Improve Your “Golf” Swing: Donna Lee and Dr. Mistry Answer a Listener Question About Erectile Dysfunction
Speaker 1:
Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.
Dr. Mistry:
Welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here with my cohost, Donna Lee.
Donna Lee:
Hello. That’s me.
Dr. Mistry:
I’m a board certified urologist. This is a men’s health show. We talk about a variety of issues that affect men and health issues that men are often involved with, especially if they include sexual function of women or your spouses. It’s a show that we love providing information on, have great input, mostly positive, right Donna?
Donna Lee:
Mostly positive. I’d say 99.99% positive.
Dr. Mistry:
Yes. I think that people sometimes don’t like our liberal use of certain words, but you know, we try to demystify topics that…
Donna Lee:
No pun intended, Dr. Mistry!
Dr. Mistry:
….demystify those topics that you might find it hard to talk about. When it comes to sensitive topics related to sexuality, when it comes to health issues that, you know, a lot of men don’t want to talk about, whether it be weight loss, whether it be nutrition, whether it be the threat of cancer–we want to make it so that you understand, we talk about these things all day.
Donna Lee:
Every day.
Dr. Mistry:
Your questions are super appreciated. You can be as detailed as you’d like. It’s what drives this show is answering those questions and providing that service to our patients.
Donna Lee:
You know what’s happening right now while everybody’s at home–you said there’s gonna be a bunch of babies in nine months.
Dr. Mistry:
I hope not. Just enough babies. We don’t want to have too many babies.
Donna Lee:
There’s probably a lot of sexual relations going on with this downtime. And along those lines, we have a couple of questions about that. How about that for a segue?
Speaker 1:
If you heard the last segment it had to do with sexual frequency, and this is kind of a topic that is very similar to that last question, and we’ll try to expand on what we do to make sex more satisfying for men.
Donna Lee:
That’s right. And remember, they’re all asked anonymously, and we will get to them as quickly as we can on the radio show. But along those lines, Dr. Mistry, this is a good one. You’re ready?
Dr. Mistry:
Let’s do it.
Donna Lee:
Alright. “I’m a 43 year old man and for the past 4 years I’ve suffered with erectile dysfunction. It seems to be getting worse. I’ve been married for several years, but when my wife and I have sex, I only get about half hard. I have to take ED medications from an online place, and I don’t seem to have the sex drive or mood to have sex anymore.” He gives his height and weight. He seems to be average in size. His testosterone, 650, and he also takes testosterone injections from his family doctor every 10 days. Blood work’s good and he goes on and on. But he says, “My wife and I used to be very sexually active–every day or every other day.” But now it’s just the issue with his erection. He’s not in the mood anymore and it’s getting depressing and he’s very embarrassed. He’s gone to a men’s clinic that I won’t even mention by name that he mentioned and they just gave him some more ED medication and that was it. They charged him a lot of money for just a couple of pills a month. He wants to know you can help with this?
Dr. Mistry:
Well, that’s a great question. So there’s a lot in there and a lot of times these questions sound real simple, but really what I’m looking for is, what is it that listener or that patient didn’t get from a previous practitioner, right? If everything was simple, I wouldn’t be needed. The first thing is that the man’s 43 years old and has ED for 4 years. That is incredibly worrisome for an underlying cardiovascular risk. So that’s a patient for sure I would make sure is definitely well-controlled on all the aspects of his cholesterol, we would do in our office something called an advanced lipid profile–we’re looking for types of cholesterol that may be more indicative of a underlying cardiovascular issue. We would almost certainly send you for what’s called a CT heart saver scan, where it costs $99 bucks to look for calcifications in the arteries that feed your heart. We would almost also certainly perform what’s called a penile doppler study to see if the blood vessels that are bringing blood to your penis are open and whether or not the blood flow to your penis is being impaired. And I would almost guarantee that with softening erections in a 43 year old, that it’s likely that that is the case, that there are some atherosclerosis of that area.
Donna Lee:
Wow. And that pop-up testosterone clinic might not check for all that.
Dr. Mistry:
There’s certainly not going to be as concerned about fixing your underlying problem as we would be.
Donna Lee:
That’s right. And we get a lot of referrals from these clinics.
Dr. Mistry:
We do. Because you know, the men get frustrated that they’re not making any progress. And it’s certainly a partnership that we value, with all of these low testosterone men’s health clinics. The reason you come to a board certified urologist is for that next level of care when it comes to your ED. So when it comes to ED, there’s a chicken-and-egg phenomenon when it comes to ED and libido. Sometimes your erections are poor because your sex drive is not strong, and sometimes your sex drive isn’t strong because your erections are poor. Back to my golf analogy.
Donna Lee:
The “You don’t know how to play golf, so you don’t.”
Dr. Mistry:
I hook the ball every time I hit it. And so I don’t like to play with others, if you know what I mean. I don’t need anybody seeing that. But if there was a pill that I could take that I could hit the ball straight down the line every time, I think I’d probably play a little more golf…
Donna Lee:
Right? You’d take that pill.
Dr. Mistry:
…you know, even though it’s a little pricey, the golf. When it comes to erectile dysfunction meds, as I said, for this 43 year old man, first and foremost, look for underlying problems that need to be corrected, because that can also reverse some aspects of ED. If you are overweight, if you have a BMI over 32, I could, I would literally guarantee that losing weight is going to make your erections better. I mean, I haven’t had a patient yet who got healthier, exercised more, and lost weight whose erections weren’t better and who didn’t have a better sex drive or better self esteem. But…
Donna Lee:
But [inaudible] a guy like this was average weight, average height…
Dr. Mistry:
You’d have to measure it. And then we also have, you know, in our office we actually do, as you know, body fat percentage calculations.
Donna Lee:
It’s such a great day when we all do that.
Dr. Mistry:
Yes. And so you know exactly what your body fat percentage is, and then we can see exactly based upon your height and weight what we think an ideal number for you is. When it comes to the issue of erectile dysfunction meds, there’s a phenomenon of, a crutch phenomenon. Let’s say you have mild erectile dysfunction and you can take a Cialis or Viagra, and you can take that medicine and it gives you a better erection, and you’re thinking, “Well that’s good. At least the meds work.” But if you become dependent on having taken that medicine before you have sex, you actually end up having less sex, because you’re like, “Well, you know, I’m kind of in the mood but I got to take the pill and I can’t eat. And this medicine gives me heartburn. This one gives me a backache.” And so you really start weighing the pros and cons of taking the pill, when now something that was always associated with fun and spontaneity, is now associated with kind of work, you know. And so the daily Cialis is absolutely a game changer. We offer the daily Cialis. We have a place where you can get it for about a dollar a pill. We offer a 6 milligram as opposed to the 5 milligram compounded variety. And it is a medication that you take every day and your erections are great or better all the time. Actually, you know, your phallus actually hangs longer all the time. Your morning erections are better. And the spontaneity gets improved, and you end up playing more golf.
Donna Lee:
And you can eat.
Dr. Mistry:
And you can eat whenever you want.
Donna Lee:
Right, because you can’t eat before Viagra.
Dr. Mistry:
There’s a timing issue or…that’s right. That’s right.
Donna Lee:
I think people forget that.
Dr. Mistry:
And I’m using golf as a…
Donna Lee:
I like your golf.
Dr. Mistry:
I’m using golf as a nickname for something else.
Donna Lee:
You’re doing great with the golf analogy.
Dr. Mistry:
That’s right. And so, for those men who think that their libido might be low because of erectile dysfunction, switching to a daily Tadalafil may be a great option for you. The caller also mentioned that they’re on testosterone, and their testosterone is 650. Now when you’re on testosterone, knowing what your level is is of really little value, because I don’t know when they drew it in your cycle. If you’re like most patients who go to a men’s health clinic, you’re getting it drawn on the last day of your testosterone cycle. But if you’re getting testosterone every 10 days, there’s an inconsistency oftentimes in how that’s being administered. I prefer weekly injections if that’s what you’re going to do, because you usually know that my injection’s on Wednesday. It’s going to be harder to remember, “Did I get my injection nine days ago or 11 days ago?” And so compliance is an issue. You also want to make sure that your estrogen level isn’t increased, because your estrogen level can increase with testosterone use and that can cause a libido drop. And then you want to make sure these other things that affect libido, like your thyroid level and your prolactin level are not elevated. But really, what I wanted to spend some time on this segment is really talking about what do we do when the pills aren’t working and what do we do for people who have complaints that reduce sexual satisfaction? And so some of those things can include a very common one called hypo-orgasmia…
Donna Lee:
Oh, I thought you were going to say getting a mistress. A hot girlfriend?
Dr. Mistry:
Getting in trouble…getting in trouble, MD. No. And so, if you are out there and you’re experiencing ejaculatory discomfort, the patients that have these tell me that I should only talk about this.
Donna Lee:
Really? Oh, wow.
Dr. Mistry:
They said it’s one of the most underreported things. So these are men who have delayed ejaculation, who take a long time to be able to orgasm, or men who orgasm and have a very kind of, you know, not exciting orgasm. And that’s depressing, you know.
Donna Lee:
That is depressing.
Dr. Mistry:
And so, we actually have treatments for men who have hypo-orgasm or delayed orgasm. We have medications and supplements that can enhance the orgasm experience and reduce your what we call ejaculatory or orgasmic threshold. We also have tests that we can do on the nerves, ,for sensation as well as vibration to see if that could be an underlying issue, as well as recommendations on a number of sexual toy enhancements that can make your sexual experience much better. And so if you think that your problem that you have isn’t typical and you don’t think it’s going to be fixed by normal meds, we’re exactly the kind of place that you need to get a second opinion.
Donna Lee:
Mhmm. Fully comprehensive. And we know how to treat “golf” problems.
Dr. Mistry:
Donna, how do people get ahold of us if they’re interested?
Donna Lee:
The can call us during the week at (512) 238-0762. Email us with these amazing questions at armormenshealth@gmail.com. That’s armormenshealth@gmail.com. We’ll be right back.
:
Dr. Mistry wants to hear from you. Email questions to armormenshealth@gmail.com. We’ll be right back with the Armor Men’s Health Hour.