#260 ‒ Men’s Sexual Health: why it matters, what can go wrong, and how to fix it | Mohit Khera, M.D., M.B.A., M.P.H. | The Peter Attia Drive

Intro

In this episode of “The Peter Attia Drive,” Peter Attia discusses men’s sexual health with Dr. Mohit Khera. They delve into the various aspects of sexual health, including erectile dysfunction, testosterone levels, and treatments for sexual dysfunction. They also explore the impact of sexual dysfunction on quality of life and relationships.

Main Takeaways

Erectile Dysfunction and Treatments

• Erectile dysfunction affects a significant percentage of men at various ages and can be linked to cardiovascular disease.
• Treatments for erectile dysfunction include drugs, shockwave therapy, stem cells, PRP, and lifestyle modifications.
• Penile ultrasound can be used to show patients that everything is working fine and help them overcome anxiety.
• Viagra, Cialis, and Levitra work by inhibiting phosphodiesterase, allowing for increased blood flow and sustained erections.
• Avanafil is a newer medication with fewer side effects but is more expensive and not yet available in generic form.

Prevalence and Impact of Sexual Dysfunction

• 52% of men over 40 suffer from erectile dysfunction in the US, which is around 30 million men.
• Sexual dysfunction is prevalent in both men and women, with 43% of women in the US suffering from some degree of sexual dysfunction.
• Sexual dysfunction has a significant impact on quality of life, causing depression, anxiety, and impairing the quality of relationships.
• Many men suffer in silence due to embarrassment and clinicians not asking about it.
• Men can enter a vicious cycle of anxiety and erectile dysfunction, leading to more anxiety and further dysfunction.

Peyronie’s Disease and Other Conditions

• Paronis disease, a curvature of the penis, can be caused by various factors and has different treatment options.
• Plaque in the tunica albuginea can cause abnormal curvature of the penis, known as Peyronie’s disease.
• Collagenase injections can be used to break down plaque and improve the curvature of the penis in Peyronie’s disease.
• Traction devices, such as the Restorex, can improve curvature and increase length and girth of the penis.

Testosterone and Hormonal Factors

• Testosterone, DHT, and estrogen play a crucial role in male sexual health, and low levels can have adverse effects.
• Testosterone replacement therapy can be administered through various methods, including pellets, topical formulations, injectable formulations, oral formulations, and intranasal formulations.
• Improving insulin resistance can positively impact erectile function.
• Lifestyle modifications such as diet and exercise can improve erectile dysfunction (ED).
• Testosterone treatment can suppress endogenous access and may lead to a lifetime of treatment.

Other Aspects of Sexual Health

• Premature ejaculation affects 30% of men, but only 9% seek therapy due to embarrassment.
• Retrograde ejaculation occurs when semen goes into the bladder instead of being ejaculated out of the urethra.
• Delayed ejaculation or orgasmia is when it takes a man a long time to ejaculate.
• SSRIs are effective in prolonging ejaculatory latency time, but the dose is important to avoid erectile dysfunction.
• Testicle size, FSH, and LH levels can indicate if there’s a production or obstruction problem with sperm.

Summary

Erectile Dysfunction and Treatments

Erectile dysfunction is a common condition that affects many men and can be linked to cardiovascular disease. Various treatments, such as drugs, shockwave therapy, stem cells, PRP, and lifestyle modifications, can help improve erectile function. Penile ultrasound can also be used to alleviate anxiety and reassure patients. Medications like Viagra, Cialis, and Levitra inhibit phosphodiesterase, allowing for increased blood flow and sustained erections. Avanafil, a newer medication, has fewer side effects but is more expensive and not yet available in generic form.

Prevalence and Impact of Sexual Dysfunction

Erectile dysfunction is prevalent among men, with around 30 million men in the US suffering from it. Sexual dysfunction also affects women, with 43% experiencing some degree of dysfunction. The impact of sexual dysfunction on quality of life can be significant, leading to depression, anxiety, and relationship problems. Many men suffer in silence due to embarrassment, and clinicians often fail to ask about it. This silence can perpetuate a cycle of anxiety and dysfunction. It’s important to address sexual health openly and seek appropriate treatment.

Peyronie’s Disease and Other Conditions

Peyronie’s disease, characterized by a curvature of the penis, can have various causes and treatment options. Plaque in the tunica albuginea can lead to abnormal curvature and is treated with collagenase injections. Traction devices like the Restorex can also improve curvature and increase penile length and girth. These treatments offer hope for individuals with Peyronie’s disease, improving both physical and psychological well-being.

Testosterone and Hormonal Factors

Hormonal factors, including testosterone, DHT, and estrogen, play a crucial role in male sexual health. Low levels of these hormones can have adverse effects. Testosterone replacement therapy can be administered through various methods, providing relief for individuals with low testosterone levels. Lifestyle modifications, such as improving insulin resistance through diet and exercise, can also positively impact erectile function. However, it’s important to consider the potential side effects and long-term implications of testosterone treatment.

Other Aspects of Sexual Health

Sexual health extends beyond erectile function. Premature ejaculation affects a significant number of men but often goes untreated due to embarrassment. Retrograde ejaculation and delayed ejaculation are other conditions that can impact sexual satisfaction. Treatment options, such as SSRIs, can help prolong ejaculatory latency time, but dosage adjustments may be necessary to avoid erectile dysfunction. Evaluating testicle size and hormone levels can provide insights into potential sperm production or obstruction problems.

Conclusion

Men’s sexual health is a multifaceted topic that encompasses various conditions, treatments, and hormonal factors. Erectile dysfunction, Peyronie’s disease, premature ejaculation, and other aspects of sexual health can significantly impact quality of life. Seeking appropriate treatment and addressing sexual health openly is crucial for overall well-being. Understanding the role of hormones, lifestyle modifications, and available treatments can empower individuals to take control of their sexual health and improve their overall satisfaction and relationships.