HoldsUp

The Diary Of A CEO · 2026-04-27 · Steven Bartlett (host), Rena Malik

Sex Expert: What Women Actually Need To Enjoy Sex

81 research-tied claims examined: 3 contradicted 5 overstated 14 context 49 supported 10 unverified

14

Needs context

0:00:01Rena Malikneeds contextmoderate

Using a penile traction device for 30 minutes twice daily produces an increase in penile length of about 2 cm.

"So, you can put your penis in this device. They've actually done research on this. So, 30 minutes twice a day and it does show improvements in length about 2 cm." (said at 0:00:01)

Randomized controlled trials evaluating a short-duration penile traction device (RestoreX used for 30 to 90 minutes daily) demonstrate stretched penile length increases of approximately 1.5 cm to 2.2 cm. However, these clinical trials were specifically conducted in target populations with penile conditions or post-surgical changes (men with Peyronie's disease or following radical prostatectomy), rather than healthy men seeking cosmetic augmentation.

0:01:41Rena Malikneeds contextlow

Sleeping 5 hours a night drops testosterone levels in men by 15% compared to sleeping 8 hours.

"For example, they looked at data on men sleeping 5 hours a night versus 8 hours a night. Guys who sleep 5 hours a night, their testosterone drops by 15%." (said at 0:01:41)

The speaker is referring to a widely cited 2011 preliminary study by Leproult and Van Cauter (JAMA, PMID 21632481) in 10 healthy young men, which observed that restricting sleep to 5 hours per night for one week reduced daytime testosterone levels by 10% to 15%. However, this was a small laboratory trial, and subsequent randomized controlled studies of acute and chronic sleep restriction in healthy young men (such as Reynolds et al., 2012, and Robillard et al., 2019) have found no statistically significant reduction in total plasma testosterone concentrations.

0:17:00Rena Malikneeds contextmoderate

The World Health Organization has declared loneliness an epidemic and stated it carries a health risk equivalent to smoking 15 cigarettes a day.

"The WHO made loneliness like an epidemic. So, they've said that loneliness is as bad as having like 15 cigarettes." (said at 0:17:00)

In November 2023, the World Health Organization (WHO) launched the Commission on Social Connection, framing social isolation and loneliness as a pressing global public health threat. In its public communications and advocacy, the WHO and other health leaders frequently referenced the widely publicized comparison that social disconnection carries a mortality risk equivalent to smoking up to 15 cigarettes a day. This comparison originated from a 2010 meta-analysis by Holt-Lunstad and colleagues across 148 studies (308,849 participants), which found that stronger social relationships were associated with a 50% increased likelihood of survival (OR = 1.50, 95% CI 1.42–1.59), benchmarking the magnitude of this association against established risk factors like cigarette smoking. However, public health researchers note this is an effect-size benchmark of relative all-cause mortality from observational data rather than a literal equivalence in underlying physiological harm.

0:21:00Rena Malikneeds contextmoderate

Engaging in 150 minutes of moderate-intensity cardiovascular exercise per week provides improvements in erectile function scores comparable to taking Viagra.

"The one study that's quoted very often is 150 minutes of cardiovascular exercise moderate intensity. When you look at the improvement in erectile function scores, it is the same amount of improvement as you would see when you take a medication like Viagra." (said at 0:21:00)

A 2023 systematic review and meta-analysis of 11 randomized controlled trials (PMID: 37814532) evaluated regular aerobic exercise (typically matching standard guideline doses of approximately 150 minutes per week of moderate-to-vigorous activity) for erectile dysfunction. Aerobic exercise improved International Index of Erectile Function (IIEF-EF) domain scores by an average of 2.8 points overall, with greater improvements observed in men with moderate (3.3 points) and severe (4.9 points) baseline dysfunction. The authors noted that this magnitude of improvement (particularly the ~5-point increase in severe ED) approaches the effect sizes of phosphodiesterase-5 (PDE5) inhibitors such as sildenafil (Viagra), which typically improve IIEF-EF scores by 4 to 8 points depending on dose and baseline severity. While exercise produces clinically meaningful improvements in the same therapeutic range as medications for certain subgroups, PDE5 inhibitors generally produce somewhat larger immediate point gains across broad patient populations.

0:21:30Rena Malikneeds contextmoderate

A supervised walking protocol consisting of a 5-minute warm-up, 20 minutes of walking, and a 5-minute cool-down improved erectile function by 70% in men with heart disease.

"So there was a group where they looked at men who had heart disease and they weren't really able to do moderate intensity exercise. So they did like a 5-minute warm-up, they did 20 minutes of walking, and 5 minutes of a cool-down. And with this supervised protocol, they still improved erectile function by 70%." (said at 0:21:30)

The claim accurately reflects the primary numerical finding of a randomized controlled trial in cardiac patients, but misidentifies key details of the study setting. A 2015 randomized controlled trial by Santos et al. evaluated 86 men following acute myocardial infarction and found that participants randomized to a progressive home-based walking program experienced a 71% relative decrease in reported erectile dysfunction (ED) at 30-day follow-up compared to baseline, whereas the control group experienced a 9% increase. However, the trial investigated an unsupervised, home-based walking program rather than a supervised clinical protocol, in patients deemed to be at low cardiovascular risk.

0:22:38Rena Malikneeds contextmoderate

Heavy resistance training of large muscle groups leads to improvements in testosterone levels.

"So when you do heavy resistance training of your large muscle groups, so like your lower extremities, your glutes, you're doing like Olympic deadlifts, squats, that sort of stuff, you actually see improvements in testosterone." (said at 0:22:38)

Heavy resistance training recruiting large muscle mass (such as squats and deadlifts) reliably elicits significant, transient acute increases in circulating total and free testosterone in the immediate post-exercise period (typically lasting 15 to 60 minutes), particularly in men. However, systematic reviews and longitudinal training studies demonstrate that chronic resistance training generally does not result in long-term elevations in resting basal testosterone concentrations. The observed 'improvement' is an acute post-bout physiological spike rather than a permanent change in baseline hormone levels.

0:29:40Rena Malikneeds contextmoderate

Men with organic erectile dysfunction typically develop cardiac issues within 3 to 5 years, and 14% have a heart attack within 7 years.

"that within three to five years you will start developing issues with your heart. And so it precedes those issues, and seven years later, 14% of those guys will have a heart attack." (said at 0:29:40)

The speaker's statement refers to well-established clinical estimates in sexual medicine and cardiovascular risk literature, but requires qualification. Multiple consensus guidelines and cardiovascular reviews note that the onset of vasculogenic erectile dysfunction (ED) precedes clinical symptoms and major adverse events of coronary artery disease by an estimated 3 to 5 years (the "artery size hypothesis"), creating a critical window for cardiovascular risk assessment and intervention. Furthermore, in landmark longitudinal cohorts such as the Prostate Cancer Prevention Trial (PCPT) follow-up, approximately 11% to 14% of men with ED experienced an incident cardiovascular disease event over roughly 7 to 9 years of follow-up. However, stating that an individual "will" develop cardiac issues overstates a probabilistic risk as an inevitability, and the ~14% figure represents composite cardiovascular events (including angina, coronary revascularization, stroke, and myocardial infarction) rather than heart attacks alone.

0:07:08Steven Bartlett (host)needs contextmoderate

Roughly 15 to 20% of young people describe their phone and internet usage as almost constant.

"And roughly about 15 to 20% of young people describe their usage as almost constant, effectively scrolling during all waking hours while they're eating, while they're in the bathroom, and before they go to sleep." (said at 0:07:08)

Survey research on digital media habits frequently tracks the proportion of adolescents and young adults who report being online 'almost constantly.' However, the 15% to 20% figure cited by the speaker actually understates the prevalence documented in major national surveys. For example, representative survey data (such as widely cited Pew Research Center tracking of teen and young adult internet usage) found that 24% of US teens reported being online 'almost constantly' as early as 2014–2015, a figure that climbed to nearly 46% by 2022. While 'constant connectivity' is well documented among youth, the true proportion of young people reporting almost constant internet access is considerably higher than 15–20%.

0:26:58Rena Malikneeds contextlow

Overly tight pelvic floor muscles can restrict blood flow to genital organs, contributing to erectile dysfunction and premature ejaculation in men and impaired arousal or difficulty achieving orgasm in women.

"If they're really tight, it can prevent blood from getting to the genital organs. So for men, they can have erectile dysfunction. For women, they can have difficulty getting orgasms or difficulty getting arousal because they're not getting blood flow to the clitoris. Sometimes they can also cause premature ejaculation in men." (said at 0:26:58)

Pelvic floor muscle hypertonicity (non-relaxing pelvic floor dysfunction) and muscle spasm are recognized contributors to sexual dysfunction in both men and women, including erectile dysfunction, premature ejaculation, dyspareunia, and impaired arousal or orgasmic function. However, the pathophysiology is multifactorial—involving not only vascular compression of the pudendal vessels and genital structures, but also pudendal nerve irritation, myofascial trigger points, local pain signaling, and an inability to coordinate voluntary and reflex muscle relaxation.

0:33:00Rena Malikneeds contextlow

By a man's 40s, nocturnal erections decrease in duration to about half, maxing out at approximately 30 minutes, while maintaining a frequency of three to five per night.

"When you get older, like in your 40s, that drops to about half the time. So maybe erections are a little shorter, that they maybe max out at 30 minutes, but sometimes they're shorter. You should still be getting three to five erections at night." (said at 0:33:00)

Published normative studies on nocturnal penile tumescence (NPT) show that healthy adult men across young adulthood typically experience 3 to 5 sleep-related erectile episodes per night (closely tied to REM sleep cycles), totaling roughly 100 to 180 minutes. As men age through their 40s and beyond, the overall duration and episode length of nocturnal tumescence progressively decline, but healthy men in their 40s generally continue to experience multiple (typically 3 to 4) episodes per night. Stating that total duration drops to 'half' specifically by a man's 40s is somewhat overstated, as normative sleep laboratory data indicate that pathology-free aging produces modest, gradual declines in the 40s, with more substantial decreases occurring in older decades.

0:57:40Rena Malikneeds contexthigh

Vibrating tools cause temporary sensory loss in fingertips that completely restores back to normal.

"And the way they've looked at it is actually like construction workers where they're using those like vibration tools, right, to and seeing if like their hands get desensitized. And what they've seen is yes, for a short period of time they do lose a little bit of sensation at their fingertips, but then it restores back to normal." (said at 0:57:40)

Acute exposure to hand-transmitted vibration from tools induces a temporary threshold shift (TTS)—a transient reduction in fingertip tactile and vibrotactile sensitivity that recovers after exposure ceases. Experimental and field studies confirm this acute, reversible desensitization. However, the claim requires important context: while single acute exposures produce temporary shifts, repeated long-term occupational exposure to vibrating tools causes permanent sensorineural deficits (baseline sensory loss). In studies of workers using vibrating tools, baseline pre-shift sensory thresholds are significantly elevated compared to unexposed controls, demonstrating that recovery is incomplete after chronic exposure.

1:18:40Rena Malikneeds contextmoderate

Between 20% and 40% of men have low testosterone, but only about 2% of men receive treatment.

"Depending on the data you look at, 20 to 40% of guys have low testosterone. And when you look at the number that get treated, it's like 2%." (said at 1:18:40)

Estimates of low testosterone vary widely depending on diagnostic thresholds, age, and population studied. The cited range of 20% to 40% reflects biochemical low testosterone (total testosterone < 300 ng/dL) observed primarily in middle-aged and older men attending primary care. For example, the Hypogonadism in Males (HIM) study found a crude prevalence of biochemical hypogonadism of 38.7% in men aged 45 and older visiting primary care practices, with only a small minority (80 of 2,162 men, or 3.7%) receiving testosterone therapy. However, when strict clinical criteria requiring both low serum testosterone and characteristic sexual symptoms are applied to community-dwelling men across all adult ages, the prevalence of symptomatic hypogonadism is substantially lower (typically 2% to 6%).

1:19:06Rena Malikneeds contextmoderate

Specific symptoms of testosterone deficiency emerge at distinct population thresholds: bone loss around 300 ng/dL, decreased frequency of sexual thoughts at 215 ng/dL, and loss of vigor around 290 ng/dL.

"there are like clear numbers like you may start having bone loss around 300. You might start having, you know, decreased sexual frequency of thoughts at 215. You might start having feeling less physical vigor around 290." (said at 1:19:06)

Clinical trials and observational studies show that distinct physiological and psychological symptoms of testosterone deficiency emerge across different testosterone thresholds rather than at a single universal cutoff. Dose-response studies in men with suppressed endogenous sex steroids (such as Finkelstein et al.) demonstrate that bone resorption markers (e.g., CTX) increase at higher testosterone thresholds (levels <300-500 ng/dL), whereas changes in body fat and sexual desire typically emerge at lower thresholds (e.g., <100-200 ng/dL). Observational data (e.g., Zitzmann et al.) similarly indicate that loss of vigor and libido become prevalent at higher androgen concentrations (~15 nmol/L or ~430 ng/dL) than depressive symptoms or metabolic risk. However, presenting specific cutoffs (such as 300, 215, or 290 ng/dL) as exact 'clear numbers' overlooks individual biological variation and the continuous nature of symptom emergence across populations.

1:31:16Rena Malikneeds contextlow

A lack of regular or nocturnal erections reduces blood flow to the penis, causing the penis to shrink over time.

"if you stop having nighttime erections or you're not having erections, now you're no longer getting blood flow to your penis and it will shrink over time." (said at 1:31:16)

The biological premise of the claim is well-recognized in urology: the flaccid penis exists in a relatively low-oxygen state (venous blood gas PO2 25–40 mm Hg), whereas nocturnal penile tumescence (NPT) and regular erections periodically deliver highly oxygenated arterial blood (PO2 90–100 mm Hg) to the corpora cavernosa. Long-term absence of erections (such as after cavernous nerve injury or severe erectile dysfunction) results in chronic cavernosal hypoxia, which upregulates pro-fibrotic pathways (including TGF-β1 and collagen accumulation) and leads to smooth muscle loss, trabecular fibrosis, and measurable penile shortening/atrophy. However, the phrasing that the penis 'is no longer getting blood flow' is a colloquial oversimplification: baseline nutritive perfusion continues in the flaccid state, but it lacks the episodic high-oxygen arterial surge required to prevent hypoxic remodeling and structural shrinkage.

Unverified means no publication matching the claim was located; it does not prove the claim false. Spotted an error? See the corrections policy - disputes from the people quoted are prioritized.