Health Longevity Secrets

Why Measure Erections?

• Robert Lufkin MD • Episode 217

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Unlock the secrets of male well-being with Christos Konstantinidis, the pioneering founder and CEO of Adam Health, as we unveil the profound link between erectile health and holistic male wellness. Discover how your body's signals, often overlooked, could be the earliest indicators of serious health concerns like cardiovascular disease. Christos provides enlightening insights into how erectile function serves as a critical health barometer, cutting across cardiovascular, neurological, and hormonal domains.

Explore the natural phenomena of nighttime erections and their vital role in sustaining erectile health, as well as the promise held by erectile dysfunction drugs in potentially extending lifespan and reducing the risk of chronic illnesses such as Alzheimer's. With Christos's expert guidance, learn about groundbreaking tools like Adam Health's erection health tracker, designed to empower men in managing their sexual health proactively. Don't miss out on the array of solutions available to tackle erectile issues, from PDE5 inhibitors to cutting-edge rejuvenation treatments, all aimed at improving quality of life and fostering an open dialogue about men's health.

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Speaker 1:

Hey Christos, Thanks so much for coming on the program.

Speaker 2:

Thank you, Rob, for having me. It's my pleasure to be here today.

Speaker 1:

I'm so excited today to talk about erections and longevity, and you're the founder and CEO of a new company that we're going to be discussing later on the program. But just to set the stage, it's called Adam Health. It's a digital health startup that aims to empower men sort of to take control of their erection health, and you have the world's first erection health tracker, which enables men to sort of quantify that, and we're going to dive into that. But first of all, let's talk about erections and how they're limited, how they relate to our overall health. How does that tie in?

Speaker 2:

So I mean erections in general for men are extremely important. I don't think there is any man who would say, you know, I don't have a problem if I'm facing issues with my erectile health. So for overall well-being I think it's an extremely important element of male health, identity, sense of well-being, masculinity and, of course, being able to enjoy sex and relationships and a partner in that sense. So very important for overall health being. Erections are often called the canner in the coal mine when it comes to male health in particular. For the penis to get erect, a number of things need to be working well. First of all you need to have a sexual response. So sexually stimulated Things that might affect anything like depression, anxiety, will prevent the erection response to be initiated. Then you need to have an intact neurological system, because the signal travels from the brain all the way down the spinal cord and then to the pelvic area nerves which then kind of indicate to the erection mechanism to allow more blood to go into the erectile chambers, fill up and then gain an erection. So intact neurological health is important. Cardiovascular health, very much linked to cardiovascular health I mean erection itself as a response, is a blood-filling phenomenon. So anything that affects cardiovascular health will affect significantly erections and of course intact penile tissue and the tissue structure itself is important. So if there's any fibrosis in the penile tissue, which happens with AIDS, which happens with loss of nighttime erections, then the whole erection mechanism will not work adequately to gain or maintain an erection adequate for sexual activity.

Speaker 2:

So it's a very good indicator, I'd say, for a number of systems and how they work. And in that sense, if anything, we know that for example, erection problems predate cardiovascular disease kind of episodes three to five years. That's very well established. Erections are dependent at least partially nighttime erections on adequate testosterone levels. So also hormonal balance is an indicator and, like I mentioned, nerves functioning properly and of course being in a right state of mind to be able to be sexually excited and engage in sexual activity. Sexual response is the initiator in that respect.

Speaker 2:

So it's a multi kind of system phenomenon and in that I think it's a it gives a very good gauge over the overall health of a man. Also it's very much age correlated with age, erectile dysfunction. So the biggest kind of predictor of erection issues is age. By from the age of 40 and above, for every decade we have a 10% increase in incidence of erection problems. So by 40, around 40% of men will have some form of erection issues, which kind of rises to 80%, 90% by the age of 80. And that's almost kind of independent even of comorbidities. So comorbidities tend to play a more important role at younger ages. But in healthy older men, 70, 80, which don't have any obvious comorbidities that I just mentioned, they still will face 70, 80% prevalence of erectile dysfunction.

Speaker 1:

So, yeah, yeah, it's fascinating. What you've mentioned here is that this single organ, the function of the single organ, as you say, is the canary in the coal mine for so many of the chronic diseases that we all face and that determine our longevity. You know, going all the way, as you say, from cardiovascular disease to neural function, to hormone function and then, ultimately, mindset and mental health. You know someone who's depressed or stressed, or you know, all these things can play a role. So it's such, it's so fascinating.

Speaker 1:

That's why it's it's so exciting recently that that some of the drugs that are originally developed for erectile dysfunction studies are coming out now showing that people who take these drugs actually have actually have improved longevity, or factors that suggest their longevity is improved, factors that suggest their risk for Alzheimer's disease is improving, which makes sense, because all these chronic diseases are driven by the same things, and ED is driven by many of the same things, and to the extent that we can roll back the erectile dysfunction issues, and to the extent that we can roll back the erectile dysfunction issues, we're also affecting all these chronic diseases. So I guess everyone's heard the term erectile dysfunction. Is there any way to quantify it? Or I guess we're going to talk about your, your product, which is an obvious answer for that, but prior to that, was there any way?

Speaker 1:

how do when? When is erectile dysfunction? Is there a definition for that? Is it or is it more kind of subjective?

Speaker 2:

yeah, I am, I typically erectile dysfunction. I mean it's a it's, it's a quite obvious phenomenon, right? Typically we would be talking about partnered sex, so a man not being able to get or maintain an erection adequate to initiate or complete partnered sex. So I mean there can be what we call transient erection issues that might be related to, you know, one of episodes of anxiety, maybe having a little bit too much alcohol, being a little bit tired, right. So I suppose any man can experience that. I wouldn't define that as erectile dysfunction. But if these issues persist, then and there's no kind of time cut off in terms of know, more than two months, three months, I think it's a matter of ongoing issues, right? So if these issues persist, then we say a man will suffer from erectile dysfunction. Now, traditionally we had a bit of kind of differential diagnosis between psychogenic. So theoretically, in psychogenic erectile dysfunction the organic aspects of the erection mechanism are intact, but you might be suffering primarily of what we call performance anxiety, so really getting stressed just before initiating sex, sex stress kind of triggering adrenaline and cortisol response, vasoconstriction, so kind of tightening of the arteries and then no blood flowing in the penis, so losing the erection, a very kind of physiological response to stress affects erections, then we would differentiate with organic erectile dysfunction. So things related, like I mentioned before, cardiovascular or vascular erectile dysfunction, post-radical prostatectomy for men who had prostate cancer and had their prostate removed, it might be related to hypogonadism, low testosterone, pelvic trauma, things that might have affect the nerve function. So a number of hosts of issues that can affect this kind of mechanism from an organic point of view. And then we also talk about mixed etiology which unfortunately, when it comes to erectile dysfunction, even a single episode of bad erections can kickstart a vicious circle where you know you might have deteriorating, let's say, erections. You get stressed about it, then the next time it doesn't work as you expected it to work. So this kind of you know, even if it's very mild and the problem might be very mild organically, it can become very severe. So we have this differentiation between organic, psychogenic and mixed erectile dysfunction. The reality is most men will fall in the category of mixed erectile dysfunction because of the reasons that I mentioned. You get stressed if you can't perform, even if the issue initially is organic.

Speaker 2:

Now the severity typically that's established with a questionnaire, self-administered questionnaire called the IAF-5. It's five simple questions. Typically it asks you how would you rate your ability to gain an erection over the past six months? Maintain it. How would you rate your ability to kind of complete the penetrative sex over the past six months? Maintain it. How would you rate your ability to kind of complete the you know penetrative sex over the past six months? And then you get a score and based on that you would have like no erectile dysfunction, mild, mild to moderate, moderate and severe. Of course, again, that's quite subjective. It's a very well-validated questionnaire. It was first established when the PD-5 inhibitors, the drugs like Viagra, cialis, came into the market and when the studies were being run they wanted a validated questionnaire to see the improvements. So that's very popular. So people might use it either for research purposes or when you come to a clinic, typically a doctor might ask you to kind of answer the IF5 questionnaire.

Speaker 2:

Now there are a few more kind of invasive tests which can be used to more objectively evaluate erectile function. One involves injecting visodilating medication like alpostadil in the corpora in the erection mechanism and evaluating the response to this medication. So it's a very powerful medication. It visodilates and in extremely severe cases it wouldn't give any response. And then, based on the response. The doctor would assess what we call E2 erection, e3 erection, e4 erection E4 is something which is fully rigid and adequate for penetrative sex. E3 engorgement, but not full rigidity. E2 partial engorgement, but not enough for penetrative sex. E3 engorgement, but not full rigidity. E2 partial engorgement, but not enough for penetrative sex. And E1, we typically say very little engorgement, little response, and sometimes also urologists. Typically they would also carry out penile duplex ultrasound just to visualize the erectile tissue, the blood flow in and out, and based on that they might support their diagnosis of erectile dysfunction.

Speaker 2:

Now there is also a device which was developed in the 80s called the Regiscan, which is also kind of served as the basis of what we are doing in Adam Health.

Speaker 2:

So the Regiscan device it was quite big, that big actually, and people would kind of wear it, take it home or in a sleep lab and it had two loops that you would put around the penis and then you would sleep with that device, the Regiscan, and it would measure how much engorgement happens during night in the penis and how rigid that engorgement is.

Speaker 2:

So it's a way to track nighttime erections. So what technically is called nocturnal penultimisans, so what technically is called nocturnal penultimisans, and this device has been used for a few years because it hasn't been really updated. It's quite old, it has fallen out of favor. So nighttime erection monitoring has fallen out of favor just because we didn't have the tools, the device to kind of, you know, be able to offer it extensively and provide access. And this is where we kind of came. Our background is we have a network of men's health clinics in Europe and the Middle East. We thought nighttime erection monitoring is an extremely important test. It's probably the most objective way to evaluate erectile function. But we thought there was a better way to do it than the old Regiscan device. So that served as our inspiration to develop the ADAM sensor, the erection health tracking device.

Speaker 1:

Yeah, and we're going to. We're going to in another episode we'll have the device here and we'll erections related to REM sleep or different factors throughout the night, and that's the healthy response In using the device. Is the device is it? It certainly will diagnose erectile dysfunction with that. Diagnose erectile dysfunction with that. Is it able to differentiate any of those causes that you mentioned, like, is there a pattern for neural type versus stress type versus you know, those other types?

Speaker 2:

At the moment. No, the short answer is no, and it's very good in kind of differentiating between organic and psychogenic, in the sense that someone who has organic erection issues will have quite intact night erection episodes. I just wanted to mention a little bit about the night erection episodes in general and their importance, because it's effectively every healthy man who doesn't have erectile dysfunction will get around three to five erection episodes at night, mostly associated with REM sleep. Now there have been extensive studies, especially in the 80s, and some of these studies I'm sure they would struggle to get like ethical board approvals nowadays but they seem to be a cohort of researchers who tested everything that you can imagine of in terms of effects on nighttime erections.

Speaker 2:

So, like I mentioned, three to five nighttime erection episodes lasting anything from 10 minutes up to 60 minutes, 70 minutes. In fact, some studies have indicated that men might spend around 60% of their sleep time in an engorged state the penis Maybe not a full erection, but an engorged state. And the question is why is this happening? And this is a mechanism we've seen in other animals as well. It's actually preserved throughout a man's life. This is a mechanism we've seen in other animals as well. It's actually preserved throughout a man's life, and the prevalent theory is that this is the body's way to maintain the erectile tissue healthy when the penis is in the flaccid state, when it's not erect effectively, the blood that's in the erection chambers, which fill up with blood, is a mix of venous and arterial blood, so it has a low oxygen tension. It's not a fully oxygenated blood, which, during that period, it means that there is a chemical called TGF-beta which is produced by the cells, the erection chamber cells and this leads to fibrosis of the penile tissue, and long-term fibrosis will mean complete erectile dysfunction. So this is a way to maintain and when we get an erection we get highly oxygenated blood. Another chemical called PgM1 is produced which inhibits TGF-beta and in that sense high-luxygenated blood is preventing the fibrosis to happen. So it's a clever way to maintain erectile tissue. Now, from an evolutionary point of view, having the longer you can maintain your erectile tissue means probably you would be able to reproduce more, so it's something which is preserved across a number of animals. Reproduce more so it's something which is preserved across a number of animals and, as I mentioned, in healthy man, pretty much into old age. So it's a very important kind of way to maintain erectile health, preserving nighttime erections. So, beyond the diagnostic value that nighttime erections might have, it's also something that one might want to kind of optimize if they want to maintain healthy erectile function into the old age, so to speak.

Speaker 2:

So to go back to your question, we can diagnose and differentiate between organic and psychogenic. Now the different types of organic erectile dysfunction would be quite difficult to differentiate. I would say this is more done also in terms of medical history. Taking so, for example, someone who has high blood lipids or potentially diabetes, this would tend to be more vascular-related erection issues with a damaged endothelium or not adequately working endothelium. Someone, like I mentioned post-radioprostatectomy would have damaged the nerves and that would have created the issues. So differential diagnosis from nighttime erections at the moment is not necessarily. We don't have the research to support it and this is what we hope to achieve also with Adam. The more data we gather I think now we have the biggest database of nighttime erection analysis in the world and the more data we gather and the more research we can actually carry out with the use of the sensor as well. Hopefully we can start seeing patterns which might imply different diagnosis as well in terms of the underlying condition.

Speaker 1:

So for everyday people, one thing that I think you've mentioned before we were talking offline about this was the idea that if you consistently don't wake with a morning erection, or if you never have morning erections, even if all your other health findings are good, your coronary calcium score is good, everything else is good.

Speaker 1:

This can indicate something is going on at some level with your body that needs attention and probably might be able to benefit from further study for all those possible causes.

Speaker 1:

And then we obviously we need to spend more time on this and we're going to do another session with the device and we can talk about more. But I want to let people know that if they have erectile dysfunction, that there are many options for therapy, of course, depending on what the root causes, as we always mentioned, but that erectile dysfunction is often very treatable and it's not just something that people should accept as well, like I'm getting older, or people should accept as well like I'm getting older, or you know whatever. You know, whatever the, the kinds in there. In fact, some of the, some of the pharmaceuticals, the phosphodiesterase five inhibitors, pde5 inhibitors you referenced earlier, like Cialis or Viagra those have been now linked to, as we mentioned earlier, longevity, and some people are taking daily doses of those low daily doses, not only for their erectile dysfunction but their overall longevity, improving endothelial function with nitric oxide enhancers like that which is the mechanism of those PDAI5 substances.

Speaker 1:

One other thing on nitric oxide. What about supplements as a way to improve nitric oxide for endothelial health? What do you recommend for that?

Speaker 2:

for endothelial health. What do you recommend for that? Yes, that's a very good question. Like you said, pd-5 inhibitors effectively work by preventing the breakdown of nitric oxide in the erectile tissue. So you could have a kind of push and pull approach if you want to fully optimize erection health, preventing the breakdown with PD5 inhibitors and potentially considering food or supplements to also increase the bioavailability of nitric oxide.

Speaker 2:

Our reading of the literature and what we kind of think is the mainstay. In terms of supplementation, I'd say we would be looking at L-citrulline, which kind of increases L-arganine, which is a precursor of nitric oxide. Now L-citrulline has much better absorption than L-arganine. So that's why we don't recommend necessarily people taking L-arganine directly. But L-citrulline has been shown consistently to be able to increase nitric oxide in the blood and in extension, in the erectile tissue and help with the production of nitric oxide which mediates the whole erection process. So I would say a kind of good supplement to consider taking if you're facing some erection issues might be on a daily basis kind of increase your either foods like beets, peanuts, which contain high levels of nitrates, or a supplement with a relatively high dose of L-citrulline and I'd say the therapeutic dose based on the literature, would be more than two, three grams a day. So it's quite more than what you would find in a lot of the kind of nitric oxide boosting supplements sometimes.

Speaker 1:

Dr David Pulmutter has a book called Drop Acid about lowering uric acid in the body, and he was describing the relationship between uric acid and nitric oxide synthetase and he was saying that high levels of uric acid can negatively affect nitric oxide. And then he points out that alcohol, ethanol, processed in the liver, drives uric acid formation, as does fructose. So you know, so there are so many complexities on this and so many things that we still have to learn and understand, but it's very, very, very complex. But I think, as we said, we'll bring you back and talk more about the device and also about some of the treatments and kind of get into more details after this introduction today. Christos, how can people find you? Could you share the website for the company? Are these available now? Your device?

Speaker 2:

Yes, we do have a little bit of a backlog ordering. Typically estimated time of dispatch is around two months from ordering at the moment. We do hope we'll be resolving all these supply constraints over the next couple of months so that people can just order and be available. So our website is wwwtalktoadamcom. We're not super active on social media, although we're trying to be, as we're trying to focus to develop the product, to be honest. So the best way would be definitely through our website. We have a good support chat there and either reach out by an email and personally. Again, I can be found. You know I can provide my email address. It's Christos at TalkToAdamcom. So yeah, that'd be the best place to get hold of us.

Speaker 1:

Well, great, well, thanks, thanks for spending the time with us today and I definitely look forward to our next, our follow up on this, where we can dive deeper. But I want to thank you, christos, for for spending time with us today and thanks all the the work you're doing to help people understand their bodies better and, uh, live, live more, full, healthier lives and I just want to reiterate what you mentioned.

Speaker 2:

Erection issues are, I would say, 100 percent treatable. There's no reason why someone should suffer in silence. They should get help. There are different treatment options. Now we have also rejuvenating treatments, so organ rejuvenation I think penis is one of the organs that we can say we can rejuvenate and turn back time, and quite objectively so. So there are a lot of exciting new developments in the field. But even if from the simple erection pills, there are very effective treatment options for erection problems and no one should not address them.

Speaker 1:

Great.