The Penis Trainer: The app to combat ED

By Jan Stemmel, translated by Austin Davis from the original German-language article in Süddeutsche Zeitung, one of the largest daily newspapers in Germany.

Looking back on things, the penis injections weren’t the worst of it. Neither were the two operations in which veins were intentionally clogged in hopes of keeping blood in his erectile tissue for just a bit longer.

For Max Kersting, the worst part was the horrible certainty of knowing that absolutely nothing made a difference — not the magic pills ordered from the most dubious corners of the internet, nor the Viagra prescribed by every urologist he’d visited. The 21-year-old, otherwise healthy student had nobody to turn to for help.

“You google until your fingers bleed”, says Kersting. “You scour every nook and cranny of the internet to find any information on the most obscure remedies–even those that would have you injecting medicine into your own shaft.” Only four people knew about his problem, among them his father, who drove him to his doctor’s appointments. But things started looking up for Kersting, now 33, a fact evidenced by the dozens of conversations he has with people every day about his genitalia. He invented something he wishes he’d had back then: a smartphone app that provides users with exercises to improve their erections and bundles together any medical information one could need on the subject. With it, Max hopes to spare others the years-long ordeal he endured.

An email from a thankful woman

Max Kersting is bright-eyed with a mop of curly hair and a three-day beard. We meet for a walk along Berlin’s Landwehrkanal on a grey afternoon in October. His app, called “Regimen,” has been available for a few months now. He’s on the phone almost every day with users who give him feedback. Conversations often turn into open discussions about his own experiences. Today, for example, he’s already received two emails. He pulls out his cellphone to read a few excerpts aloud. The first is, interestingly enough, from a woman. She thanks him: After discovering the app and installing it on her partner’s phone, her sex life has been gradually improving. The second email is from a man professing that he “LOVES” the app: “What you guys are doing is revolutionary!” Max puts his phone away, beams and fires off a few celebratory shots into the air with his index fingers: “Not once did I ever think other people’s sexual health would make me so happy.”

The Regimen app

Erectile dysfunction (the term “impotence” has gone out of style for sounding so definitive) puts a strain on many relationships. It’s a common illness kept under wraps. Estimates suggest that up to 30% of men over 30, and 40% of all men over 40, are affected. Stigma is part of the problem: Nobody talks about it. Men often need a year or more to build up the courage to talk to a doctor. Another part of the problem is that doctors underestimate the prevalence of erectile dysfunction. When Viagra made its debut in 1998, it became widely accepted that erectile dysfunction had been cured — there was pill for that.

But pills only address the symptom, not the cause, of erectile dysfunction, which is usually rooted in some combination of a lack of physical activity, being overweight and a poor diet. The vessels within the penis are extremely narrow, which means they calcify more quickly than those elsewhere in the body. That sets a vicious cycle into motion: Failed erections damage the erectile tissue until, at some point, nothing works anymore. Urologists break this down for patients with a pithy saying: “Use it or lose it.“

Thorsten Schlomm, director of urology at the Charité university research hospital in Berlin, explains that most potency issues are only discovered when men try to have sex for the first time after a prolonged period of abstinence. Though Viagra makes sense as a supplement to treatment, “We first recommend a change of lifestyle,” says Schlomm.

Diet, exercise and relaxation: recommendations that at first glance seem so banal that it’s difficult to believe their efficacy. But according to Schlomm, “Physical activity burns fat, releases testosterone and improves circulation.” Regular physical movement also positively affects the psyche and improves confidence — both important factors for a healthy erection. “Let’s put it this way: A marathon runner who’s 1.85 meters tall, weighing in at 70 kilograms, would rarely come to us complaining about erectile dysfunction.“

There’s a large market for ED solutions

Kersting’s saving grace came in the form of Wolf Beecken, a urologist and specialist for erectile health in Frankfurt. He prescribed the desperate young man three things: regular strength and breath training; a healthier diet; and a penis pump that uses suction to pull blood into the erectile tissue. “The goal was an erection a day — regardless of how,” Kersting explains. The method proved successful after a few weeks.

An extreme amount of money is being made nowadays on the internet off of potency issues. When the patent for Viagra expired a few years ago, startups began specializing in selling its active ingredient under a different name. The Munich-based firm Go Spring, whose ads can be seen on television, offers customers stylishly packaged pills prescribed by real “German doctors” via online office hours. The American retailer Pendant Hims deals in an array of taboo ailments affecting men–they sell everything from potency boosters to hair-restoring products and antidepressants. It was valued at over $200 million just a few months after its founding. When Kersting learned the extent to which investors were falling over themselves to sell pills, he recalled his own ordeal a decade earlier: “I knew from my own experience that Viagra doesn’t help a lot of people. And definitely not in the long-term.” He had just opened, and then closed, a startup with a friend from school who knows how to program. As a startup founder, he recognized a gap in the market; he and the programmer friend drew up plans for a new app. Next, he got in touch with his former doctor, Wolf Beecken. Instead of dispensing pills to men everywhere, he wanted to help them make lasting changes in their lives — just like the treatment Beecken had originally prescribed to him. Beecken, after consulting on the app, expressed interest in getting on board. The urologist and his former patient became co-founders.For health insurers, it’s a “lifestyle” issue

The program is only available in English and is reminiscent of a fitness app. First-time users are asked to fill out a detailed questionnaire about their sex lives, which results in a generated score of 5 to 25 on the International Index of Erectile Function. Using this score, the app then chooses videos clips of strength and breathing exercises as well as tips for a potency boosting diet (lots of fruit and vegetables, fish and nuts). It’s also good to write everything down in a penis journal every night: Did the day begin with a morning erection, include sexual activity, or require the use of a penis pump? The starter program lasts 12 weeks, the average amount of time it takes to cement a new routine. Afterwards, the app is meant to be a long-term companion. According to Kersting, users should be able to move up five points on average on the Erection Index within the first three months.

The three founders work together with experts from the United States and Australia, including a specialist in pelvic floor exercises from California, and a British psychologist. They want to get approval to be classified as a medicinal product as soon as possible; health insurance providers would have to reimburse the app’s fee. Ever since German Health Minister Jens Spahn’s “Digitale-Versorgung-Gesetz,” or “Digital Healthcare Act,” entered into force in December, doctors have been able to prescribe certain apps, such as a tracking program for diabetics. German health insurance providers, however, still classify potency problems as a “lifestyle issue.” Even Viagra isn’t covered. It’s possible, however, that Kersting’s app could have other possible uses. The penis, with its delicate vessels, is known to doctors as the “antennae of the heart.”

Infarction normally announces itself years in advance in the form of erectile dysfunction. If a 40-year-old man is suffering from potency issues, a doctor’s ears usually perk up; his risk of having a heart attack is about double. Instead of doping himself up with Viagra, the patient would be wise to subject himself to a medical examination and rethink his lifestyle. The findings of one American cardiologist suggest that weight control, better diet and frequent physical activity over the course of two years can improve an erection to the same degree as a regular 25-miligram dose of Viagra over the same time period.

Max Kersting only realized the magnitude of the issue — and the scope of the despair felt by those afflicted — when he began to talk about his own potency. One user wrote that he had contemplated suicide. Kersting hopes for a similar trajectory in discourse surrounding erectile dysfunction as that of a woman’s period, which until a decade ago had been just as stigmatized. Today, it’s completely normal to discuss menstrual cups. Given the multitude of much worse health issues humanity has contracted, and successfully treated, throughout its history, Kersting fails to see the controversy in what he does: “It’s only embarrassing because it concerns the penis.”