EP 646: Tell Me Why!? ED Expert Dr. Christopher Yang on Underlying Causes and Next Level Treatments

In this episode, Dr. Mistry and Donna Lee are joined by NAU Urology Specialists’ own Dr. Christopher Yang to discuss the underlying causes of erectile dysfunction and how responses to ED symptoms and treatments vary amongst their patients. For men who want to know why ED is happening to them, we offer in-depth evaluations such as blood work panels to check hormones, ultrasound imaging that tests blood flow, and physical evaluations to measure any build up of scar tissue. Our holistic approach also includes screening for conditions like hypothyroidism, sleep apnea, and mental health issues. Finally, our providers work to ensure that patients are taking their medications properly and that drug interactions aren't at the root of unwanted symptoms. Whether your ED is new or you’ve suffered for years without knowing why, our team at NAU Urology Specialists can help you find both answers and effective treatment 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.

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

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Transcript

Speaker 1: 0:00

<silence>

Speaker 2: 0:09

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

Speaker 3: 0:15

Hello and welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, board certified urologist all around. Great guy <laugh> here with my awesome, great gal, Donnel Lee .

Speaker 4: 0:26

I'm gonna get you an , an actual horn so you can toot

Speaker 3: 0:28

It. I'm going to toot my own horn. <laugh>

Speaker 4: 0:31

<laugh> . Thanks for listening to the show, everybody.

Speaker 3: 0:32

Well, I'm married, so I'm gonna have to do that myself. Hey, <laugh> , this is Men's Health Show. I'm a board certified urologist, and this show is brought to you by the practice I started in 2007 N a u Urology specialist. Donna, we are really growing showing. Why don't you tell people about our practice?

Speaker 4: 0:50

We are all over the place in central Texas. If you're on the other side of the country , um, you can still fly to see us. We're in Round Rock, north Austin, south Austin, and Dripping Springs , Texas. Our phone number, as you've probably memorized by now, 5 1 2 2 3 8 0 7 6 2 . See how I slowed that down? And our website, armor men's health.com, where you can see our shiny faces and send your questions that will answer anonymously. Due to

Speaker 3: 1:12

Having some excellent new providers, our wait times have decreased substantially. So if you're out there waiting to get a vasectomy, waiting to get your testosterone checked, waiting to get your erectile dysfunction fully evaluated, we would love to see you as a patient. You can feel free to call us, email us. Uh, and we would love to give you , uh, answers about , uh, your questions here on the radio. We'd love to engage with our , uh, patients and give you a holistic type of experience when it comes to your urologic care. We are joined today by one of my favorite people, Dr. Christopher Yang, one of the partners at N A U Urology Specialists, Chris Yang, thank you for joining us today, and

Speaker 5: 1:50

Thanks again for having me. We

Speaker 4: 1:51

Never get to see him.

Speaker 3: 1:52

So I know <laugh> , he practice South Austin . We practice all pro other places. So , uh, Dr. Yang practices at our South Austin clinic predominantly, although it does come up north. And , uh, Dr. Yang, maybe you could tell our listeners kind of a little bit about where you train and what the nature of your fellowship was. Yeah ,

Speaker 5: 2:06

Sure. So I did my medical school in the great city of Galveston, Texas. Oh . Uh , pre , uh, hurricane, knocking down the great city. Oh. After that, I did my residency in urology in Chicago at University of Illinois. And then after that, I did a sexual medicine fellowship in University of South Florida, helping the great people of Tampa, Florida.

Speaker 4: 2:27

The retired people be

Speaker 3: 2:28

Great again. Yeah. You

Speaker 4: 2:29

Know, there's a whole documentary about retired people in the Florida community, and it's like really dirty. Oh

Speaker 5: 2:35

Boy . Yeah . And they, you know, all of them, they, they want , uh, their erections fixed and that's, that's how I trained. So

Speaker 4: 2:41

It's the s t d capital or something of the country. Yeah . Yeah.

Speaker 3: 2:44

So, you know what , uh, I've been really fascinated by , uh, over the years, Chris , is how men are different in how they respond to erectile dysfunction. Sometimes you'll find a young guy that's not bothered at all, and sometimes you'll find an old guy that wakes up one day and is like completely befuddled that his erections don't work, and he's like 82 years old. And those, those are some of my favorite ones. The young guy who doesn't care about erectile dysfunction, those guys are hard to convince that they should care. But the 70, 82 year old guy that's like Dr . Misery's an emergency, I , I don't know what happened. I tried to have sex, it didn't work. And I'm like, are you sure you have a proper understanding of, of like, of like aine physiology, how sex works?

Speaker 5: 3:27

Who are you to tell an 82 year old that they shouldn't have?

Speaker 3: 3:30

I'm , I'm no one. I'm , I told you they're my favorite patient. I'm here . I'm here, I'm here to make America great again, <laugh> . So , uh, maybe you could gimme some insight into like why you think, you know, different men respond to, you know , or, or value their erections differently. Um, you know,

Speaker 5: 3:46

I think it's kind of , uh, it goes into a little bit what, what you were talking about earlier is, is there there situation, you know, some men that are married for 20, 30 years, they, they could care less. Mm-hmm . <affirmative> , some people , some men that are married for, you know, 20, 30 years, they still have sex every day and they mm-hmm. <affirmative> . And if they're not able to get an erection, then , uh, then it's the end of the world. So I think a lot of it goes into what we , uh, another condition that we treat is low testosterone, meaning, you know, men need to have that drive, that that urge, the libido to want to have intercourse. Mm-hmm. <affirmative> . So, you know, we definitely see a lot of young men who have low libido, who have low testosterone, who aren't interested. You know, we see old men who have like great libidos , um, and we can help, you know, evaluate if they have any issues with testosterone, if they have low libido.

Speaker 3: 4:36

So in the same way that men are, you know, differently affected by erectile dysfunction, we get men who have a different level of interest in figuring out what's wrong. That's the underlying condition for their erectile dysfunction. And so anyone can treat erectile dysfunction, and a lot of people , uh, can even go online and speak to a teledoc to get medicine for erectile dysfunction. But , uh, too often men actually want a next level kind of evaluation. So, you know, if, if, if you had a, let's say a 30 year old guy who came to you with softening erections and loss of rigidity, what are some next level ? What , what would be your evaluation for that patient? What should they expect from their doctor?

Speaker 5: 5:19

Yeah, definitely. I think , um, you know, like, like we were just talking about like hormones, libido, testosterone, that has a good amount to do with it. Uh, we definitely are seeing more and more younger patients who have, you know, poor hormones. So, you know, it's, it's pretty standard. If we don't have like a, you know , definite cause of their erectile dysfunction that we, you know, we check a hormone panel, make sure that there's nothing else , uh, physiologic going on,

Speaker 3: 5:45

What hormones should be in that panel. Yeah .

Speaker 5: 5:47

Typically we would check a testosterone and an estrogen just because both of those affect libido. Then we check a couple of other ones from their brain, you know, typically the luteinizing hormone , uh, follicle stimulating hormone, those affect testosterone production in men. And then prolactin is another one that definitely affects libido as well. And

Speaker 4: 6:07

These are labs that are probably not being checked at like low T centers, correct?

Speaker 3: 6:10

Probably not. And probably not , uh, by a primary care doctor either. Uh, because it's so easy just to write a prescription for a pill , uh, when really what the, what the patient wants is an answer to why they're having the erectile dysfunction in the first place. So, so you'll do a hormone evaluation? Uh, I mean, I like to add a blood pressure and a weight because I think that, you know, your overall health can have a real significant impact. Um,

Speaker 5: 6:35

Yeah, definitely. And then, you know, there's some others that, you know, we as urologists don't treat primarily, but we can definitely help evaluate for as far as, you know , uh, hypothyroidism, low thyroid levels , um, sleep apnea. I know you're really , uh, into looking into. And then other things affect erections as far as , uh, other mental health issues like depression, anxiety, stress, like all of those can affect it as well.

Speaker 3: 7:00

There are , there are medicines that patients take frequently that can contribute to erectile dysfunction too . What, what are some of the more common ones that you see? Correct.

Speaker 5: 7:08

Yeah, definitely. Um, so antidepressants can affect it , um, for one way or another. Now, now , that's not to say all antidepressants are bad, you know, we actually use some for a different condition called premature. Patients who have , um, high blood pressure, who take medications aimed at high blood pressure, like all of those do affect erection. Now, I'm not saying you should stop taking your high blood pressure medications, 'cause having high blood pressure can also cause erectile dysfunction, but that's definitely something that plays into it.

Speaker 3: 7:39

So the most common medicine that I see men taking that can lead to it are beta blockers. Yeah . Like metoprolol. So if you have a fast heart rate , uh, that could be contributing to it , uh, I see more and more men that are taking propanolol Yeah . For anxiety. Yeah, definitely. And for a nervous stomach. And then they're surprised that it's causing their erectile dysfunction. So understanding the impact that your medicine may be having is , uh, really important. So besides that, what are some other next level diagnostic ed evaluations?

Speaker 5: 8:09

Yeah, so, you know, one thing that's important to do that, that we would definitely do in the office is a physical exam. You know, that's not something you can get for some of these, these online , um, you know, evaluation clinics. Um, it's pretty important to, to actually take a feel, make sure that there's no issues with, you know, structurally the penis or, you know, testicles. Um, there's conditions called , uh, peroni's disease, which is a scarring disease that can affect erections. Um, and that's actually something that a lot of men have , uh, is just that you don't go out and tell your buddy about it.

Speaker 3: 8:43

So when it comes to , um, uh, ultrasounds and other kinds of tests, what kinds of patients are best suited to get kind of , uh, imaging tests if they need it?

Speaker 5: 8:53

Yeah, so, you know , the , that next level evaluation is typically a , it's , it's called a penile duplex ultrasound. Basically, we do a couple of things. You know, we take a normal ultrasound, images of the penis, we're looking for scar tissue, anything that could cause pones disease. Um, and then we actually evaluate the blood flow. So that does involve getting an erection. Typically it's an artificial erection that we induce using medication. It's beneficial for patients who we think that might have blood flow issues to actually diagnose it. Um, you know, and that , and or patients who have , um, structural issues that we can definitely , uh, uh, quantify the amount of scar tissue that's there.

Speaker 3: 9:34

You know, I think that , uh, far too many doctors, even urologists will roll their eyes when their erectile dysfunction patients will kind of ask them, why is this happening to me? And I think that's , uh, you know, a level of service that , uh, patients deserve to have. So , uh, you know , uh, I think as part of our practice, having an erectile dysfunction fellowship trained expert like yourself is , um, is an amazing , uh, gift that we have and a gift that we want to share , uh, with, with our patients , uh, in this community. And even for those listening from away. So if, if you ask why you're having erectile dysfunction and , and your doctor is rolling his eyes and doesn't seem very interested about doing a next level evaluation, you know, we would encourage you to seek out , uh, another opinion. So Donna, how do people make appointments with us and how do they get that second opinion? Get

Speaker 4: 10:23

Your second opinion right here at armor men's health.com. That's our website. And our phone number is (512) 238-0762 . We're in Round Rock, north Austin, south Austin, and Dripping Springs, Texas.

Speaker 3: 10:35

Hello and welcome to the Armand's Health Show. This is Dr . Mystery , your host, board certified urologist, joined by my co-host Donnel Lee . Hey everybody.

Speaker 4: 10:43

Welcome to the show.

Speaker 3: 10:45

This show is brought to you by N a u Urology Specialist. That's the group that I started in 2007. We've now grown to four urologists, one interventional radiologist, six advanced practice providers, two pelvic floor physical therapists, sex therapist, nutritionists, and a commitment to taking care of the whole you when it comes from the nipples to the knees.

Speaker 4: 11:05

Yes. Thank you so much for joining us . <laugh> . You normally keep going. He'll cut this out anyway. Yeah, that sounds great. <laugh> .

Speaker 5: 11:15

Thank you.

Speaker 3: 11:16

This is like making love to my wife, <laugh> . It would be really nice if you got a little bit involved.

Speaker 4: 11:20

Normally you say , Donna, tell us how to get ahold of her . Anyway, you can reach out to us at 5 1 2 2 3 8 0 7 6 2 . Our website is armor men's health.com. I'd like to take this moment to thank everybody for Whitney being in our life. <laugh> <laugh> .

Speaker 3: 11:35

Now , uh, we are joined by , uh, one of our fellow partners , uh, Dr. Christopher Yang. Uh, he's a urologist. Uh, he trained at the University of Illinois in Chicago and did a , uh, fellowship in men's health and erectile dysfunction. Uh, Dr. Yang, thank you so much for joining us today, and

Speaker 5: 11:50

Thanks for having me again. So ,

Speaker 3: 11:52

Um, when it comes to erectile dysfunction , uh, you know, any Tom, Dick and Harry can , uh, uh, uh, prescribe pills, but the pills don't always work. Uh, so when somebody comes to you and says that the pills aren't working , uh, why don't you go through like , uh, kind of the stepwise approach of how you advise patients on advanced treatments for erectile dysfunction? Sure.

Speaker 5: 12:14

Well, first of all, you know, we, we definitely talk more about the pills and make sure that they're taking it the correct way. 'cause you know , uh, some patients just aren't, and that's something that we can evaluate.

Speaker 3: 12:24

What are some common errors that patients make? Well,

Speaker 5: 12:26

For patients that are taking pills like Viagra and or Cialis , uh, it's typically best done about an hour before they plan to have intercourse. And it's typically best done with an empty stomach. So some patients aren't quite doing it Right.

Speaker 3: 12:40

So if you're like eating a big steak meal Yeah . Uh , and then expecting her to pay for it in the bedroom. Uh , oh . And you , uh, wow,

Speaker 4: 12:47

That sounded aggressive. <laugh> . Yeah,

Speaker 3: 12:48

I did it. Yeah.

Speaker 4: 12:50

Okay . I got scared.

Speaker 3: 12:50

Let's delete that part. Okay. No <laugh> . So, so if you're ,

Speaker 4: 12:54

Don't delete that, Whitney,

Speaker 3: 12:56

If you're, if you're eating a big steak meal , uh, and then you pop your Viagra thinking that you're gonna get lucky and then it doesn't work , uh, that would be an example of doing it the wrong way, right?

Speaker 5: 13:04

Yeah, that that's correct. Why

Speaker 4: 13:06

Don't they say that on the commercial? Because you would think that they would benefit from people using the medication correctly.

Speaker 5: 13:11

No, they benefit from using people buying it,

Speaker 3: 13:14

Buying , buying more,

Speaker 4: 13:14

Just keep buying it and not working. And

Speaker 3: 13:16

They're so cheap now. Nobody's making any money out here . And that's something also people need to remember that the pills are much cheaper today than they were five or seven years ago . Yeah.

Speaker 5: 13:24

They , they are generic. And you know, another thing that we do quite a bit is the, the daily Cialis or Talil . Um, that's something that did not used to be cost effective , but now it works effectively for a lot of

Speaker 3: 13:37

Patients and the timing issue goes away.

Speaker 5: 13:38

Exactly. Exactly.

Speaker 3: 13:40

Alright , so what if the pills really aren't working?

Speaker 5: 13:41

Yeah. So then, then we're looking at other more, you know, more advanced, potentially more invasive types of treatments. Um, there are , uh, suppositories or gels that you can put into the urethra. Uh, but you know , that is a little bit more in invasive. Uh, there are injections that you can perform into the side of the penis, and that works about five minutes later.

Speaker 3: 14:04

So , uh, you have , uh, that intraurethral alprostadil, it used to be known , uh, commercially as muse, m u s e . How

Speaker 4: 14:12

Do you put it in

Speaker 3: 14:13

You? There used to be a little inserter that would shove the little capsule in there. Yeah. Does it hurt rub? It

Speaker 4: 14:20

Sounds like it hurts.

Speaker 5: 14:21

It's not the most pleasant thing in the world, but you know, it's not terrible. It's, it may be worth it for some people,

Speaker 4: 14:26

But the end result is good. Okay.

Speaker 3: 14:27

Yes . And nowadays we get the , uh, that that same drug compounded into a gel. Correct. And you kind of stick the syringe , uh, which is no needle. So just a, a syringe and then over the hole in your penis and you squirt it in, right? Yeah,

Speaker 5: 14:41

Exactly. You squirt it right in.

Speaker 4: 14:43

<laugh> made me hold my Titi and I don't have a tee tee .

Speaker 3: 14:45

So what are some side effects that , uh, patients report from the intraurethral alprostadil?

Speaker 5: 14:49

Well , uh, the main one is like, some patients have a small percentage of patients have a reaction to the medication about, you know, 5% of people have a burning sensation. But , uh, short of that, you know, the other main side effect is, is just it not working. So that's something we would try, make sure it helps before prescribing it.

Speaker 3: 15:09

Well, that's great. And , uh, you know, I'll use it often in men who get , uh, a near perfect response from the pills, but not a perfect response. So let's say they get 80% of an erection with pills, then , uh, uh, I will often add that intraurethral alprostadil. Uh, what's your experience with using , um, the vacuum erection device? What are some of the pros and cons of that device?

Speaker 5: 15:31

Yeah , so the vacuum device, it basically creates a seal against your skin and it uses physics to draw blood into the penis. So it creates a vacuum inside of a cylinder and , um, that physically draws blood into the penis to keep the erection. A lot of patients have to use a constricting ring at the base of the penis to keep the blood in. And , and ,

Speaker 3: 15:52

And the ring is the key, like , uh, definitely. And , and the problem is , uh, you know, one size does not fit all <laugh> . Yeah. You

Speaker 5: 16:00

Have ring have to be sure you use their Correct. There's regular

Speaker 4: 16:02

Size and Indian size

Speaker 3: 16:04

<laugh> , and that's right. Right . Got it . So if you need the extra big ring , uh, you <laugh> ,

Speaker 5: 16:10

I thought you had extra small

Speaker 3: 16:12

<laugh> <laugh> if you need the , uh, and , and so there are a variety of rings. And so when I advise my patients about the benefits of the vacuum erection device, I talk about no medication related side effects, the fact that it can be traveled with fairly easily. Um, the fact that it, it works, meaning that if you can, if you can navigate the ring issue, it'll work. It'll , it's reliable. Yeah. But you have to like, not get your skin sucked into it. You have to learn how to use it. Yeah . What are some other tips? Yeah.

Speaker 5: 16:40

And then, and then for some people that it causes discomfort or pain just when it's creating the vacuum. So , um, and then some people don't like the way that it feels with the blood trapped in there with the ring at the base of the penis.

Speaker 3: 16:53

I gotcha . And then some people don't like the fact that the ring may constrict their. Yeah.

Speaker 5: 16:57

Yeah. So

Speaker 3: 16:58

If you're trying to have a baby, the constriction ring's not gonna work so

Speaker 5: 17:01

Well. Yeah. One thing we definitely tell 'em is make sure they don't fall asleep with the ring on that they take it off when they're done.

Speaker 3: 17:06

Yes. Because that ends up becoming another kind of story on this radio show. Yeah. <laugh> . And then you mentioned injections into the side of the penis , uh, that's more commonly known as trimix . Now , uh, there used to be these , uh, Boston medical groups are , do you remember

Speaker 5: 17:21

That? Yeah.

Speaker 3: 17:22

Yeah. And, and , and that they would use the trimix injection for the cure for every erectile problem. Yeah .

Speaker 5: 17:27

They guarantee on the radio that you get an erection

Speaker 3: 17:30

Guarantee, an erection, you can't

Speaker 4: 17:31

Guarantee anything in

Speaker 3: 17:32

Medicine. So how does that medicine work? What , what are we injecting? Yeah ,

Speaker 5: 17:36

So it's basically a combination of different medications. One is called , uh, alprostadil, and then there are two, two additional ones. Three , there's

Speaker 4: 17:45

Three. Yeah . Yeah . That's the try. Yeah .

Speaker 5: 17:48

Yeah . Sometimes, sometimes we do a compounded quad mix where there's four different medications, but basic

Speaker 3: 17:52

And all and all of them dilate the artery.

Speaker 5: 17:54

Yeah, exactly. They , they work and bring blood flow. Yeah. They work different ways to, to in combination to dilate the arteries. Mm-hmm. <affirmative> . And basically it's similar to Viagra, but you know, basically what I, what I tell patients is getting the medication to the tissue that needs it directly, you're , you're putting an injection into the part of the penis that needs it.

Speaker 3: 18:13

So , uh, in the patients that it works great in, they're very happy. But those patients that are unhappy with it, what are some common complaints they'll have? Yeah.

Speaker 5: 18:20

Well, number one, you know, you do have to put a needle into the side of the penis, and that's probably not the idea of fun for most men. Right . But it , but it's a tiny needle. It's a tiny, tiny needle. It's the same that we use for insulin injections. So you're

Speaker 4: 18:32

Just pricking

Speaker 5: 18:33

Your prick. Yeah. Yeah. Most people don't even feel like, like it's painful, but it's just the idea of it. Hmm .

Speaker 3: 18:39

There's a spontaneity issue as well, you know, so if you're like , uh, dating someone , um, that's regular, then it's easier to pop it in. But if you're kind of , you know, with somebody who may not be too familiar or somebody that's far younger than you, yeah. It may feel a little awkward to, to stick that in there.

Speaker 5: 18:56

Yeah. I've definitely had patients tell me they, they, you know, exclude excuse themselves to the bathroom and do a quick injection before going back

Speaker 3: 19:04

Mm-hmm . <affirmative> . And , um, this medication is often not covered by insurance. Uh , did , do you have a relative idea of how much this costs our patients?

Speaker 5: 19:11

Yeah, it's not terribly expensive. Like typically we get it through compounding pharmacies and it ends up being somewhere like three to $5 per dose.

Speaker 3: 19:19

And , uh, you know , if, if you've taken it and you've had variable responses to it working or not working, I think that , uh, a lot of patients don't understand how fragile the medicine is <laugh> , so you really have to take really good temperature care of the medication. Um, there used to be a commercially available one called Caverject. Have you seen that on the market anytime recently? Yeah, it

Speaker 5: 19:38

Still is available. Um, and , and one of the benefits of that one is you don't have to worry about the temperature control as much. You don't have to keep it refrigerated. Um, but it is definitely more expensive out of pocket , uh, compared to compounded trimm mixes .

Speaker 3: 19:54

Uh, there are some compounding companies that will get an auto-injector. So you don't have to drop the medicine or worry about looking at the needle, you just kind of put it on the side of your penis and then press a button, and then the, the , the needle will , uh, you know, inject the medicine and retract , uh, all at once. So there are ways that we can make it easier , uh, and more reliable for you. Um, and so , uh, those are kind of the non kind of, you know, expert level kind of therapies that patients can get almost anywhere. Chris , uh, if you were to , um, uh, to talk about , uh, in our next segment, things that patients should consider when , uh, when thinking about an inflatable penile prosthesis or why that may be a good option for them , uh, that's , uh, kind of the , the , the juxt of what we're gonna be talking about. Uh , Donna, how do people get ahold of us? How do people get to know where we are?

Speaker 4: 20:43

You can call us at (512) 238-0762 Monday through Friday, and our website, armor men's health.com. Don't forget to listen to our podcasts wherever you listen to free podcasts.

Speaker 2: 20:54

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