BPH, ED, and Beyond: A Urologist's Guide to Men's Health (Part 2)
Continuing our conversation on men's urological health, Dr. Shakuri-Rad demystifies common concerns like BPH and erectile dysfunction while showcasing revolutionary surgical techniques. From pioneering single-incision robotics to the truth about testosterone replacement, this episode delivers practical insights for better pelvic health. Learn why early intervention matters and how modern treatments are transforming men's healthcare.
Transcript
Dr. Kerry Winge: Welcome to the Bottoms Up podcast, where we explore the science and practice of pelvic health and sexual wellness. I'm Dr. Kerry Winge, and I've dedicated 30 years to helping patients overcome pelvic health challenges through evidence-based physical therapy and rehabilitation.
This is Part 2 of our deep dive into men's urological health with Dr. Jay Shakuri-Rad. In the last episode, we covered the intricate connections between lifestyle factors, hormonal balance, and urological function. We discussed prostate health, inflammation, and the latest surgical advances.
In today's continuation, we're going to explore some of the most common concerns that bring men into the urologist's office. We'll break down the causes, diagnostic process, and cutting-edge treatment options for conditions like erectile dysfunction and low testosterone. Dr. Rad will share insights on how sleep apnea, cardiovascular disease, and other systemic issues can manifest in sexual symptoms, emphasizing the importance of comprehensive evaluation.
We'll also tackle sensitive topics like fertility, cultural views on masculinity, and the stigma many men face in discussing intimate health problems. Our goal is to empower listeners with knowledge and normalize these vital conversations.
Before we begin, it's important to note that this podcast is for educational purposes only and does not constitute medical advice. The information shared should not be used as a substitute for professional medical treatment. Every person's situation is unique, and proper diagnosis and treatment require individual medical evaluation. If you have specific health concerns, please consult with a qualified healthcare provider.
In this episode, we'll cover:
The physiological basis of erectile dysfunction and current treatment landscape
How low testosterone affects wellbeing and when replacement therapy may be indicated
The impact of sleep apnea and other systemic diseases on sexual function
Fertility evaluation and preservation strategies
Tips for overcoming stigma and normalizing men's health discussions
Preventive lifestyle practices for optimizing lifelong urological health
So let's dive back in with Dr. Rad!
Dr. Kerry Winge: The other thing as far as men's health that I really wanted to talk about is BPH because it's so prevalent. If you can expand a little bit on BPH so that our audience can understand, and the current technologies and the treatments that you do to help men out there.
Dr. Jay Shakuri-Rad: Absolutely. So let's start with the definition of what BPH is. BPH is benign prostatic hyperplasia. That's the medical term. The translation is essentially an enlarged prostate. It's a prostate that grows to a certain size, which then leads to symptoms. If you recall that pump and tubing analogy I mentioned before, it's just talking about the bladder, which is the pump, not being able to push the urine out easily because there's a blockage somewhere in the way.
When that happens, when the prostate enlarges as us men get older, and all of us men will have some degree of BPH as we get older if we live long enough, then we start experiencing these bothersome symptoms. We go into the bathroom more. I always go to the football games and take a picture of all the guys lined up at halftime trying to get into the bathroom. And then I'm like, "Huh, I just saw that guy 20 minutes ago up there. And this guy looks like he keeps running back and forth."
Dr. Kerry Winge: You have to give out your cards.
Dr. Jay Shakuri-Rad: You have to keep them with you. This is like prime time for me to get...
Dr. Kerry Winge: Make it rain.
Dr. Jay Shakuri-Rad: And so I say, well, you know what? The guy can't enjoy a game because he's in the bathroom the whole time. And so those are kind of things that you got to pay attention to today. Like, hey, this is not right. There's something weird going on. And then, so when they come to my office, I explain to them about the simple anatomy there. And then we talk about, okay, how are we going to fix this? What are the options for this enlarged prostate?
You mentioned a term, Roto-Rooter, earlier, Kerry, and in the old days, we used to have one surgical procedure, one main surgical procedure for patients who suffered from an enlarged prostate, and that was a Roto-Rooter. You would go inside the urethra while the patient was under anesthesia with a camera system, and then we would scrape or shave out the prostate. And that was the gold standard for BPH for many years. And even today, some consider it still the gold standard. Because it works, we know how to do it, we are comfortable. However, we found that the TURP procedure or the Roto-Rooter, and TURP stands for transurethral resection of the prostate.
This procedure caused some issues in some men. Some men experienced sexual dysfunction afterwards. Some men experienced retrograde ejaculation, which means when they had orgasm, not much fluid or any fluid would come out. And some men experienced urinary incontinence because of damage to the sphincter muscle in that area. And so because of that, because of those risks, we started working on medical therapy.
So in the 90s, two medicines really came out. One was Flomax, we know it by the trade name Flomax, and another one called Finasteride. And these medicines were designed to relax the muscles around the urethra, the prostate, and allow us to urinate a little bit better, a little bit more forcefully.
And Finasteride was designed to shrink the prostate to a certain degree.
Unfortunately, medicines come with a lot of side effects sometimes. And these side effects could be life-changing. It would be debilitating in some cases.
But we kept pushing those medicines for years because the alternative was not really that great. More recently, in the past decade or so, we developed newer procedures, understanding that deficiency in the treatments. And these treatments now have become part of what we call minimally invasive surgical therapies or MIST therapies, where we offer patients something that's very minor in terms of the actual surgery, but has a big impact on outcome and doesn't jeopardize those things like sexual function and urinary continence.
The Urolift procedure was one of the first that kind of broke the space wide open. And when industries saw that there's such a demand for men to undergo these procedures and how underserved men were in this space, the industry just blew up. And now we have so many companies that are trying to help us develop better and better tools. So out of that came Urolift, which is a minimally invasive procedure where we go inside the urethra. And instead of shaving that middle part, we actually put clips in there that push everything to the side, and that opens the channel.
Dr. Kerry Winge: So it's like opening up a curtain almost. So if you're thinking about a car and doing all the maintenance, this is basically opening up the curtain to take the pressure off the urethra, which technically is a straw, where the ejaculate and the urine come out, and you're just making space.
Dr. Jay Shakuri-Rad: Exactly. We just want to create some space so that the urine can flow easier, so the bladder doesn't have to strain as much. And Urolift provides that. And we've learned how long it lasts and what the problems may be. This is an outpatient 10-minute procedure, typically. You're under sedation or that twilight sedation we talked about for about 10 minutes, and you go home usually without a catheter, which is an important term.
Catheters are these tubes that we put inside the bladder sometimes and they go through the penis or the urethra in women that drain the bladder. And they're uncomfortable, they're nuanced, no one likes these things sticking out of them. And so Urolift doesn't carry a high risk of needing catheters after this procedure. The Roto-Rooter required that. That's a requirement for the TURP procedure.
But that Urolift doesn't serve all patients. There are some patients that have prostates that are much larger than what Urolift can handle. And so we've developed other surgeries. Another very important surgical procedure is called aqua ablation. It's a water-based treatment where we go inside the urethra and use a water jet, which is, it looks like a pressure washer, miniaturized pressure washer, and we are pressure washing the prostate essentially open. And because we're using water, it is not damaging to those tissues that are there. And we do this under ultrasound guidance with a robotic technology. And so it's a very precise operation that does exactly what we need to do, which is open the tube without damaging any of the critical structures in that space, and we can apply that to many different prostate sizes and shapes. So it's been a very popular option.
Dr. Kerry Winge: Is it like a vaporization when you're in there with the water or what happens?
Dr. Jay Shakuri-Rad: So we are actually scraping essentially the prostate with water, just like you would with your, on your driveway. So if your driveway is really dirty and you go pressure washer it, the dirt kind of gets peeled off. And so this is the same thing. The prostate tissue gets peeled off. And then we take those peels or those tissues out of the bladder after we peel them off with the pressure washer. And then we do place a small catheter at that point that stays in place for a few hours and we wash the bladder with it. Some patients may be able to go home same day. Some patients may actually stay in the hospital with us overnight because we want to get rid of that catheter before we send them home. And so if they stay overnight, they often get the catheter out the next morning and they go home.
Dr. Kerry Winge: And I think it's important for the audience to understand the reason why you're using the catheter is because the urethra is a straw and you had a procedure that is going to cause some inflammation and possibly some blood clotting. And you want to make sure that that straw stays open after the procedure and that the bladder can fully empty. Is that correct?
Dr. Jay Shakuri-Rad: Absolutely. So the bladder's function is really to just collect urine, store it, and then empty it. And it's really serving our kidneys because the kidneys need space to put urine after they filter all the stuff out of your body and all the fluids out of your body. And so it's really serving our kidneys. So if your bladder doesn't function well, eventually you can sustain kidney damage long term as well. And so keeping the bladder healthy keeps the entire plumbing system healthy.
Dr. Kerry Winge: And a good reason for men to go to the urologist earlier, this happened to my dad where he just put it off. He put it off and he had problems with urination for a long time. And when you have that prostate that squeezes that tube and the urine can't get through, then the muscle of the bladder, things back up and the bladder itself becomes overstretched and weak. And if you wait too long, you can have a problem with the function of your bladder, which will back up into the kidneys, which obviously is a problem for your blood pressure and your heart and everything else in your system. So that's why it's important to really go to see your urologist when you're noticing the first signs and symptoms. Like you said, catch it early.
Dr. Jay Shakuri-Rad: Absolutely. And one way, I think the best way to get a guy to go see a urologist is if you tell them, hey, if you don't get your bladder health in check, you may end up with a condition called urinary retention where you can't pee at all and we can't fix it. And in those cases, you're going to need to have catheters, meaning you are going to learn to put a tube in your penis four to five times a day to drain your bladder. So if you don't want to have that, go see a urologist so they can keep your bladder healthy. And there's a reason there are late night commercials for catheters on TV. They're targeting the audience that usually gets in that kind of position.
Dr. Kerry Winge: Scare tactics are effective.
Dr. Jay Shakuri-Rad: Scare tactics. They are.
Dr. Kerry Winge: Agreed. Agreed. It is important, it is important. So what about the latest technology in robotic surgery? I know that you had gone to Germany not too long ago. Tell us about your travels.
Dr. Jay Shakuri-Rad: Yeah. So robotic surgery has been always my passion. So when I was young, I used to build robots, compete in robotic competitions. People remember the BattleBots and I think US First Robotics is a competition that a lot of high school kids and middle school kids can now participate in. And so those competitions I used to love, I used to build them. I was a little robot nerd. And when I went into medicine, I saw that, hey, we can use these robotic technologies to help folks. And so I got into urology for that reason.
And urology has always been at the forefront of medical technology. When there is new technological developments, we usually try to apply it somewhere in urology in your plumbing system, whether it's for benign or cancerous reasons. And robotic surgery started in around late 1990s, early 2000s, where a company by the name of Intuitive developed a robot that could be used to perform minimally invasive surgeries. Initially, the project was a military project that was meant to create telesurgeries where a surgeon could sit far away from the soldier on the battlefield and operate on them. It wasn't really applicable. The technology wasn't applicable to military at the time. And so they turned it into the civilian side of things and it became very popular among some surgeons that saw the potential.
Fast forward 25 years, and now it's one of the fastest growing segments of medicine, it's robotic surgery, where we reduce the impact, the negative impact on the body while carrying out some significant operations inside the body, and patients recover faster, they can go home sooner, they have less blood loss, and overall have a much better outcome.
So in my world, I use robotic surgery to treat things like prostate cancer, kidney cancer, bladder cancer, reconstruction of the urinary tract. So if there's a problem where things aren't flowing right, we fix it with a robot. We can do operations on the prostate for BPH. If there's a prostate that's really large that the other patients are just not enough for that, we can do robotic surgery. And I have started offering something called single incision robotic surgery where through an incision that's about three centimeters we can perform all of these tasks and all of my patients have the opportunity to then potentially go home the same day so majority of these operations I'm doing as an outpatient. In the old days we would keep patients in the hospital for at least one or two days even with the old robotic technologies but now I can send them home the same day, most times. With open surgery, sometimes you have to stay in the hospital for a week or more.
Dr. Kerry Winge: And then that proposes its own risk, nosocomial infections and on and on and on.
Dr. Jay Shakuri-Rad: And pain is a big topic, right? So we talk about opioid epidemic and pain scores are so low with robotics surgery that we don't prescribe narcotics to a lot of our patients anymore. And patients take Tylenol, ibuprofen over the counter when they go home. And they come back and they say, hey, you know what, my incision never hurt, which is great for us to hear because we know we've done a good job at that point.
And with single incision surgery, it is a more novel type of robotic surgery. Here, we performed the first single incision surgery in West Virginia. I was fortunate enough to do a prostate surgery as the first case here in West Virginia. And across the country, we have a small group of surgeons that are well-versed in this technology and these treatments, and we are teaching it now across the United States and in Europe. And that's where Germany came in, where I traveled to Germany, France, and Sweden, and I was teaching my colleagues over there how to do these operations. And so it's really encouraging. You know, from a little place in West Virginia, we're teaching folks in Europe now how to do surgery. And I think that's an exciting part of surgical treatments that's going to just become commonplace in 10, 15 years, where hopefully anyone with any big medical problem, cancers that can undergo a small surgical procedure, robotic procedure, and have the best outcome.
Dr. Kerry Winge: That's very exciting. We can change the conversation of West Virginia.
Dr. Jay Shakuri-Rad: That's right.
Dr. Kerry Winge: We really need to do that. I think this is absolutely fantastic. The other thing that I think is exciting is, you brought up the opioid epidemic and some people are like, oh my gosh, how can I have a procedure and not have an opioid? But one of the benefits of this on the flip side is that opioids slow down your bowel movements. And people don't think about that. So here you had a procedure that we talk about on your penis and your testicles, on your bladder, which are below your intestines. And then your intestines aren't working, which is increasing the amount of pressure. And it's pushing down on the area that you just had operated. So we want to keep all the pipes open. So that goes back to having better health. We need all that elimination to be able to work, so having a less invasive procedure that requires less pain medication will benefit you and you will heal quicker from a lot of different aspects.
Dr. Jay Shakuri-Rad: We always joke in urology with the patients that we say your number two is my number one because I need to make sure your bowels work because if they don't, you're going to be in trouble.
Dr. Kerry Winge: Everybody has to poop. Now, that's going to be another podcast and we'll talk about the squatty potty and positions, but those functions are very important.
Dr. Jay Shakuri-Rad: So another kind of interesting thing for the audience perhaps is, so we talk about West Virginia being, putting West Virginia on the map on a global scale. So believe it or not, if you go to Germany, especially Germany, but many European countries, if you start singing Country Roads, everyone knows what that is. They sing it with you. It's one of the most popular songs with kids all the way to older generations. And I went there, I used to live there as a kid and I talked to them about Country Roads and I'm like, I'm from West Virginia. That's where the song is. And they're like, oh, wait a second. We didn't realize that's West Virginia.
Dr. Kerry Winge: It only says West Virginia in the song.
Dr. Jay Shakuri-Rad: Yeah, it says it in the song. And they're like, oh. So when I told them, they asked, where are you from? I said, well, I'm from West Virginia. They said, and then I would pause for a second. I have no idea. And I would say, you know that song Country Roads? They're like, oh, yeah, yeah, we know what that is. So it was a very interesting conversation there.
Dr. Kerry Winge: In every bar across the globe. It's funny, when I travel, we have a running joke that we always end up meeting somebody from Morgantown. We were at the Macy's Day Parade with the kids years ago, and it was raining, and you're eight people deep, and these people that were right in the front said, please bring the kids up here. We want them to see it. And you're like, okay. So we put the kids in the front with, hey, where are you from? Morgantown. Morgantown, it doesn't matter where we travel from, we have a very special area here with cutting edge technology and fantastic surgeons.
Dr. Jay Shakuri-Rad: That's right. I think Tony Caridi always says there's always a West Virginia connection.
Dr. Kerry Winge: There is. He's right. He's right. The last thing that I wanted to talk about, which I think is one of the first things on a man's mind if there's problems below the belt is erectile dysfunction.
Dr. Jay Shakuri-Rad: Absolutely. So one of the things I joke about with my guys is I tell them that urologists are really male brain surgeons. Because when we talk about the male brain, we talk about below the belt sometimes. And so we are the male brain surgeons. And erectile dysfunction is a very important topic because it does not just affect your body, but also your mental health. So a guy that can't perform, so there are certain cultures actually where if a guy can't perform, it's a cultural issue. In our Hispanic population, we actually see that quite a bit where they come seek care for erectile dysfunction at a very young age sometimes because it's a culturally driven phenomenon for them. And erectile dysfunction affects kind of those three things I mentioned, mind, body, and spirit.
From a physical perspective, we got to understand how it works. So in order for a man to get an erection, they have to have good nervous system, and they have to have good blood flow. If they have those two things, then they're able to have and maintain an erection. Now, because of diseases such as cardiovascular disease, diabetes, certainly stressors in life can play a role there, such as even depression can affect that. Medication for depression can affect erectile dysfunction.
Because of that interplay, we see erectile dysfunction developing at all different age levels. I see sometimes young college students coming to my office saying, hey, I have erectile dysfunction. And I know based on their age, while they probably don't have enough cardiovascular disease usually or diabetes that it's going to be an issue. So I right away start talking about their mental health. And you'd be surprised how often that that's the main issue. And we talked about what is erectile dysfunction. Most people associate it with the inability to have or maintain erections, but actually if a man is having difficulty getting through intercourse or they have premature ejaculation, that's erectile dysfunction. If they don't have enough ejaculate fluid being produced, that's erectile dysfunction. If they're on medication that causes retrograde ejaculation, that's again erectile dysfunction. So all of these things have to be taken into consideration and erectile dysfunction is defined differently for each man.
So we focus on those aspects first. So my first interview with my guys addresses those things and I want to make sure I know what is causing what. Because sure, I could throw medication at guys or give them some treatments that artificially even create an erection for them. But I'm not really doing them any favors if that's not the underlying problem. And that leads us to exercise and balanced diet. So we have a hard time getting our guys off the couch sometimes. But now tell them that, hey, if you don't get off the couch, you're going to have ED. And oh, you believe me, they're going to be running miles.
Dr. Kerry Winge: They are. And then it's hard because they can go towards the other direction too that I see in my practice where, okay, they're sitting all the time, say they're students, and then they're flex forward with their posture. So they're increasing the forward flexion, which is increasing the pressure down into the pelvis, and it's not getting the blood flow. Then what do they do is they get up and they go to the gym and they lift heavy weights, which tightens up everything down below. Their hamstrings, their quads, their pelvic floor, their abs. So they're sitting and they have the compression. Then they don't have the blood flow. Then they get up and go to the gym and they make things tighter and tighter and tighter. Best thing that you can do is flexibility, breathing, yoga, cardiovascular exercise, running, but you have to have that length and the space within that pelvic floor that you're sitting on in order for everything in the area to function properly. Blood flow, you got a straw, you squeeze the straw, nothing's coming out and nothing's going in. So yeah it has a lot to do with lifestyle for sure but sometimes they'd rather just take a pill and be done with it like they say like hey doc, I just want the blue pill exactly.
Dr. Jay Shakuri-Rad: And I tell them I said you know that's one of the things is the blue pill is not a magic pill. It doesn't cause erections, it doesn't create an erection. You have to still have the vascular flow to some degree, you got to have the pelvic health established, and you got to be stimulated for it as well. So the mental part of it is important. And so I love that, that's why I love sending patients to Kerry's because I know she kind of looks at it from a holistic perspective and says, Hey, you know what, maybe you do need some yoga, maybe you do need to focus on this a different way and look at it differently. Sometimes if I tell them they don't believe me, and Kerry can convince them otherwise.
Dr. Kerry Winge: Well, it's a hard truth. I kind of lock the door and don't let them out. No, I mean, seriously, I mean, excuse my language, but there's no bullshit in the practice. You know, if they're coming and they want to get help, I'm going to be completely honest with them and transparent and saying, well, here's the things that we've identified. And if you want to get better and you want to participate in your help, here's your responsibility and here's what you want to do. Usually they appreciate it because they'd rather a recipe. And so we're completely direct. But the other thing, as I think is important to know, and you did touch on it, is that sometimes erectile dysfunction can be the first sign of cardiovascular disease.
Dr. Jay Shakuri-Rad: Absolutely. So if I have a young guy in my practice that I wouldn't expect to be having erectile dysfunction, and I've ruled out a lot of these other things, I may send them to a cardiologist, believe it or not. And so I noticed that there's early cardiovascular disease, there's atherosclerosis, maybe there's some cardiac or heart issue, functional issue with the heart. And sometimes we even find things like undiagnosed, honestly, diabetes, where they had high blood sugars and they had nerve damage. And so we really have to look at those things. And that's why cardiovascular health and diabetes control is so important for the guys that come in. And that brings everything back under that whole holistic approach.
Dr. Kerry Winge: Yeah. And I know that this, I mean, this hasn't happened very often, but it has happened to me where I have had both men and women in my office with sexual dysfunction. And after opening up the conversation, actually realized that it was emotional and that their sexual orientation and who they identify themselves as or with in a partner was different than what they currently were with. So if a woman was with a man, she realized, wait, I can't achieve orgasm. She realized that her preferences actually were for females versus males. And she never came out because of social stigma, because her family wouldn't accept her because she felt that she would be lonely and lose everything that she wanted. And it was the same thing with men. So it's really important to understand that emotional, physical, mental aspect of the problem to get to the bottom of it so that you're not putting a band-aid on it. And I don't think if I didn't take the time to really get to know my patients, we wouldn't have that aha moment. And so in that situation, I referred them to counseling and to be able to open up the conversation with somebody, a mental health specialist that could really help them through this life-changing event for them as a person, but they felt seen. And they were able to actually say yes this is the way that I feel and I do feel that this is why I am having this sexual dysfunction. Like I said rare but it happens and it happens with having the ability of having a safe space opening up the conversation.
Dr. Jay Shakuri-Rad: I think that's very important absolutely and I think some of the other things that could be a little bit of a sign is I ask my guys, when they come for ED, I say, well, are you having morning erections? And they sometimes say, yeah, absolutely. I always have morning erections, but sometimes I don't know why it doesn't work otherwise. And then that's where the relationship issues come in. And all of a sudden I say, well, maybe we should go talk to a sexual counselor. Maybe you should bring your significant other with you. And I don't assume that they're with a man or woman. I kind of try to say, hey, just bring your partner with you. And that really, I think, helps that discussion as well. Because from a physiological perspective, if a man can get morning erections, often there's not a physical issue. There's not cardiovascular disease, diabetes, those things, or they're getting blood flow to the area. They have good testosterone levels, which is another important thing for men's health. And so that's another way of kind of getting through the difficult discussions. Just break it up, say, hey, you're having morning erections, so there must be something else going on.
And speaking of testosterone, and we talked about a little bit of cardiovascular health and exercising, I think we need to also talk about sleep, which is not a commonly discussed topic. Sleep is very, very important for many, many bodily functions. And sleep apnea, for example, can cause all kinds of problems in our bodies. And one of the things specifically related to men's health that men need to understand is that your testosterone levels are based on a circadian rhythm. So when you sleep at night, your testosterone levels rise. And in the mornings, they're at the highest level.
Dr. Kerry Winge: That explains it.
Dr. Jay Shakuri-Rad: Yep, yep. And then throughout the day, it kind of diminishes. And so as a matter of fact, from a medical perspective, when we check testosterone levels for our guys, we always tell them, you got to get it checked in the morning. And they always say, why in the morning? Why does it matter? And this is why, because we want to check it at the highest level. And if you're low, then we know you have maybe a testosterone deficiency disorder, and we can treat you and diagnose you appropriately. And then that plays into the sexual health because without testosterone, our libido goes down. Depression can develop with lack of testosterone. Cardiovascular health can develop with lack of testosterone. You may lose muscle mass as well as develop osteoporosis or osteopenia, meaning a weakening of your bones without testosterone. So those are kind of one of those check engine lights, one of the tune-ups that we do for our cars. You know, we got to do that with our hormone levels as well, because those hormone levels do play a big role.
Nathaniel DeSantis (Producer): Yeah, and I'll just quickly add in here from personal experience. So I, for seven years, had really bad sleep apnea. I actually had 90 apneas per hour on my back. It was really bad. So I weighed 300 pounds and I lost all the weight. That was the cause of the sleep apnea. But it's crazy how when you take care of yourself, you feel, it's not like overnight, all of a sudden you're like wow I feel the testosterone back in me but you can tell like you're thinking better like you're not as depressed or you're not as groggy and it's just one of those things where it's like when you start taking care of your body, your health, what you're putting into your body when you start treating it like a machine kind of treating it like a car like food is fuel not like sugar when you start taking care of it and the testosterone comes back. Like everything, what we're talking about and outside of that just gets better. So it's a personal anecdote.
Dr. Jay Shakuri-Rad: I love it. And I think that that's kind of that aha moment and sharing that with others saying, hey, you know what? I had my aha moment, you know, once I realized this, I think that goes a long way.
Dr. Kerry Winge: What do you think about testosterone replacement?
Dr. Jay Shakuri-Rad: So in the appropriate setting, it's a very good treatment and there are different ways. So I'll give you an example. Sometimes testosterone is used, it's abused, it's not really used, it's abused for reasons such as, I want to just get buff, I want to develop a lot of muscle, or you're just misdiagnosed maybe and put on testosterone. I've had guys that at a young age, they were misdiagnosed for hypogonadism, which is that lack of testosterone, and they were put on exogenous testosterone that they were taking in. And later in life, when they were ready to have kids, they realized, well, that testosterone affected my testicles, my testicles shrunk, I can't produce sperm, I can't have kids. And so it's important to understand those things that, hey, there are going to be changes in your body if you apply the wrong treatment to the wrong condition. But if you apply it correctly, you can actually improve those things we just talked about. So guys, we can prevent cardiovascular disease, we can prevent bone deterioration, we can improve weight loss and because lack of testosterone causes muscle mass loss and increases fatty or adipose tissue in your body.
So having those levels at an appropriate or normal physiological level can make all the difference for some guys. But again, you have to be diagnosed appropriately. And so if the basis for your lack of testosterone is sleep, we need to fix the sleep. The answer is not me giving you testosterone. If the issue is maybe a growth on your testicle that's suppressing things, we need to apply it correctly. I've diagnosed guys with brain tumors because of lack of testosterone. So we found out, I check certain profiles and some patients can develop something called prolactinoma, which is a growth near their pituitary gland, which suppresses testosterone production. And so just by understanding what's going on with them and getting their appropriate testing, we diagnose them with what their problem is, take care of that problem. All of a sudden their testosterone levels go back to normal. So now they're not dependent on this medicine lifelong. So I think that's the message is appropriate screening, appropriate diagnosis, appropriate treatment. My mantra is you got to apply the right treatment to the right patient at the right time. If you do that, everything else plays out correctly.
Dr. Kerry Winge: Yeah. And that means that you have to look at your patient, that means that you have to listen to your patient, means that you have to interview appropriately. And it's hard because that does take time. So obviously, men and women's hormones decline per decade as we age. So are you saying some possible supplementation is if you are not within the correct range based on your age? Or do you think that it is good or important to keep a certain level of testosterone through the lifespan?
Dr. Jay Shakuri-Rad: It's age-based, certainly, because our testosterone production, for example, goes down as we get older. And so, we do have some guys that have, based on normal values, quote-unquote, have low levels, but they're asymptomatic. They have no symptoms whatsoever. So, their bodies have adjusted appropriately to that. So, there's no, one range fits all. It's really individualized.
Dr. Kerry Winge: I know that there's a big movement with men in their 30s and 40s doing supplemental injectable testosterone. Do you know anything about that?
Dr. Jay Shakuri-Rad: Yeah, that can sometimes be devastating because especially where they get these testosterone supplements from or the injections from, depending on the formulation, it can cause physiological negative changes. It can also shut down your normal physiological ability to produce testosterone later on. And so certainly, you don't want to just use it again for the wrong reason. We talk about anabolic steroids, we talk about testosterone abuse in places like bodybuilding or sports. And so those are the wrong applications. If you take care of your body, exercise, eat correctly, sleep well, your body will have plenty of what you need to live a healthy life.
Dr. Kerry Winge: So I guess the takeaway is to really look at this from a holistic view, from a multidisciplinary aspect and find out where the problem could be before you jump to doing an injectable that could cause harm long-term.
Dr. Jay Shakuri-Rad: Absolutely.
Dr. Kerry Winge: Is there anything else that you would like to discuss, Dr. Rad?
Dr. Jay Shakuri-Rad: I think the best advice I can give anyone and my own patients is be proactive. Proactive care leads to better outcomes. And being proactive sometimes requires us to break social barriers and break stigma and make it accessible to people. If you have access and you're not afraid to approach someone to take advantage of that access, then I think you can really change the way your body feels, the way your mind feels, and the way your spirit is as you move forward. Open communication with your team, your physicians, your physician assistants, nurse practitioners, physical therapists, the whole healthcare team is important. If you have a good communication with the team, they will be able to help you and do the right thing for you. And small, consistent changes in lifestyle and mindset can make a huge difference in overall health. I mean, just by changing the way you slept, you were able to really change the way your body was behaving just so that sleep apnea that you were able to address. Or if you add 10 minutes of exercise to your day, 10 minutes more, and then add 10 more minutes each week.
Something very simple you can do is when you go grocery shopping, park in the spot farthest away from the main entrance. And that simple walk from that spot to the main entrance is going to be a big difference maker if you do it consistently. So those little things I think will overall add up and hopefully we can improve health for the whole population because in the U.S. We're not doing a great job right now compared to our European counterparts. So I think it's all about education. It's about breaking down barriers and I think we're going to have a lot more happy folks running around.
Dr. Kerry Winge: Absolutely. Thank you so very much for your time, your expertise. We really appreciate it.
Dr. Jay Shakuri-Rad: Well, thank you for having me. Always a pleasure.