What Your ED Is Really Telling You About Your Heart, Blood Sugar & Hormones - Urology Roundtable

**Dr. Tobias Köhler** (0:00)
The penis predicts the first heart attack by three to five years.

**Dr. Mohit Khera** (0:04)
Healthy man should not have ED. It's a symptom of something more going on. That's a symptom of depression, cardiovascular disease, prostate cancer, diabetes. If you have low T or ED, look at what the cause is, because it could be potentially life-saving.

**Dr. Gabrielle Lyon** (0:17)
74% of Americans are either overweight or obese.

**Dr. Mohit Khera** (0:20)
Every decade by decade, the T levels are going down. And if you match and look at obesity in the United States, obesity is going up.

**Dr. Tobias Köhler** (0:26)
The good news is, cut 10% of your weight, all of a sudden, boom, T starts going up, more T available for your muscles, for your energy, for your sex drive, whenever you're starting to make gains, your T gets better and better.

**Dr. Mohit Khera** (0:38)
He may lose it, but he may gain it back again. And sometimes these patients need to use the testosterone in conjunction with the lifestyle modification to get the best outcome.

**Dr. Larry Lipshultz** (0:46)
It gets them to the gym. It keeps them in the gym. It gives them a different mindset.

**Dr. Mohit Khera** (0:50)
Yeah.

**Dr. Larry Lipshultz** (0:50)
Lifestyle modification is great, but sometimes you need something to get them started. And testosterone really does help.

**Dr. Gabrielle Lyon** (0:56)
We don't talk about the elephant in the room, which really is the stigma. It's not any longer what testosterone does. I mean, you are all still clarifying and teaching the science, but the stigma is so heavy.

**Dr. Tobias Köhler** (1:10)
Other people are gonna feel horrible. This is a fact, but I feel like every man should know.

**Dr. Gabrielle Lyon** (1:24)
Well, this is the first ever roundtable, and we have Dr. Larry Lipshultz, Dr. Toby Kohler, and of course, Dr. Mohit Khera. Welcome.

**Dr. Larry Lipshultz** (1:34)
Thank you. Great idea.

**Dr. Gabrielle Lyon** (1:36)
Well, it wasn't mine. I have a great team.
We need to talk about penises.

**Dr. Larry Lipshultz** (1:43)
Oh my God.

**Dr. Gabrielle Lyon** (1:44)
I know.
And it's funny, we joke about this, but there is a disconnect between the science, men's health, andrology, and of course, the public. I think that there is quite a big disconnect, but you guys are changing the narrative, and also I think even more importantly, changing the science. So with that being said, I have a few questions of my own.

**Dr. Larry Lipshultz** (2:10)
Good.

**Dr. Gabrielle Lyon** (2:11)
When I was in residency, we weren't even testing for hypogonadism, for testosterone, and I did a fellowship in geriatrics. This was something that when you think about scopinia and muscle mass, we weren't even looking at.
Was there a moment in each of your residencies, and obviously this is the way back when, because I'm sure it shaped to where you are now, that you got wrong?

**Dr. Larry Lipshultz** (2:35)
But we got-

**Dr. Gabrielle Lyon** (2:36)
Wrong. I know it's a bad word, but that you got wrong in your training.
Because even right now, there isn't an ease where a patient goes to their doctor and says, I have low libido, I have erectile dysfunction, I have low muscle mass. There isn't this ease of conversation as opposed to, I'm having headaches, or I'm having shortness of breath.

**Dr. Larry Lipshultz** (3:00)
But you have to look at the time. I mean, right now, I think it is fairly common. When I was training, it wasn't, people didn't talk about it at all.
So I think it's different now for you guys because you're younger and you've been brought up in the practice where you do talk about it. I don't think it's a taboo topic. There's so much in the media about testosterone and hypogonism. I think it's fairly common. Oh, for sure.

**Dr. Gabrielle Lyon** (3:28)
What about both of your experiences?

**Dr. Tobias Köhler** (3:31)
Yeah. Well, go ahead, please.

**Dr. Mohit Khera** (3:33)
Well, he trained me. Sorry, everything I learned was from him.

**Dr. Larry Lipshultz** (3:36)
It's like a father-son situation.

**Dr. Mohit Khera** (3:38)
But we learned a lot along the way. Look, the past 25 years, we learned about the fact that patients who come in with low energy, low libido, rectal dysfunction, we were taught, check a T-level. But the reality is that same patient comes in to a psychiatrist, they check for depression and only depression. That same patient walks into an endocrinologist office, they just check a thyroid. We're all in our silos. We're now learning that, no, we should be checking TSH, check, make sure they don't have depression, check a T-level. We're broadening our scope, what could be causing these symptoms. We learned a lot about side effects. We learned about erythrocytosis now. We've learned about estradiol. When we were training, we thought, men don't need estrogen, women have estrogen. Let's bring it down with some Orimidex.