The New Naked: The Ultimate Sex Education for Grown-Ups (11 page)

Men don’t just worry about size. They can worry about everything having to do with their penis, including what comes out of it. Yes, semen. It can seem fairly innocuous when it’s ejaculated, just a small amount of cloudy white fluid. But it is teeming with sperm, so a tiny drop can have a lifetime of consequences for a fertile woman when she is not planning a pregnancy.

In case you were wondering, semen is only about 3 percent sperm. The rest is primarily composed of water, with a mixture of citric acid, amino acids, fructose, enzymes, and a few other minerals. The average volume of a normal ejaculation is between 2 and 5 milliliters, about a teaspoon. (For those of you wondering the age-old question about oral sex and swallowing, semen only has 36 calories!)

Pity the poor sperm, only a few microns long. Its epic journey to the egg of its dreams is a long one because the sperm needs to swim the equivalent of about 100,000 times its own length to get there.

Semen normally tastes fairly sweet and a little bit salty. The fructose in the semen helps power the sperm and keeps them
alive on their journey from a man to a woman. But the flavor of semen can be affected by what a man eats or smokes. A bitter taste or pungent smell could be due to smoking (cigarettes or marijuana) or drinking a lot of coffee or alcohol. Some foods, such as asparagus and garlic, can give semen an odd flavor because they contain high levels of certain enzymes or elements. If you consider how your pee smells after you eat asparagus, you know what I mean! Semen might also taste bad if your partner has a low-grade urinary tract infection.

Bottom line: If his semen tastes off or bad and he hasn’t been eating anything unusual or smoking or drinking too much, he should get checked out by a doctor to rule out infections or other conditions.

Now that you know a lot more than you ever thought you’d need to know about penises and sperm, let’s move along to how and how often he uses his equipment. In other words, time to talk about his libido.

A man can have trouble with his libido for many physical reasons, and if he is really unlucky (or lazy and self-indulgent) the reason usually falls into one or more of these categories. I’ve organized this information into an easy-to-remember (and perhaps aptly titled) acronym, HEAD:

• Hormonal imbalances, congenital conditions (such as small or malformed testicles), erectile dysfunction.
  

• Weight gain (particularly around the waist), sedentary lifestyle, over-exercising (particularly with weight-training).
  

• Hormonal changes, prostate issues.
  

• Anxiety, depression, osteoporosis, drug use, self-medication, alcohol use, fatigue, sleep disturbances (particularly sleep apnea).
  

Testosterone is to men what estrogen and progesterone are to women. It’s what separates the men from the women. These are the hormones that drive reproduction and sexual desire.

Along with sperm, testosterone is manufactured in the testicles, and a normal range is anywhere from 300 to 1,100 nanograms per deciliter of blood. The only way to check this level is with a blood test. Be sure to tell your partner to ask for a free testosterone workup. That’s not testosterone he gets for free, but what he needs for his body to function properly.

A man with normal testosterone levels tends to have a normal libido. That means he likes sex; he craves sex; and hopefully he has regular, mutually satisfying sex with a partner. A man with low testosterone may have a less intense sex drive and tends to be
of the meeker variety (not that this is a bad thing). A man with too much testosterone will make you long for Mr. Meek, because he’ll be aggressive, sexually obsessed, competitive, and extroverted—an in-your-face action man.

Unlike women, though, a man shouldn’t have fluctuating testosterone levels. His testosterone should remain fairly steady. Still, an estimated two to four million men in America suffer from symptoms associated with below-normal testosterone levels, a condition called hypogonadism. It’s very common in men as they grow older, although it can happen to young men, too. Often, it’s due to a congenital issue, such as undescended testicles, which don’t reach the scrotum, or varicocele, an enlargement of the veins in the scrotum. Both of these issues cause low testosterone levels, often leaving a man too exhausted to have sex and unable to get or sustain erections.

Low testosterone is easy to diagnose with a simple blood test. The most common self-inflicted causes are not getting enough sleep, being overweight, and taking certain medications, such as analgesics like codeine.

The primary symptom of low testosterone is low energy. It’s the complaint I hear most frequently. But because so many men are fatigued, they and their doctors often don’t think of this hormone as the root cause of the problem. There are simply so many other possible reasons for ongoing exhaustion. These include the stresses of everyday life, a crummy diet (which can lead to prediabetes or diabetes, a disease that wreaks havoc on energy levels), a sedentary lifestyle (lacking regular exercise to give you energy), too much work, and not enough time. Sound familiar? Only about 5 percent of men
with hypogonadism are actually being treated for it, leaving millions to suffer.

A healthy adult shouldn’t be saying, “I’m getting older so I’m tired.” Getting older isn’t an automatic recipe for getting pooped. Thinking it is could be a self-fulfilling prophecy, though, or a sign of a much more serious condition. If you have ongoing health issues or changes in how you’re feeling, see your physician and get a full blood workup to rule out any problems.

In addition to having fatigue, a man with low testosterone may not be very interested in sex. (I’ll discuss medical treatments for erectile dysfunction in “A for Aging,” starting on
page 106
.) Other typical symptoms of low testosterone include muscle weakness, small or soft testicles, erectile dysfunction, sleep disorders, weight gain (particularly around the waist), osteoporosis, depression, anemia, and just plain feeling crummy without knowing why. These are all issues that affect not only a man’s health and emotional well-being but yours, too. If your partner doesn’t seem to care about sex anymore, the dynamic of your relationship can’t help shifting, and this can cause tremendous problems until the root cause is found.

Fortunately, it is much easier for men to raise testosterone levels on their own than for women to raise their estrogen and progesterone without supplements. A man has to be motivated to exercise regularly; eat a nutritious low-carb, low-junk, and low-sugar diet; lose some weight; and quit smoking, drinking, or drugging. With these good habits, a man can naturally improve his testosterone count.

For men who aren’t willing to do the work, or whose testosterone levels are severely deficient, hormone replacement therapies
can also work wonders. Oral testosterone isn’t a feasible option because it is not FDA approved due to an adverse effect on the liver. Gels are by far the most popular application, although injections and patches are also available, all by prescription. Gels are applied daily to the shoulders, upper arms, or abdomen. Used as directed, they usually kick in quickly, bringing a man’s testosterone levels back to normal and keeping them there. If low testosterone was the reason for a man’s exhaustion and other symptoms, he should be feeling himself again, and his libido should make itself known to you again!

Some men, however, have potentially life-threatening issues affecting them, and lower testosterone is merely a consequence. That’s what happened with Phil. He was a big guy, but he’d been a whole lot bigger when I’d first started treating him. I found a pituitary tumor that had been wreaking havoc on his hormones, treated him for it, put him on testosterone, and he lost 150 pounds. He hadn’t had sex in
fifteen years
. Once he was in much better physical shape, he wanted to have sex all of the time.

His wife called me up. “I’m not ready for that,” she said. She’d gotten used to a sexless relationship. She wasn’t sure she even wanted to have sex again. That’s not a normal state of mind, so she needed to work with a therapist to address why she was avoiding sex when she could now have it so easily.

They had a lot of work to do to get back to a healthy sexual relationship, believe me!

Even though there is a booming business in testosterone replacement therapies, I have a problem with them. As I’ve said, many men who need testosterone aren’t getting it, and many men who don’t need it are demanding it. But testosterone replacement therapy is appropriate and safe
only
for men with subnormal levels diagnosed by a doctor or licensed medical professional.

Here’s why: certain medical conditions, such as an enlarged prostate or prostate cancer, can be made much worse by testosterone. To say nothing of what it can do to a man’s mood
and temperament. (Just think of all those angry sports players jacked up on testosterone and steroid shots!) You don’t want your usually calm and collected partner morphing into the Hulk because his testosterone has skyrocketed through unnecessary hormone therapy.

In addition, taking testosterone can cause infertility in men. This is great if he doesn’t want kids or has them already. It’s not great if a couple is trying hard to have a baby. So see a doctor before diving into the deep end of this pool.

As you’ll see in the section on Viagra and other pharmaceutical helpers (starting on
page 109
), erection-enhancing drugs might be thought of as magic pills for erections, but there’s no magic pill for weight loss. Actually, there is for me—it’s called the Playing Tennis Every Day for an Hour pill. Having an intense workout with a competitive partner keeps me fit and my appetite in check (most of the time). I know I can’t stop eating, especially if someone shoves a rib-eye steak or a piece of cheesecake under my nose, so if I didn’t exercise, I’d be a blimp!

When I tell my patients that the most common cause of low testosterone is unquestionably excess weight, their eyes widen. They had no idea. I explain that testosterone is broken down in fat cells. Those cells are like greedy little sponges, sopping up all that delectable testosterone gravy and converting it to estrogen-like compounds. If there are a lot of fat cells, the testosterone gravy gets metabolized too quickly, and levels soon drop dangerously low.

You already know that too much fat isn’t good for the health of a man’s sexual organs or the rest of his body, either. A high-fat and high-sugar diet leads to high cholesterol levels and obesity, which cause an enormous range of health issues—some lethal—and increase the risk of erection problems by lowering testosterone levels. Fat in the blood can clog the small arteries that feed the penis.

Remember, what’s bad for the heart is bad for the penis.

I also tell my patients that the goal isn’t to lose
weight
; it’s to lose the
waist
.

Ideally, waist size for both men and women should be about half your height. I can take one look at a man’s belly and have a fairly accurate estimate of his testosterone count—especially bodybuilders weighing 250 pounds of solid muscle. They’ll have thirty-two-inch waists despite their weight and are positively teeming with testosterone.

So how much weight is a problem? Based on your own metabolism, think about when you were twenty-one or so. If your weight was normal then, how much do you weigh now? Has there been a significant change? For example, if you were an athlete as a teenager and you weighed 170 pounds, but your weight is now 195, that’s too much weight. If your baseline weight was 230 pounds and you’re now 240, that might not be as much to worry about.