Doctors Are Removing Testicles for This | Dr. Susan Macdonald

Most men don't know they have a pelvic floor, and most doctors aren't trained to look for dysfunction in it. The result: testicles are being surgically removed for pain that's actually neuropathic, at double the rate of a far more effective nerve-sparing procedure.

In this episode, Dr. Gabrielle Lyon sits down with Dr. Susan Macdonald, a board-certified urologist, surgical program director at Penn State, and one of only ~30 U.S. specialists treating chronic pelvic pain in men, to discuss:
• Why "prostatitis" is often the wrong diagnosis, and how rounds of antibiotics mask the real problem
• The male pelvic floor anatomy almost no medical school teaches, and how to recognize dysfunction in yourself or a patient
• Off-label medications (Cymbalta, gabapentin, amitriptyline) that are quietly transforming chronic pelvic pain treatment
• Why erectile dysfunction is rising sharply in teenagers, and the role pornography plays in rewiring young brains
• Who actually qualifies for a penile implant, and what the surgery really involves

If you've been told your pain is "all in your head," or you're a clinician seeing patients fall through the cracks, this conversation gives you the framework, the language, and the next steps to find real answers.

Thank you to our sponsors:
• Manukora - Go to MANUKORA.com/DRLYON to save 31% plus $25 worth of free gifts.
• Timeline - Get 20% off your Mitopure order at timeline.com/lyon
• BONCHARGE - Save 15% at boncharge.com with code DRLYON

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Find Dr. Susan Macdonald at:
Instagram: instagram.com/drsusanmacdonald
X (Twitter): x.com/smacdonald_md
LinkedIn: linkedin.com/in/susan-macdonald-506324191

Connect with Dr. Gabrielle Lyon
Instagram: instagram.com/drgabriellelyon
TikTok: @drgabriellelyon
X (Twitter): x.com/drgabriellelyon
Facebook: facebook.com/doctorgabriellelyon

Chapters
00:00 - Introduction
01:42 - Meet Dr. Susan Macdonald
03:00 - The high-powered lawyer nobody could help
05:01 - Why testicle pain is 5% of urology visits
07:49 - Men have a pelvic floor (and what it does)
12:46 - How a man knows he has pelvic floor dysfunction
21:30 - Why these muscles are "too tight" in men
26:33 - Chronic pain rewires the brain
29:21 - Stress, trauma, and the mind-body connection
33:29 - Stretching, breathing, and self-treatment at home
36:21 - The medications that actually work (Cymbalta, gabapentin)
44:34 - Muscle relaxers, acupuncture, and the guidelines panel
55:09 - Sexual trauma and chronic pelvic pain
01:00:08 - The "pain plus" diagnostic framework
01:05:23 - The micro-surgical denervation surgery
01:08:36 - Erectile dysfunction in 17-year-olds
01:11:00 - How porn rewires young men's brains
01:18:27 - 40% of men by 40, 50% by 50
01:23:39 - Penile implants: who qualifies, how they work
01:28:10 - Stage 4 cancer at 42 and the pivot to teaching
01:34:17 - Living big with finite time
01:39:00 - Closing message to chronic pain patients

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This episode includes paid sponsorships.

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