As a man passes the age of fifty he often finds himself encountering problems he never knew existed in his youth. Suddenly, he may find he is unable to perform sexually at the same level as before, and in some cases, he may be unable to perform at all. In our society today, advertisements about low testosterone, AKA low-T, bombard us daily. Thus, when sexual problem arise, most men—and their doctors—usually start thinking about testosterone problems before anything else.
A subsequent visit to a doctor typically results in blood tests that include a testosterone level, as well as a host of other tests. If the man’s testosterone measurement comes back in the normal range, his doctor may simply write a prescription for an erectile dysfunction drug which might help if his problem is erectile dysfunction, but is of little help for the myriad of other sexual issues. When the prescription doesn’t help, he might be told “Well, you’re getting older. You just have to accept that you cannot perform like before.” Unfortunately, some men accept this, and go through the rest of their lives suffering with problems that might be easily remedied had they—or their doctors—been willing to spend the time to look deeper.
There are several sexual problems that can befall a man as he ages. The two most well publicized and well known are erectile dysfunction (ED), and loss of libido (no sexual desire). However, some lesser known issues, like weak or delayed orgasms, and especially anorgasmia can be very distressing.
“Anorgasmia”, is the inability to have an orgasm regardless of the level of stimulation. It is quite common and many men are reluctant to discuss it even with a doctor, but it can be extremely devastating to a man’s ego and mental well-being.
While ED is also a disheartening problem, there are many medications as well as natural herbal remedies available that can help overcome it. Loss of libido can also be remedied with natural testosterone building herbs and nutrients, and skin creams that boost testosterone levels.
However, when it comes to orgasm problems, especially anorgasmia, where a man cannot have an orgasm regardless of how much direct stimulation he receives, many doctors haven’t got a clue where to start. Men often visit many different practices looking for a solution only to be told that there is no way to fix their problem. Needless to say, aside from the physical discomfort, this can result in a host of psychological problems, especially depression!
What causes these problems?
Any of these problems can be initiated by a medical condition, such as diabetes or cardiovascular disease, or can be the result of treatment like radiation or chemotherapy for cancer, surgery for prostate or pelvic cancer, and many prescription drugs, particularly antidepressants. It is well known that most antidepressants can directly cause anorgasmia. Contrary to popular belief, aging is not the usual cause. A healthy well-balanced man in his nineties should be able to perform fine sexually, albeit he will have to make some age-related adjustments.
Barring a specific medical issue or drug-induced problem, erectile dysfunction, loss of libido, and most orgasm problems generally result from a dietary or hormonal imbalance. Since the extent of hormone testing is often limited to total testosterone, the probability of uncovering a hormone-to-hormone imbalance is unlikely.
When hormone levels are reasonably within range, the actual values are of lesser importance then the relationship of each hormone to the others. For example: a man suffering from erectile dysfunction or anorgasmia could have normal testosterone levels, but elevated levels of other hormones which are causing the problem. Thus, it is not the actual level that is critical, but the relationship (balance) to other hormones. By measuring only testosterone, one cannot get a picture of its balance to other hormones, and thus, a normal level often results in dismissal of hormones as the source of the problem, leaving the patient few alternatives except to accept it.
Hormones exist in the body in two states: free (active) and bound (inactive). The free portion of each hormone is the active element that attaches to receptors on body organs and delivers its chemical message. It is common for an aging man to have total hormone values within range, while the free value of the same hormone is well below the target range. This is particularly true with testosterone. Thus, a blood test that measures total testosterone only provides part of the story. This is where saliva testing shines. Since only free hormones are measured in saliva, it provides an accurate and less expensive way of measuring several hormone values at once to get the needed information.
The hormones typically measured in a male saliva panel are all members of a family of called the sex-steroid hormones. They include: androstenediol, dehydroepiandrosterone (DHEA), dihydrotestosterone (DHT), estradiol, estrone, progesterone and testosterone. The androgens (testosterone, androstenedione and DHT), affect mostly male characteristics while the estrogens (estradiol, estrone) affect mainly female characteristics. DHEA and progesterone are precursors used by the body to build other hormones and are important to both genders.
In addition to those in the sex steroid family, other hormones that are critical to proper sexual functioning are prolactin, sex hormone binding globulin (SHBG), and thyroid stimulating hormone (TSH). These three are typically measured in blood serum.
On average, approximately 97 to 98 percent of testosterone in a man’s body is inactive, circulating in the blood bound to the blood protein SHBG. The two to three percent remaining portion is the active free value. A high level of SHBG—common in many aging men—can result in a myriad of sexual problems.
Prolactin is a hormone released in abundance after an orgasm. It is responsible for the refractory period after orgasm where it is physiologically impossible to achieve another erection or orgasm. A high prolactin level can delay or make an orgasm impossible.
TSH is a hormone released by the pituitary gland that stimulates production of thyroid hormones by the thyroid gland. Low or high thyroid function (hypo- or hyper-thyroidism respectively) can wreck havoc with sexual function.
Many men take to the Internet for solutions when they have sexual problems. Unfortunately, while there is a wealth of information available, one has no way to determine if the information is appropriate or downright dangerous. Searching for anorgasmia for example, will result in a wealth of suggestions and recommendations for, herbs, nutrients, diets, specialized proprietary supplements, exercises and other techniques—most of which are unproven and useless. Also, one should consider the issue of human differences. What might work for one man could be severely detrimental to another.
For example, searching on “herbs for anorgasmia” returned multiple sites that listed the herbs, yohimbe and tribulus terrestris as potential cures for anorgasmia. While I recommend both of these herbs in my practice for other sexual issues, they do have side effects, and there is absolutely no scientific or even anecdotal evidence that they are effective for anorgasmia.
Even on sites that list herbs and nutrients that may be useful, few recommend testing that could isolate the problem, and almost none list appropriated dosages. Thus, it is up to the suffering man to guess at where his problem originates, as well as try herbal remedies that, while useful for other problems, may be totally useless for his condition. This typically results in frustration, wasted money, and in some cases, actual harmful results.
A man suffering from any kind of sexual dysfunction would be wise to consult a practitioner that is well versed in the action of hormones on a man or woman’s sexual performance. After a comprehensive discussion of overall health, a review of dietary habits and collecting specific details about the problem, a competent practitioner can recommend saliva and/or blood tests that can help isolate the problem as well as supply herbal or nutritional remedies that may help resolve it.
A practitioner that deals with complex sexual problems on a daily basis has access to all the needed tests, nutrients and herbal remedies, as well as the knowledge of what works, what doesn’t and proper dosages.
Sexual problems can be devastating. Issues like erectile dysfunction can often be resolved easily, but orgasm problems like anorgasmia are more difficult to overcome. However, with the proper approach, some selective home saliva and/or blood tests, a little patience, a few herbal or nutritional supplements, and a knowledgeable practitioner, they are problems that many men and women have been happily able to resolve.
Read more in our Low T Health Center.