In February I happened to attend a lunch 'n learn presentation at TMCi by a company doing clinical trials based on exactly this venous insufficiency principle. I think I may have been the only one in the audience with gray hair... TMCi is the startup accelerator attached to the Texas Medical Center in Houston.
The startup company is Vivifi Medical[1] and they have clinical trials underway with ten men in a Central American country (El Salvador?). They claim that BPH reverses in a few months after their procedure. Their procedure uses a minimally invasive tool of their own invention to snip the vertical blood vessels that are backflowing from age and gravity, and splice them into some existing horizontal blood vessels. On their board of advisors is Dr. Billy Cohn[2], the wildly innovative heart surgeon who is famous for shopping for his medical device components at Home Depot. Dr. Cohn is on the team building the BiVACOR Total Artificial Heart. Vivifi presented their estimated timeline to FDA approval, with proposed general availability in 2028. My personal BPH will be at the head of the line for this procedure.
As far as a startup, their TAM is about 500 million men. I had the Urolift procedure for BPH three years ago, and it cost about $15K on the Medicare benefits statement, though Urolift's clips amounted to only a few thousand dollars. Similarly, Vivifi's charges for this procedure are only a few thousand dollars per procedure, but it holds the promise of being a final solution. Currently Urolift is much less disruptive than TURP, which needs a couple of days in the hospital and almost always leads to retrograde ejaculation (into the bladder).
Thanks for the shout out. I am the CEO of Vivifi medical. We are building off the gat and Goren’s work and making it better and more robust. More importantly making it more accessible to patients through urologists.
Our early clinical trial data from Panama is looking highly encouraging and we are working hard to bring this to the market in the fastest manner possible.
Are you planning to publish the longitudinal data, esp. of endpoints 2 and 3 (prostate size, urinary flow). It would greatly add to the public understanding of this procedure. Why didn't you go for PSA? It's easy to obtain altough one probably wouldn't expect significant changes in this short time frame.
Have you found that with your procedure, to quote the blog piece, "new venous bypasses grow to replace the destroyed spermatic veins," as found in Gat and Goren's work in follow ups? Or is the long term data not there yet?
Thank you for taking a risk on this by the way. As someone who has family history it's heartening to know there are people taking this seriously.
We actually bypass the spermatic vessels. There is historical evidence that bypassing the spermatic vessels is a superior way to treat varicoceles.
So our procedure shouldn’t have the recurrence (of varicoceles or bph) concerns. But this needs to be established through long term studies.
Thanks for sharing your story. It’s stories like yours — people with family histories and real-world experiences — that fuel everything we’re doing.
Not at all. Our device does not go through the penis, doesn’t damage the urethra or resect prostatic tissue. As a result, there is no risk to any sexual or urinary functionalities. There is no post op catheter.
I’ve long felt that the reliance on population-statistics (RCT) rather than individual diagnosis highlights how little we really know about medicine.
A mechanic wouldn’t try to fix a car based on a checklist of symptoms interventions that work X% of the time across the population of cars; they would actually inspect the pieces and try to positively identify e.g. a worn/broken component. Of course, this is harder in the human body.
I’m hopeful that as diagnostics become cheaper and more democratized (eg you can now get an ultrasound to plug into your iPhone for ~$1k), we’ll be able to make “medicine 3.0” I.e. truly personalized medicine, available as standard rather than a luxury available to the 0.1%.
What makes professional mechanics fast (and therefore makes them good profit) is knowing from experience when you can shoot from the hip like that.
But yeah, you won't find people doing things that way in any setting where it Actually Matters(TM) (e.g. expensive things where you really can't justify not fixing it right the first time)
> Screening for this disorder is simple: use a thermal camera and compare testicular temperature sitting up (or standing) versus lying down, in each case waiting five minutes or so for temperatures to equilibrate, and taping the penis up so that it does not affect the measurement.
Interesting. I wonder how many how many other issues we could screen for using such simple, low cost tools. Some scales can already detect reduced blood flow in the feet (which can be a sign of all sorts of nastiness).
Stethoscopes are pretty cheap and versatile. Human doctors in general have lots of senses which they (in some medical systems) use for diagnosis before reaching for lab tests and MRTs.
If they bother. The vast majority of appointments I’ve had, in recent memory, are the provider typing a bit on their laptop, then sending me to someone else.
This work by Gat and Gornish gives a great explanation for prostate enlargement. There's an article by Donaldson [1] that suggests a connection to vitamin K2:
A large study from 2014 by Nimptsch et al found a strong inverse correlation between intake of vitamin K2 and prostate cancer [2]. Dairy foods with K2 had the most effect (K2 is soluble in butterfat).
Vitamin K2 helps remove calcium from the elastin in artery and vein walls, reducing their stiffness. Donaldson hypothesizes that K2 improves venous flow, and hence might reduce the varicoceles that lead to too much free testosterone getting to the prostate and causing enlargement.
So eat more grass-fed butter, or take a K2 supplement. At worst, you might also improve your bone strength. At best, men might prevent prostate cancer.
I had my prostate removed six weeks ago due to Gleason 8 score cancer. The pathology revealed an aggressive cancer.
My prostate was not enlarged, my PSA at the end was 4.2. Only because my doctor was overly cautious about the slope of the PSA rise did he send me for an MRI starting the diagnosis. It remains to be seen if it escaped containment.
The point here is, I don’t think enlargement and cancer are that intertwined. Cancer happens for any number of reasons, pinning hope that it can be staved off by diet and vitamins seems to ignore tons of other environmental factors.
Issues like these reflects an evolutionary blind spot: selective pressure drops off after reproductive age, allowing defects like prostate dysfunction to persist. It's the same reason late-onset neurological diseases remain prevalent.
If it wasn’t in the past, I imagine it will be in the future with how common two working parents is now. We want more kids but we are getting zero grandparent help
You only have to live to your 40s to become a grandparent in natural conditions, and your chances of living to at least your 50s have always been pretty good conditional on living long enough to reproduce at all.
Medieval burial grounds, when examined by anthropologists, do contain some people over 60, but the majority of adults buried there died earlier, typically in the 45-55 bracket.
It wasn't just disease, but also wars and famines. And in women, deaths during childbirth, which cluster in the 20-35 bracket.
Cardinals of the Church, who led peaceful lives, didn't give birth and never went hungry, lived into their late 60s and early 70s even during the Middle Ages. But an average peasant wouldn't.
I know you're joking, but it's women that get the short end of the stick in media.
Men are (within reason) considered handsome in media even in old age. Wrinkles and gray hair can be seen as sexy (again, within reason), but only in men.
Women are discarded or relegated to sexless granny roles (except maybe for comedic purposes, where sexuality is the butt of a joke). Actresses are replaced by younger women because they are not sexy enough even when their male equivalents aren't (looking at you, Top Gun: Maverick).
I'm not saying there aren't exceptions in particular movies that deal with this topic; I'm talking about the general trend.
When you ask men who they are attracted to, at least on the surface, it’s always young women. I’m pretty sure the OkCupid stats showed that girls age 20 give or take were peak attractiveness. Reality is of course that guys will “work for food” or attention.
Women are different. It ranges — alot, and is more about EQ and scarcity. If you have a moderate baseline level of physical attractiveness, moderately fit (Jon two miles let’s say), not an asshole, and not living with mom, a 40-60 year old guy is a hot commodity.
With our modern health systems we are pretty much a huge evolutionary blind spot ourselves. Many illnesses that would be filtered out because the carrier wouldn't survive, are now trivial. And on the journey hand we can screen for known illnesses.
I think we are already post evolutionary, or control it ourselves. Not a big issue either IMO, it's totally ok that this is happening.
We are definitely not post-evolutionary; the selection pressures have simply changed. Before industrialization the big two were starvation and infectious disease. Now? Well, it's anybody's guess decade to decade. Certainly sexual selection is still with us.
The main problem is that evolution is just not a thing at our modern civilizational time scale.
And I don’t see any problems with late-life reproduction, assuming we can make it reliable and healthy. If anything, some countries desperately need it.
Evolution is really slow on average, but locally it moves quite quickly and probably explains the large variation between members of a species.
Add strong selective pressure to that high local speed and you can change a good part of the genotype within a couple of generations. See: animal husbandry. You can breed a new race of dog within 5-10 generations.
Ethics aside we could probably breed people who can sniff out Alzheimer's in less than 250 years.
Our current late reproduction style will very likely influence future generations health at older ages.
It's probably a wash. Sure people are reproducing later, but it's also more likely that they have recieved some major medical intervention to allow them to make it to that stage. For example, it could be stuff like freezing eggs before starting chemo.
I don't dispute any of your points in general. But at the same time, it brings a nostalgic smile to my face to envision starting a 250-year project in 2025.
The article sort of mentions this in passing, but doesn't subject it to much rigor, and the (completely obvious?) counterargument is that by the time it causes male infertility, the affected have already reproduced.
No. The grandparent comment was essentially saying that we, as a species, were not designed to live as long as we do. It’s only been <10 generations since medicine has been a thing. Cancers, dementia etc just weren’t a thing before because we evolved to live long enough to bring our children up to be self sufficient and reproduce, then our job is done. Like the rest of the animal world do.
Modern medicine has messed with this. We weren’t meant to “old”.
>In women, breast cancer has a similar death toll, but the breasts have an excuse: they’re much bigger; there are many more cells to go bad. They’re also much more metabolically active, capable of producing enough milk to feed a baby; the prostate’s output is tiny in comparison.
Except that you make work your prostate everyday, multiple times, since your adolescence, whereas a woman doesn't breastfeed everyday since adolescence.
Based on the simplified sketches and reasoning I'd assume that it made more sense to sclerose the two small vein sections connecting the testicles with the prostate. Does somebody know why that's not the suggested option?
The text brushes over the importance of healthy muscle motion for venous blood flow against gravity. Staying physically active, including pelvic floor exercises into the routine and correct belly breathing utilizing the diaphragm are probably the best options for preventing issues with reduced venous blood flow from the testicles passing by the prostate back to the heart.
Once per day, when peeing, do it differently.
1. Release the stream during the in-breath. 2. Stop and hold the stream on the outbreath. 3. If not yet bored or tired go back to 1. Else - finish peeing normally.
That's it.
And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.
Thank you! Didn't know I endangered people by suggesting it to them.
I usually got bored halfway and after 3-6 breaths finished peeing normally. It was also because I've noticed that the exercise made it very hard to push out the last of urine from the bladder. Now I know it's also very unhealthy not to empty all the way.
As with any internet post about exercise, someone must eventually come along and mention the good old weighted squat. Squats are well known to strengthen pelvic floor.
My own anecdata confirms the benefits of pelvic floor exercises without any kegels, at least back when I regularly did lift weights.
But is stopping the flow of urine an apt description of the exercise? Is it a case of “do it as if you were doing that, without actually doing it while urinating?” If so, I think I’d be hard pressed to find a simpler way to describe it to any man (no idea if it applies to women as well).
Huh. So that “happiness through clenching your butthole daily” or whatever-it-was copy-paste troll that was so common on Slashdot back in the day, was… very close to being excellent advice?
I think people give the cue of stopping urination to help others find the muscles that you need to engage. Otherwise, yes, you absolutely can just do them any time you want. In yoga it’s called mula bandha [1]. You’re often instructed to engage it while practicing asana or pranayama. I even focus on engaging it when I’m out for a run or lifting weights.
Thanks, I think I'll practice whole brushing my teeth, probably the easiest to not forget to do, as it's an everyday thing that I'm unlikely to ever stop doing.
> And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.
I've experienced all those benefits when I started walking two times a day, 8-10 thousands of steps a day continuously for several weeks. I haven't performed any other exercises.
But it's really boring and you need to do it every day. I do it only because I need to walk a dog.
Photography has made me realize how much I was previously ignoring. There’s so much to see, and even when walking the same route over and over, there’s an astounding amount of change over time. Often little things.
The Bird ID app made me realize just how many unique birds were making up the sounds I was hearing. As I learned to distinguish between them, I found myself fascinated in a way that I’d never been before.
Walks became almost meditative over time, and the sights and sounds a kind of salve for my often tired brain.
I often feel like I can think more clearly when walking as well, and thought processes kind of just sort themselves out as I go.
I highly recommend making walks more than just a way to move your body. They can be much more, and getting the benefits of movement almost feels like a happy side effect.
I also recommend the Seek app by iNaturalist. Though if you’re like me and use it to identify plants and every bug you see, you may not actually get that much walking accomplished.
Season likely plays a factor too. There are many plants that more or less look identical (to the untrained eye) until they either bloom or grow large enough.
Walking is considered by einstein and pretty much all thinkers to be critical to deep work. It's also covered in Cal Newport's book "deep work" briefly. Which is a short audiobook worth reading.
One such prescription would be to do deep work early in the day then walk after and walk again 2 hours before bed. Another would be split the deep work with a 1 hour walk and do the 2nd walk after the 2nd block.
It may be more fulfilling with lots of interesting ideas rattling around. YMMV
I desperately want to do this type of walking, but I live in a major city. There’s always something to distract me, which is great for boredom perhaps, but ruins any sense of zen or reflection. I would say half of every walk involves people yelling, loud vehicles, and louder music. Noise-cancelling headphones are only useful for distraction through podcasts and music, not for decompressing. I’m starting to wonder if the solution, the sad solution, is to walk on a treadmill at a gym during off-peak hours.
Have you considered earplugs? The firearms community have some pretty great ones which are readable and fit really well. Check out Axil x30i for example.
I find thunderstorm noises superior to white/coloured noise - because it's a natural sound the brain filters it out, and obtrustive noises are camouflaged within it, and filtered out too. So the loudness required is less than the loudness needed for white/coloured noise to be effective.
I don't find walking to be boring at all! Especially when I'm working on something new, I will walk as many as 10 miles a day while thinking through all of the design corners.
Even when I'm not working, I like taking long walks to think about family, friends, video games, etc.
Its a great way to get into your head without the distraction of a phone or feed or forced message.
>But it's really boring and you need to do it every day. I do it only because I need to walk a dog.
I'm lucky enough to have a pedestrian path to do my long walks (so no cars or even bikes to contend with, bikes have a dedicated parallel path), so I listen to a podcast while walking around 1 hour/day.
You must have been in really bad shape before if you're getting such noticeable health benefits from a rather modest exercise intervention like 8k steps.
I often listen to podcasts while walking. Or I think. I also own a walking pad and walk while working (1h in the morning, 1h in the afternoon - not every day but most).
Wow, I was so sure it was PC or PV muscle exercise, because author of the book where I learned about the peeing exercise said that men don't have Kegels muscles. I stand corrected.
Why do ideas like this take so long to be tested/adopted? Is it because the alternatives are “good enough”? I would think the evidence would lead to a fast shift; though maybe moving slowly is a good thing when it is surgeries.
Research and subsequently clinical testing is expensive so you have to acquire capital, usually from grant providers or working with private industry. Grant providers tend to be conservative and risk-averse so that means individuals with new ideas often won't be able to explore them until later in their career. Private industry is less risk averse but will only fund research if it has the potential to bring a patentable product to market before the parent expires.
Even once you have funding secured, the regulatory approval process is long and requires hundreds of pages of documentation, reporting, and compliance. Then you have to get insurance to cover it, which can require a procedural code being generated for it by the AMA and requires convincing insurers it's worth it, particularly Medicare in the US which other insurers take their cues from. And even once a procedure is approved and a patient can get it paid for, you still have inertia from human physicians who have been trained to perform certain kinds of treatments and not others.
And this area of human interest has been (and is) prone to abuse from unscrupulous individuals/organizations. Rigorous regulation prevents much of that as well.
At 50 cents a capsule on amazon , prostamol uno (serenoa repens) is more expensive than finasteride so it will forever remain an unrecognized herb. Also, remember we dont really know how these pills are made. Remember the story of that miracle herb, PC-SPES? Widely regarded as a miracle drug when it started selling over the counter, it did indeed significantly improve voiding symptoms as well as out even advanced prostate cancer into remission. It became so widespread that the California Department of Health Services (CDHS) investigated PC-SPES and discovered that it was adulterated with drugs, including warfarin, alprazolam, and diethylstilbesterol (DES). Each capsule had potent estrogens in it! Then the FDA recalled it.
Although the rest of the world benefitted from this research, it was the US that paid for it and did it. I am sad that we are now entering a 'transactional democracy' (you only get as much democracy as you can afford) but then again, that's where the rest of the world has been since WW2. Anecdotal data has driven 'old wives tale medicine' for millenia. I am hoping though that big data, the internet, AI, and the judicious use of Bayes' theorem can distill real knowledge from the vast sea of misinformation that surrounds us.
Unmentioned is the significance of dietary modificatioon. In one study, Japanese men had 10% of the incidience of problematic bph as americans. The offspring of the japanese in Hawaii had half the iincidence. The second generation had no difference. The analysis suggested that phytoestrogens in tofu, tempeh,etc are responsible of prostatic involution.
Animal fat contains elevated levels of lipid soluble hormones and diets high in fat (meat) are associated w bph as well as elevated risk of prostate ca.
Finally, this craze of T replacement is greatly increasing the risk of symptomatic bph (along with other cardiovascular risk factors)
> It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them.
I wouldn't say so at all. Poor eyesight carries on smartly. Baldness. I enjoy both.
But an old story about the controller code for a surface-to-air missile comes to mind.
Someone looking at the memory allocator spots an obvious resource leak: "This code is going to crash."
The reply was that, while the point was theoretically valid, it was irrelevant, since the system itself would detonate long before resource exhaustion became an issue.
So too prostate cancer back in the day: war, famine and plague were keeping the lifespan well below the threshold of every man's time bomb.
Evolution selects for one thing and one thing only, reproduction.
The answer to every "why hasn't evolution done x" question is selection pressure.
An enlarged prostate is something that people get in their 60s and later. Most people are done with reproduction long before that event. There is simply very little and very low selection pressure.
It's pretty much the reason why most humans have peak health into their 40s.
Don't expect evolution to "fix" anything for humans that doesn't commonly impact 20yos.
Weird that you pull the one quote but ignore the rest of that paragraph which is about how being the leading cause of infertility is exactly the kind of thing evolution normally fixes.
"It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them. Since it strikes at advanced ages, BPH doesn’t make a big impact on a man’s ability to pass on his genes. But being the leading cause of male infertility sure does. Their explanation is that evolution hasn’t had much time to work on the problem; in animals the spermatic vein is horizontal, and doesn’t have or need one-way valves. It’s our standing upright that yields the problem; in evolutionary terms that’s a recent development."
Not only is it recent in terms of human history; back to my point, it is only in the last few centuries that men in gneral have reached ages that expose the posture shift as a flaw.
Baldness and grey hair are indicators of male maturity. In many primate species elder males look different than younger ones, which guides their social dynamics. Similar reason why our kids stay small for their first 12 years or so - it's hard to teach someone who can physically overpower you.
It would probably take too long, but a human breeding program centered around the healthiest still fertile old men we can find and young women with spotless genetic heritage would uplift our whole species.
But then you wouldn't necessarily know that their current sperm is valuable.
A better method would be to confine the program to monozygotic twin pairs of young women with spotless genetic heritage, and inseminate one twin with frozen sperm and the other with current sperm. The "current sperm" child (CS) could be closely monitored, and the "frozen sperm" (FS) child fitted with an explosive chastity device which, in the event that CS is found to have developmental issues, are remotely-detonated to ensure the tainted line does not persist.
I think you missed the idea. Your explosive device could still come in handy though.
But you freeze the sperm at the peak of freshness. Then you wait and see how the donor does. If they live to a ripe old age without old age diseases, then go select their sperm. Otherwise, destroy it.
You can probably do this with eggs too. When a child is desired, select an egg and a sperm off the shelf, and there you go. Easy peasy. Your device ensures only munitions experts can procreate outside the system, and I think we'll need a lot of munitions experts in the ensuing generations.
I once read that wisdom teeth don't fit anymore only because we use forks and knives now. Previously we would tear our food with our teeth, always widening our pallet.
I couldn't find the source just now (in the 30 seconds I searched for it), but I always thought it was an interesting idea.
I'd be interested to see sources for the claim that poor eyesight is evolutionarily recent.
I strongly suspect it's more a matter of "won't kill you". Nearsightedness is far more common than farsightedness, and it's only in the last two hundred or so years that there's been any major benefit in seeing fine details at distance. The fuzzy shapes afforded by 20/80 vision are plenty enough to hunt a mammoth.
Having 20-20 vision is nice for avoiding lions and tigers, but it's a luxury spec, because movement acuity doesn't decrease linearly with nearsightedness, and movement acuity (plus traveling in groups, as prehistoric humans were wont to do) can take care of business decently-enough on its own - so I wouldn't call it "evolutionary-pressure"-nice.
Samson and Delilah would like to have a word with you. Also with Japanese Samurai. You loose your mythological power, leading to lost status, suicide, ...
Do you have any source for this? As someone born in the summer to a farming family with poor eyesight, I find it hard to believe that happened because I wasn't exposed to enough sun as an infant or child.
Interesting study. Myopia can definitely be caused by focusing too much on nearby things.
I just so happen to have Hyperopia with astigmatism, neither of which came from a lack of outdoor exposure. (If anything, I needed less time outside).
That's a bit of the issue I have with such a broad generalization. It's true that for some, a lack of time outdoors damaged their eyesight, it's not universally true that all or perhaps even most poor eyesight is a result of staying indoors.
There is a reason we are smart enough to develop finasteride and dutasteride that are extremely effective and safe¹ instead of relying on plants & herbs which are just weak versions of taking a drug anyway.
¹ the science is sound, the safety is absolutely a guarantee. There is a group of about 10 individuals who have spent their entire life spreading their neurological issues and obsession with fake reports and exaggerations of the harmful made-up side effects that cannot be repeated in any study whatsoever anywhere..
I actually could not believe the other day that they are still active and have managed to cause the FDA to issue a guidance that there might be higher side effect rates than otherwise were reported .
It's actually ridiculous, and every news article and study about it are almost entirely mentioning people who's just start believing in their heads that they have side effects when they actually don't. And yet the news articles took this as evidence of a story that has been hidden or something .
I really thought that those 10 or so individuals who you used to be able to read their forum posts back in 2006 when they tried to tell every young guy in the world not to take it for hair loss would have fizzled out by now.
Finasteride does seem to be able to cause some issues. It seems that DHT has many protective roles in the body and limiting it may cause problems: https://pmc.ncbi.nlm.nih.gov/articles/PMC7308241/
> In any case, the paper makes no comment as to whether the problem can be solved the same way a second time; obviously in principle it can, but finding all the new bypasses and sclerosing them might be difficult in practice.
Multiple surgeries is not sustainable. Too much uncertainty.
> The theory here is largely mechanical; and it’s not just psychiatrists like Scott who are weak at mechanical explanations; it’s doctors in general as well as medical researchers and biologists.
A tangent here, about not just "mechanical" explanations, but "mechanical" treatments —
IMHO, the insistence in modern medicine on treating recurrent bacterial infections purely with antibiotics is wrongheaded, and the cause of a lot of resistant strains of bacteria. Especially for topical/mucosal/epithelial infections, where the infected tissue is accessible without invasive surgery.
In a recurrent bacterial infection, the reservoir of the infection is one or more (almost always macro-scale) biofilms or plaques. And antibiotics just don't do much to biofilms/plaques. (If they could, you could spray Lysol on the walls of an under-ventilated shower that's developed "pink slime" biofilms — and all the slime would dissolve, or detach and run down the drain. But it doesn't do that, does it?)
Even if you kill most of the bacteria, the biofilm itself — the "fortress" of polymerized sugars which the bacterial cells have secreted to secure their position — is not destroyed by antimicrobal compounds. And the few bacteria that remain have a great position to regrow from.
What does work to clean a slimy shower wall?
Scrubbing. Scraping. Peeling. Together with targeted chemicals, that 1. get water out of the polymer (because these biofilm surface polymers are often lubricative when wet, and thus resistant to abrasion — but this effect breaks down when dry), and 2. rough up the surface of the biofilm/plaque a bit, to get a better grip on it.
Biofilms and plaques adhere to themselves — so, when you can break the biofilm or plaque into chunks, you can then get entire chunks out. (And also, by removing chunks, you create paths for antimicrobials to then get past the biofilm surface polymer. You're breaching the fortress.)
If you picture a strep-throat infection — spots on the tonsils and on the throat, etc — those spots aren't a symptom; they are "the enemy" you're trying to fight. Remove them — mechanically! — and you go from using antibiotics (picture tiny cellular infantrymen) to effectively "fight a war of attrition against an enemy with a secure position", to "a defeat in detail of an enemy with nowhere to hide."
---
Interestingly, there are certain medical specialties that think mechanically about infection.
• Dentists, obviously, know that you must abraid dental plaque away. There's no chemical that you can put in your mouth every day that will keep plaque from forming, or reduce it once it has formed. (In fact, ironically, antimicrobial oral rinses [of e.g. chlorhexidine] accelerate plaque formation, because bacterial cells killed "in place" inside their biofilm fortresses will deposit and enrich the surface polymer layer of the biofilm — much as dead sea creatures deposit and enrich limestone sediment.)
• Audiologists know that there's ultimately nothing you can do with drugs or topical treatments to get an ear clear of wax+fat+dust+anything else trapped in there. You have to go digging. Chemicals can soften the wax, to make it easier to remove; but, due to the shape of the ear, and the lack of ability to "come in from behind" (there's an eardrum in the way!), the softened wax will never come out on its own.
• Dermatologists know that a cyst can't just be drained + treated with antibiotics. The body forms a defensive pocket around a cyst — but the inside surface of this pocket ironically provides the perfect medium for a biofilm to grow on, and thus for an infection to recur after drainage. Cysts are only considered well-treated if the pocket itself is removed — thus removing the biofilm.
...and yet, when you look at most other disciplines, you see completely the opposite.
• An ENT is very much not willing to abraid biofilms out of your sinuses or throat "if they can help it", despite those surfaces being accessible to an endoscope without breaking past any barriers. They will always try first to treat "pharmacodynamically", with e.g. oral antibiotics + an antimicrobial sinus rinse — presumably in the hopes that you'll accidentally do something mechanically in the process of treatment (e.g. snorting really hard to get the remnants of the rinse out) that will dislodge the biofilm. You have to go through years of back-and-forth with an ENT before they'll actually bother to look further up inside your sinuses than they can see with an otoscope/anterior rhinoscope. (And IMHO this is why so many people suffer from idiopathic chronic sinusitis, developing into nasal polyps et al. Nobody's ever been willing to go deep up their nose with an endoscope, find impacted biofilm plaques, and say "alright, let's clear those out.")
• Kidney stones, once symptomatic, are treated ultrasonically (lithotripsy); but the thinking on follow-up prevention is entirely about preventing accretion — not in removing the cause. [In many cases, the cause of (struvite or apatite) kidney and/or urinary stones, is very likely a bacterial biofilm within the kidney, spalling off bits of biofilm, which denature into plaques after exposure to the harsh pH of the kidney/uterer/bladder; get caught on some tissue; and then act as nucleation sites for mineralization (stone formation) as dissolved minerals pass through.] Once someone gets one kidney stone, they are generally thought to just be "prone to kidney stones", and will likely get them randomly
for the rest of their life. A lot like the old — pre-infectious-origin — thinking that someone can be "prone to peptic ulcers"!
I read this with great interest, because about a decade ago, I was convinced I had prostatitis (but NHS screwed the diagnostic process up - the GP didn't do a digital rectal exam because the ultrasound would be more diagnostic anyway, and the ultrasound scan was cancelled because the GP didn't do a digital rectal exam which was part of the criteria for going through with the scan ¯\_(ツ)_/¯ ), and ended up reading quite a bit about it, and how I might try to make things better for myself in the absence of antibiotics.
I ended up on this page which I no longer remember (something something prostatitis foundation maybe?), from which I remember two things.
The first was this turkish doctor, who against all advice was suggesting a "Brocolli juice therapy" as a prostatitis cure. Fast forward to 2025 and there's lots of studies supporting this. Anecdotally I tried this back then and it really helped the prostate pain I had at the time for months go away within a week.
The second, which is more relevant here, was this guy who had a very interesting hypothesis, that a lot of the prostate troubles are actually "musculoskeletal" in origin, and muscle imbalance / weakness of the iliopsoas muscles in particular. And that this imbalance affects venous return which "somehow" causes the condition. But he was just a lay person, and the "somehow" was unclear. So this completes that image perfectly. It's interesting that this article mentions the venous insufficiency link, and that veins rely on valves to direct flow, but doesn't mention the muscular link at all.
In any case, this person was saying that in his case, doing lots of iliopsoas stretching and exercises effectively 'fixed' his chronic prostatitis problems. So I've timidly started including a couple of iliopsoas stretching exercises before any workout I do. Anecdotally, I think it helps, but I can't know for sure. But thought I'd mention here in case someone shows interest or can make that link more solid.
Finasteride or dutasteride. They control BPH perfectly, while also treating male pattern baldness. Combine with daily tadalafil to offset any chance of the dubious sexual side effects, while also reducing gynecomastia (it's also an aromatase inhibitor!). Make sure to have regular 5ari-aware PSA screenings to make sure high grade cancers are caught and you are golden.
fin/dut + tad are my favorite medications to keep men fresh for many more years than intended by nature.
Have your children before you start though, as dut will probably make you sterile eventually.
Two lifelong medications + frequent screening does not sound like "a solution" to me.
That being said, the article does state that its proposed treatment doesn't last forever, though I couldn't find any numbers on how long it is expected to last.
I’ve been prescribed, and taking for a while now, daily Dutasteride plus Silodosin (Urorec). However, the latter has the unpleasant side effect of suppressing ejaculation.
Tadalafil (Cialis) does not seem to do the same, however other potential side effects involving sight and hearing are listed.
I’ll ask my doctor if such a swap would be advisable.
In a framework where one believes PFS to exist (I strongly believe it doesn't), tad would, at best, treat a few of the symptoms of PFS.
I believe people with self diagnosed PFS have a mix of mental illness and (sometimes) non diagnosed physical illness.
I'd like to see a self diagnosed PFS sufferer not get an erection, pumped up on 150 mg sildenafil + 10g L-Citrullin.
> Is Tad addressing this hazard in your view?
Let me address your question from a different angle: Being on an sufficient amount of daily tadalafil would certainly reduce the chance of you believing you got PFS, because it would guarantee you a working erection in any situation.
Hi - there is no official diagnosis for "PFS". I have it in the sense that I have penile tissue scarring confirmed by medical imaging, with a urologist's opinion that finasteride was the likely cause. Yes, tadalafil does often help in my case, but the reduction in function is permanent and I doubt I will ever be my pre-finasteride self again.
Thanks for sharing your view. I think the possibility of something like PFS existing is real, simply because 5ARIs have widespread physical effects - I mean they regrow hair and reduce sperm motility. Why would the brain or nervous system be excluded from being affected? Eg one male hormonal contraceptive pill study was aborted in 2016 because one participant got suicidal.
Giving 90% of the gender that looks actually great with hair on their head MPB is easily one of the biggest sleights evolution has committed against our species.
I've personally had very little luck with official channels there. Most won't prescribe anything for hair loss, several dermatologists said to just get used to it, one would prescribe fin pills, i.e. systemic - which did eventually give me pain in the breast tissues (so I ceased using it), but not topical, citing that it's too new on the market. I was unable to find anyone who would or even could look at serum DHT. I eventually settled on just paying one of these apparently legal telemedicine vendors 20 bucks per topical fin prescription.
> which did eventually give me pain in the breast tissues (so I ceased using it)
You already decided to take one hormonal disruptor, so why not go all the way? Find a private andrologist that prescribes you fin/dut + an aromatase inhibitor. Daily tadalafil also acts as aromatase inhibitor by the way. Should be enough to offset the estrogen increase from finasteride. It's worth a try.
I personally don't really believe in topical min/fin/dut: You are probably just getting the same effects and side effects you'd get from a lower oral dose.
The studies on topical finasteride support this. You just believe it's not in your blood and thus there is no nocebo effect to give you ED but it very much is.
Typical patriarchal attitudes, whenever any disease affects women or non-binary people then it's a shrug of the male shoulders and on to talk about Star Wars.
This is a silly argument. Breast cancer awareness (rightfully) gets a lot of attention; it's also fine to have an article about prostates every once in a while.
Right, if anything I'd say men's reproductive health is under looked in general. Men rarely go to Urologists and issues with the prostate and penis are very much treated as just a fact of life, as opposed to something to look into it. And, even when we do look at these issues, we do it in such an overly pragmatic sense.
Like, how men feel about their penis not working or their muscle atrophying doesn't matter. What matter is does their penis work, literally? We approach it in such a blunt and apathetic manner. We don't really think about the more emotional side of hormonal changes or changes with age.
The startup company is Vivifi Medical[1] and they have clinical trials underway with ten men in a Central American country (El Salvador?). They claim that BPH reverses in a few months after their procedure. Their procedure uses a minimally invasive tool of their own invention to snip the vertical blood vessels that are backflowing from age and gravity, and splice them into some existing horizontal blood vessels. On their board of advisors is Dr. Billy Cohn[2], the wildly innovative heart surgeon who is famous for shopping for his medical device components at Home Depot. Dr. Cohn is on the team building the BiVACOR Total Artificial Heart. Vivifi presented their estimated timeline to FDA approval, with proposed general availability in 2028. My personal BPH will be at the head of the line for this procedure.
As far as a startup, their TAM is about 500 million men. I had the Urolift procedure for BPH three years ago, and it cost about $15K on the Medicare benefits statement, though Urolift's clips amounted to only a few thousand dollars. Similarly, Vivifi's charges for this procedure are only a few thousand dollars per procedure, but it holds the promise of being a final solution. Currently Urolift is much less disruptive than TURP, which needs a couple of days in the hospital and almost always leads to retrograde ejaculation (into the bladder).
[1] https://www.vivifimedical.com/
[2] https://www.texasheart.org/people/william-e-cohn/
Are you planning to publish the longitudinal data, esp. of endpoints 2 and 3 (prostate size, urinary flow). It would greatly add to the public understanding of this procedure. Why didn't you go for PSA? It's easy to obtain altough one probably wouldn't expect significant changes in this short time frame.
We are collecting PSA data as well. It’s a useful parameter for prostate cancer.
Thank you for taking a risk on this by the way. As someone who has family history it's heartening to know there are people taking this seriously.
Thanks for sharing your story. It’s stories like yours — people with family histories and real-world experiences — that fuel everything we’re doing.
I’ve long felt that the reliance on population-statistics (RCT) rather than individual diagnosis highlights how little we really know about medicine.
A mechanic wouldn’t try to fix a car based on a checklist of symptoms interventions that work X% of the time across the population of cars; they would actually inspect the pieces and try to positively identify e.g. a worn/broken component. Of course, this is harder in the human body.
I’m hopeful that as diagnostics become cheaper and more democratized (eg you can now get an ultrasound to plug into your iPhone for ~$1k), we’ll be able to make “medicine 3.0” I.e. truly personalized medicine, available as standard rather than a luxury available to the 0.1%.
But yeah, you won't find people doing things that way in any setting where it Actually Matters(TM) (e.g. expensive things where you really can't justify not fixing it right the first time)
Interesting. I wonder how many how many other issues we could screen for using such simple, low cost tools. Some scales can already detect reduced blood flow in the feet (which can be a sign of all sorts of nastiness).
A large study from 2014 by Nimptsch et al found a strong inverse correlation between intake of vitamin K2 and prostate cancer [2]. Dairy foods with K2 had the most effect (K2 is soluble in butterfat).
Vitamin K2 helps remove calcium from the elastin in artery and vein walls, reducing their stiffness. Donaldson hypothesizes that K2 improves venous flow, and hence might reduce the varicoceles that lead to too much free testosterone getting to the prostate and causing enlargement.
So eat more grass-fed butter, or take a K2 supplement. At worst, you might also improve your bone strength. At best, men might prevent prostate cancer.
1: DOI: 10.1016/j.mehy.2014.12.028
2: DOI: 10.1093/ajcn/87.4.985
My prostate was not enlarged, my PSA at the end was 4.2. Only because my doctor was overly cautious about the slope of the PSA rise did he send me for an MRI starting the diagnosis. It remains to be seen if it escaped containment.
The point here is, I don’t think enlargement and cancer are that intertwined. Cancer happens for any number of reasons, pinning hope that it can be staved off by diet and vitamins seems to ignore tons of other environmental factors.
It wasn't just disease, but also wars and famines. And in women, deaths during childbirth, which cluster in the 20-35 bracket.
Cardinals of the Church, who led peaceful lives, didn't give birth and never went hungry, lived into their late 60s and early 70s even during the Middle Ages. But an average peasant wouldn't.
Hides long list of ethical problems with the concept
Men are (within reason) considered handsome in media even in old age. Wrinkles and gray hair can be seen as sexy (again, within reason), but only in men.
Women are discarded or relegated to sexless granny roles (except maybe for comedic purposes, where sexuality is the butt of a joke). Actresses are replaced by younger women because they are not sexy enough even when their male equivalents aren't (looking at you, Top Gun: Maverick).
I'm not saying there aren't exceptions in particular movies that deal with this topic; I'm talking about the general trend.
Women are different. It ranges — alot, and is more about EQ and scarcity. If you have a moderate baseline level of physical attractiveness, moderately fit (Jon two miles let’s say), not an asshole, and not living with mom, a 40-60 year old guy is a hot commodity.
I think we are already post evolutionary, or control it ourselves. Not a big issue either IMO, it's totally ok that this is happening.
Just kill all offspring if one of the parents die of some unwanted cause.
Allows people to still get kids in the optimal age, yet applying old-age selection pressure.
The ethical problems were fun to read about! But would be significantly less fun to live through.
And I don’t see any problems with late-life reproduction, assuming we can make it reliable and healthy. If anything, some countries desperately need it.
Evolution is really slow on average, but locally it moves quite quickly and probably explains the large variation between members of a species.
Add strong selective pressure to that high local speed and you can change a good part of the genotype within a couple of generations. See: animal husbandry. You can breed a new race of dog within 5-10 generations.
Ethics aside we could probably breed people who can sniff out Alzheimer's in less than 250 years.
Our current late reproduction style will very likely influence future generations health at older ages.
I don't dispute any of your points in general. But at the same time, it brings a nostalgic smile to my face to envision starting a 250-year project in 2025.
Icelanders are a well-studied population when it comes to genetics. Frequency of some traits meaningfully changed among them in last 100 years.
Source: this book: https://www.amazon.de/dp/0198821263?ref_=pe_109184651_110380...
Modern medicine has messed with this. We weren’t meant to “old”.
Except that you make work your prostate everyday, multiple times, since your adolescence, whereas a woman doesn't breastfeed everyday since adolescence.
The problem is really prudeness in society, especially the American one (the main market for many industries). It's holding back things like sex tech.
He's archived a mindbogglingly large number of usenet posts, each being extremely high signal
Once per day, when peeing, do it differently. 1. Release the stream during the in-breath. 2. Stop and hold the stream on the outbreath. 3. If not yet bored or tired go back to 1. Else - finish peeing normally. That's it.
And note that for most people, a week to few weeks of the exercise give stronger orgasms and ability to delay the ejaculation.
I usually got bored halfway and after 3-6 breaths finished peeing normally. It was also because I've noticed that the exercise made it very hard to push out the last of urine from the bladder. Now I know it's also very unhealthy not to empty all the way.
My own anecdata confirms the benefits of pelvic floor exercises without any kegels, at least back when I regularly did lift weights.
[1] https://en.m.wikipedia.org/wiki/Bandha_(yoga)#Mula_bandha
I've experienced all those benefits when I started walking two times a day, 8-10 thousands of steps a day continuously for several weeks. I haven't performed any other exercises.
But it's really boring and you need to do it every day. I do it only because I need to walk a dog.
- I started carrying a camera
- I started using the Merlin Bird ID app
Photography has made me realize how much I was previously ignoring. There’s so much to see, and even when walking the same route over and over, there’s an astounding amount of change over time. Often little things.
The Bird ID app made me realize just how many unique birds were making up the sounds I was hearing. As I learned to distinguish between them, I found myself fascinated in a way that I’d never been before.
Walks became almost meditative over time, and the sights and sounds a kind of salve for my often tired brain.
I often feel like I can think more clearly when walking as well, and thought processes kind of just sort themselves out as I go.
I highly recommend making walks more than just a way to move your body. They can be much more, and getting the benefits of movement almost feels like a happy side effect.
Too often, pointing Seek at a plant results in "dicots", which is about half the flowering plants out there.
One such prescription would be to do deep work early in the day then walk after and walk again 2 hours before bed. Another would be split the deep work with a 1 hour walk and do the 2nd walk after the 2nd block.
It may be more fulfilling with lots of interesting ideas rattling around. YMMV
-Friedrich Nietzsche
Even when I'm not working, I like taking long walks to think about family, friends, video games, etc.
Its a great way to get into your head without the distraction of a phone or feed or forced message.
I'm lucky enough to have a pedestrian path to do my long walks (so no cars or even bikes to contend with, bikes have a dedicated parallel path), so I listen to a podcast while walking around 1 hour/day.
I do a lot of daydreaming when I walk, too (to my wife and daughter's impatience!).
https://en.wikipedia.org/wiki/Kegel_exercise
Even once you have funding secured, the regulatory approval process is long and requires hundreds of pages of documentation, reporting, and compliance. Then you have to get insurance to cover it, which can require a procedural code being generated for it by the AMA and requires convincing insurers it's worth it, particularly Medicare in the US which other insurers take their cues from. And even once a procedure is approved and a patient can get it paid for, you still have inertia from human physicians who have been trained to perform certain kinds of treatments and not others.
https://news.ycombinator.com/item?id=15834006
Although the rest of the world benefitted from this research, it was the US that paid for it and did it. I am sad that we are now entering a 'transactional democracy' (you only get as much democracy as you can afford) but then again, that's where the rest of the world has been since WW2. Anecdotal data has driven 'old wives tale medicine' for millenia. I am hoping though that big data, the internet, AI, and the judicious use of Bayes' theorem can distill real knowledge from the vast sea of misinformation that surrounds us.
Animal fat contains elevated levels of lipid soluble hormones and diets high in fat (meat) are associated w bph as well as elevated risk of prostate ca.
Finally, this craze of T replacement is greatly increasing the risk of symptomatic bph (along with other cardiovascular risk factors)
I wouldn't say so at all. Poor eyesight carries on smartly. Baldness. I enjoy both.
But an old story about the controller code for a surface-to-air missile comes to mind.
Someone looking at the memory allocator spots an obvious resource leak: "This code is going to crash."
The reply was that, while the point was theoretically valid, it was irrelevant, since the system itself would detonate long before resource exhaustion became an issue.
So too prostate cancer back in the day: war, famine and plague were keeping the lifespan well below the threshold of every man's time bomb.
The answer to every "why hasn't evolution done x" question is selection pressure.
An enlarged prostate is something that people get in their 60s and later. Most people are done with reproduction long before that event. There is simply very little and very low selection pressure.
It's pretty much the reason why most humans have peak health into their 40s.
Don't expect evolution to "fix" anything for humans that doesn't commonly impact 20yos.
"It’s odd for there to be such an easily-removable design flaw in the human body; evolution tends to remove them. Since it strikes at advanced ages, BPH doesn’t make a big impact on a man’s ability to pass on his genes. But being the leading cause of male infertility sure does. Their explanation is that evolution hasn’t had much time to work on the problem; in animals the spermatic vein is horizontal, and doesn’t have or need one-way valves. It’s our standing upright that yields the problem; in evolutionary terms that’s a recent development."
https://en.m.wikipedia.org/wiki/Paternal_age_effect
A better method would be to confine the program to monozygotic twin pairs of young women with spotless genetic heritage, and inseminate one twin with frozen sperm and the other with current sperm. The "current sperm" child (CS) could be closely monitored, and the "frozen sperm" (FS) child fitted with an explosive chastity device which, in the event that CS is found to have developmental issues, are remotely-detonated to ensure the tainted line does not persist.
Simple-as.
But you freeze the sperm at the peak of freshness. Then you wait and see how the donor does. If they live to a ripe old age without old age diseases, then go select their sperm. Otherwise, destroy it.
You can probably do this with eggs too. When a child is desired, select an egg and a sperm off the shelf, and there you go. Easy peasy. Your device ensures only munitions experts can procreate outside the system, and I think we'll need a lot of munitions experts in the ensuing generations.
Mr Trump has also expressed his interest, especially if the women are very young.
I couldn't find the source just now (in the 30 seconds I searched for it), but I always thought it was an interesting idea.
What's up with those things?!
I strongly suspect it's more a matter of "won't kill you". Nearsightedness is far more common than farsightedness, and it's only in the last two hundred or so years that there's been any major benefit in seeing fine details at distance. The fuzzy shapes afforded by 20/80 vision are plenty enough to hunt a mammoth.
Having 20-20 vision is nice for avoiding lions and tigers, but it's a luxury spec, because movement acuity doesn't decrease linearly with nearsightedness, and movement acuity (plus traveling in groups, as prehistoric humans were wont to do) can take care of business decently-enough on its own - so I wouldn't call it "evolutionary-pressure"-nice.
The life expectancy cited by Wikipedia for the paleolithic is around 39 additional years for those surviving to 15.
https://en.wikipedia.org/wiki/Life_expectancy
Do you have any source for this? As someone born in the summer to a farming family with poor eyesight, I find it hard to believe that happened because I wasn't exposed to enough sun as an infant or child.
I've worn glasses since I was 2.
I just so happen to have Hyperopia with astigmatism, neither of which came from a lack of outdoor exposure. (If anything, I needed less time outside).
That's a bit of the issue I have with such a broad generalization. It's true that for some, a lack of time outdoors damaged their eyesight, it's not universally true that all or perhaps even most poor eyesight is a result of staying indoors.
What is the problem with baldness other than having a cheap excuse for not being successful in life? I actually enjoy looking a bit like Larry Fink.
it seemed to work for me, took it for few months, 10y+ ago. "Lasted" 8-9 years.. - until recently..
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC3175703/
[2] https://wjmh.org/DOIx.php?id=10.5534/wjmh.230222
¹ the science is sound, the safety is absolutely a guarantee. There is a group of about 10 individuals who have spent their entire life spreading their neurological issues and obsession with fake reports and exaggerations of the harmful made-up side effects that cannot be repeated in any study whatsoever anywhere..
I actually could not believe the other day that they are still active and have managed to cause the FDA to issue a guidance that there might be higher side effect rates than otherwise were reported .
It's actually ridiculous, and every news article and study about it are almost entirely mentioning people who's just start believing in their heads that they have side effects when they actually don't. And yet the news articles took this as evidence of a story that has been hidden or something .
I really thought that those 10 or so individuals who you used to be able to read their forum posts back in 2006 when they tried to tell every young guy in the world not to take it for hair loss would have fizzled out by now.
One of the primary causes of BPH is from androgens, specifically the conversion of testosterone -> dihydrotestoerone via the 5-ar enzyme.
The prostate is an androgen-sensitive tissue, and DHT causes enlargement.
It's not guaranteed to fix it, but it's one option.
I wonder how many potential answers to such problems are out there, known to a few but not acted on by the masses.
Multiple surgeries is not sustainable. Too much uncertainty.
It seems highly failure prone. If you don't block the flow are you going to stroke out?
A tangent here, about not just "mechanical" explanations, but "mechanical" treatments —
IMHO, the insistence in modern medicine on treating recurrent bacterial infections purely with antibiotics is wrongheaded, and the cause of a lot of resistant strains of bacteria. Especially for topical/mucosal/epithelial infections, where the infected tissue is accessible without invasive surgery.
In a recurrent bacterial infection, the reservoir of the infection is one or more (almost always macro-scale) biofilms or plaques. And antibiotics just don't do much to biofilms/plaques. (If they could, you could spray Lysol on the walls of an under-ventilated shower that's developed "pink slime" biofilms — and all the slime would dissolve, or detach and run down the drain. But it doesn't do that, does it?)
Even if you kill most of the bacteria, the biofilm itself — the "fortress" of polymerized sugars which the bacterial cells have secreted to secure their position — is not destroyed by antimicrobal compounds. And the few bacteria that remain have a great position to regrow from.
What does work to clean a slimy shower wall?
Scrubbing. Scraping. Peeling. Together with targeted chemicals, that 1. get water out of the polymer (because these biofilm surface polymers are often lubricative when wet, and thus resistant to abrasion — but this effect breaks down when dry), and 2. rough up the surface of the biofilm/plaque a bit, to get a better grip on it.
Biofilms and plaques adhere to themselves — so, when you can break the biofilm or plaque into chunks, you can then get entire chunks out. (And also, by removing chunks, you create paths for antimicrobials to then get past the biofilm surface polymer. You're breaching the fortress.)
If you picture a strep-throat infection — spots on the tonsils and on the throat, etc — those spots aren't a symptom; they are "the enemy" you're trying to fight. Remove them — mechanically! — and you go from using antibiotics (picture tiny cellular infantrymen) to effectively "fight a war of attrition against an enemy with a secure position", to "a defeat in detail of an enemy with nowhere to hide."
---
Interestingly, there are certain medical specialties that think mechanically about infection.
• Dentists, obviously, know that you must abraid dental plaque away. There's no chemical that you can put in your mouth every day that will keep plaque from forming, or reduce it once it has formed. (In fact, ironically, antimicrobial oral rinses [of e.g. chlorhexidine] accelerate plaque formation, because bacterial cells killed "in place" inside their biofilm fortresses will deposit and enrich the surface polymer layer of the biofilm — much as dead sea creatures deposit and enrich limestone sediment.)
• Audiologists know that there's ultimately nothing you can do with drugs or topical treatments to get an ear clear of wax+fat+dust+anything else trapped in there. You have to go digging. Chemicals can soften the wax, to make it easier to remove; but, due to the shape of the ear, and the lack of ability to "come in from behind" (there's an eardrum in the way!), the softened wax will never come out on its own.
• Dermatologists know that a cyst can't just be drained + treated with antibiotics. The body forms a defensive pocket around a cyst — but the inside surface of this pocket ironically provides the perfect medium for a biofilm to grow on, and thus for an infection to recur after drainage. Cysts are only considered well-treated if the pocket itself is removed — thus removing the biofilm.
...and yet, when you look at most other disciplines, you see completely the opposite.
• An ENT is very much not willing to abraid biofilms out of your sinuses or throat "if they can help it", despite those surfaces being accessible to an endoscope without breaking past any barriers. They will always try first to treat "pharmacodynamically", with e.g. oral antibiotics + an antimicrobial sinus rinse — presumably in the hopes that you'll accidentally do something mechanically in the process of treatment (e.g. snorting really hard to get the remnants of the rinse out) that will dislodge the biofilm. You have to go through years of back-and-forth with an ENT before they'll actually bother to look further up inside your sinuses than they can see with an otoscope/anterior rhinoscope. (And IMHO this is why so many people suffer from idiopathic chronic sinusitis, developing into nasal polyps et al. Nobody's ever been willing to go deep up their nose with an endoscope, find impacted biofilm plaques, and say "alright, let's clear those out.")
• Kidney stones, once symptomatic, are treated ultrasonically (lithotripsy); but the thinking on follow-up prevention is entirely about preventing accretion — not in removing the cause. [In many cases, the cause of (struvite or apatite) kidney and/or urinary stones, is very likely a bacterial biofilm within the kidney, spalling off bits of biofilm, which denature into plaques after exposure to the harsh pH of the kidney/uterer/bladder; get caught on some tissue; and then act as nucleation sites for mineralization (stone formation) as dissolved minerals pass through.] Once someone gets one kidney stone, they are generally thought to just be "prone to kidney stones", and will likely get them randomly for the rest of their life. A lot like the old — pre-infectious-origin — thinking that someone can be "prone to peptic ulcers"!
I ended up on this page which I no longer remember (something something prostatitis foundation maybe?), from which I remember two things.
The first was this turkish doctor, who against all advice was suggesting a "Brocolli juice therapy" as a prostatitis cure. Fast forward to 2025 and there's lots of studies supporting this. Anecdotally I tried this back then and it really helped the prostate pain I had at the time for months go away within a week.
The second, which is more relevant here, was this guy who had a very interesting hypothesis, that a lot of the prostate troubles are actually "musculoskeletal" in origin, and muscle imbalance / weakness of the iliopsoas muscles in particular. And that this imbalance affects venous return which "somehow" causes the condition. But he was just a lay person, and the "somehow" was unclear. So this completes that image perfectly. It's interesting that this article mentions the venous insufficiency link, and that veins rely on valves to direct flow, but doesn't mention the muscular link at all.
In any case, this person was saying that in his case, doing lots of iliopsoas stretching and exercises effectively 'fixed' his chronic prostatitis problems. So I've timidly started including a couple of iliopsoas stretching exercises before any workout I do. Anecdotally, I think it helps, but I can't know for sure. But thought I'd mention here in case someone shows interest or can make that link more solid.
PS. found the turkish doctor page (or at least a mirror of it): https://www.oocities.org/iastr/ebroc.htm
I wish I could find that comment about the iliopsoas ... but alas I think it's probably lost in the sands of time now.
UPDATE: Well what do you know. Found it: https://web.archive.org/web/20230203201759/https://prostatit...
(and https://web.archive.org/web/20230127101206/https://prostatit... more generally)
Finasteride or dutasteride. They control BPH perfectly, while also treating male pattern baldness. Combine with daily tadalafil to offset any chance of the dubious sexual side effects, while also reducing gynecomastia (it's also an aromatase inhibitor!). Make sure to have regular 5ari-aware PSA screenings to make sure high grade cancers are caught and you are golden.
fin/dut + tad are my favorite medications to keep men fresh for many more years than intended by nature.
Have your children before you start though, as dut will probably make you sterile eventually.
That being said, the article does state that its proposed treatment doesn't last forever, though I couldn't find any numbers on how long it is expected to last.
Tadalafil (Cialis) does not seem to do the same, however other potential side effects involving sight and hearing are listed.
I’ll ask my doctor if such a swap would be advisable.
I believe people with self diagnosed PFS have a mix of mental illness and (sometimes) non diagnosed physical illness.
I'd like to see a self diagnosed PFS sufferer not get an erection, pumped up on 150 mg sildenafil + 10g L-Citrullin.
> Is Tad addressing this hazard in your view?
Let me address your question from a different angle: Being on an sufficient amount of daily tadalafil would certainly reduce the chance of you believing you got PFS, because it would guarantee you a working erection in any situation.
I've personally had very little luck with official channels there. Most won't prescribe anything for hair loss, several dermatologists said to just get used to it, one would prescribe fin pills, i.e. systemic - which did eventually give me pain in the breast tissues (so I ceased using it), but not topical, citing that it's too new on the market. I was unable to find anyone who would or even could look at serum DHT. I eventually settled on just paying one of these apparently legal telemedicine vendors 20 bucks per topical fin prescription.
You already decided to take one hormonal disruptor, so why not go all the way? Find a private andrologist that prescribes you fin/dut + an aromatase inhibitor. Daily tadalafil also acts as aromatase inhibitor by the way. Should be enough to offset the estrogen increase from finasteride. It's worth a try.
I personally don't really believe in topical min/fin/dut: You are probably just getting the same effects and side effects you'd get from a lower oral dose.
The studies on topical finasteride support this. You just believe it's not in your blood and thus there is no nocebo effect to give you ED but it very much is.
Good luck :)
I do not know about Finasterid in detail, but the small-printing for Taladafil says clearly its _not_ for daily use.
https://www.hims.com/blog/daily-cialis-costs-benefits
https://investor.lilly.com/news-releases/news-release-detail...
It's superior to taking it on an as-needed basis because it has positive long term effects on your cardiovascular and penile tissue.
Apart from that: I do not expect the skeletal pain after D2 to be less when dropping it daily? :-D
EDIT: Or i'm mixing up Sindenafil and Taladafil? Im not a medic :-D
Like, how men feel about their penis not working or their muscle atrophying doesn't matter. What matter is does their penis work, literally? We approach it in such a blunt and apathetic manner. We don't really think about the more emotional side of hormonal changes or changes with age.