Over the past 15 years, internet pornography has taken screens all over the world by storm.  To give you an idea just how high the demand actually is, globally, pornography is a $97 billion dollar industry with the United States making up about $12 billion of that number.  It’s estimated that the average viewer will have watched more than 500 pornographic videos on their cell phones in one year alone! 

If you are a frequent viewer or even just someone who visits from time-to-time for some excitement or curiosity, you know just how easy it is to find what you’re looking for to fulfill your fantasy. Within seconds you can pull up a sex video of any kind, down to the setting/scenario of the encounter, the performers’ breast size, hair color, age, penis size, race and so much more. They make it easy! The porn industry knows what viewers want to see. The website hubs use algorithms to tailor to your specific search history and view preferences. Just like your Facebook and Instagram ads, porn sites will use technology to keep you engaged in what’s already enticing content. Sounds great, but just like with anything, too much of a good thing can turn into a problem.

Is porn addicting?

Whether or not porn is truly addicting is up for debate. It is true that, similar to drug addiction, consistent usage of pornographic stimulation will result in desensitization. The viewer will require more and more heightened levels of visual stimulation to achieve the same satisfaction.  In this scenario, viewers will find themselves wandering into categories of content that they wouldn’t engage in in real life. They may even seek more explicit genres they had previously deemed distasteful or disturbing, but are now necessary to keep the gratification up to par. 

Regular viewers of porn are at a greater risk of losing interest in sex with a real life partner. Similar to drug addiction, porn becomes less stimulating over time. Men who watch often will have an increasingly difficult time achieving pleasure without escaping “mild” content and venturing into “hard-core” content. Chemically speaking, sexual arousal is associated with a surge of dopamine (AKA “feel good” neurotransmitter) in a man’s brain. Erections are dependent on receiving this message to function properly. It’s proposed that chronic internet pornography use results in down-regulation of our brain’s response to normal rewards, resulting in difficulty getting/maintaining erection and/or delayed ejaculation due to the brain’s natural reward center response system being out of whack. 

It’s controversial for adolescents and young adults.

As pornography has become increasingly available, it has been easier for children to access. Many adolescents have been exposed to pornographic sex as their first sexual exposure and unfortunately, they will only have this content burned into their brains to refer to for how sex should be. Internet porn is not meant to be educational – its purpose is for entertainment and fantasy fulfillment.  For a young and impressionable male that has only had porn as his sexual example, engaging in real life sexual activity will be wildly disappointing, as porn most often portrays unrealistic expectations for both partners. 

“Learning sex from porn is like learning how to drive a car by watching The Fast and the Furious – you will eventually crash” (Aaron Spitz, MD). 

What young adults may not realize is the actors/actresses (AKA porn stars) in these videos are just that; they are paid professionals doing their jobs! They go through hair and makeup, plastic surgery and are sought out for their genetically gifted or purchased body parts. On top of that, male porn stars will use Trimix to have longer lasting erections – don’t let the marathon duration sex scene fool you! The positioning, moans, orgasms, etc. are all extremely unrealistic, posed, carefully planned and often video modified. This sets a standard in the minds of the guys who are watching with any regularity. It’s a recipe for disappointment and a skewed mindset. Men, especially young men, will compare the size of their bodies, muscles, and penis to those seen in porn. Many viewers will begin to feel inadequate with their equipment. Before the internet porn boom, only about 5 percent of men under 40 had an issue getting it up – now it’s a whopping 1 in 3. Some may argue that these numbers could be attributed to unhealthy lifestyles such as obesity, substance abuse and smoking (factors historically correlated with ED). The truth is, these unhealthy lifestyle risks have not changed over the past 20 years or even decreased. What does that information lead us to conclude? Porn is a major factor in the increase of erectile dysfunction in young men.

To make matters worse, desire for sex has plummeted. More and more guys are left high and dry – unable to reach climax and ejaculate. There has even been a dramatic spike in percentage of young, healthy guys who fall in this category over the past 15 years. Brain scan studies done on compulsive internet pornography users (average age 25) concluded results of diminished libido or erectile function, specifically in physical relationships with women. Other studies have correlated pornography use with difficulty orgasming, decreased enjoyment of sexual intimacy and sexual performance issues. To ice the cake, marriage/relationship satisfaction will unsurprisingly decline with men who view porn daily.

Porn can be thought of as a tool in spicing up a relationship, engaging in self pleasure or simply for entertainment purposes. However, overuse of pornography is detrimental to a man’s overall sexual health, whether it be ED or difficulty being intimate with a partner due to misconceptions portrayed by the pornography industry.

When to stop?

One study concluded that men deemed compulsive sexual behaviors watched 20+ hours a week versus “normal” guys who watched about 30 minutes a week. While that number will vary from person to person, if you fall into the higher end of weekly viewing and are experiencing any side effects discussed in this post, it’s safe to say you will want to step back and reevaluate your viewing time. Years of compulsive porn viewing can actually shrink parts of the brain that are important for romantic love AND keeping erections. If necessary, a sexual medicine specialist can assist with cutting back and feeling normal again. In combination with weaning off, PDE5s (Viagra, Cialis, Levitra) can be great tools for confidence boosters to reconnect with your partner in the bedroom.

References

Spitz, Aaron, MD. “Sex, Lies, and Videotape: The Hard Facts about Pornography.” The Penis Book, 62-71. Click here

Penis pumps may be joked about in movies, but the results are no joke! It is actually one of the safest treatments on the market for erectile dysfunction. 

When it comes to getting an erection, it’s all about blood flow. These devices are great for achieving an erection from the flaccid state. It requires a cylinder to be placed over the penis against the pelvis to create a vacuum seal. Pressure is then manually applied to the cylinder using a hand pump which causes blood to rush into the penis. Once engorged it’s not just fun to look at, it’s fun to use! Constriction rings (aka a cock ring) can then be used to maintain an erection.

Medical grade versus commercially available

Pumps are sold commercially at sex shops but remember you get what you pay for. It’s your best buddy…don’t be cheap. The technology behind commercial and medical grade pumps are similar however most commercial pumps do not include an air release valve or pressure gauge. This doesn’t sound like a big deal until you have your first experience sucking a testicle up with no air release valve…Houston, we have a problem.  These pumps also do not include a pressure gauge which is vital to your safety. If too much pressure is applied, you could bruise or injure yourself. Too much of a good thing is never good. Pumping should feel comfortable and similar to a normal erection, never painful. 

Pumps are great for a number of things. Here are a few other examples for when a pump may be worth exploring. 

Physical therapy used for men after prostate surgery.  Removal of the prostate may cause damage to the nerves that switch blood flow to the penis during an erection. This surgery has come a long way and most skilled surgeons are able to perform nerve sparing procedures, but almost all patients will experience ED immediately after and for up to 1 year. 

If you don’t use it, you lose it.  Not with a partner, but want to keep up your “A” game? Think of this as doctor prescribed exercise for your penis. Going a long time without getting an erection can be damaging to the penile tissue. The tissue begins to lose flexibility and the smooth muscle cells that line the blood vessels begin to decline and replace with collagen. The penis then begins to atrophy and shorten. Proactively using a pump can prevent you from having a disappointing performance when you get pulled off the bench!

Peyronies or curvature of the penis.  Some men experience a curvature of the penis which is called Peyronies. Peyronies is an abnormal buildup of plaque that forms and curves the penile tissue. This curvature can strike men of all ages and possible causes include rough intercourse, trauma to the penis, penile injections long term and unfortunately for some men, no reason at all.  While several of the treatments for Peyronies can be invasive or expensive, the pump should be an early intervention. Pumping the penis allows the plaque to be slowly stretched over time.

Prepare to impress.  If a man can achieve an erection on their own or with other treatments like Viagra, Cialis, and Levitra but wants a little more help, a pump is a great addition. Use a pump before intercourse to “pump you up”. A constriction ring can be used after to hold blood flow in. 

If you are experiencing erectile dysfunction and looking for solutions, consider a penis pump. Pumps are a cost-effective option with little to no side effects when used correctly. Even if it is not effective as a standalone treatment, pumps are great in combination with PDE5’s (Viagra, Cialis, Levitra), trimix shots, and extracorpeal shockwave therapy. Penis pumps are not a one size fits all. To get fitted by a medical professional or explore other options for erectile dysfunction contact the trained providers at 618-632-9000 (O’Fallon, Illinois clinic) or 314-833-9000 (Town and Country, Missouri clinic). 

References

Mayo Clinic. Click here.

Spitz MD, A. The Penis Book. A Doctor’s Complete Guide to the Penis-From Size to Function and Everything in Between.

Historically, our ancestors were hunter/gatherer’s consuming a diet in an environment where most fat was consumed through seafood and wild animals containing Omega-3 fatty acids, a type of polyunsaturated fat. Not a diet of french fries or donuts! Refined oils (corn, canola, soybean) that are heavy in Omega-6, another type of fatty acid, have replaced most of those natural sources. While Omega-6 is essential for health, we don’t need that much of it and it is actually vital to have a proper ratio of Omega-6 to Omega-3. Reevaluating the food we eat to cut out processed oils and incorporating more Omega-3 will not only benefit our health, but is essential to preventing disease. 

The problem

Over the last century, our country has rapidly increased its production in refined oils resulting in about 80% of our fat source intake and accounting for 10-20% of our total calories. Refined, a.k.a. seed/vegetable oils, are a by-product of agricultural waste that found their way into our food supply for profit by way of demand for a safer alternative to lard and butter that were produced in unsanitary meat environments. They are a much cheaper alternative to traditional fats and were coined as “healthy choices” in the 60’s and 70’s because they were derived from a vegetable – no wonder it took off! Fast forward to today and they are still found in our processed food products and have replaced the majority of our fat source intake of Omega-3 with Omega-6. When this ratio is off, it can disrupt our overall health. In other words, Omega-6 fats undo any benefit eating Omega-3’s would normally give you.

Prevention of Chronic Disease

It’s no secret that the standard American diet is primarily inflammatory based. Our bodies are constantly fighting to respond to the foods we eat through various symptoms, conditions and diseases. As discussed, vegetable oils make up for a large portion of the average American’s daily caloric intake. These oils create and exacerbate inflammation, which contributes to nearly every disease that makes us fat (not the good kind of fat, think Diabetes). Over time, chronic inflammation can damage your blood vessels leading to a number of diseases including erectile dysfunction, dementia, heart disease and strokes.  One study on Omega-3 fats looked at 19 different studies from 16 different countries and found that those with the highest levels of Omega-3 fats in their blood had lower risks of heart attacks. More Omega-3 could potentially benefit your overall cardiovascular health and reduce inflammatory markers in the body. 

Mental Health

Believe it or not, your brain is mostly made up of fat! About 60% of your brain is docosahexaenoic acid (DHA), a form of Omega-3. Our brain cells rely on DHA to communicate with one another for proper brain function like memory, cognition and mood. Lower levels found in blood in older adults have been associated with a smaller brain size, which is an early sign of brain aging. Research shows Omega-3 deficiencies increase mental health and neurological disease like depression, anxiety, Alzheimer’s and bipolar disorder!

Healthy Sperm

Male fertility has decreased over the past 50 years resulting in a 40% decrease in sperm density. One reason for this decline can be directly traced back to the effects of a poor diet. We now know that Omega-6 consumption has increased dramatically in present day and that the ratio to Omega-3 has raised with it. When pertaining to fertility, this ratio is crucial as it has been implicated with impaired semen quality in men. Clinical research trials show the following positive correlation:

• Fertile men had higher blood and sperm levels of Omega-3’s compared with infertile men and the Omega-6/Omega-3 ratio was significantly higher
• Higher intake of Omega-3 was positively correlated with sperm morphology (size, shape, appearance) and overall improvement in quality of semen (total sperm count and density)
• Omega-3 has positive effects on reducing oxidative stress, an issue associated with male infertility, by acting as an anti-oxidant

Omega-3 is an excellent nutritional supplement that has beneficial effects on spermatogenesis in human studies that may improve semen quality. 

How to fix the imbalance

There are limited sources for Omega-3 available in the standard American diet and over 90% of us are deficient or falling well below the recommended amount. Food sources containing some Omega-3 include certain seeds/nuts, fatty fish and grass-fed animal products, while Omega-6 is prevalent in a huge portion of foods readily available to us for consumption. Food labels can be misleading.  An important rule of thumb is to always check the ingredient list for refined oils such as canola, vegetable, soybean, safflower and corn oils.

As an alternative to food sources, a high quality, Omega-3 (aka fish oil) supplementation is an excellent solution! It’s important to be aware that NOT all fish oil supplements are created equal. Finding a sustainably sourced fish oil that doesn’t contain environmental pollutants, heavy metals, mercury, etc. is equally as important as making the decision to supplement.

Looking for a quality grade product? *Click here* to purchase your Omega-3 supplement:

• Readily absorbable! Ideal for individuals concerned about digestive health
• NO additional ingredients required for enhanced benefits
• 3X smaller dose with the same delivery of ingredients when compared to over-the-counter supplements
• 100% fish oil, no dilution
• IFOS (International Fish Oils Standards), a third-party certification that has most strict testing on their oils and the only test that does radiation exposure in their oils

References

Hyman, Mark. “The Missing Fat You Need to Survive and Thrive.” Dr. Mark Hyman 1 Jul. 2016 link here

Benedict, Fran. “How to Incorporate More Omega-3s Into Your Daily Diet.” Chopra, 21 Aug. 2019, link here

What you should know

Despite nearly 90,000 medical articles written about the importance of a crucial molecule, many of us are chronically deficient and unaware! Glutathione plays a vital role in optimizing overall health. It is the secret to prevent aging, infections, chronic disease and even cancer. 

What is Glutathione?

Glutathione, aka “Mother of all Antioxidants” is one of the main detoxifiers in our bodies and plays an imperative role in boosting immune health. We run into toxins on a daily basis: air pollution, glyphosates from food, and in water where trace elements and heavy metals often reside. That’s right – toxins are obtained regularly from our main sources of survival: air, food, and water. 

Glutathione is an antioxidant that can make a huge difference in protecting our bodies. It is a sulfur-containing molecule, meaning its structure is sticky.  Acting as fly paper, glutathione captures the toxins that enter the body by sticking to them as they are transported and excreted out of the body. 

The good news is our body produces this simple molecule all on its own. The bad news is a modern lifestyle consisting of a poor diet, exposure to air pollution, radiation, medications, stress, trauma, aging, and infections all deplete glutathione in the body. High oxidative stress leads to high demand for antioxidants like glutathione. It becomes nearly impossible for the body to meet the supply of demand which leads to widespread deficiencies.

Normally, glutathione is recycled in the body, but when the toxic load becomes too great, the liver gets overloaded and damaged. Then, we are unable to regenerate the protective molecules. This leaves the body susceptible to even more oxidative stress, free radicals, infections and cancer because it cannot dispose of the toxins efficiently. Simply put, when glutathione becomes depleted, it leads to further sickness and chronic illness. 

Glutathione also plays a part in fighting against infections. Living in a world where medical practitioners are seeing more and more antibiotic-resistant infections, it’s imperative to find alternatives. Glutathione plays a crucial role in regulating immune cells to help them fight infection. It also stimulates activity of natural killer cells that assist in destroying cancer, bacterial and viral infections. Glutathione is even thought to have inherent antibacterial properties alone.

Other benefits tied to glutathione include:

• Control inflammation
• Keep age-related health problems at bay (muscle/vascular health, bone density and cognitive function)
• Improve heart health
• Improve skin health
• Assist in the management of Parkinson’s, Alzheimer’s disease and dementia 
• Help reduce the impact of uncontrolled Type 2 diabetes

How to optimize glutathione levels?

Now that you’re informed of the benefits, you’re likely wondering how you can assure optimal levels of this miracle antioxidant. Great news, there are things you can do to increase levels! 

Diet

Because glutathione is a sulfur containing molecule, eating cruciferous vegetables such as broccoli, cauliflower, kale, collards, watercress and cabbage are incredibly beneficial. In addition, onions, garlic, and leeks assist in glutathione production along with beef, fish and poultry. Whey protein is another option that contains the amino acid building blocks and cysteine needed for the synthetization of glutathione.

Exercise

Get moving! Exercise helps boost your immune system and in turn, boosts glutathione in the body. 30 minutes a day of vigorous exercise like walking, jogging or playing sports can help, along with resistance training a couple times a week.

Glutathione supporting supplements

Oral forms of glutathione are largely ineffective due to the body digesting the protein. However, glutathione supporting supplements are recommended:

• Vitamin C and E (work together to recycle glutathione)
• Folate and vitamins B6 and B12 (help produce glutathione)
• Alpha lipoic acid (involved in detoxification)
• Milk Thistle (known for antioxidant properties and assists in boosting glutathione levels)
• Turmeric extract (studies show that it raises glutathione levels)

Glutathione IV infusions/injections

IV infusions and intermuscular injections allow glutathione to be delivered directly into the bloodstream, bypassing the digestive tract. This is a great alternative to oral supplementation where, as mentioned, the absorption is not guaranteed due to protein digestion. As an added benefit with IV infusions, cocktails can be specialized to include other supporting supplements to increase glutathione and are a great way to help in overall hydration!

It’s quite clear and convincing that adequate availability of glutathione is critical for maintaining overall health, protecting the body from toxins and promoting longevity. 

In the world we live in it is near impossible to avoid toxins completely. Thankfully, science points us to the “Mother of all antioxidants” as an exciting potential option to prevent and/or treat infection and toxin overload. 

Book your glutathione injection or infusion today!

References

Link one

Link two

Link three

Link four

Have you ever bought an over-the-counter Testosterone Booster? Boosters are easily accessible and sold at most major supplement stores. The marketing is flashy and promises to give you hulk-like muscles, make you Hugh Hefner in the bedroom, and even improved penile length.  Seem too good to be true? You are correct.

Despite the popularity of over-the-counter boosters, the scientific rationale often remains unproven. Over 90% of boosters claim to increase testosterone, however studies found that less than 25% had any research or data to support their claims. Shockingly, 10% of the supplements studied caused a NEGATIVE impact on testosterone.

Testosterone Boosters – More harm than good

Testosterone boosting supplements are not only a scam but can actually cause more harm than good. Unlike pharmaceutical medications the supplement industry is not regulated by a governing body. For the consumer this means that what’s on the bottle may not be what’s in the pill you are purchasing. Without regulations and rigorous laboratory testing, one cannot be confident in the quality or efficacy of the product.  Bad storage conditions and unreliable ingredient sourcing are often to blame for a poor product. The quantity of each ingredient has also been noted as a potential issue. One study found that many of the tested boosters had super doses (over the tolerable limit) of the vitamins and minerals.

Testosterone Boosters bought over the counter have gained popularity as consumers are looking for a way to “naturally” raise their own testosterone. In a society of instant gratification, popping a pill daily is much more convenient then going to a doctor, exercising, and eating right. The main concern with most of these supplements is that they are taken in the oral form.  When taken in the oral form, boosters have to go through the liver to be digested which in turn can lead to issues in the liver and kidneys. According to a study in 2019, about 13% of acute liver failures are a result of supplement-induced liver injury.

Research based ways to further optimize

The safest most effective way to optimize your hormones is through a physician monitored testosterone replacement therapy. If your hormones are already optimized, the following vitamins/hormones can be the next step in optimization. 

Vitamin D- What is known as the sunshine vitamin is not a vitamin at all! Vitamin D is actually a hormone that regulates the synthesis of testosterone. Researchers found that a vitamin D deficiency, defined by levels less than 20ng/ml, is independently associated with testosterone deficiency. Men with Vitamin D deficiency were 2.65 times more likely to have testosterone deficiency compared to those with levels above 20 ng/ml. Vitamin D effects production of natural and free testosterone along with formation of male sperm cells. Supplementation with Vitamin D has been associated with higher levels of testosterone and sex hormone binding globulin. 

Zinc– Zinc is a nutrient that is found in our cells that helps in making proteins, DNA, genetic material, and helps our immune system fight bacteria and viruses. At the peak of COVID19, most stores and online stores were sold out of zinc for this reason. Research shows that a deficiency lowers testosterone levels by inhibiting prolactin secretion (testosterone inhibiting hormone). Overtraining in the gym can also lead to a zinc deficiency. Zinc is present in most multi-vitamins but is also available independently. A true zinc deficiency would need to be determined by bloodwork.  Be sure to ask your physician about the correct form of zinc as most over the counter supplements are not available in best absorbing form. 

Magnesium– Magnesium is a mineral typically found in foods high in fiber like green vegetables, seeds, and nuts. Several studies suggest a correlation between magnesium and an increase in free testosterone. Free testosterone is the unbound, biologically active portion of testosterone, AKA available for our bodies to use. Like zinc, a blood test would need to be performed to determine if there is deficiency.

DHEA– Dehydroepiandrosterone (DHEA) is a steroid hormone secreted primarily by the adrenal glands and a small amount in the testes. This hormone is oftentimes referred to as the “mother of all hormones” because it fuels the hormone pathway. DHEA is the precursor to many other hormones which helps maintain health hormone levels and promotes the stress response, to reverse stress-induced physiological responses and supports healthy aging. 

DHEA is a precursor hormone the majority of other sex hormones including, testosterone, progesterone, estrone and estradiol. Clinical studies have demonstrated its ability to maintain hormonal balance and back fill hormonal pathways.

Pregnenolone– is a prohormone that is made in the brain and adrenal glands and small amounts in the liver, skin, brain, and testicles. Pregnenolone plays a key role in hormonal balance as a key precursor to cortisol, DHEA and progesterone, and helps maintain balance in the body’s stress response. Pregnenolone levels peak during youth and continue to decline with age. Nicknamed “The Father of all hormones” because it is a parent compound to other vital neuro-steroids such as DHEA. 

If you are starting to have symptoms of low testosterone getting tested and seeing a doctor is the best first step. Outside of a prescription for testosterone there is very little research to support over the counter testosterone boosters.   

Further References

[1] Heavy Resistance Training and Supplementation With the Alleged Testosterone Booster Nmda has No Effect on Body Composition, Muscle Performance, and Serum Hormones Associated With the Hypothalamo- Pituitary-Gonadal Axis in Resistance-Trained Males. J Sports Sci Med. 2014 Jan 20;13(1):192-9. eCollection 2014. 

[2] Maggio, Marcello, et al. “The Interplay between Magnesium and Testosterone in Modulating Physical Function in Men.” International journal of endocrinology2014 (2014).

Links: one, two, three

Welcome back to Testosterone Myths and Misconceptions; BUSTED Part 3. If you missed part 1 and 2, start here.

The goal of this blog series is to debunk some of the common, false ideas about testosterone replacement therapy (TRT). We believe men should have the option to tap into more youthful, healthy living. These testosterone myths BUSTED should give you a good start on digging into the truth about TRT.

Myth: Testosterone therapy is a fad, experimental, pseudo medicine, etc. 

Truth: Testosterone therapy is and has been the standard medical treatment for men suffering from low T symptoms and/or clinical testosterone deficiency for more than 70 years. 

There is an abundance of research that shows testosterone therapy provides substantial benefits with reasonable, manageable associated risk.

As with all areas of science and medicine, we learn more and more as time goes on. This means the medical providers who specialize in TRT are constantly learning and evolving to provide the best protocols for their patients as individuals. 

Myth: Testosterone therapy causes prostate cancer

Truth: Thankfully, this is simply not true.  The thought that TRT increases risk of prostate cancer is unfounded. It is not supported by evidence. Furthermore, there is now evidence that links low serum testosterone levels to aggressive prostate cancer. For men who have undergone treatment for aggressive prostate cancer, there is a lower rate of cancer reoccurrence if the patient receives testosterone therapy once cancer treatment is complete.  

Large prospective longitudinal studies have found no association between endogenous androgen concentrations and prostate cancer risk. Meta-analyses of placebo-controlled T therapy trials have documented no increased risk of prostate cancer in men receiving T therapy. In men who received T therapy, there was no increased risk of high-grade disease. (Baillargeon J, Kuo YF, Fank X, Shahinian VB. Long-term expo- sure to testosterone therapy and the risk of high grade prostate cancer. J Urol. 2015;194(6):1612-1616 & Kaplan AL, Hu JC. Use of testosterone replacement therapy in the United States and its effect on subsequent prostate cancer outcomes. Urology. 2013;82(2):321-326.)

Myth: Low testosterone is a normal part of the aging process and isn’t necessary to be treated in older men.

Truth: Well, let’s put it this way: cardiac disease, obesity, adult cancers, diabetes and other comorbidities are more common with older age too. Does that mean we shouldn’t treat them? Of course not!  Testosterone deficiency is an important medical condition affecting the health and well-being of men; the symptoms of low T result from low levels of testosterone regardless of whether an underlying condition is identified; the impact of testosterone deficiency is global; testosterone therapy is effective, rational, and evidence based.

Testosterone is a vital part of the health and well-being of a man. To avoid treatment based on age would be a disservice to the patient.

Our staff at Victory Men’s Health takes pride in staying up to date with the latest and proven means of therapy. Please reach out to learn more.

Further References

Wu FC, Tajar A, Pye SR, et al; European Male Aging Study Group. Hypothalamic-pituitary-testicular axis disruptions in older men are differentially linked to age and modifiable risk factors: the European Male Aging Study. J Clin Endocrinol Metab. 2008;93(7):2737-2745. 

Abraham Morgentaler, MD (Chairman); Michael Zitzmann, MD (Cochairman); Abdulmaged M. Traish, PhD (writing group);
Anthony W. Fox, MSc, MD (writing group); T. Hugh Jones, MD (writing group); Mario Maggi, MD (writing group); Stefan Arver, MD; Antonio Aversa, MD; Juliana C.N. Chan, MD; Adrian S. Dobs, MD; Geoffrey I. Hackett, MD; 

Wayne J. Hellstrom, MD; Peter Lim, MD; Bruno Lunenfeld, MD;
George Mskhalaya, MD; Claude C. Schulman, MD; and Luiz O. Torres, MD  

Welcome to part 2 of Testosterone Myths and Misconceptions; BUSTED. If you missed part 1, start here.

Hopefully you will feel more equipped with the truth about testosterone after reading both parts of this blog series. It is our mission to help men everywhere obtain the information and tools to live their healthiest, most optimal life. Knowledge is power.

Myth: If I have low T, I should try testosterone boosters.

Truth: No! There are two main reasons to avoid these highly advertised products.

1. Buyer beware! Oral testosterone boosters do not raise testosterone a significant amount. In some cases, T boosters may cause a transient increase in total testosterone, but it will not sustain.
2. The most important reason to avoid oral testosterone boosters: they can be dangerous and toxic to internal organs, specifically the liver. 

You may wonder why testosterone boosters are on the market if they are dangerous. Good question. Dietary supplements are not regulated by the FDA. There is very limited monitoring and legal responsibility in producing T boosters, giving the producers of T boosters a lot of legal freedom and consumer demand for a “quick fix”. Companies who sell these products do a great job of preying on men desperately needing to feel better. Don’t fall for it. The best thing to do with symptoms of low testosterone is to find a highly trained medical provider that specializes in hormone optimization.  

Myth: Testosterone will make me angry.

Truth: This is simply not true. In fact, it is quite the opposite.  Some of the main symptoms of low testosterone include mental fog, decreased mood, depression, irrational thinking, and poor decision making. Emotional and mental well-being are expected to improvewhen testosterone is optimized. Remember, we are talking about optimal levels of testosterone, not super-physiological. There can be, in fact, too much of a good thing. It is vital to ensure your testosterone provider is well-trained on TRT and can manage levels to help you feel your best.

Myth: Testosterone therapy will negatively affect my heart heath.

Truth: Optimal testosterone levels are cardio protective. This topic has been controversial among medical providers for many years, but in contrast, there are more than 100 studies revealing cardiovascular benefits or improved cardiovascular risk factors with T therapy or with higher endogenous T levels. This appears to have been a largely media-driven phenomenon, since the science does not support it.

The natural conversion of testosterone into estrogen is also a large piece of this puzzle. As discussed in Part 1 of this blog series, it is absolutely vital to maintain natural aromatase of estrogen to protect cardiac tissue while on testosterone therapy.

Here’s what we do know:

Studies show low testosterone levels are associated with increased risk of cardiac events, endothelial dysfunction, increased coronary artery disease, dyslipidemia, increased atherosclerosis. Whereas testosterone treatment shows an increase in coronary blood flow, decrease in myocardial ischemia, increase in skeletal muscle mass, decrease in body fat, and an increase in coronary vasomotion.  Testosterone therapy is effective, rational, and evidence based.  

NOTE: Although testosterone is shown to be cardio protective, lifestyle and other comorbidities play a huge role. Proper diet and exercise are critical to achieve and maintain good heart health.

Further References

Prevention of coronary artery disease in men: male hormone, female hormone, or both? Click here

Role of Testosterone in the Treatment of Cardiovascular Disease. Click here

Heavy Resistance Training and Supplementation With the Alleged Testosterone Booster Nmda has No Effect on Body Composition, Muscle Performance, and Serum Hormones Associated With the Hypothalamo-Pituitary-Gonadal Axis in Resistance-Trained Males. J Sports Sci Med. 2014 Jan 20;13(1):192-9. eCollection 2014. Click here

The Journal of Clinical Endocrinology & Metabolism, Feb 1 1999, 84(2):573-577, “Bioavailable Testosterone and Depressed Mood in Older Men: The Rancho Bernardo Study.” Click here

Fundamental Concepts Regarding Testosterone Deficiency and Treatment: International Expert Consensus Resolutions. Click here

 

Erectile dysfunction is not just about getting or maintaining and erection. Men of all ages deal with lack of sensitivity, short duration, and lack of firmness. Research shows that 70% of men experience ED by the time they are 70 starting as early as 20 years old. All of these common occurrences can be optimized. 

Lifestyle changes

These hacks are the low hanging fruit (pun intended) to optimize your erections without a monetary cost. 

Exercise– Research shows 40 minutes of moderate to vigorous exercise three times per week is needed for improved erections. The key is to get your heart rate above resting and to break a sweat. Your heart and your hard on both rely on blood flow so it makes sense that they would be linked. The blood vessels in the penis are about 1-2mm, whereas the blood vessels to the heart are 3-4mm. Research shows erectile dysfunction is an early sign of clogged arteries which could lead to heart disease, hypertension, heart attack or stroke down the road.  So get your sweat on to improve your health and your erections.

Nutrition– Eat your fruits and veggies. Vegetables rich in nitrate and nitrites can be converted into nitric oxide (NO). NO is the key molecule to get an erection. Foods rich in NO include green leafy vegetables (kale, arugula, spinach), beets, radishes, cabbage. Fruits can provide us with antioxidants that can help protect tissues in the body and lower risks for cardiovascular disease. A healthy diet does not mean you have to lose weight but instead improve the quality of the food you eat. Your erections are what you eat!

Limit Alcohol– A few drinks may get you in the mood but any more than that can be a “Debbie downer” for erections. Alcohol acts as a central nervous system depressant decreasing overall arousal making it difficult to get and maintain an erection.

Evaluate your stress – 75% of Americans report having stress that impacts mental and physical health. Common issues that can lead to ED include performance anxiety, relationships, jobs, and financial burdens. Psychological factors are the most common cause of ED.  There are three types of erections: reflexive (due to stimulation), psychogenic (due to visual or mental associations) and nocturnal (hormonal during sleep). A disruption to any of these can cause issues. 

Stop smoking– A study at the University of Kentucky, found that when asked to rate their sex lives on a scale of 1 to 10, men who smoked averaged about a 5, while nonsmokers rated theirs a 9. Smoking also leads to restricted blood flow and depletion of NO which makes it harder to maintain erections over time. 

Next steps in getting a great erection 

Lifestyle factors all in check and looking for ways to optimize further? There are more options now than ever to maximize erections without invasive procedures like implants or injections. Start with these noninvasive options.

Optimize Nitric Oxide. Nitric Oxide (NO) is the chemical that penile nerves release in order to dilate the arteries which in turn increases blood flow to the penis. Simply put, no nitric oxide no erection. The key to getting and maintaining erections revolves around continuous activation of nitric oxide. Starting in your 30’s nitric oxide production begins to decline by 20% every 10 years. Most men over the age of 65 have lost 85% of their ability to make nitric oxide. We often think of erectile dysfunction as an older man’s issue when in fact it can begin effecting men in their 30’s. Factors influencing the decline in natural production of nitric oxide include aging, oxidative stress, lack of exercise, poor nutrition, diabetes and smoking. 

PDE5 Inhibitors are medications like Viagra, Cialis and Levitra. These medications work by blocking the body from metabolizing nitric oxide. A reduction in nitric oxide will reduce arterial dilation which in turn reduces blood flow to the penis this is why many men have no problem getting an erection but have trouble maintaining one. Picture this, PDE5 inhibitors act as the offensive line and nitric oxide is the quarterback. If nitric oxide gets sacked, you don’t!  

Shock Wave Therapy is a non-invasive procedure that improves the health of the blood vessels. Healthier blood vessels increase blood flow into the penis which improves erectile function. This is a painless, in-office procedure, that creates “micro-trauma” or inflammation in the blood vessels of the penis. Your body responds by bringing growth factors to the area helping to rebuild and create new pathways for increased blood flow.

 

Erectile dysfunction does not discriminate against age and the earlier interventions are implemented the better. Not dealing with ED yet? Now is your chance to be proactive instead of reactive. All of the above-mentioned therapies can be implemented before erectile dysfunction becomes an issue.  For more information or to discuss what options are best for you, contact Victory Men’s Health Medical providers who specialize in Sexual Health.

Source

Cleveland Clinic Med ED

Healthline

Think to yourself…when was the last time you got a great night of sleep? From working 40+ hours a week to raising children to navigating life through a pandemic, most of us are struggling in the sleep department. Have you recently heard a friend or a colleague brag about how well rested they are??  That answer is probably no. There are dozens of reasons as to why we’re not getting what we need and a lot are out of our control. On the nights your toddler or your dog aren’t crawling into your bed keeping you awake, do you have the proper sleep hygiene practices to ensure a good night’s rest? 

Blue Light

To say daily exposure to screen time has increased dramatically over the years is an understatement. Technology advancements have helped streamline and advance our daily lives but not without cost. Artificial blue light from the screens can affect sleep by throwing off our natural circadian rhythm because it suppresses melatonin, a hormone that influences our biological clock for sleep.  Blue wavelengths (Blue Light) are actually beneficial and necessary for boosting attention, reaction times and mood during the day but are disruptive at night, especially after the sun sets. There are studies suggesting that blue light has other harmful side effects aside from sleep. A Harvard study sheds a little bit of light on the possible connection to diabetes and possibly obesity. The researchers put 10 people on a schedule that gradually shifted the timing of their circadian rhythms. Their blood sugar levels increased, throwing them into a prediabetic state, and levels of leptin, a hormone that leaves people feeling full after a meal, went down. 

How to protect yourself from blue light at night:

• Use dim red lights for night lights. Red is less likely to alter circadian rhythm and suppress melatonin
• Avoid bright screens 2-3 hours before bed
• If you work at night with electronic devices, consider blue blocking glasses or downloading apps that filter blue/green wavelength at night
• Expose yourself to as much bright light during the day as you can to boost your ability to sleep at night and improve your mood/alertness during daylight

Sleep Apnea

Sleep apnea is a condition marked by abnormal breathing during sleep and is believed to affect 2-9% of adults in the US. The most common form of sleep apnea, Obstructive Sleep Apnea (OSA) occurs when the airway at the back of the throat becomes physically blocked leading to temporary lapses of breath or multiple extended pauses in breath when they sleep.  This causes lower-quality sleep resulting in fatigue, restless sleep/insomnia, decreased libido and erectile dysfunction. OSA affects the body’s supply of oxygen, leading to more serious health consequences and frequently goes undiagnosed due to the person not being aware they have it as they are asleep for their symptoms.  Often times, the partner of the person with symptoms will notice they stop breathing in their sleep followed by a noisy breath and gasps for air or loud snores. If you think you may have this condition, the best option would be to get a sleep study done for a diagnosis. 

Treatment aims to normalize breathing during sleep and address any underlying health problems; often weight loss is recommended. The options will depend on the cause and severity of symptoms and lifestyle modifications are critical steps to normalizing the problem.

Alcohol

It’s been proven that overconsumption of alcohol is detrimental to our health overtime, but a common misconception is it helps with sleep. More people use alcohol than any other sleep aid in the world due to the initial sedating effects helps the onset of getting to sleep. However, over the course of the night, alcohol is metabolized and stimulant effects kick in which often leads to sleep disruptions in the later part of a night’s sleep. Studies have shown that alcohol consumption increases both alpha and delta brain waves simultaneously. Alpha waves are present in a waking brain and delta waves are present during deep, slow-wave sleep. The push-pull between both states may result in disrupted sleep and over time by pre-sleep alcohol can have significant detrimental effects on daytime wellbeing and neurocognitive function such as learning and memory processes. Alcohol consumption before sleep also increases risk for obstructed sleep apnea by 25% for people who consume moderate or higher amounts of alcohol compared to people who consume lower or none at all. 

The take home message here is that alcohol is not actually a particularly good sleep aid even though it may seem like it helps you get to sleep more quickly. The fact is the quality of sleep you get is significantly altered and disrupted. Depending on your size, did you know that it takes about 1 hour to digest an alcoholic beverage? Stopping alcohol intake 3 hours prior to bedtime is essential to ensuring it doesn’t disrupt your night’s sleep.

Caffeine

Caffeine is a huge sleep offender. People don’t realize it, but the half-life of caffeine is between 6 and 8 hours. If you have a cup of coffee at 4PM in the afternoon, half of that coffee is still on board at 11PM that night! You may think that you can handle the stimulant and that it doesn’t have an effect on your sleep when the truth is that the quality is directly affected. Similar to alcohol, caffeine prohibits your ability to get into sleep stages 3 and 4. These stages are essential to overall recovery and is when physical restoration happens (aka our “beauty sleep”). Caffeine is a stimulant and there’s no other way around it. Being cognizant of your intake and stopping by 2PM to avoid disruption is a good rule of thumb to follow.

Odds are against us when it comes to sleep and controlling what you can is imperative to overall health. Improving sleep hygiene has little cost and virtually no risk, so why not make it a priority to fix? Take a step back and evaluate your daily lifestyle to put yourself in the best position to sleep well every night. 

Sources

Sleep apnea

MSD Manuals; Pulmonary disorders

Wiley

NCBI

Do you know the truth about testosterone? Testosterone treatment is an area of medicine that has been unnecessarily controversial for many years, so it’s hard to know what information is accurate when searching Dr. Google. It is quite common for men to feel confused, frustrated, and overwhelmed when researching what might be causing their loss of vigor and vitality.  

Testosterone therapy, when implemented correctly, can make a life-changing difference for men experiencing symptoms of low T, however; the abundance of falsities regarding testosterone therapy has led to:

• Settling for subpar care by providers who have not committed to treating based on the latest proven information
• Men opting out of seeking solutions altogether
• Patients unsure of who to trust with their treatment
• Providers that don’t specialize hormones 

Don’t let that be you. Don’t let the fear of the unknown hold you back from feeling your best. Knowledge is power.

Here are a few common myths, busted!  Stay tuned for part 2.

Myth: Testosterone level is the most important factor in determining treatment.

Truth: No! Low testosterone should be determined based on both free and total testosterone as well as symptoms. The prescribing provider should have a complete ADAM questionnaire from the patient as well as a conversation to learn the patient’s symptoms, goals and the best route of treatment. The Androgen Deficiency in the Aging Male (ADAM) questionnaire is a quantitative analysis of symptoms of low testosterone. There is not a simple answer on treatment or dosing based on lab values alone. If the question is “am I a good candidate for testosterone therapy?” and a provider gives a simple “yes” or “no” response based on a single lab value of total testosterone, it is highly recommended to get a second opinion. 

Myth: Testosterone therapy protocol must include an estrogen blocker or aromatase inhibitor (AI).

Truth: No, no, and no. For many years, this was considered the standard of care, but the medical evidence has since changed. Estrogen in men is not the enemy. Read that again! Men need estrogen to support bone health, sexual health and cardiac function. Blocking estrogen can be damaging to those areas of the body as well as worsen symptoms of erectile dysfunction. Then why do so many providers prescribe estrogen blockers? It is very hard for people, even medical providers, to unlearn what they have already learned.  Despite the overwhelming evidence not to block estrogen, it use to be the standard protocol based on the unfounded idea that “men shouldn’t have high estrogen.”

Please refer to these references for more insight on this topic:

Therapeutic testosterone myths (podcast)

The role of Estradiol in male production (publication)

Myth: Using testosterone is only for bodybuilders.

Truth: The bodybuilding community is a large part of how testosterone therapy became popularized. Of course, testosterone does help build muscle and, in some cases, people do abuse testosterone to obtain super psychological levels and physique. Keep in mind, here we are talking about using testosterone to reach optimal, safe and healthy levels, not super physiological. In addition to muscle growth, testosterone supports a number of very important functions including but not limited to; cardiac function, bone health, sexual health (libido and quality of erections), energy, body composition (fat/muscle ratio), mood/disposition, mental clarity, and more. As you can see, men need adequate testosterone to function well. So yes, whether the goal is to build muscle, be a better employee, husband, dad, or just simply live as a more efficient person, testosterone might be right for you.

Our staff at Victory Men’s Health takes pride in staying up to date with the latest and proven means of therapy. Please reach out to learn more. 

It is an understatement to say that there is wide variation in quality
among dietary supplements.

How many times have you read a news report revealing that a shocking percentage of products tested contained only a fraction of the ingredient potency they claimed to have…or a newspaper story about a supplement that was contaminated with heavy metals, or worse, adulterated with cheap material?

Dietary supplements are substances used to add nutrients to your diet and optimize cellular function. They may contain vitamins, minerals, fiber, amino acids, herbs or enzymes. Supplements come in the form of pills, capsules, powders, gel tabs, extracts or liquids.

While it is important to eat a balanced diet with a sufficient amount of fruits and vegetables, our food today doesn’t contain as many nutrients as they once did due to the depletion of nutrients in soil in combination with being picked before fully ripened to successfully transport across the world for consumption. You would have to eat a dozen bowls of spinach today to get the iron content from 1 bowl of spinach in the 1930’s. The Journal of Complimentary Medicine reports a whopping 76 percent decline in trace minerals in USA fruits and vegetables. Because of this, supplementation is necessary, IN ADDITION TO, vitamins and nutrients we get from food.

13% of us get enough fruits (1-1/2 – 2 cups daily) 87% DO NOT

8% of us get enough vegetables (2-3 cups) 92% DO NOT

While you do not need a doctor’s prescription to purchase dietary supplements, it can be overwhelming to educate yourself on where to find the best quality brands. The supplement business is a multi-billion-dollar global industry where you can find just about anything you’re looking for online or at a store at a price that is easily affordable. In short, vitamins and supplements are easily accessible, but they are NOT all made equal.

Due to the convenience of obtaining a supplement, there is an enormous amount of competition and demand for companies to stay relevant in a world where people are becoming increasingly more health conscious. An initial thought would be to seek out your local supplement store or big box store but you may want to think twice.  In 2015, The New York State Attorney General’s office found that four of five tested top-selling store brand products did not contain any of the herbs listed on four different national retailers’ labels. The tests showed that pills labeled medicinal herbs often contained nothing more than cheap fillers like powdered rice, asparagus and houseplants, and in some cases substances that could be dangerous to those with allergies.₁  Did you know that over-the-counter supplements are not required to go through a series of testing for consumer consumption?  To add more complication, large e-commerce companies such as Amazon, find counterfeit products penetrating their market making it tricky to know the quality and reliability of what’s available to you.

The best option for seeking out a trustworthy label is to find a pharmaceutical grade product. What makes them better? The below table shows the required testing standards to be categorized as pharmaceutical to ensure purity and maximum absorption:

Pharmaceutical	Over The Counter
Pharmaceutical grade vitamins must absorb in your body within 45 minutes.	No requirement for bioavailability – it may or may not dissolve in your body.
Raw ingredients must be tested before production.	No ingredient testing requirements.
Products are required to be 99% pure. This means it won’t be full of binders, fillers, dyes, or other unknown substances.	No purity requirements. Products may contain any substance deemed “safe for human consumption”.
Expiration dates guarantee the potency of the supplement through that day. This is determined through thorough testing.	FDA does not require expiration dates for nutritional dietary supplements so no guarantee of potency.
Ingredients listed on the bottle must agree with those within the capsule.	Because raw ingredients are not tested labels and contents are often inconsistent.
Only available through reputable medical practices. Note: pharmaceutical grade products are not available online or through retailers such as Wal-Mart. IF YOU SEE PRODUCTS LISTED AS SUCH, BUYER BEWARE.	Available for purchase online and at major retail establishments. These retailers do not have to regulate the source or quality of goods sold.

One would assume that all supplements would need to go through ingredient testing at the very least, but over the counter products are not required to and less than 3% of supplements meet pharmaceutical grade standards.₂   Knowing this information, one can see that it could not only be a waste of money but also a potential risk to your health without the certainty of ingredients in your supplement. At Victory Men’s Health, we offer pharmaceutical grade supplements as a commitment to transparency and efficacy. For more information on the supplements we offer, please contact one of our offices.

References

1. NY attorney general target supplements
2. What does pharmaceutical grade mean