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Meet Sally!

In these videos Sally will give you an introduction to the blog about aging male prime fertile years


Sperm health

Erectile dysfunction

Did you know … 

  • Fertility is classified as the ability to conceive a healthy pregnancy within 6 to 12 months while having unprotected sex
  • Peak male fertility is around 25-35 years old.
  • Sperm quality begins to decline at 30.
  • At 45, men begin to experience a significant decrease in semen volume.
  • Older men can also take longer to conceive
  • Infertility is often considered a “women’s issue.”
  • But when it comes to having a baby, sperm is 50% of the equation
  • And people who produce sperm are just as likely to experience fertility challenges as people who produce eggs.
  • Approximately 1 in 8 heterosexual couples face infertility,
  • Of which approx. 33% of these cases are due to the male partner’s inability to create and ejaculate healthy sperm.
  • Known as “male factor infertility.”
  • Fertility experts estimate that:

– 33% of cases are due to female factor infertility, such as polycystic ovary syndrome, endometriosis, or diminished ovarian reserve

– 33% of cases are a result of male factor infertility, such as low sperm count

– The final 33% are due to a combination of subfertility factors from both partners, or are unexplained

  • To put those figures into context, about 15% of couples are unable to conceive after 1 year of having unprotected sex. After 2 years, 10% still can’t conceive
  • Several recent studies have indicated that average sperm count and quality has declined significantly — up to 50% — in the Western world
  • One study looked at over 42,000 semen analyses performed between 1973 and 2011. They found that sperm count had declined, on average, 1.4% per year, with a total decline of 52.4% in just 38 years.
  • Additional studies of sperm count, motility, and fertility outcomes support the idea that something is affecting male fertility on a population level.
  • Most men who experience infertility don’t have a problem having sex or ejaculating
  • But sperm quality declines measurably with age

– Sperm motility at 55 is less half what it was at 30

– Couples in which the male partner is over 35 are 52% less likely to get pregnant, compared to couples with younger male partners.

– The genetic health of sperm declines with age, too

– Damaged (fragmented) DNA was 33% higher in men over 50, compared to men under 30

– DNA fragmentation can contribute to infertility, miscarriage, and adverse health outcomes for the child

  • Sperm freezing is an option for men and sperm-producing individuals who want to have kids someday, but not just yet.

Prime Time Ages for Men

  • Prime time for what must be the question?
  • Is it all about sex drive and testosterone, or
  • Feeling fulfilled with the things you bring to the table, or
  • The legacy you’re leaving, or
  • Your kids, loved ones, and employees.

Everything has its ‘time’

  • Sex drive and physical prowess, size matters – the 20s
  • Wealth, health, and family, whether or not you’ll have sex again – the 30s and 40s
  • Whether you can keep it up like you used to – the 50+’s

Men in Their 20s are Sexual Prime

  • For many this age is all about how to take a good dick pic.
  • Testosterone levels are typically at their highest late teens and early 20s.
  • That means

– Quick response to sexual arousal

– Healthy appetite for all things sexual

– Physically fit and high metabolism

  • BUT there’s a lot of learning and maturing to do

– Sex is more than an erection.

  • Sexually attracted to women and other men in their 20s

Men in Their 30s are Comfortably Prime

  • By many metrics, men in their 30s have it all together, such as

– A good career or a job they love

– A spouse and kids or a circle of great friends

– Mental and physical abilities to handle their partners’ needs, as well as their own

– Physical endurance for long sensual and sexual nights

– Knowledge of how to be a well-groomed man

– Know who they are, what they want.

– Focused, grounded, yet still willing to explore life’s great unknowns

– Sexually attracted to women or men in their mid-20s to 40’s

Men in Their 40s are Financially Prime

  • For some body mass starts to take a different turn
  • Metabolism slows down turning six-packs into keg barrels – the famous dad bod
  • For others it’s the continuation of the 30s.
  • Many men have solidified their careers
  • Family guys are enjoying watching their kiddos growing up..
  • Men between 45 and 64 are also earning the most money they’ll make during their working years.
  • Sexually attracted to women or men in 30’s to 40’s.

Men in Their 50s are at their Peaceful Prime

  • Kids are grown and more independent
  • Still have sex drives, and sex may even be better
  • Probably sexually attracted to younger men and women

Men in Their 60s are at Their Prime

  • The Golden Years begins.
  • This age is a happy prime in which the worries that occurred earlier in life are no longer relevant.
  • Sexually attracted to women of a similar age

Men in Their 70s Are Enjoying The Prime Of Their Senior Years

  • Enjoying their senior years in the comfort of knowing they did everything they could to create a happy, healthy family to follow behind them.
  • Probably more friendships, loving, caring than sexual.

Age and Male Fertility

  • The impact of age on male fertility hasn’t received the same focus as its impact on female fertility
  • Age can significantly affect sperm quality
  • 25 – 29 years of age – Peak male fertility
  • 30 years of age – Sperm quality begins to decline.
  • 36 – 37 years of age – Damage to sperm DNA begins to increase and risk for genetic disease increases slightly
  • 45+ years of age – Significant decrease in semen volume
  • Older men – Can also take longer to conceive a child and an increase in the risk for genetic disease in offspring, such as Down syndrome.
  • As men age:

– Testosterone production begins to decline, impacting sexual function and sperm quality.

– Sperm motility, or movement, is impacted making it more difficult for sperm to reach a woman’s egg.

– Increase in abnormal sperm morphology, which can affect sperm’s ability to fertilize an egg.

Causes of Male Factor Infertility

Most of the time, it’s multifactorial.


  • Effects the quality of the sperm, including

– motility

– morphology

– count

  • Fertility starts to decline for men in late 40s
  • One study suggested that conceiving during a 12-month period was 30% less likely for men who were over the age of 40 compared to men who were under 30 years old
  • Another study of intrauterine artificial insemination found that after six cycles, men who were 35 or under had a fertility rate of 52%, whereas men over the age of 35 had a fertility rate of 25%
  • Other fertility-related issues that may arise as men get older include:

– genetic abnormalities of the sperm

– erectile dysfunction

– changes in the reproductive organs and tissues.

– shifts in health, such as high blood pressure.

Sperm disorders

  • Low sperm count – too few sperm in the semen
  • Low sperm motility – too few moving, “swimming” sperm
  • Poor sperm morphology – too many abnormally shaped sperm
  • High sperm DNA fragmentation – too many sperm that carry damaged DNA
  • A combination of the above abnormal semen parameters, which often occur together
  • Read more in the article Sperm Disorders in this blog


  • Swollen veins in the scrotum that can harm sperm growth

Retrograde ejaculation

  • The semen goes back into the body instead of out of it

Immunologic infertility

  • Antibodies that attack the sperm


  • A blockage somewhere where the sperm travel

Low Libido

  • Otherwise known as low sex drive, describes a person’s desire to have sex.
  • Foods or supplements that claim to increase libido are called aphrodisiacs.

Erectile dysfunction

  • Also known as impotence, ED is when a man is unable to develop or maintain an erection


  • Low levels of testosterone, the male sex hormone, may be responsible for infertility in some men
  • Due to poor growth of sperm and low libido


  • Certain medication can impact the growth, function and delivery of sperm, such as:

– Antidepressants

– Prostate medication

– Chemotherapy

– Opioids.

Symptoms that may indicate Male-Factor Infertility

Often, there aren’t any symptoms – aside from the inability to conceive after a year of unprotected intercourse.

Erectile dysfunction (ED)

  • Most infertile people don’t have any problems with sexual function, and most people with ED are fertile.
  • However, ED is more common in men with infertility.
  • This may be due to an underlying hormone imbalance, such as low testosterone levels.

Low testosterone levels

  • Also known as hypogonadism, low T can manifest in weight gain, difficulty getting or maintaining an erection, and tiredness.
  • The process of making sperm doesn’t require high testosterone levels, so many people with low T are still fertile.
  • However, low testosterone may be a result of an overall hormonal imbalance that also affects fertility.
  • Look out for symptoms like

– low sex drive

– getting and/or maintaining an erection

– man boobs

Dry orgasm or low semen volume

  • If someone isn’t producing much semen — or any semen at all — when they orgasm, that could indicate a blockage or issue with ejaculation.

Tests for Male Fertility

  • Physical exam
  • Review of medical history, such as

– childhood illnesses

– medications taken currently and in the past

– previous surgeries

– prior exposure to radiation, pesticides or heavy metals

– lifestyle, including use of alcohol and drugs.

  • Semen Analysis to determine

– sperm volume

– sperm count

– sperm shape

– sperm movement

  • Hormone Blood Test including:

– FSH/follicle-stimulating-hormone

– Free and total testosterone

– SHBG/sex-hormone-binding-globulin

– Prolactin

– LH/luteinizing-hormone

– Estradiol.

  • General blood test

– ruling out other major health issues.

  • Scrotal Ultrasound

– To check for any structural issues.

– Placing a probe in the rectum, which then sends soundwaves to the ejaculatory ducts nearby.

– Reveals any blockages or malformations in the seminal vesicles or ejaculatory duct.

Sperm Testing  

  • Semen analysis can provide a decent snapshot of sperm health.
  • The test examines semen parameters under a microscope to determine

– Quantity – the number of sperm

– Motility – how they’re swimming

– Morphology – whether they’re the right shape and size

  • A semen analysis isn’t stamped “fertile” or “infertile”
  • Fertility is diagnosed based on a couple’s inability to get pregnant
  • Plenty of couples can conceive a child naturally, even with sperm that has one or more poor semen parameters.
  • However, this analysis can alert a person to issues with their sperm production that may affect their ability to conceive, such as low sperm count.

Sperm Count

  • A measure of the number of spermatozoa per ejaculation or per measured amount of semen,
  • Used as an indication of a man’s fertility
  • Normal sperm densities range from 15 million to greater than 200 million sperm per ml of semen.
  • You are considered to have a low sperm count if you have fewer than 15 million sperm per ml or less than 39 million sperm total per ejaculate
  • Fertility is most likely if the semen discharged in a single ejaculation (ejaculate) contains at least 15 million sperm per ml.

Sperm Disorders

  • Low sperm count – too few sperm in the semen
  • Low sperm motility – too few moving, “swimming” sperm
  • Poor sperm morphology – too many abnormally shaped sperm
  • High sperm DNA fragmentation – too many sperm that carry damaged DNA
  • A combination of the above abnormal semen parameters, which often occur together

The underlying cause(s) may be linked to:

  • Hormonal imbalances
  • Genetic factors
  • Advanced age – after 40
  • Lifestyle factors such as:

– Smoking

– Poor diets high in sugar and trans fats/seed and plant oils

– Sedentary lifestyle

– Lack of sleep

  • Exposure to chemicals that damage fertility, such as pesticides or chemotherapy
  • Exposure to EDC’s endocrine-disrupting chemicals, chemicals that disrupt the hormone, system:

– EDCs are commonly found in plastics, like the plastic in water bottles and food packaging, as well as pesticides and chemicals used in manufacturing.

– Job exposure to EDCs

– Exposure through eating food or drinking from plastic containers.

Sperm Quality and Daily Habits

  • The testes constantly make sperm— about 1,500 sperm per heartbeat – through a process that takes about 72 days.
  • Sperm quality is reflective of the past 2 to 3 months of someone’s health and habits.
  • Everything that affects a person’s overall body function will also affect their sperm.

Regular Aerobic Exercise

– One study found an improvement was seen after just 12 weeks of moderate-intensity cardiovascular exercise, 3 to 4 times per week.


  • The American Society for Reproductive Medicine (ASRM) estimates that infertility rates are about twice as high in smokers, (male or female) compared to non-smokers.
  • Smoking is associated with decreased sperm count, motility, morphology, and genetic health.
  • Physicians and researchers are also examining the impact of smoking cannabis on male infertility, and suggest staying away from it while trying to conceive.


  • A diet rich in vitamins, minerals, and antioxidants has been associated with better male fertility.
  • Eating trans-fat, seed oils, processed meats, and added sugars has been associated with lower numbers of moving sperm.


  • Men who sleep less than 7 hours per night on average, or those who have interrupted or low-quality sleep, are at a higher risk of sperm health issues.

Options for Male Infertility

In addition to sperm freezing, there are several fertility technologies that can help people and couples diagnosed with male-factor infertility.


  • To improve sperm production, hormone imbalances, testosterone levels or infections and to address retrograde ejaculation.


  • Such as correcting varicoceles, or removing blockages

Donor sperm

  • Frozen sperm from a donor

Intrauterine insemination (IUI)

  • In this process, the semen is washed to isolate the sperm, then inserted directly into the uterus to give it a “kickstart.”
  • IUI is done on the day the female is ovulating, to maximize chances of fertilization.
  • IUI can help people with moderately low sperm count or motility and requires 10 million motile sperm.

In vitro fertilization (IVF) with intracytoplasmic sperm injection – ICSI

  • IVF is a process in which eggs are removed from the ovaries and fertilized with sperm in a lab.
  • ICSI is an IVF technique in which a single sperm is injected directly into an egg, improving chances of fertilization even in cases of severe male-factor infertility or very low count.

Testicular sperm extraction

  • Some patients produce sperm, but the sperm can’t get to the ejaculate
  • Maybe because the sperm count is too low
  • Maybe there’s a problem with the vas deferens, the duct that transports sperm out of the testes.
  • A testicular sperm extraction is a procedure in which sperm are retrieved directly from the testicular tissue; these sperm can then be used in IVF with ICS.

Boosting Male Fertility

  • Fertility refers to the ability to reproduce without medical assistance
  • Infertility affects about 1 in 6 couples, and researchers estimate about 1 in 3 is due to fertility problems in the male
  • Male fertility usually depends on the quality of sperm cells, sometimes is linked to sexual function, and other times it could be linked to semen quality

Fertility Boosters

  • While infertility is not always treatable, there are some things you can do to boost fertility

Lose excess weight

  • Carrying extra weight is associated with infertility.

Stop smoking

  • Smoking impairs blood flow
  • Smoking decreases sperm quality with lower numbers of sperm and sperm’s ability to move and increased numbers of abnormally shaped sperm

Limit your alcohol intake

  • Heavy alcohol consumption, as it may reduce testosterone levels and impair semen quality
  • Heavy alcohol consumption hinders sexual performance.

Adequate sleep

  • Is vital to maintaining your health.
  • Restricted or excessive sleep has also been linked to poor semen quality

Avoid soy

  • Soy is rich in isoflavones, which are associated with lower semen quality
  • Maybe due to the Estrogen-like effects

Regular Exercise

  • Can boost testosterone levels and improve fertility.
  • However too much exercise may have the opposite effect and potentially reduce testosterone levels.

Relax and minimize stress

  • It’s hard to get in the mood when you’re feeling stressed
  • Stress may reduce your sexual satisfaction and impair your fertility
  • Prolonged stress raises levels of cortisol, which has strong negative effects on testosterone.
  • When cortisol goes up, testosterone levels tend to go down
  • Stress management can be as simple as taking a walk in nature, meditating, exercising, or spending time with friends
  • Severe stress and anxiety may need medication.

Supplements for Male Fertility

D-aspartic acid / D-AA

  • A form of aspartic acid
  • Not be confused with L-aspartic acid, which is far more common than D-AA.
  • D-AA is mainly present in certain glands, such as the testicles, as well as in semen and sperm cells.
  • Researchers believe that D-AA is implicated in male fertility.
  • In fact, D-AA levels are significantly lower in infertile men than fertile men
  • Studies show that D-AA supplements may increase levels of testosterone


  • Some evidence suggests that coenzyme Q10 improves semen quality
  • 100mg daily

Vitamin C

  • Some evidence indicates that taking antioxidant supplements, such as vitamin C, may improve fertility by reducing oxidative stress, which in turn decreases tissue damage and inflammation
  • There is also some evidence that vitamin C supplements may improve semen quality,
  • Also an improved sperm count and motility, and reduced number of deformed sperm cells

Vitamin D

  • Important for testosterone levels.
  • One observational study showed that vitamin-D-deficient men were more likely to have low testosterone levels
  • High vitamin D levels are linked to greater sperm motility
  • But the evidence is inconsistent

Tribulus root

  • Also known as puncture vine, is a medicinal herb frequently used to enhance male fertility.
  • May work as an aphrodisiac enhancing the libido-promoting effects of testosterone


  • Fenugreek is shown to significantly increase testosterone levels, strength, and fat loss, improve libido, sexual performance and strength, improved erectile function and the frequency of sexual activity.
  • Important to use fenugreek extracts.
  • It’s unlikely that whole fenugreek, which is used in cooking and herbal tea, is as effective.


  • Zinc is an essential mineral found in high amounts in animal foods, such as meat, fish, eggs, and shellfish.
  • Getting enough zinc is one of the cornerstones of male fertility.
  • Low zinc status or deficiency is associated with low testosterone levels, poor sperm quality, and an increased risk of male infertility
  • Taking zinc supplements increases testosterone levels and sperm count in those who are low in zinc
  • May reduce the decreased testosterone levels associated with excessive amounts of high-intensity exercise


  • May improve male fertility by boosting testosterone levels.
  • May improve sperm counts, sperm motility, and antioxidant status

MACA root

  • May improve libido, as well as fertility and sexual performance.


  • Low intake of folate may impair semen quality

NB! – There’s no guaranteed fix, but if nutrient deficiencies or low testosterone levels are contributing factors, chances are that the above mentioned nutrients will lift levels

ED 101

  • Defined as the persistent inability to achieve or maintain penile erection sufficient for satisfactory sexual performance.
  • Also known as impotence
  • It was estimated that, in 1995, over 152 million men worldwide experienced ED.
  • For 2025, the prevalence of ED is predicted to be approximately 322 million worldwide.
  • In fact more than 50% of men between the ages of 40 and 70 experience some form of ED
  • In the past, erectile dysfunction was commonly believed to be caused by psychological problems.
  • It is now known that, for most men, erectile dysfunction is caused by physical problems, usually related to the blood supply of the penis.
  • Many advances have occurred in both diagnosis and treatment of erectile dysfunction.
  • Since ED can be a forewarning symptom of progressive coronary disease, doctors should be more direct when questioning patients about their health, such as directly asking them about their sexual function through conversation or a questionnaire during a check-up
  • In this way doctors may be able to detect more serious health conditions sooner.
  • According to the NIH, erectile dysfunction is also a symptom that accompanies many disorders and diseases

Direct risk factors

  • Prostate problems
  • Type 2 diabetes
  • Hypogonadism
  • Hypertension / high blood pressure
  • Vascular disease and vascular surgery
  • High blood cholesterol
  • Low levels of HDL / high-density lipoprotein
  • Chronic sleep disorders – obstructive sleep apnoea, insomnia
  • Prescription drugs
  • Neurogenic disorders
  • Peyronie’s disease – distortion or curvature of the penis
  • Priapism – inflammation of the penis
  • Depression
  • Alcohol use
  • Lack of sexual knowledge
  • Poor sexual techniques
  • Inadequate interpersonal relationships
  • Many chronic diseases, especially renal failure and dialysis
  • Smoking, which exacerbates the effects of other risk factors, such as vascular disease or hypertension

Indirect risk factor

  • Age appears to be a strong indirect risk factor in that it is associated with increased likelihood of direct risk factors, some of which are listed above.

Different types (and causes) of ED

Organic ED

  • Abnormalities the penile arteries, veins, or both and is the most common cause of ED, especially in older men.
  • When the problem is arterial, it is usually caused by arteriosclerosis, or hardening of the arteries, although trauma to the arteries may be the cause.
  • Risk factors for arteriosclerosis
  • being overweight
  • lack of exercise
  • high cholesterol
  • high blood pressure,
  • cigarette smoking
  • These factors can cause erectile failure often before progressing to affect the heart.
  • Partial or complete wasting or excess smooth muscle tissue around the veins in the body of the penis triggers problems with being able to maintain a firm erection and or losing an erection too quickly
  • This is also believed to be an early manifestation of atherosclerosis and vascular disease.

Diabetes ED

  • Common in people with diabetes.
  • An estimated 2.5 million adult men in the UK have diabetes, of which 35 to 75% struggle with ED.
  • Diabetes involves premature and unusually severe hardening of the arteries.
  • Peripheral neuropathy, involving the nerves controlling erections, is commonly seen in people with diabetes.

Neurologic ED

  • Diabetes
  • Chronic alcoholism
  • Multiple sclerosis
  • Heavy metal poisoning
  • Spinal cord and nerve injuries
  • Nerve damage from pelvic operations.

Drug-induced ED

  • A great variety of prescription drugs, such as

– blood pressure medications

– antianxiety medication

– antidepressants

– glaucoma eye drops

– cancer chemotherapy agents

and many more.

Hormone-induced ED

  • Hormonal abnormalities, such as

– increased prolactin

– steroid abuse by bodybuilders

– too much or too little thyroid hormone

– hormones administered for prostate cancer

– low testosterone can contribute to ED but is rarely the sole factor responsible for ED.

Psychogenic ED

  • Performance anxiety – often caused by stress
  • Depression

Diagnosing ED

  • Patient medical and sexual history

– reveal conditions or diseases that lead to impotence

– distinguish among problems with erection, ejaculation, orgasm, and or sexual desire.

  • Physical examination

– problem in the nervous system – penis does not respond as expected to touch

– Secondary sex characteristics, such as hair pattern, can point to hormonal problems, which involve the endocrine system.

– Circulatory problems

– Unusual characteristics of the penis itself could suggest the basis of the impotence.

  • Laboratory tests

– blood counts

– urinalysis

– lipid profile

– measurements of creatinine and liver enzymes

– measurement of testosterone in the blood is often done in men with ED, especially with a history of decreased libido or diabetes.

  • Psychosocial examination

– revealing psychological factors that may be affecting performance.

– the sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse.

Early warning signs of ED

  • Trouble in getting an Erection – this is the first sign and symptom of ED
  • Inability to maintain an Erection
  • Not having the desire for sex
  • Loss of sensitivity in the penis
  • Lack of early morning erections.

Simple Solutions for Early Stage ED

Stop smoking

  • Smoking impacts blood circulation in many ways, leading to a host of related health problems including heart disease, heart attack, stroke, and ED.
  • An erection occurs when blood vessels in the penis enlarge and fill with blood.
  • The blood vessels of the Penis are impacted by smoking
  • In fact, smoking is capable of causing ED in men as young as 20.

Reduce or stop alcohol intake

  • Alcohol acts as a depressant on the central nervous system.
  • Alcohol creates a sedating effect on the brain and body.
  • However, alcohol also brings as lack of inhibition, and a decline in motor skills.
  • This effect is also called ‘whiskey dick’ where a person is not able to get an erection after heavy boozing.
  • Alcohol affects some of the critical systems involved in sexual arousal, erection, blood circulation, and nerve sensitivity.
  • But not all alcohol is bad

– 1–2 drinks per day, may help you to get a better erection, possibly by decreasing performance anxiety and increasing sexual desire.

– However, heavy drinking leads to a loss of penis nerve sensitivity, lower libido, sexual dysfunction, and other similar effects.

– Shakespeare said ‘alcohol increases desire but takes away performance’ – Macbeth


  • Some specific exercises help increase the blood flow in the abdominal area and in private parts, which may help reverse early-stage erectile dysfunction.

Kegel – pelvic floor exercise

  • These important muscles do three jobs:

– allows the penis to engorge with blood during erection,

– pumps during ejaculation,

– helps empty the urethra after urination.

Yoga Asanas

  • A few Yoga Asanas ( exercises/positions) are very helpful to stimulate the pelvic muscle and increase the blood flow in the abdominal and pelvic area and help ED
  • Positions include:

– Paschimottanasana

– Uttanasana

– Baddha Konasana

– Janu Sirsasana

– Dhanurasana

– Bhujangasana

Abdominal and Pelvic Floor Muscles

  • Bridge
  • Squat
  • Hollow Hold.

Preventing ED

  • Make healthy lifestyle choices
  • Manage any existing health conditions
  • Stop smoking
  • Limit or avoid alcohol
  • Stop illegal/recreational drugs
  • Exercise regularly
  • Reduce stress
  • Get help for anxiety, depression or other mental health concerns.

ED Fixes

Treatment for ED will be determined by you and your medical professional based on:

  • Your age, overall health, and medical history
  • Extent of the disease
  • Tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the disease
  • Opinion or preference

The Treatments

Address underlying health conditions

  • Heart disease
  • Diabetes
  • High blood pressure
  • Anxiety
  • Depression

Oral medications

  • Viagra, Cialis, Levitra, Staxyn, or Stendra
  • These pills boost blood flow to the penis during sexual arousal, making it possible to achieve an erection that is firm enough for satisfactory sexual intercourse.

Testosterone Replacement Therapy

  • TRT may improve

– Energy

– Mood

– Bone density

– Increase muscle mass

– Heighten sexual interest in older men who may have deficient levels of testosterone.

  • Testosterone supplementation is not recommended for men who have normal testosterone levels for their age group due to the risk of prostate enlargement and other side effects.
  • Testosterone replacement therapy is available as a cream or gel, topical solution, skin patch, injectable form and pellet form placed under the skin.
  • Not recommended as a first-line, single treatment for ED
  • May be used in combination with another ED treatment option, depending on the individual symptom profile.

Side effects

  • Hair loss
  • Enlarged prostate

VED (Vacuum Erection Device)

  • Often called a penile pump
  • Works by manually pulling blood into your penis using suction.
  • Once the erection is formed, a tension ring is slipped to the base of the penis, which helps maintain an erection for about 30 minutes.

Side effects

  • Mild bruising
  • Restriction of ejaculation
  • The penis feels cold to the touch when used for an extended period

Urethral suppository

  • Intraurethral therapy involves inserting a small drug pellet into the tip of the penis.
  • It only takes about 10 minutes for an erection to form
  • Which can then last anywhere from 30 to 60 minutes.

Side effects

  • A burning sensation
  • Minor bleeding from the tip of the penis

Penile injections

  • The medicine is injected at the base of the penis using a very small needle
  • Improve penile blood flow much better than the oral alternatives.
  • This is a self-injection, of course,

Side effects

  • Minor pain or bleeding at the injection site
  • Prolonged erection that can last longer than desired
  • Formation of scar tissue within the deeper tissues of the penis, primarily seen in long-term users of this therapy.

Penile implant

  • Involves a 30- to 45-minute surgical procedure that places a water-based device into the erection chambers of the penis,
  • There are two basic types of penile implants:

– Inflatable

– Non-inflatable.

  • The non-inflatable implant is a single rod that can be shaped by hand to create an erection.
  • The inflatable implant has two rods filled with fluid from a reservoir located near the bladder.
  • When you desire an erection, you use the pump to fill the rods with pressurized fluid.
  • As the rods fill, the penis becomes erect and broader.
  • The prosthesis leaves the penis completely deflated when there is no fluid in the rods, making the penis implant unnoticeable.
  • The procedure allows for control of when and how long an erection lasts.
  • Ideal if your penile blood vessels have been damaged by severe diabetes or during radical prostatectomy
  • Possibly the closest option to a cure for ED.
  • More than 90% of men and their partners report great satisfaction with this procedure.

Coping with ED

  • The loss of erectile capacity can have a profound effect on a man.
  • Many times, men will avoid sexual situations due to the emotional pain associated with ED, causing their partner to feel rejected and or inadequate.
  • ED can put a strain on a relationship.
  • Communication is essential.
  • Seek treatment for ED together
  • A lack of communication is the primary barrier for seeking treatment and can prolong the suffering.
  • Feeling embarrassed about sexual health problems may prevent many men from seeking the medical attention they need, which can delay diagnosis and treatment of more serious underlying conditions.
  • The good news – ED can usually be treated safely and effectively.
  • Erectile Dysfunction itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions.

Premature Ejaculation (PE)

  • PE is a male sexual dysfunction characterized by:

– Ejaculation which always or nearly always occurs prior to or within about one minute of vaginal penetration

– In other words the inability to delay ejaculation on all or nearly all vaginal penetrations

– Also known as rapid ejaculation, premature climax or early ejaculation

  • Is a common sexual complaint – as many as 1 out of 3 people say they have it at some time
  • It can be lifelong or acquired

– Lifelong premature ejaculation – since first beginning coitus

– Acquired premature ejaculation – previous successful coital relationships.

  • Can create:

– Distress

– Frustration

– Makes sex less enjoyable

– Impacts relationships

– Avoidance of sexual intimacy

– Fertility problems


  • The exact cause of premature ejaculation isn’t known.
  • It was once thought to be purely psychological.
  • Today it is considered a complex interaction of psychological and biological factors.

Psychological causes

  • Poor early sexual experiences
  • Sexual abuse
  • Poor body image
  • Depression
  • Worrying about premature ejaculation
  • Guilty feelings causing the person to rush through sex
  • Anxiety

– Erectile dysfunction – problems with maintaining an erection can form a pattern of rushing to ejaculate

– Sexual performance

– Relationship issues

Biological causes

  • Irregular hormone levels
  • Irregular levels of brain chemicals
  • Swelling and infection of the prostate or urethra
  • Inherited traits
  • Erectile dysfunction
  • Stress can limit the ability to relax and focus during sex.

Diagnosis based on

  • Always or nearly always ejaculate within 1 to 3 minutes of penetration
  • Inability to delay ejaculation during sex all or nearly all the time


  • If your premature ejaculation is caused by a biological/physical condition – treat the underlying condition, talk with a medical professional about the options.
  • If your premature ejaculation is caused by psychological factors treatment can be more challenging.


  • Masturbating 1 to 2 hours before having sex
  • Using a thick condom to help decrease sensation
  • Taking a deep breath will briefly shut down the ejaculatory reflex
  • Have sex with your partner on top, allowing them to pull away when you’re close to ejaculating
  • If you’re in a long-term relationship, you may benefit from having couples therapy.

– explore issues that may be affecting your relationship and be given advice on how to resolve them

– shown techniques that can help you “unlearn” the habit of premature ejaculation.

  • Strengthening pelvic floor muscles may help control ejaculation.
  • Magnesium deficiency may increase premature ejaculation


Selective serotonin reuptake inhibitors (SSRIs)

  • Can be used if self-help techniques do not improve the problem
  • SSRIs are mainly used to treat depression, but one of their side effects is delaying ejaculation.
  • Take SSRIs for 1 or 2 weeks before gaining the full effects.


  • An SSRI specifically designed to treat premature ejaculation.
  • It can be used “on demand”.
  • Usually to be taken between 1 – 3 hours before sex, no more than once a day.
  • If dapoxetine does not work, your GP may recommend trying another SSRI on an “off-label” basis.
  • Off label means the medication is used for a different purpose than it was licensed for.
  • Doctors can prescribe an off-label medicine if they decide it’s in the patient’s best interest.

Other SSRIs include

  • Paroxetine
  • Sertraline
  • Fluoxetine

Anaesthetic creams and sprays

  • Such as

– Lidocaine

– Prilocaine

  • Can make the penis less sensitive
  • Using an anaesthetic cream with a condom can be particularly effective.




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Male Health & Hormones

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