Male Health

While this isn’t specifically male health, I do write from time to time about important developments in reproductive medicine. Dr. Munire Akar from Aktinez University In Antalya Turkey reports in Fertility and Sterility the results of the world’s first human uterus transplant from a multiorgan donor. While transplant surgery has been around for a while and is a well accepted form of medical therapy, reproductive organs have come late to transplantation. This is undoubtedly the beginning of a new world for men and women previously unable to conceive for reasons of anatomy. If you’d like to hear Dr. Munire Akar talk about her work, click here. If you’d like to participate in a discussion on her article, click here.

As I’ve written in earlier posts, clomiphene is a medication that a doctor can use to increase a man’s production of testosterone in his own body. (I’ve also written about how doctors can prescribe it. If you think that you’d benefit from this medication, you should see a doctor. I can’t answer personal questions about a man’s health on this blog. Medical care is always done best in person.) But clomiphene is “off-label” for use by men and didn’t go through the rigorous series of studies that the FDA mandates for a drug for a particular use.

One good question is whether clomiphene is safe for long term use by men. John Mulhall, a great doctor in New York, recently published a report in the British Journal of Urology studying the use of clomiphene for up to three years in 46 men diagnosed with low testosterone. Blood testosterone, bone scans, and symptom scores all improved, and men did not report problems with the medication.

There are limitations to this study. It wasn’t controlled, meaning that there wasn’t a group of men treated with a placebo, or sugar pill. 46 isn’t a lot of men, and three years isn’t really a very long time. But this kind of study is what needs to be done with more men and for a longer time to really determine the safety of clomiphene for long term use in men.

Clomid surely has its advantages compared to testosterone for use in men with low testosterone. It’s a pill, and other treatments are either shots or cumbersome skin applications. It also saves sperm, as testosterone itself reduces sperm production. But information about its use is less than that of testosterone, which puts men and their doctors in a kind of Catch-22. Mulhall and colleagues are to be commended for expanding what we know of the safety of this medication.

By Jim Hotaling, M.D.

Gawker recently reported on an article in the scientific journal Human Reproduction that found sperm numbers and shape to worsen in France during a 16 year period. Studies that claim sperm are declining worldwide have been published for at least the last 20 years.  If the trend is true, one guess for its cause was suggested by the Danish scientist Niels Skakkebaek, who argues that chemicals in materials such as plastics act as synthetic hormones that interrupt a man’s own internal natural hormones.

The Human Reproduction article is well designed, studying a very large group of 26,609 men from infertility clinics in France from 1989 to 2005.  Each man had two semen analyses, which adds to the strength of the paper as sperm counts change much even from day to day.  The scientists concluded that sperm count decreased 1.9% per year in France during the time period of the study.

Before jumping to the conclusion that the fertility of French men is dipping, there are some important limitations of the study. To their credit, the scientists state most of them clearly in their paper. The first is that the scientists studied men showing up in fertility clinics. These men as a group are probably different that the average guy in France. Second, the men got older during the study. While the age increase was small, 34.2 to 35.9 years, and may not mean much, the deCODE study suggests that changes in sperm may start early in a man’s life. Third, giving a sample in an fertility lab may not be the same as when it’s delivered naturally.

This study probably isn’t great cause for concern that sperm are on a steep decline in France. Even if the numbers are going down a bit, there’s still plenty of sperm in these men to do the job.

Many men ask me about diet and sperm, and I’ve written about it previously in this blog. The same scientists that suggested then that lower intake of carbohydrates, fiber, folate, vitamin C and lycopene and a higher intake of protein and total fat had worse sperm than men with the opposite diet recently studied the semen analyses of men on two different diets, a Western one with lots of red and processed meat, refined grains, pizza, snacks, high-energy drinks and sweets, and a Prudent one with enriched in fish, chicken, fruit, vegetables, legumes and whole grains. Men with the Prudent diet had better swimming sperm.

So, if you’re looking for a “sperm friendly” diet, eat more fish, chicken, fruit, vegetables, legumes and whole grains, and less red and processed meat, refined grains, pizza, snacks, high-energy drinks and sweets, But don’t drive yourself crazy. A pizza or burger now and then keeps you sane.

We welcome Doctor Jim Hotaling as a contributor to Maledoc. Doctor Hotaling is a male infertility specialist with interests in erectile dysfunction, surgical innovation, epidemiology of infertility, and the statistical genetics of male infertility. He graduated magna cum laude from Dartmouth with majors in chemistry and history, completed medical school at Duke in 2006, and finished a six year urology residency at the University of Washington in 2012.  His goal is to expand the scope of genetic tests available to enable patients and physicians to understand what causes male infertility. He’s also studying how bicycle riding contributes to erectile dysfunction and how to solve that problem with engineering. Welcome, Doctor Hotaling!