The Future of Men’s Health: AI, Peyronie’s & Fertility After Prostate Surgery. | ANEW EP 122

When conception stalls, the male partner is half the story. In this advanced, practical follow-up, Dr. Supatra Tovar continues her deep dive with Dr. Kian Asanad to map the male side of fertility, sexual function, and recovery—linking lifestyle, toxins, and treatment choices to real-world outcomes. You’ll learn why men are overlooked in fertility care, how stress, heat, chemo, and environmental exposures degrade sperm, and what modern urology can do—from onco-fertility preservation to in-clinic AI semen testing that returns results in minutes.

Dr. Asanad clarifies the numbers men should actually know (testosterone timing, LH/FSH context, 72–74-day sperm cycle) and explains why hot tubs/saunas can derail counts for a full three months. He details evidence-based preservation paths before cancer therapy (banking sperm, testicular sperm extraction when ejaculate is azoospermic, solutions for anejaculation after spinal injury) and how couples can choose between timelines, natural conception goals, and IVF/ICSI realities.

Shifting to sexual function, we unpack erection physiology—arterial inflow, veno-occlusion, nerves, hormones, and mindset—and how anxiety, diabetes, or pelvic surgery disrupt each domain. Dr. Asanad shares confidence-building protocols (low-dose daily tadalafil, short-term boosters, referral to sex therapy) that restore performance without chasing unnecessary “sky-high” testosterone.

You’ll also get a masterclass on Peyronie’s disease—what plaque is (and isn’t), why curvature isn’t just “bending,” and the treatment ladder:

• Traction therapy (e.g., RestoreX) 30–60 minutes/day for 3–6 months to straighten and regain length.
• Collagenase (Xiaflex) injection series (expect ~30% curvature improvement) to reach functional intercourse.
• Plication for quicker straightening (with small length trade-off).
• Plaque incision + grafting for severe deformity in men with strong baseline erections
• Combined penile prosthesis + straightening for men with significant ED and curvature—often a life-changing, definitive fix.
  
  

For men after prostate cancer surgery, Dr. Asanad outlines USC’s prehab/rehab: start daily tadalafil before surgery, maintain penile blood flow afterward, and escalate to intracavernosal injections at 3–6 months if needed. He addresses incontinence (most men dry by 12 months with pelvic-floor therapy), climacturia, and surgical options for persistent leakage (AUS, slings, adjustable balloons).

Finally, we look ahead at AI in men’s health: patient-friendly education that’s readable and up-to-date, direct-to-consumer AI semen analysis integrated into clinic flow (actionable metrics in ~10–15 minutes), and early attempts to guide sperm retrieval microsurgery—promising, if still maturing.

Who this episode is for: couples seeking clarity; cancer patients considering fertility; men navigating ED, Peyronie’s, or post-prostate recovery; clinicians wanting a crisp, evidence-aligned playbook.

What You’ll Learn

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Thank you for joining us on this journey to wellness. Remember, the insights and advice shared on the ANEW Body Insight Podcast are for educational and informational purposes only and do not constitute medical advice. Always consult with a healthcare professional before making any changes to your health routine. To learn more about the podcast and stay updated on new episodes, visit ANEW Body Insight Podcast at anew-insight.com. To watch this episode on YouTube, visit @my.anew.insight. Follow us on social media at @my.anew.insight on Facebook, Instagram, TikTok, and Threads for more updates and insights. Thank you for tuning in! Stay connected with us for more empowering stories and expert guidance. Until next time, stay well and keep evolving with ANEW Body Insight!

Transcript

0:00 Dr. Kian Asanad: 0:01

Yeah, it's a really good point. 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. 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. 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? Absolutely all of those play a role in a very multifactorial manner, right? So the diet lifestyle plays a role in testosterone. If your 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, But if they had 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. 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 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 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. 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 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 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. 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 may not have an erection, but there's no ejaculate. Um, and so there are male vibrators, penile vibratory stimulation. 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 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, 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. 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 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, 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: 0:10

Yes. Oh, I deal with this all the time. Especially for people who 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 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 that. Now I really, really, really, really want to get into these AI tools 'cause I think this is super cool.

Dr. Kian Asanad: 0:12

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 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. 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 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. 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 semen analysis. 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 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. Supatra Tovar: 0:16

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 Now you just mentioned something that I actually don't understand.

Dr. Kian Asanad: 0:17

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 do with repetitive microtrauma, meaning especially men who may have some ED. So if you have a 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. 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 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. 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 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. Xiaflex is not gonna fix that. A 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. Supatra Tovar: 0:22

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 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. Kian Asanad: 0:23

Are they perfect? Do you have some baseline ED? Right? What type of prostate cancer do 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. incontinence 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? 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 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. 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. 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. 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 not some a medicine that we can give you to help improve stress incontinence. 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 if we need to do that as well.

Dr. Supatra Tovar: 0:29

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.