ERECTILE DYSFUNCTION

   ERECTILE DYSFUNCTION (ED)

“ED Got You?” We Can Help! Castellano Health Institute of Orange County California.

Erectile Dysfunction, or ED, is the inability to achieve a full or consistent erection for satisfactory sexual activity. The problem lies in either not getting enough blood in the penis or the inability to retain it there. Estimates show that up to 40% of men over 40, 50% of men over 50, and 60% of men over 60 will experience ED. We want you to know that you are not alone, ED is more common than you think.

About 80% of ED cases are a result of Chronic diseases such as Diabetes, Vascular disease, and Hormone Disorders. Of the previous diseases mentioned, Diabetes has become the major culprit of ED due to its rising occurrence in our society. As of 2014, 1 out of every 3 American was either Prediabetic or Diabetic. Diabetes results in ED through its vascular and neural damage, causing up to 50% of Diabetics to experience ED.

Medications that physicians prescribe to control blood pressure, depression, anxiety, and an enlarged prostate can result in ED. Lifestyle choices such as smoking, obesity, lack of exercise also contribute to ED. Finally, psychologic factors such as stress, anxiety, and depression can worsen or lead to ED as well.

It is useful to know the cause of the ED to treat it correctly. If ED is due to a hormonal imbalance caused by a Testosterone deficiency, the simple and most correct action is to restore the hormone balance. If the issue is poor blood supply to the penis due to chronic diseases, then the answer lies in restoring blood flow to the penis. This can be done by using various methods. Vacuum pumps are simple and non-invasive, but have a high dropout rate. There are various medications that can be used to treat ED. Oral medication are derived from the Phosphodiesterase 5 inhibitor (PDE5 inhibitors) class and include such medications as Viagra, Levitra, and Cialis. For those patients who have failed or are unable to take the PDE5 inhibitors, intracorporal injections work best. These medications include Prostaglandin (PGE1) monotherapy, Bimix (2 med combo), Trimix (3 med combo), and Quadmix (4 med combo).

PREMATURE EJACULATION (PE)

PREMATURE EJACULATION (PE) is when ejaculation occurs before or soon (minutes) after the initiation of intercourse and is associated with feelings of distress or frustration of either partner. PE is more common than we think, occurring in up to 1 out of every 3 men, and unlike ED, is not age-related and can be life-long.

Treatment option for PE include oral medication, topical gels or intracorporal injections. Some men with premature ejaculation benefit from drugs called PDE5 inhibitors, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). A PDE5 inhibitor can be used alone or in combination with a selective serotonin reuptake inhibitor (SSRI). For those patients not responsive to oral medications, we find that the intracorporal injections work best.

    WELLNESS PROGRAM

Dr. Castellano has spent years reviewing the medical literature to bring you a complete wellness program California that can lead to extending the healthy, active, fun part of your life and deferring illness, frailty, and disability to the very end. This evaluation requires that we perform and an extensive battery of laboratory tests to evaluate how well your body is functioning. We evaluate your hormonal system because optimal levels of certain hormones are associate with less degenerative diseases, and increased function and longevity.

Most chronic diseases, from diabetes to cardiovascular disease and cancer, are related to what we eat. Consuming a balanced diet that meets the RDA servings of fruits, vegetables, grains, fats, and protein does not ensure sufficient nutrient intake for optimal health. Even conservative medical journals such as the New England Journal of Medicine and Journal of the American Medical Association recommend that adults supplement their diets. We will show you how to implement the correct diet along with appropriate multi-vitamin and mineral supplements to ensure that all nutritional needs are met.

Our program is designed to improve how you look on the outside as well as how you function on the inside. You will lose body fat, gain muscle, strengthen your bones, and improve your overall health. As I tell my patients, you can pour gasoline (hormones) on wood (your body) all day and at the end of the day, all you’ll have it wet wood. Exercise is the match that lights the fuel. Appropriate exercise regimes will be addressed. The goal is to have you feeling better within 4-8 wks. Symptom resolution as well as slowing the physiologic decline of your body is the benefit of this comprehensive program.

    WEIGHT LOSS PROGRAMS

The Problem with Weight Loss

At its core, obesity is a hormonal and inflammation issue and until we address it as such, people will continue to have problems losing weight and keeping it off. Dr. Castellano understands that if you suffer from Insulin Resistance (IR), your body doesn’t work like everybody else’s, you will have a more difficult time losing weight on a low-fat diet than someone who is not IR. Dr. Castellano educates his patient on how to incorporate the latest scientific knowledge so that they can maximize their weight loss and keep it off. Our weight loss program provides a real solution to the obesity epidemic we are undergoing.

Physician supervised Weight Loss Program

This is a calorie restriction program. We help our patients understand the role that macronutrients play in weight loss. Typical weight loss averages 2-3 pounds per week. Each patient is seen on a weekly basis. It is during these one-on-one sessions that we help you understand the changes that lead to long term weight loss success.

Accelerated Weight Loss Program

For those patients seeking a kick start or are under time constraints, we off the Accelerated Weight Loss Program. Typical weight loss averages 5-7 pounds a week or more. Each patient is prescribed HCG (human chorionic gonadotropin), vitamins, and probiotics and is seen on a weekly basis by Dr Castellano. A body fat analysis is done each week so that we know whether the patient is burning fat or muscle. We want you to hold on to as much muscle as you can as it dictates your metabolism at the end of the diet.

                HAIR LOSS

About Hair Loss

It’s know that by age 50, 85% of men and 50% of women will experience significant hair loss. Although there are many causes of hair loss, the most common is Androgenic Alopecia (Male/Female Pattern Baldness) due to a combination of genetics, hormones, and aging. In men this typically presents with a receding hair line and thinning on the crown (top of head), in women, it typically presents with overall thinning of the hair.  The genes associated with Hair Loss vary across many chromosomes, thus the wide pattern in age and speed of hair loss seen. Either way, Hair loss is an emotionally difficult condition for most.  Up until recently, the only options were expensive hair replacement surgery or the use of medications which often had significant sexual side effects.  Fortunately, we now have the use of PRP for Hair Loss.

What is PRP

PRP (Platelet Rich Plasma) for hair loss is a procedure whereby the Growth Factors in a person’s own platelets are used to stimulate new hair growth. Platelets are small cells in your blood that contain up to 20 different types of growth factors that can help promote new hair growth. Blood is drawn from the patient and spun down in a special centrifuge to separate its components. We use a “double-centrifuge” technique that allows for the optimal concentration of growth factors in PRP. The PRP is then injected into the scalp where you have areas of hair loss.  PRP has been shown to grow new hair as well as increase hair thickness and darkening of existing hair. The PRP procedure is performed monthly for three months and then once a year for maintenance.  Results are generally seen at one month and continue to improve over the next 3-6 months.

The Science of PRP

Platelets contains more than 20 types of growth factors, many which have been shown to act as an ‘elixir’ for hair growth.  Some of the growth factors which help with hair loss are:

• Platelet-Derived Growth Factor (PDGF) – promotes blood vessel growth and cell replication.
• Vascular Endothelial Growth Factor (VEGF) – promotes new blood vessel formation
• Epidermal Growth Factor (EGF) – results in cellular proliferation, differentiation, and survival.
• Fibroblast Growth Factors (FGF) – promotes growth of cells and blood vessels.
• Insulin-like Growth Factors (IGF) – promotes cell growth and inhibits cell death.
• Nerve Growth Factor (NGF) – involved in the proliferation and survival of certain neurons.

In a recent 2017 literature review article in the journal, Stem Cell Investigation, the authors concluded that PRP is a simple, cost-effective and feasible treatment option with high patient satisfaction for Androgenic Alopecia (male pattern baldness).  

Advantages of PRP

• No risk of allergic reaction
• No surgery required
• Regrows you own hair
• Works for both men and women
• Stimulates new hair growth
• Makes existing hair grow thicker
• Slows down hair loss
• No significant down time

Patients not eligible for PRP

• Cancer or on chemotherapy
• On Immunosuppressive therapy
• Heavy smoker
• Chronic Liver disease or heavy drinker
• On Anti-Coagulation Therapy
• Hemophilia or other blood clotting disorders
• Certain skin diseases/current skin infection

     TESTOSTERONE THERAPY

What is Testosterone

Testosterone, a steroid hormone derived from cholesterol, is the principal male hormone. Testosterone is responsible for maintaining muscle mass, strength, fat distribution and bone mass. Low Testosterone has also been associated with changes in attitude, mood, loss of energy and earlier death

Why is it important

Starting at age 30, Testosterone levels decline at a rate of 10% per decade. Studies show a decline in Testosterone puts men at increased risk of health problems such as cardiovascular disease. Men with low testosterone levels are more likely to have elevated markers of inflammation, called cytokines, which contribute to many diseases. Another characteristic of men with low testosterone levels is that they are three times more likely to have Metabolic Syndrome than men with higher testosterone levels. Metabolic syndrome is the name given when one has three or more of the following risk factors:

1. waist measurement over 40 inches
2. low HDL (good cholesterol)
3. high triglycerides (level of fat in the blood)
4. high blood pressure
5. high blood glucose (blood sugar)

Metabolic Syndrome increases the risk of developing Cardiovascular Disease and Diabetes.

Unfortunately, as your testosterone levels decline, your chances of dying prematurely markedly increase. In the Rancho Bernardo Study, men with lower testosterone levels had a 40% greater risk of death compared to men with higher testosterone levels, independent of risk factors such as age, adiposity (fat), lifestyle, diabetes, heart disease, and metabolic syndrome.

What are the benefits of TRT

Testosterone Replacement Therapy can prevent or reduce the likelihood of developing Diabetes, Cardiovascular Disease, Obesity, Osteoporosis, as well as Depression and Anxiety. Other studies have shown that long term use of testosterone (7-10 years) was effective in maintaining bone density and muscle mass. What I consider the “Holy Grail’ of testosterone research came out in 2015, involving over 83,00 European veterans with low testosterone. Results showed that patients with low testosterone who underwent Testosterone Replacement Therapy (TRT) and whose testosterone levels were normalized were 56% less likely to die from any cause compared to those patients with low testosterone who were not treated. They were also 36% less likely to suffer from a stroke and 24% less likely to have a heart attack. The bottom line is; if you suffer from low testosterone and you want to live a long life, you are more likely to do that if you are on testosterone.

           MALE ATHLETES

Are you optimized? Are you sure? Is your body working like a well-oiled machine or are you suffering from chronic aches, pains, and frequent injuries?Is your nutrition and supplementation on point to support your level of activity? Is your vitamin D level where it should be to prevent disease and injuries? Are you getting enough Leucine in your diet to promote muscle growth and recovery? Is your exercise regimen breaking you down instead of building you up? Have you spent too much time and money on things that haven’t worked?

Do you suffer from insulin resistance? If you do, your body has different nutritional requirements than someone who is insulin sensitive. If you don’t know, you may have it and not know it, as studies show 1 in 3 Americans are insulin resistant. Unfortunately, most trainers have little knowledge or experience with insulin resistance, and they probably haven’t read the diabetic literature. I have and have extensive knowledge and experience with insulin resistance and metabolic syndrome. If your body is not responding to your diet and exercise regime, and it’s not a hormonal issue, then it’s probably due to insulin resistance. If you have spent too much time and money on ineffective therapies, come see us, we can help.

Injuries/Peptides

Injuries are part and parcel of a fitness/active lifestyle. Since we are driven to push ourselves beyond our limits, it’s only a matter of time before we push too far and incur an injury. I know, I’ve had my share of side-lining injuries. Some of these injuries take months to a year to heal, some never do. For most of our patients, that’s not acceptable. Life is movement and it’s our priority to get you back to doing the things you love.

Unfortunately, back then all we had access to was anti-inflammatories (ibuprofen), ice, compression and elevation. Although, that helped with swelling and inflammation, they did nothing to help speed up healing and repair. We now have access to compounds that can help significantly speed up recovery. Peptides are short chains of amino acids that can act at targeted receptor sites. They have been shown to speed up recovery of tendon and ligament injuries as well as injuries of muscle and bone. They work for acute as well as chronic injuries.For those who are scheduled to undergo surgical repair, Peptides can also be used after surgical procedures to speed up recovery.

         FEMALE ATHLETES

The problem with women is that they often get treated and put on nutrition and exercise program as if they were just smaller versions of men. They are not! Women have their own individual needs and requirements that are different from those of men. Women will often think they have a slow metabolism due to a sluggish thyroid or insulin resistance or a hormone imbalance. Now, sometimes that’s true, but in those cases where it’s not, it’s usually due to having very little muscle mass. Your metabolism is dictated by the size of your organs, bones and muscles, the less muscle you carry, the slower your metabolism will be. Muscles also give the body shape. Muscle allows you to shape the body the way you want. You cannot shape fat.

As women age, they tend to eat less protein. If you exercise you need more protein than the average women to repair the damage incurred both from the activities of daily living and from exercise. If you are going through menopause, you need hormonal support. If women are stressed, they make less of the beneficial hormones and more of the corticosteroids that lead to degenerative disease and aging.

If you are having difficulty getting in shape or losing those stubborn pounds, we can help. Let’s improve your energy level, decrease the belly bloat, improve your libido, and slow down the aging process. If you are just interested in keeping your skin youthful, we can help you with that as well. We have access to compounding pharmacies which can make individualized medications and creams to serve your special needs.