Dr Mohit Khera — Board-certified urologist and professor at Baylor College of Medicine, Houston, specializing in male and female sexual dysfunction, testosterone replacement therapy and infertility. He runs basic-science and clinical research labs and co-led the landmark TRAVERSE testosterone safety trial.
The gist
Dr Khera introduces the concept of 'sex span' - how long someone can engage in satisfying sexual activity - and argues it should last as long as one's lifespan. He breaks down erectile dysfunction, low libido, premature ejaculation, Peyronie's disease and female sexual dysfunction, stressing that ED is often the first sign of cardiovascular disease and diabetes. He details the four pillars (diet, exercise, sleep, stress reduction), the central role of testosterone in both men and women, and the impact of obesity, pornography and the psychogenic 'vicious cycle'. The conversation covers treatments from daily Cialis and testosterone therapy to shockwave therapy and surgical penile implants, while repeatedly urging listeners to destigmatize and seek help.
Big reveals
- Introduces 'sex span' - the length of time you can have satisfying sex - as a metric most people have never heard of.
- Claims 15% of men diagnosed with ED will have a heart attack or stroke within 7 years, making ED a first warning sign.
- Steven admits he is a 'pill skeptic' and probes the hidden costs of medicating sexual problems.
- Argues testosterone is critical for women too, yet there is no FDA-approved testosterone product for women in the US.
- Khera says he has never personally experienced sexual dysfunction, while insisting there's nothing shameful about it.
- Steven openly shares his own past psychogenic erectile issues and low libido when tired and stressed.
- Reveals the TRAVERSE trial (5,200 patients, 6 years) finally showed testosterone does not raise heart-attack or prostate-cancer risk.
- Brings out a physical penile implant he carried through airport security and had to pump up to explain to staff.
Things worth remembering
- Roughly 43-48% of women suffer from female sexual dysfunction and premature ejaculation affects 30% of men globally.
- Penile arteries (1-2mm) clog before coronary (3-4mm) and carotid arteries, so ED tends to precede heart attacks.
- Fat cells produce aromatase which converts testosterone into estrogen, so obesity directly lowers testosterone.
- Losing 10% of body weight can raise testosterone ~85 ng/dL; losing 15% can raise it ~250 ng/dL.
- Average male testosterone fell from ~700s in the 1970s Framingham study to mid-400s by 2015, a ~300 ng/dL decline.
- Less than 6 hours of sleep raises sexual-dysfunction risk; benefit plateaus above 9 hours.
- About 160 minutes of vigorous exercise a week (40 min x4) significantly improves erectile function over six months.
- Average US ejaculatory time is 5.4 minutes while women average 13.4 minutes to orgasm.
- Only 44% of men who develop ED ever tell their partner; most just start avoiding sex.
- Penile implant patient-and-partner satisfaction exceeds 92%, and in the US Medicare covers the device.
Recommended in this episode
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Recoupling: A Couple's 4 Step Guide to Greater Intimacy and Better Sex
Dr Mohit Khera and Mary Jo Rini
“you wrote a book called recoupling yes a couple's four-step guide to Greater intimacy yes and better sex” — Steven Bartlett 01:14:23Find it on Amazon
Cialis (daily, tadalafil)
Eli Lilly (inferred)
“a medication called daily Calis has become unbelievably helpful for my young patients because daily Calis is a medication that men take daily” — Dr Mohit Khera 01:18:33Find it on Amazon