Andrew Huberman· PhD
So, I don't remember the mechanism offhand. Andrew Huberman: Let's talk about prostate and prostate health. Earlier, I queued up that there's a growing trend toward, I would say, more progressive male physicians — or physicians who treat males. Excuse me. Dr. Rena Malik: Thanks for that. Andrew Huberman: Yeah. Prescribing low dose 2.5 to 5 milligram Cialis, which is tadalafil, which may assist with erections. But the rationale for this low dose, daily low dose is not centered around erections per se, it's really about prostate health. Improving blood flow to the prostate, reducing prostitis, maybe even reducing the probability of prostate cancer. What other sorts of things are you encouraging men to think about when thinking about their prostate? Dr. Rena Malik: Yes. So, before I forget, I want to mention that low-dose tadalafil is actually a treatment for erectile dysfunction. In fact, it works quite well, particularly in men who are having a lot of psychogenic issues. One, because they don't have to remember to take a pill before sex, it's always on board. And you're taking 5 milligrams every day and it has a 36 hours half-life, so you're kind of increasing those. So it can actually work quite well and is a great option for erectile dysfunction. So I do want to make that caveat. In terms of prostate health, it has been shown to be effective for BPH, or enlarged prostate, and this is a very common condition. In fact, if you look at autopsy studies, 80% of men at 80 have an enlarged prostate, like it's very, very common now. Does everyone get symptoms, and what's the long-term concerns of it and what can you do about it? So, typically, as the prostate enlarges, it's right around the urethra. It's a walnut-shaped gland sits underneath the bladder around the urethra, and it can narrow the urethra or the P-tube. And so over time, you can imagine, like, if you're, I always give this example, if you're sucking from a straw, right? You're drinking from a straw. If you have a wide diameter straw, it's really easy to drink. If your straw gets really narrow, like, say you take a coffee straw and you drink out of that, it's very difficult to drink. Very similarly, it can become very difficult to urinate if you have an enlarged prostate. Now, what causes an enlarged prostate? There's a whole host of factors. A lot of them are genetic. So if your father or your grandfather had a large prostate, you're probably more likely to have an enlarged prostate. Do we know exactly how to prevent that? Not exactly, but we know how to mediate the symptoms a little bit. So the other symptoms you'll see before you have difficulty urinating is sometimes you'll see overactivity. So you'll see your bladder is responding to having to push hard against that narrow urethra to push urine out. So it's having more urgency, like the sudden desire to go to the bathroom that you can't delay. You're maybe going more frequently, and very often, you're going more often at night. And so those are kind of the first signs people will see. And then over time, it may become more and more difficult to empty the bladder. You might see some hesitancy, like, you're waiting for your stream to start, or it stops and starts, or you're just like, I can't empty. It's not because it just drips or a very weak stream. And so those are kind of the things that can happen over a lifetime. Now, what are some things that you can do to help? Cialis helps relax the fiber, the smooth muscle of the prostate, so that it allows urine to pass more easily. There's also other medications that you can treat very often, Flomax or other alpha blockers are helpful in that area. In terms of things that you can do in general for bladder health, prostate health, there are certain things that are irritants to that area. And so what I tell people, not everyone's affected the same way, so I don't want people to be like, oh, I got to stop all these delicious things I eat and drink, but certainly it can be useful to just pay attention. So, like, if, say, you drink coffee every day and you find yourself running to the bathroom a lot. If you limit your caffeine intake, you might see that you're not going to the bathroom quite as often because caffeine is a bladder irritant. So that can be coffee, tea, chocolate, things of that nature that have caffeine in them; energy drinks — sometimes people forget they have caffeine in them. And so limiting, that may improve your symptoms. Alcohol also is a bladder irritant, and these have actually been studied in animal models. And you'll see that the bladder contracts more often when they're given these sorts of substances. And it's dose dependent. And some people can actually habituate or get used to a certain dose