Great Sex, Naturally (38 page)

In addition to
Tribulus terrestris
, L-arginine, and pycnogenol, the following are recommended for a man with ED. They’ve been found to be generally safe to use, and can be taken simultaneously.

—
L-citrulline.
An amino acid that increases nitric oxide synthesis, L-citrulline promotes healthy erections. Some researchers hypothesize that L-citrulline, which converts into L-arginine in a man’s body, may be more effective than L-arginine because of the way the body metabolizes it. If L-arginine doesn’t sufficiently improve a man’s erections to allow him fulfilling sex, he may benefit from taking the recommended daily dose of 500 mg of L-citrulline. The only potential side effect is decreased blood pressure.

—
Acetyl-l-carnitine and propionyl L-carnitine.
Acetyl-l-carnitine and propionyl L-
carnitine
supplements are recommended for treating ED by Dr. Jonathan Wright, who pioneered the use of bioidentical testosterone for men. He suggests that men use 2,000 mg of each daily, instead of drugs like Viagra. Interestingly, studies published in the journal
Urology
have shown that when men whose prostate glands are removed (which can lead to ED) take these supplements along with Viagra, the drug becomes more effective. According to Dr. Wright, both supplements also increase cognitive and muscle function.

Understanding Andropause

Just as your sexuality changes as you travel through the seasons of your life, with your hormonal shifts and evolving emotional needs, a man goes through hormonal changes of his own. His midlife transition is less obvious than yours because there’s no outward physical manifestation, like the cessation of menstrual cycles, but it deeply impacts some men nonetheless. During
andropause
, or male menopause, which typically begins between the ages of 45 and 55 (preceded by gradual hormonal changes that we call
periandropause
), there are shifts in a man’s levels of testosterone, adrenal hormones, estrogen, and progesterone. These changes present few problems for some men, but great challenges for others. Over a period of several years, a happy, outgoing man may slowly become a less satisfied person who has difficulty concentrating and sleeping, gains weight easily, frequently feels exhausted, no longer seems to care about what once mattered to him, goes through a midlife crisis, has a diminished sex drive, or experiences ED.

It’s important to remember that the changes a man experiences during andropause are a normal part of life; like menopause, andropause is natural, and not an illness. The changes may require acceptance and adaptation, but it’s very possible for men to learn to be content with their new, physiologically altered postandropausal selves.

Together, andropause and menopause can test a relationship. With your two sexual energies in flux, the balance between you can shift in unforeseeable ways. Some long-term couples have settled into familiar patterns of sexual expression, only to find themselves going through physiological and emotional transitions that deeply affect their relationship. If both partners experience life-altering changes at the same time, they may feel that maintaining their sexual intimacy is like aiming at a moving target. But the fact that men and women go through these transitions at corresponding stages of their lives can also give them new opportunities to grow
together
rather than apart. It allows them to evolve together through parallel changes, to some extent mirroring each other, and their shared experiences can deepen and strengthen their partnership as they move through time.

Solutions to ED from Chinese Medicine

When it comes to men’s sexual-health issues, Chinese medicine has a lot to say. ED is seen as the result of an underlying imbalance in a man’s chi—especially a deficiency of his yang energy. If he takes drugs like Viagra to maintain erections, the underlying imbalance remains; having drug-assisted sex without addressing it only further imbalances his chi and depletes his yang energy, causing worse ED, and lower overall health, in the long run. By balancing his chi and boosting his yang energy, however, he can often get to the root of the problem.

In the West, we often think about a man’s erection in a binary sense: either he has one or he doesn’t. This either-or mentality is quite at odds with the way Chinese medicine approaches men’s sexual health and ED. The
quality
of erections is seen as an essential factor in determining a man’s sexual health. Firm, “hot” erections are a strong indicator that his chi and yang energy are abundant and well nourished; semi-flaccid erections are a sign that they’re deficient. (Another important factor in evaluating a man’s sexual health is the way he feels after orgasm. If he feels completely exhausted and falls asleep, it means he’s chi-deficient.)

As you’ve discovered, Chinese medicine teaches that many lifestyle choices can balance chi and support yang energy. Along with the steps outlined previously in this book for a sex-supportive lifestyle, acupressure can help a man with ED address its underlying causes. To use acupressure to support yang energy and treat ED, you or your partner can press firmly for a few minutes, once or twice daily, on these points on his body: Kidney 27, Kidney 1, Kidney 7, and San Jiao 4. (To locate these points, see
Appendix A
.)

In addition, certain Chinese herbs can be effective for treating ED, either by boosting a man’s yang energy or because of their other beneficial effects. Let’s look at the most important options a man can try. (In the preceding pages you’ve explored some of these herbs for general male sex enhancement; here we examine them specifically for their ED-alleviating effects.) A man with ED may need to take these herbs for three to six months to experience many of their benefits.

—
Chinese ginseng.
Research shows Chinese ginseng can be highly beneficial for men with ED. A study published in the
Journal of Urology
in 2002, which found significant reductions of ED symptoms over a 16-week course of treatment, concluded that the herb is an effective ED treatment. Another study, published in
Clinical Autonomic Research
in 2001, reported that Chinese ginseng increases nitric oxide production in the delicate blood vessels lining the corpus cavernosum, the spongy erectile tissue of the penis (dilation of this tissue with blood is necessary for erection), and also positively affects other naturally occurring compounds in the body that may allow for improved penile blood flow. Chinese ginseng provides these benefits without causing changes in blood levels of testosterone. (See dosage and use recommendations earlier in this chapter.)

—
Lu Rong.
Although often referred to as an herb, Lu Rong is derived from deer antlers. Chinese physicians have used Lu Rong for thousands of years, usually combined with other ingredients in herbal formulas, to build yang energy, fortify libido, increase longevity, and strengthen the entire body. In recent times, it has been used by athletes to improve performance, strength, and muscle mass. It also has immune-enhancing functions, promotes sound sleep, and boosts endurance. Research shows it’s high in mucopolysaccharides, which can help regenerate tissue, and rich in IGF, a substance similar to growth hormone that helps the body recuperate more quickly from exercise. One formula containing Lu Rong, a product known as Antler 8, is used to treat ED, as well as lowered immunity and arthritis. The recommended dose is two pills three times daily; see
Appendix C
for supplier information. (Note: Animals aren’t harmed in the collection of Lu Rong.)

—
Epimedium.
As mentioned earlier in this chapter, the active constituent of this yang-building herb, found in many Chinese herbal formulas used to treat ED, is icariin. Not only can icariin help a man with ED by stimulating nerves to his genitals and increasing nitric oxide, but it has other anti-ED benefits as well. In 2003, the
Asian Journal of Andrology
published research showing that icariin positively influences blood flow to the penis and effectively treats ED through its effects on an enzyme that allows for smooth muscle relaxation of the corpus cavernosum—interestingly, the same way Viagra works. (See recommendations for epimedium’s dosage and use earlier in this chapter.)

—
Ginkgo biloba.
For a man with ED as a side effect of taking antidepressant drugs, ginkgo biloba can be especially beneficial. A study reported in
Alternative Medicine Review
found it 76 percent effective in alleviating symptoms associated with every phase of the sexual-response cycle, including symptoms of ED, in men with antidepressant-induced sexual dysfunction. Another study, published in the
Journal of Sex & Martial Therapy
, supported these results. The recommended daily dose for treating ED is 200 mg, as a standardized extract of 24 percent ginkgo flavonglycosides. (See usage guidelines described previously in this chapter.)

—
Herbal formulas.
Some Chinese formulas include various combinations of Chinese ginseng, Lu Rong, or epimedium, making them valuable for treating ED. One formula, called Man’s Treasure (also known as
Nan Bao Pian
)—which contains Chinese ginseng, epimedium, and other nourishing herbs—is recommended for treating male impotence and infertility, as well as fatigue and premature aging. The recommended dose is two pills three times daily. Another formula, Male Function, includes Chinese ginseng, Lu Rong, epimedium, and other herbs that stimulate chi and increase circulation. The recommended dose is four capsules three times daily. (Note: Either of these formulas, if taken by a man who doesn’t have ED, could cause overstimulation, which can ultimately lead to depleted chi and low libido.) For resources for Chinese herbal formulas, see
Appendix C
.

In this chapter, you haven’t yet explored one of the other important issues that can cause or contribute to ED—a low testosterone level. For some men, ED can be a symptom of low testosterone. If ED is associated with low libido or occurs around midlife, low testosterone is especially likely to be a factor. Low testosterone is a separate challenge unto itself, and so vital to a man’s sexual health that it deserves special attention; we’ll devote the next section to a detailed exploration. If a man’s ED is due to a low testosterone level, he can treat this cause with methods mapped out in the following pages.

Resolving Low Testosterone: The Joys of Renewed Libido

Men and testosterone are inextricably linked. This hormone is an integral part of what you love about your partner; it shapes his masculine nature, musculature, deeper voice, and attraction to you. You want him to have testosterone, but just the right amount. Too much, or too little, can throw off the natural balance, affect both of your sex lives, and create hormonal havoc. The good news is that there’s a lot he can do to maintain his healthy testosterone level, and a lot you can do to support him.

You have testosterone in your body, too, and as you saw earlier in this book, it plays an important role in your sexual health. Testosterone affects both males and females, and before puberty boys and girls have about the same levels in their blood. At puberty, testosterone increases in both sexes, but it surges in boys.

In a man’s body, testosterone is made primarily by the testicles. It travels through the bloodstream, acts on many organs and tissues, and provides numerous health benefits. Studies show that men with normal or high testosterone levels are more likely to have healthy blood vessels, and may live longer than those with low testosterone levels. Low testosterone is associated with obesity, diabetes, and increased risks for cardiovascular disease and heart attacks.

Testosterone is essential for the functions of your partner’s sex organs, including his penis, testicles, prostate gland, and seminal vesicles. His penis contains testosterone receptors that release chemical signals to help with erections, and testosterone is important for his sperm production, and involved in ejaculation. Testosterone also affects his entire body by increasing the size and strength of his muscle cells, helping reduce his body fat, and playing an important role in maintaining his long-term bone strength.

Your partner’s brain also has testosterone receptors, and they affect how he thinks—including his sexual thoughts about you. Testosterone is critical to the complex tapestry of biological and psychological factors we call “desire.” If your partner has low testosterone, it may be influencing your relationship in more ways than you would expect, because it can affect his moods, motivation, and attitude toward life. In some cases, the symptoms can be enormously challenging; remember that he needs your support and compassion. In the pages ahead we’ll explore the key issues around low testosterone, what you need to know if your partner has the condition, and what can be done to resolve it.

Could His Testosterone Level Be Affecting Your Relationship?

Low testosterone—the reduction in the amount of testosterone in a man’s bloodstream to a subnormal level—is more common than many people realize. It can occur at any age, but it’s most often caused by the natural decline in testosterone in a man’s body, beginning in his mid-30s, by about one percent a year. An estimated 10 percent of 40-year-olds, 20 percent of 50-year-olds, and 30 percent of 60-year-olds have low testosterone, although a lesser number may have the symptoms. Decreases in testosterone are most likely to be caused by the hormonal shifts of andropause, when a man’s testosterone-to-estrogen ratio can change dramatically, from as high as 50 to 1 to as low as 8 to 1.

If your partner has low testosterone, it can impact many aspects of your sex life and your relationship. The symptom he’s most likely to notice is decreased sex drive; he doesn’t desire sexual intimacy as often or passionately as he once did, or feels no interest whatsoever. He may have an absence of sexual responsiveness or “spark,” even in situations he formerly found arousing. The decline can be so gradual that it goes unnoticed. It can be difficult to compare the memory of a man’s sex drive of many years ago with what it is today, and he may have forgotten what it’s like to have normal libido.