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The T level needed for normal erectile physiology is much lower than many men are led to believe!
Dr. Peter Bajic
* In all of the literature that I have read, in all the textbooks that I have read, the guideline panels that I have sat on, data that we have reviewed over and over again to my knowledge there is no conclusive evidence to suggest that testosterone impacts function of the venous-occlusive mechanism specifically whether or not the valves are closing but definitely TESTOSTERONE ACTS IN A PERMISSIVE FASHION FOR NORMAL ERECTILE PHYSIOLOGYt, so the whole pathway that Viagra and Cialis work on or PDE5 inhibitors, PDE5 is a normal component in erectile physiology that pathway which Im not going to delve into because its super complicated even for me, you have to have an adequate amount of testosterone there for that whole thing to work, this is why men who are on androgen suppression therapy or hormone suppression therapy for prostate cancer most of them not all of them most of them when there testosterone goes to 0 they have a very hard time getting an erection and Viagra and Cialis don't work because they don't have any testosterone, but that NUMBER HOW MUCH TESTOSTERONE DO YOU NEED TO TURN THAT LIGHT SWITCH ON IS NOT A 1000 ng/dL LIKE SOME TESTOSTERONE SHOPS MIGHT TRY TO CONVINCE YOU, ITS PROBABLY SOMEWHERE IN THE RANGE 200-250 ng/dL OKAY SO HAVING JUST KINDA LIKE A NORMAL LEVEL, EVEN LOW-NORMAL IS USUALLY ENOUGH FOR THAT PHYSIOLOGIC FUNCTION
* How normal erection physiology works, in order to get and maintain a full erection you have to have enough blood pumping into the penis to fill it with blood, the penis relies on two arteries that are <1mm in diameter for its blood flow those are called the cavernosal arteries, and when you become sexually aroused the brain sends a signal down there to essentially cause those arteries to expand by a little bit to allow more blood to pump in, when you take a Viagra or Cialis it just helps to facilitate that dilation, TESTOSTERONE is a PERMISSIVE HORMONE for that FUNCTION so if there is no testosterone in the body that NORMAL PHYSIOLOGIC RESPONSE doesn't happen as effectively, if you have enough testosterone which is depending on who you ask SOMEWHERE in the RANGE of 250 ish ng/dL then that PHYSIOLOGIC RESPONSE HAPPENS, when the blood pumps in the pressure inside the two erectile bodies within the the penis increases okay so the two chambers they look like a double barrel shotgun, the two chamber fill with blood the pressure inside increases
* The only way that we can tell and even this is not a 100% conclusive is by doing a test called a Penile Duplex Doppler Ultrasound (PDDU) or doing an archaic test called Dynamic Infusion Cavernosometry and Cavernosograph (DICC)
* if you never get a full erection you do have venous leak but its not because the valves are broken its just because you never had enough pressure in the first place so the normal ED guy 90% of men with ED from CVD he's just not getting enough blood pumping in to trigger that valve to close that's not usually what we say venous leak its more like a true failure of those valves that no matter how high the pressure goes the valves just can't shut we see that in Peyronie's disease, we see that in just some random guys once in a blue moon but usually its with some other predisposing condition like scar tissue in the penis. from peyronie's or perhaps in men who have had prostate cancer treatment and had nerve damage the failure of the nerve signals to the penis can lead to tissue changes that cause the valve to close
28:45 The truth about "venous leak" explained
40:05 Why most men do NOT have true venous leak
43:10 The best approach to treating erectile dysfunction
Is erectile dysfunction really just a bedroom problem—or could it be the first warning sign of cardiovascular disease?
In this episode of the Dr. Geo Prostate Podcast, Dr. Geo Espinosa sits down with Dr. Peter Bajic, Medical Director for Urology at Cleveland Clinic Main Campus and Director of Men's Health within the Glickman Urological Institute.
Together they separate myths from science surrounding erectile dysfunction, venous leak, Peyronie's disease, testosterone replacement therapy, GLP-1 medications, and men's sexual health.
One of the biggest takeaways? Most men who believe they have "venous leak" probably don't. Dr. Bajic explains what is actually happening inside the penis during an erection and why cardiovascular health is often the real issue.
You'll also learn how weight loss medications like Ozempic and Mounjaro may temporarily affect testosterone, why erections are an important indicator of overall health, and what every man should know about preventing and treating Peyronie's disease.
KEY POINTS
* Why erectile dysfunction is often an early warning sign of cardiovascular disease
* The truth about "venous leak"—and why most men don't actually have it
* How erections really work (and why blood flow matters)
* Psychological vs. physical causes of erectile dysfunction
* How GLP-1 medications like Ozempic and Mounjaro affect testosterone
* When testosterone replacement therapy is appropriate—and when it isn't
* The biggest myths surrounding Peyronie's disease
* How daily Cialis may benefit men's health beyond erections
* Lifestyle changes that naturally improve erectile function
* The latest evidence-based treatments for ED and Peyronie's disease
* What every man should know about protecting his long-term sexual health
* Practical advice from one of the nation's leading experts in sexual medicine
CHAPTERS
00:00 Introduction: ED may be your first warning sign
02:45 Why erections are a window into overall health
06:20 Psychological vs. physical erectile dysfunction
13:15 GLP-1 medications, weight loss & testosterone
18:30 Combining GLP-1 therapy with testosterone replacement
28:45 The truth about "venous leak" explained
40:05 Why most men do NOT have true venous leak
43:10 The best approach to treating erectile dysfunction
49:20 Understanding Peyronie's disease
54:20 Can Peyronie's disease be prevented?
58:00 Why daily Cialis may be one of men's most useful medications
1:01:00 Xiaflex, surgery & future Peyronie's treatments
The T level needed for normal erectile physiology is much lower than many men are led to believe!
Dr. Peter Bajic
* In all of the literature that I have read, in all the textbooks that I have read, the guideline panels that I have sat on, data that we have reviewed over and over again to my knowledge there is no conclusive evidence to suggest that testosterone impacts function of the venous-occlusive mechanism specifically whether or not the valves are closing but definitely TESTOSTERONE ACTS IN A PERMISSIVE FASHION FOR NORMAL ERECTILE PHYSIOLOGYt, so the whole pathway that Viagra and Cialis work on or PDE5 inhibitors, PDE5 is a normal component in erectile physiology that pathway which Im not going to delve into because its super complicated even for me, you have to have an adequate amount of testosterone there for that whole thing to work, this is why men who are on androgen suppression therapy or hormone suppression therapy for prostate cancer most of them not all of them most of them when there testosterone goes to 0 they have a very hard time getting an erection and Viagra and Cialis don't work because they don't have any testosterone, but that NUMBER HOW MUCH TESTOSTERONE DO YOU NEED TO TURN THAT LIGHT SWITCH ON IS NOT A 1000 ng/dL LIKE SOME TESTOSTERONE SHOPS MIGHT TRY TO CONVINCE YOU, ITS PROBABLY SOMEWHERE IN THE RANGE 200-250 ng/dL OKAY SO HAVING JUST KINDA LIKE A NORMAL LEVEL, EVEN LOW-NORMAL IS USUALLY ENOUGH FOR THAT PHYSIOLOGIC FUNCTION
* How normal erection physiology works, in order to get and maintain a full erection you have to have enough blood pumping into the penis to fill it with blood, the penis relies on two arteries that are <1mm in diameter for its blood flow those are called the cavernosal arteries, and when you become sexually aroused the brain sends a signal down there to essentially cause those arteries to expand by a little bit to allow more blood to pump in, when you take a Viagra or Cialis it just helps to facilitate that dilation, TESTOSTERONE is a PERMISSIVE HORMONE for that FUNCTION so if there is no testosterone in the body that NORMAL PHYSIOLOGIC RESPONSE doesn't happen as effectively, if you have enough testosterone which is depending on who you ask SOMEWHERE in the RANGE of 250 ish ng/dL then that PHYSIOLOGIC RESPONSE HAPPENS, when the blood pumps in the pressure inside the two erectile bodies within the the penis increases okay so the two chambers they look like a double barrel shotgun, the two chamber fill with blood the pressure inside increases
* The only way that we can tell and even this is not a 100% conclusive is by doing a test called a Penile Duplex Doppler Ultrasound (PDDU) or doing an archaic test called Dynamic Infusion Cavernosometry and Cavernosograph (DICC)
* if you never get a full erection you do have venous leak but its not because the valves are broken its just because you never had enough pressure in the first place so the normal ED guy 90% of men with ED from CVD he's just not getting enough blood pumping in to trigger that valve to close that's not usually what we say venous leak its more like a true failure of those valves that no matter how high the pressure goes the valves just can't shut we see that in Peyronie's disease, we see that in just some random guys once in a blue moon but usually its with some other predisposing condition like scar tissue in the penis. from peyronie's or perhaps in men who have had prostate cancer treatment and had nerve damage the failure of the nerve signals to the penis can lead to tissue changes that cause the valve to close
28:45 The truth about "venous leak" explained
40:05 Why most men do NOT have true venous leak
43:10 The best approach to treating erectile dysfunction
Is erectile dysfunction really just a bedroom problem—or could it be the first warning sign of cardiovascular disease?
In this episode of the Dr. Geo Prostate Podcast, Dr. Geo Espinosa sits down with Dr. Peter Bajic, Medical Director for Urology at Cleveland Clinic Main Campus and Director of Men's Health within the Glickman Urological Institute.
Together they separate myths from science surrounding erectile dysfunction, venous leak, Peyronie's disease, testosterone replacement therapy, GLP-1 medications, and men's sexual health.
One of the biggest takeaways? Most men who believe they have "venous leak" probably don't. Dr. Bajic explains what is actually happening inside the penis during an erection and why cardiovascular health is often the real issue.
You'll also learn how weight loss medications like Ozempic and Mounjaro may temporarily affect testosterone, why erections are an important indicator of overall health, and what every man should know about preventing and treating Peyronie's disease.
KEY POINTS
* Why erectile dysfunction is often an early warning sign of cardiovascular disease
* The truth about "venous leak"—and why most men don't actually have it
* How erections really work (and why blood flow matters)
* Psychological vs. physical causes of erectile dysfunction
* How GLP-1 medications like Ozempic and Mounjaro affect testosterone
* When testosterone replacement therapy is appropriate—and when it isn't
* The biggest myths surrounding Peyronie's disease
* How daily Cialis may benefit men's health beyond erections
* Lifestyle changes that naturally improve erectile function
* The latest evidence-based treatments for ED and Peyronie's disease
* What every man should know about protecting his long-term sexual health
* Practical advice from one of the nation's leading experts in sexual medicine
CHAPTERS
00:00 Introduction: ED may be your first warning sign
02:45 Why erections are a window into overall health
06:20 Psychological vs. physical erectile dysfunction
13:15 GLP-1 medications, weight loss & testosterone
18:30 Combining GLP-1 therapy with testosterone replacement
28:45 The truth about "venous leak" explained
40:05 Why most men do NOT have true venous leak
43:10 The best approach to treating erectile dysfunction
49:20 Understanding Peyronie's disease
54:20 Can Peyronie's disease be prevented?
58:00 Why daily Cialis may be one of men's most useful medications
1:01:00 Xiaflex, surgery & future Peyronie's treatments
