ED As A Health Warning

Dr. Hehemann 0:00

We think of the penis as like a divining rod, sort of like a signal of how things are going with a man's general health. Heart health is intimately related with erectile functions. And if there are conditions like high blood pressure, high cholesterol, diabetes that aren't well controlled, that has an early effect on the penis. So we know that men who have ED are within seven years are very likely to have a cardiac event. Even very young men in their 20s who have ED thing could be going on.

Welcome And Guest Introduction

Grantley Martelly 0:44

This is the Real Health Black Men Podcast, where we empower men to take control of their health. We provide vital information and build community support. Join us as we discuss everything from major health challenges to mental wellness to physical fitness. So if you're ready to level up your health and your life, you're in the right place. Let's get started. Welcome back to Real Health Blackmen. Hope you've been enjoying our episodes so far. Today we have a very special guest with us, a doctor that I've met through the Backpack organization that I've spoken about in many of our episodes. And last year we had the privilege of sharing on a panel together. And our guest, Dr. Marah Hehemann, has agreed to be our guest on our podcast today. So Dr. Hehemann is a trained urologist in Seattle, Washington. She specializes in men's health, male erectile dysfunction, male infertility, male stress, urinary incontinence, and cancer survivorship. She is an associate professor, well read and well presented. And she has a very interesting topic, which I know many of you have been interested in and are interested in. And I'm calling it mensexual health or sex medicine. And Dr. Heeman will go through those things with us as we get through the podcast. And if you have any questions for us, just remember you can always send us an email at Real Health Blackman at gmail.com, or you can get on my website grantly martelli.com. Grantley with awaii, martelli with awaii.com, and you can find the links there as well to this podcast. So, Dr. Heymann, welcome to our podcast.

Dr. Hehemann 2:39

Thank you so much. It's been wonderful to get to know you through sort of the networks here in Seattle. And I'm really excited about this opportunity to talk about a really important topic that's, of course, near and dear to my heart, and I know probably near and dear to many of your listeners' hearts and minds and bodies. So I'm delighted to be here.

Grantley Martelly 3:01

Thank you for joining us on your busy schedule. Of course. As we always begin, we like our guests to introduce themselves to our audience. And we I do this because a lot of times people hear you're a doctor or uh a lawyer or politician, people I interview and they they think they're different from them. So this I think the introduction just helps people to remember that we're all the same. So plus we want to get to know you better. So could you tell us a little bit about yourself, where you're from, etc.

Dr. Hehemann 3:31

Of course. Yeah. So um I'm originally from Chicago. I being a Midwesterner really rings true in my sort of demeanor and my in my heart. I am a loyalist to the Midwest and to Chicago. Um I did a lot of my undergraduate training and um med school and then residency in the Midwest. So Michigan for undergrad and med school and residency training in Chicago. I was brought out to the University of Washington for fellowship. So that was my first sort of foray into the Pacific Northwest. I came out here to do this extra year of training, a fellowship in male sexual and reproductive health andrology. I was always drawn to this field because of many reasons. First and foremost, I deal mostly with quality of life issues and really sensitive issues that men confront with sexual dysfunction and infertility. And this affords me the ability to really help people with their quality of life. So I get to be a surgeon, but I also get to be a clinician and get to know people and have really sensitive conversations and help people feel better. And, you know, as that pertains to cancer survivors, it's really important, you know, especially prostate cancer. It's a condition that, you know, treatments have a lot of side effects. And um I feel fortunate to be someone who can men can confide in about some of those side effects and be someone who can really help treat them.

Grantley Martelly 5:02

Okay, thank you for that introduction. You, your clinic, at which I'm a patient, full disclosure, I'm a patient. I was recommended by Dr. Nyame, my my main surgeon, to the Men's Health Center in Seattle,

Men’s Health Center Care Overview

Grantley Martelly 5:18

Washington. Tell us some about the Men's Health Center, the services you provide in that center.

Dr. Hehemann 5:24

So the Men's Health Center is a part of UW. It has been around for over 15 years now, and it's really focused on caring for men with benign urologic conditions, mostly pertaining to sexual function and fertility. So that really, you know, has to do with erectile dysfunction, Peironi's disease, or this scarring disorder of the penis. I treat stress urinary incontinence, like you mentioned. So that's mostly for men after prostate cancer treatment, as well as fertility. So we do very high-level fertility care for men who have difficulty achieving fatherhood. So we do really high-level testing of sperm function and sperm quality. And then if there are deficits in sperm function or quality, we perform treatments for those men, um, and including men with really advanced infertility. So we're sort of at the cutting edge of this field of men's health in urology. And we also work very closely with our colleagues in, you know, the sexual therapy discipline as well as uh physical therapy discipline. And then we have close relationships with colleagues in in hormone health. We treat some, you know, male hormones, um, but we work very closely with other practitioners and certainly have a very close relationship with guys, primary care doctors, um, because my field is just so closely related to just general men's health, you know, heart health, et cetera. So we really we don't do that in our center, but we link very closely with those practitioners as well.

Grantley Martelly 7:09

Here,

What Sexual Medicine Covers

Grantley Martelly 7:10

that's a good segue to my next question, next two questions. One of the things that we when when we were on a panel with the topic was sex medicine. And then as I was reading your biography, there was a reference to a society of sex medicine. So what is sex medicine? Is sex medicine the same thing that you you were just described, and that's just a broad category, or is that a specific area of practice?

Dr. Hehemann 7:38

Yeah, sexual medicine is I make up just a small part of this sort of discipline of sexual medicine. I think of sexual medicine as a really large and rich field of providers and researchers who treat men, women, everybody on the gender spectrum for sexual wellness. And that can be any sort of form of sexual wellness from libido or sex drive to actual sexual function with erections. It can be sexual trauma, it can be addressing things like relationships dynamics and how that plays into sexual function. On the female side, there's really amazing research going on in menopause care and how women's sexuality changes over the lifespan. And so we, as you know, urologists, again, just make up sort of a small subset. There's gynecology, there's therapy involved, there's even basic science researchers who are doing work in the lab to look at what's going on inside scar tissue in the penis after prostatectomy and how can we, you know, rebuild nerves. You know, I did some of that work in my residency in a lab of looking at ED and nerve regeneration after prostatectomy. So it's a really big field, and hopefully we provide a lot of informative care. And um, you know, we meet once a year at the Sexual Medicine Society of North America, and it's very rich programming, and hopefully that kind of helps all of our patients.

Grantley Martelly 9:13

So urology is just one component of the sexual medicine field.

Dr. Hehemann 9:19

Correct.

Grantley Martelly 9:20

If I'm getting it correctly.

Dr. Hehemann 9:21

Absolutely.

Grantley Martelly 9:22

So our next question is talking about men's urologic health. And the topic of men's urologic health, what are some of the things that men need to be aware of when it comes to the urologic health? And what is men's urologic health? I guess we could start there.

Dr. Hehemann 9:38

Men's urologic health is so broad. I mean, I think as urologists, and as I have a leadership role in our training program and recruitment of our residents, and it always comes up in the applications of our med students into residency that why they want to go into urology. And usually one of the reasons is because it's such a broad field. You know, Dr. Niami is an oncologist, and so he cares for the cancer itself. He's a wonderful surgeon, a very dear friend of mine. We go way back, and we do sort of opposite ends of the spectrum in urology. And so when we talk about the sexual aspects of urology or male sexual health in urology, it is really focused in penile, testicular health, um, and you know, the whole genito-urinary system. So it does relate to the prostate function. It does relate to bladder function and you know, symptoms that may start early in life and you know progress into worse and worse symptoms later in life. So it's it's just just such a broad field. Um I remember when I was in med school and decided to go into urology, people sort of asked me, like, as a woman, why would you go into urology? And then especially when I pick this field of sexual medicine. And it's just such, you know, a delightful area to be a provider in, um, because we can really have the impact on people's day-to-day life. And so male urology is just such a gigantic field. It's hard to even do an elevator pitch of what it is in, you know, 60 seconds. Hopefully that answers your question.

Grantley Martelly 11:20

Yeah, that that's a great that answers my questions very well. Um so this obvious and many of the people who've been on this podcast to this day, because we're still in our first year, have been dealt a lot with cancer, cancer patients, and we survived from cancer. But as we're gonna be moving on and wanna be talking about heart disease and other things affecting men, the the entire spectrum of men's health. So

ED And Cardiovascular Risk

Grantley Martelly 11:48

other than cancer, what other health conditions have a major effect on men's urologic health?

Dr. Hehemann 11:57

That's a fantastic question. Um and the answer is the, you know, the way um heart health and your general health um manifest in urology is in things like erectile dysfunction, infertility, um, urinary symptoms. These are sort of signals of your general well-being. So we think of the penis as like a divining rod, sort of like a signal of how things are going with a man's general health.

Grantley Martelly 12:33

Okay.

Dr. Hehemann 12:34

Heart health is intimately related with erectile function. So erections are very much driven by the vascular system, the blood flow system in the body. And if there are conditions like high blood pressure, high cholesterol, diabetes that aren't well controlled, that has an early effect on the penis. So on erectile function. So we know that men who have ED are within seven years are very likely to have a cardiac event. Even very young men in their 20s who have ED, it's sort of a signal that something could be going on. And that's why we see ourselves as, you know, potentially an entry point into general health care. A lot of men don't see doctors. And this may be sort of the first thing that comes up. A guy in his mid-30s is noticing changes to the erections. And he may see me before he sees a primary care doctor to look at things like blood pressure, cholesterol, your diet. You know, I have been gaining weight. Um, and, you know, my exercise regimen has been lagging for the past five years. And hopefully that's, you know, that's a conversation I have daily with men because anything you do that's good for your heart is good for erectile function and is good for fertility. Male fertility is it's a window into men's health, into men's overall health. These sort of functions of the body are like the icing on top. And so when the overall function of, you know, weight and heart health and exercise and all those things aren't dialed in, that's where things like fertility and erectile function suffer. So when we see those things, we know that there are deeper underlying problems. And we know that men with infertility have a higher likelihood of heart disease, high blood pressure, cancer. We, as urologists, get those guys hopefully into a primary care doctor's office as well, where they can be really taking better care of themselves. Um, so super, super important to recognize that these conditions don't stand in isolation. They are a signal of other systems going on in the body.

Diabetes Damage And Why Pills Fail

Grantley Martelly 14:50

And what about uh diabetes? Is diabetes another men's health indicator?

Dr. Hehemann 14:57

Absolutely. So diabetes is probably the number one cause of erectile dysfunction.

Grantley Martelly 15:04

Okay.

Dr. Hehemann 15:06

We know that probably more than a third of Americans have diabetes at this point. And men who have diabetes, about half of them have erectile dysfunction. Within 10 years of a diabetes diagnosis, erectile dysfunction or ED is almost a hundred percent, especially in men with poorly controlled diabetes. And the reason why diabetes has such an profound impact on erections is because it affects three or four of the ingredients to a good erection. It causes high blood sugar, it causes little damage to the tiny blood vessels that feed blood into the penis. It causes damage to the nerves that send the message to the penis to get blood. If you have diabetes, you probably know that you could get neuropathy in your feet. And so neuropathy happens to the penis as well. It causes scar tissue to form in the smooth muscle that needs to be very pliable in the penis to work well, and it can affect testosterone. So very huge impact on male sexual function. And then from a from a um fertility standpoint, it also has a big impact because nerves are really important for ejaculation. And, you know, for instance, yesterday I saw a gentleman who had type 1 diabetes, so he's been diabetic for 25 years and is he's in his mid-30s, and he no longer has semen come out when he um has an orgasm. So he has infertility related to nerve damage from the diabetes. And also, you know, again, testosterone is really important for fertility, and that's kind of the male hormone that's important for making sperm. And diabetes has a huge impact on this field of men's health.

Grantley Martelly 16:52

So you said that you can have um neuropathy in the penis. Talk a little bit more about that. That's the first time I've I've heard that.

Dr. Hehemann 17:00

Yeah, for sure. So I think of the nerves to the penis, there's sort of two categories of nerves to the penis. There's the sensory nerves. And certainly guys who have neuropathy in their feet where they can't feel in their feet can get reduced sensation in the penis. But I think of it also as, you know, the nerves that run along the side of the prostate, the cavernous nerves that guys who have prostate cancer treatment know all about because you know about nerve sparing and how, you know, those nerves are really important for sending the neurotransmitters, the messages to the penis to stimulate blood flow to come in. And those nerves can be equally damaged. They're not sensation nerves, but they're more like functional nerves. And they can be damaged by high blood sugar, and that is hard to reverse. We know that men who have diabetes, for instance, are have less effect of taking pills for ED, like Viagra, for instance. Those don't work as well for those guys because those pills are really just boosting the message on those cavernous nerves. They're just sort of turning up the volume. But when those nerves are kind of damaged, or I think of them like telephone wires, if the wires are fried or frayed, you can't, you know, you could turn up the volume all day long, but you're not gonna get that message through the system. And so that's why pills don't work as well for guys with diabetes.

Grantley Martelly 18:32

And what about high cholesterol?

Dr. Hehemann 18:35

High cholesterol is a definite risk factor for erectile dysfunction, just like it's a risk factor for a heart attack. So heart attacks are where the blood vessels to the heart get clogged up and blocked, and they no longer supply blood to the heart muscle. Those coronary arteries, the blood vessels to the heart, are four millimeters in diameter. So they're, you know, pretty substantial. The arteries in the penis are only one millimeter in diameter, so they get clogged up with cholesterol way sooner. And that's why ED often precedes heart disease. It's an early sign of cardiovascular disease. The penis, again, is not an isolated organ. It's all your body's all one system. And so cholesterol that clogs your heart is gonna clog the penis even faster.

Grantley Martelly 20:00

You also mentioned exercise uh earlier in your conversation. How does exercise affect men's sexual health?

Exercise Diet And Better Function

Dr. Hehemann 20:08

Very beneficial. So there have been some good studies out of Italy that are randomized where guys were put on an exercise regimen, or they were just, you know, more diligent exercise regimen, or they were just sort of given guidance about general heart health. And the guys who were really given a program to be on for exercise had an improvement in their erectile function. And this was just exercise alone. And so we know that exercise alone can help erectile function and fertility. We know that weight loss alone can help erectile function and fertility. We know that just being more active in your day, so reducing sedentary activity for guys who are, you know, in tech or in finance or, you know, just doing work at home, getting up and walking several times a day is really important. And then all of these in isolation can help. And of course, they usually come together, right? If you're starting a good diet, mostly focused in protein, lean protein, not you know, heavy-duty meats, more lean proteins, lots of vegetables, whole grains, the sort of Mediterranean diet, so to speak. If you're doing an exercise regimen of 150 minutes of moderate intensity exercise a week, it's five days a week, 30 minutes a day, or three longer sort of sessions. If you're getting up and walking, if you do all these things, you're probably likely to lose some weight, change your body composition, lose a little bit of body fat percentage. They all amplify one another. And so that is really where we see the change in erectile function, of course, fertility, like I mentioned, and testosterone as well. So that good male hormone that sustains your brain health and your heart health and your bone health. Um, it is, it all sort of comes together.

Grantley Martelly 22:09

Okay, very very, very interesting. Now you mentioned diet. So how does diet affect men's sexual health?

Dr. Hehemann 22:18

So there have been some studies that looked at things like processed meat and found that that's one of the worst things that guys can eat for many things. For sexual function, fertility, that's my domain. Also, cancer risk. We know that heavy meat diets are a risk factor for colon cancer. And I think also prostate cancer. So I always advise away from a heavy meat and processed diet and leaning more into, you know, you don't have to go vegan, of course, but something that's more balanced, more focused on what is classically referred to as kind of the Mediterranean diet. I don't like to use that term as much because it really puts a focus on like, oh, Greek food. Well, no, I mean, there's other cultures that have this same concept of lean proteins, chickens, fish, and and whole grains, the brown rice, quinoa, you know, a lot of the plantains, like these, these healthy starches and also a lot of vegetables. And so it doesn't have to be just like fish and cucumbers and feta cheese as a Mediterranean diet. There's all sorts of cultures that are that represent healthy diet in this way. I mean, you know, Japanese food is obviously lots of fish and and grains and vegetables. So, you know, think of it more broadly. And there is really good data to support this sort of line of thinking. And when uh folks transition into like a Western diet, more processed foods, fast foods, it is definitely has a negative impact on inflammatory markers in the body, which affect erectile function, and we see also changes in erectile function.

Grantley Martelly 24:10

You you also mentioned testosterone, and there is lots of discussion out there about testosterone,

Testosterone Hype And Real Numbers

Grantley Martelly 24:18

and you see these ads on TV that you need to start ordering these bottles of testosterone pills or testosterone gummies, and if you're a man of 50 or 40, your testosterone is plummeting, and you need to get on this high testosterone supplements? What what's some of the truth about testosterone when it comes to men's health? And also remember, you know, this this podcast is focused heavily on black men and men of color who, as you know, represent a little bit differently in their symptoms and in the frequency and severity of their symptoms. How does this testosterone discussion weigh into what you do and how you see it benefiting us or being a something we need to be careful about?

Dr. Hehemann 25:08

Absolutely agree. There's so much out there on the internet and billboards and the radio about testosterone, and and there are these sort of standalone clinics that are men's clinics and that are, in my opinion, somewhat, can be somewhat predatory. They are selling, they're there to make money and to sell testosterone. And so if if guys go into these clinics, they will get a diagnosis of low testosterone and they will have recommendations to buy testosterone and buy other hormonal sort of optimizing medicines. And I would just caution men to, if this is something you're curious about, to see someone who has some expertise in this area, whether it's a hormone specialist called an endocrinologist, of course, your PCP or a men's health expert in neurology are very much sort of the that's in our domain, this testosterone conversation. And so, um, especially guys who have had a history of prostate cancer. Our field is really at the cutting edge of the data behind testosterone and prostate cancer. And that field has really changed quite a bit in terms of our recommendations, especially in the last maybe 10 years. Just to kind of give a broad overview, you know, testosterone is a hormone that's made by the testicles and goes throughout the body and has impacts throughout the body. It has beneficial effects on erections. It is not the only thing that drives erections, like I talked about, but having normal testosterone is important for erectile function. It's important for sex drive, but it's not the only thing that drives libido. So we'll talk a little bit about, I think, about mental well-being, and that has a big impact on libido as well. So it's not just testosterone. It of course protects muscle health. Um, testosterone gets converted into estrogen, which is the real powerful protector of bone health. So if you don't have enough testosterone, you won't have enough estrogen. Um, men need estrogen too. And, you know, it has impacts on brain health. So when testosterone gets too low for whether it just is because a guy's getting older, or, you know, for instance, for some of your listeners here who've been on androgen deprivation therapy for prostate cancer, we artificially lower testosterone and they absolutely see the impacts of having very low testosterone, things like low energy, low sex drive, low depression, hot flashes.

Grantley Martelly 29:08

Foggy brain, foggy brain.

Dr. Hehemann 29:09

Very foggy brain, yes. This cognitive change. So we know that having normal testosterone is really important.

Grantley Martelly 29:17

By the way, what is what is normal testosterone in layman's terms?

Dr. Hehemann 29:21

Great question. If you Google, you know, go on ChatGPT, it'll probably tell you somewhere over 300 total testosterone. And um, the way we practice is really uh a little more refined than that, which is looking at free testosterone. So free T is the more active form of testosterone in the body. It's not, it's the testosterone molecule that's not bound up to other proteins. So it's the one that can actually go and drop into a receptor on another cell and make a change. Free tea is really normal or really important. And free tea is every lab is a little bit different. So there's no discrete number. In terms of normal testosterone, I'm usually looking for if I'm gonna treat a guy or if I'm assessing him for low tea, I want him to be in the middle third of the normal range. And if we do, you know, talk about total tea, usually that's somewhere around 450. Um, guys who are in the 300s, and again, I usually look at free tea, but this is, you know, in I want to give context that most people are are used to. Um low 300s is, you know, is in the gray zone, and it may be too low for some men. They may not feel normal. Um, and so we kind of go by symptoms as well as numbers when we decide on on treatment. I I think it's a really important conversation for guys to feel comfortable with their provider to share. Like, I don't feel myself, I want to maybe go up a little bit or go, I'm okay how I feel right now. It does take adjustments, it takes titration, and in that way, you want to find someone who knows what they're talking about, trying to sell you something.

Grantley Martelly 31:10

So we we focus again on the black men and men of color in this podcast. And one of the things that comes up also, and actually Dr. John Vassel discussed, brought this up a little bit in in my second episode. He was giving like a broad overview of just all the things that men need to be thinking about for their health, not just cancer, but he was talking about everything. He is uh internist internal medicine. But one of the uh but he's also of Jamaican descent. And I'm of Barbarian descent, and we have guys of African American descent. Within these cultures the culture is very important, right? And uh a lot of decisions we make are based on our cultural heritage and our and the people around us. So there's two things in this in this question. So we're gonna divide it into two parts. The first thing is food in many of our cultures. Food is really, really important, in fact. If you get invited to somebody's house and the food is not good, you could as well make a card and you know, people are gonna be like and uh so but he was also pointing out that sometimes our food can get us because of the things that we love. So could you talk a little bit about, you know, how things that we as men may take for granted, like our culture, our food, some of our practices, could affect our men's health without us being fully aware of it until somebody brings it out to us because my husband is half Korean and half Japanese, and in both cultures, you know, food is so important.

Dr. Hehemann 32:53

It's so important to so many people, myself included. Breaking bread is, you know, a form of bonding, and sitting around a dinner table is what brings us joy in life. And so I think, you know, I heard a great talk from a dietitian actually at, I think it was at um the IPCR, our one of our societies for prostate cancer research here in Seattle, talking about, you know, cultural awareness on behalf of providers and dietitians and internists, everybody you talk to in the medical profession should have some cultural awareness about, you know, this being an important part of one's life. Making some recommendations to sort of change a diet need to be take this into account. You know, talking to you, Grantly, I'm I if you're, you know, used to eating things from your culture, I wouldn't say, oh, you will you need to just only eat salmon and sweet potatoes and broccoli. Obviously, it's important to take into account where you're from and what your family likes to eat and maybe just make some incremental changes. If you're eating meat with stew five nights a week, maybe switch it over to fish stew, you know, things like that where you're just making small incremental changes. Of course, focusing on trying not to overeat, just the amount that you're eating and keeping a lean, normal BMI is really important. And of course, if you're having celebrations for the holidays, for whatever it may be, family, you know, birthdays and big celebrations, those are times when you want to indulge. And that's of course okay. Um, but it may not mean eating two pieces of cake at the quince and yera, just one, you know. Things like that, where it's uh just a subtle shift in trying to be aware of that, you know, you're what you're taking in. And then adding to that things like the just increased activity every day, adding to it exercise. That's a huge exercise is just a huge part of being a healthy individual. And that, of course, plays a role in men's health, in bladder health, sexual health, fertility. And that you don't have to take anything off your plate as long as you add the exercise in. I think it's just cultural awareness and and making those little incremental changes to being healthy.

Grantley Martelly 35:20

So my my wife used to teach a class when she taught at university as on food as medicine. How food cannot just be beware of food, but also be aware of certain foods that help. Normally we tend to go to the negative, right? Cut this out, reduce reduce fat, reduce beet. But food as medicine to me takes the other approach.

Dr. Hehemann 35:53

Yeah. Totally great question. And probably something that I am not as, you know, well-versed in, a surgeon and you know, clinician. I certainly we of course know that there are really great benefits to certain foods. Um for instance, tomatoes have a lot of the of the compound called lycopene, which has really beneficial effects for the prostate. So um there's research on tomatoes benefiting prostate health. I think there's some research for showing that coffee can benefit prostate health.

Grantley Martelly 36:30

I hope so. I drink a lot of it.

Dr. Hehemann 36:33

I know if I had a prostate, I'd be doing great too.

Grantley Martelly 36:36

But it might be too late for me because I don't have a prostate anymore.

Dr. Hehemann 36:40

So funny. Yeah, yeah, exactly. Foods, you know, that's why this concept of the Mediterranean diet or the the diet that focuses on a lot of vegetables. Vegetables are medicine. You know, they have the antioxidants that help reduce inflamm inflammation in the body that can pose a risk for cancer. You know, that's, you know, these are things that drive cancer. Um, introducing fruits that have natural sugars obviously only has beneficial effects. Blueberries, berries have a lot of antioxidants. And of course, there's like ginger and turmeric and spices that have a lot of a lot of beneficial effects on heart health. And I do uh every year I chair this men's health update in in Seattle. It's a continuing medical education program for primary care providers generally. And over the years I kind of switched which talks we're giving. And historically I've done a heart health talk. And um, a really great provider at UW who focuses in Asian men's health or in Asian men's cardiology, he talks about potassium and that increasing potassium intake lowers blood pressure. So potassium-rich foods are potatoes, you know, some of those really healthy starches, probably yucca, again, sweet potatoes, lots of things that you you know, you think of potassium as a banana, but it's so much broader than that, and that has really beneficial effects as like you said, medicine.

Grantley Martelly 38:15

It's just to the the concept that many times we talk about food, we go to what you need to not eat. Sure, totally rather than what you need to eat or what are things that could be benefiting you. So just trying to help the guys change that mindset that you gotta go on a diet or you gotta cut this out, but you may want to look at what are the things that you need to include in your diet that you're not including right now, you know, that could be beneficial. You know, we we're always good at knowing what hurts us and what can help us.

Dr. Hehemann 38:48

No, it's a great question and something I probably don't talk about often enough.

Grantley Martelly 38:52

So let's switch to the topic uh uh mental well-being. Great. The this this topic of mental well-being to me is one of the most important, non-talked about topics in medicine

Mental Health And Masculinity Shifts

Grantley Martelly 39:06

that needs to be talked about.

Dr. Hehemann 39:08

Yeah.

Grantley Martelly 39:10

And I've been telling everybody that. And what I found for me was that in my recoveries for the major challenges that I've had in my health, that there was very little talk about the mental impact that will have on you and the changes it has on you. And surviving major surgeries or recovery, not being able to do the things you want to do. The cancer journey was obviously the biggest, and I tell people all the time that my physical recovery was much easier than my mental and emotional recovery, which I'm still going through two and a half years later. And I wish that somebody had talked to me about this on the surgical team before we even went into it. I sort of backed into it and started asking questions, and I got referred to this person and that person, that person, eventually found somebody who could help me. And it seems to be pretty common in the men that I talk to as well, who say, Yeah, I'm having a really hard time adjusting, not just physically, but mentally, and not necessarily because of the medicines, because I've not been on, not had radiation, and I've not been on some of those really strong cancer medicines, but I still had a very difficult time adjusting emotionally.

Dr. Hehemann 40:27

Absolutely something that I see every single day. And I think you're absolutely right. Many men aren't given the resources that they need right off the bat. I think it takes a lot of strength to reach out and to recognize what's going on and to ask for help. Um men classically have been taught that they need to be stoic. And men sort of hold things in and hold these emotions in. And, you know, oh, you're back in the gym a month and a half after your surgery, you must be fine. And that's not the entire picture, of course. Um, there's so much under the surface of having a big surgery or a radiation that it's changing sexual function. It changes penile anatomy, the loss of penile length, and it can change abdominal anatomy. You have scars now, it can change the relationship dynamic. Sometimes haven't had to have any procedures, luckily, in their life, and having a catheter in feels really maybe traumatizing. Um leaking urine, obviously, that's I see guys who've been in diapers for years after prostate cancer surgery, and it breaks my heart that they've never been made aware that there's something they can do, and they've been suffering silently for years. Um and obviously as a surgeon, I can luckily help some of this, but I can't really unwind that mental change that men have gone through. Um, and I can't give back, you know, the penis that you had when you were 20 or, you know, but that's again just the physical aspect. It's, you know, the mental change that comes along with prostate cancer diagnosis and treatment is huge. And um, I'm just so grateful for, you know, you making a podcast and and spreading awareness that men are not alone and that it's, you know, very much a part of the journey of a patient to have some mental health changes and that there are resources that men can seek. Um, I feel so fortunate that those things exist and I just hope to raise awareness because without being able to see it, you don't know that there is help and that there are so many guys going through it alongs alongside you, and having that community is is really, really helpful, I think. Maybe you can speak to that.

Grantley Martelly 43:01

Yeah, it is really helpful. And you know, and it's not just for prostate cancer, because we have people on the whether you have diabetes or heart disease, like you said, we lose some of those functions. And a lot of times men will say, I've lost my manhood. My manhood. And trying to deal with that is is really, really tough because the society we live in says that your manhood is tied to your sexual function. That emotion is like, what do I do? What do I do to regain my manhood? And it's like, just tell me what I need to do because this is important to me. And I cannot some of the guys say I cannot function until I get an answer to this question.

Dr. Hehemann 43:44

Right. Yeah, I see it a lot. I think the manhood being sexual function and fertility, you know, being able to be a father, create, you know, a pregnancy, are very much these sort of paradigms of what masculinity is. And I see in those guys, I see in guys who have Peyroni's disease, which is this scar tissue in the penis that causes the penis to curve, and and that really has a profound impact on all of these conditions, have a profound impact on men's well-being. And that's like I mentioned kind of at the beginning, part of the reason I love being in this field because I get to have these very sensitive conversations. And, you know, my goal is really to be a listener and an educator on what's out there. But I know that there's a lot of that's not out there about the normalization of sexual change as men age.

Grantley Martelly 44:43

Right. Not a topic that's talked about very much.

Dr. Hehemann 44:46

Yeah, it's not really talked about that male sexual health changes with age, just like women's sexual health does. You know, everyone knows what menopause is, and that changes women's hormones and sexuality, but men also undergo a gradual change. And I find myself sort of explaining this to men for the first time in as sensitive way as I, you know, as I can, that, you know, our we get wrinklier, our ears keep growing, the breasts get saggy, and the penis also changes with time too. And I wish there was a little more normalization and just understanding about what's, you know, what's normal. Because I feel like a lot of my patients just feel so isolated and abnormal. And that's really stressful.

Grantley Martelly 45:34

Yeah, and what I've found is that, you know, just talking about it gives people permission to talk about it. So now I just talk about it all the time and ask people questions. But there's a bunch of guys now we've sorta committed ourselves to just talking and rearnibid, our families, rearnibid, our children, we family reunions and trying to normalize conversations about men's health and that men do change as well. You don't always have to have cancer or diabetes or heart attack. You are s you are still gonna have changes in your body function, your sexual function, your mental well-being as you get older. And it's okay to talk about it.

Dr. Hehemann 46:15

Yeah.

Grantley Martelly 46:16

To ask for help. There's lots of ha there's lots of resources. Like I told you, once I started asking, everybody was like, talk to this person, talk to that person. That's how I found Xero. That's how I found some of the other guys that I'm working with now. It's because I started to ask. But it was until I until I brought it up, it was silos.

Dr. Hehemann 46:35

Yeah. I think it's great, you know, I always try to provide some resources for patients and sexual co, you know, think of it as sort of intimacy coaching or sex therapy, and giving a list of different options for some men may not feel comfortable talking about it one-on-one with another provider right away. They may want to listen to a podcast about it. They may want to read a blog about it and take it in for themselves in a different way or a book. So um I think the onus is on us to kind of share a bunch of different resources that men can look through and feel what's right for them.

Grantley Martelly 47:14

Yeah, that that's the goal, get them to the point where they find the get the help that they want. Right. Um, as we r as we round the corner for our interview, is there anything else that we have not touched on that you wanted to make sure that we cover

Caregivers Help Access And Next Steps

Grantley Martelly 47:28

today in this topic of men's sexual health or sex medicine?

Dr. Hehemann 47:33

I feel like this has been such a rich conversation about all the aspects from you know the physical of what how interaction is made to the emotional aspects of it. I, you know, I can't stress enough how important it is to engage not just your urologist, but also your primary care doctor or provider, you know, advanced practice provider. Again, just to make sure your total well-being, the heart health, the mental health is is all dialed in and get the right resources. I want to empower men to find the person that they feel comfortable with, you know. If you see someone for sexual health after prostate cancer and they feel like they don't jive with you and you're not trusting, go get a second opinion. There's plenty of people who are really great, are really caring and really talented. I feel lucky to be among a bunch of providers at the UW Men's Health Center. And, you know, of course, our oncology team at UW is outstanding that we can just keep it all internal, but I know that there are a lot of guys who are in more rural settings who may not have easy access. Telemedicine is great. You don't need to go into an office to be talk about your erectile function. You can have a Zoom call with someone who's an expert. You can get the right referrals and find a person that you trust. Okay.

Grantley Martelly 49:04

That's ended up also with a caregiver. What what advice would you have for caregivers or people who are dealing with men who are dealing with these things, or even trying to get their male partner just to s go to the doctor?

Dr. Hehemann 49:18

Woof. Grantly, if I had an answer to that as a married individual with a husband, it is it's a tall order sometimes for caregivers. Think that caregivers go through their own journey, especially with things like cancer. But anything, you know, having a husband who has if you've had got a husband who has diabetes, you know, you can only do so much as a caregiver to support that person. You can't make them do anything about their health, of course, as many caregivers probably know. But just being sensitive to what guys are going through and it maybe, you know, just recognizing that it can be hard for men to talk about things that's wrong with their bodies, it it does bring a lot of shame. Um, it does bring a lot of these other elements of depression and um that can be hard for men to overcome. So being sensitive, being just being there and asking what they need for support, I think is probably the best thing that you can do. And also just getting informed yourself about what's out there for men if they want to seek a support group or seek a community. And also there are similar support groups for caregivers.

Grantley Martelly 50:36

Caregiver support groups, yeah.

Dr. Hehemann 50:37

Yeah. And I found a lot of my, you know, patients' wives. I have a a patient advocate who's a guy that I've treated, and his wife acts as a patient advocate as well. And she will talk with wives of guys going through ED after prostate cancer. So there's, you know, similarly, there's a journey for the caregiver. It can be really tough on caregivers, but there's also support there and, you know, trying to come together is probably best case scenario. Um, but it can be really challenging on a marriage, on a partnership. And I'm only focusing on caregivers who are spouses or partners, but that also takes on the role of, you know, a child of going through cancer and just being there, touching base often, um, I think is the best thing you can do. Um, I'm not an expert in this area, but I know there's a lot of great resources out there as well.

Grantley Martelly 51:33

Sometimes you can't change it. You you may do your best and you can't change it. But and there are support out there for caregivers. I didn't really know that until I actually started doing this podcast, and then I started actually learning that there were caregiver groups. Yeah. How would people get in touch with you if they want to get in touch with you?

Dr. Hehemann 51:55

Yeah. Um, so I am, like you mentioned, at the UW Men's Health Center. Um, if you're in Seattle or in the region, I see men from

Contact And Support The Podcast

Dr. Hehemann 52:05

Oregon as well via telemedicine. Um, they can contact the UW Men's Health Center. We're at 206-598-6358. Um, my email address is just my last name at UW.edu. You can reach out to me directly. And if you have questions or want resources, I'm happy to be, you know, of um a resource for everybody here. I just want folks to find the right person. If you're in Atlanta, you know, I know people there. So if you're in Tampa, I know people there. So um I were it's a very small field of men's health experts, and I would feel absolutely comfortable giving men a recommendation of the the right people to see.

Grantley Martelly 52:52

So thank you very, very much. I really, really appreciate it. And I look forward to our continued relationship in the future through the symposium and through the workshops and through the research panels that we're working on. I really appreciate it.

Dr. Hehemann 53:06

Likewise. Thank you so much for the opportunity. And um, I look forward to seeing you again probably soon.

Grantley Martelly 53:13

Thank you.

Dr. Hehemann 53:13

All right, thank you, Grantley.

Grantley Martelly 53:17

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