On Call With Dr. Mark

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Male Sexual Function

Most men’s understanding of erectile function is based on their ability to have sexual intercourse. Many believe as long as they can penetrate, it is a successful sexual experience. They have no appreciation of the importance of the quality of the erection and how it impacts sexual and relationship satisfaction for themselves as well as their partner. The day they can no longer have sex is the day that most men admit there is a problem. This inability to perform at all, leads to some level of embarrassment and apprehension. This embarrassment is one of the key reasons why men often do not seek intervention. They feel this problem is unique to them or should not be happening to them and therefore avoid discussing these issues with their significant other, friends or physician.

Pituitary Gland

The decline of HGH with aging is not due to a decrease in the production by the pituitary in the majority of people. The pituitary actually maintains its ability to produce HGH regardless of age. Instead, the decline of HGH is due to decrease in the secretion of HGH. The reason for this decreased secretion is not clearly understood. However a great deal of insight is gained by studying the mechanisms that actually do regulate the secretion of HGH. There are three primary substances and several secondary factors that have a positive and negative impact on HGH secretion. HGH is under feedback loop regulation. HGH levels therefore impact the secretion HGH secretion. The hypothalamus has a direct hematological portal connection with the pituitary gland which is used regulate the secretion of important pituitary hormones. There are two hypothalamus substances that increase the secretion of HGH and one that decreases the secretion of HGH. Growth hormone releasing hormone (GHRH) and Growth hormone releasing peptide (GHRP) are the two that increase the secretion of HGH. Levels of both of these releasing factors decrease with age. Somatostatin decreases the secretion of HGH, whose levels increase with age. These increase and decrease of these regulatory factors varies by gender and between each individual. Stimulators 1) Growth Hormone Releasing Factor 2) Growth Hormone Releasing Peptide – Ghrelin 3) Sleep 4) Exercise 5) Hypoglycemia - Low

levels of blood sugar 6) Dietary Protein 7) Estradiol 8) Arginine 9) Glutamine Inhibitors 1) Somatostatin 2) Serum HGH Levels 3) Serum IGF-1 Levels 4) Dietary Carbohydrates 5) Glucocorticoids

Sexual Function and the Aging Male

Sexual Function clearly declines in men as a natural process of aging. The exact age this occurs is not clearly defined in each individual male, but is known to occur sometime after the third decade of life. It is the result of a combination of the age related changes as well as environmental factors like smoking and stress. Other disease processes such as diabetes, hypertension and vascular diseases also expedite the decline in function. Sexual Function in men is primarily modulated by their physical response to sexual stimuli, which is their erectile function. Thus, the degree of sexual arousal is affected by the ability to obtain and maintain an erection as well as the quality of that erection. The decline in erectile function with age is well documented. This loss correlates with a decline in the quality and frequency of nocturnal erections. Like any other dynamic part of the human body that needs activity to maintain function, the penis uses nocturnal erections to maintain smooth muscle and neural health. The nocturnal erections allow men to maintain function even without having sexual activity during waken hours. Thus, the quality of nocturnal erections is not only important, but can give insight to a male’s erectile health. This decrease or lack of erectile function seen eventually in most males has a dramatic and profound impact on his sexual desire and satisfaction in his sexual relationship by both himself and his partner. It is even more complicated by the fact that women tend to have an increase in sexual function over the same time period. Thus, the decline in sexual function in this partnership can severely affect the stability of the relationship. It is a lack of understanding of this natural process and the ability to alter this course safely and effectively that prevents many men from seeking assistance.

Who needs and doesn’t need Cialis or Viagra

There has been recent discussion on BUBBA about who needs and who doesn’t need Cialis or Viagra. The truth is that it varies in each individual and their state of health. Typically, most men will notice somewhere after 35 and before 55 a decrease in their performance. This doesn’t mean they can’t have successful sex, but their ability to get, maintain or rigidity of erections decreases. It is difficult to believe that 12 years after Viagra was launched there is still a stigma about these drugs. Interesting we do many things to enhance our lives, but the thought of enhancing your sexual function is still taboo. These drugs do not represent a cure all, but an opportunity for many men and women to enjoy an active and mutually satisfying sex life. They are not candy, but a prescription and you need to see your doctor. Please don’t be embarrassed, but proud you are taking a proactive approach to you and your partner’s sex life. you need to see your doctor. Please don’t be embarrassed, but proud you are taking a proactive approach to you and your partner’s sex life.

Degrees of Erectile Dysfunction

Most men still think of erectile dysfunction as impotence, “all or nothing.” Males don’t wake up one day with the inability to have sex. There is a gradual loss of function in every male over time. This decline can be defined at different levels from mild to severe. Mild erectile dysfunction is the most common type of erectile dysfunction, but also the most under diagnosed or missed form of erectile dysfunction. It is defined as a male that has the same frequency of intercourse as a normal male, but there is marked decrease in his sexual satisfaction, his partner’s satisfaction and relationship satisfaction as a result of decreased erectile function. The satisfaction problem stems not from the lack of sex, but the decrease in the quality of sex. This drop in quality is the result of a decrease in the male’s ability to get and keep an erection during sexual contact or sexual intercourse. The male still gets an erection, but it is more difficult to get a spontaneous erection with sexual stimuli when he or his partner wants. More or different types of stimulation may be needed for him to achieve an erection than was required previously. The erection may be less rigid or may loose firmness during sexual contact or intercourse. The normal male almost never has these problems, but a male with mild erectile dysfunction may have different degrees of difficulties at any given time. The problems may even progress over time and become more severe. It is not a fact of embarrassment that most men don’t seek assistance, but a lack of awareness of these quality changes and the effect they are having on their lives. Moderate erectile dysfunction is the type of erectile dysfunction when most men seek help or are diagnosed by their doctor. It is defined as a male who experiences a significant drop in the amount of sexual activity or sexual intercourse as a result of erectile dysfunction. There is a tremendous amount of sexual dissatisfaction as well as relationship dissatisfaction. Often there is a degree of apathy by one or both partners. The satisfaction problem is now a result of the decreased quality and quantity of sex. The couple is still having intercourse, but failure to get an erection sufficient for sexual intercourse now effects their lives and relationship. Unfortunately, at this stage just improving erectile function is not always sufficient to repair the relationship. Severe Erectile dysfunction was formerly the degree of dysfunction most men had to achieve to get treatment for their erectile dysfunction prior to the revolutionary class of drugs started by Viagra and later joined by Cialis and Levitra. It is defined as a male that no longer can achieve an erection sufficient for sexual contact or intercourse. Interestingly, the level of dissatisfaction is often not much worse than couples with moderate erectile dysfunction. Sex may no longer be a part of their relationship. Severe erectile dysfunction is such a degree of failure that is similar to a stroke or heart attack, which are absolute failures of other vascular tissue.

Male Sexual Function

Sexual Function clearly declines in men as a natural process of aging. The exact age this occurs is not clearly defined in each individual male, but is known to occur sometime after the third decade of life. It is the result of a combination of the age related changes as well as environmental factors like smoking and stress. Other diseases process like diabetes and vascular diseases also expedite the decline in function. Sexual Function in men is primarily modulated by their physical response to sexual stimuli, which is their erectile function. Thus, the degree of sexual arousal is affected by the ability to obtain and maintain an erection as well as the quality of that erection. The decline in erectile function with age is well documented and correlates with a decline the quality and frequency of nocturnal erections. Like any other dynamic part of the human body that needs activity to maintain function the penis uses nocturnal erections to maintain smooth muscle and neural tone. The 1.5 to 3 hour of nocturnal erections allows men to maintain function even without having sexual activity during waken hours. This decrease or lack of erectile function seen eventual in most males has a dramatic and profound impact on his sexual desire and satisfaction in his sexual relationship by both himself and his partner. It is even more complicated by the fact that women tend to have an increase in sexual function over the same time period. Thus, the decline in sexual function in this partnership can severely affect the stability of that relationship. It’s a lack of understanding of this process that prevents progress to be made in this area of men’s health.

Pituitary Gland

Testosterone

Many questions we get on the show and website pertain to testosterone. First it must be stated that low testosterone is a disease and should be diagnosed and treated by a physician. The symptoms of low testosterone may include fatigue, irritability, decreased mood and changes in body mass. Decreased sexual function may or may not be present. There is a questionaire on this site to help self-evaluate your symptoms. The diagnosis is then confirmed by getting a testosterone level in the face of some or all the fore mentioned symptoms. There are several other levels that need to be checked and these are at the discretion of your physician when being evaluated for low testosterone which is out of the scope of this blog. There are several ways to treat low testosterone and here again your physician will help determine your best option. The most common treatment is replacement through an external source. There are several options; however topical agents tend to be the most popular. Low testosterone is different from the normal fluctuations many men experience as part of everyday life, which may have some of the same symptoms but the levels are low normal and don’t require replacement. The causes of these dips become more pronounced with age. The causes that adversely affect testosterones levels include stress, lack of sleep, high alcohol intake, inactivity and a poor diet. Changes in lifestyle as well as Revita-t can help optimize testosterone levels and minimize these fluctuations. The goal is to maximize and optimize your testosterone level. Individual responses will vary and lifestyle changes are a important component of success. Revita-t is not intended to treat the disease known as low testosterone. If you are concerned that you have low testosterone based on the questionnaire or the above information you should seek an evaluation by a physician.

Decreased Ejaculation

The problem is many men are not educated about their own function or what normal function means. The ability or inability to ejaculate is related to a multitude of factors. First, ejaculation and erections are two separate mechanisms. The ability to do one or the other is possible independent of the other. However, factors that affect the ability to achieve an erection also affect the ability to ejaculate. The most common factor is simply getting older. As men age, their ability to ejaculate, the frequency of ejaculation and the volume of ejaculation decrease. It is related to the unrelenting and unstoppable process of aging. It is not hopeless, there are things men can do to slow the aging process. Maintaining general health and fitness as well as not smoking is a place to start.