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April 25, 2020

Getting You Back in the Driver’s Seat- Dr. Mistry and Donna Lee Answer Listener Questions about Changes in Ejaculate Volume and Treating ED after Cancer

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello and welcome back to the Armor Men’s Health Hour on this wonderful weekend day.

Donna Lee: 

Mhmm. Fastest hour ever.

Dr. Mistry: 

It is.

Donna Lee: 

It really is.

Dr. Mistry: 

That’s right. Some of the topics that we talk about whenever we have guests, I’m always really amazed at how quick the time goes by when you’re recording it. But then when I listen to myself on the radio, sometimes I feel maybe I do drone on and on.

Donna Lee: 

No, not you!

Dr. Mistry: 

So for those of you who are very dedicated listeners, I really do appreciate you tolerating me. You know, I think that’s why politicians have like, you know, like 3 sentence sound bites because you know, like, you know, maybe people don’t hold their attention.

Donna Lee: 

They have people saying, “Stop talking.”

Dr. Mistry: 

You know, I didn’t, honestly, if you had a men’s health show in which everything was like a 3-second answer, you would have a men’s health commercial, not a men’s health show.

Donna Lee: 

Yeah, that would be a bad show. And there are a bunch of commercials on this station.

Dr. Mistry: 

There are, probably playing during this show right now.

Donna Lee: 

That’s right. Well, that has happened.

Dr. Mistry: 

That has happened.

Donna Lee: 

Don’t believe the hype. Go to a urologist.

Dr. Mistry: 

That’s right. That’s right.

Donna Lee: 

Don’t go to a product selling, men’s awareness clinic.

Dr. Mistry: 

That’s right. I mean if you have a, if you have a men’s health problem and you are going to someone that doesn’t treat that medical condition but just sells a product…

Donna Lee: 

…and if they say the words guaranteed at the end…

Dr. Mistry: 

That’s right. That’s right.

Donna Lee: 

…for a small fee, there’s a problem.

Dr. Mistry: 

That’s right. And if they use the word “small” ever, then I’d never go to them. I mean you need a urologist that pumps up your ego as well as your penis. You know? I think that that’s really important for people to understand. If your urologist isn’t doing a job that you like, then come and see us. We love it. And if it’s one of our urologists that isn’t doing it, then email us and tell me because I’m going to beat somebody on the head, then, because that’s not how we want to be known. But what drives this show and what drives my practice and so much of our continued passion in urology are your questions and helping you out. Donna Lee, why don’t you give us the next question?

Donna Lee: 

Okay. I have a new friend, his name…oh, I can’t say his name, but anyway, he knows who he is. He says, “I am 46. I wake up at least once a night to pee. I don’t have erectile dysfunction, but the amount of semen during ejaculation is low. I’m about 20 pounds overweight…” He’s about 5′ 6″, but then he goes on…we were corresponding because I was trying to see if he wanted an appointment or just to hear the radio show and he said, “What an awesome show!” And he said, “I’d been hearing commercials about it, commercial bites on KLBJ and finally realized what it was. Then I tuned into the show.” And then he said, “Love your voice, by the way!” Smiley face. Thanks, friend!

Dr. Mistry: 

You know you never, you never fail to talk about an email that compliments you.

Donna Lee: 

Uh, yeah.

Dr. Mistry: 

Like Chris rock said, “Women love compliments.” In any case, I’ll just leave you to the comedian part of it.

Donna Lee: 

Yes, please.

Dr. Mistry: 

This is a great question. Ejaculate volume is a consequence of the function of the prostate gland. The prostate gland is what makes semen whose purpose is to be nutritive to the sperm that are being made in the testicle..

Donna Lee: 

Nutritive!

Dr. Mistry: 

I probably made up a new word.

Donna Lee: 

Is that a word? I like it.

Dr. Mistry: 

Anyway, to provide nutrition to…When that ejaculate volume goes down, it can be a result of hormonal alterations, and there can be some anatomic alterations that can lead to something called retrograde ejaculation, where the amount of ejaculate coming out is not as high as it used to be. As a matter of fact, this week alone, I had 2 patients that had infertility from retrograde ejaculation. Although this listener didn’t mention it, and if you’ve heard previous episodes, I’ll say this again and again: a lot of times men complain of poor ejaculate when really what they’re complaining about is a diminished orgasmic sensation. It just doesn’t feel as good. Because there’s only one reason to really examine how much ejaculate you have, and that’s if it just didn’t feel like quite the pop that it used to.

Donna Lee: 

The explosion.

Dr. Mistry: 

And so what men will experience is kind of an oozing of semen for even minutes after ejaculating as opposed to the shooting of semen that they’ve had when they were younger, and they’re wondering what’s going on. And so let me just mention that the act of a ejaculating is a two step process. There’s the prostate fluid that gets deposited into the urethra, the tube that you urinate from, and then there’s the rhythmic contraction of something called a bulbocavernosus muscle that then emits that that fluid out of you. Sometimes people can have a less intense orgasm or a less intense ejaculate that can be due to that muscle not working well. And we actually have a pelvic floor physical therapist named Angela Treadway that does amazing work in our office to help with that.

Donna Lee: 

She’s amazing.

Dr. Mistry: 

A lot of times those patients have associated testicular pain, could have associated back pain, could have associated urinary issues, or premature or delayed ejaculation. We have medicines like Yohimbe that can help enhance the orgasmic experience to help with that feeling of emission. And then it could just be, you know, an old sign of just low testosterone and giving you testosterone may help make more prostate fluid and a better ejaculate. So, it’s definitely something that we have seen and taken care of and would love to see you as a patient.

Donna Lee: 

That’s right. We are taking new patients and we’re just seeing a lot of them. Do you want another question?

Dr. Mistry: 

I do. With our limited time.

Donna Lee: 

This patient said, “I went through 44 treatments of radiation for prostate cancer. 6 months earlier, I received the Eligard shot, [inaudible] six months after.” I’m not sure what that means, maybe I read it wrong. “Erectile dysfunction set in and I blamed the shots for draining my testosterone levels. Can I safely take testosterone? Orgasms will occur with vibration, but not enough sensitivity to happen naturally. HELP.” In all caps.

Dr. Mistry: 

Surely. This listener was diagnosed with prostate cancer, probably had what we call an intermediate or high risk prostate cancer, and it required him to have hormone ablation therapy starting 6 months prior to the radiation therapy. What hormone ablation therapy does is it takes away your testosterone level and makes this cancer more sensitive to radiation therapy. So it radio sensitizes the cancer. By taking away your testosterone, it will cause a number of health effects: lowered libido, erectile dysfunction, it can cause your breasts to enlarge, it can give you hot flashes–essentially, you’re going to feel like you’re going through menopause on this medicine. And for that reason, I try to avoid hormone ablation in virtually all of my patients because I think it can make a lot of people not feel very good about themselves and maybe even week or going through therapy. It also leads to bone demineralization, blood sugar alterations, and a number of things. Another problem is even though the shot should only last 6 months, especially as men age, their natural production of testosterone may not come back. And so there are many instances in which we are asked to help rejuvenate or reboost men after these injections to get their testosterone level back. And that’s a simple test. You know, if you’re specially, you know, more than double the time that your injection was supposed to last and your numbers haven’t returned to some kind of sense of normalcy, it certainly may be an option to get treated with testosterone. There’s increasing evidence to suggest that normal testosterone levels and testosterone supplementation may actually keep prostate cancer from returning.

Donna Lee: 

Really?

Dr. Mistry: 

Even though that may sound counterintuitive, and we’ve always been a forward progressive practice when it comes to testosterone levels and prostate cancer. And we want you to feel good. I mean, it’s one thing to get your cancer treated, but if you’re going to feel like garbage throughout or lose important function, that’s the whole reason you picked radiation over surgery in the first place to keep your erections and now they’re gone. Right? So, we can help get that. Now the second part of the question had to do with, because the radiation itself could have evaporated your erections. It happens half the time, it gets worse the further out you get. So maybe the erections won’t come back, even with testosterone. We have other ways to give you a robust erection. Intracavernosal injections, the vacuum erection device, intraurethral Alprostadil, maximizing the use of oral medications, we have inflatable penile prosthesis…all these things that can help give you a robust erection and make it easier to ejaculate because it’s very hard–pun intended–to ejaculate with a flacid penis. And you know, what I love about that question the most is that he already understands the benefit of vibration, even though he can, you know, he can’t orgasm and ejaculate through a flaccid penis. I wonder if he’s using the Hitachi Magic Wand?

Donna Lee: 

Oh boy, I Googled that, you know?

Dr. Mistry: 

Yes.

Donna Lee: 

And it’s also a can opener.

Dr. Mistry: 

It is?

Donna Lee: 

No.

Dr. Mistry: 

Okay. That’s what a Hitachi is. But if you’re looking for, you know, the type of vibrator that’s gonna overcome even a variety of different neurologic issues, the Hitachi Magic Wand is a wonderful vibrator.

Donna Lee: 

Are they a sponsor, because you sure like to talk about them.

Dr. Mistry: 

They are not a sponsor.

Donna Lee: 

Well they should be. Maybe the podcast they’ll sponsor.

Dr. Mistry: 

That’s right. Maybe we should ask them.

Donna Lee: 

Send them a note.

Dr. Mistry: 

That’s right. If we haven’t offended most of our listenership already with the orgasm question, we have that one. But absolutely a return of testosterone after injections is an important part of your recovery, and we can do it in a way that will preserve your, the cancer cure rate that you were really looking for. And it’s a wonderful type of patient for us to take care of here because we’re going to take care of the whole body.

Donna Lee: 

Mhmm, and we’ll shout out to Hitachi.

Dr. Mistry: 

Yes. And thanks a lot for your questions! And, Donna Lee, another great show.

Donna Lee: 

That’s right. It went by so fast. Thank you guys. Send us your questions to armormenshealth@gmail.com. That’s armormenshealth@gmail.com. Our website is armormenshealth.com, where you can see Dr. Mistry’s very handsome, smiley face. And you can also see us during the week in Round Rock, North Austin, South Austin, Dripping Springs. Our phone number is (512) 238-0762. Send us your questions. I’ll respond to all of them. Thank you so much, Dr. Mistry, it’s been wonderful.

Dr. Mistry: 

Alright, Donna Lee. See you guys next week!

Donna Lee: 

Bye. Take care!

Speaker 3: 

The Armor Men’s Health Hour is brought to you by Urology Specialists of Austin. For questions or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.

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