Male Fertility, AI, and Sexual Health After Cancer: What Men Need to Know

When a couple struggles to get pregnant, most of the cultural narrative still points in one direction:
“Is something wrong with her?”

We talk endlessly about women’s biological clocks, egg quality after 35, and “geriatric pregnancies,” yet we rarely hear the same urgency or attention placed on men. In reality, the data tell a very different story.

In the second half of my ANEW Insight conversation with Dr. Kian Asanad, a fellowship-trained urologist and men’s health specialist with Keck Medicine of USC, we dug into the missing half of the fertility conversation: male factors, environmental toxins, AI tools transforming care, erectile dysfunction, Peyronie’s disease, and sexual health after prostate cancer.

This isn’t just about fertility—it’s about men’s overall health, relationships, and quality of life.

Are Men Really Overlooked in Fertility Struggles?

Short answer: yes. And they shouldn’t be.

We often act as though male fertility is endless and bulletproof, while female fertility is fragile and time-limited. Here’s what Dr. Asanad emphasized:

• About 20% of infertility cases are solely due to male factors.
• Men contribute in some way up to 30% of the time.
• Overall, men play a role in roughly 50% of infertility cases. 

Unlike women, who are born with all the eggs they will ever have, men produce new sperm daily. But that doesn’t mean sperm are invincible. They are highly sensitive to hormones, heat, toxins, health conditions, and lifestyle.

This is not about blame. As Dr. Asanad put it, men and women simply have different roles in conception—and both deserve equal attention and support.

 

Do Men’s Sperm “Age” or Degrade Over Time?

We’re used to hearing about declining egg quality in women after age 35. So what about men?

Men may keep producing sperm, but sperm quality absolutely can decline and is affected by:

• Hormonal health (especially testosterone)
• Lifestyle factors (diet, exercise, sleep, alcohol, smoking)
• Environmental toxins and heat exposure
• Chemotherapy, radiation, and certain cancers

If testosterone is very low, sperm count and quality are often poor. Sperm might still be produced, but in lower numbers and with more subtle defects that impact fertilization and pregnancy.

 

How Do Heat, Saunas, and Toxins Affect Sperm?

One of the most striking details from this episode:

A single exposure to intense heat can impact sperm production for up to three months in some men.

Why?

• Testicles are located outside the body for a reason: they need to stay about two degrees cooler than core body temperature.
• Wet heat (like hot tubs, saunas, steam rooms) can disrupt this balance.
• A full cycle of sperm production takes about 72–74 days, so damage or disruption today may show up weeks later in semen testing. 

Not everyone who uses a hot tub becomes infertile, but for some men—with specific vulnerabilities—these exposures matter.

Other factors that can damage sperm and testicular tissue include:

• Testicular cancer and removal of a testicle
• Chemotherapy (many agents cross the blood–testis barrier)
• Radiation, including scattered radiation to the testicles
• Leukemia, lymphoma, and childhood or adolescent cancer treatments 

These aren’t just fertility issues; they’re life issues that intersect with survivorship, identity, and future family planning.

What Is Fertility Preservation—and When Should Men Consider It?

Fertility preservation has become a standard part of modern cancer care.

Under current oncology guidelines, men who wish to preserve fertility should be offered sperm freezing before starting cancer treatment. This is especially critical before:

• Testicular removal
• Chemotherapy
• Radiation (including whole-body irradiation)
• Bone marrow transplant or stem cell transplant 

The most common method is simple:

• The patient gives a semen sample at a sperm bank or fertility clinic
• The lab freezes (cryopreserves) the sample for future use 

But what if:

• Sperm count is already very low?
• There are no sperm in the ejaculate (which occurs in up to 10% of men with testicular cancer)?
• The patient has a spinal cord injury and cannot ejaculate at all? 

This is where a men’s fertility specialist like Dr. Asanad steps in.

Options include:

• Sperm extraction from the testicle during surgery (for testicular cancer or low ejaculate sperm counts)
• Sperm extraction for men with leukemia or lymphoma when ejaculate is sperm-free
• Penile vibratory stimulation for men with spinal cord injuries to induce ejaculation so sperm can be frozen 

In other words: even when traditional sperm banking isn’t possible, there are often creative and effective options—if patients get connected to the right specialist early enough.

 

What Really Causes Erectile Dysfunction?

Erectile dysfunction (ED) is not simply a “manhood” problem. It is a complex, multi-system issue.

According to Dr. Asanad, a healthy erection requires all of the following:

1. Good blood flow into the penis
2. Ability to trap blood in the erectile tissue (no major venous leak)
3. Healthy hormones, especially normal testosterone
4. Intact nerves that signal arousal and erection
5. A calm enough mind to allow arousal and maintain erection 

ED can be caused by:

• Vascular issues (atherosclerosis, cardiovascular disease)
• Poorly controlled diabetes damaging nerves and blood vessels
• Pelvic surgeries (prostatectomy, colorectal surgeries) that affect the nerve supply
• Low testosterone
• Psychological stress, anxiety, depression, performance pressure, or trauma 

Many men want a “magic pill.” Yes, medications like Cialis and Viagra can help. But when all the lab numbers look normal, and the body is capable, the core issue is often stress, anxiety, shame, or relational tension.

That is where therapy should be seen as essential medical care, not a last resort.

 

How Can Therapy Help With Erectile Dysfunction?

As a clinical psychologist, I see this every day.

When we normalize mental health support as part of sexual health, men are far more likely to:

• Understand the role of anxiety, stress, and past experiences
• Learn skills to manage performance fears
• Heal shame and self-criticism
• Improve intimacy and communication with partners 

Dr. Asanad and I both share this conviction: if your medical workup is normal and you’re still struggling, therapy isn’t a failure—it’s a powerful tool.

There is no shame in acknowledging that we live in a chronically anxious world and that your nervous system may simply need help recalibrating.

 

How Is AI Being Used in Men’s Fertility and Sexual Health?

This might be my favorite part of the conversation.

While many people fear AI, Dr. Asanad is harnessing it in ways that are human-centered and clinically meaningful, especially at USC’s AI Center in Urology.

Current and emerging uses include:

1. Better Patient Education

Many patient handouts from medical societies are:

• Hard to read
• Outdated
• Not written at an accessible level 

Dr. Asanad and his colleague Dr. Geo Cacciamani are using AI to create education materials that are:

• Up to date with current guidelines
• Easier to understand
• More personalized to men’s common questions and fears 

If patients finally understand what is happening and why a procedure is recommended, they are more empowered and less fearful.

 

2. Rapid, In-Office Semen Analysis

Instead of:

1. First visit
2. Order semen test
3. Schedule lab visit
4. Return for a second visit weeks later 

AI-powered devices now allow:

• A semen sample to be analyzed in-office within about 10–15 minutes
• Instant review of sperm count and motility
• Real-time guidance on next steps 

This makes care more efficient, accessible, and less anxiety-provoking for patients sitting in a clinic in Beverly Hills, Santa Clarita, Valencia, or beyond.

 

3. Surgical and Predictive Applications

Early-stage work (still evolving) includes:

• AI-assisted microscopes during sperm extraction to help identify tissue more likely to contain sperm
• Predictive models estimating how likely a man is to recover erections after prostate surgery, based on lifestyle, cancer specifics, nerve preservation techniques, and pre-surgery function 

The goal is not to replace physicians, but to support better decision-making, faster testing, and clearer communication.

 

What Is Peyronie’s Disease?

Peyronie’s disease is one of those conditions men almost never talk about—but that deeply affects self-esteem and intimacy.

Peyronie’s disease is:

• A scar tissue (plaque) buildup in the penis
• Often felt as a firm, sometimes rock-hard, nodule
• Frequently located along the top of the penis
• Associated with curvature, deformity, or “hourglass” narrowing 

Many men do not recall a specific injury. In some, it may follow a noticeable bend or trauma during sex; in others, it likely develops from repetitive microtrauma combined with genetic factors and erectile issues.

Common complaints include:

• Curvature that makes penetration difficult or impossible
• Pain, shortening, or narrowing of the penis
• Loss of length
• Embarrassment, fear, and avoidance of intimacy 

 

Treatment Options for Peyronie’s Disease

The goal of treatment is functionality, not sculpting a “perfectly straight” penis. Options, from least to most invasive, include:

1. Penile stretching devices 
   • Example: RestoreX, worn daily to gently stretch opposite the curve
   • Can improve length and straighten over months 
2. Injections (Xiaflex / collagenase) 
   • FDA-approved medication injected into the scar
   • Softens plaque and can improve curvature by about 30% 
3. Plication surgery 
   • Short outpatient surgery to straighten the penis
   • Best for men with adequate length who can tolerate a slight loss of length 
4. Plaque excision with grafting 
   • Removal of scar tissue and placement of a graft
   • Reserved for very severe deformities and men with strong baseline erections
   • Carries some risk of erectile dysfunction 
5. Penile prosthesis with straightening 
   • For men with severe ED plus severe curvature
   • A mechanical device is implanted to provide reliable erections, and the penis is straightened surgically
   • Considered a definitive reconstruction—and many appropriate candidates are extremely satisfied 

There are far more options than most men realize. The hardest part is often making the first consultation.

 

How Does Prostate Cancer Treatment Affect Sexual Function and Continence?

Prostate cancer is common, and many men—like loved ones in my own life—face the difficult choice of surgery and its side effects.

After prostate removal (prostatectomy), men can experience:

• Erectile dysfunction
• Urinary incontinence (leaking urine)
• Climacturia (leakage of urine during orgasm) 

At USC, Dr. Asanad uses a prehab and rehab protocol:

• Assess erection quality before surgery
• Use nerve-sparing approaches when safe for cancer control
• Start low-dose Cialis daily around the time of surgery to maintain blood flow
• Follow patients closely at 2–3 months and beyond
• Use additional medications, and if needed, penile injections to maintain erectile tissue health 

For continence:

• Most men improve with time and pelvic floor physical therapy
• Many are dry by 3–6 months; the majority by 12 months
• For persistent severe incontinence, options include: 
  • Artificial urinary sphincter (AUS)
  • Male sling procedures (for mild leakage)
  • Adjustable urinary balloons 

Again, there is no shame in seeking help. These are common, treatable issues—not personal failures.

 

How Can Men Work With Dr. Kian Asanad?

For men in Los Angeles, Beverly Hills, Santa Clarita, Valencia, and surrounding areas, Dr. Asanad sees patients through Keck Medicine of USC at several locations:

• Beverly Hills office
• Santa Clarita / Valencia clinic
• Main hospital and academic center in Los Angeles 

Appointments can be scheduled through 1-800-USC-CARE. Telemedicine visits are available for those coming from out of state or long distances, followed by in-person visits when exams or procedures are needed.

For Information get more details about Dr. Kian Asanad here are his social media channels https://www.keckmedicine.org/provider/kian-asanad/ , https://keck.usc.edu/faculty-search/k…, https://www.yelp.com/biz/kian-asanad-…, https://www.instagram.com/asanadmd/?h…,  linkedin.com/in/kian-asanad-md-3691a9228 

 

Final Thoughts: Men’s Health Is Whole-Person Health

This conversation with Dr. Asanad brought home a core truth:

Male fertility, erections, and sexual confidence are not separate from mental health, cardiovascular health, or long-term cancer survivorship. They are woven into every layer of a man’s life—identity, relationships, family, and future.

If you or someone you love is facing infertility, ED, Peyronie’s, cancer-related sexual changes, or mental health struggles around performance:

• You are not alone
• You are not broken
• There are options—medical, psychological, and relational—that can help 

Frequently Asked Questions (FAQ)

1. When should a man get evaluated if a couple is having trouble conceiving?
   If a couple has been trying to conceive for 12 months without success (or 6 months if the woman is over 35), both partners should be evaluated—not just the woman. Men should see a urologist or men’s fertility specialist for semen testing, hormone assessment, and a physical exam. Early evaluation can identify issues that are treatable and prevent months or years of uncertainty.
2. Can lifestyle changes alone improve sperm quality and erectile function?
   For some men, yes. Improving sleep, movement, nutrition, and stress can meaningfully support hormone balance and vascular health. Reducing exposure to heat (hot tubs, saunas), quitting smoking, and moderating alcohol can also help. However, if fertility or erectile changes persist, it is crucial to get a full medical evaluation—lifestyle is powerful, but it doesn’t replace diagnostics or treatment when needed.
3. Is Peyronie’s disease dangerous or cancerous?
   Peyronie’s disease is not cancer and does not spread like a malignancy. However, it can be physically and emotionally painful, and it can significantly affect sexual function and intimacy. The danger lies more in the impact on self-esteem, relationships, and quality of life if men suffer in silence. With modern options like stretching devices, injections, and surgical reconstruction, many men can regain satisfying sexual function.

 

Continue Your Healing Journey

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View  here the full podcast Transcript:

​[00:00:00]

Dr. Supatra Tovar: Welcome back. We are back for the second half of our interview with Men’s Health specialist Dr. Kian Asanad. Dr. Kian gave us some really amazing insight into his inspiration to become quite the specialist in male infertility and he is really, on the edge of these, incredible new discoveries and treatments.

Dr. Supatra Tovar: I can’t wait to pick his brain some more. Dr. Kian, welcome back.

Dr. Kian Asanad: Thank you.

Dr. Supatra Tovar: So when a couple is having difficulty conceiving what role should the male partner play? We always hear about, oh, if a woman is over the age of 40, it’s gonna be very difficult for her to conceive and blah, blah, blah, blah, blah.

Dr. Supatra Tovar: But we don’t hear as much about the male.

Dr. Supatra Tovar: Why is, why are men often overlooked in this equation?

Dr. Kian Asanad: Yeah, it’s a really good point. [00:01:00] So. We know that when women are born, they’re born with a certain number of eggs and that’s all they get, right? And we know women over the age of 35, the egg quality and quantity decreases. It’s not the same for men. Men are making for the majority of the time, fresh, new sperm every day. You see a 75-year-old in a wheelchair coming down the hallway, he’s making fresh new sperm every day, right? And so we tend to think of infertility as a female factor issue, but that’s also really not the case. 20% of the time, it is solely due to a male factor, actually. And I really try to educate, folks in my community, my patients, that it’s not anybody’s fault.

Dr. Kian Asanad: There is just roles that men and women play in achieving a pregnancy, right? And so 20% of the time, solely due to a male factor. Men can contribute to infertility up to 30% of the time. [00:02:00] So overall, 50% of the time men are playing a role in the fertility space and in terms of achieving a pregnancy, but it’s overlooked because men have an infinite amount of sperm, if you will, right?

Dr. Kian Asanad: There is no, we’re not born with X number of sperm. We’re making new sperm every day. And so there really is a educational component that plays a role here.

Dr. Supatra Tovar: Absolutely. And do male sperm degrade in a certain way? You know, we talk about, females, eggs not being as viable as they get past age 35.

Dr. Kian Asanad: Are

Dr. Supatra Tovar: there, we, and we’ve talked about certain lifestyle factors like diet and exercise that may play a role, but what about like stress and environmental factors like toxins, and do they degrade the quality of the sperm?

Dr. Kian Asanad: Absolutely all of those play a role in a very multifactorial manner, right? So the diet lifestyle plays a role in testosterone. If your [00:03:00] testosterone is really low sperm quality is gonna be pretty bad, and the sperm counts could be low, right? Toxins play a huge role, right? One of the most important exposures I tell patients is, have you been in a hot tub, a sauna or a steam room in the past three months? Heat exposure to the testicle plays a huge role in sperm production. That’s why the testicles are outside of the body. They’re kept two degrees cooler than core body temperature,

Dr. Supatra Tovar: Hmm.

Dr. Kian Asanad: Even a single exposure for some men can disrupt sperm production for three months. Why three months? A, a fresh cycle of sperm is about 72 to 74 days. So I’m not saying everybody who goes in a jacuzzi or a hot tub is going to be infertile, but some men are affected, right? So a wet heat exposure plays a role in fertility, other toxins, right? If some of the most common cancers in young men, testicular cancer, both from the testicle being removed and the cancer itself.

Dr. Kian Asanad: But if they had [00:04:00] chemotherapy, many of the chemotherapy agents crossed the blood testis barrier, right? They can impact the germ cells of the testicle. Leukemia, lymphoma, especially, some of these guys are prepubescent when they had these diagnosis or they’re in their teens, right? They’ve been exposed to these harmful toxins and chemicals. They’ve had radiation. Radiation for cancer, scattered radiation in the testicle. All of this can disrupt sperm production, sperm quality. And I think that’s when, kind of like fertility preservation comes in, which is a whole separate thing. But yeah, there’s a lot of things that can impact the quality of sperm as you, and those are kind of just to name a few.

Dr. Supatra Tovar: Wow. You just mentioned fertility preservation and now I’m very interested. What is that exactly and what does that entail? How can they preserve their fertility?

Dr. Kian Asanad: So it’s, it’s this a, fertility preservation is a really well established part of cancer treatment nowadays. By the, ASCO guidelines. Men who are interested in [00:05:00] fertility prior to cancer treatment should undergo fertility preservation that most commonly includes things like freezing sperm, giving a sample and having it frozen prior to the commencement of any cancer treatment. Whether we’re removing the testicle for cancer, whether you’re getting chemotherapy, radiation, a bone marrow transplant, whole body irradiation, freezing your sperm for men and freezing eggs for women now is an important part of cancer treatment. Um, sometimes, right due to the cancer. As you mentioned, there’s stress, hormonal stress on the body. Men can be sick, right? They could be immunosuppressed. Sperm counts are low when you have a cancer diagnosis, up to 30% of men can have lower sperm counts, and 10% of men with testicular cancer have zero sperm. So what does that man do? He goes to free sperm yeah, and then the lab tells him there’s no sperm here, but what are his options? That’s when we kind of get into [00:06:00] the more detail. That’s kind of when I, when my oncology colleagues will kind of call me and say like, Hey, we’re starting, chemotherapy.

Dr. Kian Asanad: He wants to bank sperm and freeze his sperm. There’s no sperm. What are the options available? So something we can employ is a sperm extraction that could be done at the time of the testicle being removed if it’s testicular cancer or if patient has leukemia, for example, and is undergoing systemic therapy. We’ll take the patient in the operating room under a light sedation, open the testicle, and we could find sperm in the testicle that’s not able to come out of the ejaculate. It’s low numbers. So it’s sometimes we can’t find it in the testicle has its own kind of as associated success rates. It could be anywhere from 30 to 50%. So sperm extraction is a procedure. Other things that prevent men from bank banking, sperm, right? Like some men with spinal cord injuries, they suffered a fall, they had a car accident. These men can’t ejaculate. They are anejaculatory. They may or [00:07:00] may not have an erection, but there’s no ejaculate. Um, and so there are male vibrators, penile vibratory stimulation.

Dr. Kian Asanad: We can medically vibrate the penis to induce ejaculation so we could freeze that sample. So outside of the, go to a cryobank and freeze sperm, I mean, I think that’s like 80 to 90% of the time. But there are instances. barriers at play that where a fertility specialist comes into play.

Dr. Supatra Tovar: Yes. And you’re mentioning the inability to have an erection, so let’s go into that a little bit. What are some of the main reasons why men are unable to have an erection?

Dr. Kian Asanad: So let’s think first about what makes a good erection. Like what is the process of an erection? Right. So it is a passive process, so you need to get good blood flow to the penis. As the penis fills with blood, the smooth muscle of the penis expands. These are the corporal bodies, and it compresses the veins around the [00:08:00] penis so you don’t lose that blood. so blood flow into the penis, ability to maintain that blood. So you don’t have things like venous leak. The hormonal environment, if you will, needs to be normal, like normal testosterone, right? Low testosterone. Erectile dysfunction is an important symptom of low testosterone. So I’d say the hormonal environment needs to be important. The nerves important for erections have to be normal, right? So poorly controlled diabetes. If you’ve had a pelvic surgery in the past, whether that was your prostate was removed, your you had colon cancer and they did a low anterior resection and the rectum was removed. All the nerves for the pelvis and penis are in that space. So the nerves need to be important, right? Tho those need to be at play. So all those need to play at play in addition to the mindset, which is one of the most important things, right? Psychogenic or what I like to call a confidence based erectile dysfunction plays a huge role if everything is totally normal, [00:09:00] but you’re depressed, you’re stressed, you’re super anxious, new partner. All of that would result in erectile dysfunction. So, it really takes the whole history to kind of understand what’s the likely culprit like, you’re actually really anxious, and that’s why you can’t get a good erection. the good news is we know I give men Cialis low dose daily, boost their confidence and get good blood flow to the penis.

Dr. Supatra Tovar: Or go to a therapist.

Dr. Kian Asanad: And they realize that they don’t need to take these medications after three months and everything is totally normal. Right.

Dr. Kian Asanad: As you mentioned, sexual health therapy plays a huge role. I think it’s highly underutilized. I mean, guys just wanna take a pill and sometimes I, and they want their testosterone to go be through the roof and I tell ’em, your testosterone’s normal and there’s nothing medically wrong. You’re just stressed and anxious. You should see a therapist. No. No, but like I heard my testosterone should be a thousand. I mean

Dr. Supatra Tovar: Yes. Oh, I deal with this all the time. Especially for people who [00:10:00] really wanna lose weight you know, and wanna improve their health. They really want just that magic pill to make the problems go away and you are, just making the point for me that there is no magic pill. There are lots of amazing interventions like you are providing, but if

Dr. Supatra Tovar: all of your numbers are okay. There is absolutely nothing wrong with going to talk to somebody about anxiety. We live in an anxiety producing world and need to find proactive ways to deal with it. And so I, I think a lot of people have that negative view still that stigma around mental health, but I think if we can couch it in just building better skills.

Dr. Supatra Tovar: Learning how to handle stress better. You know, finding ways to thrive in your life. Maybe we can get more people on board with the mental side of erectile dysfunction. So I’m really glad you mentioned [00:11:00] that. Now I really, really, really, really want to get into these AI tools ’cause I think this is super cool.

Dr. Supatra Tovar: I love new technologies. So what are these tools being developed and how do they help identify root causes of male infertility or sexual dysfunction?

Dr. Kian Asanad: Yeah. So, this is a very kind of new space especially in the men’s health world. There’s not a lot of work being done so far. There’s few colleagues around the country and the world who are kind of working in this. And it goes anywhere from using AI to the time of a sperm extraction to help you identify areas that may have sperm for men who have no sperm, to things like using AI to develop patient education materials and the readability of things for patients in the men’s health space to things like predicting after radical prostatectomy for prostate cancer, what is the [00:12:00] probability that this patient’s erections will be improved naturally on all their kind of cancer history, their lifestyle, their pre-surgery, testosterone, all those sorts of things, and to semen testing. So right now, what I’m really focusing on with one of my colleagues, Dr.

Dr. Kian Asanad: Geo Cacciamani who is the kind of director of the AI center in urology at USC we’re working to build patient education materials in the fertility and men’s sexual health space for patients that that we’re trying to show is much more improved than the ones from our urologic societies. I mean, Urologic Association, different societies have. Hey, read this if you wanna have a vasectomy or if you wanna have a vasectomy reversal, or if you wanna have a penile prosthesis. And we’re learning that a lot of these patient education materials don’t do a great job explaining it to patient in a way [00:13:00] that’s readable, understandable. Right. And that’s ultimately like that’s we’re first signing up a patient for surgery and we’re giving ’em things to read about.

Dr. Kian Asanad: And if they can’t understand it, because the accessibility is poor. I mean, we need to do a better job at that. So we’re looking at ways to use AI to develop up to date, not even just improve readability and accessibility and understandability, but a lot of these things are outdated. They’re referring to guidelines and studies from seven years ago, and we have new guidelines, but we’re not updating the patient side of things.

Dr. Kian Asanad: So we’re developing it using AI platforms that patients can say, this is much better. I understand this more. This is up to date. And it’s much more effective. Right. And I’m working on that space with him. And at the same time, we’re trying to integrate AI within our men’s health clinic. we are process of obtaining and studying a direct to consumer [00:14:00] semen analysis.

Dr. Kian Asanad: So in office. Tiny little machine. Patient provides a semen sample with a single drop of the semen sample. Within 15 minutes we can obtain those results. Rather than the traditional way. You come in and see me, I tell you what you need to do. You go do your homework if you will, right? Go to the lab, make an appointment to do a semen test. Do another semen test. ’cause we recommend to back a month later. This way, they come in on the day of the appointment, semen sample. I get the results within 10 minutes. I could immediately tell ’em, using this AI technology, these are your numbers. This is where things stand. This is what we need to do, this is what you need to optimize if we can.

Dr. Kian Asanad: So

Dr. Supatra Tovar: Wow.

Dr. Kian Asanad: We’re trying to integrate it from those standpoints.

Dr. Supatra Tovar: Is there any movement towards using AI in surgery at all? Do you see anything in that realm?

Dr. Kian Asanad: Not really from the men’s health, like the implant peyronie’s space just yet. With within surgery there are some groups that, I was at the [00:15:00] meeting at the American Society of Reproductive Medicine last year from Turkey, I believe, and China, looking at using a microscope at the time of a sperm extraction, but identifying areas. it’s like an AI form of a microscope that set, that could tell you based on the human eye, but an ai availability. This area may be more likely to harbor sperm. You should target this area rather than what we kind of do now using a microscope to look for tubules that are more full compared to others the data there is not really strong yet.

Dr. Kian Asanad: It’s really a work in progress, especially from the fertility and men’s health side. But those are kind of things that within surgery that are I’ve seen being implemented.

Dr. Supatra Tovar: That is so cool. I think a lot of people are really afraid of AI taking over the world, but I think if we utilize it in a way that speeds things up for us, helps us, makes things more understandable, helps with diagnostics. I mean, come on you guys. Let’s speed up here. Let’s get this [00:16:00] Now you just mentioned something that I actually don’t understand.

Dr. Supatra Tovar: What is Peyronie’s disease and what are the treatment options available for men dealing with this?

Dr. Kian Asanad: Sure. So Peyronie’s Disease is a scar tissue buildup or plaque buildup of the penis. We don’t really understand why it occurs for many men. So some men have had trauma to the penis that they could recall. The majority of men don’t remember that maybe they had an awkward sexual position resulted in a bend of the penis, and you could have a fracture or a

Dr. Supatra Tovar: Ah.

Dr. Kian Asanad: breaking of the, the strong sheath of the penis that surrounds the corporal bodies that can result in erectile dysfunction and that can result in scarring at that area, causing curvature and or deformity, right? So many times men don’t re recall anything and they start to notice that their penis starts to be more curved, typically at the ages of 50 or so. We think it has to [00:17:00] do with repetitive microtrauma, meaning especially men who may have some ED.

Dr. Kian Asanad: There’s some micro bending of the penis with intimacy and maybe there’s a genetic component to it, but plaque builds up typically on the top side of the penis. It’s not cancer, it’s not dangerous, but men could feel like a hard nodule there, sometimes it could be calcified. It feels like a, literally like a rock. the middle of their penis. And when the penis stretches with a, if they have a good erection, that can cause a bending up of the penis, it could bend to the side. There’s other deformities where the penis can be, out, out, out. And then it kind of hour glasses and then it comes out, causes a deformity like that. Men report length loss of the penis ’cause the corporal bodies can’t stretch as much, and so the penis feels shorter and skinnier. Right? So really different kinds of deformities. It’s not just a curve. I think that’s kind of the misconception. Treatment options are really based on functionality, right?

Dr. Kian Asanad: So if you have a [00:18:00] little bit of a curvature, it’s not causing an inability to penetrate you. You could still have sex, you can make do with it. We don’t have to do anything about it. Right. We just keep an eye on it. If it gets worse, then we could focus on treatment for functionality.

Dr. Kian Asanad: The meaning, the take home is like we’re not working to get you an aero straight penis. Again, we’re trying to improve it so you can improve your sexual quality of life. And if that prevents you from, having intercourse, then we want to get you to be able to do that. So. From least invasive to most invasive.

Dr. Kian Asanad: Most men don’t want a lot of invasive things done to their penis, right? You only have

Dr. Kian Asanad: one penis. He’s your best friend. You wanna take good care of ’em, right? And so, the least invasive thing there are stretching devices. There are stretching devices for the penis to stretch the penis straight and opposite the curvature. That’s been shown to if you apply it daily for 30, 60 minutes a day for the next three to six months the penis could. Gain length as well as [00:19:00] Straighten, typically recommend a device, no prescription required. It’s called Restore X. You could purchase it online. It was developed by a colleague, Landon Trost who was at the Mayo Clinic at the time.

Dr. Kian Asanad: He’s a really brilliant mind in the men’s health world. So that works well. I tell patients about that all the time. Then we go onto injections. We can inject the scar tissue of the penis with a medicine known as collagenase or Xiaflex is the brand name. Xiaflex is the only kind of FDA approved medication that we inject to soften the plaque, and that can help improve the curvature about 30%, right?

Dr. Kian Asanad: So if your curvature is, we measure it. If it’s 60 degrees, the goal is to get you down to kind of 30 and it’s functional and it’s okay. So Xiaflex is an option. I tell guys when we treat the Peyronie’s, gotta give up something, right? Are you gonna give up your time? Like Xiaflex can take six months for the whole process. It’s a series of injections over a six to eight month period. Right now we’re moving over [00:20:00] to surgery, right? We could do a quick surgery. I could straighten the penis, known as a plication. Works best if the curvature is kind of mild. Men have a long penis. Why? Because when we plicate the penis, you can lose a little bit of length. So if you don’t mind losing a touch of length, straighten the penis one and done surgery takes about an hour, you’re good to go. Great. It’s a great option you’re worried about length loss in general, you don’t want to have surgery, not a good option, and then finally, this is the most kind of invasive options.

Dr. Kian Asanad: We can surgically remove the scar, right? Open the, basically open the penis. Remove the scar, suture in a graft to take up that space. That can cause erectile dysfunction. So you really need to be an excellent candidate for that surgery. Who is a candidate for that surgery? Men who have really severe deformity, like severe curvature, like 90 degree curvature, the penis is bending back on itself, right?

Dr. Kian Asanad: Xiaflex is not gonna fix that. A [00:21:00] stretching device is unlikely to make that functional. And you need to have good erections, right? Because that surgery makes erectile dysfunction a little bit more common. Most of the time, if, if these are men who are older, 65, they also have bad ED, they have curvature, we’ll do a, just a complete reconstruction which we’ll do a penile prosthesis and straightening at the same time, right?

Dr. Kian Asanad: So we’ll do a mechanical device for the erections, straighten the penis at the same time, and the end result is a totally straight penis that can get hard with mechanical pumping and men are super happy with that procedure. I’m doing a couple this week. It’s like one of my favorite operations ’cause men are incredibly happy and if they’re a good candidate for that surgery, they have bad ED anyways.

Dr. Kian Asanad: The penis is, super curved and deformed. This is the best sort of ultimate definitive surgical reconstruction.

Dr. Supatra Tovar: Wow. There are so many ways, and I think you’re giving some guys out there a couple ideas about how to increase their length without going to [00:22:00] surgery, so Wow, that’s amazing. There’s so many options out there. It’s incredible. Now I, I really wanna know about, my dad has prostate cancer. He is managing it and he had the prostate actually removed.

Dr. Supatra Tovar: But that leads of course, to sexual dysfunction and different, uh, other difficulties. So how do you counsel and treat men who experience sexual dysfunction because of prostate cancer treatment? Um, especially those who really wanna regain some intimacy.

Dr. Kian Asanad: Yeah, so you know at our at USC, we do a prehab and post prostatectomy penile rehab protocol. So I like to be very aggressive for men who wanna be about optimizing their penile health before and after surgery, So predictors of what sexual function will look like after surgery. We wanna look at what’s your erections before surgery?

Dr. Kian Asanad: Are they perfect? Do you have some baseline ED? Right? What type of prostate cancer do [00:23:00] you have? Is your surgeon, can they, successfully and safely perform a kind of bilateral nerve sparing approach? Meaning we preserve completely the nerves for erections. but even with those techniques, right, there’s stretching of the nerves that results that can cause issues with erection.

Dr. Kian Asanad: So. I put men on medication. Low dose Cialis five daily has been shown to improve erections after prostatectomy. I’ll start that before surgery. We’ll start that after surgery. And I see men pretty closely in the office, so at about two to three months after surgery, see what their erectile function is like, and we slowly escalate things from there.

Dr. Kian Asanad: If men wanna be aggressive about maximizing their penile health. I’m right there with them. If men, some men are older, they don’t really care, wanna let it go by the wayside. I mean, I just counsel ’em appropriately. I think the other side of things that plays a huge role in sexual function is the incontinence right

Dr. Kian Asanad: Prostatectomy

Dr. Kian Asanad: incontinence [00:24:00] is very common and it can take three to six months for men to achieve continence. And so if you’re leaking urine, it’s hard to get you a good erection and be intimate. It’s not very sexy when you’re leaking urine. So even men who regain their continence can suffer from climacturia right? When they orgasm, the pelvic muscles relax and they could leak urine, right?

Dr. Kian Asanad: These all play a role in sexual function, so usually the guys who are three months out are not really thinking about erections. They just don’t wanna leak anymore, don’t wanna be in a diaper and a pad. So. The, while we try to manage ’em concurrently, it’s, it’s super common. It’s super normal.

Dr. Kian Asanad: Men wanna get dry first before they treat the erection. So, we just take it with that, keep ’em on the Cialis, get the blood flow going in the penis. Have ’em, booster dose with Viagra a couple times a week as well, kind of maximize blood flow to the penis, but usually as early as three to six months if their erections are not satisfactory with the medication. the bilateral nerve sparing [00:25:00] approach, I’ll get men on injections. We’ll start injecting. wanna maximize the health of the penis. How do we do that? Get a good erection, right? So I’ll have men inject the penis with medication to stretch the penis. Do that two to three times a week. That could help improve natural erectile recovery.

Dr. Supatra Tovar: Wow. And just. Real quick. I mean, this is something that my dad had gone through the incontinence. How do you treat that?

Dr. Kian Asanad: Yeah, majority of men will regain continence is the good news with time and pelvic floor physical therapy. So we send men to see a pelvic floor physical therapy expert at USC Kegel exercises, pelvic muscle training. 60% of men will be dry at about six months. Some men are even dry at three months. The good news is at 12 months, 90% of men will be dry. That’s a 12 month period for some men, but almost all men will be dry at 12 months if it is an ongoing issue. [00:26:00] And some men do have persistent severe incontinence. Maybe they also had radiation after prostatectomy and things like that can make recovery really difficult. There are a lot of treatment options, so there’s prosthetic surgery, prosthetic sphincters, which I do known as an AUS artificially or neuro sphincter where we surgically implant a prosthetic device that will keep the urethra closed to prevent you from leaking. kind of, that’s kind of the gold standard.

Dr. Kian Asanad: There’s other options like male slings. So just like in women who may leak after, having children there are slings for men, but they’re usually reserved for men with really mild incontinence. Not a candidate. If you’ve had radiation or you’ve had, you have a lot of leakage, like you’re wearing five, six pads a day, it’s not gonna help that much. And there’s some new kind of continence balloons that are adjustable continence balloons that we have experts at USC who can do that work well for the moderate incontinence space as well. So there’s really a lot of options. Unfortunately they’re surgical options. They’re [00:27:00] not some a medicine that we can give you to help improve stress incontinence.

Dr. Supatra Tovar: Wow. Well, I gotta get my dad from Colorado to California to come and see you for sure. And speaking of that, since we’re low on time, can you please tell people how they can come and work with you? Because you are a wealth of knowledge, um, you are at the cutting edge of these treatments and I think men are gonna

Dr. Supatra Tovar: be calling you soon. So how do they get ahold of you?

Dr. Kian Asanad: Sure. Yeah. So, really fortunate to be part of the USC faculty and department. I do have a few locations. I’m in the Beverly Hills office every week I’m in Santa Clarita actually today. And have an office here seeing patients in the Valencia area as well as the main hospital.

Dr. Kian Asanad: So, really reach out to USC. 1-800-USC-care. They can set an appointment to see me. Happy to see you either in any location that works, either that’s in person, we could do a video call or a telemedicine visit as well to start things off if you’re coming from far, and then get you in for an exam [00:28:00] if we need to do that as well.

Dr. Kian Asanad: So, it’d be a pleasure to take care of you.

Dr. Supatra Tovar: Yay. And that all that will be in the show notes. You guys, I really encourage you to reach out to Dr. Kian if you are experiencing any of these problems, and you know, if you are, and they might be some lifestyle factors, we’ve given you a lot of directions that you can go in to help improve your sexual health and your cardiac health as well.

Dr. Supatra Tovar: General health as well, so please take those seriously if it is a psychological thing, there is no shame in that, we live in an anxiety producing world and there are plenty of therapists out there, myself included, who would be happy to help to restore your sexual health if it’s a psychological

Dr. Supatra Tovar: problem. So thank you so much for Dr. Uh, for coming on the podcast, Dr. Kian. I really appreciate you spending this time with me.

Dr. Kian Asanad: Thank you. Thank you for having me. It’s been such a nice hour to hang out.

Dr. Supatra Tovar: [00:29:00] Definitely. And thank you everyone for tuning in. I am really looking forward for our next exciting interview, and I will see you next time.

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