ကျား"): The Future of Men’s Health: From the SARMs Craze to the Next 20 Years of Restorative Urology The Future of Men’s Health: From the SARMs Craze to the Next 20 Years of Restorative Urology The Future of Men’s Health: From the SARMs Craze to the Next 20 Years of Restorative Urology

နောက်ဆုံး ပြင်ဆင်သည် ဩဂုတ် 17, 2026

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The fields of urology and sexual medicine are going through one of the most exciting changes in their history. For decades, treating men’s health problems mostly meant managing symptoms — replacing a missing hormone here, or prescribing a short-acting pill for erectile dysfunction (ED) there. But medicine is now shifting away from these temporary fixes and toward something far more ambitious: actually repairing and restoring the body’s natural function.

This shift was the central theme at the 31st Annual Scientific Program of the Sexual Medicine Society of North America (SMSNA), held during the American Urological Association (AUA) 2026 meeting in Washington, DC. Experiencing these presentations firsthand while shadowing Professor Mohit Khera gave me a remarkable look into the future of our field. One thing became crystal clear: the choices men make today about popular, unregulated substances like SARMs are directly connected to the high-tech restorative treatments we will be using over the next twenty years.

Part I: The SARMs Dilemma — Big Promises, Hidden Costs

One of the biggest talking points at AUA 2026 was the explosive popularity of Selective Androgen Receptor Modulators (SARMs). These compounds have jumped from obscure laboratory experiments to substances that anyone can buy online without a prescription. Fitness enthusiasts and aging men looking to improve their physique often see SARMs as a kind of modern holy grail — promising the muscle-building, fat-burning benefits of traditional anabolic steroids, but supposedly without the frustrating side effects like prostate enlargement, severe acne, or hair loss.

One point to be clear about from the start: no SARM is an approved medicine. They are investigational compounds, sold online as research chemicals or supplements, outside any regulatory system. Independent analyses of products bought online have repeatedly found contents that do not match the label — a different compound, a different dose, or an undeclared anabolic steroid. Whatever the science says about SARMs as a class therefore says very little about what is actually in a bottle bought on the internet. They are also prohibited in sport: SARMs sit on the World Anti-Doping Agency’s prohibited list, and athletes have been sanctioned after taking supplements that turned out to contain them without saying so on the label.

The idea behind SARMs is something called tissue selectivity. Regular testosterone switches on androgen receptors all over the body, which is why it causes side effects everywhere. SARMs are designed to be smarter — targeting the receptors in muscle and bone while staying mostly quiet in sensitive areas like the prostate and skin.

The muscle effect itself is real and measurable: trials have consistently found gains in lean muscle mass. What is far less consistent is whether that extra muscle translates into anything a man can actually feel or do. Smaller studies reported improvements in practical measures such as walking speed in older adults, but larger development programmes have failed to show a reliable functional benefit, and extra lean mass on a body composition scan is not the same thing as being stronger, fitter, or healthier. That gap between a number on a scan and a change in someone’s life is exactly the kind of distinction that gets lost when a compound is marketed rather than prescribed.

The Catch: There’s No Such Thing as a Free Lunch

Despite those muscle gains, the expert presentations drove home an uncomfortable truth: SARMs come with a real price tag for your health. Because they’re so easy to buy online without any medical supervision, most users have no idea about the systemic problems these substances can cause. The conference highlighted several key concerns:

• Everyday side effects: Many users report annoying symptoms like persistent headaches and dry mouth.
• Heart health risks: One of the most consistent findings is that SARMs lower HDL cholesterol — the kind that protects your blood vessels. Over time, this could increase the risk of cardiovascular problems.
• Liver stress: At higher doses, SARMs can put strain on the liver, showing up as abnormal liver test results. Cases of serious drug-induced liver injury have been reported in people using SARMs bought online.
• Shutting down your own hormones: This is the big one. Even though SARMs are marketed as a gentler alternative to testosterone, they actually suppress your body’s own natural testosterone production. The more you take, and the longer you take it, the more your own hormone system gets switched off.

Here’s how that last point works: when you take a SARM, your brain senses the extra androgen activity and responds by telling your body to stop making its own testosterone. The signal from the brain to the testes gradually goes quiet, and your natural hormone levels drop. Worryingly, this suppression can last much longer than the time you were actually taking the substance — and the long-term effects on fertility remain largely unknown, because proper human studies simply haven’t been done yet.

If you are already using one of these compounds, the useful thing is not to hide it. Tell your doctor what you have been taking and for how long — the assessment is straightforward, involving hormone levels, a lipid profile, liver tests and, where fertility matters, a semen analysis. Suppression often recovers after stopping, but it can take months, and it is worth knowing where you stand rather than guessing. What does not help is treating a suppressed hormone system with more unregulated compounds bought from the same source, which is how a temporary problem becomes an entrenched one. If low testosterone turns out to be genuine and persistent, that is a treatable condition in its own right — managed with properly monitored testosterone therapy, or, where a man still wants children, with medicines that raise his own production instead. Yellowing of the eyes or skin, dark urine, severe abdominal pain, chest pain or breathlessness need medical attention straight away.

Where SARMs Might Actually Help: A Specialized Role in Cancer Care

Interestingly, the real value of SARMs may lie not with the general public, but in very specific medical situations. A good example is a specialized SARM being studied in prostate cancer survivors.

Prostate cancer is normally fueled by male hormones, which means survivors who struggle with muscle wasting and erectile dysfunction usually cannot safely take standard testosterone therapy. In a carefully controlled trial involving men who were well past their prostate surgery with stable, undetectable cancer markers, researchers tested whether this targeted SARM could help. The results revealed both promise and limits: the drug safely built muscle and reduced body fat without reactivating the cancer — a genuinely encouraging safety result, though in a small, selected group followed for a limited time, which is not the same as long-term safety being established. It did not improve sexual function, a reminder that erectile problems after prostate surgery have deep, complex causes that one drug alone cannot fix. The researchers concluded that much more data is needed before this could be used in everyday practice. Nothing in that trial applies to a compound bought online: it used a specific agent, at a controlled dose, in a monitored population with undetectable PSA.

Part II: What About DHEA and Other Over-the-Counter Options?

During the session, the discussion turned to where common supplements and alternative hormones actually fit into a urologist’s toolkit. A couple of clear conclusions emerged:

• DHEA: This widely available supplement can slightly nudge up testosterone levels in some studies, but over the long term it does not produce any reliable improvement in physical performance or strength. Asked whether adding DHEA to testosterone therapy helps, the panel was honest: there is no solid evidence that it does. It is not a neutral substance either. DHEA is a hormone precursor that the body converts to both testosterone and oestrogen, the actual content of supplements varies widely between products, it is best avoided by men with hormone-sensitive cancer, and it is prohibited in competitive sport. If you are taking it, say so at your appointment — it can change how your hormone results should be read.
• 5-alpha-reductase inhibitors (finasteride and dutasteride, used for prostate enlargement and for hair loss): these are worth understanding properly rather than in passing. They work by blocking the conversion of testosterone to DHT, so serum testosterone actually rises a little while DHT falls sharply — they are not a way to raise testosterone in any useful sense. A minority of men experience reduced libido, erectile difficulty or ejaculatory changes, and those symptoms are worth reporting rather than quietly tolerating. Two further points matter: these drugs roughly halve the PSA reading, so the doctor interpreting your prostate cancer screening must know you are taking one, and — as with any prescribed medicine — you should not stop it on your own. Raise it with the doctor who prescribed it.

The take-home message from the SMSNA session was clear: while SARMs and over-the-counter options can change the muscle-to-fat ratio, their side effects, unpredictable hormone suppression, and lack of real benefit for sexual function mean they are not ready for everyday use.

Part III: The Next 20 Years of ED Treatment

The highlight of the scientific sessions was a fascinating, forward-looking lecture by Dr. Johanna L. Hannan titled “ED Targets Most Likely to Translate Into Clinical Practice in the Next 20 Years.” Her talk completely reframed how we think about treating erectile dysfunction. If you want the present-day picture rather than the future one, I have written separately about erectile dysfunction as a symptom rather than a disease.

To understand where we’re going, it helps to look at how far we’ve come:

• 1970s: Treatment was purely mechanical — vacuum devices and early, rigid penile implants.
• 1980s: The arrival of penile injections brought localized medication into the picture.
• 1990s: The real revolution — oral pills like sildenafil changed everything.
• 2000s: More oral options arrived, and early stem cell research began.
• 2010s: The focus moved to minimally invasive physical therapies such as shockwave therapy and platelet-rich plasma (PRP) injections.
• The road to 2040: The focus is now shifting entirely toward gene therapy and true regenerative medicine — fixing the underlying tissue damage rather than just treating the symptom.

This matters because current pills like sildenafil and tadalafil work by temporarily boosting blood flow — but they need intact nerves and healthy blood vessels to do their job. For men with serious tissue damage from pelvic surgery, advanced diabetes, or natural aging, these pills often simply stop working. That’s the gap the next generation of treatments is designed to fill. Today there are hundreds of clinical trials around the world focused on erectile dysfunction, and a meaningful share of the most cutting-edge ones are devoted to regenerative approaches like stem cells, PRP, and shockwave therapy.

A word of caution about that 2010s group, though, because it is where the marketing is loudest. Low-intensity shockwave therapy has a growing but still mixed evidence base and is offered to selected men. Platelet-rich plasma injections for ED are a different matter: they are sold commercially in a great many clinics, including here in Thailand, on the strength of very limited evidence, and the professional societies do not currently endorse them outside a research setting. Stem cell injections for ED are in the same position. It is worth holding on to the distinction — an active area of research is not the same as a proven treatment, and the fact that something can be purchased says nothing at all about whether it works.

Part IV: Repairing the Body — Nerve Stimulation, Gene Therapy, and Nanotechnology

Dr. Hannan’s lecture spotlighted three specific scientific pathways that could revolutionize practice by directly healing damaged nerves and blood vessels. All three are research findings rather than treatments you can ask for: none is approved or available in routine practice anywhere, including in Thailand.

1. A Pacemaker for the Nerves

When a man undergoes surgery to remove the prostate for cancer, the delicate nerves responsible for erections — which sit right next to the prostate — are often bruised, stretched, or damaged. This can lead to erectile dysfunction caused by nerve injury.

Researchers have developed an implantable device that acts almost like a pacemaker for these nerves. A soft, flexible electrode is placed gently over the erection nerves during the healing period after surgery, connected to a small generator that can be recharged wirelessly. By delivering gentle electrical stimulation, the device helps protect the nerves from dying off, encourages them to regrow, and supports the healing process. In an early clinical trial following patients for a full year after robotic prostate surgery, the device proved safe — with no device-related infections and no significant pain — and men maintained erectile function during recovery. An early trial of this kind is designed mainly to answer whether a device is safe; whether it genuinely works better than recovery without it is the question the larger US-based study now underway is meant to settle.

2. The Science of Touch and Sensation

Another fascinating frontier involves understanding how physical touch turns into sexual signals at the cellular level. Recent studies in top journals like Nature and Science have mapped out tiny specialized sensors in the genital skin that drive sexual response. When these sensors don’t work properly, the erectile response to physical stimulation drops significantly.

Scientists have also identified specific touch-sensitive channels that appear to be linked to premature ejaculation — when there are too many of them concentrated in certain areas, ejaculation tends to happen faster. Understanding these channels opens the door to precise, localized treatments that could fine-tune sensation without numbing it, offering better control over both erections and ejaculation timing in the future. This work is at the stage of mapping biology in laboratory models, not of designing a product — a target being identified is the beginning of a long road, not the end of one.

3. Rebuilding Healthy Blood Vessels

The final pillar focuses on repairing the blood vessels themselves using a powerful natural signaling protein called SDF-1, which recruits the body’s own repair cells to fix damaged tissue. In laboratory models of nerve-injury-related ED, injecting this protein directly helped preserve erectile function where it would otherwise have been lost.

But nobody wants repeated injections. So researchers have gone a step further, packaging the genetic instructions for this repair protein inside microscopic protective nanospheres — advanced nanotechnology that delivers the healing message directly into the cells. When injected, these nanoparticles stay localized exactly where they’re needed, with no unwanted spread to the rest of the body. In diabetic models — a notoriously difficult cause of ED — a single localized treatment produced a marked recovery of erectile function. This is one of the most exciting directions in the entire field. It is also, at this stage, animal work: the step from a laboratory model to a treatment given to patients is long, and many promising therapies do not survive it.

Part V: Preventative Urology — Extending Both Healthspan and Sexspan

The final takeaway from Dr. Hannan’s presentation connected sexual medicine to the bigger picture of healthy aging. The goal of future medicine isn’t simply to make us live longer — it’s to extend our healthspan, the years we spend healthy and free from chronic disease. And alongside it, what we might call our sexspan — the years we maintain a healthy, satisfying sexual life.

The Zombie Cell Problem

As we age, some of our cells enter a strange state: they stop dividing but refuse to die. Scientists call these senescent or zombie cells, and they accumulate over time, leaking out a mix of inflammatory chemicals into the surrounding tissue. This slow drip of inflammation is thought to contribute to many age-related diseases — heart disease, diabetes, dementia and others. In men’s health, the same process appears to damage the blood vessels and smooth muscle in the penis, and it is one proposed driver of both prostate enlargement and erectile dysfunction. This is an active and plausible research model rather than settled fact, and it should be read as a promising explanation rather than a proven mechanism you can act on today.

Fighting Back Against Cellular Aging

To counter this cellular decay, urologists are looking at a range of strategies:

• Lifestyle first: Structured exercise combined with a healthy diet — think Mediterranean-style eating, rich in olive oil, nuts, and antioxidants — forms the foundation. These choices calm down systemic inflammation and keep blood vessels healthy and flexible. This is the only item on the list with strong evidence behind it today, and it is also the only one available to everybody right now.
• New longevity medications: An emerging class of drugs aims to either clear out these senescent cells entirely or quiet down the chemicals they release — protecting the delicate nerves and blood vessels that erections depend on. These remain experimental, and the anti-aging compounds sold direct to consumers on that premise are not the same thing as the agents being studied.
• Metabolic helpers: The growing use of modern weight and diabetes medications (like the well-known GLP-1 drugs) reflects a major shift toward proactive, preventative care — tackling the root metabolic causes of disease before they damage sexual health. These are prescribed by endocrinology and internal medicine rather than by this urology clinic, which does not provide them.

The Bottom Line: A Clear Vision for the Future

Attending AUA 2026 in Washington, DC, while shadowing Professor Khera gave me a clear sense of where men’s health is heading. The message for the next generation of doctors and patients comes down to three simple principles:

1. Repair, don’t just patch. Move beyond short-term fixes that only mask symptoms, and focus on therapies that actually heal the underlying cause of erectile dysfunction and tissue damage.
2. Deliver treatments precisely. To bring these breakthroughs safely into the clinic, we need smart delivery systems — like the nanoparticles — that act exactly where needed without affecting the rest of the body.
3. Prevent early. True care means combining advanced surgery with proactive prevention — targeting root causes like cellular aging and metabolic health to extend both healthspan and sexspan.

The journey from today’s unregulated SARMs craze to tomorrow’s precise, gene-based tissue repair represents an incredible leap forward. Guided by rigorous science, the next twenty years may fundamentally redefine men’s health. But it is worth ending where a doctor has to live rather than where a conference programme ends: the treatments that genuinely work today are the unglamorous ones — getting the metabolic risk factors under control, and using the established therapies properly. Nothing described in Parts III and IV is something you can be offered this year, and any clinic that tells you otherwise is selling something.

If you have questions about men’s health, testosterone, or erectile ကမောက်ကမဖြစ်မှု and would like a comprehensive, up-to-date evaluation, Dr. Soarawee Weerasopone offers specialist consultations at ဘန်ကောက်ဆေးရုံ