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“Porn” problems unlike any known addiction in largest neuroscience study


Like I’ve said all along…

When studying addictions, there are known relationships between certain stimuli and reactions in the brain. These reactions have, in some instances, become the benchmark for what constitutes an addiction and addiction-based behaviors.  There has been heated debate over the very existence of porn “addiction” and what that addiction would look like when studied.

porn addiction, no such thing

In the largest neuroscience study of porn addiction to date, research conducted at UCLA found a clear reversal of the brain’s typical addiction response in study participants when they were shown sexual images. With the use of brain wave monitoring, participants who reported major problems controlling their viewing of sex films showed decreased brain reactions when shown the sexual images, rather than heightened activity as having a “porn addiction” would suggest.

The study shows that the brain does not react the way an addict’s brain would react to cues for their drug of choice. In fact, the study shows that the hypothetical “sex addict” brain reacts in the opposite way that a drug addict’s brain reacts, questioning whether sex addiction actually exists.

“This finding is important, because it shows a reversal of a part of the brain response that has been consistently documented in other substance addictions and gambling disorder,” Prause said. She also noted that this was consistent with their previous study, in which participants served as their own control and no relationship existed between the severity of their sex film problems and their brain response.

Many self-identified “hypersexual” people say they have an uncontrollable urge for sexual stimuli, and that it has resulted in negative life consequences such as loss of jobs or loss of relationships. For this reason, many clinicians have suggested that “sex addiction” be diagnosed much like drug addiction.

“While we do not doubt that some people struggle with their sexual behaviors, these data show that the nature of the problem is unlikely to be addictive,” said Prause.

The study involved 122 volunteers, both men and women. Some had problems controlling their viewing of sex films and met suggested criteria for problem use of pornography by three different questionnaire measures. Others denied any problems with their viewing of sex films. The 122 participants viewed images and were monitored using electroencephalography (EEG) that measures brain waves. The images were of sexual and non-sexual scenes. They included photos of people skydiving and of a man and woman engaging in intercourse, among others.

The study measured the late positive potential (LPP). Co-author Greg Hajcak described, “The LPP reflects electrical activity of the brain that is recorded at the scalp and time-locked to the presentation of pictures.” The LPP is a very common measure in studies of emotion. “The size of the LPP reflects the intensity of an emotional response, and reflects brain activity occurring in the visual system and ancient subcortical structures,” explained co-author Dean

“Hundreds of studies have found that the LPP is larger for emotional compared to neutral pictures,” described Hajcak, “and previous work from myself and my colleagues have shown that cocaine addicts have an increased LPP to cocaine-related pictures.” To test for correlation with hypersexuality, one would expect the brain to show high rates of activity when shown sexual images. In this study, a reverse effect was shown.

“The extent that individuals struggle with attempts to control urges or other internal states such as thoughts or emotions may change how problematic pornography viewing becomes,” co-author and psychologist Cameron Staley added. “Labeling a person’s attempt to control urges a ‘sexual addiction’ may interfere with therapy approaches such as Acceptance and Commitment Therapy (ACT) that can reduce distressing sexual behaviors.”

The study appears in the current online edition of the scientific journal Biological Psychology (…).

Authors on the study are Dr. Nicole Prause, Liberos LLC (; Dr. Vaughn R. Steele, The Mind Research Network, UNM-Albuquerque; Dr. Cameron Staley, Idaho State University, Pocatello, ID; Dr. Dean Sabatinelli, University of Georgia, Athens, GA; Dr. Greg Hajcak, Stony Brook University, Stony Brook, NY.

This research was conducted in the UCLA Department of Psychiatry and Biobehavioral Sciences (, which is the within the David Geffen School of Medicine at UCLA for faculty who are experts in the origins and treatment of disorders of complex human behavior. The lead author is the founder at Liberos LLC, a company in the UCLA startup program devoted to neuroscience research and the treatment of human sexual problems.
Complete Article HERE!

Dr Dick’s Sex Positive Doctrine

No podcast today; instead there’s this…

Have you ever wondered about the term, sex positive? If you’re like me you see it all over the place, especially on sex-related sites. I confess I use it way more often than I should. It’s become one of those industry buzzwords that has, over time, become so fuzzy around the edges that it’s now virtually meaningless. In fact, if the truth be known, I believe the term sex positive has been taken over by the sex Taliban who have made it a cover for their strict code of political correctness. Oddly enough, this is the very antithesis of its original meaning.

If you want to shame someone in the sex field—be it a sex worker, blogger or adult product manufacturer—you label that person as sex-negative. You may not know anything about that person other than you were offended by something they did, said or made. But still, you hurl the epithet as if you were exorcising a heretic. This is a very powerful tool for keeping people in my industry in line. But I’ve begun to wonder, who is setting themselves up as the arbiter of what is and what is not sex positive? I have to ask: What is the agenda? I mean, could compulsory ideological purity of some artificial standards of thought or behavior be “positive” anything? I say, no!

Like all good ideas that have gone bad due to overuse—or worse, sloppy use—the sex positive concept once had meaning that was life-affirming and enriching. Sex positive has been in the lexicon at least since the mid-1950s. It frequently appears in journals and research papers to describe a movement that examines and advocates for all the other beneficial aspects of sex beyond reproduction.

I’ve been using the term since 1981 when I opened my practice in Clinical Sexology and Sexual Health Care. The opening words of my mission statement read: “I affirm the fundamental goodness of sexuality in human life, both as a personal need and as an interpersonal bond.” Way back then, I was flush with my quixotic pursuit to stand steadfast against all the cultural pressures to negate or denigrate sexuality and pleasure. I dedicated myself to spreading the gospel that healthy attitudes toward sex not only affect a person’s sex life, but his/her ability to relate well with others.

This came relatively easy for me, because I’d learned something very important about evangelization in my life as a Catholic priest. (Another quixotic pursuit, but we’ll have to save the details of that misadventure for another time.) One of the first things one learns in seminary is how to proselytize, to sow the seeds of a creed, and then nurture them taking root by endless repetition of the articles of faith. Of course there is a downside to this, too. Repetition fosters mindlessness, stifles creative thought, and worse makes things boring.

But the creed statements of the world’s three great monotheistic religions are masterful works of theological art.

Barukh ata Adonai Eloheinu Melekh ha’olam!
Allaahu Akbar!
In the name of the Father, and of the Son and the of the Holy Spirit!

Each contains the most profound kernel of religious truth the believer needs to know, but all are easy enough for a child to learn. And like I said, the secret is in the repetition. For the true devotee, these creedal statements are uttered dozens of times a day and to great effect.

Early on in my career as a sexologist, I decided to put the principles I learned in the Church into disseminating my new belief system. First, keep the message simple! I settled on: “Sex is Good—and Good Sex is Even Better.” This has been my mantra for decades. It contains everything you need to know about being sex positive, but it’s easy enough for a child to learn. Even now, I close each of my podcasts with this same article of faith. To this day it soothes me to hear myself say these words. And it comforts me in the same way blessing myself did in my priestly days.

Despite my apprehensions, I continue to be an apostle of the sex positive doctrine. I know that even though my industry has corrupted the concept, others have yet to hear the good news. And there’s something almost spiritual about seeing someone grasp the idea for the first time. Let me tell you about one such instance. Some while ago I was asked to offer a workshop for a group of doctors on the topic: Health Care Concerns Of Sexually Diverse Populations. Unfortunately, just a handful of doctors attended the workshop—which was pretty disconcerting, considering all the work I’d put into the presentation. I guess that’s why kinksters and pervs, as well as your run-of-the-mill queer folk, are often frustrated in their search for sensitive and lifestyle-attuned healing and helping professionals.

Since the group of doctors attending was so small, I decided to ask them to pull their chairs in a circle so that our time together could be a bit more informal and intimate. Frankly, I’ve never found it easy talking to doctors about sex; and discussing kinky sex was surely going to be very tricky. So, I decided to start off as gently as I could. My opening remarks included the phrases “sex positive” and “kink positive.”

Sitting as close to my audience as I was, I could see at once that these fundamental concepts weren’t registering with them. I was astonished. Here was a group of physicians, each with a large urban practice. Could they really be this out of touch? I quickly checked in with them to see if my perception was correct. I was right! None of them had heard the term, sex positive. The two who hazarded a guess at its meaning thought it had something to do with being HIV+. I had my work cut out for me.

I decided to share my creed with them. “Sex is Good—and Good Sex is Even Better.” I asked them repeat it with me as if I were teaching a catechism to children. Surprisingly, they did so without resistance. After we repeated the mantra a couple more times, I exposed them to the sex positive doctrine unencumbered by political correctness.

  • Sex Is Good! Sex is a positive force in human development; the pursuit of pleasure, including sexual pleasure, is at the very foundation of a harmonious society.
  • And Good Sex Is Even Better! The individual makes that determination. For example, what I decide is good sex for me, may be boring sex to someone else. And their good sex may be hair-raising to me. In other words, consensual sexual expression is a basic human right regardless of the form that expression takes. And it’s not appropriate for me, or anyone else, to call into question someone else’s consensual affectional choices.
  • Sex Is Good! Everyone has a right to clear, unambiguous sexual health information. It must be presented in a nonjudgmental way, particularly from his or her health care providers. And sexual health encompasses a lot more then just disease prevention, and contraception.
  • And Good Sex Is Even Better! The focus is on the affirmative aspects of sexuality, like sexual pleasure. Sexual wellbeing is more than simply being able to perform. It also means taking responsibility for one’s eroticism as an integral part of one’s personality and involvement with others.
  • Sex Is Good! Each person is unique and that must be respected. Our aim as healing and helping professionals is to provide information and guidance that will help the individual approach his/her unique sexuality in a realistic and responsible manner. This will foster his/her independent growth, personal integrity, as well as provide a more joyful experience of living.
  • And Good Sex Is Even Better! Between the extremes of total sexual repression and relentless sexual pursuit, a person can find that unique place, where he/she is free to live a life of self-respect, enjoyment and love.

Finally I told them they ought to think creatively how they could adapt this concept to their own practice. It was up to each of them to make this creed their own. As it turned out, this primer was just the thing to open my planned discussion of health of kinksters.

In a way this experience was a bit of a spiritual reawakening for me, too. Despite my misgivings about the contamination of the sex positive doctrine by malicious people bent on using it as a weapon against those they disagree with. I can’t tell you how refreshing it was to watch these sex positive novices hear, and then embrace, the message for the first time. It was nothing short of a religious experience.

Rapid Fire Dick 2

Name: Tom
Gender: Male
Age: 43
Location: Atlanta GA
Dr Dick I have a large dick and would like to know if size does make a difference, mine iscarrotdm7.jpg 11.5 X 7 I have a problem sometimes with this size, they say it is all in how you use it is this true. Thanks T/Tom

You must think I was born yesterday. NEXT!

Name: maddy
Gender: Female
Age: 14
hi, um i know i’m young and all but with the world today you’ll see anything, and the thing is is that i’m OBSESSED with penises (and really want to suck one, but wont and cant since i’m so young) and um i don’t know if its my teenage hormones or not, could u suggest what is wrong with me? thank you very much, bye.

Fourteen year old female OBSESSED with penises? I think not. You too must think I was born yesterday.

Ya know, folks, if you’re gonna make up shit, the least you can do is be creative. Plausibility is also a requirement. NEXT!

Name: ???
Gender: Male
If I bareback with another guy and he sperms in my ass will I get an STD if he doesn’t have one? If I drink another guy’s sperm will I get an STD if he had no STD?

Are you on acid?

stupid-tee-shirt.jpgHow could you get something (STI/STD) from someone who isn’t infected with anything? All ya have to do is think things through, right?

Perhaps, someone who’s unable to logically put 2 and 2 together is not yet mature enough for partnered sex. Perhaps, that person should stick to pullin’ his pud.

Name: Sam
Gender: Male
Age: 22
Location: UK
Hi Dr. I am a 22 years old male and I have two questions. 1- me and my boyfriend are having anal sex without using condoms, does that affect any of us in any way? 2- my penis is straight which is good, but is there any way that I could make it curve upwards?

WTF? Is this an epidemic of idiocy, or what?

(1) You’re 22 and you still haven’t got the message about the risks of barebacking? If you boys aren’t HIV- and in an exclusive relationship and you’re lovin’ without a glove; then you’re courting disaster. I guess this is one way to cull the herd.

(2) if your unit is straight, that’s the way it’s gonna stay. You won’t be able to train it to curve upward or any other direction.

Name: dave
Gender: Male
Age: 45
Location: oregon
Can a person catch h.i.v by swallowing the cum of a h.i.v. positive lover?

D’oh! You’re 45 and still don’t know the score about HIV transmission? Have you been living under a rock all these years?

Swapping bodily fluids is a sure-fire way of spreading the disease.

Name: John
Gender: Male
Age: 18
Location: Australia
hey, i’ve been finding that while having sex with my g/f that my foreskin is being pulled back upon entry, i’m pretty sure it’s meant to do this anyway when it’s erect but it never really has and frankly i find it a little bit painful. when masturbating i don’t pull it back and it doesn’t decrease pleasure, what do you think i should do?

Sounds like you need to stretch your foreskin so that it will easily retract over your dickhead whenever you want it to.

I’ve written and spoken about this extensively in the past. See the CATEGORY section to the left — in the sidebar? Look of the category Foreskin. Click on that and it will take you to all my podcasts and postings on the topic.

Name: s
Gender: Male
Age: 14
Location: ny
i am uncircumcised and my foreskin and frenulum are perfectly intact. i recently read a blog that said that the first time you have sex your foreskin will “snap” back. if this is true, does it hurt? if not, will how will my foreskin bend back?foreskin002

Nope, that’s untrue…all of it! But you have come to the right place for information about all things that relate to your natural (uncut) cock.

Did you notice the advice I gave to the fella (John) above you? Good! Because that information applies to you too.

It’s too bad that your dad (or parents) didn’t taken the time to clue you into what you can expect from, or how to properly care for your foreskin. It’s his (their) responsibility, ya know. Alas, many parents shirk their duty in this regard.

Listen up parents! Do the right thing. Sit the youngens down for the body/sex talk, why don’t cha already? If ya don’t, your kids will be saddled with all sorts of myths and misconceptions, like the one presented by this young pup. Passing on clear, unambiguous information about their body (including their genitals) and sex is as much your responsibility as putting food on the table.

And finally, mom and dad, if you are unclear about the nuts and bolts of how our bodies work and/or the ins and outs of sex; educate yourself before you lay the info on the kiddies. Remember, it’s your job to educate and enlighten, not add to their misinformation.

Name: BILL
Gender: Male
Age: 53
Location: NEW YORK
Would you cover the topic of sex after prostate surgery? It’s been 16 months since my surgery and i notice a decrease in my penis size. Why did that happen and will it return to normal?

Not only will I, but I already have!

See the CATEGORY section to the left — in the sidebar? Look of the category Prostatectomy
Click on that and it will take you to two podcasts I’ve done on the topic.

As to the decrease in the size of your unit; I’d guess that it has something to do with the trauma your genital area received during surgery. I’d be willing to bet that a whole lotta slow and pleasurable massage/masturbation will increase the oxygen-rich blood flow to the area and this will, in time, restore your willie to its former stature.

Name: steven
Gender: Male
Age: 34
Location: rsa
hi there. i have a webbed penis is it necessary 2 correct this and does it hinder foreskin restoration stretch exercises which seem 2 be working very slowlycircum_egypt.jpg

The term “webbed penis” can refer two different conditions. The first is where the skin of the scrotal sack extends part way up the shaft of the penis. Boys are born this way.

The second condition is a result of adhesions forming between the scrotal skin and the penile skin due to a botched circumcision.

Since you’re practicing foreskin restoration, I’m gonna guess that your condition is the result of a bungled circumcision.

It’s a bummer when an over-zealous doc (or Mohel) docks too much of a boy’s foreskin. It can make for painful erections when he get older. Sadly, this happens way more frequently then most people realize. There’s no way to correct this. In fact, if I were you, Steven, I’d keep my precious cock as far away from a scalpel as possible. I think enough damage has been done already, don’t you?

The foreskin restoration exercises you’re doing will help stretch the skin of your dick shaft and offer you some relief, especially if your erections cause a painful tightening of your dick skin. But, as you suggest, this will take a long time to achieve. I encourage you to keep at it though, because it’s truly worth the effort.

Name: Mike
Gender: Male
Age: 47
Location: Australia
Last year I contracted genital herpes. It eventually cleared up and fortunately has not re occurred. If I have fellatio performed on me and subsequently ejaculate, will I be placing my partner at risk of catching the herpes? Even though I show no symptoms of the disease? I would appreciate your advice. Regards, Mike.

Did you know that there are two herpes viruses? There’s the HSV-1 type (cold sores) and HSV-2 type (genital herpes). Did you know that up to 80 percent of adults have HSV-1 and 25 percent of adults have HSV-2? Kinda amazing, huh?

Obviously it’s pretty easy to catch one or both strains. A whole lotta infected people don’t even know they’ve been infected. Because they never have an outbreak, or the outbreak they have is so inconspicuous they don’t even notice.

Since you know you have herpes, Mike, it’s incumbent upon you to be upfront with your partner(s) about it. Just because you don’t notice an outbreak, doesn’t mean you can’t pass on the infection. That being said, since one out of every four adults has already been exposed, the information you will be sharing won’t be all that startling.

Being upfront with your partner(s) gives him/her the opportunity to make an informed decision about going down on your pole without a condom. And certainly as to weather or not he/she decides to accept the “gift” of your spunk, if ya catch my drift.

Anything less than full disclosure would mark you as a man who has no regard for the wellbeing and best interests of his partner(s).

Good luck ya’ll


My inbox overflowth! …and that ain’t pretty. Let’s attend to this glut with some snap.

Name: david
Gender: Male
Age: 19
Location: florida
i like my 6 inches and i work it well but,personaly i want atleast 7,should i worry about it or what should i do doc? thank you

You shouldn’t worry about it, pup. Like you say, 6″ is plenty. Besides, where would you find an extra inch if you absolutely needed to get one? I didn’t see any on e-bay!

Name: shane
Gender: Male
Age: 18
Location: las vegas
what is a more efficiant way to masterbait?

Beat your meat like it owed you money!

The way you jerk off isn’t efficient? Dare I ask, what inefficient method you are currently employing? How much more efficient do you want this exercise to be? Are you in that much of a hurry?

Name: Jen
Age: 33
Last night, my sex partner came on my face, and his seamen got in my eye. I woke up today, and my eye is blood shot, and a bit swollen. Am I okay?


Bad shot!

I think you mean semen, right? Seamen are sailors! And boy, if you ever get a sailor in your eye, you’d wake up being a lot more than a little bloodshot and swollen.

Gettin’ spooge in your eye is no picnic; it stings like the dickens. You should be ok, though…that is if your sex partner is healthy. If he’s not, or if the redness and swelling continue see your doc right away!

Name: miles
Gender: Male
Age: 26
Location: Rapid city sd
I just started to let girls and guys fist me what is the posibel dangers.

You’re lettin’ folks shove a fist up your ass and you’re just now getting around to asking about the possible dangers? YIKES!

Well you’re in luck. I did a Sexual Enrichment Tutorial on fist fucking in a podcast a couple of weeks ago. Check it out: Sex Advice With An Edge — Podcast 04/30/07. Listen to my response to Dena.

Name: holly
Age: 18
Location: brisbane
hi… i have been with my partner now for 13 months and the sex we are having is getting boring as both of us are females..i just want to know if there is enything u can suggest for us to do to help spice it up a tad.. yours thankfully hol

Yeah, that girl on girl sex can get mighty boring, huh? All that carpet munching, and for what? Good thing you’ve turned to someone without a pussy or a clit for some helpful suggestions on spicing things up lesbian style. Hmmm, this sounds mighty fishy to me…and I don’t mean “fishy” in that way.

Have you tried strapping one on?

Name: thunder tounge
Gender: Male
Age: 37
Location: brooklyn, ny
do those penis inlarger pils work and if they do which ones are the best to get?

Nope, they don’t. Don’t waste your money!

Name: Nadine
Age: 31
Location: Ontario
My boyfriend bugs me to give him a blowjob and I just can’t and he always bugs me which bugs me more that I never want to do it. What can I do?

Why can’t ya smoke some pole, darlin’? It’s all the rage these days.

Maybe you could learn to like it. See my Sexual Enrichment Tutorial: So Ya Wanna Be A World-Class Cocksucker.

If ya can’t stomach the idea of a cock in your mouth, maybe you need to find yourself a boyfriend with out a dick…I think they’re called lesbians!

Name: joe
Age: 39
Location: boston
why do women like sucking dick

They do? That would be news to me…and Nadine, the person right above you. She begs to differ.

Sure, I know some women like to suck cock. There are even those whose skill is renowned. Why, they can suck the chrome off a trailer hitch. But I fear, givin’ a man a humble hummer is an odious task for most women. It ranks right up there with having a bad hair day.

Good luck

The Thrill Is Gone

Name: Billy
Gender: Male
Age: 46
I have heard it’s normal for sex drive to diminish as you age. I’ll run this by you. I’m a 46 year old male and the last time I was at a strip club with bare boobs bouncing around me, you may as well have rolled a grapefruit across the floor. Actually, I can see more use from the grapefruit. I don’t recall the last time I did it, and jerking off was almost disgusting. My tool has shrank to nothing. I barely touch it and it just dribbles, it doesn’t fire off anymore. I don’t even like to touch it to go piss anymore. I’ve had to shave around it, so I actually find it, to keep from pissing my pants. Is this normal?

No, Billy, this isn’t normal. I think you already know that too, right?

andropauseDo you know anything about andropause? If not, you ought to. Here’s what I suggest. Use this site’s search function in the sidebar. Type in the key word: “andropause” and you will come up with a wealth of information about this issue.

You can also use the CATEGORY pull down menu. Look for the subcategory: Sex and Aging, under the main category: Aging. Everything is alphabetized.

But for the time being, here’s a typical question and response —

Name: Wilson
Gender: male
Age: 58
Location: Lancing MI
I’m a successful entrepreneur, in decent health (I could stand to lose a few pounds.) I have just about everything a man could want in life, but I’m miserable. I have no energy and I feel like I’m sleepwalking through my life. I have no sex drive at all; my wife thinks I’m having an affair…I wish. Even Viagra doesn’t do the trick anymore. Is this just old age, or what?

Old age, at 58? Middle age, perhaps! Regardless what we call it, you sound like you’re in the throws of andropause — male menopause — ya know, the change of life!

Never heard of such a thing? You’re not alone. It’s only been recently has the medical industry has begun to pay attention to the impact changing hormonal levels has on the male mind and body. Most often andropause is misdiagnosed as depression and treated with an antidepressant. WRONG!andropause-1

Every man will experience a decrease testosterone, the “male” hormone, as he ages. This decline is gradual, often spanning ten to fifteen years on average. While the gradual decrease of testosterone does not display the profound effects that menopause does, the end results are similar.

There is no doubt that a man’s sexual response changes with advancing age and the decrease of testosterone. Sexual urges diminish, erections are harder to come by, they’re not as rigid, there’s less jizz shot with less oomph. And our refractory period (or interval) between erections is more pronounced too.

While most all of us have heard of a mid-life crisis, and it’s tragic consequences — red convertible sports cars, comb-overs, and the trophy wife or lover — fewer have heard of andropause. A mid-life crisis is essentially a psycho-social adjustment to aging — bored at work, bored at home, bored with the wife or partner — that sort of thing. Andropause, although it may coincide with a mid-life crisis, is not the same thing. Andropause is a distinct physiological phenomenon that is in many ways akin to female menopause.

Unlike women, men can continue to father children after andropause, but like I said, the production of testosterone diminishes gradually after age 40. I suppose you know that testosterone is the hormone that stimulates sexual development in the male infant, bone and muscle growth in adult males, and is responsible for our sexual drive. But did you know that by the age of 55, the amount of testosterone secreted into our bloodstream is significantly lower than at 45. And by age 80, most male hormone levels have decreased to pre-puberty levels.

Men, are you over 50? Are you feeling weak, lethargic, depressed, and irritable? Do you have mood swings, hot flashes, insomnia, and decreased libido, like our buddy Wilson, here? Then you too may be andropausal. You need to get some lead back in your pencil!

mutateAll kidding aside, andropausal men might want to consider Testosterone Replacement Therapy (TRT). Ask your physician about this. Just know that some medical professionals resist testosterone therapy, mistakenly linking Testosterone Replacement Therapy with prostate cancer. Even though recent evidence shows prostatic disease is estrogen-dependent rather than testosterone-dependent. However, before starting a testosterone regiment, insist on a complete physical, including blood work and a rectal examine. Mmmm, rectal exams!

Testosterone is available in many forms — oral, injectable, trans-dermal and by way of implants. The oral form is not recommended because of the high risk of liver damage. But injections, patches, pellets, creams and gels might be just the answer. I encourage you to be informed about TRT before you approach your doctor, because the best medicine is practiced collaboratively — by you and your doctor.

Good luck

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