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#260 ‒ Men’s Sexual Health: why it matters, what can go wrong, and how to fix it | Mohit Khera, M.D., M.B.A., M.P.H.

The Peter Attia Drive

Release Date: 06/26/2023

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The Peter Attia Drive

Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling...

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The Peter Attia Drive

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#361 - AMA #74: Sugar and sugar substitutes: weight control, metabolic effects, and health trade-offs show art #361 - AMA #74: Sugar and sugar substitutes: weight control, metabolic effects, and health trade-offs

The Peter Attia Drive

In this “Ask Me Anything” (AMA) episode, Peter explains how to evaluate sugar and its substitutes in the context of health. Peter explores the role of sweeteners in three common use-cases – beverages, protein supplements, and sweet treats – and breaks down how our evolutionary craving for sweetness now clashes with today’s food environment. He examines whether sugar is uniquely fattening, the hormonal effects of sugar consumption, and the significance of timing in sugar intake. The episode compares natural versus refined sugars, sugar in beverages versus in solid foods, and the...

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#360 ‒ How to change your habits: why they form and how to build or break them | Charles Duhigg, M.B.A show art #360 ‒ How to change your habits: why they form and how to build or break them | Charles Duhigg, M.B.A

The Peter Attia Drive

Charles Duhigg is a Pulitzer Prize-winning journalist and best-selling author known for distilling complex neuroscience and psychology into practical strategies for behavior change, performance, and decision-making. In this episode, Charles explores the neuroscience behind habit formation, including how cue-routine-reward loops drive nearly half of our daily actions and why positive reinforcement is far more effective than punishment. He explains how institutions like the military and Alcoholics Anonymous engineer environments to change behavior at scale, as well as discussing the limits of...

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The Peter Attia Drive

Eric Verdin is a physician-scientist and the CEO of the Buck Institute for Research on Aging whose career has centered on understanding how epigenetics, metabolism, and the immune system influence the aging process. In this episode, Eric traces his scientific journey from studying viruses and histone deacetylases (HDACs) to leading aging research at the Buck Institute, offering insights into how aging impairs immune and nervous system function—including thymic shrinkage, chronic inflammation, and reduced vaccine response—and how these changes impact lifespan. He explores the metabolic...

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#358 ‒ Peter’s takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying | Quarterly Podcast Summary #6 show art #358 ‒ Peter’s takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying | Quarterly Podcast Summary #6

The Peter Attia Drive

In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Paul Turek and Paula Amato on male and female fertility; Rachel Rubin on menopause and hormone replacement therapy; Brian Kennedy on the biology of aging; Tanuj Nakra and Suzan Obagi on facial aging and skin rejuvenation; and BJ Miller and Bridget Sumser on lessons we can learn from the dying about how to live. Peter highlights the most important insights from each episode and any behavioral...

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#357 ‒ A new era of longevity science: models of aging, human trials of rapamycin, biological clocks, promising compounds, and lifestyle interventions | Brian Kennedy, Ph.D. show art #357 ‒ A new era of longevity science: models of aging, human trials of rapamycin, biological clocks, promising compounds, and lifestyle interventions | Brian Kennedy, Ph.D.

The Peter Attia Drive

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The Peter Attia Drive

In this “Ask Me Anything” (AMA) episode, Peter addresses frequently requested topics, including brain health, exercise programming, and body composition. He explores the factors that influence dementia risk—including metabolic health, fitness, sleep, hearing, cholesterol levels, and more. He explains how to implement zone 2 training and VO₂ max intervals for cardiovascular fitness and also covers how to combine cardio modalities, how to stay in zone 2, and special considerations for women. Peter highlights the benefits of light movement after meals and offers strength training tips...

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The Peter Attia Drive

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The Peter Attia Drive

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Mohit Khera is a world-renowned urologist with expertise in sexual medicine and testosterone therapy. In this episode, Mohit provides a comprehensive overview of male sexual health. He begins with an in-depth exploration of erectile dysfunction, shedding light on its prevalence across different age groups, diagnostic methods, and its intriguing connection to cardiovascular disease. He then ventures into Peyronie's disease, penile fractures, penile enlargement treatments, prolonged erections, premature ejaculation, and anorgasmia. Shifting gears, Mohit delves into the intricate workings of testosterone, DHT, and estrogen, emphasizing their physiological significance and interplay. He explains blood tests for diagnosing low testosterone, the correlation between symptoms and blood levels in cases of low testosterone, and the pros and cons of different methodologies for increasing testosterone. He concludes with a thought-provoking conversation about the role of testosterone in patients with prostate cancer and addresses concerns surrounding DHT, finasteride, and post-finasteride syndrome.

We discuss:

  • Mohit’s career path and interest in sexual medicine and infertility [3:00];
  • The anatomy of the male genitalia [5:45];
  • The prevalence of sexual dysfunction, its impact on quality of life, and the importance of seeking help [7:15];
  • Erectile dysfunction (ED): definition, diagnosis, pathophysiology, and more [11:00];
  • The history of medications to treat ED and the mechanisms of how they work [15:30];
  • Relationship between aging and erectile dysfunction and Mohit's approach to treating patients and prescribing medications [20:00];
  • The impact of lifestyle on sexual health and the association between ED and cardiovascular disease [29:30];
  • Causes and treatments for Peyronie’s Disease, penile fracture, and more [37:30];
  • The value of ultrasound for ED diagnosis and management strategies [47:45];
  • Various treatment options for ED: injections, penile prosthesis, and more [50:15];
  • Priapism (prolonged erection): what is happening and when to seek treatment [57:15];
  • Shockwave therapy as a treatment for ED [1:02:45];
  • Stem cell therapy for ED [1:08:15];
  • Platelet-rich plasma (PRP) injections as a treatment for ED [1:12:00];
  • Premature ejaculation (PE): prevalence, pathophysiology, and treatment [1:14:45];
  • Anorgasmia: causes and treatment [1:22:00];
  • The interplay of sex hormones, the impact of aging, symptoms of low testosterone, and considerations for testosterone replacement therapy (TRT) [1:26:45];
  • Methods for increasing endogenous testosterone [1:38:45];
  • Testosterone replacement therapy: various forms of exogenous testosterone, weighing risk vs. reward, and more [1:52:30];
  • The physiology and purpose of testosterone and DHT, why some men feel fine even with “low” testosterone, personalized approaches to treating low testosterone, and more [2:02:30];
  • Post-finasteride syndrome [2:09:00];
  • The role of testosterone in prostate cancer and addressing the notion that TRT could increase risk [2:16:15];
  • The effects of testosterone as an adjunct to therapy for estrogen-sensitive breast cancer in women [2:27:15];
  • Resources for those looking for healthcare providers [2:28:45]; and
  • More.

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