Dr. Gabal on The Unplanned Parent: Everything Men (and Women) Should Know About Sexual Health
From nicotine and the “Ozempic penis” phenomenon to PRP, testosterone, and why the Women’s Health Initiative did women a disservice — Dr. Gabal covers it all with Dr. Angel on Episode 3 of The Unplanned Parent podcast.
Watch the full episode above, or listen on your favorite platform — YouTube, Apple Podcasts, or Spotify.
Most men would rather Google their symptoms than talk to a doctor about what’s happening below the belt. That’s exactly why Dr. Lamia Gabal — board-certified urologist, 17-time Orange County Top Doctor, and Founder of Prestige Medical Group — joined Dr. Angel on Episode 3 of The Unplanned Parent podcast for one of the most direct, informative conversations you’ll hear about men’s and women’s sexual health.
Over 65 minutes, Dr. Gabal covered nearly every question patients are too embarrassed to ask: what nicotine and marijuana actually do to erectile function, why anxiety creates a vicious cycle that makes ED worse, the truth about testosterone replacement and fertility, the “Ozempic penis” phenomenon, and why so many women are still being denied the vaginal health treatments they need decades after the Women’s Health Initiative shook up hormone replacement therapy.
Below are the key takeaways — with links to the treatments and services she referenced. Full chapter markers are at the bottom for jumping to specific topics.
Nicotine, marijuana & erectile health
Dr. Gabal opened with a topic that touches nearly every patient she sees: the impact of nicotine and cannabis on erectile function. Nicotine damages the delicate vascular lining of the penile arteries — the same vessels that need to relax and dilate for an erection. The effect is vasoconstriction (arteries narrowing), which reduces blood flow and directly impairs erections.
Marijuana works differently but is equally problematic. THC lowers testosterone and raises estrogen — a hormonal shift that impacts both libido and erectile function. Dr. Gabal shared the story of a young football player who came to see her for ED and was smoking cannabis daily; that context alone was the diagnosis.
The bottom line: if you smoke, vape, or use cannabis regularly and you’re noticing changes, the substance is almost certainly a factor. And notably, Dr. Gabal does not perform PRP injections on active smokers — nicotine-damaged vessels won’t heal or respond to regenerative treatment the way healthy tissue does.
The anxiety cycle — a common cause of ED
Dr. Gabal emphasized that performance anxiety is one of the most under-diagnosed causes of ED — and that it creates a self-perpetuating cycle. A single unsuccessful encounter creates worry about the next one; that worry creates the very conditions that lead to another failure; and the cycle deepens.
Understanding the mind-body connection is essential. Many men benefit from addressing both the psychological and physical components together, rather than assuming ED is either “all in your head” or purely mechanical. It’s rarely one or the other.
Anything heart healthy is penis healthy.
— Dr. Lamia Gabal, MD, FPMRSObesity, metabolic health & the “Ozempic penis”
Dr. Gabal walked through the tight link between obesity, metabolic syndrome, and erectile dysfunction. Excess weight impacts vascular health, hormone balance, and testosterone — all of which affect erectile function. And she pointed out that anything that supports heart health supports penile health, because both rely on the same vascular system.
The conversation also touched on the “Ozempic penis” phenomenon — the increasingly common observation that men on GLP-1 weight-loss medications like semaglutide and tirzepatide often notice significant improvements in erectile function alongside their weight loss. Improved circulation, hormonal recalibration, and reduced metabolic burden all contribute.
Regenerative sexual medicine: PRP, shockwave, exosomes
Dr. Gabal walked through the regenerative toolkit she uses to treat ED: Platelet-Rich Plasma (PRP), shockwave therapy, exosomes, and stem cell approaches. Her key point: these treatments work better together than any of them work alone. Combining shockwave with PRP, for example, typically produces stronger results than either treatment in isolation.
She also made an important point about proactive penile health: use it or lose it. Regular sexual activity supports vascular and tissue health, similar to how regular exercise maintains muscle function.
Testosterone replacement & sperm production
Dr. Gabal broke down one of the most misunderstood aspects of hormone therapy: external testosterone shuts down the body’s own sperm production. When you supplement testosterone, your brain stops sending the signal to make more — and that signal is what drives sperm production as well.
The takeaway: men who want to preserve fertility should not take supplemental testosterone, or should discuss fertility-preserving alternatives with a specialist first. She also discussed andropause — when testosterone levels start to decline with age — and the framework for deciding when treatment is appropriate.
Sperm morphology: 4% normal is the norm
One of the most eye-opening moments in the episode: only about 4% of a man’s sperm looking morphologically normal is actually average. Many men see this number on a fertility panel and panic, assuming something is deeply wrong — when in fact this is baseline for the population.
Dr. Gabal also explained that sperm shape reflects what’s happening inside — nutrition, stress, sleep, substance use, and environmental exposures all show up in sperm quality. Small lifestyle changes over 90 days (the time it takes to produce new sperm) can measurably improve numbers.
Vaginal wellness: the estrogen conversation
Dr. Gabal shifted to women’s sexual health with the same directness. Her key point: topical estrogen is dramatically underused, and too many women are suffering from vaginal dryness, atrophy, and painful intercourse when a safe, localized treatment could restore comfort and function.
She also spoke about the MonaLisa Touch laser — an in-office, non-hormonal option that stimulates collagen and moisture in vaginal tissue. And she was direct about a hard truth: the Women’s Health Initiative in the early 2000s did women a massive disservice by scaring both patients and providers away from hormone replacement therapy — and many doctors still haven’t fully corrected for it. Modern hormone therapy, particularly when started earlier rather than later, is far safer and more effective than the WHI’s outdated conclusions suggested.
Destigmatizing sexual health
Perhaps the most important theme of the episode: embarrassment is the biggest barrier between most people and the help they need. Dr. Gabal used an analogy about her daughter’s asthma inhaler — nobody feels shame about carrying an inhaler for a lung condition. Why should sexual and urologic health be any different?
Dr. Angel wrapped the episode by pointing out that almost nobody has these conversations publicly — but the data is real, the conditions are extremely common, and the treatments genuinely work.
Dr. Lamia Gabal is board-certified in urology with subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). With 25+ years of experience, she is a specialist in male and female sexual wellness, regenerative medicine, and restorative urologic procedures. She is the creator of the P-Thick™ Protocol, a certified provider of P-Long®, P-Shot®, BoCox®, O-Shot®, and Clitoxin®, and serves as Principal Investigator for multiple clinical trials.
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