Does low testosterone actually cause ED? What TRT claims get wrong

What did @jeremygoodmanmd actually say?

Pretty much what it sounds like. A self-identified urologist rattled off five ways men damage their genitals chasing size: unregulated supplements, unsupervised vacuum pumps, jelqing, black-market filler injections, and going to unqualified providers. He closed with a pitch: "I'm a urologist and I help guys get bigger pickles every day." The video is framed as a warning list, but it doubles as marketing for his own injectable procedure practice. That dual purpose is worth keeping in mind as you read the rest of this.

The claims themselves are medically grounded. The framing, however, leans hard on alarm without much nuance about what legitimate options actually exist or what their real-world success rates look like.

Does the science back this up?

On the dangerous stuff, yes, mostly. The evidence against jelqing, unregulated supplements, and unqualified filler injections is solid. Where the video gets thinner is around vacuum erection devices, which have a legitimate clinical track record that he glosses over by focusing only on misuse.

Jelqing has no peer-reviewed evidence of efficacy and documented harms. A 2019 review by Veale et al. in the Journal of Sexual Medicine found no high-quality evidence supporting any penile stretching or manual exercise technique for increasing size, and noted scarring and erectile dysfunction as documented outcomes. On filler injections, a 2021 case series published in the Journal of Urology (Matz et al.) documented severe complications from non-medical hyaluronic acid and silicone injections administered outside clinical settings, including penile necrosis and deformity. Vacuum erection devices, by contrast, have Level 1 evidence for post-prostatectomy penile rehabilitation (Kohler et al., 2007, Journal of Urology) when used correctly with a tension ring and time limits. He's right that unsupervised, unlimited pumping causes injury. He's wrong to imply pumps are inherently dangerous.

What did they get wrong (or right)?

Credit where it's due: the warning against hotel-room filler injections is legitimate and urgent. These procedures have caused permanent disfigurement, and the lack of regulatory oversight is a real patient safety problem. His point about provider qualifications is also clinically sound. Penile anatomy is unforgiving and filler migration or vascular compromise in that region can have irreversible consequences.

Where he oversimplifies: vacuum erection devices are FDA-cleared medical devices used in legitimate urology practice. His framing, "you buy a pump and don't put a limit on it," addresses only the misuse scenario. A listener could walk away thinking pumps are inherently dangerous, which isn't accurate. There's also no acknowledgment that prescription-based treatments like PDE5 inhibitors or TRT for confirmed hypogonadism address the underlying physiology of erectile dysfunction, which is often what men are actually trying to fix when they reach for enlargement products. The root cause conversation is missing entirely.

What should you actually know?

Most men seeking enlargement are, at their core, dealing with either body dysmorphic concerns or erectile dysfunction. These are different problems with different solutions, and conflating them leads to poor decisions. A 2020 study by Veale et al. in BJU International found that the majority of men seeking penile enlargement fell within the normal size range, suggesting psychological evaluation is frequently more appropriate than any physical intervention.

For erectile dysfunction specifically, the evidence-based options are well-established: lifestyle modification, PDE5 inhibitors, vacuum erection devices used correctly, penile rehabilitation protocols post-surgery, and in cases of confirmed hypogonadism, hormone evaluation. None of those involve a hotel room or a product with nine unpronounceable ingredients. If you're watching TikTok for penile health advice, the most useful thing any video can do is send you to a board-certified urologist. This one at least does that, even if it buries the recommendation in a content funnel.

The bottom line on this video

This is a urologist correctly identifying dangerous behaviors, but packaging legitimate clinical warnings as engagement content to build a patient pipeline. The medical content is more right than wrong. The framing is selective. If you take one thing from this: the procedures that cause the most documented harm are the ones that bypass medical oversight entirely. That part he gets right.