Anyone who watches professional sports on TV is bombarded with commercials dealing with erectile dysfunction (ED).
But despite what the ads may lead one to believe, men’s sexual health issues are more complicated than simply taking a pill and “letting the dance begin.” Men do have a biological clock. They do experience age-related hormonal changes, and there are good medical reasons not to ignore ED, even when it responds to medication.
Here are some facts about men’s sexual health that may surprise avid sports fans, Cosmo and GQ readers alike, all vetted by Mike Hsieh MD, program director of UC San Diego’s Male Fertility and Sexual Health Program, the region’s only medical center with a specific focus on male fertility issues.
ED is an early sign of cardiovascular disease
ED is an early marker for vascular problems. This is one reason why your primary care physician may – and should – ask you about your sex life. It’s a way to detect potential heart issues.
“Many men come to my office to talk about ED and they leave with a referral to one of our cardiologists,” Hsieh said.
Why is ED a risk factor for heart attack? Simple geometry: The penile artery is one-tenth the diameter of coronary arteries. The narrower tube is likely to clog before larger arteries in the heart.
Obesity, diabetes, sedentary lifestyle, smoking and hypertension put men at higher risk of ED and also heart disease. “They really are the same problem, just different parts of the body,” Hsieh said.
One study, published in the Journal of Urology, found that approximately 75 percent of men with chronic coronary artery disease had ED.
Men and women are equally likely to have fertility issues
Not too long ago, men were believed to be fertile forever (practically), but that’s not true.
“A 50-year-old man is not as fertile as a 30-year-old. That’s the take home message,” said Hsieh, who is also an assistant professor in the Department of Urology.
Advanced paternal age is associated with lower sperm counts and lower sperm quality, and increases a couple’s chances of having a child with genetic problems, he said.
Besides issues related to aging, men may have anatomical blockages, hormonal imbalances or genetic problems that can lower sperm counts, impair sperm motility or cause dysfunctional sperm shape.
Many of these conditions are treatable at UC San Diego Health.
Testosterone supplements are birth control for men
Locker room jokes about the anatomical disparities of body builders can have a real scientific basis.
“Testosterone therapy tells a man’s body it can shut down,” Hsieh said. “It gets lazy.”
The brain monitors testosterone levels and when it detects adequate amounts of the hormone, it directs the testicles to go on vacation. This halts sperm production.
“Giving a man testosterone is like giving him birth control,” Hsieh said. If a man is in his 50s or 60s, the fertility issues surrounding testosterone therapy are likely irrelevant, but for younger men who want a family, doctors should identify why there is a hormonal imbalance. Certain medications, including antibiotics and cancer drugs, can reduce testosterone production. In rare cases, low testosterone can also be the result of a brain tumor.
Food for thought: Male athletes who have taken performance enhancing drugs do not necessarily regain their full fertility after they stop taking the drugs. There can be permanent damage to a man’s sperm production.
Vasectomies are reversible
A vasectomy is surgical sterilization, but it is not permanent. A man still makes sperm after a vasectomy and if it has been less than ten years since the procedure there’s a 95 percent chance that the spaghetti-sized tubing (vas deferens) that was cut or clamped can be reconnected.
A vasectomy reversal is done under a microscope with sutures as fine as eye lashes. “It’s like sewing pasta together,” said Hsieh, who is an expert on the procedure.
The bad news: Vasectomy reversal costs between $8,000 and $9,000 and is not covered by insurance. The good news: It’s still way more affordable, and less invasive, than in vitro fertilization (IVF) and at UC San Diego Health it can performed as an outpatient procedure.
“Manopause” is real
Men don’t get hot flashes, but they do experience age-related declines in sex hormones that mirror female menopause. Andropause usually begins as men approach middle age in the 40s and beyond.
“Every man goes through andropause,” Hsieh said. “But symptoms vary. Some men experience irritability, fatigue, weight gain, low sex drive and erectile dysfunction. Some don’t.”
Both male and female sex hormone levels diminish with age in men, and lowered estrogen levels can contribute to health problems, such as osteoporosis. The symptoms most men notice and complain about are usually associated with lower testosterone levels.
Testosterone therapy, however, poses its own set of health risks, including acne, balding, blood thickening and urinary dysfunction caused by an enlarged prostate. New studies show testosterone may also elevate a man’s risk of heart attack and stroke.
“We are starting to recognize the risks of hormone replacement in men,” said Hsieh.
Bottom line: Aging happens. Men who go on testosterone therapy should make sure they are closely monitored for potentially serious side effects.
Almost all forms of cancer treatment can have sexual side effects
Chemotherapy impairs sperm production because the treatment, by design, target cells with robust replication rates, such as hair follicles and sperm cells. Meanwhile, surgery or radiation, especially in the pelvic region, can damage nerves or alter blood supply to reproductive organs. The stress of cancer itself can also cause hormonal imbalances, which may hinder sexual function and fertility.
“We recommend fertility preservation for all men and women who have been diagnosed with cancer and want to have children,” Hsieh said. For men, fertility preservation involves freezing sperm or testicular tissue. The service is offered at UC San Diego Health.
Care at UC San Diego Health
Male Fertility and Sexual Health Program