Dr. Mohit Khera: How to extend your sexpan and libido

Erectile dysfunction is often the first sign of serious cardiovascular disease. Dr. Khera cites data showing that 15% of men who present with ED will have a heart attack or stroke within seven years, and that one in five men with ED may already have significant coronary artery blockage. Low testosterone is also linked to higher rates of heart attacks, diabetes, obesity, depression, and fractures. Practically: if you notice persistent ED or major libido changes, treat that as a prompt to get screened for blood pressure, glucose/diabetes, cholesterol, and testosterone rather than just chasing a quick erection fix.

Khera repeatedly stresses that no pill is stronger than diet, exercise, sleep, and stress reduction. Mediterranean-style eating (whole grains, legumes, vegetables, fruit, mostly fish, minimal red meat and sweets), 160 minutes per week of moderate–vigorous exercise, and 7–8 hours of sleep can significantly improve erectile function and overall sexual performance in both men and women. Cardiac rehab–style programs have shown up to a fourfold improvement in women’s sexual function. Action: adopt Mediterranean eating, schedule 4×40-minute workouts weekly, protect your sleep window, and intentionally lower stress as first-line treatment for libido and erection issues.

Libido is hormonally and neurologically complex. Khera uses the mnemonic PET: Prolactin, Estrogen, Thyroid, Testosterone – imbalances in any of these can lower desire. Neurotransmitters matter too: higher dopamine and norepinephrine raise libido, while higher serotonin lowers it and can delay orgasm. Common antidepressants and finasteride (for urinary or hair issues) frequently blunt libido. Practical steps: if libido drops, ask your doctor to review PET hormones and all current medications, especially antidepressants and finasteride; consider alternatives or dose changes under supervision.

Excessive porn can create a gap between expectation and reality that contributes to ED and low desire with partners. Khera notes studies where heavy porn usage correlates with ED, and in clinic he sees men whose erections are fine with porn but fail with partners – a sign of psychogenic ED. For many, just stopping or cutting porn leads to improvement. Additionally, a single bad erection can trigger an anxiety loop (“I hope I don’t lose it”) that itself causes ED. Action: if your erections are strong alone/porn but not with a partner, scale back or stop porn for a period, and consider sex therapy or temporary medical support to break the anxiety loop.

Men’s average testosterone has fallen from ~700 ng/dL in the 1970s to mid‑400s by 2015, largely in parallel with rising obesity and diabetes. Low T drives low libido, weaker erections, more fat, less muscle, and higher disease risk. For men, Khera distinguishes two approaches: stimulating natural testosterone (e.g., clomiphene, hCG, weight loss) when fertility must be preserved, and direct testosterone replacement (injections or modern oral forms) when fertility is no longer needed and symptoms plus low levels are confirmed. Women naturally produce and benefit from testosterone too – it boosts libido, muscle, bone density, and wellbeing – yet there is no FDA-approved female formulation in the US, so clinicians often use one-tenth of male doses off‑label. Key actions: if you have symptoms (low libido, ED, fatigue, body composition changes), get your testosterone measured; only consider therapy when both levels and symptoms line up, and avoid exogenous testosterone if you still want children.