Supporting Healthy Libido & Function in Men By Antonio Reale, ND


talk extensively about the role of estrogen and its effects on women's bodies, but the conversation about testosterone as it relates to sexual function receives decidedly less attention. Erectile dysfunction often occurs with other more serious conditions, such as high blood pressure, diabetes, and elevated cholesterol levels, making it important to fi rst rule out any underlying disorders. In other cases, testosterone is either too low or there is not enough hormone available to support healthy libido and erections. Depending on the cause, we can use a va- riety of herbs, amino acids, and nutrients to promote sexual health and function.


E


Citrulline & Arginine: Nitric Oxide and Vasodilators


Once we've ruled out more sinister


causes of ED, we can use amino acids like arginine and citrulline to support erec- tion quality. These amino acids increase a substance called nitric oxide (NO), which works in the body as a vasodilator. Vaso- dilation, or the widening of blood vessels, is important for healthy blood fl ow and therefore, stronger erections. Medications like Viagra work by inhibiting an enzyme called PDE-5, resulting in vasodilation. When a patient reports trouble attaining or maintaining erection, but does not note a decrease in libido or desire, it's likely that the problem is related to perfusion (blood fl ow), rather than hormones. Instead, if a patient tells me he is experiencing de-


rectile dysfunction (ED) and decreased libido can be an uncomfortable topic for many men. Culturally, we


All too often, I see men with symptoms of erectile dysfunction and decreased libido and fi nd that only the most basic blood tests


have been ordered to assess hormone function.


creased libido, it becomes important to determine whether an imbalance in hor- mones can be affecting sexual function.


Testosterone Testing: It's Not Just About the Total


Maintaining healthy testosterone (T)


levels is part of a complex process, which is why it's essential to test more than just total testosterone levels. All too often, I see men with symptoms of erectile dysfunction and decreased libido and fi nd that only the most basic blood tests have been ordered to assess hormone function. On symptom- atic patients, I like to run what I call a "full" testosterone panel, one that includes free and bioavailable testosterone, in addition to a protein called sex hormone-binding globulin (SHBG). Depending on a man's age, only 1-2% of testosterone in the body is "free and available" for use; the rest is at- tached to hormones while being transported throughout the bloodstream. By testing the free and bioavailable testosterone, we're able to determine just how much testoster- one is available for use to meet the body's


needs. It's not uncommon to fi nd healthy total testosterone levels, only to learn that bioavailable and free T are below range.


So how does testosterone become less


available in the fi rst place? For this, we have to look to the protein, sex hormone- binding globulin. Its function is to bind testosterone, but too much of this in men can mean that not enough testosterone is free and available to carry out its func- tions. The exact opposite is true for women, where low levels of SHBG can lead to too much free testosterone and unwanted symptoms, such as hair growth. This is why it's important to test and consider SHBG when treating men with ED and low libido. If levels are too high, we can use herbs to lower SHBG in the blood, ultimately freeing up testosterone for use. By ordering more comprehensive blood work, we can treat the patient more specifi cally, targeting the problem at hand.


Estrogen & Aromatase: "A Vicious Cycle"


Some of my patients are surprised to learn that men, too, have estrogen in the body. While low levels are perfectly healthy, increases in estrogen can be prob- lematic and cause unwanted symptoms like decreased libido, erectile dysfunction and gynecomastia (breast enlargement). A simple blood test will let us know whether estrogen levels are too high, but determin- ing the source of this increase is key to treatment. One of the most common issues lies with an enzyme called aromatase, whose role is to convert testosterone into estrogen. Aromatase is abundant in adipose


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