Male libido-sex drive process begins “above the belt” in the brain and is necessary to drive “below the belt” sexual function for strong hard erections. If libido is low that has to be corrected first before you can attain and maintain strong erections. Factors for a low or normal-high libido /sex drive in a younger male can be:
1.Fatigue, overtraining, too much uncontrollable stress,
2.Depression,
3.Use of certain medications including certain anti-depressants, medicines like Propecia,( Finastride ,which promotes hair growth), and many others can impact sexual desire.
4.Use of non-aromatizing (non-estrogen producing) anabolic agents like the Nandrolone family of anabolic steroids (Nandrolone-decanoate, Stanazolol, Oxandralone etc.).
5.Poor quality diet and poor sleep patterns and sleep quality.
The nandrolone anabolic agents when used alone are highly anti-sexual. An example is Provera (MPA: methyl progesterone acetate), a synthetic progesterone that has a molecular structure very similar to many of the synthetic anabolic nandrolone hormones. MPA has been given by injection to male sexual offenders to decrease sexual interest and drive. Some men refer to a sexual situation called – “Deca-Dick” (erectile dysfunction syndrome) from the sole use of nandrolone synthetic anabolic agents especially Nandrolone undecanoate . However if you add in a natural testosterone product, which can convert to estrogen in the brain than libido and erections may return.
Other factors for sex drive:
1.Proper training, intensely with heavy weights in short “bursts” or “wind sprints” can elevate testosterone and growth hormone for a few hours. Many men feel more sexual after properly exercising. Stress levels decrease and there is also an increase of the “feel good” endorphins-enkephalins in the brain. If you train more than 1.5 to 2 hours frequently and “very intensely” you may not get the “feel good” normal effects and instead you may experience fatigue, decreased sex drive and sexual interest, and erectile dysfunction.
2.Good quality sleep promotes GH release and testosterone production especially slow wave (non-REM/ non dream sleep) sleep is associated with nighttime GH spike-release in men.
3.Men can roughly determine if their testosterone production levels are normal and adequate by noticing if they have morning erections. If are present then they likely are producing normal amounts of testosterone. If erections do not occur in the early morning then it should be investigated with laboratory studies such as testosterone (total and free), estradiol, cortisol, lutenizing hormone, prolactin and dihydrotestosterone (DHT). These have to be in proper ratios of testosterone (total and free) to estradiol, DHT and cortisol in order to have a strong sex drive and sexual-appetite.
4.Dietary factors: Total vegetarians (vegans) usually do not get enough sexual nutrient intake and often have low sexual desire and poor erectile function. It is important to get whole proteins from lean meats, fish, and whey protein etc, Soy protein is not a complete source of all the amino acids you need. Some vegetarians only eat protein sources like tofu, soy milk, nuts etc. These individuals often will lack many nutrients to synthesize testosterone, nitric oxide, and certain neuro transmitters. You need to have an active dopaminergic brain center to have a good sex life. This sexual brain center requires amino acids such as tyrosine, phenylalanine and testosterone to keep the brain on a sexual mode.
A young healthy male in his mid twenties normally produces about 5 to 7 mg of testosterone from the testes daily. An average good blood testosterone level for a young male in should be maintained at about 800-1,000 ng/dl total testosterone (normal range of total testosterone 250-1100 ng/dl) and about 100-135 pg/ml of free testosterone (normal range is about 35-155 pg/ml free testosterone).
NOTE: Each different lab usually will have it’s own normal range of testosterone levels and other hormone concentrations. By being “In Range”
according to laboratory standards does not mean they are the optimal testosterone values, especially if you factor in a younger person’s age.
European labs use different for many lab value units nm/L etc. The U.S laboratory numbers needs to be translated to European equivalents.
For sexual desire-libido you do not need testosterone levels as high as you would need for a larger muscle mass and strength. Total and free testosterone is more or less somewhat proportionate to a persons total muscle mass, but not so for sexual desire or erections. For sexual desire and sexual function many men can have a good libido and erectile function at a total testosterone of about 375-450 ng/dl (normal range being 250-1100 ng/dl) and free testosterone levels of 40 to 60 pg/ml (normal range : 35-155 pg/ml) . Usually below those testosterone levels many men can have a low mood, depression, low sexual interest and a low libido.
It is not true that the higher the testosterone levels the greater the sexual drive or sexual appetite a male has. It is more complicated as discussed before. For sexual desire there has to be a proper balance between free testosterone, estradiol, dihydrotestosterone (DHT), prolactin and cortisol. Plus you need to be living a relaxed stress controlled lifestyle and environment for good sexual function.
Often in my clinic I see that “when men show the biggest shift from a low to a high or normal testosterone levels” they usually experience the greatest improvement in sexual drive and better sexual function and mood. Once they get adjusted to the normal testosterone levels they may lose this initial “sexual boost” effect.
In many cases men may have normal free and total testosterone levels and still have decreased sexual desire and poor erections. These men may be overproducing estrogen via aromatization in fat cells or within muscle. This process especially occurs more often in older and fatter men. These men may not be able to lower estrogen levels by fat loss. To block estrogen conversion from testosterone using some of the following may be helpful:
1.Decrease soy intake,
2.Using pure red wine extracts (alcohol removed from the wine) have been shown to contain natural substances that block testosterone conversion to estrogen. Drinking too much red wine may have the opposite effect of raising estrogen levels.
3.6-OXO – a semi synthetic substance has some blocking effects on testosterone to estrogen aromatization,
4.Use Zinc at 35-50 mg per day.
5.Chyrsin is a weak estrogen blocker and recent studies have shown that there may be some liver toxicity associated with it.
6.Medicines that that may be useful and are potent estrogen blockers like Anastrazole, Letrazole, Exemestrane. These are prescription medicines in the USA often used to decrease estrogen in certain types of breast cancer patients. I often prescribe 0.35 mg of anastrazole to be used every three days to keep the estradiol levels in a desireable normal range. If some one has very high testosterone levels they may need a higher dose. Too little estradiol is bad for bone and cardio-vascular health. So estradiol levels need to be monitored.
Some men have sexual problem from low DHT levels with normal testosterone, but high estradiol levels. These men may do better by raising DHT via pharmaceutical therapy and stopping using medicines like Propecia (finasteride and dutasteride -avodart), which block conversion of testosterone to dilydrotestosterone-DHT). Decreased DHT levels can lower sex-drive. Sometimes I prescribe compounded preparations of testosterone (T) gels with T mixed with DHT . They can be very helpful to enhance sexual interest and even erections. I have treated men in my clinic who are in their late 30’s or 40’s who still have extremely and unusually full head of hair. Which upon lab testing they turned out to be “Estrogen Dominant Men.” Some lacked conversion of T to DHT and some had androgen receptor resistance. Since DHT has greater affinity for the androgen receptor than testosterone it made a lot of sense that their sexual lives got much better when DHT was added to their testosterone therapy.
I have treated such men with 70% T mixed with 30% DHT gels or creams (70 gm T + 30 gm DHT) or 80-20% (80 gm T + 20 gm DHT).
These T+DHT topical preparations remarkably increased their sex drive and erections and made their sexual live s much better.
ERECTILE DYSFUNCTION ENHANCEMENT NOW THAT YOUR APPETITE AND SEX DRIVE ARE STRONG – HOW TO ENHANCE ERECTIONS?
Hard and long enduring erections are a function of sexual “lust”, erotic environment and good penile blood flow.
Blood flow to the penis decreases with smoking, anxiety (often from performance anxiety), recreational drugs like cocaine, amphetamines, “crack” etc. and many medical drugs or illnesses. It is interesting that many younger women’s sexual function, drive and lust often goes up with use of stimulants like cocaine, amphetamines etc whereas men often have the opposite effect. An essential nutrient for blood vessel dilation (erections) is the amino acid L-Arginine. During the night you cannot synthesize L-Argenine since you are not eating.
Some of my patients use 3-6 grams of L-Arginine 2-3 hours before sex on an empty stomach to enhance erections. Some men have poor responses to the erectile drugs (Sildenafil, Toldalafil, Vardenafil) because they lack of L-Arginine in their diet and may need supplement.
I have men 20 to 30 years old coming to my clinic for erectile problems. Usually their laboratory tests are normal as well as their medical examinations. Some have “condom syndrome” – loss of erections once a condom is put on. Usually they respond to one of the erectile drugs and get over the fear of condoms over time.
Some men can have elevated prolactin levels with poor libido, erections and low mood. These men need further investigation with pituitary MRI imaging to look for micro adenomas ( excessive growth of prolactin producing cells) in the pituitary gland. Over time small prolactin producing adenomas decrease testosterone, sex drive and sexual function. Often this “prolactinoma ” problem can be treated successfully with dopaminergic agonist medications such as bromocriptine and others.