Jan 05

Photo src: thetastingnote.com

Viagra, the popular anti-impotence drug, may stop working for many patients after 2 years, the results of a study suggest.

Dr. Rizk El-Galley of the University of Alabama at Birmingham and colleagues interviewed 151 men who had filled prescriptions for Viagra. Overall, 74% reported that 25 milligrams (mg) to 100 mg of the drug enabled them to initiate and maintain erections sufficient for intercourse.

The improvement rate ranged from 50% for patients with impotence caused by diabetes, to 78% for those with no specified reason for impotence, to 100% for those with suspected leakage in their veins.

3 years later, the investigators re-interviewed 82 of the men, of whom 43 were still using the drug. Sixteen of those 43 (37%) said they had needed to increase the dose by 50 mg to achieve an adequate erection. It had taken between 1 and 18 months for the treatment to lose its effects. There was no correlation between the need to increase the dose and frequency of use.

‘In general, 81% of patients who were still receiving treatment were satisfied, and 92% were able to achieve and maintain erections sufficient for sexual intercourse in more than 50% of attempts,’ El-Galley and colleagues wrote in The Journal of Urology.

Of the 39 patients who had stopped taking Viagra, 28 had initially reported a good response. Fourteen of those patients who stopped said the drug no longer worked, and six said they had regained the ability to have spontaneous erections.

There is notable disappointment about the fading powers of the ‘blue miracle pill’ in the professional world. ‘According to my observations, Viagra only helps half of all patients with erectile dysfunction caused by physical factors’, P. Derahshani, head of the urology department of the Kölner Klinik am Ring (Cologne, BRD) reports. A potential health-risk lies in the fact that for patients showing habituation effects, the dose can only be rised by the ones who have previously used 25 or 50mg, while for doses above 100mg, the risk of side effects such as circulatory weakness, nausea or headaches increases remarkably.

No substitute for psychotherapy or sex therapy

“One should not forget that Viagra is only indicated for erectile dysfunction for those men whose potency problems have physical causes,” the Viennese urologist Werner Reiter of the impotence clinic at the Vienna General Hospital said in an interview with the “SĂŒddeutsche” (SZ). Especially in older men who smoke a lot and suffer from high blood pressure or heart disease, Viagra often loses its effect after prolonged dosing. In men with stable health, on the other hand, there is rarely a (physiological) habituation effect.
“If the impotence is caused by mental factors, Viagra will just cover up the first symptoms for a while,” warns Reiter. For long term success, these patients could only be helped with psychotherapy or sex therapy.

Health risks often underestimated

Fatally, many men ignore or underestimate the risk of self-medication. But an alarming number of 40 percent of the men who visit a doctor because of erection problems, suffer from arteriosclerosis of the coronary arteries (which may, but is not always the cause of erectile dysfunction). Impotence ‘may nevertheless be a sign of a disease or an incipient disease. However, to simply cover up symptoms and to look away from the real causes, has never worked out on the long run, neither in medicine nor in psychotherapy,” says sex therapist Karl F. Stifter. It is important to keep the whole person in mind, which in this case would mean to check for physiological causes of the erectile dysfunction before considering any medication.

Underestimated by many men is the risk of suffering a heart attack. Like most drugs that interfere with the blood circulation of the body, Viagra & Co. involve special risks for patients (sometimes unknowingly!) suffering from heart conditions. In particular, patients who are taking nitroglycerin or blood pressure lowering drugs, which also relax the smooth muscles, may not take the pills to avoid potentializing their effects. Together with medications containing nitrate (eg for angina pectoris), the drug may lead to a fatal drop in blood pressure and heart diseases in men with circulatory failure. An examination by a physician is therefore absolutely necessarily before taking them.

In fact, no other medications are responsible for as many deaths due to negligent use as the new “erection helpers”. Worldwide, 616 deaths after taking Viagra were reported during the first 3 years after its introduction alone. The easy availability of the tablets over the Internet or on the black market poses a big problem, because they are extremely inviting for self-medication, and there is a relatively high risk to purchase harmful imitations. The ‘copycat’ market of the tablets, mainly India and China, is hard to control, with all the associated risks for the end user. Often enough the tablets are also not only taken at a far too young age, but also abused as kind of a ‘lifestyle drug’, completely ignoring the impact on the cardiovascular system – and probably also the production of our endogenuous ‘drugs’ that help to build and maintain an erection, as the study mentioned above could indicate.

So there is reason to expect a massive increase of the number of ‘Viagra Veterans’ during the next years who suffer from what I’d call ‘multisystemic erectile dysfunction’: psychogenic erectile dysfunction by men who furtheron developed organically caused erectile dysfunction either from resistance against the drug or by underproduction of endogenous drugs from longterm use of the supplementary drugs). These men may well find themselves suck in a dead end once they reach an age (or have to deal with side effects of physical illnesses) involving a natural decrease of the erectile function without many remaining options to treat their impotence.
It has been proved that in the vast majority of men under the age of 50, erection problems are caused psychologically – but even (and especially) at a higher age, a medical examination is necessary before starting to take medication. If there is no clear evidence for a physical cause, in the interest of one’s health (and perhaps also to keep the “Viagra trump card” for more difficult times), it is recommended to seek counsel from a sex therapist or psychotherapist rather than to reflexively grab one of the readily available “blue pills”.

(Sources: Reuters.com; Rizk El-Galley et.al., “Long-Term Efficiacy of Sildenafil and Tachyphylaxis Effect” in: The Journal of Urology – September 2001 (Vol. 166, Issue 3, Pages 927-931); Image source: creakyeasel.com)

Dec 27

Many clients tell me of difficulties finding the right relationship partner. Of course such problems almost always have psychological reasons – in one way or another, these persons sabotaged themselves, they suffer from forms of social anxiety or (in my experience, this is the most common reason) have low self-esteem.

The issues around dating, attraction and sexual attraction have inspired researchers and artists since the beginnings of mankind. Under this – rather ironic – article headline, I will summarize the results of relevant studies and research – and continuously expand and update this collection as soon as there are new findings.

But beware: I’ll not guarantee for the plausibility – or especially success – of any of these hints! 😉

Attractiveness and mate selection

  • “Attractive bodies and faces are symmetrical” – when selecting a partner, we jump on aesthetic impressions indicating a good state of health and fitness, including reproductional capabilities (Source).
  • People with symmetrical physique receive more positive attention when dancing and during mate selection” (source)
  • Women without ideal measurements are stronger, tougher and more resistant to crises” – in Western countries, women with a greater waist-hip ratio than 0.7 are considered to be less attractive than in other world regions, but better prepared for times of crisis (Sources: [1, 2, 3])
  • Estrogen makes women’s faces look more attractive.’ –  during their fertile days, the faces of women obviously look more attractive (Source)
  • Women tend to be selected if they are beautiful, men are more likely to be selected if they act dominantly‘ – this actually refers to political elections, but then, maybe not .. if you consider the other research results mentioned in this blog entry (source)
  • Beauty makes insecure.‘ – this, and that attractive men and women usually find it more difficult to find partners than averagely attractive people, would be a possible conclusion from the so-called ‘sidewalk experiment’ by James Dubbs u. Neil Stokes (‘Beauty is Power: The Use of Space on the Sidewalk’, 1975): on a sidewalk, pedestrians altered their walking direction more often to give space to men rather than for a woman, for 2 people rather than for just 1, and for pretty than for  unattractive women. Their theory was that attractiveness, group size and gender are signals of power which involves territorial claims causing the aforementioned evasive behavior (Source).
  • Other attributes for attractiveness will be judged based on attractiveness of the clothing‘ – attractively dressed subjects were judged as more competent and social than non-attractively-dressed individuals, and, as the researchers suspected, probably as physically more attractive as well (source).
  • Taller men are sexually and socially better off than shorter ones. ‘ – men seem to have their greatest difficulties when dealing with strong, attractive and wealthy competitors, but the taller they are, the less of a role these attributes play in dealing with them. Little men tend to be most jealous. In women, however, the taller and shorter ones are more jealous than the ones of average size. Average-sized women are most shaken by tall and socially dominant rivals just as by other women’s  persuasiveness (link)
  • women prefer older men, older men prefer younger women.’ – a possible explanation for the biological causes of this phenomenon was provided by a study that found that women with a four-year-older partner, and men with a six years younger partner show the greatest reproductive success (source).
  • Man perhaps lost his body hair because it was sexy to the opposite sex.’ – new hope for bald people? (source)
  • Results of an econometric analysis of online dating behavior showed that men who reported that they were in search of a long-term relationship achieved much more success in online dating than those who were merely out on an affair. For men, the appearance of women is of outstanding importance; for women, the man’s income is of utmost importance: the richer the man, the more emails he receives. Income increases the attractiveness of a woman for men as well, but only up to a certain height. [..] Men are attracted by female students, artists, musicians, veterinarians, and celebrities, and they avoid secretaries, retired women and women who work in the military or the police. Women prefer soldiers, policemen and firemen as well as lawyers and financial experts in a management position, but they avoid laborers, actors, students [..]. The data analysis of about 30,000 users also revealed that men have significant drawbacks when they are short. For women, obesity is fatal. That’s probably why many online daters ‘adjust’ these parameters relatively often: male online daters are slightly taller than the average man while the typical female online dater is 10 kg lighter than its real counterpart. In the book Freakonomics in which the results can be read in detail, the authors described their findings, obtained by mathematical methods, as follows: ‘In the world of online dating, a head full of blond hair has about the same worth for a woman as a college degree.’
  • “‘Nasty’ men not only get most women, but also the most beautiful ones.” – in most studies on this subject, these men showed distinctive combinations of narcissism, Machiavellianism and psychopathy (Sources: [1], [2], [3])
  • Men should not act as if they were ‘carried away’: uncertainty about the feelings of the opponent increases his/her attractiveness (Source: E. et.al in Whitchurch: “Uncertainty Can Increase Romantic Attraction”, Psychological Science, 01/2011).


Sexuality

  • ‘The mere presence of a woman increases the testosterone levels’ – regardless of her appearance, the testosterone levels in men sitting in the same room as a woman increased by 8% within 300 seconds (Sources: [1],[2])
  • The frequency of female orgasms increases with the income of their partner ‘ – sex with wealthy or powerful men probably feels more exciting by women because it may help to obtain access to wealth and power, or to keep this access up (Sources: [1], [2], [3])
    Addendum 04/2010: a counter study was published that shows different results.
  • The more attractive women consider themselves to be, the greater demands they make on their sexual partners – in men, this correlation doesn’t exist, which could mean that they are less picky or less inclined to enter into permanent relations aiming at reproduction (Sources: [1], [2])
  • (indirect) relationship between voice and sexual activity’ – volunteers with a voice perceived as attractive had about equally long fingers on both hands (reference to the context of attractiveness by symmetry, see above), their first sex at a younger age, more sexual partners and more affairs (Sources: [1], [2])
  • Women respond differently to male body odor.’ – their brains can differ normal male perspiration from perspiration resulting from sexual arousal (Source)
  • Women’s tears put off men and reduce their testosterone level. (Source: Shani Gelstein et.al, “Human tears contain a chemosignal” in: Science 01/2011, DOI: 10.1126/science.1198331)

Family / Children / Fertility

  • ‘Correlation between wealth and reproductive success‘: a British study found higher reproductive success for wealthy men; in women, the number of children declines with increasing education and income (Source)

(First published in German language (‘Wissenschaftliche Aufriss-Tipps’) in 01/2008; continuously updated. Last update: 12/2011)

Dec 27

Andropause is an onset of hormonal changes in men – mostly between the ages of 40 and 50 -, which is triggered by reduced testosterone levels.

Testosterone is the primary male sex hormone and is produced in the testes. It affects all body cells and is responsible not only for sexual development, but also for the specific skin, bone and muscle structure of men. It is equally important for the production of red blood cells, which supply the body with oxygen. And after all, testosterone also plays a significant role in providing sexual pleasure and emotional balance. At around one’s middle years, however, the production of this hormone gradually drops, and so do the testosterone levels in the blood. This reduction causes problems for many affected men: in German language, the saying “die Fitness ist kraftlos und die Lenden sind saftlos” (freely translated as ‘no gas in the muscles, no fluids in the loins”) expresses the feeling when the so-called andropause kicks in: depression, irritability, loss of concentration and vitality.

Possible symptoms of the andropause include:

  • Mood disorders such as anxiety, irritability, aggression
  • Tendency to depression
  • Increased weight and body fat, increasing abdominal girth
  • Increasingly poor short-term memory
  • Decreased concentration and attention span
  • Sleep problems and / or stronger daytime fatigue than before
  • Reduced desire for intimacy and lower sex drive..
  • ..or rational desire for sex, but still, sexual apathy
  • Erectile Dysfunction
  • Less frequent and intense ejaculation
  • Osteoporosis
  • low self-esteem
  • Hot flashes and night sweats

There are, however, considerable differences of opinion among experts as to which of these symptoms actually indicate a so-called ‘male menopause’ or andropause and were initially caused by testosterone deficiency, because for each of the symptoms in the list, there could be other root causes, even if a reduced testosterone level would actually be detected in a patient. Thus, in a way, the so-called ‘testosterone replacement therapy’ is often not much more than a ‘shot in the dark’.

Testosterone replacement therapy – yes or no?

Some doctors and hospitals today offer testosterone replacement therapy without much hesitation to men, often with the particular aim of helping them to regain their desire for a satisfying love life. Even with impending cardiovascular diseases, this hormone is sometimes used for prevention, because studies have shown that testosterone has a protective effect on arteries and veins, so there are good, potential reasons to say ‘yes’ to this kind of therapy (usually in the form of tablets, gels, patches or nose sprays). However, it is important to know that a hormone replacement therapy does not help at all if one simultaneously depletes his bodies’ health and resources. It is remarkable and perhaps not entirely coincidental that many men who are looking to start a hormone replacement therapy are also often frivolous users of  ‘fitness booster medication’ (self-medicated).

Ideally, taking on an artificial testosterone substitution should increase muscle mass, bone density, libido and performance. Under certain conditions, the ‘extra dose’ testosterone may also accelerate the development of an existing prostate cancer. A preventive control (PSA control) is therefore highly advisable.

But there are also proven health tips for men, which in contrast to the artificial feeding of testosterone reliably pose no health risks and are also very well suited to raise the testosterone levels:

  • Development of more self-discipline for a healthy lifestyle – something that many men never achieved in their lives
  • Balanced nutrition (vitamins: more fruit and vegetables; low-fat: greasy, oily foods and refined carbohydrates lead to weight gain, but: obesity appears to influence the production of testosterone!)
  • The waist circumference should be less than 100 cm (see BMI test on this website)
  • Enough sleep – at least 6-8 hours per day
  • Care for a balanced mental state – if something brings you out of your balance on a reglar basis, seek necessary support through psychotherapy or coaching: optimism and a balanced state of mind help to reduce stress. On the other hand, if men are overloaded (perhaps even chronic), endocrine glands will produce significantly less amounts male sex hormones.
  • Smoke and drink less
  • Natural resources: oats and ginseng have a testosterone-like effect, and an extra portion of zinc also helps the testosterone levels: lobsters, oysters and shrimp, soybeans, wheat bran and pumpkin seeds. Casanova was known to eat 40 oysters a day!
  • Exercising also stimulates the production of testosterone: best results are achieved with intense strength training with sets of 10-15 reps, peppered with breaks of 60-90 seconds (intervals of 15-30 sec will stimulate the production of growth hormone).
  • Good sex: sexual excitement and ‘games of desire’ help to raise our hormone levels over a period of up to two days and thus counteract the natural way of deficiency. Even erotic fantasies will stimulate testosterone production in the short term, falling in love raises our testosterone for up to many months.

Men have the luxury of being able to affect their hormone levels through their lifestyle more than women, because their hormonal situation does not change so abruptly and radically with age.

In the “self test” on my website you will find a self-test for testosterone deficiency, which can allow an initial self-assessment. In case of doubt, a medical examination with blood test is recommended.

(Initially published in German language (‘Testosteron-Spiegel erhöhen’) in 10/2010. Image source: understandinglowt.com)

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06.01.16