Erections & Testosterone - Erectile Dysfunction and the Link to Muscle Mass | Dr Tobias S Kohler

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In this groundbreaking episode, Dr. Gabrielle Lyon sits down with Dr. Tobias Kohler, a professor of urology at the Mayo Clinic, to discuss a topic most people are afraid to talk about: men's sexual health.

Dr. Kohler shares eye-opening insights, backed by over two decades of clinical experience and research, on the powerful link between foundational health habits and male sexual function. They reveal why erectile dysfunction is a critical "check engine light" for heart disease and how building muscle and exercising can improve not just your erections, but your overall longevity.


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Chapters
0:00 - Link between muscle mass & erections
0:52 - Erectile function
1:13 - The truth about penis size & penile implants
2:32 - The foundational pillars of men's health
8:48 - Erectile dysfunction is an early sign of heart disease
16:14 - The role of anxiety, alcohol & cannabis on ED
24:29 - The "use-it-or-lose-it" organ
29:31 - The truth about PDE5 inhibitors (Viagra & Cialis)
46:46 - The "C"s of urinary frequency
54:43 - The connection between muscle, testosterone & sexual function
1:02:07 - Is there a point of no return for penile health?

Erections: A “Check Engine Light” for Your Health
One of the most striking points from the discussion was Dr. Kohler’s perspective on erectile dysfunction (ED). He described it not just as a sexual problem, but as one of the earliest "check engine lights" for heart disease. The blood vessels to the penis are smaller than those in the heart, so plaque buildup (atherosclerosis) affects them first. Persistent erection issues can signal vascular problems that may soon affect your heart. As Dr. Kohler put it, "If the penis is failing, assume you'll have heart problems soon until proven otherwise." The good news: what’s good for your heart—exercise and a healthy diet—is also good for your penis.

The "Use-It-or-Lose-It" Organ
The conversation also tackled the surprising phenomenon of penile shortening. When the penis goes into a "garage" for an extended period—meaning there is a consistent lack of erections—it can lose length. Dr. Kohler shared that a consistent lack of erections for just three months can lead to a loss of 1-2 centimeters in length due to the formation of scar tissue. This is why he calls the penis a "use-it-or-lose-it" organ. The key to maintaining penile health is to exercise the penis through erections, and tools like a vacuum erection device can be used for penile rehabilitation.

Muscle Mass, Testosterone, and Sexual Function
For many men, this is where the conversation gets personal. Dr. Kohler highlighted the direct correlation between muscle mass and erectile quality. Studies show that men with more muscle mass have better erections and higher testosterone levels. The reverse is also true: men with less muscle mass often have lower testosterone, lower libido, and worse erections.
In fact, a modest 10% decrease in body weight can be as effective as ED medication in improving erections. Regular exercise also plays a huge role. Dr. Kohler cited a study that found 150 minutes of exercise per week decreased the rate of ED by 20%, while 300 minutes decreased it by nearly 40%. The takeaway is clear: if you want to improve your sexual function and overall longevity, you have to move iron and get strong.

The Pillars of Health and the Point of No Return
Before considering surgery like a penile implant, Dr. Kohler urges men to focus on diet, exercise, sleep, and stress control—the first line of defense against ED and chronic disease.

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