260 ‒ Men’s Sexual Health: why it matters, what can go wrong, and how to fix it

Full episode and show notes: bit.ly/3Pu6LL0
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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 in-depth 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 post-finasteride 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 - Platelet-rich 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 - Post-finasteride 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 estrogen-sensitive breast cancer in women
2:40:08 - Resources for those looking for healthcare providers
-
About:
The Peter Attia Drive is a deep-dive 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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[@PeterAttiaMD]

In this episode, we discuss: 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 - Platelet-rich 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 - Post-finasteride 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 estrogen-sensitive breast cancer in women 2:40:08 - Resources for those looking for healthcare providers

[@RikimaruNobunaga]

Terrible terrible advice to take a neuro toxic SSRI everyday for erectile disfunction. Truly unbelievable. SSRIs are clearly toxic to the human body and should not be prescribed like they are. Please Peter.

[@TECHNOSINNER.]

Antidepressants have caused me permanent damages

[@AB34137]

It's repulsive the way Attia interacts with Mohit the way he patronises him no communication skills whatsoever his jeering quips throughout the interview also rushes Mohit interjects without giving him enough notice to organise his thoughts and articulate his science laden answers. No appreciation whatsoever of the guest the valuable information or the viewership Mohit was trying to educate. Must be the pharaoh syndrome that most Egyptians suffer from once they have acquired a bit of knowledge or they are in a position of influence though Attia has long disowned his Egyptian and Arabian heritage that he's ashamed of as he's a gargantuan uncle tom and is enamoured with his first name and western enunciation and mispronunciation of his last name. Just goes to show you can have 10 phds to your name still you are always a slave and knowledge didn't liberate you the more you excel the more uncle tom and slave genes ignite inside and manifest in your behaviour.

[@DEricKuhn]

.

[@FedeArgentina]

PERSONAL CONSULTATION: 30 years old, I can have an erection, I can have sex without problems, But if we 'change position' or stop for only 10... 15 or 20 seconds... My erection is gone (+50% of the time), and I have to get exited again. Do I suffer ED? Or it's just in my mind? ... My theory all this time is that if I focus on talking about something else, whether it's answering a question like "what was that noise?" or stop the relationship and a phone starts ringing, then there is no sex for 10/20 seconds... I have no idea if losing an erection in those cases is normal for all men

[@HARRYSANDHUTEAMBOSS]

You conduct the best interviews - you let them speak - you interject for the viewer clarity - you ask the right questions - you rarely miss any key points. Master of your craft, Pete. Thank you

[@christykirkendolwatsonm.d.3419]

As a physician in the TRT/HRT world this was phenomenal and changed my practice! SOOOO much information. Keep more like this coming!

[@ronmexico79]

Hello, I'm currently looking for trt/hrt treatment, but I don't know where to begin. Can you help??

[@christykirkendolwatsonm.d.3419]

@@ronmexico79 yes absolutely. Where do you live?

[@ronmexico79]

@@christykirkendolwatsonm.d.3419 wilmington delaware

[@rethinktestosterone]

More conversations like this are needed! Well done Dr. Khera and Dr. Attia!

[@afkVahn]

Post-Finasteride Syndrome (PFS) has utterly destroyed my life. I suffer from genital numbing, penile tissue deformations and shrinkage, zero libido/arousal, ED and other physical symptoms. This has been going on for a years and it’s driving me to suicide because no one is taking it seriously and the suffering is inhumane. Please doctors, I don’t want to be another statistic in this. Help us with raising more awareness, funds and research. It’s so badly needed for all the people who are suffering from this horrific disease.

[@JCPProductions01]

I'm sorry to hear that. I wonder if anabolic/ androgenic steroids would help. For example, high test or trenbolone for the very high libido and drive side effect

[@Abdullah-mt9ns]

It is way more common than people think

[@afkVahn]

@@JCPProductions01 no, it’s been tried. People with PFS don’t respond (correctly) to high doses of test or any steroid for that matter. Imagine that.

[@JCPProductions01]

@afkVahn thank you! I was definitely curious

[@cupofmozzarella]

You think you have other issues because finasteride nowhere near as invasive as you proclaim it to be.

[@garyyencich4511]

Great episode. Your video setup is always top notch but Dr Khera speaks so clearly and concisely and having him on-site took it to yet another level. The interplay between the various hormones and drug treatments coupled with individual situation is so complex it’s mostly beyond the ability of the average patient to make sense of. Even if that was the only thing I took away from this podcast it still would have been totally worthwhile. No one else is doing these kind of discussions at this at this level. Bravo!

[@vasileraischii4269]

O😅

[@charleneshaver7146]

As the wife of someone who has recently developed Ed, this is gold! It was a great way to help my husband. He watched the podcast, and it is helping guide us through the interventions with his urologist. We never would have known where to look for help! Dr Khera explains everything is such a calm reassuring way, that it really put my husband at ease. He had talked to the NP at our PCP's office, who presented all the options in a much scarier way, not intention, I'm sure but my husband was convinced, "I'm getting old, this happens to everyone and why bother." Such a same bc we've always had a healthy robust sexual relationship, and now bc of this information, there is hope. Thank you both Dr Attia and Dr Khera.

[@slong8602]

I'm on a gel and run a consistent 1200 test. After the last 3 years of the Covid jab there's no way I trust Big Pharm. I'm sure they will be adding MRNA if not already..No thanks

[@AC-ns4gu]

Thank you so much Dr. Khera and Dr. Attia for shedding light on Post Finasteride Syndrome (PFS). This condition is devastating and we badly need support. I am a 27 year old man who has been suffering for 4 years and my life has been totally destroyed. I am broken neurologically, physically and sexually. I’ve spoken to countless men all over the world who are being subjected to inhumane torture as a result of finasteride. I’ve even had a good friend take their own life because of PFS.

[@patrickr9931]

Was that Marc?

[@AC-ns4gu]

@@patrickr9931 yes it was

[@ballislife9924]

This podcast raises suspicion to the validity of PFS. I don't understand how you can be happy with this video as it basically denies the possibility of PFS if you really understand what these two are talking about.

[@TheLocalDank]

@@ballislife9924-Kevin Mann cult member

[@patrickr9931]

@@ballislife9924 shut commerce gimo

[@kentwright5346]

Dr.Attia, This is an excellent lesson that is absolutely a residency-level lecture for any physician who treats men. Many thanks for your work!

[@petermartff]

Dr. khera is great at explaining this topic. Very knowldgable and communicative. Great questions by Dr Attia

[@randallsample1005]

Oh, man, the parts of this discussion regarding prostate cancer really hit home. I was diagnosed with a high grade, high volume prostate cancer and underwent a radical prostatectomy about a year and a half ago, at the age of 62 (relatively young for this to happen, and in otherwise very good health). Dr. Attia is absolutely right in his recommendation of surgery. For me, the decision was a no-brainer, very clear. Nonetheless, there is the possibility of biochemical recurrence. If that were to happen, I'd really hope that the principles of the Transformer Trial have become more well known and applied! Excellent episode.

[@nickstrapko7549]

Glad youre doing good. Im about to do a mri and bone scan for my cancer

[@macfin4862]

Hope you're still doing well. Definitely the right decision going for the surgery, my dad made the same call at 67

[@randallsample1005]

@@macfin4862 I'm still doing very well, PSA has remained undetectable 2 1/2 years after the surgery. Thanks for asking! I hope the same is true for your dad, please send him my best wishes.

[@Redjamm90]

Wish they had also talked about PSSD, SSRI have caused me sexual dysfunction. Ruined my life.

[@lowestprime]

Love that Peter is aware of PFS @2:18:00. Would be amazing to have a finasteride/PFS specific episode with a prominent researcher.

[@cupofmozzarella]

An episode about PFS with facts? Good luck with that!

[@ayan0834]

Great point. I would also be fascinated to hear similar discussions on the effects of SSRIs on sexual health (even after cessation) from experts in both mental health and sexual health, and revisit whether as a society, we are grossly overusing these drugs without adequate respect towards potentially life-changing adverse outcomes.

[@ethanbaggoo1513]

​@@ayan0834I would like to see this as well

[@JZGreengo]

With PSSD I’m stoked it was mentioned, thank god people are speaking up about Post Finasteride Syndrome, the awareness sufferers are doing must be working 💪🏻

[@patrickr9931]

Should I off myself extreme pfs at forty six

[@davidgrimes4726]

Mohit was a fantastic guest! Just his smile is contagious! 😃 I also loved the discussion about PFS. At this point I think the most important question for any patient to ask a new physician is: what non-consensus views do you hold and why. If they can't come up with anything move along!

[@user-cc5ij3co6e]

Fantastic conversation - its missing and needed! For clinicians also!!! I hope Dr. Khera is teaching therapists and other health professionals.

[@poostenbrug3053]

Thank you for shining light on PFS and all your hard work doctor. I myself have PFS and have been suffering for 7 years. Started when i was 22 after only 5 months of finasteride. 0 libido and 0 erections. I was always healthy and exercised a lot. I've started TRT a year ago as a hail mary but still no effect on erections and libido.

[@deepak70413]

What about post SSRI Sexual dysfunction (PSSD). Many ppl are suffering from it. Please spread the awareness

[@cartertodd6061]

exactly what i was gonna say !!! he has no problem giving those out lol

[@supermellow1]

This is one of the best, most informative podcasts I’ve ever heard.

[@eliteboxfitness]

Thanks for this conversation drs. Learned a lot . Can't take anything for granted.

[@HoraceFoca]

Such a magnificent discussion, thank you for making it available for us Peter

[@aaronbailey23]

Ok, this is really crazy. In 2017, at age 35 I started having ED issues. 2 years later I had a massive heart attack. This podcast should’ve happened 6 years ago! 😆

[@ballislife9924]

This podcast raises suspicion to validity of PFS if anything

[@bardsamok9221]

​@@ballislife9924Arron's comment has nothing to do with "PFS". Did you even watch the podcast or just the PFS section as you suggested before?

[@bardsamok9221]

Absolutely! Much respect to the candour of this discussion. The description connection between sexual and heart health is eye opening! Perfect two people to discuss it so clearly at a high level. Best of luck.

[@ballislife9924]

@bardsamok9221 Yes, my bad. Didn't read carefully enough.

[@aaronbailey23]

@@ryu_street_fighter561 not really

[@TruthQuest4700]

This has been a very enlightening discussion and the idea of receiving this level of medical care and fine-tuning is off of my radar! My physician put me on T therapy in my mid-forties because it was below 200 and never ordered tests to check LH and FSH. I eventually found an endocrinologist to check LH and FSH but had to get off T therapy for six weeks before testing and being off T for six weeks is not pleasant. The test levels came back in range except now I can't get copies of the results from the lab because for some reason the lab orders indicated female and so the lab has no record of the results I can access. With the exception of obesity, I have all of those symptoms mentioned even with T therapy and it's very frustrating just trying to improve stamina.

[@allisa-vi7lp]

Please help these young men (and old) who are suffering from PFS (Post Finasteroid Syndrome). It is so tragic and life changing. It reminds me of damage that can result from benzo withdrawal. Please please use your platform to shed light on this. (Oh just saw you discussed this later in the broadcast, but more is needed)

[@Yiahi65]

You’re too kind

[@aaronbailey23]

Good grief Peter let the guy finish one thought lol. There were a few times there where I really wanted to hear the rest of what he was saying.

[@sirdwayne8504]

Have the Dr. On again. So informative and so eloquent. Awesome Dr. Attia. Thank you.

[@Alistair_Spence]

Very insightful questions, and very comprehensive answers. I learned a ton listening to this.

[@carlynnerau]

Thank you both for this in-depth conversation! 🙌💙 I look forward to Dr. Attias podcast on Breast Cancer. 🙏🎗️

[@monroetinker9844]

Great episode thank you for this information. I worked primary care as an NP for over six years and I can't tell you that males have an extremely difficult time talking about sexual issues in general. Just getting patients into the office to control diabetes and hypertension let alone a annual physical is a challenge itself. Ty Dr. Attia.

[@monroetinker9844]

Dr. Attia, Is it possible to send me a link where I can purchase a lactate monitor that you discussed in your zone 2 to training? It would be greatly appreciated. I am a fitness enthusiast.

[@ethanbaggoo1513]

Thanks for putting a spotlight on pfs - many of us sufferers appreciate it greatly

[@anneboyer6359]

Please seek help with proper doctors and rule out other issues too. Mohit Khera is funded by the post finasteride foundation. Go look up his studies.

[@Kalley_Kavia]

​@@anneboyer6359And why do you think that is? Because sufferers of this condition are desperate to find answers. If the medical community took this seriously from the beginning more people wouldn't get their lives destroyed by a cosmetic "medication".

[@ethanbaggoo1513]

​@anneboyer6359 Are you serious man? You do realize us sufferers regularly donate to the damn foundation because we have pfs. This condition only arose once I took finasteride, it is most certainly that damn drug that gave me these enduring side effects. Get educated.

[@patricksandridge6242]

Thank you 👨‍⚕️ & 🧑‍⚕️ this was an amazing episode with so much information

[@armandofelipe3462]

Dear Dr Attia Thank you so much for bringing this subject to your podcast, I follow most of your content attentively. I have been suffering from PE for these last 5 years, I’ve visit with two urologist specialist and they both prescribed SSRIs. And sprays medication. Nothing has really help… I am an active person in considerably good health, 36 years old. I’ve tried it all. But sadly, nothing works I live in Richmond TX, in the greater Houston area. Is there anyone that you or Dr. Mohit can recommend so I can seek treatment…Thank you so much. 🙏🏻 God bless

[@mickcunningham7786]

Absolutely loved this one. Please do a follow-up episode.

[@skmrgoo5717]

What I was disappointed about is that you didn’t ask him what is known about the risk of using a PDE-5 inhibitor such as Cialis long term. Some interesting melanoma papers have surfaced throughout the years and I think that he needed to give his take on them Other than that a fascinating podcast!

[@christopherdixon2310]

This doctor nailed it. Most comprehensive talk.

[@ludobmw540i]

Androgen receptor density is increased by strength training, so one could argue that a 50 plus male who trains hard could benefit from going on trt

[@Laz3rs]

Amazing episode. This guest is great to listen to.

[@MXF11]

Cialis is the best drug for BPH, too! I tried the others. Horrible side-effects! Cialis also makes me very vascular!

[@rogerp1477]

Very fascinating interview. Lots of good information. One question though. Dr. Mohit says he doesn't like Finasteride. For BPH he recommends alpha blocker or daily cialis? What about people who use Finasteride for hair loss? Any alternative? Thanks.

[@maximilian8339]

Thank you for speaking out about Post-Finasteride Syndrome! It is a terrible chronic disease triggered by Finasteride that is destryoing the life of thousands around the globe and has caused hundreds of suicides already! We need more research to find treatment options!

[@ballislife9924]

This podcast actually raises suspicion of the validity of PFS if you actually listen to what they are saying. Kheras points get dismantled and questioned. And it's no coincidence that Khera is on the PFS Foundations payroll while having his studies FUNDED by the PFS Foundation. That's a real problem when it comes to objective research. He also says stuff that is just plain wrong. I don't understand how you can be happy with this video.

[@AlexM-jd2ro]

Agree wholeheartedly....in some countries they already figured out that Finasteride destroys prostate gland...

[@patrickr9931]

Men are dying through suicide because compost finasterude syndrome. Unwilling shortly be one of them in likelihood I havemuwcleneastage and impotence.I had offensive 2009 and was mild for years in fact it i had visited theatricality he could have cured me.but Imlive innEyrope. I took seroquel for sleep and crashed again lost muscle libido total we I am a huge suicide risk also.bad insomnia

[@jonathanmitchell8668]

Has it gotten any better? Any update? I hope things are going well.

[@Doormat00]

My lifelong type of anorgasmia is due to not feeling enough phyisical stimulation from coitus. I have a history of phimosis until I got circumsized 5 years ago. What can I do to remedy or improve sensitivity so that I can reach climax?

[@Novilicious]

Incredible podcast Dr Attia. Please have Dr Gundry and Dr Lustig on your podcast as well. You ASK THE BEST QUESTIONS. No other MD quite like you!

[@Ph4t3]

As a long-time member, what a tremendous episode! I had to laugh at @2:22:25 when Peter just can't help himself and outlines a study design Mo should've done instead, basically telling him the one he did was trash, in a nice way though. Insane density of info and topics covered on this one, loved Mo as a guest, more like this please. These are the topics that it's extra hard to find advice you can trust.

[@Kevin-qy9wf]

I couldn't help but notice the same thing, that "ahh" and eye roll is so uncharacteristic of Dr. Attia but you can't blame him when Dr. Khera had already shared false information by that point.

[@xyzzy4567]

I’m glad he pushed back. It doesn’t appear the issue is settled. It’s good to bring up, but there were clearly serious issues with the design of that particular study. Hopefully research dig into this further over time and get some more solid evidence one way or another.

[@christianstetz5235]

The Traverse study mentioned was published in NEJM July 13, 2023, and showed testosterone treatment did not increase the risk of ischemic heart disease.

[@ahrengroesch8774]

I'm asking my doctor about daily tadalafil because of this. I check all the boxes pointing to it addressing my problem. Atrophy makes too much sense. Thank you.

[@MajorSpam]

So the electrical treatment would be at 2hz, I assume? What about other non-medical, non-surgical treatments like ultrasound theraphy? Would it help to promote angiogenesis? At which frequency? 40khz, 60khz, 80khz, 1mhz, 3mhz?

[@paddy3622]

it almost sounds, to me, that taking 5mg prophylactically is the way to go. even if everything is good downstairs.

[@TheBswan]

I assume you mean 5mg Cialis, rather than some of the other drugs mentioned. I'm not a doctor, but I agree that could make sense

[@danilascercovas6226]

Sometimes it's even considered as longevity drug

[@JL2LB]

awareness is key! thank you

[@Zoe.TheBody360]

Brilliant information.

[@NY2CALINiclk]

I'm grateful for coming across this information. I'm 54 and 1 year post Radical Prostatectomy plus a nerve. Pulling my MF hair out.... I'm trying to spread the word for people to pay attention and get checked out...

[@Thechroniclespodcast]

Let’s continue to cover these topics my good people!👍🏿👍🏿👍🏿

[@IgrwOw]

Post-finasteride syndrome is real. My life changed after taking topical finasteride for only 14 days. I have insomnia, anxiety, ED, low libido, tinittus, dry skin, dry hair, suic1de ideation and brain fog. its been 6 months I stopped taking finasteride and I still suffer.

[@FedeArgentina]

Do you exercise? Zero .. or Some hours / week?

[@IgrwOw]

@@FedeArgentina I have been going to gym for 1 year every single day. 6 months before finasteride and 6 months after. I try hard and have low fat and defined muscles . 700 total testosterone, 20 free testosterone and 14 shbg. I should have up to 8 hours exercise weekly not including 1 hour cardio(runnings). My sleep was good, 9 hours daily, straight.

[@IgrwOw]

@@FedeArgentina I'm only 28 btw..

[@IgrwOw]

@@FedeArgentina been to a cardiologist before finasteride and before even goin to gym, my blood was simply perfect with close to zero bad cholesterol and very high good cholesterol. Been on diet since I was 18. Low sugar and fat diet.

[@Verysoft5737]

@@IgrwOw I’ve heard low fat diets can be harmful for sexual health. Also you don’t need to go to the gym everyday you need some time for recovery

[@Snapkrackpop]

Dr Khera is has been my doc for a few years now. He really is one of the best MDs out there. He has been treating me for hyposexual desire disorder. I’m thrilled to see him in this show as a guest.

[@_FightForYourFreedom_]

You are very lucky. Very few doctors know their subject the way he does. Which city is he located in please?

[@davetherave4599]

Great episode. So much incredible information! Question. What do you do if you live in country (Israel)where HRT is hardly ever prescribed, no matter your symptoms. Or even blood work. If you're a woman, no problem. Gay and "transitioning?" Easy as pie. But a regular straight guy with all the classic symptoms, and with a Testosterone level normal only for a centarian? You are out of luck. What should be such a person's next step. Telemedicine? The black market and wing it? Any suggestions would be greatly appreciated.

[@LALA-dw2ez]

I hope that many people try it for premature ejaculation. The more people the problem PSSD have the bigger the desire to search for a solution.

[@robertkraychik1884]

tremendous episode. thank you, gentlemen.

[@Abdullah-mt9ns]

PFS ruins lives!

[@MusixPro4u]

Highly informative, much appreciated! If there's one point of critique; Peter sometimes really does have a hard time containing his excitement, which outs itself in slightly jarring interruptions of the guest.

[@ashdgee]

What an insightful podcast

[@kvsurdas]

Isn't GFC ( Growth factor concentrate ) better than PRP ( Platelet rich plasma ) ? For any treatment??

[@hkpestcontrolpestcontrol9216]

Mohit khera is a great doctor.

[@Pccoffee1776]

Very informative lots to unpack. Why no mention of using Pregnenolone and DHEA to increase hormone down chain in HRT. Dr. Khera focuses on percent of free testosterone. I am curious to why not just increase amount of free testosterone vs increasing percentage?

[@gif24gt60]

What about low dose cialis with low dose telesmisartan? How do u reduce refractory period? Can't nattokinase or serrapeptidase help clear plaque? Inquiring minds need to know.

[@macfin4862]

Tramadol for premature ejaculation sounds like a recipe for disaster.

[@paddy3622]

Ultram. Yikes. I agree with you

[@giovannitolenaars1879]

I skipped the video to PFS part, will watch the whole interview later. This man is woke about Finasteride, thanks for speaking out and taking PFS seriously! Time will tell alot and more then ever before.

[@ballislife9924]

This podcast actually raises suspicion of the validity of PFS if you actually listen to what they are saying. Kheras points get dismantled and questioned. And it's no coincidence that Khera is on the PFS Foundations payroll while having his studies FUNDED by the PFS Foundation. That's a real problem when it comes to objective research. He also says stuff that is just plain wrong. I don't understand how you can be happy with this video.

[@anneboyer6359]

What? finasteride has been around for more nearly 30 years. what are you talking about?

[@ethanbaggoo1513]

​@@anneboyer6359what's your point? There have been people reporting getting pfs ever since it hit the market. People have been reporting getting pssd for decades now as well, antidepressants still being readily prescribed doesn't discount the validity of pssd in the slightest

[@bardsamok9221]

​@@ballislife9924Quote something that's "plain wrong". Humour us with your expertise, instead of throwing pointless jibes with no substance.

[@bardsamok9221]

​​@@ethanbaggoo1513Did you even watch the video? He's perfectly clear about PFS being real in his opinion, and even explains the scientific basis for it being real. Pay attention.

[@clarencecalistro169]

Good information, thank you very much.

[@serinodiaz4140]

Thank you! Do you use any of these knowledge on yourself or if you ever needIt?

[@hughtoobin7207]

I am very interested in the kinetics of exogenous testosterone. I would appreciate a link to the studies that show that SC is 20% better that IM and that cypionate is more anabolic than enanthate. I have been searching but cannot find any study that demonstrates these claims. Thank you.

[@michaelsing5988]

It's a shame this type of information wasn't available when I was younger. I was pretty good at massaging but all of the preparation leading up to actually messaging wasvery little to none. You depended on your male friends to share the best way to approach the subject. Obviously, that was often a disaster. I would love to have those opportunities back again. I'm starting late, but at least I'm starting. Thanks for your videos. They're great!

[@eddiemartinez1337]

Is daily cialis better to be taken at night or in the morning

[@ayan0834]

These are so important and enlightening conversations! Thanks a lot, docs! If I had a chance, I would like to get both of your views on SSRIs having "lingering" impacts on sexual health, along similar (e.g., epigenetic) or different pathways as 5AR inhibitors. SSRIs are so commonly doled out (much more commonly than 5AR inhibitors, in my experience), that any small risk of post-SSRI (lingering) sexual side-effects warrant a much more thorough look, including well-designed trials, etc., in my opinion. It tends to simply get shrugged off by professionals in the mental health profession, since it has been made out to be the "lifeblood" in treating anxiety and depression. Since Dr. Khera touched upon the "therapeutic use" of SSRIs in sexual medicine even (e.g., to decrease genital sensitivity, prolonging IELT by >10x), I would be fascinated to have real-world insight from people like him, as to whether SSRIs can potentially--in a small population of men--cause permanent negative sexual side effects, much like finasteride, which I personally agree with Dr. Khera's insight as being a "bad" drug to prescribe to men, period.

[@ethanbaggoo1513]

To have both of these persistent syndromes discussed like this in the mainstream is very heartening. If conversations like these continue to occur we could have a real shot at moving towards treatment for us sufferers. Acknowledgement is the first step.

[@ConsiderItHealth]

Dr. Atilla, thank you for your continued high quality episodes. I would ask to please let the guests talk more and interrupt them less. We know how brilliant you already are and sometimes trying to clarify the minutia can distract from the big picture and enjoyment of listening to the info.

[@fhowland]

Was hoping to hear him talk about bike riding and how much of a risk factor it is for ED.

[@SenorSS]

There are three isozymes of 5α-reductase encoded by the genes SRD5A1, SRD5A2, and SRD5A3. The guest said that there are only two. He also didn't even mention the PFS study conducted at Baylor, where he practices. pubmed.ncbi.nlm.nih.gov/34247957/

[@MXF11]

What about the curvature of the penis due to chemotherapy? Can it be repaired? And, how dangerous is it?

[@clydeespinosa6286]

Thanks Doc i love your channel. I’m 52 on 100 T sub q at 0.25 Sunday/Thursday and feel great for 6 months i have always had high LDL low triglycerides and high HDL. i don’t really want to take a statin however i saw another of your videos showing you take rouvastatin every other day and am curious i way 180 good music not over weight but could be a little leaner thanks

[@mr.o4610]

Great Episode!

[@erwinrogers9470]

Great interview 🔥

[@darcybrown7369]

I've seen a few youtube videos about risks of blindness with use of PDE5 drugs such as cialis/viagra ? Primarily damage to the optic disc and nerves around that, any idea how common this is and if it affects men with certain pre-existing conditions? If it is a risk how often should men using such drugs get the back of their eye checked? Just figured if anyone could clarify this it would be you. Maybe you could interview consultant optometrists or similar. Thanks for all you do.

[@albertmeneses3132]

I’m totally inspired by these guys and check out their biceps!

[@kwats]

This is a Great interview .. Wondering, any of you guys getting that symptom of lacking feeling down there? Mine is primarily in the morning but I also feel like I'm not getting the feeling I used too.. (dont wanna use numb) but almost.. I just hit 50 yrs today.. I'm pretty healthy overall.. only thing I can think is that I occasionally use Delta 8 gummies to help me relax.. any feedback here from people reading the comments would be GREATLY appreciated.

[@willemvanriet7160]

I had ED at 43. Was 100% psychological. I'm now 53 and only need Cialis after multiple consecutive days. It's mostly in the mind. Delay meds as long as u can.

[@contrerasmcr100]

Is in the mind but you need cialis? Come on man.....

[@RHt09]

You clear didn't watch the video where he explains why it works in psychogenic ED@@contrerasmcr100

[@N02tradamus]

amazing interview

[@noBody-ue6cs]

How can I aquire inorgasmia? I really dont care for ejaculating and the refractory, i like to stop when im tired but i have to stop alot to not NUT

[@patricklachance6880]

What about using DHEA for normalizing hormone levels like testosterone in men?

[@Annhienmoingay3333]

You can forget many things but don't forget to exercise. Because health is a prerequisite to help you have a fully happy life.🥰

[@tamil1001]

I am a 50 year male suffering from a severe case of post finasteride syndrome since 2015 without improvement. I have multiple sexual side effects, chronic fatigue, muscle weakness, inability to gain any muscle mass, and insomnia. Its a horrible, horrible illness.

[@alexryan9869]

What about endrocine disrupters. Hormone disrupters are everywhere. Also how about systemic enzymes to dissolve the fibrin. Also nattokinase, serrapeptase and k2 dissolves artierial plaque.

[@rickylewis4443]

Did you get the address to where we can purchase our stretcher???? I saw that look when he said you can get up to 1inch with the stretcher use. You looked like I did he said you.can gain up to a inch. I was thinking damn that is a third gain. Hell yea!

[@jeffrey4577]

138:00 Dr attia were both anemic with low t and shbg etc it's our anemia but doesn't hold us back because we're metabolically fit

[@jmg810]

For topical testosterone - how long does the patient need to avoid possibly exposing child or partner after applying?

[@shawnpeters2196]

Did you take it?

[@hfud11]

PSSD ruined my life

[@mindofown]

What might help men is to begin acknowledging the value of the prepuce and to stop removing the foreskin a functional pleasure giving sex organ from males especially as its done before they consent

[@drainmonkeys385]

Acoustic wave therapy is advertised around here is that a good option and for who, if utmis

[@Avata976]

Does PDE 5 inhibitors could cause priapism?

[@darrenfarnsworth9654]

Did anyone catch where to buy 90 days of daily 5mg Cialas for ~$20? I was driving and can't recall....

[@TheBswan]

Believe they mentioned Mark Cuban's drug company, also GoodRX. Sounds like it's not too expensive anywhere though

[@REGJRMD]

GoodRx…

[@jdsirrom4314]

This is simply cured from much rest, diet, and exercise (the more consistent; the more the benefit!)! Remember when you were a child?

[@qeva_]

Wow.. that's a ton of information

[@woodrowdean6640]

I wonder has Dr. Khera done any research on penile vacuum pumps. 🤔 I wish that could have been a topic.

[@unkwm128]

That was my question: Would Heparin be used ? But Aspirin would work.