Over the last two years, Dr. Joel Pash has injected dermal filler into around 600 Bay Area penises. The CEO of Upsize, a nationwide penile enlargement franchise that’s headquartered in San Francisco’s Stonestown mall, Pash charges patients up to $10,800 (the XL package) to increase their girth by 1 to 1.5 inches, a size boost that lasts for around two years. 

In general, length rather than girth tends to be at the top of the enhancer’s to-do list, “but up to this point, there was nothing simple—or safe—to be done,” said Pash.

But everything changed with the insertion of Bryan Johnson into the quantified self scene.

The suddenly-everywhere multimillionaire longevity guru has developed a cult following through his attempts to cheat death via young blood transfusions and his Blueprint diet. Among Bay Area biohackers, he’s “legit” said Jeff Tang, 26, the founder of Eat Blueprint, a meal delivery startup based on Johnson’s nutritional program. “He’s serious about using data to build community and increase longevity.”

On Jan. 31, Johnson posted his penis protocol on X: 100 units of Botox had been injected into his penis, resulting in a 1 centimeter increase in flaccid length and increased hardness and sexual satisfaction. 

Johnson’s viral post inspired Pash, a Stanford University-trained anesthesiologist, to investigate the science behind so-called “Bocox” injections. He’d known that Botox was being used experimentally for erectile dysfunction but hadn’t appreciated its shaft-lengthening qualities. “These aren’t things that were in a textbook in medical school,” he said. 

Two days post-tweet, Pash performed his first penile Botox treatment, priced at $1,890. To date, he’s treated 20 men with penile Botox in his San Francisco office, with more scheduled, and references Johnson on his marketing material: “Penile lengthening biohack as posted by Bryan Johnson on X.”

Pash and the majority of penile plumpers use FDA-approved dermal fillers and neurotoxins off-label, a common approach among physicians who specialize in Botox treatments. However, these procedures can go wrong—a New Jersey internist had his license suspended after patients complained he botched their penile fillers, and in 2023, ProPublica published an expose of the penile implant business.

But risks aside, the popularity of penis boosters appears to be growing within the Bay Area’s hyper-competitive, optimization-obsessed tech scene. Part of that trend is attributable to biohackers’ interest in Johnson, who has stoked many people’s desire to increasing their testosterone levels alongside their sleep scores and biological ages.

Earlier in March, penile botox headlined the flyers for San Francisco’s fourth Don’t Die meetup, a longevity-optimizing event, loosely based on Johnson’s published protocols.  

“People are curious to know more” about penis enlarging, said Tang, who co-hosted the gathering. “One centimeter is not nothing.”

Tang’s event was located in the backyard of Newton, a Duboce Triangle coworking space for AI startups, and featured ice baths, pink electrolyte drinks, blood draws, free samples of Blueprint-branded olive oil shots ($60 for 1.5 liters), a trampoline and a DJ. To access the restrooms, attendees had to tiptoe past a scientific lecture on supernuclear weapons, a separate event. Upsize was given a table, and Pash’s staff handed out hundreds of brochures and Upsize-branded tape measures. 

“I’ve been following Bryan’s journey … but I’m not sure if this is something I would do,” said Christopher Jing, 24, the co-founder and CEO of Autonomo, a connected car payment startup, folding a flyer in half. “Later in life, it might be more relevant.” 

For now, Jing’s primarily concerned with improving his sleep hygiene and optimizing other health areas. “There’s a [return on investment] in prolonging the time we have,” he said. “I want to be able to play with my grandkids.” 

One hour in, the man of the moment himself, Johnson, climbed onto a picnic table for a brief Bocox Q&A with Pash. 

“The question was how would you make the penis younger. … What can you do to rejuvenate it?” asked Johnson rhetorically. He stressed that erectile health strongly correlated with cardiovascular fitness. But doesn’t injecting toxins run contrary to the Blueprint protocol, queried one Patagonia-vest-wearing man.

“We were willing to make the exception to look at the science,” said Johnson.

Upsize is just the tip of the growing number of penis-boosting treatments taking place in the Bay Area. Some address erectile issues, but many patients just want to get bigger.

In 2023, Dr. Judson Brandeis, a San Ramon urologist and regenerative medicine specialist, who made guest appearances on biohacker Ben Greenfeld’s podcast and BioHackers Lab, rolled out penile botox at his Male Rejuvenation Center. Also on offer: penile platelet-rich plasma, penile shockwave therapy (another treatment beloved by Johnson) and stem cell therapies. 

“I get a lot of really nice, normal guys—lots of engineers—who want bigger penises,” he said. “It makes them feel better about themselves.” 

Some patients have self-requested penile shockwave treatment, despite no erectile issues; they’ve heard Dave Asprey or Dennis Rodman promote it. Brandeis is willing to administer such treatments, but only after performing a full set of labs, a test measuring maximal oxygen consumption or “VO2 max,” and a body composition scan. 

“The nice thing is that it’s pretty safe,” he said. “You’ll get more rigid erections and a shorter refractory period.” 

Dr. Tracy Evans, who runs Pacific Skin, a cosmetic dermatology practice in Pacific Heights, added Scrotox” (scrotal botox) to her treatment list in 2023, due to patient interest. “We already did a lot of Brotox. … Men are much more interested in aesthetics than they used to be,” she said. For Scrotox, she injects around 100 units of neurotoxin into the scrotum, which results in a smooth, elongated appearance.

“It’s not a difficult procedure, it’s a fast procedure and it’s very effective,” Evans said. 

But genital glow-ups are still a rarity for Evans. “It’s five times more expensive than treating frown lines … and it only lasts for about four months.” Bocox is on her radar, but she’s waiting for the science to catch up. “That’s a newer, rarefied treatment,” she said.

At Upsize, penile botox is increasingly being requested by patients, according to Pash. To date, each of Upsize’s nine clinics has performed at least one. “Our patients are high-performing, successful men,” said the CEO; the average age is early 30s, and a large proportion work in tech and startups. Patients appreciate discretion, he added, which is why the doctor’s name, rather than the Upsize brand name adorns his clinic door.

“Most guys that are coming to us have normal-sized penises … and they just want it bigger,” said Pash. (For reference, the average length of a flaccid penis is 3.6 inches, and an average erect penis is 5.2 inches). “No one needs it bigger. … It’s a cosmetic procedure.”

But for some, any risk is a worthy trade-off for a (potential) bigger penis. Said one patient in a text message shared by Upsize and seen by The Standard: “I have so much confidence in myself now…I like seeing it even when I shower. Man, it’s awesome. 😊” 

Aside from the purported cosmetic improvements, Johnson also claims that Bocox boosts erection longevity. Pointing to his erectile dataset (don’t ask), he said that nighttime erections are a biomarker for physiological, cardiovascular and sexual health and generally decrease with age. Johnson’s interventions—including penile botox and penile shockwave treatments— have reversed that, he said. 

Every night, he straps on a penis-style Fitbit, which measures and scores the duration and quality of his erections. Pre-treatment, his erections lasted 124 minutes and now clock in at 179 minutes. “That’s just shy of the movie Titanic,” he quipped at the Don’t Die meetup. 

Though they admitted some curiosity, no one I interviewed at the event seemed eager to book a Bocox treatment. Ketan Agrawal, 24, an engineer at the AI enterprise security startup Robust Intelligence, said he was not even the least bit interested. But while drying off after his one-minute ice bath, he reached for an Upsize flyer. “It’s quite the novelty brochure. … That’s the reason I have one,” he said. 

Even if he’s just perusing brochures for the time being, he’s convinced that penile botox is here to stay. “There will be lots of people doing it, following in Bryan’s footsteps.”