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Erectile Function and Fatigue

Most men find that their sexual desire increases after they start testosterone replacement. Sexual dreams and nighttime/morning erections may be more easily achievable, but in some cases testosterone alone does not make erections strong or lasting enough for successful intercourse.

For these men the use of prescription phosphodiesterase type 5 inhibitor (PD-5) medications like Viagra, Cialis, and Levitra - may be needed in combination with testosterone replacement. However, some men do not respond well to these oral agents or have side effects such as headaches, nasal congestion, flushing, gut problems, and, in the case of Cialis, back pain. Cialis may last longer than the others (36 hours compared to 4 hours for Viagra or Levitra), but so may its side effects. Some men take ibuprofen with these drugs to pre-treat nasal congestion and headaches, respectively. Cialis is also approved for daily use at 5 or 10 mg/day dose (regular dose is 20 mg/day). They are available by prescription but I have heard that some men are ordering them without a prescription from overseas websites to save money (overseas sources can be ten times cheaper than products in the United States). This book does not endorse the use of these drugs without a prescription, but it is my duty to mention facts about what is happening out in the real world.

Other options for men who need an extra erectile boost while using testosterone replacement:

Yohimbine - increases sex organ sensitivity. It can raise blood pressure and cause insomnia and anxiety, so talk to your doctor. A small study showed that men who used yohimbine with the amino acid arginine had better erections

Penile restriction rings—These rubber or leather restricting bands (commonly known as “cock rings”) can be very effective at maintaining erections after the penis fills up with blood. Be careful not to use it too tight. Neoprene and leather rings are the most common. They can be found online.

Other options are penile vacuum devices and penile implants. Due to the scope of this book, these two options will not be reviewed. Plenty of information can be found by Googling those terms.

Medications that could cause decreased sex drive or erectile dysfunction:

Medications can cause erectile dysfunction in some men. A great review of all studies of drugs that affect sexual function in men was provided by Dr Walter K.H. Krause. He was able to identify evidence from different studies (many uncontrolled and small) about the common classes of prescription medications that can cause erectile dysfunction. It is not known if testosterone replacement can counteract the effects of these medication classes.

Among the medications are:

  • Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, monoamine oxidase inhibitors
  • Blood pressure medications (antihypertensives): Alpha andregenergic antagonists, beta-blockers, diuretics, guanethidine, methyldopa
  • Narcotics and opiates
  • Barbiturates and benzodiazepines
  • Hormone related products: anabolic steroids, antiandrogens used in prostate cancer, estrogens, medroxyprogesterone, 5-alpha-reductase inhibitors
  • Anti-acids: Histamine 2 receptor antagonists, proton pump inhibitors
  • Cholesterol –lowering agents: Bile acid sequestrants, fenofibrates, statins

Fatigue

If no improvements in fatigue are observed after 6 weeks of testosterone replacement, factors beyond hypogonadism may be present. Thyroid and adrenal function should be checked to ensure that those two glands are working properly Sleep apnea can also be a factor involved in the failure to improve stamina. Depression may still need to be addressed with the proper medications and counseling.

Thyroid Function:

The thyroid is a butterfly-shaped endocrine gland located in the lower front of the neck. It produces thyroxine or T4, which is converted to tririodothyronine, or T3. T4 production is controlled by thyroid stimulating hormone or TSH, a hormone produced by the pituitary. Hypothyroidism, or low thyroid hormone, can cause sexual dysfunction as well as depression, fatigue, dry skin and hair, weight gain and increased sensitivity to the cold. Blood tests to measure TSH, T4 and T3 are readily available and widely used.

Adrenal Function:

The adrenal glands, located in the abdomen above the kidneys, regulate stress in the human body. When the body encounters an emergency situation, the adrenal glands release hormones, such as adrenaline, that enable the body to respond accordingly. You may have encountered this reaction, called the “fight or flight” response, if you have encountered danger, fear or shock. Adrenal fatigue is the controversial idea that the adrenal glands can become worn out, creating illness, if continually over stimulated. Proponents of the “adrenal fatigue” theory hold that the adrenal glands may be over worked in some individuals and therefore become “fatigued” and unable to produce sufficient hormones. When your adrenal glands become exhausted, your natural cortisol levels drop significantly. Cortisol is your naturally occurring stress hormone. In addition to low sex drive and infertility, symptoms of adrenal fatigue may include chronic fatigue, low blood pressure and low blood sugar, dizziness, headaches, anxiety or panic attacks, depression,and other equally debilitating reactions. Some doctors may prescribe low doses of corticoid steroids if your morning levels of cortisol (measure by blood, saliva or urine tests) are low. But be careful with corticoid steroids since they can increase fat mass and decrease bone density if given in doses that exceed what the healthy adrenals would produce.

DHEA:
The adrenal glands also produce dihydroepiandrosterone (DHEA), the most abundant hormone found in the blood stream. The body uses DHEA as the starting material for producing the sex hormones testosterone and estrogen in men. Studies have shown that it only increases testosterone in women. The production of DHEA diminishes in most people after age 40. In people aged 70 years, DHEA levels will be approximately 30 percent lower than what they were at age 25. Low blood levels of DHEA have been associated with many degenerative conditions. Some controversial and non-conclusive studies have shown that people with immune deficiencies and fatigue may benefit from supplementation with this hormone. It is still available over-the-counter in the United States. This may change soon due to a new bill passed by Congress that classifies it as a performance-enhancing steroid (no studies have shown that it has such effect). One study showed that women with the correct levels of DHEA can convert it into testosterone as their body needs while men do not benefit to the same degree. You need a blood test to know if you have low DHEA-S since most of the DHEA converts into this sulfated form. Common doses for women are 5to 30 mg a day, while men tend to benefit from 25-100 mg per day (to bring low levels of DHEA-S to normal) All the hormones mentioned can be tested with blood tests or by using the easy-do-it-at-home mail order saliva hormone tests that are permissible without a prescription.

Sleep Apnea:
Sleep apnea is a sleep disorder in which the patient briefly stops breathing or breathes shallowly many times during sleep and therefore does not get enough restful sleep; oxygen levels drop in the blood, starving the brain of oxygen. In addition to causing daytime fatigue, it can increase blood pressure and cardiovascular risks. Testosterone-replacement therapy has been associated with exacerbationof sleep apnea or with the development of sleep apnea,generally in men who use higher doses of testosterone orwho have other identifiable risk factors for sleep apnea (high body weight, thick necks, snoring, alcohol consumption, and others). Upper-airwaynarrowing does not seem to be caused by testosterone replacement therapy,suggesting that testosterone replacement contributes to sleep-disordered breathing by central mechanisms rather than by means of anatomicalchanges in the airway. If your spouse or partner complains that you snore loudly at night and you suffer from fatigue, tell your doctor. The only real way to find out if you have sleep apnea is to have your doctor refer you to a sleep lab for a sleep study. If you are diagnosed with sleep apnea, a Continuous Pressure Airway Pressure (CPAP) machine can be prescribed to help you open up your airways with a small air pump while you sleep. Some people love it while some hate wearing a mask while being hooked up to a machine at night.


PERSONAL COMMENTS: Because of terrible bouts with fatigue in the past, I was referred to a sleep lab and diagnosed with mild sleep apnea. I tried CPAP with different masks (they are smaller ones with “nose pillows” and many other designs, so don’t give up early without trying different styles). I could not get used to it. I have had my thyroid and adrenal functions checked without finding any problems.Unfortunately I get anxious if I use them for long periods, so I only use them as needed. What has made the most difference, besides keeping my testosterone in the upper side of the normal range, is going to bed around the same time at night and waking up also at the same time. Traveling and other factors can interfere with maintaining a normal sleep cycle, but the fact is I need to listen to my body’s needs. I can usually be tired enough to get better sleep by the time bedtime arrives if I avoid caffeine after 3 pm and don’t exercise too late at night.

Spider venom shows promise for treating erectile dysfunction

A toxin synthesized from the venom of a spider may offer an alternative to today’s erectile dysfunction drugs, a new study suggests.

The toxin, unpoetically named PnTx2-6, comes from the bite of the Brazilian wandering spider (Phoneutria nigriventer). In humans, a bite from a wandering spider is very painful. What’s more, male victims may find themselves with priapism, or unrelenting and painful erection. It was this symptom, turning up in emergency rooms after spider bites in Brazil, that first alerted researchers to the potential of PnTx2-6 as an erectile dysfunction drug.

The toxin has been shown to improve erections in rats with hypertension and diabetes; now, researchers have tested it in aging mice and found that the toxin is effective in reversing age-related erectile dysfunction as well. ”It’s working in aging, which is a natural process,” study researcher Kenia Nunes, a physiologist at Georgia Health Sciences University, told  ”It’s not just in disease.”

Viagra, Levitra and other erectile dysfunction drugs on the market work by inhibiting an enzyme called PDE5. To get an erection, a man’s body must release nitric oxide, which relaxes the smooth muscle around the arteries of the penis, allowing for his blood vessels to dilate. The nitric oxide is a first step in a series of chemical reactions that allow this muscle relaxation to take place. One step in the series is cGMP, a signaling molecule that acts to keep the muscles relaxed. PDE5 degrades cGMP. That’s a good thing for ensuring that erections don’t last forever, but too much PDE5 can mean an erection doesn’t happen at all. By blocking the enzyme, PDE5 inhibitors solve the problem.

The spider toxin works differently. Instead of affecting PDE5, the compound seems to trigger nitric oxide release, acting directly to relax the smooth muscles. Because about 30 percent of patients don’t respond to PDE5 inhibitors, the toxin could provide an alternative to erectile dysfunction treatments currently on the market, Nunes said.
In the new study Nunes and her colleagues injected aging and young rats with the toxin extracted from the spider venom. They found that the toxin reversed age-related erectile dysfunction, offering hope that the toxin could eventually move out of animal testing and into human use. The toxin has not yet been tested in humans.

The researchers have since developed a synthetic version of the toxin. The next step, Nunes said, is to make sure that the compound doesn’t have any nasty effects beyond its intended purpose.

Men with diet-induced erectile dysfunction may benefit from hitting the gym

Obesity continues to plague the U.S. and now extends to much of the rest of the world. One probable reason for this growing health problem is more people worldwide eating the so-called Western diet, which contains high levels of saturated fat, omega-6 polyunsaturated fatty acids (the type of fat found in vegetable oil), and added sugar. Researchers have long known that this pattern of consumption, as well as the weight gain it often causes, contributes to a wide range of other health problems including erectile dysfunction and heart disease. Other than changing eating patterns, researchers haven’t discovered an effective way to avoid these problems.

Searching for a solution, Christopher Wingard and his colleagues at East Carolina University used rats put on a “junk food” diet to test the effects of aerobic exercise. They found that exercise effectively improved both erectile dysfunction and the function of vessels that supply blood to the heart.

Methodology

For 12 weeks, the researchers fed a group of rats chow that reflected the Western diet, high in sugar and with nearly half its calories from fat. Another group of rats ate a healthy standard rat chow instead. Half of the animals in each group exercised five days a week, running intervals on a treadmill.

At the end of the 12 weeks, anesthetized animals’ erectile function was assessed by electrically stimulating the cavernosal nerve, which causes an increase in penile blood flow and produces an erection. The researchers also examined the rats’ coronary arteries to see how they too responded to agents that would relax them and maintain blood flow to the heart, an indicator of heart health.

Results

The findings showed that rats who ate the Western diet but stayed sedentary developed erectile dysfunction and poorly relaxing coronary arteries. However, those who ate the diet but exercised were able to stave off these problems.

Animals who ate the healthy chow were largely able to avoid both erectile dysfunction and coronary artery dysfunction.

Importance of the Findings

These findings may suggest that exercise could be a potent tool for fighting the adverse effects of the Western diet as long as the subjects remained very active over the course of consuming this type of diet, the authors say. Whether exercise would still be effective in reversing any vascular problems after a lifetime of consuming a Western diet is still unknown.

"The finding that exercise prevents Western diet-associated erectile dysfunction and coronary artery disease progression translates to an intensively active lifestyle throughout the duration of the ‘junk food’ diet," the authors say. "It remains to be seen if a moderately active lifestyle, or an active lifestyle initiated after a prolonged duration of a sedentary lifestyle combined with a ‘junk food’ diet is effective at reversing functional impairment."

Tadalafil Succesfully Treated Erectile Dysfunction

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A study of the investigational drug Tadalafil, an oral PDE5 inhibitor, found that it increased intercourse success in men with erectile dysfunction (ED) at up to 36 hours after dosing. The study was conducted by Dr. Hartmut Porstclinical investigator in private urological practice in Hamburg, Germany and the international tadalafil study group.

In the study, 348 men with mild to severe ED were given either Tadalafil 20-mg or placebo. Patients were asked to attempt intercourse on four separate occasions: once 24 hours after a dose, once again 24 hours after a dose, once 36 hours after a dose, and once again 36 hours after a dose.

Tadalafil significantly increased the percentage of successful intercourse attempts at 24 hours (57 percent) and 36 hours (60 percent) post dose compared with placebo (31 percent and 30 percent, respectively). Secondary measures of efficacy — penetration ability, hardness of erection, overall satisfaction - showed tadalafil to have greater efficacy than placebo at both 24 hours and 36 hours post dose.

Tadalafil was well tolerated; headache, flushing and dyspepsia (upset stomach) were the most common side effects, but most were mild to moderate in intensity. The extended duration of effectiveness did not appear to increase the rate of side effects or their severity, and very few patients receiving placebo or tadalafil discontinued due to side effects.

"We are very pleased to see that tadalafil allowed a majority of men in this trial to achieve normal sexual functioning at up to 36 hours after taking the drug," said Dr. Porst. "The extended duration of responsiveness may help eliminate the need for planning sexual intimacy and could potentially set new expectations in the treatment of ED."

Erectile dysfunction is the consistent inability to attain or sustain an erection adequate for satisfactory sexual intercourse. It is estimated to affect more than 30 million men in the United States.

Bisexual men face unique challenges to their sexual health

Bisexual men have many unmet public health needs, which leave them vulnerable to sexually transmitted infections (STIs) and other health problems. This new study from the Centers for Disease Control and Prevention (CDC) illuminates the behavioral, interpersonal, and social realities of men who have sex with men and women (MSMW), and it explores possible interventions to better serve their needs.

MSMW represent a small portion of the population, with about 2% of sexually active males reporting sex with both men and women. Although low in numbers, the bisexual male population is disproportionally affected by HIV and STIs. According to study author William L. Jeffries IV, PhD, MPH, MA, factors that may affect the sexual health of MSMW include sex without condoms, early sexual debut, forced sexual encounters, increased numbers of sexual partners, substance use, exchange sex, risk behaviors of their male and female partners, and attitudes toward pregnancy. These factors shape MSMW’s vulnerability to HIV and STIs in ways that distinguish bisexual men from gay and heterosexual men. Negative attitudes toward bisexual individuals, economic barriers, masculinity norms, and the meanings associated with their sexual identities are among the social factors that may negatively influence their sexual partnerships and risks for HIV/STIs.

While HIV prevalence among MSMW is lower than among gay men, MSMW are more likely than heterosexual men to become infected with HIV. Also, MSMW are less likely than gay men to be tested for HIV, which can lead to undiagnosed HIV and transmission to partners. Along with HIV, other STIs are common among MSMW, with 21% of these men reporting STI treatment in the past year, compared to 12% for gay men and 2.3% of heterosexual men.

"MSMW’s increased likelihood of insertive sex without a condom, as well as commonly occurring oral sex with men and women, likely increase MSMW’s vulnerability to STIs readily acquired via penile-insertive and oral sex," writes Dr. Jeffries. "Moreover, receptive and insertive sex without a condom with men (no matter how common) makes MSMW more vulnerable to HIV than men who only have sex with women because HIV is more prevalent among men than women in the United States."
Dr. Jeffries also identifies other behavioral factors that may increase chances of acquiring HIV and STIs among MSMW, including early sexual experiences, multiple partners, illicit drug use, and attitudes towards pregnancy.

"MSMW’s attitudes toward pregnancy influence their sexual health. Qualitative data from black men suggest that desires to prevent pregnancy may prompt some MSMW to consistently use condoms with women," Dr. Jeffries explains in the paper. "Yet, MSMW may avoid condom use when their female partners use other contraceptives or when female partners perceive condom use as a sign of relationship infidelity. Further, MSMW’s desires to produce offspring biologically may prompt sex without a condom with female partners. In this regard, desires for fatherhood may indirectly increase these men’s vulnerability to HIV/STIs and transmission of these infections within their sexual networks."

In the current social climate, MSMW face several sociocultural obstacles including biphobia, or negative attitudes towards bisexuals.
"Biphobia can manifest in erroneous beliefs that MSMW are gay men who have not disclosed their sexual orientation and, particularly for black men, responsible for HIV transmission to women," Dr. Jeffries adds. "Experiencing these sentiments can contribute to MSMW’s social isolation and psychological distress, which in turn may promote HIV/STI risk through substance use, sexual risk behaviors, and the avoidance of prevention services."

This new research not only describes an understudied population, but also recommends interventions to better serve bisexual men. Dr. Jeffries suggests that some strategies for comprehensively promoting MSMW’s sexual health may be to:

  • Launch social marketing campaigns that use affirmative images of sexual minority men to counteract the biphobia and homophobia that MSMW experience 
  • Develop comprehensive sexuality education programs that provide invaluable HIV/STI prevention education to MSMW, including promoting school safety for MSMW 
  • Encourage social spaces that cultivate a sense of community to provide opportunities for social support and candid discussion of sexual health concerns 
  • Engage medical and health professionals in sensitivity trainings to lessen any hostility encountered by MSMW when they seek information about sexual health or HIV/STI testing

While more research and outreach is needed to better understand the particular health and other needs of bisexual men, this study sheds new light on the current situation.

"Sexual health promotion for MSMW should not be limited to HIV/STI prevention alone," concludes Dr. Jeffries. "Recognition of MSMW’s unique sexual and social experiences can lay the foundation necessary for ensuring that these men have healthy and fulfilling sexual experiences. Purposefully designed and tailored efforts for MSMW are indispensable for improving the sexual health of this vulnerable population.

Headaches during sex likely more common than reported

About 1 % of adults report they have experienced headaches associated with sexual activity, and that such headaches can be severe. But the actual incidence is almost certainly higher, according to a Loyola University Medical Center neurologist and headache specialist.

"Many people who experience headaches during sexual activity are too embarrassed to tell their physicians, and doctors often don’t ask," said Dr. Jose Biller, who has treated dozens of patients for headaches associated with sexual activity (HAS). Biller is chair of Loyola’s Department of Neurology, and is certified in Headache Medicine by the United Council for Neurologic Subspecialties. Comedians have long joked about spouses avoiding sex by claiming to have a headache. But sex headaches are not a laughing matter, Biller said.

"Headaches associated with sexual activity can be extremely painful and scary," Biller said. "They also can be very frustrating, both to the individual suffering the headache and to the partner."

Headaches in general usually are caused by disorders such as migraines or tension-type headaches. But headaches also can be secondary to other conditions, and some of these conditions can be life-threatening.

The vast majority of headaches associated with sexual activity are benign. But in a small percentage of cases, these headaches can be due to a serious underlying condition, such as a hemorrhage, brain aneurysm, stroke, cervical artery dissection or subdural hematoma. “So we recommend that patients undergo a thorough neurological evaluation to rule out secondary causes, which can be life-threatening,” Biller said. “This is especially important when the headache is a first occurrence.”
Sexual activity is comparable to mild- to moderate-intensity exercise. The ancient Greek physician Hippocrates first noted the association between headaches and exercise and sexual activity. And in 2004, the International Headache Society classified HAS as a distinct form of primary headache.

Biller said men are three to four times more likely to get HSAs than women. There are three main types of sex headaches:

  • A dull ache in the head and neck that begins before orgasm, and gets worse as sexual arousal increases. It is similar to a tension headache.
  • An intensely painful headache that begins during orgasm and can last for hours. It’s called a thunderclap headache, because it grabs your attention like a clap of thunder. One of Biller’s patients, who asked to remain anonymous, described such a headache this way: “All of a sudden, there was a terrific pain in the back of my head. It like someone was hitting me with a hammer.”
  • A headache that occurs after sex and can range from mild to extremely painful. The headache gets worse when the patient stands, and lessens when the person lies back down. This headache is caused by an internal leak of spinal fluid, which extends down from the skull into the spine. When there’s a leak in the fluid, the brain sags downward when the patient stands, causing pain.

Depending on the type of headache, certain medications can help relieve the pain or even prevent the headache, Biller said.
Individuals can reduce their risk of sex headaches by exercising, avoiding excessive alcohol intake, keeping a healthy weight and counseling, Biller said.

New insights into premature ejaculation could lead to better diagnosis

There are many misconceptions and unknowns about premature ejaculation in the medical community and the general population. Two studies provide much-needed answers that could lead to improved diagnosis and treatment for affected men.

Premature ejaculation can cause significant personal and interpersonal distress to a man and his partner. While it has been recognized as a syndrome for well over 100 years, the clinical definition of premature ejaculation has been vague, ambiguous, and lacking in objective and quantitative criteria. This has made it difficult for investigators to conduct clinical trials on experimental drugs and for doctors to effectively identify and treat affected patients. In 2008, the International Society for Sexual Medicine issued a definition of lifelong premature ejaculation, but a definition has been lacking for acquired premature ejaculation. “The lack of an evidence-based definition for acquired premature ejaculation promotes errors of classification, resulting in poorly defined study populations and less reliable and harder-to-interpret data that are difficult to generalize to patients,” said Ege Can Serefoglu, MD, FECSM, of the Bagcilar Training & Research Hospital, in Istanbul, Turkey.

By reviewing and evaluating the medical literature, Dr. Serefoglu and his colleagues on the Second International Society for Sexual Medicine Ad Hoc Committee now provide a unified definition of lifelong and acquired premature ejaculation. The committee proposed the definition to be a male sexual dysfunction characterized by

  • ejaculation that always or nearly always occurs prior to or within about 1 minute of vaginal penetration from the first sexual experience (lifelong) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired);
  • the inability to delay ejaculation on all or nearly all vaginal penetrations; and
  • negative personal consequences, such as distress, bother, frustration, and/or the avoidance of sexual intimacy.

"The unified definition of lifelong and acquired premature ejaculation will reduce errors of diagnosis and classification by providing the clinician with a discriminating diagnostic tool," said Dr. Serefoglu. "It should form the basis for both the office diagnosis of premature ejaculation and the design of observational and interventional clinical trials," he added.
The committee also conducted and published a study to provide clearly worded, practical, evidenced-based recommendations for the diagnosis and treatment of premature ejaculation for family practice clinicians and sexual medicine experts. Led by Stanley Althof, PhD, of Case Western Reserve University School of Medicine in West Palm Beach, Florida, the experts reviewed previous guidelines for premature ejaculation and examined new findings. “There are many misconceptions about premature ejaculation. We sought to disseminate the most up-to-date information to non-sexual health specialists so that they can confidently treat patients suffering from this condition,” said Dr. Althof. “We also reveal the burden of this dysfunction on the patient and his partner and discuss, in depth, the multiple treatments available.” It also offers specific questions to ask patients during evaluations and detailed descriptions of various psychological, behavioral, educational, and pharmacological interventions.

Men with erection problems are three times more likely to have inflamed gums

Men in their thirties who had inflamed gums caused by severe periodontal disease were three times more likely to suffer from erection problems, according to a study.

Turkish researchers compared 80 men aged 30 to 40 with erectile dysfunction with a control group of 82 men without erection problems. This showed that 53 per cent of the men with erectile dysfunction had inflamed gums compared with 23 per cent in the control group. When the results were adjusted for other factors, such as age, body mass index, household income and education level, the men with severe periodontal disease were 3.29 times more likely to suffer from erection problems than men with healthy gums.

"Erectile dysfunction is a major public health problem that affects the quality of life of some 150 million men, and their partners, worldwide," says lead author Dr. Faith Oguz from Inonu University in Malatya, Turkey. "Physical factors cause nearly two-thirds of cases, mainly because of problems with the blood vessels, with psychological issues like emotional stress and depression accounting for the remainder. "Chronic periodontitis (CP) is a group of infectious diseases caused predominantly by bacteria that most commonly occur with inflammation of the gums. "Many studies have reported that CP may induce systemic vascular diseases, such as coronary heart disease, which have been linked with erection problems."

The average age of the men in both groups was just under 36 and there were no significant differences when it came to body mass index, household income and education.
Their sexual function was assessed using the International Index of Erectile Function and their gum health using the plaque index, bleeding on probing, probing depth and clinical attachment level. “To our knowledge, erectile dysfunction and CP in humans are caused by similar risk factors, such as aging, smoking, diabetes mellitus and coronary artery disease,” says Dr. Oguz. “We therefore excluded men who had systemic disease and who were smokers from this study. “We particularly selected men aged between 30 and 40 to assess the impact of CP on erectile dysfunction without the results being influenced by the effects of aging. “The result of our study support the theory that CP is present more often in patients with erectile dysfunction than those without and should be considered as a factor by clinicians treating men with erection problems.”

Viagra could prove useful in the fight against obesity

Researchers from the University of Bonn have treated mice with Viagra and discovered that the drug converts white fat cells (those unwanted denizens of the belly and similar swollen regions) into beige fat cells. Instead of storing excess energy, these recently discovered beige fat cells burn the energy from ingested food and convert it to heat. Viagra also appears (at least in mice) to decrease the risk of other complications caused by obesity.

Viagra (also known as sildenafil citrate) is used to treat erectile dysfunction, pulmonary arterial hypertension, and altitude sickness. It increases levels of the intracellular messenger cyclic guanosine mono-phosphate, which produces smooth muscle relaxation and thereby ensuring the blood supply for an erection.

Another effect of Viagra was noticed in a 2007 study. Mice dosed with Viagra for a 12 week period did not become fat when placed on a high-fat diet. The reason for the unexpectedly small gain of weight was not known at the time.

Following on from these earlier studies, Prof. Dr. Alexander Pfeifer, Director of the Institute for Pharmacology and Toxicology at the University of Bonn, and his colleagues studied the effect of Viagra on fat cells in mice. After giving the subjects the drug for seven days at about ten times the maximum approved dosage for human use, they discovered that a significant number of the white fat cells in the mice had been converted into the far healthier beige fat cells.

The study also establishes that larger levels of cyclic guanosine mono-phosphate prevent the remaining white fat cells from hypertrophy. When white fat cells store more energy, they become fatter rather than dividing into a larger set of cells. At least, they do this until they reach about four times their normal size, at which point they eventually divide.

Before this division happens, hypertrophy of the white fat cells causes them to release cytokines, which are immunomodulators – that is, they change the immune status of the body. In this case, they ramp up the action of the immune system, leading to chronic inflammation, which is at the base of most chronic health conditions, including cardiovascular disease, diabetes, arthritis, and even cancer. The white fat cytokines are particularly damaging to heart tissues.

The overall summary of the findings is that, at least in mice, Viagra can convert fat into calorie-burning beige fat, prevent white fat cells from overgrowing their bounds, and reduce the inflammatory response of the fat cells while reducing the amount of inflammatory cytokine messengers that are at least partly responsible for much of the chronic disease being fought by our medical systems. “It seems that sildenafil prevented the fat cells in these mice from getting onto that slippery slope,” says Prof. Pfeifer.

As always in medical studies, mice are not humans, and taking severe overdoses of Viagra to change the operation of your immune system, aside from being extremely expensive, is probably not an ideal course of action at this point. “We are currently in the basic research stage, and all the studies have been exclusively performed on mice,” stresses Prof. Pfeifer.

It may be some time before potentially suitable drugs for decreasing white fat cells in humans will be found, but perhaps this will eventually give users of Viagra another reason to be happy.

Contraception changes affect relationships

Women’s sexual satisfaction in long-term heterosexual relationships may be influenced by changes in hormonal contraceptive use, research from the University of Stirling shows.

The study was carried out by researchers from the universities of Stirling, Glasgow, Newcastle, Northumbria and Charles University in Prague. The team looked at a sample of 365 couples, and investigated how satisfaction levels - in both sexual and non-sexual aspects of long-term relationships - were influenced by women’s current and historical use of hormonal contraception.

"Our findings showed women who had met their partner while taking the pill and were still currently taking it - as well as those who had never used the pill at any point - reported greater sexual satisfaction than those women who had begun or stopped using the pill during the course of the relationship," says lead researcher Craig Roberts from Stirling’s Division of Psychology.

"In other words, the congruence of women’s pill use throughout the relationship had a greater influence on sexual satisfaction levels than either simply being on the pill or not being on the pill."

The team found there was no difference in the non-sexual aspects of relationship satisfaction between the groups of women. Additionally, women’s history of pill use was also found to make no difference to their male partners’ relationship satisfaction in both sexual and non-sexual contexts.

"Previous research has shown that hormonal contraceptives, such as the pill, subtly alter women’s ideal partner preferences and that often women who are using the pill when they meet their partner find the same partner less physically attractive when they come off the pill," says Roberts.

"Our new results support these earlier findings but, crucially, they also point to the impact a change in hormonal contraceptive use during a relationship - either starting or stopping - can have on a woman’s sexual satisfaction with her partner."

According to Roberts, “The pill has been a tremendously positive social force, empowering women and giving them greater control over their lives, but there is also a lot of controversy surrounding the question of whether hormonal contraceptives alter women’s libido and sexual satisfaction.”

"These results show that examining current use is not enough to answer this question. What seems to be important is whether a woman’s current use matches her use when she began the relationship with her partner. We hope our results will help women understand why they might feel the way they do about their partner when they change use," Roberts concludes.

Researchers compare hip width and sexual behavior

In a new study, women who were more inclined to have one-night stands had wider hips, reveals Colin A. Hendrie of the University of Leeds in the UK. He is the lead author of a study into how a woman’s build influences her sexual behavior.

The study into whether hip width or waist-to-hip ratio was a better predictor of a woman’s sexual behavior was conducted among 148 women between 18 and 26 years old. The participants all had at least one sexual partner previously. Their hip width (defined as the distance between the upper outer edges of the iliac crest bones of the pelvis) was measured, as well as their hip circumference at the widest point and their waist circumference at its narrowest point. Participants also completed a questionnaire about their sexual histories, including the age at which they lost their virginity, the number of sexual partners they had had, and information about emotionally significant sexual relationships they had had.

The results show that the number of sexual partners a woman had is largely driven by one-night stand behavior. This, in turn, correlates with a woman’s hip width and not waist-to-hip ratio. Overall, women in this study with hips wider than 36 centimeters (14.2 inches) had more sexual partners and more one-night stands than women with hips under 31 centimeters (12.2 inches) wide. More specifically, the women for whom one-night stands accounted for three out of every four of their sexual relationships had hips at least two centimeters (0.8 inches) wider than their counterparts in whose lives such fleeting relationships were not as prevalent.

The researchers, Hendrie and co-authors Victoria J. Simpson and Gayle Brewer, surmise that women with wider hips are more likely to engage in sex because the birth process is generally easier and less traumatic for them than for smaller-hipped women (below 31cm). This in turn relates back to how humans learned to walk upright and the subsequent development of narrower hips to make it easier to walk. In the process, female hips have become just wide enough to allow childbirth. Infants are born at a less developed stage than most other primates because of this restriction, and therefore need much more care and investment after birth from their mothers and fathers.

"Women’s hip width has a direct impact on their risk of potentially fatal childbirth-related injury. It seems that when women have control over their own sexual activity this risk is reflected in their behavior. Women’s sexual activity is therefore at least in part influenced by hip width," concludes Hendrie. He added, however, that statements about causality cannot be made using the current data and it remains to be seen if these conclusions can be generalized to other populations and cultures.

How to naturally boost your libido?

There are many reasons why a person’s sex drive can suddenly start to wane unexpectedly - excess stress, rapid aging, poor nutrition, and chronic depression are just a few common causes of low libido. But resorting to those little blue pills to fix the problem in an instant should be a last resort option, as there are plenty of natural remedies for treating this common condition that address its root causes rather than its symptoms. 

1) Supplement with adaptogenic herbs to fix your hormonal balance. For many people, and particularly men, low libido is a direct result of low testosterone, which is often caused by perpetual exposure to estrogenic foods and chemicals. The modern world is a rather unfriendly place for men, it turns out, as plastics, soy, fluoride, and other toxins deplete men of their vigor over time, and leave them feeling weak and uninterested, or even unable to effectively engage, in sex.

Besides eliminating these estrogenic exposures as much as possible, it is important for men to actively fight back against this anti-testosterone onslaught by supplementing with adaptogenic herbs like maca root, ashwagandha, Siberian ginseng, cayenne pepper, astragalus, damiana, and ginkgo biloba, to name just a few. Such herbs not only aid the body in holistically adapting to various exposures and stress, hence the name adaptogen, but they also help improve circulation, warm the body, and correct underlying hormonal imbalances that could be the cause of low libido.

2) Get your liver, kidneys in working order. For some people, poor-functioning organs are responsible for a depressed sex drive, as the amount of toxins going into their bodies exceeds the amount being flushed out. Poor fat metabolism, digestive problems, nutrient malabsorption, blood sugar problems, weak immunity, neurological problems, and hormonal imbalances are all common symptoms associated with a toxic liver, for instance, which can eventually lead to renal failure. And urinary incontinence and kidney stones are associated with poor functioning kidneys.

If you ever hope to truly restore a healthy sex drive, you must regularly cleanse these and other organs. Coffee enemas are one great way to keep your liver in tip-top shape, as they not only cleanse and heal the colon, but also directly flush the liver, which is the body’s primary filter for collecting and eliminating toxins. Juice fasting, supplementing with probiotics, drinking plenty of clean, fluoride-free water is also helpful for cleansing both the liver and kidneys.

3) Exercise, practice yoga. If you spend a lot of time sitting throughout the day, whether it be in your chair at the office or on the couch at home, chances are you are not getting enough regular exercise to combat stress and promote healthy circulation, two factors in low libido. Whether you are a man or a woman, exercise plays a crucial role in promoting healthy sex drive, not to mention health in general.

If you enjoy sports, try joining a local pick-up team that meets several times a week. Particularly if you are a man, you might also join a local gym and sign up for strength training classes that involve shorter-duration, higher-intensity workouts to promote muscle building. Moderate strength training not helps build strength and stamina, but it can also help boost testosterone levels naturally.

4) Take natural aphrodisiacs. Many of the herbs used in cooking ethnic or spicy dishes are also natural aphrodisiacs, which means they can help put you in the mood for sex by promoting relaxation, releasing inhibitions, inspiring passion, and sometimes even directly stimulating erogenous zones. By eating such foods on a regular basis, and particularly within the half hour before intimacy, you can help boost your sex drive more subtly by naturally stirring your senses, which is far safer than taking prescription drugs.

Common aphrodisiacs include anise seed, cardamom seed, cayenne pepper, cinnamon bark, cloves, coriander, cumin seed, curry, fennel, garlic, ginger, mustard seed, nutmeg, parsley, rosemary, sage, turmeric, and vanilla. Just be sure to seek out non-irradiated varieties of these herbs, as irradiation tends to denature nutritional quality and reduce potency

Cialis vs. Viagra (Tadalifil citrate)

Cialis (Tadalifil citrate) is the second-generation Viagra, more or less. While the little blue pill may work to give you an erection for 6-8 hours, Cialis is good for 36-48 hours. This obviously makes it much more practical. Why are we talking about this? Well I doubt anyone using endogenous testosterone would need to consider the use of such a compound, this drug can still have some uses during post-cycle therapy. A lot of men find that once they go off steroids and begin post cycle therapy (PCT), they suffer reduced libido as well as erectile dysfunction. Well, Cialis may be useful for helping this, at least during PCT.

The efficacy and safety of Tadalafil for the treatment of erectile dysfunction was assessed in a 6-month study. Men with mild, moderate or severe ED were given tadalafil (20 mg) as needed or placebo.

Tadalafil significantly improved erectile function compared with placebo (which only succeeded in embarrassing the men who took it and tried to get laid). At the end of the study, sexual intercourse attempts success rate for those using Cialis was 73.5% (this only refers to the ability to achieve erection and have intercourse, not the actual success rate of those attempting to get laid on a given night.

Cialis Side Effects

Of particular interest to those considering the use of Cialis is that Lack of sexual activity due to erectile dysfunction actually decreases testosterone (T) levels through a central effect on the hypothalamic-pituitary axis Cialis was given to men for a month, and at the end, they had considerably higher testosterone levels, because they got laid more, as it is unlikely that the drug has a different direct effect on the pituitary-testis axis.

This stuff is actually very safe, and was even given 3x a week to men for an extended length of time, and was well tolerated, had very few sides, and was very effective. Thus, it could be another potential compound for inclusion in PCT. Tadalafil (20 mg) significantly improves erectile function, could increase testosterone, and is well tolerated, certainly something to think about after your next cycle.

Circumcision could prevent prostate cancer … if it’s performed after age 35

Men circumcised after the age of 35 were 45% less at risk of later developing prostate cancer than uncircumcised men. Prostate cancer is rare amongst Jewish or Muslim men, the majority of whom are circumcised. While the specific causes of this cancer remain unknown, three risk factors have been identified: aging, a family history of this cancer, and Black African ethnic origins.

Researchers at the University of Montreal and the INRS-Institut-Armand-Frappier have shown that men circumcised after the age of 35 were 45% less at risk of later developing prostate cancer than uncircumcised men. This is one of the findings that resulted from a study undertaken by Andrea Spence and her research directors Marie-Élise Parent and Marie-Claude Rousseau. The researchers interviewed 2114 men living on the Island of Montreal. Half of them had been diagnosed with prostate cancer between 2005 and 2009, while the others participated in the study as the control group. The questions covered their lifestyle and medical history, if they were circumcised, and if so, the age at which the operation had been performed.

Greater benefit for Black men

Across the board, the participants who were circumcised were 11% less likely to later develop a prostate cancer compared to those who weren’t. The size of the reduction is not statistically significant. “This proportion reflects what has been shown in other studies,” Parent explained. However, babies who were circumcised before the age of one were 14% less likely to develop prostate cancer. Moreover, the removal of the foreskin at a young age provides protection, over the long term, against the most aggressive forms of cancer.
Prostate cancer is rare amongst Jewish or Muslim men, the majority of whom are circumcised. While the specific causes of this cancer remain unknown, three risk factors have been identified: aging, a family history of this cancer, and Black African ethnic origins. Amongst the 178 Blacks who took part in the study — of whom 78% were of Haitian origin — the risk of prostate cancer was 1.4 times higher than amongst Whites. 30% of the Black men were circumcised compared to 40% of the White men. Interestingly, the protective effect of the circumcision was limited to the Black men, whose risk of developing prostate cancer was decreased by 60%, with a very significant statistical effect.

Circumscribing the discovery

Researchers do not know what mechanism enables circumcision to protect men from prostate cancer. However, many studies have shown that this operation reduces the risk of acquiring a sexually transmitted infection (STI). “Unlike the skin that covers our bodies, the inner surface of the foreskin is composed of mostly non-keratinized mucosal epithelium, which is more easily penetrated by microbes that cause infections,” Parent explained. Removing the foreskin could therefore reduce the risk of an infection that might be associated with prostate cancer. In any case, the protective effect of circumcision (in particular the effect observed in the Black population) must be confirmed by other studies, especially in consideration of the relatively few Black men who participated in research.

The Facts About an Enlarged Prostate

An enlarged prostate is a problem most men will confront in their lifetimes. If a man lives long enough, he’ll most likely have an enlarged prostate.

The prostate is a male reproductive gland tasked with producing the fluid that carries sperm out of the body during ejaculation. The prostate surrounds the urethra, the tube through which urine passes during urination. As men age, the prostate gland grows bigger. It is originally about the size of a walnut, often increasing in size by the age of 40 to the size of an apricot. By the time a man is 60 years old, his prostate gland may have enlarged to the size of a lemon. The enlarged prostate ends up squeezing the urethra like a clamp on a garden hose, causing the flow of urine to become weak and slow. The condition is also known as benign prostatic hyperplasia. It’s not cancerous, and it doesn’t increase a man’s risk of contracting prostate cancer. More than 50 % of men in their sixties have symptoms of enlarged prostates due to benign prostatic hyperplasia, and that number rises to many as 90 percent when men reach their seventies and eighties.

Why Enlarged Prostate Occurs

The causes of enlarged prostate are not well understood. The only two risk factors doctors have been able to associate with enlarged prostate are growing old and having a functioning set of testicles. Men who have had their testicles removed when they were young do not develop benign prostatic hyperplasia.

Other explanations for an enlarged prostate include:

  • Decreased testosterone level. The amount of testosterone in the blood decreases as a man ages. When that occurs, the proportion of naturally occurring estrogen in a man’s body increases, and may promote growth of the prostate.
  • Increased DHT level. The prostate derives a substance called dihydrotestosterone, or DHT, from testosterone. Even though blood testosterone levels drop in older men, DHT production doesn’t slow down, so high levels of DHT continue to build up in the prostate. This could lead to the growth of prostate cells.
  • Genetics. It has also been suggested that genetic instructions inside some prostate cells may order them to activate later in life and begin to grow.

An enlarged prostate also can result from a prostate infection or from prostate cancer, although those occur less frequently and are not as inevitable as BPH.

The symptoms of enlarged prostate always revolve around a problem with the ability to urinate. Men might find that they can only maintain a hesitant, weak stream that frequently stops. They also may need to urinate more frequently, because the bladder is not completely emptied with each episode of urination, particularly at night. There is usually no pain involved in BPH; if there is pain, it could mean an infection has occurred.

There’s no way to prevent benign prostatic hyperplasia. It occurs as a function of aging.

Enlarged Prostate: Diagnosis and Treatment

The means used by physicians to diagnose an enlarged prostate include:

  • Rectal exam. The prostate gland can best be felt through the rectal cavity. A doctor inserts a gloved, lubricated finger into your rectum to feel how large the prostate gland is, and whether there are any abnormalities, such as an area that is hard or lumpy.
  • Urine and blood tests. Results of a urine test can suggest that the prostate may be enlarged due to infection, while a blood test can measure prostate specific antigen (PSA), which is high when prostate cancer is present. The United States Preventive Services Task Force recently recommended against PSA tests for prostate cancer, but many medical experts say men should still get screened. PSA tests may also be used to calculate PSA density, which is your PSA score divided by the size of your prostate (determined through ultrasound). A high PSA density is more likely to be indicative of cancer; a low PSA density suggests prostate enlargement.
  • Ultrasound exam. Sound waves are directed at the prostate through a probe inserted in the rectum. The echoes of these sounds waves then create an image of the prostate on a television screen.
  • Urine flow exam. You urinate into a special device that gauges the speed and strength of urine flow.
  • Cystoscopy. A small tube is inserted into the penis through the urethra, allowing a doctor to see the inside of the urethra and bladder, and to visualize areas compressed by an enlarged prostate.

Benign prostatic hyperplasia-related enlarged prostate is most often treated through drug therapy or surgery:

  • Drug therapy. Medications known as alpha-blockers relieve pressure and restore urine flow by relaxing the muscles near the prostate. They don’t reduce the size of the prostate, however. Another drug known as Proscar (finasteride) is able to reduce the size of the prostate gland by blocking an enzyme that normally interacts with testosterone to stimulate prostate growth. By stopping this interaction, finasteride slows the growth of the prostate gland and even reduces the size of the prostate, which could reduce blockage.
  • Surgery. There are several surgical options for treating BPH-related enlarged prostate. In extreme cases, the prostate may be removed. A more common surgical approach — accounting for 90 percent of benign prostatic hyperplasia surgeries — is to widen the urethra by trimming excess tissue away from the gland. This option generally doesn’t cause some of the complications of other prostate surgeries, such as incontinence and impotence.

Unfortunately, an enlarged prostate can reoccur after surgery that trims excess prostate tissue, or if a man stops taking his medication. Untreated enlarged prostate can lead to urinary tract infections, kidney or bladder stones, or urinary retention and kidney damage. That’s why it’s so important to see a doctor if you have symptoms that may suggest a prostate problem.