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Male Biological Clock

A man's genes, coupled with the facts of his life, set the limits of his sexual biological clock. But men can still do a lot to improve their fertility and their sexual performance.

A man's genes, coupled with his life circumstances, set the broad limits of his sexual biological clock. In other words, the quality of his semen and his sperm, his average testosterone level, and the quality of his erections are controlled, to a large extent, by his unique genetic heritage. But men can still do a lot to improve their fertility and their sexual performance. In this chapter, I'll look at general ways that any man can slow or reverse his biological clock and improve his sexual health.

Following these guidelines will absolutely make a difference, regardless of your age or whether you have any current problems. Remember that sexual anatomy is a lot like a fairly complicated machine, and, like any machine, it will perform better if it is used properly and maintained regularly. Both men and their partners should consider what follows an instruction manual for the care and upkeep of the male sexual anatomy.

Eat the Proper Fuel, Do the Proper Amount of Exercise

The old cliche "You are what you eat" contains a fair amount of truth. A man's body, including his sex organs, is made from the food he eats, the beverages he drinks, and the air he breathes. Eat right, and everything improves—including sexual health. As with most things in life, an appropriate guide for eating to promote sexual health is "All things in moderation, including excess." The idea is to avoid extremes in any direction and yet preserve the pleasure of eating.

For example, much research shows that a high-fat diet, high cholesterol levels, and obesity lower testosterone levels and increase the risk of erection problems. That's because excess fat is converted to estrogenlike compounds that curtail the production of testosterone, and fat in the blood can clog the small arteries that feed the penis. Remember, what is bad for the heart is bad for the penis. A recent study, in fact, found that, conversely, improving cardiac health improves erections, a fact recently illustrated by a study showing improved erectile function in a group of men treated with a cholesterol-lowering medication.

On the other hand, studies also show that very lean men—for example, marathon runners—have lower-than-average testosterone levels. That's because the compound used to build testosterone molecules in the body is cholesterol, and extreme exercise lowers cholesterol levels to abnormal levels. A man needs enough cholesterol in his diet to maintain testosterone production, but not so much that it produces body fat or clogged arteries.

A similar dynamic exists with vitamins and minerals. Many studies in both animals and men show that deficiencies of vitamin E, vitamin B12, zinc, selenium, and a host of other vitamins reduce sperm production. But that doesn't mean guys should go out and start popping extra zinc tablets. Taking megadoses of any vitamin can cause problems—the body is simply not built to absorb such large amounts, and a man will both be wasting money and harming his health by doing so.

Men need adequate levels of all the key vitamins, particularly the so-called antioxidant vitamins A, C, and E. Although the current recommended levels of these and other vitamins and minerals may not be perfect (they are revised periodically in light of new research), I think it makes sense to follow the latest recommendations and take a general-purpose vitamin supplement every day that will "cover your bases."

Here are the latest dietary guidelines for men published by the National Research Council. This is the best guide for determining if you are eating enough of a given nutrient, such as fiber, and for determining how much, if any, vitamin and mineral supplements you need.

  • Vitamin C: 90 milligrams

  • Vitamin D: 10 micrograms

  • Vitamin E: 15 milligrams

  • Calcium: 1,200 milligrams

  • Iron: 10 milligrams

  • Zinc: 15 milligrams

  • Beta-carotene: 5–6 milligrams

  • Folate: 400 micrograms

Of course, it would be best if we all derived an optimal vitamin and mineral balance every day from the foods we eat, but that's not always easy or possible these days. A supplement is particularly important for vegetarians or those on other limited diets because, unless one is very careful, vitamin and mineral deficiencies can occur.

Science has not found any particular diet that reliably improves testosterone or fertility. Everything points to the general idea that if a man eats for whole-body health, he'll be eating for his sexual health as well. The following guidelines are recommended.

  • "No wheat, no weight." Limit wheat products such as breads, pizza, pasta, cookies, and cake.

  • Avoid white flours, white rice, and sugar; all these cause large spikes in blood sugar levels that can sap energy and lead to adult-onset diabetes. Whole grains are far preferable (and are often more tasty as well).

  • Switch from saturated fats such as butter to unsaturated fats such as liquid oils.

  • Eat plenty of fruits and vegetables (just don't drown them in butter or salad dressing)

  • Keep portions of protein, particularly red meat, modest.

  • Get more fiber in your diet. A morning high-fiber cereal is a very good way to help reach the recommended level.

  • Eat a diet that is balanced in protein, carbohydrates, and fats; you'll feel less hungry. In general, consumption of carbohydrates increases appetite, while consumption of fats and proteins decreases appetite—but don't push this to extremes.

These guidelines may sound overly simple, but you don't need to follow complicated regimens, fancy diets, or other faddish ideas such as a low-carb diet, a low-protein diet, or a low-fat diet. Most people instinctively know how to eat well; the problem is not succumbing to the temptations produced by our inborn cravings for fat and sweets, cravings that served our species very well ten thousand years ago but are now causing us grief.

Optimal sexual health is also promoted by moderate, regular exercise. Again, the key is avoiding extremes. Studies show that men who exercise strenuously (i.e., men who run more than 100 miles a week or who bicycle more than 50 miles a week) usually have a lower testosterone level than men who exercise more moderately. Given that most men do not, in fact, exercise even moderately, this is not exactly a huge public health problem.

Exercise at any level, even walking, is better than no exercise, but maximum benefit is derived when exercise is strenuous enough to be aerobic, meaning any activity that uses large muscle groups, can be maintained continuously, and is rhythmic in nature. Such activity causes the heart and lungs to work harder than normal, which is the key to achieving both the physical and mental advantages of exercise.

When an overweight man, particularly one with excess abdominal fat, has a low testosterone level (which often is the case), I do not recommend that he begin exercising right away. It's simply going to be frustrating because he will lack the drive and energy needed to exercise. Instead, I boost his testosterone levels medically, and almost always, he then finds he wants to exercise because it simply feels good. Exercise may cause an initial small weight gain from added muscle mass, but this is usually followed (in overweight men) by significant weight loss, because more calories will be burned and the added muscle mass raises a man's metabolic rate. 

Men need to think about their sexual health when they're making choices about which foods to eat and whether or not to exercise. It's one thing for a man to know in the abstract that it's good to exercise and eat right; it's quite another to understand that doing so will help his sex life and potency.

Quit Smoking

Several studies show that men who smoke have lower sperm counts and their sperm are somewhat more likely to be abnormally shaped. Smoking also makes it harder to get and maintain an erection because it releases (among other things) adrenaline and other stimulating compounds that make it harder for blood to flow into the penis in response to sexual stimulation. Smoking is one of the major risk factors for erectile dysfunction.

Clearly, however, smoking by itself doesn't cause infertility, nor does it make sex impossible—if it did, the tobacco industry would be out of business very quickly! Smoking is just one of many lifestyle habits that when added together can significantly erode fertility or sexuality.

Avoid Anabolic Steroids

As we saw in Chapter 2, more and more men these days are using anabolic steroids to gain a competitive edge or become "bulked up." Anabolic steroids act like testosterone in the body. Taking the doses commonly used by athletes is like flooding the body with extra testosterone, which cripples a man's natural testosterone production and fertility. Although some athletes take steroids in six- to twelve-week cycles, resting in between in order to "give their bodies time to recover," it actually takes between six months and a year for sperm and testosterone production to return to normal after a course of steroid use.

Anabolic steroids are simply bad for fertility—and ultimately bad for your overall health. (Note that corticosteroid medications such as prednisone and cortisone, which are used to relieve itching, rashes, allergic reactions, and other medical conditions, are not the same as anabolic steroids and have no effect on either fertility or sexuality.)

Avoid Hot Tubs

Hot tubs are great, and if all a man cares about is sex, there's no harm done and possibly plenty of good to come from a nice relaxing soak (particularly if it's done with a partner). Unfortunately, as mentioned earlier, heat and sperm are a bad mix. Sperm are made in the testicles, which usually hang from the body in the scrotum. As we've seen, the sperm-making cells of the testicles don't work right unless they are cooler than body temperature by a few degrees Fahrenheit.

In order to keep the temperature of the testicles relatively constant, the scrotum is lined with temperature-sensitive muscles. In warm conditions the muscles relax and let the testicles hang far from the body, whereas cold temperatures (particularly cold water) make the scrotum contract, pulling the testicles tight against the body for added warmth. Soaking in a hot tub makes it impossible for the testicles to remain as cool as they would like to be, which may reduce sperm formation or harm sperm that are already made. (This impact on fertility also occurs if a man is running a high fever.)

Avoid Drugs

Abuse or long-term heavy use of alcohol, marijuana, cocaine, or practically any other recreational drug clearly impairs both fertility and sexual performance. As Shakespeare wryly noted in Macbeth, alcohol "provokes the desire, but it takes away the performance." The same can be said for other drugs when used to excess.

But the jury is still out about whether occasional or moderate use of drugs has any kind of significant long-term effects on reproductive health. Although animal studies and research with relatively high doses of THC (the active ingredient in marijuana) have shown a negative effect on such factors as sperm quality and quantity, a recent report by the Institute of Medicine says: "It remains to be determined whether smoked marijuana or oral THC taken in prescribed doses has a clinically significant effect on the fertilizing capacity of human sperm."2 In addition to this, the report notes that studies of marijuana's effects on fertility "have yielded conflicting results." The situation with alcohol is similar: effects can be demonstrated at high doses or in alcoholics, but the evidence is mixed at the levels most people consume.

Common sense suggests that men with fertility or erectile problems should abstain from, or indulge only very moderately in, alcohol or other recreational drugs.  

Check Your Medications

Many medications commonly used to treat other illnesses or conditions can affect fertility or sexuality. As noted in previous chapters, some antidepressants impair erection and make it difficult or impossible to achieve an orgasm. (Of course, as we saw in Chapter 3, this can be an advantage for men with premature ejaculation.) Other medications degrade sperm quality. Here's a list of the major classes of drugs that have the potential to harm sexual health:

  • Calcium channel blockers, beta-blockers, and thiazide medications for high blood pressure

  • Cimetidine (for peptic ulcers)

  • Cyclosporin (after an organ transplant)

  • Chemotherapy for cancer

  • Antidepressants of the selective serotonin reuptake inhibitor (SSRI) class

Men who suspect that they are experiencing an adverse sexual reaction to a drug should talk to their doctor as soon as possible about switching to another drug or changing their dose.

The preceding advice in this chapter can help every man, whether he's experiencing a problem or not. Remember: what's good for your heart is good for your sexual health, and anything that improves your overall health will improve both your fertility and your sexual performance.