So let’s talk about other treatment options here because the one that comes right up right up at the top is lifestyle changes are some of the things that we have to look at but again that that might be one of the more one of the more simple things to take care of it at the top change your lifestyle and things you can get back you can get back up to the to the plate and you can take the swings that’s right so some of these are some of the treatment options lifestyle changes I think it’s huge I encourage those all the time because they’re also gonna help them from other medical from the other medical promises patients may potentially have reviewing the medications again doesn’t give me an excuse to stop them but that’s something they want to look into psychotherapy is time-consuming can be little bit difficult but there are certain patient populations that would severely benefit from that prescription medication testosterone therapy very controversial yet one of these things that do have a small part to play in the actual rectal function domain vacuum devices and of course the penile implant what about holistic treatments and vitamins do they work there’s a lot of stuff out there I don’t tend to push that because I try to follow guidelines a guidelines set forth by the American urologic Association and the SMS and a these are the governing bodies that can tell us hey this is how we should practice medicine but you’ll find a lot of stuff out there and quite frankly you should be careful with some of these holistic medications because some of these can be detrimental to your health wait a minute say that again because there are I cannot tell you how many times we do shows and people always talk about holistic medications or these alternative medications and ways to treat but you have to be very careful because with some of them it is the common snake oil salesmen absolutely and not only that you can imagine some of these most of these do not go through the FDA and so you can be buying something than maybe saying hey this is this is what my medication has and they can put anything they want in there so yes you have to be careful with some of these holistic therapies that you see out you