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.

In this episode:

- Why ED is a blood-flow problem "until proven otherwise," and who needs a calcium score

- The ceramide test: what it measures and the score that sends you to a cardiologist

- Statins, LDL goals and testosterone

- Baseline T at 25, the ~500 target, why 1,000 runs hot

- The 1980s trial: exercise vs. high-dose testosterone vs. both

- Tolerance, the new set point, and the irreversible side effects

- Trading obesity for sarcopenia in the GLP-1 era

- Peyronie's disease: not cancer, not an STD

- Pills, shots and implants; what 90–95% satisfaction means

- Penile rehab after prostatectomy

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.).

Dr. Kohler's first episode → https://youtu.be/__xtrUa3Dck

Clip: Why Every Man Should Prioritize Muscle Mass → https://youtu.be/PgBntuDnzTQ

Chapters:

00:00 Men are dying earlier — the penis is the check-engine light

02:01 Men's longevity is "50 years behind"

03:26 Boys stop seeing doctors — the Office of Men's Health

09:09 Princeton IV: ED predicts heart attacks; calcium scans; Cialis

10:46 The ceramide blood test your cholesterol panel can't replace

15:19 Ceramides, muscle, and knowing if your exercise works

20:51 Statins, testosterone, and your LDL goal

24:01 GLP-1s and "what's the risk of doing nothing?"

25:32 Testosterone: ~500 target, 1,000 too hot, 2,000+ and the heart

28:49 Check your T at 25 — but only if you feel good

29:19 Why steroids won't make you a pro athlete

31:52 Tolerance and the set point redlined men can't escape

35:18 The trial: lifting without steroids beat steroids without lifting

38:58 Steroid cocktails, arrhythmias, WrestleMania mortality

42:42 Irreversible side effects

45:45 Obesity to sarcopenia in the GLP-1 generation

47:51 Peyronie's disease explained

50:53 Viagra vs. Cialis

52:20 Penile implants: the knee-replacement analogy

54:17 Pills, injections, surgery: how long each works

57:15 Sexual rehab after prostatectomy

1:01:08 Fertility and the questions to ask before cancer treatment

1:03:20 The patient who got stronger with zero testosterone

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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.