Dhru Purohit Show
Struggling with Low Libido? Your Blood Sugar Could Be to Blame. Top Tips for Boosting Libido with Sex and Metabolic Experts
Mon, 14 Apr 2025
This episode is brought to you by Levels and Maui Nui. When most people think about metabolic health, they think of weight management and steady energy. But here’s what often gets overlooked: metabolic health also plays a major role in sexual function and fertility. Our hormones depend on a delicate balance—and when blood sugar spikes and crashes, that balance gets thrown off. The result? Not just weight gain, mood swings, and fatigue, but also a higher risk of erectile dysfunction, infertility, reduced sexual pleasure, and more. Today on The Dhru Purohit Show, we’re bringing you a special compilation episode featuring Dhru’s conversations with experts on how sexual health can reflect your overall metabolic health. Dr. Casey Means explains that blood flow, hormones, and psychology are the three pillars of good sexual function. She shares how diet impacts all three through a hormonal cascade, along with effects on nitric oxide and neurotransmitter production. Dr. Rena Malik dives into the importance of a healthy sex life and the common challenges men and women face—from low libido and hormone imbalances to lifestyle factors that get in the way. She breaks down the science behind sexual health, including the roles of diet, exercise, and orgasms, and unpacks the key roadblocks that can prevent us from experiencing a truly fulfilling sex life. Dr. Casey Means is a Stanford-trained physician, Co-founder of the metabolic health company Levels, and author of Good Energy. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tools that foster a deep understanding of their bodies and support personalized, sustainable dietary and lifestyle choices. Dr. Rena Malik is a board-certified urologist with a talent for dispelling medical misinformation, discussing intimate topics, and evidence-based discussions of taboo topics. Dr. Malik is also a prominent reconstructive urologist treating bladder conditions, sexual dysfunction, pelvic pain, and hormone management. In this episode, Dhru and his guests dive into: Paying attention to your sexual and overall health (1:37) The link between sex drive and metabolic function (5:49) Three key ways metabolic and sexual health are connected (8:41) Habits that restrict blood flow and negatively impact sex drive (14:21) The alarming rate of fertility decline (18:50) How metabolic health affects egg quality, sperm quality, and hormone balance (22:11) The connection between sex, longevity, and a healthy lifespan (33:09) How exercise boosts internal motivation and physical desire for sex (36:14) The effects of a sedentary lifestyle on libido and sexual health (33:11) Top factors interfering with a pleasurable sex life (37:39) Hormonal and menopause-related challenges—and potential solutions (44:14) Hormone therapy and its benefits for women’s libido (49:25) Physical factors that can prevent enjoyment of sex (51:23) Final thoughts (55:14) Also mentioned: Full episode with Dr. Casey Means Full episode with Dr. Rena Malik 3 Ways metabolic health affects sexual function This episode is brought to you by Levels and Maui Nui. Right now, Levels is offering my listeners an additional 2 FREE months of the Levels annual Membership when you use my link: levels.link/DHRU. Make moves on your metabolic health with Levels today. Right now Maui Nui Venison is offering my listeners a limited collection of my favorite cuts and products. Just go to mauinuivenison.com/dhru to secure your access now —but hurry, supply is limited! Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What is the connection between sexual health and metabolic health?
You might not immediately think that these things are connected, but the truth is your sexual function, fertility, and even your desire for intimacy can all provide insights into many other areas of your overall health. So in today's compilation episode,
I'm sharing portions of my conversations with Dr. Casey Means all about the ways that metabolic health can impact your sexual health and sexual function. Dr. Means is a Stanford-trained physician, one of the founders of the metabolic health company Levels, and of course, the author of one of my favorite books, Good Energy.
She's also an associate editor of the International Journal of Disease Reversal and Prevention and a lecturer at Stanford University. And in addition to Dr. Means, we also speak with board-certified urologist and prominent reconstructive urologist, Dr. Reena Malik, all about the role that hormone imbalances play in sexual desire, function, and much more.
But first, let's listen into my conversation with Dr. Casey Means. you had shared that if you care about your long-term health, if you care about your being in your optimal health, you want to pay attention to your sexual health. Let's talk about that. I think we got a lot of people who perked up all of a sudden. They're very interested in this topic.
Chapter 2: How does blood sugar affect libido?
What do you mean by paying attention to our sexual health and how that's connected to our optimal health?
This is a fascinating link that I've been discovering as I've dived deep into the metabolic health world. And what we've really come to realize is that if you care about sexual function, fertility, and even sexual pleasure, then you really need to be thinking about metabolic health and metabolic optimization. The link now is extremely clear and we don't really talk about it.
And it makes sense because metabolism is fundamentally how we produce energy in every cell of our body. And sexual function and fertility are incredibly complex very well-orchestrated events in the body that involve so many things. They involve neurologic factors, vascular factors, psychological factors, and hormonal factors just to get things right when you're thinking about sex or fertility.
Chapter 3: What are the key factors influencing sexual function?
All of those elements of the body, all of those cell types that are involved, they all require the cells to make energy properly, which is metabolism. As you know, we are dealing with a metabolic disease epidemic in this country. You've talked about it so many times on your podcast, but 88% of American adults are metabolically dysfunctional. This is unbelievable.
This means that 88% of American bodies are not producing energy properly in their cells. And we cannot have any health without having our cells having their basic functions met with energy. And so this really is paralleling issues that we're seeing with sexual dysfunction in this country, which are actually becoming quite rampant. The statistics are harrowing and sobering.
So if you look at women, about 40% of all women have issues with sexual dysfunction, and this means arousal or interest or orgasm. When you get to menopausal age, that number goes up to 85%. Wow. The vast majority of women having issues with sexual function and sexual pleasure. which is an incredibly important part of life and well-being. So those numbers are way too high, in my opinion.
When you look at men, you see that about 50% of men are dealing with issues with sexual function, and this largely manifests in erectile dysfunction. And even under the age of 40, a quarter of men are dealing with erectile dysfunction. this number should probably be closer to zero.
And again, when we think about erectile dysfunction, we're thinking about a complex orchestra of physiologic events, all of which require good metabolism to work. So that's kind of the landscape of what we're talking about when we need to think about the relationship between metabolic health and sexual function. And happy to dive into all of that more.
but I think it's a super important topic to go into. And I think it's also part of how we make metabolic health be sexy, is to actually talk about the direct link that it has to our sex drive in our life. That's actually one of the openings that you had in one of the articles that you wrote on this topic, which we have a link to in the show notes over here.
And because sometimes, if you're trying to talk to young people, especially, and the rates of diabetes and metabolic health for young people are also crazy. Every year, younger and younger, you're seeing kids with diabetes and other indicators of poor metabolic health.
and i think if we're going to reach the younger audience we have to also help them understand that number one first and foremost it's crazy to have to say this in this day and age but actually the drive for sex is a good thing right of course we want to have good and proper sexual education for people that's available to them and we shouldn't be ashamed the fact that people have a sex drive men and women who historically you know women got the short end of the stick
saying that women shouldn't have a sex drive. So I think all those things are important to talk about, but if we're gonna get them excited, it's like, hey, actually eating healthier, living healthier is important to how you not only perform, but your interest in wanting sex in the first place.
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Chapter 4: Why is fertility declining?
many or most Americans are, it may be a big red warning sign. There are things happening under the hood in terms of our metabolic health and metabolic dysfunction that will lead to very serious issues down the road, like all the diseases we understand are related to metabolic dysfunction. And we know this by looking at certain statistics like
In men with erectile dysfunction, they have a 1.5 to 2.6 times higher chance of developing cardiovascular disease. There are these direct epidemiologic links between this non-lethal pain point in our life and the risk of future metabolic issues. Because when we look from that root cause perspective of what is the actual physiology that's going wrong,
when we have some of these issues, we see that there are clear links between these diseases. And I think you're absolutely right. I mean, metabolic health is sexy. And I think the reason it's sexy to me and endlessly fascinating is that, as we've talked about on other podcasts, metabolic health is this core link that's connecting so many of the diseases and symptoms that we're facing to
today in the American Western industrialized world. These metabolic associated diseases and symptoms are making up 90% of our $4 trillion healthcare costs. And the beauty is, and why it's sexy is because we can do something about it.
Chapter 5: How can metabolic health improve sperm and egg quality?
This is something where we can lean into dietary and lifestyle behaviors in our own lives to actually have a positive impact on these factors and have multifarious benefits in terms of our health, and things like our sexual function and pleasure and interest. So it's exciting.
Let's talk a little bit about how you were maybe taught to look at the problem in your training as a physician from a conventional standpoint, right? How were you taught to look at what are the drivers for, let's talk about specifically sexual health, interest, or even just... Again, it's so complicated and there's a lot of different layers here. Therapy can play a role in couples.
There's a lot of different factors, but we're specifically talking about the physiological side, which actually also, I think this is going to be a big insight for people as they listen today, it actually influences the mental side too.
That actually might be worth touching on for a second because there's some people that are paying attention today and saying that, hey, listen, what does metabolism have to do with some of the mental aspects of the pursuit or the enjoyment of sexual health?
Yeah, so to answer your first question, which is how are you conventionally trained to think about these things, I can sum it up in about one sentence. What are your symptoms? Oh, I have low sex drive and I have trouble having an erection. cool, here's some Viagra. It's symptom and then diagnosis and then medication.
It's just so algorithmic and it's so unfortunate because when you give that medication, something like Viagra or Cialis or whatever it is, you are missing an incredible opportunity to help this person understand their fundamental health so much better and make the choices that are ultimately going to positively impact that specific issue, but so many other areas of their life.
And that leads into the question of what's really going on here with some of the physiology, including the psychological component. So there are really three main ways that metabolic health and sexual function are linked. The first is blood flow, the second is hormones, and the third is psychology and mood. So when we think about blood flow, this gets at the Viagra conversation.
So what does Viagra do? It allows you to produce more of a chemical in the blood called nitric oxide, which is a vasodilator. It allows blood vessels to dilate. And when you do that, you can get engorgement of erectile tissues, and that's part of arousal and sexual function.
Interestingly, in both men and women, really for any sexual function, you need dilation of blood flows and blood flow to go to the erectile tissue. In the women, this is going to be all the areas of the clitoris and around the clitoris. And in men, of course, it's going to be the penis.
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Chapter 6: What lifestyle changes can boost libido?
Now, before we get to the other couple ones, let's just start off a little bit with what are some of the things that restrict that blood flow in the body?
Like what are some of the things that the lifestyle factors, so we know that it's through the mechanism of poor metabolic health, but what are some of the things that people are doing every day that are contributors to having plaque buildup and restricting the blood flow which ends up negatively impacting your sexual drive? All right, I got a question for you.
What if you could track your food, sleep, exercise, blood sugar, and key biomarkers all in one place? Well, I have good news for you. With the Levels app, this is not only possible, it's actually needed if we're gonna fix our broken healthcare system.
You wanna hear something pretty shocking that I learned from the Levels founder, Josh Clemente, recently on this podcast, is that there are so many people who are unhealthy and they don't even know that they're unhealthy. This is where the Levels app comes in.
We have over half of US adults that have prediabetes or diabetes, and just these two conditions alone set the stage for things like Alzheimer's, heart disease, and even cancer. That's why it's so important to use technology, things like the Levels app, to stay on top of your metabolic health and stay on top of all your biomarkers and your exercise and your sleep and the tracking of your food.
I've had to use a bunch of different apps to do this. Now with the Levels app, I can do this all in one place. I can track my metrics, my macros, my habits, and my glucose levels from a continuous glucose monitor. And now with their new features, you can even track step count, sleep, and more to understand how your daily habits shape your health.
Plus you can get labs directly through the Levels app Or if you have your own blood work, you can upload it to track 10 key biomarkers and see the full picture of your metabolic health over time. And this is huge because there are key actions that you can take to improve it.
For example, when Josh was on this podcast, he mentioned that even a 15-minute walk after meals can dramatically improve glucose control. And with levels, you can see these effects in real time.
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Chapter 7: How do hormones affect sexual health?
Right now, if you're interested in this, the app that tracks it all in one place, Levels is offering my listeners two free months of their annual membership when you sign up through my link, levels.link slash dhru. I don't know how long this offer will last. So if you've been thinking about learning more about your metabolic health and trying
tracking all of your metrics in one place, now is the time to get started. Just go to levels.link, levels.link slash DHRU to get two free months of their annual membership today.
Yeah.
so the big lifestyle factors that we think about is really anything that causes blood sugar spikes and anything that leads to insulin resistance so there's a lot of different things that contribute to insulin resistance in the body but of course a key one is going to be are we eating diets that are spiking our glucose over and over and over throughout the day and causing this glycemic variability this roller coaster of ups and downs swings in glucose one of the reasons that's problematic is that not only does it contribute to insulin resistance
and makes the body essentially numb to this insulin signal, but it also induces oxidative stress. So the production of advanced glycation end products and excess reactive oxygen species. So these are metabolic byproducts that can cause damage to our cells and bodies. And what we know that reactive oxygen species and an excess of them being oxidative stress can do
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Chapter 8: What are the solutions for hormone-related challenges?
is lead to narrowing of blood vessels. It can cause thickening of the capillary and arterial walls and cause that narrowing and constriction. Another thing that happens when you have those big blood sugar spikes over and over, and ultimately when this leads towards things like prediabetes and diabetes, is it affects the nerves that actually impact the elasticity and dilation of arteries.
And then, of course, also the nerves of things like the penis and clitoris and whatnot. So it's multifactorial, it's nitric oxide, it's reactive oxygen species, it's impact on nerves, but one of the key things you can do is keep the blood sugar down.
So eating in a way that allows your blood sugar to be more balanced, which we've talked about on many of our podcasts together, things like eating a whole foods, unrefined diet,
where you're really avoiding the refined sugars, refined carbohydrates, making sure that you're pairing your carbohydrate sources with fat, protein, and fiber, not just eating naked carbohydrates that are gonna get into the bloodstream quickly and spike the glucose. That's all really important. But there are several other factors, of course, for eating a metabolically healthy diet as well.
We wanna make sure that we're eating probiotic and prebiotic rich foods, which are gonna support our microbiome, which directly feeds into our metabolic health. We wanna be eating lots of antioxidants and micronutrients to support the metabolic machinery in the body that lets us make energy properly in our cells.
And we wanna be focusing on clean organic food because we know that some of the pesticides that are covering So much of our food today are actually toxins that hurt our metabolic machinery. And they even have a new class of names for these types of chemicals called obesogens because they directly lead to obesity.
So a really micronutrient, antioxidant-rich, probiotic, prebiotic-rich diet that's ideally cleanly and sustainably sourced and doesn't spike glucose. is the name of the game when it comes to having a more metabolically healthy diet. So I know that sounds pretty complex, but it's basically like eat real whole foods as much as you can.
Yeah, a lot of things sound complex when you're getting started, but the more that you listen to people who are good at breaking them down, and you are great at breaking it down. And also, I love your newsletter, which also has great recipes inside of there. We'll link that up. If anybody wants fantastic recipes on a weekly basis, your newsletter is Dr. Casey's Kitchen, is what it's called, right?
Yeah. Is a fantastic one. You know, I was really blown away to... See, one stat that you had referenced in your article, it said, twice as many women with type 2 diabetes experience sexual dysfunction compared to women without. That's mind-blowing.
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