Nicolette: 0:01

Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.

Mark: 0:27

Welcome to the Deep Dive. Today we're tackling a topic that well. It affects millions of men, but it's often just quickly dismissed Erectile dysfunction. So many people, maybe even some doctors. They just write it off as, oh, just low testosterone or maybe just part of getting older, right, and then it's straight to a prescription.

Rachel: 0:50

And that's exactly the trap we want to talk about. We're really here to challenge that new jerk reaction because, ed, it's so much more than just, you know, a performance issue. It's often the body's first like alarm bell. It's signaling something much deeper and maybe significant underlying vascular problems or hormonal or metabolic imbalances. It's basically your system saying hey, pay attention. And these issues affect way more than just sex. They impact your long term health.

Mark: 1:16

Yeah, that makes sense, but the really unfortunate thing is most men never actually uncover these deeper issues, do they?

Rachel: 1:21

No, they don't. They get pills often without the right lab work or they're just told oh, it's just aging.

Mark: 1:26

So that's our mission for this deep dive we want to really unpack the clinical data, look at the evidence and show you how ED is well more often tied to these really crucial underlying things like insulin resistance, maybe unbalanced testosterone and estrogen, even silent liver disease.

Rachel: 1:41

Yeah, and explore how the common medications you know they often just paper over the cracks. They treat the symptom, not the real root cause. We want to show how this often starts in the blood, really not just in the bedroom.

Mark: 1:54

And, importantly, how personalized lab testing can actually help you figure out what's truly going on. Absolutely, that's key. So let's just start by kind of reframing how we think about ED. It's not just a bedroom issue. It's more like a metabolic red flag system wide.

Rachel: 2:10

Exactly A systemic signal. I mean we're talking over 30 million men just in the US affected by this and consistently it points towards these broader health concerns.

Mark: 2:19

It's amazing how often the culprits are these things you don't immediately connect right, like you said insulin resistance, hormone balance, liver health.

Rachel: 2:26

Yeah, the unseen connections. Research really points to those Insulin resistance, the whole testosterone-estrogen balance piece, and silent liver issues. They're not just minor factors, they're often right at the heart of the problem. It tells you the body's already struggling elsewhere.

Mark: 2:42

Which is exactly why getting a handle on these links is so vital, not just for sexual health but, you know, for overall long-term well-being.

Rachel: 2:50

Couldn't agree more and one of the most, I'd say, surprising connections for many people is between ED and insulin resistance.

Mark: 2:59

Right, because you usually think diabetes.

Rachel: 3:01

Exactly. Most people link insulin resistance straight to diabetes, but there's a ton of research now showing it's one of the most underdiagnosed causes of ED, especially in men under 50.

Mark: 3:12

Wow, under 50. So how does that work? How does something like insulin resistance, which is about blood sugar, actually mess with getting an erection?

Rachel: 3:21

Well, it really boils down to damage at a very basic level, the cellular level. When your body gets resistant to insulin, your blood sugar and your insulin levels they stay high for too long and over time this literally damages the endothelial cells. Those are the cells lining your blood vessels, including those really delicate tiny blood vessels in the microvasculature, and this damage, it screws up nitric oxide production.

Mark: 3:46

And nitric oxide is the key signal.

Rachel: 3:48

It's the crucial signal. It tells blood vessels to relax, open up, let blood flow in. That's fundamental for an erection. If that's impaired, things just don't work right.

Mark: 3:58

That sounds pretty significant. Is there good evidence linking this metabolic damage directly to ED, even before someone has full-blown diabetes?

Rachel: 4:06

Oh, absolutely, and it's compelling stuff. There was a study in 2021 in Frontiers in Endocrinology. It found insulin resistance was independently associated with ED, even in guys who weren't diabetic yet weren't even necessarily obese.

Mark: 4:19

Wow.

Rachel: 4:20

It clearly showed that metabolic health is critical for sexual function way earlier than most people, even some doctors, realize. And the scary part is, by the time ED shows up that metabolic damage, it might already be pretty far along.

Mark: 4:32

So you need to catch it early.

Rachel: 4:33

Yes, that's why those early markers are so important. Things like fasting insulin, your A1C, the triglyceride to HDL ratio. These can flag problems even before your fasting glucose looks officially abnormal.

Mark: 4:46

Okay, this really sheds light on why some men find those common ED drugs, you know, the Viagras, the Cialis, why they just don't work that well for them sometimes.

Rachel: 4:56

Exactly right. A lot of men don't respond well to those PDE5 inhibitors precisely because their vascular system is already damaged from years of this silent insulin resistance. Like the sources say, if blood flow can't improve naturally, no pill can fix that. It's a fundamental problem.

Mark: 5:12

So the actionable takeaway here is if you're dealing with ED and you haven't checked your fasting, insulin or glucose, you're missing a huge piece of the puzzle.

Rachel: 5:21

Absolutely One of the most common root causes. It's a critical first step.

Mark: 5:24

Okay, let's shift gears a bit. Let's talk about the puzzle, absolutely One of the most common root causes. It's a critical first step. Okay, let's shift gears a bit. Let's talk about the liver. You mentioned it earlier. It feels like an unsung hero, or maybe villain, in this story. Testosterone gets the headlines, but the liver is doing some heavy lifting with hormones too.

Rachel: 5:35

It really is Hugely important, often overlooked, one of its key jobs is processing and clearing out excess estrogens, specifically estradiol.

Mark: 5:45

OK, estrogen.

Rachel: 5:46

Yeah, and estradiol gets made when testosterone, the hormone we typically want more of, gets converted by this enzyme called aromatase.

Mark: 5:54

Ah, aromatase, I've heard of that.

Rachel: 5:55

Yeah, Think of it like a little chemical switch that flips testosterone into estrogen. Now some estrogen is normal and necessary for men, but too much that works against you.

Rachel: 6:04

Ok, Now some estrogen is normal and necessary for men, but too much that works against you. Okay, and here's the rub If your liver function is impaired, maybe from something like non-alcoholic fatty liver disease, nafld, which is super common now, right, it can't clear that estrogen effectively, so estrogen levels build up and that imbalance it definitely contributes to ED, often along with things like fatigue and low libido too.

Mark: 6:24

And I remember reading that this aromatase that deep belly fat.

Rachel: 6:31

You got it Exactly Visceral fat is like an aromatase factory.

Mark: 6:34

Yeah.

Rachel: 6:34

So the more belly fat, especially that deep internal fat common in guys with insulin resistance.

Mark: 6:39

The more testosterone gets converted to estrogen.

Rachel: 6:42

Precisely, yeah, and remember high insulin levels, which we just talked about. They actually promote storing more of that belly fat.

Mark: 6:49

Oh wow, so it's a vicious cycle.

Rachel: 6:51

It's a total vicious cycle. More belly fat means more estrogen. Excess estrogen messes with sexual function and this leads to that kind of hormonal paradox you hear about.

Mark: 7:01

Where total testosterone might look normal on a lab test.

Rachel: 7:14

Right, but the guy still has ED symptoms because his estradiol is too high or his free testosterone is too low, all thanks to that ramped up aromatase and the liver struggling to clear the estrogen.

Mark: 7:16

So if the liver is overwhelmed, maybe it's fatty, maybe it's inflamed it just can't keep up with detoxifying that extra estrogen being pumped out by the fat tissue.

Rachel: 7:25

That's it in a nutshell. It slows down estrogen metabolism. The excess estrogen hangs around longer, disrupting the whole hormonal balance, and it's amazing how often the symptoms maybe subtle mood shifts, lower libido, just not great erection quality, gaining body fat get missed. If only total T is checked, Because if that liver isn't working well, even just a little bit of extra aromatase activity can lead to estrogen buildup. That undermines everything, even if someone's on testosterone therapy.

Mark: 7:53

So let's map out that vicious cycle clearly. High insulin promotes more belly fat. That fat has more robitase on, which converts more testosterone to estrogen. The liver struggles to clear it. Estrogen builds up Free testosterone effectively drops impaired sexual function.

Rachel: 8:10

Perfect summary. That's the loop.

Mark: 8:12

So for someone listening, experiencing ED, wanting to check this liver hormone link, what labs are essential?

Rachel: 8:18

Okay, good question. For a proper workup here you definitely need estradiol, shbg that's sex hormone binding globulin. You need liver enzymes, definitely ALT, ast and GGT. Those are like the liver's stress signals.

Mark: 8:31

The check engine lights.

Rachel: 8:32

Exactly the check engine lights, plus total and free testosterone and, going back to our earlier point, fasting insulin. You need that full picture.

Mark: 8:40

Got it Okay. Now let's tackle the elephant in the room, the medications, the quick fix. For a lot of men, the first thing they're offered is a pill right Like Viagra, Cialis, a PDE5 inhibitor. They work by boosting nitric oxide signaling, relaxing blood vessels, increasing blood flow. And look when they work, they can feel like a miracle.

Rachel: 9:01

They can absolutely.

Mark: 9:02

But when they don't work, or stop working as well, that's often a sign something deeper is wrong, isn't it?

Rachel: 9:08

That is such a critical point it often gets completely missed. These PDE5 inhibitors, they can only work their magic if the underlying machinery is basically sound, Meaning you need reasonably good vascular health, decent hormonal balance and nerves that function properly. If any of those are compromised and they often are in men with insulin resistance or low free T or poor nitric oxide production, overall Then the drugs won't work well. They might have little effect or none at all. They basically amplify an existing signal. They don't create the signal from scratch.

Mark: 9:44

If the basic system is broken, the amplifier can't do much. So if the pills aren't giving you the results you hoped for, that's actually a massive clue to dig deeper. It's not just about needing a stronger dose.

Rachel: 9:51

That's a really smart way to look at it. Yeah, Studies back this up a good chunk of men with metabolic syndrome or type 2 diabetes just don't respond well to these drugs.

Mark: 10:00

Because the underlying plumbing is already damaged.

Rachel: 10:02

Exactly that. Insulin resistance has already damaged the endothelium, the lining of the blood vessels. It makes it harder for nitric oxide to work. Like we said, if blood flow can't improve naturally, the pill isn't a magic fix.

Mark: 10:16

And the danger is relying on them, even if they do work initially.

Rachel: 10:20

Yes, that's a huge concern. If a man gets some results, he might just keep taking the pills without ever asking why he needs them and that reliance it can seriously delay finding out about underlying pre-diabetes or fatty liver or a hormone imbalance. It's just quietly getting worse in the background.

Mark: 10:36

So it could be masking something serious less of a solution, more of a cover up, potentially.

Rachel: 10:42

It really can be. Think about it. If you're using ED meds and you notice they're not working as well as they used to, that's probably not the drug failing. It's more likely your underlying physiology changing, getting worse.

Nicolette: 10:53

Wow.

Rachel: 10:54

These pills can offer temporary relief, sure, but they're not diagnostic tools. Ed itself is the flag, the metabolic red flag. Just relying on pills without testing, you risk masking early cardiovascular disease, hormone issues, liver problems, things that really need proper medical attention.

Mark: 11:11

So the practical advice here is pretty clear.

Rachel: 11:13

Yeah, I think so. If you found yourself needing ED meds more than just say a handful of times, that's your cue. It's really time to get tested Check your glucose control, your liver function, your full testosterone panel, maybe even inflammation markers.

Mark: 11:27

Which brings us perfectly to the big question what labs should you actually run if you're experiencing ED? Because we've established it's almost never just skin deep.

Rachel: 11:37

Exactly. Ed is so often that canary in the coal mine signaling something's off internally. Before jumping to meds, before even thinking about hormone therapy, you absolutely have to understand what's happening underneath.

Mark: 11:49

Get the data.

Rachel: 11:49

Get the data. The right lab work helps you pinpoint if the root is metabolic, hormonal, vascular, hepatic or, very often, a mix of things. That's the real power of diagnostics it tells you where to focus.

Mark: 12:02

Okay, so break it down for us. What are the core areas, the key tests people should be looking at?

Rachel: 12:06

All right, let's go through them. Five core areas. First, glucose and insulin control. We've hit this hard, but it's critical. Poor glucose regulation, high fasting insulin, super common root causes. These tests catch insulin resistance early, often years before diabetes is diagnosed.

Mark: 12:23

So what tests specifically?

Rachel: 12:25

You want fasting glucose hemoglobin A1c. That gives you a longer-term picture. Definitely fasting insulin and maybe calculate home AIR. That's a score that shows how insulin resistant you might be becoming.

Mark: 12:35

Okay, number one glucose and insulin. What's next?

Rachel: 12:39

Second, hormonal health. And, like we said, just checking, total testosterone not enough, not nearly enough.

Mark: 12:46

Right. Need the full picture.

Rachel: 12:47

You need the full picture. Total testosterone, yes, but also free testosterone, SHBG, that protein that binds testosterone, estradiol, E2, DHEAS and sometimes, depending on the results, LH and FSH to check pituitary signals.

Mark: 13:01

Got it Hormones covered. What's area three?

Rachel: 13:04

Area three liver function and estrogen clearance. Remember the liver's role in clearing estrogen. If it's impaired, hormones get unbalanced, even if T looks okay.

Mark: 13:12

The check engine lights again, yep.

Rachel: 13:13

ALT AST GGT Check If T looks okay. The check engine lights again. Yep, alt AST GGT Check those liver enzymes. Also bilirubin and albumin can give you a broader sense of liver health. Okay, area four Four is lipids and inflammation. This is all about vascular health, Endothelial function, nitric oxide vital for erections. These labs assess cardiovascular risk and background inflammation.

Mark: 13:34

So the usual suspects, plus inflammation.

Rachel: 13:36

Yeah, total cholesterol, hdl, ldl, triglycerides, for sure, yeah, but also HSCRP, that's high sensitivity C-reactive protein, a key inflammation marker. Optionally, maybe homocysteine or an omega 3 index test too.

Mark: 13:48

Okay, lipids and inflammation. And the fifth area.

Rachel: 13:51

Finally, number five thyroid function. Don't forget the thyroid. Thyroid hormones affect everything Metabolism, libido, even SHBG levels. Even mild subclinical hypothyroidism can contribute to ED.

Mark: 14:04

So basic thyroid panel.

Rachel: 14:05

TSH, free T3 and free T4. Absolutely, you know. What's really interesting is how often men come in with ED. Their total testosterone looks normal on paper but when you run these comprehensive panels, boom. You see clear signs of insulin resistance or maybe high SHBG or fatty liver markers things you'd completely miss otherwise.

Mark: 14:27

And the good news is getting these tests done is actually pretty accessible now, right Even at-home options, absolutely.

Rachel: 14:32

You can often get comprehensive panels like these done quite conveniently, sometimes even with at-home test kits. It puts the power back in your hands.

Mark: 14:39

Okay, so let's wrap this up. The big takeaway here seems to be ED is fundamentally a reflection of your overall health. That's it For so many men. It's that first really noticeable sign that something deeper is out of balance. Could be insulin resistance, could be low free T, too much estrogen, poor liver function, maybe even the early stages of cardiovascular changes.

Rachel: 14:59

All of the above.

Mark: 14:59

sometimes, and unfortunately, the standard approach often just skips right over these root causes and goes straight for the pills, which might help short term but doesn't fix the underlying issue.

Rachel: 15:12

But and this is the crucial empowering part ED doesn't have to be this big mystery. It doesn't need a one size fits all pill approach If you get the right data from personalized labs you can take targeted action. Exactly Targeted, effective action becomes possible. You can actually work to restore sexual function and maybe, more importantly, protect your long term health. It's about moving from guesswork to actual results based on what your body needs.

Mark: 15:38

That's a really hopeful message. So, essentially, ed is often reversible, but only if you treat the real cause.

Rachel: 15:44

Couldn't have said it better myself Guesswork leads to frustration. Testing leads to results. Treat the cause, not just the symptom.

Mark: 15:51

So a final thought to leave our listeners with.

Rachel: 15:54

Yeah, I'd say this Don't wait for things to get worse. The sooner you dig in and uncover what's really going on inside your body, the more power you have, the more options you have to make a real difference. This isn't just about erections. It's about setting yourself up for better health across the board. For the long haul. It's about optimizing your entire health trajectory your entire health trajectory.