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.).

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⏰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.