Archive for April, 2010

Impotence: 14 Secrets for Success

April 28, 2010

Sure it’s a night you’ll remember. For all the wrong reasons.

It had been a hectic week. You’d been working hard on that proposal, and never once made it home before midnight. Tonight, you were going to make it up to your wife.

You brought roses. She uncorked your favorite wine. After dinner, when you took the phone off the hook, she slipped behind you, kissing your neck in that way of hers that always drives you crazy. Everything seemed to unfold according to plan.

Everything, that is, except a certain part of your anatomy. A certain crucial part.

And that left you to wonder: What in tarnation is going on? Is this going to happen the next time? What the heck can I do about it?

Plenty. Realize, first, that you’re not the only man in the world who’s had this happen. “If men are honest, every one of them will tell you they’ve sustained an impotence episode at one time in their lives,” says Neil Baum, M.D., director of the New Orleans chapter of the Male Infertility Clinic and an assistant professor of urology at Tulane University School of Medicine. “Not every incident is a ten.”

“It can be devastating when it occurs,” he says. “A man’s whole concept of his masculinity may be undermined. ”

Experts sayan estimated ten million men suffer from impotence, the term used when a man is unable to achieve and maintain penetration until he ejaculates.

Until the early 1970s, experts thought that most erection problems pointed to underlying problems in the psyche. Today, the medical community recognizes that almost half of all impotent men have a physical or structural problem that’s at least partly responsible.

What can you do to keep erection problems at bay?

Here’s what our experts advise.

Give yourself time. “As a man gets older, it may take a longer period of genital stimulation to get an erection,” says Dr. Baum. “For men aged 18 to 20, an erection may take a few seconds. In your thirties and forties, maybe .a minute or two. But if a 60-year-old doesn’t get an erection after a minute or two, that doesn’t mean he’s impotent. It just takes longer.”

The time period between ejaculation and your next erection also tends to increase with age. In some men aged 60 to 70, it may take a whole day or longer to regain an erection. “It’s a normal consequence of aging,” says Dr. Baum.

Consider your medication. Drugs your doctor has prescribed might be at the root of the problem. Or it might be those over-the-counter antihistamines, diuretics, or sedatives you’re using. Realize, of course, that what affects your neighbor may have no effect on you.

More than 200 drugs have been identified as problematic. Drug-induced impotence is most common in men over 50, says Dr. Baum. In fact, in an American Medical Journal study of 188 men, drugs were the problem 25 percent of the time.

If you suspect your medication, consult your doctor or pharmacist. He may be able to change the dosage or switch you to a different drug. Do not, however, attempt to do this on your own.

Beware of recreational drugs. Troublemakers that Richard E. Berger, M.D., a urologist with Harborview Medical Center in Seattle, Washington, lists in his book BioPotency: A Guide to Sexual Success, include cocaine, marijuana, opiates, heroin, morphine, amphetamines, and barbiturates.

Go easy on the alcohol. Shakespeare hit it on the head when he said in MacBeth that alcohol provokes desire but it takes away the performance. That happens because alcohol is a nervous-system depressant. It inhibits your reflexes, creating a state that’s the opposite of arousal, says Dr. Berger. Even two drinks during cocktail hour can be a cause for concern, he says.

Over time, too much alcohol can cause hormonal imbalances.

“Chronic alcohol abuse can cause nerve and liver damage,” says Dr. Baum. “When you have liver damage, you cause a dynamic where the man has an excess amount of female hormones in his body.” You need to have the right proportion of testosterone for everything to work properly.

Know that what’s goodfor the arteries is goodfor the penis. “In the last five years, it’s become quite evident that the penis is a vascular organ,” says Irwin Goldstein, M.D., co-director of the New England Male Reproductive Center at Boston University Medical Center in Massachusetts. The very things that clog your arteries-dietary cholesterol and saturated fat-also affect blood flow to the penis. In fact, says Dr. Goldstein, all men over age 38 have some narrowing of the arteries to the pems.

So watch what you eat. “High cholesterol is probably one of the leading causes of impotence in this country,” says Dr. Goldstein. “It appears to affect erectile tissue.”

Don’t smoke. Studies show that nicotine can be a blood vessel constrictor, says Dr. Baum. A study of healthy adult mongrel dogs at the University of California at San Francisco showed that the inhalation of smoke from just two cigarettes was enough to prevent five dogs from getting a full erection and a sixth dog from maintaining one. The researchers believe that inhalation of cigarette smoke blocks erection by inhibiting the smooth muscle relaxation of the erectile tissue.

Do what you need to feel good about your body. Are you thinking about taking off a few pounds?

Studying karate? Starting a weight-training program? Do it. “Sex is body contact,” says James Goldberg, Ph.D., research director of San Diego’s Crenshaw Clinic in California. “The more a person feels good about his body, the better he’ll feel going into the event.”

Don’t overdo it on the exercise. If you exercise excessively, you’ll stimulate the body’s natural opiates, the endorphins. “We’re not sure how they work, but they tend to lessen sensation,” says Dr. Goldberg. “Over the short run, exercise is good for you. Beyond a certain point, though, the body gets into the habit of protecting itself.”

Wait out pain. Your body also produces its own opiates when you’re in pain, says Dr. Goldberg. These opiates can tum off any sexual stimuli. “There’s not much you can do,” he says, except wait for a better time.

Relax. Being in a relaxed frame of mind is crucial. Here’s why. Your nervous system operates in two modes. When the sympathetic nerve network is dominant, your body is literally “on alert.” Adrenal hormones prepare you to fight or take flight. Nerves shuttle your blood away from your digestive system and penis and into your muscles.

You can tum on your sympathetic nervous system just by being too anxious, says Dr. Baum. “For some men, the fear of failure is so overwhelming that it floods the body with norepinephrine, an adrenal hormone. That’s the opposite of what you need to have an erection.”

The key here is to relax and let your parasympathetic nervous system take over. Signals that travel along this network will direct the arteries and sinuses of the penis to expand and let more blood flow 111.

Avoid whole-body stimulallts. That means caffeine and certain questionable substances touted as potency enhancers. “The main thing during sex is to be relaxed,” says Dr. Goldberg. “Stimulants tend to have an overall effect. They constrict the smooth muscle that must dilate before an erection can occur.”

Refocus your attemioll. One way to relax is to focus with your partner on the more sensual aspects of intimacy. Play with and enjoy each other without worrying about that erection.

“The skin is the largest sexual organ in the body,” says Dr. Goldberg, “not the penis. So don’t be led by your penis. The whole body has to react.”

Plall ahead. Dr. Berger thinks it is a good idea to decide in advance what you’ll do if you don’t get an erection. “What are your alternatives?” If you’re not so focused on the erection itself, it will make it easier for the erection to come back, he says.

Talk to your partller. Don’t risk increasing the tension in the bedroom by maintaining a sullen silence.

Together. you can play detective and figure out what’s going on. Pressure at work? Strain over a child’s illness. A touchy issue you two haven’t resolved yet?

“If you understand some of the things that can cause impotence, you can find a way to explain it without attributing it to something that’s not there,” says Dr. Berger. “And you should talk about what your alternatives are. Will you continue your lovemaking in a different way? Don’t let the erection, or lack of it, interfere with your intimacy.”


NEIL BAUM. M.D., is director of the New Orleans Male Infertility Clinic, a clinical assistant professor of urology at Tulane University School of Medicine, and a staff urologist with Touro Infirmary in New Orleans, Louisiana.

RICHARD E. BERGER. M.D., is a urologist with Harborview Medical Center in Seattle, Washington.  He is the author of Biopofency: A Guide fa Sexual Success.

JAMES GOLDBERG. PHD., is research director of the Crenshaw Clinic at San Diego, California, and a clinical research pharmacologist.

IRWIN GOLDSTEIN. M.D., is co-director of the New England Male Reproductive Center at the Boston University Medical Center in Massachusetts and is an assistant professor of urology at Boston University School of Medicine.

Sexuality in Later Life

April 28, 2010

that won’t cause sexual problems.

Help is available

There are several things you can do on your own to keep an active sexual life. Remember that sex does not have to include intercourse. Make your partner a high priority. Pay attention to his or her needs and wants. Take time to understand the changes you both are facing. Try different positions and new times, like having sex in the morning when you both may have more energy. Don’t hurry-you or your partner may need to spend more time touching to become fully aroused. Masturbation is a sexual activity that some older people, especially unmarried, widowed, or divorced people and those whose partners are ill or away, may find satisfying.

If you do seem to have a problem that affects your sex life, talk to your doctor. The most common problem that affects women is painful intercourse. For most women, lubrication can be provided with creams orjellies. If the problem is estrogen deficiency, this can be supplied with topical estrogen creams or oral estrogens if there are no contraindications such as estrogen receptor positive breast cancer.

If a man complains of a loss of libido, the problem may be related to testosterone deficiency that can be replaced with injections, topical jells or the insertion of testosterone pellets. If impotence is the problem, it can often be treated with oral medications such as Viagra, Levitra, or Cialis. If the medications are not successful then injections, vacuum devices, or surgical implants can be performed.

Bottom line: Just because a man or women enters their senior years does not mean that sexual intimacy has to cease. Older men and women can and do enjoy intimacy.

Pellets for Improving Your Libido or Sex Drive

April 27, 2010

Nearly 30 million men suffer from erectile dysfunction (ED) or impotence and nearly half that number have a decrease in their sex drive or libido.  However, many men believe that erectile dysfunction and diminished libido are the same thing.  It is important that men understand the difference between ED and libido.  ED is the inability to achieve and maintain an erection adequate for sexual intimacy with a partner.  Loss of libido is a decrease in the interest for sexual intimacy.  ED and loss of libido can be separate issues or can occur together as it is common for a man who suffers from ED for a prolonged period of time will also experience a decrease in libido.

What are the symptoms of decrease in libido and what are the causes of this condition?   A decrease in libido is usually a result of a decrease in the level of testosterone which is a hormone produced in a man’s testicles.  A decrease in libido is the most common symptom of testosterone deficiency.  Men with a decrease in testosterone also experience a lack of energy and often complain of lethargy.  Men with decrease in testosterone also experience a decrease in strength or endurance, lose height, fall asleep after dinner, and may even experience depression or a decreased enjoyment in life.

Now there are treatment options for low testosterone which include the insertion of testosterone pellets, Testopel, underneath the skin.  The pellets will boost the testosterone level for 4-6 months.

How is Testopel administered?

Other than the initial stick of a needle used to numb the insertion area, Testopel insertion is pain-free.

The insertion area is 3-4 inches below your beltline–approximately at the top of your rear hip pocket.

  • Each Testopel pellet is very small – about the size of a grain of rice
  • Testopel is placed just below the skin into your fat layer. Once implanted, most men have no awareness that the pellets are there.
  • The right number of pellets is based on the serum testosterone level
  • After Testopel is inserted, your doctor will close the implant site using Steri­Strips. Stitches are not needed. The area will then be bandaged and a cold compress applied.
  • Patients can return to work the same day that the pellets are inserted

The Testopel results in improvement in:

• Improved mood

• Increased sexual interest

• Restoration of erectile function

• Increased muscle mass

• Increased strength of bones

Bottom Line:  Testosterone deficiency is a very common disorder.  The diagnosis is made by a blood test that detects a low level of testosterone.  Treatment with Testopel is a very effective treatment option.

Living With Prostate Gland Enlargement-Lifestyle Changes

April 26, 2010

Prostate enlargement or benign prostate hyperplasia (BPH) is a common, non-cancerous condition affecting nearly 14 million men over the age of 50.

The symptoms of prostate gland enlargement include decrease in the force and caliber of the urinary stream, frequency or urination, urgency, feeling of not emptying the bladder and nocturia or the need to get up at night to urinate.

Although lifestyle changes will not cure the problem, they can alleviate some of the symptoms.

Making some lifestyle changes can often help control the symptoms of an enlarged prostate and prevent your condition from worsening. Try these measures:

Remember what goes in must come out.  Therefore don’t drink anything several hours before you go to sleep.  Especially avoid caffeinated beverages such as coffee (also causes insomnia) and tea as the caffeine acts as a diuretic and causes increased urine output that may result in getting up at night to empty your bladder,

Limit your alcohol consumption especially at the dinner meal.  Again alcohol acts as a diuretic causing increased production of urine causing your bladder to fill up sooner than you would like.

Avoid spicy foods.  These appear to irritate the bladder and can result in urinary frequency and nighttime voiding.

Check your medications.  Some medications like lasix and hydrochlorothiazide are diuretics and increase urine production.  I suggest you take those medications early in the day when going to the bathroom to urinate is not such an inconvenience.  You may also speak with your doctor about lowering the dosage of the diuretic especially the evening dose if you are bothered by nighttime urination.

Avoid antihistamines and decongestants as these cause the bladder to decrease the force of contraction and results in the bladder not to empty as well.  If you have to take anti-histamines, use them earlier in the day.

Don’t hold off going to the restroom.  This habit distends the bladder and can result in a weaker muscle to expel the urine from the bladder.

Use the clock to help with urination.  If you find that you are going to the bathroom infrequently and then more at night, make an effort to urinate every 3-4 hours.  Putting your bladder on a schedule is very helpful and a good habit to have.

Go and then go again.  Double voiding is a technique to ensure adequate emptying of the bladder.  If you stand at the toilet and empty your bladder, walk away from the toilet for a minute or two and then return and try emptying the bladder again.  This helps to expel more urine from your bladder than just standing there one time and voiding.

Avoid cold seats such as at football games in the winter.  The cold temperature seems to cause the muscles around the prostate gland to contract and makes urination difficult.  Instead take a blanket or a cushion. Your prostate gland will be glad that you did.

If you bike ride, especially for long distances, stand on the pedals every 10 or 15 minutes to take the pressure off of your prostate gland.  Also consider using a seat that has a groove down the middle which alleviates the pressure on your prostate gland.

Bottom Line: These steps won’t cure the enlarged prostate but they will lessen the symptoms.  If they don’t help, see your doctor for medication one of the treatments that reduces the obstruction of your prostate gland.

Hypoactive Sexual Desire- or I’ve Got a Headache!

April 25, 2010

He: “Are you in the mood?”

She: “Naw, I’ve got a headache!”

If you are a female and you experience these feelings about loss of desire for sexual intimacy, you may have hypoactive sexual desire (HSD).  In other words, you’re rarely in the mood; you neither initiate sex nor seek stimulation. Hypoactive sexual desire is the most common form of female sexual dissatisfaction and occurs when there is a persistent lack of desire or absence of sexual fantasies.

Lack of desire often occurs as a result of problems with your partner.  Communications problems, anger, a lack of trust, a lack of connection and a lack of intimacy can all adversely affect a woman’s sexual response and interest.  If this sounds like you, counseling and therapy with your partner is probably your No. 1 treatment option to overcome HSD.

In addition to psychological causes there are medical causes of HSD.
Many commonly prescribed drugs, such as antihypertensives, antidepressants and birth control pills, interfere with sex drive, arousal and orgasm by affecting the balance of sexual hormones and the transmission of chemical messengers. Antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), combat depression by increasing the production of serotonin in the brain. Although serotonin may decrease depression, it also dampens sexual desire.

The onset of menopause, either surgically produced by removing the ovaries or naturally as a consequence of aging, is characterized by a gradual decline of the hormones estrogen, progesterone and testosterone. Reduced testosterone levels can lead to a decline in libido. Ironically, the conventional hormone replacement regime of estrogen given to relieve menopausal symptoms can make matters worse, because estrogen increases a protein (called steroid hormone-binding globulin) in the blood that binds to testosterone, causing testosterone to become less available to the body.

Depression is also associated with HSD. A common symptom of depression is diminished sex drive, which, in turn, can exacerbate depression. Studies indicate that 12 percent of all women will experience clinical depression at some point in their lives. One of the side effects of the popular antidepressants Prozac, Paxil and Zoloft is loss of libido. Even with a lower-grade form of depression that is not easily recognized because you can function with it. A woman with depression may feel isolated and overwhelmed and withdraw from sex and social activities.

Overcoming HSD
If you’re suffering from loss of libido and think there is a medical basis for your problem, here are some solutions to consider:

Talk to your doctor about testosterone, especially if you have had your ovaries removed, are taking estrogen or under severe stress. Get your testosterone level evaluated and if it is below 20 nanograms per deciliter, consider starting testosterone therapy. Testosterone is central to a woman’s sexual function that no amount of sexual stimulation can make up for its absence.  Using testosterone to treat FSD has not been approved by the FDA, so you’ll need to find a physician open to prescribing it to treat lack of sexual desire. If you are already on hormone replacement therapy for menopausal symptoms, ask your doctor to add testosterone to your regimen.

Switch to medications known to have less effect on sexual function or lower dosages. The antidepressants Prozac, Zoloft and Paxil, of which women are major consumers, cause loss of libido in as many as 60 percent of patients. I suggest asking your doctor to change to an antidepressant that has less sexual side effects like Celexa, Wellbutrin, BuSpar, Serzone or Effexor.

Viagra, the little blue pill used to treat erectile dysfunction in men, may help jump-start your sex life as long as you have the desire to engage in sex and have been stimulated enough for it to take effect,. It’s especially helpful if your lack of desire is related to hysterectomy or menopause. Doctors aren’t exactly sure how Viagra helps rekindle lust but it helps women achieve arousal, which is the phase that comes after desire, by increasing blood flow to the vagina, clitoris and labia.

For more information contact your physician or find a physician who has experience treating HSD.  I also recommend the best-selling book For Women Only by Jennifer and Laura Berman.

Kegel Exercises for Men

April 25, 2010

Kegel exercises have been helpful for women with urinary incontinence and have been used for years with favorable success.  Recently, these same exercises have been useful for men suffering from erectile dysfunction, urinary incontinence, and premature ejaculation.

This article will review the purpose of Kegel exercises and how they are effective for treating erectile dysfunction, premature ejaculation, and dribbling after urination.

Kegel exercises focus on the muscles of the pelvic floor, which supports the bladder, the prostate gland and the bowel and is made up of layers of muscle that stretch from the tailbone at the back to the pubic bone in front.  Exercising these muscles will increase the support of the prostate gland, the bladder, and improve the blood supply to the penis, and increase the tone of the urinary sphincter or the muscle that surround the urethra and helps control urination.

By regularly performing Kegel exercises men report improvement in their erections and even in the quality of their orgasms.  A European study surveyed 55 men with an average age of 59 who had erectile dysfunction.  The study demonstrated that 40 per cent of the men regained normal erectile function and 35.5 per cent improved.  Perhaps the most dramatic finding was the improvement resulting from pelvic floor exercises compared to the use of Viagra – the results were the same.

Approximately 10% of men will have some mild urinary incontinence after surgical removal of their prostate gland for prostate cancer.  This is usually temporary and subsides after several months.  The period of incontinence can be significantly shortened if the men practice Kegel exercises before the surgery and immediatley after the surgery.

Pelvic floor rehabilitation is also effective for premature ejaculation, the condition when ejaculation occurs within seconds after vaginal penetration.  This is a condition that is very common and is a source of anxiety and disappointment for the man who has the problem and also for his partner.  Men who do Kegel exercises can expect a 50% improvement in time from vaginal penetration to ejaculation.

How to find and use the muscles of the pelvic floor

The pubococcygeal muscle and other muscles in the pelvis support the bladder, prostate gland, the urinary sphincter which is responsible for control of urination.  As men age, or after surgery, especially for prostate gland surgery, these muscles become weakened and men will have problems controlling urination and\or erectile dysfunction.  This group of muscles can be strengthened by performing Kegel exercises.

In men, this exercise lifts up the testicles, also strengthening the cremaster muscle, as well as the anal sphincter, as the anus is the main area contracted when a Kegel is done. This is because the pubococcygeus muscle begins around the anus as well as around  the urinary sphincter.

How to find the pelvic floor muscles

To find your pelvic floor muscles, you should sit or lie comfortably with the muscles of your thighs, bottom and stomach relaxed.  You should then tighten the ring of muscle around your anus without squeezing your bottom. To feel these muscles, try to stop your flow of urine mid-stream, and then restart it.  Although the exercises have to be learned (possibly over a matter of days), with practice they can be carried out while watching TV or while waiting for the light to turn from red to green.

Getting started

First, go to the bathroom and empty your bladder.  Next tighten the pelvic floor muscles as if you were preventing gas from escaping from your rectum and hold for a count of 10.  Then relax the pelvic muscles completely for a count of 10.  Repeat this cycle 9 more times.  Do this same exercise 3 times a day (morning, afternoon, and night).

You can also identify the pubococcygeus muscle when you are urinating over a toilet by starting and stopping the flow of urine.  You can do the same exercise when you are not urinating.

You can do these exercises at any time and any place. Most people prefer to do the exercises while lying down or sitting in a chair. After 4 – 6 weeks, most people notice some improvement. It may take as long as 3 months to see a major change.

Bottom Line:  Erectile dysfunction, premature ejaculation, and dribbling after urination are all amenable to strengthening the pelvic floor muscles.  This can be accomplished by performing Kegel exercises.  Remember a Kegel 3 times a day, keeps the doctor away!

The Vaccine For HPV Infections in Women

April 25, 2010

Human papillomavirus (HPV)causes one of the most common sexually transmitted diseases (STD). HPV can infect the genital area of men and women including the skin of the penis, the vagina, cervix, or rectum. Most people who become infected with HPV will not have any symptoms.  Some of these viruses may cause abnormal PAP tests and may also lead to cancer of the cervix.  This article will discuss the incidence, diagnosis, and treatment of HPV.

Approximately 20 million Americans are currently infected with HPV. At least 50 percent of sexually active men and women acquire genital HPV infection at some point in their lives. By age 50, at least 80 percent of women will have acquired genital HPV infection.

Some HPVs may cause genital warts. Genital warts are single or multiple growths or bumps that appear in the genital area. Genital warts usually appear as soft, moist, pink, or flesh-colored swellings, usually in the genital area. They can be raised or flat, single or multiple, small or large, and sometimes cauliflower shaped. They can appear on the vulva, in or around the vagina or anus, on the cervix, and on the penis, scrotum, groin, or thigh. After sexual contact with an infected person, warts may appear within weeks or months, or not at all.  Genital warts are diagnosed by visual inspection. Visible genital warts can be removed by medications the patient applies, or by removing the warts in the doctor’s office.

Most women are diagnosed with HPV on the basis of abnormal PAP tests. A PAP test is the primary cancer-screening tool for cervical cancer or pre-cancerous changes in the cervix, many of which are related to HPV. Also, a specific test, HPV-DNA, is available to detect the virus in women. The results of HPV-DNA testing can help health care providers decide if further tests or treatment are necessary.

Approximately 1\3 of HPV viruses can lead, in rare cases, to development of cervical cancer.  Although only a small proportion of women have persistent infection, persistent infection with “high-risk” types of HPV is the main risk factor for cervical cancer.  Cervical cancer is the second leading cancer killer of women worldwide.  About 10,520 American women will develop invasive cervical cancer and about 3,900 women will die from this disease. Most women who develop invasive cervical cancer have not had regular cervical cancer screening.  With early detection, cervical cancer is usually treatable.

A PAP test can detect pre-cancerous and cancerous cells on the cervix. Regular PAP testing and careful medical follow-up, with treatment if necessary, can help ensure that pre-cancerous changes in the cervix caused by HPV infection do not develop into life threatening cervical cancer. The PAP test is responsible for greatly reducing deaths from cervical cancer.

Currently, the only HPV vaccine approved by the federal Food and Drug Administration is Gardasil, which protects against some strains of HPV.  It is recommended that the vaccine be given to girls between 11 and 12 years of age, before they become sexually active. The vaccine, which consists of three shots totaling $360, protects against strains of the virus that cause about 70 percent of cervical cancer cases.

There are no serious side effects from the vaccine.  The only problems noted were mild soreness around the site of the injection and occasionally, a slight temperature.

Bottom Line: HPV is a common virus that affects millions of American men and women.  The virus is responsible for some cases of cervical cancer.  Tests are available to identify which patients are likely to have the virus and which cases need to be treated.  A vaccine is available which can help prevent HPV infections if given to girls before they become sexually active.  See your physician for more information.

Attention Bicycle Riders-Your Seat May Be Affecting Your Sex Life

April 25, 2010

A middle age bike rider, who was perfectly potent, noted that his penis went numb at the end of a two-day, 200 mile charity ride.  The numbness continued for nearly six months and was accompanied by the inability to achieve an erection adequate for sexual intimacy or impotence.  After a work-up revealed arterial damage at the base of the shaft of the penis, his potency returned after treatments that increased the blood supply to his penis.

To understand the relationship between bicycle seats and impotence, you need to know a few things about male anatomy. The penis is a hydraulic system. During sexual stimulation, its twin chambers fill with blood until it’s firm and erect. After stimulation ends or there’s ejaculation, the blood leaves and the penis softens again. The trigger for this increased blood flow is nerve impulses that originate in the brain and race down the spinal cord to the penis.

When you’re riding a bicycle, your weight is being focused on the perineum, the area between the rectum and the scrotum, and that’s where the arteries and nerves that feed the penis are located. Since the arteries are essentially unprotected, they’re prone to damage from constant  pressure from the bike seat.   When a man sits on a bicycle seat he’s putting his entire body weight on the artery that supplies the penis.

There are a number of things you can do to protect your potency:

• Penile numbness and excessive genital shrinkage are warning signs that there may be too much pressure on your perineum. The nerves in the perineum are being pinched, which means the artery that feeds the penis is also being compressed.

• Make the following changes in your riding style and/or your positioning on the bike: 1) Make sure your saddle is level, or point the nose a few degrees downward. 2) Check to see that your legs are not fully extended at the bottom of the pedal stroke. Your knees should be slightly bent to support more of your weight. 3) Stand up every 10 minutes or so to encourage blood flow.

• There are a multitude of anatomic racing saddles on the market, ranging from ones with a flexible nose to models with a hole in the middle. You may want to experiment with a wider, more heavily padded brand or a “double bun seat” that places the weight on the bones and off of the perineum.

• Heavier riders may be more at risk of arterial compression damage because of the greater weight that’s placed on the perineum. If you’re in this category, you should consider a wider saddle with extra padding.

• When riding a stationary bike, the tendency is to stay seated and grind against big gears for long periods. Get off of the seat as frequently as you would on your regular bike and be certain that it’s set up the same in regards to riding position.

•  Get off of the seat when riding over rough or irregular terrain. Use your legs as shock absorbers.

Most men are not aware of the relationship between their bike and their erections. My final advice for good health is that men shouldn’t necessarily ride farther but ride a lot smarter.

Testosterone Replacement Therapy-A little Dab Will Do Ya

April 25, 2010

A man’s sex drive or libido is thought to be connected to the level of testosterone, the hormone produced in the testicles which circulates in his bloodstream. Low testosterone, also known as hypogonadism, affects approximately four to five million American men. The condition is also linked with diminished interest in sex, impotence, reduced muscle mass, decreased bone density and lowered mood and energy levels.

Who needs testosterone?

Though the body’s own production of this hormone trails off gradually in men after the age of 30 or so, not many men seek testosterone-replacement therapy or even get their testosterone levels tested.   If a man is experiencing a decrease in his libido or sex drive, complains of lethargy or tiredness, he should see his doctor and obtain a simple blood test to determine if he is deficient in this important hormone.

In the past the only treatment to replace the testosterone was injections of the hormone every two weeks or applying testosterone patches to the scrotum or other areas of the body.  The injections were occasionally painful and the patches often caused skin irritation.

Now testosterone is available as a gel or paste (AndroGel, Teststim) applied to the skin of the shoulders, upper arms or abdomen once a day.  The gel is clear, colorless topical gel that men apply once daily to the shoulders, upper arms and/or abdomen. The gel dries within a few minutes, during which time the skin absorbs the testosterone. The skin serves as a reservoir for the hormone, which slowly enters the bloodstream. Normal testosterone levels are restored soon after application.  The testosterone gel will be available with a prescription in pharmacies throughout the United States by the end of the summer.

In studies conducted on hundreds of men who are testosterone deficient, the gel quickly raised circulating testosterone to desirable levels, and maintained it within normal range. The gel also increased sex drive, bone mineral density, and lean body mass and improved mood and energy levels.

At the present time the gel is not indicated for use in women and has not been evaluated in women. Pregnant women should avoid skin contact with the area on men where the gel has been applied as the testosterone in a pregnant woman can cause harm to the fetus.  The testosterone gel is not recommended in young men to improve athletic performance.   Testosterone is contraindicated for men who have prostate cancer that is spread beyond the prostate gland.  For some men with localized prostate cancer who have symptoms of low testosterone, a low serum testosterone level, and a PSA that is at very low levels, they may receive testosterone if they are monitored closely with PSA testing.  (See my blog “Testosterone Treatment in Men With Prostate Cancer-The Controversy”)

The next step.  If you are experiencing a decrease in your sex drive, feel lethargic, or have less energy, you may have a decrease in your testosterone level.  Contact your physician and request a testosterone blood level.  If it is decreased, the solution is just a dab of gel away.

Testosterone Treatment in Men With Prostate Cancer-The Controversy

April 25, 2010

I have been a proponent of testosterone replacement therapy in men

with documented low levels of testosterone.  Men with low testosterone

present with lethargy, malaise, decrease in libido, erectile

dysfunction, falling asleep after meals and loss of muscle mass.  The

diagnosis is easily made with a blood test, the serum testosterone

level, and is easily treated with injections of testosterone or the

application of testosterone gels to the skin.  The medical textbooks in the 1990’s state that the treatment is

contraindicated in men with difficulty with urination, untreated

obstructive sleep apnea, high blood counts, and in men with prostate


But now there are a few doctors who question the advice of avoiding

testosterone in men who have been successfully treated for prostate

cancer.  For decades the prevailing treatment for men with prostate

cancer that spread beyond the prostate gland was to decrease the

testosterone produced by the testicles.  This was accomplished by

removing the testicles or orchiectomy, or medically castrating the men

with drugs that produced castrate levels of testosterone in the blood.

Dr. Abraham Morgentaller, a urologist a Beth Israel Deaconess

Hospital in Boston, began treating men with prostate cancer, who had

symptoms of low testosterone and confirmed by the blood testosterone

test, with supplemental testosterone.  This was certainly against the

previous advice of other urologists.

What is the evidence to support this new approach to testosterone

deficiency in men with prostate cancer?  Dr. Morgantaler published a

report that men who developed prostate cancer had a statistically

lower testosterone level than men who were free of prostate cancer.

He also started treatment of a select group of men with prostate

cancer with testosterone and followed them closely with PSA tests and

found that there was no increase in the PSA test but marked

improvement in the men’s libido, energy level, and over all quality of


So what is a man to do?  Talk to your doctor.  If your doctor agrees

that there may be a roll for testosterone in men with prostate cancer,

you can receive therapy with testosterone replacement.  In my practice

I select men who have zero, or near zero, PSA tests for at least one

year after treatment for prostate cancer.  They receive testosterone

replacement under close scrutiny and must agree to getting a PSA test

every month.  If the PSA rises, then they must agree to discontinue

the testosterone replacement therapy.  For more information go to my