Men's Health with Dr. Wayne Kuang
"Men's health is such an unaddressed issue in our community at large, you know as men, we suffer from toxic masculinity, every day we put on that armor and over...
INTRODUCTION: Welcome to Qualgen's podcast where we talk about all things health and wellness related, including hormones, pharmaceuticals, health trends and ways you can help better your life.
Jennifer: Hi everyone! Thank you for taking time out of your day to listen in. Today I am talking with Dr. Wayne Kuang who is based out of Albuquerque. Dr. Kuang is the only fellowship-trained men’s health specialist in New Mexico specializing in testosterone rebalancing, erectile dysfunction, prostate health and no-needle vasectomy. After completing his undergraduate studies at the Massachusetts Institute of Technology, he received his medical degree from Stanford University. Dr. Kuang then pursued his urology residency at the Cleveland Clinic to become a board-certified urologist then specialized in men’s health with an andrology/infertility fellowship also at the Cleveland Clinic. Dr. Kuang – thank you so much for joining me today!
Dr. Kuang: Of course, Jennifer, thanks for having me on and what an important topic in this day and age.
Jennifer: Absolutely. He owns MD for men in Albuquerque and June is men's health month, I think actually specifically this week is men's health week. So, that is what I brought him on to talk to me about today. Can you tell me what made you decide to specialize in men's health?
Dr. Kuang: You know, men's health is such an unaddressed issue in our community at large, you know as men, we suffer from toxic masculinity, every day we put on that armor and over time and through a lot of hard work by so many people guys are realizing, hey, I don't have to put this armor on all day and specifically in health care. Hey, what can we do to be able to say, hey, look health care is easy and it doesn't take a lot and it shouldn't be fearful? And how do we get guys into the clinic to say, hey, how do I improve the prostate health, bladder health, sexual health, hormone balancing. Right? And as we improve the health of guys at a younger age, we're now adjusting the health curve at an earlier age. So now these guys are going to be better dads, fathers, husbands, coworkers, right? At an earlier age for a longer period of time. So, we're having a bigger impact on lives.
Jennifer: That's awesome. Yeah, I definitely think there is a need for that because I think women's health has always been such a major thing that not men's health, kind of like you said. I want to go in depth about some of the main treatments you provide. So, I do want to start with that hormone balancing with the low testosterone. Can you get me a brief summary of what low testosterone looks like and how you treat it?
Dr. Kuang: So, one thing is just understanding that low T is a lot more common than we know and we talk about. 40% of guys, 45 older will have evidence of low T and it's because of the stressful lifestyles we now have. No one's getting good sleep, people aren't eating well, they're suffering from an American diet, right? And the phone keeps going off every couple of seconds, we have that impulse of stress hormones and it's just not healthy for our bodies. And as a result, our whole symphony of hormones is starting to decline. So, starting at age 40-45, we're seeing testosterone levels starting to drop. We're seeing guys come in with mood disorders, low libido, low energy, fatigue, mental fog, unmotivated to hit the gym, right? And it's part of the equation. I stress to everyone - it's not everything. You still have to work on your diet, your exercise, your relationships, your mindfulness, right? And the other second key point is, you're not just a number, you're a number within the context of your greater lifestyle and that's really important. Also, in the greater context of your overall health. Guys with metabolic syndrome, diabetes, right? Guys with cardiovascular disease. So, it's part of the equation and really working with your physicians or your health team to have a holistic wellness approach to it. And you know, a lot of that, its really simple guys, it's just a blood test. Make sure they're looking not just at the low T, but some guys will look at free T or free testosterone, your sex hormone binding globulin, your estradiol, the hormones from your brain, luteinizing hormone, follicle stimulating hormone, maybe a proactive level. So, it's not just one hormone, it's a contextual thing. So, talk to your docs learn more about it in - the therapies out there very, very accessible. Whether it's injection therapy, whether it's pellet therapy, whether it's transdermal through patches or gels or creams. So many options out there guys to realize that you can improve the quality of your life by optimizing your performance. We're not trying to roid guys out, but just like we're starting to make adjustments just like, you know, Jennifer, you might like to sleep at 68 degrees. I like to sleep at 70 degrees – they’re both normal numbers, but there might be one number that works better for your body and your lifestyle.
Jennifer: Absolutely. And I, you know, I think low testosterone, what you said about the roid, I think everyone when they think of testosterone, they think of it as a steroid. Like you're just like getting pumped up with testosterone, that's not at all what it is.
Dr. Kuang: You know, Jennifer, you and I tell people - think about thyroid, low thyroid, we know tons of people who are on hormone replacement therapy for their low thyroid, it's the same concept, just a different hormone. However, it just got a lot of bad press just through its abuse and we do need to be mindful of that because unlike thyroid hormone, it's very easy to get caught up in - well if some is good more must be better and that's why it's really important finding a provider team, a health care team that's going to be checking on you, check on your labs, let the data drive the decision making. So, you're taking an appropriate amount of risk for the benefit, because we all want you guys to be Granddad's. So, you're watching your grandkids go to college, right? We’re playing the long game, it's a marathon. We're trying to get everyone in 90-100 living the best version of themselves.
Jennifer: Absolutely. I know erectile dysfunction can be caused by low testosterone. However, are there other causes to that? And what treatments are there for that condition?
Dr. Kuang: Jennifer we could be here all day, but this is great stuff. Number one guys, there's several elements, one - men are wired a little bit differently, right? And you know, the head game is really important. I tell guys, look if I gave you 1,000 Viagra's and 1,000 beautiful women, but I stuck a gun to your head, that negative thought will obviously not give you an erection, right? So, men are very complex circuitry there between the mind and the body. So that's very important. Step two is the initiation of blood flow. So, anything that's going to affect that, we know that nitric oxide levels are in incredibly important. Now nitric oxide levels mostly come from our diet: beets, super greens, kale, arugula, spinach, but on the American diet by about age 40 we've depleted those levels, right? By about 50%. So, obviously telling guys, hey get on a better diet, those super greens, those super beets, but a lot of guys will do supplementation. I totally get it because after a while, super greens and beets can only taste so good. Right? A lot of guys are thinking about the L arginine, the L sertraline supplementation to help generate more nitric oxide molecules, which are so important - not just for your erectile function in your blood flow in your penis, but blood flow to your body, your muscles, your mind, your body. We have guys that take a pre workout as well as before, you know, just for their sexual health, as well. And then third step is really going to be, how do you once you've initiated that blood flow, how do you prolong it? How do you optimize it? Unfortunately, as we all know, as we all get older, whether it's through diabetes and microvascular disease or atherosclerosis, things are going to start blocking up the blood flow. Think about all the guys who are smokers, high blood pressure cholesterol, diabetes, heart vessels are clogging up and having heart attacks. Those blood vessels are four millimeters, the penile blood vessels are half the size. So, it just takes a fraction of atherosclerosis and sludge to start to diminish blood flow in the penis, right? A public service announcement - hey, if you have erectile dysfunction often that is a precursor about 2 to 5 years of some cardiac event. So, make sure you get in to see your cardiologist or your primary care doctor and go “Hey, you know, I've got this family history of heart attack and things aren't working well downstairs. Maybe can you check out my heart?” Maybe you get a calcium score with a C. T. Scan? Just make sure you're okay. So, this is a quick public service announcement but in regard to optimizing blood flow, right? One is we talk about the pills, the blue pills, you know the Cialis, the Viagra's, the generics, Sildenafil. Those help maintain the signal that's been initiated by nitric oxide to prolong blood flow and optimize it. But how about long-term solutions? Well, long term solutions the biggest area that advances that have been regenerative medicine, right? We hear about radio pulse waves. We’re using sound waves, just like we use with kidney stones to break up kidney stones and clear out the kidney stones. Now we can use sound waves at a lower energy level to break up that atherosclerosis to break up the sludge. But more importantly stimulate the body to say, hey, this is an area that needs to be healed. So, right now you're stimulating the body to heal those blood vessels, as well as stimulate the growth of new blood vessels augmented with things such as platelet rich plasma. Some folks are using stem cell therapy in conjunction with nitric oxide supplementation, pills, as well as, vacuum erection devices. So, a whole regenerative medicine approach and then obviously down the road, there's other therapies, whether it's injection therapy directly into the penis or even surgical long-term solutions such as penile implants. So, I know that's a lot covered there, but it's a really important topic. One - guys, you're not alone, right? 40% of guys, 50% of guys in the fifties, right? They're going to have erectile dysfunction. You're not alone. And the best thing - we have solutions so you don't have to hide out in the shadows and just live with it. You can actually reach out to your provider, get the data, with like for example, penile ultrasound, find out how the flow is going in your penis and then allow that to drive what type of therapies might work for you.
Jennifer: Right, and there's so many multiple treatments. So just because one doesn't work, there's other options.
Dr. Kuang: Exactly.
Jennifer: Let's talk about vasectomies. What exactly is a vasectomy?
Dr. Kuang: Vasectomy, it is probably the number one thing guys fear in the modern era. I mean it's just gotten so much press and it scares guys. So conceptually guys have two testicles, that's the factory where we make sperm, and we make testosterone and from the factory there are conduits or tunnels and that's the vas deferens. That's the plumbing that goes all the way up to the penis carrying sperm. Now, vasectomy is probably what's so cool is that now guys are stepping up their realizing, hey, I don't want my partner to be on those chemicals, those oral contraceptive pills, or the implants or the IUDs and it's great to see guys stepping up because now it is so much easier. In the heyday, you know, you're using a scalpel, you're using a knife, you're using needles, putting guys up with their legs up in stirrups like they're going to deliver a child, right? It's just very demoralizing, emasculating guys. But now, with technology, no needle, no scalpel, vasectomy is a single office visit. You have a consult, you just go right into your vasectomy, you're in and out in about 30-45 minutes.
Jennifer: That's amazing.
Dr. Kuang: I mean now with the advent of the big thing for us, we playfully have coined it “mananesthesia”, which is basically just nitrous oxide or laughing gas. I mean the experience is totally different for guys now, you know, we just have a guys lay flat, it's a couple spritzes of an anesthetic spray on the scrotum, they start breathing in on the nitrous oxide laughing gas. They get nice and comfortable, and we need our guys to be comfortable and as relaxed as possible, because as they relax well then, the boys are going to relax, which allows us to the procedure a lot more effectively. And so, we're going in, there's multiple techniques, but probably the most common is going in cutting out a small piece, burning the ends and then tying them off and so that's probably the most common and they do with sutures, we do it with clips, but it's really the procedure might take the actual procedure itself, maybe 11-12 minutes. But your whole experience from the consult, the single office visit in and out, probably 30-45 minutes, depending on how smoothly, you know, the whole day goes for you. So, it's really changed for a lot of guys, especially with “mananesthesia”, nitric oxide laughing gas.
Jennifer: And it's a pretty easy recovery time too?
Dr. Kuang: Most of our guys purposely do it on a Thursday, so they can take easy Thursday, Friday, Saturday, Sunday, get back to things on Monday. Obviously, guys aren't going to go mountain biking or horseback riding that weekend, you know, take it easy, you're taking one for the team. Set yourself up in the man cave, order pizza from, you know, maybe set it up for March Madness. And you know, 50 million guys are having, have had vasectomies. Over half a million are getting them every year because they're realizing it's that easy and it's a great option. It's so much healthier and safer compared to your partner being on drugs and chemicals and hormones. So yeah, that’s a vasectomy.
Jennifer: Well, that's very interesting. I honestly have never known how to, like I've obviously heard of vasectomies but never knew what it was. Well, I knew what it was, but not how it worked, I guess is what I'm trying to say.
Dr. Kuang: Well, it's not part of the body. It's a hard thing to talk about. But I think, you know, guys are coming of age and the modern guys like, hey, it's so simple and when I get it done, it's so much healthier.
Jennifer: Yeah. Well, and I think just in general, men's health is just becoming, like you said, just more of a prominent thing. So, before it was like, unheard of to just talk about this, but now it's becoming more of the norm, which I think is great because everyone just needs to be open about it because it's life.
Dr. Kuang: Exactly.
Jennifer: So, benign prostatic hyperplasia. What is this condition? And how is it treated?
Dr. Kuang: Yeah. So, it's an interesting thing as men were not designed to live this long, right? We’re designed to procreate and, you know, in your teenage years, and then by 19 we'd probably go out, go hunting for some saber tooth tiger, that we end up getting killed by and you know, that was it. But the problem is we kept getting older. Due to modern technology and modern advancements in health. The problem is that we didn't plan on the fact that we'd be living to the point that our prostate, would also keep growing. So, what is the prostate? Well, it's a part of our sexual health, sexual organ, and it's like a doughnut. The bladder is a muscle and it's a muscle that squeezes to push urine through the prostate out through the penis. And as men get older, so by 50% of guys, between the ages of 51-60, they've gotten to a point that as they've gotten older, that prostate, which is like a doughnut, as the doughnut gets bigger, the doughnut hole is going to get tighter. So, now that bladder muscle is having to squeeze through a tighter doughnut hole. And as a result, first - things are just going to slow down, the flow is going to slow down and then second - the bladder muscle itself is going to start to struggle, and as it starts to struggle, it's going to be like an overactive child. It's going to start to have urgency frequency and getting up in the middle of night and if you really don't take care of it, that bladder muscles actually going to become like a rebellious child, it will actually start to act out without your permission, cause you to leak all over yourself, causing incontinence. And so, these guys, we don't talk about it, there's so many guys that suffer from incontinence, they have to wear pads, liners, Depends because that bladder muscles is so dysfunctional and heaven forbid you ignore your bladder health, which is related to your prostate. You can actually get to the point just like your heart is a muscle that can have a heart attack, your bladder is a muscle and that can all of a sudden stop working and you show up in the emergency room, needing a catheter, and heaven forbid, just like your heart muscle can go out, you go into heart failure, your bladder muscle can go into bladder failure. Where you actually need a catheter for the rest of your life.
Jennifer: My gosh.
Dr. Kuang: It's really important that from a public service announcement, Hey guys, this is a bigger issue. And the things so many guys hide in the shadows. Oh, my dad suffered this. My granddad suffered from this. It’s just part of getting older, but there's so much new technology. We can now begin to understand the health of your bladder. We can understand how the muscles are working in the bladder, we can understand the size and the shape of the prostate, which dictates therapies, which is kind of what you were kind of leading to. In the heyday, the answer was drugs, America got into a very bad habit, poly pharmacy was the way to go - here you got a problem? Take a drug. Still got a problem? Take a higher dose. Still got a problem? Take a second drug. The paradigm is shifting because guys are like, look, do I really want to be on drugs for the next 20-30 years, and we mistakenly think of drugs as being minimally invasive. But in truth, drugs are maximally invasive. They touch every single cell in your body. So, guys are realizing it's not just about living longer is about living better without chemicals in your body. So go and talk to your doc, talk to your urologist, get an assessment of where your bladder health is, where your prostate is. If you're suffering from a slow flow, if you're getting up three times at night, if you're having problems getting to the bathroom in time, having urgency, frequency or heaven forbid leakage, get more information because the therapies now exist way beyond drugs. We now have minimally invasive technologies and therapies that can happen in the office. You'll hear terms like your urolift - these are all new technologies out there that can really help guys treat the prostate to improve the bladder health and relieve guys of these symptoms. Then we have surgeries that are tried and true that we've done in the hospital which we used to call roto rooter. You basically go in and open up the inside of that doughnut hole. It does require being in the hospital, general anesthesia, but for certain prostates that may be the therapy of choice and then very extreme is really big surgeries where we actually open people up and actually take out the inside of the prostate. My point being is that there has been so many more options now other than just adding more drugs to the equation and a lot of guys are looking at it because a lot of them can be done in the office with a minimal side effect profile with significant benefit.
So that's really important - just really helping those guys because there's so many. Our fathers and grandfathers and ourselves that really can use that information, because we know even guys starting at 45 can have issues that might need therapy.
Jennifer: Well, that was going to be my next question is at what age generally should men start seeing a doctor about their prostate and how often should they get that checked?
Dr. Kuang: So, in regard to peeing, it's really what we talked about when they're starting to have issues with signs of things are really slowing down or having to use the bathroom every 30 minutes, every hour, more frequently than they would be used to. Or getting up several times at night, signs that the bladder health is beginning to suffer. In regard to overall prostate health and so, you know, a lot of guys, we talk about starting age of 55 getting what's called a blood test or a prostate specific antigen, which is a blood test that we use for screening for prostate cancer. Now, when you're working with your doc, if you are African American, or if you have a family history of prostate cancer, then you really want to be checking in on that probably earlier than that age of 55. So, coming in, getting a risk assessment, getting a sense of where you are, but really the number one thing is being able to be willing to come in and be evaluated. So many guys are like, “no man, I just really don't want to do that.” It's just so frustrating. That's kind of how MD for men came about. That's our goal is how do we empower our men with the guest experience to evolve fearlessly into the best version of themselves? Because so much of health care for men is surrounded by fear - scares the crap out of us. I mean, you know, whether we like it or not, women are programmed culturally, pap smears, having kids, you guys see doctors and health care providers so much sooner.
Jennifer: And it's normal.
Dr. Kuang: It's normal. But for guys, often their very first contact in health care is their vasectomy. That's the very first time they had to see them and that's terrifying.
Jennifer: That is.
Dr. Kuang: At MD for Men, we are trying to change that curve because we're seeing so many guys for vasectomies, but showing them, hey, healthcare can be very easy and comfortable and without fear. Once they learn that message then they can extrapolate that the other parts of the health care. So now they're going to go on - so guys remember, you know, starting at 45-50 go and get that colonoscopy for colon cancer screening, right? So now they're not going to be as scared about doing that stuff, as well.
Jennifer: So, when it comes to men’s general health, which is kind of the same, it is important to go regularly, but how regular should they be going? I mean how - what's the routine like?
Dr. Kuang: Well the routine really is going to dictate on what they find, right? It's really fun establishing with a health care provider, a primary care provider, who can do the general screenings, your lipid, your overall health, lifestyle, behavior, maybe getting that PSA check. Just doing the regular routine assessment and based on that they're going to really dictate - your hemoglobin A1C. Are you at risk for diabetes, are you pre diabetic? Because that's really going to dictate what the frequency of intervention and screening will be. But really someone is just taking the first step and just picking up the phone and going, hey where can I go? Asking your wife, “hey do you like your doctor” or asking a friend “who do you like in town” or finding that version of MD For Men that's out there that works for you and your local community. There's so many out there so please take that first step I think that's the most important message.
Jennifer: Absolutely. Well, I think that was all great information. Is there anything additionally you would like to add?
Dr. Kuang: No, I think you know, happy Father's Day. I think that's most important. It's coming up.
Jennifer: It is
Dr. Kuang: Thank you everyone for being great dads and great husbands and great sons. And I do believe that that is a stepping a springboard for our community and our countries - how do we bring back the family unit? Right? And how do we bring back stronger fathers, stronger sons, stronger brothers. And I think that is stronger husbands. And so, thank you for everyone out there and Happy Father's Day.
Jennifer: Yes - Happy Father's to everyone. I think that is this Sunday, isn't it?
Dr. Kuang: It is Sunday. So, you know, enjoy a barbecue and enjoy time with family and get outdoors and enjoy each other.
Jennifer: Absolutely, well, thank you again for joining me! For more information on Dr. Kuang, please visit his website at mdformen.com. And thank you everyone for listening. Please make sure to subscribe and follow us on social media to stay up to date on Qualgen. Thank you again, Dr. Kuang!
Dr. Kuang: Thanks, Jennifer.
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