July 10, 2025 • 16 mins
Erectile dysfunction (ED) is more than a bedroom issue—it's often the body's first signal that something deeper is wrong. In this episode of The Health Pulse, we uncover the metabolic and vascular roots of ED that are frequently overlooked in standard care.
You’ll learn how insulin resistance silently damages the blood vessels required for healthy erections—often years before diabetes is diagnosed. We also dive into the liver-hormone connection, where poor liver function leads to estrogen buildup, disrupting testosterone balance and worsening ED even when lab values appear “normal.”
We explain why ED medications only work if the underlying systems are intact, and what it means when these drugs fail. More importantly, we share the five essential lab tests every man should consider to identify the real cause of ED—and how this knowledge can help prevent cardiovascular disease, diabetes, and further hormonal decline.
If you’ve ever been told ED is “just aging,” this episode will change your perspective—and give you a roadmap to take back control of your health.
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💬 Enjoyed the episode? Leave us a review and let us know what topics you'd like us to cover next! Your feedback helps us bring you the content that matters most.
Disclaimer: The information provided in this podcast is for informational purposes only and should not be considered medical advice. The content discussed is based on research, expert insights, and reputable sources, but it does not replace professional medical consultation, diagnosis, or treatment. We strive to present accurate and up-to-date information, medical research is constantly evolving. Listeners should always verify details with trusted health organizations, before making any health-related decisions. If you are experiencing a medical emergency, such as severe pain, difficulty breathing, or other urgent symptoms, call your local emergency services immediately. By listening to this podcast, you acknowledge that The Health Pulse and its creators are not responsible for any actions taken based on the content of this episode. Your health and well-being should always be guided by the advice of qualified medical professionals.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Nicolette (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Mark (00:27):
Welcome to the Deep Dive.
Today we're tackling a topicthat well.
It affects millions of men, butit's often just quickly
dismissed Erectile dysfunction.
So many people, maybe even somedoctors.
They just write it off as, oh,just low testosterone or maybe
just part of getting older,right, and then it's straight to
(00:47):
a prescription.
Rachel (00:50):
And that's exactly the trap we want to talk about.
We're really here to challengethat new jerk reaction because,
ed, it's so much more than just,you know, a performance issue.
It's often the body's firstlike alarm bell.
It's signaling something muchdeeper and maybe significant
underlying vascular problems orhormonal or metabolic imbalances
.
It's basically your systemsaying hey, pay attention.
(01:11):
And these issues affect waymore than just sex.
They impact your long termhealth.
Mark (01:16):
Yeah, that makes sense, but the really unfortunate thing
is most men never actuallyuncover these deeper issues, do
they?
Rachel (01:21):
No, they don't.
They get pills often withoutthe right lab work or they're
just told oh, it's just aging.
Mark (01:26):
So that's our mission for this deep dive we want to really
unpack the clinical data, lookat the evidence and show you how
ED is well more often tied tothese really crucial underlying
things like insulin resistance,maybe unbalanced testosterone
and estrogen, even silent liverdisease.
Rachel (01:41):
Yeah, and explore how the common medications you know
they often just paper over thecracks.
They treat the symptom, not thereal root cause.
We want to show how this oftenstarts in the blood, really not
just in the bedroom.
Mark (01:54):
And, importantly, how personalized lab testing can
actually help you figure outwhat's truly going on.
Absolutely, that's key.
So let's just start by kind ofreframing how we think about ED.
It's not just a bedroom issue.
It's more like a metabolic redflag system wide.
Rachel (02:10):
Exactly A systemic signal.
I mean we're talking over 30million men just in the US
affected by this andconsistently it points towards
these broader health concerns.
Mark (02:19):
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 (02:26):
Yeah, the unseen connections.
Research really points to thoseInsulin resistance, the whole
testosterone-estrogen balancepiece, 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 alreadystruggling elsewhere.
Mark (02:42):
Which is exactly why getting a handle on these links
is so vital, not just for sexualhealth but, you know, for
overall long-term well-being.
Rachel (02:50):
Couldn't agree more and one of the most, I'd say,
surprising connections for manypeople is between ED and insulin
resistance.
Mark (02:59):
Right, because you usually think diabetes.
Rachel (03:01):
Exactly.
Most people link insulinresistance straight to diabetes,
but there's a ton of researchnow showing it's one of the most
underdiagnosed causes of ED,especially in men under 50.
Mark (03:12):
Wow, under 50.
So how does that work?
How does something like insulinresistance, which is about
blood sugar, actually mess withgetting an erection?
Rachel (03:21):
Well, it really boils down to damage at a very basic
level, the cellular level.
When your body gets resistantto insulin, your blood sugar and
your insulin levels they stayhigh for too long and over time
this literally damages theendothelial cells.
Those are the cells lining yourblood vessels, including those
really delicate tiny bloodvessels in the microvasculature,
(03:42):
and this damage, it screws upnitric oxide production.
Mark (03:46):
And nitric oxide is the key signal.
Rachel (03:48):
It's the crucial signal.
It tells blood vessels to relax, open up, let blood flow in.
That's fundamental for anerection.
If that's impaired, things justdon't work right.
Mark (03:58):
That sounds pretty significant.
Is there good evidence linkingthis metabolic damage directly
to ED, even before someone hasfull-blown diabetes?
Rachel (04:06):
Oh, absolutely, and it's compelling stuff.
There was a study in 2021 inFrontiers in Endocrinology.
It found insulin resistance wasindependently associated with
ED, even in guys who weren'tdiabetic yet weren't even
necessarily obese.
Mark (04:19):
Wow.
Rachel (04:20):
It clearly showed that metabolic health is critical for
sexual function way earlierthan most people, even some
doctors, realize.
And the scary part is, by thetime ED shows up that metabolic
damage, it might already bepretty far along.
Mark (04:32):
So you need to catch it early.
Rachel (04:33):
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 evenbefore your fasting glucose
looks officially abnormal.
Mark (04:46):
Okay, this really sheds light on why some men find those
common ED drugs, you know, theViagras, the Cialis, why they
just don't work that well forthem sometimes.
Rachel (04:56):
Exactly right.
A lot of men don't respond wellto those PDE5 inhibitors
precisely because their vascularsystem is already damaged from
years of this silent insulinresistance.
Like the sources say, if bloodflow can't improve naturally, no
pill can fix that.
It's a fundamental problem.
Mark (05:12):
So the actionable takeaway here is if you're dealing with
ED and you haven't checked yourfasting, insulin or glucose,
you're missing a huge piece ofthe puzzle.
Rachel (05:21):
Absolutely One of the most common root causes.
It's a critical first step.
Mark (05:24):
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 (05:35):
It really is Hugely important, often overlooked, one
of its key jobs is processingand clearing out excess
estrogens, specificallyestradiol.
Mark (05:45):
OK, estrogen.
Rachel (05:46):
Yeah, and estradiol gets made when testosterone, the
hormone we typically want moreof, gets converted by this
enzyme called aromatase.
Mark (05:54):
Ah, aromatase, I've heard of that.
Rachel (05:55):
Yeah, Think of it like a little chemical switch that
flips testosterone into estrogen.
Now some estrogen is normal andnecessary for men, but too much
that works against you.
Ok, Now some estrogen is normaland necessary for men, but too
much that works against you.
Okay, and here's the rub Ifyour liver function is impaired,
maybe from something likenon-alcoholic fatty liver
disease, nafld, which is supercommon now, right, it can't
clear that estrogen effectively,so estrogen levels build up and
(06:18):
that imbalance it definitelycontributes to ED, often along
with things like fatigue and lowlibido too.
Mark (06:24):
And I remember reading that this aromatase that deep
belly fat.
Rachel (06:31):
You got it Exactly Visceral fat is like an
aromatase factory.
Mark (06:34):
Yeah.
Rachel (06:34):
So the more belly fat, especially that deep internal
fat common in guys with insulinresistance.
Mark (06:39):
The more testosterone gets converted to estrogen.
Rachel (06:42):
Precisely, yeah, and remember high insulin levels,
which we just talked about.
They actually promote storingmore of that belly fat.
Mark (06:49):
Oh wow, so it's a vicious cycle.
Rachel (06:51):
It's a total vicious cycle.
More belly fat means moreestrogen.
Excess estrogen messes withsexual function and this leads
to that kind of hormonal paradoxyou hear about.
Mark (07:01):
Where total testosterone might look normal on a lab test.
Rachel (07:14):
Right, but the guy still has ED symptoms because his
estradiol is too high or hisfree testosterone is too low,
all thanks to that ramped uparomatase and the liver
struggling to clear the estrogen.
Mark (07:16):
So if the liver is overwhelmed, maybe it's fatty,
maybe it's inflamed it justcan't keep up with detoxifying
that extra estrogen being pumpedout by the fat tissue.
Rachel (07:25):
That's it in a nutshell.
It slows down estrogenmetabolism.
The excess estrogen hangsaround longer, disrupting the
whole hormonal balance, and it'samazing how often the symptoms
maybe subtle mood shifts, lowerlibido, just not great erection
quality, gaining body fat getmissed.
If only total T is checked,Because if that liver isn't
working well, even just a littlebit of extra aromatase activity
(07:48):
can lead to estrogen buildup.
That undermines everything,even if someone's on
testosterone therapy.
Mark (07:53):
So let's map out that vicious cycle clearly.
High insulin promotes morebelly fat.
That fat has more robitase on,which converts more testosterone
to estrogen.
The liver struggles to clear it.
Estrogen builds up Freetestosterone effectively drops
impaired sexual function.
Rachel (08:10):
Perfect summary.
That's the loop.
Mark (08:12):
So for someone listening, experiencing ED, wanting to
check this liver hormone link,what labs are essential?
Rachel (08:18):
Okay, good question.
For a proper workup here youdefinitely need estradiol, shbg
that's sex hormone bindingglobulin.
You need liver enzymes,definitely ALT, ast and GGT.
Those are like the liver'sstress signals.
Mark (08:31):
The check engine lights.
Rachel (08:32):
Exactly the check engine lights, plus total and free
testosterone and, going back toour earlier point, fasting
insulin.
You need that full picture.
Mark (08:40):
Got it Okay.
Now let's tackle the elephantin the room, the medications,
the quick fix.
For a lot of men, the firstthing they're offered is a pill
right Like Viagra, Cialis, aPDE5 inhibitor.
They work by boosting nitricoxide signaling, relaxing blood
vessels, increasing blood flow.
And look when they work, theycan feel like a miracle.
Rachel (09:01):
They can absolutely.
Mark (09:02):
But when they don't work, or stop working as well, that's
often a sign something deeper iswrong, isn't it?
Rachel (09:08):
That is such a critical point it often gets completely
missed.
These PDE5 inhibitors, they canonly work their magic if the
underlying machinery isbasically sound, Meaning you
need reasonably good vascularhealth, decent hormonal balance
and nerves that functionproperly.
If any of those are compromisedand they often are in men with
insulin resistance or low free Tor poor nitric oxide production
(09:30):
, overall Then the drugs won'twork well.
They might have little effector none at all.
They basically amplify anexisting signal.
They don't create the signalfrom scratch.
Mark (09:44):
If the basic system is broken, the amplifier can't do
much.
So if the pills aren't givingyou the results you hoped for,
that's actually a massive clueto dig deeper.
It's not just about needing astronger dose.
Rachel (09:51):
That's a really smart way to look at it.
Yeah, Studies back this up agood chunk of men with metabolic
syndrome or type 2 diabetesjust 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 alreadydamaged the endothelium, the
lining of the blood vessels.
It makes it harder for nitricoxide to work.
Like we said, if blood flowcan'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, hemight just keep taking the pills
without ever asking why heneeds them and that reliance it
can seriously delay finding outabout underlying pre-diabetes or
fatty liver or a hormoneimbalance.
It's just quietly getting worsein 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 younotice they're not working as
well as they used to, that'sprobably not the drug failing.
It's more likely yourunderlying 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, themetabolic red flag.
Just relying on pills withouttesting, you risk masking early
cardiovascular disease, hormoneissues, liver problems, things
that really need proper medicalattention.
Mark (11:11):
So the practical advice here is pretty clear.
Rachel (11:13):
Yeah, I think so.
If you found yourself needingED meds more than just say a
handful of times, that's yourcue.
It's really time to get testedCheck your glucose control, your
liver function, your fulltestosterone panel, maybe even
inflammation markers.
Mark (11:27):
Which brings us perfectly to the big question what labs
should you actually run ifyou're experiencing ED?
Because we've established it'salmost never just skin deep.
Rachel (11:37):
Exactly.
Ed is so often that canary inthe coal mine signaling
something's off internally.
Before jumping to meds, beforeeven thinking about hormone
therapy, you absolutely have tounderstand what's happening
underneath.
Mark (11:49):
Get the data.
Rachel (11:49):
Get the data.
The right lab work helps youpinpoint if the root is
metabolic, hormonal, vascular,hepatic or, very often, a mix of
things.
That's the real power ofdiagnostics it tells you where
to focus.
Mark (12:02):
Okay, so break it down for us.
What are the core areas, thekey tests people should be
looking at?
Rachel (12:06):
All right, let's go through them.
Five core areas.
First, glucose and insulincontrol.
We've hit this hard, but it'scritical.
Poor glucose regulation, highfasting insulin, super common
root causes.
These tests catch insulinresistance 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-termpicture.
Definitely fasting insulin andmaybe calculate home AIR.
That's a score that shows howinsulin 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, justchecking, 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, butalso free testosterone, SHBG,
that protein that bindstestosterone, estradiol, E2,
DHEAS and sometimes, dependingon 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 inclearing estrogen.
If it's impaired, hormones getunbalanced, 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 thoseliver enzymes.
Also bilirubin and albumin cangive you a broader sense of
liver health.
Okay, area four Four is lipidsand inflammation.
This is all about vascularhealth, Endothelial function,
nitric oxide vital for erections.
These labs assesscardiovascular 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 keyinflammation marker.
Optionally, maybe homocysteineor 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 affecteverything Metabolism, libido,
even SHBG levels.
Even mild subclinicalhypothyroidism 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 ishow often men come in with ED.
Their total testosterone looksnormal on paper but when you run
these comprehensive panels,boom.
You see clear signs of insulinresistance or maybe high SHBG or
fatty liver markers thingsyou'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 yourhands.
Mark (14:39):
Okay, so let's wrap this up.
The big takeaway here seems tobe ED is fundamentally a
reflection of your overallhealth.
That's it For so many men.
It's that first reallynoticeable 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 rightover these root causes and goes
straight for the pills, whichmight 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 bigmystery.
It doesn't need a one size fitsall pill approach If you get
the right data from personalizedlabs you can take targeted
action.
Exactly Targeted, effectiveaction becomes possible.
You can actually work torestore sexual function and
maybe, more importantly, protectyour long term health.
(15:33):
It's about moving fromguesswork to actual results
based on what your body needs.
Mark (15:38):
That's a really hopeful message.
So, essentially, ed is oftenreversible, 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 thesymptom.
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 anduncover what's really going on
inside your body, the more poweryou have, the more options you
have to make a real difference.
This isn't just about erections.
It's about setting yourself upfor better health across the
board.
For the long haul.
It's about optimizing yourentire health trajectory your
(16:25):
entire health trajectory.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Mark (00:27):
Welcome to the Deep Dive.
Today we're tackling a topicthat well.
It affects millions of men, butit's often just quickly
dismissed Erectile dysfunction.
So many people, maybe even somedoctors.
They just write it off as, oh,just low testosterone or maybe
just part of getting older,right, and then it's straight to
(00:47):
a prescription.
Rachel (00:50):
And that's exactly the trap we want to talk about.
We're really here to challengethat new jerk reaction because,
ed, it's so much more than just,you know, a performance issue.
It's often the body's firstlike alarm bell.
It's signaling something muchdeeper and maybe significant
underlying vascular problems orhormonal or metabolic imbalances
.
It's basically your systemsaying hey, pay attention.
(01:11):
And these issues affect waymore than just sex.
They impact your long termhealth.
Mark (01:16):
Yeah, that makes sense, but the really unfortunate thing
is most men never actuallyuncover these deeper issues, do
they?
Rachel (01:21):
No, they don't.
They get pills often withoutthe right lab work or they're
just told oh, it's just aging.
Mark (01:26):
So that's our mission for this deep dive we want to really
unpack the clinical data, lookat the evidence and show you how
ED is well more often tied tothese really crucial underlying
things like insulin resistance,maybe unbalanced testosterone
and estrogen, even silent liverdisease.
Rachel (01:41):
Yeah, and explore how the common medications you know
they often just paper over thecracks.
They treat the symptom, not thereal root cause.
We want to show how this oftenstarts in the blood, really not
just in the bedroom.
Mark (01:54):
And, importantly, how personalized lab testing can
actually help you figure outwhat's truly going on.
Absolutely, that's key.
So let's just start by kind ofreframing how we think about ED.
It's not just a bedroom issue.
It's more like a metabolic redflag system wide.
Rachel (02:10):
Exactly A systemic signal.
I mean we're talking over 30million men just in the US
affected by this andconsistently it points towards
these broader health concerns.
Mark (02:19):
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 (02:26):
Yeah, the unseen connections.
Research really points to thoseInsulin resistance, the whole
testosterone-estrogen balancepiece, 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 alreadystruggling elsewhere.
Mark (02:42):
Which is exactly why getting a handle on these links
is so vital, not just for sexualhealth but, you know, for
overall long-term well-being.
Rachel (02:50):
Couldn't agree more and one of the most, I'd say,
surprising connections for manypeople is between ED and insulin
resistance.
Mark (02:59):
Right, because you usually think diabetes.
Rachel (03:01):
Exactly.
Most people link insulinresistance straight to diabetes,
but there's a ton of researchnow showing it's one of the most
underdiagnosed causes of ED,especially in men under 50.
Mark (03:12):
Wow, under 50.
So how does that work?
How does something like insulinresistance, which is about
blood sugar, actually mess withgetting an erection?
Rachel (03:21):
Well, it really boils down to damage at a very basic
level, the cellular level.
When your body gets resistantto insulin, your blood sugar and
your insulin levels they stayhigh for too long and over time
this literally damages theendothelial cells.
Those are the cells lining yourblood vessels, including those
really delicate tiny bloodvessels in the microvasculature,
(03:42):
and this damage, it screws upnitric oxide production.
Mark (03:46):
And nitric oxide is the key signal.
Rachel (03:48):
It's the crucial signal.
It tells blood vessels to relax, open up, let blood flow in.
That's fundamental for anerection.
If that's impaired, things justdon't work right.
Mark (03:58):
That sounds pretty significant.
Is there good evidence linkingthis metabolic damage directly
to ED, even before someone hasfull-blown diabetes?
Rachel (04:06):
Oh, absolutely, and it's compelling stuff.
There was a study in 2021 inFrontiers in Endocrinology.
It found insulin resistance wasindependently associated with
ED, even in guys who weren'tdiabetic yet weren't even
necessarily obese.
Mark (04:19):
Wow.
Rachel (04:20):
It clearly showed that metabolic health is critical for
sexual function way earlierthan most people, even some
doctors, realize.
And the scary part is, by thetime ED shows up that metabolic
damage, it might already bepretty far along.
Mark (04:32):
So you need to catch it early.
Rachel (04:33):
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 evenbefore your fasting glucose
looks officially abnormal.
Mark (04:46):
Okay, this really sheds light on why some men find those
common ED drugs, you know, theViagras, the Cialis, why they
just don't work that well forthem sometimes.
Rachel (04:56):
Exactly right.
A lot of men don't respond wellto those PDE5 inhibitors
precisely because their vascularsystem is already damaged from
years of this silent insulinresistance.
Like the sources say, if bloodflow can't improve naturally, no
pill can fix that.
It's a fundamental problem.
Mark (05:12):
So the actionable takeaway here is if you're dealing with
ED and you haven't checked yourfasting, insulin or glucose,
you're missing a huge piece ofthe puzzle.
Rachel (05:21):
Absolutely One of the most common root causes.
It's a critical first step.
Mark (05:24):
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 (05:35):
It really is Hugely important, often overlooked, one
of its key jobs is processingand clearing out excess
estrogens, specificallyestradiol.
Mark (05:45):
OK, estrogen.
Rachel (05:46):
Yeah, and estradiol gets made when testosterone, the
hormone we typically want moreof, gets converted by this
enzyme called aromatase.
Mark (05:54):
Ah, aromatase, I've heard of that.
Rachel (05:55):
Yeah, Think of it like a little chemical switch that
flips testosterone into estrogen.
Now some estrogen is normal andnecessary for men, but too much
that works against you.
Ok, Now some estrogen is normaland necessary for men, but too
much that works against you.
Okay, and here's the rub Ifyour liver function is impaired,
maybe from something likenon-alcoholic fatty liver
disease, nafld, which is supercommon now, right, it can't
clear that estrogen effectively,so estrogen levels build up and
(06:18):
that imbalance it definitelycontributes to ED, often along
with things like fatigue and lowlibido too.
Mark (06:24):
And I remember reading that this aromatase that deep
belly fat.
Rachel (06:31):
You got it Exactly Visceral fat is like an
aromatase factory.
Mark (06:34):
Yeah.
Rachel (06:34):
So the more belly fat, especially that deep internal
fat common in guys with insulinresistance.
Mark (06:39):
The more testosterone gets converted to estrogen.
Rachel (06:42):
Precisely, yeah, and remember high insulin levels,
which we just talked about.
They actually promote storingmore of that belly fat.
Mark (06:49):
Oh wow, so it's a vicious cycle.
Rachel (06:51):
It's a total vicious cycle.
More belly fat means moreestrogen.
Excess estrogen messes withsexual function and this leads
to that kind of hormonal paradoxyou hear about.
Mark (07:01):
Where total testosterone might look normal on a lab test.
Rachel (07:14):
Right, but the guy still has ED symptoms because his
estradiol is too high or hisfree testosterone is too low,
all thanks to that ramped uparomatase and the liver
struggling to clear the estrogen.
Mark (07:16):
So if the liver is overwhelmed, maybe it's fatty,
maybe it's inflamed it justcan't keep up with detoxifying
that extra estrogen being pumpedout by the fat tissue.
Rachel (07:25):
That's it in a nutshell.
It slows down estrogenmetabolism.
The excess estrogen hangsaround longer, disrupting the
whole hormonal balance, and it'samazing how often the symptoms
maybe subtle mood shifts, lowerlibido, just not great erection
quality, gaining body fat getmissed.
If only total T is checked,Because if that liver isn't
working well, even just a littlebit of extra aromatase activity
(07:48):
can lead to estrogen buildup.
That undermines everything,even if someone's on
testosterone therapy.
Mark (07:53):
So let's map out that vicious cycle clearly.
High insulin promotes morebelly fat.
That fat has more robitase on,which converts more testosterone
to estrogen.
The liver struggles to clear it.
Estrogen builds up Freetestosterone effectively drops
impaired sexual function.
Rachel (08:10):
Perfect summary.
That's the loop.
Mark (08:12):
So for someone listening, experiencing ED, wanting to
check this liver hormone link,what labs are essential?
Rachel (08:18):
Okay, good question.
For a proper workup here youdefinitely need estradiol, shbg
that's sex hormone bindingglobulin.
You need liver enzymes,definitely ALT, ast and GGT.
Those are like the liver'sstress signals.
Mark (08:31):
The check engine lights.
Rachel (08:32):
Exactly the check engine lights, plus total and free
testosterone and, going back toour earlier point, fasting
insulin.
You need that full picture.
Mark (08:40):
Got it Okay.
Now let's tackle the elephantin the room, the medications,
the quick fix.
For a lot of men, the firstthing they're offered is a pill
right Like Viagra, Cialis, aPDE5 inhibitor.
They work by boosting nitricoxide signaling, relaxing blood
vessels, increasing blood flow.
And look when they work, theycan feel like a miracle.
Rachel (09:01):
They can absolutely.
Mark (09:02):
But when they don't work, or stop working as well, that's
often a sign something deeper iswrong, isn't it?
Rachel (09:08):
That is such a critical point it often gets completely
missed.
These PDE5 inhibitors, they canonly work their magic if the
underlying machinery isbasically sound, Meaning you
need reasonably good vascularhealth, decent hormonal balance
and nerves that functionproperly.
If any of those are compromisedand they often are in men with
insulin resistance or low free Tor poor nitric oxide production
(09:30):
, overall Then the drugs won'twork well.
They might have little effector none at all.
They basically amplify anexisting signal.
They don't create the signalfrom scratch.
Mark (09:44):
If the basic system is broken, the amplifier can't do
much.
So if the pills aren't givingyou the results you hoped for,
that's actually a massive clueto dig deeper.
It's not just about needing astronger dose.
Rachel (09:51):
That's a really smart way to look at it.
Yeah, Studies back this up agood chunk of men with metabolic
syndrome or type 2 diabetesjust 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 alreadydamaged the endothelium, the
lining of the blood vessels.
It makes it harder for nitricoxide to work.
Like we said, if blood flowcan'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, hemight just keep taking the pills
without ever asking why heneeds them and that reliance it
can seriously delay finding outabout underlying pre-diabetes or
fatty liver or a hormoneimbalance.
It's just quietly getting worsein 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 younotice they're not working as
well as they used to, that'sprobably not the drug failing.
It's more likely yourunderlying 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, themetabolic red flag.
Just relying on pills withouttesting, you risk masking early
cardiovascular disease, hormoneissues, liver problems, things
that really need proper medicalattention.
Mark (11:11):
So the practical advice here is pretty clear.
Rachel (11:13):
Yeah, I think so.
If you found yourself needingED meds more than just say a
handful of times, that's yourcue.
It's really time to get testedCheck your glucose control, your
liver function, your fulltestosterone panel, maybe even
inflammation markers.
Mark (11:27):
Which brings us perfectly to the big question what labs
should you actually run ifyou're experiencing ED?
Because we've established it'salmost never just skin deep.
Rachel (11:37):
Exactly.
Ed is so often that canary inthe coal mine signaling
something's off internally.
Before jumping to meds, beforeeven thinking about hormone
therapy, you absolutely have tounderstand what's happening
underneath.
Mark (11:49):
Get the data.
Rachel (11:49):
Get the data.
The right lab work helps youpinpoint if the root is
metabolic, hormonal, vascular,hepatic or, very often, a mix of
things.
That's the real power ofdiagnostics it tells you where
to focus.
Mark (12:02):
Okay, so break it down for us.
What are the core areas, thekey tests people should be
looking at?
Rachel (12:06):
All right, let's go through them.
Five core areas.
First, glucose and insulincontrol.
We've hit this hard, but it'scritical.
Poor glucose regulation, highfasting insulin, super common
root causes.
These tests catch insulinresistance 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-termpicture.
Definitely fasting insulin andmaybe calculate home AIR.
That's a score that shows howinsulin 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, justchecking, 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, butalso free testosterone, SHBG,
that protein that bindstestosterone, estradiol, E2,
DHEAS and sometimes, dependingon 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 inclearing estrogen.
If it's impaired, hormones getunbalanced, 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 thoseliver enzymes.
Also bilirubin and albumin cangive you a broader sense of
liver health.
Okay, area four Four is lipidsand inflammation.
This is all about vascularhealth, Endothelial function,
nitric oxide vital for erections.
These labs assesscardiovascular 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 keyinflammation marker.
Optionally, maybe homocysteineor 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 affecteverything Metabolism, libido,
even SHBG levels.
Even mild subclinicalhypothyroidism 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 ishow often men come in with ED.
Their total testosterone looksnormal on paper but when you run
these comprehensive panels,boom.
You see clear signs of insulinresistance or maybe high SHBG or
fatty liver markers thingsyou'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 yourhands.
Mark (14:39):
Okay, so let's wrap this up.
The big takeaway here seems tobe ED is fundamentally a
reflection of your overallhealth.
That's it For so many men.
It's that first reallynoticeable 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 rightover these root causes and goes
straight for the pills, whichmight 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 bigmystery.
It doesn't need a one size fitsall pill approach If you get
the right data from personalizedlabs you can take targeted
action.
Exactly Targeted, effectiveaction becomes possible.
You can actually work torestore sexual function and
maybe, more importantly, protectyour long term health.
(15:33):
It's about moving fromguesswork to actual results
based on what your body needs.
Mark (15:38):
That's a really hopeful message.
So, essentially, ed is oftenreversible, 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 thesymptom.
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 anduncover what's really going on
inside your body, the more poweryou have, the more options you
have to make a real difference.
This isn't just about erections.
It's about setting yourself upfor better health across the
board.
For the long haul.
It's about optimizing yourentire health trajectory your
(16:25):
entire health trajectory.
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