Healthcast 665 - The Male Orgasm and Testosterone

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In general, I spend my time defending women and the fact that our problems and sexual physiology is ignored, by the governmental powers and physician organizations in the US, so I try to do my part to bring information to women about their hormones and the aging process. Today I am changing my focus to men and the way men’s normal sexual function is considered a “normal” and rarely discussed outside the men’s locker room and or porn sites. So here goes…The fact is that men’s sexuality isn’t just the act of sex, but men spend a lot of their sexual energy on fantasies and just thinking about having sex.  Men’s ability to have an orgasm is not just a wham- bam—thank you…well you know the phrase…and there are many physiologic factors that must work, in the background to bring a man from thinking about sex or desire, to an orgasm.

Sadly, in the current environment couples don’t talk about sex….they don’t tell their partner what makes them excited or even what they want…. because none of us can read minds, too many of us don’t get what we want when it comes to sex.

With lack of communication between partners, leads couples to trial and error without a map.  Neither sex knows how the other sex “works”.  I decided to describe the normal series of what men go through on their way to orgasm to educate them and their partners.  In addition, the process is not always the same in each person and as men age the time between the first sexual thought to completion gets longer and longer…sometimes these detours include episodes of losing an erection, sometimes getting it back and sometimes not which leads to frustration of both partners.

In youth when a man’s free testosterone is high and his arteries are free of plaque, between puberty and age 35, erections may occur often, and they last a long time if the man is stimulated for a long period of time. At this point sex is automatic and easy to complete to orgasm and ejaculation.

As time goes on, free Testosterone starts to decrease with age, as does the diameter of a man’s arteries…blood flow doesn’t rush to the pelvis to create an erection like it did in youth. The things that lower free testosterone.  What happens with age that cause erections and ejaculation to be less and less automatic and easy?

• T and free T drops after age 35 in most men and becomes critical by age 55, even in healthy men.
• Ejaculate decreases due to lowering of free T
• Vasectomies decrease the volume of ejaculate by 1/3
• Stress causes free T to decrease.
• Hypertension causes arteries to contract and deliver less blood to the pelvis for an erection.
• High blood sugar and diabetes destroys the arteries in the pelvis making blood have a more difficult time getting to the penis.
• Stress causes Cortisol to rise and free T decreases,
• Obesity increases the estrogens in men and that decreases free T by binding it with sex hormone protein and inactivating it.
• Any medication the constricts blood vessels (ADD medicine, Phentermine, speed, etc) decreases blood flow to the pelvis.
• Some medications that lower blood pressure lower It in the pelvis too low so that men are impotent (e.g. Lisinopril).

For men who don’t know all these medical, aging changes that happen to most men, these changes cause fear and anxiety which of course makes it worse.  Men who have this issue (most men) are even reticent to talk to me about it and they haven’t talked to their spouse either.

So here is what I tell them:  You are aging like everyone else, and that fact can’t be changed, however, your lifestyle and your medical health, or poor health is affecting your orgasms and your ability to have sex.  These factors CAN be changed.  You can change your BP medicine to

one that doesn’t impair erections.  You can get your diabetes or obesity under control, and you can improve your erections.  However, to get it all back you will need testosterone replacement if your free T is under 129 ng/dl. The safest way to accomplish this is with my practice BioBalance® Health…we do it better and know all the tricks to making you healthy productive and potent!

What is in the ejaculate? mature sperm are mixed with whitish, protein-rich fluids with prostaglandins are produced by the prostate. These fluids nourish and support the sperm so they can live after ejaculation for a limited time to fertilize an egg.  This mixture of fluid and sperm, known as semen, and is what is moves through the urethra in the form of ejaculate.

Sensory stimulation travels from the skin to the brain and stimulates dopamine and endorphins which are neurotransmitters that make a man fee happily ecstatic during and after an ejaculation.  These neurotransmitters also stimulate the Hypothalamus to make oxytocin, a bonding hormone that binds couples together. Many nerves, vessels and the brain are involved in a successful sexual encounter.

The culmination of a sexual encounter is complex and involves the whole body. I find it interesting that the “medical view” of orgasm is still divided into 4 different steps when, if you are a male (or even a female who has had sex with a male) the divisions seem very arbitrary and is ALWAYS connected to ejaculation.

It is a fact that men and women can have sexual intercourse and orgasm without ejaculation.

The following is how the practice of medicine describes the male sexual act.   In contrast I have educated my patients by comparing sex to a on the fact that men can have orgasms which occur in the brain when endorphins flood the neurons, even without ejaculation.  So I will discuss, the male sexual experience to them, not with the “4 easy steps of male sexual response”, but as a “process” of achieving orgasm in men.  It is more like a recipe, that requires each ingredient to be added in order, but sometimes you can stop in the middle and start again.  It is not always a straight line from sexual desire to orgasm.

In general, all men need testosterone to have sexual desire, and sexual desire to have sex, however both men and women can be physically or visually stimulated to be aroused without true sexual desire. If the man has a long history of having sex often, then the habit of having a sexual response can be achieved without enough testosterone, however the erection will not necessarily last long enough.   Continued physical stimulation can bypass desire, and therefore testosterone, and a man can be stimulated into having an erection of sorts and into having an orgasm with or without ejaculate

An erection requires testosterone to become fully erect, however there is a “work around” now and men without testosterone can have an erection with Viagra, Cialis pills, or prostaglandin injections into the penis itself. Men can also have a penile implant placed so they can have sex without testosterone or Viagra/Cialis. However, let’s talk about sex with testosterone in men who have good pelvic blood flow who don’t require medication to become erect.

The second necessary ingredient after testosterone is stimulation, which can be with touch, visual stimulation, auditory stimulation or even imagination that causes a man to be stimulated. The sexual response to any of these stimulations send messages through the nerves from the brain to the pelvis that dilates his veins and arteries. This sends blood to the penis from the arteries and blocks the veins from draining the blood out.  This creates an erection. Testosterone’s role is to cause the arteries to dilate by stimulating the production of nitric oxide from the arterial walls. Remember the stimulation? The ongoing stimulation (mental, visual, auditory or imaginary) keeps the erection hard with vascular dilation.

At this point stimulation can be changed or paused and other stimulation can prolong this part of the process.  Holding the base of the penis can keep it hard, or any tight encircling toy can keep the erection from proceeding to orgasm for some time or the erection can go away without continued stimulation.

The third step is the preparation for orgasm which can last from as long as 30 minutes and as short as 2 minutes. A clear “pre-ejaculate” is produced that lubricates the penis for intercourse, and if ejaculation is to take place there is a “loading of semen” that takes place from the seminal vesicles readying the man for ejaculation.  At this point the penis contracts the muscles quickly in rapid repeating emissions that shoot the semen out of the urethra. This is the orgasm and ejaculation that occur together, which is typical of normal youthful ejaculation.  As men get older the force at which they ejaculate decreases.

After ejaculation/orgasm the brain is flooded in endorphins, the feel-good neurotransmitters, that make a human feel happy and satisfied.  This is solely the result of the orgasm after a sexual encounter. The feeling of ejaculation does relieve pelvic pressure but is not needed to experience orgasm in most men.

Medical science has been able supply an assist for desire (testosterone) and erectile function (vasodilation and release of nitric oxide but they have not discovered the “pill” to make ejaculations occur or to improve their volume.  It is important for an aging man to accept that orgasm doesn’t require ejaculation since we don’t have an answer to recreating the youthful ejaculation.  Besides age, vasectomy can also limit ejaculation.  dehydration, vasoconstrictors, anti-hypertensive drugs and diuretics can limit the volume of the ejaculate as well.

After the “process of sexual orgasm” the penis loses tumescence, blood leaves the pelvis and overall relaxation occurs throughout the body. Then a period of time must pass before another erection can occur.  Over time some “twice a day men” can turn into once every week…..this can be changed by practicing…..having sex more often.

The sexual response in both men and women is more like a symphony with several movements, than a recipe, but it is definitely not a series of steps that is followed in every human in every circumstance. It is the job of the physician to help patients both understand and live with any variations in the sexual process.  Much of what I do is act as a teacher to my patients who need to understand their own bodies and any dysfunctions thereof.  Understanding becomes treatment over time.