1 00:00:00,870 --> 00:00:04,800 Anne Truong: This podcast is for you, the Modern Man. I'm Dr Anne 2 00:00:04,800 --> 00:00:08,130 Truong, your host. I'm an intimate health medical doctor 3 00:00:08,130 --> 00:00:11,580 and best selling author of the book, Erectile Dysfunction Fix. 4 00:00:11,700 --> 00:00:15,150 I'll do a deep dive into sexual health and performance and how 5 00:00:15,150 --> 00:00:18,330 it affects men of all ages and backgrounds. So let's get 6 00:00:18,330 --> 00:00:21,000 started, and be sure to visit my website at 7 00:00:21,000 --> 00:00:24,720 sexualhealthformmenpodcast.com for more information and 8 00:00:24,720 --> 00:00:27,480 resources from the show. See you on the inside. 9 00:00:37,710 --> 00:00:43,320 Men, are you struggling with ED? In this episode, I'm having a 10 00:00:43,350 --> 00:00:48,450 unique conversation with Dr. Mohit Khera from Baylor College 11 00:00:48,450 --> 00:00:53,730 of Medicine, a world renowned urologist and an expert in 12 00:00:53,730 --> 00:00:58,410 erectile dysfunction. He will share his perspective on 13 00:00:58,410 --> 00:01:02,400 treatment for erectile dysfunction and discover how you 14 00:01:02,400 --> 00:01:09,060 can regain your confidence and your sexual vitality again. You 15 00:01:09,060 --> 00:01:14,130 do not have to live with ED. So stay tuned for this whole 16 00:01:14,220 --> 00:01:19,530 episode. I will guarantee, you will learn something powerful. 17 00:01:19,600 --> 00:01:25,960 Hello there, modern man. In today's episode, we have one of 18 00:01:25,960 --> 00:01:30,970 the best urologists in the country, Dr. Mohit Khera, 19 00:01:31,000 --> 00:01:36,670 because I have been admiring his work for years, and we both 20 00:01:36,670 --> 00:01:42,220 graduated from the same program. So Dr. Mohit Khera is the 21 00:01:42,220 --> 00:01:45,310 professor in Department of Urology at Baylor College of 22 00:01:45,310 --> 00:01:50,800 Medicine, and holds the F. Brantley Scott Chair at urology, 23 00:01:50,800 --> 00:01:55,690 we'll dive into what that means, and he has published hundreds of 24 00:01:55,870 --> 00:02:00,700 research papers on men's sexual health, and is really the 25 00:02:00,700 --> 00:02:07,000 leading researcher and clinician in men's sexual health. I am so 26 00:02:07,000 --> 00:02:11,860 honored to have him here today in our episode. So welcome, Dr 27 00:02:11,860 --> 00:02:12,370 Khera. 28 00:02:12,850 --> 00:02:14,410 Dr. Mohit Khera: Thank you so much for having me on the show. 29 00:02:14,590 --> 00:02:18,310 Anne Truong: Okay, so I'm gonna ask you some questions that I 30 00:02:18,340 --> 00:02:23,890 wanted you to share from your perspective. What is the latest 31 00:02:23,920 --> 00:02:27,670 in men's health at this time? What's working? What we're 32 00:02:27,670 --> 00:02:31,930 finding out that may not work? Because I know you on the cusp 33 00:02:32,230 --> 00:02:36,370 of research and about to do great research coming up, and 34 00:02:36,370 --> 00:02:40,210 I'm going to be following you and as listener, follow him, 35 00:02:40,210 --> 00:02:45,130 because he is the best in what he does in male sexual health. 36 00:02:45,250 --> 00:02:46,840 Dr. Mohit Khera: Thank you. That's a loaded question, 37 00:02:46,840 --> 00:02:50,440 because there's so much innovation and change going on 38 00:02:50,440 --> 00:02:53,290 in men's health and sexual health as we speak right now. 39 00:02:53,500 --> 00:02:56,260 But I think the biggest thing for me is this full paradigm 40 00:02:56,260 --> 00:03:02,020 shift from being proactive and reactive historically, when in 41 00:03:02,020 --> 00:03:05,680 sexual dysfunction, we've been very reactive. We wait till the 42 00:03:05,680 --> 00:03:09,370 man gets erectile dysfunction. He comes into my office, I give 43 00:03:09,370 --> 00:03:13,870 him Viagra, and he goes on his way. That is reactive. And what 44 00:03:13,870 --> 00:03:16,420 we're now seeing is we're changing the paradigm. We're 45 00:03:16,420 --> 00:03:19,390 being proactive. We're preventing the erectile 46 00:03:19,390 --> 00:03:22,420 dysfunction from happening in the first place, and how do we 47 00:03:22,420 --> 00:03:27,100 do that? Diet, exercise, sleep, stress reduction. People are 48 00:03:27,100 --> 00:03:30,550 becoming much more aware of their bodies and preventing it. 49 00:03:30,580 --> 00:03:33,580 They're taking more care into their hormone profiles, looking 50 00:03:33,580 --> 00:03:35,980 at their testosterone level, women, for example, their 51 00:03:35,980 --> 00:03:38,770 estrogen, testosterone, progesterone, and we're also 52 00:03:38,770 --> 00:03:41,320 focusing on regenerative therapies. I know we talked 53 00:03:41,320 --> 00:03:44,830 about that earlier, just about stem cells and PRP and shock 54 00:03:44,830 --> 00:03:47,230 wave. And now we're looking into new things such as radio 55 00:03:47,230 --> 00:03:49,810 frequency, potentially hyperbaric oxygen. So there's a 56 00:03:49,810 --> 00:03:52,720 lot of new things on the horizon. But I think the biggest 57 00:03:52,720 --> 00:03:55,330 thing for me, and I think the most interesting, is this 58 00:03:55,360 --> 00:03:59,530 paradigm shift of shifting from, let me just give you Viagra. I'm 59 00:03:59,530 --> 00:04:02,800 actually going to give you a treatment like diet exercise, 60 00:04:02,800 --> 00:04:04,000 sleep and stress reduction. 61 00:04:04,090 --> 00:04:07,480 Anne Truong: Wow. So that's a loaded question. What does that 62 00:04:07,480 --> 00:04:11,950 mean? Can you clarify diet, exercise, sleep and stress 63 00:04:11,950 --> 00:04:16,000 reduction, so our listener can have an idea what really that 64 00:04:16,000 --> 00:04:16,360 mean? 65 00:04:16,630 --> 00:04:19,120 Dr. Mohit Khera: Yeah, let's take a step back. If you look at 66 00:04:19,120 --> 00:04:21,580 all the podcasts that we're listening to today. You're going 67 00:04:21,580 --> 00:04:25,720 to hear two big buzz words. The first word is lifespan. The 68 00:04:25,720 --> 00:04:29,800 second one is health span. You hear health span and lifespan 69 00:04:29,860 --> 00:04:34,090 over and over again. And so Anne, you and I both want our 70 00:04:34,150 --> 00:04:37,840 health span to last as long as our lifespan. I don't want to 71 00:04:37,840 --> 00:04:41,290 live till 80, but only be healthy till 60. That would not 72 00:04:41,290 --> 00:04:45,220 be good for me. Well, interestingly, most people think 73 00:04:45,280 --> 00:04:49,030 about their sex ban. Your sex band is the portion of your life 74 00:04:49,030 --> 00:04:52,180 where you'll be able to engage in satisfying sexual activity. 75 00:04:52,390 --> 00:04:56,170 We, most of us, want our sex band to last as long as our 76 00:04:56,170 --> 00:04:59,920 lifespan, and so that's very important. And so how do you do. 77 00:04:59,920 --> 00:05:02,440 Diet? Well, many of the techniques that you're hearing 78 00:05:02,440 --> 00:05:05,590 online and hearing on these podcasts of how to improve your 79 00:05:05,590 --> 00:05:09,490 health span is are the same things that improve your sex 80 00:05:09,490 --> 00:05:13,780 span. So when I talk about diet, diets that typically are anti 81 00:05:13,780 --> 00:05:18,040 inflammatory, that have high antioxidants, a low glycemic 82 00:05:18,040 --> 00:05:21,460 index, typically have more impact on improving sexual 83 00:05:21,460 --> 00:05:24,670 function. The one that's quoted the most is the Mediterranean 84 00:05:24,670 --> 00:05:28,480 diet. We have the most data on the Mediterranean diet for 85 00:05:28,480 --> 00:05:31,510 sexual dysfunction. Now, I don't think the Mediterranean diets 86 00:05:31,540 --> 00:05:33,880 right for everybody, and I think what's unique about the 87 00:05:33,880 --> 00:05:36,280 Mediterranean diet is it does have it's very high 88 00:05:36,280 --> 00:05:39,550 antioxidants. It's a low inflammatory diet. We talk about 89 00:05:39,550 --> 00:05:42,790 sleep. Do you need at least seven to eight hours of sleep a 90 00:05:42,790 --> 00:05:46,900 night to help improve your sexual function. If you get less 91 00:05:47,080 --> 00:05:49,480 than six hours of sleep per night, it actually is 92 00:05:49,480 --> 00:05:53,140 detrimental to your sexual function. It can actually impair 93 00:05:53,170 --> 00:05:55,960 sexual function. Some people say, Well, Doctor, I heard, the 94 00:05:55,960 --> 00:05:59,020 more sleep I get, the better sexual function I'll have. But 95 00:05:59,020 --> 00:06:02,950 that's not exactly true. Roughly around nine hours, it plateaus. 96 00:06:02,980 --> 00:06:06,220 So sleeping 12 hours doesn't make your erections better. You 97 00:06:06,220 --> 00:06:09,430 really want to be in that sweet spot of seven to eight hours, 98 00:06:09,430 --> 00:06:12,550 and remember that it's not just the amount of hours you sleep. 99 00:06:12,730 --> 00:06:15,520 We also talk about quality of sleep, right? So you want to 100 00:06:15,520 --> 00:06:18,340 have good quality, good REM good, deep sleep. And you also 101 00:06:18,340 --> 00:06:21,490 want to mitigate sleep disorders, the number one sleep 102 00:06:21,490 --> 00:06:23,950 disorder causing sexual dysfunction in the world is 103 00:06:23,950 --> 00:06:26,680 sleep apnea. Sleep Apnea significant increases sexual 104 00:06:26,680 --> 00:06:29,380 dysfunction. The number two disorder in the world is 105 00:06:29,380 --> 00:06:33,070 insomnia. So just be careful, if you have these conditions, 106 00:06:33,220 --> 00:06:35,830 addressing those conditions can make a big difference. 107 00:06:35,890 --> 00:06:39,580 Anne Truong: Wow. So I want to kind of circle back a little bit 108 00:06:39,610 --> 00:06:44,260 when you say, why is there a paradigm shift from reactive to 109 00:06:44,260 --> 00:06:47,800 preventative? Now, what has happened that created that? 110 00:06:47,000 --> 00:06:49,260 Dr. Mohit Khera: I think the biggest is social media and 111 00:06:49,318 --> 00:06:52,507 podcasts. People are listening to social media. They're 112 00:06:52,565 --> 00:06:56,159 listening but they had, did not have this vehicle in the past. 113 00:06:56,217 --> 00:06:59,927 And that is really important. If you look at the health podcast, 114 00:06:59,985 --> 00:07:03,116 look just like this one. Now. People are getting their 115 00:07:03,174 --> 00:07:06,478 education through you, not through the newspaper anymore, 116 00:07:06,536 --> 00:07:09,957 not through the TV anymore. They're getting their education 117 00:07:10,015 --> 00:07:13,551 through you. And what you'll see on many of these podcasts is 118 00:07:13,609 --> 00:07:17,319 they're talking about improving health, improving the quality of 119 00:07:17,377 --> 00:07:20,797 health, and being proactive about your health. Whether some 120 00:07:20,855 --> 00:07:23,870 people talk about red light therapy, they talk about 121 00:07:23,928 --> 00:07:27,174 meditation, and mindfulness. I mean, everything is about 122 00:07:24,770 --> 00:08:37,550 So I love how you use the word sex span. That's the first I've 123 00:07:27,232 --> 00:07:30,653 improving your health, and so these in effect, are actually 124 00:07:30,711 --> 00:07:33,957 improving your sex being it's the same thing. Let's take 125 00:07:34,015 --> 00:07:37,319 exercise for a second. We published a paper two years ago 126 00:07:37,377 --> 00:07:40,682 showing that exercise alone, just exercise, significantly 127 00:07:40,740 --> 00:07:44,218 reverses erectile dysfunction. In our study, we looked at 11 128 00:07:44,276 --> 00:07:47,754 meta analysis, and it was on average 40 minutes four times a 129 00:07:47,812 --> 00:07:51,175 week. That's all you gotta remember. 40 minutes four times 130 00:07:51,233 --> 00:07:54,305 a week. It's 160 minutes over a period of six months, 131 00:07:54,363 --> 00:07:57,726 significantly increased the IIEF for the erectile function 132 00:07:57,784 --> 00:08:01,320 scores. What's so interesting is the more severe the erectile 133 00:08:01,378 --> 00:08:05,146 dysfunction you had, the greater the improvements in IIEF scores, 134 00:08:05,204 --> 00:08:08,740 and that's just with exercise right now, if I tell someone to 135 00:08:08,798 --> 00:08:12,219 do 40 minutes of moderate to vigorous exercise four times a 136 00:08:12,277 --> 00:08:15,523 week, I will significantly reverse and improve their sex 137 00:08:15,581 --> 00:08:19,002 band. But guess what, Anne, I'm also going to improve their 138 00:08:19,060 --> 00:08:22,364 health. I'm also going to improve their lifespan. I mean, 139 00:08:22,422 --> 00:08:25,842 I get other benefits besides just improving their sex band. 140 00:08:25,900 --> 00:08:29,495 So I think the same principles that we use for health span and 141 00:08:29,552 --> 00:08:31,640 lifespan absolutely apply to sexpan. 142 00:08:37,550 --> 00:08:41,690 heard of it, and it's almost like, Hey, if you improve your 143 00:08:41,690 --> 00:08:45,590 sexual health, you will live longer. So that may motivate 144 00:08:45,590 --> 00:08:49,550 people to correlate both of it, because everybody want to live 145 00:08:49,550 --> 00:08:54,710 longer and be healthy and have quality of life. But what we 146 00:08:54,710 --> 00:08:59,240 find out in this view, is that it's so hard to motivate people 147 00:08:59,330 --> 00:09:01,160 to exercise. 148 00:09:01,310 --> 00:09:03,890 Yes, no, I agree, but I will tell you very interesting story. 149 00:09:04,010 --> 00:09:06,680 There was a study that came out of Saint Louis, and they were 150 00:09:06,680 --> 00:09:11,090 looking at young men, 18 to 40, and they looked at them coming 151 00:09:11,090 --> 00:09:15,410 in with a diagnosis of ED and they would screen them for 152 00:09:15,410 --> 00:09:19,400 diabetes. And what they found was that roughly 30% of the men 153 00:09:19,400 --> 00:09:22,550 who came in for a diagnosis of erectile dysfunction had 154 00:09:22,580 --> 00:09:25,520 actually pre diabetes or diabetes on diagnosis, that's a 155 00:09:25,520 --> 00:09:29,780 lot of people, 30% now I want you to think about when you and 156 00:09:29,780 --> 00:09:34,670 I were 3025, 30. We don't go see the doctor a 28 year old I'm not 157 00:09:34,670 --> 00:09:37,370 going to go in and go get my blood pressure checked. I have 158 00:09:37,370 --> 00:09:39,110 other things to do. I'm not going to go in and get my 159 00:09:39,140 --> 00:09:43,640 cholesterol, my sugar checked. But if a 28 year old man gets 160 00:09:43,670 --> 00:09:47,300 erectile dysfunction, he is the first person at my door tomorrow 161 00:09:47,300 --> 00:09:50,450 morning saying I got a problem. And why is that important? 162 00:09:50,630 --> 00:09:54,260 Because I believe that sexual dysfunction is the gateway to 163 00:09:54,260 --> 00:09:57,050 treating all the other medical conditions. If he's going to 164 00:09:57,050 --> 00:10:00,500 come in for that moment, I have a window and opportunity. Unity, 165 00:10:00,620 --> 00:10:04,190 to screen that hemoglobin A1C to look at those lipids, to see 166 00:10:04,190 --> 00:10:07,550 what else is going on with his health. And if I tell him that, 167 00:10:07,550 --> 00:10:10,070 if you improve your blood sugar, you will actually improve your 168 00:10:10,070 --> 00:10:13,730 sexual function, many men are more motivated do that than if I 169 00:10:13,730 --> 00:10:15,980 just say, Hey, you got pre diabetes. Keep an eye on it. 170 00:10:15,980 --> 00:10:19,040 Let's try to improve it, they will be more motivated to take 171 00:10:19,040 --> 00:10:22,520 care of their health. Do sexual function, and that, in a way, 172 00:10:22,520 --> 00:10:25,550 has a trickle down effect on all the other comorbidities. 173 00:10:26,180 --> 00:10:29,210 Anne Truong: So that's going to lead me to the next two 174 00:10:29,210 --> 00:10:32,450 questions. So, since we're talking about younger men, 175 00:10:32,690 --> 00:10:37,070 what's going on? Why are we seeing younger men now with ED? 176 00:10:37,100 --> 00:10:42,620 We should see that more in the men over 60 or 50. Why? What's 177 00:10:42,620 --> 00:10:43,370 going on? 178 00:10:43,430 --> 00:10:45,440 Dr. Mohit Khera: Let's look at many different reasons why. 179 00:10:45,440 --> 00:10:48,470 We'll start with just a general statement about the population 180 00:10:48,470 --> 00:10:52,580 is becoming more unhealthy decade after decade. If I showed 181 00:10:52,580 --> 00:10:57,710 you a graph of obesity, diabetes and metabolic syndrome, a graph 182 00:10:57,890 --> 00:11:01,070 and I show you decade by decade, the percentage of men who have 183 00:11:01,070 --> 00:11:04,280 obesity, diabetes and metabolic syndrome from the ages of 18 to 184 00:11:04,280 --> 00:11:06,590 40, you're going to see it skyrocketing in the United 185 00:11:06,590 --> 00:11:10,370 States like this, and that lines in the mimic ED rates in men, as 186 00:11:10,370 --> 00:11:13,610 well as population because diabetes is the number one risk 187 00:11:13,610 --> 00:11:18,320 factor of having ED four times more likely obesity. All of 188 00:11:18,320 --> 00:11:21,560 these conditions also significantly drop serum 189 00:11:21,560 --> 00:11:24,860 testosterone levels, no question. So as I drop the serum 190 00:11:24,860 --> 00:11:29,090 testosterone level, as I become more obese, diabetes, these are 191 00:11:29,090 --> 00:11:31,640 comorbidities that will take a hit on erectile function. Number 192 00:11:31,640 --> 00:11:36,080 three is that there is now a era of social media, and what's 193 00:11:36,080 --> 00:11:39,590 happening is the porn has significantly increased, and 194 00:11:39,590 --> 00:11:42,380 when you see a significant amount of pornography. What 195 00:11:42,380 --> 00:11:47,180 happens is your expectation is far greater than your reality, 196 00:11:47,540 --> 00:11:51,650 and so that delta can cause many of these men to develop erectile 197 00:11:51,650 --> 00:11:54,710 dysfunction. So we ask them, Do you have many men? Say, look, I 198 00:11:54,710 --> 00:11:57,470 have ED. I can't get erection. I say, How about by yourself? Oh, 199 00:11:57,470 --> 00:12:00,410 no problem. Okay, then now I got the idea, if you have 200 00:12:00,410 --> 00:12:02,450 masturbation, I have no issue. How about in the morning when 201 00:12:02,450 --> 00:12:05,390 you wake up? No issue. But with my partner, I have ED, what 202 00:12:05,390 --> 00:12:07,910 they're telling you is they have psychogenic ED, and I've seen 203 00:12:07,910 --> 00:12:10,700 the rate of psychogenic ED go up, and I think it has to do 204 00:12:10,700 --> 00:12:13,610 with porn. I think it has a lot to do with social media and the 205 00:12:13,610 --> 00:12:16,730 lack of interaction we all have now, most of our interactions 206 00:12:16,730 --> 00:12:18,920 with the phone and not with other people. 207 00:12:18,950 --> 00:12:22,250 Anne Truong: Well, not to mention now AI. I was at a 208 00:12:22,250 --> 00:12:24,800 conference, and now I'm looking at chat GPT, and you can 209 00:12:24,800 --> 00:12:28,820 converse with it. Now there's a voice chat GPT, you can converse 210 00:12:28,820 --> 00:12:32,210 with that. Even give it a name, will be as if you're talking to 211 00:12:32,210 --> 00:12:35,990 a person. So imagine that if you're at home, you can talk to 212 00:12:35,990 --> 00:12:39,050 somebody else that could you could give it a name, it's like 213 00:12:39,050 --> 00:12:41,450 you don't even have to leave the house anymore now, right? 214 00:12:41,480 --> 00:12:44,000 Dr. Mohit Khera: Right, but, but now there's a whole era of 215 00:12:44,030 --> 00:12:48,830 marketing coming out with sexual AI. In other words, you can find 216 00:12:48,830 --> 00:12:53,180 a partner online who will talk to you. And there was one study 217 00:12:53,180 --> 00:12:55,940 that I just wasn't a study. It was just a it was an article 218 00:12:55,970 --> 00:12:59,600 describing a gentleman who had fell in love with his AI bot 219 00:12:59,750 --> 00:13:02,450 wanted, and you have to pay every time you talk, and 220 00:13:02,480 --> 00:13:06,560 roughly, spend almost $2 million and trying to keep this 221 00:13:06,560 --> 00:13:09,920 conversation going and this relationship going. So I think 222 00:13:09,920 --> 00:13:14,060 it's you just gotta be careful, because I think AI and what's 223 00:13:14,060 --> 00:13:17,000 happening in the world of Sexual Medicine is going to change 224 00:13:17,000 --> 00:13:17,720 drastically. 225 00:13:17,000 --> 00:13:20,960 Anne Truong: So what you were saying that the person was not a 226 00:13:20,960 --> 00:13:24,500 person. It was an AI you were talking to? 227 00:13:24,770 --> 00:13:26,840 Dr. Mohit Khera: Right. Fell in love with, could not stop 228 00:13:26,840 --> 00:13:31,130 talking to, was sexually attracted to, and it was, I 229 00:13:31,130 --> 00:13:34,610 believe it was, roughly $2 million astonishing number. But 230 00:13:34,610 --> 00:13:39,530 in other words, you just have to realize that these AI bots and 231 00:13:39,530 --> 00:13:43,160 the area of Sexual Medicine is growing. There are now Virtual 232 00:13:43,160 --> 00:13:46,910 Reality places that you can go into to have sexual encounters 233 00:13:47,030 --> 00:13:52,610 with AI bots as well. So it's changing our field of sexuality, 234 00:13:52,880 --> 00:13:57,590 and how we perceive sexuality. How we have sex is changing. 235 00:13:57,780 --> 00:14:00,960 Anne Truong: So what are your views on that when we're now 236 00:14:01,080 --> 00:14:05,580 moving to virtual reality and so forth. Obviously not good, 237 00:14:05,610 --> 00:14:09,000 because we're social being, and we're taking away that touch and 238 00:14:09,000 --> 00:14:11,490 feel, that sensation. What are your views on that? 239 00:14:11,490 --> 00:14:13,080 Dr. Mohit Khera: So I'm personally against it at this 240 00:14:13,080 --> 00:14:15,330 point. I mean, I just feel that there's something important 241 00:14:15,330 --> 00:14:17,850 about the human connection. There's something important 242 00:14:17,850 --> 00:14:21,090 about being intimate with another person. It's my personal 243 00:14:21,090 --> 00:14:23,880 opinion. I think there are others that say this is great. 244 00:14:23,880 --> 00:14:27,030 You do things on your own. And personally, I do feel that it's 245 00:14:27,030 --> 00:14:30,450 important to have the human connection, keep the intimacy 246 00:14:30,660 --> 00:14:33,990 and keep that relationship going with another person. I think 247 00:14:33,990 --> 00:14:34,680 it's important. 248 00:14:34,830 --> 00:14:38,490 Anne Truong: You just give me an idea for my next episode to talk 249 00:14:38,490 --> 00:14:43,440 about virtual reality, virtual AI, so another question was that 250 00:14:43,440 --> 00:14:46,530 you give me the scenario of a younger man who's more motivated 251 00:14:46,620 --> 00:14:52,350 because he has ED and that is a gateway for opening a gateway 252 00:14:52,350 --> 00:14:55,680 for better health for him down the road. What about I wouldn't 253 00:14:55,680 --> 00:15:01,290 say older, but a man over 5055, that has. ED. What would be your 254 00:15:01,290 --> 00:15:05,610 approach for him versus a younger male in their 20s? 255 00:15:05,580 --> 00:15:07,957 Dr. Mohit Khera: Sure, you know most of the time, the younger 256 00:15:08,011 --> 00:15:11,523 patients are more likely to have psychogenic ED, so you just want 257 00:15:11,577 --> 00:15:14,927 to be careful about asking about getting morning erections and 258 00:15:14,981 --> 00:15:17,737 masturbation. But older men typically have comorbid 259 00:15:17,791 --> 00:15:21,087 conditions that they've acquired that have now caused them to 260 00:15:21,141 --> 00:15:24,491 have erectile dysfunction. And my only wish, my only hope, was 261 00:15:24,545 --> 00:15:27,679 that I had had to had the opportunity to meet them earlier 262 00:15:27,733 --> 00:15:31,083 in life, to where I could change the trajectory so they're not 263 00:15:31,137 --> 00:15:34,324 coming to me at 55 and we could have done things earlier to 264 00:15:34,378 --> 00:15:37,782 prevent the ED from happening at that time. Maybe it would have 265 00:15:37,836 --> 00:15:41,078 been lifestyle modification, could have been hormonal, could 266 00:15:41,132 --> 00:15:44,536 be with your partner. So those are things that you think about. 267 00:15:44,590 --> 00:15:48,103 But if he comes in, obviously, I want to first look at everything 268 00:15:48,157 --> 00:15:51,128 that could be hurting his erectile function, modifiable 269 00:15:51,182 --> 00:15:54,262 risk factors. Maybe it's an SSRI, an anti androgen. Maybe 270 00:15:54,316 --> 00:15:57,396 they're on finasteride. Maybe they're on something that's 271 00:15:57,450 --> 00:16:00,530 causing them to have the ED. So you want to take away the 272 00:16:00,584 --> 00:16:03,826 enticing so whatever's causing the ED away, then you want to 273 00:16:03,880 --> 00:16:07,014 look at other modifiable risk factors. And we talked about 274 00:16:07,068 --> 00:16:10,418 this earlier, but it's lifestyle modification, diet, exercise, 275 00:16:10,472 --> 00:16:13,552 sleep, stress reduction. I want to optimize the hormones, 276 00:16:13,606 --> 00:16:16,361 particularly the testosterone level. Optimizing the 277 00:16:16,415 --> 00:16:19,819 testosterone can significantly help this patient. And then once 278 00:16:19,873 --> 00:16:23,169 you've done all that, you have to make sure you ask about the 279 00:16:23,223 --> 00:16:26,411 partner, and I'll just give you a story. When I finished my 280 00:16:23,540 --> 00:18:19,790 Anne Truong: Wow. So what you're saying is that if you treat one 281 00:16:26,465 --> 00:16:29,761 fellowship, I was very proud of myself, and I was able to get 282 00:16:29,815 --> 00:16:32,679 these men, these amazing erections, great, livid, and 283 00:16:32,733 --> 00:16:35,921 they would go home and they would have noone have sex with, 284 00:16:35,975 --> 00:16:39,271 because their wives would say, one woman called me. She said, 285 00:16:39,325 --> 00:16:42,675 Look, things were great until he met you, and now we fight all 286 00:16:42,729 --> 00:16:45,809 the time because he wants to have sex and I don't, and we 287 00:16:45,863 --> 00:16:49,267 haven't had sex in 10 years. And now we fight all the time, and 288 00:16:49,321 --> 00:16:52,454 it's because of you. And I thought to myself, she's right. 289 00:16:52,508 --> 00:16:55,480 I mean, either leave both libidos low or leave put both 290 00:16:55,534 --> 00:16:58,776 libidos high, but you never put one high and one low, right? 291 00:16:58,830 --> 00:17:02,018 That's a big mistake. And so very quickly that year, I flew 292 00:17:02,072 --> 00:17:05,206 out, I spent some time with Erwin Goldstein, who's the god 293 00:17:05,260 --> 00:17:08,178 bother of female sexual dysfunction. Went a lot of his 294 00:17:08,232 --> 00:17:11,203 courses at ish wish. And for 6017, years now, I've been 295 00:17:11,258 --> 00:17:14,445 treating women. Because by treating the woman, I'm actually 296 00:17:14,499 --> 00:17:17,741 treating the man. By treating the man, I'm actually treating 297 00:17:17,795 --> 00:17:21,091 the woman. The best examples I can give you. And have you and 298 00:17:21,145 --> 00:17:24,441 have you seen this over and over again? Erwin Goldstein did a 299 00:17:24,495 --> 00:17:27,521 study with Levitra. He took men and he gave half the men 300 00:17:27,575 --> 00:17:30,817 Levitra, Half the men placebo. He said, I don't want to meet 301 00:17:30,871 --> 00:17:34,275 your female partner, but can you give her this questionnaire at 302 00:17:34,329 --> 00:17:37,571 the beginning and the end of the study? It's called the fsfi 303 00:17:37,625 --> 00:17:40,921 female sexual function index, most commonly used. He gave the 304 00:17:40,975 --> 00:17:44,163 questioner to all the women at home, what he found was that 305 00:17:44,217 --> 00:17:47,459 those men who had the Vitra had an improvement in the rectal 306 00:17:47,513 --> 00:17:50,323 function. Those women at home also had a significant 307 00:17:50,377 --> 00:17:53,186 improvement in their female sexual function, meaning 308 00:17:53,240 --> 00:17:56,320 arousal, libido, orgasmic function, and those men who got 309 00:17:56,374 --> 00:17:59,454 placebo, those women, saw no improvements in their sexual 310 00:17:59,508 --> 00:18:02,696 function. So think about this, and I am actually treating a 311 00:18:02,750 --> 00:18:06,154 woman by just treating the male partner, I'm seeing significant 312 00:18:06,208 --> 00:18:09,558 improvements, just like I'd see if I gave her a pill or I gave 313 00:18:09,612 --> 00:18:12,908 her testosterone. And we did studies showing the opposite. If 314 00:18:12,962 --> 00:18:16,366 I treat her and I skyrocket her libido. Guess what happens? His 315 00:18:16,420 --> 00:18:19,770 erection is improved, so it's linked. You can't just treat one 316 00:18:19,824 --> 00:18:22,580 person without addressing the other person at home. 317 00:18:25,730 --> 00:18:29,480 partner, the other partner will also improve, even though you're 318 00:18:29,480 --> 00:18:33,470 not directly treating their spouse or significant other. 319 00:18:33,530 --> 00:18:37,040 Dr. Mohit Khera: Absolutely. Absolutely well documented, well 320 00:18:37,040 --> 00:18:40,100 shown. So when I treat that male partner in my office or that 321 00:18:40,100 --> 00:18:43,340 female partner in my office, I know that the sexual function of 322 00:18:43,340 --> 00:18:47,660 the other partner at home will improve. The problem is, is that 323 00:18:47,660 --> 00:18:51,410 we have to actually address what's going on like the biggest 324 00:18:51,410 --> 00:18:54,140 mistake you can do is give the man via Go and tell me the home 325 00:18:54,170 --> 00:18:56,810 not even ask about the female partner. What if this partner 326 00:18:56,810 --> 00:18:58,940 does not want to have sex? What if this partner is there's an 327 00:18:58,940 --> 00:19:01,850 issue, there's something you want to address them both as a 328 00:19:01,850 --> 00:19:05,270 couple, if you want to improve the efficacy of that whole 329 00:19:05,270 --> 00:19:09,080 relationship, giving him Viagra and telling him to go is not the 330 00:19:09,080 --> 00:19:12,110 solution. You need to say, Tell me about your partner. Is she 331 00:19:12,110 --> 00:19:15,110 post menopausal? Does she have pain with intercourse? Anyone 332 00:19:15,110 --> 00:19:17,660 who has pain is going to avoid the activity the house or 333 00:19:17,660 --> 00:19:20,780 libido. Any issue with arousal? Has there any issues with 334 00:19:20,780 --> 00:19:23,960 orgasmic dysfunction? How is the quality of the relationship? Oh, 335 00:19:23,960 --> 00:19:26,630 have you seen my sex therapist? She's amazing. So there's things 336 00:19:26,630 --> 00:19:30,410 you can do to make that much better, but the handing the 337 00:19:30,410 --> 00:19:33,410 Viagra and saying goodbye is a mistake. 338 00:19:33,560 --> 00:19:36,560 Anne Truong: I love that, and I encountered this a lot, where 339 00:19:36,740 --> 00:19:39,680 we'll treat the men and their functioning, but the women who 340 00:19:39,680 --> 00:19:44,860 are maybe in their 50s or 60s, or going to menopause and 10, 341 00:19:44,920 --> 00:19:47,980 you know, we're done. We have kids out of the house. We're 342 00:19:47,980 --> 00:19:53,200 done. I'm not interested in sex anymore. How do you address that 343 00:19:53,200 --> 00:19:54,040 scenario? 344 00:19:54,220 --> 00:19:56,080 Dr. Mohit Khera: So it depends on what the problem is. Let's 345 00:19:56,080 --> 00:19:59,920 define what female sexual dysfunction is. FSD has four. 346 00:20:00,000 --> 00:20:04,500 Components, decrease libido, decrease arousal, orgasmic 347 00:20:04,500 --> 00:20:08,040 dysfunction, or pain within a horse. If you have one of these 348 00:20:08,040 --> 00:20:13,200 four, and you're bothered by the condition, you suffer from FSD. 349 00:20:13,260 --> 00:20:15,720 So if a woman comes in and says, I have low libido, but I really 350 00:20:15,720 --> 00:20:18,000 don't care, not bothered by it, I say, okay, then you don't 351 00:20:18,000 --> 00:20:21,860 suffer from FSD. How many women in the United States suffer from 352 00:20:21,860 --> 00:20:28,520 FSD, 43 to 48% that is a lot of women. 43 to 48% how many of 353 00:20:28,520 --> 00:20:32,360 those women actually get therapy? Less than 9% so that is 354 00:20:32,360 --> 00:20:35,660 a big population of women that are suffering in silence. I call 355 00:20:35,660 --> 00:20:38,420 that suffering in silence. Many of them say, I don't know where 356 00:20:38,420 --> 00:20:41,500 to go. Many of them, when they go to their OB GYN say they 357 00:20:41,500 --> 00:20:44,560 don't want to treat it, they don't treat FSD, and so they 358 00:20:44,560 --> 00:20:48,520 just try to find ways to get cures for this problem. And it's 359 00:20:48,520 --> 00:20:51,100 actually very sad there should be better resources. The other 360 00:20:51,100 --> 00:20:54,040 problem is, there's very minimal research in FSD. We have a lot 361 00:20:54,040 --> 00:20:56,860 more research in ED, erectile dysfunction, but the amount of 362 00:20:56,860 --> 00:21:00,540 money that we spend on FSD is a fraction of what we spend in 363 00:21:00,540 --> 00:21:03,960 men, but in either case, if she has those symptoms, then we try 364 00:21:03,960 --> 00:21:06,660 to figure out what is the best way to address it. I think that 365 00:21:06,660 --> 00:21:09,540 looking at the triangle is very important. For me. The triangle 366 00:21:09,540 --> 00:21:13,080 is estrogen, progesterone and testosterone. Most people only 367 00:21:13,080 --> 00:21:16,200 look at estrogen, progesterone, you have to look at testosterone 368 00:21:16,200 --> 00:21:19,080 in women. Is extremely important. It's the number one 369 00:21:19,080 --> 00:21:22,460 driver for sexual desire in women, even more than estrogen. 370 00:21:22,640 --> 00:21:26,060 In fact, a woman makes more testosterone in her body than 371 00:21:26,060 --> 00:21:29,420 she does estrogen. So we have to look at the triangle. We look at 372 00:21:29,420 --> 00:21:33,260 the outside triangle, which is cortisol. We look at that 373 00:21:33,260 --> 00:21:35,960 thyroid, which is very important, a growth hormone, any 374 00:21:35,960 --> 00:21:39,080 other outside hormones that we can look at are very important. 375 00:21:39,140 --> 00:21:41,680 And then don't forget, I think I tell the woman, this is a 5050, 376 00:21:42,040 --> 00:21:44,200 you're going to help me with diet, exercise, sleep and 377 00:21:44,380 --> 00:21:48,460 stress. Most women I can see start doing some exercise. They 378 00:21:48,460 --> 00:21:53,140 do some change your diet. It's the sleep and stress in women 379 00:21:53,140 --> 00:21:57,160 that I see take a big hit. And if a woman is fatigued, let's 380 00:21:57,160 --> 00:22:00,240 say she's exhausted. It's 10 o'clock at night and she has a 381 00:22:00,240 --> 00:22:03,180 choice between sex and sleeping, she's most likely to sleep. I'm 382 00:22:03,180 --> 00:22:05,700 just going to tell you right now, a man, he still makes you 383 00:22:05,700 --> 00:22:08,280 sex, even if he's tired, but a woman is typically going to say 384 00:22:08,280 --> 00:22:12,720 and especially on stress. Think about this, many men use sex to 385 00:22:12,720 --> 00:22:16,260 relieve their stress. That's a common thing. Many men use sex 386 00:22:16,380 --> 00:22:20,900 because women typically have to relieve their stress in order to 387 00:22:20,900 --> 00:22:24,080 have sex. It's kind of the opposite. And I tell these men, 388 00:22:24,080 --> 00:22:27,200 I say, Look, you want to engage in sexual activity with your 389 00:22:27,200 --> 00:22:29,780 wife, take her to Hawaii, take her on a trip. Relieve her 390 00:22:29,780 --> 00:22:32,360 stress, help her with anything she can, and drop her stress 391 00:22:32,360 --> 00:22:34,880 level. Her desire will go up, but take her out of the 392 00:22:34,880 --> 00:22:37,580 stressful environment. So again, we're different, and I think 393 00:22:37,580 --> 00:22:41,140 it's really important to understand her situation, what's 394 00:22:41,140 --> 00:22:44,860 going on, but to not address the female partner when you're 395 00:22:44,860 --> 00:22:47,020 taking care of the male patient, I think, is a mistake. 396 00:22:47,080 --> 00:22:48,940 Anne Truong: And now, do you always do that? When you treat 397 00:22:48,940 --> 00:22:53,020 the male you also encourage their female partner to come in 398 00:22:53,000 --> 00:22:56,240 Dr. Mohit Khera: I do many times they don't, but I will go 399 00:22:53,080 --> 00:22:53,560 as well. 400 00:22:56,240 --> 00:22:59,360 through the same question or ask the male patient, tell me about 401 00:22:59,360 --> 00:23:01,820 her desire for sex. Tell me about arousal. Do you have any 402 00:23:01,820 --> 00:23:04,370 pain within a course? How old is she? She post menopausal? She 403 00:23:04,370 --> 00:23:07,070 don't any hormones? Is she on any SSRIs that's going to set 404 00:23:07,070 --> 00:23:10,010 down her libido and say, I'm always willing to help. But many 405 00:23:10,010 --> 00:23:13,100 women don't feel comfortable. Sometimes they say, Look, I have 406 00:23:13,100 --> 00:23:16,010 a little libido, but I'm happy with it. I say, great. So that's 407 00:23:16,010 --> 00:23:19,370 fine. So some couples do come in together, which is great, and 408 00:23:19,370 --> 00:23:22,430 that's a great discussion. Some women come in after I see the 409 00:23:22,430 --> 00:23:24,860 male, then they'll come in afterward and say, Look, my 410 00:23:24,860 --> 00:23:27,140 husband told me that you may be able to help. And I say, Great, 411 00:23:27,140 --> 00:23:30,800 let's talk. But when they come in, it's not just about handing 412 00:23:30,830 --> 00:23:33,590 her hormones and pills like it's not just about giving her 413 00:23:33,590 --> 00:23:36,230 estrogen, progesterone, handing her some testosterone, some 414 00:23:36,230 --> 00:23:39,920 vaginal estrogen, and saying goodbye, we go heavy, heavy 415 00:23:39,950 --> 00:23:43,190 lifestyle modification. Um, she's gotta help me with the 416 00:23:43,190 --> 00:23:46,190 lifestyle modification, whether it be weight reduction. Now, I 417 00:23:46,190 --> 00:23:49,280 have found one thing that's actually helped a lot of men and 418 00:23:49,280 --> 00:23:53,240 women, more than even hormones and when it comes to sexual 419 00:23:53,240 --> 00:23:56,420 dysfunction, and that's weight loss. You know, when a woman 420 00:23:56,540 --> 00:24:01,460 loses 3040, pounds, she feels amazing. She feels like a new 421 00:24:01,460 --> 00:24:05,390 person, new clothes, new outlook, self image skyrockets, 422 00:24:05,570 --> 00:24:07,970 and obviously helps with the joint pain and the blood sugars 423 00:24:07,970 --> 00:24:10,010 and the hypertension and the cholesterol. I mean, a lot of 424 00:24:10,010 --> 00:24:13,310 other things improve as well, but we use a lot of GLP1 in the 425 00:24:13,310 --> 00:24:16,700 Select population of patients, and putting him or her on the 426 00:24:16,730 --> 00:24:20,150 GLP1 has really made a difference in my practice. 427 00:24:20,180 --> 00:24:24,020 Anne Truong: So you put them on GLP one and on a hormone 428 00:24:24,020 --> 00:24:26,840 replacement therapy at the same time, or use diagram, yes, 429 00:24:26,870 --> 00:24:28,760 Dr. Mohit Khera: it's synergistic. So remember this, 430 00:24:28,790 --> 00:24:31,040 and we're almost done with this. We're doing a trial now at 431 00:24:31,040 --> 00:24:34,520 Baylor, where if you give someone a GLP1 agonist, they 432 00:24:34,520 --> 00:24:37,610 actually can start seeing a loss in muscle mass too. 433 00:24:37,610 --> 00:24:39,980 Unfortunately, because you're decreasing your caloric intake 434 00:24:39,980 --> 00:24:43,790 and the muscle mass will go down in hypogonadal patients or women 435 00:24:43,790 --> 00:24:48,230 with low T if you put them on testosterone and ask them to 436 00:24:48,230 --> 00:24:51,860 lift weights, to lift muscle mass, then we don't see a 437 00:24:51,860 --> 00:24:54,530 significant decline in muscle mass, because testosterone is 438 00:24:54,530 --> 00:24:57,980 anabolic, it actually increases muscle mass and decreases body 439 00:24:57,980 --> 00:25:01,520 fat. So very important that if. You can use these together. 440 00:25:01,580 --> 00:25:04,190 They're very synergistic. I'm not saying I mean treating a man 441 00:25:04,190 --> 00:25:06,530 who has a normal testosterone level will not help putting him 442 00:25:06,530 --> 00:25:09,800 on more testosterone. But in most cases, I would say in most 443 00:25:09,800 --> 00:25:13,160 cases, but typically, I say that these medications, the GLP1 and 444 00:25:13,160 --> 00:25:15,500 testosterone, are very effective together. 445 00:25:15,560 --> 00:25:20,480 Anne Truong: So you feel that most men and women after the age 446 00:25:20,480 --> 00:25:24,440 of maybe 50 to 55, when the testosterone level dropped for 447 00:25:24,440 --> 00:25:28,610 women and men that they should be on a hormone replacement 448 00:25:28,610 --> 00:25:29,180 therapy? 449 00:25:29,300 --> 00:25:31,730 Dr. Mohit Khera: If they're symptomatic. Well, party lines 450 00:25:31,730 --> 00:25:34,400 if they're symptomatic but I would say that I do think that 451 00:25:34,400 --> 00:25:37,160 there is beneficial effects beyond just being symptomatic. 452 00:25:37,190 --> 00:25:41,870 For example, testosterone is one of the best markers of overall 453 00:25:41,870 --> 00:25:44,780 health. If a man has low testosterone, we know that he's 454 00:25:44,780 --> 00:25:47,330 at a higher risk of having a heart attack, non-negotiable. 455 00:25:47,450 --> 00:25:50,030 Increases risk for MI. Low testosterone increases risk 456 00:25:50,030 --> 00:25:52,550 demands for diabetes and obesity, non-negotiable. 457 00:25:52,730 --> 00:25:55,610 Increases his risk for bone and bone fracture. We know that 458 00:25:55,640 --> 00:25:58,550 osteopenia and osteoporosis significantly go up in these 459 00:25:58,550 --> 00:26:01,310 patients. We also know that low test also increases the risk for 460 00:26:01,310 --> 00:26:03,980 depression. It was my study significant increases for 461 00:26:03,980 --> 00:26:08,030 depression. So forget sex. I told you if I had a blood test 462 00:26:08,090 --> 00:26:10,760 that I could order that would give you a window to your heart, 463 00:26:10,820 --> 00:26:14,540 to depression, to diabetes, obesity, bone fracture. We know 464 00:26:14,540 --> 00:26:17,930 that low test also has been associated with prostate cancer 465 00:26:17,930 --> 00:26:21,560 risk as well. You show me in another blood test I can get 466 00:26:21,770 --> 00:26:25,010 that's a better marker of men's overall health. It's not TSH, 467 00:26:25,100 --> 00:26:27,800 it's not lipids, it's not C reactive proteins, it's not your 468 00:26:27,800 --> 00:26:31,670 gas, doctor, not a single blood test is a better marker of 469 00:26:31,670 --> 00:26:35,000 everything I just told you in men's health, and that blood 470 00:26:35,000 --> 00:26:39,470 test also gives you a window of symptoms, energy, libido, 471 00:26:39,500 --> 00:26:44,030 erectile function. So every man over the age of 40, I believe, 472 00:26:44,030 --> 00:26:47,870 should have a serum testosterone level checked annually. And we 473 00:26:47,870 --> 00:26:50,540 started a nonprofit. It's called the testosterone project. The 474 00:26:50,540 --> 00:26:53,750 testosterone project has three missions. One, increased testing 475 00:26:53,780 --> 00:26:57,650 for all men over the age of 40, every man. Number two, that we 476 00:26:57,650 --> 00:27:00,380 should actually deregulate testosterone. It's shocking to 477 00:27:00,380 --> 00:27:03,380 me that testosterone, and natural hormone that we make, is 478 00:27:03,380 --> 00:27:06,140 treated just like Vicodin, where it's regulated in the same 479 00:27:06,170 --> 00:27:10,070 capacity. And three, the mission of the testosterone project is 480 00:27:10,070 --> 00:27:14,060 to bring testosterone to women through the FDA and make it 481 00:27:14,060 --> 00:27:16,550 available. I mean, think about this. Testosterone has been 482 00:27:16,550 --> 00:27:19,880 around since 1935 so that's when it was first synthesized by moon 483 00:27:19,880 --> 00:27:24,260 in lucica, 1935 shortly after testosterone was used in women 484 00:27:24,290 --> 00:27:28,970 in the late 1930s if you and I walked into Walgreens today and 485 00:27:28,970 --> 00:27:31,430 said, Give me all the testosterone for men put out 486 00:27:31,460 --> 00:27:34,850 over 20 products sitting on top of the counter, I said, Give me 487 00:27:34,880 --> 00:27:38,360 all the testosterone products available for women, zero, not 488 00:27:38,360 --> 00:27:41,900 one. FDA approved testosterone product in for women, if we went 489 00:27:41,900 --> 00:27:45,140 to Australia, that would be if we went to UK, we could get a 490 00:27:45,170 --> 00:27:49,580 test. Also for women, not in the US, we have to improvise. We 491 00:27:49,580 --> 00:27:52,850 have to use the testosterone. For men, use 110th dose. We have 492 00:27:52,850 --> 00:27:56,090 to compound it with the cream. We have to be creative. But she 493 00:27:56,090 --> 00:27:58,850 can't go in. She says, Look, my husband goes in. He pays $10 494 00:27:58,850 --> 00:28:03,200 copay. I go in, I gotta pay full price. Why? Why do I have to pay 495 00:28:03,320 --> 00:28:06,770 and he doesn't. We both make testosterone. In fact, I make 496 00:28:06,830 --> 00:28:09,710 one makes more testosterone any woman in the body, but I have to 497 00:28:09,710 --> 00:28:13,520 pay full price. Why? It doesn't make any sense. And so that's 498 00:28:13,520 --> 00:28:15,410 one of the goals of a testosterone browser. 499 00:28:15,000 --> 00:28:18,780 Anne Truong: I love that. I have to check that out as well too. 500 00:28:18,780 --> 00:28:21,870 But that we know there's always been a sexual disparity in 501 00:28:21,870 --> 00:28:26,370 research for men versus women health, like how many medication 502 00:28:26,370 --> 00:28:29,760 there are for ED versus how many medication there are for female 503 00:28:29,940 --> 00:28:31,080 sexual dysfunction. 504 00:28:31,350 --> 00:28:32,760 Dr. Mohit Khera: I want to give you an example of that. So Anne, 505 00:28:32,760 --> 00:28:37,200 remember this for many years, if in 2014 if you went again to 506 00:28:37,200 --> 00:28:39,750 Walgreen, just said, Give me all the sexual dysfunction drugs for 507 00:28:39,750 --> 00:28:45,990 men, over 30 drugs. In 2014 we had zero approved for women. It 508 00:28:45,990 --> 00:28:50,130 wasn't till 2015 when flibanserin got first FDA 509 00:28:50,130 --> 00:28:53,130 approved, the first drug for women ever, for FSD. Then it 510 00:28:53,130 --> 00:28:56,070 came out till 2015 several years later, we had Vyleesi, which 511 00:28:56,070 --> 00:28:59,310 came out, and then we have two. But can you imagine the amount 512 00:28:59,310 --> 00:29:03,180 of research that we have devoted to female sexual dysfunction? 513 00:29:03,180 --> 00:29:05,760 It's just a fraction. And the amount of treatment options we 514 00:29:05,760 --> 00:29:08,730 have for women is just a fraction of what we have for 515 00:29:08,730 --> 00:29:11,310 men, which is unfortunate, because, as I mentioned earlier, 516 00:29:11,370 --> 00:29:15,270 up to 48% of women, the US suffer from this condition. And 517 00:29:15,270 --> 00:29:17,790 now I turn around and say, I don't have much to offer. I 518 00:29:17,790 --> 00:29:20,190 mean, fortunately, we have starting to see some traction, 519 00:29:20,400 --> 00:29:21,720 but we need more research. 520 00:29:22,170 --> 00:29:26,670 Anne Truong: So when you say 48%, is that all from over 40 or 521 00:29:26,700 --> 00:29:28,350 just across anything over? 522 00:29:28,830 --> 00:29:31,200 Dr. Mohit Khera: I think, I believe it was over 40. The 523 00:29:31,290 --> 00:29:36,330 studies showed 40. I forgot the cut off age where he started. To 524 00:29:36,330 --> 00:29:37,050 be honest with you. 525 00:29:37,110 --> 00:29:39,660 Anne Truong: Yeah, I think it's over 40. Yeah, we've heard that 526 00:29:39,660 --> 00:29:42,990 around 50% it's probably an underestimate actually, because 527 00:29:42,990 --> 00:29:44,850 that study with a long time ago. 528 00:29:46,110 --> 00:29:48,180 Dr. Mohit Khera: But I do think that it's underestimate. I think 529 00:29:48,180 --> 00:29:51,750 many women who suffer from FSD don't talk about it. I mean, 530 00:29:51,780 --> 00:29:54,810 there's a stigma about sexual dysfunction. I give you an 531 00:29:54,810 --> 00:29:57,420 example. I was giving a lecture, and I said to everyone in the 532 00:29:57,420 --> 00:30:00,540 crowd, can you raise your hand if. You suffer from 533 00:30:00,540 --> 00:30:04,080 hypertension, and actually quite a hand. Few hands went up. Then 534 00:30:04,080 --> 00:30:07,500 I asked, Can you raise your hand if you have sexual dysfunction? 535 00:30:07,890 --> 00:30:12,540 Almost no. One hand went up. It was a woman. One hand, okay. And 536 00:30:12,540 --> 00:30:16,050 you know very well statistically that that's not true, because up 537 00:30:16,050 --> 00:30:18,900 to 48% of women will have FSD. And we know if you look at the 538 00:30:18,900 --> 00:30:23,880 men's statistics, 40% of men have ed at 40, 50% at 50, 60% at 539 00:30:23,940 --> 00:30:27,930 60, 70% at 70, 100% at 100. It's one of the most prevalent 540 00:30:27,930 --> 00:30:31,770 conditions out there. But we will not raise our hand for 541 00:30:31,770 --> 00:30:34,200 sexual dysfunction. We have no problem raising our hand for 542 00:30:34,200 --> 00:30:37,200 hypertension. We have to destigmatize it's okay to have 543 00:30:37,200 --> 00:30:40,500 sexual dysfunction. It's a normal part of aging. It's okay. 544 00:30:40,560 --> 00:30:43,620 Now there's ways to mitigate that and change it, but it's 545 00:30:43,620 --> 00:30:46,950 Shouldn't it be destigmatized. You should not be embarrassed. 546 00:30:47,050 --> 00:30:50,140 Anne Truong: I love that. So it's okay to have sexual 547 00:30:50,140 --> 00:30:53,080 dysfunction. It doesn't mean you're less of a woman or less 548 00:30:53,140 --> 00:30:57,460 of a man. And as we work in sexual health, they always 549 00:30:57,460 --> 00:31:00,940 think, Oh, my God, it's like cancer, but it's as it's part of 550 00:31:00,970 --> 00:31:05,350 aging, but definitely can be managed like diabetes or 551 00:31:05,350 --> 00:31:09,070 obesity. It can be managed almost the same way it has a 552 00:31:09,070 --> 00:31:10,060 heart condition, right? 553 00:31:10,080 --> 00:31:12,000 Dr. Mohit Khera: So think about this, if a 60 year old man comes 554 00:31:12,000 --> 00:31:15,510 into me and says, I cannot believe I have erectile 555 00:31:15,510 --> 00:31:17,760 dysfunction, what's going on? I say, did you know you're the 556 00:31:17,760 --> 00:31:22,140 minority? Do you know that 60% of men at 60 actually have 557 00:31:22,170 --> 00:31:25,500 erectile dysfunction. More men that your age have it than do 558 00:31:25,500 --> 00:31:27,990 not. And then they sit there and say, oh, and actually feel 559 00:31:27,990 --> 00:31:31,440 better. They realize I'm not alone. Many people suffer from 560 00:31:31,440 --> 00:31:34,380 this condition, and it's not unique to me, and I think that's 561 00:31:34,380 --> 00:31:36,480 very important. We didn't talk about something very important. 562 00:31:36,480 --> 00:31:39,780 You know, sexual dysfunction is one of the best barometers of a 563 00:31:39,780 --> 00:31:42,600 man's overall health, that if a man gets erectile dysfunction 564 00:31:42,600 --> 00:31:45,480 today, you know that 15% will have a heart attack or a stroke 565 00:31:45,480 --> 00:31:48,900 within seven years, 15% many people have also shown that if a 566 00:31:48,900 --> 00:31:52,590 man has ED today, he's much more likely to get diabetes, almost 567 00:31:52,590 --> 00:31:56,790 two times likely to get diabetes than a man who does not ED is 568 00:31:56,820 --> 00:31:59,760 increased risk for not only heart attack and stroke, but 569 00:31:59,760 --> 00:32:03,780 increased mortality. Men with ED are much more likely to die, 25% 570 00:32:03,780 --> 00:32:09,300 increased risk if they have ED today. So it is a window of not 571 00:32:09,300 --> 00:32:12,900 only cardiovascular risk, mortality, diabetes, also 572 00:32:12,900 --> 00:32:17,340 depression and anxiety. So it's not just this erectile 573 00:32:17,340 --> 00:32:20,730 dysfunction. He's trying to tell you that something's going to 574 00:32:20,730 --> 00:32:23,310 come in the future, and we need to talk about it and take care 575 00:32:23,000 --> 00:32:24,560 Anne Truong: I love that. And not a lot of doctors are aware 576 00:32:23,310 --> 00:32:23,640 of it now. 577 00:32:24,590 --> 00:32:25,820 of the different treatment for ED other than Hey, they go and 578 00:32:25,880 --> 00:32:33,260 talk to their primary care doctor, they give them Viagra, 579 00:32:33,260 --> 00:32:36,080 and some don't even do blood work or look at their hormones 580 00:32:36,080 --> 00:32:39,320 or even assess whether it's psychological or not. They're 581 00:32:39,320 --> 00:32:44,570 either on the ED meds and then progressive tri mix as well, 582 00:32:44,570 --> 00:32:47,600 without really looking at the other lifestyle factors that are 583 00:32:47,810 --> 00:32:50,630 important that we talk about. And as you know, is just take 584 00:32:50,660 --> 00:32:53,840 extra training. My daughter right now is in medical school. 585 00:32:53,840 --> 00:32:57,980 She's in third year medical school here in Virginia, and I'm 586 00:32:57,980 --> 00:33:02,300 just flabbergasted at the amount of education they're even 587 00:33:02,300 --> 00:33:07,280 getting now we're talking about 2024, 2025 she did her third 588 00:33:07,280 --> 00:33:11,000 year, about to become a doctor in about a year, nothing been 589 00:33:11,000 --> 00:33:14,600 taught, even in the first and second year about hormones and 590 00:33:14,600 --> 00:33:18,140 hormone replacement therapy or even preventative therapy. 591 00:33:18,140 --> 00:33:21,170 They're being taught almost the same thing that I had one I was 592 00:33:21,170 --> 00:33:28,910 in med school from '89 to '93 It is astonishing that there is 593 00:33:28,970 --> 00:33:32,390 nothing on hormone replacement therapy. She's rotating through 594 00:33:32,390 --> 00:33:36,710 her OB, and she's about to do urology during the OB. Nothing 595 00:33:36,740 --> 00:33:40,010 on hormone replacement therapy for women, or even sexual 596 00:33:40,010 --> 00:33:45,200 dysfunction discussion, even in her clinical rotation, and we 597 00:33:45,200 --> 00:33:48,590 have to learn all that post residency or even post 598 00:33:48,620 --> 00:33:52,820 fellowship. Have there been changes in curriculum in Baylor 599 00:33:52,820 --> 00:33:54,200 about that at all. 600 00:33:54,330 --> 00:33:56,220 Dr. Mohit Khera: Yes. So you know you're absolutely correct. 601 00:33:56,250 --> 00:34:01,050 Very few medical schools teach sexual dysfunction. Very few 602 00:34:01,080 --> 00:34:03,900 people get their training even in residency with sexual 603 00:34:03,900 --> 00:34:06,360 dysfunction hormones. Most of the time, you know, where they 604 00:34:06,360 --> 00:34:08,940 learn it, they learn it from podcasts. They learn from 605 00:34:09,030 --> 00:34:12,390 meetings, CME meetings that we put on. You've been to one. We 606 00:34:12,390 --> 00:34:14,640 talked about this in Orlando. I mean, there are meetings that 607 00:34:14,640 --> 00:34:17,100 you'll get that's where they get their education from. It's not 608 00:34:17,130 --> 00:34:20,250 during their true medical education training. Now I'm 609 00:34:20,250 --> 00:34:22,650 going to talk about an organization called the Sexual 610 00:34:22,680 --> 00:34:25,410 Medicine Society of North America, by far the best 611 00:34:25,410 --> 00:34:28,260 organization on the planet. I would say, when it comes to 612 00:34:28,260 --> 00:34:32,100 sexual medicine and education. And the Sexual Medicine Society 613 00:34:32,100 --> 00:34:34,530 of North America has now started a new initiative to 614 00:34:34,530 --> 00:34:38,520 significantly increase medical school education in sexual 615 00:34:38,520 --> 00:34:42,510 medicine in all 50 states, and so basically, help support it. 616 00:34:42,810 --> 00:34:45,390 Have champions located in medical centers in all 50 617 00:34:45,390 --> 00:34:48,450 states, and those champions will have monthly meetings. We 618 00:34:48,450 --> 00:34:50,670 currently are doing this already, and we meet with the 619 00:34:50,670 --> 00:34:54,750 medical students, and we teach them sexual medicine once a 620 00:34:54,750 --> 00:34:57,390 month. We've been doing it at Baylor now for three years. Once 621 00:34:57,390 --> 00:35:00,180 a month, every month, we meet with all the medical students 622 00:35:00,180 --> 00:35:03,150 who are interested. They come, we have some dinner, and we talk 623 00:35:03,150 --> 00:35:06,420 about sexual medicine. Ours. These are called rigs, regional 624 00:35:06,420 --> 00:35:10,200 interest groups. And so we're trying to significantly increase 625 00:35:10,260 --> 00:35:12,720 medical school education, because I think it starts in 626 00:35:12,720 --> 00:35:15,360 medical school. It's even because that's when better than 627 00:35:15,360 --> 00:35:18,360 even going getting ready to teach it in medical school. Make 628 00:35:18,360 --> 00:35:21,060 it a true curriculum, and we're actually helping the SMS and A 629 00:35:21,060 --> 00:35:24,180 is helping develop the curriculum for those medical 630 00:35:24,180 --> 00:35:24,630 schools. 631 00:35:24,720 --> 00:35:27,000 Anne Truong: Oh, that's wonderful. I am really glad to 632 00:35:27,000 --> 00:35:28,770 hear that. And you're still the chairman? 633 00:35:29,280 --> 00:35:32,430 Dr. Mohit Khera: I just finished my presidency. So I just 634 00:35:32,430 --> 00:35:34,170 finished my presidency of the SMS and A. 635 00:35:34,200 --> 00:35:37,080 Anne Truong: Gotcha. And I'm proud to say that I'm also a 636 00:35:37,080 --> 00:35:40,740 member as well of this association. I love the blog 637 00:35:40,740 --> 00:35:44,400 that you guys published, and I love that initiative, and I 638 00:35:44,400 --> 00:35:47,460 wanted to share that. So I want to touch upon what is your 639 00:35:47,460 --> 00:35:51,600 approach on the psychogenic ED component, because that is 640 00:35:51,600 --> 00:35:56,670 really intertwined with physical ED. You have physical ED, you 641 00:35:56,670 --> 00:35:59,460 don't have psychological ED, and they're kind of almost 642 00:35:59,460 --> 00:36:02,550 interchangeable, and I find it sometimes that it's more 643 00:36:02,550 --> 00:36:05,910 challenging to address the psychological component, because 644 00:36:05,910 --> 00:36:10,020 it just not involves the man, but also their partner as well. 645 00:36:10,230 --> 00:36:12,090 So what is your approach on that? 646 00:36:12,000 --> 00:36:14,340 Dr. Mohit Khera: So I think let's take a step back and look 647 00:36:14,340 --> 00:36:16,950 at exactly what's happening in this situation. Let's say a man 648 00:36:16,950 --> 00:36:20,220 has erectile dysfunction just once. Maybe he drank too much 649 00:36:20,220 --> 00:36:22,920 that night, or he just had erectile dysfunction when he 650 00:36:22,920 --> 00:36:27,210 engages in sexual activity. The next time, many men are saying, 651 00:36:27,240 --> 00:36:30,840 I hope I don't get erectile dysfunction again while they're 652 00:36:30,840 --> 00:36:34,410 having sex, as they say that they're fixated on not getting 653 00:36:34,410 --> 00:36:35,940 erectile dysfunction, they're going to get erectile 654 00:36:35,940 --> 00:36:38,250 dysfunction. In other words, they're more consumed then 655 00:36:38,250 --> 00:36:40,530 they'd have sex again. And now say, Look, I've had it twice. 656 00:36:40,590 --> 00:36:44,100 Sex now becomes anxiety provoking. They start getting 657 00:36:44,100 --> 00:36:46,800 nervous when they say, they say, I hope it doesn't happen. So I 658 00:36:46,800 --> 00:36:49,830 call it the vicious cycle. More sex they have, and the more ED 659 00:36:49,830 --> 00:36:52,080 they have, the more ED they're going to have. It just kind of 660 00:36:52,080 --> 00:36:55,890 gets into their head. So what you have to do is ask them 661 00:36:55,890 --> 00:36:58,260 certain questions. First of all, they say, with masturbation, do 662 00:36:58,260 --> 00:37:01,950 you have any problems? No, okay, that's psychogenic. If you get 663 00:37:01,950 --> 00:37:04,020 up in the morning, you wake up, do you have more strong morning 664 00:37:04,020 --> 00:37:06,660 erections? Yes, then that's psychogenic. It means the 665 00:37:06,660 --> 00:37:09,810 hardware is working fine. Everything is working fine. It 666 00:37:09,810 --> 00:37:12,240 just doesn't work well when you're with your partner. That 667 00:37:12,240 --> 00:37:16,260 is psychogenic ED. So a person who has true ED would not be 668 00:37:16,260 --> 00:37:19,230 able to get great erections with masturbation or wake up with 669 00:37:19,230 --> 00:37:22,020 morning erections because the erections don't work. So we 670 00:37:22,020 --> 00:37:24,360 that's very important. What's my favorite way to break 671 00:37:24,360 --> 00:37:28,230 psychogenic ED? My favorite way to break psychogenic ED is daily 672 00:37:28,230 --> 00:37:31,770 Cialis. When I give a man daily Cialis, many of these men will 673 00:37:31,770 --> 00:37:34,110 start waking up with morning erections, and when they engage 674 00:37:34,110 --> 00:37:36,420 in sexual activity, many of them don't need to take a pill. They 675 00:37:36,420 --> 00:37:39,180 just have sex. When they want to have sex, they feel normal 676 00:37:39,180 --> 00:37:41,610 again. When they feel normal again. And every time they 677 00:37:41,610 --> 00:37:45,630 notice, hey, past 10 times I had sex, everything was great. I had 678 00:37:45,630 --> 00:37:48,930 no ED. Then I start taking back the Cialis, little by little. 679 00:37:48,930 --> 00:37:51,480 You can take it every other day, then you can take it to twice a 680 00:37:51,480 --> 00:37:54,360 week, and you can stop. Many men don't want to stop the Cialis. 681 00:37:54,390 --> 00:37:57,450 And I think Cialis is a fantastic medication. It's FDA 682 00:37:57,450 --> 00:38:00,840 approved for ED, FDA approved for BPH, FDA approved for 683 00:38:00,840 --> 00:38:03,270 pulmonary hypertension that protects the lining of the blood 684 00:38:03,270 --> 00:38:05,700 vessels, protects the endothelium. It's a win, win, 685 00:38:05,700 --> 00:38:09,510 win on all three. So I really recommend those, particularly 686 00:38:09,510 --> 00:38:12,930 for the men over the age of 50. So I think that psychogenic ED 687 00:38:12,930 --> 00:38:15,510 can be broken with that kind of showing them everything's fine. 688 00:38:15,810 --> 00:38:18,990 You make a referral to a sex therapist. Most of them will not 689 00:38:18,990 --> 00:38:22,020 see the sex therapist, but they does help seeing a sex therapist 690 00:38:22,290 --> 00:38:25,740 and getting a penile ultrasound and showing them that everything 691 00:38:25,740 --> 00:38:29,460 is perfect, actually, is very therapeutic to them as well. Oh, 692 00:38:29,460 --> 00:38:33,480 look, Mr. Smith, your peak systolic was 40. Was fantastic. 693 00:38:33,570 --> 00:38:36,840 Your end diastolic was only two. You have very healthy blood 694 00:38:36,840 --> 00:38:39,930 vessels and penis. They feel better. They actually feel 695 00:38:39,930 --> 00:38:41,310 better knowing that everything is fine. 696 00:38:41,480 --> 00:38:44,120 Anne Truong: I love that, and I actually do that a lot. I've 697 00:38:44,120 --> 00:38:47,150 learned, you know, ultrasound from the urology here, and it's 698 00:38:47,150 --> 00:38:50,090 the best thing you can do, because it's objective evidence 699 00:38:50,090 --> 00:38:52,520 that, hey, everything is working. The plumbing is working 700 00:38:52,550 --> 00:38:55,550 really, really well. And so what dose? 701 00:38:55,000 --> 00:38:58,330 Dr. Mohit Khera: the quality of the relationship? Though, that's 702 00:38:58,330 --> 00:39:01,420 really important. The quality of the relationship. I don't care 703 00:39:01,420 --> 00:39:04,120 how much medication I give you, if the quality of the 704 00:39:04,120 --> 00:39:08,080 relationship is poor, it will have a big impact, and not 705 00:39:08,080 --> 00:39:10,720 knowing that piece of information will make it more 706 00:39:10,720 --> 00:39:11,920 difficult to treat that patient. 707 00:39:11,990 --> 00:39:15,050 Anne Truong: Well, let's say the quality is poor. As the doctor, 708 00:39:15,050 --> 00:39:16,070 what can you do about it? 709 00:39:16,240 --> 00:39:18,520 Dr. Mohit Khera: We have three phenomenal sex therapists that 710 00:39:18,520 --> 00:39:20,650 we use, and actually they're different ages and they have 711 00:39:20,650 --> 00:39:23,170 different personalities, so I kind of tailor my referral to 712 00:39:23,170 --> 00:39:26,290 that right person I think will suit the best for that with that 713 00:39:26,290 --> 00:39:29,230 sex therapist. They're all amazing, but I do think that 714 00:39:29,260 --> 00:39:33,040 seeking sex therapy would be important. I think also making 715 00:39:33,040 --> 00:39:37,090 sure that the partner does not suffer from FSD was some of the 716 00:39:37,120 --> 00:39:39,940 reasons that could impair the quality relationship is if the 717 00:39:40,060 --> 00:39:43,180 male partner is constantly wanting to engage in sexual 718 00:39:43,180 --> 00:39:45,790 activity and putting pressure when she does not want to engage 719 00:39:45,790 --> 00:39:49,270 in sexual activity, that can make it very challenging. So you 720 00:39:49,270 --> 00:39:53,800 have to take a deeper dive when on her and find out what's going 721 00:39:53,800 --> 00:39:56,020 on, and vice versa when I'm treating the female patient, 722 00:39:56,230 --> 00:39:59,020 that it's very important and libido is actually, is 723 00:39:59,020 --> 00:40:01,300 interesting. Don't forget about what I teach the residents 724 00:40:01,300 --> 00:40:04,780 called PETT. PETT stands for prolactin, estradiol, thyroid 725 00:40:04,780 --> 00:40:08,560 and testosterone. Check the PETT on anyone who has low libido, 726 00:40:08,710 --> 00:40:09,970 because those could be off. 727 00:40:10,140 --> 00:40:16,860 Anne Truong: So PETT? So check that testosterone, thyroid, 728 00:40:16,890 --> 00:40:18,810 estrogen, that's right. 729 00:40:19,320 --> 00:40:20,700 Dr. Mohit Khera: All very important when you talk about 730 00:40:20,700 --> 00:40:23,730 libido and sexual orgasm function as well. 731 00:40:24,620 --> 00:40:28,370 Anne Truong: That's exactly what I check too. So often time we 732 00:40:28,370 --> 00:40:30,830 see men, they come in and the only thing that's checked is 733 00:40:30,860 --> 00:40:35,600 total testosterone. That's it. No SHBG, which stands for sex 734 00:40:35,600 --> 00:40:39,830 hormone binding globulin or estradiol, anything like that. 735 00:40:39,830 --> 00:40:42,620 It's the whole picture. Testosterone, if you're 736 00:40:42,620 --> 00:40:45,650 listening to this men, the total testosterone alone isn'y going 737 00:40:45,650 --> 00:40:49,250 to tell you the whole picture, what's going on in the body. 738 00:40:49,520 --> 00:40:52,550 I hope you enjoyed the episode. I know it's long, but it's 739 00:40:52,550 --> 00:40:57,800 packed with great information. Let me know how you think about 740 00:40:57,800 --> 00:41:01,550 it. I love to hear from you. I would appreciate it if you 741 00:41:01,550 --> 00:41:04,940 subscribe, hit the notification button and share it with 742 00:41:04,940 --> 00:41:09,110 somebody you know that can benefit from this, because you 743 00:41:09,110 --> 00:41:13,160 may help somebody without even knowing about it. And also, do 744 00:41:13,160 --> 00:41:19,100 not suffer with ED. Do not suffer in silence. There are 745 00:41:19,160 --> 00:41:24,050 solutions out there, so check out the Modern Man Club. It's a 746 00:41:24,050 --> 00:41:29,150 space where I share information on how to get out of ED and for 747 00:41:29,150 --> 00:41:34,820 you to regain sexual confidence again. And together, you can get 748 00:41:34,820 --> 00:41:41,570 out of ED and have solution for sexual confidence. So check it 749 00:41:41,570 --> 00:41:46,850 out at noedman.com I hope to see you in there, and I will see you 750 00:41:46,850 --> 00:41:48,110 in the next episode.