St. Petersburg Health & Wellness

Men’s Sexual Health – Les Cole, MD
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Silhouette 50Male sexual health…

is often not discussed leaving many men not knowing where to turn for help. There are several sexual issues that often get jumbled together that result in the frustration, discouragement and sometimes despondency of failed sexual interaction. These take a toll on the self-esteem of both partners and the intimacy (sexual and otherwise) of the relationship. So let’s sort these contributing factors out. There are 2 primary contributors to male sexual difficulties. The first factor is low libido or sexual desire which arises from a complex of hormonal, emotional, mental and other inputs. The other important contributor is erectile dysfunction which is dependent on blood flow. Another important issue for some men is either premature or delayed orgasm. We will discuss each of these below.



Sexual desire often wanes for men as they age. The most frequent cause is a decrease in testosterone. Some of the symptoms of low testosterone which may contribute to decreased libido are a decrease in self-confidence, assertiveness, vitality, and energy. Low testosterone can also lead to diminished clarity of thought, decreased muscle mass and can affect mood causing anger or depression. It is important to be able to recognize these symptoms, because Bioidentical Testosterone Replacement Therapy can not only improve all of these symptoms, including low sex drive, but can also protect your blood vessels and heart. Another hormone deficiency that can contribute to low libido is hypothyroidism, which also affects a host of other health issues. To see if you may have low Testosterone download, complete, save and email Male Hormone Questionnaire to [email protected].


Erectile Dysfunction (ED)

ED has several causes that are all related to blood flow. We will take them in turn.


Nerve Damage

Nerve damage does not occur often. When it does, the most common causes are diabetes, prostate surgery or injury. Initiation of an erection occurs generally through stimulation of nerves, which occurs as a result of sexual thoughts, visual stimulation or touch. The nerves signal increased production of nitric oxide (NO), a strong vasodilator, which increases blood flow. If these nerves don’t function correctly, there is no increase in NO and no increased blood flow. In this case, Viagra, Cialis or Levitra may help as they prevent NO that is normally produced in smaller amounts on an ongoing basis from being broken down. If these are not effective, there are other effective treatments.



Atherosclerosis or hardening of the arteries is a rare contributor to ED, primarily seen in men with diabetes. If this is the cause, an ED medication may help or, if not, other solutions are available.


Nitric Oxide and Endothelial Health

The most frequent cause of ED is the loss of nitric oxide in the blood vessels. Nitric oxide (not the same as nitrous oxide in the dentist’s office) is a molecule with tremendous biologic significance. It is produced by every cell that lines every blood vessel in your body. These are the endothelial cells. There are millions of endothelial cells and one of their main functions is to produce NO or nitric oxide for the purpose of causing the smooth muscle cells in the blood vessel wall to relax. This causes the blood vessels to dilate (vasodilation). Vasodilation is extremely important throughout the body. In the heart, NO production occurs when we exercise so the heart gets enough blood and doesn’t get damaged. It helps prevent high blood pressure. In the gut, NO production and vasodilation happens every time we eat so we can digest and absorb our food. And for arousal to occur for both sexes vasodilation needs to occur in the sex organs.


ED is most often a sign of decreased nitric oxide (NO) production. Viagra, Cialis and Levitra block the enzyme that breaks down NO once it is produced by the endothelial cells so there is more around to do its job. That’s wonderful, but it does nothing to address the underlying problem – the endothelial cell dysfunction (also known as ED) throughout the rest of the body! Endothelial dysfunction happens equally throughout the body, so if it’s happening anywhere, it’s happening everywhere, which means if you have ED (erectile dysfunction) because of generalized poor NO production, you have ED (endothelial dysfunction). Endothelial dysfunction contributes to many chronic diseases: high blood pressure (HBP), heart disease, hardening of the arteries, heart attack, stroke, kidney disease, diabetes related problems, etc.


It is important to improve endothelial function so you don’t develop any of these conditions. Fortunately, there are supplements that can increase your own body’s ability to produce nitric oxide and not only improve endothelial dysfunction but also improve erectile dysfunction. Most of these supplements contain arginine, an amino acid, which is the molecule that NO comes from. Taken on a daily basis this can help prevent or improve both types of ED. Be aware that arginine can reactivate herpes simplex and herpes zoster (shingles) in some people. Not all supplements are created equally. We have a great product


Testosterone and Thyroid Hormonal deficiencies

Testosterone is important in preventing ED because it regulates and promotes the health of endothelial cells, which as we’ve seen, is critical for blood vessel health throughout the body and for blood flow. If you have symptoms of low testosterone, including ED, Bioidentical Testosterone Replacement may help. To see if you may have low Testosterone download, complete, save and email Male Hormone Questionnaire to [email protected].

Thyroid hormone is important for the functioning of all cells in the body. When it is low, nothing works right, including blood vessels and the ability to achieve & maintain an erection. To see if you may be Hypothyroid download, complete, save and email Hypothyroid Risk Questionnaire to [email protected].


Premature and Delayed Ejaculation

Premature Orgasm (PE)

PE is an extremely frustrating problem for men who have it. It, unfortunately, can be a source of shame that arises from the associated stigma, which implies that somehow the man with PE is responsible or at choice. This is both inappropriate and unfortunate because this condition, like most health conditions, is due to an imbalance in hormones or metabolism. There are two known imbalances that are associated with PE. (It is also of interest that some women have the identical problem known as premature orgasm.)

Thyroid Hormone – Hyperthyroidism

The thyroid hormone is involved with the “clock speed” of your nerve transmission. When it is too high, known as hyperthyroidism, your nerve impulses can be speeded up leading to faster summation of both sensory (from the penis & elsewhere) input and thought input (fantasy) on the orgasmic centers in your brain and spinal cord. This speed-up of sensory input can actually make more areas of the body erogenous zones. The faster summation of fantasy also can have these centers so “prepped to go” that a simple touch may set off these centers. It is important, therefore to have a complete evaluation of your thyroid function with the correct testing. The good news is that if you have PE due to elevated thyroid (hyperthyroid), even if it is mildly elevated, lowering your thyroid may help. To see if you may be Hypothyroid download, complete, save and email Hyperthyroid Risk Questionnaire to [email protected].

Histamine – Histadelia

Histadelia is a condition of increased levels of histamine that can be due to several different problems. One of these problems is known as a methylation defect from an enzyme called MTHFR. Another problem can be a defect in and enzyme called DAO. Both of these enzymes metabolize and thus reduce histamine levels. Histamine is a neurotransmitter, as well, as a component of the immune system that is responsible for allergy symptoms and asthma among other functions in the body. It comes from the amino acid Histadine. It is an excitatory neurotransmitter, which in certain individuals, when elevated can increase the occurrence of PE. Many doctors are unaware of the condition or the association. We can test histamine levels, as well, as MTHFR and DAO.

Delayed or Absent Ejaculation

Men can also experience delayed ejaculation or even be anorgasmic, meaning you are unable to achieve orgasm. Again, thinking about “clock speed”, if the nerve impulses build too slowly and with little intensity reaching the threshold of release may be slowed or even non-existent. So, if you have too little thyroid hormone (hypothyroid), this can also be treated and is likely to improve your sex life. See Signs & Symptoms of Hypothyroidism.

If you have questions, are interested in Testosterone or other Bioidentical Hormone Replacement or have Sexual Health issues contact St. Petersburg Health and Wellness. We are happy to help.

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