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Downward Facing Dog

Downward Facing Dog

Of late, it seems as if I see more men complaining of fatigue, lack of drive and losing their interest in sexual activity. It is not eighty year-old men, it is men in their early twenties to late thirties. Some young men are in their late adolescence. There is no question that circulating testosterone levels tend to drop with advancing age, but this well recognized age related phenomenon does not explain the massive drops men are experiencing.

Men are taught from an early age that they should be the head of the house, whatever that means. Associated with this king-like duty, more often than not is a forty to sixty hour work week to provide financial security to his family as well as yard work duties and family obligations on the weekend. Although woman bear the brunt of the childcare responsibilities on the whole, men have begun to take over more and more child rearing responsibilities. Women are rising in the workplace hierarchy and some men have remained home to assume traditionally female roles; there is a great amount of psychosocial stress being created by the uncertain role men play in today's society. So what happens to men when they get stressed? Despite the impression that the television series Game of Thrones on the HBO cable network, constant, unrelenting stress in men (and women) is devastating. Just look into the effects of chronic war on our veterans who have returned from the Mideast after two or three tours of duty. Post traumatic stress disorder has risen to a public health condition in the first order.

Not only do men experience kidney, liver, pancreatic and heart disease, they also experience significant disturbances in the regulation of their sex hormones and sperm production. Men lose their interest in sex, develop erectile dysfunction and become disheartened over their lack of libido and sexual performance.

In men under normal conditions, their brain releases a hormone from the hypothalamus called Luteinizing Hormone Releasing Hormone (LHRH). It's primary role is to stimulate the pituitary to release Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). Men do not have ovarian follicles to stimulate. Instead LH stimulates the testicle to release testosterone into the circulation and FSH stimulates testicular sperm production.

It is probably no surprise that when a significant stressor appears, the entire hypothalamic - pituitary - testicular system shuts down. LHRH concentrations decline quickly. Shortly after circulating LH and FSH levels decline. The testicle goes quiet like a small New England coastal fishing village preparing for a hurricane. There is a significant decline of circulating testosterone levels. Injury, illness, and starvation shut down the male endocrine system. Constant energetic stress in men significantly lowers their testosterone levels. There is no such thing as constant "good" stress. Ever.

Even subtle psychosocial stressors are just as disturbing. Put men in subordinate positions or put them through a stressful learning task and their system just shuts down. Even though they do not like to admit it, in the US Officer Candidate School, researchers found that rigorous training programs significantly lowered a candidate's circulating androgen levels at the end of training.

How does stress affect men so strongly? There are a number of contributing factors. With the onset of stress, the endorphins and enkephalins (the brain's opioid-like neurotransmitters) increase. These two neuropeptides block the release of LHRH from the hypothalamus. I suspect some of my patients have experienced a runner's high; the sense of joyful calm an athlete feels when they hit about thirty minutes of cardiovascular exercise. Do endorphins from exercise inhibit testosterone release. It depends. Research shows that extreme amounts of exercise like professional soccer players experience or runners who log forty to fifty miles per week have significantly lower circulating LHRH, LH, and testosterone. These men also have smaller testes and a decrease in functional sperm. I do not know if any studies have been performed in the NFL.

There is no question that exercise improves your health. There seems to be the notion that the more one exercises, the better one's health will be. But because humans are a convergence of cells regulated by negative feedback, it stands to reason that too much exercise will be detrimental. It seems as if too much of anything can be as bad as too little. There are optimal points of allostatic balance. Moderate amounts of running can increase bone mass while thirty-year old athletes who run forty to fifty miles a week decalcify their bones, decrease bone mass, significantly increase the incidence of stress fractures and scoliosis. If some is good, more is definitely not better. Intense, insane frequent workouts when a person is in their thirties gives them a skeleton of a seventy year-old person.

There are a number of studies that reflect the behaviors of modern day hunterer - gatherer societies. Not one of them shows that these primitive cultures exercise more than just tracking down prey. None of their members run twenty-six miles at a time. They would think running what seems to be forever as stressful. I believe the first man to run 26 miles died after he delivered his message to the General of his army.

But stress does not just lower LHRH in men, it also increases prolactin secretion from the anterior pituitary which decreases the sensitivity of the pituitary to LHRH. Another damaging fact is that cortisol and other glucocorticoids block the testes' response to LH. So you Cross Fit athletes beware: enough is enough and enough is too much sometimes.

What about erections? There seems to be a relatively large population of young men asking for medication to reverse erectile dysfunction. Most of them are just stressed out with their life. There is a enormous amount of complicated physiology going on for a male to initiate and maintain an erection. Fortunately by design, it happens instinctively. To divert and engorge a penis, the parasympathetic nervous system must have dominion over the body. In the beginning, men need to be calm, relaxed, interested in their mate and almost vegetative. Remember it is no time to have an erection running from a grizzly bear unless of course, you are a hyena.

When I was in medical school, we learned about the four F's of the sympathetic nervous system: Fight, Fright, Flight and Sex (or slang word for coitus). During the sexual adventure, a calm relaxed male gradually turns on the sympathetic nervous system one mechanism at a time. First breathing rate increases, then the heart rate quickens and sometimes aggressive physical activity ensues. Some men try to stave off the total transition to the sympathetic system by breathing deeper or thinking of a serene country setting or a quiet cool pool of crystal blue water. Eventually like the crescendo of a Beethoven symphony, the sympathetic nervous system will take over. The parasympathetic nervous system will cut power at the penis. What happens then? Ejaculation. I think there can be some incredibly complicated choreography between two people having intercourse before the final event occurs.

Although older men can develop stress induced changes in their vascular system limiting blood flow to their genitalia, thereby limiting their ability to have an erection, the vast majority of younger men suffer from too much sympathetic activity at the time of potential coitus. Then there are men who are actively engaged in the act of sexual activity and for some reason they think about the money they lost in the recession and
- shazaam - they lose their erection immediately or ejaculate prematurely. That's no fun at all.

It is fairly obvious, stress trumps erections. Stress may not stop desire, although in my practice, a lack of libido is a common everyday complaint of both men and women. Not every male mammal is as sensitive to stress as the human. There are species of animals that fight for dominance before winning the right to copulate with the female of whom they have chosen to mate. Elk, moose, deer and many other species live in accord with this unique rule of nature. Lions have another interesting behavior. Their sexual act is a prolonged wildly metabolically demanding activity. The pair may copulate for hours and sometimes days. No eating or sleeping is stressful no matter what one is doing. But in these animals, it seems as if endurance weeds out the weakest of the males since the prolonged stress of mating does not cause erectile dysfunction in the strongest, most fit male. I do not think that rule of the jungle applies to most male or female humans.

Stress reduces sex hormones in males. But if a male has some testosterone and a few sperm, many times he can muddle through a sexual encounter as long as his parasympathetic/sympathetic nervous system regulates properly. If a man is under a high amount of psychosocial or physical stress daily, the likelihood that he will initiate and maintain a sexual encounter is probably remote. What is more rare? Cialis®, Viagra® or Levitra® will fix stress induced impotence.

Yoga is probably a better treatment than the Blue pill. Especially a prolonged a pose of the Downward Facing Dog.
Posted by Amanda Sanders at 8:54 AM
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