The Dr. Gabrielle Lyon Show

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

Find Dr. Gabrielle Lyon at:
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- Weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page
- Pre-order my new book – https://www.amazon.com/exec/obidos/ASIN/1668085623

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.

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.

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

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📺 Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:
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Website: https://bit.ly/3NdV2kT
Books: https://bit.ly/4r6ugZK
Newsletter: https://bit.ly/402QCAj

⏰Chapters
00:00 Men are dying earlier than women the penis is the check-engine light
03:26 Boys stop seeing doctors for 20 years the case for an Office of Men's Health
10:57 Princeton IV: ED predicts heart attacks, calcium scans, and Cialis
12:44 The ceramide blood test your cholesterol panel can't replace
20:37 Cardiac risk calculators, statins, and what your LDL should be
25:38 GLP-1s, fertility, and "what's the risk of doing nothing?"
29:05 Testosterone: the ~500 target, why 1,000 runs hot, what 2,000+ does to the heart
31:44 Check your testosterone at 25 and why steroids won't make you a pro
36:57 Tolerance and the new set point redlined men can't escape
38:13 The 1980s trial: lifting without steroids beat steroids without lifting
42:06 Steroid cocktails, arrhythmias, irreversible side effects, and the sarcopenia trade-off
53:04 Peyronie's disease and Viagra vs. Cialis
57:32 Penile implants: the knee-replacement analogy and the pills-to-surgery ladder
1:02:27 Sexual rehab after prostatectomy and the questions to ask before cancer treatment
1:07:55 Closing: be proactive and the patient who got stronger with zero testosterone

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.

You say "steroids" and picture a baseball scandal, a jacked guy, a bad spray tan. But cortisol is a steroid. Estrogen is a steroid. The cream you put on poison ivy is a steroid. The word covering all of them is also covering testosterone therapy for women, and that collision is quietly costing women muscle and bone they don't have to lose.
In this solo episode, prompted by a magazine interview on steroid use in women, Dr. Gabrielle Lyon breaks down what these molecules actually are, what they do inside a cell, and why the line between medicine and misuse has nothing to do with the word "steroid."

Study and References:
The Effects of Supraphysiologic Doses of Testosterone on Muscle Size and Strength in Normal Men (Bhasin et al., NEJM 1996) - https://pubmed.ncbi.nlm.nih.gov/8637535/
Testosterone Enhances Estradiol's Effects on Postmenopausal Bone Density and Sexuality (Davis et al., 1995) - https://pubmed.ncbi.nlm.nih.gov/7616872/
Global Consensus Position Statement on the Use of Testosterone Therapy for Women (2019) - https://pubmed.ncbi.nlm.nih.gov/31498...
ISSWSH Clinical Practice Guideline for the Use of Systemic Testosterone for HSDD in Women (2021) - https://pubmed.ncbi.nlm.nih.gov/33814...
The Global Epidemiology of Anabolic-Androgenic Steroid Use: A Meta-Analysis (Sagoe et al., 2014) - https://pubmed.ncbi.nlm.nih.gov/24582...
What Is the Prevalence of Anabolic-Androgenic Steroid Use Among Women? A Systematic Review (Piatkowski et al., Addiction, 2024) - https://onlinelibrary.wiley.com/doi/1... "
The Compounds for Females Are Really Commonly Faked!": Women's Challenges in Anabolic Steroid Acquisition (Piatkowski et al., Drug and Alcohol Review, 2024) - https://onlinelibrary.wiley.com/doi/1...

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Website: https://bit.ly/3NdV2kT
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Newsletter: https://bit.ly/402QCAj

📺 Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:
YouTube: https://bit.ly/4boCFC3
Spotify: https://bit.ly/4cWTbLG
⏰ Chapters:
00:00 - Beginning
01:25 - Introduction: The Sister Who Says "Oh My Gosh, You're Taking Steroids" Why Medicine Needs a Shared Vocabulary
03:43 - What a Steroid Actually Is: Four Rings of Carbon
04:49 - Anabolic vs. Androgenic: Same Receptor, Different Effects
06:16 - A Brief History: From Wasting Disease to the Weight Room
08:59 - Restoring vs. Exceeding: Why the Range Is the Whole Game
11:38 - The Davis Trial: Testosterone, Bone Density, and Lean Mass
13:38 - Oral Compounds, the Liver, and Why Conversion Matters
14:20 - What Gets Sold Isn't What's Labeled: The Australian Drug-Checking Data
15:31 - The 1.6% vs. 4% Myth: Reading the Prevalence Data Correctly
18:33 - Why GLP-1s Are Pushing Women Toward Androgens
20:26 - Permanent Effects: Voice Changes and What the Literature Shows
21:33 - The Four Questions to Ask Before Any Androgen Conversation
24:25 - Closing: Entering the Sarcopenia Era
‼️ Disclaimer: The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.

Most people assume becoming a parent is an emotional change, but a measurable part of it is hormonal, and it happens in fathers too. I sat down with Aldrich Chan, Psy.D., to talk about what changes in the brain, why the split we draw between mind and body does not hold up, and what decides whether stress reads as manageable or overwhelming when the hormones are identical either way.
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📱Connect with Aldrich Chan, Psy.D
Website: https://www.drchancnc.com/
YouTube: www.youtube.com/@draldrichan
Instagram: https://www.instagram.com/draldrichan
Facebook: https://www.facebook.com/draldrichan
LinkedIn: https://www.linkedin.com/in/draldrichan/
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📺Watch the “Dr. Gabrielle Lyon Show” every Tuesday at 9AM EST:
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📱Connect with Dr. Gabrielle Lyon:
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Books: https://bit.ly/4r6ugZK
Newsletter: https://bit.ly/402QCAj
⏰Timestamps:
00:00 - Introduction: what a neuropsychologist measures
03:25 - Mild cognitive impairment and proactive interference
04:52 - The SAD theory: separation, alienation, discord
06:30 - The default mode network and 46.9% mind wandering
08:56 - Reframing ADHD as an evolutionary advantage
18:21 - Evolutionary mismatch and hunter-gatherer comparisons
21:03 - Neuroplasticity, epigenetics, and the 24-hour timeline
24:29 - Mind-body dualism and the gut-brain connection
31:31 - What fatherhood does to the brain and testosterone
36:47 - Choice overload and the four-bit working memory limit
39:54 - Temporal discounting and building immediate feedback
43:23 - Vital signals and how to identify a core value
49:49 - Intuition, somatic markers, and the vmPFC
55:00 - The 20-watt brain versus a 10-gigawatt supercomputer
01:02:58 - Only 35% of the brain is built at birth
01:06:13 - Creativity, nothingness, and the fear of uncertainty
01:16:31 - Process, flow states, and the jazz pianist studies
01:22:53 - Mirror neurons, group selection, and the rat experiments
01:34:20 - Eustress and the line between moderate and major stress
01:44:39 - Alloparenting and what the Hadza numbers show
‼️Disclaimer: The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.
This episode includes paid sponsorships.

You might think bone density is something you build slowly over a lifetime, but nearly all of your peak bone mass is set before age 18, in a four-year window most parents never see coming. In this solo episode I break down what happens to a child's skeleton during that window, what GLP-1 medications do inside a body that's still growing, and the protocol I'd want every parent to follow. Muscle and bone are not what a body has they're what a body was built to become.
In this solo episode, Dr. Gabrielle Lyon breaks down the science of bone health in children, adolescent GLP-1 use, and muscle building in kids:
Why the four years around age 12 in girls and 14 in boys account for close to 40% of the total bone mineral a person will carry for life
Why a hip fracture in a healthy 29-year-old is almost always a story about a childhood building phase that never happened, often tied to a history of restriction like anorexia
What semaglutide and other GLP-1 medications do inside a still growing skeleton, and why no long term bone density data exists for adolescents on these drugs
Why a JAMA Network Open trial found the group combining liraglutide with resistance training lost the most weight with bone mineral density statistically unchanged, while the drug alone caused bone loss
The complete protocol for parents: track strength and function over the scale, muscle strengthening and bone loading exercise three days a week each, protein at breakfast, and a screen time floor instead of a ceiling

Muscle and bone are not what a body has; they are what a body was built to become, and childhood is the only window that bone accrual and muscle development happen. Understanding pediatric bone health, sarcopenia in children, and the real research on GLP-1s and adolescents is the difference between guessing with your child's skeleton and protecting it on purpose.
Study and References:
Sarcopenic Obesity in Children - https://pubmed.ncbi.nlm.nih.gov/41995008/
Sedentary Behaviors in Today's Youth (AHA) - https://www.ahajournals.org/doi/10.1161/CIR.0000000000000591
Semaglutide and Body Composition (STEP 1) - https://pmc.ncbi.nlm.nih.gov/articles/PMC8089287/
Peak Bone Mass Position Statement (NOF) - https://pubmed.ncbi.nlm.nih.gov/26856587/
Bone Health After Exercise vs GLP-1 Treatment - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820308
Resistance Training in Kids: An Umbrella Review - https://pubmed.ncbi.nlm.nih.gov/32757164/

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Explore More from Dr. Gabrielle Lyon
Premium Podcast Subscription: Ad-free episodes, key takeaway summaries, exclusive Q&A, and behind-the-scenes content https://foreverstrong.supercast.com
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Connect with Dr. Gabrielle Lyon:
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TikTok: https://www.tiktok.com/@drgabriellelyon
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Facebook: https://www.facebook.com/doctorgabriellelyon

Chapters
00:00 - Introduction
00:44 - The 29-Year-Old Who Fractured Her Hip
01:20 - Muscle and Bone Are Childhood Assets
03:01 - The Question I Keep Getting From Patients
03:39 - The 30-Year Lifting Debate Is Over
04:23 - Sarcopenic Obesity: More Muscle, Less Strength
07:01 - What a Mouse Model Reveals About Muscle Potential
08:24 - Screens: What the Data Shows
10:00 - Food, Sleep, and the Screen-Weight Loop
12:38 - GLP-1s in Teens: The STEP TEENS Trial
13:52 - The Muscle Framing Mistake Everyone Makes
16:49 - The Four-Year Window Bone Gets Built
18:02 - The Trial That Proves Exercise Protects Bone
20:29 - Prescribing Into an Unstudied Window
20:46 - Why Lifting Doesn't Stunt Growth
21:49 - Kids Get Stronger Without Building Muscle
22:29 - The Protocol: What to Do Starting Today
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Disclaimers: This episode includes paid sponsorships.
The Dr. Gabrielle Lyon Podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast, YouTube, or materials linked from this podcast or YouTube is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions.