Shockwave Therapy for Sexual & Erectile Dysfunction with Judson Brandeis

Shockwave therapy can be used to improve blood flow to the penis and vagina by stimulating the growth of new blood vessels. Today we focus on the male application but everything discussed translates to women’s sexual health also. Perhaps the most important takeaway from this episode is that erectile dysfunction is a proxy for overall health. More often than not, it mirrors coronary health. In this episode, you’ll learn about what to look out for and what may be the cause.

Episode Intro

Dr. Michael Ruscio, DC: Hi, everyone. Welcome to Dr. Ruscio Radio. This is Dr. Ruscio. Today I’m here with Dr. Judson Brandeis. We’re going to be talking about shockwave therapy—which is a mini-wave, almost like a jackhammer for your genitals, that can help increase blood flow—in addition to male health as a general topic. Judson, thanks for being on the show today.

Dr. Judson Brandeis: It’s my pleasure. Thank you for inviting me.

[Continue reading below]

Dr. R’s Fast Facts Summary

Erectile function is a proxy for overall health

  • Mirrors coronary health – can be an early sign of cardiovascular disease
  • Mirrors blood pressure health as well
  • Can be tied to other health issues – diabetes, smoking, not rested, too much to drink, other health conditions

What is shockwave therapy?

  • Shock waves perturb the cell membrane – causing an inflammatory response which leads to healing
  • The body then produces new blood vessels and tissue
  • Shockwave therapy is curative for erectile dysfunction unlike all other therapies that yield temporary results

Research

Other Therapies

  • Nitric oxide supplements
  • PRP or Platelet Rich Plasma

What to expect from shockwave therapy

  • Results vary depending on your level of health
  • Typically takes about a month to see improvement

Does testosterone play a roll?

  • Testosterone plays into libido and desire to have sex
  • It does not directly correlate with an erection – that has to do with circulation

How much does shockwave therapy it cost?

  • $3000 for six treatments
  • $500 for maintenance treatments

Where to learn more

Erectile Function
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In this episode…
Episode Intro … 00:00:40
Erectile Dysfunction and Heart Health … 00:03:43
Causes of Erectile Dysfunction in Young Men … 00:05:54
What Is Shockwave Therapy? … 00:07:34
Shockwave Therapy for ED: Studies … 00:11:42
Natural Herbs for ED Treatment … 00:15:03
PRP or the “P Shot” …00:19:05
GAINSWave Review … 00:22:42
Does Shockwave Therapy for ED Work? … 00:27:04
Can Low Testosterone Cause ED? … 00:28:18
Testosterone Lab Tests … 00:32:00
Shockwave Therapy for ED Cost … 00:35:40
Episode Wrap Up … 00:36:42

Download Episode  (Right click on link and ‘Save As’)


DrMR: It’s good to talk about a subject that I think doesn’t get enough attention on the internet or in general: male health. We hear more about female health. We probably don’t hear much about male health because as men, we don’t like to talk about it. But I’m sure there are men out there, perhaps suffering in silence, who could use a bit of a tune-up.

DrJB: We tend not to hear it until it’s too late. It’s much better to be proactive about these things. There are things that we can do these days to forestall the inevitable.

DrMR: So let’s get into this. But before we do, tell people about your background and how you got into your work. You’re trained in conventional medicine. But now you’re doing some non-conventional out-of-the-box therapies and you’re a bit more progressive. Tell us a little about your background and then how you got to this broader model of urology.

DrJB: Sure. I’m a board-certified urologist and I went to medical school at Vanderbilt Medical School. During medical school, I got a Howard Hughes sponsored research fellowship to go up to Harvard Medical School to do research on kidney transplantation. I worked in the lab where they won the Nobel Prize for doing the first successful kidney transplant and did a lot of research on transplant immunology. I thought I was going to be a kidney transplant surgeon. And I learned a lot about how to do research, about immunology, about transplantation.

I went back to medical school and decided to become a urologist because urologists do kidney transplants. I started doing urology at UCLA and decided I didn’t want to do kidney transplants. I wanted to do general urology. When I got out into practice in Walnut Creek, California, I found that I was really fascinated by technology, and I was one of the first doctors in the country to use the Da Vinci surgical robot to do robotic prostatectomies. I was a pioneer in using lasers in urology, a pioneer in using MRI technology. I’m just a gizmo kind of person.

Then I read about using shockwave therapy for erectile dysfunction. I was initially really skeptical, like, could this actually work? I delved into the literature and I researched it. I flew out to Miami. I got trained in GAINSWave, which is the brand behind shockwave therapy. They basically popularized shockwave therapy: they ran the early training courses. I came back to Walnut Creek and I decided I was going to bring this to northern California.

Erectile Dysfunction and Heart Health

DrMR: For those in the audience who are used to the very scientific narrative, we’ll go through some of the high-level science on the GAINSWave and shockwave therapy devices in a bit. Before we get there, let’s touch on why male erectile function is a proxy for overall health. I think we can view it at least partially as such. But I don’t think everyone fully understands that if a male is not having optimal erectile function, that’s a symptom of more global dysfunction or potentially another system dysfunctioning. And that’s an alarm sign. It’s not just something that’s inconvenient and may be at times embarrassing, it’s a signal to something deeper that needs to be looked into.

DrJB: I think that’s really a critical point. I think that’s the most important thing to learn from the podcast today because the coronary arteries (the arteries that go to your heart) are basically the same size as the penile arteries and the internal pudendal arteries. If the arteries in the penis are getting clogged, there’s a pretty good chance that the arteries in the heart are getting clogged.

“…if a male is not having optimal erectile function, that’s a symptom of more global dysfunction or potentially another system dysfunctioning.”tweet e1540485375388

DrMR: Certainly one of the first things we want to think about is coronary health. Are there any other major factors that one may want to look into as a flag if they’re noticing that their erectile function isn’t optimal?

DrJB: Your normal blood pressure is, say 120/80, but the arteries in the penis generate blood pressures into the 300s. One of the first things to go would be erectile function. If you’re in your forties or fifties, even early sixties, and you begin to get erectile dysfunction, it may make sense to go to your primary care doctor and let them know. And instead of just getting put on Viagra, maybe it’s time to take a trip over to the cardiologist to get a stress test, check your lipids, or do an overall health check to make sure that everything’s okay.

Causes of Erectile Dysfunction in Young Men

DrMR: What about when you see this occurring in men who are younger? Are you thinking more non-cardiovascular causes?

DrJB: It’s all over the map. There are so many different causes of erectile dysfunction. Sometimes people get diabetes early on, some people are obese, some people are smoking, some people are drinking heavily, some people are smoking marijuana, some people even have pornographic addictions. Some people have neurologic diseases or multiple sclerosis. So it’s important if this is going on, to figure out the underlying cause.

DrMR: Are there a few that you find to be the most common? I’m assuming that stress, sleep, and a healthy diet are foundational, as is probably exercise. But outside of those things, are there a couple others that you commonly find?

DrJB: It’s mostly cardiovascular disease that isn’t initially recognized, whether it’s because they have a family history or because of poor diet. The other issue that people don’t understand is: if you’re going to play in the country club tennis tournament and you want to win your tennis match, you don’t drink a couple of bottles of wine, have a big meal, and wait until 11:00 to play your tournament. You want to optimize your health and your blood pressure. You want to drink a lot of water. You want to be well-rested. The issue is, a lot of guys will try to have erections at 11:00 or 12:00 at night, but that’s not really the optimal situation.

What Is Shockwave Therapy?

DrMR: Tell us a little bit about what shockwave therapy is. I’m sure most people haven’t even heard of it, so take us from the floor up here.

DrJB: These are shock waves, rather than sound waves. We use sound waves for diagnostic purposes and they’re very smooth sinusoidal waves. Shock waves are more of a pulse wave and they perturb the cell membranes. When the cell membranes are perturbed in a certain way, they sound the alarm. The alarm that cells send out is the same alarm that they send out in trauma. It would be like the cells are being traumatized by some sort of injury, but the injury is actually not occurring. It’s just shock waves. When the cells get injured, they generate an inflammatory response and in the body, an inflammatory response is a healing response.

Part of healing is growing new blood vessels. Your body produces what’s called VEGF (which is vascular endothelial growth factor) and other growth factors that generate blood vessels and generate stromal tissue inside the penis. They help support the delivery of new blood vessels and increase the size of existing blood vessels in the penis so that you can get better penile blood flow.

DrMR: You could say this is one of the most foundational ways of supporting healthy erectile function. You’re stimulating this repair in new blood vessel angiogenic process through almost a hormetic stressor, to get more blood to where you need it.

DrJB: Exactly. It’s a totally natural process and it’s one of the only curative treatments for erectile dysfunction. If you take Viagra, the effect is temporary. If you do injection therapy, the effect is temporary. If you use vacuum erection devices or an implant, the effects are basically temporary. This actually is curative.

Sponsored Resources

DrMR: Hey everyone. I’d like to thank two companies that can help you to improve your health and have also allowed this podcast to be possible.

GainswaveLogoSqFirstly, GAINSWave. GAINSWave therapy can help enhance sexual function by using sound waves similar to ultrasound to both stimulate angiogenesis, or the growth of new blood vessels, and breakdown plaques in existing blood vessels. And GAINSWave has been shown to improve erectile function in men according to two meta-analyses and there have also been 40 clinical trials showing various degrees of favorability in using GAINSWave therapy.

I personally have done one round and I had been very happy with the results of GAINSWave. So if you’re a man suffering, I would not go any longer suffering and I would definitely give GAINSWave a look. They have an offer of one free GAINSWave therapy session if you visit gainswave.com/patient. And for medical professionals, if you want to learn more, you can go to joingainswave.com/provider.

Plantinum Logo SqAlso, Platinum LED, who makes perhaps the best red light therapy unit on the market. And red light therapy can improve your health by stimulating mitochondria, which make energy for your cells. Now, the research while preliminary has shown encouraging results for an array of applications with red light therapy, thyroid, skin health, anti-aging, joint pain and body composition to name a few. And I’ve also been using a Platinum LED unit at home and so far I’m really liking it. I do feel like my skin looks much healthier, as has been documented in some of the studies can reduce wrinkles.

Now, in a direct side by side test Platinum LED lights have produced the highest radiants of any led light on the market today. And I’ll link to a cool video for this in the transcript. And this is the coolest part. All their lights come with a 60 day trial period and a full three-year warranty. They’re offering $50 off certain products at platinumtherapylights.com, if you use a coupon code Ruscio50 at checkout. Check them out.

Shockwave Therapy for ED: Studies

27321373DrMR: That’s a nice transition. There are three meta-analyses I want to give the audience because I know people are curious about the scientific support. First, you can look at Low-intensity extracorporeal shock wave treatment improves erectile function, a systematic review and meta-analysis. To quote them, “We reviewed 14 studies of men who received low-intensity extracorporeal shock wave treatment for erectile dysfunction. There was evidence that these men experienced improvements in their ED following [the procedure].”

27986492Another quote from a second meta-analysis: “In this meta-analysis of seven randomized control trials, treatment of ED with [shockwave therapy] resulted in a significant increase in [sexual function scores].”

There’s a third entitled Low-intensity shock wave therapy for erectile dysfunction. It asks, is there strong enough evidence? The conclusion they come to is that there is some preliminary evidence showing benefit, but more research is required, which I think is totally reasonable for a therapy that’s newer.

29576441What I’m trying to impress upon the audience is that there have been clinical trials performed and they have shown benefit. Does this mean a 100% benefit rate? No, and that would be really fantastic. It would also be highly unlikely. But there’s definitely, I think, at least a solid body of preliminary evidence showing benefit from this therapy. And let me throw it over to you, Judson, because you’re performing some of this research. How would you comment on that body of literature?

DrJB: First of all, the easiest place to find that body of literature is to go to the GAINSWave website, and it basically lists every paper that’s ever been published on shockwave therapy. So it’s a very easy place to find all this data.

Very recently I’ve been asked to be the director of clinical excellence for GAINSWave. It’s a great position and what I’d like to do with it is lead clinical research on shockwave therapy. There are a few guys out there that are doing really excellent scientific research. There’s Tom Lue at UCSF and he actually does acoustic shockwave therapy on rat penises. Then he sacrifices the rats and they stain for stem cells. And they find activation and proliferation of stem cells in these rats that have been subject to acoustic wave therapy.

What I’m more interested in is not rat penises but human penises. We’re going to do some really large-scale clinical studies because there are almost 300 to 350 GAINSWave providers around the country.

We want to figure out exactly what the best protocol is. Is there a best machine? Is there a best number of shockwaves? Is the intensity or frequency of the shockwaves important? We also want to know who doesn’t do well. Do Type 1 diabetics do well? Do patients who have had prostate cancer, surgery, or radiation do well?

There are a lot of unanswered questions. This is a wide open field. I would like to be part of the scientific effort to answer these important questions.

What we do know is that 75% to 80% of patients will get good results.

DrMR: As far as therapies go, that’s pretty good. I can speak for the body of knowledge I have the most familiarity with, which is research in gastroenterology. That’s a very good response rate: 70% to 80%.

DrJB: There are patients that come in that I know aren’t going to be effectively treated by six treatments, which is our starter dose. I tell them upfront, you’re going to need 12 treatments, or you’re going to need 12 treatments and what’s called a P-Shot or platelet-rich plasma.

Natural Herbs for ED Treatment

DrMR: That’s a good segue to other therapies that may also help with erectile function and may be synergistic with the GAINSWave. In fact, I know you’re doing what you term “triple therapies,” so let’s talk about that.

DrJB: When I started doing shockwave therapy, I was very skeptical. I was interested, but I wasn’t really convinced that it worked. I was wracking my brain, asking, “What can I add to shockwave therapy to help it work better?”

When I was at UCLA, there was a doctor named Dr. Louis Ignarro who won the Nobel Prize in 1998 for the discovery of nitric oxide as a second messenger. He had a chance meeting with one of my professors, Jake Rajfer, in a stock elevator and that chance meeting resulted in a collaboration, which resulted in a New England Journal paper showing that nitric oxide was the second messenger system that was used in Viagra or sildenafil.

Nitric oxide was always on my radar. I said, “Maybe a nitric oxide booster will increase the chance of success?” Increasing nitric oxide will increase the signal that gets sent to the blood vessel. Then, if you’re improving the signal and you’re improving the blood vessel, those two things work synergistically. On top of that, if you take a low dose PDE5 inhibitor like Viagra or Cialis, then you have increased nitric oxide boosting, you block the uptake of nitric oxide, and you improve the blood vessels.

affirmThat’s how we developed what I called AFFIRM. You can pick up AFFIRM at  AFFIRMscience.com. AFFIRM is l-citrulline, which is the most potent nitric oxide booster. L-citrulline is watermelon, red beet extract, muira puama (a Brazilian root that is a strong nitric oxide booster), and Asian ginseng. We use those four compounds because they are all compounds that there are very good scientific data behind.

We didn’t want to fill the supplement with all sorts of vitamins and minerals that there are really not data for, that are just fillers. Those four are the only ones that I could find that have real, legitimate scientific data.

DrMR: You chose l-citrulline over arginine because there’s there’s less of a regulatory impact from the body on it compared to arginine?

DrJB: Right. The problem with l-arginine is it gets metabolized. By the time it hits your body, it is basically decomposed. The only thing it does is drop your blood pressure. L-citrulline is converted to l-arginine in the kidney. And then l-arginine, once it’s in the bloodstream, becomes the nitric oxide donor. Then it’s recycled back to l-citrulline. There’s a little circuit in your body.

PRP or the “P Shot”

DrMR: You also mentioned PRP. For people who haven’t heard of PRP, tell them a little bit about what that is, how that works, and how you’re using that in the application of sexual function.

DrJB: There’s a whole field of regenerative medicine. To be honest, we really don’t know very much in regenerative medicine, in terms of stem cells and growth factors. We know that there are stem cells, we know that there are growth factors, but we don’t really know exactly how to activate them. In fact, the Sexual Medicine Society of North America came out with some warnings that PRP and stem cells are experimental or there is not all that great evidence that they work.

prpThere’s a spectrum of regenerative medicine that people use. One thing is called PRP, which is platelet-rich plasma, also popularly known as the P-Shot. PRP is used for the P-Shot, it’s used for the O-Shot, it’s used for hair growth, it’s used in orthopedics. It’s fairly widespread in use.

Platelets are round, but if you cut yourself it’s hard for round things to form a clot. When platelets become activated and get signaled to come to a site of an injury, they reach out their arms. Instead of being round, they become like starfish. The arms of the starfish join the other arms of the starfish and form a web. That web then catches thrombin and complement and other factors that create a clot. It’s a really amazing system because when the platelets open up their arms, they release something called alpha granules. Alpha granules are loaded with growth factors.

If you ever wondered why, when you cut yourself, your skin grows really fast there, and the skin doesn’t grow anywhere else on your arm or your leg where you cut yourself, it’s because the platelets are releasing growth factor. Those growth factors are stimulating the growth of tissue there through vascular and ethereal growth factor, epithelial growth factor, keratin growth factor. All sorts of growth factors are being released in that area.

PRP takes advantage of those growth factors. To use it, first you draw blood, you put the blood in the centrifuge, and then you centrifuge it down. When you centrifuge blood, the red blood cells have iron, so the iron goes to the bottom. The plasma, which is like the water that the blood floats in, goes to the top. Then you have a small layer in the middle, which is basically platelets and white blood cells. You take out the platelets and white blood cells, and then you inject it.

You can inject it into the hair, for hair growth. Or you can inject it in the penis for growth or for stimulating the growth of blood vessels. Also, it works really well for Peyronie’s disease, which is a disease of scar tissue on the inside of the penis that causes penile curvature.

DrMR: Ah, so it’s being used for that. I didn’t know that.

DrJB: Yeah, it works pretty well. That’s a very difficult problem to tackle, so anything that we have to improve that is a blessing.

GAINSWave Review

DrMR: To share my experience with the audience, I’ve tried some of these therapies. I’ve done six treatments of GAINSWave over at Judson’s clinic. You have a pretty cool clinic. You have a lot of devices over there. The last time I was in, I saw what looks like Star Trek chair. I think it was for urinary incontinence that uses magnetic stimulation?

DrJB: It’s called the Emsella Chair. It’s amazing technology. I was at the Aesthetic Show and sat in the chair for two minutes. I turned to the rep and said, “You know, I need to have one of these, how much is it?” They said, “$120,000.” I said, “I need to have one of these.”

36195087 0 BTL Emsella modelIf you take a muscle and you put an electrode on either side of the muscle, and you run current through the muscle, the muscle will contract. Our muscles all have electrolyte gradients. Those gradients create electricity and that causes contraction of the muscle. Nobody wants to have electrodes on both sides of their muscles.

This chair uses a T2 magnet, which is a very powerful magnet, and it creates powerful electromagnetic fields which cause massive contraction of the muscles. They have the Emsella Chair, which is for the pelvic floor, they also have something called the Emsculpt, which you can use to contract the abdominal muscles, or the gluteus muscles.

It’s really interesting because when you go to the gym, and you have a really, really good workout, you’re working out maybe 30% to 40% of your muscle. You hear these stories where a boulder falls on someone, and they’re able to summon all of their strength to move it. I always wondered how that works. You have, like, a circuit breaker in your brain that prevents you from using 100% of your muscle activity, because if that happens, you may tear the muscle off the bone. If you’re a caveman, and you tear the muscle off the bone, you’re not able to hunt food, and you’re not able to survive. Animals have this flip switch that doesn’t allow them to use 100% of their muscle.

If you run current through a muscle, you are able to recruit 100% of the muscular fibers. That’s what these chairs do through electromagnetism with a T2 magnet. They’re able to massively contract these muscles. It’s really amazing. It works great for stress incontinence, for overactive bladder, for pelvic floor prolapse.

DrMR: Cool chair. I took a quick gander at it last time I was in the office. But like I was saying, I’ve done six treatments with the GAINSWave and after my third week, it was pretty remarkable. Then I leveled out. But I leveled out definitely at an improvement from where I was previously. I could certainly notice increased blood flow. Without a doubt, that was achieved.

I definitely saw some nice results with it. I have not tried the PRP injection into the penis. I haven’t quite gotten that bold just yet. However, I have tried it for hair. The other doctor in my office has been doing this for a while, and he asked me if I wanted to be a guinea pig. I said, “Sure, why not?” The jury is out, it’s still a little bit early. With the hair, I believe you need to have at least a three to four-month trial, probably even closer to six to really be able to tell.

It’s a bit premature, but as a cliffhanger for the audience, we’re going to be doing a fairly comprehensive session on hair therapies including hair lasers and PRP. We’ll have more to follow on that in the future. So far, my experience with one treatment cycle on the shockwave, the GAINSWave, has been really promising. It’s something that I can say I’ve done. You can definitely feel, at least in my case, an improvement in blood flow.

Does Shockwave Therapy for ED Work?

DrJB:  I think that’s great. I’m really happy that you said that. It’s important to understand what people can expect. If someone’s erections are really poor even on Viagra or Cialis, we’re not going to be able to get those kinds of patients off the medication. Basically, we can move you up a class. If you’re taking Viagra or Cialis and it’s not working all that well, we can get you to the point where it’s working pretty well.

If you’re taking Viagra and Cialis and it’s working pretty well and you’re not able to perform without them, those are the kind of patients we can get off taking those medications. The other important thing to know is that it’s not something that happens typically after the first or second treatment. It usually takes about a month because we’re growing blood vessels. Blood vessels don’t grow overnight.

DrMR: That’s what was funny about my situation. I was starting to notice something in the second week and I try to always catch myself and say, “Okay, this could be placebo.” But by the third week, it was undeniable, which you were telling me was pretty fast in terms of response. But I’m pretty healthy.

DrJB: You’re a strong responder.

Can Low Testosterone Cause ED?

DrMR: I’ll take it. I also wanted to ask you, Judson, how do testosterone levels tie-in? I know there’s perhaps a bit of controversy, in terms of the correlation between testosterone and erectile function. I wonder if some of that controversy is inflated because of the abuse of testosterone in certain circles. If someone has, maybe, in the middle of the reference range or higher, I wouldn’t think they would be able to gain much from additional testosterone. Clearly, if they’re flagged low, that would make sense that they may. Where I’m more curious is that borderline low, skirting around the edge of the low range. What are your thoughts in terms of testosterone’s impact on erectile function there?

DrJB: In terms of affecting blood flow, testosterone really doesn’t affect blood flow. Erections, for the most part, are circulation. What we’re trying to do with the GAINSWave is to increase blood vessels and increase circulation. That’s what we’re trying to do with AFFIRM, PD5 inhibitors, and triple therapy in general. Testosterone is much more tied into libido and the desire to have intercourse.

The question of what to do with someone who’s borderline low is a really good question. It’s something that I struggle with, because once you begin to replace testosterone on someone, you’re pretty much stuck replacing it for the rest of his life. I had a really good lesson when I saw an ex-[football] defensive end, this mountain of a man, 350 pounds. He came in and I examined him. I think I was gonna do a vasectomy on him and his testicles were the size of little marbles. Obviously, this guy had been using high-dose steroids for quite a long time. It basically atrophies the testicles. At a certain point, your body doesn’t begin to reproduce testosterone. It loses the ability because you’re pumping in a lot of exogenous testosterone.

DrMR: It seems reasonable to me to conclude that’s not something you would want to exercise unless all other options have been explored first. Correct me if I’m off on this, but if someone’s using HCG at the same time, they should be able to prevent testicular atrophy and likely keep fertility as something on the table. Would you agree with that?

DrJB: Yeah, I agree with that, but taking HCG is a little bit more complicated than taking testosterone.

DrMR: How do you feel it is complicated?

DrJB: To be honest, I don’t treat my patients with HCG. Typically in that situation, I’ll refer them to an endocrinologist.

View Dr. Ruscio’s Additional Resources

Testosterone Lab Tests

DrMR: Gotcha. Just for the audience, LH is released from the brain. This will essentially tell the testicles to make testosterone. Testing for LH seems to be tricky because it’s not a very solid output. It has this pulsation. Pinning this down on lab work may be difficult. Again, Judson, I’ll defer to your knowledge here. Would you say it’s challenging to get a good read on someone’s LH levels?

DrJB: It is. Usually, the only time we use it is for fertility.

The important thing to understand is that there’s a negative feedback loop, so when you take testosterone exogenously, it feeds back onto the anterior pituitary. It tells the pituitary to stop sending down LH. It feeds back to the brain and tells the brain to stop releasing LH, RH, lutein as a releasing hormone. That negative feedback loop basically interferes with the natural production of testosterone.

DrMR: There’s no free lunch in biology. This is why we’re in agreement when we say testosterone would be one of the last things to consider, because of those effects you’ll have of downregulation of your endogenous production.

DrJB: Right. It’s also important to check the free testosterone because testosterone is a bound molecule. It binds to proteins, including sex-hormone-binding globulin. So you can have a very high total testosterone, but if your free testosterone is low, then it doesn’t really matter what the total testosterone is.

AdobeStock68934200WEBDrMR: Very much agreed. For the audience, I plan on doing more of a direct podcast on just hormone levels in men. One of the things that we’re going to be researching is the impact of the liquid chromatography with mass spectrometry method of testing. If you remember back in our discussions on thyroid, we discussed how that method may be more accurate for cases that might be hypothyroid but don’t fully look like it. By using this dialysis LCMS methodology, you filter out these binding proteins that can confound the results of the free fraction in the blood. I’m assuming the same thing could apply here. Rather than doing your traditional free testosterone via immunoassay, you could do this dialysis with liquid chromatography with mass spectrometry, which filters out some of the binding proteins and gives you a better read.

You can also test sex hormone binding globulin in the blood directly, so it’s another thing to look at. These are things, along with estradiol, that can help give you a picture. For example, if you’re too low carb, carbs are anabolic, so you could have a very high sex-hormone-binding globulin and that could be decreasing your free testosterone. Conversely, if you have some type of inflammatory burden that may be upregulating the aromatase enzyme, you may be converting some of your testosterone into estrogen. These are things we’re gonna explore a little more in a detailed fashion and try to lay out some thoughts on in a subsequent episode. Judson, anything else on hormones and testing while we’re on this topic?

DrJB: I’m actually working on a supplement to boost testosterone naturally. That’s yet to come.

Shockwave Therapy for ED Cost

DrMR: Cool, keep me in the loop. I’m happy to be a guinea pig on that one also, as I am for many a thing. What would someone expect to pay for this? One of the things I’m trying to provide people with is how to know if the therapy is reasonably priced or if someone is just jacking it up.

DrJB: The standard price for shockwave therapy for erectile dysfunction is $3000 for six treatments. Then, typically what I tell patients is six months after the initial treatment you’ll come in for one maintenance treatment. That’s $500. Most patients, when they finish treatments, say that we’ve turned the clock back about five or 10 years. But you continue aging, so it’s important to come back for maintenance treatment so you keep resetting the clock.

DrMR: Cool, is there anything else that you want to leave the audience with here before we close?

Episode Wrap Up

DrJB: Not much more than what we talked about before. Sexual health can predate the development of other cardiovascular disease. If erections aren’t as firm as they used to be, it’s important to get in to see the primary care physician who can check out your heart and other aspects of your cardiovascular health.

DrMR: Good point. Certainly, don’t want to let a cardiovascular issue slide until it’s too late.

DrJB: The other point that I’d love to make is that at the PUMP Center in Walnut Creek (short for the Pacific Urology Male Performance Center) we really try to take erectile dysfunction very seriously in terms of the global way that we talk about it. First of all, our staff is all very well-trained to take it very seriously. It’s not a joke to us. This is a real important disease and it’s a vascular disease. Patients typically aren’t ashamed to go to a cardiologist. They shouldn’t be ashamed to go to a urologist.

It’s basically the same disease, just a different end organ. We try to create a really nice comfortable environment for men to come in and feel comfortable talking about really difficult things. Guys typically don’t like coming to the doctors. And we try to create an environment in the PUMP Center where guys are really comfortable to come in.

We typically have old classic football games or basketball games up on the big screen. We’re playing really good music. We offer guys drinks. We just got an espresso and cappuccino maker. We really try to make this a very pleasant experience so that guys don’t feel bad about coming to the doctor.

DrMR: Judson, thank you again for taking the time and also for doing what you’re doing. Like I opened with, it’s an underserved area. I’m glad that you’re out there doing what you’re doing.

DrJB: My pleasure. It’s great to talk to you.

DrMR: You too.

What do you think? I would like to hear your thoughts or experience with this.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

Discussion

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2 thoughts on “Shockwave Therapy for Sexual & Erectile Dysfunction with Judson Brandeis

  1. Would shockwave therapy be appropriate for a patient with spina bifida occulta and hearing loss but no standard ERD risk factors? No obesity, insulin resistance, perfect glucose control, etc.

  2. Would shockwave therapy be appropriate for a patient with spina bifida occulta and hearing loss but no standard ERD risk factors? No obesity, insulin resistance, perfect glucose control, etc.

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