Episode Transcript
[00:00:00] Hi everyone. It's been a little while. It's Dr. Laurie and I'm back to do another Anti Aging Unraveled for you guys. And it's a fun topic, a little bit not talked about enough, I would say it's a little taboo, if you will. And we're going to focus on men for a change. And we're actually going to talk a little bit about erectile dysfunction and honestly, why Viagra doesn't fix men's health or erectile dysfunction in general, and why it's not enough.
[00:00:28] Welcome to Anti Aging Unraveled, the podcast where we redefine aging and empower you to age your way. I'm Dr. Laurie and this show is rooted in the life philosophy. Living life the way you want to with energy, clarity, purpose and longevity. Here we break down integrative functional medicine, bioidentical hormones, peptides, metabolic and brain health, gut immune connection, and cutting edge longevity therapies. So you're not just living longer, you're living better.
[00:01:01] If you believe aging should be intentional, personalized and on your terms, you're in the right place. Welcome to Anti Aging Unraveled. Let's unlock longevity and help you age your way.
[00:01:15] I want to start with just Talking about a 47 year old man who sat across from me on a video call last month and said literally 11 words I've heard hundreds of times, doc, I got the little blue pill and it's not working. And here's the thing, he's not lying. It genuinely wasn't working. He ordered it from an online website. No blood work, no exam, no conversation. And a photo of his driver's license, a credit card and a few questions, probably three to be exact. And a prescription. So what we did is what nobody else has done for him. And we ran labs and his total testosterone came back at 216, which is literally a high female level. His, his level should be around 800 to 1100 at the peak of his functioning. And his fasting insulins were through the roof. So when fasting insulin is through the roof, his sugars aren't doing well. His A1C was flirting with pre diabetes. That's his three month sugar number. And his vitamin D was tanked. It was in the basement. And he'd been sleeping five and a half hours or six night, six hours a night for years because he convinced himself that that's what it required to be successful. And a doctor had really never handed him a doctor he never met, rather handed him a vasodilator. And that is The Viagra. And this is the thread that I want to talk about through this entire episode, that this pill was never designed to try to fix erectile dysfunction. Not one thing on that list was it meant to fix. It's not a bad drug. It's a brilliant drug. It's just pointed at the wrong problem, at the wrong issue.
[00:02:51] So on that note, welcome to all my outside the box thinkers to the anti Aging Unraveled podcast. I'm your host, Dr. Lori Gerber, and today we're having the conversation that having The Conversation, the $12 billion erectile dysfunction industry would very much prefer that we skip and not have this pod. But today we're talking about why Viagra doesn't fix men's health. And before anybody emails me, I'm not anti Viagra. We prescribe it, I use it, I prescribe PDE5 inhibitors all the time. And they are an elegant piece of chemistry, and they've restored intimacy to millions of men.
[00:03:30] And that's not nothing. But hold two ideas at once because once. Because grownups can do that, right? If one, one, the drug works, and two, working is not the same as fixing. So just keep an eye on that. As we're going through this, we're going to talk about a lot of studies, and we're going to talk a lot about instances where these drugs by themselves might not work or maybe it just doesn't fix the problem.
[00:03:54] So here's the frame, and in my practice, we talk about. We use the Real3 method. We retrieve, we eliminate, we add, and we use lifelinks plus longevity. And underneath that says what we call the Life Jevity model, which is those six life links that we talk about a lot. Gut, immune, hormones, metabolism, detox, cellular health, and of course, the longevity life link, which talks about brain, cardiac, and preventive care and prevention and deprescribing.
[00:04:23] So on that note, we want to tie this into the full picture, all right? Erectile dysfunction is not its own disease. ED is what shows up when the hormone link LifeLink, the metabolism life link, and the cardiac or longevity life link are all quietly falling or failing at once.
[00:04:41] It's the smoke. And for 30 years, we've been selling men a very expensive way to not smell smoke, right? To not look at a symptom.
[00:04:50] So what the pill actually does, why ED is one of the loudest cardiovascular warning signs in medicine and why almost nobody says this out loud. Here it is, guys. ED is a very late sign of low testosterone, not an early one. The other causes are earlier than low testosterone. So what actually works and ranked honestly is, is treating the problem and then using erectile dysfunction drugs as helping with a symptom. That's how we should be doing this. We're not talking about anything that's revolutionary here. This is biology. So let's unravel this. Let's really talk about what this means.
[00:05:34] So let's start with the mechanism, because we need to know what this pill actually does. Once you understand the mechanism, the rest of the story becomes obvious. An erection is a hydraulic event in male terms. Women don't understand hydraulics generally, but it's a hydraulic event driven by a chemical signal. Nerve endings and the endothelium, or the one cell lining of your blood vessels release something called nitrous oxide. Nitrous oxide. It makes a messenger called CGMP or cyclic gmp. This tells your smooth muscles to relax.
[00:06:07] When smooth muscle relaxes, it actually enlarges the vasculature. Blood rushes in and the plumbing now does its job. Right? So now we have blood flow to an area so we can have. Because we have this dilation. Then there's an enzyme called phosphodiesterase type 5, or PDE5, whose job is to break down or break that CGMP. It stops it. It's the eraser.
[00:06:36] So sildenafil, Tadalafil, your Viagras of the world and Cialis of the world, all of them, they don't create a signal. They block the eraser. They block that PDE5. Okay, so you're stopping the, basically the elimination of the cgmp, and in doing so, you keep an erection. So here's my analogy. A PDE5 inhibitor is a very expensive amplifier. If the microphone is unplugged, a louder amplifier does nothing. It doesn't make nitrous oxide. It doesn't repair the endothelium or the lining of the blood vessel. It doesn't raise testosterone and insurance. That doesn't give you desire.
[00:07:19] These drugs do not create a want.
[00:07:22] They only are going to serve the man who already wants or wants it. So if desire is gone, you have a completely different problem.
[00:07:29] And the pill has nothing to do or say about that. Right.
[00:07:33] So let's tease apart some numbers. In 1998, New England Journal of Medicine sildenafil trial reported 84% of men improved on 100 milligram dose versus 25% on placebo. That's the number you see in every ad. Okay, so all the TV ads, here's a number that isn't talked about in that Same trial In the final four weeks, 90 or, sorry, 69% of intercourse attempts succeeded. Meaning even among those responders, roughly One third or 31% of those attempts still failed. Then the group nobody talks about. In 2018, a review put real world on demand efficacy at 60 to 70%.
[00:08:20] Right. So 30 to 35% of men didn't respond at all. So on demand efficacy at 60 to 70, and about a third, or 35%, of men didn't respond at all. And that's in 2018.
[00:08:32] So a third of men take this miracle pill and nothing happens. Now, what happens when you ask, why give the same drug to men with type 2 diabetes? And we talked about some of the things that happen with diabetes, and improvement drops from 84% to 64.
[00:08:51] So the same molecule, now we have basically a damaged substrate or what? It's trying to work on a lower ceiling. So that tells you the drug is telling you something about that man. That man has a problem inherently that is keeping this drug from working.
[00:09:08] Right.
[00:09:09] So what is that problem? Well, we know that diabetes is not great for vasculature, and we're going to talk about that. But here's the study that should be famous, but isn't. In 2006, researchers took 32 men who had failed on 100 milligrams of sildenafil, checked their testosterone. It was low, and gave them testosterone. 11 of those 32. So 34% got satisfactory erectile dysfunction on testosterone alone without any PDE. Another 12 succeeded in combo. Okay, so 2/3 of the group labeled Viagra failures were never really Viagra failures. They were undiagnosed, low testosterone or hypogonadal men holding the wrong prescription. Right. Had they just started with the testosterone to begin with or one of the other precursors that go into this, then they wouldn't have been non responders of Viagra. Okay, so there's a gorgeous mechanistic reason. Low testosterone reduces nitric oxide synthetase, or, sorry, synthase activity. So in castration models, so people that don't have testosterone, but it actually decreases that nitrous oxide BY up to 45%.
[00:10:27] So it lowers the amount of PDE5 enzyme in the tissue as well. So you're lowering that enzyme that Viagra works on, and they have no testosterone, so they have no nitrous oxide synthase activity, so they can't dilate those blood vessels. Let's think about that. You can't inhibit an enzyme that's not there to begin with. The drug's target depends on that hormone that the man is missing. Okay, so it's just not gonna work. A more concrete study, Another one in 2022, a paper found actual fat cells accumulating inside the corpus cavernosum, which is part of the tissue of the penis in men with deficient testosterone deficiency. Okay, so fat cells actually accumulating inside there in men with testosterone deficiency. Well, when you have this extra fat in there, what happens? Well, we're going to see. 78% of ED patients versus 9% of controls had that fat cell accumulating inside the corpus cavernosum in men with testosterone deficiency. So that's a structural problem. That's basically a venous leak or a vein leak. So in these men that already had testosterone deficiency, when you try to dilate those blood vessels, it doesn't work. No vasodilator fixes a tank that won't hold pressure because it's all leaky. These, these vessels are leaky. And now they have, because they have these fat cells accumulating around the area that actually has to dilate and get good blood flow. All right, so here's the honesty time, because I'm not going to tell you one side of the story. Let's tell you the other side of the story. The largest, best design trial in this space is in the Annals of internal medicine for 2012. It added testosterone to sildenafil in 140 men and found no significant benefit. How do we reconcile that? So it's actually quite easy. And it's the whole, it's the whole ball game. That trial enrolled men already responding to optimized sildenafil. The positive trials enrolled documented non responders. Testosterone rescues the men the drug abandoned. So it adds very little for the men it's already serving. So if it's already working, adding testosterone into the mix did not really change very much. Okay, so but the other way around, adding testosterone first and then adding sildenafil 100% changes the story. Okay, because you know, again, you're giving it a target to work on.
[00:12:59] Testosterone rescues the drug abandoned. Right. It's the ones that could not get the benefit.
[00:13:05] So the strongest argument against My thesis in 2024 is a meta analysis over 1.2 million subjects that found PDE5 inhibitors. Users had about a 30% lower all cause mortality rate. Real finding, but it's observational. Right.
[00:13:22] So this is again a retrospective cohort. And the likeliest explanation for this is that the men are getting, that are getting the prescriptions and that care about this are actually healthier and seeing a doctor and getting treated for any of their other comorbidities, which, if anything, proves my point that we need to treat everything around the erectile dysfunction. Last piece. And it's the one that keeps me up at night. A 2025 survey of men aged 18 to 40. Okay, 18 to 40. 57% screen positive for ED. That's more than half. 39% use an ED medication. Nearly a third got it from a direct consumer website. Again, another problem where they're not doing any kind of lab testing and only 28% could correctly describe how to take it. That is extremely disturbing that you're getting this medication that actually does affect blood vessels and vasculature to the penis and you don't know how to take it. So to me, that's not healthcare, that's vending machine medicine. And it's manufacturing the exact non responder population that we've just spent the last five minutes discussing. Right, because they're not addressing the entire problem.
[00:14:36] And that's honestly why our program really strikes a chord with a lot of people, because we are constantly looking at the whole picture. So, quick pause. Because if I landed on something uncomfortable, something close to home, I don't want you sitting with that for another 20 minutes. I want you to do something with it right now. Tell Just send us a message to 215-259-8774 and I will send you our free men's performance download and I will do a set you up for a free consultation and we'll run the exact lab panel that I run in every single male in my practice. We'll go through your symptom timeline, we'll talk it through, and before anyone writes your prescription, we will absolutely get labs and figure out any other issues that are going on. And if you prefer just to get started, go right to mydoctorlori.com d o c T-O-R l o r-I.com and just fill out that intake and you can schedule your free consultation right on there as well. No cost, no obligation. I promise it takes longer than three clicks and a photo of your driver's license intentionally. But we want to do this the safe and the right way.
[00:15:43] So let's talk about what happens when you have erectile dysfunction. All right, if you take one thing from this whole episode, make it this piece. Erectile dysfunction is one of the earliest and most accessible warning signs of cardiovascular disease in all of medicine. And most men, and plenty of doctors treat it as a lifestyle inconvenience the anatomy is almost too tidy. Right. Penile arteries roughly 1 to 2 millimeters. Coronary arteries feeding the heart are 3 to 4 millimeters and carotids are 5 to 7.
[00:16:17] So atherosclerosis is systemic. And it doesn't pick favorites. It deposits plaque everywhere roughly at the same rate. So which vessels do you think will clog first? Which ones cause the smallest vessels? Right. To cause the biggest symptoms. And it's called the artery size hypothesis. And it means that your erection is an early warning sign from your heart. A stress test you run several times a month for free. And it's the one men are most highly motivated to pay attention to. The data is not subtle. 300 consecutive patients admitted with chest pain angiography confirmed coronary disease.
[00:16:56] 49% also had ED.
[00:16:58] And 67% of those men, the ED came on first on average 38.8 months before the cardiac symptoms. So that's like what, three years before the cardiac system. Cardiac symptoms of advanced warning. And you know, if you could have three years warning sign, you could do something about it, right? It's something we're missing. Over and over, the COBRA trial and the European Heart Journal went and took that a step further. In men with chronic coronary disease and ED, sexual dysfunction came first 93% of the time. And ED tract disease burden 22% with single vessel disease versus 55% with multi vessel disease.
[00:17:44] So your erection is grading your arteries on a curve that you can't argue with. It's telling you that there's a problem ahead of time. Another study of the prostate cancer prevention trial in JAMA from 2005 followed over 9,000 men. New onset ED predicted cardiovascular events with a hazard ratio of 1.25. So the authors wrote a sentence, and I'm going to quote this to more men in here because I quote this to more men than anywhere else when I talk about erectile dysfunction. The incident erectile dysfunction had air quotes an equal or greater effect on subsequent cardiovascular events of the same magnitude as a family history of myocardial infarction, heart attack, cigarette smoking, or measures of high cholesterol hyperlipidemia. So read that again. We treat family history, we treat smoking, we treat cholesterol, and we hand you a pill for the one that predicts just as well cardiovascular disease instead of treating you early for cardiovascular disease or looking for it.
[00:18:50] So ED is an alarm bell wired to your coronaries. If you're under 55 and your erections have changed, that's a cardiovascular workup, full stop. The mechanism data backs it cleanly. Researchers measured blood vessel function in the arm in men with ED and no other clinical cardiovascular disease at all. And their arm arteries were already failing. Okay. This is also confirmed by a 2024 meta analysis across 3000 participants.
[00:19:21] These men look perfectly healthy on paper and their blood vessels were not.
[00:19:27] So when 50 asymptomatic men with vascular erectile dysfunction went through the actual coronary angiography, they got the dye in their heart arteries.
[00:19:38] 19% had silent, undiagnosed coronary artery disease. One actually had a heart attack during the study. Again, we're talking about a three year warning sign here. And I'm not telling you this to frighten you. I'm telling you this because honestly, it's fantastic news. You've been handed a warning sign three to five years early in a form that you cannot ignore and won't forget. Most people don't get a warning. They get a Tuesday morning in an ambulance. Right. Don't silence the alarm. Let's listen to it and answer it. So again, we're going to take a quick break because if you're a man under 55 and your erections have changed in the last two years, that's not a bedroom problem solely. It's your cardiology problem or wearing a disguise and calling for help. So go to mydrlori.com fill out that intake, schedule your free consultation and let's run some panels that tell you what your arteries are actually doing. Not the four labs, your annual physical calls, air quotes complete. So text us at 215-259-8774 or go and get our to get our free men's playbook or just go to mydoctorlori.com sign up for that free men's playbook on the men's section and you can also just get started. You can set up your free consultation and fill out your intake if you're ready to go. Just to look at these cardiovascular markers and tell if we're on the same page. It's very, very important.
[00:21:01] So let's look at this next section that ED is a late sign of low testosterone. And take it a step further. The sentence I say in the clinic most every day, and I have almost never heard said anywhere else in my training or otherwise, is erectile dysfunction is not an early sign of low testosterone. It's one of the last signs by the time a man's testosterone has fallen enough to break erection, your body has been sending invoices and warnings for years. He just didn't realize or recognize the handwriting on the wall. And here, here are some of the receipts. The European male Aging Study.
[00:21:37] 3,000 3,600 men in eight European centers. It was listed in the New England Journal of medicine for 2010. They did something very clever. Instead of asking what counts as low testosterone, they asked at what level does each individual symptom start appearing?
[00:21:56] We know that the whole body, loss of drive starts first and then loss of morning erections. And then erectile dysfunction, I usually say below around 600 starts that whole body loss. Morning erections is usually about 4 to 500. Erectile dysfunction is below, usually about a 2 to 300 level, generally speaking. And morning erections, most men kind of contribute to being normal, and that is a sign of changing erectile function.
[00:22:30] So ED is the last thing to break, not the first.
[00:22:34] Okay, so, you know, we want to make sure we know when morning erections disappear. That is the single most underreported symptom in men's health. Nighttime erections are more androgen responsive. As testosterone falls, the number drops, rigidity drops, and the duration drops. Okay, so it's not just normal aging when it doesn't feel the same, it doesn't last as long. Okay. It's changes.
[00:23:04] Vigor. Collapsing is not just being tired and needing a nap is actually a symptom or your body is tired. That's a symptom of early low testosterone. And body composition changes as well. So this redistribution of visceral or belly body fat is also a predictor of low testosterone.
[00:23:23] So that's actually one of the first predictors of low testosterone. We also see night sweats and whole body body aches and joint pains and failure to recover. So by the time we get to this erection stage where we're not getting good erections again, that's very, very, very late. And it's happening to younger and younger men. In 2021, the national survey of Sexual well Being. It was the first nationally representative U.S. update in two decades on this topic. Foundation overall ed prevalence of 24.2%.
[00:23:56] But look at the young end. 17.9% of men aged 18 to 24. Nearly 1 in 5 complained of erectile dysfunction. 1 in 5, 18 to 24 or 17, 18 to 24. And the second story is just as loud. Only 7.7% of men reported ever getting a clinically clear erectile dysfunction diagnosis. Two thirds of these men aren't in the system at all.
[00:24:26] And then you have these other young men that are complaining and men that aren't even getting a diagnosis. If you don't get a diagnosis. How are we looking for heart disease early on? We're just not okay? So, you know, I think we need to understand that something is happening to men and it's not happening slowly anymore. It's happening younger and more rapidly than it ever did previously.
[00:24:48] So before anyone accuses me of selling testosterone as the cure all, here's the counter evidence because you do deserve to hear both sides of the story.
[00:24:56] In the testosterone trials, 790 men over 65 in the New England Journal of Medicine for 2016, testosterone improved sexual function and mood and produced no significant benefit for vitality or fatigue. A companion trial found no improvement in memory or any cognitive domain. I will tell you that clinically speaking, that's not what I see.
[00:25:19] So precisely. Low testosterone is associated with fatigue and brain fog and replacing it did not reliable reliably fix either of those in those trials. Association is not reversibility. Anyone promising a hormone shot will restore your 25 year old brain is definitely selling you something and not practicing medicine. But I will tell you what testosterone reliably does clinically when you can get it. Long acting and sustained sexual function, body composition, mood, decreased anxiety, decreased night sweats, improved insomnia, improvement in bone density that has been shown in men and women as well as mental clarity and ambition. So a real, there is a real list here, not just an infinite one. And it just keeps going. And I will tell you that the biggest key to me with these studies is getting sustained levels that are very consistent. Okay? The other thing that's a problem on a practical note, is when you go to your primary and you're in the total testosterone normal reference range. Most men are told they're fine, but they've landed inside a reference range built from a population that includes a whole lot of unwell men. But total testosterone is also mostly bound and not biologically available. So we should be calculating a free testosterone with binding globulin and using an algorithm to actually calculate that free bioavailable testosterone. If that is not done, then your workup is not finished and it's just inadequate.
[00:26:51] So that symptom ladder I just walked you through morning erections, being vigorous and having energy, body composition, mood and then erections.
[00:27:00] Right. It's all on my men's performance download. So go download it, print it, circle what's true for you. Take our little quiz, bring it to whoever your doctor is, me or somebody else. But please make sure that you address that testosterone being low early. You can always text us to 215-2598-7,7,4. Let us know you want that free download or go to mydrlori.com and fill out the intake and book your free consultation. Because this isn't just vanity. This is urgent physiology. And it's your cardiologic, your cardiologic clock telling you that something is a problem. All right? Okay, so let's talk about testosterone not being the only culprit, because it's not. We alluded to that in the beginning, right? We want to put all the usual suspects in a lineup against the wall. Suspect one, insulin resistance.
[00:27:53] 145 studies all pulled together, point to ED prevalence in diabetic men. Okay. Plain and simple. Okay? It's roughly three and a half times that of a non diabetic male. Okay, so insulin resistance shows up in young men's erections before it shows up in their hemoglobin A1C. So before you're seeing a three month sugar number change, you're seeing ED and insulin being high way, way sooner. Suspect two, visceral fat.
[00:28:25] This one's a trap. Fat makes aromatase, an enzyme that converts testosterone to estrogen. Okay, so what happens when you convert into estrogen is you actually keep the system going. You actually create more and more and more belly fat. Okay, A Mendelian randomized study, about as close to proving causation as we can get in observational genetics, right? Found going from a BMI of 30 to 25 is worth about a 13% rise in testosterone. Just with that BMI decrease, we're increasing that testosterone. So why would we not preach this? Right, so in European data, losing more than 15% of body weight was associated with the testosterone rise of about 164 nanograms per deciliter.
[00:29:13] That's a bigger swing than most men get from their original starting dose of trt. All right, so weight loss is huge. That belly fat is massive. Three, blood pressure medication. I mean, let's just talk about what it does. You're decreasing the pressure in the pipe, right? So when you do that, you're actually limiting blood flow to the smallest little blood vessels in your body, which can be also cause erectile dysfunction. Okay, so when we know beta blockers, atenolol, right? What do they do?
[00:29:47] They, they basically decrease the heart rate. By decreasing the heart rate, you're again, you're decreasing the blood flow to the smallest vessels in the body. All right, so that is going to affect erectile dysfunction. All right, so four SSRI.
[00:30:05] Okay. SSRIs are serotonin reuptake Inhibitors. Right. And what we're going to talk about here is basically there's a couple, there's a couple of different reasons. But I'm going to give you the trials first.
[00:30:18] So registration trials. Relying on men to spontaneously volunteer, it reported sexual dysfunction rates of 2 to 15%.
[00:30:27] When researchers prospectively asked 1,021 patients, 59% said that citalopram, paroxetine, they all affected their erectile dysfunction in a negative way. All right, post SSRI sexual dysfunction is real enough that European regulators added it to their labels in 2019.
[00:30:51] So, but there's no credible prevalence figure. Like we don't have a number, but any. So anyone quoting you a prevalence or a percentage is basically making it up. But I will tell you on self reporting studies it is, was extremely high that the SSRI sexual dysfunction was real. Real enough. Like I said, that European study or real Europeans added to their labels in 2019.
[00:31:16] All right, suspect five, sleep. I put this near the top. Okay, that's 10 healthy young men on average, 24, restricted to five hours, five hour nights sleep for one week.
[00:31:30] Their daytime testosterone dropped from 10 to 13%.
[00:31:35] It dropped by 10 to 13% in one week. That's it. That's the hormonal equivalent of aging 10 to 15 years. And you can do it by yourself on a Friday night. Sleep apnea is even worse.
[00:31:47] 69% with obstructive sleep apnea say that they have ED compared to 34% without sleep apnea. So treating apnea is necessary and getting a consistent sleep is necessary, especially in our young men.
[00:32:03] All right, number six, cortisol. Elevated cortisol. Basically, cortisol is a precursor of testosterone.
[00:32:11] So if you have a mismatch of cortisol to testosterone, you're basically in a stress mode and your body will drop the amount of testosterone it produces. Okay, so your body is in a stress mode.
[00:32:25] And by being in a stress mode, the factory directly affects the testicle. It actually will shunt to cortisol. We actually see that in women as well with periods and basically over exercising or high stress rates. So just remember that high cortisol acutely drops testosterone very, very quickly.
[00:32:45] And number seven, thyroid. Thyroid is a big one. We know that hypothyroid specifically in men created a 64% with lower desire and ED. All right? They also had delayed ejaculation hyperthyroid. On the contrary, 50% had premature ejaculation with hyperthyroid. So they almost look similar. Right?
[00:33:07] So if nobody checks your thyroid, your DD workup is not complete. We know that the thyroid can definitely affect erectile dysfunction. And number eight is nicotine. All right, including vapes, every 10 cigarettes a day raises ED odds by 14%. And E cigarettes are not a safe, safe harbor. Basically, daily users had roughly a 2.2 fold higher incidence of ED, about 2.4 fold in men under 65 with no cardiovascular risk at all. So we know that nicotine is a big driver of this.
[00:33:45] All right? And the last major one is the pelvic floor.
[00:33:50] So we know that actually not just in women, but men can actually have pelvic floor issues.
[00:33:55] And with doing regular biofeedback pelvic floor exercises at six months, 40% of men regain normal erectile dysfunction. That's huge. And another 34.5 actually showed improvement. We do this for women all the time, but we never really talk about this for men. And pelvic floor is massive. When we talk about regulating, and especially as we get older because our muscles just get weaker, we really do a disservice by never offering this to men.
[00:34:25] Last but not least, I want to do a little talk on alcohol because the clean story is booze just wrecks erections. No pun intended. But the Meta analysis of 154,000 participants found no significant association at heavy intake. Almost certainly confounded because sick people quit drinking. I won't quote you data because I believe it just flatters my narrative. Alcohol wrecks your sleep and your metabolic health, and those wreck your erections. And that's just the chain, right? Glucose goes up, metabolism goes down, sleep goes down, erections go down. There's really no other way around it. All right, So I think that this meta analysis is completely wrong because I think they really just stopped drinking and that's what happened. And last, let's talk about pornography. So one widely circulated review says Internet porn is driving young men's erectile dysfunction.
[00:35:26] And there are some studies that say that, large studies that say that it does not seem. Air quotes. To be a significant risk factor.
[00:35:34] I will tell you clinically what I do see is that performance anxiety and associating themselves with porn and is a real problem in my office.
[00:35:46] And the psychologic effect of porn on men is definitely a problem. It's almost always with men. You know, it's obviously it's physiologic, but it's also psychologic. With women, it's a lot more psychologic. But I will tell you that pornography definitely can drive an expectation effect in young men, contributing to some erectile dysfunction.
[00:36:07] So that's a Lot of suspects. And you know, if you're getting your prescriptions for erectile dysfunction from a website that asks you three questions and basically just asked for your license and didn't check anything else and didn't check for any of these other issues, I think you're in trouble. Right? You know, this is not, this is not the way that you want to take care of your body.
[00:36:30] So what actually works? Let's talk about some solutions and how strong the evidence really is, because air quotes. Natural is not a synonym for proven and prescription is not a synonym for necessary. Right. So I think the non negotiable is to actually start checking labs and getting a full history. Right. We want to get a good foundation in place.
[00:36:56] And I think it's really, really important to start getting a vigorous aerobic activity and losing some of that belly fat. I think that's a non negotiable. You've already seen that getting that belly fat down and getting cardiovascular exercise in nearly a third of erectile dysfunction resolve without a pill. All right? So I think that's first and foremost the biggest thing you can do for yourself. The second is trying to deprescribe. We want to actually try to get you off of your insulin resistance meds, get your diabetes gone again. That goes back to weight loss and eating clean and getting off the sugars. We also want to try to get seven to eight hours of sleep to try to get that score boosted and get rid of any apnea if you snore. Right. We also, if we can, want to try to deprescribe any of those blood pressure medications that might be affecting you if it's not needed. Again, that lifestyle modification may get you to a place where we can actually get those medications gone. And then you can get also get back more testosterone, which will help to raise that, improve your erectile dysfunction functioning, if you will. So, but nobody sells this tier. Right? It's not something that we're making money on. It's not something that tends to be a focus of these online practices, which is why nobody really talks about it. But it's so important.
[00:38:12] And of course, there is evidence for some supplements that we can add in that are rarely talked about. L citrulline is one of them. It has a really nice result with helping with the nitrous oxide precursor. Right. So improving nitrous oxide. There's ginseng, which is Panax ginseng or red ginseng, which has also had some promising data in some studies. Ashwagandha, another one we've seen actually with testosterone increase and honestly I, I like the adaptogen for the cortisol regulation as well. Right. If we can get that cortisol regulated with these herbs, if you, for cortisol then we can definitely start to improve testosterone. And you know, you see some weaker claims for some other supplements like vitamin D and zinc, which I don't necessarily think are super functional for erectile dysfunction. Not to say we don't need it for metabolic functioning, but from a perspective of Ed, I don't think that it's very promising.
[00:39:12] And then you know, there's a couple of supplements on the market like Tribulus, Tonga Ali and I do like those products for stimulating some testosterone production. I also like plant sterols. They also do a very good job of improving testosterone production on a supplement level. So for me more recently I think the peptides are the go to for erectile dysfunction. PT141 has been genuinely amazing because it works on the brain and it can be used in conjunction with testosterone and, and it doesn't work on the blood vessels. It's the only tool that addresses want rather than the ability to actually have an erection. There's actually an FDA approved version called Vyleezi for hypoactive sexual desire in women, especially premenopausal women. But I use it in men and women as a peptide. It comes as a nasal spray. It also comes as an injectable and a lot of the times it's combined with oxytocin which is another brain hormone to help feel desire.
[00:40:15] That is not going to work on blood vessels or hormone.
[00:40:19] So I love those two and two peptides were just taken off of the restricted list actually in the last couple of days, which I like for treating the metabolic issues that go into low testosterone. BPC157 and TB500 are two of those. And I like to use those with Mott. See C for sugar. So we do anti inflammatory immune health and mot C for sugar and insulin control. And between the two of those I really like that for helping get the metabolic causes of erectile dysfunction to go by the wayside. So and of course there's testosterone therapy. We do a ton of testosterone therapy and we know that the testosterone trials confirmed real improvement in sexual function.
[00:41:06] Adding testosterone and a PDE produced even more meaningful improvement in that erectile dysfunction arm. But and for the right man, it's extremely transformative. We do it as an injectable, we do it as lozenges or troches, we do it as pellets and we will do it as compounded creams. I am not a big fan of the gels on the market because they do create a lot of estrogen and aromatization. So not my favorite way to force the testosterone into the system.
[00:41:38] So let's talk a little bit about fertility.
[00:41:42] We know that exogenous testosterone shuts down your own production of sperm. So if you want children now or in the near future, we don't usually use testosterone as your first move. We know that there are alternatives to raise testosterone and preserving what we would consider your sperm production or your HCG axis. We use em, clomiphene and HCG all to help to get your own sperm production going and to encourage testosterone production.
[00:42:15] There is also gonadoraline which is a peptide version of that HCG as well that can also stimulate testosterone production. So don't forget that, you know, we, we always ask these questions like where are you at in the timeline of having kids? And of course we gotta talk a little bit about estrogen for men. Men need estrogen. We can't suppress it too low. It's essential for libido and for anti inflammatory and cognition and bone.
[00:42:43] So we want to make sure we keep a man's estrogen within a reasonable range and not over decrease it with aromatase inhibitors, which is a very common mistake. I see. And honestly that can also destroy the libido. If you bring it down too low, the estrogen too low. So we want to keep that in a nice, safe, happy range. So let's bring this home. That 47 year old from the beginning of the episode, we didn't start with a prescription. We started with comprehensive labs. We went to retrieve, right, our R full medication review and real history.
[00:43:16] Then we eliminated, we eliminated the sleep debt, the insulin resistance and the two medications that had quietly outlived their usefulness.
[00:43:25] And we made additions, we used targeted evidence based medicine and added it in the right order. And his erections came back.
[00:43:34] So this is generally the least interesting thing that's happened to him because honestly, here's what else happened. His hemoglobin A1C came down, his insulin and sugars came down, his visceral fat came off, his energy came back and his total metabolic and lifestyle trajectory changed.
[00:43:51] Because we treated his six life lengths, hormones, metabolism, gut detox, cellular and longevity with the cardiac and brain and prevention because erection was never the problem, it was the symptom or the messenger, right? It was the smoke. So we treated all around it so that, that stopped and that's my whole quarrel with the little blue pill. Not that it doesn't work because we talked about as it often does work, but it sometimes doesn't.
[00:44:19] But it's that it silences a man's three to five year cardiovascular early warning system window for no reason. For $70 a month and an entire industry online healthcare. We're literally not talking about the fact that we can help men earlier with this cardiovascular warning sign. Thank you for listening, but you don't have a Viagra deficiency. You might have a testosterone problem, you might have a metabolic problem. You might. You might have a sleep problem, you might have a vascular problem, a medication problem, a thyroid problem, quite possibly all together at the same time. And all of those are findable.
[00:44:54] All of them are fixable, just not by a website that asks you three questions. So if you're ready, go to mydrlori.com, fill out this intake schedule your free consultation because it costs you nothing but the willingness to find out what's actually going on in your body. You can also text us at 215-259-8774 and we'll send you that men's performance download. You can get that symptom ladder. Take that little questionnaire before anyone hands you a prescription. Let's ask the questions. Let's get the numbers again. This isn't just vanity. This is biology. This is your vasculature and your cardiac system giving you a warning sign. So let's help you age your way the right way and join me in the LifeEvity revolution. So I hope you'll join me for the next episode and I thank you guys for listening. Until then, I will talk to you soon.
[00:45:47] Thanks for joining me on this episode of Anti Aging Unraveled, where longevity is personal and you're empowered to age your way. If you found today's episode helpful, be sure to subscribe to the podcast or our YouTube channel, Anti AgingUnravel.
[00:46:03] And of course, follow us on social for more tools, insights and conversations rooted in lifeevity philosophy. Living life the way you want to take your next step, visit mydrlori.com click get started now and fill out your wellness or weight loss intake to begin your personalized longevity journey. Until next time, keep living with intention, vitality and purpose.
[00:46:28] Here's to longevity, lifeevity and aging your way.
