Men’s Health

Men's Health

Male sexual health can be due to problems with libido (sexual desire), the ability to get an erection and/or sustain it. (Erectile function). Problems of early ejaculation (premature ejaculation) can also be an issue in many. Male sexual health also includes treatment of sexually transmitted diseases and treatment of male infertility.

Although hormones can affect the desire and the ability to have sex, mental and emotional factors also play important roles. Various factors can cause Erectile dysfunction (ED), including stress, depression, relationship issues, abnormally low testosterone, damage to genital organs, and even atherosclerotic arteries. In fact, it can also be a warning sign for heart disease.

ED can be treated with pills, testosterone replacement or at times with injections into the penis or delivery through the urethra, or with use of vacuum devices.  Men can also experience difficulties like premature ejaculation, delayed ejaculation, or rarely the inability to experience orgasm upon ejaculation (anorgasmia). These can be corrected with medications or through counselling.

An important obstacle to improving men’s health is their reluctance to consult Endocrinologist. Also, many myths surround men’s health like they do not care about their health,  but in fact they feel unable to talk about their concerns or seek help until it is often too late. At IDEACLINICS, a team of endocrinologists can provide treatments for various conditions as mentioned here.

Know More About Men's Health Conditions

Loss of libido is lack of desire in sexual activity. About 10% of men have decreased libido and  increases with age.

What causes decreased libido?

Decreased libido has many causes. Men with erectile dysfunction though usually  do not have loss of libido, with time erectile dysfunction can lead to reduced sexual drive.

Common causes of low libido include:

  • Low testosterone (male hypogonadism)
  • Excessive alcohol
  • Relationship problems
  • Erectile dysfunction (ED)
  • Depression
  • Medications (Antidepressants; medications for prostate cancer etc)
  • Systemic illness (heart,, kidney, liver failures, Joint pains, cancers etc)

What is the treatment for decreased libido?

Treatment is dependent on the cause for loss of libido. Healthy lifestyle, with good sleep, diet and exercise with no alcohol and low stress can help.

For others treating underlying condition, changing culprit medications, counseling can help.

Testosterone replacement hormone therapy is very effective for those with hypogonadism.

What is erectile dysfunction?

Erectile dysfunction is otherwise known as impotence, where the man is unable to  initiate or keep an erection long enough for satisfactory sex. Blood flow into and stay in the penis until orgasm. Problems with erections once in a while for men is common and if there is consistent problem medical treatment may help.

What causes erectile dysfunction?

The most common causes of  Erectile Dysfunction are

  • Atherosclerosis: Due to long term diabetes, obesity, smoking, high BP or cholesterol. Erectile Dysfunction may be a sign of heart disease or other serious health problems.
  • Drugs: Medications like antidepressants, hypertension, pain, or prostate cancer. Also, habits like alcohol, tobacco, and illegal drugs.
  • Lack of sexual desire: This can result from stroke, depression, anxiety and low testosterone levels.
  • Nerve damage: Damage to the nerves can occur due to diabetes, spinal cord injuries, prostate surgery, radiation therapy etc.
  • Hormone imbalance: High prolactin levels and low testosterone.
  • Chronic kidney and liver disease: These diseases affect blood vessels, nerves, and hormone levels and result in erectile dysfunction.

How is erectile dysfunction treated?

Treatment for ED will depend on the cause and severity.

Treatment options can include the following:

  • ORAL MEDICATION

Three commonly used ones are sildenafil, vardenafil, and talafadil which work by increasing blood flow to the penis.

  • PENILE THERAPIES

Medications injected into the penis or inserted into the urethra to increase blood flow. These  may work when oral medications do not.

  • TESTOSTERONE REPLACEMENT THERAPY

Testosterone can be replaced through injections, skin patches, gels are an option particularly if testosterone levels remain low.

DEVICES AND SURGERY

  1. Vacuum device in the form of an external plastic cylinder and vacuum pump pulls blood into the penis and causes an erection. Sometimes, placing an elastic ring around the base of the penis to prevent blood from flowing back into the body may be needed.
  2. Penile implants. Penile implants are useful in selected few who does not respond well to other treatments.
  3. Vascular surgery. Young men with penile blood flow problems sometimes may need surgery.
  4. Psychological counseling will work with relationships or emotional causes.

DIETARY SUPPLEMENTS ARE UNPROVEN TREATMENTS FOR ED, AND SOME CONTAIN HARMFUL INGREDIENTS.

What is gynecomastia?

Gynecomastia is breast enlargement in boys or men with an increase in breast tissue resulting from an imbalance between testosterone and estrogen levels. Gynecomastia can make breasts tender but are benign (non-cancerous).

Who develops gynecomastia?

Gynecomastia is common in boys going through puberty and sometimes seen in  newborns due to exposure to their mother’s estrogen. In both cases, it usually goes away on its own, however in adults, it’s most common in men over the age of 50 years.

What causes gynecomastia in adults?

  • The hormonal changes of aging with less testosterone and more estrogen.
  • Increased body fat and increase estrogen levels due to conversion from testosterone.
  • Medicines: Medicines that affect testosterone (prostate cancer), Some antacids, antibiotics, chemo for cancers, BP and heart medications, psychiatric drugs, phytoestrogens, alcohol, illegal drugs like amphetamines, heroin, marijuana, anabolic steroids or androgens used by bodybuilders.
  • Diseases: Hyperthyroidism, Liver & Kidney disease, some tumours

How is gynecomastia diagnosed?

  • Physical examination and History
  • Blood tests to check hormone levels
  • Tests to see whether the liver, kidneys, and thyroid are working properly
  • A mammogram to rule out breast cancer and ultrasound.

What is the treatment for gynecomastia?

  • In most cases no treatment is needed.
  • Treatment of underlying cause.
  • Tamoxifen are medicines that block the effect of estrogen in breast tissue.

Surgery to remove breast tissue for men who have severe gynecomastia.

What is infertility?

Infertility is the inability to get pregnant even after one year of trying. Over a third of infertility problems  are due to the male partner.

What causes male infertility?

  • Around 30 to 40 percent of cases, the problem is in the testes, damage to testes can be due to conditions like mumps, trauma, surgery or chemo treatments.
  • Heat can affect sperm production. Undescended testes or varicocele may  raise the temperature in the testes and may cause low sperm production.
  • Some genetic or inherited diseases can cause low or no sperm production or decrease motility. eg: Kallman’s syndrome, Klinefelter’s etc.
  • In 10 to 20 percent of cases, the problem is a blockage of the tubes that carry sperms to the penis called the vas deferens. It can be due to infections, vasectomy or cystic fibrosis.
  • Retrograde movement of sperm into the bladder, instead of towards the penis can lead to infertility.
  • Infertility can rarely result from hormone deficiencies. Pituitary tumours can lower Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) which otherwise stimulate the testes to produce testosterone and sperm.
  • In 30 to 40 percent of men with infertility cause may not be found, usually have abnormal sperm like abnormal in shape, or low in number or motility.
  • Other problems like chronic illness, obesity, certain drugs may decrease sperm production and fertility.

How is male infertility evaluated?

Endocrinologists  or urologists can help diagnose and treat male infertility. After a medical history, physical exam, a semen analysis and Blood tests for hormone deficiency appropriate treatment is commenced.

How is male infertility treated?

Treatment for male infertility depends on the cause.

  • SURGERY : Surgery can repair a blockage in the sperm transport system with reversal of Vasectomy or with repair of varicoceles. However, it may not be  able to restore fertility completely.
  • HORMONE THERAPY : If the cause is low gonadotrophins, treatment with hormone injections (LH and FSH) is usually successful. It may take a year or longer to get enough sperm production and facilitate fertility.
  • ASSISTED REPRODUCTIVE TECHNOLOGIES: In vitro fertilization (IVF), or Intracytoplasmic sperm injection/ ICSI (injecting a single sperm into an egg) will improve chances for successful pregnancies.
  • Healthy lifestyle, exercise, healthy diet, and stop smoking or use drugs can help.

What is the role of testosterone?

Testosterone is the most important sex hormone for men. Apart from development of male characteristics during puberty, hormone also helps maintain sex drive, sperm production, and bone health.  Hypogonadism (low testosterone) can cause drop in sex drive, Poor erections, Low sperm count, Enlarged breasts.

What causes low testosterone?

  • Testicular injury, trauma, castration or infection
  • Radiation or chemotherapy treatment for cancer
  • Medications like opiate painkillers
  • Hormone disorders (pituitary tumors or hyperprolactinemias)
  • Diseases of liver or kidney, obesity, type 2 diabetes, and HIV/AIDS
  • Genetic conditions Klinefelter syndrome, Kallmann syndrome, Prader-Willi syndrome. hemochromatosis,
  • Anabolic Steroid use in the past

How is low testosterone diagnosed?

  • Physical examination including testes.
  • Blood tests for total testosterone level, may need more than one early morning (7–10 AM) and tests of pituitary gland hormones.

How is low testosterone treated?

Testosterone replacement therapy can improve sexual interest, erections, mood and energy, body hair growth, bone density, and muscle mass. There are several ways to replace testosterone:

  • Gel or patches that you put on your skin
  • Injections (monthly or three monthly intramuscular)

Some Facts about Testosterone Replacement Therapy:

  1. Testosterone is a hormone produced primarily in the testes. Testosterone helps maintain  muscle mass, bone density, fat distribution, facial and body hair, red blood cell production, sex drive and sperm production
  2. Testosterone levels generally peak during the teenage and typically decline about 1 percent a year after age 30 or 40. The decline could be due to normal ageing or importantly can be due to underlying hypogonadism.
  3. Hypogonadism happens if the person is unable to produce normal amounts of testosterone as a result of problems with testes or the pituitary.
  4. Testosterone replacement therapy can improve the signs and symptoms of low testosterone in these men. These  replacements are available in the form of injections, patches or gels in India. Oral testosterone are not preferable.
  5. Low testosterone levels and can manifest as:
  • Changes in sexual function with reduced sexual desire, fewer erections and infertility.
  • Physical changes like increased body fat, reduced muscle bulk and strength, and decreased bone density. Lack of energy, hair loss, gynaecomastia can also be a sign of low testosterone levels in men.
  • Emotional changes can include depression, trouble with concentrating, memory loss, lack of motivation or self confidence can happen in few. Low testosterone can sometimes cause insomnia or even other sleep problems.
  1. A blood test is the only way to diagnose a low testosterone level.
  2. Testosterone therapy can help reverse the effects of hypogonadism, but at present remains unclear of any benefit for older men.
  3. Testosterone therapy has various risks and may:
  • Stimulate noncancerous growth of the prostate (benign prostatic hyperplasia) and growth of existing prostate cancer.
  • Testosterone therapy may impact the risk of heart disease but remains controversial at present.
  • Can thicken blood by causing polycythemia and increase the risk of a blood clot (deep vein thrombosis and pulmonary embolism)
  • Theoretical risk in limiting sperm production or cause testes shrinkage
  • Also, can cause gynaecomastia, acne, worsen sleep apnea.

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