Dr. Azar's morning erection claims need some context

What did @dr.ghassanazar actually say?

Here's the problem: the actual spoken transcript from this video is incoherent. The words don't form coherent medical sentences in English or any recognizable clinical language. What we can evaluate is the written caption, which makes specific medical claims. The caption states that "almost all men under 70 experience nighttime penile tumescence (NPT)" and lists weight, blood pressure, cholesterol, diabetes, stress, and depression as reasons it might stop happening. Those are the claims worth examining.

Since the transcript cannot be verified as genuine medical commentary, this fact-check is based entirely on the written caption. That's an important caveat. A video with 585,000 views carries real influence, and the gap between what's written and what's spoken is itself a red flag worth noting.

Does the science back this up?

On the core claim, yes, the research is fairly consistent. NPT is a well-documented physiological phenomenon. The caption's claim that most men under 70 experience it holds up in the literature, though the framing deserves more precision than the caption provides.

Studies like those by Hirshkowitz et al. (1992, Sleep) established that healthy men typically experience three to five NPT episodes per night, averaging 25 minutes each. This decreases with age and is significantly associated with cardiovascular health. Research by Montorsi et al. (2003, European Urology) directly linked impaired NPT to subclinical cardiovascular disease, finding that men with erectile dysfunction had measurable endothelial dysfunction years before cardiac events. The conditions listed in the caption, including hypertension, dyslipidemia, diabetes, and depression, are all supported as NPT disruptors in peer-reviewed literature. The American Urological Association's 2018 guidelines on erectile dysfunction explicitly identify these as contributing factors.

What did they get wrong (or right)?

Credit where it's due: the underlying message is medically sound. Absent or reduced morning erections can be an early signal of vascular or metabolic problems, and dismissing them is a genuine missed opportunity for early intervention. The hashtag "LowTestosterone" is where things get murkier.

Low testosterone is notably absent from the caption's list of causes, yet it's the primary hashtag. That's not a minor inconsistency. Hypogonadism does affect NPT, but the relationship is more complex than a hashtag implies. Research by Buvat et al. (2013, Journal of Sexual Medicine) found that testosterone plays a modulatory role in NPT, but vascular factors dominate. Tagging a video about NPT with TRT-adjacent hashtags without mentioning testosterone in the actual content feels like audience capture, not clinical education. It implies TRT is the solution when the caption itself doesn't make that argument.

The "almost all men under 70" framing also flattens a more nuanced picture. Prevalence studies show considerable variation based on health status, not just age.

What should you actually know?

Morning erections are a proxy measure for vascular and neurological health, not just sexual function. If they've become noticeably less frequent or stopped entirely, that's worth mentioning to a doctor, not because it signals a testosterone deficiency, but because it might indicate something happening in your cardiovascular system that's worth catching early.

The clinical workup for absent NPT typically includes metabolic panels, blood pressure assessment, and a conversation about mental health and sleep quality. Testosterone levels may be part of that picture, but they're one data point, not the whole story. Research by Corona et al. (2016, Journal of Sexual Medicine) found that hypogonadism accounts for a minority of erectile dysfunction cases overall. Jumping to TRT without ruling out vascular and metabolic causes first is not standard care and could delay identifying something more serious. If you're concerned, a structured evaluation through a licensed provider is the appropriate next step.