The ED Conversation We Need to Be Having

Urologist Dr. Steve Kaplan sits down with an NYC-based Sexual Health Expert to discuss the real state of erectile dysfunction care — the stigma, the gaps, and why a new generation of men deserves better options.  

Dr. Steve Kaplan, MD  |  Chief Medical Officer, Aspargo Labs  ·  Board-Certified Urologist

UNDERSTANDING ED

SEXUAL HEALTH EXPERT

Dr. Kaplan, let’s start with the basics. How do you define erectile dysfunction, and how prevalent is it really?

DR. STEVE KAPLAN

Erectile dysfunction — ED — is the persistent inability to achieve or maintain an erection sufficient for satisfying sex. And I want to emphasize the word “persistent,” because almost every man will experience occasional difficulty. That’s normal. ED is when it becomes a pattern that affects quality of life, relationships, and confidence.

The prevalence of ED is staggering.  Estimates suggest that roughly 30 million men in the United States are affected to some degree. Globally, that number approaches 320 million. And those figures are underreported because stigma keeps millions of men from ever raising the issue with their doctors.

30M  Men affected by ED in the USi

320M  Global ED cases estimatedii

<25%  Men who seek treatmentiii

52%  Men ages 40–70 reporting some degree of EDiv

SEXUAL HEALTH EXPERT

What are you actually seeing in your practice? Who is coming through the door? 

DR. STEVE KAPLAN

The profile has changed significantly over the years. We used to think of ED as primarily an older man’s condition — something that crept up after 60. What I’m seeing now is a much younger patient population. Men in their late 20s and 30s are coming in, often confused and embarrassed, wondering what’s wrong with them.

What’s also notable is how long they waited before coming to see me. On average, men sit with this problem for two to three years before seeking help. Unfortunately, it’s just not something they want to talk about and be proactive about.

STIGMA & THE SILENCE 

SEXUAL HEALTH EXPERT

You mentioned stigma. Can you talk about how deeply that affects men who are dealing with this? 

DR. STEVE KAPLAN

ED strikes at something very core to masculine identity — or at least, the version of masculinity that many men have been raised with. Men feel ED is a symbol of weakness or a “loss of manliness”, not a medical condition that can be addressed.

I have patients who are highly accomplished — executives, physicians, athletes — who have confided that a conversation about ED was harder than any professional challenge they’ve ever faced. That’s how much psychological weight this carries. And it’s compounded by the fact that, unlike many other health issues, men rarely talk to their friends about this. 

“Men often interpret this as a fundamental failure of who they are — not as a medical condition that can be addressed.” — Dr. Steve Kaplan, MD  |  CMO, Aspargo Labs

A YOUNGER PROBLEM

SEXUAL HEALTH EXPERT

You hinted that ED is trending younger. What’s driving that shift? 

DR. STEVE KAPLAN

Multiple factors. First, the obvious lifestyle issues: poor diet, being sedentary, obesity, and poor sleep are all vascular risk factors that directly impact erectile function. We’re seeing younger men with the cardiovascular profiles we used to associate with middle age.

Second, chronic stress and anxiety are enormous drivers of ED in younger men. Performance anxiety in particular creates a vicious cycle and before long, it’s a self-reinforcing loop that becomes hard to break without intervention. 

Third, pornography has changed the expectations around sex and made it harder for men to be aroused in real-life scenarios.

And finally, alcohol and substance use — especially cannabis and tobacco — are contributing factors that many young men don’t connect to their bedroom difficulties.

SEXUAL HEALTH EXPERT

So what are the unmet needs you see most clearly? Where is current care falling short? 

DR. STEVE KAPLAN

Several places. First: spontaneity. The existing treatments for ED require planning. You need to take them 30 to 60 minutes before sexual activity, ideally on an empty stomach for optimal absorption. That timing requirement creates so much emotional pressure and can ruin the relaxed spontaneity that makes sex enjoyable and fun. HEZKUE's oral spray format is designed to act faster and work, regardless of food intake.

Second: discretion. Men want privacy around this. HEZKUE is in a sleek bottle that is sprayed in the mouth so there’s no need to split pills or have water available. Just spray and go with no awkwardness when things get intimate.

Third: innovation — and accountability. HEZKUE contains sildenafil, which is the same active ingredient physicians have trusted for over two decades to treat ED. There is genuine scientific rigor behind this product. Its efficacy and safety have been backed by multiple clinical trial studies filed with the FDA. HEZKUE has already been established as the standard of treatment in the EU and has received high patient satisfaction scores and growing physician trust.

SEXUAL HEALTH EXPERT

What ED treatments are currently available on the market and how do they compare with each other? 

DR. STEVE KAPLAN

The most common ED treatments are oral PDE5 inhibitors — which work by increasing blood flow to the penis in response to sexual stimulation. They're effective but come with  limitations as I mentioned before: tablets can take 30–60 minutes to work, food can delay or reduce absorption, and the experience feels disruptive for many men.

There is a clear unmet need for an ED solution that works fast and fits seamlessly into real life,. and HEZKUE aims to solve that.   Rather than a tablet that has to be swallowed and absorbed through the digestive tract, HEZKUE is absorbed through the tissues of the mouth, which means it bypasses first-pass metabolism entirely. 

That means a much faster onset. We’re talking about a meaningful reduction in absorption time compared to a standard oral pill, and importantly, food does not interfere with absorption the way it does with pills. Many of my patients complain that their generic ED medication doesn’t work after having a nice dinner after date night, so that’s a real lifestyle advantage.  

SEXUAL HEALTH EXPERT

Final question: what’s one piece of advice you have for men who are dealing with this issue? 

DR. STEVE KAPLAN

That this is something that many men deal with for a multitude of reasons, it is not a character flaw. That you are not alone  and that the options available to you in 2026 are meaningfully better than what existed even five years ago.

There are solutions out there that really work and can fit into your lifestyle seamlessly. Everybody is different, be an advocate for yourself and find out what works best for you. You don’t need to compromise your confidence, your relationships and your happiness because of ED. 

Dr. Steve Kaplan is a board-certified urologist and Chief Medical Officer at Aspargo Labs. HEZKUE® is a prescription product available through licensed telemedicine providers. Visit hezkuedirect.com to learn more and connect with a provider.