An interview with Dr. Nathan Thakur, Medisys Health Group.
Q: About 10-15 years ago, men’s sexual health was a bit of a “taboo” subject. What's it like now?
A: We definitely get a lot more men in our practice who are freer or more comfortable with a discussion on sexual health. More and more men proactively bring up the subject during their visit, and as physicians, we appreciate it. Unfortunately, there are still a great deal of men who are intimidated by the topic of men’s sexual health, so it’s good to be able to talk about it in settings like this to bring more awareness to the issues that exist.
Q: When it comes to performance, what is "normal"?
A: There really is no "normal". We’re seeing younger men (eg. in their 30’s) and men in their 80s experience the same performance issues. That being said, many men who are north of 70 and have preserved sexual function are often able to perform sexually because they have been doing a great job of exercising and taking care of their bodies. Sexual health and general health go hand-in-hand. If you are a healthy and active person, and continue to be as you age, you'll have a better chance of preserving sexual function as you age. As physicians, we would love for everyone to focus on preventive health and exercise more, but even those who aren't willing to do so have a number of treatment options that can help bring their performance in the bedroom back up to speed.
Q: When it comes to libido, what are the most common concerns that you hear?
A: The concerns that we tend to hear most about are regarding sexual performance issues or low sex drive, and those things, of course, can lead to relationship difficulties or other problems including emotional health issues. It’s a shame because in a lot of cases, it doesn’t have to end up like that, there are a lot of treatment options. It's natural for testosterone levels to decline as men age, but sometimes low testosterone can cause low sex drive and even depression. Men don't often pay close enough attention to the early warning signs of bigger health problems.
Q: What are the most common causes of a decreased libido in men?
A: Decreased libidos are often simply related to age, unfortunately, and how hormones change. Testosterone levels in men begin to decline after age 50, in addition, men over the age of 50 tend to experience decreased amounts of sleep on a regular basis which makes issues worse. Decreased libido is also attributed to increased stress as well as poor diet (eg. diets high in refined sugar, unhealthy fats, and processed carbs), excess alcohol consumption, as well as a lack of exercise. When you are stressed out, eating crappy food, not sleeping well, and not exercising you’re likely not excelling in many parts of your life - sexually is no exception. The other cause of decreased libido that men don’t often consider is cardiovascular disease. The blood vessels in your genitals are small and easily clogged, thus they may be one of the first areas impacted by heart disease. In fact erectile dysfunction (ED) could be an indicator of heart disease or other health problems and so if you suffer from ED it's important to discuss this issue with your doctor.
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Q: What are some of the typical recommendations you give to male clients with sexual performance concerns?
A: When these men come in, the treatment or recommendations are fairly individualized. We investigate how much of it the issue may be due to underlying cardiovascular issues, or whether it’s related to abnormally low testosterone relative to age, or if it’s simply a result of lifestyle factors such as sleep and exercise.
Q: For guys who might think that it’s “just age,” what are some things they can do to correct it?
A: The first thing we do is give our clients a cardio assessment to determine the root of the problem. As far as treatment goes, there are a few medications out there that can help to establish blood flow, and there is also hormone therapy with testosterone. Our hope is that we can help men to feel more confident, and better about their overall health. 9 in 10 Canadians have at least one risk factor for cardiovascular disease, and about 40% have no idea.
Q: What are the main health concerns that you typically hear from men in your practice?
A: We’re finding that a lot of men actually tend to delay coming in to see a physician and, when they do, it tends to be around the 40-year mark. We're in the business of preventive healthcare - we want to see you before you start developing serious health issues, we want to address health risk issues at their earliest possible stage. Men often only become more proactive at seeing a doctor regularly when they age and start worrying about their heart, prostate, and cancer.
Q: Do you find a lot of men come in asking about low testosterone?
A: Yes, it has been much more common lately. Men are feeling a lot more fatigued these days with stress from work and at home, so there is a very large push to optimize testosterone in terms of maximizing a man’s vigour and vitality.
Q: Why is it so important to address the issue of low testosterone?
A: Testosterone levels are so important because they can manifest themselves in so many ways and can have an effect on multiple aspects of life. For example, if you’re not sleeping well, your testosterone can’t replenish itself throughout the night. This alone will cause you to feel fatigued all day. As testosterone dips even further as time passes, it may go on to affect sexual vigour in the form of a lower sex drive or sexual function. In response to this, everyone is very quick to jump on the Viagra bandwagon. However, many patients tell me that it didn’t work for them or that it did work, but not very well. This is often another sign of their testosterone being on the lower end of normal, or even well below normal. Finally, addressing low testosterone allows us to optimize a man’s energy and strength (as testosterone is a hormone that helps you gain muscle mass) which increases motivation to exercise, which in turn improves sexual dysfunction. As men are looking towards their future, many are asking themselves if they are going to be able to be as physically active as they were in their youth. Maintaining testosterone is important in achieving long term health and wellbeing.
Q: What are the ways that you treat low levels of testosterone?
A: The first step to treating low levels of testosterone is diagnosis, which is done through simple blood testing which can be done at any Medisys preventive health clinic. If we do find lower levels of testosterone we can issue optimization therapy. The common therapy is actually a gel (not a pill) that a man would apply to his shoulders or his muscles on a daily basis. This gets absorbed by the muscles, and has been shown to increase testosterone levels substantially over a three month period.
Q: What’s your last piece of advice for men out there?
A: An ounce of prevention is worth a pound of cure. Make the time to put your health first, talk to a doctor if something about your health just doesn't feel quite right, and get an annual preventive health assessment. It will put you and your family on a better path for years to come.
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