I am not sure about you, but I want to age well. I want to feel strong, clear minded and healthy. As a male, I grew frustrated by the lack of support, quality information, and guidance to help me understand what is normal and when to ask for help. I realised I was not alone when my patient base naturally began to shift from predominantly female to male. Rather than putting their head in the sand and waiting for something to ‘break’, men are starting to take control of their health.
Today, my patients are looking for comprehensive assessments to baseline their health, while others had a more targeted concern. One of the main themes/concerns I see in my practice is sexual performance and erections – and there is a lot of misinformation out there. As part of Movember, I wanted to share with you a few Frequently Asked Questions that I often hear in an appointment. My goal is to open a healthy, non-judgemental discussion, and to normalise our concerns.
Why is my erection less hard?
No pun intended, but this is a loaded question. More often than not, the cause of ED is multifactorial. With that said, some patients want a quick fix. Why not just take Cialis or Viagra? I agree! But that is a band aid solution. Our sex life plays an important role in how we feel and using a “bridge” like cialis is a tactical way to patch the issue while we restore the natural function of your body.
To be transparent, most men, especially as we age, have some variability in hardness. What is healthy and what is not? There are various tools, including the SHIMs assessment tool, that guide treatment options. In my opinion, it is important to address changes earlier rather than waiting optimistically for things to resolve on their own – they rarely do. The first step is to evaluate any underlying factors that are decreasing blood flow. This includes a review of your medical history, medication side effects, supplements, injuries and so forth. It is also important that you have comprehensive blood work that evaluates a full hormone panel, as well as markers for diabetes, cardiovascular health, inflammation, liver and kidney function. As a naturopathic doctor, my approach is to restore the natural function of the body by addressing the root cause. If the reason for ED is linked to low testosterone, we lift the barriers that prevent your testicles from making testosterone on its own. If you live with metabolic syndrome – you guessed it – we work towards weight loss. Wired but Tired? – we work towards shifting you into a “rest and relax” nervous system so you can get an erection. Are the muscles in your pelvic floor restricting blood flow – we assess your pelvic floor and prescribe tactical strengthening and stretches exercises.
A good practitioner will need to complete a thorough assessment to get to the root of the issue. Erection quality is impacted by pretty much every system in your body. Although this may feel overwhelming, there are strategic steps that are taken through the evaluation process to identify where the imbalance rests. It is worth noting, and from my vantage point, almost every male who has struggled with his erection will at some point be faced with performance anxiety – which is the #1 boner killer in my opinion.
I feel like my penis is shrinking – HELP!
Last winter I ran a cold water immersion workshop and some of the guys joked about shrinkage. The reality is that it is normal to experience shrinkage in cold water just like it is healthy for testicles to stretch/lower with heat. But what happens if you observe that your penis is less full/smaller and feels “pulled in” all the time?
The 4 most common reasons are the following:
- Low Testosterone: Normal testosterone keeps the tissue in your penis profuse by increasing nitric oxide, collagen formation as well as supporting healthy nerves and blood flow. On the other hand, low testosterone will result in a hardening of the penile tissue (fibrosis), less fullness (flaccid and erect), and decrease sensitivity. It is also common for males to notice that their testicles decrease in size as well (testicular atrophy). On the flip side, as testosterone increases to a normal range, you may notice an increase in fullness and length.
- High Estrogen: Estrogen is needed in males to regular sex drive, increase sensitivity on the head of your penis, fertility, and bone health. However, estrogen can accumulate in the male body with poor liver health, excess fat tissue, diabetes, thyroid issues, environmental exposure and excess testosterone production/TRT (testosterone can convert to estrogen). When the ratio between testosterone and estrogen is imbalanced, not only will a male experience shrinkage, but he may also develop depression, low libido, gyno, and weight gain.
- Pelvic Floor Imbalance: You can either over or under train the muscles within your pelvic. The consequence of a weak pelvic floor is the inability to hold blood within your penis, less bladder control, and a decreased “pumping” sensation when you ejaculate. On the flip side, if you over train, there is a possibility that you have created an imbalance which can restrict blood flow, cause your penis pull to one side, and/or experience pelvic pain/discomfort. It is very important to mention that some of these symptoms can also be caused by prostate issues.
- Cardiovascular (blood flow restriction): This one seems obvious – lack of blood in the penis = smaller penis. To be honest, there are easy solutions like shockwave therapy and PDE5i/Triple P/Trimix (injection) which dilate blood vessels to increase fullness. However, as a naturopathic doctor, my clinical mind shifts to the rest of the body. If the blood vessels in the penis are restricted, what is going on the rest of the body? More importantly, how do we increase longevity by supporting the entire cardiovascular system?
What is the difference between Libido and Testosterone?
Most of my patients associate high testosterone with high libido. But this is not always the case. There is a misunderstanding that for men, getting turned on is as simple as turning on a light switch. We are socialised to think this way however libido is more complicated than that.
Low Libido/Normal Testosterone:
There is an expectation that we should always be ready for sex – to perform on demand and that is a lot of F*%^*$ pressure! Contrary to popular belief – We have feelings, we get tired, we don’t feel valued in our relationship, all of which affect our libido or desire for sex. Our testosterone and sexual function can be top notch but we struggle to get turned on. When this happens, it is important to shift the focus away from testosterone and towards the nervous system, stress management, mood and so forth.
Very High Libido/Normal Testosterone
It is not uncommon for a male come in with average/normal testosterone levels and an exceptionally high libido. If testosterone levels are normal, what is driving such a high frequency/need to ejaculate? A blast of serotonin, oxytocin, nitric oxide, vasopressin, prolactin! This bundle of hormones shifts the nervous system into a rest and relax state – a natural anti-anxiety treatment. I have found that men who masterbate daily, if not twice a day, use ejaculation as a way to down – regulate their nervous system. Inevitably, even with this self treatment, they still have poorly managed stress and sleep issues which will eventually lower their testosterone.
Low Libido/Low Testosterone
This can be very frustrating and in such cases, it is important to have a comprehensive assessment including a full hormone panel to evaluate the root cause. At this point, I am sure you are now aware that high stress, poor sleep, high estrogen, excess body weight, diabetes, poor cardiovascular health, anxiety, and depression all play an integral role in your sexual health. Finding a trusted clinician is key to rebuilding your body.
Normal Libido/Normal Testosterone:
No treatment needed 🙂
Dr. Yousuf listens to his patients and builds strategic, effective and realistic approaches that will leave them empowered and feeling stronger.
- Low testosterone, Male Infertility, Anxiety, Depression, ED, male Pelvic pain, Prostatitis, BPH, Performance Anxiety and other Reproductive Issues
- Menopause (including BHRT), Vaginal Dryness, Hot Flashes, IC, and frequent yeast infections.
- Addressing the underlying cause of Chronic Fatigue Syndrome including Infection, Hypothyroidism, Depression, Anxiety, and infection.
- Digestive issues including SIBO/SIFO/Crohn’s/Colitis/GERD/IBS of unknown cause
- Intravenous Therapy
- Institute of Functional Medicine (present)
- IV Certification Course
- University of Florida: Bio Identical Hormone Compounding
- Pelvic Floor Therapy Level 1 (Male Only) – Incontinence/Prostate
- Pelvic Floor Therapy (Male Only): Overactive Bladder, Pelvic Pain, Genital Pain, ED, Genital Numbness.
- University of Guelph: Sex Therapy
- Certified Yoga Instructor
- University of Toronto: Motivational Interviewing Certification
- University of British Columbia Ontario Therapeutics and Prescribing Course
- Doctorate in Naturopathic Medicine
- Internship at the Brampton Civic Hospital (Naturopathic Clinic)
- Internship: Sherborne Medical Clinic
- Externship: MamaBaby Haiti
- Externship: Ayurvedic Hospital, Kerala India
- Bachelor of Architectural Science
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