When Should You Treat Peyronie’s with the P-Shot® Procedure…Early After Onset, or Later?

Question (name changed)...

Dr. Runels:

I'm an ENT doctor but in this case a urology pt with recent-onset (noticed 2-3 weeks ago) Peyronie's. My urologist ______ in ______ gave me your flier about the Priapus Shot® treatment.

(1) Does your Rx address the plaques?

(2) Does it stop or reverse the Peyronie's process?

(3) Is it better to treat early (now) or wait 8-10 months when the plaques stabilize?

Thank you.


(1) Yes! Research shows a decrease in plaque size.
(see research listing below)

(2) If you mean, does the Priapus Shot® procedure help the curvature? Yes, in most men.  If you mean, does it permanently reverse the underlying process so the curvature never recurs...then probably in some. To further elaborate with some data, we did the following research (click to read) with lichen sclerosus (also thought to be an autoimmune process, like Peyronie's), showing that our process with the O-Shot® procedure decreased inflammation according to 2 blinded dermatopothologists--indicating that somehow the procedure down-regulates the autoimmune response.  There are other papers showing this downregulation of the autoimmune process by PRP.

Further as to permanence, our provider group has seen women who see a recurrence of their lichen at 1 year out, a few who are not helped at all, and many who are still well at 3-4 years post procedure. How these data will relate to Peyronie's disease remains to be seen but we expect a similar spectrum.
(see research listing below)

(3) DEFINITELY  better to treat early  before the scar tissue matures. I saw Dr. Virag lecture in Venice this past summer when we shared the podium and he will soon publish data showing that using PRP is more effective and safer than Xiaflex. Depending on how you look at the data, Xiaflex has a 1 in 50 to 1 in 100 risk of fracture/impotence post procedure. The Priapus Shot® procedure has associated with it the probable side effect of an improvement in erection quality by around 5 - 7 on the 25 point scale commonly used.
(see research listing below)

IMPORTANT! If your provider is not on the following list of physicians who have studied the accepted methods of the Priapus Shot® procedure (click) and agreed to follow them, then your physician may be a wonderful provider, but I have no way of knowing who or how he/she was trained and what method he learned. So, I have NO way to make any comments about the quality of the procedure he/she may provide. What I can say, is that your physician (if she/he says he's providing the P-Shot® but is not listed on that directory) is either knowingly or unknowingly breaking the law and pretending to be part of a group that he/she is NOT a part of. The certified providers of the Priapus Shot® procedure share notes with each other, finance research, and support the advancement of the effectiveness of the procedure. THOSE WHO USE THE NAME "PRIAPUS SHOT" BUT WHO ARE NOT LISTED AS ONE OF OUR MEMBERS ARE USING THE FRUITS OF OUR LABORS ILLEGALLY and possibly providing and inferior service by deceiving patients.

Certified Members of the Priapus Shot® Provider Group (click)<--
Research Listings for the Priapus Shot® Protocol for Treating Peyronie's Disease (click to read)<--

Best regards,

Charles Runels, MD


Inventor of the Priapus Shot® Procedure


Walking to Your Best Penis

Dr. Runels Explains How Walking Can Improve Your Penis & Your Life

Since sex can ask for the heart about as much as walking up stairs, man is good in bed for about as long as he can comfortably walk up stairs.  Is that enough to encourage you to think about walking?

Ask your physician before following any advice on this podcast...

Priapus Shot® Providers<--
Apply to Join Priapus Shot® Provider Group (physicians and physician extenders only)<--

Resources Mentioned...

4-Color Pens (these make people happy:)
Airpods for iPhone


iPhone 7

 The Great Courses (click)<--


Let's talk about walking. Now, why is walking so important and other forms of aerobic exercise are important, but why do I prefer walking over those other forms of exercise? I'm a big fan of swimming. The problem with swimming is that it requires a swimming pool. If you don't have an indoor pool, then the weather must be proper and it's expensive to maintain this. Usually if you're using a YMCA pool or something like that, access to the pool is a problem.

The problem with biking is that it's been shown that long-term use of the bicycle seat can cause erection problems because you're sitting on the pudendal nerve. You can have numbness and it can cause erectile dysfunction. It's not just one study but multiple studies showing this to be a risk. Of course you could have a properly seated or fitted bicycle seat that might help with that but, again, you're also limited to you need your gear and there's some risk involved with actually being on the street. It seems like there's a person killed about every third year in the town where I live where there's a lot of biking that goes on. I used to do triathlons. The culture of the triathlon crowd was that it wasn't if you're going to crash, it's when you crash your bike, how badly would you be injured? It's just a part of the risk that you have from using a bicycle everyday.

Part of the reasons that I prefer walking over other aerobic exercises is that it's safe. You don't need much gear. You can do it anywhere and it seems to be very, very, very effective. Now, walking does much more than just "increase your circulation." It's the best. It's probably the best, at least in the top three best habits that I could tell you to do. Here I mean this is a keystone, cornerstone habit. For example, what do I mean by cornerstone habit? Let's say that I tell you it's a good thing to have an apple a day. Well, one apple a day is a good thing. It's an appetite suppressant for more caloric, calorie-dense foods that may not be so helpful. An apple has some nutrients that are useful to you.

But one apple a day does nothing, relatively nothing, in comparison to walking a certain number of miles per day, which we'll get to. Walking does so many other things because it changes other things in your secondarily. So, for example, keystone bad habits might be smoking. Smoking does so many harmful things that it's really a cornerstone bad habit. So this is the thing that I see most consistently. It's the thing that I see most consistently in men who function sexually into their eighties with normal sexual function without any medications, and it's the thing that I see most consistently in people who just maintain clear thinking and productivity and excellent health into their seventies and eighties. And of course, it's not just about maintaining this excellent health into your eighties, it's the fact that this same cornerstone habit gives you improved health in your forties and fifties.

I'm a big fan of George Sheehan, who wrote prolifically. He's a cardiologist who wrote prolifically for Runner's World when other cardiologists were saying that walking and jogging would create this athletic left ventricle hypertrophy, and it was a bad thing to do. And now we know of course that is not true, and that walking is a very good thing to do. We'll get to why that is so very shortly. But George Sheehan always said "You know, even if walking or jogging does not improve or extend the length of my life, being out on the street everyday, doing the miles improves the quality of my life today."

You know, one of the ways I like to think about health is what I call the Titanic philosophy. If you're on the Titanic would this be a habit that you would do everyday while you're on the Titanic? Suddenly you wake up, you're on the Titanic and you think "Hm. There's a good possibility I will be gone in this very cold, very frigid water within a week." What would be the habit?

I would still do miles because I'm going to show you how these miles add to the life of that day, but I don't think that I would overdo it and be a marathoner that day because then it would take to much out of my day for the other things that I want to do. But I would still do the number of miles that I'm going to tell you because I would do things during those mile that would make me happier, and there would be things that happened during the day after those miles that would make my day better.

So walking is extremely, extremely important. And let's talk about some of the more specific reasons about why I'm saying all these things and going on and on about walking. There's research showing that it helps with depression, that it helps with your bone density. It helps with so many things, so here's some more specifics. One study showed that in women, their ability to orgasm improved for the first hour after aerobic exercise. Think about that. This is like an aphrodisiac, orgasm enhancer. Suppose you had a pill that did that. What would that sell for? But here's something that's free if you just go walking with your lover, take your wife with you. And then you have sex when you come home. It's a free aphrodisiac that's been proven to increase her ability to have an orgasm.

Next reason. It does actually do more for your heart and your circulation than any pill. Now we've talked already about how your erection is basically a water balloon that's filled with the waters, metaphorically, the water is blood, and the ability to blow up the balloon depends upon your ability to pump blood into the balloon and the integrity of the blood vessels so that the veins are not leaking and the arteries are open, so the veins have to close off, so that there's no blood flow out of the balloon, and the arteries have to be able to pump enough pressure into the penis to blow it up. And the extent of the hardness and the size of the penis is going to be determined by that pressure.

So let's suppose that you had something that's been proven to improve your blood flow and improve your heart better than any other pill on the market. Better than diabetes pills, blood pressure pills. What would that be worth to you? What I'm saying to you is that walking is that magic bullet, and it was actually used, that exact phrase was used. "This is the closest thing we have to a magic bullet" in the New England Journal in reference to walking, but the walking has to be to a certain extent, so another research project, and we're getting to what that needs to be shortly, but, another research project showed that the greatest predictor of whether you're going to have heart attack within the next year is not even whether you smoke.

The greatest predictor is whether you've had a previous heart attack. That puts you at high risk, but the second greatest predictor, even if you've had a previous heart attack. The next best thing, the next best predictor of whether you will have a heart attack this year, and of course, that ... but whether you're going to have a heart attack is an overall guide to how healthy is your heart. The greatest predictor is your anerobic threshold, meaning what's your aerobic fitness level. Anerobic threshold has to be measured with a mass spectrometer, or it can be calculated. The most direct measurement is you breathe into a mask while you're walking and then you extend your intensity or you increase your intensity while you're walking and then jogging until your body has to swap from aerobic to anerobic metabolism. So the amount of oxygen you're burning exceeds the amount that you're able to pull in and supply. So that involves everything from the function of your lungs to the pumping ability of your heart. All the way down to the mitochondria within the muscle cells and how they're able to metabolize the oxygen.

You can actually measure the number of mitochondria, and within a week or so of starting an aerobic program of walking, you can see an increase in the number of mitochondria per muscle cell. And very elite athletes have a high number of mitochondria, so that makes them more efficient at burning oxygen.

So that is the number one predictor, second only to a previous heart attack. The problem is, and the reason it's not talked about by your physician is there's no drug to sell. There's no beautiful drug rep that comes into your doctor's office and say "Hey, you should prescribe walking because it's the best thing on the market for preventing heart attack" and improving erectile function and all the other things we're going to get to about mental state and such. And there's no ads on TV to tell you that. There's no one teaching you that because there's no money to be made. That's not necessarily a bad thing, but it's a thing, and it's the reason your doctor doesn't talk about it so much, or maybe yours does if you have a more progressive thinking physician.

So, I want you to think very deeply about that. What I just told you is that even if you smoke, if you have a high aerobic capacity, you're at less risk of a heart attack than if you don't smoke and your aerobically out of shape. Next reason for walking, hormones. You get this whole change in metabolism that comes from your hormones. It's not just about pumping blood around your body or even about increasing your aerobic capacity. Some things happen, your thyroid functions in a different way, in a more efficient way. You make some hormones that decrease your appetite for sweets, what you want to eat changes. The amount you want to eat changes. It's a free appetite suppressant that, rather than putting your heart at risk for a heart attack as some appetite suppressants do, walking actually improves your heart and decreases your appetite for about two hours afterwards.

This is another reason why I prefer aerobic exercise as opposed to say biking. When I did biking, when I did bike races and triathlons, and the reason I use the past tense is the risk of crashing, I just saw so many serious crashes. I decided it wasn't worth it. And noticed that my penis would go numb sometimes after biking a long way. That didn't seem to me to be a healthy thing, so before I ever read the research about this being associated with erectile dysfunction, it just made sense to me that anything that put my penis to sleep like your arm goes to sleep or your hand goes to sleep when you sleep a crooked way, in the same way, I thought, wow, something puts my penis to sleep doesn't seem to be a good idea, so that's why I keep using the past tense. I don't bike anymore.

But, when I did I noticed my appetite went up. When I lift weights heavily, there's a little bit of a decreased appetite immediately afterwards, but my overall appetite can become more ferocious, which again if I'm trying to build strength or I'm trying to build the size of my thigh muscles so I can be an Olympic biker, then maybe that's not such a bad thing, but when I'm trying to maintain a lean body and a healthy aerobic capacity, then perhaps a decrease in appetite, especially for unhealthy foods, is a good thing and that's exactly what happens, what's been proven to happen after aerobic exercise.

The other part, and I can ... this is part is maybe you're going to call science fiction, but it's real, is that there's over two hundred hormones made by the pituitary gland. And the possibilities of what might be going on that we don't the exact mechanism for but we see the effects of are really extremely exciting. What happens with those two hundred plus hormones with aerobic capacity we're not sure of, but we know that some of the things that happen with thinking are not just with the body habitus or the shape of the body and the function of it, but the way the thought processes go are extremely, extremely exciting.

For example, and let's talk about that thinking now. If you look at the people who are walkers, Harry Truman always wanted the reporters to go walking with him to talk with him. Steve Jobs is well known for the fact that he preferred to do meetings while walking in his per usual uniform at work was walking shoes. Charles Dickens wrote in the morning and then he walked and walked and walked for many hours around London even into the evening, late even hours, was a very robust walker. When you look at the prophets, Gandhi walked and he walked, he walked across India. Jesus, you read stories of him walking on the road to Damascus and walking from city to city, and if you look at the miles that he walked, he was a walker. And Beethoven, he composed in the morning and in the afternoon, he walked for hours and hours and hours through nature and took little slips of paper with him where he would listen to nature for sounds and rhythms and then stop and compose while he was walking.

Thomas Jefferson, brilliant statesman, wrote, you know, he was one of the founders of our, basically a revolutionary, we think our founding forefathers, but it's nice to stop and think about, hey these guys were risking their lives to basically tell the king to kiss off. These were smart guys but they were also bad asses, and Thomas Jefferson thought anything less than two hours of exercise per day put you at risk and made him less thoughtful.

Also, walking has been shown to decrease inflammation. There was this time that we thought people with arthritis should not move, but now we know that actually movement decreases the inflammation in people with rheumatoid arthritis, forms of inflammation. And of course, we are talking about the penis, and walking has been shown, it's almost cliché now, I don't know why we even need any more studies to show it. It's been shown over and over and over again that aerobic exercise improves the erection usually by about five on that five to twenty-five scale.

Now why would you not want to walk? There are some legitimate, there are legitimate reasons for not going walking. First it does take some time, and I don't know many people who feel like they have extra time. Most people between their work and their hobbies and their avocation and their vocation and their family and their spouse, their children and their friends, their clubs, their associations, their ... all these things that are pulling at them, they feel pressed for time. Part of the reason that Americans are probably sleep deprived, well no "probably". We are sleep deprived, most of us ... is that there's this urge to do more, do more, do more, and so to ask someone to do the amount of walking that I think makes people healthy, if it takes away from your time, you're not going to do it.

But of course, I'm going, if you follow my plan, you're going to have more time in your day if you do walking the way I show you how to do it. So I'll take that reason away from you, if you follow my plan.

What about the fact you have to go outside to do it. If you live in an area where's too hot or it's raining, in my area sometimes there's lightning, there's a lot of rain, we have the most inches of rain where I presently live of anywhere in the United States. Not the most days, but the most inches, and huge amounts of lightning. You may live where it's cold. You may live where there's traffic or crime, so getting out of your safety zone of your office or your house could be a problem, and then there's of course injury. Are we going to wear out our joints or twist an ankle or be hurt by a car, or mugged or shot or robbed. These are things that are legitimate concerns.

As far as the physical injury, there's this logarithmic curve where, if you look at the injury rate, there's almost nothing, if you're at home, of course you could fall off the couch or something, but generally speaking you're unlikely to be injured if you just don't walk at all. But if you look at the injury rate, it stays near zero until you pass about twenty-five miles per week. Once you pass the twenty-five mile a week mark, the injury rate goes up. When was in a marathon club, everybody had a little nagging something that was bothering them. Eventually I developed some heel spurs and people just get stuff when you start running twenty miles a day or you're doing eighty miles a week, a hundred miles a week. You start to have injuries. So I think that you should keep your range in a particular range, and particularly under the twenty-five mile mark to avoid those injuries.

So let's plunge into the way I think you should, can walk in order to avoid these problems. First of all, as far as the way to make sure you do the miles, I recommend that you do an out and back course. If you walk in a circle, it's too easy to stop. If you walk on a treadmill, it's too easy to just stop and get off the treadmill, and so there are times when you need to do that because of the weather and traffic and such, but as a general rule I recommend that you walk outside of your door, your hotel or your mother's house, wherever you happen to be that day. And you walk half the distance you intend to walk and then you turn around and you walk home.

Now you can split it up so if you're goal is to walk five miles a day, you walk two miles this morning and three miles in the evening, and so you walk a mile out, turn around and walk back, and you've done two miles. Or you could walk two and a half miles out and turn around and come back and you've walked five miles.

You realize that, when I say Cortez, that's the guy who came here, the conquistador who came here and his ... to the states and his men were about to rebel and wanted to go home, and he just took that option away by burning the ships. Then his men knew they had to either win or they would be destroyed by the natives. So they fought ferociously because there was no retreat. So in that same way, if you're walking laps, you can stop, but if you walk out and that's usually the easiest part of your walk is when you are starting, and then you have to come home unless you call someone to come pick you up. You have to walk home, so that helps us with the psychology.

Another thing is what I call my "ten minute rule." When you're ready to walk, never decide to not walk sitting on your booty. Get up, walk for ten minutes, and after ten minutes if you still feel like you don't want to walk, you can stop. But make that decision after walking ten minutes, and you'll discover that you'll have some of your most wonderful walks after you do that. After you think that you don't want to walk, but then you go ten minutes, you think "Hey, I feel pretty good" and then you want to keep going. So you just keep going. So do follow the ten minute rule.

So how far should you walk? I recommend that you make a goal of twenty-one to twenty-five miles a week. And I prefer a weekly goal because you might have days when you're busy and you can't walk at all. Or maybe you have a rest day because of your convictions with your religion, you prefer to rest on Saturday or Sunday and not do anything. That's fine. It's a good thing. So take that day off and don't walk at all. But if you make up for it, so if you're only going to walk five days, I prefer a twenty-one to twenty-five mile week. That gets you into the range of health, and that range has been show to decrease your overall mortality in half. It cuts it in half. So over the course of the coming year, it's been proven all cause, I mean it's getting shot by a thief, crashing your car, all cause mortality. I think this reflects the fact that it changes behavior. It changes what you do and where you go because how else can you account that there's even less trauma who walk to this amount.

But it doesn't happen with ten minutes a day or three miles a week, it starts to happen when you approach the twenty mile per week mark. So twenty-one to twenty-five miles per weeks, that could be three miles seven days a week, it could be five miles five days a week, it could be two miles today and five miles tomorrow, and six miles the day after that and one mile the day after that, but I would set a weekly pattern so if you intend to rest on Saturday and not walk at all, and Monday's a busy day, maybe you walk five miles on Sunday, and one mile on Monday, and four miles on Tuesday ... you get the point, but you decide how many miles you're going to walk each day and you keep that pattern.

I have found that that pattern changes for me depending on what's going on in my life. When I was a medical, when I was in my training as a resident, I trained for a marathon by running thirteen mile twice a week. Thirteen miles twice a week because I two days when I could be out of the hospital and fairly rested, but then the other days I was in the hospital often working all night, unrested, unable to go outside because of my duties within the hospital, so that was what I had, I had two days. So those two days went thirteen miles. For a total of twenty-six miles a week.

So I prefer that you spread it out more than that. Actually it's been shown that you do better even doing two episodes. Doing a walking session twice a day so you would have, you could have ten walking sessions per week. So I don't want to beat this to death, but those are the principles I would follow. And then, very, very importantly, keep a record. It's been shown over and over again, if you want to change the behavior, one of the most powerful things you can do is just start keeping a record of it. Keep a daily record, keep a weekly record. I prefer that it be actually on a piece of paper, although you can use your computer or your phone to record it while you're doing it.

I like it to be out of my computer where I can look at it, in a notebook or on the wall somewhere. But I can't stress the importance of this enough. As a matter of fact, I will almost guarantee that you will not be successful with your walking program if you're not keeping a record. It's been shown over and over and over again in research that people over-estimate the amount of exercise they do and the under-estimate the number of calories they eat. You just can't, some things we are just too biased to be accurate recorder, estimates of, and these are two of those things. So you will lie to yourself and as Shakespeare and many proverbs have said, we tend to lie to ourselves. So keep a record. Let me say it again, keep a record.

Okay. So another thing. Bring a few, as far as comfort along the way, don't make a big deal out of it. Bring a few bucks in your pocket if you want to stop and buy a bottle of water while you're walking, if you want to stop in the park. If you have a turn around point that involves a park bench or a rock that you want to sit on in the forest. Stop and sit on it. I don't want you to get hung up on how fast you're going. I want you to think about the distance. I want you to think about the distance. That seems to be the most important.

So, I want to stress this also. If you get hung up on your pulse rate, you will probably stop doing this. Imagine that I told you the most healthy thing you could do on the planet, would be go get a massage for an hour, seven days a week. Giving up that hour, I would actually have more trouble with that than walking because sitting there is a zombie state where I'm either meditating to a different level of consciousness, I'm not reading, I'm not learning, not doing all the other things you're going to learn how to do when you're walking, I'm just basically losing that hour for some benefit from the massage but probably more benefit, there's a decline in the amount once you pass a certain state. There obviously are some benefits from massage. I don't want to take away from that.

But too much of it, where I'm giving up my life, I'm back to the Titanic principle. So, I would quit doing it. The point being that even for something pleasurable, you can't do it, you won't do it consistently. Even if it's pleasant, if it's pulling from your life. So how can you expect to do walking consistently if you make it unpleasant. If you make it ferocious. Now you will reach a point to where you sometimes want to touch into the pain zone, maybe you want to do what's called the Fartlek System where you get your heart rate up by walking or jogging or sprinting depending on your level of fitness and the health of your joints, and then you slow down, you go fast and you go slow.

That's good, and maybe you have a time when you want to train. You're young enough, you're training as an elite athlete, and it's a different level of fitness. But if you're in this for the long haul to be healthy and you say to yourself "This walk is worthless unless I reach a certain level of pulse or discomfort" then you'll stop doing it. As far as the calories go, it's a physics problem. If you tell me you went walking for thirty minutes, that tells me nothing. You could walk a foot and stop and you could take a thirty minutes of being, a little bit over exaggerating here, but you could sure take thirty minutes to walk across a room, just move a foot, one of your feet every inch or so.

And you would be honest to say that you walked for thirty minutes. But if you tell me you took a body, a mass that weighs 50 kilograms and you move it a mile or a meter, then you can calculate that. It's mass times distance and that's foot/pounds. So if I take a hundred and ninety pound man and I move him 5,280 feet, then I've moved him 190 pounds times 5,280 feet and that you get the number of foot pounds. That are the work that, of a hundred and ninety pound man uses to move his body a mile. So when you look at calories per mile on the charts, what they're doing is assuming a twenty minute walk or a ten minute jog which ... and then there's extrapolating from that the number of calories. They don't actually know to get the exact number of calories you would use, the weight times the distance and you would have a finagle factor based on the amount of heat produced.

You only have about ten percent more calories if you're jogging versus walking. , So listen to that again. If I walk a mile, I'm going to burn the same number of calories almost as if I jog a mile, I'll just take twice as long to do it. And they'll be about ten percent more, that's it, if I do the jog versus the walk. So now knowing that, if you, as far as the calories go with the weight loss or the maintenance of weight, it doesn't really matter whether you walk or jog it. What George Sheehan used to say was "Go at a speed that you're able to talk comfortably. If you went a little bit faster you would be unable to talk comfortably." So if you're having to ... stop ... in the middle ... of a sentence ... like that when you're jogging then you may be getting into an anerobic range and that's not a bad thing, you can do that periodically by speeding up your walk or your jog, but it's not necessary to do that the whole distance where somehow you've wasted your time. Which unfortunately some health people, physicians/personal trainers teach people, and I think that's not a smart thing to do.

So you're going to walk at a speed that's comfortable, where, and if you want you can reach to a place where you're able to speak easily but faster might make it less easy, and you're going to record the distance. I wouldn't worry so much about the time. Just record the distance. And you're going ... most people are going to take about twenty minutes for a mile or about an hour to walk three miles. So think about that for a second. If you're going to commit to twenty-one miles a week, you're committing to an hour, and average of one hour out of your day, seven days a week, that's a big commitment.

Which brings us to the next part of this, which is when will you do it? And what can you do during that time so that you're not actually losing time, but gaining time. So as far as the "when" I recommend when you first wake in the morning, during which time you can do your affirmations, you know, some of the other things we'll talk about later. The affirmations are great first thing in the morning or prayers. Visualizations. Those three things go very well, even while walking, although you can do them while meditating, or sitting as well, but walking, affirmations are great when walking.

If you have a job that confines you and you have less freedom, you have to work strict brackets of time so you come in at eight and you work until noon and then you have an hour for lunch and then you have to start back at one, you will have a much healthier day if you walk during that lunch time and your lunch becomes a protein shake or something you can eat easily within fifteen minutes. I love protein shakes because you can drink them. You know exactly how many calories there in there. You can put fruit in there so you can have a couple of servings of fruit and some protein and you can consume it in five minutes and use the other fifty-five minutes for you walking.

Immediately after work is great, either, I prefer either before you leave work, so you put on your walking shoes and you walk at work, or you walk out the door. You walk and come back, you drive home, or you stop on the way home at the YMCA or somewhere, a park, or the forest, and you walk and then you complete your drive home. It's really, really difficult when you come home and there's family and they want to ... then immediately put on shoes and walk out the door, unless which is the next option, you may want to come home, and put on your shoes, and you walk with your spouse or your children and then you come home and you have dinner.

If you wait for the walk after dinner, it can sometimes become very, very difficult to have the energy. It's just too tempting to stay. So this is my least favorite time to go walking, immediately after dinner. I tend to get lazy and want to do other things. Right before bed, it's a really nice time to walk, although this is time for more leisurely walk, or the increase in heart rate can cause you to have trouble sleeping.

Now, as far as walking with other people, this brings me to another thing. It's very seldom that people want to walk at the same speed. So what do you do with that? I prefer to let the slower person set the pace or else you're going to interfere with the slower person's desire to walk. And with children, I let them walk ahead of me. If I'm with someone who's somehow not as fit or bothered by something, joints or something, I let them set the pace. Another wonderful thing to do, thought, if you're walking with children, and as a single father, with my children with me most nights of the day before they left the house, most nights of the week before they left, grew up and left, I had the ways of doing this.

One is that you walk back and forth in front of your house, so if you walk ... if you have a quarter mile marked off such that your house is in the middle of the quarter mile street, so a block is a tenth of a mile, so it's about, let's say, two blocks. A distance with your house in the middle of it, then you walk a block one way, you come by, you pass your house, you walk a block the other way, you just walked two tenths of a mile. The you back past your house and the point is that every time you pass your house, your checking the house isn't burning down, kids are in the front yard and behind the fence, everybody's happy, you actually never lose sight of the house if you're never more than a block away.

And you can back and forth again, I'm not a big fan of doing laps but that can be a way to do it, if it's necessary because of children. I lived at a place once out in a rural spot where my drive way was two tenths of a mile so I could walk out to mailbox and come back and that was almost a half a mile. My children could be out in the front yard playing around the house and I never lost sight of them. Everything was wonderful.

Another great way, I love this next way, to do your walking if you have small children is get to a school somewhere and then you put the children out in the middle of the football field and you walk around them. So they're out there with a ball or even in a playpen if they're that young, and you never lose sight of them, they're in the fresh air. They're having fun and you get to walk around them. Again it's a lap system, so it's not ideal, but sill pleasant and most high schools or YMCAs ... the high schools, of course if they're having a football game you can't do that, but it's a way to do that. On the weekends or during the off season when their track is available. They usually like that especially if you have children going to that school.

Another thing that I like is when you're at a sporting event. Let's say your children are practicing football or baseball or soccer, whatever their sport, you can walk around the field so instead of sitting there with the other parents, which of course, you need to do occasionally to be sociable and those connections that are so useful between parents. Instead of doing that, you can walk around the field and still see everything that's happening, and it's wonderful. So that's a great thing to do.

I sometimes even do that during the event, which is maybe a little bit disrespectful in the eyes of some people because it looks like you're not paying attention. But of course you're paying attention. You're more alert and you can cheer as well as anyone, you're just seeing ... you happen to go to the enemies' side because you go to the opponents side of the field if you make a complete lap. But I have done that, although I do that less often during events. It's more appropriate I think during practice.

Other things you can do to help your walks ... we just got through talking about how to walk and make it appropriate with your family. But what about just getting things done. What are some things you can do so that the walk doesn't take from your day, it adds to your day. Remember I said that I promised you that if you ... I'm going to show you how to make the walk not take time out of your day, but give time to your time. It's counterintuitive.

One thing you can do is make phone calls. You know how Steve Jobs did his meetings while walking? Well, how much time are you on the telephone? In most work places, it can be more than hour per day on the telephone. You'll be more alert. It's wonderful the technology we have. Right now, I'm using the air buds that come with an iPhone. So they're not getting tangles up with the cords. The sound is wonderful and I can have a conversation unless the traffic is really, really loud, and in that case, I use some Bose noise canceling earplugs that connect with a wire. It's a combination. It seals the air, so it's like wearing ear plugs and it counteracts the noise so you're able to hear very well.

My preference is to never be in traffic, that that's loud, that is that loud, and so the air buds are how I prefer to make my phone calls. I'm more alert, especially if it's a call that's going to be difficult for me emotionally, I have to deliver bad news or have a conversation, say with my attorney about something that's not pleasant. There's always battles to be ... we all have battles. We have battles with the forces that want to kick over our sand castles. You know, I live near the beach, and it's interesting. You can build a sand castle and then sit there in a chair and watch. And most people walk by and admire the castle, and ninety-nine out of a hundred people walk by without admiring it, they'll walk around it ...

But then you'll get that one out of a hundred who will come by and take pleasure in kicking over your sand castle. And those people are there. They're out there. And so we have out battles, we have the, just this thermodynamic force that says things go to a place of less organization. And if you want things to be organized with your business, with your personal life, with your spiritual life, you will fight battles. And for those conversations that require you're warrior state, walking is ... makes you more alert and it makes you a better warrior, so that's when you make those phone calls.

Next thing. What if I told you that I could give you the equivalent of weeks of free time in class. Let's calculate this. If you did an hour walking per day, and during that time you're listening to books, that's one hour times three hundred sixty-five days. That's close to four hundred hours. So to make the math easy let's say four hundred hours, and let's say that you have a forty hour work week, four hundred divided by forty is ten weeks. That's two and half months of full time, forty an hour per week, class. And when I was in college, I was not in class forty hours, but if you counted class plus studying then that was forty hours, sometimes more.

But so now that you basically ... what I'm telling you is this. If you listen to a book, every time you go walking that's equivalent to a full time class for two and half months out of your year. What could you learn with that? I know a Dad became a very successful investor and retired in his early fifties on his investments, and most of his learning about investments involved listening back then to cassette tapes. There was no ... the options were much less. There were no ... there was no iPhone. It was a cassette tape player to listen to. So listening to books is amazing what you can do.

Suppose I told you that you could go walking with Aristotle. You could go walking with Warren Buffet to learn about investing. You could go walking with spiritual leaders. You go walking and listen to St. Paul read his letters to you. You could walking and listen to the professors from the Ivy League colleges. It's amazing. That's exactly what you can do with a pair of earbuds and iPhone. So, would that add to your life? Would that make the rest of your life easier? And the other wonderful thing about this is I will promise you that you will, and that's my iPhone telling me something now, but I promise you that you will, you absolutely will retain more. You're going to learn more, you're going to have ideas that occur to you more if you're walking and listening to this.

What do you do if you have ... if you suddenly have a problem that you just have to solve. It's life or death. You have to figure this out. Do you sit at your desk? Intuitively, without thinking about it, without me telling you to do anything, you're going to get up and pace the room. And it's not just burning up energy, you're thinking better on your feet. I love something George Sheehan said. He said "I never trust an idea that I get while I'm sitting on my bottom."

Think about that. I'm not saying you don't get ideas sitting. You might get amazing ideas sitting and meditating, but don't trust it until you go walking and think about it.

So next thing I want you to think about is that don't just think about the books. You can pose yourself a problem and say "Okay. I'm going to walk and think about this problem while I'm walking." And my favorite way to do that, because when you're ... is to take note cards. Take a three by five index cards, two or three of them. Stick them in my pocket with a cheap pen hat doesn't matter if I drop it or I lose it, it gets wet in the rain when I'm walking. And then say "What I want to figure out" and then instead of pacing your office, this is going to be theme of this walk. To figure out how I should deal with this problem with my child. To figure out a new way to market this particular product in my office. And then you go walking.

If you want you can listen to a book that relates to that while you're walking, but you could also just listen to what's inside of you, what the piece of God that's inside of you, or the piece of you that's inside of God, however you want to think about that. And sometimes it's better to leave the phone off is what I'm saying and bring a pen and an index card in your pocket.

Just a safety thing I would say is that when you are walking with your phone, stop when it's time to fiddle with the phone so that you don't step in a hole or step in front of a car. Just stop walking, it's okay. Remember I told you it's more about the distance than your heart rate? I used to think when I was a teenager running track that if I was going to run five miles, if I stopped to tie my shoe, the five miles didn't count. You just had to run it start to finish without stopping. But I grew up. Don't worry about it if you need to stop. Just stop and fiddle with your phone, pull up the book, dial the phone, then after you dial the phone and you're talking, now throw your phone in your pocket and walk and talk.

Now we mentioned this previously but another wonderful thing to do while your walking is to have meetings. You know, we talked about how Steve Jobs preferred to have his meetings that way, especially if you have a meeting that's going to be emotional. It really helps if you're walking and talking. Even a creative meeting, you bring paper with you or you stop and you make audible notes or recordings on your phone, and you and the person you want to meet with go walking, or persons. It gets to be a little bit more cumbersome if it's more than three people. Two people. I think it's ideal for a walking meeting. But you can do it with more. Once you get more than about three or four people, though, it becomes more awkward because it gets hard to hear. But it's a great way to have a meeting.

Now let's talk some about gear. I will tell you my preference, and my personal preference for my feet .. I have high arches ... is High Balance. If your feet, it may be a different type of shoe. But I do recommend that you not skimp on the shoes. Find yourself some good shoes. Part of what threw my feet off is I decided it wasn't most ... it wasn't difficult enough to do my ten mile runs in shoes. I had to do them in boots, and if goofed up my feet. You need well fitting shoes, and I recommend that you go to a real shoe store. There's a subculture of people who just love to run, but they don't just love to run, they love shoes. And they study them. These days they even have computers that analyze your feet if you stand on something, and these people study shoes. They love making your feet happy.

You can go see a podiatrist and have them think about your feet. If you have feet problems and they're able to make inserts for your feet. They can make you whole, all the way up your spine happier. It's amazing what the proper shoes can do for you. But unless you have a problem with your feet. I think it's sufficient to go to a good running store. And when you walk in the store, id there's ... if it's an assembly line, and that person you're talking to is chewing bubblegum and they look like they've just started working there yesterday, find another person to help you or another store.

Persons who ... when you walk in you should see somebody who loos like they're a runner, and they should know ... they should want to talk to you about the shoes because they love them so much. You'll know you're in the right place.

As far as clothing goes, I used to make a big deal out of what I wore and in the cold weather it was one thing and hot weather ... you know, don't sweat it too much. The more difficult you make it to get out the door, the more likely you are to not go walking. These days I just throw on my walking shoes. I'll go walking in my suit. I'll go walking with a tie. I don't make a big deal out of it. Usually all I have ... I prefer, though, a pair of jeans and a comfortable shirt and my New Balance shoes. I gran my iPhone with my air buds and I'm ready to go. I might grab an index card and a pen.

I like the old school, four color Bic pens. I just still like that it's they're great for note taking. If I lose it, I actually like to lose them because that way somebody finds a pen that writes in four colors. It makes me happy. So I have a four color Bic pen I throw in my pocket with an index card. And I like to get the index cards that have my name and address printed on them that I get from a stationery store, so it's ... if I make notes on it and hand it to somebody, they have my contact information. So that's all I need.

I might grab a hat if it's cold or gloves. If it's raining I don't worry about it. I just leave the iPhone at home and go walking or I put it in a plastic bag in my pocket. But lightning keeps me home. If it's too icy where I'm going to fall and break something, I stay home. And when I stay home, I mean, I go walking on an elliptical trainer or a treadmill. I have a gym that's close to me that's twenty-four hours. I prefer a twenty four hour gym that's available so it matches my schedule. You may not have something like that available. If you don't, then I recommend that you by yourself an elliptical trainer or a treadmill.

I like ellipticals because they don't put a strain on your joints. But have those for your bad weather times. I prefer to go outside. There's something about the outside that's really good for you, I think. But you may live in a place where the crime's too bad or the traffic's too bad. If you're having to stop and just wait so much that it's a nuisance because there's so much traffic, then get to a place where there's an elliptical trainer and do everything else the same. You can listen to the books, you can make the phone calls, and if you keep the pace at a comfortable pace, you'll still be able to do your training and not jump off before you're done.

Adjust the tension or if it's too hard because ... and you feel more like you're lifting weights or pedaling up hill on a bicycle, then you're elliptical trainer is either the wrong machine or the settings are off. Make it to where it feels about like you would feel if you were walking up a one percent grade or on flat land. If you're on a treadmill, that's usually about a five percent grade. If you're on elliptical, you just have to fiddle with the setting on the tension to where it feels about like what you would feel if you were walking on flat land.

If you want you could use a Garmin watch or an iWatch to help you with your keeping track of things. I think that's useful and fun and it helps you with your record keeping. I have a walking app on my phone that I'll put the link to. All the links to all this will be beneath the podcast. Everything that I've talked about, so I have an app that's wonderful. It keeps track of everything, and I even have it send an email to my EverNote account so there's a record of where I went that day and what the weather was like. And it's nice to have maps of where I've walked, whether I'm visiting family or happen to be on a business trip.

So those are my tips for walking and I hope what you've seen is it's amazing. I just told you how to get almost three months of full time class and remember it better than if you were sitting in a classroom with the great thinkers of the world. I've told you how to do meetings in a way that Steve Jobs have done it. And how to do creative work in the way that Beethoven and Charles Dickens did it. And the way revolutionaries like Thomas Jefferson thought about overthrowing a fricking King. And these were walker people. And I've also told you how, as a side effect, you're going to have a healthier penis that's straighter. You're going to have decreased inflammation if you have Peyronie's. And it's going to be harder because you're going to able to pump blood into that thing because you're heart's going to be functioning better and you're blood vessels are going to be more open to pumping blood.

So there you go. I sure hope you find this useful. I hope you'll stay in touch with me, subscribe to my emails. Join our group. See the doctors that I've trained and stay in touch and let me know how you do.

Thank you very much.

Peace & health,

Charles Runels, MD

Inventor of the Priapus Shot® Procedure

Hormones (other than testosterone) that affect men’s sexual function

Estrogen, Prolactin, Human Chorionic Gonadotrin, Throid, Human Growth Hormone...and their function in men's sexuality...

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Harder, Straighter, Bigger. Step 4. Hormones. Testosterone.

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Hello this is Charles Runels and we're still talking about ways to help Peyronie's disease and erectile disfunction. Today we're talking about testosterone. Testosterone is associated with Peyronie's disease, we're not sure exactly why, but I have a theory about that. Peyronie's has an autoimmune component to it and for some reason men are less susceptible to autoimmune problems than women, so women have more rheumatoid arthritis, they have more lupus, they have more lichen sclerosus. All those things are caused by the immune system attacking itself. They have more multiple sclerosis and it's been shown that men who get MS, more likely to get it, as they approach andropause when their testosterone levels fall. Men are more likely to get Peyronie's disease if they have a low testosterone level. Likely that has to do with the protective effect of autoimmune, protecting from an over-active autoimmune system by having a normal testosterone level. There are other reasons for correcting your testosterone level and I'll get to those.

First I'd say that after treating many thousands of women and men over the years, I would say that the primary hormone that regulates sex drive and erectile function is testosterone. It's almost impossible to have a normal libido without it, for a man or a woman. It's difficult to have normal erectile function. Without it the penis actually starts to shrink, just like the muscles would shrink and atrophy without testosterone. Other benefits of it though would include the heart, which is also a muscle and so testosterone is needed to maintain the health of the heart. There was at one time this idea that perhaps testosterone was dangerous to the heart, but now we know that not to be true. It's the opposite is true, that if testosterone level is low, the heart suffers and can become weaker. Of course muscle mass is not just about looking pretty, it also has to do with functioning.

As people age, the number one reason for going in the nursing home is people becoming too weak to get to the restroom, and they start urinating on the floor. Muscle is not just about being attractive or looking fit, it has to do with functioning and as people get older, it becomes crucial to be able to move and there's like a bank system, whatever, as you age and the muscles become less forceful, whatever you had banked as a young person is drawn upon and if you didn't bank a lot of strength when you were young, there's less to draw upon and you're more likely to become feeble as you get older. Depression, we know that having a low testosterone level is associated with depression and correcting it help, but not only that, concentration and focus and just energy level. I've also seen some people who at one time were just absolute lawyers, people who were bouncers or special forces, military, or high intensity athletes. You know, snow board athletic acrobatic people.

Then they come to me with panic attacks and you think, how out of character that here's a man that a few years ago was in a situation where he was required to be very brave and now he gets panic just sitting around the house, and when you do blood work on those men, oftentimes their testosterone level is very, very low. Which can be traced back to oftentimes a head injury and pituitary function is not working and so they are completely out of character and become like a castrated animal basically. Going from very bold to very panicky and fearful because they lost their testosterone. Bone mass is also related to testosterone levels, and even more so than with muscle there's a deposit of calcium into the bone and inaudible 00:04:32 bone is not static like a board that supports your home, bone is constantly remodeling by osteo-blasts and osteoclast, adding and taking away calcium to the bone itself. As a young person there's more deposits and as people get older there becomes more withdrawal on a flow system. There's always coming and going of calcium into bone.

There becomes more going of calcium instead of coming as people get older. Testosterone helps hold onto the bone, it helps to bank bone, it helps keep bone strong. Weight. This is sort of tricky because weight, part of the reason that men have a lower percentage of body fat is because they have a higher testosterone level and yet, if you use testosterone as standalone to lose weight, it will not work because what will usually happen is people increase their, not only their sex drive, but they'll increase their appetite for food. If they don't counterbalance that with more exercise, they just gain weight. Although it's true that testosterone as a general rule decreases percentage of body fat, if it's not part of an overall health system that includes exercise and watching, being careful about how you eat, then it leads to weight gain. On the other hand, without testosterone, a man or woman can exercise ferociously and still have very much difficulty maintaining a normal body weight, and maintaining a lean body.

It's crucial. Those are some of the reasons why you would want to use testosterone. Why would you not want to use testosterone? One reason is some men worry about it effecting the prostate. Now we know after multiple, multiple studies, over and over again for the past 20 years, that having a higher testosterone level does not correlate with prostate cancer. After a man has had prostate cancer, there becomes this strategy to sometimes lower testosterone levels to help keep it from recurring, but most urologists these days will tell you that at some point after a man has become cancer free for a while, they will put him back on testosterone. So prostate cancer is not a side effect of testosterone replacement. My personal opinion is that even though the evidence is still not conclusive to some physicians, I think prostate cancer probably evolves out of chronic inflammation and chronic prostatitis. Prostate cancer correlates more with that, with a history of sexually transmitted diseases and chronic prostatitis than it does with testosterone levels. We know that chronic inflammation leads to cancer, and we know that infection leads to cancer to in other areas like the cervix.

Other things that make a man may not want to be on testosterone do include weight gain, but as I mentioned before, this is not a problem if the man's maintaining an active lifestyle. You can't undo a sedentary life and a very self-destructive diet by just using testosterone. Using testosterone along with an active lifestyle and a healthy diet will improve the results of those two things. Another side effect of testosterone can be acne, again this can be controlled in most people by just watching the levels of testosterone that are given, or just treating the acne itself, usually with Retin A or something like that. Hair loss is a, male pattern hair loss can happen in men and women who use testosterone. I don't have a solution for that. That's guaranteed. Although there are helps, inaudible 00:08:58 is one that can be used topically to block the conversion of testosterone to inaudible 00:09:03 or testosterone and can help with that. Lipids, some people have worried about testosterone causing problems with Lipid profiles, but we now know that in most people testosterone improves the cholesterol and Lipid levels and profiles.

There was a time when people worried about the liver. The liver problems that arose from body builders using testosterone came from using oral testosterone supplements. Not from parental or avoiding the gut, because when you take testosterone by mouth, it passes through liver before it gets distributed to the body and that strains the liver to convert it or to process it. That can lead to liver problems, but when you take it as an injection or a cream and you bypass the liver, then that's not a problem. Actually, it can help regenerate the liver. There are studies showing that when a man has, for example, cirrhosis of the liver, alcoholic cirrhosis, and if he stops drinking the testosterone can be used to help regenerate apatisites 00:10:13, or regrow the liver. Some things can't be regrown, but the liver is one of the organs that can actually regenerate itself. Those are the basic why's and why not's of testosterone. If a man is suffering with Peyronie's disease, I would highly recommend that he consider being, making sure his testosterone level is normal. We're getting to how to check it and how to replace it.

Same with erectile disfunction, and any of those other problems that we mentioned. Now, let's talk about how to replace testosterone. First to measure it is a little tricky because it varies during the day. It's usually higher in the morning and then there's a sine wave sort of response, but the highest level is usually in the morning. Some people make a big deal out of if you replace it, trying to somehow replicate that up and down that happens on a daily basis. There's really no evidence that's convincing to me that that's necessary. That's one of the arguments, for example, of using a testosterone cream is to apply it in the morning and it's higher in the morning. Before we get to how to replace it pharmaceutically, it's worth thinking how it might be replaced just naturally. Here are some of those strategies. One is just maintaining a healthy lifestyle. Those things your mother told you to do; sleep. Sleep is not just some thing that your body rests, it seems sort of a simplistic way of thinking about it.

What really is going on is that your brain somehow, which we don't fully understand, does things biochemically. For example, the pituitary gland, which is the master gland that tells the others what to do and how and when, the pituitary gland controls your adrenals, your testicles, your thyroid. It secretes over 200 hormones that we know about, over 200. We're not sure what all it's doing, but we do know that it creates a separate spectrum of hormones in deep sleep, as opposed to when walking around or awake during the daytime. Those deep sleep hormones have to do with regenerating, not just the brain, but the entire body. There's a spike in growth hormone for example. Sleep is one of the things that can help regenerate or elevate testosterone levels. Also, a high sugar diet has been show to lower testosterone levels and so a lower carbohydrate diet that's higher in protein is helpful. Occasional fasting, not extensive, but periodic fasting on very low calorie diet for one or two days every week to a month is something that will boost testosterone levels.

The old-school body builders like Vince Geronda 00:13:24 were big into periodic fasting, not as a way to lose weight, but as a way to gain strength. Empirically they figured out that it raises hormonal levels and helps anabolic repair. Those are some of the things that we know. Other things that are less talked about that we know is for example, there's evidence that the more a man ejaculates the lower his testosterone level will become. This thing that somehow it doesn't, there's really no downside to indiscriminate masturbation, is really false. Those are the natural things that can be done. Now, if that's not helpful for whatever reason, and it can happen at any age, things that might lower testosterone level even at a young age include head trauma, even trauma to the head that does not cause loss of consciousness can effect the pituitary gland. It's dangling from a little tiny stalk that with sheer forces can cause micro-infarction's and decrease circulation to the pituitary. Head trauma.

It could be from playing sports or a fall, or post-concussive syndrome from a nearby bomb in a war situation. It's a known phenomenon that's been talked about in the New England Journal. Other things that might lower testosterone in a young man include smoking pot, which will not only lower testosterone, but raise estradiol levels and taking narcotics. Narcotics like Oxycontin and Lortab 00:15:10, those morphine-like pain medicines basically put the pituitary gland to sleep. There's less luteinizing 00:15:18 hormone and folical stimulating hormone. Which are the hormones that tell the testicle to make testosterone. Pituitary goes to sleep and the man makes less testosterone when he's on narcotics. Assuming all these strategies have been tried and the man still has a low testosterone level, the pharmaceutical ways to raise it, actually before we get to that, let's talk about measuring testosterone. Testosterone is up and down as we mentioned before, but not only is it up and down, but it's bound so some of it is floating free in your bloodstream, and some of it is connected to a protein.

Sex binding globulin. If you measure a total level, it can be misleading because you're measuring not just the free part, which can actually activate your tissue and do the work, but the bound part. Picture it like a train and the proteins are like the box cars on the train that are carrying the testosterone around, but it's only the testosterone that jumps off the box car, jumps off the train and into the bloodstream that's doing any work. If you measure all the testosterone that's on and off the train, you can't really tell what you're doing. The way to get to that, the most accurate way to get to the actual free testosterone, which is the part that's jumped off the train, is to measure the total amount of it, that's on the train and off the train, or what's bound to the protein and what isn't, and also measure the sex binding globulin. Then you can calculate what part of it's free.

Then looking at that, my suggestion is that you put your testosterone levels in the upper 25% of normal for a 35 year old man. You don't need to be 18, but you don't need to let it just taper off down to nothing either. Okay. Once that's measured and it's determined that you need replacement and if you do the things that you know to do to try to bring them up normally, and that's not helpful, then some pharmaceutical options include Human Chorionic Gonadotropin 00:17:46, testosterone pellets, injections and a cream. Now, HCG, or Human Chorionic Gonadotropin, is a small amino acid peptide protein like luteinizing hormone, and so the body thinks it's luteinizing hormones, the testicles do, so when you use Human Chorionic Gonadotropin the testicles think the pituitary gland just told them to make more testosterone. For a young person who's close to normal, that is a good option. It's given sub-Q like an insulin injection twice a week, usually 2000 units twice a week. It's an odd hormone though in that if you go up on the dose, it can actually cause less response. It's better to start low and be patient.

You're fertilizing testicles, so you won't really know what the results of it are until you give it six to eight weeks, and then re-check your testosterone levels. The next thing that can be done are testosterone pellets. The downside to these are that whatever you put in, it's there for the next three months. There are those who've made a really nice business out of doing lots of pellets. My suggestion is that you do not use a pellet until you used injections to get an idea about what the ideal dose for you is, because if the pellets not enough, you're sucking wind. If it's too much, then you deal with side effects. Although pellets are a very elegant treatment, I think it's better to save that until after you've determined a proper dosage by using an injection of testosterone. Again, this is my opinion and there are many excellent physicians who have a different opinion and have amazing results. Medicine is still an art, and there are some parts of it that there's still some discussion about what the best strategy is.

I'm acknowledging that pellets are a wonderful option, whether it's something you start with or it becomes a second step, it's up to you and your physician. My preferred first step is injections using depo testosterone, most men should start with 200 milligrams IM every 14 days, or 100 milligrams IM every seven days. This is one where I do not prefer a compounded hormone because it seems that the quality variable varies. My preference is a name brand testosterone injected IM every two weeks. There is are also testosterone creams, the downside of the cream is you don't really know how you're absorbing it. People forget it, one day you do something and you're sweaty and you sweat it off. The next day you don't. There's just too much variability in my opinion. I'm not a big fan of testosterone creams. The problem with the cream is after being on it for six weeks, if you don't see anything changing, you don't really know what you have unless you do blood levels because you don't really know how much of it you've absorbed.

If you do injections, you know that you've absorbed what you injected and then you can make decisions based on that. Those are some of the ideas and strategies with testosterone. I highly recommend that every man know what their level is and that they do something to maintain healthy levels. On the other hand, testosterone is not the end-all, be-all, for example, a prolactin can decrease sex drive and make a man impotent even with amazing testosterone level. As can a low thyroid level or a very low growth hormone level. So it's not the magic cure, but it is a necessary ingredient and I highly recommend that you speak with your physician about it if you're having problems with erectile disfunction or Peyronie's.
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Straighter, Harder, Bigger. Step 3. Priapus Shot®

Priapus Shot® Procedure

The Priapus Shot® procedure indicates a specific way of treating the penis with blood-derived growth factors extracted from the man’s own blood (autologous). Some people call these blood-derived growth factors platelet-rich plasma (PRP) but there may be growth factors in plasma we don’t yet know about that do not come from the platelets. The name “Priapus Shot®” is registered with the US Patent & Trademark office as a “service mark” to protect patients by indicating a specific protocol. The name is not a synonym for the injection of blood in to the penis—such a definition would not be specific enough to indicate any particular quality of care. and so would not warrant protection as intellectual property.

The trademark defines a specific method of that providers agree to follow and develop; this agreement offers quality control and is followed and developed by over 500 urologists, interventional radiologists, family practitioners, and internists in multiple countries and by faculty in medical schools where further studies are being done.

The Priapus Shot® procedure protocol also involves patient selection, patient evaluation & education (including explanation of consent), preparation of the PRP, local anesthesia, PRP injection, post injection use of a penis pump on a daily basis, and a daily dose of tadalafil (in come men). Other post injection steps can include: stopping smoking, CoQ10 (12), vitamin E (13), Trimix, and aerobic exercise. Protocol steps vary depending on the patient and those variations also comprise the Priapus Shot® protocol.

Patient selection includes identifying those who may need hormonal treatment, or family counseling, or vascular surgery, as well as those who may have co-morbidities or who may be taking drugs that interfere with sexual function. Some patients are not treated with the Priapus Shot® protocol because another treatment or no treatment is more appropriate.

The policy of most of our providers of the procedure offers a complete refund to any man who is not happy with the Priapus Shot® procedure.

Consulting with the patient includes informing him that unexpected side effects could occur and the results will vary with some patients seeing no benefit. Antibiotics fail in 1 in 5 people in the hospital with pneumonia—resulting in death. Antibiotics “work” but do not work for all people. The same can be said for most all procedures including the Priapus Shot procedure.

The preparation of the PRP involves a device approved by the FDA for isolating PRP from whole blood for autologous use. Since blood is not a drug, it is not governed by the FDA but the devices used to isolate PRP for injection back into the body are regulated by the FDA. Multiple kits have gained FDA approval. Some of the approved kits include Regen, Magellan, TruPRP, Eclipse, Pure Spin, Harvest, & Emcyte. There are over 8,000 research papers on pub med discussing the science of PRP, and not one serious side effect has been documented when FDA approved kits were used to prepare the PRP.

Most men find the procedure very comfortable if a topical lidocaine cream is applied to the penis about 15 minutes prior to the procedure. A very small needle (1/2 inches long, 30 gauge) needle is used for the injection. However, some men do ask for a dorsal nerve block which can easily be done using 2% lidocaine for a near painless procedure (this same block can be used for prosthesis placement—so it makes a 30 gauge needle completely painless for most men.

The Science

An early report that PRP may be useful in the penis appeared in a paper published in Urology in 2003 mentioning that, in animal models, using blood-derived growth factors injected into the penis successfully treated erectile dysfunction and also mentioned that such a strategy may be feasible in men— actually providing a way to correct the underlying pathology (1). In contrast, Viagra and Trimix do not correct the underlying pathology of decreased penile circulation.

Another animal study in 2010 showed that transferring adipocyte derived stem cells (ADSCs) into the penis caused endothelia cell growth (new blood flow) as well as increased nitric oxide activity in the dorsal nerve (harder erection). But, the ADSCs were tagged before injection (to keep up with them) and most of the injected stem cells died! So the improvement seen was not from maturation of the ADSCs but rather from recruitment and activation by growth factors of stem cells already in the body—indicating PRP may demonstrate a similar effect (2).

Dr. Virag (also a pioneer of Trimix injections) published research demonstrating improvement in erectile function, size, and correction of Peyronie’s disease with the use of PRP. His studies both published (and to be published) demonstrate a mean increase of 7 on the ED Intensity Score when PRP is injected into the plaque and into the corpus cavernosum of the human penis (3).

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One of the growth factors found in PRP (over 20 known) includes vascular endothelial growth factor (VEGF). In one animal study, the animals were castrated causing a shutting off of testosterone to create a penis that demonstrated, on microscopy, atrophy of smooth muscle and nerves as well as endothelial cell pathology. Then another group received VEGF injections directly into the corpus cavernosum along with castration. VEGF injection into the penis at the time of castration prevented the atrophy as effectively as did testosterone replacement. Moreover, VEGF reversed cavernosoetric findings of leakage (4).

The above studies and others not cited indicate an improvement in the health, circulation, and strength (density) of penile tissue with injection of blood-derived growth factors into the penis.

What Goes with the Shot?

In regards to improvement in erection firmness, the Priapus Shot® protocol also includes a recommendation of aerobic exercise which by meta analysis of 5 randomized controlled studies using the Erectile Function Scale showed an increase of 5 (5,6).

As previously stated, the complete Priapus Shot® protocol, also includes the use of a penis pump, which as a stand-alone therapy has been demonstrated to improve erection both as part of a penile rehabilitation program as well as an adjunct to other therapies (7,8).

This same penis pump strategy, even without the PRP, has been demonstrated to increase penis size by 2-3 cm, while traction (another physical therapy that can be included as part of the Priapus Shot® protocol) was shown to increase penis length by 1.5-2.5 cm (8, 9). Adding PRP to the protocol shows improved results according to data collected by urologists currently utilizing the Priapus Shot® protocol (to be presented). The 2.5 cm improvement seen with the penis pump alone is in the 10-20% growth range for the average sized penis. As previously stated, while patient results vary, any patients that are not happy with the procedure are given a complete refund.

Ultrasound studies of humans, post treatment, by Dr. Virag and by other physicians who offer the Priapus Shot® protocol demonstrate improved blood flow, an increase in endothelium (improved health), and decreased plaque size. Dr. Joseph Banno of Chicago recently presented a paper showing the Priapus Shot® procedure decreased venous leak as well as increased intra-penile arterial pressure.

Dr. Virag’s studies, using the injection of PRP as a stand-alone (without physical therapies), also demonstrate improvement in the angle of the penis in men suffering with Peyronie’s disease (3). Also, strict adherence to a penis pump regimen is part of the Priapus Shot® protocol and the pump alone improves the angle significantly in over one-half of those studied in one study in the British Journal of Urology (10). This same study demonstrated growth of the penis using the pump alone (without the PRP injection). The PRP alone, in Dr Virag’s study, out-performed the pump with demonstration of remodeling of the plaque. I recommend using both methods: vacuum pump and Priapus Shot®.

Studies show that the non-surgical treatment of Peyronie’s is most effective when a synergy of multiple modalities is engaged (11). So, the Priapus Shot® procedure includes the injection of PRP (demonstrated effective by Dr. Virag) combined with daily physical therapy using a penis pump for ten minutes twice a day and a daily low-dose of taladafil. Other modalities in the Priapus Shot® procedure that have been demonstrated to be synergistic include the following: stopping smoking, CoQ10 (12), vitamin E (13), trimix, and aerobic exercise. Such strategies are not intended to take the place of surgical correction or of the use of chemical surgery with collagenase—but rather to offer the man suffering with Peyronie’s disease the optimal non-surgical treatment as a first step with surgery reserved if non-surgical therapies fail.

The penis pump alone (part of the Priapus Shot® protocol) has been shown to improve the effectiveness of Cialis and of Trimix injections (8). We are seeing men decrease the dosage of Viagra and/or Trimix by about 50 percent when the complete Priapus Shot® protocol is used. The Priapus Shot® protocol does not intend to make any particular therapy obsolete (including surgery) but rather to offer a protocol for enhancing an overall, synergistic approach to correcting penile pathology. However the surgical treatment of Peyronie’s disease can be unsatisfying and lead to serious complications (14); we (the Priapus Shot® providers) are seeing the safety profile of PRP and the Priapus Shot® protocol as offering an appealing conservative and often effective step to take before proceeding to surgery. The risk from PRP is certainly much less than for surgery and less than for collagenase—offering another reason to start with the Priapus Shot® when treating Peyronie’s or erectile dysfunction.

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When considering the duration of effectiveness of the Priapus Shot® procedure and risks involved, you may find it helpful to consider the nature of the cell biology employed. A review article considering the basic science of PRP discusses the fact that the autologous growth factors are exactly what’s generated to propagate healing should the man have surgery. The healing peptides, chemotactic factors, and pluripotent stem cells employed are exactly what’s generated by the normal healing process and offers no inherent risk for infection or allergy (16).

In over 8,000 papers published about PRP on pub med, there is not one serious sequelae reported that I can identify (multiple review articles address safety). This seems logical when you consider the material being injected is autologous and normally produced to help healing and to fight infection.

Wound care studies demonstrate the nature of multiple tissue types being regenerated (with no reported risk of neoplasia in multiple biopsy studies (17-20).

Moreover, in rat studies (where biopsy of the dorsal nerve is feasible), PRP has been shown to help regenerate nerve tissue and restore erectile function when prostate surgery is modeled with crush injury to the dorsal nerve (21,22). Some studies of stem cell therapies demonstrate that the stem cells do not actually mature into healthy tissue but rather signal for the improvement of the involved ganglion and nerve conduction by recruitment of stem cells to the area - exactly what happens with PRP.

Stem cells are not directly prepared as part of the Priapus Shot® procedure, but we are seeing similar results as what’s reported with stem cell studies. Stem Cell studies often use PRP as a carrier for the stem cells, bringing into question which is the active agent (23-24).

The idea of safety is further emphasized by the literature indicating that not only are there no reports of serious allergic reactions to PRP, but research also shows that PRP can attenuate the autoimmune response. One split-scalp study (with placebo control) showed improvement in alopecia areata, with the use of PRP, that out-performed triamcinolone (25). Another study using PRP in the genitalia of women, showed improvement in lichen sclerosus as determined by both patient survey and by 2 blinded dermatopathologists (26). This attribute of PRP (attenuation of the autoimmune response) could partly explain the effectiveness of the Priapus Shot® protocol for the treatment of both Peyronie’s disease and erectile dysfunction since Peyronie’s is thought to be partly caused by an autoimmune response.

Hard & Easy Cases

Hard Cases

  • Penis Growth-Only 60% of men achieve 1/2 inches or more in growth (circumference and length). But, men in that 60% sometimes see up to 1.5 inches in circumference & length (often after 2 to 3 procedures).
  • Men with long-standing vascular disease see less response. If the blood flow going to the penis (ileac arteries) is blocked, then the Priapus Shot® injection into the penis will not help much. The man needs a vascular surgeon. One way to get an idea here….if the man sees absolutely no response when taking Viagra or Cialis for more than 2 years, then he may have blockages or other problems that the Priapus Shot will not help.

Easy Cases

  • Post op for prostate surgery as part of a penile rehabilitation program. If the man could achieve erection before the surgery, the following the Priapus Shot® protocol could be very beneficial (even if it’s been 2 or 3 years since surgery).
  • Improved firmness of erection in the man who can already achieve erection. Typical results are that he may be able to cut the dose of Viagra or Trimix in half (but still need the drug) or if he needs only a low dose of the drugs he may be able to stop using them.
  • Improvement in lichen sclerosus. This is HUGE since lichen sclerosus appears on the foreskin with severe discomfort and often recurs even if the man has a circumcision.
  • Peyronie’s Disease. This possibility is another HUGE benefit of the procedure—with the Priapus Shot® probably safer and more effective than collagenase injections (research to be published soon). If a man undergoes surgery for Peyronie’s disease, the curvature often recurs later since the autoimmune process continues. Also, with surgery, there can be infection and shortening of the penis. None of those side effects have been seen with the Priapus Shot® procedure (side effects include INCREASE in size in most men with Peyronie’s).


In summary, multiple studies support the idea that blood-derived growth factors (when prepared in a proper way using a kit approved by the FDA for the preparation of PRP), as used in the Priapus Shot® protocol, support the health and function of the penis. Erectile dysfunction is associated with anhedonia, and successful treatment leads to better function, better relationships, and more pleasure in life (27).

Hope you find this helpful!

Peace & health,

Charles Runels, MD
Inventor of the Priapus Shot® Procedure

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2. Garcia MM, Fandel TM, Lin G, Shindel AW, Banie L, LinC-S, and Lue TF. Treatment of erectile dysfunction in the obese type 2 diabetic ZDF rat with adipose tissue-derived stem cells. J Sex Med 2010;7:89–98

3. Virag R. A New Treatment of Lapeyronie’s Disease by Local Injections of Plasma Rich Platelets (PRP) and Hyaluronic Acid. Preliminary Results. e-mémoires de l'Académie Nationale de Chirurgie. 2014;13(3):96-100.

4. Rogers R. Intracavernosal vascular endothelial growth factor (VEGF) injection and adeno-associated virus-mediated VEGF gene therapy prevent and reverse venogenic erectile dysfunction in rats. International Journal of Impotence Research. 2003;15:S24-9.

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8. Pahlajani G,Raina R, Jones S, Ali M, and Zippe C. Vacuum erection devices revisited: Its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy. J Sex Med 2012;9:1182–1189.

9. Sellers T, Dineen M, Wilson SK. Vacuum protocol and cylinders that lengthen allow implantation of longer, inflatable prosthesis. Toronto, ON: (Abst) Society of Sexual Medicine; 2008.

10. Raheem A. The role of vacuum pump therapy to mechanically straighten the penis in Peyronie's disease. BJU Int.. 2016;117(4):E7.

11. Levine L. Peyronie’s disease: contemporary review of non-surgical treatment. Transl. Androl. Urol. 2013;2(1):39-44.

12. Safarinejad M. Safety and efficacy of coenzyme Q10 supplementation in early chronic Peyronie’s disease: a double-blind, placebo-controlled randomized study. International Journal of Impotence Research. 2010;22(5):298-309.

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23. Rene' Y. Safety of Intracavernous Bone Marrow-Mononuclear Cells for Postradical Prostatectomy Erectile Dysfunction: An Open Dose-Escalation Pilot Study. European Urology. 2016;69(6):988-991.

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