Most men between the ages of 45 and 80 will notice a change in both their libido and sexual function. The medical term for this condition is andropause, or the decline of androgens, the hormones related to sex. Because of the great variance of symtomology and a general reluctance of men to seek medical consultation when the body elicits the early signs, andropause is often overlooked as a major factor in men’s health. In fact, sexual health is an important indicator of overall wellness.

Andropause is alternatively called male menopause. This is because certain aspects of the condition are similar to women’s menopause. There is a decline of the hormones relating to sex: testosterone in men, estrogen and progesterone in women. Typically the onset of male menopause is age 50, the median age for women experiencing menopause. Yet that is where the similarities end. Men will continue to release sperm, while women cease ovulation. The decline in male sex hormones occurs at a modest rate compared to the sudden cessation occurring in women.

Table 1 presents the major causes of decline in sexual fitness. Based on the numerous cases of men I have assisted to regain their sexual function by using natural therapies, I have developed a risk factor assessment system, similar to that for cardiac health. The factors are weighted for their contribution, with the final tabulation reflective of the condition of a man’s sexual health.

There has been much press coverage of the pharmaceutical Viagra^© (Pfizer). Viagra is the first of several vasocongesting drugs that promise to restore sexual function by improving blood circulation to the penis. In my 12 years of clinical experience, only 20 to 40 percent of the cases of male sexual dysfunction I have managed can be attributed solely to circulatory disorder. Sexual health is more than just the sum of testicular and penile function. I have found that the most common causes of ailing sexual function are, in order of importance:

• Brain health
• Endocrine function
• Nutritional status
• Circulatory condition
• Neurological status
• Other contributing factors

Viagra will fail in all etiologies other than that of circulatory condition. Furthermore, drugs that operate on the mechanism of vasocongestion may have only a limited success in cases where sexual dysfunction originates from a combination of these issues. A long-term strategy that employs multi-modal treatments of natural therapies holds excellent potential for sexual recovery as well as the enhancement of overall wellness and longevity.

The proper diagnosis and treatment of male menopause requires a multi-disciplinary approach. Physicians must recognize that hormonal, physical and psychogenic effects combine to directly impact sexual fitness. Male menopause is a full-body event, therefore assessment of the whole person is key for formulating an appropriate treatment program. Refer to Table 2 for the PATH Medical protocol for the reliable diagnosis and effective treatment course for male menopause. The key element in battling this condition and restoring sexual fitness is early assessment and early intervention.

Brain tissue, being lipid-rich, is particularly susceptible to free radical damage. As brain neurons degenerate the brain loses its ability to properly signal the endocrine, cardiovascular, circulatory, muscular, skeletal and other body systems—all of which are important to sexual health. To combat free radical damage, nutritional supplementation may be useful. A daily regimen may include B-complex vitamins and antioxidants (beta-carotene, vitamin C and vitamin E), plus the trace elements magnesium, selenium and zinc.

Cranial Electrical Stimulation (CES) is an at-home, self-administered treatment technique that improves brain health. CES is a therapeutic form of electromedicine that modulates brain waves to restore a more normalized pattern. Three main reasons why CES is a valuable modality for the restoration of sexual fitness are:

1. CES is FDA-approved for the treatment of anxiety, depression and insomnia, all of which are important psychological factors linked to sub-optimal sexual function.
2. This therapy corrects exposures to electromagnetic fields, which have been shown to alter the alpha brain wave (the wave of alertness, creativity and concentration) into theta waves (normally the predominant of sleep). This is valuable for cases of sexual dysfunction caused by psychological issues of concentration or detachment.
3. CES boosts the uptake of amino acids and their conversion into neurotransmitters. By doing so, levels of endorphins are increased, influencing a man’s desire, arousal and response in a sexual experience. Thus CES works well in conjunction with nutritional supplementation.

To resolve impotence of a psychogenic nature, which is often based on a disruption of the arousal process, I find that men respond well to a regular EEG (neuro-) biofeedback training program. By training an individual to become alert for his subtle, personal triggers or sensations that may lead to performance anxiety or inhibition, he becomes able to deliberately alter his behavior to overcome the obstacles to the sexual experience. EEG biofeedback offers an overall enhanced sense of calm and wellness, with an improved ability to focus and concentrate. These all contribute to the state of mind in which a pleasurable sexual encounter occurs.

Emotional issues including detachment may benefit from personality de-stressing exercises. At PATH Medical our patients undergo a personality evaluation, using the Millon Clinical Multiaxial Inventory (MCMI) and Myers-Briggs Type Indicator (MBTI). In our analysis of the results from these profiles we ascertain a complete profile of a patient’s best and worst personality characteristics. At my practice, we employ a set of personality de-stressing exercises that correct flaws and deficits revealed by the MCMI and MBTI.

Counseling with a licensed sex therapist or couples counselor may be appropriate to address emotions that result from sub-optimal sexual performance. Stress often occurs between partners as a consequence of repeated failed or unsatisfactory sexual experiences. Left unaddressed, this issue may jeopardize the couple’s relationship. Qualified therapists are readily found through referral organizations.

Table 4 outlines the concept of neuroendocrine shutdown and its impact on sexual health. Numerous studies demonstrate that sexual dysfunction of an endocrine origin is more than just the decline of testosterone. Indeed, it is a multiple-organ decline. This decline directly affects sexual performance.

Replacement of deficient hormones can be performed using safe hormone therapies. Testosterone is most easily administered via a transdermal patch but a regular exercise program has been shown in several studies to increase serum testosterone. Growth hormone in a synthetic preparation is administered via injection. DHEA and melatonin are available in capsule or tablet form for oral administration.

Periodic retesting of blood levels assures against the development of adverse effects. A potential for enlarged prostate has been associated with testosterone therapy, while contraction of diabetes mellitus is a minimal risk with growth hormone therapy. DHEA may exacerbate prostate troubles and lead to imbalances with thyroid hormones. Physicians must be familiar with the benefits and risk implications of hormone therapy in order to assure that it proceeds in a safe manner.

As people age, their ability to absorb nutrients from food sources becomes less efficient. Absorption of vitamins, trace elements, amino acids and fatty acids declines, a condition that may be termed “gastropause.” Gastropause may occur at any age but is common in men over the age of 50. Often it can be correlated to a lack of nutritional value in the daily diet of older people. Dietary changes to incorporate high-quality protein sources (including fish, chicken, eggs, dairy products and nuts), whole-grain foods and extra servings of vegetables and fruits will provide the body with the resources it requires to derive the building blocks for necessary cellular function.

Amino acid therapy is particularly applicable to regaining general health and sexual fitness. Arginine is a precursor to nitric oxide synthase (NOS). Viagra, by enhancing NOS levels, functions by relaxing the smooth muscle tissue in the penis, allowing an increased blood flow that creates erection. Arginine can mimic the actions of Viagra. In the PATH Medical Total Health Nutrients SX Formula, arginine is combined with vitamin B activators and zinc to boost its activity.

By restoring circulatory health, men regain strength and energy, thereby promoting sexual vigor. At my practice a blood work-up to assess the levels of vitamins, trace elements, amino acids and fatty acids often reveals deficiencies in patients experiencing male menopause. Niacin and vitamin E are necessary for proper circulation. The amino acid carnitine may combat cardiovascular illness by decreasing high TGL levels and increasing HDLs, while tyrosine may increase sex drive by stimulating adrenal hormone production and increasing energy levels.

Prostaglandins are a group of three lipids produced by cells, functioning as hormones that are locally secreted for immediate action. Prostaglandin E1 has been found to be of direct impact on sexual health. In fact, prostaglandins are the active ingredient in MUSE inserts, which contain transurethral alprostadil.

Prostaglandin secretion may be boosted by supplementation with essential fatty acids (EFAs).

A blood screening that determines the presence of toxic or heavy metals in the blood leads to the treatment option of chelation, which allows the regulated removal of noxious contents from the bloodstream with the concurrent infusion of therapeutic vitamins. Physicians and their staff should abide by the protocols of the American Board of Chelation Therapy (ABCT). Chelation corrects memory loss, depression, psychosis, degenerative systemic diseases and elevated blood pressure, all of which have a profound impact on the restoration of sexual health.

Neuropathies, by debilitating sensory and motor capacities, pose a particularly significant factor in ailing sexual health. Neuropathies are typically associated with diabetics and alcohol and drug abusers. The important factor with correction of sexual dysfunction of a neuropathic origin is early intervention.

Neuropathic damage responds well to vitamin B12 injections, as well as a nutritional program including B-complex, carnitine and vitamin E.

Lack of exercise and improper diet may impede sexual health. Regular aerobic exercise, by benefiting the circulatory system, improves vascular condition, which is critical in proper sexual function. Dietary instructions may include:

1. proper protein intake to provide amino acids
2. whole-grain products
3. extra portions of vegetables and fruits
4. polyunsaturated or monosaturated oils
5. spring and mineral waters.

Sugar, sugar substitutes and alcohol, as well as additives, fillers and preservatives ideally are eliminated from the diet. Foods high in zinc (such as oysters), thyroid-stimulating foods (high in iodine content), and items containing cortisone-like substances (such as the herb sarsaparilla) may assist sexual drive by boosting hormone production. Interestingly, some foods may reduce sexual function: thyroid inhibitors (cabbage family), purely vegan diets (lack adequate protein sources) and excesses of sugar and chocolate. A consultation with a dietitian is often valuable in planning a well-balanced diet.

The liver is responsible for the proper filtering of unwanted or excess compounds from entering the bloodstream. A normal functioning liver is the body’s barrier against damage from alcohol, medications and illicit drugs. The abuse of alcohol or drugs or a prolonged dependence on OTC or prescription medications damages the liver to the extent that it is unable to clear the body of toxic compounds. An overworked liver results in an unhealthy body, often associated with unsatisfactory sexual function. If the loss of sexual drive is secondary to alcohol abuse, substance abuse or smoking, it is imperative to establish a goal of cessation. Patients should be encouraged to enroll in a counseling program. A plan should be implemented to reduce the prolonged use of OTC medications and pharmaceuticals by finding natural alternatives. Blood work to assess the impact of these offensive compounds assists in monitoring the success of a treatment program.

Men in post-operative situations often experience hypoactive desire. In post-myocardial patients, studies find that the lack of libido is secondary to psychological factors, including stress, anger and fear. This may generate interpersonal problems with the partner, complicating the situation. In these cases, counseling is often an appropriate choice.

Infertility studies demonstrate that vitamin C (up to 3 gm daily), extra doses of zinc, plus the vitamins, minerals and fatty acids listed in this article are valuable. This research holds important implications for the treatment of sexual dysfunction because supplementation that produces increased quality and quantity of sperm and semen may also benefit men failing to reach ejaculation.

Virtually all cases of sexual dysfunction in men are treatable with natural therapies. The key element is accurate and early assessment. A multi-modal approach to both diagnosis and treatment ensures satisfactory recovery. Because male menopause has a gradual and silent onset, many men—and their physicians—fail to recognize the condition.

With increased awareness from both the medical community and patients, male sexual fitness can readily be regained or maintained. With all of the treatment choices available for sexual health there is no reason why men cannot have enjoyable sex lives well into their senior years.

Table 6 summarizes the natural options for restoring male sexual fitness. I expect that new research advances in the next few years will provide physicians with even more natural-based therapies to assist their male patients with their sexual fitness.