Author: Akash Kapadia, MD

Could How You Grow Your Hair Be Causing ED?

Man looking in mirror touching hair

One of the most concerning issues that male patients discuss with their friends or physicians is hair loss. For many, hair is a sign of virility, and despite the inevitability of male pattern, baldness, which ultimately comes down to genetics, we still fight for that hair tooth and nail. It’s no wonder that hair restoration has grown to be such a huge industry and is rife with therapies that work and others that many claim to be effective but don’t have much data to support the assertion. From micro-needling rollers to caffeine ointment, red light therapy, various essential oils, and medication, there’s an overwhelming amount of information to process and seemingly impossible decisions to make.

Enter Finasteride

Finasteride is a drug known as a five alpha reductase inhibitor. Its main claim to fame is the very effective blockage of dihydrotestosterone (DHT (finasteride blocks upwards of 90% of DHT in the prostate and 70% in the blood)). DHT is essential to the normal workings of our bodies and is instrumental in developing male characteristics. However, excess DHT on our scalp later in life can cause hair follicles to shrink and ultimately die. By controlling the DHT systemically via the oral intake of finasteride or locally through topical applications, we see some of the very best hair regrowth results of any therapy.

It’s worth understanding that finasteride was not developed as a treatment for hair loss but rather to slow the growth of the prostate to fight a natural process known as benign prostatic hyperplasia (BPH) that affects most men later in their lives. However, it soon became clear that men taking this drug grew more hair on their scalps, and you have the ubiquitous drug we are used to hearing about today.

The Side Effects of Finasteride

For all its benefits, Finasteride has some potentially significant side effects. They mostly revolve around the effects of very low DHT, including low libido, reduced general function, depression in some, and even erectile dysfunction. These effects seem more pronounced when finasteride is taken orally, but the topical version can also be problematic. Younger men seem to have greater side effects than their older counterparts. As such, if you are currently using finasteride therapy for hair loss and having difficulty maintaining an erection, you may wish to speak to Dr. Kapadia to understand more about the systemic effects that both the oral drug and, to a lesser extent, topical application can cause.

What Is the Answer?

If you look up the recommended dosages of oral finasteride, you may be shocked to see how varied they are. Dosages from .5 mg up to 5 mg are routinely prescribed. Why so much variance? We all react differently to finasteride; no single dosage makes sense for every patient. However, as with most drugs, we strongly encourage working with your primary care physician, urologist, and hair loss specialist, to take the minimum effective dose. This helps ensure the drug can take effect while minimizing its potential, side effects, and considerations. This dosage can, of course, be modified to find a sweet spot. And patients should be aware of how their body reacts in the days and weeks after changing their dosage.

It’s also important to remember that finasteride may not cause erectile dysfunction and that aging is making it more difficult for you to achieve and maintain an erection during intercourse. In this situation, we can work with you to develop an erectile dysfunction treatment plan, including medication like sildenafil (generic Viagra) or tadalafil (generic Cialis), or for more severe erectile function, problems, course of injections, or even a penile implant.

Most importantly, speak to us about this and any other erectile function issues he may have. While it may feel awkward to have that conversation, we’ve helped thousands of men with the same problem, and want you to rest, assured that it is nothing to be ashamed of. Ultimately, erectile function can be achieved, no matter how bad your condition.

Male Infertility and Testicular Heat

Man in white shirt and underwear with hand on hip

You probably heard it at some point in your life – stay away from those “tighty whiteys.” It may seem like a trivial piece of advice that was never fully explained to you as a child or young adult. However, it is a warning rooted in excellent science and can make a difference in a man’s fertility.

To understand precisely how the proper function of the testicles makes a difference in male fertility, we need to understand more about the anatomy. There is a good reason why the testicles hang outside of the body exactly the way they do – for temperature regulation. Sperm production and quality are most efficient at several degrees below average body temperature – around 93 degrees Fahrenheit.

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Why Can It Take So Long to Regain Erectile Function After Prostatectomy

Man and woman lying together holding hands on the mans chest

In the early days of radical prostatectomy, the anatomy of the prostate remained poorly understood. Erectile dysfunction occurred in all men who underwent a prostatectomy in those times. However, with an improved anatomic description of the prostate several decades ago, we began understanding the erectile nerves that envelop the prostate gland. This led to the advent of a procedure known as a nerve-sparing radical prostatectomy, which is now performed most often robotically. Despite taking great care in sparing the erectile nerves with the incredible 3-D visualization of robotic technology, virtually all men still get erectile dysfunction temporarily. Many fortunately regain erectile function over the period of months to a year. This is not to say that the nerve-sparing feature of the surgery is not essential. Quite the opposite. However, it has become evident that the involvement of other structures during surgery contributes to ED.

How Long Does Erectile Dysfunction Last After Prostatectomy?

Despite the nerve-sparing nature of the surgery, most patients experience ED that lasts beyond the physical recovery time after a prostatectomy. We expect most patients to regain erectile function in one to 12 to 18 months. That is considered the goal; for some, it can take up to two years. Up to 50% of patients may never regain erectile function and will need to consider alternative treatment options.

What Can Be Done?

For patients that require a prostatectomy to address fast-growing or aggressive prostate cancer, the best option is to visit a urologist and men’s health specialist like Dr. Kapadia, who has a specific program for patients with post-prostatectomy impotence. Our program follows a stepwise approach to address the two most common and disruptive concerns a man will face after a prostatectomy – ED and urinary incontinence. The first phase starts soon after cancer treatment and will include daily 5mg Tadalafil, generic Cialis, or Sildenafil, generic Viagra, on demand. If necessary, we may move on to injection therapies and other proven rehabilitative options. For most, this will improve erectile function satisfactorily; however, for some, we may need to continue to the restoration phase of treatment if we do not see results within the first year to 18 months. That said, we don’t give up because everyone’s anatomy is different, and there is no linear improvement in erectile dysfunction. Learn more about Dr. Kapadia’s post-prostatectomy rehabilitation and restoration program.

The Long-term Solution

For those who have not regained satisfactory erectile function after 12-18 months, there is a good chance that the dysfunction will not reverse. At this point, it is time to discuss an inflatable penile prosthesis, also known as a penile implant. Penile implants carry a very high satisfaction rate for couples and represent an elegant solution to a complex problem. The implant is completely customized to a man’s anatomy and provides a natural-appearing erection. Most importantly, the sensation, the ability to climax, and urination are completely unchanged. This means a man can enjoy a full and normal sex life with their partner.

For more information, we encourage you to contact our office to explore erection rehabilitation options after prostatectomy. If you are experiencing erectile dysfunction for any reason, we can discuss the possibility of a penile prosthesis.

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The Different Causes and Treatments for Erectile Dysfunction (ED)

Man standing covering crotch with both hands crossed

The prospect of erectile dysfunction, or not being able to perform sexually, either due to the inability to achieve an erection or maintain that erection throughout intercourse, strikes fear into the hearts of young and older men alike. And while ED may seem like a concern that would only affect those of advanced age, that’s not necessarily the case. There are different reasons why erectile dysfunction may occur, and each of these has treatment options to address the root cause.

Here at our practice, we have no shortage of younger men – those under the age of 40 – that experience problematic ED. These men can suffer from a variety of issues, both organic (structural) and non-organic such as anxiety, poor past sexual experiences, depression, and more. Regardless, they are often relieved that the cause of their erectile dysfunction can often be treated with medication or talk therapy.

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Is It BPH or Prostate Cancer?

Skeletal diagram showing a highlighted prostate

Patients often worry about the possibility of prostate cancer when they experience lower urinary tract symptoms, like urinary frequency, urge to urinate, or an inability to fully empty the bladder. These concerns are legitimate, but many patients’ minds go directly to the worst-case scenario they can think of – cancer. However, it is essential to understand the differences between benign prostate issues, like BPH, and something insidious, like prostate cancer.

First, the patient should understand that prostate cancer rarely presents with symptoms, especially in the earliest stages. Therefore, if you are experiencing some or all the symptoms above, chances are it is related to an enlarged prostate and not cancer. This is not to say that a trip to a urologist is not warranted—quite the opposite. Visiting your urologist at this point is essential as we can help eliminate the symptoms associated with BPH and improve your quality of life and lifestyle. Remember that BPH is a progressive disorder, and purported remedies such as saw palmetto have no proven benefit. On the flip side, minimally invasive BPH therapies like Rezum, which uses water vapor to ablate or destroy excess prostatic tissue, are convenient and very effective for upwards of five years from the procedure day.

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The PSA and How We Use It

PSA test held by person in glove

Prostate-specific antigen, or PSA, was discovered in 1970, and a purified form that could be used for diagnostics was developed in the 1980s. PSA measurement started as a way to track the effectiveness of prostate cancer treatment but, in the early 1990s, quickly became the definitive first-line diagnostic measure for prostate cancer. PSA is unique in that it is only produced in the prostate, and levels can fluctuate based on the health of the prostate. In fact, much of the reduction in prostate cancer mortality since the 1980s has been attributed to PSA screenings.

However, early on, patients with elevated PSA were often biopsied as a matter of course. Then, when prostate cancer was found, they were referred, amongst other treatments, to surgery in the form of a prostatectomy. This started an era of overtreatment of prostate cancer. We now know that many cases of prostate cancer are not aggressive, and some men may even be able to live normal lives with prostate cancer and routine watchful checkups, never needing to treat it in their lifetimes. We also know that using a single PSA reading makes this testing method unreliable in predicting clinically significant prostate cancer.

The result was that many men were unfortunately rendered impotent and incontinent due to prostate cancer surgeries that were the standard of care at the time, but we now know to have been unnecessary. We still see some patients that implant inflatable penile prostheses years or decades after becoming impotent due to prostatectomy.

Upon analysis by a U.S. Preventative Task Force in the 2010s on the effectiveness of screening (including PSA), there were some damning results in a report that was subsequently used to campaign against this test. Of course, there were some significant limitations, including no urologic specialist being on the task force and the use of older data from the times of overtreatment. For a while, it seemed that PSA, as a front-line diagnostic tool, would be relegated to the history books. Fortunately, this was not to be the case.

Modern PSA Testing

In what can only be described as a stunning turnaround for PSA testing, we now consider PSA to be one of the most accurate diagnostic tests in urology, and maybe all of medicine, not because of a single reading but because of how they trend. Today, we use a series of two or three PSA readings to understand whether the prostate should be biopsied and, ultimately, if prostate cancer should be treated. With this newfound knowledge and a deeper understanding of the art of PSA trend testing, we are better able than at any time in the past to differentiate clinically insignificant prostate cancer from that which needs biopsy and treatment.

Of course, prostate cancer still exists, and tens of thousands of men die each year due to aggressive forms of this cancer. Along with better diagnostic tools, we need men to prioritize prostate cancer screening, which is not only simple but less invasive than many other cancer screenings.

Next Steps

Prostate cancer is insidious because it often does not show symptoms until it has reached a more advanced stage. The first step toward improving prostate health and early cancer detection is speaking to your primary care physician or a men’s health urologist like Dr. Kapadia to understand your risk for prostate cancer and develop an appropriate screening plan. It is worth noting that lower urinary tract symptoms like urgency, frequency, the inability to empty the bladder fully, and more are typically due to a benign condition known as benign prostatic hyperplasia or enlarged prostate and are rarely caused by prostate cancer.

As such, we encourage you to visit Dr. Kapadia for a consultation on your prostate health and to learn more about how to screen for prostate cancer and manage those findings.

Testing for Male Infertility

Depiction of sperm swimming in-front of blue background

Couples looking to conceive are often hypersensitive about their fertility. Many couples do not realize how long it can take to conceive – the general guidance for seeking fertility assistance is after about one year of trying. We’ve also learned much more about the causes of infertility over the past few decades, and we now know that male infertility accounts for about 50% of all cases. Before we get into testing, it is important to understand why males may be infertile. Ultimately, there are three overarching reasons:

  • First is a production problem. If the testes do not produce enough semen or sperm, they typically cannot reach the egg for fertilization.
  • Second, the shape (morphology) and movement (motility) of the sperm will also play a role, as these dysfunctional or deformed sperm cannot efficiently travel to the egg.
  • Finally, some men will also experience a blockage that prevents sperm from being ejaculated.

How We Test for Infertility

When couples suspect infertility, the next step is to see their respective sexual health specialists. For men, a urologist and men’s health specialist like Dr. Kapadia has the tools and diagnostic equipment to best assist. We take a stepwise approach toward understanding what issues, if any, may be preventing our patients from conceiving. These include:

When we first meet a male patient with infertility concerns, we perform a complete medical and lifestyle workup to understand more about potential contributory factors. We will discuss stress, diet, exercise, and other markers that may be impeding proper sexual health. The psychological component of infertility should not be overlooked, so we will discuss those concerns.

Semen analysis. As a first step, a semen analysis is required. This involves getting a sample and analyzing semen and the sperm contained therein. We will be looking at several markers, including the volume of semen produced, the amount of sperm within it, the ability of the sperm to move properly, known as motility, and the shape or morphology of the sperm. Semen analysis is very straightforward and performed in our office. However, we will take multiple semen samples over a few weeks as levels can change over time.

Hormonal analysis. Our body is regulated by chemicals produced in various areas of the body known as hormones. High or low hormone levels can cause infertility, so checking these levels through simple bodily fluid tests is a quick way to understand if there are any problems. Most commonly, we check on follicle-stimulating hormone (FSH) and testosterone. Other hormones may be checked as well.

Urinalysis. We may test patients’ urine for white blood cells, a sign of infection in the body, and test for sperm in the urine, known as retrograde ejaculation.

Ultrasound and X-ray. Using diagnostic imaging tools, we can check to see if there are blockages that would limit the flow of sperm into the semen,

Biopsy. In some cases, a biopsy of the testes, removing a small piece of tissue, may be appropriate to understand how sperm are produced and if there is a problem on the testicular level.

Can You Test at Home?

Most of the advanced diagnostic testing will be performed at your urologist’s office or a lab. However, there are home test kits to check for sperm count problems. These tests can be very accurate and relatively easy to use. However, low sperm counts should be confirmed and ultimately diagnosed by an appropriate specialist. Remember that the causes of infertility are many and varied, so using only one marker may not give a complete and accurate picture.

Is Male Infertility Getting More Prevalent?

The short answer to this question is yes. It seems that fertility rates are declining in men. This also appears to be happening in women. The most likely cause of this decline is endocrine disruption which involves hormonal or chemical imbalances. Research has been done on hormone-disrupting chemicals, many of which have been popularized by Dr. Shanna Swan. Public awareness of what is in our food and the products we use is starting to increase, but slowly. Chemicals in just about everything we consume, like BPA, phthalates, and PFAs, may all contribute to this fertility decline. Sadly, health regulatory agencies have not caught up to this potential threat.

Is It My Partner?

As mentioned above, about 50% of infertility cases are caused by a man, and a woman causes the other half. Breaking it down further, approximately 1/3 of cases can be attributed to the woman, 1/3 to the man, and the final third represents issues associated with both partners. We typically suggest that both partners visit their respective reproductive health specialists to get a complete picture of what may be causing infertility and receive appropriate treatment. Dr. Kapadia works with his female reproductive health counterparts to develop a comprehensive treatment plan if one or both partners have a fertility problem.

The Bottom Line

Infertility is becoming more prevalent in modern society because of several modifiable and non-modifiable factors. Speaking to a qualified men’s health specialist is truly the best way to understand more about infertility and possible treatments. However, patients should be aware that pregnancy does not often happen on the first or second try, so they should not jump to conclusions and do not need to visit a specialist for about a year without any luck. It is also crucial that partners keep an ovulation calendar, as this can dramatically improve the chances of conception. Lastly, a healthier lifestyle can improve the quality of sperm and the chances of getting pregnant sooner.

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Can Tongkat Ali Boost My Testosterone? A Urologist’s Perspective

Disclaimer: We want to address Tongkat Ali due to its recent and sudden rise in popularity, however, it is important to note that these studies are poorly designed and lack high-quality data. We can’t be sure of the benefits of Tongkat Ali until they are shown in well-designed clinical trials. Patients should consult with a physician regarding safety before starting any supplement regimen.

man dumping Tongkat Ali supplement from bottle into hand

Tongkat Ali or Longjack, an herb found in Southeast Asia and commonly used as part of traditional holistic medicine there, has risen in popularity due to claims about its effectiveness in increasing testosterone, reducing stress, and potentially even boosting male fertility. Various podcasters, including Joe Rogan and Professor of Neurobiology at Stanford University Andrew Huberman, have discussed this herb in depth. They posit that taking Tongkat Ali boosts antioxidant levels in the body to fight free radicals while normalizing certain hormones like testosterone and Cortisol. Do these claims hold water? Let’s dive in.

Before we evaluate each of these claims, it is important to note that the FDA does not oversee supplements. Therefore, you must do your due diligence about which supplements to buy, as their purity and concentrations can vary. Safety should be your primary concern. Continue reading “Can Tongkat Ali Boost My Testosterone? A Urologist’s Perspective”

Can “Forever Chemicals” Be Causing Male Infertility?

Several takeout containers including cups and bag lying across a counter

In the spirit of bringing you the latest research that affects male fertility, a Danish study¹ was recently published about the effects of forever chemicals and, in particular, PFAS or per and polyfluoroalkyl substances on sperm count and mobility. The study sought to understand how a mother’s exposure to these toxic chemicals during pregnancy could affect the child’s fertility later in life. Why does this matter? Testicular development in males occurs during the first trimester of pregnancy, and this is also a time when external endocrine disruptors can make a big difference. In this case, PFAS made up of thousands of different chemicals, accumulates in the human body and crosses the placental barrier into the child.

What This Study Showed

Approximately 860 men were evaluated. Their mothers provided blood samples during the first trimester of their pregnancy between 1996 and 2002. The study found that mothers with higher PFAS levels had children who were more likely to have a lower sperm count and mobility issues than adults.

Why This Study Matters

When we look at the increasing rates of male infertility, we know that there is no single cause. Instead, cases of infertility must be discussed and evaluated both from an individual and a societal level. It seems that exposure to these, amongst other environmental chemicals, may be partly to blame for some infertility cases. Most Americans have been exposed to and therefore retain PFAS in their blood – remember, once exposed, the body cannot remove these chemicals (hence the “forever” moniker).

Beyond infertility, these chemicals can also cause significant diseases later in life. Research suggests that these chemicals may cause metabolic disorders, including type-2 diabetes, high cholesterol, obesity, and more, all of which can also affect urinary health.

What’s the Prognosis?

Unfortunately, because of the ubiquitous nature of these chemicals, most pregnant mothers have been exposed to these toxic chemicals. Virtually every adult has been as well. Why? These chemicals are often used in food product packaging to improve their water and grease-resistant properties. The result is that many of your fast food and takeout containers have PFAS. Some of the most egregious packaging includes fast-food wrappers and boxes, popcorn bags, and pizza boxes.

How Can You Avoid These Chemicals?

Unfortunately, we do not yet have a regulatory structure identifying and regulating these chemicals. However, much like BPA and phthalates, consumers and food producers are taking note. Companies like Chick-fil-A, Chipotle, Whole Foods, and Burger King have alluded to or promised to remove these chemicals from their packaging. Of course, the time and cost to do so are such that we can expect to be exposed to these chemicals for many more years unless something is done from a public awareness or regulatory standpoint. For the time being, the fact that PFAS is not visible nor has acute effects (that we are aware of) often makes it a lower priority for many people. Regardless, working with a men’s health specialist like Dr. Kapadia is an essential first step to understanding the potential causes of infertility and developing a treatment plan to address it.

In the meantime, do your research to find out if any of the products you or your family members consume contain harmful chemicals. You may even wish to consider choosing products that specifically exclude these chemicals from their packaging. Even though it’s likely that we have all been exposed to PFAS already, reducing our future exposure can only be beneficial. Be your own health advocate by ensuring that what you eat and drink is not tainted by harmful chemicals.


  1. Petersen KU, Hærvig KK, Flachs EM, Bonde JP, Lindh C, Hougaard KS, Toft G, Ramlau-Hansen CH, Tøttenborg SS. Per- and polyfluoroalkyl substances (PFAS) and male reproductive function in young adulthood; a cross-sectional study. Environ Res. 2022 Sep;212(Pt A):113157. doi: 10.1016/j.envres.2022.113157. Epub 2022 Mar 19. PMID: 35318009.

Dr. Kapadia to Join Georgia Urology

Dr.Kapadia behind green and white background with Kapadia logo and Georgia Urology logo

After several successful years at Wellstar Urology, where he has become one of the leading penile implant surgeons in Atlanta, amongst other distinctions, Dr. Kapadia is excited and proud to be joining Georgia Urology in November 2022. Georgia Urology is celebrating 50 years of helping patients in Atlanta with their varied urologic needs and is the largest urology practice in Georgia and one of the largest urology practices in the country.

Dr. Kapadia will continue to be a leader in male infertility and erectile dysfunction at Georgia Urology and will serve patients throughout Atlanta. Of course, our attention to patient needs and quality is paramount, and this change will enhance our ability to provide the care you’ve come to expect from our team.

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