The guest
Dr. Rena Malik: A board-certified urologist and pelvic surgeon practicing in Southern California, specializing in male and female urological, pelvic floor and sexual health. She is also a prolific public educator on YouTube and Instagram.
What this episode covers
Andrew Huberman and Dr. Rena Malik cover the full landscape of urological and sexual health for both men and women. They explain pelvic floor anatomy and the critical distinction between an overly tight versus overly weak pelvic floor, including why excessive Kegels can cause dysfunction. The conversation parses the neural, vascular and hormonal contributors to erectile dysfunction and female arousal/orgasm, debunking the idea that hormones drive most sexual dysfunction. They also tackle UTIs and prevention, kidney stones, prostate health and BPH, oral contraception controversy, SSRIs, anal sex, supplements, and the role of porn, masturbation and communication in healthy sexuality.
Also referenced (named, not recommended)
ProductReferenced
Trimix
Trimix
“They'll take medications that increase blood flow, like Trimix. And you'll inject it into the penis, and you'll see an erection.”— Dr. Rena Malik
ProductReferenced
Viagra
Pfizer
“medications that inhibit phosphodiesterase, like Viagra and Cialis, tend to prevent the breakdown of that c-GMP, so you have longer-lasting erections.”— Dr. Rena Malik
ProductReferenced
Cialis
Eli Lilly
“I think low-dose daily Cialis is excellent for erectile function in men.”— Dr. Rena Malik
ProductReferenced
L-citrulline
“L-citrulline is pretty good. Ashwagandha for stress reduction, which also has implications for sexual function. Tongkat Ali has reasonable data.”— Dr. Rena Malik
ProductReferenced
Vyleesi (bremelanotide)
Palatin Technologies
“There is actually an FDA-approved medication called bremelanotide is the generic name, Vyleesi is the brand name, which is FDA-approved for women with low desire.”— Dr. Rena Malik
ProductReferenced
Addyi (flibanserin)
Sprout Pharmaceuticals
“The other medication that's available for low libido is called flibanserin, also known as Addyi is the brand name, and that also works on serotonin.”— Dr. Rena Malik
ProductReferenced
Wellbutrin (bupropion)
GlaxoSmithKline
“antidepressants like Wellbutrin, bupropion, which increases dopamine and norepinephrine.”— Andrew Huberman
ProductReferenced
Flomax (tamsulosin)
Boehringer Ingelheim
“there are medications like flomax, which are used for enlarged prostate as well, that actually relaxes the ureteral smooth muscle to allow the stone to pass.”— Dr. Rena Malik
ProductReferenced
Androgel
AbbVie
“getting Androgel tubes from the pharmacy and putting a tenth of one tube on the back of the calf or the upper outer buttock.”— Dr. Rena Malik
ProductReferenced
Crystal Light
Kraft
“One easily accessible thing is Crystal Light. It has a high citrate composition, so you can drink Crystal Light with that, two to three liters.”— Dr. Rena Malik
ProductReferenced
D-mannose
“D-mannose is one of them. Where you take about 2 grams a day of D-mannose and you drink it, and that actually helps reduce UTI risk.”— Dr. Rena Malik
ProductReferenced
Tongkat Ali
“this Indonesian herb is typically the one that I am aware works best for mild libido enhancement.”— Andrew Huberman
ProductReferenced
Maca root
“Also things like Maca root, which we don't really know how these things work exactly.”— Andrew Huberman
ProductReferenced
Shilajit
“Shilajit, this ayurvedic herb, which there is at least one study that I think is done well that shows increases in FSH.”— Andrew Huberman
ProductReferenced
Ashwagandha
“L-citrulline is pretty good. Ashwagandha for stress reduction, which also has implications for sexual function.”— Dr. Rena Malik
Big reveals from this episode
- Only 3% (up to 6%) of erectile dysfunction is hormonal in origin; most is vascular/blood-flow related.
- Doing excessive Kegels can create a tight, short pelvic floor and cause dysfunction rather than fix it.
- About 85% of women require clitoral stimulation to climax; very few orgasm from vaginal penetration alone.
- Orgasm gap: 95% of men orgasm in first-time encounters versus 45-50% of women in heterosexual but 90% in homosexual encounters.
- As a doctor she can't fully trust supplements because the industry is unregulated; one melatonin study found 400% variance from the label.
- Viagra was originally studied as a blood pressure drug; men in the trial didn't return samples because of better erections.
- Erectile dysfunction is a 'canary in the coal mine', ~15% of ED men have a cardiovascular event within seven years.
- Her team analyzed hundreds of Reddit threads finding oral-contraceptive-related low libido via raised sex-hormone-binding globulin.
Worth remembering
- Women have more testosterone in their bodies than estrogen, and testosterone drives desire in both sexes.
- About 50-52% of men over 40 have erectile dysfunction, rising roughly with each decade of age.
- Autopsy studies show 80% of men at age 80 have an enlarged prostate.
- Suppressing estrogen with drugs like anastrozole can crush male libido; estrogen is good for libido and brain function.
- A study found ~50,000 articles using the word 'penis' versus only ~2,000 using 'clitoris.'
- Cranberry works via proanthocyanidins (PACs); you need 36mg in a soluble form, not whole-berry supplements.
- Priapism (erection over four hours without arousal) is a medical emergency that can cause tissue scarring and fibrosis.
- High-volume cyclists show up to 50% rates of genital numbness from pressure on the pudendal nerve and artery.
- STIs are more likely with anal sex because anal tissue is thin and friable; the anus makes no endogenous lubrication.
- Vaginal estrogen is highly effective and safe for recurrent UTIs, lowering vaginal pH back to a protective acidic level.
More from Andrew Huberman
All 3803 recommended