The human male has a distinct physiology that brings its own health opportunities and challenges. In this special report we look at the natural and preventive health strategies a man can use to stay healthy for a lifetime.
Anatomically, the male reproductive system comprises the testes and the penis with a system of ducts and glands, including the prostate. The testes are a pair of egg-shaped glands that sit in the scrotum on the outside of the body next to the penis and it’s these (stimulated by the action of pituitary hormones) that produce both sperm and the male hormone, testosterone. The brain, through hormone regulation by the pituitary and hypothalamus, plays a critical role in the control of the male reproductive system.
In young men, the prostate is about 20g (but it becomes enlarged as men age. The prostate doubles in size between the ages of 21 and 50, then doubles again from 50 to 80 years old, although it’s not fully understood why this happens.
Testosterone is the primary male sex hormone (androgen) synthesised from cholesterol. Its synthesis and secretion occur mainly in the testes; its production is stimulated by the hormone from the pituitary gland, in turn stimulated by the hypothalamus. Once it’s released into the general circulation, about seven per cent is tightly bound to the storage form – sex-hormone-binding-globulin (SHBG) – and unavailable for biological activity. Forty-eight per cent is bound to albumin, serving as a buffer to protect it from rapid metabolism, and about two per cent is free testosterone – the bioavailable and active form.
Testosterone’s metabolism is regulated by feedback mechanisms and by the liver, which breaks down the hormone to its inactive metabolites after use. Testosterone is also secreted by the adrenal glands, which is why stress can impact on its levels.
Testosterone and oestrogen interact in complex ways and liver congestion can seriously affect the balance. The pathways in the liver that detoxify environmental chemicals also break down hormones such as oestrogen so, with the high chemical exposure of today, these pathways are overloaded and hormone breakdown and secretion are reduced.
Testosterone regulation determines male health. It plays a key role in the development and function of the male reproductive system. Testosterone has major anabolic effects, is responsible for muscle growth and strength and plays a role in the normal inflammatory response.
During foetal development, testosterone promotes maturation of the sex organs, particularly the penis and the scrotum. This process is initiated in the first four to six weeks of conception when the male characteristics start to develop.
Once the male baby is born, testosterone levels rise, triggering the masculinisation of the brain where it crosses the blood-brain barrier into the male brain, a pathway that’s blocked in females. During puberty, androgen levels rise (in both boys and girls), causing adult-type body odour, and increased oiliness of the skin (sebaceous glands enlarge), acne, and appearance of pubic, facial, body and armpit hair and, in males, the deepening of the voice. In boys, androgens stimulate male sexual differentiation and development, a heightened level of free testosterone in the blood, triggering sperm production, increasing male fertility and libido, penis enlargement and the frequency of erections.
In adult males, testosterone is essential for healthy sperm development, regulating the hypothalamic-pituitary-adrenal axis (the stress pathways) and increasing competitive and challenging behaviour.
In terms of sexual arousal, testosterone levels peak early in the day, regardless of sexual activity. Research shows that the degree of sexual arousal is exquisitely sensitive to levels of testosterone and there’s a marked increase in male testosterone levels when meeting a new female. Males are also very sensitive to female body odour and testosterone levels rise when exposed to an ovulating female – sexual arousal in men is heightened when women are most fertile. The prostate secretes a slightly alkaline fluid that transports the sperm into the female vagina for conception. This alkalinity counters the acidity of the vaginal tract and prolongs the life of the sperm.
As men age, circulating androgen levels decline. Between the ages of 20 and 70, serum testosterone levels fall, with an increase of SHBG of 30-50 per cent, causing a decline in free testosterone of 30-50 per cent. The principal androgen in the prostate is dihydrotestosterone (DHT) and, as men age, the balance of DHT is increased with the reduction in serum testosterone
Androgen (male hormone) receptors for these hormones occur in the prostate but are also widely distributed throughout the body, including in vascular, endothelial and smooth muscle cells. As such, many physiological systems of the body are influenced by androgens, including the cardiovascular system (nitric oxide release, lipid metabolism and insulin sensitivity), calcium mobilisation (bone density), vascular integrity and regulation of the stress response (sympathetic nervous system), inflammatory enzyme systems and reactive oxygen species (free radical) generation.
Testosterone deficiency is a major health issue today and can generate many symptoms, including a decline in libido, erectile dysfunction, increased fat deposition, decreased muscle mass and muscle quality, reduced bone mass, reduced production of haemoglobin, decreased energy and motivation and impaired brain function. As men age, these symptoms may also include fatigue, decreased self-confidence, irritability, increasing frailty and weakness, osteoporotic (bone) pain, depression and reduced cognitive ability and the lethargy associated with anaemia.
Testosterone deficiency also contributes to cardiovascular disease, including atherosclerosis, heart attack and strokes, metabolic syndrome and type 2 diabetes.
Testosterone deficiency is a complex issue and can be related to ageing, stress levels, diet and lifestyle choices, obesity, smoking, alcohol consumption, various medical conditions and some pharmaceuticals.
Research has shown that increasing levels of abdominal (visceral) fat in ageing men contributes to a reduction in levels of testosterone – total levels of testosterone, free testosterone and SHBG. This pattern of weight gain is also a major indicator of type 2 diabetes, insulin resistance, cardiovascular disease and obstructive sleep apnoea.
Testosterone plays a critical role in the health of the cardiovascular system.
Testosterone and Fertility
Testosterone is essential for normal quantity and quality of sperm and therefore for male fertility. It takes about 70 days for sperm to mature and be able to fertilise an egg. This short time for their maturation makes them more susceptible to environmental influences. When released from the testes, the sperm take two to10 days to travel through the epididymis and become motile (gain the ability to swim strongly) so they can attach to and penetrate the female egg.
Rising infertility in couples is a global health issue involving about 15 per cent of the world’s population; male infertility accounts for about 40 per cent of cases. Low sperm count and quality (oligozoospermia) is a significant issue impacted by problems that affect sperm production or the sperm transport process. These may be genetic, physiological or environmental. Sperm production problems can be caused by undescended testes, varicose veins or torsion (twisting) in the testes, genetic factors or environmental factors such as radiation, infections, chemical exposure and some pharmaceuticals. Sperm problems can also be related to infection or prostate disorders (or vasectomy).
Sexual problems are related to erection or ejaculation issues: Erectile dysfunction, failure of ejaculation, prostate surgery, some medicines or spinal cord injuries. Hormonal problems such as low testosterone, pituitary hormone disorders or steroid abuse (widespread among bodybuilders) are also common.
The most common symptoms as men age are the development of lower urinary tract symptoms and prostate disorders.
Nocturia (having to get up repeatedly in the night to urinate) plays a big role in men’s health, causing lack of sleep, sleepiness during the day, reduced sense of wellbeing and vitality, lowered productivity and deteriorating mental health. It’s associated with a negative feedback mechanism where it’s caused by low testosterone but, in turn, also lowers testosterone.
Benign prostatic hyperplasia (BPH), an enlargement of the prostate, is one of the most common conditions in older men. More than 50 per cent of men aged over 70 show symptoms of this condition. With the age-related decreases in serum testosterone, a rise in hormones such as oestrogen and growth factors contribute to this condition. The first symptom often noticed is nocturia. Other common symptoms are dribbling and a sensation of incomplete emptying of the bladder. In advanced stages of the condition, there’s an increase in the incidence of obstructive symptoms: Delayed beginning of micturition, weak urinary stream and residual urine in the bladder. There symptoms can significantly disrupt quality of life.
Diagnostically, prostate-specific antigen (PSA) is the main blood test along with a rectal examination for enlarged prostate. Ideally, the PSA level should be less than 4.0ng/mL, but as the prostate gland increases in size it produces more PSA. The rate of change can be a useful marker – a rise of 0.75ng/mL per year is considered normal.
Prostate cancer is the sixth leading cause of death for males. Early detection also has positive benefits as the condition is more easily treated successfully, from both a medical, herbal and nutritional perspective.
Changes in testosterone and dihydrotestosterone play important roles in the development of this condition. As men age, their prostate becomes increasingly sensitive to androgens, demonstrating an increased metabolism toward the production of dihydrotestosterone which, in combination with oestrogens, contributes to abnormal growth and cell accumulation (by a reduction in the rate of cell replication).
With the age-related alterations in the androgen-oestrogen balance contributing to prostate pathology, androgen deprivation therapy (ADT) is the common focus for medical treatments. Unfortunately, due to the enormous susceptibility of prostate cells to androgen deprivation, many men will develop hormone refractory cancer or castration-resistant prostate cancer. Androgen deprivation therapy may also increase cardiovascular risk, particularly in men with pre-existing cardiovascular disease.
Testicular cancer is a cancer that develops in the testicles. Symptoms may include a lump in the testicle or swelling or pain in the scrotum. It is the second most common cancer in young men aged 18 to 30 and the incidence is increasing. There is evidence that testicular cancer may be triggered by environmental (chemical) factors such as endocrine disruptors, which impact on oestrogens and androgens, particularly in the developing male. If the tumour hasn’t spread, the main treatment is an orchidectomy: Removal of the testicle affected. This is often the only treatment necessary and, if the tumour is detected early, is usually successful.
Herbology and Male Health
The regulating effect of medicinal plants on male reproductive function is associated with many activities: their ability to regulate testosterone levels, their anti-inflammatory activity and their antioxidant activity. Antioxidants provide the critical defence against free radical-induced male infertility as well as prostate disorders such as BPH and prostate cancer.
In recent years there has been an increase in testosterone prescriptions; however, while this treatment may improve symptoms in some men, it can be associated with adverse events, including increased risk of serious cardiovascular events.
A western-style diet impacts negatively on testosterone metabolism and is associated with lower circulating testosterone levels. Although negative feedback mechanisms balance this to some extent. The ‘Mediterranean’ diet, on the other hand, has shown a positive impact on men’s health. Eating organic food improves nutrient levels and reduces chemical exposure.
For many reasons it’s important to reduce weight if overweight. Research has shown that testosterone levels normalise as overweight men lose that excess flab, particularly abdominal fat.
Exercise regularly. High-intensive exercise in short bursts is very beneficial for overall health and cardiovascular function. Exercise to your level of fitness and make sure it’s something you enjoy. It must be done for a minimum of three or four times per week. Both resistance and high-intensity exercise are beneficial in normalising levels of testosterone and cortisol (the stress hormone) in both lean and obese individuals. There are also significant improvements in cardiovascular function and metabolic syndrome.
Intermittent fasting along with regular exercise has been shown to improve hormonal levels and reduce the risk of cardiovascular, metabolic syndrome and inflammation.
Sexuality, Sperm Count and Fertility
Increasing evidence suggests environmental factors can be a cause of deteriorating sperm quality. These include exposure to various chemicals, heat, radiation and heavy metals such as lead and mercury (infertile males had a 40 per cent higher mercury level in their hair than fertile males). High mobile phone use may also be a factor.
Exposure to environmental oestrogens, pesticides and herbicides is linked to alteration in spermatogenesis. Synthetic oestrogens are used agriculturally in the livestock, poultry and dairy industries. Many commonly used pesticides such as organochloride compounds have oestrogenic effects in the body and chemicals such as DDT, dioxins and PCBs are known to interfere with spermatogenesis.
Bisphenol A (a plasticiser common in plastic water bottles and in the water they contain) is a well-known endocrine disruptor that affects both the male and female reproductive systems. BPA (and associated chemicals) is a known oestrogen disruptor causally linked to adverse health effects in humans, including disrupting normal development of the male reproductive tract.
Cigarette smoking has been associated with decreased sperm count, alterations in motility and an overall increase in numbers of abnormal sperm.
Male fertility is reduced by infection, inflammation (which inhibits sperm maturation) and oxidation, closely linked with the inflammatory response. Obesity has been shown to be a factor in male infertility as well as in type 2 diabetes, metabolic syndrome, cancer, high cholesterol, heart disease, hypertension, sleep apnoea and renal failure. Infertility in obese men is three times higher than in men of normal weight, related to the negative impact on erectile dysfunction and sperm health.
There is significant evidence of a global decline in sperm quality, but observational studies have shown that when men shift to a healthier diet and lifestyle their sperm quality and fertility increase. A total of 1944 articles were identified, of which 35 were selected for qualitative analysis. Generally, the results indicated that healthy diets rich in nutrients such as omega-3 fatty acids, antioxidants (vitamins E,C, beta-carotene, lycopene) and minerals (selenium, zinc and magnesium), vitamins D, K2 and folate, and low in saturated fatty acids and trans-fatty acids (hydrogenated oils) were positively associated with sperm quality. Similarly, diets focused on fish (low mercury), shellfish and seafood, organic poultry, cereals, vegetables and fruits and unsweetened fermented dairy products such as kefir, were also associated with higher sperm quality..
Herbal Tonics, Nutrients and Vitamins
Vitamin D is essential for the healthy development of the nucleus of the sperm cell and helps maintain both sperm heath and sperm count. It also increases levels of testosterone (when measured over one year) and therefore increases libido. Vitamin D deficiency is at epidemic proportions in the western world. Vitamin D also has a major role related to calcium metabolism. As such, it improves bone metabolism but is critical in the health of the cardiovascular system, where it influences blood pressure, coronary artery disease and cardiovascular conditions such as heart failure and atrial fibrillation.
Vitamin K2 has many roles in the human body, including the regulation of osteoporosis. It also has shown promise in prohibiting cell proliferation in prostate cancer cells that are hormone resistant, possibly due to its antioxidant activity.
Ginseng, a well-known male tonic, is Chinese medicine, with substantial research. Two major clinical trials showed that at a dose of 2.7g/day for eight weeks, versus placebo, there was a significant improvement in cases of erectile dysfunction.
Ashwagandha, an Ayurvedic herb, has multiple uses. It relieves anxiety, assists with stress management and improves muscle strength and recovery. With its significant antioxidant activity, ashwagandha increased fertility by improving sperm count and motility and has been shown to improve the symptoms of benign prostatic hyperplasia.
Tribulus Terrestris. Research shows tribulus, or bindii, has substantial effects on male health. It is a tonic, aphrodisiac, stomachic, diuretic, antilithic and astringent. A potent herb in Ayurvedic medicine for the genito-urinary tract, it is prescribed particularly for the removal of kidney stones (it inhibits oxalate formation). It is also cardiotonic and antihypertensive, has been shown to regulate blood sugar in diabetics and lowers serum cholesterol.
Antioxidant nutrients are critical to raise testosterone levels, including vitamins E, C and carotenoids, as well as the minerals zinc, selenium and magnesium.
Zinc is a critically important nutrient for testosterone production. It has been calculated that 45 per cent of men over the age of 60 are critically low in zinc. It’s vital for healthy sperm production, sperm formation and motility.
The prostate gland contains the highest level of zinc of any body tissue and zinc is therefore essential for the health of this gland. Zinc is secreted into the seminal fluid and has a multifaceted role in sperm release and motility. It acts as an important anti-inflammatory factor and protects against sperm oxidative damage. It has multiple roles in male reproductive health and is essential for conception and embryonic implantation.
Selenium. Low levels of selenium have serious adverse consequences for male fertility. It plays a crucial role in the antioxidant protective system, preventing free radical damage to sperm. A major study showed that serum selenium was inversely correlated to prostate cancer susceptibility. Higher levels of selenium were associated with lower risk of metastases in men with prostate cancer.
Magnesium. Low levels of magnesium may increase blood levels of C-reactive protein, a significant marker of inflammation and heart disease. Drinking alcohol and reduced consumption of green leafy vegetables play a role in this deficiency, the symptoms of which also include anxiety, spasms and cramps, high blood pressure and stress. Magnesium plays a major role in stress response (both mental and physical stress), so higher stress levels increase magnesium elimination from the body.
Vitamin E status is associated with lower risk of prostate cancer. It is a vital fat-soluble antioxidant molecule in cell membrane. As such, it protects sperm integrity and motility.
Omega 3. Ideally, healthy fats should comprise 50 per cent of the dietary fats and come from a variety of sources: animal, vegetable, seafood, game, nuts and seeds. High omega-3 fatty acids are important as they reduce inflammation, improve cardiovascular function, reduce depression and improve cognitive function. They also play a big role in the management of healthy prostate function.
In an interesting rat study, fish oil supplementation prevented reproductive dysfunction in rats on high-fat diets and improved the function of genes that synthesise testosterone. Krill oil is recommended at 3-4g per day. Krill oil has a higher bio-availability than fish oil for omega-3 supplementation. |