Dudley Seth Danoff's Blog, page 4

Governor Jerry Brown And His Prostate Cancer

It has been widely reported in the media that Jerry Brown, governor of the state of California, has just completed radiation treatment for early prostate cancer. When I saw him on television recently, he looked fit, alert, and vigorous and bore no apparent adverse effects from his treatment.

Although the details of the governor’s illness have not been released, it seems apparent that his diagnosis was initially made because his PSA (prostate-specific antigen) level was elevated. The controversy surrounding the efficacy of PSA testing in a man 74 years old has been hotly debated, but in this case, the test seems justified.

Governor Brown’s oncologist was quoted as saying that “fortunately, this is early stage localized prostate cancer, which is being treated with a short course of conventional radiotherapy. The prognosis is excellent, and there are not expected to be any significant side effects.” This statement also indicated that the governor was “continuing a full work schedule.”

The only reliable way of diagnosing early-stage localized prostate cancer is with a PSA blood test. The digital rectal exam will almost always pick up a lesion in the prostate at an advanced stage but may not detect the type of lesion diagnosed in the governor. Although lesions detected in early-stage prostate cancer are often not treated but carefully monitored in a program called active surveillance, the governor’s urologist decided to proceed with radiation therapy. Both active surveillance and localized radiation therapy are treatment options that need to be carefully monitored. Active surveillance is increasingly favored for older men because prostate cancers tend to be very slow growing.

In my estimate, the reason Brown’s physicians chose to be a bit aggressive with limited radiation therapy despite his age is that the governor is healthy, he is in excellent physical shape, and his actuarial life expectancy is probably longer than that of the average 74-year-old. In addition, the side effects of the modern delivery system of radiation are very minimal, and survival data, which goes out about 15 years, is extremely favorable and compares to a more aggressive surgical approach as treatment.

According to Dr. Christopher Rose, a radiation oncologist at the Center for Radiation Therapy of Beverly Hills, “Conventional radiotherapy implies external beam radiation therapy, and is generally offered in a course of treatment lasting anywhere from 5 1/2 to nine weeks. However, accelerated treatments exist in which five treatments are delivered over the course of eight days.”

In describing the technical features of the treatment, Dr. Rose noted that “a three-dimensional model of the prostate—as well as organs that the oncologist wants to avoid—is pieced together using CT scans. The patient lies on his back and a 360-degree radiation source delivers beams of radiation to the patient in a way that targets the prostate but avoids other structures as much as possible. The beams can be delivered at differing degrees of intensity and in a concave shape so that the rectal tissues, lying near the walnut-shaped prostate, are avoided.”

Dr. Rose explained that “other advances allow a CT scan to be taken at each treatment session and lined up with the initial map so that the patient can be precisely positioned and the same tissue volume irradiated each time” and that “with these advances, the potential for a cure goes up and the potential for injuring adjacent organs goes down.”

Rose also noted that “with conventional radiation treatment, each session takes a matter of minutes and is performed on an outpatient basis. My patients all work through their treatments. Sometimes, 1 in 4 suffer fatigue but that usually occurs at the end of the day. Gov. Brown seems at the top of his game, and it probably won’t interfere with activities of daily life.”

The prognosis for the type of cancer that the governor apparently has is extremely favorable. His condition will be followed by monitoring the blood levels of PSA and perhaps performing biopsies in the future.

The takeaway message is that most men diagnosed with early-stage localized prostate cancer who choose either the active surveillance program or localized radiation treatment, as in the case of Governor Brown, die of something other than prostate cancer.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

The Circumcision Controversy – Finally Resolved?

The highly respected and authoritative American Academy of Pediatrics (AAP) has changed its position on infant male circumcision. Several studies in Africa suggesting that the procedure may protect heterosexual men against HIV brought the academy to conclude that the health benefits of infant circumcision outweigh the risks.

The conundrum, however, is that the academy stopped short of recommending routine circumcision for all baby boys, saying the decision remains a family matter. For decades, families made the choice based on religious, moral, and ethical principles that were, at best, ethereal. The academy had previously taken a neutral position on circumcision.

It has been more than a decade since the AAP has issued a policy statement regarding newborn circumcision. The new statement, which appears in the journal Pediatrics, is important because the group’s guidelines greatly influence pediatric care and decisions about coverage by insurers. The academy said that circumcision should be covered by insurance.

The academy’s new policy position seems to be in direct conflict with the sentiment against circumcision, which is gaining strength in the United States and parts of Europe.

Circumcision rates in the United States declined to 54.5 percent in 2009 from 62.7 percent in 1999, according to one federal estimate. Last year, a ban on circumcision was placed on the ballot in San Francisco, but a judge ruled against including the measure.

In Germany, a government ethics committee recently overruled a court decision that removing a child’s foreskin was “grievous bodily harm” and therefore illegal. However, Germany’s Professional Association of Pediatricians called the ethics committee ruling “a scandal.”

In Austria, a provincial official told state-run hospitals in the region to stop performing circumcisions.

In the United States, the Medicaid programs in several states have stopped paying for the routine circumcision of infants. Furthermore, the Centers for Disease Control and Prevention has been examining the issue for several years, but it has not yet issued a position on circumcision recommendations or comments regarding the AAP’s new policy statement.

Dr. Douglas S. Diekema, a member of the academy’s task force on circumcision and main author of the new policy, said, “This is not really pro-circumcision. It falls in the middle. It’s pro-choice, for lack of a better word. Really, what we’re saying is, ‘This ought to be a choice that’s available to parents.’”

Taking the opposite view is Georganne Chapin, founding director of Intact America, a national group that advocates against circumcision. “The bottom line is it’s unethical,” said Chapin. “A normal foreskin on a normal baby boy is no more threatening than the hymen or labia on your daughter.” Opponents of circumcision are vocal and maintain that no one—not even a well-meaning parent—has the right to decide to remove a healthy body part from another person.

The AAP updated its 1999 policy after the academy’s task force reviewed the medical literature on the benefits and possible harms of the surgery. The review began in 2007 and was completed in 2012. It included 248 citations in a 30-page report involving 14 studies that experts characterize as fair evidence that circumcision in adulthood protects men from HIV transmission from a female partner, cutting infection rates by 40 to 60 percent. The three largest studies were carried out in Africa, where HIV is spread primarily among heterosexuals.

According to Dr. Diekema, circumcision does not appear to reduce HIV transmission among men who have sex with men. “The degree of benefit, or degree of impact, in a place like the U.S. will clearly be smaller than in a place like Africa,” he said.

Conversely, two studies reviewed have found that circumcision actually increases the risk of HIV infection among sexually active men and women.

Although male circumcision is not associated with lower rates of gonorrhea or chlamydia or even syphilis, circumcision has been linked to low rates of infection with human papillomavirus and herpes simplex type 2.

One thing is certain: there is virtually no incidence of penile cancer reported in circumcised males, and the procedure has long been recognized as a factor in lowering urinary tract infections in early life.

The question of complications is always brought up, but the true incidence of complications after newborn circumcision is unknown. The procedure is relatively safe, but deaths are not unheard of, the review noted. The complication rate is about one in 500 procedures, and most complications are minor. Although rare, severe damage or even amputation of parts of the penis can occur.

The new policy statement by the AAP certainly carries considerable weight and may convince more families that newborn circumcision is advantageous, but clearly that decision remains controversial to its very core.

 

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Testosterone Replacement Therapy – Not Just For Cheating Jocks

Testosterone is a key male hormone. It drives libido, affects muscle mass, elevates mood, fights fatigue, adds strength, and improves cognitive ability. Unfortunately, as men age, their testosterone levels begin to decline. This process, called hypogonadism, is a normal part of getting older. But low testosterone levels are more than just an inconvenience of aging. Hypogonadism can cause sexual dysfunction and lead to health problems, including depression and osteoporosis (bone thinning). About 40 percent of men older than 45 suffer from low testosterone levels. After age 45, serum testosterone levels decline about 1 percent per year, and half of men aged 80 and older have low testosterone, according to the American Urological Association.

Slow changes to the body—including loss of muscle mass, reduced body hair, infertility, lowered sex drive, and decreased prostate size—are all symptoms of low testosterone. It is not uncommon to find hypogonadism in patients with infertility. The testicles actually produce testosterone, but the pituitary gland and the brain send signals to the testicles to regulate testosterone production. Although low testosterone levels can result from problems either in the pituitary or in the testicles, the most common cause is testicular dysfunction in the aging male. Less common causes for low serum testosterone are testicular injury, undescended testicles, the results of radiation or chemotherapy, and mumps infection affecting the testicles. Other factors resulting in low serum testosterone can include inflammatory diseases (such as tuberculosis), HIV and AIDS, opiate use, obesity, and type 2 diabetes.

Low testosterone levels not only affect sex drive and sperm function but may also have a negative impact on bone health, red blood cell production, and the development and distribution of muscle and fat.

The most common side effects associated with low testosterone include reduced strength, depressed mood, fatigue, anemia, cognitive problems, and hot flashes. The gold standard for diagnosing hypogonadism is to measure the total testosterone levels in the blood. The normal range for testosterone is 300-1,000 ng/dl (nanograms per deciliter). Anything below 300 is considered abnormal. It is important to draw the blood for testing in the morning, when testosterone levels are typically the highest.

Over the past several years, testosterone replacement therapy (TRT) has increased dramatically, and between 2003 and 2010, testosterone sales jumped more than 500 percent. Although initial studies by the National Institutes of Health could not find any major adverse effects from TRT, side effects can include acne and an increase in circulating red blood cell volume. TRT is contraindicated in men with normal circulating testosterone.

Contrary to common thinking, TRT does not cause prostate cancer. However, if a small, undiagnosed prostate cancer is present, TRT can accelerate the growth of the tumor. Men with a high PSA (prostate-specific antigen) level are not suitable for TRT. Patients receiving treatment need to have their serum testosterone and overall condition monitored on a regular basis. It is recommended that patients who respond well to treatment be monitored every 3-4 months during the first year of treatment. In men over 50 years of age, a prostate examination and PSA testing every 6-12 months is recommended.

Men with confirmed low testosterone levels who choose to undergo treatment have a number of options. Studies show that TRT can help rebuild muscle, restore sexual function, and prevent osteoporosis. Unfortunately, no simple pill exists that can be taken because the oral ingestion of testosterone is extremely toxic to the liver.

Treatment options include injection therapy, wherein testosterone is administered intramuscularly once every two weeks. The disadvantage of injections is that there is a strong surge in the level of serum testosterone shortly after the injection, and this level decreases dramatically at the end of the two-week cycle.

The good news is that a number of topical preparations are available. The testosterone is applied to the skin and is absorbed into the bloodstream at a constant level. A patch can be applied to any hairless surface on a daily basis. The disadvantage of the patch is that it can often cause skin irritation. Several gels that can be applied to the lower abdomen, upper arm, or shoulder are also available. As the gel dries, the testosterone is absorbed through the skin. The gel is less irritating than the patch, but patients should be advised not to wash for several hours after applying the gel and to avoid contact with their children and female partners. On the rare occasions that a pituitary tumor is found as the source of low testosterone, the patient may need surgery or radiation in addition to hormone replacement.

Most importantly, TRT is absolutely contraindicated in men with normal serum testosterone levels. If given in this setting, a patient is no better than a cheating jock attempting to get “juiced” for enhanced physical performance. The results can be disastrous.

 

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Nonsurgical Treatment For Prostate Cancer Is Gaining Favor

With the current controversy on prostate cancer screening and PSA (prostate-specific antigen) testing, a trend appears to be developing away from aggressive surgical treatment for early-stage localized prostate cancer.

Today, most urologists and radiation oncologists regard watchful waiting or active surveillance as an effective strategy for managing low-risk prostate cancer. Oddly though, only a minority of urologists currently recommend it to their patients. Remember, urologists are basically surgeons.

A study presented at the North Central Section of the American Urological Association showed that 47 percent of urologists recommended surgery, 32 percent recommended radiation therapy, and only 21 percent recommended active surveillance for low-risk prostate cancer.

Not surprisingly, the physicians’ recommendations aligned with their specialties: Most urologists recommended surgery, and most radiation oncologists recommended radiation therapy. Oncologists were 10.7 times more likely to recommend radiation therapy than surgery, and urologists were 4 times more likely to recommend surgery than radiation.

Dr. Simon Kim, a urologic oncology fellow at Mayo Clinic in Rochester, Minnesota, assessed the attitudes and treatment recommendations for low-risk prostate cancer from a national survey of prostate cancer specialists. Between 2011 and early 2012, a survey was mailed to 1,494 physicians in the United States who are active in the treatment of prostate cancer. All of the surgeons were asked how they view active surveillance as well as what their treatment recommendations were for patients diagnosed with low-risk prostate cancer. Of the 722 physicians who responded to the survey, 72 percent thought active surveillance was effective for low-risk prostate cancer, and about 70 percent were comfortable routinely recommending this approach.

In spite of these findings, active surveillance or watchful waiting still lags behind aggressive treatment, which would include surgery and radiation therapy. Part of the explanation for the higher rates of surgery and radiation therapy rather than active surveillance in the treatment recommendation for low-risk prostate cancer may also reflect patient preferences. Many patients are very uncomfortable “living with their cancer.”

Despite the push for the more aggressive treatments that physicians continue to promote, this current study suggests a positive trend toward active surveillance. Surgeons and radiation oncologists agree that this approach is entirely safe and does not decrease the survival rate from early-stage prostate cancer.

 

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

The Mo The Better

As a urologic oncologist, I stand on the receiving end of a remarkable phenomenon. Movember, a brilliant idea hatched in Australia in 2003, encourages men worldwide to “grow a Mo” (a moustache) during the month of November as a vehicle to raise money for research and patient support in the treatment of prostate cancer and for general issues pertaining to men’s health.The idea is simple enough. Guys register at www.movember.com in October and start on November 1 with a clean-shaven face. During the month, they grow and groom their moustaches while raising awareness and money for prostate cancer and other men’s health issues.

Proceeds from the US campaign go to the Prostate Cancer Foundation (PCF) and Livestrong. PCF funds high-impact research to find better treatments and cures for prostate cancer; Livestrong offers services to men with prostate and testicular cancer that help them and their families navigate the best treatment options. Since prostate cancer is my business and my life’s work, I am grateful that the roughly 240,000 new cases of prostate cancer that will be diagnosed in the United States in the coming year—and the 40,000 deaths that will occur from prostate cancer—will be affected in a positive way.

It is one thing for a doctor to pontificate about the need for financial support in the research and treatment of this deadly disease, but it is quite another thing for two guys sitting in a bar in Australia in 2003 to come up with the genius of Movember as a fund-raising vehicle with a twinkle.

Movember raised over $126 million globally during the 2011 campaign and over $15 million in the United States alone. The 2012 goal for the US campaign is projected at $25 million.

Movember participants are known as Mo Bros. The women who support their guys, or just love Mo’s, get involved and are referred to as Mo Sistas. Talk about grassroots support. Fun without running a 10K for dollars—the Aussies got it right.

Since 2003, a new generation of men and women has had its awareness elevated and has begun to take positive action with regard to men’s health, and an enormous amount of money has been raised. A woman would never miss her annual Pap smear and breast examination, but a man must be brought to his urologist kicking and screaming for his annual exam. I guess men are from Mars and women are from Venus.

The Movember movement has changed that mind-set. During the 2011 campaign, there were nearly 30 million visits to the Movember website and nearly 4 billion social media messages worldwide. More than 1.8 billion Facebook users were reached, and more than 110 million tweets on Twitter carried the Movember message around the world. All of this support—just by growing a Mo!

As a health professional, I am ready with my team, Dr. D’s Dudes, to “Mo up” and move the agenda forward in our war to conquer prostate cancer and raise the level of awareness across the board for men’s health issues. To join my team, go to http://us.movember.com/team/461665. A urologic surgeon in a white coat preaching from the mountaintop is not nearly as powerful as the Mo Bros and the Mo Sistas across the globe who grow and support the Mo’s in their lives.

 

Dudley Seth Danoff, MD, FACS

President and Founder

Cedars-Sinai Tower Urology Group

Author, Penis Power: The Ultimate Guide to Male Sexual Health (Del Monaco Press)

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

The Robot Wins Again Robotic Technology and Prostate Cancer Surgery

In a recent study presented at the annual meeting of the American Urological Association, Dr. Jeffrey K. Mullins of the Johns Hopkins Brady Urological Institute in Baltimore concluded that the adoption of robotic technology in organ-confined prostate cancer surgeries has a positive impact on patient morbidity, length of hospital stay, post-surgical hospital readmissions, and overall recovery. The study compared men operated on at hospitals employing robotic technology with men operated on at hospitals with no robotic technology. All of the men in the study underwent radical prostatectomy for organ-confined prostate cancer between 2000 and 2011.

Patient outcomes were analyzed by looking at in-hospital mortality, intensive care unit admissions, length of stay, and 30-day readmissions rates. The results show a statistically significant decrease in all of these areas in men who underwent robotic surgeries when compared with those who underwent conventional surgeries.

In hospitals utilizing robotic technology, the number of operative procedures for the treatment of prostatic cancer increased. Though the impact of this increase has not been studied to date, the rise in robotic technology surgeries is an interesting observation.

The effect of robotic technology on postoperative morbidity is noteworthy because men who get out of the hospital faster, and stay out of the hospital, are more likely to have a smooth recovery after surgery. Decreasing morbidity, length of hospital stay, and the 30-day readmission rate has a significant health-care cost implication. Robotic technology is expensive, however these potential cost savings might justify the added expense of acquiring robotic technology for many hospitals across the country.

In terms of significantly improved post-surgical morbidity, this preliminary data suggests that the robot clearly wins again.

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Skinny Is Better Than Fat For Good Sex

Let’s face the truth: It is a lot easier for a man to operate smoothly and vigorously in bed if he is not carrying a 20-pound belt of blubber around his waist. Not only are there health risks to being overweight, but for most women, a lean physique is much more attractive than a chubby one. But even more important than how other people see you is your perception of your body.

Maintaining a healthy body weight encourages self-confidence and promotes a healthy and positive outlook on life. In addition, if you are overweight, you might start thinking of your penis as small because layers of fat obscure so much of it. Remember, the penis comes from under the pubic bone. If there are two or three inches of fat above the pubic bone, your erect penis will need to traverse that distance before it sees the light of day. Excess belly fat creates the illusion of a very short penis, which, in turn, will cause you to think “small” about your penis power.

In general, I have found that men with poor body images have some degree of penis weakness. Men who are comfortable with their bodies and are content with their looks have a higher likelihood for super potency.

You do not necessarily have to emulate the image of a man with a sleek, muscular body, with a gorgeous woman at your side, promoting everything from a deodorant to a pickup truck. Whose self-image could possibly live up to those standards? You need to avoid comparing yourself to other men, especially images of the “perfect” man portrayed in magazines and on the silver screen.

The key to achieving a good body image is a proper diet, regular exercise, and maintenance of a sensible weight. This regimen will, in itself, promote a sense of general well-being and improve your sexuality.

If you are dieting, you know you have to count calories, carbs, and fats. But recent studies have shown that if you really want to keep the weight off, you might want to focus on the glycemic index, a measure of how quickly foods are digested. High-glycemic foods cause a surge in blood sugar, followed by a crash. This biologic reaction releases hormones that stimulate hunger, lower metabolism, and make it difficult to both lose and maintain weight.

In a recently published study in the Journal of the American Medical Association, Dr. David Ludwig compared a low-carbohydrate, low-fat, and low-glycemic diet to see which burned the most calories daily. The low-carbohydrate diet was the best, the low-fat diet was the worst, and the low-glycemic diet burned more calories per day than the low-fat diet. But most importantly, the low-glycemic diet proved easier to stick to over the long term than even the low-carbohydrate diet.

The key to this combination of a low-carbohydrate and a low-glycemic diet is to start eating more fruits and vegetables. When it comes to carbohydrates, choose those with a lower glycemic index: brown rice versus white, whole-grain pasta rather than regular pasta, and steel-cut oats instead of quick-cooking oats. Avoid processed foods like white bread, white rice, breakfast cereals, and crackers, all of which have a high glycemic index.

According to Dr. Ludwig, low-glycemic foods “increase the metabolic rate and decrease hunger, giving us a biological advantage” in losing and maintaining weight. Natural foods—like most vegetables and fruits, nuts, beans, and whole grains—wind their way slowly through the body’s digestive system, using up more energy and burning more calories in the process than high-glycemic foods do.

Dr. Ludwig points out that this study was short and not conclusive. He is working to design a better study that examines diet and weight-loss maintenance over a longer period of time.

I would recommend a moderation in foods containing carbohydrates and fats. I would also emphasize moderate exercise (at least 60–90 minutes every day) as an important part of the equation. This regimen of diet and exercise is guaranteed to improve your sex life, irrespective of age or level of physical fitness.

Skinny Is Better Than That For Good Sex

Let’s face the truth: It is a lot easier for a man to operate smoothly and vigorously in bed if he is not carrying a 20-pound belt of blubber around his waist. Not only are there health risks to being overweight, but for most women, a lean physique is much more attractive than a chubby one. But even more important than how other people see you is your perception of your body.

Maintaining a healthy body weight encourages self-confidence and promotes a healthy and positive outlook on life. In addition, if you are overweight, you might start thinking of your penis as small because layers of fat obscure so much of it. Remember, the penis comes from under the pubic bone. If there are two or three inches of fat above the pubic bone, your erect penis will need to traverse that distance before it sees the light of day. Excess belly fat creates the illusion of a very short penis, which, in turn, will cause you to think “small” about your penis power.

In general, I have found that men with poor body images have some degree of penis weakness. Men who are comfortable with their bodies and are content with their looks have a higher likelihood for super potency.

You do not necessarily have to emulate the image of a man with a sleek, muscular body, with a gorgeous woman at your side, promoting everything from a deodorant to a pickup truck. Whose self-image could possibly live up to those standards? You need to avoid comparing yourself to other men, especially images of the “perfect” man portrayed in magazines and on the silver screen.

The key to achieving a good body image is a proper diet, regular exercise, and maintenance of a sensible weight. This regimen will, in itself, promote a sense of general well-being and improve your sexuality.

If you are dieting, you know you have to count calories, carbs, and fats. But recent studies have shown that if you really want to keep the weight off, you might want to focus on the glycemic index, a measure of how quickly foods are digested. High-glycemic foods cause a surge in blood sugar, followed by a crash. This biologic reaction releases hormones that stimulate hunger, lower metabolism, and make it difficult to both lose and maintain weight.

In a recently published study in the Journal of the American Medical Association, Dr. David Ludwig compared a low-carbohydrate, low-fat, and low-glycemic diet to see which burned the most calories daily. The low-carbohydrate diet was the best, the low-fat diet was the worst, and the low-glycemic diet burned more calories per day than the low-fat diet. But most importantly, the low-glycemic diet proved easier to stick to over the long term than even the low-carbohydrate diet.

The key to this combination of a low-carbohydrate and a low-glycemic diet is to start eating more fruits and vegetables. When it comes to carbohydrates, choose those with a lower glycemic index: brown rice versus white, whole-grain pasta rather than regular pasta, and steel-cut oats instead of quick-cooking oats. Avoid processed foods like white bread, white rice, breakfast cereals, and crackers, all of which have a high glycemic index.

According to Dr. Ludwig, low-glycemic foods “increase the metabolic rate and decrease hunger, giving us a biological advantage” in losing and maintaining weight. Natural foods—like most vegetables and fruits, nuts, beans, and whole grains—wind their way slowly through the body’s digestive system, using up more energy and burning more calories in the process than high-glycemic foods do.

Dr. Ludwig points out that this study was short and not conclusive. He is working to design a better study that examines diet and weight-loss maintenance over a longer period of time.

I would recommend a moderation in foods containing carbohydrates and fats. I would also emphasize moderate exercise (at least 60–90 minutes every day) as an important part of the equation. This regimen of diet and exercise is guaranteed to improve your sex life, irrespective of age or level of physical fitness.

Testosterone – Not Just For Sex

Over the years, testosterone has usually been relegated to improving a man’s libido and bulking up the muscles of body builders. But recent studies indicate that testosterone is an essential factor in men’s health and, in fact, may be the best indicator of a man’s general health, according to a panel of experts reporting at the annual meeting of the American Urological Association in Atlanta.

Abraham Morgentaler, MD, associate clinical professor of urology at Harvard Medical School in Boston, said, “We used to think of testosterone as being all about sex. Today the evidence suggests that the single best indicator of a man’s health status is his serum testosterone.”

Surprisingly, in the United States, more than 14 million men age 45 and older have low serum testosterone. It has been widely shown that men with low testosterone levels are at a higher risk for type 2 diabetes and metabolic syndrome complex—which includes obesity, hypertension, high blood pressure, high serum lipids, and a type of diabetes that is resistant to insulin—than men with normal testosterone levels.

A low baseline testosterone level is predictive of metabolic syndrome complex, and testosterone replenishment appears to improve all aspects of a man’s health in this regard.

Men who experience erectile dysfunction, a diminished libido, impaired orgasmic function, or metabolic syndrome complex conditions should be screened for testosterone deficiency and treated with testosterone replacement therapy if a deficiency is found.

It is well known that testosterone deficiency leads to osteoporosis, and about one-third of hip fractures worldwide occur in men. The consequences of hip fractures in men are profound, with a mortality rate as high as 37.5 percent within one year, according to Dr. Morgentaler. Although the process is slow, testosterone is known to improve bone mineral density, diminish osteoporosis, and decrease the incidence of bone fractures.

An emerging body of evidence indicates that testosterone replacement therapy (TRT) is also beneficial for cardiovascular disease and diabetes in general, particularly in men who have a low serum testosterone.

Because testosterone cannot be taken orally, as it is toxic to the liver, the recent development of several topical delivery systems consisting of gels, creams, and patches has made the administration of testosterone extremely easy. Testosterone can also be given by an intramuscular injection, though injections must be administered every three weeks or so.

All of this new data suggests that testosterone may be the best indicator of men’s health and is an essential hormone that should be measured and replaced if deficient.

Dudley S. Danoff, MD, FACS  is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!

Vasectomy – Is There Another Way?

I am often asked if there are any choices for male birth control other than vasectomy. Unfortunately, the only effective, practical and safe alternatives that currently exist are abstinence, the use of condoms or other prophylactics, and withdrawal. However, I would predict that with the rapid rate of the advances we have seen in medical science, men will soon be able to simply take a pill to control the release of their sperm, just as women take a pill to control the release of their eggs.

There have been a number of research groups, particularly in China and the UK, that have explored experimental alternatives to vasectomy for male contraception. A few of these experimental concepts include injected plugs, heat methods, pharmaceutical methods, hormonal methods, and vas occlusion (blocking the vas deferens instead of cutting it, such as in vasectomy). Although these developments and discoveries are highly fascinating and offer an exciting glimpse of the future possibilities for male contraception, they still remain highly experimental. I want to state clearly that the FDA has approved none of these methods for use in the United States, and I would discourage taking foolish and dangerous risks with such a valuable appendage!

Vasectomy is safe and effective for all men who no longer wish to have children. The procedure involves interrupting the continuity of the vas deferens, the tube that carries sperm from the testicles, where sperm is made, to the seminal vesicles, where sperm is stored until ejaculation. Vasectomy stops the passage of sperm so that none is included in the semen that is ejaculated. The procedure is performed in less than 10 minutes in a doctor’s office, under local anesthesia, through a tiny nick in the scrotal skin (the “no scalpel” technique). The postoperative discomfort is minimal, and patients rarely require an analgesic.

As for penis power, absolutely no change occurs after vasectomy. There is no reduction in sensation, desire, circulating testosterone, the ability to get or keep an erection, or satisfaction when having an orgasm. The only difference after vasectomy is that no sperm is released. The sperm component is a minuscule portion of seminal fluid to begin with, so there is no reduction in the volume that is ejaculated.

In fact, a vasectomy has the potential to increase penis power in many men because they are no longer inhibited by concerns about pregnancy. Longtime partners often feel more spontaneous. They do not have to interrupt lovemaking to deal with diaphragms or condoms, and they often feel heightened sensation during intercourse because there is no latex between the penis and the vagina.

Some vasectomy patients change their minds about having children and request a reversal. This procedure, called a vasovasostomy, involves reconnecting the vas deferens. This operation is a bit more difficult than the original vasectomy. However, vasovasostomies have a high rate of success, and most patients are able to conceive children afterward. As with a vasectomy, the reversal does not diminish penis power. In fact, there is a potential bonus: after a vasovasostomy, a couple is now making love for the express purpose of conceiving a child, so lovemaking often becomes even more romantic than ever.

The typical vasovasostomy patient I see in my practice is reversing a vasectomy he obtained when he and his first wife decided not to have any more children. Now he is remarried, usually to a younger woman who wants to have a family with him—a terrific turn-on for a middle-aged man. For a man fitting this profile, I strongly encourage vasovasostomy. It is a safe and effective procedure. (Just for the record, the above example is not intended in any way to encourage men to seek divorce, but rather is a reflection of the demographic realities I have observed in my practice.)

At the end of the day, office vasectomy is a safe, simple, time-tested method of male birth control with virtually no downside.

 

Dudley S. Danoff, MD, FACS is the attending urologic surgeon and founder/president of the Cedars-Sinai Medical Center Tower Urology Group in Los Angeles, California. He is the author of Penis Power: The Ultimate Guide To Male Sexual Health (Del Monaco Press, 2011) and Superpotency (Warner Books).

Read discreetly with the Kindle™ edition of Penis Power™ now available for purchase from Amazon. The Nook Books™ edition from Barnes & Noble and the Sony eReader™ edition from Sony’s Reader Store. Available for under $7.00!