5 ways to boost your libido

May 3, 2017

The bad news: men’s sex drive is based on the serum testosterone level which starts to decrease about 1% a year in second decade of a man’s life.  The good news is that low testosterone can easily be replaced.  Here are a few steps or suggestions that you can easily do to restore your libido without testosterone replacement therapy.

Re-connect: Now that the children have left and it’s just you and your partner again, it’s time to re-connect. Raising a family might have kept you very busy, oftentimes taking you away from each other. Spend some time re-connecting and getting to know one another again in order to reignite that flame.  I suggest having a date night with your significant other.  And one other piece of advice: turn off your cell phone and focus on each other! 

Exercise: Health conditions and poor circulation can impede on your libido, while being as healthy as you can is a great way to support your sex drive. Exercise can help reduce your risk of illness and boost your circulation to ensure all your parts are working as they should.  I suggest 20 minutes of cardiovascular exercise at least three times a week.

Be mindful: Stress is a big mood killer, so practicing mindfulness and reducing stress can help boost your libido.  There’s an app for that.  I suggest Headspace.  It’s free and a nice way to learn the art of meditation.

Seek therapy: Maybe you need to see a therapist and work through any underlying issues that could be preventing you and your partner from connecting on a sexual level. Addressing these concerns can help you get past the wall you or your partner may have built between each other.  I suggest that you seek out a therapist that has expertise in dealing with sexual problems.  You can find a therapist near you at: https://www.aasect.org/referral-directory

Check your medications: Some medications cite low libido as a side effect. Antidepressants and pain medications are most known for this. Check with your doctor if you are on any meds.

Bottom Line:  A decrease in libido doesn’t mean you have to live a life devoid of sex. Speak to your doctor.  Get a blood test to check your testosterone level and consider replacement therapy using testosterone injections, topical gels, or tiny pellets inserted under the skin all of which can successfully restore the testosterone level and more importantly your ability to engage in intimacy with your partner.

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Nourishment for Your Nature

April 28, 2017

Since the late 1990s there has been a great advancement in the treatment of erectile dysfunction.  We know pills, pumps, and surgeries work for erectile dysfunction, but what about food and nutrition? Are there things you can eat that can help with ED? This article will discuss several options that may be an alternative to medications, injections and surgery for ED.

Watermelon

This sweet, refreshing fruit has a compound that can have effects similar to ED meds on your blood vessels. It may even rev up your libido. Most of watermelon is water, however the rest is loaded with lycopene, an antioxidant that’s good for your heart, prostate, and skin and even your erections .

Oysters

These shellfish may boost your testosterone levels, and that can help with sex drive. They’re also chock-full of zinc, a nutrient your body needs. One caveat is to be sure they are they’re cooked properly.

Coffee

Your morning cup of joe is more than a satisfying pick-me-up. It may give your love life a boost, too. Men who drank two or three cups’ worth of caffeine a day were less likely to have erectile dysfunction. That’s because caffeine helps increase the blood flow to the penis.

Dark Chocolate

This treat may have perks in your private parts. An ounce of chocolate a few times a week can help your Johnson. Chocolate is rich in flavanols, plant nutrients that can increase blood flow and lower blood pressure.

Nuts

Walnuts have lots of arginine, an amino acid your body uses to make nitric oxide. They’re also good sources of vitamin E, folic acid and fiber.

Juice

Maybe you enjoy an adult beverage made from grapes, but here’s a reason to drink the stuff kids like. Nutrients in grape juice also increase the amount of nitric oxide in your body. If you’re not wild about drinking grape juice, try pomegranate juice.

Garlic

The strong-smelling bulb may raise the dead. If plaque forms on the walls of the arteries, blood flow could be decreased. Garlic in your diet may help keep your arteries healthy, open and clear as you age.

Fish

Salmon and other fatty fish are great sources of heart-healthy omega-3 fatty acids, which may boost nitric oxide in your body. These omega-3 fatty acids also lower your blood pressure and your risks for heart attack and blood clots.

Greens

Kale is also a nitric-oxide booster. They’re packed with vitamins, minerals and omega-3s.

Peppers

You might spice up your love life by adding some chili peppers to your diet. Chilies can also help lower blood pressure and cholesterol and prevent blood clots.

Olive Oil

Olive oil may help your body make more testosterone. It’s also full of u monounsaturated fat, which can help get rid of the bad cholesterol in your body, the LDLs.

Bottom Line:  Let the truth be told there is no magic bullet or food that can restore your nature.  But there are foods that can help you “keep ‘em up!”

Pain Pills Won’t Put Potency In Your Penis

April 25, 2017

There’s a opioid epidemic in the United States as the number of prescriptions written for opioids has skyrocketed over the years. From 1991 to 2013, the total number of prescriptions written for opioid painkillers skyrocketed by 172%. It is estimated to cause nearly 40,000 deaths in the United States which is more than those people who died in car accidents each year.  Besides the risk of death and havoc on the user and his\her family, opioids cause a deficiency in testosterone which significantly impacts a man’s sexuality.

Testosterone deficiency is an underappreciated consequence of using opioids.

Understanding the risks and the potential treatment options available may help minimize the impact of opioids on testosterone levels. This blog will discuss the relationship between opioid use and testosterone deficiency.

Yes, it is true that opioids are well-known to be highly effective at managing pain. Also well-known is their negative impact on testosterone levels in men taking these potent pain killers.   Interestingly, even with the recognition of this phenomenon, this side effect of reducing testosterone remains an underappreciated consequence of treatment.

Testosterone deficiency can lead to serious health consequences. Symptoms include reduced libido, erectile dysfunction, osteoporosis and decreased bone density, fatigue, depressed mood, reduced muscle mass, poor concentration, and sleep disturbances. As such, testosterone deficiency also impacts quality of life and may even be involved in the development of heart disease.

New Findings

In a large study a higher risk of low testosterone was found with opioids. Data revealed that men on long-acting opioids were significantly more likely to be testosterone deficient.

Treatment Options

The management of low testosterone levels in men taking opioids begins with the checking the symptoms of low T such as decreased sex drive, loss of energy, loss of bone and muscle mass and the confirmation with testosterone testing. However, monitoring of hypogonadism can be a challenge as patients may not necessarily report their symptoms.

Additionally, when possible, baseline serum testosterone levels should be obtained prior to initiating therapy with potent pain medications. Testosterone levels could then be recorded at regular intervals to monitor changes.

If a patient presents with opioid-induced low T, there are several possible treatment options that can be pursued. Strategies that allow for opioid reduction could be considered, such as the concomitant use of non-opioid pain medications. The good news is that discontinuing opioid therapy can result in the normalization of testosterone, with data suggesting recovery of symptoms may occur as fast as a few days to up to 1 month after stopping treatment. Unfortunately, this is an unlikely option for men suffering from chronic pain.

Lastly, testosterone replacement therapy is a viable option for some patients. Testosterone can be given via injections, topical gels, or pellets inserted beneath the skin to restore the normal level of testosterone that will improve the symptoms of low T.  Close monitoring by your doctor will help identify the development of low T levels. Men who are educated on this potential side effect of low T can also be active participants in helping to identify this complication. While several treatment options are available, the best course of action for treating hypogonadism will ultimately depend on symptoms and the blood level of testosterone.

Bottom Line:  Opioids can help with the control of pain but with the price of decreasing the testosterone level in men.  Men who use opioids should speak to their doctor about their symptoms of decrease in sex drive, loss of energy or loss of muscle mass are candidates for hormone replacement therapy.

Take Two (Miles) and Call Me In the Morning

April 17, 2017

Take Two (MileI am often asked what’s the best way to stay healthy and avoid medications and even avoid visiting  the doctor.  I am of the opinion that running may be the single most effective exercise to increase life expectancy. The new study found that, compared to non-runners, runners tended to live about three additional years, even if they run slowly.

The findings from the Cooper Clinic in Dallas, TX found that as little as five minutes of daily running  was associated with prolonged life spans.

Cumulatively, the data indicated that running, whatever someone’s pace or mileage, dropped a person’s risk of premature death by almost 40 percent, a benefit that held true even when the researchers controlled for smoking, drinking and a history of health problems such as hypertension or obesity.

Scientists then determined that if every non-runner who had been part of the reviewed studies took up the sport, there would have been 16 percent fewer deaths over all, and 25 percent fewer fatal heart attacks.

Perhaps most interesting, the researchers calculated that, hour for hour, running statistically returns more time to people’s lives. Figuring two hours per week of training, since that was the average reported by runners in the Cooper Institute study, the researchers estimated that a typical runner would spend less than six months actually running over the course of almost 40 years, but could expect an increase in life expectancy of 3.2 years, for a net gain of about 2.8 years.

Bottom Line:  an hour of running statistically lengthens life expectancy by seven hours for each hour on the track.  So a combination of diet and regular exercise is better than an apple to keep the doctor away!

Pain in Your Private Parts-When You Hurt Below Your Belt

April 12, 2017

Pain below the belt should never be ignored.  This blog will discuss a few causes which may cause “pain in your pouch” and should be reported to your doctor.

Pelvic pain

If you have difficulty with urination, pain in the pelvic area or between your scrotum and your rectum, accompanied by fever and flu-like symptoms, then you may have an infection in your prostate gland.  This requires an appointment with your doctor as this requires an examination of your urine and possibly receiving a prescription for a course of antibiotics.

Painful urination

If you have a burning sensation with urination and the frequent urge to urinate, you may have a urinary tract infection (UTI), an enlarged prostate gland or an early sign of bladder cancer.  This requires an appointment with your doctor as if an infection is identified, then you will need antibiotics since UTIs are the most common cause of these symptoms.  If you do not have an infection, you may be advised to have other tests to determine if something else is causing your symptoms.

Sudden testicular pain

If pain comes on quickly as a sharp quick to the groin and feels like a dull ache and make walking difficult.  The sudden onset of pain may be accompanied by swelling of the scrotum.  This condition may be a testicular torsion.  This condition occurs when the flow of blood to a testicle gets cut off.  This is a medical emergency as this condition requires surgical relief of the torsion in order to save the testicle.

Bottom Line: Don’t take lightly any pain or discomfort in your private parts.  Your sex life might just depend on obtaining prompt medical care.

The New Skinny On Prostate Cancer Screening With the PSA Test

April 11, 2017

Prostate cancer remains one of the most common cancers in men and is the second most common cause of death from cancer in men.  (Lung cancer is still leading the list)  The American Cancer Society projects more than 161,000 new cases this year in the U.S., with about 26,730 deaths each year.  Prostate cancer accounted for 4.4% of all cancer deaths in the United States last year.

The U.S. Preventive Services Task Force, an independent and influential panel of experts, published new guidelines in early April 2017 for screening for prostate cancer for the first time in five years.

The new recommendations: Men ages 55 to 69 should “make an individualized decision about prostate cancer screening with their clinician.” That’s updated from a blanket recommendation in 2012 for no routine screening at any age.

The task force also recommends that those men older than 70 shouldn’t undergo PSA screening.

Now doctors are saying that the older recommendation in 2012, i.e., not to screen for prostate cancer likely resulted in deaths that could have been avoided..

The PSA test is a simple blood test that determines levels of the prostate-specific antigen protein, and elevated PSA can be a sign of prostate cancer. But elevated PSA can also be caused by other conditions, like inflammation of the prostate or benign enlargement of the prostate gland.

The risk of potential harm of over-diagnosis has led to confusing recommendations for screening. Treatment for prostate cancer, including removal of the prostate and radiation, is associated with the side effects of incontinence and erectile dysfunction.

False positives can lead to unnecessary further testing or treatment, and many cases of prostate cancer are slow-moving and require watchful waiting rather than immediate treatment.  This means that the men with slow growing, non-aggressive cancer can be followed with a digital rectal exam, frequent PSA testing, and perhaps additional prostate biopsies.

So how useful is PSA screening? According to the New England Journal of Medicine, studies imply that 1 prostate cancer death is averted per 1,000 men screened several times each, and followed for 10 to 15 years.

On the flip side, the authors reported, data show about 35 over-diagnosed cases per 1,000 men screened.

Some groups are at higher risk for prostate cancer, including African-American men and those with a family history of the disease.

Bottom Line: It is my recommendation to my patients 55-69 they have a discussion with their physician and weigh the benefits vs. the harms of PSA testing.  With that discussion the men can make the best choice for themselves, together with their doctor.

ED and Good Health

April 10, 2017

Many men are unaware of the relationship between ED (impotence) and their overall health.  ED not only include ability to engage in sexual intimacy but also includes problems with libido, and abnormal ejaculation.

ED is defined as the consistent inability to attain or maintain a penile erection of sufficient quality to permit satisfactory sexual intercourse.

The process of diagnosis and treatment begins with a careful sexual history.  Men with a sexual problem will probably be asked:

  • Are you currently having sexual relations?
  • With whom do you have these relations (men, women, or both, and how many partners)?
  • When was the last time you had intercourse?
  • Are you satisfied with the quality and frequency of your sexual experiences?

The answers will clarify what aspects of sexual dysfunction are occurring and inform the rest of the evaluation. If libido is intact but ED is a complaint, then what underlying medical conditions or medications may be contributing to the problem? If libido is affected, are there significant psychologic or emotional contributing factors that need to be addressed as well as measuring the serum testosterone level.

Although sexual problems are not necessarily caused by aging; it is true that aging is associated with an increase in sexual issues. As early as 40 years of age, up to 40% of men report some impaired sexual function.  Inability to attain or maintain an erection consistently for satisfactory intercourse was reported in 67% of males over 69 years of age in another study.  Testosterone decline is common with age. While this may play a hormonal role in sexual dysfunction, it is important to thoroughly evaluate all possible causes before initiating testosterone replacement therapy for sexual dysfunction alone.

Similarly as men age, interest in sex may decline due to lack of novelty as well as an increase in stress that often occurs in older men. Fatigue, lack of privacy in the family setting, and unresolved anger with a partner may all be determinants of sexual problems in the older male. More critically, loss of interest in sexual activity and loss of libido may be manifestations of depression.  Depression can cause sexual problems, but the reverse may also be true.

In addition to these factors, diabetes, blockage of the blood vessels, and adverse effects from medications, both prescribed and recreational (marijuana and cocaine) may all play roles in sexual functioning. Disease states such as hypertension, diabetes, heart disease, and obesity can affect the blood flow into the penis. Blockage in any of the major arteries feeding the blood supply to the penis can lead to inability to obtain and maintain an erection. Diabetes, for example, this can also affect the mechanism of erection and cause ejaculatory disorders such as backward ejaculation of the fluid to the bladder instead of out of the tip of the penis at the time of orgasm.

Medications that are often identified as causes of erectile disorder which include medications used to treat depression, blood pressure lowering medications, cholesterol medications, and drugs used to treat prostate cancer.  Excessive alcohol use is the most common substance that can lead to ED, though cocaine, heroin, and marijuana have all been linked as well.

Bottom Line:  ED is a common problem affecting millions of middle age and older American men.  The diagnosis can often be attributed to underlying disease states.  A careful history and physical examination will help to elucidate the problem and start you on the road to successful treatment.

The Latest Advice on Screening for Prostate Cancer

April 5, 2017

The concept of screening for prostate cancer is a moving target. Screening for this common cancer in men has undergone significant changes in the past ten years. This blog is intended to provide you with advice on whether you should participate in prostate cancer screening.

 

Another progress being made is that men with early-stage tumors have been spared the side effects of treatment, such as erectile dysfunction (impotence) and urinary incontinence, which can be devastating. A recent report notes that 15 years after diagnosis, that 87% of men who underwent surgery and 94% of men who had radiotherapy were unable to engage in sexual intimacy.

 

So what do you need to know about prostate cancer screening?

 

Talk to your doctor about obtaining a PSA tests if you are at high risk for prostate cancer. These include African American men who are twice as likely to be diagnosed with prostate cancer and have an aggressive form of the disease and 2.4 times more likely to die from it than Caucasian men.

 

Men with a family history of prostate cancer are twice as likely to have prostate cancer and to die from it.

 

New tests for prostate cancer

We have been looking for a test that will better predict prostate cancer than an elevated PSA level. There are four new tests to enhance the diagnosis of prostate cancer.

 

A urine test, PCA3 looks for the presence of a specific prostate cancer gene. This test is more accurate than the PSA test in deciding whether a man needs a prostate biopsy.

 

The Prostate Health Index (PHI) blood test evaluates three different components of PSA to determine whether the elevated PSA level is due to infection, benign prostate disease or possibly prostate cancer.

 

The 4K score blood test is similar to the PHI test but looks at four components which can predict a man’s risk of developing prostate cancer.

 

Finally, the prostate MRI or magnetic resonance imaging test which can accurately diagnose aggressive prostate cancer.

 

If any of these four tests are positive, then the next step is a prostate biopsy.

 

So what is my “bottom line” on prostate cancer screening? I suggest a baseline PSA test for all men at age 50 and for higher risk patients at age 45. Men with very low PSA levels, less than 0.7ng\ml at baseline can have the PSA test every 5 years, and those 60 and older with levels less than 2.0ng\ml or lower may be able to avoid future PSA testing for the rest of their lives….as long as they remain symptom free. If you have any questions, check with your doctor.

Body Builders Using “Juice” Beware!

March 30, 2017

I don’t know of any physicians who would condone the use of anabolic steroids in men with normal testosterone levels whose only complaint is desire to increase their muscle mass or their athletic performance.  The use of anabolic steroids in young men is fraught with danger and can result in permanent hormone deficiency and permanent infertility.

Testosterone was first identified in 1935 as responsible for its masculinizing effects along with the effect of increasing lean muscle mass.

However, recently the illicit use of performance enhancing drugs has become an issue for athletes and those men wishing to increase their athletic performance, their strength and muscle mass.   It is estimated that there are 3 million anabolic steroid users and abusers.  And now we have found that nearly 5-6% of middle and high school students have or are using anabolic steroids.

These anabolic drugs are now identified to negatively affect the pituitary glands hormones that stimulate the testicle to produce testosterone and result in prolonged reduction of natural testosterone production and even permanent decrease in testosterone production for many months and even permanently in men who have used and abused anabolic steroids.  Most men will return to baseline natural production of testosterone in 1-2 years after discontinuing the use of anabolic steroids.

There are numerous reports of profound suppression of testosterone in nearly half of all men who have used anabolic steroids.  Because anabolic steroid can have a profound reduction in sperm production, men should understand the consequences of anabolic steroid use.  That is, if they want to father a child, they need to stay farther away from anabolic steroids.

Bottom Line: Anabolic steroid abuse can affect a man’s production of testosterone and may cause permanent reduction in testosterone production by a man’s testicles.  I suggest that all men who might consider using anabolic steroids to take this into consideration before making a bad choice that may affect their health and well being forever.

 

Low T-Review of New York Times Editorial, March 28, 2017

March 29, 2017

 

Low testosterone affects millions of American men.  Testosterone prescriptions in the United States nearly doubled in recent years from 1.2 million in 2010 to 2.2 million in 2013. Testosterone replacement is not the panacea to restore a middle aged man’s fountain of youth.  However, testosterone replacement can improve a man’s sex drive or libido, can increase his energy level and does improve bone strength and a protector for osteoporosis in men.

That’s the good news.  The bad news is that a single study comparing testosterone gel to placebo for one year found a “buildup of noncalcified plaque” in the coronary arteries of the men treated with testosterone.  However, other studies have not demonstrated any increase in heart problems in men using testosterone.

Although the positive changes were modest in the testosterone group there was a significant improvement in men’s mood in the group using testosterone gel.  The study also pointed out that older men with low testosterone levels often have other chronic health conditions, like obesity, than can affect hormone levels but these can often be managed by lifestyle changes such as an exercise program and diet.

It is important to mention that the results of the recent study do not support the promise implied by advertisements for testosterone that using it “will make you stronger and fitter,” though many men said they simply “felt better” while on the drug, and some improvements in walking could be seen when findings were analyzed.

Again, I would like to emphasize that testosterone has no place in men using these hormones for bodybuilding purposes.  At the present time use of testosterone is snot approved by the FDA for bodybuilding purposes.

The Bottom Line: Hormone replacement therapy has a role in men who have symptoms of low T and documented low blood levels of testosterone.  All men who receive testosterone need to have close follow up with PSA testing, a digital rectal examination and a blood count to check for overproduction of red blood cells.