Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.
Anne Truong: 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.