All protocols

Use unstructured journaling to write down anything that comes to mind for about 5–10 minutes; 10 minutes is ample for most people, 5 may be enough, and some may use 30 minutes. This can also be done in the morning as a data dump to clear mental clutter and help structure thinking and behavior.

Use journaling with a specific intention or topic, such as goals and aspirations. Write about what you want now and in the future, including accomplishments, contributions, and desired feeling states. If you feel you do not know what you want, journal specifically about that uncertainty. Flesh out details such as the kind of community, role, setting, or process you want rather than keeping goals vague.

400–800 mg daily, usually with a meal; taken for vascular function and blood flow, not for lifespan extension; described as reasonably safe at those dosages and relatively low cost.

Intravenous NAD infusion at a facility or via a company that comes to your house; he has used 500–1,000 mg, especially when feeling run down or post-illness; recommends doing it earlier in the day due to anecdotal sleep disruption later in the day; slower drip rate can improve tolerability; often uncomfortable and some people use anti-nausea medication.

If doing an NAD infusion, have the administrator slow the drip rate to make it more tolerable rather than trying to finish the bag in 45 minutes or less.

Schedule NAD infusions earlier in the day, since later-day infusions may create sleep challenges.

Avoid sauna exposure when trying to protect sperm production because external heat to the scrotum can impair testicular function; sperm production is more heat-sensitive than testosterone production.

Establish care with a primary care doctor, especially if preparing to start a family and not already engaged with healthcare; screening can include blood pressure, lipid levels, and fasting blood glucose.

Avoid recreational drug use because it can negatively affect semen quality.

Maintain a good diet as part of supporting fertility and cardiovascular health; in general, what is good for heart health is also good for fertility, alongside exercise and maintaining healthy body weight.

If concerned about sperm counts, keep cycling below about 5 hours per week; during rides, stand up in the saddle periodically to dissipate heat; get a saddle fit; and if cycling causes pain, numbness, or dysfunction, change saddles or riding style.

Use a bicycle saddle designed to reduce pressure on nerves and blood vessels between the sit bones to lower risk of numbness and sexual dysfunction.

If not having normal erectile function, see a physician.

If waking at night to urinate, urinating often, or having a weak stream is bothersome, see a physician.

Consider sperm DNA fragmentation testing if one has the disposable income and wants more detailed reproductive data.

Try earlier rather than delaying fatherhood, because older paternal age is associated with increased risks in offspring.

A male UTI is rare enough that it should prompt evaluation for anatomic causes such as urethral scar tissue, bladder stones, kidney stones, or incomplete bladder emptying.

Oral phosphodiesterase inhibitor used as first-line treatment for erectile dysfunction; usually started in the middle-to-higher dose range and often used on demand.

Oral phosphodiesterase inhibitor option for erectile dysfunction.

Oral phosphodiesterase inhibitor option for erectile dysfunction.

Use erectile dysfunction medication on demand if sex is only a few times per month; daily dosing may be more useful if sex is very frequent.

A urethral suppository/gel/jelly vasodilator can be used when oral therapy is insufficient; may cause tingling or burning.

On-demand penile vasodilator injections; efficacy about 80 to 90%. First dose is taught in clinic, starting low and titrating at home until erections last about 20 to 30 minutes.

Surgically implanted device for erectile dysfunction when other treatments fail; available as non-inflatable bendable rods or inflatable systems.

A persistent split urine stream should be evaluated because it may reflect a urethral issue, prostate issue, meatal issue, or inadequate flow.

Do not use post-pubertal dihydrotestosterone-like drugs such as oxandrolone for penis enlargement; the guest explicitly would not recommend it.

Approach finasteride and dutasteride seriously/cautiously because some men experience low libido, erectile dysfunction, and sperm count drops; if finasteride causes a dramatic sperm count reduction, stopping it may allow recovery over roughly 3 to 6 months.

Men with persistent low libido or erectile dysfunction after finasteride should see a specialist for evaluation and treatment options.

Check estrogen levels, especially in the context of obesity or suspected excess aromatization.

Men concerned about fertility should be evaluated for varicocele because it is common and a frequent cause of infertility.