This podcast is for you, the Modern Man. I'm Dr Anne

Truong, your host. I'm an intimate health medical doctor

and best selling author of the book, Erectile Dysfunction Fix.

I'll do a deep dive into sexual health and performance and how

it affects men of all ages and backgrounds. So let's get

started, and be sure to visit my website at

sexualhealthformmenpodcast.com for more information and

resources from the show. See you on the inside.

Men, are you struggling with ED? In this episode, I'm having a

unique conversation with Dr. Mohit Khera from Baylor College

of Medicine, a world renowned urologist and an expert in

erectile dysfunction. He will share his perspective on

treatment for erectile dysfunction and discover how you

can regain your confidence and your sexual vitality again. You

do not have to live with ED. So stay tuned for this whole

episode. I will guarantee, you will learn something powerful.

Hello there, modern man. In today's episode, we have one of

the best urologists in the country, Dr. Mohit Khera,

because I have been admiring his work for years, and we both

graduated from the same program. So Dr. Mohit Khera is the

professor in Department of Urology at Baylor College of

Medicine, and holds the F. Brantley Scott Chair at urology,

we'll dive into what that means, and he has published hundreds of

research papers on men's sexual health, and is really the

leading researcher and clinician in men's sexual health. I am so

honored to have him here today in our episode. So welcome, Dr

Khera.

Dr. Mohit Khera: Thank you so much for having me on the show.

Okay, so I'm gonna ask you some questions that I

wanted you to share from your perspective. What is the latest

in men's health at this time? What's working? What we're

finding out that may not work? Because I know you on the cusp

of research and about to do great research coming up, and

I'm going to be following you and as listener, follow him,

because he is the best in what he does in male sexual health.

Dr. Mohit Khera: Thank you. That's a loaded question,

because there's so much innovation and change going on

in men's health and sexual health as we speak right now.

But I think the biggest thing for me is this full paradigm

shift from being proactive and reactive historically, when in

sexual dysfunction, we've been very reactive. We wait till the

man gets erectile dysfunction. He comes into my office, I give

him Viagra, and he goes on his way. That is reactive. And what

we're now seeing is we're changing the paradigm. We're

being proactive. We're preventing the erectile

dysfunction from happening in the first place, and how do we

do that? Diet, exercise, sleep, stress reduction. People are

becoming much more aware of their bodies and preventing it.

They're taking more care into their hormone profiles, looking

at their testosterone level, women, for example, their

estrogen, testosterone, progesterone, and we're also

focusing on regenerative therapies. I know we talked

about that earlier, just about stem cells and PRP and shock

wave. And now we're looking into new things such as radio

frequency, potentially hyperbaric oxygen. So there's a

lot of new things on the horizon. But I think the biggest

thing for me, and I think the most interesting, is this

paradigm shift of shifting from, let me just give you Viagra. I'm

actually going to give you a treatment like diet exercise,

sleep and stress reduction.

Wow. So that's a loaded question. What does that

mean? Can you clarify diet, exercise, sleep and stress

reduction, so our listener can have an idea what really that

mean?

Dr. Mohit Khera: Yeah, let's take a step back. If you look at

all the podcasts that we're listening to today. You're going

to hear two big buzz words. The first word is lifespan. The

second one is health span. You hear health span and lifespan

over and over again. And so Anne, you and I both want our

health span to last as long as our lifespan. I don't want to

live till 80, but only be healthy till 60. That would not

be good for me. Well, interestingly, most people think

about their sex ban. Your sex band is the portion of your life

where you'll be able to engage in satisfying sexual activity.

We, most of us, want our sex band to last as long as our

lifespan, and so that's very important. And so how do you do.

Diet? Well, many of the techniques that you're hearing

online and hearing on these podcasts of how to improve your

health span is are the same things that improve your sex

span. So when I talk about diet, diets that typically are anti

inflammatory, that have high antioxidants, a low glycemic

index, typically have more impact on improving sexual

function. The one that's quoted the most is the Mediterranean

diet. We have the most data on the Mediterranean diet for

sexual dysfunction. Now, I don't think the Mediterranean diets

right for everybody, and I think what's unique about the

Mediterranean diet is it does have it's very high

antioxidants. It's a low inflammatory diet. We talk about

sleep. Do you need at least seven to eight hours of sleep a

night to help improve your sexual function. If you get less

than six hours of sleep per night, it actually is

detrimental to your sexual function. It can actually impair

sexual function. Some people say, Well, Doctor, I heard, the

more sleep I get, the better sexual function I'll have. But

that's not exactly true. Roughly around nine hours, it plateaus.

So sleeping 12 hours doesn't make your erections better. You

really want to be in that sweet spot of seven to eight hours,

and remember that it's not just the amount of hours you sleep.

We also talk about quality of sleep, right? So you want to

have good quality, good REM good, deep sleep. And you also

want to mitigate sleep disorders, the number one sleep

disorder causing sexual dysfunction in the world is

sleep apnea. Sleep Apnea significant increases sexual

dysfunction. The number two disorder in the world is

insomnia. So just be careful, if you have these conditions,

addressing those conditions can make a big difference.

Wow. So I want to kind of circle back a little bit

when you say, why is there a paradigm shift from reactive to

preventative? Now, what has happened that created that?

Dr. Mohit Khera: I think the biggest is social media and

podcasts. People are listening to social media. They're

listening but they had, did not have this vehicle in the past.

And that is really important. If you look at the health podcast,

look just like this one. Now. People are getting their

education through you, not through the newspaper anymore,

not through the TV anymore. They're getting their education

through you. And what you'll see on many of these podcasts is

they're talking about improving health, improving the quality of

health, and being proactive about your health. Whether some

people talk about red light therapy, they talk about

meditation, and mindfulness. I mean, everything is about

So I love how you use the word sex span. That's the first I've

improving your health, and so these in effect, are actually

improving your sex being it's the same thing. Let's take

exercise for a second. We published a paper two years ago

showing that exercise alone, just exercise, significantly

reverses erectile dysfunction. In our study, we looked at 11

meta analysis, and it was on average 40 minutes four times a

week. That's all you gotta remember. 40 minutes four times

a week. It's 160 minutes over a period of six months,

significantly increased the IIEF for the erectile function

scores. What's so interesting is the more severe the erectile

dysfunction you had, the greater the improvements in IIEF scores,

and that's just with exercise right now, if I tell someone to

do 40 minutes of moderate to vigorous exercise four times a

week, I will significantly reverse and improve their sex

band. But guess what, Anne, I'm also going to improve their

health. I'm also going to improve their lifespan. I mean,

I get other benefits besides just improving their sex band.

So I think the same principles that we use for health span and

lifespan absolutely apply to sexpan.

heard of it, and it's almost like, Hey, if you improve your

sexual health, you will live longer. So that may motivate

people to correlate both of it, because everybody want to live

longer and be healthy and have quality of life. But what we

find out in this view, is that it's so hard to motivate people

to exercise.

Yes, no, I agree, but I will tell you very interesting story.

There was a study that came out of Saint Louis, and they were

looking at young men, 18 to 40, and they looked at them coming

in with a diagnosis of ED and they would screen them for

diabetes. And what they found was that roughly 30% of the men

who came in for a diagnosis of erectile dysfunction had

actually pre diabetes or diabetes on diagnosis, that's a

lot of people, 30% now I want you to think about when you and

I were 3025, 30. We don't go see the doctor a 28 year old I'm not

going to go in and go get my blood pressure checked. I have

other things to do. I'm not going to go in and get my

cholesterol, my sugar checked. But if a 28 year old man gets

erectile dysfunction, he is the first person at my door tomorrow

morning saying I got a problem. And why is that important?

Because I believe that sexual dysfunction is the gateway to

treating all the other medical conditions. If he's going to

come in for that moment, I have a window and opportunity. Unity,

to screen that hemoglobin A1C to look at those lipids, to see

what else is going on with his health. And if I tell him that,

if you improve your blood sugar, you will actually improve your

sexual function, many men are more motivated do that than if I

just say, Hey, you got pre diabetes. Keep an eye on it.

Let's try to improve it, they will be more motivated to take

care of their health. Do sexual function, and that, in a way,

has a trickle down effect on all the other comorbidities.

So that's going to lead me to the next two

questions. So, since we're talking about younger men,

what's going on? Why are we seeing younger men now with ED?

We should see that more in the men over 60 or 50. Why? What's

going on?

Dr. Mohit Khera: Let's look at many different reasons why.

We'll start with just a general statement about the population

is becoming more unhealthy decade after decade. If I showed

you a graph of obesity, diabetes and metabolic syndrome, a graph

and I show you decade by decade, the percentage of men who have

obesity, diabetes and metabolic syndrome from the ages of 18 to

40, you're going to see it skyrocketing in the United

States like this, and that lines in the mimic ED rates in men, as

well as population because diabetes is the number one risk

factor of having ED four times more likely obesity. All of

these conditions also significantly drop serum

testosterone levels, no question. So as I drop the serum

testosterone level, as I become more obese, diabetes, these are

comorbidities that will take a hit on erectile function. Number

three is that there is now a era of social media, and what's

happening is the porn has significantly increased, and

when you see a significant amount of pornography. What

happens is your expectation is far greater than your reality,

and so that delta can cause many of these men to develop erectile

dysfunction. So we ask them, Do you have many men? Say, look, I

have ED. I can't get erection. I say, How about by yourself? Oh,

no problem. Okay, then now I got the idea, if you have

masturbation, I have no issue. How about in the morning when

you wake up? No issue. But with my partner, I have ED, what

they're telling you is they have psychogenic ED, and I've seen

the rate of psychogenic ED go up, and I think it has to do

with porn. I think it has a lot to do with social media and the

lack of interaction we all have now, most of our interactions

with the phone and not with other people.

Well, not to mention now AI. I was at a

conference, and now I'm looking at chat GPT, and you can

converse with it. Now there's a voice chat GPT, you can converse

with that. Even give it a name, will be as if you're talking to

a person. So imagine that if you're at home, you can talk to

somebody else that could you could give it a name, it's like

you don't even have to leave the house anymore now, right?

Dr. Mohit Khera: Right, but, but now there's a whole era of

marketing coming out with sexual AI. In other words, you can find

a partner online who will talk to you. And there was one study

that I just wasn't a study. It was just a it was an article

describing a gentleman who had fell in love with his AI bot

wanted, and you have to pay every time you talk, and

roughly, spend almost $2 million and trying to keep this

conversation going and this relationship going. So I think

it's you just gotta be careful, because I think AI and what's

happening in the world of Sexual Medicine is going to change

drastically.

So what you were saying that the person was not a

person. It was an AI you were talking to?

Dr. Mohit Khera: Right. Fell in love with, could not stop

talking to, was sexually attracted to, and it was, I

believe it was, roughly $2 million astonishing number. But

in other words, you just have to realize that these AI bots and

the area of Sexual Medicine is growing. There are now Virtual

Reality places that you can go into to have sexual encounters

with AI bots as well. So it's changing our field of sexuality,

and how we perceive sexuality. How we have sex is changing.

So what are your views on that when we're now

moving to virtual reality and so forth. Obviously not good,

because we're social being, and we're taking away that touch and

feel, that sensation. What are your views on that?

Dr. Mohit Khera: So I'm personally against it at this

point. I mean, I just feel that there's something important

about the human connection. There's something important

about being intimate with another person. It's my personal

opinion. I think there are others that say this is great.

You do things on your own. And personally, I do feel that it's

important to have the human connection, keep the intimacy

and keep that relationship going with another person. I think

it's important.

You just give me an idea for my next episode to talk

about virtual reality, virtual AI, so another question was that

you give me the scenario of a younger man who's more motivated

because he has ED and that is a gateway for opening a gateway

for better health for him down the road. What about I wouldn't

say older, but a man over 5055, that has. ED. What would be your

approach for him versus a younger male in their 20s?

Dr. Mohit Khera: Sure, you know most of the time, the younger

patients are more likely to have psychogenic ED, so you just want

to be careful about asking about getting morning erections and

masturbation. But older men typically have comorbid

conditions that they've acquired that have now caused them to

have erectile dysfunction. And my only wish, my only hope, was

that I had had to had the opportunity to meet them earlier

in life, to where I could change the trajectory so they're not

coming to me at 55 and we could have done things earlier to

prevent the ED from happening at that time. Maybe it would have

been lifestyle modification, could have been hormonal, could

be with your partner. So those are things that you think about.

But if he comes in, obviously, I want to first look at everything

that could be hurting his erectile function, modifiable

risk factors. Maybe it's an SSRI, an anti androgen. Maybe

they're on finasteride. Maybe they're on something that's

causing them to have the ED. So you want to take away the

enticing so whatever's causing the ED away, then you want to

look at other modifiable risk factors. And we talked about

this earlier, but it's lifestyle modification, diet, exercise,

sleep, stress reduction. I want to optimize the hormones,

particularly the testosterone level. Optimizing the

testosterone can significantly help this patient. And then once

you've done all that, you have to make sure you ask about the

partner, and I'll just give you a story. When I finished my

Wow. So what you're saying is that if you treat one

fellowship, I was very proud of myself, and I was able to get

these men, these amazing erections, great, livid, and

they would go home and they would have noone have sex with,

because their wives would say, one woman called me. She said,

Look, things were great until he met you, and now we fight all

the time because he wants to have sex and I don't, and we

haven't had sex in 10 years. And now we fight all the time, and

it's because of you. And I thought to myself, she's right.

I mean, either leave both libidos low or leave put both

libidos high, but you never put one high and one low, right?

That's a big mistake. And so very quickly that year, I flew

out, I spent some time with Erwin Goldstein, who's the god

bother of female sexual dysfunction. Went a lot of his

courses at ish wish. And for 6017, years now, I've been

treating women. Because by treating the woman, I'm actually

treating the man. By treating the man, I'm actually treating

the woman. The best examples I can give you. And have you and

have you seen this over and over again? Erwin Goldstein did a

study with Levitra. He took men and he gave half the men

Levitra, Half the men placebo. He said, I don't want to meet

your female partner, but can you give her this questionnaire at

the beginning and the end of the study? It's called the fsfi

female sexual function index, most commonly used. He gave the

questioner to all the women at home, what he found was that

those men who had the Vitra had an improvement in the rectal

function. Those women at home also had a significant

improvement in their female sexual function, meaning

arousal, libido, orgasmic function, and those men who got

placebo, those women, saw no improvements in their sexual

function. So think about this, and I am actually treating a

woman by just treating the male partner, I'm seeing significant

improvements, just like I'd see if I gave her a pill or I gave

her testosterone. And we did studies showing the opposite. If

I treat her and I skyrocket her libido. Guess what happens? His

erection is improved, so it's linked. You can't just treat one

person without addressing the other person at home.

partner, the other partner will also improve, even though you're

not directly treating their spouse or significant other.

Dr. Mohit Khera: Absolutely. Absolutely well documented, well

shown. So when I treat that male partner in my office or that

female partner in my office, I know that the sexual function of

the other partner at home will improve. The problem is, is that

we have to actually address what's going on like the biggest

mistake you can do is give the man via Go and tell me the home

not even ask about the female partner. What if this partner

does not want to have sex? What if this partner is there's an

issue, there's something you want to address them both as a

couple, if you want to improve the efficacy of that whole

relationship, giving him Viagra and telling him to go is not the

solution. You need to say, Tell me about your partner. Is she

post menopausal? Does she have pain with intercourse? Anyone

who has pain is going to avoid the activity the house or

libido. Any issue with arousal? Has there any issues with

orgasmic dysfunction? How is the quality of the relationship? Oh,

have you seen my sex therapist? She's amazing. So there's things

you can do to make that much better, but the handing the

Viagra and saying goodbye is a mistake.

I love that, and I encountered this a lot, where

we'll treat the men and their functioning, but the women who

are maybe in their 50s or 60s, or going to menopause and 10,

you know, we're done. We have kids out of the house. We're

done. I'm not interested in sex anymore. How do you address that

scenario?

Dr. Mohit Khera: So it depends on what the problem is. Let's

define what female sexual dysfunction is. FSD has four.

Components, decrease libido, decrease arousal, orgasmic

dysfunction, or pain within a horse. If you have one of these

four, and you're bothered by the condition, you suffer from FSD.

So if a woman comes in and says, I have low libido, but I really

don't care, not bothered by it, I say, okay, then you don't

suffer from FSD. How many women in the United States suffer from

FSD, 43 to 48% that is a lot of women. 43 to 48% how many of

those women actually get therapy? Less than 9% so that is

a big population of women that are suffering in silence. I call

that suffering in silence. Many of them say, I don't know where

to go. Many of them, when they go to their OB GYN say they

don't want to treat it, they don't treat FSD, and so they

just try to find ways to get cures for this problem. And it's

actually very sad there should be better resources. The other

problem is, there's very minimal research in FSD. We have a lot

more research in ED, erectile dysfunction, but the amount of

money that we spend on FSD is a fraction of what we spend in

men, but in either case, if she has those symptoms, then we try

to figure out what is the best way to address it. I think that

looking at the triangle is very important. For me. The triangle

is estrogen, progesterone and testosterone. Most people only

look at estrogen, progesterone, you have to look at testosterone

in women. Is extremely important. It's the number one

driver for sexual desire in women, even more than estrogen.

In fact, a woman makes more testosterone in her body than

she does estrogen. So we have to look at the triangle. We look at

the outside triangle, which is cortisol. We look at that

thyroid, which is very important, a growth hormone, any

other outside hormones that we can look at are very important.

And then don't forget, I think I tell the woman, this is a 5050,

you're going to help me with diet, exercise, sleep and

stress. Most women I can see start doing some exercise. They

do some change your diet. It's the sleep and stress in women

that I see take a big hit. And if a woman is fatigued, let's

say she's exhausted. It's 10 o'clock at night and she has a

choice between sex and sleeping, she's most likely to sleep. I'm

just going to tell you right now, a man, he still makes you

sex, even if he's tired, but a woman is typically going to say

and especially on stress. Think about this, many men use sex to

relieve their stress. That's a common thing. Many men use sex

because women typically have to relieve their stress in order to

have sex. It's kind of the opposite. And I tell these men,

I say, Look, you want to engage in sexual activity with your

wife, take her to Hawaii, take her on a trip. Relieve her

stress, help her with anything she can, and drop her stress

level. Her desire will go up, but take her out of the

stressful environment. So again, we're different, and I think

it's really important to understand her situation, what's

going on, but to not address the female partner when you're

taking care of the male patient, I think, is a mistake.

And now, do you always do that? When you treat

the male you also encourage their female partner to come in

Dr. Mohit Khera: I do many times they don't, but I will go

as well.

through the same question or ask the male patient, tell me about

her desire for sex. Tell me about arousal. Do you have any

pain within a course? How old is she? She post menopausal? She

don't any hormones? Is she on any SSRIs that's going to set

down her libido and say, I'm always willing to help. But many

women don't feel comfortable. Sometimes they say, Look, I have

a little libido, but I'm happy with it. I say, great. So that's

fine. So some couples do come in together, which is great, and

that's a great discussion. Some women come in after I see the

male, then they'll come in afterward and say, Look, my

husband told me that you may be able to help. And I say, Great,

let's talk. But when they come in, it's not just about handing

her hormones and pills like it's not just about giving her

estrogen, progesterone, handing her some testosterone, some

vaginal estrogen, and saying goodbye, we go heavy, heavy

lifestyle modification. Um, she's gotta help me with the

lifestyle modification, whether it be weight reduction. Now, I

have found one thing that's actually helped a lot of men and

women, more than even hormones and when it comes to sexual

dysfunction, and that's weight loss. You know, when a woman

loses 3040, pounds, she feels amazing. She feels like a new

person, new clothes, new outlook, self image skyrockets,

and obviously helps with the joint pain and the blood sugars

and the hypertension and the cholesterol. I mean, a lot of

other things improve as well, but we use a lot of GLP1 in the

Select population of patients, and putting him or her on the

GLP1 has really made a difference in my practice.

So you put them on GLP one and on a hormone

replacement therapy at the same time, or use diagram, yes,

Dr. Mohit Khera: it's synergistic. So remember this,

and we're almost done with this. We're doing a trial now at

Baylor, where if you give someone a GLP1 agonist, they

actually can start seeing a loss in muscle mass too.

Unfortunately, because you're decreasing your caloric intake

and the muscle mass will go down in hypogonadal patients or women

with low T if you put them on testosterone and ask them to

lift weights, to lift muscle mass, then we don't see a

significant decline in muscle mass, because testosterone is

anabolic, it actually increases muscle mass and decreases body

fat. So very important that if. You can use these together.

They're very synergistic. I'm not saying I mean treating a man

who has a normal testosterone level will not help putting him

on more testosterone. But in most cases, I would say in most

cases, but typically, I say that these medications, the GLP1 and

testosterone, are very effective together.

So you feel that most men and women after the age

of maybe 50 to 55, when the testosterone level dropped for

women and men that they should be on a hormone replacement

therapy?

Dr. Mohit Khera: If they're symptomatic. Well, party lines

if they're symptomatic but I would say that I do think that

there is beneficial effects beyond just being symptomatic.

For example, testosterone is one of the best markers of overall

health. If a man has low testosterone, we know that he's

at a higher risk of having a heart attack, non-negotiable.

Increases risk for MI. Low testosterone increases risk

demands for diabetes and obesity, non-negotiable.

Increases his risk for bone and bone fracture. We know that

osteopenia and osteoporosis significantly go up in these

patients. We also know that low test also increases the risk for

depression. It was my study significant increases for

depression. So forget sex. I told you if I had a blood test

that I could order that would give you a window to your heart,

to depression, to diabetes, obesity, bone fracture. We know

that low test also has been associated with prostate cancer

risk as well. You show me in another blood test I can get

that's a better marker of men's overall health. It's not TSH,

it's not lipids, it's not C reactive proteins, it's not your

gas, doctor, not a single blood test is a better marker of

everything I just told you in men's health, and that blood

test also gives you a window of symptoms, energy, libido,

erectile function. So every man over the age of 40, I believe,

should have a serum testosterone level checked annually. And we

started a nonprofit. It's called the testosterone project. The

testosterone project has three missions. One, increased testing

for all men over the age of 40, every man. Number two, that we

should actually deregulate testosterone. It's shocking to

me that testosterone, and natural hormone that we make, is

treated just like Vicodin, where it's regulated in the same

capacity. And three, the mission of the testosterone project is

to bring testosterone to women through the FDA and make it

available. I mean, think about this. Testosterone has been

around since 1935 so that's when it was first synthesized by moon

in lucica, 1935 shortly after testosterone was used in women

in the late 1930s if you and I walked into Walgreens today and

said, Give me all the testosterone for men put out

over 20 products sitting on top of the counter, I said, Give me

all the testosterone products available for women, zero, not

one. FDA approved testosterone product in for women, if we went

to Australia, that would be if we went to UK, we could get a

test. Also for women, not in the US, we have to improvise. We

have to use the testosterone. For men, use 110th dose. We have

to compound it with the cream. We have to be creative. But she

can't go in. She says, Look, my husband goes in. He pays $10

copay. I go in, I gotta pay full price. Why? Why do I have to pay

and he doesn't. We both make testosterone. In fact, I make

one makes more testosterone any woman in the body, but I have to

pay full price. Why? It doesn't make any sense. And so that's

one of the goals of a testosterone browser.

I love that. I have to check that out as well too.

But that we know there's always been a sexual disparity in

research for men versus women health, like how many medication

there are for ED versus how many medication there are for female

sexual dysfunction.

Dr. Mohit Khera: I want to give you an example of that. So Anne,

remember this for many years, if in 2014 if you went again to

Walgreen, just said, Give me all the sexual dysfunction drugs for

men, over 30 drugs. In 2014 we had zero approved for women. It

wasn't till 2015 when flibanserin got first FDA

approved, the first drug for women ever, for FSD. Then it

came out till 2015 several years later, we had Vyleesi, which

came out, and then we have two. But can you imagine the amount

of research that we have devoted to female sexual dysfunction?

It's just a fraction. And the amount of treatment options we

have for women is just a fraction of what we have for

men, which is unfortunate, because, as I mentioned earlier,

up to 48% of women, the US suffer from this condition. And

now I turn around and say, I don't have much to offer. I

mean, fortunately, we have starting to see some traction,

but we need more research.

So when you say 48%, is that all from over 40 or

just across anything over?

Dr. Mohit Khera: I think, I believe it was over 40. The

studies showed 40. I forgot the cut off age where he started. To

be honest with you.

Yeah, I think it's over 40. Yeah, we've heard that

around 50% it's probably an underestimate actually, because

that study with a long time ago.

Dr. Mohit Khera: But I do think that it's underestimate. I think

many women who suffer from FSD don't talk about it. I mean,

there's a stigma about sexual dysfunction. I give you an

example. I was giving a lecture, and I said to everyone in the

crowd, can you raise your hand if. You suffer from

hypertension, and actually quite a hand. Few hands went up. Then

I asked, Can you raise your hand if you have sexual dysfunction?

Almost no. One hand went up. It was a woman. One hand, okay. And

you know very well statistically that that's not true, because up

to 48% of women will have FSD. And we know if you look at the

men's statistics, 40% of men have ed at 40, 50% at 50, 60% at

60, 70% at 70, 100% at 100. It's one of the most prevalent

conditions out there. But we will not raise our hand for

sexual dysfunction. We have no problem raising our hand for

hypertension. We have to destigmatize it's okay to have

sexual dysfunction. It's a normal part of aging. It's okay.

Now there's ways to mitigate that and change it, but it's

Shouldn't it be destigmatized. You should not be embarrassed.

I love that. So it's okay to have sexual

dysfunction. It doesn't mean you're less of a woman or less

of a man. And as we work in sexual health, they always

think, Oh, my God, it's like cancer, but it's as it's part of

aging, but definitely can be managed like diabetes or

obesity. It can be managed almost the same way it has a

heart condition, right?

Dr. Mohit Khera: So think about this, if a 60 year old man comes

into me and says, I cannot believe I have erectile

dysfunction, what's going on? I say, did you know you're the

minority? Do you know that 60% of men at 60 actually have

erectile dysfunction. More men that your age have it than do

not. And then they sit there and say, oh, and actually feel

better. They realize I'm not alone. Many people suffer from

this condition, and it's not unique to me, and I think that's

very important. We didn't talk about something very important.

You know, sexual dysfunction is one of the best barometers of a

man's overall health, that if a man gets erectile dysfunction

today, you know that 15% will have a heart attack or a stroke

within seven years, 15% many people have also shown that if a

man has ED today, he's much more likely to get diabetes, almost

two times likely to get diabetes than a man who does not ED is

increased risk for not only heart attack and stroke, but

increased mortality. Men with ED are much more likely to die, 25%

increased risk if they have ED today. So it is a window of not

only cardiovascular risk, mortality, diabetes, also

depression and anxiety. So it's not just this erectile

dysfunction. He's trying to tell you that something's going to

come in the future, and we need to talk about it and take care

I love that. And not a lot of doctors are aware

of it now.

of the different treatment for ED other than Hey, they go and

talk to their primary care doctor, they give them Viagra,

and some don't even do blood work or look at their hormones

or even assess whether it's psychological or not. They're

either on the ED meds and then progressive tri mix as well,

without really looking at the other lifestyle factors that are

important that we talk about. And as you know, is just take

extra training. My daughter right now is in medical school.

She's in third year medical school here in Virginia, and I'm

just flabbergasted at the amount of education they're even

getting now we're talking about 2024, 2025 she did her third

year, about to become a doctor in about a year, nothing been

taught, even in the first and second year about hormones and

hormone replacement therapy or even preventative therapy.

They're being taught almost the same thing that I had one I was

in med school from '89 to '93 It is astonishing that there is

nothing on hormone replacement therapy. She's rotating through

her OB, and she's about to do urology during the OB. Nothing

on hormone replacement therapy for women, or even sexual

dysfunction discussion, even in her clinical rotation, and we

have to learn all that post residency or even post

fellowship. Have there been changes in curriculum in Baylor

about that at all.

Dr. Mohit Khera: Yes. So you know you're absolutely correct.

Very few medical schools teach sexual dysfunction. Very few

people get their training even in residency with sexual

dysfunction hormones. Most of the time, you know, where they

learn it, they learn it from podcasts. They learn from

meetings, CME meetings that we put on. You've been to one. We

talked about this in Orlando. I mean, there are meetings that

you'll get that's where they get their education from. It's not

during their true medical education training. Now I'm

going to talk about an organization called the Sexual

Medicine Society of North America, by far the best

organization on the planet. I would say, when it comes to

sexual medicine and education. And the Sexual Medicine Society

of North America has now started a new initiative to

significantly increase medical school education in sexual

medicine in all 50 states, and so basically, help support it.

Have champions located in medical centers in all 50

states, and those champions will have monthly meetings. We

currently are doing this already, and we meet with the

medical students, and we teach them sexual medicine once a

month. We've been doing it at Baylor now for three years. Once

a month, every month, we meet with all the medical students

who are interested. They come, we have some dinner, and we talk

about sexual medicine. Ours. These are called rigs, regional

interest groups. And so we're trying to significantly increase

medical school education, because I think it starts in

medical school. It's even because that's when better than

even going getting ready to teach it in medical school. Make

it a true curriculum, and we're actually helping the SMS and A

is helping develop the curriculum for those medical

schools.

Oh, that's wonderful. I am really glad to

hear that. And you're still the chairman?

Dr. Mohit Khera: I just finished my presidency. So I just

finished my presidency of the SMS and A.

Gotcha. And I'm proud to say that I'm also a

member as well of this association. I love the blog

that you guys published, and I love that initiative, and I

wanted to share that. So I want to touch upon what is your

approach on the psychogenic ED component, because that is

really intertwined with physical ED. You have physical ED, you

don't have psychological ED, and they're kind of almost

interchangeable, and I find it sometimes that it's more

challenging to address the psychological component, because

it just not involves the man, but also their partner as well.

So what is your approach on that?

Dr. Mohit Khera: So I think let's take a step back and look

at exactly what's happening in this situation. Let's say a man

has erectile dysfunction just once. Maybe he drank too much

that night, or he just had erectile dysfunction when he

engages in sexual activity. The next time, many men are saying,

I hope I don't get erectile dysfunction again while they're

having sex, as they say that they're fixated on not getting

erectile dysfunction, they're going to get erectile

dysfunction. In other words, they're more consumed then

they'd have sex again. And now say, Look, I've had it twice.

Sex now becomes anxiety provoking. They start getting

nervous when they say, they say, I hope it doesn't happen. So I

call it the vicious cycle. More sex they have, and the more ED

they have, the more ED they're going to have. It just kind of

gets into their head. So what you have to do is ask them

certain questions. First of all, they say, with masturbation, do

you have any problems? No, okay, that's psychogenic. If you get

up in the morning, you wake up, do you have more strong morning

erections? Yes, then that's psychogenic. It means the

hardware is working fine. Everything is working fine. It

just doesn't work well when you're with your partner. That

is psychogenic ED. So a person who has true ED would not be

able to get great erections with masturbation or wake up with

morning erections because the erections don't work. So we

that's very important. What's my favorite way to break

psychogenic ED? My favorite way to break psychogenic ED is daily

Cialis. When I give a man daily Cialis, many of these men will

start waking up with morning erections, and when they engage

in sexual activity, many of them don't need to take a pill. They

just have sex. When they want to have sex, they feel normal

again. When they feel normal again. And every time they

notice, hey, past 10 times I had sex, everything was great. I had

no ED. Then I start taking back the Cialis, little by little.

You can take it every other day, then you can take it to twice a

week, and you can stop. Many men don't want to stop the Cialis.

And I think Cialis is a fantastic medication. It's FDA

approved for ED, FDA approved for BPH, FDA approved for

pulmonary hypertension that protects the lining of the blood

vessels, protects the endothelium. It's a win, win,

win on all three. So I really recommend those, particularly

for the men over the age of 50. So I think that psychogenic ED

can be broken with that kind of showing them everything's fine.

You make a referral to a sex therapist. Most of them will not

see the sex therapist, but they does help seeing a sex therapist

and getting a penile ultrasound and showing them that everything

is perfect, actually, is very therapeutic to them as well. Oh,

look, Mr. Smith, your peak systolic was 40. Was fantastic.

Your end diastolic was only two. You have very healthy blood

vessels and penis. They feel better. They actually feel

better knowing that everything is fine.

I love that, and I actually do that a lot. I've

learned, you know, ultrasound from the urology here, and it's

the best thing you can do, because it's objective evidence

that, hey, everything is working. The plumbing is working

really, really well. And so what dose?

Dr. Mohit Khera: the quality of the relationship? Though, that's

really important. The quality of the relationship. I don't care

how much medication I give you, if the quality of the

relationship is poor, it will have a big impact, and not

knowing that piece of information will make it more

difficult to treat that patient.

Well, let's say the quality is poor. As the doctor,

what can you do about it?

Dr. Mohit Khera: We have three phenomenal sex therapists that

we use, and actually they're different ages and they have

different personalities, so I kind of tailor my referral to

that right person I think will suit the best for that with that

sex therapist. They're all amazing, but I do think that

seeking sex therapy would be important. I think also making

sure that the partner does not suffer from FSD was some of the

reasons that could impair the quality relationship is if the

male partner is constantly wanting to engage in sexual

activity and putting pressure when she does not want to engage

in sexual activity, that can make it very challenging. So you

have to take a deeper dive when on her and find out what's going

on, and vice versa when I'm treating the female patient,

that it's very important and libido is actually, is

interesting. Don't forget about what I teach the residents

called PETT. PETT stands for prolactin, estradiol, thyroid

and testosterone. Check the PETT on anyone who has low libido,

because those could be off.

So PETT? So check that testosterone, thyroid,

estrogen, that's right.

Dr. Mohit Khera: All very important when you talk about

libido and sexual orgasm function as well.

That's exactly what I check too. So often time we

see men, they come in and the only thing that's checked is

total testosterone. That's it. No SHBG, which stands for sex

hormone binding globulin or estradiol, anything like that.

It's the whole picture. Testosterone, if you're

listening to this men, the total testosterone alone isn'y going

to tell you the whole picture, what's going on in the body.

I hope you enjoyed the episode. I know it's long, but it's

packed with great information. Let me know how you think about

it. I love to hear from you. I would appreciate it if you

subscribe, hit the notification button and share it with

somebody you know that can benefit from this, because you

may help somebody without even knowing about it. And also, do

not suffer with ED. Do not suffer in silence. There are

solutions out there, so check out the Modern Man Club. It's a

space where I share information on how to get out of ED and for

you to regain sexual confidence again. And together, you can get

out of ED and have solution for sexual confidence. So check it

out at noedman.com I hope to see you in there, and I will see you

in the next episode.