Listen to today’s episode Covid-19’s Impact on Erectile Dysfunction with Dr. Justin Houman through the podcast player embedded above.

Erectile Dysfunction Radio Podcast

Dr. Justin Houman joins us to discus all things Covid-19 and erectile dysfunction. We discuss the the latest information on how contracting Covid-19 can impact erections, the vaccine, the social impact of pandemic-related lockdowns on erections, and telemedicine.

Dr. Houman is a urologist whose practice is focused on men’s health, including treating men with erectile dysfunction. He is based in Los Angeles California with Tower Urology.

The Erectile Dysfunction Radio Podcast is dedicated to educating and empowering men to address erectile dysfunction, improve confidence, and enhance the satisfaction in their relationships. This podcast is hosted by certified sex therapist, Mark Goldberg, LCMFT, CST.

Transcript of Episode 40 – Covid-19’s Impact on Erectile Dysfunction with Dr. Justin Houman

Mark: Today, we are joined by Dr. Justin Houman. Dr. Houman is a urologist with Tower Urology in Los Angeles, California. He completed a fellowship in male reproductive medicine and surgery, and has published numerous articles and research papers on those topics. He is a champion of men’s health and has dedicated his career to helping improve the quality of life for men.

Today we want to explore what it’s like working with a urologist to resolve erectile dysfunction during and after the Covid-19 pandemic. To get us started, can you tell us a bit about your practice?

Dr. Houman: I am a urologist, as you mentioned. And with urology, obviously, urology is a very broad field, we deal with all types of issues with the urinary system, from kidney stones to incontinence, to urinary tension, prostate issues, and cancers, the various cancers.

I do all of that, but I’m specifically focused, or least I’m fellowship trained in Men’s Health, so essentially I help guys who have difficulties having intercourse, achieving fertility, so it’s a lot of male fertility involved, a lot of erectile dysfunction, testosterone management, and really anything sex-related. That’s a big part of my practice in terms of what I see.

Mark: As a urologist, when someone’s struggling with the erectile dysfunction comes to you, what is the standard diagnostic and treatment process like?

Dr. Houman: You can’t treat everybody the same. So some patients will come in and have horrible erections and they’re not too bothered by it, and other times, some guys have, their erections are almost perfect, but they’re very bothered by it because they’re not perfect, so a lot of it’s tailored towards the patient getting a good sense of where they are, where they want to be, what their goals are, and then really figuring out what is causing their erectile dysfunction.

It’s very easy for me to just give patients medications, whether it is simply giving them by Viagra or Cialis, prescribing them Viagra or Cialis and telling them to come back in three months, but my goal, always for patients is to diagnose the issue because erectile dysfunction really is a sign of your overall health.

If you are experiencing ED, specifically, especially at a young age, it’s important to diagnose it and treat it. Potentially your early onset diabetes, high blood pressure, high cholesterol levels that’s causing this, so the diagnosis is very key, and that’s just blood work, and sometimes it’s even low testosterone, that’s causing it, but yeah, it’s really… diagnosing is key is a key component to figuring out what’s causing erectile dysfunction.

Mark: And I would gather that the diagnostics will dictate what the treatment procedure would be, is that correct?

Dr. Houman: Precisely. Sometimes a guy will come in and blood flow in terms of the physiology for the most part is good, but he may have a low testosterone that’s caused. And by fixing his testosterone levels, we’re able to enhance his erections or sometimes he has high blood pressure or he has early onset diabetes, and by correcting that we could not only reverse the diabetes but improve the erectile quality as a result of that as well.

Mark: Got it. Now, Dr. Houman, you’re located in California, which has seen some of the most restrictive lockdown measures in the United States, probably similar to what is going on in many other countries around the world. Has that had a measurable or at least a corollary impact on the occurrence of a erectile dysfunction in otherwise healthy men?

Dr. Houman: Without question. So yes, especially young men. Young men who typically, they’re social, they’re active, they live normal lives. Before covid they were living normal lives, or they’re going to work, having a social life outside work, exercising regularly.

And a lot of those guys they’re confined to, especially the ones that are single, they’re not in relationships, they are confined to their apartments where they’re working from home every day and spending a lot of time in front of the computer and that social interaction is not a huge part of their life, or especially during the worst parts of covid.

They were having minimal social interaction, and that takes a mental toll obviously, but more importantly, a large chunk of those guys, they masturbate more and masturbation is definitely healthy to a certain extent, but excessive masturbation could cause sexual dysfunction issues as well.

So it’s two-fold with that, a lot of these guys will develop a erectile dysfunction or sexual dysfunction as a result of the lockdown measures and then the activities that they engage in because of the lockdown measures.

Mark: Now, there were some stories in the news of men who developed erectile dysfunction after having covid, is there currently any evidence that indicates this is an associated risk of covid, and have you seen men for erectile dysfunction after they have experienced Covid-19?

Dr. Houman: So yeah, I’ve heard of this myself, I haven’t seen any patients who have had complained of erectile dysfunction as a result of covid, as a result of getting the covid virus. Some patients had said, “Hey listen, I had covid, I was having erectile dysfunction before, but now I’m here to see the doctor because it’s the right time to discuss it.”

But the only thing I could think of as a result of covid potentially causing some form of ED, as we do know, with covid, patients would get elevated, they get fevers, and that could transiently, so temporarily that could decrease your testosterone levels as the testicles could get warmed up and the testicles are very temperature sensitive, so if you increase the temperature too much, you may not be able to produce testosterone that’s at the same level.

And as a result of that a small subset of guys had stated or they claim that they had some form of erectile dysfunction, but that’s the only mechanism I could think of in terms of the covid-virus causing erectile dysfunction.

Mark: And I recognize that oftentimes, these stories are meant to grab people’s attention and meant to raise awareness, and a lot of times they are only around for about a week or two. I imagine that if this was a widespread issue this would be covered in a far more pronounced type of way in the media.

Is this a topic that would be covered much more widely if it was a pronounced or an associated risk of Covid-19?

Dr. Houman: Yeah, I believe so. I would think that if it was much more pronounced, or at least we’d be seeing a lot of patients or more patients in clinic exhibiting these symptoms as a result of the covid virus.

Mark: Is there any known concern that the available vaccines for Covid-19 would impact male sexual function?

Dr. Houman: : It’s a great question, and it’s a question a lot of guys have come to ask both from sexual function as well as fertility. And there’s currently zero evidence to suggest that the vaccine is going to lead to either one of those, whether it’s sexual dysfunction or male infertility. This is based on data that we have now. Now, is that 100% true or is that.. years from now going to stand?

It’s tough to say, but from my standpoint, I can’t imagine any mechanism of the vaccine that could be leading to sexual dysfunction or infertility.

Mark: So that should not be of concern from where the medical view point is right now, recognizing that nobody can guarantee what things mean down the road, but in all likelihood, from what you can see right now, there’s no reason to be concerned about that. Is that correct?

Dr. Houman: Exactly, right.

Mark: So we’re currently living in a telemedicine environment which has advantages and disadvantages, do you have an opinion on this, and what are the benefits and limitations that you see in particular with regard to treating erectile dysfunction?

Dr. Houman: Telemedicine is here. Covid has pushed telemedicine forward in terms of the role it plays in a medical practice, and it has its role… it has its role. Is it for every patient and every diagnosis? No, because many diagnosis, especially urological, especially in men’s health, they require in-person consultation, not just to meet the patient, greet the patient, but more importantly from a physical exam standpoint.

And there are certain tests that we do run in the office that need to be performed, especially from an erectile dysfunction standpoint, that could lead to an accurate diagnosis and with the accurate diagnosis leads to a better treatment.

Otherwise, from my standpoint, when it comes to treating erectile dysfunction, doing it purely on a telemedicine basis, it’s not impossible, and there are patients that could benefit, but for the broad majority of patients, it does require some of these diagnostic tests that we can do to figure out what’s causing the erectile dysfunction.

The thing I’ll mention here is Romans and Hims, for example, they’ve been, they’ve essentially been having the telemedicine model for treating erectile dysfunction for a couple of years before covid, and there is a study that looked at patients who come in with erectile dysfunction and 40% of the time those patients had a reversible cause of their ED.

So a lot of times just giving Viagra or Cialis or these oral medications, they mask or they were masking some, an underlying medical issue that could have been corrected, that could have corrected there, not only preventing that chronic disease from developing, but also fixing the erectile dysfunction that was causing.

So it’s important, to see a doctor in person if you are experiencing real dysfunction.

Mark: And we could definitely appreciate that on this podcast about trying to help men get to the root cause of what is driving the erectile dysfunction and not just looking for a fix or a patch.

One of the things that people talk about with telemedicine though, is that the increased access that telehealth and some of the platforms that you mentioned has made for men to be able to come forward and get some of these conditions treated. Now, I understand that you work in a major metropolitan area, but for people who generally have problems accessing high quality care, has that been something which is advantageous from your perspective through the pandemic or being able to reach otherwise inaccessible professionals?

Dr. Houman: Absolutely, so I’ve had patients who have called from Las Vegas, Arizona, Northern California, even San Diego area, who we do telemedicine consults, and it’s not to say that they’re getting substandard care, but what it means is they’re getting some of the tests and diagnostic tests that I was alluding to earlier, they are getting those done locally at local facilities, so from a patient standpoint, it gives them the opportunity to access doctors who are in major metropolitan centers who are super sub-specialized in that particular diagnosis.

So it’s great for patients. And from a physician standpoint, it’s great, so you’re able to provide this type of quality of care, not just to your local 10-15 mile radius, so it’s a win-win, it’s a win-win for both doctors and patients, and ultimately it leads to better patient outcomes.

Mark: And we have seen that also on the sex therapy side, where people can access us from really anywhere in the world at this point, and that really has been fueled by the pandemic, we’ve seen that as an advantage, and we also understand that on the medical side, if you’re going to work with a professional having access where you are to the test that may be necessary is going to be an important component of your treatment.

Dr. Houman: Exactly right.

Mark: One of the focuses of this podcast and our website is the role of the brain in the erection process, and ED, as a urologist, what do you see as the role of the mind in erections? How common is it that erection issues are caused by or worsened by mental aspects, like performance anxiety and relationship issues?

Dr. Houman: Huge component, especially in younger guys, so you can’t discount the role that the mind, your psyche, going into having an erection, you can’t underestimate the value of that.

I have a lot of young patients in their 20s that are experiencing erectile dysfunction, and obviously, I want to make sure that the physiology makes sense, everything is okay from an anatomic standpoint, so hormonally, their nerve functions okay, the blood flow to the penis, you want to make sure all those things check out.

And many times, a broad majority of times, all of that physiologically, they’re great, but it’s in the mind. My typical story is a guy will have a long night of drinking, try to have perform that night, he’s unable to perform, and the next time he’s trying to perform he’ll remember this and just a little bit of stress associated with a little bit of anxiety associated with that, he’ll remember that previous time, it leads to a poor erection this time, and then as you can imagine, the third time, fourth time and its this viscous cycle as the erection just continue to get worse.

And that’s all in the head, the psyche, that’s where sex therapy is wonderful because sex therapists, their role is to break that cycle and re-establish that brain and penis connection, and as a result of that their able to achieve better erections.

Mark: Now, every man experiencing erectile dysfunction is different and unique, and the treatment plans will vary. Is there a most common intervention or treatment that ends up as a satisfactory solution?

Dr. Houman: I’ll always tell patients, I promise you some way, somehow you will have an erection, a good satisfying erection. It all depends on how aggressive you want to be as the patient.

Most patients, about 70, 80% of patients do very well on the oral therapies, the more common ones, the Viagra and the Cialis. Again, 70%, 80% will do well on those… if those that don’t, we advance them to slightly more invasive therapies, and these include injections, gels, shock wave therapy, which is a newer therapy, and sometimes even stem cell therapy platelet rich plasma therapy, and then sometimes even surgery with penile prosthesis, so tons of options are available.

But yeah, to answer your question, most men do very well, at least three-quarters of men do very well with the oral therapies.

Mark: Got it. What have you learned from the many men that have come to you who are dealing with erectile dysfunction?

Dr. Houman: How common it is, how very, very common it is. Every man will experience some form of erectile dysfunction in his life.

I’ve learned that most guys are very scared to talk about this, and I get it, obviously I’m a guy and I get it. The thought of speaking to a doctor about this or even engaging in that discussion to say, “Hey listen, I’m not able to perform in the bedroom.”

It’s a tough discussion to have with the doctor, but I always tell patients, it’s so common. It’s incredibly common, and there’s no reason to be scared about talking about it, so I always try to make it as comfortable as possible for the patient, but yeah, that’s the one thing that I’ve learned that it’s incredibly, incredibly common.

Mark: If you had to give a line or two of advice to a younger, relatively healthy man who has experienced erectile dysfunction for the first time during the Covid-19 pandemic, what might be something that you would advise them of?

Dr. Houman: That a lot of this is a product of the time we’re living in this somewhat artificial environment that we’re living in in terms of being stuck at home, minimal social interactions, and the mental and psychological impact that has on us and that definitely can impact erections. So if you’re experiencing this, number one, you’re not alone.

Like I said, I’ve seen a lot of patients not just in person, but with telehealth, we’ve discussed this, and if you are feeling anxious if you are worried about it, seek consultation because there are a lot of good options and a lot of good doctors out there, we’re happy to figure this out for you.

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