EP 610: Get EDucated on ED: Must-Know Info on Erectile Dysfunction Symptoms, Diagnosis, & Treatment

In this segment, Dr. Mistry and Donna Lee lay out everything you never wanted to know about erectile dysfunction. This all-too-common condition has different and often multiple causes. How do urologists know what's keeping each patient down? Dr. Mistry explains why a thorough assessment of the factors that contribute to ED helps him determine the best treatment course and best outcome for each patient. NAU Urology Specialists offers an array of treatment options, including the latest advances in surgical penile enhancement and even implants. If you or someone you love is experiencing symptoms of erectile dysfunction, Dr. Mistry has the answers you need. To schedule an evaluation, please give us a call today!

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.

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Transcript

Speaker 1: 0:07

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

Speaker 2: 0:14

Hello, this is the Arm, men's Health Hour. I'm Dr. Mystery, your host. Here's always with my cohost, the wonderfully communicative and very helpful, and some people think the funnier of the two Donna Lee.

Speaker 3: 0:26

Correct? That is true. All of those are true. As a matter of fact, I am wonderfully communicative, fabulously cute, and very funny. Did you say cute?

Speaker 2: 0:34

I did not. Oh,<laugh>. This is a men's health show. Uh, this is a show in which we touch on many topics that affect general health, uh, men's health in our practice, uh, which is AAU urology specialists. We do treat both men and women for a number of urologic concerns, including kidney cancer, kidney stones, uh, bladder problems, incontinence, hormonal issues, and a variety of other things that, uh, affect kind of lifestyle as well as, uh, life threatening conditions. Mm-hmm.<affirmative> on this show, we discuss both of those, uh, types of topics. Donna, we are very, very appreciative of the incredibly, uh, interactive and engaged audience that we

Speaker 3: 1:07

Have. Mm-hmm.<affirmative>, we have tons of patients who call just because they heard us and they want to see you specifically. So we should also let them know we have other providers. We

Speaker 2: 1:15

Do, we have, we have three other physicians excellently trained, not just you. We have four mid-level providers. We have two pelvic floor physical therapists. We have sex therapy available. We try to really focus on nutrition and health and supplements and all sorts of things that kind of appeal to your basic desire to get healthy on your own. Of course, we do pills and surgery too. I love to do surgery. So

Speaker 3: 1:36

<laugh>, is

Speaker 2: 1:36

That right? I am a surgeon.<laugh>.

Speaker 3: 1:39

Is that why you're always cutting steak and chicken when

Speaker 2: 1:41

We walk in the kitchen very, very nicely in little

Speaker 3: 1:43

Squares cutting things up.

Speaker 2: 1:44

<laugh>. It's the only thing I can do. Really?

Speaker 3: 1:46

Yeah. Cuz we fix so many patients with nutrition and, um, all of the other holistic options we have that you probably could be doing more surgery if we weren't so proactive<laugh>.

Speaker 2: 1:54

That's right,

Speaker 3: 1:55

That's right. With our other

Speaker 2: 1:56

Patients. So your questions are really what drive this show. Uh, Donna, why don't you give us our first question? Well,

Speaker 3: 2:01

It's kind of a discussion. It's, um, of, of course, anonymous. All of these are always anonymous, but we had a patient reach out to me directly because one of our providers said, Hey email Donna, she'll get you this brochure. So he was asking all about our spark wave treatment, how it compares to other shockwave treatments and linear compression focus ultrasound. And I know we've talked about this quite a bit for the new listeners though, I thought this would be a interesting discussion. This patient has tried Viagra daily. Cialis, he's, um, just very frustrated and he said in our tons of emails going back and forth, he said his wife's very frustrated with him. So I can tell he's hurting and suffering a little bit. So I wanted to kind of revisit the discussion, especially since we changed our pricing to, to$1,400 for six treatments. Um, instead of the, what,$10,000 you might pay elsewhere.<laugh>, I think it's like

Speaker 2: 2:49

$5,000. I I think that it's really important for our listeners to understand that, that men are different when it comes to their response to erectile dysfunction. There's a group of men who are in their thirties that think, oh, I'm getting older, it's normal to lose my erections. Mm. And then there's the guy in their eighties who's surprised, like genuinely surprised<laugh> that something is going on with his erections. Right. One of the tough parts that we have is, uh, the psychological impact that losing what a man, uh, you know, that some men feel is their virility to lose that and not be able to get an erection on demand. Right Now, women, their partners sometimes feel like it's their fault that their attractiveness is somehow not as high in their partner's eyes. Mm-hmm.<affirmative>, and that's what's leading to the problem that can, that attractiveness can be, you know, emotional attractiveness or it can be physical attractiveness. Mm-hmm.<affirmative>. And then that leads to this feedback loop where, you know, the man is afraid of disappointing his wife. And anxiety really leads to, you know, quite a erection killer mm-hmm.<affirmative>. And so that performance anxiety gets compounded by this feeling of disappointing the other partner. Right. And it can really be a very difficult issue to overcome mm-hmm.<affirmative>. So sometimes we can improve somebody's blood flow or improve their nervous system function or improve their hormones and they still have the psychological factor, right. That's impeding their ability to get and keep a good erection

Speaker 3: 4:22

Because that's not an on and off switch. That's kind of a long term fix

Speaker 2: 4:26

It. You have to fix it over some time, especially if it's been some time since you were able to get back into the habit of having regular, you know, sustained intercourse mm-hmm.<affirmative>. Now I'm not gonna say we can fix everyone, but I will say that we can fix most people and by fix what I mean is we can give you the tools necessary to be able to get a good erection to be able to have intercourse. Now, some of the things are relatively easy and some of the things are harder. Mm-hmm.<affirmative>. So I thought I'd first kind of just talk about kind of what, how our approach is to erectile dysfunction. Maybe in the second half of this discussion we can talk about the specific things that we offer here mm-hmm.<affirmative> or am I explaining erectile dysfunction to patients? I say that this organ that we have is com almost completely dependent on blood flow. Uh, to work you have to have an intact nervous system. However, you have to have the ability to feel things. But even men with spinal cord injury can get an erection that's spontaneous as long as they have good blood flow. You need arterial flow that goes into the penis and that's, that can be affected by high blood pressure, high cholesterol. So you need good arterial flow and then the blood has to get caught into the penis and that's done by blocking the veins or the outflow of the penis. So you have to have good blood flow in mm-hmm.<affirmative> and you have to have intact veins and valves that keep the blood flow from leaking or leaving the penis. Right. That's a double thing. So those patients that have peroni's disease where you have a curvature of the penis, we talk about peroni's disease a lot on the, on the show. Mm-hmm.<affirmative>, they can have difficulty with the blood flow leaving the penis. Right. And those people who get older with diabetes, high cholesterol, longstanding hypertension, they can have difficulty with blood flow going in. So blood flow is a big part of it. The intact nervous system, the sensation of the penis is important. That can be affected by spinal cord injury. Uh, previous back surgery, it can be affected by multiple sclerosis, or the most common one is gonna be diabetes that leads to diminished sensation in the skin. Mm-hmm.<affirmative>, the third area that we try to attack is going to be hormonal impact. So when we, when I was in medical school, they would teach us that testosterone only has an impact on sex drive, not on erections, but in the last 20 years we've had a much better understanding to understand that if your testosterone level isn't normal, the healing, the blood flow, the nervous system of the penis is also going to be adversely affected. So mm-hmm.<affirmative>, making sure that we get your testosterone and estrogen ratio kind of imbalance, that's gonna be a part of what we do. Right. And then the fourth one is your brain psychological, your brain, especially the younger you are, the more you're gonna get impacted either because the relationship's not as long either because you're not as confident in yourself, whatever the reason be. So like if a 22 year old guy comes into our practice, you're gonna think, you know, 80% psychological mm-hmm.<affirmative>, 20% physiological. And if you get a 60 year old guy, you're gonna reverse that. You're gonna say this is probably 80% physiologic and 20% psychologic. Right. And that kind of really talks to our how much time we spend, uh, on these things. So when you come to see us, the first level evaluation is going to be kind of just understanding what's happening. Are you having trouble getting, are you having trouble keeping? Are you having trouble getting and keeping? If it's because you can't go a third or fourth time<laugh>, it's a different issue. Sometimes people, they have, they think they have erectile. That's right. You're like, that's like, that tortures me. Then there's those people who have, they come in for a erectile dysfunction, they really have something else, premature or delayed. Mm-hmm.<affirmative>, some people they can't orgasm when they have sex with a person, but they can orgasm when they have sex, you know, when they. And so all of these things require a different kind of, uh, approach, approach to them. And that's, that's why you have to ask some questions. So Viagra and Seattles are not gonna be the solutions to everything because not everybody has the same problem. But if

Speaker 3: 8:14

You watch tv, that is the solution

Speaker 2: 8:16

To everything. It just seems to be the solution. And then when they don't work, then you feel kind of, kind of defeated. So a hormonal evaluation in our practice will include a testosterone, estrogen, usually a free testosterone level. There's a special hormone called prolactin that can be elevated that can cause a erectile dysfunction. We check that. We want to check your thyroid physically. We can actually check the nerve system function of your penis. We can do what's called a vibratory and temperature, uh, stimulation test. Mm-hmm.<affirmative> to make sure that you're able to feel the penis properly. This is in the office. That's right. This is especially useful in diabetics who have difficulty in keeping the erection. So these are men who lose the erection, like mid, mid act. Oh. And so those patients, um, we test it and if it doesn't work, then we sec we can recommend certain types of vibratory or temperature stimulation during intercourse to maintain your erection. Then we want to make sure that the blood flow works. So for those special patients, there's

Speaker 3: 9:10

A lot of things involved.

Speaker 2: 9:11

<laugh> we do, but we can because that's awesome. You know, a lot of the men we get are just sick and tired of not somebody not trying to find the underlying reason. Even if I can't fix it, I might not be able to fix your diabetes, but at least I can give you an answer. Mm-hmm.<affirmative> of, of, um, uh, about what might be go, you know, going on. Right. We have psychological evaluations. And then I think one of the real special things that we offer for ED is the biomechanical option. This idea that we have a pelvic floor physical therapist, we have two of them, uh, on staff mm-hmm.<affirmative> that are here to like, you know, understand what's going on in your pelvis. Are you yourself, the way that your body is working, is that contributing to some of the problem mm-hmm.<affirmative>. And that kind of entails what our evaluation for a erectile dysfunction is. And I think in the second part what we'll do is we'll discuss kind of, uh, what our approach is, what our treatments are, and we'll include what, what value does ultrasound therapy or shockwave or spark wave or whatever you're gonna call it in the community gonna have. Right. Uh, Donna. Uh, but before we, uh, leave this first section, how do people get ahold of us?

Speaker 3: 10:12

You can call us at(512) 238-0762. You can even ask for me, our email address for these amazing questions and discussions is armor men's health gmail.com. And you can visit our podcast or listen to our podcast wherever you listen to free. Amazing podcast. Thanks, Dr. Mystery.

Speaker 2: 10:29

Thank you, Donna. I'm Dr. Mystery, your host, a board certified urologist, founder of N AAU urology Specialist and a proud host, co-host, really the second host. Mm-hmm.

Speaker 3: 10:39

<affirmative>, don't forget

Speaker 2: 10:40

That part. You know, you know why co-host is appropriate because there's like a pilot and there's a co-pilot. Oh, you're not both

Speaker 3: 10:45

Co-pilots. No, you're right. You're the, you're the host. I'm the co-host.

Speaker 2: 10:49

I'm the co-host because you run the show without me sometimes. That's

Speaker 3: 10:51

True. Yeah. Because people like that<laugh>, they like the Dr. Donna by herself.

Speaker 2: 10:57

This is a men's health show. We have a urology practice that we treat both men and women for a number of urologic conditions. But this show is really dedicated oftentimes to issues that just affect, uh, men hormonal issues, erectile issues, uh, although we discuss kidney stones and cancers that affect both sexes. We love your questions and we love the discussion that we get. So please keep your questions coming via email and we'd love to answer them.

Speaker 3: 11:21

Hey, Dr. Mystery, I heard that a patient was in the room with a doctor recently here and the guy's really young, and he said he came for to talk about ed problems. Mm-hmm. And the doctor said, um, sir, you're gonna have to stop masturbating. And the guy said, why? And the doctor said, because I need to examine you,<laugh>. It was a poor start, but I ended

Speaker 2: 11:41

Well. That was pretty good. Uh, I thought we'd continue our discussion on erectile dysfunction. We discussed in the first part, um, kind of what our evaluation is, how I subdivide the causes of erectile dysfunction when I approach a patient mm-hmm.<affirmative>. And now we're talking about the real nitty gritty, the,

Speaker 3: 11:56

The nitty

Speaker 2: 11:56

Gritty. We'll talk about, you know, what we do for treatment. First of all, a good evaluation is critical to understanding, uh, what the causes of the erectile dysfunction are gonna be. Mm-hmm.<affirmative>, whether it be vascular, neurologic, psychological, or hormonal. If it's hormones, then we try testosterone. If we think it's predominantly vascular. So like the classic patient, a 57 year old man who is a little overweight, maybe a diabetic one drug high pressure. That's funny. I already had a heart attack.

Speaker 3: 12:23

That's already Exactly.

Speaker 2: 12:24

I've already, I've already, I'm envisioning your husband right now. Wow. While I think, think about this patient, sorry, Michael, with some erectile dysfunction. And you know, he, a lot of times they'll come in and they'll already have tried pills. My favorite one of the guys that, that tried pills that they've bought at the gas station or Mexico, I mean, Mexico's fine, at least that's drugs, but I'm sure, I'm sure your gas station's not selling like, you know, proof pharmaceuticals. I have a guy that's like, like he swears by this thing called white tiger. I love white tiger, white tiger. It's$7 a pill. Oh. And I'm like, what is it? That seems like a lot of money.

Speaker 3: 12:57

Is it like a

Speaker 2: 12:58

Supplement? It's just fake. It, it's like somebody took it, something, a supplement and then sprinkled a little Viagra in there and it works. But they think they're like subverting the system somehow because they're able to get white tiger from the Please do not buy pharmaceuticals from your gas station, white

Speaker 3: 13:12

Tiger. That

Speaker 2: 13:13

Sounds sexy. And, and, and these things come on the market and come off the market because the FDA goes around and tests them and finds out they really do have drugs in them. Well just buy the real drug. Right. It's easy enough, it's cheap

Speaker 3: 13:24

<laugh>,

Speaker 2: 13:25

So

Speaker 3: 13:25

It's less confusing

Speaker 2: 13:26

And, and it's safer. So yeah. When people are taking medications, it's critical that you take these medications properly. I speak about it often on the show. Viagra, it's optimal uses on empty stomach an hour before intercourse. And by empty stomach, I mean no food. So, uh,

Speaker 3: 13:42

They don't tell you that on

Speaker 2: 13:43

The commercial. I know, but it's great for like a morning pill. So you roll out bed, pop the pill next to your bed and then, you know, read the newspaper for an hour and then go for it. Oh no. Um, sounds terrible to me. Newspaper quote unquote newspaper. And then, uh, Cialis, which we like on an on demand way needs to be taken four hours before intercourse if you're still one of these, uh, folks that takes Lavera. Uh, not too many of you guys out there, I

Speaker 3: 14:08

Haven't heard that name in a long time,

Speaker 2: 14:09

Time know it's, it's the same as Viagra hour before course of Stomach. There's a medicines called Stendra that really, um, puts itself out there as being a medicine that you can take after eating and only need 30 minutes to work. I assure you that if you want it to work really, really well, empty stomach r foreign intercourse,<laugh> and the Cialis, uh, can be taken in two ways. One is four hours prior intercourse and the other one is daily, which is our favorite mechanism of using it. Right. It's inexpensive, you know, less than 30 bucks a month. You take it every morning like your second vitamin C, vitamin C, Alice,<laugh>, and you'll be able to have good spontaneity for a great

Speaker 3: 14:44

Big dose of

Speaker 2: 14:45

Vitamin C function. Your, your<laugh> erections in the morning will be, will be more firm and you'll feel a lot more confident. And uh, that's really what we're trying to get out of it. Again, if it's a hormonal issue, then testosterone or fixing your thyroid or reducing your prolactin would be things that we would kind of do. If it's biomechanical, if it's difficulty in how your pelvic floor is relaxing or mm-hmm.<affirmative> being overly strained, then we have, again, two pelvic floor physical therapists on staff.

Speaker 3: 15:11

I'd like to suggest that 80% of the men listening who have Ed haven't thought that there's a pelvic floor component.

Speaker 2: 15:18

I would agree with you. And that's why, you know, I that's more one of the purposes of the show is so that when you come and see us, you're educated or you see any urologist. Right. You have some kind of expectation of what's gonna happen. And if you're just going to one more pill popper, you know, pusher, then, then maybe the gas station is an appropriate alternative because, because you really want to have alternatives to treatment. Mm-hmm.<affirmative>, a lot of men don't want to use pills. So we want to try to find a more natural way. We use lots of supplements, uh, although, uh, we don't get reimbursed or paid or sponsored by anybody. We use Arteri cell quite a bit mm-hmm.<affirmative> as a supplement. And if you're interested, you can email us more and we'll send you an email to that, that

Speaker 3: 15:55

Link. I am gonna get us a sponsorship from White Tiger though.

Speaker 2: 15:58

<laugh> white Tiger. We like appropriately sourced, uh, horny goat weed. Oh. Which I think is the one of the best named supplements that's out there. Horny goat weed.

Speaker 3: 16:07

Yes. Uh, that you can also find at the convenient store.

Speaker 2: 16:09

You can also find that. But, but we want good stuff. We buy it here. We want the stuff. Uh, l Arginine we use a lot as a supplement as well. We have a very close relationship with sex therapy mm-hmm.<affirmative>. So especially we get a lot of students from University of Texas, believe it or not, we have a great relationship with their health department there. And you know, when a young kid comes in with a erectile dysfunction, like it perks some ears up. Right. And it's probably beyond the, the usual kind of capabilities of just a traditional primary care doctor to deal with. Right. Ed and a young person.

Speaker 3: 16:38

And we're gonna have Dr. Bag de on the show. She's with the Center for Relationships, our partnered sex therapy group. So she's gonna be on our show in the next month or so.

Speaker 2: 16:45

Well, that's perfect. Then what comes to the kind of specialty things that we offer? We offer PRP injections, it's also known as the P shot. It uses your own plasma rich plasma mm-hmm.<affirmative> that gets spun down and then extracted and then injected into your penis. That doesn't sound great,<laugh>, but it's a one time thing. Pea shot has been known, um, especially, uh, in patients who have diminished sensation. Mm-hmm.<affirmative>, we use it a lot there, uh, works for erectile dysfunction and we want to see it also used for a condition called lichen sclerosis, which is a skin condition of the penis. We're using it increasingly in that we then do the shockwave therapy. So shock wave therapy uses ultrasound energy kind of in a way to cause microtrauma in the blood vessels and the nerves that kind of help innovate and, and, um, allow blood flow into the penis. Mm-hmm.<affirmative>, it then allows for a regenerative process. That's what we're looking to kind of build you back better. And that's what the purpose of that

Speaker 3: 17:41

You went political all of a

Speaker 2: 17:42

Sudden build back better. It does. And I will say that it does not work in everyone. So if you're out there and you're hate, when I see this, I see like a 75 year old guy mm-hmm.<affirmative>, who hasn't gotten an erection in 10 years, drop$10,000 at some popup, you know mm-hmm.<affirmative> place and come to me and say, well, it didn't work. Well no kidding, it didn't work because it's not gonna raise you from the dead. It's not gonna, and it's not gonna like take something that hasn't worked for 10 years and then all of a sudden give it a new spark. What what it's really designed to do is to help improve firmness in people who are losing firmness. It's really ideally suited for the man, in my opinion, between 45 and 65, who has like 70% native erections. The pills are working, but is having side effects and wants to get off the pill. That's gonna be kind of your ideal kind of demographic. Right. If the pills don't work, the shockwave doesn't work. Then we have, we have other treatments. We have an injection that you can put into the penis called Trimix. Uh, this, uh, used to be kind of the only treatment that these popup ed clinics used to have called, like Boston Medical Group and things like that, where they would just, everybody would get the same thing. It's the treatment for premature is the, it's the treatment for erectile dysfunction. It's just the treatment. And, um,

Speaker 3: 18:53

Everybody's walking around with heart ons all over

Speaker 2: 18:55

<laugh>. And when there was a problem, they'd have to call a real urologist. Right. And so they would call fix it to fix it. So, uh, this injection, although very kind of, uh, mentally, um, something to overcome, these are the benefits. It works independent of your psychology. Yeah. So if you have severe performance anxiety, so I get a lot of young couples, especially from South Asia mm-hmm.<affirmative> in which they cannot have intercourse. Right. They're simply unable to. The man cannot maintain it. He's fearful. They can't even practice, they can't do anything. I

Speaker 3: 19:25

Should have married somebody from the Southeast Asia.

Speaker 2: 19:26

Yeah. You should have been. He's two PPEs a in a pod.

Speaker 3: 19:30

We don't have the sex.

Speaker 2: 19:32

And um, and, and they come to me when they want have kids mm-hmm.<affirmative>. And so these are people, you know, where the injection into the penis to give them an erection will help them overcome any performance anxiety. Give them the time. And if you're, if you're out there and you erectile is function so severe that you simply depressed relationships kind of crumbling, these are the kind of things in which you should, should be open to mm-hmm.<affirmative>. And you get the guys that are, that understand that and are happy with it, with the treatment and accept it and move on. And then you get the guys that are tough to some guys out there think that somehow I have some magic treatment that I'm keeping from them.<laugh>. I assure you, I assure you I'm not, I'm not. If I have a way to help you, I will do that.

Speaker 3: 20:16

We've had lots of patients too ask me if that's the last resort treatment, the spark wave. And I, I, I always say it's not the last resort. It's just one of the many tools in the toolbox that

Speaker 2: 20:24

We have. Of course. And we want, we want it early in the system, not mm-hmm.<affirmative> not, not late. So Donna, um, wonderful discussion. How do people get ahold of us? How do people send us questions?

Speaker 3: 20:32

You can reach out to us to armor men's health gmail.com. You can call us at(512) 238-0762 during the week. And you can listen to our podcast wherever you listen to free

Speaker 1: 20:43

Podcasts. Dr. Mystery wants to hear from you. Email questions to Armor Men's health@gmail.com. We'll be right back with the Armor Men's Health Hour.