Peter Attia MD260 ‒ Men’s Sexual Health: why it matters, what can go wrong, and how to fix it
At a glance
WHAT IT’S REALLY ABOUT
Urologist Mohit Khera on Male Sexual Dysfunction, Testosterone, and Emerging Therapies
- Khera says sexual dysfunction is very common, with ED affecting roughly 40% of men at 40 and rising by decade, yet men suffer in silence because of embarrassment and because clinicians rarely ask.
- ED is framed as an early warning of cardiovascular disease, mostly driven by venous leak and endothelial dysfunction, and responds to lifestyle changes, daily tadalafil, injections, or a penile prosthesis.
- Khera is cautious about shockwave, stem cell and PRP therapies for ED, calling them promising but still investigational and often oversold, with shockwave the one he likes best.
- On testosterone, he argues symptoms matter more than numbers, favors calculated free T, and prefers twice-weekly subcutaneous injections for men committed to TRT while warning that starting TRT can suppress fertility and the endogenous axis.
- He distrusts finasteride because of post-finasteride syndrome, and he cites bipolar androgen therapy and a saturation model to argue testosterone does not drive prostate cancer.
IDEAS WORTH REMEMBERING
5 ideasMen suffer in silence with sexual dysfunction
Khera cites a survey in which only 51% of affected men told their doctor and 44% told their partner, mainly from embarrassment, while clinicians often don't ask because of time pressure.
ED can be an early sign of cardiovascular disease
Khera cites studies showing that organic ED often precedes cardiac events, with endothelial dysfunction as the prevailing common link, so lifestyle changes like diet, exercise, sleep and stress reduction matter.
Daily low-dose tadalafil is more than an on-demand pill
Khera sees 5 mg daily Cialis as helping tissue health, breaking the psychogenic vicious cycle, treating BPH, and possibly improving systemic endothelial function, and notes generics are now very cheap.
Work out whether ED is psychogenic or organic first
Khera says that good erections with masturbation or on waking suggest psychogenic ED, treated with sex therapy and daily tadalafil, and that penile ultrasound can show arterial insufficiency versus venous leak.
Newer ED treatments are promising but not proven
Khera says shockwave devices vary widely, stem cell and PRP lack placebo-controlled trials, and patients are vulnerable to expensive claims given a high placebo response.
WORDS WORTH SAVING
5 quotesThat's suffering in silence, and the main reason was they were embarrassed. Also, clinicians don't ask about it.
— Mohit Khera
So when you take Viagra, you are not curing your ED, you're just covering it that night while the disease continues to progress.
— Mohit Khera
It's the first sign of cardiovascular disease. Numerous studies have shown that.
— Mohit Khera
I never understood why we use this number 300. What are you telling me? 300 nanogram is a, is the definition for hypogonadism. So are you telling me that 290 we must all feel bad, and at 310 we must all feel good? That is not true.
— Mohit Khera
The science is coming up, and I would say that it may be beneficial for patients who have mild to moderate ED. But I just... Be careful on the ads that are given
— Mohit Khera
High quality AI-generated summary created from speaker-labeled transcript.
