Great Sex, Naturally (48 page)

APPENDIX I

Natural Testosterone for Men:
Recommended Doses, Methods of
Administering, and Follow-up Testing

For most men, including men with ED or low libido due to low testosterone, the usual starting dose of natural testosterone is 50 to 75 mg daily; this can be adjusted to 100 mg daily, depending on a man’s response and test results. A man should always use the smallest amount needed to achieve the desired effects. The goal is to return to his own natural testosterone level, not to oversupply his body with testosterone or produce the controversial levels some athletes seek, using testosterone-like substances, to enhance performance. (Natural testosterone treatment shouldn’t be confused with the use of synthesized anabolic steroids, often taken by bodybuilders in doses many times the normal levels of testosterone.) Let’s examine treatment methods for using natural testosterone:

—
Gels and creams.
The most common method in the United States, gels and creams allow a man to apply testosterone to his scrotum or anal mucosa on a daily basis. The advantages of this method are convenience of application and good transdermal (through-the-skin) absorption for most men. In addition, a man can ask his doctor to order gels or creams through many compounding pharmacies that make them. The disadvantages of gels and creams: they may cause skin irritation in some men, and you should avoid direct skin contact with areas where your partner applies them for two hours after application (since contact might affect your own testosterone level).

—
Patches.
Testosterone-releasing patches are typically applied daily to a man’s scrotum, abdomen, or side. The advantages: they’re relatively convenient, and available from many compounding pharmacies. The disadvantages include poor absorption in some men, visibility of the patches on the skin, and skin irritation that many men experience. Transdermal patch products that deliver natural testosterone include Androderm and TestodermTTS.

—
Pills taken orally.
Pills aren’t the best way of delivering testosterone into a man’s body. When testosterone is taken in pill form, most of the hormone first passes through his liver, potentially causing liver stress and damage.

Two to three months after beginning any method of treatment, a man’s total testosterone, free testosterone, and estrogen should be retested to make sure his testosterone level is within normal range. His symptoms should also be monitored for signs of improvement. In addition, it’s recommended that he have another SHBG (sex hormone binding globulin) test, as well as a new blood test that measures dihydrotestosterone (DHT) and its breakdown products, called a
testosterone metabolites profile
. (This test, which also measures how well a man is breaking down testosterone, can be valuable in preventing potential problems associated with taking testosterone. It’s available through Meridian Valley Lab; see
Appendix C
.)

In some cases, men who discontinue treatment find that their testosterone levels remain normal without additional treatment—in other words, they don’t return to their pretreatment lows—as if temporary treatment was all they needed to jump-start their natural testosterone-producing ability. The reason for this isn’t well understood, but it’s worth noting that a man may not need to continue testosterone treatment indefinitely. He may want to suspend it occasionally, to see if his symptoms are resolved.

APPENDIX J

Are You at Greater Risk for HIV and Other
STIs If Your Partner Is Circumcised?

As
Chapter 7
indicates, statistics suggest that you’re less susceptible to sexually transmitted infections, including HIV, if your partner is intact. The United States has the highest medicalized circumcision rate in the industrial world—
and
one of the highest HIV transmission rates. In Europe, where the vast majority of men are intact, the HIV infection rate is far below that of the United States. Researchers point out that the foreskin’s natural lubrication and mobility reduce vaginal and penile dryness, chafing, and abrasion during sex, decreasing chances of infections for both partners. According to Intact America, circumcised men may be 50 percent more likely to infect their partners than men who are intact.

Circumcision certainly doesn’t prevent the spread of HIV and other STIs; both circumcised and intact men can contract and transmit them. The proven, effective prevention methods are safe sex (see
Appendix G
), abstinence, and education programs about risky behaviors. Even in recent years, the media has echoed erroneous claims that circumcision prevents HIV—a notion that may
increase
HIV risk by creating a false sense of security among circumcised men (already less apt to use condoms due to reduced penile sensation) and undermining safesex practices.

APPENDIX K

How Foreskin Restoration Works

Most foreskin-restoration methods involve devices worn on a man’s penis, allowing its skin and tissue to be pulled downward over the glans with moderate, steady tension. Some devices, attached with tape or “tapeless” methods, use weights or elastic straps; others use “dual tension” traction devices requiring neither weights nor straps. (A cottage industry has developed to meet the growing demand, with manufacturers becoming increasingly inventive.) If a device is worn daily for a long enough time, the skin and tissue gradually stretch, eventually covering the glans.

Foreskin restoration relies on skin-and tissue-expansion principles often used by plastic surgeons. It works because gradual stretching stimulates mitosis (cell division or reproduction); the total number of cells increases, resulting in new skin and tissue. Done properly, any technique should be gentle, and not cause pain. The key is patience and long-term commitment, but the time needed varies from one man to the next. You may hear claims that some men achieve a foreskin within months, but for most it’s a matter of years before they’re satisfied with the results.

What often
does
happen within the first few months is that a man notices distinct changes in the sensitivity of his glans as it sheds its layer of keratinized cells—the early effects of its being consistently covered by skin and tissue, after all the years of unnatural exposure to clothing. This surge of new sensation can be powerful confirmation that he’s on the right track and an encouraging preview of what’s in store if he follows through with his restoration.

Foreskin restoration has centuries-old roots, but the modern movement can be traced to the early 1980s, when it began catching on in the United States. Jim Bigelow’s groundbreaking 1992 book
The Joy of Uncircumcising!
sold 18,000 copies in its first printing—it can be conservatively estimated that upwards of 50,000 men have practiced restoration—and a newer edition of Bigelow’s book, which remains the classic on the subject, is available.

Two important caveats need to be added about foreskin restoration. First, doctors aren’t trained in restoration, and may discourage it, since many are pro-circumcision. (Doctors often present expectant mothers, for example, with circumcision’s supposed “benefits” while failing to accurately disclose its risks and consequences.) Foreskin restoration is self-help and requires a willingness to act autonomously. Second, although it can result in a penis that looks surprisingly like it has a natural foreskin, restoration won’t replace all that’s lost to circumcision. The thousands of specialized nerve endings that were removed, for instance, won’t grow back after restoration. (Nevertheless, some sensitivity can be regained; as
Chapter 7
points out, men who practice restoration report increased capacity for sexual pleasure—as well as strongly positive emotional reactions.)

You can learn more about foreskin restoration from the National Organization of Restoring Men (
www.norm.org
).

APPENDIX L

Recommended Reading:
Great Texts for Great Sex

Cass, Vivienne.
The Elusive Orgasm
. Emeryville, CA: Marlowe & Company, 2007.

Herrera, Isa.
Ending Female Pain
. Charleston, SC: BookSurge Publishing, 2009.

Komisaruk, Barry, Carlos Beyer-Flores, and Beverly Whipple.
The Science of Orgasm
. Baltimore, MD: Johns Hopkins University Press, 2006.

Northrup, Christiane.
The Secret Pleasures of Menopause
. Carlsbad, CA: Hay House, Inc. 2008.

Steelsmith, Laurie, and Alex Steelsmith.
Natural Choices for Women’s Health
. New York: Three Rivers Press, 2005.