The device can be used as a hanger or an extender, but you have to purchase the extender seperately. I already had an X4 extender, but they sell two brands of extenders if you want to go that route. You can also purchase the vac device with or without the extender part. If you want to use an extender, you will need to purchase the one that says ‘modified vac extender 4.2’, otherwise, get the ‘vac ADS 4.2’.
From the research I have done, most say to hang and hang only. Do not mix any other PE methods other than light jelquing between sets to restore blood flow.
Like mentioned, I am now only on day 11 of use, so I don’t know much about mixing other PE methods with hanging. I’m just going by what I have learned on the forum.