Testosterone and the Hypothalmus- How It Works

June 11th, 2013 by Nick Cannone, FNP

TestosteroneTestosterone levels in your body are controlled by a complex system that includes your brain, testes, and several different hormones.

Testosterone levels begin to increase in males during puberty.  Men reach peak levels during adolescence and young adulthood.  At about age 30, men start to drop their testosterone by about 1% per year.

The hypothalamus, which is located in the brain, secretes hormones that pulse throughout the day.  The release of these hormones is controlled by a negative feedback loop.  When adequate levels of hormones are reached, a signal is sent to the brain to slow down production.

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If you are diagnosed with low testosterone, blood tests can help identify the cause of the low testosterone.  Men are usually diagnosed with either primary hypogonadsim or secondary hypogonadism.  This diagnosis depends on laboratory results.

Primary hypogonadism is a problem with the testes.  In secondary hypogonadism, the problem is with the hypothalamus or pituitary.  Identifying the cause of hypogonadism is important as treatment options may be different.

Testosterone treatment can be complex.  It is important to see someone experienced in treatment as the evaluation and treatment options may affect future issues.

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Medical Tests

April 19th, 2013 by Paul Nelson

Medical TestsMedical tests are funny things. They are a snap-shot of one single aspect of your body’s condition at a single moment in time. It isn’t until you have repeated at least a few medical tests and established a baseline for your normal that the doctor has an idea of your health patterns.

Of course, a single test that shows an extreme response or condition will result in some action on the part of the doctor. For most of us, though, it takes a while to see how our body functions as ‘normal’.

It is extremely important to be aware of daily activity that can affect outcome of tests. I have a friend who called me in a panic because his PSA test had jumped several points over the course of a year. He had himself diagnosed with cancer and facing his mortality within hours of getting the results.

I asked him what he had done the day before. He had been part of a 40 mile bike race. I asked him if he had been sexually active. “Of course,” he said. “After a race like that, I always have great sex with my wife.” Had he told his doctor this? No. It just so happens that both of those activities can greatly affect his PSA score.

Sure enough, he called his doctor back, told him what he had been doing, and the doctor told him not to worry about it and scheduled him for another PSA test – with a request to avoid sexual activity or biking for a day or so before hand. The next test was perfectly normal.

When your doctor enters the examination room and asks you how you have been, it’s not just a polite conversation starter. Be sure to tell him what you have just been doing. I often encourage guys to tell their doctor the best thing and the worst thing that has happened to them since the last visit.

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Communication is Key

March 7th, 2013 by Paul Nelson

Communication is the most critical aspect of the doctor/patient relationship. This seems obvious, of course, but all too often, we find that there is important information or clues that a man will forget to tell his doctor. It’s rarely intentional that men leave out information. For the most part, we hear a lot of “I didn’t think it was worth mentioning.”

Every aspect of your physical and mental health has a direct bearing on your sexual health. Your healthcare is a complicated mosaic of pieces that, when strung together, create an image of your overall health. If even the smallest of those many pieces is not looking good, it is going to have an effect on the entire picture.

I was talking to one patient who mentioned that he did not like his partner to touch his testicles. When asked why, he said they hurt – all the time. They did not hurt a lot, but enough that they did not enter into sexual play or stimulation. The doctor had not been told this small bit of information. Why? It just didn’t seem like that big a deal. The reality is, pain is not a normal state of the human body. While this man may have learned to live with mild pain in his testes, it is a pretty important piece of information for the doctor to know.

Before you see your doctor, take a moment and make an inventory of your body, your mood, your stress levels and your activity. Never assume that an ache, a pain, or a difference in your body is too unimportant to tell your doctor. Write it down so you don’t forget. Give him a copy to put in your files. He may see a pattern that you don’t. Let him decide which piece of the puzzle is going to affect the picture of your health.

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No Man Is an Island – and Neither is Your Penis

February 1st, 2013 by Paul Nelson

IslandThere is an oft quoted poem by John Donne, written in 1624. The first lines are:  “No man is an island, Entire of itself. Each is a piece of the continent, A part of the main.” (As an interesting side note, the last line of this same poem gave Earnest Hemingway the title of his most famous book, “For Whom the Bell Tolls”) The idea is that no man functions independently of his fellow man. I often think the same thing about how men treat their penis.

The penis is part of our body and everything we do to our body will eventually affect our penis – for good or bad.  High cholesterol, lack of exercise, obesity, smoking, alcohol, drugs, poor nutrition and stress all exact a terrible toll on our bodies and this includes our penis. I have often found that pointing out the penile benefits of a healthy lifestyle creates a very strong motivator for life changes.

For example, it is pretty commonly known that for every 30-35 pounds that a man loses, he will regain one inch of his penis which was buried in pubic fat. 30 pounds! That sounds like a lot. Well, how about 15 pounds for half an inch of penis?  That sounds a bit more doable. And, half an inch more of penis to use? That sounds good too. Time to forego that second cheeseburger.

Most men worry about heart attacks or strokes with high cholesterol. The fact is, the effects of too much ‘blood sludge’ often show up first in the penis with less firm erections, or no erections at all! The poor circulation caused by smoking will do the same thing. Lots of cardio exercise is the best exercise you can do for your penis. Time to hit the treadmill.

Stress is a killer. We all know that. Adrenaline (the ‘’fight or flight” hormone) is a miracle chemical, capable of enabling heroic feats of strength. Interestingly, adrenaline is also responsible for maintaining a flaccid penis. Too much stress = too much adrenaline = no erections. It also kills our libido, makes us grumpy, edgy and a poor partner for our lover’s amorous moods. Exercise, yoga, meditation/prayer, and good relationships all help lower stress levels. Time to go for a walk and then sit in the shade.

Our mental health, emotional well-being and mood greatly affect our libido as well as sexual performance. Feeling  loved and connected will carry anyone through the rough patches of any sexual difficulty.  Time to hang out with someone you love.

Holistic medicine is hugely successful at this approach to maintaining health. Your penis is connected and affected by every aspect of your physical, mental and emotional life.  In fact, it is often the first indicator that one of these things is facing trouble. Time to go make sure it’s working alright!

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Your Health Is In Your Hands

January 4th, 2013 by Paul Nelson

Believe it or not, you can masturbate badly. We’re not talking about it being bad to masturbate – that’s between you and yourself! But many, many men develop solo sexual habits that can ultimately have a deleterious effect on their partnered sex life.

For many couples, the subject of masturbation never comes up or they refuse to discuss it. Often the man feels a sense of disapproval if he should masturbate.  Some men might have religious guilt over masturbation.  Some women don’t want to know their partner masturbates. The reasons men masturbate generally have little to do with how they feel about their partners. But men’s feelings about masturbation certainly affect how they masturbate.

One of the most frequent results we see of bad masturbation is a desensitized penis.  Whether it is out of a need to masturbate secretly, or quickly, or just out of habit, many men stimulate so tightly and so roughly, that they deaden the sensory nerves in their penis. After years of this, the penis comes to depend on that sort of intense stimulation in order to climax. Compared to a tightly gripping dry hand, the gentle sensation of a vagina is often not enough to lead to orgasm.

The second most common problem we see is climax control. So many men try to keep the masturbation session so short that gradually train their body to orgasm as quickly as possible. While this technically is not the same as the medical definition of premature ejaculation, it can still create a lot of havoc in a couple’s sex life.

OK, so how does one masturbate well? Think of masturbation as a sexual tune-up for the body. It’s time you’ve set aside to check in on all systems to make sure they are working and sensing properly.  Be aware of the firmness of your erection. Be aware of the level of orgasm. Be aware of changes in your responses.

First – start with time. Discover how much time you need to enjoy your body. Most men find that having a longer masturbation session is far more enjoyable than they expected. Train yourself to be able to control when you climax – go through the first sensation of climax and try to delay it.

Second – be gentle. Use lots of lubricant and loosen the grip. Enjoy a variety of sensations. Mimic your partner’s touch. Explore different sensations. Tune up your body for sex with your partner.

Giving ourselves permission to enjoy and explore our bodies is a rare gift. Practice makes perfect, they say. So practice what you really want to perfect!

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Rules of the Playground

December 14th, 2012 by Paul Nelson

rulesIsolation is one of the most difficult aspects of men’s sexual medicine.  It’s almost part of the Man Code – Don’t talk about it. It seems the whole world snickers at the TV ads for ED drugs. What guy is then going to turn to his friends and admit he has ‘that’ problem?  Who can he talk to? Most men even find it very uncomfortable to talk to their partners about their difficulties. So, many men simply avoid the topic, avoid the discussions and avoid seeking help.

Taking that first step of reaching out for help can be terrifying. For many men, their lives and relationships are almost in ruins before they are willing to make that first step. Self-blame, guilt, embarrassment and this blow to their manhood can be paralyzing factors. Facing the fact that they need to get help often comes when they can’t avoid the issue any longer.

Many men will turn to the anonymity of the internet to seek help. This is a perfect setup for the scams and con-artists that are waiting for desperate men to stumble onto their promise of complete restoration of sexual virility. Men are often willing to pay anything, try anything and do anything to get their sex life back. This vulnerability is exactly what the hustlers are looking for.

When I talk to men about this isolation, I often ask them to turn the tables on themselves. What if their friend came to them and wanted to talk about his sexual problems? Every single one of them has said they would want to help. Would they laugh? Nope. Would they tell his other friends? Nope. So, why is it that so many men are still living by the rules of the middle school playground: never let them see you sweat?

Reaching out is the hardest step.  Call your doctor. Guaranteed – no one is going to laugh.

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