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When Your Diet Goes Head-to-Head

Posted on by Akash Kapadia, MD in ,

Man smiling while eating healthy lunch, putting fork to mouth

Erectile dysfunction (ED) is more common than many realize, affecting millions of men, as well as their partners, worldwide. Modern medicine has developed wildly impressive and effective solutions, ranging from medication to penile implants.

What modern medicine can’t change is how you treat your body. In other words, what you eat, how you move, and how you manage stress can all influence your sexual function.

Foods That Can Help

You are what you eat has more truth to it than many realize. A diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats not only nourishes your body but also your sexual health. Leafy greens, beets, and berries are particularly helpful because they contain nitrates and antioxidants, compounds that support the ability of your blood vessels to expand and increase blood flow. Healthy blood flow to the penile arteries results in strong, consistent erections.

Whole grains and legumes, packed with fiber, help regulate blood sugar and cholesterol, which also protects vascular health. And healthy fat isn’t your enemy – unsaturated fats from olive oil, nuts, and fatty fish support cardiovascular function and, indirectly, sexual performance.

Lean proteins from poultry, fish, or plant sources help maintain muscle mass and overall metabolism, contributing to hormone balance. Some studies suggest that men who follow Mediterranean-style diets, which are high in fruits, vegetables, whole grains, healthy fats, and fish, experience lower rates of erectile dysfunction than men who follow typical Western diets high in processed and fried foods.1

Foods That Can Hinder

Not all “healthy” foods are created equal – even foods with labels such as natural, diet, or zero-calorie can contain hidden sweeteners and other undesirable ingredients that aren’t so helpful. Processed foods with refined carbohydrates, saturated fats, and excess sodium can also sabotage sexual performance.

Refined carbohydrates, such as white bread, pastries, and sugary snacks, spike blood sugar and can worsen insulin resistance over time. This creates vascular stress and may reduce blood flow to the penis. Saturated and trans fats, commonly found in fried foods, fast food, and many baked goods, contribute to the development of atherosclerosis, which narrows arteries and impedes circulation – everywhere. High sodium intake can raise blood pressure, again negatively affecting vascular health.

Even moderate levels of unhealthy eating, when repeated daily and over time, can gradually compromise metabolic health and erectile function. On the flip side, the occasional indulgence alongside otherwise healthy dietary habits promotes physical health, reduces stress, boosts mood, and creates enjoyable social experiences that actually enhance sexual wellbeing.

Creating better habits like replacing processed snacks with whole foods, cooking with olive oil instead of margarine, and moderating caffeine intake can drastically improve blood flow, energy levels, and hormone balance. What hinders vascular and endocrine health can hinder erections.

There’s More: Exercise and Metabolic Health

We’ve mentioned it a few times, and we’ll say it again: erectile function depends heavily on cardiovascular and metabolic health. Regular physical activity improves circulation, lowers blood pressure, helps stabilize healthy body weight, and reduces stress, all of which can impact the ability to obtain and maintain an erection.

Aerobic exercise (including activities like walking, jogging, swimming, or cycling that get your heart rate up) strengthens the heart and blood vessels, increasing the availability of nitric oxide – a compound necessary for smooth muscle relaxation and adequate blood volume to the penis. Resistance training (as in push-ups, curls, deadlifts, and planks) helps regulate testosterone production, preserves muscle mass, and improves metabolic function. Pelvic floor exercises (such as Kegels, bridge pose, and squats) directly strengthen the muscles involved with erections and ejaculation, augmenting rigidity and control.

Obesity is also linked to erectile dysfunction – excess body fat, particularly around the abdomen, creates inflammation, insulin resistance, and lower testosterone levels. Fortunately, even modest weight loss can yield noticeable improvements in sexual function.

Moderating all of these aspects of lifestyle creates a positive feedback loop: improved circulation and hormonal balance support sexual performance; increased confidence and energy encourage continued healthy behaviors.

That’s Not All: Smoking, Alcohol, Stress, and Sleep

Yes, all of these factors can affect sexual performance. Poor sleep, particularly obstructive sleep apnea, insomnia, and nighttime shift work, is strongly associated with low testosterone and impaired vascular function. Research indicates that short sleep duration itself may negatively influence erectile function – men who consistently get insufficient sleep are at higher risk for developing ED, even after accounting for age and other medical conditions.2

Not getting regular quality Z’s has also been linked to a wide range of other disorders, including diabetes, hypertension, and major depressive disorder, all of which can further contribute to sexual dysfunction. Studies suggest that sleep-related disruptions in neuroendocrine systems, molecular signaling pathways, and vascular regulation can all lead to ED.2 Establishing consistent sleep habits not only supports better erectile function, but it can also enhance responsiveness to medical treatment.

Smoking damages blood vessels and reduces nitric oxide availability, making erections more difficult. Chronic alcohol use, on the other hand, can impair testosterone production and cause nerve damage. Chronic psychological stress elevates cortisol, which can decrease testosterone and interfere with the nervous system pathways involved in erections. Anxiety, depression, and performance pressure further compound the problem.

Oftentimes, smoking, alcohol consumption, and mental health go hand-in-hand, making this one of the most challenging lifestyle aspects to tackle. If you or someone you know is struggling with substance dependency or emotional well-being, please reach out to a healthcare provider for additional support and guidance.

Get Your Head in the Game

Erectile dysfunction is rarely just a bedroom issue – it’s often a signal indicating your body needs cardiovascular, metabolic, hormonal, and even mental health support.

Diet and lifestyle have a dynamic impact within the body, sometimes rivaling medication in effectiveness. When healthy habits are combined with medical intervention, these strategies provide the most comprehensive approach to ED and your overall physical mojo.

If you’re struggling with ED and want personalized guidance, schedule a consultation with Dr. Kapadia. With a few adjustments and solid medical advice, you can regain sexual confidence and peak performance.

Resources:

  1. Di Francesco, S., & Tenaglia, R. L. (2017). Mediterranean diet and erectile dysfunction: a current perspective. Central European journal of urology, 70(2), 185–187. https://doi.org/10.5173/ceju.2017.1356.
  2. Zhang, F., Xiong, Y., Qin, F., & Yuan, J. (2022). Short Sleep Duration and Erectile Dysfunction: A Review of the Literature. Nature and science of sleep, 14, 1945–1961. https://doi.org/10.2147/NSS.S375571.

The Sleep-Sex Disconnect

Posted on by Akash Kapadia, MD in

Close-up of man in bed, stretching hand behind head

You can fake your way through a workday on little sleep, but not through passion – it’s hard to feel like a powerhouse on four hours of shut-eye. Over time, irregular sleep or ongoing disruptions chip away at multiple body systems and inevitably impact your sex life.

Sleep is foundational, and sleeping less than 7 hours per night can interfere with cognition and the hormonal rhythms that keep your body balanced and your mood stable. Chronic sleep deprivation has been linked to weight gain, insulin resistance, hypertension, depression, and cardiovascular disease, but it also takes a toll on sexual desire and other markers of male sexual function.¹‾²
Whether it’s sleep apnea, late nights, or stress keeping you up, reclaiming rest may be one of the most overlooked ways to reignite your libido.

A Dip in Desire

Grogginess. Patience that runs thin. A body that feels like it’s running on fumes. Several nights of inadequate sleep can make anyone cranky, but it can also dim sexual desire.

Your libido is the mental and physiological drive for sexual activity, and research increasingly shows that sleep has an impact on maintaining sexual impulses. Unlike erectile dysfunction, which describes a specific physical challenge, libido encompasses desire, motivation, and interest in romantic engagement.

Men with obstructive sleep apnea (OSA), non-standard work shifts, or chronic sleep deprivation often report decreased sexual drive, even when testosterone levels are within the normal range, suggesting a fatigue-induced deficit in neuroendocrine pathways, rather than through hormone deficiency alone.² Disruptions in circadian rhythm and fluctuations in testosterone bioavailability can produce hypogonadal symptoms (fatigue, low energy, and diminished sexual interest) in otherwise healthy men with biomarkers that appear normal.²

Running on Empty

Sleep recharges us mentally, but it also recalibrates hormones. Short-term sleep restriction in young men has been shown to lower daytime testosterone by 10–15%, particularly in the afternoon and evening, which may reduce energy, vigor, and libido.³ Luteinizing hormone (LH), which signals the testes to produce testosterone, follows a circadian rhythm. When that rhythm is disturbed by sleep loss or irregular schedules, testosterone secretion drops, and with it, the motivation and vitality that support a healthy libido. ⁴

Preliminary evidence also suggests that short-term sleep restriction may reduce sex hormone-binding globulin (SHBG), a protein that regulates the availability of testosterone in the body. ⁵ Lower SHBG levels can alter free testosterone levels, possibly contributing to fatigue and diminished sexual interest. Researchers also noted that afternoon cortisol levels increased in response to restricted sleep, reflecting a stress-hormone response that may further influence energy, mood, and sexual drive.

Prolactin, a modulating hormone that is naturally already low in men and related to sexual function, metabolism, neurogenesis, and immune function, may decline further when sleep is curtailed or interrupted in the second half of the night. ⁶ That same predawn sleep interruption also reduces morning testosterone, and sleep deprivation-related shifts in metabolic hormones (like leptin and insulin) can compound fatigue and reduce overall sexual motivation. ⁷ Though the studies include a small number of participants and more research is needed to fully understand the endocrine consequences of poor sleep on libido, the trends are consistent.

The downstream effects of disrupted sleep can throw off hormone balance and alter how men experience desire, stamina, and performance, and obstructive sleep apnea (OSA) is one of the most common culprits. The combination of intermittent oxygen deprivation and fragmented sleep undermines testosterone production and dampens arousal pathways in the brain. In one study, men with sleep apnea were 9.4 times more likely to develop erectile dysfunction than those without, even after adjusting for other factors like age, BMI, and comorbidities. ⁸

Men who work irregular hours, especially overnight or rotating shifts, as well as men at a higher risk of insomnia, frequently report lower libido and symptoms consistent with hypogonadism. In two separate observational studies involving nearly 1,000 men, those who were ‘very dissatisfied’ with their quality of sleep scored significantly lower on measures of sexual function and satisfaction than their well-rested counterparts. ⁹

Reconnect Rhythm, Rest, and Romance

Men who maintain consistent sleep schedules, reduce late-night screen exposure, and create a calm sleep environment often find that their energy and desire improve naturally. Managing stress, light exercise, and structured downtime can further stabilize hormonal rhythms, supporting both mental clarity and sexual motivation.

Interestingly, the relationship between sleep and sex also spins the other way: research shows that sexual activity, particularly orgasm with a partner, can improve sleep through oxytocin, prolactin, and cortisol modulation, helping the body relax and fall into deeper, more restorative sleep.¹⁰ Better sleep can improve libido, and a stronger libido can equate to more satisfying sexual activity; renewed sexual activity, though its own reward, is reinforced by even better sleep.

Small changes – shifting bedtime earlier, carving out moments for intimacy, and tending to stress – can nudge your rhythm in the right direction. But it helps to understand exactly what your body is telling you in the first place: is it hormonal, metabolic, sleep-related, or a combination?

A urologist who specializes in men’s health can help identify where the imbalance begins – whether it’s hormonal dysregulation, metabolic stress, or lifestyle factors. Through targeted evaluation of testosterone, LH, and SHBG levels, alongside a review of sleep patterns and daily routines, it becomes possible to pinpoint whether fatigue stems from the endocrine system, the nervous system, or both.

If you’ve noticed a slump in libido or diminished sexual function, Dr. Kapadia can help pinpoint the source. Contact us for a personalized consultation and bring balance back between the sheets.

Resources:

  1. Consensus Conference Panel, Watson, N. F., Badr, M. S., Belenky, G., Bliwise, D. L., Buxton, O. M., Buysse, D., Dinges, D. F., Gangwisch, J., Grandner, M. A., Kushida, C., Malhotra, R. K., Martin, J. L., Patel, S. R., Quan, S. F., Tasali, E., Non-Participating Observers, Twery, M., Croft, J. B., Maher, E., … Heald, J. L. (2015). Recommended Amount of Sleep for a Healthy Adult: A Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 11(6), 591–592. https://doi.org/10.5664/jcsm.4758.
  2. Kohn, T. P., Kohn, J. R., Haney, N. M., Pastuszak, A. W., & Lipshultz, L. I. (2020). The effect of sleep on men’s health. Translational andrology and urology, 9(Suppl 2), S178–S185. https://doi.org/10.21037/tau.2019.11.07.
  3. Leproult, R., & Van Cauter, E. (2011). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 305(21), 2173–2174. https://doi.org/10.1001/jama.2011.710.
  4. Chen, K. F., Liang, S. J., Lin, C. L., Liao, W. C., & Kao, C. H. (2016). Sleep disorders increase risk of subsequent erectile dysfunction in individuals without sleep apnea: a nationwide population-base cohort study. Sleep medicine, 17, 64–68. https://doi.org/10.1016/j.sleep.2015.05.018.
  5. Reynolds, A. C., Dorrian, J., Liu, P. Y., Van Dongen, H. P., Wittert, G. A., Harmer, L. J., & Banks, S. (2012). Impact of five nights of sleep restriction on glucose metabolism, leptin and testosterone in young adult men. PloS one, 7(7), e41218. https://doi.org/10.1371/journal.pone.0041218.
  6. Schmid, S. M., Hallschmid, M., Jauch-Chara, K., Lehnert, H., & Schultes, B. (2012). Sleep timing may modulate the effect of sleep loss on testosterone. Clinical endocrinology, 77(5), 749–754. https://doi.org/10.1111/j.1365-2265.2012.04419.x.
  7. Reynolds, A. C., Dorrian, J., Liu, P. Y., Van Dongen, H. P., Wittert, G. A., Harmer, L. J., & Banks, S. (2012). Impact of five nights of sleep restriction on glucose metabolism, leptin and testosterone in young adult men. PloS one, 7(7), e41218. https://doi.org/10.1371/journal.pone.0041218.
  8. Chen, K. F., Liang, S. J., Lin, C. L., Liao, W. C., & Kao, C. H. (2016). Sleep disorders increase risk of subsequent erectile dysfunction in individuals without sleep apnea: a nationwide population-base cohort study. Sleep medicine, 17, 64–68. https://doi.org/10.1016/j.sleep.2015.05.018.
  9. Kohn, T. P., Kohn, J. R., Haney, N. M., Pastuszak, A. W., & Lipshultz, L. I. (2020). The effect of sleep on men’s health. Translational andrology and urology, 9(Suppl 2), S178–S185. https://doi.org/10.21037/tau.2019.11.07.
  10. Lastella, M., O’Mullan, C., Paterson, J. L., & Reynolds, A. C. (2019). Sex and Sleep: Perceptions of Sex as a Sleep Promoting Behavior in the General Adult Population. Frontiers in public health, 7, 33. https://doi.org/10.3389/fpubh.2019.00033.

A Vicious Cycle Undermining Men’s Health

Posted on by Akash Kapadia, MD in ,

Man sitting on park bench with legs crossed, smiling

Obesity, left unchecked, has the potential to outpace smoking as the leading preventable cause of death in the United States.¹ Obesity raises LDL (“bad”) cholesterol and triglycerides, lowers HDL (“good”) cholesterol, and interferes with how the body responds to insulin. Over time, this imbalance drives up blood sugar and inflammation, setting the stage for heart disease, stroke, diabetes, and other chronic illnesses.

But beyond the cardiovascular and metabolic impacts, excess weight can undermine one of men’s most defining hormones: testosterone. Obesity and low testosterone form a self-perpetuating loop that affects everything from energy and metabolism to fertility and confidence. The heavier a man becomes, the lower his testosterone tends to fall – and as testosterone drops, body fat accumulates even faster.

The better we understand this cycle, the more strategically we can intervene to restore hormone balance and improve men’s health.

Understanding Testosterone

Most of us think of testosterone as the ‘male hormone’ because it’s responsible for many of the traits that define male physiology: muscle mass, bone strength, body hair, and the deep voice that emerges at puberty. But it’s also a primary player in reproductive function, sperm production, libido, mood regulation, and even energy levels and metabolism. Simply put, it affects nearly every aspect of men’s physical and mental well-being.

Testosterone levels naturally rise during puberty, peak in early adulthood, and then remain relatively stable for years before gradually declining after 45. Most men retain adequate levels well into older age, but certain factors can accelerate this decline. Among the most significant is obesity. While aging contributes to a slow, predictable drop in testosterone, excess body fat, especially in the midsection, can push levels far lower, and much faster, than time alone. Studies show that waist circumference is an even stronger predictor of low testosterone than body mass index (BMI) – a four-inch increase in waist size can raise a man’s odds of having low testosterone by 75%.¹

One of the mechanisms by which obesity disrupts hormone balance is through aromatase activity. Fat tissue contains an enzyme called aromatase, which converts testosterone into estrogen. The more adipose tissue a man has, the more testosterone gets converted, tipping the hormonal scales and reducing the levels of this vital male hormone.²

Obesity also lowers levels of sex hormone-binding globulin (SHBG), the protein that carries testosterone through the bloodstream. With less SHBG, the amount of free, biologically active testosterone drops, even if total testosterone levels appear only modestly reduced.²

Obesity is also closely linked with hyperleptinemia, a state of elevated leptin levels. Leptin normally helps regulate appetite and energy balance, but chronic excess can cause leptin resistance. This resistance can suppress the hypothalamic-pituitary-gonadal (HPG) axis (the brain-to-testes signaling pathway that controls testosterone production) by inhibiting gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) secretion. In other words, the brain’s commands to produce testosterone are dulled.²

Insulin resistance and chronic low-grade inflammation, both common in obesity, further impair the HPG axis and directly affect Leydig cells in the testes, which are responsible for testosterone production. The result is a functional, yet potentially reversible, hypogonadism called pseudo-hypogonadism: the testes are still capable of producing testosterone, but systemic factors prevent them from doing so effectively. Removing those factors helps with regaining functionality. Sustained weight loss, whether through diet, exercise, or medical interventions, can restore testosterone levels and help break this self-perpetuating cycle.²

Understanding Bidirectionality

Low levels of testosterone also turn the tables on adipose storage, creating a vicious cycle. Just as excess fat can lower testosterone, low testosterone levels can accelerate fat accumulation, particularly in the abdominal region, while reducing lean muscle mass. This combination worsens metabolic dysfunction, insulin resistance, and glucose intolerance, making weight management even more challenging.

Research also shows that low testosterone can impair mitochondrial function in muscle, reduce insulin sensitivity, and increase visceral fat storage, exacerbating the feedback loop that accelerates metabolic decline. Men with both obesity and low testosterone often show worsened glucose tolerance, higher waist-to-hip ratios, and more pronounced dyslipidemia than those with obesity alone.³

An offshoot of this interplay between obesity and testosterone is erectile dysfunction (ED), which is in itself affected by either on its own and compounded by their simultaneous presence; ED can be one of the first visible signs that something is off hormonally or metabolically.

Low testosterone is rarely the sole cause of erectile dysfunction (ED), but testosterone still has a huge impact on sexual desire, libido, and overall sexual function. While normal adult testosterone levels are not strictly required for erections, hypogonadism (the most common endocrine disorder linked to ED) can reduce sexual interest and responsiveness. ⁴

Obesity itself increases the risk of ED through several mechanisms. Excess abdominal fat contributes to vascular dysfunction, insulin resistance, and inflammation, all of which impair blood flow to the penis. Studies show that men with larger waist circumferences or higher BMI have significantly higher odds of developing ED, independent of age. ⁵

When low testosterone and obesity coexist, their effects on erectile function multiply. Reduced testosterone can dampen libido and sexual confidence, while obesity impairs the physiological ability to achieve and maintain an erection. Even moderate weight loss has been shown to reverse ED in many men, highlighting the interconnectedness of metabolic health, testosterone, and sexual function. ⁶

The bidirectionality of testosterone and increased body mass explains why traditional weight loss efforts alone may only partially restore testosterone levels, and why interventions that address both hormones and metabolism together (such as lifestyle modification combined with medical therapies) can be more effective in the long run. ⁶ Targeted strategies based on individualized health characteristics are the most effective way to truly break the cycle and restore men’s health.

Breaking the Cycle

Lifestyle modification is at the root of almost any ailment, whether or not medical intervention is involved. Restoration of hormone balance is no exception, as diet, exercise, and sustained weight loss can improve testosterone levels, reduce visceral fat, and even reverse erectile dysfunction in many men.

For men with confirmed hypogonadism, testosterone therapy (TTh) can amplify the benefits of lifestyle interventions:

  • Fat Reduction and Muscle Preservation: TTh reduces visceral fat and total body fat while preserving lean muscle mass, something diet and exercise alone often struggle to achieve. ⁷
  • Metabolic and Hormonal Effects: By increasing bioavailable testosterone, TTh can help mitigate some of the systemic suppression of the HPG axis commonly observed in obesity.
  • Motivation and Energy Rebound: TTh can improve energy, mood, and motivation, making it easier for men to adhere to diet and exercise programs. ⁸

Research consistently shows that pairing TTh with lifestyle modification produces the best results. For example, a 56-week randomized controlled trial in men with obesity and low testosterone found that those receiving TTh plus a very-low-calorie diet lost significantly more visceral fat, preserved lean muscle, and maintained weight loss better than those only refining their diets. ⁸ Targeting both simultaneously interrupts the self-perpetuating cycle more effectively than addressing either condition alone.

Regaining Control

With targeted interventions, men can restore hormone balance, reduce body fat, preserve muscle, and improve both metabolic and sexual health. To know if your weight puts you at risk for testosterone deficiency or related health issues, calculating your BMI, measuring waist circumference, getting precise assessments, and discussing testosterone levels with a healthcare provider are practical first steps.

For men with obesity and low testosterone, combining lifestyle changes with medical therapies like testosterone replacement offers the greatest potential to interrupt the effects that they have on each other. Even modest weight loss, when paired with targeted hormonal support, can help restore vitality, enhance sexual function, and lay the groundwork for long-term health.

Dr. Kapadia helps men address hormone imbalances, metabolic roadblocks, and lifestyle factors to help them regain control over their health, energy, and confidence. Schedule a consultation so you can start seeing everyday improvements in your sexual wellness, vitality, and stamina.

Note: TTh is not recommended for men without symptomatic hypogonadism, and potential risks, including fertility issues and sleep apnea, must be considered. Speak with a qualified health practitioner before beginning hormone therapy or engaging in new lifestyle modifications, especially if you have underlying health conditions.

Resources:

  1. Harvard Health Publishing. (2011, March 1). Obesity: Unhealthy and unmanly. Harvard Health; Harvard Health Publishing | Harvard Medical School. https://www.health.harvard.edu/mens-health/obesity-unhealthy-and-unmanly.
  2. Varnum, A. A., Pozzi, E., Deebel, N. A., Evans, A., Eid, N., Sadeghi-Nejad, H., & Ramasamy, R. (2023). Impact of GLP-1 Agonists on Male Reproductive Health—A Narrative Review. Medicina, 60(1). https://doi.org/10.3390/medicina60010050.
  3. Caliber, M., & Saad, F. (2020). Testosterone Therapy for Prevention and Treatment of Obesity in Men. Androgens: Clinical Research and Therapeutics, 1(1). https://doi.org/10.1089/andro.2020.0010.
  4. Rajfer J. (2000). Relationship between testosterone and erectile dysfunction. Reviews in urology, 2(2), 122–128. PMID: 16985751.
  5. Harvard Health Publishing. (2011, March 1). Obesity: Unhealthy and unmanly. Harvard Health; Harvard Health Publishing | Harvard Medical School. https://www.health.harvard.edu/mens-health/obesity-unhealthy-and-unmanly.
  6. Caliber, M., & Saad, F. (2020). Testosterone Therapy for Prevention and Treatment of Obesity in Men. Androgens: Clinical Research and Therapeutics, 1(1). https://doi.org/10.1089/andro.2020.0010.
  7. Kelly, D. M., & Jones, T. H. (2015). Testosterone and obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(7), 581–606. https://doi.org/10.1111/obr.12282.
  8. Caliber, M., & Saad, F. (2020). Testosterone Therapy for Prevention and Treatment of Obesity in Men. Androgens: Clinical Research and Therapeutics, 1(1). https://doi.org/10.1089/andro.2020.0010.

Fuel Your Fire: Naturally Boosting Testosterone

Posted on by Akash Kapadia, MD in ,

40% of men over 45 experience clinically low testosterone.¹

Sounds straightforward enough, but think about what this hormone actually powers: energy, muscle, motivation, mood, and libido. That statistic means 40% of men could also be feeling drained and fatigued, struggling to stay strong, noticing a lag in sex drive, or experiencing fewer spontaneous erections.

Many men turn to prescriptions, a viable option, but there’s also a growing interest in natural ways to keep testosterone in a healthy range. From lifestyle factors such as diet, sleep, exercise, and stress management to herbs, micronutrients, and specific foods, several practical strategies can help maintain (or even modestly boost) testosterone production.

Food

What you eat ripples through nearly every body system, including the glands and pathways that regulate testosterone. A healthy diet is one of the most effective methods to maintain hormone balance. Nutrient-dense meals give your body the raw materials it needs, while restrictive or unbalanced diets can throw your whole system off-kilter.

Two minerals in particular, zinc and magnesium, play outsized roles in testosterone synthesis. Zinc is involved in both the production and secretion of luteinizing hormone (LH), the chemical messenger that signals your testes to make testosterone. It also helps convert testosterone into its more potent cousin, dihydrotestosterone (DHT). When zinc levels are low, testosterone levels tend to follow. Studies show that supplementation with zinc in zinc-deficient men can raise both total and free testosterone.²

When paired with exercise, magnesium supplementation has also been shown to increase testosterone, likely by reducing oxidative stress and inflammation (which can damage testosterone-producing Leydig cells) and by increasing the availability of more bioavailable hormone. In studies combining exercise and magnesium supplementation, testosterone (both free and total) was elevated.²

Taking a multivitamin tailored to your gender and age typically provides most of the essential minerals and vitamins you need, but additional supplementation may become necessary in some cases. Vitamin D, iron, calcium, and B vitamins are common gaps, and addressing them can make a measurable difference in how your body functions.

Most people think of vitamin D as “the bone vitamin,” and that’s true. It supports healthy skeletal bone, but it’s actually more like a hormone that influences the whole body. Receptors for vitamin D are found throughout the body, including in penile tissue, which means it can directly affect sexual health. When vitamin D binds to specific receptors, it helps regulate thousands of genes that guide how cells grow, repair, and function.³

In practical terms, being low in vitamin D doesn’t just weaken bones – it can also interfere with testosterone production and healthy erectile function. Low vitamin D often goes hand-in-hand with low testosterone, and long-term supplementation in deficient men has been shown to raise both total and free testosterone.⁴

Whole foods provide essential vitamins that support testosterone naturally, and if you need a boost, the plate is a good place to start. Here are some foods that pack hormone-friendly nutrients:

  • Oysters, beef, pumpkin seeds, chickpeas – rich in zinc
  • Spinach, almonds, dark chocolate, and avocados – sources of magnesium
  • Egg yolks, salmon, fortified dairy – supply vitamin D
  • Olive oil, nuts, fatty fish – provide healthy fats for hormone production
  • Pomegranate, berries, and cruciferous vegetables (like broccoli) – support antioxidant balance and hormone metabolism

One last mention on diet: We often hear about the dangers of high cholesterol and being mindful of keeping it low – if your numbers are elevated, that’s generally sound advice. But if your cholesterol is already in a healthy range, going ultra-low-fat might actually backfire.

Cholesterol is the raw material from which testosterone and other steroid hormones are made. Diets too low in fat can limit cholesterol production (hence testosterone), while higher-fat approaches (including ketogenic diets) have been linked to increased testosterone, especially in men who strength train.⁴ Chronic calorie restriction or pushing your body too hard without proper nutrition can suppress LH signaling and lower hormone output.

Herbs

Certain herbs, plant extracts, and phytochemicals (naturally occurring compounds in plants) may help preserve testosterone by limiting its conversion to estrogen and gently nudging hormone pathways in the right direction.⁴

Many of these come from traditional medicine, including plants in the Araliaceae family (like ginseng) and Zingiberaceae species (such as ginger and turmeric), along with fruits like mangosteen, grape seeds, white button mushrooms, and even red wine. (Easy does it on the red wine; alcohol intake can wipe out nutrients your body needs to stay healthy.)

For example, mangosteen supplementation in one study increased free testosterone levels and improved strength outcomes compared to a placebo.⁴ Certain flavonoids – apigenin in parsley and chamomile, chrysin in honey, catechins in cocoa and prune juice, and resveratrol in red wine – also show promise in supporting testosterone by acting as natural aromatase inhibitors (substances that help prevent the conversion of testosterone into estrogen).

Other herbs often talked about for testosterone support include puncture vine (Tribulus terrestris), fenugreek (Trigonella foenum-graecum), ashwagandha (Withania somnifera), Tongkat ali (Eurycoma longifolia), and ginseng.⁵ It’s hypothesized that they work by stimulating the glands that produce testosterone, improving responsiveness to luteinizing hormone (LH), reducing stress and inflammation, or protecting testicular cells from oxidative damage. Some men notice appreciable changes in energy, libido, or strength, while others see minimal results. Quality, dose, and individual differences like age, baseline hormone levels, and overall health all contribute to the effect of supplements and lifestyle changes.

While encouraging, most of this research is still preliminary. Many studies are done in vitro (test-tube or cell culture) or in animals rather than humans. Human studies tend to be small, and the real-world effects depend on dose, preparation quality, bioavailability, and baseline nutritional or hormonal status. These herbs show promise, particularly for men with low testosterone or stress, but they’re not guaranteed fixes. Larger, high-quality studies are needed to clarify which herbs work best and in what amounts. Most importantly, don’t start any supplementation regimen without your doctor’s oversight.

Sleep

Sleep is essential for many of the body’s mechanisms to function properly, and hormones are no exception. When we are sleep deprived, we also become hormone, nutrient, and energy deprived.

In one study, 10 healthy young men were observed sleeping 10 hours per night for three nights. Then, their sleep was restricted to only five hours per night for eight consecutive nights. Researchers observed that daytime testosterone levels dropped by 10-15% compared to when individuals were better rested, particularly in the afternoon and evening. Participants also reported feeling less energetic and motivated when experiencing reduced sleep. Interestingly, the testosterone decline occurred without a significant change in cortisol (a stress hormone), suggesting that sleep loss itself (not just stress) directly lowers testosterone.⁶ (Although cortisol does affect hormone levels, as we’ll see soon.)

Missing sleep, even a little, lowers testosterone production – if sleep is cut short, disrupted, fragmented, or of poor quality, testosterone tends to fall. Sleep disorders, like obstructive sleep apnea (OSA), can make this worse.⁷ In OSA, the airway collapses repeatedly during the night, interrupting deep sleep and reducing oxygen levels. This repeated disturbance can significantly blunt testosterone release and is often compounded by excess body weight.

Even if you’re technically “in bed” long enough, broken or shallow sleep keeps testosterone from reaching normal peaks overnight. Research also suggests that testosterone is most sensitive to the amount of deep, restorative sleep (stages 3 and 4 of non-REM).⁷ Prioritizing both sleep quantity and quality is one of the most effective ways to support testosterone and overall vitality naturally.

Exercise

How do different measures of fitness and body composition relate to total testosterone (TT) levels? Researchers explored this by looking at 87 men, measuring their body fat percentage, cardiorespiratory fitness, muscle strength, agility, and flexibility.⁸

Here’s what they found: men with higher amounts of fat, particularly abdominal fat, tended to have lower testosterone, and those with better cardiorespiratory fitness (how efficiently the heart and lungs work) had higher testosterone.⁸

Escalating aerobic exercise with activities that improve your heart and lung capacity and lowering body fat (with emphasis on belly fat) appear to be some of the most effective natural strategies for raising testosterone, especially in men with erectile dysfunction (ED).⁸ Resistance training (lifting weights) also helps, but combined aerobic and strength training with trimming the midsection delivers a bigger testosterone boost than lifting alone.

Stress

Chronic stress takes a toll on nearly every system in the body, and over time, it can quietly chip away at testosterone levels. Animal studies show that prolonged stress causes the testosterone-producing Leydig cells in the testes to falter, shrinking in size and output. The main culprit is cortisol, the body’s primary stress hormone, which interferes with the biochemical steps needed to make testosterone.⁹

Chronic stress also alters how Leydig cells respond to luteinizing hormone (LH), one of the primary signals the body uses to instruct the testes to produce testosterone. When that communication is disrupted, the cellular machinery can’t properly convert raw materials into testosterone. As this process drags on, baseline testosterone secretion decreases, resulting in consistently lower levels than they should be.

Additionally, chronic stress tends to accumulate through effects such as increased inflammation, oxidative stress (where cells are damaged by reactive molecules), and potential decreases in eating, sleep, or energy availability, all of which can further impair testosterone production.

There is a caveat worth mentioning about the difference between acute stress and chronic stress. Acute stress puts our system into action and can actually be healthy. In a study where researchers measured testosterone in participants’ saliva at baseline and during exam stress, they found that short-term psychological stress, like facing a test, might raise testosterone in men (at least temporarily). But how this happens depends on who you are, your personality, how much you dwell on things, and how well you handle your emotions.¹⁰

That said, if you’re under constant stress, your testosterone is likely to drop, not just temporarily but in a more lasting way. Managing stress through good sleep, realistic workloads, relaxation practices, therapy, or lifestyle changes can help maintain healthier, more stable testosterone levels over time.

Finding Balance

Optimizing testosterone takes seeing the big picture and creating a healthy balance in life. Diet, sleep, exercise, and stress management all work together to support hormone production, and even small, consistent changes can make a significant difference in how you feel day-to-day.

It’s important to note that natural products are not a substitute for medical advice, and they aren’t risk-free. Some can interact with prescription medications or existing health conditions in ways that may not seem obvious – don’t self-prescribe or mix therapies without guidance.

The best step you can take is to have an open conversation with your urologist. A specialist can evaluate your hormone levels, review your current medications, and help you choose safe and effective strategies—whether pharmaceutical, natural, or a combination.

For professional guidance on naturally boosting testosterone and combining lifestyle approaches with medical care, schedule an appointment with Dr. Kapadia. Together, we’ll develop a practical plan tailored to your goals.

References:

  1. Sizar, Omeed, et al. “Male Hypogonadism.” PubMed, StatPearls Publishing, 25 Feb. 2024, www.ncbi.nlm.nih.gov/books/NBK532933/.
  2. Zamir, A., Ben-Zeev, T., & Hoffman, J. R. (2021). Manipulation of Dietary Intake on Changes in Circulating Testosterone Concentrations. Nutrients, 13(10), 3375. https://doi.org/10.3390/nu13103375.
  3. Canguven, O., & Al Malki, A. H. (2021). Vitamin D and Male Erectile Function: An Updated Review. The world journal of men’s health, 39(1), 31–37. https://doi.org/10.5534/wjmh.190151.
  4. Zamir, A., Ben-Zeev, T., & Hoffman, J. R. (2021). Manipulation of Dietary Intake on Changes in Circulating Testosterone Concentrations. Nutrients, 13(10), 3375. https://doi.org/10.3390/nu13103375.
  5. Smith, S. J., Lopresti, A. L., Teo, S. Y. M., & Fairchild, T. J. (2021). Examining the Effects of Herbs on Testosterone Concentrations in Men: A Systematic Review. Advances in nutrition (Bethesda, Md.), 12(3), 744–765. https://doi.org/10.1093/advances/nmaa134.
  6. Leproult, R., & Van Cauter, E. (2011). Effect of 1 week of sleep restriction on testosterone levels in young healthy men. JAMA, 305(21), 2173–2174. https://doi.org/10.1001/jama.2011.710.
  7. Wittert G. (2014). The relationship between sleep disorders and testosterone in men. Asian journal of andrology, 16(2), 262–265. https://doi.org/10.4103/1008-682X.122586.
  8. Yeo, J. K., Cho, S. I., Park, S. G., Jo, S., Ha, J. K., Lee, J. W., Cho, S. Y., & Park, M. G. (2018). Which Exercise Is Better for Increasing Serum Testosterone Levels in Patients with Erectile Dysfunction?. The world journal of men’s health, 36(2), 147–152. https://doi.org/10.5534/wjmh.17030.
  9. Xiong, X., Wu, Q., Zhang, L., Gao, S., Li, R., Han, L., Fan, M., Wang, M., Liu, L., Wang, X., Zhang, C., Xin, Y., Li, Z., Huang, C., & Yang, J. (2022). Chronic stress inhibits testosterone synthesis in Leydig cells through mitochondrial damage via Atp5a1. Journal of cellular and molecular medicine, 26(2), 354–363. https://doi.org/10.1111/jcmm.17085.
  10. Afrisham, R., Sadegh-Nejadi, S., SoliemaniFar, O., Kooti, W., Ashtary-Larky, D., Alamiri, F., Aberomand, M., Najjar-Asl, S., & Khaneh-Keshi, A. (2016). Salivary Testosterone Levels Under Psychological Stress and Its Relationship with Rumination and Five Personality Traits in Medical Students. Psychiatry investigation, 13(6), 637–643. https://doi.org/10.4306/pi.2016.13.6.637.

Do Penile Implants Need a Tune-Up?

Posted on by Akash Kapadia, MD in ,

Happy couple hugging and laughing

“When can I have sex with it?”

“How long does it last?”

“What happens if I use it too much?”

“What happens if I don’t use it enough?”

“How often should I see my doctor?”

Penile implants are a game-changer for men with erectile dysfunction, and these are common questions that come up. Curiosity is a good thing, and implants perform best when you understand the basics. To keep your game fresh, it helps to pay attention to proper use, catch problems early, and keep your tune-ups in check.

Time to Activate

If you think you’ll be able to jump back into your nighttime extracurriculars right after surgery, your expectations will need an adjustment. After surgery, the soft tissues and incision areas need time to heal. Usually, about four to six weeks after surgery, you’ll be allowed to “activate.” Activation refers to the first intentional inflation of the prosthesis after the surgical site has healed and swelling has resolved.

The initial activation often happens in the surgeon’s office, allowing the patient (and partner) to learn proper pump technique and ensure the device works as intended. During the activation session, the surgeon demonstrates how to operate the pump-deflation mechanism and addresses any questions you may have to make sure you’re comfortable with the process. This education is pretty important, since proper technique can prevent mechanical issues and early mishaps that could stress the device or tissue.

Once you’ve been cleared for activation, it’s important to cycle the device regularly. Cycling refers to inflating and deflating the implant to keep the internal components moving. Regular cycling also helps maintain the health and elasticity of penile tissue.

Resuming sexual activity is an exciting milestone, and as soon as your healthcare provider has cleared you, game on. The timeline varies based on individual healing and comfort levels, but it’s usually around the same time as activation. A month or more may seem like a long time to wait, but be patient – jumping the gun could increase the risk of infection, wound dehiscence (rupture), or cylinder migration.

Whatever you come to them with, your provider has likely heard it before, so communicate openly about any concerns or questions during this period.

Know the Limits

You’ve gotten through surgery, you’ve been cleared for resuming activity, and now the fun begins. Is it possible to have too much fun with a prosthesis?

Not really…. If you’re using it properly. An inflatable penile prosthesis (IPP) is designed to withstand sexual activity without damage, and the concept of “overuse” is more about misuse than frequency. Behaviors such as forcing the cylinders against resistance during inflation, bending the device at extreme angles, or using it before complete healing can lead to mechanical issues or injury to the penis.

Underuse also occurs, and yes, it can be problematic in more ways than one, but we’ll focus on just one. If the inflatable cylinders remain deflated for extended periods, especially in the early months post-surgery, the surrounding tissue may contract, making future inflation more challenging. We often recommend scheduled early cycling, inflating and deflating the device regularly after activation. This keeps the cylinders flexible and maintains a healthy range of motion.

After the healing period, occasional use is fine – most patients don’t need to inflate daily once comfortable with the device and satisfied with their sexual routine.

Maintaining

IPPs don’t require routine tune-ups like a car, but some practical steps help keep the device working well:

  • Proper use: Learn pump mechanics and avoid unnecessary stress on the device.
  • Early cycling: Being consistent helps the device settle and prevents corporal contraction (the tightening of smooth muscle cells in the penis).
  • Monitoring: Watch for signs of complications, such as pain, swelling, or malfunction.

Regular follow-up appointments with your healthcare provider can also minimize long-term complications and ensure the implant functions reliably.

Even after healing, IPPs can encounter issues. And while many implants function well for years, revision surgery could become necessary. Potential complications and reasons for revision include:

  • Infection: Persistent redness, swelling, drainage, or fever signals urgent evaluation. Although rare, infections can occur and may require device removal.
  • Mechanical problems: Cylinder leaks or pump malfunction may require replacement, and sometimes parts just wear out over time.
  • Erosion or migration: The implant may shift or move through surrounding tissue, but proper sizing and avoiding early trauma usually prevent this; treatment usually involves explantation (surgical removal of the implant).
  • Fibrosis: A lack of early cycling can lead to scarring that limits the expansion of the cylinder.

The Weeks and Years Post-Op

Routine follow-ups help catch potential issues early, ensuring the IPP continues to function optimally. Follow-up schedules vary, but a typical timeline includes:

  • 1 Week Post-Op: Initial check-up to assess the surgical site.
  • 4-6 Weeks Post-Op: Activation session and functional assessment.
  • 3-6 Months Post-Op: Evaluate implant function and patient satisfaction.
  • Annually: Long-term follow-up to monitor implant condition and address any concerns.

These visits are also a chance to review technique, ask questions about changes in your sexual routine, and talk through any new symptoms. Even years after surgery, most patients benefit from maintaining contact with their provider to ensure a smooth operation.

Managing chronic health conditions such as diabetes, high blood pressure, or cardiovascular disease also plays a significant role in long-term implant success. Good control of these conditions supports proper blood flow and healing, reducing the chance of complications. Lifestyle factors, such as maintaining a healthy weight, staying physically active, and not smoking, further support overall penile and vascular health.

It’s worth noting that most inflatable penile implants last well over a decade, with high satisfaction rates among patients and their partners. Knowing that your device has a strong track record of durability can provide peace of mind as you return to normal life.

If you’re considering a penile implant or want long-term guidance with your device, consult with an experienced specialist. Dr. Kapadia has been designated as a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence surgeon for penile implants – one of the few surgeons in the nation to achieve this dual designation. His expertise ensures patients receive the highest level of care from surgery through long-term follow-up.

Online Pharmacies vs. Brick-and-Mortar Urologists: What’s Really the Better Route for Men’s Health?

Posted on by Akash Kapadia, MD in ,

Man looking at online pharmacy screen on phone

In recent years, online pharmacies and telehealth platforms have become an increasingly common way for patients to access medications and medical advice. With just a few clicks, you can order prescriptions, connect with a provider virtually, and have medications shipped directly to your door. For busy patients or those living in rural areas, the convenience is undeniable.

At the same time, the question naturally surfaces: Are online medical platforms as safe and effective as visiting my doctor and picking up a prescription from the local pharmacy?

Both approaches have their place. Online pharmacies offer discretion, privacy, and quick access to treatment, especially when it comes to sensitive issues like erectile dysfunction or urinary problems. And yet, as appealing as online platforms are, they can never fully replace the depth of care that comes from an in-person visit.

Let’s explore the pros and cons of both approaches and where each may (or may not) fit into your healthcare decisions.

The Appeal of Online Pharmacies

It’s easy to see why online pharmacies have carved out such a strong niche – there’s no denying the convenience factor. Online platforms allow you to:

  • Access care from anywhere: Whether you live hours from the nearest clinic or simply prefer the comfort of your home, telehealth and online prescribing can make treatment more accessible.
  • Save time: No waiting rooms, no pharmacy lines, and medications can often be discreetly shipped within days.
  • Avoid face-to-face interactions: For sensitive conditions like erectile dysfunction or urinary issues, many patients appreciate the discretion of talking to a healthcare provider over the phone or online chat, along with the ability to order through a website.
  • Potentially lower cost: Some platforms offer competitive pricing, bulk discounts, or subscription models that can sometimes be easier on the wallet.
    For straightforward, low-risk prescriptions, online pharmacies can be a safe and practical option. For example, medication refills for patients who are already stable on a regimen may be well-suited to online ordering.

The Risks of Skipping In-Person Care

While the advantages are real, there are equally important drawbacks to relying solely on online pharmacies or telehealth platforms for sexual and urologic health.

An online questionnaire is not as thorough as an in-person exam, and can result in missed diagnoses. Urologic symptoms like urinary frequency, blood in the urine, or erectile dysfunction may seem straightforward, but can sometimes point to more serious conditions.

Even though a provider may review them, online intakes can’t pick up on the subtleties of your health or replace a physical exam, lab testing, and imaging when needed. On that note, many online pharmacies are often run by mid-level providers with minimal to no supervision. To make things worse, the supervising physician might not even be a urologist.

A strong, ongoing relationship with a physician allows for nuanced care – your physician keeps track of your health history, test results, and past treatments, weaving them together into a bigger picture. Online encounters, by contrast, can feel transactional and limit the patient-provider relationship, with different providers, different systems, less opportunity to ask questions, and no one connecting the dots. Online platforms like Hims or Ro are more like one-trick ponies and aren’t capable of offering the comprehensive treatments a specialized provider like a urologist can.

When you encounter different providers online or switch platforms, important aspects of your medical history may be lost, which can disrupt the continuity of care necessary for long-term outcomes.

There are also medication safety concerns. While some online platforms are reputable, others operate in a gray zone. The U.S. Food and Drug Administration (FDA) has repeatedly warned about unlicensed or foreign-based sites selling counterfeit drugs, contaminated pills, or incorrect doses.¹ Even when the medication is legitimate, the oversight and follow-up are often limited compared to what you’d get with your doctor and a trusted local pharmacist.

Reputable online pharmacies do exist, but distinguishing them from fraudulent ones can be difficult for patients.

The Value of In-Person Care

In-person care is still the cornerstone of good medical practice. A doctor who sees you face-to-face can perform a comprehensive evaluation, catch early warning signs that can be easily missed in a telehealth setting, provide a nuanced interpretation of symptoms, and coordinate with specialists or labs when needed. There’s also reassurance in knowing that your medications are being dispensed by a licensed pharmacy, staffed by pharmacists trained to double-check prescriptions for safety, side effects, and interactions.

Because of the live interaction, in-person doctors and pharmacies can help safeguard your health – you get a team that knows you, your history, and your goals.

When Online Pharmacies Can Work Well

It’s not a question of “all good” or “all bad.” Online pharmacies have their place, and they can work well in the right situations. A reputable online platform can be effective when:

  • You need a refill for a stable, ongoing prescription.
  • You live far from medical care and need interim access to medication.
  • Common conditions are managed under the supervision of an established and qualified healthcare provider.

Patients who choose online platforms should verify legitimacy, ensure the site requires a valid prescription, and avoid offers that sound too good to be true (like extremely low prices or “no prescription needed”). Use platforms that are U.S.-based, licensed, and verifiable through the FDA or the National Association of Boards of Pharmacy (NABP).

A good online pharmacy should always require a valid prescription, provide a physical U.S. address and phone number, and have licensed pharmacists available to answer your questions. If a site skips those steps or promises miracle deals, it’s a sign to steer clear.

A Balanced Approach

The future of medicine is not either/or. You don’t have to choose between technology and tradition. The wiser move is to explore your pathways to better health based on your medical history and the specific condition for which you’re seeking help.

Online pharmacies and telehealth services will continue to expand access to care, and for certain scenarios, that’s a positive thing. But they should complement, not replace, the personalized care of an in-person physician. Better treatment outcomes often happen when patients utilize technology as a tool, while relying on brick-and-mortar doctors and pharmacies as the foundation of their healthcare.

If you’re considering online options, do so thoughtfully. Research licensed, verifiable platforms and use them for convenience, not comprehensive care.

Keep your doctor in the loop, and never ignore new or concerning symptoms. Online convenience should never delay a needed diagnosis or exam. And whether you order online or locally, make sure your provider is aware of all the prescriptions you’re taking.

There are no shortcuts in healthcare – a trusted doctor and pharmacist know you, your history, and your health goals in ways an online questionnaire never can. Only a physical exam, lab work, or imaging can rule out serious underlying conditions. In these cases, online convenience isn’t just inadequate – it can be unsafe.

As a fellowship-trained urologist specializing in male fertility & men’s health, Dr. Kapadia’s greatest passion is helping men restore confidence in their sexual and urologic health. If you are unsure where to turn, reach out to our office to schedule a confidential consultation. Symptoms such as blood in your urine, new or worsening pain, sudden changes in urination, new-onset erectile dysfunction, or anything out of the norm demand an in-person evaluation.

Reference:

  1. U.S. Food and Drug Administration. (2025, June 20). Internet Pharmacy Warning Letters. FDA. https://www.fda.gov/drugs/drug-supply-chain-integrity/internet-pharmacy-warning-letters.

A Reboot in the Bedroom: Penile Implants for Gay Men

Posted on by Akash Kapadia, MD in

Gay men couple walking, laughing, holding coffee

If you’ve experienced erectile dysfunction (ED), you’ve probably already tried the usual suspects – pills, pumps, injections. When those stop working or never quite do the job, a penile implant (also called a penile prosthesis) moves from “someday” to “maybe.”

Penile implants are researched and time-tested with high satisfaction rates for the right candidates. What the current medical literature doesn’t do brilliantly – at least not yet – is speak directly to the experiences and outcomes of gay men. Most studies lump everybody together, so specific data by sexual orientation are sparse. Still, we can combine what the evidence shows about implants overall with the practical realities of gay men’s sexual practices to help you make a confident, informed decision.

(A quick note on language: we’ll say “gay men” for readability throughout this article, but we mean that to include any men who have sex with men.)

Penile Implant Basics (The 60-Second Version)

A penile implant is a device placed inside the penis to create a dependable erection on demand. There are two main types:

  • Inflatable implants (most popular): Two cylinders are placed in the penis, a fluid reservoir sits internally (usually in the lower abdomen), and a small pump hides in the scrotum. Squeeze the pump for an erection; press the release to deflate. These offer the most natural aesthetic and rigidity or flaccidity when you want it.
  • Malleable (semi-rigid) implants: Bendable rods keep the penis firm at baseline; you position it up or down manually. They’re simpler, but less discreet under clothing and less “natural” in appearance.

Across studies, patient satisfaction is typically high – often in the 80 to 90% range for inflatable devices, with partners also reporting improved quality of life. The risk of infection for first-time inflatable implants is low (approximately 1–3%), thanks to antibiotic coatings and modern surgical techniques. Device reliability is strong, with eventual wear-and-tear addressed via revision surgery if needed.¹

There is a small but growing body of work looking specifically at men who have sex with men and penile prostheses, suggesting overall satisfaction as well, though the samples are small and not yet definitive.²

Why Talk About Orientation at All?

Because sexual goals, positions, and expectations can vary – and those details matter when you’re choosing a device, sizing cylinders, and planning recovery. For example, anal intercourse can place higher axial (straight-line) forces on the penis than vaginal intercourse, so rigidity and stability are central to comfort and performance.³ That doesn’t mean you need a different kind of implant; it means your surgeon should customize device choice and sizing with these realities in mind. ⁴

Who’s a Good Candidate?

You’re typically a candidate if:

  • ED has been persistent (often 6–12+ months) and medical therapies (pills/injections/vacuum) aren’t working or are not tolerated.
    You’re medically optimized for surgery (e.g., diabetes reasonably controlled, smoking addressed, any active infections treated).
    You want a dependable erection, value spontaneity, and understand that the implant replaces natural erectile function.

Men with scarring (as in conditions like Peyronie’s disease), post-prostatectomy ED, or long-standing diabetes-related ED routinely do well with implants, though the surgical plan may be slightly altered from a straightforward surgery.

Choosing Your Implant: What Matters for Gay Men?

Rigidity and angle control. Anal intercourse, especially in positions that create higher leverage, requires strong axial rigidity from an implant to prevent “buckling.” Three-piece inflatable devices generally provide the best blend of firmness for penetration and a natural, comfortable flaccid state for daily life and concealment. Device design and cylinder materials differ slightly across brands; some offer greater maximal girth or perceived rigidity at a given length. Your surgeon will match device characteristics to your goals and anatomy. ⁵

Girth vs. length expectations. Implants don’t increase natural penile length; in fact, men can sometimes perceive a slight decrease in size due to long-standing ED and tissue remodeling. The priority is functional length and reliable rigidity. Sizing is individualized during surgery to maximize usable length safely and effectively. Over-lengthening risks erosion; under-lengthening compromises performance.

Glans support and curvature. If you have Peyronie’s disease, your surgeon may correct the curvature at the same time. Some men benefit from techniques that improve glans (head of the penis) support when indicated.

Concealment and day-to-day comfort. Inflatable devices are designed to deflate completely when not in use, allowing the penis to hang naturally and remain discreet under clothing. When you want an erection, the pump in the scrotum allows you to inflate the cylinders on demand, providing rigidity only when needed.

The Operation and Recovery

Surgery is typically performed on an outpatient basis, and the procedure usually takes approximately one hour. You’ll go home the same day with pain control instructions, antibiotics as indicated, and a scrotal support.

Pain and swelling peak in the first few days, then steadily improve. Most men are back to light desk work in about a week, and more physical jobs in two to three weeks (per your surgeon’s guidance).

There may be a bit of a learning curve when it comes to activation. With an inflatable implant, you’ll be taught to cycle the device (inflate/deflate) to get comfortable using it and to keep tissues supple. Many surgeons start gentle cycling around two to four weeks after surgery.

Sexual activity will have to be put on hold for a while as the anatomy heals. Penetrative sex is usually cleared at around six weeks, once tenderness subsides and you’ve mastered cycling, though your exact timeline may vary.

Sex After an Implant

Positions and comfort. Early on, choose positions that let you control depth and angle. High-leverage positions (where the partner’s body weight or angles create greater force) may be more comfortable after you’ve had a few weeks of practice with the device. Remember, anal intercourse can require higher axial forces; that’s normal, and your implant is built for function, but your body and soft tissues are still recovering.

Lubrication and condoms. Use plenty of lube to reduce friction and pressure on soft tissue. Condoms are still a viable recommendation for STI prevention; implants don’t change STI risk. Choose higher-quality condoms that fit your girth comfortably.

Communication. If you’re the insertive partner, communicate about pace and angle. Let your partner know you’re getting used to a new device and may need a gentler start the first few times of resuming sexual activity.

Ejaculation and orgasm. An implant restores erection, not sensation, libido, or the ability to orgasm – those depend on nerves, hormones, and overall health. Many men report stable or improved sexual satisfaction once the anxiety about ED is gone.

Risks, Complications, and How Surgeons Reduce Them

All surgery carries risk. For implants, the big three are infection, erosion, and mechanical failure over time.

  • Infection: Modern infection rates for first-time, three-piece inflatable implants are approximately 1–3%, which is reduced by meticulous sterile technique and the use of antibiotic-coated devices. Risk is higher with poorly controlled diabetes and other underlying health conditions. If an infection occurs, the device may need to be removed and later replaced. ⁶
  • Erosion or tissue injury: This is rare, but the risk increases if a device is oversized or if tissues are too fragile. This is why careful sizing and experienced surgical technique are imperative.
  • Mechanical issues: All devices can eventually wear out, and revision rates naturally increase after many years of use. Your erection is dependable for as long as the device works, and devices can be replaced when needed.

Your surgeon will screen for modifiable risk factors (optimizing blood sugar, encouraging smoking cessation, treating skin infections), choose the right device for your anatomy and goals, and use infection-prevention protocols to reduce complications. ⁷

What About Satisfaction, Specifically in Gay Men?

Research is limited but encouraging. In a study of MSM undergoing inflatable penile prosthesis, men reported a renewed sense of vitality and overall greater satisfaction in daily life. We need larger studies that correspond with sexual orientation, but the available signal aligns with what many patients report in the clinic: once healed and comfortable with the device, sexual function becomes consistent, and confidence returns. ⁸

A penile implant is a durable, on-demand solution for ED with high satisfaction and low infection risk in well-selected patients. For gay men, the key is personalization: choose a surgeon who will talk candidly about your sexual goals, optimize device selection and sizing for strong axial rigidity and comfort, and guide you through recovery so you can return to the sex life you want, safely and confidently.

As a fellowship-trained urologist in men’s sexual health, Dr. Kapadia prioritizes respectful, individualized care. He has been designated as a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence surgeon for penile implants. If you’re considering an implant or just want to understand your options, schedule a confidential consultation. Bring your questions, your goals, and your partner if you’d like. We’ll talk through candidacy, device choices, recovery, and what sex can look like afterward so you can make an informed decision that truly fits you.

Notes on evidence: Research specifically focused on gay men with penile implants is limited but growing; early studies suggest high satisfaction, consistent with broader implant literature. Anal intercourse can involve higher axial forces, which is relevant for device selection/sizing and return-to-sex recommendations.

References:

  1. Levine, L. A. (2024, April 25). AUA2024 PREVIEW Prevention and Treatment of Inflatable Penile Prosthesis Infection, and Placement Following Explant – American Urological Association. American Urological Association News. https://auanews.net/issues/articles/2024/april-2024/aua2024-preview-prevention-and-treatment-of-inflatable-penile-prosthesis-infection-and-placement-following-explant.
  2. La, J., Loeb, C. A., Barham, D. W., Miller, J., Chung, E., Gross, M. S., Hatzichristodoulou, G., Park, S. H., Perito, P. E., Suarez-Sarmiento, A., Van Renterghem, K., & Yafi, F. A. (2023). Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high. International journal of impotence research, 35(6), 564–568. https://doi.org/10.1038/s41443-022-00603-2.
  3. Miller, J. A., Loeb, C. A., La, J., El Khatib, F., & Yafi, F. A. (2023). Penetrative anal intercourse may require high axial loading forces. The journal of sexual medicine, 21(1), 40–43. https://doi.org/10.1093/jsxmed/qdad156.
  4. Thirumavalavan, N., Cordon, B. H., Gross, M. S., Taylor, J., & Eid, J.-F. (2018). Rear Tip Extenders and Penile Prosthesis Rigidity: A Laboratory Study of Coloplast Prostheses. The Journal of Sexual Medicine, 15(7), 1030–1033. https://doi.org/10.1016/j.jsxm.2018.05.001.
  5. Chung, E., Bettocchi, C., Egydio, P. H., Love, C., Osmonov, D., Park, S. S., Ralph, D., Xin, Z. C., & Brock, G. (2022). The International Penile Prosthesis Implant Consensus Forum: clinical recommendations and surgical principles on the inflatable 3-piece penile prosthesis implant. Nature Reviews Urology, 19, 534–546. https://doi.org/10.1038/s41585-022-00607-z.
  6. Baird, B. A., Parikh, K., & Broderick, G. (2021). Penile implant infection factors: a contemporary narrative review of literature. Translational andrology and urology, 10(10), 3873–3884. https://doi.org/10.21037/tau-21-568.
  7. Moukhtar Hammad, M. A., Barham, D. W., Sanford, D. I., Amini, E., Jenkins, L., & Yafi, F. A. (2023). Maximizing outcomes in penile prosthetic surgery: exploring strategies to prevent and manage infectious and non-infectious complications. International Journal of Impotence Research, 35, 613–619. https://doi.org/10.1038/s41443-023-00773-7.
  8. La, J., Loeb, C. A., Barham, D. W., Miller, J., Chung, E., Gross, M. S., Hatzichristodoulou, G., Park, S. H., Perito, P. E., Suarez-Sarmiento, A., Van Renterghem, K., & Yafi, F. A. (2023). Satisfaction rates of inflatable penile prosthesis in men who have sex with men are high. International journal of impotence research, 35(6), 564–568. https://doi.org/10.1038/s41443-022-00603-2.

Low T: Patch, Pellet, Pill, or Shot

Posted on by Akash Kapadia, MD in

Man touching hormone patch on arm

Testosterone replacement therapy (TRT) is having a moment. Scroll through social media, tune into late-night radio, or walk past a strip mall, and odds are you’ll spot an ad or clinic offering to “boost your T.” But behind the hype is a decades-deep history of clinical use and an evolving toolkit designed to restore balance for men dealing with low testosterone.

Just how many decades back did the research start? In 1889, physician Charles-Édouard Brown-Séquard injected himself with a concoction made from animal testicles, believing it rejuvenated his vitality. While his experiment was probably more alchemy than science, it sparked over a century-long exploration into testosterone’s potential. By the 1930s, testosterone had been isolated and synthesized in a lab; by the 1950s, longer-acting injections became the gold standard of therapy.¹

Since then, TRT has expanded to include intramuscular injections, transdermal gels, subdermal pellets, buccal tablets, nasal sprays, and, more recently, oral capsules, each with unique pharmacokinetics and benefits.

We’ve come a long way, with options that are more ethical, advanced, accessible, and personalized – but they also require thoughtful guidance. In the following sections, we’ll dip into modes of testosterone delivery, how they work, and what patients can expect from each one.

Modern Options

Testosterone, the primary male sex hormone, plays a central role in sexual development, reproductive function, muscle mass, bone density, and mood regulation. When levels dip too low – a condition known as hypogonadism – men may experience symptoms ranging from fatigue and depression to erectile dysfunction, infertility, and reduced lean body mass. In cases where testosterone is measurably low (typically under 250 nanograms per deciliter), clinicians may recommend therapy to bring levels back into a normal physiological range.

While testosterone levels naturally decline with age, dropping about 1% per year starting around age 30, not all men develop symptoms. That’s why treatment isn’t based solely on numbers, but on the presence of real, disruptive symptoms supported by lab work and a legitimate medical evaluation.

The FDA-approved options on the market today offer flexibility in how testosterone is delivered, how often it’s dosed, and how steadily it’s absorbed. Each route comes with its rhythm, risks, and appeal depending on your lifestyle, goals, and medical profile.

Subdermal Pellets

Testosterone pellets are tiny cylinders placed just under the skin (usually in the upper buttock or hip area) during a quick in-office procedure. Once implanted, they slowly release testosterone over several months by diffusing steadily into the surrounding tissue and bloodstream.

Why people like them: They’re hands-off after insertion. No daily doses, no weekly shots, and most people get them reinserted every 3 to 6 months. Pellets are popular for their consistency, eliminating the need for self-administration or adhering to a strict daily schedule.

What to consider: The timing of symptom relief and when levels start to taper can vary. Some men feel great right away, while others may experience a lag as hormone levels build. Toward the end of the dosing cycle, it’s common for symptoms to return as the pellets lose potency.

There’s also a small risk that the pellet may work its way out or cause skin irritation or infection at the insertion site. It doesn’t happen often, but it’s worth being informed when making a decision.

Intramuscular Injections

Testosterone injections have been around longer than any of the other methods of delivery. They’re typically administered into a large muscle (like the glute or thigh) every 1 to 2 weeks, depending on the formulation or brand.

Why people like them: Injections deliver a full dose of testosterone directly into the bloodstream, which can bring fast symptom relief. Many men appreciate the simplicity and cost-effectiveness, especially when self-administering becomes routine.

What to consider: Levels can spike and crash between injections, leading to mood swings or fluctuations in energy. Some men find the needle aspect intimidating at first, but with a little practice (or help from a provider), it usually becomes second nature.

Transdermal Gels and Patches

Transdermal testosterone is delivered through the skin in two forms: gels and patches. Gels are applied once daily to clean, dry skin – typically on the shoulders, upper arms, or abdomen – while patches are worn continuously, usually on the back, thigh, or upper arm, and replaced every 24 hours.

Why people like them: Both gels and patches offer a consistent, daily dose of testosterone that closely mimics the body’s natural hormone cycle, offering steady absorption and bypassing the peaks and valleys commonly associated with intramuscular injections. Gels absorb quickly with minimal mess, and patches are easy to use once you get into a routine – no needles or office visits required for administration.

What to consider: Transdermal methods require careful hand-washing and drying time before dressing to avoid skin transfer to others, especially children or partners. Patches can sometimes cause mild skin irritation or redness at the application site, and may not stick as well in hot or humid climates. Still, many men find these options easy to integrate into daily life with a bit of trial and error, and rotating where the patch is applied helps to reduce skin irritation.

Oral Capsules

Several oral testosterone options have been FDA-approved in the last five years. In the past, oral testosterone was discontinued due to concerns about liver toxicity. But newer formulations have solved that issue by bypassing the liver entirely – they’re absorbed through the lymphatic system instead, making them a safer option for long-term use.

Why people like them: Oral testosterone is straightforward and needle-free. It’s in a form most of us are familiar with, and dosing is usually twice a day with food. There’s no need for patches, gels, or procedures, and it avoids the skin-to-skin transfer risks associated with topical products.

What to consider: Despite the convenience, hormone levels can sometimes fluctuate compared to other delivery methods until you get a rhythm going. Some men also experience gastrointestinal side effects, and for those with cardiovascular concerns, you’ll need to work more closely with your provider.

Buccal Tablets

These are small, sticky tablets that you press against your upper gum twice a day, where they slowly dissolve and deliver testosterone through the tissues in your mouth.

Why people like them: They’re discreet, they don’t require needles or gels, and they don’t come with the peaks and valleys of some other methods. Once they’re in place, you can go about your day with a steady release of testosterone.

What to consider: They can take a little getting used to. Some men notice a strange taste and potential gum irritation. The need to apply it twice a day like clockwork creates a steady influx of the medication, so missing a dose can throw off the constant flow your body gets used to.

Nasal Spray

Nasal delivery is a fast-absorbing option for men seeking more frequent microdoses – one spray in each nostril, three times a day. It might seem odd to take a hormone through your nose, but the nasal lining gives testosterone a direct and efficient path to your bloodstream.

Why people like it: It’s a good option if you’re looking for something less invasive that keeps hormone levels from swinging too much, and it has the advantage of minimal systemic buildup, meaning there’s less chance of having to dial back the dose to avoid off-target effects from elevated testosterone levels.

What to consider: Because it requires multiple applications a day, it might not suit everyone’s schedule. Nasal irritation or a stuffy nose are potential side effects, and the delivery can be impacted by congestion, especially in allergy season.

The Next Move

Research shows that most delivery methods are equally effective in raising testosterone to therapeutic levels and improving body composition, mood, and sexual function.² What differs most is the side effect profile and how well each method fits into your daily life. Other medications you take will also be a deciding factor.

With so many options on the market, it can be tricky to navigate legitimate therapy and fly-by-night online distributors. That’s why it’s essential to work with a knowledgeable and experienced provider who understands the nuances of hormone therapy and can tailor treatment based on your full medical picture.

If you’re feeling a drop in energy, a dip in sex drive, or noticing changes in mood or muscle tone, Dr. Kapadia specializes in personalized hormone therapy that prioritizes safety, efficacy, and your preferences. Reach out to schedule a consultation and start feeling like yourself again.

References:

  1. Figueiredo, M. G., Gagliano-Jucá, T., & Basaria, S. (2022). Testosterone Therapy With Subcutaneous Injections: A Safe, Practical, and Reasonable Option. The Journal of clinical endocrinology and metabolism, 107(3), 614–626. https://doi.org/10.1210/clinem/dgab772.
  2. Ahmad, S. W., Molfetto, G., Montoya, D., & Camero, A. (2022). Is Oral Testosterone the New Frontier of Testosterone Replacement Therapy?. Cureus, 14(8), e27796. https://doi.org/10.7759/cureus.27796.

Dyspareunia in Men: When Sex Hurts

Posted on by Akash Kapadia, MD in ,

Man lying in white sheets experiencing discomfort, both hands over eyes

Many people, for a multitude of reasons, don’t talk about experiencing pain during sex. When the infrequent conversation does come up, it’s usually in the context of women’s health. In men’s health, it comes up even less often.

Do a quick search online, and you’ll find that most articles and studies about dyspareunia focus on women. Very few address men. That knowledge gap reflects just how little attention it gets, even though men can also experience pain during or after intercourse. Pain during sex in men remains under-recognized, under-reported, and under-studied.

That doesn’t mean it’s uncommon. Studies estimate that about 5% of men worldwide experience painful intercourse at some point in their lives – that’s roughly 190 million men across the globe.¹

Intimacy is natural, and a healthy sex life is part of overall well-being. When things in the bedroom become uncomfortable, it’s not something to ignore. In this article, we’ll spotlight common causes, what you can do about them, and when it’s time to speak with a healthcare provider.

What’s Triggering the Pain?

Sex isn’t supposed to hurt. When it does, it’s likely a signal that something deeper could be going on, so don’t just power through it. Do some medical detective work with your urologist and men’s health provider to figure out what’s going on. Although not exhaustive, here are some of the most common causes.

Infections and Inflammation

Pain during sex can be the body’s way of sounding the alarm for an underlying infection. Urinary tract infections (UTIs), sexually transmitted infections (STIs), and prostatitis (inflammation of the prostate) can all cause discomfort or burning during ejaculation, urination, or penetration. Balanitis (inflammation of the head of the penis or foreskin) is another common source of pain. Any inflammation in the genital region can make even mild friction feel unbearable.

We can’t avoid every germ we encounter or the disruption microbes can cause. Still, safer sex practices and good hygiene can create a physiological environment that is inhospitable to them. When the culprit isn’t bacterial, proactive health strategies (like regular checkups, stress management, and an anti-inflammatory lifestyle) can support immune function and lower the risk of chronic inflammation.

Treatment depends on the source: antibiotics for bacterial infections, antivirals for STIs, and pelvic floor therapy or medication for chronic prostatitis. All of the above respond well to additional dietary or lifestyle adjustments in conjunction with medical attention.

Pelvic Floor Dysfunction

When the pelvic floor muscles are overly tense, imbalanced, or irritated, they can compress or entrap nearby nerves like the pudendal nerve, which runs through the pelvis and into the genitals. This can lead to pain that radiates into the groin area, thighs, lower back, and toward the penis or scrotum that’s sharp, burning, tingling, or aching. Some people also describe a pressure or “foreign body” sensation in the rectum or urethra.

The pelvic muscles also support the bladder, bowel, and reproductive organs. Because of the neighboring structures, issues with pelvic floor dysfunction (PFD) can create a cascade of symptoms that feel worse with sitting, sex, bowel movements, or stress.

Referred or radiating pain is one reason PFD can be misdiagnosed or overlooked. It often mimics other issues like prostatitis, sciatica, or hernias, but doesn’t respond to antibiotics or typical treatments for those conditions.

Pelvic floor dysfunction can stem from physical strain, injury, prolonged sitting, poor posture, or stress-related muscle clenching. It’s especially common among cyclists, weightlifters, and people with chronic tension patterns. Unlike infections or injuries, this type of pain often doesn’t show up on imaging or lab work, making it frustrating to diagnose.

Once it can be identified, it’s highly treatable. Pelvic floor physical therapy, biofeedback, breathing exercises, and bodywork can all help retrain muscles to relax and coordinate properly. In some cases, muscle relaxants or targeted injections may be helpful, and many men find lasting relief through conservative, movement-based approaches or a combination of therapies.

Skin Conditions

The skin on the penis is delicate, and like skin anywhere else, it can be affected by dermatological conditions. Eczema, psoriasis, lichen sclerosus, and contact dermatitis can all show up in the genital area, sometimes without warning. These conditions may cause redness, dryness, flaking, or cracking of the skin. Add the friction of sexual activity to already irritated skin, and discomfort is almost inevitable.

Flare-ups can be mitigated by identifying triggers – harsh soaps, fragranced body products, latex, certain fabrics, or even excessive moisture can all contribute to skin irritation. When it comes to our more sensitive parts, switching to gentle, non-irritating products can go a long way.

Treatment often includes topical steroids or barrier creams, but a dermatologist’s insight is warranted, especially if the condition is chronic. Avoiding allergens, keeping the area clean and dry (but not overly so), and using lubricants during sex can help prevent skin irritation.

Phimosis

Phimosis is a condition in which the foreskin is too tight to be pulled back over the head of the penis. In some cases, it’s present from birth and resolves naturally. But when it persists or develops later in life, often due to repeated infections or inflammation, it can make erections and intercourse painful. Even minor retraction can cause tearing or micro-injuries, making future encounters more stressful and uncomfortable.

Maintaining good hygiene and avoiding irritants can help prevent inflammation that exacerbates tightness. In recurrent or more severe cases, topical steroid creams can reduce tightness and inflammation, sometimes eliminating the need for surgery. Gentle stretching exercises may also help at times when inflammation isn’t present. When conservative options don’t work, surgical approaches like circumcision or preputioplasty might be considered.

Peyronie’s Disease

Peyronie’s disease occurs when scar tissue develops under the skin of the penis, causing it to bend or curve, sometimes too sharply, making erections quite painful. The curvature can make sex painful or even impossible. The condition can develop gradually or occur after an injury, and some men may not recall a specific event that triggered it.

There’s no surefire way to prevent Peyronie’s disease, but reducing the risk of injury during sex by using adequate lubrication and avoiding rough thrusting can help. Early diagnosis and treatment in the initial inflammatory stage can help prevent progression.

Treatment depends on the severity of the symptoms. For mild cases, watchful waiting may be enough. In more bothersome cases, options include injections into the scar tissue, traction therapy, or surgery for unresponsive cases.

Past Trauma or Surgery

Past injuries to the penis, pelvis, or perineum, usually from accidents, sports, or surgical procedures, can leave behind more than just scar tissue. Nerve damage, altered anatomy, or chronic pelvic floor tension may develop long after the original injury has healed. Even surgeries like hernia repair, prostate procedures, or circumcision can lead to lingering pain or changes in sensation that show up most clearly during sex.

Prevention isn’t always possible, but seeking early treatment for injuries and being proactive with post-surgical care can reduce incidences of long-term pain.
Treatment depends on the nature of the trauma. Pelvic floor therapy, nerve pain medications, scar tissue mobilization, or even reconstructive surgery might be needed. It’s also helpful to work with a provider familiar with post-surgical complications, particularly if pain develops months or even years after the event.

Pain Echoes

Sexual pain is often made worse by the stress it causes – our perception of pain, and the anticipation of it, can intensify how we experience it. Anxiety, fear of pain returning, and a sense of embarrassment can create a feedback loop, where worry tightens muscles, dulls arousal, and heightens the body’s pain response.

Even when the root cause is physical, the nervous system’s pain signals can become amplified, and the body may stay on high alert. Addressing pain with awareness of both the source and the surrounding stress is part of a holistic approach to care and leads to better outcomes.
Therapists who specialize in sexual health can be a real asset in this department. They’re trained to help people reconnect with their bodies through guided support that calms the stress response, reduces discomfort, and rebuilds confidence in intimacy.

Get In Touch

Painful sex doesn’t need to be your norm, and it’s not something to tough out alone. If you’ve been experiencing discomfort that doesn’t go away, seems to be getting worse, or is interfering with your ability to enjoy intercourse, it’s time to talk to someone.

Start with a provider who listens, takes your symptoms seriously, and is willing to explore beyond surface-level explanations. You deserve honest answers and relief.

Dr. Kapadia is a board-certified urologist with fellowship training in male sexual and reproductive health. Schedule a visit to dissolve pain, restore intimacy, and start enjoying your sex life again.

Reference:
  1. DelCea, C. (2019). Dyspareunia in Men. International Journal of Advanced Studies in Sexology, 1(1), 48–52. https://doi.org/10.46388/ijass.2019.12.11.120.

Rebuilding Connection: Penile Implants & Quality of Life for Patients and Their Partners

Posted on by Akash Kapadia, MD in ,

Couple embracing outdoors during sunset

Sex isn’t just about sex. It’s about closeness, confidence, desire, and feeling like yourself. When erectile dysfunction (ED) enters the picture, it can take a toll far beyond the bedroom. Patients often describe a quiet erosion of connection, marked by less eye contact, increased distance, and fewer shared moments. Partners feel it too – frustrated, concerned, or unsure how to help.

For couples dealing with ED, the strain is both physical and emotional. Research shows ED can significantly impact mental and emotional well-being, not just for the individual, but for their partner, too. Many patients experience a dip in self-esteem, confidence, and even depression. Partners often report feeling unwanted, rejected, or isolated in response.¹ And when pills or pumps don’t work (or stop working), it’s easy to feel like hope is off the table.

But it’s not.

Inflatable penile prostheses (IPPs), also known as penile implants, are a highly effective, discreet, and long-lasting solution that’s helping men restore their sexual function and reclaim their quality of life. And research shows that both patients and their partners are overwhelmingly satisfied with the results.

Information about the mechanics of penile implants is widely available. But let’s focus on what really matters: how people feel afterward.

What the Numbers Say

Psychological factors such as stress, negative self-talk, or fear of failure in the moment are almost the worst part about ED – what researchers call “cognitive interference.” A penile implant eliminates the need to mentally manage the timing and success of medication, removing a significant source of anxiety.¹

In one study, more than 83% of patients were satisfied with their implant a year or more after surgery and said that they’d recommend it to a friend.² Another review noted satisfaction rates as high as 90%, putting penile implants on par with other life-enhancing surgeries like knee replacements and breast augmentation.³

Why so high? There’s the obvious reason, of course – regaining an erection. But it also brought people back to a place of comfort, connection, and spontaneity. For many couples, the implant removes the performance anxiety and pressure that often comes with ED. Intimacy becomes possible again, without the clock ticking on medication or external devices.

Men, as well as women, just want to be close to their partner again, and 85% of partners reported satisfaction with the results, alongside the men themselves.⁴ The better the partner feels, the more satisfied the patient is, and vice versa. Restoring erectile function helps restore emotional equilibrium for both partners.

Partners play a huge role in recovery, communication, and emotional healing. That’s why more urologists now encourage couples to come to consultations together to ask questions, express concerns, and start rebuilding trust as a team.

More Than an Erection

Sure, regaining sexual function is important. But the benefits of a penile implant often reach well beyond the bedroom. Patients frequently report improved confidence, reduced stress and anxiety, increased relationship satisfaction, and a return to physical closeness that had been absent for months or even years.

And while not every couple discusses these feelings out loud, many describe a quiet shift in their relationship – hand-holding comes back, affectionate jokes return, and emotional intimacy starts to feel easier again.

Some men worry the implant will “feel fake” or that their partner won’t accept it. In reality, most partners are grateful to regain intimacy and connection. Many couples report that once they adjust, the experience feels natural and emotionally freeing. And while the idea of surgery can seem daunting, the procedure itself is straightforward. Most patients return to light activity within a few days, and sexual activity within 4 to 6 weeks – just a brief recovery when you consider the months or even years of frustration that came before. Even better? Most implants last 10 to 15 years or more, making them a long-lasting solution to a long-standing challenge.

Most implants today are inflatable, discreet, and completely concealed within the body. Once healed, there’s no visible sign, and the function is entirely under your control. That means no waiting for pills to kick in or worrying about timing. It’s there when you want it, and completely undetectable when you don’t.

And with satisfaction rates this high, you’re investing in so much more than a medical device – you’re investing in quality of life, for yourself, and your partner.

Penile implants offer men and their partners a chance to reclaim something deeper. Whether ED has been a lingering issue or a recent frustration, you deserve to know your options and to have a partner in that conversation.

If you’re ready to talk about what life after ED could look like, Dr. Kapadia is here to help. He is a Coloplast Titan and Boston Scientific AMS 700 Center of Excellence for penile implants, and one of the few centers in the nation to achieve this dual designation.

He can offer expert guidance to patients and couples exploring treatment options, and has helped many people find their way back to a satisfying, connected life.

The earlier the ED is addressed, the less emotional distance builds between partners. Don’t wait until things feel unmanageable – many couples say they wish they’d explored treatment sooner.

References:

  1. Allen, M. S., Wood, A. M., & Sheffield, D. (2023). The Psychology of Erectile Dysfunction. Current Directions in Psychological Science, 32(6), 487–493. https://doi.org/10.1177/09637214231192269.
  2. Jorissen, C., De Bruyna, H., Baten, E., & Van Renterghem, K. (2019). Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Current Urology, 13(2), 94–100. https://doi.org/10.1159/000499286.
  3. Barton, G. J., Carlos, E. C., & Lentz, A. C. (2019). Sexual Quality of Life and Satisfaction With Penile Prostheses. Sexual Medicine Reviews, 7(1), 178–188. https://doi.org/10.1016/j.sxmr.2018.10.003.
  4. Jorissen, C., De Bruyna, H., Baten, E., & Van Renterghem, K. (2019). Clinical Outcome: Patient and Partner Satisfaction after Penile Implant Surgery. Current Urology, 13(2), 94–100. https://doi.org/10.1159/000499286.