Male sexual issues are often not discussed, leaving many men not knowing where to turn for help. There are several sexual issues that often get jumbled together, resulting in the frustration, discouragement and sometimes despondency of failed sexual interaction. These take a toll on the self-esteem of both partners and the intimacy (sexual and otherwise) of the relationship. So let’s sort these contributing factors out.
    There are two primary contributors to male sexual difficulties. The first factor is low libido or sexual desire which arises from a complex of hormonal, emotional, mental and other inputs. The other important contributor is erectile dysfunction which is dependent on blood flow.

Libido
Sexual desire often wanes for men as they age. The most frequent cause is a decrease in testosterone. Some of the symptoms of low testosterone which may contribute to decreased libido are a decrease in self-confidence, assertiveness, vitality, and energy. Low testosterone can also lead to diminished clarity of thought, decreased muscle mass and can affect mood, causing anger or depression. It is important to be able to recognize these symptoms, because Bioidentical Testosterone Replacement Therapy can not only improve all of these symptoms, including low sex drive, but can also protect your blood vessels and heart.

Erectile Dysfunction (ED)
ED has several causes that are all related to blood flow. We will take them in turn:

Nerve Damage. Nerve damage does not occur often. When it does, the most common causes are diabetes, prostate surgery or injury. Initiation of an erection occurs generally through stimulation of nerves, which occurs as a result of sexual thoughts, visual stimulation or touch. The nerves signal increased production of nitric oxide (NO), a strong vasodilator, which increases blood flow. If these nerves don’t function correctly, there is no increase in NO and no increased blood flow. In this case, Viagra, Cialis or Levitra may help as they prevent NO that is normally produced in smaller amounts on an ongoing basis from being broken down. If these are not effective, there are other effective treatments.

Atherosclerosis. Atherosclerosis, or hardening of the arteries, is a rare contributor to ED, primarily seen in men with diabetes. If this is the cause, an ED medication may help or, if not, other solutions are available.

Nitric Oxide and Endothelial Health. The most frequent cause of ED is the loss of nitric oxide in the blood vessels. Nitric oxide (not the same as nitrous oxide in the dentist’s office) is a molecule with tremendous biologic significance. It is produced by every cell that lines every blood vessel in your body. These are the endothelial cells. There are millions of endothelial cells, and one of their main functions is to produce NO or nitric oxide for the purpose of causing the smooth muscle cells in the blood vessel wall to relax. This causes the blood vessels to dilate (vasodilation). Vasodilation is extremely important throughout the body. In the heart, NO production occurs when we exercise so the heart gets enough blood and doesn’t get damaged. It helps prevent high blood pressure. In the gut, NO production and vasodilation happen every time we eat so we can digest and absorb our food. And for arousal to occur for both sexes, vasodilation needs to occur in the sex organs.    
    ED is most often a sign of decreased nitric oxide (NO) production. Viagra, Cialis and Levitra block the enzyme that breaks down NO once it is produced by the endothelial cells so there is more around to do its job. That’s wonderful, but it does nothing to address the underlying problem—the endothelial cell dysfunction (also known as ED) throughout the rest of the body! Endothelial dysfunction happens equally throughout the body, so if it’s happening anywhere, it’s happening everywhere, which means if you have ED (erectile dysfunction), you have ED (endothelial dysfunction). Endothelial dysfunction contributes to many chronic diseases: high blood pressure (HBP), heart disease, hardening of the arteries, heart attack, stroke, kidney disease, diabetes-related problems, etc.
    It is important to improve endothelial function so you don’t develop any of these conditions. Fortunately, there are supplements that can increase your body’s ability to produce nitric oxide and not only improve endothelial dysfunction but also improve erectile dysfunction. Most of these supplements contain arginine, an amino acid, which is the molecule that NO comes from. Taken on a daily basis, this can help prevent or improve both types of ED. Be aware that arginine can reactivate herpes simplex and herpes zoster (shingles) in some people.

Testosterone. Testosterone is important in preventing ED because it regulates and promotes the health of endothelial cells which, as we’ve seen, is critical for blood vessel health throughout the body and for blood flow. If you have symptoms of low testosterone, including ED, Bioidentical Testosterone Replacement may help.

Dr. Les Cole practices Anti-Aging, Functional-Metabolic, Integrative and Preventive Medicine. He is certified by the American Academy of Anti-Aging Medicine and American Academy of Integrative and Holistic Medicine, and is currently working on his Masters in Nutrition and Metabolism. To learn more about Male Sexual Health visit StPeteHW.com, call St. Petersburg Health & Wellness at 727-202-6807, or one of Dr. Cole’s other locations for an appointment. See ads pages 24 and right.