#260 ‒ Men’s Sexual Health: why it matters, what can go wrong, and how to fix it | Mohit Khera, M.D., M.B.A., M.P.H.

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The Peter Attia Drive
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02:33:12

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Mohit Khera is a world-renowned urologist with expertise in sexual medicine and testosterone therapy. In this episode, Mohit provides a comprehensive overview of male sexual health. He begins with an in-depth exploration of erectile dysfunction, shedding light on its prevalence across different age groups, diagnostic methods, and its intriguing connection to cardiovascular disease. He then ventures into Peyronie's disease, penile fractures, penile enlargement treatments, prolonged erections, premature ejaculation, and anorgasmia. Shifting gears, Mohit delves into the intricate workings of testosterone, DHT, and estrogen, emphasizing their physiological significance and interplay. He explains blood tests for diagnosing low testosterone, the correlation between symptoms and blood levels in cases of low testosterone, and the pros and cons of different methodologies for increasing testosterone. He concludes with a thought-provoking conversation about the role of testosterone in patients with prostate cancer and addresses concerns surrounding DHT, finasteride, and post-finasteride syndrome.

We discuss:

  • Mohit’s career path and interest in sexual medicine and infertility [3:00];
  • The anatomy of the male genitalia [5:45];
  • The prevalence of sexual dysfunction, its impact on quality of life, and the importance of seeking help [7:15];
  • Erectile dysfunction (ED): definition, diagnosis, pathophysiology, and more [11:00];
  • The history of medications to treat ED and the mechanisms of how they work [15:30];
  • Relationship between aging and erectile dysfunction and Mohit's approach to treating patients and prescribing medications [20:00];
  • The impact of lifestyle on sexual health and the association between ED and cardiovascular disease [29:30];
  • Causes and treatments for Peyronie’s Disease, penile fracture, and more [37:30];
  • The value of ultrasound for ED diagnosis and management strategies [47:45];
  • Various treatment options for ED: injections, penile prosthesis, and more [50:15];
  • Priapism (prolonged erection): what is happening and when to seek treatment [57:15];
  • Shockwave therapy as a treatment for ED [1:02:45];
  • Stem cell therapy for ED [1:08:15];
  • Platelet-rich plasma (PRP) injections as a treatment for ED [1:12:00];
  • Premature ejaculation (PE): prevalence, pathophysiology, and treatment [1:14:45];
  • Anorgasmia: causes and treatment [1:22:00];
  • The interplay of sex hormones, the impact of aging, symptoms of low testosterone, and considerations for testosterone replacement therapy (TRT) [1:26:45];
  • Methods for increasing endogenous testosterone [1:38:45];
  • Testosterone replacement therapy: various forms of exogenous testosterone, weighing risk vs. reward, and more [1:52:30];
  • The physiology and purpose of testosterone and DHT, why some men feel fine even with “low” testosterone, personalized approaches to treating low testosterone, and more [2:02:30];
  • Post-finasteride syndrome [2:09:00];
  • The role of testosterone in prostate cancer and addressing the notion that TRT could increase risk [2:16:15];
  • The effects of testosterone as an adjunct to therapy for estrogen-sensitive breast cancer in women [2:27:15];
  • Resources for those looking for healthcare providers [2:28:45]; and
  • More.

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