Healthy hormone balance and general fitness and wellbeing are essential to male health, and underpin a healthy reproductive function as well as fertility, stamina, vitality, optimal libido and a healthy sexual function.
Erectile dysfunction, lowered libido and male infertility are on the rise: One in five men over 40 have difficulty getting or keeping an erection; and male infertility accounts for up to half of all infertility cases.
Erectile dysfunction (ED)
A multifactorial condition, ED is primarily a physical condition and is strongly linked to cardiovascular disease, lack of exercise, obesity, smoking and hypercholesterolemia.
Dr Carolyn Allan, the medical advisor to Andrology Australia, believes 75% of erectile dysfunction has a physical cause and in most cases it’s likely to be artery damage.
Physical causes such as nerve damage after prostate surgery or introduction of a medication that affects sexual function may be implicated. But for most men with erection problems there is an underlying cause that interferes with how the penis functions by decreasing blood flow or affecting nerves, such as diabetes, obesity, hypertension or high cholesterol.
Men with ED may experience an inability to attain an erection; an inability to maintain an erection adequately for intercourse; delayed or absent ejaculation despite adequate stimulation; and an inability to control timing of ejaculation.
The effects of ED on men may include depression, loss of self-confidence, loss of intimacy in a relationship and reduced quality of life.5 Despite these far-reaching effects however, statistics have shown men are reluctant to address the condition with only 6% men with ED ever seeking treatment.
In men, libido is governed by both gonadal hormones and brain neurotransmitters and is known to gradually decline in men after the age of 50. A reduction in male libido is associated with low testosterone.[7,8]
Researchers suggest changes to male testosterone synthesis and metabolism during ageing may be responsible for this shift, changes may include an increase in sex hormone binding globulin (SHBG) and a decline in testosterone receptor sensitivity.
Other factors may include obesity, hyperinsulinaemia, chronic stress and oxidative stress. Medications such as selective serotonin re-uptake inhibitors (SSRIs) are also associated with sexual dysfunction, with 25% of users affected.
Common signs and symptoms of low libido include lack or loss of sexual desire, difficulty achieving orgasm, and anxiety and/or depression.
Male infertility is often asymptomatic with the most common, presenting symptom being that the patient’s partner is unable to get pregnant after 12 months of unprotected intercourse. Male infertility accounts for up to half of all infertility cases and affects approximately 1 in 20 men.
It most commonly occurs when the male is unable to produce or deliver fully functioning sperm to the female ova. If the sperm is underdeveloped or abnormally shaped, is unable to move properly, or the numbers of sperm in the ejaculate are abnormally low, infertility is not uncommon.
Mounting evidence suggests that oxidative stress is a major contributing factor in 30-80% of male infertility cases. Oxidative stress occurs when the production of reactive oxygen species (ROS) exceeds the body’s antioxidant defense mechanism leading to cellular damage. ROS damage sperm cell membranes resulting in reduced sperm motility and altered sperm DNA, compromising the quality of semen parameters and reducing the ability of the sperm cell to fertilize the oocyte.
Other major causative and risk factors that can contribute to the incidence of male infertility include: sperm production problems (from genetic causes, infections, medicines and chemicals), blockage of sperm transport, sperm antibodies, ejaculation issues, hormonal problems,9 stress, structural reproductive disturbances due to trauma, varicoceles, mumps, hormonal imbalances such as testosterone deficiency, oestrogen excess, sperm antibody production, an increased toxic load from smoking, excess alcohol, recreational drugs and nutritional deficiencies.
Nutrition for men’s health
Zinc plays an important role in human cells and body processes and is perhaps the most critical trace mineral for male sexual function.
Involved in virtually every aspect of male reproduction, including hormone metabolism, sperm count, motility and morphology, and normal testicular development, zinc can be found in high concentrations in the both the prostate and the testes. Zinc also plays an important role in the polymeric organisation of macromolecules such as RNA and DNA, in protein synthesis and cell division and assists the stability of the cell membranes.[110,11]
An important component of the body’s antioxidant system that retards the oxidative process, zinc is also a specific and essential cofactor for the adequate formation and function of the antioxidant enzyme copper-zinc superoxide dismutase and various metalloenzymes.
Chronic zinc deprivation generally results in not only an increased sensitivity to the effects of oxidative stress due to inadequate activity of these enzymes, but to oligospermia, hypogonadism and idiopathic male infertility.[13-15] In fact, even marginal zinc deficiency may lead to decreased levels of testosterone levels and spermatogenesis, with lower levels of zinc typically found in infertile men.
Many studies have shown an improvement not only sperm count but in motility and morphology too when zinc supplementation is used.[16-21]
Selenium is essential in the synthesis of testosterone, the production and maturation of healthy spermatozoa, and sperm motility.[22-24]
Found in high concentrations in the tail of the sperm, selenium profoundly influences the structure of sperm, with the tail of the sperm reliant on adequate selenium status to maintain its “whip-like” action. Without sufficient selenium, sperm are unable to swim in the right direction or display marked immobility thus preventing fertilization of the oocyte.
Involved in several major metabolic pathways including antioxidant defense systems, immune function and thyroid hormone metabolism,25 sperm capsular selenoprotein is also involved in the stability and motility of the mature sperm and forms part of the glutathione peroxidase antioxidant system.[6,2726,27] This is paramount for spermatogenesis and protects the sperm against the effects of reactive oxygen species.
Along with its protective antioxidant effects, L-carnitine can be found in high concentrations in the epididymis and is required by spermatozoa for maturation and semen quality.
The motility of the sperm correlates directly with the L-carnitine content;[29,30] the higher the L-carnitine content, the more motile the sperm. Conversely, when L-carnitine levels are low, sperm development, function and motility are drastically reduced.
Herbal medicines for men’s health
Turnera diffusa (damiana)
Traditionally used in Mexican medicine for sexual inadequacy, impotence, and as an aphrodisiac and an invigorator, damiana has also been prescribed in western herbal medicine for depression and anxiety with a predominant sexual factor.
Tribulus terrestris (tribulus)
A popular herb in both Ayurvedic and Chinese medicine, tribulus is prescribed as a tonic that increases virility, fertility and sperm production,31 and used in Eastern European folk medicine for increasing muscle strength and sexual potency.
Modern application and research has shown tribulus to be valuable in increasing sperm motility, viability and velocity, and has effects on libido and sexual functioning.[11,33]
These modern uses, however, stem from Bulgarian research using a standardised tribulus leaf preparation, which is rich in the steroidal saponin protodioscin. Protodioscin has been clinically proven to improve sexual desire and enhance erection via the conversion of protodioscine to DHEA (De-Hydro-Epi-Androsterone).
Tribulus grown on different soils does not consistently produce the active component protodioscin. The geographical region in which this herb is grown can greatly impact its phytochemical profile, with Bulgarian tribulus showing a totally different chemical profile and a much higher concentration of protodioscin when compared to the commonly used Indian tribulus.[34,35]
Panax ginseng (Korean ginseng)
With a strong reputation as a male tonic, Panax ginseng has been used to promote energy in men where there is lowered vitality and where physical performance and sexual function require enhancement.
Shown to increase production of gonadotropins in vitro, with wide-spread benefits to male fertility and reproductive function, Panax ginseng not only increases testosterone levels, and improves both sperm count and motility, but clinical trials have also shown ginseng to improve erectile dysfunction and lowered libido.
Major constituents of ginseng, the ginsenosides, have been shown to have corticosteroid-like effects, binding to the glucocorticoid receptor. These steroidal saponins may partly explain the attenuating effects of Panax ginseng on elevated corticosterone in both acute and chronic stress models.
It is believed the ginsenosides, may also help the body adapt to stress through regulation of the endocrine and immune systems via the hypothalamic-pituitary axis. Panax ginseng may also raise plasma adrenocorticotropic hormone (ACTH) in the relaxed state, thereby increasing the ability to withstand stress.
Withania somnifera (withania)
Known as Indian ginseng, withania root has been used in Ayurvedic medicine as a strengthening and rejuvenating tonic for debility and convalescing, an aphrodisiac and for insomnia. Withania is also regarded in Ayurveda as a rasayana herb and so promotes physical and mental health, increases resistance of the body to stressors, revitalises the body in debilitated conditions and increases longevity.
Often prescribed as an adaptogen, withania can also improve semen quality by regulating reproductive hormone levels, reducing oxidative stress, and reversing lowered levels of testosterone, LH, FSH and prolactin.
Withania root contains steroidal compounds including withanolides that are regarded as quality markers.
Pinus pinaster (pine bark)
The production of abnormal quantities of ROS is thought to be involved in many facets of human male infertility. Sperm exposed to superoxide anions are rendered dysfunctional by lipid peroxidation and altered membrane function, as well as impaired metabolism, morphology and motility.
Through its antioxidant action, maritime pine bark improves sperm function and quality, and erectile dysfunction by enhancing superoxide dismutase activity and increasing nitric oxide levels, which is the chief chemical mediator of penile erection.[43-45]
Men’s healthy lifestyle tips:
- Moderate alcohol intake
- Maintain a healthy weight
- Stop smoking
- Exercise regularly
- A balance diet
- Good quality sleep
- Herbal and nutrition supplementation
- Regular health checkups with your GP
- Erectile dysfunction. Andrology Australia, 13 August 2013, [Source]
- Tremellen K. Oxidative stress and male infertility--a clinical perspective. Hum Reprod Update 2008 May-Jun;14(3):243-258. [Abstract]
- Goodyer P. The (real) secret to longer lasting sex. The Sydney Morning Herald, 30 Nov 2010, [Source]
- Fertility type conditions. Bottom line monograph 2013, [Source]
- Erectile dysfunction. Bottom line monograph 2013, [Source]
- Tan HM, Low WY, Ng CJ, et al. Prevalence and correlates of erectile dysfunction (ED) and treatment seeking ED in Asian men: the Asian men’s attitude to life events and sexuality (MALES) study. J Sex Med 2007;4(6):1582-1592. [Abstract]
- Carruthers, M. Time for international action on treating testosterone deficiency syndrome. Aging Male 2009;12(1):21-28. [Full Text]
- Low libido. Andrology Australia, 18 September 2013, [Source]
- Male infertility. Andrology Australia, 30 May 2012, [Source]
- Pizzorno JE, Murray MT. Textbook of natural medicine, third edition. St Louis: Churchill Livingstone, 2006. [Source]
- Braun L, Cohen M. Herbs and natural supplements: an evidence-based guide, 2nd ed. Sydney: Churchill Livingstone Elsevier, 2010. [Source]
- Powell SR. The antioxidant properties of zinc. J Nutr 2000;130(5S Suppl):1447S-54S. [Abstract]
- Hartoma TR, Nahoul K, Netter A. Zinc, plasma androgens and male sterility (letter). Lancet 1977;2(8048):1125-1126. [Source]
- Prasad AS. Zinc in growth and development and spectrum of human zinc deficiency. J Am Coll Nutr 1988;7(5):377-384. [Abstract]
- Colagar AH, Marzony ET, Chaichi MJ. Zinc levels in seminal plasma are associated with sperm quality in fertile and infertile men. Nutr Res 2009;29(2):82-88. [Abstract]
- Chia SE, Ong CN, Chua LH, et al. Comparison of zinc concentration in blood and seminal plasma and various sperm parameters between fertile and infertile men. J Androl 2000;21:53-57. [Abstract]
- Kynaston HG, Lewis-Jones DI, Lynch RV, et al. Changes in seminal quality following oral zinc therapy. Andrologia 1988;20(1):21-22. [Abstract]
- Tikkiwal M, Ajmera RL, Mathur NK. Effect of zinc administration on seminal zinc and fertility of oligospermic males. Indian J Physiol Pharmacol 1987;31(1):30-34. [Abstract]
- El-Tawil AM, et al. Zinc deficiency in men with Crohn’s disease may contribute to poor sperm function and male infertility. Andrologia 2003;35(6):337-341. [Abstract]
- Hadwan MH, Almashhedy LA, Alsalman AR. Oral zinc supplementation restores high molecular weight seminal zinc binding protein to normal value in Iraqi infertile men. BMC Urol 2012;12:32. [Abstract]
- Khan MS, Zaman S, Sajjad M, et al. Assessment of the level of trace element zinc in seminal plasma of males and evaluation of its role in male infertility. Int J Appl Basic Med Res 2011;1(2):93-96. [Full Text]
- Hawkes WC, Turek PJ. Effects of dietary selenium on sperm motility in healthy men. J Androl 2001;22(5):764-762. [Abstract]
- Vezina D, Mauffette F, Roberts KD, et al. Selenium-vitamin E supplementation in infertile men. Effects on semen parameters and micronutrient levels and distribution. Boil Trace Elem Res 1996;53(1-3):65-83. [Abstract]
- Ursini F, Helm S, Kiess M, et al. Dual function of the selenoprotein PHGPx during sperm maturation. Science 1999;285(5432):1393-1396. [Abstract]
- Brown KM, Arthur JR. Selenium, selenoproteins and human health: a review. Public Health Nutr 2001;4(2B):593-599. [Abstract]
- Rayman MP. The argument for increasing selenium intake. Proc Nutr Soc 2002;61(2):203-215. [Abstract]
- Agarwal A, Nallella KP, Allamaneni SS, et al. Role of antioxidants in treatment of male infertility: a review of the literature. Reprod Biomed Online 2004;8(6):616-627. [Abstract]
- Kefer JC, Agarwal A, Sabanegh E. Role of antioxidants in the treatment of male infertility. Int J Urol 2009;16(5):449-457. [Abstract]
- Li K, Li W, Huang YF, et al. Level of free L-carnitine in human seminal plasma and its correlation with semen quality. Zhonghua Nan Ke Xue 2007;13(2):143-146. [Abstract]
- Banihani S, Agarwal A, Sharma R, et al. Cryoprotective effect of l-carnitine on motility, vitality and DNA oxidation of human spermatozoa. Andrologia 2013, 3 July. [Epub ahead of print] [Abstract]
- Mills S, Bone K. The essential guide to herbal safety. St Louis: Churchill Livingstone, 2005. [Source]
- Zhao J, Dasmahapatra AK, Khan SI, et al. Anti-aromatase activity of the constituents from damiana (Turnera diffusa). J Ethnopharmacol 2008;120(3):387-393. [Abstract]
- Tribulus (Tribulus terrestris). Natural professional monograph 2013, [Source]
- Adimoelja A. Phytochemicals and the breakthrough of traditional herbs in the management of sexual dysfunctions. Intern J Andrology 2000;23 Suppl 2:82-84. [Abstract]
- Dinchev D, Janda B, Evstatieva L, et al. Distribution of steroidal saponins in Tribulus terrestris from different geographical regions. Phytochemistry 2008;69(1):176-186. [Abstract]
- Salvati G, Genovesi G, Marcellini L et al. Effects of Panax ginseng C.A. Meyer saponins on male fertility. Panminerva Med 1996;38(4):249-254. [Abstract]
- Choi HK, Seong DH, Rha KH. Clinical efficacy of Korean red ginseng for erectile dysfunction. Int J Impot Res 1995;7(3):181-186. [Abstract]
- Lee YJ, Chung E, Lee KY, et al. Ginsenoside-Rg1, one of the major active molecules from Panax ginseng, is a functional ligand of glucocorticoid receptor. Mol Cell Endocrinol 1997;133(2):135-140. [Abstract]
- Mills S, Bone K. Principles and practice of phytotherapy. Modern herbal medicine. Edinburgh: Churchill Livingstone, 2000. [Source]
- Bhattacharya SK, Muruganandam AV. Adaptogenic activity of Withania somnifera: an experimental study using a rat model of chronic stress. Pharmacol Biochem Behav 2003;75:547-555. [Abstract]
- Ahmed MK, Mahdi AA, Shukla KK, et al. Withania somnifera improves semen quality by regulating reproductive hormone levels and oxidative stress in seminal plasma of infertile males. Fert Ster 2010;94(3):989-996. [Abstract]
- Ganzera M, Choudhary MI, Khan IA. Quantitative HPLC analysis of withanolides in Withania somnifera. Fitoterapia 2003;74(1-2):68-76. [Abstract]
- Roseff SJ. Improvement in sperm quality and function with French maritime pine tree bark extract. J Reprod Med 2002;47(10):821-824. [Abstract]
- Duračková Z, Trebatický B, Novotný V, et al. Lipid metabolism and erectile function improvement by Pycnogenol®, extract from the bark of Pinus pinaster in patients suffering from erectile dysfunction-a pilot study. Nutr Res 2003;23(9):1189-1198. [Full Text]
- Burnett AL. The role of nitric oxide in erectile dysfunction: implications for medical therapy. J Clin Hypertens 2006;8(12,Suppl 4):53-62. [Abstract]