Diabetes and Erectile Dysfunction: Dr. Mistry On Protecting Your Vascular Health

Thanks for tuning in to the Armor Men’s Health Hour Podcast today, where we bring you the latest and greatest in urology care and the best urology humor out there.

In this segment, Dr. Mistry and Donna Lee answer a listener's question about low testosterone and diabetes. Inquiring on behalf of her husband, who is only 38 years old with diabetes and erectile dysfunction, our listener wonders how to go about treating the ED given his other medical concerns. Dr. Mistry explains that because this man already has diabetic retinopathy, an eye disease caused by vascular degeneration brought on by diabetes, there is reason to screen him for other vascular changes. Diagnostic imaging such as the HeartWise CT scan and scans of his lower extremities and carotid arteries can rule out a more extensive vascular issue. Then, Dr. Mistry recommends he go on a daily dose of Tadalafil to improve blood flow to the penis and improve erections. He also suggests this listener maintain a healthy lifestyle to avoid dependence on medications. At NAU Urology Specialists, we have an in-house holistic wellness provider, Shefaly Ravula, who helps patients implement a healthy diet and focus on preventative measures. If you or someone you love is interested in learning more about this program, or about managing ED and diabetes, please give us a call today!

This episode originally aired on 8.28.21. Don’t forget to like, subscribe, and share us with a friend! As always, be well!

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Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.

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Transcript

Welcome to the Armor Men's Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: Hello, welcome to the Armor Men's Health Hour. I'm Dr. Mistry, your host, here as always with my incredibly helpful, wonderfully bubbly, and very funny cohost, Donna Lee.

Donna Lee: Oh, I thought you were going to say somebody else's name. Thank you.

Dr. Mistry: No, no, no.

Donna Lee: I think we're trying to be TikTok famous soon. We have a TikTok page, and apparently we were going to go live on Tik TOK today, that was gonna be my experiment. And then I found out you needed 1000 followers to do so. And we have seven .

Dr. Mistry: Okay. Well, I don't know [inaduible] start the show off like that. This is a men's health show.

Donna Lee: Join the TikTok.

Dr. Mistry: I'm a board certified urologist. I have to delete the TikTok app off my phone because I end up spending an hour on the toilet every time I have it on my phone.

Donna Lee: It went from Facebook to TikTok that you're in there all the time?

Dr. Mistry: That's right. Now it's just The Economist magazine. So, [inaudible] shorter.

Donna Lee: You went from tech talk to The Economist? That's how my husband calms me down. If I'm yelling at him, he'll just put my phone up in front of me for TikTok and I just sit down quietly and I watch it for two hours.

Dr. Mistry: You're like a three-year-old child.

Donna Lee: I am. With boobs.

Dr. Mistry: This is a men's health show. This is brought to us, brought to you by the urology practice that I started in 2007. I am a board certified urologist. That is a doctor who specializes in things from the nipples to the knees, we say. We have a specialty in kidney stone surgery and management, prostate cancer, bladder cancer, a wide variety of sexual health and hormone complaints. That's kind of the things that a urologist would do. In our practice, we've taken that a step further by integrating functional medicine, wellness medicine, into the program in the hopes of making you healthy, not just with medicine and surgery, but also lifestyle management. And so we would welcome you to become part of our practice by calling us for an appointment. We are in the Austin area because our show is made into a podcast. So people listen to us from all over the world .

Donna Lee: I thought you were gonna say we're in the Austin area because our spouses make us live here.

Dr. Mistry: That may be true for you. Donna, if people want to get ahold of us for an appointment or know where our offices are, why don't you give us some information?

Donna Lee: Yep. Call us at (512) 238-0762. You can email us at armomenshealth@gmail.com and we will answer your question anonymously for the radio show slash podcast . Our website is armormenshealth.com. We are all over the place: Round Rock, north Austin, south Austin, and Dripping Springs, Texas. Have you been there lately? It's so cute.

Dr. Mistry: We love that place. They love Dripping.

Donna Lee: They do love dripping. Their signs say "We love Dripping," but we're trying to fix that.

Dr. Mistry: Your questions to the show and of course your engagement in our office as a patient are what keep us going. So when you send us questions, we love answering them. Donna, do you have a question for us?

Donna Lee: I do. I have a question from a female listener about her husband. She says, "I have a question for my husband. He's 38 and he's diabetic. He most likely has been a diabetic for a few years, but didn't know. I finally talked him into going to the doctor and he had been working really hard on his health. He dramatically changed his diet and he's his medication daily. His numbers for his diabetes are so much better. He does have to get, he does have to get eye infections in his eyes because of the diabetes." I'm not sure what that means. "His eyes are improving since taking the shots and we are on a good path to that arena. I talked to him about going to a urologist and he has been taking testosterone since 2021 of this May of 2021. His numbers started out at 277 and in August is up to 353. His doctor wants him to double up on his testosterone gel for another six months. Here's my question. At what point do you try sound wave technology to help with ED issues? Does his testosterone levels need to be higher before trying anything else? Since taking the testosterone gel, we can tell his attitude is a lot better and he's overall feeling better, but still has ED problems. Thank you for your help."

Dr. Mistry: It's a , it's a great overall question.

Donna Lee: It's loaded. It's a lot.

Dr. Mistry: And there's so much in there. The first one is what do you do when you're a young man diagnosed with diabetes?

Donna Lee: Right, and only 38.

Dr. Mistry: So not only is he a diabetic, but he's already starting to have diabetic retinopathy. That's the eye problem.

Donna Lee: What does that mean? What eye problem?

Dr. Mistry: The blood vessels of the back of the eye become malformed from the diabetic process and can affect vision negatively. When somebody has that, you could almost certainly expect them to have blood vessel disease or problems with the nervous system that leads to erectile dysfunction. They're also at risk for heart attack and stroke and peripheral vascular disease. So the fact that he was able to take and change his diet and really take this problem by the horns is really important. We actually end up diagnosing diabetes often in young men, more often than you might think. And it's because we see for, we see men for fertility, erectile dysfunction, and because they usually come in because their foreskin is not, is not working. So if you're uncircumcised and your foreskin starts closing and you're young, we find you have diabetes a high percentage of the time. Like 15% or 20% of the time.

Donna Lee: Really? And a lot of those people don't have a primary care physician.

Dr. Mistry: And they never knew it because they're, you know, 32 years old and had no idea that this was a problem. The second part of this is what do we do with low testosterone, the young man, and ED. And that's a unique situation because we want to put in place strategies that will work for the long-term, because the guy's only 38 years old. So first, we want to make sure that that erectile dysfunction is not just a, just the tip of the iceberg of a larger vascular problem. So oftentimes we'll do something called a HeartWise CT scan to make sure that the arteries of their heart are open. We will do lower extremity imaging to make sure that the blood vessels are open in the lower extremities, and of course of the carotids as well. So we'll do a more extensive cardiovascular exam in the young man who's a diabetic with ED. Then we will often put them on a low dose of Tadalafil every day. This is what's the generic Cialis. It will improve blood flow to the penis. It will help maintain the erections longer and will hopefully allow them to have continued good sexual performance.

Donna Lee: Okay. So there's no contra-indication between Cialis and anything for diabetes.

Dr. Mistry: That's right.

Donna Lee: Okay.

Dr. Mistry: Then we will often try shockwave because we're trying to get their penis and their penile arteries back to normal, so that, so that they're able to function more normally. So we will often hit the ED aspects of a diabetic separate from testosterone, where we might not do the same. His wife is asking us if we should just double down on the testosterone before we do anything when it comes to the erection. And my argument with a diabetic is that oftentimes the erectile dysfunction is , is related to the ongoing vascular effects the diabetes and not just the testosterone. So when it comes to the testosterone, you know, you've chosen gel to, to, to fix his testosterone, and you've seen exactly what gels do. It takes you from 200 to 300. If you read the inserts, if you look at the studies, that's about what it does. Now, 300 may not be enough for him. He may need to be sitting at 500 or 600 or 700. Now 300 is technically normal, but may not be actually normal for him. So doubling down on the gel could work, but now you're having to put all that gel on him and, you know..

Donna Lee: It might transfer and messy.

Dr. Mistry: ...and the transference may be an issue. If he's 38, you probably in your thirties , there's nothing in the message about whether they want to continue having children. But if you have any hopes of trying to continue to have children then testosterone gels may reduce the sperm count, so make sure you're aware of that if you're a young person on testosterone.

Donna Lee: It's always so interesting to me that testosterone diminishes sperm count .

Dr. Mistry: Well so many things that we take out from the outside, if the body doesn't think that, you know, you need it anymore, it'll, it'll stop its own function . And so , I think that it's a natural , you know, it's not just in testosterone, it's a lot of things. Now where people make mistakes, they think it's for things like blood pressure or they're going to get--erectile dysfunction is a great example. So people are worried that if they take the meds for erectile dysfunction that they'll become dependent on it because their body won't do it on its own anymore when that's not really what, what's happening. What's happening is that the underlying medical condition that caused the erectile dysfunction in the first place continues to evolve--whether it be again, diabetes, high blood pressure, or vascular disease, nervous system issues, whatever that is going on continues. And so you'll feel like you still need the med or that you need more higher doses, but it's not because you started it in the first place. It's because whatever condition you're taking it for is getting worse.

Donna Lee: So if that condition's fixed, then potentially the erectile dysfunction is also going to fix itself?

Dr. Mistry: Precisely. So weight gain is the classic example there. So a lot of times guys will come to us complaining of worsening erections. And then if you ask them, they're also having increasing weight gain. Those two hit each other. They hit each other because of self-esteem issues, hormone issues like estrogen and testosterone, blood pressure issues. And so oftentimes losing 20 pounds, you know, for a guy who's overweight will, their erections will magically return. And , but it's very hard to prescribe weight loss, and that's for most practices. That's why we have an integrative nutritionist on staff, we have supervised weight loss programs. We really try to hit the weight loss hard on a young guy with erectile dysfunction, because although we have pills to fix it and injections and surgery and everything, you just hate having to put a 40 year old guy on pills. I mean, it just, you just feel like you're giving up. That's why we try so hard with the functional aspects of the supplements and the shockwave, everything that we can possibly do in the young guy to get him back to normal function. Because in a way, once you start down the pathway of just taking pills to fix the problem, you've kind of just kind of given up that you're going to get better on your own.

Donna Lee: Good point.

Dr. Mistry: And I don't want to give up on you. So if you're out there and you want somebody to work hard for your erections...

Donna Lee: A very political statement.

Dr. Mistry: ...how do people give us a call and make an appointment, Donna?

Donna Lee: You can learn more about Dr. Mistry's political aspirations by calling us at (512) 238-0762. And you can send us your questions to armormenshealth@gmail.com. Whenever I watched that 600, My 600 Pound Life show, I always wonder how they're having sex. So what you're saying is you should probably lose 400 pounds probably have successful sex, right?

Dr. Mistry: Next time.

Donna Lee: Okay. And our website is armormenshealth.com. Check out our podcasts. They're free wherever you listen to podcasts. Thank you, Dr . Mistry.

Dr. Mistry: Thank you, Donna.

The Armor Men's Health hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.