Prompt Cast
Male Sexual Health: Erectile Dysfunction, Testosterone, and Fertility
TLDR The episode delves into male sexual health topics such as erectile dysfunction, testosterone, premature ejaculation, and fertility issues, discussing various diagnostic methods and treatment options available. It highlights the importance of overall health, regular penile muscle use, and informed decision-making when considering testosterone therapy for male sexual health.
Timestamped Summary
00:00
The episode discusses various aspects of male sexual health, including erectile dysfunction, Peroni's disease, testosterone, premature ejaculation, and other related topics.
07:46
Approximately 30 million men in the US suffer from erectile dysfunction, with prevalence increasing with age, but often goes unaddressed due to embarrassment and lack of clinician inquiry.
14:51
Ultrasound can be used diagnostically to induce erections and treat erectile dysfunction by understanding the mechanism of action of medications like Viagra and Cialis.
22:14
Aging can lead to venous leak in the penis due to lower testosterone levels causing muscle atrophy, but regular penile muscle use, including through nocturnal erections and sexual activity, can help prevent atrophy and maintain tissue health, with daily Cialis potentially serving as a preventative measure.
29:43
Evolution may not necessarily limit men's reproductive capabilities as they age, as demonstrated by older men in good health who have no issues with sexual function, emphasizing the importance of overall health in maintaining sexual health.
37:05
The majority of patients with erectile dysfunction start out with venous leak, which is often the cause of abnormal curvature in the penis, known as Peronese disease, with treatments such as collagenase injections or surgical options available.
44:25
Penis stretching devices can help improve curvature and size, with potential gains of up to one inch in length, but require consistent use for lasting results.
51:37
Men have various options for treating erectile dysfunction, including injections, penile implants, and prostaglandin suppositories, with penile implants being a long-standing and effective treatment option that allows for erections on demand.
58:34
Penile implants can be inserted within the first three months after priapism to avoid complications and improve outcomes, with ultrasound used to assess the need for shunt procedures, while Gaines Wave shockwave therapy can help improve erectile dysfunction by inducing trauma and promoting tissue healing.
01:05:49
Shockwave therapy clinics have been rapidly expanding across the country, with electro-hydraulic and electromagnetic machines showing some effectiveness in treating mild to moderate erectile dysfunction, but caution is advised due to the lack of extensive scientific evidence and the high placebo response rate in this vulnerable population.
01:13:05
The prevalence of ejaculatory dysfunctions, such as premature ejaculation, is significant, with 30% of men experiencing some form of dysfunction, but only a small percentage seek therapy due to embarrassment, and treatment options range from lidocaine sprays to SSRIs and sex therapy.
01:20:16
Tramadol is a high-risk narcotic therapy for premature ejaculation, while alpha blockers like Flowmax can prolong ejaculatory time but may lead to retrograde ejaculation, and SSRIs like Paxil are effective in delaying ejaculation but may cause delayed orgasmia, with no FDA-approved treatments available for this condition.
01:27:47
The size and hormonal status of a man's testicles are crucial indicators of fertility, with small testicles and elevated FSH and LH suggesting a production problem, while normal FSH and LH with no sperm indicate an obstruction problem.
01:35:53
Symptoms and how a patient feels are more important than testosterone numbers when deciding on treatment, with various options available including clomid, HCG, and injectable testosterone.
01:43:18
Treatment options for male fertility issues include medications like clomid, HCG, and testosterone, with different dosages and frequencies depending on the patient's needs and underlying conditions.
01:50:28
Men, especially younger men, are turning to cheaper testosterone options obtained illicitly, such as intranasal testosterone like Natesto, which has a rapid onset and decline but does not significantly suppress spermatogenesis.
01:57:33
Testosterone therapy options such as injectables, pellets, and oral medications are popular, with injectables being favored for their convenience, effectiveness, and lower risk of erythrocytosis compared to other forms of therapy.
02:04:42
An Androgen receptor assay coupled with free testosterone levels can help make more informed decisions regarding testosterone therapy.
02:12:25
A study found that a small percentage of men taking phenasteride for alopecia experienced negative symptoms, including suicide, which raises concerns about the drug's potential impact on mental health.
02:20:07
High doses of testosterone in patients with castrate-resistant metastatic prostate cancer showed no difference in overall survival compared to standard care, but significantly improved quality of life and may lead to greater survival rates, suggesting a potential shift towards therapeutic use of testosterone in the future.
02:27:17
Testosterone replacement therapy with aromatase blockade in women with breast cancer may be a therapeutic option, as testosterone is suggested to be protective against breast cancer.
Categories:
Health & Fitness
