Armor Men's Health Show

Bonus Episode: Are There Links Between Type 2 Diabetes, ED, and Penile Shrinkage? Dr. Mistry Answers Listener Questions

November 04, 2022 Dr. Sandeep Mistry and Donna Lee
Armor Men's Health Show
Bonus Episode: Are There Links Between Type 2 Diabetes, ED, and Penile Shrinkage? Dr. Mistry Answers Listener Questions
Show Notes Transcript

In this bonus episode, Dr. Mistry and Donna Lee answer listener questions on all things urology--or as we like to say, anything from the nipples to the knees! Today, Dr. Mistry explains: Why are men with Type 2 Diabetes at higher risk for erectile dysfunction and penile shrinkage? Are Trimix injections right for me? What are the differences between daily and on-demand Viagra and Cialis? And is there a Viagra equivalent for women? Listen in to get answers to these and other candid questions from our curious listeners. Then send us yours at armormenshealth@gmail.com. We'll answer them anonymously in a future episode!
 
Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot

Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.

Phone: (512) 238-0762

Email: Armormenshealth@gmail.com

Website: Armormenshealth.com

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Speaker 1:

Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.

Speaker 2:

Hello and welcome to the Armor Men's Health Show. I'm Dr. Mystery, your host. Here's always with my co-host Donna Lee.

Speaker 3:

Hey, everybody. Welcome to the show. We're gonna answer some questions

Speaker 2:

Today. This is a men's health show. We talk about a lot of things from the nipples to the knees, but we are very honored to have guests many times on the show. If you have ever wanted to hear from an ophthalmologist or a gastroenterologist or a colorectal surgeon, this could be the longest consultation you ever have with a doctor like that.

Speaker 3:

Mm-hmm.<affirmative> sounds like people you don't wanna have a party with, but you should listen to them on Saturdays right here at Klbj

Speaker 2:

<laugh>. Good. Listen to those, uh, old archived, uh, conversations we've had with so many of them. Amazing in depth conversations with oncologists, surgical oncologists talking about breast cancer in your wives and your girlfriends. We can talk about so many other things on this show. We, we really look forward to continuing to deliver content, which we've done for over three years now.

Speaker 3:

Mm-hmm.<affirmative>, it like feels like 10 minutes

Speaker 2:

Underwater. Underwater, Uh,<laugh>, I'm a board certified urologist. This show is brought to you by the urology practice. I started in 2007. AAU urology specialists. Uh, we have four physician providers we have, or mid-level or advanced practice practitioners, and then we have two pelvic floor physical therapists, sex therapist. We have a wonderful health coach, Lauren, who helps with more a holistic approach to what's going on with you. Mm-hmm.<affirmative>, and really a, a very strong commitment to your urologic

Speaker 3:

Care. Don't forget sleep coordinator.

Speaker 2:

Oh, that's right. We also do a lot of sleep. That's a big, big thing for you, huh?

Speaker 3:

Mm-hmm.<affirmative>, I get up a lot at night. I think I need to go through the program.

Speaker 2:

<laugh>, I need to go through the program.

Speaker 3:

Is that, is am I a candidate if I get up 10 times a night? You

Speaker 2:

Are. And you, you're also a candidate for the hormones, which

Speaker 3:

I love my hormones though. Great. I love hormones. I just don't sleep.

Speaker 2:

I just don't sleep well. Uh, what questions do you have for us? And, uh, tell people how to get ahold of

Speaker 3:

It. That's right. You can reach out to us at armor men's health.com where you could submit your amazing questions and we'll answer them anonymously on the show. I'll even respond. I'll let you know. Uh, when you can hear the answer from Dr. Mystery. You can check us out there. Armor men's health.com. Our phone number(512) 238-0762. You can ask for me the first question. Are you ready, sir? Yeah. Mystery. M i s t r y. By the way, I'm 67 years old. I'm sexually active with the help of Trimix. Now I have type two diabetes. I don't think those were related, but he just said that as a second sentence. Uh, my penis seems to have shrunk and is not very sensitive anymore. Can you help? That's a

Speaker 2:

Great question.

Speaker 3:

My husband sent that

Speaker 2:

<laugh>. So thanks Michael, for supporting the show. There's a lot packed into there. So first, let's talk about erectile dysfunction in 60 year old men and what people can expect. And the answer is, who knows? Because every 67 year old man is different. Some guys come in like completely flabbergasted that their erections are soft. Really?

Speaker 3:

Like what happened? Is it overnight for me?

Speaker 2:

Did I, did I offend God in some way?<laugh>, my erections aren't as hard. And other guys, you,

Speaker 3:

You offended your wife with that soft, hard answer,

Speaker 2:

<laugh> and, and other guys come in being like, Hey, I'm 67. Well, you know, what was I gonna expect? This is gonna be a natural part of aging. And although erectile dysfunction would be considered a very commonly encountered part of aging, by no means do we think that not getting appropriate blood flow or having diminished sensation or you know, a loss of sexual satisfaction be a normal part of aging. As I say, constantly on this show, my favorite patient is the 80 year old guy who comes in wanting an erection because we can help him find one, you know,<laugh>,

Speaker 3:

Whether it's his or someone else's,

Speaker 2:

No, we're gonna help him by the way out mine is getting blood flow to the penis. These are things that can be achieved in so many, uh, patients. This particular patient, uh, caller, uh, or listener, is saying to us that he already has gone through the routine ways of dealing with erectile dys function. Mm-hmm.<affirmative> and is using injections that he self administers into. His penis is called trimix injection. Now, uh, do you know how trimix injections were first introduced to the urologic community

Speaker 3:

On

Speaker 2:

A bet? It's infamous. It's infamous. Oh, I can't wait. This guy, this one physician researcher,<laugh> Yeah. Literally injects himself in the middle of the American Urologic Association meeting. Stop it behind the podium. No. And steps around with a hard on, with a whole convention center full of urologists.

Speaker 3:

No, that is not how this happened.

Speaker 2:

That's exactly how it happened.

Speaker 3:

Is this, We can Google

Speaker 2:

This. No, it's, it's, it's an infamous, you know, in the urology community, it's an infamous urologic thing. And you know, like, you know, the old guys, they were there, you know,<laugh>. And so this idea, it's like a magic. It hadn't, like, usually when you inject a medicine into a blood, to a blood vessel, that medicine goes everywhere. And the penis is really a humongous blood vessel. That's what gives us an erection. And so to have medicine to be injected into the penis and not go throughout your whole system is something that's kind of, you know, it, it's, it, it's a little against what we normally would think. Right. But in fact, if you inject this three part, let's try mix. There are three medicines in there. Mm-hmm.<affirmative>, all of which are, uh, to dilate or open up the arteries that go into the penis. Mm-hmm.<affirmative>, because if you use one and too high of a dose, then it may go into the blood streamer, it may not work as well, or it may hurt. And so we use this special mix now, it's not just a off the shelf mix. In our office alone, we have 15 different, uh, combinations of these three different medicines Oh. That, that you can put together. So there's a little bit of trial and error. And so, um, when you inject it into the penis mm-hmm.<affirmative>, you can start, uh, you, you get an erection oftentimes within just a, a minute or two, and it can last for, you know, anywhere between half an hour and a couple hours. If it lasts four more than four hours, then you need to call us and come back. So we can give you the anti tell everybody, you know, one pill. Right. It last for more than four hours.

Speaker 3:

Tell, So wait, when does it go? Like after the, the guy has sex and he's finished. Is the the erection gonna go down on its own with trimix? Not

Speaker 2:

Always. Still, not always. A lot of times it'll stick around.

Speaker 3:

So it's not like Viagra where you have to have sex to relieve the erection.

Speaker 2:

That's right. In this case, sometimes the, the, the erection can stick around. Ooh. And so, but, but, but that shouldn't, that shouldn't make you fair scared. Like if, if you're usual sexual encounter lasts for about half an hour, then we dial down the dose and dial down the, you know, the, the kind half an hour. I know Jesus.

Speaker 3:

What are you guys doing?

Speaker 2:

Your husband's like, What am I gonna do? The other 29 minutes? Yes.

Speaker 3:

20, 29 and a half minutes.

Speaker 2:

You can almost watch half F1 raising all time. That's perfect. So if, if you're out there and you're using and you have hit the wall and people have recommended these types of injections and you've just been very, very hesitant to like proceed with them, I assure you of several things. The needle that goes that you use is small and generally does not hurt. Yeah.

Speaker 3:

Teeny tiny.

Speaker 2:

And, uh, there's a very high rate of satisfaction mm-hmm.<affirmative>. And so, although I'm not gonna talk more about just erectile dysfunction, I do want to talk about type two diabetes. So type two diabetes is, uh, blood sugar anomalies. Your blood, your body's not handling blood sugar like it should be. And erectile dysfunction is an incredibly common, like co uh, a symptom of, of type two diabetes. Gotcha. So especially if your diabetes isn't particularly well controlled, then your, uh, the blood vessels that feed blood to your penis will be damaged by the diabetes. And so those two are very much linked. Mm-hmm.<affirmative>. But the real question this guy's asking is, why is my penis getting smaller? Right. And I get that question all the time. Isn't

Speaker 3:

That natural that part of life?

Speaker 2:

I mean, I don't, I'm not gonna say mean for something. I'm not gonna say that it's a universal truth that your penis is gonna get shorter, but here are several things that all interact together to give you the appearance of a shorter penis. Number one is if you start gaining weight in your mom's pubis, you're gonna start getting less of it being like out of you and more of it being kind of tucked into you. Is that the ppa? That is a little bit of the fpa.

Speaker 3:

Okay. That's the, like the little fat above

Speaker 2:

Your, above your penis in

Speaker 3:

This case, not really your belly, but things

Speaker 2:

Of the belly. That's right. Right. The mons pubis. Okay. And so that's one thing that could be occurring. Number two is when you have erectile dysfunction for a long time, that's one of those, if you don't use it, you're gonna lose it. Situations, uh, don't tell my where, where it kind of retracts in because you kind of a lack of, you know, endogenous blood flow. Mm-hmm.<affirmative>, there is a potential that the trimix could be causing it. And, um, it, with, with, in some patients, not universally, but in some patients, one component of the trimix can kind of cause a little bit of scarring in the Oh. In there that kind of cons, contracts the penis. So for a patient of mine, if there are complaining of some sort of penile contraction or shrinking, we will remove one of the components of trimix called prostaglandin. Oh. And just go with a BI mix or two of them. And

Speaker 3:

Those, that's going back to the 15 variations you mentioned.

Speaker 2:

That's right. As part of the 15 variations, oftentimes, and certainly regularly, if anybody's complaining about penal shortening, we'll put them on a vacuum erection device program. Mm-hmm.<affirmative> where you, where we use daily, we have you cycle up the penis to its maximum rigidity and have it go down even if you don't kind of keep that erection with a ring and, uh, put you on a daily Cialis, which will keep blood flow at its maximum going to your penis. Hmm. Uh, there is no great way of reversing shortening, but we are hopeful that we can find ways to keep it from getting any worse. And this conversation we have not only with patients who just complain of penile shortening in general, but especially in those patients that have had prostate surgery, where oftentimes penile shortening is something that, that they experience and that's when their prostates removed from a radical prostatectomy.

Speaker 3:

Oh, that sounds so intense when you say ectomy to anything.

Speaker 2:

So, uh, we love those kinds of very in depth questions. We love explaining what's going on, and we would love to see you as a second opinion if you don't think you're getting the care that you want. Donna, how do people get to become patients at aau Urology specialist?

Speaker 3:

Well, you can call us at(512) 238-0762. We have more staff now, so your phone calls will be answered and you can reach out to us through the website if you'd like. Um, we have armor men's health.com for our general questions, and you can listen to the show and our podcasts, but you can also check us out@northaustinurology.com, where we are in Round Rock, North Austin, South Austin, and Dripping Springs, Texas, and we have an award-winning podcast.

Speaker 2:

I'm Dr. Mystery, your host, board certified urologist at Naau Urology Specialist, which is the proud benefactor of this show. We are a practice with four urologists and many, many other practitioners that are, you know, trying to give you an amazing experience. We are doing our best to, uh, be responsive to your request for appointments. Even though just like many people, we are very busy, uh, we would ask that you have lots of patients love doing vasectomies and want to take care of all of your urologic needs. And I'm joined by Donnel Lee, my co-host, and my, you know, since you've been joining us, since you've joined us as our practice, our practice has been nothing but exploding.

Speaker 3:

<laugh>, you're welcome. Are you saying I'm paying your, your mortgage? No, because

Speaker 2:

Of thanks. Thanks to you and the relationship you have with my wife, my Morgan seems to get higher and higher every day.

Speaker 3:

That's true. Good luck on that renovation.

Speaker 2:

<laugh>, how do people get ahold of us? Send us questions.

Speaker 3:

You can reach out to us during the week at 5 1 2 2 3 8 0 7 6 2. My extension, by the way, is two 20. If you just wanna leave a question there, you can also visit armor men's health.com. Submit your questions there. Our parent website, the NAU urology specialist website, naau is north austin urology.com. But give us a call. We're in Round Rock New, I almost said New York. New York. We're in Round Rock in New York. We're in Round Rock, North Austin, South Austin and Dripping Springs. We're not in New York. Quite a commute. Wow. That was intense. I have more listener questions for you, sir. Let's do it. Dr. Mystery, on a recent show, I caught you at the end of the discussion talking about taking daily Cialis. Um, is there any harm in taking daily Cialis, please advise.

Speaker 2:

That's a great question. So, um, Cialis or Tadalafil is a class of medicine called a phospho diorize inhibitor. So PDE e i five inhibitor PDE five inhibitor in New York. And so, and so that, that that part of the body that this medicine is inhibiting present in many different parts or or tissues in the body besides just the erectile tissue. And so some of the common places that we see it in are going to be the nasal passages in the, um, the, the way that our eyes kind of detect light, in particular, the ones that Cialis can, uh, kind of cross cover are the, the large muscle groups of the latisimus door sign in the back. So,

Speaker 3:

So many

Speaker 2:

Words. So, so the kind kind of side effects people can experience include, uh, changes in how they're looking at different colors. So Viagra very, you know, notorious for the, a blue green haze occurring around eyes, around lights, and then you have nasal stuffiness that can occur kind of an upset stomach or dyspepsia. And then with Cialis, I see a lot more people potentially having joint pain or back pain.

Speaker 3:

What's the percentage though? That's like a really small

Speaker 2:

Percentage there. It's a pretty small percentage. I would say that with Viagra, I see probably like a 15 to 20% rate of some kind of side effect and daily on demand. Cialis mm-hmm.<affirmative>, I'll see somewhere about an 8%. Uh, and I'm not talking about the product insert, I'm just talking about kind of what my own experience with these medicines have been. Mm-hmm.<affirmative>. But with daily Cialis, I see very, very low amounts of side effects and it's because the amount you're taking at once is, is a much lower dose. And so, and the effect is cumulative. Um, uh, I find that the back ache is probably the most common and most subtle kind of side effect that we see. Uh, but if, if you suffer from erectile dysfunction, especially if you have a erectile dysfunction with any urinary complaints, the daily Cialis is so much more consistent and they've done studies to show that men on daily Cialis have more sex or sex more often than people taking on demand and psychological effect. When you take a daily Cialis, your penis hangs lower, it's so much easier to get erections. You get morning erections that are better. You think about sex more and you feel a lot more confident that you're gonna be,

Speaker 3:

Because you're physically taking a pill every day. That part of it's psychological.

Speaker 2:

I think it's because the medicine's always in you, so you're always gonna get a better erection. And so what's that? And so, uh, now if you're using it on demand mm-hmm.<affirmative> and especially Cialis, which you know, if you've heard the show, we want you to take four hours before intercourse. I mean, that's a long time. It is. And then you're just sitting around waiting

Speaker 3:

And you can't eat. No, that's Viagra.

Speaker 2:

That's right. Viagra agree. We don't want you eating after you take it, uh, or before you take it. In fact, we don't want you eating. You have to be on an empty stomach when that,

Speaker 3:

So you can't go on a date, like sexy date night at a restaurant.

Speaker 2:

You wanna pop that Cialis like at noon on that sexy date night. Oh. But if you're taking Viagra, then taking it, um, really it's, it's for, for, for our patient's. Viagra really works better in than medicine. Just give up then. What's the purpose of dinner?

Speaker 3:

Just dinner. Why

Speaker 2:

Even eat? Just,

Speaker 3:

Just just feeding me what's excellent.<laugh>

Speaker 2:

Your Tinder website. I would like you to buy me nice dinner, but don't expect anything outta it.

Speaker 3:

<laugh> don't swipe right.

Speaker 2:

Do we have any other related questions?

Speaker 3:

No, but we have, um, a discussion about, we can talk about the Viagra versus Cialis, but you said that just daily cis, why would a patient want to take a daily, I'm sorry, an on demand Viagra, Like do they ever argue with you? I'm like, No, I really wanna take this on demand instead of the daily because he's worried about side effects overall, like long

Speaker 2:

Term. That's a great question. So, um, there really is, um, a, it's an individual thing when it comes to these medicines and in the past we had to worry about cost and insurance coverage. But today, you know, most of the medications except for stendra, which is still, uh, or vad, uh, I think it's vad, nfl, but, uh, but, but Stendra mm-hmm.<affirmative>, which is the, uh, the trade name is the only one that's not available generically, and each of them has their own kind of perks. But today, you know, the only two kind of pills that we use routinely are going to be Sildenafil or Viagra. Mm-hmm.<affirmative>, Sildenafil is often sold as 20 milligram tablets, although you can get it in the hundred milligram tablet, which is the highest dose. Uh, I don't usually use Sildenafil daily, although I have come across a few patients that decide to do so. And that's because the, the effectiveness of it, the effectiveness is only about four hours. So, Oh,

Speaker 3:

That's a short

Speaker 2:

Orgy. That's a short orgy<laugh>. Uh, whereas the, um, the Cialis can be used and it has a much longer time that is effective in your body. Cialis, um, it takes, you know, to, to have its most effective use takes about four hours for it to become effective. Mm-hmm.<affirmative>, but you can eat. And so that's kind of a positive thing in the insert. It says that you can take it an hour before intercourse, but, um, then patients will come tell me that, Oh, the SALs used to work, but now it doesn't work. Similarly, they'll say the Viagra used to work, but now it doesn't work. And so that can be kind of offputting or disconcerting to, to to to men. Mm-hmm.<affirmative>. So if the medicine stops working, we try to first look at why the medicine stopped working. Did it stop because you became kind of lazy about how you're using it? Are you using it kind of how we want you to use it? Mm-hmm.<affirmative>, is there something else going on? Are you losing sensation in your penis? Is your blood flow to your penis getting worse? Is there some underlying condition like your, your heart disease or your diabetes getting, uh, controlled properly to make sure this doesn't get worse? Oh, that's true because it's, you know, the, the knee bone is connected to the penis bone and it's connected to your heart bone, and that's how the body works. Mm-hmm.<affirmative>, it's a, it's, it's not, it's not any one physiologic component of our body that is independent of others. Mm-hmm.<affirmative>, we rely on strong heart, strong blood flow, a good immune system to have good erections. Uh, exercise and lifestyle can play a big role. Uh, in our, in our practice, we, we really emphasize lower body weight-bearing exercises, even walking up inclines, although it's hard to walk up inclines both ways,<laugh>,<laugh>, uh, but, uh, but if you're using a treadmill to add incline to what you're doing, that lower extremity kind of workout tends to boost testosterone levels and improve, uh, blood flow and, and erectile health in our experience. Uh, we also think that getting your testosterone level checked and making sure that that levels are normal, make sure your estrogen level's not too high. Right. If you're on therapy right now, if you're getting testosterone therapy right now and they're not taking checking your estrogen, which happens, I would say the majority of patients that to get transferred to us that are on testosterone therapy are not routinely getting their estrogen level checked, then let us check your estrogen. If you're 40 pounds overweight and you're using testosterone, there's a good chance that your estrogen level over time is getting too high and that can cause your erectile function to worsen or your libido to drop. Mm-hmm.<affirmative>. And so the idea that testosterone replacement therapy is, um, relatively safe, I completely agree with mm-hmm.<affirmative>, but that it can be done without any kind of monitoring. I don't agree with that at all.<laugh> it requires, it requires somebody paying attention and making sure that you're getting exactly what you need, uh, for the therapy.

Speaker 3:

Can women take Cialis, we talked about women taking Viagra. Can women take Cialis? Does it not work as well?

Speaker 2:

Um, so when, when you talk about women using these medications, we're talking about an off-label use, meaning that's not what it's intended for. Right. But we use these kinds of medicines in women all the time, particularly for a specific kind of sexual dysfunction that's called, uh, poor arousal. So it's kind of hard, maybe get your arms around, but the idea here is that it's just hard to get turned on. Mm-hmm.<affirmative>, your clitoris isn't getting hard and you're having difficult with kind of the engorgement of the, uh, of the genitals that, because if, if, if a, if you think about what is the penis like from an embryologic standpoint in a woman, it's the outer lips of the vagina as well as the clitoris. That's what makes up the, that's what that organ turns into in women. Mm-hmm.<affirmative>. So if those areas are not getting en gorged, if you're not getting, uh, the clearest heart enough, then, then those medicines work and the exact same kind of patient that you would expect to have a erectile dysfunction is the exact same woman that's going to have arousal, dysfunction, diabetics, people on metoprolol or alls for their high blood pressure, beta blockers. Mm-hmm.<affirmative>, it's going to be people who are overweight and who have, have abnormal hormones.

Speaker 3:

Okay. Well that makes sense. You're making so much sense today,

Speaker 2:

Man. That's, I must have had a pill.

Speaker 3:

<laugh> was a ticket of

Speaker 2:

Viagra. My Viagra, Donna, how do people get ahold of us? How do people me, just for second opinions,

Speaker 3:

You can call us at(512) 238-0762 or visit our website, armour men's health.com. Check out our podcasts wherever you listen to free podcasts, and you can catch our show if you're in the Austin, central Texas area on News Radio, Klbj, get the free app. By the way, we're on Saturdays at 3:00 PM and, um, we're in Round Rock in North Austin and South Austin in Tripping Springs. So if you're listening on the other side of the world, we really appreciate you as well. But send us your questions. Thanks Dr.

Speaker 2:

Mystery. Thank you so much, Donna. The

Speaker 1:

Armor Men's Health Hour is brought to you by Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armour men's health.com.