Men Are Not Always Thinking About Sex. Study Says: There Are At Least 4 "Good" Reasons They Don't - Stress Is #1! Plus: A Proven De-Stress Protocol to Restore Your Libido

If either of these individuals remind you of yourself, you should reduce his stress levels.

Recent research suggest: The good old saying that "Men always think about sex!" is essentially untrue (The "!" indicates that I used the feminist version of this common "wisdom").

If we put faith in the results of a recent European study from the Department of Clinical Psychology at the Instituto Universitário in Lisbon, Portugal, the Department of Psychology at the University of Tromsø in Tromsø, Norway, and the Sexology Unit at the Faculty of Humanities and Social Sciences, University of Zagreb, Croatia, stress is the common denominator that distracts men from their original duty to do what has to be done for the survival of the human race ;-)

Homo coitum quaerens aut evitarens?

It may sound surprising, but unlike sexual function, the sexual desire of the male members of the human race has not been examined as extensively as the one of their female counterparts. When you think about the initially quoted "wisdom", it is actually not that surprising.  Men are are after all believed to be always looking for the next "catch".

The problem cannot be that prevalent, can it? Yes it can! According to recent data from the The National Health and Social Life Survey (NHSLS), the average American's prevalence of “lacking desire for sex” ranged from 14% (for those 18–29 years old) to 17% (for those 50–59 years old). In spite of the fact that the exact figures are debatable, the currently available literature supports the notion that 15-20% of the US men 'don't think about sex at all'. If we take a look at international data the figures don't look better: Depending on the geographic region 13% to 28% of the ~14,000 men aged 40–80 years from 29 countries in the Global Study of Sexual Attitudes and Behaviours said that their sexual desire had been low for at least 2 months Laumann. 2005).

After focusing more or less exclusively on functional aspects of male sexuality for decades, research does now start to draw and embrace a more versatile image of male and general human sexuality. According to studies by Hyde and Janssen, the black-and-white gender differences which is also at the heard of the saying "men think about sex all day" is in fact non-existent. On the contrary, gender theorists have recently suggested that greater diversity exists within gender than between gender (Hyde. 2005+2007; Janssen. 2008).

Sexual disinterest is stressful!

Faced with the surprisingly high rates of sexual disinterest in men, scientists like Mccarthy et al. have already identified several major relationship problems as potential culprits. In view of what you've learned already, it should be obvious that these problems are not necessarily related to the 'classic' mismatch in sexual interests between a hyperactive male and an (under-)active female partner. On the contrary, the data in Figure 1 makes it plain obvious that for men in their thirties, it would not be unlikely that they are disinterested and their wives or girlfriends dissatisfied.

It goes without saying that problems like these and the mismatch between the perceived and the expected level of sexual desire are stressing - very stressing, according to the data Ana Carvalheira's, Bente Træen's and Aleksandar Štulhofer gathered in inteviews with heterosexual men from Portugal, Croatia, and Norway (Carcalheira. 2013):

Figure 1:Lack of desire and professional stress, two sides of the same coin? Data based on Carcalheira (2013)

In the worst case scenario a man will get caught in a vicious circle of professional stress ⇆ lack of sexual desire ⇆ private stress that is hard to break. Against that background it's only logical that the essence of the recommendations in the bottom line of this article is to get rid of the stress that's keeping you from thinking about sex.

"Stress ⇆ Sexual Disinterest" - it's that easy!

A 2013 study by Talbott et al. suggests that Tongkat Ali, a traditional testosterone and libido booster works mainly be reducing stress levels (learn more)

If you don't believe in the deeper truth of this 'equation', I suggest you go back to an article I wrote earlier this year (see Beyond Testosterone: 200mg/day of Tongkat Ali (Eurycoma Longifolia) for Stress Management & Improved Mood!?" | read more). It deals with a traditional "testosterone booster" and its effects on stressed individuals... you will see: Stress is not only a libido-, it's also a testosterone -killer (no surprise, right?).

It is thus not really surprising that the data from the Carcalheira study tells us that men who feel distressed about their own lack of libido were 2.5x more likely to suffer from anxiety right before sex  and/or have trouble maintaining an erection.

To be stressed or not to be stressed - that's the question!

Just as the cliche would have it, the highly reserved Norwegians were 3x more likely than the red-blooded self-proclaimed Latin lovers from Portugal to suffer from a lack of sexual desire. With a 50% higher risk of losing interest in the other sex, the participants from Croatia end up somewhere in between the 'Latin lovers' and the 'prudish Vikings'.

Table 1: Sociodemographic characteristics, individual variables, and relationship-related characteristics as correlates of a distressing lack of sexual interest among healthy heterosexual men who are not using antidepressants (Carcalheira. 2013)

Aside from their origin there were other sociodemographic characteristics, individual variables, and relationship-related characteristics which were found to be associated with the an increased risk of suffering from a lack of sexual desire. As the data in Table 1 goes to show you, having children, even young ones, was, contrary to what you may have expected, not among these characteristics. In contrast to the self-confidence on erectile function, of course.

What's I personally find quite telling is the high rate of a distressing lack of sexual desire in long-term (5years +) relationships and as a consequence of an indifferent attitude towards the attractiveness of the sexual partner. Interestingly, finding your wife or girlfriend "neither attractive, nor unattractive" is an even greater turn down than thinking of her as a "very unattractive" (see Table 1).

"And that's all stress?"

No, that's not all stress... In the previous paragraph we have already learned about a libido killer that cannot be traced back to stress: The lack of 'adventure', 'novelty' or whatever you may call it - a phenomenon which is probably also the reason that people start looking at their partner as "neither attractive nor unattractive" is another important contributor to sexual disinterested in men. One out of 22 if you will - 22 items on the scientists list of potential causes of a reduced sexual interest:

Table 2: Self-assessed causes of a reduced sexual interest during the past 6 months among heterosexual Portuguese, Croatian, and Norwegian men in percent (Carvalheira. 2013)

I know, not all of them appear logical. Why would masturbating too often be associated with a reduced interest in sex? ⇦ That does not sound right - right? Something similar can be said for the Croatian porn fans (22.5%). In the end, though, it does not change the overall picture: It is stress that's gnawing at our sexual desire, guys.

The Dimou protocol: Diaphragmatic breathing is performed by taking deep diaphragmatic inspirations followed by slow prolonged expirations.  In the second phase of PMR relaxation, patients were guided through successive contractions and relaxations of different large muscle groups in a down-top orientation. The process was complemented by guided imagery involving mental exercises, designed to allow the mind to influence the health and well-being of the body (GI is used with standard medical treatment in people with cancer and other diseases, such as fibromyalgia, as it can help to reduce stress, depression and manage pain). In each step, the patients were encouraged to focus on the difference between tension and relaxation, thus gradually sharpening the perception of the relaxation response.

What So what can be done? By now the question "what can be done" should - at least on the surface level - already have a rhetorical character. It's obvious that you have to de-stress. The only question is: How do you do that? Luckily (for us), P.A. Dimou et al. have just successfully tested an anti-stress program that consisted of progressive muscular relaxation (PMR), diaphragmatic breathing and guided imagery and was topped off with a handful of tips to achieve better time management. The program was designed to optimize sexual health in young men and it worked! It worked like a charm: Over the course of the 8-week stress management program practicing the PMR + diaphragmatic breathing + guided imagery regime twice a day effectively reduced the number of men who were totally or somehow dissatisfied with their sex life decreased from 9 to 4 (-55%; cf. Dimou. 2013). Aside from the intended benefits in sexual satisfaction, the young 60 young men in the active arm of the Dimou study also lost weight (-3% BMI), felt less overall less stressed (-23%; social stress subscale -11%) and achieved +6% higher scores in the general health evaluation.

PMR and guided imagery does not sound like you? Well, I guess simply limiting your mobile phone, email, Facebook and SMS use, making room for the occasional time out with a cup of tea during the working hours, a rigorous 7h+ sleeping regimen and letting go of the 'more is more principle' will work wonders even in the absence of 'meditative' interventions....ah, and don't forget: Don't stress about de-stressing that would ruin all your efforts to find inner peace ;-)

Reference:

• Carvalheira A, Træen B, Štulhofer A. Correlates of Men’s Sexual Interest: A Cross-Cultural Study. J Sex Med. 2013 [accepted manuscript]
• Dimou PA, Bacopoulou F, Darviri C, Chrousos GP. Stress management and sexual health of young adults: a pilot randomised controlled trial. Andrologia2013,xx, 1–10 [accepted manuscript]
• Hyde JS. The gender similarities hypothesis. Am Psychol 2005;60:581–92.
• Hyde JS. New directions in the study of gender similarities and differences. Curr Dir Psychol Sci 2007;16:259–63.
• Janssen E, McBride K, Yarber W, Hill B, Butler S. Factors that influence sexual arousal in men: A focus group study. Arch Sex Behav 2008;37:252–65.
• Laumann EO, Nicolosi A, Glasser DB, Paik A, Gingell C, Moreira E, Wang T; GSSAB Investigators’ Group. Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. Int J Impot Res 2005;17:39–57
• Mccarthy B, McDonald D. Sex therapy failures: A crucial, yet ignored, issue. J Sex Marital Ther 2009;35:320–9.

2g Vitamin C Ameliorate Low Testosterone Levels and Sexual Dysfunction in Diabetic Rats. Usefulness in Normoglycemic Individuals Still Questionable.

Illustration 1: In view of the increase in renal
vitamin C clearance with higher plasma levels
(Friedmann. 1940), it may be sensible to use a
time-released vitamin C formula, or, even
better, eat a serving of veggies or fruits that
are high in vitamin C multiple times a day

Yes, I know, supplemental vitamin C does not ward off the common cold... the same applies for taking super high doses of vitamin C as antioxidant buffers before or around workouts. In fact, studies have shown that the antioxidant overkill of a combination of vitamin C and other powerful antioxidants could negate the beneficial effects exercise has on human blood glucose management. Now, a group of Brazilian scientists has published a rodent study that seems to suggest that in the absence of exercise the addition of 2g (human equivalent for 80kg male) of vitamin C to your diet could partially restore sexually function and increase testosterone levels in diabetic patients (Fernandez. 2011).

In their study, the Fernandez et al. had fed 10 out of 20 hyperglycemic rats vitamin C enriched chow (+150mg) and found that the addition of the water-soluble vitamin had beneficial effects on oxidative strees biomarkers in the erythrocytes, which have proven to be a valuable indicator of stress levels for the whole body (Naziroğlu. 2001; Garg. 2000)] (cf. figure 1),

Figure 1: Stress markers TBARS, SOD, GSHt and GSH/Px in hyperglycemic rats after 30 days on normal (placebo) and vitamin C enriched chow; data expressed relative to normoglycemic controls (data adapted from Fernandez. 2011)

as well as reproductive organ weights, sperm parameters, plasma hormone levels (FSH, LH and testosterone), testicular and epididymal histo-morphometry and histopathology.of the hyperglycemic rats (cf. figure 2).

Figure 2: Organ weights (*visceral fat / 100g), reproductive hormones and sperm number and quality in hyperglycemic rats after 30 days on normal (placebo) or vitamin C enriched chow; values expressed relative to normoglycemic control (data adapted from Fernandez. 2011)

Vitamin C supplemented or not, compared to the normoglycemic control,  the diabetic rats must still be regarded as partially impotent and overall sickly, which is an observation the scientists omit, when they conclude

[...] the present study showed that vitamin C supplementation minimized some alterations in the male reproductive system caused by hyperglycemia such as reduction of testosterone and LH levels and impairment in sperm morphology. [italicization by Dr. Andro]

After all, what's the worth of a "minimizing" the negative effect on testosterone levels to  -71%? This may be 10% less damage than without vitamin C, but wouldn't it be much better not to get yourself into such a misery in the first place?

Note! Not everything that is good for sick people makes a viable addition to the supplementation regimen of a healthy or even athletic person. Even Fernandes and her co-workers emphasize that "is possible that the beneficial effects of vitamin C supplementation are only relevant to those individuals with low levels of vitamin C and high levels of oxidative stress that occur in hyperglycemic condition."

Well, regular exercise and the avoidance of high fructose corn syrup and the other sweet suspects you poise yourself with on a daily basis would be the way to go - and you know that!

Andropause? Low Testosterone? At Risk of Developing Diabetes? Get a Free Hormonal Panel and Access Your Personal Health Risks With an Old-Fashioned Measuring Tape.

Image 1: Not as realiable as bloodwork,
but a valid first indicator of testosterone
levels and metabolic health in general
(image from Millionlineincome)

I have been writing about getting hormones tested before. And if you listened to Thursday's episode of Super Human Radio and tuned in even before I was on, you will have heard Dr. Crisler from "All Things Male" talk about the paramount importance of optimal testosterone and free testosterone levels on physiological and pyschological health of the purportedly "stronger" sex (yeah, I am talking about us, guys ;-) If that got you interested or you suspect, for whatever reason, to have low testosterone levels, but are unwilling or unable to spend money on a blood test, you may well be interested in the results of a study that was published in the May issue of the Asian Journal of Andrology (Alan. 2011).

Alan et al. who investigated the relationship of age, adiposity and testosterone levels in 207 otherwise healthy aging men (>= 54 year) with symptoms of hypoandrogenism found a significant correlation of both total and free testosterone levels and the waist-to-height (WHt) ratio of their subjects:

[...] WHt ratio was more strongly correlated with TT and cFT than either WC [waist circumference] or BMI. Furthermore, in models of TT and cFT, the addition of Ht to WC resulted in an increase in the magnitude of the regression coefficients for both WC (inverse correlate) and Ht (positive correlate), with the contributions of both WC and Ht both being significant (P<0.05 for all).

Table 1: Waist-to-height ratio corresponding
to increased risk of high blood pressure,
elevated blood glucose and high triglyceride
levels (data adapted from Leitzmann. 2010)

Or in other words, if your tall and lean chances are your erectile dysfunction or whatever possibly androgen-related problem is plaguing you, is not a result of low testosterone levels. While this does not exclude the possibility that overtly high estrogen levels or low 5a-reductase activity and consequently low DHT levels (I have written about the importance of DHT in the context of "all things male" before) are at the bottom of your problems, you will at least know that checking testosterone alone probably won't provide the answer to your question.

On the other hand, these results exemplify the viscous circle of how low, or as many family physicians like to refer to them, "age appropriate", androgen levels, predispose to (predominantly visceral) adiposity, which - apart from its direct detrimental effects on metabolic health (cf. table 1) - in turn increases aromatization of testosterone to estrogen and thus further reduce the availability of the primary male sex steroid. While it appears that this is another instance of the "chicken and the egg, who was first?"-question, I would argue that chances are that the "age appropriate" decline in androgen levels goes hand in hand with increasing obesity and should thus also be addressed by a multi-faceted approach constituting of professionally* supervised hormone replacement therapy and appropriate life-style changes, in other words, the incorporation of regular exercise and healthy eating habits into your daily routine.

* the attribute "professional" obviously excludes your average family Dr. who considers your testosterone level "age appropriate" and refuses to measure estrogen, DHT, DHEA and all the other endocrine parameters without which you will never get the full picture

Now Its Official: Propecia Drug Finasteride Kills Male Libido Permanently

Image 1: Chemical structure of finasteride

Other than the FDA some European medicine and health care agencies, such as the Swedish Medical Products Agency and the Medicines and Healthcare Products Regulatory Agency of the United Kingdom already had the guts to declare in their patient informations that "persistence of erectile dysfunction after discontinuation of treatment with Propecia has been reported in post-marketing use." While this was obviously no reason for the all-mighty FDA to correct or re-evaluate their own documents, two it did intrigue Michael S. Irwig and Swapna Kolukula, two US scientists from Washington and Baltimore, respectively.

In their study (Irwig. 2011), the scientists conducted standardized interviews with 71 otherwise healthy men (age: 21–46y), who experienced permanent (>3 months) sexual side effects after temporary use of Finasteride. Their reports are staggering:

94% developed low libido, 92% developed erectile dysfunction, 92% developed decreased arousal, and 69% developed problems with orgasm. The mean number of sexual episodes per month dropped and the total sexual dysfunction score increased for before and after finasteride use according to the Arizona Sexual Experience Scale (P < 0.0001 for both).

These sexual side effects occurred after a "mean duration of finasteride use [of] 28 months" and they were persistent up to the interview date. For the study population this meant that they had already been suffering 40 months, on average, when the interviews took place; and chances are that many of them will suffer the consequences of an insufficient (or should I say incompetent or corrupted?) drug approval process and consequent indoctrination of medical practitioners for the rest of their lives.

Note: After receiving some critical feedback via facebook, I feel that it is necessary to point out that the result of the study may not be misinterpreted as "Every Finasteride user will experience persistent decreases in libido, erectile disfunction etc.", but as "In those percentage of Finasteride users, where such side effects occur, they can potentially be permanent." So the news is neither that Finasteride will cause these effects in each and every user, nor that it may cause such side effects (that is in fact mentioned in the package insert, I suppose), but that IF side effects occur, it is possible that they are persistent.

Chrysine: 5,7-dihydroxyflavone for Bigger Balls and Higher Serum Testosterone

Polyphenols in general and flavonoids in particular are every supplement producer's favorite. Its so easy to pick up some exotic plant from somewhere deep down in the jungle, extract an exotic flavonoid, give it a fancy chemical looking name and provide some in-vitro data on his anti-oxidant omnipotence or whatever. In most cases the compounds disappear from the market within weeks, yet chrysine which is extracted from the Common Passion Flower, has been around for years. A recent study (Ciftcy. 2011) by Ciftci et al. provides further evidence that its market persistence may not be without a reason.

Over the time course of the scientists fed a group of lab rats 50 mg/kg chrysin (human equivalent ~8mg/kg) or placebo for 60 days and found:

that chrysin significantly increased GSH, CAT, GSH-Px and CuZn-SOD levels, but did not change the formation of TBARS significantly. In addition, sperm motility, sperm concentration and serum testosterone levels significantly increased, whereas abnormal sperm rate significantly decreased with chrysin treatment.

In essence the improvement in antioxidant markers (vs. placebo) went hand in hand with a measurable increase in sperm health and serum testosterone.

Figure 1: Testosterone levels of rats after 60 day intervention with 50mg/kg chrysin. (Ciftcy. 2011)

 "Great", well, maybe not so... although this is an almost 50% increase in testosterone, we do not know how other important hormonal parameters such as SHBG (binds testosterone and thus renders it basically useless), estrogen or cortisol looked like. An estimation of the "muscle building effects", the producers of respective supplements are advertising, is thus futile. And, if you asked my opinion, even if SHBG did not budge and we have an appropriate increase in free testosterone, the latter is probably too little to induce noticeable changes in strength and/or body composition.