The Sex Beat, E1: Dr Andrew on Sexual Health Lifestyle Websites
4:57AM May 15, 2021
Dr Andrew Yap
sexually transmitted infections
Hi, I'm Jeannette, and this is The Sex Beat where everything's an experiment. Lately, I've been doing research on traditional medicines for improving penis performance. And as part of that research, I've been looking into Viagra a little bit. And I've been curious about it. Because I've seen quite a number of websites selling viagra or treatments for men, and they're sold as packages, you pretty much go to the website, you click on, say, hair loss or erectile dysfunction, and they have a package that's available for you to just buy. And I was just wondering if this is something that works, because these are medications, right? And how would you know what kind of treatments that work for a specific person or if they're having a problem that needs to be fixed by that specific medication in the first place? So I talked to a doctor that I know. Full disclosure, I work with him on some projects, and he's the one I turn to whenever I have these sorts of questions, because he's always very ready to answer them for me. So I'm going to share that conversation with you today. Hi, Andrew, thanks for being with us today.
Thanks for inviting me on.
I guess I should call you Dr. Andrew. Dr. Andrew, maybe you can tell us a bit more about yourself, the work that you do and your clinic.
Right. My name is Dr. Andrew Yap, I lead my team at a place called The Red Clinic. It's in Petaling Jaya, Selangor. Basically, I would describe this as a general practice clinic that has a lot of Allied Health elements, including psychology, dietetic and ultrasound as methods to aid medical practice. And I think we, I guess, we have a reputation of being known for being very inclusive and being a safe space to discuss, I guess, very difficult medical problems. And I am actually not sure why I'm the one chosen for this topic.
Yeah, so the reason I asked to talk to you was because we were having this conversation about how there are all these men's lifestyle websites that are coming up. And they were selling subscriptions for things like, you know, hair loss prevention kits and erectile dysfunction kits and things like that. And there was something that you said about it that I thought was very interesting about how some of these sites or companies promote, like one size fit all kind of solutions, when actually there are so many reasons for certain problems that a man might face, right? So for example, hair loss, you sent me this long article about all the different reasons why a man might be losing hair. But some of the sites that I've visited have just one solution. And it pretty much prescribes drugs, as well as some hair tonic and things like that. And I don't know how well these things work, right. But I guess one thing I would like to start with is, maybe you can share some of your thoughts on why you think there are more of these kinds of services now, these gender focused lifestyle, medical websites, you know.
I think in our clinic, we have like a couple of keywords that we wish, like repeat for ourselves, which and one of them is patient centric. And I guess the idea is that no patient is exactly the same every patient you sit down in front of is like a fresh poker hand. You know, you might get the exact same poker hand like two times in your lifetime. But you know, it doesn't happen too often, I think a lot of angles of the discussion, for example, economies of scale is one of them. So like in the COVID era, you know, we're trying so hard to scale up vaccines, and we generally just make one vaccine. And we expect that one vaccine to fit anyone that you want to give it to, even if we have multiple vaccines, which we do, yeah, we still don't really ask the question of which vaccine should go to who, right? We haven't really gotten to that point of medicine where we can tailor all our solutions to you know, to be perfectly patient centric. And to be really patient that takes a lot of time, right? So he takes me sitting down with a patient and you know, spending an hour trying to figure out all the angles of his or her problem, and you know, kind of tailor making a plan for that. So economies of scale is one thing, time consuming visibility. And then on the other side of the spectrum, I feel like the problem also exists from the consumer, right. So it's not just from the person who sells their health care or from the doctor, right, is like a very natural yearning for a single solution to be true. You know, like I have a hair loss problem. There must be a solution for this. I would really want the solution to Be it Oh, a something that I can just buy off the shelf, you know, and you'll just work, right? And you see this a lot as online. And I feel the reason buying like health screening packages in Malaysia as an example is a very good example, like you mentioned about meal, right? It just gives you something to cling on to I'm being I'm buying a meals cleaning package. Right?
It's a bit customised. Is it?
Yeah. So it's like, it gives you this idea of like, Okay, this is made for me, right? To some degree, right. But the reality is, is really not that simple. It was like, it's not a one parameter thing, right? Yeah. Yeah. So I guess, you know, on the marketing side and sales side, you take advantage of this illusion that, you know, you that little illusion that this thing is made for you, you know, I send you the link that they have all the different causes that can cause you know, men to lose hair, it's so obvious that there are so many different causes, and all the solutions could be different. And I think that is quite, it's quite telling lie, you know, that our way of selling is not quite in line with, you know, clinical medicine. Right. Right.
As in rent clinics we are selling or
No, I mean, just just the way people sell healthcare stuff in general on the internet. Yeah. I mean, like, for example, supplements are another good example of a situation where people wish that you know, there is like a universal solution to health, you know, I can take this multivitamin or this, this supplement, and I will magically be healthier, right. And I can recommend this same supplement to the guy sitting next to me, and he will be healthier, too. Right.
So you have all of these multi level of marketing
sort of thing, right? Yeah. Yeah. I mean, it's, it's a I guess it's a it's a very natural wish from from a human being, I guess. I mean, just one kind of simple solution.
Yeah. Yeah. So okay, if it's not that simple. What I'm curious about is what are some of the causes for, say hair loss? Are things like erectile dysfunction? erectile dysfunction, simple? Like, is it just like one issue that causes it? Or is there like a whole bunch of issues that could lead to these things?
Well, I mean, in general, erectile dysfunction is a very meal kind of area or product, right? It's very, you know, I mean, it's very suitable for this sort of website, you know, and I think if a patient kind of presents to me with old doctor, you know, very brief vision, by the way, not many patients come in and just volunteered is in revision is like, direct, you know? Oh, yes, sir. This is my main problem. I'm seeing you here today, you know, that we normally try to educate them from this angle, right? So I normally tell them, if you have erectile dysfunction, the smart thing to do is ask why. Right? Right. Because you have not had erectile dysfunction for all your life. And the guy sitting next to you who is exactly your age and very similar profile to you doesn't doesn't have erectile dysfunction. So why you Why now? If we could answer that question, we could very easily help you without a standardised solution, like Biograph for example. Right? Right. So to me, viagara is kind of like the very ending of the of the problem, right? You cannot be direct during sex, right? Yeah. And you just by aggress? Might the physical equivalent of just turning the tap one, play more? Right, but you do that ask yourself, is the exit of the tap blocked? Or, you know, is the pipe you know, like, kind of narrow, or, you know, is there something wrong, right? So simple possibilities of y could be cardiovascular disease, it could be all your pipes are blocked, you have a heart problem, you know, like blood vessel problem, you know, it could be you have diabetes, you know, it could be you have thyroid problems or other hormonal problems. And then a very, very underappreciated one is, I always remember this patient who was young enough for me to be like, maybe you shouldn't be complaining about erectile dysfunction at your age, you know. And then after he told me a story, which was very unique, he said, Actually, I have a very kind of funny angle to this problem. He said, whenever it's like a one night thing, right? Like the Google club, I picked someone up or something like that, right? I never have this problem. But whenever there's a chance of something serious, like we have gone out for dinner, like a couple of times, and it happens, it always has this problem.
On my side. It's really a psychological thing already.
Yeah. Yeah. It's like a psychological aspect of it is also possible. Right? So in the end, I asked one of the clinical psychologists and are pleased to see you. And we tried to solve the problem from from that angle, rather than, you know, from biografia. There's a range easy example of why not a single solution kind of fits,
right? So in cases where there are other issues, you know, like, say cardiovascular disease or diabetes, would you say that simply prescribing or I don't know if it's prescription medication, but if you just take Viagra as a sort of like quick fix for it? Could it actually cause more harm?
Yes, it could. I mean, best case scenario in the guy who has a psychological cause of erectile dysfunction, you just turn the tap on bigger and you don't damage anything else. You don't affect his psychology. In fact, you might even give him a little bit more confidence maybe. But in the case where your pipes are already leaky and about to burst, right, you tend to tap one, you know, a bit stronger, and you might cause a problem, right? So a very simple kind of warning that you should give patients when you give them viagara is the possibility that, you know, if you do have a cardiovascular problem, it should be addressed. You know, before you use by grindel. Yeah. Right.
So you know, earlier, you mentioned that most patients who have erectile dysfunction will not come into the clinic and say, I have erectile dysfunction. How do you eventually discovered that that is
their problem? Well, imagine you're a patient. And that's actually your problem. I guess, if you're brave enough, you probably go to the doctor and just like a doc, and get it up, you know. But obviously, not every patient will be. And by the way, oh, that highlights a very good point about the way things get stole online, right? Sometimes, because the patient doesn't dare to do that. They search for a solution online. Yeah. Often from a non expert point of view, or, you know, some the person who is selling it to you is not a doctor.
And they always promote the whole, like, discreet shipping or something like that. Right?
Yeah. I mean, I will, obviously indirectly we deal with a lot of sexual health, chemical issues, right, HIV medicine, you know, sexually transmitted infections, that kind of stuff. And I was once approached by a company that was kind of really, really pushing the the space of online consultations with doctors. And then they were like, Oh, we want you to be on and I was like, But why me, right? isn't like, there's literally a clinic next door, go go look for him, right. So I realised very slowly that the reason why they were chasing me is because I have this reputation of, you know, during consultations, you know, about sexually transmitted infections. And then very quickly, they realised after lunch that, hey, so many of the conversations that get purchase are something to do with STDs, or something to do with HIV tests. And basically, they're all just conversations that people don't want to have in person. Right? team composition as erectile dysfunction condition. Right? Right.
Yeah. So then they go into the clinic, and they won't tell you that they have issues there. So what do they go to the clinic for actually finding vitamins.
Sometimes, sometimes the patient gets enough courage gets into the room, but the patient will beat around the bush. And there is like, I guess, it's even taught in medical schools or perspective, from, you know, kind of cleaning kind of consultation, that if you have a hunch that the patient has a hidden agenda, it's not coming out, you need to drag it out. And it's even part of medical exams, you know, like even postgraduate exam, sometimes they will purposely put a kind of a clinical patient where the patient is an actor, and he's going to beat around the bush, you need to drag out the hidden agenda from him. Right? So I guess it's a consultation skill, like a clinical consultation skill, if you can sense that, oh, it's beating are good. Maybe direct questions are better and not open ended questions. Right. I can remember one of the exams in medical school was, it was an old lady who refused to go for breast cancer screening. And her doctor was very distressed about this. And a doctor asked me, the doctor or the student who is going to the exam to try to talk to and then supposedly, the skill that was required was to dig out what was the reason why he doesn't want to go for for the breast exam. And it turns out that, you know, it's something like, Oh, she just so happens to have multiple very close friends who are really suffering from breast cancer, and they've all passed away. And it's something very traumatic for her and she just doesn't want to go through it again, something like that.
Right. So actually, human beings are more complex than we realise.
Yeah, yeah, for sure. I think being patients and chick is something unfortunately, of a rarity. I think our hospitals tend to work that way as well. You know, patient is bit number one and his diagnosis What? Yeah, and we never really get to the bottom of it. Everybody in medical school keeps telling you take a social history, take a social history, but all we do in medical school, say Are you married? How many children do you have it all?
Right. Right. Earlier you mentioned some patients really find it hard to talk about these things, right? Is it a cultural thing?
I think culture definitely plays a part, right? For example, I mean, if you expect a young girl who is born and bred in Saudi Arabia or something like that, and to come forth and, just be forthright and say, Hey, Doc, do you know that she's sexual by Ms this past year? Two of them with no condoms? You know something that I can you please do an STD check for me, it's obviously not going to happen and realising. So culture definitely plays a big part. And I guess religion in particular, right, it really does influence a lot. And I think one of the things I've discovered over the past couple of years is that the conversation seems to happen a little bit easier. If you kind of have a reputation. If a friend of the person says, you know, it's okay, I think you can go in tell, just just tell Andrew, this, you know, walk in the room, don't be afraid, you just tell him this, right? It tends to happen a bit easier because of the reputation. And also, it tends to happen a bit easier if we kind of lower ourselves to the level of the patient and kind of like behave almost like we're in the same community as a patient and speak their lingo and make them feel comfortable. You know, like if there was a common kind of terminology for young people for what erectile dysfunction is, if there was a dose that lingo for certain STDs, you use it in the consultation? Or if there was a lingo for certain sex acts, also, then you'd want to use it, you know, because it makes the patient kind of present the problem with more forthright nature.
Right. Do you think if in general conversations like these were normalised people would feel more comfortable talking to their healthcare providers about these things? Yeah.
So I think this is a two way street, right? I guess we haven't really managed to get all healthcare providers comfortable with talking about everything. Oh, yeah, that's true. So there's a side of the street, which belongs to the healthcare provider. And then there's a side of the street that belongs to you know, the person seeking the health, which is why the reputation is like an element. Right? Because once the business wants to see to help they already like they heard it from somebody that is okay, you know, we can tell this person this problem. Yeah. Just imagine if you had like a problem, similar to erectile dysfunction, for example, right. And then you walk into a room, and you see a doctor who is dressed, you know, in like a full, you know, kind of Muslim, you know, like, all black, you know, covering everything except the eyes, and you know, everything to the wrist and everything to the toe, you know, kind of thing. I'm sure you feel more intimidated as well, you know, you'd be like, Oh, no, like, maybe I should not bring this problem up, and then you'll make some excuse that you have diarrhoea or something. Yeah, yeah. Yeah. Makes sense. Speaking the lingo and so on and so forth. I think the appearance also plays a part, if you see a doctor who's Okay, maybe not too young, you know, like, these 40s. You know, he looks like he's well dressed, you know, you see a tattoo on his sleeve, you know, and we can speak casually to you, you'd feel much more comfortable, you know, in trying to have this kind of position. That is true.
Right. So in this case, like stereotypes.
Yeah, in both directions, right.
Yeah. This has been very insightful. I think it's very interesting to learn that, you know, erectile dysfunction, especially cannot be fixed with Viagra all the time, different people react to treatments differently. And I guess a patient centric approach is very important.
Yeah, I think that is certainly the philosophy that I personally cling on to as much as I can, you know, and I think there's a demographic of my patients who really can appreciate that.
So that was talked to Andrew, I hope to be able to do more of these interviews and recordings and share them with you. If you have any feedback, stuff you liked, didn't like stuff you want more of, feel free to get in touch with me via email at firstname.lastname@example.org. That's G and n e t t e. a hitch ey.com. Thanks for listening.