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The Male Sex Drive — How it Changes With Age

Published on July 24, 2023 .
Kristopher Bunting, MD  Author

This article is a repost which originally appeared on healthnews

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

For many men, having a strong sex drive—or libido—can be an important part of feeling healthy and having a good quality of life.

Key takeaways:

‧ Male sex drive and testosterone levels decrease with age.

‧ Less sex does not mean less sexual satisfaction.

‧ Good health improves sexual function and sexual quality of life at any age.

‧ Aerobic exercise can improve sexual function and sexual satisfaction.

However, as men age and their bodies change, so does their sex drive. Sex drive tends to decrease with age after it peaks in men in their 20s, but that does not mean that aging has to have a negative effect on sex.

Age, sex drive, and sexual satisfaction

Most men (and women) are more sexually active in their 20s than in any other decade of life. Men’s sex drives seem to peak in their 20s and begin to decrease in their 30s and onward slowly. Men in their 40s and older are also more likely to have problems with sexual function, including erectile dysfunction.

Men have less sex as they get older, but that is only half the story. Sexual satisfaction does not necessarily decrease with age.

A study in Norway found that although sexual activity decreases with age and sexual dysfunction increases with age, sexual satisfaction is more complex. According to the study, men in their 20s had the highest level of sexual satisfaction, followed by men in their 50s. Surprisingly, despite increased sexual dysfunction and decreased sex drive, men in their 50s reported higher sexual satisfaction than those in their 30s and 40s.

Another study from the US found that overall, sexual quality of life tended to decrease with age but was higher in older people who had a better quality of sex. The authors attributed this to “sexual wisdom”—better sex through past experience. No matter the cause, this is certainly good news for anyone worried about their odds of having a fulfilling sex life as they age.

Testosterone and sex drive

Testosterone levels play a major role in the male sex drive. Testosterone is the primary sex hormone responsible for male sexual development and is also associated with sex drive. Research has shown that men’s testosterone levels decline with age beginning after age 30, and reach their lowest levels after age 70—when sex drive is at its lowest.

Low testosterone in men is called male hypogonadism. Hypogonadism in men can cause or contribute to lower sex drive, erectile dysfunction, infertility, loss of bone mass, loss of muscle mass, and depression.

Testosterone replacement therapy can treat male hypogonadism, and research shows that in older men, it can improve sexual activity, sexual desire, and erectile dysfunction. In a study of men with poorly controlled type 2 diabetes, testosterone replacement therapy was shown to improve not only sexual function but also the quality of life and memory.

While considered a normal part of aging, low testosterone can be caused by various medical conditions, including head injuries and some medications. Certain prescription medications can decrease testosterone levels, including opioids (painkillers), hormone therapy for prostate cancer, and a few other drugs.

Remember, do not stop taking any medication without first talking with your healthcare provider. If you are concerned about your testosterone levels, discuss it with your doctor or another healthcare provider.

Better health means better sex

As men age, health plays an increasingly important role in their sex life. According to research, people in better health are more interested in sex, have sex more often, and have a better sexual quality of life. On the other hand, high blood pressure, heart disease, and other conditions that affect blood flow can affect sex drive and contribute to male sexual dysfunction.

Medications can also affect sex drive and sexual performance in men, including some prescription medications for high blood pressure, depression, prostate disease, and hair loss. Common medications that contribute to low sex drive and sexual dysfunction are beta-blockers, diuretics, and finasteride (Propecia, Proscar). Always discuss possible medication side effects with your healthcare provider—the benefits may outweigh the drawbacks.

Erectile dysfunction

Along with a decreased sex drive, aging, poor health, and certain medications can also lead to erectile dysfunction—a known contributor to depression. Fortunately, modern medicine has dedicated a great deal of research to improving men’s erections.

Nowadays, there are several ways to successfully improve erectile dysfunction, including penile implants and medications such as sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxn). While these medications are safe for many men, they can cause dangerous side effects in people taking nitrates (such as nitroglycerin, isosorbide, and others).

However, it is possible to improve erectile function with natural means such as CBD oils. The latter is one of the best ways to reduce anxiety and stress interfering with libido. CBD oils and gummies improve blood flow in vessels, thus benefiting erectile function. Full-spectrum CBD oils are believed to be a better choice for erectile dysfunction containing both CBD and THC in moderate amounts.

Exercise can improve sex

It is no secret that aerobic exercise is good for your health. It helps reduce cholesterol, blood pressure, and body fat in addition to decreasing the risk of death from coronary artery disease. Studies also show that aerobic exercise is also important for sexual health.

A study in Japan found that regular aerobic exercise improved sexual function in men aged 43-59. Another group of researchers in the U.S. showed that aerobic exercise—running, cycling, or swimming—improved sexual function in men aged 18-50. The potential for better sex life is excellent motivation to get more exercise,

When do men stop being sexually active?

If you think that people stop being sexually active when they get older, you would be wrong. Research shows that men have a sexual life expectancy well into their 70s. While it is true that sexual activity decreases with age, even the elderly are busy getting busy.

In fact, the 55 and older population has had a significant increase in sexually transmitted diseases (STDs) over the past few decades, including chlamydia, gonorrhea, syphilis, and HIV. While an increase in STDs may be alarming, it clearly indicates that both men and women keep having sex well into old age.

As men age, they tend to have less sex but have high satisfaction with their sex life. Aging and health can have significant effects on sexual function and satisfaction, but medical treatment and exercise can improve both sexual function and sexual satisfaction at any age. If you are concerned about decreased sex drive or sexual dysfunction, talk with your healthcare provider.

Resources:

1. BJU International. Assessment of male sexual function by the Brief Sexual Function Inventory.
2. NIH. Sexual Quality of Life and Aging: A Prospective Study of a Nationally Representative Sample.
3. StatPearls. Physiology, Testosterone.
4. Endocrine Reviews. The Decline of Androgen Levels in Elderly Men and Its Clinical and Therapeutic Implications.
5. Mayo Clinic. Male hypogonadism.
6. The Journal of Clinical Endocrinology & Metabolism. Testosterone Treatment and Sexual Function in Older Men With Low Testosterone Levels.
7. ENDOCRINE SOCIETY. Testosterone improves quality of life, sexual function, and delayed verbal recall in men with uncontrolled type 2 diabetes.
8. ISSM. Can prescription medications affect testosterone levels?
9. thebmj. Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing.
10. NHS. Low sex drive (loss of libido).
11. Mayo Clinic. High blood pressure and sex: Overcome the challenges.
12. MedlinePlus. Finasteride.
13. NIH. Sexuality in Ageing Male: Review of Pathophysiology and Treatment Strategies for Various Male Sexual Dysfunctions.
14. NIH. Increased incidence of depressive symptoms in men with erectile dysfunction.
15. NIH. Health benefits of aerobic exercise.
16. NIH. Regular aerobic exercise improves sexual function assessed by the Aging Males’ Symptoms questionnaire in adult men.
17. NIH. Exercise Improves Self-Reported Sexual Function Among Physically Active Adults.
18. EmergencyMedicineNews. STI Rate Has Doubled Among Senior Citizens.

Relationships Can Affect Testosterone Levels, Doctors Say

5 Ways Your Relationship May Affect Your Testosterone Levels

On the flip side, low testosterone might cause issues with your partner, too.

By Erica Sweeney

Published: Feb 20, 2023

This article is a repost which originally appeared on Men’s Health

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

Key Points

‧ Being in a loving relationship can be good for optimizing hormone levels.

‧ Signs of decreased testosterone levels may include a decline in muscle mass, increased anxiety, and sleep issues.

‧ Seeking out a medical professional is a good idea if there’s a suspicion of low T.

BEING IN A LOVING, committed relationship is good for your health. It can lower stress, give you a sense of purpose, and even strengthen your immune system and help you live longer. There also may be a connection between relationships and your testosterone levels.

While research is mixed on the direct link between testosterone levels and relationships, there’s some evidence that certain aspects of having a partner, like sex and emotional connection, can influence your levels of the hormone. Other not-so-pleasant parts of being in a relationship, such as stress and fighting, might play a role, too.

When your testosterone—the key male sex hormone produced by the testicles—is low, it brings with it symptoms like fatigue, a depressed mood, erectile dysfunction, and low libido—all things that can affect relationships.

“We see that things like mood and stress impact our hormonal axis,” says Ryan Smith, M.D., associate urology professor and urologic microsurgeon specializing in men’s health at the University of Virginia Health. “So, there’s some data to suggest that when you’re in a healthy relationship, you may have lower stress levels and that may play a role.”

You’re likely happier and have an overall sense of well-being, when you’re in a healthy relationship, he adds. “But, how that translates to serum levels [or the measure of testosterone in your blood] is more challenging to interpret.”

Here’s a look at the relationship-testosterone link, specifically how being in a relationship could affect your levels and how low testosterone might affect your relationship. And, what to do if you suspect your testosterone levels are low.

How Relationships Affect Your Testosterone Levels

Overall, studies have shown that men in relationships tend to have lower testosterone. But, there are lots of variables. And, certain elements of relationships can have different effects on your levels, including:

The Length of the Relationship

The excitement and warm, fuzzy feeling of a new relationship may give your testosterone a boost. A 2015 study found that single men and men in new relationships had higher testosterone levels than men in long-term relationships. Researchers concluded that the findings showed that testosterone might play a role in motivating men to seek new mates.

It appears that the longer you’re in a relationship, the bigger impact on your hormonal levels. Research suggests that men who are in committed, romantic relationships (married or unmarried) have about 20 percent lower testosterone than men not in relationships.

How Happy You Are

It’s believed that the lower testosterone among men in long-term partnerships helps them to be more nurturing, which fosters loving, supportive relationships.

A 2016 study published in Hormones and Behavior found that older men with the most emotional support (four or more sources from romantic and social relationships) had lower testosterone than individuals with just one source of support. Lower testosterone helps facilitate supportive relationships, researchers said.

Other research found that the quality of a relationship, including satisfaction, commitment, and investment, lowered testosterone for both men and women, and that couples were more satisfied when one person had lower testosterone.

The Stress Level of Your Relationship

Fighting and conflict happen in every relationship from time to time. How often you have conflict and the stress that comes along with it might cause your testosterone to fluctuate.

In a 2018 study, 50 male-female newlywed couples were asked to discuss four marital problems and how much oppositional behavior they felt from their partner during the discussions. Saliva tests measured their testosterone. Men, but not women, showed “heightened testosterone reactivity” to opposition from their partners.

Some studies have shown that psychological, physical, and actual stress can lower testosterone levels, though.

How Affectionate You Are

Increased testosterone—or even testosterone replacement therapy—is often linked to rage and aggression, but that’s generally a myth, says Brian Black, D.O., an osteopathic board-certified physician in family medicine. “There are many other factors that contribute to aggressive behavior, such as genetics, environment, and upbringing.”

A study with animal subjects published in 2022 showed that testosterone increased nonsexual and prosocial behaviors in male rodents. When the subjects received a testosterone injection while with their partners, they showed “positive social responses,” like cuddling. Testosterone influences the activity of oxytocin cells, also known as the love hormone. So, that’s great news if you and your partner are regular cuddlers and generally affectionate.

How Much Sex You Have

Testosterone is responsible for sexual functioning, including getting erections and a healthy libido. Research is mixed on whether having sex regularly influences testosterone levels, although the testosterone-sex link is often seen when men start testosterone therapy. “Many see improvements in certain aspects of sexual health,” Dr. Smith says.

How Low Testosterone Might Impact Your Relationship

Testosterone plays a crucial role in many bodily functions. When your levels are low, you might experience a range of symptoms that could impact your relationship.

Not everyone with low testosterone, or hypogonadism, experiences symptoms, Dr. Black says. Those who do might have “decreased libido, erectile dysfunction, and decreased muscle mass.”

Decreased sex drive and erectile dysfunction could affect your sex life. This might increase stress, affect your sleep and cognitive function, and cause a disconnection with your partner.

“All those things could translate to having impacts on a relationship,” Dr. Smith says. “If a man undergoes treatment, if libido and potentially erectile function improve, maybe we could see that translating to improvement in their relationship.”

Low testosterone has also been linked to fatigue, depression, and a change in mood, Dr. Black says. There’s a connection between depression and relationship problems. When you’re generally not feeling well or like yourself, it can be difficult to connect with others, including your partner.

If you find that you’re experiencing any of these symptoms, it’s a good idea to talk to your doctor, Dr. Black emphasizes. They may recommend getting your testosterone levels checked and potentially prescribe testosterone replacement therapy.

 

 

 

 

 

5 reasons for low sex drive in men these days and how to treat it

TIMESOFINDIA.COM | Last updated on -Mar 11, 2023, 00:00 IST

This article is a repost which originally appeared on Times Of India

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

Key Points

‧ 1 in 5 men experience low libido.

‧ There could be several reasons why men experience low libido or ED (Erectile Dysfunction).

‧ Stress can cause low libido through different feedback loops.

01/7 Reasons for lack of sexual desire

Among every 5 men 1 faces the problem of low libido due to various reasons like stress or hormonal imbalances that make them want to avoid any kind of sexual activity. Yet, sometimes a loss of sex desire is a symptom of a deeper issue. Men’s decrease of sex desire can frequently be attributed to depression, stress, drunkenness, illicit drug usage, and weariness.

Here are several reasons why men may experience low sex drive:

02/7 ​​Stress: ​

High levels of stress can affect testosterone levels and reduce sex drive. If a person is distracted by a certain situation or goes through severe mental pressure, then his sexual drive decreases.

03/7​​ Hormonal imbalances:​

Dr. Caranj S.V., M.B.B.S., M.S. (General Surgery), M.Ch. (Urology), Medical expert with Kindly Health says, “Issues such as low testosterone levels, can lead to decreased sex drive. Men who have hypogonadism are determined to struggle with the problem of low testosterone levels estimated below 300 ng/dl. Such men face a lack of urge for any sexual activity.

04/7 ​​Medications: ​

Some medications can have side effects that reduce sex drive, such as antidepressants and blood pressure medications. Men taking radiation treatments or chemotherapy for cancer suffer from decreased sex drive along with those who take anabolic steroids like sportsmen.

05/7​​ Poor lifestyle habits: ​

Poor diet, lack of exercise, smoking, consumption of excessive alcohol, and drug use can all contribute to low sex drive. Also, if proper sleep and rest are not taken then that also creates problems and causes low sex drive.

06/7 ​​Relationship issues: ​

Problems with a partner, such as communication issues or unresolved conflicts, can reduce sexual desire.

07/7​​ The solution to low sex drive in men include:​

Addressing stress: Finding ways to manage stress, such as through exercise, meditation, or therapy, can help improve sex drive. Adopting a healthier lifestyle: Cessation of smoking, eating a balanced diet, exercising regularly, and reducing alcohol and drug use can all help improve sex drive. Treating hormonal imbalances: According to Dr. Caranj, “If low testosterone levels are the cause, hormone replacement therapy may be necessary.” Addressing relationship issues: Working with a partner to address communication issues and resolve conflicts can help improve sexual desire. Switching medications: If medication side effects are the cause, switching to a different medication may be necessary.

Can Low Testosterone Cause Anxiety and Depression?

October 6, 2022 / Men’s Health

Low testosterone levels can mimic symptoms of depression and cause anxiety over time

This article is a repost which originally appeared on Cleveland Clinic healthessentials.

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

Our takes:

‧ Low testosterone will manifest itself via several symptoms.

‧ Depression can be a symptom but can also be a contributing factor to developing low T.

‧ Having too high levels of T may result in irritability/becoming easily angered.

If you’re experiencing low sex drive, diminishing energy and overall fatigue, you may feel like it’s just another part of getting older. But if you’re a man or a person assigned male at birth (AMAB) and you’re experiencing a host of physical symptoms, coupled with a consistent depressive mood, you could actually be dealing with hypogonadism (low testosterone) or undiagnosed depression.

But figuring out whether you’re dealing with depression or low testosterone is tricky and requires further examination from a healthcare provider. Urologist Lawrence Hakim, MD, explains more about the connection between low testosterone and your mood, and how these conditions may be related.

How low testosterone impacts your mood

Androgens, including testosterone, are the hormones that give people their “male” and “female” characteristics. They also play a critical role in puberty, the development of your sexual reproductive system and your ability to reproduce.

You can think of all hormones, including androgens, like switches on a circuit board: When the production of these hormones are turned on or off, different things happen. You can experience physical, mental and emotional changes whenever production of these hormones increase, decrease or stop completely. The severity of these changes can vary widely from one hormone to the next, and these changes don’t happen in a vacuum. When the levels of one hormone changes, others may change in response. An increase in one hormone might mean a decrease in others. And when you have these hormonal imbalances, it can cause a variety of conditions to develop.

Testosterone levels tend to decrease normally as you get older, but they can also fluctuate for many reasons. Studies show these changes in testosterone can impact your mood in different ways. And these changes can occur in response to many different factors, including stress, lack of sleep, changes in your diet, aging and increasing or decreasing your physical activity.

If your testosterone levels are too high, for example, you may feel irritable or quick to anger. In comparison, low testosterone can make you feel extremely tired, depressed, weak or low in energy.

“People with hypogonadism, or low testosterone, will often say they have no energy, no desire for sexual activity and that they noticed a decrease in muscle mass,” says Dr. Hakim.

“In fact, hypogonadism is often associated with increased fat mass and reduced muscle mass, which can lead to obesity and other health risks, including cardiovascular disease. Those are all common signs and symptoms that may be associated with low testosterone.”

Signs and symptoms of low testosterone and depression

Low testosterone and depression share a lot of the same symptoms, including:

‧ Irritability.
‧ Mood swings.
‧ Decreased libido.
‧ Fatigue.
‧ Lack of motivation.
‧ Social withdrawal.
‧ Anxiety.
‧ Difficulty focusing.
‧ Interrupted sleep and restlessness.

“When we say people are depressed, what are we describing? We’re often describing someone as having low energy and no desire to partake in activities that normally bring them pleasure — these are common things we see with low testosterone, too,” notes Dr. Hakim. “Sometimes, people are actually misdiagnosed with clinical depression and they might instead have low testosterone or hypogonadism. It is therefore important to rule-out a physical cause of the condition, such as hypogonadism, prior to treatment.”

Various physical symptoms may be associated with either depression or low testosterone. People who have depression might complain of back pain or neck pain, but might not experience other symptoms typically associated with low testosterone that include:

‧ Decrease in muscle mass.
‧ Increase in breast tissue.
‧ Loss of strength.
‧ Sudden weight gain.
‧ Erectile dysfunction

And if you also have depression or even an anxiety disorder, your symptoms may worsen over time if low testosterone levels are leading to a further decline in sexual performance and libido.

“If you come in to see your doctor with any of these symptoms, especially if you have some form of sexual dysfunction, it is important to evaluate your total and free testosterone levels, since hypogonadism may be the underlying cause,” advises Dr. Hakim. “You don’t want to ignore low testosterone. You want to address it as well as look for any other underlying diagnosis that needs to be addressed.”

When to see a doctor

If you’re experiencing physical symptoms like sudden weight gain or decrease in your sex drive or sexual performance and other mental and emotional symptoms, you should talk to a doctor about testing your testosterone levels. There are many effective treatment options to restore your testosterone levels to the normal range, if your testosterone levels are abnormally low. But even if you discover you don’t have low testosterone levels, understanding those test results will often provide some reassurance and help your healthcare provider better understand and manage your symptoms.

“Many of these symptoms, especially as men get older, can be due to other factors such as stress, anxiety, pressure, work, aging, relationship issues and even other medications,” says Dr. Hakim. “Ultimately, a multispecialty approach is important to assure the best outcomes and patient satisfaction.”

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

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)

 

 

 

 

 

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

The ketogenic diet corrects metabolic hypogonadism and preserves pancreatic ß-cell function in overweight/obese men: a single-arm uncontrolled study

The ketogenic diet corrects metabolic hypogonadism and preserves pancreatic ß-cell function in overweight/obese men: a single-arm uncontrolled study

This article is a repost which originally appeared on PUBMED

Edited for content.

Endocrine. 2021 May;72(2):392-399. doi: 10.1007/s12020-020-02518-8. Epub 2020 Oct 15.

Sandro La Vignera, Rossella Cannarella, Fabio Galvano, Agata Grillo, Antonio Aversa, Laura Cimino, Cristina M Magagnini, Laura M Mongioì, Rosita A Condorelli, Aldo E Calogero

PMID: 33063272 PMCID: PMC8128723 DOI: 10.1007/s12020-020-02518-8

Abstract

Background: Overweight and obesity are increasingly spread in our society. Low testosterone levels are often present in these patients, the so-called metabolic hypogonadism, that further alters the metabolic balance in a sort of vicious cycle. Very low-calorie ketogenic diet (VLCKD) has been reported to efficiently reduce body weight, glycaemia, and the serum levels of insulin, glycated hemoglobin, but its effects on β-cell function and total testosterone (TT) levels are less clear.

Aim: To evaluate the effects of VLCKD on markers suggested to be predictive of β-cell dysfunction development, such as proinsulin or proinsulin/insulin ratio, and on TT values in a cohort of overweight or obese nondiabetic male patients with metabolic hypogonadism.

Methods: Patients with overweight or obesity and metabolic hypogonadism underwent to VLCKD for 12 weeks. Anthropometric parameters, blood testing for the measurement of glycaemia, insulin, C-peptide, proinsulin, TT, calculation of body-mass index (BMI), and HOMA index were performed before VLCKD and after 12 weeks.

Results: Twenty patients (mean age 49.3 ± 5.2 years) were enrolled. At enrollement all patients presented increased insulin, HOMA index, C-peptide, and proinsulin levels, whereas the proinsulin/insulin ratio was within the normal values. After VLCKD treatment, body weight and BMI significantly decreased, and 14.9 ± 3.9% loss of the initial body weight was achieved. Glycaemia, insulin, HOMA index, C-peptide, and proinsulin significantly decreased compared to pre-VLCKD levels. Serum glycaemia, insulin, C-peptide, and proinsulin levels returned within the normal range in all patients. No difference in the proinsulin/insulin ratio was observed after VLCKD treatment. A mean increase of 218.1 ± 53.9% in serum TT levels was achieved and none of the patients showed TT values falling in the hypogonadal range at the end of the VLCKD treatment.

Conclusions: This is the first study that evaluated the effects of VLCKD on proinsulin, proinsulin/insulin ratio, and TT levels. VLCKD could be safely used to improve β-cell secretory function and insulin-sensitivity, and to rescue overweight and obese patients from β-cell failure and metabolic hypogonadism.

Keywords: Insulin; Metabolic hypogonadism; Proinsulin; Testosterone; VLCKD; β-cell dysfunction.

Conflict of interest statement

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

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Why is My Penis Small, or is it?

Why is My Penis Small, or is it?

Medically reviewed by James Keith Fisher, MD on February 26, 2019 — Written by Eleesha Lockett, MS

This article is a repost which originally appeared on HealthLine

Edited for content

When Penises Are Small

How do we decide what’s small?

What’s too small? What’s too big? Research suggests that many men desire a bigger penis regardless of whether they think that their penis size is average or not. And, some men believe they have a small penis when it’s actually within the average range.

This article will look at the science behind the average penis size, how to measure your penis, and the conditions that can cause a penis to be or seem smaller than usual.

What’s average?

The average length of a penis is roughly 3.6 inches flaccid and 5.2 inches erect. But how did this become the number?

Research on penis size

There have been several studies over the years that have attempted to give a definite number for the average penis size.

One smaller 2014 study in the Journal of Sexual Medicine looked at the average penis size in 1,661 men. The researchers found that the average erect penis length and circumference of participants was 5.6 inches (14.15 centimeters) and 4.8 in. (12.23 cm), respectively.

Another larger study from 2014 compiled data from over 15,000 men to determine average size. In this study, length and circumference measurements were taken both flaccid and erect. The results determined the average penis length to be 3.6 in. (9.16 cm) while flaccid and 5.2 in. (13.12 cm) while erect. In addition, the average penis circumference was measured as 3.7 in. (9.31 cm) while flaccid and 4.6 in. (11.66 cm) while erect.

It’s important to note that the first study used self-reported measurements, while the second study used measurements taken by a health professional. Both studies have their limitations, but the numbers reported are consistent with similar studies on average penis size.

Perspective

Keep in mind that sizes of “small” and “large” are comparative and that averaging penis size is based on what’s known. Known measurements, even a substantial study where more than 15,000 men were measured, are based on groups. The United Nations reported the world’s male population to be at about 3.8 billion in 2017. That means 15,000 men is only about 0.0004 percent of the world’s male population.

Collectively, average measurements from similar studies set a good average and are important to have, but there’s always more to know.

How to measure your penis

If you’re curious about how to measure the size of your penis, here’s a correct way to get an accurate measurement:

  1. You will need to have either a tape measure or ruler on hand.
  2. To measure the length, start your measurement at the base of the penis, where the penis meets the pubic bone.
  3. Run the ruler or tape measure along the full length of the penis from the base to the tip (glans). Do not measure excess foreskin length.
  4. To measure the girth, wrap a flexible tape measure around the shaft of the penis at the base or around the midpoint between the base and head.
  5. If you are measuring your penis flaccid, be careful not to pull on or stretch it as this can potentially cause injury.

When do penises grow?

Research suggests that there are different periods of penis growth throughout the life cycle. In one study, researchers tracked penis size in more than 3,000 males from birth to 16 years old.

They found that on average, the penis grew rapidly from birth until about 1 year of age. From the ages of 1 to 11, penis growth slowed down to some extent. At about age 11 and entering puberty, the researchers observed another period of rapid growth.

When penises seem small

Most males fall into the range of average penis size. However, some boys and men may have what is known as a micropenis. Also, not all small penises are micropenises.

Micropenis

Micropenis is a condition, most often diagnosed in infants, characterized by a penis that falls below the average size range. The criteria for micropenis in infants is generally a penis size of smaller than .75 in. (1.9 cm), based on the stretched penis length.

According to University of Rochester Medical Center, one of the most common complications of micropenis is lowered fertility due to a decreased sperm count.

A sex hormone imbalance called hypogonadism is a leading cause of micropenis.

Although there are different treatment approaches for micropenis, hormone treatment can be key in treating babies. Early administration of testosterone may even help to increase penis size by 100 percent during the initial course of treatment for an infant.

In cases where hormone treatment doesn’t work, surgery may be an option, while speaking with mental health professional can provide more long-term benefits.

Inconspicuous penis

Inconspicuous penis is an umbrella term for any number of conditions that cause the penis to appear smaller than normal.

The following conditions are all linked to having a smaller than usual penis size.

  • Buried penis. Buried penis is primarily caused by an excess accumulation of skin around the penis. The penis may be buried, or hidden, beneath the abdomen, scrotum, or even thigh. In most cases, the penis is a normal length and functions normally. However, this condition may cause difficulty with sexual arousal and function as well as urination.
  • Webbed penis. Webbed penis occurs when the skin of the scrotum is attached too high on the penis. This can affect the angle at which the penis rests, causing it to appear “webbed” and shorter than normal. Cosmetic surgery is a common treatment approach for this condition.
  • Trapped penis. Trapped penis can occur as the result of a circumcision not healing correctly. With a trapped penis, the scar tissue from the circumcision causes the penis to become trapped beneath the healed skin. This condition can cause serious issues with urinary dysfunction, so steroid therapy or surgery are necessary.

Many of these conditions are uncommon, affecting a small portion of the population. In all cases, however, it’s important to remember that penis size does not necessarily determine sexual attractiveness.

Penis size is only one small element in a list of items sexual partners find attractive — with emotional attractiveness being near the top. Besides, one 2006 study found that almost 85 percent of women are content with the size of their partner’s penis.

The takeaway

Although many men are concerned that their penis is too small, research has shown that most men have an average-sized penis. It’s also important to remember that penises, just like vaginas, come in all different shapes and sizes. There is no one perfect penis, and penis size does not determine your sexual attractiveness or self-worth.

For those who fall outside of typical penis size range for any reason, there are interventions that can help promote a positive and fulfilling sex life. If you are still concerned with your penis size or feel that it’s affecting your sex life, reaching out to a sex therapist can help.  [Editor’s Note: There are plenty of techniques for increasing the size of your penis using manual exercises on PEGym.]

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.

Testes: Anatomy and Function, Diagram, Conditions, and Health Tips

Testes: Anatomy and Function, Diagram, Conditions, and Health Tips

Medically reviewed by Alana Biggers, MD on May 29, 2018 — Written by Tim Jewell

This article is a repost which originally appeared on HealthLine

Edited for content

What are testes?

The testes — also called testicles — are two oval-shaped organs in the male reproductive system. They’re contained in a sac of skin called the scrotum. The scrotum hangs outside the body in the front of the pelvic region near the upper thighs.

Structures within the testes are important for the production and storage of sperm until they’re mature enough for ejaculation. The testes also produce a hormone called testosterone. This hormone is responsible for sex drive, fertility, and the development of muscle and bone mass.

Anatomy and function of testes

The main function of the testes is producing and storing sperm. They’re also crucial for creating testosterone and other male hormones called androgens.

Testes get their ovular shape from tissues known as lobules. Lobules are made up of coiled tubes surrounded by dense connective tissues.

Seminiferous tubules

Seminiferous tubules are coiled tubes that make up most of each testis. The cells and tissues in the tubules are responsible for spermatogenesis, which is the process of creating sperm.

These tubules are lined with a layer of tissue called the epithelium. This layer is made up of Sertoli cells that aid in the production of hormones that generate sperm. Among the Sertoli cells are spermatogenic cells that divide and become spermatozoa, or sperm cells.

The tissues next to the tubules are called Leydig cells. These cells produce male hormones, such as testosterone and other androgens.

Rete testis

After sperm is created in the seminiferous tubules, sperm cells travel toward the epididymis through the rete testis. The rete testis helps to mix sperm cells around in the fluid secreted by Sertoli cells. The body reabsorbs this fluid as sperm cells travel from the seminiferous tubules to the epididymis.

Before sperm can get to the epididymis, they can’t move. Millions of tiny projections in the rete testis, known as microvilli, help move sperm along to the efferent tubules.

Efferent ducts

The efferent ducts are a series of tubes that join the rete testis to the epididymis. The epididymis stores sperm cells until they’re mature and ready for ejaculation.

These ducts are lined with hair-like projections called cilia. Along with a layer of smooth muscle, cilia help move the sperm into the epididymis.

The efferent ducts also absorb most of the fluid that helps to move sperm cells. This results in a higher concentration of sperm in ejaculate fluid.

Tunica: Vasculosa, albuginea, and vaginalis

The testes are surrounded by several layers of tissue. They are the:

  • tunica vasculosa
  • tunica albuginea
  • tunica vaginalis

Tunica vasculosa is the first thin layer of blood vessels. This layer shields the tubular interior of each testicle from further layers of tissue around the outer testicle.

The next layer is called the tunica albuginea. It’s a thick, protective layer made of densely packed fibers that further protect the testes.

The outermost layers of tissue are called the tunica vaginalis. The tunica vaginalis consists of three layers:

  • Visceral layer. This layer surrounds the tunica albuginea that shields the seminiferous tubules.
  • Cavum vaginale. This layer is an empty space between the visceral layer and the outermost layer of the tunica vaginalis.
  • Parietal layer. This layer is the outermost protective layer that surrounds almost the entire testicular structure.

What conditions affect the testes?

Many conditions can affect the testes. Here’s a list of some of the most common ones.

Hydrocele

A hydrocele happens when excess fluid builds up in the cavities around one of your testicles. This is sometimes present at birth, but it can also result from an injury or inflammation.

Hydrocele symptoms include:

  • testicular swelling that gets more noticeable as the day goes on
  • a dull ache in your scrotum
  • feeling heaviness in your scrotum

Hydroceles usually don’t require treatment unless they’re very large or painful. Most go away on their own, but more severe cases might require surgical removal.

Testicular torsion

Testicular torsion means that your testicle has rotated in the scrotum. This can wind up the spermatic cord, cutting off blood supply, nerve function, and sperm transport to your scrotum.

Symptoms of testicular torsion include:

  • severe scrotum pain
  • swelling of the testicle
  • lower abdominal pain
  • feeling nauseous
  • vomiting
  • feeling like the testicle is out of place
  • urinating more than usual

Several things can cause testicular torsion, including:

  • injury to the scrotum
  • exercising too long or hard
  • being exposed to cold temperatures
  • free movement of the testicle in the scrotum caused by a genetic condition

Your doctor can treat testicular torsion by moving the testicle by hand. Some cases might require surgery to untwist the spermatic cord.

Orchitis

Orchitis refers to a swollen or inflamed testicle. Like epididymitis, orchitis often results from an infection caused by an STI.

Orchitis symptoms include:

  • testicular pain and tenderness
  • a swollen testicle
  • fever
  • feeling nauseous
  • vomiting

Both bacterial and viral infections can cause orchitis. A combination of antibiotics or antiviral medication, along with nonsteroidal anti-inflammatory drugs or cold packs can help reduce discomfort and pain. Orchitis usually disappears in 7-10 days.

Hypogonadism

Hypogonadism happens when your body doesn’t make enough testosterone. It can result from a testicular issue or because your brain doesn’t properly stimulate hormone production.

You can be born with this condition. It can also happen due to an injury, infection, or other condition that affects testosterone production.

Symptoms of hypogonadism vary depending on age:

  • In infants. The genitals might not be clearly male, or both sets of genitals might be present.
  • In teenagers. Symptoms may include:
    • a lack of muscle development
    • little body hair growth
    • no voice deepening
    • unusual arm and leg growth relative to the rest of the body
  • In adults. Symptoms may include:
    • a lack of fertility
    • loss of body hair
    • growth of breast tissue
    • loss of bone density
    • an inability to get an erection

Hypogonadism is usually treated with hormone replacement therapy. It’s aimed at either the brain or testes, depending on the source of low testosterone production.

Testicular cancer

Testicular cancer happens when cancerous cells multiply within the tissue of your testicles. It commonly starts in the tubular testicle structures that help produce sperm.

The cause of testicular cancer isn’t always clear.

Symptoms of testicular cancer can include:

  • a lump in your testicle
  • feeling heaviness in your scrotum
  • fluids in your scrotum
  • testicular pain
  • abdominal or back pain
  • swollen or tender breast tissue

Sometimes, your doctor can surgically remove the affected tissue. In other cases, you may need to have an entire testicle removed. Radiation therapy or chemotherapy can also help destroy cancer cells.

What are common symptoms of a testicular condition?

See your doctor if you notice any of the following symptoms in one or both of your testes:

  • long-term pain that’s either dull or sharp
  • swelling
  • tenderness
  • a sensation of heaviness

Other symptoms of a problem with the testes include:

  • feeling sick
  • throwing up
  • abnormal abdominal or back pain
  • having to pee frequently
  • abnormal growth of breast tissue

Tips for healthy testes

Try the following to keep your scrotum in good health:

Do a monthly testicular self-exam

Roll each testicle around in your scrotum using your fingers. Check for lumps and swollen or tender areas.

Bathe regularly

Take a shower or bath every day to keep your entire genital area clean. This reduces your risk of infections that can cause other complications. Keep your penis and scrotal area dry after bathing. Moisture trapped in the area can quickly become a breeding ground for bacteria.

Wear loose, comfortable clothing

Try to avoid wearing tight underwear and pants. Allow your scrotum to hang naturally from your body to help keep the scrotal temperature low and prevent injury.

Wear protection when you have sex

Wear a condom when doing any kind of sexual activity involving your penis. This helps to prevent sexually transmitted diseases that affect your scrotum and testicles.

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.