Dr. Gapin defines ED as an inability to attain an erection that is satisfactory for intercourse; however, he points out the subjectivity of an erection and brings down the definition to “an inability to have satisfactory intercourse”. He distinguished ED from performance anxiety by addressing the psychological component of a person’s psyche that acts up when one worries and develops anxiety over underperforming.
Various causes of ED
He distinguished various causes of Erectile Dysfunction into four categories and briefly talked about the disorders that could cause these dysfunctions. Disruption of normal nervous function Disrupted blood flow to the penis Hypogonadism, thyroid, hyperlysinemia from poorly controlled diabetes, and hypercortisolemia from chronic stress. Cognitive component plays an important part in erectile function. According to Dr. Gapin, stress can act as a disruptive component in a person’s life driving them away from the thought of sex.
Evaluating ED
Dr. Gapin addresses the systems-based approach that is followed in healthcare practice. He alerts people to recognize the multiple components that could cause ED before trying to fix it with a pill. He promotes the human systems approach with his patients where he understands and addresses the sleep patterns, stress, vascular health, hormones, and all other factors that could affect erectile function. He advocates adjusting to healthy nutrition and change in lifestyle to reverse the effects of ED by improving glycemic control, weight loss all of which have an effect on energy, hormones, and cortisol which ultimately come down to sexual health.
Improving erectile function by improving six areas of health
Dr. Tracy emphasizes improving six areas of health – Nutrition, sleep, mindset and stress, hormones, detox, and fitness to ultimately improve erectile function. While quantity is an important factor of sleep, he focuses on the quality of sleep. Poor sleep is said to raise cortisol levels and blood sugar, make you store fat, and lower testosterone levels ultimately affecting sexual function. He counsels on following a healthy diet by following an individualized plan on what foods to eat and avoid, as genetics play a big role in nutrition. As stress is an important component that men take up about various aspects of their lives, he emphasizes practicing gratitude and mindfulness by the following meditation and breathing through the nose. In the area of fitness, Dr. Tracy recommends strength training, cardio, low-intensity activities, and stretching. For more than 50% of men, improving their health in all the above areas will profoundly improve their sexual function.
Treatment options
Dr. Tracy talks about “band-aid treatment” including oral medications and intracavernosal injectables. Commonly used oral medications are Viagra and Cialis and they last from 24-48 hours depending on the medication. Intracavernosal injectables like trimix, bimix, or quad mix are taught to be directly injected into the penis and it gives an erection for up to two hours. These treatments are short-term fixes and won’t fix the underlying cause.
Fixing the underlying cause will help in improving the blood flow to the penis for the long term. He suggests a Vacuum pump that acts as an actual vacuum by sucking the blood into the penis to create an erection. A penis ring can be used to maintain the erection and to help with penis compression. It’s a non-invasive procedure, and he recommends using it 10-15 minutes every day to have a profound effect.
Two of the regenerative treatments are gain wave and PRP. Gainswave is a low-intensity shock wave therapy used to focus the shock waves at a specific point under the skin to cause neovascularization and angiogenesis to create new blood vessels in the penis. It’s done by stimulating stem cells and growth factors to produce new blood vessels and can be done over 8 to 10 sessions. Platelet-rich plasma (PRP) is when you draw a patient’s blood to separate the layer of platelets and growth factor and inject it in five different spots on the penis to stimulate stem cells and growth factors to produce new blood vessels. It’s done in a single session.
Dr. Tracy talks about Penile Implant as a last resort. It’s a surgical procedure done by placing an inflatable cylinder-like device into the penis which can be manually pumped to stimulate saline to go from a reservoir placed in the belly into the cylinder to create an erection. He explains several downsides to the procedure like a slight penis shortening, losing sensitivity, losing the feel of a natural erection, and damaging the chances of ever having a natural erection.
Testosterone Pandemic
Dr. Tracy opens us up to some shocking numbers of drop in testosterone levels and fertility levels over the last 30 years. He talks about the chemicals and endocrine disruptors in the environment that are decreasing the hormones, causing immune disease, obesity, infertility, hormone issues, and cancers. He points out the difficulty in avoiding those as they are present everywhere in our food products, plastic water bottles, packaging containers, household cleaning products, personal care products- shampoo, deodorant, cologne, sunscreen, soap, etc. To curb the effects, he says we need to teach and learn how to minimize exposure to these chemicals.
