Testosterone Deficiency Relatively Rare In Men

A new study reveals that relatively few men, only 5.6 percent of the male population, actually suffer from low testosterone accompanied by clinical symptoms. That percentage, however, rises substantially with age.

Low testosterone levels are typically defined as less than 300 ng/dL (nanograms per deciliter) of total testosterone and less than 5 ng/dL of free testosterone. Free testosterone is the amount of the hormone unbound to other proteins and is “free” to work inside the body. “Low levels of testosterone impact many aspects of male physiology,” said Andre B. Araujo, Ph.D., a research scientist at the New England Research Institutes in Watertown, Mass., and lead author of the study. “This is particularly significant because the ongoing aging of the U.S. male population is likely to cause the number of men suffering from androgen deficiency to increase appreciably.”

Consistent with a recently issued Clinical Practice Guideline from the Endocrine Society, symptomatic androgen deficiency in the study by Araujo and colleagues is defined as low total and free testosterone plus the presence of low libido, erectile dysfunction, osteoporosis or facture, or two or more of the following symptoms: sleep disturbance, depressed mood, lethargy, or diminished physical performance.

For this study, the researchers analyzed data on 1,475 randomly selected men enrolled in the Boston Area Community Health (BACH) Survey. The survey tracked subjects between the ages of 30-79 and compiled complete data on factors such as testosterone, symptoms of hormone deficiency, and medications that may impact sex hormone levels. Among all men in the study (mean age 47.3 plus-or-minus 12.5 years), approximately 24 percent had low total testosterone and 11 percent had low levels of free testosterone. Interestingly, while low testosterone levels were associated with symptoms, many men with low testosterone levels were asymptomatic (e.g., among men aged 50 years and older 47.6 percent were asymptomatic).

“Since these men would not likely come to clinical attention,” said Araujo, “it may be important to determine whether there are clinical risks to missing these asymptomatic men with low testosterone levels.” Overall, only 5.6 percent of men in the study had symptomatic androgen deficiency. For those men in the upper range of ages in the study (70 years or older), however, the percentage increased to 18.4 percent.

The researchers predicted that by the year 2025 there may be as many as 6.5 million American men 30-79 years of age with symptomatic androgen deficiency, an increase of 38 percent from year 2000 population estimates.

“This study did not assess whether men with symptomatic androgen deficiency are good candidates for testosterone therapy,” said Araujo. “Well designed randomized placebo-controlled trials would be needed to address the risks and benefits of testosterone therapy.”

The BACH Survey was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (Grant DK 56842). Analyses for the current study were supported through an unrestricted educational grant from GlaxoSmithKline.

A rapid release version of this paper has been published on-line and will appear in the November 2007 issue of the Journal of Clinical Endocrinology & Metabolism, a publication of The Endocrine Society.

Source: Science Daily

Premature Ejaculation: It's Not All In Your Head

In a four-week study of 1,587 men, researchers report that men who suffer from premature ejaculation (PE) had an average intravaginal ejaculatory latency time (IELT) of 1.8 minutes, compared to 7.3 minutes in men who did not. Men with PE and their female partners also had higher ratings for personal distress, interpersonal difficulty with their partner, lack of ejaculation control, and dissatisfaction with sexual intercourse.

This scientific study, appearing in the May issue of The Journal of Sexual Medicine, is the first large epidemiologic study to define patient populations of those with (207) and without (1380) premature ejaculation by measuring average times to ejaculation with stopwatches. This average, or IELT, is defined as the time between the start of vaginal intromission and the start of intravaginal ejaculation.

This study is also one of the first data sets to address the concerns of female partners. Both members of the couples studied were asked to report on a variety of subjective factors. Significant overlap in IELT was observed between the groups who suffered from PE and those without. Thus, the study data suggest IELT may not be sufficient to diagnose PE, and that subjective factors, like lack of control, may also be valid indicators.

"Most people think uni-dimensionally about PE in terms of considering it a disorder of time," states Stanley E. Althof, Ph.D., corresponding author of the study. "This article demonstrates that subjective factors like sense of control, distress, and sexual satisfaction need to be considered when treating this highly prevalent disorder."

PE is the most common male sexual dysfunction affecting men and their partners. However, available data suggest that only 1-12% of males self-reporting receive treatment for their dysfunction. According to The Journal of Sexual Medicine editor Irwin Goldstein, most physicians do not inquire about the existence of premature ejaculation when the patient has other sexual complaints or when the partner has orgasmic dysfunction. As seen in this study, premature ejaculation adversely affects sexual satisfaction, and partner distress is a common motivation for afflicted men to seek treatment.

Source: Science Daily

Protein Translation In Sperm

A new paper in the February 15th issue of Genes & Development lends novel insight into the cellular changes that occur in sperm while they reside in the female reproductive tract -- providing a new understanding of the molecular genetics of successful fertilization.

It had been believed for decades that spermatozoa are translationally silent. However, Dr. Yael Gur and Haim Breitbart (Bar-Ilan University, Israel) now show that, in fact, protein translation does take place in mammalian sperm prior to fertilization.

Their paper has been released online ahead of print at www.genesdev.org.

After ejaculation, sperm reside in the female reproductive tract for several hours. During this time, a number of biochemical changes take place within sperm, collectively known as "capacitation," that render the sperm competent to penetrate and fertilize the female oocyte.

In their new report, Drs. Gur and Breitbart demonstrate that human, rat, bovine and mouse sperm all incorporate labeled amino acids into polypeptides during the capacitation phase. They identify that mitochondrial translation machinery (as opposed to cytoplasmic) directs translation of nuclear-encoded genes in sperm, and that its inhibition leads to a marked decrease in sperm motility, actin polymerization, the acrosome reaction and in vitro fertilization rates.

Thus, protein translation in sperm is essential for sperm functions that directly contribute to fertilization. Dr. Breitbart is confident that "The new findings would give us better understanding for treatment of male infertility and developing new male or female contraceptives."

Source: Science Daily

Daily Sex Helps Reduce Sperm DNA Damage And Improve Fertility

Daily sex (or ejaculating daily) for seven days improves men’s sperm quality by reducing the amount of DNA damage, according to an Australian study presented June 30 to the 25th annual meeting of the European Society of Human Reproduction and Embryology in Amsterdam.

Until now there has been no evidence-based consensus amongst fertility specialists as to whether or not men should refrain from sex for a few days before attempting to conceive with their partner, either spontaneously or via assisted reproduction.

Dr David Greening, an obstetrician and gynaecologist with sub specialist training in reproductive endocrinology and infertility at Sydney IVF, Wollongong, Australia, said: “All that we knew was that intercourse on the day of ovulation offered the highest chance of pregnancy, but we did not know what was the best advice for the period leading up to ovulation or egg retrieval for IVF.

“I thought that frequent ejaculation might be a physiological mechanism to improve sperm DNA damage, while maintaining semen levels within the normal, fertile range.”

To investigate this hypothesis, Dr Greening studied 118 men who had higher than normal sperm DNA damage as indicated by a DNA Fragmentation Index (DFI). Men who had a more than 15% of their sperm (DFI >15%) damaged were eligible for the trial. At Sydney IVF, sperm DNA damage is defined as less than 15% DFI for excellent quality sperm, 15-24% DFI for good, 25-29% DFI for fair and more than 29% DFI for poor quality; but other laboratories can have slightly different ranges.

The men were instructed to ejaculate daily for seven days, and no other treatment or lifestyle changes were suggested. Before they started, levels of DNA damage ranged between 15% and 98% DFI, with an average 34% DFI when measured after three days’ abstinence. When the men’s sperm was re-assessed on the seventh day, Dr Greening found that 96 men (81%) had an average 12% decrease in their sperm DNA damage, while 22 men (19%) and an average increase in damage of nearly 10%. The average for the whole group dropped to 26% DFI.

Dr Greening said: “Although the mean average was 26% which is in the ‘fair’ range for sperm quality, this included 18% of men whose sperm DNA damage increased as well as those whose DNA damage decreased. Amongst the men whose damage decreased, their average dropped by 12% to just under 23% DFI, which puts them in the ‘good’ range. Also, more men moved into the ‘good’ range and out of the ‘poor’ or ‘fair’ range. These changes were substantial and statistically highly significant.

“In addition, we found that although frequent ejaculation decreased semen volume and sperm concentrations, it did not compromise sperm motility and, in fact, this rose slightly but significantly.

“Further research is required to see whether the improvement in these men’s sperm quality translates into better pregnancy rates, but other, previous studies have shown the relationship between sperm DNA damage and pregnancy rates.

“The optimal number of days of ejaculation might be more or less than seven days, but a week appears manageable and favourable. It seems safe to conclude that couples with relatively normal semen parameters should have sex daily for up to a week before the ovulation date. In the context of assisted reproduction, this simple treatment may assist in improving sperm quality and ultimately achieving a pregnancy. In addition, these results may mean that men play a greater role in infertility than previously suspected, and that ejaculatory frequency is important for improving sperm quality, especially as men age and during assisted reproduction cycles.”

Dr Greening said he thought the reason why sperm quality improved with frequent ejaculation was because the sperm had a shorter exposure in the testicular ducts and epididymis to reactive oxygen species – very small molecules, high levels of which can damage cells. “The remainder of the men who had an increase in DFI might have a different explanation for their sperm DNA damage,” he concluded.

Source: Science Daily

Obese Men Have Less Semen, More Sperm Abnormalities

Obese men should consider losing weight if they want to have children, a scientist told the 24th annual conference of the European Society of Human Reproduction and Embryology July 9. Dr. A Ghiyath Shayeb, from the University of Aberdeen, Aberdeen, UK, said that his research had shown that men with a higher body mass index (BMI) had lower volumes of seminal fluid and a higher proportion of abnormal sperm.

Dr. Shayeb and colleagues looked at the results of seminal fluid analysis in 5316 men attending Aberdeen Fertility Centre with their partners for difficulties in conceiving. 2037 of these men had complete data on their BMIs. "We felt that it was possible that male overweight might contribute to fertility problems," he said, "particularly since it is a known risk factor for problems in conceiving among women."

The scientists divided the men into four groups according to their BMI, from being underweight to being considerably overweight. Taking into account other characteristics that could confound the analysis, such as smoking, alcohol intake, age, social deprivation, and the length of time of abstinence from sex prior to producing a semen sample for analysis, they looked for a relationship between BMI and semen quality. The analysis showed that the men in Group B, who had an optimal BMI (20-25, as classified by WHO), had higher levels of normal sperm than those in the other groups. They also had higher semen volume. There was no significant difference between the four BMI groups in sperm concentration or motility.

The researchers did not look at DNA damage in the sperm, preferring to look at the parameters of the routine semen analysis, which all men attending the fertility centre will have at least once. "Other studies have suggested an association between male obesity and increased DNA damage in the sperm, which can be associated with reduced fertility as well," said Dr. Shayeb.

"Our findings were quite independent of any other factors," he said, "and seem to suggest that men who are trying for a baby with their partners, should first try to achieve an ideal body weight. This is in addition to the benefit of a healthy BMI for their general well being.

"Adopting a healthy lifestyle, a balanced diet, and regular exercise will, in the vast majority of cases, lead to a normal BMI. We are pleased to be able to add improved semen quality to the long list of benefits that we know are the result of an optimal body weight."

The team intends to follow up their research by comparing male BMI in fertile and infertile couples to see if the poorer semen quality correlates with reduced fertility. "There has been a significant rise in the numbers of men with poorer semen parameters in the industrialised world," said Dr. Shayeb, "but this has not been reflected so far in male infertility. To compare male BMI in these two groups therefore seemed to us to be a logical next step."

Further research is also needed on exactly how obesity affects semen production, said Dr. Shayeb. "The mechanism for the relationship could be a number of things -- different hormone levels in obese men, simple overheating of the testicles caused by excessive fat in the area, or that the lifestyle and diet that leads to obesity could also lead to poorer semen quality. We just don't know the answer yet, but this is an important question that needs urgent attention."

Source: Science Daily

Exercise Facts for Men

Interesting facts about exercise and health

The National Center for Health Statistics has found that a quarter of all Americans get virtually no exercise at all, putting them at higher risk of having a heart attack, diabetes and cancer.Levels of education, income and marital status seem to affect whether or not someone exercises. 1 in 4 adults with an advanced degree do high levels of exercise compared with only 1 in 7 with less than a school diploma. Men are more likely to exercise than women. People from the Southern States of America do the least exercise. The poorer you are the less exercise you do. Adults with incomes below the poverty level are 3 times less likely to exercise than adults in the highest income group.

Research undertaken at the University of Colorado has found that obese people have more trouble dissolving blood clots. A clot-busting agent called 'tissue plasminogen activator' is produced and released less in obese people who are inactive, leading to a greater likelihood of heart attacks or strokes. The study found that around half the obese participants who walked 40 to 45 minutes 5 times a week for 3 months began releasing the chemical t-PA needed to lessen their chances of getting a blood clot.

Your sex life and exercise:

A German study from Cologne University Medical Center has found that physical exercise can be as effective as Viagra in dealing with erectile dysfunction. Over 80% of their participants with mild to medium circulatory problems reported better erections compared to 74% taking Viagra!

You've made the decision to do more exercise, so what's next?

Consult an expert? It may be a good idea to consult a qualified expert if:

You have a long-standing or recent serious heath problem or

You are very overweight. Go see your doctor first to get his expert opinion on any exercise restrictions you may need to observe. You will get the most out of exercise plan if you feel confident about your abilities.

You just need guidance on a good exercise regime tailored just for you or...

you find it difficult to keep to an exercise program. it might be worth getting a personal trainer either at your home or at a gym, or both! It could be that by combining exercise with a bit of social interaction you will keep up your motivation. Fitness experts need not be expensive, choose one that is qualified and experienced.

Exercise and your heart

Get a heart workout. Your heart is most important muscle in your body and you must keep it in shape. It is this organ that you start with to build up your levels of stamina and strength. One of the most effective ways to do that is do regular aerobic exercise. That is exercise that works the large muscle groups. Cycling, swimming, stepping, brisk walking are the easiest and cheapest.

Use your pulse as a monitor to maximize the effect of your workout with the minimum input. Using a wrist monitor that displays your pulse rate makes this easier. Calculate your cardiac training range (CTR) by Firstly getting your maximum cardiac rate (MTR), something that you should not exceed during any form of exercise. To do this subtract your age from 220. Your Cardiac training range is between 70 and 85 per cent of your maximum training range. For example, if you are 40 years of age the MTR is 180 (220 minus 40)- your CTR is 126 to 153 (70 to 85 per cent of 180.

Knowing this you can adjust your workouts to get the most from the time you spend exercising. It is this area that you may need to adjust if you have a medical complaint and you should ask your doctor what range you should be aiming for.

Upping your metabolic rate

If weight loss is a major part of your exercise programme then your aim is to maximize the calories you burn up. This will depend on the amount of effort you put in. Examples are, brisk walking burns up 200 to 250 calories an hour, jogging-about 400-600, cycling 200-650.

Regular exercise can increase the amount of energy you burn up during rest. Regular exercise increases your metabolic rate for about 8 hours after each workout.

Get good equipment

There is a lot of equipment around for exercising the dollar as well as the body. Certainly the most important piece of equipment that you should invest is a good pair of trainers, even if you do not intend to jog. Exercise bikes, rowing machines, bar bells are all excellent. Anything that gets you going is good, but it is not essential. Getting fit does not have to cost you anything. Pulse rate displays are an inexpensive investment and it makes monitoring your pulse rate easy.

Monitor your progress and reward yourself

Keeping up your motivation is essential. Exercise tones up your muscles, burns up calories, helps you loose fat from different parts of your body, not just the bits you are targeting and can increase your metabolic rate. If you think you will stick to your fitness regime if you combine it with a social outing then a health club or gym is for you. Think about rewarding yourself with special treats when you meet certain goals that you set yourself, i.e. 2 weeks sticking to a fitness program, 4lbs weight loss, better body shape, etc, etc.

Your biggest reward is a long term investment in health, longer life and greater wellbeing.

Source: About.com

A sustained and painful erection (Priapism)

Priapism refers to an erection, usually painful, that lasts for more than four hours and is not necessarily the result of sexual arousal. This condition develops when blood in the penis becomes trapped and unable to drain. The condition is most common between the ages of 5 to 10 years and 20 to 50 years.

Priapism needs to be treated immediately to avoid the likely outcome of permanent erectile dysfunction. Priapism does not usually resolve itself so medical attention is definitely required.

Causes of Priapism

Although up to one third of cases have no specific cause, other conditions causing priapism include:

Sickle cell anemia. Up to 42% of men with sickle cell will develop priapism.

Alcohol and cocaine abuse

Spinal cord trauma or conditions

Trauma to the genital area

Medications such as Desyrel used to treat depression, Thorazine used to treat certain mental illnesses

Medications to prevent blood clotting and drugs used to treat blood pressure can all cause priapism

Anesthesia

In rare cases some types of penile cancer can cause priapism
Penile injections designed to treat impotence can also cause priapism

Penis changes that cause priapism

In a normal erection the veins narrow and that’s what makes the penis get bigger and hard. In priapism the veins do not relax after an orgasm so the penis remains erect and usually becomes very painful.

Diagnosis of Priapism

The doctor will ask about your medical history and examine you. He may do some tests, possibly an ultrasound or angiogram and blood tests.

Treatment of Priapism

Treatment is aimed at making the erection go, then treating the underlying cause, if one can be discovered. Treatment is usually in the form of injecting a decongestant medication, often following the draining of a small amount of blood from the penis to relieve pressure. A local anesthetic to numb the penis is usually given prior to this procedure.

Surgery will be required to restore normal blood flow if the cause is a ruptured artery. A surgical shunt for low flow priapism may be required. This is inserted into the penis to divert the blood flow and restore normal blood flow and function.

People with sickle-cell disease usually receive intravenous fluids and a transfusion of blood. If that fails to have the desired effect surgery may be required.

Some men experience semi-erect and painless erections. This is usually a result of trauma where too much blood flowing into the penis, rather than narrowed veins, is the cause. This can be treated via surgery or with a catheter threaded through blood vessels in the groin.

Importance of medical intervention for Priapism

Always seek treatment as quickly as possible to avoid any future problems of permanent erectile dysfunction.

Source: About.com