Ep. 41 - COVID, Testosterone & Male Sexual Dysfunction

[00:00] Introduction: Testosterone and COVID

Dr. Bawa: Welcome to another episode of Dr. Sex Fairy. I am Dr. Kanwal Bawa, and I am here to transform your life. For those of you who follow my podcast, welcome back, and thank you for joining me on this journey towards sexual and intimate wellness. For those of you who are listening to the Dr. Sex Fairy podcast for the first time today, welcome. Make sure you follow this podcast and share it with the people in your life who truly matter. Do support this podcast and me by leaving a five-star review.

Dr. Bawa: My super hit TikTok account, Dr. Sex Fairy, stands at about 47 million views at the time of this recording. It keeps reaching more and more people all over the world every second of every day. My attempt at an honest and respectful discussion about sex and sexuality has clearly resonated with millions around the globe. They are finding great value in it, and so will you. And so, make sure that you follow me on TikTok at Dr. Sex Fairy as well. Today we are discussing the relationship between testosterone and COVID.

Dr. Bawa: I was recently interviewed by Channel 10 News in Miami. It is an ABC affiliate. This is an important topic. People need to know about this, and that is why I went on the news and why I am doing this podcast today.

[01:39] What Is Testosterone?

Dr. Bawa: Let's start with the basics. What is testosterone? It is a hormone that is produced in the testes of a man. Here's a fun fact: testosterone is also present in women, in whom it is produced in the ovaries along with estrogen. Now let's get back to the men and discuss what testosterone does for them. It is a major sex hormone for men. To begin with, it helps with the development of the genitalia, including the penis and the scrotum. It plays an essential role in puberty, from the development of a deeper voice to the beginning of facial and pubic hair.

Dr. Bawa: It helps men with sexual function. It gives them their sex drive or libido. It also helps with sperm production. It affects bone density and growth. Testosterone also affects a man's muscles with both size and strength. It even affects how fat is distributed in the body. An important effect of testosterone that does not get much limelight at all is its effect on mental function and clarity. It helps men with their mood as well. As I mentioned earlier, testosterone is an important hormone for women as well.

Dr. Bawa: And just like with men, it affects their libido. It also affects their bone density. Women experience a dramatic drop in estrogen around the time of menopause. But for men, the drop in testosterone is slower. It goes down about 1 to 2 percent per year for men. Add other comorbidities to the mix, and the testosterone level drops much faster. What I mean is that if you have diabetes, heart disease, COPD, and COPD, for those of you who don't know, is chronic obstructive pulmonary disease, and even obesity, you will lose more testosterone than the average male.

[03:46] What Low Testosterone Can Do

Dr. Bawa: Since I already discussed with you the role of testosterone, it makes sense that when levels are low, the symptoms include poor libido, a lower sperm count, outright infertility, and erectile dysfunction. There is weight gain and a decrease in muscle mass as well. These individuals also develop a mental fog and symptoms of depression. And of course, there is lower bone density and a higher risk of fractures.

[04:19] Low Testosterone, ED and Depression

Dr. Bawa: I have a heck of a lot of experience with the connection between low testosterone and both erectile dysfunction and depression. I am a sexual medicine specialist at my practice, Bawa Medical, in Boca Raton, Florida. I see men with these problems on a daily basis. They are lacking good sexual function, and so they feel depressed. And then, because they are depressed, sexual function suffers. It's a vicious cycle. One of the first things I do is to check testosterone levels. While testosterone is not the only treatment for erectile dysfunction, it is a key factor in a man's sexual response.

Dr. Bawa: I have been treating low testosterone levels with gels, shots, patches, and more, but I don't like prescribing pills due to the side effects associated with them. The other way I treat erectile and female sexual dysfunction is by improving blood flow in the genital area for both men and women by using my special method of acoustic or shockwave therapy called BawaWave. I am also doing my unique Bawa shots, which involve PRFM, or platelet-rich fibrin matrix, injected directly into the penis or clitoris.

Dr. Bawa: But don't worry, my method is completely painless. This improves blood flow, sexual function, sensation, and orgasms.

[05:47] Shrinkage, BawaWave and BawaBig

Dr. Bawa: A side effect of low testosterone that very few people either recognize or fully understand is that people with low testosterone develop shrinkage in their scrotum, penis, and even their clitoris. Low testosterone can literally make a penis smaller. I do a unique form of penis enlargement at my practice, Bawa Medical. Not only is it non-surgical, it actually makes men bigger long term, and it's an immediate increase in size. There's big, and then there's Bava big. In fact, that's what we call our penis enlargement procedure, BawaBig.

Dr. Bawa: So, as you can imagine, not only am I helping men have less depression, more mental clarity, and better bone density, I am transforming their lives by giving them better sexual function. I am also increasing their penis size without ever cutting the penis and inserting an implant.

[06:48] ED and Penis Shrinkage Are Not Just About Age

Dr. Bawa: You have heard me say this before. Erectile dysfunction and penis shrinkage is not limited to a certain age. Twenty percent of men in their twenties suffer from erectile dysfunction, and the prevalence increases by a whopping 10 percent for every single decade of life. This means that at least 50 percent of men in their fifties suffer from this. At this point, you're wondering why I talked about a connection between testosterone and COVID. After all, what could a sex hormone and a worldwide pandemic possibly have in common?

[07:26] What Changed During COVID

Dr. Bawa: Before we launch into why I connected the two, let me tell you about what I have been seeing in my office since the very beginning of this pandemic. COVID affects men much more than it does women. This was obvious right at the beginning of the pandemic. Once COVID happened, the number of men complaining about erectile dysfunction in my office increased. Simultaneously, the average age of the men complaining about erectile dysfunction plummeted. More were coming in, and they were coming in younger.

Dr. Bawa: Some were even complaining about how they were unable to get their wives pregnant. When I checked their testosterone levels, so many more men had lower levels than before. Men whose testosterone levels we already knew about had dips, and then there were other men who were new to Bawa Medical whose levels were far lower than what I would expect for their age. Many of them were complaining about their penis actually shrinking in size. What on earth was going on?

[08:39] COVID in the Testes and Sperm Production

Dr. Bawa: In January 2021, the University of Miami's Miller School of Medicine published a study led by Dr. Ranjith Ramasamy, associate professor and director of the Miller School's reproductive urology program, titled Histopathology and Ultrastructural Findings of Fatal COVID-19 Infections on Testes in the World Journal of Men's Health. This study found that COVID was present in the testes of people even after they had theoretically recovered from it. You see, COVID-19 has an affinity for ACE2 receptors, and since there are more ACE2 receptors in the testes, the male reproductive tract, specifically in the testes, may be a target of COVID.

Dr. Bawa: Researchers even found an inverse association between ACE2 receptor levels and the production of sperm. So, the more COVID was grabbing onto these receptors, the less sperm the testes were able to make.

[09:37] COVID, Endothelial Dysfunction and Erectile Dysfunction

Dr. Bawa: But what about erectile dysfunction, you ask, and you're still wondering what testosterone has to do with all of this. In May 2021, the University of Miami's Miller School of Medicine published another study titled, COVID-19 Endothelial Dysfunction Can Cause Erectile Dysfunction: Histopathological, Immunohistochemical, and Ultrastructural Study of the Human Penis. This study, too, was led by Dr. Ramasamy. They found that widespread blood vessel dysfunction, which is also known as endothelial dysfunction, caused by COVID-19 infection contributes to erectile dysfunction. Endothelial dysfunction occurs when the lining of the small blood vessels is unable to perform all of its functions normally, and so the tissue supplied by those very blood vessels undergo damage.

Dr. Bawa: Dr. Ramasamy said, Our research shows that COVID-19 can cause widespread endothelial dysfunction in organ systems beyond the lungs and kidneys. The underlying endothelial dysfunction that happens because of COVID-19 can enter the endothelial cells and affect many organs, including the penis. In our pilot study, we found that men who previously did not complain of erectile dysfunction developed pretty severe erectile dysfunction after the onset of COVID-19 infection. Of note, COVID was being found in the testes of men who had otherwise recovered six to eight months prior.

Dr. Bawa: Can you believe that?

[11:08] Testosterone, COVID and Hospitalization Risk

Dr. Bawa: So now I guess you understand why COVID causes ED, but you're still wondering about the testosterone connection. Let me remind you about something. Testosterone is made in the testes. COVID lives on in the testes even after the infection has technically resolved. A study titled Association of Male Hypogonadism with Risk of Hospitalization for COVID-19 was published in JAMA, the Journal of the American Medical Association, just this month, which happens to be September 2022.

Dr. Bawa: This study was led by Dr. Sandeep Dhindsa and sought to elucidate the connection between testosterone and COVID, and found that men with low testosterone were 2.4 times more likely to be hospitalized after COVID-19 infection compared to those with normal levels, independent of other known risk factors. This increased risk was not observed among men receiving adequate testosterone therapy. An earlier study by the same author titled Association of Circulating Sex Hormones with Inflammation and Disease Severity in Patients with COVID-19 measured testosterone levels in hospitalized men admitted with COVID and found that 89%, 89% had low testosterone levels upon hospital admission.

[12:27] Testosterone, ICU Admission and Mortality

Dr. Bawa: Yet another study sought to study this very connection. Effect of Serum Total Testosterone and Its Relationship with Other Laboratory Parameters on the Prognosis of Coronavirus Disease 2019 in SARS-CoV-2 Infected Male Patients: A Cohort Study was published in Aging Male in September 2020. This study showed that men with lower testosterone levels were at significantly higher risk for ICU admission and consequently higher mortality or death rate. It showed that COVID caused testosterone levels to plummet. So, you can now see a direct correlation between testosterone levels and the risk of death.

Dr. Bawa: Low testosterone levels put a person at higher risk for a tougher course of COVID, ICU hospitalization, and ultimately death.

[13:16] What Men Can Do

Dr. Bawa: So, what is a man to do? To begin with, I recommend that a man gets his testosterone levels checked and, if low, treated. However, there are some people who are simply not candidates for testosterone replacement. Men who have prostate or breast cancer cannot take testosterone. Men who are at high risk for prostate cancer, those with BPH-related severe urinary symptoms, and men at risk for or diagnosed with heart disease, heart attacks, that sort of thing, need to be very cautious taking testosterone.

Dr. Bawa: Erectile dysfunction and penis shrinkage can be treated by the multiple treatments available at my practice, Bawa Medical, and I mentioned those earlier in this episode. I have my very own Dr. Sex Fairy supplements that include a testosterone booster, a libido booster, and even a nitric oxide booster to increase blood flow. I also have a penis pump designed by me that will increase blood flow into your penis. This will help with both function and size.

[14:25] Treatment, Supplements and Virtual Care

Dr. Bawa: Many of you travel to me from all over the world, but just as many of you receive care virtually. Start by emailing me at askme@drsexfairy.com so that I can help you in your journey towards sexual wellness and fulfillment. If you would like to receive my newsletter full of tips, tricks, and transformation, go to drsexfairy.com right now and fill out the short newsletter sign-up form. Until next time.

[14:50] Recorded Outro

Dr. Bawa: I hope you enjoyed the Dr. Sex Fairy podcast today. I would love to continue this conversation with you. If you would like to get in touch with me, email me at askme at drsexfairy.com. Don't forget to follow this podcast and leave me a five-star review. And make sure you follow my blockbuster hit TikTok account, Dr. Sex Fairy.