Mens Sexual Health After 60: Procedures That Actually Work

because of overstimulation over time through masturbation and sex. And also just the tissue aging. And so we want to make sure things also feel good again so that men can feel more engaged in the activities that they're actually dabbling in with their partners and with themselves so that they can— are able to sustain their erections.

There are probably quite a significant number of men who may have wished at some point in their lives that they had a bigger penis, or maybe they wanted a firmer erection. Or maybe they just wanted a more aesthetically pleasing penis. My guest today is a guy called Chris Bustamante. He's from Lushville Aesthetics. He's based in New York. His job is to give men some of that confidence that they might lack through some of the procedures. He's known on Instagram as Injector Chris, which should tell you something about what his specialty is. Chris, welcome to Sex Advice for Seniors.

Thank you so much for having me, Suzanne Noble. Yes. So as you mentioned, I am based in New York City, also have a satellite location in San Diego, California. I'm a board-certified nurse practitioner who specializes in aesthetic medicine, but also has had training in men's sexual health, urology, and also proctology as well. So kind of full spectrum with when it comes to sexual health.

So when it, when it comes to sort of all the older men that you see, what are some of the most common procedures that they're looking for and that they, that they come to you for?

Yeah. So, I would categorize, you know, the type of men coming to see me into two compartments and they can definitely overlap. So, one of them will be more sort of the functional medicine component where it's wanting to improve, you know, erectile and erectile enhancement. It's gonna want to help to whether through different modalities as well. So, we have different procedures that we can kind of dive into for that. So, it'll be shockwave therapy, P-Shot. It'll be our signature Showtox procedure, which is penile Botox. And then we have more of the aesthetic treatments, which will be girth fill. It's utilizing filler to enhance the size of the penis. And so some men are coming to see us just for functionality improvement, wanting harder, firmer erections. Some of them are seeing us just for aesthetic concerns and wanting to enhance the size of their penis or change the aesthetic of it. But then also many times, of course, it's, it's both, right? Depending on what the patient's needs and wants are, we kind of, you know, address it based on the procedures that we have available to them. And so You know, a lot of times I think that we see men as they get older, you know, erectile, you know, performance is something that people have many concerns over. Of course, there are the pharmaceutical route, which, you know, there's lots of safe options there. But I think that in medicine, we find that combined approaches are going to give people the best outcomes. So, when I offer people, especially men of a certain age, treatments such as shockwave therapy or P-Shot or Showtox, it's not necessarily saying, hey, do this and see instead of taking your Cialis, if that's prescribed by your, you know, your urologist or your primary care provider. But it's saying like, hey, let's use that in conjunction with your Cialis. Right. Because what we're treating here with shockwave therapy and P-Shot and Showtox is going to be more of like kind of the root cause. Right. You know, the tissue has sort of aged over time. The ability of blood flow is not as sufficient. And so we want to be able to improve that physiology.

Interesting. I noticed that I think I'm right in saying that your approach to P-Shots, and you can explain to people what this is, is a little bit different than what they might expect at some other clinics.

Yes. So I looked at, you know, what would be giving patients the best results possible. And I think that sometimes people, they, when it comes to PRP, there's so many options out there. PRP is platelet-rich plasma. It's when we draw blood up from, you know, your arm. We'll spin it in a centrifuge and extract that gold plasma, which is the, the PRP, and inject that into the corpus cavernosum of the penis. It helps deliver your own body's growth factors into the tissue to help the regenerative process of helping with improving the capillary fill, helping to improve nerve sensation. So, both of those components are, you know, components of what triggers an erection, right? It needs to feel good and it also needs to be able to fill up with blood. Now, we always want to make sure we're delivering the most amount of growth factors possible. And so not all centrifuges that we spin blood in are created equal. Most of them are, you know, kind of your standard centrifuges that we use for kind of routine blood work. And we do see this a lot in the aesthetic space as people having— usually working with these type of basic centrifuges. There's nothing wrong with them. But in terms of for P-Shot, we really want as many growth factors as possible. And a standard centrifuge those test tubes that you all are familiar with that we, we get blood work done there, they usually hold about 8 mL of blood. We spin it and we get about half of that converted into PRP. It's a really low conversion rate. It's going to be very low concentration. I draw up 120 mL of blood into these two rather large test tubes, and then I spin that twice to bring it down to 14 mL of HDPRP, so high definition PRP. So it's a really high conversion rate, and so that way I'm getting as as many growth factors as I possibly can from the patient's blood to give them the best results. So that's why, um, in my practice, when people come in for P-Shot, it's not a series of P-Shots that you come in for. You just come in, you get the treatment done. Um, for most patients, I recommend doing it twice a year, so once every 6 months, um, versus some other clinics will say like, oh, you need to come in for a series of like 3 to 6 P-Shots. That's kind of ridiculous. It doesn't matter if it's even the same price or cheaper. It just doesn't make sense because you're basically mostly just injecting Honestly, like your own body's like water and electrolytes doesn't really have many growth factors. So you're going to want to look for someone who has a double spin centrifuge for P-Shot. Even if it's not me, you're going to— that's what you're going to look for.

That's really interesting. What is— and because of that, is the outcome— is the result faster? Do you see faster results doing that?

It's a faster result because it's just a one-time treatment. Patients should expect the full results within 6 weeks. And it's also just a more efficient treatment. This is the type of device that's also utilized by medical providers who treat like joints with PRP, where it's going to be that really, again, that really high quality, high concentration. Because you have to think about for those procedures, when people are treating joints, those are usually ultrasound guided. They're kind of a little bit more invasive. And, you know, they, they take a little bit more time in the office. So you're never going to want to do one of those procedures with sort of like a single in, you know, cheap centrifuge. Like, it's always done with the highest quality because you just want to get in there once and do it. For a lot of those treatments, they really just only want to do that like once a year tops. So I'm using the same type of centrifuge in my practice for when it comes to P-Shot.

What can men expect after 6 weeks?

You're going to expect erections that are a little bit more spontaneous, more things also feel better. The quality of the erection is harder and firmer and works really nice in conjunction with any medications that you're already taking. I like utilizing it in my practice in combination with shockwave therapy. Shockwave therapy helps to basically send these pulses through the corpus cavernosum, the erectile tissue, and actually causes these little micro injuries that you don't notice or feel because the procedure is actually painless. It helps to tell your body to help heal these areas by causing these sort of micro injuries, and so your body lays down new vasculature, so more capillaries, and helps to also improve the nerve sensation in that area. So typically a lot of times my patients will do a package. They'll come in for about 3 to 4 shockwave sessions first, and then we'll do a P-Shot to introduce growth factors into the healing tissue, and then they usually wrap up with another 1 or 2 shockwave sessions. And this will really help the patient feel, again, more of that spontaneity, not having to feel like you have to always completely rely on medication, but also helps with the quality and firmness of the erection. And again, the sensation, because I keep saying sensation a lot because I think we only really talk about blood flow when it comes to erections.

Yeah.

But I don't think that people realize unless they've really gone into the specifics of erections, But there usually is sort of a dulling that happens to the penis as men age. It does— things don't really feel quite as good as they used to because of overstimulation over time through masturbation and sex and also just the tissue aging. And so we want to make sure things also feel good again so that men can feel more engaged in the activities that they're actually dabbling in with their partners and with themselves so that they can— are able to sustain their erections.

Yeah, no, that makes absolutely perfect sense. I mean, I don't know if it works the same way in men as it does in women, but I know with women, for instance, with the clitoris, the smaller nerves just start to deteriorate over time and the larger nerves take over. And so they just require a lot more stimulation, which is why we have a vast selection of vibrators that are available to us now because, you know, sometimes we old ladies, we need that kind of stuff. I'm assuming the penis kind of works the same way, that just over time things just become a little less sensitive and they need a little bit more friction and, you know, attention. Yeah, attention.

Exactly. So another procedure that I like, that this— so Showtox, which is penile Botox, we— I love this procedure for men who are a bit older who are on medication, um, because this one works the most synergistically with, like, Cialis, Viagra, etc. So what penile Botox does, it actually relaxes the sheet of muscle that surrounds the corpus cavernosum, and so it'll allow it to dilate easier so that your erections fill faster and they fill harder. So it's not technically really functional medicine because it's not using your own body's mechanisms to heal itself, like shockwave therapy or using your own body's growth factors. This is a— Botox is a medication that relaxes muscles. And so by relaxing this sheet of muscle, it's going to help it fill faster. So why does that work so synergistically with medications such as Cialis and Viagra? Because those increase blood flow. So if it's increasing blood flow with medication, now the Botox has relaxed that muscle, it'll fill up faster, and it'll also allow more blood to fit into the penis technically. So you're really allowed to be further engorge. So, men will notice that they're getting faster erections, fuller erections, harder erections. And so, I really like that for patients who are already on those medications because it makes it work that much better. Botox lasts, you know, 3 to 4 months. So, depending on the patient's needs, they would get this procedure done, you know, every, you know, I would say 2 to 4 times a year depending on what they're looking for. But that's a really quick procedure. It takes me, after numbing, it takes me about like a minute to perform. So overall, it's really fast. Yeah. And it takes 2 weeks to kick in because Botox does take 2 weeks to kick in. But patients love that, whether it's part of their daily life that they want to sort of have this all the time, or maybe it's for special occasions for, you know, they're going away for the summer or they're going away on vacation. They want to feel a little extra, you know, wham bam. And so I think that that's a really, really nice treatment for that.

Yeah. And I'm curious to know, similar to Botox that you put elsewhere in your body, does it— when the penis is flaccid, does it look fuller?

So it does potentially have that aesthetic effect of, you know, relaxing the penis a bit more, and therefore it could look a little bit, you know, fuller, longer when it's in its flaccid state, because it's not able to fully retract, is really what it, what it is, what it comes down to. I think that the aesthetic effect is very variable, whereas the functional effect is very reliable. So I, I really see everyone have a really nice response to the functional component to it. As for the aesthetic effect, I think it's so multifactorial because it's gonna be a lot of like, because that retraction is dependent on your stress levels, you know, the temperature outside, kind of like what you're wearing, you know, in terms of clothing. So depending on how guys kind of perceive themselves in that way, they may not really fully appreciate that result. So I try not to market it that way because I feel like I can, for some people, can feel a bit disingenuous, and I never really want that to be the case. Do some guys tell me like, oh, I really like this, kind of like I hang a bit more? I'm like, yeah, of course, you know, some guys will tell me that and that's great. I'm gonna, I'm gonna say yeah, that's awesome, because I think that anything that we can do that makes us feel better and things that we notice about ourselves is always a plus. But when it comes to sort of that aesthetic effect, that's kind of where the filler comes in. And so, GirthFill is our signature penile filler procedure. And we're basically injecting dermal filler that we would use for the face, nice, thick, robust HA fillers that really mimic that natural look and feel of erectile tissue underneath the subcutaneous plane of the penis. So, it's above the erectile tissue, but below the skin. And so, it's going to thicken the penis both when it's erect and flaccid. And that one also does a really nice job because it physically will modulate the penis so that you're not really able to fully retract. So guys will look bigger in their flaccid state. Really great for kind of like if you're, you know, self-conscious in the locker room, or even guys just tell me like around walking around their, their partners, even if they're, they're married, they kind of just feel like if they're very small when they're flaccid, they kind of feel less sexy. And so they kind of feel like by, you know, being a little bit bigger, even just in that flaccid state, they feel like their sex lives improve because they feel less self-conscious and they feel like they're kind of, as a lot of guys will tell me, like more likely to kind of make a move, if they will. And they kind of like spurts, spurts that spontaneity with their partners, which I think is really fantastic. But yes, of course, you're also increasing the size of the penis, which I have a lot of men who will come to me after, whether they're recently divorced or they are now empty nesters is a big one as well. They find that I'm kind of spicing things up with my partner again. And my wife and I are like, we know we're getting back into things again. And, you know, this is kind of their way of kind of freshening up, if they will. A lot of times, you know, they've told me that their wife has also done something, maybe, maybe she's had Botox or her lips done. And so it's like they're both kind of like treating themselves a little bit so they can kind of feel, you know, really sexy for each other again. And I think that that's a really cool thing, and I think that that's really what we talk about is empowerment, right? And what we can do to make ourselves feel better for any stages of our lives when it comes to sex. Yeah.

Yeah. And I mean, you know, penis size for some guys gives them a huge amount of confidence, right? I mean, it just does. And I suppose it's kind of like walking around. I remember a guy years ago that used to walk around and be like, oh, I've got a semi on now. It's like, he seemed to, he seemed to always have one. And it was like, oh, okay, fine. So it's kind of like, it's like having a semi all the time, really, I suppose.

Yeah, you're kind of just like a bit more ready. You're ready to show off. And I think that for some people and their partners, that really kind of spices it up. It kind of makes you feel like you're in your 20s again. You know, you're always kind of like ready to go and you're excited about it. A lot of guys will tell me that girth fill is kind of like, you know, them treating themselves to like, you know, their Ferrari. Like a lot of, you know, there's always that joke of men in like sort of midlife, later life, they get a really expensive car. They're like, I've always wanted this. Well, in my practice, it's like, well, I've always wanted a big dick, so now I'm just gonna buy myself one. And now you can. And that's exactly what it is, right? And so I have men coming in, many, many men in their 60s, and I also have men in their 70s coming in for this. And they're really like, they're like, I'm just here to have a good time, I just want to have fun. And they're really just focused on fun for, you know, they're like that sort of later stage in life. I think that why the hell not, right? Like, who's for anyone to say to anyone how they are to live their lives? So I think that that's a really cool thing. But then the last procedure I would like to highlight that I think is really gaining a lot of popularity because now, I'm sure you've had this conversation many times on, on your podcast, is that more and more people, men and women, are doing hormone replacement, right? Um, and that's making people feel— yeah, men, men and women are— it's making them feel really great and later in their life and they feel like it really helps rejuvenate their sex lives. And so while I don't offer testosterone replacement in my clinic per se, I do treat a lot of men who are on testosterone replacement and I love it. I think it's fantastic when they're seeing the right provider for it. But one of the side effects that is not so fun is, you know, the testicular atrophy or the shrinking of the testicles. It is a very normal and it's, it's kind of an expected side effect. It kind of happens kind of progressively as you're on treatment. And the reason for that is because the testicles are a gland. And so they are the responsible party for producing testosterone in your system. And of course, as you get older, this sort of declines in their ability to do so. But when you start introducing a synthetic hormone like testosterone to your body from an external source, you know, when we, you know, inject it, it tells the body that the testicles are no longer needed for this at all. And so when glands are not needed, they shrink. And so there's lots of forums, lots of Reddit pages. You do a couple Google searches and you'll find everything you need to see. But it's called testicular atrophy, or guys will say their balls are shrinking. They literally do. It's very real. And so a lot of guys, as they're on testosterone longer, they get very self-conscious of the fact that their balls are a lot smaller. And so I created a procedure for this called Scro-Fill. And so what I do is I use kind of the opposite of penis filler where I'm using a very thick filler that's nice and firm. I'm using a very thin filler that's very, very thin and watery that I'm injecting intradermally. So into the skin itself, nothing goes inside the scrotum. It goes into the skin. And I strategically place all these microdroplets with a very tiny needle. You're fully numb for this. You don't feel it. And it thickens that skin of the scrotum to make it look fuller. And so it actually makes it look like you have bigger balls. And so, and I have, and I have before and afters for all this on my website. So if anyone's ever curious to check this out, it's lushfulaesthetics.com. We have before and afters for girth fill and scrofil. But this helps to really enhance the size of the scrotum again so that men can feel more confident, like their balls haven't shrunk. And I have younger patients who did this procedure just because they want bigger looking balls and bigger bulges. But I find that for my more mature patients, they really see this as kind of a more of like a restorative rejuvenation procedure as well, even though it is just aesthetic, right? It's kind of like no different than a woman kind of going in for a breast lift, right? And so wanting to kind of feel like that area that you once had before kind of now looks a bit more like it did before, and you can still reap the benefits of your testosterone therapy.

And I'm assuming, like all Botox therapies, that it requires a certain frequency of visits. So once every 3 months, once every 6 months, how often Do people have to come and visit you if they want to keep this aesthetic look?

Yeah. So when it comes to the filler procedures such as GirthFill and Scrofil, filler is different than Botox. Botox is a medication that's injected into muscles. The filler is actually an HA, and so it lasts significantly longer. So people come in for touch-ups just once a year or year and a half the most, and they're able to maintain the results. So it's not like Botox where they have to come in every 3 to 4 months to reintroduce the medication into the muscles. These fillers that actually produce volume, they last significantly longer. And so they just kind of need to do like about every year, year and a half for a touch-up.

Cool. And obviously these are incredibly specialist procedures. I've done over 100 of these podcasts and way over 100 actually. And yeah, I mean, I've spoken to people about P-Shots and things like that, but I have to say that the girth fillers and stuff like that, I've never spoken to anybody about them. So obviously these are super specialist procedures. How much would one expect to pay on average for something like girth filler, for example?

Yeah. So girth filler, the average treatment we would use 15 syringes. It sounds like a lot cuz for the face you would never do that. But for the penis, it's actually, it's even for average size penises, they actually are considerably large in terms of surface, surface area. And in order to actually see volume that's, you know, worth doing, we do 15 syringes and that averages out to about $10,500 US. The scrotum would be pretty much about the same. So you would do the same amount there and you would, For the maintenance and the touch-ups, I tell people they should expect to do about half of that every year to year and a half to maintain it. So the initial treatment, about $10,500, and you would do about half of that for your touch-ups. And then, yeah, it's definitely something that is going— you're gonna wanna see someone who does this on a regular day basis for it. You're not gonna wanna just go to your dermatologist or any plastic surgeon. It's really someone who just focuses on this area. In my practice, this is the really what my practice is built for. I actually don't really dabble too much with the face anymore. I really just focus on sexual enhancement. And I do about anywhere from 3 to 5 girth fill procedures a day in my clinic.

And finally, yeah, finally, are there any procedures that you do for women or is the stuff that you do in the sexual health space just focused primarily for men?

My clinic is focused just for men. Yes. So I do have colleagues that I will usually refer people out to when it comes to, you know, women coming in for, you know, there's the O-Shot, which is the comparable procedure of P-Shot. And so is injecting PRP into the clitoris. And the one procedure that I will see some women for is Hulotox. And so that's anal Botox. And so it's in my practice, excuse me, in my practice, it's mostly for gay men, but I do also have cisgender and transgender women that come in for Hulotox. It helps to relax the anal area a little bit. So they're able to receive anal sex a bit easier. And so I do have some women who come in for that when they're exploring anal with their partners, which I think is also fun for people to just try new things.

That's really super interesting. And how long have you been doing this? And I mean, I should have asked you at the very beginning because it's—

yeah.

What made you want to go into this area?

It kind of came to be through just my experiences in terms of clinical experience. So I was always interested in facial aesthetics. I went to nursing and school with the idea of being a face injector, and I worked for an injector when I was in nursing school and after nursing school. And then I also got a job working for a proctologist. And so that's, if anyone doesn't know, it's kind of like, it's an, he was an anal surgeon, if you will. So he would help correct hemorrhoids, fissures, those types of things. And he was really, he was really kind of the pioneer of like utilizing Botox in that area for sort of non-pathologic reasons. So people who kind of just had what we kind of called like generalized anal tightness. And so I saw that as an opportunity of being able to take it even more kind of mainstream and offering it to more people in a way that's just kind of not having to try to go through all the, the failed attempts of insurance and just being able to be able to offer it. And then during, um, my NP program, I got to work with a sexual health urologist, and that was fascinating to me. And we talked a lot about hormone replacement, ED, shockwave therapy, P-Shot. And that's also kind of where I saw, cuz you, you meet so many men, like, I mean, several a day, you know, that are coming in with all sorts of different needs and interests. And a lot of times I saw men who have kind of done some sort of augmentation to their penis, um, and it was really— I don't think I really saw many of them that I actually thought were well done back then, um. And so it was still kind of an emerging thing in the US, um. And so I was like, wait, I could do this and I could do this better, um. And so that kind of led me on this mission on being able to kind of take all these things that I've learned from these different avenues of work and having them in my clinic and being able to kind of really just phone— focus in and hone in on them and refine them and kind of perfect the technique, the aesthetic, and kind of cater to just sort of that niche. And so as time has gone on having my own clinic, I've kind of felt like I've leaned in further and further into these niche procedures. And I think that that's kind of what's led to the prosperity of my clinic and being able to deliver such consistent, optimal results. And that's what people really seek us out for.

Yeah, absolutely. And I think it's a really fascinating area. And also, as you said, you know, if a guy is looking for confidence and he's looking for that aesthetic, you are there to support those people. And it sounds like it's a completely safe procedure and there's no, there's no risk attached to any of this.

They are very safe procedures, meaning that there's minimal risk when in the right hands. But with any medical procedure, there are basic risks. I mean, I think that anytime anyone's injecting anything into you, there's always a small risk of infection, right? But we really don't see those in clinic, but it is technically on paper. Bruising, swelling, those are very common and should almost always be expected. But those are really honestly the most common things. It's a very safe procedure in my practice. I don't lose sleep over it because I know that I take all the necessary steps. I, when it comes to the filler procedures, I prescribe prophylactic and low-dose antibiotics for a week. We'll do like a low-dose steroid for swelling and inflammation, and that's pretty much it. You know, the bruising and swelling kind of resides on its own, and then people can kind of just go about their days. And there's very minimal downtime for the filler procedures. There's kind of like 3 days of no hot tubs, no pools, no saunas, no sex, you know, just really kind of minimizing that infection risk when it comes to the functional procedures, because those are done with like very, like very, very, very tiny needles. It's basically just like 1 day of downtime. And so people are able to kind of go back to their, to their life the next day as if nothing ever happened. So really minimal interruptions, I think, to people's lives with very great benefits.

Terrible. Anyway, I'm having a little bit of a bit of internet difficulty here. I don't know if you can see that at your end, but I'm having it at my end. Hopefully it's all going to be okay. I can see that it is trying to reconnect. So fingers crossed, this is all going to work. Chris, it has been absolutely lovely to have you on the program. I hope that this is still connecting. It says it is, so that's good. It's been really lovely to have you, and like usual, we'll be putting all the details about where we can find your clinic in the summary that goes out via Substack and any other links that you want me to include, that would be absolutely fantastic. And thank you so much for being on the show.