Erectile Dysfunction, Low Testosterone & Fertility Explained

Sexual health is one of the most searched—but least talked about—topics online. In this episode of Baptist Health Talk, we’re breaking the silence.

Dr. Anthony Gonzalez sits down with Dr. Justin Dubin, Director of Men’s Sexual Health at Baptist Health Miami Cancer Institute, to answer the questions many men are too embarrassed to ask—from erectile dysfunction and testosterone to fertility and the impact of lifestyle choices.

Learn how sexual health connects to overall health, why symptoms like low libido and ED may be early warning signs, and when it’s time to stop Googling and see a doctor.

Whether you're concerned about performance, hormones, or starting a family, this conversation delivers real answers backed by medical expertise.

🔔 Subscribe for more expert health insights from Baptist Health South Florida.

Host:
Anthony Gonzalez, M.D.
Chief of Surgery, Baptist Health Baptist Hospital
Medical Director of Bariatric Surgery, Baptist Health

Guest:
Justin Dubin, M.D.
Director of Men’s Sexual Health
Baptist Health Miami Cancer Institute

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Transcript

SPEAKER_01 0:00

So, erectile dysfunction is the most common sexual dysfunction in men. Uh, about 50% of men on earth, when they're living, will deal with it at some point in their lives.

SPEAKER_00 0:11

Welcome to Baptist Health Talk, a podcast on all things healthcare powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness.

SPEAKER_02 0:21

Hello, everyone. I'm your host, Dr. Anthony Gonzalez. Welcome back to a new episode of Baptist Health Talk, where we answer your most search questions on trending health topics. Today we're talking about the quiet internet searches nobody likes to admit to, sexual health, from performance and fertility to hormones and the truth behind common myths. We're bringing real answers to questions so many people are asking, but rarely saying it out loud. Today, we're joined by Dr. Justin Dubin, Director of Men's Sexual Health at Baptist Health Miami Cancer Institute. Thank you for being here.

SPEAKER_01 1:06

Thank you so much for having me. I'm so excited to be here and talk about this heavy stigmatized topic that we need to get more guys talking about today.

SPEAKER_02 1:14

Sexual health. That's what we're talking about. Absolutely. Sexual health isn't just about sex itself, isn't it?

SPEAKER_01 1:20

Oh no. So this idea of sexual health just being about sex is completely incorrect. Uh what we do know is that sexual health really is a window into your overall health. Uh, there's so many components going good into a good sex life: bio, psycho, social, emotional, physical. And really, there's actually something that we've started to look at called your sex span. Now, your sex span is actually the time in your life that you either you desire and are able to engage in sexual activity. And that has actually been shown to be linked very closely to your total health span. Why? Because any issue that comes up with your sexual health is often a warning sign of something else going on with your health. And so we really need to take a quick, uh, better look at men's sexual health and really help it be the main guiding light uh for men to go see a doctor, which we're already not doing.

SPEAKER_02 2:25

Yeah, of course, nobody wants to talk about it. So you deal with men's health, uh sexual health, and day in and day out. For the average guy, it can be really, really tough and a lonely topic uh to be really uh talking about. What kinds of real life men's health conversations are you hoping to normalize through this?

SPEAKER_01 2:44

So I think one idea that I continuously see in men's health, uh, I've coined it as this, the IKEA problem. Uh it's used to be we're a little bit older, we used to not use Google Maps, it was, you know, MapQuest problem or the maps directions problem. But, you know, so I I've modified it. But what guys typically like to do is uh they like to fix things themselves. They like to man up and and be the guy for their family, be the leader, and really just try to fix a problem themselves. So instead of going to see a doctor and asking questions that they need to ask, they go online and they try to fix the problem. And that's kind of like IKEA. I'm going to IKEA, you go to IKEA, I buy a piece of furniture. I'm not looking at the instructions to build this thing. I'm gonna figure it out by myself. It may take me three hours instead of taking an hour, and one leg is a little bit wonky, and then my partner comes in the room and says, What are you doing? Go follow the instructions. I go back, do the same thing, and it works out fine. And that's what guys are doing with their health, especially their sexual health. They're trying to take it on their own and they're not really able to. And instead, they're wasting their time online, buying products, doing things that at best delay their time to seeing a doctor. At worst, they're actually paying a lot of money for something that doesn't work or harming their health. And so I think what we're dealing with a lot of guys is that we need to really change the shift in their brains, showing that, you know, trying to fix something yourself isn't really the way to be a man, right? You want to be there for your family, you want to be the best partner, you want to be the best father, you want to be the best friend, you want to be the best coworker. And in order to do that, you have to be the best version of yourself.

SPEAKER_02 4:33

Yeah, asking for help sometimes is not easy.

SPEAKER_01 4:35

Exactly. And we need to shift this idea that, you know, to be the best version of yourself, you need to get the help that you need. And that starts with going to see a doctor and talking about the problems that you have. And hopefully, I mean, people are doing it, but a lot of the times the truth is their sexual health, which are the things they identify as being a man and being the most masculine, are the things that are going to drive them to the to the doctor more than other things like blood pressure or diabetes. But those things all impact your sexual health.

SPEAKER_02 5:09

So let's talk about one of the problems that they're always uh, obviously, somebody would come to you with erectile dysfunction, E. D. What are the most common issues men face? What should our listeners know? When is it really the time to see a doctor?

SPEAKER_01 5:23

So erectile dysfunction is the most common sexual dysfunction in men. Uh, about 50% of men on earth, when they're living, will deal with it at some point in their lives. I would argue it's even higher, right? So, how common is it? 40% of men in their 40s, 50% in their 50s, 60% in their 60s, 70% in their 70s, you get the idea there. And so your erection is actually a really good surrogate for your health. We're talking about sexual health. And the way I like to describe it is you need five things to get a good erection. And if any of these things go wrong, it could be a sign of uh it could be a problem with your health, right? So, one, you need good blood flow to your penis. What causes issues with that? Smoking, vaping, heart disease. You and I both know that erectile dysfunction is considered a canary in a coal mine, meaning that it is an early warning sign for a heart attack or stroke risk in the future. Number two, you need good nerves. Now, things can compromise your nerves like surgery. You know, I'm a urologist. I see a lot of men who struggle with prostate cancer after radiation or surgery. Um, but the other thing that people forget is diabetes, which you have a lot of patients who struggle with. And, you know, we think about the nerves in our hands and our feet when it comes to diabetes, but oftentimes the first thing to go is our erections. Number three, you need good testosterone levels. And that's something that you see all over the news now. Everyone on social media is talking about it. So a lot of people are starting to investigate that one more than they previously were. But testosterone, low testosterone is associated with obesity, as you know, uh, diabetes, uh, cancer diagnosis, uh, uh other health issues, chronic inflammation issues, autoimmune diseases. So there's a lot of things that can be causing your low testosterone that people are not addressing. Number four is you need to be aroused. And this is that biopsychosocial component. Uh, I see a lot of guys and I ask them how their relationship is with their partner. And if it's not good, you're probably not going to be able to have a good performance.

SPEAKER_02 7:32

So definitely psychological as well.

SPEAKER_01 7:34

Absolutely. You know, I send so many people to therapists, sex therapists, and that's such an important component that we always have to address. And the last one is you need to be in a good state of mind, stress, anxiety, depression. Uh, unfortunately, some of the medications that treat those things can also cause erectile dysfunction. To quote the late great Robin Williams, he said God gave man a brain and a penis and only enough blood to control one at a time. And he's absolutely correct.

SPEAKER_02 8:04

All right. So I saw your numbers. As you get older, it gets more prevalent. Yes. What about younger patients? Are you seeing this type of ED problem in younger patients?

SPEAKER_01 8:14

Unfortunately, we are. We we did a study, we surveyed men under the age of 40 uh about erectile dysfunction. We gave them a validated survey to see if they had erectile dysfunction, and about over 50% of them actually surprisingly did. Around 50% and over 50% of them had used erectile dysfunction medications in the past. And we are seeing an increase in erectile dysfunction in younger men. And the question becomes why? Well, I think as a society, you you can also go and ask the same question about why we're talking about low testosterone. I think as a society, we're unfortunately never been more sedentary, we're eating less healthy, we have very high stress, anxiety levels. Um, and all of these things impact our sexual health because they impact our overall health. And if we can put these two things together and show men that our health is being impact is impacting our sexual health, I think we can get more guys going see the doctor.

SPEAKER_02 9:15

Wow. All right, so another topic, fertility. Obviously, you need an erection to become fertile unless, you know, you use some alternative measures, but fertility is especially for men trying to start a family, because when people hear about fertility, they almost think about only women. I learned, of course, that it's not the case as a physician. So, how often are men really in that part of that picture of fertility and what drives male infertility?

SPEAKER_01 9:39

So, this is a really, really important concept. As we've seen on the news, as we've seen on social media, fertility is one of the really hot topics of our time, where we're seeing fertility rates decline in in couples. And I think that you have to understand the numbers in order to really understand what we're we're dealing with here in terms of male infertility. So, with any couple that comes in and struggling for infertility, which by definition is about a year of trying with unprotected sex, um, six months if the female partner is uh above the age of 36 or 35, uh 50% of the time, 50% of the time, a male factor is involved. 30% of the time, it is strictly a male factor alone. So the fact that men are not getting worked up is unacceptable. We are in a place with fertility, where women are unfairly taking on the burden of fertility. And here's the thing, and this is very simple. If you want to be a good partner, just go get tested. Your partner's getting worked up. There's no reason that you should get worked up because the truth is your workup is a lot easier and you might be making a difference. Your best ability as a man is availability.

SPEAKER_02 11:05

Well, you mentioned it's one of the five uh factors for uh for an erection is testosterone. So, and of course, testosterone has to play into fertility as well. So, what about low testosterone and fertility?

SPEAKER_01 11:17

Absolutely. So, low testosterone is absolutely associated with fertility because where is testosterone and sperm made? In your testicles. And so a low testosterone is a signal that you're not your testicles are not functioning as they should. And so what we're doing is we're we're investigating reasons why your testosterone is low. Often that just because you have low testosterone, does that mean you have low sperm count? Not necessarily. But have I seen guys who have low testosterone and a low sperm count, and we fix one and the other one gets better? Absolutely. So, once again, your fertility, your sexual health, these are markers and a window into your overall health. And by linking these two and understanding their significance and how your health is impacting your fertility, your testosterone levels, I think that we can really focus on how to live a better, healthier, and hopefully satisfying life. You know, whether your goal is having a kid, whether your goal is having a better sex life, we can do it as long as we're addressing your health issues.

SPEAKER_02 12:22

I wonder how many physicians are really asking that, right? They ask you, have you having chest pain? Are you having pain in your abdomen? Anything bothering you in your regular checkup? But do physicians ask about libido, right? That's another topic. How can low testosterone affect uh somebody's libido? How can it affect their mood, their energy, their weight? Um, is that more than what people realize?

SPEAKER_01 12:43

Oh, absolutely. So actually, low testosterone, what are the signs and symptoms of low testosterone? Well, the number one sign, meaning this the most sensitive, as we like to say, the biggest sign that you have low testosterone is actually having a low libido, a low sex drive. Um, the other signs and symptoms, low energy, weight gain, breast development, body hair loss, not head hair loss, because then we would all have low testosterone, but um, also erectile dysfunction, osteoporosis, osteopenia, which is bone health issues, muscle loss, uh depression, lack of focus issues. Um, these are all things that are pretty generalizable, could be other things, but when we talk about the biggest sign for low testosterone, it's often uh your your low libido. So that is a very important marker. Um, and you're right. If it's something that you're struggling with, you should bring it up to your doctor because even if they may not be able to do the test or do the workup or provide you with the care, they're going to be able to point you in the direction of someone who can, someone like me or some other urologist.

SPEAKER_02 13:53

All right, you talked about online searches and people delaying their care. So online searches for some men have come across testosterone therapy. How would you know if testosterone therapy is for them? And how would they start that conversation?

SPEAKER_01 14:07

So you have to be careful anytime you're online, right? So we did a study, we looked at TikTok and Instagram and the top searched men's health topics. And to be to cut it short and make it summarized quite easily, all the information is terrible, okay? Most of it is not given by healthcare providers of any kind. Um, and so you're getting bad information. But how do you find good information, right? Well, the first thing is asking who's giving me this information. Is it a professional? Is it a doctor? Is it a nurse? Is it a nurse practitioner? What is their reason to do it is? Are they selling me something? Are they just educating me? Are they telling me to download some kind of link or use some link for a discount code? Um, and then what's my plans with this, right? Anyone who goes online, I always encourage people to do their own research, as I'm sure you do. But the qu the point is, before you do anything, before you purchase anything, before you put something in your body, you should always have a second resource. And that should be your doctor. Okay. And I I have never met a doctor who has been like, please don't tell me about some medication that you're going to want to buy online. Please tell us. Please tell us. And and I think that really who's a good candidate for testosterone, it goes to our guidelines, right? A urology guidelines means you have to have two things in order to be a good can't a good candidate for low testosterone. One, you have to have signs and symptoms of low testosterone that we've discussed. And two, you have to have a low testosterone. Now, we as the AUA, the American Urology Association, our cutoff is 300 total testosterone. Does that mean that everyone at 300, no, right? We have to individualize care and individualize care, these guidelines are guides, they're not law. So, you know, having a conversation with your doctor, having a conversation about why you want to do these things, having a conversation about the risks and benefits of their use is incredibly important before you just start taking a medication.

SPEAKER_02 16:10

All right, another online search besides testosterone therapy, GLP1s. Yes. Huge. Obviously, you know, obesity more prominent and more of a problem in women and more treated in women. Obviously, I know as a bariatric surgeon, but are GLP1 treatment and medication in men? Is that helping men, hurting men, fertility, sexual health?

SPEAKER_01 16:30

So GLP1s, as you know, you know more than most, have been an incredible, uh, incredible tool in the armament of obesity. And now we're starting to see its benefits in outside of the weight loss environment when it comes to heart disease, chronic kidney disease. Um, and when it comes to sexual health, we're actually starting to believe that there are some benefits as well. We're seeing, I have already told you that having obesity or struggling with obesity is a risk factor for low testosterone, which is also means it's probably a risk factor for low sperm count. And there's some preliminary data suggesting that going on GLP1s can absolutely increase your testosterone levels and it can potentially improve your sperm count. So these are real things that is it's it's a really microcosm for this bigger picture that we've already talked about, how improving your overall health can improve your sexual health and it can improve your fertility. So I'm very excited to see where GLP1s will be in the men's health space, even in the next year or two years, because I I think they're going to be a game changer potentially for a lot of people.

SPEAKER_02 17:39

So it's obviously completely opposite of what people are saying on the internet that you know these GLP one medications can decrease your testosterone and decrease your sperm count.

SPEAKER_01 17:48

There is there's no data suggesting that. Um, I will say there is a little bit of data suggesting maybe it can decrease your sex drive a little bit. And that makes sense, right? Because it decreases your desire for for food and it may also decrease your desire for the other things as well. Reward center in the brain. So it's it's still being investigated, but that has been a that's been a conversation uh amongst physicians.

SPEAKER_02 18:18

All right. So if somebody's listening and feels embarrassed or unsure about their sexual health, about hormones or fertility, what's the one thing you want them to know before they start panicking and searching that internet at two in the morning?

SPEAKER_01 18:33

So I think the biggest thing is if you're searching the internet at two in the morning, you might as well wake up early and just make a phone call to go see a doctor. Because the truth is that less than 50% of men under the age of 40 are seeing a doctor on an annual basis. And that is going to be the real key to improving your health and addressing the problems that you may have. Because at the end of the day, we can talk here all we want and you can read online all you want. But if you're not in the room, if you're not getting the care you need and talking to a doctor, you're not gonna get the help you need. And that may be very hard for a lot of guys to do. I know it's hard to find the time. It's hard to, you know, take your time away from your family, your kids, your work. But but you have to realize you're investing in yourself, you're investing in them, and you're investing in your future together down the line.

SPEAKER_02 19:31

You got to take care of yourself first before you can take care of your family. Absolutely. Well, this has been a great conversation. Thank you for being here and for sharing your insight with our audience. Remember, viewers, be sure to hit that subscribe button on our channel here to keep up with the latest health topics and wellness information and tips from our experts. Thanks for watching.

SPEAKER_00 19:52

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