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 KohlerTobias 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.).Dr. Kohler's first episode → https://youtu.be/__xtrUa3Dck🙌 Thank you to our sponsors:Cozy Earth - Egg Life - Ladder - 📺 Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:YouTube: https://bit.ly/4boCFC3 Spotify: https://bit.ly/4cWTbLG 📱 Connect with Dr. Gabrielle Lyon:Instagram: https://bit.ly/4uk9adc TikTok: https://bit.ly/3OFK3kJ X.com: https://bit.ly/4l3YlaX Facebook: https://bit.ly/3MBrJso LinkedIn: https://bit.ly/3N1nrdL Website: https://bit.ly/3NdV2kT Books: https://bit.ly/4r6ugZK Newsletter: https://bit.ly/402QCAj ⏰Chapters00:00 Men are dying earlier than women the penis is the check-engine light03:26 Boys stop seeing doctors for 20 years the case for an Office of Men's Health10:57 Princeton IV: ED predicts heart attacks, calcium scans, and Cialis12:44 The ceramide blood test your cholesterol panel can't replace20:37 Cardiac risk calculators, statins, and what your LDL should be25:38 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 heart31:44 Check your testosterone at 25 and why steroids won't make you a pro36:57 Tolerance and the new set point redlined men can't escape38:13 The 1980s trial: lifting without steroids beat steroids without lifting42:06 Steroid cocktails, arrhythmias, irreversible side effects, and the sarcopenia trade-off53:04 Peyronie's disease and Viagra vs. Cialis57:32 Penile implants: the knee-replacement analogy and the pills-to-surgery ladder1:02:27 Sexual rehab after prostatectomy and the questions to ask before cancer treatment1:07:55 Closing: be proactive and the patient who got stronger with zero testosteroneDisclaimer: 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.