Male sexual health and reproductive medicine: All that glitters is not gold

September 19, 2022
Navid Leelani, DO, Scott D. Lundy MD, PhD

This article is a repost which originally appeared on Urology Times.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Telehealth is an increasingly popular method for obtaining medical services

· More studies need to be done in the areas of male sexual and reproductive medicine.

· Studies cite the prevalence of ED as high as 52%!

“With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness,” write Navid Leelani, DO, and Scott D. Lundy, MD, PhD.

With the intensified direct-to-consumer marketing of male sexual medicine treatments, the recent legislative changes in reproductive rights and their unknown long-term effect on assisted reproduction availability for infertile men, and the explosion of telehealth, the practice of male sexual medicine is evolving at a breakneck pace. Specialists in male sexual and reproductive medicine have been tasked with digesting the evolving literature and forming evidence-based treatment guidelines for men with erectile dysfunction, Peyronie disease, infertility, and a host of other conditions. Compared with other areas of urology and medicine in general, male sexual and reproductive medicine has a disappointingly small number of well-designed prospective studies, along with a significant gap in funding for male reproductive health compared with female reproductive health. Several manuscripts published in 2022 started to narrow this gap and provide valuable level 1 evidence supporting (or discounting) key areas within sexual medicine and infertility.

For men with severe male factor infertility and nonobstructive azoospermia, surgical intervention is often indicated to retrieve sperm. Testicular sperm aspiration (TESA) and microdissection testicular sperm extraction (mTESE) are 2 commonly used approaches. A recent study by Jensen et al compared the efficacy of these 2 approaches in one of the few prospective randomized-controlled trials in male infertility.1 In the study, 49 patients were randomly assigned to mTESE with a sperm retrieval rate of 43%, and 51 patients were randomly assigned to TESA with a sperm retrieval rate of 22%. Men with failed TESA then went on to salvage mTESE with a combined sperm retrieval rate of 29%. Participants in the mTESE arm, however, had decreased postoperative testosterone levels, and 24% of participants experienced de novo hypogonadism at 6 months. Prior literature has suggested the testosterone drop is transient and that it will likely recover by 12 months. In summary, the study results showed that mTESE remains the gold standard for treatment of nonobstructive azoospermia, but patients should be counseled on the risk of de novo hypogonadism.

Despite this, mTESE success rates remain modest and are subject to the expertise and skill level of the laboratory and andrologist processing the tissue. Multiple hours can be spent trying to find the few viable sperm hidden among a sea of distractors. A recent study by Lee et al examined the power of artificial intelligence to detect human sperm in semen and mTESE samples using bright-field microscopy for nonobstructive azoospermic (NOA) patients.2 They first trained the program to identify sperm from semen samples of fertile patients. After validating the effectiveness of their algorithm, they retrained it to identify sperm in tissue from NOA patients that had been spiked with large amounts of sperm. When testing it on samples containing 3000 to 6000 sperm among other cell types, they achieved 84.0% positive predictive value and 72.7% sensitivity. Finally, without retraining their algorithm, they tested it on samples containing 10 to 200 sperm, replicating the “rare sperm” phenomenon seen in patients with NOA. Their model was able to detect 2969 sperm cells out of a total 3517 with an 84.4% PPV and 86.1% sensitivity. The clinical applications of artificial intelligence and machine learning in medicine continue to expand and have made their way to male infertility. Although this is not ready for immediate clinical use, it does highlight the need for further work to harness the power of technology to improve workflow of andrologists and in turn increase the success of infertility care for patients.

There has been a rapid rise in the need for male sexual health and reproductive specialists as the population ages and the number of comorbidities rise, although certain disease processes that fall within this specialty may be able to be addressed by a general urologist. In an analysis of the current educational landscape, Asanad et al call attention to the need for a structured educational curriculum in residency for male infertility.3 In a survey of urology residents, 54 of 72 respondents (75%) reported that male infertility comprises less than 10% of their training. Compared with residents who did not learn from infertility-trained faculty, residents who were exposed to infertility-trained faculty were 14.4 times more likely to feel confident performing infertility procedures (P < .001) and were more likely to feel confident performing fertility procedures after residency (P = .001).3 For trainees, their career depends on what they are exposed to. Smaller subdisciplines within urology may be more difficult to teach uniformly, and perhaps there are ways to improve the exposure to these areas for motivated residents (eg, visiting other programs).

Within male sexual health, one disease process that all urologists should be able to diagnose and initially manage is erectile dysfunction (ED). With studies citing the prevalence of ED as high as 52%, the demand for providers to manage ED remains sky high. Current treatment options include phosphodiesterase type 5 inhibitors (PDE5is), intracavernosal injections, vacuum erection devices, and penile prosthesis. A newcomer to the field is shock wave therapy, which uses controlled energy to induce angiogenesis.

The short-term effectiveness of focused shock wave therapy for patients with moderate ED was investigated in a double-blind, randomized, sham-controlled trial.4 In this study of 70 patients with moderate ED, 35 were randomly assigned to low-intensity shock wave therapy (LiST) and the other 35 were randomly assigned to sham therapy. After a 4 week washout from PDE5i, patients underwent LiST or sham twice weekly for 6 weeks. One month after treatment completion, 59% patients in the LiST group experienced an International Index of Erectile Function (IIEF) score improvement of at least 5 points, compared with 1 patient (2.9%) in the sham group (P < .001). This effect remained present at 3 months post treatment. Thus, the short-term data for LiST are compelling and suggest this may be a viable option in the management of vasculogenic ED for men with mild/moderate ED. Further studies are desperately needed to validate these findings, and urologists have an obligation to provide patients with an honest assessment of the data and only recommend treatments where the risks (including the financial burden) are outweighed by the benefits.

In stark contrast to focused therapy, radial shock wave therapy uses low-pressure radial shock waves to treat ED. In order to characterize its effectiveness, a randomized, double-blind, sham-controlled clinical trial enrolled 80 men with mild to moderate ED.5 Patients were treated weekly with either radial wave therapy or sham therapy for 6 weeks, and the primary outcome measured was change in the IIEF score between baseline and after treatment. Study results showed that there was no significant difference in IIEF scores between groups at 6 weeks or 10 weeks after randomization. Study results displayed the lack of evidence to support the use of radial wave therapy.

Despite the evidence of their ineffectiveness in managing ED, shock wave therapy and particularly radial wave therapy have been heavily marketed directly to consumers in the US. A recent article using a “secret-shopper” method found troubling marketing and practice trends in the US. The authors noted that patients often are not adequately educated on the different types of treatments and may not know if the administrator is a licensed medical professional.6 With the average cost of treatment ranging from $2600 to $3900 per cycle, clinics offering radial wave therapy have an obvious financial incentive to continue marketing despite the lack of evidence of its effectiveness.

Recent advancements in the field of male sexual health and reproduction present a bright future for the field with new diagnostic and therapeutic options on the horizon. However, it is apparent that demand still outpaces supply for men’s health specialty care. Urologists must work diligently to fill this void to not only increase access for patients to receive evidence-based care, but also to prevent men from falling to prey to practices looking to take advantage of this unmet demand and a vulnerable patient population.

References

1. Jensen CFS, Ohl DA, Fode M, et al. Microdissection testicular sperm extraction versus multiple needle-pass percutaneous testicular sperm aspiration in men with nonobstructive azoospermia: a randomized clinical trial. Eur Urol. Published online May 19, 2022. doi:10.1016/j.eururo.2022.04.030

2. Lee R, Witherspoon L, Robinson M, et al. Automated rare sperm identification from low-magnification microscopy images of dissociated microsurgical testicular sperm extraction samples using deep learning. Fertil Steril. 2022;118(1):90-99. doi:10.1016/j.fertnstert.2022.03.011

3. Asanad K, Nusbaum D, Fuchs G, Rodman JCS, Samplaski MK. The impact of male infertility faculty on urology residency training. Andrologia. 2022;54(8):e14457. doi:10.1111/and.14457

4. Kalyvianakis D, Mykoniatis I, Pyrgidis N, et al. The effect of low-intensity shock wave therapy on moderate erectile dysfunction: a double-blind, randomized, sham-controlled clinical trial. J Urol. 2022;208(2):388-395. doi:10.1097/JU.0000000000002684

5. Sandoval-Salinas C, Saffon JP, Martínez JM, Corredor HA, Gallego A. Are radial pressure waves effective for the treatment of moderate or mild to moderate erectile dysfunction? A randomized sham therapy controlled clinical trial. J Sex Med. 2022;19(5):738-744. doi:10.1016/j.jsxm.2022.02.010

6. Weinberger JM, Shahinyan GK, Yang SC, et al. Shock wave therapy for erectile dysfunction: marketing and practice trends in major metropolitan areas in the United States. Urol Pract. 2022;9(3):212-219. doi:10.1097/UPJ.0000000000000299

Renowned Doc Reveals The Simple Secrets To Being A Healthy Man

Dr. Frank Lipman talks about “the male way of seeing” health and how it got us to this men’s health crisis point.

This article is a repost which originally appeared on Fatherly.

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· One of the greatest challenges for men getting appropriate medical treatment is resistance through lack of caring.

· Biohacking can provide some solutions to medical challenges for men.

· Erectile Dysfunction (ED) is usually a systemic issue.

One of the biggest threats to men’s health has always been the challenge of getting them to care about it. “It’s hard to say the exact reason, but men don’t really do anything preventatively,” explains physician Frank Lipman, M.D. Through nearly 40 years of experience practicing functional medicine, he has found that men generally “are not interested in subtle changes in their body, and they traditionally wait until they have a heart attack or something serious,” Lipman says. And although he can’t point to a single catchall reason for why this is, it’s always been the case. “That’s the male way of seeing things: It’s not a problem until it’s a big problem.”

That’s not to say there haven’t been attempts to engage men to take a more proactive approach to their health and wellness. But much of this has been geared toward optimizing their performance. That’s why erectile dysfunction and low testosterone have been a major part of these efforts, because they affect men’s ability to perform in bed, at work, and on the field. As a result, these are the concerns that might get men in to see their doctors and screened for more serious risks such as heart disease and diabetes.

But now, thanks to a combination of telemedicine, wearable tech, and the mainstreaming of biohacking, doctors like Lipman have been able to spin this competitive edge into a more holistic approach to healthcare. “A lot of guys are learning that they can do a lot of health testing at home, use wearables, and do things in order to perform better,” Lipman says. Being able to track things like their sleep, exercise, and how much alcohol they’ve cut back on, and bond with other guys while competing over these progress, might be what gets them paying more attention to their minds and bodies.

“Men generally are more competitive, so if that can be spun in a positive way, then they will take more notice,” Lipman says. “Being able to measure these things at home and compare it to their friends is a positive.”

Although the overall outcome remains to be seen, Lipman sat down with Fatherly to discuss his optimism about the future of men’s health, and how we can gamify it for the better.

Over the course of your career, how have you seen men’s interest in their health change? What’s different now, and what is still the same?

Traditionally it’s been the spouse or significant other bringing men into the doctor. But there’s been a shift, and now men seem to be paying more attention to athletes and other role models for men, on Twitter and social media, talking about how when they started doing ice plunges, they started performing better. A lot of them are athletes because there’s a lot more awareness about health for them. All of that has made men more aware. Instead of their spouses getting them to care about their health, there are successful role models.

With so many men getting this information from social media, are there concerns about misinformation?

There’s always going to be some misinformation, but overall I think it’s much more positive. There’s much more good coming from it. And if it brings them into the doctor, they can do more testing, and their health can be a little bit more controlled.

What conditions are guys coming into your office worried about?

They’ve become more aware of heart disease, which usually is a disease that’s easily picked up from biomarkers. I think men are usually more concerned about performance and issues related to that, like Alzheimer’s and other cognitive issues. They’re worried about not having the energy to play basketball with their friends. They’re worried about not being able to perform as well as the younger people at work.

It seems like men aren’t that interested in worrying about diseases like cancer that could develop. Is it fair to say, when you try to get men to worry about preventative healthcare so far in the future, it may not work?

Yes, you’ve got to present it in a way that’s going to make them make changes. You can’t say, “If you don’t do this, you’re going to get heart disease.” Or, “If you don’t do this, you’re going to put on weight.” It’s more about, “If you don’t do this, you’re not going to have the energy to do the thing you want to do.

Having heart disease or a problem with your health is going to affect your penis as well, because ED is not isolated to that particular organ. Usually when someone has ED, it’s a systemic thing — it’s vascular disease all over the body. That’s a generalization, but you’ve got to scare men in a way that’s going to change the way they’re going to see things.

You mentioned biomarkers. For someone who’s new to telemedicine, wearable tech, and biohacking, what are some biomarkers they should pay attention to? Or what sort of things should they have tested?

A lot of the blood work done by doctors is not particularly helpful. Guys should be asking for an advanced lipid panel that looks at the particle size of the cholesterol molecules — that measures inflammatory markers. It’s a much more extensive test that gives us much more information about heart disease and inflammation than regular tests.

They should have their uric acid checked. They should have nutrient levels checked, which are not usually checked. For instance, they should have their Omega-3 levels checked. They should have their red blood cell magnesium checked. They should have their B-12 checked.

And then hormones; men should not only have their testosterone and free testosterone checked, they should check for estrogens as well. Too much estrogen can be a problem for men as well as women.

What are the limits to biohacking?

The biggest things that get ignored are moving your body, how you sleep, meditation or stress reduction, spending time in nature, having some purpose in life, having some connection, or being connected to family or a community. Those to me are the primary biohacks of the body.

The secondary hacks are when you want to take it to the next level. So guys who are biohacking by measuring their blood glucose and their sleep and taking all these crazy supplements, it’s all fine, and I don’t think they’re dangerous. But to me, those are secondary hacks. If you’re thinking of biohacking, you can’t ignore the primary biohacks.

Sleeping seems to be a big thing that men can track for the sake of their mental and physical health.

Poor sleep puts you at risk for almost every chronic disease from Alzheimer’s to heart disease to diabetes to obesity. So poor sleep is the first place you need to do some work, because men don’t take sleep seriously enough. Sleep is when your body is recovering and repairing. It’s when your brain cleans all the toxins out. Sleep is crucial to one’s health.

Alcohol seems similar, in that it puts men at risk for a lot of problems, but it also can be managed and tracked easily with apps. Does it work the same way?

Yes, too many people drink too much alcohol, which not only affects sleep, but it can affect so many other parts of the body and predispose you to so many problems. Three to four drinks a week isn’t a problem, but most men are drinking three to four drinks a night for three or four nights a week, and that becomes a problem. It puts a load on most organ systems, and is probably one of the primary risk factors for many of the diseases men are presenting with.

Sleep and alcohol also seem to have a large effect on men’s mental health, which has been said to be in a state of crisis. Do you believe men are facing a mental health crisis, and has it always been this way?

I’m not sure the problems with men’s mental health are a new thing. I think it’s probably more of an issue now because there’s more stress in people’s lives, whether it’s financial or otherwise. And men are starting to deal with it instead of suppressing it. Younger men are much more aware of their mental health and are in therapy, again because there have been more role models. People like Michael Phelps make a difference and help things.

I think younger men are more aware of their mental and emotional health, and it’s great that that’s shifted. But also, there is more pressure on everyone, including men, than there was 20 years ago.

And how can paying attention to physical health in the ways we’ve discussed help with mental health?

To me, mental and physical health are all one thing. Men paying more attention to their physical health will absolutely help with their mental health. I think teletherapy has made men more comfortable going to therapy from their home and that’s also helped a lot with that.

If you were to take into account all the avoidance and mental and physical health risks we’ve discussed, do you think that being a man should be considered a pre-existing condition, or a medical diagnosis in itself?

I don’t see it that way. We all have different pre-dispositions. Especially with genetic testing now, we can tell who’s more genetically predisposed to heart disease or diabetes or whatever. Certain diseases might happen more for men, but I don’t see being a man as a health risk, to be quite honest. I think it comes down to how health information is presented, and I think now it is being presented to men in a more accessible way.

Explained: Why men must not ignore sexual health problems

While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

IANS Updated Jul 24, 2022 | 06:43 AM IST

This article is a repost which originally appeared on TIMESNOW

Edited for content. The opinions expressed in this article may not reflect the opinions of this site’s editors, staff or members.

Our Takeaways:

· Men are usually hesitant to discuss sexual matters with others in a social setting.

· Professional consultations for sexual problems have more than doubled since 2020.

· Discussing sexual concerns can help to relieve stress and to discover potential solutions.

When was the last time you heard a man discussing his sexual wellness in a peer group or a social setting, or even with his loved ones? Chances are, you’ve never heard of such a thing. These conversations, while critical, just do not happen.
While as individuals, we are hardwired to share our issues with our near and dear ones, certain conversations still take place in hushed tones. Sexual wellness is one such topic. Since such issues are not spoken about and people refrain from seeking treatment due to a lack of awareness and right online platforms in the country.

Just like physical and mental well-being, men must take care of sexual wellness to lead a healthy and happy life. Thankfully, we’re on our way to speaking out loud about these issues as a society. Sexual wellness consultations increased by almost 139% in the year 2020 compared with the previous year.

1. Performance Pressure: Sexual health and effectiveness are taboo in society and specifically for men for various reasons. It is often assumed that sexual activity comes more naturally to men than women. While that is untrue, this notion gets even more troublesome when men aren’t able to perform in bed. Men suffer from performance anxiety a lot more than women, which is a leading cause of erectile dysfunction.

2. Erectile Dysfunction: The commonly used term for ED is impotence. The mere association of this word with men arouses discomfort in social circles and, more often than not, leads to a scarred image. But the problem is not as rare, just less talked about. As per the Massachusetts Male Aging Study, nearly half of the men in the age group of 40 to 70 face this issue due to reasons varying from arterial malfunction or other abnormalities that can be checked and treated. ED can be caused by endocrinological diseases such as prostate malfunction, hypogonadism or even diabetes. Trouble maintaining an erection could very well be caused by fibrosis or atrophy, which is a sufficiently organic process but could also be caused due to drugs or smoke. Another myth surrounding men’s sexual health is that ED is a psychological disorder. While the cause could be neurological, the issue definitely needs to be probed for clarity and subsequent treatment.

3. Low Libido: Libido comes naturally to all genders, given they’re in a suitable space in their head. Sexual pleasure is a recreational activity that does not need to be and ideally is not supposed to be imposed upon anyone. So, not being in the right mind space, like experiencing stress or anxiety, could lead to low libido. There could be very many reasons that need to get checked by an expert.

4. Premature Ejaculation: Generally, one out of three men has been known to complain about premature orgasm. This creates a lot of pressure upon men as they feel they’re somehow incapable of pleasing their women. This further causes a loss of self-confidence, adversely impacting their mental health and even leading to severe problems. Those days are gone when there wasn’t any scientific explanation for biological processes. Society has advanced a great deal to know for sure that there are underlying causes for many of the activities affecting sexual health. All the community collectively needs to do now is talk openly about sexual diseases and discomfort like other diseases. The bubble needs to burst now more than ever when we are experiencing a time when multiple genders exist in society.

Sexual pleasure, like any other need in life, is an individual’s responsibility. But acceptance in relationships plays a significant role in bringing that sort of communication out loud. This helps improve relationships and emotional health and leads to enhanced confidence and perspective in all aspects of life. Again, acceptance is the key in the end.

(Nilay Mehrotra, Founder & CEO of Kindly)

 

 

 

 

 

A Collection of Some of Our Best Thread Links and Resources

Here’s a list of some shortcuts to our favorite TheBioHacker forum threads:

 

A description on how to navigate the forum as well as what to expect- and what’s expected from you:
READ THIS BEFORE YOU POST!!!!! Maximize Your Success Here.

 

A great link database for setting up your journal and seeing other members’ progress:
MUST READ Sticky Threads – Progress Forum

 

Setting the right emotional backdrop for obtaining maximum results from male enhancement training:
The training mindset

 

This is important if you’re considering male enhancement training but suffer from anxiety or depression:
Please Read First

 

A list of contributing experts to TheBioHacker:
MEET THE EXPERTS

 

A database on links and resources for contending with the various causes of erectile dysfunction:
MUST READ Sticky Threads – Erectile Dysfunction Forum

 

A detailed account of a medical doctor’s experience with dealing with “hard flaccid”:
A Doctor with Hard Flaccid – Updates and Advice

 

An excellent instructional for non-medical measures for contending with pelvic floor problems and poor Erection Quality (EQ):
The HANS Protocol

Inner Demons: When it’s All in Your Head (from The Ultimate Guide To Male Enhancement)

The following is a chapter taken from the book: The Ultimate Guide To Male Enhancement.

The top cause of impotence today is due to performance anxiety or fear. There are many ways in which fears can originate. These include: inexperience, self-loathing, pressure from a partner, or even a partial physical cause which contributes to the equation.

Why does this seem to be such a growing epidemic- especially among younger men?

According to self-reports, most men have experienced some form of performance anxiety in their lives. How you handle incidents of erectile dysfunction can have a very huge impact on whether or not it sticks around.

One huge contributor of ED among younger men comes from unrealistic expectations obtained by watching porn.  Not only will most men be intimidated by the fantastic dimensions observed in many porn films, but the orchestrated reactions that become expected from these films also interferes with normal expectations.

Another aspect of ED caused by porn use involves detraining. This is discussed in much greater details further in this publication under the section titled “The Detraining Effect – Understanding and Reversing Negative Habits To Improve Erection Quality and Sexual Confidence,” but to summarize here, it’s when you become so accustomed to being an inactive participant in masturbating to porn, such that when real emotions and expectations are encountered (as in a real live sexual scenario), anxiety sets in.

The simplest answer to this is, when the sexual response is replaced by anxiety (or something intensely distracting to arousal), the penis isn’t allowed to function in an unencumbered fashion. The use of direct will in attempting to force an erection often has the opposite results. What becomes necessary in scenarios like this is getting to the root cause of the issue. Anxiety itself is merely a symptom of this.

In most cases, psychological ED is very temporary and has an ephemeral quality. In most cases, a man will shake this off- or if he’s generally very secure with himself, he may learn to laugh it off.

It’s usually when one strings together several worsening episodes does the situation become chronic and in need of professional treatment.

The Ultimate Guide to Male Enhancement

Can Specific Foods or Diets Boost Your Testosterone Levels?

Can Specific Foods or Diets Boost Your Testosterone Levels?

What you eat or drink may affect levels of the male sex hormone, but whether a diet can increase libido or energy depends on many things.

By Randi Hutter Epstein, M.D.

Published Nov. 2, 2021Updated Nov. 3, 2021

This article is a repost which originally appeared on The New York Times

Edited for content.

Can I increase my testosterone levels through the foods I eat? And if so, which foods or diets work best?

Many men, particularly as they age, are concerned about their levels of testosterone, the male sex hormone touted to build muscle, sex drive and vigor. But individual foods are unlikely to have an impact on testosterone levels — though drinking excessive amounts of alcohol might. If you are overweight, altering your diet to lose weight may help, since carrying excess pounds is a common cause of low testosterone. But in terms of specific foods or diets, any uptick you achieve may not have a noticeable impact on libido, energy or muscle mass.

“If someone was not overweight, I wouldn’t put them on a specific diet to raise testosterone based on the data we have now,” said Alexander Pastuszak, an assistant professor of urology and surgery at the University of Utah in Salt Lake City, who co-authored a review on alternatives to testosterone therapy.

In men, normal testosterone levels range from 300 to 1,000 nanograms per deciliter of blood. Ups and downs within that normal range are unlikely to have any impact on sex drive or vitality. Only when levels consistently drop below 300 points — as confirmed in two blood tests by an accredited laboratory — are symptoms like low libido, erectile dysfunction, fatigue, low mood or loss of muscle mass likely to appear, a medical condition known as hypogonadism.

Starting at around age 40, men’s testosterone levels start to decline by about 1 percent per year. But the drop can vary tremendously, with some older men maintaining levels similar to healthy young men. The trajectory of falling testosterone is steeper among men who gain a lot of weight, said Dr. Shalender Bhasin, professor of medicine at Harvard and the director of the Research Program in Men’s Health: Aging and Metabolism at Brigham and Women’s Hospital.

Studies on foods or diets and testosterone levels have generally been small and the findings far from conclusive. A recent British review that pooled data from 206 volunteers, for example, found that men on high-fat diets had testosterone levels that were about 60 points higher, on average, than men on low-fat diets. Men who followed a vegetarian diet tended to have the lowest levels of testosterone, about 150 points lower, on average, than those following a high-fat, meat-based diet. Still, Joseph Whittaker, the lead investigator and a nutritionist at the University of Worcester in Britain, said he would not recommend a man increase the fats in his diet unless he had low testosterone levels and symptoms of low T and was already restricting fats.

Another study in the Journal of Strength and Conditioning Research tested two styles of diets in 25 fit men between the ages of 18 and 30. Calories consumed were the same, but one group ate a high-fat, very-low-carb, ketogenic-style diet, consisting of 75 percent of calories from fats, 5 percent from carbohydrates and 20 percent from protein. Men in the other group ate a more traditional Western style, low-fat diet, containing 25 percent of calories from fats, 55 percent from carbohydrates and 20 percent from protein. After 10 weeks of eating the high-fat diet, testosterone increased by 118 points, on average, while after the low-fat diet, levels declined by about 36 points.

Similarly, a study of 3,000 men found that those who reported eating a low-fat diet had slightly lower testosterone levels — about 30 points lower — than men who ate higher-fat diets. But none of the men had low testosterone.

“The moral is that healthy men who are of normal weight with no significant comorbidities are unlikely to benefit from restrictive diets,” said Dr. Richard J. Fantus, one of the study’s authors and a urologist at NorthShore University HealthSystem in Evanston, Ill.

Diet studies are complicated, because changing one component of the diet, such as fat intake, alters so many other things, such as the amount of carbohydrates, protein and micronutrients consumed. It’s unclear which component of the diet may have prompted the hormonal changes, Dr. Bhasin said. Furthermore, testosterone levels may also be shaped by how much a person sleeps, or whether they are jet-lagged, or if they are eating most of their calories at night or in small meals throughout the day.

Dr. Faysal Yafi, chief of the division of Men’s Health and Reconstructive Urology at the University of California, Irvine, says his patients who opt to follow specific diets tend to start exercising more and drinking less alcohol, all of which can raise testosterone levels. He suspects any links between diet and testosterone may be the result of an overall healthier lifestyle.

Some men worry that eating lots of soy foods may cause their testosterone levels to fall, because soy is rich in isoflavones, which mimic the structure of estrogen. But the evidence doesn’t support their concerns, even if men eat foods like miso, tofu or soy milk at every meal. (Doctors did report one anecdotal case in which a 19-year-old man with Type 1 diabetes who followed a vegan diet containing 360 milligrams of soy isoflavones daily — nine times higher than a typical Japanese diet, and 100 times higher than the typical American diet — developed low testosterone levels along with low libido and fatigue. His symptoms improved when he stopped eating the soy-heavy, vegan diet.)

Long-term alcohol abuse lowers testosterone by damaging cells in both the testes, which make testosterone, and the liver, which alters testosterone metabolism. But binge drinking every now and then does not appear to have much of an impact — it lowers testosterone for only about 30 minutes, according to one study, after which levels bounce back to baseline.

Obese men who have low levels of testosterone can increase levels by cutting calories and losing weight — the type of diet does not matter, studies suggest. On the opposite extreme, Dr. Bhasin said he is seeing an increasing number of men at his clinic who have body dysmorphic issues and are suffering from low libido and fatigue. Strict calorie restriction, exercising intensely and being chronically stressed can all cause testosterone levels to plummet and are likely to blame, he said.

The bottom line is that for otherwise healthy men who are following a reasonably healthy lifestyle, fiddling with specific foods or the composition of the diet is not likely to make much of a difference on the testosterone score card. As Dr. Fantus of NorthShore University put it: “I don’t think there is a way to game the system to get really large increases by changing the diet.”

Correction: 

An earlier version of this article incorrectly stated that men who ate low-fat diets tended to have higher testosterone levels. Men who ate high-fat diets tended to have the higher T levels.

The article also referred to a 19-year-old man with low testosterone levels who was eating a diet containing 360 milligrams of soy daily; his diet actually contained 360 milligrams of soy isoflavones.

 

How Common Is Erectile Dysfunction?

How Common Is Erectile Dysfunction?

By Katie Wilkinson, MPH, MCHES

Published on September 28, 2021
Medically reviewed by Matthew Wosnitzer, MD

This article is a repost which originally appeared on verywell health

Edited for content.

Erectile dysfunction (ED), or impotence, is the inability to achieve and maintain an erection for sexual activity. While the occasional failure to get an erection is not uncommon, if it happens consistently, or more than 50% of the time, it may be ED. It can be a temporary experience, or develop into a long-term condition that requires treatment.

Prevalence

On a global scale, ED affects 3% to 76.5% of all men. The wide range is due to the different measures used in studies to evaluate ED.

In the United States, it’s estimated that 30 million men experience ED.2 Worldwide, there are about 150 million men living with ED, and by the year 2025, it’s predicted that over 300 million men will have ED.

Common Causes

ED can be caused by a number of factors relating to physical and mental health, including:

  • Physical and health conditions that involve different systems in the body, such as the vascular, neurological, or endocrine systems; can include issues with nerve signals or blood flow to the penis
  • Side effects from medication, which can include antidepressants, medication to manage blood pressure, tranquilizers, sedatives, ulcer medication, and prostate cancer therapy
  • Psychological or emotional causes such as depression, anxiety, fear associated with sexual performance, general stress, or low self-esteem
  • Lifestyle behaviors and health-related factors that are associated with ED include smoking, being overweight, lack of exercise, and substance (alcohol or drug) use

Risk Factors

Certain risk factors have been found to increase the likelihood of experiencing ED. They can include:

    • Age: The chances of developing ED increases with age, particularly in men over 60 years old.
    • Tobacco use: Research has found that smokers are 1.5 times more likely to experience ED than nonsmokers.
    • High blood pressure (hypertension): About 30% to 50% of people living with hypertension also experience ED.
    • Type 2 diabetes: Between 35% and 90% of diabetic men will develop ED.
    • High cholesterol: Statins used to treat high cholesterol showed improved erectile function.
    • Hypogonadism: This is a condition where the body doesn’t produce enough sex hormones, including testosterone. Since testosterone is necessary for the ability to maintain an erection, people with hypogonadism who are treated with testosterone replacement therapy can see improved erectile function.
    • Obesity: Several studies have indicated that men with a body mass index (BMI) greater than 25 begin to experience a 1.5 to three times greater risk of ED than those with lower BMIs.
    • Depression: Men living with depression are two times more likely to experience ED. Treating depression with selective serotonin uptake inhibitors (SSRIs) can also increase risk of ED.

Stress and anxiety, particularly performance-related anxiety, can also cause issues with sexual activity and erectile function.

Associated Conditions

In addition to diabetes, hypertension, and hypogonadism, the National Institute for Diabetes and Digestive and Kidney Diseases also lists the following conditions and diseases as associated with ED:

  • Heart and blood vessel conditions, including atherosclerosis
  • Injuries of the spinal cord, penis, prostate gland, bladder, or pelvic area
  • Prostate or bladder surgery
  • Chronic kidney disease
  • Multiple sclerosis
  • Peyronie’s disease, a condition where scar tissue develops and creates a bend in the penis

Treatment

Treatment for ED can take many forms and depends on the root cause of the individual’s ED. Because of ED’s impact on sexual relationships, it’s worth discussing treatment options with your sexual partner.

Lifestyle

Avoiding or stopping the use of tobacco, alcohol, and other drugs may help with ED.

Increasing physical activity and maintaining a healthy weight can also be a way to improve erectile function.

Mental Health Counseling

Because emotional and psychological concerns can play a role in ED, speaking with a mental health professional can be beneficial. They can help identify ways to manage anxiety and work through stress that may be impacting sexual performance.

Medication

Oral (PDE5 inhibitors), injectable, or suppository medications can be prescribed to help achieve and maintain an erection. For those with low testosterone (hypogonadism), testosterone replacement therapy may be prescribed.

Treatment may also involve adjusting or changing current medications that hinder the ability to get an erection.

Devices and Procedures

The following devices and procedures can be used to treat ED:

  • Penis pump: This device uses vacuum action to pull blood into the penis to create an erection. It has a tube where the penis is placed and a pump that draws air out of the tube and creates suction. Once the blood is pulled into the penis, an elastic band is placed at the base of the penis to prevent the blood from going back into the body and to keep the erection for about 30 minutes.
  • Arterial repair surgery: Procedures to repair clogged blood vessels in the penis may increase blood flow to allow for erections. This treatment is usually reserved for patients under the age of 30.
  • Implantable devices: These include surgically placed devices that either inflate or include semi-rigid rods to help a person achieve an erection.

A Word From Verywell

While many men might feel embarrassed by their erectile dysfunction, it should be a comfort to know that it is a very common condition, affecting at least 150 million men worldwide. It is also a very treatable condition.

Talk to your healthcare provider if you experience issues achieving and maintaining an erection. Even though it may be uncomfortable to talk about, proper sexual functioning is a key part of your overall health and well-being.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Cleveland Clinic. Erectile dysfunction. Updated October 14, 2019.
  2. National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts for erectile dysfunction. Updated July 2017.
  3. Kessler A, Sollie S, Challacombe B, Briggs K, Van Hemelrijck M. The global prevalence of erectile dysfunction: a review. BJU International. 2019;124(4):587-599. doi:10.1111/bju.14813
  4. Kalsi J, Muneer A. Erectile dysfunction – an update of current practice and future strategies. J Clinic Urol. 2013;6(4):210-219. doi:10.1177/2051415813491862
  5. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & causes of erectile dysfunction. Updated July 2017.
  6. DeLay KJ, Haney N, Hellstrom WJ. Modifying risk factors in the management of erectile dysfunction: a review. World J Mens Health. 2016;34(2):89-100. doi:10.5534/wjmh.2016.34.2.89
  7. Mourikis I, Antoniou M, Matsouka E, et al. Anxiety and depression among Greek men with primary erectile dysfunction and premature ejaculation. Ann Gen Psychiatry. 2015;14(1):34. doi:10.1186/s12991-015-0074-y
  8. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for erectile dysfunction. Updated July 2017.
  9. Urology Care Foundation. What is erectile dysfunction? Updated June 2018.
  10. Nguyen HM, Gabrielson AT, Hellstrom WJG. Erectile dysfunction in young men—a review of the prevalence and risk factors. Sexual Medicine Reviews. 2017;5(4):508-520. doi:10.1016/j.sxmr.2017.05.004
  11. International Society for Sexual Medicine. Can a vasectomy cause erectile dysfunction (ED)?
  12. Ssentongo AE, Kwon EG, Zhou S, Ssentongo P, Soybel DI. Pain and dysfunction with sexual activity after inguinal hernia repair: systematic review and meta-analysis. J Am Coll Surg. 2020;230(2). doi:10.1016/j.jamcollsurg.2019.10.010

Aloe for Male Enhancement: Is It Safe and Does It Work?

Aloe for Male Enhancement: Is It Safe and Does It Work?

Medically reviewed by Joseph Brito III, MD — Written by Rachael Zimlich on June 7, 2021

This article is a repost which originally appeared on Healthline

Edited for content.

Aloe vera can be found in many products. It can help boost the moisture content of your skin and even help heal burns and other wounds.

While it may seem like something of a miracle product, it can’t help with everything. In fact, you may want to be cautious before applying it everywhere — including your genitalia.

Keep reading to find out how aloe vera can be used for sexual health and when to avoid it.

What is male enhancement?

Male enhancement is a general phrase used to describe any efforts to improve the appearance, size, or function of genitalia — specifically the penis.

Some common enhancement strategies include:

  • stretches and exercises
  • topical or oral medications and herbal remedies
  • pumps
  • clamps and rings
  • surgery
  • grooming techniques

The goal of these strategies is to increase the size or appearance of the penis, improve erection strength and duration, or resolve ejaculation issues.

In some cases, male enhancement aims to treat erectile dysfunction (ED). This term typically refers to the inability to have or maintain an erection, but there can be varying levels of ED. In many cases, there’s another root issue, like cardiovascular disease or a medication side effect.

Improvement of ED is commonly pursued either for sexual pleasure or fertility purposes. Treatments should be designed based on the goal in mind.

Talk with a doctor about your specific symptoms and goals before beginning any new therapies or medications.

Does research support the use of topical aloe vera for male enhancement?

The use of aloe vera for general health and skin care is fairly common. However, you may be wondering if it could be used for male enhancement.

Most herbal or plant remedies are based in cultural practices, but there’s not a lot of clinical research on some claims of aloe vera benefits, like male enhancement.

Some studies have been done with animals, but the results were generally inconclusive. If anything, some of these studies raised concern about the use of aloe vera for sexual health benefits.

Here’s a breakdown of some relevant research in this area:

  • In a 2011 animal study, topical aloe vera reduced sperm concentration and quality.
  • A 2014 study showed possible benefits to sperm health and hormone levels in mice that received injections of an aloe vera compound.
  • A 2015 study showed that that aloe vera may potentially harm fertility in male rats.
  • There have been reports of libido enhancement with aloe use, but results may vary based on the specific form of aloe.

If you’re concerned about ED or another sexual health issue, talk with a healthcare professional. They can help guide you toward the right treatment for your situation.

Other natural treatments for male enhancement

There are many natural remedies you can try if you’re interested in male enhancement. However, you should always discuss any supplements you’re considering with a doctor first.

Several herbal remedies that have shown promising effects on male sexual health and performance include:

  • L-arginine
  • panax ginseng
  • L-citrulline
  • L-carnitine
  • gingko biloba

Other ways to improve your sexual health and performance include focusing on an overall healthy lifestyle, including:

  • staying active and exercising
  • eating a healthy diet
  • reducing stress
  • avoiding alcohol and other drugs
  • spending time outdoors

While regular exercise and a healthy diet are always good choices, talk with your doctor before starting any new therapies or supplements for male enhancement.

How is aloe vera used?

Aloe vera has been used on the skin and in the body for thousands of years. It can be found in all kinds of products — from juices to lotions.

Oral use of aloe vera usually comes in a pill form or as liquid extract or juice that you can drink. It’s thought to help with the following conditions:

  • obesity
  • diabetes
  • hepatitis
  • inflammatory bowel disease

However, there isn’t enough data to determine if oral aloe is effective for improving these conditions.

Evidence on the benefits of topical use — such as a gel, ointment, or lotion — is clearer, demonstrating that aloe can be helpful in treating:

  • acne
  • lichen planus
  • oral submucous fibrosis
  • burning mouth syndrome
  • burns
  • scabies
  • skin toxicity due to radiation

While aloe vera is generally considered safe, be sure to check the ingredients of the specific product you’re using.

Some oral aloe products may contain additional compounds that could result in side effects or interact with other medications. Even topical products may be mixed with alcohol compounds or other ingredients that can cause irritation.

Are there any possible side effects?

Aloe vera is widely used as both a topical and oral supplement. However, there have been some side effects linked to aloe vera use — either orally or topically — including:

  • liver problems
  • skin irritation
  • stomach pain or cramps
  • diarrhea
  • electrolyte imbalances

To avoid side effects, read the label of the product you’re using to understand all the ingredients it contains. You should also check for safety statements on the label.

For topical uses, it’s also a good idea to do a patch test by applying a small amount of product to an area of skin to test for sensitivity or irritation before applying liberally. This is particularly important when it comes to applying topicals, like aloe vera, to sensitive skin areas, like your genitalia.

The bottom line

There isn’t much evidence showing that aloe vera helps improve the size of your penis or your sexual performance.

However, if you decide to try it as a topical or oral supplement for enhancement, be sure to check the product’s safety, like performing a skin patch test before widespread application.

Always talk with your doctor or another healthcare professional about any supplements you plan on taking and your reason for taking them. They may be able to help treat the source of any sexual health problems you’re facing.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Take Control of Your Health During Men’s Health Month

Take Control of Your Health During Men’s Health Month

This article is a repost which originally appeared on U HEALTH

Edited for content.

Jun 07, 2021 8:30 AM

Author: Men’s Health Services

Schedule Preventive Health Care

June is Men’s Health Month, making it a great time for men to get schedule preventive health checkups. Only three out of five men get an annual physical and more than 40 percent of men only go to the doctor when they have a serious medical condition.

We’d like to see a change in those statistics. The majority of health issues men face are more treatable and more manageable in the early stages. Preventive care and checkups are important. I encourage men to take control of their overall health, including their sexual health, which is frequently linked to other, sometimes serious, health issues.

Checking every box on your health care list can seem overwhelming, especially if you’re entering the stage of life in which you need to start screening for different possible health issues.

Where to Start

Start with a couple of easy steps.

1. Find a primary health care provider if you don’t already have one. If you do, schedule an appointment.

2. Make small lifestyle changes.

A. Start exercising regularly, if you don’t already. Even a short walk once a day is a great start.

B. Eat a healthy diet. If you aren’t sure where to start, ask your provider for a referral to a registered dietitian, who can help you set realistic goals.

Do You Need a Men’s Health Provider?

If you’re experiencing any of the following conditions, schedule an appointment with one of our men’s health providers, while you’re at it.

  • Erectile Dysfunction. ED is a common condition that can affect quality of life. It’s common in men after prostate cancer treatment and those with diabetes or cardiovascular disease. ED is treatable with medication and with surgery.
  • Peyronie’s Disease. This condition usually happens to older men. If you’ve got a bent penis, and it is affecting your ability to have an erection or to have sex, you shouldn’t live with it. Several treatment options are available to straighten the penis.
  • Infertility. Men are the cause of infertility in a couple about 50 percent of the time.
  • Low Testosterone. Testosterone can decrease as men age, starting at age 30. If you’re feeling tired or like you’ve lost your edge, low T treatment could help you feel better.
  • Testicular Pain. Many men have testicular pain at some point in their lives, but it’s treatable. If you have aching or pain in your testicles, contact one of our men’s health providers.

Men’s health month is a great reason to think about what’s important to you. Taking care of health issues may seem inconvenient, but it’s more convenient now than it will be if you let them continue for longer! Don’t be afraid to talk to a men’s health provider.

We are here for you.

Erectile Dysfunction: Signs & Ways To Eliminate Its Risk

How To Detect The Early Signs Of Erectile Dysfunction & Eliminate The Risk Once And For All

Updated on May 04, 2021, 18:00 IST · 4 min read

By Snehal Sharma

This article is a repost which originally appeared on MENSXP

Edited for content.

It’s not easy to talk about sex, especially if you’re grappling with insecurities.

For the longest time, erectile dysfunction was ascribed to psychological origins. Most ancient cultures, including Ayurveda, believed that ED can be treated with the help of natural herbs such as Indian ginseng, sesame powder, Safed Musli and more.

Today, we know more about its causes and have treatments to address the issue. But before we talk about eliminating the condition, we need to dispel the stigma associated with ED.

Studies have clarified that ED is not just “in your head”. According to a 2017 study by the Department of Urology Tulane University School of Medicine, New Orleans, 20% of men across all age groups battle ED in India and 30% of them are younger than 40.

Most of the times, it is experienced due to an underlying cause that can be treated.

But no cure is possible until men accept the problem and stop shying away from asking for help.

What Is Erectile Dysfunction?

Erectile Dysfunction (ED), also known as impotence, is a condition in which a man experiences difficulty in getting or maintaining an erection during sexual performance.

The symptoms may also include reduced sexual desire or libido. If the condition lasts for more than a few weeks or months, your doctor is likely to diagnose you with ED.

Signs Of Erectile Dysfunction

Every piece of the body—including your emotions, hormones, brain, nerves, muscles and blood vessels—plays an intricate role in male arousal. When any of these isn’t aligned, it results in some kind of dysfunction.

Your mental health impacts your sexual ability equally. Stress, anxiety and other mental health concerns can worsen erectile dysfunction.

Experiencing minor or occasional sexual problems don’t necessarily mean you’re dealing with erectile dysfunction. But lookout for the consistency of these symptoms.

● Reduced or no desire for sex.

● Inability to get an erection.

● Inability to maintain an erection.

Who Is At The Risk?

The risk of ED increases as you age, especially if you have lived a sedentary lifestyle. It can worsen if you:

● Have a psychological condition like anxiety, depression or stress.

● Have an injury that might damage the nerves and arteries that contribute to erections.

● Use tobacco, drugs or alcohol.

● Are overweight.

● Are undergoing radiation treatment for cancer.

● Are taking antidepressants or high blood pressure medications.

● Have heart disease or diabetes.

How To Prevent Erectile Dysfunction

The healthier you are, the easier it’ll be to fight erectile dysfunction. There’s no one-size-fits-all way to prevent ED but you can avoid persistent problems by taking care of its causes and yourself. The following measures may help:

● Reduce stress.

● Take care of your mental health.

● Exercise daily.

● Limit alcohol consumption.

● Quit smoking and stop using recreational drugs.

● Manage diabetes and heart disease.

How Can You Treat Erectile Dysfunction

The causes of ED vary and so does the treatment. Work with your doctor to create a plan that’s best for you.

1. Counselling

If you feel anxious, depressed or have any other mental health concern, seek therapy. Along with consulting a professional, indulge in relaxing activities such as music, painting, poetry or aromatherapy. Geranium oil helps those with low libido.

2. Ayurveda to the rescue

It’s not feasible for everyone to collect and consume the recommended herbs for sexual wellness. But you can always rely on natural supplements that provide men with the right nutrients optimised for better and stronger erections.

3. Lifestyle changes

Manage weight, exercise or do yoga consistently, stop smoking, avoid alcohol and illicit drugs and manage your health with the help of a doctor.

4. Prescribed medication

If the above treatments don’t work, your doctor may prescribe oral medications—like Viagra, Levitra, Aronix, Tadalafil, Stendra and Cialis, self-injection such as an Alprostadil or testosterone replacement.

5. Physical treatments

Penis pump or penile implants. However, these aren’t generally considered until every other treatment has failed.

Final Thoughts

Recognise the symptoms and consult a professional. If you’re diagnosed with erectile dysfunction, your doctor will help you figure out the cause of ED.

Work on the treatment options and before you know it, you’ll start seeing the results.