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Mohit Khera is a urologist with expertise in sexual medicine. In this episode, he provides an overview of male sexual health. He first goes indepth on 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. Mohit then delves into the intricate workings of testosterone, DHT, and estrogen, emphasizing their physiological significance and interplay. He explains blood tests for diagnosing low T, the correlation between symptoms and blood levels in cases of low T, and the various methods for increasing testosterone. He concludes with a conversation about the role of testosterone in patients with prostate cancer and addresses concerns surrounding DHT, finasteride, and postfinasteride syndrome.

We discuss:
0:00:00 Intro
0:01:18 Mohit’s career path and interest in sexual medicine
0:03:25 The anatomy of the male genitalia
0:05:06 The prevalence of sexual dysfunction & impact on quality of life
0:08:58 Erectile dysfunction (ED): definition, diagnosis, pathophysiology
0:13:41 The history of medications to treat ED and the mechanisms of how they work
0:18:21 Relationship between aging & erectile dysfunction and Mohit's approach to treating patients
0:29:14 The impact of lifestyle on sexual health & the association between ED and cardiovascular disease
0:37:52 Causes and treatments for Peyronie’s Disease & penile fracture
0:48:32 The value of ultrasound for ED diagnosis and management strategies
0:51:55 Various treatment options for ED: injections, penile prosthesis
0:59:38 Priapism (prolonged erection)
1:05:40 Shockwave therapy as a treatment for ED
1:11:46 Stem cell therapy for ED
1:15:48 Plateletrich plasma (PRP) injections as a treatment for ED
1:18:36 Premature ejaculation (PE): prevalence, pathophysiology, and treatment
1:26:34 Anorgasmia: causes and treatment
1:31:52 Sex hormones, impact of aging, symptoms of low T, & considerations for testosterone replacement therapy (TRT)
1:44:49 Methods for increasing endogenous testosterone
2:00:03 Testosterone replacement therapy: various forms of exogenous testosterone & weighing risk vs. reward
2:11:03 The physiology and purpose of testosterone and DHT, why some men feel fine even with “low” testosterone, personalized approaches to treating low T
2:18:25 Postfinasteride syndrome
2:26:42 The role of testosterone in prostate cancer and addressing the notion that TRT could increase risk
2:38:29 The effects of testosterone as an adjunct to therapy for estrogensensitive breast cancer in women
2:40:08 Resources for those looking for healthcare providers

About:
The Peter Attia Drive is a deepdive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 60 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health & more.

Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.

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