Know your Mortality Rate? This Will Help

November 4th, 2014 by admin

VO2In a recent New York Times health and wellness blog, discussion about your fitness age and lifespan was discussed. There is an increasing amount of research coming out on cardiorespiratory fitness assessments and predicting cardiovascular disease risk.  Assessing an individual’s peak exercise capacity can also determine their mortality rates. A “Vo2max” or “Maximum Oxygen Consumption” is how you can measure one’s exercise capacity. This test essentially measures your body’s ability to utilize oxygen during exercise, or how well your heart and lungs work in conjunction with one another to provide oxygen to the body’s working parts. Recent research shows an inverse relationship to your Vo2max and all-cause mortality. Meaning, the higher your Vo2max, the lower your risk of illness and death!

Typical past use:

Vo2max testing has historically been used by athletes to measure their exercise capacity. Typically, the higher their Vo2max, the better their cardiovascular endurance . Thus, it is important for competitive athletes to achieve as high a score as possible. In any timed event, athletes are always striving for lower times. Increasing your Vo2max would theoretically increase your propensity for training and ability to achieve better times. This type of testing can now be used in the general population and assist in the assessment of an individual’s health status.

Clinical use:

With increasing availability of Cardio Pulmonary Exercise Testing equipment, in both wellness centers and doctor’s offices, the -non-athlete can –assess their Vo2max. In many medical journals, studies have compared the relationship between Vo2max scores and disease risk. The studies have concluded that Vo2max scoring was  a better  predictor of risk of death among both -l patients with and without cardiovascular disease than the traditional risk factors (age, BMI, cholesterol, blood pressure, diabetes, etc.). Understanding your Vo2max is an essential part of your overall wellness and ability to have a high quality of life.

How to achieve a higher Vo2max:

I know you didn’t think I’d throw all that information out there without telling you how to improve your Vo2max score, did you? One thing that must be noted is that there are two main components of your Vo2max. One is a genetic component, and the other is your fitness training!  You only have control of your fitness training.

Studies have shown that interval training produces a greater increase in exercise capacity than steady state exercise. Interval training is defined as the constant elevation and depression of the heart rate. This means training at a high intensity for short bursts, followed by “active rest”. For example, you’d see much more benefit from alternating sprinting and walking instead of jogging at one slow pace for 30 minutes. This does not mean you need to sign up for Cross Fit or any other High Intensity Interval Training routines, but anything that will elevate your heart rate up to ~85% of your age-adjusted heart rate maximum will do!

If you are someone who is deconditioned at this point, you should always start off with  lower to moderate intensity excercise.  This willallow  your body to adap to the new movements and stresses of exercise. Eventually the body will adapt to the exercise and you will be able to move to higher intensity. The goal is to build your body up to the point where you can tolerate around 3 days of interval training for 30 minutes.

Maintain your body:

Exercise capacity can plummet to your genetic baseline after 6-8 weeks of sedentary behavior. It will be essential to listen to your body when training. Sometimes, your rest days will be just as important as your work days. You have to give your body time to adjust to the workouts and recover. Overtraining is a frequent obstacle for people who exercise. Incorporating resistance training and mobility exercises will be important to help decrease your injury risk. Remember to listen to your body and take necessary steps to maintain your structural integrity, because all the hard work can be gone in 6 short weeks if you suffer an injury!

Even if you are a regular exerciser, additional data on your body is never a bad thing. You can always look to improve your routine, or tweak a few things to optimize your health. After all, the idea is to live a long and awesome life, right?

 

A Little Bit of Everything = A Whole Lot of Something

September 29th, 2014 by Michael Sargent

Exercise LogoLet’s be honest, we are all looking for the best way to either get fit, stay fit, or improve our health to the point where our doctor is satisfied. Whether it is for health reasons, personal goals, or our own vanity, it is essential that we are taking care of ourselves. I get a lot of questions about the latest and greatest supplements and exercise routines out there that can help us achieve a higher health status or a more desirable body. We all have common goals – to live longer, better, and healthier.

The answer to the question on how to achieve this is, quite simply, a little bit of everything.
Nutritionally speaking, people are looking for a way to get ahead. Stressing the importance of moderation is an essential part of healthy nutrition. There needs to be a healthy balance of our essential nutrients; carbohydrates, fats, proteins, and water. The amount of each will differ on the individual, but all of these nutrients are essential for optimal body function. My advice is to stay away from the diets that want you to cut out one thing or the other out entirely. Complex carbohydrates should be chosen over simple carbohydrates, unsaturated fats should be chosen over high saturated fat foods, and complete proteins should be your protein source.

Improper portion control is a major flaw in our country. We find ourselves going out to eat at a nice restaurant and making a point to finish whatever is put in front of us. This is often too much food for one sitting. Moderation is the key for anything we are consuming. If we eat a balanced amount of meats, plants, and whole grains (unprocessed), then we should be able to fulfill our body’s nutritional needs from our diet. In certain cases supplementation may be necessary if we cannot get certain things from our diet, or we have some underlying issues that inhibit our utilization of certain nutrients in the body.

When speaking about exercise there is one main point I want to drive home. Your body is designed to adapt to the stress that is put upon it. For instance, if you started running 5 miles a day today, then it may be very difficult. However, if you run 5 miles every day for one month, then you will find it much easier to run 5 miles at the end of the month. The physiological benefits you may have at the beginning of a running program will plateau and the improvements you saw at the beginning of your program will slow or stop eventually. Thus, having a well-rounded repertoire is a way to prevent your body from plateauing. Keep moving forward!

There are 4 components of your fitness you need to be aware of: (1) Cardiorespiratory Fitness- Training your heart and lungs will keep your heart and blood vessels in proper condition to live longer and perform better, (2) Power- our fast-twitch muscle fibers decrease rapidly as we age. Power movements are essential for our ability to maintain these fibers and perform our activities of daily living as we grow older. (3) Muscular strength/endurance- Maintaining healthy lean mass is essential for our structural integrity and ability to perform daily tasks. (4) Flexibility/Mobility- Having proper mobility and flexibility will decrease the likelihood of injury to our body that will inhibit our ability to do what we love. Each component needs to be addressed on a weekly basis. This means you should elevate your heart rate, perform some type of resistance training, and work on mobility (stretching, yoga, etc.) a couple times a week. These things could be done in two-three bouts of exercise a week!

Bottom line, if you stay well-rounded in your workouts and eat balanced with moderation, achieving a higher health status is a certainty.

10 Lifestyle Changes That Help Erectile Dysfunction – Part 2

May 14th, 2014 by Paul Nelson

smoke and drink

Hopefully, you read Part 1 of 10 lifestyle changes that help erectile dysfunction.  If not, you can read it here. As promised, here is the second part of the list – enjoy, and hopefully you will find some of these tips useful!

Mild/Moderate Alcohol

Interestingly, mild to moderate amounts of alcohol (1-2 drinks per day) has been shown to reduce ED.  Moderate alcohol consumption has been shown to increase NO levels in laboratory animals. However, excessive alcohol suppresses NO production, damages the muscle cells of the penis and increases premature ejaculation!

So, it looks as if that glass of wine with dinner is good for your penis, after all. Just keep it moderate. Too much alcohol may increase the desire – but absolutely will decrease performance!

Point 6: Enjoy alcohol in moderation.

Smoking

This hardly needs any discussion. Studies have shown that smoking, as well as second hand smoke, increase the incidence of ED. Cardiovascular damage and disease coupled with smoke destroying Nitric Oxide makes it sexual suicide to continue to smoke. If you need help quitting, see your doctor.

Point 7: Quit Smoking

Antioxidants

We’ve all heard of antioxidants – they are in the news a lot. The best known anti-oxidants are beta carotene, vitamins C and E, and the mineral selenium. Other anti-oxidants include ginkgo biloba, coenzyme Q10, tocotrienols.

Polyphenols are potent antioxidants found in high amounts in certain foods. Pomegranate, tea (especially white tea), red wine, blueberries, strawberries, raspberries are all great. Black berries have twice the amount of the other berries. Dark cocoa, low in sugar, has a tremendous benefit for increasing NO production. Spices such as rosemary, oregano, cinnamon, turmeric, black pepper, cloves, garlic and paprika have even been shown to reduce the harmful effects of a high fat meal!

Point 8: Eat your fruits and vegetables and add spices to your meals.

Testosterone

We see the TV ads everywhere. “Got low T?” The truth is, many men are walking around with low testosterone. Low energy, depression, weight gain, loss of libido are all symptoms of low testosterone levels. In a nutshell, testosterone is what makes you feel like a man. The energy to compete, create, explore, and conquer comes from this male hormone. So does the desire and ability to have sex.

Despite the temptation, don’t run to your nutrition store and try to fix this on your own. You can create huge problems by tampering with hormones on your own. If you think you might have low T, ask your doctor.

Point 9: Go get a physical

Supplements

There has been a lot of research lately into the effects of supplements on sexual performance. A study in the International Journal of Impotence Research by the Reproductive Partners Medical Group, has created a list of supplements that have been shown to increase NO production and preservation. This includes

Omega-3 Fish oil              1000mg
Folic Acid                             400 micrograms
Vitamin C-500 mg.           1000mg
Vitamin E 200 UI               200mg
L-Citrulline                          2 grams
Pycnogenol                        50-120 mg.
Green Tea                           3 cups/day
Chocolate (low sugar)    1 oz/day

Surprisingly, L-Arginine did not make the list. It has been found that most of the recommended doses are so small, that the drug is synthesized almost completely before it has time to affect NO production. If you want to try it, the dose that seems to have the greatest effect is 5 grams.

Point 10: Talk to your doctor about supplements at your next visit.

 

10 Lifestyle Changes That Help Erectile Dysfunction – Part 1

April 23rd, 2014 by Paul Nelson

r-HEALTHY-LIFESTYLE-large570In western medicine, we often look for a simple cure to anything that ails us. We get sick, we take a pill. We have pain, we take a pill. We have ED, we take a pill. The problem is, real health care is often far more entangled and involved than that. The factors that can cause us health problems may pose no threat on their own, but when piled up on each other, in combination, this multiplied effect can reach the tipping point and cause some frustrating medical issues.

Dealing with ED is no different. The little stresses of life we subject our bodies to, all take their toll on our penis and its ability to function. After too much abuse, our body signals that it is giving up the fight. An holistic, lifestyle approach to treating ED can help the recovery and maintenance of a functioning penis.

The chemistry of an erection is amazing. It begins with the fragile molecule, Nitric Oxide (NO), which signals the muscles lining the blood vessels of the penis to relax and let blood engorge the penis. NO is a molecule with unbalanced electrons – that means that it will breakdown instantly with certain other molecules. The production and stability of NO relies on antioxidants to protect it so that it has time to deliver its effect before it breaks down (in less than a few seconds). Amazingly, almost every aspect of our lifestyle affects the production and function of NO as well as the presence of antioxidants to protect it.

Weight Control

When it comes to penises, size does not matter. When it comes to waist lines, size really does matter. Being overweight or obese is one of the worst things you can do to your penis. First of all, men tend to accumulate fat in their lower abdomen and in the pubic area at the base of the penis. As this pad of fat increases, available square footage of penis decreases. For every 15 pounds of extra fat, you lose ½ inch of penis. That’s just the beginning.

One of the byproducts of being overweight is insulin resistance. Even if not diabetic, the overweight man has created an environment where his body is not able to respond to insulin as it should. Insulin is a primary stimulator of NO production. Lower insulin response equals lower NO! Higher sugar levels of overweight men also impair NO production.

Point 1: Lose Weight!

Exercise

According to a recent study published in the International Journal of Impotence Research, the most important lifestyle factor influencing ED is exercise – both whole body exercise and penile exercise. It has been shown that a sedentary lifestyle increases ED by 2-10 fold, whereas moderate activity has been reported to reduce ED by 60% and high activity by over 80%. Physical exercise causes increased NO production throughout the whole body. Exercise also increases the body’s sensitivity to insulin (seeing a pattern here?).

Sadly, systemic bodily exercise does not increase blood flow to the penis. Gladly, the penis must be exercised as well. Regular stimulation that induces erections will increase the presence of NO in the penis as well as improve the penile response to it.

Point 2: Exercise helps create healthy erections!

Stress

Most of us tend to think of stress as feeling as if there’s too much to do and too little time to do it – too much on our plate! But stress is actually a very complex combination of physical and psychological interactions. At its most basic level, stress is the body anticipating the need for extra energy. This means everything from the highest level (panic, fury), the middle level (frustration, deadlines) to the lowest level (lack of sleep, not eating, worry). Your body’s response to every level is to pump adrenaline into your system as well as pump sugar into your blood stream for extra energy (remember insulin resistance?). This is the fight-or-flight response you hear about.

The major sexual aspect of stress is that adrenaline is what keeps your penis flaccid on a daily basis. So, even the smallest amount of worry or stress is going to pump adrenaline into your system, which will instantly kill an erection.

Point 3: Managing stress is key to your sexual health.

Reduce Fat Intake

Fat causes blood vessels to become inflamed. This inflammation greatly reduces the effect of NO. Fat in the blood stream increases oxidation – which breaks down NO. Fat reduces the effects of insulin. A high fat meal can also render the effects of Viagra completely useless. Fat increases cholesterol which can clog the tiny arteries of the penis.

Fat makes you fat! (remember the weight control issue?)

So, how is all this sounding? Those French fries may taste great going down, but are they worth making sex more difficult?

Point 4: Cut out fat in your diet.

Reduce Sugar Intake

Sugar levels in your blood are directly related to Insulin levels and creating insulin resistance. Higher sugar levels also raise oxidation levels which break down nitric oxide.

Sugar makes you fat. Can you really justify that candy bar if it’s going to ruin an erection?

Point 5: Reduce sugar in your diet.

 Stay tuned for the other 5 lifestyle changes!!!

Release Pelvic Pain in 2-3 months with Pelvic Floor Physical Therapy

March 25th, 2014 by Evelyn Hecht

male-pelvic-painMany evidence based studies prove that pelvic floor physical therapy is an effective treatment approach for men and women suffering from pelvic pain caused by tight muscles and restricted tissues. The pelvic floor muscles, namely the levator ani, coccygeus and obturator internus can develop adhesions, tension or trigger points which restrict movement and cause pain. Trigger points are palpable spasms/knots within muscle tissue and can occur in pelvic floor muscles. Trigger points can lead to adhesions of fascia/connective tissue of the abdomen, groin, pelvic floor and even restrict the viscera (colon, uterus, bladder, prostate gland) within the pelvic bowl.

The pudendal nerves and its branches, traveling from the sacrum (back of the pelvis) and running all through the pelvic floor region innervates the vaginal/penile and rectal areas. The nerves can become squeezed as it travels through tight muscles and fascia, which then decreases optimum pelvic floor function and increases pain.

The pelvic floor muscles are located INSIDE our bodies, in women the muscles are approximately 1-2 inches up from the vaginal/rectal region and in men, the muscles are approximately 1-2 inches up from the base of the penis/rectal region.

The pelvic floor muscles are key for four functions of the body:

1) lower back/core stabilization; 2) normal urinary function; 3) good bowel function; 4) satisfying sexual function.

As a core stabilizer, the pelvic floor works with 3 other core muscles, the Transversus Abdominus (deepest stomach muscle), Multifidus- (deep low back extensor muscle), and deep fibers of the Iliopsoas (hip flexor muscle). These 4 muscles work together to keep our core strong, flexible and prevents lower back pain. If one of the 4 core stabilizer muscles becomes weak or injured, then the other 3 muscles have to work harder to compensate. Over time this puts great strain on the whole core, which leads to back pain/stiffness/weakness.

The pelvic floor muscles are directly involved with three bodily functions, urinary, bowel and sexual.

For functional urination, the pelvic floor muscles surround the urethral opening and should relax when you are voiding and maintain closure or tension when you are not voiding. If the muscles are in spasm, urinary symptoms such as leaking, or feeling a strong urge to void, or having to go to the bathroom multiple times a day (called urinary frequency) and/or being awoken at night to void more than once (called nocturia), can occur. Women using public restrooms should not “hover” over the toilet, as this sustained half squat creates tension in the pelvis and does not allow full relaxation of the sphincters around the urethra to allow full urination. Best to use the protective toilet seat covers and sit comfortably.

For normal bowel movements, the pelvic floor muscles should be able to open and widen to allow the full passage of stool. When not having a BM, the pelvic floor maintains tension at the rectal opening to prevent leakage. If the pelvic floor is weak, leakage can occur. If the pelvic floor is tight, constipation resulting in sitting too long at the toilet, straining to defecate can occur. Toileting should take no longer than 5 minutes following the urge to void. Even though you may not feel completely empty, it’s better to stand and leave the bathroom versus continue to sit and strain. Constant straining can result in hemorrhoids and/or the development of a rectocele, which further impedes good function.

For satisfying sexual function, the toned and flexible pelvic floor allows for more intense orgasms in men and women. A fully relaxed pelvic floor helps women experience pain free intercourse with their male partners. Many patients who are experiencing sexual pain may experience difficulty with partner relationships or even avoid them due feeling of shame or inadequacy.

Pelvic pain due to restricted muscles can be released and return to normal function, no matter how long a person has been experiencing symptoms.

Physical therapists trained and mentored in pelvic floor work can:

  • apply targeted manual therapies to rid muscles of trigger points
  • utilize biofeedback therapy to help patients learn how to either downtrain (relax) their pelvic floor or to uptrain (strengthen) the pelvic floor
  • perform visceral mobilization to improve the mobility of organs lying within the pelvic bowl
  • mobilize and teach a patient self-connective tissue (skin rolling) techniques to abolish tight skin and fascia of the inner thighs and abdomen
  • teach patients gentle stretching techniques with foam rollers, tennis balls, knobbles, Theracane, S –wands and dilators
  • educate in exercises for a strong core
  • teach diaphragmatic breathing and visualization to help lower tension of the pelvis and to increase oxygenation to the body and decreased stress
  • guidance in cardiovascular exercise to pump more oxygen and nutrients to the tissues
  • teach proper bladder and bowel techniques and habits

Most people start to feel better after 2 months of consistent, twice a week therapy which incorporates many of the above techniques. Some reach goals sooner; others may take up to 3 months. By attending regular pelvic floor physical therapy and performing all the home exercises, faulty pattern are reversed and many people are pain free within 2-3 months.

 

As the owner of EMH Physical Therapy, Evelyn Hecht oversees all patients who are referred to the practice. She meets regularly with each staff licensed Doctor of Physical  Therapy (DPT ) to discuss plan of care and treatment options, she reads  every evaluation report prior to it being sent to your referring doctor and ensures that all patients attain optimum results in their recovery.

Solo Sex

March 10th, 2014 by Paul Nelson

do not disturbOne of the most common responses we see from men when they face sexual or erectile difficulties is simply avoidance. It makes sense. If sex has become frustrating, challenging, embarrassing, or humiliating, then why in the world would anyone continue trying to be sexual? Avoid all that pain by simply avoiding sex. It’s simple!

While it is an understandable feeling and a logical response, it might be compared to someone who has a leg injury who decides to simply give up on walking. It certainly is one answer, but it’s probably not the best answer. It is not in the best interests of anyone to go through life denying their human sexuality.

It remains a basic human need to be sexual. Even though sex may not be working the way we’re used to, or the way we’d like it to, we all still need to maintain both a solo sex life and an intimacy with our partners. It’s good for our mental health. It’s good for our physical health. It’s sort of like that not-walking choice. Eventually, it will lead to further complications and problems.

The first place to start is to think about solo sex. The great thing about solo sex is that you can try things out all by yourself to see how they work, how they feel, and how you respond. Every time I talk about a new technique or therapy with a man, I always caution him to try it out in private and solitude. For example, I hear stories about men who got their penis pump in the mail and are so excited to try it out, that they call in their partner to witness the resurrection of their penis – only to witness a DOA. Well, when things go badly, the letdown makes hope seem more far-off than ever.

No matter what, guys need to remain connected to their penis in more than just a flesh and blood relationship. Even if it’s not working right, even if it’s not feeling right, even if it bears no resemblance to the penis you used to have, you still need to have fun with it.

Many guys don’t realize they can still ejaculate and orgasm with a flaccid penis just as they can with an erect one. Yes, masturbation techniques may change, but the outcome should not. Lots of lubricant, patience, and an exploring spirit can result in some pretty rewarding moments of pleasure.

In addition to adjustments in technique, men may have to find erogenous areas of their bodies they’ve never had to pay much attention to. The perineum, testes, nipples, thighs, anus and groin can all provide some very intriguing sensations. It might take some bravery and a sense of fun adventure, but the rewards are worth it.

Be a pioneer. Be an explorer. The voyage of sexual self discovery is one that has no final destination – but it’s one heck of a journey!

Sexual Aids for Men

January 29th, 2014 by Paul Nelson

Browser bewareSexual aids for men have always had a troubled existence. For decades, they have been associated with lurid porn shops in seedy parts of town. Often, the items just look scary as their specific use remains somewhat of a mystery. Even the packaging can create some unease. Sex toys and porn have been inextricably linked for far too long.

The reality is that marital aids, as they are clinically called, can be a very valuable tool in helping restore and improve sexual performance in men. It is true that the penis needs regular cycles of tumescence for optimal health. If the penis is not experiencing erections during the sleeping cycle, it is really helpful to create erections during waking moments. Use of sexual aids can help create erections which bring in fresh blood and will keep penile tissue healthy.

In the absence of a partner, or if intercourse needs to be avoided for a time, sexual aids can provide a stimulatory outlet that can create great pleasure while maintaining safety and intimacy. I know of one couple where she packs him a surprise sex toy in his suitcase while he is on the road for business. When he gets to his destination, the fun of discovering it is a game that brings them closer even though they are continents apart. When he gets home, telling her about how he enjoyed using it is part of the plan.

Incorporating sex toys into the relationship can provide a sense of fun, excitement and adventure while preserving privacy. Not every couple can create a romantic weekend or plan an erotic setting when the kids are around. But slipping a small, new toy under the pillow shortly before bed can provide a sense of surprise and adventure.

One couple that had been trying to conceive found that sex on demand and on schedule was becoming a point of stress for them. I urged them to bring some toys into their lives. They bought a simple vibrator for her and a vibrating constriction ring for him. They told me that sex to get pregnant became a lot more fun when they had toys to distract them from the pressure of conception.

Go online and take a look at the dizzying array of toys. Think about what might be fun for you. Think about what might feel good. Think about what turns you on. Read reviews. Make an investment and have some fun!

 

 

Sex Hormone Binding Globulin

December 16th, 2013 by Nick Cannone, FNP

confused-man-old-funnyJim, a 70 year old man, comes in with significant symptoms of low testosterone including low libido, decreased energy and decreased concentration.  He reports having his testosterone levels checked with is internist.  He was told they were around 700ng/ml which is normal.

After a thorough history and physical, his hormone panel was repeated.

His total testosterone levels were 700ng/ml.  However, his sex hormone binding globulin was 80nmol/L.  Thus, his free androgen index was low.  Treatment with testosterone replacement was started and his symptoms improved.

Total testosterone provides a look at the total amount of testosterone circulating in the bloodstream.  However, 98% of testosterone is bound by proteins, only 2% is free in the bloodstream.  In order for cells to utilize testosterone, it must be free or not attached to proteins.    About 40% of testosterone is bound to SHBG and 55% to albumin or other proteins.

The problem with SHBG is once testosterone is bound to it, it is irreversible.  Testosterone bound to albumin and other proteins can be freed and then utilized.

Thus, if your SHBG levels are high, there is less testosterone available for use.

In Jim’s case, his internist only looked at the total testosterone level and not what was available for his cells to use.  We aimed for Jim to get to 1100ng/ml with his total testosterone.  As his testosterone levels increased, more was available for use and his symptoms resolved.

Some conditions that lead to elevated SHBG levels include aging, chronic liver disease, hyperthyroidism and certain medications.

It is important to have a complete hormone panel done in order to identify all possible causes.

 

Yours, Mine, Ours

October 15th, 2013 by Paul Nelson

Vibrators

Men love toys. As boys, they love boy toys. As men, they love man toys. Men often have special places where they play with their toys – the garage, the basement, the shed, the man cave. We men usually need to collect more toys to work on our toys. Some people might call them tools. But the fact is, there is often very little distinction between a tool and a toy for many men. Tools are simply toys used to work on other toys.

Men tend to take pride in their toys. Maintaining a classic car can make a guy feel like a brilliant engineer. Any guy that can handle a chainsaw feels like a stud. Keeping the boat afloat and in pristine condition makes him captain of his domain. Fixing a computer can make him feel like a genius.

When it comes to sex toys, men are no different.  Many times just a sex partner is a great toy! That’s great! Bodies are very cool toys! But, having other toys to use on your partner  is even cooler. Many men get their hands on a sex toy and they tend to work on their partner much as they would their Porsche. They get the engine warmed up, then revved up. They check fluid levels and oil. They check the clutch – of course it’s a stick shift. They take it for a spin. The test drive is a success. They are clearly master mechanics.

In my work with men, I often ask men if they ever use the toys on themselves. I usually get a blank stare. Clearly I don’t get it. Tools, or toys, are meant to be used on the other person, right? That’s just how it works. Well, not exactly. Remember those childhood lessons on sharing? It applies to sex and sex toys too. When men hand over the toys to their partner and lets her use the toys on him – the new playground rules can be pretty fun!

Some men might consider it an abdication of power and duty to turn over the control of toys to their partner. After all, isn’t it the man’s job to wear the tool belt?  But, that’s exactly what a lot of men need to do. Guys tend to be big into control. It can be scary to let go and…well…let go. The change in roles can be exhilarating. Some of the most powerful sexual moments happen when the man relinquishes all control and turns over the control of the situation to their partners.

So, everything you learned in kindergarten applies here as well: Be nice to each other, take turns and share your toys.

End The Confusion: Testosterone Replacement Options Explained

September 13th, 2013 by Nick Cannone, FNP

Over the past few years, the FDA (Federal Drug Administration) has approved several new testosterone replacement therapy (TRT) products.  Patients now have several options to choose from.   Treatment can be applied to the skin via a gel or patch, injected into a muscle, placed in the mouth and allowed to absorb through the gums or inserted under the skin by their provider.

There is no right or wrong choice.  TRT modalities are numerous, and all have advantages and disadvantages in terms of safety, convenience, efficacy, ability to mimic physiologic levels, and adverse effects. Choice of treatment must take into account the patient’s age, existing medical conditions, previous and current response to treatment, and preference, as well as cost.

Topical Therapy:  The topical class is the one we typically start patients on.  They are easy to use and the dosage can be adjusted easily to reach goal levels.  There are 4 approved agents in this class.   There is similar efficacy between the products.  The differences between products is where and how much to apply.    All products need to be applied daily.  We find that about 20% of patients will not get good testosterone levels with the topicals due to absorption problems, no matter which of the 4 products is used.   These patients will need to use another delivery system to reach goal levels.  One of the risks of the topical medications is the accidental transfer of the medication to partner or child.  It is important to wash the area before having skin to skin contact with anyone.

A patch, which has been approved for years, is also available.  It is applied daily to the body.   There is no risk of transfer with the patch however some patients will experience a rash.  The patch needs to be applied daily as well.

Testosterone injections have been around for years.  The medication is injected deep into a muscle where it gets absorbed.   The medication is injected once a week or once every two weeks.  In order to monitor levels, patients will typically have their levels checked between injections.   Injections provide  a bolus of medication and thus patients will typically feel better after an injection but may become symptomatic a day or two before their next dose.  There is also an increased risk of polycythemia (an increased hematocrit level which can increase your risk for blood clots).

Testosterone pellets get inserted under the skin during an office procedure.  The pellets get absorbed over the course of 3-4 months.   There is no risk of transfer and absorption of the medication is good.  Testosterone pellets are a good option for patients who have difficulty reaching goal levels with the topical products, are tired or are poor at applying a medication daily or patients who want to decrease the risk of transferring the product to their partner or child.  There is a chance of pellet extrusion or infection although these risks are low.  Also, you cannot make quick changes to dose.

A buccal formulation exists.  It adheres to the gum tissue above the incisors, transbuccal testosterone is absorbed slowly, as it is hydrated by the buccal mucosa.   It is taken twice a day.  Associated adverse effects are mild to moderate and include gum or mouth irritation or tenderness and bitter taste. Other potential concerns include inadvertent swallowing of the tablet resulting in decreased blood levels of testosterone and transfer of salivary testosterone to the partner.

It is important you work with someone who is knowledgeable with all treatment options as this will give you the best chance of success.