Great Sex, Naturally (40 page)

Any man considering using testosterone needs to know the crucial distinction between natural testosterone and its synthetic counterpart. Natural testosterone is called “bioidentical” because it’s composed of the same kind of molecules a man’s own body produces over the course of his lifetime, as opposed to the chemically altered version found in synthetic testosterone products. Synthetic testosterone is neither natural nor bioidentical—testosterone expert Dr. Jonathan Wright says it doesn’t qualify as a real hormone—and has a host of potential side effects, health risks, and safety issues that can be avoided by using natural testosterone. Natural testosterone is preferable to synthetic for the same reasons that natural bioidentical hormones are preferable for women: it’s always better to use molecules as close as possible to nature and to the ones your body naturally makes.

Natural testosterone is safe and effective if used with the guidance of a qualified health-care professional who can help a man determine the right dose and monitor his treatment. A man who wants to take natural testosterone needs to find a doctor trained in natural hormone treatment. (A prescription is required.) Licensed naturopathic physicians are typically well versed on current natural methods; see
Appendix B
to find a qualified practitioner. To explore methods of taking testosterone, recommended doses, and follow-up testing, see
Appendix I
.

Further Considerations: Other Potential Benefits and Effects of Natural Testosterone Treatment

—
Heart-health advantages?
Some concerns have been raised that increasing testosterone might elevate risk of heart disease in men, but research indicates that many risk factors for cardiovascular disease, such as hypertension, cholesterol, obesity, and high blood sugar, may be greater in men with
low
testosterone. In
Maximize Your Vitality & Potency
, Dr. Jonathan Wright and Lane Lenard cite multiple studies showing that natural testosterone treatment significantly decreases total cholesterol and unfriendly LDL cholesterol. And higher testosterone levels seem to protect against atherosclerosis, while low levels may be a risk factor. There appears to be growing evidence that normal testosterone levels are beneficial for heart health.

—
Potential side effects.
Although natural testosterone is safer than synthetic testosterone, it’s not without some of the potential side effects that synthetic testosterone has:

• First, for some men there may be overconversion of testosterone to its by-product dihydrotestosterone (DHT), which can cause increased head-hair loss. This potential effect can be prevented or mitigated by using saw palmetto, in the same dose recommended earlier in this chapter for general sexuality enhancement.
  
• Second, testosterone treatment may decrease a man’s natural sperm production, although sperm count is typically restored within three to six months after discontinuing treatment. This may be an advantage for couples who don’t want to conceive, but men with concerns about infertility, or who are being treated for it, shouldn’t use testosterone.
  
• Third, some men experience acne during testosterone treatment, as a result of increased oil production in the skin; this typically decreases after several months of use.
  
• Finally, as described in
  Appendix I
  , some men may have skin irritation when using gels, creams, and patches.
  

—
Prostate issues.
It was once generally thought that testosterone treatment could increase a man’s risk of prostate cancer by accelerating growth of prostate-cancer cells, but new evidence suggests that testosterone treatment is prostate-safe. As a 2004 article in the
New England Journal of Medicine
pointed out, “there appears to be no compelling evidence at present to suggest that men with higher testosterone levels are at greater risk of prostate cancer.” Harvard professor Abraham Morgentaler, M.D., writes in
Testosterone for Life
that “although it has been widely believed for several decades that higher testosterone levels are associated with prostate cancer risks, it turns out there is no scientific evidence that this is true.” Despite this, some doctors still cling to the belief that testosterone treatment is linked with prostate cancer.

There are growing concerns that prostate-cancer risk could be higher for men with
low
testosterone. Morgentaler goes on to say that “men are at increased risk for prostate cancer when they are older and their testosterone levels have declined. Men never develop prostate cancer when they are young and their testosterone levels are at their lifetime peak. New evidence suggests that low testosterone, rather than high testosterone, may be a risk for prostate cancer.”

It has also long been assumed that testosterone treatment could pose concerns for men with a history of prostate cancer and put them at increased risk. Because of this, all testosterone treatment products bear an FDA-required warning that they’re contraindicated in men with prior history of prostate cancer. Some studies in recent years, however, have indicated that testosterone treatment may be safer than once thought for men in this category. Today, some doctors may prescribe testosterone to men who have previously been treated for prostate cancer.

Along with the myth that testosterone treatment increases risk of prostate cancer, there has been a widespread belief that it could result in benign growth of the prostate gland (also known as
BPH
, which we’ll look at in the pages ahead). But numerous studies have suggested that testosterone treatments aren’t likely to increase the chances of this condition or its symptoms.

Even though evidence shows testosterone treatment won’t cause prostate-gland problems for most men, it’s a good idea for a man to have his prostate health monitored before and during treatment with prostate exams and PSA tests. Maintaining prostate health is important—which brings us to the next topic in our exploration of men’s sexual health issues. …

Supporting Sexuality by Preserving Prostate Health and Addressing BPH

Your partner’s prostate gland is located between his penis and bladder, in front of his rectum. The largest sexual gland in his body, it can be of immense importance to his healthy, vital sexual function. When he’s on the verge of ejaculation, his prostate gland secretes sperm-nourishing fluid into his urethra. At some time in his life, he may develop a normal enlargement of the prostate gland—estimated to affect up to 60 percent of men 40 and older—called
benign prostatic hyperplasia
, or BPH.

Prostate enlargement can be due to hormonal changes in a man’s body as he ages, and may be caused, in part, by excess conversion of testosterone to estrogen. This conversion happens to some extent in all men, but increases with age—especially in overweight men, or those with insulin resistance (a prediabetic condition). Estrogen plays a role in the development of not only BPH but also prostate cancer. Another contributing factor to BPH is DHT, which as noted above is a by-product of testosterone. Many BPH treatments, both natural and pharmaceutical, are aimed at decreasing either estrogen or DHT in the prostate gland.

Preventing Prostate Cancer

Prostate cancer can be serious, but it’s often curable with early detection and treatment. As you’ve discovered in this chapter, research shows that drinking eight ounces of pomegranate juice daily can help prevent prostate cancer, and according to the authors of
The Science of Orgasm
, higher frequency of ejaculations correlates with lower prostate-cancer risk. You’ve also seen that a healthy testosterone level may help prevent prostate cancer. In addition, sufficient sleep is important: a study published in the
British Journal of Cancer
in 2008 found that men who sleep under six hours a night are 34 percent more susceptible to prostate cancer than those who sleep nine or more hours nightly. The study’s authors suggested that melatonin, the naturally produced sleep-promoting hormone that also has effective antioxidant and anticancer properties, may help prevent prostate cancer.

A man should have a manual prostate-gland exam, as well as a PSA test, done annually beginning at age 50. (If he has a family history of prostate cancer, it’s recommended that he begin these at a younger age.) A PSA test is commonly done by medical doctors on annual visits. A high reading can indicate a prostate infection known as
prostatitis
, or be a sign of cancerous cells in the prostate gland. Another test, called a
complexed PSA
(or cPSA) test, is also available, and may be more accurate.

If a man has BPH, his prostate gland may enlarge until it eventually exerts pressure on his urethra, causing an urge to urinate frequently. He may also experience reduction in intensity of urine flow and urine volume, irregular stopping and starting of urine flow, incomplete emptying of his bladder, and urine leakage after urinating.

BPH is noncancerous and typically doesn’t interfere with a man’s libido or ability to maintain erections, but it can disrupt his life and his sex life. He may have to urinate often in the middle of the night and be conscious of bathroom locations whenever he goes out. And the potential side effects of some prescription medications for BPH can drastically interfere with his sex life. A study published in the journal
The Prostate
in 1996 found that a commonly prescribed BPH drug, Proscar (finasteride), decreases sexual function, lowers libido, and increases impotence. And in 2004 the
New England Journal of Medicine
reported that while pharmaceutical BPH medications that decrease DHT may reduce overall prostate-cancer risk, they also render certain forms of prostate cancer more aggressive.

The undesirable consequences of conventional BPH treatments on a man’s sexuality may not be limited to the side effects of drugs. In severe cases, BPH can compress the urinary canal to the point that it causes pain and requires surgery, and an outcome of surgery could be sexual dysfunction.

Considering the potentially serious effects that pharmaceutical and surgical approaches to BPH can have on a man’s sexual health, it seems all the more important for your partner to maintain his prostate health and, if he has BPH, use natural remedies whenever possible. Many men with BPH experience reduced symptoms and dramatic improvement without resorting to drugs like Proscar. Let’s look at the most effective natural methods of treating and preventing BPH:

—
Saw palmetto.
In mild to moderate cases of BPH, saw palmetto can be especially effective. Research shows it can help lower DHT and hinder its effects, significantly improve symptoms after two months of use, and has no side effects at appropriate doses. (At high doses, side effects may include slight nausea or intestinal discomfort.) See dosage recommendation earlier in this chapter.

—
Pygeum africanum
.
An herbal medicine used for many years in Europe to treat BPH,
Pygeum africanum
contains beta-sitosterol, which has anti-inflammatory effects. Research shows it can improve urinary symptoms in many men with BPH; studies cite daily doses of 25 to 50 mg for addressing BPH issues.

—
Omega-3 fats.
As you explored previously, omega-3 fats support prostate-gland health. A man can increase his omega-3 fats with the doses of flax and fish oils recommended earlier in this chapter and by eating pumpkin seeds and walnuts.

—
Zinc.
An important supplement for prostate health, research shows that zinc can inhibit production of DHT, and help prevent BPH. The recommended dose is 25 to 50 mg daily.

—
Nettle root.
Researchers have found several mechanisms by which nettle root can help a man with an enlarged prostate gland, and reduce likelihood of BPH. The recommended dose is 300 mg daily.

Restoring Pleasure: Hidden Secrets about Circumcision and Sexual Sensation

If you assume circumcision can’t have anything to do with your sex life, think again. Its rate in America—the only Western country where it’s still widely perpetuated—may be directly affecting your sexual experiences with your partner. Although in some parts of the world both girls and boys undergo circumcision (the removal of portions of the genitals by cutting or surgery, usually in infancy or adolescence), in America circumcision is the removal of the male foreskin—the retractable outer part of the penis.

You might think circumcision has little to do with you personally because, as a female, if you live in the U.S., you’re protected by law from all forms of cutting of your genitals without your consent—regardless of your age, your parents’ religious preferences, the portion of your genitals removed, or whether the cutting takes place in medical settings. But even though you’re safe from circumcision, the fact that males aren’t equally protected could be impacting your sexuality in more ways than you realize.

In 2010, after nonprofit groups had fought for decades on behalf of children’s rights, the
New York Times
reported the U.S. circumcision rate had plummeted to just 32.5 percent in 2009 (from 56 percent only three years earlier). This was a watershed moment; it meant that leaving baby boys intact had at last become the norm in America. Perceptions are changing rapidly, and more states are refusing Medicaid funding for circumcision, but the United States lags far behind other Western countries. For example, the estimated rate of medicalized circumcision in England is 2 percent, in Canada 9 percent, in Australia 13 percent, and in New Zealand less than 1 percent.

No discussion of men’s sexual-health issues—and particularly how your partner’s sexuality influences yours—would be complete without addressing circumcision, because even though it’s in decline, males born during its peak are in their adult years. As a result, many women are still in intimate relationships with circumcised men. In the pages ahead, you’ll discover how circumcision may be affecting you personally, including the immediate repercussions it may be having in your sex life, and what can be done about it.