Bill Klaproth (Host):
Today, we are tackling a subject that many men find uncomfortable to discuss.
Yes, erectile dysfunction. It's a sensitive issue that affects countless men,
but understanding the facts and the latest treatment solutions can make a
significant difference in the lives of these individuals.

Host: So, let's talk with Dr. Jagan Kansal, Head of the
Center for Men's Sexual Health and Male Fertility at Down There Urology,
located in the Chicagoland area. This is the Top Docs Podcast. I'm your host,
Bill Klaproth. Dr. Kansal, thanks for being here.

Dr. Jagan Kansal: I appreciate you guys having me. It's
always a fun conversation to have, so I'm excited to share a little education.

Host: Absolutely. Well, that's what we're interested in,
is education. So, how common is ED?

Dr. Jagan Kansal: Well, if you talk to most guys, they
want to say it's not common because a lot of people don't want to talk about
it. But based on data and just anecdotally, we know it's a tremendous amount of
people it affects. Just statistics-wise, we know 30 million people in the
United States have erectile dysfunction and it affects any age. So, we know
it's a huge topic. I mean, obviously, for all the commercials you see, all the
advertisements you see, we know it's out there. And I tell patients all the
time, no one wants to be the first one to ask the questions, but everyone wants
to know the answers to it in a sense. And so, podcasts like this to really get
the conversation started is really important for us. Because once you get the
conversation started, a lot of people come out and start relaying like, "Oh,
I do have this problem. It's a normal thing. Let me get some help."

Host: So, you said this can affect men of any age. I
think my perception is this is only older men, but it sounds like this can
happen to younger men as well.

Dr. Jagan Kansal: Yeah. Historically, people want to say
it happens with age. But we know based on data, it happens to all ages. We see
people in our practice from the age of 20s up to their 90s. And so, there's a
huge range that it can affect. There's data looking at the percentage of people
that have erectile dysfunction based on age. So, new data's come out to show
that up to 40% of men, by the time they turn 40, have some degree of erectile
dysfunction. I mean, just think of how many millions of people that is. And
that's not that old. And we tell guys, you need a good sex life for a long
period of time. And when you're talking about your 30s, 40s, and 50s, that's a
big part of your sexual activity and your sexual life. And so, by the time you
turn 40, if 40% of guys are experiencing some erectile dysfunction, that just
tells you how significant it can be.

Host: Forty percent of men by the age of 40 have
erectile dysfunction. I never would've thought that. Never would've thought
that. Wow.

Dr. Jagan Kansal: And I tell guys with erectile
dysfunction, it ranges. So, guys have mild erectile dysfunction where they're
not performing all the time and they're not getting as rigid or hard as what
they used to be to full blown ED, right? And that might be a little bit older
when you can't get an erection at all. And so, 40% of men have some degree of
erectile dysfunction by the age of 40. And really just getting education out
there, like you were saying, a lot of people don't realize that.

Host: So, you said there are varying levels of ED. When
is it time to see the doctor?

Dr. Jagan Kansal: Yeah, that's a great question. So, my
philosophy and all this kind of stuff is to get treated as early as possible,
right? With any type of disease process, you don't want to wait until the last
stages because there's less treatment options that we have. Now, a caveat to
that is no matter how bad the erections are, there's always some solution. So
just as a caveat, no matter if we say it hasn't been working for years, there's
always something that we can do to make it work again.

But to answer your question, you know, guys aren't good at
going the doctor. We never go to the doctor. A lot of the guys I'm seeing in
their 30s, 40s, 50s, it's the first time they've ever seen a doctor. And so, I
tell guys the biggest thing that we want to do is just to get the education out
there. We're normal people. I promise you. We're not intimidating people. We're
not intimidating doctors that are going to get mad at you for not doing
something and not eating your vegetables and all that kind of stuff. We
understand we're guys. I'm a guy. I understand that this is a very common and
sensitive topic. So, really just getting people in the door early on because
the earlier you come, there's actually treatments now that can fix the problem,
fix the underlying problem if you come in early enough.

Host: So, let me ask you this, how do you diagnose this?

Dr. Jagan Kansal: Yeah. So, there's two different levels
of diagnosis. One is just the patient history, subjective diagnosis is what we
call it. So if you come in and say, "Hey, doc. I'm not performing the way
I used to," well, you have some level of erectile dysfunction, whether it
be psychological, whether it be vascular, there's a whole bunch of different
reasons people can have ED, but it's still considered erectile dysfunction
regardless of the cause.

And then, a lot of people are starting to have, or a lot of
people as they get older even in their 40s, have vascular ED. So, the analogy
that I use there is in your penis, there's two cylinders. They kind of look
like bike tires. And the analogy that I use all the time is like trying to fill
a tire. So, there's two real reasons why people have erectile dysfunction from
a blood flow issue. It's not rocket science, all the penis is doing is filling
up with blood when you get aroused, right?

So, there's two reasons why people get erectile dysfunction.
One, the blood flow's not getting into the penis, right? So if you think about
the tire analogy, the air's just not getting in there. Or the air is getting in
there, but it's leaking right back out. And the analogy that I use there is
like you're trying to fill a flat tire, right? So, it's a blood flow issue when
we talk about a lot of the vascular-related issues.

So, my job as a specialist in sexual medicine is to try to
figure out why you're having erectile dysfunction. Is it up here? Is it down
there? Is it a combination or is it hormonal? Testosterone-related stuff and
things like that can cause abnormalities with erectile dysfunction. So, that's
where I come in, that's where my job is to try to figure out the problem. Then,
there's always a solution, depending on what you want to do.

Host: So with vascular ED, it sounds like that could
potentially be the symptom of a larger health issue.

Dr. Jagan Kansal: Absolutely. And this is why it becomes
even more important if you're experiencing any type of erectile dysfunction,
even in your 30s or 40s to get treated early. Because if we do diagnose you
with vascular ED, I tell guys the blood vessels in your penis are microscopic.
They're very, very small. Now, downside, no one likes to hear small and penis
in the same sentence, but just anybody, the vascular is very small. And what
happens is if there's a blood flow issue, we know that the blood flow and the
issues and the microscopic arteries and veins are being affected, that's an
early sign of heart disease because in your heart you have really large
vessels. So if your microscopic vessels are being affected right now, it's an
early sign or it helps us predict if you're going to have any heart disease
later on. So if you're a guy in your 30s and 40s and you have a family history
of heart disease, that's really important to get evaluated because we're not
only focusing on the penis and erections, we're focusing on your overall
health.

Host: So, don't ignore this is the basic message. One,
it could be the symptom or a sign of a larger health issue. Two, you want to
make sure you're having a good sex life too. You want to be able to perform
when it's time to perform.

Dr. Jagan Kansal: You got it. It's important to a lot of
guys and a lot of couples. And I tell patients all the time, it's not a one
person disease. It does affect your partner, right? I mean, it's always a
two-person disease. And so, getting addressed early on, there's a ton of things
that we can do earlier on. If it gets too late, there's still things we can do,
but it's limited.

Host: Right. So before we talk about treatment options,
for someone that may have mild ED, can they modify their lifestyle to improve
this? Like, "Okay, I'm going to start running, I'm going to get my
cardiovascular in shape, so I can really increase the blood flow where it needs
to go." Is that something.

Dr. Jagan Kansal: So, absolutely. Part of it's
diagnosing what the root cause is, right? So if it's a vascular thing, if it's
psychological component, if there's a combination of both, which a lot of times
it happens, I tell patients all the time, once you start thinking about your
penis is not going to work, there's a vicious kind of feedback system there.
But the answer is yes. If you're overweight, if you're obese, we know your
testosterone's low, we know your confidence is low, we know there's vascular-related
problems in terms of venous leak and that blood flow issue. So, there's a lot
of things. If you're unhealthy, that's going to cause erectile dysfunction.

So, fixing that lifestyle thing can increase your testosterone,
can increase your confidence, can get your blood flow going back there. So,
absolutely, that's one component of it. And then, just in general, lifestyle
stuff. So, chronic alcohol intake, chronic marijuana intake, some of these
other recreational drugs, which a lot of people do nowadays, which is fine.
It's just everything in moderation is okay. But if you're doing a lot of these
things, it can absolutely affect your blood flow and your hormones and all
these things. And one of the most important things for guys is their erections and
their sex life. And that's normal, especially, in younger, even older guys. So,
we don't use fear as a motivational thing sometimes. But for guys, sometimes
fear is a good motivator. You know, I tell guys to stop drinking every day,
otherwise you're going to lose your erections. I tell guys to stop smoking,
otherwise your erections are going to go bad or guys with diabetes. So, I'm
very easy going in terms of not being a doctor saying, "Don't do this,
don't do that." But when it's affecting your sexual life and you're coming
in for ED, we sometimes put a little fear in guys and sometimes that helps.

Host: Yeah. Well, erections are important to men. So
saying, listen, this is not gonna happen anymore if you keep doing this is a
good way to put it. So for someone that does change their lifestyle, if you
will and it doesn't work, can you tell us about treatment options and any newer
treatment options that might be out there?

Dr. Jagan Kansal: Yeah. So, the nice thing about
erections is that no matter what degree of severity you are at, there's always
a treatment option. Now, with the erectile dysfunction, the way I explain
things is it's a progressive degenerative disease. So if you have a timeline
here and you're here on the timeline, eventually you're going to kind of work
your way down the timeline. It's just natural as you get older, other comorbidities
kind of fill in the sex. Even if you're all the way here, there's always a
treatment option that we can talk about. So, I really reinforce the guys,
you're never too late in coming to the doctor for erectile dysfunction. We can
definitely help.

But the point of this conversation is I'm focusing on the
treatment options more in the mild to moderate erectile dysfunction. So for the
younger guys, they're starting to notice a little bit of erectile dysfunction.
It's just starting to creep in. The guys that might be on Viagra and Cialis,
some of those traditional treatment options that are right there, those are
always options, right? So, those are the traditional options. Those kind of
cover up the problem. It doesn't necessarily fix the underlying problem if you
know what I mean. So, I have guys all the time that have been on Viagra for 10
years and all of a sudden they're saying, "Hey Doc, it's not working for me
anymore," right? It's not fixing the underlying problem. It's covering it
up. So, there's been a new class of treatment options that people have talked
about. They're called regenerative therapy, so that's the newest thing in
erectile dysfunction. So, the question is how do we fix the underlying problem
rather than covering it up with meds or things like that. So, the biggest one
people are talking about right now that's all over the place, if you Google it,
it's everywhere, it's called low-intensity shockwave therapy. And that's the
newest treatment option that I can get into.

Host: low-intensity shockwave therapy. So, tell us more
about that. How does it work?

Dr. Jagan Kansal: Yeah. I tell guys, "Don't be
scared. It's not shocking the penis." Basically, there's this ultrasound
technology that stimulates you to be able to get more blood flow in the penis.
So, it's the same technology. A lot of people have heard of kidney stones and
shocking those kidney stones from outside, the same technology. So, we know
there's energy that's going through it. And it's a good way to stimulate the
cells of the penis to release these growth factors that get more blood vessel
development. That's the technical term for it. But the analogy that I use
there, it's like imagine going to the gym, in order for you to bulk up and your
muscles to get bigger, you're actually causing a little bit of damage and your
body repairs that and you get bigger and you get more healthy. In a sense,
we're not damaging the penis, but we're creating an environment with this
ultrasound technology to shock, in a sense, the cells and they release these
growth factors. And it's like basically going to the gym for your penis is what
I call shockwave therapy. But the education I'm trying to get out there is
there's a lot of people advertising shockwave therapy. But shockwave therapy's
not all the same. But it's advertised the same. So, you really want to go to a
place that understands what shockwave therapy is and they're actually doing the
right type of shockwave. That's a whole different conversation. But if
anybody's ever interested, we can go in that a little more detail. But you
really want to get low-intensity shockwave therapy and there's been like 150
clinical trials worldwide showing that can help really with guys in that mild
to moderate phase. And that's what we're talking about coming in early for
getting treatment.

Host: So for people with vascular ED, this is a help as
well.

Dr. Jagan Kansal: Absolutely. This primarily helps with
patients with a vascular ED and in that mild to moderate phase. And we have
different diagnostic techniques and things that we can do to diagnose you if
you're vascular or not in terms of putting you in a category. But usually, it's
been shown to help and fix the underlying blood flow issue, and it really helps
guys with that mild. So, we define mild as starting to notice the problem,
maybe not performing all the time, or if you're taking pills and you're taking
a little bit of Viagra, a little bit of Cialis. Or for the guys that have been
on Cialis and Viagra, that it's not working a hundred percent, that's kind of
that mild to moderate range. And that's where the target population for these
newer regenerative therapies works the best.

Host: Well, I don't think I'll ever forget the phrase,
it's like going to the gym for your penis. So, thank you for that, Dr. Kansal.
I love that. That is great. So, is the process over a period of months then,
this low-intensity shockwave therapy? Tell us how it works, how long the
procedure is, what someone has to do.

Dr. Jagan Kansal: Yeah, it's actually pretty easy. So,
we do it in our office. It's just 30 minutes, and the standard protocol that
has been shown in the data to work is once a week for six weeks. So, the
minimum that we recommend is six treatments. You can drive yourself home.
There's no anesthesia. It's actually not painful at all. And so, it's actually
very well tolerated. So, it's one of those like is it too good to be true kind
of things sometimes. And for the right guy, it can be a life-changing thing
sometimes in terms of fixing or improving the erections, especially when
they're mild, we just start to notice that erectile dysfunction.

Host: So then, what do you tell guys about all the
advertisements for treatments on ED? You mentioned Viagra and Cialis. We're
bombarded with this stuff all the time. What do you tell people?

Dr. Jagan Kansal: That's a great question. In general, I
tell patients if it sounds too good to be true, it's probably too good to be
true. Otherwise, we'd be giving it to everyone. So, next time you open your
laptop and see a magical pill that's going to grow your erection or penis by
five inches and make you that big, don't believe it. There's actually a study
looking at some of these supplements if you go to the gas station and look at
all the things that are going to help your erectile dysfunction, all that kind
of stuff. And they showed that like 60-70% of the ingredients in these things
are actually a Class C or Class D recommendation and they don't recommend it.
There's only about 20% of things in that that might help. But when you're
talking about erectile dysfunction, I tell guys, if it sounds too good to be
true, it's most likely too good to be true. And some of these advertisements
and marketing people, put millions and millions of dollars to market
specifically to guys like us who may buy it. And there's a reason they're
preying on this desperation almost now that guys have. They don't want to go to
the doctor, so they look at these things. It's easy to order, let's just try it
kind of thing. But they don't work.

Host: So, this not going to the doctor thing, it's a big
issue. How would you like men to say this to you? What is an easy way for a man
to come to you and say, "Doc, I'm having trouble gaining an
erection." Is that the easy way for them to say it? Can you give us some
advice on that to say, "Guys, just come in and tell us this."

Dr. Jagan Kansal: Yeah, I reassure guys, you know, I'm a
board-certified urologist and I specialize in sexual medicine. This is a
conversation I literally have every day multiple times a day. And some people
have to remind me, "Hey, this is not a normal conversation." I talk
about it all the time that it's just very easy for me to talk about it, let me
put it that way. I understand when patients come in, it's not easy for them.
And what we really want to do is make them feel comfortable. I almost guarantee
you, for once patients actually get in the door and they see the ease that we
talk about this stuff, we talk about erections, we talk about ejaculation, we
talk about orgasm, we talk about fertility stuff, we talk about penises and scrotums
all the time. This is a very normal conversation for us. So once you actually
get into the office and realize, "Wow, it's not a big deal. I can talk to
a doctor that specializes in this, and then it's easy to do," then people
start opening up. But it's just getting that initial conversation. That goes
back to my initial point. No one wants to be the first person to take that
step. But you need to understand, once you take that step, there's so many
options for you, but you can't get help until you actually ask for it.

Host: Right. Well, it's a hard thing to admit, I would
imagine for men because our manhood is wrapped up in that, being able to
perform, being able to make love to our wives or whoever, it's tough to admit,
"Hey, I'm having problems in this area," right?

Dr. Jagan Kansal: A hundred percent. The two things that
I treat are men's sexual medicine and male fertility issues. And those are like
two of the most sensitive things that make guys guys, right? I mean, it's like
trying to get someone pregnant with sperm and if you don't have me sperm,
that's a big deal. Or getting an erection or, you know, anything with your
sexual medicine-related stuff, orgasm or ejaculation, whatever it may be. I
tell guys, once you normalize the conversation, and if you think about 30
million men in the US having this problem, you understand that this should be a
conversation everyone's having, right? I mean, your primary care dog, you
should be coming in and asking you if you have these problems, but a lot of
people don't talk about it.

So, finding a place that specialized in it, it's very
comfortable talking about it, I think is important because there's a whole
world out there of treatment options that people don't realize, and we can fix
these problems. It's just trying to get an understanding of, first of all,
getting the patient in. And diagnosing what's going on and then finding the
right treatment and that's something we do every day.

Host: Absolutely. Well, as we wrap up, Dr. Kansal, thank
you so much for your time. Anything else you want to add as we talk about ED
and treatment options?

Dr. Jagan Kansal: Just stressing component of get an
appointment, come on in. We do telemedicine appointments, we do in-person
appointments. A lot of people don't want to be in-person right away. So, just
talking on the phone. You start realizing, "Hey, this is not a big
deal." We can talk about some options for you and that kind of thing. So,
I would say, I would leave it on this, is there's so many people that have it.
You're not the only one experiencing this problem. And you'll realize that once
you start having these conversations. And it is a two-person disease, so it is
affecting your partner. So if you don't want to do it for yourself and say,
"Hey, I can tolerate it, I can deal with it," there is another person
being affected by this. And so, having these conversations, getting the
conversation started with your partner or a doctor or some kind of healthcare
provider that specializes in this, is a great next step and I guarantee you
there's some treatment option we can offer you.

Host: Absolutely, Dr. Kansal. Thank you so much. If
someone wants to learn more or book an appointment with you, what should they
do?

Dr. Jagan Kansal: Yeah. We are a sexual health
urology-based clinic in Chicago. So, we have two locations in Chicago, one
downtown, one in the northwest suburbs. So if you are local, we can always see
in person, that's no problem. We understand it's a sensitive topic and we do
treat people throughout the country. And so, if you're ever interested in just
getting in to a consult, we do telemedicine consults every day. And so if you
want to just get the conversation started, you're not sure if you want to
actually come in person for a doctor's appointment yet, I'm happy to talk to
you for five, 10 minutes just to get the conversation started. And so, we have
patients coming from all over the country. So if you're not local, feel free to
give our office a call. I can give you the number or you can include it in the
link. But our name of our group is called Down There Urology. That's another
story in itself, but we decided to name it that, because we want people to
understand this is what we do and this's what we specialize in. And it's a very
easy conversation to have. So if you Google Down There Urology or find it, call
us anywhere. If you're throughout the country, we're more than happy to
schedule a telemedicine appointment with you just to get a conversation
started. But we're available.

Host: Sounds great. Dr. Kansal, thank you so much for
your time. We appreciate it.

Dr. Jagan Kansal: Awesome. Thanks guys. Appreciate you
having me.

Host: Yep. And if you found this podcast helpful, please
share it on your social channels and check out the full podcast library for
topics of interest to you. I'm Bill Klaproth. This is the Top Docs Podcast.
Thanks for listening.