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Healthy Habits, Healthy Erections: The I-75 of your Body – Part 2

Posted on by Akash Kapadia, MD in , ,

Man looking out with hands behind head, stretching

Are your lifestyle habits questionable? They could be impacting your ability to achieve an erection.

In part one, we illustrated the hormones associated with male sexual health and some of the underlying mechanics of performance. For part two, we wanted to stress that your choices in life will impact your health in surprising ways and that positive change is within reach.

This time of year, when motivation is naturally higher for many, is a useful entry point for affecting personal changes. Building new habits, breaking old ones, and sustaining them over time is rarely simple. Starting small, choosing goals that feel realistic, and identifying what actually motivates you tends to be far more effective than drastic overhauls that don’t last.

Perhaps knowing how better habits affect your sexual prowess will help!

Physical Activity and Hormones

Regular exercise directly influences the hormonal and vascular systems that make erections possible. Point blank. Movement affects how hormones are produced, how efficiently they signal, and how well blood vessels respond during sexual arousal. Low activity equals a multi-system internal slowdown, but when regular physical activity is reintroduced, those same systems often recover in parallel.

Exercise in general helps regulate testosterone, cortisol, insulin, and growth hormone. Aerobic activity improves cardiovascular efficiency and increases nitric oxide availability, a compound essential for relaxing smooth muscle and allowing blood to flow into the penis. Resistance training supports testosterone production, preserves lean muscle mass, and improves insulin sensitivity. Pelvic floor exercises strengthen the muscles directly responsible for erectile rigidity and ejaculatory control, reinforcing the physical mechanics of performance.

Physical activity also improves many of the underlying health conditions that commonly interfere with erectile function. Regular movement lowers blood pressure, stabilizes blood sugar, reduces abdominal fat, and dampens chronic inflammation.

So, what do we mean by “being active?” First of all, it doesn’t have to be extreme; in fact, it’s better if it’s not. (Overly strenuous exercise can be just as bad for you as no exercise.) You want to elevate and sustain the heart rate at a level where breathing is faster but still controlled. Brisk walking, cycling, swimming, rowing, or light jogging done consistently for 20 to 40 minutes should do the trick.

Strength training involves compound movements that recruit large muscle groups, like squats, deadlifts, lunges, push-ups, rows, and overhead presses. Engaging in this type of exercise two to three times per week stimulates testosterone signaling, preserves muscle mass, and improves insulin sensitivity.

Stretching is often overlooked, but it matters more than most men realize. Maintaining hip, lower back, and pelvic mobility supports nerve signaling, blood flow, and pelvic floor function, while also reducing injury risk and improving recovery between workouts in the gym and the bedroom.

If you have underlying health conditions that limit activity, be realistic – modify rather than intensify. Talk to a trainer as well as your doctor about which exercises are modest enough to keep you out of trouble but also intense enough to get what you want out of it. The point is to create a positive feedback loop: improved circulation and hormone balance support sexual performance, improved energy and confidence reinforce healthier habits, and the system begins to self-correct.

Diet and Hormones

The visible result of constant overindulgence is seen in your waistline, but what you don’t see right away is the influence of diet on hormones and blood vessels. Diet provides the raw materials for hormone production, determines how well those hormones signal, and correlates directly with vascular health.

An often misunderstood piece of this is cholesterol. Surprise! It’s a foundational building block from which testosterone and other steroid hormones are made. Diets that are overly restrictive, chronically low in calories, or devoid of healthy fats can blunt hormonal signaling and suppress output. But wait, aren’t we supposed to restrict dietary cholesterol?

The body produces most of its own cholesterol in the liver, and how much it makes varies from person to person based on genetics, activity level, and metabolic health. For some men, dietary cholesterol has very little effect on blood levels; for others, it can raise them more noticeably. The goal in managing cholesterol isn’t to eliminate it altogether, but to find ways to maintain levels that support bodily processes without compromising blood vessel health. This happens by having an open dialogue with your physician about lab trends, diet, and overall risk.

A healthy cardiovascular system (and sexual performance) depends on more than cholesterol levels. Arteries that can respond quickly, relax fully, and deliver blood efficiently make for a solid erection and the stamina to use it. A healthy diet influences this responsiveness through inflammation control, blood sugar regulation, and protection of the vascular lining.

Diets built around vegetables, fruits, whole grains, lean proteins, and unsaturated fats are what you want to aim for. Foods rich in antioxidants and natural nitrates help maintain nitric oxide availability, allowing penile arteries to dilate appropriately during arousal. Leafy greens, beets, and berries help blood vessels relax and improve circulation. Whole grains and legumes regulate blood sugar and cholesterol, protecting the arteries. Healthy fats from olive oil, nuts, avocados, and fatty fish support cardiovascular function and provide the building blocks for hormone production. Lean proteins help preserve muscle mass and metabolic health.

Diets that are high in refined carbohydrates, excess sugar, and unhealthy fats do the opposite: they promote inflammation, insulin resistance, and vascular stiffness that impair blood flow everywhere, including to the penis. Target sustainable eating habits that include indulgences now and then; this tends to improve mood, reduce stress, enhance quality of life, and support sexual wellbeing. Like exercise, dietary changes don’t have to be extreme to be effective, just consistent.

Specific nutrient supplements might also be beneficial, depending on your personal health history. Zinc is critical for testosterone synthesis and for the signaling pathway that tells the testes to produce it. Magnesium helps reduce inflammation and oxidative stress while improving the availability of free testosterone. Vitamin D functions more like a hormone than a vitamin, has receptors throughout the body (including penile tissue), and deficiencies are commonly associated with both low testosterone and erectile dysfunction.

Lifestyle Optimizes Treatments

Even the most advanced therapies perform better when the body isn’t fighting against chronic inflammation, vascular disease, or hormonal traffic jams. Testosterone replacement therapy (TRT), oral or injectable ED medications, vacuum devices, and even penile prostheses are all highly effective when deployed within a system that is actively supported by healthy habits. Regular exercise, balanced nutrition, and metabolic health improvements create the environment that allows these therapies to reach their full potential – the interventions can be life-changing, but you still have to do the work to keep the system fully operational.

Multiple “drivers” (hormones, nerve signals, blood vessels, raw building blocks, and psychological cues) are moving through your body simultaneously, and sexual function is rarely a single-lane issue. Your choices – how you move, what you eat, how you sleep, and how you manage stress – influence whether those drivers arrive efficiently at their destinations. When the highway is clear and the traffic flows smoothly, your body is positioned to perform at its best, in the bedroom and beyond.

Dr. Kapadia specializes in reproductive urology and sexual medicine, with extensive experience in male hormone therapies, fertility, and advanced erectile dysfunction treatments. His approach focuses on comprehensive evaluation, individualized treatment plans, and long-term outcomes.

For men experiencing changes in sexual performance or concerns about hormone health, a consultation with Dr. Kapadia provides guidance and solutions that address both the underlying system and the visible symptoms.

Hormone Networks and Your Erection: The I-75 of Your Body – Part 1

Posted on by Akash Kapadia, MD in ,

Man looking at smart watch after physical activity outdoors

Your body is running on a constant stream of information. Messages are sent, received, adjusted, and rerouted every second of every day, telling your body to breathe, eat, sleep, work, bathe, and yes, even have sex.

Hormones are the couriers of that system, the vehicles that get those messages across the body. They are a major part of the internal interstate that connects your brain, testes, adrenal glands, blood vessels, nerves, and tissues into a coordinated network. Just like I-75, there are downtown connectors and major interchanges along the way, some of which can become less than productive.

When you’re at the top of your game, and signals are flowing healthily, energy is steady, sleep is restorative, sex feels natural, muscles respond, and erections happen without negotiation. When one piece falters in this delicate system (signals are delayed, messages are distorted, or exits are missed altogether), a cascade can occur.

Predominant Hormones in Men’s Sexual Health

Erections are the result of precise coordination between hormones, blood flow, nerve signaling, and mental state. Testosterone, estrogen, cortisol, thyroid hormones, growth hormone, prolactin, and others alert various body systems of the intention to pursue sex and support the body’s ability to follow through.

These are some of the predominant male hormones involved with sexual health and what happens when their signals get scrambled.

Testosterone

Testosterone is the representative hormone of maleness. It’s fundamental for a healthy libido, sperm production, muscle mass, bone density, mood, and energy. Adequate testosterone helps prime the brain for sexual interest and supports the physical mechanisms required for erections.

When testosterone is too low, men may notice decreased sex drive, fewer spontaneous or morning erections, fatigue, loss of muscle, increased body fat, and mood changes. Excessively high testosterone (usually due to misaligned supplementation) can lead to acne, hair loss, mood changes, elevated blood pressure, and even increased cardiovascular risk.

Estrodial (Estrogen)

Yes, men have estrogen, and they need it. Estradiol is produced when testosterone is converted by an enzyme called aromatase. When balanced, estradiol supports libido, erectile function, sperm health, bone density, and mood.

High estradiol can contribute to low libido, erectile dysfunction, fatigue, breast tissue growth (gynecomastia), and mood changes. Low estradiol can cause bone loss, anxiety, and sexual dysfunction.

Elevated levels most commonly stem from increased conversion of testosterone to estrogen, which is frequently driven by obesity (fat tissue contains aromatase), aging, liver dysfunction, excessive alcohol use, and mismanaged testosterone supplementation. Low estradiol is usually seen alongside low testosterone or from over-suppression during hormone therapy, and can leave men feeling flat, fatigued, achy, and disconnected both physically and emotionally.

Prolactin

Prolactin levels are low in healthy men and non-pregnant women, as it’s usually associated with lactation. Made by the pituitary gland, prolactin mainly acts as a modulator in men by fine-tuning other systems; normal levels support male reproductive balance and proper signaling between the brain and testes. It fluctuates naturally throughout the day with stress, sleep, exercise, and orgasm, and appears to be involved with the neuroendocrine circuitry of ejaculation.¹

Too much prolactin interferes with the effects of testosterone, leading to low libido, erectile dysfunction, infertility, fatigue, and male breast enlargement. Certain medications (notably antidepressants, antipsychotics, and opioids), untreated hypothyroidism, chronic kidney or liver disease, and benign pituitary tumors called prolactinomas are common causes. Because prolactin is produced by the pituitary, persistently elevated levels are a red flag that warrants further evaluation rather than symptom-based treatment alone.

Cortisol

Most of us know cortisol as the “stress hormone.” In short bursts, it’s meant to be helpful – it sharpens focus, mobilizes energy, and gets the body ready to respond to immediate demands. It raises blood sugar, increases alertness, and temporarily suppresses non-essential functions so you can do what you need to do under duress.

However, when cortisol is chronically elevated, it becomes disruptive. It suppresses testosterone production, interferes with sleep, increases abdominal fat, and drains energy and libido. Men under constant stress from work, overtraining, or even untreated health conditions can experience a lag in the bedroom. High cortisol levels crowd the hormone highway and can make erections less reliable, desire dip, or both.

Thyroid Hormones

Thyroid hormones primarily regulate metabolism and energy. Both underactive and overactive thyroid states can mimic or worsen symptoms of low testosterone, including fatigue, mood changes, reduced libido, and erectile dysfunction.

Thyroid disorders disrupt the Hypothalamic-Pituitary-Gonadal (HPG) axis, which affects sex hormone levels. Thyroid hormones influence testicular tissue development and function, impacting sperm production and hormone release, and issues can affect the nerves and muscles essential for erection and ejaculation.

Symptoms of a thyroid disorder can appear subtle at first, and sometimes overlap with Low-T symptoms; when evaluations focus too narrowly on testosterone alone, other drivers can be missed. Correcting thyroid levels under an endocrinologist’s care typically resolves or improves these sexual dysfunctions. When additional support is needed, a urologist specializing in men’s health can help coordinate care and tailor treatment to restore sexual function.

SHBG (Sex hormone-binding globulin)

SHBG determines how much testosterone is actually available to your tissues.

High SHBG can leave you with “normal” total testosterone but low free testosterone: symptoms persist despite reassuring numbers on paper. That can seem confusing, so here’s an illustration to help explain how this works: SHGB binds to free testosterone, carrying it through the bloodstream and preventing it from being used immediately. Free testosterone is “free” to enter tissues, while SHBG-bound testosterone is largely inactive until released. Healthy SHBG levels maintain a balance between bound and free testosterone, ensuring there is enough to “go around.” If there is too much binding happening, tissues don’t get the testosterone they need.

Testosterone can look normal on lab results because most standard blood tests measure total testosterone, which includes both bound and free testosterone. If SHBG is high, total testosterone may appear within the normal range, but the fraction that is free and actually usable by the body is low.

Low SHGB levels do the opposite and allow for more free testosterone. On the surface, that can sound like a good thing. But even though there’s more available testosterone, it can be a marker for metabolic syndrome, a cluster of conditions that can include high blood pressure, elevated blood sugar, excess abdominal fat, and abnormal cholesterol levels. It also increases the risk of heart disease. Common causes of this kind of hormone shift include obesity and excess body fat, insulin resistance or diabetes, an underactive thyroid, excess androgen exposure (including testosterone therapy), and conditions such as Cushing’s disease.

DHEA (Dehydroepiandrosterone)

DHEA is a precursor hormone. Produced by the adrenal glands, DHEA also supports them, feeds into both testosterone and estrogen pathways, and acts in the central nervous system. Low levels are associated with fatigue, low libido, mood changes, and sexual dysfunction. DHEA levels drop in men primarily due to natural aging (a dip around 30), but they can also be reduced by adrenal gland issues (like Addison’s disease), pituitary dysfunction, severe stress or burnout, certain medications (like glucocorticoids), and other systemic illnesses that disrupt DHEA production.

High levels, often from unsupervised supplementation, can also cause problems and confuse the body’s natural hormone feedback loops, producing acne, oily skin, mood swings, hair loss, irritability, and gynecomastia.

Growth Hormone (GH)

Growth hormone has emerged in fitness and longevity circles for its perceived anti-aging, body-composition, and performance benefits. Its appeal is in its involvement in tissue repair, muscle recovery, fat metabolism, and overall vitality. Over-supplementation, however, can lead to joint pain, fluid retention, insulin resistance, abnormal facial or hand growth, and cardiovascular strain. Too much is also associated with certain cancers and can diminish athletic performance despite muscle growth.²

In adults, deficiencies can lead to fatigue, reduced muscle mass, increased abdominal fat, impaired exercise recovery, and reduced sexual interest. How does it become deficient? Usually from pituitary dysfunction, chronic poor sleep, untreated sleep apnea, head trauma, aging, or prior pituitary surgery or radiation.

GH works closely with other hormones, meaning disruptions here can ripple outward:

  • Testosterone availability: GH supports pituitary signaling that helps regulate testosterone production.
  • Energy and metabolism: GH interacts with thyroid hormones and insulin, and disruptions can lead to fatigue, altered blood sugar control, and reduced muscle performance.
  • Vascular health: GH promotes nitric oxide production and supports healthy blood flow. Trouble here can impair erections even if testosterone levels are adequate.
  • Body composition and fat distribution: GH works alongside cortisol and sex hormones to regulate fat and muscle mass. Interruptions in this network can shift fat to the abdomen, indirectly affecting testosterone-to-estrogen conversion and libido.

Every hormone has a specific job, but they also rely on one another to function. Sexual vitality is not governed by a single hormone; it’s regulated by a system. (And this is certainly not an exhaustive list of what’s at play.) Hence, changes in erections, libido, energy, or morning salutations aren’t just “performance issues.” Rather, they can be an indication of poorly regulated hormone traffic commonly caused by lifestyle interruptions and/or underlying health conditions.

Only 25% of men in the US who are prescribed treatment for Low-T undergo appropriate testing. I cannot stress enough how important it is to see the right doctor and undergo the right testing; other serious conditions can cause similar symptoms. Online clinics or pharmacies have their place and can seem convenient. But they can also overlook contributing factors such as sleep disorders, thyroid problems, adrenal dysfunction, medication interactions, or pituitary issues.

A full workup typically involves a detailed medical history, lab panels measuring total and free hormones, evaluation of thyroid, adrenal, and pituitary function, and sometimes imaging or specialized testing. Resulting therapies are targeted because they’re informed by your body’s unique chemical makeup.

Once you’ve been evaluated and discussed treatment options with Dr. Kapadia, it’s time to optimize your results. How, you might ask? Check out Part 2.

Dr. Kapadia is a distinguished member of a small, closely knit Reproductive Urology and Sexual Medicine community. He has published extensively in well-known medical journals and presented his research at both national and international meetings on male fertility and sexual medicine. His practice focuses on male fertility, sexual medicine, and hormone therapies, with an emphasis on personalized, system-wide care.

Resources:

  1. Valente, S., Marques, T., & Lima, S. Q. (2021). No evidence for prolactin’s involvement in the post-ejaculatory refractory period. Communications Biology, 4(10). https://doi.org/10.1038/s42003-020-01570-4.
  2. Australian Government Department of Health, Disability and Ageing Therapeutic Goods Administration. (2022, May 26). Too much of a good thing: the health risks of human growth hormone. Therapeutic Goods Administration (TGA). https://www.tga.gov.au/news/blog/too-much-good-thing-health-risks-human-growth-hormone.

 

A Vicious Cycle Undermining Men’s Health

Posted on by Akash Kapadia, MD in ,

Man sitting on park bench with legs crossed, smiling

Obesity, left unchecked, has the potential to outpace smoking as the leading preventable cause of death in the United States.¹ Obesity raises LDL (“bad”) cholesterol and triglycerides, lowers HDL (“good”) cholesterol, and interferes with how the body responds to insulin. Over time, this imbalance drives up blood sugar and inflammation, setting the stage for heart disease, stroke, diabetes, and other chronic illnesses.

But beyond the cardiovascular and metabolic impacts, excess weight can undermine one of men’s most defining hormones: testosterone. Obesity and low testosterone form a self-perpetuating loop that affects everything from energy and metabolism to fertility and confidence. The heavier a man becomes, the lower his testosterone tends to fall – and as testosterone drops, body fat accumulates even faster.

The better we understand this cycle, the more strategically we can intervene to restore hormone balance and improve men’s health.

Understanding Testosterone

Most of us think of testosterone as the ‘male hormone’ because it’s responsible for many of the traits that define male physiology: muscle mass, bone strength, body hair, and the deep voice that emerges at puberty. But it’s also a primary player in reproductive function, sperm production, libido, mood regulation, and even energy levels and metabolism. Simply put, it affects nearly every aspect of men’s physical and mental well-being.

Testosterone levels naturally rise during puberty, peak in early adulthood, and then remain relatively stable for years before gradually declining after 45. Most men retain adequate levels well into older age, but certain factors can accelerate this decline. Among the most significant is obesity. While aging contributes to a slow, predictable drop in testosterone, excess body fat, especially in the midsection, can push levels far lower, and much faster, than time alone. Studies show that waist circumference is an even stronger predictor of low testosterone than body mass index (BMI) – a four-inch increase in waist size can raise a man’s odds of having low testosterone by 75%.¹

One of the mechanisms by which obesity disrupts hormone balance is through aromatase activity. Fat tissue contains an enzyme called aromatase, which converts testosterone into estrogen. The more adipose tissue a man has, the more testosterone gets converted, tipping the hormonal scales and reducing the levels of this vital male hormone.²

Obesity also lowers levels of sex hormone-binding globulin (SHBG), the protein that carries testosterone through the bloodstream. With less SHBG, the amount of free, biologically active testosterone drops, even if total testosterone levels appear only modestly reduced.²

Obesity is also closely linked with hyperleptinemia, a state of elevated leptin levels. Leptin normally helps regulate appetite and energy balance, but chronic excess can cause leptin resistance. This resistance can suppress the hypothalamic-pituitary-gonadal (HPG) axis (the brain-to-testes signaling pathway that controls testosterone production) by inhibiting gonadotropin-releasing hormone (GnRH) and luteinizing hormone (LH) secretion. In other words, the brain’s commands to produce testosterone are dulled.²

Insulin resistance and chronic low-grade inflammation, both common in obesity, further impair the HPG axis and directly affect Leydig cells in the testes, which are responsible for testosterone production. The result is a functional, yet potentially reversible, hypogonadism called pseudo-hypogonadism: the testes are still capable of producing testosterone, but systemic factors prevent them from doing so effectively. Removing those factors helps with regaining functionality. Sustained weight loss, whether through diet, exercise, or medical interventions, can restore testosterone levels and help break this self-perpetuating cycle.²

Understanding Bidirectionality

Low levels of testosterone also turn the tables on adipose storage, creating a vicious cycle. Just as excess fat can lower testosterone, low testosterone levels can accelerate fat accumulation, particularly in the abdominal region, while reducing lean muscle mass. This combination worsens metabolic dysfunction, insulin resistance, and glucose intolerance, making weight management even more challenging.

Research also shows that low testosterone can impair mitochondrial function in muscle, reduce insulin sensitivity, and increase visceral fat storage, exacerbating the feedback loop that accelerates metabolic decline. Men with both obesity and low testosterone often show worsened glucose tolerance, higher waist-to-hip ratios, and more pronounced dyslipidemia than those with obesity alone.³

An offshoot of this interplay between obesity and testosterone is erectile dysfunction (ED), which is in itself affected by either on its own and compounded by their simultaneous presence; ED can be one of the first visible signs that something is off hormonally or metabolically.

Low testosterone is rarely the sole cause of erectile dysfunction (ED), but testosterone still has a huge impact on sexual desire, libido, and overall sexual function. While normal adult testosterone levels are not strictly required for erections, hypogonadism (the most common endocrine disorder linked to ED) can reduce sexual interest and responsiveness. ⁴

Obesity itself increases the risk of ED through several mechanisms. Excess abdominal fat contributes to vascular dysfunction, insulin resistance, and inflammation, all of which impair blood flow to the penis. Studies show that men with larger waist circumferences or higher BMI have significantly higher odds of developing ED, independent of age. ⁵

When low testosterone and obesity coexist, their effects on erectile function multiply. Reduced testosterone can dampen libido and sexual confidence, while obesity impairs the physiological ability to achieve and maintain an erection. Even moderate weight loss has been shown to reverse ED in many men, highlighting the interconnectedness of metabolic health, testosterone, and sexual function. ⁶

The bidirectionality of testosterone and increased body mass explains why traditional weight loss efforts alone may only partially restore testosterone levels, and why interventions that address both hormones and metabolism together (such as lifestyle modification combined with medical therapies) can be more effective in the long run. ⁶ Targeted strategies based on individualized health characteristics are the most effective way to truly break the cycle and restore men’s health.

Breaking the Cycle

Lifestyle modification is at the root of almost any ailment, whether or not medical intervention is involved. Restoration of hormone balance is no exception, as diet, exercise, and sustained weight loss can improve testosterone levels, reduce visceral fat, and even reverse erectile dysfunction in many men.

For men with confirmed hypogonadism, testosterone therapy (TTh) can amplify the benefits of lifestyle interventions:

  • Fat Reduction and Muscle Preservation: TTh reduces visceral fat and total body fat while preserving lean muscle mass, something diet and exercise alone often struggle to achieve. ⁷
  • Metabolic and Hormonal Effects: By increasing bioavailable testosterone, TTh can help mitigate some of the systemic suppression of the HPG axis commonly observed in obesity.
  • Motivation and Energy Rebound: TTh can improve energy, mood, and motivation, making it easier for men to adhere to diet and exercise programs. ⁸

Research consistently shows that pairing TTh with lifestyle modification produces the best results. For example, a 56-week randomized controlled trial in men with obesity and low testosterone found that those receiving TTh plus a very-low-calorie diet lost significantly more visceral fat, preserved lean muscle, and maintained weight loss better than those only refining their diets. ⁸ Targeting both simultaneously interrupts the self-perpetuating cycle more effectively than addressing either condition alone.

Regaining Control

With targeted interventions, men can restore hormone balance, reduce body fat, preserve muscle, and improve both metabolic and sexual health. To know if your weight puts you at risk for testosterone deficiency or related health issues, calculating your BMI, measuring waist circumference, getting precise assessments, and discussing testosterone levels with a healthcare provider are practical first steps.

For men with obesity and low testosterone, combining lifestyle changes with medical therapies like testosterone replacement offers the greatest potential to interrupt the effects that they have on each other. Even modest weight loss, when paired with targeted hormonal support, can help restore vitality, enhance sexual function, and lay the groundwork for long-term health.

Dr. Kapadia helps men address hormone imbalances, metabolic roadblocks, and lifestyle factors to help them regain control over their health, energy, and confidence. Schedule a consultation so you can start seeing everyday improvements in your sexual wellness, vitality, and stamina.

Note: TTh is not recommended for men without symptomatic hypogonadism, and potential risks, including fertility issues and sleep apnea, must be considered. Speak with a qualified health practitioner before beginning hormone therapy or engaging in new lifestyle modifications, especially if you have underlying health conditions.

Resources:

  1. Harvard Health Publishing. (2011, March 1). Obesity: Unhealthy and unmanly. Harvard Health; Harvard Health Publishing | Harvard Medical School. https://www.health.harvard.edu/mens-health/obesity-unhealthy-and-unmanly.
  2. Varnum, A. A., Pozzi, E., Deebel, N. A., Evans, A., Eid, N., Sadeghi-Nejad, H., & Ramasamy, R. (2023). Impact of GLP-1 Agonists on Male Reproductive Health—A Narrative Review. Medicina, 60(1). https://doi.org/10.3390/medicina60010050.
  3. Caliber, M., & Saad, F. (2020). Testosterone Therapy for Prevention and Treatment of Obesity in Men. Androgens: Clinical Research and Therapeutics, 1(1). https://doi.org/10.1089/andro.2020.0010.
  4. Rajfer J. (2000). Relationship between testosterone and erectile dysfunction. Reviews in urology, 2(2), 122–128. PMID: 16985751.
  5. Harvard Health Publishing. (2011, March 1). Obesity: Unhealthy and unmanly. Harvard Health; Harvard Health Publishing | Harvard Medical School. https://www.health.harvard.edu/mens-health/obesity-unhealthy-and-unmanly.
  6. Caliber, M., & Saad, F. (2020). Testosterone Therapy for Prevention and Treatment of Obesity in Men. Androgens: Clinical Research and Therapeutics, 1(1). https://doi.org/10.1089/andro.2020.0010.
  7. Kelly, D. M., & Jones, T. H. (2015). Testosterone and obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(7), 581–606. https://doi.org/10.1111/obr.12282.
  8. Caliber, M., & Saad, F. (2020). Testosterone Therapy for Prevention and Treatment of Obesity in Men. Androgens: Clinical Research and Therapeutics, 1(1). https://doi.org/10.1089/andro.2020.0010.

Online Pharmacies vs. Brick-and-Mortar Urologists: What’s Really the Better Route for Men’s Health?

Posted on by Akash Kapadia, MD in ,

Man looking at online pharmacy screen on phone

In recent years, online pharmacies and telehealth platforms have become an increasingly common way for patients to access medications and medical advice. With just a few clicks, you can order prescriptions, connect with a provider virtually, and have medications shipped directly to your door. For busy patients or those living in rural areas, the convenience is undeniable.

At the same time, the question naturally surfaces: Are online medical platforms as safe and effective as visiting my doctor and picking up a prescription from the local pharmacy?

Both approaches have their place. Online pharmacies offer discretion, privacy, and quick access to treatment, especially when it comes to sensitive issues like erectile dysfunction or urinary problems. And yet, as appealing as online platforms are, they can never fully replace the depth of care that comes from an in-person visit.

Let’s explore the pros and cons of both approaches and where each may (or may not) fit into your healthcare decisions.

The Appeal of Online Pharmacies

It’s easy to see why online pharmacies have carved out such a strong niche – there’s no denying the convenience factor. Online platforms allow you to:

  • Access care from anywhere: Whether you live hours from the nearest clinic or simply prefer the comfort of your home, telehealth and online prescribing can make treatment more accessible.
  • Save time: No waiting rooms, no pharmacy lines, and medications can often be discreetly shipped within days.
  • Avoid face-to-face interactions: For sensitive conditions like erectile dysfunction or urinary issues, many patients appreciate the discretion of talking to a healthcare provider over the phone or online chat, along with the ability to order through a website.
  • Potentially lower cost: Some platforms offer competitive pricing, bulk discounts, or subscription models that can sometimes be easier on the wallet.
    For straightforward, low-risk prescriptions, online pharmacies can be a safe and practical option. For example, medication refills for patients who are already stable on a regimen may be well-suited to online ordering.

The Risks of Skipping In-Person Care

While the advantages are real, there are equally important drawbacks to relying solely on online pharmacies or telehealth platforms for sexual and urologic health.

An online questionnaire is not as thorough as an in-person exam, and can result in missed diagnoses. Urologic symptoms like urinary frequency, blood in the urine, or erectile dysfunction may seem straightforward, but can sometimes point to more serious conditions.

Even though a provider may review them, online intakes can’t pick up on the subtleties of your health or replace a physical exam, lab testing, and imaging when needed. On that note, many online pharmacies are often run by mid-level providers with minimal to no supervision. To make things worse, the supervising physician might not even be a urologist.

A strong, ongoing relationship with a physician allows for nuanced care – your physician keeps track of your health history, test results, and past treatments, weaving them together into a bigger picture. Online encounters, by contrast, can feel transactional and limit the patient-provider relationship, with different providers, different systems, less opportunity to ask questions, and no one connecting the dots. Online platforms like Hims or Ro are more like one-trick ponies and aren’t capable of offering the comprehensive treatments a specialized provider like a urologist can.

When you encounter different providers online or switch platforms, important aspects of your medical history may be lost, which can disrupt the continuity of care necessary for long-term outcomes.

There are also medication safety concerns. While some online platforms are reputable, others operate in a gray zone. The U.S. Food and Drug Administration (FDA) has repeatedly warned about unlicensed or foreign-based sites selling counterfeit drugs, contaminated pills, or incorrect doses.¹ Even when the medication is legitimate, the oversight and follow-up are often limited compared to what you’d get with your doctor and a trusted local pharmacist.

Reputable online pharmacies do exist, but distinguishing them from fraudulent ones can be difficult for patients.

The Value of In-Person Care

In-person care is still the cornerstone of good medical practice. A doctor who sees you face-to-face can perform a comprehensive evaluation, catch early warning signs that can be easily missed in a telehealth setting, provide a nuanced interpretation of symptoms, and coordinate with specialists or labs when needed. There’s also reassurance in knowing that your medications are being dispensed by a licensed pharmacy, staffed by pharmacists trained to double-check prescriptions for safety, side effects, and interactions.

Because of the live interaction, in-person doctors and pharmacies can help safeguard your health – you get a team that knows you, your history, and your goals.

When Online Pharmacies Can Work Well

It’s not a question of “all good” or “all bad.” Online pharmacies have their place, and they can work well in the right situations. A reputable online platform can be effective when:

  • You need a refill for a stable, ongoing prescription.
  • You live far from medical care and need interim access to medication.
  • Common conditions are managed under the supervision of an established and qualified healthcare provider.

Patients who choose online platforms should verify legitimacy, ensure the site requires a valid prescription, and avoid offers that sound too good to be true (like extremely low prices or “no prescription needed”). Use platforms that are U.S.-based, licensed, and verifiable through the FDA or the National Association of Boards of Pharmacy (NABP).

A good online pharmacy should always require a valid prescription, provide a physical U.S. address and phone number, and have licensed pharmacists available to answer your questions. If a site skips those steps or promises miracle deals, it’s a sign to steer clear.

A Balanced Approach

The future of medicine is not either/or. You don’t have to choose between technology and tradition. The wiser move is to explore your pathways to better health based on your medical history and the specific condition for which you’re seeking help.

Online pharmacies and telehealth services will continue to expand access to care, and for certain scenarios, that’s a positive thing. But they should complement, not replace, the personalized care of an in-person physician. Better treatment outcomes often happen when patients utilize technology as a tool, while relying on brick-and-mortar doctors and pharmacies as the foundation of their healthcare.

If you’re considering online options, do so thoughtfully. Research licensed, verifiable platforms and use them for convenience, not comprehensive care.

Keep your doctor in the loop, and never ignore new or concerning symptoms. Online convenience should never delay a needed diagnosis or exam. And whether you order online or locally, make sure your provider is aware of all the prescriptions you’re taking.

There are no shortcuts in healthcare – a trusted doctor and pharmacist know you, your history, and your health goals in ways an online questionnaire never can. Only a physical exam, lab work, or imaging can rule out serious underlying conditions. In these cases, online convenience isn’t just inadequate – it can be unsafe.

As a fellowship-trained urologist specializing in male fertility & men’s health, Dr. Kapadia’s greatest passion is helping men restore confidence in their sexual and urologic health. If you are unsure where to turn, reach out to our office to schedule a confidential consultation. Symptoms such as blood in your urine, new or worsening pain, sudden changes in urination, new-onset erectile dysfunction, or anything out of the norm demand an in-person evaluation.

Reference:

  1. U.S. Food and Drug Administration. (2025, June 20). Internet Pharmacy Warning Letters. FDA. https://www.fda.gov/drugs/drug-supply-chain-integrity/internet-pharmacy-warning-letters.