ED Predicts Heart Attacks Better Than Chest Pain: The 2 Tests to Ask For | Dr. Tobias Kohler

Your testosterone number matters at every age, but most men never learn what theirs should be. Mayo Clinic urologist Dr. Tobias Kohler explains why ~500 is the target, why 1,000 is already running hot, what 2,000+ does to the heart, and why a randomized trial found lifting without steroids beat steroids without lifting. Plus: the blood test that catches heart risk your cholesterol panel misses.
Dr. Kohler returns for his second appearance (his first, on erections, testosterone and muscle mass, is one of the most-watched episodes in the show's history). This time: why men's longevity is roughly 50 years behind women's; the Princeton IV consensus he co-chaired, which treats ED as one of the strongest predictors of a future heart attack and points young men toward a coronary calcium scan; the 0–12 ceramide blood test that changes with your behavior; how to get a testosterone baseline that actually means something; what redlining to 2,000–3,000 does to the heart, the set point and the skin; Peyronie's disease, Viagra vs. Cialis, the pills-to-implant ladder, sexual rehab after prostate surgery, and a patient who got stronger with zero testosterone.

About Dr. Tobias Kohler
Tobias S. Kohler, MD, MPH, is Professor of Urology at Mayo Clinic, a fellowship-trained andrologist with 25+ years of clinical and surgical experience and 250+ peer-reviewed publications. He co-chaired the Princeton IV Consensus Guidelines on ED and cardiovascular disease, co-founded the EROS penile implant registry, and co-edited Contemporary Treatment of Erectile Dysfunction (2nd ed.).

🙌 Thank you to our sponsors:
Cozy Earth - Get 20% off at bit.ly/3RLZNEv
Egg Life - bit.ly/4yxBs5l
Ladder - bit.ly/4ggxfLK

📺 Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:
YouTube: bit.ly/4boCFC3
Spotify: bit.ly/4cWTbLG

📱 Connect with Dr. Gabrielle Lyon:
Instagram: bit.ly/4uk9adc
TikTok: bit.ly/3OFK3kJ
X.com: bit.ly/4l3YlaX
Facebook: bit.ly/3MBrJso
LinkedIn: bit.ly/3N1nrdL
Website: bit.ly/3NdV2kT
Books: bit.ly/4r6ugZK
Newsletter: bit.ly/402QCAj

⏰Chapters
00:00 Men are dying earlier than women the penis is the check-engine light
03:26 Boys stop seeing doctors for 20 years the case for an Office of Men's Health
10:57 Princeton IV: ED predicts heart attacks, calcium scans, and Cialis
12:44 The ceramide blood test your cholesterol panel can't replace
20:37 Cardiac risk calculators, statins, and what your LDL should be
25:38 GLP-1s, fertility, and "what's the risk of doing nothing?"
29:05 Testosterone: the ~500 target, why 1,000 runs hot, what 2,000+ does to the heart
31:44 Check your testosterone at 25 and why steroids won't make you a pro
36:57 Tolerance and the new set point redlined men can't escape
38:13 The 1980s trial: lifting without steroids beat steroids without lifting
42:06 Steroid cocktails, arrhythmias, irreversible side effects, and the sarcopenia trade-off
53:04 Peyronie's disease and Viagra vs. Cialis
57:32 Penile implants: the knee-replacement analogy and the pills-to-surgery ladder
1:02:27 Sexual rehab after prostatectomy and the questions to ask before cancer treatment
1:07:55 Closing: be proactive and the patient who got stronger with zero testosterone

Disclaimer: This podcast is for general informational purposes only and does not constitute medical advice or create a doctor–patient relationship. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not disregard or delay seeking medical advice because of something you heard here.