Episode 17: Is Viagra the New Longevity Drug? | Peter Koshland

Is Viagra the New Longevity Drug? | Peter Koshland | Talk With Turek  (Ep. 17)

New research connects erectile dysfunction in men over forty to a cardiovascular mortality risk on par with a smoking history. Episode 17 of Talk with Turek examines what that means for prevention, prescribing, and longevity.

Viagra began as a heart medication. Pfizer was developing sildenafil in the early 1990s as a treatment for angina, and when the cardiac trial failed to deliver on its primary endpoint, the men in the study quietly refused to return their pills. The compound was relaunched in 1998 under a new name and an entirely different category. Nearly three decades later, the cardiovascular hypothesis those patients accidentally protected is being taken seriously across men’s health. Viagra and the broader PDE5 inhibitor class are no longer understood as sexual health medications alone. They are emerging as a window into endothelial function and overall cardiovascular risk.

Trailer

Inside Episode 17 of Talk with Turek

In this episode, Dr. Paul Turek, founder of The Turek Clinic and co-host Rob Clyde, sit down with Peter Koshland, PharmD, CEO of Koshland Pharmacy and Assistant Clinical Professor at the UCSF School of Pharmacy. The conversation moves through what the most current research on PDE5 inhibitors actually shows, what every man approaching forty should be asking his physician, and how the rapid expansion of telehealth ED platforms has changed the clinical landscape in ways few patients fully understand.

The clinical headline: erectile dysfunction in a man’s forties now correlates with a cardiovascular mortality risk roughly 2.2 times baseline. That is the same risk profile attached to a smoking history. The implication reshapes how an ED diagnosis should be interpreted. It is often the earliest visible signal of endothelial dysfunction, and a meaningful predictor of heart disease, stroke, and metabolic decline.

Full Episode

What the conversation covers

• The persistent myths surrounding Viagra, Cialis, and the broader PDE5 inhibitor class since 1998, including priapism, addiction, fertility concerns, and the long-running assumption that higher doses produce better outcomes, examined alongside the clinical reasoning behind each answer
• The regulatory distinction between FDA-approved finished drugs and compounded ED formulations, why this matters more than most patients realize, and how to evaluate a compounding pharmacy before trusting it with a prescription
• The blind spots embedded in telehealth ED prescribing, including the clinical conversation that men should be having and rarely is, and what gets lost when convenience replaces evaluation
• The physician, pharmacist, and patient triad as a model for personalized prescribing in a category increasingly dominated by volume and speed
• How psychogenic erectile dysfunction mimics organic vascular disease, and the dose-titration diagnostic method Dr. Turek uses to distinguish stress from cause
• The physiological reason Viagra produces nasal congestion, the surprising presence of erectile tissue in the nasal passages, and what that shared anatomy reveals about how these drugs act systemically
• The current state of female sexual dysfunction science, and how the clinical, cultural, and research conversation has evolved over the last twenty-five years

Why this conversation matters now

The telehealth ED market has expanded into a category where compounded sublingual formulations combining multiple active ingredients are being prescribed with limited or no in-person evaluation. Against that backdrop, the case for understanding what is in your prescription, how it was formulated, and who is overseeing your care has rarely been more practical.

Who this episode is for

• Men in their thirties learning to ask the right questions early
• Partners working to understand what an ED prescription actually signals
• Physicians refining their counseling approach in light of new cardiovascular data
• Anyone tracking longevity, preventive medicine, and the broader science of healthspan

The patients who participated in that 1998 trial recognized a benefit the data has needed nearly three decades to validate. Episode 17 examines what the science now says, and what it asks of every man paying attention to his own health.

Guest Bio

Peter Koshland, PharmD 

• CEO of Koshland Pharmacy 
• Assistant Clinical Professor of Pharmacy, University of California, San Francisco, School of Pharmacy 
• Chemistry degree from Georgetown University, PharmD from UCSF 
• Koshland Pharmacy specializes in compounded, customized medications with pharmaceutical- grade sourcing and clinical oversight 
• Website: koshlandpharm.com

Production Credit 

• Produced and recorded in South Pasadena, California, in association with Galaxy Media Ventures
• Executive producers: Jennifer Harris and Rob Clyde 
• Episode produced by Max Flora • Engineered and edited by Drew Unser 

Disclaimer 

This podcast is for educational and informational purposes and is not a substitute for individualized medical advice. Please consult a qualified physician about your own health.