Posts Tagged ‘low sperm count’

Everything You Wanted to Know About Low T (Testosterone) But Afraid To Ask

February 21, 2015

Low testosterone is a common condition that impacts the sex life and the quality of life of millions of American men. This blog will discuss the symptoms of low T and what treatment options are available.

Testosterone is a hormone required for male development and is produced primarily in the testicles. It is responsible for building muscle and bone mass as well as sperm production and sex drive. It influences male pattern fat distribution, hair distribution such as a man’s beard, bone density, and red blood cell production.
Lack of or underproduction of testosterone either directly due to decreased production in the testes or indirectly due to lack of stimulation of the testes to produce testosterone by the pituitary gland is called hypogonadism and is a medical condition requiring treatment.
In the normal developing male, testosterone peaks during early adulthood. Once you reach age 30, testosterone levels slowly decline by approximately 1% a year. This is a normal part of aging.
The low limit of testosterone levels in men is about 300 nanograms per deciliter and the upper normal limit is approximately 1000-1200 ng/dl. A low level needs to be investigated further to distinguish it from normal aging.

Low testosterone (low-T) is underproduction or lack of production of testosterone.
Causes of low-T include chronic medical conditions such as diabetes, infections, obesity, or other hormonal conditions.

The symptoms of low-T include: erectile dysfunction (ED), decreased libido, change in sleep patterns, decreased sperm count and motility of sperm, and emotional changes such as depression and despondency.

My take home message is that low-T testing includes linking symptoms with testosterone blood levels.
Treatment options
Treatment options for low-T include different forms of testosterone therapy.
Some of the conditions that can lead to a low level are:
Obesity
Diabetes (type 2)
Chronic medical conditions (especially liver or kidney disease)
Hormonal disorders
Infections

What is the treatment for low testosterone (Low-T)?

Treatment of low testosterone is possible for most men who suffer from the symptoms of low T. There are several ways that testosterone therapy can be administered:
Transdermal (skin patch): Usually applied once a day (for example, Androderm). Tends to be clean and easy to apply. There is an available mouth patch which sticks to the upper gums and is applied twice daily.

Gels: Applied directly to the skin and then absorbed through the skin (for example, Androgel, and Axiron. Dosing is more difficult although these gels are available in single applications packages or premeasured pumps.

Injections: Testosterone can be delivered by direct injection.

Pellets: Pellets can be implanted into the soft tissue and release the testosterone.

I am often asked what treatment options are available that do not require any medications, gels, or injections. My advice is to get enough sleep, keep a healthy weight, and stay active.

Possible side effects and risks of testosterone therapy for the normal aging male include:
Stimulation of growth of the prostate (benign prostatic hypertrophy) and possible growth of existing prostate cancer. Please note that testosterone doesn’t cause prostate cancer, but if you have prostate cancer, testosterone can accelerate the growth of an existing cancer.
Skin reactions
Limiting sperm production and shrinkage of testicles
Over-production of red blood cells (which can be a contributor to a heart attack)
Some studies have implicated testosterone in an increase in cardiovascular events although there are studies that suggest that low testosterone levels places men at risk for heart disease and stroke.

Testosterone therapy is accepted as a treatment for men with symptoms of low T, which is a clearly defined medical condition.

In older adults who have markedly decreased testosterone levels without significant symptoms or who have modestly decreased levels with significant symptoms, testosterone therapy should be considered after a discussion with your doctor about side effects and possible positive effects of therapy.

Bottom Line: Testosterone deficiency is a common problem in middle age and older men. The diagnosis is easily made with a blood test to check the level of testosterone. Treatment can be accomplished with injections, topical gels, or pellets. For more information, speak to your physician.

Testosterone Replacement In Men Who Wish To Continue Family Planning

November 24, 2014

Testosterone Replacement In Men Who Wish To Continue Family Planning

Millions of men have testosterone deficiency. Most of the men are middle age and older and, therefore, family planning is not an issue. However, if younger men have a low testosterone level and wish to continue family planning, the usual replacement with testosterone injections, gels or pellets is contraindicated because testosterone can reduce the sperm count making fertility difficult or impossible. This blog will discuss treatment of low T in younger men who wish to continue to have a family.

Function of Testosterone

Testosterone is the most important sex hormone or androgen produced in men. The function of testosterone is primarily the producing the normal adult male characteristics. During puberty, testosterone stimulates the physical changes that constitute the attributes of the adult male.

Throughout adult life, testosterone helps maintain sex drive, the production of sperm cells, male hair patterns, muscle mass and bone mass. Testosterone is produced in men by the testes and in the outer layer of the adrenal glands.

The hypothalamus controls hormone production in the pituitary gland by means of gonadotropin-releasing hormone (GnRH). This hormone tells the pituitary gland to make follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). LH orders the testes to produce testosterone. If the testes begin producing too much testosterone, the brain sends signals to the pituitary to make less LH. This, in turn, slows the production of testosterone. If the testes begin producing too little testosterone, the brain sends signals to the pituitary gland telling it to make more LH, which causes the testes to make more testosterone.

Symptoms of Low Testosterone

The failure of the testes to produce a sufficient level of testosterone in the adult male results in a low testosterone level. Physical signs of low testosterone in men may include:

Declining sex drive,
Erectile dysfunction (ED),
Low sperm count
Decrease in lean muscle mass
Insomnia or sleep disorder
Depression
Chronic fatigue.
Conditions Causing Male Testosterone Deficiency

Testosterone deficiency can be caused by different conditions: 1) effects of aging; 2) testes based conditions; 3) genetics; and 4) conditions caused by the pituitary and hypothalamus.

The effects of aging on testosterone production
Testes disorder
Pituitary/Hypothalamus disorder
Genetically-based condition
Function of Testosterone Therapy

The function of testosterone hormone replacement therapy is to increase the level of testosterone in the adult male diagnosed with testosterone deficiency (low testosterone) or hypogonadism. Testosterone replacement should in theory approximate the natural, endogenous production of the hormone. The clinical reasons for treatment of testosterone deficiency in men include:

Increased male sex drive
Improve male sexual performance
Enhance mood in men
Reduce depression in men
Increased energy and vitality
Increase bone density
Increased strength and endurance
Reduce body fat
Increase body hair growth
Reduce risk of heart disease
Develop lean muscle mass with exercise
Function of HCG Therapy is to Stimulate the Testes to Prevent Loss of Natural Testosterone Production and Avoid Testicular Atrophy while the Male Patient is Undergoing Testosterone Hormone Replacement Therapy

The hormone HCG is prescribed for men in this therapy to increase natural testosterone production during the course of therapy as a result of the stimulation of the testes by the HCG. No testosterone medication is administered in this treatment. The treatment objective is to cause the male testes to naturally produce a higher volume of testosterone by HCG stimulation of his testes with the result that the patient experiences a continuing higher blood level of testosterone while on treatment. Another treatment objective is to avoid the use of any anabolic steroid and its adverse side effects upon the patient.

HCG Therapy normally increases natural testosterone production by the male testes while HCG is administered to the patient during the treatment period However, HCG Therapy can also result in a continuation of increased testosterone production and a resulting higher level of testosterone in the bloodstream after treatment is completed when the cause of the patient’s low natural LH secretion by the pituitary is not due to the patient’s natural genetics, aging process, injury to or loss of one or both testes; a medical disorder or disease affecting the testes, or castration.

HCG Therapy can result in a continuing higher level of natural testosterone production by the testes after HCG Therapy is completed when the underlying cause of the low LH secretion and resulting low testosterone production (1) is due to the prior use of one or more anabolic steroids by the patient or (2) due to the administration of testosterone in a prior hormone replacement therapy without the required concurrent HCG Therapy to prevent the patient’s endocrine system (hypothalamus pituitary-testes axis) from shutting down the natural production of testosterone by the testes and causing testicular atrophy.

Types of Testosterone Therapy for Men

A good male testosterone replacement therapy produces and maintains physiologic serum concentrations of testosterone and its active metabolites without significant adverse side effects.

The leading types of testosterone therapy for men include:

Testosterone Injection with HCG
Testosterone Transdermal Cream with HCG
Testosterone Transdermal Gel with HCG
Benefits of HCG Therapy for the Male Patient Undergoing Testosterone Hormone Replacement Therapy

Increases natural testosterone production by the testes
Prevents loss of natural testosterone production by the testes while the male patient is undergoing testosterone hormone replacement therapy
Prevents atrophy of testes while male patient is being treated with testosterone replacement therapy
Increases physical energy and elimination of chronic fatigue
Improves sex drive
Improves sexual performance
Improves mood
Reduces depression
Increases lean muscle mass
Increases strength and endurance as a result of exercise
Reduces body fat due to increased exercise
Increases sperm count and therefore male fertility
HCG Therapy can also result in a higher level of natural testosterone production after HCG Therapy is completed when the cause of a man’s current low testosterone production is the prior use of anabolic steroids that shut down or reduced the pituitary gland’s production of LH and decreased testosterone production.
Human Chorionic Gonadotropin (HCG)

HCG is compounded by a compounding pharmacy or manufactured by pharmaceutical company in 10,000 IU (International Units) for reconstitution with sterile water for injections in 10 cc vials.

HCG is a natural protein hormone secreted by the human placenta and purified from the urine of pregnant women. HCG hormone is not a natural male hormone but mimics the natural hormone LH (Luteinizing Hormone) almost identically. As a result of HCG stimulating the testes in the same manner as LH, HCG therapy increases testosterone production by the testes or male gonads as a result of HCG’s stimulating effect on the leydig cells of the testes.

The Decline in Gonadal Stimulating Pituitary Hormone LH (Leutenizing hormone)

The natural decline in male testosterone production that occurs with aging is attributed to a decline in the gonadal stimulating pituitary hormone LH (Luteinizing hormone). As a result of the hypothalamus secreting less gonadoropin-releasing hormone (GhRH), which stimulates the pituitary gland to produce LH, the pituitary gland produces declining amounts of LH. This decrease in the pituitary secretion of LH reduces the stimulation of the gonads or male testes and results in declining testosterone and sperm production due to the decreased function of the gonads. The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

The decreased stimulation of the testes by the pituitary’s diminished secretion of LH can also cause testicular atrophy. HCG stimulates the testis in the same manner as naturally produced. HCG Therapy is administered medically to increase male fertility by stimulating the testes to produce more sperm cells and thereby increase sperm count or Spermatogenesis.

How HCG Therapy Increases Plasma Testosterone Level in Men with Low Testosterone Production

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone. The male endocrine system is responsible for causing the testes to produce testosterone. The HPTA (hypothalamic-pituitary-testicular axis) regulates the level of testosterone in the bloodstream. and . The hypothalamus produces gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to release Leutenizing hormone (LH).

LH released by the pituitary gland then travels from the pituitary via the blood stream to the testes where it triggers the production and release of testosterone. Without the continuing release of LH by the pituitary gland, the testes would shut down their production of testosterone, causing testicular atrophy and stopping natural testosterone produced by the testes.

As men age the volume of hypothalamus produced gonadotropin-releasing hormone (GnRH) declines and causes the pituitary gland to release less Luteinizing hormone (LH). The reduction if the volume of LH released by the Pituitary gland decreases the available LH in the blood stream to stimulate the testes to produce testosterone.

In males, HCG mimics LH and increases testosterone production in the testes. As such, HCG is administered to patients to increase endogenous (natural) testosterone production. The HCG medication administered combines with the patient’s own naturally available LH released into the blood stream by the Pituitary gland and thereby increases the stimulation of the testes to produce more testosterone than that produced by the Pituitary released LH alone. The additional HCG added to the blood stream combined with the Pituitary gland’s naturally produced LH triggers a greater volume of testosterone production by the testes, since HCG mimics LH and adds to the total stimulation of the testes.

HCG Clinical Pharmacology

The action of HCG is virtually identical to that of pituitary LH, although HCG appears to have a small degree of FSH activity as well. It stimulates production of gonadal steroid hormones by stimulating the interstitial cells (Leydig cells) of the testis to produce androgens.

Thus HCG sends the same message and results in increased testosterone production by the testis due to HCG’s effect on the leydig cells of the testis. HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level.

Following intramuscular injection, an increase in serum HCG concentrations may be observed within 2 hours; peak HCG concentrations occur within about 6 hours and persist for about 36 hours. Serum HCG concentrations begin to decline at 48 hours and approach baseline (undetectable) levels after about 72 hours.

HCG is not a steroid and is administered to assists the body in the continuing production of its own natural testosterone as a result of LH signals stimulating production of testosterone by the testis.

This LH stimulates the production of testosterone by the testes in males. Thus HCG sends the same message as LH to the testes and results in increased testosterone production by the testes due to HCG’s effect on the leydig cells of the testes. In males, hCG mimics LH and helps restore and maintain testosterone production in the testes. If HCG is used for too long and in too high a dose, the resulting rise in natural testosterone will eventually inhibit its own production via negative feedback on the hypothalamus and pituitary.

HCG therapy uses the body’s own biochemical stimulating mechanisms to increase plasma testosterone level during HCG therapy. It is used to stimulate the testes of men who are hypogonadal or lack sufficient testosterone

Testosterone and the Prostate Gland-It’s Not Gasoline On a Fire

November 3, 2014

For the past two years I have made the decision of treating prostate cancer patients who are documented to be hypogonadal with testosterone replacement therapy. Many of my colleagues have asked me about this decision and I would like to provide you with the evidence that this treatment of hypogonadal men who have been treated for localized prostate cancer with either radical prostatectomy or radiation therapy is safe.

In the late 1980s Dr. Abraham Morgentaler, a urologist in Boston, Massachusetts, began researching the relationship between testosterone and prostate cancer.  Since the early 1940s testosterone had been believed to be a key contributor to the development of prostate cancer, and once cancer was established, testosterone was believed to be its fuel.  As a result, generations of medical students around the world were taught that providing additional testosterone to a man with prostate cancer was “like pouring gasoline on a fire.” On the flip side, it was similarly believed that low levels of testosterone protected a man from ever having prostate cancer.

As one of the first physicians in the modern era to offer testosterone therapy to otherwise healthy men with sexual problems, Dr. Morgentaler was concerned that this treatment, while effective, might precipitate rapid growth of undetected, “occult” prostate cancers in his patients.  In order to avoid causing more harm than good, Dr. Morgentaler took the bold step of performing prostate biopsies in these men to exclude the possibility that these men harbored an undetected prostate cancer, even though they had none of the standard indications for a biopsy, such as elevated PSA or a nodule.  Although it had been assumed these men were at extremely low risk for prostate cancer because of their low testosterone levels, Dr. Morgentaler and his colleagues found exactly the opposite. One in seven of these “normal” men that underwent biopsy was found to have cancer, a rate similar to that seen in men known to be at increased risk.

Dr. Morgentaler presented his findings at the annual meeting of the American Urological Association in 1995.  At the end of the presentation an influential chairman of a major urology department came to the microphone and loudly described this work as “garbage.” “Everyone knows high testosterone causes prostate cancer and low testosterone is protective,” he proclaimed in a booming voice.  The research was published the following year in the prestigious Journal of the American Medical Association.

As the testosterone and prostate cancer link became less persuasive, Dr. Morgentaler began to offer testosterone to men with pre-cancerous abnormalities on prostate biopsy, and reported no increased rate of subsequent cancer. Yet at his own hospital, the Beth Israel Deaconess Medical Center, a senior endocrinologist complained to the administration that this research was “dangerous”.

However, Dr. Morgentaler prevailed and went on to publish clinical research on the safety of testosterone in men with actual prostate cancer, some treated with radiation or surgery, and even in selected men with untreated prostate cancer.

Dr. Morgentaler’s results were difficult to accept initially because a longstanding treatment for advanced prostate cancer has been androgen deprivation, a surgical or medical treatment designed to permanently reduce testosterone levels as much as possible. Numerous studies in these men had shown improvement in prostate cancer with this treatment, so it seemed logical that raising testosterone would cause prostate cancer progression.

Dr. Morgentaler’s elegant solution to this apparent paradox was the saturation model, based on studies in humans, animals, and in prostate cancer cell lines in the laboratory. It turned out that prostate tissue does indeed require testosterone for optimal growth, but that it can only use a limited amount of testosterone (or its metabolite, dihydrotestosterone) before it reaches a maximum. In biological terms, this is called saturation.  Once saturation is achieved, additional testosterone has little or no capability to stimulate further growth. And saturation occurs at very low levels of testosterone, approximately 20ng\dl. This explained why testosterone treatments did not appear to harm men with existing or treated prostate cancer, namely because the cancers already had seen all the testosterone they could use.

The Evidence

A number of physicians have treated patients with testosterone despite the fact that they’d been treated for prostate cancer in the past. The first to publish their experience with doing this were Drs. Joel Kaufman and James Graydon, whose article appeared in the Journal of Urology in 2004.

In this article, Drs. Kaufman and Graydon described their experience in treating seven men with T therapy some time after these men had undergone radical prostatectomy as treatment for prostate cancer, with the longest follow-up being 12 years. None of the men had developed a recurrence of his cancer. Soon afterward, there was another paper by a group from Case Western Reserve University School of Medicine describing a similar experience in 10 men with an average follow-up of approximately 19 months. Then another group from Baylor College of Medicine reported the same results in 21 men.

In all these reports, not a single man out of the 38 treated with testosterone developed a cancer recurrence. It is important to emphasize that all these reports included only men who were considered good candidates because they were at low risk of recurrence anyway. And in some cases, the duration of time the men received T therapy was relatively short. But it was reassuring that none of the 38 men who had suffered from prostate cancer in the past and who were treated for years with testosterone had developed a recurrence of prostate cancer.

This reassuring experience was bolstered by the published experience of Dr. Michael Sarosdy, who reported the results of T therapy in a group of 31 men who had received prostate cancer treatment in the form of radioactive seeds, called brachytherapy. This less-invasive form of treatment does not remove the prostate, so theoretically there is the possibility that a spot of residual cancer might still be present. With an average of five years of follow-up in these men, none of the 31 men had evidence of cancer recurrence.

My Approach

Men who have low-grade prostate cancer, i.e., Gleason score of <6, and low stage disease, T1 or T2, and have a nadir of their PSA following curative treatment with either surgery or radiation for 9-12 months, and have symptoms of hypogonadism and documented low testosterone levels, are candidates for hormone replacement therapy. I provide them with educational materials similar to what is in this newsletter and request that they return every month to monitor their PSA levels. Any increase in PSA levels for two successive months results in cessation of their hormone replacement therapy. Of the several dozen patients that meet this criteria and have received testosterone replacement therapy, none have had a rise in their PSA or evidence of recurrence of their prostate cancer.

Bottom Line: Today, most urologists throughout the world, myself included, are comfortable using testosterone in men without the fear of causing prostate cancer, and in the US a majority will now offer testosterone treatment to some men previously treated for prostate cancer.  This revolutionary change in medical beliefs and practice resulted directly from the work of Dr. Morgentaler, who became a David against Goliath and was relentless in his pursuit of scientific truth and making it possible for some men who have prostate cancer with documented hypogoandism to receive hormone replacement therapy.

Stress Getting You Down-It May Also Be Affecting A Man’s Fertility

May 19, 2013

Stress just may have an impact on a man’s sperm quality. Men with higher levels of stress and anxiety have lower sperm counts. Also those with the highest anxiety levels were also more like to have sperm that are less motile or have the ability to swim through the cervical canal to find an egg in the tubes connecting the ovary to the uterus. This report appeared in the February 13, 2013 issue of Fertility and Sterility.

Bottom Line: Want to have a baby and your partner is not getting pregnant? Then consider chilling out and find ways to reduce your stress level. It just may help those sperm reach the egg and get your family started. If you have questions regarding male infertility, see your urologist and get a semen analysis. It’s a test that every couple with an infertility problem should do.

Men, Start Your Engines…Take The Road To Good Health

July 8, 2012

Unfortunately, men, including myself, often have the attitude that if ain’t broke, don’t fix it.  As a result men don’t take as good care of their health as they should.  There are some men who will spend more time, energy, and money taking care of their cars than they do of the wonderful machine called their body.  Men seldom see a doctor after they leave their pediatrician’s office at age 20 and never get medical, and especially preventive health care until they over 50 years.  That’s 30 years or a third of your life without any fine-tuning or maintenance.  Is it any wonder that our bodies breakdown in middle age?  It doesn’t have to be that way.  In this blog I will summarize an article, 6 Questions to Ask Your Doctor, by Dr. Matt McMillin that appeared in WebMD the Magazine on July 8, 2012

Your Diet

But eating right most of the time is an essential part of taking care of yourself. No matter how much you work out you can’t maintain a healthy weight unless you stick to a healthy diet. So be sure to satisfy your appetite with good-for-you foods, and make an effort to keep an eye on calories.

Men are often surprised that even though they are exercising four days a week, they are not losing weight. It’s all about portion control.  For example many men drink beer. To burn off the 150 calories in one can of beer, the typical man needs to jog a mile in less than 10 minutes or do 15 minutes of stair climbing.

Exercise

It’s simple: To get or stay fit, you have to get and stay active. According to the latest federal guidelines, that means a cardio workout of at least 30 sweat-inducing minutes five days a week, plus two days of dumbbell workouts or other weight-training activity to build and maintain muscles. Crunched for time? Kick up the intensity to vigorous exercise, such as jogging, riding a bike fast, or playing singles tennis, and you can get your cardio workout in just 25 minutes three days a week.

Exercise protects against so many conditions — from heart disease to colon cancer to depression — that the best choice is to start exercising now, no matter how healthy you are or think you are. If you haven’t been exercising regularly, see your doctor first and get medical clearance before engaging in a good exercise program.  I also suggest that you read the book, Younger Next Year by Chris Crowley and Henry S. Ledge, M.D.  This book will give you the motivation and the schedule for a real get-in-shape program consisting of diet and exercise. 

 

Stress Reduction

Stress is harmful. It can wreak havoc on your sex drive, increase your blood pressure, and overwork your heart. Here’s the facts: middle-aged and older men who reported years of moderate to high levels of stress were more than 40% more likely to die than men with low stress.

One of the best stress busters is exercise.  You might also try yoga or meditation in addition to exercise.

The D word-Depression

At least 6 million men in the United States suffer from depression each year, according to the National Institute of Mental Health. However, many guys don’t like to talk about their feelings or ask for help. Identifying those problems is a crucial part of any man’s checkup. Depression is more than simply feeling sad, unmotivated, and without energy. Depression is a real illness, and it can be life-threatening. That’s especially true for men, because it increases the risk of serious health problems, such as high blood pressure, heart disease, and stroke. Depression is also the leading cause of suicide — and men are four times more likely than women to take their own lives.

A lot of men are reluctant to discuss their feelings with friends, spouses, their clergyman\woman, or their doctor. Identifying those problems is a crucial part of any man’s checkup. Depression is more than simply feeling sad, unmotivated, and without energy. Depression is a real illness, and it can be life-threatening. That’s especially true for men, because it increases the risk of serious health problems, such as high blood pressure, heart disease, and stroke.

Depression is also the leading cause of suicide — and men are four times more likely than women to take their own lives. “I discuss how common it is so they see they are not isolated,” says White, who screens men for depression during their annual checkups. “Too often, it takes until they reach the end of their rope before they come to see you about it.” Depression is also the leading cause of suicide — and men are four times more likely than women to take their own lives. Medication, exercise, and therapy are all treatment options.

Get your zzzz’s-sleep

It’s hard to overestimate sleep’s importance. Diabetes, high blood pressure, and heart disease are all linked to insufficient sleep, as are excess weight and mood disorders. A recent study showed that young men who skimp on shut-eye have lower levels of testosterone than men who are well-rested. Lower testosterone translates to a decrease in sex drive and sexual performance including impotence or erectile dysfunction.  Meanwhile, older men risk high blood pressure if they don’t get enough deep sleep.

Sleep disorders can also have physical causes. Obstructive sleep apnea (OSA), for example, disrupts breathing and forces you to wake up to draw a deep breath. It affects an estimated 4% to 9% of middle-aged men (twice the rate in women), yet as many as 90% of cases go undiagnosed. OSA raises the risk of heart disease, stroke, and high blood pressure as well as car crashes, which are more common among the sleep-deprived.

You can vastly improve your sleep by practicing good sleep hygeine: Go to bed and wake up at the same time each day, exercise regularly and early in the day, avoid caffeine in the afternoon and evening, don’t eat large meals at night, skip the alcohol right before bedtime, and use the bedroom for sleep and sex only. If these measures don’t help, see your doctor.

Good Health Equals Good Sex

 Erectile dysfunction (ED) is a concern that goes beyond the bedroom.  Years ago, ED was thought to be just a psychological problem or do to testosterone deficiency.  Now we know that ED is most a problem of disease in the blood supply to the penis and now we have learned that ED is a risk factor for heart disease.  Men with ED are twice as likely to have a heart attack and nearly twice as likely to die of heart disease than other men. Men who have trouble with erections tend to be overweight or obese, and to have high blood pressure and high cholesterol.

The younger you are, the more likely your erectile dysfunction is a sign that you are at risk of heart disease.

Many of the men White sees for ED ask for quick fixes such as erection-enhancing drugs like Viagra, Levitra, or Cialis. For a long-term solution, you need to make some lifestyle changes. Sexual health depends on getting and staying fit, physically and mentally.  Yes, Viagra, Levitra, or Cialis will help but the real solution is to get fit and open up those blood vessels to the heart and also to penis.  Your heart and your sexual partner will thank you.

Bottom Line:  Men, you can’t buy good health.  It doesn’t come in a bottle or with one visit to the doctor’s office.  It comes with discipline, hard work, and the commitment to leading a healthy lifestyle.  Good health is within reach of every man.  Get off of the couch and into the pool, on to the jogging track, or into the gym.  You can thank me latter!

Dr. Neil Baum is a physician in New Orleans and the co-author of ECNETOPMI-Impotence It’s Reversible.

Low Sperm Count? The Culprit Might Be Your Laptop Computer

December 24, 2010

Whoever invented the ‘laptop’ probably didn’t worry too much about male reproductive health.  Turns out, unsurprisingly, that sitting with a computer on your lap will crank up the temperature of your genitals, which could affect sperm quality.

It is well known that the scrotum and its contents are about one degree cooler than the core body temperature of 98.0F.  If the testicles are exposed to increased heat such as frequent hot tubs and certain occupations such as bakers and welders, it may decrease the sperm count and result in infertility. Under normal circumstances, the testicles’ position outside of the body makes sure they stay a few degrees cooler than the inside of the body, which is necessary for sperm production.

The researchers at State University of New York at Stony Brook hooked thermometers to the scrotums of 29 young men who were balancing a laptop on their knees. They found that even with a lap pad under the computer, the men’s scrotums overheated quickly. To hold a laptop on your knees, however, you need to sit still with your legs closed. After one hour in this position, the researchers found that men’s testicle temperature had risen by up to 2.50.

Nearly one in six couples in the US have trouble conceiving a baby, and about half the time the man is at the root of the problem.  This number may be much higher for men using laptop computers for long periods of time.

Bottom Line: Your laptop may be hazardous to your sperm production.  The extra heat generated to the testicles is enough to impact sperm counts. The solution may be as simple as putting your laptop on a desk or spreading your legs to allow the added heat to escape.

 

Male Infertility-It’s Not Always the Woman’s Fault

May 9, 2010

Nothing is more devastating to a couple than the inability to conceive and have a child.  Infertility is currently a problem for one out of five couples presently trying to have children.  In one-third of the couples the problem is due to a problem in the man; one-third is due to a female cause; and one third is due to both the man and the woman.  Therefore in nearly 2\3 of the couples, there is a male factor associated with the failure to conceive or for the woman to become pregnant.

Any couple embarking on an infertility work-up does so with some fear and reluctance.  It often helps to know what is ahead, to be informed and aware of how it will feel and what the doctor is hoping to find.

The nature of the infertility work-up necessitates that it become a priority in your daily life.  Suddenly, there are specific days that you must have intercourse.  In certain tests you even have to report to the doctor’s office a specific number of hours after intercourse.  As a result, spontaneous lovemaking becomes difficult.  Vacations and business trips become low priority.  Schedules have to be made to fit the demands of the testing cycle. Many women find it hard to take time off from work, especially if they don’t want it known that they are undergoing an infertility evaluation.  It is a stressful time.  Both husband and wife are being tested and scored.  There is a feeling of “pass or fail” and a real sense of despair if a test comes back showing questionable or negative results.  Women often feel frightened and violated by the infertility tests.  Men often feel helpless.  For the husband, testing is over if the semen analysis is normal.  In contrast, he may see his wife having to go through various tests which can be painful and frightening.  This understandably can upset both members of the couple.  Added to this worry and uncertainty is the lingering fear of what the doctor will find.  What if they indeed find an answer, but a discouraging one?  Suffice it to say that deciding to start an infertility workup is a big decision. (This paragraph could be deleted if you are pressed for space)

The following is an overview of the tests involved.  You may want to use it to understand what may be required medically or as a tool to double-check that you have had all the tests.

Initial Appointment

Some infertility specialists like to see the couple together for the first appointment.  This provides a opportunity for the couple to establish good communication with the doctor.  It also is an opportunity to evaluate what, if anything, has been done and what will be needed in the future.  The doctor will be able to explain tests to the couple and will give them a time frame in which he or she hopes to complete the evaluation.(Could be deleted)

The doctor will take a very careful medical history from the male. The doctor will want to know about the medical history of the immediate family.  Attention will be paid to details concerning previous surgery, infections, chronic illnesses, and hospitalizations.  Background information on smoking, alcohol intakes and medications and exposure to environmental or occupational toxins will be requested.  Of course, a reproductive history from both partners will be needed.  Details about the types of birth control practiced will be obtained.  In addition, any history of previous pregnancies should be discussed. Information about frequency and nature sexual intercourse and previous venereal disease is crucial in the evaluation.

Physical Examination

A physical examination of the male is usually done on the first visit.  The physical exam will include an examination of the genital organs, with the doctor noting size, position and condition of the penis and testes.  A rectal exam is done to determine the size and consistency of the prostate gland and seminal vesicles.  The doctor will also note the development of secondary sex characteristics such as hair and fat distribution.

The Medical Evaluation of the Male

Semen Analysis – This is the first and most informative test done on the male.  An analysis can be done any time because a man is not cyclic as women are.  Abstinence from intercourse for 48 hours before the analysis is suggested.  Abstinence for a longer period than two days is not necessary.  For the semen analysis, the doctor will ask the man to masturbate a specimen into a sterile container.  This can be done at home and kept at body temperature and delivered to the lab for evaluation.   Then the laboratory will examine the specimen under a  microscope looking for the number of sperm present, how fast the sperm are swimming (motility) and the shape of  the sperm (morphology).

A fertile semen specimen should have at least 20 million sperm, with at least 50% of the sperm motile and 50-60% with good morphology.  Normal volume is 2-5 cc.

Several additional tests may be done on the male if the semen analysis is not normal.

Evaluation for a varicocele is done by palpating the scrotum while the man is bearing down or coughing.  The link between the presence of a varicocele and infertility is not clearly understood.  The most common theory is that the presence of a varicocele causes poor circulation which ultimately inhibits normal sperm production.

In the event of a subfertile semen analysis, a small biopsy of both testicles may be done.  This procedure is done in a hospital under local or general anesthesia.  The testicular tissue is examined in the laboratory.  This test can tell the doctor if there is an absolute infertile state with no sperm-producing tissue present, or blockage in the vas deferens indicated by the presence of normal testicular tissue yet little or no sperm in the ejaculate.

Finally, if a blockage in the vas deferens is suspected during a testicular biopsy, a vasography can be done to pinpoint the area of  the blockage.  This is an x-ray study in which dye is injected into the vas deferens and a series of x-rays are taken.

Once an infertility work-up is underway it is  important that the couple get the results of each test as they are done.  Couples should ask  their doctors for explanations if need be.  It is your body and you have a right to know what is being discovered.  Sometimes it is wise to make a consultation appointment with your doctor if you feel confused or upset about the tests end results.  This is especially important if the work-up has been going on for a long time or if there is a male factor  problem as well as a female one, which is being treated by another doctor.  It is easy to feel helpless and powerless during an infertility work-up.  Good communication with your doctor can help alleviate some of these feelings.

If men have a normal semen analysis, then the focus shifts to the female partner.  For men who have decreased sperm counts or abnormal motility, there are medications that can be given to enhance the number of sperm and methods to put the sperm in contact with the egg.

Bottom Line: Infertility is problem that impacts the lives of many young couples hoping to conceive a child.  The man is cause of the problem in 50% of infertile couples.  Help is available and much can be done to help a couple make their dreams come true.

Male Infertility-Tips To Putting a Little Vim and Vigor Into Your Sperm Count

May 9, 2010

Patients with infertility can have some control of their reproductive function by living healthy lifestyles. Often some negative lifestyles may be contributing to their infertility. Therefore, if patients live healthy lifestyles, it is possible that there will be some improvement in their reproductive function. There may not be conclusive evidence for all these lifestyle recommendations, but rarely will following these guidelines hurt, and often they may help:

  1. Avoid excessive heat (avoid waterbeds, saunas, hot tubs, etc.).
  2. Limit coffee to 1 or 2 cups per day.
  3. Do not smoke.
  4. Do not use marijuana, cocaine, or other recreational drugs. Marijuana stays in the testes for over 2 weeks; so even using it once every two weeks will have a negative effect.
  5. Exercise regularly and moderately.
  6. Drink no more than 2 ounces of alcohol twice per week. Alcohol is a male reproductive tract toxin, which associates with a decrease in the percentages of normal sperm. Female should abstain from alcohol if pregnant.
  7. Have good nutritional habits, especially a diet rich in fresh fruits and leafy vegetables (organically grown foods).
  8. Be aware of sexual problems and do not hesitate to ask for medical help.
  9. Infertile men should educate themselves about health and reproduction.
  10. Seek emotional and/or psychological support; consider meditation to reduce stress.

Key Vitamins and Nutritional Supplements: Taking certain vitamins (C, E, B12, etc.) may help improve your fertility. The mechanism of action is believed to be as follows: The breakdown of oxygen as it passes through the cells in our body results in substances known as free radicals. Infertile men have a higher concentration of free radicals in their semen as compared to fertile men. Free radicals attack and destroy the membrane that surrounds sperm. Anti-oxidants fight against these bad effects. Therefore, Vitamins are natural anti-oxidants!

I suggest you also take:

Vitamin C (500 mg/day). It helps to protect sperm against free radical damage. It also guards sperm from oxidative damage. Many studies show that supplement Vitamin C also improves the quality of sperm in smokers and reduces sperm agglutination (a condition when sperm stick together, then fertility is reduced.).

Vitamin E (400 IUS/day). Vitamin E has an important function as an antioxidant. Therefore, Vitamin E supplements can decrease and mop up enough free radicals to prevent the damage to sperm cells.

Selenium (200 mcgs/day). A double-blind study shown that selenium supplement can significantly increase sperm motility.

Multivitamins containing zinc (20 mg). Zinc plays an important role for the male reproductive system. A lack of zinc can effect the normal sperm production. For men with low testosterone, zinc supplements may raise testosterone levels and increase sperm production.

Bottom Line:  All of these recommendations may not have scientific merit but they certainly won’t hurt you or cause any deterioration of your sperm count.

Varicocele-A Cause of Male Infertility

May 9, 2010

Varicocele is a mass of enlarged and dilated veins that develops in the spermatic cord within the scrotal sac. A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle.

Incidence and Prevalence

Approximately 40% of infertile men have a varicocele and among men with secondary infertility -those who have fathered a child but are no longer able to do so-prevalence may be as high as 80%.

Signs and Symptoms

Most men who have a varicocele have no symptoms. Asymptomatic (i.e., symptom-free) cases are often diagnosed during a routine physical examination. Signs and symptoms include the following:

  • Ache in the testicle
  • Feeling of heaviness in the testicle(s)
  • Infertility-can suppress sperm counts and sperm movement
  • Shrinkage (atrophy) of the testicle(s)
  • Visible veins under the scrotal skin-the veins collapse when the man lies down
  • Recurrent or constant discomfort or pain in the genital region should be reported to a urologist to determine the cause.

Treatment

If the patient with varicocele is asymptomatic and infertility is not an issue, no treatment is warranted. If the discomfort is mild, the condition usually can be managed by wearing an athletic supporter or snug-fitting underwear during strenuous activity or exercise.

Surgery

If the varicocele causes pain or atrophy (rare) or if the condition is causing infertility (most common), surgery may be recommended. Most varicoceles can be corrected through a surgical procedure called varicocelectomy (i.e., surgically “tying off” the affected spermatic veins).

Surgical ligation

This treatment usually requires general or regional anesthesia. In this procedure, a 2- to 3-inch incision is made in the groin or lower abdomen, the affected veins are located visually, and the surgeon cuts the veins and ties them off above the varicocele to reroute the blood through unaffected veins. Surgery can be performed on an in- or outpatient basis. The patient typically can resume light activity within a week and strenuous activity in about 6 weeks.

About 50% of men who undergo varicocelectomy to correct infertility father children within the first year. It takes about 90 days for a sufficient quantity of new sperm to be produced to permit fertilization. Semen analysis usually is done at 3- and 6-month intervals after the operation.

Bottom Line: Varicoceles are very common and can be a cause of male infertility.  Help is available and most men can have improvement in their sperm counts after surgical correction