Judson Brandeis, MD
Brandeis, MD – Male Rejuvenation Center
100 Park Pl Ste 140
San Ramon, CA 94583
(925) 255-7867
Global Men’s Wellness
Dr. Brandeis AI (Ask Any Question)
brandeismd.com
“Combining a Nitric Oxide Boosting Dietary Supplement With Sildenafil Improves Nighttime Erections More Than Sildenafil Alone,”
The Journal of Sexual Medicine, Volume 22, Issue Supplement 4, November 2025 (8/2026)
(AI generated summary of interview transcript reviewed and edited by interviewer Kirk Hamilton PA and approved by Judson Brandeis, MD)
BACKGROUND: In this interview Kirk Hamilton PA interviews urologist Judson Brandeis, MD, about his study examining whether combining a nitric oxide-boosting dietary supplement (Affirm) with sildenafil improves nighttime erections more than sildenafil alone. Dr. Brandeis describes his background, beginning with his undergraduate education at Brown University and subsequent work with the American Red Cross, where he became interested in kidney transplantation. He attended Vanderbilt Medical School and conducted research at Harvard Medical School involving kidney transplantation and immune tolerance before completing general surgery and urology training at UCLA. Although he initially planned to become a kidney transplant surgeon, he ultimately pursued general urology and developed an interest in innovative approaches to men’s sexual and urologic health. He explains that his interest in nitric oxide and erectile function was influenced by his UCLA professors and by his experience treating men with low-intensity shockwave therapy. He became interested in boosting the body’s nitric oxide and eventually developed a supplement containing citrulline, beet extract, Panax ginseng, and muira puama. According to Dr. Brandeis, the rationale was to support the biological process involved in blood-vessel dilation and erectile function. He also explains that some of his older patients reported improvements in mental sharpness while taking the supplement, which prompted him to investigate and develop the product further.
NITRIC OXIDE BOOSTERS AND PDE5 INHIBITOR SYNERGY: A major portion of the interview focuses on the relationship between nitric oxide, blood vessels, and PDE5 inhibitors such as sildenafil. Dr. Brandeis explains that nitric oxide contributes to the production of cyclic GMP (cGMP, or cyclic guanosine monophosphate), which participates in the process that opens blood vessels, while PDE5 inhibitors such as sildenafil prevent the breakdown of cGMP, allowing the signal to persist. He describes nitric oxide as being obtained through dietary pathways involving citrulline and foods containing nitrates, including beets and green leafy vegetables.
ENDOTHELIAL FUNCTION: He also discusses the endothelium, the inner lining of blood vessels, and the glycocalyx, which he describes as a protective structure over the endothelial cells.
NIGHTTIME ERECTIONS AND SLEEP: The conversation then turns to nighttime erections and why they can provide a more objective way of evaluating erectile function. Dr. Brandeis explains that erections normally occur during REM sleep and that declining nighttime erections can be an early indication of reduced penile blood flow as men age. He describes the use of a device called the “tech ring,” which is worn around the penis during sleep and communicates with a phone through Bluetooth to measure changes associated with erections. He notes that this provides a more objective measurement than subjective erectile-function questionnaires, which can be influenced by circumstances, stress, relationships, sleep, and other factors. He also emphasizes the importance of sleep and describes his observation that dietary intake before sleep can affect nighttime erectile measurements.
THE STUDY: The study itself is presented as the next step in Dr. Brandeis’s earlier investigation of the nitric oxide-boosting supplement. He explains that the initial part of the study used the nighttime measurement device after a cleanout period and compared nights without the supplement to nights when participants took two supplement tablets (AffirmScience®). He reports approximately a 35% improvement in the area under the curve per hour of sleep, which he describes as a way of standardizing measurements despite differences in the number of hours participants slept. The second part of the study examined whether the supplement could work synergistically with sildenafil. Dr. Brandeis chose 40 milligrams of sildenafil rather than the full 100-milligram dose because he wanted enough room in the measurement range to detect an additional effect rather than potentially “maxing out” the response. He explains that the theoretical reason for combining the two approaches is that nitric oxide contributes to the production of cGMP while sildenafil prevents cGMP from being broken down, meaning the two mechanisms converge on the same signaling pathway enhancing blood vessel dilation. He says the purpose was to determine whether the combination could improve nighttime erectile function while potentially allowing men to use a lower sildenafil dose and therefore experience fewer dose-related side effects. He describes the results as meeting his expectations and discusses how the findings could potentially be applied by men using PDE5 inhibitors.
CONCLUSION: The interview concludes with Dr. Brandeis discussing his educational approach, his efforts to make complicated men’s-health concepts understandable, his book and educational resources, his use of artificial intelligence (Gobal Men’s Wellness – Ask Dr. Brandeis Any Question) to provide additional educational material, and his clinical practice.
Brief Outline of Key Points
- Dr. Brandeis’s Background
- Brown University undergraduate education.
- Work involving kidney preservation and transplantation.
- Vanderbilt Medical School.
- Research at Harvard Medical School.
- General surgery and urology training at UCLA.
- Transition from kidney transplantation to general urology and men’s health.
- Interest in Nitric Oxide and Erectile Function
- Connection between nitric oxide and blood-vessel dilation.
- Relationship between nitric oxide, cyclic GMP, and PDE5 inhibitors.
- Interest in improving erectile function through nitric oxide support.
- Development of the Nitric Oxide-Boosting Supplement
- Citrulline
- Beet extract
- Panax ginseng
- Muira puama
- Developed initially in connection with his work involving shockwave therapy
- Nighttime Erections
- Affirm® Alone
- Participants underwent a cleanout period.
- Nighttime erections were measured without the supplement and then with two supplement tablets.
- Dr. Brandeis reports approximately a 35% improvement in the area under the curve per hour of sleep.
- Sildenafil Combined with Affirm®
- Used 40 mg of sildenafil rather than the full 100-mg dose.
- Examined whether nitric oxide supplementation and sildenafil had a synergistic effect.
- The rationale was based on their interaction with the cyclic-GMP pathway.
- The goal was to determine whether the combination could improve erectile function while potentially permitting a lower sildenafil dose.
- Other Issues Discussed
- Possible effects of large meals on nighttime erections.
- Importance of sleep and REM sleep.
- Sildenafil and tadalafil differences discussed in relation to duration of action.
- Dr. Brandeis’s emphasis on patient education.
- His book, online educational resources, podcasts, YouTube channels, and artificial-intelligence-based men’s-health resources.
- Practice, Persistence and Patience – My Favorite. The first story of transformation that “jumped out” at me before my cancer and then the first one “sent” to me after my cancer diagnosis. A physician cures herself of a rare, life threatening sarcoma after chemo, radiation and alternative therapies had been tried.
- ”Source” the Documentary – The Science behind the practice. Highly recommended.
- Proof – Stories of Transformation (listen to a few stories of transformation from serious health problems)
- Stories of Transformation – YouTube Channel
- Research: The Science Behind Mind/Body Healing and Meditation
- Dr. Joe Dispenza’s Book: Becoming Supernatural
Falun Dafa – Truthfulness, Compassion and Forbearance
Brief Introduction to Falun Dafa
Falun Gong Misconceptions
Books & Recent Writings of Mr. Li Hongzhi
Video & Audio Materials
Take an Online Class
Kirk Hamilton PA-C
Prescription 2000, Inc.
3301 Alta Arden, Suite 3
Sacramento, CA 95825
(916) 489-4400 (w)
krhammer@surewest.net
www.StayingHealthyToday.Substack.com
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