Hormonal dysfunctions can have a variety effects upon male fertility, and given the rising incidence of hormonal dysfunction and infertility in both men and women, new strategies are needed to counter these effects.
Hypothalamic-pituitary dysfunction
Consistently high levels of FSH indicate dysfunctional Sertoli cell function, and is usually accompanied by low LH and low testosterone levels. Such findings may indicate testicular failure, in which there is no medical treatment available. Holistic methods however, may make use of the rich repertoire of aphrodisiac and genitourinary trophorestorative botanicals used in both Chinese and Ayurvedic medicine.
Among those used in Chinese medicine, the majority of them are used to nourish and support the Kidney Yang, including Lu Rong (Deer antler, deer antler velvet), Ge Jie (Gecko), Dong Chong Xia Cao (Cordyceps), Yin Yang Huo (Epimedium grandiflorum), Ba Ji Tian (Morinda officinalis), Bu Gu Zhi (Psoralea coryfolia), Yi Zhi Ren (Alpinia oxyphylla), and Du Zhong (Eucommia ulmoides) Such Kidney restoratives however may be used in conjunction with those that support the Kidney Yin and Blood, especially symptoms of heat signs are found, including Shu Di Huang (Rehmannia glutinosa), Dang Gui (Angelica sinensis), Bai Shao (Paeonia lactiflora), Gou Qi Zi (Fructus lycium), Xi Yang Shen (Panax quinquefolium), Tian Men Dong (Asparagus cochinchinensis), Shi Hu (Dendrobium nobile), and Nu Zhen Zi (Ligustrum lucidum). In Ayurvedic medicine aphrodisiac remedies are called vajikarana rasayanas, meaning “to do like a horse,” and include Ashvagandha (Withania somnifera), Kapikachu (Mucuna pruriens), Tila (Sesamum indicum), Amalaki (Emblica officinalis), Gokshura (Tribulus terrestris), Shatavari (Asparagus racemosa), Jatamamsi (Nardostachys jatamansi), and Bala (Sida cordifolia ).Other substances used in Ayurvedic medicine to enhance male sexuality include Shilajitu (Mineral pitch), goat testicles, and tortoise eggs.
Consistently high levels of LH accompanied with low testosterone levels can indicate problems within the Leydig cells, whereas onsistently low levels of both LH and FSH may indicate problems within the hypothalamic-pituitary axis. Both of these situations call for the use of botanicals high in steroidal saponins, such as vajikarana and Kidney Yin/Yang restoratives such as Ashvagandha (Withania somniferum), Dang gui (Angelica sinensis), Ren Shen (Panax ginseng) and Licorice root (Glycyrrhiza glabra). Any genitourinary trophorestorative therapy however should be given for a sustained period of time, and should accompany major dietary and lifestyle changes such as stress reduction, the elimination of coffee, alcohol, nicotine and recreational drugs, and an adherence to a whole foods diet.
Gynecomastia
Gynecomastia is the enlargement of the breast, most usually in pubescent males as a transient swelling of breast tissue under the areolae that appears as a hardened disk. Gynecomastia may also occur with aging, or may accompany hepatic disease, regular marijuana consumption, and with the use of various pharmaceutical drugs. Obesity is also a risk factor for gynecomastia, due to the conversion of androgens into estrogen by adipose tissue. (Berkow 1991, 1815; Rubin 2001, 549)
The holistic treatment of gynecomastia depends upon the cause, with weight loss management if this is a suspected cause, or the use of botanicals such as Chasteberry (Vitex agnus castus) as a dopaminergic to counter elevated prolactin levels in a pituitary tumor. Additional therapies include hepatoregenerative and cholagogue botanicals such as Milk Thistle seed (Silybum marianum), Turmeric (Curcuma longa), and Wu wei zi (Schizandra chinensis), the symptomatic usage of phytoestrogens such as Red Clover (Trifolium pratense), and the use of reproductive trophorestoratives such as Ren Shen (Panax ginseng) and Ashvagandha (Withania somnifera).
Thyroid function
Both the hyperfunction and hypofunction of the thyroid can alter sperm production and decrease libido. If hyperthyroidism is suspected or indicated by diagnostic tests the most important botanical to consider is Bugleweed (Lycopus virginicus), which contains lithospermic acid that acts as competitive inhibitor of thyroid stimulating hormone (TSH). Additional measures to control palpitations and nervous irritability include Motherwort (Leonorus cardiaca) and Night-blooming Cactus (Selenicerus grandiflorus). Hypothyroidism is best treatment by using foods high in organic iodine such as sea weed, and botanicals that act as adaptogens such as Siberian Ginseng (Eleuthrococcus senticosus), Sarsaparilla root (Smilax spp.), and Ren Shen (Panax ginseng). Other botanicals that can be of use in hypothyroidism include Cayenne fruit (Capsicum spp.), Oregon Grape root (Mahonia aquifolium), Guggulu (Commiphora mukul).
Sperm dysfunction
Male infertility is often linked with various forms of sperm dysfunction. Spermatogenesis and sperm morphology has already been discussed in Part Two, and factors that negatively affect male fertility are discussed in Part Four. Oligospermia is a low sperm count, which apart from anatomical issues, usually relates to hormonal deficiencies. The holistic treatment of oligospermia rests upon the use of herbs that enhance spermatogenesis, including Chasteberry (Vitex agnus castus), Ren Shen (Panax ginseng), Sarsaparilla (Smilax spp.), Ashvagandha (Withania somnifera), Epimedium (Epimedium macranthum), and Kapikachu (Mucana pruriens). Asthenospermia is poor sperm motility, and as the only factor is usually indicative of a genitourinary infection. Thus the treatment of asthenospermia requires the use of antimicrobials such as Buchu (Barosma betulina), Bearberry (Arctostaphylos uva-ursi), Pipsissewa (Chimaphila umbellata), and Myrrh (Commiphora mukul). Teratospermia is poor sperm morphology, which in association with poor motility often indicates an autoimmune reaction to the spermatozoa. Immunomodulants such as Ling Zhi (Ganoderma lucidum) and Huang Qi (Astragalus membranaceus) are indicated, as well as a diet with a low level of immunogenicity (e.g. the Paleolithic diet). Other key strategies involve avoiding the ingestion of sperm, often from post-coital cunnilingus. Pyospermia is a high white blood cell count in semen, and is indicative of a genitourinary infection, and should be treated accordingly.
The ubiquitous presence of xenoestrogens in the diet and environment may be responsible for a variety of effects upon male fertility. Reduced sperm counts, a rise in anatomical defects such as undescended testes, hermaphroditism, and rise in reproductive cancers can all be correlated to the influence of xenoestrogens. The rates of male infertility have risen sharply since the early 1980’s, and over the last 50 years there has been a substantive decrease in the quality and quantity of sperm. In Britain, for example, the testicular cancer rate has more than doubled in the last 50 years, and is now the most common cancer in men under 30 (Moller and Evans 2003). Thus, measures should be taken to limit the effects of xenoestrogens by enhancing hepatic elimination with cholagogues and the use of phytoestrogens. Further, the diet should be comprised of organic whole foods, supported by a Danish study published in the Lancet that showed that male farmers who ate pesticide-free foods produced roughly double the average number of sperm (Abell et al 1994).
Erectile disorder
Erectile dysfunction (ED), also called impotence or sexual arousal disorder, refers to the inability to attain or sustain an erection satisfactory for sexual intercourse. There are two primary forms of ED. Psychogenic ED is caused by psychic factors, such as an abnormal fear of the vagina, sexual guilt, fear of intimacy, or depression. Organic ED can result from vascular, nervous, or hormonal causes. At one time, psychogenic ED was thought to be the primary form of ED, but it is now recognized that organic ED accounts for up to 80% of all cases. In some situations however, psychogenic effects occur simultaneously with organic causes. (Berkow 1992, 1575; Brosman 2005)
There are many conditions associated with ED, including aging, chronic disease (cardiovascular disease, liver disease, renal disease), endocrine abnormalities (hypogonadism, hyperprolactinemia, hyper/hypothyroidism, hyperinsulinemia and diabetes), lifestyle habits, neurogenic causes (e.g. multiple sclerosis, spinal cord injury, herniated disk), penile injuries, drugs, psychological issues, pelvic trauma or surgery, and pelvic radiation. The most common medical conditions associated with ED are those conditions in which there is an impairment of arterial flow to the erectile tissues, or disruption of the neuronal circuitry. Patients with diabetes mellitus have the highest rates of ED as a result of vascular disease and autonomic dysfunction. Up to 25% of ED cases are caused by medication, most commonly those used to treat hypertension (e.g. diuretics, beta-blockers, and sympatholytics) and psychiatric disorders (e.g. antipsychotics, anxiolytics, and antidepressants). Additionally, both the regular consumption of alcohol and smoking has been associated with an increased incidence of ED. With aging there is typically a diminution of spontaneous erectile function with erotic thoughts or activity. The easy to achieve erection that occurs in youth begins to become less a feature of male sexuality by about mid-life. Often, some form of consistent tactile stimulation is required to sustain an erection, and when achieved, may not be as hard as experienced in youth. With these changes, the man may become increasingly anxious about his sexuality, which may further exacerbate the condition. (Berkow 1992, 1575; Keene and Davies 1999; Brosman 2005)
In the recent past the success of medical treatments for ED were acknowledged to be ineffective, cumbersome, or invasive. Previously popular measures included vacuum devices used prior to sexual activity, the urethral insertion of a prostaglandin compound, and penile implant surgery. Oral medications consisted of testosterone, which has since been shown to be ineffective if the cause is not hormonal. The introduction of sildenafil however, has largely replaced these measures, and has been shown to enhance erection during erotic stimulation without surgery or invasive procedures. Sildenafil acts by blocking the activity of phosphodiesterase V, an enzyme found primarily in the penis. The inhibition of this enzyme allows for corporal smooth muscle relaxation and the prolongation of penile engorgement and erectile enhancement. Adverse effects of sildenafil include headache, flushing, dyspepsia, and visual disturbance, the latter or which is most likely due to the weak inhibition of phosphodiesterase VI located in the retina. Severe adverse reactions and even fatalities have been documented when sildenafil is taken with other medications. Thus, the American College or Cardiology recommends that patients taking multiple antihypertensive medications, who have a recent history of angina or myocardial infarction, have severe left ventricular dysfunction and low blood pressure, or are taking drugs that can inhibit the hepatic cytochrome P450 system, should avoid sildenafil.
The holistic treatment of ED is essentially the same as it is for sperm dysfunctions such as oligospermia, using dietary, lifestyle, nutritional, and botanical therapies to enhance male reproductive function and the overall “vital essence.” One botanical traditionally used in the treatment of ED and sexual dysfunction is the bitter tasting Yohimbe bark (Pausinystalia yohimbe), native to tropical West Africa and used traditionally by the Bantu people as stimulant in mating rituals. It is a central nervous system stimulant and mild hallucinogen with cholinergic and adrenergic-blocking activities, increasing pelvic blood supply and affecting the spinal ganglia to promote erections. The dose of a 1:5 tincture is 5-30 gtt., and the effects last anywhere from 2 to 4 hours. Yohimbe however, is a monoamine oxidase inhibitor, and if taken with sedatives, tranquilizers, antihistamines, narcotics, or alcohol, may promote a severe hypotensive crisis. Taken with amphetamines, LSD, methylxanthines such as caffeine, or dairy products, Yohimbe may promote a hypertensive crisis. Like sildenafil, Yohimbe is contraindicated in cardiovascular disease and with antihypertensive medication.
Safer than Yohimbe is Yin Yang Huo (Epimedium grandiflorum), a Chinese botanical used to nourish the Kidney Yang, whose name translates as “Horny Goat Weed.” Bensky and Gamble report that it has been shown to enhance sexual activity, increase spermatogenesis, and stimulate sexual desire (1993, 342). It is often prepared in rice wine, but an ethanol extract may also be made (1:5 40% alcohol), dosed between 3-5 mL. Yin Yang Huo is contraindicated in dryness, thirst, and symptoms of heat and inflammation.
Another helpful botanical in ED that is used in Ayurvedic medicine is Kapikachu seed (Mucana pruriens), a slender climbing annual found throughout India. Apart from its use in the treatment of ED, it is an important botanical in the treatment of Parkinsonism, and contains significantly high amounts of naturally occuring L-DOPA, up to 7.64% (St-Laurent et al 2002). The dose is 3-5 g of the powdered seed, or 3-10 mL of a 1:3 tincture (40-50% alcohol).
Although botanicals such as Yohimbe bark (Pausinystalia yohimbe) and Epimedium herb (Epimedium grandiflorum) can be successfully used to treat sexual dysfunction, the are, by their very natures, highly stimulating. If they are taken long term or used inappropriately they can lead to the depletion of the vital essence or have negative side-effects. Thus, these botanicals should be used in association with others that have a more generalized nutritive property, such as American Ginseng (Panax quinquefolium), Dang Gui (Angelica sinensis), Ashvagandha (Withania somnifera), Saw Palmetto (Serenoa serrulata), and Milky Oat seed (Avena sativa).
Relationship factors play an important part in ED, and if the man is in relationship, both partners will need to be part of the treatment strategy. Although sexuality is often heightened in the early stages of a relationship, over time sexual roles may take on almost perfunctory nature. If this dynamic is apparent in the relationship the couple should be encouraged to examine new levels of intimacy and sensuality. Men with ED require more time to achieve an erection and thus extended sessions of foreplay prior to intercourse may be of benefit. Further, the use of sexual stimulants may enhance the patient’s sexual appetite, and the partner should be made aware of this possibility.
Lifestyle and dietary factors are essential to take into consideration. The sexual response is mediated by the parasympathetic nervous system, the rest and restorative aspect of autonomic function. Thus, if the patient with ED is found to have a high level of emotional stress this could be the underlying cause of the condition. Other important habits include all those that enhance and rebuild the vital essence of the body such as the avoidance of nicotine, alcohol, caffeine, and marijuana, and limiting excessive exposure to solvents, cleaning agents, industrial chemicals, and electromagnetic radiation. Controlling weight gain is another aspect in the treatment of ED, and measures taken to improve self-image will go a long way to enhancing sexuality. The diet should be comprised of organic, whole foods, with possible supplements that include vitamin B complex (100 mg daily), vitamin C (to bowel tolerance), selenium (200 mcg daily), and zinc citrate (50 mg daily).