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Chapter 1: What is the significance of men's health in today's society?
Hello and welcome to The Midpoint. Today's episode is one I've been wanting to do for a long time and I finally think I have the perfect expert to talk to. Today we're going to talk about erectile dysfunction with Professor Vaibhav Modgill. And if you're listening to this as a woman and you think, oh, hang on, I'll just fast forward, this isn't for me.
Well, hold on, because even if your partner is okay or appears to be okay right now, he may well suffer in the future. And it's not just middle-aged men who have erection issues. There are younger men increasingly presenting themselves with problems. And many of those issues that men are presenting with indicate something a little bit more sinister. So do listen up if you can.
And just to reassure you that Professor Modgill is indeed an incredibly eminent voice on this topic. He's a consultant urological surgeon and andrologist at Manchester Andrology Centre. which is Manchester Royal Infirmary, part of Manchester University NHS Foundation Trust.
And he is Honorary Clinical Professor at the University of Manchester and Editor-in-Chief of Trends in Urology and Men's Health.
Chapter 2: How does erectile dysfunction affect men of different ages?
He serves on very many associated medical boards. He mentors surgeons. And he's the male fertility lead at St Mary's Manchester. He's produced 60 academic papers since 2019. So in short, what this man doesn't know about erectile function isn't worth knowing. Let's go meet Professor Modgill. Professor Modgill, can I call you Phoebe? Because I've heard that's what people call you. Quite right.
Or prof, maybe. We'll go with Viva. I've given quite an upsum of your incredible career, eminent career to date in your introduction to kind of reassure the listener that we do have, I think, probably one of the best people on the planet to talk about this topic. And it's been one I've been wanting to get stuck into for a while. Yeah.
What drew you into urology and this area in the first place, though?
Good question. Firstly, thank you very much for having me. Let's hope I live up to it. I haven't heard the intro, but let's hope I live up to it. To be honest, I always wanted to be a surgeon from a very early stage. And like many things in life... It was probably more being surrounded by people who I looked at and thought, I want to be a bit like you.
And most of them happened to be at that time when I was training, I was young urologists. And then I think it was a case of once I'd done my general urological training. I met people who were men's health, specifically men's sexual health surgeons and reproductive health surgeons. And I got more and more drawn into that because, A, I don't think it's particularly well served.
But B, and I'm sure we'll come on to it in the goodness of time, I think there's a lot to be said about it. the stigma that goes with it still, even in 2026. So it was a combination of things really, but that's probably where it came from.
Let's get stuck into it then, because men do still find it difficult to talk about their erectile dysfunction or functionality generally, don't they? It's not something that you hear them talking about in the same way that women can talk to each other about their gynecological issues.
100% right. And you've come on to two things there. So number one, the difficulty that men have. And number two, why is it that our female counterparts don't have the same difficulty? I don't think we really have a complete answer for it. It's multifactorial. But men historically have always struggled.
Less so now, I think, because of the advent of social media, the internet, information being widely available. That's a double-edged sword because widely available information doesn't mean that it's reliable. There's an incredible amount of misinformation out there.
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Chapter 3: What are the psychological barriers men face regarding erectile dysfunction?
Interestingly, if you slept more than eight hours, your erections weren't far better either. The sweet spot was probably somewhere between six to eight hours. So you've got to sort your sleep out. You've got to get the fat percentage down. You've got to get the lean muscle mass up. And therefore... And you will know this only too well.
The huge emphasis now on strength training, you know, strength, mobility, flexibility. 20, 30 years ago, it was all about you've just got to do HIIT training and cardiovascular exercises and walk around the block 10 times. That's not a bad thing. Of course, it's a great thing to do.
But we underestimated, I think, the power of strength work, its subsequent impact on a man's serum testosterone and therefore insulin resistance and the sort of metabolic outcome that you get from that.
And young men who have succumbed to being bombarded with messages of how they should look and the things that they should take, and some of those things, as you point to, are not things that you would, you know, particularly want to put in a young man's body, whether it's, you know, steroids and other powders that convince them they're going to get bigger and stronger and bulk up quicker.
How are they affecting their... Because we hear these anecdotes that, you know,
Testosterone.
Yeah.
Yeah. Testosterone. And it's rife, you know. And again, it's at multiple levels. So there's one thing taking testosterone. There's another thing taking testosterone, which you think is testosterone, but you don't really know where it's come from. You don't know how much of what is in the injection. And you've no way of measuring the outcomes. So it's dangerous. It's very dangerous.
And, you know, across the board with testosterone, you know, there was a time when it was seen as the sort of fix it all agent. Then there was a time where it was very much the villain. And the truth is, is neither. Mm hmm. Testosterone replacement therapy performed appropriately in a patient that needs it, and we can come on to why they might need it, is absolutely the right thing to do.
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Chapter 4: What role does testosterone play in men's health?
I mean, to be honest with you, historically, we used to have this thing about men almost earning their penile implant surgery. We don't really do that in any other aspect of health care. There used to be this dogma about, oh, they've got to have an injection or they've got to try a vacuum device. Well, what if they don't want to? It's a choice thing.
What's really important is that they're counseled appropriately so that they know what options exist. And if a patient turns around to me, having read up about the options, the patient's been to my clinic a couple of times, says, I don't want that. I don't want to inject my penis when I wish to be intimate.
Well, I think they're perfectly within their rights to make that decision, you know, so long as they know that injections exist. Yeah. So, you know, if you look at the satisfaction rates from penile implant surgery, they're pretty staggering. I don't do another operation that gives that level of satisfaction to a patient.
Yeah.
And in terms of the other reasons why a man, and we discussed kind of the psychology and obviously the vascular elements, if you're a young, healthy man and you have an issue, could there be something else that's going on?
Yeah, of course there can. And, you know, that's... That's for every patient. And so when you go and see a clinician, you know, if a young man comes to see me, it's not a case of, oh, it's all in your head, mate, you know, and dismiss it. That's the worst thing you can do.
Because first things first, you've got to acknowledge what it took for them to walk into your room, particularly for the younger patient. I'm massively reassured if they walk in
with a parent or their partner or a friend because i think at least they've shared that burden because you can't underestimate the burden of something like that on a young man you know that young guys can get themselves in a really really deep hole and it's difficult to get out of that so the first thing i'd say to any young person or anyone who knows a young person who's listening is if you think that's going on please try and initiate some form of conversation you know and there's several different ways of doing that
You also, you mentioned before, have fertility experience as well. What are you noticing about male fertility patterns?
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