Frequently Asked Questions about:
Male Sexuality

More detailed discussion can be found in my book Sexual Health for Men: The Complete Guide- Published 2000-Perseus Press. 

Updated (4/17/01)

Note:  Information provided below is intended as a source of information and a guide.  For specific details about your own health, speak to  your doctor. 

1.  Every now and then when I want to have sex I can’t get or maintain my erection.  Is there something wrong with me?
2. Will taking more testosterone make me sexier?
3. Will taking more testosterone make me stronger?
4. How do I know if I have enough testosterone in my body?
5. But what if my testosterone value is at the lower end of normal?  Wouldn’t I feel better with a higher blood testosterone count?
6. What is the best way to increase my own blood testosterone level?
7.  I am 55 years old. My wife was told to use female hormone replacement therapy and takes estrogens every day. Do I need male hormone replacement therapy and should I have a testosterone booster?
8. Is there a “male menopause”?
9. Do men have hot flashes?
10. Mark McGwire took androstenedione pills the season he hit 70 home runs.  They sell androstenedione pills in my local store.  Should I start taking androstenedione to increase my own testosterone level?
11. My husband has a low testosterone level and the doctor’s are planning to start testosterone treatment.  What precautions do I have to take? Will he turn into a sex maniac if his testosterone level is increased?
12. My wife and I have been trying to have a baby but cannot.  The doctor told her that she is all right but that I have a low sperm count and that is why she doesn’t get pregnant.  But I don’t understand how that can be.  We have no trouble having sex and I ejaculate lots of semen out when I climax. How can our infertility be my fault?
13.  I have heard that some men can get an erection on demand by injecting a chemical into their penis.  It sounds creepy.  Do men really do this? Doesn’t it hurt?

Answer: No you are fine. Every man at one time or other during his lifetime experiences one or more sexual failures. It is only when sexual problems persist that a man needs to find out why so that he can find out what caused his setback to sexual function.  The reasons for a temporary lapse in sexual function are usually age-specific.

a.   For the young man on his first outing, anxiety about his performance and not living up to his partner’s expectations are the most common deterrents to successful sex.  Reassurance and a little confidence building are all that is needed to overcome this hurdle of self-imposed anxiety.

b.   For the mature sexually experienced man preoccupations of the business day are difficult to check at the bedroom door. Once insinuated into the sexual encounter these mundane worries so disrupt his concentration that he loses his he vital “sensate focus”.  See page 227-229 of My book Sexual Health for Men for more details.  A resolution of business conflicts or if necessary a series of sensate focus exercises are all that is needed to reverse the trend so that sex is more enjoyable again.

c.   For the more senior man the erotic spontaneity of youth is no longer what it once was.  His sexual systems still function but at a slower pace. Patience during the lovemaking process will keep his sexual life vibrant and enjoyable again. 

d.   If problems persist-see your doctor.

Answer: Yes, but only if you take large amounts of testosterone, more than is generally available from a doctor’s prescription. Athletes and body builders have known this for years but doctors have been skeptical.  Here’s what puzzled doctors: athletes who become stronger after anabolic steroid use also train furiously.  Was the training or the steroid use responsible for their improved performance?  

To find out the answers found athletes and untrained men “couch potatoes” and gave them either massive doses of testosterone-roughly 15 times what a normal man’s testicle churns out each week and evaluated their weight and weight lifting capacity before and after treatment.

a.   Those in the placebo injection group had no improvement in body weight or in their weight lifting capacity. 

b.   With massive doses of testosterone trained athletes did best increasing body weight and muscle mass as well as their weight lifting capacity.

c.   Even those untrained men in the “couch potato” group improved muscle mass and weight lifting capacity. 

d.   The muscle and strength-promoting effect was only seen when treatment increased blood testosterone levels to 3000ng/dl more than any man could hope to accompllsh on his own.

4. How do I know if I have enough testosterone in my body?

Answer: Despite claims to the contrary, there are no diets or over the counter medications that can reliably increase a man’s blood testosterone level.  Testosterone and all other testosterone-like pills favored by athletes and body builders though available have serious side effects damaging the liver occasionally causing liver cancer. Table 1 lists the currently approved treatments a man can use to increase his own testosterone level. All require a doctor’s prescription

Table 1.  Currently Available Testosterone Treatments 

Speak to your doctor to decide if you need testosterone supplements and if so which of the treatments listed above is best for you.

Answer: This is a common question more frequently asked by women than by men presumably because of an egalitarian expectation that both sexes should experience “equal opportunity afflictions of aging”.  The facts are these. 

a.    A woman’s menopause occurs because her ovaries abruptly stop making estrogens, and it is the lack of estrogens that is responsible for her hot flashes, vaginal dryness, and on occasion alteration in mood.

b.    As man ages his testicles continue to churn out testosterone as well as sperm allowing him to maintain both sexual desire and fertility into his senior years.  But man does not escape totally unchanged by the aging process.  The number of testosterone producing cells decline so that the older man’s testosterone levels while normal are not quite as vigorous as they were when he was younger.

c.   In Europe the ADAM (Androgen Deficiency of Aging Man) syndrome has gained popularity and spawned the development of “Andropause Clinics” where aging men are provided with testosterone supplements, but that trend has not yet caught on in this country.

Answer: Yes they do, but only under certain circumstances. Hot flashes are common in men who

a.   Have metastatic (spreading) prostate cancer and have had surgical removal of their testicles (castration) or medically castrated with every 3 month injections of leuprolide (Lupron) to obliterate their own testosterone production. Testosterone fuels the continued growth and spread of prostate cancer.  Eliminating testosterone stifles prostate cancer spread.

b.   Undergo surgery to remove both testicles as treatment for their testicular cancer.  After surgery their testosterone levels plummet to zero.

c.   Develop spontaneous failure of their testicles to produce testosterone-a condition called hypogonadism. Men with hypogonadism also have low testosterone levels and are prone to develop troublesome disconcerting hot flashes exactly like those experienced by menopausal women.

d.   Testosterone treatment is safe only for men whose hot flashes are the result of spontaneous hypogonadism or have had surgery for testicular cancer. Testosterone is not safe and should not be used in men with metastatic prostate cancer.

Answer: Some legends fueled by snippets of information, wishful thinking and aggressive promotion become a life force of their own and run counter to reality but do not cause enough distress to create alarm.  Here is what we know about androstenedione or as it is popularly known “Andro”. 

11. My husband has a low testosterone level and the doctor’s are planning to start testosterone treatment.  What precautions do I have to take? Will he turn into a sex maniac if his testosterone level is increased?

Answer: The word of mouth mythology surrounding testosterone is stunningly inaccurate-but persists because people want it to.  The facts are these.

1.   A man’s testosterone surge begins in adolescence.  As long as a full ration of testosterone continues to flow he will fulfill his destiny as a sexually and reproductively competent male.  But if his testosterone levels fall  he will sacrifice some of the benefits he enjoyed when his testosterone levels were normal.

2.   Men with low testosterone levels are less strong, less interested in sex, not quite as effective in business dealings and possibly a little testy. 

3.   Give a man with a low testosterone just enough testosterone to bring blood testosterone levels back to normal and he will be like the man described in 1. -no more or no less. If he was not a sex maniac before, he will not become a sex maniac after, you give him back the just the right amount of male hormone his body craves and needs.

12. My wife and I have been trying to have a baby but cannot.  The doctor told her that she is all right but that I have a low sperm count and that is why she doesn’t get pregnant.  But I don’t understand how that can be.  We have no trouble having sex and I ejaculate lots of semen out when I climax. How can our infertility be my fault?

13.  I have heard that some men can get an erection on demand by injecting a chemical into their penis.  It sounds creepy.  Do men really do this? Doesn’t it hurt?

Answer: The line I use in my book is “Puncturing the penis with a needle is not for the squeamish, ” Still penile injection has become an accepted and approved form of therapy for many men with erectile dysfunction.  Penile injection with Caverjectäworks because the injected chemical-alprostadil -once in the spongy cylinders (corpora cavernosae) of the penis encourages a rapid inflow of blood causing the penis to swell and become rigid simulating a spontaneous erection..  The erection caused by penile injection differs from the erection that occurs after men use Viagra in several ways.

1.   The erection created by the Caverject™ occurs within minutes after injection and does not require any sexual stimulation whereas men who take Viagra need some sexual stimulation- manual, oral, or fantasy to develop an erection.

2.   The process of injecting Caverject™ is surprisingly not that uncomfortable but men often experience a burning sensation as the penis is transformed from limp to erect, something that does not happen when men have an erection after using Viagra.

3.   A new device called MUSE™ (medicated urethral suppository) allows men to instill alprostadil into their penis without giving themselves an injection.  The erection-activating medicine-alprostadil- is embedded in a pellet  which is released after being inserted directly into a man’s urethra (the tube through which he urinates).  Once released there it has the same effect as the injected alprostadil in causing a spontaneous erection.  Men who use this device do get a satisfactory erection but report the same sort of burning pain experienced by men who use Caverject™.

4.   MUSE™and   Caverject™ often succeed when Viagra does not, particularly in men whose ED is the result of some nerve damage.