The Penis Podcast – Episode 5

Transcript – Episode 5

DATE: December 3, 2020

DURATION: 28m 30s

START OF TRANSCRIPT

 

[00:00:02] 

Hi everybody, I’m Dr. Gavin Scriven, people call me Dr. Gav, and with me is the founder of the non-surgical penis augmentation procedure we call Calibre, Dr. Jayson Oates.

[00:00:02] 

Thanks Dr. Gav, and together we are the dick doctors and we are going to be talking about all things penis, our area of expertise is injectable penis augmentation. There’s a lot to talk about penises and together myself and Dr. Gavin will be doing that.

[00:00:12] 

Welcome, everybody, I’m Dr. Gavin and I’m here with Dr. Jayson from Perth, We are the Calibre Clinic, confidence changes everything and we’re here to talk about penises today and thanks for joining me today Dr. Jayson.

[00:00:46] 

Thanks, Dr. Gav, and just to remind everybody that confidence changes everything. So so, Dr. Gav, today we’re talking about erectile dysfunction.

[00:00:57] 

Yes, we are and it’s something that we talk a lot about with our patients being the dicks doctors, and it’s it’s a unfortunately a very common problem and have a lot of people out there suffering with erectile dysfunction and not knowing where to turn or who to talk to. I guess my advice is always the first point of call would be your GP, don’t know if you agree with that, Doctor Jayson.

[00:01:25] 

Yeah, well, the numbers seem to indicate that 50 percent of the men over the age of 50, in fact, they even say starting from the age of 40, are having some erectile dysfunction. So the first thing would be to see your GP because it’s not just the function of your penis that you’re worried about with the erection, obviously it’s the flow of blood into the penis, and the blood vessels in your heart are about the same size as the blood vessels in your penis. And so if you’re not getting enough blood into the penis, one of the things that your GP may want to check out is the blood flow to your heart. So I guess that’s the sort of thing that as a GP, you’d be wanting to ask some questions about.

[00:02:15] 

Yeah, definitely, and that’s really interesting. You said it’s 50 percent of men over the age of 50.

[00:02:23] 

Well, the study that I read was suggesting over the age of 40, I couldn’t believe that, now I’m over the age of 50 and yeah, that would be a concern if that many guys are having it, but I don’t think it means that none of them can get an erection, it just means that they aren’t getting the erections and maintaining the erections,

[00:02:47] 

Not like they used to when they were 18.

[00:02:49] 

Yeah and the function that I wish to achieve with their erection.

[00:02:54] 

Sure. Yeah OK, well that makes more sense then. But yeah, I’m sure if we, if there was a survey put out, if your erection quality and the, the hardness and the duration of your erection, is it the same as when you’re 18, I’m sure

a lot of people put their hands up and say it wasn’t. So yeah, I think starting with the GP looking at simple things like your cholesterol levels that of course, affect your cardiovascular system, looking at your fasting glucose levels because the risk of diabetes is the other sort of big one.

[00:03:29] 

I guess the two major sort of functional things that can happen in a penis is a change to the blood flow or change to the the nervous supply. And so the cholesterol and the build up of like atherosclerosis, decreasing that blood flow into the penis is one, and if the nerves aren’t working as well and you’re not giving that nervous impulse that comes with the generation of an erection and nerve problems are a very, very common in diabetes, and of course, diabetes is becoming much more common with obesity and the type two diabetes.

[00:04:09] 

Yep, exactly. And of course, in general practice, without screening, not only screening for diabetes and really everyone over the age of 30 these days, of course with every lady who goes through pregnancy, they get screened for gestational diabetes, not that this is a problem with women, but it’s very prevalent, unfortunately, in our society today, and I guess most guys wouldn’t realise that that could affect the quality of their erections. But most people understand it affects things like their eyes and their feet, but the smaller blood vessels and we do put checks for diabetics that maybe, unfortunately, part of the common practice should be doing an erectile dysfunctional penis check for people who are prediabetic or diabetic.

[00:04:51] 

Yeah, well, maybe if we spoke to younger people and said that one of the major causes, I think it’s around about a quarter of erectile Dysfunction is put down to diabetes. They said you’re going to lose your ability to get an erection. Maybe more guys would be out there exercising, watching their diet and losing weight.

[00:05:11] 

Sugar would be off the shelves in their homes.

[00:05:14] 

That’s right. So I guess the other thing that guys often think about and want to put it down to is a change in their testosterone levels and especially getting into their 50s. Do you check guys testosterone levels?

[00:05:33] 

Yeah, as a GP, we do routinely check testosterone levels if someone’s come in for to talk about erectile dysfunction, but I do let everyone know that it’s not a common cause of erectile dysfunction, it’s actually one of the rarer causes, but it’s probably one of the first things people think about, I guess. And especially guys, I think it has something to do with the manly input, the testosterone levels. And yes, it’s of course, it’s a possibility and if you have low testosterone, that does affect erectile function, but it’s not a common cause.

[00:06:03] 

So you may have erectile dysfunction and you may have a low testosterone level, but it doesn’t necessarily mean that that’s causative.

[00:06:16] 

Exactly.

[00:06:17] 

And yes, if you sort of go on to testosterone, you might sort of increase in muscle mass and possibly lose a little bit of weight. Maybe you’ll have an improvement in your erectile performance, but once you start on testosterone, my understanding is it’s it’s hard to get off of it, because once you stop that testosterone, your natural production of testosterone is being suppressed and you can’t even get to the point where the testicles shrink, which doesn’t sound great. And then if you stop your testosterone supplements, then you really feel bad because it takes time for your natural testosterone level to sort of come back up.

[00:06:57] 

Yes, so I think it’s important to understand that there are many other causes other than low testosterone. Probably the most common ones we’ve talked about already are the high cholesterol, diabetes, high blood pressure, anything that affects the cardiovascular system in a negative way. So it’s important to that’s why I said at the very beginning, start with your health checks, find out if your cardiovascular health is in check and looking at the blood flow in your whole body is important for erectile dysfunction. And of course, the other major component we have mentioned is the psychological component, which is probably the other major cause of erectile dysfunction and I guess is part of the clinical history that we take as doctors, we suspect that is the case, then that’s a little bit more tricky to deal with. And we still have to go through all the other checks and balances before we can say it is psychogenic in nature. But it’s not, it’s a very important one to understand.

[00:07:55] 

Absolutely. Yeah I think there was a time 30 years ago with sort of the majority of erectile dysfunction was sort of put down more to psychological sort of things, the stress of that sort of thing. And then we started to move more

into the the physiological the blood vessels and the nerves, that sort of thing. And then, of course, we started getting the little blue tablets, which would fix it. And then everything was sort of put down to being a physical sort of cause. And I think now it’s sort of back into that sort of medium sort of thing..

[00:08:32] 

Yeah, there’s multiple contributing factors.

[00:08:36] 

Yeah, part of the problem is if a guy’s suffering from depression, stress, that sort of thing, is you might get put onto an antidepressant medications. And what’s one of the most common complications of some of the antidepressant medications?

[00:08:54] 

Erectile dysfunction.

[00:08:55] 

And so then you’re in that sticky situation where there might be somebody does have an element of depression and they’ve got erectile dysfunction. And do you continue with the medication? Do you stop the medication? Yeah, it’s not an easy situation to be in. And, blood pressure medications as well, some of them, it’s a common complication, I guess that’s part of the history is sort of just checking what they’re on and whether it’s what we call iatrogenic that’s been caused by something that the doctor’s doing to them.

[00:09:29] 

Yeah. Yeah so, so many things that could really affect a man’s erection, you know, certain diseases, certain medications, psychological conditions, so it’s multifactorial and of course, as you said, one complained to the other, if you have a slight decrease in erectile function because your cardiovascular health is not as good, that can make you feel a little bit down and it can become a psychological issue after a while and feel performance anxiety and then that feeds and sort of goes in a in a cycle, as they say.

[00:10:01] 

One of the things I tell all of my guys is exercise more, improves your cardiovascular health, it’s a great natural way of improving your testosterone level. It’s actually shown to be almost as good for depression as the antidepressant medications.

[00:10:23] 

Definitely.

[00:10:24] 

If you look better, especially if you lose some of that tummy. It makes your penis look bigger as well, it makes you look more attractive all around. You’re more likely to get an erection if you exercise more. So there’s no downside to exercising.

[00:10:43] 

Excellent. Well, if we can take one thing out of today, I think we’re both running home today.

[00:10:51] 

Only live about five minutes away, so that’s not so bad.

[00:10:56] 

And so, yeah, we touched on a lot of the causes, but you did mention one of the solutions previously.

[00:11:05] 

Yes, so Viagra, as as everybody knows, is that magic blue pill that can restore erections and it’s it’s a use as you need it sort of thing. So it’s not something that you’re taking every day on there out other versions, like Cialis being perhaps the common sort of one where it has a Cialis and has an effect for several days, so you don’t have to be popping it as you need it or that Viagra. Yeah, very much like you’re going to need an erection, right time to take the blue pill.

[00:11:48] 

The show is happening in the next hour.

[00:11:49] 

Yes.

[00:11:52] 

And so what was the idea behind the medications is to increase the blood flow, right?

[00:11:58] 

Yeah, that’s sort of where they came from. They were a sort of an offshoot of when they were looking for another blood pressure treatment medication and its side effect was dilating blood vessels into the penis and getting an

increased blood flow into the penis and creating an erection. And then that leads to some of the complications of Viagra, which is that pounding vascular headache, because the blood vessels sort of dilated in your brain, lowering your blood pressure and then having to be really careful about mixing Viagra and some other blood pressure lowering medication or famously the nitroglycerin paste or a heart attack. And so if you’ve had a Viagra, they can’t use the impact that drops your blood pressure so much that.

[00:12:51] 

You might hit the floor.

[00:12:53] 

Yeah, so that’s great. Unfortunately, Viagra doesn’t it doesn’t suit everybody, comes in I think is three separate strength’s, dosages. So some guys have to go up and up and up, but you can get to the maximum dose and still not have a benefit. Or the side effects can be too much.

[00:13:11] 

And it’s obviously the other medication we mentioned before, some of them can be quite costly, ongoing if they’re using it on a regular basis. So and some people don’t like the idea of medications and side effects. So I guess that sort of brings us to what other options are out there for erectile dysfunction.

[00:13:30] 

So the next thing after the after the tablets is, is the injections, so more definite is to do the the injections into the penis, which then dilate the blood vessels there. And can almost definitely create an erection in most guys. It means it’s a bit more intrusive, obviously, into the whole sexual adventure, if you’ve got to say, excuse me, I’ve just got to put a needle into my penis so I can get an erection.

[00:14:06] 

Kills the mood a little bit.

[00:14:07] 

Yeah, it’d kill my mood.

[00:14:18] 

But they can be highly effective, obviously, and bypass some of the side effects that we get from the oral medications.

[00:14:22] 

Yeah, the downside potentially of it is them having an erection that lasts too long, priapism. And and that can be a serious issue. It can be extremely painful for guys if it lasts longer than four hours. I had a patient come and see me and this was unrelated to medications, it was actually a blood clotting problem. He had an erection for four days and some guys might be thinking, hey, that sounds great, but not great. Incredibly painful, incredibly embarrassing and unfortunately, that was his last erection, it damages the nerves in the blood vessels in there. And so, again, he was looking for a solution for now, truly serious erectile dysfunction.

[00:15:17] 

Mm hmm. And so so the injectables may not be for everyone either for for a number of reasons. So then what what next? Really after that, I guess there are some more novel treatments out there that have some some evidence.

[00:15:34] 

Yeah. So there’s there’s a few things, the next real medical treatment obviously is the surgical sort of one where they can either do a flexible cord or probably more commonly nowadays is the pumps and the pump can be either in the scrotum or in your groin and you’ve actually got to pump that fluid into a bag that’s inside the penis and that creates an erection. Now, this is obviously sort of a no going back type thing. And if nothing else has worked, then that’s the way of getting an erection, that’s the way. So then we’re starting to get into perhaps some more novel and at this stage, still experimental treatments. There is a urologist in Egypt who’s published a couple of papers on injecting Botox into the penis. So this was an interesting thing.

[00:16:32] 

Counterintuitive I imagine.

[00:16:33] 

It was like trying to get the wrinkles out maybe.

[00:16:39] 

Relaxing the penis, people would ask, would that relax the penis?

[00:16:43] 

Yeah, well, maybe relaxed is good. In fact, what it does is it relaxes the muscles around the blood vessels that are restricting the blood flow in there. And so I took a urologist who really understood the physiology of erection. And of course, we use Botox to relax muscles in the face and get rid of wrinkles, but we also use it in places like the armpit

to reduce sweating. It’s a particular nerve and a particular what we call neurotransmitter that releases that chemical message from the nerve to the muscle or the armpit, the sweat plane. In the penis, it’s the same neurotransmitter going to that muscle that keeps the blood vessels closed down and restricts the arterial blood flow in. So we came up with this idea of injecting Botox in with moderate success, not great success, but the idea of success was perhaps to be able to lower your dose of Viagra or if you could shift from doing an injectable treatment to go down to something like a tablet to be able to gain an erection. So some benefit of use it on on a few guys with limited benefit. For some guys, it perhaps reduces shrinkage and maybe we’ll talk about shrinkage as a separate sort of topic. Perhaps it increases the blood flow into the penis, that’s still very experimental at this stage.

[00:18:13] 

And then, of course, we offer something in our clinics both of us, which has a lot of science, scientific sort of evidence behind it in certain areas of medicine, maybe not so much in this area, which is platelet rich plasma that someone some people know it as the p-shot, penile rejuvenation, many different names out there. People might recognise it, but essentially we’re taking people’s own blood, spinning it off down into its components and separating the platelets out of the blood into platelet rich plasma, so a higher concentration of platelets than you would find in your normal blood. And we’re injecting these back into the penis to stimulate some kind of rejuvenation. Talk us through that a little bit more Dr. Jayson.

[00:18:59] 

Yeah so, platelets have a couple of main functions, they start the clotting process, so you get cut and it helps stop your bleeding. So that’s great, bleeding to death’s not a not a great outcome, but then you’ve got an injury there, So the platelets were already also stuffed full of growth factors and there’s so many growth factor, skin growth factors, blood vessel nerve, there’s like 40 or 50, and they keep on finding more and more growth factors. So a clever orthopedic surgeon in Germany 30 or 40 years ago thought about doing this, spinning the blood down, getting the platelets, injecting into bad knees, elbows, shoulders. He never was so great on doing the science and publications, but enough good reports about it that so many American basketball and footballers were going over there to have their PRP injected into their busted up joints. So when I had my knee meniscus injury and I asked my orthopedic surgeon, he said there’s not enough evidence and so I had the arthroscopy and had the cartilage shaved, three months later, review comes out saying that maybe PRP into the knee is just as good as having surgery, three months late for me. So it’s been around for a long time. Oral surgeons have been injecting it into jewels for a long time then. Dr. Charles Grinnell’s in the US came up with this idea that he wanted it to be injected into penises, which I thought was really brave because it’s the clotting mechanism, so anything into the penis and it clots. Is it going to then sort of dry up and drop off. My understanding is that he tested it on himself first.

[00:20:55] 

As every good adventure, adventurous kind of doctor will do.

[00:21:02] 

And when you’re starting off in this sort of area. It’s so good to get it on himself. And fortunately, it’s turned out that you’re after thousands and thousands of treatments that none have dropped off it. It has that allure that it’s your own platelets, there’s nothing injected into you, there’s nothing foreign, there’s no medication. It’s just encouraging the body to heal itself. We’ve both got the same PRP machine, I think, and it generates like 10 times the concentration of platelets that’s naturally in your plasma, which is about as high as any machine can, can get a million platelets per meal. It is still experimental, there’s really no good scientific evidence that it does what it’s meant to do and cure erectile dysfunction.

[00:22:00] 

Anecdotally, what have you found with your clients?

[00:22:05] 

Clients have liked it, and it’s such a subjective thing, and so it’s really hard to know. Of course, I never get to see the benefit of it, I Don’t know what is happening, but guys seem to be happy with it. There’s a few other indications that people use it for and perhaps we’ll discuss that in another video and podcast. So it doesn’t seem to be able to cause any problems, yes it involves needles, uses your own growth factor to stimulate increased blood flow in improved nerve function in your penis. Guys seem to be happy with it, so we do it.

[00:22:43] 

And one of the things I notice for the guys who do respond positively, which has been quite a high percentage, is they notice some morning erections more frequently, erections during the night more frequently. Those kind of things that I didn’t have before that they came and saw me, which is quite interesting.

[00:23:02] 

Yeah I don’t really want to say it’s like this magical injection for making you 18 again, but there’s certainly something about it.

[00:23:14] 

Something you said about it.

[00:23:15] 

Yeah and I really hope we get some more publications. Maybe we should be doing one our ourselves, but you can’t do every publication in the area.

[00:23:26] 

But it’s worth opening the conversation and encouraging others.

[00:23:32] 

When when you’re looking at the range of treatments that are available to you, if you’re looking at, you know, what can improve the function of my penis, then the PRP injection is something that you should be considering, at least you should know about.

[00:23:49] 

Mm hmm. Yeah, definitely. All right. And I think I think that really there’s not too many other things we we haven’t talked about, apart from simply the low intensity shock wave therapy some people ask about.

[00:24:02] 

So Low intensity shock therapy, I think this is definitely going to be something big in the future, certainly in Europe and now starting in the US, it’s becoming more and more popular. And at least there are studies, I’ve got about 30 or so studies that I’ve seen talking about it. So it’s not electric shock, guys. Don’t worry, it’s not low level and don’t go and get a nine volt battery and start wiring yourself up to anything. It’s it’s related to the machines that crank kidney stones for lithotripsy. And then the smaller handheld versions have been used in physiotherapy for quite a while. I always call it the thumper and if you experience that, you get to understand exactly why, because it has this little hydraulic jack in it and thumps backwards and forwards and you can do it between five and 20 times a second, really. And there’s something about these low intensity shock waves going into the penis that are release nitric oxide, stimulate stem cells and stimulate blood vessel growth. And this was sort of found elsewhere in the body and then some bright spots said, well, if it’s growing, you blood vessels opening up blood vessels, let’s use it in erectile dysfunction. So in the last five or so years, lots and lots of studies coming out, the gradually studying it for longer and longer periods and seem to be getting benefit going out to 12, 18 months. So we we have it here in the clinic in Perth. We were using it for other treatments as well. But yes, we find the guys are very keen, it’s not something that every guy just wants to rush in and have their penis thumped. We often combine it with the patient so they’ll have the platelet rich plasma and a series of these low intensity shockwave therapies, but I’ve seen some remarkable transformations in erectile function with that. Gone from needing the injections to get an erection to waking up in the morning with erections. So they certainly do work.

[00:26:25] 

And makes sense to be combining therapies that are both stimulating blood flow into the penis.

[00:26:31] 

Yeah, yeah it’s sort of it makes sense. And there’s really there’s no downsides to them. It’s not like a lot of the medications that there are potential side effects for these, apart from the inconvenience of having to come in and have the treatment. That’s really it.

[00:26:48] 

An interesting thing I learned from a sexual health physician that actually helped us train with our PRP device we use for the for the PRP into the penis was that you don’t have to stop any of your other standard type of treatments, for example, the medications, they also increase blood flow into the penis, he believes if you continue to use those medications, you continue to exercise, continue to be healthy and create as much blood flow into the penis as possible. It’s like a muscle in any other part of your body. If you increase the blood flow and use it more often, it will it will be healthier and stronger as a result. So I guess the moral of the story is try everything, keep exercising and keep using it.

[00:27:29] 

Yeah, yeah. Not that you’re saying that the penis is a muscle. We all know this itself is not a muscle, there are there are little muscles in there, but the penis is not a muscle.

[00:27:42] 

But yes, it’s about getting that blood flow into the base and it’s combining multiple therapies to try and get to that get that solution that you want.

[00:27:52] 

Yeah. Look, thanks a lot Dr Gav. That was great being able to talk about erectile dysfunction with you, I’m Dr Jayson, together we are the dick doctors. Remember, confidence changes everything, if you’ve got any comments that you’d like to make about what we’ve been talking about questions, feel free, feel free to post those below and we’ve got some more interesting topics coming up soon.

[00:28:22] 

Thank you very much for having me Dr. Jayson, speak again soon.

[00:28:24] 

Talk to you then.

END OF TRANSCRIPT