Male Health

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.

Canadian television recently interviewed me on work in our bioengineering lab investigating how bicycle seats may cause problems with erections, and how current seats fall short in protecting men.  The interview may be viewed here.  It took place over Skype, and the sound quality is poor.  (I don’t really sound as if speaking through tissue paper.)

You can’t fault a man for thinking his penis a single use tool.  But it’s more like a Leatherman or a good Swiss Army knife.  One great use is as a barometer for gauging the health of a man’s heart and blood vessels.

The structure of the penis is basically a sponge with a tiny artery that supplies blood.  The sponge fills with blood, and the penis becomes erect.  (It’s actually a really impressive piece of engineering, with veins at the outer edge of the sponge that are pressed closed as the penis fills, trapping the blood and holding the erection.)  The artery supplying the sponge is very small, only about half the diameter of the coronary blood vessels supplying the heart.  If the arteries are getting clogged, the arteries in the penis go before the heart ones do, giving a man a two to five years heads-up that something bad is happening, not just to the penis, but that may be life-threatening.

Recently published guidelines recommend that if a man is experiencing problems with erections, that he be evaluated for high cholesterol and other artery clogging problems, and that if the labs are out of whack, he be treated aggressively with medication.

As important as the penis is, the heart’s kind of necessary.