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#12 – Optimizing Sexual Performance, Nitric Oxide and Testosterone Boosters, Using Stem Cells to Turn Back the Clock in the Bedroom and the Gainswave Craze with Dr. Amy B. Killen

All the questions about sexual performance you wanted to know but were afraid to ask! In this episode of the Gene Food podcast, we talk to Amy B. Killen, MD. Amy is an anti-aging physician based in Utah whose practice focuses on optimizing and restoring sexual performance in both men and women. We cover a wide range of topics including whether stem cell injections can turn back the clock on sexual performance, how Gainswave therapy works, how to overcome erectile dysfunction, options for boosting testosterone, how to get more nitric oxide from food, why Listerine can be a downer in the bedroom, what men can learn from morning erections and how cholesterol can help or hurt in the bedroom. Very fun episode covering all things sex headed your way!

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This Episode Covers:

  • How mental health and stress impact on sexual health [8:50];
  • Increasing testosterone naturally and when testosterone replacement therapy is called for [11:00];
  • Nitric oxide (NO) production, plant based diets and sexual performance [16:00];
  • Importance of NO in health, nitrate depleted food and NO supplements [20:30];
  • Erectile dysfunction and heart disease [28:30];
  • Prostate health and sexual performance [31:00];
  • Can stem cells turn back the clock in the bedroom? [33:00];
  • Sexual optimizations for women [37:10];
  • Gainswave therapy – what is it and how does it work? [40:00];
  • Propecia, male pattern baldness and sexual performance [46:15]


Dr. Killen: So after about age 40, adding things like L-Arginine, L-Citrulline in high doses is not actually effective for increasing nitric oxide. Which is interesting in that if you look online if you google right now, you know nitric oxide booster, you’ll have hundreds of them. And pretty much all of them will have L-Arginine or L-Citrulline in there, which are not gonna do anything for most people, you know, over the age of 40 or 50.

John: Welcome to the “Gene Food Podcast.” I’m your host, John O’Connor. Hey guys, today we have on a really interesting guest, Dr. Amy B. Killen MD. Dr. Amy has been pretty much all over the internet. She’s become an influencer, and somebody who’s very well known has done a lot of big podcasts on the subject of sexual health, sexual optimization, anti-aging. She’s really a leading expert in that field. She was an emergency physician for seven years and then kind of had this transition over to holistic medicine.

And often those are the most fascinating, holistic docs to talk to, the ones that have the traditional MD background, and then they’ve moved into stuff that’s a little bit more alternative and a little more integrative.

We had Dr. Amy on today because she knows a ton about a bunch of issues that men and women wanna know more about but are afraid to ask. So we got deep in the weeds and just pulled no punches. We asked Dr. Amy about stem cell injections in the penis. We asked Dr. Amy about how to improve sexual performance. We asked Amy about erectile dysfunction, we asked her about new technology called the GAINSWave which some men are using to improve sexual performance.

It’s a very candid, thorough, deep dive into all things testosterone, nitric oxide, sex, wellness, machismo, biohackers, all that stuff. It’s a lot of fun, we get into pretty much everything you’re gonna wanna know about supplements. So without further ado, here is Dr. Amy.

Basically, you are somebody who, when I consume your content, I feel optimistic about taking my kids to Europe at some future time on Instagram. Because I think you’re doing a really good job traveling with your family. It seems like you guys are having a good time taking the kiddos to Italy and all that. So that seems cool. I’m very sort of like anti-Griswold. And I… go ahead, sorry, go ahead.

Dr. Killen: Oh, no, I’m glad that you think it looks cool. It definitely is cool. I feel lucky to get to do that.

John: Yeah, doing the family trips is great. And then I also think, man, on this whole family theme, I think maybe I should be injecting my penis with stem cells. So let’s start on that. I mean, that’s something that you’re doing at your clinic. And can you just walk us through that whole process in terms of who’s coming to and why?

Dr. Killen: I like that we’re just getting right to it.

John: We’re jumping in, we’re going for it on this episode.

Dr. Killen: Totally. So you know, I do various types of sexual optimization procedures as well as, I work with patients sort of on integrative techniques and lifestyle things. But one of the things that I do are what we call the P-Shot, but I do it with stem cells instead of just with Platelet-rich plasma, which is what’s commonly done. So basically, I get some blood from the patient, and then I get some stem cells for the patient. And then oftentimes combine those with other growth factors and messaging systems like exosomes or umbilical growth factors or things like that, that we can get from a lab.

And I put those things together, and then I numb up the penis first with some numbing cream, so it’s not horrible. And then I do some injections into the corpus cavernosum, which are the tubes that fill with blood when you get an erection. So they’re the tubes that have a network of cells, and they are capable of filling with blood. And as men get older, as well as men who have, you know, other chronic disease problems, they tend to lose the ability to either get or maintain an erection.

And so these types of stem cell therapies are essentially aimed at communicating with their own stem cells with your own stem cells, to try to get your cells to be more active to regenerate tissue, to improve blood flow. And the end game being to try to help improve sexual performance.

John: Right. Yeah, because I wanted to jump right in because there was like a million questions that I wanted to ask you. I’m sitting here with Ray, my sound engineer, we are like debating testosterone therapy and all this stuff but like we gotta ask her all this stuff. So that’s a solution, the stem cell thing where you’re already having problems, or is that something that you do prophylactically.

Dr. Killen: Both, you know, I have a lot of sort of young biohacker types that come to me that don’t necessarily have problems, but maybe they’re in their late 30s or early 40s, and they’re like, “You know, can we just kind of keep things as youthful as possible.” And so we’ll do these procedures. The procedures are so simple and so safe that you know, I’ve done them on all different ages from, you know, 30, up to 75-year-old men.

And it seems to help people, even I had patients who don’t really have problems, but they’ll still come back and say, “You know, what, I feel like, my erections are harder, or they’re lasting longer or the refractory period is shorter, or the skin is more sensitive. Even if I didn’t think I had a problem before, it turns out, you know, with time things change.” And if we can kind of turn the clock back a little bit with these procedures, then that’s what we’re trying to do.

John: Absolutely. And I think one of the things that’s so cool about getting the chance to talk to somebody like you is, you’re being included on some really personal conversation. So guys are coming to you I’m sure you’ve probably heard it all. How do you know whether you have a problem? And the second issue to that because some people listening think well it may seem obvious, but how instructive should your morning wood quality be to your overall feeling as to where you’re kind of like performance status sits?

Dr. Killen: So it’s normal, you know, most younger guys are gonna wake up with morning erections and that’s totally normal. You know, they oftentimes will have multiple erections during the nighttime, they just don’t know about it. And what older men or men who have medical problems like diabetes, or high blood pressure, or things like that will start to notice is it they’re not having as many or as strong morning erections. One thing that I think can be informative in younger men, especially, I see some younger men who come in and they’re having erectile dysfunction with their partner, but they’re still having morning erections that are totally normal.

And so you know, in those cases, maybe it’s more of a psychological issue. Maybe we need to start exploring the relationship or you know, the stress or financial issues, or you know, other things that could be going on. Maybe it’s not a physiologic blood flow issue. And that could be helpful for younger men. Usually, as men get older, it becomes a blood flow issue. Usually, it’s either the blood is not getting there, because of arterial insufficiency, or arterial plaque from like atherosclerosis. Or the blood is getting there, but not staying there in what we call venous leak.

Which is basically, the cells in the penis have become less expansive, less elastic. And so, therefore, you can’t expand the penis like you should, and so the blood is not getting trapped, and it just comes right back out again. So that’s more common in patients as we get older than the psychological kind of ED problems.

John: Yeah, like you said, I mean, you’ve had some… and we can mention it publicly because they’ve blogged about it. And you’ve been on a bunch of podcasts. But like the Ben Greenfield Fitness world and Dave Asprey, like you’ve kind of done these optimizations for men who are out there trying to maximize performance. We’re gonna spend the majority of the time talking about those physical issues, but I think just for somebody listening in at home, that might be kind of trying to figure out for themselves, like, is this an issue with a relationship, or is this a physiological thing?

Sometimes, yeah, for younger men, I think the issue can just be you’re not connected to your partner, maybe you’re not communicating with your partner effectively. What tips do you have, before we jump into all this good physiological stuff to kind of… if any, for that guy at home, who’s kind of looking in that other direction?

Dr. Killen: You know, just keep in mind that there are so many things that feed into it. You know, obviously, the brain is where the sexual response starts. So if there’s a lot of stress that you’re not handling well, you know, if you’re having anxiety, or depression, or you know, any number of different psychological problems. You know, obviously, relationship problems. But there are so many things that play into it at the level of the brain, that prevent people from you know, having normal erections and a good sex life. And so you have to pay attention to those things it’s not all about blood flow.

I mean, eventually it is, but in the beginning, it’s the brain saying, hey, I’m interested or I’m not. And stress, I think, is the biggest thing that I see, that really puts a damper on sex for both men and women. You know people who… we know that high cortisol does all kinds of bad, you know, in all different parts of the body. And, you know, it affects the way the hormones are reacting, it affects the way that hormones are made. And it certainly affects your interest in sex and your ability to have sex. So starting with the basics is important before you jump into thinking about procedures, and you know, other things like that.

John: For sure. I mean, the whole stem cell conversation is so interesting. And I don’t think most people are even aware that these procedures are taking place, because you’re right on the cutting edge of kind of the science in this regard. So I was kind of doing a little bit of clickbaity thing there kind of capture the audience’s attention with that procedure. But we’re gonna get into the GAINSWave and more on this stem cell stuff and even the PRP.

But before we do your content surrounding stress, sleep, testosterone, can we start with the whole testosterone issue? My sound engineer and I the conversation we were having back and forth prior to getting on the interview with you being like, okay, we definitely wanna ask Dr. Amy, this. What do you think about testosterone replacement therapy? What do you think is a normal range for testosterone if somebody is going getting their lab work done? All that.

Dr. Killen: Okay. So I think testosterone replacement can be very helpful in certain populations of men. I don’t think that everyone needs it, I don’t think we should be handing it out like candy. But I do think that it could be really helpful for a number of reasons. I mean, I think that getting your testosterone up to optimal levels is the goal. So that’s the goal, whether or not I’m giving you testosterone, or I’m giving you another medication that increases your own testosterone. Or preferably, you’re increasing your production because the things you’re doing in your life that are smart that you know, to do.

So I always counsel men, especially again, younger men under age 45, or 50 if they have low levels, let’s start with lifestyle. So you know, things like making sure you’re exercising, doing both high-intensity interval training plus weight lifting is gonna increase testosterone. You have to sleep, if you’re not sleeping well, you’re not gonna make testosterone, you’re not gonna make growth hormone, you’re going to feel miserable. So you have to get good sleep.

You know, making sure you get enough of the key elements and hormones and chemicals and things like vitamin D, and zinc, and some of these, selenium. Some of these things that we need to make testosterone is important. Getting enough protein and branched-chain amino acids, getting enough light. There’s actually some studies that show that men who don’t get outside and get sunlight have low testosterone levels. And if you just get out and get some sunlight, even like 10 minutes a day or 10 minutes every few days, that will increase your testosterone production.

So there’s all these little tricks that we could do, just from a lifestyle standpoint. I mean, obviously, diet is a big one, eliminating sugar, eating a healthy diet, low glycemic is gonna boost testosterone. Getting rid of excess weight, if you’re obese or overweight, that extra weight is gonna lower your testosterone. And then the stress piece we already talked about.

So starting with that, and then… but if we still have someone who’s doing pretty much all the right things, and they still have very low levels, then I start talking to them either about adding in testosterone itself. Which is just gonna be just like the testosterone that you make only it’s something I’m giving you as an injection, or a pellet or something like that. Or there are also some medications that we use, like Clomid, or HCG, that essentially communicate with your testes and tell them hey, we need to make more testosterone. So both of those are options depending on your age, and probably where you’re coming from.

John: Okay, right, because it’s the testicles that are gonna make testosterone. I think I heard you do an interview where there was a guy who was concerned that he wasn’t gonna be able to make enough testosterone because he’d lost a testicle to cancer. So what are the issues that can inhibit the production of testosterone, like testicular cancer, maybe varicocele? Are there things that you’re seeing that are biological they can get in the way of that process?

Dr. Killen: There are definitely are testicular cancer and you can usually still make enough testosterone with just one testis, you know, you don’t necessarily have to have two, but certainly it can affect it. You know, one thing that we sometimes see is men who’ve had head trauma, like concussions, you know, they played football or soccer, whatever, and had concussion several times throughout their youth or young adulthood, you can get injuries to the pituitary gland that is responsible for it. You know, it starts the hormone cascade that eventually leads to the production of testosterone. So that’s something that’s not that uncommon, actually.

Certainly, put other pituitary problems like tumors in the pituitary gland, which we usually look for. But most of the men I’m seeing, though, are healthy men who don’t really have a good reason but they have low testosterone. And I think, you know, we know that testosterone levels now, compared to 50 years ago, have gone down significantly. Our average testosterone for men is going down, sperm production is going down, fertility is going down.

And a lot of that is probably due to environmental factors, you know, food factors, toxins, you know, there’s so many things that we don’t know exactly what’s causing it, but we know that it’s happening. And so I have men who are healthy, who are doing everything, right, who have testosterone levels of 250 and you know, they’re 40 years old, and they’re like, “What’s going on?” They feel miserable. And so those people, sometimes we do have to talk about doing some medication of some sort.

John: I think there’s also an important distinction between testosterone and then free testosterone. So what’s your message there in terms of how you can increase… Have you seen like, Carnitine at all, supplements?

Dr. Killen: Yeah, Carnitine can sometimes be helpful. You know, I do look at both free testosterone and total testosterone. So total testosterone is including testosterone that’s bound to protein as well as the free testosterone that’s kind of just roaming around your body. The free testosterone is what’s going to be biologically active at that given moment. But testosterone can bind and unbind, you know, intermittently, it’s not gonna be staying in one form. But both are important.

You wanna look at like the SHBG, which is one of the binding protein levels. And sometimes that can be important. I mean, basically, when you’re seeing a doctor for testosterone, you just wanna make sure you’re seeing someone who knows what they’re doing and it’s not just checking testosterone. You wanna also check the other hormones, like estradiol, and SHBG, you know, check your thyroid hormones. I mean, even things like your cholesterol are gonna play into testosterone and are gonna be affected by testosterone. So it’s taking sort of a more holistic sort of full-body approach to replacement of testosterone, I think is really important, and not just, you know, handing out needles full of testosterone.

John: Yeah, for sure. So you mentioned cholesterol, that’s something that’s kind of a charged topic, everybody’s kind of trying to win that war, in terms of my diet is the best diet. We had on Chris Masterjohn, who’s a nutrition science Ph.D., a few episodes back. I don’t know if you’ve heard of Chris or seen his work. But he was talking about a really interesting story of how he had a cholesterol deficiency on a vegan diet that he believed led to some mental problems for him that he was able to solve by changing diet.

And then you have like the new “Game Changers” movie that’s coming out soon, which is James Cameron’s movie. And they basically measure like, overnight erection levels of male athletes on a plant-based diet versus a meat diet. And one of the big claims of a plant-based diet is you reduce your cholesterol. So where do you wanna see optimal testosterone and optimal cholesterol for peak sexual performance in your patients?

Dr. Killen: So testosterone, you know, it depends on the person, but I would say at least in you know, sort of middle of normal to high normal range. So you know, depending on the lab that you go to, is generally somewhere in the like 700 to maybe 1,100 range, is kind of the goal for most people. But certainly, if you have a testosterone of 500, and you feel amazing, and everything is functioning perfectly, that’s great. Maybe you know, maybe your receptors are responding better or whatever, than other people. But you know, in general, 700 to about 1,100 is optimal, I think.

Cholesterol is obviously a little bit trickier because there’s so many different facets you have to look at. I do think that not just regular cholesterol panel is important that you want to maybe look at the things like the particle numbers, and the Lp(a) and all the like little variations that show us like levels of inflammation and such. Versus just the hard numbers that we used to look at with cholesterol. It is definitely true that if you don’t have enough cholesterol, though, that you will not make as much testosterone.

And so your point about that is definitely valid because cholesterol is the parent compound to make your hormones including cortisol, including estrogen, progesterone, testosterone, so you have to have cholesterol. So if you’re not eating enough cholesterol, then you won’t make your hormones properly and you’ll be deficient and you’ll feel bad.

As far as the plant-based diet goes, you know, it’s very interesting, I just finished reading a book by Dr. Nathan Bryan, who’s a Ph.D. who studies nitric oxide. Which, you know, you and I have discussed briefly. But like this is one of my favorite things to talk about with sexual health is nitric oxide. And one of the things that he talks about is that, you know, certainly, a plant-based diet can be really helpful.

But the main thing is with any diet, whether it’s the DASH diet, or the Mediterranean diet or you know, even like a paleo diet, is you want to have enough of these nitrate and nitride containing foods, which are these green leafy vegetables and such. Because getting enough nitric oxide turns out is actually one of the key things to general health. So whether you’re getting it from… you know, whatever kind of diet you’re getting it from, it’s those green leafy vegetables, and high nitride nitrate foods that we’re gonna wanna focus on.

John: Yeah, no, and that’s gonna be a huge subject of this podcast. That was kind of the origin story of the episode, I wanna talk a lot about that. When I started digging in more into the procedures you guys were doing, I was like, oh my god, I have to ask her about all this stuff, too, because it’s just terribly interesting. But nitric oxide is cool because that’s something that people can do… Well, you know, for us, we’re interested in nitric oxide, it’s meted to a certain degree by genetics. And then there’s stuff you can do at home to improve you just mentioned two of them.

So why is it important? What can we do to eat a nitric oxide-high diet, what inhibits it? Who do you think wins in these debates? You read the, you know, plant-based paleo you figure it’s individual. What’s your sense of all this for eating for nitric oxide?

Dr. Killen: As far as the food debates go, I think that there’s definitely a lot of evidence for a plant-based diet. But I also think that it’s important to get enough protein. So I tend to follow more of, you know, kind of a… I don’t know, I kind of call it like a metabolic flexibility diet. I mean, I’m not ever doing one thing all the time. But I tend to follow just generally a low glycemic diet and then making sure that I’m getting enough, you know, of the good vegetables and a little bit of fruit. And then whatever else that looks like, you know, the sort of organic and a little bit of meat along the way.

I do think that certainly… the key thing, I think for all of these diets is that you have to eat enough of your vegetables and your fruits and your whole foods. And everything else, I think it’s less important, because if you’re getting enough vegetables and whole foods, then you’re not gonna be eating a lot of the riffraff stuff, that’s gonna cause problems. The sugar, the preservatives, you know, that kind of stuff.

As far as nitric oxide goes, it’s such an interesting molecule. And it’s something that… I mean, I just the last few years started becoming interested in it because I didn’t even know about it. As a doctor, I was like, this is not something I really heard about. Classically, it’s a molecule that the body releases to open up your blood vessels. So to increase blood flow or vasodilate your blood vessels, it requires nitric oxide. And we’ve known that for a long time.

But what’s become apparent in the last number or last decade or so is that nitric oxide it’s important for basically every single cell in your body. It’s important for prevention of atherosclerosis and keeping your arterial walls healthy and flexible, potentially for preventing diseases like Alzheimer’s and cancer. And it’s important for athletic performance, a lot of people will use nitric oxide boosters before they go to the gym, because it helps to use oxygen efficiently.

And a few things have happened, so a lot of our food stores now do not have as much nitrate and nitride as they used to. So a lot of the farming practices have changed there’s not as much nitrogen in the soil in different places around the U.S. And so the foods have variable degrees and amounts of these nitrates and nitrides which your body can use to make nitric oxide. So that’s a problem because you know, if you live in New York City, for instance, maybe you’re buying you know, the best organic kale you can get. And it actually has, you know, a 10th as much of these nitrates or nitrides as you might be getting from some non-organic kale in Dallas. And there’s actually been some comparisons done that have shown that it’s interesting.

John: No, no.

Dr, Killen: Yes, yes.

John: …you’re saying the New York City of vegetables are terrible and depleted? That’s terrible.

Dr. Killen: I can’t say that they all are, all I can say is that… One of the studies that I was reading that Dr. Bryan did where he compared… He went to like Chicago, and Raleigh, and Dallas, and New York, and compared six or seven different vegetables and looked at their nitrate, nitride, you know, numbers. And basically New York, those vegetables were not nearly as high in nitrate, and like a 10-degree difference than the ones in like Dallas.

And he also found… this is interesting. And I don’t want to dissuade people from eating organic. But in his study… and again, it was kind of small. But that the organic vegetables actually ended up having a lower nitrate, nitride percentages compared to non-organic. Which is interesting I think.

John: Why?

Dr. Killen: And I don’t know why.

John: It blows my mind that in Dallas… I mean, I’m gonna have to have a conversation with the some of these vendors at the Union Square farmers market and see what’s what. Because we’re certainly not paying low nitric oxide or low nitrate prices for our vegetables here. So that’s kind of ridiculous but I don’t know.

Dr. Killen: So what’s interesting about nitric oxide is that you know, you can make some of it yourself. And about half of your nitric oxide comes from your own body. Like the cells and the blood vessels making nitric oxide from L-Arginine or L-Citrulline. So that’s why you see, you know, when you go to like the Whole Foods, or you know, you go to a market and you go to GNC and you get like a nitric oxide booster, like a pre-workout. It’s gonna have L-Arginine and L-Citrulline in it, that’s pretty much everything does.

And so your body can use those things to make nitric oxide and that’s about half of the production that you make. But what ends up happening as you get older, and by older, I mean after about age 40, your body is not able to make as much nitric oxide because you get atherosclerosis which messes up the cells in the blood vessels ability to be able to make nitric oxide from those compounds. So after about age 40, adding things like L-Arginine and L-Citrulline in high doses is not actually effective for increasing nitric oxide.

Which is interesting in that if you look online, if you google right now, you know, nitric oxide booster, you’ll have hundreds of them. And pretty much all of them will have L-Arginine or L-Citrulline in there, which are not gonna do anything for most people, you know, over the age of 40, or 50. So that’s a key point. So really, the other mechanism for getting it is from your food. And again, that’s green leafy vegetables, that’s beets, even dark chocolate, pomegranate, things like that will have high nitrate or nitrite levels, which is what you want.

But what happens with the food that’s important to know is that you have to have a couple of things, you can’t actually make nitric oxide just from nitrates on your own. So you require certain types of bacteria in your mouth to do the first step in reducing that. And you also require the acid in your stomach to do the second step. And a lot of people have done a lot of things to their health to mess up either one of those two steps. So even if they’re taking in large quantities of spinach, they’re still not able to make nitric oxide because they don’t have the bacteria in their mouth that they need or the stomach acid they need.

John: It makes me feel like we just need to move somewhere calm, and peaceful, and buy like non-New York City vegetables and like just chew it really slowly. And just chill the f out and stop checking our phone every five seconds and things might actually look you know, even better for a lot of us. I have this in my notes. So another really fascinating thing… And this is another thing we were kind of debating here, internally. Listerine, I’ve heard you say is something that… back to this whole idea of you need the bacteria in your mouth, and you need the right bacteria in your mouth to transition this stuff. So Listerine and then also oil pulling, I wanted to ask you about this. So if you can speak to those two issues.

Dr. Killen: What was the second one, Listerine and what else?

John: The second one… well we also wanna know about oil pulling, because our last guest is a huge advocate of oil pulling. So we all went out and bought… you know, we kind of dusted off our ayurvedic oil pulling thing. But then once I started doing research for this show, I was like, hmm, I don’t know where I come down to this anymore. Because if your mouth bacteria is so key… So anyway, leave it to you to tell us.

Dr. Killen: Okay, so I don’t know much about oil pulling. So I’m happy to hear what you have to say about that. But I can talk about mouthwash. Antiseptic mouthwash, the ones that kill bacteria can be really bad for nitric oxide production. So basically you’re killing the bacteria on the back of your tongue, that are needed to reduce nitrates to nitrite, which is the first step. And so they’ve actually done studies where they’ll give someone like an antiseptic mouthwash for a week, and they’ve seen increases in blood pressure that is because of lack of nitric oxide. Nitric oxide causes lower blood pressure if you have enough of it.

So you know, killing those bacteria in your mouth with mouthwash is a problem, and can directly affect your ability to make nitric oxide. Also, forsaking antibiotics, you wanna obviously not take them if you don’t have to, because those are gonna also kill those good bacteria in your mouth. So that’s the first thing and that’s very common, you know, millions of Americans use mouthwash every day.

The other thing that is very, very common and a big health problem, I think, is the overuse of antacids and you know, antiacid medications, like proton pump inhibitors, or H2 blockers. So things like that, you might get prescription like a Prilosec, or even like over the counter ranitidine or some of these medications, but essentially decrease your stomach acid production. And this is a big problem because you need to have an acidic stomach in order to do the second step of the nitric oxide formation from food.

So we know now that people who are on these PPIs, these like very strong acid blockers, which millions of Americans are on them like doctors put them on them all the time. But those people we know have a 30% increased risk of developing heart attacks and strokes. And that’s probably at least partially if not completely due to their inability to make nitric oxide. Because nitric oxide we know is preventative for heart disease, for strokes for all kinds of things. So you have to have stomach acid, and you have to have good bacteria in your mouth. And if you’re doing things to block those, then you can’t make nitric oxide properly.

John: Wow. And that all ties in full circle to before we get into these optimization procedures, which are like next-generation stuff. You and others have said it’s pretty common knowledge, the plant-based community loves to talk about this. How issues with sexual performance, especially in men are like the canary in the coal mine, like the early stage of heart disease. So could you just kind of speak to that a little bit more, it kind of riffs nicely with the nitric oxide, and then we can get into the procedures that are being used to kind of help regenerate.

Dr. Killen: Yeah, absolutely. So if you think about blood vessels in your body… you know, what causes heart disease? Heart disease is atherosclerosis. So it’s plaque building up in the blood vessels that go to your heart, and that blood vessel gets more and more narrow, and eventually, the plaque breaks off, or it just is so narrow, you don’t get blood flow. So that’s a heart attack when that happens, right? If you think about the blood vessels that go to your penis are actually smaller than the ones that go to your heart.

So the plaque is still building up just like it is in your heart, just like it is in your brain. But the vessels themselves are so much smaller, it actually takes less plaque building up to cause symptoms, to cause problems, because of lack of blood flow. So that’s why a lot of cases, ED is one of those sort of early warning signs of you know, problems yet to come. Like you may have erection problems, 10 years before you have a heart attack, or before you have a stroke, it’s just the size of those blood vessels are different. And so it’s sort of a key that helps us to see that.

So the same kinds of things that you wanna look at to help prevent heart disease in general, are the things that we would use to help prevent ED. So you know, it’s the same things we all know, like, keep your blood sugar down, keep your blood pressure down, you know, make sure you’re not using a lot of sugar, cholesterol, keep that in the right ranges, exercise, you know. All the things that we know are sort of smart and good for our health are gonna be good for both our penis, and for our heart, and our brain, all the other organs that need blood flow.

John: Dr. Joel Cohen we had him on the podcast, he is a… we’re from the same community. I know him to be a very excellent cardiologist, but he’s also an advocate of plant-based diets. And I remember maybe a couple years ago or something, he wore a t-shirt on to “the mindbodygreen” speaker stage with basically these two circles. Like one was a slightly larger circle, which was meant to represent like the width of like your normal artery. And then the other circle was quite a bit smaller, it was minuscule. And that was meant to represent the width of like your penile arteries, basically. And it said on top of it “feeling lucky.” You know, so that’s like the topic that the plant-based world kinda wants to dominate.

You know, one of my mentors in this whole, like health and wellness journey was this endocrinologist in San Diego. And he… I think this is a topic that doesn’t come up very often. And I’m not sure how much you have to say in it. But it’s prostate health, you know, he always said, “If you wanna have an anti-aging protocol as a man, you need to really be prepared to think about and take care of your prostate.” Because prostate cancer is a very common disease for men. And also that’s a driver of also sexual performance. So do you do anything with your male patients in regards to prostate? Or do you sync up with neurologists or kind of what’s your take on that whole issue?

Dr. Killen: Oh, yeah, I totally agree. I do think the prostate is very important, and a lot of my men who have ED, it’s because they had to have prostate surgery to have their prostate taken out because they had prostate cancer. So it certainly is important. I tend to defer to urology for managing the prostate, but certainly advocate, you know, general healthy lifestyles that would help prevent prostate cancer.

And, you know, we know that most cancers, you know, again, you wanna avoid sugar, and some of the main diet things, inflammation in general. All of this is going to increase your risk for prostate cancer, just like it does most of the other cancers. And so certainly being aware of that is important. But I tend to have the urologist manage the actual prostate issues once they come up because that’s just their field and not mine.

John: Absolutely. So that puts us into what we mentioned briefly at the beginning of the episode. So I’m so curious to ask you just what’s the state of the science on the stem cell injections. The stem cells that we talked about getting injected directly into the penis, it’s a regenerative therapy. Where do the stem cells come from? How comfortable are you in the kind of maturity of this process? How often are you doing it? All that good stuff with the stem cell procedures?

Dr. Killen: All right, yeah. So you know, I do feel like we’re still fairly early days in all of this, you know. Stem cells obviously have been around for a long time but being utilized in people just over the last few years really, in sort of, across a large scale. There are a number of studies using either stem cells and they could be stem cells from the patient, like bone marrow stem cells, or fat-derived stem cells from the patient. We call those autologous stem cells. Auto meaning from the patient, or using other types of stem cells like placental or amniotic kind of growth factor mixes, or exosomes, which are all kind of over the counter lab-produced products. As well as PRP which is Platelet-rich plasma, which comes from the patient themselves.

So all of these things have been used. There’s a ton of animal studies that look at injecting rats’ penises with various, you know, combinations of these therapies, and then seeing what happens. So for instance, they’ll take a rat, and they’ll cut the cavernous nerve. The cavernous nerve is the nerve that communicates from the brain to the penis to tell it, hey, let’s have an erection. And you have to have that nerve you know, to have an erection, and to get the blood to stay in there. So they’ll cut the nerve, and then they’ll inject, you know, right afterwards or sometime after they’ll inject stem cells into the area or PRP or placental products or whatever they’re studying.

And then they’ll do a control they just put saline in there. And then they’ll follow the rat for, you know, a month or two out. And what they see is that all the ones that get these PRP stem cells they’ll oftentimes regenerate that nerve. And they will be able to have erections almost as strong, if not exactly as strong as the rat that didn’t have any surgeries at all. Versus the ones that had… you know, just saline-injected would have the surgery, they have no erections, and they’re very unhappy little rats.

So there’s a ton of studies like that, like, I mean, there’s many, many of them, various things like that. They have diabetic rat models, where they essentially induce diabetes and do the same kind of thing, but without the cutting of the nerve. And they’ve also seen success in treating diabetic erectile dysfunction you know, from diabetes in a rat model.

As far as human studies we do have some finally, but they’re mostly all very small numbers. So we’re talking about, you know, eight patients, 10 patients, 50 patients, maybe, where they’re doing the same kinds of things, injecting either different types of stem cells, or PRP, into the penis of men who’ve had either prostate surgery, ED, or they’ve had diabetes, or they have high cholesterol, or you know, different causes of the ED.

And in those studies, at least half of the patients if not more, like 70% or 80%, tend to have improvements when they get these regenerative products objected. Dr. Elliot Lander in the last couple of years, who’s a urologist out of California has done a couple of interesting studies. Where he’s paired the shockwave therapy with a low-intensity shock therapy like GAINSWave, with a single injection of stem cells in actual human men, and has kept you know, records on that.

And it has definitely had some good results. I think… I can’t remember the numbers, but it was over 60 or 70% of men who previously had, you know, pretty severe ED, are having significant improvements, and many times even able to have sex, sometimes without Viagra, sometimes with it. But you know, essentially, there’s improvements to be made. But it’s not perfect at this point, you know, not everyone is getting better. And we’re still kind of learning the right combinations to use.

Certainly, I think that using GAINSWave in conjunction with the stem cell therapy. GAINSWave is like a sound wave therapy that is a protocol that we use to increase blood flow, and recruit stem cells to the area. It’s proved very effective and it’s well studied, actually, in Europe, especially. I use GAINSWave in conjunction with my stem cell procedures now every time because I think the two of them work so well together.

So we’re learning a lot as we go. I think it’s very safe. Never heard of anyone having a problem or side effect, besides maybe a little bruise you know, that lasts more than a day or two. And a lot of positive results but we’re still learning kind of as we go.

John: No, very cool that you’re not like… I think one of the things that’s probably true of these types of procedures is that the degree to which it’s gonna help you is probably the degree to which you’re also caring for yourself when you go into the process, I would imagine.

Dr. Killen: Absolutely.

John: I wanna talk about GAINSWave too, but we’ve focused a lot on almost entirely on men because that’s where most of the science in sexual performance really sits, I believe at this point. But you can also do I believe the stem cell injections for women as well. Do you wanna walk us through how that goes?

Dr. Killen: Yeah, and you’re totally right. So most of the studies that have been done, you know, even the rat studies, most of them are on men. But you know, we know that the female sexual system, genitalia is similar in a lot of ways to men. And so we do have… there’s a procedure called the O-Shot that a lot of doctors do with just PRP, or I also do it with stem cells as well. Where we’re injecting PRP and stem cells into the anterior vaginal wall, kind of where the G spot is or where the underneath side of the urethra is, as well as into the clitoris.

And this can be… and a lot of patients can help with symptoms of you know, problems with sensation or the people wanna improve pleasure orgasm. Or even in some patients improving the symptoms of stress urinary incontinence. Which is you know, when you kind of pee a little bit when you cough or sneeze. And there are some studies in women looking at… the studies that I’ve seen in women mostly are not looking at improving sexual performance as much as they are treating a problem.

So I’ve seen studies looking at treating like Lichen sclerosus, which is a scarring disease of the vulva and these therapies seem to be really helpful for that. Or as a few studies looking at treating stress urinary incontinence and using these injections around the urethra to help with that. So again, some interesting research coming out of those areas. But for whatever reason, I haven’t seen it studied as much just looking at pure, you know, pleasure improving sexual pleasure in the woman like I have in the man, which is unfortunate.

John: Yeah, sounds like we need some studies on that for sure. Maybe it’s just this whole what is it? Multi…I don’t wanna say billion but hundreds of millions of dollar industry for erectile dysfunction drugs. And correct me if I’m wrong, but I believe there’s essentially like a female Viagra that’s coming out. Have you heard of that?

Dr. Killen: I have. If it’s the one I’m thinking of. There’s a peptide called PT 141, which is also called Bremelanotide, which has just gotten FDA approval. They’re gonna be selling it under the brand name Vyleesi, which I don’t think it’s out quite yet. But the peptide itself PT 141 has been around for a long time, and it’s actually been used by a number of patients. It’s an injectable peptide. And it’s been used for men and women actually, even men who have ED have seen some benefit from it.

But it actually works in the level of the brain. And it’s a whole different thing, it’s not the same as Viagra, but it works at the brain to increase interest in sex. And it’s interesting, I think that… I’m interested to see how the response is once it comes to market because it doesn’t increase blood flow, but it seems to have some benefits. The only problem I’ve talked to some of the guys who use the peptides a lot, the companies who sell them, the problem with this one is that they say it takes anywhere from like two to six hours to take effect. So you inject yourself and then you’re just like hanging out, like waiting around like, okay when is it gonna hit me you know. So that’s a little bit…

John: Have a drink.

Dr. Killen: …unwieldy in that regard. But yes, it’s coming.

John: It reminds me of the Ben Greenfield Fitness, I think was like a blog or something he did. He came to your office, and then the whole GAINSWave issue, which is sort of like… when I think about it, I’m like, you know, if I was gonna do one of these procedures for optimization, I would probably go for the GAINSWave. Because it’s less invasive. And then Ben Greenfield, who’s… For those of you who don’t know, Ben Greenfield he’s like a biohacker extraordinaire, endurance athlete, just like… and super smart guy, one of these biohacker dudes.

And he saw Dr. Amy and then wrote about it and said, he was at like a dinner with his grandmother. And he had like this huge boner and it was just like this whole thing. So yeah, so let’s transition into that, the GAINSWave.

Dr. Killen: Yeah. So GAINSWave it’s basically just a protocol name or a marketing name for what’s called Low-intensity extracorporeal shockwave therapy. That’s kind of the handful. That’s the big word, the big name of it. So the shockwave therapy, as I call it, it’s been studied in Europe for more than 10 years for erectile dysfunction. It’s also been used for all kinds of other things like musculoskeletal pain, there’s some cardiac studies with it.

I mean essentially, what it does is it creates a micro-trauma in the tissue, whatever tissue you’re doing it over. And these sound waves create micro-trauma, and then the micro-trauma causes increased blood vessel formation, improve blood flow, stem cell recruitment, nitric oxide release. Like all the things that we know are good for healing. So this works in your muscles, but it also works in the penis.

And so this has been something that… usually, it’s about 6 to 12 treatments over the course of a few months, where you go in, you’re there for like an hour, it’s not painful, it’s not invasive. It’s just like a little machine, that kind of sound like a jackhammer just goes up and down, and it sends these sound waves in, and then you go home. And over the next few weeks to a couple of months, that blood flow improves, and men tend to have great responses to it.

You know, in our network, and again, I’m part of the GAINSWave network, and we see… it’s about 80% of men, at least, in the network that have some measurable positive response, which is fantastic. Because a lot of these men… you know, I have patients that Viagra doesn’t work, like nothing works for them. And they’ll do the GAINSWave and, you know, at the end of it, then Viagra works and they’re having you know, normal sex again. Or I have men who Viagra works, and they don’t wanna have to take meds anymore and they’ll do the GAINSWave and they don’t have to take their medications anymore.

So you know, depends on where you’re starting from as far as how far you’re gonna go, but it’s very often effective. And what I like about it is it actually causes regeneration of the tissue. So it’s not just you know, getting a medication that works for a few hours, and then it goes away, it’s actually improving blood flow, improving oxygen delivery, you know, improving all the things that tend to go down as we get older.

John: Right. So if somebody at home was interested in doing that procedure, walk them through from you know, they have their coffee in the morning, they get in the car, they drive to your office. What happens when they walk through the door?

Dr. Killen: So they walk through the door, and my medical assistant is the one who does the procedure, but usually I’ll do a consult with patients first. But basically, if they’re ready for the procedure, all they do is we give them some numbing cream, they put the numbing cream on the penis. It stays there for like five minutes because it doesn’t take very long. And then after that my medical assistant does the treatment, which is again, it’s just like in the office, it takes about 30 to 45 minutes depending on if it’s the first treatment or not.

But it’s painless, with numbing cream it’s totally painless after that. And then we clean the cream off and they go home. And they go back to work, go to the gym, they can have sex the same day. Like there’s literally no downside side effects or anything. No one even knows you’ve had it done. But it’s you know, an hour-long process and that’s what’s cool about it, is there’s no needles, there’s nothing else aside from these sound waves.

John: That’s so crazy. So if you’re getting the six procedures, do you come in six days in a row, or do you go six weeks out? Like what does that look like?

Dr. Killen: It’s usually about… we try to do two times a week for three weeks for the first six. They’ve done studies and looked to see if you spread those treatments out over, you know, multiple month period, like if you do it over six months, once a once for six months. And they found that it’s not as effective as doing them closer together. So we do two to three sometimes a week. And we’ll do the six that way.

I have a lot of patients who travel in to see me to do some stem cell procedures. And I’ll have them come in, you know, a week or two early if they just happen to wanna visit the area. And we’ll do a GAINSWave series of six in those two weeks. And then I’ll do the stem cells, you know, P-Shot injection at the end of it. So they’ve gotten basically this microtrauma, they’re starting to regenerate, and then I’m giving them all of these great regeneration cells, and exosomes and signallers that could help that process even work better.

John: And you’re in Park City or are you spending time in LA like where’s your primary location?

Dr. Killen: Oh, I’m all over the place. But my practices are in, yeah, Park City and then Draper which is south Salt Lake. So I have two different practices. The stem cell practice is in Salt Lake City, the more sort of integrated medicine practice where I do the hormones and have other integrative treatment modalities is down in Salt Lake City, but they’re both in Utah.

John: Cool. And how much do these different procedures cost?

Dr. Killen: GAINSWave if you do six treatments is almost universally about $3,000, sometimes there can be a little less places, but that’s about the average everywhere. The stem cell procedures vary quite a bit depending on what you’re getting done, and what you’re getting injected. So the PRP only procedures start at about 1,500 probably depending on where you are. And then they can go up to several thousand dollars if you doing actual stem cells, or, you know, exosomes, or growth factors, or things like that. So it really is very dependent on what we’re putting in that mix that we’re injecting and how much of it we’re putting in as to how much it costs.

John: Cool. The last thing I had on my agenda to ask you, I know you don’t have unlimited time here. But what about men who are taking drugs to halt like balding in hair loss like prophylactically especially, what’s your take on that? Because that’s something… you know, actually I have a couple of friends who I don’t even really think need to be taking this… you know, in terms of their hair to me looks great. But they’re convinced that there’s some initial, you know, receding hairline and they’re taking this stuff. And I know that… I forgot the name of the medication but it can affect sexual performance. So what is your take on that whole world in terms of the interplay?

Dr. Killen: Yeah, so medications like Propecia. So Propecia is the brand name for Finasteride. Finasteride is used for prostate but Propecia is used for hair, it’s just a dosage difference. But essentially what that is, is called a 5-alpha-reductase inhibitor. And that inhibits the formation of DHT from testosterone. So normally testosterone turns into DHT or part of it does, and DHT is Dihydrotestosterone. DHT is kind of the hair enemy, the enemy to hair, in men who have male pattern baldness, or women who have male pattern baldness.

Their hair follicles become very sensitive to DHT so that if they have higher levels of DHT that it can cause their hair to lose it more frequently. So these 5-alpha-reductase inhibitors like Propecia, what they do is they decrease the amount of DHT that is made from testosterone in those patients. Which is considered to be really helpful for halting hair loss. The problem is that a small percentage of people… and by small it’s about 2 to 3% of users, so it’s very small of Propecia, these men will have problems with erectile dysfunction because the DHT is also sometimes important to having normal erections.

So I think that it can certainly be a problem and I have patients that have had problems with it. But by and large, most people who are on standard doses of Propecia are not gonna have problems with ED. And it’s not usually a problem but in 2 or 3% of people, it is.

John: So sounds like you would say that if you feel like you’re wanting to protect hair loss that that actually could be a good intervention that has pretty minor side effects?

Dr. Killen: Yeah, I would say… I do work with men for hair loss as well and I do some of these regenerative treatments for men, and Propecia is definitely something I talk to them about. There’s Finasteride or something called Dutasteride which also is the same group, same kind of idea. But I do think that they can be helpful. I offer it to men as an adjunct of treatment. I also you know, do things like low-level light therapy, or red light therapy, the topical, you know minoxidil, or some of the other… you can also do a topical Finasteride. That’s something else that compounding pharmacies certain ones will make a topical Finasteride. So you don’t have to do the systemic you know, the oral, the pill form that’s gonna cause ED. If you’re worried about that you can do a topical form that also is effective or seems to be without the systemic side effects.

John: Cool. So in closing, where can everybody find you online? I mentioned your Instagram account, which is actually a really cool account to see all the medical stuff, but also just kind of like you know, your life in Utah makes me wanna go to the mountains and sort of like escape the city all the time. So just tell everybody where they can find you online, your practice, all your websites, Instagram all that stuff.

Dr. Killen: All right the easiest way to find me is at And then from there, I have the links to all my different practices, because I have several different practices Yes, I am active on Instagram and that’s at dr.amybkillen on Instagram. And also Facebook, I have a doctor account under the same name. So I love social media and try to be… I’m a little bit like silly and ridiculous sometimes, but it’s a lot of fun.

John: That’s what social media is for. We really appreciate you taking the time. I’m so glad we got to cover so many topics, so much expertise, so much valuable information for people out there. Great chatting with you.

Dr. Killen: Thank you, John. Have a great day.

John: Yep, bye-bye. The”Gene Food Podcast” is our attempt to synthesize the latest developments in the fields of genetics, nutrition, and medicine, and offer you practical tips and stories you can use in your own unique health journey. If you enjoy this podcast, you can find more information online at

John O'Connor

John O'Connor is the founder of Gene Food, a nutrigenomic startup helping people all over the world personalize nutrition. John is the host of the Gene Food Podcast and a health coach trained at Duke's Integrative Medicine Program. Read his full bio here.

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