Erections & Testosterone - Shocking Link to Muscle Mass & Men's Health | Dr Tobias S Kohler

**Dr. Tobias Kohler** (0:00)
Men with more muscle mass have better erections. Men with less muscle mass have horrible erections, have low libido, have lower testosterone.

**Dr. Gabrielle Lyon** (0:06)
You just got the attention of every male listener on the planet.

**Dr. Tobias Kohler** (0:11)
150 minutes of exercise per week decreased the rate of erectile dysfunction by 20 percent, 300 minutes by essentially 40 percent.

**Dr. Gabrielle Lyon** (0:20)
Erectile dysfunction is one of the earliest signs of heart disease. What do you mean by that?

**Dr. Tobias Kohler** (0:25)
If the penis is failing, you should assume you're going to have problems with your heart soon until proven otherwise. Anything that is good for the ticker, the heart, is good for the penis and vice versa. We know that men who don't get erections commonly get penile shortening. So you lose length of the penis.

**Dr. Gabrielle Lyon** (0:41)
How rapid and how much?

**Dr. Tobias Kohler** (0:42)
If you've got a consistent lack of erections for three months, you lose centimeters of length.

**Dr. Gabrielle Lyon** (0:47)
That's a lot.

**Dr. Tobias Kohler** (0:48)
Significant. The best overall marker for overall health in men is erectile function. Why? Because you have to have excellent vascular integrity, excellent overall health, and the penis requires normal mental health. There are many men who have never had a normal erection their entire life.

**Dr. Gabrielle Lyon** (1:13)
Dr. Tobias Kohler, welcome to the show.

**Dr. Tobias Kohler** (1:16)
It's a real honor to be here.

**Dr. Gabrielle Lyon** (1:18)
You are a professor of urology at the Mayo Clinic in Rochester. You have treated patients with urological problems for over 20 years. A woman could go to a plastic surgeon, say you live in Houston, you could go to Christie Hamilton and say, I want a B cup. Can a man go to a urologist and say, I would like this penis size?

**Dr. Tobias Kohler** (1:41)
Well, no, unfortunately, if we could change penis size, I think it'd be busy operating currently. But what we can do with penile implants is guarantee an erection every time with no worries, no anxiety, no pill shots or anything. It's a great surgical solution to a problem that's been around for a really long time.

**Dr. Gabrielle Lyon** (2:01)
How long have penile implants been on the table for people?

**Dr. Tobias Kohler** (2:07)
Most people are really surprised to know that it's 50 years, 5-0. We just had our 50th year anniversary last year. This treatment for erectile dysfunction actually preceded pills, shots, vacuum devices, pretty much anything else. And that's one of the reasons actually why it's covered by insurance, because it's the oldest treatment.

**Dr. Gabrielle Lyon** (2:25)
Wow. I'm fascinated. You have to break this down. Erectile dysfunction is a huge problem.

**Dr. Tobias Kohler** (2:33)
Yes.

**Dr. Gabrielle Lyon** (2:34)
Dr. Mochera, our very good friend, says 40% of men at the age or over the age of 40 have it, 50% of men have it at 50, and so on. So erectile dysfunction is a major problem.

**Dr. Tobias Kohler** (2:47)
Absolutely.

**Dr. Gabrielle Lyon** (2:48)
Probably the first-line solution isn't surgical. Is that...?

**Dr. Tobias Kohler** (2:52)
Of course. The first-line solution is to prevent it from happening in the first place. And that, of course, is based on foundational pillars of health, diet, exercise, sleep, stress mitigation. Those are the core tenets that are going to keep your penis healthy for a long time. But sometimes in life, we get, I don't know, prostate cancer or whatever we need, a surgery, and you get collateral damage. And so it's from that collateral damage that often men will develop problems with erections that no longer are responsive to pills. And once that happens, you can make the decision to fix it definitively with a surgery.

**Dr. Gabrielle Lyon** (3:29)
Can you walk me through, just on a very high level, how does that work? How is that surgical procedure implemented?

**Dr. Tobias Kohler** (3:36)
Well, I guess the first thing to understand is that in order to get a good erection, you have to have blood flowing into the penis, and that blood has to be trapped there, right? So when you look at why erections stop working, the most common cause is a vascular problem. So nearing of the blood vessels going to the penis, so you have a blood flow in problem. Those can be often mitigated or addressed with pills or shots or even exercise, right? So if you exercise, you get better blood flow to the area, you can fix these problems. That's one set of reasons why the penis fails. The other one is the blood isn't trapped there appropriately. So you have to develop what the surgeries try to do is mimic mother nature, and instead of blood flowing into the penis, we put a kind of aligning inside the penis, a prosthesis, where men will pump normal saline or salt water into the device. And when they pump the device, the fluid is transferred from a holding tank or reservoir, which is typically hidden next to the bladder or somewhere in the abdomen. And so they'll pump the fluid into the penis, and they'll keep the erection for as long as they leave the fluid in there. Right? So, you know, you can have an erection for four hours, for 15 minutes, it doesn't make a difference. And then when you're done, you hit it to flight button, and the normal saline goes back to the holding tank. So as a surgeon, when I do an implant, I put in three, four ounces of fluid, 100 milliliters or so of saline, and that same saline powers the device for the next many, many years. The average device.