A Link between COVID-19, Low Testosterone, ED, and Photobiomodulation Therapy?
A Link between COVID-19, Low Testosterone, ED, and Photobiomodulation Therapy?
By Ryan Novak, DC
Erectile dysfunction (ED) is becoming even more of common problem for men of all ages, especially in the COVID-19 era we live in today. Multiple studies in the past few years have shown that a prior COVID-19 infection in men younger than18 is associated with a 27% increase in newly onset ED, a 30 to 50% decrease in testosterone levels at 12 months and seven months, respectively, post-COVID, and a 10% risk of experiencing a continual degradation of testosterone levels.1,2,3
We know ED and low testosterone are not the root of the problem but are symptoms indicating much more severe cardiometabolic disorders. Could photobiomodulation therapy (PBMT) be the first-line, cost-effective treatment of choice (with lifestyle modification) for these interrelated conditions?
ED is complicated and many physical, biochemical, microbiota, and emotional factors play into normal sexual function. There is a known bidirectional relationship between neuropsychiatric conditions, such as depression, and difficulties with starting and maintaining an erection. Whatever the cause(s) may be for each person, there is a lack of blood flow and retention of blood to the penis.
The standard of care for nonsurgical treatment of ED is oral phosphodiesterase-5 (PDE5) inhibitors, such as sildenafil (Viagra) and tadalafil (Cialis), unless contraindicated (e.g., patients with high cardiovascular risk). The typical side effects of these oral drugs include headaches, flushing dyspepsia, and nasal congestion, as well as other less common side effects that include visual abnormalities, back pain, myalgia, and erections lasting longer than four hours.
Current alternative treatments available include administering extracorporeal shockwave therapy, platelet rich plasma (PRP), and stem cell injections along the corpus cavernosum at the 10 and two o’clock positions and at the glans penis. These have proven to show satisfactory treatment outcomes, but the treatments are very costly to the provider and the patient and come with their own possible side effects of pain, swelling, bruising, and nerve damage. These treatments also do not address the possible neuropsychiatric component of ED.
When an ED patient goes to a chiropractic physician’s office, the provider currently has limited valid treatment options that directly affect ED outcomes because they are either outside the scope or principles of the chiropractic physician or outside the budget of a standard chiropractic office to implement. Photobiomodulation therapy (PBMT) devices, on the other hand, are readily available, affordable, and within the scope of the chiropractic physician and can be quickly, easily, and safely implemented.
ED-Correlated PMBT Research: Although PBMT is not currently approved by the FDA for the treatment of COVID, ED, low testosterone, or any sexual dysfunction or interrelated conditions in the US, numerous studies in literature worldwide have been conducted indicating a plethora of beneficial effects beyond its very well-known anti-inflammatory effects.
Erectile Function Improvement: One study of 44 ED participants from the department of urologic surgery in Israel suggests applying PBMT with nonpulsed 808 nm laser energy along the corpus cavernosum for 20 minutes two times a week for six to eight sessions, suggesting ED improvements that lasted for an average of six months with no adverse effects.4
Increased Sperm Count and Motility: A foreign clinical trial was conducted by applying PBMT with nonpulsed 635 nm and super pulsed 904 nm laser energy to the testes of men with oligozoospermia for four minutes two times a week for 10 sessions, which suggested a significant improvement in sperm motility and number, along with increased libido.5
Increased Testosterone Levels: It is well known, especially in the biohacker community, that light therapy increases testosterone production, but the data is very elusive. One study in rats found that irradiating the testes at 360 J/cm2/day for five consecutive days with 670 nm light energy was effective at increasing serum testosterone levels without causing any visible histopathological side effects.6
Nitrous Oxide Increase: Nitric oxide (NO) relaxes the muscle tissue to allow blood flow into the penis for an erection. This can be achieved in multiple ways, including PDE5 inhibitors, PMBT, etc. PMBT with near infrared light improves endothelial dysfunction by increasing NO.7
Neurovascular Regeneration: In a 2024 study, PBMT was used to restore erectile function through the regeneration of neurovascular connections in mice with an induced cavernous nerve injury.8
Gut-Brain Axis Balancing: In another 2024 study, a gut microbiota imbalance was shown to not only cause psychological ED, but it can also increase TMAO levels that damage the vascular endothelium, which leads to the development and progression of physiological ED.9 Research suggests that PBMT may have a beneficial effect on gut microbiota through gut inflammation reduction, increasing beneficial microbial communities and decreasing pathogens and toxic metabolites.10
In a double-blind clinical trial in the US on sexual dysfunction for major depressive disorder, t-PBM was applied with 823 nm light energy to the forehead bilaterally, per EEG placement map, directed to the F3 and F4 sites for 20 to 30 minutes two times a week for 10 sessions, which suggested a significant improvement in sexual desire, arousal, and orgasm for the subjects receiving the t-PBM versus those receiving the sham treatment.11
Stem Cell Proliferation, Differentiation, and Steering: It is well known internationally that PBMT increases stem cell proliferation when applied to superficial bone-marrow-rich sites, such as the tibia, which can have potential therapeutic application for many conditions. In multiple studies, PMBT has been used for stem cell proliferation and differentiation and steering to target tissue.12,13
PBMT could theoretically be used as a multifaceted, personalized approach to address interrelated issues in each ED patient. Treatment could consist of treating points on the abdomen to balance the microbiota and metabolic flexibility; bone-marrow-rich sites for stem cell proliferation; major artery or vein for a systemic anti-inflammatory effect; internal pudendal artery for localized increased blood flow; affected tissue of the testes, corpus cavernosum, and glans penis for neurovascular regeneration and by treating the neuropsychiatric component through t-PBM.
Because of the immense safety of PBMT, this treatment could be conducted at the convenience and comfort of the patient within their home with instruction from the provider. The International Index of Erectile Function (IIEF) questionnaire and Erection Hardness Score (EHS) are readily available to the provider to be used as outcome measurements.
Preliminary data is very promising, but more research is needed to determine if PBMT will become the new first-line, cost-effective treatment of choice for erectile dysfunction (ED).
About the Author
Dr. Ryan Novak is a practicing naturopathic and chiropractic physician. He is also the chief scientific officer (CSO) for a sonophotobiomodulation therapy medical device facility and consulting firm that develops and distributes FDA-approved and registered devices, such as the PainBuster Super Pulsed Laser. Visit painbusterlaser.com.
References
Hebert KJ, Matta R, Horns JJ, Paudel N, Das R, McCormick BJ, Myers JB, Hotaling JM. Prior COVID-19 infection associated with increased risk of newly diagnosed erectile dysfunction. Int J Impot Res. 2024 Aug;36(5):521-525. doi: 10.1038/s41443-023-00687-4. Epub 2023 Mar 15. PMID: 36922696; PMCID: PMC10015534.Accessed: 9/28/2024.
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Yacobi Y, Sidi A. Department of Urologic Surgery, The Wolfson Medical Center, Holon, Israel.
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