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Vitality, PSA, and Power: Why Men Shouldn’t Settle for Less · Intellectual Medicine

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  You need to be willing to accept the realm of uncertainty, which
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  by the way, is universal. There is no certainty in life
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  and certainly not in the realm of prostate cancer and prostate
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  health. You have to be comfortable with
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  your decisions. What if things progress?
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  You have to be comfortable that you made your best decision with
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  the information and with the values that you place.
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  At a high level. The presence of a libido in a
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  capacity for sexual activity is a sign of good health.
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  Now, what you do with that is your prerogative.
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  This doesn't change just because you have an elevated PSA, an
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  abnormal prostate MRI, or even prostate cancer.
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  Whether it has been actively treated or you're in a watchful
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  waiting mode, you need to be thoughtful about how you want to
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  manage your sexual vitality. Of course, my advocacy is to
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  avoid the biopsy in the 1st place.
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  However, I respect the fact that some of you will choose a
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  different path, and maybe you already have.
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  Do not despair. There are things that you can
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  always do to preserve vitality and it starts with acknowledging
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  you know what you want to achieve.
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  Have a conversation with your partner.
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  If you don't have a partner, have a conversation with
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  yourself. This is not out of bounds.
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  This is central to the entire vital living dynamic.
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  Not too many men or women would voluntarily relinquish their
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  sexual vitality, and there's nothing that says you need to do
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  that just because of a diagnosis or a risk.
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  All right, so let's erase some fear factors.
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  First of all, it does not harm you, your prostate, nor does it
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  affect the pattern of your prostate cancer.
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  If you have orgasms, if you have sex now, will it help protect
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  you? That's less is known about that.
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  What can be said about frequency of orgasm?
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  From a landmark study in 2004, Journal of the American Medical
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  Association. It was associated with a 33%
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  reduction and subsequent prostate cancer.
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  And they followed those men out 10 years.
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  Now bear in mind this is an observational cohort.
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  It doesn't prove causality. Nevertheless, it's kind of
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  comforting now. Frequent orgasm.
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  In the study they defined it as 21 * a month.
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  Yikes. You can wear out your partner,
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  but you don't need to have this with another person.
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  Furthermore, I wouldn't advocate that you force yourself into an
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  activity on a regular basis with the abstract hope that it can
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  help. So there are other variables.
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  One thing we know is that men with a low testosterone level
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  have a higher incidence of prostate cancer.
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  That's a little different from saying if you replace it with
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  testosterone therapy, it'll lower that risk.
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  But that could be a a variable. Now how about the use of
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  enhancers for sexual function? Now one of the coincidences or
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  one of the phenomena is men who are diagnosed with an elevated
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  PSA or an abnormal prostate. MRI or even prostate cancer
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  typically occurs at a time in life when testosterone levels
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  may be naturally declining in sexual vitality and erectile
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  function may not be quite as robust.
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  Now we know that tadalafil Cialis or sildenafil Viagra,
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  these are known as PDE Dash 5 drugs, phosphodiesterase drugs,
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  these can help improve circulation to the penis.
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  That's a good thing. Sometimes they work great,
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  sometimes not quite enough. What we know about tadalafil in
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  particular is that it can be used every day without risk of
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  harm, up to 20 milligrams every day.
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  It correlates with better blood flow to the penis, better
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  erections, better urinary flow, a reduced risk of heart attack,
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  stroke and dementia. So I like that as a foundational
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  piece. Don't be shy to introduce this
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  into your treatment regimen. Make sure, of course, you're
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  working with your doc to ensure monitoring.
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  In many cases, I will add sildenafil or Viagra to the
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  tadalafil. So tadalafil in the morning,
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  later in the day, A dose of sildenafil, typically about 3
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  hours before activity on an empty stomach, can enhance
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  erections. Now we're talking about
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  erections. See men, we tend to think about
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  erections as being the equivalent of sexual activity.
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  Let's take a step back and broaden our perspective.
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  The erections may or may not be sufficient for penetration.
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  That may or may not be a critical element to your sexual
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  vitality. But don't be shy, guys.
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  If the erections are not full masked, your wife, your
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  girlfriend, your boyfriend, your partner still loves you.
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  They still want to have physical intimacy.
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  You need to get over any kind of self.
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  I don't know awareness or concern right about that.
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  So yes, I want to help you maintain your best erectile
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  function, but we're going to, we're going to take a side bend
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  here to talk about sexual vitality in a different way.
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  Remember, for women, only about 15% of women can achieve climax
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  through penetration alone. They must have clitoral
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  stimulation either before, during or after men.
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  If you're not skilled at clitoral stimulation, it's time
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  to acquire the talent. This is not a natural organic
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  phenomenon that we are inbred with.
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  The knowledge about how to achieve procreation does not
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  require a woman to have an orgasm.
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  A little bit unfair, I don't know why, but that's just the
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  way home human beings are made. However, bonding and intimacy
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  very much enhanced by that activity.
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  So think about clitoral stimulation, either manually or
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  orally. Yes, guys, that works
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  beautifully or with vibration devices in the bedroom.
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  So as you mature, as you get over your youthful inhibitions,
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  as you get over your pornographically induced
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  perceptions of male dominant sex, you could start to become a
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  lot more creative. And that is helpful.
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  There are observational, let's call that a parallel
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  masturbation form of sexual activity.
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  Whereas a woman is getting clitoral stimulation, the guy
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  often times men can achieve climax without a completely full
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  erections. Having the pressure to penetrate
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  can sometimes be a barrier toward enjoying sexual vitality.
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  The penetration, of course, is wonderful when it can occur, but
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  if it can't, don't let it stop sexual connectivity.
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  So think creatively, don't be shy, don't be inhibited.
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  This is not a time to think about the biases against sexual
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  vitality. You know what?
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  It's interesting to me that as docs, we don't often ask about
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  sexual activity. How many times do you have sex?
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  Do you have orgasms? Why ought this to be sort of
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  avoided? It could be a little
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  uncomfortable, but if you don't talk about things, guys, you
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  can't achieve solutions to problems.
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  Now, when it comes to talking about sex with your partner,
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  it's better to do it outside of the moment of intimacy.
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  Otherwise, it feels like a review or a critique.
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  Gee, how did that go? I give it three stars.
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  Maybe the next day, maybe another time or environment.
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  Maybe you're better off texting, writing, you know, what do you
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  like? What do you not like?
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  These conversations can really help enhance the bedroom or
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  wherever you choose to have sex, the kitchen, I don't know.
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  So point is to be broad minded and do not let challenges with
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  erection cause you to turtle up and quit engagement.
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  All right, let's go back to the actual preservation and
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  reinforcement. Sometimes a needle biopsy can be
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  disruptive of sexual activity. Maybe it's psychological, maybe
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  there's nerve disruption, but that can't happen.
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  So think of your pharmacologic support for that.
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  Concurrent with that is the need for testosterone.
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  Now, in some cases, testosterone can be safely administered to
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  men with an elevated PSA, even to men with an abnormal prostate
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  MRI. You need a very knowledgeable
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  clinician with an open mind to contemplate this.
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  And you you need to be willing to accept the realm of
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  uncertainty, which by the way, is universal.
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  There is no certainty in life and certainly not in the realm
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  of prostate cancer and prostate health.
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  If you go on testosterone and you have an elevated PSA, will
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  it make things worse? Maybe, but the evidence is not
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  quite that direct. The idea of testosterone pouring
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  gas on the fire is a long held bias concept, belief if you
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  will. It's being challenged.
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  So they're good reasons to consider that as a worthy area
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  of challenge. There's actual evidence that
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  testosterone therapy can have a role to play.
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  We'll talk about that at another time.
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  The point of this conversation is that if you're on
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  testosterone and your PSA spikes and you have an abnormal MRI, it
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  does not mean that you need to suspend use of testosterone.
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  I have men in my practice who are doing both and are enjoying
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  a high quality of life as well as stability of the underlying
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  PSA and prostate anatomy. You have to be comfortable with
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  your decisions. What if things progress?
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  You have to be comfortable that you made your best decision with
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  the information and with the values that you place at a high
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  level. So testosterone, not off the
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  table, but what else is out there?
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  If you're struggling with erections or have had any kind
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  of a procedure, a surgical procedure, radiation therapy,
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  the penile pumps actually have a role.
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  I know they're comedic. I, you know, I saw Austin Powers
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  and I get it right. But this is about overcoming
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  inhibitions. This is about living boldly.
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  The vacuums can help a few ways. First, the vacuum can help draw
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  blood into the penis, helping it to become engorged.
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  Then a ring is placed at the base to maintain erection.
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  Totally legitimate, safe, can often times be very effective.
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  The vacuum can also be used as part of penile rehabilitation.
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  If you're not engorging your penis periodically, you can have
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  penile atrophy, fibrosis. So the idea of use it or lose it
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  applies toward the anatomy of the penis, the corpus
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  cavernosum, those hydraulics within the penis that make
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  everything work. They have to be maintained so a
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  pump can be used outside of sexual activity as part of a
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  penile rehabilitation and maintenance.
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  A few other things that I like, peptide therapy.
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  Interesting. Now peptides, I'm referring to,
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  let's call these functional peptides, not available in the
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  pharmacy, but they are available from legitimate FDA monitored
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  compounding pharmacies at the direction of your doctor.
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  Guys, don't go on the Internet and self treat.
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  It's a black hole, but you can ask about the following two
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  peptides that have value. One of them is melanotan.
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  Not melatonin, but melanotan. Melanotan is a peptide that
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  stimulates the part of the brain where sex drive, erection and
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  orgasm live. So it'll enhance sexual
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  responsiveness in men and in women.
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  It also will cause skin pigmentation.
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  It stimulates the melanocytes to release pigment giving you a
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  tanned color. Some people like that it's a non
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  sun induced tan. In fact, people.
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  The researchers have hypothesized that this may be
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  protective against skin cancer since tanning is the body's
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  natural defense. That is an unknown, so we really
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  don't know what effect it'll have on on skin cancer.
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  Side effects of melanotanin can be nausea if you take too much
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  and some folks just don't like the tanning phenomenon.
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  The melanotan can be used on a regular basis, typically three
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  times a week. Another peptide that I like is
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  PT-141PT141 is a cousin of melanotan.
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  It has more sexual stimulation and less skin pigmentation.
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  This peptide can be injected typically 6 hours before sexual
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  activity, stimulating the part of the brain where sex drive,
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  erection and climax all live. And that can have a durable
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  effect when you do it six hours before activity.
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  I've seen it last for 24 hours, and it can be used several times
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  a week. Of course, this requires a
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  degree of planning, premeditation.
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  That's generally a good thing, right?
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  We've talked about the two kinds of sex drive libido, spontaneous
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  and reactive. Spontaneous means that you're
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  sitting in traffic, you're at work, all of a sudden you're
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  thinking about having sex. That type of libido happens less
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  as you get older, regardless of your hormonal status.
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  But reactive libido, which means you start to have foreplay and
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  everything shifts into gear that can be maintained indefinitely.
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  So the PT141 a nice play melanotonic consideration and
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  these can be used in combination with the PDE drugs in order to
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  enhance erection, which does nothing for libido and the
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  libido along with it. So putting these all together
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  guys, you can maintain healthy, robust sexual activity.
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  It requires above all else the desire to do so.
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  A loving partner would not abandon a critical part of the
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  partnership without putting forth effort.
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  So we'll talk more about this topic.
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  I think it's super important and a little bit neglected.
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  Until then, keep practicing. Don't quit, don't be shy, don't
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  be afraid. Live life fully all the time.
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  All right, guys. Talk to you soon.