As a physician specializing in men’s sexual health, I’ve had the privilege of witnessing remarkable progress in our field over the past decade. Today, I’d like to share some of the most promising recent advancements in treating male sexual health issues. These innovations are bringing new hope to millions of men worldwide who struggle with conditions like erectile dysfunction, low testosterone and premature ejaculation.
Personalized Medicine for Erectile Dysfunction
Erectile dysfunction (ED) affects an estimated 30 million men in the United States alone. While drugs like sildenafil (Viagra) revolutionized ED treatment in the late 1990s, we now understand that a one-size-fits-all approach isn’t optimal for every patient.
Erectile dysfunction is caused by multiple underlying pathologies and every patient is unique. Urologists are now better equipped to pin down the exact etiology of ED through advanced diagnostic tests such as penile doppler studies using intracavernous injections. The realization that ED can be a harbinger of cardiovascular disease has allowed urologists to use specialized tests such as cardio-lipid testing and coronary artery calcium scores to tease out the men with ED at risk for impending cardiac events.
Advanced genetic testing and biomarker analysis are allowing physicians to tailor treatments to each individual’s unique physiology in some areas of men’s health. For example, researchers have identified specific genetic variants that influence how a patient responds to drugs used to treat advanced prostate cancer. These genetic tests may allow us to tailor ED therapies to an individual’s unique DNA footprint very soon.
Additionally, new drug delivery systems are improving treatment efficacy and convenience. Dissolvable oral films and troches provide faster onset of action compared to traditional pills. For patients who don’t respond well to oral medications, innovative technologies like low-intensity shockwave therapy (LISWT) show promise in regenerating blood vessels in the penis and improving erectile function. At Obsidian Men’s Health, we have seen quite a bit of success using Corewave, a form of LISWT only available to urologists.
The link between low testosterone and the efficacy of oral ED medications has been fully elucidated over recent years. Men with low testosterone may not respond to oral medications such as Viagra or Cialis, often the first line therapy for men with ED. Restoration of normal testosterone levels using testosterone replacement therapy (TRT) can facilitate the effectiveness of oral ED medications. At my practice, about 50% of men presenting with ED have low testosterone amenable to TRT.
Hormone Optimization with Testosterone
Low testosterone, or “low T,” is increasingly recognized as a significant health concern for men as they age. While traditional testosterone replacement therapy (TRT) has been available for decades, some new delivery systems have hit the market in recent years.
Natesto is a nasal spray that delivers testosterone through the nasal mucosa three times a day. Studies have shown that Natesto may be less likely to suppress endogenous testosterone production compared to other drugs such as injectable or topical testosterone. This may help maintain fertility through preservation of sperm production..
While oral testosterone has been available for decades, older methylated versions of testosterone proved to be toxic to the liver. For this reason, oral testosterone was not FDA approved in the United States until recently. The drug manufacturers figured out how to produce an oral testosterone drug that bypassed the liver via the lymphatic system around 2019. These new drugs (Jatenzo, Tlando and Kyzatrex) are not hepato-toxic and provide patients with an excellent oral option for treating low testosterone.
Injectable testosterone has been a popular form of treatment for decades. The classic approach to using injectable testosterone is a once a week intramuscular injection. More recently, subcutaneous administration using testosterone enanthate has become available. Subcutaneous testosterone injections are less painful and may be associated with fewer side effects.
Furthermore, advanced monitoring techniques have allowed urologists to minimize the toxicity of testosterone therapy and fine-tune treatment protocols to achieve optimal hormone balance for each patient.
Multimodal Treatment of Premature Ejaculation
Premature ejaculation (PME) is the most common sexual dysfunction experienced by men. Up to 30% of men experience bothersome PME during their lifetime. Premature ejaculation can cause significant distress and impact relationships adversely.
Our understanding of PME has improved over the past decade and this has allowed us to tailor treatment to the individual. Some cases of premature ejaculation appear to be correctable. An appropriate evaluation by a urologist can uncover these treatable conditions.
For men without an obvious correctable underlying etiology, multimodal treatment offers quite a bit of hope to men suffering from PME. Mental health professionals who specialize in sexual dysfunction can be instrumental in treating men with PME. They have specific techniques that hold promise and can also help couples incorporate medical therapies into a healthy sexual relationship.
Medical therapy for PME may require topical analgesics to desensitize the penis along with a variety of oral medications that can delay the ejaculatory response through a variety of mechanisms. Daily Cialis, a drug used to treat ED, has demonstrated some efficacy at treating PME. Even severe cases of PME often respond to a multimodal approach using a variety of these treatments in combination.
Addressing the Mind-Body Connection
As our understanding of sexual health evolves, we’re increasingly recognizing the crucial role that mental health and lifestyle factors play in male sexual function. Innovative treatment approaches are now incorporating psychological and holistic elements alongside traditional medical interventions.
Cognitive behavioral therapy (CBT) specifically tailored for sexual issues has shown remarkable effectiveness in treating psychogenic ED and premature ejaculation. New digital health platforms are making this type of therapy more accessible, allowing men to work with specialized therapists from the privacy of their homes.
Mindfulness-based stress reduction techniques are also gaining traction as complementary treatments for various sexual health concerns. Studies have shown that regular mindfulness practice can lower stress hormones, improve blood flow, and enhance overall sexual satisfaction.
Additionally, wearable devices and smartphone apps are empowering men to take control of their sexual health. These tools can track important metrics like sleep quality, stress levels, and exercise habits – all of which impact sexual function. FirmTech has produced the first ever smart cock ring that can help men track their penile health while also enhancing the sexual experience.
The Promise of Regenerative Medicine
Perhaps the most exciting frontier in male sexual health is the field of regenerative medicine. This innovative approach aims to restore or replace damaged tissues and organs using the body’s own healing mechanisms.
Platelet-rich plasma (PRP) therapy, which involves injecting a concentrated form of the patient’s own blood platelets into the penis, is showing promise for treating ED and Peyronie’s disease (painful curvature of the penis). The growth factors in PRP stimulate tissue repair and new blood vessel formation, potentially restoring erectile function. Stem cell therapy is another investigational approach to improving the vascular health of the penis in men with ED.
Even more revolutionary is the use of bioengineered tissues to treat severe cases of ED or penile injury. Researchers have successfully grown penile tissues in the lab using a patient’s own cells seeded onto a 3D-printed scaffold. While still in the experimental stage, this technology could one day offer a true cure for men with severe structural damage to the penis.
Conclusion
The field of male sexual health is advancing at an unprecedented pace, bringing new hope to millions of men worldwide. From personalized medicine and hormone optimization to regenerative therapies, we now have more tools than ever to address the full spectrum of male sexual health concerns.
As a physician and urologist, I’m thrilled by these developments and the positive impact they’re having on my patients’ lives. However, it’s important to remember that sexual health is complex and multifaceted. The most effective treatment plans often combine these innovative approaches with traditional therapies, lifestyle modifications, and attention to overall health and well-being.
If you’re experiencing sexual health issues, I encourage you to speak with a urologist who specializes in sexual health. Urology is the only medical specialty with extensive training in male hormones and sexual dysfunction. Urologists are the only physician specialists equipped to use these remarkable advancements with precision and expertise. There’s never been a better time to take control of your sexual health and improve your quality of life.
