A Urologist Explains Stronger Erections

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A Urologist Explains Stronger Erections

Transcript:

Welcome to the Sexual Vitality Summit. I’m your host Susan Bratton, and I am pleased for you to meet Dr. Judson Brandeis, a urologist. He’s been a top-five urologist in the Bay Area for many years, and he’s also my friend through GAINSwave. He is The Clinical Director for best practices for Gainswave. In this interview, we will talk about Gainswave. He was the former Chief of Urology at the John Muir Hospital. Judson has been around the clinical world of erectile dysfunction, prostate issues, and everything to do with a man’s penis, testicles, and prostate. We will learn much about penis health, erectile dysfunction, and prostate issues. We will talk about leading-edge news and new treatments Judd has been doing to help men banging boners. It’s not just about ED; it’s about having the most robust, fantastic, and firm erection you can for your whole life.

Dr. Brandeis, thank you for joining me today at the Sexual Vitality Summit. It’s my pleasure. Thank you for having me.

I’m looking forward to many long and fun collaborations with you. We’re getting started. I first want to talk about how erections work to give guys a level of what their equipment does and how it performs because it will shed light on many other things we will discuss.

There are two parts of erectile function. One is the psychological part, but I’m most involved in the physiological part of increasing blood flow to the penis. Men have three ways they can get stimulated. One is emotional, the second is visual, and the third is tactile.

You can imagine yourself in a sexual position. The second evokes an emotion in you, or the third is purely skin sensation. From there, the impulse goes down through nerves to the cavernosal or penile nerve. The cavernosal or penile nerve secretes a substance called nitric oxide, a critically important neurotransmitter, a chemical that your body secretes to communicate between nerves and arteries. That chemical causes dilation or opening up of arteries that increase in the size of the artery. It allows more blood to get pushed into the penis.

Amazingly, your heart pumps blood into the aorta; the ordered pressure is about 120 over 80. That’s your average blood pressure. Your penis has to generate a blood pressure of three to four hundred to get enough blood into the penis to cause a rigid erection. Still, the penis has to elevate into the proper anatomical position. What needs to happen is the nerves need to be adequately stimulated. It would be best to have enough nitric oxide to create that signal between the nerves and arteries. Then the blood pressure has to get high enough for a rigid erection and for the penis to elevate into a proper anatomical position.

What are the most common reasons for erectile dysfunction?

The most common reason is vasculogenic. If you look at the anatomy of the vascular tree, the heart pumps blood into the aorta. The aorta goes down into the iliac. The iliac then goes down into the external and internal iliac, which have different branches. The last branch of the internal iliac, the last thing in the body that gets blood, is the internal pudendal artery which becomes the penile artery. The final branch of your blood vasculature is the artery that goes to the penis. If there’s a blockage in the heart, valves, aorta, iliac, or any area along that vascular tree, the final common pathway is the artery to the penis. Anything that causes atherosclerotic disease, high cholesterol, smoking, drinking alcohol, too many donuts, hamburgers, inactivity, and diabetes will affect the delivery of blood down to the penis.

Remember that blood pressure has to get up to three or four hundred millimeters of mercury as opposed to the blood pressure in the heart and the aorta, that’s only 120 over 80. The final pathway is what happens as you get an erection. It blocks blood return into the veins, so the blood pressure has to get high enough to stop the venous return. If it doesn’t, you’re pumping blood in, but the blood is going out, and that’s a problem.

I’ve also heard an issue with endothelial rigidity, the smooth muscle cells that lock the blood into the penis. Sometimes, endothelial or smooth muscle tissue can have a problem. I’ve heard the venous leak issue that I’ve also been doing is the number one issue.

You’re 100% correct. The endothelium is critical in this whole process. Until 15 years ago, we didn’t even recognize that the endothelium was its organ and a particular part of blood vessels but the endothelium. Endo means inside, so the inside lining of the arteries is critical. That’s where the blockages build up the cholesterol deposition. They also secrete nitric oxide. You have systolic and diastolic blood pressure. When your heart pumps, it pumps blood into the vessels, and you have 60,000 miles of blood vessels in your body. If you took the little blood vessels in your body and lined them up, they would circle the world twice. Your heart is a pump that has to pump blood into the vessel, but the inside of your arteries has muscle, so you have a second heart in the blood vessels. That’s why you have systolic and diastolic blood pressure.

That’s why you have a pulse in your arteries. They expand and contract. The secondary propulsion of the blood throughout your body is mediated through nitric oxide. Nitric oxide gives your blood vessels elasticity. Once nitric oxide levels drop, and for the average American, by the time you’re 50, you’ve lost 50 percent of your nitric oxide production. By the time you are 70, you’ve lost about 80 percent of your nitric oxide levels.

That turns these dynamic tubes into PVC pipes, so your pulse and propulsion of blood aren’t as strong, so the heart has to pump even harder. When the heart has to pump harder against stiffer blood vessels, your blood pressure goes up, the delivery of blood to that internal pudendal artery isn’t as strong, and erections go away. On top of it, your primary care doctor says you have high blood pressure. We’re going to put you on medication to drop your blood pressure. What does that do to the blood pressure you can deliver to the penis? It goes down. What does that do to your erections? They go down.

Plaque in the arteries is from different components. I’ve heard our arterial plaque is fatty pieces running through our bloodstream and getting stuck to the sides of the blood vessels. Fibrin gets attached. What do those things go into the arteries, and how do you get them out?

They’re tough to get out of once they’re in. You can use stents or a balloon in the aorta in the heart. Once it’s terrible, you can use stents, angioplasty, or surgery. Coming from mild to extreme is a gray area. There isn’t much you can do. The critical thing is getting a better diet to get on something like statin, a blood pressure medication that decreases blood cholesterol to stop smoking and exercise.

There are a host of things you can do to be heart-healthy. It’s important to check in with your cardiologist or primary care doctor. Other hacks to be penis-healthy for an aging penis aren’t quite as intuitive as exercise, water, diet, and quitting smoking and drinking. A guy can get an erection and stay hard for a while but gets bendy during sex. I’ve noticed that guys feel as soon as they get an erection, they need to have penetration immediately because they’re afraid that they’re going to lose their hearts. What causes that is primarily anxiety or a physiological issue at work.

The critical thing is that a rigid erection prevents the return of venous blood back into the system. You must maintain a blood pressure of three to four hundred millimeters of mercury the whole time. Getting an erection. There are two systems: the sympathetic and the parasympathetic system. The sympathetic system is fight or flight, and that’s critically important for survival. The parasympathetic system brings blood to the kidneys to make urine, the intestines to process food, and the penis to reproduce.

Think about it this way. You’re a caveman in a cave with your cavewoman, and there’s a saber-toothed tiger out front. That saber-toothed tiger is pacing back and forth because he sees you as dinner, and finally, after two or three days, your cavewoman gets a little irritated. She’s getting hungry and pissed off.

She’s calling you a wimp and saying why don’t you take care of that saber-toothed tiger? Finally, you sharpen up your spear and get sick and tired of hearing your cavewoman nagging at you. You leave that cave and clear the saber-toothed tiger through the skull. You kill the saber-toothed tiger. That requires a massive output of sympathetic hormones, and you’re not charging out of there with an erection.

There’s no blood flow to the penis. There’s no blood flow to the intestine. There’s no blood flood to the kidney. It’s all to the eyes, big muscles, and brain. Once you kill that saber-toothed tiger, those sympathetic hormones go away, and you drag that saber-toothed tiger back to the cave, and your cavewoman is all fired up. “Oh, my caveman. He’s the best. You got that saber-toothed tiger on the spit with the fire going. Oh, my hero!”

Suddenly, those sympathetic hormones disappear, and you start perfusing the kidneys. You start perfusing the intestines, and soon you begin perfusing the penis. That’s the time to reproduce. That’s how things work in modern-day America.

You’re not charging out of the cave to get a saber-tooth tiger, but there’s no different set of hormones for work, financial, marital, or kid stress. It’s the same set of hormones.

In modern-day America, our saber-toothed tiger might be the mortgage or your boss pissing you off at work. Once you get through those troubles, the parasympathetic hormones go up; the sympathetic hormones go down.

If you’re in the middle of intercourse and something pops into your brain, “I didn’t pay my bills last week, or The kid is out with the car, and I’m worried that she’s gonna crash that,” thirst for sympathetic hormones decreases the arterial blood pressure to the penis.

All of a sudden, the venous blood goes back into the system, and there goes your erection, and then all of a sudden, you’re going like, “My erections have gone down.” There’s a more sympathetic hormone, and the erection gets even worse. It’s critically important to be obviously in the moment to be present. Do whatever you can to maintain that high arterial blood pressure in the penis. Maintaining that high arterial blood pressure would be taking good care of yourself, working out, and eating well. Another would be staying in the moment, in your turn-on, and not letting yourself get into your mind and worry.

I’ve often said that making love is similar to meditation. It’s a practice and a state of mind. It’s a way of focusing, concentrating, and being present. Many guys who get up in their heads start strategizing about turning their woman on, whether she is having a good time or worrying about anything.

That’s when things get a little bendy. Continuing to bring yourself back to the pleasure you have when co-creating can help with that. I want to thank all men in the history of the world for managing the saber-toothed tigers and the trash and all the bugs and snakes and icky things from us ladies.

We love and appreciate you sending that down to all men. I’m sending that to the University of Men. We, women, appreciate you. The other thing to think about, which I always talk to my patients about, is if you were in a country club and played tennis. You were playing in the club tennis championship.

How would you get ready for that match? You would get a good night of sleep the night before. You would eat well. You wouldn’t eat a big fatty meal and wouldn’t drink any alcohol. You won’t get liquored up before you play that Club Tennis Championship. You’d stretch out a bit, maybe do a little mindful meditation or get ready.

When many guys have intercourse or have sex, it’s usually after going out for the night, having a couple of drinks, or having a big fatty meal. It’s 11 o’clock. You’re a bit tired, and it’s an emotional act. It’s also a physical act. To get a good erection, you want to optimize the physical conditions to produce the highest blood pressure in the penis. When you’re 25 years old, it’s not a big deal. You can do anything you want, but as you become more mature when you’re in your 50s or 60s, or 70s, you have to be a bit more mindful of generating three or four hundred millimeters of mercury blood pressure into the penis.

I keep harping back on that, but it’s a high number, it’s a high bar to get to, especially if you have some atherosclerotic disease, if you have blood pressure issues, if you are on blood pressure medication, I’d like you to go boom!

What are the reasons that a guy walks into your office? What are you seeing across your patient population as issues number one, two, and three?

Vasculogenic erectile dysfunction is the thing that I see the most. It’s either from heart disease, age, diabetes, or smoking that causes vascular issues. It’s typically from medication, antidepressants, blood pressure, and medication. Men come in for Peyronie’s disease. It is a curvature of the penis. It’s from plaque that forms or scar tissue that forms on the inside of the penis. Those are by far and away the most common reasons.

I also treat men for penile size. There’s a new FDA-approved operation called the pneuma. That is a silicone implant we put inside the penis. I see men for that as well. I know a lot of men with premature ejaculation. There are a lot of things we can do for premature ejaculation. I do vasectomies. I see a whole host of sexual issues. Remind me to leave enough time in the end for the poo hanuman.

This was like a laundry list of things I’m fascinated by. I love men’s erectile function. I’m a champion of men, as you can already tell. I’m thanking him for the saber tooth tigers. I love my guys.

Let’s talk about premature ejaculation because that is one of the biggest issues that guys talk to me about, in addition to erectile function and penis size.

I’m a big champion for men having the penis they’d like to have by whatever means are healthy and positive. People don’t understand because they don’t work with many men and don’t talk about their sexual issues.

Some so many men walk around in shame. They don’t love themselves because of the size of their penis. It could be a perfectly normal-sized penis, and it prevents them from dating. They’re afraid to be embarrassed; there’s nothing wrong with them. Some men have quite a small penis, but some things can be done that I want to get to very quickly. Let’s perform premature ejaculation because part of it is physiological and emotional.

Men would like to last longer than they do. Many men feel they come too fast. For some men, that’s three or four minutes. For some men, that’s 10 or 20 seconds. It can be a level of severity. That’s quite a swing in the amount of time. If you feel like you come too fast or your partner feels like you come too fast, it drives a wedge in a relationship, if you even have one. It forces you to a wedge from you having a relationship. Talk to me about premature ejaculation from a urologist’s perspective. These are all critical problems that no one talks about.

When patients see me in my office, we try to make them as comfortable as possible because guys don’t like coming to the doctor. They don’t like coming to the doctor for these issues. It’s critically important not to be judgmental, to honor men, to honor where they’re at, and to treat these problems as if they’re heart disease or diabetes that is life-threatening. Its quality is life-threatening for these men or even worse. Men live in depression or despair because of sexual issues—the approach to premature ejaculation. For every 100 searches online for erectile dysfunction, there are 60 searches for premature ejaculation. Not nearly as many things have been invented or we can do for premature ejaculation.

The first line is lidocaine or prilocaine. It’s a topical cream, wipe, or spray you can put on the penis to desensitize the penis. That’s by far and away the most common approach. Another approach is an SSRI or a selective serotonin reuptake inhibitor which are antidepressants like Zoloft, Prozac, and Wellbutrin.

There’s a new one called Trilogy. The problem is that you have to stay on those medications constantly to get the effects reduced, what’s called the intravaginal latency term.

The amount of time you spend in the vagina varies for guys. Sometimes guys ejaculate before they even get in there. Sometimes guys ejaculate within 30 seconds or a minute, and it’s dissatisfying to their partner. It would be considered premature ejaculation.

I’m developing a supplement that should be out within a month called pre-long, and it contains St John’s Wort and l-citrulline. L-citrulline supports erectile function because it’s a nitric oxide booster. St John’s Wort is a weak selective serotonin reuptake inhibitor. It works in a different way than pharmaceutical reuptake Inhibitors. It’s more natural. It has fewer side effects and significantly improves men’s time before they ejaculate. That’s called prolong.

I’m glad you’re creating that. In one of our other episodes in the Sexual Vitality Summit, I interviewed Jim Benson. He has a technique called the ME breath. He helps men with premature ejaculation issues learn how to last as long as she wants them to and become multi-orgasmic men.

It’s based on Ancient Taoist practices, and it’s a combination of masturbating while you’re edging and getting yourself close to but not to your point of no return and practicing getting better at going up and down the arousal scale through self-stimulation.

It’s a combination of breathing, a certain type of breathing, leveraging the PC muscle, the pubococcygeus muscle, and a certain kind of squeeze. If you squeeze one way, it exacerbates it and makes you run faster, but if you squeeze the correct way, it holds back the urge to ejaculate.

He combines that with a certain type of pelvic rocking. It’s a squeeze, a breath, and a thrust together that he has found and trained thousands of men to do that can be used during intercourse to maintain and help you last and hold you back from ejaculating.

What’s great about that particular thrust is it’s different from the in-and-out porn star piston type of thrust. It’s a certain type of rocking that relaxes a man’s pelvis as he’s doing the breathing and the squeezing. It feels incredible to the woman. She’s like, I’ve never had you make love to me that way. Can you do that thing again? It’s been a way that Jim has helped thousands of guys. What’s nice is it doesn’t require you to take an SSRI or use humming cream if you want to get to the point where there are some presents. I will ensure you get a copy of that multi-orgasmic Lover for Men program to add to your kit of non-medical or body-based things.

The lidocaine creams are an excellent first start, but getting control over ejaculatory choice when you want to and not a minute sooner. Once you work with a technique like that, you can let go of that numbing cream so you don’t have to get on the SSRIs. I like your St John’s Wort concept. That makes sense. Citrulline is a great nitric oxide precursor, much better than arginine because any guy that has herpes he’s not going to want to take the arginine solution.

Let’s share more data because I get together, teach each other things, and help other people. We’re learning from each other, which is one of the things I love about these Summits. It gets the conversation going three ways, you, me, and you.

I love talking to you because I come from a very scientific background. You’ve got a white coat. I’ve got the look. I come from a clinical scientific background.

Physical intimacy is the marriage of those two worlds. I was at the sexual medicine Society of North America meeting, and I found two additional things going through clinical trials, we live in a digital world. It’s like a masturbator widget, for lack of a better word. It interacts with the iPhone. It’s almost like a biofeedback device that you can look at. You were talking about that technique, but that was two thousand years ago.

We have iPhones, and we can use our iPhones to get that same feedback. The other is from an Israeli company with an electrical stimulation patch that you put in the perineum that you can dial up and down on your iPhone and sends out electrical stimulation that prevents the nerve stimulation to the pubococcygeal muscle from causing ejaculation.

In the Taoist tradition, that’s called the million dollar point, that perineal location where the buried shaft of the penis is. When you press on that, it can slow down or delay ejaculation. I’m interested in these new technologies. They call them sex tech, which I like, and I track a lot of sex tech. I’m glad to hear about these.

My first thing about masturbatory sleeping was what material in that sleep does it have? Phthalates are toxic plasticizers. I want to make sure it’s medical-grade silicone. That would be the number one thing; anything you have to fuss around with your phone takes you off the turn-on.

They’re interesting. They might be good tools, but in my bedroom, I want a body on body, skin on skin. All the EMFs have to be out of the room. We’ve heard how harmful EMF is for our erectile function, but I want to ask you another question for both men and women.

I wish we had more time. We might have to do two segments because I have so many things I want to talk to you about. One of the things I want to talk about is the buried shaft. I always explain to people how the penis, what you see on the outside, is part of the penis. Getting that buried rest of the penis inside the body and getting that stimulated, full of blood, and engorged helps delay men’s ejaculatory urge.

When they get a hard-on, they go for a sensation. They’re not giving themselves time to get fully engorged. Feeling down under the perineum and down into the abdominal cavity and filling and stroking that part of the penis can be highly pleasurable for guys.

Tell me more about what the penis looks like inside and your thoughts about what I said. For people that don’t know, half of the penis is on the inside, and half of the penis is on the outside. I use Gainswave to stimulate blood flow for the entire shaft. Gainswave is shock wave therapy to stimulate the growth of new blood vessels to increase blood flow or blood supply to the penis.

It also stimulates the Schwann cells, which are nerve cells. It improves sensation. I can’t prove that to you because that’s a complex experiment, but I can tell you that most report an improved sensation in the hundreds of men I’ve treated with Gainswave. Most of them report improved erectile rigidity. That’s one thing that can help sell; it’s German. We found as we age, we lose sensation. We lose the ability to feel. Many guys have delayed ejaculation because they can’t feel enough sensation to ejaculate. You’ve got your PE guys and your DE guys on the opposite side of the spectrum. DE is often, especially with diabetic neuropathies, an issue for sensation. I’m glad you segued into Gainswave.

Let’s dive into that. I am an official company spokesperson for Gainswave, and you are The Clinical Director of Excellence for Gainswave. You and I both are drinking the Gainswave Kool-Aid in a big way. I visited them and said I love what you do for men so much that I want to be associated with your company.

I want you to educate and train me. I want to tell everybody about Gainswave. I was talking to all my guys. I have thousands of men who follow me and tell me you should check into this thing. I had this done. It has changed my life. I’ve got my erection back. The more guys I talked to about it, the more I saw that it worked for 95 percent of the guys I spoke to. There are some guys that it’s not. I have another interview with some doctors doing stem cell work at this Summit.

There’s going to be a segment on stem cells. We’re going to talk about that. Most men and young men of all ages have erectile issues. Gainswave isn’t just for straightening Peyronie’s issues or fixing severe ED. You’re doing this for a wide range of men I know. You talk so well about it. I wanted our listeners to understand that we are well-versed in Gainswave and champions of it because we see it working. A lot of times, guys are afraid to try new things, especially my husband, Tim. He’s like, I don’t want to do any of this, but he had Gainswave, and he looked a couple of months later at a box of Viagra on his desk with dust on it. He was like wow, I’m going to throw these. I don’t even need these anymore, and he’s 55.

I encourage you to pay attention to Dr. Brandeis because these outpatient treatments can give you incredibly firm, rigid, long-lasting erections. I sound like a commercial. I’m that excited about it. What can I say about Gainswave? It’s an amazing technology. The military discovered shock waves during World War II. When they dropped depth charges to blow up submarines, they found that shockwaves from the explosion tore people up on the inside but left people pristine on the outside. That’s how they discovered shock waves.

We focus the shock waves on breaking up kidney stones. If you turn the energy down even more, it becomes regenerative. Some of the work done at UCSF on rat penises show an increase in vascular endothelial growth factor, creating neovascularization or the growth of new blood vessels. It stimulates stem cells. It stimulates Schwann cells which are nerve cells. It enables the release of nerve growth factors and stems cells in the vasculature.

It grows new blood vessels. Four weeks after the start of shockwave therapy Gainswave, you get the growth of new blood vessels. You get an improvement in erectile function, which continues for six to ten weeks. Suppose I have a 55-year-old gentleman who’s on Viagra. I can get them off Viagra if I have a 70-year-old patient who comes in. Viagra is not working for them anymore. I can get them to the point where Viagra is working. If I have a man on Trimix who has to inject a medication directly into his penis with a needle every time he wants an erection.

I can get that person uphill where the pill works. I can’t take that person from Trimix to get off Viagra. That’s only the big guy in the sky who can do that. Gainswave is great. The other untapped patient population is if you look at the Massachusetts male aging study, which is the biggest study that looks at erectile function. Everyone quotes this. They’ll say that in their 40s, 40 American men have erectile dysfunction in their 50s, 50 American men in their 60s, and 60 American men.

It’s not like this clip that you drop off when you become 45. You gradually increase the amount of erectile dysfunction you have until you get to the point where you can’t produce that three or four hundred millimeters of mercury blood pressure anymore. This concept I came up with, biohacking the aging penis or keeping your penis in shape, is as you get older physically, you’re not as capable anymore.

Most men reach their peak in their 30s. For every decade, you lose 10 of your physical abilities. That’s the same with erectile dysfunction, but you don’t recognize it till you get into your 50s and say things aren’t working as well as they used to. There are things you can do as a man as you age to keep your penis in shape.

One thing is a nitric oxide booster. As we age, we produce less nitric oxide. Nitric oxide is the signal that goes between the nerves and the arteries. One super simple thing you could do is to replace nitric oxide. We have a supplement called a nitric oxide booster available. This will increase the amount of nitric oxide. Within a week of taking this, you’ll notice better morning erections during intercourse. If you read the literature on nitric oxide, replacing nitric oxide reduces the risk of dementia and Alzheimer’s. I’ve had patients say that their neuropathy gets better. It’s a question of increasing circulation throughout the body. A lot of elite endurance athletes take nitric oxide boosters. That’s a straightforward thing you can do.

The second simple thing you can do is take a pde5 inhibitor. Whereas a nitric oxide booster increases the amount of nitric oxide, a pde5 inhibitor blocks the body from taking up that nitric oxide and leaves that nitric oxide within the synapse so it can continue to stimulate the blood vessels to cause vasodilation.

That’s a simplified explanation, but a pd5 inhibitor allows the nitric oxide to work longer. That’s the second thing you can do. The third thing you can do is Gainswave. You can do that early on. You can do that in your 40s. You can do it in your 50s to prevent the inevitable decline in erectile function. You can avoid the unavoidable decrease in blood flow to the penis by creating new blood vessels. That’s what Gainswave is. That’s what it’s been shown to do scientifically is to increase the amount of vascular flow, and they’ve proven this using a Doppler model.

You inject medication into the penis and watch the blood flow. For people with fake treatment, there’s no change in blood flow for men with Gainswave. You can see a dramatic increase in blood flow. Quick question: does Gainswave also increase the penile tissue itself because many guys that have talked to me have said that their penis visibly looks bigger. Is that from the new blood vessels and more blood-carrying capacity, or is regenerative tissue occurring?

That’s an excellent question, so as director of clinical excellence, I will begin to run those studies. Those are challenging studies to run because measuring these things is difficult. Typically we use the SHIM score. It’s a series of five questions that help us evaluate erectile function. For example, I had a patient the other day who came in, and he’s like a hundred dollars. I said what do you mean 100? He goes a hundred dollars down the drain. I said what do you mean a hundred dollars down the drain? He went, and I took my wife out to dinner.

I bought an expensive bottle of wine because I loaded up on Viagra, and one stupid thing I said and a hundred dollars down the drain. The point is that it’s a hard experiment to do when one stupid thing that comes out of your mouth at the wrong time can blow the whole experiment. I could help that guy with the seduction techniques.

We don’t have clinical data, but when they look down at their penis. It could be regenerative tissue.

As the Director of Clinical Excellence, we’re doing several studies. One is a large registry study. Thousands of men with Gainswave show once and for all that Gainswave improves erectile function. It’s to look at who most benefits and who doesn’t benefit. There are specific subsets of patients who don’t benefit. If you have type 1 diabetes and destructive vascular disease, you won’t benefit all that much. You won’t benefit if you’ve had a non-nerve-sparing radical prostatectomy. We must figure out who benefits the most and the least. What are the ideal protocols?

The other thing we can do is look at the penile size. We’re looking at Gainswave and other regenerative techniques to improve penile size. Does it enhance penile curvature with Peyronie’s disease? Gainswave is beginning to help me as the lead clinical investigator to try to understand how we can best use this unique technology. It is remarkable to have a minimally invasive technology that doesn’t hurt, and that’s semi-permanent.

You take Viagra. It lasts six or eight hours, and suddenly, you’re back to where you started. This is a technology that can improve things more permanently. It can turn back the clock.

Many of my patients tell me, doc, you’ve taken me back five or ten years. I haven’t taken them back 40 years, but five or ten years can make a huge difference for a man and a couple and their relationship and family.

I started as a general urologist. I was among the first in the United States to do robotic surgery. I was one of the first to do MRIs, prostate cancer lasers, and enlarged prostate, but treating erectile dysfunction and getting men back to where they were has been one of the most rewarding parts of my career.

We get so happy at Brandeis MD when patients tell us great stories. I had a patient. He had been my patient for 15 years. I was managing his enlarged prostate. He had a wife who had Alzheimer’s. He was a nice guy. He took such loving care of his wife for ten years, and after ten years of suffering from Alzheimer’s, she passed away, and he mourned for a year or two.

Finally, after a year or two, he got a girlfriend. He came to me with severe erectile dysfunction and a lot of atrophy. We put him on our full-court press, what we call quadruple therapy. Pd5 inhibitor, a firm nitric oxide booster, 12 treatments of Gainswave, and a vacuum erection device. If we have time or at another webinar, it’s important to discuss vacuum erection devices.

After five weeks of treatment, he came in and was 78 years old. He came in like a 16-year-old boy the first time to get laid. They get that glow and that giddy smile. He’s 78 years old. He came into my office with that glow and that giddy smile, and we were like, what happened? He said my girlfriend and I went away and took a loading dose of Viagra. He said I had intercourse for the first time in 15 years. He started crying, and how can you put a price on that? It was so golden. I’ve cured many men of prostate, kidney, and bladder cancer and taken kidney stones out, which was one of the highlights of my career.

I gave this guy a new life. That’s what you and I do. We give people a new life. It comes down to trust for many people—one of the reasons why I wanted to be an official spokesperson for Gainswave and vacuum erection devices. I am an official company spokesperson for the Dr. Joel Kaplan company because they make the best penis pumps, what people call them. I wanted it to show that these things work and you can trust them because guys don’t know who to trust.

When you hear stories like the one you just told, those fill my world. Those emails I get from guys who took your advice. I did the Gainswave. I’ve been pumping for 13 weeks. I looked down, and I could not believe what I saw. It’s incredible. I have the best sex because I’m old enough to be a great lover. I think lovers get better.

We get better at sex the longer we do it. Practice makes perfect. We’ve got good equipment that works. It’s a beautiful thing. I hope if there’s anything that you’ve taken away from this conversation with Dr. Brandeis, it is that if you have erectile issues… If you have premature ejaculation… If you have delayed ejaculation… If you have any of these issues, even if you don’t think your penis is big enough and want to do an implant of some kind…

I wish we had had more time to talk about that. We’ll make some more conversations. There are many things you can do that guys worldwide are doing that are working successfully.

You don’t need to feel like life is over. You can get your sex life back because there are wonderful people like Dr. Brandeis and other practitioners, and you, Susan, like him and me.

Guys don’t know what they’re doing, and they’re always like, I can take it. They try to pump it. It can return the penile length that men have lost over the years. It can improve erectile function, yes, and we need to get together and talk about that because that’s a critically important thing. It’s a date. You’ve been at the Sexual Vitality Summit with me, your host Susan Bratton. I should call myself the hostess, I suppose, and Dr. Judson Brandeis. I hope you enjoyed this session, and we’ll see you on the other side.