A recent study shows that 10% of men aged 40-70 have severe or complete ED. Josh Spendlove MD, a Urologist from Kennewick, WA, joins the Invigor Medical Podcast with Chris Donovan to discuss how and why he got into medicine, what roles steroids and vasectomy may or may not play when it comes to ED and how he performs last resort surgeries for men that allow them to “pump up” their penis to make it erect.
- 0:49 – Why Medicine?
- 2:23 – Why Urology?
- 5:38 – What surgeries have you done?
- 6:52 – Have you had any rough kidney stone stories?
- 7:03 – How do you break up the stones?
- 8:25 – Confirm info?
- 8:15 – What percentage of your patients are women and men?
- 8:46 – What do you subscribe for ED?
- 12:17 – Has anyone called you about seeing the blue tint?
- 14:22 – What are the side effects of injections?
- 15:19 – What are some unique things that you have come across being a Urologist?
- 16:00 – Implant surgery explanation.
- 16:43 – Are you in a teaching hospital?
- 17:17 – Have you had any patients try and self help their ED situation?
- 17:55 – Collagen into the tip of his penis. That’s what people put in their lips, right?
- 18:49 – Don’t do medical procedures on your own.
- 19:42 – What type of devices did you have to cut off the genitals?
- 19:57 – Metal Cage?
- 21:02 – You help women with low libido?
- 22:15 – So no one has overturned this study?
- 23:00 – Where can people find you?
- 24:01 – If you had one piece of advice for someone to stay healthy, what is it?
- 25:21 – So you’re saying someone that got the peni implant isn’t going to run up to you and say hi?
- 25:47 – How often do you get called to the ER?
- 26:12 – Does a vasectomy play a role in ED?
- 27:10 – Is it weird that a wife would want to sit in on the procedure?
- 28:14 – Does testosterone play a role in ED?
- 30:19 – What supplements would you suggest for low Testosterone?
- 30:44 – What level of testosterone should they have?
- 31:03 – Do steroids play into low testosterone?
- 31:35 – What do you suggest people do naturally to help?
- 32:20 – Are there any food or beverages that can help?
- 32:55 – Do most of the people that you suggest go out and do some lifestyle changes, still have to get on ED supplements?
- 34:25 – How long is someone on ED medicine?
- 35:13 – Why do you think that ED is showing up more in younger men?
- 36:08 – Urinary tract infections, do they worsen the effects of ED or cause them?
- 36:31 – Pumpkin seed oil helps with these infections?
- 37:00 – How many kids do you have?
Josh: I say this kind of jokingly, cuz I’ll get guys who are like, “Doc, I’ll do anything. I’ll do anything to get, you know, to have an erection again, like you just name it.” And like I’ll do it. And I’m like, “Well, will you inject your penis with a medicine?” And they’re like, “Mmm, no.” And I’m like, “Well, you really weren’t willing to do anything.”
Narrator: Welcome to the Invigor Medical Podcast, where our mission is to provide personalized medical care through scientifically backed education and wellness solutions.
Chris: All right, we are here with the Invigor Medical Podcast with Dr. Josh Spendlove, MD. Josh, how are you, man?
Josh: Hey, I’m doing well. How about yourself?
Chris: I’m doing good. Thank you. Thank you for joining me. This is really awesome. You’re one of the first guests to come in studio. Awesome
Josh: This is cool. This is quite the setup here.
Chris: It is a nice setup, but we’re here to talk about you and what you do in medicine and all that good stuff. But the first question that I like to ask all my guests is why medicine?
What, in your mind happened and you said, “Yes, I’m gonna go to school for a very long time, and I’m gonna help people.” What was that?
Josh: Well, you know, it’s funny because, you know, you get that question a lot, especially as you’re going into medicine and, getting accepted into med school and residency.
But, you know, I wish I had this really cool altruistic like story, but just kind of growing up, going through school, I always loved biology. Those were my like, favorite subjects, especially human biology. I just thought I was just fascinated with it. And then, I remember, my dad, just with his career choice.
There was always like these concerns of layoffs and…
Chris: I lived through that.
Josh: So I remember, I don’t remember what age, but it was really young. Probably way younger than I probably should have been thinking about these things. But I remember watching the news and I’m like, you know what?
I never hear or see anything about unemployed doctors. And so…
Chris: Nope. There are lots of people out there messing things up, so…
Josh: Exactly. So I just remember like, wow, you know, what a life to have there where you don’t have to worry about being laid off and, or always kind of, looking over your shoulder or looking for a new job.
So, that’s what kind of got me started. And then, I just continued and, you know, I enjoyed learning all that stuff. So going to all that school for that long really wasn’t that big of a deal.
Chris: It really wasn’t that, the hardship that most people think when they go to school?
Josh: No, no, no. Not if you enjoy it. I guess like anything, if you enjoy it, you’ll put forth the effort.
Chris: Why urology though? What landed you there?
Josh: Good question. So, this is a little complicated here too. I always knew I wanted to do surgery. I loved working with my hands. I loved the thought of being able to like, go inside somebody and fix them and sew them back up. I was…
Chris: That scares me. That’s awesome that you like that.
Josh: Exactly. I’m fascinated with that, the power to do that. And the ability, and you look at those people and you’re just like, “Oh my gosh, how do you do that?” So I was always fascinated with that. When I went into med school I thought I was gonna be a general surgeon.
And as I started doing that and it was going through what are called rotations, I realized that, “Wow, these guys are on call all the time.”
Chris: I’ve watched Grey’s Anatomy once or twice.
Josh: And they are like super busy. And I quickly realized that like, “Wow, I don’t know if this is quite the life for me.”
And then I just happened to, so I was in, med school in Nebraska, and, before, probably about a couple years before med school, I started getting into rock climbing. And, so when I went to Nebraska, there’s really nothing to climb, but there is a, at the University of Nebraska, Omaha, there was a rock wall.
And so I started going to the rock wall and then, climbing. And then it turned out I met a guy who was a urology resident at the hospital. And he was just really excited about urology, too. And when he heard that I was a med student, he was all about, “Hey, you know, why don’t you come shadow me?”
And at the time I thought urologists, all they did was like, you know, deal out erectile dysfunction pills and check a bunch of prostates. Like I had no idea that they actually did a lot of surgery. And so I started following him around and I was realizing that, “Wow, like you guys do a lot of surgery, like this is really cool.”
And then as I started looking to do it more, I’m like, “There’s definitely a few urology emergencies, but nothing like general surgery.” And most of the people I talked to, you know, they’re kind of had the nickname of the “Happy Surgeons” because the urologist really weren’t on call all the time.
And so it was…
Chris: The smart choice to make if I’m hearing you correctly.
Josh: Apparently, but, you know, so you say that, but it was really weird every year, there’s a company called MetScape that does, what was it, MetScape? No, I don’t remember actually who did the survey. I think it was…
Actually it wasn’t because I had a bunch of other career paths, but just this year I guess urologist got, was voted the, or ranked the highest, most stressful job.
Chris: Most stressful? Geez. I would, well, I guess with what you’re looking at sometimes.
Josh: So yeah, I was like, kind of, I’m like, well, maybe I can kind of see that, but…
But anyway, so I started following him and realized that, like, I love the surgery part, but, I don’t wanna be on call at time. So I matched into urology. And I think the other part too is that it’s really specialized, like there’s not a lot of them. Like, you go to most programs like that, train doctors, and there’s usually like, for every year there’s like 10 to 15, sometimes 20, general surgery residents.
Usually with urology, there’s like maybe two to four every year. So there’s not a lot in the country. And I kind of thought about, you know, it’s kind of nice to be something that’s selective, that’s small.
Chris: Well, yeah. I mean, you used to, keep talking about surgeries. What surgeries have you done? Have you done transplants?
Josh: So I did it as a resident. We, so there are, there is a couple of career paths that a urologist can take. But, some programs will do, kidney transplants.
Chris: And you’ve done those?
Josh: I’ve done those as a resident, you know, granted, you know, I’m not, you know, responsible.
Chris: Stop playing it down. You were 100% in that room working on someone with your hands in them. You were part of it, too. You were awesome. That’s awesome.
Josh: It’s funny, one of the coolest parts was going on, like, around the procurement. So you’re hopping on this, like, private jet and you’re, you know, jetting off to…
Chris: Go get the kidney.
Josh: Go get the, you know, or you know, harvest all the organs and come back in. You’re riding in an ambulance. I thought that was pretty cool.
Chris: That’s pretty nice. You got to where they fly you to where, I mean, it’s kind of weird you’re flying somewhere to pick up a kidney, but…
Josh: Yeah, I think when I was in Nebraska, I think the farthest I ever went to is, not really, not that far. Chicago or something.
Chris: Okay. Yeah, not far at all.
Josh: So not very far. But, so, other surgeries, you know, I take out kidney, so Nephrectomies. Traditionally a urologist does, like a prostatectomy, so prostate removal for prostate cancer. I don’t do those just cuz it’s a very specialized procedure and you need to do a lot of them.
But I do, probably the most things that I do, are kidney stones.
Chris: Have you had any real rough ones of those?
Josh: I’ve never had kidney stones. I treat, you know, I probably do two to four a week.
Chris: Do you have to pass them now still, or do they use the shockwave stuff to break them up?
Josh: So, shockwave is actually kind of older technology.
What we do now is something called ureteroscopy. It’s a tiny, little scope that goes in through the urethra bladder up the, ureter, that’s the tube that connects skinny, the bladder. And we go, and have a little laser, acts like a jackhammer, breaks up the stone.
Chris: Makes it way easier than it was back in the day.
Josh: So, yeah. I mean, there’s pros and cons. I mean, it’s probably a little bit more uncomfortable go through, but we have a better chance of clearing out all the stones from that, but, I do incontinence surgeries.
Chris: Elaborate on that. What’s that?
Josh: So like, definitely more common with women, but, so like leaking, with like, coughing, sneezing, laughing, stuff like that.
So we put in, I’ll put in, different types of slings, and then men will also have issues with incontinence. So I’ll do these, call it a turp or the lingo is a roto-rooter.
Josh: Yeah. So, go in, kind of, remount the prostate so that it’s easier to pee.
Chris: Oh, roto-rooter. I’m not sure I ever wanna go through that process, but if I need to, I’ll give you a call. So you do obviously, supply the ED stuff. We have tadalafil. We have PT-141 for the women’s libido. What percentage of your patients are women, female or men? Men, female?
Josh: So, I probably see maybe 60% men, 40% women.
Chris: More of a problem than men usually, for prostate, obviously.
Josh: Yeah. So, definitely, with like prostate issues and stuff like that. And then, you know, as far as the sexual component to it, I think most women end up going to their gynecologist for those types of things.
I see a little bit of it, but not a whole lot. I typically see more men for issues with sexual function.
Chris: Ed, what do you subscribe for ED?
Josh: So, I usually tell patients, I kind of have two pathways. I have the traditional pathway and then there’s kind of the non-traditional pathway.
So the traditional pathway, we begin with lifestyle changes. So we say things like, you know, really, I really harp on sleep because, there are some great case studies as well as some data that shows that sleep is essential for testosterone production. So I tell guys that, you know, you really need to be shooting for seven, eight hours of sleep, okay?
You have to, you know, whatever it takes to lower stress in your life, whether it’s, altering your job hours, whether it’s meditation, whether it’s finding a hobby, I mean some outlet so that you can decrease your stress.
Chris: Climbing rocks?
Josh: Climbing rocks or what have you. Working on cars, running, whatever it takes.
And then exercise, I, really, big proponent of resistance training. So big compound movements like, squats, deadlifts, things like that, will raise testosterone. And then, you know, diet and exercise, types of things. So once we’ve really focused on the lifestyle, then we’ll go into the pharmaceuticals.
So there’s the PDE5 inhibitors. They all work pretty much the same. There’s some differences with them, but, generally, I find that, if a patient, like, if one, for instance, you know, doesn’t work, it’s not real typical that another one will. Sometimes we’ll cycle through there, but I usually use the common ones that are generic.
So tadalafil and sildenafil.
Chirs: Okay. Yeah, we have those.
Josh: I usually start out, I don’t really start low and go high. I usually, you know, start high and have them either like break the pill in half. So, if there’s a hundred milligram sildenafil tablet, I’ll usually have them break it in half and go from there.
Or if it’s a tadalafil, I’ll do the 20 milligram tablet and have them break it in half. The guys that have some urinary difficulties, I’ll do it like a daily tadalafil. So, there is a, there’s an indication to treat lower urinary tract symptoms too.
Chris: So benefit there, too.
Josh: So, and then, there’s some others that I, you know, to be honest with you, I don’t think I’ve ever prescribed like levitra and stendra.
Chris: From my understanding, there’s quite a bit of options out there for that stuff now.
Josh: There’s definitely more out there, I’m sure more expensive. I mean, I haven’t looked at this recently, but I don’t think any of the literature shows that any one is better than another. I think the claim to fame for stendra is like a 10 or 15 minute onset.
I usually tell patients, you know, what are you looking for? So, a tadalafil has a longer half-life. So it’s kind of like nice, you know, you could take it on a Friday and you know it’s still in your system by Sunday. But I also tell patients if you’re gonna have a side-effect, unfortunately sometimes that side-effect is gonna be present for longer as well.
So, headaches are pretty common, really bad nasal congestion. Some guys will have like body aches. And then there’s the sildenafil, which has a shorter half-life. So if you’re gonna have a side effect, it’s kind of nice where, you know, maybe you’re only gonna have a headache for, you know, four-hour period of time. Type of thing.
The unique thing about Viagra or sildenafil is that it can actually cause a blue tent to your vision.
Josh: So, I’ll tell patients, you know, don’t get too worried when it’s almost like you’ve got a blue, like a pair of glasses…
Chris: With a blue lens on them?
Chris: Wow. I did not know that.
Josh: There’s one of the same enzymes, the cyclooxygenase, is found in the retina. And so you can mess with the, I don’t remember if the rods or cones.
Chris: Has anybody ever called you after they got that prescription and been like, “Blue! Man, it was weird.”
Josh: I’ve never had anybody, like, really get worried about it. But I did have one guy that after I told him that, he’s like, “Oh, that makes sense. Like, I thought that like, you know, my eyes were like playing tricks on me or something.”
Chris: And it did happen.
Josh: And so it did happen. But then after, you know, if those medicines don’t work, it really depends.
Like if you’ve got a guy that’s somewhat healthy, that’s not, you know, morbidly obese who’s in his, you know, fifties, maybe early sixties, generally, I have pretty good luck with those. But if I got a guy that has like a really brittle diabetic who’s, I mean, there’s definitely some guys where you look in there and they’re like, they’re struggling just to breathe, just being in, you know, walking up the stairs to get to your office or something.
Typically they’re not gonna respond to the PDE5 inhibitors.
Chris: They’ve got enough stuff going on in there that’s messing it up.
Josh: So, for the next step, you know, I’ll throw in things like the, there’s a vacuum erection device, you know, couple that with, like a cock ring or something like that.
But to be honest, I think I’ve only had a handful of patients who have actually, repeatedly used a vacuum erection device. A penis pump. I mean, they just, it’s not real natural. It’s kind of uncomfortable.
Chris: Well, at least you give them the options. I mean, a lot of doctors in situations like this would just prescribe and say, “Get outta my office.”
Josh: Yeah. I mean, and then oftentimes I’ll combine it so you can, you know, you can use the Viagra with the vacuum erection device or something like that. After that, it’s injections, so penial injections. There’s a bunch of stuff out there. The most common one is something probably called Trimix.
And there’s different, you know, so it’s three medications. There’s prostaglandin, papaverine, and, phentolamine. And there’s different concentrations of each that, the people will mix in. I don’t know. I think you don’t, you guys do…
Chris: We do have some of, yeah, we have some instructional videos also online that you can check out.
Josh: How to do it?
Josh: So I don’t know what particular concentration that you guys have or offer, but some, you know, some patient might react a little bit better to one versus another.
Chris: Well, usually the injection of any type of supplement is gonna work a lot better than the pill.
Josh: Oh, it’s gonna, you know, it’s gonna work in like 90 plus percent of patients.
Chris: Lots of side effects?
Josh: It can be, you know, it is really funny though. I say this kind of jokingly cuz I’ll get guys who are like, “Doc, I’ll do anything. I’ll do anything to get, you know, to have an erection again. Like, you just name it. I’ll do it.” And I’m like, “Well, will you inject your penis with a medicine?”
And they’re like, “Mmm, no.” And I’m like, “Well, you really weren’t willing to do anything.”
Chris: So you’ve been in this for, how long have you been in medicine?
Josh: So, gosh. So, I graduated residency in 2014. So, that’s when I’m officially, you know, be able to practice on my own. But I mean, I started this whole process in 2004. I was in practice in New Mexico for a while, and then I came up to Walla Walla for a few years, and then I’ve been here almost three years in Tri-Cities.
Chris: What, in that 10 years that you’ve been in, through school and through residency and stuff, what, I would say crazy, but unique.
What are some of the unique things you’ve come across? Like, I’ll give you an example. We had a plastic surgeon on once and he said that a deer went through somebody’s front windshield. Now I wasn’t thinking that he would say something like a deer being a plastic surgeon. So I kind of curious to see what a urologist is gonna say.
Josh: So, you know, it is interesting cuz I do these surgeries and, for whatever reason, it drives a lot of attention in the operating room. Like, so when somebody, you know, looks on the board and sees that I’m doing one of these surgeries, there’s a lot of interest. So I do what are called penile prosthesis.
So, it’s a surgery for guys that have such extreme erectile dysfunction that they can’t get an erection at all. So, they’re either unwilling to do the injections or they’ve tried them and they don’t work. And essentially what we do, is we implant a device inside the penis. So there’s two kind of erection tubes that fill with water.
So, we implant that inside the penis. We put a little reservoir of water next to the bladder and then a little pump button in the scrotum. And essentially what they would do is they would squeeze this button in their scrotum and it transfers water from the reservoir into the erection tubes. And you get an erection.
Chris: There you go.
Josh: So you get an erection as long, you know, anytime you want, for as long as you want. And then you click a little button and it goes down.
Chris: Okay. I had shoes like that in the nineties.
Josh: Like the Reebok?
Chirs: Like the Reebok! Right. Okay.
Josh: Very similar.
Chris: I don’t wanna make fun of it too much because I know it is a situation. But I’ve never, ever heard of that. Now, are you, where you do the surgeries, is it a teaching hospital or, no. So, they can’t watch?
Josh: No, I mean, we’ve got, like, I mean, the staff. So there’s like the, they’re called the surgical techs and the operating circulator nurses.
You know, will always come down and have a little look, you know, there’s always, you know, giggles…
Josh: Definitely a lot of curiosity.
Chris: Well, you’re married. What does your wife say about it?
Josh: Kind of grosses her out.
Chris: That is interesting. So you said lifestyle changes is the first thing you obviously suggest, and then after that you do the supplements.
Have you had anybody try to self-help themself to fix their ED without, like, I mean, you know what I mean? Like, people do weird things, like bee juice I know could work or something like that. I, rumors?
Josh: Yeah. So, I’ll address that, too. But there’s also, so I had a guy, who wanted to address premature ejaculation. And so he basically injected collagen into…
Chris: Oh, no.
Josh: The head of his penis. And it, you know…
Chris: I think I’ve heard of people putting it in their lips, right? To make it bigger?
Josh: So I had never heard of this, and then I kind of did a little bit of research and I guess that like, there are some people that do that to help kind of like desensitize the penis or something. And also I guess maybe make it a little bigger or something.
Chris: Sounds uncomfortable.
Josh: But he had a complication that I’ve, you know, I don’t think it’s very common, but you know, it does happen where it can cause tissue necrosis.
So if that collagen, you know, blocks off a significant portion of the blood flow to whatever organ, it can cause that, the tissue, distally to that to die. And so he had basically the top, you know, several layers of around the penis that essentially died.
Chris: Died? Oh man. He didn’t even help his own cause, he made it even worse.
Josh: Exactly, exactly.
Chirs: I can suggest to anybody, don’t do any of this medical stuff on your own. You’ve seen stuff about people trying to make their butts bigger or whatever by putting different things. Don’t, don’t, don’t do it. Go to a doctor.
Josh: No, no, no. I mean, I’ve had guys with, that are high, like on meth and heroin that did, like, the vacuum erection device. And then they put like a cock ring there and then, you know, passed out or you know, whatever. And so, you know, hours or something later, they’re…
Chris: That’s not healthy either.
Josh: It really does look like an eggplant.
Chris: Oh geez! Did they have to come in and get it fixed at that point?
Josh: So it really depends. These are all kinds of weird stories, so, we’ve had to put like ring, special ring cutters, like, you know, sometimes, in accidents, emergency rooms, people have like a ring on their finger that they have to cut off. So there’s a special device for that.
We’ve had to use those in the operating room to cut off different types of devices.
Chris: From the genitals?
Chris: Ouch. Besides the tube, and I don’t know if I wanna know the answer to this question, what type of devices?
Josh: So, you know, it was really interesting. So I saw this guy, you know, I got this call from the emergency room and I’m like, “What?”
They’re like, “Yeah, it’s like some metal cage that this guy…”
Chris: Cage? Cage is the word they used?
Josh: Cage. And so, and I, anyway, I told him like, “Look, you’re gonna have to find some really advanced…” Because, you know, they have like ring cutters that can cut through like titanium and stuff. So I’m like, “You’re gonna need some really advanced stuff to cut through that metal.”
So, you know, we knocked him out, ended up cutting it off, but then, I went to, there’s an adult novelty store here in town called Castle. And I’m in there and sure enough, in one of the display cases there is this, like, it’s basically a chastity belt for men.
Josh: That’s exactly what this guy had
Chris: And he couldn’t get it off?
Josh: He had kept it on, like, way too long.
Chris: Like one of those Chinese finger handcuffs they had or whatever?
Josh: Yeah, what typically happens is you start to get a lot of swelling that are distal or past where the constriction is. And so they try to slide it off and they can’t.
Chris: It’s taking more than it should. So, when you go to Castle, that’s all work research, of course?
Josh: Of course!
Chris: So, okay. So women, we’ve talked a lot about men in Ed. You help women with low libido and stuff along those lines?
Josh: So, I’ve done a little bit, you know, it’s really interesting. If you look at the literature, there’s not great guidelines for like hormone replacement as far as libido for women.
I do think it was a huge travesty. I don’t really necessarily want to go into this cuz I don’t know the research very well, but there was a big study maybe 15 years ago that basically said that hormone replacement of women was bad. That it was associated with, you know, breast cancer and ovarian cancer and everybody on hormone replacement should stop immediately.
And, you know, they did some subsequent analysis of that study and it found out that it, you know, was basically full of shit. Like, they did the statistics wrong. And actually the hormone therapy was actually really beneficial for a lot of women.
Chris: Oh man.
Josh: But unfortunately, the cat was outta the bag. So now you know, lots of women that are going through, you know, menopause have got these horrible symptoms.
And they think that they just have to live with it. And a lot of like, you know, permacare docs and, you know, gynecologists think like, “Oh, we can’t do hormone replacement on these women because, you know, they’re all gonna get breast cancer and die.” And so they’re suffering, they’re struggling, and you know, hot flashes, poor sleep quality…
Chris: And nobody’s gone and turned this study over and gotten…
Josh: Oh no. There’s lots of people who have done it, but it’s like, just anything in medicine, it takes a long time to, you know, it’s slow to adopt. And it’s slow to change, you know, and there’s some good to that, but there’s a lot of bad and so, that’s one thing that’s just kind of a pet peeve of mine, that right now, like there’s still not a lot of info out there showing that, you know, women don’t have to suffer.
Chris: Yeah. No, I mean, and to get the word out is the best thing. That’s what we do here at Invigor Medical. We help people make decisions to have a healthier life.
Which is what you do cuz you’re a doctor. PT-141 is one of the things we have here. I’m not too familiar with it, but it is one of the options. You can go to invigormedical.com check out all that stuff. Where could people find you?
Josh: So, I am employed by Trios Hospital. So I’m at the professional building next door.
Chris: That’s in Kennewick, Washington?
Josh: Kennewick, Washington, correct. Yeah. Trios Hospital, South Ridge, I think.
Chris: Yeah. South Ridge, yep. Are you on social media at all?
Josh: So I am, but I don’t have like, just a personal account.
Chris: Be like LinkedIn. Go to LinkedIn if you want to find him.
Josh: Yeah. I mean, eventually, so I’ve kind of got these plans of I have this joke that, I’m basically like a human plumber. And so…
Chris: Yes. Yeah, you are. You work on all the plumbing.
Josh: And so I am working on like more of a social media presence, but you know, The Human Plumber.
Chris: Human plumber. I like that we can work on a logo for you.
So, if you had one piece of advice for somebody, I know you’ve given some really good nuggets so far. If there’s one thing someone can do in their life, just blank in general to make their life better. What would be your suggestion? Now, I don’t want to put anything in your brain, but you tell me what you think.
Chris: Exercise. Okay.
Josh: There’s some amazing studies that show that the degree of muscle mass that you have at later in life as well as something called vo2 max, which is basically a way of measuring kind of like your aerobic capacity. So if you’ve got high aerobic capacity and you’ve got high muscle mass in your, you know, seventies, eighties, nineties, that is gonna be way more predictive of longevity than just about anything else.
Chris: And that, you see, lower signs of ED and stuff like when people to exercise and are in shape and everything?
Josh: Oh, absolutely. Absolutely. That’s the first thing. When a guy comes to me with erectile dysfunction, I’m like, “You know, you’ve gotta move. You’ve got to lift weights.”
It’s gotta be more than just going out for a walk. I mean, that’s great. But it, you just need to do more.
Chris: I’m gonna take a note here. I’m not old enough to have that issue yet, I hope, but I am gonna get a gym membership and I am going every day cause I don’t wanna have to live with that.
Josh: It’s really interesting because I’ve practiced mostly in small towns. And I run across my patients so often in the community and, you know, I often feel bad when I ignore patients that walk by and you know, I do it for a reason because I don’t want other people to be like, “How do you know him?”
And then open up a can of worms they weren’t necessarily wanting to open.
Chris: Oh my gosh, that’s smart.
Josh: But, no, it’s surprising how often I run across patients.
Chris: So you’re saying some guy that might have gotten the Reebok, pump put in, I dunno if I should say that or not, but… Wouldn’t necessarily come up to you on the street and be like, “Hey Doc, what’s up?”
Josh: Exactly. Or, you know, put something in the urethra and I had to fish it out, you know, three weeks ago, or so.
Chris: Did you work in the emergency room at all?
Josh: No, but when the emergency room, when patients come there and the emergency room docs are like, “Ah, I don’t know what to do with this.” That’s when they gimme a call.
Chris: How often does that happen?
Josh: Gosh, it probably happens, I probably get six or seven calls a week.
Chris: Wow. Really?
Josh: I mean, but it’s for more common things. Not, you know, foreign bodies in the urethra. It’s usually kidney stones or…
Chris: Like daytime stuff, not usually like…
Josh: There’s a, you know, at night some guys got, you know, a kidney stone at like 2 AM. Then there’s some other associated factors and I’ll have to go in and see them.
Chris: Okay. So one of the questions we get a lot on Google is vasectomies. Do they play a role in ED?
Josh: So they don’t.
Chris: Good. Cause I’ve had one.
Josh: Exactly. I’ve got one too. Yeah. So essentially, all we’re doing is we’re cutting the sperm tube, the vas deferens. So we’re just making it so that sperm can’t travel from the testicle out. So, the actual, you know, component that the testicle provides for semen is very small, so there’s not even really a production in volume.
We don’t do anything to testosterone production. The testicle is just fine. There’s also kind of a caveat to that too, is that there’s a lot of people, for whatever reason, there’s been the thought of an association putting in vasectomy and prostate cancer.
That one is not as clear. We think in general it’s no, but if you scour the literature, there is some evidence to show that there might be a slight association. Not necessarily causation with vasectomy and prostate cancer.
Chris: Okay. Is it weird that a wife would want to go in and make sure that the surgery was taking place?
Josh: You say that. I have had several times where, so I usually cut a piece of the vas, the sperm tube out and, I had one, oftentimes the wife is there in the room. So, she wants to see it. And then I had one that actually wanted to keep them.
Chris: Keep them? Okay. My wife didn’t wanna keep it, but she definitely wanted to be in the room. All I did is smelled something burning for a second, and I wasn’t really happy about that, but, okay.
So, vasectomy doesn’t necessarily affect ED, there’s still, do the vasectomy and prostate. That’s still kind of…
Josh: So it’s, I mean, overwhelmingly like I recommend, like I’ve had a vasectomy, I recommend doing it.
But again, if you really like, I’ll be honest with patients, like, I still recommend doing a vasectomy, like I wouldn’t do it because you’re concerned about prostate cancer. But if you did kind of research on your own, I wanna be very transparent and be like, look, there is some literature that maybe shows a little bit of an association.
Chris: Okay. Okay. Well, does testosterone, does that play a role in ED?
Josh: So it does. The role that it plays is actually pretty complex. And, I’m really upfront with patients cuz a lot of times there’s this notion that like, “Oh, if I’ve got low testosterone, that’s the reason why I have erectile dysfunction. If I fix that, I’m good.”
And unfortunately it’s not necessarily the case. For instance, there’s oftentimes where I’ll treat prostate cancer. And one of the things we do is we cut their testosterone off. So we’ll give them medication so their body doesn’t produce it. And they could still get erections.
Chris: So it’s like a testosterone based cancer?
Josh: Correct. Yeah. So it’s, testosterone has a weird role, but it can kind of feed it, you know.
Chirs: Well, estrogen feeds breast cancer, stuff like that.
Josh: And so, yeah, so these guys that don’t have hardly any testosterone, yet they’re still having erections. It’s really bizarre.
Usually if you look at the causes for erectile dysfunction, the most common one is vascular. So what tends to happen is the endothelial lining of the blood vessels that are in the penis, they’re supposed to be responsive. So there’s some signals from the brain that tell these blood vessels to dilate.
So as they dilate, they draw in more blood. As the blood comes in, it actually compresses the veins that take blood out of the penis. So that’s why you get an erection. Through, the same thing with like, cardiac disease, plaques, and stuff like that. You get blood vessels, they’re not super responsive and so they can’t dilate with blood like they should.
And so that’s why you guys will not be able to have an erection. There is some issue too with the innervation of the penis and the nerves that help control erections. There’s a thought that those nerves can sometimes be damaged and that’s why. But, you know, the number one cause of erectile dysfunction is this inability of the blood vessels to really dilate.
What role testosterone plays is really not super well known. Like we just don’t know, but we do know that there are many, many cases where guys that have low testosterone, hypogonadal, if we replace that testosterone, they can get erectile function back.
Chris: What, would you, what supplements and stuff would you suggest for that?
Josh: So with guys that have kind of marginally low testosterone, again, I’ll go really harp on lifestyle.
I’ve heard case studies of guys who are even like, you know, bodybuilders, these extreme athletes that just kind of ran themselves down, that weren’t sleeping very well. They were working out too hard, too often. They would get these testosterones where they have a total testosterone of like a 100, 120
Chris: And what are they supposed to have?
Josh: You know, a guy in his thirties, like, I would like his total testosterone to be 450, 500. His free testosterone, you know, 12 to 15ish is where I’d want it to be. So these guys are super low. But like, they’re, these, you know, they’re athletic, they’re built, and it’s just from having their body run down.
Chris: Do you think that this, if steroids play into low testosterone?
Josh: It can. So definitely with like bodybuilders and stuff. Yeah.
Chris: Now I’m not saying these people are on that, but I’m suggest, I’m assuming even…
Josh: Even a history of, you know, being on testosterone for a significant period of time that the testicles basically say, “Hey, look, there’s plenty around. We don’t need to make it anymore.”
And they shut down and oftentimes they don’t restart back up. So, it is pretty common. I’ll see guys in their late forties, fifties, that are on testosterone because they abused steroids earlier in their life.
Chris: Yeah. And what do you suggest naturally for people to do to try to keep…
Josh: So, you know, the lifestyle stuff and the, but there’s also, there are some supplements. There’s, blanking on the name now that we’re here on the podcast. Tongkat ali, I think is what it’s called. It has, depending on a few studies, I think I saw this first on something called the Huberman Lab. Another podcast there.
That there are some studies that show that it can raise testosterone by a 100 to 200 points.
Chris: That’s double the gym guys
Josh: Yeah, exactly. And there are, there’s some evidence of these things like GNC and these other herbal supplements that they can modestly raise total testosterone.
Chris: Okay, but what about like foods? Like any foods or any beverages or any type of…
Josh: No, I mean, there is some thought that anything that increases blood flow or nitric oxide. So there is this thought that like beets of high nitric oxide. I think there’s beta alanine, I think, citrulline, I think is another supplement that have been shown to kind of increase blood flow.
Chris: How often do you subscribe supplements to people with ED? Like, do you do, I know we’ve talked about this a little bit, but you make them, you try to make them do the lifestyle first.
And they come back in and do it. Do most people that do the lifestyle change have to get on ED medicine?
Josh: So I would say, unfortunately, yes. And I think it’s mostly due to, you know, changing your lifestyle is like the hardest thing ever. And I tell patients this, I’m like, “Look, I, you know, I’m not judging you.”
Like, you know, when this doesn’t happen. I mean, this is, you know, change of behavior is like the hardest thing to do ever. And especially a lot of these things that we ask you to do, you know, you’ve had, you know, 20, 30, 40 years of really bad habits. It’s not gonna be something that just happens overnight.
And so I don’t want them, I want them to know how important it is. But I think shame is not something that you need to do to these people, like that. They already kind of feel it. They already know what they kind of need to do. I just think most people just need encouragement.
Chris: And that’s one of the things that we like to do here. We have this conversation. So when they do end up in your office, they have more tools to be able to talk to you about things. Or their own doctors or what not. Most people aren’t gonna sit here and talk about, you know, penis pumps and stuff like that. I do appreciate your candidness with stuff like that.
Josh: Sure, sure. So, yeah, and I was gonna just add, you know, there’s some people who will be so kind of maniacal about lifestyle changes that they won’t do the other things. And I’m a big proponent of like, look, your testosterone’s low.
I think we can kind of jumpstart things. If you’re low, let’s replace it and you do X, Y, and Z as well with that and that’s gonna, you know, be even better than trying to just do this on your own.
Chris: What’s the length of somebody that’s on ED? Is it just like, is it month by month? Is it a six-month thing? Is it a 12-month thing? Because, you know, I’m thinking in my mind, I’m thinking cholesterol medicine, heart, you know, heart whatever, medicine, you know…
Josh: It really depends. If it’s an older guy, it’s probably gonna be a lifetime.
Chris: Okay and that’s a pill every week or whenever they do it?
Josh: Whatever they want, But, you know, it is really surprising. I think a lot of times just with age, you know, sexual desire, appetite, you know, libido. It tends to wane. And so, I would say a lot of my patients get to a point where that’s just not that big a deal for them. Which is sad, but I mean, I understand. I don’t wanna push it on them.
And then the younger folks, you know, I tell them that, you know, this is real surprising, too. I could go on a whole conversation about this. We’re seeing erectile dysfunction in younger guys every year.
Chris: Why do you think that?
Josh: There’s a number of reasons we think maybe it’s coupled to, we’ve also noticed decreased sperm counts. And there’s a thought that…
Chris: Maybe that’s just Darwin?
Josh: Exactly. We think there’s a lack of hormone disruptors, we think, you know, the royal common one we hear about is BPA. But there’s a lot of chemicals we think that we’re being exposed to now that we weren’t necessarily 20, 30 years ago.
And that these are, are causing low testosterone levels and in turn may be causing low sperm counts.
Chris: Energy drinks?
Josh: I don’t know if there’s been any association between that. But I do know that, you know, those energy drinks often have lots of sugar. And probably the worst thing for you is liquid sugar.
It gets absorbed so fast, it causes your insulin to spike so hard. And…
Chris: Insulin resistant jumps in and you’re all sorts of messed up.
Josh: Exactly. And then it just kind of perpetuates itself. So yeah.
Chris: So stay away from liquid sugar.
Josh: Liquid sugar, exactly.
Chris: Okay. So, urinary tract, your a urologist. Does any of those type of issues, like make ED worse or better?
Josh: Not really. I mean, they’re not, there’s not really an association with them, but it is associated in the fact that it’s more common as you get older. So the older a guy gets, the more likely he is to have urinary issues and then the more likely he is to get erectile dysfunction.
Chris: And you said something about pumpkin seed oil earlier, right?
Josh: Yeah. So, there’s two natural supplements. There’s something called pumpkin seed oil, and then saw palmetto. There are a lot, there are others out there, you know, that can help. But these are actually, probably one of the, some of the more well-studied…
Chris: Are they over the counter?
Chris: Pumpkin seed oil and saw palmetto over the counter to help urinary.
Josh: Yep. Yep. Absolutely. And then there’s a lot of other supplements that’ll have things like turmeric and some other things in there that, you know, can potentially help.
Chris: Great, great. You’re married. How many kids?
Josh: So, his and her situation. So, I’m on my second marriage. I’ve got two kids and then my wife has got four kids, so total we’ve got six. So we’ve got quite the circus.
Chris: Do you have a housekeeping named Alice?
Josh: No, I wish. Definitely my wife wishes.
Chris: Oh yeah, I bet. Right?
Josh: So, yeah, we recently had to buy a new vehicle there that seats eight. I never imagined myself having a vehicle that seats eight people but…
Chris: Giant excursion or something. Maybe even a small bus.
Josh: Well you know what? So it gets where, you know, like Chloe’s family, like they’re, they had one of those Ford econo line bus, basically van? Like a van 13 passenger van, you know?
Chris: Yeah. I mean, yeah. Cause we were talking earlier before the show and your wife has like 7,000 siblings.
Chris: Okay. Josh, thank you so much for joining the show, like you said, LinkedIn, they can find you?
Josh: Yep. LinkedIn and just the, if you go to the TRIOS website, find a provider, urologist. I’m the only urologist there.
Chris: And go into the comment or the notes on the episode two, his information will be in there. Josh, thank you so much for joining the show.
Chris: I appreciate you coming in and being one of the first episodes.
Josh: I love it.
Chris: First guests in studio. Thank you, sir.
Josh: Hey, thank you so much. I appreciate it. Take care.
Narrator: Thank you for joining the Invigor Medical Podcast. For more information on the show, Invigor Medical, or to get ahold of Chris, go to invigormedical.com.