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Two More Orgasms Per Month? Why Not?

I was at dinner with an old physician colleague of mine who happens to be French. Despite living in the Midwest for decades, he continues his lifetime subscription to Le Monde and preserves–no, cultivates–his accent so efficiently that I miss about ten percent of what he’s saying. Given we were both well into our second martini, it was inevitable that issues of male sexuality would find their way into conversation.

“David,” he began (and don’t bother to read this in your fake French accent), “as we grow older, and unfortunately not all that much older, sex becomes…(he paused, seeking the right word, which he knew all along, but his pause enhances the profundity of his statement)…memory.”

“Memory? You mean that at a certain point sex is no longer an active verb?”

“Only memory. Think Proust, sitting in his cork-lined room obsessively reviewing his sex life. Think The Three Musketeers. Well, the four of them (remember, there are really four musketeers) start out in their 20s, though D’Artagnan is still in his teens, having sex with everyone in sight. But by the time we’re in the third and fourth novels, decades later, they’re mainly into politics, chatting about their younger hypersexual sexual days (what is the word?) wistfully.”

“And you think there’s nothing to be done? There’s a new study…”

He was still deep into literature. “Oh, and your Saul Bellow! Read his novels? Everything is in the past tense. I once sat next to him at some fundraising dinner. He dominated the conversation, listing the famous women he’d been to bed with. Sex, David, is a memory, nothing but a memory.

I wasn’t buying it
Although it’s challenging to change the mind of an erudite Frenchman, he did let me finish my point. I began, “Just let me quickly review how our bodies change and why you feel compelled to rely on your erotic memoirs.”

Levels of your male sex hormone testosterone drop slowly and relentlessly. Yours peaked at D’Artagnan’s age–late teens, early 20s. A list, called the Psychosexual Daily Questionnaire (PDQ), lets you know how much testosterone is involved in your life. Enrollees in studies are given this list to be filled out at the end of every day, a sort of “At any time today, did you experience?…”

  1. Sexual daydreams
  2. Anticipation of sex
  3. Sexual interaction with partner
  4. Flirting by you
  5. Orgasm
  6. Flirting by others
  7. Ejaculation
  8. Intercourse
  9. Masturbation
  10. Spontaneous erection at night
  11. Spontaneous erection during day
  12. Sexual arousal erection

Over the years, the PDQ has been administered to thousands of men. The results correlate strongly to blood levels of testosterone (mainly) and estradiol (to a lesser extent).

An important research study, published just last month in the prestigious Journal of Clinical Endocrinology & Metabolism, measured the testosterone levels and tracked the PDQ responses every three months in 470 men. Half were given testosterone, the other half a placebo. In this particular study, all the men were over 65, but certainly men as young as their 30s can have both low PDQ scores and low testosterone levels.

The study has gotten a lot of publicity because, after one year, among those men receiving testosterone, ten of the 12 PDQ questions showed statistically significant improvement. The only two that did not change after T treatment were flirting by others and daytime spontaneous erections.

As a bonus, just about every man taking testosterone enjoyed two additional orgasms every month.

The downside: ED
However–always a big however–what also didn’t change was erectile dysfunction (ED). Testosterone does not help ED.

“Ha” snapped my physician-friend, “Nothing like being horny and helpless!”

I put my hand up to object.

Next, of course, is dealing with the unreliability of your penis. Now that you can move your testosterone to a respectable level, you need Viagra, Levitra, Cialis, or Stendra within reach. But even this may not be enough. There’s more to sex than a tent pole in your pants and the testosterone of a 20-year-old. You also need to consider:

  • Prescription drugs  The big villains here are antidepressants and meds for blood pressure, but here’s a more comprehensive list. You can talk to your doctor about discontinuing or switching meds, such as moving from Zoloft (a libido/penis killer if there ever was one) to Wellbutrin.
  • Your life  Here the sex drive killers are obvious: stress, alcohol, partner problems, fatigue, too little sleep, having kids, or simply a lack of closeness. Less obvious are poor body image, obesity, depression, or having a partner who’s experiencing menopause-related painful intercourse and vaginal dryness.

My friend acknowledged that all these possibilities–raising testosterone, enhancing erections, managing sex-killing meds–undeniably offered hope. But he couldn’t leave it alone.

“David, memory is easier. And you can enhance memory with your imagination. No one ever said that sexual fantasies as rich as any Marseille bouillabaisse need be truthful. We go through life relentlessly kidding ourselves.”

Okay, so I’ll never get anywhere with my Gallic friend.

Better sex bucket list
For you, here’s a better sex bucket list:

  • Just because the study was done on men over 65, don’t wait to get started on this. No matter your age, you’re entitled to a good sex life.
  • Start by reviewing your medication list. If your libido crash began shortly after you started a medication, it’s the likely culprit. Don’t discontinue any meds without first discussing with your doctor, but generally an alternative can be found. Here again is the list of pharmaceutical sex villains.
  • Click to this list called “Sex Drive Killers.” Examine your life and see if some professional help is needed.
  • Have your doctor order a sex hormone profile, which checks both free and total testosterone, estrogens, sex hormone binding globulin (SHBG), and DHEA. This link explains these and other hormones.
  • I regard “low testosterone” as any number either below normal or in the bottom quartile. Unfortunately, most insurers won’t pay for testosterone replacement in the low-normal range. However, testosterone from a compounding pharmacy is actually about 75% less expensive than name brands like Axiron and Testim.
  • If your testosterone is low and you’re reluctant to start hormone replacement, consider the supplement Testosterone Formula (by Integrative Therapeutics), taken as two capsules daily. Even the frequently skeptical Consumer Health Digest gives it a thumbs-up.
  • Take a completely non-pharmacologic approach with traditional Chinese medicine (TCM). The combination of acupuncture and Chinese herb blends can be extremely effective. Any of our three TCM practitioners (Mari Stecker, Cindy KudelkaHelen Strietelmeier) have excellent protocols for low libido.
  • If erectile dysfunction is an issue, ask your doctor for a sample of one of the four ED drugs (Viagra, Levitra, Cialis, or Stendra). Your insurance company will generally cover about 9 to12 tablets a month, but if not you can fax a prescription to Canada and get the generic tablets mailed to you from the UK (which is perfectly fine). The price drops from $50 a pill to $3 a pill. (Unbelievable, eh?) If your jingoism insists on a US product, start with the 100-mg size and cut them in half so you’re taking 50 mg per dose.

I’d like to add that I didn’t discuss this bucket list with my dinner companion. He’d started sipping a Charentes cognac and was recalling some philosophy student he’d seduced while at the Sorbonne. He was probably about 25 at the time, when concepts like low libido and erectile dysfunction were the stuff of dystopic science fiction.

Be well,
David Edelberg, MD

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DIAGNOSE-IT-YOURSELF: COVID-19

Far and away, the commonest phone call/e mail I receive asks about COVID-19 diagnosis.
Just print this out, tape it on your refrigerator door, and stay calm.

ALLERGIES

• Runny nose
• Sneezing
• Red, swollen eyes
• Itchy eyes and nose
• Tickly throat
• No fever

COLD
• Runny nose
• Sneezing
• Sore throat
• Mild muscle aches
• Mild dry cough
• Rarely a low fever

STREP THROAT
• Painful sore throat
• Hurts to swallow
• Swollen glands in neck
• Fever

FLU (Standard seasonal flu)
• Fever
• Dry cough (no mucus)
• Sudden onset over few hours
• Headache
• Sore throat
• Fatigue, sometimes quite severe
• Muscle aches, sometimes quite severe
• Rarely, diarrhea

CORONAVIRUS-COVID 19
• Shortness of breath
• Fever (usually above 100 degrees)
• Dry cough (no mucus)
• Slow onset (2-14 days)
• Mild muscle aches
• Mild fatigue
• Mild sneezing

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