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“A hundred years ago, women lived one year longer than men, but now they live five years longer than men. And things are getting worse. Currently, the lifespan of men in the U.S. is declining due to alcohol, opioids, and suicide. These trends need to change.
I take care of men. I’ve been a urologist for almost 25 years and have seen thousands of men as patients, many of whom have shared their most personal thoughts and feelings with me. I’ve followed many men in my practice for 15 to 20 years and have witnessed the slow physical decline that is inevitable with age. Over that time, I have also aged, yet many of my patients have had it far worse than I have.
As a urologic surgeon, clinical researcher, physician educator, and practicing clinician, I have embarked on a journey to help myself, my patients, and other physicians meet these challenges, to maximize our health and maintain the glow and vitality of youth.”
Judson Brandeis is a urologist.
He shares his story and discusses his KevinMD article, “The catastrophe of men’s health and how we can help.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have Judson Brandeis. He is a urologist and sexual medicine expert, and he wrote the KevinMD article “The catastrophe of men’s health and how we can help.” Welcome to the show.
Judson Brandeis: Oh, thank you so much, Kevin, for having me. I appreciate it.
Kevin Pho: We’re going to talk about the article in a little bit, but first off, can you share your story and journey to where you are today?
Judson Brandeis: Sure. I started out at Brown University. I was a history major, but I always wanted to go to medical school. I went to Vanderbilt medical school after doing a year of research at the American Red Cross for Harold T. Meryman, the guy who figured out how to freeze blood. From Vanderbilt I went to Harvard and did a research fellowship in the Merrill and Murray lab, where they did the first living-related kidney transplant, sponsored by the Howard Hughes Medical Research Institute. Then it was off to UCLA, where I did two years of surgery and four years of urology.
From there I went off to Walnut Creek, California, where I went straight into private practice in general urology. I was fortunate to be at the birth of surgical robotics, so my hospital had the second da Vinci surgical robot, and I really helped pioneer surgical robotics, especially in urology. I’ve always been sort of an early adopter of technology, so I was one of the first five practice doctors to do MRI-guided prostate biopsies.
Then about three years ago I discovered new technologies in sexual medicine, including low-intensity shockwave therapy and platelet-rich plasma, and so I branched off into sexual medicine, and now more into total male rejuvenation, including using high-intensity focused electromagnetic waves to build muscle, and bioidentical hormones. I’m doing a lot of clinical research and device development. Most recently I wrote the book The 21st Century Man, which really is the most complete and medically accurate book on men’s health: over 101 chapters, 900 pages, and 60 co-authors. So that’s me in a nutshell.
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Kevin Pho: Tell us a little about your practice, about some of the patients that you see, some of the cases that you handle.
Judson Brandeis: Yeah, so I had an absolutely amazing practice. I stopped taking medical insurance about three years ago, and I spend an enormous amount of time with my patients. A new patient consult is about an hour, and we go into every aspect of a man’s health, because what I really discovered was that to adequately treat someone’s physical intimacy issues, you have to understand the whole picture. Sleep apnea can affect erectile dysfunction, or testosterone can affect erectile dysfunction, or obesity, or lack of exercise, or relationship issues. That was sort of the genesis of The 21st Century Man: Let’s find out every aspect of a man’s health that can affect his sexual function, and then let’s write about it.
I’ve been blessed to have a great geographic location, so I’m close enough to Apple, Google, Facebook, Lawrence Livermore Labs, and Oracle that I have really fascinating patients that come in. They come in because typically they have erectile dysfunction, but what’s leading to the erectile dysfunction may be obesity, or poor diet, or smoking, or sometimes it’s just old age, and we’re able to help them with some of these regenerative technologies and get them back to being able to be physically intimate with their partner. To be honest, I’ve cured plenty of men with prostate cancer, bladder cancer, and kidney cancer, and taken out kidney stones. It’s the most rewarding thing to have a guy come in after a month or two of working on them and have them tell you some great story about what happened over the weekend with their spouse.
Kevin Pho: In primary care, when someone comes in with erectile dysfunction issues, typically they leave with a prescription for Viagra, Levitra, Cialis. You’re certainly on the cutting edge. You talk about regenerative technology, so talk more about some of the techniques that you’re using.
Judson Brandeis: Yeah, so I have an algorithm that I really use. First of all, what a lot of people forget about is nitric oxide boosters. Nitric oxide boosters are supplements that can have an amazing impact on circulation. I started a company called The Firm Science, where we have a supplement called The Firm that I give to men. It’s mostly citrulline, which is from watermelon, and nitrates, which are from beets, and that decreases blood pressure, increases cognition, increases athletic performance, and improves erectile function.
Then I use PDE5 inhibitors fairly liberally, especially daily-dose tadalafil, and especially taking it before you go to sleep, because nighttime erections are really the way that we improve and maintain erectile function. If you lose nighttime erections, then you will much more quickly lose the ability to get an erection.
Then I’m one of the pioneers of low-intensity shockwave therapy for erectile dysfunction. This relatively simple treatment, with absolutely no side effects, has been shown to improve what’s called the SHIM score, which is the validated questionnaire that we use to assess erectile function, by about five points. So if I have a 53-year-old guy with erectile dysfunction that does fine with Viagra, I’m usually actually able to get him off Viagra. If I have someone in their mid-60s for whom Viagra is not working so well anymore, I can get them to the point where Viagra works pretty well. And if I have someone in their 70s for whom Viagra doesn’t work anymore, I can get them to the point where Viagra is working OK.
Then I combine that with something like PRP, platelet-rich plasma injections, which we use for hair growth, we use in orthopedics, and we use in dentistry, but we’re beginning to use in regenerative urology, for the ability to improve erectile function. Then I have a whole host of other things that I use, including peptides like bremelanotide or oxytocin, and apomorphine. We use penis pumps to help rejuvenate the penis. So in the book The 21st Century Man, I have a whole algorithm that I lay out that would be great for primary care physicians to read and understand, on how we can turn back the clock for men.
Kevin Pho: All right, let’s talk more about that article you wrote on KevinMD. It’s titled “The catastrophe of men’s health and how we can help.” Now, for those of you who get a chance to read your article, can you just walk my audience through it?
Judson Brandeis: Absolutely. Men’s health is a catastrophe, and I see that every day. Just a few tidbits of information: A hundred years ago, women lived a year longer than men. Now women live five years longer than men. Most of us know this, but the longevity of Caucasian men in the United States is actually declining, and that was going on even before COVID, and that’s because of alcoholism, opioid abuse, and suicide.
Men are half as likely to go to the doctor, especially their primary care physician, as women. So we have to help men access the health care system. I think it comes really from women who have babies, right? So they already have an obstetrician or gynecologist, and they’re used to going there, and probably more women take their kids to the pediatrician than men, so they at least know where the health insurance card is. I have patients that are PhDs in physics at the Lawrence Livermore lab that don’t even know whether they have an HMO or a PPO. That’s how bad it’s getting.
Kevin Pho: So what are some of the solutions, and what are some avenues that we have to improve men’s health, or men’s access to health?
Judson Brandeis: Yeah, so first of all, doing something like you’re doing, Kevin, of providing really good information to men at places where people access information. As physicians, I was present during the last 25 years, when we basically lost the battle for health care economics and power in medicine. There’s always a slide that’s put up at a lot of medical meetings that shows an increase in the number of physicians over the past 20 years, and it’s increased by about 10 percent, and then an increase in the number of health care administrators over the past 10 or 20 years, and that’s increased 2,000, right? So we’ve allowed this whole class of people to come in and sit there and tell us what to do, even though they don’t have the same training that we do, and we’ve lost control of health care economics.
And guess what? We’re losing control of the dissemination of health care information, and it’s because we expect patients to read little brochures that we give them, or books, and so on and so forth. Really, the issue is we’re not on Facebook, we’re not on Instagram, we’re not on YouTube, and even when we are, we’re not providing really entertaining content. Let’s just be honest. I watch the Today show every morning, and it’s just this flash of image after image after image, and that’s what people are used to. So if you’re a physician and you’re sitting there droning on and on like I’m doing right now, people aren’t going to be that interested in you.
So you have to provide information to patients, especially men, in the way that people take in information these days. I’ve actually experimented with YouTube videos, which are one-minute videos. You have to kind of make them funny, but we have to be creative as physicians and as smart people in meeting our patients where they’re going for information.
Kevin Pho: Well, that’s so well said. I’ve been talking about this for years: A lot of patients, or the majority of patients, get their health information on social media, Facebook, Twitter, and YouTube, and if physicians aren’t there, they’re going to get their information from pseudo-practitioners, from politicians, from people who aren’t necessarily physicians. So it’s more imperative than ever, especially now in the age of COVID, for more of us to be online and, like you said, be where patients are.
Now, let’s say we bring men into the exam room, and I’m a primary care physician. What are some of the questions we should be asking them to uncover perhaps unexpected things about their health?
Judson Brandeis: You know, Kevin, the most important question I think I ask men, especially men over 50, the question that really throws every man for a loop, is, “What do you do for fun?” I get at least one man a week starting to tear up in my office, right?
I teach my patients, first of all, how to come to the doctor’s office, and I make videos that we send to patients to prepare them to come to my office. I tell them, “Write down your medical history, bring in a list of medications, bring in a list of your imaging studies, write down a history of present illness, and write down a list of questions for me.” So when my patients walk into the office, they hand me a sheaf of paper, and then I use Dragon. I’ve been using Dragon for 15 years, 20 years, and I just dictate it, and then I have a lot of time with my patients to talk about all the issues that they want to talk about.
The Harvard longevity study showed the most important factor in health is the quality of your relationships. Now, you don’t go to the cardiologist to talk about the quality of your relationships, but if you’re not talking about the important issues in somebody’s life, you’re missing the bigger picture.
Kevin Pho: So other than erectile dysfunction and relationships, what are some other men’s issues that you see in the exam room that also could be applicable in a primary care setting?
Judson Brandeis: So one piece of technology that I have is an InBody body composition analysis machine, and that gives men a percentage of body fat. It gives them their basal metabolic rate. It gives them what their strength is in their arms, their legs, and their trunk. And men respond to numbers. It’s really absolutely amazing. I don’t have any training in weight loss and very little training in muscle building, other than that I was a competitive athlete, and I have just astonishing results in building muscle and having men lose weight.
A lot of it is attributed to going over an InBody body composition analysis and explaining to men how you lose weight: that one pound of fat is 3,500 calories, that fat is really hard to lose because our body desperately clings on to fat, because it’s fuel. Explaining what alcohol actually is: that alcohol is empty calories, it’s a depressant, it disinhibits you. You really have to explain the macro of what people are doing, and then allow men to follow their numbers. Giving men quantifiable numbers to follow, I think, has made an enormous impact on how my patients do.
I have a whole series of men that I’m actually going to send to a journal to get published, between the ages of 60 and 70, and over a period of about four months, using my male rejuvenation protocol, I have men in their 60s building 5 to 10 pounds of muscle and losing 10 to 20 pounds of fat over four months. Men in their 60s. It’s just astonishing what men can do when you provide them with the proper information and really take the time to explain the path by which they can get better.
Kevin Pho: We’re talking to Judson Brandeis. He’s a urologist and sexual medicine expert. He wrote the KevinMD article “The catastrophe of men’s health and how we can help.” Judson, a lot of primary care physicians, we don’t have an hour to spend in the exam room with patients. We have 10 to 15 minutes, and, as you can imagine, all these check boxes on electronic medical records, and regulations, and forms that we have to fill in in that limited period of time. What is some of the highest-impact advice you could give to primary care doctors? You did recommend a question: “What do you like to do to have fun?” What other tips do you have for primary care doctors to improve their male patients’ health?
Judson Brandeis: Yeah, be like you, Kevin. Make videos. I have a male sexual health curriculum on my YouTube channel. It’s two hours of videos that I made. These days it’s easy to make a video. Everyone’s got an iPhone, the iPhone’s got 4K video, you have a little app that’s a teleprompter app, and just have someone in your office, or use a gimbal, and make videos and explain this stuff: This is how I explain diabetes, this is how I explain heart disease. Because you need an extender.
Let’s be honest, 20, 25 years ago we got paid a lot more money than we do now. It’s the same dollars, but medical cost inflation is 4 percent per year, so every year the government or somebody’s taking 4 percent from you, so you’re making a fraction of what you were making 20 years ago. What we did was just cram more patients into the day, but at a certain point you can’t cram any more patients into the day. And then, like you said, you’ve got all these rules and regulations and the electronic medical record, and so you need to be able to extend yourself in some way.
The way I found is I ask my patients, “Watch my two hours of video on men’s sexual health before you even come in, and then when you come in, we can have a higher level of conversation. And you write your history of present illness, you write your questions for me. Let’s make the most efficient use of the time that you have. I don’t want to spend half the time that I’m with you explaining stuff that you could learn at home.”
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Judson Brandeis: Yeah, the take-home messages are that sexual health really matters, the quality of relationships that your patients have really matters, and men’s health really is a catastrophe. Men are living less long, even before COVID men were living less long, and you really have to delve into getting your male patients to trust you and to use you as a resource, and really provide high-quality information for men on the internet and other places where they access information.
That’s the reason that I wrote The 21st Century Man, which is the most comprehensive and medically accurate book ever written on men’s health. It’s over 900 pages and 101 chapters, and that would be a resource that would be fantastic for primary care physicians to hand to their patients. We have cardiologists writing chapters on cardiology, hand surgeons, and pulmonologists, vascular surgeons, urologists, andrologists, you name it, over 60 medical experts providing top-tier information. That’s really the name of the game these days: We need to be the influencers for our patients. Don’t let the internet trolls be the information.
Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.
Judson Brandeis: Hey, thanks a lot, Kevin. I really appreciate it.
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