Do Eating Disorders Affect Sexual Health?

Yes, Bulimia Can Affect Men’s Sexual Health

This eating disorder may cause a drop in testosterone and lead to a number of issues.

Author: David Hopper
Published: May 18, 2023

This article is a repost which originally appeared on Giddy

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

Key Points

‧ Eating disorders can have serious repercussions on hormone levels and health.

‧ Many eating disorders in men go unnoticed.

‧ Other risky behaviors often accompany eating disorders.

Chris, a 40-year-old man, had been struggling with body image and shame when he went to see a sex therapist. The body image issues had led to a manifestation of bulimia nervosa, a potentially life-threatening eating disorder marked by overeating or binging and, commonly but not always, self-induced vomiting.

Chris’s partner had made hurtful comments about him “finishing too fast” and threatened to leave the relationship because he was not “man enough,” said Robyn Flores, M.S., L.M.F.T., a sex therapist and doctoral candidate who provides client care in Texas and Colorado for Respark Therapy. She worked with Chris.

Editor’s note: We have changed Chris’ name so Flores could speak freely about his case.

“He feared abandonment and the potential end of the relationship, so he decided to restrict his diet,” Flores explained.

One patient beats his eating disorder

During this time, Chris internalized most of his emotions, fearing expressing them would push his partner away even more. He hit a point when he entered the binge-restrict cycle. He started bingeing on food, then either exercising for several hours or purging for a sense of “relief” from the feelings of shame he incurred by eating the “bad” food, Flores said.

In therapy, Flores explored how Chris’ binge cycle began and what perpetuated it as she guided him in taking steps to break the cycle.

“He was initially shamed for experiencing pleasure through sex, then criticized, and experiencing pleasure with food, and was also criticized,” Flores said. “He was in an invalidating relationship in which his needs for comfort and acceptance were not present.”

Fortunately, through a combination of radical acceptance and mindfulness, as well as care from a registered dietitian, Chris was able to overcome his eating disorder.

What is bulimia?

Eating disorders are a psychiatric category of illnesses in which individuals have maladaptive behaviors regarding their eating, or lack thereof, or harmful behaviors that involve food intake, according to Roberto Olivardia, Ph.D., a clinical instructor of psychology at Harvard Medical School.

“Eating disorders are very dangerous,” Olivardia said. “Eating disorders are psychiatric diagnoses, but they’re also medical diagnoses. They absolutely have a whole host of different adverse and negative consequences.”

Common eating disorders include anorexia nervosa, bulimia nervosa, binge eating disorder and avoidant restrictive food intake disorder (ARFID).

Studies show that anywhere from 25 percent to 30 percent of people with eating disorders are male, and approximately 1 percent to 1.5 percent of the United States male population will struggle with bulimia at some point in their lifetime.

“Bulimia nervosa is a condition where someone tries to achieve a certain body ideal by doing things to make up for what they’ve eaten,” said Jason Nagata, M.D., an assistant professor of pediatrics at the University of California, San Francisco and an expert on eating disorders. “The classic bulimic behaviors in women include vomiting, fasting or use of laxatives to prevent weight gain. In men, compensatory behaviors can include excessive exercise and using muscle-building drugs or supplements.”

Bulimia involves repeatedly eating large amounts of food in a short period of time. Nagata pointed out that the volume of food consumption during binge eating episodes may be larger in men than in women.

“For men, eating a lot of food in one sitting might be called a ‘cheat meal’ and seen as a good thing if they are trying to build muscle,” Nagata said.

What causes bulimia?

The causes of bulimia are similar in men to what they are in women. That list includes a complex array of factors, according to Meghan Gillen, Ph.D., an associate professor of psychology at Penn State Abington who studies eating disorders.

Bulimia can be genetic. If a man has a family member who struggled with an eating disorder, he’s more likely to have one. Feelings of depression, stress or anxiety can be contributing factors, too.

“Food can sometimes feel like a form of self-medication to ease someone’s negative emotions,” Gillen said.

Men with bulimia tend to be impulsive and might struggle with impulse control issues, and the disorder often co-occurs with substance use, Olivardia explained.

“It’s often characterized by people who have some emotional dysregulation issues, where it’s very difficult for them to manage their feelings and their emotions,” he said.

What often precipitates bulimia is the dieting behavior of restricting and not eating enough.

“Then nature overrides that and says, ‘We’re gonna eat a lot.’ And then they binge,” Olivardia said.

Athletes are at higher risk for bulimia due to the weight cutting or gaining involved with certain sports. Past experiences or trauma can also contribute to the development of bulimia. For example, being teased or bullied about their body or appearance could lead them to feel worthless.

Compounding these facts is the fact that we live in a culture that dictates certain bodies are more valued and idealized, according to Olivardia.

Bulimia and sexual health

Eating disorders tend to affect sexual function. In men, eating disorders can lead to low testosterone levels and a reduced sex drive.

Low-T and libido

“When a man’s body does not get enough nutrition, the body enters a starvation state, and testosterone production is reduced,” Nagata said.

Bulimia can result in a low body mass index (BMI) because of purging or excessive exercise.

“Their BMI may decrease, and that can lead to lower testosterone, which can affect their libido,” Gillen said. “It can also impact their sperm count as well.”

Risky sexual behavior

Some eating disorder behaviors, such as vomiting, may even be associated with more sexual partners and unprotected sex.

“An explanation for why people with bulimia nervosa engage in purging behaviors is that they may be more impulsive, which can also lead to risky sexual behaviors,” Nagata said. “Men who have impulsive personalities may have a higher chance of developing both disordered eating habits and engaging in more sexual behaviors.”

Men who have bulimia may take muscle-building supplements and drugs such as anabolic steroids. Men who use these performance-enhancing drugs have been found to have more sexual partners and are at a higher risk of getting sexually transmitted infections (STIs) compared to men who don’t use them.

Self-consciousness about sex

Because eating disorders make men feel anxious or self-conscious about their bodies, this can have a psychological impact during sex.

“That can affect men’s confidence,” Gillen said. “If someone is really concerned about their body, they may feel more uncomfortable in sexual situations.”

Does bulimia cause infertility?

Bulimia in men is understudied and underreported. The effect bulimia has on women has received much more attention.

“I think we don’t know as much about men; there’s just not as much work on it,” Gillen said. “For women, when they get to that lower BMI, it affects their menstrual cycles, and that has a number of implications for women’s fertility and general overall health.”

For men, it’s not as clear-cut.

“It’s much more objective for women than for men,” Gillen said. “We need more research on how it impacts men’s fertility.”

Nagata said he’s not aware of any studies specifically examining bulimia and infertility in men.

“However, eating disorders can lead to lower levels of follicle-stimulating hormone [FSH] in men, an important hormone for stimulating sperm production,” he explained.

If you or a loved one are struggling with an eating disorder, Nagata recommends seeking professional help.

“Eating disorders are best supported by an interdisciplinary team, including a mental health, medical and nutrition provider,” he said.

How Can Sleep Affect Men’s Health?

By Hidaya Aliouche, B.Sc.
Reviewed by Sophia Coveney

This article is a repost which originally appeared on News Medical

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

Key Points

‧ Adults should get an average of 8 hours of sleep per night.

‧ A lack of good sleep can cause many serious maladies.

‧ The use of a CPAP can be beneficial in many cases of sleep apnea

Sleep is known to affect several systems and processes in the body. Overarchingly, sleep deprivation is associated with negative health consequences.

With regards to specific effects of sleep on men’s health, dysfunctional sleeping patterns have been shown to impact erectile dysfunction, lower urinary tract symptoms, hypogonadal symptoms, low testosterone, and male infertility.

What is considered to be appropriate sleep?

The average number of hours of sleep required for an adult is between 7–9 for optimal health. However, a considerable number of adults do not meet this requirement.

A study conducted in 2012 demonstrated that 29.2% of men achieved an average of 6 hours or less of sleep each evening. the institute of Medicine further estimates that between 50 and 70 million Americans suffer from a chronic sleep disorder; this epidemic is associated with societal changes which include increased reliance on technology, increased working hours, and poor sleep hygiene.

In addition, non-standard shift working patterns can divulge significantly from circadian patterns which further increases the risk of impaired sleep quality.

The interrelationship between disrupted or inadequate sleep and the manifestation of disease

The relationship between health and sleep is bi-directional. There are several medical conditions associated with inadequate or disrupted sleep which include restless leg syndrome, insomnia, hypogonadism, sleep apnea, and depression.

Furthermore, several studies have revealed that short and sleep or disrupted sleep can produce health conditions including diabetes, coronary heart disease, hypertension, heart attacks, stroke, and several endocrine and cardiovascular disorders. Moreover, poor sleep also impacts the patients’ perception of symptoms and their severity alongside the clinical responses observed.

Combined with independent risk factors such as age, body mass in tax, mental health conditions that affect the perception of symptoms such as depression, and clinical characteristics, sleep functioning can moderate clinical symptoms and impact the quality of life experienced by patients.

Sleep and erectile dysfunction

In the general population, longitudinal studies have revealed that approximately 50% of men experienced erectile dysfunction to some degree. Several studies have reported that sleep can affect erectile dysfunction. For example, a cross-sectional analysis of 2676 men over the age of 67 found that those with a sleep dysfunction called nocturnal hypoxemia were more likely to experience moderate or complete erectile dysfunction.

In the same study, a similar condition that disrupts sleep, sleep apnea, was studied in relation to erectile dysfunction. In a randomized sham-controlled trial, a total of 61 men were assigned to groups to investigate whether the use of continuous positive airway pressure (CPAP) could improve erectile function in men who suffered from both erectile dysfunction and obstructive sleep apnea.

Overall, men who were randomized to CPAP showed no change in erectile dysfunction; however, when further examined in terms of patients who used the CPAP machine for over four hours per night, those who did so experienced a significant improvement. A placebo trial showed that a medication commonly used to treat erectile dysfunction did not significantly improve erectile dysfunction in these men.

These results suggest that in men with obstructive sleep apnea, sleep quality contributes to the condition, and may not respond to first-line treatment for erectile dysfunction with a PDE5 inhibitor; suggesting that in fact, correcting the underlying sleep impairment could produce more significant improvement in erectile dysfunction.

Alongside obstruction to breathing, non-standard shift work that has a significant effect on sleep has been shown to impact erectile dysfunction. A correlation between insomnia and erectile dysfunction has been confirmed by several studies. Some of these studies suggest that the correction of poor sleep in isolation may lead to a clinical improvement in manifestations of erectile dysfunction. This body of research continues to grow.

Sleep and lower urinary tract symptoms

Aging male populations commonly experience lower urinary tract symptoms. This is frequently associated with benign prostatic hypertrophy. Symptoms include poor urine stream, incomplete emptying of the bladder, straining, changes to the frequency of urination, urination hesitancy, and nocturia.

The urge to urinate is often exacerbated during the night, which leads to disrupted sleep and a decrease in overall sleep quality. A survey conducted on 5335 men who were diagnosed with lower urinary tract symptoms demonstrated that only 13% reported continuous sleep periods of more than two to three hours, illustrating the degree to which urinary tract symptoms can affect sleep.

Other studies have verified an association between lower urinary tract symptoms and other sleep-affecting conditions. For example, men with obstructive sleep apnea are more likely to experience urinary tract symptoms compared to those who do not. The severity of obstructive sleep apnea in this context has been found to correlate the most strongly with daytime frequency, urgency, and frequency of nocturia.

CPAP machines have been found to reduce lower urinary tract symptoms in those with obstructive sleep apnea. For example, a man with both lower urinary tract symptoms and obstructive sleep apnea who implemented CPAP for 12 months showed a significant increase in bladder compliance, as well as decreases in nocturia frequency and nighttime urination volumes.

Insomnia is also considered to be an aggravator of lower urinary tract symptoms as well as non-standard shift work.

Sleep and male fertility

Several studies have demonstrated that sperm counts have been decreasing over the past 40 years (50 to 60%). Unlike the linear correlation between erectile dysfunction and sleep, the relationship between sleep and male fertility is less clear.

Evidence suggests that an inverted U shape relationship exists, meaning that excessive and insufficient sleep are equally associated with reduced fertility. In a study of 198 infertile men, this relationship was found. However, interestingly no differences in semen volume, sperm motility, luteinizing hormone, or follicle-stimulating hormone were observed.

An additional study found via testicular biopsies in idiopathic infertile men that full circadian disruption – as manifested by too little or too much sleep – may affect the oxidation state of the testicle, shifting spermatogenesis.

Despite these correlative studies, no studies have assessed the impact of obstructive sleep apnea on fertility. With regards to non-standard shift work which impairs sleep quality, this has been suggested to impair spermatogenesis, although findings from studies have been inconsistent: some studies have demonstrated that men performing shift work had higher odds of experiencing infertility, while others have found no effect.

Conclusion

Poor sleep affects men and women alike. However, the unique effects in men concern urological problems, including erectile dysfunction, lower urinary tract symptoms, hypogonadism, and male infertility.

Alongside these, poor sleep is associated with a higher risk of several health problems that affect the quality of life including but not limited to cognitive impairment, social impairment, mood disturbances, and an increased risk of cardiovascular disease and associated manifestations such as atrial fibrillation.

References

‧  Kohn TP, Kohn JR, Haney NM, et al. (2020) The effect of sleep on men’s health. Transl Androl Urol. doi:10.21037/tau.2019.11.07.
‧  Irer B, Celikhisar A, Celikhisar H, et al. (2018) Evaluation of Sexual Dysfunction, Lower Urinary Tract Symptoms and Quality of Life in Men With Obstructive Sleep Apnea Syndrome and the Efficacy of Continuous Positive Airway Pressure Therapy. Urology. doi:10.1016/j.urology.2018.08.001.
‧  Soterio-Pires JH, Hirotsu C, Kim LJ, et al. (2016)The interaction between erectile dysfunction complaints and depression in men: a cross-sectional study about sleep, hormones, and quality of life. Int J Impot Res. doi:10.1038/ijir.2016.4.
‧  McBride JA, Kohn TP, Rodriguez KM, et al. (2018) Incidence and characteristics of men at high risk for sleep apnea in a high volume andrology clinic. J Urol. 10.1016/j.juro.2018.02.1358.

 

 

Do men have biological clocks? It’s not just women who have to worry about age and fertility, experts say.

Kaitlin Reilly
January 30, 2023

This article is a repost which originally appeared on yahoo!life

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

Key Points

‧ There is not as much data on male fertility compared to female fertility.

‧ Certain birth risk factors go up as men age.

‧ Increased medication use as men age can contribute to fertility problems.

When it comes to fertility, the focus tends to fall on women and their (loudly ticking) biological clocks. Yet it’s not just women who have to take age into account when considering when to have children. Experts agree that men’s fertility also depends on their age.

According to Dr. Jane L. Frederick, a reproductive endocrinologist, women get most of the attention because they have a finite number of eggs at birth and must contend with changes in egg quantity and quality starting at age 35.

“Women play an obvious role in reproduction, leading us to believe that the topics of fertility, pregnancy and childbirth are women’s issues, void of male involvement after they provided sperm,” she explains. “However, older men over the age of 45 are much more likely to have children than four decades ago, and yet few men recognize their biological clock is ticking as well.”

A 2017 study from Beth Israel Deaconess Medical Center and Harvard Medical School looked into IVF patients and found that while women of age 40 to 42 had the most difficult time conceiving, the chance of a live birth decreased with older men — even those whose parters were younger women. Exactly why that is, however, remains to be researched.

Dr. T. Mike Hsieh, the director of UCSD Men’s Health Center and professor of urology, tells Yahoo Life that although there is “not as much data” on male fertility as for females, it’s clear that “increased paternal age is associated with decline in sperm count, sperm quality, semen volume, testosterone and ability for sexual activity or erectile dysfunction.” While there isn’t a “specific cutoff,” what’s generally accepted as advanced paternal age starts at around 45.

Dr. Paul Turek, a urologist and expert on fertility in men, adds that men in their late 50s and 60s experience a “definite decline” in fertility compared with younger men. The cause of this decline, he says, may not only be a body’s biological clock, but also the fact that certain risk factors go up as men age. As he notes, “a body has to be very healthy to be normally fertile.” He adds that the “quality of the DNA package” is “altered or reduced” as men age.

“That means that when the DNA payload gets delivered to the egg at the time of fertilization, it is broken into single strands, rather than intact, in double strands,” Turek explains. “Eggs try as hard as they can to ‘fix’ the DNA early on after fertilization, but if the load of damage is in excess of the egg’s capacity to repair it, then there will be no pregnancy or possibly a miscarriage — another case, at a biological level, of women cleaning up the messes that men make.”

Frederick also points out that “the risk of developing a medical condition or being exposed to environmental toxins increases with age for men,” which may make them less fertile.

“A history of chronic illness, such as sickle cell disease, chronic kidney failure, liver conditions like cirrhosis or malnutrition may have an effect on sperm production,” she notes. “Men who develop medical problems later in life may be taking medications that can affect sperm function in an adverse way.”

Men’s testosterone levels steadily decline over time, which can also affect their ability to father a child.

“Declining testosterone levels in men may cause a decline in sexual desire, problems with erection and difficulty in achieving ejaculation — all contributing to the couple’s infertility,” Frederick explains. “The level of testosterone does appear to influence the sexual function and desire in a man, and testosterone replacement improves erectile function, but also causes sperm production to go down and lead to infertility.”

Ultimately, however, Frederick notes that this field has a long way to go. “Many unknowns remain with regards to the older male and infertility,” she says. “Further research will give us a better understanding of age and its impact on all areas of male infertility.”

 

 

 

 

 

 

 

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

Men’s health: Employers must tackle low testosterone levels

by Helen Lake

Low testosterone is sapping the energy levels of two million men in the UK. Helen Lake discusses some of the issues and misconceptions surrounding low testosterone, as well as outlining the actions that employers can take to support their staff who are suffering with this hard-to-spot condition.

27th Jul 2022

This article is a repost which originally appeared on HRZone.

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

Our Takeaways:

· A large percentage of men suffer from emotional concerns in silence.

· 40% of men aged 45 or older have clinically low levels of testosterone.

· Testosterone Replacement Therapy (TRT) should be considered a tactic of last resort for men with hormonal issues.

It’s estimated that around two million men in Britain suffer from low testosterone levels, making it a very real issue for a large proportion of the UK workforce.

For those working men suffering with it, symptoms can include low energy levels, poor concentration, memory loss and side effects that are often misdiagnosed as depression. Longer term, men living with a testosterone deficiency are more susceptible to serious health issues including cardiac arrest, infertility and osteoporosis.

Recent research by Peppy found that 39% of employees experience disruption due to men waiting until a health problem becomes severe before talking to their HR team.

With low testosterone impacting a man’s general wellbeing, as well as his performance at work – increasingly, there are calls for greater workplace support and awareness around male testosterone deficiency.

Men’s Health Awareness Week recently took place, but we shouldn’t only focus on men’s health during this time. At any point in the year, organisations should examine what can be done to raise the bar for men’s health, including their ‘t-levels’.

Who is impacted by low testosterone?

The research also revealed that an estimated 40% of men aged 45 and older have low testosterone. But, since this is an issue unique to men, it’s likely that the true figures are much higher than are reported.

Testosterone is the male hormone produced that boosts bone strength, powers sex drive, and helps to maintain muscle mass.

An estimated 40% of men aged 45 and older have low testosterone, with the true figure thought to be much higher.

It is mostly produced in the testicles, with production rising rapidly during puberty, triggering a whole host of teenage side-effects in young males and peaking around the 20s.

Levels begin to decline naturally in men by around 2% a year from their mid-30s. By their 40s, the more common symptoms – such as mood swings, low energy, loss of muscle mass, and poor concentration – are more likely to occur.

The imbalance of such a crucial part of a man’s hormonal make-up can have wide-ranging implications, both for him and his workplace.

A wide range of symptoms

While concerns around the impact menopause can have upon women in the workforce have taken deserved precedence in recent years, the issue of low testosterone in men of a working age is a cause for increasing concern among medical professionals.

And it should be for employers, too.

The ‘andropause’, as it’s been dubbed, may not present with as severe a set of symptoms as those experienced by some women during menopause, but the gradual decline in testosterone levels can have a devastating impact on the long-term health of men.

At the heart of the problem, is the fact that low testosterone isn’t always correctly diagnosed. Symptoms are commonly attributed to ‘working too hard’ or just getting older, and are often mistaken for depression – or else not identified at all.

The gradual decline in testosterone levels can have a devastating impact on the long-term health of men.

The symptoms of low testosterone vary between individuals. In some cases, low levels of testosterone do not appear to cause many symptoms for reasons that are not clear.

Impacts on men’s mental health and emotional wellbeing include poor sleep quality, mood swings and irritability – making it an issue employees and employers need to be aware of. Erectile dysfunction is another common sign, but is often viewed as an embarrassing issue that contributes to men suffering in silence.

In more severe cases, a decline in testosterone can affect sperm count and cause men to grow ‘moobs’ or man boobs, due to changes in the body’s fat distribution. The knock-on effect of low testosterone can therefore impact body image, self-confidence, and even family plans.

Most cases are caused by ageing, or through being overweight or type 2 diabetes – both of which are prevalent in the male population of the UK. In addition, low levels of testosterone can affect younger men as a result of stress, lack of sleep, poor diet and lack of exercise.

The impact on male mental health

For many men, low testosterone levels are the real culprit for that general feeling of low mood and exhaustion that so many experience.

But, when men are half as likely as women to visit their GP, many go years if not decades experiencing high levels of fatigue and decreased energy levels without finding out that it is hormone related and treatable.

In the UK today, one in eight men struggle with a common mental health problem such as anxiety or depression, and this is likely to be higher than is officially recorded. One in three men also attribute poor mental health to their job, making this a serious issue for workplaces.

In the UK today, one in eight men struggle with a common mental health problem such as anxiety or depression.

Directly or indirectly, the impact low testosterone levels can have on a man’s health and lifestyle – from loss of libido, to weight gain, to lack of quality sleep, to low mood – is very likely to trickle through to their mental and emotional wellbeing.

For organisations committed to improving their male workforce’s mental health, tackling testosterone must become part of the conversation.

How workplaces can tackle the problem

At present, accessing specific support is difficult for men suffering with low testosterone. Tests are only available on the NHS to those with severe symptoms, and these people must firstly have made an appointment with the GP and made it through the system, just in order to be diagnosed with low testosterone.

Workplaces are uniquely placed to give employees the practical and emotional support they need – and this starts with raising awareness.

Employees of all genders, ages and life stages should be made aware of the signs, symptoms and risks of low testosterone, so they know what to look out for in themselves, their colleagues and even their partners. Providing resources in the workplace for improved physical and mental health for employees should also be a priority.

Organisations should make the pathway to support as easy to access as possible by giving employees access to specialist men’s health support, including highly-trained urology specialist nurses, as well as nutritionists and fitness experts. Crucially for men, support should be available remotely and entirely confidentially to maximise uptake.

The help provided should include access to at-home hormone tests and personalised, expert advice on how to treat the side-effects of low testosterone.

Testosterone replacement therapy (TRT) should always be the last resort.

There is no ‘quick fix’ when it comes to low testosterone levels. Simple lifestyle changes like diet, exercise, sleep and work-life-balance can have a miraculous impact on an individual’s testosterone levels and should be explored first.

Testosterone replacement therapy (TRT) should always be the last resort, with any potential underlying medical cause excluded.

Leading employers are transforming men’s health

Forward-thinking employers and their employees are already reaping the rewards of connecting their people to a team of real, human experts.

With the right tools at their fingertips, individuals from leading consultancy firms, high street retailers and law firms are able to work alongside nutritionists, personal trainers, urology specialists and mental health experts – building the habits that can help to restore healthy testosterone levels.

Because eliminating the unwanted effects of low testosterone won’t just benefit the individual, but their workplace as well.

With the right holistic support and wellbeing initiatives, employees can spot the signs, identify the causes and take immediate, practical steps towards rebalancing their hormone levels, enabling them to bring their best selves to work each day.

Penises are shrinking because of pollution, warns environmental scientist

It may sound like a joke, but this research shows the full extent of how much we are damaging reproductive health.

By Marthe de Ferrer • Updated: 13/12/2021

This article is a repost which originally appeared on euronews.green

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

Our Takeaways:

· Pollution is proving to causing penis shrinkage and decreasing fertility worldwide.

· Some scientists believe the trend of infertility and smaller penises will qualify humans as becoming an endangered species.

· Phthalates which are now found in the environment are disrupting endocrine systems.

Pollution is causing human penises to shrink, according to one scientist.

A leading epidemiologist and environmental expert has published a book that examines the link between industrial chemicals and penile length.

Dr Shanna Swan’s book, Count Down, argues that our modern world is altering humans’ reproductive development and threatening the future of our species.

The book outlines how pollution is leading to higher rates of erectile dysfunction, fertility decline, and growing numbers of babies born with small penises. Though the headline fact about shrinkage may sound like a laughing matter, the research paints a bleak portrait of humanity’s longevity and ability to survive.

“In some parts of the world, the average twenty-something today is less fertile than her grandmother was at 35,” Dr Swan writes, dubbing the situation a “global existential crisis” in the book.

“Chemicals in our environment and unhealthy lifestyle practices in our modern world are disrupting our hormonal balance, causing various degrees of reproductive havoc.”

According to the book, humans meet three of the five possible criteria used to define whether or not a species is endangered. “Only one needs to be met,” writes Dr Swan, “the current state of affairs for humans meets at least three.”

How is pollution causing problems with fertility?

According to Dr Swan’s research, this disruption is caused by phthalates, chemicals used in plastic manufacturing, which can impact how the hormone endocrine is produced.

This group of chemicals is used to help increase the flexibility of a substance. They can be found in toys, food packaging, detergents, cosmetics, and many more products. But Dr Swan believes that these substances are radically harming human development.

“Babies are now entering the world already contaminated with chemicals because of the substances they absorb in the womb,” she says. Much of Dr Swan’s recent work has focused on the effects of phthalates, initially looking at phthalate syndrome in rats.

In 2000, however, there was a breakthrough in the field, and it became possible to measure low doses of phthalates in humans.

Since then Dr Swan has authored papers on how these chemicals can pass between parents and their offspring, the impact on female sexual desire, and – most recently – on penile length.

One of her most famous studies examined the intersection between sperm count and pollution in 2017, in ground-breaking research which looked at men’s fertility over the last four decades. After studying 185 studies involving almost 45,000 healthy men, Dr Swan and her team concluded that sperm counts among men in Western countries had dropped by 59 per cent between 1973 and 2011.

But there is some good news. Since the creation of the European Environment Agency, European citizens are exposed to 41 per cent less particulate pollution than we were two decades ago. It’s believed that these regulations have gifted Europeans an extra nine months of life expectancy, on average.

“A demand for change from citizens and subsequent strong policies have helped to clear the air in parts of Europe before, and can continue to do so to ensure that high pollution today does not need to be tomorrow’s fate,” says Michael Greenstone, director of the Energy Politics Institute at the University of Chicago.

So if pollution reduction measures can be properly implemented, there is still hope for the future and humanity’s fertility.

 

Breakthrough into the cause of male infertility

Scientists at Newcastle University have identified a new genetic mechanism that can cause severe forms of male infertility.

Our Takeaway:

  • Scientists collected and studied DNA from 185 infertile men and their parents. They identified 145 rare protein-altering mutations that are likely to negatively impact male fertility.
  • As many as 29 of the mutations affect genes directly involved in processes related to spermatogenesis — the process of sperm cell development.
  • Experts have found that mutations occurring during the reproduction process, when the DNA of both parents is replicated, can result in infertility in men later in life.
This article is a repost which originally appeared on ScienceDaily
Newcastle University - JANUARY 10, 2022
Edited for content and readability - Images sourced from Pexels
Source: https://www.ncl.ac.uk/press/articles/latest/2022/01/maleinfertilitystudy/

This breakthrough in understanding the underlying cause of male infertility offers hope of better treatment options for patients in the future.

The study, published today in Nature Communications, shows that new mutations, not inherited from father or mother, play a major role in this medical condition.

Improving understanding

It is hoped that this new knowledge will help to provide more answers in the future about the cause and best treatment options available to infertile couples.

Professor Joris Veltman, Dean of Newcastle University’s Biosciences Institute, UK, led the research which involved patients from Newcastle Fertility Centre and Radboud University Medical Centre in the Netherlands.

He said: “This is a real paradigm shift in our understanding of the causes of male infertility. Most genetic studies look at recessively inherited causes of infertility, whereby both parents are a carrier of a mutation in a gene, and the infertility occurs when the son receives both mutated copies, resulting in problems with their fertility.

“However, our research has found that mutations which occur when the DNA is replicated during reproduction in parents plays a significant role in the infertility in their sons.

“At present, we don’t understand the underlying cause in the majority of infertile men, and this research will hopefully increase the percentage of men for whom we can provide answers.”

Scientists collected and studied DNA from a global cohort of 185 infertile men and their parents. They identified 145 rare protein-altering mutations that are likely to negatively impact male fertility.

As many as 29 of the mutations affect genes directly involved in processes related to spermatogenesis — the process of sperm cell development — or other cellular processes related to reproduction.

Experts identified mutations in the gene RBM5 in multiple infertile men. Previous research carried out in mice has shown that this gene plays a role in male infertility.

Importantly, these mutations mostly cause a dominant form of infertility, where only one mutated gene is required. As a consequence, there is a 50% chance that infertility caused by these mutations will be passed on to the man’s child (if assisted reproductive technologies are used) and this may result in infertility, particularly in sons.

Millions of children have already been born through assisted reproductive approaches as a result of infertility. This research indicates a significant proportion of these children may inherit infertility from their father.

Professor Veltman said: “If we are able to obtain a genetic diagnosis, then we can start understanding better male infertility problems and why some infertile men still produce sperm that can be used successfully for assisted reproduction.

“With our information, and the research others are doing, we hope clinicians can improve counselling for couples and recommend what is the best course of action in order to conceive, either by proposing an appropriate medically-assisted procedure or in cases where none is suitable, provide appropriate alternatives.”

Infertility problems

It is estimated that up to 7% of men are affected by infertility and 50% of fertility problems within a heterosexual couple are due to the man. In around half of male infertility cases, the cause is unexplained.

Moving forwards, the scientists want to expand their work by studying thousands of patients and their parents in a large international consortium.

They will follow-up their research by conducting further studies into the role these newly identified mutated genes have on the impact of spermatogenesis and on the overall fertility in humans.

Does testicular cancer affect fertility?

Testicular Cancer Will Not Stop You From Experiencing Fatherhood: Tips From Fertility Expert Treatment of testicular cancer may affect hormone levels in men and cause infertility. So, it is advisable to consider consulting a fertility expert before you go for any treatment.

Written by Editorial Team | Updated : December 24, 2021 6:16 PM IST

This article is a repost which originally appeared on TheHealthSite

Edited for content

Cancer impacts the body physically and mentally in many ways. Treatment of cancer can also impact fertility among both men and women. While breast cancer and cervical cancer are common among women, men are affected by testicular cancer. With the correct treatment, testicular cancer can still be cured and, you may still have a chance to become a father.

What is testicular cancer?

Testicular cancer is a condition in which cancerous cells develop in testicles among men. In most cases, men only develop cancer in one testicle. However, in rare cases, both the testicles can be affected.

Symptoms of testicular cancer

  • Heaviness in the scrotum
  • Painless lump or swelling in either of the testicles
  • Fluid in scrotum
  • Dull pain in lower abdomen/groin
  • Chest pain, phlegm, and breathlessness (in later stages)

Risk factors of testicular cancer

  • Age: Testicular cancer mainly affects younger men between 15-35 years of age.
  • Family history: If anyone in your family has a history of testicular cancer, you stand at a higher risk.
  • Race: Testicular cancer is much more common among white and non-Hispanic men.
  • Infertility: Infertile men are more likely to develop testicular cancer.

Does testicular cancer affect fertility?

Treatment of testicular cancer can affect hormone levels in men and cause infertility. If cancer develops only in one testicle, the other one works normally and releases enough testosterone to lead a healthy life. However, if both the testicles have to be removed, you will have to take testosterone in the form of monthly injections to maintain normal levels in the body. Therefore, removing one testicle does not usually cause infertility among men. However, chemotherapy can cause infertility for some time during and after the treatment. It may also cause permanent damage to fertility among a few men. Chemotherapy can also reduce your sex drive for some time. Usually, if there is one testicle left, men can conceive after cancer has been treated or two years after chemotherapy is finished.

What options do men have?

According to a study, most men who suffer from testicular cancer can conceive biologically. Sperm banking is a good option for men in case of infertility caused by testicular cancer. Even if your chances of getting infertile are low, your physician will advise you for sperm banking, if you wish to conceive later in life. Before any cancer treatment, you can store your sperms so that they are not damaged due to radiation or chemotherapy.

Sperm banking is also a great option for boys who have passed puberty and wish to conceive a few years later. Sperms can be stored for longer periods.

Also, orchidectomy or removing a testicle will not affect your chances of conceiving, until your other testicle is healthy.

Whether you have less or high chances of being infertile after treatment of testicular cancer, you should always consider consulting a fertility expert before you go for any treatment. A fertility specialist will suggest you options like using a donor sperm.

How to prevent testicular cancer?

Many of the known risk factors of testicular cancer cannot be prevented. Because of this, testicular cancer cannot be prevented. Also, most of the cases are found accidentally. Therefore, men should examine their testicles, starting from puberty. See what feels normal, especially after a shower and bath. Consult with your physician if you notice any signs and symptoms of testicular cancer.

The article is contributed by Dr Lavanya R, Fertility Specialist, Nova IVF Fertility, Whitefield, Bangalore.

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.

Does Garlic Increase Your Sex Drive?

Can Garlic Improve Your Sex Life?

Written by Rachael Link, MS, RD on May 25, 2021 — Medically reviewed by Kim Chin, RD

This article is a repost which originally appeared on Healthline

Edited for content.

Garlic is a popular ingredient that has been linked to a long list of health benefits.

According to some studies, garlic could help fight inflammation, reduce cholesterol levels, and protect against chronic disease.

Given its many medicinal properties, people may also wonder whether garlic can improve sexual function or increase libido.

This article looks at the evidence to determine whether garlic can increase your sex drive.

May improve blood flow

Some research suggests that garlic may help increase blood flow, which may be beneficial for treating issues like erectile dysfunction in men.

In fact, multiple human and animal studies have found that certain compounds found in garlic can increase blood flow and improve blood vessel function.

What’s more, one study among 49 older men found that a medication containing ingredients like aged garlic extract, ginseng, and velvet antler improved erectile function.

Garlic can also increase nitric oxide levels, a compound that helps blood vessels dilate to promote better blood flow. This could potentially help improve erectile function.

However, more human studies are needed to evaluate the effects of garlic on erectile dysfunction specifically.

Summary

Garlic may help improve blood flow, which could help prevent erectile dysfunction. However, more human research is needed.

May enhance male fertility

In addition to increasing blood flow, some studies have found that garlic may help promote male fertility.

One review of 18 studies concluded that garlic helped boost sperm production and increase levels of testosterone, which may be due to its antioxidant properties.

In a recent animal study, S-allyl cysteine, a compound found in garlic, increased testosterone production in mice.

Another animal study also showed that aged garlic extract could protect against changes in sperm production and testosterone levels caused by chemotherapy.

Still, further research is needed to determine how garlic may affect male fertility and testosterone levels in humans.

Summary

Although studies in humans are limited, some research shows that garlic and its components could improve male fertility, enhance testosterone levels, and increase sperm production.

Acts as an antioxidant

Antioxidants can not only help protect against chronic disease but also may play a key role in sexual health and fertility.

Fresh garlic and aged garlic extract are rich in antioxidants and can help neutralize harmful compounds known as free radicals.

According to one study among 100 men with infertility, taking an antioxidant supplement increased sperm count.

Interestingly, one study in rats with diabetes found that S-allyl cysteine from garlic improved erectile function by blocking the formation of free radicals.

However, additional studies are needed to understand how the antioxidants in garlic may affect sexual function and fertility in humans.

Summary

Garlic is a good source of antioxidants, which may improve sexual health and fertility.

The bottom line

Garlic is a powerful ingredient that has been linked to many potential health benefits.

According to some human and animal studies, it may improve sexual function by increasing blood flow and enhancing fertility, especially in men.

Still, limited research is available on garlic’s effects on sex drive specifically, and it remains unclear how it might affect sexual function in women.

However, it can easily be enjoyed as part of a nutritious, well-rounded diet to support overall health and protect against disease.

Just one thing

Try this today: When using garlic, be sure to crush or chop it, and let it sit for at least 10 minutes before cooking. This increases its content of allicin, a compound responsible for many of the health benefits associated with this popular ingredient.