About this video

• Video Title: 260 ‒ Men’s Sexual Health: why it matters, what can go wrong, and how to fix it
• Channel: Peter Attia MD
• Speakers: Peter Attia, Mohit
• Duration: 02:42:03

Overview

This video features an in-depth discussion between Dr. Peter Attia and Dr. Mohit, a specialist in men's sexual health and reproductive medicine. They cover a wide range of topics related to male sexual health, including the prevalence and causes of erectile dysfunction (ED), Peyronie's disease, premature ejaculation, and issues related to testosterone and its replacement therapy. The conversation also touches upon the importance of a holistic approach to sexual health, linking it to overall well-being and cardiovascular health, and discusses various treatment options from lifestyle modifications to medical interventions and surgical solutions.

Key takeaways

• Prevalence of Sexual Dysfunction: Approximately 40% of men experience some form of sexual dysfunction, yet many suffer in silence due to embarrassment or lack of knowledge about where to seek help.
• Erectile Dysfunction (ED): ED is common, with prevalence increasing with age (e.g., 52% of men over 40). It's often linked to cardiovascular health issues and lifestyle factors like diet, exercise, sleep, and stress.
• Treatments for ED: Options range from lifestyle changes and medications (like PDE5 inhibitors such as Viagra and Cialis) to injections, penile implants, shockwave therapy, and emerging treatments like stem cells and PRP, though the latter require more research.
• Premature Ejaculation (PE): Defined by a short ejaculatory time (under 2 minutes for lifelong PE), lack of control, and being bothered by the condition. Treatments include topical numbing agents, SSRIs (used on-demand or daily), and sex therapy techniques.
• Testosterone Replacement Therapy (TRT): TRT is considered when symptoms and low testosterone levels are present. Discussed are various forms of administration (injectable, oral, topical, pellets) and their pros and cons, including the impact on fertility and potential side effects.
• Finasteride and Post-Finasteride Syndrome: The discussion highlights concerns about finasteride's potential to cause persistent sexual and psychological side effects in a subset of users, with a plausible link to neurosteroid disruption.
• Testosterone and Prostate Cancer: Contrary to common belief, current evidence suggests testosterone therapy does not increase the risk of prostate cancer and may even be protective, particularly at higher doses, challenging the traditional approach of androgen deprivation.
• Holistic Approach: Sexual health is intricately linked to overall health, including cardiovascular function, mental well-being, and lifestyle factors. Addressing these underlying issues is crucial for effective treatment.

The main treatment strategies for premature ejaculation (PE) include:

• First-line therapies:

  • Topical numbing agents: Sprays containing lidocaine applied to the penis before sexual activity.
  • SSRIs (Selective Serotonin Reuptake Inhibitors): These antidepressants can be taken daily for consistent effect or on-demand (though this requires taking them 6-8 hours before activity and may have side effects like reduced libido or ED).
  • Sex Therapy: Techniques such as the "start-stop" and "squeeze" methods are taught to help patients prolong ejaculation.

• Second-line therapies:

  • Tramadol: An opioid pain reliever, though its use is cautioned due to risks of addiction and exacerbation.
  • Alpha-blockers: Medications like alosens (Uroxatral) or tamsulosin can prolong ejaculatory time, though they carry a risk of retrograde ejaculation.

The key criteria for diagnosing PE, as outlined in recent guidelines, involve three variables:

1. Decreased ejaculatory time: Lifelong PE is typically less than 2 minutes; acquired PE can be defined as 50% of the typical ejaculatory time or a reduction to 2-3 minutes.
2. Sense of loss of control: The individual feels unable to control ejaculation.
3. Bother: The condition causes distress or dissatisfaction to the individual.

The video touches upon factors that can influence semen quality indirectly, particularly in the context of fertility and testosterone levels.

Here's what's mentioned:

• Testosterone and Fertility: The discussion on testosterone replacement therapy (TRT) mentions that young men starting TRT without proper information might become infertile. It also details protocols using HCG, Clomid, or recombinant FSH to potentially reverse this or improve spermatogenesis in specific conditions like Klinefelter syndrome.
• Seminal Parameters and Health: Dr. Mohit notes that a man's testicular size (volume and consistency) is an indicator of his fertility status and that semen parameters can be affected by overall health.
• Lifestyle Factors: The importance of diet, exercise, sleep, and stress reduction for overall sexual health is highlighted, which would generally contribute to better physiological function, including reproductive health.
• Medical Conditions Affecting Fertility: Conditions like hypogonadism (low testosterone), pituitary pathology, and genetic abnormalities like Klinefelter syndrome (XXY) are discussed in relation to their impact on fertility and hormone production.

While the video doesn't directly offer strategies for "improving semen quality" as a primary topic, it does discuss the hormonal and physiological factors that are critical for reproductive health and fertility, which are intrinsically linked to semen quality.