PODCAST- Dr. Judson Brandeis – Optimizing Men\’s Sexual Health

About Our Guest- Dr. Judson Brandeis – Optimizing Men\’s Sexual Health

Dr. Judson Brandeis trained in Urology at UCLA and currently practices sexual and rejuvenative medicine for men in San Ramon, California.  He was a pioneer in Surgical Robotics, Greenlight Laser and MRI prostate biopsy.  Dr. Brandeis was the Chief of Urology at John Muir Hospital and Hill Physicians from 2012-2018, and he was voted Top Urologist in the SF Bay Area (SF Magazine) 2014-2020.  

Dr. Brandeis has appeared on The Doctors Show and dozens of Podcasts and Webcasts.  He created the SWEET (Shock Wave Erectile Enhancement Trial) Study which is the largest study of Shock Wave therapy for ED ever done.  His other clinical research studies include the SWAP Study (Shock Wave and Peyronie’s) utilizing his special Peyronie’s disease SWT protocol, the P-LONG study for minimally invasive penile elongation, the MenSella Study using HIFEM technology for improving the intensity and duration of orgasm and the SURGE study using a transdermal technology to deliver Nitric Oxide to the penis.  

BrandeisMD in Northern California is at the leading edge of male rejuvenation and sexual medicine. Among the many cutting edge technologies, we use BioTE testosterone supplementation, Emsculpt and Emsella for muscular rejuvenation, and GAINSWave therapy and PRP for sexual rejuvenation.  

Dr. Brandeis also founded AFFIRM Science which creates supplements based on the most recent scientific data (AFFIRMScience.com).  

Full Podcast Transcription

Judson Brandeis 00:01
I mean everyone has an important role. But men are in a certain sense are really a linchpin of a certain part of society. And if you help that man, feel better about himself, you know, lose some weight, build some muscle, his hormones are better. He\’s having some regular physical intimacy, he\’s going to be much happier and he\’s going to make the people around him in his family, and his spouse, in his community, in his workplace so much better. So it\’s it\’s kind of like spreading the love. 

Diva Nagula 02:02

Hello everyone and welcome to another episode of From Doctor To Patient. Today I\’m joined with Dr. Judson Brandeis. He trained in neurology at UCLA and currently practices sexual and rejuvenative medicine for men in San Ramon, California. He was a pioneer in surgical robotics, greenlight laser and MRI prostate biopsy. He was the Chief of Urology at John Muir Hospital and Hill Physicians from 2012 to 2018. And he was voted top neurologist in the San Francisco Bay Area from 2014 to 2020. His appeared on the Dr. Show and dozens of podcasts and webcasts. He created the Sweet Study, which is Shockwave Erectile Enhancement Trial – it\’s the largest study of shockwave therapy for erectile dysfunction ever done. His other clinical research studies include the swab study, shockwave in Peyronie\’s disease, utilizing a special Peyronie disease SWT protocol. The P-long study for minimally invasive penile elongation, the mensella study using HIFEM technology for improving the intensity and duration of orgasm, and the surge study using a transdermal technology to deliver nitric oxide of the penis. Brandeis MD in Northern California is at the leading edge of male rejuvenation and Sexual Medicine. Among the many cutting edge technologies, we use bio-t testosterone supplementation, Emsculpt and Enstella for muscular rejuvenation in Gaines-Wave therapy and PRP for sexual rejuvenation. He also founded Affirm Science, which creates supplements based on the most recent scientific data. Affirm is a nitric oxide boosting supplement, Prelong as the management of premature ejaculation, Support is a natural testosterone booster and Spunk is to improve prostate health. He attended Brown University and as an undergraduate and Vanderbilt for medical school. He received a Howard Hughes Medical Institute Research Award for his year of transplantation immunology research at Harvard Medical School, is a member in good standing of the American Neurological Association, Sexual Medicine Society of North America and the International Society of Sexual Medicine. Dr. Brandeis, thank you so much for joining me here.

Judson Brandeis 04:28
Oh, it\’s my pleasure to be here. Thank you for inviting me.

Diva Nagula 04:31

You have such great accolades and it\’s really an honor to have you with your expertise to talk about sexual health. So I look forward to our conversation. How did you really hone in on this specific niche? I know you\’re an urologist, so naturally, you deal with a lot of sexual issues in men and in women, but your niche takes on a new, different style and it\’s very ingenious in how you\’ve put together all this knowledge and technology to really optimize sexual health.

Judson Brandeis 05:04
Yeah, you know, that\’s a great question. So everything in life that you do kind of builds on each other. And so, you know, the research that I did at American Red Cross, and when I was at UCLA, and when I was at Harvard, doing research kind of built onto that research base, and then the stuff that I did as a urologist, you know, sexual medicine is kind of a peripheral aspect of Urology. But I\’m a kind of a new technology junkie. So when robotics came out, I wanted to be the first one on the block to do it. When MRI guided prostate biopsies came out, I wanted to be the first one on the block to do it. And when I found out about shockwave therapy for erectile dysfunction, I thought, well, this is too good to be true. But if it really works, I want to be the first on the block to do it. And, and it actually really works in properly selected patients. And what I found was, it was really joyous to watch men in their 60s and 70s be able to recapture that part of their life, that was so important to them when they were younger. And then, you know, Viagra came out, so a large portion of the population was able to become sexually active again, but at a certain point, Viagra doesn\’t work anymore and so you need a regenerative technology like shockwave therapy, like PRP to be able to recapture those kind of things. And just seeing guys come in with that sort of giddy grin after five or six treatments, just was, was so rewarding that I sort of became addicted to sexual medicine.

Diva Nagula 06:40

Yeah, it\’s fantastic. And it\’s definitely rewarding when you\’re able to transform an elderly male and capture his youth and recapture his youth, because that\’s what everyone is really looking for. And I feel that really addressing sexual health can actually allow a person to feel young again, and that\’s, you know, really the fountain of youth, in my opinion, is being able to look and feel like you were when you\’re in your 30s and 40s as a 60 or 70 year old.

Judson Brandeis 07:10

Yeah, absolutely. I mean, we all have a decay curve, meaning that we\’re all going to get old and, and pass away anyway. You know, I have, in my practice, I have professional athletes, I have fighter pilots, I have all these sort of super high performing folks. But there\’s a slide that I show all my patients, which is the world record for the 100 yard freestyle, in swimming, and there\’s a definite curve. So between the ages of 20 and 60, the times for the best swimmers in the world are pretty close. But after 60, the slope of that change changes significantly. And then after 80, the slope of that change changes significantly. And this is for the top athletes in the world. So no matter what you do, you\’re going to decline more once you hit 60. And then that\’s going to accelerate when you when you hit 80. So my goal really is to help my patients maximize the life that they have. So we do that through shockwave therapy. We do that through a technology called emsculpt, which utilizes high intensity focused electromagnetic waves to improve muscle tone. We do that through supplementation. So I developed a supplement called Affirm, which is a nitric oxide booster and it\’s really a very overlooked part of physiology, are the nitric oxide supplements, but that itself really makes a tremendous difference in boosts physical activity, boosts cognition, boosts sexual function, boosts circulation about 10%.

Diva Nagula 08:46

When you start looking at a person, a male who has a erectile dysfunction, there are different causes of erectile dysfunction. And they\’re not the same across the board. So can we go into a little bit about what ED is and and the different stages of ED and low libido?

Judson Brandeis 09:05
Sure, absolutely. Well, libido and erectile dysfunction are two intertwined but separate functions. So, libido really comes from the hormone testosterone which is made by the testicle, it\’s the male hormone, it increases during puberty, which is responsible for our development as as men you know, pubic hair, penile elongation, deepening of the voice, building muscle, so on and so forth. And so it\’ll peak around 900, at about 20 years old. And then there\’s something called ADAM or the androgen decline of the aging male. And so over time, you can draw a line from 900 when you\’re 20 years old to 200 when you\’re 80 years old, and there\’s that slow and steady decline and libido was wrapped up in not just testosterone, but also life circumstance, right? So when you\’re young and you\’re carefree and you don\’t have a mortgage and you don\’t have kids, and so on and so forth, you run around, and you\’ll hump anything. But when you\’re 40, or 50, or 60, and you have a bunch of kids, and you have responsibility, and employees and job, and so on and so forth. You know, sex becomes part of your life, but it doesn\’t become the primary focus of your life, like it is when you\’re younger. And so that\’s sort of the libido story. And then there\’s also the complexity of relationships, right? If you\’ve been, I\’ve been married for 20 years. Marriages are complex things. There\’s all sorts of different aspects of marriages and physical intimacy is just a part of that. Now, in terms of erectile function, erections are almost entirely a focus of blood flow, right? So your heart pumps, and the first place the blood goes is back to the heart, then it goes to the brain, then it goes to the lungs, then it goes to the liver, then it goes to the kidneys, then it goes to the intestines, and then it splits into left and right. And then it splits into leg, and pelvis. And then within the pelvis, you go to the tailbone, you go to the gluteus muscle, you go to the bladder, you go to the prostate, and the very last branch of the internal iliac artery, goes to the penis, right, so the toes and the penis are the two last places they get blood. So that\’s kind of a bummer, right? You know, it\’d be nice if it was higher up on the vascular tree. And then if you think about the blood going to the foot, right, it goes in, and then it goes back out through the veins. But that\’s not good if you\’re the penis, right? Because the penis, you want to trap the blood. So what has to happen is the blood goes in, and then you have to have a mechanism by which the blood gets trapped within the penis. And so the way that the good Lord designed things is, as the blood pressure in the penis increases, the veins that take the blood out of the penis are trapped between two layers of connective tissue. And so as the pressure builds up, the exit of venous blood gets squished between those two layers. And when that happens, then you get penile rigidity, then you get the penis going up, right, so the penis is the only organ of the body with skin but no muscle. And it\’s the only organ in the body that moves entirely based on blood flow. Right? So you have to have a way to trap that blood flow in the penis. And so really, my job or one of my jobs, when my patients come in complaining of erectile dysfunction is to figure out a way to get the blood pressure in the penis high enough to prevent that venous leak. So I have a whole algorithm of ways that I do that. And I\’d be happy to go through that.

Diva Nagula 12:49 Yeah, that\’d be great. Sure.

Judson Brandeis 12:50
Okay. So your body moves blood around from place to place, right? So you wake up in the morning, you go for some exercise, blood is in the muscles, right? Then you go eat breakfast, blood goes to the intestines, then you go to work, blood goes to the brain. So how does your body move blood around from place to place? Well, first of all, you have a signal. And then second of all, you have the pipes. Okay, and in your body, the signal for opening up blood vessels is a molecule called nitric oxide. And I was at UCLA when one of my professors Louis Ignarro won the Nobel Prize for figuring all this out. Right, but it\’s totally ingenious. What happens when you want to open up a blood vessel, is a nerve secretes nitric oxide. And nitric oxide makes this stuff called CGMP. Right? You don\’t need to memorize what CGMP is, other than to know that CGMP is the linchpin of the whole system. So the more nitric oxide you have, or release, the more CGMP you make, the more blood vessels open up. And guess what happens to nitric oxide as you as you age, it goes down. So at the age of 50, if you\’re an average american, you probably have 50% of the nitric oxide production that you\’d normally should have. Now, the thing is, it\’s like a dimmer switch in a room. If the dimmer switch is 50%. You can still walk around the room, you can still see you could probably still read, but you can\’t do surgery, and you can\’t speed read. And as you get older and older that nitric oxide keeps declining, and we assume that that\’s part of natural aging, which it kind of is, but that\’s something that\’s very simple to fix. Right and you fix it with a nitric oxide boosting supplement. And most good nitric oxide boosting supplements contain something called L-citrulline. Which is from watermelon, beets, ginseng; and so I created a supplement called Affirm from Affirm Science, which contains citrulline, beets, ginseng, and Muira Puama, which is a potency herb. Okay, so that\’s the first thing we do is we get everyone on a nitric oxide booster. Another beautiful thing about a nitric oxide booster is it\’ll naturally decrease blood pressure about four or five points, right? And so, blood pressure medications cause erectile dysfunction, right? They do that because they dilate peripheral vasculature. But I mean the central vasculature but the peripheral vasculature and remember the penis is at the end of the line and getting blood. So if you\’re dilating centrally, you\’re not going to get peripheral blood flow, right. So blood pressure medications will cause erectile dysfunction. So if I can get someone off a blood pressure medication, by doing it naturally with a nitric oxide booster, then I\’ve helped their erectile dysfunction immensely. Okay, so we get these guys on a nitric oxide booster. The brain has more nitric oxide receptors than any other organ in the body. So you improve cognition. A lot of elite endurance athletes will take nitric oxide boosters because it improves circulation. I have had diabetics that tell me that they take less blood, you know, their blood sugar\’s better. You know, it\’s just a question of blood flow. It\’s not anything magical that nitric oxide is doing to each of these end organs. So I get everyone on nitric oxide booster, the equivalent of three grams of L-citrulline every day. Then, a lot of my patients, I\’ll put them on Cialis or Tadalafil, right? So a PDE five inhibitor, the way that that works is remember, nitric oxide is boosting the level of CGMP. Right? So you have this enzyme system called the PDE system in your body, right? And what the purpose of that is, is to break down CGMP into an inert form. So that blood vessels close, right, because you want to open up blood vessels, but you also want to close blood vessels. So the beautiful thing about PDE is that there are different PDE\’s all throughout the body. So nitric oxides the same wherever you go in men and women and cats and dogs, and rhinoceroses – all mammals use nitric oxide, but there are different PDE receptors. So there\’s PDE1 one in the brain, PDE6 in the eyes. That\’s why people get that bluish haze sometimes when they take Viagra. There\’s PDE4 in the lungs and the penis, it\’s PDE5. That\’s why when you take Viagra or Cialis, it\’s called a PDE5 inhibitor. So if you block PDE5, then that CGMP sticks around for longer, and you maintain an erection. Okay, so now the thing is, when you\’re younger, you get 30 to 60 minutes of erections every night. Right? And that\’s how you maintain a healthy penis. Right, so you and I are sitting here, and the blood pressure in our penis right now is 30. Right, the rest of the body is 120 over 80. But in the penis, it\’s 30. And it\’s mostly venous blood, non-oxygenated blood. So during the day, you\’re not getting much oxygen in the penis and you\’re not stretching out the penis very much. So how does your penis stay healthy? Well, the good Lord created this system, where at night you get erections every time you slip into REM sleep, blood fills up the penis, you get an erection for five or 10 minutes, and then once you get out of REM sleep, the erection goes away. So that way your penis gets oxygenated blood. And it stretches out because the lining tissue of the penis is this really thick collagen and elastin. So if you\’ve ever operated on someone in an open up the aorta, the aorta is a millimeter thick, right? the aorta is the biggest blood vessel in your in your body. It takes huge blood pressures and huge volumes of blood. The tunica of the corpus cavernosa is two millimeters thick. So it\’s actually twice as thick as the biggest toughest vascular structure in your body. Because it\’s got to maintain high blood pressure and it gets banged around a lot, right. And if in in the wild, you\’re getting a fractured penis, then you\’re not going to procreate. So evolution favored a really tough, thick, tunica. But because it\’s thick, and it\’s tough, it doesn\’t stretch very well. You need a lot of blood pressure to stretch it out. And if you\’re not getting routine erections, then you\’re not going to stretch it out. So my guys that are in their 60s and 70s and 80s they always complain that their penis isn\’t as big as it used to be and that\’s that\’s the reason why. So I put a lot of my patients on generic Tadalafil, five milligrams before they go to bed. Right and I have a video on this on my YouTube site. If you go to YouTube, Brandeis MD, just look up nighttime erections and it goes through the whole physiology and algorithm for nighttime erection. So, you know, I recommend guys in their 40s when they start to lose nighttime erections, take a nitric oxide booster before they go to sleep. That\’s what I do. If you begin to lose your nighttime erections, say in your 50s, or 60s, even when you\’re on a nitric oxide booster, then go on something like Tadalafil, you can start with two and a half milligrams and go up to five milligrams, the beautiful thing is at that dose, there\’s hardly any side effects. If you continue to have problems, something like Gaineswave shockwave therapy works really well. Or, you know, when I get a lot of guys who are in their 70s, and they get divorced, or they get widowed, they get back into the dating pool, but they haven\’t had a good direction in 5 or 10 years. And I\’ll actually use a vacuum erection device. And so I have these guys for five or 10 minutes in the morning, stretch their penis, get some good blood flow in there, and five or 10 minutes before they go to sleep, stretch their penis, get some blood flow in there. You know, it takes a little bit of coaxing because it looks goofy. Everyone saw it on Austin Powers and everyone you know, it\’s kind of a joke, but at the same time, it\’s the cheapest, easiest, best way to maintain penile health.

Diva Nagula 22:21

Now, with with race, you\’re talking about these different modalities? Do you use what modality and if it fails, you add the second and then you keep doing it until you\’ve used all four that you\’re just talking about.

Judson Brandeis 22:31
So I evaluate every patient individually. And so I don\’t take insurance – I have a very open, honest relationship with my patients, they pay me for my services. And I spend as much time as I need with the patients. And I get to know my patients really, really well. Patients tell me, you know, their deepest, darkest secrets, because, you know, you should be very open and honest with people that really care about you and are taking care of you know, I had a patient, he was mid 50s, he was contractor, in really good athletic shape, working out an hour or two a day. And something just didn\’t make sense to me, why this guy would be having these problems. And finally, after 15 minutes, you know, he just looked at me and said, You know what, I was a meth addict for 15 years. And all of a sudden, his physiology totally made sense. And I was able to help him in a really significant way. But everyone comes into my office with their own individual story both psychologically, emotionally, spiritually, physically, mentally, and you really have to incorporate everything that those folks are telling you to create an individualized treatment plan. There\’s some there\’s some clinics out there where everyone that comes in gets shockwave therapy, and I just don\’t believe in that. You really have to honor the individual and honor each individual story and craft an individualized treatment plan.

Diva Nagula 24:06

The question I had those coming up when you said that average males have about 30 to 40, nocturnal erections. And obviously this is through REM stage sleep. As we get older, our REM stage, you know, may may change a little bit and our overall sleeping patterns may change. If you\’re a deep sleeper, or if you\’re a light sleeper. I mean, how do you know if you\’re able to achieve 30 to 40 erections throughout the night?

Judson Brandeis 24:33
Yeah, so it\’s it\’s 30 to 40 minutes of erectile function and you can, there are tests that you can do that there\’s a little kind of gauge you can put around the penis that that kind of feels the pressure of erections. You know, we don\’t really do that test anymore. there\’s a there\’s a little they used to call it the stamp test. You can put stamps around the penis, and, you know, see if it breaks in the morning. And you know that you got an erection? I don\’t know if that when they do sleep studies, if they do that kind of stuff like in medicine A B, that\’s a good question. I\’ll ask my, my sleep colleagues, if they do that kind of stuff.

Diva Nagula 25:11

Yeah, I was really curious. You were talking about Gaines wave. And I was wondering if you could elaborate on how Gaines wave works. It\’s magic, you know, I have a fairly broad understanding. But when you talk about it, it makes sense in your algorithm, that how you use Gaines wave in conjunction with everything else to really optimize a reptile function.

Judson Brandeis 25:33
So the first thing to know is that Gaines wave treats what we call vasculogenic. erectile dysfunction. So there\’s, there\’s a number of different ways you can get erectile dysfunction. So there\’s neurogenic. So if there\’s some effect on the nerves, either from prostate surgery, or from multiple sclerosis, or a stroke or something like that, you know, if you have one of those conditions, causing erectile dysfunction, gains, waves not going to work, or diabetes is common cause of of neurogenic erectile dysfunction. You know, if it\’s purely psychogenic, it\’s not going to help. But for vasculogenic, which is about 85 90% of erectile dysfunction is purely from blood vessels. That\’s where Gaines wave can really benefit you. And what it is, is shock wave or high pressure acoustic wave therapy, right. So they discovered this during World War Two, when they were trying to blow up submarines, they would drop depth charges. And what they found was that there was a wave of energy that came off the explosion that caused massive internal injuries to sailors that were were swimming in the water, you know, boat was capsize. And so then in the in the 70s, urologist figured out how to harness shock waves to use them to break up kidney stones. And then in 2010, a brave soul in Israel decided to try low intensity shockwave therapy to generate new blood vessels within the penis, right. And so they were using it for wound healing and other and other ways to generate new blood, new blood flow. And so I guess, they decided, well, this is a great way to try to generate new blood flow in the penis. And so what it is, is the wave form of the shockwave perturbs the cell membranes of the blood vessels in the penis in a way that your body thinks it\’s being injured. When your body thinks it\’s being injured, you generate an acute inflammation, and part of that acute inflammation is a healing response. And part of the healing response is the generation of new blood flow or new blood vessels. And when you actually do the experiment, so a guy named Tom Lou and UC San Francisco did these experiments on rats. So if you\’re ever in San Francisco, and you see a bunch of rats with no penises, you know that they were part of this experiment. But they did acoustic wave therapy on the penises of rats. And then they cut off the penises, and they looked at him under the microscope. And what they found was an upregulation of stem cells. So stem cells are cells that can become other cells. So you\’re stimulating stem cells to become new cells or new blood vessels. You saw an upregulation of what\’s called viaggia. For vascular endothelial growth factors your body produces. growth factors tell your body to grow new blood vessels. And they also saw an upregulation of endothelial nitric oxide synthase. So it\’s a it\’s an enzyme that helps create nitric oxide. Remember, nitric oxide is the the molecule that helps open up blood vessels. They also saw an increase in nerve growth factors, which is really important. And so, you know, this is the mechanism by which these mysterious sound waves are or shock waves are able to generate new blood vessels.

Diva Nagula 29:01

So this is really amazing because you have this technology, where there are some inherent ways to regenerate the cells that are in the in the penal area, vascular wise as well as nerves. When do you start to implement the utilization of things like stem cells and PRP?

Judson Brandeis 29:20
Yeah, so I\’ll go through each of them individually. Okay. So PRP is called platelet rich plasma for folks out there that don\’t know it and don\’t feel bad two, three years ago, I had no idea what PRP was. So say you\’re out in the woods and you\’re running around and you cut yourself, okay, what happens? Okay, the tissue that gets injured, produces what\’s called inflammatory cytokines. Right. So that\’s a messenger that\’s sent out by these cells that get injured. That is asking for help. It\’s like back in the day when bank robbers would rob the bank. They\’d pull an alarm and the police would know exactly where to go. Right. So the first responders in this situation are platelets, right, the first thing you get to do is stop the bleeding, okay? platelets around. But when platelets become activated by a lot of the calcium that gets released in an injury, they become activated. And so they stick their arms out, they come, they look like starfish. And they the arms of the platelets grab on to the other platelets. And they formed kind of a netting that thrombin and red blood cells and a bunch of other stuff gets caught in to stop the bleeding. But when platelets open their arms, they release what are called alpha granules, and alpha granules contain growth factor. So there are about 140 different identified growth factors within platelets, including vascular endothelial growth factor, platelet derived growth factor, keratin growth factor, endothelial growth factor, so all the growth factors that you need to regrow the tissue. So what you can do is draw blood, spin the blood. When you spin blood, the red blood cells have iron, right, so they go to the bottom, the plasma, which is just water, floats up to the top. And in the middle, you have a little layer of platelets and white blood cells. And so you get rid of the red blood cells, you sock off some of the plasma, and you get this nice golden layer in the middle with platelets and, and white blood cells. And then you can use that to inject in a variety of different places in your body anywhere that you want to accelerate the growth. So a big use of PRP is with hair growth. And if you\’re interested in that, you can go to my YouTube channel, I have a video of myself getting injected with PRP for the hair. There\’s no video of me getting injected for PRP for the penis. But I\’ve done that too. They use it in orthopedics, they use it in dental surgery, anywhere it Think of it like fertilizer, right. So shockwave therapy is like planting a seed. You don\’t put fertilizer on a seed, you put fertilizer on a little plant. So once the gains waiver shockwave therapy start to grow the plant, then you put some PRP fertilizer on there and accelerates the growth. And just a word of advice. Anyone that\’s looking for PRP, make sure that you find someone who has a double spin system. So there\’s a single spin system that\’s first generation, there\’s a double spin system, the double spin systems tend to have a much higher platelet concentration. And if you\’re gonna do it might as well get the most platelets are the dose of medication that you\’re getting. Right. Okay, stem cells are different. Okay, and this there\’s a huge misunderstanding about stem cells. It\’s a very kind of wide open field, but I can explain it all in about five minutes if you aren\’t sure. Let\’s do it. Alright, so stem cells, okay, sperm meets the egg, right? 23 chromosomes and each one sperm meets the egg. Now you got 46 chromosomes in one cell. Okay, that\’s the Omni potent stem cell. Omni means All right, so that one cell with 46 chromosomes becomes the trillions of cells that we are when we\’re fully grown adults. Okay, and then that cell grows and grows and grows and it makes a ball called blastula. Right and the blast chiller and then becomes the morula. And the morula has three layers. It has the endo layer, the mizo layer and the Ecto layer. So endo means inside, right, so that endo Derm becomes the mouth all the way to the rectum. Right, so mouth and esophagus and stomach and intestines. The ectoderm is on the outside. So it\’s the skin and the bones. And the mizo is the middle. So it\’s everything in the middle. So it\’s the blood vessels and the nerves and the heart and liver and all that kind of stuff. Right? So when you\’re looking for stem cells to grow blood vessels, you\’re looking for mesenchymal stem cells, the middle stem cells, okay? So that\’s the first thing that you want. Now, you can get stem cells from lots of different places. You can get stem cells from fat, okay, so some people get like a liposuction, and then they spin the fat cells and they they isolate the fat stem cells. Now, in me, my fat stem cells would be 53 years old, right? So 53 year old stem cells aren\’t going to grow as fast as newborn stem cells. And fat stem cells are going to be looking to grow fat. Now they\’re influenced by the environment that you inject them into, but They\’re not going to grow blood vessels as efficiently as other types of cells. Okay? Now another type of cell is you can get from bone marrow, it\’s what we call a hematopoetic stem cell or a stem cell that grows blood vessels, okay? That may be closer to, you know, growing blood vessels, but typically it\’s growing red blood cells, white blood cells, platelets, okay? It hurts to get bone marrow taken out of your hip, okay? It\’s a big needle, it goes to a bone, it\’s not comfortable. And it\’s still 53 year old stem cells, but you make a lot more blood cells, then you make fat, so it\’s a lot faster growing stem cell. Okay. So that\’s the two types of stem cells we typically get from people are either fat, or bone marrow. Okay, now, what about babies? Right newborns, right, there\’s all this birth, you know, you get a baby, you pass the baby off, but there\’s all this birth waste that that comes along with it. So there\’s cord blood, there\’s the placenta, there\’s Wharton\’s jelly. There\’s the amniotic fluid that has cells that are growing super, super fast, right? You know, you go from one cell to a nine pound baby and nine months. That\’s pretty cool. The problem with that is one, it\’s not your own stuff, right? And so, though, they have to check the women for all sorts of viruses, infectious diseases, so on and so forth, and to, a lot of folks aren\’t too keen on having someone else\’s DNA in your body. Okay, so you can either use mesenchymal stem cells from Wharton\’s jelly, and placenta cord blood, or you can take what\’s called the amniotic fluid. So that\’s the fluid that the baby is floating in. And the fluid that the baby is floating in has tons of growth factor, right? And so you can use amniotic fluid. Or the last thing you can use are what are called exosomes. Okay, what is an exosome. And exosome is a little vesicle, or a little balloon that cells put messenger RNA into messenger RNA is how cells communicate with each other like little post, it notes that cells communicate with each other. And so there are what we call stem cell lines. So the Bush administration decided that it wasn\’t a good idea to research stem cells in this country. So we have about 20 stem cell lines that are existing. And if you stimulate those stem cell lines, you can get what\’s called the exit date, or the the fluid that the stem cell lines produce, you can suck that up, and that\’s got a lot of exosomes, and those exosomes will tell the cells what to do.

Because what we\’ve discovered is that stem cells work through what\’s called a Peregrine effect, right? So there\’s this fantasy that, you know, you take stem cells, and you put them in the body, and they just actual stem cells grow up into other stuff. But that\’s not really the case. Within a couple of generations, those stem cells are gone. And what they do is that the fluid, and the the messages that the stem cells secrete is really how the stem cell therapies in our body actually work, is they stimulate our own tissue, to start to do the things that they should be doing.

Diva Nagula 38:28

So in essence, you really need when you\’re injecting stem cells, it\’s optimal to use the exosomes and a stem cell line from fat or bone marrow, just so that you can optimize the effect and the direction that these stem cells are led to grow.

Judson Brandeis 38:44
Yeah, you know, the, it\’s a really exciting field. And, and one day, people are going to really understand how best to use it. I know at least in Sexual Medicine, I haven\’t really followed the literature and other fields in Sexual Medicine. We\’re really at the infancy of understanding the best use of both PRP and of stem cells. That doesn\’t mean that people don\’t use it. I mean, PRP is totally safe. I\’ve I\’ve seen anecdotally benefit, I\’m actually doing research, IRB approved clinical research on using PRP to increase both the girth and the length of the male penis. So a lot of guys want bigger penises. Not too many people actually do something about it, but some people do. And sometimes there are disastrous consequences. People get suspensory ligaments cut, people get fat injected into the penis, they get fillers injected into the penis. There\’s even an operation where they put a silicone taco in the penis to make the penis bigger, you know, 300,000 women a year get breast implants. There\’s no sort of physiologic reason to get breast implants other than cosmetic. So, you know, there\’s nothing wrong with a guy wanting a bigger penis, but the problem is, it\’s a lot easier to get bigger breasts than it is Get a bigger penis, right? And there are physicians out there that kind of prey on men\’s insecurities. And so I decided, Well, you know, I need to find a better way. And the better way for me was using PRP and a penile traction device and a PR suction device and my affirm nitric oxide boosting to improve circulation improve erections. And we\’re still at the sort of the beginning stages of patient recruitment. I haven\’t filled all the patient recruitment, but we had a number of patients who we recruited before COVID. And then we had to kind of stop patient recruitment. So I have, you know, a handful of patients who were part of the protocol before COVID. And they\’ve grown both in girth and length. That\’s amazing. And it\’s proportional to so you know, when you do fillers, or when you do surgery, that kind of stuff, you grow the shaft, but the head of the penis is the same, right? So then you get kind of an awkward looking penis. Whereas with the Pilon study, we get a natural look to the penis, you know, it grows proportionally.

Diva Nagula 41:11

I kind of want to take a little different approach to discussing male sexual health. I know we\’ve been talking about what are the modalities and how we can improve? What are some other ways that we can improve male sexual health and vitality? You know, when we talk about, you know, mind, body and spirit?

Judson Brandeis 41:31
Yeah, so that\’s kind of a really interesting question. So I started out and when I shifted from general urology to Sexual Medicine, I just kind of dove right into Sexual Medicine. But what I found was that guys didn\’t want to have sex if they didn\’t feel good. And they didn\’t feel like they look good. And that kind of led me into a more holistic or integrative approach to Sexual Medicine, which really, you know, men who develop erectile dysfunction, that\’s the canary in the coal mine for cardiovascular disease. So if you look at the literature, if you develop erectile dysfunction, within five or 10 years, you\’re likely to develop cardiovascular disease, you\’ll have a heart attack or a stroke, or, you know, some sort of ischemic event, if you don\’t do something. So when I have my patients who are in their late 40s, or 50s, that haven\’t really taken care of themselves, and they come in, just because they think they\’re gonna get some Viagra or some shockwave therapy, they get a lecture from me, because the the arteries to the penis are one or two millimeters, right? The arteries to the heart are three or four millimeters. So what\’s going to get blocked First, the one or two millimeter artery, but guess what? The three or four millimeter artery is next. And when that gets blocked, you might end up in a box. Right. So that\’s why I have an inbody, that that that does a body composition analysis, and I make sure all my patients get cardiovascular risk panels, I send my patients out for us. CT scans, you know that though, heart scans to look for calcium score for the heart, you know, because of what I\’m, I\’m in a strange way. I\’m acting as a vascular surgeon for them. And I have a very close relationship with the vascular lab next door, we do a lot of work together. And we share a lot of patients because when I get young guys that come in with erectile dysfunction, that\’s an early warning sign. And if you don\’t heed that early warning sign, you\’re going to be in big trouble. So I work on the general health of my patients, you know, what, how do you eat? How do you exercise, that kind of stuff, and that that\’s going to improve your overall outlook on life. And in the end, you\’re going to be a better person, you\’re going to be happier, you\’re going to have better physical intimacy with your partner. So that\’s one part. The another part that I work on is the hormonal aspects, right? A lot of primary care physicians. First of all, a lot of them don\’t even test it. Right. So Kaiser, you have to basically like, make a giant fuss just to get a testosterone test and they don\’t even test free testosterone, they just test total testosterone, I\’m not criticizing Kaiser system. Kaiser is great at what it does, which is you know, population health management. But I don\’t do population health management, I do individual health management, and when someone\’s sitting across the desk from me, it\’s my sacred obligation to do everything that I possibly can to improve the health in all aspects of that individual. And so I always check testosterone levels and if the sastra levels three 400 or less, you know, we have a conversation about testosterone replacement because That\’s a super easy thing to do to improve strength, vitality, libido, getting rid of fat building muscle, you know, I had a patient the other day. And he came in and I put them on testosterone therapy is a great guy, you know, owns a big company. And he said, You know, my wife and all of my employees really, thank you. So what do you mean? He said, I was just a Grumpy Bear, before you put the distortion in me, and he said, you know, after you put the testosterone in me, you know, I\’ve been so much more pleasant to everyone in my immediate area. And so that, I feel like that, I mean, everyone that has an important role, but men are, in a certain sense, are really a linchpin of a certain part of society. And if you have a grumpy, frustrated, man, he\’s gonna make a lot of other people\’s lives miserable. But if you help that man, feel better about himself, you know, lose some weight, build some muscle, his hormones are better, he\’s having some regular physical intimacy, he\’s going to be much happier, and he\’s going to make the people around him in his family and his spouse in his community in you know, in his workplace, so much better. So it\’s, it\’s kind of like spreading the love.

Diva Nagula 46:22
Yeah, I couldn\’t have said that better. And I think that\’s a great way to conclude our show. So great information, thank you so much for sharing all this science behind everything that you do. I mean, you think about it from that perspective, everything makes so much sense in the way you do it from step two, to step to step. And then also addressing everything from an integrative approach, which is what I espouse in, which is what I believe, and it\’s not about, you know, a pill that can fix everything, it\’s really a whole series of, of avenues and modalities and, and techniques and tools to really enhance the sexual nature of a human being, whether it\’s male or female. And, as a matter of fact, that should be applicable for any disease process that we\’re facing in the Western society. So it\’s a really good reminder for that. So thank you. And for our listeners who really, I\’m sure they want to reach out to you and find out more information and maybe become a patient of yours. So what\’s the best way for them to look for you on the net?

Judson Brandeis 47:19
My website is brandeis.md.com. And for anyone who\’s in the Bay Area that\’s interested in the P-Long study, which is a penal elongation study, they can just go to the website, tI have five clinical research studies going right now and just look at that clinical research. And then for anyone that\’s interested in a nitric oxide boosting supplement, you can go to a firm A f IR m science.com. And we have a firm which is nitric oxide booster we have pre long which is for premature ejaculation we have support, which is a natural testosterone booster it contains d h EA, which is a stop from precursor and dim, which blocks the conversion of testosterone to estrogen. And then we have a spunk, which is a natural supplement for improving prostate health. Awesome. Thanks so much for joining us, Dr. Brandeis. Oh, my pleasure. Thanks for having me on.