of the cardiovascular side effects.
38:14
It doesn't interact with other medications in the same way that the oral meds do.
And it can work really well when the oral medications no longer work.
So that's kind of a progressive step.
And then the final step would be the surgical implant that we can put inside of you.
And it's kind of like those old pump up Reebok shoes that we had back in the 80s and 90s.
38:32
You just pump it up when you're ready to have sex, walk around with a towel on it.
I don't care what you do with it.
And then when you're done with it, you hit the release valve and it goes back down South.
There are really some great options.
And especially as my guys get older, they're on more medicines.
Maybe they've had prostate cancer, things like that.
38:47
It's really nice to know that there are these other options that you can still have that intimacy with your partner.
38:52
Speaker 3
That's a wonderful medical progression.
38:55
Speaker 1
Yeah, and the pumps have been around for ages.
And I know one of the companies that does a great job with their pump is actually coming out with a Bluetooth model, so you can inflate and deflate from your phone instead of having to pump, which is really great for guys with maybe Parkinson's or dexterity issues.
So it's pretty cool.
That should be out maybe in the next 5 to 10 years.
39:12
Speaker 3
And are those expensive as well or not too bad?
39:14
Speaker 1
They are, but the nice thing about that is they are covered by insurance.
So whatever your surgical split is, the 80207030, but the pumps themselves are about 20 to 25,000.
So you're still putting out several $1000 to get that.
But you know, we have guys in their 50s that have their prostate removed for cancer.
39:31
That's a long time to not have sex.
39:33
Speaker 2
Yeah, they're taking Medicare out of my paycheck every two weeks to fund someone's penile implant pump.
39:40
Speaker 1
That's right.
Doesn't that make you feel good?
39:42
Speaker 3
How do you feel about that?
If it was you, I think you.
39:45
Speaker 1
Careful, you have a marriage IQ podcast, you better like that.
39:48
Speaker 3
That's what I was thinking, if it saves a marriage, right?
39:51
Speaker 2
No, I think it's great.
I just thinking about all this Medicare that I'm paying into, which is fine, whatever, but.
39:57
Speaker 1
Hopefully it'll still be there when.
39:58
Speaker 2
We yeah, I doubt it, but I think I'd be remiss too if I didn't mention at least some medicines that that can lead to erectile dysfunction.
And I one of the biggest ones are antidepressants.
Yeah.
So SSRI that's going to be like the Prozac or fluoxetine or Zoloft, Lexapro.
40:15
Speaker 3
Which is kind of a problem when we're talking about specifically porn induced Ed because it does have a high correlation with mental health issues.
40:25
Speaker 1
Yeah, or guys coming back from the military with.
40:27
Speaker 3
Oh yeah.
40:28
Speaker 2
PTSD.
40:29
Speaker 3
Yeah, yeah.
40:30
Speaker 2
So yeah, that that's probably one of the biggest ones.
I mean there's some antidepressants that don't affect as much as others and it's some of the newer ones from Telex.
40:40
Speaker 3
What do you find?
40:41
Speaker 1
You know, I find that not only does it the SSRI's for sure, I know Wellbutrin is supposed to be less, but I still have guys have issues with that.
What I've also noticed is it affects their libido.
They don't even desire sex in the same way.
And so a lot of times I have them work with their psychiatrist, therapist, whomever who's prescribing the mental health meds and we're try and find a balance of, OK, I'm going to give you Ed meds, but maybe we can try one of these other mental health meds that maybe has less side effects with it.
41:09
But yeah, we see.
41:10
Speaker 2
Yeah, and you're right about bupropion.
It definitely has less effect on that as far as the, well, erectile function and libido.
But there are other reasons to put people on SSRIs and not bupropion and it gets really tricky sometimes.
41:24
Speaker 3
So go back to sexual communication and being able to talk about some of these things.
We do see benefits for couples who read books about sex.
That starts giving them the language to use and expanding their perspective.
41:40
I think for our listeners, it's important that it's within framework that they feel comfortable with, right?
Like Scott said, more monogamous sex and just kind of at a level that they're comfortable with.
Often faith-based even, I would say, but to help them have a language to speak about these things and to make improvements and see what the possibilities are.
42:00
What would be some of your favorites that you recommend?
42:02
Speaker 1
You know, I don't have a lot of books.
The one I know Come as You are is a great book just as more female focus.
42:08
Speaker 2
The Gauss key, yeah.
42:09
Speaker 1
Yeah, that's one of my best books that I like.
But I really have found, at least in my demographic of where I treat podcasts and blogs, YouTube videos, things like that, are really a lot more of what I've been promoting to people and sharing, especially depending on what the issue is.
42:25
If it seems to be more physiological, I'll send them to the Ed Cure website, which is put out by Boston Scientific and has some really great information more on the physiological side and the different interventions we have.
If it's more on the psychological side, I'm sending podcasts like Marriage IQ or some other ones out there in that regard, little plug there.
42:47
So it really kind of depends on where I feel their need is.
But I have found that the the podcast and the blogs, because they're shorter, it's easier for them to share with their partner and say here, watch this on your way to work.
Well, please don't watch while you're driving, but listen on your way to work.
43:02
And let's talk about this tonight over dinner because I found this interesting and that has been more of my go to than books.
43:08
Speaker 3
You know what, You're right.
You're right.
I think I listen to podcasts to learn things quickly if I don't have a lot of time, and I watch YouTube videos as well so.
43:18
Speaker 2
I think like she comes first.
43:20
Speaker 1
Oh yeah, that's a good one.
43:22
Speaker 2
The art of oral sex, which, you know, I guess there's an art.
Who would have thought?
43:26
Speaker 1
Well, for those of us who have received oral sex, there's an art.
43:28
Speaker 2
Well, there it is.
43:29
Speaker 3
Actually, marriage is one of our favorite.
43:31
Speaker 2
There's several and.
43:32
Speaker 1
You know with all these AI things out there too, if you are trying to find the right verbiage, type in to ChatGPT.
Hey I want to talk to my spouse about our sex life, specifically their erectile issues.
Give me 4 examples of questions to start the conversation.
There you go.
43:47
Speaker 3
That's progressive, yeah, right.
43:49
Speaker 2
Just start at least somewhere to start with that.
43:51
Speaker 1
Absolutely, absolutely.
Because for some people, just saying the words penis and vagina are difficult, obviously not in my world, but for some people they are.
And so it's you.
Maybe you just need AI to give you a question to ask that.
OK, And now I can practice it in front of the mirror and I can get used to saying this word out loud, this concept out loud.
44:12
And then I'm going to be more comfortable to say it to my partner.
44:14
Speaker 2
She said penis.
44:16
Speaker 3
Oh no, I love that idea though, because that's really quick.
It doesn't take a lot of time.
And you're right, you can plan, you can prepare.
You don't have to make it through a whole book.
You can get just some quick tips with it and be able to have the conversation tonight.
44:35
Speaker 1
Yeah.
And then maybe once you start the conversation, then you go find books that hey, let's both read these books or whatever.
But at least the faster things can kind of get those conversations going for you.
44:45
Speaker 2
I like it.
Yeah.
These are good things to think about for our audience today.
Maybe things they haven't thought about before or have and wanted further information, if they want further information from you.
We mentioned your podcasts between the sheets, right?
Yes.
45:00
Speaker 3
And we're going to be on there.
Yeah, it is coming.
45:03
Speaker 2
So that's Apple, Spotify, and then where else do you have a website too?
45:07
Speaker 1
It's between the sheets with Doctor z.com, so the websites there, which has links to the podcast, we're on YouTube, TikTok, social media, everything that way.
But yeah, we have a great plethora of things you want to listen to, things you might not.
I know my mother picks and chooses which episodes she listens to.
45:23
It is not every episode isn't for everyone, but there is something for everyone is what I like to say.
Well.
45:28
Speaker 3
That's great.
And if they want to see you personally, you're in Maryland.
45:31
Speaker 1
Right I am, yes.
I practice in Columbia, MD with Chesapeake Urology.
45:35
Speaker 2
Well, thanks for joining us today.
45:36
Speaker 1
Thank you so much, what a great conversation.
45:38
Speaker 3
This has been so great.
I've learned a lot.
Scott probably knows a lot of what you were already talking about, but I think it's important to make it accessible for people that don't have the right language to even ask the questions.
Yeah.
So that's really helpful.
Well, everybody, thank you for being here.
We thank Doctor Stephanie so much for being with us, for sharing her knowledge and wisdom.
45:57
And we hope that you all have a wonderful week and we'll see you back on another exciting episode of.
